In-depth study of health Issues
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- In-depth study of health Issues
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Community Health Learning Programme
2010
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Community Health Learning Programme
March 2010 to November 2010
REPORT
Mr.H.Hanumanthappa
Intern,Community Health Cell
Mentor
Mr.E.Premdas
Coordi nator
Community Health Cell Bangalore
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Community Health Learning Programme - My growth
1.
Background
I come from a backward community. My parents eked their livelihood as labourers.
We were 6 siblings - 4 boys and 2 girls. Living in utter poverty, I struggled with lack of
proper clothing and food, and managed to complete my SSLC. During my free time from
school, I was working. After completing my SSLC, 1 continued to work, while studying for
my B.Com, apart from working as a newspaper delivery boy. I continued to deliver papers
till I came here. During my free time, I was involved in social work.
Since the past 5 years, I have worked with several district level organisations and district
fora. I have involved myself actively with fighting for the rights of dalit and oppressed
communities.
I was helping disabled children from the community to join schools and
making it possible to complete their education with ease.
empathise with them.
dignity for them.
This was because I could
I did not want others to go through the pain - I wished a life of
Even to this day, I visit hostels as often as possible and discuss the
systems there.
In 2006, I met with an accident where I fractured my leg - I was in a cast upto my thighs.
Prior to this, my left leg had broken twice in an accident. It was only when my leg was in
cast that I realized the problems a disabled person faces and hardships he/she
undergoes. That was when I decided that I would work in the field of disability for the rest
of my life.
During 2007-08, I came to know about Janaarogya Aandolana Karnataka (JAAK).
Prasanna and Obalesh conducted a 2 day training Davangere. After the training, I did not
give much thought to it. In 20009, Karibasappa and Obalesh from JAAK conducted series
of meetings to organise a "Public Hearing on health - Janata Nyalaya" in Davanagere
district. The objectives was to create awareness about the health situation among the
people. As part of this, they wanted to draw the attention of the District administration
towards the Primary Health Centres.
In the course of this public hearing in which 1 was involved, I came to know about CHLP
and was encouraged to apply for this. This gave me an opportunity for further learning
and provided me with an opportunity to increase my knowledge-base.
3
2.Objectives
•
•
•
•
Indepth study of health rights
Study of National Rural Health Mission 2005
Understanding the issues and linkages of ICDS and health system
Understanding the issues of the people with disability and their health rights
3.Community Health Learning Programme - Major learnings
3.1 Summary of learnings
❖ Understanding the determinants of health rights and social situation, the effect of
natural and man-made disasters, globalization on health and the people who are
oppressed as a result.
Understanding regarding the Alma Ata Declaration, privatization, primary health
care, etc., the reason for health rights not reaching the rural populations, the
roadblocks thereof.
Learnings about people’s health movement, denial of health to the community, the
manner in which health reforms are not reaching the community and the denial of
rights to people.
Concept of community health: Health is not limited to medicines, doctors, injections
alone.
I have realized that health involves social, cultural, spiritual, environmental and
current affairs, as well as technical know-how, skills, health, agriculture, food, income
generation programmes - on the whole, it involves integrating health with all
developmental programmes, which is needed to have an integrated view of health.
Primary health care: It is already 32 years since the Alma Ata declaration whose aim was
to adopt approaches to ensure health for all through the 8 important issues to for the
health care to reach even the last person in the community. I learnt that health care has
been limited to certain selected programmes.
ICDS: Though this Government programme has noble of objective, it is not functioning
properly.
The Anganawadi workers have failed to deliver this programme to the
community. Providing supplementary nutritious food to children in the age group of 1-6 to
prevent children suffering from malnutrition, and the programme that was designed to
educate girls and pregnant women regarding food and nutrition is not being implemented
properly due to the negligence of the workers and officials appointed in the programme.
Hence, I realized that rural women and children are suffering from malnutrition
4
The disabled: The 1996 Disability (Equal Opportunity) Act was modified in 2005. Even to
this day, the aids and equipment (walking stick, wheelchair, hearing aids, care of mentally
retarded children) needed by the disabled is not available at primary health centres.
I
have seen that there are neither ramps nor separate toilets for the disabled in primary
health centres.
The disabled community is denied education, health and employment
opportunities. The staff at primary health centres need to be trained about disability and
conduct awareness programmes regarding disability
3.2. Learnings / experiences from Field Visits
i)
•
Study of nutritional status in houselholds
I have understood the health situation of agricultural labourers, their lifestyles,
food situation, the wages they get, accommodation and the denial of these
social and health determinants
•
I have realized the connect between the income of farmers, their health and the
incidences of suicides amongst them
•
The reason for rural households suffering from malnutrition, the effects of
privatization, the influence of modern methods, natural calamities and other
pressures on the mental health of rural people and the realization of
interconnectivity of all these factors
•
I have understood the connection between women, gender discrimination and
the effect it has on health. Though rural women work as hard as
men, they
are not only considered second-grade citizens, but she is denied proper wages,
food and education. This has resulted in the increase of malnutrition among
women. Satyashri's lecture helped me gain insight into these aspects.
•
During the Nutrition Study conducted at Kotha village, I learnt as io how the
people living in rural areas need to cope with limited resources and facilities,
and the manner in which they can live together as a community .
ii)
Potnal visit: It was possible to learn about Integrated community health
concept during the Potnal visit - visit to Jagrutha Mahila Sanghatan (JMS).
Through income generation programmes, organic agriculture, herbal medicine,
terracotta, education of child labourers, training of health workers, it has been
possible for them to achieve holistic health, which is the uniqueness of this place.
This organisation was started by the Dalit community. I have learnt how the Dalit
community can participate in the decision-making processes that has a bearing on
their lives.
5
Hannur visit: During the visit to Hannur to Comprehensive Rural Health
iii)
Project (CRHP), I realized that if the local problems have to be solved, the
community has to identify those problems and look for solutions that is suitable to
them.
During the visit to Hannur in Chamarajanagar district, I have learnt how
community participation is achieved and a solution to peoples’ problems can be
reached as well as the importance of maintaining a continuum in the process.
iv)
Ruwsek visit: For any community to involve themselves in any kind of activity,
education is the first and foremost need. It is possible for people to solutions from
within, through education.
During the Tamilnadu visit, I have learnt that before
starting any organisation, it is necessary to put a lot of forethought into it. Rusek is
an organisation started by Dalit women in Tamilnadu - it has been functioning
successfully since the past 22 years and has been a model for other communities.
For any sort of changes to be felt in a community, it takes a couple of years. It is, I
learnt, not something that can happen in a span of 2 or 3 years.
v) Natural and man-made disasters: I have learnt from first hand experience, in
my 9 months of learnings and field visits, about the effects of floods and droughts
on the health of the common people.
Apart from this, my thoughts have also
veered towards the manner in which man brings on disasters on himself through
exploitation of the environment (Eg: Hiroshima-Nagasaki). By participating in the
padayatra organised by the Flood Relief Committee and peoples’ organizations in
Raichur, I have understood the need for primary health care.
3.3
New skills learnt
The 9 month training has changed my view of life. This programme has helped me
shape up into a good worker. I got the opportunity to learn and broaden my knowledge
base through a series of lectures and also by reading lots of books. This has changed my
views on society. I have learnt the following skills:
•
Providing health training and community organisation.
•
Understanding community health, health rights and social determinants.
•
Report-writing skills.
•
Knowing the background of problems and insisting on the granting of rights.
•
Measuring the body mass index and understanding level of nutrition.
•
Providing information in a short time through charts and power point
presentations.
6
3.4
Knowledge and outlook gained about community health in Community Health
Cell
With my head full of information from Davangere, I arrived at Community Health
Cell - it was a pleasure to be there. It was like mini-lndia with 13 students from Tamil
Nadu, Gujarat, Orissa and Karnataka participating in the training. Students from different
backgrounds shared their experiences. Though initially, we faced a language problem,
gradually we integrated ourselves as a community.
Each and every one shared their
experiences.
Initially, since English was the language predominantly used, and my fellow
students spoke Engllish, I was not able to respond to anything properly. On the first day,
we were given photocopies and several books related to our area of learning.
On the second evening, Mr. E. Premdas explained to us about the 40 day
orientation programme, topics that would be discussed and handed over books translated
into Kannada and said, "you will be informed about things which are in these books; so,
you have to read them”. From the next day, prior to the start of the day’s progamme, I
would read about it. This helped me understand things better. Some of my Kannada
friends explained what I did not understand. Some things I would learn from E. Premadas.
This helped me participate with more enthusiasm in the programme.
I was not able to use all the facilities available at Community Health Cell. Though
there were a number of books, video documentaries in the library, I was able to read only
a few books and view a couple of documentaries. I am not very happy about it. This
place is a cell of knowledge about the health system. But, it is sad that I could not read
most of them due to my lack of knowledge of English.
The 40 day training gave me more knowledge than I would I have gained, even if I
had studied for a MBBS degree. It makes me proud to think that I have been trained by
doctors who have 20-30 years of experience and held important posts, apart from training
countless medical students.
I felt there was no comparison between me and the the
experienced people who do not waste a minute of their precious time.
My heartfelt
appreciation and thanks to Drs. Ravi Narayan, Thelma Narayan, Vasundhara, Shirdi
Prasad and Akhila Vasan, Shobha Managoli and Sathyashree for imparting knowledge
about health care, health rights and National Rural Health Mission and inspiring us to
question the establishment. I am also grateful to Maria, James, Sarvamangala, Pushpa,
Prahlad, Joyce, Swami who extended their cooperation during the programme.
I have gained a lot of knowledge and experience from each and every person. I
am grateful to CHLP and Community Health Cell, for giving me an understanding that it is
7
essential to go to the root of the problem, understand the system, give thought to it and
then proceed to set right the system, which has helped me shape into a good community
worker.
Monsoon game: This is an important part of my 9 month learning. This game helped me
understand the problems faced by dalit farmers, the effect that vagaries of nature and
middlemen have on their lives, be it losing their land or houses, as well as the objectives of
those who lend money and to what sort of families money is loaned.
Leadership qualities: If one has to cultivate good leaders in the community, one needs
to personally learn and make space for others to learn too. One needs to set things right
at the personal level; it is also essential that one does not thrust one’s experiences on the
community. I have learnt that is essential that one makes use of skills available in the
community.
Group learning: is an important thing I learnt during my training. I learnt from my fellow
students Lavanya and Vinaya, the manner in which one needs to discuss in a group,
presentation and the manner of presentation of those discussions to others
Alma Ata declaration: The Alma Ata declaration was signed in the USSR town of Alma
Ata in 1978, under the aegis of the World Health Organisation, with 134 nations
participating as signatories to the declaration “Health for All by 2000", to which India was
also a signatory. All the nations accepted that health was a human right. Though primary
health care was declared to be the primary necessity for all citizens to be healthy, I have
learnt that even in the year 2010, it has not been implemented in its full letter and spirit.
Organising trainings: Learning how to conduct training programmes, the objectives,
methodologies, subject of training programmes and material necessary for conducting
training programmes based on the needs of the groups - be it for the rural people or for
the educated.
Personality development: The three sessions taken by Shoba Managoli have changed
the direction of my life. Instead of concentrating only on activism/struggles, I have realized
that it is also important to understand the system and the methodology to correct the
wrongs thereof.
Effect of globalization on health: The session on Globalisation and privatization by
Akhila Vasan opened my eyes as to how the Government has established a stranglehold
8
on the health system, and through privatization and globalization policies the manner in
which the Government has backtracked from its duty of providing health services to the
common man.
Library: My knowledge has increased by reading books on health related topics - Health
for All now, Health Rights, Equity and Inequity, NRHM, lives of nomacs, globalization and
ideology, and so on.
Experiential learnings:
Public Dialogues: During the Public Hearing on health
organised by JAA-K District
committees in Haveri, Tumkur and Raichur, I learnt about the situation of the local primary
health centres, denial of health to people, mother and child mortality, attitude of the
personnel at the health centres, how to make presentations. Due to this, it was possible
to conduct a successful rally in Chitradurga, demanding health rights for people.
During the learning process, apart from understanding the system, I have
participated in the struggles/protests for social and health rights. I have also identified the
facilities available at health centres.
My experiential learning has been in the areas of looking at the health system from
various perspectives, monitoring community health and the manner in which community
participation can be brought about, as well as imparting information to the community.
My learning has also been about difficulties faced by the community and the denial
of care at the primary health centres. In this period, I got the opportunity to participate in
various meetings.
I also got the opportunity to enhance my skills and knowledge of
conducting programmes
3.5
Opportunities I got: The opportunities I got during my 9 month training period has
helped me shape myself into a good health worker. Due to this, I have already begun to
disseminate knowledge regarding health and malnutrition, and primary health centres to
women’s groups in the community. I have been able to health administrators and discuss
with them about the health system. The movements and organisations in my District have
begun to recognise me as a health worker/activist. I have gained the friendship of people
in many districts. My perspective of health has changed too.
9
ANM
Axilary Nurse Midwife
ASHA
Accrecated Social Health Activist
CESCR
Committee on Economic, Social and Cultural
Rights
ICDS
Integrated Child Development Scheme
IPHS
Indian Public Health Standards
JAA-K
Janarogya Andolana - Karnataka
JMS
Jagruta Mahila Sanghatane
NREGA
National Rural Employment Gurantee Act
NRHM
National Rural Health Mission
VHSC
Village Health and Sanitation Committee
10
on the health system, and through privatization and globalization policies the manner in
which the Government has backtracked from its duty of providing health services to the
common man.
Library: My knowledge has increased by reading books on health related topics - Health
for All now, Health Rights, Equity and Inequity, NRHM, lives of nomacs, globalization and
ideology, and so on.
Experiential learnings:
Public Dialogues: During the Public Hearing on health
organised by JAA-K District
committees in Haveri, Tumkur and Raichur, I learnt about the situation of the local primary
health centres, denial of health to people, mother and child mortality, attitude of the
personnel at the health centres, how to make presentations. Due to this, it was possible
to conduct a successful rally in Chitradurga, demanding health rights for people.
During the learning process, apart from understanding the system, I have
participated in the struggles/protests for social and health rights. I have also identified the
facilities available at health centres.
My experiential learning has been in the areas of looking at the health system from
various perspectives, monitoring community health and the manner in which community
participation can be brought about, as well as imparting information to the community.
My learning has also been about difficulties faced by the community and the denial
of care at the primary health centres. In this period, I got the opportunity to participate in
various meetings.
I also got the opportunity to enhance my skills and knowledge of
conducting programmes
3.5
Opportunities I got: The opportunities I got during my 9 month training period has
helped me shape myself into a good health worker. Due to this, I have already begun to
disseminate knowledge regarding health and malnutrition, and primary health centres to
women’s groups in the community. I have been able to health administrators and discuss
with them about the health system. The movements and organisations in my District have
begun to recognise me as a health worker/activist. I have gained the friendship of people
in many districts. My perspective of health has changed too.
9
ANM
Axilary Nurse Midwife
ASHA
Accrecated Social Health Activist
CESCR
Committee on Economic, Social and Cultural
Rights
ICDS
Integrated Child Development Scheme
IPHS
Indian Public Health Standards
JAA-K
Janarogya Andolana - Karnataka
IMS
Jagruta Mahila Sanghatane
NREGA
National Rural Employment Gurantee Act
NRHM
National Rural Health Mission
VHSC
Village Health and Sanitation Committee
10
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