A Road of Learning

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Title: A Road of Learning
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COMMUNITY HEALTH FELLOWSHIP PROGRAM
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A Road of Learning

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Presented By: Mr. Prabhu Sa ran Masih
Fellow, Community Health fellowship program M.P.

1

Annexure

Sub section

Sections

Page
Number

Few words from my side

3
5

Abbreviations

Introduction

About Sochara
About Self
District back ground
Placement organization

11

Health profile of Chhatarpur

Events

Core training
Collective teaching program
Cluster meetings

Strengthening of ASHA
Strengthening of Village Health &
sanitation Committees_________
Village Health & Nutrition day

Assessment of
Sub Health center

Nutritional Promotion Activities

14
15
15
16
17

Reading
Writing

Strengthening of
Communitization Part of National
Rural Health Mission

6
7
8
9

21
30
34

36

Implementation of Positive Deviant
Hearth

41

Growth Monitoring and Promotion

49

Organizational activities

52

working on different profiles

59

Key Learning

60

Conclusion

63

Attachments

64
2

Few words from my side
“Community health fellowship program” is a continue travel towards the community.

This was one of the best learning series of my life where I discovered the real meaning of
community health. This program is an eye opener for me.
During the entire duration of the fellowship program I have gone through many ups and downs. Living

with the mix group, people from different backgrounds, different religion, various age groups and

different experiences helped me to think on the communities who are also living in the same
condition.

This was a good time to update my knowledge, learn new ideas, develop new skills and also build
relationship with many peoples in the social sectors and in government sectors.

I would like to thanks them who guided me and inspired me to complete the fellowship program

I would like to thanks Dr.Theima Narayan and Dr.Ravi Narayan for the initiative of starting

“community Health fellowship Program” in Madhya Pradesh. Thanks “Ravi”^ sharing your journey
and experiences. Your stories inspired me to learn more and be a part of the group.
Thanks “Thelma” for inviting me to join the fellowship program. Thanks for your appreciations and
continuous support to all fellows.

I would like to Thanks "Mr. Prasanna saliqram’’ - Manager of the CPHE Bhopal Team. Your efforts

and brotherhood made me to complete the fellowship.

I learn many things from you and my best learning from you is "working in difficult situations”.
I will remember your different “topis” and this will help me in dealing with different peoples and

different situations in public health practice.
I would like to thanks “Mr. Juned kamal” from CPHE team. You have guided me in entire period of
the fellowship program as my “Mentor" and helped me in various ways as a good friend. You never let

me feel that I am older then you and some times when I feel tired your “smile" made me to go forward.

Thanks “Mr. Bhaqwan Verma” for your company during all Collective programs and your support in

reading and learning Nutrition. You never let me feel that I am away from my family.
3

Thanks “Ms. Sudeepa” for your support during the fellowship program and also after you left the
program.

Thanks “Dr. Durbhrohini Kumar ” for your valuable support in literature review and encouraging me
through “SMS”. Even I missed most of the Yoga classes but the YOGA session’s photographs are

very helpful. Your feedbacks are valuable and always welcomed.
Thanks “Dr. Deepak Kumar swami” for everything which you teach me from “epidemiology to

literature search and being a part of my life as a best friend”. Your mails are always helpful to learn
more about maternal health program.

Thanks to all team member of CPHE Bhopal “Mr. K.P.Pandey, Ms. Archana, Ms. Gincy,

Mr. Pra/csah” for their love and support.
Thanks to Mr.Vinav John - Field Mentor, your guidance and continuous support in my learnings

made me able to accomplish the tasks and also to learn many new topics in health.

In last but not least I would like to thanks to my entire colleague (fellow travelers) because you all
made me to continue my learning even we had many “matbheds” but never “manbhed”. We will

continue our learning through “MP CHAIN”.

4^

ABBRIVIATIONS

NRHM

National Rural Health Mission

ASHA

Accredited Social Health Activist

VHSC

Village Health and Sanitation Committee

VHND

Village Heath and Nutrition Day

SHC

Sub Health Center

PHC

Primary Health Center

CHC

Community Health Center

SOCHARA

Society for Community Health Awareness, Research and Action

CHC

Community Health Cell - Bangalore

CPHE.

Centre for Public Health & Equity

IMNCI

integrated management of neonatal and childhood illnesses

5

Section A.

Introduction

The Centre for Public Health and Equity (CPHE) is a functional unit of the “Society for Community
Health Awareness, Research and Action” (SOCHARA)1. It works predominantly in the areas of
public health education and policy advocacy. It promotes a new public health paradigm focused on
health equity; social justice; underlying social determinants of health including gender; inclusive and

responsive health systems; and health policy development.
CPHE’s work can be divided into four broad themes.
1. Strengthening global and national policy commitment to Health for All with comprehensive primary
health care as an approach.

2. Strengthening the social and community dimensions in public health education, with focus on

capacity building.
3. Promoting a community paradigm in public health research, including engagement with civil society.

4. Supporting the global and national Peoples Health Movement (PHM) and simultaneously catalyzing
a public health alliance of professionals from multi-disciplinary backgrounds that can be supportive of
the Health for All movement.
Centre for Public Health and Equity inaugurated its Resource Centre for Public Health in Madhya

Pradesh on 29th October 2010. The CPHE Bhopal office is consolidating and building on the

experience of supporting public health policy processes and community action for health by
SOCHARA in MP. These have included the response to the Bhopal Gas Disaster, the Rajiv Gandhi

Health Missions, the Jan Swasthya Rakshak Programme evaluations, support to the Madhya Pradesh
Human Development Report and active involvement in the second National Health Assembly of the

Jan Swasthya Abhiyan in Bhopal in 2007. It also uses and builds on the approaches of SOCHARA,

CHC and CPHE.

Presently the

centre

is facilitating

the Madhya

Pradesh

Community

Health

Fellowship

Programme (MP-CHFP) and developing a network for community health and public health. The
evolving network has started with NGOs and others working with communities and the health system
on health and development, with civil society organizations, peoples’ movements and academics.

The first Community Health Fellowship program was started on 4th November 2009. 20 fellows were

selected in the first batch and were placed in 14 districts of Madhya Pradesh.

1 www.sochara.orfi - SOCHARA

6

About the Fellow (Self)

I belong to a middle class family from Bihar. Some missionaries supported me for my primary

education. I was interested in health and my dream was to go for higher studies in medical field but
due to poor economical conditions my parents was not able to support me for higher education. After

completion of my high school studies I joined a private nursing home to learn clinical activities.
I started my carrier as an assistant of a gynecologist from Raxual Bihar. Then I worked with different

private doctors, nursing homes and NGOs.
I started my Rural Health carrier as a Para Medical worker “Leprosy” in 1982. I was trained at Gandhi
memorial Leprosy foundation - Wardha (Maharashtra” in 1984. I worked in Bihar, Utter Pradesh and

Uttaranchal with different NGOs.
I joined Emmanuel Hospital Association2 in 1992 as multipurpose health worker at Christian

Hospital Chhatarpur. I have gone through much training on health and development and presently
working as team leader of “Prerana Health and Development Project”. Prerana Project is a unit of
“Christian Hospital Chhatarpur”.

I completed community based health and development course from “Jamkhed” Maharashtra in 2005

and from “INSA India Bangalore” a course “community health & development trainer’s program” in
1997.

During the planning meeting of “community Health Fellowship program” at Bhopal I meet with Dr.
Thelma Narayan. After a brief presentation of the program I realized that this type of program will be
very helpful for me to understand the Community health and to learn the depths of the issues related

to the rural communities.
During discussion with Dr. Thelma she invited me to join the program and I came in this fellowship

program.

2 WWW.eha-health.org
7

Introduction and Historical Background of the District3

The District Chhatarpur is named after Maharaja Chhatrasal the great warrior of the region. Earlier
st

this District was under Vindhya Pradesh, with the formation of the Madhya Pradesh on 1
November 1956, it was included in the state. The district occupies a central position in

Bundelkhand region of the state.
Chhatarpur was founded by great Bundela King Maharaja Chhatrasal Singh Joo Deo in the
year 1707. Before Bundelas it flourished under the rule of Chandel rulers who built the world famous

Khajuraho Temples where beauty and love are aesthetically carved in the stone. These lofty
temples stand as the perfect example of Nagar Style of architecture. Chaturbhuj temple belonging to

the chain of these temples probably is the only of its kind in India where Mukhdawar faces west and
not east which is against the Conventional Hindu temple architecture. Bhimkund and Jatashanker

are places of great religious significance whose antiquity is traced back to Puranas and are

shrouded by natural mysteries.
The district is situated at north-east border of Madhya Pradesh and is spread over an area of 8,687
square kms with longitudes and latitudes of 24.06 & 25.20 on north 78.59 & 80.26 on east

respectively.
.The district stretches to a maximum of 185 km in length and 121 km in width. It is surrounded by
Panna district (MP) in the last Mohoba district (UP) in the north, T.ikamgarh (MP) in the west and

Sagar (MP) in south-west and Damoh (MP) in the south. Small portion of the district boundary
touches Jhansi district (UP) in the North West.

Chhatarpur District occupies a central position in the plateau of Bundelkhand. The rivers Ken and
Dhasan form the physical boundaries on east and the west respectively. The rivers Ken and Dhasan

separate the district respectively from Panna district in the East and Tikamgarh in the West.

For administrative convenience, Chhatarpur District has been divided into 7 tehsils, 8 Development
Blocks and 558 Gram Panchayat. There are 1189 villages in the district, of which 116 villages are
deserted. 5 Assembly constituencies and 2 Lok Sabha constituencies fall in the district.

3 www.nic/chhatarpur.in

8

Placement organization - Christian Hospital Chhatarpur.4

CHRISTIAN Hospital Chhatarpur is a 100-bed, full-service healthcare facility that has been providing
compassionate care to the community for more than 75 years. Services include maternity services,
general medicine, outpatient services, dental services, eye services, pediatrics and surgical services.
Christian Hospital Chhatarpur was started in 1930 by missionaries from Friends Foreign Missionary
Society in 1930, to serve the needy women and children in the backward Bundelkhand region of
Madhya Pradesh. The hospital's mission is to transform the people of Bundelkhand through provision
of good health care at affordable costs, community based development initiatives, and nursing

training.

The Prerana Project refers to the overall initiative of the Christian Hospital Chhatarpur to improve the

health and living conditions of communities covering a population of 37, 123 people distributed in 37
villages.
Tele-clinic Project
This being the 3rd phase of the project, capacity building and training of Accredited Social Health
Activist (ASHAs), Auxiliary Nurse Midwives (ANM)and Anganwadi Workers (AWW) and building

stronger linkages with them and establishment of community monitoring system in 15 villages, have

been accomplished. The project trained 12 ANMs, 14 ASHAs and 25 AWWs of the project villages on

RCH, vector borne diseases, water borne diseases and other diseases prevalent in the area.
Due to the project providing ambulance service to people living in villages 24*7, 93 patients were
transported to the Hospital out of which 68 were women in labour. The rate of institutional delivery has

increase to more than 70 per cent.

Primary Health Care
This has been provided by 15 health workers through 15 health centres with 20 essential medicines in
medicine kits. The tele-clinic centres manned by tele-health workers treat people for basic illnesses,

contact the main Hospital in case of medical emergency or to request for ambulance. A visiting nurse

conducts bimonthly clinics providing treatment for illnesses and ANC.
School Health Program:
Under this program 4663 students were taught about common illnesses, good personal hygiene and
the importance of sanitation. The project team developed an attractive curriculum (a book on Primary

Health Care Education for Schools), trained 26 teachers of 10 middle Schools on the same and

distributed them to 816 students. Health education was given in villages on locally relevant diseases.

Special IEC campaigns with puppet shows and rallies were conducted on health day and health
melas.
4 www.eha-health.org/hospitals/chhatarpur

9

Medical Assistance Programme (MAP)

MAP continues to operate a micro-health insurance programme. Last year 76 families with 388
members enrolled in MAP. Out of this 125 availed treatment in the Hospital and 421 persons at the

Tele-clinic centers.
Community Mobilization and Empowerment

This has been done by forming 15 Village Health and Development Committees. These have been
trained in record keeping and accounting to enhance skills of VHDC. The Tele-health workers’
monthly stipend and Funds for IEC programmes etc have been credited to the 15 VHDC bank

accounts. The payments are made by the respective VHDC leaders.
Women’s Development Project

During the year 471 women in 36 SHGs have been strengthened in many ways. This year their credit
base has been increased by Rs. 4,58,420.00. Members of the SHGs are currently actively
participating in village governance as women Sarpanch in Panchayat meetings and in other forums.
They are also familiar with banks, postal services and other such agencies. 24 adolescent groups with

308 members were formed and educated on reproductive and sexual health.
Water and Sanitation

Five community animators sensitized and built awareness in the communities regarding diseases that

spread as a result of contaminated water and poor hygiene. Rallies and campaigns on safe drinking
water were conducted in 3 villages. These were also discussed in the village health and development

committees. Apart from promotion of soak pits and construction of wash platforms, the project
facilitated the repair of five open wells and-constructed four community bath rooms to promote

personal hygiene and sanitation among women.

10

Health profile of Chhatarpur district

Health Facilities in District Chhatarpur, MP

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Source: www.nic .in/chhatarpur/district profile

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As per the 2011 census, the total population the of district was 17,62,857. There are 9,35,870
males and 8,26,951 females in the District. Total Literates in the District are 9,62,827 out of which

5,85,128 are males and 3,77,694 are females.5
Sex ratio is 884/100 male population which is very low than Madhya pradesh’s (930/ 1000 male

population) Madhya Pradesh has 50 districts and among all district sex ratio of Chhatarpur district in
on 44th place.

SEX RATIO
Chhatarpur

■ Madhya Pradesh

972

967

943

943 949’
9223

947
920

946

945

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891

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921

920

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1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011

Table: 2 “Sex ratio of the district compared with state”

The above table shows that the sex ratio of Chhatarpur compare to Madhya Pradesh is always low
and is gone down from 1941 and still 46 points below from MP.
During discussions with the people in villages on the issue I understand the following possible

reasons for low sex ratio:
Desire of male child in the family from the traditions and motivation for small family to get

maximum befits of the government program or schemes e.g. Janani suraksha, ladli Laxmi, etc.

2 children norm in government sectors for job opportunities and for participation in elections in
local bodies people go for the sex selection before birth by using modern technique of ultra

sonography (USG). There are 3 USG centres are in chhatarpur city and 1 in Nawgoan city.

5 Dic_chhatarpur 2011

12

Chhatarpur is a part of bundelkhand where the life is very difficult. Health facilities, literacy and
livelihood options are the major challenges for the people of the district.

Health
There are the followings existing Health centers in Chhatarpur District:

Facilities

Sn

Available

Need as per the

lacking

Guidelines

District Hospital

1

1

1

2

Community Health Centres

08

12

4

3

Primary Health centres

40

29

11

4

Sub Health Centres

192

249

57

Table 1: details of health centres in chhatarpur district
Source: CMHO office Chhatarpur - march 2010

During my visit to most of the CHCs and PHCs I found that these facilities are facing many problems.

Lack of man power, building and availability of basic services like schooling of children, market,
protection of women staff in remote areas and transportation facilities leads most of the staffs to stay
at district head quarters.

Most of the time and especially during night time the services of PHCs and SHCs were not accessible
or available to the people.

It is often the untrained private practitioners who provide most of the Health care services in the rural

areas. These practitioners overcharge and often practice with drugs that are harmful for the human
immune system. There is also a gross inadequacy in health care protection for the poor and the

vulnerable. The public health care system is not found very efficient in meeting all the health needs of
the rural poor.

The inadequate health care services and health care protection to a great extent lead to poverty. This
often forces people to spend their earning kept for investment to finance healthcare. The poor
sometimes spend from own pockets even for minor illness while government is having a decentralized
public health care system to serve the rural poor.
13

Chronic illness (like TB) not only affects the infected person but the well being of other people in the
locality. Such illness weakens the body and also makes the person unable to work, which affect the

family income. If the affected person is the head of the family, it would affect the health of the whole

family.
Mostly the untrained traditional midwives in the rural areas provide the maternity care services. Added

to this there are number unhealthy MCH practices in the rural villages, which could harm both mother

and child. Health care access is also a very important issue as the formal health care providers are
located in towns and cities, which are far away from the rural areas. Now after the initiation of national
rural health mission some of the practices are being changed. ASHAs were placed in the village and

Village Health and Nutrition Day (VHND) is now taking place. But their main focus is on institutional
deliveries.

The rates of institutional deliveries are gone high but still health seeking behavior is not changed too
much. My focus during the fellowship program is on strengthening the Communitization part of NRHM
(ASHA, VHSC and VHND).

Literacy

Particulars

S. No.

India

Unit

M.P.

Chhatarpur

1

Total

%

65.38

64.11

53.44

2

Male

%

75.85

76.8

65.5

3

Female

%

54.16

50.28

39.38

4

Rural

%

59.4

58.1

47.r

5

Urban

%

80.3

79.67

73.6

Table 3: comparative literacy rates
(Source: - Distt. Statistical Book, Chhatarpur -2006)

This table shows the literacy rates of India, MP and Chhatarpur district. The literacy rates of Madhya
Pradesh is low then India’s literacy rates but when compare to chhatarpur and Madhya Pradesh

status the rates are almost 11 points below.
But while I visited some of the schools and found that most of the children of class 5th can’t write
correctly in Hindi if you dictate some paragraphs.
Scarcity of teachers in all schools and also they were assigned many surveys, pulse polio and have to
attend meetings at various places. This affects on the teaching and other regulars activities.
Overall the standard of education in the district is poor and needs improvement.
Education is the component that affects on the health status and we can see some states like Kerala
and tamilnadu where the health status is much better than Madhya Pradesh and these states have

achieved the higher literacy rates among the Indian states.

14

Section B
B.1

Events / Programs

Core Training

During the first week we have given orientation on Fellowship program, SOCHARA, CHC and CPHE
Dr.Ravi Narayan shares his experience and How SOCHARA was formed.

Fellowship program’s content were discussed:
There are 4 components of the program:
Academic, Activities, Lab, Action - Reflections
SOCHARA Web site was introduced to the participants.

Dr. Ravi shared his life journey. After returning from London he was involved in St. Johns Medical
Collage’s Community Medicine Department.
They started 6 clinics in the nearby villages where the milk cooperatives were successfully running.

They selected a village named “Mallure” and started their activities. He focused on the success story

of Mallure village.
I learned the differences in Health, Public Health and Community Health.

Dr. Ravi’s presentation “Be a Balloonist” was the most appealing theme for me. This was a starting
point to look the community and community’s problems. This was a eye opening theme for me .
I learn these also
SWOT analysis , Rules for Feed Back, Type of Leadership:
Paradigm Shift: from Bio medical model to Social / Community Model6

We learned a lot on population, state and districts, health indicators, social determinants, health
situations health system. Alma Ata Declaration, COMPREHENSIVE PRIMARY HEATH

CAREHEALTH MANAGEMENT STRUCTURE, Village Health Committee, Sub Centers, Primary

Health Center, Community Health Centers, Health System Development, Universal Health System,
Nutrition, Malnutrition, NRHM, History of NRHM, Current Status of NRHM in MADHYA Pradesh,

Dindayal Mobile Hospital, district Health Committee, Janani Suraksha Yojna, antodya upchar yojna,
Appropriate Technology, IPHS Standard at various levels of the system / what is Standard? SOCIAL
DETERMINENTS, Public Health Standard, Commutization, Village Health and Sanitation
Committees, Globalization, Panchayati raj, gram Panchayat, Millennium Development Goal,
Community Diagnosis

6 Table 1 pradigm shift
15

Collective Teaching Programs:
During the entire period of 2 years six collective teaching programs were organized at

different venues.
One collective was held at Jabalpur, one in Indore and 4 were organized at Bhopal.
Collective teaching program was full of knowledge and skill development exercises.

We met with many public health professionals who guided us in our learning.
I learn the policy of mental health, maternal and child health, communicable and non

communicable diseases, and many other issues. List of topics are shown in annexure.
We were exposed on Bhopal gas disaster, climate change, and child right issues.
NRHM and health system of India, IPHS standard for different public health centers were

helped me to discuss related issues with the government officials and to build capacity of

ASHA, VHSC and ANMs of my focused area.

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16

B.2

Cluster Meetings

Whole group were divided into 4 Clusters. Bhopal, Indore, Jabalpur and Gwalior clusters.

I was in Gwalior cluster where participants from “Chhatarpur, Tikamgarh, damoh and Gwalior were

associated in the cluster.
The cluster meets on every one and half month to share the progress, difficulties and their
learning. Mr. Juned kamal from CPHE team was our Team Leader for Gwalior region.
Cluster meeting was a good platform to share our achievements discusses our problems and

learns from each others. Also we learn many things from the places where we had cluster

meeting.
We had some exposures on IMNCI program at Shivpuri, NRCs at Jabalpur and learning on

maternal health issue in chhatarpur Cluster meeting.

t

17

*

B.3Field Activities

(Strengthening the Communitization section of National Rural Health Mission)

B.3.1

B.3.1.1

Reading and Writing

Reading

Reading was the most important part of the fellowship. Special attention was made on the reading
section during the fellowship program.

This helped me to know and understand the background, situations and the depth of the issues
and subjects.
I left my regular schooling in year 1979 after completion of my high school. In beginning I found it

very difficult because I had left the practice of regular reading.
Sometimes due to more focus on field activities I found it very difficult to make my attention on
reading part.

I have decided and made it into 2 sections.
1. Individual Reading
2. Group Reading

Individual reading is being done mostly in nights from 10 to 11 pm and some time in day at the
office.

Group teaching was planned at Prerana office with the Prerana team on every Saturdays.
Sometimes we made it on Fridays when the team remains in the office.

Mostly after each collective program I use to read the given materials (articles and books) with the

team members.
Some article were downloaded from the web and for any clarification we use to discuss with the
them, ask support from mentor (Institution) and clarify the issue with the team leader or team

members of CPHE Bhopal.
During the last 2 years we have read many articles, books and literatures on the following
issues:
(NRHM) National Rural Health Mission (2005-2012) Mission Document, ASHA Training manuals,

VHSC guidelines, IPHS Guidelines, Mental Health policy 2008, Maternal and Child health, IMNCI,
Malnutrition & RD Hearth, Communicable disease (TB, Malaria, leprosy), Non Communicable
Diseases & Yoga. Books, article, guidelines and reports were provided by CPHE Bhopal.

18

B.3.1.2 Writing

The writing section helped me to express my thoughts and feelings. It also helped me to present
my achievements and failure.

The technique which was taught during the fellowship was very good. Sections for writing any
report, easy, articles and statement of problem for research helped me to improve my writing

skills.
B.3.1.2.1

Essay Writing

This exercise was to understand the context of a particular subject or problem and after
understanding the situation think the severity of the problem and give our expressions.

Essay writing exercise was done 2 times during the fellowship program

1st. essay was on Village Health worker based on the article written by David Warner.

This article was written on Village health workers. An article was written by “David warner’ and we
seen the article in the context of ASHA in our country. What are the similarities in situations,
selection of workers and their responsibilities?
Both the articles show that a community health worker is the key link between the community and

health department / NGOs working for the promotion of community health. Many countries are
promoting the concept of community health workers in their health programs and achieving good

results.

The community health worker can undertake various tasks such as case management of
childhood illnesses, developing healthy behaviors among the community, mobilizing community,
delivery of preventing interventions, etc.

There is a need of close monitoring of the program and fair evaluation of the program from
beginning to the end.

19

The process of selection, training and monitoring of the program needs to be fairly implemented
and the role of the persons and institutions should be re oriented to them again.

The program is design well but the implementation part is very weak. Some support system is

needed to support them in every point such as payment system, moral support, technical support,
guiding them and helping the in the time of any type of problem.

Community support as well as organizational support but overall the political support is badly

needed

for

the

success

of

this

program.

2nd Article was on RD Hearth

Malnutrition is one of the biggest problems in children under 6 years in India.

In Madhya Pradesh the malnutrition is causing many deaths every year. Many studies and
surveys show the severity of malnutrition in the children.
Due to many reasons parents refuses to go to Nutritional rehabilitee centers (NRC) and due to

lack of awareness they are fail to give proper care and nutrition to their children. Due to poor care
and poor nutrition and unhygienic practices children getting sick and many of them die within this
age group. (Survey of malnourished children in village Rangua and Khairo - chhatarpur, 2010 by Prabhu

saran)
During the fellowship period in chhatarpur district we have experienced some child deaths last

year were associated with the problem.
In my survey of 3 villages I found many malnourished children.7 This is one of the best community

based approach to address malnutrition problem in rural area

Because of less number of NRCs and facilities and services of NRCs are also not very good in

many places, the distance and approach to NRCs are not very easy for many villagers we need to
apply this process at village level. RD Hearth process can be one approach to fight against

malnutrition at community level.

20

B.3.1.2.2 Research Statement
Research statement exercise was done by me. This was a part of learning.

Dr. Aas Mohammad ji and Mr. Prassana Shaligram guided us the outline of the research
statement.

I have chosen the topic “social and medical causes of maternal deaths in chhatarpur district”.

I met Dr. Shalini Cherian - Gynecologist from Christian hospital chhatarpur. She guided me well

and I learn about maternal death audit through verbal autopsy.
I started the outlines of the research statement and sent to CPHE. After receiving some feedbacks

from CPHE team I have restarted the statement and sent to the CPHE team.

This assignment was not completed during the given period because due to other activities I was
unable to focus on the task and left the process.

The process helped me to understand the research methodologies and the guidelines for drafting
a research proposal.

B.3.1.2.3 Article Writing

This was started after the Bhopal collective workshop in March 2011. I have started to write an
article on maternal health status of Chhatarpur district. After started writing the outline and based

on the continuous feedback my article’s title was changed from maternal health to the “impact of

functioning VHCSs on maternal health status”.
Literature review portion is very difficult. I found difficulties in selecting related available literatures
on the net. First there are very few literatures are available and which one to be chooses for

further reading and review.
CPHE team members helped me in literature review in various ways.
Mr. Prassana shaligram has taken some sessions during the collective teaching program.

He

showed how to search literatures on the web. Internet searching and use of Google for literature
search.

How to read literatures, relating the situations and using any literature for the articles.

Dr. Durbh Rohini Kumar, Mr. Juned Kamal from CPHE team, dr. Deepak Kumarswami from

Sochara Bangalore team also guided me and helped me by giving their feed backs and sending
some related literatures for reading.
21

B.3.1.2.4 Report Writing

Report writing process was also full of learning. Designing the report, use of words in the
report, reflections, learning, etc were very helpful.

have made monthly reports, training reports, field visit reports etc.
Regular feedback from the CPHE team members helped me to improve my reporting skills.

Especially making report in Hindi font.
Systematic reporting (What, Where, When and How), problems faced and reflections or

learning. By using the format I found it very easy to present all things in the report as

previously some information were left.
Before reporting making out lines of the report and then start writing. Use of daily dairy for

report writing was also a good learning.
B.3.1.2.5. Report Presentation

During all cluster meeting and collective learning session we were assigned to present our

reports. After the presentations feedback was given by the CPHE team member and present
resource persons.

This helped me to improve my presentation skills. This also helped me to build my
confidence to present a report to unknown audience and to a group of experts.

We used electronic media as laptops to present the reports. We used power point.
I learn how to prepare report in power point e.g. Use of fonts, color and contents in power

point presentation.
Even I have made many reports but still I found it difficult.

22

B.3.2

Strengthening of Communitization Part of NRHM

This was my focus during the entire period of fellowship in the field.

GOAL: To strengthen the Communitization Component of NRHM in 6 villages of Isanagar
Block of Chhatarpur District.

This was the main focus during the fellowship program in the field. I have chosen Isanagar

(Chhatarpur) block for my field activities and from the block I have chosen 6 villages to focus on
strengthening the Communitization part of NRHM

The Villages were; Rangua, Khairo, Sahasnagar, Pipora khurd, Barajkhera, Budoor

B.3.2.1. Strengthening of ASHA (Accredited Social Health Activist)8

B.3.2.1.1

B.3.2.1.1.1

Relationship Building

Meeting with District Program Manager (DPM -NRHM)

DPM NRHM knows me as a leader of Prerana project but as a Fellow when I introduced myself to
him he welcomed me as a support hand in the Isanagar Block. This meeting was regular once in a
month we meet at his office and discusses on the progress and future possibilities.

District program manager (DPM) is very cooperative with me. We together discussed on the

field activities and how I can give my inputs to the present ASHAs.

He introduced me to the Block Program managers of Isanagar and Rajnagar Block and helped me
by approving my proposal to provide training to the ASHAs of selected villages on selected topics

(Leadership, communication and accounts).
He visited the CHC Isanagar and some of the villages with m e and also participated and

motivated ASHAs during the training period.

8 ASHA Guidelines MHFWnewdelhi

23

B.3.2.1.1.2 Meeting with Chief Medical and Health Officer (CMHO)

Met the CMHO of the district and shared about the fellowship program.

CMHO just asked about what I am planning to do and what support I am expecting from him. He
instructed the office staff to provide information that I needed.

He was cooperative and sometimes invited me in the departmental meeting of NRHM.

During his absence Dr. V.S.Bajpai - DTO was in the charge of CMHO. He also gave me time to
share and provided me the required information regarding ANMs.

I use to meet CMHO once in 3 months with my proposals and progress reports.

B.3.2.1.1.3 Meeting with Block Medical Officer (BMO) Block Program Manager (BPM NRHM) and CHC staff of CHC Isanagar

I have developed a format to collect information on CHC. We were taught in collective programs
regarding CHC. Infrastructures, manpower and services provided by the CHC.

I want to know about the Isanagar CHC9 that where this CHC according to the CHC norm and how

and how much people are utilizing the services of this CHC.

I Visited the community health center (CHC) Isanagar regularly
CHC Isanagar is 18 km away from district headquarter. CHC covers 25 villages, 8 Panchayat and
about 50000 populations. CHC has linked with 3 Primary Health centers (PHC).

Number of Sectors:

4

Number of Sub Centers:

26

Number of Doctors Available

02 (1 MBBS + 1 Ayush)

Number of ANMs :

38

Number of MPWs:

25

Number of Supervisors: Male

04

Number of Supervisors: Female

05

Number of ASHA connected with PHC

230

Number of Village Health and Sanitation Committees formed:

91

9 Mohfw/health system of india

24

Services Available at CHC :

1.

Ambulance

-1

2

Janani Express

-1

3

Operation Theater

Present only for minor operations

4

Generator

1 in working condition

5

Beds (Number)

6 ( 4 male + 2 Female)

6

OPD

9am - 3 pm

The Block Medical Officer lives in nowgaon and comes around 11 am to this CHC and returns
around 3 pm because she was in charge of CHC Isanagar and PHC Lahera purva.
During nights there are no doctor lives in the CHC campus even there are facility (quarters)

available for the medical officers in the campus.

The Block Program Manager of NRHM is new and always cooperative. Mostly we discussed

on the ASHA training, monitoring of VHND, activation of Village Health and sanitation

committees (VHSC, untied fund of VHSCs10 and Sub health centers and issues of ASHAs.
With the help of BMO and BPM I was able to conduct 2 special health camps in village Khairo
and Rangua.

I have participated in the Health workers meeting regularly and shared my findings and
suggestion for the improvement of Sub Health Center Rangua and VHNDs under the villages

of CHC.
I have participated in ASHA trainings of CHC ASHAs on 5th module at Isanagar and at CMHO

office at Chhatarpur.

B.3.2.2 Capacity Building of ASHA

During the fellowship program we were oriented on NRHM and ASHA.

My field assignment was strengthening the Communitization process of NRHM. ASHA is the

main player from NRHM in the community.
I went to the field and want to know that “what the status of ASHA in the area is”. What was
the selection criteria, training and about the role and responsibilities of ASHA as per the given

guidelines.
10 Mohfw/guidelines for VHSC

25

B.3.2.2.1

Collection of ASHA and VHSC List from Isanagar CHC

For collection of the lists I have visited CHC Isanagar several times. I meet with BMC, BEE
and the Computer operator Mr. Pal.

First list was very old but they helped me and updated the data and provided me the
updated list of ASHA and VHSCs.
Collected the list of ASHAs and Village Health & Sanitation Committees from CHC

Isanagar and later from the DPM-NRHM office Chhatarpur for whole district.

208

100%

20

9.61 %

10th pass

170

81.73%

Less the 10th

18

8.65%

TOTAL

ASHA

-'iT' . k.

Highly Qualified

..

+2 or Graduate

Table 2: educational status of ASHAs in Isanagar CHC

About 91% ASHAs are educated up to class 10th. This is a good sign that in place like chhatarpur

where the education facilities are very poor and facility for middle or high school is far from the
villages women are getting educated and coming forward for social work.

This will really help the program like NRHM to reach the really needy people of the district.
Health awareness and women health status in rural community can be improve of the area by the
efforts of these women.

B.3.2.2.2 Meeting with ASHAs from the 8 selected Villages of Chhatarpur Block
After collection of the list I visited all 6 selected villages for my field activities.
I met with 6 ASHAs and shared my plan for the fellowship. Regularly I visited the
ASHAs and build my relationship with them and with their family members.

B.3.2.2.3. Developing Interview format for ASHA interview (3)

After building relationship I developed a format for the assessment of the ASHAs. I have
received some formats from my co fellows and taken some points from there. Field test

was done in Khairo village and then the final format was developed.
26

B.3.2.2.4 ASHA Interview
After developing the format I discuss the format with my team mentor as well as the BPM and
made the final format. Dates were finalized for the interview with the consultation of ASHAs.

The interview was based on the selection process, Training received, materials supplied during

ASHA training module 1-4, drug kit of ASHA, what are the activities she is doing, what type of the
records she is maintaining.
I have conducted Interview for all 6 ASHAs during the first 3 months of the field placement.

B.3.2.2.5 Analysis of Information’s collected through ASHA Interview
Analysis done and report was shared with the ASHA, BPM and CPHE team.

Some findings were:
ASHA from the focused Area:
There are 8 ASHAs in the selected area All were interviewed by me during my visits to the field

Major finding of ASHA interview
All were selected through gram sabha’s recommendations. 6 out of 8 ASHAs were aware about her
selections after they were selected. Mostly their family members made all formalities.

Only 6 ASHAs were received training on “ASHA module 1-4 of NRHM They were trained at

Chhatarpur city by some NGO.
They were not aware on use of drugs from the drug kit because there are no proper orientation and
training on the use of these drugs. There is no system for refilling the drug kits and drugs were

supplied once only. At the time of discussions and interview they were not able to answer about
counseling. Some of them said that they need some inputs or training on Home visits and personal
counseling

They are not fully aware regarding village health and sanitation committee. While asking about the

meetings of VHSC and how they are conducting the meetings they asked me “you tell me how to
conduct VHSC meetings” then I will do that”.

I asked them if they are aware of Village health action plan they said yes. But they are not involved in
the process. And they don’t know the process for making “village health action plan.
During the interview I found that the Training on 5th module was not started in the district

27

B.3.2.2.6 Sharing the findings with different groups and the working NGO (Prerana)

The major findings were shared with the Prerana team in the regular meetings with BPM

during CHC meeting and CPHE team & Fellows during the collective meeting at Jabalpur.

B.3.2.2.7 Preparation for ASHA Training
Based on the findings of ASHA interview I planned the trainings for ASHAs of the concern
villages.
I related this with Prerana Project’s training program for ASHAs. Prerana Project Chhatarpur is
providing regular trainings to the ASHAs on various health issues.

B.3.2.2.7.1

Self Preparation (Getting updated for training on 5th Module)

For the training of these ASHAs I found the need of more knowledge on ASHA program and
TOT on the 5th module training of ASHA. For self preparation I have Read the training manual
facilitators book and during collective workshop at Bhopal we have gone through TOT process

done practice.

B.3.2.2.7.2 collection of training materials

I received training manual from CPHE Bhopal and other materials like posters, literatures were

collected from NRHM office Chhatarpur.
Prerana project chhatarpur provided the other materials like white board, markers, note books

and pen, food and travel expenses were also paid by Prerana Project Chhatarpur.

B.3.2.2.7.3

Getting Permission from NRHM and organized Trainings

After collection of training materials I have taken permission from the DPM office for the
training of ASHAs from the selected villages

28

1st Training on Leadership development

The first training of the ASHAa was held on dated: 18th December 2010 at Prerana Project’s
training hall. This was 2 days training program where some other ASHAs from the Project villages
were also participated.

The main topics covered in the training were; communication, how to conduct meetings,
leadership styles, etc.
16 ASHAs from 14 villages were present in the training program. This was one day training

program. Resource persons were from Prerana Project and Mr. Vinay Shrivas from Chetna
NGO - Nawgoan.

•I’.*

•'K

i Uh

. E....,...

i ■.. wn

“I' IL. i
; 1

■I l,

One ASHA is communicating with a villager

Participants during the learning session.

2nd Training on Account Keeping
Second training was on account keeping. During my visits and ASHA assessment it was seen that

they are facing problem during the submission of report of untied fund utilization. They use to keep
only vouchers and receipts of the expenditure.
Sometimes they are facing difficult to prove a expense because they are making simple receipts
(written by themselves only) without dated.
So during discussion I asked them whether they want to learn how to keep accounts and they agreed
fortraining.

I conducted training on account keeping for the selected ASHAs. We organized the training with the

help of Prerana Project’s staff at the Prerana office Chhatarpur.

29

14 ASHAs were present in the training. I and Mr. Ashok Kumar - accountant of Prerana Project were
the resource persons.

Topic covered; what is account, what is Cash Book, making receipts, entering the amount in cash
book and making monthly financial summary report.

•S ■
.Sj I
it
.II-1t .*> *“i.-■ -4
(

Participants of the training.

Ji

»'• ■
“» ,

Mr. Ashok Kumar - teaching on making cash Book

3rd Training on 5th Module for ASHA of NRHM
The 3rd training was based on the 5th module for ASHA training (NRHM ASHA Training Module - 5),

8 ASHAs from 6 focused villages were present in the training.

Main topics were:
Knowing Myself, ASHA as a Health Activist, Values of ASHA, Decision-Making Skills, Negotiation

Skills, Coordination Skills
This was a 2 days training organized at Prerana Project Chhatarpur.

The resource persons were from - Prerana Project and Fellow, CHFP.
BPM CHC Isanagar, distributed the certificates after the completion of the training. All the efforts

were appreciated by the Block Medical Officer - Isanagar CHC and a appreciation letter also provided
by the BMO to the Prerana Project Chhatarpur.

k l

• r
L. '

T
If

30

B.3.2.2.8

Regular Follow-up Visits

Regular Follow-up visits made to all 6 villages where I meet ASHAs. ASHAs were motivated and
appreciated for their efforts.
We found that after these training improvements are taking place in following areas:

-

18 ASHAs were trained during the period from 14 villages.

-

They are now showing their confidence in the work.

-

4 villages have completed their Village Health plan and working on the plan.

-

3 out of 6 selected villages (Rangua, Khairo and Sahasnagar) started the regular VHSC meetings.

Overall I have gain a good experience on working with ASHA. They were very friendly and always
ready for learning.

They are working hard and well known in their communities. Any time they are available for
community and especially for the pregnant women to take them to the hospital for deliveries.
They are facing many problems from many sides. CHC staff’s attitude towards their works is not very
positive. They are also given targets for family planning cases and if someone is failed to achieve that
their incentives were delayed by the CHC.
ANM and MPWs are demanding money for approving their reports and for verification of the
expenditures of untied funds they have to pay some money to the accountants of the CHC.

I asked them to raise their voice against the corruption but they are not ready to come forward. They
have a fear that if they will make complain they will lose their positions.
Gram Panchayat is also not supporting them. Panchayats are also not aware about the role and
responsibilities of ASHA. Asha is also not sharing her work report or problems to the Panchayat and
not accountable for the gram Panchayat.

There is no monitoring and support system for ASHAs in the district. I felt that some kind of support
system should be very important to give support to the ASHAs. This can be improve their status and
motivate them to perform better.
Mentoring Group for community action (MGCA) can be a good starting point but depends on the
motivation and interest of the members.

B.3.3 Strengthening the VHSC11 (Village Health and sanitation Committee)

During the meeting with ASHA and visits of these villages I met with many villagers and
Anganwadi workers. I asked about the VHSCs that how they are functioning in the village. I
found that most of them are not aware of VHSC and the VHSC members were also not fully
aware on the VHSC and its functions.

So I discussed with them and we decided to organize some training for the VHSC members
nMohfw/nrhm/ Village health and sanitation committee guidelines

31

B.3.3.1. Selection of VHSCs for Strengthening

I have selected 3 Village Health and sanitation committees for 6 focused villages to give inputs
and build their capacity.

1. Rangua

2. Khairo
3. Sahasnagar
But the ASHA of village Sahasnagar started living at chhatarpur for her health and other family

reasons so I have given my inputs in only 2 VHSCs.

B.3.3.2. Meeting with VHSC members during Village visits

After selecting the village I met with the ANM and ASHA and discussed on the VHSC.

In the both villages the VHSC members were only ANM, ASHA, Anganwadi workers and one

Mahila panch. No NGO representative, SHG representative and other mohalla’s

representatives were included as member of the VHSC.
I visited the both villages and met individually with the members of VHSC.
In beginning it was very difficult to motivate some of the self help group (SHG) leaders and

other villagers for participating in the meeting.
Slowly after regular meetings and encouraging them for participation in VHSC we were able to
include SHG leaders and some mohalla’s representative and Health worker of Prerana project

in the VHSCs of both villages

B.3.3.3. Meeting of selected VHSCs
After meetings with the member we decided to organize meeting of VHSC on the Village

health and nutrition day (VHND) at anganbadi center.
Slowly we started to meet regularly after VHND12 at anganbadi center.
During our meeting we use to discuss on the health issues of the village. Members were
oriented on the concept of VHSC and the role of members.

12 Mohfw/NRHM/VHND guidelines

32

Now in both villages VHSC is meeting regularly on the VHND days. They are keeping the
meeting minutes.

VHSC was not recognized in the village. Most of the villagers were not aware about the VHSC

and its activities. Untied fund was also not shared with the member as well as villager. We

decided to call a general meeting with villagers and shared about the VHSC and UNTIED
fund. Slowly most of the people in the village specially SHGs, Farmers Groups, Panchayat
members and other stake holders are aware about VHSC and Untied fund.

B.3.3.4. Need Assessment of VHSCs for capacity Building

I found that most of the members were not aware about the concept of VHSC and about their
responsibilities. Many of the members were not aware about untied funds of VHSC and for

what purpose they can use the fund.

VHSC Meetings were not regular. Members were not aware about the village health action
plan. We discussed and decided to organize some trainings on :

Village Health and sanitation committee (concept of V HSC and responsibilities of members)
Account keeping for untied fund and drafting village Health action plan

B.3.3.5. Organizing Trainings on (VHSC -concept and need of VHSC, role of members,
untied fund, Account keeping, making Village Health Plan)

I have facilitated 2 trainings for the VHSC members. The booklet on VHSCs provided by

CPHE was used for the training.

Concept & role of the VHSC members

These trainings were organized in the villages for all VHSC members.
In village Rangua the training held at Anganbadi center. ANM, MPW, 2 Anganbadi workers,

SHG representative and representative from Prerana Project attended the training program. In
village Khairo also the training was organized at anganbadi center.

The Topics covered:
■

What is the need of VHSC

■

Who can be the members of a VHSC

■

What is the role of VHSC members

■

What activities can be done through VHSC

33

Training on Village Health Action Plan
Training on Village Health Action Plan was organized at Village Khairo. 6 members were
participated from the VHSC and Panchayat Secretary of the village and 2 Volunteer from the
village were also present.

■

We discussed on the Health issues of the village

■

Priority setting of the listed issues

■

What can be done by the village health committee and what we can be done by

Panchayat and NGOs working in the village.

This was a 4 hour exercise and in the end all members were aware about the village health action
plan. Material used for the training was the format of village health plan provided by CPHE.

B.3.3.6. Facilitation in drafting the Village Health action Plan
After the training we discussed on the various issues of the village.
We listed out the problem of the villages and done exercise on problem prioritization. And after

that the VHSC meets several times to develop the village health action plan in village Rangua and

Khairo. This was a learning exercise for the VHSC.
We shared this plan with the villagers and Panchayat members.

34

B.3.3.7. Regular follow-up

Regular follow-up visits held by the fellow to these village and facilitation of VHSC meetings are
done.

During last 2 years I visited these villages and facilitated the VHSC meetings in these 2 villages
but I found that when I was unable to attend the meeting the members and ANM were not
interested for conducting meetings.

This shows that still the motivational factor is missing and they are not ready to take ownership of
their village and to address the health problems themselves.

35

B.3.4 VHND (Village Health and Nutrition Day)

I learned about Village Health and Nutrition Day (VHND) in the fellowship and when I visited

NRHM office at Chhatarpur I asked about the VHND. I also visited some of the villages to know
the reality.

I meet with Anganwadi workers of village Rangua and Khairo. These villages have two

anbanwadies in each village. I visited these villages with the ANM on VHND day.

The Health team was there (ANM, MPW and ASHA). In beginning I only observed the process of
the VHND. I found that they are doing only Immunizations.
I found that in VHND there are no physical checkups, blood pressure checkup and urine,

Hemoglobin checkup of antenatal was done. Only weight is taken and after giving Tetanus toxide

injection the ANM gave IFA tablets to the ANCs.

Anganwadi worker supplies one food packet to the ANCs. No other activities were held. No written
information was there on VHND.
I discussed the issues with the ANM and ASHA and shared the need of having all the activities
during the VHND. I discussed and shared the importance of physical checkups, BP weight and the

tests (urine and Hemoglobin).

B.3.4.1

Meeting with CDRO of ICDS

Before visiting the Anganwadies I meet with CDRO of Chhatarpur block- Mr. Anand Shivhare. I
shared the VHND and its importance. I expressed the need for improvement in the VHND from the

VHND team. I shared the plan with him. He assured me his full support.

B.3.4.2 Sensitization of VHSC members & Self Help Group members on VHND
Sensitization sessions on VHND were done in both villages. We included self help group members

also in sensitization program.
Film show on VHND was organized for the Team and other villagers at the anganbadi organized.

The film provided by Jaika was shown and after the film show we discussed how to improve the

process of VHND in the village.

36

After regular effort of whole team some changes are taking place as ASHA is now teaching the
adolescents and ANCs, ANM is started physical check-ups. But still Blood pressure and urine and

hemoglobin test are not started.
I have discussed with DPM NRHM and BMO of the Area to provide instruments and test kit to the
ANM.
Now after VHND we use to sit together and discuss the process and how to improve more.

I have suggested the VHSC to purchase BP Instrument and Test kit from the Untied fund.

B.3.4.3. Facilitation of VHNDs

VHND sessions in both villages are facilitated by me regularly and in absence of me one of the

staff members from Prerana project is helping in facilitation.
One person helps in registration of new ANC and child, second helps in weighing the child and

ANCs. ANM gives vaccines and MPW is responsible to distribute IFA, family planning counseling

ASHA sits with adolescents and teaches them on personal hygiene and other health issue.
Anganbadi worker looks on the Nutritional part (growth monitoring chart, counseling the mothers
of malnourished and severe malnourished children, referral to NRC or Hospirtal and supply of

nutritional packs, records, etc.

’ v tJ W ■
’

'i-

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-

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... ‘

X' - I" ';V

<

v Y ,4

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/Ki

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37

?

B.3.5 Assessment of Sub Health centers as per IPHS
(Indian Public Health Standard) Guidelines)

B.3.5.1. Sensitization of VHSC and VHDC (Village Health and development Committees)
members on Sub Health Center

The sub health center (SHC) is at Rangua village. This SHC is covering 10 villages of 5 kilometer
radius.
When I asked the villagers of Rangua about the SHC, they were unable to reply. Some of them
asked me that what is this? They only know that ANM comes once or twice in a month in the

village for Immunization and for family planning cases.

So I felt the need to sensitize the health committee members on sub health center.
There are 2 committees in the village. One formed by the ANM (VHSC) and second formed by the

NGO (Prerana Project) is called VHDC (Village Health and development Committee)
Sensitization program organized for both committee members in the village.

I share about the sub health center
■

How much population to be covered by SHC

■

What facilities should be available in the SHC

■

Services of the SHC

■

Untied fund of the SHC

B.3.5.2 Formation of team for assessment

A team was formed for the assessment.
- 1 VHDC member (health worker of Prerana Project)

-

2 VHSC members (ANM +Anganbadi worker)

-

MPW of the SHC

1 NGO representative from Prerana project

38

B.3.5.3. Orientation of team member on assessment form

Orientation given on the IPHS format and objective of the assessment was to find out the current
status of SHC.
Introduction: Introduction given by the fellow that why the sub health centre is established in the

village and what facilities and activities should be provided by the sub health centre in the village.
Purpose of the Assessment:

The main purposes of the assessment were:
To find out the gaps in the sub health centre and present the report at PHC to improve the facilities /

services of the SHC and make the SHC functional.
To create awareness regarding the sub health centre’s activities / services to increase the utilization

of services provided by the sub health centre.
B.3.5.4. Assessment
Assessment of Sub Health Center:

Assessment of sub health centre was done on 11/5/2010. Following persons were present

during the assessment.

MPW, ANM, Anganbadi Worker, Project Officer- Prerana project, Tele Health WorkerPrerana Project

Assessment Criteria:
We used the IPHS Checklist for Sub Health Centres to find out the major gaps in the sub
centre.
•

Findings:

Manpower Health worker (female)

1

Health worker (male)

1

Voluntary worker to keep
the Sub-centre clean and 1 (optional)

not available

Physical Infrastructure:

Rented room - 1

Furniture

1 old examination table (not in use)

Equipment

not shown (ANM will provide the list later)

Drugs:

not shown (ANM will provide the list later)

Support Services

39

a) Laboratory:
Minimum facilities like estimation of hemoglobin by using a Approved Hemoglobin

Color Scale, urine test for the presence of protein by using Uristix, and urine test for
the presence of sugar by using Diastix should be available.

Not available at the centre at present

b) Electricity:

No electricity facility

c) Water:

no water facility at the centre

d) Telephone.

ANM has mobile

e) Transport No transport available for the centre

Monitoring mechanism:
Supportive supervision and Record checking at periodic intervals by the Male and Female Health
supervisors from PHC at least once a week) at the CHC level on their meeting days and very

occasionally they visit the village.

•

Major gaps identified:
People are not fully aware about the activities / services of the sub health centre

No ownership of the community in govt, health services
Centre is running in a private Room

Citizen charter is not displayed
Only registration of ANCs and Immunization of ANC & under 5 are provided by ANM in
the Anganbadi centre on fix day. (once in a month)

No proper disposal of used syringes and niddles, niddele cutter is not seen with the

ANM.
Centre is not utilized by the ANM for any kind of services.

Most of the villagers are not aware about the sub centre place.

Provision of untied fund to the Sub-centers (currently Rs. 10,000 per Sub centre

is provided under NRHM) for facilitating the service management at the Sub-Centre
people are not aware about the fund.

Panchayat can plan for the construction of sub centre building
ANM and MPW should stay in the village

40

Suggestions:
There is a need of close monitoring of the sub health centre. Excess of workload non
accountability for the community worsen the situation of the sub health centre.

Need of restructuring of the Village Health and Sanitation Committee and Motivation of P RI
members that can improve the current status of the sub Health Centre. Block Medical officer can
visit the sub centre at least once in 2 or 3 months Working NGOs and CBOs can be involved in

monitoring and other activities. Skill updation of the workers is also needed.

B.3.5.5. Sharing of findings with VHSC and CMC staff
The finding were shared with the VHSC members of Rangua Village. The members
discussed on the findings and they aksed to the ANM and MPW that what can be done to
make improvement in the sub health center.

The findings were also share with CHC staff ( LHV and BPM of Isanagar CHC).
They accepted that some improvement can be done in the services. I approached to the

BMO and BEE of the CHC also for the supply of basic instruments which were old and not in
working condition like; BP instrument and blood and ne testing kits.

B.3.5.6. Sharing the findings with Panchayat leaders of Rangua Panchayat

The findings were also shared with the Panchayat leaders. The need of the building for SHC was
raised with the Panchayat. We discussed why we need the building?

The nurse is not living in the village because she is not finding some secure place to stay. No
instruments, medicines and other belongings of Sub health center is available in the village due to

lack of building.

If the nurse will start to live in the village then 24 hours health care facility and also sub health
centers facilities will be available for 24 hours to all the villagers.

During the emergencies she will be available to provide emergency care.

41

The newly elected sarpanch and Vice sarpanch shown their interest for construction of the Sub

Health center’s building. Later they made a plan and submitted to the Zilla Panchayat for the
construction of Sub Health center Building.

The planned was passed and construction was stated in September 2010.

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Now at the end of July 2011 the SHC’s building is constructed and hoping that will be
started soon for the public service.

42

B.3.6

Nutritional promotion activities

During the fellowship program we had some exposure and sessions on the burning issue of

malnutrion. Malnutrition is a challenging issue in Madhya Pradesh.
The state fact sheet shown that 60% of the children were malnourished, but the recent report
says, 71.4% children in tribal families are living with the curse of malnutrition. (Status of child

and maternal health in Madhya Pradesh

vikas samvad)

The nutritional status of children in MP is very poor, according to National Family Health
Survey (NFHS). Under nutrition is very high in the state. Fifty seven percent of all children
under four are underweight for their age, and 22% are severely under-weight. The situation

reflects the same for backward districts of MP which include the concerned districts
(chhatarpur, damoh, panna, satna, Tikamgarh, etc).
(Study on Bundelkhand_ yogesh kumar, Samarthan Bhopal)

I have discussed the issue with the team mentors and facilitated some of the

Anganwadi workers for nutritional promotion activities through the Community
approach.

B.3.6.1. Strengthening of Anganbadi Centers

B.3.6.1.1. Meeting with anganbadi workers

After the learning on nutrition at Jabalpur collective
meeting I met the Anganwadi workers in 3 villages of

Isanagar block (Sahasnagar, Rangua and Khairo).
I shared about my field plan with them.

Regularly I have visited these villages and gone
through their records. These Anganwadi centers are opened regularly. Anganwadi Worker and
Sahayika are regular and doing their regular works. Sahayika is opening the center, cleaning the

center and calling children by visiting door to door. Worker is teaching the children some poems,

songs, numbers and alphabets.
Mid day meals were distributed by the self help groups member and Anganwadi worker distributed

the nutritional food supplement packets to the antenatal and postnatal women.

43

Anganwadi worker’s details:

Education level

Name of the

Designation

Name

Village
Smt. Asha singh Solanki

Anganwadi worker

Sahasnagar

12^

Smt. Leela Dwevedi

Anganwadi worker

Rangua 1

BA

Smt. Geeta Namdeo

Anganwadi worker

Rangua 2

Smt. Savitri Mishra

Anganwadi worker

Khairo 1

Smt. Sanju Dubey

Anganwadi worker

Khairo 2

Table 3: list of Anganwadi workers in Focus villages
n -

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B.3.6.1.2. Need Assessment of Anganbadi workers
During my visits I asked the anganbadi workers what they want to learn that I can teach them. They

are doing lots of documentations and reporting. I found that the “growth monitoring register in

Sahasnagar village is not completed and also she told me that she is trying but some time she felt it
hard.

B.3.6.1.3. Facilitating in preparation of Growth monitoring register
I helped her to learn how to fill the growth monitoring register and regularly I helped her to fill the

growth monitoring card of children. Now the anganbadi worker of Sahasnagar Village knows to fill the
Growth monitoring register.

44

B.3.6.2 Positive deviant Hearth (P.O. Hearth)

Implementation of PD Hearth Process:
During the collective teaching program of Community Health Fellowship Program at Jabalpur we were

oriented on the PD HEARTH process.

The status of malnutrition among the children under 5 years is very high in Madhya Pradesh.
I am placed in Chhatarpur district for my field learning. The malnutrition among the < 5 children shows

about 58% in many studies. But it can be more If we conduct a study in some of the area of
chhatarpur block.

Steps taken for the implementation:

Discussion with the Prerana Project’s team member:
Discussion held with the Prerana team members. I presented the plan and presented the need of

the PD HEARTH in the area.
I shared the health status of the children and status of malnourished children in Madhya Pradesh

and in Chhatarpur district. About 58% children are malnourished in the district according to the
studies done in the district by various groups / programs ( DLHS, NFHS and by abhar Mahila

samiti, etc)
Discuss the process of the PD Hearth and possible benefits of the process to the community. How

the plan will take place and what kind of support and cooperation is needed to make the plan

success. The team members assured their full support for the program in their concern villages.
B.3.6.2.1. Discussion with the Field staff of Prerana Project:

A meeting held in Prerana Project’s office with the field staff of Prerana Project to share and

discuss the plan of PD HEARTH.

Discuss the plan with the field staffs of Prerana project Chhatarpur. 15 THW and 2 SHG
workers were present in the meeting:

An orientation was given on PD HEARTH and then we discussed the need and possibilities of
the process in thes villages where they are working.
Slide show presentation was given by the fellow in the meeting.

Discuss the process of the PD Hearth and possible benefits of the process to the community.
How the plan will take place and what kind of support and cooperation is needed to make the
plan success.
Need and Role of Village level committies and Volunteers were also discussed with them. The
field staff assured their full support for the program in their concern villages.

45

B. 3.6.2.1a. Discuss the plan with ICDS - CDPO & Team of Isanagar Block:

I discussed the plan with the ICDS officer Mr. Anand
Shivhare ji in their office and given a presentation on

PD Hearth Process.
We discussed on the malnutrition status in the district

Sc J

and especially in Chhatarpur block.
Mr. Shivhare was also very concern on the issue and

is willing to do something to improve the status but he
told me that he have no any support and as I am
willing to do he will give his full support and the

anganbadi workers in the villages will also involved in
the process and will help in survey, weighing the children and conducting the sessions.

He also suggested that we can use the anganbadi centers where they have building for the
sessions and He will participate in the session.

Mr. Shivhare visited the village Khairo with me. We met the Anganwadi worker and visited the

houses where she had identifies severe malnourished child.
We also visited the house of all malnourished children and motivated the parents to

come to the anganbadi center.
We discussed the plan with the parents and Panchayat members at the meeting held at
anganbadi center.

B.3.6.2.1b. Discuss the plan in village Health & Development committees/ village

Health & sanitation committee:
We decided to discuss the plan with the Heath committees in village Rangua, Khairo village.
We organized their meeting and discuss the PD Hearth process in village Rangua and Khairo.
Sahasnagar village is 2 km far from Rangua and is in the same Panchayat but the VHSC in

not functional so we met with Anganbadi worker, Asha and some of the villagers and
discussed the program individually because the ASHA is living in chhatarpur.

46

B.3.6.2.2. Selection of village for implementation of PD Hearth process:
After analyzing the data and discuss the program with ICDS department, Anganbadi workers

and Village Health committees we decided to start the PD Process first in Rangua village and
then we see how to implement the process in other villages.

B.3.6.2.3. Data Verification/ validation:

We have taken the list provided by the Anganbadi worker of the villages and verified some of
the children as sample basis with the help of Prerana team members.

We found that there are more children who are malnourished but not coming to the Anganbadi
center. We decided to go door to door in village Rangua and the take weight of all under 6

children and make a new list of the children who are malnourished. Re confirmation by using
MAC tape and go further in the process.
B.3.6.2.4. Selection of Volunteers:

Selection of volunteers has been done with the help of Anganbadi workers and Prerana team
in village Rangua.

Volunteers:
Health worker Prerana project, Anganbadi workers 2, ASHA, 1VHDC member, dai
B.3.6.2.5. Orientation of volunteers

Orientation on PD Hearth Process was done in Anganbadi center of village Rangua by the

Fellow - Mr. Prabhu saran on 7/9/2010

Smt. Leela Dwedi - anganbadi worker and Mr. Samuel Das, Project officer - Prerana project

assisted me in the orientation.

47

B.3.6.2.2 Collection of list of malnourished children from the selected villages

Details of malnourished Child in Project Villages as on 1st July 2010

according to weight

Total
Name of the

SN

Village

Name of

Angan
badi No

the worker

contact
Number

Sector

Sector

supervisor

children
enrolled in

General

malnourished

severe
malnourished

anganbadi
Smt. Savitri

Khairo

1

Khairo

2

Rangua

1

Rangua

2

1

2

3

4

5

6

Budoor

Smt. Sanjai

Smt. Leela

160

Smt. Geeta

7

Ku. Gomti Dixit

Matgua

90

9754118438

Matgua

136

119

14

3

Matgua

126

101

23

2

Matgua

0
_

Smt. Madhu

Budoor

pandey

1

Jain

Chhatarpur

patel

Smt. Sushila

Thara

0

9407006575

96

100

9993339960
82

Chhatarpur

Sharma

8

16

75
44

2

(Male33)

Male 22

Male 1

Female 18

Female .22

Female 1

34

45

51

Smt. Manju

1

20

Namdeo

Smt. Rajkumari
Baraj khera'

140

Dwevedi

Singh solanki
1

Smt. Bela jain

Dubey

Smt. Asha

Sahasnagar

Matgua

Mishra

(Male 20)

Male 25

Female 14

Female .20

Female 1

3 (Male 1)
23

Female 2

Male 35

Male 14

All were sent to

Female 46

Female 9

NRC and now

81

Thara

2

Sudha Sharma

104

Chhatarpur

recovered well

9

Table 4 : status of malnourished Children in selected 6 villages
48

The table 3 shows the malnutrition status of registered children in the Anganwadi centers of
the concern village. Migration is a big issue of the area and about 30 to 40 % of families
migrated for labor works to the nearest cities and some to metro cities.

The children of the migrated families and who doesn’t contacted by the Anganwadi workers
are not enlisted here.

Name of
SN

the

Number of

Name of the

Anganbadi

Worker

no

village

Smt Savitri

Khairo

1

Mishra
Smt. Sanjai

2

Khairo

3

Rangua

4

Rangua

Children

■

malnourished
■

■

J

■

■■

j

enrolled
140

■

20

■

.

:

■

■■■

2

--------

2

90

14

04

1

136

14

03

Dubey
Smt. Leela

Dwevedi
Smt. Geeta

Namdeo

Total

Table 5:

1

Severe

malnourished

—
2

126

23

02

4

492

71 (14.43 %)

11 (2.23%)

Percentage of malnutrition in children of village Khairo and Rangua, where PD

hearth sessions were planned.

B.3.6.2.5. House visit for Data Validation

After collection of the list of malnourished children we visited the houses to validate the data.

Anganbadi worker Sahayika and some of the volunteer visited with me and we together
validated the list. We also motivated the mothers and mother in-laws to send their child to

anganbadi center for PD Hearth session.

Many families refused to come for PD hearth session due to their busy schedules in their field

and for other reasons.
Awareness on nutritional value of locally available foods are very less in the families having

malnourished children.

49

Parents use biscuits for feeding their children and dry roties. Proper care of the child is a big

challenge in the villages because most of the children were taking care by their elder brother

or sisters in the house.

JI
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B.3.6.2.6. Planning of session for RD Hearth
We had planned 5 days sessions for RD hearth process.

□ay 1

Registration, weighing of the child and knowing food practices of each other

Available foods in the village, seasonal foods
Day 2 - foods that contains nutritious value (vitamins, minerals, fats, etc)
Day 3 - food during the sickness, management of diarrhea
Day 4 - Immunization, vitamin - A supplement, nutritional packs of anganbadi center
Day 5 - Care of child, personal Hygiene (cleaning of child), importance of oil in food
Weighing of child.
(Every family will bring one food item with them ( rice I dal / aata/ vegetable / oil, etc)

•

Every day after the learning session all (mother / care takers) will jointly cook the food

at Anganwadi center and feed the child.

•

At 1st day and 5th day every child will be weighed and we will see if any difference.

•

Anganwadi will provide utensils for cooking.

•

Panchayat will provide the fuel (wood).

We have started the process at anganbadi but due to continuous heavy rain the whole

schedule was disturbed. Second measles and viral fever in the village disturbed and
demotivated the parents to join the session.

50

We together discussed (the volunteers and ICDS team) and then we decided to do the
promotional activities in the houses.

B.3.6.2.7. Growth Monitoring and Promotion

I discuss with the Prerana Project’s team and took help of the nursing students who were

visiting the village regularly for continue teaching on nutrition, personal hygiene and use of

ICDS services.
This activity was started in 2 of the focused village when we failed to conduct PD hearth
session.

The table shows the number and percentage of malnourished and severe malnourished
children in both villages.

This is not the complete figures of the villages. About 30 families migrated to the cities for
labor works and they have most of the malnourished children.

I developed a register of the malnourished child and every month during the VHND and

my regular visits to the villages, taking weight of these children to see progress.
During the visit to the family we do Counseling of family member and promoted Referral

services. We had sent 6 children to NRC at Chhatarpur from 3 villages and all are improving.

The Anganbadi worker’s doing regular follow-up of these children and I use to visit the
children at least once in 2 or 3 months.

51

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This is the sample of the register for tracking malnourished children.

Some good results have been seen in the villages.

Name: Ramkesh aadiwasi 20 month

52

Some good results have been seen in the villages.

Name: Ramkesh aadiwasi 20 month

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Ramkesh aadiwasi was born in the village Khairo but their parents went to

Delhi for labor work. The family is migrated for 8 to 10 months in a year. We
found the child in the village during the survey.
We discussed the family the severity and possible results if the will not take

his care and look on the nutritional requirements.
We visited regularly to his family and guided them on the feeding practice.
He was referred to the NRC and was admitted there for 14 days. He was
recovered and gain his weight. Now regularly his mother is bringing him for

weighing and feeding him as per the guidance of the Anganwadi worker and
Prerana staffs.

53

Before the
intervention

%

After the
intervention

%

Total children

86

100

86

100

Healthy (Green)

60

69.76

65

75.58

Malnourished (Yellow)

22

25.58

16

18.60

Severe malnourished (Red)

4

4.65

Table: 6.

5.81

Anganwadi 1 / Village Rangua - distribution of children according to weight for Age

Prem lai aadiwasi 18 months

Prem lai aadiwasi is belongs to a aadiwasi family of Khairo village. Their parents are also
migrated from the village to Gwalior where they are doing labor works.
During our survey he was graded as severe malnourished. He was admitted in NRC by the
Anganwadi worker. After discharges he started to lose weight. We followed him at their
house and guided his mother on nutrition and balanced diet. Anganwadi worker supplied
him some extra food packets and guided his mother for feeding him regularly. Now he
again increasing his weight and looking healthy. His parents are thankful for the Anganwadi

services.

A

54

went to severe grade(red) from malnourished (yellow) \Ne enquired with the family members
and found that she is losing her weight regularly. She was advised and counsel by me and
Anganwadi worker to go to NRC.
Tab
After the
%
%
Before the
le:7
intervention
intervention
Total children
Ang
100
112
100
112
Healthy (Green)

90

80.35

96

85.71

Malnourished (Yellow)

21

18.75

14

12.50

Severe malnourished (Red)

1

0.89

anw
adi
21
Villa
ge
Ran
gua

- distribution of children according to weight for Age
Tanu d/o Nandu lodhi age 2 year became severe malnourished (red) from malnourished
(Yellow). She was having acute diarrhea in October and she loses her weight.Source: weight
register of fellow_2010-11

I
■

I
During house visits for follow-up of malnourished children
B.3.7 Organizational Works*
B.3.7.1 Orientation of

Pre ran a staffs on

Fellowship program

Orientation on the
fellowship was given to

Regular house visits of the malnourished children and

proper teaching / counseling of mothers / care takers
of the children made some behavioral change in the

Prerana project team

community. As result we can see the improvement in

members. 10 staffs and

the health of some child. 6 children from Anganwadi 1

volunteer were present in

and 7 children from Anganwadi 2nd improved their

orientation program.

weight in home itself.

The team is involved in
community health and
55

the

32

development program and I found it helpful to share my learning with the team for
their motivation and improvement of learning.

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B.3.7.2 Staff Monthly Meeting of Prerana project

I Participated in the monthly meetings of Prerana project regularly. I helped them for

preparing their monthly plans, monthly reports of project staffs.
Regularly after every collective program I use to share my new plans and learning of

the Collective program with the staffs during their monthly meetings.

B.3.7.3 Staff Trainings:

Facilitated trainings for Prerana staffs on the following topics:

56

NRHM and Role of ASHA, Village Health & Sanitation Committee, Village Health and
Nutrition day, Village Health Action Plan, Integrated management of neonatal and
childhood Illness (IMNCI), NRC - need and services

B.3.7.4 Participation in Emmanuel Hospital Association’s Meetings

I Participated in EHA’s community health program’s six monthly and annual reporting
meeting. There I shared on Fellowship program with the unit officers, project

managers and director of community health program.

B.3.7.5 Global fund round 9’s TB Program
This program was launched in Madhya Pradesh last year. Emmanuel Hospital

Association is also a partner with the UNION and implementing the program

“AKSHAY INDIA” in 2 districts of Madhya Pradesh. Sivni and chhatarpur.
I participated in the program as a resource person in several trainings and orientation

for CBOs, NGOs, Private practitioners, govt, workers

i

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29/00/201

I

B.3.7.6 Adolescent Groups District level workshop
57

Adolescent health program is initiated by Prerana project chhatarpur. The program
helps the adolescents in learning the family education. Regular teaching session were
conducted at village level.

The main objective of Prerana project in organizing adolescent girl workshop was
To aware of their own sexually & physical well being and enable them to acquire

knowledge on family planning, Life skills development.
Misconception and unhygienic practiced will be improved and reduce the morbidity.

In November last year they organized a district level workshop for these groups. The
theme was “personal hygiene and sanitation”. I participated in the workshop and taken

a session on personal hygiene.

1
-

<4

5
i
1

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gali
B.3.7.7 Health Mela and Health camps

One Health Mela and 3 Health camps were organized in the field with the help of

BMO Isanagar CHC and Prerana Project chhatarpur.
Health Mela was organized at village Rangua. Peoples from 6 villages participated in

the Heath Mela. The focus was on Nutrition and malnourished children from the
villages.

Anganbadi workers from 6 nearby villages brought many malnourished children in the

Mela where doctor from CHC Isanagar and Prerana project screened the children and
provided some vitamin and Iron supplements. Severe malnourished child referred to

NRC chhatarpur.

58

Awareness on nutrition to the Antenatal and Adolescents were organized through
different stalls. Nurses of Prerana project helped the women and adolescent in

learning on nutrition and importance of balanced diet.
Health workers of Sub Health center aware people on different health schemes as

JSY, family planning program, Din Dayal antyoday upchar yojna, malaria control, TB
program, etc.

Health camps were held in village Ramnagar, Bardwaha and Parva. Mostly women

and children were received the services of the health camps.

t Y'. I
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B.3.7.8 Disaster risk Reduction Program

I have participated in the Disaster Risk reduction planning of Prerana project.

Chhatarpur district is facing drought situation since last 7-8 year. Drinking and
irrigation water (both) is a big issue of the area. Project is planning to have some

program to face the challenge.

59

B.3.7.9 Community Based Rehabilitation program (CBR)
CBR program was planned for the chhatarpur district by Christian Hospital
Chhatarpur. Project is focusing on the specific issue related to the Eye problems.

I had an opportunity to participate in 2 trainings on CBR in Chindwada and Betul.

This was a new learning for me.

, f i 9 Sr-

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SIMM]
B.3.7.10 ANM Training:
I have facilitated the ANM training organized for the Government ANMs working in
Prerana Project area. 14 ANMs were trained on different RCH issue.
Special focus was given on physical checkups and Blood pressure management

Practical session were organized at Christian hospital chhatarpur to learn the growth
of the fetus, counting fetal heart sound, taking blood pressure and use of Uristix for
examination of urine for albumin and for hemoglobin test.
Doctors from Christian hospital and CMHO chhatarpur also presents during the
sessions.

60

fl ■

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.

B.3.7.11 Anganbadi Worker’s Training

Training of Anganwadi workers was organized by Prerana project chhatarpur. I have
participated in the trainings and presented the status of Malnutrition in chhatarpur
district. Workers were trained on general health issues of women and children.

IK

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B.3.7.12 Proposal writing for Prerana Project

I participated in proposal writing for Prerana project with Prerana team members.
We have developed a proposal on health and development for next 3 years.

B.3.7.13 Staff Assessment
I was involved in the Staff performance and development assessment process of

Prerana project chhatarpur.
B.3.7.14 Report writing of Prerana Project
61

I was involved in report writing process of Prerana project with the team members.

B.3.7.15 Project Evaluation

I have participated in Evaluation of the Prerana Project with the Evaluation Team.

The Evaluation was conducted for last 5 years program.

This was a good learning for me on Evaluation a project or program.

working on different profiles

Section C

During the fellowship I have prepare some profiles. This was a learning process and

to a During the preparation of these profiles I visited the CMHO office, NRHM office

CHC, PHO, Villages, District information center and planning commission office at the
district Collector’s office for collection of information and old profiles.
I met various people and PRI members, ASHA, VHSC members, ANM, MPWs, BMO,

BPM and health staffs of PHC and CHC.
I have collected the profile and analyze the information even many information was
missing in the profile.

There are some major gaps in health infrastructures and manpower. Most of the

health facilities are based at district headquarter. Most of the health staffs are living at

chhatarpur due to not having living facilities at Sub health center, PHC and CHC level
(Housing, water, electricity, schooling facilities for children and also for female workers

security issue is also there).
I found much issue which needs focus in coming days for strengthening process of
Communitization part of NRHM. (lack of awareness in the community and in the
members of different committees about VHSCs role, ASHA’s role)

Profile prepared:
1 Preparation of district profile

2

Preparation of PHC Profile of Isanagar
62

I

3

Preparation of ASHA Profile of focused area

4

Preparation of VHSC Profile of focused area

5

Preparation of Village Profile of focused area

All profiles are attached with the report.

63

Key Learning

Section D

I have many learning experience during the entire fellowship program. Knowledge and

skills developed in various field / areas. I experienced many learning through the
activities.

a. Learning from the teaching sessions during collective teachings and cluster meetings
Effective way of presenting the topics- mix with discussions, stories, case

studies and pictures, graphs etc to make your presentation easy to
understand.

Use effective communication tools
Positive Body language
Involve participants in the learning session by providing them time for sharing,

discussions and in role play

Use simple words while teaching or sharing
How to use Google scholar for searching a specific articles or study report

Literature review
Use of references in a report, article or in any statements
Knowing BMI

Making Log Frame

Feedback receiving and giving
Reading techniques

b. Learning from fellow travelers

Report making, Report Presentation , Preparing graphs, tables, etc.

c. Learning from the community
Caring of others, helping the needy , Forgiveness, their Culture, Home remedies for
treating minor elements, Time management, Use of local available resources, Never
give up, Humbleness, Living in difficult situation

d. Learning from failures
Failures gives a hope to win
Failures brings improvements

64

D.1 Knowledge Gained

During the fellowship program I have gained knowledge in following:

Difference between Public Health and Community Health

Depth knowledge of “National Rural Health Mission”
Health structures ( SHC - PHC - CHC - District Hospital), District Health society

Globalization and its effects, Critical analysis

National Health Programs (TB, Malaria, Leprosy), Mental Health, IMNCI program

NRCs, Malnutrition and PD Hearth , Non Communicable diseases, Yoga & Health
Communication , Management, Log Frame, Research methodology

Article Reading, Literature review, Drug policy, Urban Health issues
Assisted Reproductive technologies

D.2Skills Developed

•

Planning skill - planning of any activity

•

Analysis skill - analysis of data and critical analysis of any data, report and
situations.

•

Reading skill - how to read any book, article, literature or report

•

Report Preparation skill - presenting self to others, report presentations

•

Use of Computer - use of internet for study, use of power point

•

Search on Google - literature, article report search by using google scholar and

- use of inverted comas
•

Training skills - facilitation skill, preparation, presentation and effective group

discussions

D.3Value Addition
Respect towards public health workers, ASHA and community is increased

Positive thinking towards government program and workers

Looking the information / data ( positive side as well as negative side)

65

Conclusions:

The entire period was very inspiring for me. Learning from the experiences of the CPHE
team members especially from Dr. Ravi Narayan was very inspiring and created interest

in me to know more. This also supported my decision for joining the fellowship program.

Different definitions, Measurements, Health Indicators, Epidemiology, Numbers, different

rates, Ratio, and the comparisons were very helpful to understand the real picture of our
country and state (Madhya Pradesh). These helped in my organization work and to find

out the situation of our district and prepare a profile of the district.

Group discussions and the field visits helped me to understand the basics of the
Fellowship program and to know each of the participants better.

The entire program was full of new opportunities for me to know the different peoples and
the different types of the community and to develop my skill to do SWOT.
Many topics were very new for me and sometimes I felt difficult to understand the depths

of the subjects. But slowly when we studied the topics and practiced some of the activities
in the field I found these very helpful for me in planning and working together with health

department of our district.
Theses learning also helped me to present myself to the Health officials of concern blocks
(Isanagar and Rajnagar Block). Regular meetings and building relationship with DPM,

BPM of NRHM and CMHO staffs, ASHAs, VHSC members and Panchayat help me to go

closer with them and with the communities where I am working.

Regular sharing with the govt, officials, ASHAs, VHSC members, CHC staffs and Prerana

project team members improved their knowledge on the specific topics.
Periodic trainings and learning sessions improved my skills in training and presentation of

a subject and same time developed skills of ASHA, VHSC members, ANMs, Anganwadi
workers and Prerana project staff members.

List of Attachments:

66

1. Table for Paradigm Shift
2. Essay on ASHA

3. List of ASHA form selected villages
4. CHC - Profile (CHC Isanagar)

5. Village Profile - 2 villages
6. Essay on PD Hearth

7. Organization Profile - Christian Hospital Chhatarpur
8. ASHA Profile

9. Village Health and sanitation Committee Profile
10. Curriculum for VHSC Trainings
11. Essay on Village Health worker
12. District Profile - Chhatarpur

67

1.Paradigm Shift: from Bio medical model to Social / Community Model
BIO MEDICAL MODEL

SOCIAL/COMMUNITY
MODEL

HEALTH TEAM

Doctors, Nurses

ASHA, VHSC, Anganbadi
worker, ANM, Multipurpose
workers, TBA, PRIs, Social

Workers, DOTs Workers, CH
Fellows

TECHNOLOGIES

Medicines, Drugs,

Education

Vaccines
INSTITUTIONS

Dispensaries, Hospital

CBOs, Mobile Clinics, Schools,
Anganbadies

ACTIONS

Provision of Distribution

Awareness Campaigns, Movement,

Social actions, Empowerment
DETERMINENTS

Physical and Mental

RESEARCH

Intra Cellular

Social, Economic, Political, Cultural

Balloonist

68

Essay on ASHA
The Government of India has decided to launch a National Rural Health Mission (NRHM) to
address the health needs of rural population, especially the vulnerable sections of society.

The Sub-centre is the most peripheral level of contact with the community under the public

health infrastructure. This caters to a population norm of 5000, but is effectively serving much
larger population at the Sub-centre level, especially in EAG States. With only about 50%
MPW (M) being available in these States, the ANM is heavily overworked, which impacts
outreach services in rural areas.

Previously Anganwadi Workers (AWWs) under the Integrated Child Development Scheme

(ICDS) are engaged in organizing supplementary nutrition programmes and other supportive
activities. The very nature of her job responsibilities (with emphasis on supplementary feeding
and preschool education) does not allow her to take up the responsibility of a change agent
on health in a village. Thus a new band of community based functionaries, named as

Accredited Social Health Activist (ASHA) is proposed to fill this void

ASHA will be the first port of call for any health related demands of deprived sections of the
population, especially women and children, who find it difficult to access health services. In
following paragraphs, the role, responsibilities, profile, selection procedure, training modality

and compensation package for ASHA has been explained. It has been envisaged that states
will have flexibility to adapt these guidelines keeping their local situations in view.

SELECTION OF ASHA
The general norm will be ‘One ASHA per 1000 population’. In tribal, hilly, desert areas the

norm could be relaxed to one ASHA per habitation, dependant on workload etc.
The States wi.ll also need to work out the district and block-wise coverage/phasing for
selection of ASHAs.
It is envisaged that the selection and training process of ASHA will be given due attention by
the concerned State to ensure that at least 40 percent of the envisaged ASHAs in the State

are selected and given induction training in the first year as per the norms given in the
guidelines. Rest of the ASHAs can subsequently be selected and trained during second and

third year.

69

Criteria for Selection
ASHA must be primarily a woman resident of the village - Married/Widow/Divorced’ and
preferably in the age group of 25 to 45 yrs.
ASHA should have effective communication skills, leadership qualities and be able to reach

out to the community. She should be a literate woman with formal education up to Eighth

Class. This may be relaxed only if no suitable person with this qualification is available.
Adequate representation from disadvantaged population groups should be ensured to serve

such groups better.

Selection Process
The selection of ASHAs would have to be done carefully. The District Health Society
envisaged under NRHM would oversee the process. The Society would designate a District
Nodal Officer, preferably a senior health person, who is able to ensure that the Health

Department is fully involved. She/he would also act as a link with the NGOs and with other

departments. The Society would designate Block Nodal Officers, preferably Block Medical
Officers, to facilitate the selection process, organizing training for Trainers and ASHA as per

the guidelines of the scheme.

The Block Nodal Officer would identify 10 or more Facilitators in each Block so that one
facilitator covers about 10 villages. The facilitators should preferably be women from local

NGOs; Community based groups, Mahila Samakhyas, Anqanwadis or Civil Society
Institutions.

In case none of these is available in the area, the officers of other Departments at the block

or village level/local school teachers may be taken as facilitators.
These facilitators should be oriented about the scheme in a 2-day workshop which should be

held at the district level under supervision of the District Nodal Officer. During this meeting,

the Block Nodal Officers should also be present. The District Nodal Officer will brief the
facilitators and Block Nodal Officers on the selection criteria and importance of proper

selection in effective achievement of the objectives of the same and also the role of

facilitators and Block Nodal Officers are required to play in ensuring the quality of the

selection process.

70

The facilitators would be required to interact with community by conducting Focused Group
Discussions (FGDs) / workshops of the local self help groups etc. This should lead to
awareness of roles and responsibilities of ASHA and acceptance of ASHA as a concept in the

community. This interaction should result in short listing of at least three names from each
village.
Subsequently a meeting of the Gram Sabha would be convened to select one out of the three

short listed names. The minutes of the approval process in Gram Sabha shall be recorded.

The Village Health Committee would enter into an agreement with the ASHA as in the case of
the Village Education Committee and Sahayogini in Sarva Shiksha Abhiyan. The name will
be forwarded by the Gram Panchayat to the District Nodal Officer for record.

State Governments may modify these guidelines except that no change may be done in the
basic criteria of ASHA being a woman volunteer with minimum education up to VIII class

and that she would be a resident of the village. In case any of the selection criteria or

guidelines is modified, these should be widely disseminated in local languages.
Capacity building of ASHA is critical in enhancing her effectiveness. It has been envisaged
that training will help to equip her with necessary knowledge and skills resulting in

achievement of scheme's objectives. Capacity building of ASHA has been seen as a
continuous process.

Induction Training: After selection, ASHA will have to undergo series of training episodes to
acquire the necessary knowledge, skills and confidence for performing her spelled out roles.
Considering range of functions and tasks to be performed, induction training may be

completed in 23 days spread over a period of 12 months. The first round may be of seven
days , to be followed by another four rounds of training, each lasting for four days to complete

induction training.
Training materials: would be prepared according to the roles and responsibilities that the
ASHA would need to perform. Her envisaged functions and tasks will be expanded into a

listing of competencies and the training material would be prepared accordingly. The training

materials produced at the national level would be in the form of a general prototype which

states may modify and adapt as per local needs. The training material will include facilitator’s

guide, training aids and resource material for ASHAs

71

Periodic Trainings: After the induction training, periodic re-training will be held for about two
days, once in every alternate month at appropriate level for all ASHAs. During this training,
interactive sessions will be held to help refresh and upgrade their knowledge and skills,

trouble shoot problems they are facing, monitor their work and also for keeping up motivation
and interest. The opportunity will also be used for replenishments of supplies and payment ofperformance linked incentives. ASHAs will be compensated for attending these meetings.
On-the-job Training: ASHAs needs to have on the job support after training both during the

initial training phase and during the later periodic training phase it is needed to provide on the

job training to ASHAs in the field, so that they can get individual attention and support that is

essential to begin and continue her work. ANMs while conducting outreach sessions in the

villages will contact ASHA of the village and use the opportunity for continuing education.
NGOs can also be invited to take up the selection; training and post training follow up.

Similarly block facilitators identified earlier for selection of ASHAs can also be engaged for
regular field support.

Continuing Education and skill up gradation: A resource agency in the district of state
(preferably an NGO) will be identified by the State. The resource agency in collaboration with

open schools and other appropriate community health distance education schemes will

develop relevant illustrated material to be mailed to ASHAs periodically for those who would
opt for an eventual certification.

Venue of training : The principle of choice of venue shall be that the venue should be close
to their habitation that the training group should not be more than 25 to 30. In most situations

this could be the PHC or alternatively Panchayat Bhavan or other facilities that are available.

ROLES & RESPONSIBILITIES
ASHA will be a health activist in the community who will create awareness on health and its

social determinants and mobilize the community towards local health planning and increased
utilization and accountability of the existing health services. She would be a promoter of good
health practices. She will also provide a minimum package of curative care as appropriate

and feasible for that level and make timely referrals. Her roles and responsibilities would be

as follows:
ASHA will take steps to create awareness and provide information to the community on

determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living

72

and working conditions, information on existing health services and the need for timely
utilization of health & family welfare services.

She will counsel women on birth preparedness, importance of safe delivery, breastfeeding
and complementary feeding, immunization, contraception and prevention of common
infections including Reproductive Tract Infection/Sexually Transmitted Infection (RTIs/STIs)
and care of the young child.

ASHA will mobilize the community and facilitate them in accessing health and health
related services available at the village/sub-center/primary health centers, such as
Immunization, Ante Natal Check-up (ANC), Post Natal Check-up (PNC), ICDS, sanitation and
other services being provided by the government.
She will work with the Village Health & Sanitation Committee of the Gram Panchayat to
develop a comprehensive village health plan.
She will arrange escort/accompany pregnant women & children requiring treatment/
admission to the nearest pre- identified health facility i.e. Primary Health Centre/ Community
Health Centre/ First Referral Unit (PHC/CHC /FRU).

ASHA will provide primary medical care for minor ailments such as diarrhea, fevers, and
first aid for minor injuries. She will be a provider of Directly Observed Treatment Short-course
(DOTS) under Revised National Tuberculosis Control Programme.
She will also act as a depot holder for essential provisions being made available to every
habitation like Oral Rehydration Therapy (ORS), Iron Folic Acid Tablet (IFA), chloroquine,
Disposable Delivery Kits (DDK), Oral Pills & Condoms, etc. A Drug Kit will be provided to
each ASHA. Contents of the kit will be based on the recommendations of the expert/technical
advisory group set up by the Government of India.

Her role as a provider can be enhanced subsequently. States can explore the possibility of
graded training to her for providing newborn care and management of a range of common
ailments particularly childhood illnesses.
She will inform about the births and deaths in her village and any unusual health
problems/disease outbreaks in the community to the Sub-Centers /Primary Health Centre.
She will promote construction of household toilets under Total Sanitation Campaign.
Fulfillment of all these roles by ASHA is envisaged through continuous training and up
gradation of her skills, spread over two years or more.

** source: ASHA web site

73

I

Table.6

list of ASHAs from the selected villages

fBi
- ;
J

74

Smt. Pushpa Shukla

Khairo

10th

December 2006

Smt. Sudesh Mishra

Papta (Khairo)

8th

August 2009

Smt. Rajni Dubey

Khairo -2

12th

November 2009

Smt. Anguri Dubey

Rangua

8th

26/3/2008

Smt. Anita Goswami

Budoor

12th

July 2997

Smt. Laxmi patel

Barajkhera

8th

20/12/2008

Smt. Shagun Sen

Gopalpura

8th

28/11/2008

Smt. Laxmi Mishra

Sahasnagar

10th

February 2009

COMMUNITY HEALTH CENTER - Profile
Name of the PHC:

ISANAGAR Primary Health Center

Distance from Chhatarpur:

26 k.m.

75

Staff Details:

Designation

Name of the Staff

Dr. Sudarshana Sullere

Block Medical Officer

Shri. Amit Gupta

BPM -NRHM

Dr. Megha Oberai

Doctor 2

Specialization

MBBS

MBBS

BEE

Shri. B.K.Gupta

Lady Health Visitor

Smt. Meena Shrivastva

Senior Nurse

Smt. Sushma Thakur

Nurse

ANM

Smt. Munni Richariya

Nurse

ANM

Smt. Chandrakanta

Nurse

ANM

Shri. Bhumaidin Anuragi

Compounder

Shri. Sanjai Saxena

Lab Teachnicial

Vaccant

X-Ray Technician

Vaccant

Pharmasist

Ashfaq Husain / Rajesh lawania

Driver

Total Population Covering.

50,000

Number of Villages Covered:

25

76

Number of Panchayat:

8

Number of linked PHCs:

3

Number of Sectors:

4

Number of Sub Centers:

26

Number of ANMs:

38

Number of MPWs:

25

Number of Supervisors: Male

04

Number of Supervisors: Female

05

Number of ASHA connected with PHC

230

Number of Village Health and Sanitation Committees formed:

Services Available:

1.

Ambulance

1

2

Janani Express

1

3

Operation Theater

Present only for minor operations

4

Generator

1 in working condition

5

Beds (Number)

6 (4 male + 2 Female)

6

OPD

9am-3 pm

7

Medicine supply

available

77

91

SWOT ON Isanagar PHC:

Strengths
Location: the PHC is situated at the end of the road and well connected with the near by
villages.

1.

Staff:
a.

The Block Medical Officer is a Lady Doctor

b.

2 senior nurses living in the campus

c. Adequate supportive staff
2.

Facilities:
a.

Well established campus surrounded with boundary wall,

b.

Well conditioned staff quarters

c. Separate office, Consultation Room, Computer Room, Stores
d.

Hand Pump for drinking water

e. Functional toilet facilities
f.

6 bedded ward

g.

Mini Operation Theater

h.

Regular supply of prescribed medicines
Functional Ambulance services

J-

Janani Express facilities

k.

Vaccine store with ILR facilities

I.

Functional Generator facilities

Weakness
i.

Most of the villages which connected to this PHC is located to the opposite of main road

and they are not visiting the PHC because they can access to Chhatarpur city easily then
Isanagar
2.

The lady Doctor is living in Nowgoan and looking after 2 PHCs and coming to this PHC
after 11 am and stays here for 3 - 4 hours only.

78

3.

Most of the staffs are coming from Chhatarpur in the morning around 11 am and back

around 4 pm.

Opportunities
1.

Lots of NGOs are working in the target villages and a network can help the PHC to increase
their performance and to provide their services to the many people

2.

To increase the maternal and child care services by staying in PHC during night time as there

is quarter available.

i|K
11
feu,.

t

-s *

t

’’ts

a
,1®

-

’

79

Village Profile 1
Name of the Block:

Isanagar (Chhatarpur)

Name of the Village:

Rangua Distance from Chhatarpur:

Name of the Panchayat:

Rangua

Name

28 k.m.

Contact Number

Name of the Sarpanch

Smt. Mannu Devi w/o

Shri. Manak lai Namdeo
Name of Vice Sarpanch

Shri. Rakesh Dwevedi

Name of the Secretary

Shri. Ram Ratan lodhi

Total Number of Ranch

20

Male Ranch

5

1.

Smt Rajni Khatik

Female Ranch

5

2.

Smt. Ramkuar Rai

3.

Smt. Ram Bai Konder

4.

Shri. Rakesh Dwevedi

5.

Smt. Shyam Bai Ahirwar

6.

Shri. Chet Ram Ahirwar

7.

Smt. Laddo Bai Ahirwar

8.

Shri. Ganesh Lodhi

9.

Shri. Mathra Dhimar

10. Shri. Hargovind Lodhi

Total Population:

2256

Number of House Hold:

324

Male:

1200

Female:1056

Major Casts of the village: Ahirwar, Konder, Lodhi, Brahmin, Basor, Agrawal, Sen
Facilities available:

Health Facilities:

Number of Private Practitioners available in the village:

80

02

Nearest Primary Health Center:

Matgua - Not working properly

Distance 3 km

3 Private clinics in Matgua

Nearest Health care facility / Hospital:

Rangua

Sub Health Center:

Contact Number

Name
Smt. Dropati Sen

07682-247648

Shri. Dhan Prashad Jain

9754161370

Name of the ANM
Name of the Multi Purposes Worker

Sub Center building

No own Building

Day for Immunization

1st Tuesday of the month

Name of the ASHA: Smt. Anguri Devi

Contact Number:

9926522910

Name of the Trained Birth attendant / Dai: Smt. Jasoda Bai / Smt. Hari Bai

Anganbadi center:
Name of the Anganbadi worker 1

Smt. Leela Devedi

9754118438

Name of the Anganbadi worker 2

Smt. Geeta Namdeo

9669816427

No

Anganbadi Building

1st Tuesday of the month

Day for Village Health & Nutrition day

Educational Facilities:

Middle School

1

Primary school

2

Private Schools

1

Drinking Water Facilities:
Well

3

Hand pumps

6

Post office:

Khairo

Nearest Bank:

Madhya Bharat Gramin Bank, Matgua

Nearest market place:

Matgua

Police Station:

Matgua

Others:

81

Working NGO/ Private organization in the village:
Prerana Project, Chhatarpur

Priyawart Mahila utthan Samiti Chhatarpur

SWOT analysis of Gram Panchayat Rangua
Strengths

Panchayat Building

Local Panchayat Secretary
2 Primary and 1 Middle School
2 Anganbadi Centres

12 active women Self Help Groups
Connected with National Highway through Pradhan Mantri Gram Sadk

Yojana

Solar system for electricity
Presence of good NGOs like Christian Hospital Chhatarpur
Presence of Village Health and Development committee
Primary Health care provision through Tele Clinic program
Weaknesses

un experienced Panchayat leaders

Caste dominated area and grouping
Interference of husbands of the Panchayat members

ASHA is not active

VHSC is not active, formed on papers only
ANM and MPW are living in Chhatarpur city

No Building for Sub Health centre and Anganbadi
Opportunities

for learning
to work with the help NGOs
to develop good relationship with Zilla Panchayat as Unicef officer is
very cooperative

for Building the Health Centre and Anganbadi through MNREGA
for community organization and training
Threats

82

Caste factor
Non cooperation from old Panchayat members & Leaders

Availability of Funds

Village Profile 2

Name of the Block:

Isanagar (Chhatarpur)

Name of the Village:

Khairo

Name of the Panchayat:

Distance from Chhatarpur: 20 km

Khairo

Contact Number

Name
Smt. Pachia Bai Sahu

Name of the Sarpanch

w/o. Shri. Natthu Sahu

Name of Vice Sarpanch

Shri. Puran Lal Sen

Name of the Secretary

16

Total Number of Panch
Male Panch

9

Female Panch

7

Ward no. 1

Smt. Gomti Mishra

Ward no 2

Smt. Laxmi Nayak

Ward no 3

Shri. Nandi Sharma

Ward no 4

Shri. Chhannu Kachi

Ward no 5

Shri. Hari Kachi

Ward no 6

Smt. Radha Bai Vishvakarma

Ward no 7

Shri. Ram Prashad Adiwasi

Ward no 8

Smt. Janki Bai Nayak

Ward no 9

Smt. Mallu Bai Adiwasi

Ward no 10

Smt. Shanti Ahirwar

Ward no 11

Shri. Magan Lal Ahirwar

Ward no 12

Shri. Ghanshyam Prajapati

Ward no 13

Shri. Rajju Vishvakarma

Ward no 14

Shri. Shyam Nayak
83

Ward no 15

Smt. Pana Bai Rajput

Ward no 16

Shri. Ramkishan Rajput

Total Population:

1887

Male:

975

Female:

912

Number of House Hold:

311

Major Casts of the village:

Ahirwar, Kushwaha, Brahmin, Konder (Aadiwasi), Baser

Facilities available:

Health Facilities:
Number of Private Practitioners available in the village:

2

Nearest Primary Health Center:

Matgua - Not working

Nearest Health care facility / Hospital:

3 Private clinics in Matgua

Sub Health Center:

Rangua

Name

Contact Number

Name of the ANM

Smt. Dropati Sen

07682-247648

Name of the Multi Purposes Worker

Shri. Dhan Prashad Jain

9754161370

Sub Center building

No own Building

Day for Immunization

3rd Tuesday of the month

Name of the ASHA:

Smt. Pushpa Shukla

Contact Number:

9165549813

Name of the Trained Birth attendant /Dai:

Smt. Girja Bai

Anganbadi center:
Name of the Anganbadi worker 1

Smt. Savitri Mishra

9425877325

Name of the Anganbadi worker 2

Smt. Sanju Dubey

9807006575

Anganbadi Building

Yes for 1st Anganbadi

84

3rd Tuesday

Day for Village Health & Nutrition day

Educational Facilities:

Middle School

1

Primary school

1

Private Schools

1

Drinking Water Facilities:

Well

4

Hand pumps

8

Others:
Post office:

Khairo

Nearest Bank:

Madhya Bharat Gramin Bank, Matgua

Nearest market place:

Matgua

Police Station:

Matgua

Working NGO/ Private organization in the village:

Prerana Project, Chhatarpur
Priyawart Mahila utthan Samiti Chhatarpur

85

SWOT analysis of Gram Panchayat Khairo
Strengths

Panchayat Building
Local Panchayat Secretary
2 Primary and 1 Middle School, 1 private School
2 Anganbadi Centres and Building for 1 centre
12 active women Self Help Groups
3 ASHA in the Panchayat
Presence of Tejaswini Project for women development
Connected with National Highway
Presence of good NGOs like Christian Hospital Chhatarpur
Primary Health care provision through Tele Clinic program

Weaknesses

un experienced Panchayat leaders
Caste dominated area and grouping
Interference of husbands of the Panchayat members
VHSC is not active, formed on papers only
ANM and MPW are living in Chhatarpur city
No Building for Sub Health centre and Anganbadi
Opportunities
for learning
to work with the help NGOs
to develop good relationship with Zilla Panchayat as Unicef officer is
very cooperative
for Building the Health Centre and Anganbadi through MNREGA
Promotion of Toilets through TSC
for community organization and training

Threats

Caste factor
Non cooperation from old Panchayat members & Leaders
Availability of Funds

86

Essay on PD HEART
Introduction:
PD HEARTH Process was introduced to the Fellows during Jabalpur collective workshop.

This is one of the best community based approach to address malnutrition problem in rural
area.
Malnutrition is one of the biggest problems in children under 6 years in India.

In Madhya Pradesh the malnutrition is causing many deaths every year. Many studies and
surveys shows the severity of malnutrition in the children.

Due to many reasons parents refuses to go to Nutritional rehabilitee centers (NRC) and due
to lack of awareness they are fail to give proper care and nutrition to their children. Due to

poor care and poor nutrition and unhygienic practices children getting sick and many of them
die within this age group.

Need of PD Hearth
Because of less number of NRCs and facilities and services of NRCs are also not very good

in many places, the distance and approach to NRCs are not very easy for many villagers we

need to apply this process. PD Hearth process can be one approach to fight against

malnutrition at community level.

Advantage / Benefits of PD Hearth

-

-

This approach is easy and easily applicable in the village with a limited resources
Parents / care givers can be easily approached and they can learn by their fellow
villagers the care and feeding practices with live examples.
No need of stay away from their home and to lose the daily wages
They can take care of other children and the house hold
They can be very comfortable within the village and can participate according to their
time
One of more family members can participate and learn the good practices
The learning will remain with the family for ever

87

Possible Results of PD Hearth

If the process will be completed as per the instruction with the give period and the
child participated full time in the process there are chances for good recovery.
Moderate malnourished children can gain health very soon.
Other people can adopt the practices soon and the malnutrition problem will be
decreased in coming days very faster.
Many other issues can be identified during the sessions and awareness level will be
increased in the community.
Many behavioral changes can be seen in future in the community.
Community organization and community mobilization process will be improved.

Conclusion

In end we can see that PD Hearth process is really helpful to fight against the big problem as
malnutrition which is a big challenge in the community. We are facing this problem at large
scale and after all efforts and when all programs are failed to address this problem PD Hearth
can be a right tool to fight against the problem of malnutrition.
This is a community based approach. Easy to implement and with a limited resources and
with a small effort we can help the community to identify positive practices of caring and
feeding the baby we can reduce the malnutrition in the community.
In this process we can appreciate the mother / care givers who are using right practices and
teach the right methods of caring and feeding of babies to all other parents those having
malnourished babies by using locally available resources in the community .

By this community based approach we can improve the nutritional status of the children and
reduce malnutrition in children less than 6 years of age and build a healthy society for the
future.
This will be a beginning of Health for all....

Mr. Prabhu Saran Masih

Fellow - Community Health Fellowship Program - M.P.

88

_

____ .

_________________________________

CHRISTIAN HOSPITAL
(A Unit Of Emmanuel Hospital Association)
HISTORY
Christian Hospital Chhatarpur was started in the year 1930 as “THE ELIZABETH JANE BELL
STEPHENSON MEMORIAL HOSPITAL”, and was made possible by a gift from Catharine
board member of
S.Stalker and Dr. Jennie Stephenson. Catharine Stalker was a prominent
|
the Friends Foreign Missionary
Society, which-was instrumental in
sending out Deilia Fistler and
Esther Baird, pioneer missionaries
to Chhatarpur and Nowgong. The
Hospital thus was opened first as
" r
.
a women and children’s general
Hospital.
_...
•
In an auspicious ceremony
held on the 26th Jan. 1931, Col.
•
Tyrell the British Government’s 1TA
'h’
s
physician for all of Bundelkhand
. J. '
! i____ _
came and formally opened the
hospital. The first doctor was Dr.
Ruth Hull and Nurse Alena
Calkins. Later, Dr. Grace Jones H
(Singh), an Indian and other
tl.
nurses were joined our staff were
all kept busy with many Medical, Obstetrical, Surgical and Pediatrics cases.
....

■

.

.

■■

•i

i

i

• ri

r

xI

-!

®

One of the purposes of starting this hospital in Chhatarpur was to provide a place to
train orphan girls. So Alena Calkins started a nursing training school affiliated with the
National Council of Churches’ - Mid India Board of Examiners for mission nurses, which is
today popularly known as MIBE. In Feb. 1949, Dr. Devol and his wife Frances Devol arrived in
Chhatarpur to take up the challenging medical work at the hospital, which was by now a very
busy general hospital.
On 7th may 1957, Dr. Mategaonkar, an Indian doctor who graduated from CMC
Vellore, joined the hospital. He raised the bed strength to 85 beds. On 17th April 1974, after
26 years of services in India and Nepal, Dr. and Mrs. Devol returned to USA.
On the 7th May 1982, Dr. Mategaonkar completed 25 years of glorious service in
Chhatarpur and after securing a replacement Dr. Anne Cherian, left in April 1983 to take up
another job in Nagpur. The leadership passed on to Dr. Samson Retnaraj who continued till
the beginning of 2000. In 2000 June, the ANM School was upgraded to a General Nursing
and Midwifery Diploma Training by the provisional permission of MIBE.

89

GEOGRAPHIC LOCATION
Christian Hospital Chhatarpur is situated in the District at North East border of Madhya
Pradesh. The District is touched by Mahoba District (Uttar Pradesh) in the East, Tikamgarh
(M.P.) in the West and Sagar (M.P.) in the South East.

J

Del

Afghanistan
China

The district has a Government District Hospital, 4 Community
Health Centers, 40 Primary Health Centers, 186 Sub Health
Centers and 45 Sectors.

-

I

Pakistan
Nef<al

.

|

fofOmn —

''

'
The nearest Railway Station is situated at Harpalpur on the
Jhansi-Manikpur line and an Aerodrome is situated at
Khajuraho. The District also has a Telephone Exchange, a
Radio Station, (All India Radio) and a Television Relay
Centre.

r

z, I

___ 300M.lo

J

\

U

300 Kilometer!

Andaman,
Blondsj
(lnd>a)f

INDIAN OCEAN
■

• Sri Lanka

Nicobar
Blands'
(India) <>

The climate of Chhatarpur district is mostly dry. Usually the summer starts from the beginning
of March and lasts up to July. The winter is very comfortable even though it lasts for a short
time. In the middle of summer the temperature goes up to 45 - 48 Degrees Celsius, which is
the worse time for the people here.
MANAGEMENT

As a unit of Emmanuel Hospital Association the management of the hospital is centrally
directed by EHA through a well-constituted administrative structure comprising of an
Executive Committee and a Regional Administrative Committee. This hospital is listed under
the central region of EHA. In the unit level, the day-to-day management is vested on the Unit
Management Committee (UMC). The following persons are serving as the UMC members at
present.

Dr. Christopher Lasrado, Medical Supdt/SAO
Mr. Emmanuel Baghe, Administrator
Dr. Anil Cherian, Director community Health
Mrs. Elizabeth Johnson, Nursing Supdt
Mr. Vinay John, Principal
Co-opted
Staff Representative
Staff Representative
Staff Representative

90

: Chairman
: Ex-Officio
: Ex-Officio
: Ex-officio
: Ex-officio
- Para Medical
- Nursing
- 4th class

Category of Staff
Medical

No.

Facts at a glance

Total Bed Strength

6

100

Nursing

33

Total No. Hospital Staff

87

Nurse /Ward Aid

1

Nursing School

5

Sanitation

12

Prerana Project

10

Administrative

12

Para-Medical

7

Maintenance

9

Security

4

Daily Wage

3

91

ASHA PROFILE-1

Name of ASHA:
Age:
Qualification:
Husband's name:
Village:
Date of Selection:

Smt. Pushpa Shukla
40 years
10,h Pass
Shri. Ashok Shukla
KHAIRO
December - 2006

Selection Process:

Gram Panchayat receives a letter from the Primary Health Center Isanagar to select one ASHA in
village Khairo and Papta.
Smt. Pushpa Shukla applied for the ASHA post for the village. She was selected by the Gram Sabha
and forwarded to the PHC Isanagar for approval. Because there was another candidate and she was
given the letter first so Smt. Pushpa Shukla was appointed as ASHA in village Papta. Village Papta is
about 2 Im from her own village. Now since last July onwards she was given the charge of village
Khairo because the ASHA of village Khairo has resigned due to her personal reasons.

Training Details:

What

When

Where

1st Module

23/12/2006

By using lectures, Power point
presentation

29/12/2006

CM HO Office
training Hall,
Chhatarpur

Module

4 days April
2007

Shagun Vatika,
Chhatarpur

By using lectures, case studies,
Power point presentation,
pre test and post test, etc

Mahila Samiti
Chhatarpur

3rd Module

9/10/2007
to
12/10/2007

Shagun Vatika,
Chhatarpur

By using lectures, case studies,
Power point presentation,
pre test and post test, etc

Mahila Samiti
Chhatarpur

4th Module

13/10/2009
to
16/10/2009

Shagun Vatika,
Chhatarpur

By using lectures, case studies,
Power point presentation,
pre test and post test, etc

Mahila Samiti
Chhatarpur

Christian
Hospital
Chhatarpur

By using lectures, case studies,
Power point presentation

Prerana Project
Chhatarpur

2nd

Refresher
Course on
ASHA

How

92

By Whom

NRHM office

Remarks on Training:
The trainings were residential. Accommodation was shared rooms for 2 participants. Food
and stay arrangements were very good. Facility for the care of small children who came with
their mothers was provided by the training organization.
Refresher course was not residential. Traveling costs and food arrangements was bear by
Prerana Project Chhatarpur.

Materials Received:
■
■
■

Photo copies of ASHA Book 1-4
Water testing kit
Drug Kit supplied once by PHC Isanagar
List of Medicines:

■
■
■
■
■
■

Awareness building on Antenatal care, Immunization, Post natal care
Health Teaching to ANCs & PNCs
Conducting Mangal Diwas
Participation in "Gram Swasthya Evem Poshan Diwas" in the village
Promotion of Institutional Deliveries
Conducting monthly meeting of Village Health and Sanitation
Committee
Escort with the pregnant women to PHC / Hospital for delivery

Main Activities:

■

Documents Maintaining:
Immunization Records
Birth Records
Death Records
ANC Registration
Meeting Register

93

ASHA PROFILE-2
Name of ASHA:
Age
Education :

Smt. Anguri Dwevedi
25 years
8th Pass

Husband's name:

Shri. Dinesh Dwevedi

Village:

RANGUA

Date of Selection:

26/03/2008

Selection Process:

In village Rangua one ASHA was selected in year 2007. She wan not a member of the village or it's
Panchayat. She is living in another village (about five k.m. away from the village). She was not
available regular in the village and also in nights it was very difficult to contact her.
Many villagers of village Rangua objected the selection and discussed the issue with the local
Panchayat. The Panchayat calls fresh applications from the villager for ASHA. By common
understanding of the villagers Smt. Anguri Devi was recommended for the 2nd ASHA of the village.

They sent their complaint for previous ASHA and the new application was submitted to Block Medical
Officer of Isanagar Block. In March 2008 Smt. Anguri Devi was selected for the ASHA of Rangua
Village.

Training Details:

What
1st Module

2nd

Module

3rd Module

4th Module

When
1-3-2009
to
7-3-2009
1-10-2009
to
4- 10-2009
5- 10-2009
to
8- 10-2009
9- 10-2009
to
12-10-2009

Where
Shagun Vatika
Chhatarpur
CMHO Office
Chhatarpur
CMHO Office
Chhatarpur

____________ How_________
By using lectures, case studies,
Power point presentation,
pre test and post test, etc
By using lectures, case studies,
Power point presentation,
pre test and post test, etc
By using lectures, case studies,
Power point presentation,
pre test and post test, etc

By Whom
Mahila Samiti
Chhatarpur
Resource persons
of NRHM
Resource persons
of NRHM

CMHO Office

By using lectures, case studies,

Resource persons

Chhatarpur

Power point presentation,
pre test and post test, etc

Of NRHM

Remarks on the training:

94

The training was residential. Accommodation was shared rooms for 2 participants. Food and stay
arrangements were very good. Facility for the care of small children who came with their mothers
was provided by the training organization.

Materials Received:
Photo copies of ASHA Module 1-4 supplied by the training
organization
■ Drug Kit was supplied once by PHC. No refilling has been done by any
one.
List of Medicines:
■

Main Activities:
■
■
■
■

■
■

Awareness building on Antenatal care, Immunization, Post natal care
Health Teaching to ANCs & PNCs
Participation in Mangal Diwas
Participation in "Gram Swasthya evem poshan Diwas" in the
Anganbadi center of the village
Promotion of Institutional Deliveries
Escorting with the pregnant women to PHC / Hospital for delivery

Documents Maintaining:

Birth Registration
Death Registration
ANC Registration
Immunization Records
Marriage Registration
Post Natal Mothers Records

95

ASHA PROFILE-3
Name of ASHA:
Smt. Anita Goswami
30 years
Age:
12th
Qualification:
Husband's name: Shri. Janki Goswami
Village:
Budoor
Date of Selection: July 2007
Selection Process:

Smt. Anita Goswami was selected as ASHA in July 2007. There was no problem for her selection
because she was the only candidate from her village.
Her application was forwarded by the gram Panchayat to the BMO Isanagar and she got selected.

Training Details:
What
“In

When

By Whom

Where

How

Gandhi Ashram
Chhatarpur

Mahila
Samiti
Chhatarpur

Residential with
all necessary
arrangements like;
food stay, provision
for child care, etc
were available.

12/8/2007
to
23/8/2007

Utsav Mandapam
Chhatarpur

Mahila
Samiti
Chhatarpur

Residential with
all necessary
arrangements like;
food stay, provision
for child care, etc
were available.

3rd
Training

16/8/2009
to
19/8 2009

Utsav Mandapam
Chhatarpur

Mahila
Samiti
Chhatarpur

Residential with
all necessary
arrangements like;
food stay, provision
for child care, etc
were available.

4th

20/8/2009
to
23/8/
2009

Utsav Mandapam
Chhatarpur

Mahila
Samiti
Chhatarpur

Residential with
all necessary
arrangements like;
food stay, provision
for child care, etc
were available.

training

7
days
2nd

Training

Training

13/5/2007
to

19/05/2007

96

Remarks on Training:
The trainings were residential. Accommodation was shared rooms for 2 participants. Food
and stay arrangements were very good. Facility for the care of small children who came with

their mothers was provided by the training organization.
Refresher course was not residential. Traveling costs and food arrangements was bear by
Prerana Project Chhatarpur.

Materials Received:

Photo copies of ASHA Book 1-4
Dug Kit supplied once by Isanagar PHC
List of Medicines:
Main Activities:
Participation in Immunization program
Motivation for Institutional Delivery
ANC registration
PNC follow up
Health & Nutrition day celebration
Chlorination of drinking water well
Acting as depot holder for family planning materials

Documents Maintaining;

Birth record
Death Record
Marriage
ANC
Immunization

97

fine

ASHA PROFILE-4

Name of ASHA:
Age:
Qualification:
Husband's name:
Village:
Date of Selection:

Smt. Anuradha Chaturvedi
35 years
8th Pass
Late. Shri. Jamuna Prashad Chaturvedi
Pipora Khurd
December 2009

Selection Process:

Smt. Anita Goswami was selected as ASHA in July 2007. There was no problem for her selection
because she was the only candidate from her village.
Her application was forwarded by the gram Panchayat to the BMO Isanagar and she got selected.
Training Details:
What

1st Training

When

Where

21/12/2009 to
24/12/2009

CM HO office
Chhatarpur

Organized
by
Mahila Samiti
Chhatarpur

How
The training was
residential.
Methods were
lectures, case
studies, Power
point
presentation,
pre test and post
test, etc

Remarks on Training:
The trainings were residential. Food and stay arrangements were very good. Facility for the
care of small children who came with their mothers was provided by the training
organization.
Refresher course was not residential. Traveling costs and food arrangements was bear by
Prerana Project Chhatarpur.

Materials Received:
Main Activities:

Photo copy of ASHA Book 1

Participation in Immunization program at Anganbadi center
Escorting with Pregnant women to Hospital
Documents Maintaining:

Birth record
Death Record
Marriage
ANC
Immunization

98

ASHA PROFILE-5

Smt. Sagun Sen
20 years
8th Pass
Shri. Balmukund Sen
Gopalpura
28/11/2008

Name of ASHA:
Age:
Qualification:
Husband's name:
Village:
Date of Selection:
Selection Process:

Smt. Shagun Sen was selected as ASHA in November 2008. There was no problem for her selection
because she was the only candidate from her village.

Her application was forwarded by the gram Panchayat to the BMO Isanagar and she got selected.

Training Details:

Training

RCH Training

Place

Duration

4 days

Christian
Hospital
Chhatarpur

Remarks

Organized by

Prerana
Project

Training on
RCH

Materials Received:

Dug Kit —

ASHA Book 1-4
Water testing kit
once supplied by Isanagar PHC after Training
List of Medicines:

Main Activities:
Assisting ANM in Immunization / ANC registration and ANC clinic
Motivation for institutional deliveries
Escorting with pregnant women to hospital for delivery
Water purification in the village
Maintaining records
Documents Maintaining:

Birth
Deaths
ANC & PNC
Immunization

99

ASHA PROFILE-6
Name of ASHA:
Age:
Qualification:
Husband’s name:
Village:
Date of Selection:

Smt. Savita Patel
25 years
8th Pass
Shri. Suresh Kumar patel
Baraich Khera
20/12/2008

Training Details:
Training

Duration

1st training

23 to 29
December 2008

straining

4 days

3rd Training

4 days

4th Training

4 days

Place

Swarup
Mandapam,
Chhatarpur
Gandhi Ashram,
Chhatarpur
Gandhi Ashram,
Chhatarpur
Gandhi Ashram,
Chhatarpur

Organized
by
NRHM - District
Office,
Chhatarpur
Mahila Samiti,
Chhatarpur
Mahila Samiti,
Chhatarpur
Mahila Samiti,
Chhatarpur

Remarks

Remarks on the trainings:

The trainings were residential. Accommodation was shared rooms for 2 participants.
Food and stay arrangements were very good. Facility for the care of small children
who came with their mothers was provided by the training organization.

Materials Received:

Photo copies of ASHA Book 1-4
Dug Kit supplied once by Isanagar PHC
List of Medicines:

Main Activities:
Participation in Immunization program
Motivation for Institutional Delivery
ANC registration
PNC follow up
Health & Nutrition day celebration
Chlorination of drinking water well
Acting as depot holder for family planning materials

Documents Maintaining:

Birth record
Death Record
Marriage
ANC
Immunization

100

Village Health and Sanitation Committee -1

Name of the Village:
Date of Formation:

Rangua
15/03/2009

Formed by whom:

ASHA and ANM of the village

Formation Process:
After getting instruction from the Block Medical Officer of Isanagar Primary Health Center the
ANM discussed the issue with the ASHA, Anganbadi workers and village secretary, she formed the
VHSC according to instruction given to her.

Formation Guidelines:
Given by the officer:
Written or Verbal:

BMO ISa Nagar
Verbal

Meeting Details:

Irregular
Regular or Irregular:
Monthly or Quarterly:
Not Meeting at all: only one meeting held
Bank account:

Have or Not:
Bank account opened
Date or Month of account opened: 19/03/2009
Yes

Untied Fund Received:
If yes
Amount Received so far: Rs. 5000/Expenditure of the Fund received:

Nil

Activities Done:
Any Future Plan

Planning to make 4 soak pits in the houses, which are near to the Anganbadi center.
Also planning to bye one Dari for the VHSC meeting.

101

Identification of the
Name

Designation

member

Smt. Laxmi Dwevedi

Ranch

President

Smt. Anguri Dwevedi

ASHA

Secretary

Shri. Dhan Prashad Jain

MPHW

Member

Smt. Dropati Sen

ANM

Member

Smt. Leela Dwevedi

Anganbadi Worker I

Member

Smt. Gomati Sen

Anganbadi Assistant I

Member

Smt. Geeta namdeo

Anganbadi Worker II

Member

102

Village Health and Sanitation Committee -2

Name of the Village:

Khairo

Date of Formation:

November 2007

Formed by whom:

By ASHA and ANM

Formation Process:
After getting instruction from the Block Medical Officer of Isanagar Primary Health Center the
ANM discussed the issue with the ASHA, Anganbadi workers and village secretary, she formed the
VHSC according to instruction given to her.

Formation Guidelines:
BMO Isa Nagar
Verbal

Given by the officer:
Written or Verbal:
Meeting Details:

Irregular

Regular or Irregular:
Monthly or Quarterly:
Not Meeting at all:

only one meeting held

Bank account:

have
November 2009

Have or not:
Date or Month of account opened:

Yes

Untied Fund Received
If yes

Rs, 5000 /- in November 2009

Amount Received so far:
Expenditure of the Fund received:

Nil

Activities Done:

NIL

Any Future Plan

Nil

103

Name

Identification of the member

Designation

Smt. Chameli Bai Ahirwar

Ranch

President

Smt. Pushpa Shukla

ASHA

Secretary

Shri. Dhan Prashad Jain

MPHW

Member

Smt. Dropati Sen

ANM

Member

Smt. Sanjay Dubey

Anganbadi Worker

Member

Smt. Savitri Mishra

Anganbadi Worker

Member

Shri Vinit Pathak

Sarpanch

Member

Shri. Rural Lal Sen

Panchayat Secretary

Member

104

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ESSAY ON COMMUNITY HEALTH WORKER

BY PRABHU SARAN

Introduction:

When we talk about “Community health worker and ASHA” they seem very similar. The
concept is same and the proposed impact is also same.

Community health workers /ASHA are chosen from the same village by the community to
work for the community. They are very familiar with the local problems, culture, belief,
practices and the people. When we read the article “achieving child survival goals” we can
see that how and what level of contributions that the community health workers have
contributed in the community in prevention and control of the communicable diseases.
If we see the health system in many countries especially in under developed and developing
countries, the health systems are very weak and the interest of the health care providers
(doctors and Nurses) is to stay in the cities and work in a good hospital. They are not
interested to work in rural setups where there is a big need of health care. The training period
is very lengthy and the cost of the trainings is very high.

When the cost to train and equipped a community health worker is very low and you can
easily get interested people from the community. In India jamkhed is a live example of
developing community health workers and sustaining the community ti identify their health
problem and solve them in the community.

Selection process:

The selection process is varying in different places or countries but the Who suggested that a
community Health worker should be:
Resident of the same village
Age between 25 to 35 years
Should be selected by the community
Answerable to the community for their activities
Supported by the health system but not necessary a part of the organization.

If we see the selection criteria of ASHA is looking very similar.

But in the reality the selection of ASHA is done without following any procedure. Most of the
ASHA are selected from the rich families and the interest levels of them are questionable.
They are forced to be selected and many of them are not working. Their husbands or other
closed relative are doing their work. They are limited to the immunization clinics and escorting
pregnant women to the hospital.

107

They did not appeared in any interviews.

Relationship between community and community health worker/ASHA:
Relationship between the community health worker and the community should be as a
member of the family. The community health worker comes from the community and he / she
is the part of the community so the relationship should be balanced. The worker should be
supported by the community and answerable to the community.
He/she knows the community and the groups in the village and people also know him/her.

When we see the ASHA, she is not familiar with the community and their relation with the
community is not so good. They are not visiting the families or clusters so there are a major
gap in the relationship between the ASHA and the community. People knows them as a wife
or doughter-in-law of powerful families.
Even they did not trying to build relationship with the community. In some cased their
relationship with other health care providers such Abganbadi workers and ANM is also not
good.

Roles and Responsibilities:
•

•
•
•
•
•
•
•

The role of a community health worker is to mobilizing people. Prime focus is to work
on preventive measures in the community.
Bringing awareness on health issue
Role of a teacher and liberator.
Counselor / advisor
Identify the harmful practices and make people aware
Motivate people to adopt healthy behavior
Help the health team in organizing immunization and Antenatal Checkups.
Guide the community to access secondary health care facilities.

When we compare these with the present ASHA, we will find that they are not doing anything
else then escorting pregnant women to the hospital and just sitting in the Anganbadi centers
on immunization days and filling their register because they will get get money for
participating in the program.

Most of the Anganbadi workers and ANMs are complaining us that they are not cooperating
in informing the villagers and motivating them to come for ANC and immunizations.

7 out of 10 ASHA interviewed by me in Chhatarpur district does not know their key roles.
They did not know the number of ANC and under 5 children in their villages. They did not
know the immunization schedules. They did not know about Village Health and nutrition day
108

of their village. They don’t know about village health plan even some have the copy of the
plan given by the ANM.

Training:

The community health workers needs some specific trainings on

•
•
•
•
•
•

Leadership skills, teaching skills
Prevention & control of the communicable disease, technical support on health care
like; case identification and case management.
Identification of high risk cases in antenatal
Home base management of Diarrheal diseases
Water purification skills, etc
Networking skills

The quality of ASHA training is questionable. They have attended basic trainings and
received certificates but most of them are unable to answer simple questions based on their
training modules.

Success of worker in which situations:
The success of a community health worker depends on how much cooperation and support
they are getting from the community. They need identification in the community, respect and
love.
They can be success if community and government departments can support them. A
support system is needed to address their needs and problem and solved in time. The
workers need regular updating on new problems or issues through refresher courses.

Their payment system should be transparent and easy. The payment should be on time.

Community support is the key for the success of a health worker.
The success of the ASHA program which is one of the best models to promote health and
healthy behavior in the community is depends how these ASHAs are playing their roles in the
community.
They need to be take interest and come forward, develop a good rapport and their family
members allow them to perform. Until they are ready and willing to learn and take this
opportunity as a challenge the success is not possible.

109

Limitation of works:
The health worker’s work should be limited to some area. They are basically health promoters
and in some extent they can provide primary health care. They are not a professionals or
medical experts.
The scope of an ASHA is not limited. They can do a lot for their own community. They can
mobilize community and bring a big change. They can produce demand and do advocacy for
the needs of the communities. The can bring awareness on national health programs, healthy
behaviors, sanitation issues, promote good personal and environmental sanitation.
Conclusions:
Both the articles show that a community health worker is the key link between the community
and health department / NGOs working for the promotion of community health. Many
countries are promoting the concept of community health workers in their health programs
and achieving good results.

The community health worker can undertake various tasks such as case management of
childhood illnesses, developing healthy behaviors among the community, mobilizing
community, delivery of preventing interventions, etc.

There is a need of close monitoring of the program and fair evaluation of the program from
beginning to the end.
The process of selection, training and monitoring of the program needs to be fairly
implemented and the role of the persons and institutions should be re oriented to them again.
The program is design well but the implementation part is very weak. Some support system is
needed to support them in every point such as payment system, moral support, technical
support, guiding them and helping the in the time of any type of problem.
Community support as well as organizational support but overall the political support is badly
needed for the success of this program.

Submitted by,

Prabhu saran Masih

Community Health fellow
Chhatarpur, Madhya Pradesh.
Date : 16/02/2010
110

DETAILS OF BLOCK/PHC/CHC/SUB HEALTH CENTER IN CHHATARPUR DISTRICT

SN

Name of the Block

1

RAJ NAGAR

33

9

1

2

ISANAGAR

26

4

0

3

SATAI

19

6

1

4

NOWGOAN

26

7

1

5

BADA MALAHRA

19

4

1

6

BUXWAHA

14

1

0

7

LAUDI

22

4

0

8

GAURIHAR

27

5

0

Total

186

40

4

Number
of Sub
Centers

Number of Primary
Health Centers

Number of Community
Health Centers

There are the followings existing Health centers in Chhatarpur District:
Total Sub Health Centers are
Total number of Primary Health Centers
Total number of Community Health Centers

111

186

40
04

Health Facilities in District Chhatarpur, MP

/ o

Legend

TALUK NAME
I GAURIHAR

-------- Other Roads

|

I LAUNCI

|

1 NOWGONG

| RAJNAGAR

HBB| Urban Area
PHC’S

Sub Centres

M-ap comps sec by NIC
Source R<3). SOI

112

U.WS.^HIHYA
irinv/A HlSf

List of Major Hospitals and Nursing homes in Chhatarpur City
Sn

1.

Name of the Health
center / Hospital/
Nursing Home

Contact Person

District Hospital
Chhatarpur

Civil Surgeon

Contact

Facilities Available

Number

■

■

■
■
■

■
■
■
■
■
■
■

2.

Christian Hospital
Chhatarpur

Dr. Christopher
Lasrado
Medical
Director

07682 -244311

113

200 beds with separate
ward for Medical,
surgical, children,
Trauma, Burn, eye,
Maternity, etc.
Well established OPD
facilities
Emergency OPD Block
Team of well Qualified
and specialist Doctors
Functional Lab
Facilities
X-Ray, USG & ECG
facilities
Functional Blood bank
Medical store
Dharamshala
Toilet and Drinking
water facilities
Generator facility
School of Nursing
100 beds with separate
ward for Medical,
surgical, children, eye,
Maternity, Isolation and
Private wards, etc.
Well established OPD
facilities
Team of well Qualified
and specialist Doctors
(MBBS, Surgeon,
Gynecologist, Dental,
Pediatrician,
Ophthalmologist, etc)
Functional Lab
Facilities
X-Ray, USG & ECG
facilities
Operation Theaters -2
Medical store
Dharamshala
Toilet and Drinking
water facilities
Generator facility
School of Nursing

3.

Dr. Pandey Nursing Home

Dr. K.P.Pandey

4

Dr. Chaubey Nursing
Home

Dr. Subhash
Chaubey
Dr. Shakuntala
Chaubey

5

Dr. Khare Memorial
Nursing Home

Dr. Dr. Ajai. Khare

GENERAL & Private
wards
OPD
Operation Theater
Lab & X-ray
Toilet and Drinking
water facilities
Medical store
Generator facility
Generator facility

6

Shrivastava Nursing Home

Dr. Arun
Shrivastava

GENERAL & Private
wards
OPD
Operation Theater
Lab & X-ray
Toilet and Drinking
water facilities
Medical store
Generator facility

7

Dr. M.P.N.Khare Nursing
Home

Dr. M.P.N.Khare

GENERAL & Private
wards
OPD
Operation Theater
Lab & X-ray
Toilet and Drinking
water facilities
Medical store
Generator facility

GENERAL & Private
wards
Operation facilities
Lab & X-ray
Medical store
Toilet and Drinking
water facilities
Generator facility
GENERAL & Private
wards
OPD
Operation Theater
Lab & X-ray
Toilet and Drinking
water facilities
Medical store
Generator facility

114

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