WOMEN'S HEALTH EMPOWERMENT ISSUE-1
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- WOMEN'S HEALTH EMPOWERMENT ISSUE-1
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A Collaborative effort of MOHFW & NGOs
ISSUe-1
Overview
There is an increasing concern that disadvantaged
and marginalised women suffer from various
physical and emotional health problems. In our
society, there is a culture of silence. Women hardly
come forward to share their health problems and
when few of them do show the courage and come
forward, they do not have access to'early
diagnosis, cure and treatment from the primary
health care system. Due to lack of access to
information and services, women tend to suffer
more, and often needlessly, spending their scarce
resources in seeking private health care which
generally results in a situation of women and
families being exploited. It has been experienced
that when women are empowered with
information on why and what causes illnesses
and diseases and where and how to find
assistance, they are able to live healthier and
more productive lives; by demanding women friendly quality public health care system. This leads to the
overall well being of families and communities in which they live in.
The right to information is one of the basic rights of a person, to be exercised and enjoyed by one and all,
regardless of class, caste, religion, and region and gender boundaries. However, for most women in rural
India and in the urban slums, the right to information is still a distant reality. This is evident when we look at
their health, social status and well being.
To achieve the goal of wellbeing and to improve the lives of the rural-poor women of our country, the
Ministry of Health and Family Welfare, Government of India, (MOHFW) New Delhi, initiated a project
“Women’s health towards empowerment”. The project’s aim was to train and disseminate health
information among village-based women’s groups in interior rural and tribal areas. This was a unique
example of a collaborative partnership between the Government and Non Government Organizations. This
pilot project was initiated during 1998, in various states of India with financial
assistance from the World Health Organization (WHO). The financial support for
the project continues till September 2001.
The uniqueness of this program was the active participation of experienced
NGOs and experts at every stage of planning and development. The
experienced NGOs were actively involved in sharing concerns of the
disadvantaged and poor women.
CHETNA Editorial Team
Indu Capoor, Pallavi Patel,
Gayatri Giri, Pallavi Shah,
Bindu Rathore
April 2001
Source:1,2- State of India's Health VHAI-Dclhi
1
Women’s Health
The health of a nation is assessed by the health status of its
people. The maternal mortality and the morbidity pattern and
fertility rate is an indicator of women’s health. Environmental
degradation, violence, occupational hazards and gender
discrimination contribute and have grave implications on
women’s health which is presently grossly neglected.
Approaching the 21st century, we still face the grim reality
that health is the second largest cause of indebtedness
among the rural poor. Majority of the communities still
borrow money for seeking health care ironically mainly for
menfolk. Even though women suffer from various mental,
physical and psychological disabilities, they still do not have
adequate access to diagnosis, care and treatment from the
Primary Health Care System due to existing socio-cultural
and economic constraints. Hence, women’s health
concerns remain largely unrecognized and thereby
untreated.
Effective health care depends on
self-care.
It is a well-recognized reality that there is a missing link
between women’s health and the prevailing development
scenario. Prevalent gender biases in society contribute
significantly to further widen these gaps. If women are better
informed about their health, they can take better care of their
own and that of their families’ and communities’ health.
Glimpses on Statistical Data
on Women’s Health
Examining India’s pre and post independence
scenario has revealed that the crude fertility rate
and the infant mortality rate have substantially
reduced and life expectancy at birth has also
increased from 40 to 62 years. This has been
possible due to the effective implementation of
various health and development programs.
However, we lag behind our national goal of
Health for all by 2000 AD, specifically the
reduction of maternal mortality. To bring about a
reduction in maternal mortality, we have to work
towards addressing specific socio - cultural,
economical and political concerns.
2
Health is a personal* '
and social state of
balance and well-being in
which a woman feels
strong, active, creative,
wise and worthwhile,
where her body's vital
power of functioning and
healing is intact, where
her diverse capacities
and rhythms are valued,
where she may decide
and choose, express
herself and move about
freely.
Women and Health (WAH!)Program - India (1993)
Statistics on women’s health status
Indicators
India
Sex ratio, 2001****
933
Literate Women (6th. +)***
48.6
Women Involved In Decision
Making About Their Own Health*** 51.6
Crude Birth Rate, 1999*
27.20
Crude Death Rate, 1997*
08.90
Infant Mortality Rate,1997*
72.00
Maternal Mortality Rate, 2000***
05.40
Total Fertility Rate, 1994*
03.50
Life Expectancy at Birth, 2000*
Male
62.36
Female
63.49
Couple Protection Rate, 1999*
29.10
Source: ’ From SRS Bulletins. - CMIE, India social sector
*" NFHS-2 *"* Provisional Census 2001.
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Women’s Health Towards
Empowerment.... Project
Process of Developing
Training Modules
The outreach strategy was divided in two phases, developing
a training manual and modules and Training of Trainers.
Participatory training approach was the tool used to reach
out to disadvantaged and marginalised women for
dissemination of health information. Based on the modules,
trainings were organized for the district and the village level
trainers. The village level leaders later imparted health
information to the women of self help groups.
Development of state level training
manual followed a participatory process,
which involved needs identification,
drafting of manual, review of draft
training manual by government officials
and experts of the topic and finalization
of the training manual. Initially, it was
planned to develop the manual by
ensuring the contribution and
participation of different NGOs.
However, the major contribution came
from CHETNA. In addition, SEWA
(Ahmedabad), The Foundation for
Research in Community Health (Pune),
CINI (Calcutta) and the Community
Health Cell (Bangalore) contributed. The
State Level manual, focused on
comprehensive information on 23
topics* related to women’s health.
From each state, competent NGOs and training institutes
were selected to organize the district level Master Trainers
training. Trainers representated both NGOs and GOs. From
each state district, 5 Master trainers were trained for 15 days
in one or two phases. After receiving the 15 day training, the
master trainers had organized a training program for the
village leaders. The state level trainers provided follow up
support and guidance in planning and execution of the
village level training. During the follow up visit, the master
trainers expressed the need for the refreshers course, and
the village leaders were keen to have a second round of
educational intervention. To meet these needs and to
enhance their training capacity refreshers training courses
were organized in all the states. During these trainings few
topics were introduced such as Wiser women’s health,
Tobacco and women’s health and Leprosy and women’s
health. At present the project is being evaluated and very
soon the scaling up of the learnings will be ensured.
GEOGRAEICAL AREA
13 Slates* of
India
Andhra Pradesh
Gujarat
Himachal Pradesh
Karnataka
Kerala
Maharastra
Madhya Pradesh
Orrisa
Rajasthan
Tamil Nadu
Uttar Pradesh
Urban slums- Delhi
West Bengal
COVERAGE
In each state, 5 districts were covered.
In each district, 72 Self-help Groups were identified.
From 72 Self-help Groups, 144 Village Leaders were
trained. Thus in each state, 360 self help groups and
720 village leaders were trained.
In all the three levels of the modules
women centered health perspective and
issues pertaining to the deep rooted
gender discrimination against women
was the central theme.
The district level module was developed
by incorporating the learning objectives,
training design, training methods and
detailing the various training activities by
the CHETNA team. The village level
module focused on the important health
messages. It had an added feature of
information on the role of the family
particularly men , Self help groups and
Panchayat members. This information
was particularly useful for the village
women to develop their action plan to
improve the health status of women of
their village. It also served as monitoring
indicators to measure the change at the
community level.
The training modules were graphically
illustrated and translated in local
languages, prior to the training. The
translation and the printing was done
state wise.
Participatory Approach
for Training of Trainers
In the implementation of the Master Trainers
Training program, a participatory training
method was adopted. The participatory
training method is a non-formal, on-going
process, in which both trainers and trainees
learn from each other. This approach to
training is intended to build on the learner’s
confidence and their capacity to observe,
analyze and figure out things for themselves.
Learners are active participants in the
educational process, and their need and
questions, mirrors their reflection and
analysis, and their strategies for change
carry the process forward.
In participatory training, the emphasis is
more on learning than on training.
Learners are encouraged to voice their
own ideas and explore ways to solve their
problems, investigate their own reality on
the basis of their own
experience. The learners
discover that they are just as
good as their teachers and
others.
Principles of Participatory
Training
It is participant centered. The training
arises out of specific needs of
participants as articulated by them.
ft Comprehensive nature of participatory
training necessitates combined focus on
awareness, knowledge and skills.
ft Experimental approach relies heavily on
the past experiences of the participants.
ft Creation of a suitable learning
environment is crucial consideration in
participatory training.
ft What is learnt in a training, needs to be
utilized in real life situations.
ft It is geared towards building and
strengthening the group.
ft The trainer’s behaviour is an
important element in the
participatory training.
'Source: Participatory Research in Asia.
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(PAIA, New Delhi), 5th edition 1998.
Go to the people, live with them, love them
Start with what they know; build with what they
have.
But with the best leaders, when the work is .
done, The task accomplished,
The people will say,
’’We have done this ourselves.’’
Lao. Tsu. China,700 B.C. Training for Transformation, A Handbook
for the Community worker, Vol. 1
Learning Environment
In the context of learners and the learning process, the
challenges of building and sustaining an environment
that would facilitate both individual and collective
learning. Some salient features of an enabling learning
environment are:
© Valuing learners and their experiences: Valuing the
learner, his/her uniqueness, experience,
contributions, knowledge and capacity to learn, grow
and change.
© Sharing personal experiences: Easy, open,
systematic and effective sharing of their past
experience in relation to specific learning objectives
with other learners and the trainers. To facilitate
sharing in small groups, expressing, opening up,
articulating, listening to others and caring for others is
important.
© Openness: Openness to learn, question, examine and
observe.
® Challenging: Learners are provoked, stimulated and
challenged.
• Safety: Psychological safety and comfort.
© Support: Emotional, intellectual and behavioral
support.
• Feedback: Feedback from the trainers and the I
earners.
Murphy’s Law
If something can go wrong-it will!!! (
We at CHETNA feel that
“Murphy was an optimist!"
The only way to beat Murphy is to be a professional
and use the Pls
• Planning
Preparation* . • Perfection.
Source: The Trainer's Pocketbook: John Townsend
Experiences of Women’s Health towards
Master Trainers Training
In each state, the trainers that participated were a mix of literate, semi literate or neo-literates.
Those who were not literate had a rich experience working at the field level. For many trainers,
exposure to participatory training was a new experience. The participatory training approach
provided an opportunity to develop a comprehensive perspective on women’s health based on life
experiences. Integration of scientific information with socio-cultural aspects was also greatly
appreciated. The exercise of master trainers conducting the session along with the trainers
provided an opportunity to develop their training skills and increase their confidence.
Gender concern was interwoven throughout the training. Trainers were able to relate field level
experiences with reality and develop strategies to address the issues that were discussed. The
discussion on useful traditional health and healing practices for various illnesses and viewing
health from a holistic perspective also provided ample scope to the trainers to share their
f experiences and make the discussions more enriching.
Peeling of Onion
“I am an enthusiastic and a very talkative person.
I have been working with SEWA for the last 10 years.
I would like to share as to how this training has brought a change
in my life. You will not believe the fact that earlier I used to hate men.
The reason being that when I was studying, my best friend ran away with
a ‘Bava’ (Sadhu). She was already married at the time. All the blame for
her actions was put upon me and my family blaming me, beat me up. I was
innocent but nobody believed me. That was the day,! decided to leave
school. This experience instilled fear in me. I developed a hatred for men.
But the turning point in my life was last year, when I participated in this
training program. When the topic on gender was discussed, I felt
motivated and it made me change my attitude. At SEWA we are told that,
there is no word such as ‘No’. Now I can talk to men such as a male
doctor frankly. I have also developed a gender training manual especially
for men.
-A 45 year old Participant from SEWA, Ahmedabad.
Voices of Grass root Trainers
“The content, activities and methods of the module were liked and enjoyed by
the participants. The important achievement of the training was that the
women got clear and correct information about their body, especially on the
fertile days and reasons of infertility. The self-help groups and organized
groups of surrounding villages demanded a similar training for themselves”.
•Q? Experiences from the State of Rajasthan
“As a trainer team, our experience in using the module was very positive. The
guidelines given to follow each training session were excellent. The master trainers
felt that this module and the training were an example of a comprehensive and
integrated women’s health”.
% i 9
^QcExperiences from the State of Gujarat
“Most of the key messages were well understood by the
participants. Almost all participants were unaware of the deadly
disease called AIDS. A few knew about STDs. All the participants
have demanded a continuity of such training programs. They
would also appreciate guidance from the Core Trainers,
especially from the MPVHA Program Staff’.
Source:! ,2-BuiIding and Strengthening of Mahiia
Mandat. Dept. WCD Govt, of Raj
“Most of the information in the module was
based on women’s health in a systematic
way. Illustrations in the module were useful
and effective. After the training, the
negotiating capacity of the women
participants has increased. Now they have
become more vocal with the panchayat
members, family members and with the PHC
staff’.
•Q*“ Experiences from the State of Madhya Pradesh
“Close proximity with mothers and children
has been very useful whenever we follow the
format of the module. Sufficient information
was given which was very interesting and
encouraging for the participants”.
-'Q-Experiences from the State of West Bengal
Experiences from the State of Karnataka
“The master trainers felt that this module and
the training were an example of a
comprehensive and integrated women’s
health program”.
‘.Qc Experiences from the State of Gujarat
6
Acknowledgement
Partner NGOs in this Initiatives:
Andhra Pradesh- Andhra Pradesh Mahila
Samakhya Society(MSS)-Hyderabad, UNDPKurnool.
The State, District and Village level modules are
the result of a great amount of discussion and
interaction between the Government of India
and Non Governmental Organizations who have
been actively involved. At every stage of
development, activists brought with them the
concerns of the marginalised women and
worked with the technical specialist in order to
come up with information that is need based,
acceptable and more importantly easily
understandable.
This module was therefore the result of the
dedication, commitment and insights of a large
number of people. To each, our special
gratitude and thanks.
K. Sujatha Rao
Joint Secretary, MOHFW, New-Delhi
? Gender, Self-Esteem and Empowerment
$ Nutrition and Women’s Health
? Women’s Work and Health
? Violence and Women’s Health
*23
? Women’s Mental (Emotional) Health
? Access to Health Care
T
$ Panchayati Raj and Women’s Health
O
P
$ Traditional Health and Healing Practices
1
$ Water Borne Diseases and Women’s Health
$ Tuberculosis and Women’s Health
? Water Sanitation and Health
? Reproductive Health-Our Growth
? Conception
? Adolescent Health and Development
? Reproductive Health: Maternal Health
$ Child Birth and Care after Child Birth
$ Abortion
? Infertility
$ Contraception
$ Reproductive Tract Infections
? HIV/ALDS
? Cancers-Cervical Cancers
? Cancers-Breast Cancer and Tobacco Related
Cancers
Gujarat - CHETNA-Ahmedabad, SEWA
Ahmedabad, Mahila Samakhya Society
(MSS)-Rajkot and Vadodara
Himachal Pradesh- SUTRA-Solan
Karnataka - Community Health Cell (CHC)Bangalore
Kerala -Integrated Rural Technology CentreMundoor
Madhya Pradesh- M.P. Voluntary Health
Association (MPVHA)-lndore.
Maharashtra - The Foundation For Research
in Community Health (FRCH),(Pune).
New Delhi - MAMTA- Health Institute for
Mother and Child-New Delhi, Dipshikha-New
Delhi, SHARP-New Delhi, Voluntary Health
Association of India (VHAI)-Delhi.
Orissa - National Institute of Applied Human
Research and Development (NIAHRD)Cuttack.
Rajasthan - CHETNA Jaipur CUTSChittorgarh, IIRD -Jaipur, Seva Mandir Udaipur.
Tamilnadu -Tamilnadu Voluntary Health
Association (TVHA)-Chennai, Resource
Centre for Ecology, Agriculture and
Community Development-Kanyakumari,
NATURE-Pudukkottai, Kumbakonam
Multipurpose Social Service
Society-Kumbakonam, Coimbatore
Multipurpose Social Service Society
Coimbatore, READS-Tiruvannamalai
Uttar Pradesh - Mahila Samakhya
Society(MSS) -Lucknow.
West Bengal - CINI-Calcutta, Pally Unnayan
Samity -Howrah, Nivetida
Community Care Centre -Hooghly, Pallisthi Parganas
•
V
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•
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•'
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For further information about
the project, contact: Ms. Sujatha Rao, Joint Secretary, MOHFW,
Nirman Bhavan, New Delhi- 110011
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Dear Partners,
l/Ve are happy to share with you the first
newsletter of Women’s Health Towards....
Empowerment, a joint effort of GOs and
NGOs and hope that you find the newsletter
to be interesting and informative.
In the continuation of the same effort, we are
planning to bring out three more issues this
year. The second newsletter will be
published in May, 2001. The highlight will be
the sharing of Master Trainer’s experiences,
information on additional topics that were
included in the training module and glimpses^
of the participatory training methodology
used.
We request all the readers and the master
trainers to contribute their rich experiences
at the field level. We would also appreciate if
case studies and other methods/activities
such as stories, songs, drama, role-play,
card games, illustrations, games are shared
by the trainers.
Layout & Design: Anil Gajjar, Nagji Prajapati & Pallavi Patel
April 2001
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