RF_COM_H_16_SUDHA.pdf
Media
- extracted text
-
H - lb I
RF_COM_H_16_SUDHA
CULTURAL
PROGRAMMH
by
JANADHARE
ON THE INAUGURAL DAY OF THE 4lst CONVENTION
OF CATHOLIC HOSPITAL ASSOCIATION OF INDIA
23rd. NOVEMBER 1984
****
2
PROGRAMME
1.
Invocation Dance °0 °o
2.
Song s
3.
nMooka Baya Beli-01age;s (The Fenced Dumb)
^Prabhu Pi thane Sharanam??
by Clementina
Lyrics and Music by Vincent
i?Yelegalu Nooaru” (The leaves are
hundreds but the colour is green)
Script and Direction by Vincent.
4.
Dalit Songs ? !?Sahukarara Bagilige Namme Mooleye
ThwaranaK (for the doors of the
rich, our bones are the decoration)
i5Yarige banthu Nalavathelara
Swathantharat? (To whom did. the
1947 Independence come ?)
50
Kolata °
A folk art of Karnataka,
This art express the joys and sorrows
through song and dance during festive
seasons. Janadhare would like to revive
this folk form. They are adopting the
songs to bring out the cry and. the
anguish of the people.
Today’s programme consists of 4 songs with
four different rhythms/steps in the Kolata.
+ + + -r +
- 3 SYNOPSIS OF THE PLAY
This play represents the people’s angle to the
problem of the medical care.
The poor, illiterate and mostly rural based
masses are the ones who are greatly alienated
from the present health system as prevalent in
the Government system of health care or the
voluntary and charitable institutions of
health.
Though many of the hospital^ run by religious and
charitable institutions were primarily started for
the service of the poor, yet in most of the
situations the very purpose is defeated by the
nature and function of the professionals and the
institutional structure. For example, the way the
medicine is dispensed, the hospital set-up and
village set-up etc.....
To the non-availability of the heal services the
primary causes are the people’s situation of
poverty, concentration of progress in the towns,
illiteracy and exploitative situations at all levels.
For the heroine, in the last scene, pleads for the
life of the dead husband. In that context she
raises a few questions
Why is the access to modern medicine denied to the
poor ?
"^0 poor have any right to live ?
;/hy no alternative inexpensive medical care is
thought of or worked for the poor ?
0 We are in tatters so that you
Further she laments °
can have a ward-robe full of clothes.
We go hungry sc .that you may have plenty to eat and
relish in delicacies.
Our poverty is your wealth,
Our ignorance your wisdom,
Our misery, dirt and squalor afford you to have
health and decent living.
We are human beings we too have a right gor a decent
living, WHY DO YOU EXPLOIT US ?
- 4 -
TO TALK ABOUT JANADHARls
Janadhare ’’PEOPLE’S STREAM” is a cultural
troupe of twentyfive youngsters who arc
socially involved.
They try to express
the aspirations and struggles of the
people through cultural media.
In cultuizjX. action they bring out the
’’Culture of the Oppressed” 9 reinforce
their value system, and initiate an
educational process provoking debate.
JANADHARE was formed in 1982.
On the stage:
Lilly Theresa, Shantharaj,
David, Xavier, Upakari,
Clementica, Jacintha, Carmela 9
Hridayaraj, Raju, Lawrence,
Nicholas, Prakash Raj, Prasad Rai.
The Catholic Hospital Association of India
C. B. C. I. Centre, Goldakkhana, New Delhi - 110001
Tel. 310694, 322064
?
HatxoHal
The approach of our ancient uedical
system was of a
iolistic nature, which tool:
into account all the aspects of human
nealth and disease,
Nevertheless j due to the influence of the
w e s t, it has been reduced
to curative , an urban-biased9 top-down
and an elite-oriented
approach.
- lis improvements have to be made
to combate DLINDITESS 2 I'iALARlA s
DlAhhHOEAL DISEASES9 LEPhOSY, T'
etc.
In order that our health service are to be effective,
arises the need for transfer of knowledge, simple skills and
tli. ere
t echnologi es to health voluntaries who are selected by the cormt
nities.
Moreover,9 primary health care must be provided with
special emphasis on
preventive promotive and rehabilitative
on preventive,
aspects together with other systems of indigenous medicines,
such
UKhlTI, SIDHA, HOISOPATHT, YOGA, NAT’dRCPATHY, etc
Hence the large stock of such health manpower could be utilised
ior promoting an effective health care services in India.
Besides tnese aspects, attention to be paid in the ot er
aspects such as a well developed distribution of low cost food,
of acceptable quality, available to every person especially to
the rural poor, prevention of food adulteration and maintenance
qVnlitythe
driving water, proper environ
mental sanitation, immunization programme, a well planned matternal
9
and child health services to reduce morbiditv. disabilities
morbidity 9
and
mortalities SO as to promote bettor health.
Production of life saving drugs tuider their generic names
especially for the treatment of T3 arid leprosy are to be within
are
the reach of the rural poor who suffer mostly from these diseases.
The use ci 1OW cast and no cast iildigenoas
herbal
medicines
ar e to be encouragedo
Nevertheless 9 vilien we critically analyse
this stat en: e nt 2
w e see that
very little efforts have beer, made in the
promotion
of low cast drug s for example, nearly 40 to
60 million people
suffer from endemic: GOITRE through its
prevention is so cneap by
using iodized salt
~2But nt the same time, our ox the total production
? out of the total
was taken
taken away by Vitamins and
WOO million (m 1976) 2^ was
hiS today.
of E.
Hence, it is not
Hence
enough to
soe that drugs are produced by Indians and in
tbundence, but it
is even more important to sec what drugs
are produced and for
whom? 0.6". the diseases of poverty such
as TB and Leprosy get
scant attention and thus DAPSOH for
Leprosy and 'ZMH for TB are
constantly in short supply.
tonics while 20% by anti-biotics.
H^nce ^11 health and human development must
constitute on
integral component of the
ultinately
overall socio-economic
development process in the country,
It is thus of vital importance
en s ur e effective
to ensure
^o-oraination between health and other
dev e 1 o pnent al activities in order to build healthy communities.
Heferencej 1.
Statement oh National Health Policy (1982)
2. Seminar on the National Health Policy - a report.
COIilxWITY HEALTH department
J CHAZ
EMERGENCE OF A NEW PUBLIC HEALTH
The process of health service development in India has
thrown up a number of ideas whihh have imparted a new dyna
mism to discipline of public/ community health. Many of
these ideas had to be generated de novo to meet special
contingencies existing in a Third World country like India.
Many ideas have been developed to strengthen aspects ofk
hhe knowledge of public health which has evolved in West
ern Industrialised countir
<2 o no /H - / 6 i|_
The Catholic Hospital Association of India
C. B. C. I. Centre, Goldakkhana, New Delhi - 110001
Tel. 310694, 322064
Ref. No.
COnNSKLLING ; TECHNIQUES & METHODOLOGY
^ate
'Councelling is an enabling and helping relationship, in
which the person seeking help is encouraged for positive growt ,
and also to take counsel with oneself. The result ox counsell
ing understood, in this way would be that the client can ge
back to the main stream of life as a normal human person.
Thus a new behaviour in the person counselled is the overall
aim of counselling.
I
In broad terms we can say that there are two approaches
in counselling;
The first one is called Dispensary approach, and it is
characterised by monologue on the part of the counsellor.
ce
counselee
is
the
counsellor
prescri
the problem of the
shared
bes solutions and readily provide them, instead of enabling
the counselee to go deeper into the problem by himself/herseli,
and arrive at a decision to solve it. Sympathy towards the
counselee is the predominant feeling here.. When this appro ch
is used it can hardly be called a counselling session.
The second approach is called Bartender approach. Instead
of sympathy, the counsellor displays feelings of empathy
towards the counselee. Companionship is offered to.the
counselee in his/her distress situation and not advise, ihe
counselee is re-assured by the counsellor's attitude of 1
am with you1, ' I care about you1, towards him/her. Here the
entire attention is focused on the counselee. The counsellor
never takes responsibility of the counselee's problem, but
rather (s)he encourages and enables him/her to take the
responsibility.
The person who comes for counselling is apparently in a.
state incongruence. In other words (s)he has lost the equili
brium in his/her inner personality. The measure of happiness
or unhappiness a person has is often determined by the level
of congruence (s)he enjoys within his/her personality. Whe
a person is not properly settled within oneself (s)he falls
into a state of incongruence. According to Kasl Rogers this
happens because of ‘the disharmony between*
The real me: How I view myself ( at this Prese^t moment)
The possible me: How
1_.. I view myself that I could be.
Ideal me; How I view myself that I should be.
The counsellor’s role is to enable the counselee to
attain the state of congruence. This in practical terms means
helping the counselee to become aware of his/her inner
feelings, to accept them and also to communicate them
if appropriate.
YOUR ATTITUDES & YOUR EFFECTIVENESS
Personal Attitudes; Before we start counselling others, it
is very important to know and realize about our own personal
The check list given in Appendix I
- 2
If the majority of the answers are 'Yes' or'I think so'
you have the disposition, and the potential to become a good
counsellor. The 'NO's' are indicators for you to know where
you need to make most efforts to become a good counsellor.
Personal Effectiveness:
The ability to handle ones own problem is important for
the counsellor. Mohari Window’ as designed by Joseph Luft &
Harry Ingham may help us to increase our own personal effect-
iveness.
Ij
---------------------- —
- ------- 1-
1
2
i
;
f^e acti-j
Blind sPot I
of
I[ Area
{ vity
3
!
f
!
I!
mask
I
!
I
;_________ {
~l
///////////\//////\
unknown
'/////I/////),/////'/1
f
f
f
f
f
!•
!
!
I
1st Quadrant:
Information about myself shared by me and others, Close
friendship takes place here. 1 I know and you know', In this
area one feel comfortable with others, And” others are also
confortable with us.
2nd Quadrant:
bu.u known to others
-------------( eg. mannerisms,
----- . .,
Data not known to us, but
certain unconscious gestures etc) Unless others are free with
us they will not feed us with these things.
3rd Quadrant :
well, but
Information about myself, which I know too well
Very often
We
from
keep
hidden
others.
it
unimown to others,
image
self
prevents
revealing
that
one
from
,
it is the wrong l_
them to others, They wear masks and it is very difficult to
deal with such people.
h-th Quadrant:
Information not known to us and^ others,
n°! that
„.f
kn°“n'' t?
nfOr“tiOn
heard people
telling
strength in me' Usually these ' Unknown’ manifests itself if
emergency situations.
- 3 a. Self disclosures
This means opening ourselves to others as we are. Normaly 9
we dont do it for fear of boasting (false humility) or because
we are afraid to show ourselves to others as we are, and thus
we prefer to beat around public facts or things known to everybody. Lack of self awareness also can hamper self disclosure.
To talk freely and openely about myself, I need to have
a healthy image of myself. Very often we experience tension
within ourselves between the ’real me, but not acceptable to
and the ’Acceptable me, but not the real me’. At
me;’
least the awareness of this will go a long way in helping a
person for self disclosure.
Love and acceptance are essential ingredients for human
growth, ^e can love and accept ourselves only when some one
loves and accepts us. VJe must give them a chance to do so.
b • Feed back:
Feed, back means the remark^ comments, or responses we receive from others about ourselves, It is not easy to be open to
feed back.: But it is important for our own personality
development. Very often acceptance of this feed back depends
also on how it is given. (eg: feed back given in an accusing
and hurting way) Because emotions play an important role here.
The feed back given to us need not be necessarily cent
percent true or valid. Nevertheless, it gives us an indication
as to how others see us. And this is important.
To conclude this section, we may say that to function
as an effective counsellor, we must improve our own personal
attitudes towards others, and also increase our effectiveness
through opening ourselves for more self disclosure and feedback.
THE ART OF COUNSELLING
The constituent elements of counselling are LISTENING &
RESPONDING. In other words the art of counselling means
listening with a sensitive ear and responding with an understand
ing heart. God has given us two ears, but one tounge, so that
we may listen double than we talk’.
listening doesn’t mean listening of the verbal experessions
alone, but a clear observation of non verbal communications
(Body language). eg. Facial expression, tone of voice, body
position, gestures etc. When you attentively listen you are
telling the person that ’you are important.to me’. The
following points are important for better listening.
- sitting position - to be able to look at the other
directly close enough.
- There should’nt be any external distraction.
- Avoid any internal distraction eg: Frankly.admitting the
feeling in the beginning itself, structuring of the
U -
At this stage^one thing the counsellor should keep in
mind is to remain free from
------1 any prejudices of his own. Very
often we wear ?eye glasses’
------ ' made up of our own experiences,
background etc . :These eyeglasses may not help us to help the
couns elee. Another point oto-keep in mind is the danger of
'filtering out'.
,n’h ’ * This means our tendency to listen and see
what we want to hear and see, and thus we stand to miss the
wholeness of the picture , which the counselee is trying to
present.
Through sensitive listening and accurate responding , the
counselee enters into the internal frame of reference of the
other; the counselee’s experiences is felt as if his/her
(councellor) own experience This 'As If’ feeling is called
Empathy. Here the counsellor feels with the counselee and ■
not feel FOR him/her.
At this stage we have to check our own attitude towards
the counselee. Three attitudes that seem to manifest are
authoritarian,, Paternalistic and Companionship. Needless to
say that the companionship attitude is the one we should
nurture in a counselling session.
It is genuineness, understanding and acceptance that
characterises the real helping relationship in a counselling
situation. Genuirieness of the counsellor (True to oneself,
and fearlessness in expressing it) wins the respect, trust and
confidence of the counselee, and also it serves as a model for
th® couns Biee to be genuine himself/herself. It is understanding
that helps the client for self exploration. When (sjhe feels
correctly understood (s)he is encouraged to explore deeply
into the source of his/her trouble. The counsellor’s underst
anding of the counselee is communicated through responses.
The responses should PARROT response. ACCEPTANCE attitude
of the counsellor creates a condusive atmosphere for the
counselling session. However, this does’nt mean that the
counsellor agrees with everything that isbeing said by the
counselee.
The counsellor should'nt take the responsibility for the
counselee and his/her problems. (S)He should be an enabler of
the counselee to take care of his/her problems. The possibi
lity of confrontation in a counselling session can’t be ruled
out fully. It takes place normally when discrepencies are
observed in the client in the following areas (a) The ideal
versus the real (b) verbal expression and behaviour (c) what
onesays about oneself and the counsellor’s experience of
him/her.. These confrontations may hurt the client, but this
hurting is meant to heal.(eg; surgery) However, this must be
cased on reality (eg. X’ray). Experiences have shown that
this sort of confrontations help the counselee to be more
genuine in the session and after.
For an effective counselling session, the fol leva ng skills
are required1 on the part of the counsellor.
A. Att ending:
___
Attending to the counselee has various
aspects.
- 5 The physical setting of the counselling room should be
1.
pleasing, welcoming and relaxing.
Personal attendance would mean attending to the personal
2.
needs and requirements of the counselee.
The posture we display in a counselling session is also
3.
since that
ll- 1 too
1-- communicates the attitudes and the
important, i------internal feelings of the counsellor.
Visual contact means the proper use of our .eyes in a
c ouns elling s es si* onl . It also includes the use of all our
grasp fully what the counselee is trying to express.
senses to
■
Psychologists are of opinion that only 2^% of
is communicated through oral communication.
the message
The energy level of the counsellor as well as the counselee
is also a deciding factor of the effectiveness of the counselling.
The degree of congruence also should be thoroughly
observed by the counsellor. What people say and how they say
it reveals the depth of problem as well as how they see it
by themselves.
Attending also means listening. Listening, is an art, which
everybody can develop, but at the same time, which all of us
tend to practice less and less in our day-to-day life. Proper
and careful listening is the key factor which determines the^
should be focused
success of a counselling session. Attention -/-.-I
on
the
tune
but
also
how one says
and
not only on the words,
and
(5W
Where9
Whv
Why
(^W
How
H)
should be
it. Who, What, When,
throughly listend to.
B. Responding:
Ad aquate, eippropriate and timely responding by the
to bring out more of
------counsellor, encourages the counselee
himself/herself and also increases his/her confidence. This
responding should be.characterised by the empathy (experiencing
of another person's world 'AS IF' you were there)
The counsellor should:
1,
Respond to the content: eg: You are saying
(or) In other words
2.
Respond to the feeling”. The feeling can be understood
through observing the behaviour and presentation. (If the
counsellor feels blank, (s)he can ask himself/herself; How
would I feel myself in such a situation?)
•
eg: you feel
(for examples of different feelings ref. Appendix II)
3.
Respond to the content and feeling:
because
(5^ H)
eg: You. feel
Proper responses^ as mentioned earlier, helps the
6 of his/her own situation, Personalizing in the counselling
context means enabling the counselee to understand where
(s)he is and where (s)he wants to be.
Personalizing has to be done in three areas. viz9.
Personalizing the problem: It means helping the counselee
to understand what (s)he cannot
do that has led to his/her
-—
experience. In other words, what is the counselee
•
I
—
contributing to the’iroii^ ---------------- j deficit)
±S
2.
Personalizing the feeling: eg 9 you feel
because
.
you can't
3.
IPersonalizing the goals. eg., you feel
because you
cant .... and you want to...
In
personalizing
(
the counsellorb own experience can contribute a lot") the goals
, . A Personalizing helps the counselee for an understand of
his/her problem in a better way.
1. Initiating
This means finding direction in life. Through
this skill
Through this
skill
idIntif?Id\1OT4-^nableS the counselee to operationalize the goals
identified in the personalizing process, eg., You want to
as indicated by....... Your first step ifou;. .1 p (The
d6Cide Yhat his/her Hrst steP should be)
stage the counselee should be helped to initiate a
schedule for action.
(with different ste-ps and actions)
I..- ^itiation enables the counselee for action which will
uitimateiy led him/her towards a state of congruence and
integrated personality. This ofcourse is the ultimate goal
&
of counselling,
(Ref: Appendix III)
Counselling a Group in Tension
X ot F iS ?ot uncorflmon that interpersonal conflicts and
breakdown of communication takes place in a team or group of
people working together towards a common goal. Counsel 11 ng
can be an effective instrument in resolving the conflict in
such situations.
In such a group counselling session, th
the counsellor will
have to display atmost restraint and balance,
-J, cl
so that each
member of the team can build trust in him/her and
— thus
----- > feel
free to express himself/herself fully.
most important task of the counsellor in a situation
like this is to get the people concerned together in a place.
Once tney are collected together thus, the counsellor should
ensure that each one listens to the other, with out inter
rupting the one who speaks. Very often when feelings run
high, people, tend to fail to see other's views. And during
the session it might be possible that each one dwell in his/
her own views, trying to articulate his/her stand. To over
- 7 The physical setting for the session should be arranged
in a semi-circle way, through which each one faces the counsellor
and sits at an equal distance. It could be in the following
way.
Counselee
X -■ Counsellor
The counsellor should show acceptance to each individual
attention should be paid as in an individual counselling session.
The counselees should get the feeling that they are individually
attended to. This is possible only when the consellor can
(S)H’e should never
enter into each one’s frame of reference.
show favour to any one, for get baised. The counselees should
be asked to direct the communication to the counsellor and
not to any one in the group. This is important especially
in the beginning of the session.
Through adaquate responses of the counsellor to each
one's point of views, every one else in the group gets a chance
to hear twice his/her own and other's views. This facilitates
better understanding of the other's standpoint for more effect
ive interpersonal relationship in future. It is worth mentioning
here that the experience of many groups have proved that
conflicts and tensions in a team or group can lead to strong
interpersonal relationship, if worked out properly. The^skills
required by the counsellor in group counselling and tension
management and the processes are the same as that of individual
counselling.
Conclusion
Nobody can overemphasize the importance of counselling
techniques for personnel involved in people based health
and development programmes. The techniques and methodology
for individual and group counselling described about is not
exhaustive. This paper is meant to be a supplementary
reading after the course on counselling.
prepared by
community health department
catholic hospital association of
India
c.b.c.i. centre, goldakhana p.o.
new delhi 110 001 (phone 310694-)
r ef; 1. "Barefoot Counsellor" by Fr. Joe Currie S.J
2. "The Art of Helping - III" (Robert R. Carkhuff, Ph.D)
Appendix
I
CHECKLIST
(From Barefoot Counsellor by Fr. Joe Currie, S.J.)
1. Do I ■f'ind other people interesting?
2. Do I find it easy to like others - even those who are
quite different from me?
3. Am I enthusiastic about others' chances for wellbeing
and happiness?
Can I trust others to take decisions and assume
responsibilities?
with, others?
Do I generally relate freely and easily with
6. Do I have a deep and open relationship with at least
some others?
trustworthy and dependable.
7. Am I consistently
<---uL.o feelings and private personal
8. Can I identify withB the
without
becoming excessively weighed
meanings of others
down by their nroblems, "downcast by
d
frightened by their fear, or engulfed by their dependency ?
9. Are people important and significant to me?
10. Can I let others be as they are , even when I don't agree
with them nor approve of their behaviour?
11 i Do I have confidence in my own abilities?
12. Do I dislike dominating and controlling others?
13. Can I accept my own weaknesses and shortcomings?
lb-. Am I ready to accept help from others when I myself
am
arn emotionally upset?':."
upset?'."
1^. Do T find it generally easy to listen, to give my fu
attention, to others?
16. Am I convinced, that I am an important person.
Do II encourage others to stand on their own feet, and
17. Du
fight the temptation to take them under my wing .
18. Can I accept myself am I am, without undue anxiety about
fulfilling the expectations of others?
19. Am I open to new and better ways of doing things?
20. Can I be a good follower as well as leader?
21. Do others generally find me a warm and loving person?
22. Do people find me approachable and easy to talk to?
23’. Can I talk easily and frankly
the one hand boasting and, on the other, feeling
embrrassed?
oL. Dn T t^eat each person as an individual* giving him a
Sancoio pKve himself before fitting him into a category?
Can I communicate warmth toward people and sensitivity to
% thrir neS^ithout being uncomfortable myself, or making
CATEGORIES OF
FEELINGS
(From the Art of Helping III. Sy Robert R. Cark
Levels of Intensity
Strong
Mild
|
Happy
Sad
J
J
J
J
J
J
I
J
J
J
Excited
Hopeless
Furious
Elated
Overjoyed
Sorrowful
Depressed
Seething
Enraged
Cheerful
Up
Good
Upset
Distressed
Down
Annoyed
Frustrated
Agitated
Glad
Sorry
Uptight
Cont ent
Lo st
Di smay ed
Satisfied
Bad
Put Out
I
Angry
J
i
J
i
W eak
J
J
5
J
iJ
J
J
J
J
J
Appendix
III
CHECKLIST.
(From Barefoot Counsellor by Fr. Joe Currie, S.J.)
I. General attitude toward the counselee:
1. Do I respect his independence?
2. Do I feel responsible for him and want to protect him?
3. Do I look forward to seeing him?
U-. Do I tend, to over-id entify with him?
5. Do I feel resentment or jealousy toward him?
6. Am I bored with him?
7. Am I afraid of him?
8. Ami overly impressed by him?
9. Do I want to punish or get rid. of him?
II. Iff behaviour during the interview:.
1 . Do I tend to tighten up and feel uncomfortable?
4.
2- Do I select certain material to dwell on?
3. Do I get angry at him for not responding the way I want?
U. Do I discover that I dislike him without reason?
j. Am I vulnerable to his criticism of me?
56. Do I try to impress the other and make a favourable impact.
III. In between interviews:
1. Do I dream about the other?
2. Do I find myself preoccupied with fantasies about the other?
3. Do I plan the course of future inverviews?
IV. At the end of counselling:
1. Ami reluctant to let the other go when it is clear that he
has reached as far as he can with me?
TEN
D 0’S
1. Be yourself.
2. Concentrate,? but in a relaxed way.
3. Listen to the full message of the other.
U-. Respond adequately and creatively.
5. Communicate interest, warmth andunderstanding.
6. "Prize" the other.
.
Confront, if and when necessary, responsibly and sensitively.
7. Confront
8. Help the other to sort out and clarify his problem.
9. Use simple and direct language.
10. Help the other to take charge of himself.
D ON 'T S
TEN
1. Don't advise or look too hastily for a solution.
2. Don't question from couriosity or from uneasiness.
3. Don't moralize or intellectualise.
U. Don't make the other depend on you.
5. Don't categoriese or pre-judge the other.
6. Don't be falsely re-assuring or supportive.
7. Don't evaluate the other or his behaviour or attitudes.
8. Don't talk too much , or project yourself into the interviews
or encourage, long narratives.
9. Don't hok for, o±
16 5
TRAINING PROGRAMMES IN COMMUNITY HEALTH
The Catholic Hospital Association of India takes up
training programmes in Community Health/ normally after a pre
programme study, for Dioceses, Congregations, Action groups and
for any group seriously involved inpeople oriented health and
development programmes.
The over all aim of such short term training in C H is
to help people to participate in building up healthy communities
with emphasis on people’s involvement, using appropriate and
local resources and responding to the needs of the people.
During the training the participants are enabled to understand
the health status of our country in relation to the wider social
reality around. They are trained as to how to analyse the society/
its functioning and to find out the root causes of ill health
in the Indian context* The training also aims at enabling the
trainees to initiate themselves
to acquire and
develop skills, knowledge and attitude to work with people and
to build support systems with their team at the local, congregational
or Diocesan levels. To make the course essentially an on Igoing
one we ensure the follow up of the participants at different
intervals. The duration of the follow up visits depends on the
level of involvement and the need of the people working in
the field.
For a one. week or ten days programme we uaually follow a
pattern which has topics such as social analysis, concept of health.
Community health - as a process of organizing people, skills in
awareness building, certain skills in training village level
personnel, Drugs, Herbal and home remedies, different activities
such as M C H, School Health etc. The spiritual and scriptual
diamension of health and development are stressed very much
throughout the course.
As a rule,the medium of instruction is
English. The
courses are strictly residential starting in the evening of the
first day.
The course expenses of the resource team
met by the organizing
body.
are
to be
H " Ik G
ORIENTATION PROGRAMME IN COMMUNITY HEALTH - THE CONTENT-THE PURPOSE
The term ’Community Health* is being widely used to
express various types of programmes in health. Public Health#
outreach programmes extension services# village health programmes#
of thcS2 programmes when analysed will show that there
are a lot of differences ir/'un%erstanding and the activities.
Community health understood and promoted by CHAl/CHD
is explained during the orientation programme, Wq also bring
in the need for promoting community health taking into account
the present health practises in our country# situating the
existing health institutions in the context of people’s health#
the situation of our society# the country. Hence# social
analysis becomes an essential part in understanding the Indian
context and the context of the health infrastructure. Merely
analysing the society and its various structures and systems in
short is not sufficient to give an idea to the participants as to
how to initiate community health and how to go about it.- A few
aspects in organizing and training of health workers are
integrated. Basically
one gets involved in community
health practises . is because of
personal conviction and so
the need for motivation based on faith reflection# spirituality#
Philanthrophy, depending on the group participating# in the
prog-TA.mme will be incorporated. All said and done oriertjation
is not training but more a concepts clarification and a peep
into the wide spectrum of community health to have a glimpse of
what it is.
This provides you with certain basic idea on the need
for working with people and the reasons for a radical transfor
mation in the health care system. Community health is not just
curative and preventive# but curative# preventive and promotive
health.
Normally an orientation programme takes 3- 4 full days
the time element could be reduced
but depending on th© group
or increased. Orientation prog.r,:imme is a prelude to further
training in Community health as it helps the
groups to
decide whether to go in for community health or not.
We also charge a fee of Rs. 500/- towards our expenses
i
(S o
H - I -6 •
PRE-PROGRAMME STUDY - WHAT JT IS MEANT FOR?
Community health department of CHAI undertakes
pre—programme study by field visits, contacts, discussions, before
taking up any training programme and involving in any community
health activities, with any group. Diocese and Congregation,
to
This is/enable us to have a rather clear picture of the area
of operation, the type of involvement required, the culture
and life of the people of the locality etc. This also helps
us to understand the type of activities undertaken by the
concerned groups. Diocese or Congregation, the reactions of
the people towards them, the kind of involvement of the concerned
group in the locality and with which section of the people.
Discussions at different levels give us a picture of the thinking
of the party concerned in their present understanding of the
society, their new thinking ( if there is any), any move to
initiate new line of functioning in the light of the new thinking
in the church and in the society. By our pre—programme study
we don’t intend to do any inspection of the functioning of the
institution. This has been a fear in some cases just because
we happen to be from an organization of which many of them are
members.
Discussions in smaller groups in different centres
provide an opportunity for personal reflections on the work they
are involved in and for us to understand the hopes and
disappointments of many who function, facing the hard realities
of life, often without much result or even very often counter
results.
/ The process we go through is to visit the individual
centre and few villages around, along with the coordinator
(director) and hold discussions with the people concerned at
the centre on their activities. This process also helps the
future participants to have an understanding of the type of
training programme conducted by CHAI on the one hand and the
requirements and expectations of the participants in term of
their training on the other.
2
Then having a session with the higher authorities
concerned clarifies various plans and programmes as well as the
process of thinking taking place in the congregation etc.
This will also help us not to take up training programmes
not to got involved where there cannot be a serious involvement
The success of the Pre'—programme study will depend on the
openness on the part of both the parties concerned and that has
been our experience*
Programme Director
Community Health Departne nt/ CHAI
28071987/100—spska.
(Sc
&
>
d
.THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
Grams
: CEEHAI
SECUNDERABAD 500 003
Telephones : 8482 93, 84 84 57
Telex
: 0425 6674 CHAI IN
Post Box 2126
157/6 Staff Road
SECUNDERABAD 500003
REPORT OF THE ANNUAL REFLECTION ON THE INVOLVEIjENT OF
CHD/CHAI HELD AT HYDERABAD FROM JULY 24 TO 28, 198?
The Procedure :
The CHD team, the former team members * Fr Chacl<o, Mr John
T Samuel and Sr Mariamma, CHAI’s Executive Director Fr John
along with the facilitators Mr Rudy Lobo, Dr K R Antony and
Ashwin Patel constituted the participants. Starting on 24th
evening there were deliberations in the general group on
each day, followed by team level (The CHD team) meetings in
the evenings where the days insights were further reflected
upon and the points for the next day was identified.
A background paper prepared by the CHD team 9 mentioning some
of the issues that the team has been concerned about, was
circulated among the facilitators to serve as a pointer to
the state of thinking pattern of the team and the direction
they would like to take.
SETTING THE CONTEXT 2
Since 1981, CHD has been involved in the promotion of community
health, consolidating the experiences of the team, formulating
a philosophy of community health and working out specific
strategies, the team revitalized is involvements in 198J. Over
the years the team has been busy catering to the requests from
various groups - diocesan, congregational and lay, either for
Orientation, training, project study or follow up of earlier
involvements; and numerically taken such activities have been
on the increase, well indicated by the fact that the previous
year the team had to commit for around 60 field programmes
alone.
Much more than our evaluation of the activities, it would be a
process of reflection as the very involvement itself, and
situating that in the wider realities of ill health viz-a-viz
the society that vze would like to create.
J
- 2 Hence the involvements of CHD/CHAI during the past 4-5 years
and a projection for the future would be the focus of reflections0
And taken in that context, the group felt that to direct the
discussions effectively, we would have to identify issues which
have a history and a future. It has to be a process of
problem solving and direction viewing.
THE REFLECTION ;
One of the issues identified was: In the light of the momentum
that is gathered by the oppressors viz-a-viz the team’s
involvement, the team feels a sense of stagnation. Against this
background the quantitative spread of the involvement of the
team, the qualitative growth, and the relevance of seeking other
roles would have to be looked into.
This particular mental disposition is not the result of a
feeling of frustration, but a deviation of the aspiration of
CHD team. Taken that way it becomes a challenge to move ahead.
It stems out of a basic feeling that fI am not utilizing my
full capacities’, ’which is a sign of restlessness and this
is a constant attribute of ’my work’ which has to be essentially
a dynamic process. This adds a dimension of search to the
involvement that one is making, and this is opposed to the concept
of stagnation which has with it the basic trait of being static’,
A rr
in a growing sense of realization of the forces is itself an
indicator of the element of growth that the team is experiencing.
The dream of CHD,s as others involved in people-based involvements',
is of a just society, a healthy society, and the efforts have
been to generate a movement of people. But the fact remains
that there is no appreciable sign of a movement taking shape
while the other forces intent on choking the moves of the people
are gaining strength and they make their appearance through
subtle ways. The feeling of the team has to be situated in
this connection. Here two questions become relevant: What is
taking place in the Society, and how do we perceive the realities.
And.a corollary of these questions is, basically the strategy
of CHD has been to work with groups that can facilitate people’s
action;- but then why the groups are not effectively moving.
Taking into consideration the involvement of CHD/CHAI, it is a
- 3 Here we try to perceive the dynamics of the wider forces that
act against the emergence of such a societyj and here we try to
develop a structural systematic understanding of the forces.
This effort is done with a national perspective and we would
be dealing with the intangibles. In our efforts to move the
groups, we try to share these concepts and concerns which take
the form of providing information or ideas through talk through
words. But the grass root level groups, the focus is not
intangible at all, instead they are real immediate and quanti
fiable. The big oppressor for them is there in their neighbour
hood and they have to have a life of compromise to exist lest
the power acts on them to the extent of physical threat or even
extinction. The power of the oppressors as compared with our
strength is infinite both at the national level and in the
grass root level, but however, for the national team the threat
would not come in physical terms, in most cases it becomes a
pressure to silence us co-opting. Hence, the reality of the
forces in the micro level has to be seen with this difference.
To be effective, actually wc are asking the groups to go
beyond their life of compromise and counteract. It is sure
that we have to provide the required ammunition. How can we
counteract the power which has got an infinite dimension.
We too have to grow into that infinite dimension to equate that.
.ur power, our force is but the spirit, spirit which is infinite,
and imbibing the infinite proportion of it, we have to generate
a multiplier effect. And basically this is what has to be
transferred to the groups.
In this context we also have to critically examine the type of
follow up efforts that we make.
In the light of the reality of the grass root level forces, and
the ongoing confrontation of the groups, we have to develop a
relevant therapy. It has to have a focus on appropriate skills.
Otherwise our involvements would just become that of orientation
and motivation. Relevant information and ideas on appropriate
strategies and skills which could be progressively imparted to
the groups have to be developed. Unless we make an effort at
this, our successive involvements cannot be called training
programmes, and the group also would inevitably become rather
- 4 Here, our effort has to be, as we continue to involve with
groups, to develop an operational theory through a dialogical
process with the group. This should have stress on strategies
beyond ourselves
and,, skills.
National perspective
X Gb spirit Systems
‘
Intangible
z
GC Spirit
-----:--CHD
inf
---------->
CHAI
tic
Talk
f /' Just \
Idea
orces
Grass
root
group
action
Z
equate
multiplier
i
effort of the forces
Big Opprcs
r
quantifiable
Immediate
Local
From here, we started deliberating on our clientele and the
sphere of activity and infrastructure they come from. Majority
of them are the medical personnel, trained and conditioned to
treat sickness, working either in hospitals or dispensaries,
all invariably forming part of the medical system. If we take
the Catholic Sector alone, the number of institutions runs to
2500. Apparently it would look that the smaller institutions
situated in the remote villages (the big institutions would be
only around 600) are more susceptible to the idea of people
based health action. But in principle, all these are units of
one and the same system, and seeds of hospital. The natural
concorn for them is to germinate and grow into hospitals. Now, the
question is how can we situate them effectively in the context of
making a movement in health action. Here our intervention
would be an action against the natural growth.
The Sharing was based on the following frame :
awareness
individual
Health
Dispensary
Credibility
I
>
Community awareness
Community
People Action to_
tackle basic problems.
society^)
( QQKL
-
Low priority
for people
oi- /
i
j
derived need
forces
Hcusing/High
priority
income
I Just
'■
Q,
a r' r* *i
/
1 ^7(7^
v
For the people, health is not a priority, for them , the areas
of priority may be income, housing, etc, Health is a derived
need, coming after the fulfillment of other needs. Hence health
cannot be placed as a driving force, and health as to spark
off other aspects. The dispensary/health centre has got a
credibility in tackling health questions. Here the dispensary
personnel should be enabled to think and link up health with
other issues,, issues which really make people sick, unhealthy.
This effort should bring about a conversion in the medical
personnel, where she/he tries to situate the sick person in the
society and the individual awareness is converted into a community
awareness leading to community action. It should be noted that
with this, credibility increases because s/he starts working
towards real solutions. As the people start tatfing up action,
there would be more challenges from the oppressive forces,
with the result that the emerging leadership gets more activated
and reinforced, and the struggles sparks off. Here leadership
is referred to as the capacity to mobilize people. And the
role of the dispensary personnel would bo to provide inputs to
this leadership.
COMMUNITY
HEALTH
Our effort should be to look at the community element starting
- 6 Hence the nurse/doctor would not have to feel out of place
that it is an area of involvement for social activists. This
is but a health involvement. The person remains in the health
field, but trying to move ahead.
A cautioning note here is that, it should not be a process
where medical personnel could get more stuck up with the
medical involvements. And also the institutions should not
get more reinforced in their logic and dynamics.
Looking into all these aspects, a relevant question for CI-ID
team is how do we structure our training inputs.
i
The usual, natural logic of the evolution of the dispensaries is
that as time passes on, dispensaries turn out into hospitals.
Sometimes this particular evolution does not take place in
physical terms but in terms of values, attitudes and thinking
patterns the evolution occurs.
congregatior
Commitment to
poor people,
not to patients
(fuhdin
barrie
■V> Do c ton—
- Hospital
Dispensary
2 beds
This is dnotner logic,
dealing with the poor, converting patients to people
It is to this clientele that we are trying to present a different
logic. This is a logic of moving in the opposite direction, which
is against the usual, the natural course. It is logic of commit
ment to the poor, where patients are converted into people* But
then this would not bring in money. And usually this is the
barrier that blocks people from this type of an involvement.
CHD is called upon to add the community dimension to health.
This politicizes health. And this is to be done in the context
of the institutionalised setups whore there is not much room
- 7 It is the people who take up action and they create the movement,
io play a meaningful role in this the dispensary has to undergo
a thorough transformation. In generating the movement the leaders
from the health and community have to play a role, the dispensary
^C - Leaders in community
V.
Leaders in the dispensary
H
should be the meeting point, and the dispensary should make the
synthesis of this. Here a different kind of commitment emerges
from technical competence , from ’doctor self’ to commitment to
individuals, to people, to poor. In this process s/he has to
depend on the people. And in the enormity of the task ahead, a
demystification takes place, In this sphere, there is need
to generate more experiments, more knowledge.
Here, people begin to be treated as human beings, not as objects/
cases. Here the soul of the individual is touched, the soul of
the sister (the dispensary personnel) is in communion with the
soul of the people.
The opposing forces are rich in material resources, V/e do other
involvements because we lack material resources. When the spirit
is motivated nothing becomes impossible. The infinite spirit
generated acts as a strong counter pressure acting against the
infinite material resources. This is the thrust of history,,
leaning of history. One example would be the Indian independence
struggle.
Commitment releases the spiritual energy for creativity, life
giving use of myself, for the poor.
Community health is not a goal , and it cannot be a movement as
such; the movement has to be the movement towards just society.
Community health is a platform to discuss, to address larger
issues, eg: issue of water, provision of water to achieve health.
Community health is a means towards a larger goal, a means in
movement. .And it is not irrespective of the dispensaries, but
with dispensaries acting as promotive structures.
CH a means
Health in relation to
other forces
political
' God’s
kingdom
\
]
- 8
In reality during cur training sessions vze meet the medical
personnel (mostly nurses) who are trained and moulded to be
confined to the sickness aspects by dispensing medicines. We
have tc basically move these people, so that they can gradually
become health activists and ultimately social activists.
The CHD team shared the various types of involvements of the
team orientation, training, project study & planning etc. Then
the question on the expertise of the team, the structuring of
the programmes, follow-up sessions etc., came up.
PROFESSOR
/
FORMAL
Theory
Skills,
Knowledge
PracticeScientific
Training
V 8
Follow up
Trainee becomes
professor
CH
Training - Emphasis cn ideolo
gical preferences/
positions Future
Perspectives
NOT
Based on past body of knowledge
No Hisotry for knowledge.
The team has to seriously think about theoritizing the community
health experiences, thus developing a body of knowledge, skills.
Follow-up otherwise becomes a big problem without that body of
knowledge. The room for progressing intensification of one’s
ideas and skills would be less. Theories from other disciplines
could be sought, but it has to be a new synthesis, incorporating
into, testing out in the field level realities. The CHD team
is in a Very advantageous position to do it since the team has
access to the literature on theoritical input, on the one hand
and the information on the field level realities and initiatives
(all over the country) on the other.
At present the medical personnel treat sickness based on a
particular epidemiology which is very much confined when thinking
about the root causes of illnesses. So new concept of epidemiology
has to be developed keeping in mind the broader understanding
of health. It has to look into the current realities which
9 -
- Death
- disability
Rx L- Chronic
- Cure
Disease
Political science
nanagcflltht
social
sciences
-Community
diagnosis
ideology—
( Physical\
I
ISocio\ cultural/
\politiodl
Environment
epidemiology still to
be developed
Epidemiology
This itself has to be developed into a science drawing experiences
from the field, A field based theoritical research has to go
into this.
At this point, the training content follow-up sessions
etc were taken up for discussion.
The community health programme as envisage- and presented by
CUD|CHAI is really new and it is a pioneering effort. It is
more of a good intention that a skill. Much more has to be
learned from the field based on the actions that are being
taken. It is a question of developing a different school of
thoughtt The community health department team has to grow with
the groups that are trained by the team, who by virtue of their
involvements grow in the concepts and skills of operationalizing
the community health ideology into which they were introduced.
Unless this takes place there is the danger that the team gets
stuck up with the motivational aspects and the ideological
orientation, while the field level groups really require ongoing
training which are relevant to the dynamic situations in the
field.
Powerf
counteract the powerful
Goal
Just
powcrle^ s
becomes Pow”:rfli
Society
community
more efficient, effective
4
CHVZ
experience
training
teaches = sharing
^follpwup
!,desc23iptive)
Ideological
Orientation
Value
Knowledge
Club with the'
experience of
others Theoretise
CHD - Value-Based
10 -
Speaking of the training capacities of CHD team, the following
points were shared
Ideological inputs
Primary level
1
Analytical capacity of situation
2
Secondary level
- Synthesis of field experiences
- Training
- Metamorphosis of various groups
- Scientific inputs to arrive at nearer
■ effective strategies
---- -y Statistics
epidemiology
Managemento
Then deliberations took another turn.
CHAI organisation :
What is happening to
CHAI is a political force which is not realised and utilized,
placing itself in the health situation in India what is CHAI’s,
and hence our role : How can CHD activate CHAI, converting the
potential energy into Kinetic energy: Here there is relevance
for a new emergence with a projection towards future, to make a
national impact.
Taking the existing situation CHD is located at the grass roots,
and speaking of CHAI, at the National Level it does not have much
existence* It is very much inward looking and not a force in
the service of the poor. But CHD can help CHAI to emerge* In
this context a question was raised - unless there are channels of
communication with the base level institutions, how can the
involvement be national.
International Organisation
National Organisation
Regional Organisation
Vaccines
Malaria eradication
Leprosy control
TB....... . O 4 <»
Iodised salt
Privatization
of health
care
Banned drugs
- 11
Looking at the history of community health involvements by
CHAI, it started in 1981,9 that time training grass root level
workers. From 1983 onwards CHD started involving in the middle
level workers• And now,9 we are thinking cf making further
involvements apart from the involvement with the middle level
groups. Here we arc thinking about, for eg: the issue of vacc
ines, non availability of iodized salt, privatization of health
care, issue of banned drugs, quality testing of drugs, malaria
eradication programmes, leprosy control programmes, IB contrcl
programmes with regional, national and international organisations.
And such action surely will have its repercussions - reactions
from the national and even international forces, hence these would
be very much political involvements too.
We should keep in mind all the activities have to be based at
the base, o.e. the 2500 member institutions, and invariably we
always have to address the 80% of the people, the poor - broadly
speaking these are some issues and involvements to be taken up by
CHAI. Here there are limitations too. While thinking about
involving the member in these endeavours, the me hers are not
aware of the channels of communication; Again another big
constraint is the lack of appropriate and sufficient infra
structure at different levels which include also the lack of
committed, efficient personnel. In this context it would be
worth thinking of the role of CHD :
CHD is capable of identifying and picking up these issues fast.
CHD has to feed CHAI with this analysis of issues. When it comes
to the level of CHAI, it generates a polarization of thought
processes, and there is a feeling of being threatened. Between
CHAI and CHD, there is a basic difference, if not a difference of
ideologies, a difference in understanding of philosophy.. It may
not be a difference in ideology because basically there has to
be only one ideology, i.e. that of the Healing Ministry of Christ.
And here CHD is percieved as a destabilizing force and it gets
attacked. But this is an indication cf being recognised, which
comes from a realization that the power centre lies more in the
CHD of CHAI. It also indicates the fact that mature attention is
given by the powerful
Here the deliberations should be on ’what strategy would I use
to counteract the negative forces through my life:
funds
National
CI® but P
Non modi :al
people
Non
medical
analysis rooted
sociopolitical analysis
Small rural
Centres
12
niergencc
Not
jjeta product o i^aqmbership
National
BUT
a creation of Executive director
—^^An artificial implant
CHfil
CGNFRCNTATJffN
CHD X
Multiplier
effect
\ Soc/Lo-DisPQ
\ political
\_J analysis
Medical Problems
Disease - Based
arics
[os pita Is
Medical Locus
(P-stands for programme
CH - A programme of CHAI
not exactly a dept* yet)
( A- the Association
which constitutes of
hospitals and dispensaries)
If CHAI had given birth to CHD, there would have been only a
medical/paramedical analysis and not a socio-political thrust/
analysis as we are having right now. If our socio-political
analysis is correct, the catholic hospitals will not be able
to withstand the increasing commercialization and the competition
creeping into the health care system. Coupled with this if
the government system becomes less corrupt and little more
efficient, this will be another pressure. In this process
only the really mighty and established hospitals will be able
to survive. But for this again there is the problem of funding
as this is not a priority area for the funding agencies, And
looking into this overall situation, hospitals have only a
t short life span. Hence naturally they would have to develop
openness, and they would be forced to adopt CHD.
CHAI’s national force is not recognized, And similarly CHD
can become more national. CHD can become national through
CHAI. CHD and hence CHAI has to become a political force
on behalf of people, It thus becomes mutual, Here there is
no room for confrontation but only convergence, There is only
love and those in CHAI should experience this.
Currently, the understanding at large is that CHD is dominant
force in CHAI, and the ’real children’ (Hospitals and
dispensaries) feel neglected.
Hospitals have always been inward looking and CHAI is basically
- 13 CHD has to look at the totality, not just rural areas alone,
and has to respond in a national way. At present we are very
much grass root centred - we tend to institutionalize ourself
into the locus of ruralness. We have to get out of this. We
have to diffuse into hospitals and dispensaries rather than
narrow down ourselves and have to act as a multiplying factor
and not a substracting factor^
Hence can we restructure our CHD’s medical dimension so that
from the ’Health1 stand point we can look at the whole society 9
so that we can have the locus of the medico-socio-political
analysis, of which of course the socio-political dimension is
the major constituent.
For us as well as the hospitals, there is one common factor concern for people. But for hospitals it is the concern of
people as individuals. Now, start/on the common platform,^/ing
the effort has to be to convert this concern for individual into
the concern for community. It is possible for them to make this
shift by giving them a chance to get involved in their levels
not with socio-political logic but starting with hospital
based logic. CUD has to diffuse itself so that hospitals get
activated and get placed in society.
SimultaneouqZy
egra
/
(Dispensary
\
Hospital
/
wider
Xcrces in
terms of
coverage
questioning rhe
credibility., ido
CHD has the basic responsibility to work for ■‘bringing about
change in CHAI. Then for CHD, CHAI becomes a laboratory for
experimenting the initiatives in community health in an
atmosphere where there are lot of oppositions, non-caperations
indifference, etc. And by attempting to do this, we ourselves
would be undergoing the agony that the people are undergoing
in the field. We are the grass root pressure. Unless wc take
up this course we cannot speak about the empowering of grass
root level people. In this effort, basically, we have to
work more with the policy makers since the personnel would be
there only for a short while either in diocese or congregation.
We have to have a hospital based analysis, taking up their
I
- 14 They arc a dying breed. Give them a chance to live, Make
a sympathetic understanding, not an attack. And based on that
help them to move, live. Help them to interrelate to experience
social integration rather than alienation.
And, also we are not the only faces. Ally with other forces.
To activate CHAI, we have to activate the ’A1 aspect (Association)
that we have to activate H (hospitals). For this different
methodology has to be worked out. Convert this problem into
a structural analysis. Then it becomes a fact, and not a
belief, and that cannot be devised.
Another common platform is the faith dimension, It is the faith
dimension that impells people. Hence, this also could be
starting point leading further wider questions.
While speaking about activating the ’A1 aspect a strategy
could be broadining our base by empowering the village-based
dispensaries, so that they would emerge into a force.
The effort of chd has been to make community health
a movement for the realization of health for
the poor majority in India. Hence it was felt
that it would be good if there are some
reflections on this question.
Sneaking of movement, it is still an abstract idea, a concept
which is yet to be developed fully in sociological and
development work context. Hence the reflection that are
shared are also very much theor- tical and inconclusive. Earlier,
there had been some efforts made by the team to deeper our
insights into this. Yet, it was felt that cur insights were
very broad and we were not really able to articulate what is
it that really takes place inside’ the movement.
And even for a study into this, there is no proper, sufficient
literature. That again is yet to be developed. There are not
many experiences also; and even the very few initiatives that
may be there,5 are not analysed and documented in depth.
Movement involves large number of people. People wlxo have
been suffering and undergoing tension. The conducive climate
for movement is the time when there is an acceptance of* an
- 15 The leader moves * The others, the community feel that they
would suffer because of this. The struggles begins, simul
taneously the oppression by vested interests also starts.
This adds momentum to the emerging .struggle. The charismatic
leader can convert this to give it a moral overturn. Eg:
Gandht.ji, The cultural and religious factor play a major
role here. New type of value systems, attitudes emerges.
There is a cultural transformation taking place which is
basically a change in the 1self’-s of people and this leads
to a greater lease of life. Such value based moral questions
are fundamental and these make people emerge to a fuller lifeeg: Christ, Buddha. Another eg: is technology has the capacity
for total distruction. But the generation of moral and
ethical values can counteract this and even direct it to the
betterment of humanity.
The marginalised has the capacity to internalise the suffering
and give it a religious overturn. But it would be moving from
the domesticating elements, moving towards liberation. Moving
away from fatalism, and moving away from the culture of silence
to a culture of repression and action. To facilitate this
process in the people an outsider is required - egs Gandhiji.
The outsider comes and undergoes a rebirth with the people, an
incarnation. Then he lives and dies with the people - enters
into their sorrows and struggles and gives his life fully in
that. Here the word becomes flesh.
WORD
BECUNING
FLESH
This is an act which is truly human. But there is a divine
intervention here. It is an instance of God intervening in
history through man. And this is the power of faith. And the
person is transformed to become saint, by being fully human, by
fully exercising his love for his fellow-beings.
The outside person has a higher perception, a different percep
tion by virtue of his distancing from the situation. This gives
him a sense of objectivity in his understanding and analysis.
Also, by exposure to other situation, literature, etc,, he
would have developed certain skills and frame of thought in.
- 16 The leader articulates the issues in verbal form and poses it
before the larger community. Here he applies a moral pressure
too, which takes the form of questioning the existing values,
attitudes, thoughts etc. This would touch and move the individual.
There would be also an effort to build up allies. This might
also lead to splits in the opposite camps.
The outside person is also an expert in faith, capable of
adding a new dimension, a liberating dimension to faith. A
lot of poor are dying without living their lives the human way.
And they live their lives dying. People have their faith, but
a faith which creates fatalism and martyr complex. Starting
with faith, the outsider has to give the dimension of life in
faith, confirming life instead of death so that the individual
can live his life and contribute towards the society.
The people, society can have life in its fullness here and
now. This is a matter of developing a new spirituality. Here 9
when we speak of faith, it is not only the Christian faith,
but the faith that can activate the spiritual energy and release
of man. There is a historic need to develop a new leadership
giving emphasis to this dimension of faith, so that they can
go for the impractical.
A continuing note was raised. Jhere are very many movements of
people in the country - They move towards a certain goal,
fighting against the systems. But on the way they compromise
at certain points. Sometimes they deviate from the track, And,
othertimes they end up in extremist involvements, But the
relevant question here is - arc they real movements 9 though
apparently they appear to be.
The culmination point for the movement is the Just society.
The distance trecked would vary. But what matters is not the
distance but the direction.
The poor and the marginalised thirst and cry for freedom. The
believers arc the hand of God. Give the poor a hand of God.
We shall locate ourselves on the side of the poor. We are the
part of this historic momentum. The specific place of ours is
the part of health. People are unhealthy because of other
- 17 Here the medical person becomes more effective; s/he would be
involved in the real role of making people healthy. The role
is not played by the conventional medical practitioners.
In the movement, the group , which is a political force focusses
on a specific point. For us the focus is health. Hence the
medical personnel do have a role.
Community health itself is not a movement. There is only one
movement. And community health is a means contributing towards
it. CH is a current, a stream contributing towards the main
current, the main stream. But it has all the qualitative
elements. Wo should make constant efforts to identify the
existing movements nd contribute our mite.
There is an orthodoxy in health care. Diocesan - Hospitals Doctors. This is cost intensive also. But this is not meeting
the needs of today since the real issues, the social factors,
the community factors, are left unresolved. An approach based
on social factors is cost effective also. This understanding
to be ingrained into these people.
The movement in community health has to merge into the main
movement that is taking shape in different parts of the country.
This understanding is not based on a belief but on analysis
which is rational.
A
HEALTH CARE
SOCIAL
POLITICAL
CULTURAL
ECONOMIC
SPIRITUAL
Speaking of health there are different dimensions and aspects
in it.
Community health is a sub movement, which has with it the
medical and socio-political dimension.
4
Medical
HC
CO
People
Just Society
J
- 18 -
Since sometime there has been feeling in the team that
we have involved in too many activities that the
quality of our work has been affected. Hence the
questions were :
- Should we reduce the quantity to increase the
quality
- or maintaining the quantity can we still extract
quality.
The quality of programmes can be assessed in terms of the
involvements of the participants after the programmes.
Repetitions cannot stand. One session should respond to the
dynamic social processes, so that the participants can respond
realistically to the changing situations* Here no static
theory can help. The participants lose enthusiasm when it
becomes repetitive. Session after session we have to grow in
quality. There has to be serious reflections into this* It
should be a structured, analytical reflection focussing on the
key issues.
Speaking of quality, effectiveness and efficiency are two terms
that come up quite often, Being effective refers to the impact
on the environment, efficient refers to being less expensive- in
terms of material. time and spending ourselves•
Project Planning
Training
Effective - Orientation
Quality
empowering
CHD as a force in
■A CHAI.
Our quality indicators come from people, how much it helps
people to get empowered and taka up action. And another
dimension is have we, and hence CHAI has made a force for the
service of the poor.
successful - can move forward
CHD Training
cannot move
X not successful - Sen:
- Analysis
/f Contradiction
Medical
system as
anti people
General Theory
- 19 We are operating in a theoretical context and operating at the
macro level, while the groups are working in the micro level.
Our analysis, theory and the conceptual frames apply everywhere
and the participants would accept that. But we are not giving
them any specific skills or tools to act in a particular
situation. The leaves the participants with many unanswered
questions, leading them to a mood of frustration. This is a
state of ambivalence for them.
Again,- taking the individual person working in a particular
geographic, socio-political context, s/he would be doing some
thing with.a certain knowledge and skills. The target of the
work would be empowering which definitely destroys security.
The reality forces them to go for compromise and to do something
-that ensures security. Our analysis tells them that what they
are doing is not meaningful. But we arc not giving any counter
knowledge applicable in specific gcographic-socio-politicocultural context, making the individual, succumb to a public
confession and a sense of frustration that ’if I do I would
be destroyed’. And the ultimate result is that they resort to
mechanisms that defend themselves.
o ensure
urity
Ensuring
Individual
ecurity
Targe
doing something
skill knowledge-
empov/ering
That can destroy
security
In our training sessions when we take micro-details, which is
addressed to the person, fear develops. To transcend this fear 9
the faith dimension becomes important, and God comes as the
underlying element.
Once we transcend the fear, s/he takes the first hesitant step
and gradually builds up confidence. '£he fear element gradually
diminishes. The person becomes more creative and works more
and more with people.
To tie down the person to the existing compromising involvements ,
there are other influencing factors - the conditioning impact of
- 21 Destabilizing the status quo
fo
up
Goal
Knowledge
congrcgatj on
goal
CHD
training.
sg?r
Proc cep.wfes
Orgn. 2)f
diopeftbaifios
safety
nct^u
'I
Hierarchy
on
skills
nev
i > Knowledge
People
skills
I
A
diseasesC-±rr^
daspeiwSFjr
apting on
771
. . _ acti(hn
eat
’ succ^e^/'ddf
suec
action
strcs4^
victim
-g
---empowering
on
PCT
."gwTPnpr
-------------congregate n
health
parametres Again the deliberations centred around maintaining
and improving the quality of the orientation/training
programmes. The above frame has been used to explain
those aspects.
.--n- -..-rr-
U*' -«4
We are working in a situation where people are made victims of
diseases, reducing them to mere objects of the environment. The
effort has to be at making people subjects of the environment.
This is the process of empowering. Here lies the success of
CHDfs efforts. In this process the involvement of CHD is
through the organisation - the congregation - which is the
organization at one level and the dispensary, the organisation
at another level. The intervention of CHD is with the staff and
the hierarchy.
In the process of people getting empowered and taking action
directed against the environment, the congregation perceives
threat! Based on this perception, and the attitude towards the
congregation either goes for or against the programme of
community health.
Here the question is how to improve the quality ?
This can be assessed by the feedback we got on the action which
is success, failure or even inaction. Another means for assess
ment is observation of the environment. Here again the reference
22 -
directed towards the environment which is creating and
prepetrating illness. The action has to result in destabili
sing this environment. Hence the effectiveness of the staff
and hence CHD's involvement (which is always with the staff)
could be assessed by the effective-ness of people’s action.
In this, to escape threat or extinction, the organisation the dispensary or the congregation can have built in ’safety
nets’. This is through emphasizing the health aspects which
acts as a cure, by promoting health dominated action, but
definitely, and specifically angled and oriented towards the
wider aspects. But this would not be apparent, vivid or
immediate.
It is a question of transforming the individuals who have been
working in risk-free, self-security environments. For the
person, it becomes a personal challenge. A spiritual struggle
should take place so that the person can undergo a radical
change, a metamorphosis.
Here again, the faith dimension is of crucial importance
to urge people to this kind of an action. It needs some
more eleboration.
EGO
I
t
/
GOD
Our training programmes are effort to push the ego element with
more skills for action. But, more and more, there should be
efforts to introduce more of God element into the ego. This
would result in release of more energy for action, following
the principle and the personality becomes a charged personality.
From here the reflections moved on to the involvement
of CHD. The effort was to develop a critique of the
involvements in terms of the quality, effectiveness and
a futuristic thrust to emerge into new areas.
Looking at the involvement of CHD,
- 23 -
Now the effort of the CHD team at this juncture would be going
beyond that, through a reflection cpnsolidatipn of our
experiences and ideas in Training, Orientation and Project
Planning so that we cease to be mechanical, and filling up
more quality.
Another major effort that CHD should make is to decentralise its
grass root involvements with and through partners. It would be
developing a higher level of trainers working at the regional
level as a resource pool. Speaking about this, we have to
be extremely careful to see that we really equip people so that •
the danger of our simplification and that of giving too much
emphasis on medical expertise/inputs will not take placet If
we are really successful in developing effective groups, they
could share the efforts of CHD to train middle level workers.
Formation of CHAI regional units could be a good strategy in
this direction. In addition there could be dialogue and
contacts with other existing training groups. While making
efforts (from the part of CHDO for convergence of ideologies
and philosophies, and while working out strategies together,
it should not be that it is necessarily a CHAI vision that we
are pushing, but developing an atmosphere and a practice of
dialogical interaction. But CHD has to become more skill
oriented in addition to the ideological and motivational
orientation.
Speaking generally on activities, it is not the quantum of
activities, but the significance of it at the national level
that makes it (qualitatively) important, relevant. The in
volvement of the trained groups of CHD, and hence the trainings
undertaken by CHD, can be made more significant by linking
up these various groups.
The training should emerge as orienting people, equipping with
skills and activating them to make involvements in their areas
as well as to establish networks. This, then becomes training
as establishing networks among people’s organization. To
make this effective, improve our professional quality based on
the involvement with people. If our existing involvements
are really authentic, then we will become nationally relevant.
k
- 2k -
The involvement of CHD tends to be unidimensional
- concentrating on socio-political dimensions, and unifocal
- catering only to nurses, But CHD has to open up to more
and more categories of people, groups. For eg: it could
move on to conducting programmes for health consumers either directly or through groups..
E
F
F
E
C
T
I
Another major area is that of drugs and rationalization of
the use of drugs in our institutions which can set a trend
in the wider society,
funds
support
K
desire
CHD
Illi
E
rosearch
- Orientation
- Knowledge
- skills
- contacts
CHAI (support
programmes)
CHAI effective
training
grassx octs
T-
People
Xfunds
V if th# come to the understanding ofCHAI
CHD has been involved in training, orienting, skills development,
etc., and has been in touch with the grass roots and the people
through the groups (agencies) and for these groups, not with
standing the fact that there is genuineness in their involvements
coming to the understanding of CHAI has been the legitimizing
factor for receiving funds and this becomes more and more
dominant.
For CHD the desire at present is to move on to more areas,
through direct ventures as well as through eliciting, facili
tating supportive activities from and in CHAI. And as said
earlier, this benefits both CHD and CHAI, in making both
relevant to the poor and nationally significant, relevant.
Research and regional involvements are two political areas in
which CHD can concentrate more. There could be a separate
cell for research. But usually research programmes without
taking people/grass roots turns out to be of the dominant
mode. But in its place grass roots should acquire the
1
- 25 -
Documentation based just on narrative information becomes
conventional. But there is room for incorporating analytical,
research inputs into documentation.
The research that CHD/CHAI could involve is field based. And
this is possible for CHD by virtue of its very locus among
people. It should be an effort to collage evidences and
emprical date from the people on their lives, struggles, ini
tiatives, their moves, the efforts made by facilitating groups
etc., processing, organising and synthesizing such data and
placing it back anong people so that people could be helped
to move with a different frame, so that the iacilitating
agencies (animators) are enabled to critically reactivate
their approaches.
Another major area which was taken up for critical reflections
was ’Project Study*. Project study is an activity for which
CHD has been getting increasing number of requests; much of
which forced upon us by the funding agencies. This itself is
a growing evidence of our cridibility.
This involvement itself
creates a tension among the ’h’ aspect, the hospitals as well
as the ’A’ aspect, the association. It could be an entry into
a programme, but in an attitudinally ill disposed atmosphere
from the part of the group (that has requested for funds).
And that toe in an atmosphere where we don’t have time. Hence
the opportunity becomes a burden. One involvement in the post
funding period, with orientation and ongoing training, becomes
very intensive. In this context, the relevant questions are
- how do we enhance our credibility, and how do we deepen our
involvements.
Taken the positive aspects, it offers us opportunity to widen our
networks, establishing more contacts, a nd initiating a different
planning precess and presenting the danger of groups going for
approaches counter to our ideology. But the negative aspects
would be, the material - quantitative aspect involved in the
project on that we might have to spend time, the power attached to
money, and the consequent relationship based on that, the
increasing number of requests, etc.... in this context how can
we maximize the positive aspects and minimize the negative areas.
We should not be succumbing to the needs of the funding agencies,
•t
CO rv\ H - / 6 9
T II E
CATHOLI C
HOSPITAL
association
I N D I A
OF
C.B.C.I. Centre, Goldakkhana, New Delhi -110001
Tel: 310694/322064/322174
Ref .No
Date
COMMUNITY HEALTH PROGRAMME - THE NEW VISION OF THE
CATHOLIC HOSPITAL ASSOCIATION OF INDIA (CHAI)
Introducti on
The members of the community health department together with
some resource persons and some others representing other organi
sations, had discussions, orientation and planning in two sessions
lasting for ten days each in the months of April and June 1983 at
St. John’s Medical College, Bangalore.
The session was organised
jointly by CHAI and the Preventive and Social Medicine Department
of St. John’s Medical College.
Between the first and second session
the community health department team members spent some time to
study some existing projects and also to study in detail the
various
documents from the Church, Government and otherwise, dealing with
Community Health. The following isi a brief account of what resulted from the various discussions.
In putting this on record we are
f^lly aware of our limitations and we know for certain that we can
not claim anything new, nor this as the'Tast word.
hope this will serve as a guideline
However, we do
for our future work, and with
the help, suggestions, guidance and encouragement of all concerned
we will be able to contribute our share to make the dream of WHO,
i.e. Health for All by 2000 A^, a reality, for which the count down
has already begun.
Philosophy and Vision
In the light of the WHO’s call ’’Health for All by 2000 AD”,
the revised national health policy of the Government, and in line
with the document by Pontifical Council Cor Unum on "the new orien
tation of health services with respect to primary health care", the
teaching of the Church and of the recent Popes, and the statements
of the CBCI from time to time, as well as in the light of this
consultation, the working team of CHD of CiiAI concludes that:
1.
In a country like India, so vast and varied, where 80$ of
its population live in the rural areas and about 90$ of the
country’s health care system caters to the needs of the
2
2.
Health is the total well-being of individuals, families
and communities as a whole and not merely the absence of
sickness.
This demands an environment in which the basic
needs are fulfilled, social well-being is ensured and
psychological as well as spiritual needs are met. Accor
dingly a new set of parameters will have to be considered
for measuring the health of a community such as the
peoples part in decision making, absence of social evils
in the community, organising capacity of the people, role
of
the women and youth play in matters of health and develop
ment etc. other than the traditional ones like infant mortality rate, life expectancy etc.
3.
The
present medical system with undue emphasis on curative
aspect tends mainly to be a profit-oriented business, and it
concentrates on ‘selling health1 to the people, and is hardly
based on the real needs of the vast majority of the people
in the country.
The root causes of the illness lie deep
in social evils and imbalances, to which the real answer
is a political one, understood as a process through which
people are made aware of the real needs, rights and respon
sibilities, available resources in an around them, and get
themselves organised for appropriate actions.
Only through
this process can health become a reality to vast majority
of the Indian masses.
4.
The concept of Community Health here should be understood
as a process of enabling people to exercise collectively
their responsibilities to maintain their health and to
demand health as their right.
Thus it is beyond mere dis
tribution of medicines, prevention of sickness, and in
come generating programmes.
In the light of the above conclusions,we identified the
expl>ited and the unorganised masses, particularly in rural
areas as our target group.
V/e intend to reach this groups
through the existing health institutions in the country,
8 3-
pecially through the member institutions of CHAI and other in
dividuals and groups engaged in the field of people-oriented
3
with other voluntary organisations, which up-holds similar
philosophy and objectives will beexplored to the maximum.
We also felt that the Church in India should take a clearer
stand on our involvement in the health field based on the documents
mentioned and this stand should be made known to all our health
care
institutions and others concerned. In order to facilitate
this we also felt that this study of the documents dealing with
this new concept of health shouldform an intergral part of the
curriculum in seminaries and religious formation houses.
The same,
we felt, holds good for all our educational institutions.
Conclusion
V/e are fully aware that we have still a long way to go
towards the implementation of these plans*
Yet we are optimistic
and confident that, with the guidelines from the
various documents
and cooperation from the thousands fo our institutions and. in colla
boration with and with the assistance of various organisations
with similar vision at various levels, we will be able to intitiate this process of education
for liberation and development
at least in some parts of this country.
29
Fr^jJ^hril^Vattama11om SVD
Executive Director, CLAI; and
Secretary, Health Section of the
C1>CI Commission for Justice,
Development and Peace.
8 - 1983.
4
Appendix - I
List of some of the documents refered and studied.
1.
New Orientation of health services with respect to
primary health care work - Pontifical Council Cor Unum
1978.
2.
Statement on National Health Policy, Government of India,
Ministry of Health and Family Welfare, 1982.
3.
CBCI documents, particularly reports of 1978 and 1983.
4.
Health for All, and Alternative Strategy, ICK1B, ICSSli,
New Delhi.
5.
Encyclicals such as Populorum Progression, Call to Action,
etc.
Appendix - II
Resource ter sons who assisted the team during the sessions.
1. Dr. Bavi Narayan, St. John*s Medical College, Bangalore.
2. Dr. (Mrs) Thelma Narayan
n
ii
3. Dr. Dara Amar
n
ii
4. Mr. S. M. S. Shetty
n
ii
5. Fr. D.S. Amalorpavadas, Anjali Ashram, Mysore.
6. Fr. Stan Lourduswamy , ISI, Bangalore.
7. Mr. ’ • T. Bajan, SOLAl, Katpady.
8. Fr. Claude D1Souza, Bangalore.
9. Sr. Dolores Kannampuzha, Kottayam, Kerala*
10. Dr. Jessie Tellis Nayak, Bangalore.
11. Prof. B.L. Kapur, Bangalore.
12. Dr. Marie Mignon Mascarenhas, CBEST, Bangalore.
13. Dr. Daniel Isaac, CMAI, Bangalore.
14. Ms. Lehka, SEABCH, Bangalore.
15. Ms. Krupa, SE4BCH, Bangalore
16. Ms. Sujatha de Magrey, INSA, Bangalore.
17. Ms. Simone Liegeois, VHAI, New Delhi.
***************
C^o
fA- ( G ■ (O
PALASTINE
and^Sjed. t^^ociSSiScaf^onSxt^n^ich SfliJed
a±± jKnow for certain that Jesus
of history lived
in Palestine.* 7
~
~
For about 600 t¥®ars'.
-- palastine
was under the
dominion of colonial
■
------ powers.
(Persia B.C 538-33; Greece;
B.C 333 - 63? Rome B/c’eTZ AD 135)o
7 *
135). During
the time of Jesus
Palestine was subjected u”
also to the internal domination1 °f
the Landlords and the Rich in Palestine itself.
Se°ar.a2h ic_F e atures:
Palestine had two distinct geographic regions.
1. JTOEA
WaS sltuated around Jerusalem and the Tempie0
'
i
It,was a mountaneous
J
mostly dry land.
area,
having
Predominantly,
Olive and fruit were cultivated here
and
goats
Sheep
were
also reared here. since the region had lots
--- > of shurbs and forests.
2. GALILEE
This was a fertile region. T"._
Wheat and Vine were grown here
extensively.
Fishing in the lake of
—Galilee and the costal
regions gave occupation to many. T'
The people in this region
w2em5S'’aJ°S"?d “rlng^Ss?"^rlSiS
^’i°h
?SriCra£tS; flshln9 «<=•
th?n?eilhSd of“S UoXeneSS'
S"S!rCiai rou1=^ that .passed through SalUee.
One
frO”’ Darnasc“« to Jerusalem.
Fotsibn folhant- DMaod^hS?
?zeSoe”,:te °hiiaren b"^“°tte
The
revollts
oriJinated here and there wore peasant
(Map of Palasttne^Mn'a
during the time of Jes^.
axastme during Jasus Ministry - Appendix Z)
p or
sincece631Inwi2°VS\tPtheStine W^® Under the Roman ^Pire
Boman dominati=f
the
Economic levels
The wealth of Palestine
was expropriated by the Romans
mainly through two types: of taxes.
They were:
1. Tributum - This ■
was, personal tax, which amounted
to
of the total harvestii. Annona
The tax in kind or through work, for the Army
Apart from these.i ^ere were unofficial amounts which the
Roman officials snatched away from the people.
- 2
x. > through official taxes of the Roman Empire alone/ about
o million Roman Denarii were extracted from Palestine every
year* (One Denarius was equal to one day’s work’ .
^xlong with the above mentioned two taxes/ the Temple was
also extracting taxes from the people. Thoy were;
This was something similar to the state
tax we have today (eg. Sales tax). This
was meant for thestate.
- for the temple
Tithe -
for the clergy
(ii and iii were Religious taxes)
Political level
The Roman Procurator of Judea, who lived in Casarea,
personified the Roman colonial
the•• • High
Priest in Jerusalem (
•
religiously and politicaly) from among the 4 dominant and
rich families of the time^
^Galilee/ Roman Political nower manifested itself
through King Herod Antigas. ’
- The Roman Empire indirectly controlled the land owners
through its arbitrary powers of dismissal of property
rights. During the reign of Herod (B.C 37 - 4) he
confiscated the land from small land holders and
marginal farmers and handed it over to Zamindars and
usinessmen, to facilitate increased agricultural
production and large scale export of the produce
" Th® intermediary officials in Palestine were
recruited
were recruited
oy Rome/ from among the Sanhedrin members and the
great families. The-.’ remained docile to the Roman
powers and perpetuated the imperial domination.
- Those responsible for collecting the taxeswere
chosen by the Romans from
—i among the lower social classes
in Palestine.
" SsoPthrSSM°Wer 2f the R°man
Empire was manifested
Rom ®lso controlled the Jewish autonomy. They reserved
for themselves the power of capital punishment
.£SL2£_IHE _VARJOUS SYSTEMS THz\T EXISTED IN PALESTINE
1.
5congmic_System
collective ownership of land prevailed among
thp
among
tS Golt '
Relieved that the land ultimately belongs
X^n+.(^evitlc^s 25/23s *Your land must not be sold on a
- 3
and you are like foreigners who are allowed to make use of it),
ut since the time of Herod feudal system emerged in the
VI ages.
Barter system was also not uncommon at the villacre
level.
Jerusalem Temple was the centre of intense trade and
th^r^J5” fThe.,T®rple Possese<3- the treasury and functioned
rd®
i® f a ^lonal Bank.
Jerusalem had trade links with
ThQ celebration of Annual Jewish
Sds SrCe anC' Phoenicia’
feasts were an occasion for the Jewish people to come to
Jerusalem.
The Urban workers, and the lower middle class,
thG S^a1^ £armers suffered very much during Jesus'
this td account of the multipple tax system that existed at
this time, due to which inflation, unemployment, poverty, birth
.ev-ruy, on on
of armed bands etc. resulted.
Social_System;
Palestine was a ] ‘ '
stratified society, during the time
of Jesus.
There were different social
They were:
---- - groups.
1. .§a.^-uoees^ They belonged to the Jewish
Aristocracy, and
'
represented the most conservative group. They
were closely
linked to the colonial power for their economic interest.
+-hXy w?r? iearnod people and were specialists in ’Torah’
“
the original law of Isreal.
opposed the escatological
-1. They
beliaves and denied the ressurection of the dead.
2.
Phariseess
‘ ’
They_belonged
to the urban middle class,
class. and
upheld the escatological beliefs
-—--.J and believed in life after
death.
They had a very pessimistic idea of man and stressed'
on the other world, which according to them had to be
attained through strict observance of the law.
They believed
in individual salvation.
••"•W-jvrii mi.
.j.
—b
a»
3,
■’ ’
ESEihesj. They were the
specialists in religious legislation
and of the penal code, and enjoyed a monopoly over it.
since
they knew Hebrew well,
This group believed in escatolosy and
exerted
. tremendous control
.
----- over the masses and were very
active in the synagogues on sabbaths.
However, they could’nt
get along will with the Priests.
4O
Were ?
group, belonging
a special ethnic c—
Among the priests there
’Higher Clergy*
The priests
the monopoly over the rituals and
.J were responsible for law
and order. The latter function was carried out through the
intermediary of the levites.
5.
EEViE'sEa. Law and order was maintained by them"
ie the
police function.
They also assisted the clergy in
their
various functions.
6.
.^.Z^llcjaisi, They had very low social status. Among those
ho hao Jewish origin were entrusted with the task of
lax collection.
7.
Sinners^
8.
bossesscds Those with illness, especially mental ill
nesseso
to^thFSibe
Those who had one way or other transgressed the law.
- 4
II« Z!?e.„.^alotss
actLiSes acainTS1*117 ! Politic^ °ne engaged in guerrilla
activities against Romans, to restore Jewish -State in its
(Thrz-aiot^took1011' 10 th2 line °f Davidian Messianism.
Hhe zealots took over power in A.D 68, after killina the hirrh
priest in Jerusalem. They established a now high criest! fSm
uhe traditional families. In 70, the Romans retaliated
nS
“tboatyrtotitsris«tO
th®
°f P°»sr anfi
of^mSn^^t^^bicr^and0 Rural Lev21 the upper class consisted
cities
tS
Generally they lived in the
owners.
(Those’who mJTfferant craftsmen belonged to the middle class,
These products
were soj OU? du?£Ukho t
ral^ious costumes)
.
The
y dj.rmg the Jewsih feasts in Jerusalem
m?rihaJsfal
tha slavas ( generally owned by the
unemployed (Mt. 20; 6) belonged to the
loS cllss.
1
At the Urban^ey^, the i
upper class
was constituted of the
~
sacredotal aristrocracy, (composed of the> ffour families,
from
among who the Roman procurator choose the Hiah Driest)
-) the big
merchants and the high officials. 9 prr.st)
urban craftsmen, small
The
merchants, middle level officials the priests and the levites
formed the middle class. To the lower class belonged the workers
attached to the temole, slaves,, sinners, publicans, unemployed.
beggers etc..
ie pure and irJtrataflcation was done also on ethnic factors,
proved tricing SU=!J|rf° • PufltY of Jewish blood had to be
Israel (Mtl J 1?)
°f the tW3lve tribes of
plgiI\
verj muih re^pereLd;
aUtflOritV in tha f^ily was
SoStT^waFi?th.
Political structure in the Palestinian
wore taken and power wariXSred by Si ^nciHi^TdeS1!iOnS
comSSll IffSre00 sluing vilj11 h^Seh°lds ’ through regulating
ors If law et^’ThSriM^
At the urban level, also there was a council composed of
aristrocratic families,
wners etc.
»
They monopolised
the political and economic
—J power.
elders iJjJruial+m? cojnpofedjfGffin'
The Sanhedrin, which was thS
the council of
saducees, and nrresta) wa« +-i->
members (Pharisees, scribes,
located in the KmSe and
P°We1rful?°dy. Sanhedrin was
similar to the supreme court.
This body generated idJre
s a: ^e?£
, political and administrative levels.
(See Apendix II)
Ifeolqaical.Systemg *
the Sciil,gypoliticaieandP1cnati?n
mOral JustifNation of
political
economic
and
Of a givenIs^baS of
5
In palastine it was essentially a religious ideology, which
was vary conservative and law oriented.
The temole, symbolized
the ideology, for Isreal,
Since God resided in the temple,
it gave a divine guarantee to the ideological system.
Theproducers of this powerful religious ideology were
the religious elite.
(The high priest, the pharasees, the
scribes etc),
The ideological system kept the social and
political system completely under its control.
It was into this Palastine, that Jesus, the Redeemer,
Liberator and the Prophet, was born. As he lived mostly in
Galilee,
_
' Hgr wqs fully exposed and thus aware of the plight
of the poor,
77* Hetook a defenitc option for the poor and He
chose to live with them and His associates
--------- ; were from among them.
Right in the beginning of His ministry itself, Jesus
declared His mission in unambiguous
’ ’
> terms; That iss
come.ooo." To bring good news to the poor
I have come.o
To proclaim liberty to the captives
To bring sight to the blind
To set free the oppressed
To announce that the Lord will save His people"
(Lk 4s 18-19)
To some extent, the word ’poor' used by Jesus is
misinterpreted today,
In the gospel according to St, Luke,
whenever Jesus spoke this word He always meant those people
who wore economically and socially deprived, and those who
ware.in the lower strata of the society. ( and NOT the
spiritually poorl) When Jesus spoke to the disciples of John
the Baptist He mentioned who were the poor for Him.... .
The
blind, deaf, lame, lepers...,, (lk 7s22) While speaking about
the invitioos for the banquet, ho again speaks of'the poor;
the
crippled, the lame, the blind.(Lk 14 si 3) Talking about
the rich man and lazurus, (Lk 16s20) Jesus illustrates clearely
what he meant by poverty. When Jesus asked the rich man to
He meant material
sell everything and give it to the poor.
wealth, and He had in mind those who were deprived of it, and
not the rich who have made the vow of poverty (Lk 18s22,
Mt. 19S16-21). The economic dimension of richness or poverty
is clear again, when Jesus spoke about the poor widon (Lks 23s3)?
and the rich fool (Lk 12s 16—20). From all these it is very
clear that Jesus option was for those people who wore poor
in the literal and ordinary sense of the word.
Well, does this mean that Jesus excluded the rich in
His mission, or that He had no message for the rich? Ono thine
that is clear from the Bible is that Jesus never overlooked
the rich people because they wore rich.
Nevertheless, on many
occasions, the good nows of Jesus turned out to be a bad
(Because He never rationalised or
news to the rich.
compromised J)
6
Many a time Jesus accepted the hospitality of the rich
(Lk 14? 1, 19? 6). But He always had the guts to speak to their
face about their greed and injustice and very often sitting
The response
under their own roofsJ (lk 6? 24, 18?25 etc)
Of Zacheus (Lk 19?8) clearly indicates the radical change that
occured in him, probably after the long discussion that Jesus
had .It?, liim. While eating a meal in the home of a leading
pharisee, we see Jesus boldly exposing their attitudes and
challenging their mentality, and making concrete suggestions.
(Lk 14? 1-14, Lk 7? 36-50),
In those days, some at least would
have really thought that to invite Jesus was to invite trouble.1
Jesus situated himself basically within the religious field,
But ho did not belong to the religious elite and was therefore
not entitled to enter the ideological system (Mk ll?27-28);
what right do you have. ....?) He took upon the escatology of
the prophets , and severely criticized the Jewish religious
practices, as made up of purely external laws and observances.
This brought Him to the violent confrontation with the
Pharisees, who saw Him as a threat to their position and power.
He was seen as one who defied religious authority and was
accused as a disruptive element (lk 23? 5), that must be got
rid of for the good of the nation.
Apart from upsetting theostablished order, the
the popularity
popularity
which Jesus enjoyed through His presence and His teaching
(Jn 11? 47,48£ Mk 11? 48), increased the worry of the elite.
And accordingly they concluded that it was better that one man
die than the whole nation getting destroyed (Jn 11?50).
But as capital punishment was reserved to the Roman authorities,
the only possibility that was open to the Sanhedrin was to make
it appear that Jesus had defied the Roman authority.
The sanhedrin condemoned Jesus before the High Priest on
on
■cne. grouncs of blasphemy, but played a clever role and changed
their accusation from the religious order to the political
order, in front of Pilate (Lk 23 ? 2-5). When Pilate was not
convinced of His culpability to deserve a death sentance, he
was threatened of his own position (Jn 18?28-38).
The game
played by the.Sanhedrin to get Jesus killed is very clear
from the passion narratives given in St. John and St Luke •
Lk 22? 35-38, 47 -54; 63 - 71
23? 1
27 and
Jn 18? 1-14; 19-40, 19s 1-16
It is
important to note that the questioning of Jesus
Pfocedure_were conducted ' early in thei
(Jn 18?28; Lk 22?66). This was ; shrewdly and cunningly morning*
planned
by the Sanhedrin. Because it was easy, for them to handle
Jesus in the absence of His supporters, who were already in
Jerusalem in large numbers for the passover feast. They were
the people from the country sides, who heard and loved Jesus.
1hey were not staying in the Temple complex. The ’People’
1 People1 and
7
masters told r• •
of their own daily bread, ;and they
w^s a^matter
simply reflected and resounded
---- d what was in their masters’
minds.
After a heavy and late dinner (passover feats) on the
" ^1OUS nigat, it was very late in the morning when the real
Jesus c.ame to the temple complex;
but on?v%nnn SU?forters
but only to be witnesses of their leader being led to Calvary,
eepmg ane wailing they followed Him1
(Lk 23s27).
Conclusion
It has to be noted that the execution of Jesus was the
result of the plot jointly hatched by
J the coalition between
the Jewish religious and social c”
elite and the Roman authority,
authority.
because Jesus was a threat to the social & religious order
of the day, which the rich and the powerful vzere determined to
keep at all costs to maintain themselves in their privilodged
position in the society
Jesus’ death was therefore primarily
a political event. J
Jesus was crucified (crucifixion was the
punishment for political criminals)
----) not because he claimed to
be the Son of God, ]but•_ :because he attacked the traditionally
established ideological system,
j which dominated and maintained
all other systems, <anc.- \because his message and practice aimed
at the subversion of the jsocial^
‘ " order that existed, towards
the creation of a nevz society where peac^,
, justice and brotherhood
would prevail.
Prepared by
Community Health Department
Catholic Hospital dissociation of India
157/6 Staff Road
P B No. 2126
Secunderabad - 500 00 3,
Phono - 848293, 848457
Telex ? 0425-6674 CHAI IN
tj ska - 200
<
r
/
* Sidan
I . : x PALESTINE DURING •
•
‘
/
/
z
/
/
/
• /Tyre
7
-
■
’
i
.
■
-
-
A- f z
h/
..’
.
*
!
'
t
I
•
co "
„ J
. . • <
:
•
*
/
/
/
v
9Bethsaida
♦/^HWVKE GALILEE
Nazareth
y -
H
■
j
i
I
i
I
I
♦
X
I
a
/
11
I/
»
IDUMEA
cj Gerasa
\ Q1
I
I
I
i
. •**
♦ G^idara
/
a<
4- - -
i
i
i
Bethany
Bethleham
t
I
I
I
i
. Mh
V
H
Jericho H
Emmaus
Jerusalem > Beth phac^
*
JUDAEA
Dj
y
Ephraim
f
U M
O H -
I
I
Ariibathea
f
I
CO
H S
u
II
II
SAMARIA
I
I
5
Aenoh-v* l -
.
I
tn
'‘Salim )
Sychar
Z'
/
I
1
■ ' f^Caesarea
ty >
f
x
f
i
\ Nain
i
i
I
X
X ?/
-W •
K”’
•
TRACMONITIS
•W <
Magadan
Tiberias
t
' '
\
Ch ?razin
Capernaum
(
I
f
/
/ GALILEE
Gennesaret
\
\
l
i
j
/
/
/
i
/
' ' X
.‘
/
t
r
’ •, • ’£4 •
/
/
"'Caesarea
r Philippi
t
’ 'A .
.
j
l ABUKEBE
/x- — —
t
/
I
f
/
y Zarephath'
zJESUS 1 MINISTRY. '■
Appendix
/
/
/
I
1
I
I
!
I
I
>
I
Appendix li
SlS,Jeru salem Tempie
The Jerusalem Temple played a •very important role in the
life
of the Jewish people." The temple"exerted tremendous
; influence
. — -----This
r^ious
was the^SriSnplTfS'.J^s1ana
-1—
they came from all over the
1 sacrifies especially
- - ihough Synagogues existed in many
places, they were only housesj of prayer, and not for sacrifices.
£s2.£er?g
The first Temple T^S.bu^1^^
*
'
• - Solomon ( IKgs Chapter 5 to 8),
but after 400
-J years in B C587, it was robbed and destroyed by
Nabukaden eser
-- the
_l.o emperor of Babylone.
After 50 years, under
Zerubabel, -■'
they started the construction again.
In B Co 515
it was almost
-- <completed. During the attacks of Greeks and
Syrians the temple
itwas Ki™Swf™aiaily damaged' but not destroyed,
In
B C 20-10, :■
Temple
expanded
and
the
constructed it in the way
T’-;- it existed during the lime
_ ...j of Jesus*
Renovation of the Temple
ana
carried
on
entire
work
nilf
t-i a Ft
i
*
'
the
zd n
was
completed
b. <—
completely destroyed L TO*
D m,
I3-’ — ?"ly
to be
- to
the
Roman
by
Army.
The foundation stones
of
the
wall
—>
western
side
is
still
remaining to this day.r as a monument of
thegreat Jerusalem Temple.
The cleansing of the Tempie (Mk 11ip) x. t
symbolic attack on the vested
CSUS Was a
concentrated in the Temole
Aa'ana the powers that were
pager, the Temple was the
else“h“o in this
t
power structures,
According to S-»- Mark itauthorities started lookina f or^ thlS ,incident that the Jewish
SKarrGd booking for ways and means to kill Jesus
(Mk 11-18)
The structure of the Temple was like thiss
1. Holy of Holies
2. Holy Place
3. Main Alter
4. Place for
Priests and
5. Sanhedrin
Severs
k:r<rL.
h
13
p1L
---
I
I
i
I
i
I
I
4
I
10
i
l
I
I
4
C3.
I
i
J
i
I
l
i
i
i
1^
I
I
3
!
i
%
Orv\ J-'l - I G • 11
CATHOLIC HOSPITAL ASSOCIATION OF INDIA
W. DELHI
QUIZ 2
M health
1. The largest number of deaths in India are because of;
a. Deficiency diseases b. Heart disease c. Cancer
d. Low birth weight and diseases of infancy
2. In. Bombay babies born in rich families have a w
moan birth
weight of 3300 gms. While in poor families have
- .e a weight of;
2000 gms
a.
2600 gms
b.
c.
2800 gms
d.
3000 gms
3. The percentage of children under 5 years who are underweight is;
a.
30%
b. 50%
c. 65%
d. 78%
d.
4. In India the typical diet has how many kilo calories?
a.
1500
b. 2000
c.
2500
d. 3000
5. a) What is the daily calorie requirement for a man doing
(Ploughing Stone breaking etc.)?
heavy work (Ploughing,
a.
2400
b.
2800
c.
3200
d.
3900
b) According to an estimate in a poor family the average
kilo calories for a man is;
a.
1400
b.
1 600
c.
1700
d.
2100
6. a) What is the daily calorie requirement for a woman doing
(Agriculture Construction work etc.)?
heavy work (Agriculture,
a. 1900
b.
2200
c.
2800
d.
3000
b) According to an estimate in a poor family the average
kilo calories for a woman is;
a. 1400 b. 1600 c. 1700 d. 2100
c ) What is the extra daily calorie requirement for
pregnant woman?
a. 100
b. 200
c
300
d.
400
d.) A survey in South India showed that percentage of
pergnant woman with symptoms of malnutrition
- — - — — -1 is ;
ao
20%
b. 30%
c.
50%
d.
60%
7. Which of the following diseases
are directly related, to
the nutritional status of the person?
Diarrhoea
Tuberculosis
2
8. The percentage of all conditions reported in India which
arc definitely pro’-cntable are;
a.
40%
50%
b.
c
a.
60%
70%
9. In
in 1976 the patients treated for dysentry
dysentry, typhoid an!
gastro-enteritis (all spread by contaminated water and
food) were more than:
a.
10 lakhs
b.
29 lakhs
c.
49 lakhs
d.
69 lakhs
10. The percentage of diseases of- :ring in rural areas which
arc caused by lack of clean drinking water and sanitation is s
a.
40%
b. 60%
c.
75%
a.
80%
11. In a^city in U.Pe after water work and sanitation were in
stalled
-----the cholera death rate decreased by:
a. 25%
b. 52%
c.
74%
a.
85%
12. A jsurvey found that of all the tube wells 1...
installed by the
Government 9 the percentage of wells still in
la use are;
a. 15% b. 25% C C 50% d.
a. 99%
13. What is the percentage of villages in India which still does
not have a safe drinking water supply?
a. 30%
14.
b.
50%
c.
c.
70%
d.
a.
90%
India it is estimated that the :rich
’
'have a life expectancy
of 65 years while the
—? poor have an average life expectancyr of;
a. 35 years b. 45 yrs. c. 50 yrs. d. 60 yrs.
After discussing the ranswers write down the conclusion that
emerges out of this quiz.
I. The per capita comparable land:
in India is 0.27 hectacres
in China is 0.15 hectacres
Life expectancy;
in India is 51.5
in China is 64
Infant mortality:
in India is 129/1000 live births
in China
— is
—> 56/1000 live births
- 3
Annual death rate;
in India is 13.9/1000 pop.
in China is 8.8/1000 pop.
How is it that a (country like China with more population and
population and
less per capita land ass compared to India more
able to have better
health status?
II.
The population of India in
1971 was 54,81,9 59,652
1981 was 68,38,10,051
The total grain production in
1971 was 9,40,80,000 tons
1978 was 11,38,10,000 tons
The amount of per capita grain availability in India
ins
1971 was 453 gms/day
1978 was 469 gms/day
The amount of ];per
’ capita
• 1 grain required by man doing1
sedentary work (office) 2
400 gms
Man doing hard work
S
650 gms
The amount of land used for growing food crops was
12,81,22,000 hectacres
Non-f^od crops like tobacco , coffee, tea was
11,41,000 hectacres
The amount of food exported by India in 1979 was
3,12,997 tons
Pulses are the major source of protein in the diet
The amount of pulses produced per person in
1956 was 70.4 gms
1975 was 40 gms.
Analyse the information given above and give your
conclusion
POPULATION
1• The <---average number of children produced by
a family in
d
is s
Indi aanno
a. 5.7
b. 4.8
c.
6.3
d. 8.0
2. The reasons for producing so many children are:
a. Ignorance
b. Children are an economic asset
c. Children are a security in old. aage
d. . Too many children die in the 1st3 year of life
e<. No family planning services available
f. No other entertainment in thee village
3. How many children does a family in India need to help
collect enough fire wood----•
for cooking, lighting etc. for
- 4
1 . The amount of
money spent on training a doctor is;
a. 20,000
b.
2. The amount of
a. 3,000
b.
cc..
50,000
70,000
d. More than 1,00,000
money spent on training an ANM is;
4,000
c.
c.
5,000
d. 6,000
3. The amount of
a, 600
montj' spent on training a VHW is (Govt,);
c . 1,000 d..
800 c.
1,200
b.
4. The ppercentage of ailments that c_ '
can be prevented or
treated by a“vHW in'the
(before becoming serious)
■
village
is:
a.
2O?6
b.
40%
c.
7076
d.
85%
5. The percentage of hNM
working in the
a.
47%
b.
57%
c.
7O?6
d.
rural areas is:
87%
6. The percentage of Doctors
working in the rural areas:
a. 20% b. 30% c.
40% d
50%
7. The number of people for each
nurse (nurse population
ratio;-) is;
a.
1500
b.
3000
c.
4500
d. 6300
" number of
People for each doctor(doctor
ratio) is:
population
a.
2500
b.
3900
c.
4500
d. 10000
9• The p
■
percentage of hospital beds in
8O76 of the
rural areas where
—- people live is:
a. 1476
b.
32%
c.
48%
d.
57%
10. Through the Fifth
Five Year Plan
health budget; was spent in rural what percent of the
areas?
a. 10% b. 20%
c. 3076 d. 50%
11 . The number of ( '
children that go blind every yCM
Vitamin A deficiency is 14
giving Vitamin h. the cost s°P^vent blindness by
’jc its:
per Child per year would.
a.
0.50
b.
1.00
’’Prepared by”
c.
2,00
d.
3.00
Community Health Team
C-14, Community Centre
' l (s {'K
1
THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
Community Health Department
: CEEHA1
SECUNDERABAD 500 003
Telephones : 8482 93, 84 84 57
Telex
: 0425 6674 CHAI IN
Grams
Post Box 2126
157/6 Staff Road
SECUNDERABAD 500003
health care in capitalist and socialist countries.
Modern societies, without exception, view certain basic health
care services as commodities to which every member of the so
ciety should be guaranteed access, regardless of their ability
to pay. Whatever their cultural and political outlook this has
been accepted. However, vastly different approaches have been
adopted for achieving the goal. It has long been established
that ‘basic health care’ includes food-clothing-shelter -safe
water - sanitation as well as medical care. But to many it
still means medical intervention to prevent and treat diseases.
In the socialist countries, the state is responsible for all
aspects though the citizens contribute to its financing. In
the developed capitalist countries in the matter of safe water
supply, education and sanitation the state’s responsibility
is quite significant but food - clothing - shelter remains an
individual’s responsibility. However, various social security
schemes help the poor citizens and guard against death from
poverty.
CAPITALIST COUNTRIES?
A study of the evolution of health standards a.h developed
capitalist countries reveal three significant points.
1. During the second half of the 19th century a definite im
provement in the general health of the public became appa
rent in much of Europe and North America as reflected in
the fall in death rates from infectious diseases and mal
nutrition. Greater economic prosperity brought about improve
merits in the general nutritional state. Better housing and
working conditions rather than antibacterial drugs and vita
mins brought about better health. The basic progresses in
health standards took place before the outstanding medical
discoveries of our times were widely made use of. It was
therefore due to overall improvement in nutrition and liv
ing conditions rather than to purely technical advances.
2. Public health and preventive medicine also greately contri
buted to this health progress. In response to the growing
evils of industrialisation and the frequent epidemics of
Cholera, public health was born around 1840 in England and
1850 in N.America and spread to most ^f Western Europe in
the second half of the 19th century, feis was the period
of the "great sanitary awakening"" Anti—filth crusade,
clean water and proper sewage systems and housing. Preven
tive medicine began towardsthe end of the 18th century and
introduced "the era of disease prevention by specific
measures”.
3'.
The capitalist economic system transformed medical care in
to a commercial commodity. This process by individualising
medical care and making it available in the market place
restricted it to those who can afford it. Medical care be
came a most profitable industry.The scientific and techno
logical advances of modern medicine which resulted was how
-2Approaches to.medical care differ. In the U.S.there is no
Girect state intervention. But in the last twenty years/ the
state has taken the largest share in national health care
care ex
Medicare (for the care of the aged)
Pr?gr^irnmes
ana Mecicard (for the poor) have been introduced and the state
is also providing financial support to other agencies. The si
tuation in the United Kingdom is quite different from other
countricsthe U.K., the National Health Service
t-kes c'irG of thG medical care of all/ is run entirely
state revenue. In Canada medical care is almost totally
state care. Other countries of the West depend heavily on di
fferent kinds of insurance systems with heavy state and employer
contributions.
'
SOCIALIST COUNTRIES;
There are wide differences in health standards and delivery
systems within socialist countries like Russia and the Eastern
European countries and the developing countries. The health
incicators of China/ Cuba and Vietnam were formerly very piti
ful. But today they are closer to the health indicators of de
veloped countries than to those of developing countries. Let
us take a look at the health indicators of some capitalist an
socialist countries in 1960 and 1985 to give us an idea of
progress made.
I.
U.S.A.
Death Rate
Birth rate
Life Expectancy
Infant Mortality Rate
1960
1985
9
24
70
26
9
16
75
11
12
17
71
23
12
13
74
10
II. U.K.
Death Rate
Birth Rate
Life Expectancy
I. M. Ro
III.U.S.S.R.
Death Rate
Birth Rate
Life Exoectancy
I.M. R.
7
24
68
38
9
19
72
24
19
37
47
150
7
19
69
36
IV. CHINA;
Death Rate
Birth Rate
Lo Expectancy
I. M. R.
V. CUBZ-i.
<•
f
-3-
v
VI, VIETNAM*
Death Rate
Birth Rate
Life Expectancy
Infant Mortality Rata
. 19.60
1985.
23
41
44
156
10
30
60
72
After the revolution, Chinese policy makers understood that
in order to ensure mass participation in the public health
programmes the peoples’ felt need of medical care must somehow
be met. So they set up a comprehensive organisation to serve
oven the remote inaccessible areas. The three key problems
they faced were?
(i) Drastic shortage of medical personnel
(ii) Heavy concentration in cities.
(iii) Elite attitudes.
To overcome this, thousands of urban personnel were transfared’
to the countryside to serve
mobile medical teams. 'rhe ■ wage
disparity was diminished by freezing higher salaries. The
difference in status between specialists and doctors was mini
mised by their common work with paramedics, ^t was in China
that the concept of barefoot doctors first emerged. These are
young people of peasant background who go through 3 to 4 months
of initial training by health progessionals. They provide
environmental sanitation, health education, preventive medicine
and first aid while continuing their farm work. They are cho
sen by their communities and their responsibility is to the
community which selects and maintain them. The first Congress
of Public Health laid down 4 principles which still guide health care in China today. They are?
!♦ Health care must serve the common man the majority of whom
live in rural areas.
2. Prevention must be given priority.
3. Western medicine and Traditional medicine must be inte
grated.
4. Health consigns must be ombined with other mass campaigns
The Chinese realised that the point was to provide some form
of medical care to all regardless of standard and quality
which could come later. The Chinese health system is now so
organised that a citizen of a remote village is assured of the
most sophisticated treatment, if needed in an urban centra.
CUBA:
In Cuba health is considered a fundamental human right
and health service arc free for everyone* After the 1958 revo
lution, high priority was given to rural areas. Most of the
Physicians and hospitals were located in urban centres. For
eg. 65% of the physicians and 55% of the hospital; beds were
in Havana, the capital of Cuba which had only 22% of the p
pulation of the country. But through the policy of regional
•>
-4Vietnam too the most important achievements were
t
the creation of the whole medieal-hoalth not work down to
vill&cp.level, making medical care available to the peasant
living in the remotest villaje and the training of medical
and health workers of peasant stock. These countries emphasise
preventive rather than curative medicine. Issues like sani
tation and immunization are taken up and implemented at local
level. Mass campaigns aimed at eradication of disease and health
education form part of the programme.
Medical care continues to be one of the most pressing felt
needs of all societies. For people’s acceptance of any health
care service, it is necessary to have medical care components.
But the health achievements of China, Cuba and Vietnam are
clearly related to their radical socio-economic, political
andideological transformations. Their experience"shows what
improvements in nutrition, water supply, sanitation, education,
mobilisation, employment, land distribution etc. mean in rais
ing health standards of developing countries. This confirms
the growing recognition everywhere that the fundamental re
quisite for a healthy society is not just effective medical
care but ensuring thit suitable conditions are created in which
health can thrive.
*
*
*
Sourcess
1. Health care in lodia by George Joseph, John Desrochers and
Mariamma Kalathil.
2. Link, Newsletter of the Asian Community Health Action
Network. Vol.6 No.2. July-Aug. 1987.
3. Radical Journal of Health. Vol.1 No. 3 Dec. 1986
4. The state of the world’s children 1987 (Unicef)
18/ll/1987o
rs o Ik
100 Copies.
h - I
13-
AN OVriRVIEW OF DIFFERENT COMMUNITY HEALTH PROOUI^IES IN INDIA
(MODELS AND approaches)
1 •
INTRODUCTION
Community health approach to health care has been widely reco
gnised as the right alternative for ensuring health to the
poor millions in developing natives.
In India too, governmen
tal as well as voluntary efforts are made for the promotion of
community health• In the evolution of health care system, this
approach has emerged through a process of dialogue between the
medical and the social sciences in an effort to make the
health care system relevant and responsive to the socio-politicoeconomic realities in the society#
Again, in the process of
evolution and formulation of community health in terms of its
principles, philosophies and methodologies, various models
have been proposed and practised#
In this paper an attempt
is made to categorize these models into four, each with its
own characteristic features.
Further, each model with its characteristics could be explained
as following a certain approach in community health.
approaches are broadly divided into three.
These
Am understanding
of these three approaches could give us a frame work to assess
as to which approach each models follows. Another interesting
correlation is that each of these three approaches reflects
a certain philosophy of development work.
In the following paragraphs an introduction is made into such
an analytical overview.
In the latter part of this paper the
four models with their characteristics are listed out* Under
each model, the particular approach into which it fits into it
is also given with certain indicators of assessment.
2.
DIFFERENT MODELS IN COMI4UNITY HEALTH
A study of the ongoing projects and the literature available
on them reveals that in India there exists different models/
types of community health products, They fall under four
major categories# Each one is run by different types of institutional set ups as big hospitals, small hospitals, rural
dispensaries, or run by non structured voluntary health/action
groups. Again, each, model is unique in terms of infrastructure,
services rendered, needc met, and the results achieved.
It
3.
- 2 DIFFERENT APiROACHES IN COMMUNITY HEALTH
Three approaches have been identified in community health.
They are : Medical approach,9 health extension approach,
Comprehensive approach.
a)
ApaX approach :
i
Considers health as the absence of diseases brought about by
medical intervention based on modern sciences and technology and
sees the role of the community (the people) as responding
to the directions given by the medical professionals. It
has its roots in the medical model of health care which beli
eves that the eradication of ill health depends on doctors and
medicines.
b)
Health- extension^ approach :
Based on a critique of medical approach. It accepts WHO
defination of health as the total physical, mental and social
well being of the individual. Mere advancement of medical
technology and the sophistication of services would not
bring health to the majority of the people - especially the
poor - and that the approach should be a planned re—distri
bution of health care facilities to reach the vastness of the
society. The approach also advocates other socio-economic
uplift programmes to enable people to benefit from health
care facilities. Preventive care is also emphasized.
G)
• .Qpmpr eh ens iye apj/rcach °e
Vievzs health, the concept of total well being in the context
of the situational realities of the individual. This concept
is elaborated by stating that health, the state of total
well being, is also a human condition which does not imporve
either by providing more services or mobilizing the community
for providing more health services. It improves only by
having the community take control and responsibility for
decisions about how to mobilize, utilize and distribute
services and resources. Here community is the subject, decision
maker. It is a process of sonscientization* organisation and
capacitation of the community for action. It has bearing on
the social, economic, political and cultural dimensions of
human life, in the sense that the approach strives to bring
about changes in them so that there would emerge a society
4.
copmjnitx
A1®.51?.
- o deveil
-phent
°,
Development work is based on certain analysis of the backwardness
of the people. According to the analysis, different philosophy of
development work are arrived at. They are mainly three approaches ;
Modernisation approacn, welfare approach, and social justice
approach. In the context of speaking about different approaches
in community health work, it would be worth mentioning these
approaches. It is interesting to note that reflections of these
approaches are found in the three community health approaches
approaches.
a) The modernization approach analyses poverty as the lack of
enough production and it makes efforts to gear up production
through advanced technology in the field of agriculture and
industry. It believes that the results of modernization
would trickle down to the lower strata of society.
b) The welfare approach recognizes different classes and castes
1't is due to the co-existence of
existing in the society.
development and under development in the society, This state
is accepted as a normal reality.
Efforts are made to alleviate
the sufferings of the poor through organizing relief and
charity work. People are passive receipients here. Recently
there has been some changes in this approach and it recognizes
the participation of the people and the mobilization of their
resource. Programmes also have improved remarkably from
relief work to development programmes aimed at the uplift.of
the poor^, through income generating programme, literacy
programmes, vocational training etc. The poor continues to
exist and the disparity between the rich and the poor also
continues as a reality. Statusquo is not disturbed.
c ) In social justice approach a critical analysis of the society
employed and poverty and backwardness are understood as man
made historical reality. The reasens are attributed to the
various forces and the dynamics at work in the society.
Poverty is precipitated as a result of injustice. Justice
could be brought in only through a restructuring of the
society. It could be achieved through empowering the people
through awareness building and organization. Ultimate
development of the poor would mean fair distribution of the
means of production, living wages, consumption of good food,
availability of public amenities, practice of human values
as love, cooperation and unity.
- 4 It becomes clear that the analysis and approaches of development
work has co relation with that of community health work,
characteristics of modernization approach are reflected in
medical approach and features of welfare approach find expression
in health planning approach. Social justice approach goes well
with, comprehensive approach in terms of its analysis and
approach.
5. T' n FOUR MODELS AND THREE API ROACHES IN COMMUNITY HEALTH
As mentioned already the community health programme existing
in the country could be classified into four based on the
characteristics. The following table would give that. Under
each programme a note is made as to which approach of community
health it belongs to. To make it clear six indicators are given
based on which this assessment is made. These indicators are s
- role of health services
- role of professional
- role of community worker
- Community participation
- Evaluation & Financial support.
For each approach these indicators shew different explanations.
Conscientization is "an awakening of consciousness, the
development of a critical awareness of a person’s on identity
and situation, a reawakening of the capacity to analyse the
causes and consequences of one’s own situation and to act
logically and reflectively to transform that reality’’
(David Millwood)
5
MODEL
Type of institution/
infrastructure^
Capital intensive, highly
sophisticated and insti
tutionalized big hospitals.
Mobile medical team with
doctor & medicines
CHARACTERISTICS
A
I
Need
Nature of Services
— I.—I
—-1 ■
*»-' •- -
11
■■ **
Rendered
- Extensive service from
hospital.
~ Curative care
- Running village clinics.
- Referral service, free
medicines.
- Weekly or fortnightly visits
- Treatmen
physical
- Referral
transpor
hospital
B - THE APPROACH FOLLOWED
. «■» .i • ■■ - i te —a*- -<
—k **■-•r'i'.drr -
r*
The approach followed is medical approach- The following are six indicat
assessment on that s
Explanation
Indicators
- means to improve the health status
a) Role of health service
- Key to the programme - manager, plan
b) Role of Medical Professional
evaluato
clinician* leader, teacher, evaluato
- a means by which medical advances c
c) Role of community health
worker
- A means to ensure more acceptibility
d) Community participation
- Based on analysis and interpretation
e) Evaluation
and results of applied medical scien
- needed to create, expand and mainta
f) Financial support
6
MODEL II
A - characteristics
Type, ^f institution/
infrastructure
Capital intensive, sophisticated
and institutionalised small
hospitals.
Medical team with or without
doctor.
Nature of .service s_rendcred.
- Extension services.
- Curative and preventive
care
- Village clinics
- Referral services
- Medicines at reduced rates
- weekly or fortnightly
visits.
- Health education
- MCH programmes/immunization
- Village health workers
with medical kit.
N
- Trea
ailm
- refe
tran
• the
pers
ronm
B - APPROACH FOLLOWED
The approach followed is Medical approach?- But.there are certain change
strictly Medical approach/ There
’ “ is
’ ■ an a^clin^io^toj^
__ ' ’__ J, __ _
.7-. JL.—-- Exten
Indicators
Explanation
a Role of health services
- Leans to improve the health status o
b Role of medical professional
- Medical professional continues to be
a role here.
*•
»* >■
t r
.«■ _
----
c Role of Community Health
Worker (CffW)
d Community participation
e
Evaluation
f Financial support
bei2g a pers°n t0 ensure
CHW also imparts preventive health e
"
“
ens^re “ore acceptability
mmate ideas of preventive nealth ed
inb?rPretation
.
-i 4-1 .
applied medical scienc
ne-aiin education.
- needed to create, expand and maintai
r^ODEL^III
Type; of inptitution/
Rural health centres
manned by nurses, not
institutionalised, still
very much structured.
-
7
-
A -
Nature ofscryices ppndered
Needs, m
- Preventive promotive and.
- Better env
curative
sanitation
- Community health workers
- M C H Ser
with simple medicines.
- Supplement
- Health Education, Adult
for a sect
A team composed of a
’Education
population
nurse and social
- Small income generating
worker.
projects
- Kitchen garden
- MCH
4 Collaboration with Govt,
and other agencies
- village meetings and
discussions on diff
erent problems
- promotion of collective
action.
B - .Afg^Cg FOLLOgD
The approach followed is health extension approach. The following indi
PSiSES.
Exp2? J1? ° ns
a Role of health services
- as it views that good health isthe res
irom otner fields as economists, socia
make services effective.
b Role of medical professional- The medical professional is viewed
,
.
...
-- as
experts irom ether disciplines are als
etc. Attempts are also made to include
c Role of Community health
- CHIV is considered as an agent of change
Worker
worker which include medical services
--- pr
education, nutrition education, food pr
d Community Participation
- Participation of the community is consi
a resource base
~—e, a means to mobilize mo
material. Mainly it involves the commu
8
e
^Valuation
f
Financial support
whether a programm
- Concerned with assessing
development
economic
progra
from health to
--improvements lor cne least
—
terms of health
11 health centres and to
- Used to build small
material. The program
and
man power, moeny
A - CI1ARACTERISTICS
MO DE
IV
Type of institution^/
infrastructure
Rural health centres/
action groups
Flexible and non
structured.
One team composed of a
nurse and activitist.
Nature of seryice_rendered
Needs m
- Basic n
the peo
caeir u
- Community diagnosis
efforts
- Critical understanding of health & - Better
its relation to unjust socialerder.
the Gov
- Awareness building through nonformal education programmes.
- Organising the people for collective
action.
- Exposing social illness
- Formation of Action groups, Nahila
manuals, youth clubs, village
committees, farmer’s exub, irade
unions.
- Demanding services from the Govt,
from health as well as other
departments.
- Identifying and training village
animators.
- Promotion of low cost and simple
home remedies.
- Services aimed at building healthy
communities.
9 -
In this model the
B comprehensive^roa^ is followed,
Bx£ianjitipn£
Role of health services
b
—
following expl
Rcle of medical
professional
— The concept of nealth is totally integr
of the community. Hence health services
point for development and a tool in pro
- Since the role of health service is to
stwctSis (to bring about equity of op
eBio° SaSrZ^dSln-^’r
professional is accountable to tne peop
c
d
e
Rcle fo community
health worker.
SSetSe^thJoug^heSt^and S"vcJop»
Community participation
Evaluation
- Community participation in health is a
over their own lives by collectively ,^
and take control of policies which affe
- The community is the evaluator - it ^
decides on the objectives, gtioriiics
^^“toS aeMa^«%^
Sop£'andnt“Gel?ortSatI'br!Shf aboGt
£d t£e establishment h Iltc-rn
f
Financial support
/for
rrsources in terms of man power, materi
It ?£ksZseed £ney. Maxim™ efforts a
at the cost of allowing them io dictate
in its orcccss cf growth towards aware
” 10
CONCLUSION :
Community health is a term understood and interpreted in
different ways by different people. This is due to the
differences in the analysis of the ill health. Based on one's
analysis the programme that is initiated would confirm to a
particular approach and philosophy.
This paper, we think, would help the implementors of community
health programmes as well as those who intend to start one to
develop a still more reflective understanding. This understanding
blended with our commitment to the poor would help us all to
make our involvement more meaningful.
-x16-02-88/200
mm/
-x-
■7^
*
-X-
& c>r^} H "
4
AN OVERVIEW OF VARIOUS_SYSTRMS OF MEDICINE IN INDIA
All ancient civilizations developed their own systems of
medicine : Ayruveda, Arabic, Egyptian, Greaeco-Roman, Chinese,
etc... Most of them have been practiced in India to s ome
degree. While western medicine or allopathy has been on the
scene in India for only about 200 years it has entrenched
itself and grown. But now there is a growing awareness’ of
;—
traditional systems like the ayurveda.
The Indian system
starts with the rigveda in 2000
B.C.
-- -- - and is known as Ayurveda.
Ayurveda in Sanskrit means "the science of life". According
to ayurveda there are three constiuents in the
psylological
system called ’doshas’. They are ’vayu’(wind) ’pitta’(bile)
9
and’kapha’(phlegm). Good health results from an ideal balance
between the three factors, The ayurvedic physician evaluates
the patient and sets right the balance by means of drugs,
diet and practices.
There is a predominant ’dosha’ in one’s constitution and this
decides which foods and activities are suited for tlae person.
Ayurveda teaches exercising the highest care in selecting
what is wholesome in the matter of food, conduct and behaviour,
It does not treat a person in parts. The body is dealt with
as an integral unit.
In India today there are
243153 practitioners of ayurveda
1452 ayurvedic hospitals
11100 ayurvedic dispensaries
97 ayurvedic colleges.
Sidha
xne Sidha
oiana system which resembles ayurveda is said
The
to have originated from the sage Agastya with its records
in Tamil and is practised almost only in Tamil Nadu and
Kerala.
i
2
/
105 Sidha hospitals
311 Sidha dispensaries
1 (Sidha college.
—USUI Unani Tibb came to India as early as the 13ih century
with the Persian scholars fleeing from Persia and Central Asia.
With the support of the Mughal emperors, this system of Arab
medicine took root in India under the name ’Unani1 which is
derived from the Sanskrit ’yavana* meaning Greek. It was the
Greek ’father of medicine’ Hippocrates who laid the foundation
of the Unani system more than 2000 years ago. It is based on
the Hippocratic theory of humours. Each person is a combination
of four humours - blood, phlegm, yellow bile and black bile.
One’s temperament is sanguine, choleric, phlegmatic or melan
cholic depending on which of these humours predominates. The
Unani physician treats a person’s body as one unit and not the
symptoms of the disease. It holds that the human body has its
own regenerative powers. Medicine is given to help these regenerative powers to surface once again. There are in India today
28021 Unani practitioners
98 Unani hospitals
860 Unani dispensaries
17 Unani colleges.
Homeopathy Unlike other indigenous systems of medicine,
there is controversy on whether homeopathy can be classified
as’traditional medicine’ • It is neither ancient as ayurveda
or Unani nor is it native to India, But it has been so widely
practised in India that the government recognises it as a
traditional system of medicine. In the 18th century, Hahneman
a German physician founded the principles of homeopathy, A
basic principle of homeopathy is ’like cures like*. To
strengthen the patients’ reative powers, he is given a drug
known to imitate the particular symptoms observed. In homeo
pathy it is not the disease that is cured but the symptom
it generates in a particular individual.
In India there are today
122173 homeopathic practitioners
121 homeopathic hospitals
- 3
Naturopathy
Holds that good wholesome food, enough sleep,
exercise and no tension are prescriptions for good health.
The main aim of nature cure is to prevent disease. It teaches
a person the principles of balanced living. The body has
natural ways to counter the onset of disease. The aim of
treatment should be to assist nature in eliminating toxins
from the blood□ Suppressing the symptoms by medicine, only
results in the basic disease becoming chronic.
In India today there are
97 naturopathy practitioners
10 naturopathy hospitals
26 naturopathy dispensaries.
Yoga Therapeutic yoga is basically a system of self-treatment.
In any medical system the primary reliance is on medicine. In
the yogic system this external agent is not needed at all
rather, it is the patient himself whose personal understanding,
practise and care cures his disease. It ensures health by
physical and mental purification through control of mind and
body.
In India tod .y are
J yoga hospitals
6 yoga dispensaries
Acupuncture is a system of treating disease by penetrating
needles to know points of the body selected according to the
disease. Like the traditional Chinese medicine system, the
principles of acupuncture are based on the concepts of Yin
and'Yang, the universal opposites. Ill health is due to an
imbalance between Yang(male, sun, sharp, strength, warm, positive)
.. pnd Yin (female, moon, dawn, quiet, cold, negative) and
acupuncture is designed to restore the balance. The art of
acupuncture is widely known for its pain relieving abilities.
Acupuncture was introduced to India in 1959 at Calcutta by the
late Dr. B K Basu a member of the Dr. Kotnis Medical Mission to
China *
The allopathic system of medicine was introduced into
Allop chy
South India by uhe Portuguese in the early 16th century. It
was spread by the doctors of the East India Company & European
- 4
However its costs are high, it makes people dependent on drugs
the side effects of its drugs and abuse of drugs are all draw
backs of this system
Today in India there are
297228 medical practitioners
7474 hospitals
26840 dispensaries
106 medical colleges
Modern medicine had brought hope for everybody once. But now
people all over the world are looking for alternatives :
In the west there is a growing demand for ’’alternative” herbal
remedies and in the Third World it is now accepted that
cheap readily available remedies should replace expensive
western drugs on the market. Almost 70% of our people cannot
afford^Sifh cost of drugs and diagnostic proceedures of
allopathy. Traditional medicinesare being recommended as an
added component to India’s health care system because they
are cheap and do not have the side effects associated with
allopathic treatment.
Sources
1
2
3
4
5
Health Care in India by George Joseph John Desrochers
and Mariamma Kalathil.
Health for the Millions (VHAI) June 1987 Vol. XIII No. 3.
Manorma year Book 1987.
Yogic Cure for Common Diseases by Dr Phulgenda Sinha.
Health Information of India, 1968.
1 4-11-87/100
rs :mm
Ihe Catholic Hosp'ta! Z’’iciation of India
157.6, SlafiRoad,
Opp. Cariionr. sni Workshop
P B. No. 21 £6.
Secunderabad-500 003. (A.P. )
Cor^\ H 1
,
lcr
THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
Community Health Department
Grams
Post Box 2126
:
CEEHAI
SECUNDERABAD 500 003
Telephones : 8482 93, 84 84 57
: 0425 6674 CHAI IN
Telex
157/6 Staff Road
SECUNDERABAD 500003
MINISTRY OF THE CHURCH IN HEALTH SERVICES
Introduction :
’’Action on behalf of justice and participation in the transforma
tion of the world fully appear to us as a constitutive dimension
of the preaching of the Gospel’1 .
- Synod of Bishops 1971
4
t!
Behind the revolutions of our day, is man’s struggle for human
dignity. Christ is at work here and we cannot proclaim Him to
contemporary man if we do not participate in this struggle. In
such participation we have to work with men of all faiths and
no faith. Christian living is, in this sense, living in response
to the WORD and to the world. It demands the conscious
transcendence of our limited groups solidarities and moving
towards the new humanity which is free from all discriminations”.
- National consultation on the
role of Church in contemporary
India, 1966.
”If we wish to be faithful to Christ and take up this attitudes
with regard to our fellowman, we must work for the over all
development of each man, and focus on the sick person more than
on his sickness. Since development also means solidarity we
must necessarily turn our attention towards the human community
of the patient, his family first, but also his neighbourhood or
village. This means we must practice community medicine”.
- Pontifical Council Cor Unum,
Document on Primary Health
Care Work, 1978.
’’The mission that we have given is a call for a true conversion
of our hearts and also of our methods. Secularization is spreading
in people’s hearts from the industrialized and technological
world to the developing world countries. We need to be converted
all the time in order to bear witness as Christians to the sick
who, through our work, will discover the love of Christ, The
rapid development in the field of health service technology has
- 2 Since Christians are the leaven, we must reach out towards the
masses by providing simple, accessible and promotional health
care according to our own possibilities, modest as they are 9
or in conjuction with the public services,9 where this is
allowed.
Let us ever be mindful of the fact that service to the sick
begins and continues to operate through the patient's human
environment. COMMUNITY HEALTH CARE IS THEREFORE PART OF THE
COMPREHENSIVE PASTORAL WORK OF THE CHURCH1’0
- Cor Unum Document, 1978.
”Presently, despite the constraint of resources, there is
disproportionate emphasis on the establishment of curative
centres — dispensaries, hospitals institutions for specialised
treatment - the large majority of which are located in the urban
areas of the country r... A dynamic process of change and
innovation is required to be brought in the entire approach to
health man power development ensuring the emergence of fully
integrated bands of workers functioning within the ’’Health
Team” approach”.
- New National Health Policy
1982’
’’The demand for justice has been one of the dominant notes
of this half of the country. Perhaps no other period in
History has witnessed a greater denial of justice also
’The Church, bearing within itself the pledge of the fullness
of the Kingdom, views with joy the present concern for justice
and with anxiety the grave threats to justice all around us.
It is her endeavour to interpret the implications of the Gospel
message of justice and peace in the varying situations being
unfolded in the course of the human pilgrimage on earth. She
has to be the ’Leaven’ and the ’salt’ of the earth in the con
fusion likely to prevail in the search for justice”•
- CBCI,
1978.
’’The Church should give its whole hearted support to the peace
ful social changes taking place in the country by verbalising its
support of any efforts made for bridging the gap between the
rich and poor.
3
"We want our health services to take
primary health care to the
masses, particularly in the rural and urban slums. Catholic
Hospitals and dispensaries should stress the preventive and
promotive aspects of health care. Specifically, we would urge
them to join hands with the civil authorities in their
programme for the eradication of leprosy.
Our health outreach programmes may demand a change in the
routine especially of religious communities of men and women
involved in this work, and their formation should prepare
them to meet the new spiritual challenges that are posed".
“ CBCI,
II
1978.
The commission being conscious of :
a the situation of massive ;
poverty of over 60% of our people;
b the unjust structures which
maintain and perpetuate it;
c the injustices perpetuated on the weaker section of the
people;
considers it imperative to reaffirm our commitment to the poor
in imitation of Christ’s preferential option for the poor.
The creative struggle of the people to bring about a new society
invites us to enter into critical collaboration with people of
all religions, ideologies and agencies who strive after
a just
s ocioty.
A meaningful participation in this struggle calls for :
a • a serious analysis of society with 'the tools of social
b.
c.
sciences and in the light of faith;
taking definite and unambiguous stand o n various issues;
initiating concrete action programmes for change.
As a credible sign of this process the Church initiates action
for justice within its own structure. In this context partici
pation of all sections of people especially of the laity is
of vital importance”.
CBCI,
1983.
ii
With this orientation in view the Commission proposes the
following priorities of work, in the field of health :
1
2
Promote Community Health Programmes on the Priority basis;
Train health care personnel with a bias to rural health
4
3
A commission could be set up to study the prevailing conditions
and problems, attitudes and values of doctors, nurses, oara—
medical personnel and other employees.
-
CBCI, 1983.
The relevance of quotations cited above can be viewed by different
people differently depending on the concept of health one has.
One thing is* getting more and more clear that health is no more
an isolated factor and it is not merely the absence of sickness
but the total well being social, physical, mental and spiritual
of individuals, families and communities. It is in this sense that
the above quotations have their relevance when dealing with
ministry of the Church in Health Care.
Health care is a field in which the Church in India has been
busy for over a hundred years. With more than 2000 health care
institutions all over the country run directly by the dioceses
or religious congregations, the volume of work done by the
church is enormous. With ohe well established medical college and
more than hundred nurses’ training institutions we train every
year an army of health care personnel and add to the already
existing ones in the field. With the emphasis since some years
on the field of community health, a new army of village level
health workers (called under different names) are trained and they
are in the field. We have also national organisations, under the
auspices of the Church, dealing with various aspects of health
care i.e. the Catholic Hospital Association of India, Catholic
Nurses’ Guild, Catholic Doctors’ Guild, Natural Family Planning
Association of India etc. This certainly shows the richness of
the resources at our hand. The question will have to be asked is
are all these properly utilised for the best interest of the
people of God in India particularly the bast majority of them
living in rural areas and urban slums.
1 .
COMMUNITY HEALTH s
CHAI has definitely committed to this cause for the coming years.
And we do hope to do something thereby contributing our share
to achieve the goal set by WHO and accepted by our country, l.e.
Health For All by 2000 A.D. This we hope to achieve through
our member institutions and others, and with the cooperation,
help and guidence particularly from the members of the CBCI and
2.
- 5 Promotion of Pro-Life Activities :
Efforts will have to be made by all concerned to bring an aware
ness about the seriousness of this all important aspect of life.,
CHAI will be taking some definite steps in this regard in the
coming years.
3.
Pastoral aspect of health care
This is a field rather neglected by the Church. Complaints about
even rude behaviour by the Staff towards patients in our health
care institutions are not a rare phenomenon. Then the question
is, have we given them the necessary training and orientation ?
Keeping this in mind CHAI organises seminars for health care
personnel from time to time. It is our plan to develop a separate
department in CHAI to meet this crying need in our country.
We also plan to organise regular residential course for Chaplains
etc. in the future.
Against all what has been mentioned , particularly the various
documents menti oned , the following suggestions are put forward
for Justice;: Development and Peace in General and the health
section in particular. In this connection, it was very meaningful
to have put the health section with commission for justice,
development and peace.
1.
To have an evaluation of our existing institutions for
education., training and services in the field of health
in accordance with the present concept of health mentioned
in the documents ( of also the CHAI documents )
2 .
Community Health Programme accepted as a priority should be
promoted in all the Dioceses. The members of the CBCI and
CRI should accept this end and make it known to all our
health care institutions.
3.
In order to implement this, St. John’s Medical College,
National Organizations like CHAI, NEPAI, CARITAS INDIA,
IGSSS etc. will have to plan together in collaboration with
other organisations in the field such as VHAI, CMAI, ISI etc.
4.
Possibility of organisations like, CHAI, Catholic Nurses’
Guild, NEPAI to work together will have to be explored, for
better effect and to avoid any unnecessary duplications.
5.
The teaching of the concept of Community Health based on
- 6
6.
7.
In this connection this commission will have t
o work in
collaboration with the commission on
Seminary Training etc.
This commission should also i
w rk in collaboration with the
commission for Laity and Family.
These are a few suggestions, however practical they may be
which came to my mind. The implementation of them may be
difficult but necessary if we want to respond to the needs of
the time. We all agree that making statements (for whichwe
seem
to be experts in this country) alone will not solve the
problems* We need to translate them into action, which is by
far difficult. But we are left with no choice but to do it if
we want to be meaningful to the society today
and faithful to
the gospel message. Let me conclude this with another
quotation,
this time from Ashok Menta.
"We must reclaim 900 million people (the number is more now)
of.the world who are today in a state of abject depression.
This human reclamation requires a peculiar type of social
engineering. This is to my/mind the big challenge that all
people,.all men of religion, all men of God have to face.
And if it is the proud claim of the Christian Churches that
they have.that spiritual understanding, that spirited agony and
hat spiritual out glow is greater than that of other men of
God, it has to be proved, as I said in the crucible of life
itself. If it is the claim of Christians that even to this
day they feel the agony of Christ on the Cross whenever
humanity suffers as it were, it has to be proved, in action and
not by statement".
Fr John Vattamattom svd
Executive Director
Catholic Hospital Association
of India.
23-11-87/200
mm/
o
M ' I
I
•>
IWEMELi'J
HEIRESSIQhi (PLux)','1-^l-296/'1 AbHOK N4G/^,HYLEJWn
NTR POLICE Rj-.J IR .dWER.
rR^BuSh „
The AoPoPolicd has once again figured prominent!;
,n ‘the national
gewsoThis time it is the increasingH number of custodial deaths which
earned them notoriety. In September month alone six people have been txxtx
tottured to death in six different police stationsoThe deaths occurred in
Tungathurthy Police station (Nalgonda Dtc) , Vijayawada V Town police
station (Krishna Dt),Gu#jala police station(Guntur),Banswada police
station (Nizamabad Bt),Bellampally police station (Adilabad).In 1986
so far 16 people have been killed in lock-upsoAnd all together 61 people
have been tortured to death in the police stations since NTH has
assumed po wer.
In all the instances police tried to portray the deaths as natural
deaths or sucidesoBut civil rights organisations hove brought intt lime
ligut the facts about the incidents.In all the cases the persons who
died in the custody were hail and healthy at the time of detention0All
of them died duo to torture in the lock-up.In two instances even the
judicial enquiry has proved that police men are guilty of murder.These
enquiries were conducted t into the death of GoRamg Rao and Prabhakar
Rao in Vijayawada and Chirala Police stations respectively.
In view of the massive protest against the custodial deaths from
defferent sections of-the society and the extensive punlicity given
to these Incidents by the press the government was forced to order
judicial enquirty into the six custodial death incidents that occurod
in thoK month of September 1986.However a careful scrutiny of the state
ments issued by the government only shows the dual attitude of the
government ek regarding the gustodial deaths. The government has
announced that judicial enquirty would be ordered into all the gUKK&iK±x
custodial death incidents.Further they also stated that guilty police
men would not be spared.But it is note worthy that judicial enquirty is or
ordered intt eight incidents of custodial deaths only., So far only onepolice official is punished.In the remaining cases FIR is filed.But
that is no guarantee that criminal proceedings would begin.Police may
close the case by saying that kkx there is no evidence to prove that
the policemens are guilty.In fact government has preferred judicial
enquiry instead of launching criminal proceedings against the erring
policemen,only to delay the matter.The government appears to be
dragging its feet in punishing the guilty policomen.The statements made
by the Chief Minister that "police men are gods" and that "they are
his right Hand",prove this point bejiond doubt.
-
4
i r/ .
J L
''V-
o
■-> Ik'
-2The 'encounter' incidents,for which the state was famous,are also
occuring with equal rapidity.Since NTR has assumed power 52 people have
been killed in 'encounter's'. In September 1986 alone 4 people wore
killed in fake 'encounters'. While two were killed in Wahangal town the
other two died in 'encounter' in Karimnagar and Nizamabad.
It is well known fact that during emergency period 77 people have
been killed in ' encounters'.The Ta'rkunde committee ,whic„ enquired into
those 'encounter' deaths has charaetcriosed them as cold-blooded murdcri
hftcr throe years respite thos’c incidents started recurring again.
There is one noticoblc feature about the encounter death incidents in
the post-1980 poriod.During this period many people wore killed brazenly
in the towns itself ..During the emergency police mon used to kill the
detained persons in ,tno,foi;cst areas to show that a real 1 encounter1
took place.4s the government is totally supporting the policemen t^oy
now kill the detained person in tx.c vicinity of towns with impunity.
The repression on the people in the rural areas of Bizamabad,
Wrnangal,Karimnagar,4diIabad,Khammam and East Godavari districts is oven
more honious.Crops are destroyed,houses arc pulled down, property is.
damaged with out compunction. In Karimnagar alone 550 houses are ostinstud to have been destroyed by the police in the yast two ycats.In two
weeks clone, commencing from 1985 august last week,81 houses were dest
royed ,in Karimnagar.XaixEK KKkxxEk tags
In the tribal areas people arc chased w away from houses and. the
entire village is burnt down.In booth,Utnoor and Khanapur talukes of
Adilabad district alone 20 villages have been burnt down.Many such
of East Godavari .district.
instances also occurred in the tribal areas
Women are the worst victims.In many tribal areas women are subjected to
sexual harassmoii't •
Mass arrests and torture is yet another form of harassment.Between
>1985 September and 1986 May 408 people wore arrested in Mahadcvpur tq.
of Karimnagar.In thoonsuing torture it is alleged that 5 people uioc.
Many people bribe the policemen to escape the arrest and torture.
-5Tho houses of various loaders of Rythu Coolie Sanghain aro being XKidc
raided cvenday in Warangal district in view of tuo anii-arrack contract©
ers agitation.The arrack contractors onit crores of rupees by duping
the people and the police is deployed to safeguard this exploitation.
The house of Smt.PhoolaEuno,president district RCS was raided twice and
their relations abused and insuited by the police.
In none of the Yuxugu ® Telangana districts mootings are permitted.
In 1986 itself attempts to hold RCS conference in Aloru,Nalgonde district
wore foilod.All the delegates were chased away by the police.Police
prevented a convention on drought in the same district in the month of
June 1986 . The attacks on the civil rights organisations should be
soon against this backdrop.As the civil rights groups arc bringing into
limo light the police excesses and illegal activitos they have become targ
-target of the police attacks.Membprs-of the civil rights gronpr. arc
implicated in eases,threatened end physic:lly assaulted.Every attempt is
made to silence the protest against the
assault on the rights
of people.
•»
Wo ere sending to you this note to sock your support to fight
against the police o raj in Andhra Pradesh.
Yours Faithfully,
Dated: 2^-'10-/1986
( T. mtfiUW)EUN RAJ TT371
CONVENOR.
• Cer^ H ' /
gy%g.l{INES FOR THE iyiAINTENANCE OF RECORDS _IN .COmUNITY HEALTH AKED
DEVELOPMENT PROGRAMIiSSo
A good record system helps us to plan, implement and evaluate our
work effectively,
It also aids in the smooth running and systamatic
effectively.
well as for its continuity in the
functioning of the programme as v/ell
future.
Why records are important?
1.
Records are important in setting objective, evaluating our work
and modifying them if necessary. For example, inorder to build
a healthy community, we have to make the community realise that
many diseases are preventable; we have to record the illness they
suffer from; how many are suffering from preventable diseases/
what are the social illness found in the community; how diseases
are influenced by socio, political/ economic and cultural factors
etc, have to be identified ffom the records.
2.
Records facilitate the smooth functioning of our work as well as
to build good rapport with both govt, and funding agencies inorder
to avail their assistance in our work.
3.
An effective report should contain components such ass
AN INTRODUCTION containing the statement of the problem or task;
THE SUMMARY of what has happened; BODY of the report contains the
method used, significant facts given in the body** of the reoort’
RECOMENDATIONS OR SUGGESTIONS; And the appendix containing a '
table as well as less relevant information^.
►
*
i
Programme.
^necessary _f or community he al th and development
I. Minute-book
II. Village Diary
III* Daily Diary or Chronicle
IV. Family Record.
I* MINUTES BOOK
Why do we maintain a minutes Book?
a.
b.
Co
d.
It helps the team to plan ahead the activities to be carried
out during a limited period of time.
It gives the team thh opportunity to discuss and plan together
the activities to be implemented.
It also gives them^bhance to set priorit^'for various activities
within the limited time.
Team spirit is strengthened by their role assignment and
getting support and strength from each other.
£•
Planning helps in performing the task more systematically.
f.
It also paves the way for evaluation and assessment of the
team work.
Setting time limit for the implementation of programmes and
evaluation, helps us to keep up with our work.
g.
2
39!^?o _maintain
the
minutes
book
'’
though minutes refer to the summary of the meeting or discussion that
had taken place with its various details, here we refer to boJb the
°£
acSoS
since iast teas, meeting Sd ?he pja^f
action for a specific future period ( eg; 15 days)
P
In the beginning of the team meeting itself the report of the previou
be XS
have to
S^h^SintShOUid 5° read- S»eclal
Special attention
attention „111
will have
to be
given
the
of
previous
u
to
second
the
---part
_
,
, -- x—'-'-'■‘-j report, which is the Dian of given
nefirs
_.
ItsSf^
since we have to evaluate thGm
them in ^'beginning
the beginning of the team meeting
itself. for
lor examples
lhe team members A, B and C ’had
example; The
___1 their team
that
meeting
the
following
SXel "
X»
■■*
^bat meeting the following activities
activities wre
-u Gil 111'C* LI®
1.
2.
3.
4.
5.
Visit to BDO office before 7-3-85, by A & B.
Discussion with the Parish Priest on 9-3-85
Visit to the Programme village on Tuesday and Friday.
One meeting of the women group 1C1 will lead the discussion on
’attrocities of women1
Meeting with the sisters of the community on 14th. ’B* will
initiate the Discussion.
To have the next team meeting on 15-3-85.
Minutes of th^teajjimeeting on 15th March^ 1985.
The meeting started at 3.00 p.m.
Topics to be discussed (Agenda)
1.
members present - A, B, C
2.
Formation of youth groups
Immunization of the children
3.
Non Formal Education for women.
After fixing up the agenda, the report of the- previous ■'
team meeting
(ie. 1-3-85) is read, out and
an evaluation of all the activities
in particular is done. For Example
I—
1.
2.
II
IM 'WTniinaBfc-.W|||
Previous Plan of Action.
:
Unfortunately BDO could'nt be met, since he was on leave.
In a
mneIsWaAnd°°R>beC?US^ T3' C°Uld not go that day because: of
illness, ana B only had met him before.
fiXCd °n 9th' Since the ^ish Priest
Wa^b^^wZ^H1?^
was busy we had the meeting on 13th. He listened to us H>ut not
X
vi lteabConStereSt’ Perhaps we should invite him to the '
vi±±ay<— oxiue.
3.
4.
5.
Except on 13th Friday we visited the i
programme village as
planned. This was because of the meeting^rth
’
‘ h Parish Priest,
The discussion could have been more interesting and parti cipatory
I™
Photos or paper
paper reports could have been used,
Malathy could have been asked
-- to
-o share her own experience
Howevo?-C'°^d and with that
^ul^havo started the discussion
did a
helping the women to think :more.
Since we had
guests on 14th the community meeting could not
be held
3
Silent
tO
listeners than
We have to think of different methods and
techniques to be used for discussion
-1 with them.
activerp!?tiJ!panS!n
The following are the plan of action for the
next 15 days;
1. To conduct r“
one youth meeting to know the interests of the youth«
’B’ will be in charge of it.
2. Make a survey
.—
" • the
‘
of
village to know how imany children are there
vzithout immunization.
—»
’C’ will take care of it.
3- Begin informal discussions with
the women to motivate them for
non formal education.
4. Briefing of the work with the community on
17th January.,
will initiate the discussion.
5
Visit to B.D.O. office on 21st.
’B*
& 'C' will go to BDO.
6. Meeting with the women on 26th. ’A’ will prepare a set of
cartoons to help the discussion, on Unity.
7. Visits-to the r—.ill_ will be on
programme
village
Tuesdays and Fridays.Other villages will be visited
.—--- .d depending on the convenience.
The •■meeting-was •concluded ...at 5*3.0
'TT.yXLLAGg pTARY' -T.._ Village
- °f* significant, events -which- we,have
nr. diary is a :
village* vis
its?* It is also -a ■
about-durMig our- -village
seen or heard about-during
visits.thoughts' feelings and observatipns„ahQUt.
our village.
-Xe. nggd, to keen a village diary?
It helps us to see the change in our villager over a period^
of time. Thtsechanges could be?
- in people’s attitude towards us
- in people’s living habits
- more unity in tke village etc
Eg. After working for a number of months in .a village the
local dal brings a pregnant vzoman to us for examination,
his could mean that the dai has finally accepted us as
who will help -persons
her ----J
and no
J take away her
j t• try to
i
has -changed her attitude towards us’
livelihood. She he3
2.
-It helps us to see the change in our
-- own
attitudes and
behaviour towards the people we are workjno^4ith~
'
Over a period of time we haves
- developed greater trust in the people
,
ood the reasons for certain habits
m the village
— learnt how to resolve conflicts in
village meetings etc.
4
3-The
-ln evi!1“etin9 the
of our (
Changes in attitude and
behaviour
7-' a5e difficult to evaluate, so making note of significant
events in the village can help> us see the change over a period
of time
4. A village diary can help a i_.„
new member of the team familiarize
herself with all that has beeni L
happening in the: village. It
will help her to get. to know-• the
—-a finer details of the village
in a shorter time.
diary?
1. Keep a separate diary for each village.
2. Note down the date of the visit
3. Below the date give a short summary of the visit
include the following?
following
This should
a»
Any significant event like discussions with the Sarpanch,
village leaders, quarrels in the village etc.
b.
Any observation and tentative conclusions drawn from
the observation.
Co
Plan of action.if any for the next visit.
4. All village meetings must be recorded
even if they are
routine meetings.
5. Make it a habit to fill in the village diary immediately
after the visit, otherwise you will forget to note down
important points.
6. It is necessary to record every single visit to the village.
took place in the village (Example)_
visited the programme village named Bhedia.
We went to the house of Panchayat President Mr Ramen who was
getting ready to go out on an important errand. Hence he
promised that he would meet us on Friday at 4.p.m. We- found
t at inspite of the fact that he was in a hurry,' the President
in us and so, he promised that he would meet us
V4_F idlyAi^After he left' we spent some time with his wife who
extended
warm welcome to us and asked us the purpose of our
v^sit. While we were explaining, she showed great interest
which gave us encouragement to go there again. . Sheetold us that
e was teaching in the village school and she feS^fce glad to
render any service^ to us. Thus we came home happily.
April 15th
We visited few houses in different parts
•
of the village and we
found that. on the whole the people. were very welcoming. Many
were asking us to col.
their village, preferably after
5
happy to meet us again, r
We discussed with him in detail about the
purpose of our visit to the village, He seemed to be very understand
and really interested in his people, He invited us to the village
meeting which
be held on April 20th to attend the village
meeting.
April 20th
We reached the village to attend the village meeting.
The president
and about 40 men and 10 women
•en/partiqipated’in the meetingr. The
president introduced US ^d/^ur^purpose
/^our
' visiting the village to
in
c
the people, On.hearing
thisz the people were happy and showed
interest in their work^ They
'
asked us to attend"the village^
meeting every month and this
has (gave us encouragement to start our
work with confidence, The meeting was concluded
------- 1 at 8 p.m. after
which we came home.
I
III. DAILY DIARY OR CHRONICLESg
Daily activities of the sisters working in the health team have
to be recorded in brief.
brief, in the daily diary.
Why do wc need the daily diary?
a.
It helps the sisters to recall the various activities
undertaken by them during each day of the month,, year etc
the team during evaluation
b. It helps
.
- ---- - ---- - to see now
how iiinxiy
many days they
have spent for their work, whether that is sufficient
----- -j. etc o
c . It also helps in the continuity of the work when written
chronologically.
the daily diary or chronicies g
i
February 10th - Visit to the programme village.
February 11th - Preparation of assignment. reading, study etc
in the convent.
February 12th - Visit to Gody village adjacemenb to the
programme village
February 13th - Visit to PHC and discussion with the Doctor
February 14th - Community meeting in the convent for discussing
the village work.
However, the details of visits in the programme village such as
what happened in the village during the visit , what discussion
was held in the PHC in relation m
to the programme village etc.,
will be given in the village diary
------ ± while
••-.Ho the content of the
community meeting will be written in brief in the minutes book.
>1
IV.
FAMIL RECORD5
6 -
Hhy do
tain. g,.family record?
a.
Family record gives the history of
and their particulars.
b.
Xt gives an idea about the size of the village.
family etc.
Since it contains various details about each familv it is a
c.
“d
SS
d.
each family with its members
relatio„ship
It helps in immunization programme.and
—-----.. .
to identify
the -member y
of youth both boys and girls, children, men, women etc.
Who
could be. organised into different groups.
How tomaintain a family record.
dHoi
/ a
I'
rl ?
5J
1
:e . No. .. .
t
;
sl
NO 4
■
~T "f
i
i
•
i
i
; Age ; sex J
i
7
I
I
i
[
Head/rela- [[Marital[Educate[Occuf
tion to head {Status [Quali. [tion
---— r
T
i
i
i
i
i
i
«i
f
<
|
:
r
I
!
i
i
i
X
i
i
i
i
i
i
i
I
I
I
I
i
t
t
I
I
I
I
--- -—
~
*
i-- --- -- --- ---
,
Name
f
w
I
I
f
i
I
I
I
t
I
I
f
f
I
r
i
i
i
i
i
i
I
I
Lx
Two fshould be set asile for
pages at■ least
each family in which
the various details of that fl
family is recorded. As visits are
made.regularly to some family,j some more details containing
confidential matters could al^
also be noted which will help us to
understood persons in a better
tor way.
Community Health Department
Catholic Hospital Association c± Ind
157/6 - Staff Road,
P.B. No. 2126
Secunderabad - SOO 00 3 A.P.
i
Cor^ H "
SYMPTOMS OF DECZ<Y
1.
Exploitation of the poor
- in the market place
- by business men
- by media
2.
Harassment by officials
- corruption
- bribery
3,
Landl as sno s s/Lan cl 11 ienation
4.
Lack of food
5.
Adulteration of food
SOLUTIONS SUGGESTED
I h) •
—
-2SYMPTOMS OF DECAY
6.
Lack of safe drinking water
7.
Lack of oroper facilities
- education
- transport
- govt, health care
- communication facilities
8.
Lack of credit facilities
9.
Money lending practices
10.
Low Wages
11.
Lack of knowledge in legal
matterso
SOLUTIONS SUGGESTED
-3SYMPTOMS OF DECAY
12.
Illiteracy
13.
Inferiority Complex
14.
Unemployment
15.
Migration
16.
Bonded Labour
17.
Child ^abour
SOLUTIONS SUGGESTED
-4SYMPTOMS OF DECAY
19.
Exploitation of Women
- no decision making power
- female foeticide
- wife-beating
- Pur dah system
- rape
- prostitution
- dowry system
- widowhood-remarriage
- female invalidism
- property rights
- occupational hazards
- undernutrition and mal
nutrition
20.
Discrimination on the
basis of caste
21.
Alchoholism, smoking.
- leading to quarrels
- poverty. & ill-<hoalth
.SOLUTIONS SUGGgSTSD
-5SYMPTOMS OF DECAY
22.
Extravagance in marriage
and other celebrations
23.
Fatalism.
24.
I nd iv i du al i sm.
- lack of unity
25.
Environmental pollution
SOLUTIONS SUGGESTED
- no sanitary facilities
- pesticide pollution
- water pollution
26.
Unhygienic Housing
I
-6SYMPTOMS OF Dj ]C2i Y
28.
Rapid urbanisation
- increasing number of slums
29.
Loss of respect for the
culture and traditions of
people.
craze for "modern" &
"foreign" things
30.
Unquestioning faith in
doctors and medicines
31.
Commercialisation and
privatisation of health
care.
32.
Proliferation of irrational
drugs.
- ineffectiveness of drugs
- lack of essential drugs
- massive misuse of drugs
SOLUTIONS SUC-C.:USTED
-7-
SYMPTOMS OF DECAY
■
■
1 IW»
I I w I 1 ■■■ ■O
III
IB
I
33.
Non-availability of
vaccines
34.
Sexually transmitted
diseases
- AIDS
35.
Religious fanaticism
- communalism
- religious fundamentalism
36.
Lack of committed leader
ships
SOLUTIONS SUGGESTED
<2 o r^x H " I 6 I
THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
*
Community Health Department
Grams
CEEHAI
SECUNDERABAD 500 003
Telephones : 84 82 93,' 84 84 57
Telex
: 0425 6674 CHAI IN
Post Box 2126
157/6 Staff Road
SECUNDERABAD 500003
STRUCTURES AND SYSTEMS ;
(This is an attempt to understand and explain certain
terms and expressions often used by Social Scientists
and others to express their understanding of Society
and to analyse it. This is not a critique of the
structures and systems but just a thecritical
description)
The term ’Structure’ is used today to understand various realities,
which are related to man’s life. The word ’structure’ evokes in
our minds the image of various parts, components or elements
organised into a unit. Infact the different elements of a structure
can be understood only in through their relationship with one
another and the totality. There is a functional relation between
them. This can be illustrated by the example of the diverse organs
of the human body, which are parts of a whole, as as such draw
their meaning from their relationship with ohe another and the
whole.
When we apply this concept of structure to the field of human
activity we can identify certain structures there too. For ins
tance, a family, an army, an institution, in it each person
possesses his position and ’status as well as his own role and
funtion. Each person carries on his task in relation to others
and to Society.
In the simplest understanding this term is applied to understand
a construction, a building, a set up because of which the
transformation or change of structure is often understood as
getting rid of a demolition of a building or an institution.
We use this term to understand the social realities and functions
of the Society. Social posiUon can be defined as the particular
point occupied by a person or group in a Social Structure. This
is often identified with social status and includes the set of
attributes or priviliges attached to that position. In the
context for example we have the caste system, the hierarchy
of castes with their attributes and previliges or discriminations.
J
2
There are established patterns
of behaviours and standardised
procedures - and we can say that the interactions are institutionally defined and controlled,
In other words, we can say
that a Social Structure is a set of - institutionally defined
and controlled
relati ns between individuals and especially
groups 5 these relations <are studied and understood through
a proper analysis of the society which.1 will bring out the
various control measures and hidden mechanisms which control
and limit man ,s life and actions.
Different structures have different interests and values,
often they become conflicting and one tries to control the
other or overpower the other, which leads to disharmony,
tension and exploitation. Thus the very structure itself
becomes oppressive, dehumanizing and exploitative. The power
ful structures force their ideology,, values,
values, rules and regulations
and keep them under
community to
on therestof the community
them and
d iminate them
to dominate
their control, unless suitably
challenged gives 4-hem
them more power
suitably challenged
and better positions in the Society. This controlling mechanisms
is often not understood by the vast majority of the poor
sections of the society and thus not in a position to counteract,
as often the powerful use ideological system to achieve this
end. In this process the injustices get institutionalized and
in turn internalized by the society. Thus it becomes an established order of behaviour sUu. remained unchallenged until someone
wakes un andunderstands the undercurrents and the diverse
mechanisms employed to achieve this end. This structure today
we call an unjust structure.
A social system can be defined as a coherent complex of
structures and behaviour arranged according to time and space,
A system is a broad unit comprising several structures which
interact as different components do in a structure. The
structures of Production , distribution, exchange and consumption
for example interact and form a single economic system. And
the various social systems similarly interact and make a
'global system' or Society. A Society is comprised of the
economic, political, social, noligious, cultural and ideological
systems. The first three systems c ncern the organization of
Society while the last three deal with the meaning that men
give to their individual and collective life.
I
I
- 3 Religious and cultural systems don’t seem to be of much concern
to them, though Marx has a critique on religion.
Economic Systems
Every individual and Society has to satisfy certain physical and
psychological needs or wants, as for example food, clothing,
shelter, medicine, entertainment etc. Man’s Primary and basic
activity is that of Production. The economic system comprises
of four basic structures : Production, distribution, exchange
and consumption. In the process of producing and circulating
the material goods that meet these needs man relates to nature
through certain technological tools called instruments of
labour. They also relate to one another and form certain relations.
The sum total of all these is called the economic system.
The Political System
Man basically is a being with intellect and will which enable
him to make decisions for his own benefit and that of the society.
But when there is a bigger group, individual decisions can affect
the common good and hence there is need for a joint decision
making to ensure the benefit of all the members of the society.
This process of making the decisions is the political system.
When this decision making power is exercised through the elected
representatives of the people we have a democracy ; a rule (govt.)
of the people, for the people and by the people. This is to
ensure a smooth functioning of the Society/Nation. The decision
making power is handed over to the elected representative so
that rules and regulations can be made to the advantage of the
whole community. Historically speaking we also come across many
others forms of government. Autocratic, Military and Monarchy.
Even in a democratic system the common good very much depends
on the ideology behind, namely capitalist or Socialist approach.
The Social System
Interactions between man and man, and between social groups when
structured and institutionalized becomes the Social System.
This concept implies a certain distribution of. Social Prestige
and Status, or in other words a certain Social Stratification
understood as the differential ranking of human individuals,
t
- 4 Various factors do, or can contribute to form this social
stratification in different types of societies. In the Indian
context the social system influenced and determined by caste
system , which divide the people into high and low on the basis
of birth. Set of rules and regulations are established by the
society in terms of man’s life, relationships and behaviour ?
hence traditions, customs become part of this system. But
today we realise that there is a class caste combination which
controls and dominates each aspect of Indian Society.
Religious System
Religion 'basically is the established form of Man & God relation
ship. This relationship when organised and institutionalised
becomes a religious system which regulated and controls various
aspects and structures in terms of worship, Morality, ethics
and values. Jt is distinguished from other meaning systems
by its emphasis on the ultimate. It offers a systematic message
capable of giving a unified meaning to life, by proposing a
coherent vision of the world and of human existence, and by
giving them the means to bring about the systematic integration
of their daily behaviour. This message is always situated in a
precise historical context, and provides believers, reasons
justifying their existence as in a given social position.
Cultural System
Culture could be said as the sum total of Man’s Social Life in
a geographical, historical context in terms of the values
expressed through attitudes, thinking pattern and behaviour
which are manifested in the customs and traditions in a given
sociological Milieu. Knowing the people is to know their
culture : Why they behave and act in a particular way, what
decides their life circle, why certain parctices exist, why
they have certain value systems etc. The value system in
turn also influences their life and activity. The very value
system is also very much influenced by the religion they
practice. Thus culture and religion has a close link.
Ideological System
The term ideology was first used in 1797 by Claude De Tracy as
- 5 ideas and judgements which serves to describe, explain, interpret
or justify the situation of a group or collectivity and which
largely inspired by values proposes a precise orientation to
the historical action of this group or collectivity, Houtart
speaks of ideology as a system of explanations bearing on the
existence of the social group, its history and ins projection
into the future, and rationalising a particular type of power
relationship : The legitimation that an ideology provides to a
social group is never absolutely logical, but contains emotional
elements which are capable of motivating men and giving them a
feeling of security. Ideology is thus a fundamental element
in the culture of every human, ethnic, social or even religious
group. In this modern sense, ideology always includes in a
more or less explicit manner an understanding (analysis) of
society, a vision of the future, and a choice of strategies
and tactics understood in this way. The concept of ideology
can be used for both a small group (trade union, political
party etc.) and a whole society or nation. They foster the
interest of a particular group in society, and promote a specific
socio economic and political organisation. They can be
classified as reactionary, conservative, liberal and revolutionary.
* * * * * * * *
2 0-11-87/250
SP:mm
Co
H - i & l °)
MICRO LEVEL VOLUNTARY HEALTH PROGRAMME
A Case Study
Village S is situated off the national highway on the main bus route
to the taluk headquarters. It has a population of 3000 people. The main
occupations of the people are agriculture, sericulture and dairy. A few
families weave carpets out of unprocessed sheep wool. The land is owned by
65 per cent of the families. The plots range from half an acre to twenty-five
acres. 35 percent of the people are landless labourers. Most of them
are harijans and they live in a separate part of the village.
The village has a primary and middle school, few shrines and a chawki
rearing centre. The Government health centre (PHC) is 8 kms away and one
of its subcentres is 2 kms away.
The highlight of the village is a milk
cooperative which collects 5000 litres of milk per day and sells it to a
government dairy in the city 45 kms away. The cooperative provides feed,
fodder, fertiliser, tractor facilities and loans to all its members which
include 45 percent of the families.
Health Programme
1973-75 : A voluntary agency (VA) based in the city and interested in
community health work initiated discussions with the leaders of the milk
cooperative to start a health centre in the village. As an experiment in
self-support the cooperative agreed to set aside 3 paisa per litre of milk
for health activities. From the Rs.2400 - 2700 that was available each
month through this scheme, the VA assisted the cooperative in identifying
a doctor and nurse from the city to work in the centre.
Three villagers were
identified, to be trained informally as record clerk, compounder aid dai.
The health cooperative (HC) was run by a committee which consisted of
leaders of the milk cooperative and representatives of the VA, government
dairy and PHC. The doctor was the secretary of this management committee.
It met every month to assess and plan the work of the centre.
The HC rented out an old hotel for the centre and some accomodation for
the staff. Medicines were brought at wholesale rates from the city. Tonics
and injections were stocked to prescribe to non-members and supplement the
income of the centre. Some medicines, vitamins and vaccines were tapped
from the PHC. The VA provided technical advice and obtained donations
of medical equipment and a motor-bike for the doctor from foreign donor
agencies•
He provided curative services through a daily clinic. Preventive and
Promotive services which included maternal and under-five child care,
immunizations, vitamin and iron supplementation, chlorisation of wells and
film shows were also organised. Curative services were available free to
members while non-members had to pay a nominal cost. Preventive services
were available to all free of charge, Poor non-members families were
.... 2
.. .
—
The doctor and his wife started a Mahila Mandal which organised a
balwadi, child feeding programme and obtained a sewing machine for the
village women.
A young farmers club was also started which organised games
for village youth and helped the centre during immunization, health •
education
u.
programmes and specialist camps.
1,976 : The cooperative stopped setting aside Rs.200/- per month for
concessional treatment fco poor families. The VA took up this responsibility.
The doctor left the centre? after differences of opinion with the leaders and
started private practic. in a neighbouring village . The VA helped the centre
to identify another doctor«
''.‘lie Mahila Mandal closes down and the
sewing machine is kept by a panchayat leaders wife.
1977.: The nurse left the centre after training the dai in all aspects uf the
centre’s work>
The committee ivied to find a replacement but ultimately
decided to appoint the trained da- as the. 'nurse1 pf the centre. Committee
meetings were held once in 5- 4 - •. .’
.•.■So
■12.7P : The milk production in the *. lllage came down drastically while
sericulture increased in rhe a.:eaa The health cess per litre became too
high to run the basic health services. So nee it was difficult to
cooperatise sericulture rho mill?: cooperative after some hesitation
invested some money it had kept aside for a chilling plant, into a fixeddeposit endowment for the health'c entre
Because cf the Increase sn sericulture, landless harijan families
began to get mere work and ;nary acquired a local milch animal. They.tried
putting some milk into i;he <common pool to get membership status and free
health facidities, The cooperative committee closed membership to keep them
out o
1979.: An evaluation was conn to study tne impact, of the centre. It found +
that though all : '.j.j.lief were aw-are
of the centre., some of them did not
utilise xts services t. Some richer families preferred private practitioners
in neighbouring village
I. c..:y landless families had apprehensions about
theattitudes of some of t.:io smfi . Triple antigen and polio immunizations
had been given to 35 perccn: of the children. Malnutrition and Vitamin A
deficiency had not improved - in fact there were indications that it had
become worse0
There was no ohacgo in environmental sanitation. The centre
did no family planning ?rork, because of the church connections of the VA.
1982,: The centre got its fourth doctor since 1977 •
Each of the previous
ones had stayed for periods va.cging from few months to two years / with the
help of ’lovemment subsidy and asome
om e savings the cooperative also built a
health centre and medical officers quaiters.
The VA donates furniture
and more equipment to the centren
Task: le What are your impros?..; <71 s about this health programme ?
si *
4—-
Date
Date
House No*
From Road to
Health Chart
Child’s No.
----
Mother’s Name
Husbaikl’s Name
CM
---- o
House No.
Father’s Name.
Mother* s Age
Child*s Name
tc
Parity
°o
—
E D D
Child’s Date of
Birth
H
H
u
H
HI
H
I
so
BCG
o w
oj
n
Booster
hj Co
§
1
xO
January
A
O
8
g
8
H
&
%
O
Date
y w
By Whom K
o
t ••
s
o
April
Si
cn
May
So
§
June
o
I
February
March
£
Type
Place
H
O
Booster
cn
8
f
xO
CT
»-3
to
W
Ti
o
(O
g
H
O
W
cn
I
§
Still/live
birth_____
J-
Sex of
child
September
Birth weight
October
H
6
-w
August
w
xO
0}
November
December
I
■
g
r
Cr-
i
is. No.
Name of Pat isn't
Age
Sex
Caste
V?
Village
Diagnosis
Treatment
o>
Register
xO
Actual co st ..of
Medicine
-o
Service charge
Total charge
ro
8*-d
Amount paid
-d
Concession
H
3
g
o
§
O
i
L
i
CD
J
H
H
(2,0
H'
VALUES & VALUES (F)
Miss Sumati was from a very poor family. She lived in
a hut near the bank of a river. She was in love with Mr. Sunil,
who lived on the other side of the river, and was also from a
poor family. This love affair was known to both the families.
Ome day Sumati heard that Sunil is seriously ill. It was
monsoon time and the river was overflowing. She had to cross the
river by a country boat. But she had no money to pay the boat man.
She approached Suresh, her neighbour to borrow some money, but
he refused to give. She then met Shankar, the boat man and ex
plained to him the situation, and assured him that she will pay
him the boat fare later. Shankar insisted that only if she
pays the boat fare (rs. 2/-) he will take her to the other side
of the river. She pleaded with him and told that her lover is
seriously ill, and that she must meet him immediately* Shankar
told her that if the matter is so urgent he will take her to the
other side on the following day provided she is prepared to
sleep with him that night. When Sumati realized that arguments
were of no use she agreed to the condition.
On the following morning Sunati reached Sunil's house, and
in the course of their heart to heart talks, she narrated the hardships she had to go through inorder to meet
--- him.
-- . Sunil got a
shock of his life when he realized that Sumati is no more a
Virgin, and in his anger he beat her and chased her out of the
house. Sumati returned home very sad and frustrated.
When Sathish, her brother asked Sumati the reason for her
sadness she told that Sunil rejected her and she was ill treated
and beaten by him when she visited him at his sick bed. Infuriated
by this Sathish rushed to Sunil's house, pulled him out of his
bed and killed him.
Who is the most virtuous character in this story? Why?
Who is the worst character in this story? Why?
17/11/1987.
t. j o /I. k.
200. P.
Community Health Department
Catholic Hospital Association
of India, P* B«, 2126,
Secunderabad - 500 00 3.
' Ik'
♦
CATHOLIC HOSrITZL'ZSSQCI/iTION OF INDIZ
C.L.C.I. CENTRE, GOLDZIG-H/iNZ
W DELHI - 110001
QI'S F^CBLEMi^N EXFEBliyIENT
IN Z.DULT LITEBZiCY
( J.T. Matheikal,S£. Xavier’s Delhi )
iis Frei re <explains ( of his bocks ’’Pedagogy of the oppressed ”
and ’’Cultural /action for Freedon”), it is not enough to give a per-s
son the ability to read and write, if our basic concern is to enable
him to achieve more human conditions of
life.. More important even,
---- ------he should be enabled to see what elements contribute to his dehumaniseci situation ana ^he snould be helped to acquire the conviction and
confidence that he can bring about greater humanisation by action
on the unjust order that oppresses him
This new method of adult literacy was tried out in a pilot pro—
i^rammo undertaken by an ZICUF Unit of Delhi. It has been found that
it could train a group of people, who did not know how to read at
all, in such a way that in only ^ivc weeks of our one hour sessions
per day, they could begin to read the Hindi newspapers. In this
period they learned hovz to write two or three paragraphs, in simple
-utinoi, on a variety of topics. Zllong with this literacy achieved
there were several other benefits also that came to these people.
Those will be pointed cut later as they will be une’erstood best per
haps only after the method has been explained.
THE METHOD
First a picture, preferably of a social situation common to
their daily life, eg. that of a bazar (market place), is shown to
the group. They are asked questions about the situation depicted
in the picture or about the people who appear it, and they are
helped to discuss the event in their daily life eynbolised by the
picture. This discussion will last ordinarly for about half and
houn,. but the duration can be adjusted" to the exigencies of the
ses sion.
This discussion has the very important function of enabling
the adult-students to acquire a critical comprehension of the social
reality, the first step in conscientisation, according to Freire.
The picture helps the student to objectify the social situation and
gain a certain psychological distance from it. The unreflecting
illiterate, on the contrary, experiences himself submerged in the
world. ’’With no possiblity of emerging from it, and adjusted and
adhering to reality” (Freire); hence algo lacking both self-know
ledge and knowledge of the world. The objectification and analysis
of reality enables men to ’’add to the life they have the existence
T’ discission of the picture helps the
they make
/ ” (Freire).
■
students to acquire gradually the quiet dignit that comes
----- -- from
_ —i a
certain detached understanding of life; tand' also insight into the
causes of the problems of life gives then/confidence, faith in their
ability to change the dehumanising order.
When we have had a discussion that is satisfactory we tell the
group that they have been so far discuss!ong the ””ba:ja:r ”. Nov;
2
When the students write, <especially during the first few days, they
need close supervision by the instructions,. A ratio of one-to five
of instructors and students, is found to be necessary. (This need
discourage us since what is demanded of the instructors who
„r..j super
sup er-
vise the writing is only that they know how to write Hindi letters;
primary school liindi is more than enough, Hence any school boy can
be an instructor here)
This stage demand a great deal of patience from
boy
fren the school boy
who act as instructors and is an education in itself for the boys.
For they see how the adults painfully form the letters, how difficult
the adult finditto grasp many things the boys take for granted, and
the finally through repeated failures emerges success in mastering
the contours of the alphabets. Besides, the under standing and the
helpfulness that the school boys ordinarily show the adult-students
at this time brings the instructors and the students closer together
in mutual understanding and appreciation.
Next the word nba:ja:r” is split up into its phonemes (or different syllabic sounds) as bajar,j tand’ the
“
group shown how different,
sets of phonemes could be formed with each
------ consonant.
--------------- . ils for example:
ba ba: bi bi: bu bu: be bai: bo bau bam
ja ja: ji ji: ju ju: je jai: jo jau jam
ra ra: ri ri: ru ru: ra rai: ro rau ram
The students are made to write down all these phonemes of the
three different consonants. This will be a laborious process for
them the first few days, /ifterwards, however, they vzill find it
quite easy as the vowel-combinations are writen the same way for
practically all the consonants.
When the students have written down, all the three sets of phonenes we tell them that as the word 'ba:ja:r'’ <can be formed selecting
and writing together three of the phonemes in the sets they have,. so
many other words they know can be formed by selecting and joining
other phonemes, e.g., j-or; ra; ja: Now the students are asked to
make as many words like these as they can.
/ifter the students have exhausted all the different possibili
ties and have made quite a number of -words we collect all the
words they have written, from each individual, and write them on
the black board, If one or orther student notices on the board that
he does not have in his list he writes it down on his paper.
In the above manner our pilot group able to make the first day
about 35 words. In a group where the first picture used was that of
a boy to introduce the generative word ’ba:lak’ (boy) the students
made words like the following on the first day: Bail (hair), Ka:la:
(black), kal (tomorrow), bulbul (^one variety of bird), bail (bullock),
bi:bi: (wife), bo:la: (he said), ke:la: (plantain).
Next session, the whole process is repeated with another picture
e.g. of a cha:dar, to lead the students to a new words with sone
letters different from those of the proceeding. In this way parti*
cally the whole alphabet can be covered in two weeks.
In the next stage we train the students how to write joint
consonants, again with the help of pictures and discussions. This
work could occupy the third week. By the end of this week the
students can read and write all the letters and their combinations.
?.t this stage they can also read the natter in the newspapers, al
I
3
In the fourth vzeek we start discussing a picture with the stu
dents. lifter the discussions the students are asked to write four
or five sentences about the picture: actually just to write down
that they have been saying during, the discussion. In the beginning
the stuc.ents, especially, if they are villagers, write sentences in
their village dialect. Then the instructors help them to make the
proper alterations to change the dialect-rlanguage into simple gramatical Hindi.
During the fifth week the students can bo taught how to fill in
forms e.g» money orders forms, applications, etc. They can be also
given instruction on how to write dufferent kinds of letters. The
best method appears to be give these activities as assignments and
then to make the necessary corrections through common discussions.
301-^ SIGNIFICANT Zi&rKCTS
i)
In the first stage, during the discussion the students becone
emotionally involved in the situation and the word that depicts the
firnly. The result is
the picture is engraved in the subconscious firmly.
that when the word is finally written on the black board it is re
ceived as some thing almost expected and is retained by memory with
little effort.
ii) The words that introduce the letters and the word that are made
by the students are all completely relevant to their life, and enti
rely functional.
iii) When the students fern words they are choosing certain phonenes
and rejecting certain others. This ’’choosing and creating” enables
theni to experience a deep sense of achivenent which is not a snail
factor in keeping up their interest in the prograroQ.
iv) The discussion part has another important function, Depending
on the instructor who guides this, it can become an excellent occ
asion to sensitise the people to any su?jject or value. For example,
asking the proper questions, we can, during a discussion of the
ba;ja;r, discuss topics like the price rise, the mechanics of a
market, budgeting, storage, hoarding, the laws of demand and supply
consumer-cooperatives, etc. It is for this part that we need instru
ctors who are knowledgeable in the language and who are experts in
the art of putting across ideas to others
v)
The discussion part also develops the- ability bf the students
to think logically and express themselves clearly and systematically.
Besides, soon the students lose their inhibitions about speaking
before others, and learn how to listen and take part in a discussion
fruitfully.
vi) Writing the different phonemes and the words the students make
vies them also the much-needed drill in writing the letters, without
their realising that they are being drilled in them. In fact they
experience this exercise as a giame and thoroughly enjoy it.
vii) As I hope it is clear, except for the discussion part, it is
not', necessary that the instructors ise experts in Hindi. In seve
ral cases, as in the pilot group in Delhi, the instructors were
actually able to learn now words and ways of expressing things,
from the students.
4 -
In order to instruct boys l .
the method it is enough if theyand girls of colleges or schools in
/ come ano attend one session of the
P^Sranne. No special course is needed as far
as the teaching of
txxe alphabet is concerned. To
carry out the sensitisation part, on
the other hand, orientation course,
preparatory study classes, etc.,
will be helpful, even necessary.
sane instruwt, present at all the sessions. F
VZe can have a group of
turn;
™pie’
in gUiGmg the seasiona, one eact day: thus each - ? Ciuring the week
one will not hinder
b’‘ ’i11
ety 1»""S
sone refreshing variix)
For our young people, r
. -?Se and high school studeats, this is a very eaSy Tout extremely C011
useful
- project in social
action, The
r*
students will be «2^
’,,“ x ^
elP.tfaeir fellow-citizens to
become literate
---- ■ and to sensitise them ito different aspects of life.
lit the
the ^scuZsion
-0117
--------part, they will
become Xre^rthZ^00
aware of the socio-economic <conditions
'*
health situation and cultural values, in short, ofi_ the people, their
, in short, they wilj come into
intimate contact with
"L the
ILj oridinary, real Indian.
" instructors in
this pr ograrxie get^ple’ opportunities°to Wh°
naturity and good sense of their • "illiter°+°°De \°
°W tile Faience,
students. This enables the forr-er *llterat?’ under-privileged" adult
their less fortunate brethern ZLl
F re3peCt and lovo of
reCucea Barriers between classess but also helps the <5^ F?*
°yS tO cultivata ^ial eoncern in the truest sense!
x)
The literacy programme will be t
any village
or slum,
—- Almost everybody is anxiousa welcome project in
the common misunderstandings of the ] to become literate. If gome of
people are cleared and if the
location of the lsessions and their timings
suit the
j convenience of
the people^ it should
-------: not be difficult to persuade them
to come for
programme.
the
find since the method is
‘interest of the people will also be kept completely functional the
up throughout.
xi) It is suggested that this
literacy netted be tried especially
of the
for young people iust
F
people ifao
erFP’ 15~25- They are
feel they have
education, who experience their
ieat hSr-8
illiteracy as a
..,7
great hancicap in nodera life
Th™
and unafraid of new ideas. They also have tho iF
Stl11 young
for the p“
of betterment in their work an^in 2^!
k?*"8
prospects
they become literate, Besides, they ha^^e^n tLlrliTt
venture farther end
selves. ’
become enthusiast!
of their reo™ity
method to change their
— ——
X -I. JL t? $
xii) This method is
one that ^enciF
involves8 IF- 11*tle exPense. /Jl
that a student needs is ■ papeFand
pencil.
paper
and
because anything they write can beLpnt f (Baper is better than slate
write Frf™
instructor needs a coloured
F
* fUtBOe Ief«»ee.) The
Chalk needs can, be taken fron any Zer
pictare
by himself.
7 Faper °r Wa^ine, or could be even drawn
5
xiu)
For villagers or slun-dwellera it will be better if the se
ssions are held in their locality, in a shed, under a tree, etc.
near their houses, rather than in the unfardliar surroundings of
a school or a big building.
xiv)
This method, of course, can only be used to teach people
their mother tongue. (One cannot teach English, for example, using
uis method). 4ny Indian language can however be taught through this
nethoo to those who speak it since all Indian languages are phonetic
m elaborating their script.
xy)
The words that were used in cur Delhi programme were the following, in line order in which they ■were taken up:
Ba:Ink (boy), Cha:Car (shawl),
'
(fish), sanno (opposite),
), kachali:
bhikha:rin (beggar-wonan)x, gariib
(p
>J001,)? Bhojan (meal), Koyala(coal),
ajcfcii (nan), aurat (woman)),7 odhni: (veil), jharna: (water-fall),
ta:la;b (lake), Tabala (crur.?.),
). ha:th (hand), dhanu^h (bow), Va:n (arrow)
hathaudi: (banner), kharges (h
N_iare), pha:vada: (spade), pa:thsa:la:
x
(school), ghonsla: (nest)
akshar (letter), vigyan
t) u:nt^ (camel),
(knowledge-picture used,-a book),, /inru:d (guava) a:i :na(nirr or) , ina:
rat (building) utna: (so much),(picture showing contrast),
ainak
(spectacles).
The anin principles we
the following:
had in nind in choosing the words were
a) The words were.to.be frora the ordinary life of the people
. ‘ and
as far as possible, depicting concrete situations. (b)
(
Especially in
the beginning the words should have at least three consonants (c) the
courses are begun with letters that are easy to furn and acre fre
qucntly used.
/ilthough sone thought had gone into the selection ef the words
they were not the-- result
of any rigorous linguistic t
----------------analysis and they
need not be the nost appropriate words nor in the best
sequence.
xvi )
It is important that there should be <a well-though-out followup progranne for sone nonths at least after the
course, if the newly
i
literate arc net
to lapse bacl^ into illiteracy. It should be Dost
desirable that there is availablej literature that is relevant
to the
lives of those odult—atudonts. The matorinl ]
in
presently
available
Hindi is quite inadequate, V/x-i
Writers in Hindi and
g
the governnent
and
—
will
educational
other....
agencies
-- do a great service indeed to the coun,
Meanwhile one of the best methods we found for following un
on tae students has been to take daily newspapers to then and after
yaking then read out relevant items from the papers, help theA to
Oiscuss the topics and write about then. This way these adults
lest 01 the worZdane, at the same time, aone taste is cultivated
“resP°P®r reading and discussing the current affairs
1f-tk0h
which hopefully will enafcle then to grow in\heir
nent and effective participation in social and political life.
1
CoH
The Catholic Hospital Association of India
C. B. C. I. Centre, Goldakkhana, New Delhi - 110001
Tel.
310694, 322064
Ref. No.
Date
ADULT EDUCATION AIW ^COITSCIENTIZATIPN
ACCORDING TO PAULO FRBIRE
YVON AMBROISE
(Note? This paper was prepared with the notes of Dr. Mary
Pillai and Dr. S. Emmanuel.)
1 • ^an s Subie^t qr Object
The starting point of Adult Education or Non Formal Educa
tion programme of Paulo Freire is man. Man in the concrete
existential situation. He defines man a being ox relation
ships with Nature, others, society and with the Transcendental
power (God/Gods). The relationships are pluralistic and
they are impregnated with challenges., Man has to face these
Such reactions may be reflex
challenges and thus react,
9
actions or reflected action Reflex actions pertain to birds
and animals, Han should reflect and act. That is to say
‘
others and the society
man should relate himself to nature
other
should have a critical
.
„
,
In
words
he
in a critical way. L—---enters
into relationships
those
with
whom
he
perception of ---------- --In the act of critical perception men discover their temp
orality - i.e. - they reach back to yesterday, recognize
today and come upon tomorrow. This consciousness of tempor
ality creates in them a sense of their historical nature.
Thus men do not submerge in a totally one dimensional 1 today1
but emerge from time. They cease to be prisoners of a
permenant today but free themselves from it. Their relations
with one another and with the world become tnereforee
impregnated with consequences.
For Paulo Freire the normal roleof man is thus not passive,
participation and intervention in the
rather it is one of
<
* * , Entering
reality of existence witn the object by changing it.
into and intervening
intervening in the reality consists ofs
- inheriting acquired experiences
- creating and recreating
- intergrating themselves into their context
- responding to the challenges of realities of life
- discex'ning, transcending, and with these entering
into the domain of history and culture.
When man intervenes in the reality in this way Paulo Freire
says he becomes an integrated_ man.According to ni*.A,
integration IS A DISTINCTIVE HUPJAN ACTIVITY • u_t results
from man’s capacity to know the reality plus the critical
capacity of making choices in order to transform the reality.
The integrated man is a person, a SUBJECT
Opposite to this stands ADAPTION to reality which means
man’s inability to understand the reality and to make a
2
2, Levels._ of Pe.op.le^_^jisj;^ousness
The Central problem of our ITon-formal Education is to under
take programmes that will raise the level of awareness
of the illiterate, poor and the oppressed masses of our
people, so that they become aware of the variety of forceseconomic, social, political, religious and psychologicalthat are affecting their lives.
A key concept developed
by Freire in ’Conscientization1 - a social process by which
human beings (not as receipients, but as knowing subjects)
achieve an increasing awareness of social-cultural realities
which influences and shapes their lives and develops their
abilities to transform their society.
If these processes of conscientization has to take place
first of all the level of consciousness of people has to be
From experiences we see that all people are not
found out.
Based on this experiece
in the same level of conscio sness.
Paulo Freire divides the consciousness of awareness into
This concept of levels of consciousness has
three levels.
been defined in a more concrete way by Smith,,
According
to these experts verbal behaviours of a person are the
manifestations of the level of his awareness, namely, either
magical, or naive of critical.
2.1 Magical
It is the consciousness of men belonging to ncircumscribed 1’
and’’introverted” communities.
It is the characteristic of
men ’submerged’ in the historical process.
Men of this
consciousness cannot understand problems situated outside
their sphere of biological necessities.
Their interests
centre almost totally around survival and they lack sense
This consciousness
of life on a more historical plane.
represents a disengagement between men and their existence.
Discernment is difficult in this state.
In men of such
consciousness there is a confusion in their perception
of the objects and challenges of the environment and they
they cannot
fall a prey to magical explanation because
apprehend true casual!ty Q
Hence they are trapped by the myth of natural inferiority.
It is this sense of inferiority and impotence which prevents
them from identifying the de-humanising situations and
restricts them to magical explanations and limits their
Their
activities to passive acceptance and resignation.
problems are of physical nature, related to basically
survival concerns and they feel that these problems are
governed by some superior powers, beyond their control.
In short, the casual!ties of the problems are attributed
to supernatural forces which control them fully and hence
they feel they have to submit to them since they cannot
Naturally a total
fight against Supernatural forces.
Thus magical consciousness
submission and inaction results.
is characterised by fatalism which leads men to fold their
arms and be resigned to impossibility of resisting all the
supernatural powers.
2.2
Naive or transitive Consciousness
ni w » i w -iri ■ i ■
>.■ 11 i i '— b mi i ^Tri—1 ■a>’i i win* t mkx —
irnuara
3
Initial stage of naive consciousness is characterised by
the se qualitiess
- by an over-simplification of problems
- by a nostalgia for the past.
- by under-estimation of the common ipan
- by a strong tendency to gregariousness
- by a lack of interest in investigation
- taste for financful explanation
- by a strongly emotional style
- by a practice of polemics rather by dialogue and
- by magical explanations.
Although men with naive consciousness response to stimuli,
their responses have a magical quality.
Halve transivity
is the consciousness of men who are stilx almost part of
the mass, their capacity for dialogue is fragile and
capable of distortion.
At the naive level of consciousness the oppressed do not
conform to the siutation any more, but they desire to reform
themselves and certain corrupted individuals and group of
individuals. According to them the system itself is sound.
Hothing is wrong with it.
This is expressed by two sub-levels?
the individuals blme themselves and their conm-ui-ity
members for breaking the rules and regulations of the system
They thus ’’Play host” to the exploiters’ beliefs, ideas and
values, by expressing self-guilt and violence agaxnst
members of their own community.
Therefore, their actions
are directed naturally at reforming themselves and becoming
(b) At the second sub-level
more like their exploiters.
the exploited individuals accuse an individual exploiter
or a particular exploiter group for breaking the rules and
norms of the system.
They know that the actions oi the
exploiters are harmful, but they hold the individuals
responsible for it. So, they try to defend themselves from
the*violence of the exploiters.
Oppressed individuals at the naive level of consciousness
They can identify specific
accept that something is wrong.
injustices and relate long stories how they are exploited.
But, their under-standing does not go beyond blaming
individuals. They fail to see that a system of powerful
forces act together to coerce both tne oppressed ana the
oppressor.
They naively, romantically, nostalgically assume
that individuals are basically free agents, indepehdeiit
of socio economic system in which they live.
2.3
Critical or criti•
The qualities of the critical consciousness are the followings
- depth in the interpretations of the problems
for magical explanation
- substitution of causal principles
t^e testing of one’s findings and ’openness’ to revision
- the
-when perceiving problems and
attempt to
to avoid
- attempt
a.--- distortion
----to avoid preconceived notions ■when analyzing them®
- refusing to transfer responsibility
- rejecting passive positions.
- soundness of argumentation
4
Critically aware individuals perceive that the system is in
need of transformation. No more patching up the relation
ship between the exploiters and the exploited will change
the basic reality that a system, a coercive sot of norms
The trans
which govern botji, is the cause of exploitation.
formation process begins when the exploited start rejecting,
casting out the ideologies and views of the exploiters and
are led to an increased sense of self-identity, self-worth
and peer powers.
From the periphery of the problem, they
rea.cn to the real cause, the core of the so cio-economic politico-religious sphefes where the events and facts are
placed in the universal context. At this critical level
individuals begin a process of trying out new role-models,
specifically relying on self and community resources,
boldness, risk-taking and iddependence of the exploiters.
This helps him to be creative and self—determinant•
Oppressed individuals moving into the third stage of
consciousness come to realize that no matter how hard
they try, they cannot be like the oppressor, and they
decide they do not want to be like the oppressor as a
role-model.
They focus upon their own ethnicity, not
because
they hate the oppressor and want to be different,
but because they want to be themselvees unique persons who
are honest about their heritage and their habits.
3 • £.orcs ci ent j. 5ati p
Conscientization represents the development of the awakening
of critical consciousness of awareness.
IT IZUST GROW OUT
OF A CRITICAL BDUCATIONAL FFB'ORT based on favourable
historical conditions.
It requires an active, dialogical
educational programme concerned with social and political
responsibility and prepared to avoid the danger of
massification.
Trie growvri ox sell — awareness involves toeing critical of
social, economic, political conditions in an effort to
ctoange tne existing institutions, so that full humanization
The raising of ’awareness is necessary so thet
take place.
people can not only analyse critically their ’world’ and
thus attain freedom, but also become aware of their own
dignity as human beings.
oooeoooo
oooooooo
cooooooo
oooooooo
oooooooo
oooooooo
oooooooo
oooooooo
Coryy H
/&• 2-^
Community Health Cell
CHAI Golden Jubilee Evaluation Study
4th July, 1992
SECOND ROUND OF
QUESTIONNAIRE - II
pOLICY DELPHI METHOD TO IDHNp'TKf FUTURE THRUSTS
NOTE TO PANELISTS
— _~„ j-Q Question —
1. we have received varied and interesting responses
‘ , This
Four from 37 panelists (73%).
-- - is regarding issues that
areas’of priority in its future work.
CHAI should take up as <---,
The ideas that emerged broadly fit into six groups namely
/
Role
identification
Need to
clarify
const!tuoncies
/ Organisational \
aspects or
\
/
mechanism that
icould be introduced/
;
strengthened to
enable effective j
functioning
/
x
Basic
premises/underlying ■
assumptions that |
must be considered/
\
Important
health and related \
issues that CHAI J
should respond to |
k
Strategies of
work/interventions
to implement its
objactives/
priorities
.
J
used to develop Questionnaire XI comprising of
2. These have been
We would like you to rate a-1 items/ideas
seven questions,
Please do not
according to the scale given for each question.
leave any item unanswered.
. .2
2.
3. As you undertake this exercise, we request you to keep in mind
the predicted broader situation in India (fifteen years from
now) as it relates to health/health services and also the possi
ble priority health problems and issues. However it is parti
cularly important to keep in mind the specific reality of CHAI etc.7 and in this context tr
its membership and infrastructure etc.,
rate the different ideas, Please give reasons for your ehoice
in short statements.
4.
Please continue to think widely,' creatively, even differently
and critically about the process and the issues raised so far.
If you would like to introduce a new idea or a different pers
pective, or to bring up something that has been omitted, please
do so.
5. It is important to keep your focus on a period fifteen years
ahead from now - so that CHAI can undertake futuristic planning.
6. The method benefits from opposing/dissenting view points,
Some
instances of differing view points that have emerged are :
a) Some panelists feel that CHAI should focus its activities
primarily towards its membership, whereas some others feel
that it should play a larger role.
b) Some panelists strongly feel that the focus of work should
be on community based, non-institutional health interventions,
whereas others feel that there is a role for good quality
medical care based in hospitals/dispensaries that are accessible to the poor.
While there may be no definite points of resolution, it would be
useful to get the views of other panelists on these issues and
other aspects covered in the first round.
7. We will mail you a duplicate copy of this questionnaire shortly
as your personal copy.
PLiEASE MAIL THE QWESTIOMAIRE
TO
COMMUNITY HEALTH CELL
No. 326, V Main, I Block,
Koramangala,
Bangalore-560 034.
SCALE
Please enter the
alphabet code in
A - Very Important - first order priority
the boxes provided
B - Important
and respond to all
points
C - Unimportant
- third order priority
D - Not able to judge
- second order priority
QUESTION - 1
Please rate the different types of roles that CHAI could play
in the future?
1.1.
Inspirational role, with/for members
1.2.
Coordinating rolez with/for members
1.3.
Trainers role, with members
1.4.
Technical support role to members
1.5.
Information/communication role to members,
public
1.6.
Supplementary role to government, through
members
1.7.
Catalyst role, with members and others
1.8.
Networking role, with like-minded groups
1.9.
Activist role with/supportive of people’s
organisations
1.10. Any other (specify)
COMMENTS , REASONS ETC . ,
CHC
CGiTES
SCALE
Most relevant
Please enter the
A - Very Important
alphabet code in
- Relevant
B— Important
C - Slightly Important - Insignificantly
relevant
the boxes pre zided
and respond to all
points.
D - Unimportant
E -Not able to judge
- Nor relevant
QUESTION - 2
Please, rate, according to the scale given, the basic premises that
must be considered by CHAI for their future work (perhaps as a
statement of philosophy).
2.1.
Need to focus on spiritual dimensions of health
and healing
(deeper spirituality, nurture of role of faith
and idealism, relate faith to medical work)
^2.2.
Focus on preferential option for the poor
(promote work in remote rural and backward areas,
particularly of underdeveloped States, urban
slums, tribal groups, marginalised groups,
indigent population)
2.3.
Focus on enabling/empowering people in health work
(to analyse and respond to their health problems
themselves, to avoid everything that creates
dependancy and non participation, to support a
people’s health movement, enhance liberation and
growth of people, to increase community responsi
bility for health work)
2.4.
Focus on justice dimensions of health/health work
(to support/build the organisational capacity of
people, to demand a more just health and social
service system, to act as a counterveiling power
to the pharmaceutical industry and to vested
interests)
2.5.
To improve accessibility for the poor to medical/
health care services
(life saving biomedical services, good quality,
low cost basic health care)
2.6.
To promote community based, non institutional
health work
"(demystification, deprofessionalization, building
on people’s health knowledge/practices, culture
sensitive)
/
..2
2,
2.7..
To promote an integrated approach to medicine and
health
(studying, understanding, using Indian and other
systems of medicine - Ayurveda, Siddha, Unani,
Homeopathy, Acupuncture, etc.,)
2.8.
To promote a holistic approach to health
(harmony in body, mind, spirit, society and
environment)
2.9.
To focus on gender related issues
(women’s health status, their access to health
care, impact of technology on women)
r.
2.10. To create awareness on environmental/ecological
issues
(as they relate to health)
2-. 11. To strengthen/foster self-reliance at all levels
(promote herbal/home remedies, non drug therapies,
low cost care, appropriate health technology,
reduce dependance on drugs/medical industry)
2.12. To promote rational therapeutics and rational
drug policy
2.13. To develop a sense of understanding and caring
among health workers and in health institutions
2.14. To promote a sense of community and belonging as
being critical to well being and wholeness
(make people interdependant and concerned about
each other)
COMMENTS, REASONS ETC.,
CHg
Ggjes
1
SCALE
Please enter the
alphabet code in
A—Very Important - First order priority
the boxes provided
B - Important
and respond to all
points.
- Third order priority
C - Unimportant
D —Unable to judge
QUESTION
§
K
- Second order priority ;
3
Please give your rating regarding the constituencies/groups on
which CHAI should focus its activities
3.1.
On its membership
(to support, strengthen, challenge, to meet
genuine needs as felt by them though it might
be in conflict with CHAI1s most important agendas,
but this is the only way that they can have a
sense of belonging)
3.2.
Also on the Church membership
(the lay congregation, the religious, the
structures, the educational system)
3.3.
Developing working links with other national
level associations
(Voluntary Health Association of India, Indian
Hospital Association, Christian Medical Associa
tion of India, Indian Society for Health
Administrators etc. These are important to
achieve Health For All and to help in restruc
turing of health sectors in both the voluntary
and non-voluntary sectors)
3.4.
Better operational links with non-catholic,
secular health organisations/persons
(at national, regional, local levels)
3.5.
Linking with development qroups/volags at the
grass roots
3.6.
Developing functional linkages with
Government
3.7.
Interactinq/influencing Government in policy
making and legislation
(in association with entire voluntary sector)
3.8.
Supporting/working with activist groups/peoplefe
organisations
(in different fields - environmentalists, women’s
movement, dalits, labourers, working children)
3.9.
Focus on youth
.. 2
2<
3.10. Work at parish level
(smallest unit, composed of families in a
geographical locality that worship in a Church)
3.11. Focus on society at large
(Mobilize public opinion)
3.12. Play a role in South East Asian countries
(besides within the country as well)
COMMENTSz REASONS ETC,.
GGJES
Please enter the
Alphabet code in
the boxes provided
and respond to all
points.
SCALE
A - Very Desirable - extremely beneficial
- beneficial
B - Desirable
C - Undesirable
- not beneficial
D - Harmful
E - Not able to judge
QUESTION - 4
agyeetg
Please rate according to the
giwn, th@
or mechanisms that could be introduced/strengthened to enable effe
ctive functioning.
4.1.
Define /redefine objectives
(with the concurrence of members)
4.2.
Fonnulate clear strategies to achieve
objectives
4.3.
Increase internal cohesiveness between member
institutions
(CHAI is too loosely knit, with no clear
corporate objective)
4.4.
Prioritize, make choices and work consistently
and vigourously on them
(do a few things well)
4.5.
Encourage lay membership
4.6.
Decentralize and promote regional units and
regional planning
(these units can also be reference points for
members within the area)
4.7.
V\icrk out a health policy for catholic health
care institutions
4.8.
Set up a mechanism for reviewing/monitoring/
evaluating the work done and implementation
of recommendations
4.9.
Make a conscious effort to maintain a simplicity
of life style and structures within CHAI
(also encourage members to live in simple tem
porary dwellings. Present concrete structures
make them far removed from reality)
4.10. Encourage/support members to move to/work with
the most needy, the marginalised groups and the
most dehumanising health problems
(considered a strength of catholics)
4.11. Change name
Tdrop hospital from it, call it Catholic Wholistic
Health Association or something similar)
Any suggestions?
COMMENTS / REASONS ETC.z
Please enter the
alphabet code in
the boxes provided
and respond to all
points.
SCALE
A - Very important
First order
priority
Second order
B - Important
priority
C - Slightly important - Third order
priority
D - Unable to judge
QUESTION - 5
Please rate the important health problems that CHAI could respond to
5.1
Mental Health
(counselling including for chronically ill,
terminal care, hospices, promoting positive mental
health)
5.2.
Substance Abuse
(alcoholism, drug addiction including tobacco)
5.3.
AIDS and STD 1s
(educational work for prevention, developing
hospices for AIDS cases to die in dignity)
5.4.
Natural Family Planning/population issues
Tfamily welfare programmes, family counselling,
there was mention by some panelists that
Natural family planning has not been successful)
5.5.
Child Survival
(Through growth monitoring, oral rehydration,
breast feeding, health education, nutrition
and immunization)
5.6.
Care of the Aged
(geriatrics in hospitals/dispensaries, also to
open homes/day centres for the elderly)
5.7.
Disability Care
(rehabilitation and prevention)
5.8.
Communicable disease prevention
5.9.
Occupational health
(of unorganised labour, women, organised sector)
5.10. Women's Health Care
5.11. Urban Health Care
(for urban slumsT
COMMENTS, REASONS ETC.t
c-guEs
Please enter the
SCALE
alphabet code in
the boxes provided
A - Extremely necessary
and respond to all
C - Not very necessary
points.
D - No judgement
QUESTION
B - Necessary
6
Please give your rating regarding the necessity f>r CHAI to promote
the following in its future work.
6.1.
Health Education
(education for health using effective communication
skills, developing effective material, public
education regarding understanding of health)
6.2.
Primary Health Care, Preventive and Promotive Health
C a re
Tfind ways of effectively implementing principles
and components of PHC towards Health For All)
6.3.
Community Health
(Staffing of community health care units with
mental health, spiritual health, social work
personnel, besides medical and para-medical staff)
6.4.
/
/
Improving hospital/dispensary based health care
systems
(by iitroducing spiritual and counselling.methods,
mental health care, health education, rational
therapeutics, effective lowcost humane care,
technologies that can be taken closer to the
community and by making service accessible to
rural and urban poor. Keeping in view the growing
privatisation of health services, the small clinic
and hospital member institutions of CHAI have an
important role to play in the future)
6.5.
Help government run hospitals and dispensaries
(to improve overall situation and work ethic)
6.6.
Medical Ethics
(issues relating to human fertility,, abortion, end
tissues)
of human life, use of human organs and
l
6.7.
Pastoral Care/Spiritual health
(training courses for lay, religious,
on an inter-religious basis)
/
/
. .2
nsmun oJto vnoid"ioc(6
noHiodB
'
(esusaxcf brts anep-xo nenu/rf io saw .siH nemurf 'i’o ' "
.6.8.
heaUh^knc>w^dge^r?d..systejns/^
’
Traditional/indigenaus
Alternative mg fchods1 x
■$
—
(develop a
workers and for their training, promote investigation/
and study, prepare teach ng materials for members,
• •
integrate different systems into health care
services)
6.9.
Understanding of public health principles and
epidemiology
(including changing epidemiological scene in the
country and its implications for health services)
2.
f
6.10. Health Care financing
(improved cost effectiveness, innovative models)
6.11. Management principles and skills in health
(planning, personnel management,- improved service
effectiveness, concept of total quality management,
identifying performance indicators, developing
management information systems, increasing interinstitutional cooperation)
\,
?—
\
r
6.12. Rational Drug Therapy / P
(introducing concept actively in member
,3/3
/
institutions,.campaigning at national level)
6.13. Lobbying for regulating the standard of operation
of health services. dJJs9ri JS£Jj^lq.5\9^EQ Je^iaS?
^14.
r
-g<-vrn-en g t17;
(of health problems, health service research.,
evaluation)
6.15. Involvement in determining training of health
personnel
(a. more community oriented formation;
b. participate in evolving nursing curricula,
e.g., include women’s issues, AIDS, addiction,
role of new technology, increasing speciali
sation in nursing profession is making it
competitive with allied professions;
c. training para-professionals/non-professionals
for comprehensive health care work;
d. participate in re-orienting,reorganising medical
education to produce more socially sensitive
physicians)
6.16. Multi-disciplinary health team functioning
(with equal respect for people from the different
disciplines, have less places with nuns and
less scandals and better reception from people)
COMMENTS# REASONS ETC.,
CHS
priests w
Please enter the
SCALE
alphabet code in
the boxes provided
A - Extremely useful and necessary
and respond to all
C - Not very useful and necessary
points.
D - No judgement
B - Useful and necessary
QUESTION - 7
Please rate the different possible strategies of work that can be
utilised by CHAI to implement its objectives
7.1.
Continuing education for members
(human resource development for various types of
health workers through workshops, seminars,
training programmes - to introduce greater
professionalism into peripheral health care
programmes of CHAI members)
7.2.
Publications
(more in regional languages to support community
primary health care workers;in English about
healthy living, causes of ill-health, health
hazards, drug issues etc.,)
7.3.
Evolving models/innovative programmes of health care
(that would be viable, applicable by religious and
non religious workers, affordable and sustainable
by the people, taking into consideration the
socio-economic-political structures)
7.4.
Developing education/training models
(in tune with our realities, at various regional
levels in regional languages, to support the
models developed and to cater to the vast majority
of people still outside the health care system)
7.5.
Re-assessment, re-orientation, rejuvenation of
Catholic resources in health care to the urgent
priorities of the time
7.6.
Networking with voluntary organisations
(at national, regional, local and international
levels, increasing sharing and collaboration,
avoid duplication)
7.7.
Appropriate manpower/health personnel development/
especially to meet new needs
7.8.
Advocacy/lobbying/campaigning for change at a
national level
(so that basic health needs, for example clean
water are satisfied for all, and for government
to revise priorities to emphasise health services
for the poor, also against alcoholism, drug
addiction, environmental degradation)
/
/
/
. .2
*
7.9.
Bold media coverage
(national/regional to educate/inform regarding
components of health, causes of ill-health, what
ails the system etc.,)
7.10. Developing a capacity for policy level input into
national health policies/plans
7.11. Organising national/regional consultations and
conventions
(for example organise an inter-religious,
ecumenical convention to prepare a health covenant
for life for service to the poor, to which medical
personnel, Christian and others can commit
themselves)
7.12. Inter-sectoral coordination in areas of their work
to demonstrate the need and scope in this area,
get involved with non health issues, for example
water shed management^ eco-farming, developing
credit systems for poor/women.
CCTMEWTS< REASONS ETC.^
THMK YOU FOR YOUR RESPONSE
Go
H - f 6 • 2- 5^
COMMUNITY HEALTH CELL
Dt:08.05.1992
ANNEXURE-I
THE DELPHI METHOD *
The Delphi method was developed initially in 1964. During
its early years it uas used primarily for technological forecast
ingsparticularly in the areas of defence,industry and business.
Typically it used several geographically seperated experts
to make forecasts or estimates about the development of neu
technologies, to assess their impact,to estimate markets in the
future etc.
However the method which hypothetically used both the left
half of the brain( the more logical half basing on factual in
formation) and also the more intuitive right half,generated a
lot of interest among futurologists in general.
A broad definition given by Linstone and Turoff states that
’’Delphi may be characterized as a method for structuring a group
communication process so that the process is effective in allowing
a group of individuals, as a whole, to deal with a complex
problem”.
Since 1969 it has been used increasingly for a variety of
different purposes. Thus from the ariginal '’Classical Delphi n
method developed by the Rand Corporation in the United States of
America for defence purposes and still used for technological
f o rec as t i ng, vari ous modifications have developed*' f^r example
Decision Delphi,Pol icy Delphi etc.
. .2
* A background note prepared for the panelists in the Delphi
Method,being used as part of the Catholic Hospital Association
of India Golden Jubilee Evaluation Study.
.2.
The Delphi method is therefore essentially a group method,
performing functions similar to a committee,but different in thata ) Anonymity is maintained - this avoids identification of an
poinion with a person.
b) The questionnaires/communications from the study team not
only ask questions but provide information and controlled
feedback or summaries of responses of the panelists
(respondents).
c ) There are repeated rounds of questionnaires so that argu
ments for or against options can be shared and panelists
can change their ratings in subsequent rounds if they uantto.
d) A statistical group response for different issues/dptions is
provided. Rating scales for importance,desirability,
feasibility etc can be used.
The Policy Delphi rests on the premise that the decision maker/s
are not interested in having a group generate decisions, but rather
have an informed group present all the options and supporting evi—
dences for consideration,
is su es .
It is a tool for analysis of policy
Generating a consenses is not the prime objective,though a
rating is obtained,
It infact seeks to generate possible opposing
vieus or to explore differing positions and the principal pro and
con arguments for those positions.
It is therefore an organised method for correlating views
and information pertaining to specific policy areas and for allow
ing the respondents the opportunity to react to and assess differ
ing viewpoints.
Further Readings
1. tinstone H A and Turoff Fl, 1975, The Delphi Method- Techniques and
Applications,Addison - Uesley Publishing Co.,9 Massachusetts.
2. Rauch W,1979, The Decision Delphi, Journal of technological
forecasting and social change,15,159-169.
3.C olli gen D, ’’Your gift of prophecy tj 9 1982,Readers Digest,
pp 223-232.
4.Sackman H.^”Delphi Assessment’. Expert Opinion Forecasting and
Group process,Rand Corporation,1974.
COmUNITY HEALTH CELL
CHAI Golden Jubilee Evaiuation^Study
Dt:09.05.1992
Anpexure II
THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA .(CHJU)
A BACKGROUND NOTE FOR THE PANELISTS ON THE JOEL
1. CHAI is a national level association of health care institute lore
and facilities under Catholic auspices.
2. It has 2,304 members (as of October 1991) spread across the
country. The breakup according to size of institutions:
i) Health centres/dispensaries with no
beds for inpatients to be admitted
1,150
(50%)
ii) Health Centres/dispensaries with
1 to 6 beds
iii) Hospitals with 7 to 100 beds
388
591
(17%)
iv) Hospitals with more than 100 beds
86
(4%)
v) Diocesan Social Service Societies
\J i) Associate members (individuals having ,
no voting rights)
57
(2%)
32
(1%)
T otal
2,304
3. The geographical distribution of members is as follows:
i) The four Southern States
(Kerala - 403,Tamilnadu - 380,
Karnataka — 153 and Andhra Pradesh—228)— 1,164
(26%)
(100%)
(52%)
ii) The BIMARU States
(Bihar - 160,Madhya Pradesh - 205,
Rajasthan - 30 and Uttar Pradesh — 118)—
513
(23%>
iii) The North Eastern States
(Manipur — 20,Meghalaya — 47,Mizoram —
04,Nagaland - 19,Tripura - 4,Sikkim -01
and Assam - 51)
146
(7%)
392
(18%)
2,215
(100%)
iv) Other States
(Goa - 29,Gujarat - 58,Haryana - 11,
Himachal Pradesh - 03,3ammu & Kashmir05 , Maharashtra - 94,Orissa - 79,Punjab 28, West Bengal - 68 and Union
Territories - 17)
Total
(NB: 57 Diocesan Social Service Societies and 32 Associate
Members are not included here)
. .2
.2.
4. The Aims and Objectives of CHAI are
i) To improve standards of hospitals and dispensaries in
India;
ii) to promote,realise and safeguard progressively higher
ideals in spiritual,moral,medical,nursing,educational,•
social and all other phases of health endeavour;
iii) to promote community health and family welfare programmes;
iv) to assist Voluntary Health Organisations in procuring
quality amenities/equipments/medicines at the minimal
possible rate.
(N.B:(i) and (ii) were articulated when the constitution was
reformulated in 1961 and (iii) and (iv)were introduced by
an Amendment in 1978. CHAI has been a registered Society
since 1944).
5.a In the organisational struc-ture the members of the general body
elect a 9 member Executive Board with a President, two VicePresidents ,Secretary,Treasurer and four Councillors. The
Board appoints an Executive Director. There are various de
partments staffed by over sixty people.
b Regional Units;
There is a provision for the formation of Regional Units in the
attempts were made to form them with
‘
Constitution. Sporadic
varying success, Regional or State units are seperate registered bodies, but linked to the Centre. The membership fees
equally -between the centre' and the units, The
are
divided^
Lu
4. O
uu J. v u. vu <_2
units at present are :
1) Kerala Catholic Hospital Association.
2) Catholic Health Association of Tamilnadu.
3) Catholic Health Association of Andhra Pradesh.
4) Orissa Catholic Health Association.
5) NECHA - North Eastern Community Health Association covering
seven states.
6) RUPCHA - Rajasthan, Uttar Pradesh Catholic Health
Association.
Karnataka and West Oengal have had occasional meetings, Some
-dioceses also have diocesan level activities.
6. The Headquarters and Units
»|
=»a--bwg.Tn .-r-1 ■ r—nB—mi i» i h
■ m m i-rn »i ■aMqpBMaanamM*
i) Departments
a ) Administration (general)
b ) Accounts and finance
c ) Central Purchasing Service
d) Community health with four sub units1 . Rural Health
2. Urban Health
3. Research (Planning stage)
4. Low cost communication media.
e Continuing Medical Education
f Documentation
9 Electronic Data Processing
h Membership
i) Pastoral Care
. .3
.3.
ii) There is a Zonal Office in New Delhi.
iii) A seperately registered Society namedI ?7Health Accessories For
All” (HAFA) brings out a monthly magazine called Health Action
and other publications.
i v) Add it i onal Projects:
a ) The CHAI Farm Project - with poultry 9 agriculture, etc, for
income generation and plans to start a model integrated
health centre with community health programmes and a
training centre.
b) A Central Drug Quality Assurance Laboratory is planned.
This will test drugs and pharmaceuticals as part of quality
control for rational drug therapy and to support the network of low cost generic name drug manufacturers.
c ) The Golden Jubilee Project, uhich includes this evaluation
study.
7. Fund jnq
The funding of the activities of the Association depended on
membership fees and donations from members. Some funds were
available from purchases from abroad through donor agencies.
Additional sources from exhibitions of medical' products and.
advertisements at the. conventions also brought some funds. This
has been restricted since the mid eighties in order to fit -in
with the overall philosophy of the Association., In the
-- mid
from foreign donor agencies
1 .
seventies and in the eighties, funds
began to be utilised for specific projects and programmes,, Other
the .farm and
initiative have been the starting of a Corpus Fund, i-a raffle,besides sale of publications by HAFA.
8. Thrusts in the 1980’s
i
in—i
—,t—.-jrotmn
Health for Hany Flore”
Here - a
i?uJ, CHAI adopted the goal of ’’Health
a) ±n
In 1980
modification of the WHO Alma Ata goal of Health For All by
2000 AD. A department of -Community Health was initiated.
There was a more specific and analytical focus on the issues
and problems of the poor. A new vision of health was arti
culated where health was understood as the total well being
of individuals? families and communities as. a whole and not
merely the absence of sickness. Community Health was under
stood as a process of enabling people to exercise collectively
their responsibilities to maintain their health and to demand
health as their right. They developed strategies and a
variety of training programmes towards realization of the
newly emerging goal of building a healthy and just society.
b) The Headquarters which had a small office space in Delhi
shifted to a much larger place in Secunderabad in 1986^
preceding further development of departments and training
programmes.
c) Pastoral Care courses with outside resource people were
held and a new department started in 1990.
d) The in-house journal ’Hedical Service1 was discontinued.
Under a scperate registered body,the new magazine,’’Health
Action” was launched. It is available to subscribers from
the membership and general public.
. .4
.4.
e ) There was an increased focus on smaller member institutions.
Voting rights were equalised. A discretionary fund was
started to support these institutions in the area of primary
health care.
f) The department of Responsible Parenthood was merged into
that of Community Health.
g) Advocacy and training towards Rational Therapeutics and a
Rational Drug Policy were initiated and promotion of alter
native non-drug therapies is being done.
h) Several short courses and workshops are offered in the areas
management^ legal aid,human and spiritual growth through
clinical practice , etc.
i) Developing and maintaining linkages has always been done
and was continued actively with groups like the Christian
Medical Association of India (CMAI),Voluntary Health Assoc
iation of India (VHAl),Asian Community Health Action Network
(ACHAN) and the All India Druq
Drug Action Network (AIDAN). An
I ndo-Philippine exchange programme has been initiated.
9,
A few important points from the history
. p—H—iiiHMirr— i ■—ill
-■
> ■ xxxa - -
-*
■ n >■! ii : rn n
i
—'mh
a ) It was an association that was started and run by religious
sisters who were medical professionals (nurses,doctors,
pharmacists, etc).
etc) . This continued for fourteen years.
b) The focus during these years was on professional‘education
so that far flung medical institutions could be staffed
adequately.
Their endeavours were in the area of nursing,
pharmacy,lab technology, and other grades of health workers.
They also worked towards starting a Catholic Medical College.
This project was then handed over to the Catholic Bishops
Conference of India and*resulted in the starting of St.John’s
Medical College, Bangalore.
c ) Annual Nestings (which are used for educational purposes)
and publication of a journal have been regular features
from 1944 onwards.
d) The formation of Catholic Nurses Guilds and Doctors Guilds
were encouraged and fostered. These were later federated
at the national level as totally autonomous bodies.
e') One of the reasons for this was to uphold ethical
values in medical practice. This was considered an
important aim in the formation of the organisation.
f) There were no full time staff during these years and
no external funding.
g) THe first full time Executive Director was appointed in
1957.
h) There was the formation of Departments and increased staff
from the mid‘sixties.
. .5.
.5.
i) The importance of Public Health,Social and Preventive
Medicine and outreach into the community uas recognised
since the 1950’s.
j) The term '’Community Health:’ uas first used in 1959.
This resulted from a consultation of Christian health
leaders in that year held under the sponsorship of the
Christian Medical Commission, Geneva. This lead to the
formation of the ecumenical Coordinating Agency for
Health Planning (CAHP), uith the joint support of CMAI and
CHAI. The Executive Director of CHAI, uho had been in that
position for seventeen years
years, uas very actively involved
in all these developments, uhich led to the formation of
the Voluntary Health Association of India (VHAl). He held
the leadership position in VHAI for several years, Several
members of CHAI became and still are members of VHAI as uell.
■K
*
"X"
-K-
I
COMMUNITY HEALTH CELL
No.326, V Main, I Block,
Koramangala,
Bangalore 560 034
ft nnexure
CHAI GOLDEN OUBILEE EVALUATION STUDY
DELPHI METHOD - LIST OF PANELISTS^
SI-^NO ,
NAME
PLACE
01.
Mr.Desmond A.D’Abreo,
Bangalore
02.
Prof.Alfred Mascarenhas.
Bangalore
03.
Prof.V.Benjamin.
Bangalore
04.
Dr.Daleep S.Mukerji.
New Delhi
05.
Prof. B.Ekbal.
Thiruvananthapuram
06.
Ft.Claude D’SouzajSO
Bangalore
07.
Dr.Prem Chandran John.
Madras
08.
Er.George Lobo,S3
Pune
09.
Dr.Hari 3ohn.
Madras
10 .
Mr.S.Srinivasan.
Baroda
11 .
Dr .Sulochana Krishnan.
Neu Delhi
12.
Mr.G.Kumaraswamy Reddy,I.A.S.
Hyderabad
13.
Mr.A.K.Roy.
Bangalore
14.
Dr.R.Parthasarathy.
Bangalore
15.
Dr.Esther Gaiima Mabry.
Bangalore
16.
Dr.Rajaratnam Abel.
Vellore
17.
Mr.Averthanus D’Souza.
Neu Delhi
18.
Prof.Jacob K John
Vellore
..2
.2.
SL.NO.
NAME
PLACE
19.
Dr .P.Zachariah.
Vellore
20.
Dr.Gerry Pais.
Bangalore
21 .
Mr.Alok Mukhopadhyay.
New Delhi
•22.
Dt.Abhay Bang.
Gadchiroli
23.
F r.S.Arockiaswamy,S3
New Delhi
24.
Prof.R .Srinivasa Murthy.
Bangalore
25.
Dr. B.M.Pulimood.
Vellore
26.
Prof.Grace Mathew.
Bombay
27.
Ms.Sujatha De..Magry.
Bangalore
28.
DriQaseem Chowdhury.
Bangladesh
29.
Mr.P.0.George.
Kalamassery
30.
Prof.E.P.Menon.
Bangalore
31. •
Prof .’(Sr . )V . J .Kochuthresia.
Kalamassery
32.
Fr.Ooseph Thadathil.
Thiruvananthapuram
33.
Fr.Theo Mathias,S3
Damshedpur
34.
Mrs.R.K.Sood.
New Delhi
35.
Dr.L.N.Balaji.
New Delhi
36.
Francis Houtart.
Belgium
37.
Dr.Marie Mascarenhas.
Bangalore
38.
Prof.H.R.Amit.
Canada
* As on 09.05.1992 thirty-eight experts.have agreed to be i^i
.........
the panel. 11We expect1 a *few more would
join the panel.
Therefore this list is incomplete
" ‘ j now.
■>
do
CHAI GOLDEN JUBILEE RESEARCH PROJECT
Dear SJl-tV-L t
Greetings from Community Health Cell 1
As you may know CHAI (Catholic Hospital Association of India)
will be celebrating their Golden Jubilee Year during 1992-1993.
The Governing Board and Executive Director felt that it would
be important at this point in the history of the Association,
to take stock by conducting a study of the organization, its
past and present and also look to the future.
Brainstorming around the objectives and methodology for the
CHAI Golden Jubilee Research Project has been done during
February and March 1991. This draft proposal which is
enclosed, is being sent to you and several others for your
comments and suggestions. We feel that this exercise will
help to fill in areas/gaps that we may have overlooked. We r
would appreciate receiving your feedback by the end of June ''
1991, so that we can go ahead with the finalised proposal.
The time framework of the study is such that the final report
should be ready by October 1992. Since member institutions
of CHAI (currently 2,224 in all) are spread across the country.
we will have to keep to a fairly tight time schedule.
7
Looking forward to your comments.
Thanking you,
Yours sincerely,
for CHAI GOLDEN JUBILEE RESEARCH PROJECT,
THELMA NARAYAN,
CO-ORDINATOR.
Please send reply to
*mk/tn
Community Health Cell,
No. 326/v Main, I Block,
Koramangala,
Bangalore - 560 034.
COMMUNITY HEALTH CELL
Bangalore,
15-3-1991
CHAI GOLDEN JUBILEE RESEARCH PROJECT
(Second draft proposal)
Preamble s
The Catholic Hospitals Association was formally initiated at a
meeting of 16 Sisters in Guntur, Andhra Pradesh, in 1943.
This
was under the dynamic leadership of the first ever nun-doctor.
Dr. Sr. Mary Glowery, M.D. J.M.J. The sisters,who were all
involved in medical work,were moved by the suffering of the
masses of people, especially women and children.
They were also
concerned about the need to uphold ethical principles of medical
practice. To meet these two needs they felt that it was important
to work towards the establishment of a Catholic Medical College in
Indiao They looked forward to the day when young Indian graduates,
imbued with a sense of values would be able to work in health
institutions in different parts of the country.
Thus, with
remarkable vision and faith and a rallying cry of 'Union gives
Strength' they registered the Association. They decided to meet
regularly and run a bulletin for their members.
The Association has come a long way since those early days,
There
has been a quantum growth in the number of members from 16 to
2,224 in early 1991, spread over different parts of the country.
After several years of determined work the Medical College project
was handed over to the CBCI and St. John's Medical College became
a reality in 1963.
The early in-house journal 'Catholic Hospital*
started in 1944, was transformed into 'Medical Service* and more
recently into 'Health Action* which is available to a wider
readership. Annual meetings or conventions have been a regular
feature. Besides dealing with organizational issues discussions
around topical health themes were introduced since the fifties.
e o o2
2.,
The central office and also the range of activities taken up by
it has increased manifold.
These include the membership section,
the central purchasing service, the community health department,
the continuing education unit, the pastoral care department and
the Health Accessories for All (HAFA) Trust (with its major
monthly publication Health Action) among others.
During the Silver Jubilee of CHAI in 1968, the Executive Committee
felt that it was important to document its history.
This was done
by Sr. M. Adelaide Orem, S.C.M.M., and CHAI published the book ‘Out
of Nothing - the genesis of a great initiative'. An earlier 'Short
History of the Catholic Hospitals Association of India' has been
written by Mother M. Kinesburge in 1961. With the Golden Jubilee
drawing near, the Governing Board and the Executive Director thought
that it would be a good time to pause, take stock and renew its
vision for the future.
When undertaking such an exercise, it would be important to keep
in mind important events and changes that have taken place since
1943,in the church and also in the Indian and’International
situation, particularly in the area of health.
Within the church
there has been the second Vatican Council, the Cor Unum document,
several statements by the CBCI, a greater indigenization and
inculturation of the church in India etc,, all of which have been
important influencing factors. Within India, .since Independence,
the Government has built up a countrywide health service
infrastructure and an army of health personnelo
More recently,
the contributions of the indigenous systems of medicine, folk
health practices and of the large numbers of personnel working in
this sector are gaining increasing recognition.
Today, India also
has four decades of experience of health planning and organizing
control programmes for major health problems. Simultaneously, the
private sector in medical care has also developed and is flourishing.
Internationally too, there have been very rapid developments in the
health sector. Side by side with technological and curative
developments, there have been major changes in thinking regarding
o . o 3
health and health care,
some of these changes.
Issues of equity and social justice underlie
For e.g., The Alma Ata Conference of the
World Health Assembly accepted Health for All as a goal with primary
health care as a major strategy. Another aspect that any health
service system must take into consideration is the health status of
the people it seeks to serve, the major determinants of health and
disease in that society and the complex interaction between all
these factors. These points have been mentioned briefly to
illustrate the changed and dynamic situation in which CHAI and its
members have to function and to find a meaningful role to play in
the light of its own vocation of being part of the healing ministry
of Christ.
The study being planned in preparation for the Golden Jubilee will
attempt first to know and understand more about CHAI itself - the
what, where, who, how and why of its own members.
It will attempt
to enlist as much participation as is possible in the circumstances,
from the member organizations in the process of the study.
It will
try and contextualise the role played by CHAI and its members in
reference to the broader realities of Indian Society in which they
function. Together with the CHAI members it will t'ry to evolve
broad directions in which CHAI could move forward in the future.
At this moment all this does seem a rather large task,
Vie need to
look back for inspiration to the far-sighted vision, enthusiasm,
faith and hard work of the pioneers of the Organization.
The
project will also require a certain flexibility to allow for
creative innovation in approaches and methods that may be used for
the study.
The study will not be, therefore, an orthodox evaluation
by a team of outside resource persons, but a reflective and interactive
process with the members and all those involved with CHAI.
4.
I.
GENERAL OBJECTIVES s
1. To build up a data base of the
member organizations of the
Catholic Hospital Association of India.
2. To undertake an analytical study-reflection on the
organization and functions of the Catholic Hospital
Association of main during the pMt 5 deoaaes< focU5sl
particularly on the past 25 years.
3O To explore possible roles the Catholic
Hospital Association
of India could play in the future,
in the context of the
voluntary health sector and the national
health policy.
11- SPECIFIC objectives s
1" Pata base of CHAI Members
2
To collect information regarding a number of
aspects of work
of CHAT members so that a
composite picture of the current
health work being carried out by them is
available. This
would include information about
.>
about
1.1
Geographical distribution according to State,
district.
diocese, urban, rural. tribal.
1.2.
Distance of nearest referral
1.3.
Year when institution was founded.
1.4.
Size of institution - bedstrength.
1.5.
Facilities available
pharmacy; lab-routine/other; X-ray; blood bank;
facility.
labour room; O.T.; staff quarters.
1.6.
Health personnel available.
1.7.
Classification of main activities, viz.,
curative - outpatient; inpatient.
. . .5
5. .
extension clinics, mobile clinics,
pastoral care programmes,
preventive health and community health programmes,
mother and child health, family planning/welfare,
school health, health education,
leprosy/T.B./other communicable disease programmes,
mental health programmes,
care of the disabled, care of the aged,
participation - collaboration with Government health
programmes,
socio-economic programmes,
community organization and awareness building.
1.8.
Utilization of services - a profile
average number of outpatients/day.
Total number o’f outpatients during 1990,
Bed occupancy.
Total number of inpatients during 1990,
Number of deliveries/year.
Number of surgeries/year.
Population covered by community health programme.
1.9.
Training programmes conducted for different levels of
health personnel.
Undergraduate^ diploma, postgraduate, continuing
education.
1.10. Linkages established with other Voluntary/NGO agencies.
1.11. Management.
1.12. Funding.
2.
Analytical study-reflection of CHAI s
2.1.
To undertake an analytical historical review of the
policies and activities of CHAI in the context of
. .6
6O
i) The vision of the initiators of CHAI,
ii) The Memorandum of Association, and
iii) The change of direction as it evolved over the
years o
The review would take into account the broader context
of the healing ministry of the church and the appropriate
national policies.
2.2.
To ascertain the views of the CHAI members regarding 2
i) Their expectations about the organization and
activities.
ii) The appropriateness and adequacy of CHAI 1 s
current activities.
iii) The factors contributing to the gap between
expected and observed actions, and
iv) Alternate measures to be adopted to fill in
the gap.
3.
Future role of CHAI
To determine the views of a representative sample of members
and of a select group of individuals regarding the possible
future role of CHAI with particular reference to 2
i) its mandate,
ii) its role in the broader Indian Scene,
iii) the role it can play in Asian and other countries.
The section would also take into account
i) the evolution of health policies and health services
in India since Independence,
ii) a brief overview of the health status of the people of
India and existing services from available reports, 7ith
an attempt to identify areas of need.
iii) a brief look at international trends in thinking
regarding health and health services.
. . .7
7
iv) a review of statements of the church regarding medical and
health work.
III. METHODOLOGY s
1.
For Objective 1 (data base of CHAI rrembers)
s
A questionnaire will be developed,
It will have 4 sections.
besides a common introductory note,
Section A will be
relevant particularly to health centres/dispensaries with
less than 6 beds. Section B will cater to larger health
institutions.
Section C will be specific for Diocesan Social
Service Societies and Section D for Associate Members.
This questionnaire will be made computer compatible, so that
data can be entered directly into the computer.
The
questionnaire will be pilot tested and analysed,
Modifications
will be made based on this.
Suitable modifications will have to be written into one of th?
existing software packages (e.go/ D base 1, 2Z 3 or Lotus 1,2.3)
to facilitate data entry and analysis.
The questionnaire will be administered to all the CHAI member
institutions.
The current list of members from the CHAI membership department
will be used for this purpose.
80% of members will receive
just this basic questionnaire by post.
The remaining 20% wil .
be studied in greater detail (see under methodology for
objective 2).
Two reminders will be sent to members who do not respond to
the posted questionnaire within a month. Notices requesting
participation will also be carried in Health Action. If
feasible the Regional Units of CHAI will also be asked to help
in getting back filled questionnaires. Response to postal
questionnaires in India is generally rather low - about 15-201h
Hence special efforts will be needed to ensure as great a
response rate as possible, Since the idea of this exercise
is to build up a data base. a 9 0--100% response would be ideal .
It has been suggested that we may have to think of translating
. . ,8
8.
the questionnaire into 2 or 3 major Indian languages - Malayalam,
' ,
Tamil, Hindi.
Computer facilities in one of the existing institutions in
Bangalore will be utilized.
A couple of private organizations
and some of the existing facilities within the church network
have been approached with favourable response.
2.
For Objective 2 (analytical study-reflection on organization
and functions of CHAT.)
For the historical review, sources of information would be- of
2 types s
i) Secondary sources would include
a) Minutes of the Association; Council/Board meetings.
Catholic Medical College Committee.
b) Convention reports. Annual reportso
c) Issues of Catholic Hospital, Medical Service,
Health Action.
d) Autobiography of Dr. Sr. Mary Glowery, JMJ.
e) Books
- 'A short history of the Catholic Hospitals Association
of India' by Mother M. Kinesburge, FMM, 1961.
'Out of Nothing* by Sr. M. Adelaide Orem, S.C.M.M.,
CHAI, 1968.
'A Nun Revolutionizes' by F.L. Swamikannu, JMJ
Provincialate, Secunderabad, 1972. and
f) Other documents pertaining to the Association.
ii) Primary sources would consist of discussions/interviews with
relevant persons.
A detailed questionnaire will be administered to 20% of the 2,224
members. It will be a stratified random sample taking into
consideration geographic distribution and. size, Besides the
first part of the proforma which collects basic information (the
same as for objective 1) it is intended to ascertain member's
c ■
9
views through open-ended questions regarding the different
activities of CHAI.
Their views as to the role CHAI could
play in the broader context will also be requested,
This
questionnaire will be personally canvassed by interviewers
who will receive a prior orientation cum training.
Ten to
fifteen interviewers would be required to cover the 20%
sample of 445 members i.^., each interviewer would be required
to cover 30-45 members. Possibilities of utilising the serrices
of seminarians or social work/sociology graduates as interviewers
are being explored. They would require to have a certain
competence and maturity as they will have to meet and discu -s
with senior personnel at the member institutions viz., the
administrator, medical superintendant, doctors, nursing chi- f
and pharmacist. We are also considering the utility/
possibility of conducting focus group discussions with each
of these 20% member organisations.
3O
Fox’ Objective 3 (future role of CHAI)
i) As mentioned above, the questionnaire and discussions for
the 20% sample would elicit the members views regarding
the role of CHAI
ii) The Delphi method in two rounds would be employed for
the additional group of 50-75 thinkers/expertse
iii) This question will also be posed during personal
interviews conducted for objective 1 iae.z to the
previous governing board members, director, and key
staff (past and present),
iv) We may need’ to hold 2-3 regional meetings of about 20-.5
people to discuss the role of CHAI in the broad context
mentioned earlier and also in the context of the actual
work situation of the members. This would be done during
the latter part of the project.
4.
In general, background reading and discussions with key meml er
of similar organizations within the voluntary health sector ir
India will also be conducted eog0, with the Christian Medico
Association of India, Voluntary Health Association of India nnd
the CSI Ministry of Healing.
, . 10
10.
IV. ORGANIZATIONAL DYNAMICS s
This important aspect will be finalised once feedback and
suggestions are received on the sections sent so far. Broadly
this will include :
Advisory committee.
Peer group.
Time frame work.
Budget,
Format of final output.
■k
k
k
k
k
*
■k
---- j
THE CATHOLIC HOSPITAI, ASSOCIATION OF INDIA
Obj ectives s
H
i) To improve standards of, provide services to,
member institutions and others;
ii) To promote, realise and safeguard progressively
higher ideals in religious, moral, medical, nursing,
educational, social and all other phases of hospital
endeavour;
iii) To promote community health; and family welfare
programmes . ”
Memorandum of Association, 1961
*mk/tn
0 rvt H. " I 6 •
HISTORICAL PERSPECTIVE POPULATION GROWTH & ITS EFFECTS
By Dr.Luis Barreto
Basic Data :
World, population today has crossed 3.8 billion mark,
increase during the last 2 decades.
There has been a rapid.
World population :
Guesstimates1 10-15 million at the end of stone age.
Era - 250 million.
Beginning of Christian
By A.D. - 1650 population doubled and rose to about DOO
1750-700 million.
million. 'A centui-y later
1850 - a hundred and fifty years ago population extended the first billion,
1,091 million.
1830 - 1 billion
1900 - li billion
1925 - 2 billion
1966 - 3 billion
1971 - 3-5 billion
1976 - 3.89 billion
ANALYSIS: It took human species
about a million years to multiply
to a billion in 1830’s.
But it took less than a century to
add the second billion and 30 years
to add the 3rd billion.
At the current rate - we might
have over 7 million by 2,000 A.D.
GROWTH OF HUMAN POPULATION
MILLION B.C. TO A.D. 2000
PROM
Approximate
period or
year
Total population
100,00 B.C.
125,000
300,00 B,C.
25,000
1 million
5 million
8,000
1,000
10 million
100 million
A.D. 1
250
1,500300
1,650
565
623
1,700
906
1,800
1.billion
1,830
1,850
'1,194
.1,900
1,608
1,„25
1. billion
1,960
3 billion
2,000 projection 6-7 bilj-ipn
REASONS BEHIND THIS 1SCENDING GR/kPHi
During first million years of man’s evolution births and deaths almost cancelled
each other - due to enormous environmental hazards people were exposed to.
since
2nd billion was easy enough Z Jenner, Pasteup
1 Listre and Sennel Weiss
launched the beginnings of the health revolution - to save man from
mi c rongani sms.
The third billion has come about during this century that has witnessed
-more
inventions and discoveries, then all the others put together - both in Health,
agricultural development and production, industrial production and overall economic
advancement.
Man’s countless inovatioEs\ in the health sciences have alleviated suffering,
‘
s
: 2 :
It
.....to double to 1J billion
took 165- centuries
3 centuries 1650 — I960
....
3 billion(six fold)
Multiplication rate has therefore been, at an accei era ting -•rate-.-
;
-
Roughly everytime the clock ticks, day and night anothe-r' hiingr^y -m^Uth -i-is ■
born
...... 170,000 people in one day are born
...j.
——------------130 nillion in one year born
-z
-d
70 nillion in orie yea'r- '-die-' '
s
a.'
.■•.-1111;; Qc|.f . 9 . The population curve therefore if we start from 250,000 years ago - the
Swancombe Man and his Missus - it is li^e an aircraft taking off - for
most of the times it skims along time axis then about A.D* 1600 the
undercarriage is raised and it begins to soar today it is rising almost
vertically - norelike a rocket.
I
250,000 A.D.
1,600 A.D.
1975
INDIA75 POPULATION GROWTH :
I dia today(in the world) ranks second in population numbers, China tops the
list. More than 750 million people.
Land area - India 7th. i e. 2.4% of world area
India1?/? of iJs/a?tines U.S. population(204 nillionm 1970)
NATURE OF INDIA7S POPULATION GROWTH :
Very slow - during early years
•p -p-i (A durins last half century
.
aP
*- -3 million(?) (world 250 million)
300 B,C< -100 - 140
then it remained static for about 2,000 years because of
If this is true ih^
high death rates.
lcl-lb.
Burmai and Ceylon)
(excluding D--1600 A.D* — undivided India
million (world’s - 500 million)
,
100 - 300 ifind that during
150 million(we
During next 2g- centuries (upto 1850)
this period i.e. 20 million in 250 years).
High birth rates and high death ratesCwars, economic equalled eather other
famines and ePide§^ghapidly
population grew/after British rule
after 1921.
growth
slow initially ^nd rapid
;
■
: 3 :
GROWTH OF INDIA1 S POPULATION 300 B.C, to 1911 A.D*
Period or
census year
Population
in millions
Increase or
decrease in
millions
Percentage
variation
during pro
ceeding decade
300 B.C.
100
1600 A.D.
130
1^50
133
1881
253
1901
236.3
0.4
0.20
1911
252.1
15.8
5.73
1921
251.4
0.7
0.31
1941
316.7
37.7
14.22
1951
361.1
44.4
13.31
1961
439.2
78.1
21.50
1964(Mid year
estimate)
471.6
197O(mid year
estimate)
550
1971
547.3
108.1
24.48
Analysis:
1881 - 1891 - Population grew 9%
1891 - 1901 - Increase 0.2% - expensive crop failures plague, cholera and
malaria 5-6 million lost their lives
1901 - 1911 - India recovered from famine and plague, •
ia
1911 - 1921 - First world war and influenza epidorac 1918 - 1919 crop
failures
12
- 13 million Indians died
This wiped off the population increase of the last 7 years.
Therefore 1891-1921 was a slow period
1921 - total decrease of 0.3%
1921 - Makes a division in the history of India*s population
Improvement of health facilities, modernisation,
The fertility and
mortaility patterns began to vary considerably.
1891 - 1921
15 million only in 30 years
1921 - 1951
110 million
1951 - 1961
78.1 million
1961 - 1971
108 million
0)
o
o
ft
a
o
: 4 :
•H
s
o
o
Droughts, floods, and food scarcity was 1
-- - handled better - suitable measures
have taken to control- epidemics by the Government* Therefore, calamities
on a national scale was prevented.
9
7x10
6
5
o
w
<D
Pm
4
S
£
o
ft
(1 ,J)-2000 ad)
5
a
o
ft
World population
India’s population
(1600 4iD—200)
2
1x10
9
/
\ /
\ 'r
7> \
Ii,D00 400
600
800
1000
1 200
1600
1400
1800
1900
2000
REASONS FOR GROWTH IN NUMBGR DURING LAST HALF CENTURY
1. High population to start with
2. High birth rates
5* Decrease in death rates
India has a young population 1961 - 40.2^ of total population
in the
0-14 age group
15-49 age group - 47.9%
- 11.9%
50 and above
4. Universality of marriage bring
- religious.
5. Early marriages (Sarada Act 1924)
Marriage 13-16 for female in this century
6. Remarrying of widows was banned earlier (last decade -30 million remarried)
7. India - basically on Society - need for sons and labour,,but now this
has been abolished.
8. No old age nor retirement benefits nor any kind of
b cial/ security
nned for sons
9. Beginning of health revolution in India
1901 - D.R. - 42.6/1000
1910 - D.R. - 14/1000
M.M.R. and I.M.R. have decreased,
th2 JnCtho n1S W\tness®d a grater decline in the overall death rate
than m the proceeding half century.
CAUSES FORJjECRaASE IN THE DEATH RATE :
'
Increase in the number of medical colleges
in related institutions
1941
1971
20
94
f
...5
f
'5“ •
2.
D.DJo Spraying for malaria eradication^
3.
BoCoG. Vaccination for T.BO
4
Increase services of midwiveso
5.
American technical aid particularly in malaria eradication.,
6.
Assistance of WHO and Colombo Plano
Therefore higher Birth rate.,
I his
Expectation of life has increased
however is not the cause of
decrease in the death rateo
?<»
New River—valley projects"
Decrease in
floods
droughts
Increase in irrigation
Green revolution etcoo.
8.
Better transportation rapid food movement and import of large amounts
of foodo
ECONONIC jjj_D .SO C: I AL IN P LIC AT IONS OF POPULATION CROWTH
Me can study this in relation to
- food supply
- Educational facilities
-Sob opportunities
per capita income
Total food production - 1950
7
51
50 million tonnes
1968 - 69 -> 96 million tonnes
Nee availability of food increased by 43% 1951 - 69
Per capita availability increase by 18% for same periodo
The reason is of-course the growth of India’s population,,
Minimum requisite of food intakenaccording to FAO-18 oz./dayo
Availability of food grains 1968 - 14O8 oz.
Therefore the Average Indian consumes 82% of his needed daily calorie '
requisites«
2eout of 4 persons in India are malnourshiedo COne out of 4 are underfedo
That is only 325 million people in India are well nourished
Even Green revolution has not solved the problem..
During 1975 - 76 -------- 135'million tonnes of food grain had to be imported
Therefore no self sufficiency in food inspite of the political slogan
NO FOREIGN 3READ’e that cannot be implemented unless we double our ag
ricultural productiono This can be done only at the cost of our industrial
development which may not be advisable.,
Valuable foreign exchange therefore will be spent and Indian economy will
continue to be more extractive than productiveo
Educational Facilities^Number of universities
The picture is the same - considerable progress
but poor per capita shares
1947
1970
16
72
(cogether with hundreds of liberal arts, science and agricultural and
medicalj engineering9 veterinary and other proffessional colleges.,)
!
4
But still 1000’s of students with requisite accademic qualifications fail
to be admitted in these colleges*
The increasing facilities fail to keep pace with the needs of
population.
’ s an indication of the
Pg_s_ition of labour forde is
population size
)
country’s
a
This depends on
b)
the growing
development of a country
g ro wt h rat e
c) st ructure
d) other characteristics
with large population of juvenile
India - unfavourable age structure,
population ----- high dependency ratio.
Because of this low ratio of adults;children ---------- labour force has been
increasing at a slower rate as compared to total population increase.
ded
Though in relation to population Labour.force is small, total number adds
^there
to it every year is large.
Thoreforo/increusc: m unemployment problems. .
Chart 9s Chandrasekar pg 257
1966-71 - According to Planning Commission 23 million.added to.national
Labour Force with an existing backlog of 12 million, e .o . 35 million
more jobs have to be found
4th Five Year Plan (1968-74)- ‘would -provide 20 million jobs
Even if this materialised 15 million still would remain unemployed
Low wages- low levels of consumption and poor standards of living quail y
of labour force falls.
‘ '' 3 flooding the labour market making
The impoverished population multiplies
and improductive
labour cheap, unskilled, inefficient
i---- ------India* s Total National .Jncgmes-
1948-49 — 86 billion Rupees
1967-68 — 147 billion Rupees
This shows an increase by 73.25 percent over two decades
But per capita during same period Rs*248
Rso,297.17 i.e. 19.76 percent
Indies per capita is amongst the lowest to-day.
The most important reason for all this is the growth of India's populations
The gains of the growth of national income were absorbed by the growing
population to maintain the existing low standard of living.
To provide for net additions of nearly 13 million every year the country
needs
- 126.500 schools
37 2.500 teachers
- 5.9 million housing units
- 188 million metres of cloth
- 12.545 quintals of food
- 4 million jobs etc.
I
I8
should be provided
0
8
High illiteracy/overcrowding/poor housing facilities/urbanisation etc.
are amongst the main reasons responsible for perpetuating the cycle.
is
All these suggest a necessity of introduction of certain policy
measures 0
(1) Large failles — Higher Infant Mortality Rate
(2) Highe- B* *— Higher Infant
(3) Higher H-.rity — Higher infant mortality
Effective family Planning — Smaller family — better share of family
resources/child, lower morbidity & lower IMR etc
Once community achieves a lower IMR - the parents realise that a great
majority of infants survive and small family norm can become an accepted
pattern.
Rapid population growth is manifestly central to the economic and social
development of many countries»
The relationship between large additions of population levels of
production etc. can be studied under two schools of thoughts
(i) the neo-Malthusian and (2) Humanitarian
/
.SSUEiC
that high level of f ert’il'ity and morality and low levels of /^'ese
production and concumption are the major characteristics of a
developing country
(Refer to page 265)
Low levels of production and’'consumption and
high levels of mortality and fertility
increasing production per caoita
I
increasing levels of living
1
I
!
increasing application
of alien technology
■J/
increase quality
increase effectiveness
of health services and efficiency of health
per capita
services
^Rapidly
Mo rt a 1 it y
z
Die production per Capita \
Die levels of live
<» o o o
o • o o o
quality
of
health Services per capita
Slowly decrease population growth
M/
Slowly decrease Mortality
further decrease population per capitaX.
decreasing quantity of
health services per capita
further decrease birds of living
Constant High fertility v
T
^Increasing Mortality
Decreas^e pooulation Crouth
Low levels of population a — high
:8::
HULkNIT^RI iN CYCLE!
Low levels of production and consumption and high levels of mortality
and fertility
Increase technology development ^—7-7^
w
Increase socio-economic
development
_____1
4
ri
Increase production (p er capita)---------
i
Increase consumption (per capita)
1
i
i
I
Increase levels of nutrition
sanitation and health services
♦
i
4 Mortality and Morbidity
•Increasing fitness for work
H ealth
length of productive life
/F\
V
Increasing survival for children
—
/r
I
Family Planning
^investment in physical
capital
■" --our dcpcndancy.
Jlnvestment in human
capital
High levels of productive and consumption
and low levels of mortality and fertility
TACKLE OF HIGH DEATH RATE;
Layed down in the 1st five year plan
Only 1967 - vigourous efforts are being made especially after the
Bihar Famine#
Decided to buy BR
41
25 if not 20
30mUNIC,.TI0N PROBLEM
In India - Illiteracy - 70 percent
- small schle farms 80 percent
- Spread over 564,000 villages
- speaking 14 languages and 200 dialects
105 million couples in India today
90 million arc in the Reproductive age
I Target Couples-
"1
, ninlsirv i>r Health and Family Planning
National
State?
I
1
unit in ovrary state
Family Planning
! plI, / .hit. / twin / teMPlalP"
J,
1
Approvals!. Interview/ Dialogues
RED Z\
****^*************
***********
METHODS?
Caf etarea Approach
-1- Rs. 250.00
Incentives 5 days pay
(a) vasectomy
(b) Tubectomy
(c) IUD
Requirmont —. 300 million?
(d) C • •Irion
urban wives.)
(Q) Pill
.uJ,000
(f) Abortion
In 1970J.
-100 million
3,687 urban family
g^oing family planning
sterilisations /lUD
1,926 other urbantos^
ingerting / and performing
862 mobile units
-IS 000 doctors trained
125’,000
paramedical workers
F un ds L
1st Five year plan
(1951-56)
2nd - 56-61
3 million
clinics
Rso (-|47 Family Planning
spent)
1„5
milli° n
started and only
-Rs. 22 million - 4,1 65
3rd 61-66 - Rs .270 million
4th 69-74 —
Rs. 3,150 million
F^REWNJI^
United States "* 40 S
♦
Indiginoous
•; of total plan outlay.
1.2 percent
1680 cents
11/.--
UNEKPLOYMSMT AMONG DOCTORS
ITS ROOTS XN SOCZO-ECO NOMTC DEVELOPMENT TN INDIA,
’’people are sick because they are poor, they become
poorer, because they are sick and they become sicker because
they are poorer”.
B.R
In India health is more than a problem
BLEOM
It is a
challenge - a challenge that has to be met by the majority of
the population*
The most obvious shortcoming of the health system in
India is that it caters to the few at the cost of the majority this is not ?,n unique situation, for the ’WHO states bluntly
that in most developing countries the health system ntonds to
concentrate on urban areas and in particular for the wealthy
sections of the big cities - the rural masses are deprived of
ade qu at e ho a 1 th c ojr e n o
Some of the important reasons for this disparity ares
1.
The vast majority of people for whom the health
s orvices ar o run 9 have been left out of the process of
planning and determining the goals of the system which is
me ant to cater to their needso
2.
Increased dependence on the doctor and lack of
encouragement to the community to cater to their own hea.lth
ear o.
3.
Health planners and policy makers and those who
have a powerful voice in the shaping of health programmes
(such as medical man-power) are themselves by a.nd large from
the urban elite and naturally have vested interests in
providing the type of medical education to suit their ovm
clas s o
4.
Our elite has been greatly influenced by Western
models which are unsuitable to our health needs.
Very
few planners may have spert some time in rural areas and therefore this has reflected in their planning and specially s o o
in as much as health is concerned.
t
* Dro Luis Barreto Lecturer & Postgraduate Student9
Community Medicine department,,
M.G«X•MoS o 9 Savagramo
2
2
o
Abundant in concepts and novel techniques and packaged
into well drafted documents with what John Lewis has acclai-
»the superb Indian ability to articulate1 (Lewis 1964)
o.ir V year plans have even been held as models for developing
med .as
nations to emulateo
The primary aim of our plans has been to take the
■
country forward towards the goal of a st.o-dy rate of economic
growth bringing with it the benefits of a better standard
living o
of
Towards realisation of this objective a two-pronged
strategy has been adopted which deploys on one hand
rapid
industrialisation and on ths other modernisation
of agricultureo
The imploment at i on of the plans due to various reasons
s
was however very slow as a result of which in
many sectors
lirce public health the progress was far from satisfactory.
Why are we discussing all this when talking- of
unemployment amongst doctors,
This is because all along
in our planning, the elite which found its way in the various
planning committeess was planning to suit their interests
ana the hcaltn situation today is a reflection of the system
wherein
the urban bias of health policy is again
of reversal of priorities so that the major
are elitee
the result
oneficlaries'
From tne 1st plan onwards there has bee a dichotomy
between the stated and the actual prioritieso
1.
Provision of water supply and sanitation, pa-rti
cularly in the rural areas o
2O
Control
eradication of communicable diseases.
3
Increasing the number of medical and paramedical
manpower in the countryo
4.
.
Building
and improving institutional framework
for health care, particularly in the rural
areas (by establishing Primary Health Centres)
3
7ha.t a paroay when we analyse the situation today?
These priority sound impressive but a glance at the
existing situation makes one wonder what went wrong and
where.
Inspite of heavy investment of over one thousand
crores in the 1st 4 plans on water supply and sanitation9
more than one lakh villages have no water supply within one
kilometer distance.
Most of the large cities have water
supplies 9 for it is here that a large percentage of the
elite livesoo
A walk
wa.lk to the suburbs of those cities shows
how scarce water is in these slums and it is not strange to
see people 9 bathing in what to them is water9 but is
actually industrial effluentso
In the comba^t of
communicable diseases it is the preven
tive measures and tno paramedicals which have played a
.major role in eradication of smallpox and other communicable
diseases.
Inspito of these efforts we find that malaria is
coming back in a big way. TB
lopr.Qsy and water-borne
diseases together with malnutrition continued to be the
major causes
causes oi morbidity and mortality specially in rural
India.
In training of medical and paramedical personnel
the lion’s share of funds has gone to medical colleges and
what is the by product of the 106 medical colleges existing
in our country today — ppoxily sophisticate treincd doctor
unfit for rural areas — not prepared menta.llys neither
professionally to work in a rural set up o
This results in
his negative attitude to work there 9 even for a short period
of time.
Majority of our medical institutions are situated
in the urban areas and just a handful in the rural areas 9
the so called rural medical colleges.
One has a tendency
to look at them rather as medical colleges in a rural
area because the product from here is not really much
different from that passing out from other medical colleges y
situated in anurban area.
4
4
medical colleges? It
is invariably tho sons of the elite ? political leadersj
Of course a few candidates from the
big bus ine s sman etc
Who does usually get into the
rural areas9 schedule c^sts
.nd schedule tribes tends to
appe as<3. the c on.s,cjionce.
Coming from urban background, a customed to certain ■
•standard of life which is usually maintained in our medical
is but natural that when the students
pas ses out he will refuse to work in a rural areas wnere the
basic amenities like a good house 9 social life of a respecinstitutions9 it
table standard? schools of the class his children should
it
In
fact
xxi xaeu,
go to
w 9 picture houses etc* are not available*
would be surprising if
ho opts to work in a rural set up
We have not done anything to change their mentality either during the 5 years of medical education*
i/hy snould
we anyway-as long as he is armed with the toold to work in
an urban hospital9§ or take the next flight abroad.
his is
definitely guarenteed in our Medical colleges,
A look at our V year plans shows that the outlay on
health has increased from a mere 14o crores during the 1st
plan to Rs. 2334 crores during the V plan*
plan. A closer look
reveals that the highest amount is spent on Medical education9
training and research, This has increased from 21 * 6 crores in
the 1st plan to 117o76 crores in the V plan* This has resulted in an increase from 42 medical colleges to 106 colleges
t oday*
Corresponding increase for other systems ox medicine
has been from 20.20 crores during the 1st plan to 40*81
crores during the V plan.
Primary Health Centres have increased from a mere
52 during the first plan to 5328 in the Vtn plan with
34,088 sub-centres*
This surely is remarkable,
remarkable, but a
look at the budget allocation of the same is not very
It was Rs.25.00 cores during the 1st plan
encouraging*
With over 100 villages
and today , it is 155*62 crores.
to cover, with an average population. of about 80,000 this
definitely shows a great dispai’ity.
5
3
In fact the budget triangle shown below shows the
budgottry discropencies in our health planning.
PATTERNS OK ILLNESS PYRAMID
Very complicated
dGS6^W rr‘- *
Require care of specialists and
sophisticated drugs and equipment
in hospitals0
require care of doctor9health
slightly more complicated dosoasos
centre aad modern drugs
Require care of para medical
personnel at village level
Ordinary illnos^se^
Health
UNJUST BUDGET ALLOCATION
JTTL TOP -ISAVY 3MPHASIS
P^ttorj
/
ill
Xhis is yet another evedcnce of the way the elite class
perpetuates its vested interests in budget allocation in
health wherein the left overs trickle down to the bottom
9
where they are most required.
The present system of education for health personnel
as mentioned earlier is hospital based9 sophisticated?
cura-
tive oriented and results in trained health personnel, wnos Q
main- concern cannot bo identified with the health needs with
of the majority of the people.
Y77777 Urban areas
pyp^.aiit0-2o^
T Rural areas
T
i
doctors
:
6
s
Tho ontcorae of the present medical system
can be diagra-,
matically represented by the diagram given
on the previous
page«
There are today 200,003 doctors
registered with the various Medical buncil in different
states. 138,000 doctors
are supposed to have
graduated from our lOo Medical Colleges•
Of these 39^0 are postgraduate diploma
or degree holders.
This gives a doctor population
ratio of 1:4200, which is
not far from Mudaliar- committee’s
expectations-namely 1:3500
these figures however are
very deceptive-and it may look that
our doctors
are spread into the far flung villages of our
is not
country. Unfortunately this
not the
the case, since the doctor
this is
the urban
urban areas
areas varies
population ratio in the
varies anywhere between
I, 5
1:200 population to lx
00 population
population while m some of the
500
rural areas the same ratio is 1sIl,000, to 1,50.000 populaarons
ion in some of the very remote
■
-ty lunore areas, xhe transport system
being very poor in some
of these remote areas, we find that
people sometimes take a whole day to avail themselves of
any
health services , and that too at a P.H.C. It has been
reported t-iat some of these rural areas do not have
any health
facilities within a distance of 50 KmWe have been talking so far mainly of allopathic doc-
tors a
Let us have a look at the Indian systems of hedicine.
17}325 qualified homeopathic doctors and 71,058
gistered on experience making a total of 88,383 are
re-
rogistered with State Homeopathic Boards/ Councilsas on
Another 53,402 are enlisted
ringing the total to 141,785.
Besides these there are 90, .165 institutionally qualified
registered Ayurvedic practicioners, 73,317 not institutio
nally qualified Ayurvedic practicioners, 14$5 institutional
ly qualified Unani practicioners, 9033 not institutionally
qualified practicioners and 60 institutionally Sidha and 1235
not institutionally qualified doctors, giving a total of
184,584 as on 31.12.74. How is this vast' manpower
resource
readily available today being utilised, H it is*nt 9
5
is it so?
th on why
Besides 106 Medical colleges allopathis ^edical Colleges
there are 89 Ayurvedic Colleges,9 12 Unani colleges and I Sidha
Colege•
i
7
i/ith much emphasis that has been la.id on allopathic
medicine these colleges have received comparatively lesser
attention# This is also reflocted in the budget allocation
namely 20•20 crores in the 1st plan and 40.81
crores in th©
V Plan.
The sons of tho elite usually do not try for admission
into these institutions unles they have miserably failed af
ter all sorts of techniques, to got into ono of the allopathic
medical colleges.
However it is worth noting that htese students would
respond to tho call from tho rural areas more easily then, allo
pathic medical doctors, coming as they do invariably from
a comparitivoly lower socio-economic background. Another
reason for this is the fact that they find it difficult to
compete with tho allopathic doctors 9 in the largo cities
Th© drug industry in India has played an important role
in preparing tho typo of'doctor wo have today.
Tho pharmaceutical industry is the largest Industry( ex
eluding fertiliser) in the country today#
Capital investment
stands
at
compared
to 24 crores in 1952,
today
Rs 250 crores as
a tenfold
ih-C-r>oaSo. The total amount of production of drugs
is Rs. 500 crores. 25 crore worth of drugs are exported from
India. 8 crores are spent on R & D. The development of this
company has suppressed the development of the Indian Medicines.
The brainwashing by medical representatives starts even during
the preclinical period. The attractive presents,
literature,
presents
parties and dinners thrown for the doctors,
doctors make him so depen
dent on those fanciful preparations
nronarations 9 that when he has to work
with simple drugs and a limited
quantity of tho same as is the
case in most of our P.H.C.’s, he finds he is unable po cope
up with the situation , and thus his- discontent grows.
It has been estimated that about 13,000 doctors ar© today
unemployed in India , and many more are underemployed. Is it
really that they are unemployed 9
9 or is it that they refuse to
respond to tn© call to work in rural areas, and even if they do
not got Government jobs, to start private practice in these
areas? Most of th© doctors may join th© medical institution with
good intentions of* serving the people. Unfortunately the millieu
8
in our meuical institutions not being very conducive to
tain these interests, results in production of doctors,
sus-
who
are more interested in practicing in an urban hospital ? or
migrating to a foreign country for better
financial and educational pastures.
Coming as most of them do from economically sound background, they can easily afford to wait for sometimes
prolonged
periods of time 9 till such time as
they get a chance to work
in an urban hospital, or they get a
post-graduate seat 9 or_
perhaps till they get their visa to migrate to
a foreign country.
Can we really change their mentality as
long as we keep
on taking students from the present background?
If doctors
for the rural areas are to be produced
9 then the government
has to see that.,, people from rural
area s find their way into
medical faculties . Besides this it is important that tho
training be done in those areas. This will however will pose
a problem to our staff who are tuned to teaching withing the*
4 walls of our medical institutions•
The social values attached to a doctor
, the expectations,
a good car, suit perhaps,
a good wife with a fat dowry and so
on 9 all play it 1s role. If
a practicioner is seen with his shirt
and pant on a cycle, the
'
people may say that ho is'nt doing
very well in his practice.
This is by no means a
comprehensive analysis. 1 am sure
that my freinds Dr. Vinayak sen and Dr.
Vidyut will deal in
detail with tho root causes
unemployment in the medical
education system and the cultural inhsritage of an Indian
doctor
»hat I tried to bring out is that tho problem lies
in the political will and a radical change, in the concept
of
and approach to health is requirod to moot Gandhi's
goal
of wiping every tear from every face.
###**#**#** %.■*
(*) Paper prepared for presentation at
the Illyd Annual
Convention of the Medico Freinds Circle, to be
organised from the 26th-28th of January-178
9
«
9
References:
1.Indian Social Institute publication- Indian Capitalist
class and Imperialism before independence.
2. Workshop on health care - F.K.C.H- I.C.S.S.S report.
3. WhO Magazine July 1976 pg.4.
4. Lewis 1964 report.
5® Robert Grolicen report 1969
6. Pocket book of health statistics 1976
pg. 20.
7® Alina Ghuttani’s paper on Health caro delivery Systems
in India.
8, Medica 1 care accessible to the massesI.S.I. publication
9 Pocket book of* health statistics of' India-;
Pgs, 31,22,41942,and 39.
10. Statistical outline of India 1975
( Tata Services limited )
11. doctors desk reference book 1978.
12. MFC paper by Dr. Abhay.
21-12-19T8.
V
<Sc>/>A H.
.
: j-;
DIFFERENT APPROACHES TO DEVELOPMENT
In India, especially after the independence, we see thousands
of individuals and groups engaged in the field of development
either full time or part time. To be a social worker or
development worker, to some extent adds to ones status and
position in society today. In spite of all these countless
efforts we hardly see any significant changes in the life of
the nation as a whole. A national net work for a concerted
effort in the field of development is yet to be evolved.
A close look at these groups and individuals in the field of
development will show us thaytheir understanding of poverty
and the corresponding approaches to development varies and in
certain cases diametrically oppose each other. Though one cann’t
question their good will and sincerity of purpose, we should know
that, mere good will and. a sense of sacrifice and committment
do not indeed suffice to make our contribution to development
and social justice meaningful.
The approaches commonly adopted by different people in the
development field can be classified into three. They are :
1)
2)
3)
Welfare approach;
modernization approach
social justice approach
All these approaches proceeds from a clear and definite analysis
and understanding of poverty or underdevelopment, however
scientific or unscientific the analysis may be.
Before we proceed further > let us be clear about certain
initial facts.
i.
1
Our ability to identify factors and forces that create wealth
and poverty determines our ability to tackle the problem.
2
Each one of us has an understanding of poverty and under
development, whether at the conscious or subTConscious
level. We may have never formulated it, but a closer look
at our work will reveal it to us, Always the solutions and
methods adopted, follows from our analysis.
- 2
Our.preception of reality is conditioned by our position in the
society. Thus the causes of poverty identified by the rich may
not be the same as those indicated by the poor.
<
1)
'
■
The Welfare Approach :
This approach is deeply .rooted
1 ‘ in the mentality of religious
minded people and humanists* favoured by many private
< ' is
-- and
('
in both
agencies and governments —
-- developed
and in developing
countries. The fabulous investments
------- j in men and money that
welfare enjoys, compels us to reflect seriously on whether
it deserves it or not#
In this approach, development and under development
are
considered as two parallel realities that
have always coexisted, and that will always co-exist#
Jiere poverty is
accepted as a normal result of forces outside the
control
of man# These forces are identified
as natural and supernatural, Here the symptoms are treated with a rather fatalistic approach , rather than the root causes of the problem
with, a critical analysis. Natural forces are seen as
disasters, epidemics, earthquakes, cyclones, floods,
draughts,, etc. over which man has no control. In the
supernatural sphere, man's status in life is seen as predet
ermined. It is his fate, it is in the plan of God, and
explanation of poverty reflects a religious tone. Development
workers with this understanding regrets poverty, but accept
it as fate.
People who see poverty as created by forces outside the
control *of man, see little possibility for change. The
solution is seen as a sharing of material goods and talents
by the blessed and privileged, and the acceptance of these
goods and services by those who are in need of them. The
disposition advocated is a basic contentment with one’s
state of life, Work for the poor assumes the nature of
alleviating the suffering of the poor rather than eradieating poverty itself, Development work here becomes an
ongoing relief or charity, characterised by ’dolling out’benefit to the poor people according to their-needs.
- 3
And in the recipients
, it often develops attitudes of dependence, laziness and passivity and sometimes
creates division
among the poor. It always diverts
the attention of the poor .
from the real issues and anaesthatizes them.
Even a limited study of the
history of the welfare approach
and a superficial analysis of the *
functioning of society
reveal that most of the evils treated
by the welfare approach
are the inevitable by products of certain
forms of social
organization.
2) Modernizati on approach
Like the previous approach modernization too
rests on a certain
understanding of poverty and under development.
they say has to be bigger before it can be shared.TheSo cake,
in this
approach increased production and economic growth is stressed,
to remove poverty, Here it is implied that people are poor
because, there is not
enough production of goods. Modernization
approach relies on industrialization
and on rather sophisticated and capital intensive technology®
Family planning
of prime importance
and thus to promote economic growth.
r0“rXSthre t1S°
Pr“e lmport“‘:e
‘“ep
the birth
Here-, development is seen as the
successful utilization of
resources, natural and human. Such
an understanding stresses
the need for patience, hard work,
self descipline, sacrifice
investments and quality education,
needed for the production
of bigger cake. Under development is
seen as the result of
the slow and inadequate establishment
of the system of
production and consumption present in the
developed countries.
To a great extent modernization then
means westernization following closely the methods and patterns
of the developed.
The advanced countries become the
guides of the developing
countries. On the cultural level
it leads to the acceptance
of the ideals of western countries
and the adoption of
their attitudes and values.
Those who can produce more are
encouraged to the level best,
with the contention thai/the
benefits will 1trickel down’ to
This method of ’’Backing the strong’ (green revolution)
- 4 Even though impressive statistics can be given on the growth
of agricultural and Industrial production, on the number of
students enrolled in educational institutions, education and
public services, a question could be asked : who progresses?
The rich, who only posses the purchasing power, with their
demands, command .and control the market, and often fund to
imitate western standards of living. Industrialization
responds to this demand.. .and produces luxury articles which
give higher rates of profit. The production is done at the
minimum cost often introducing sophisticated and capital
intensive ■'technology, thus increasing unemployment. Poverty
and unemployment place the; workers at the mercy of the landlords and industrialists, with
with low
low wages, and miserable and
inhuman conditions of work. The state accentuates the
situation
by limiting or forbidding strikes,
Whenever the labour force
is so large and employment so scarce,
favoritism and corruption
unavoidably prevail, Extreme poverty drives poeple to borrow
for their subsistence and social needs; money lenders prosper,
for no bank or credit society, would lend money in such
circumstances. All this creates a vicious circle.
In a society where serious inequalities already exist a
technological advance leading to increased productivity is
likely to be limited to those
endowed with superior wealth and
social status to the exclusion of the poor majority’ says the
United Nations research institute for social development,
Geneva•
The modernization approach, therefore, ends with the abundance
of luxury articles and' the scarcity of basic goods; with
sophisticated technology and unemployment, low wages, debts and
bonded lab ours• It produces the wealth of the few and the
poverty of the many. The limited resources of the nation
are
thus used by a small groups for their selfish interests.
3) Social Justice Approach
The Failure of the modernization and welfare approach lead some
to evolve a different approach to development based on a critical
analysis of the various forces and dynamics at work in the
- 5
There is the conviction that non-economic factors that is the
overall social context of society with its institutions and
structures - Play a very important role in development. It
tries to tackle the rocJt causes of poverty and pays great
attention tn the proper distirbution of wealth. It does not
accept mass poverty or under development as a fate.
Modernization becomes important only when fare shares to the
masses are possible. The root causes of under development accord
ing to this approach is injustice. If 85% of Indian population
are below or just above poverty line, it is because 15% un
justly enjoy the results of the labour of the 85%.
In this approach one is convinced that deprived groups and
nations_can develop only in the context of a direct attack on
poverty and a move for just distribution of wealth and power.
Instead of depending dispropotionately on capital formation
and move modern attitudes and values, development ultimately
depends on land ownership, land utilization, employment, wages
and the level of food comsumption. What would development
mean in this historically created condition of under development.
It means the restructuring of society! Efforts in this direction
can be seen in Trade Union, (Balance of power in the production
sector through collective bargaining) marketing co-operatives
(challenge to the unscruplous exploitation of middleman) credit
unions, ^against money lenders) Mahila mandals (against low
status of women). Always it was the awareness of injustice
and exploitation in these cases that resulted in the organi
zation of people at various levels. So in this understanding
of development, the approach one would adopt will be awareness
building which will definitely culminate in action.
Genuinely effective development work will have to challenge and
re-organise the relations between the substructures in the
society. The wealthy are the socially privileged, and the
politically powerful. Power and privilege proceed from economic
standing. Culture and religion seem to reinforce the inter
relationship by providing sanctions andjustifications. A
total transformation of these structures and support, is in
evitable. In the economic sphere, this would mean policies
geared to serve the needs of the people and not as at present,
for the profit of a few. This would require that the means of
- 6 New ways of thinking feeling and acting, collective promotion ~
rather than individual promotion. On the political level, to
evolve an organizational set up that makes possible real and
effective decision making power for the people. Thus this
approacn aims at a socialist society.
Unlike the previous two approaches to development, this one is
a rather distributing approach, as it demands a commitment to
struggle, and a struggle against the powerful dominant group;
-and it is no easy task. As development workers, what options
does our above understanding leave us with? Can our sincere
desire to alleviate the wretched misery of our countrymen
express itself in meaningful actions that contribute to this
process of collective awareness, collective organization
* and collective struggle?
Community Health Department
CHAI, Post Box 2126
157/6 Staff Road
Secunderabad 500 003 A.P
* * * * * *
(Z 0 rv\ vA -
• THE CATHOLIC HOSPITAL ASSOCIATION OF INDIA
‘
Community Health Department
Grams
: CEEHAI
SECUNDERABAD 500 003
Telephones : 8482 93, 84 84 57
Telex
: 0425 6674 CHAI IN
Post Box 2126
157/6 Staff Road
SECUNDERABAD 500003
STRUCTURES AND SYSTEMS :
(This is an attempt to understand and explain certain
terms and expressions often used by Social Scientists
and others to express their understanding of Society
and to analyse it. This is not a critique of the
structures and systems but just a theoritical
description)
The term ’Structure’ is used today to understand various realities,
which are related to man’s life. The word ’structure’ evokes in
our minds the image of various parts, components or elements
organised into a unit, Infact the different elements of a structure
can be understood only in through their relationship with one
another and the totality. There is a functional relation between
them. This can be illustrated by the example of the diverse
organs
’ ' ’ are parts of a whole, as as such draw
of the human body, ’which
their meaning from their
-- ‘ relationship with che another and the
whole.
When we apply this concept of structure to the field of human
activity we can identify certain structures there too. For ins
tance, a family, an army, an institution, in it each person
possesses his position and status as well as his own role and
funtion. Each person carries on his task in relation to others
and to Society.
In the simplest understanding this term is applied to understand
a construction, a building, a set up because of which the
transformation or change of structure is often understood as
getting rid of a demolition of a building or an institution.
We use this term to understand the social realities and functions
of the Society. Social posiUon can be defined as the particular
point occupied by a person or group in a Social Structure. This
is often identified with social status and includes the set of
attributes or priviliges attached to that position. In the
context for example we have the caste system, the hierarchy
of castes with their attributes and previliges or discriminations.
2
There are established, patterns of behaviours and standardised
procedures - and we can say that the interactions are institu
tionally defined and controlled. In other words, we can say
that a Social Structure is a set of - institutionally defined
and controlled - relations between individuals and especially
groups; these relations are studied and understood through
a proper analysis of the society which will bring out the
various control measures and hidden .mechanisms which control
and limit man’s life and actions.
Different structures have different interests and values,
often they become conflicting and one tries to control the
other or overpower the other, which leads to disharmony,
tension and exploitation. Thus the very structure itself
becomes oppressive, dehumanizing and exploitative. The power
ful structures force their ideology, values, rules and regulations
on therestof the community to d minate them and keep them under
their control, unless suitably challenged gives them more power
and better positions in the Society. This controlling mechanisms
is often not understood by the vast majority of the poor
sections of the society and thus not in a position to counteract,
as often the powerful use ideological system to achieve this
end. In this process the injustices get institutionalized and
in turn internalized by the society. Thus it becomes an estab
lished order of behaviour and remained unchallenged until someone
wakes un andunderstands the undercurrents and the diverse
mechanisms employed to achieve this end. This structure today
we call an unjust structure.
A social system can be defined as a coherent complex of
structures and behaviour arranged according to time and space.
A system is a broad unit comprising several structures which
interact as different components do in a structure. The
structures of Production, distribution, exchange and consumption
for example interact and form a single economic system. And
the various social systems similarly interact and make a
'global system' or Society. A Society is comprised of the
economic, political, social, religious, cultural and ideological
systems. The first three systems c ncern the organization of
Society while the last three deal with the meaning that men
give to their individual and collective life.
Il
I
- 3 Religious and cultural systems don’t seem to be of much concern
to them, though Marx has a critique on religion.
Economic Systems
Every individual and Society has to satisfy certain physical and
psychological needs or wants, as for example food, clothing,
shelter, medicine, entertainment etc. Man’s Primary and basic
activity is that of Production. The economic system comprises
of four basic structures : Production, distribution, exchange
and consumption. In the process of producing and circulating
the material goods that meet these needs man relates to nature
through certain technological tools called instruments of
labour. They also relate to one another and form certain relations.
The sum total of all these is called the economic system.
The Political System
Man basically is a being with intellect and will which enable
him to make decisions for his own benefit and that of the society.
But when there is a bigger group, individual decisions can affect
the common good and hence there is need for a joint decision
making to ensure the benefit of all the members of the society.
This process of making the decisions is the political system.
When this decision making power is exercised through the elected
representatives of the people we have a democracy ; a rule (govt. )
of the people, for the people and by the people. This is to
ensure a smooth functioning of the Society/Nation. The decision
making power is handed over to the emoted representative so
that rules and regulations can be made to the advantage of the
whole community. Historically speaking we also come across many
others forms of government. Autocratic, Military and Monarchy.
Even in a democratic system the common good very much depends
on the ideology behind, namely capitalist or Socialist approach.
The Social System
Interactions between man and man, and between social groups when
structured and institutionalized becomes the Social System.
This concept implies a certain distribution of Social Prestige
and Status, or in other words a certain Social Stratification
understood as the differential ranking of human individuals,
their treatment as superior or inferior etc.
4
Various factors do, or can contribute to form this social
stratification in different types of societies. In the Indian
context the social system influenced and determined by caste
system , which divide the people into high and low on the basis
of birth. Set of rules and regulations are established by the
society in terms of man's life, relationships and behaviour,
hence, traditions, customs become part of this system. But
today we realise that there is a class caste combination which
controls and dominates each aspect of Indian Society.
Religious System
/
Religion basically is the established form of Man & God relation
ship. This relationship when organised and institutionalised
becomes a religious system which regulated and controls various
aspects and structures in terms of worship, Morality, ethics
and values. St is distinguished from other meaning systems
by its emphasis on the ultimate. It offers a systematic message
capable of giving a unified meaning to life, by proposing a
■coherent vision of the world and of human existence, and by
giving them the means to bring about the systematic integration
of their daily behaviour. This message is always situated in a
precise historical context, and provides believers, reasons
justifying their existence as in a given social position.
Cultural System
Culture could be said as the sum total of Man's Social Life in
a geographical, historical context in terms of the values
expressed through attitudes, thinking pattern and behaviour
which are manifested in the customs and traditions in a given
sociological Milieu. Knowing the people is to know their
culture : Why they behave and act in a particular way, what
decides their life circle, why certain parotices exist, why
they have certain value systems etc. The value system in
turn also influences their life and activity. The very value
system is also very much influenced by the religion they
practice. Thus culture and religion has a close link.
Ideological System
The term ideology was first used in 1797 by Claude De Tracy as
the 'Science of ideas'.. Mos® contemporary Sociologist, under
- 5 ideas and judgements which serves to describe, explain, interpret
or justify the situation of a group or collectivity and which
largely inspired by values proposes a precise orientation to
the historical action of this group or collectivity. Houtart
speaks of ideology as a system of explanations bearing on the
existence of the social group, its history and ins projection
into the future, and rationalising a particular type of power
relationship : The legitimation that an ideology provides to a
social group is never absolutely logical, but contains emotional
elements which are capable of motivating men and giving them a
feeling of security. Ideology is thus a fundamental element
in the culture of every human, ethnic, social or even religious
group* In this modern sense, ideology always includes in a
more or less explicit manner an understanding (analysis) of
society, a vision of the future, and a choice of strategies
and tactics understood in this way. The concept of ideology
can be used for both a small group (trade union, political
party etc.) and a whole society or nation. They foster the
interest of a particular group in society, and promote a specific
socio economic and political organisation. They can be
classified as reactionary, conservative, liberal and revolutionary.
* * * * * * * *
20-11-87/250
SP :mm
Community Health Cell
CHAI Golden Jubilee Evaluation Study
Policy Delphi Method - Resjapnge to Question-l_of first round
27th June, 1992.
A SUMMARY OF RESPONSES CONCERNING ECONOMIC, SOCIAL AND POLITICAL
TRENDS IN THE COUNTRY AND THEIR POSSIBLE IMPACT ON THE HEALTH
STATUS OF THE PEOPLE
• -> collation and reading we have separated the
To facilitate
’though in reality they are closely inter-related.
inter-related.
is therefore some overlap.
There
I. ECONOMIC TRENDS s
and are described first.
These were foremost in the responses
felt that the newr economic policy
panelists (80%)
Twenty-six p---.j for sometime and would have
recently introduced would continue
on the health status of people and
an overall adverse effect A
summary’ of the broader economics
on health care services.
’’’
l impact is given first and later the
related scenario and health
care services.
.—
more specific impact on health
A. National and international Economic Scenario
1. With the new economic order wej are now in a unipolar world,
advanced and industralised nations are
The economically a—---The underdeveloped/
1.
coming together and dictating terms.,
seeking
grants/aid/loans
developing nations will keep on r
.
and Gradually become overdependant and impoverished.
y
s favoured the advanced nations
and g^ou
has q1
War.
the Second
The
situation will be worse in the
since the
World
Second ’World VJar.
world as
unipolar world
there will be no bargaining power at all.
as \-2. international agencies like the World Bank, IMF, IDA, IFC
tools of exploitation, determining
and ADB have become Cl
national policies.
3'
control1
4
These new trends
trends have
have been
been variously described asglobathe neo-liberal model of development, the Americanisation
of our economy etc.
5.
There are very few options with the new policy. We will
aXalLHon, privatisation, liberalisation, »
in exports, a decrease in imports, an increased need for
repayment of foreign loans, and a.decrease m government
spending. Unscrupulous, middle men arid women will play
havoc.
fCal ■'2
2.
' j will occur primarily by a
6. Decreased government speeding
in
the services and development
reduction of expenditure
other
changes
in
sectors as <---. government spending would cause
upheaval
among
the
organised
labour and elite rainori y.
an
1
•
•
-c~’’
that
to health.
subsidies
Thus several panelists felt
---education, housing and other services will reduce, There
will be a reduction of budget allocation per person for
health.
7 This economic process will benefit the business and industrial
' community to become richer, with marginal benefit to the
organized sector of labour. There will be a more affluent
middle clacs
However the majority comprising of marginal
SmeJs? Arters In the unorganized sector, landless labourers
and daily wage earners will not be benefitted. Among them the
children^ women and the illiterate will be the sufferers.
Poor peoole(s) everywhere will lose control more and more
of the ability to determine their livelihood and lifestyles.
SeS health status »111 deteriorate end they will be unable
to avail themselves of the services of privatised health,
education etc.
B. Poverty
between the 'haves' and.
1. It was widely felt that thegap
due to inequitable distribution
'have-nots1 would increase
of resources.
would
2. Impoverishment and the absolute number of the poor
increase.
C. Agriculture, Forestry
1
The agriculture sector will move towards cash crops rather
* than essential foods. This would further deplete available
food stuffs for the poor, especially the rural poor, leading
• to greater malnutrition.
to pressures
pressures of modernization,deforestation and replace22. Due
Due
ment to
wi?h social forestry programmes using fast growing trees
like Eucalyptus would cause decreased precipitation, decreased
rain dllrelsed water table, increased droughts and floods
and11 therefore an increase in water borne diseases. Defore
station would also cause loss of top soil, decreased fertility
of soil, decreased production of food, malnutrition and
starvation.
D. Industry
1
will
.ii lead to a
The nresent liberal’ industrial policy wj
of all kinds of industries^ throughout the
(
T hie
would not have adequate machinery, or the will.
to safeguard the environment.
;
; a growth in
2. The new economic policy would bring
to the world market.
consumer based production
------- geared
t
This would have the following results, namely
a) ignoring of’local needs, which will affect the poor
badly/
. .3
b) crowth of large national and multinational agencies,
bottling th! small scale Industries resultirg w
Sc?eased’unemployment and breakdown of mental health,
with resultant
c) large scale environmental destruction
health hazards and avoidable deaths.
3. The technological model of development will be pursued.
middle class needs. It will have ill
vigourously to meet
(energy) needs will
rn eg.
eg . , increasing power
effects on health
(dislocating people)
polluting)) or dams
be met by coal (highly
(
(causing hazards due to radiation).
or through nuclear plants (
4 The openino
markets ro
companies will result
of markets
to multinational
• j of
u
in increased
availability and consumption of more chemicalised,
increased availability
foods, and artificially flavoured and coloured foods,
preserved i-and increased cancers.
This will cause dietary imbalance
E. lifestyle Changes
--- growing
the market economy
As already indicated above
-consumerism will affect lifestyles of the middle class and
for the poor ,eg.z there will
<
create consumerist compulsions
,
be a loss of traditional food habits.
1
F. Changes in Budgetary Priorities
!. Changing attitudes « social co^erna and the reduc^^vailg^igl^on^^cXi^a^^S c^Gently health,
pattieulauy el high rish greup s
llye
2- S:rth”tc1thl ;a»-Sitaty and binary sectors.
economic forces on health
Comments regarding the impact of these,
care services were as follows
G. Commercialisation and Privatization
increased commercialisation
1. Several panelists predicted an
oFmedical/health
services.
and privatization cf
J
'
of
2. This is already evident in the rapid proliferation
’Apollo
Syndrome'o
private polyclinics and the
■ -j "business
3. There will be further' mushrooming of corporate
tech’facilities
and
with expensive, high --- health centres" 1-consumerist promotion and values.
country at the
4. This will be promoted ’byr the leaders of the
services.
G- cost oFbasic'health
Health professionals in general and medical ^ofessionais
in particular have succumbed to commercialisation
curative services.
services will flourish.eg., new drugs
6. Only the profitable
and diagnostics and certain higher specialities.
5
. .4
4.
demand on the system
7. The affluent•; middle class will create a
mainly urban based.
for these ■type of services. They will be
H. Accgjssibi 1 i'ty
.
will marginally
lo Medical unities
.
i-----no accessibility to specialised
for common people.
medical services will keep
The cost of diagnostic and curative ,__y services presently
on going up at a galloping rate
Many
their reach in
affordable to common people will go beyond
.
10-15 years.
services will compete
church based groups providing health
' 5th the private sector to retain "market share . Overall
-- - income groups.
less attention will be paid on lower
in health insurance schemes for
4. There will be an increase
the public.
5. There will
services.
Sin
SS eare^ill^e Selected.
the "°st ana hs"e less acoess “
jType of Medical Care
1- AS ^Srvr'teSSrogicK^aiiiitXs^bSflung^ewrr.peopie
2
I?PS"pix Of the pyramia. These will primarily satisfy
Xe caregivers. There will be increased aependancy on,the
to maintain health, rather than self reliance,
SEentlyrS Sve^entleirthiaJJ-syJtim-is^ordly
health care system is hardly
Srkina partly because of shortage of funos. It will be
unaSe W cope with increased demands ano pressures on the
suffer.
system in the future. Rural and tribal health care may
j. Pharmaceutical / Medical Industry
There will be a sharp rise in drug prices due to unjust
1. claims of intellectual property rights.
pharmaceutical industry will now have a ^eater say in
2. The psetting of priorities and in determining the directio
the l
that health services will take.
3 • SSnSinX
pharmaceutical
and■traditional
health care systems.
increased large scale experiments of new
4. There will be
drugs on the poor.
of mechanistic procedures
5. There will be an increased pushing
will be a greater need for health
In summary, so far, there
"while paradoxically, access to health
poor
services for .the
be limited to the privileged groups only.
services will
--. .5
5.
aspirations
Health Personnel, their education ond—
K
..g commercialisation of education
1. There will be an increasing
capitation fee/
of
•in health sciences, with proliferation
prt
■ ’
•> turning out untrained.
Their education \--personnel seeking jobs in
2. Doctors, nurses and other medical
and living conditions
India or abroad for a better salary
a
correct attitude to
may often fail to maintain/develop
their profession/association.
Ir.
trends at present
' it the economic
____
1. Three panelists (9%) felt tha
were positive.
and these likely during the next 10-15 years
increase income and
It was felt that market economy would
above the poverty
More people
be brought
money flow
ah would
fThere woul/be
production of2 goods. There
increased:-----line,
All these
would
-would be increased1 and better transportation.
health status positively.
affect the 1• -» sector,
hospitals in the corporate
2. There would be a growth of
hospital/health management
t a means ci '
■
-- > would be eradicated or• controlled but
3. Communicable diseases
incidence of heart diseases.
there would be an increased :------diabetes. cancer etc.
may be the
panelist felt that improvement in education
improvement
Economic
M. 1. One
most’ important factor affecting health.
associated
with
often
and reduction in population growth are
improved educational status, particularly of women.
mioration encourages industry, impro2. It was felt that urban j
r about economic growth.
ving the GNP and thus helping in bringing
workforce with massive
3. AIDS could cause a depletion of the
economic losses.
" ■' wasa not totally
’
suggested that health
lo Another panelist
social issues alone.
and
political <-—--economic,
dependant on
(-felt that the questionnaire was not formulated to
t+2, Sn? out obieXively the causative factors of health and
sickness, so that one can ascertain in which direction o
move in the future.
...Le and social status of people
3. It was felt that the economic
’
i
in the world and in India would rise independant of any
political system. However
1----- haves and have-nots would
increase.
the economic aspect.
O. One panelist did not comment on
IT. SOCIAL TRENDS
A. Urbanisation
i The nrocess of increased urbanisatioh will continue and
’ SlPbe“ major factor affecting the health of IndlvKluals.
. .6
2. There is an extension of big cities and the urban poor have
a. lower health status than the rural population.
3. Adequate facilities will not be available for this group.
Sanitation problems, garbage piles, over crowding, insuffi
cient civic services lead to degeneration of quality of
environment, subhuman conditions and more ill health.
4. Slum lords and mafias further deprive families in slums of
their earnings, resulting in further deterioration of health.
5O Increasing pollution due to industries.
K • D^niographic Changes
1. The health status of women is going to get. worse as the sex
ratio over the years is going from bad to worse. Social
pressures and the low value for women and girl children will
continue for sometime.
2. The increasing number of the elderly will bring about a major
shift in health service needs.
i
3. Further increase in population will put greater pressure on
existing services, with the result that they will be less
efficient. It will result in deterioration of other available
resources.
Cw Family Types
1. The single or nuclear family system will be more common.
2. The breakdown of the family unit would bring most of health
care from homes to the service sectors.
D. Education
1. Improvement in education may easily be the jnost important
factor affecting health, particularly education of women.
2. However, the quality of education and values promoted by
it could be questionable.
G
E. Role of Media
1. Television will play a major role in the social lives of
people leading to greater consumerism.
2. For eg., advertisements will bring about an attitudinal
change with respect to food stuffs,moving people away from
healthy natural foods to junk foods.
3. With a new culture dominated by TV propaganda, old values
systems will be replaced.
F
YQlues / Spirituality / Religion
1. The sense of community will loose ground and a narrow sense
of individualism will thrive.
..7
!
I
1
7o
Several health and related problems stt.. ire? common ills
like man's confusion, lark of identity ano responsibility,
materialism and humaniscic beliefs, false values and lack
of spiritual strengths.
2
.
3. There will be apr°9rc5siVcrosion of values in social life.
4. The most disturbing element in the present social condition
the highest offices of the country.
and social services. Majority of tne so called mte i
gentsia are willing to make any kind of compromise m their
life for personal gain/prosperity. The system of accepting
"capitation fee" alone has opened up a.flood gate of corruption.
Tax avoidance, unscrupulous trade and business practices have
crept into the social service institutions in a significant
manner. Even institutions related to various religious bodies
are not free from dubious practices. The t;i-ny minon y wo
try to stand against such a wave are labelled as unsmart
and ’’outdated”.
Socio economic maladjustment is resulting in increased social
tension and violence of various forms. Mental disorders are
on the increase. Many modern health^problems originate from
social problems eg., tdisucj sbuse, AIDS, STD etc®
5O Churches will loose their popularity.
splincer groups of Christianity.
There will be many more
Cultural Changes
1. There will be accelerated cultural alienation eg.,, leading
medicine,
of_ ....
traditional
-to abandonment of traditional system^ l
food practices.
2. Many will follow a westernised style of life.
3. There will be a marginalization of sections of the population
including dalits.
H. Change in Life Styles
1. There will be an increase in smoking, drinking (alcohol)/ and
an increase in levels of tension.
2 Change in dietary habits and increased use of vehicles.
3 Need pattern and so health pattern will change.
4. Change of life style will change the epidemiological scenario
of the country. The problem of chronic non-communicable
diseases will increase, while most communicable diseases will
be eliminated or controlled.
I. Fimdamejmtial isnu / Separatism
1. Reoional, ethnic, linguistic, communal and caste conflicts
will lead to large scale victims.who will have to be treated.
This is already happening in Jammu and Kashmir, Punjab and
other places.
2
Religious consciousness, probably without god-experience as
love, and the consequent communalism*could be on the increase
affecting social and individual life and health.
. .8
3. The associated problems of mental health and adjustment
will need greater attention.
J. Social Probl eras
1. Social problems like crime, delinquency and prostitution
will increase.
2. There will be increased social disharmony and tension.
K. Awareness
1. The awareness of people will grow and a sort of helplessness
may grow leading to greater unrest and violence. This will
be exploited by vested economic and political groups.
2.
The public are going to be more aware of their rights to
medical services, There is likely to be more litigation in
the health field.
3O Consumer protection councils will make all government'
employees to be more accountable. This may make government
jobs less attractive than now/forcing even currently employed
personnel to leave the government service.
L. Social Trends
On the positive side
will be on
1. Educational level
rise. Therefore need for
,
--- the
-- -----freedom and better life style will be on the rise.
2. Science and Technology will be increasingly at the hands of
our people with techniques and skills to improve life.
3. Focus on ecological and gender issues in public policy.
III. POLITICAL TRENDS
A. International
1. Politically we are not going to be as autonomous as we are tod.
2. There will be greater neo-colonial exploitation through the
oppressive “new world orde^"o
3. India will be more and more subject to one new world order,
dictated by the West and Washington, with the cooperation of
the local elite.
4. The fall of communism in Europe will adversely affect the
concept of national health insurance in other parts of the
world.
5. There is a chance of a stable government. Changes in the
Soviet Union will have an impact on political parties.
Relationship with United States will not be very good as .our
country tries for self-sufficiency and development.
6. Another highly disturbing element'-is that some politicians,
though small in' number, serve the interests of the foreign
nations.
■»
. .9
B. National
Several panelists raised the issue of political mstabili
and inadequacy. There is hardly any political party with
the goals of good government based on a policy or directio .
And there is no reasonable chance of continuity. Health will
be one of the difficult areas which cannot be improved m a
developing country without political will and stability.
Unless ofcourse, effective health care is possible outside
the governmental system.
1
2. There will be greater criminalisation of our politics.
3. Political power is grabbed at whatever cost.
There will be negative political activities.confusing and
confounding the average person at the grass roots level.
At present there are1 many political parties working in an
aggressive and competitive way, each decrying the other.
party and the party in power in a particular state, making
it difficult for constructive and progressive work to be
undertaken to completion in the overall interests of the
people and country. People at the grass-roots who need the
services of health personnel will not get it as there will
be artificially created hurdles.
4
5. With political instability at national level and other
seperatist/fundamentalist movements .and divisive forces of
language and caste working oni a political level, health and
the marginalised will be most
social welfare programmes for
f
affected.
6. There is a serious fear that communalism is on the ascent.
If by any chance such parties gain control the whole political
life will change. This would seriously affect all volunteer
aqencies, especially as foreign money for social services will
be seriously curtailed, The church will be asked to remain
Sunday worship and not to enter the
:
with the four walls for
field of health or education.
7
of1 “divide
"divide and rule”
The principle
rule" is being used by politi
‘
cians of all ideological colours. Communalism is dividing
the poor also, so that they are unable to get together in
an'organiseTmovement’and fight or struggle for their rights,
reoard to health and other basic human necessities.
8
Political support to corruption and dishonesty at all levels
health care delivery system, forcing people
g
of the government
to go to non-governmental private agencies.
9. Politically it will be the moneyed who run the country.
10. There will be efforts^ by the marginalised groups to take to
extremism.
11. The organised might of the organised sections will resist
efforts to mobilise the unorganised million.
12. A strengthening of the conservative agenda of the current
government will set the climate for national development.
Health budgets will be reduced.
. .10
'I
13. Politics and politicians in the country have earned a very,
negative connotation because of the degraded form of political
culture pursued since 1947. Honest politicians interested in
the welfare of common people cannot survive. They will be
attacked mentally and physically even - all under the Gandhian
veil of non-violence. People who protest get labelled as
terrorists and disruptionists. Most nefarious socio-economic
violences are skillfully protected by the guardians of the
country, with no punishment meted out.
■•■■ ‘
; are self-seeking. The
14. The overwhelming majority of politicians
and
there
cannot
give
their work the shape
odd idealists here a.._
‘
of a movement to bring changes.
15. The left wing is totally unnerved by recent political changes in
the international scenario. They never did have a big say in
Indian politics, neither is any significant change expected.
The right wing is divided into two basic group socialdemocrats
and ultraright. The so called social democrats have substantially
lost popularity and power as they could not demonstrate social
interest, they did not try to distance themselves from the
self-seeking (investor class of) politicians. Gradually thei
image was tarnished. The emergence of fundamentalist force
could be even disasterous. But people are more or less tired
with both Gandhian and non Gandhian democrats, they are aware
about all bid promises since 1947, and opt for a change in the
coming election. There is reason to believe that the funda
mentalist group may try to change and adapt to secure their
forces are
are not
not at
at sight,
sight, no
position in Indian politics. New forces
are
to
intelligentia
willing
enter into
amongst
the
sane person
into
it,
are
jumping
unscrupulous
who
It
is
the
politics.
their attraction is big money, big name (may be due to notority),
Zlv position
—— in society.
black deeds, stupidity, failure
big
could be covered up quickly by the miracle touch of 1 Money
force".
16
Indians, as people in x^ussia and so on will hate* violent social
movements and Marxist analysis, separating or focussing on the
poor or weak alone, creating imbalance in approach to social
issues and so to health issues.
17. There will be stabilisation of the Government by the Congress
as a political party.
----- , Several
18. Rightist and communal forces will be on the increase.
panelists felt that: the flatter wiU-jaf fact health servi<?^&'
'Ill .V'."
tx.
...
>
C.---------------- •
adversely.
19. Decline of trade unionism -- this will make it possible for
U----- too
-- much labour trouble.
hospitals to run without
20. The growing disparity between haves and havenots caused by
inequitable distribution of resources shall result in social
tension, strife, disturbance, de-stabilisation, increased
criminal activities seriously affecting quality of life.
be an increasing political consciousness and
21. There will be
will need to give more personalized care.
literacy. Hospitals
j
22. There will be increased student movements.
. . 11
23. Total absence of a positive national interest by the leaders,
in the public services and the various sectors that contribute
to the health of people.
C. Regional
1. Problems of- seperatisin especially in border states may intensify.
2. Instability of government at the regional level (as is already
happening in the North-East, Punjab and Kashmir) will affect
health care services (government and private) and health status
too.
3. There will be increasing autonomy to the states. This will
require hospitals to satisfy local needs and abide by local laws.
4. There will be increasing consciousness among tribals and dalits.
Assertion by ethnic groups and subgroups,politically and econo
mically, resulting in increased autonomy by/for such groups.
Their demands and needs will have to be satisfied by hospitals/
health services.
5. There will be greater awakening among the marginalised, espe
cially dalits, tribals,.and backward classes. It would mean
their participation in social, political ^nd economic processes
in the country will become a demand, 'and justly s®. People
centred, participatory health care processes will be the demand.
6. Increased regionalisation will lead to intolerance of people
from other regions in the country.
IV. EFFECTS ON HEALTH/HEALTH CARE - due to a combination of the various
factors (other than those already mentioned)
1. Basic Factors
influencing the health status of the population and contributing to
the quality of life are water supply, sanitation, housing, food
(nutrition),
uiun)j environment, education(awareness), overall socio-eco
nomic conditions (including safety and security). Trends in the
different factors are s
'
2. Water Supply
Some quantitative iirrpiovenk ;it in ' < 've-rage (through tube-wells etc.,)
is expected. But maintenanc . i. quality (safe, potable water) will
not occur in the next ten to fifteen years, Mortality is already
reduced. but morbidity due to water borne diseases will remain high.
The two other views were that due to deforestation and increased
water utilisation for agriculture, the availability of drinking
water will become critical leading to increased water related
diseases.
3. Sanitation and Housing
Presently committed resources are meagre .as compared to the need.
There could be a marginal improvement in this. However incidence of
air borne diseases will remain high.
. .12
- hutrit1onal Status
*
There could be a major breakthrough in food production. However,
status of the poor are low.
chances of improvement in nutritional
------Hl
rise in food prices further
Withdrawal of subsidies will cause
oilseeds
has
already
and
created havoc,
the impact on pulses <
disproportionately
rising
-* due to use, of.
production costs are
-- -------improved farming methods and technology - hybrid seeds, irrigation,
use of chemical fertilisers and pest control.. The
The distribution
distribution
increased
export
is"
of
food items to
system is also faulty. There i
The
of
common
lot
the
people
meet the foreign exchange crisis,
will therefore remain unchanged.
5 o Environmental Degradation
Will continue.' The small movements here and there are like ripples
that will not develop into a tide in the near future. Manifold
effects on health will result.
6. Education (Awareness)
There will be improverr.ent in literacy rates, but there is.cause
for pessimism regarding real "education”. The new education
policy and the system promotes mass production of technocrats.
There is a neglect of the humanities and overemphasis on science
and technology, which will produce more technologically knowle
the^poorer
poorer sections
dgeable "inhumans",. Schooling facilities for the
government schools are already
<
overwill be inadequate. The qovernment
crowded and' in a poor state.
The holistic approach to health is practicable in an educated
society only.
7. There will be an increase in tobacco related diseases including
cancer, respiratory tract and cardiovascular disease. The huge
profit'margins of the cigarette manufacturing companies is clear
evidence of this.
8. The pandemic spread of HIV and AIDS could result in the reversal
the gains of other health programmes. A conservative estimate
is that over one million people in India are affected by HIV.
9. Increased cancers and other diseases due to industrial pollutio
anT'dumping'’of” industrial waste'including nuclear waste, from
rich countries into the Third World.
10 The increasinclv cornel ex drugs i.market w? 11 be useo and
prescribed indiscriminately, f > that iatrogenicor meaicine induced
ilmess will increase, fc: mple allergies, side effects.
e Ethical problems related to the use of modern medical technology
have already surfaced, for example provision of services tor
diagnosing and eliminating the female fetus.
12. Wholesale adoption of allopathy, without critical evaluation, will
create new health hazards and economic exploitation.
13 The weaker sections will realise that unless they have a signi* ficant say in the running of health services, they will be cheated
of their rights to health as in education.
14 Monopoly in the medical system - in our vast country, there is room
for many levels of health workers, who need to be trained ano dep
loyed to do their jobs responsibly and competently. With a strong
support system ’(up and down and sideways) and with good team leaaership, the impact on health will be positive. Kowever professiono.
councils do not want to change with the times, and continue
selfishly in isolation, for fear of loosing their monopoly.
.c
(S O r^\ H ' / 6 S’
<
Community neal.th Cell
CHAI Golden Jubilee Evaluation Study
Policy Delphi rlethod
4th July,1992.
A P,UUURY OF x^SPQN§2Sja^^
YEARS
used for this collation.:
(The 35 panelists, whose replies were
a wide range of problems
on the 'Health Scenario', listed out
in the next fifteen
and issues that would be significan
lm be of much greater
Some
vears in India.
Some ideas
ideas seemeo
seemed to
some
number,
than
to
a
larger
concern to = i^ger number, than some others which were
brought up by one or more participants only.
classified the responses into 2
While analysing the response we
i) Specific Health problems
ii) Broader ’health' issues
and specific•
iii) Health Care issues -• broader
-The classification was
rom the^anelist s .
prehensive understanding
A'uch a distinction
Most of the^anelist^had ^not^^o^bi,nations of all
these subsections JJhile 3 listing thea more > ^uent xdeas^ni-
-^^e-^tL-idr^ y^rsi^ ~:.ier
is some overlap between sections but, this
an exercise of this sort.)
Head.th Scenari o In India Xn The,
Text Fiiteen Years
The health p„hle..s of India will
.nvl?ona»nt,
1„ the years ahead .Wile »e
development,
poverty, poor hygiene, poor nutrrtron and
w shall increasingly experience the problems
affluence and modernization.
newer
with the resurfacing of old,r dr se.se^.o 0x0^ •
trends and patterns.
resources, our ability to
While y
o^0 theXational'and ’laternational ’ soene that ,1U deterndne
our d'rSlopdeat, uelfare and health policies.
Health Problems
that we will have to tacKle
The si giiifi cant health problems
in the. years ahead , will be • —
1 • Nutrition rej-ated problems
which will continue to
This will include malnutrition,
to poverty, populati on, deforestation,
increase due
policies of the government
of new economic
the effects
. ..2
*
wsThese will be further complicated by incr
on the poor.
easing adulteration and che.ni call sat ion of our foods as
also the promotion of junk foods by the food industry
siniultaneously with decreasing $tate/governmental inter
vention in nutrition progre mies.
2. Water borne diseases
This will include diarrhoeas and dysentries, gastroentertis,
typhoid, cholera, Hepatitis B, parasite infestations, /hile
rural areas will contiir e to be affected duo to inadequate
sanitation resources, urban areas including metropolitan
cities will not be spared due to grossly inadequate services^
This may be further compounded oy increasing ’waterlessness*
due to indiscriminate harvesting of water table, destruction
resources by
of natural forests, and monopolising of water resources
urbanisation,
cropping.
and
cash
commiercial interests,
3. Co ramunicab1e Di se a se s
Some of the major communicable diseases like Malaria, TB,
Leprosy, Kalazar, acute respiratory infections and preve
ntable childhood diseases will continue to take their toll.
■While re source s/knowledge are available for their control
and prevention, these will be neglected or inadequately
utilized and, complicated by the problems of inadequate
therapy a id problem of resistance.With decline in public
health and health care investment of the State, national
programmes for these diseases will suffer.
4. Hon-Commu.-icable dxseases
Diseases such as heart disease, hypertension , diabetes and
cancer will increase due to development especially of the
middle classes with increas in ageing pop .lation, change
in food habits axic life styles, increase in stress and
Smoking and increase in obesity and sedentery occupations.
5 . AIDS
This was predicted to become a ...ajor pc.bxic health problem
due to i) neglect of measures in nospitals to prevent
spread, ii ) br. akdown of values ana tabuos that have determined sex patterns, ill) change in sex hygiene and habits,
iv) infected blood donations, v) increasea migration axxd
tourism, vi) ineffective control measures, vii) lack of
oroper awareness, viii) present apathy about the problem
Other
lid time lost in'recognising its significance.
sexually transmitted diseases will also increase for some
of the above reasons.
6 • Problem of Mental Ill health
----; of stress related
These will include the whole range
psyche
and
somatic
psychological prablems,
di so rders,
suicide s, dementias and other mental health disorders.
. . *3
3.
They Wu.ll be caused by i) increasing stress, ii ) effects
of urbanisation and increasing unemployment, iii) family
breakdown, iv) increased disparity and dissatisfaction,
v) increased competition, vi ) loss of meaning/significance
of lift, vii) breakdown of family and traditional support
system , viii) increased family and community violence,
ix) breakdown of values, x) ixicreased miseries in an
economy of lopsided distribution and security, xi ) reduc
tion in vital faith and motiveition, xii ) lack of positive
powerful ’myths1 to sustain society and breakdown in
ideals of honesty, compassion, socialism and nationalism.
7. Addictions and Substance Abuse problem s,
These w-11 include problems related to narcotic and hallucinogenic drugs, alcohol and tcoacco.
The problem will
increase due to i ) increased, tensions, ii ) breakdown of
religion and values, iii) profiteering by pushers,
iv) changing cultural values, v) ana inadequate efforts to
create awareness, prevent or control the problem.
Some of
the factors described in (6) will also contribute to the
increase in the problem.
8. Pollution related diseases inducing allergies, asthua
other hazards
These will increase due to increasing environmental pollu
tion of air, water and soil by che>.deals and other hazards
ii) adulteration and harmful additives in food, iii) pes
pe sticides and other occupational hazards, iv) inadequate
dumping of nuclear and industrial wastes, v) increased
pollution by fuel burning and smoking, vi) increased covring up of facts oy commercial interests and, vii) inade
quate measures for prevention and control.
9• Disabilities and Handicap problems
This will be a major problem particularly affecting children
due to i) inadequate pre-natal care and immunization progr
ammes, ii) neglect of curable blindness, iii) increased
drug iatrogenesis, iv)g..notic diseases, v) decreased
This problem will be further compounded by
mortality.
breakdown of traditional family and other support systems
aid inadequate intervention or non-availability of better
solutions/methods for handicap care putting strain on the
families and increasing the distress of the children.
10.Health probleias of the -^ged
Problems of the aged (geriatric problems) will increase due
to an ageing population caused oy increased longevity, and
there will be a consequent increase in the number of negle
cted, lonely, depressed, inadequately cared for old people.
Similar to the above group this will bo complicated by
breakdown of traditional family support systems especially
joint family system.
...4
1 1 • Iatrogenic diseases
Txiis will oe recognised as a new and increas-ng problem
especially medical drug—related ./dt to i) indisc ruinate
medication, ii) over-prescription, iii) gunshot therapies 9
iv) irrational drug therapy, v) spurious drugs, vi) in
adequately tested drugs introduced into the hieiricet,
vii) unbridled advertisement of pills and related factors.
12. Accidents
both road traffic vehicular and occupationsrelated
accidents will increase due to urbanisation, industria
This
lisation nd .increase in transportation and travel.
will be further compounded by increasing violence in
society - social conflicts, at work place, on roads and
in the family.
At work apart from accidents,
also increase a great ceal.
occupational hazards -will
Apart from the above 12 major groups of diseases and problems
which the. panelists commonly identified a few other problems
These included i) more rheumatic
were mentioned in passing.
and
fever
related heart conditions in children, ii) ulcers
and piles, iii) iron deficiency anemia, iv) iodine deficiency,
v) resistanc-e to, drugs, vi ) chronic ill health and sub-optimal
Some of
functioning in daily work particularly among women.
the participants emphasised that many of these problems would
primarily affect the poor a id among them wox.ien and children
would be most affected.
Health Issues
Related to the above groups of health problems and contribu
ting to them (as mentioned above) or complicating the situation
further, the panelists listed a number of health issues that
would gain significance in the next fifteen years, these are;
* ^vi5OI^ental pollutior. and deterio ration of ecology, with
consequent effects
effect s on health and
and. quality of
oi? life. ~This will
be of air, water &Land and .ifect both rural and urban
areas•
2. Challenge of Enviroxiuental Sanitation
Inadequate provision of safe potable water, poor sanitary
facilities or solid wastes management, including disposal
of garbage & night soil due to inadequate resources and
increasing disparities.
Large segments of the population
will be denied this basic requirement for health.
3• Urbaaizatioa and its consequonees/contribution to health
of slum dwellers
The problems of slums will probably becuhie unirnaginable
due to inadequate planning, inadequate financial resources 9
...5
There will be increased migrant labour, increase of urbun
poor, increase in urban stress and unemployment ana <.11
related consequences*
Z|. greakdovn of Family
Many panelists have predictedI increased family oreakdowns
due to problems of divorce, separation and
ano o „hm ra^rit:1
problems, increased family disorganisation ana violence
and break up of traditional joint family system and support
systems with their consequences on mental health of people,
as also on the family's ability to handle its health
problems especially caj^e of children, a god and 1110 hanciica —
pped .
5 ’ Ethi call s sue s in medicine ^n^j^edi£aj^care
■ - ” cover
- -- the whole
will
These vill become very important and
invi
tro
fertilization,
range of issues such as invi vo ano. i—- --tissues
human organ transplantation, use of foetal
for transplants, with
human
organs
trading
,
in
euthanasia
cheap supp-Lieis? arug'misuse, overuse and oO
poor becoming cheap suppliers" <
ethics
I/iedi cal o
— and
----- values will be increasingly ocus
on.
upon •
6• Rational therapeutic issues
The growth- of multinationals in the pharmaceutical
pharmaceutical industry
m
a„< th,
the Motors
factors of
c. th<> «.rkot
the
problems
increase
are
UnKed to
economy
expected to
oy
drug tnuostjy
drugs^nc spuaous drug.. kxploit..tlon
th,
Exploitation 1 „
and luereasiug dependoueo on uestsm teouh.logy « J„brldl«d
of self reliant indigenous knowledge is predicted. Unbridle
^rtfso^t of pilL and tonics pill oontriouto to aggravating the problem.
7. Population Issues
of papulation growth
The problem of increasing pressur
and
its
consequences on
illiteracy
coupled "with high
have b »en predicted.
^-here will oe
resources and health
planning and
family
efforts
in
need for increasing, but these will be complicated by family
population control
planning issues which include newer contraceptives,
, abortion, infanticide, invivo/invitro fertili
foeticide
spe cially
effects of abortion/sterilization health, es_
zation,
of women and. so on.
s added the
In addition to these broader issues some panelist their contrifollowing to the list though the exact nature of
bution to the health scenario was not outlined.
...6
6.
iv) Influence of international politics and their adverse
effects on health related problems.
v) The paradox of longe r life span but poorer quality of
life .
vi) Increase in more incurable ailments - caused by high
technology power generation, radiation reltited gadgets
like xuicrowave, TV and Computer terminals, reactors
and nuclear installations.
vii) Irrational and non-consistent political decisions
about alcohol use/prohibition policy leading to
increasing death due to poisoning from spurious brews.
viii) The iusue of control of technology and the type of
uiultinational operations in India -with its implications
from the perspective of medical ethics and the develop
ment of indigenous research capabilities and foreign
exchange.
Health Care Issues
As distinct from health problems and health issues outlined
in earlier sections, panelists also identified many key aissues
•which may be classified as health care issues or dLssues signifi
cant to the development of health care delivery systems that could
These includeds
respond to the evolving health scenario.
** • Health care planning - cheHenges and problems
This would include a host of questions and issues;
i) Inadequacy of comprehensive health care planning
at? national level and overall lack of coordination.
ii) The dilemma of basic health care Vs sophisticated
health care - problems of perspective.
iii)-Increasing inapprepriateness of existing health care
service and non-availability to majority.
iv) Pressure on limited resources Of a complex epidemiological situation in the future i.e., diseases
of poverty and diseases of development/moderiiization occurring side by side.
v) Increasing rural-urban disparities.
vi) Increasing government priority to high tecnhology
medical care.
vii) Inadequate planning of secondary health care •
viii) Universal access to health system 9 particularly
to the poor.
ix) Effective referral syste*a beyond primary health
care/ceutre•
x) Need for greater clarity in content, direction,
objectives and strategies of public health policy.
xi) Clarifying role of xpublic/private/NGO philanthropic
groups in dvelopment of services. Harmony with
autono-my wit-.in a negotiated overall framework of
policy and priorities.
xii) More equitable distribution of health care delivery,
corresponding to population distribution and need.
....7
nnd Financing of health Care - The issue of
inve sti^ent .
These would include issues like;
i
i) L- ss and less government allocation of funds for
health care.
ii) Tignterning celt and increasing austerity - affecting
welfare and health investments.
iii) Rising prices of food, drugs and equipment.
iv) Higner cost of treatment, beyond economic capabili
ties of majority.
)
of cost of" drugs and equipment oy MNCs in
Escalation
v
the name of quality, intellectual property rights etc.
vi) Rise of consumerism and the market economy.
vii) Increasing privatization/commercialisation of health
care •
viii) The question of affordability of higher tech medical
care •
ixflh
‘ lc quest for cost effective medical care.
) The challenge of organising seIf-financing and selfsupport systems including health cooperatives etc.
3e Human Health manpower development - chellenges and problems
This will include on the one hand inadequate supply of the
right type of doctors to run the system because:
-i) Medical education remaining inappropriate for our
needs.
ii) Mushrooming of medical colleges and declining quality
of medical education.
iii) Over-specialisation among doctors and inadequate
availability of GPs.
iv) L^.ck of committed meoical personnel.
v) Medical profession becoming a lucrative business
rather than a service profession with doctors
becoming very money minded.
On the other hand there will oe a luck of intermediate peo jle
with Liedical expertisej as well as lack of village eased
There will be need for seriously re-looking
health workers,
at categories of health training incluumg doctors.
4. Rational Drug Policy
The availability of adequate drugs for the health care
delivery system must be ensured by a rational drug policy
that clearly identifies roles and limits for arug produc
tion, iwailability, distribution and sale for the govern
ment, liiultiaational and small industry sector and controls
medical advertiseme.it as well as misuse, overuse of drugs.
5. Primary Health Care Issues
The comiaitment of Health for All (HFA) through Primary
Health Care will include the challenge of providing:
i) Primary Health Care services - accessible to all
. ..8
3 <?'
ii
Primary education for all.
Minimum housing facilities for all.
iv Increasing health education and health awareness
building. In the community ano particularly in
z schools.
v) deed for appropriate technology in health care,
vi) deed for increased accountability of government
health care services.
6. Se c< ndary/^crt inry Care Issues
tec
These will include the issues.of affordability of high
hnology medical care, priorities a*id need for appropriate
choices at different levels.
Quality of care will also become
This concept will need definition as well as the
important.
development of a system of quality assurance.
7•.Health Edu cation
This will be an important issue and will have to bo. actively
pursued t) develop more positive health attitudes an cupacit
towards primary good health at all levels and stages of
life.
The scho . 1 system will need to be inore involved and the
c■•nsumers made more aware of the available services. Care
will have to be taken not to allow health education efforts
to become commercialised.
8. Integr ticn of medical systems
There will be need to integrate various health systems,
western and indigenous, into an overall system of service
deliver; with mutual learni:\g and even fertilization bet
For this the inadequate emphasis and promo*
ween systems.
tion of other systems will have t be changed towards a
more supportive development — standardising, regulating,
researching and priority setting in these systems.
Efficacy of indigenous systems of medicine and research
on herbal medicines and home cures v/ill dec nne important
i ssues •
9F fie search in Health Care
Issues for greater research in the new health scenario
will be
- - 3 to medical and
i) research into alternative approaches
:
_ efficacy of other systems.
hectlth care including
to understand
ii) deeper study of social psychology
health behaviour*
iii) increased focus on womens'’ health issues.
into holistic health care and
iv) increase research
----- ---related issues
...9
I
s
1 0 • To^/ur d s H olisti c no a 1 th
listic/wholictic health in the
Finally thu issue cf H .
holiness
'uodul will b^c -ao in'creasingl;
context oi' a positive
basic dimensions jof
five
t
...e
iiiiport;...it "wit-h. stracs 01nutritional awareness, environmental
self responsibility,
sensitivity, physical fitness and stress awareness anCi
This will have to be built on our own rich
ixna ge me nt.
culture of positive health especially in the
heritage and culture of
Ayurveda/y >ga system.
appear
The overall health scenario painted by the panelists may
looming at it from a more positive
sorao-w^at stark and bleaK out
thoit the scenario of health and health
angle one could conclude ----- -viH need a creative, multi dimencare in the next rifteen years
’ and holistic response and this will
sional, multi disciplinary a—
Challenge" facing health organisations such as
be the greatest <---C1IAI by 2000 AD.
* * * * * ** **
* * * *
* * * ***
* * *
* * *
* *
*
Position: 1293 (4 views)