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extracted text: RF_DEV_2_A_SUDHA

REACHING THE UNREACHED
G. Kallupatti, Near Batlagundu,
Madurai District - 624 203.
Tamilnadu, INDIA
Phone : 30 Genguvarpatti

21st October,

1991

Ref: AD/CHD/91/i^/f^
To
Community Health Cell,
367, Srinivasa Nilaya,
Jakkasandra, I Main I Block,
Koramangala,
BANGALORE - 560 034.

I

Dear Sir/M.adam,

RTU is an organisation involved in implementing programmes for social
and economic development of the rural poor.

Medical care, education,

community health, housing, drinking water and income generation are

some of the important programmes of RTU.
The community health and development programme is currently being
implemented in 13 villages.
was the entry point.

In the earlier villages, community health

Village health workers were identified and

trained and programmes for health education and health awareness with the

participation of the community were initiated.

Subsequently in these

villages, community development activities were also started by forming

sangams of men and women.
We now wish to take up an evaluation of the programme to find out the

impact of the programmes implemented in 6 of the villages where the
programme has been implemented for 4 years or more (the longest period

of intervention is 7 years and i.e. in case of 2 villages).
Oxfam has been involved in these programmes.

When we discussed the

issue of evaluation of the programme, Mr. J. Vimalanathan, Project Officer
Oxfam (Bangalore) suggested that we get in touch with you since he was
of the opinion that your team was

with our staff.

capable of conducting an evaluation

The evaluation is planned for the first quarter of 1992.

-2An organisation involved in programmes for social and economic development of the most backward sections
of rural society.
A Society registered under the Tamilnadu Societies Registration Act of 1975, S.No. 42 of 1978, Dindigul.
Donations exempt under section 80 G of the Income Tax Act, 1961.

REDING

THE

UNREACHED:

CONT:

l

dote: 21/10/91 subject:

This is to request you to consider the proposal and let us know
at the earliest if you could take up this evaluation.

On your

confirmation, the other details could be worked out.

I hope to

hear from you at an early date.

Thanking you,
With regards.

Yours sincerely.

3IRISH\ME
>nt Director.
Assistant

Cc: Mr. jy. Vimalanathan
Project Officer,
OXFAM, Bangalore.

5|s91

31-10-91

Mr. Girish Menon,
Assistant Director,
REACHING THE UNREACHED,
G.Kallupatti, Near Batlagundu,
MadurAi District - 624 203,
Tamilnadu.
Dear

SAx. (^/Vi-rA.

Greetings from Community Health Cell!
Received your letter dated 21st October 91, regarding evaluation of
your Community Health and Development Programme.

This is to confirm that a member of CHC - Dr. Shirdi Prasad Tekur
and Dr. Gururaj, an Epidemiologist from NIMHANS-Bangalore are
interested in participating in this proposal as a study-team.
Depending on the need, this study team may add one or more members.
Our understanding is thats
a} We cannot 'evaluate' any organisation. We can participate
with members of the same in a 'participatory study' of their
work in an objective manner, to help see how they have evolved,
where they are, and what could they do ahead.

b)

This arrangement will be between the members of the study-team
and your organisation as friends and colleagues and not for any
funding agency, etc., to maintain objectivity.
The study report
may be used for your needs.

c)

To understand the needs and areas of study, we require some
background material from you (annual reports, earlier
evaluations, base-line surveys and other such material) which
will help in the study.

d)

We could plan the study with you early to be able to brain-storm
with other colleagues here and prepare the ground-work in
advance.

2

2
e)

Dr. G. Gururaj being in Government service, may require an
official request from you to be on the team. We will
inform you about how to go about it.

f)

CHC having registered as *
Society
a
f<5r Community Health
Awareness, Research and Action' since May 1991, we will be
putting this to our Executive Committee for confirmation as
per rules.

g)

Your terms and conditions for the proposed study may be
intimated at the earliest for action here.

With regards and best wishes.

* spt/vnnr

S»

S -

/■
\

/
/

/ _

I

I
I\v

/ \V

■/[ _<w

REACHING THE UNREACHED
G. Kallupatti, Near Batlagundu,
Madurai District - 624 203.

Tamilnadu, INDIA
Phone : 30 Genguvarpatti

15th Novemoer, 1991.

mi
Ref: AD/CHD/91/(^7^
To
Mr. Shirdi Prasad Tekur,
Community Health Cell,
No.367, Srinivasa Nilaya,
jakkasandra, I Main,
I Block, Koramangala,
SANGALORE - 560 034.

V

Dear Mr. Shirdi Prasad Tekur,

Thank you for your letter dated 31.10.91 and your positive response
for organising the evaluation of our Community Health and Development

programme.
I endorse your view point that the evaluation has to be a participatory

study and that it should be objective.

The purpose of we desiring for

external resource people is to ensure that the exercise is scientific

and productive and that, the inferences are neutral and unbiased.

I would also like to point out that the need for an evaluation[_felt
by our staff and has not been suggested by Oxfam.

The purpose of our

contacting Oxfam was to get from them names of resource persons,
because of which we could get in contact with you.

For a slightly better understanding of our organisation, I am sending you

We had not conducted any baseline

a copy of our latest annual report.
survey before starting the programme.

surveys at various points in time.

However, we have been conducting

We will be collecting the survey
Since

analyses from our staff and sending you the same shortly.

you cveu.i<l

tkcn. have the information, you could suggest on how best we could go about
planning for the evaluation.

An organisation involved in programmes for social and economic development of the most backward sections
of rural society.
A Society registered under the Tamilnadu Societies Registration Act of 1975, S.No. 42 of 1978, Dindigul.
'2<V Donations exempt under section 80 G of the Income Tax Act, 1961.

REACHING

THE

UNREACHED:

CONT:1

date: 1 5/11/9 1 subject:

We shall put in an official request for Dr. G. Gunaraj to be on the
team.

Kindly let us know to '

1 it should be addressed and what

specific points are to be made in the request.

We also appreciate

and understand that you will have to get your executive committee

approval for enabling you to take up this evaluation.
Regarding terms and conditions, I would appreciate^you could make

the suggestion.

As I understand, the duration of the study would be

anywhere between 7 to 10 days.

We shall be making adequate arrange

ments for your boarding, lodging and transportation.

services

Our support

(typing, cyclostyling, photocopying, cassettes and tape

recorder, accounting help and any other secretarial support service)
will be made available to you to suit your convenience.

In addition

we would be willing to pay the necessary consultancy charges, which
should be specified by you.

I hope to hear from you at an early date.

Thanking you,

'With regards.
Yours sincerely.

{J.

£»

__

dev,

feoy-

V'tll^ges.

(A) NATALITY RATE (7 VILLAGES) FOR PER 1OOO POPULATION

i
I
.NO,

f
I
I
KEELAKOTTAlPATTI j SRIRAMNAGAR j KOTTAlPATTY j KANIMARKOILPATTI II PALAPATTY :UTCHAPATTY
I
(
Total
%
Total $ Total $
Total %
i
Total
%
Total
%
I

I SAKLYARMOOPANUR
PARTICULARS

I

Total

‘fo

r

I
1988

1o

2O

I

NATALITY

1989

15

J2_
259

-

1990

12

4

4

(12)

10

(41)

242

546

409

NATALITY (BIRTH RATE)

TOTAL

t28)

145

(29)

YEARWISE

ALL VILLAGES

1988

18

1989

29

1990

59
TOTAL

(16)

256

597

5.

4

(42)

-

(55)

I

85

______________

;

5
268

(11)

4
271

(15)

■

1
(5)
572

5

(10)

509

6 (17) 5 (10)
—
512
575

4

577

(11)

2

514

(6)

CHV; DEPT.; RTU. . GVET,

(3) INFANT ANDADULT MORTALITY RATES (7 VILLAGES) PER 1QQQ POPULATION

KEELAKOTTAIPATTI
p

SAMIYARMOOpANUR
M
g

SRI RAM NAGAR
M
p

KOTTAIPATTI

KANNIMARKCILPATTI
p

PALAPATTI
F

UTCHAPATTI
p (

S.NO

PARTICULARS

1O

INPANT MORTALITY
(INN)
1988

-

-

-

-

1 r
r^-(100)

-

-

-

-

?
_L_(165>67)

_

0-1 Year

-

y|-(76S2)

-

-

-

-

- -^-(533.35)

_

_2_(75O)

_

~

“

-

-

-

—|—<666.67)

-

-

- -4-(505

--

-

-

-

-

-

-|—(666.

_

—^166.67)

1989

1990

^-(83«33)-^-(83«55) -J-(250)

1-5 Years 1988
1989

-

—^—(166.67)

y=—(76.92)

-

-

-

-£<666.67) -^-(500)

-

-

1989 -t4-(1 53.85) t|(1 55^.5)
° ■
15

-

-

—(500)

-

.

-

1

1990
Above 5

1988

1990

A83.5)

-^(83.35)

12

12

^(1'00)^200)

-

-

-^-(100)

50)y^8.33) -J-(25O) ~(25O) - -4-033.5)

-4r(35o-4-v33.
b 35) 3 "33)

-

-

_

_

2_(666. @7)—(250)—(250)4-(20.0)

3

4
DEATH RATE - 0-1 YEAR

AGE GROUP

MALE

FEMALE

0-1

3

12

1-5

1

4

<5

18
22

r- .
54

_

_

-

16
32

4

4

5

5

(0) MORTALITY RATE PER 1000 POPULATION IN CHS PROGRAMS AIUAS

S AMIYARMCGPANUR

MORTALITTY .. ’
RATE:
moo
i yoo
»

1989

1990

KEELAKOTTAIPATTI

SRI RAM HAGAR

KOTTAIPATTI

KANNIMARKOILPATTI

PALApATTI

MALE' FEMALE

MALE

FEMALE

MALE

1
2^5

3
265

_1
W

MALE

FEMALE

MALE

FEMALE

MALE

FEMALE

4
“W

A ■
584

.
~

-

2
252

2
252

(10.42)

(10.25)

5
597

5
597

(7.56)

(7.55)

2

2

5

406

406

(4.92)

(2.44)

1
159

J
159

(8.62) (8.62) (7.19) (7.19)

-

-

-

1
145

-

'

1
145

(6.99) (15.98)

(5.77) (11.52)

-

5
268

FEMALE

UTCHAPATTI

MALE

FEMALE

1
509

3
509

/
(5.25) (9.71)

.(2.72)

-

.

1
575

(2.68)

(11.19)

1

1

1

4

542

4
272

577

577

514

5U

(10.77)

(14.71)

(2.65)

(2.65)

(5.18)

(12.75:

MALE.

FEMALE

TOTAL

1988

10

15

25

1989

4

9

15

1990

7

11

18

55

54

Total

= 87

PARTICULARS
1. STILL BIRTH
RATIO

SAMIYARMOOPANLR

1 . 13 ' x IUUU

(76.92)
per 1OOO children

KEELAKOTTAlPATTI

SRI RAM NAGAR

KOTTAIPATTI

KANNIMARKOILPATTI

~~ x 1000
4

~ x 1000

-J- x 1000
4

-J- x 1000
5

(500 per 1000

(100 per 1000

(250 per

children)

children)

1000 chile
dren)

(353.35 per 1000
children)

•

PALAPATTI

UTCHAPATT
1
3

—

z

(533=33 pe
1000
children

HOUSING CONDITIONS

TABLE-5

( K - KATCHA, P - PUCCA, SP - SEMI PUCCA HOUSES, E-ELECTRI PIED, NE - NOT ELECTRIFIED)

SAMYARMOOPANUR

KANNI MARKCI IPATTI

UTCHAPATTI

KAMATCHIPURAM

PALAPATTI

KEELAKOTTAI
PATTI

HOUSING
CONDITIONS

2O

5©

4«

5= _

SRI RAMNAGA

K

P

SP

K

' P

SP

K

p

SP

K

P

SP

K

P

SP

K

■p

SP

K

P

SP

K

P

SP

78

1

7’

-

-

62

3

T

121

15

17

70

-

- 100

59

3

23

—

-

40,

27

1

30

.E

2

1

—

—

—

20

1 •

1

—

10

8

-

-

-

8

5

-

3

-

2

2

-

3

NE

11

-

4

—

—

42

2

-

121

5

9

70

-

-

92

56

-

15

-

-

38

24

-

27

E

11

-

1

—

—

-

-

-

-

4

1

2

-

-

-

2

1

2

-

-

-

2

-

NE

27

2

5

—

—

-

-

-

6

2

5

-

-

-

5

.2

6

-

E

-

-

1

-

• -

-

-

-

-

2

-

—

—

-

1

3

2

-

-

-

-

1

-

1

-

Types of Total
Houses

NUMBERS OP
ROOMS
1o

KOTTAl
PATTI

-

NE

9

1

4

—

-

-

-

-

-

-

1

E

1

-

-

-

-

-

-

-

-

1

1

NE

6

.1

1

-

-

-

E

-

1

-

NE

3

2

1

-

-

-

-

1

-

-

-

“

-

-

-

-

-

-

-

-

-

-

-

2

-

30

-

MORETHAN
5 ROOMS

-

-

-

-

BATHROOMS YES

47

1

6

-

NO

26

-

4

-

-

-

-

-

-

2(E)

-

-

-

-

-

-

-

-

62

-

-

—

2

6

3

-

- 180

-

-

-

-

-

121

2-89

-

40

DISEASES RATIO (IN PERCENTAGE#)

s . No.

particulars

SAMI:yarmoopanur

KEELakO TTAIPATTI

SRI ram nagar

(28.67) '

(1.65)

1
143

(0.70)

1
242

(0.41)

1
(0.70)
143

lb <°-37)

(1.73)

8
242

(1.24)

3
(2.11)
143

14
346

(4.05)

19
2 42

(7.85)

_7_
(4.91)
143

(1.01)

3
346

(0.87)

2
242

(0.83)

8 397

(■? •uz
n? ;
\z

.9
346

(5.49)

12
242

(4.96)

3

(0.76)

2
346

(0.58)

2
242

(45.45)

(0,58)

4
242

1
346

(0.29)

(3.53)

6
346

9
397

(2.27 )

Vit. D. Deficiency

4
397

7.

Vit. B. Complex

8.

Vit.C

131 xl00(32.99)
397

78
346

(22.54)

2.

T.B. Ratio (1989)

6
xl00(1.51)
397

2
346

3.

Leprosy (1989)

7
397

. (1.76)

4.

Vit. A Deficiency
disease

14
397

5.

Protein deficinecy

6.

Deficiency

397

PALAPATTI

%

%

41
143

110
242

Point Prevalence
Rate(persons)

1.

K.K.PATTI

%

%

%

%

KOTfAlPATTI

%

145 (38.87 )'
373

221 (32.3'

268

268

9
373

(2.41)

4
577 (1-28

1
373

(0.27)

-

2W <2-61’

7

18
373

(4.83)

6
312 (1-92

9'
268 <3-36’

41
373

(10.99)

22— (a. a.o

(0.75)

7
373

(1.89)

-2- (0.9F
312

222(40.67)

312

312

2
(0.31)
143
0
6.29)
143

758 (4-85)

27
(7.24)
333

577 (6-09'

(2.83)

1
143

268

9
373

(2.41)

377 (1'28

(0.70)

zoo

9.

Anaemia Ratio

16
397

(4.03)

8
346

(2.31)

9
242

(3.72)

6
(4.11)
143

758 <4-48)

67
373

(17.96)

12
— (5.77
312 1 *

10.

Diarrhoea cases

2
■397

(0.50)

1
346

(0.29)

2
242

(0.83)

1
(0.70)
143

25s <0.37)

2
373

(0.54)

577 <°'64

11.

Skin diseases
18 ^,53)
(including infections) 397
4
U.R.I.
(1.01)
397

3
346

(0.87)

11
242

(4.55)

2
(1.40)
143

758 <5-97)

17
373

(4.56)

572 <2'24

2
346

(0.58)

6
242

(2.48)

1
(0.70)
143

268

11
(2.95)
373

577 <°-32

(42.42)

6
16

|y-(56.86)

29
60

7^—(16.36

12.
13.

Malnutrition

36
62

(58.06)

14
41 .

(34.15)

14
33

13.

Handicapped
(including polio)

2
397

(0.50)

1
■ 346

{0.29)

-

(37.50)

1
(0.70)
143

Z OO

(0.37)

(48.33)

377 <0-64

FOOD HABITS, LAND HOLDING

TABLE - 6

Ko Ko PATTI

SAMIYARMOOPANUR

PARTICULARS

(%)

KITCHEN
GARDEN

' •.
No

UTCHAPATTI

KAMATCHIPURAM

PALAPATTI

KEELAKOTTAI
PATTI

KOTTAI
PATTI

SRIRAMNAGAR

GO

(£)

(%)

GO

(^-)

8 (9)

5 (4)

8 (25)

5 (6)

92 (91)i \

82 (96)

52 (75)

(?«)

(%)

■ 1 (1).

5 (5)

• 1(1)

7 (7)

85 (99)

59 (95) ,

120 (99)

• 95 (91) ~

54 (94)
z

2 (2)

-

-

8 (15)

18 (15)

4 (4) ’

19 (19)

49 (79)

101 (85)

98 (96)

81 (81)

FOOD HABITS

T TIME

-

2(3)

(EAT)
PER DAY

2 TIME

7 (8)

J TIME

79 (92)

INCOME

2 (2)

7 500

■ ■

8 (15)

■' ' 6 (5)

5600

...

76 (88)

’ "57 ( 92)

’115 (95)

I

:

-

-

-1 (2)
85 (100)

59 (87)

57 (1'00)
z

7 (7)

5 (4)

-

8 (8)

16 (16) . ■

.? (2)

-

1 (2)

94 (92)

77 (77)

80. (94)

40 (100)

56 (98)

9

4

4

-

2 (2) .

6 (10)

8 (9)

3600-7500

PER YEAR ■'
BELOW

-

.

6

12

11

9

. 21

4

'4

2

-7

11 .

4

1

—

2

2

2

1

6

2

-

—

ii)- NON-IRRIGATED

6

. 4

5

56

54

9

5

4

LANDLESS ■’

74

’ -57

105

49

62

60

52

55

A) DEBITS

6

4 ’

’

4

' 1 '

14

7

6

6

. -

-

- -------- . -

-

farmers

MARGINAL

i) IRRIGATED

SMALL

’ '

BIG

GOOD

( OPINI ON)

.

.

1 (1)

E.-I H____________ -_________________ -_____________ -__________ 1 ( 1 _________________ L_L2_________2 --------------------- ----------------------- -

ILd
INDIFFERENT

86 (100)

-

61-(98)

1 (2)

-.121 (100)

• -

_ 101 (99)94 (94)

82 (96)

2(2)

1(1)

“

40 (100)

57 (100)

■

NED, G.KAL--UPATelopment department

ICS

BASIC PCPUL.

(SURVEY 1990) TABLE—I

. SOCIO-ECONOMIC STATUS:

POPULATION
S. No ,

VILLAGES

TYPES OF FAMILY

Popu
lation

Male

Nuclear

%

Total
Families

Joint

%

59

69

86

a
lo

Samiyarmoopanur

2.

Kannimarkoilpatti

3•

Utchapatti

86
62

129

208

52

147
3
15

78

I

i

I

189

48

397

27

31

55

121

45

268

17

27

45

72

62

181

58

131

42

312

122

95

7

5

129

259

50

254

50

513

76

75

26

25

102

188

50

185

50

373

31

31

69

!

69

100

176

51

342

48

56

37

1 44

85

70

143

33

82

7

121

242

39

68

18

.

-

I
4.

Kamatchipuram

102

c

Palaoatti
-

100

6.

Keela Kottaipatti

85

‘•

Kottaipatti Colony

40

8.

Sri Ram Nagar

i
i
I

11.12.1990

58

59

27

166

i

1
i

17

40

32

58

AGEWISE DISTRIBUTION

TABLE :II

Samiyarmo opanur

Keelakottai
Patti

Kanimar Koil
Patti

Ut chapatty

Kamatchipuram

Pallapatti

Male Female

Male

Female

Male Female Male 'Female

j---------------------Kottaipatti Sriramnagar
Colony

Ageuise
^isiribution

Male

Female

Male

Female

0-1

5

8

7

5

6

4

9

6

5

8

8

5

1

5

5

5

1-5

22

27

29

12

51

14

51

22

25

22

14

14

5

7

16

9

5-10

26

58

57

21

28

19

58

55

15

26

17

22

7

9

52

29

10-15

45

21

55

29

41

27

44

57

21

25

15

12

3

5

17

14

Male Female

Male Female

a
15 and at ove

107

100

56

41

79

65

158

155

118

112 \ 155

104

• 50 |

55

51

66

3
EDUCATIONAL STATISTICS

X
ILLITERATE 1S
. No

No .

0/

1 - 5th

6 - 10th

11th & 12th

i

1

Villages

1

31.

LITERATES
i
Beyond 12th .Technical

1

Samiyar Moopanur

356

90

28

5

•5

Nil

Nil

10

2.

Kannimarkcilpatty

216

81

39

17

2

Nil

Nil

19

3.

Uthapatty

304

97

4

2

2

Nil

Nil

3

4.

K.Kamatchipuram

268

52

61

38

4

1

Nil

48

R

Palapatti

193

52

135

31

4

-

48

6.

Keel a Kottaipatty

196

57

65

78

13

-

43

7.

Kottaipatty

54

38

22

15

2

-

62

a
8.

/
Sri Ram Nagar

Total
Average %
i ___ ________________ ________________ L
i
i

i
-

1
1
•j

222

92

1809

11

9

1

365

199

30

1

1

8

i

30

1
j

70
1
1

"

!

--------------------------------

i

TABLE :IV

OCCUPATIONAL STATUS

-

So NO.

VILLAGES

1. ’

Samiyar Moopanur

352

2.

Kannimark oiIpatt i

‘3o

COOLIES

CATTLE H£RDs/sHEPHERBS

I
BUSINESS |
|
I

PRIVATE JOBS

GOVTo JOB

11

2

2

4

26

212

13

4

5

5

18

Utchapatti

259

9

1

1

2 .

4

4.

K.Kamatchipuram

302

9

5

2

18

21

5o

Pallappatti

186

11

3

2

8

29

6.

Keelakottaipa-tti

264

. 15

4

3

23

91

?o

Kottaipatti

86

1

1

-

2

6

8t

Sriramnagar

136

1

2

-

1

4

I

FARMERS

14-12-91

51:91

Mr. Girish Menon,
Assistant Director,
Reaching The Unreached,
G. Kallupatti,
Near Batlagundu,
Madurai District,
Tamil Nadu - 624 203.

Greetings from Community Health Cell J
Thank you for your letter dated 30th November 1991 with enclosure
of earlier survey reports.
I have discussed the matter with Dr. G. Gururaj, and we plan to
visit /?RTU on 28th and 29th December 1991 to have a preliminary
visit and plan the evaluation with you.
'

This is to enable us to be with you on 28th Saturday when offices
are open, and any overflow to Sunday.
We would like to be back
at Bangalore on Sunday, night..itself j. or latest by Monday mornirjg.
Please arrange bus/train reservations for the same.
The details
are
1. Dr. Shirdi Prasad Tekur / Male / 38 years
2.

Dr. G. Gururaj / Male / 35 years.

We would like to know hot; we could get to your place, since we
plan to leave Bangalore on 27th evening/night for Madurai. Also
how do we contact you on phone? The CHC phone No, is 53 15 18
(9 A.M. to 5 P.M.).
My residential number is 62 07 40 (before
8 A.M. / after 8 P.M.).
Please inform by return of post at the
earliest.

With regards and best wishes.

* spt/vnnr

REACHING THE UNREACHED
G. Kallupatti, Near Batlagundu,
Madurai District - 624 203.
Tamilnadu, INDIA
Phone : 30 Genguvarpatti

29th November,

1991.

Ref: AD/CHD/9 1/1615"

To
Mr. Shirdi Prasad Tekur,
Community Health Cell,
No.367, Srinivasa Nilaya,
jakkasandra, I Main, I Block,
Koramangala,
BANGALORE - 560 034.

Dear Sir,
Further to my last letter to you regarding evaluation

of our community health and development programme, I am
enclosing survey analysis of surveys conducted by our
team, which may be of use to you in understanding the
type of our programmes.

at the earliest.
With regards.

Yours /sincerely.

Kindly confirm your schedule

26.12.91
Girish Menon,
Assistant Director,
Reaching the Unreached,
G.Kallupatti, Near Batlagundu,
Madurai District.

30
624 203

REFER OUR LETTER 14.12.91(.) UNABLE TO COME(.)

Shirdi Prasad Te

C.James

rea ching
the unreached
of village india

Postal Address:
GANGUVARPATTI
PERIYAKULAM TK

S. INDIA

Society Registered Dindigul
S. No. 42 of 1978

624 203

30/12/1991.

Ref: AD/CHD/91/ H37
To

b

Mr. Shirdi Prasad Tekur,
Community Health Cell,
367, Srinivasa Nilaya,
jakkasandra, I Main I Block,
Koramangala,
BANGALORE - 560 034.

Dear Mr. Shirdi Prasad Tekur,
I am in receipt of your letter of 14.12.91, which was received
by me only on 26.12.91.

Hence, I could not respond positively

by agreeing to organise your visit.

that may have been caused to you.
to visit us on any day

I regret the inconvenience

I request you to arrange

between January 20th to 25th.

Kindly confirm.
',,’ith regards,
Yoursfflteineerely

MENON,
nt Director

A programme to give substantial care to leprosy patients, TB Patients, old people, malnourished babies and mothers,
the homaless, abandoned children, the sick and handicapped and uneducated children of the village of India,

REACHING THE UNREACHED
G. Kallupatti, Near Batlagundu,
Madurai District - 624 203.
Tainilnadu, INDIA
Phone : 30 Gonguvaipatti

21st January, 1992.

To
M/S. Community Health Cell,
367, Srinivasa Nilaya,
Jakkasandra, I Main, I Block,
Koramangala,
BANGALORE - 560 034.

Dear Sir
I wish to inform you that we can now access to courier services,
the name of which is Franch Express Courier. The following is the
location of the offices of this courier service in your city:

S.No.

PLACE

1 .

BANGALORE
CENTRE I

ADDRESS
13/1 231, S.C. Road,
Lakshmi Nivas Opp:
Corporation Bank,
Next to Hotel Kapila,
Near Anand Rao Circle,
BANGALORE - 9.

STD CODE

PHONE

0812

269434
269435
269436
269437

0812

361486

Mr. H.S.P. JAIN.

2.

BANGALORE
CENTRE II

Swastic Complex,
2nd Floor,
Subedhar Chatram Road,
BANGALORE - 20.
Mr. S. Periya Sukumar.

Please note that while addressing mail, do mention "Via. Sholavandan
on the address which wi 11 ensure faster receipt of mail.
Thanking you,

Yours /sincerely

G1RISH ENON,
Assistant Director
An organisation involved in programmes for social and economic development of the most backward sections
of rural society.
A Society registered under the Tamilnadu Societies Registration Act of 1975, S.No. 42 of 1978, Dindigul.
Qonrujpns exempt under section 80 G of the Income Tax Act, 1961.

10-1-92

51:92

Plr. Girish Menon,
Assistant Director,,
Reaching The Unreached,
Ganguvarpatt i,
Periyakulam Taluk,
Tamil Nadu - 524 203.
Dear

•-.'sov r.,

■'

Neu Year Greetings from Community Health Cell!
Thank you for your letter dated 30.12.91.

I consulted with Dr.

G. Gururaj and it is not possible for

us to visit between 20-25 January 1992 as he is out-of-station du
during that period.

The next possible dates are Sth and 9th February 1992 (second

Saturday).

Please inform if these dates are convenient.

With regards and best wishes,

Yours sincerely,

Shirdi.Prasad Tekur.

*spt/vnnr

REACHING THE UNREACHED
G. Kallupatti, Near Batlagundu,
Madurai District - 624 203.
Tamilnadu, INDIA
Phone : 30 Genguvarpatti

28th January,

1992.

RjTU
Ref: AD/CHD/92/-235
To

Mr. Shirdi Prasad Tekur,
Community Health Cell,
367, Srinivasa Nilaya,
Jakkasandra, I Main I Slock,
Koramangala,
BANGALORE - 560 034.
Lear Sir,
Thank you for your letter dated 18.1.92.

I regret to inform.

you that the dates Sth and 9th of February are not convenient
since I will be out of station.

Could you therefore postpone

the same to the next week end, that is, February 15th and

16th?

The other alternative is during the week, that is,

February 13th and 14th.

I am indeed sorry in case

inconvenience is being caused to you.

Thanking you,
With regards,
Yours^sincerely,

any

51:92/

11-2-92

Mr. Girish Menon,
Assistant Director,
Reaching The Unreached,
G.Kal lupatti,
Near Batlagundu,
Madurai District,
Tamil Nadu - 624 2D3.
Dear
Greetings from Community Health Cell!

Thank you for your letter dated 23th January 1992(Ref.
92/232).

No.AD/CHD/

The dates - suggested by you are not possible due to prior
commitments here.
I had contacted Dr. V. Benjamin, Retired Professor at CMC-Vellore
and a promoter of Community Health to be involved in this request
from you.
Unfortunately all three of us are busy right through February 92,
and will not be able to get to your place.

Hence, I have decided that if you could indicate suitable dates
between 5th to 15th of March 92, between the three of us, one or
two could definitely make it convenient to visit you.
Please
write early.
Also, we do not know how to get to your place from Bangalore - bus/
train routes etc.
If you could send details of this in your reply
it will hdlp us inform you and plan the travel.

With regards and best wishes,

Yours sincerely

ftr

*spt/vnnr

L-—P'rasad Tekur

reaching the unreached
G. Kallupatti, Near Batlagundu,
Madurai District - 624 203.
Tamilnadu, INDIA
Phone : 30 Genguvarpatti

20th February, 1992.

To

Dr. Shirdi Prasad Tekur,
Community Health Cell,
367, Srinivasa Nilaya,
Jakkasandra, I Main I Block,
Koramanqala,
BANGALORE - 560 034.
Dear Dr. Tekur,

Thank you for your letter dated 11.2.92 (No.51:92).

It is

unfortunate that you will not be able to come here this month.
Hence, I would suggest the following dates:
March 5 and 6 or March 13 and 14 or March 16 and 17.

I hope one of these dates would be convenient to you.
For reaching our place, you may take the KSRTC Super Delux Kodaikanal

bus leaving Bangalore at 9.15 p.m. and get down at Batlagundu, which

is

This bus reaches - Batlagundu at around

i stop, after Dindigul.

5.45 a.m.

You will however have to take tickets upto Kodaikanal.

From Batlagundu, you may take taxi which you can get from the taxi

stand opposite the Batlagundu bus station.

from Batlagundu to our place.
G. Kallupatti High School.

The distance is 10 kms.

You may ask the taxi to take you to

RTU campus is just opposite to^school.

The taxi charge is likely to be about Rs.60/-.

Kindly confirm your programme at the earliest.
ith regards.
Your

Lncerely,

GIRIS MENON,
p Assistant Director.
y/2, — 5^6

in

<
eeonnmie d.v.iop™.,

”,976’SN0'42

moS. P—d —

■

Vp> •i1 <£PT ‘tvjs'CvvKU-iV £tvv> C (^zi/viA-h, A/]£«>S
/£.7O
.- wU» C^bt^r
lv<it i-<^ frrkcotUl Kj R7(/.
UNREACHED,
G. KALLUPATTI
•REACHING
—
• ”* - _ THS
- -- ... .......
_ ... . . .a - ......
_. _ ...............__ .
Community Health & Development Program

Questions we need to address:
(A)

GOADS of the CHD Program

03JECTIVES in operationalized plan

(3)

INTERVENTIONS developed

DEFINING focus population/sector
DESIGNING of mechanisms

(C)

MONITORING procedures/mechanisms

ASSESSMENT provisions (in built)
(D)

How this meshes into other RTU efforts +
Gove rnment efforts.
^-RTU (Office)

-—■ Field workers

at 3 levels

Vi 11 age/peop 1 e

Additional injco / What can fit into above:

‘ 1)
2)

History and Evolution.
Decision making process at village level
f requenftl^^heetings/minutes/ decisions/follow-up/.Area

including "co-operation

S'

•^3)

Monthly staff meetinos

..

Minutes
I , ,,
. .
x follow-up review
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^/enumerate difficulties encountered in

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.z^)

5)

Review VHW's medicine kit.

Content of Training - HWs / /As / COs / NFE teachers

+

job responsibilities. ~hjk
6)

Self-sustenance in health.

7)

Special programmes for women

Strategical areas of gender

discrimination.
3)

Communication process
Health education

- tools/processes/medias/

Peode.

Adult education.—
10)

Socio-economic development programmes

- loans

etc.

(P.T.O.)

/V

11y

Mobile clinic & its use.

12yz How participation is fostered.
#13>/

Compare old & new villages in whichever areas of

work taken up.
14)

Traditional/other - herbal etc.
measures utilized.

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CHD
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E ebruary

Holy
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Hospital
Theni
CHD
Dept

Remarks

Expected Result
By I.‘horn
Internal
External

(Hov;?)
Process

Planned Activities
Ccri al
Dumber

Field placement and
Theory

Govt. Schemes and
Facilities.

’

cl-

Pinclout the
Knot.-ledge, Attitude
and Practice of
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-nts and Sangams
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Programmes)

C
D

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Camm.unity
Health
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Members and Staffs

COi-J-.UUTY HEALTH & 31' Vl.LCl-MEiFT 111'a Eli-.Ml
R1A0HIHG the unreaceei)
. flSOLIRATEL OBE' YEAR REPORTS (FROM JAiiUARY TO DECE14BER 1Q911

.. . o

11X1

-

v...

.

—■■ .-

uhiam

'■ her of Cases Treated in 1991

-

.

1

1RI RAr. KaGaR

20

2

Adi-. il CallUrJi 1.
i\E-ELa 110’*11 iii 1- aiii
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KOTT^IRaI-TI COLONY

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24

50

25

2

25

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Ao

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40

40

50 4C

40

50

50

11

5

10

:>5

15

10

20

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20
20

28
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1
1
1
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KAI LAS AiATTl
SATHA FOIL RAl'TI
R.T.U. Campus (Clinic)

1

street ilay at Setmij-ar i.oopanur
--01 j_

P ct "t "t 1

1

T.T>

p0LI0

a

HEALTH ju3UC.-.i‘±0i. llrl. seovs
SRIRA1. EAGAR1
EAMA^l IFURAE
<
KLELAKGllAIRATTI
kOlTpiIRAITi CvLC..l
S Al’xL I. x-R r.OCRAx.UR
KawKIMR KOILR.ilTI
UlCHARAl’TI
1

U*
t } iU

" TRHUSTZEU in C~1 L ■ -■

22
14
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1
6

12

8

6

22

4
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1

5

5

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2
1

5

2

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1

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11
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1

4
1

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1

5
2

0

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One Ferna]
infant Cas

1

1 Female
2 :. f si L'l't 10 i C\
CASE
•j

1.0. of Audience }. resent
200
250
200
50
350
200
400
200
400
50C
185

2 times conducted by Sangam Members Subjects on Co-operation, Family Planning & Sanitation
1
"
Subject on NEE Importance

1-.CE11E CUrllC CxSE YLaR RE1CJ1

O-RlAL

-■

OS SHE

: ■.

DUMBER OS PATxEMJS TREATED
I lie
S'emale

1

ARI RAM MAG AR

c.

PADARATTI

-1

4

KAMATCHIPUR I.
KOTTAIPATTI COLG1D

5
6

KEELA KOTTAIPATTI
c A1-1YA R MO ClAR UR

7
r

KAMIMAR KOI! PATTI
UTCEAWTI

%

CucvX

AC
T --

m . -■
iOv&i

ARC Checked

95
52

3

62

44
58
C4

156

10

32

42

55
13

?<

66

57
106

94
172

6
20

10

21

51

_'A0

_22
421

_52
699

2'76

7

„1
25

I'Tumher of Children
Weighed
80
70
93

51
56

75
49
474

-emarks

E -iTTj ._.niCL

.BEU

n/C

M/C

W /;;

. . .65

67.36 o

71.60

55.02

65.76 n

75.05

5A 55

°2- 31 z

’ ■ . 00
or.06
\ *z ry , r 7
a

s r7 '--r)

24-65
30

NOTE :

Both Men’s and Women’s

'

PERCENTAGE OF ATTENDANCE

r
J » y >

/■

. 58

07
5
79.07

71.05 5’

79.59

’

61.78 5
69.35 6'

r'1.35 ('
100

: meeting were Cunducted in one/two times for evcrjjj month (one month interval)

LI EE HISTORY & PROGRAMME OF CHVJ & SEPT. RTU, G.KALLUPATTI

Physical Caverage
Villages

Month &
Year

January to
December
1989

Total No0 of ARC
Checkupped

8- Villages

January to
December
1990

6- Villages

101 (10.89$)
Per Month
Checkupped

Total Nooof Cases Treated
at Mobile Clinic

Total No.of Treated

Total Cases Treated
by VHWS (One Year).

Male

Female

259

381

640

1455

632

1748

1380

1798

GOATS SUPPLIED DETAILS

FIRST KIDS'GIVEN:No of Kids

Date

Villages

Upto Date No0of Beneficiaries

15»5o90

7

Saniyarmoopanur

9

13o6o88

4

Kottaipatti Colony First Given

14

9

Sriramnagar

15

»84

7

Utchapatti

36

84

6

Kannimarkoi'lpatti

54

„6o90

•

Month. & Year

Name of Villages & Programme
Implemented

■ October &
December. 1982

Selected Poolathur, Nandankarai &
Kumbaraiyur. Survayed, free clinic,
Youth ClubSo

, . 2.iHigh Lights

Finance Problem, People
no Co-operation, Over
distance from RTU.

I
December 1'982

Others

Problems

Stopped 3-Villages in
December 19820

Selected-Bagavathi Nagar, Li.iui
Kamakkapatti,Kannimarkoilpatti,
Kottarpatti, Veriappanayakkanpatti &
Utchapatti-Community Health &
Development Programme.
f

January &
March 1983

Plan for new Programme (ioe)
Self sufficient of Villagers.
Conducted Sangam meetings.

April-June 1983

Family Health Insurance Cards
(Reg.Fee Rs3/-) Per Year

9th May 83to14th
May 83

Selected VHWS (4 Male+
1 Female) 2 Weeks Training
14th Januartt to February
28th February 1§83 to
-VHWS. Theme of VHWS Train
ing:- (SCHEME) Personal
hygiene Enviornmental
Sanitation, Nutrition.
■ MCH, Diarrhoea, and DRS,
AN6tPNC,Anaemia,Leprosy,
First Aid, Indigenous
Medicine Methods of
Survey & so On. Other wor‘.
- Gidance to VHWS
- Review Meetings.-- ’

Formulated Health
Committee Members
in each Villages

—

Priority given them
on health treatment

Salary for VHW Paid from
this Collection.

Followup Meeting with INSA at
Tanjoor.

•

e

I
!

SCHEME:- Under five Cards
- ANC
- Primary Education
- Analysis of Survey
- report-Undergive

.onth h
I ear

Name ofthe Village a Programme
implemented

July-&
September
1983

- 20 Children for formal Education
- Text books and Slates Donated
- Valuable Practical Training
- Followed road to health Cards

august 1983

All Children Weights taken &
Vitamins tablets given.

Highlights

Problems

HEALTH COMMITTEE MEETINGS
DISCUSSED' PPIETS:-

1. Distributing drugs at
very low cost by VHP.'
2. Guidelines to COA.EO
3. ETU-Miaday Meals to
Studentso
I 40 Organising Mahalir Mandram.
Octoberc&
December
1983

Soakage pits-Constructed
Health Committee Meeting
Free Medication (Kottarpatti)
BAGAkATHINAGAR:- Under -5 Weighted
- Vit-A Given

August 1984

7- Goats Supplied to 7 Sangam Members
in Utchapatti Village

II

6-Kids (Goats) given to 6 Members in
in Kannimarkoilpatti Village on
( 15o8o1984)

' TRAINING;

; Audio-Visual aids
■ One week Cours Health Meetings
■ at Hottarpatti (Environmental
' Sanitation) Kottarnatti
I M/C & W/C.

r-1

CD

p

C'

o

r!

o

(I-

c*

t 'l •
IB

c+
ts"

t3 U
1

<
0 D

O

ro

H
<

5' o
pO Edl

t'l
a.

fl

a

E
1

Pc+ 'Vi K. <[30 III

[x
o w >r' r/j
I-3 <
T
> |-' d- H tr
lCl p P f» o
l
o ’ H 0’1 H
;>-(D
h a-'-CD (D <
D
da, «H cM
Cj H o,

(1
)

i-l

6

F
-i

‘

Selected 3 New Villages
1. Sriramnagar
20 Kottaipatti
3» Samiyarmocpanur

ll

o

-H

£

•P

855' Covered
C ommunity Health
Development
Programme.

/

RTU Borewell Here
61-Houses Constru-7
cted by RTU By
f
Support to BlvH

Lackot Co-Opera
tion among sangam
members

I ' Soap,Making’
; Training Planned
■ to this people

Lackot Co-Operation
So,Stopped all RTU
Programme on
September 1989 at
J ega j eevannagar„

1

ation Programme
running well
(Animator
l-.r oSelvaraj)
1987

1

o

<H

G
) £5

'<J Uj o

•

Started Mans Clula
*
(61 Members in
I
this Club)
I
1987

UJ

o

P

co

O

o 'O | 3

1

•P t-I F|

(P i

Q
)

—

1 „ rcU Adult
Education
Burning One
Year
2„'Constructed
E.2U Houses
167 (Total)
J.IZ.Iiagar46+
Er ;-AmbedKar i
‘Eagar 128=167

October
1986

january

LJ
•H

E-l

<D

>

i

(1)

1

Fi

,

a.1

.-I -.1'1

.

>1

Jegejeevan Nugar

l

o

tO P-1 O

Fi

CL

- ebruary

P i i-l

C

Q 15
‘ O

-L-

28^ Literocy got
by this Adult
Education Programme

|
j
I

3- Balwadi /
Schools /
-Basic Health
- Care M.C.H
- AiiC care
- Health Education
-3- Adult Edu
cation centres

■

!M/C & V.'/C formated
all 3 new Villages

1

i

i

■u
0)

(D

P

P-<

f-i
a;

-U

i i

Di-I

|

i

i

*—

■* •

K- 1./ V

' hl othersJGlubjs.
Seminar' (by
Social Welfare
Board-•Extension
Officer
(MrSo Lakshmi)

987
i
1

6th Otto
987

: Utchapatti

Balwadi Started /
(16O10O1987)

987

Utchapatti

72-Housing Constru- /
cted by RTu
Zz

ovember
7

Kotxaipatti &
Palapatti

„nuary
988

Sriramnagar
Palapatti
J egajeevarmagar
Koataipatti
Utchapatti

op,

Noon Meal Scheme
Adopted

Colera epidemic at
Kottaipatti &. Palapatt
RTU actively Involved
on ccuring & Preven
ting activities agains
it.
In 1988 5-^'illa.ges
Adult Educat i cn
Programme Started

.KottaipattiColony
4-Goats Supplied to
Sangam Members at
KottaipattiColony

'EVALUATION' Done
byohw Staffs

j Sr-ramnagar:
!24 Peoples got
I Buffaloes loan
6- Person-Sheep loan

Highlight | Problems

I Others

-

18

J„KoNagar

o

H

(f)

1

£

-

r-7

I- '

|—

p.

J

IScheme Adopted

Lj

hj

Leadership
Training Cours
1

(D

ecember
988

I

ctober
988

42

05

October 10th to
15th 1988 Sangam
Members Training

r

•> I

ctober
988

H

Participants

Dr„Ambedkar
Sheeprearing
Society for
mated with
42 members
by Utchapatti
Peoples,,

Health
awarness
here
*
'DRAMA
by-Uindigul
St.J oseph
Hospital with
support RTU
CHV!
|

Bagawathinaga
Sriramnagar
J.KhNagar
Utchapatti L
Other Project
C overing
Villages

anuary
989

i

Kottaipatti &
J oK.Nagar

i
i

Benefits from
g ovt „
- 62 Persogot
Govt. Benefits
during this
months in all i
8 Villages
- 28-V’idow
Pensioners
- 5 Streetlight
- 4 Viat er taps:

People Cont
ribution
cost of
Medicine
: Bso35o90

i Nooof Cases
Treateo-27

iear

uh Jebruar
ogg

Utchar-atti

J.K.Nagar

ebruary 1989

.arch §9

J.KoNagar

; Chiles Barents
C entribute
Rs. 5/~ per
Eontho

4-Borewe.ll by RTU

BelwadiStartec .
□ecri-i of
::c—co-operation
anonr people.

1. Jawahar well
Digging loan
sanctioned.
- 15 Members
(J.KoNagar).
2.8 OoAoP
5. Terming sheep
society IQ
’Widows and 1
Hundicapted
Persons

12-V'ater Taps
from Govt.at
J.KoNagar. ■
-7 O.A.P
-11 Pregnant
v omens aid
-ANev; Street
light
-Buffolow loan
-8

Sheep loan-2
NooOf Cases
Treated-?2
People Medicine
Contribution
Re.57.75/o o o j. a u i e n i. c
Treated—19o
Balwadi Share
(Utchanatti)
Rso1107-

All Villages

Kannimarkoilpatti
Palapatti and
n o utainatt 1

iemale
infanticide
(kok.patti)

4-Street light
& one Borewell
and Water Tap

17c, of Cases
-Tt- lee- i
' i d ow Daught e r s
Marriage aid
3 Families

9-9

1989

(Leral aidMeeting at

56

Palepatti
Utchapatti
S ami ya rm c o pa nur

Road repaired

Ka nn i ma rk o i 1 patti
Kottaipatti

RT •. Oonstrucui cn 58 Houses
an Kannin&rkAC ilpatti

j'TC.of Casses
T^eated-104
I-/C Registred
at Dingirul
Samiyarm o opanur

Registred i-/C
& V:/C at
■^indigul

5.6.89 New Things
Supplied to
Utchapatti Ealwcdi.
Borewell and a
Community hall
from got by
Kannimarkoilpa11 i
h'/C Sangam

I
1989

K.K.Patti
S ami yarm o opanur
Utciiapatti

Pi Imshows
(Healthcare)

Palapatti
Kottaipatti

Awareness Street
P lays

!

-

I

_

I

Registred M/C at
Dindigul

I
1
4+7
KHealth Training)

26o9oS9
Filmshows Street
Sengulathupatti Play
K.KoPatti
St0Josephvillage Film shows
Vinohanagar &'
Thummalapatti

I
i
i
i
0 0

9«.

No0of Cases
Treated-125 onegot well d iggi ng
j (free) called
■ Jevandhare-3
■' V'omens got 0..4.F
' AH Villages
Medicine rontri■ hut ion Rs o 27 o 85
No.of Cases
Treated-129
-1-person got
sheep rearing
loan (Utchapatti
people contribu
tion Rso45=40
i

U
Cl)

(D

CD

No.of Cases
Treated-117

Compound wall ,
against flood
control by M/C
I Sangam at
Kottainatti .
. (Colony}

Palapatti
Sriramnagar

K„K«Patti
S amiyarmm o opa nur

SPn l-.eetings
Conducted by
C-.R.I for
M/C L V./C
Improvement
(Advised &
Planning)

I
I
I
I

5-Street light
4-Street light
4-Street light
got by Mens Cl

NOoOf Cases Tr
101
Got compound w
4 street light

CD CQ CO

I
■

No. of Cases
Treated-149
T’v.'ADB-Boreweel
near HTU Balwadi
at J.KoNagar

CD

Ik ottamatt i

I

P

O (I)

ember
9

ralapatti

Fornated a
Prohibition
I Committee
against.
F emale
Infantioile at
Kannimarkoil, natti
i
I

I

No-cc—over
at ion v.'inh
all steps
of ETL"
Frogran-.-.e by
K/C !'embers

,

Sangan problem
(Police cased
(Senraman)

(Q

I

.nuary
, 1990

bruary
90

Samiyarnoopanur

-

Started a Valuadi

Filmshows -2
(Healtheducation)

-’th

Eea1th Drama
at Lluvanampatti
155-Oases
treated by VHv
Bullock loan-1
and sheet
rearing -oan-1
Sanctioned
-

-

I

z*ch

li. o J?*- o

50

Li U 1

Kottaipatti

-

-

-

-

Sanectioned
4 Street lights ■
20-hut services j
1-Preganant
women aid from i
govt o (March90)
2. Street lights'
Sanctioned

147- Cases Treats
by VHWS

I

ril190

1
(Bore-well
repair
Training)

12

Sami yarn ccp.anur
-i. o u t a r pa t u x
Sriramnagar
S am i ya rm o o p a n ur
h o 1-o — cxtt 1

Filmshows Conduc
ted J-Villages

Conducted 11onformala education
v< eekly 2-Pavs by
irw 'Q

-

A

7.

Sanctioned
(S 0Moopanur)
Motivation work
d one ah out
' CHEDIT UH1CK'
Scheme in
Selected Villages^
(i„e) KeelaKottai
Patti
o o o

11 0

0 3

86- Cases Treated
by VHV;S

-11-

mth &
;ar

No., of Training

ay 1990

2
(C-Orgrs Health
Training)

■

M/C±V,/C+C/C
Health Training

High light

Schemes
Ad opted

’illages

21+5=26
(Teachers
(CHWi)
Awarness

K.KoPatti
Palapatti

Film shows

Samiyarmoopanur
»1

Introduced new
credit Union
Method

Diggened Pits
for Tamarind
tree planting
6-Kids (Goa'ts) on either sides
of link road
. Supplied to
(K.KoPatti)
6-Sangam
Members
(15.5.90)

Samiyarmoopanur
K.KoPatti
Utchapatti
.Keelakottaipatti
Kottaipatti
Colony
Kamatchipuram
Palapatti
S r iramnagar

8-Village. -.
Covered
Forums for
Health &
Education-1

'-4 T

One 9th
990

une '90

Programme
Implemented

No o of
Participants

52+36+59=107

Utchapatti
20.6o90

109

v.

—

9-Goats given
firstly to 9
Families.

—

G oKallupatti
Utchapatti

Film Shows

Others

168-Cases Treated
by VHWS

Film Shows

Palapatti
Keelakottaipatti
Kattaipatticolony

■

l

___________________ L
i

Sri ramnagar

M/C+W/C+C/C
| Training

| Problems

-4 Traings for
VHWS
-1844 6ases
Treated by VHWS
during 1990
-22-Review
Meeting for
VHWS in 1990

M/C & W/C created
& Runing well
- Fund collection
done and it
- Deposited to •
Bank

Shad owlshed repa
ired , |
Soactage Pits
Diggoned-2 near
RTU Borewells

125-Cases Treated
by VHWS

Combined work
d one-Road
repaired by
S angammemb ers

—

.4

—

175-Cases Treated
by VHWS

.

'Threshing floor
from Union BTL
(Utchapatti)

-

-

-12programme
Implemented

□nth & Year

Villages

eptember '90

Palapatti +
KottaipatticolonyI

ctober '90

Gandhipuram

ovember '90

St„Peterschool
(26o11o90)
Kamatchipuram
(21e11o90)
Ammapatti
(22o11o90)
Samiyarmoopanur

rroblems

High light
Completely Road
repaired and
extented by people
Union CO-operation
(Falapatti)

Others

i
i 166-Cases Treated
! by VHWS
I

i
-

Filmshows (24»10091)

184-Cases Treated
by VHWS210-Cases Treated
by VHWS

Health Filmshows

"

I
December ’90

Scheme Adopted

”

•
Link road Structured
and repaired by full
Co-operation of
Sangam members at
Samiyarmoopanur
Villages

-

150-cases Treats
by VFT.'.’S

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Education for health aims at creating awareness among people

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pre-recuisite for this.

6.

Involvement of traditional healers, Dais and indigenous
systems.

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village to be trained and ANC and PNC made locally
sustainable.

Indigenous systems practitioners in the

village to be integrated into the community health programme.
' Promote herbal gardens as part of kitch garden scheme.

C Compile and document local herbs used, their effectivity,etc.

7

VHW

VHWs illiterate.

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simple meaningful record keeping / understanding health

messages and for better communications is to be undertaken
as part of their training.

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simplified to suit their limited role in minor ailment
treatment^

More efforts^ to preventive end promotive

The job specifications depending on their capabilities and
community needs is to be made and their training programme

tailored to suit this

The VHWs skills to be upgraded

referral system to

A

hospital/health ,centre to be strengthened.-^^
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2A |

BACKGROUND
tAx. K-vvzerx AzA'C R.I oj

The project

started in the year 1975 and registered in

1978 at G.Kalupatti, Madurai District^

an attempt to reach

be<?t>H vnthe unreached.. The felt need of medical aid in this '■Errne led

I

'

A

to the starting of a small base health- clinic and'mobile clinic

to surrounding areas.

This spread into

* felt.

_SE£:

jxtciv (U

needs of the people,

housing, education, water,

foster-

families^ income generation programs and other social welfare
measures.
(D ORIGINS

The community health program started 4

later (in 198^/^)

using health as an entry point for overall development of the
communities in^tnis area^^It began with non-formal education

incorporating health messages, and slowly evolved into a
community health program.

In course of time this ex

transformed into a (community Health and JSevelopment/jprogram^
Crj f) ct&weP wJfo
RJTU-

0,'v^dv tTu/

(^)gC..LS AND

OBJECTIVES

The goals of this community health and development programme!
as stated in their progress report are:-

TO REACH OUT TO A LARGE Z&i OF PEOPLE IN DISTANT AND REMOTE
VILLAGES AND ENABLE THEM TO IMPROVE THEIR QUALITY AND STANDARD

OF LIFE.WITH THEIR ACTIVE INVOLVEMENT.USING HEALTH AS AN ENTRY

POINT

This is aimed at building up egT7rTt~h_jne:

of confidence and

self-reliance in the villages and to initiate a process of
common village development through formation of sangams

(associations) of men and women.

CF
2
evolutic;

To chronologies ^describe the evolution pattern:

1.

The earliest activity was the mobile clinic of R.T.U.

2.

While pursuing this activity,

, eight villages were

identified for using mainly community health interventions
towards overall development.

The criteria for selecting

these villages weres-

a)

lack of any health or development activity;

b)

remoteness from centres of development activities;

c)

being small (population size) and therefore manageable

and
d)

people belonging to predominantly backward and underprivileged

sections of society.

3.

Formation of local Health Committee and selection of Village

(VW")

Health Worker («3^Tnr)

Formation of village level health committee^was preceded by
awareness building for health through street theatre and

This health committee identified a health

public meetings.

A

worker who was acceptable to the community.

These VHWs from

8 villages were trained at RTU for a period of 15 days.

During

1985-36 the programme was stagnant because initiators left.
irfkMy

■

.

1

In 1987^it restarted^
’

4.

'

'

'

!

f

Sanqam formation,;.
Sangams for_ men—end women of the village were formedf vj 1 th the

r~n—mni f~y. which, were intended to be the , stub of all health
and development activity.

All adults were invite<^to join

the sangams, and those interested joined the same.^ ‘iSyase
sangams

registered and members contribute^ a fee for

common expenditure.

tccoLAAsnas

tb

Sangam members wtre^ Lohmeet atleast once a month to mobilise

A

community support for developmental activities.

&

These sangam^

3

activities were facilitated by "fiSl to utilize,. Governmental and

'

IKZVI
other resources.

Thg. . sflrn_)l>'Wf t.ieg& instrumental in activities in

health and also other areas like building of roads, provision of
water and electricity, running of balwadis, impexving
transportation facilities and income generation activities for

the community.

Study
$ PURPOSE OF SKhLUKEKE-U'
Based on a felt need bp
*
the community health department of
RTU, the present participatory study was undertaken to find out. ,

the^ impact of ^community health programs in theW village^'7 This
participatory study by an external resource group was to see
how the community health programme evolved;

b)

pre sent status;

It is to be specially noted that this participatory interactive
exploration of community health and development activities was

intended to facilitate the community health department -fes=—
planning itff’ f'.itnr.a. , This study focussed on community health

beyvcknwtrfc. vw|fYirvMUCifn wXi

A
and not on other activities of RTU.

Since^nofc-

available,1 a

quantitative evaluation study was not feasible^process
fc'VV 'iwA/Lz

oriented qualitative exploration study was undertaken with ssr

emphasis on statistics, survey data, questionnaire, etc.

Hsssssee^

£he available periodical reports containing quantitative data ha$
£,
*

been reviewed.

There were also constraints of time - total time

for the study^-3b days, divided into

blocks of 2b days and one

'
*
tfc/iz

..Jrrl nieK. of

\J

days.

METHODOLOGY

The present qualitative approach to evaluation consisted of

a) review of available records;
b) discussion with staff at RTU

field level functionaries

c) discussion with members of sangam and non sangam members

4

4
d) observations during field visits; and
eliciting opinion from nearby health care delivery agencies

An elaboration^ on

the above follows

records reviewed

included the annual reports/ reports to funding agencies^ reviews

of past and future plans? mobile clinic records? records at
health centres^' village registers^ training programmes and their

curricula/ diaries and registers maintained by field staff
the type of information and their relevance to ongoing community

health activities.

iscussions were held at RTU with JX rector, Assistant Director,
Avid
tMexUcal ctepanfauLtrf c^ZTlf
Manager
the two community organisersAt the field level,
A
BdZtzVtizK'
the village health workers, Balawadi teachers^ and their staff,
gSSJanimators, traditional birth attendants, and informal

-A

e

focussed discussions with them

and attitudes were

.conducted in a non threatening manner

/

ira/ t'rr

'Sangam members,^ non sangam members aas

fep■*>r ejst were

also

contacted in a similar manner and their views "/ere elicited".

//Visits to the village included studying the condition of housing
water, sanitation, kitchen gardens, nutrition# prograH^- at
Balwadis, NFE classes and the quality of rapport between as&r staff

and community members.

interaction with the

^edical officer and Medical Superinten

dent at the nearby referral centre at Batlagundu (Leonard hospital)

consisted of identifying local disease patterns, availability of
health care services and patterns of utilisation.

The other components studied were library and health education

resource materials, VHW's kit, medical stores and other units of
RTU

i vriTgkthe medical department ✓Av

5

5
In addition, the gw staff participated w

aLlon

and made available existing documents and also^ pr'ocess^ft^additional information requested by the study team.

7

The present study was not focussed on measuring the health status
of the community in quantitative

but on the process and

relevance of community health and development (to enable people
5qr- understanding- the importance of the same to improve their
quality of life^)and hence the methodology

RESULTS

The results are presented as a situational analysis at the

village and in the various activities of the organisation

(J. >

Villager

<-'/

The 8 villages where the community health department operates

are away from the main road, and relatively inaccessible.

The

< population of these villages ranges between 200 to 700
^Illiteracy is high and ranges between

to 95% with a high

drop-out rate noticed after the primary level of education.

/few’
dtti

The

occupation of the people is mainly as agricultural labour
(seasonal) and marginal farmers and shepherds.

Most houses

are kutcha houses, with one or two rooms, non-electrified and

with no toilets.

is inadequate.
inadequate.

2 Kms.

Even though potable water is available, it
All villages have street lights, though

Most primary schools are within a distance of

Transport and communications are generally available

but inadequate.

Balwadis organised by RTU are functioning

where not covered by the ICDS scheme

Most villages do not

have a community television
The villages are in two clusters, with a government health
centre nearly each of the cluster.^, located at Ganguvaripat^i

and Viralipatfcf.

The government health workers visit these

villages mainly for immunization and family planning activities

6

6
Programmes on nutrition are conducted under thp/rTNTP? governmental—

In RTU built houses, ventilation is good and there is no smoke

nuisance from the kitchen, since it has smokeless chulhas and
is built away from the living room:

i ACTIVITIES

The membership of the sangams in relation to the total village

population varies between 10% to 60% with a higher percentage

of women being sangam members compared to men
The percentage of attendance at meeting:

- in Men’s meetings - range 54 - 87%
in Women’s meetings-range 51 - 100%»

On an average one meeting per month is held in both mens and

womens sanghas.

However, during harvesting and planting seasons

meetings are irregular

The sangams have been able to mobilise people to avail various

facilities through government schemes in areas of income-generation
roads, electricity, water supply, and obtaining of pensions for

widows.
It is to be noted that a major contribution of RTU is in the
area of providing housing facilities which has generated great
interest and attraction among sangam members

Sangam leaders

are given leadership training at RTU periodically.

Some specific achievements^ are:

1986 - construction of 167 RTU houses I T_
- Borewell - one
I J^gjivannagar
1987 - 72 RTU houses at Utchapathi
Zh<S
1988 - Goats/Buffaloes/Sheep# - for income generation
EstablishSS^sheep rearing society.
1989 - Total 90 persons benefited from government schemes including
28pensions for widows/
,
streetlights and £ water taps;/
borewells by RTU +, lz2^^er<taa»sA
■e

7

7
-/Buffalo loans /
- Jawahar well-digging loan sanction^
- Sheep rearing society form&tuO'w/
- 4

strool 1 l'jin-s/1 borewell/1 tap. ~

- Road repair sj^
- Widow daughter’s marriage through aid/^^^r/trvx

- 5€r-RTV—houses/1 bor-ewe-H/community hal 1/4—wp! 1/
a/old age pensions/1, cheep retiring loan;
- formation of prohibition committee against female
infanticide^/
- Flood control wall construction/U .ifrprl. I.igkitg.

1990 - Bullock and sheep^rearing Ipans/^ street lights/^ hut
electrification/^Mp^C^edit^p ion format ion/$|(^oats/^^^&^

tree planting alongside roadWrffegeaste/shed repair/

'

^^soakage pits/road-repair/Threshing flooi^link roads bu-l-ibt/
,
._________ .
(A 16U&& ,

1991

Some oroblems areas ;

Apart from minor ^Z^E^^n'p^svandv&uah. problems, usually found
in human groups, others noted were:
- Leaders beasSws^orrupt and leading to loss of faith in them;
- Enthusiastic participate' from sangams generally peaked when

houses were constructed and waned dramatically after the event;
- Internal land and caste factors interfered with sangam activity;
- Traditional caste based elders who managed conflict felt

threatened by the new sangam leadership.

VILLAGE HEALTH WORKERS (VHW)

Village Health Workers selected by the Village Health Committee
were women, a majority of whom were illiterate.

They were given

an initial training in community health for 2 weeks

£

of the curriculum showed that the contents were far/too
and voluminous to

be covered in this short period^C Subsequent"

refresher courses and clarifications at periodic meetings are

continuing.

The VHWs are mainly involved in minor ailment treatment,

helpdngj^assisting| at RTU’s mobile clinic and helping the
government health workers in their health activities.

They also

..8

are expected to visit 5 families a day and conduct health
education.

The VHWs are provided with a kit containing medicines for
treating minor ailments, which is utilized to treat 20 to 30

cases on an average every month at a subsidized rate.

They

also utilize traditional herbal remedies quite confidently on

their own initiative.

They

record the vital events of

births and deaths with the help of a literate.

of Rs.lOO/lP?g

An honorarium

them and this is given either by RTU

or sangamS
We observed that the VHW is well accepted and has a good

rapport with the community.

Record keeping activity is

inadequate due to their illiteracy.

Being sangam members

they also participate in all other sangam activities, but are

considered by the people as mainly health resource

^.MOBILE CLINIC

The mobile clinic operates twice a week, in the afternoons
effectively reaching each of the 8 villages once a month.

team consists of the CHD manager, a C.O.,

The

a'person from the

medical department and the local VHW.
(frhey provide curative services to the whole population, with
a focus on Ante and Post-natal care.// The records show that

they see an average of 60 patients a year per village

ANC patients and growth monitoring of 40 childreniy(afifc>±h front
Medicines at a subsidized rate are distributed, and
Health education imparted.

The schedules of the mobile clinic

are very variable, mainly because of dependences on availability

of the van for transport ef the team. / The health records are
minimal, Jast thetTa^z- encumbered by accounting procedures.

The

records do not provide a clear picture of disease patterns, but

discussions with the team and the local referral centre

9

9
indicated that the common ailments are diarrhoeas, skin

diseases, eye diseases and problems of malnutrition.
Tuberculosis and leprosy are two common major problems and

these are treated with the help of governmental^sources.

has been effective

cholera epidemics in the past, the

in tackling the problem with

In

government

HEALTH EDUCATION
In dtclition^ to health education given by the VHW and at the
mobile clinic in a personalized manner, mass health education

programmes are conducted on an overage of once a month in each
of the village^ This is mainly film shows and slide shows.

A
Street theatre, puppet shows and drama are occasional events.

--------

——------ ----------- --------- -------------------- -—

*y!j£he topics covered, include - Cooperation,

family plamiipq^Z1
23

sanitation and hygiene, N.F.E., MCH and nutritionjZTHealth

Education also forms a component of the training programmes
Film shows are popular with the

1. The RTU
s
*

CHpDepartment has established a good rapport with the

community as well as the government agencies /W
2. The formation and nurture of sangams has enabled the people to

begin to understand their health and development problems and
also evolve some solutions.
3. A large number of activities have been initiated in a short span

of time inspite of meagre resources.

Consequently, there has been

a blurring of clarity and focus in their well-meaning efforts.
Curative efforts still form a major part of the health programme,

while in development avenues for tapping available resources are
being efficiently explored.

Since the selection of villages was based on criteria of poverty
and under-development, the approaches and activities of RTU-CHD

have been predominantly welfare oriented.

10

10;
The enthusiasm of the sangams seems to plummet as soon as

their immediate felt needs are met from external agencies
This seems to blunt the potentiality of their initiatives^^
using their own resources

AS
T^-Cgst-ef fort-effectiveness of mobile clinic is low

*
-3 *

V»W '

3

-Recommendations

z’

J

To effectively strengthen the ongoing and proposed activities
the following recomendations are made
Community organisation and participation

Sangarns have already been formed.

This valuable resource

needs to be fostered and strengthened with further training/
exposure of staff and sangam leadership.

Interactions

inbetween RTU sangams and others outside is likely to help
this process.

The large membership precludes intensive study and
understanding of local issues.

The suggested corrective

is the formation of smaller working g roup s^ to take up

specific issues.
the help of

Planned training for these groups with
expertise will be of help.

Mens and Womens sangams need to meet together^ atleast twice
a year reviewing their activities in the interim period and

evolve better courses of action.

/

Practical solutions to problems of meetings during

harvesting and plantings seasons are to be evolved.

e.g.

the executive committee/working groups could attempt to
meet, or (if this is found to be impractical) the meetings

at these times are suspended and- iiTtcfolflEd subsequently.

Long term comprehensive planning on all relevant development
issues is to be initiated and follow up by the sangams.

11

11

Proper documentation and review of past decisions etc
will re-inforce this process
Mechanisms/bomprehensive feed-back at regular intervals

on decisions and proposed actions both at RTU and sangam
levels needs to be established.
Greater accountability^should be fostered by open exchange

of information on resourcesbetween

1

sangamsaJt~ (Kaa

s
Invitation or local government officials to sangam meetings

3's v

should be encouraged.

Apnronriate
be
ehnol-otsr„ for
health
and
development
' " ■~T rr
---------------» ,-r
*
,,
, n
.
I .r - • — .
!■ i ■ i----- ITIII■ n niu

People should be encouraged to utilize government health
services and make them

responsive to their needs

/ko Ccjh
< fee mobile clinics b

.S *

S

r

4

with alternative approaches like decentralization^transfer
of medical stores along with reduction of team-size and
upgrading of village resources (VHW and TB£)

5

.-than—wi fed r a un in a phased manner
Where local/traditional herbal medicines are being utilized

‘I

as alternatives, allopathic drugs provided, may be

Xi)

withdrawn in a phased manner, e.g.. Benzyl Benzoate replaced
• with Turmeric/Neem leaves, for scabies treatment.

Explore alternative sources of energy like bio-gas, solar

cookers,

solar powered street lights, etc

Development of simplified recording systems tailored to the
needs of the community

3.

Community support for health care
Formation of local

working groups^ of atleast 5

members each from the mens and womens sangams^will be an
important step.

a) This group will be specially trained to improve health
education and will be responsible for mond)t<bring all

12
(%U<91'wvvctizn'i (XA
health activities andean activist group to interact

with governmental and other agencies for health.

b)

To explore ways and means of making the community^.
self-supporting in terms of finance and other relevant
resources.

4.

Health integrated with Development
A health-education component is to be incorporated in all

training and otherprogrammes of development both at RTU
and at the village level.

This is likely to make people

more conscious and responsible for their own health.
A contributory health service scheme could be linked to
/»
income-generation programing. This is intended to promote

;tenance

services .4A1

At RTU level, staff from all departments are to be
sensitised and oriented towards the importance of C.H. in

development and should be encouraged and expected to
contribute to C.H. concepts in their areas of work.

As a starting point, the medical department could take
responsibility for all curative services, and step into

areas of prevention and health promotion in the villages
where the community health department is active.

All health

programmes can be jointly planned by these two departments.
Similar cooperative efforts can be planned with other
departments in their areas of work.

5.

Education for health

y ^Considering the high levels of illiteracy in the villages,

adult and NFE should be strengthened and expanded with
health as a major component.

Ito? ongoing Health Education the village working group should

be trained to take up responsibility in all aspects of health
education in the village.

Some effort should be made to

educate the working group on the elements of communication
skills

13

PARTICIPATORY STUDY
of

COMMUNITY HEALTH AND DEVELOPMENT PROGRAM
of

"REACHING THE UNREACHED"

G. Kallupatti,
Madurai District,
Tamil Nadu.

Study Group

1»

Dr. V. Benjamin

2.

Dr. G. Gururaj

3.

Dr. Shirdi Prasad Tekur

O5th March 1992

To

26th April 1992

A

CONTENT

No.

LIST

Details
I.

Summary

II.

Back ground
1• Origins
2. Goals and objectives.

III.

Purpose of study

IV.

Evolution

V.

Methodolo gy

VI.

Results

1. at village
2. of Organisational activities

(a) Sangams
(b) Village Health Worker

(,c) Mobile Clinic

(d) Health Education.
VII.
VIII .

IX.

Conclusions
Recommendations

Appendix

I.

SUMMARY

The Community Health and Development fegjgE) initiative of
'Reaching The Unreached' (RTU) tries to reach people remote

to development through health measures
*

The Goals are to

actively involve people and enable them in improving their
quality of life.
Sangams (associations) of men and women is the means and the
nucleus of all health and development activities in the eig^it

villages this programme addresses.

The Community Health and

Development (gjfcST) pro gramme has gone through a phase of

stagnation and re-activation in its evolution.
This study is in response to the need felt by the CHD^to know
about their evolution, their present status and pointers to

the future to help plan aheadto be done by an external
resource group.

Constraints limit quantitative assessments

and the focus is on qualitative and process exploration.
The village^ chosen are remote and in need of health and

development inputs.

Sangams of men and women are operational

and function fairly well with limitations due to local
circumstances.

Village Health Workers are effective in

minor-aliment management and are well accepted by the community

The mobile clinic initiative is not cost-effort-effective.
Health education effort needs strengthening.
The conclusions of the study point to positive areas of good
rapport, credibility and initiative while serving in areas of

peoples needs.

Numerous activities with small resources, a

focus on curative approaches, problems of sangam dynamics and

a need for upgrading Health Education efforts are the drawbacks

seen.
2

2

Recommendations are for focussed activity, putting more
efforts into making the sangams far-sighted, involvement of
other departments of RTU in the CHD effort, exploring local

and other governmental resources and methods of documentation
to help the CHD evolve relevant plans for the future.
II.

BACKGROUND
The project ’Reaching The Unreached• (RTU) started in the

year 1975 and registered in 1978 at G.Kalupatti, Madurai

District; it is an attempt to reach people in the remote,
unreached areas.

The felt need of medical aid in this place

led to the starting of a small base clinic facility and a

mobile clinic to surrounding areas.

This spread into meeting

other needs of the people, such as housing, education, water,
foster-families for children, income generation programmes
and other social welfare measures.

1 ) ORIGINS
The community health programme started later (in 1982/85)

using health as an entry point for overall development of

the communities in eight villages of this area.

Two

volunteers from RTU initiated a process of community
organisation.

The programme remained stagnant during

1985-86 when these initiators left, and was restarted in

1987

by the present manager of the Community Health

Department (CHD).

It began with non-formal education

incorporating health messages, and slowly evolved into a

community health programme.

In course of time this

transformed into a Community Health and Development ^gWTF)
programme, and the department of CH & D came into existence

at RTU.

Two community organisers have joined this

department over the past two years to help the Manager
who has been handling this programme single handed.
2)

GOALS AND OBJECTIVES

The goals of this community health and development program

..3

3

as stated in their progress report arei
TO REACH OUT TO A LARGE NUMBER OF PEOPLE IN DISTANT AND

REMOTE VILLAGES AND ENABLE THEM TO IMPROVE THEIR QUALITY
AND STANDARD OF LIFE, WITH THEIR ACTIVE INVOLVEMENT,
USING HEALTH AS AN ENTRY POINT.
This is aimed at building up of confidence and self-reliance

in the villages and to initiate a process of common village
development through formation of sangams (associations) of

men and women.
III.

PURPOSE OF STUDY
Based on a felt need of the community health department of

RTU, the present participatory study was undertaken to find
out the qualitative impact of the community health program
in the eight villages they work in.

This participatory

study by an external resource group was to see

a)

how the community health program evolved)

b)

its present status; and

c)

to provide guidelines in planning the future.

It is to be specially noted that this participatory

interactive exploration of community health and development
activities was intended to facilitate the community health

department.

Hence, this study focussed on community health

and not on other activities of RTU.

Since baseline benchmark

information was not available, a quantitative evaluation
study was not feasible.

Therefore a process oriented

qualitative exploration study was undertaken with minimal

emphasis on statistics, survey data, questionnaire, etc.
The available periodical reports containing quantitative data
have been reviewed.

There were also constraints of time -

total time for the study being seven days, divided into two
blocks of two days and one of three days.
The present study was not focussed on measuring the health
status of the community in quantitative terms, but on the

process and relevance of community health and development

(to enable people understand the importance of the same to
improve their quality of life) and hence the methodology

adopted.

4

IV.

EVOLUTION

To chronologically describe the evolution pattern:

1.

The earliest activity was the mobile clinic of R.T.U.

2.

While pursuing this activity, eight villages were identified
for using mainly community health interventions towards

overall development.

The criteria for selecting these

villages were:

a)

lack of any health or development activity}

b)

remoteness from centres of development activities}

c)

being small (population size) and therefore manageable} &

d) people belonging to predominantly backward and
, underprivileged section9 of society.
,

A

^'2. Formation of local Health Committee and selection of Village

u biZxVi
cta

C^-b

Health Worker (VHW).

CUt^L
6^0

Formation of village level health committees was preceded

.

by awareness building for health through street theatre and

public meetings.

This health committee identified a male

health worker who was acceptable to the community.

These

VHWs from eight villages were trained at RTU for a period
of 15 days.

During 1985-86 the programme was stagnant due

to reasons not clearly identifiable.

The male health workers

stopped pursuing community health activities.

In 1987 when

it restarted, female village health workers (VHWs) were

selected from each of eight villages and given a similar

"

fifteen day training.

Guidance and supervision of these

VHWs has been continuous and regular since then.
4.

Sangam formation:
Sangams separately for men and women of the village were

formed.

These sangams were intended to be the hub of all

health and development activity.

All adults were invited

to join the sangams, and those interested joined the same.

Some of these sangams are registered and members contribute

a fee for common expenditure.

Sangam members were expected to meet atleast once a month

to discuss local issues and to mobilise community support
for developmental activities.

These sangam activities were
..5

5

facilitated by the CHD to utilize both Governmental and other
resources.

They were instrumental in initiating activities

in health and also other areas like building of roads,

provision of water and electricity, running of balwadia,
improving transportation facilities and income generation
activities for the community.

v. methodology
The present qualitative approach to evaluation consisted of
a)

review of available records}

b)

discussion with staff at RTU, and field level functionaries)

c)

discussion with members of sangam and non sangam members of
the villages}

d)

observations during field visits;

e)

eliciting opinion from nearby health care delivery agencies.

and

An elaboration on the above followss

a)

The records reviewed included the annual reports; reports

to funding agencies; reviews of past and future plans;
mobile clinic records; records at health centres; village

registers; training programmes and their curricula; diaries

and registers maintained by field staff;
«for the type of information and their relevance to ongoing

community health activities.
b)

Discussions were held at RTU with the Director, Assistant

Director, Manager, the two community organisers and staff
of medical department of RTU.

At the field level, the

village health workers, Balwadi teachers and Balwadi staff,

lion-formal Education (NFE ) animators, traditional birth
attendants, and informal focussed discussions id th them and

the people on their work and attitudes were conducted in a
non threatening manner.

c)

Sangam members, their office bearers, and non sangam members

were also contacted in a similar manner and their views
elicited—- On CHD and their staff, on sangams and their

functioning - in relation to peoples problems.

..6

6
d)

Visits to the village included studying the conditions
of housing, water, sanitation, kitchen gardens,

nutrition programs at Balwadis, NFE classes and the
quality of rapport between CHD staff and community

members.
e)

An interaction with the Medical Officer and Medical

Superintendent at the nearby referral centre at
JBatlagundu (Leonard Hospital) consisted of identifying
local disease patterns, availability of health care

services and patterns of utilisation.
The other components studied were library and health
education resource materials, VHW’s kit, medical stores

and other units of RTU including the medical department
in relation to CHD activity.

In addition, the CHD staff participated readily and made
available existing documents and also co-operated in
processing additional information requested by the study
team.
VI.

RESULTS

The results are presented as a situational analysis at the

village level and in the various activities of the organisation.
1• The Villages

The eight villages where the community health department
operates are away from the main road, and relatively

inaccessible.

The population of these villages ranged

between 200 to 700.

The villages are in two clusters, with

a government health centre near each of the clusters, located
at Ganguvarlpatti and Viralipatti.

The government health

workers visit these villages mainly for immunization and

family planning activities. Programmes on nutrition are
conducted under the Tamilnadu Integrated Nutrition Improve

ment Programme (TINIP).

In RTU built houses, ventilation is good and there is no
smoke nuisance from the kitchen, since it has smokeless
chulhas and is built away from the living rooms.

..7

From available data we found that illiteracy is high and ranges

between 40 to 95% with a high drop-out rate noticed after the
primary level of education.

The occupation of the people is

mainly as agricultural labour (seasonal) and marginal farmers

and shepherds.

Most houses are kutcha houses
*

rooms, non-electrified and with no toilets.
potable water is available, it is inadequate.

schools are within a distance of 2 Kms.

with one or two

Even though

Most primary

Transport and

communications are generally available, but inadequate.

Balwadis

organised by RTU are functioning where not covered by the

Integrated Child Development Scheme (ICDS).

not have a community television,. bcwwvOvLvy
2.

Most villages do
■'iw

Organisational Activities

a ) San gam

The membership of the sangams in relation to the total
village population varies between 10% to 60% with a higher
percentage of women being sangam members compared to men.

The percentage of attendance at meetings:
- in Men's meetings

- range 54 - 87%

- in Women's meetings

- range 51 - 100%.

On an average one meeting per month is held in both mens
and womens sangams.

However, during harvesting and planting

seasons, meetings are irregular.

The sangams have been able to mobilise people to avail
various facilities through government schemes in areas of

income-generation, roads, electricity, water supply, and
obtaining of pensions for widows.

~------

It is to be noted that a major contribution of RTU is in
the area of providing housing facilities which has generated
great interest and attraction among sangam members. ^
Sangam
*

leaders are given leadership training at RTU periodically.j
8

8

Some specific achievements as per records arei

0
..
„
J Jagjivan Nagar.

1986

- construction of 167 RTU houses
Boreveil - one

1987

- 72 RTU houses at Utchapathi

1988

- Distribution of Goats/Buffaloes/sheep - for income
generation;
Establishment of sheep rearing society.

1989

- Total 90 persons benefited from government scheme
inc luding

- 28 pensions for widows/streetlights and water taps/

borewells by RTU/Buffalo loans/Jawahar •well-digging
loan sanction/Sheep rearing society formation/ Road
repairs/widow daughter’s marriage through aid/Coramunity

hall construction/formation of prohibition committee

against female infanticide/ and Flood control wall

construction.

1990

- Bullock and sheep rearing loans/street lights/hut

electrlfication/old age pensions/Credit Union formation/
goats for income generation/tree planting alongside road/
road-repair/link roads/shed repair/soakage pits/ and

threshing floors in the

villages.

1991 - Sheep rearing loans/bullock cart loans/loans for petty

trades/old age pensions/borewells/water-tank with taps/
monthly savings scheme started/threshing floor construction

and allotment of house-sites.
Some problems areasi

Apart from minor problems, usually found in human groups,
others noted were:
- Leaders becoming corrupt and leading to loss of faith in them;

- Enthusiastic participation from sangams generally peaked when
g.T.U.houses were constructed and waned dramatically after the event;
- Internal land and caste factors interfered with sangain activity;
- Traditional caste based elders who managed conflict felt
threatened by the new sangam leadership.
..9

9
b)

Village Health Workers (VHWs)

Village Health Workers selected by the Village Health Committee

were women, a majority of whom were illiterate.

They were

given an initial training in community health for 2 weeks.
Subsequent refresher courses and clarifications at periodic

meetings are continuing.

The VHWs are mainly involved in minor ailment treatment,
assisting at RTU•s mobile clinic and helping the government

health workers in their health activities.

They also are

expected to visit 5 families a day and conduct health education.

The VHWs are provided with a kit containing medicines for
treating minor ailments,which is utilized to treat 20 to 30
cases on an average every month at a subsidized rate.

They

also utilize traditional herbal remedies quite confidently
on their own initiative.

They record the vital events of

births and deaths with the help of a literate.

An honorarium

of Es. 100.00 per month is paid to them and this is given either
by RTU or sangams.

We observed that the VHW is well accepted and has a good rapport
with the community.

A review of the curriculum showed that the

contents were far too technical and voluminous to be covered in

this short period.
to their illiteracy.

Record keeping activity is inadequate due

Being sangam members, they also participate

in all other sangam activities, but are considered by the people
as mainly health resource.
c)

Mobile Clinic

The mobile clinic operates twice a week, in the afternoons,
effectively reaching each of the eight villages once a month.
The team consists of the CHD Manager, a community organiser,

a person from the medical department and the local VHW.

They

provide curative services to the whole population, with a
focus on Ante and Post-natal care.

The records show that they see an average of 60 patients a
year per village, including ANC patients and growth monitoring

10

10

Medicines at a subsidized rate are distributed,

of 40 children.

and Health Education imparted.

The schedules of the mobile

clinic are very variable, mainly because of dependence on

availability of the van for transport of the team.

The health records are minimal, while their work is encumbered
by accounting procedures.

The records do not provide a clear

picture of disease patterns, but discussions with the team and
the local referral centre indicated that the common ailments

are diarrhoeas, skin diseases, eye diseases and problems af

malnutrition.

Tuberculosis and leprosy are two common major

problems and these are treated with the help of governmental

resources.

Tn cholera epidemics in the past, the CHD has been

effective in tackling the problem with government and other

agencies.

d ) Health Education
In addition to health education given by the VHW and at the

mobile clinic in a personalized manner, mass health education

programmes are conducted on an average of once a month in each
of the villages.

This is mainly through film shows and slide

shows.

Street theatre, puppet shows and drama are occasional

events.

Health Education also forms a component of the

training programmes and other meetings at RTU.

Film shows are

popular with the people.
Records show that the topics covered include - Cooperation,
Family Planning, Sanitation and Hygiene, N.F.E., MCH and
Nutrition.

VII.

CONCLUSIONS
1.

The RTU*s CHD Department has established a good rapport with
the community as well as the government agencies in areas of
health and development.

2.

The formation and nurture of sangams has enabled the people to
begin to understand their health and development problems and
also evolve some solutions.

11

11

3.

A large number of activities have been Initiated in a

short span of time Inspite of meagre resources.
Consequently, there has been a blurring of clarity and

focus in their well-meaning efforts.
4.

Since the selection of villages was based on criteria of

poverty and under-development, the approaches and
activities of RTU-CHD have been predominantly welfare

oriented.

5.

The enthusiasm of the sangams seems to plummet as soon as

their immediate felt needs are met from external agencies.
This seems to blunt the potentiality of their initiatives,
in using their own resources.

6.

Curative efforts still form a major part of the health

programme, while in development, avenues for tapping
available resources are being efficiently explored.

7.
8.

Cost-effort-effectiveness of mobile clinic is low.
The VHW is well accepted by the people and functions

effectively in activities alloted to her.

However, her

inability to maintain effective records, makes it difficult
for the CHD to make quantitative assessments of health

parameters.
9.

Health Education remains largely an effort of the CHD

(with its myraid activities and meagre resources) and has
not received the attention it deserve
.
*
VIII.

RECOMMENDATIONS
To effectively strengthen the ongoing and proposed activities,

the following recommendations are madei
1.

Community organisation and participation
Sangam
*

have already been formed.

This valuable resource

needs to be fostered and strengthened with further
training/exposure of staff and sangam leadership.
Interactions inbetween RTU sangams and others outside is
likely to help this process.

12

12
The large membership precludes intensive study and understanding
of local issues.

The suggested corrective is the formation of

smaller working groups in each sangam to take up specific issues.
Planned training for these groups with the help of expertise

will be of help.

Mens and Womens sangams need to meet together in addition to

individual sangam meets, atleast twice a year reviewing their
activities in the interim period and to evolve better courses
of combined action.
Practical solutions to problems of meetings during harvesting
and plantings seasons are to be evolved.

e.g. the executive

conimittee/woxking groups could attempt to meet, or (if this is

found to be impractical) the meetings at these times are
suspended and the frequency increased subsequently.

Long term comprehensive planning on all relevant development
issues is to be initiated and followed up by the sangams.

Proper documentation and review of past decisions etc., will
re-inforce this process.

Mechanisms for comprehensive feed-back at regular intervals on
decisions and proposed

actions both at IITU and sangam levels

needs to be established.

Greater accountability and mechanisms for the same should be
fostered by open exchange of information an-.re sources, plans,

activities, and achievements between CHD and sangams at their

meetings.
Invitation of local government officials to sangam meetings

should be encouraged.
2.

Appropriate strategies for health and development
People should be encouraged to utilize government health services

more and make them responsive to their needs.

13

13
The cost-effort-effectiveness of the mobile clinics can be
improved -with alternative approaches like decentralization

and transfer of medical stores along with reduction of team

size and upgrading of village resources (VHW and TBA) also

utilizing government health resources.

This can be implemented

in a phased manner.

A prospective time-bound study of the mobile clinic component
in terms of
- patient utilization of services from within and outside the
specified villages?

- hours/personnel/raedicine/transport/costs etc., involved; and
- areas of non-clinic activities facilitated^needs to be
included in the future plans.

"Where local/traditional herbal medicines are being utilized

as alternatives, allopathic drugs provided, may be withdrawn
in a phased manner.

e.g., Benzyl Benzoate replaced with

Turmeric/Neem leaves, fox’ scabies treatment.
Esq>lore alternative sources of energy like bio-gas, solar

cookers, solar powered street lights, etc.
Development of simplified recording systems tailored to the
needs of the community as explained in the annexure<
The VHW/TBA/NFE animators/Balwadi teachers and their equijjifbents

from government health resources are to meet periodically and
evolve ways and means of implementing sangam decisions.
3.

Community support for health care

Formation of local working groups on health, consisting of
atleast five members each from the mens and womens sangams

working together as a team will be an important step.

a)

This group will be specially trained to improve health
education and will be responsible for monitoring all health

activities and also function as an activist group to interact
with governmental and other agencies for health.

14

14
To explore ways and means of making the community self-

b)

supporting in terms of finance and other relevant resources.

4.

Health integrated with Development

A health-education component is to be incorporated in all
training and other programmes of development both at RTU and

at the village level.

This is likely to make people more

conscious and responsible for their own health.
A contributory health service (CHS) scheme could be linked to
income-generation programs.

This is intended to promote

self-sustenance of health services in the village.
At RTU level, staff from all departments are to be sensitised

and oriented towards the importance of C.H. in development and
should be encouraged and expected to contribute to C.H. concepts
in their areas of work.

As a starting point, the medical department could take
responsibility for all curative services, and step into areas of

prevention and health promotion in the villages where the
community health department is active.

All health programs can

be jointly planned by these two departments.

Similar cooperative

efforts can be planned with other departments in their areas of
work.

5• Education for Health

Education for health aims at creating awareness among people of
all factors that affect health and promoting positive life-styles

towards health.

Literacy need not be a pre-requisite for this.

Considering the high levels of illiteracy in the villages, adult

and NFE should be strengthened and expanded with health as a

major component.
J»vx

ongoing Health Education the village working group should be

trained to take up responsibility in all aspects of health
education in the village.

Some effort should be made to educate

the wo rising group on the elements of communication skills.

15

15
6• Involvement of traditional healers, Dais and indigenous systems

a)

The VHW’s knowledge base to be increased.

b)

The TBAs in the village to be trained and ANC and PNC made
locally sustainable.

c)

Practitioners of indigenous systems in the village to be
integrated into the community health programme.

ppromote
d)
e)

7.

herbal gardens as part of kitchen/garden scheme.

Compile and document local herbs used, indications for use,
and their effectivity, etc.

CHW / VHW

The VHW is illiterate.

Therefore functional literacy to tackle

simple meaningful record keeping/understanding health messages

and for better communications is to be undertaken as part of
their training.

Their training also needs to be simplified to

suit their limited role in minor ailment treatment and more

efforts put in to preventive and promotive health aspects.
Their job specifications depending on their capabilities and
community needs is to be made and their training programme
tailored to suit this.

The VHWs skills to be upgraded to meet all local minor ailment

needs.

A referral system to hospital/health centre to be

strengthened in the followings

a)

Developing an official liaison between RTU-CHD and government
or private referral centres)

b)

Enabling the VHW to establish a rapport with the centres of
referral; and

c)

Upgrade the VHWs knowledge to selecting the appropriate
referral centres for specific problems.

16

16
Appendix
Suggestions for simplified, comprehensive, relevant record-keeping

to enable future planning.
1.

A register alloted to each village only for records on health to be kept at the village, accessible to the CHD and sangam

health working group for updating.

2.

The first 20 pages of register to be kept aside for indexing,
comprehensive record of focussed activity (eg., immuniaation/ANC/
Child births/PNC/vital events, etc)

3.

One page per family for details eg., names of family members/

house no./type of house/illnesses in members (chronic)/sangam
membership/facilities availed from sangams etc.
4.

Start with families with ANC/PNC/lmmunization care.

with other sangam members,

Continue

then non-members, such that over a

period of 3 to 6 months, complete village records will be

available.

This will also form the base-line data much needed

for future evaluations and planning.
5.

Examples of what is to be recorded:

a)

Village name/address on cover;

b)

Page 1 - map of village (folded sheet can be pasted)}

c)

Page 2 to 9 for index of family by name/house number;

d)

Page 10 to 20 for comprehensive records.

p)

i-' 2A C'M/VC

z WV6l-vV“C

pM/V'wL'V') ''\X.CC~r~isti, Ol'iC

,

p

Immunization records

U.

Apri l/May/June/July/etc.

No. of children under
5 years age.
No. of children
completed BCG

No. of children
completed DPT/OPV
1st dose
2nd dose
3rd dose

V^j/co ,
by kuiWL

..17

17
No. of children completed
Measles vaccine

No. of children completed
1st booster dose
No. of children in Balwadi
roster/receiving suplementary
nutrition, etc.
ANC / PNC records

from April 1992
April / May / June / July / August

No, of mothers pregnant
No. of mothers received
T.T. injection

No. of live births
No. of still births

Dates of delivery
Place of delivery
(village/out side)

Delivery conducted by
TEA
No. of PNC

AND SIMILARLY FOR LCANs/CAPa/VITAL EVENTS, etc.

w S''-''5

REACHING THE UNREACHED
undia

ANNUAL

REPORT

1990 — ’91

HERE is thy footstool and there rest thy

feet where live

the poorest, and lowliest, and lost.

When I try to bow to thee my obeisance cannot reach down

to the depth where thy feet rest among the poorest,

and lowliest.

and lost.

Pride can never approach to where thou walkesi in the

clothes of the humble among^the poorest, and lowliest, and lost.

My iheart can never find its way to where thou keepest
company,with the^companlonless amonglthe'poorest, the lowliest,

and the lost.

Rabindranath Tagore

(Gitanjali X)

PRESIDENT'S

INTRODUCTION

The sole purpose for our existence as an organisation is to reach the unreached
those st'H hidden away by their poverty or remoteness or lack of power. It is vital for
all cf us to keep this in the forefront of all our planning and activities, otherwise there
is the danger of stagnation or inbreeding, or worse still, selfishness. The Gandhi's
and the Mother Teresa's of this world keep on reminding us of this, as does
Rabindranath Tagore and indeed. Jesus Christ- This has been a year of quite remarkable
growth in all directions, in efficiency as well ;as in improving lhe quality of life of an
enormous number of people from day-old babies to the very old; from individual
families to whole villages. A quick glance at this report for one single year of work
will demonstrate just how wide and how deep is our outreach and our caring and how
excellent ate our techniques and enterprise.

Dedication is a word rarely used here but it is always in evidence every day of
the year and in all the various segmentsjof our work. It is positively evident to the
many visitors who come this way and who often remark on the cheerful dedication of
the staff who make up this whole programme and without whom none of it would be
possible
In all this, I feel that we need to keep much in mind that those we reach out
to are individuals each of them with his or her own special problems and needs and
joys
It is sometimes necessary to actually meet these people and to communicate
with them even if our work does not require this. Without these individuals the
purpose of our being here would not exist. In a way the very poor are the be-all and
the end-all of the whole of our work
We must keep on striving to make sure that our
work is people-centred and not project-centred. We who run this whole programme
are ro mote human than the ones we try to help : they have as much right to our
facilities and our influence as we have ourselves, and indeed, they have more right to
them.

Once again it is my happy duty to thank all our staff for yet another year of
hard work of development, of outreach in the best of ways and for their cheerful
dedication at all times. Thank you
It is also my bounden duty to thank all those
who help us in any way. A large amount of our income comes from individuals who
often make quite large sacrifices in order to show their solidarity with the poor. There
are many times when I am deeply touched by the generosity and caring of so many
people who work with us in this way. They cannot be here, as we are, but they still
wish to share in what we are doing.
To the big donots, who are after all a
conglomeration of a lot of individual donors, and to the many individual friends in
India and all over the world: many thanks. Do know that we deeply appreciate all
you do to help us and those in our care.
BRO JAMES KIMPTON
REACHING THE UNREACHED
G. KALLUPATTY, NEAR BATLAGUNDU
MADURAI DISTRICT-624 203
TAMIL NADU, INDIA

MEDICAL

PROGRAMME

The medical programme provides primary health services to the people of
about 26 villages.

This programme is project based and functions from the clinic in

the project campus

The clinic functions in two sessions, morning and afternoon.

The programme can be classified into the following :

1)

General clinic

2)

Ante-Natal Care

3)

Mother and Child Health Care

4)

Leprosy and T.B. clinic

5)

Laboratory

6)

Physiotherapy unit

7)

Day Care Centre

In addition, the medical programme is also involved in health education,

through house visits, mobile clinic for outreach villages and medical check-up and

treatment for school children under RTU's education programme.

General clinic: During the year a total of 1 5,377 cases were treated. Most
of these cases were common ailments like cold, cough, fever, skin trouble, burns,

injuries etc.

Earlier, the general clinic functioned only in the mornings.

However,

from this year onwards, the general clinic was operational in the afternoon sessions

also for those who were not in a position to come in the mornings.

Complicated or

serious cases were referred to the government or private hospitals in Batlagundu.
these, 47

cases were referred for treatment at RTU's expense.

Of

To improve the

quality of diagnosis and treatment, a lady doctor was appointed to visit the clinic
twice a week during the morning session.

Her presence has strengthened the skills o f

the team of para-medical workers.

Ante-Natal Care:

The ante-natal

through the clinic on Thursday afternoons.

care for pregnant women is provided
It ensures that the women who are

registered for treatment come to the clinic at least once in a fortnight.
begins from the third month of pregnancy onwards.
ante-natal care were provided treatment.

Registration

A total of 1,498 cases of

On an average, there were 18 new cases per

month. 46% of the women registered themselves for treatment between the third and

fifth month of pregnancy, whereas most of the others registered between the sixth and

e:ghth month of pregnancy.

The clinic recorded 160 normal deliveries among those

who were registered in the clinic.

4 abortions, 3 premature deliveries and 4 still

The condition of most of the women undergoing treatment and

births were recorded.

the children delivered by them was normal

The treatment consists of providing iron

and folic acid tablets and tetanus toxide doses.

As part of health education, audio

visual shows on health and nutrition of women

and

children

were arranged on a

monthly basis.

Mothes' and Child Health Care :
care cases.

This is a follow-up of the ante-natal

The medical team follows up the immunisation status of the children

during the first year and motivates the mothers to get their children immunized through

the government programme Immunizations are done by the government health staff in

the campus to protect children against tuberculosis, polio, diphtheria, whooping cough
During the year, this programme covered 749 children

tetanus and measles.

Leprosy and T.B. Clinic :
active in the

area,

rehabilitation.

With the government leprosy programme

RTU’s responsibility was restricted to motivation

follow-up and

The government leprosy department visits the project campus every

month When they dispense treatment for the leprosy patients.

The medical team of

RTU is constantly in touch with these patients to ensure that their treatment is

comprehensive.

The shoe making unit of RTU provided 115 pairs of micro-cellular

A total of 3,773 leprosy cases were followed

rubber footwear to the leprosy patients

up.

Under the TB programme, surveys were conducted in Kallupatti and Genguvarpatti

villages to identify TB patients for treatment.
recorded.

7,713 cases of TB treatment were

The number of patients on record at the beginning of the year (April 1990)

was 27. to which 68 new cases identified during the year were added.
patients

completed

the

treatment and

were declared

cured,

A total of 40

while 7

patients

discontinued treatment.

At the end of the year, there were 47 patients on record

undergoing treatment.

The TB patients came from 9 surrounding villages.

Laboratory;
medical team.

The laboratory plays a supportive role to the activities of the

Normal clinic tests such as stool test, urine and blood test like widal,

VDRL, HB % ESR, total counts and differential count test are taken up.

A total of

4,276 lab tests were conducted, which are done by a trained lab technician.

Physiotherapy Unit:

The physiotherapy unit had more cases this year. 35

Children were being treated in this unit.

These children were in the 3-1 3 age group.

During the year, 14 children suffering frcm various forms of physical disabilities were

ope’ated by an expert orthopaedic surgeon

Dr. John Karuppaiah.

Six children who

were cperated in the previous year underwent rehabilitative treatment in the clinic. 24

sets of calipers and 1 5 sets, of crutches were provided to the children.
equipped with various equipment for exercising the limbs.
herbal oils

This unit is

Massaging is done with

This unit functions in the

Electro magnetotherapy is also provided.

early mornings and late afternoons-

Day Care Centre: The day-care centre is for childien under three years of age
who are severely malnourished.
centre at any point in time.

On an average, there were 25 children in the day-care

They are provided with nutritious food consisting of milk

porridge, vegetables, fruits and eggs.

An additional

helper

appointed to ensure that all the children are well cared for.

for the centre was

The day care centre

staff started a system of organising parents' meetings periodically to educate them on

child care personal hygiene and sanitation

Mobile Clinic:
programme

The medical team visits two villages under the mobile clinic

These villages are Kombaipatti

and

Gandhipuram.

patients treated during each visit is in the range of 10-20.

The number of

Subsequently, the team

undertakes house visits and advises the people on health related issues.

undertakes mobile clinic visits on Monday and Friday afternoons.
visited weekly.

The team

Each village is

A third village. Dharmalingapuram, was dropped because

of the

inadequate response to the programme by the people.

House Visits :
undertakes

house

visits

On Tuesday and Wednesday afternoons, the medical team

in

Kallupatti and

Genguvarpatti.

This gives them an

opportunity to meet and discuss with the people matters pertaining to health and

hygiene.

1 his also gives them a chance to follow up the treatment provided earlier to

the people.

SchooS health : During the year, the team conducted frequent medical
check-ups and treatment to the children covered under RTU's education programme.
The total number of cases checked and treated was 11,182.
A system of giving tetanus toxide doses to the staff and workers of RTU on a

quarterly basis was started during the year.

About 200 people are covered under

this activity.
Through the

system of voluntary contribution by the people, an amount

averaging Rs. 300 per month was collected.

This programme is largely supported by

Caring for people (U.K), RTU (U.K) and other groups and individuals.

MONETARY

ASSISTANCE

PROGRAMME

This programme provides assistance to people in need. They constitute TB and
leprosy patients, widows, physically handicapped, old aged, destitutes and sickly
people
They can broadly be classified as under :

Leprosy patients

:

59

TB patients

:

7

Destitutes

: 96

Others

:

TOTAL

: 181

19

Some of these beneficiaries are given temporary assistance as a short term
relief measure and are subsequently removed from the list when their condition
improves. Most of them belong to the local villages and come to the project campus
on Friday mornings to collect the assistance amounts. For those living in farther
villages, arrangements are made to have the amounts disbursed at points nearer to their
homes. The assistance amount is in the range of Rs 10 to Rs. 50 per week,
depending upon the need of the beneficiary and the family situation. A constant
review of the beneficiaries is done to ensure that only the most needy are benefited.
Six people are put on a monthly assistance and a few are also sent money by post if
they are living in far ^way villages.
7 old aged people live in RTU's care in houses constructed by RTIJ. They are
provided with food thrice a day and weekly assistance of Rs. 15. Their personal needs
such as clothing are also attended to. In addition 17 old aged people are provided
food thrice a day and a weekly assistance of Rs. 15 each. They come to the project
campus to get their food.
Every year, on the occasion of Deepawali (an important festival), a set of
clothes is gifted to each person. Some needy people especially the old, are provided
with blankets in the cooler season.

In August 1990, during an eye camp organised jointly by the Aravind Eye
Hospital at Theni and RTU, many of these people were treated and some operated for
various visual defects.

This programme is supervised by the medical department. It aims to ensure
that deserving and needy people are provided with a certain measure of physical and
emotional security.
This programme is supported by DWHH (Germany), SOIR-IM (Swedenj,
Ftierds of Leprosy patients (U.S.A.,), DCF (Denmark) and others.

COMMUNITY HEALTH AND DEVELOPMENT PROGRAMME
The Community health and development programme is implemented in 7
villages as part of the outreach programme. Community health is the main intervention
in these villages, in the initial stages through formation 01 sangams (associations) of
men and women
Subsequently community development activities are taken up. This
is aimed at building up a certain measure of confidence and self-reliance in the villages
and to initiate a process of common village development Sangam meetings are held
regularly, at least once a month. Each member pays a certain amount to the sangam
every month for creating a fund to meet common expenditure. Meetings in the project
campus, trainings, exposure visits and audio visual shows are also organised.
During the year, the programme was withdrawn from one of the villages,
JK Nagar, due to consistently inadequate response to and interest in the programme.
The programme in Kannimarkoilpatti was temporarily suspended when some of the
members refused to abide by some decisions taken by the sangam in consultation with
RTU and the inability of the sangam to sort out the differences within the group. On
the positive side though, the programme was revived in Utchapatti in August 1990
after about 6 months, on repeated representations from the village people to RTU on
this issue
The programme was implemented in a full fledged manner in Keelakottaipatti- Kamatchipuram was a new village in which the programme was introduced from
October 1990 onwards. The team also established contacts with Vadivelpuram,
Karuppamoopanpatti, Sathakovilpatti, and Perumalkovilpatti villages, where the
programme is likely to be introduced in the near future. The villages where this
programme was being implemented were: Sri Ram Nagar, Palapatti, Kottaipatty
Samiyarmoopanur, Utchapatti, Keelakottaipatti and Kamatchipuram.

Community Health .*
This component of the programme encompasses the activities of the village
health worker (VHW), health education and mobile clinic. The village health worker is
selected from within the village, who is trained in basic healthcare and dispenses
treatment. Serious cases are referred by her to the nearest government health centre
or hospital
She also promotes health messages. An average of about 200 cases
were treated monthly by the VHWs in the 7 villages. Most of these cases were cold.
Cough, fever, aches, diarrhoea and skin diseases.
21 review meetings of health
Workers were conducted in the campus.
/
The mobile clinic supports the work of the VHWs. The clinic visits each

village monthly and undertakes ante-natal care (ANC) checks, weighing of children
under five, treatment and health education 61 mobile clinic visits were made, during
the course of which 109 ANC cases were given treatment. A total of 563 men, 659
women and 11 77 children were also treated. An amount of Rs. 1,002 was spent on
medicines towards which, the people contributed Rs. 573 as their share.
1 5 audio-visual shows were conducted in the villages using films and slides.
These covered a variety of topics such as child care, nutrition, environmental sanitation
etc.

Community development :
The following is a brief statistical account of the sangams ;

Name of the
village

Sangam
Membership

Average attendance
in meetings (%)

Sangam fund
collection during
the year(Rupees)

Men

Women

Men

Women

Men

Sri Ram Nagar

37

43

65

87

340

75

Palapatti

43

70

54

63

90

100

Kottaipatti

35

34

59

82

303

352

Keelakottaipatti

40

48

71

91

560

9C0

Utchapatti

24

78

79

71

1,000

208

Samiyarmoopanur

37

11 2

75

86

1,110

517

Kamatchipuram

25

117

67

100

234

400

TOTAL

241

502

67

83

3,637

2,552

Women

The sangams were largely involved in mobilising the people to avail benefits
frcm the government
Applications were made for loans for purchase of milch cattle,
goats and sheep, petty trades and for social services Like old age and widow pension.
Representations were made for water supplies, housing, electricity and roads. With
the help of RTU they were also involved in running balwadies, developing kitchen
gardens and tree plantation on homesteads. Disputes among groups within the village
were also settled through the intervention of the sangams, for which, in a couple of
cases, assistance of the local police was also sought.
One of the highlights of the programme was the co-operation among the
sangams of Palapatti, Kottaipatti and Keelakottaipatti villages in getting a kutcha road
laid with the assistance of the panchayat union and contribution from the people, on
the basis of which, they managed to get a bus route connecting their villages to the
nearest town, sanctioned. This was possible after several representations to the
concerned authorities. The bus has however not yet started plying, and the people are
determined to continue to press for their demand till the very end. This has stood out
as an example for other sangams to emulate.

50 kitchen gardens were developed in 6 villages as a supplementary income
generation activity. A variety of vegetables were grown. This met with a good response
from the people, who irtend to continue this activity. 850 trees were planted in
homesteads in 7 villages, in addition to plantation along village roads. Some women of
Keelakottaipatti were involved in preparation of a nutritious powder for children which
was supplied to RTU. A group credit scheme for goat rearing was initiated in one
village, involving a total of 9 groups of 5 members each. The balwadi in Utchapattj
was re-started in September 1990, for which the people contributed Rs. 3,000 for
purchase of materials. Since then, this balwadi and the one in Samiyarmoopanur have

/been functioning satisfactorily, with the parents taking keen interest in the programme.
Arrangements for feeding have been made in the village itself, which is being supervised
by the parents. Each balwadi has 30 children
with one teacher and two
assistants for each balwadi. Tha health status of the children is monitored regularly.
The education department provides the necessary support.
8 one day training sessions each for men women and children were held
between May and December 1990 involving about 25 participants in each session.
1 hese trainings covered issues related to overall village development. Two trainings
on leadership and health awareness were held for one day each, involving a total of
62 participants
The departmental team too participated in these trainings, in
addition to which they had their own meetings to review the programme
implementation.

The programme had its share of problems too. The most common problems
were those related to sangam leadership. Dishonest piactices and instances of
corruption among the leaders, apparent or perceived resulted in a loss of confidence
among the people for their leaders. However, the sangams were strong enough to
meet the demands of the situation and take remedial action. Internal village disputes.
mostly related to land and caste, adversely affected the working of sangam, which too
called for sangam intervention

The following is a brief account of the achievements of the sangams in their
respective villages.

Sri Ram Nagar.' Sheep rearing loan for 15 members, bullock cart loan for 4
members, leans for petty trades for 4 members, old age pension for 5 people.

• Palapatti." Old age pension for 8 people

Kottaipattir Old age pension for 2 people.

Keelakottaipatti.' Borewell for drinking water
savings scheme for all members.

from the government, monthly

Utchapatti.' Sheep rearing loan for 24 members, construction of threshing floor
by the government.
Samiyarmoopanur; 112 house sites alloted, pension for 3 widows, water tank
with 6 taps from the government.
These are an indication of the initiatives taken by the people to bring about
village development.

This programme is being supported by Oxfam (U.K).

EDUCATJOfJ

PROGRAMME

The education programme can be classified into the following components :
a)

Balwadies (pre-primary schools) for children in the 3-5 age group.

b)

Full-time primary schools for students in the 5-11 age group.

c)

Supplementary schools for children in the 5-15 age group.

d)

Trade schools for vocational skills for boys and girls.

e)

Boys' hostel.

f)

Scholarships for advanced studies.

The number of students covered under each of these programmes at the
beginning of the academic year was

Programme

Boys

Girls

Total

Balwadies

64

64

128

Full-time primary schools

174

177

351

Supplementary schools

847

432

1,279

Trade schools

7

27

34

Boys' hostel

23

—

23

Scholarships

13

6

19

1,1 28

706

1,834

During the year, the retention rates of students for the three main programme
of education were-balwadies 91%, full-time primary schools 97%, supplementary
schools 82% The major factor causing drop outs was, as usual, migration of families
to other places in search of employment. In the case of supplementary schools, drop
out among girls was also reported on their coming of age. As in the previbus years,
many drop outs were reported in the month of March when the government schools in
which the supplementary school children are enrolled, close down for study holidays or
conduct the final examinations. About 61.5% of the students enrolled were boys and
38'5% girls In addition, the education programme also supported two balwadies in
the outreach villages which came under the supervision of the Community Health and
Development programme, in the villages of Utchapatti and Samiyarmoopanur. Details
regarding these balwadies are reported in the section coveting the community health
and development programme.

As in the early years, emphasis was laid on upgrading the skills of the teachers
through trainings organised in the campus during summer and exposure visits to other
schools involved in similar work. Regular meetings among the teachers were held to
enable sharing among themselves. Teachers of each programme met monthly during
which some of them took model classes, which were then evaluated by the others
present. These meetings were in addition to the team meetings held in each school

and centre.
For the purpose of co-ordination within the education programme
those in charge of each education centre met monthly to share their experiences. It
was with the purpose of strengthening the programme at the field level that the post
of a Programme Assistant for the education department was created in early 1991.
The Programme Assistant was expected to lend support to the teachers in teaching
methods and planning. He was also expected to assist the Co-ordinator of the
department in the implementation of the programme
The post of an Administrative
Assistant for the schools was created to reduce the administrative burden of those in
charge of the two full-time schools and the two supplementary schools in Kallupatti
and Ganguvarpatti.

Involvement of parents was high through a system of quarterly meetings, when
the teachers and the parents discussed issues related to''the overall development of
the children with specific emphasis on academics. The purpose of th^se meetings was
also to impress on the parents the need for them to take an active interest in the
education of their children.
The parents of the supplementary school students
contributed at a rate of Rs 25 per student and Rs. 35 per student annually, for the
primary and secondary level students respectively, while the parents of the students of
the balwadies and full-time primary schools contributed Rs. 55 per student annuallyDuring the year, an amount of about Rs 50,000 was received from the parents as their
contribution to the programme. This amount was deposited in a fund for future
exigencies The parents also took an active interest in the various extracurricular
activities organised from time to time.

Balwadies."
The balwadies are for the children in the age group of 3-5. The activities in
the balwadies include singing, dancing, story telling, games and simple art work.
Tamil alphapets and numbers are introduced to the older children in the group to
prepare them for their primary education.

There are 3 balwadies under the programme, of which 2 are in Kallupatti (Sisu
Bhavan & Miriam Balwadies) and one in the neighbouring village of Pushparaninagar
(Nirmala Balwadi). The children are divided into two groups, one group for the 3—4
age group and the other for the 4—5 age group. The Kallupatti balwadies have 1
teacher and 2 helpers each, while the Pushparaninagar balwadi has 2 teachers and 2
helpers The strength in each of the 3 balwadies is restricted to 40.
The health and
nutrition status of the children is given lot of importance as it is an integral part of the
programme. The selection of children for the balwadies is done by the teachers such
that only the children from the most backward sections of the village are admitted.
Medical check-ups are conducted by the medical team every quarter.
Discussions in parents' meeting usually centre around child care. Towards
the end of the year, the teachers held a feedback session with the parents regarding the
programme, so that constructive suggestions coming from them could be incorporated
in future implementation.

Primary Schools :
During the year, the St. Peter’s School (Kallupatti) went up to standard
5 and the Arul Malar School (Ganguvarpatti) went up to standard 3. This
necessitated construction of additional class rooms
3 additional class rooms for
each school was constructed in mid-1990 to accomodate the additional students.

The schools follow the government syllabus prescribed for the students, in
addition to which life oriented topics relevant to the village situation are added.

Besides imparting literacy and numeracy skills

the syllabus is designed to cover a

wide variety of concepts and topics such as health, sanitation, personal hygiene,
environment social issues etc.

Importance is also given to extracurricular activities

hke art, handwork, singing tree plantation etc.

The teachers adopt teaching methods

which interest the children and hence enable them to grasp easily.

Children are also

encouraged to save by developing in them an attitude of thrift.

During the year,

children from the full-time schools collected an amount of Rs. 3,200 as savings.

A

system of giving additional coaching for students who were academically backward

was started in December 1 990,

Teachers with the help of some students conducted

these classes after normal school hours and on holidays.

Special attention was also

given to students o f standard 5 to ensure that they were comfortable with the basic

concepts

and literacy

for their future studies

and

numeracy skills,

which

would

form the foundation

Six-monthly medical check-ups for students were conducted

by the medical department, which also followed-up the treatment taken.

Regular contact with the parents was
house visits

maintained through meetings and

The parents gifted a steel water container to the St. Peter's School and

a small sound system to the Arul Malar School on the occasion of Christmas.

In the

feedback session towards the end of the year, the parents asked the teachers to
develop in the children capacity to memorize and an attitude for hard work in their

homes.

The teachers were involved in a serious debate on the future of the programme.
The question was whether to go beyond standard 5 and whether to seek government
recognition for the schools

After a series of discussions which included external

resource persons, it was decided that the schools would go up to standard 8, when the
students would appear for a public exam conducted by the government as private
candidates.

Hence, from the academic year 1991-92, these schools will go to the

middle school level.

The administrative side of the schools was taken care of by St. Josephine, who
spent sometime examining the system of maintenance of various records including
those related to academics such as lesson planning.
Her suggestions are expected
to strengthen this side of the programme also.

Supplementary Schools :
The supplementary schools function in 5 villages in the mornings and evenings
for about 2 hours each. These schools are in the villages of Kallupatti (Gandhiji
School), Ganguvarpatti (Mother Theresa School), Sengulam (Valluvar School),
Pushparaninagar (Nirmala School) and Dharmalingapuram (Avvai School) The purpose
of the supplementary schools is to improve the standard of education and learning
of the students going to the government schools, through providing them with
additional coaching in academics and an opportunity to participate in several
extracurricular activities for complete development.
It also aims to make the children
more responsive to the society and community to which they belong.
The highlight of the programme during the year was that the students of
Avvai school scored a 100% result. All the students coming to this school who
appeared for the examination in the government school were declared successful. This
year saw a marked improvement in the relationship with the local government schools
both in academics and extracurricular activities. This coordination is beneficial both
for the supplementary schools and for the government schools, resulting in a much
better input for the students.

A new system of vocational training for the students of standards 8,9 and 10
was started.

This was a suggestion that came from the parents in one of their

meetings

25 boys were selected for training in screen printing, electric wiring and

carpentry.

This training was to be imported to them on Saturdays and Sundays.

Training in screen printing and electric wiring was imparted by the trade school while

for carpentery, they went to a workshop in the nearby town of Batlagundu.

This has

received a good response from the boys.
An evaluation of the programme was conducted for the students of standard 5.
45 supplementary school students who had been enrolled in the programme for 3-5
years were tested and their scores compared with that of 20 students who appeared
for the same test but did not come to the supplementary schools or attend private
tuition classes. The test was for Tamil, Maths and Science subjects. It was found
that the scores of the students coming to the supplementary schools was about 19%
more than that of those not attending these schools. Though it was apparent that
students coming from supplementary schools had an edge, certain areas of weaknesses
in the programme were also identified, which will form the basis for further
strengthening the programme in future.

The students were also involved in various extracurricular activities.
Competitions were held in quizzes, oratory, essay writing and singing Students took
up tree plantation and social work programmes in the villages. The students from three
schools who were involved in savings, collected an amount of Rs. 2 300 during the
year. The students were covered under the six-monthly medical check-up conducted
by the medical team

Baste Trade Schools.'
The trade schools aim to provide vocational skills to boys and girls above 15
years of age to enable them to be self-employed or seek gainful employment in future.
The trade school for boys imparts training in carpentry, electric wiring and

screen printing

Due to lack of adequate response on part of the trainees, this trade

school increasingly concentrated on production activities.

of cards, book binding works, photo framing works etc.

given on-the-job training with a monthly stipend of Rs. 75.
period of 6 months.

These included printing

A small group of 7 boys were
This training is for a

This school has earned a revenue of Rs. 16,000 for various works

done during the year, including photocopying, which is done in this school

The trade school for girls imparts
handwork.

training in tailoring

embroidery

and

This school was strengthened with the appointment of a trained and

experienced teacher at the beginning of the academic year.

The girls undergo a one

year training at the end of which, they are made to appear for a government exam,

which earns them a certificate on their being declared successful.

to avail of bank loans for buying sewing machines.

This enables them

This school also started making

marketable products and earned a revenue of about Rs. 1,500 through sale of dress
materials.

Boys' Hostel :
The newly constituted boys' hostel started functioning in the campus foim the
beginning of the current academic year onwards The strength of the boys in the
hostel was 23 in the age group of 1 0 — 16 (standard 5 to standard 10).
Preference
was given to complete orphans and sons of widows from very poor families. The boys
attended the government schools in the village. A warden was appointed to supervise
the hostel. Adequate arrangements for their boarding was made. Provision was
also made for games and recreation. The parents/guardians contributed Rs. 10 per
month for each hostel inmate. These boys also attended the supplementary school
programme. Importance is given to their health and nutrition, which is taken care of
by the medical department.

Scholarship :
This is a provision for students who have completed their basic academic
courses and intend to study further. Preference is given to students seeking
admission for vocational and professional courses like teaching, nursing, typewriting
and various polytechnic courses.
Scholarship amount is granted based on the
economic and academic background of the student and on his or her gaining admission
to a recognised institute.
The scholarship amount is restricted to a maximum of
Rs. 3 000 per year or two-thirds of the total amount required per year whichever is
less and is given in monthly instalments The education department keeps a record
of the progress made by the students during the course
This is expected to benefit
the students by enabling them to find gainful employment on completion of their
courses. In some cases, RTU itself is in a position to provide employment, as in
the case of those who have completed a course in teaching.
The following is a brief account of the activities of the students and teachers
during this period :

C

Annual examinations were conducted by the full - time and supplementary schools
in April 1 990

O

Mr. Sathyabalan of Action Aid conducted a 5 day teachers' training programme to
upgrade the skills and improve teaching methods in May 1990.

0

The students and teachers of Arul Malar School started a child-to-child literacy
programme for the non-school going children in the area in June 1990.

©

Students’ councils were formed by the students of the full-time schools in
June 1990. The same month, they started savings.

0

Planning for the academic year 1990-91 was done by the teachers of all the
programmes in June 1990.

0

On completion of construction of additional classrooms, the full-time school
children took up tree plantation in front of the school building.

Q

In August 1990, RTU hosted a meeting of education co-ordinators of organisations
funded by Action Aid. This was organised by Action Aid.

O

All schools celebrated Independence Day on August 1 5, 1990.

©

In August 1990, the supplementary school students formed student's councils in
their respective schools.

•

Two groups of full-time school teachers went on an exposure visit to Vikasana
School, Bangalore and Kinder Garten School, Madras in October 1990.

£

Children of the 3 balwadies went on an excursion to a nearby picnic spot in
October 1 990.

(J

A sports day for all the schools was held on November 14, 1990 to commemorate
Children's Day.

®

A group of supplementary school teachers went on an exposure visit to Kinder
Garten School, Madras in 1990.

O

Half-yearly exams were conducted in the full-time schools in December 1990.
Special classes for academically backward students were started.

G

Children's get-togethers were organised in each school on the occasion of
Christmas
Exhibitions and entertainment programmes invoving parents were
organised differently in each school.

(3

A science exhibition was conducted by the full-time and supplementary schools in
the government high school in Kallupatti in the month of January 1991.

Q

Half-yearly exams were conducted by the supplementary schools in January 1991.

Q

Inter-school competitions for quiz, essay writing and singing was organised by the
supplementary schools in January 1 991.

£

Republic Day was celebrated on January 26,

Q

The annual day celebration involving all the schools was conducted in February
1991 . A variety entertainment programme was staged.

O

Social service groups of full-time schools students were formed in February 1991.

o

The students of standard 1 0 of the supplementary schools gave feedback on the
programme in March 1991.

@

The evaluation of the supplementary school programme for the standard 5 level
was conducted in March 1991.

@

Sports day for the balwadi children was organised in March 1991.
month, students lot standard 1 were selected from the balwadies.

O

The students and teachers of the full-time and supplementary schools started
preparation for the annual examinations on the conclusion of the academic year
1990—91, in March '91.

1991.

In the same

The education programme is supported by Action Aid (U.K.), DCF (Denmark)
Enfants De L' Univers (France), SKIP (Switzerland), DWHH (Germany), RTU (U.K ),
St. Peter’s School (U.K.), SECOLI (Rome) and other groups and individuals through
sponsorship and non-sponsorship funding.

NUTRITION

PROGRAMME.

Under this programme, food is provided to the children of the daycare centre,
balwadies. primary school, supplementary schools and boys' hostel totalling to about
1.600 children. 25 old people are also provided with food

Since the coverage of children under this programme is substantial, efforts are
made to optimise the nutritional intake in a cost effective manner. The day care centre
children are provided with a diet consisting of milk and porridge in the morning, lunch
in the afternoon consisting of rice, pulses and vegetables and occasionally, fruits
The
balwedi children are provided milk in the morning, lunch in the atternoon and snacks
before they leave in the late afternoon. Mid day meals and snacks are provided to the
primary school children. Breakfast is provided to the supplementary school children
attending the morning session and snacks to those attending the evening session.
The boys in the hostel are provided with breakfast, lunch and dinner. Special meals
or dishes are pre pared on festive occasions. The children are provided with eggs one
a week. Chicken or mutton is prepared once a month.
A comprehensive internal study of the programme with special reference to
children under the education programme and nutritional intake was undertaken The
following were the important findings :

Planned

Planned
intake %

Present
intake %

Cost per day
(Rs. )
per child

Balwadi

50

62

50

96

75

21

50

67

1 64

Full-time-Primary

50

23

50

52

75

14

50

38

1 48

Supplementary-Primary

25

13

25

26

35

45

25

32

0.60

Supplementary -Secondary

25

16

25

20

35

2

25

24

0.83

Hostel

100

127 100 178 100

23

100

61

8 73

intake %

Present

Programme

intake %

i

Present
intake%

Iron

Planned
intake %

Vitamin-A

present
intake %

Protein

planned
intake %

Calories

The planned intake was a proportion of the nutritionaI requirement of the
children for different age groups, proposed to be met through the programme and the
present intake was a calculation of the actual nutritive value derived from the food
supplied under the programme. The figures for cost included cost of ingredients
required to prepare the food and excluded apportioned salaries of cooks and other
general overheads. This exercise was based on a sample menu of one working week
of 6 days. The study has enabled the department to plan the menu such that the actual
nutritional intake is closer to the planned intake.

The food supplied is prepared in 6 kitchens located near the schools.
these cater to the requirements of the old aged people.

One of

The funds for this programme come from sponsorship amounts of the education
department and from specific provisions under schemes funded by SKIP (Switzerland),
DWHH (Germany) and caring for people (U.K.).

FOSTER

FAMILY

PROGRAMME.

This programme cares for children who have been abandoned or are in danger.

We accept children who are saved from female infanticide or have been found on a
roadside left to their own devices.

Children who have lost both parents are also

welcomed as well as those from single parent families whose remaining parent finds it
They are entrusted to a widow or a virtual widow who

impossible to care for them.

is still young enough to wish to care for children and who has proved that she has the
right qualities and motivation to accept these most deprived of children. We now have

98 children with 23 ''mothers", each family group in its own house.
Of these 7 are foundlings left on the roadside, 6 have been saved from female
infanticide, 13 are orphans and 6 are handicapped children.

In the past 12 months 38

new children have been taken into the foster families and six new "mothers".

Two of

the older girls have started work in our handloom workshops and are doing well.

During the year, 5 new houses had to be built to accomodate the influx of children and
another water source had to be identified as the one existing supply was now not

sufficient.

A new water tower was built with a 5.000 litre capacity and this

feeds into half of the houses.
A small library was started.

gift for the children.

More books are needed and would be a welcome

The playground equipment was added to and an aviary for small

birds is now happily alive.

Once again we had a visit from our friends of SKIP in

Switzerland who have been funding this project for some years.

decided to stop further funding.

Sadly, they have

We must now look for another organisation which

will help us with finance from 1992 onwards.

We are deeply grateful to SKIP and, in

particular, to Mrs. Meinberger for all their help.
One of the most outstanding achievements this year of reporting has been the
full scale and deep evaluation that was done by Mr & Mrs. Rosario from Bangalore.

With their own wide experience, a good study was made of the programme and

suggestions have been made and accepted, which are now being followed up.
Another outstanding event of great happiness to all of us was the marriage

of the very first child to be admitted to the foster mother project.

It was because of

her and her sisters and brother that the whole conception of foster-families originated.

The marriage took place in our own chapel amidst much happiness.

Each child from the day it arrives into our care, no matter how young, is given

a personal bank account.

Over the years

this savings account accumulated to a

considerable sum and during the year, we invested the accrued amounts from the

accounts of those who have been with us for more than a year into Unit Trust of

India's Children's Gift Growth Fund.

These sums cannot be touched by anyone until

the child reaches the age of 18 and then, only the account holder can take the money.
Thus the child will be assured of a handsome sum of money with which to start out life

The "mothers” receive training in dress

on its own when the time comes for this

making and at the annual sale of work in Kodaikanal in which RTU always participates,

their products raised around Rs. 950.

This is just a beginning and we hope that sales

will increase.
The Foster-Mothers’ Sangam has been running well since its inception and the

mothers have their monthly meetings to sort out their own problems and to make
decisions relating to their work.

This same sangam has its own Credit Union and to

date has a sum of Rs 13,930 in its account.

The whole compound of this home for children, called Anbu lllam. Place of
Love, is now full of flowering trees and shrubs, carefully maintained by the families.

Each family is also responsible for the care of one coconut tree on the playground.
We are deeply grateful to the many visitors who have encouraged us during the
year and for the gifts that are given for this beautiful work among the poor.

2-3OUSHRJG

RURAL

PROGRAMME

The main concentration of this programme was on group housing schemes.

Individual (sundry) houses, campus buildings and works and construction activities
for other groups and organisations were the additional works taken upduring the year.

304 houses were constructed, of which 295 houses were in group settlements

in the villages of Sathakoilpatti (95),

(141)

Kannimarkoilpatti

(59)

and

Kailasapatti

The other houses were constructed in the surrounding villages including

Kallupatti

and

Ganguvarpatti.

constructed in each of

A

the 3 group

Ganguvarpatti were re-roofed.

meeting

hall

settlements.

and

a threshing floor

were

19 houses in Kallupatti and

A new dimension to the programme was added by

taking up construction of toilets, which is likely to gain significance in the local

villages.

The tally of the number of houses constructed in the villages as at the end

of March 1991 stands at 2,455.

The construction measures taken up in the RTU campus consisted of 4 staff
quarters, 5 houses for foster families, classroom extensions to the two primary schools,
clinic building for the Ammapatti project, a weaving shed for the handloom unit,

a workshed, a store room and water tanks for
miscellaneous works.

the

tile

making

unit and other

RTU provided a clinic building for a group of nuns in Kavirayapuram and
reconstructed the building for Anbu I Ham (a Madurai based voluntary agency) by
arranging for the funds required.

An in-patient ward and staff quarters for Arogya

Agam (a voluntary agency based in Andipatti) and a school building for a school run

by the Presentation Convent sisters in Theni were the other works executed.
A rigorous system of identification and selection of beneficiaries from the

socially and

economically backward sections in

construction activity.

Initial meetings were held to arrive at an agreement of under

standing between the beneficiary

responsibilities.

the villages preceded the actual

groups and RTU on

These were followed by fortnightly

implementation of the programme.

their respective roles and

meetings to ensure smooth

Digging of soak pits for draining waste water from

the bathrooms, tree plantation and levelling of paths and lanes within the settlement

were integral components of the programme.

The average cost of a 289 square feet

house with a cattleshed and bathroom in the local villages was around Rs. 9 000, while

for those in the outreach villages, it was in the range of Rs 10,500 to Rs. 11,000.

Minor changes in the construction of houses were made as part of a continuing
effort to modify and improve.

Brick support pillars on the verandahs were replaced by

cement pipes packed with cement mortar, which are stronger and more lasting and
result in some saving of space.

Complete window frames replaced two wooden

supports for the windows to make it stronger.
in a big way as roofing material.

White (fibre concrete) tiles were used

92 houses, 2 meeting halls, a weaving shed and

workshed and store room for the tile making unit were roofed with these tiles.

A significant development during the year was financial collaboration between
RTU and the government in the implementation of a housing

programme for 150

members of the Rani Mangammal Mahalir Mandram, an association of women from

socially and economically backward groups, in the village of Pottapanayur, about

15 kms. from Madurai.

This is

a

of the association, a substantial share

resettlement

programme

for

of whose

earnings

is

spent on house rents in and around Madurai city.

the

members

currently

being

The average cost of a house is

estimated in the range of Rs. 15,000 to Rs. 16,000, of which Rs 8,500 was the

Government's (Tamil Nadu Co-operative Housing Federation) share and Rs, 500 was

contributed by the beneficiaries for each house.

The balance amount was arranged by

RTU, which also took the responsibility of execution of the work. Since the house sites

were located on a tank bed, the work was extremely challenging.

It had to be ensured

that the foundation was strong enough to protect the house from the shifting clay soil
in the dry seasons.

An association of the construction workers was promoted in September 1990.
85 workers enrolled themselves as members and started saving regularly.

of Rs 35,000 was collected as savings, which
7 members, nominated from among themselves.

and collected Rs. 35.000.

is

An amount

managed by a committee

of

The contractors too started savings

This amount is used to give loans to one or two contractors

at a time to purchase materials in bulk and thus save on costs.
need for RTU to give loans from its own funds.

This has obviated the

This will also enable them to pay

compensation to RTU in case of incomplete contracts.

The staff attended four seminars on low cost housing conducted by the

National Building Organisation, Madras and participated in seminars conducted by the

Gandhigram Rural Institute (GRI) on rural technology.

RTU is currently finalising with

GRI plans to collaborate in civil construction works using low cost building technology

for its campus works

Visits were made to the ASSEFA project and to Trivandrum to

see the houses constructed by Mr. Laurie Baker (a noted architect) by the staff to get
themselves exposed to other initiatives in the field of low cost housing.

DWHH (Germany) was the largest supporter of this programme, in addition to
which funds were also received from DCF

(Denmark), RTU (U.K.), Weyer Trust

(Germany), Mr. Michael Kimpton (U.K.), Mr. David Cassidy (U.K.), Caring for People

(U.K.), Miriam Dean Trust (U.K.), De La Salle Brothers (U.K.),

(Coatbridge, Scotland) and others.

St. Augustine’s

WATER

DEVELOPMENT

PROGRAMME

RTU continued to receive requests from the villagesof Dindigul Quaid-E-Milleth
District for taking up water development in remote villages. The main purpose of this
programme was to ensure that water for domestic use, especially drinking, is made
accessible to the rural masses. Efforts were made to ensure that one handpump was
installed for about 50 families in the villages where this programme was taken up.
A total of 104 bores were drilled and handpumps installed at 96 points where
water was struck. The entire divining work was done by Bro. Kimpton. The success
rate in divining during this period was 92%. With this, the total number of handpumps
installed by RTU is 742. An estimated 44,000 people benefitted under this programme
Batlagundu was the nearest Panchayat Union where this programme was taken up, the
farthest being the Palani Union. The farthest village where this programme was
taken up was in Palani Union, at a distance of about 1 30 kilometres from the project
campus. The following are the details of work executed .

Name of the Union
Periyakulam
Batlagundu
Nilakottai
Kodaikanal
Sanarpatti
Gujiliamparai
Palani
Authoor
Vedasandur
Ottanchattiram
Dindigul

Completed water
supplies

1

No. of people
benefitted
3 600
7,250
6,450
3,300
4,000
6,250
3,450
4,850
3 500
900
500

96

44,050

8

16
14
8
9
13
7
10
8
2

The identification of villages for this programme was done by the District
Collectorate. The need for handpumps in these villages was ascertained by RTU at the
time of divining. It was ensured that the benefits of this programme reached the
socially backward groups, which often faced problems of accessibility to a source of
water even if it was available in the village, The panchayat unions provided transport
and hospitality during divining. For drilling, rigs were hired on a contract basis.
A team of mechanics, fitters and masons went around installing handpumps and
constructing platforms. The usual time taken for completing the work from divining
to installation and construction of platform was one week, at a cost of under
Rs. 10,000 per completed water supply.

In addition, the programme also covered projects catering to the need for water
supplies. The following is a brief account of such projects :

It

The well in the foster families’ locality was deepened and a tank with
a capacity of storing 5,000 litres of water was installed. Pipelines were
also laid This has benefitted 22 families living in the locality

2)

2 borewells were drilled for a Kallar (backward caste) high school in a
village called Vilampatti. One of the borewells was fitted with a
compressor motor with which water was pumped to a tank constructed
for this purpose. Pipelines were laid to supply drinking water On the
other borewell, a handpump was installed.
This has benefitted
800 students of the school.

3)

A borewell was fitted with a compressor motor and a water tank
constructed and pipelines fitted for supplying drinking water to the
500 children of the Nirmala supplementary school and balwadi.

4)

2 borewells were drilled for a girls' high school in a village called
Chatrapatti, which is run by a voluntary organisation, the Gandhiji
Seva Sangam. One of the bore wells was fitted with a compressor
motor with pipelines for water supplies. The other bore was fitted
with a handpump. This has benefitted about 1,000 students of this
school

The new programme taken up during the year was a training course for
handpump maintenance for village youths. It was realised that the programme could
be sustained in the villages only if there was a mechanism for handpump maintenance
to ensure continued water availability. While the government has a system for
maintenance of handpumps, timely maintenance is difficult and often impossible
because of lack of adequate manpower and large areas to be covered. The problem is
more acute in remote villages
This training aimed at providing basic skills at the
village level so that their dependence on outsiders could be reduced and that, in that
sense, a certain measure of self reliance at the village level could be developed Since
the cost of routine maintenance is low, the finances could be arranged for by the
village itself through a system of contribution. A course was developed such that this
training could be imparted in 3 to 5 days' time Theoretical lessons and practical
sessions were arranged for the participants.
At the end of the course, each participant was given a set of reference notes
which could be easily referred to.
It was suggested that there should be two
participants from each village. Two such trainings were held, one in the month of
April for the villages of Batlagundu union and the other in the month of June for the
Periyakulam union. A total of 30 participants from 15 villages attended the trainingIt is proposed to develop this programme further and offer this to other voluntary
organisations who may be interested in their project area villages to be benefitted.

DWHH (Germany) was the largest supporter of this programme.
British
Society of Dowsers (U.K.). DCF (Denmark), Weyer Trust (Germany), Miriam Dean
Trust (U.K.) were the other major groups who funded this programme.

ST. JOSEPH’S

INDUSTRIES

This is the major income and employment generation unit of RTU, consisting
of the handloom and batik sections. The handloom unit is primarily for employment
c eneration for women, while the batik section was started as a rehabilitation centre for
cured leprosy patients who are physically handicapped.
The details of this unit are as
under ;

No. of looms :

66

No. of people employed :

Handloom section

Batik section

Combined turnover

No. of winding machines :

31

Handloom — Men
— Women

5 |
99

Total

...

Batik

6 |
2

Total

...

— Men
— Women
...

...

Local Sales

Rs.
Rs.

217,751

Total sales

Rs.

1,391,274

Rs.

127,939

Exports

Rs.

247,LOO

Total Sales

Rs.

' 375,839

Rs.

1,767,113

- (a) + (b)

—

8

1,173.523

Exports

Local sales

104

(at

(b)

The average monthly turnover registered a 5% increase over that for the
previous reporting period. The exports of handloom goods was less than that in the
previous year. However, in the batik section, a healthy growth was registered with
exports accounting for two-thirds of the turnover. This was a very encouraging sign
since, in the previous year, there was a plan to shut down the batik section because of
lack of orders.

During the year, a new weaving shed was constructed and 10 additional looms
were installed. This provided an opportunity for diversification of handloom products.
Lungies (loin cloth), mini jacquard towels and napkins and pillow covers were some of
the new items produced. New designs for other products were also developed. In the
batik section, sarees were made using the tie & dye printing technique.
In terms of marketing also, there were some positive developments. New
groups like Almas-lndia. Madras and Victoria Technical Institute, Madras were
identified for domestic and consignment sales respectively, in addition to three other
cutlets for consignment sales. A commission agent was also appointed for promoting
local sales. Regular orders were forthcoming from MESH (New Delhi), Cottage Craft
(Kodaikanal), Kriya Boutique (Pondicherry), CODES (Vellore), Asha Handicrafts
(Madras) and others A substantial quantity of handloom goods was sold through the
wholesaler in Madurai, Messrs. Christo Textiles. On the export front, orders were
received from Oxfam Trading (U.K.) and Unravel Mills (U.K.) through SIPA, Madras, a
federation of producer associations, of which RTU is a member. A substantial order
for batiks was placed by OS3 (Switzerland) for the first time, which was routed through
SIPA. A few overseas buyers from Germany and Australia also made enquiries and

placed sample orders A show room for retail sales was started in the campus in the
later part of 1 990. This has facilitated direct sales of products locally from the campus
itself. This show room is also used as an outlet to promote sales of the products of
the boys' and girls' trade school and the handwork items prepared by the foster
mothers.
On May 1, 1990. on the occasion of Labour Day, the handloom and batik
workers formed a Welfare Association, continuing the credit activity which they had
started in the previous year
However, this association has sought to be more broad
based in terms of its objectives and scope of activities. During this year, the activities
promoted by this association were savings linked credit scheme, fair price shop and
literacy
The following are some details regarding the association :

Savings linked credit scheme :
:
101
Numbers of members
1,122
Membership fees collected
:; Rs
Savings collected
: Rs. 11,538
Credit disbursed during the year :: Rs. 78,900
Repayment of credit
: Rs. 54,994
Fair price shop ;
8,000
Initial deposit
: Rs.
Turnover
: Rs.
9,8z7
Literacy :
No. of participants
: 50
No. of teachers
:
3
The functioning of the association is supervised by an 11 member executive
committee, which in turn has 3 office bearers selected from among themselvesPresident, Vice-President and Secretary cum Treasurer. The committee meets every
month, while the general body meeting is held quarterly. The savings and credit
scheme and the fair price shop are managed by a woman member who is paid for her
services by the association under the supervision of the committee. In December 1990,
the association declared a Re. 1 bonus per member from the distributable profits of
the association.
This a isociation is also used as a forum for discussing issues related to the
department between the supervisory staff and the workers. Quality of production and
productivity are issues invariably discussed in these meetings. To encourage
productivity, for the first time since its inception, the unit declared a bonus to the
workers at a rate of 8% of their wage earnings during the year 1990.
It was very
encouraging to see most of them receiving bonus in the range of Rs. 150 to Rs. 200
In addition, productivity awards were given to three workers each from three different
categories of handloom workers (a total of 9 awards).
It is expected that these
measures would go a long way in boosting the morale of the workers and improving
their well being
During the year, an amount of Rs. 82,000 was received as export incentive.
Of this, an amount of Rs. 43,400 has been distributed to the workers in form of
allocation for various activities of the association and bonus.

AGRICULTURE
This is a programme for internal revenue generation, expected to fi iance

programmes such as medical and education in future

The gross revenue from sale of

farm products was Rs 369,640, the break-up of which was as under :
Particulars

Quantity

Amount

Coconut

8.1 4 nos.

13,817

Coconut seedlincs

5,748 nos.

37,247

Cotton

1,340 Kg.

15,614

Flowers

334 Kg

5.993

Banana & Leaves

1,975 bundles

36 203

Vegetables

6,040 Kg.

22,227

Tomato

2.60 baskets

2 939

Amount

Farm :

Goat

—

400

Meat

15 Kg.

465

Sheep

2 nos.

3,797

138,702
dairy :

Milk

7 647 Lts.

Cow dung

—

33,053

2,100

Sale of cow

1 no.

2.000

Sale of calf

1 no.

1,230

38 383
Poultry :
Sale of chicken

TOTAL

12,653 Kg.

192,555

192 555

369,640

The monthly average gross revenue was about Rs 30,800, which meant an
increase of more than 30% over that in the previous year. This was inspite of the fact
that the rainfall in the area during the year was less than normal, resulting in lower

yields and lower offtake of coconut seedlings.

A significant development was the purchase of an 8.5 acres farm adjoining to the

present one in March 1991. with the financial assistance of DWHH.

In addition to

increasing revenues, it is also expected to cut down on costs due to economies of
scale.

Three bores were drilled for irrigation purposes of which two were successful.

2 compressor motors were installed to draw water from the bores, while the open well

on the farm was fitted with an electric motor.

-An additional poultry shed for 1,000 birds was

constructed.

With

this,

there are 6 poultry sheds.

The dairy farm with 6 cows, 7 calves and 2 bullocks, which was located in the

project campus, was shifted to the farm early in 1991, to enable better supervision.

Plantation of 2.000 casuarina trees was done along the bunds in the farm.

Production of thatch for sale was started with the increasing availability of dried palm
leaves,

A sheep rearing scheme which was started in mid-1990, was discontinued

after about three months since it was not viable.

With the farm activities being labour intensive, the number of people working

on daily wage basis regularly rose to 30 in the current year from 20 during the
previous year, in addition to the permanent staff.

The wages paid were in the range

of Rs 1 0 to 1 6 per day.

Some of the farm workers started a savings scheme by contributing a certain
amount each week. 11 workers saved to the tune of Rs. 4,000 during the year.
Mapy farmers from , the area visited the farm to seek technical

advice on

cropping methods and use of agricultural inputs, especially pertaining to coconut
plantation.

TtLE MAKING UNIT
The tile making unit is involved in manufacturing fibre concrete tiles. The
inputs for making these tiles consist of cement, sand, coconut fibre and water. The
tiles are white in colour, bigger than the conventional clay tiles and lighter in weight
too. These tiles cause the room to be brighter and cooler. RTU has been a pioneer
inthe introduction of these tather unconventional tiles in this area. It is gradually
gaining acceptance as an alternative roofing material. For RTU, it is also developing
into an important income and employment generation programme.
This unit initially started with one vibrating

machine.

Towards the end

of 1990, two more machines were added to the unit which were donated by the Weyer
Trust (Germany) and supplied by Parry Associates, U. K..

One of these two additional

machines became operational from January 1 991 onwards and the other is likely to be

operational later in 1 991.
has gone up to 540.

With two machines operating, the daily average production

The employment generation capacity has gone up to 24 daily

wage earners, mostly women.
During the year, a total of 102,800 tiles were produced.

In March 1991, the

rnanufacture of ridge tiles and glass tiles were taken up on an experimental basis and

has proved to be successful.

In terms of infrastructure also, there were some developments. A new work
shed was constructed for the two new machines. Anew storeroom was constructed
for storing cement and other inputs. 5 new water tanks for curing the tiles were
constructed
Wooden boxes to enable transportation with minimum breakage were
made

Of the total production during the year, tiles worth nearly Rs. 104,000 were
used under RTU’s rural housing programme and for various other works in the campus.
Since February 1991, tiles were sold to private parties, which accounted for a gross
revenue of Rs 8,500.

With the popularity of these tiles increasing inthe area, the

sale of tiles to private parties is expected to grow in future.

This has also been a

useful source of feedback on the quality and utility of these tiles.

An exercise in costing and pricing of these tiles was taken up in January 1991
to enable better planning and formulating a pricing policy. This can now form the
basis for cost and price revisions in future

The people working in the tiles making unit started savings and credit activity
from February 1991 onwards. The group collected a savings of Rs 1,400 from its
members, out of which it gave credit of Rs. 700 to its members.

AMMAPATTI
The Ammapatti project is a branch project of RTU, located about 35 Kms from
G. Kallupatti. It is an integrated development project working in 13 villages, involved
in community health, education and community development activities.

Community Health : The health team consisting of para-medical workers
and a part-time doctor, cater to a large number of outpatient cases, the total number of
which was 59.786 during the year. These mainly consisted of a variety, of primary
ailments Treatment was dispensed through a clinic in Ammpatti in the mornings,
which was rebuilt during the year to make it more spacious and enable unrestricted
work While most of the patients came from the local villages, many cases of people
coming from as far as 30 kms. away were also recorded, an indication of the
credibility of the health services provided. The average number of cases per day which
was about 200 in April, 1990, rose to about 350 in March 1991 .
Under ante-natal care, 100 cases of pregnant women were registered, most
of whom registered themselves by the fifth month of pregnancy.
67 deliveries
including one premature delivery and 2 abortions were recorded. Due to lack of health
services in the area, many deliveries, including complicated ones, were conducted by
the health staff.
The immunisation status of infants was monitored regularly in
co-ordination with the government health staff. The vaccinations were provided by
the government while the health staff motivated the mothers to get their children
immunised.

Afternoons were devoted to village visits which had to be undertaken on foot
by the health staff due to inaccessibility of villages and constraints of vehicle
availability. Weighing, monitoring the nutritional status and providing supplementary
nutrition packets to severely malnourished children under five years of age were the
main activities taken up during the visits. On an average, there were 442 children on
record each month. The weight of each child was taken monthly and the parents
advised suitably on the health of the child. 42 children on an average each month
were taken on under special care and provided with nutritional supplements.

Visits to the villages also enable the health staff to educate people on basic

health care, hygiene and sanitation.

Each village was visited 4 or 5 times during a

month.
The day-care centre in Ammapatti functioned under the supervision of the
health staff to provide care to severely malnourished children under the age of three.
There were, on an average, 27 children in the centre at any given point in time. They
were fed on a special nutritional diet from the centre, where they were looked after
during the day.

There were 9 female village health workers, one for each village, who were from

the respective village itself and were trained in primary health care by the project.
Fortnightly review meetings were held, during which sharing sessions were conducted

and skills and awareness upgraded through slide shows and discussions.

Medicine

stocks were supplied to the health workers to be supplied in their respective villages
when needed.

Treatment of leprosy and tuberculosis (TB) were given special attention.
This also involved health education, especially in case of TB which is highly infectious,

to reduce its prevalence.

Intensive door-to-door surveys were conducted in the project

villages to identify leprosy and' TB patients and motivate them to take treatment.

statistics of these cases were as under :

The

.

LEPROSY

TB

Number of patients on record as on 1—4—90

54

93

Number of new patients added during the year

22

56

Total number of cases under treatment

76

149

Number of patients declared cured

22

42

Number of patients died

—

1

Number of patients discontinued treatment

13

43

Number of patients on record as on 31—3—91

41

63

Films were used to educate the people on health issues such as common

ailments, child care, prevention and cure of diseases etc,

7 film shows were conducted

during the year.

An eye camp was organised in September 1 990, which was conducted by the
Aravind Eye Hospital, Theni.

Over 300 cases of visual defects of various kinds were

examined and some operated.
The laboratory attached to the clinic

provided useful support service in

diagnosis of ailments. The test conducted by the lab included blood, stool, urine, ESR,

sputum and smear tests.

lab technician.

A total of 6,192 tests were conducted during the year by the

Education :
The education programme consisted of
three components - balwadi
(pre-primary), supplementary school and non-formal education.
The balwadi in Ammapatti had 40 students - 22 boys and 18 girls in the age
group 3 to 5. There were 4 drop outs during the year. The average attendance was in
the range of 90% t o 95% In June 1 990, at the commencement of the academic year the
first batch of 23 students from the previous set were enrolled in the government primary
school in the neighbouring village of Ammapuram, on their attaining the age of 5
the
daily routine in the balwadi included imparting pre-literacy and pre-numeracy skills,
songs, games and story telling. Nutrition of the children was given due importance
and the children were provided with breakfast and lunch. The health staff attended to
the medical check-up of these children and followed up the treatment required.
A supplementary school was started in July 1990 in Ammepueam for children in
the standard 1 to 5 category.
This school operated from the government school
premises. The students of standards 1 to 3 attended the morning session and those of
standards 4 and 5 attended the evening session. Supplementary nutrition was provided
in the form of breakfast for the morning session students after tit® ©leases and snacks
tor the evening session students before the classes. In addition ta eesching in
academics, rhe students were involved in extra-curricular activities like games, quiz
and social work. In its first year of existence, this school met with a very good
response from the students and their parents alike. 125 boys and 77 girls (a total
of 202) were enrolled in the school at the end of the period under report. There were 7
drop-outs during the year, registering thus, a retention rate of 97%.

The non-formal education (NFE) classes were conducted for non-school going
children and adolescents and school drop-outs who were illiterate or semi-literate in

the age group of 6 to 20, and included both males and females.
students in each NFE class was in the range of 15 to 30.

The number of

The NFE classes were

operational in 8 villages during the year - Ammapatti, Ammapuram. Kendikaranpatti,
Vadapudupatti,

Sokkathevanpatti,

Meenakshipuram, Sakkaraipatti and Savadipatti.

Of these the programme was discontinued in Ammapuram and Vadapudupatti villages
in May and November 1990 respectively, while it was introduced in Meenakshipuram

in August 1990 and in Sakkaraipatti and Savadipatti in October 1990.

The NFE classes were conducted late in the evenings or at nights at a public
place which could be a school, a temple or a community hall, by a village animator who
was a reasonably educated youth from the respective village with an aptitude for
teaching. The course covered topics on literacy, numeracy and generel awareness.
The participants were also involved in games and social work programmes.
The
following are the figures of average attendance in the NFE classes :

Village

Percentage attendance
Male

Female

Ammapatti

78

60

Kendikaranpatti

69

62

Sokkathevanpatti

59

38

Meenakshipuram

—

80

Sakkaraipatti

80

78

Savadipatti

88

75

Community Development :
This programme which had earlier been implemented only in Ammapatti with
the formation and registration of a youth sangam in 1989, was extended to Sokkathevanpatti and Kendikaranpatti villages
In both these villages, youth sangams were
formed and registered in February 1 991. A sangam was also formed in Savadipatti
village in March 1991. The sangam members met regularly to discuss issues of
common interest and mobilise people to approach the local authorities and avail
benefits under government programmes. Some social work programmes like clearing
village roads and clearing the government hospital premises, were taken up. The
membership in each of these sangams was as under :
Village

Sangam membership

Ammapatti

70

Sokkathevanpatti

60

Kendikaranpatti

35

Savadipatti

25

During the year, the campus infrastructure was upgraded to facilitate the
working of the team. The post of Programme Assistant was created to handle the
education and community development programmes, under the overall supervision of
the Programme Co ordinator. Necessary administrative and technical support was
provided by the staff in Kallupatti, when required.

In a significant development with positive long term implications. Action Aid,
the Bangalore based donor agency, agreed to take over the management of the project
including funding as a principal donor from July 1 991 onwards, with the status of a
large project initiative (LPI) and sponsorship based funding. This is expected to lead
to horizontal and vertical expansion of the activities of the project, with an important
addition of income generation and agriculture activities. A certain degree of change
in policies related to programme design and implementation is also envisaged to make
the programme more development oriented.

A DM Ift! tSTR AT IO I'd
Co-ordination among the various departments and groups within the
organisation, high level of motivation and morale among the stalf, proper implementa
tion of administrative and financial systems and staff development were the important
concerns of the project administration. Efforts were made to ensure that the administ
ration was dynamic and flexible to make it more responsive to changing circumstances
This was with the realisation that a strong administration could greatly influence the
quality of programme implementation
Monthly meetings of heads of departments were held on a regular basis to
share information and decide on important issues related to the organisation as a
whole. tach department convened interdepartmental committe (IDC) meetings
quarterly to discuss policies and issues pertaining to a particular programme. An IDC
for each department is constituted by the head of the respective department, two or
three heads of other related departments, the Director and the Assistant Director.
A system of internal auditing was introduced for each department towards the end of
1990
One of the heads of departments who was also a member of an IDC for a
particular department (other than the one of which he is the head) was selected as an
internal auditor for that department. Internal auditing was taken up on a quarterly
basis from December 1990 onwards, which also focussed on the implementation of
programmes.
RTU's auditor, Mr. K. Shivakumar, conducted a seminar on internal
auditing for the internal auditors to introduce them to the basic priniciples of internal
auditing.

Two staff development programmes were held in June and December 1990
respectively, with about 60 participants in each programme from different departments,
which also included the junior staff. This gave the participants an opportunity to
explain to the group the programmes of their respective departments and discuss
socio-economic issues which they encounter in their daily work. Issues like leadership
and team work were also discussed and debated.
Heads of departments and departmental assistants were involved in a three-year
planning exercise for the period 1991—93. This gave them an opportunity to reflect
on the past programmes, conceptualise and sharpen their own planning skills.
This
was taken up during the last quarter of 1990. Based on this, the plan of implement
ation for 1991 was drawn up
A system of one day retreats for heads of departments was started on an
experimental basis to give them a chance to take time off from their routine work and
indulge in reading and reflection on matters pertaining to RTU's programmes.
This
was followed up by presentations in monthly meetings to develop their articu
lation skills and enable them to share their ideas with the others. It is also proposed
to involve the departmental assistants in such retreats in future.

The new service conditions for staff came into effect from January 1991 which
was comprehensive. This was aimed at improving the level of job satisfaction and
security among the staff and streamlining personnel policies. The system of
performance appraisals for staff was modified to make it more constructive and enable
free and frank discussion on the working of the group within the departments. These
were essentially self-appraisals.

Staff awards were instituted for outstanding performance during the year 1990.
The awardees were selected through a process of nominations. 7 awards were
presented. The award winners were presented with a certificate and a cash prize of
Rs. 250. They were :
Mr, B llango (Education),

Mrs. E. P. Kamatchi (Medical),

Mr. P. Subramaniam (Nutrition),

Mr. T. Raghavan (Education).

Mr. D. Kamaraj (Education),

Mrs. B Bharathi (Education)

Mrs. Jothimani (Foster families).

34 other staff members who were nominated for the awards were presented
certificates,
The staff were motivated to form welfare associations to promote their own
interests, which included activities like savings and credit. This was outside the
purview of the organisation's activities. Four welfare associations were formed Each
of these received a small sum as corpus fund from the staff benefit fund of RTU. These
associations were formed in August 1990.

RTU applied for and was granted exemption under Section 80(G) of the
Income Tax Act. This would enable RTU's donors in India to claim tax exemption for
the amounts they donate to RTU.
Mr. K. Shivakumar continued as the auditor for RTU. His guidance and advice
on financial planning, accounting and administrative systems were of immense value
to the society.

To strengthen the society further, RTU enrolled new members who were active
in diverse fields of rural development. RTU's association with them is expected to
contribute positively to its development,
An important decision of participating actively in the management of Anbu
lllam, (a voluntary organisation based in Madurai involved in assisting poor patients
coming for treatment to the city hospital) was taken inlate 1990 in association with
another
voluntary organisation, Arogya Agam.
Some staff members from RTU
enrolled themselves as members of Anbu lllam and is represented in its executive
committee by 4 of its members.

During the course of the year, RTU was visited by representatives of donor

These

agencies, supporting groups, collaborating agencies, government and friends.

Ute Rossing (DWHH), Mr. D.K. Oza (Gandhigram Rural Institute),

included Mrs.

Mr. Ravi Narayanan and Mr Chris Stocks (Action Aid). Mr. Trevor and Mrs

Bro.

(Enfants De L'Univers), Mr

Vimalanathan

(SKIP), Mr

& Mrs

Eric.

Patton

Val-

Terence Kay (U.K.) Miss Nelly Bouchardeau

Dorey (Miriam Dean Trust).

(Oxfam), Mrs. Francoise

Meienberger

(Salford Housing Association), Mrs. Julie

Marie

George (Oxfam Bridge), Mr. John Cioffi (Volunteer Eye Surgeons International), Bro.
Dominic (Rome), Mr. Panchaksharam (SIPA) and Mr. Manimaran (Collector, Madurai).
A television group, CTVC, produced a film on Bro. Kimpton and RTU's activities for

the BBC (Channel 4) for which it spent a week with RTU.

The strength of staff in each department as on 31 —3—91 was as under ;

Full-time Staff

Part-time staff

Total

Accounts & Administration

9

1

10

Community Health & Development

4

—

4

Education

48

26

74

Farm

7

—

7

Foster families

1

—

1

Industries

6

—

6

Medical

13

1

14

Nutrition

9

6

15

Rural Housing

5

—

5

Tiles Unit

3

—

3

Water development

2

—

2

Ammapatti project

19

2

21

Transport

1

—

1

127

36

163

Department

ONE OE THE MANY BATIK PRODUCTS

THE FAIR PRICE SHOP RUN BY THE WEAVERS FOR ALL
THE STAFF
_______________________

LOW COST HOUSING

HANDLOOM WEAVING
MEETING OF A WORKERS1 COMMITTEE

A TYPICAL FOSTER-FAMILY FOR CHILDREN IN NEED

COMMUNITY HEALTH & DEVELOPMENT:
PEOPLE TO HELP THEMSELVES

ORGANISING THE

TRANSPORT
Transport is an essential requirement for the implementation of programmes.
RTU's fleet of one van, two jeeps, five motorcycles and six mopeds provide useful

support services to the various departments.
The van is mostly used for purchasing yarn and other inputs for the handloom

and batik products, foodgrains and groceries for the nutrition programme, transporting
materials for the water development programme and taking the foster children to school

in the nearby town of Batlagundu.

The jeeps are used for the mobile clinic and village visits and for rushing
emergency cases to the hospitals.
The motorcycles and mopeds have been allotted to the different departments,

depending upon the nature of their work.
The trailer for the jeep was sold during the year as it was not put to much use.

The moped allotted to the agriculture department was replaced by a new one.

PROGRAMMES AND ACTIVITIES FOR 1990-91 AT A GLANCE

Programme

Medical

Financial outlay
(Rs. in '000s)

Villages
covered

No. of
beneficiaries

Main activities

25

N.A.

General clinic, tuberculosis, leprosy,

389

antenatal care, mother & child health

care, mobile clinic, day care centre,

physiotherapy, laboratory.

Monetary assistance

Community health and

7

1 38 people

Weekly, monthly cash assistance.

250

1,000 families

Village health workers, health education

84

mobile

development

clinic,

sangam

formation.

balwadies.

Education and Nutrition

5

1,800 children

Balwadies, primary schools,

1,383

supplementary schools, trade schools,

hostel, scholarship, school meals.

Foster families

—

23 mothers,
98 children

Care for abandoned/orphaned children
and destitute/widowed women.

497

PROGRAMMES AND ACTIVITJES FOR 1990-91 AT A GLANCE

Programme

Villages
covered

Rural housing

5

No. of
beneficiaries

304 families

Main activities
House construction in group settlements,

Financial outlay
(Rs. in '000s)

5,654

individual houses, campus works.

Water development

St. Joseph's

villages in

44,000 people,

11 panchayat

2.300 school

unions

children

4

11 2 producers

1.121

in villages, water supplies for rural
schools, training in handpump maintenance.

Handloom weaving, batik printing,

1,864

development programmes for workers.

Industries

Tile making unit

Handpump installation for drinking water

2

24 producers

Agriculture

Manufacture of fibre concrete tiles.

183

Farming, dairy, poultry for internal

941

revenue generation.

Ammapatti

13

1,250 families

Medical care, community health,

education, community development.

486

ACKNOWLEDGEMENTS
We acknowledgement, with deep gratitude, the assistance received from
numerous donor agencies and groups, individual donors, friends and well wishers, both
f nancial and otherwise, thanks to which, we have been able to keep up our endeavour
of reaching out to the poorest and the most underprivileged. While concluding our
report for the period January 1989 to Marh 1990, we would like to mention their
names.
The following names under the respective classifications, are in an
alphabetical order.

Donor Agenctes and Grouiprs :
Action Aid, India (H.O. UK.)

British Society of Dowsers, UK.

Caring for People, UK.
Deutsche Welthungerhilfe, Germany.
Friends of Leprosy Patients, USA.

Kodaikanal International School, India.
Les Enfants de L' Univers, France.

Miriam Dean Trust, UK.

Oeuvres Hospitalieres Francoises De L' Ordre De Malte, France.
Oxfam (India) Trust, (H 0. UK )

The Parishoners of St Werburgh s Church, Chester, UK.
Reaching the Unreached Trust, UK.

Salford Community Housing Association, UK.

Secoli, Italy.

Stiftung Kinderdorf Pestalozzi, Switzerland.
St. Augustine's Coatbridge, UK.

St Peter's Old Boys’ Association, UK.
St Peter s School, UK.

Swedish Organisation for Individual Relief, Sweden.

Revd. Turner's United Benefice, Hampshire, U.K,
U-Landsfonden, Denmark.

Weyer Trust, Germany.

Individual Donors •

Mrs. Amy Bhabha, India.

Bro. Anthony Cheung, Malaysia.
Bro. Anthony Porter, UK.

Bro. Austin (Oxford), UK.
Mr. Claus Darmstadt, Germany.
Mr. David Cassidy, UK.
Mr. David Lobo, India.

Bro. Dennis Robert and Bro. Walgan, UK.
Bro. Etienne Pierre, F rance.
Mr. & Mrs. G. Oakshott, UK.

Bro. Henry Pang, Hong Kong.

Mr. & Mrs. J. Mansfield, Wales, UK.
Mrs Jean Brooks UK.
Mr. John Cioffi, USA.
Dr. John Karuppaiah, India.

Mr. John Motha, India

Or. Kesavamurthy, India
Miss. Keya Ghosh, India
Mr. Michael Kimpton, UK.

Bro. Michael Jacques, Malaysia.
Mr. Michael Piou, France.

Mr. 4 Mrs, Norman Lindrea, Australia.
Mr. Paul Hooi, Singapore.
Miss. Ria De Meulenaer, Belgium,
Mrs. Sujatha De Magry, India.
Mr. V.C. Arnott, UK.
Mr. Yves Mille, France.

Friends and Well Wishers;
Almas-lndia, India.

Asha Handicrafts, India.
Canara Bank, G. Thummalapatti, India.
CODES, India.
The Collectorates, Madurai and Dindigul 0. E. M. Districts.

Cottage Craft Shop, India.

Mr.D.K. Oza, Vice-Chancellor, Gandhigram Rural Institute. India.

”

Mr. John Dalton, Arogya Agam, India.
Sr. Josephine, Presentation Convent, India

Karur Vysya Bank, Batlagundu, India.

Kriya Boutique, India.
Leonard Hospital, Batlagundu India

*

MESH, India.

Oxfam Bridge, UK and India.
SIPA, India.
State Bank of India, Ganguvarpatti, India.

Trustee Savings Bank. UK.

Victoria Technical Institute, India.
There are many more friends who have been a source of constant encourage

ment for our work, and it is not possible to name them all.

There are also some very

special individuals in the donor agencies whose support to our work goes beyond their

organisational commitments.

realising our objectives.
time to come.

We value each one of those who have helped us in

We hope that we will continue to work with them for a long

All of us at Reaching the Unreached join together in extending our best

wishes and warm regards to each one of them.

Printed by :

Manicka Vilas Press, Feriyakulam : —91

REACHING THE UNREACHED
G. Kallupatti. Near Batlagundu,
Madurai District - 624 203.
Tamilnadu, INDIA
Phone : 30 Genguvarpatti

28th April, 1992

Ref: AD/CHD/92/i I
To

Dr. Shirdi Prasad Tekur,
Community Health Cell,
367, Srinivasa Nilaya,
Jakkasandra, I Hain I Block,
Koramanoala,
BANGALORE - 560 034.
Dear Dr. Tekur,

Thank you for visiting us as scheduled on April 24th and 25th.
unfortunate that I could not meet you.

It was

However, Mr. James informed me

about the discussions you had with the staff and people from the village.
I hope you had a comfortable stay and that you were facilitated in data

and information collection.
report finalisation stage.

Mr. James told me that you are in the

We shall eagerly await the same.

Please find enclosed the first draft of the programme documentation of
the Community Health department which is being done by a group called

INTERVENTION based in Bangalore as part of the management study of RTU.

You may find it useful for the purpose of your report.
With warm regards.

Yours\ sincerely,

Id MENON,
;ltant Director.

Encl: As above

An organisation involved in programmes for social and economic development of the most backward sections
A Society registered under the Tamilnadu Societies Registration Act of 1975, S.No. 42 of 1978, Dindigul.
Donations exempt under section 80 G of the Income Tax Act, 1961.

PROGRAMME DOCUMENTATION
R.T.U.,Genguvarapatti, Madurai

PAGE 1
9204CHW.REP

COMMUNITY HEALTH DEPARTMENT

1. BACKGROUND
Bro.James started his work in the Genguvarapatti, Kallupatti and
other surrounding villages while he was in Boys’ village during
the period 1974-1977.
RTU was established during 1977 and was
operating from
a small office at G.Kallupatti.
Since its
inception,
RTU
is running a clinic offering health care to
villagers.
The services included MCH, Immunisation, Leprosy and
TB care, treatment of minor ailments etc.,

During 1982,
RTU started a health outreach programme in its
target villages.
Youth Clubs were formed in 3
villages.
However,
the programme was stopped within few months owing to
non-co-operation from the villagers.

During 1983, 6 new villagers were selected.
Health Committees
were formed and various health programmes were implemented at the
village level.
Family Health Insurance Cards
(Fee-Rs. 3 per
year)
was introduced.
The fee was used to support a Village
Health Worker.
Mahila mandals were also formed in some villages.
During 1984, 90 households from 2 villages were assisted under
the goat-rearing scheme (as a income generation activity).
Each
household was given an average of 6 goat kids.

During 1984, Mr.Keith and Ms.Caroline (volunteers from UK)
and
Mr.Keba (who was involved in the clinic) participated in a
training
programme
on
community
health
conducted
by
International Nursing Service Association
(INSA),
Bangalore.
Consequent to this training,
8 villages were selected
to
implement a health outreach programme on a systematic basis.

2. AIM
To improve the health status of the community through
community health programme

effective

3. OBJECTIVES

>

>
>

To offer health services at the village level in the
selected
villages
To establish health workers at the village level who can
provide health services to the community
To integrate other developmental activities along with
health programmes

BANGALORE
APRIL 1992

Pr. at 1130 Hrs
on 20 April 1992

PROGRAMME DOCUMENTATION
R.T.U.,Genguvarapatti, Madurai

PAGE 2
9204CHW.REP

4. STRATEGIES
1. The main strategy used by RTU is to develop a village health
worker network in the target villages through identification of
a appropriate person and imparting health training.
2. Another strategy is to initiate other developmental activities
once the health programme is well established.

The outreach programme envisaged the following activities:
*
*
*
*
*

Village Health Programme
Health Committees consisting of village leaders
Training programme on community health
Provision of medical kit
Health education

5. PROGRAMMES : GROWTH AND DEVELOPMENT
There are 4 distinct phases in the programme life
and Health Department, as follows:

of

Community

I PHASE : 1982-84

The programme implementation has already been described
background section.

in

the

1985 and 1986 were dull years for this department when not
of activities were undertaken.
During 1986,
Mr.Keith
Ms.Caroline left RTU resulting in further setback to
programme implementation.

much
and
the

II PHASE : 1985-86

III PHASE : 1987-88
1987

During 1987, Mr.G.James took charge of this programme.
Mr.James
was with RTU since 1985 (in the clinic).
He has a Diploma in
Community Health and has also undergone training in Audio-Visual
Aids (from Centre for Development and Communication) and in Rural
Health Programme (from INSA, Bangalore).
After

Mr.James

BANGALORE
APRIL 1992

took

charge of this programme,

out

of

Pr. at 1130 Hrs
on 20 April 1992

the

8

PROGRAMME DOCUMENTATION
R.T.U.,Genguvarapatti, Madurai

PAGE 3
9204CHW.REP

villages selected previously, 6 villages were dropped for various
reasons.
3 new villages were identified and the programme was
implemented in a total of 5 villages.
The selection of villages
was based on the following criteria:

>
>
>

Extent of poverty in the village
Health status
Population of village (smaller village was
operational convenience)

preferred

for

During this year, there was not much of community participation.
Sangha formation was initiated.
The health activities included-* Ante natal care
* Under-five immunisation and growth monitoring
* Health education
The sangha activities included:

* Formation of men and women clubs (registered)
* Regular meetings
* Leadership training
* Regular subscriptions (about Rs.2 per month)
Adult education was initiated but was discontinued within
year due to ineffective planning and implementation.

one

During this year, the programme staff was only Mr.James who
assisted by 5 village health workers.

was

1988

During this year,
the programme was expanded from 5 to 8
villages.
The department recruited 2 more staff and 3 more VHWs.

Non-Formal Education was also initiated to benefit
school
dropped-out children in the age group of 6-14 years.
The
programme covered about 30 children on an average in 5 villages.
24 households were assisted with credit for rearing buffaloes and
42 households for sheep-rearing.
A sheep-rearing society with 42
members in Utchapatti village was formed.
IV PHASE : 1989-Till date

1989
ADMINISTRATION

Girish

Menon joined RTU as the Assistant Director who

BANGALORE
APRIL 1992

Pr. at 1130 Hrs
on 20 April 1992

initiated

PROGRAMME DOCUMENTATION
R.T.U.,Genguvarapatti, Madurai

PAGE 4
9204CHW.REP

steps to streamline programme implementation and
systems
of all departments including Community
Development department.

monitoring
Health
&

During the year one more staff was recruited.

PROGRAMMES

Government Benefits:
On the programme side, benefits under various government schemes
like Widow-pension, street lights, drinking water taps etc., were
mobilised.
Noon-meal programme was initiated in a balwadi in one
of the village.
Income Generation Programmes:

Another sheep rearing society was formed with 19 members.
Health

Street plays, film-shows etc., were organised in many villages as
part of health education.
Other health activities were carried
out in all the programme villages.

1990
HEALTH

One Balwadi was started at S.Moopanur village.
Other health
services were carried out in the selected target villages.
Community Organisers’ training was organised in
also participated.

which

teachers

INCOME GENERATION ACTIVITIES

Poultry
:
2 hen and 1 cock each was provided
beneficiaries as a source of supplementary income.

to

31

Rabbit rearing:
A new breed of Rabbit called New Zealand white
(Meat purpose only) was provided to
2 beneficiaries on an
experimental basis as a source of supplementary family income.
Goat rearing :

45 beneficiaries were assisted to purchase goats.

Savings & Credit scheme :
Under this scheme, the sangha members save a prescribed
(Rs.5
onwards) every month.
Amount is collected and is lent among the

BANGALORE
APRIL 1992

Pr. at 1130 Hrs
on 20 April 1992

PAGE 5
9204CHW.REP

PROGRAMME DOCUMENTATION
R.T.U.,Genguvarapatti, Madurai

members at a reasonable interest rate.
1 village - 45 members - Rs.15 per month regular saving
e.,
i.
Rs.16,200 savings in 2 years + Interest
Kitchen Garden :

Seeds were distributed at 50% cost.
planting was also taken up.

In

two

villages,

tree

1991
5 more villages were selected.

HEALTH
II phase of health training of VHWs was undertaken

The Leprosy programme was handed over to the
government.
However,
surveillance and monitoring of treatment is being
continued.

NON-FORMAL EDUCATION
Non-formal Education
(NFE) was introduced in 5 villages.
The
animators were given training for 3 days.
However,
no special
curriculum is being used.

INCOME GENERATION PROGRAMMES
Poultry - 30 families in 5 villages were assisted to purchase
7 poultry birds each which will provide them with supplementary
income.

Vocational Training - The women sangham members were given a
training in pickle making, vegetable preservation and pappadam
making.
About 32 women participated in the training programme
conducted by Gandhigram.

OTHER PROGRAMMES

Tree Planting - 8 villages was provided with 1250 tree
and seedlings for planting them in the private lands.
BANGALORE
APRIL 1992

Pr. at 1130 Hrs
on 20 April 1992

saplings
However,

PROGRAMME DOCUMENTATION
R,T.U.,Genguvarapatti, Madurai

PAGE 6
9204CHW.REP

owing to poor monsoon, more than 60% of the seedlings have
destroyed.

been

Kitchen Garden - About 158 families in 9 villages were provided
with vegetable seeds to be cultivated in the homesteads.
The
programme met with mixed success.

Puppetry training - A puppetry training was conducted in which
about
25
selected individuals from the
target
villages
participated.

Balwadi - In S.Moopanur village, RTU constructed a building to
house the Balwadi for which the community contributed 1/3 of the
cost.
Afforestation
:
Though an afforestation programme was planned
during the year, the programme could not get off the ground due
to lack of motivation among the villagers.
I

R.T.U

COMMUNITY HEALTH & DEVELOPMENT
SL.
NO.

YEAR

1.
2.
3.

1988-89
1989-90
1990-91

97378
54476
111720

TOTAL

263574

AMOUNT

COMMUNITY HEALTH & DEVELOPMENT
Plan Allocation

51:92

15-07-92

Mr. Amal Susairaj,
Community Health & Development
Programmes,
Reaching The Unreached,
G. Kallupatti,
Near Batlagundu,
Madurai District,
Tamil Nadu - 624 203.

Greetings from Community Health Cell J
Enclosed is a photocopy of experiments on "Eco-restoration" from
Rajasthan.
Pass it on to Girish and Bro. James too.

This is to enable you to understand the magnitude of involvement
its logistics, and the extensive ground/field information and
organisation required for such a venture.

Since such an idea has been conceived by you, it will help you
to begin the ground work as you consolidate your health and
development program.
It will facilitate a well - planned
venture in the future.
Hope you and your team have been able to go through the study
evaluation report and initiate some action.
Please keep in touch.

With regards and best wishes to all at RTU,

Yours sincerely,

Member rpcharge-Training & Advisory Services

Encl: paper on eco-laboratories (Xerox copy)

*spt/vnnr

51/92

15th June 1992

Mr. Gi$igh Menon.
Assistant Director,
teaching the Unreached,
G.Kallupatii,
Near Batlagundu,
Maduari District,
Tamil Nadu 624 203.

Dear

,

Greetings from Community Health Cell ’
Thank you for your letter alongwith the copies of the report of the
Study group from Bangalore.

Below is a list of typographical errors noticed in the printout
which you can get corrected in the floppy.
1. Content List page
- V. Methouology
to be added
- VI. fd) Health Education
2. Page 1 - 2nd para - last line! stagnation
- Last para -last lines Education
5. Page 2 - Last para -10th lines In course of time
4. Page 3 - 1st para - 2nd lines as stated....
5. Page 4 - 2.a) - health
2.c) - manageable
6. Page 5 - V.b) - 2nd Line - Manager..,.
IB.c) - Last Line - in relation to
.
7. Page 6 - 1st Line - incLuded
8. Page 7 - one Line between 1st and 2nd Line is missing $
-- smoke nuisance in the kitchen, since it hae-inu.
smokeless .....
9. Page 9 - 3rd line - initial
10. Page 10 - 3rd Line - of 40 children
- 2nd para 2nd line - encumbered
- 2nd para 2nd last Line - tajckling
— (d) last line - MCI!
11. Page 12 - 3rd para 2nd line - harvesting and plantings.
12. Page 13 - 2nd para last Line - included
13. Page 14 - 5. 3rd Line end
- need

The rest of the thing is okay.

With regards and best ’wishes,

51:92

08-05-1992

Mr. Girish Menon,
Assistant Director,
Reaching The Unreached,
G.Kallupatti,
Near Batlagundu,
Madurai District,
Tamil Nadu - 624 203.

Dear
Greetings from Community Health Cell!
Enclosed is the finalised report of the study group on the
Community Health and Development program of R.T.U. for

- review and correction of any factual inaccuracies?

- seeking of clarifications and elaborations;
- any details required for implement-action in the future.
I am sure the CHD staff will be able to review this and send it
to us at the earliest for our signatures, etc.

You may be able to put this on your computer and send copies
to the members of the study team.
With regards and best wishes,

Finalised report of the study group on the CHD program of RTU.

*spt/vnnr

PARTICIPATORY STUDY
of

COMMUNITY HEALTH AND DEVELOPMENT PROGRAM
of

"REACHING THE UNREACHED"
G. Kallupatti,
Madurai Di »tric t 0
Tamil Nudu.

Study Group

1»

Dr. V. BenJamia

2.

Di'. G. Gururaj

3»

Dr. Shirdi Prasad Tekur

O5th March 1992

To

25th April 1992.

CONTENT

No.

LIST

Details
I.

XX.

Sumrsixy
Back ground

1. Origins
2. Goals and objectives.

III.

purpose of study

IV.

Evolut ion

V.

Methodology

VI.

Results

1. at village
2. of Organisational activities
(a) Sangams

(b) Village Health Worker

(c) Mobile Clinic

(d) Health Education.
VII.
VIII.

IX.

Conclusions
Reooumendationa

Appendix

I.

$U?4MiRY
The Community Health and Development ^SSD-) initiative of

<£r’

'Reaching Hie Unreached' (RTU) tries to reach people remote
to development through health measures
*

The Goals are to

actively involve people and enable them in improving their
quality of life.
Saugaas (associations) of mon and women is the means and the
nucleus of all health and development activities in the eight

villagea this programme addresses.

The Community Health and

Development (@2£) programme lias gone through a phase of

stagnation and re-activation in its evolution.
This study is in response to the need felt by the CHD-^o know
about their evolution, their present status and pointers to

the future to help plan ahead

resource group.

to be done by an external

de

Constraints limit quantitative assessments

and the focus is on qualitative and process exploration.
The village5chosen are remote and in need of health and

development inputs.

Sangams of men and women are operational

and function fairly well with limitations due to local

circumstances.

Village Health Workers are effective in

minor-aliment management and are well accepted by the community.
The mobile clinic Initiative is not cost-effort-effective.

Health education effort needs strengthening.
The conclusions of the study point to positive areas of good
rapport, credibility and initiative while serving in areas of

peoples needs.

Numerous activities with small resources, a

focus ou curative approaches, problems of sangam dynamics and

a need for upgrading Health Education efforts are the drawbacks

seen.
2

2.
Recommendations arc for focussed activity, putting laore
efforts into Making the sangams far-sighted, involvement of
other departments of HTU in the CHD effort, exploring local

and other governmental resources and Methods of documentation
to help the CHD evolve relevant plans for the future.

XX. BACKGROUND
The project ’Reaching The Unreached * (HTU) started in the

year 1975 and registered la 1973 at G.Kalupattl, Hadurai

District} it is an attempt to reach people in the remote,

uiiroached ureas.

Ths felt need of medical aid in tills place

led to the starting of a small base clinic facility and a

mobile clinic to surrounding areas.

This spread into meeting

other needs of the people, such as housing, education, water,

foster-fauiilies for children, income generation programmes

and other social welfare measures.
1 ) ORIGINS

The coiavunity health programme etarted later (in 1932/85)

using health as an entry point for overall development of
the communities in eight villages of this area.

Two

volunteers from RTU initiated a process of community
organisation.

The programme remained stagnant during

1985-36 when these initiators loft, and was restarted in

1987 by the present manager of the Coinmunity Health
Department (CHD).

It began with non-formal education

incorporating health messages, and slowly evolved into a

community health programme.

In course of time this

transformed into a Community ileal th and Development (-tSS)
^'
*

programme, and the departiuent of CH « D came into existence

at RTU.

Two community organisers have Joined this

department over the past two years to help the Manager

who has been handling tills programme single handed.
2) GOALS AND OBJECTIVES

The goals of this community health and development program

3

3
aa stated in their progress report are;
TO REACH OUT TO A LARGE NUMBER OF PEOPLE IN DISTANT AND

REMOTE VILLAGES AND ENABLE THEM TO I.iPROVE THEIR QUALITY
AND STANDARD OF LIFE, WITH THEIR ACTIVE INVOLVEMENT,
USING HEALTH AS AN ENTRY POINT.

This is aimed at building up of confidence and self-reliance
in the villages and to initiate a process of common village
development through formation of sangaias (associations) of

men and woaen.

III. PURPOSE OF STUDY

Based on a felt need of the community health department of
RTU, the present participatory study was undertaken to find

out the qualitative impact of tho community health program
in the eight villages they work in.

This participatory

study by an oxternal resource group was to see
a)

how tho community health program evolved?

b)

its present status; and

c)

to provide guidelines in planning the future.

It is to be specially noted that this participatory
interactive exploitation of community health and development

activities was intended to facilitate the community health

department.

Hence, tills study focussed on community health

and not on other activities of RTU.

Since baseline benchmark

information was not available, a quantitative evaluation

study was not feasible.

Therefore a process oriented

qualitative oxploration study was undertaken with minimal
emphasis on statistics, survey data, questionnaire, etc.

The available periodical reports containing quantitative data
have been reviewed.

There were also constraints of time -

total time for the study being seven days, divided into two

blocks of two days and one of three days.

The present study was not focussed on measuring the health
status of tiie community in quantitative terras, but on the
procees and relevance of community health and development

(to enable people understand the importance of the same to
improve their quality of life) and hence the methodology

adopted.

IV. gVOLOTIOM

To chronologically describe the evolution patterns
1.

The earliest activity was the mobile clinic of R.T.U.

2.

While pursuing this activity, eight villages were identified

for using mainly cosanunity health interventions towards

overall development.

The criteria for selecting these

villages wares

a)

lack of any health or development activity?

b)

remoteness from contras of development activities;

c)

being small (population size) and therefore manageable; &

d)

■ft QoWl, -‘4

people belonging to predominantly backward and
/
underprivileged sections of society®
.
« 4,^
■
, W guv -Uc-ppCA
c u-un
S'elccte-tl
of local Hez
Health Committee and selection of Village
3® Formation °f

Health Worker (VHW)•
C'rr'J)
. A

Formation. of village level health committees was preceded

by awareness building for health through street theatre and

public meetings®

Thio health committee identified a male

health worker who was acceptable to the community®

These

VHWa from eight villages were trained at CTU for a period

of 15 days.

JJuring 1985-86 the programme was stagnant due

to reasons not clearly identifiable.

The male health workers

stopped pursuing community health activities®

In 1987 when

it restarted, female village health workers (Wb) were
selected from each of elg^t villages and given a similar
fifteen day training.

Guidance and supervision of these

VJIVe has been continuous and regular since then.
4.

Sangam formation!
Sangams separately for men and women of the village were

formed.

These sangams were Intended to be the hub of all

health and development activity.

All adults were invited

to Join tho sangams, and those interested Joined the same.

Some of these sangams are registered and members contribute

a fee for common expenditure.
Sangani members were expected to meet atl®ast once a month
to discuss local issues and to mobilise community support

for developmental activities.

These saiigam activities were

5

5
facilitated by the CHD to utilise both Govexiuaentai and other

resources.

They were instrumental in initiating activities

in health and also other areas like building of roads,

provision of water and electricity, running of balwadis,
improving transportation facilities and income generation

activities for the community.
V.

METHODOLQgr

Tile present qualitative approach to evaluation consisted of
a)

review of available records;

b)

discussion with staff at RTU, and field level functionaries;

discussion with members of sangam and non sangam members of
the villages;
d) observations during field visits; and
c)

e)

eliciting opinion from nearby health care delivery agencies.

An elaboration on the above follows;
a)

The records reviewed included the annual reports; reports
to funding agencies; reviews of past and future plans;
mobile clinic records; records at health centres; village

registers; training programmes and their curricula; diaries
and registers maintained by field staff;

for the type of information and their relevance to ongoing <

community health activities.

b)

Discussions were held at ItTU with the Director, Assistant

Director, Manager, the two conuuunity organisers and staff
of modi cal department of HTU.

At the field level, the

village health workers, Balwadi teachers and Balwadi staff,

Kon-fonnai Education (NFE) animators, traditional birth
attendants, and informal focussed discussions with them and

the people on theix
*

work and attitudes were conducted in a

non threatening manner.
c)

Sangara members? their office bearers, and non sangasi members
were also contacted in a similar manner and their views
*
elicited.

On CHI) and their staff, on sangams and their

functioning - in relation to peoples problems.

..6

6
dj Visits to the village included studying the condition
*
of housing
*

kitchen gardens
*

water, sanitation
*

NFE classes and th®

nutrition programs at Balwadis
*

quality of rapport between CHD staff and coiauaunity
members a

e ) An interaction with the Medical Officer and Medical
Superintendent at the nearby referral centre at

iJatlagundu (Leonard Hospital) consisted of identifying
local disease patterns
*

availability of health care

services and patterns of utilisation.

The other components studied ve.ro library and health
education resource materials, VHH's kit
*

medical stores

and other units of i<TL including the .'.ladlca! department
in relation to CHD activity.

Tn addition
*

the CHD staff participated readily and made

available existing doexaaents and also co-operated in
processing additional information requested by the study

team.
VX . ivLSULT S

The results are preseated us a situational analysis at th©
village level and in the various activities of the organisation.

1 • ^1£j Villages
The eight villages where th® community health department

operates are away from the icuin read, and. relatively
inaccessible.

The population of these villages ranged

between 200 to 700.

The villages are in two clusters
*

a government health centre near each of the clusters
*
at Ganguvaripatti and Viralipatti.

with
located

The government health

workers visit these villages mainly for iiuiHiinisiatiou and
family planning activities. Programmes on nutrition are

conducted under the Tasnilnadu Integrated Nutrition Improve

ment Programme (TUJIP).
In RTU built houses
*

ventilation is good and there is no

smoke nuisance from the kitchen
*

since it has smokeless

chulhas and is built away from the living rooms.

..7

7
From available data wa .found that illiteracy is high and ranges
between 40 to 95/» with a high drop-out rate noticed after the

primary level of education.

The occupation of the people is

mainly as agricultural labour (seasonal) and marginal farmers
and shepherds.

Most houses are kutcha houses, with one or two

rooms, non-electrified and with no toilets.

JJven though

potable water is available, it is inadequate.

schools are within a distance of 2 Kus.

Most primary

Transport and

communications are generally available, but inadequate.

Balwadis

organised by HTU are functioning where not covei-ed by the
Integrated Child Development Scheme (ICDS).

Most villages do

not have a cossaunity teleyiaion^ CWijwpyvttj i’-co-v /Lvu urffvc-r
v-c t

2•

6 s w Ta uvvv L -U

Avl,

aational Activities

a) San gain
The tseiabership of the sangams in relation to the total

village population varies between 10'^ to 60$ with a higher
percentage of woiaan being sangam members compared to men.
The percentage of attendance at meetings;

«■ in Men
*
a meetings

- range 5^ ~ &7$

- in Women's meetings

- range 51 - 10t>?3.

On aii average one meeting per month is held in both mens

and womens sangams.

However, during harvesting and planting

seasons, meetings are irregular.

The sangams have been able to mobilise people to avail
various facilities titrough government schemes in areas of

income-generation., roads, electricity, water supply, and
obtaining of pensions for widows.

----- ---------—-----------

It is to be noted tiiat a majox
*
contribution of HTU is in
the area of providing housing facilities which has generated \
great interest and attraction among sanga.ua members. £sungara y

leaders aro given leadership training at RTU periodically•j

8

records aret

Soiaa specific achiovotaonts as j*
er
1986

- construction of 167 liTU houses
3orowel1 - one

6 ja<d±van Nagar.

1937 - 72 RTU houses at Utchapathi
1988

- Distribution of Goat s/Uuft’aloe 3/Shoop - for income
generation;
Establishment of sheep rearing society.

1989

- Total 90 persona benefited from government scheme
includiag^^g*
(• 28 pensions for widows/street lights and water taps/
borewells by RTU/Buffalo loans/Jawahai’ well-digging

loan sanction/Sheep rearing society formation/ Road
ropsirs/Vidow daughter’s marriage through aid/Community

hall construction/foriaation of prohibition committea

against female ixii'axitlcide/ and Flood control wall
construction.

199O

- Bullock and sheep rearing loans/street lights/hut

electrification/old age pengions/Credit Union formation/
goats for incuiae gonoration/tree planting alongside road/

road-re pair/link roads/shed repair/seakage pits/ and
threshing flours in the
1991

villages.

- sheep rearing lourrs/btillock cart luans/loeais for petty

tradea/old age pensions/Jx»rewella/water—tank with taps/

monthly savings scheme started/threshing floor construction
and allotment of house-sites.
Some problems areas«

Apart from minor problems, usually found in human groups,
others noted were 4
— Leaders becoming corrupt and leading to loss of faith in them;
- Enthusiastic participation from sangams generally peaked when
gTV houses wero constructed and waned dramatically after the event;

- Internal land end caste factors interfered with sangam activity;
- Traditional caste based oldera who managed conflict felt
threatened by the new sangam leadership.

..9

9
b)

Village Health Workers (VHWp)

Village Health Workers selected by the Village Health Committee
were women, a majority of whom were illiterate.

They were

given an initial training in community health for 2 weeks.

Subsequent refresher courses and clarifications at periodic
meetings are continuing.

The VHWs are mainly involved in minor ailment treatment,

assisting at IlTU’s mobile clinic and helping the government

health wortera in their health activities.

They also are

expected to visit 5 families a day and conduct health education.
The VHWs are provider! with a kit containing medicines for

treating niiuox' ailments,which is utilized to treat 20 to JO
cases on an average every month at a subsidized rate.

They

also utilise traditional herbal remedies quite confidently

on their own initiative.

They record the vital ©vents of

births and deaths with the help of a literate.

An honorarium

of te.100.00 per month is paid to them and this is given either
by RTU or sangams.

We observed that the VHW is well accepted and has a good rapport

with the community.

A review of the curriculum allowed that the

contents were far too technical and voluminous to be covered in

this short period.
to their illiteracy.

Record keeping activity is inadequate due

Being sangam members, they also participate

in all other sangam activities, but are considered by the people

as mainly health resource.
c ) Mobile Clinic

The mobile clinic operates twice a week, in the afternoons,
effectively reaching each of the eight villages once a month.
The team consists of the CUD Manager, a community organiser,

a person from the medical department and the local VHW.

They

provide curative services to the whole population, with a

focus on Ante and Post-natal care.

The records show that they see an average of 60 patients a
year per village, including ANO patients and growth monitoring

10

10
of 40 children.

Medicines at a subsidized rate are distributed,

and Health Education imparted.

The schedules of th© mobile

clinic nra very variable, mainly because of dependence on

availability of the van for transport of the team.
The health records are minimal, whll© theix- work la encumbered

by accounting procedures.

The records do not provide a clear

picture of disease patterns, but discussions with the team and

the local referral centre indicated that the common ailments
are diarrhoeas, skin diseases, eye diseases and problems «f

malnutrition.

Tuberculosis and leprosy are two common major

problems and these are treated with the help of governmental
resources.

In cholera epidemics in the past, the CHD has been

effective in tackling the problem with government and other

agencies.
d)

Health Education

In addition to health education given by the VHU and at the
mobile clinic in a personalized manner, jaass health education

programmes are conducted o»i an average of once a month in each
of th© villages.

This is mainly through film shows and slide

snows.

Street theatre, puppet shows and drama are occasional

events.

Health Education also forms a component of the

training programmes and other meetings at RTU.

Film shows are

popular with the people.

Records show that the topics covered include - Cooperation,

Family planning, Sanitation and Hygiene, N.F.E., MGH and

Nutrition.
VII. CONCLUSIONS
1.

The RTU’s CHD Department has established a good rapport with

the community as well as the government agencies in areas of
health and development.
2.

The formation and nurture of sangams has enabled the people to
begin to understand their health and development problems and

also evolve some solutions.

11

11
3.

A large munbor of activities have been initiated in a
■bort span of time inspite of meagre resources.

Consequently, there has been a blurring of clarity and

focus in their well
»raeaning
*
4.

efforts.

Since the selection of villages was based on criteria of

poverty and iuider«dovelopment
*

the .approaches and

activities of HTU-C11D liavo boon i>redominantly welfare
ord. on ted.

5« The enthusiasm of the sangaius seems to plummet as soon as
their immediate felt needs are met from external agencies.
This seems to blunt the potentiality of their initiatives
*

in using their own resources.

6.

Curative efforts still form a major part of the health

*
programme

while in development
*

avenues for tapping

available resources are being efficiently explored.

7.

Cost-effort-efi’ectlvoiiess of mobile clinic is low.

3.

The VHW is well accepted by the people and functions
effectively in activities alloted to her.

However, her

inability to maintain effective records
*

makes it difficult

for the GUI) to meuce quantitative assessments of health
parameters.
9. Health Education remains largely an effort of tire C11D

(with its myraid activities and meagre resources) and has
not received the attention it deserved.

VIII. RECOMMEHIUTIONS
To effectively strengthen the ongoing and proposed activities
*

the following recousaendations are made:

1. Community organisation and participation
Sangams have already been formed.

This valuable resource

needs to be fostex-ed and strengthened with further
ti'ainlng/exposure of staff and sangam leadership.

Interactions inbetween RTU sangams and others outside is
likely to help this process.

12

12
The large membership precludes intensive study and understanding
of local issues.

The suggested corrective is the formation of

smaller working groups In each sanguis to take up specific issues
planned training fox' these groups with the help of expertise

will bo of help.
Mens and Womens sanganis need to Meet together in addition to

individual sangara Meets, atleast twice a year reviewing their

activities in the interim period ana to evolve better courses
of combined action.

Practical solutions to problems of meetings during harvesting
and plantings seasons are to be evolved.

e.g. the executive

committee/working groups could attempt to moot; or (if tills is

found to be i;.ix>ractical) tile meetings at these times are
suspended and the frequency increased subsequently.

Long torn comprehensive planning on all relevant development

issues is to be initiated and followed up by the sangaias.
Proper documentation and review of past decisions etc.
*

will

i'e-inforco this proccaa.

Moehanisras for comprehensive feed-back at x’ogular intervals on
decisions and proposed /actions both at KTU and sangam levels

needs to be ostablishod.
Greater accountability and mechanisms for the same should be

foetered by open exchange of information on resources
*

*
activities

*
plans

and achievements between (SID and songams at their

moetiugs.

Invitation of local government officials to sangam meetings

should be encouraged.
*
2

Appropriate strategies for health and development

People should be encouraged to utilise government health service
more and make them responsive to their needs
*

13

13

Thee cost—effort-offectiveneu
*

of the mobile clinics can be

improved with alternative approaches like decentralization

and transfer of medical stores along with reduction of team
**

size and upgrading of village resources (VHW and TiJA) also
utilizing govaniiBent health resources.

This can be implemented

in a phased manner.

A prospective time-bound study of the mobile clinic component
in terms of

- patient utilization of services from within and outside the
specified villages;

— hours/pcrsomiel/znedicine/transporfc/costs etc., involved; and
- areas of non-clinic activities facilitated^needs to be
included in the future plans
*

■tfiiex-e local/traditional herbaft medicines are being utilized

as alternatives, allopathic dz-tigs provided, may bo withdrawn
in a phased manner
*

,
g
*
e

Benzyl Benzoate replaced with

Tui'iaeric/j.'eeia leaves, for scabies ti'eatmeat.

Explore alternative sources of energy like bio-gas, solar
cookers, solar powered street lights, etc.

Development of simplified recording systems tailored to tho

coeds of the community as explained in the aunexura.

The VUW/TBA/HFK aniroators/Balwadi teachers and their equipsaess^e-

from government health resources are to meet periodically and

evolve ways and means of implementing sangam decisions.
3» Community support for health care
Formation of local working groups on health, consisting of

atleast fivo members each from the mens and womens sangams

working together as a team will be an important step.
a)

This group will be specially trained to improve health

education and will be responsible for monitoring all health
activities and also function as an activist group to interact

with governmental and other agencies for health
*
**14

14
b )Tb explore ways and iaoan» of making the community self-

supporting in terms of finance and other relevant resources.

4• Healtli integrated with Doyelopa.snt
A health-education component As to be incorporated in all

training and other programmes of development both at KTU and
at the village levol«

This is likely to make people more

conscious and responsible for their own health.
A contributory health service (CHS) scheme could he linked to

incosae-generation programs.

This is intended to promote

self—sustenance of health services in the villag®.
At RTU level, staff from all departments are to be sensitised

and oriented towards the importance of CAI. in development and
should be encouraged and expected to conti'ibute to CAI. concepts
in their areas of work.
As a starting point, the medical departiaent could take

responsibility for all curative services, and step into areas of
prevention and health promotion in the villages where the

coasuunity health department is active.

All health programs can

be Jointly planned by these two departments.

Similar cooperative

efforts cun be planned with other departiasnts in their areas of
work.

5• Education for Health

Education for health aims at creating awareness ataong people of
all factors that affect health and promoting positive life-styles
towards health.

Literacy need not be a pre-requisite for this.

Considering the high levels of illiteracy in tho villages, adult

and NFE should be strengthened and expanded with health as a
major component.

ongoing Health Education,the village working group should be
trained to take up responsibility in all aspects of health

education in the village.

Some effort should be mad® to educate

the working group on the elements of communication skills.

15

15
6.

Involvement of traditional haalers, Paia and indigctious systems

a)

The VHU's knowledge base to be increased.

b)

The TBAs in the villa30 to be trained and ANC and PNC made
locally sustainable.

c)

Practitioners of indigenous systems in the village to be
integi-ated into the community health programme.

^Proiaote
d)
e)

7.

herbal gardens as pert oi' kitchen/garden scheme.

Compile and document local herbs used, indications for use,
and their efinactivity, etc.

CHV / VHW
The VHW is illiterate.

Therefore functional literacy to tackle

simple meaningful record keeping/understanding health messages

and for better communications is to be undertaken as part of

their training.

Their training also needs to be simplified to

suit their limited role in minor ailment treatment and more
efforts put in to preventive and promotive health aspects.
TheVjob specifications depending on their capabilities and

community needs is to be made ami their training programme
tailored to suit this.

The VHWs skills to be upgraded to modC all local minor ailment
needs.

A referral system to hospital/health centre to be

strengthened in the foilowingt

a)

Developing an official liaison between RTU-CHD and government
or private referral centres;

b)

Enabling the VHW ’to establish a rapport with the centres of
referral; and

c)

Upgrade the VHWs knowledge to selecting the appropriate
referral centres for specific problems.

16

16
Appendix

Suggestions for simplified, comprehensive, relevant record-keeping
to enable future planning.

1. A register allotted to each village only for records on health —

to be Icept at the village, accessible to the CliD and sangam
health working group for updating.

2.

The first 20 pages of register to be kept aside for indexing,
comprehensive record of focussed activity (eg., itaiaunisation/ANc/
Child birtiis/PXC/Vital events, etc)

3.

One page per family for details eg., names of family members/

house no./type of house/illnasses in members (chronic )/sangam

meiabership/facilities availed from sangams etc.

4.

Start with families with AKC/PHC/lmmunization care.
with other sangam members,

Continue

then non-members, such that over a

period of J to 6 months, complete village records will be

available.
*
fox

This will also form the base-line data much needed

future evaluations and planning.

Examples of what is to be recorded;
a) Village name/address on cover;

b) Page 1 - map of village (folded sheet can be pasted);
c) Page 2 to 9 fox’ index of family by name/house number;
d) Page 10 to 20 for comprehensive records.
'

Immunization records

Ko• of children under
5 years age.

iwwaAvj,

Ap xi 1 / Hay/Jun&/ J u ly■/ e t c

Ml

Ko. of children
completed BCG
Ho. of children
completed BPT/OPV

1 st dose

W ’>’1

2nd dose

3rd dose

V\A/w\£..

'Via

17
Ho. of children completed
Measles vaccine

Jwnit

No. of children completed
1st booster dose

tilt” li

HiA

No. of children in Balwadi
roster/receiving aupleiaentary
nutrition, etc.
ANG / PNC records

from April 1992
April / May / June / July / August

No, of mothers pregnant

tii

II

Dttf

No. of mothers received
T.T. injection

No. of live bii'ths

III}

l

1

No. of still births
•ilo •

Dates of delivery
Place of delivery
(village/outside)

Vvo

vo

f*
7
/ &C1 vj

Delivery conducted by
TBA
No. of PNC

w

AND SIMILARLY FOR LOANS/OAPs/VITAL EVENTS, etc.

REACHING THE UNREACHED

G. Kallupatti. Near Batlagundu,
Madurai District - 624 203.
Tamilnadu, INDIA
Phone : 30 Genguvarpatti

29th Pay,

1992.

Xf &TU
AD/CHD/92/ ^4-46

Shirdi Prasad Teloir,
Community Health Cell,
367, Srinivasa "Haya,
Jakkasandra, I Main I Block,
Horamangala,
••C.AL0R3 - 560 034.
Dear Dr. Tekur,

Thank you for your letter of 8.5.92 and the enclosed report

of the study group on the Community Health St Development
programme.

Your report is fairly clear and articulate and

at the moment, we do not need to seek clarifications from

you.
cone

He are harry to see the details in to which you have
SVio ft
insnite of the .
span of the study. The

community health staff will soon be sitting together to
discuss with report and take corrective actions wherever

necessary.

As required by you, I am sending 3 copies of the

re-sort for the members of the study group.
to keep in touch with each other.
With warm regards,

Y ou r <= sincerely.

MENO:

We do hope

REACHING THE UNREACHED

G. Kallupatti
Pariyakulam Tk. 624 203
S.lndia

11.5.92

Dear Doctor:
Many thanks for your letter and the thank you
from your daughter. That such small gifts
should bring such nice rewards means a lot.

I hope the "portrait" does not frighten herJ
Just today I received good photos from a wealthy
Parsee lady who has long been a friend of ETU.
They were of her g'daughter and are truly
beautiful. She wishes to have a portrait done
and I hope I can rise to her expectations.
I will enjoy doing them.

Thank you too for the copy of your report. I
have glanced through it and will make a study of
it eventually.
One of the things I most want to do for at least
a year is to consolidate what we now have in
hand, which will allow for natural growth but
hold off any new ventures until we have stabilised
and can support more outreach. I think we are
being improvident by trying to do more for the
sake of doing more. Every project needs a
period of consolidation and I do believe we have
reached that stage after rather furious growth.
I do hope you are well. I wish you were closer ..
Greetings to your companions and all my thanks
for your off-the-cuff help and genuine^ interest.
Cordially yours,

James Kimpton

participatory study
of

COMMUNITY HEALTH AND DEVELOP WENT PROGRAM

of
"REACHING THE UNREACHED"

G « Kailupat ti 3
Madurai Di st ric t1
Tamil Nadu.

Study Group

*
1

Dr. V. Benjamin

2.

Dr. G. Gururaj

3.

Dr. Shirdi Prasad Tekur

05th March 1992

To

26th April 1992

C 0 N T E N T

Jio.

LIST

Details
I.

Summary

XI.

Back ground

S. Origins
*
&

Goals and objectives.

III.

Purpose of study

IV.

Evolution

V.

Methodology

VI.

Results

1o at village
2. of Organisational activities

(a) Sanganis
(b) Village Health Worker

(c) Mobile Clinic
(d) Health Education.

VII.
VIII.

IX.

Conclusions

HecoEsuendat ion s

Appendix

I. SUMMARY
The Conununity Health and Development

initiative of

'Reaching The Unreached' (KTU) tries to reach people remote
to development through health measures.

The Goals are to

actively involve people and enable them in improving their

quality of life.
San gains (associations) of men and women is the means and the

nucleus of all health and development activities in the eight
villages this programme addresses.

Development

Th© Community Health and

programme lias gone through a phase of

stagnation and re-activation in its evolution.

This study is in response to the need felt by the CHD^to know
about their evolution, their prosent status and pointers to

the future to help plan alia ad J- to be done by an external
resource group.

Constraints limit quantitative assessments

and the focus is on qualitative and process exploration.
The village^chosen are remote and in need of health aid

development inputs.

Sangams of men and women are operational

and function fairly well with limitations due to local
circumstances.

Village Health Workers are effective in

tainor-aitment management and are well accepted by the community

The mobile clinic initiative is not cost-effort-effectivo.
Health education effort needs strengthening.
The conclusions of the study point to positive areas of good
rapport, credibility and initiative while serving in areas of

peoples needs.

Numerous activities with small resources, a

focus on curative approaches, problems of sangam dynamics and

a need for upgrading Health Education efforts are the drawbacks
seen.

..2

2
Recommendations are for focussod activity, putting tuore
offoris into taaking the sangams far-sighted, involvement of
other departments of RTU in ths CUD effort, exploring local

and other governmental resources and methods of documentation
to help the CUD evolve relevant plans fox' the future.
II.

BACKGROUND

The project ’Reaching The Unroachsd' (RTU) started in the
year 1975 and registered in 1978 at G.Kalupatti, Madurai
Districts it is an attempt to reach people in the remote,

unreached areas.

Th® felt need oi
*

medical aid in this place

led to the starting of a small base clinic facility and a

mobile clinic to surrounding areas.

This spread into meeting

other needs of the people, such as housing, education, water,

foster-families fox’ children, income generation programmes

and other social welfare measures.

1) ORIGINS
The community health programme started later (in 1932/85)
using health as an entry point for overall development of

the communities in eight villages of this area.

Two

volunteers from RTU initiated a process of community

organisation.

Th© programme remained stagnant during

1985-36 when these initiators left, and was restarted in
1937 by the present manager of the Community Health
Department (CMD).

It began with non-formal education

incorporating health messages, and slowly evolved into a
community health programme.

In course of tiiae this

transformed into a Community Health and Development ^BSS^)
programme, and th® department of CH «S> D camo into existence
at RTU.

Two community organisers have joined this

department over the past two years to help the Manager

who has been handling tills programme single handed.
2) GOALS AND OBJECTIVES

The goals of this community health and development program

-.3

3
as stated in their progress report are>
TO REACH OUT TO A LARGE NUMBER OF PEOPLE IN DISTANT AND
REMOTE VILLAGES AND ENABLE THEM TO IMPROVE THEIR QUALITY

AND STANDARD OF LIFE, WITH THEIR ACTIVE INVOLVEMENT,
USING HEALTH AS AN ENTRY POINT.

This is airaed at building up of confidence and self-reliance
in the villages and to initiate a process of common village

development through formation of sangams (associations) of

taen and woiaan.
Ill.

PURPOSE OF STUDY

Based on a felt need of the community health department of
RTU, the present participatory study was undertaken to find

out the qualitative impact of the community health program
in the eight villages they work in.

This participatory

study by an external resource group was to see
a)

how the community health program evolved;

b)

its present status; and

c)

to provide guidelines in planning the future.

It is to be specially noted that this participatory

interactive exploration of coouaunity health and development
activities was intended to facilitate the community health

department.

Hence, tills study focussod on community health

and. not on other activities of RTU.

Since baaelino benchmark

information was not available, a quantitative evaluation
study was not feasible.

Therefore a process oriented

qualitative exploration study was undertaken with minimal

emphasis on statistics, survey data, questionnaire, etc.
The available periodical reports containing quantitative data

have been reviewed.

There wore also constraints of time -

total time for the study being seven days, divided into two
blocks of two days and one of three days.
The present study was not focussed on measuring the health

status of the community in quantitative terms, but on the
process and relevance of community health and development
(to enable people understand the importance of the same to

improve their quality of life) and hence the methodology

adopted.

..4

4.
IV.

EVOLUTION
To chronologically describe the evolution pattern
*
1.

The earliest activity was the mobile clinic of ll.T.U.

2. While pursuing thia activity, eight villages were identified

for using isainly cojmnunity health interventions towards

overall development.

The criteria for selecting these

villages ware
*

dvu/v

thhicl n\ J ,

a)

lack of any health or development activity)

b)

remoteness from centres of development activities;

c)

being small (population sise) and therefore manageable; &

d)

people belonging to predominantly backward and
underprivileged sections of society.

Some.-

uct-ve- cvt&'ppciL

tko prwjivwilVy SeUdul

prvcjra^

Formation of local Health Committee and selection of Village
Health worker (VHW).

tUj wA>vvvc> .

Formation of village level health committees was preceded
by awareness building for health through street theatre and
public meetings.

This health committee identified a male

health worker who was acceptable to the community.

These

VHWs from eight villages were trained at 11TU for a period
of 15 days.

During 1985-86 the programme was stagnant due

to reasons not clearly identifiable.

The male health workers

stopped pursuing community health activities.

In 198? when

it restarted, female village health workers (VHWs) were

selected from each of eight villages and given a similar
fifteen day training.

Guidance and supervision of these

VHWs has been continuous and regular since then.

4. Sangani formation
*
Sangams separately for men and women of the village were

formed.

These sangams were intended to be the hub of all

health and development activity.

All adults were invited

to Join the sanguine, and those Interested joined the same.

Some of these sangams are registered and members contribute

a fee for common expenditure.
Sangam members were expected to meet atleast once a month

to discuss local issues and to mobilise community support
for developmental activities.

These sangau activities were

5

5
facilitated by the CHD to utilize both Governmental and other
resources.

They were instrumental in initiating activities

in health and also other areas like building of roads
*

provision of water and electricity, running of balwadis,

improving transportation facilities and income generation
activities for the community.
V.

METHODOLOGY

The present qualitative approach to evaluation consisted of
a)

review of available records}

b)

discussion with staff at RTU, and field level functionaries;

c) discussion with members of sangaia and non sangam members of
the villages;

d)

observations during field visits;

a)

eliciting opinion from nearby health care delivery agencies.

and

An elaboration on the above followst
a)

The records reviewed included the annual reports; reports
to funding agencies; reviews of past and future plans;
mobile clinic records; records at health centres; village

registers; training programmes and their curricula; diaries
and registers maintained by field staff;

— for the type of information and their relevance to ongoing

community health activities.
b)

Discussions were held at RTU with the Director, Assistant
Director, i^kuiager, the two community organisers and staff
of medical department of RTU.

At the field level, the

village health workers, Balwadi teachers and Balwadi staff,

on-formal Education (NFE) animators, traditional birth
attendants, and informal focussed discussions with them and

the people on their work and attitudes wore conducted in a

non threatening maiuier.
c)

San gam members, their office bearers, and non sangam members

were also contacted in a similar manner and their views
^On
*
elicited

CHD and their staff, on sangams and their

functioning - in rclatiozi to peoples problems.

..6

6
d)

Visits to the village included studying the conditions
of housing, water, sanitation, kitchen gardens,

nutrition programs at Balwadis, NFS classes and the
quality of rapport between CHD staff and co&uaunity

members.

o ) An interaction with the Medical Officer and Medical

Superintendent at the nearby referral centre at
hatlagundu (Leonard Hospital) consisted of identifying
local disease patterns, availability of health care
services and patterns of utilisation.

Th© other components studied wore library and health
education resource materials, VHW’s kit, medical stores

and other units of KTU including th® medical department
in relation to CHD activity.

In addition, the CHD staff participated readily and made
available existing documents and also co-operated in

processing additional information requested by the study

team.
VI.

RESULTS

The results ara presented. as a situational analysis at the
village level and in the various activities of th© organisation.
1• The Villages

The eight villages where th© community health department

operates are away from the main road, and relatively
inaccessible.

The population of these villages ranged

between 200 to 700.

The villages are in two clusters, with

a government health centre near each of the clusters, located

at Ganguvarix>atti and Viralipatti.

Tho government health

workers visit these villages mainly for immunisation and
family planning activities. Programmes on nutrition are

conducted under the Tatnilnadu Integrated Nutrition Improve
ment Programme (TIN1P).

In RTU built houses, ventilation is good and there is no
smoke nuisance from the kitchen, since it has smokeless
chulhaa and is built away from the living rooms.

..7

7
I'rois available data va found that Illiteracy is high and ranges
between 40 to 95/» with a high drop»out rate noticed after the

primary level of education.

The occupation of the people is

mainly as agricultural labour (seasonal) and marginal farmers

and shepherds.

Most houses are kutcha houses, with one or two

rooms, non-electrified and with no toilets.

potable water is available, it is inadequate,
schools are within a distance of 2 Kras.

liven though

’Jost primary

Transport and

communications are generally available, but inadequate.

Balwadis

organised by RTU are functioning where not covered by the
Integrated Child Development Schema (IGDS).

Most villages do

not have a community t oleyl sion^
t\,V\

2.

T^VVVvLvvixZ^/vv- <

Organleatlon&l Activities

a) Sangam

The membership of the sangams in relation to tire total

village population varies between 10;
*

to 60$ with a higher

percentage of wotsen being sangam members compared to men.

The percentage of attendance at meetings;
■» in Man's meetings

- rang© 5^ “ &7$

- in Women's meetings

- range 51 ~ 1OO^».

On an average one meeting per month is held in both mens

and womens sangaias.

However, during harvesting and planting

seasons, meetings are irregular.

The sangasas have been able to laobilise people to avail
various facilities through government schemas in areas of

income-generation, roads, electricity, water supply, and
obtaining of pensions for widows

It is to be noted that a major contribution of RTU is in

the area of providing housing facilities which has generated
great interest and attraction among saugaui members. £jsangara
leaders are given leadership training at RTU periodically«~p

8

a
Sorje specific achievement a as per records are:
1986 - construction of 167 ItTU houses
Sorewell - one

1987

Jagjivan Nagar.

- 72 HTU houses at Utchapathi

1938 - Distribution of Goat s/Bufi'aloes/Sheep - for income
generationj
Establishment of sheep rearing society.

1989

- Total 90 persons benefited from government scheme

28 pensions for -widows/streetlights and watei' taps/
bore-wells by HTU/Buffalo loans/Jawahar well-digging

loon sanction/Sheep rearing society formation/ Hoad

repairs/Vidow daughter's marriage through aid/Community
hall eonstruction/forelation of prohibition committee
against female infanticide/ and Flood control wall

construction.

1990

- Bullock and sheep rearing loans/street lights/hut
electrification/old age penaiona/credit Union formation/
goats for income genex-ation/tree planting alongside road/
road-repair/link roads/shed repair/soakage pits/ and

threshing floors in the ..villages.
1991

- Sheep rearing locus s/bullock cart loans/loans for petty

trades/old age peuaions/borewells/water-tank with taps/

aontiily savings scheme started/threshing floor construction
and allotment of house-sites.

Some problems sraass
Apart from isinor problems
*

usually found in human groups
*

others noted v/era t
- Leaders becoaiing corrupt and leading to loss of faith in them}

- Enthusiastic participation from sangams generally peaked when
R.T.Uhouses were constructed and waned dramatically after the event}

- Internal land and caste factors interfered with sangam activity]
- Traditional caste based elders who managed conflict felt
threatened by the new sangam Leadership.
9

9
b)

Village Health Workers (VHWs)

Village Health Workers selected by the Village Health Committee

vere women, a majority of -whom were illiterate.

They were

given an initial training in community health for 2 weeks.

Subsequent refresher courses and clarifications at periodic

meetings are continuing.
The VHWs are isainly involved in minor ailment treatment
*

assisting at RTU' s mobile clinic and helping the government

health workers in their health activities.

They also are

expected to visit 5 families a day and conduct health education.
The VHVs ai
e
*

provided with a kit containing medicines for

treating minor ailments,which is utilised to treat 20 to 30
cases on an average every month at a subsidised rate.

They

also utilize traditional herbal remedies quite confidently
on their own initiative.

They record the vital events of

births and deaths with the help of a literate.

An honorarium

of m.100.00 per month is paid to them and this is given either
by RTU or sangams.

V© observed that the VHW is well accepted and has a good rapport

with the community.

A review of the curriculum showed that the

contents were far too technical and voluminous to be covered in
Record keeping activity is inadequate due

this short period.

to their illiteracy.

Being sangam ineiabers, they also participate

in all other sangam activities
*

but are considered by the people

as mainly health resource.
c)

Mobile Clinic
The mobile clinic operates twice a week
*

in the afternoons
*

effectively reaching each of the eight villages once a month.
The team consists of the CHD Manager
*

a community organiser
*

a person from the medical department and the local VHW.
provide curative services to the whole population
*

They

with a

focus on Ante and Post-natal care.

The records show that they see an average of 60 patients a

year per village
*

including ANC patients and growth monitoring

10

io.
of 40 children.

Medicines at a subsidized rate are distributed;

and Health Education imparted.

The schedules of
*

the mobile

clinic are very variable, mainly because of dependence on

availability of the van for transport of the tenia.

The health records are minimal, while their work is encumbered
by accounting procedures.

The records do not provide a clear

picture of disease patterns, but discussions with tho team and

the local referral centra indicated that tho cowion ailments
are diarrhoeas, skin diseases, eye diseases and problems af

malnutrition.

Tuberculosis and leprosy are two common major

problems and these are treated with til© help of governmental

In cholera epidemics in tho past, the CUD hue been

*
resources

effective in tackling the problem with government and other
agencies.

d)

Health Education
In addition to health education given by the VHW and at the

mobile clinic in a personalized manner, was health education
programmes are conducted on an. average of once a month in each
of the villages.

This io mainly through film shows and slide

shows.

street theatre, puppet shows and drama are occasional

events,

ileal til Education also forms a component of the

training prograsosa and other meetings ut HTU.

Film shows are

popular with the people.

Records show that the topics covered include - Cooperation,

Family Planning, Sanitation and Hygiene, N.F.E., MGH and

Nutrition.
VH. CONCLUSIONS
1. The RTU's CHD Department has established a good rapport with

the community as well as the government agencies in areas of

health and development.
2. The formation and nurture of sangams has enabled the people to

begin to understand thoir health and development problems and

also evolve some solutions.
11

11
3.

A large number o£ activities havo been initiated in a
sliox't span of time inspito of meagre resources.

Consequently, there has been a blurring of clarity and
focus in their well-meaning efforts.

4.

Since the selection of villages was based on criteria of

poverty find under-dovelopjnent, the approaches and

activities of RTU-CHD have been predominantly welfare
oriented.
5 • Tho enthusiasm of the sari gums seems to plummet as soon as

their immediate felt needs are mot from external agencies.
This seems to blunt the potentiality of their initiatives,

in using their own resources.

6. Curative efforts still form a major part of the health
programme, while in development, avenues for tapping
available resources are being efficiently explored.

7. Cost-effort-effectiveness of mobile clinic is low.
8.

The VHW is well accepted by the people and functions
effectively in activities allotacl to her.

However, her

inability to maintain effective records, makes it difficult

for the CHD to make quantitative assessments of health
parameters.

9.

Health Education remains largely an effort of tire Cl ID
(with its myraid activities and meagre resources) and has

not received the attention it deserved.
VIII. RECOMMEHNATIONS
To effectively strengthen the ongoing and proposed activities,

the following recommendations are made:
1• Community organisation and participation

Sangams havo already been formed.

This valuable resource

needs to be fostered and strengthened with further

trainlng/exposure of staff and sangam leadership.
Interactions inbetween RTU sangams and others outside is

likely to help this process.

12

12

The large membership precludes intensive study and understanding
of local issues.

The suggested corrective is the formation of

smaller working groups in each sangam to take up specific issues
*
Planned training for these groups with the help of expertise

will be of help.
Mens and Womens sangams need to meet together in addition to

individual sangam insets, at lea st twice a year reviewing their
activities in the interim period and to evolve better courses
of combined action
*

Practical solutions to problems of meetings during harvesting
and plantings seasons are to be evolved.

e.g. the executive

committee/working groups could attempt to taoot
*

or (if tliis is

found to be impractical) the meetings at these times are

suspended and the frequency increased subsequently.
Long term comprehensive planning on all relevant development
issues is to be initiated and followed up by the sangams.

Proper documentation and review of past decisions etc.
*

will

re-inforce this process.
Mechanisms for comprehensive feed-back at regular intervals on

decisions and proposed

sections both at KTU and sangam levels

needs to bo established.

Greater accountability and mechanisms for the same should be

fostered by open exchange of information an resources
*

*
activities

*
plans

and achievements between CID and sangams at their

meetings.

Invitation of local government officials to sangam meetings

should bo encouraged.

2. Appropriate strategies for health and development

People should be encouraged to utilize government health services
more and make them responsive to their needs.

13

13
The cost—effort-effectivenose of the mobile clinics can be
improved with alternative approaches like decentralization
and transfer of medical stores along with reduction of team

size and upgrading of village resources (VHW and TEA) also
utilizing government health resources.

This can be implemented

in a phased manner.
A prospective time-bound study of the mobile clinic component
in terms of

- patient utilization of services from within and outside the
specified villages}

- hours/persoiuiel/iaedi cine/transporfc/costs etc., involved} and
- areas of non-clinic activities facilitated,, needs to be
included in the future plans.
Where local/traditional herbal medicines are being utilized
as alternatives, allopathic drugs provided, may bo withdrawn

in a phased manner.

e.g., Benzyl Benzoate replaced with

Turmeric/lieem leaves, for scabies treatment.

Explore alternative sources of energy like bio-gas, solar

cookers, solar powered street lights, etc.

Development of simplified recording systems tailored to the
needs of the community as explained in the annoxure.

The VHW/TBA/NFE anisuators/Balvadi teachers and their aqulfSsienta
from government health resources are to meet periodically and

evolve ways and means of implementing sangam decisions.

3, Community support for health care
Formation of local working groups on health, consisting of

atleast five meiabers each from the mens and womens sangams
working together as a team will be an important step.

a) This group will be specially trained to improve health
education and will be responsible for isonitoring all health
activities and also function as aji activist group to interact
with governmental and other agencies for health.

14

14
b ) To explore ways arid means of making the community selfsupporting in Sorias of finance and other relevant resources.
4.

Health integrated with Development

A health-education component is to bo incorporated in all
training and other programmss of development both at RTU and
at the village level.

This is likely to make people more

conscious and responsible for their own health.

A contributory health service (CHS) scheme could be linked to
incoiao-generation programs.

This is intended to promote

self-sustenance of health services in the village.
At RTU level, stuff from all dapartnsents are to be sensitised

and oriented towards the importance of C.H. in development and
should be encouraged and expected to contribute to C.H. concepts
in their areas of work.

As a starting point, the medical department could take
responsibility for all curative services, and step into areas of
prevention and health promotion in the villages where the

community health department is active.

All health program
*

b® jointly planned by these two departments.

can

similar cooperative

efforts can be planned with other departments in their areas of
work.
5• Education for Health

Education for health alias at creating awareness among people of
all factors that affect health and promoting positive life-styles

towards health.

Literacy need not be a pre-requisite for this.

Considering the high levels of illiteracy in the villages, adult

and MFE should be strengthened and expanded with health as a

major component.
iSMt'ongoing Health Education the village working group should be

trained to take up responsibility in all aspects of health

education in the village.

Some effort should be made to educate

the working group on tlio elements of communication skills.

15

15
6. Involvement of traditional healers, Dais and indigenous systems
a) The VHW’s knowledge base to bo increased.
b)

The TBAs in the village to be trained and ANC and PNC wade
locally sustainable.

c)

Practitioners of indigenous systems in tho village to be
integrated into the community health programme.

i>Proiaote
d)

herbal gardens as part of kitchen/garden scheme.

a) Compile and document local herbs used, indications for use,
and their efi'ectivity D etc.

7. CHV / VHW

The VHW is illiterate.

Therefore functional literacy to tackle

simple meaningful record keeping/understanding health messages
and for better communications is to be undertaken as part of

their training.

Their training also needs to be simplified to

suit their limited role in minor ailment treatment and more

efforts put in to preventive and proactive health aspects.

Tiiei/job specifications depending on their capabilities and
community needs is to be made and their training programme
tailored to suit this.

The VIHIs skills to be upgraded to weetall local minor ailment

needs.

A referral system to hospital/health centre to bo

strengthened in the followings

a) Developing an official liaison between RTU-CHD and government
or private referral centres?

b) Enabling the VHW to establish a rapport with the centres of
referral; and
c)

Upgrade the VHWs knowledge to selecting the appropriate
referral centres for specific problems.

16

16
Appendix

Suggestions for simplified, comprehensive , relevant record-keeping
to enable future planning.

1. A register alloted to each village only for records on health -

to be kept at the village, accessible to the CUD and sanguis
health working group for updating.
2. The first 20 pages of register to be kept aside for indexing,

comprehensive record of focussed activity (eg., immuniBation/ANC/

Child births/pNC/Vital events, etc)

3.

One page per family for details eg., names of family members/

house no./type of house/illnesses in members (chronic)/sangam
membership/facilities availed from sangams etc.

4.

start with families with ANC/PHC/Xmmunization care.

with other sangam members,

Continue

then non-membors, such that over a

period of 3 to 6 months, complete village records will be

available.

This will also form the base-line data much needed

for future evaluations and planning.
5.

Examples of what is to bo recorded;
a) Village nauie/address on cover;

b) Page 1 - map of village (folded sheet can be pasted);
c)

Page 2 to 9 for index of family by name/house number;

d)

Page 10 to 20 for comprehensive records.

Immunization records

. Of
No• of children under
5 years age.
No. of children
completed BCG
No. of children
completed DPT/OPV

1st dose

4F W

2nd dose

M

3rd dose

11

17
Ho. of children completed
Measles vaccine

No. of children completed
1st booster dose

No. of children in Balwadi
roster/receiving suplementary
nutrition, etc.
ANC / PNC records

froia April 1992
April / May / June / July / August

No. of raothers pregnant
No. of mothers received
T.T. injection
No. of live births

No. of still births
Dates of delivery
Place of delivery
(village/out side)

Delivery conducted by
TEA
No. of PNC
AND SIMILARLY FOR LOANs/OAPs^VlTAL EVENTS, etc.

PARTICIPATORY STUDY

of

COMMUNITY HEALTH AND DEVELOPMENT PROGRAM

of

"REACHING THE UNREACHED"

G„ Kai litpatti ,,
1'1 a cl ur a :i. D i t. r :i. c: t,,
Tarni 1 Nadu

Study Group
1 „
,7*
Il

Dr. V„ Benj amin
Dr., G „ Gururaj
D i- „ Sh:ii. rdi Prasad Tekur

G5th March 1992 To 26 th April 1992,,

CONTENT

No..

I.

ii „

LIST

Details

Summary

Back ground

I..

Origins

2Goals and objectives.

:i: i i

iv.

V»

VI

VII „

VIII .

IX.

Purpose of study

Evolution

Methodology

Resul ts
1.

at village

2„

of Organisational activities
(a)

Sangarns

(b)

Village Health Worker

(c)

Mobile Clinic

Conelusions

Regommen d a t. i on s

Appendi x

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saqoE’ouddi?
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xawwwns

Recommendations
are
for
focussed
activity,,
putting
more
efforts
into making the sangams far-sighted,, involvement
of
other
departments of RTU in the CHD effort,, exploring
local
and other governmental resources and methods of documentation
to help the CHI) evolve relevant plans for the future.,

II BACKGROUND

1)

ORIGINS
The community health programme started later' (in
1982/85)
using health as an entry point for overall development
of
the
communities
in eight villages ot
this
areas,,
Two
volunteers
from
RTU
initiated a
process
of
community
organisation„
The
programme
remained
stagnant
during
1985-86
when these initiators left,, arid was restarted
in
1987
by
the
present manager
of
the
Community
Health
Department
(CHI)),,
It began
with
non-formal
education
incorporating
health messages,, and slowly evolved into
a
Community
health
programme.,
In
course
time
this
transformed
into
a
Community
Health
and
Development
programme,,
and
the
department
of
CH
&
I)
came
into
existence
at RTl.J„
Two community organisers
have
joined
this department over
the
past three years
to
lie Ip
the
Manager
who
has
been
handling
this
programme
single
handed„

2)

GOALS AND OBJECTIVES
The? goals of this commuity health and development.
as started in their progress report are ::

program

TO
REACH OUT TO A LARGE HUMBER OE PEOPLE IN
DISTANT
AMD
REMOTE
VILLAGES AND ENABLE THEN TO IMPROVE THEIR
QUALITY
AND STANDARD OF LIFE,, WITH (HEIR ACTIVE INVOLVEMENT,, USING
HEALTH AS AN ENTRY POINT,.

and
Self
This
is
aimed
at building up of
confidence
process
of
reliance
in
the villages and 'to initiate
a
of
sangams
ccjjnmon
vi 1 lage development throngh -formation
(associations) of men and women,,

III,.

PURPOSE OF STUDY

Based
on a felt need of the community health
department
of
RTU.,
the present parti ci patory study was undertaken to
find
out the qualitative impact of the community health program in
the eight villages they work in.,
This parti ci patory study by
an external resource group was to see

the community health program evolved:;

a)

how

b)

its present status:;

c)

to provide guidelines in

and

planning

the

future.,

It
is
to
be
specially
noted
that
this
participatory
interactive exploration
of community health and
development.
activities
was intended to facilitate 'the
community
health
department,,
Hence,, this study focussed on co'mmunity
health
and not on other activities of RTU,.
Since baseline benchmark
information
was
not available,,
a
quantitative
evaluation
study
was
not
feasible,,
Therefore
a
process
oriented
qua 1 i tative
ex p 1 ora t :i. on
study was undertaken
wi th
min ima 1
emphasis on statistics,, survey data,, questionnaire, etc,.
The
avai 1 ab 1 e
period :i. ca 1
reports con tain :i.ng
quan ti ta tive
data
have
been reviewed,,
There were also constraints of
time
total
time for the study being seven days,, divided into
two
blocks of two days and one of three days,,

The
present study was not focussed on measuring
the
helath
status
of
the community in quantitative terms,, but
on '“{.he
process
and
relevance of community health
and
development
(to
enable people understand 'the importance of the
same
to
improve
their
quality of life) and
hence
the
methodology
adop ted

Page :;

IV,.

4

EVOLUTION
To chronologically describe

the evolution pattern

::

1The earliest ac tivi ty was the mobile clinic of R„T„U„
While
pursuing
this
activity.,
eight
villages
were
identified
for
using
mainly
community
health
i n terven tions towards overal1 d eve.lopmen t „
The cri ter ia
for selecting these villages were ::

a)
b)
c)
d)

lack of any he/g.th or development activity:;
remoteness from centres of development activities:;
being small, (population size) and therefore manageble:;
people
belonging
to
predominantly
backward ^and
under pr ivi 1. eged sect i on s of soci ety..
Some of the originally selected villages were
dropped
from the program and others added on depending on
CHI)
assessments and v:i. 1 lage dynamics..

3.

Formation
of local Health Committee and
V i 11 ag e Hea 1 t h Wo r ke r (VHW) ..

selection

of

Formation of village level health committees was
preceded
by
awareness building for health through
street
theatre
and public
meetings.,
This health committee identified
a
male
health
worker who was acceptable 'to
the community..
These
VHWs 'from eight villages were trained at RTU for
a
period
of
15
days.,
During 1985--86
the
programme
was
stagnant
due
to reasons not clearly
iden tifiable,,
The
male
heal th
workers stopped
pursuing
community
health
activities,,
In
1987 when it restarted,,
female
village
health
workers
(VHWs) were selected 'from each
of
eight
villages
and
given
a
similar
fifteen
day
training,,
Guidance and supervision of these VHWs has been continuous
and regular since then,,

„

San gam formation

::

Sangams
separately for' men and women of the village
were
formed,,
These sangams were intended to be the hub of
all
health and development activity,,
All adults were
invited
to
join
the sangams,, and those
interested
joined
the
same.
Some of these sangams are registered
and
members
contribute a fee for common expenditure,,

Sangam
members were expected to meet at least once a month
to discuss local issues and to mobilise community
support
fo r
d e v e 1 o pm en t a 1
a c t i v i t i e s..
T hes e
san g am
a c t iv i t i es
were
facilitated by the CHI) to utilize both
Governmental
an d o t he r resou r ces „
T hey we re i n s t rumen ta 1 i n i n i t :i. a t i n g
activities
in health and also other areas
like
building
of
roads., provision of water and electricity,, running
of
ba 1 wad i s ,
impr oving transportai on -fa ci 1 i t ies
an d
in come
generation activities for the community..

METHODOLOGY
tative approach to evaluation consisted of

presen t qual

a)

review of available records;;

b)

discussion
with
fun c t i on a r i es;;

c)

discussion with members of sangam and non sangam
o f t h e v i 11 a g e s;;

d)

observations during field visits;;

e)

eliciting
agencies,,

opinion

An elaboration on

a)

staff

from

at

RTU,,

nearby

and

field

level

members

and
health

care

delivery

the above follows ::

The records reviewed included the annual reports;;
reports
to
funding
agencies;; reviews of past
and
future
plans;;
mo b i 1 e
c 1 i n i c re co rd s;; re co rd s a t hea 11 h cen t res;;
v i 11 ag e
registers;; -training programmes and -their curricula:; diaries
and registers maintained by field staff;;
type of information
and
their
commun i ty hea 11 h ac t :i. vi t :i.es..

relevance

to

b)

Discussions
were held at RTU with the Director,,
Assistant
Director,,
llanadter,, the two community organisers and
staff
of
medical
department of RTU„
At the
field
level,,
the
vi 11 age hea 11h workersDa 1 wad i teacliers and Ba 1 wad i staff.,
bl o n - f o r m a 1
Ed u c a t i o n
(bl I- E) a n i m a t o r s,,
' t r a d i t i on a 1
bi rth
attendants., and informal focussed discussions witl'i them and
the people on their work and attitudes were conducted in
a
non threatening manner.,

c)

Sangam
members,,
their
office
bearers.,
and
non
sangam
members
were also contacted in a similar manner and
their
views
elicited
— on CI-ID and their staff., on
sangams
and
thier functioning
pn relation to peoples problems,.

Page s

6

cl)

Visits
to the village incul cl eel studying the conditions
of'
housing „
water,,
san 1 tat ion ,,
ki tchen
gardens,,
nutri tion
programs
at
Bal wad is,,
NEE classes
and
the
quality
of
rapport between CHI) staff and community members,,

e)

An
interaction
with
the
lied i cal
Officer
and
lied i cal
Superintendent at the hearby referral centre at
Batlagundu
(Leonard
Hospital) consisted of identifying local
disease
patterns,, availability of health care services and patterns
erf uti 1 isation „

The
other
components
studied
were
library
and
health
education
resource materials,, VHW's kit,, medical stores
and
other
units
of
RTU including
the
medical
department
in
relation to CHI) activity.,
In
addition,,
the CHI) staff participated
readily
and
made
available
existing
documents
and
also
co-operated
in
processing
additional
information requested
by
the
study
team,,

VI „ RESULTS

The
results are presented as a situational analysis
at
village
level
and
in
the
various
activities
of
o r g an i sa t i on s „

1 ■■

the
the

III®. Vi.l 1_ages
T he
e i g h t v i 11 ag es w he re t he commun i ty hea 11 h
d e pa r '('.men t
operates
are
away
from the main
road,,
and
relatively
inaccessible,,
The
population of these
villages
ranges
between
200
to 700,.
The villages are in
two
cluster's.,
with a government health centre near each of the clusters,,
1 oca ted a t Gen g u var pa 11 i an cl V i ra 1 i pa 11 i .,
T l ie
Gove rn men t
health
workers
visit
these
villages
mainly
for
immun i zation
and family plann ing activi ties „
Frogr ammes
on nutrition are conducted under the Tamilnadu
Integrated
Hu t r i tion 1 mprovemen t Fr og ramme ( T1 bl.1F) „

no In
RTU built houses, ventilation is good and there i s
From
chulhas
and
is built away from the living
rooms..
available data we found that illiteracy is high and ranges
between
40
to 95 “i
with a high
drop-out
rate
noticed
after
the primary level o f education..
The occupation
of
trie people is mainly as agri cultural labour (seasonal) and
marginal
farmers and shepherds.,
Most houses
are
kutcha
house's,, with one or two rooms., non-electrifled and with no
toilets..
Even though potable water is available.,
it
is
inadequate..
Most primary schools are within a distance of
2
Kms„
Transport
and
communications
are
generally
available,, but inadequate,.
Balwadis organised by RTU
are
functioning
where
not covered by the
Intergrated
Child
Development
Scheme (IC.DS),,
Most villages do not
have
a
community
television,, commonly seen in other villages
in
Tamilnadu„

2-

Qm^nlsaticMlAl. A.ct.i.yit.ies

a) Sangam

The
membership of the sangams in relation to the
total
village
population varies between 10
to 60
with
a
higher percentage of women being sangam members compared
to men.
The percentage of attendance at meetings

- in Men's meetings

- range 54 - 87 k

- in Women's meetings

- range 51 - 100

s

On an average one meeting per month is Field in bot.Fi mens
and
womens
sangams..
However,,
during
harvesting
and
planting seasons,, mee tings are :i rregular,,

The
sangams have been able to mobilise people to
avail
various
facilities through government schemes in
areas
of income-generation ,, roads., electri ci ty., water
supply.,
and
obtaining of pensions for widows.,
Sangam
leaders
are given leadership training at RTU
periodically .,
It is to be noted that a major con tri button of RTU is in
the
area
of
providing housing
facilities
which
has
generated
great
interest and attraction
among
sangam
members.

kji>

m*vccz -if- Km

w

page :;

8

Some specific achievements as per records are ::

1986 -• Construction erf 167 RTU houses
Borewell ■■■ one

J>

Jagjivan
blagar..

1987

72 RTU houses at Utchapatti

1988

Distribution of Goats/ Buffaloes / Sheep
In come generati ons:;
Estab.l i shmen t

■for

s h e e p r e a ring s o c i e t y..

scheme
including
28
pensions
for
widows/streetli girts and water taps/ borewelIs by
RTU/Buffalo
loansATawahar
wel1-digging
loans
san tion/Sheep
rear1ng so<::iety formation/
Road
repairs/Widow
daugliter's
marriage
throngh
a :i d/Commun i ty
hal 1
const ruction/format ion
of
prohi bi tion
commi t tee
against
f ema 1 e
infanticide/
and
Flood
control
wall
construct! on

1990

■■■ Bullock
and
sheep
rearing
loans/street
1 :i.g hts/hut
electrif i cation/old
age
pensions/
Cred i t
Un i on
f ormati on/goa ts
f or
in come
general.ion/tree
plan ting alongside
road/road r epai r/1in k
roads/shed repair/soakage
pi ts/and
t hresh i n g f 1 oo rs in t lie v i 11 ag es

Sheep rearing 1oan s/bu11ock cart loans/loans for
petty
trades/old age
pensions/borewe:
Is/watei....
scheme
tan k
with
taps/month1y
savin gs
s 'ta r ted /1 h res h i n g
f 1 oo r
con s t rn c t: on
and
a 1 lotment of house -si tes..

Some p r o b 1 em s a r e a s s
Apart
from
inor
problems
groups,, otheirs note d were::
-■ Leaders be
in them:;

ng

:i. n

human

corrupt and leading to loss c:.f

faith

usually

f ounch

Enthusiastic
parti ci pation
from
sangams
generally
peaked
when
RTU houses were constructed
and
waned
d ramat i ca 11 y af ter t he even t
internal land and
activity:;

caste factor’s interfered with sangam

Traditional caste based elders who
managed
conf 1 :i.c:t
felt threatened by the new sangam leadership,.

Page ::

9

b) Vil laqe Health Workers
Village
Health
Workers selected by the
Village
Health
Committee were women., a majority of whom were illiterate,,
They
were given an inXitiCal training in community
health
for
2
weeks,,
Subsequent
refresher
courses
and
clarifications at periodic meetings are continuing,,

The VHWs are mainly involved in minor ailment
treatment,,
assisting
at
RTU's
mobile
clinic
and
helping
the
government
health
worker’s in. their
health
activities,,
They
also
are expected to visit 5 families
a
day
and
conduct health education„

The VHWs are provided with a kit containing medicines for
treating minor ailments,, which is utilized to treat 2.0 to
30
cases on an average every month at a subsidized rate,,
They
a1so
ut i1i ze
t r ad i tion a1
he rba1
r emedi es
qu i te
confidently
on
their own initiative,.
They
record
the
vital
events
of births and deaths with the
help
of
a
literate.,
An honorarium of Rs., .1.00,,00 per month is
paid
to them and this is given either by RTU or’ san gams..
We observed that the VHW is well accepted and has a
good
rapport
with the community..
A review of the
curriculum
showed
that
the
contents were far
too
technical
and
voluminous
to be covered in this short
period,,
Record
keeping
activity is inadequate due ’to their
illiteracy,.
Being sangam members., they also participate in all
other
sangam
activities,, but are considered by the
people
as
m a i 111 y h e a I t h r e s o u r c e..
1

c)

Mobi_le. Cl ini.£
The
mobile
clinic
operators
twice
a
week,,
in
the
afternoons,,
effectively
reaching
each
of
the
eight
villages
once
a month,,
The team consists
of
the
CHI)
Manager., a community organiser,, a person from the medical
department
and
the local VHW„
They
provide
curative
services
to the whole population,, with a focus
on
Ante
and Post -natal care,.

Page

.1.0

The records show that they see an average of 6(3
patients
a
year
per village., including ANC patients
and
growth
monitoring
oP 40 children,,
Medicines at.
a
subsidized
rate are distributed., and Health Education imparted,.
The
schedules of the mobile clinic are very variable.,
mainly
because
of
dependence on availability of
the
van
for
transport of the team.,

The
health
records
are minimal., while
their
work
is
encumpred
by accounting procedures.,
The records do
not
provide
a
clear
picture
of
disease
patterns,,
but
discussions
with the team and the local referral
centre
indicated
that the common ailments are diarrhoeas,,
skin
diseases,,
eye
diseases and
problems
of
malnutrition.,
Tuberculosis
and leprosy are two common
major
problems
and
these
are
treated with the
help
of
governmental
resources.
Tn cholera epidemics in the past,, the CHD has
been effective in tackling the problem with government and
o t h e r a g e n c i e s,.

d)

Health Education
In
addition to health education given by the VHW and
at
the
mobile clinic in a personalized manner,, mass
health
education programmes are conducted on an average of
once
a month in each of the villages.
This is mainly
through
■film shows and slide shows.
Street theatre., puppet shows
and
drama are occasional events.
Health Education
also
forms
a component of the training programmes
and
other
meetings at RTt.i„ . Film shows are popular’ with the people.

Records
show
that
the
topics
covered
include
Cooperation,,
Family
Planning,, Sanitation
and
Hygiene.,
bl.F.E.,, (VKCH and Nutrition.

CONCLUSIONS
1 „

The
RTL.l's CHI) Department has established a good
rapport
with the community as well as the government agencies
in
areas of health and development.

2„ The
formation
and nurture of sangams
has
enabled
people
to
begin
to
understand
their
health
development problems and also evolve some solutions.

the
and

3.,

A
large
number of activities have been initiated
in
a
short
span
of
time
inspite
of
meagre
resources..
Consequently.,
there has been a blurring of
clarity
and
•focus in their well "-meaning efforts.,

4,.

Since
the selection of vilages was based on cri teria
of
poverty
and
under—development.,
the
approaches
and
activities
of
RTU-CHD have been
predominantly■ welfare
orien ted,.

5,.

The en thusiasm of the sangams seems to plummet', as soon as
their
immediate
felt
needs
are
met
from
external
agencies..
This seems to blunt the potentiality of
their'
initiatives., in using their own resources™

6..

Curative
efforts still from a major part of
the
health
programme.,
while
in development., "avenues
for
tapping
available resources ar e being effi cien tly explor ed,.

7..

Cost-effort-effectiveness of mobile clinic is low,,

8,.

The
VHW
is well accepted by the
people
and
functions
effectively
in activities alloted to her,,
However,,
her
inability
to
maintain
effective
records,,
makes
it
difficult for the CHD to make quantitative assessments of
heal th parame ters,.

?„ Health
Education
remains largely an effort of
the
CHI)
(with its myraid activities and meagre resources) and has
not received 'the attention it deserves.,

111RECOMMEND AT IONS

To
effectively
strengthen
the
ongoing
and
proposed
ac tivi ties,, the fol lowing re commend a t ion s are made i:

1

ConynuT-ELtZ

sVl£!. fi^E.'ti.ci.|:jation..::.

Sangams have already been formed,,
This valuable resource
needs
to
be
fostered ’ and
strengthened
with
further
training/exposure
of
staff
and
sangam
leadership,.
Interactions inbetween RTU sangams and others outside
is
l:i.kely to help this process,.

Page 8

1®

The
large
membership
precludes
intensive
Study
arid
under standing of local issues,.
The suggested
corrective
is the formation of smaller working groups in each sangam
to
lake up specific: issues,,
Planned training for
these
groups with the help of expertise will be of help.
Mens and Womens sangams need to meet together in addition
to
individual
san gam
meets,,
at least
'twice
a
year
reviewing
their activities in the interim period and
to
evolve better courses of combined action,,

Practical
solutions
to
problems
of
meetings
during
harvesting ^Tand
plantings seasons are
to
be
evolved,,
e „ g ,. -the ex ecu t i ve commi ttee/wor king g roups could at tempt
to
meet,,
or (if this is found to
be
impractical)
the
meetings
at these times are suspended and the
frequency
:i. n c r e a s e d s u b s e q u e n 11 y .,
Long
term
comprehensive
planning
on
all
relevant
development issues is to be initiated and followed up
by
t he san g ams- „

Proper
documentation and review of past decisions
will re-inforce this process.

etc,,,,

Meehan isms
for
comprehensive
f eed-back
at
regular
intervals
on decisions and proposed actions both at
RTl.J
and san gam levels needs to be established,,

Greater accoun tab! 1 i ty and median isms for' the same should
be fostered by open Exchange of information on resources,,
plans,,
activities,,
and achievements
between
CHI)
and
sangams at their meetings,,

Invitation
of
local.
government
meetings should be encouraged„

officials

to

sangam

App.ropriate stra.teg.ies for heal.th and. development.::.
People should be encouraged to utilize government
health
services more and make them responsive to their needs.,

0

cos t--ef f ort-ef f ectiveness of the mobile clinics
can
improved
w:i. th
al ternative
approac^ge^
1 i ke
decentralization
and
transfer of medical
stores
along
with
reduction
of team-size and
upgrading
of
village
hea11h
resources ( VHW and TBA) also utili;' i n g g overnmen t
resourcesn
This can be implementec:l in a phased manner,,

The

time--bound
A
prospect. ive
componen t. i n terms o'f

study <:rf

I ■.he

mobile

clinic:

•■■■ patient utilization of services from within and outside
the spe c i f i ed vi 11 agesi;

hours/personne 1 /med i cine/1ranspor t/costs
involved
and
— areas of non "■•clinic activities
included in the future plans.,

facilitated,,

e'I:.c „

needs to be

Where
local/trad! I. ion al
herbal
med i cines
are
being
utilized as alternatives,, allopathic drugs provided.,
may
be
withdrawn in a phased manner,,
e.,g.,., Benzyl
Benzoate
r e p 1 a c e cl
w i t. h
T u r m e r i c / bl e e m
1 e a v e s,,
fo r
s c a I:) i e s
t reatmen t.,

so 1 a r

Bevelopment
of simpl ified recording systems tai 1ored
to
the needs of the community as ex plained in the annexure,.

T he
VHW/ TBA/MI" 11
an i ma 'to rs/Ba 1 wad i
tea he rs
an d
t he i r
equivalents "from government, heal th resources are to
meet
periodically
and evolve ways and means
of
implementing
s a n g a m dec i s ions.,

Izu

or t

for h£>3.1.fth cares

Formation
of local working groups on health,,
consisting
of
atleast
five members each from the mens
and
womens
sangams- working together- as a team will be an
important
Step.,

This
group will be specially trained to
improve
health
education
and
will be responsible
for
monitoring
all
health activities and also function as an activist
group
to
interact
with governmental arid
other
agencies
for
health„

To
explore ways and means of
making
"tine
community
in terms of finance and
other
relevant
se I f -su p po r t i n g
re sources.

Health i.ntegjrated wi.tln IJey.elopmen. t.-.

Education. ’.ClSJl
Education
for
health aims at creating
awareness
among
people
of all factors that affect health
and
promoting
positive 1 ife--styJ.es towards health..
Literacy needjj? not
he a pre-requisite for this,,

Considering
the
high
levels
of
illiteracy
in
villages,
adult
and
Nl-E
should
be
strengthened
expanded with health as a major component.

the
and

In
ongoing Health Education,, the village
working
group
s In o u 1 d
be
t r a i n ed
t o t a ke
up
r e s po n s i b i 1 i t y
in
a J. J.
aspects of health education in tine village,,
Some
effort
should
be
made
to educate the
working
group
on
the
e 1 emen ts of commun i ca t ion ski 11 s.,

Pa g e ::

^lllvement
of
■LlLtL^lC-UcuAS szstemsj

a 1.

11® <ii. <£ rSa.

Dai .s

and.

a)

The VHW's kn owl edge base to be increased,.

b)

The TBAs in the village to be trained and ANC arid
made 1 ocal. 1 y sustainab 1 e..

PNC

c)

Practitioners of indigenous systems in the village
be integrated into the community health programme,.

to

:!)

Promote
scheme.,

e)

herbal

gardens

Compile and documen' local herl
useand thei r e ffe< tiv:i ty,, etc : c>

CHW

k i t c h e n / g a r d en

pa r't

1 ■<

i n d i.cations for

VHWs

The VHW is illiterate,,
Therefore functional literacy
to
tackle ■ simp 1 e
mean ing fu 1
record
keepingZund ers'tand ing
health
messages and for better communications is
to
be
undertaken
as
part of their training,,
Their
training
also needs to be simplified to suit their limited role in
minor
ailment
treatment
and more
efforts
put
in
to
preventive and promotive heal th aspects,,

Their job specifications depending on the
and
community
needs is to be made
and
prog ramme tai 1 ored 'to sui t this „

The
VHWs skills to be upgraded to meet all
local
minor
ai1men t
needs«
A referra1
systern
to
hospi ta1/hea11h
centre to be. strengthened in the followings

a)

Developing
an official liaison between
government or private referral centres:;

b)

Enabling
the
VHW to estahlish a
c e n t r e s o f r e ~f e r r a 1a n d

c)

Upgrade
the
VHWs
knowledge
to
selecting
the
appropriate referr al cen tres for specif i c problems,,

RTU--CHD

rapport

with

and

the

Page

s

id

APPENDIX i
Suggesti ons
for
si mp 1 i f i <•:■?<:!cornprehensi ve,,
r ecord' -keeping to enable future planning „

relevan t

:! „

A register alloted to each village only 'for records on
health
to be kept at the village,, accessible to
the
CH.D
and sangam health working group for updating..

2.

The first 2.(3 pages of register to be kept
aside
for'
indexing„
comprehensive record of
focussed
activity
(eg .,,, i mmun i za ti on/ANC/Chi 1 d b i r ths/PIMCZVi ta 1
even ts,,
etc „ )

3. One page per family 'for details eg.., names of
family
members/' house no ../type of house/i 1 In esses in
members
( chroni c)/sangam
membersI ii p/far:i 1 i ties avai 1 ed
f rom
san gams etc,,

A.

Start with 'families with ANC/PNC/Immunization care.,
Continue with other sangam members., then
non-members.,
such
that
over a period of 3 to 6
months.,
complete
also
v i 11 a g e
r e cord s
will be available..
Thi. s
w i 1J1.
future
form
the
base- line
date
much
needed
f or
e v a 1 u a t i o n s a n d planning.,
Exam p1es of w 11 at is to be recorded

a) V i 11 a g e n a m e / address on cover
b) Page 1

map of village

(folded sheet can

be pasted)

c) Page 2 to 9 for index of family by nameZhouse number;;

d)

Page 1(3 to 2(3

e)

Page 21 onwards
per family,,

for

D t. o f
re cording

comprehensive records,,

individual family records

Apri 1

May

June July

one page

etc -

X

No. of children under
years age.

pH

No. of children
coml eted BCG
Mo. of children
comleted DPT/OF 'v

Uli

1st dose

2nd dose
3rd dose

Xi
X

H

(Tally marks by VHW/Co)
individual updating by name in family records

Na. of children
completed Measles
vaccine

No. of children completed.
1st booster dose
No. of children in Ba1wadi
roster/receiving supple—
mentary nutrition, etc.

X X
X n>
jjK X

ANC / PNC records from April

No.

1972:

x

of mothers pregnant

No. of mothers received
T .T. inJ ection
No.

of

live births

No.

of

still

of delivery

Pla

of delivery
1 la qe/outside)

Delivery

No.

1111
nil

births

Dat

111

1

1

V/'j/c

conducted by TEA

of PNC

AND S11'11 EARLY PGR' I .GANS/OAPs/V I TAI... EVERTS,,

August

Position: 1764 (3 views)