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* * * ******* * *********** * * * * * * * * * * * * *
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A
REVIEW
O F
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PROCESSES
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I N
IMPLEMENTATION
O F
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THE
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CHILD SURVIVAL
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AND
CHILD
DEVELOPMENT (CSCD) PROJECT
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O F
THE
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CHRISTIAN MEDICAL ASSOCIATION OF
INDIA
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* * * * * **************
********* * * * * * * *
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Dr. Shirdi Prasad Tekur MDBS DCH Ex-Capt.ANC
(Co-ordinator, Community Health Cell - Bangalore)
Sri. Justin Jeba Kumar BSc MSW
(Programme Officer, CHAT. - New Delhi)
Kum. Peena K. Nair BA NSW
(Assoc i ate , Community Health Cell - Bangalore)
* * *
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X- * *
M-
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■*
1
•:+ * * * *
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CONTENTS
Executive Summary
03
Background
04
Process and Methodology
05
Appendix -A
07
Appendix -B
10
Appendix -C
22
Review of activities for CSCD
Field Observations
23
Review of Processes
-at CMAI HQs
26
-between CMAI HQs and CSCD Micraprojects
26
-at CSCD Microprojects
20
-■among people at CSCD microproject
locations
Strengths, Weaknesses, Recommendations
33
Appendix -D
36
Individual reports of 22 Microprojects
2
I
31
EXECUTIVE SUMMARY
A PROCESS REVIEW of CMAI's Child Survival
and Child
De velopmen t
project was done at the end of the current phase covering
25 microprojects,
between March and May 1996. Twenty two (22) of
the
twenty
five
(25) microprojects were visited and studied during thi s period,
with preliminary, quantitative data analysis done in a two-month phase
earlier.
The compiling, reporting, etc., was completed in the month
fallowing the field visits.
The service component
is well-tried, tested and
established
as a
workable model, addressing the varied needs of the poor scattered
al 1
over the country - at a low cost.
non-hosp i tal-based
The
abililty
of
non-hospital-based
development
and
serv ice
organisations to take up such work for children and mothers,
c re at ing
awareness
and promoting participation in services available from the
Government and Voluntary agencies in the area has been confirmed,
The
needed
training,
monitoring and technical support have been we 11planned and delivered.
The direct contact with people in need and raising of awareness levels
and participation
abililties have emerged as the highlights of
the
project - as seen on field.
The microprojects implementing the CSCD project have also been enab 1ed
to
identify and initiate other health-related activity depending
on
local needs - eg. logical extension of child care beyond two years of
age
/ non-formal
education
of mothers for health
/
reviving
of
traditional
and home-based remedies for minor ailments
/
nutrition
education, supplementation and other technical support, etc .
Discovering
of
the complexity of
factors
affecting health
and
action according^peop1es' needs has delayed microproject
p romoting
initiatives towards sustainability of the CSCD component.
The working conditions at microproject level being far from ideal, the
three year phase of support planned for CSCD needs to be extended
for
a
further period of two to three years to make
the
efforts
truly
fruitful.
Further
training
and networking within the microprojects
and with
Government and Voluntary agencies is needed to meet the emerging needs
of
the people, in areas of - First-aid / Minor ailment management
/
Integrating into other development activity, etc.
Decentralization,
Communication
in regional/local
language
and
generation of locally relevant health education material are
logistic
problems which need to be addressed, considering the scattered
and
remote location of microprojects.
3
I
BACKGROUND:
The CMAI has taken up the Child Survival and Child Development
p ro j ec t
- as part of its broader approach to Community Health;
- to enable non-hospital based agencies working in other areas
development to take up health as an area of concern; and
- to evolve a demystified/simp1e approach addressing the most
needy among people in an area of work that
could make
a
visib1e/palpab1e impact on their lives - viz. in taking care
of their children.
This project is implemented through 25 micro-projects attached
to voluntary agencies who have taken up social-service as
an
activity, all over the country.
An earlier phase covering 50 projects was tried, and monitored
between 1988 and 1991.
This was evaluated for suitability of
approach, and for learning in early 1991.
The present phase was started between 1993 and 1994, selecting
suitable organisations,
training the personnel
f rom microprojects and monitoring their progress over 2 1/2 to 3 ye ars.
A need to review the 'processes' generated by the CSCD project
was f e 11 towards the end of the planned 3—year phase to deepen
the understanding of this
intervention'.
The Community Health Cell was informed of this, and Dr. Shirdi
Prasad Tekur who had earlier been involved 1 in the 1991 studyevaluation, agreed to take it up between March to May 1996.
Th is
'Process-review '
is
a study of
these projects from
documents, field-visits and discussions with the micro-project
personnel and people at these locations.
4
PROCESS AND METHODOLOGY ADOPTED
Pre 1iminary activity:
An initial meeting in mid-February between the reviewing
team
and
CMAI personnel evolved a plan of action for the
review,
keeping
in mind
the
review needs.
Over
the week,
the
following were done —
a) A travel plan to cover 22 of the 25 projects between
18th
March '96 to 6th May '96.
b) An
overview of
each project prepared
f rom
available
documents, and
c ) The
most suitable methodology that could b e
adopted
to
cover the needs of the revieuj.
While
a)
and b) above were handed
over
to the
t h e Programme
Officer CSCD, c) was evolved by the reviewer in consultation
with colleagues and other library material on why? how?
etc.
of such a review.
( Ref. Appendix
A )
By end February 1996, the Programme Officer CSCD CMAI had
- prepared overviews of each project which were studied,
- analysed all quantifiabl e data from the microprojects, and
- informed micro-projects about field visits and what was
planned, making necessary travel, stay and financia1/adminis
—tnative arrangements for the same.
( Ref.
Appendix -B for Map with
project
locations,
Travel
schedule, etc. )
Meanwhile,
a format for the process review planned
and approved.
was
made
Confirmation
and review of all the above was completed
three
days prior to the field visits, which started on 18 march '96.
Field Visits;
Field visits were made as planned to all 22 micro-projects by
- the reviewer - Dr. S.P. Tekur; and
- the CSCD Programme Officer - Mr. Justin J eba Kumar, and,
- Ms.
Reena K. Nair, a CHC Associate,
who
accompanied
and
helped the team during 8 project visits in South India.
During micro-project visits, the review team
reviewed documents at the micro-project HQs, and discussed
problems faced in documentation/reporting,
~ visited field areas covered by micro-project and interacted
with project personnel, people directly involved by the
CSCD project and others.
- discussed with the project implementors and
their Board,
and
- prepared concise notes for;, purposes of the report
at
the
end of each project visit.
5
PEOPLE/PERSONS MET/TALKED WITH during field visits
A.
YMCA Board members/others related to
the project not directly implementing CSCD
66>
B.
CSCD Project Executive members viz: CEOs and PMs
31
C.
CHVs employed part/ful1-time to implement
CSCD project
76
Other Health Professionals in area connected
or not to CSCD Project
19
Pregnant women and mothers influenced by CSCD
Project
187
Other v i11 age persons not connected with
CSCD
192
TOTAL
571
D.
E.
F.
Details of personnel
interacted
with
and
areas
of
questioning are in Appendix-C.
Details of observations, and discussions
at
the microprojects are recorded separately for each project.
Appendix D -(Details of 22 micro-projects)
Reporting;
Fol lowing
the
project
visits, ending 06 May
'^6,
the
review team of Dr. S.P. Tekur, and CSCD Programme Officer,
Mr .
Justin Jebakumar met
- the Co-ordinator, Community Health Department,
- the Community Health team members, and briefed
them about
the
impressions gathered prior to
finalizing
the
review
report.
The finalized report prepared by the reviewer was circulated in
draft
form to all these members of the field review team to
consolidate
and confirm
- the format of reporting,
and
its contents,
- the completeness of the document, and
- to add to/modify/e1aborate on aspects which need mention
to
make this review — useful.
This process reached the last week of May 1996. The draft
circulated
to all
the review team members
and CMAI,
finalised by end-June 1996.
6
was
and
I
APPENDIX ' A '
BEVIES 2E PROCESSES OF IMPLEMENTATION OF C5CD PROJECTS
The CSCD project of CMAI has been conceived and implemented as
an
innovative
approach to Community Health
with
the
objectives of
introducing
simple,
loui-cost
and
effective
health
interventions
that
c an
help women and
chiIdren
in
the
commun i ty.
focussing
on
communities of
low
soc1o-economic
g roups
predominantly in rural areas, and
ensuring that all children born in the community reach their
second birthday.
The project is implemented in the current phase as 25 microprojects
across the country, each working with an
identified
community of
approximately 5000 or rmore population,
with
a
high Infant Mortality Rate and between.) 100-150 births occuring
each year.
The life of each micro-project is three years.
A
participatory study-evaluation of 50 minor projects
in
an
earlier phase was done in 1991 confirming the ability of
such
attempts to address the objectives adequately.
The
CSCD project is part of the CMAI's broader
Community Health
approach
to
- Believing
that people have an important role
to play
in
their own health, and that
~ non-hospital based Christian and Social
agencies
al ready
working with people in various areas could take up health
work
also even if they do not have any prior experience
in
health related activities.
The project focusses on these aspects in its approach,
design
and
implementation,
as seen
in the study of
1991
cited
ear 1 i e r .
PROCESS REVIEW METHODOLOGY
A review of the PROCESS of implementation in
the
project's
current phase covering
cove
25 micro—projects will
be
there fore
pre-dominantly qualitative
with quantitative data analyzed to
offer support or otherwise to it, since adequate quant i tat i ve
data
is already available as part of
the
implementing
and
monitoring mechanisms of the project.
7
!
The Review will consider the processes between and within
following three key groupings of the project.
CMAI's CSCD
P ro j ect (1 )
1 .
(2)
---- >
CHATzs CSCD PROJECT;
CSCD
(3)
Mic ro-Pro jec ts
(4)
----
the
(5)
P eop 1e
tc consider
a. Importance of CSCD project in its CH approach,
b . CSCD Program Officer - role, respon s i b i1 itie s
Pro ces s es se t up to tackle
these.
CHAI 's LINKS WI TH THE MICRO-PROJECTS
a. Process through the Program Off i c e r like
- identification of projects
- training of personnel at micro-projects
- reports, returns and follow-up on them,
b . Training, Support and Monitoring activities,
c . Any other - Resource mobilization and Networking.
CSCD NICRCRPROJECTS
CEO's,
Project Managers
Roles,
Responsibilities,
activities,
b . Community Health Volunteers,
Integration efforts into other activities of the microproject.
d . Documentat ion, information sharing.
cl .
4.
MICRO-PROJECT LINKS WITH PEOPLE
a. Community organisation and participation for Health
How?
b . Information dissemination
modes and effect!vity,
c . Services offered - nature, need and effectivity,
d. Steps taken for sustainibi1ity.
5.
PEOPLE
a. How people view and utilize the CSCD attempts,
b . Acceptance, Appropriateness of CSCD project,
c . CSCD
impact/effect
on
internal
processes
already
operating in the communi ty.
In the above format, the process review will have to consider
p e rsons
and processes these persons are involved in from the
project and individual points of view.
8
I
Persons will
be interviewed in an open-ended manner' in
the
spirit of
a "shared interview', where both
interv i ewer
and
interviewee make
a
joint search
for
a genuine,
hsared
understanding of
the processes seen/evolved during
CSCD
project implementation.
II
All
aspects of the CSCD project will be explored during
the
interviews,
and
evidence
looked
for
in quantitative
or
qualitative
terms to substantiate the
shared understanding,
eg . ,
1.
3.
4.
The history and evolution of the project.
The
Information
and services planned,
p rovided
and
problems, solutions evolved etc.
The utility and effectiveness of links with CMAI and
the
people for the project goals.
Innovations, setbacks and other such vari at ions seen
in
project implementation.
Specific other areas that will be covered during the? interview
will include both positive and negative aspects of
-
Evidence pointing to ENABLING AND EMPOWERING processes.
Evidence pointing towards SELF-SUSTENANCE processes.
Signs of commitment, cohesion and solidarity to CSCD goals.
Improvement in Technical competence, and Managerial ability.
Capacity for collective reflection, analysis and action.
Flexibility in approaches to suit local needs.
These
are
likely to yield
pointers on MECHANISMS
DIRECTIONS of the processes in the CSCD projects.
and
from these, the CSCD micro-projects attempts
Apart
influenced by
be
will
a. Other/External processes in the Community which
influence
the project
i.e., governmentalZNGO activity in
the
area
that help/retard project activity.
b . Processes within
the Community
itself
which will
i tse1f
be
influencing/influenced by the CSCD project.
Being
a
qualitative
review,
other
interesting
direct ions/process
independent
of
the
CSCD
project,
goals/intent ions which may have occured will also be
looked
for.
9
APPENDIX ‘S'
TRAVEL SCHEDULE FOR CSCD PROJECT EVALUATION
DATE
TRAVEL DETAILS
18.3.96
Bangalore to Mysore by Bus
Visit Mysore Rural Development Project
Mysore to Bhadravathi by Bus
19.3.96
Visit YMCA Bhadravathi Project. Stay.
20.3.96
Bhadravathi to Davangere by Bus.Project visit.
St ay.
21.3.96
Continuation Project visit.
Davangere to Bangalore by Bus.
22nd ?■/ 23rd
Bangalore - discussion & further planning.
24.3.96
Bangalore to Adoni by Bus
25.3.96
Visit Adoni Area Rural Development Project
Adoni to Hyderabad by Bus.Stay.
26.3.96
Visit YMCA - Narayanguda Project.Stay.
27.3.96
Hyderabad to Vijayawada by Train
Visit SAMATA project
28.3.96
Continuation of Project Visit. Vijayawada to
Vizag by Train.Vizag to Koraput by bus.
29.3.96
Project visit ~ YMCA Koraput
30.3.96
Koraput to Bhilai by Train
Visit YMCA
Bhilai. Stay at Bhilai
1.4.96
Bhilai to Amaravathi by Bus.Stay.
2.4.96
Visit Rural Evangelical Mission Project
Amaravathi to Nagpur by bus.
3.4.96
Return to DeIhi/Bangalore
10
II PHASE
15.4.96
Bangalore to Madurai by Train
16.4.96
Madurai Project Visit
Madurai to KanyaKumari by bus. Stay.
17.4.96
Visit YMCA Mui 1 ank i n av i 1 a i
18.4.96
Visit Vinnarasu Association.
KanyaKumari to Madras by Train.
19.4.96
Madras YMCA Boys' Town visit. Stay.
20.4.96
Madras to Calcutta by air & stay.
21.4.96
Calcutta to Silchar by air.
Silchar to Aizawl by bus.
22.4.96
Visit YMCA Tanhril. Stay
23.4.96
Visit Salvation Army & YMCA S.Hlimen
24.4.96
Visit YMCA Zemabawk
25.4.96
Aizawl to Silchar by bus
26.4.96
Silchar to Imphal by air
Imphal to Yaripok by bus. Stay.
27.4.96
Visit STNBA Project.
Yaripok to Imphal. Stay.
28 . 4 . 96
Imphal to Kohima by bus. Stay-
29.4.96
Kohima to Chizami by van.
30.4.96
Chizami to Dimapur. Stay
02.5.96
Dimapur to Calcutta by air.
Calcutta to Patna by train
03.5.96
Visit YMCA Patna. Patna to Delhi by train.
04.5.96
Stay at CMAI, New Delhi.
Consolidating Visit Reports.
06.5.96
Meeting with CMAI Community Health Team.
07.5.96
New Delhi to Bangalore by air
YMCA Moolanchal
YMCA Lungdai
*************************************************************
11
A
J
, ftWUT - Self AfrMiNisreRet>
I
I
~l~
I.
'
I
I
< AREA
1.
2.
i
' I •
3.
4.
5.
b.
7.
B.
9.
INDIVIDUAL SCORE
Training
Community Org.
& participation
Staff
Health Education
Health Bsrvicas
Subtai nab1111y
;• Development Prog.
MIS
Financial Report
WEIGHTADE
TOTAL
SCORE
10
12
2
1.25
20
15
10
9
51
9
24
4
3
1.2
1.11
O. 196
1.11
0.416
2
1.66
12
10
10
10
10
‘ 0
5
•i
1OO
Th* format In detail
1b encl dbecJ •
i
I'
I.
i a.
•’
, b.
Training
Project co-ordinator/Manager attended
No review meeting
1 review meeting
2 review meeting
3 or more review me*tlng
507.
757.
1007.
Percentage of CHVs trained
-X-
0
1
2
3
1
2
3
0
1
•n
c.-‘
CEO attended meeting with CMAI none
one
al 1
d.
Project co-ordinator/manager trained at
O
RUHSA / Oamkhed
No
Yee
2
Max. ecore
Mui11 ply with
i
II.
a•
*
Communi ty parti cipation/organieat 1 on
Mahila Mandal or woman** co-operative
/
Formed
Regi stored
I
b.
10
2
■
’
1
2
I
Other functionary group* (eg. Youth/farmere)
F ormed
1
2
Active
12.
I
I
c.
I
Local advisory committee formed
’ •
1
2
3
4
Meets once a year
Meets twice a year
Meets twice or more per year
I
I
<1.
Representation of women in local advisory committee
nil
0
upto 30%
1
,
31 % to 50%
2
more than 50%
3
I
Mqx . acoro
i
I
Required 15
12
Multiply total acoro with 1.25
III. Staff
■
a.
h
•1
o.
rorcentage of staff skilled 50%
75%
d.
Project co-ordlnator/managcr’s understanding of tho
objectives
nil
0
fair
1
good
2
c.
CHVtj understanding of thoir role
nil
fair
good
*
max. score
multiply with
■
r
!
1
n
Staff continuing in the i>rogram since lnccx»tlon
50%
1
n
75%
I
!
50%
75%
b.
i
i
Staff in position
1
2
0
1
2
10
1.2
IV.
Health
a.
Topics covered in one year (expected 12 per year)
Education
Less than 15%
15 - 25%
26% - 50%
Moro than 50%
12.-A
0
1
2
3
/
-3t>r
o.
Dcalth education sessions held per month
(expected 4 per month per.CUV)
Less than 10%
10X - 25*
26* - 50X
more than 50*
0
1
2
3
Purtlcipuuts at the session
(Expected 10 per session
por month per CHV)
4U
So, 10 x 4
less than 2b*
26 - 60*
rooro than 60*
1
2
3
D
1.11
Max.score
Multiply with
A • V.
a.
Health Services
Maternal euro
Woinon rocolvinfl 3 visits by an professional
0
less than 30 X
1
40 X
30
2
74*
50
3
75X and more
Women rccelvlDH full TT covcruH©
leas than 30X
30X
40*
74X
50*
more than 75X
I
I
*
0
1
2
3
»
i
i
Deliveries conducted by trained personnel
0
less than 30*
1
30 - 40 *
2
50* - 74*
3
75* and more
i
1
i
I
b.
i
Caro of under 1
Infant exclusively breast_fed upto bth month
40X1
60*
2
00*.
3
Infants weaned at 5 months of aae
40 X
60*
UOX
Itnmiinj
ion
BCG coveraao
40*
60£
9UX
13
i
i
i
I
i
1
2
3
1
2
3
I
I
i
I
<
-4-
c.
I
3 OW coverage
40X
60%
00%
1
2
3'
3 DPT coverage
40%
60%
00%
1
2
3
Hcaeles coverage
25%
50%
7 5%
1
2
3
Caro of under 2
Children with diarrhea received 0115
50 - 74%
75 - 00%
00 % & above
1
2
3
Vit.'A supplementation given to
25 - 40%
50 - 74%
75 % & above
1
2
3
API cases identified and reported
Appropriate action taLkcn
1
2
Growth monitoring
(Give maximum score only)
50 % children weighed once in 3 months
75 X
50 % children weighed once in 2 months
75 %
n
1
3
4
Malnutrition
50 % suffer from any degree of malnutrition 0
1
25 %
2
10 %
d.
Family planning
Women accepting family methods post delivery
1
30%
25%
( New acceptors )
2
40%
40%
3
50 % and more
Couples practicing temporary methods for more than
10 months
(denominator ~ all uses of temporary method)
1
25 - 30%
n
40 - 40%
3
50 % and more
U-A
\
V
E.
-
I
I
■
Minimum Medical care available
not aval 1 able
Gt
f v /. /
1
0
Maximum score
Multiply with
31
0. 19b
fVI.' Sustainability
a.
Financial contribution by Church/Agency
/
sox
SOX
' . Si
60X
61
7SZ •
more than 73X
!
.P
0
1
2
3
1
i
' ■ bO
(
CHVs salaries as a percentage of total budgeted
salari es
11 - A ’! .
25 - 397. .
1
40 - 497.
2
SO
and more
3
‘
i
c.
I
>
! I
Government support
No
Yes
O
1
Othar NOO support
No
o
Vw
1
Support from Church bodies
No
Yes
0
.! I!
i
!
pl >'GG
1
Total •
Multiply with
!
:
Vil.
i . a.
9
1.11
Development activities
Vocational training started
10 people participate
13
20
Dank loan la available
.5 families benefltted
- IO
15
c.
1
2
3
1
2
3
ti
Village crafts started
5 families bensfltted
IO
it
13
1
2
3
J4-
I
I
I
j
i
/
I
•i
V • .
i’. •
.■
■
\'d
Govt, programme introduced
' • •
5 families benefitted
15
1
2
3
e.5P:'. Assistance available from other NGOs
5 families benefitted
! r.
10
15
1
2
3
’10
.
"
i. s
,
i
. i
Beneficiaries of loan or tralnina employed or oelf
employed
0
Less than 25X
I1
25 - 39 %
2
40 - 40 X
3
50% and more
• 1
Adult education /F nonformal education started
10 people benefited
15
"
2
1. •
E.
20
h.
i
■
‘
r.
• J’
■
?; <■
i
”
Other devolopmental activities started Environmental
upgradation eg.
afforestation
smokeless chuln
—
construction of toilets etc.
1
5 families benefited
2
•
10
3
15
Max. score
Multiply with
. •■-! 1
"
i
I
24
0.416
? '•
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CSCD PROJECTS ANALYSIS DETAILS - CsT^7 €
LOCATION
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19°^.
nSLnNAME OF PROJECTS
n
LNo. P 2,7>l J AN No. B
n ..
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hl hSocio Economic Devet.
■*■
■_«■------------------------------------------------------------- ---------------------------------------------------
h2 hRural Evangelical Mission i
n3 nYHCA - Bhilai
■
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RO
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5 ?3
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to 2
«5 nYMCA - Davangeri
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h6 nYMCA - Narayanguda
3? ■ ^6i
fl 7 fiAdoni Area Rural Devt.
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1
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i
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1993
nSLnKAME OF PROJECTS
n
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APPENDIX *C'
DETAILS OF PEOPLE MET DURING FIELD VISITS
YMCA Board members/Others related
to project
not
directly implementing CSCD project.
CSCD Project Executive members — CEOs and PMs
CHVs employed part/full time to implement CSCD project
Other health professionals connected or not to CSCD
Pregnant women and mothers affected by CSCD project
Other village persons not connected to CSCD
CMAI's classification based on
monitoring
and se 1 fadministered questionnaire.
Re-classification considering
field
realities
and
processes evolved.
A
B
C
0
E
F
G
H
SI .No
Name
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Mysore Rur Dev.
YMCA Bhadravati
YMCA Davangere
AARDIP Adorn
YMCA Hyd'bad
SAMATA Vijwda
YMCA Koraput
YMCA Bhilai
REM Mahar.
P.C.Centre Madurai
YMCA Mlnkvli KK
YMCA Moo 1 chi K.K
Vinnarasu Assn
YMCA Madras
YMCA Tanhril
YMCA S.Hlimen
YMCA Zemabawk
Salvation Army
YMCA Lungdai
STNBA Manipur
CES Chizami
YMCA Patna
Total :
A
5
4
4
B
C
D
E
F
G
H
1
1
1
3
3
4
5
20
IO
20
15
5
5
5
10
25
20
5
8
10
5
6
IO
4
50
15
10
10
6
7
6
4
5
8
5
1
3
7
10
3
8
1
5
12
15
5
AA
AA
G
G
G
AA
P
P
AA
AA
G
G
AA
AA
A
P
A
A
P
A
A
P
G
AA
AA
G
G
A
P
A
G
AA
G
G
G
G
G
P
AA
P
P
AA
AA
P
187
192
26
6
2
1
2
1
1
2
1
1
1
2
1
1
2
2
1
2
1
2
2
1
2
3
66
31
76
19
3
4
1
3
4
5
1
12
2
5
9
3
5
12
4
4
2
2
2
2
1
•-y
Total No. of people met : 571
CHAI's classification;
Good - 5; AA - 7; Average - 5; Poor
5.
Reel ass ification after re v i eu;:
Good -9; AA - 6; Average - 2; Poor - 5.
C1 ass ification remains unchanged in - 9.
Classification upgraded in
10.
Class i f icat ion downgraded in
3
i
a
r*
22
I
REVIEW OF ACTIVITIES FOR CSCD - FIELD OBSERVATIONS
PROGRAMME OFFICER:
The CMAI considers CSCD project an important component
in
promoting the Community Health approach to make Primary Health
Care
a part of peoples' activity.
The CSCD project is under
the Community Health Department of CMAI,
with
a Programme
Officer taking all responsibility for the functioning of
the
25 micro-projects across the country.
The Programme Officer
independently handles all prob 1ems of the micro-projects, from
funding,
to training and liaison to monitoring
and
advisory
serv ices.
The Programme Officer is supported with advice
from the
Community
Health Department
during
their regular
staff
meetings,
when the status, problems etc. of the projects
are
highlighted and discussed.
Implementation processes receive
prominence during such meetings, with a global perspective of
the CSCD projects.
The Programme Officer works out details
suitable to individual micro-projects.
1)
as
in
present incumbent CSCD Programme Officer came
The
He h as been
of projects had been completed.
the
selection
involved in
- visits to projects for on-site assessments;
- conducting training programs for project holders and staff
as per their needs;
of
the
form projects as part
- receiving
reports/returns
monitoring process, including advise; and,
the
- handling fund-related and administrative problems of
projectsand
The
needed
liaison
correspondence
1iaison networking,
also
documentation
for the CHAI in this project activity are
attended to by the Progranie Officer.
is
As part of the Community Health Department of CHAI, he
activities,
related
also
involved in other Community Health
co-operating with colleagues of the department.
The
above processes have been educative
and capability
building in nature for the Programme Officer providing a range
of perspectives in Community Health from the micro-projects .
The distribution of the microprojects across the country have
helped cross-fertilization of
ideas
and
initiatives
from
varied situations unique to each project/1ocation, yet useful
somewhere
else.
The programme officer not being
a medical
professional has helped promote community perspectives well,
though
a handicap
at tackling medically oriented project
initiatives
is noticed.
He has effectively made use of
medical
expertise
at local levels, which, to an extent has
'medicalized'
some projects, detracting from the Community
Health/Primary Health Care approach viusalized by CHAI.
23
I
2.
MICRO-PROJECTS;
The CSCD micro-projects have already been tried and tested
an initial round evaluated in 1991 as mentioned earlier.
in
The
in
locations for micro-project work have been well chosen
areas of dire need and lack of access to health care.
The
training programs, curriculum and resources for
train i ng
have been
well selected and organised.
The mix of g roups
t r a in ed ,
locations for training and frequency have been well
p1anned ,
to help the evolving micro-project,
with
adequate
attent ion
given to the Community Health
volunteers,
Proj ect
Managers and Chief Executive Officers roles.
During field visits,
all micro-projects.
the following observations were common to
a)
A request for further training programs to help them
beyond CSCD, to make CSCD sustainable.
b)
A request to help micro-projects identify other development
needs in their area which could mesh with CSCD and
Community Health perspectives.
c)
to help the micro-projects in conducting training programs
locally, in regional language, for
•for a larger number to their
project personnel.
Language
facility and communication in English has been
as a major problem by micro-projects.
go
seen
This was observed during field-visits, when the micro-projects
have not been able to effectively communicate their work
and
involvement through reports/returns, though adequate provision
for the same has been made.
A major implementing group have been the YMCAs, with 13 out of
25 micro-projects being held by YMCA.
4 of these YMCAs are
well
established, 2 are yet to be affiliated to the National
Council of YMCAs, and most have only CSCD as a project
in
health.
24
The
YMCAs
being similar
in
terms
of
administration,
re 1 at ionship
to the National Council of YMCA,
and overall
perspec t i ves in terms of the YMCA movement, the following have
been observed
to affect the CSCD processes
implemented by
them.
a) The YMCAs being governed by a Board of members, who are
otherwise employed
and
involved
in numerous
other
activities,
CSCD
is
just one
of
the
initiatives,
dependant on
a full-time Project
Manager.
Manager.
They are
handicapped when
a change of P.Ms occurs,
especially
occurs,
when it is the transfer of a YMCA trained secretary
for
project implementation.
b) Frequent changes in the
elected Board,
and
annua 1
changes as seen in the Mizoram projects changes the CEO
of the CSCD project as well.
c)
A frank opinion expressed by the President of a YMCA was
~
"We are all men here, and the CSCD related
to women
and children. We take time to really understand and work
to be effective in these circumstances".
This
lacuna
has been obviated in YMCA Patna, where women members are
also on the YMCA Board.
ci) The newly established YMCAs have yet to make an
impact
in other areas of work, to support
CSCD effectively,
They do find CSCD as a good initiative
towards social
and community relevance of their work, and are happy
to
be 'different' in their perspectives.
e ) The YMCA projects are also caught in
the dilemma of
catering
to some needs of their own membership,
wh i 1 e
promoting
a social concern like CSCD, which may entail
entirely different sets of activities.
25
I.
PROCESSES INITIATED AT CHAI HEADQUARTERS
1.
Evolving the Child Survival Child Development project as a
Community Health oriented initiative, focussing on Mothers
and Children, for the most needy areas of the country.
2.
Developing this idea through trial, testing and evaluation
during
an
earlier phase between
1988
to
1991.
This
includes a manual, methods of recording and reporting, and
information
for technical support in a simplified
format
for implementors.
3.
Selection
of
suitable
implementing
agencies
(at
25
locations across the country) that are non-hospital
based
Christian/Socia1 Service organisations.
4.
Appointing a Programme Officer (P.O.) at CMAI headquarters
vested
with
full responsibility for all aspects of
the
project.
5.
Providing
adequate backing
to Programme
Offic e r
in
resource
mobilization, training, networking
and
1i a i son
for implementation of the project.
6.
Monitoring of the technical aspects of
project
activity
p roj ec t
through the Programme Officer's reports at staff meetings
with
the Community Health Department team of CMAI.
The
administrative, and finance aspects being monitored by the
concerned departments at CMAI headquarters.
7.
Developing of an internal monitoring and advisory system
through
- regular monthly reports/re turns from micro-projects
- evolving a self-administered questionnaire for the Chief
Executive Officers (CEOs) and Project Managers (PMs)
of
the implementing agencies, referred to as micro-projects
of the CSCD program.
II . PROCESSES BETWEEN CMAI—HQs and CSCD micro—projects
1.
Training programs for the CEOs, PMs and
Common i ty Heal th
Volunteers (CHVs) for
- Orientation
to the CSCD project philosophy,
Primary
Health Care concepts and Community Health approaches;
- Methodology for need-assessment and steps to meet
the
needs of the people of the area for CSCD; and
- Reports, returns, monitoring of the projects, including
technical, managerial and financial aspects.
(Details
of training programs - numbers,
locations,
who
at tended , curriculum and resource persons in Appendix-B)
26
il ITT
This
'Direct contact'
as mentioned
in
the
activity
profiles of each organisation seems to be the underlying
reason why
- people recognise the CSCD effort
and participate in CSCD activities;
- CHVs are under pressure to learn more about
health and dissemination of information;
and
the implementing agency learns of people's needs
and has to evolve methods of tackling them.
Con versely,
the
lack of popularity of
mass communication
methods both
the
organisations can ve
among
people and
und e rstood in this context.
Health as
it emerges is an i n tense 1y personal
and
family
activity,
best
addressed by direct contact
uii th
the
clientiele.
Apart from a real need, the 'medicalization'
of
p rog rams
as commented on
at several
places,
could
be
attributed to the personal and direct contact provided there.
3.
In agencies where community organisation already exists as
a basic strategy for other programs, the CSCD efforts
are
being
integrated easily.
Also, the number of
CHVs have
been
reduced
in most organisations to 2 or 3 f rom the
original 5 appointed for reasons of
- ease and familiarity of CSCD implementation
- weeding out of those CHVs who are ineffective, and
- difficulties
in payment for a larger number,
since
CHAI funds do not support salaries of CHVs.
The need for atleast one full-time worker to ensure CSCD
program effectivity is felt by all organisations, lasting
for
full
3 years of the program.
This is acutely felt when
such
persons
leave
the job mid-way for various reasons
and
a 1 so
when
continuity of program is disrupted
whenever part-1 ime
CHVs shift to other jobs,
Th is is a recurrent theme when
the
ups and downs of the CSCD m ic ro-pro j ec ts are studied.
During
d iscussions
at
various
micro-proj ects,
the
me thodo1ogy of integrating CSCD goals with other development
activity in the area is not yet clear to the
implementors,
since
they still
perceive CSCD as
a separate
activity
requi ring Medical/Heal th professionals.
Many organisations,
especially YMCAs have activity which is membership
related,
and
away from project location to enable integration.
Also,
focussing
on specific groups,
like orphans,
vocational
trainees, etc., makes integration difficult.
29
4.
Sus t a i n ab i1ity;
The sustainabi1ity of CSCD activity beyond the 3 years
p1ann ed
is related
to
integration
into other
non-CSCD
activity, which is yet to occur in most agencies.
ic,
A systemat
systematic,
continuously developing
CSCD proj ect
ov e r two years could lend itself to
activity over
i mplament i ng
a
and handing over phase during
withdrawal
the
th i rd
year,
making it sustainable.
The
practical
aspects of
ups
and
downs
in CSCD
functioning at micro-project level added to lag periods due to
postal, bureaucratic , fund-flow and information flow problems
has made this a difficult ideal to reach.
□n the field, the actual conditions observed are,
there
is adequate information
(knowledge)
dissemination,
with
attitudinal
and practice changes
lagging behind
and
needing the facilitatory activity of CSCD personnel.
- Adequate levels of community organisation to be able to hand
over the CSCD activity to people is yet to emerge
in
a 1mos t
all
places,
except
two viz.,
Vinnarasu Association
at
Kanyakumari and AARDIP at Adoni, A.P.
an
emerging need of the Community to be
ab 1 e
to handle
common/minor ailments and
ability
to recognise
se r ious
illnesses at peoples' level itself without complete dependence
on medical aid from outside.
(Utilization of safe herbal/home remedies
knowledge
already
available
with
the community, but
marginalized due
to a
dependant attitude on Western medicine has been brought to the
notice
of
executives/CHVs of
the
micro~projects
dur i ng
discussions with them.
Also, the need to transfer demystified
medical
information on why diseases occur/what
first-aid or
immediate help is needed, etc
etc.. has been discussed).
—
the areas selected for CSCD implementation being
the most
needy
in all aspects, more inputs in the following areas
are
needed before sustainabi1ity can become a reality a) Social and economic programs to fulfil basic needs of
the community viz: employment, food security, safe
water and housing;
b) nutrition education/supp1 ementat ion
appropri ate
to
local conditions and needs; and
c) General education and awareness to overcome gender,
class/caste, cultural and other traditional biases
hindering development. Also, bringing into reach of
these people, various programs from the Government
and Voluntary agencies addressing these and for other
development purposes.
30
Considering these, the requests from most agencies to
continue the CSCD support to them for at least a year
or
two more is justified.
A planned strategy to
effect withdrawal over a period of time is not yet
a
part of the micro-project thinking.
An oft-repeated question by the review team while
talking to people was - "We hear the CHVs are doing
good work with you.
We would like to take them to
areas where there is more need.
What do you feel?"
The peoples' reply was very telling - "We need them
for a year or two more - may be you could take them
away then.
We could help others too, after that!"
IV.
PROCESSES seen AMONG PEOPLE met at CSCD mic ro-p ro jec t areas
1.
Those related to CSCD projects.
Those related to non-CSCD/other initiatives.
Independent
processes conducive
to positive
Health.
Communi ty
1 . a)
of mothers and children, regular fol louifor CSCD needs has
created an awareness of their life situation and
that
improvements
can
be made
by
themselves,
with
Government and other voluntary agency help,
focussed
their concerns on the needs of
women
and
children in the community,
made
sense
locally of
the
Government mass-media
efforts on Mother and Child Health
Immunization, OPS,
Family P1anning/We 1fare, etc.
These, and most importantly the idea that other people are
concerned
about them has brought in a feeling of being
a
part
of
the
National
mainstream,
and
not
a
neg 1ected/ignored population.
-b )
The frequent contacts with friendly CHVs has also helped
them voice concerns about other health matters which
they
feel important, like -
The registration
up and education
- tackling of minor/common health problems at their level
i tse 1 f
- avenues that can be explored for low-cost medical
care
from surrounding areas, and
- promotive,
preventive and
rehabilitative
measures
related
to water-supply and sanitation,
nutrition
and
hyg i en e, care of the elderly and disabled, schooling and
non—forma1 education, etc.
-c)
The community have been enabled to understand the need
for participation in health related activity overcoming
caste/class and other social barriers.
31
A
09595
z
The communities
commun i t i es being organised for othe r purposes on
political,
social,
ethnic, religious lines, do not yet
soc i al ,
for Health,
the need
for Community Organisation
feel
though
they favour participation if/when others organ ise
for the same .
2)
It
i s only a few agencies that
have
well
estab 1ished
Community
developmen t
development
initiatives,
w 11 h
commun i ty
organisation.
Some
micro-projects
as
at
Adon i,
Bhadravathi and Vinnarasu Association Kanya Kumari,
have
communities organised for various reasons, ranging
from
Survival imperatives, to po1i t ica1 and statutory needs,
Host
of
these
are related to
obtaining of
resourc e
benefits
f rom
the Governmen t
other
and
Valuntary
Agencies,
though not averse and able to tackle
internal
conf 1icts,
evolve common goals and
lead
to comb ined
act ion.
They have histories of more than
five
to six
years.
Integration of CSCD activity into this
f ramework
has been smooth and e asy.
Commun i ty organisation for development and health
(also
CSCD) initiated at organisations in the past two to three
years are yet nascent and will need time to mature, since
p eop 1e still view these efforts as the initiatives of the
volun t ary
agencies cone e rned,
and
not
their
own.
Levelop i ng
a sense of
'OWNERSHIP',
as seen by the
Hyderabad YMCA seems to be the stumbling block.
3)
People are upgrading ’Health" to a higher priority
among
their basic needs and are willing to invest in it
as a
resource
for better life conditions.
This is man i tested
in the following
- seeking and participating in health initiatives by the
government and voluntary organisations;
- exploring
low-cost,
self-help
and
appropri ate
interventions to tackle morbidity;
- developing
an
awareness of
their
rights
and
responsibilities as consumers of the health industry.
- looking at health implications of occupation, education,
environmental degradation and development; and,
- expressing concern
in
various
ways
for
those
marginalized
in
terms of health,
like
the
aged,
disabled, children and women.
32
*
I
A.
STRENGTHS / WEAKNESSES / RECOMMENDATIONS
AT CMAI HEADQUARTERS
STRENGTHS?
1 ) A well
conceived, planned, monitored
and
evaluated Health
project
addressing the most-needy, for implementation
through
non-hosp i t a1
based organisations with simplified,
demystified
methodology providing them adequate technical support.
2) Wei 1
selected (development oriented)
implementing
agencies,
given
appropriate
training to bring Health work
into their
amb it .
3)
Low-cost,minimal and appropriate documentation,
establish
direct
contact
with
people
are
h i gh 1 igh ts .
and ability
to
the
projects'
4) Non-medical Program Officer vested with
full
responsib i1i ty
for
all
aspects of the project, supported
by
the Community
Health Department of CMAI.
5 ) Transfer of ability to identify and
initiate Health Action
beyond
project needs and in directions appropriate
to
local
area.
WEAKNESSES:
1 ) Scattered distribution of micro-projects across the country,
varied
nature
of populations
addressed
and problems
of
communication with them makes for a fairly rigid,
centralized
planning
to
meet
their needs.
Hence,
responses
to
immediate/urgent needs and flexibility to suit
micro-projects
evolution becomes difficult for a Programme Officer.
2) Extensive and tiring travel needs for training, monitoring and
follow-up of the Program Officer and Project holders makes for
less contact
than optimum between these persons - a key
to
evolving appropriate solutions to emerging situations.
3) Med ical and Public Health initiatives to suit the differing and
evolving
natures of each micro-project (though not part of
the
project, yet affecting it)need technical support from the CMAI
HQs
(eg.
in endemic areas of Malaria,
Kala-azar,
etc.,
and
drought-prone or water-logged areas)
RECOMMENDATIONS:
1) Decentralized training, monitoring and follow-up facilitation
through regional CMAI membership adequately trained for project
needs.
Regional language usage will make them more appropriate
to peoples' needs.
33
I
2) Clustering of micro—projects
regional networking for them.
and
developing
of
adequate
3) Public Health advisory visits for technical support by Pub 1 i1c
He a1 th/Medica1
personnel
from or nominated by CMAI
HQs,
familiar with project goals.
4) Extending of support for a total period of 5 to 6 years to help
projects:
- get over problems of understanding
implementation as
they
need to work at the peoples' pace.
- develop
and implement a strategy for
sustainib i1i ty
among
peop1e.
- support other health action initiated by micro-projects
to
shift local needs and problems.
The
present 3 year phase could be a mid-point to determine
what
support the micro-projects need and taking appropriate action,
to
go beyond CSCD.
B.
AT THE MICRO-PROJECTS
STRENGTHS:
1) Recognizing Health work as
a
soc i a 11y—re levant
initiative
bringing the organisations into closer and direct contact
with
people and their needs.
2) Ability to demystify and innovate simple methods of
health awareness among the poor and needy.
spreading
3) Understanding
and utilizing
the
available
Government
and
Voluntary agency initiatives in Health in local needs, with
a
good coverage in Immunization, Family Welfare and Maternal
and
Child Health achieved.
WEAKNESSESs
1) Dependance on
local medical
personnel
for
tackling minor
i1Inesses and
endemic d isease
problems,
who
'med ica1i ze'
intervent ions,
making
them
'c1 in ic'-based,
rather
than
Commun i ty-based.
2) Difficulty
in mobilizing resources for peop1es'
f e1t-n e eds
beyond
CSCD,
like Balwadis,
supplementary nut r i t ion
for
children and mothers, etc.
3) Difficulty in liaison and networking with Govt.
agencies
agenc i es and
between regional CSCD/other Volag activity, and looking towards
CMAI for the same.
34
1
4) Paucity of motivated staff, staff turnover and other staff
related problems due to low honoraria offered and dependence on
training on CMAI mainly.
5) Giving
inadequate thought and action
to make
the project
sustainable as a people's activity, and finding ways and
me ans
of addressing their immediate and emerging health needs beyond
CSCD.
6) Dependence on CMAI to sort out all issues which emerge out
CSCD activity.
of
RECOMMENDATIONS;
1 ) Evolve ways and means of tackling common/minor disease problems
using traditiona 1/1oca 1/herba1 knowledge already available with
peop1e.
2) Utilize peop1es'
participation emerging as outcome of
the
project
towards making
it
a peoples'
activity wh i ch
is
sustainab 1e.
3) Moving away from the ‘medical' and 'curative' solut ions wh i ch
are high-profile to preventive and promotive in i 11at i ves uih ich
strike at the causes of health problems.
4) Network
actively with Government and Local
towards combined action for Health.
5)
agency
Integrate Health into all other development activity in
their
work,
from Non-formal Education to Income-generation, and
not
keep them compartmentalized as separate activities.
35
I
Voluntary
APPENDIX
'D ■
L INDIVIDUAL REPORTS OF 22 CSCD MICRDPRQJECTS
CSCD MICRO PROJECT X
1 . Details of the Project
a. Mysore Rural Development Project - Karnataka
Date of starting project - 1.1.1993.
b. This project covers 6 Villages, approximately 25 km from
Mysore City,a population of 6000 mostly SC and ST, uj 11 h
75% below poverty line.They are Daily wages labour, Rura 1
~agriculture , and urban - construction work.The levels of
literacy are low and health conditions poor.There is one
PHU for medical needs in the area,and No other voluntary
agencies.
c. The CEO has implemented a CSCD project earl ler in a Tribal
area at Periyapatna. Now, he has selected a nearer area with
similar problems for better implementation.
The difficulties he has faced are due to
new area,
t ecruitment of Local Health Volunteers and Fund — flow problems.
Interviewed:
1 CEO, 2 CHVs, 20 Mothers, 5 youth.
2. CSCD Ac 11v i ties
a. Registration of Mothers and Children, Follow up as per CSCD
guidelines being done,ensuring good direct contact with them.
b. Special efforts have been made to overcome Caste/Class
differences through education. Utilization of all services
from PHC, including an Ayurvedic Dispensary is promoted.The
credibility of staff is good with people,who participate well
in CSCD activity.
c. Record keeping is adequate and reporting is regular.
CHVs are from local area and familiar with people.
Utilization of Growth-monitoring cards for education of
mothers needs to be promoted.
3. Non—CSCD Ac tivities
a. Non-Formal Education of mothers directly helpful to CSCD
activities.
Dispensary for minor ailments and Medical <camps ‘helpful to
’
the
community, utilizing Government Medical personnel.
Balwadis supported by CMAI for'a period of one year started
as a logical extension of the CSCD effort.Thi s was handed
over to the Government, with people paying for the Teacher
employed.
36
b . Overcoming of Class/Caste differences in area through
special efforts in all contacts of staff with people,
despite separate Anganwadis run by Government for different
castes.
Community participation in project activities good due
to
direct contact with people.
Community Organisation still in nascent stage,
with
the
Hahila Mandals recently formed (2 months)
and not yet
active.
4. Pe1 at ionsh ips / L i a i son
a. With Government -good -as mentioned above with the
Health
Services.
Their credibility
and
liaison wi.th- • -.Soc i a 1
Welfare Department/ICDS also very good.
K -C.
b . Networking with Voluntary agencies outside area - *yet
to
start. Help of Church related organisations - Diocese, CTVT, etc.
is being taken.No other Voluntary agencies work in the area .
c.
Community not yet ready to take over responsibility for Health.
5.
Discugsions/Suqqestions during r e v i e w t e am visit
a. The morbidity due to minor ailment^ is still high, desp i te
dispensary and PHC ut i 1 i zat ion i^-hey are
main1y,
season a 1
Respiratory, / G.I./ Skin diseases.
To explore local/herbal medicine initiatives as an enabling/
empowering process.
b . Focus on Community Organisation - to be able to hand
to people — the work being done by the project.
c . Consider organisation of youth and
employment
for them to tackle economic probl ems.
ove r
generation
d. To focus on nutrition education.
e . Potential areas of development include
- School Health
~ Adolescent/youth education - especially girls.
- Womens' Health.
f. CEO in process of planning for Integrated development work
in larger area of 31 villages with Diocesan and CTVT help,
To
consider all the above to add to experience already gained.
Q-
To utilize mass-education methods and Government Health
Education
resources
as well as Voluntary
agencies with
expertise outside the area.
37
I
6. Summary of Processes
a. CSCD activities systematic and with adequate understanding,
well organised and documented, good community participation.
b . Good liaison with Government agencies in heal th, soci a1
welfare and ICDS (Child development).
c.
Logical extension of CSCD into Pre-school. Anganwadi started
and handed over to Government.
d . Community Organisation - Mahila Mandals just
not yet estab1ished/active .
beginning
e . Require about 2 years to hand over activities to Government
or peop1e.
CSCD Micro Project II
1 . De tails of the P ro j ec t
a. Y.M.C.A. Bhadravathi.
Date of starting project 1.1.1993c
b . Wor k in two urban slum areas in Bhadravathi - Ve 11ore Shed
covering a population of
approx imate1y
and
Zinc
line,
5000.A majority J. i v e on Daily-wages and areas like -Domestic
work/ factory labour/petty business,
1abour/construetion
vegetable
vending,
etc. The literacy and socio economic
levels are poor. The Zinc-line community is well organised,
b e i. n g a large S.C. settlement.
c . This is
IS a newly established YMCA, affiliated to the National
council.CSCD is their first project and their well- trained
Project Manager left after initiating this project. A new
Project Manager has been appointed recently - not yet well
oriented.
They have shifted from Fishermens colony to
Vellore- Shed slum, finding a greater need here.
e.Interviewed- YMCA Board members—6; CHVs—3; + 1 TBA,
Doctors/Nirmala Hospital Staff-3,Mothers/People-15.
2. CSCD Activities;
a.
Registration of Mothers,ChiIdren as per CSCD guidelines
being done. Immunization and follow-up adequate,though
Documentation not adequate/regular.
38
b.
Weekly dispensary (Health Camp!) facility at each of the
locations
(Wednesday and Thursday)
with doctor
f rom
Nirmala Hospital and private doctor - FREE OF COST.
Zinc
line Community have
provided
a place
and
are
constructing a new room for medical activities as commun i ty
con t r ibut ion.
People have adequate information/practice of immunization,
ANC and PNC.
They are well backed by Nirmala Hospital
(Catholic Hospital) for hospital based facilities. This h as
led to Medical orientation of activity with Preventive
and
PHC Orientation minimal.
YMCA Board members cite Medical
entry point for CSCD activity.
activity being used as
an
Records/Reports - not well planned/executed due to leaving
of Project Manager and new person not yet well
oriented .
YMCA Board Members
are also not well
oriented
to this
activity.
d . CMAT. Classification
~T
Above average.
Non CSCD Activities
NFE for women(is being assisted by CMAI. ) , and Tailoring
ac t i v i ty
to
CSCD
for girls,
- Not
connected/related
activity.
issues of
Seminars/Symposia for youth during vacations on
topical interest - separate from CSCD activity.
4 . Re 1 at ionship /L i a ison:
a . No
1i aison
with
Government
agencies
formal 1y.
CHVs/Organisat ion helped in Pulse Polio campaign with good
success.
b . Good liaison with Nirmala Hospital and a P r i v a t e doctor for
medical activity, They are able to obtain free/coneess ional
and necessary help
for needy people of
area.
TBA in
Vellore shed also helpful in CSCD activity, as a volunteer.
c . Well
organised community already at Zinc
lane.
Liaison
with them and obtaining of place/new room built freely as
community contribution to YMCA - CSCD activity.
Community
participation
good
both
areas
at
enthusiastic/committed activity,
They have good
community and are well accepted.
" 39
due
to
contact
CHVs
uii th
due
YMCA Board members not deeply involved
employment needs and need proper orientation.
to
their
own
5 . D i scuss ions during revi eui team visit;
orientation to Preventive and Primary Health care
Staff
concepts.
for
t ack ling
remedies
Introduction of Alternatives/Home
minor ailments.
Education for Girl Child/Women on Health.
Socio-economic development activities, especially for youth
and their involvement in health.
Shifting from 'Medical' orientation to handing over activity
to peop1e/peop1es' organisations.
SUMMARY
Record ing
good ,
Participation
activities good .
1 . CSCD
inadequate.
Newly established YMCA therefore few other activities helpful
to CSCD.
agenc i es
3. Good
relations
for medical needs with Volunt ary
hospitals, Nil with Government.
to
4. Selected one area with good Community Organisation - have
utilize full potential for handing over health to people.
CSCD Micro Project III
1 . Detai Is of the Project;
a. Y.M.C.A. Davangere.
Date of starting project 1.1.1993.
b . The selected population is Rural - 6 villages - with
is
Access by road
approximate population 3,500 plus,
and
in socio-economic
difficult;
the population poor
1abour
in
ag ricultural
in
health
terms,
involved
dry/irrigated areas. Select ion is need based.
c.
This is the first project of this newly established YMCA,
affiliated to National Council.In addition they are operating
and
in urban slum area of 800 population,
where Tailoring
attempted
NFE Activities are conducted for women.They have
wi th
liaison with Government for socio-economic programmes
no success.
They had established a FREE Clinic at a village, which was
recently closed due to local political factors.
40
e . Met 4 Board members,! CEO/Medical team - 2 doctors/3 CHVs72
AWWs/1 Government Health Inspector/20 mothers and 5 others.
'n
CSCD Activities;
a. Registering of mothers/chiIdren as per CSCD guidelines with
good follow-up. Contact regular and good.Records and Reports
exemplary and simp 1fied/systematic.
Awareness levels of
b. Good rapport of CHVs with community.
people good. Activity restricted to CSCD project.
Activity of camps/clinics/dispensary medically oriented
and
clinic recently stopped.
Have not been able to influence Anganwadi activity in Kuru.ba
locality.
Good
Liaison with upper classes of
village who
permit CSCD activity with understanding of peoples'
needs,
despite local politics.
c. Well running CSCD with good recording,
especi a 11y g rouith
monitoring, immunization, etc.
3. Non-CSCD Activities:
a. Tailoring/NFE in urban area not related to CSCD activity in
rural community.
Nil other activity.
b . Attempted Income Generation Programmes of Government for
rural areas, with inadequate success.
4. Relationship/Liaison
Government Services: utilize Government Health Education
and Immunization services well for CSCD programme.
b. Voluntary Aqenc i es: Utilize advise and services of Doctors
of
Medical
College
for running of
CSCD
programme,
especially of Community Health Department. Hence able
to
have systematic and well documented programme,
CHVs
also
well trained . - .
c.
- Good level of awareness among people on CSCD, due
to a
good direct contact and follow-up.
- Good liaison with members of different class/caste groups.
- CHVs well-trained/enthus iastic/effective .
time
required
- YMCA board members unable to devote more
for
programme
due
to
personal
work
commitments,
the
'Medical‘
approach is strong.
Involvement mainly in
Clinic approach to Preventive care.
Mass education and
Community Organisation to be promoted.
a.
41
W '1
5. Discussions
a) To focus on Community Organisation of Village Health
Committees/Youth groups/Mahi1 a mandals etc.to enable local
decision making process.
b) Alternative systems/Herbal medicines for minor aiImen t
treatment.
c ) Utilization of Government and other NGOs
as
resources
for development activities in area.
6.
Summary
a) Neu»ly established YMCA with separate activity at Urban
level, not linked to CSCD program in rural area.
b ) Good rapport of CHVs, with community,
Participation
and
awareness in community of CSCD activity good.
c ) Excellent,
systematic,
simplified
documentation
of
academic standards,
with involvement of Community Health
Professionals from Medical College.
d ) Local problems have restricted utilization of Government
programs,free
medical clinic and such welfare measures
in
the villages.
e ) Community Organisation, Minor- ailment tackling with local
resources/herbal medicine.
CSCD MICRO-PROJECT IV
1.
Details of Project
a) Adoni Area Rural Development Initiatives Program.(AARDIP)
Date of starting program — 1.1.1993.
b) This project
covers - 4 villages, around 25
kms from
Adon i town,a chronic drought affected area,with a Poverty
ridden/SC and ST population of landless labour -approx.
1900 fami1iesZBOOO+popu1 ation.
c) Started
as Integrated Development project
for p o v e r t y
alleviation.
Have been tapping Governmental
and other
programs
as
available, Linking up with other NGOs and
programs
in district to build a good network of peop1es'
organisations towards a peoples' movement.
d) CEO/PM;
2 CHVs, 2 Animators, 2 ANMS,
2 Act i v i t ists,
Others 25,
.
2.
C.S.C.D Ac t i v i t i es
a) As per CSCD guidelines • Registration
~
’
of Mothers/ChiIdren,
and
Direct H.E./Immunization through Government.NEE for
mothers for Integration into non-CSCD activities.
42
6.
Summary
a)
b)
c)
d)
e)
Project wholistic in approach for overall development
in
well selected area where people are still struggling
for
survival.
CSCD well
received and integrated
and
part of other
development activity.
Community Organisation <and participation - good,
with
leadership in networking of NGOs> in the d istrict.
Poverty and related problems of nutrition/
education
being tackled - needs a
long
time
despite
good
organisation and participation, due to lack of
needed
resources.
To initiate me asures to put Peoples's health i n peop1e ' s
hands by p romoting
trad itions/cultures conduciv e
to
h e a 11 h .
CSCD Micrg project V
1.
Detai Is of the project
a) YMCA Narayan aquda
Developmen t
and
department
Hyderabad, Andhra Pradesh.
Date of starting project — 1.1.1993.
Soo i a 1
cone e rns
b ) This project covers 8 villages as part of a larger set
24 villages.
of
Dici not visit villages due to local YMCA problems & 2 CHVs
having
shifted to other jobs.
Work stagnant for past 2
months.
I had visited these villages during the 1991 evaluation,
and Programme Officer CMAI twice in past 2 years.
c ) This is <-a part1 of YMCA's plans for Comprehensive Sustainable
Rural Development near Secuderabad in
z:<+ villages
in 24
villages taken
taken up
on criteria of backwardness. They are in
3
sets
in 3 sets of
of 8
villages each,with work shifted to the next set
every
every 2
years. The 2nd phase of the program is nearing completion.
Fund
flow and
internal
problems of
YMCA have
been
interfering with project.
d) CEO/PM - Mr. Boneventure
2.
CSCD Activities
a) CEO has utilized learning from
'
earlier project.
A
approach is through schools and
-- school
----- 1 ch i 1 d ren i n
educating the community.
44
major
The project has established Mahila Sanghas, where Training
& Education have been given importance. NFE, Tailoring,
Kitchen gardens,
Legal education for women
and socioeconomic programs.
They have
also initiated herbal-medicine use
•for minor
ailment management.
b) Special efforts have been made to build
a sense o f
’•OWNERSHIP"
among people to make the development
e f forts
sustainab 1e.
They have been transferring experience
from
working with urban poor and street children to rural area,
effectively.
c ) Records/Reports adequate.
d) CMAI's classification - GOOD.
3.
Non-CSCD Activities
a) Savings schemes
in Mahila mandals and
obtain inq of DWCRA
support.
b ) Interactive seminars on National Integration, Superstitions
and Social ills, Legal issues of poor and women,etc.and
celebration of events like Environment day, World Health Day,
etc. at village centres. Each-one-teach-one programs for
1iteracy,Vocational training for youth, Rotation Chick,
Baby show and other such innovative programmes etc.
4.
R.e 1 a t i onsh ips/ 1 i a i son :
a) Good relationship with Government Health Services/PHC
for
immunization,
maternity and Health Education Services.
Also,
liaison with other Government agencies/programs
in
Integrated development efforts.
b) Networking for combined action and solidarity with other
voluntary agencies on issues concerning poor.
Discuss ions
to enable networking at peoples' level
for
transfer of
knowledge and processes.
to consolidate herbal medicine initiative- to tackle
all
minor ailments in area.
to
involve volunteers from other systems of medic ine
in
rural development work.
to help spread their experience and understanding to other
fledgling voluntary agencies in need.
45
CSCD Mic ropro j ec t VI
1.
De t ai1s of Proj ect
a) Society for Ameliorating Mass and Tribal Action.
- SAMATA, Vijayawada.
Date of starting project
1.1.1993.
b ) The project covers 10 villages in Mylavaram and A.Konduru
40
Krishna district,
approx.
km.
f rom
mandals
of
V i j ayawada.
The former, with SC population and latter with tribal Lambadi
population, totalling approximately BOOO.
c) This Voluntary
agency started 7 years back
1 n well
identified area of great need.
CSCD is their only project in area at present,
no
with
other
activity for heal th/development.
Wark
re 1 ated
to
fund flow.
Activity stopped since Dec '95 as CSCD project ended.
d) Met CEO/PM
1 ; CHVs - 12; P eop 1e-75.
CSCD Activities:
a) As per CSCD guidelines, in registering and follow-up.
b ) CSCD messages have reached people,
though practice
is
inadequate.The CHVs employed are all male. Hence,
contact
with mothers for proper ANC/PNC not satisfactory.
Most ANC/De1iveries are at Government PHC facility 30
k: m
away .
People
incurring heavy medical
in
expenses
h ands of
private practitioners
Kalajathas with CHVs done earlier to spread CSCD message.
Co-operative effort in Pulse polio very effective.
Their efforts have been mainly to try to create
awareness
among people.
c) Records/Reports adequate - maintained upto Dec '95 only.
d) CMAI Classification — Above Average.
3.
Non CSCD Activities;
- Thrift programs and Mahila mandals have just been initiated,
~ No other activities in area of development - to help CSCD.
- Land patta and housing schemes of Government - an awareness
being initiated.
4.
Relationship/Li aison;
a) Co-operating with Government in Health care programs.
b) No other Volags in area.
5.
Discussions
a) To take up other development
act i v i t i es,
includ ing
employment generation for youth.
b) Strengthen self care capabilities of Community with herbal
med ic ine.
c ) To organise Community - towards handing over to people and
focus on social problems.''
46
CSCD Microproj ect VII
1.
Details of Project:
- YMCA - Koraput - Orissa
Four
villages - 25 kms. and over
from Koraput.
Tribal
population with high illiteracy levels and working as
agricultural
labour at low wages.
Villages cut off
f rom
main
road
and Koraput for 4 months in
a year due
to
flooding
and bad access roads.
Considered poorest
areas
of Koraput district which Prime Minister has also visited
- no
improvement despite such attention.
Now,
Koraput
district
(as large as Kerala) has recently been divided
into 4 districts.
Hence,
improvement
Government
iin
n
activity in recent past.
YMCA started
in
1989, affiliated in
1993.
Nil
other
Ni 1
projects
in hand, except CSCD.
CEO is LIC officer
off icer and
busy.
Homoeopathic doctor has joined the
team
is
t e am and
helping in conducting clinics so far. No replacement found
as yet to YMCA project officer who left after starting the
proj ect .
— Met CEO, PM (Homoeo Doctor) and about 35 people, target
non-target population.
2.
CSCD Ac tivities;
- as per CSCD guidelines,
Unable to cope up with work due to
lack of permanent staff.
- Immunization inadequate due to PHC being far off (> 25 kms.)
- Deliveries at home or Koraput
which is nearer and easier
to access by bus/road.
“ People i11iterate/unemployed.
Alcoholism
rampant,
and
festivals celebrated for prolonged periods.
- Anganwadi/Primary school not attended
- badly running.
Govt, building new premises for school.
- Homoeo Doctor conducts regular clinics and immunisation.
3.
Non—CSCD Activities:
- Government housing program (Indira Awas Yoj ana
recen 11y. )
- NEE for adults - started recently.
- Food for work programs on road building.
None of these integrated with CSCD activities.
Nil programs by YMCA.
47
started
and
4.
Relationships/Li aison:
- With government agencies
improving with recent break up
of Koraput district into 4 for easier administration.
Government Health Services marginally touching village.
Nil other Vo lags in area.
Networking etc. with others in Orissa not done.
5.
D i scuss i ons;
- Tribal medicine becoming extinct.
To revive the same
and
for minor
promote herbal
medicine
a iIments wh i ch
are
rampant.
- To consider appointing a full-time worker to be ab 1 e to do
regular work.
to start other activities relevant to local needs and likely to
provide employment for youth, like carpentry
trad i t iona1
crafts, etc.
to make more frequent contact and conduct mass edueat ion
programs on health.
to network with other NGOs
and
Gove rnment
to fulfill
identified needs of the people.
5.
Summary
est ab1ished YMCA has chosen area of work where
Newly established
real
need
is present.
present.
Permanent trained YMCA person needed
to
continue work in
i n a regular manner.
Improving life and living
conditions of people should be prime focus, with tackling of
minor
ailments with local resources, and making people
more
health conscious.
Starting of
development
programs
and
tackling
social
problems
like
alcoholism needed,
With
improving Government administrative reach, better network ing
with Government and other Volags will help.
CSCD M i c rop ro j sc t VIII
1.
Detai1s of the Project:
YMCA Bhilai
Rural - Covering 4 village areas with
approx imately 30O0
population.
This village has been adopted by Bhilai Steel Plant
(BSP)
for Education
and Medical support and
is a
'model'
village in Durg district with unanimously elected Sarpanch
who
is enthusiastic and active.
Villages clean with no
class/caste conflicts.
Earlier villages selected were dropped due
to political
interference problems. Also, Project Managers have changed
twice
during the project period.
New incumbent is still
getting
a grip of the situation.
Peculiar nature of
Bhilai - always "outsiders".
49
4 YMCA Board members/IProject Manager/1 Doctor/4 village
leaders and 1 teacher/2 Village level workers/10 others.
CSCD Activities:
- as per CSCD guidelines.
Adequate.
- Medicalized approach due to BSP support for medical camps.
Good NFE for women by Eswari Bai ~ a motivated woman of
the
village
who has got national
recognition
and TV
coverage.
Government programs for
i mmun i z at ions/ORS/e tc,
well supported by BSP specialist camps spreading
awareness
through their nurses and students.
No TB.
Leprosy 30 pts.
under treatment. Malaria rampant.
- Records/Reports good/adequate.
- CMAI - internal monitoring status
POOR.
3.
Non-CSCD Activities:
- Nil in village area.
Those at HQ
more relevant to
i ts
membership and urban ethos.
Indira Awas Yojana, Jawahar Rozgar Yojana,
Rajiv Bandh i
library
for neo—1iterates are Government
p roqrams we 1 1
utilized by active Sarpanch.
Integration
of
CSCD
activities into these not explored.
BSP
support
to building of school
well
utilized
for
medical programs/camps of specialists - EYE/ENT/F.P., etc .
Enthusiastic school teacher available for help.
4.
Re 1 at i onsh ips/L i aison:
With Government agencies/programs good due to standing of
BSP and Sarpanch's initiatives.
- Nil other Volags in area.
Networking with others not y e t
initiated- need not felt.
ESP
is the biggest Volag, since it has
adopted
the
village.
YMCA members being
employees of BSP,
the
relationship is good.
5.
D i scuss ions;
- School health program to become chiId-to-chiId and Child-tocommunity Health program - to be explored.
- Introduction and promotion of Herbal
medicine
for common/m i r
ailments to be explored.
- To network with MPVHA.
- To start other development oriented programs with Diocesian suppor
- To explore Anganwadi/Balwadi as logical extension of CSCD
program - Eswari Bai has already volunteered for same.
49
Summary
YMCA's CSCD program is going on well despite change
Bh i1 a i
and
in Project Managers - due to BSP's medical support
adoption of 'model village' for its activities.
anganwadi
Approach being 'medicalized', avenues of school,
shifting
to
for,
and NFS programs
p rog rams
available to project
preventive, promotive and 'Health' app roach.
Initiatives to evolve methods for hand 1i ng over health
activity to people needed.
CSCD Micropro j ec t I X.
1.
Petal Is of the Pro j ec t
The Rural Evangelical Mission of India
a)
Daryapur, Amaravathi - Maharashtra.
Rural, covering population of approximately GOOD across
b)
and
10
villages.
People
tribal,
scheduled castes
village
landless labour, 10 to 20 km. from Daryapur. One
health
Gove rnmen tai
recognised
as model village. Good
recent
facilities which are being utilized adequately in
a
past.
Literacy 607. for male and 407. for female, w 11 h
good degree of awareness of health.
Related to fund flow.
Nil other funding/other projects of
c)
REMI.
Depend on available Government programs and
their
utilization.
d)
CMAI links through PC's visitZTraining programs/Reports &
Returns.
e)
1 CEO/1 Pastor/5 CHVs/2 ANMs
18 local people.
2.
CSCD Activities
- as per CSCD guidelilnes.
- Awareness of CSCD activities good.
Reach
facilities for mother and child - good.
- Occassional Health camps and co-operation
Eye & F.P. camps.
- Local
Dais trained
at CHAI and
doing
de 1 i veri es.
CEO is Homoeo Doctor, his wife is ANM and
doctor employed.
Records/Reports - ad equat e.
CMAI's internal evaluation status
Above
3.
of
Government
w i th
Gove rnmen t
well
in
home
another Ayurvedic
Average.
Non-CSCD Activities; .
- NFE for women and informal
on
Women's g roups meeting
contemporary health issues.
Health of Adolescents, Vocational training opportunities,
employment opportunities — publicised.
50
I
Government programs on Smokeless chulhas, latrines,
supply programs promoted.
Balwadis for pre-school ch iIdren being run .
water
Principal
approach through creating
awareness,
co-operating
with
Government
programs and
maximizing
utilization
of
available p rog rams.
Utilized all training opportunities for different people
e ach
time from NIPCCD, FARMS INDIA, CMAI etc, creating a larqe base
of persons aware of Community needs.
4.
Relationship/Liaison:
- Good
with Government services - Health and Development,
- Nil other Volags in area, but utilizing training facilities
wherever possible.
Good relationship with PHC and its staff.
Have not in t e r f e r ed with/influenced local
realities,
yet
co-operative w i th
all bodies on
health matters.
Good
relationship w i t h Panchayati Raj
and utilization of
facilities.
5.
D i scussi ons
ci )
To encourage/promote local herbal remedies to help people
t ack 1 e minor i 11 ness/ai1ments by themselves.
b)
To organise community to take over CSCD activity
for
sustainabi1i ty
c)
To liaise w i th/utilize other NGG programs in development.
d)
Frequent visits by the CEO/PM to the target area.
Summary
A well chosen rural community for project.
Utilizing
all
available Governmental
programs in Health
and
Development .
Approach principally through creating awareness and maximizing
utilization of
available programs,
doing
well
in
CSCD
program,
and need to take steps to hand over same
to people
towards sustainability.
CSCD Microproj ect X
1.
Details of p ro j ec t
a)
Pankajam Caroline Clark Health Centre
Madurai.
b) c).
Seven
rural
areas,
covering
approximately
7,500
population off Madurai town.
The centre is well known
for over 85 years for its work dedicated to the poor
in various rural areas around Madurai.
These areas now taken up are new, with SC, ST and tribal
population with low levels of literacy
and
awareness.
51
09595
I
'A
d)
They are daily wages labour in agriculture, construct ion
work
and
domestic
work.
Tuberculosis,
Anaemia,
Malnutrition and Skin diseases are common,
The approach
i. s 'medical' through a mobile weekly clinic in addition
to training of Dais and CHVs.
An orphanage and adoption
facility
for rejected female infants is a un i que
ongoing
activity of need in this area.
Supported by CSI
and Diocese of Madurai and Ramanad in its activity.
CEO; PM; Doctor; 9 CHVs; IO Mothers; 6 othe rs.
CSCD Ac t i v i t i es;
- as per CSCD guide 1ines/adequate.
- NEE for women.
~ Good communication through CHVs on womens
issues and CSCD
programs through charts (self-generated); Songs and street
theatre.
Focus on girl child due to female
infanticide
prevalence in this area.
- Medicalized
approach
for health
needs through uj e e k 1 y
clinics.
Trained Dais deliver mostly at home.
- Free
medication
for common
illness
like
scabies,
diarrhoeas, ARTIs, Tuberculosis and Leprosy prevalent, with
medication help being provided from other funds of Diocese,
and donated medicines.
- Orphanage and adoption facility for female infants.
Records/Reports adequate.
CMAI's classification - ABOVE AVERAGE.
3.
Non-CSCD Activities
- Orphanage and Adoption centre cited above.
- Creating awareness on Womens' issues/Girl child.
- Utilization of Government services on Housing, Wat e r supp1y
and Immunization.
- Balwadi for pre-school children
started mi th CSCD help
and now shifted to other funding sources.
Nil
other direct development
activities
in
social/economic problems; Employment; Youth etc .
4.
5.
area
Relationship/Liaison
With government Services main 1y on
immu.n i zat ion ,
hous ing/water
- With other church related Volags. of Diocese, CSI .
of
and
Discussions;
— to encourage/promote self-help with herbal/local resoruces
for minor ailment management and wean off clinical approach.
- to promote community organisation for handing over activity
to Community.
52
1
- to tackle social/economic/employment problems through other
Volags/approaches to get to roots of health problems.
— to
identify and promote other Government
aid programs
available/relevant to needs of people.
6.
Summary
A
well
established
and
recognized
Volag
with
‘medical' approach to social, economic problems, Doing well in
areas
of
CSCD and
female
infant/Girl
child
issues.
Communicating well, and having good rapport with
Commun i ty.
Need
to evolve methods of shifting responsibi1i1ty to people
and
enab 1ing/empowering
them
to utilize
avai1 able/local
resources to tackle own problems.
CSCD Micropro j ect X I
1.
De t a i 1. s
- YMCA
Mui 1 ank inav i 1 a i - K.anyakumari Dt.
A we 11-estab1ished YMCA (since 1977) have taken up Nat tai am
village
in K.illiyoor Block with approximate population of
5000.
The
literacy
level is about 587*,
though health
awareness
is equally
lacking
in both
literate
and
illiterate population.
The
YMCA has been working in areas of
NFE for adults;
Envi ronmen t,
Water
and sanitation p rog rams;
Pre-schoo1
educat ion,
Youth talent promotion and summer schools;
in
add i t ion
to savings, socio-economic and income
generation
p rograms
in
areas of spinning,
tailoring,
handicrafts,
fibre
units and loan schemes.
Youth are trained in
type—
writing and leadership.
All. these are implemented through
an organized
form of Village Development
Commi t tee.
The
CSCD program
is
a welcome activity to
their community
Health program where
liaison
with
Government
is
the
mainstay.
Help to rehabilitate widows is also undertaken,
All
these
are supported
by
the
Community and
other
funders, with self-generated funds.
- CEO/PM; 3 CHVs; 5 mothers; 2 widows; 5 others.
'-y
CSCD Activities:
— as per CSCD guidelines.
Systematic
and we 11-organ ised
through Community Health approach with 1 CHVs for approx.
500 population.
- Components of CSCD organized as part of
Communi ty Health
approach, utilizing only Government Services avaialable
in
area, and facilitating PHC activity with co-operat ion.
Direct contact with people and
utilization of Village
Development committee for support ensures good coverage.
— Activities — EXCELLENT.
Records/reports: GOOD.
- CMAI's classification - GOOD.
53
3.
Non—CSCD Ac tivities;
- NFE of adults, youth, pre-school children.
- IGPs and 1oan/savings schemes.
- Creating awareness of Environment
Water
San i t ation
as
already listed above.
- Widow rehabilitation & tackling of social problems.
- Medicalization of activity with camps and medications
for
ailments.
- Logical extension of Child Development ac tivities
Day
Care Centre.
4.
Re 1 at i onsh ips/L i aison;
- With Govt. - good on health/medical
issues and maximal
utilization of services.
With
other voluntary agencies - in networking
on
issues
relevant to area.
5.
D i scuss ions
- to explore herbal medicine/local
resources
in
tack ling
minor/common ailments and enable people to take care of ou/n
health.
- to integrate CSCD activity into all other programs to m a k e
it susta inab1e.
- to promote nutrition education and Kitchen gardens for both
nutrition and herbal medicine.
- to
reduce
dependency
on
Western
medicine
and
' med ical ' solut ions to health problems with ’’Education
for
Health”.
Summary
A well established YMCA with good credibility in areas of
socio-economic problem tackling and creating awareness in
all
segments of population through specific programs.
Community
Organisation and participation good.
Needs to be handled over
CSCD
responsibility along with
integration
into
other
activities to make it sustainable.
CSCD Miero-project XII
1.
Details of Project
- YMCA - Moolachal, Thuckalay.
- Rural - 6 villages under Vilavoor town panchayat
covering
10,000 plus population.
80% of these landless labour below
poverty
line.
The YMCA has been
running
free Medical
clinics weekly and EYE/Dental camps 6 monthly.
Veterinary
help
for
livestock 3 loans
and Poultry
vaccination are
undertaken.
Help to deserving school students as fees,
uniforms and other expenses; encouragement too, in form of
prizes for best students are other activities.
- 3 YMCA Board members/CEO
PM/5 CHVs/ 6 others.
'54
2.
CSCD activities
- as per CSCD guidelines.
- CHVs had additional/continued training by Neyyoor Hosp i ta 1
apart from CMAI's training.
- Doctor from Neyyoor Hospital conducts clinics/ camps.
- No Infant Mortality in past 1 year.
- Medicalization of approach with Clinic base.
Records/Reports
GOOD.
GMAI's classification
GOOD.
3.
Non-CSCD Activities:
- Embroidery centre provides employment and generates funds
too .
- Tailoring training for girls/women.
- Creche for children (30) focussing on most needy with p reschool
teaching and feeding of
3 me als/day undert aken .
Looking for donors, since need is for more than double
the
present strength.
- YMCA involved in Primary English Medium school construction
on own land.
4.
Re 1. at ionsh i ps/L i a i son :
~ Government - good for immunization activity.
- other socio-economic programs from Govt, to be
t apped.
Voluntary organisations
- KNH Hospital is functioning nearby.
- Network on local issues when needed.
- Utilize Neyyoor Hospital for all medical needs
training needs.
5.
Discussions
- To explore herbal medicine to enable taking care of m i nor
ailments by people themselves.
- To explore possibilities of
support ing creche
through
Government help/other Volag help.
- To organize Community to take over health care .
- To
reduce
'medical' approach and shift
to
'commun i ty'
approach.
6.
Summary
Well
estab 1ished YMCA with good credibility includes
CSCD
along with socio-economic
income
generating
and
education activity.
Govt. resources and Volag.
Utilizing Govt,
Hosp i tal
resources for medical needs of well
identified
popu1 at i on.
Need to shift to community organisation
and
exploring local resources towards sustainability.
55
CSCD M i crop ro j ec t
1.
XIII
Details of Project
- Vinnarasu Association
Marthandam - K.K. Dist. TN.
- Rural, covering
(
12 wards of entire Panchayat of Kappiyarai,
which
is one of
the 8 village
areas covered by
this
organisation.
Started work in these villages in 1973 and
registered in 1984 as an Ecumenical Christian Movement
for
Human Development.
Have a holistic approach to development
working
through small groups of 30 families each,
called
'Neighbourhood groups', with a leader.
Activities
include
- Leadership training;
Help
to poor students;
Womens'
programs for self-help; Community based health care;
and ,
Inter Faith dialogue for peace.
- CEQ/PM, 12 CHVs, 10 others.
CSCD Activities:
As per CSCD guidelines.
Well organised and executed as part
of Community Health program.
- CHVs trained by CMAI, and also by TNVHA as lay first-aiders
(LFAs)
- CSCD well understood and well integrated into program.
- Use
herbal and alternative systems as part
of program,
though dependant on Govt, health services.
- Approach
through
education creating
awareness
and
mobilizing for group action.
- Records/Reports - GOOD.
- CMAI s classification — Above Average.
3.
Non—CSCD Ac:tivities
Tailoring for girls/women; non-formal education at
r egu 1 a r
group meetings; Credit-unions for savings.
~ Creating awareness and utilizing all available Governmental
programs in area related to health and development.
4.
Re 1 at ionship ZL i a i son
Good
relationship with Government
for Health Services.
Able to utilize and co-operate with same .
- Nil other NGOs in area.
Network with other NGOs and TNVHA
on broader issues of the area.
Have been gradually developing the concept of
'neighbourhood
committees' and able to hand over most activities to Community
for
discussion, decision-making and
implementation,
through
this simple method of Community organisation.
56
5.
Discu.ssions ;
- To strengthen herbal medicine/other self-help methods
in
the area of health and minor-ailment management,
To evolve methods of tackling
Bronchial
Asthma in
a
manner,
wholistic
manner,
since
it
is
a major
problem
in
K an y a k urn a r i D t.
Summary:
A well organised Volag. with the idea of putting health
in
peoples' hands through a wholistic approach to Development and
working through small groups of people - Neighbourhood g roups
- consisting of 30 families each.
Approach through creatilng awareness and promoting necessary
action
for Community needs.
Need to give needed
help/inputs
to make health a self-sustainable effort of the people.
CSCD Micropreject XIV
1.
Details:
a) YMCA
Madras - Boys town.
b ) Peri-urban/rural
area off Madras, covering
two Ranchayat
areas with population of over 5000.
Well
est ab1ished
Volag. working with Orphanage, Vocational training centre
and School.
They have experience of working
with CSCD
program in adjacent areas earlier.
-- CEO/PM; 1 Doctor; 4 CHVs; 5 pregnant women; 5 mothers; 5
others.
2.
CSCD Activities:
- as per CSCD guidelines.
CHvs are visiting area
regularly
and have good rapport with people.
- Conduct NFE in addition to Health Education during d i rect
contact with mothers at home.
Community part ic ipat ion
enthusi ast ic.
- Approach medicalized and clinic based due to
availability
of Gynaecologist as Doctor in clinic,
Well backed by VHS
services for de 1iveries/immunization
and
1i aison
with
nearby Catholic Hospital.
- Records/Reports and returns adequate - well maintained.
- CMAI's classification : Above Average.
2J.
Non-CSCD Activities:
- NFE for adults mentioned above.
- Vocational tralining, Orphanage and Formal School.
- Not integrated into CSCD activities.
Have developed good rapport with surrounding Community
good credibility for CSCD activity.
57
and
Lin i or
4.
Re 1 at ionsh ip/L i aison;
- With govt, agencies for immunization and F.P.
services.
Others related to Non-CSCD activity.
- With Volags
like VHS and nearby Catholic Hospi t al
for
Medical needs.
5.
D i scussi on
- Alternative medicine/Herbal medicine avaialble u» i t h CHVs
and Community - not being utilized,
To promote s e 1 f reliance in minor ailment management.
- To proceed from vertical/compartmentalized medical
care
towards demystification and Community Health approach.
- To evolve methods of handing over health
care
to
commun i t i es.
- School health programmes.
6.
Summary;
A
ui ell
established
volag with good
rapport
uii th
community and
doing effective CSCD program,
Need to shift
f rom
'Medic a 1'
to
'Commun i ty'
approach,
wi th
en ab11ng
dimensions
for self-help and
eventual
handing
over
to
Communi ty.
CSCD M i crqpreject XV
1.
Details:
a)
The Salvation Army - Aizawl - Mizoram.
b)c)A well known and well established organisation focussing
on
the poor in its activities.
They
are
involved
in
Community Health
activities through
Community Health
Action
Network
(CHAN)
with
key
themes
of
Care ,
Counselling, Training and Hope.
The project works in four phases, I - Samaritan House for
female sex workers; II - Family counselling centre; III Mobile Health unit providing free medical care; and IV
Vocational
training for rehabilitation.
Find need
for
medical
personnel
to be involved in CSCD and Health
Education programs.
Extensive activity in other areas
has affected CSCD work.
— IPM/CE01/NFE teacher1;2CHVs;IMother;1 other.
- The CSCD financial assistance being small, the
interest and attention is minimal.
2.
CSCD Activities:
Initiated well, but ran into problems with trained CHVs not
able
to
function well, migratory population in
taken up
area of work
and
rapid urbanization
of Aizawl
town,
bringing Government Health Services closer to area.
58
I
- CHV upgraded to PM and handed over project ~ is unable
to
manage due to lack of medical knowledge.
- Plan
to shift area of work to 2 other needy
areas and
recruit 2 new CHVs with nursing background.
- Records/Reports adequate.
- CMAI's classification Averag e .
3.
Non —CSCD Activities;
- In
areas of rehabi1itation,
counselling
and
vocatlonal
training.
Not integrated with CSCD activity.
— Professionalization and vertical approach to problems seen ,
hence
expect
CSCD also to be
handled
by
health
professionals .
4.
Re 1 at ionsh ip/L i aison:
- Good, with Govt, due to credibility and standing,
Ab 1 e
to
garner support for activities.
- No co-operation/networking with other Volags, mainly since
NIL other Volags in area, and Volag concept is new to them.
5.
D i scuses i on :
- High
literacy levels in area needs more written/printed
material for use.
- Changing/dynamic nature of population i n Aizawl area points
to taking up more interior and rural areas for work.
6.
Summary:
A well recognised Volag involved in multiple Commun i ty
level activities in vertical, compartmenta 1ized manner,
High
level
of
professionalization
occuring,
with problems of
imp 1emnetat ion being impeded by paucity of same in CSCD area,
Feel need for written material, shift of location of work, and
recruitment of professionals.
CSCD Mio roproj ec t XVI
1.
Detai Is of project;
YMCA - Tanhril - Aizawl district, Mizoram.
a)
West of Aizawl, well connect by road to the city, approx.
b)
45 mts. distance by road. Covers population
of
approx.
3000,
scattered
in the hilly terrain, with
local
mudroads and pathways for access.
YMCA in centre of town in a rented building used as a centre for
most community activities.
People are all tribal/Christian,
involved in agricultural activity
and domestic animal rearing.
Literacy levels more than 90*Z with Primary,
Middle
and
High Schools in Tanhril.
Most houses made of bamboo and
thatch, with just enough water from a reservoir at higher
level
of hills. Nil industry in area, except
for petty
shops conducting business for daily needs.
' 59
c)
d)
2.
YMCA
recently estab 11ished, and recognized
Council of YMCAs.
Met CEO/PM, 4 CHVs, 4 mothers and 8 others.
by
Nat ional
CSCD Activities;
a)
b)
c)
d)
As per CSCD guidelines, registering
and
f O 1 1 our-up of
mothers and children being done regularly.
Deliveries conducted at nearby Health sub-centre
or by
ANM at home.
Adequate ANC and PNC.
Good
Health Education activity from H e a. 1.1 h Department,
the CEO being from same department.
H.E.
posters
in Mizo language seen in most houses on
Mother
and Child care,
Breast-feeding,
□ RS,
etc .
Innovative exercise seen in this area, is boards painted
with CSCD messages at highly visible locations on village
roads,
Records, reports adequate.
CMAI's classification
AVERAGE.
Non-CSCD Activities:
- N.F.E. program being utilized for CSCD p romotion and other
community needs, since literacy levels are high. YMCA helps
as centre for marriages and other social activities.
- Weaving centre for women being supported by YMCA to help i n
socio-economic development.
- Medical camps with Government
Pvt. Doctors
for general
disease problems in area.
J.DD well tackled
with
iodized
salt being available and used in village.
- Local type of pit-latrine available at all houses, bui1t by
community,
and has helped in good
reduction of worm—
infestation among people of the village.
- People
using herbal medicine to limited
extent.
Common
problems
in
area - Diarrhoeas
and
Resp i ratory
tract
i n f ec t i ons.
4.
Relationship/Liaison:
a) Good relationship with Govt. Health services, with nearby
health
centre,
and CEO himself
being
f rom
H.E.
department.
He also is available to help people
during
medical emergencies and other medical needs,
Liaison and
work with VDP, HLIM etc., good — in
commun i ty buiId ing
activities.
b)
Nil other Volags in area.
Networking with volags outside
the area not done.
c) Medicalized approach to problems due to high need in
this
area.
Water supply and
sanitation being given
due
prominence with community
involved
in
evolving
local
solutions - eg. pit latrines. People noticed that mosquito
menace and rampant malaria is also due to pit latrines.
60
5 .
lUj5£ii^ipnsj..
P eop 1e
U5SG?
a 1 r e a ci y usi i. n g h e r b a J. m e ci i c i n e - to promote
on
ci e p e n d e n o e
for common/minor ailments in area and reduce
m e d i c.*. i. n e s .
by
be
t a c k J. e d
b e 11 e r
Fl e si p j. r a t cj r y
p r c:> b 1 e m s c: c? u 1 ci
prom o ti ng chi mn eys in kitchens and smo ke1e s s chu1has.
ft n a e m i a a n ci n u t r i. t i o n p r o b 1. e m s t o b e h i g h 1 i g h t e ci t o help
i n b e 11 e r i n g h e a 11 h s t a t u «5.
sk i 11
l:; h e i r
opportuni ty
for
for Y
Youth
oi.i t h
and
F:) rog r acnmes
t r a i n i ng »
6.1 n
Summary
t h a t has taken
u.p
CDSCD work
e s t a h 1 i. s t ) e ci Y I’'! CD ft
N e u) 1 y
i
n
t
o
o
t
h
e
r
areas
o f h e a 11 h
and
extended
e n thusi as t i c a11y
c?
d
u.
c:
a
t
i
o
n
a
n
d
c
r
e
a
t
:i.
n
g
awareness
needs.
With high literacy,
i.*/
i
t
h
i
n
n
o
v
a
t
i
v
e
(net
h od s o f
1 i n e o f a p p r o a c: h , u/
is
th e ma i n
availability
and
creating
facility
for
c ommuni ca ti on. Con stan t
CSCD
an ci
health
has
firmly
soci a1
aact
ct iivviitties
ies
beyond
t h i s>
o r g an i z a t i. on
for
e s t a b 1 i. s;i hi e ci
th e
c r e ci i b i. 1 i t y of
s u s t a i n a b 1 e ci e v e 1 o p m e n t uj a r k i n t h e are a .
Q§£.I2 Microproject
1 .
XV11
GxXailJi. of. a££Li.e.£.t
ft i ai.'j 1 Distr ict, Mi zoram.
a)
Y M C A •“ 7 e m a b a w k ,
city,
m ith
north-east of ft i z aw 1
area
b ) c ) Peri---lirban/ rura 1
Nat i on a 1
n e w ]. y e s t a b .1. i s h e d Y M C ft (19 91. ) a f f i 1 i. a t e d t o
Council of YMCfts«
scat t e r e d
i. n
CDov e r
a popu. 1. a t ion of a p p r o x i m a t e 1 y 300O ,
p o p u. 1 a t i o n .
hilly t e' r r a i n a r o u n ci t h e Y M C ft c: e n t r e - 9 Q/ S T
Y M CD ft b y c:> n e o f
i t s m e mb e rs ,
but no
Land
don at eci
to
Office runs from premises of one of the
building as yet.
CD S CD D i s t h e o n 1 y p r o j e c t r u n b y the Y M C ft
Ei o a r ci m e m b e r s .
at
p r e s e n t.
r e p o r t s / r e t u r n s * adc-c^u ate .
0
Mo t h e v=5;
5
1.
CD P. 0 / P M ; b Y M C ft B o a r ci m e m Io e r s
2 CD H V s ;
c:l)
o t h e rs «
2.
CSCD
a) F" o 11 o ui i n g
of
r e g i ss t e r i n g / f o 11 o uj - up
CD S CD D g u i d e 1. i. n e s f o r
m o t h e r s a. n ci c h i 1 ci r e n .
of
CDOCDI) good
among people
as
YMCDft-C'Mftl
b ) ftwareness
initiative.
Utilization of Government services, for ftMCD,
Maternity
and PNCD, with immunization. Dependence on
same
for disease problems in area.
H.E. efforts well received.
c.) Fl e p o r t s / r e t u r n s m a i n t a i n e d , w i t h ci e 1 a y s ci u e t o c h a n g e - o v e r
Y M CD ft B o a r ci m e m b e r s , i n c 1. u d i n g P M / CD F£ 0 cj f 0 S CD D e v e r y
of
CD H V ' s p a r t o f Y M CD ft n e t w o r k , a 1 s o c h a n g e .
ye ar ft V E Fl ft G F.".
ci) CMAI's u 1 a s s i f i c a t i o n
6.7 1
3.
Non—CSCD Ac t i v i t i es:
a) NFE - not functioning as such, due to high literacy in the
area.
Being used to create awareness of health.
Nil
other projects/activities. One YMCA Board member
is having a private enterprise of Silkworm rearing,silk
reeling and thread-making. He provides employment for
a no. of women in the area.P1anning to innovate on
weaving for local needs to meet marketing needs.Another
Another runs private school and is a member of political
g roup.
4.
Relationship/Li aison:
a) Good with government Health Services, especially in P rimary
Care .
b ) Nil other Vo lags in area.
YMCA members are also part
of
other
local
organisations
1 ike
VDA,
HMIP.
etc. ,
and
influence better working of
YMCA along with them.
c ) Local shawl/clothing unit run by a member, providing
employment to local people.
5.
Di scussions:
a ) To promote/utilize herbal medicine form locally available
herbs and
knowledge to prevent
dependence on haspi ta 1
medicine.
b ) To enhance
activity in H.E.
on
issues
1. i k e Anaemia,
nutrition,
safe water, lodized-salt etc., to help? health
efforts.
c ) To train CHVs regularly for CSCD/other health activity to
meet people's needs.
6.
Summary
New ly established YMCA (1991) with CSCD being the
only
project
activity.
Good
1i aison
liaison
and
utilization
of
government
Health
Services.
Suffering
del ays
in
documentation due to changing of YMCA Board eve ry
year and
d isrupt ion of activity.
consequent disruption
Need
to develop selfreliance and sustenance measures for health activity.
CSCD Microproject XVIII
1.
De tails:
a) YMCA - South Hlimen - Aizawl District.
b) Rural
area South of Aizawl city, connected by road approx. 45 mts. away.
People scattered in hills around
area. Nil industrial activity. Population agriculturists —
doing
Jhum cultivation.
Very similar
in characteristics
recorded in other rural projects of Mizoram.
62
H e a 111”
I
The
CSCD project team and YMCA board members were not
available during the evaluation team's visit to S.Hlimen.
Hence,
visits/meetings with CHVs,
peop1e,
mothers
and
children was not possible.
Five members of the YMCA Board visited us at the
hot e 1
the same night after receiving the message that w e
h ad
visited their location.
The following is from talks with
them:
-
~
“
~
YMCA South Hlimen is a newly established YMCA
(1991)
which has not yet been affiliated to the National Council
of YMCAs.
Regarding CSCD, they informed us that
All records/reports are being maintained, and had been sent
to YMCA Shillong for onward
transmission
(CMAI-CSCD to
fol low up) .
They plan to conduct CSCD activities, even if YMCA support
for CHVs salaries was not available, since they found CSCD
helpful.
They are able to get all. women delivered at the Government
Hosp i tal
facility.
Al 1
chi 1d ren
have been
receiving
immuni zat ion services f row same, and the results have been
sat i sf ac tory.
Their liaison w ith Government Health Department
has
also
brought about 3 Medical camps in the past year to help the
peop1e.
Regarding NFE, they said that all the target
non-1iterate
persons having migrated out for
socio-economic
reasons,
they find only a literate population left!
CMAI c1 assification — POOR.
CSCD Microproject XIX
1.
D e t a iIs
a) YMCA Lungdai
Aizawl district
Mi zoram.
b) A newly established YMCA (1991) yet to be
affiliated
to
the National Council of YMCAs.
No prior experience
with
any projects. CSCD taken up to help service ideas focussed
on Mother and Child.
Population covered - mostly scheduled tribes - approx.
3,500 people scattered in the hills. The literacy level is
about 50*Z and nearest Government Health Centre
--- -.j is over 25
kms. away.
c) The CEO/PM is the Headmaster of a School and busy with
own
assignments,
CUV's f ind the training and work useful
to
them as well as people, but do not find adequate support
from YMCA.
63
The existing peoples' organisations like VDP
(Village
Defence
Party),
HLIM
g roup
(Women's group
organised
by
Government)
and political parties are serving most needs
of peop1e.
The
CEO/PM who * is
a YMCA Board member
expressed
a
frank opinion of the people, that one more
organ isat ion like YMCA is not needed in the area and hence
is non-functiona1.
ci) CMAI links through POs visits/Training programs/Reports
&
Returns.
e ) PM/CEO, CHVs, 3 Mothers, 5 others.
*7
CSCD Ac tivities:
cl) Reg ist rat ion
and follow-up of mothers and children not
being
done
adequately, since there is no
full-timer
to
take responsibility for same.
The evaluation team met
a
young
girl educated at Bangalore, who was willling to do
the same.
We introduced her to the YMCA team.
b ) - ANC, Maternity and PNC awareness present among people due
to Government Health efforts and CSCD efforts which
are
not regular/cons isten t.
- Immunization of children being done through Governmen t
func tionaries.
- Awareness of IDD not yet adequate.
So also,
regarding
Water, Sanitation, Disease problems, and nut r111on.
c ) Records/Reports not maintained.
d ) CMAI's classification - POOR.
3.
Non-CSCD Activities:
NIL.
4.
Re 1 at ionsh ip/L i aison;
a) Adequate
u/ith Government Health services to serve CSCD
needs.
Other health and
socio-economic problems - nil
addressed.
b) Other Vol.ags. like VDP, HLIM etc. in area appear
to b e
strong 1y politically connected and interfering with
YMCA
and CSCD functioning.
5.
Discussions
a) To revive CSCD work with literate girls/women of
area
one of whom was identified by evaluation team.
b) To continue CSCD even if as non-YMCA project,
To consider
any other liaison with CMAI if possible.
c) The CHVs were very enthusiastic about
further
training,
which had already helped them in CSCD work earlier,.
To
sponsor suitable volunteers for CMAI training programs
for North-East India.
64
6.
Summary
- Newly established YMCA - not affiliated as yet
to
ational
Council
due to (?) local
problems.
CSCD program
lnade^uate i-eports/records due to non-availability
worker and paid CHVs.
People and CHVs found
the
CSCD useful, but hampered by lack of in111at i ve/support
from
T I I Lj rn »
CSCD Microproject XX
1 -
De t a i Is
a) South Tangkhul Naga Baptist Association (STNBA)
b ) This
is
an Association of
75
seif-supporting
vi11ag e
clusters
uiork ing
for sp i ri tual
and
socio-economic
development of
the
villages since
1959,
cove ring
a
approx. 17,000 peopl e .
population of approx.
The villages are
in
Ukhu r 1
district of Manipur at Indo—Burma border in hilly
areas.
Villages are on hilltops, consisting of 20 to• 40
houses with fair—weather roads for transport,
The main
occupation
is
agriculture,
w i th
dependence
on
Jhuna
cultivation
and
the monsoon.
The
1i teracy
and soc10economic conditions are poor,
Medical
fac1111 i es -on 1 y
Gov t .
sub-centres which function erratically and far
away
for' most of the people.
c ) Educat ion is an important need-based activity of STNBA,
w i th a schoo1 (upto High School)
and boarding facility at
Irong, Yaripok, catering to 550 students. — --The CSCD project
has been taken up in remote villages, covering about
populat i on, 80 kms, away from Irong, the HQ. 4 CHVs ; 4000
manage
this
activity and find immunization reach from the Govt .
very difficult, Supervision is also difficult for
reasons
of distance
and access,
NEE is conducted for women
in
areas surr-wuna
ing irong,
surrounding
Irong, as a separate
activity.
Local
tribal
problems
p rob 1erns between
Kukis
and
Magas
restricts
continuous activity through the year.
d) Met 1 PM/1 CEO/2 CHVs/7 mothers and
12 others.
2.
CSCD Activities:
- Initiated
as |per ---CSCD guidelines,
uji th
registration of
mothers/chiIdren and- follow‘---—-up.
CHVs <complained of irregularity of immunization
activity
by Govt.
health centres,
and consequent
d
ifficulties
.
Attempts
at' immunization through
agencies
voluntary
through medical camps being done to supplement Govt. work,
Awareness
of
nut r i t i on ,
sanitation
and
diarrhoea
management
adequate,
but
influenced by socio-economic
conditions of peop1e.
65
Reports/Records adequate.
adequate.
Clarifications about utility
were
done
during the visit, since new PM
and CEO have
taken over CSCD work.
Considering
shifting of CSCD activity
to nearby are as
which have equal need and advantage of conducting of NFE
for adults in the same area.
CMAI's classification : AVERAGE.
Z.
Non-CSCD Ac tivities:
- Education both schools and NFE as listed above.
- Community Organisation and
Development,
Soc io-economic
activities related to agriculture
horticulture,
poultry,
piggery, cardamom plantations etc. and vocational training.
CSCD and Health Education not being incorporated into these
p rog rams.
4.
R e 1 a 11 onsh ips / L. j a i son
a) Good with Government in Health
and
Development
areas,
though erratic and limited nature of services due to local
and
political
problems does not address peoples'
needs
adequately.
b ) Nil other Vol.ags. in area.
We visited Manipur VHA
and
liased with Mr. Ruber Singh - the Secretary -for transfer
of material in local language for H.E*
5.
Discussions
a ) To shift CSCD to villages nearer to HQ in areas of similar
need for better monitoring and implementation.
b ) To continue CSCD activity in earlier distant villages
and
secure
adequate support locally, since it is useful
and
appreciated by people, ie., continue CHVs in old area and
train new ones for nearer villages.
c ) To
incorporate
A11ernative/Herba 1
medicine
for
minor/common
illnesses to enable people to take care of
themseIves.
d ) To strengthen nutrition education and
on Hygien e
and
sanitation in surrounding areas.
e ) To start school health program,
evolve
ChiId-to-chiId
program and progress to ChiId—to-Community program
for
p rogram
health,
since
education upto High School
is a major
activity of the organisation.
66
CSCD M i c rop roj ec t XXI
1 .
D e t a iIs:
a)
Christian English School, Chizami, Nagaland.
is
b)c)Chizami
a
large village
settlement
surrounded
by
smaller
villages, 5 hours by road from the Capital
c. i t y
1 oc a t ed in Phek district, bordering Burma
of Kohima, located
and
Man ipur
in
hilly
terrain.
The
population
is
about
1 1 ,000,
mainly
agricultural
labour
in
conditions
of
cond i11ons
poverty
and
low literacy.
Chizami English
School
has
grown over past years into a high school.
It is
is
located
i n the basement floor of the Baptist Church, with a
good
support
from the people in its running.
Teachers
f rom
various parts of the country are employed here, and
they
are
involved in Community development activity - one
of
the
schools with a social concern.
A nearby
Government
sub—centre caters to immunization and minor medical needs
of
the
Community, though the services
are
limited.
A
majority of deliveries occur at home by Traditional Birth
Attendants, with assistance from the Government nurse
in
case
of
problems.
A school and dispensary
run
by
a
Catholic organisation also provides some health
services.
Hygiene and Sanitation are poor, with water-supply
being
catered for at a Community level.
d)
CMAI links through PC's v i s i t/Tr a i n i ng p rog r ams/Repor ts ?■<
Returns + Earlier CSCD project.
e)
PM/CEG, 26 Church elders, 12 Mothers
children, 1
local
nurse, 1 TBA, 25 others.
2.
CSCD Activities:
a)
As
per
CSCD guidelines, Registration
&
fol low-up
of
mothers and children.
CSCD
messages passed through
church
activities,
NFE
groups for women and direct contact.
b)
Good understanding of CSCD.
Community being organised by
church,
gives
good
participation
in
health
work
controlled by church elders.
c)
Records/Reports adequate.
d)
CMAI's internal evaluation classification
AVERAGE.
3.
Non—CSCD Activities:
Mainly
revolve around education
and
creating
awareness
through
school,
schoo
1, church and NEE.
Have direct relation
to
CSCD activity.
People
hold
the church and the school
in
high
esteem.
Hence,
have
good
rapport
in
all
activities
either
spiritual, educational or service, Schoo1 teacher involved
in
running
a
school dispensary
wh ich
also
caters
to
health/disease needs of the Community.
67
i
4.
Relationship/Li aison
- Good with Government Health Services for medical care ,
immunization and Health Education.
- Liaison with Catholic School and
dispensary for health
problems of the people which can be tackled by them.
5.
D i scuss i ons
a) To initiate and foster use of herbal medicine knowledge of
Community for minor/common ailment management.
b) To initiate school health programs, which can evolve into
chiId-to-chiId and chi1d-to-community programs later.
c) Organise youth wing of organisation to clean up the waterstorage
tank,
since
the
incidence
of
water-borne
diarrhoeal disease will increase with onset of monsoon.
d ) Create
awareness of community to needs of p re-schoo1
child, Adolescents and elderly for a rounded-off Community
Health program.
CSCD Mieroproj ec t XXII
1 .
De t ai Is
a)
YMCA Patna - Bihar
b) c)Newly established YMCA (1991) affiliated to the Nation a1
Council
of YMCAs. The YMCA Board is unique
with
f ema 1e
members on
the Executive,
and have
a YMCA
trained
secretary
.
for
implementing project
CSCD.
An
earlie r
selected rural area, 25 km. away has been given up due to
logistics of
transport and supervision. A new area
in
peri-urban
fringe of Patna (4 kms from City) which is
is a
Harijan settlement has been taken up since the beginning
of
this year.
This area has no medical/he al th care
facility working, nor any Vol.ags. in area.
A med ical
approach with a weekly clinic, Doctor, 2 Nurses, etc. has
been
initiated
to gain a foothold for health work.
A
volunteer social
worker,
Mr.
Ravi
Shankar,
who has
single-handedly made literate the children and elders, is
helping
the project.
The co-operation of
the Sarpanch
and a local lady CHV are also available.
d)
1
CEO/1 PM/6 YMCA Board members/1
Doctor,
2 Nurses,2
CHVs, 3 Mothers and 5 others.
2.
CSCD Activities:
- Registration and follow-up of ANC,PNC mothers and ch iIdren
has been initiated and needs to be completed.
- Good rapport with Community through the local CHVs,
active
use of tmedical
‘
‘
---- activities by people
support for
CSCD
in
addition to minor ailment management.
- Records/Reports - initiated we 11/adequate.
- CMAI classification — POOR.
68
3.
Non-CSCD Activities:
- Nil initiated directly by YMCA.
Supporting the NFE work of
Mr.
Ravishankar
through provision
of
books,
etc.
Utilization of Hygiene
and Sanitation
efforts of
this
volunteer to spread health messages.
~ Co-operation with this volunteer and support of Panchayat
through Sarpanch auger well for a comprehensive Communi ty
Health approach.
4.
Relationship/1iai son
- With government Health Serv ices
for
immun ization
and
problems of maternity.
With civic authorities for water and sanitation.
Nil
other Vol.ags.
in
area.
Networking
with
other
volags/federat ions like VHA Bihar and DEVNET discussed.
5.
Di scussions
a)
To emphasize preventive and promotive activities even
at
clinic.
b)
To shift from 'Medical' to
'Commun i ty‘
approaches
in
tackling health probl ems .
c)
To initiate ChiId-to-Community programs from nearby schools.
d)
To train
and strengthen skills of
local
CHVs towards
Community Health approaches for Primary Health Care.
e)
To
liase wi t h Bihar VHA and
DEVNET
(
a group of
youngsters
involved in Education activity in Bihar)
for
new approaches to foster Community Health and Development
in selected area.
69
Position: 2659 (2 views)