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CHAI
GOLDEN JUBILEE EVALUATION STUDY
AT THE FIFTIETH MILESTONE
Evaluative feedback -from members concerning
the Catholic Hospital Association o-f India (CHAI)
June
Thelma Narayan,
Assisted
Society
1993
Tomy Philip,
by
Johney Jacob
Xavier Anthony
Community Health Cell
-for Community Health Awareness, Research and
No . 326 , Fi-f th Main, First Block,
Koramanga1 a
Bangalore - 560 034
Action,
CONTENTS
Page No■
Acknowledgements.
v
1.
Introduction.
1
2.
Aims and Objectives.
3
3.
Methodology.
4
4.
Find ings .
1 1
5.
Discussion,
6.
Bibliography.
131
7.
Append i x.
132
Conclusions and Recommendations.
101
Detailed
Index
of Findings
Page No
Part A
4.1
Functioning and closed members
4;2 Breakup by region,size and location
4.3 Information regarding personnel interviewed
4.4 Membership of CHAI
4.5 Reasons for joining CHAI
4.6 Organisationa1 issues
4.6.1 Feedback on stated objectives
4.6.2 Feedback on organisational structure
4.6.3 Participation in CHAI units
4.6.4 Suggestions regarding CHAI units/their activities
4.7 Interaction between CHAI central office and members
4.7.1 Visits by CHAI sta-f f /others to member institutions
4.7.2 Circulars received from CHAI
4.7.3 Participation in CHAI special training programmes
4.8 CHAI Conventions- participation and -feedback
4.9 Publications
4.9.1 Health Action
4.9.2 Other priced pub1ications/productions
4.9.3 Publications sent free to members
4.10 Central Purchasing Service
4.11 CMMB medicines/consignments
4.12 Discretionary Fund
4.13 Project Proposals
4.14 Community Health Department
4.15 Medical Moral A-f-fairs
4.16 Other services/activities of CHAI
4.16.1 Drug Quality Assurance Central Testing
Laboratory
4.16.2 Integrated Health Centre
4.16.3 Urban Health
4.16.4 Documentation Department
4.16.5 Low cost Communication Unit
11
12
14
16
17
19
19
20
21
23
25
25
27
29
32
39
39
43
44
47
52
55
58
60
68
70
70
70
70
71
72
Part 8
4.17
4.18
4.19
4.20
4.21
4.22
Problems faced in medica1/hea1th work by members
Strengths of CHAI
Weaknesses of CHAI
Expectations of members from CHAI
Suggested future thrusts for the Association
General comments/suggestions
( ii )
73
75
79
82
87
92
INDEX OF TABLES
Table
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Table heading
Functioning respondent institutions by region
Functioning respondent institutions by location
Size of -Functioning respondent institutions
Functioning respondent institutions by State
Designation of the main responding personnel
Length of stay of responding personnel
Number of participants during each interview
Year of joining CHAI as a member
Type of constitutional membership
Participation in Diocesan Units
Details of visits paid to member institutions
Institutions visited according
to State
Number of personnel who have participated in
special training programs
Annual participation in different programs
Opinion on content of special training programs
Feedback on methodology of special training
programs
Annual participation in conventions
Designation of personnel attending convention
Statewise list of institutions represented at
conventions
Statewise subscription to Health Action
Readership of Health Action
Purchase of priced pub 1ications/productions
Comments about priced pub1ications/productions
Receipt of free publications
Comments about free publications
Statewise utilisation of CPS by members
Yearwise items purchased through CPS
I terns purchased through CPS
Frequency of purchase of items through CPS
Details of CMMB consignments
( iii )
Page
No■
12
12
13
13
14
14
15
16
16
22
26
27
28
29
30
30
33
34
35
40
41
43
44
45
46
48
49
50
50
52
Table
No■
31
32
33
34
35
36
37
38
39
40
41
42
43
Table
heading
Annual break-up of CMMB consignments
Yearwise utilisation of discretionary fund
Statewise utilisation of discretionary fund
Annual processing of project proposals
Statewise participation in CHD programs
Personnel participation in different CHD programs
Views on content and methodology of CHD programs
Awareness of members about the vision of CHD-CHAI
Relevance of CHD-CHAI vision to their work
Overall levels of interaction / participation /
utilisation by members of different services and
activities of CHAI during the past 5 years
Utilisation of different services of CHAI
analysed by region, size and location of member
institutions
Statewise pattern of utilisation of CHAI services
Comparison of uti1isation/participation in CHAI
activities/services by Southern and Central States
< iv >
Page
No■
53
55
56
58
61
62
62
63
64
125
126
128
129
ACKNOWLEDGEMENTS
This
major sub-unit of the CHAI Golden Jubilee Evaluation
Study
was
possible
because of the support and participation
of
many
people.
We express our deep gratitude to all of them.
A.
Over 400 member institutions of CHAI have given of their time
and
thought
to
answer questions -from
the
rather
lengthy
pro-forma
used
by
the investigators.
Their
feedback
and
suggestions form the core of the evaluation.
We are grateful
to
them
for
these inputs and for the
hospitality
to
the
investigators.
B.
The Rectors/ Superiors of the Capuchin, Franciscan, Jesuit,
Delhi
Diocesan
seminary
and
St.Thomas
Mission
Society,
Mandya,
generously gave permission for forty Scholastic
and
one
priest volunteer to participate as investigators in
the
study.
They
allowed
adjustments
in
time
tables
and
programmes
to
fit into
the needs of the study.
For
this
support we are grateful to:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Fr.
Anil Sequeira, OFM,Cap., Rector,
Kripalaya,
Bogadi,
Mysore.
We are also thankful for the hospitality and arrangements
made
for
the training and feedback sessions
that
were
held at Kripalaya.
Fr.Sydney
Mascarenhas, OFM, Provincial, St.Anthony's
Friary, Bangalore.
Fr. Richard D'Silva, OFM, Guardian, (early phase)
Atma Jyothi, Bogadi, Mysore.
Fr.James, OFM, Guardian, (later phase) Atma Jyothi,
Bogadi, Mysore.
Fr.John Kadookunnel, Regional Director, St.Thomas Mission
Society, Mandya.
Fr.Joe Mathias, S.J., Rector, Vidya Jyothi, New Delhi.
Our
gratitude for the hospitality and
arrangements made
for
the training and feedback sessions that were held
at
Vidya Jyothi.
Fr. Anil Couto, Rector, Pratiksha, New Delhi.
Fr.Henry Baria, S.J., Provincial, Ranchi, Bihar.
Fr.Joseph Kalathil, S,J., Provincial, Jamshedpur, Bihar.
Fr.Mathew Chemplany, S.J., Provincial, Patna, Bihar.
Fr.P.C. Mathew, S.J., Provincial, Calcutta, West Bengal.
Fr.Patrie Kullu, S. J . .Provincial, Raigarh District,
Madhya Pradesh.
(v)
C.
Very special thanks to the scholastics /priest who
underwent
a
training and participated as investigators in
the
study.
They in-fact are a part of the study team for this section
of
the
study, as they undertook the crucial component of
field
work
for
data collection.
They travelled
extensively
to
visit
remote
health
centres, hospitals
and
other
member
institutions
of
CHAI.
They have
done
a
thorough
job,
enhancing the reliability of the findings.
There have also been positive ' unintended effects ' of
this
exercise.
It
provided
a morale booster to
the
many
CHAI
members
visited.
It was also
an occasion
to
deepen
the
investigators own understanding of the realities and needs of
the
health
apostolate, and of the
personnel
involved
in
hea1 th work.
Our deep gratitude
a>
Br.Alban D'Souza,
Br.Anthony Lopez,
Br.Edward Pinto,
Br.Estevao Rodrigues,
Br.Gerald Lobo,
Br.Joachim D'Souza,
Br.Lawrence Almeida,
holastics
(OFM.,Capuchins)
laya, Bogadi, Mysore.
Br.Louis Pen,
Br.Maxim Pinto,
Br.Oswald Madtha,
Br.Peter D'Souza,
Br.Rayappa Deepak,
Br.Valerian Fernandez,
Br.Walter Pen.
0)
9)
10)
11)
12)
13)
14)
the following Franciscan
cholastics (OFM) who
volunteered from Atma Jyo hi,Bogadi, Mysore.
1)
3)
5)
7)
9)
c)
:
the following Capuchin
S
who volunteered from Krip
1)
2)
3)
4)
5)
6)
7)
b)
to
Br.Amaldass,
2) Br.Babu Jose,
Br.Chinnappan Devaraj,
4) Br.Felix Gassam,
Br.Francis Kaviyil,
6) Br.James N,
Br.Leos Ekka,
8) Br.Pakianathan,
Br.Prasad Reddy,
10) Br.Salim Joseph.
the following Jesuit Scholastics
from Vidya Jyothi, New Delhi.
1)
3)
5)
7)
9)
Br.Alex Dung Dung,
Br.Cornelius Lakra,
Br.Francis Perumalil,
Br.Ignatius Abraham,
Br.Sylvanus Kerketta,
(vi )
2)
4)
6)
8)
10)
who volunteered
Br .Chonhas Kindo,
Br .Cyriac Sebastian
Br .George Soreng,
Br .Ignatius Xalxo,
Br .William Tigga.
d)
1)
3)
5)
C
e)
D.
scholastics
the -following
New De1 hi.
(Diocesan)
Br.Anthony Francis,
Br.Benedict Francis,
Br.Julius,* and
N.B: * Due to sudden ill
undertake the -field work
Fr.Michael Maliekal,
Mandya, Mysore.
2)
4)
6)
-from Pratiksha,
Br.Ajay Ghosh,
Br.Devadhas,
Br.Lourdsamy.
health he was unable to
3
-from St.Thomas Mission Society,
The
St.Joseph's Evening College and Data Processing
Centre,
Bangalore
extended every support and made available all
the
•facilities and expertise necessary -for the computer
analysis
o-f the data.
Our deep gratitude to all the following:
1)
2)
3)
4)
5)
Fr.Walter Andrade, S.J.
Mr.Ramesh.
Mr.Shanmugam,
Ms.Lydia and
Mr.Pradeep Kumar Tripati.
Many
1)
3)
5)
thanks
to the
-following
(Director)
(Programmer)
(Programming, supervision
and technical support)
-for
Mr.Xavier Anthony
Mr.V.T.Joseph.
Mr.Murali.
the data entry:
2)
4)
Mr.Sathya Prakash.
Mr.Asgar Ahmad.
E.
Mr.Thomas
Kunnil, Head, Membership Department of
CHAI,
and
other staff helped in retreiving the membership list of
CHAI
used
for
the
sampling
framework
and
gave
available
information regarding member institutions in the 20 per
cent
sample.
F.
Our
deep gratitude to members of the Advisory
the study for their support and guidance:
Committee
of
1)
Dr.C.M.Francis.
Chairman,
Director
of St.Martha's Hospital, Bangalore
and previously Dean of St.John's Medical College, Bangalore
2)
Prof.P.Ramachandran.
Consultant,
Director,
and Research, Bombay.
3)
4)
Institute for Community Organisation
Dr.Ravi Narayan.
Coordinator, Community
Health
Cell,
Society for Community Health Awareness,
Bangalore.
Sr.Adrianna Plackal,JMJ.
St.Theresa's Hospital, Hyderabad,
the Executive Board of CHAI.
(vii )
Research and Action
previously Treasurer of
5>
6)
7)
G.
Fr.John Vattamattom, SVD.
Executive Director,
. The Catholic Hospital Association of
India,
Secunderabad.
Fr.Jose Mellettukochiyi1,CST.
Assistant Executive Director,
The Catholic Hospital Association of
India,
Secunderabad.
Mr . P. R. Srinivasan , Hyderabad, joined as -financial consultant
to the study.
He has retired -from senior positions in
the public sector o-f the Government o-f India.
Our gratitude also goes to the -following
team members from
Community
Health
Cell, who supported the many
day
to
day
needs and pressures of the study.
1)
3)
5)
Mr.M.Kumar,
Mr.M.S.Nagarajan,
Mr.James.
2)
4)
(viii)
Mr.V.Nagaraj
Mr.S.John,
Rao,
1.
INTRODUCTION
The
Catholic
Hospitals' Association (CHA)
covering
undivided
India,Burma
and
Ceylon was -formed in 1943.
It
was
tranformed
into
the Catholic Hospital Association o-f India (CHAI) in
1957
and is now in its Golden Jubilee Year.
It has not only
survived
but
has
grown -from strenth to strength, both in
numbers
and
in scope and range o-f activities and involvement.
During
the
past decade the need for an
evaluation
has
been
raised
several
times
at the Executive
Board
meetings of
the
Association.
Thus, a reflective evaluative study was
initiated
in
1991
as a preparation for its Golden Jubilee,
and
for
the
purpose of evolving future plans of action towards Health for All
by 2000 A.D. and beyond.
Since
this
was the first time that a large study
of
CHAI
was
being
undertaken
it
was
broad
in
scope
and
had
several
components.
This particular report covers the following areas:
*
*
*
*
*
the awareness of members regarding the objectives
and
organisational
structure
of
CHAI,
along
with
suggestions for possible change;
the levels of interaction between member
institutions
and
CHAI
in
terms of
their
participation
in
the
different
activities,
programmes and in
the
annual
conventions of CHAI;
the
patterns
of
utilisation
by
members
of
the
various services offered by the different
departments
of CHAI and comments/suggestions regarding these;
the
overall
strengths
and
weaknesses
of
CHAI
as
perceived by members;
their expectations from CHAI and suggestions regarding
the future thrusts of CHAI;
The overall study included:
*
♦
an analytical
developing
a
CHAI members;
historical review of the Association;
profile of the health related
work
-1-
of
»
*
*
identifying
-future
roles and
policy
options
in
the
context of the predicted future scenario
of
the
country
using the Policy Delphi method of research;
eliciting
structured feedback from the staff
members
of
CHAI,
from members of the
executive
board
and
from representatives of the regional units of CHAI,
interviews with people who were more closely
involved
with the Association.
Seperate reports of each component of the study
have
been/
are
being written up.
The discussion document "Seeking the Signs
of
the Times" has covered some of the key findings of this report in
the section "Feedback from the field".
The
purpose
of
this
report
is
to
make
available
to
the
Association the methodology and the findings of this component of
the
study
in detail.
This exhaustive evaluative
reflective
study of CHAI was undertaken as part of its planning process.
The number of functioning respondent member institutions for most
of
the
questions
are
407.
This
number
therefore
is
the
denominator for these tables.
However, the general evaluative questions which were raised
with
the
entire
membership are also dealt with in the
report.
The
number
of
functioning
respondent
institutions
for
these
sections,which have been indicated in the text, are 1,415.
Thus a large proportion of member institutions have participated.
They
have responded to open-ended questions regarding
important
aspects
of
CHAI.
While
several have
raised
similar
issues,
which have been grouped together, there are also points raised by
only a few persons.
These suggestions/comments raised by one
or
less
than ten persons have also been included.
A
quantitative
cut-off
point would have made the report less
bulky.
However,
some
of the views given by even just a few people
are
valuable
qualitatively.
It was felt that in a democratically
functioning
association all views need to be made known and considered.
-2-
■
2.
AIMS AND OBJECTIVES
The overall aims of the entire study into
component of ‘feedback from members' fits,
which this
particular
were as follows;
1.
To
undertake
an
analytical study
reflection
on
the
Catholic
Hospital Association of
India
during
the last five decades, focussing particularly on
the
last twenty five years and the present.
2.
To
explore
possible
roles
the
Catholic
Hospital
Association
of India could play in the
future,
in
the
context
of
the
needs
of
its
members,
the
national
the voluntary health sector and the health
apostolate of the Church.
The specific objectives concerning this aspect of the study
as given in the project proposal (5) are given below:
1.
2.
To elicit information and feedback from CHAI
members
on :
a)
their
involvement and nature
of
interaction
with CHAI;
b>
their expectations from CHAI in relation to their
own activities;
c>
their
views regarding the
appropriateness
and
adequacy of CHAI's activities;
d>
their views regarding factors contributing to the
gap between expected and observed actions; •
e>
their suggestions regarding alternate measures to
be adopted to fill in the gap.
To
determine the views of members and of
a
select
group of individuals (panelists of the Policy
Delphi
Method>,regarding
the possible future role of
CHAI
with particular reference to:
i)
its mandate,
ii)
its role in the broader Indian scene,
iii)
the role it can play in Asian and other countries.
A few changes were made.
Factors contributing to the gap between
expected and observed actions were not explored specifically with
this
group.
This was covered to some extent
during
interviews
with people who were more closely involved with the
Association.
Similarly,
the broader Indian scene and the role that
CHAI
can
play
in
Asian and other countries was taken up
in
the
Delphi
Method.
-3-
3.
3.1
METHODOLOGY
The project proposal
Based
on
discussions
with
Fr.John
Vattamattom,
SVD,
Executive
Director
of CHAI, the -First idea
draft
of
the
study
was
written
by
Prof.P.Ramachandran
in
September
1989.
This
was
responded
to
by
Dr.C.M.Francis
and
Dr.Thelma
Narayan.
After
a brain
storming
session
in
February
1991
at
which
all
members
of
the
Advisory
Committee and the Study Coordinator were present the
first
draft project proposal was written in March 1991.
This was
circulated to members of the Board, all Departments of CHAI
and to 144 other persons.
Modifications were made based on
the
responses
and
after
further
reading.
The
final
project
proposal
for
the overall study
was
written
in
October 1991.
3.2
Sampling
For
the
purpose of this detailed evaluative
study
of
CHAI,
a
20
per cent random
sample
of
its
constituent
(institutional) members was selected. The membership as
of
October
1991
consisting
of
2,270
members
formed
our
sampling framework.
Individual associate members (who have
no voting rights) were not included in the study.
The
sample
was stratified for size
of
institution
and
region of the country where they functioned. The membership
was
divided
into two categories according
to
size.
One
category
included those with 0-6 beds.
This
comprised
1,590
member institutions.
The second
category
included
those
with more than seven beds. This group consisted
of
680 member institutions. The rationale for
stratifying
by
size
was
that size was indicative of different
types
of
health/
medical functions performed by
the
institutions,
namely involvement in primary and secondary levels of
care
respectively.
It was hypothesised that institutions
with
these
different functions would have different
needs
and
different expectations from CHAI.
-4-
For
stratification by region, the twenty-five
States
and
seven
Union
Territories
(U.T.)
of
the
country
were
divided
into two broad categories, based on the levels
of
certain
well known health indicators. The
two
indicators
used
were
the Infant Mortality Rate (IMR) and
the
Crude
Death
Rate
(CDR).
The Infant Mortality Rate
is
widely
accepted
as
being
a sensitive indicator
of
the
health
status
and level of living of a population.
It is also
a
measure of the health delivery system of an area / country.
The
Crude
Annual Death Rate
is also
considered
a
fair
index
for comparative
purposes.
Statewise
data
for
the IMR and CDR are available.
These
are collected by the
Sample Registration System (SRS ) which
is considered to be
the most reliable in the country.
The
goal
for the Infant Mortality Rate
for
1990
was 87
/
1000
live births per year, and the goal for
the
Crude
(Annual)
Death
Rate
for 1990
was
10.4/1000
per
year.
During
the
planning phase of the study, 1987-88
was
the
latest year for which published data was available.
There
fore
achievement of goals for 1990 already in 1987-88
was
taken
as the cut off point for the study.
States /
Union
Territories
that
achieved the goals for IMR and
CDR
for
1990,
as
laid
down by the National
Health
Policy
(of
1982) were placed in one category, namely of better
health
indicators
or better health status.
The number of
member
institutions in this category were 1,555.
Those States / Union Territories which had not yet
reached
these
goals were placed in the second category of
States/
Union
Territories
of poorer health indicators
or
poorer
health
status.
The number of member institutions in
this
category
were 715.
The States/Union Territories
in
the
two categories are given as follows.
-5-
Division of. gtates/Union Territories into Regions according
to hea1th status using available hea1 th indicators
Poor Health Status
Better Health Status
(715 member institutions)
(1,555 member institutions)
1.
2.
3.
4.
5.
6.
7.
8.
9.
flrunachal Pradesh
Assam
Bihar
Gujarat
Madhya Pradesh
Orissa
Rajasthan
Sikkim
Uttar Pradesh
CN.B:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Andhra Pradesh
10. Meghalaya
Goa
1 1 . Mi zoram
Haryana
12. Naga1 and
Himachal Pradesh
13. Punjab
14. Tamil Nadu
Jammu and Kashmir
Karnataka
15. T ri pura
Kera1 a
16. West Bengal
Maharashtra
17. All the
Manipur
Union Teritories
(Andaman and Nicobar Islands,
Chandigarh, Dadra and Nagar Haveli
Daman and Diu, De1 hi,Lakshadweep
and Pondicherry.)
Andhra Pradesh which had a CDR of 10.6 / 1000/ year and
Meghalaya
with
a
CDR
of
10.5/1000/year
were
also
included
in this category. The IMR was
not
available
for Nagaland, Manipur, Goa, Tripura, Meghalaya and
all
the Union Territories.
They were categorised into this
group
based on the CDR.
For Mizoram even the CDR
was
not
available.
It has a small population and a
small
number
of
member
institutions.
Because
of
its
similarity
to
the other North Eastern States
it
was
included in this category empirically.)
This
broad
categorization,
using
just
two
indicators,
was done so that the differing health situations/problems and
needs
of
people
could
be
taken
into
account.
It
was
hypothesized that the type of health interventions
required,
the prioritization and approaches in medica1/hea1 th work,and
the level and functioning of the government and health system
would differ in these areas.
The work responses and needs of
CHAI
member institutions would also possibly
be
different.
This
would
also probably result in
differing
expectations
from
CHAI and its supportive services.
It was felt that
it
would
also
be
useful to study
the
distribution
of
CHAI
members
and the utilisation of services of CHAI
using
this
criteria.
-6-
Distribution o-f membership by region and size o-f
0-6 Beds
More than
7
institution
Beds
Total
Better Hea1 th
Indicators
1,018
537
1,555
Poorer Hea1 th
Indicators
572
143
715
1,590
680
2,270
Total
Distribution o-f
the sample by region and size of
0-6 beds
More than 7
beds
.institution
Tota 1
Better Health
Indicators
204
108
312
Poorer Health
Indicators
114
29
143
Total
318
137
455
In
the report the two categories according to
region
are
referred to as regions with better health status and poorer
health status (o-f people) respectively.
3.3
Interview Schedule - the instrument -for data collection
Data
collection
was
personnel
(decision
institutions.
done
through
interviews
with
key
makers)
in
the
selected
member
An
interview schedule was developed as the instrument
-for
data
collection.
Part-A
was identical
to
the
mailed
questionnaire that was administered to all members in order
to
gather data regarding the activities/pro-fi 1 e o-f
health
related
work
being done by member institutions
of
CHAI.
Part-B gathered -feedback about the various aspects o-f CHAI.
There
was
a
special note
-for
Diocesan
Social
Service
Societies.
The
interview schedule was pilot tested by members o-f
the
study
team.
This was done in 14 institutions o-f which
12
were
in
Karnataka and 2 in Kerala. They
included
large,
medium and small institutions and a Diocesan Social Service
Society.
Necessary changes were made
prior to printing.
-7-
3.4
Investigators
(interviewers)i
Forty
volunteer
investigators
participated
in
the
study
by undertaking -field work to visit
institutions
in
the 20 per cent sample for the interviews. Thirty-nine were
scholastics in the final years of their formation/ training
to
become
priests
and one was
a
priest.
They
were
motivated,
reliable,
highly educated and well
suited
to
interact
with personnel from member institutions of
CHAI,
who
were also all religious personnel.
Some had
previous
exposure to research.
A
five
day training was conducted for them.
This
was
done
twice,
as
there
were two
groups.
One
group
of
Capuchin
and Franciscan scholastics were based
in
Mysore
and
another group of Jesuit and Diocesan scholastics
were
based in Delhi.
The priest from St.Thomas Mission,
Mandya
joined
the
Mysore
group.
Topics
covered
during
the
training included : the objectives/purpose of the study, an
introduction
about
CHAI
and
its
various
activities,
techniques of interviewing as used in research studies, use
of
the
schedules
(proformas)
including
explanations
regarding
all
the technical terms that were
used.
Seven
background
papers
were given to
them
(see
Appendix-I).
Mock interviews (classroom) and trial interviews in
nearby
member
institutions
were conducted
using
the
interview
schedule and discussions held regarding the experience.
Thus
41
member
institutions were covered
by
the
trial
interviews.
Of these 25 were in Karnataka, 6 in Delhi,
3
in
Haryana
and
7 in Uttar Pradesh.
These
were
member
institutions who were not in the 20 per cent sample.
Data
from Part-A of these forms has been included along with the
analysis of the mailed questionnaire , which is reported in
the
'Profile
of
health
work
done
by
CHAI
member
institutions'.
The
field
work was completed during
the
holidays
in
December
1991
and May-June 1992.
It
involved
extensive
travel to remote areas,often under difficult
circumstances
including interstate conflicts, problems of terrorism, wild
animals
etc.
Two letters were written
to
participating
member institutions informing them of the purpose and dates
of
the visits and requesting information of how
to
reach
them.
Available information from the membership department
of
CHAI
was also used.
Inspite of this
we
were
unable
to
get
information
about
some
institutions
and
the
investigators
just used local sources of
information
and
their sense of adventure to arrive at the institution.
-8-
Logistics
of
working
out
routes,
purchase
of
journey
tickets etc, w?s done mainly by the investigators with
the
help of the study team and the CHC team.
Study team members conducted supervisory field visits to
a
few
institutions in South India when the
interviews
were
being conducted.
After
completion of the fieldwork, debriefing was held
in
group and individual sessions to share overview impressions
and to collect the filled proformas, settle accounts etc.
3.5
Mai led Questionnaire
A
mailed
questionnaire was sent to the remaining
807.
of
member
institutions
(1,815).
The first purpose
was
to
collect
information regarding the
medica1/hea1 th
related
work of all CHAI constitutional members.
Therefore Part
A
of
the
mailed questionnaire and interview
schedule
were
identical.
The
second
purpose
was
to
put
the
key
evaluative
questions
regarding
CHAI
to
the
entire
membership.
The questionnaire was pretested, modified
and
mailed
to
members in December 1991.
Two
reminders
were
also sent at an interval of a month each.
3.6
The overa11
process
A
summary
of
the purpose, aims and
broad
areas
to
be
covered
by
the study was sent to all
members
for
their
information and comments before the final project
proposal
was written.
This was mailed with the circular sent by the
Executive Director.
The membership was also kept
informed
about the study by the Executive Director, senior staff
of
CHAI and the study team during the 1991 Annual Convention,
regional
meetings
and subsequent circulars.'
There
was
scope for interaction at all these points.
3.7
Data analysis
The
data was coded and entered into computers. This was
a
time consuming task.
Data entry was also cross-checked by
the study team.
D-base
I 11+
was used for the analysis of
the
data.
The
staff of St.Joseph's Evening College - Data Processing
and
Computer
Centre helped the study team in writing
out
the
programmes and commands necessary for analysis and in other
technical problems that arose.
-9-
Computer
viruses
were a major problem as
a
number
of
students
used the same systems -for their
practical
work.
The
team
also
had to fit into
their
class
schedules,
examination
schedules
etc.
However,
we
received
much
support
and
cooperation and without this ready
help
the
analysis would not have been completed in time.
3.8
The Advisory Committee to the Study and study
process
The
committee
played a very active and
supportive
role
through
out.
It met four times during the period
of
the
study.
There were however several
informal
interactions
and
correspondence.
Members
also
gave
very
valuable
comments on all the reports.
-10-
4.
4.1
FINDINGS
FUNCTIONING AND CLOSED MEMBERS
Of
the
455
member institutions that
comprised
the
207.
sample for the detailed study,
17 were not visited due
to
the
sudden ill health of
an
investigator.
Th-y were
in
the States of Jammu and Kashmir (2), Himachal Pradesh
(1),
Uttar Pradesh (11) and Madhya Pradesh (3).
We were unable
to
find a trained replacement and the study
team
members
also
could not be spared as the
workload
of the
overall
study was great.
We therefore mailed them the
proforma.
Three responses were received but were too late. They
were
therefore not included in the analysis.
We therefore
have
information from 438 institutions.
This comprises 19.37. of
the
total membership of 2,270 (October 1991).
Of
the
17
for
which we have no information 3 were from regions
with
better health status and 14 from regions with poorer health
status, 12 were from the 0-6 bed category and 5 from
the
more than 7 bed category.
The
number
of
functioning member
institutions
in
this
sample was 407
(92.97. of 438).
This number therefore
is
the
denominator
in
all
the
tables.
The
number
of
institutions c losed/currently not functioning was 31
(7.17.
of
438).
It can be extrapolated roughly from this,
that
of
the
2,270
members,about 161 would be
closed
or
not
functioning.
In
some cases replies were received from other persons
at
the
address in response to our first communication to
say
that
the institution was closed.
These institutions
were
not
visited if they were out of the way. In
other
cases,
the
investigators
found them closed during
their
visit.
The
reasons
for
closure
given
by
persons
from
the
(religious) community were:
♦ there was no further need for the institution
because
other facilities (mostly private) had developed in the
area;
t due to lack of personnel, there was temperory closure;
* other problems.
-11-
ANALYSIS BY REGION,
SIZE,
LOCATION AND STATE
The break up of the group of 407 -functioning respondents by
region
(according health status), by size o-f
institutions
and by urban, rural and tribal location is given below:
Institutions by region
312
21
03
31
17
-0
14
119
(83.27.)
288
(92.37.)
1
455
Total
407
M
10
7.
n = 407
•
143
Number
funct
ioning
Number
not
visited
■
Poorer hea1th
status
Better hea1 th
status
Number
c1osed
C
D
Number
in
samp1e
1
Reg ion
MS M
Functioning Respondent
i
1.
1
Table
1
4.2
100.0
health
21
out of the 31 institutions closed are in better
There
is
also
a
disproportion
in
regions.
status
14 were in poorer health
status
institut ions not visited.
in
regions
and comp rised 9.87. of this group, while 3 were
better health status regions comprising 1.07. o-f this group.
Therefore
the representation o-f institutions
-from
poorer
health
status
regions
in the total
o-f
407
-functioning
institutions becomes slightly lower.
Table 2.Functioning Respondent
Institutions by
location
Number
Location
(n=407)
Urban
Rura 1
Tribal
70
269
68
17.2
66.1
16.7
Tota 1
407
100.0
N.B:
This and the -following tables exclude
institutions that are closed/not visited.
the
This
is
similar
to
the
overall
urban,
rural,
distribution o-f member institutions.
This was -found
16.67.
urban, 67.87. rural and 15.67. tribal -from
the
component o-f the study.
-12-
tribal
to
be
other
Table 3.
Size of Functioning Respondent
Number
Size
SmaIler- (0 - 6 beds)*
Larger (More than 7 beds)
*
Institutions
7.
(n = 407)
65.6
34.4
267
140
included 19 social welfare
This
soc ia1 service societies etc.
centres,
diocesan
As
per
the information, with 'CHAI as of Oct
1991,
70.17.
were in the 'smaller' group and 29.87. in the 'larger'.
The
clubbed data from the 2 samples showed a slight shift
that
has
taken place with a few less than 6
beds
institutions
having
grown into more than 7 bed institutions.
However,
there
is
also
some
under
representation
of
smaller
institutions
as
12
out of the 17
not
visited
were
in
the 0-6 bed category according to available information.
Table 4.
Functioning Respondent
State
1 . Andhra Pradesh
2. Assam
3. Bihar
4. Goa
5. Gujarat
6. Haryana
7. Karnataka
8. Kerala
9. Madhya Pradesh
10.Maharashtra
11 .Manipur
12.Meghalaya
13.Mizoram
14.Naga1 and
15.Orissa
16.Punjab
17.Raj asthan
18.Tami1nadu
19.T ripura
20.Uttar Pradeesh
21.West Bengal
Tota 1
Institutions
by State
Total
membership
7. of instituttions in that
State
45
7
29
5
1 1
3
31
80
34
18
3
11
2
5
14
2
7
70
2
18
10
232
55
160
30
58
1 1
159
416
209
96
21
47
4
19
79
28
30
393
4
122
70
19.4
13.7
17.7
17.2
18.6
27.3
19.5
19.2
16.3
17.7
14.3
23.4
50.0
26.3
17.7
7.1
23.3
17.8
50.0
14.7
14.3
407
2,270
17.9
Functioning
members in
207. sample
The
percentage of the total
in each State is also given.
-13-
number of member
institutions
4.3
INFORMATION REGARDING PERSONNEL
a)
INTERVIEWED
The
designation
of key personnel
group is given below:
Table 5.
Designation o-f
the main
interviewed
responding
in
personnel
Number
7.
(n=407)
Nurse
Administrator-cum-Nurse
Administrator (not trained)
Administrator-cum-other
Health Worker
Other Health Workers
Administrator (trained)
Doc tor
Trained Social Worker
No information
109
124
104
26.8
30.5
25.5
13
24
1 1
14
01
07
3.2
5.9
2.7
3.4
0.2
1.7
Total
407
100.0
Designation
this
The
table
shows
that
the
personnel
interviewed
were
trained health professionals working mainly in positions of
responsibility and decision making within the member insti
tutions.
Their
feedback
regarding
CHAI
is
therefore
valuable.
b)
The length of stay of the main personnel
the member institutions is also given:
Table 6 .
Length of stay of
responding
interviewed
personnel
(n=407)
Length of Stay
Number
Be 1 ow 12 months
13 to 24 months
25 to 36 months
Above 36 months
No information
84
81
63
166
13
20.6
19.9
15.5
40.8
3.2
Total
407
100.0
-14-
7.
in
56.37.
of
the
personnel have
worked
in
the
member
institutions
-for over three years and 76.27. -for more
than
two
years.
The majority have therefore had
a
sufficient
length of stay in the member institution to understand
the
relationship
with CHAI and to give feedback.
It
is
also
likely
that previous institutions in which
the
religious
personnel
would
have worked were also
members
of
CHAI.
Only
recent
graduates undergoing their
first
or
second
posting would be new to CHAI.
c)
The
number
of
personnel from
the
respondent
member
institutions who participated during interviews is given
in the table below:
Table 7.
Number of
participants during each interview
Number of
personnel per
interview
Number of
Institutions
7.
n=407
One
T wo
Three
Four
Five
Six
No information
265
96
34
07
01
01
03
65.1
23.6
8.3
1.7
0.2
0.2
0.7
Tota 1
407
100.0
Since
it
was
the
member
institution
and
its
views
regarding
CHAI
that
was
being studied, and
also
given
the fact
that religious
personnel are transfered after
certain
periods,
it was felt that more
than
one
person
could represent the institution since different persons may
be
knowledgeable
about
different
aspects
of
the
relationship
with CHAI.
However in all institutions
the
key decision maker/director/administrator was requested
to
participate.
-15-
4.4
MEMBERSHIP OF CHAI
This
data
is
derived
from
i.e.j-from
the
interviewed
questionnaire.
a>
The
year
of
table
below.
samp 1es.
Trend
Table 8.
SI .
No .
joining CHAI
This
data
Time period
decades
in
Total
The
type of membership
Number of
insti tutions
7. of total
(1,415)
5
32
108
333
539
36
362
0.4
2.3
7.6
23.5
38.1
2.5
25.6
1,415
100.0
Table 9 .
is also
Type o-f constitutional
below:
membership
7.
(n=l,415)
977
336
102
69.0
23.7
7.2
1 ,008
99.9
Annual member
Life member
No information
Tota 1
1970's and an even
the 1980's.
indicated
Number
Type
the
the
membership
The trend shows a marked increase in the
greater- increase in the c urrent phase of
b)
insti tutions
the
mailed
as a member is given
in
is
derived
•from
both
in growth o-f CHAI
1943 - 1950
1951 - 1960
1961 - 1970
1971 - 1980
1981 - 1990
1990 and after
No information
1 .
2.
3.
4 .
5.
6.
7.
1,415
member
group
and
Only 917 institutions specified the type of membership. 257.
of
respondent institutions below 6 beds are
life
members
and 31.6 -percent of those above 6 beds are life members.
Analysis
of
membership according to
region
showed
that
40.07. of respondents from States with poorer health
status
and
36.67. of those from States with better
health
status
were life members.
(N.B:Analysis by size and
region
-16-
is
for 407 institutions)
4.5
REASONS FOR JOINING CHAI
This
question was asked both in the mailed
questionnaire
and
in the interview schedule and are
jointly
reported.
71.0 percent (1,004 out of 1,415) member
institutions
who
participated
in
the study gave reasons as
to
why
they
joined CHAI.
They were given in response to an
open ended
question.
Similar reasons have been clubbed
together and
are given below in descending order o-f priority.
4.5.1
For guidance/in-format ion/training (S30 or 58.67.)
Large
nun bers
joined
for
guidance,
support
and
help
in
(388 )
and
for information regard ing new
developments
hea1th
care
so as to keep up-to-date and to
improve
the
standa rd of serv ice (380).
Smaller
numbers
joined -for training o-f
hea1th
(57)
and
to attend courses and seminars o-f fered
(05) .
personne1
by
CHAI
(456 or 32.27.)
4.5.2 To avai 1 o-f the benef its of-fered by CHAI
This was to obtain free medicine (172); to obtain financial
advantage
of
assistance/materia1
help (162), and to take
all the benefits offered by CHAI (122).
4.5.3 For togetherness, cooperation and support
(389 or 27.57.)
The
reasons
given
were: to gain
mutual
cooperation
to
fulfill
objectives
(64),
to share
ideas,
problems
and
experiences
with others and for mutual support (47),to
be
part of a larger organisation (88), to work together
(34),
for
(78) ,
and
for
so 1 ida rity
(36),
to streng then CHAI
safety and security (42).
4.5.4 Because of its Catholic na ture (299 or- 21.17.)
for
These were mainly because it is a Catholic body (179),
for
interaction
among
Catholic
hospitals
(48) ,
better
to
Catholic
hospitals
(25) .
of
oneness
with
fee 1ing
integrate
the principles of Christianity in
health
care
(24),
and
because
it
is
a
coordinating
agency
for
Catholic hospitals (9).
Smaller
numbers
mentioned
that it was a
policy
of
the
Congregation (6),on the advice the Bishop (2), as CHAI is a
link
between the Church and Government (2), as advised
by
CRI (1>, to fall in line with Catholic health policies (1),
since CHAI was started by a Sister of the same congregation
(1), and to be a partner in the healing ministry with
CHAI
( 1 ) .
-17-
4.5.5
Because o-F its objectives, pol icies and other
activities <47 or 3.37.)
Much smaller number of members gave the -following
reasons:
because
o-f its community health policy (10), to work
with
CHAI to build a healthy nation (10), to seek help in
legal
problems
(0S),
to have a forum to voice problems
to
the
Government
(06),
because
of
its
objectives
(05),
for
effective coordination of community based health care (05),
being inspired by the Annual Conventions (02), and
because
of its approach in health work (01).
4.5.6
Other miscel laneous reasons inc luded (14 or 1.07.)
Invitation to join (10), to ensure the participation of lay
people in CHAI (02), since the institution was started with
the
help
of
CHAI
(01),
and
being
fascinated
by
the
Association (01).
More
than one reason has been given by many
institutions.
The
need for information/ training support to
their
work
has come out consistently even under expectations.
Future
thrusts
indicate
specific areas in which
this
could
be
provided.
Availing of assistance/ benefits has also
come
high
on the list.
The need for togetherness and
support
and
because
it is a Catholic organisation come
next.
A
much
smaller
proportion mention that the
objectives
and
policies are the reasons for their joining CHAI.
-18-
4.6
ORGANISATIONAL
ISSUES
FEEDBACK ON THE STATED OBJECTIVES OF CHAI
4.6.1
74.77.
(304)
of
the
respondents
were
aware
of
the
objectives
of CHAI.
This is a very large
proportion.
It
must
be
kept
in
mind however
that
the
next
question
actually gave the objectives.
This was done since we
were
more
interested in knowing whether members felt that
the
objectives
should
be changed.
In order to
get
specific
suggestions regarding reformu1ation of the objectives,
the
present
objectives were given.
An additional
reason
was
that during informal interactions with staff and members it
was found that many were not
aware about the objectives.
15.2Z (62) members felt that the stated objectives
of CHAI
need
to
be changed.
79.97. (325) felt
that
change
was
not
necessary,
1.2Z (5) were unable to comment
and
3.7Z
(15)
did not respond. 39 (of the 62) gave
specific
017as
that
should be considered when
reformulating
objectives.
These are given below:
1)
It
was
felt
that
mention
should
be
made
in
objectives
regarding preferential option for the
and focus
on
people especially the rural
and the unreached (15).
2)
Mention should be made regarding need for social equity,
and
for
social
awareness
regarding
socio-political
issues, as this was considered necessary for good health
(5) .
3)
It
was
felt that CHAI should focus more
on
Objective
Two,
namely "To promote,rea1ise and safeguard
progres
sively
higher
ideals in
spiritual,
moral,
medical,
nursing,
educational,
social and all other
phases
of
health
endeavour"(1).
A
suggestion
was
that
this
objective
needs
to
be
modified
by
emphasising
the
importance
of human values (2).
It was also felt
that
this objective needs greater clarification (1).
4)
It was felt that greater emphasis needs to be given
to
Community
Health and Family Welfare
programmes,name 1y
Objective Three "To promote community health and
family
welfare programmes" (3).
-19-
the
poor,
poor
Mention
should be made of the shift from
the
curative
to
the preventive/promotive approach, health
education
to
be specified, mu 11i—discip1inary approach in
health
care and a wholistic approach in the healing ministry to
be included.
5)
Need
to stress and emphasise Objective
One,namely
"To
improve the standards of hospitals and dispensaries
in
India".(1)
Another
member
felt
that
emphasis
on
institutions should be revised.
Yet another felt
that
need
for
a
uniform policy
for
member
institutions
should be stated as an objective.(3)
6)
The
services
of
CHAI
could
be
specified
in
the
objectives (01).
This
could be added to Objective One
or Four or else objectives could be related to services/
activities (1>.
In this regard specific suggestions included: service in
rural/ unserved areas (1), need to emphasise service
to
small/
poor
member institutions (1), legal aid
as
an
area
of
service
(1),
and
training
programmes
for
different health care personnel to be included (1).
7)
Objectives should indicate need for flexibility by
CHAI
to
be
able
to
respond
to
the
specific
needs
of
different areas in the provision of its services (1).
There
was no association (statistical)
between
awareness
regarding
objectives
and the size
of
institution
(bed
strength),
region
(health
status)
or
location
(urban/
rural/tribal).
There was also no
need
for
change
location.
4.6.2.
association between the opinion as to the
of objectives and the
size,
region
or
FEEDBACK ON ORGANISATIONAL STRUCTURE OF CHAI
Again,
a large proportion of 64.6 per cent of
respondents
(263)
stated
that they were aware of
the
organisational
structure
of
CHAI.
Of these 80.97. (213)
felt
that
the
present organisational structure was suited to achieve
the
objectives
of the association.
However, 19.17.
(50)
felt
that it was not suitable for the purpose and there was need
for change.
Changes suggested were predominantly regarding
decentralisation of power (6) and strengthening of regional
units (7). Related comments were
-20-
that
the
organisational
structure
should
have
equal
participation ,(representation)
-from
all
levels
(3),and
greater
representation in decision making from
the
lower
(periferal)
structure (2). The Executive Board
must
have
representatives from the regional/ state/ local units
(2).
Another
related
suggestion was the need to shi-ft
from
a
unitary
(centralised)
set
up
to
a
more
federal
and
participatory structure.
A suggestion was that rural areas
should
be
given
greater
representation
in
the
Board.
Another
stated
that the Executive Director
should
be
a
member of the Board.
(As chief executive he is now present
in all Board meetings).
Additional
suggestions
were
that
the
organisational
structure
should
facilitate
the
achievement
of
the
objectives
of CHAI (2).
It should also
enhance/
promote
inter-re1ationship between members (1).
46.0
Z
of
those
who
stated
that
the
organisational
structure should change, did not give suggestions regarding
the type of changes that could be made.
4.6.3
PARTICIPATION
IN CHAI
UNITS
46.9 per cent of respondent institutions (191) stated
that
they
participate in regiona1/State/diocesan units of CHAI.
They are not mutually exclusive. The details are as follows:
a)
Regional Units
(covering more than one State)
NECHA
(North Eastern Community Health
Association )
RUPCHA
(Rajasthan,Uttar Pradesh Catholic
Health Association)
b)
c)
State Units
Kerala CHA
Andhra Pradesh (CHAAP)
Tamilnadu (CHAT)
Orissa (OCHA)
Karnataka CHA
Diocesan Units
(details give in next table)
-21-
Number of Institutions participating
28
11
33
25
17
11
02
70
Table
10.
Participation
in Diocesan Units
SI .
No.
Diocese
01 .
02.
03.
04 .
05.
06.
07.
08.
09 .
10.
1 1 .
12.
13.
14 .
15.
16.
17.
18.
19.
20.
21 .
22.
23.
24.
25.
26.
27.
28.
29.
30.
31 .
32.
33.
Ooty
Vellore
A j mer
Kumbakonam
Sa 1 em
Bangalore
Bellary
Bombay
Indore
Raigarh
T anj ore
Tuticorin
Ambi kapur
Ju 11 and har
Palayamkottai
Ranchi
Trivandrum (AD)
Vijayawada
Ba 1asore
Bi jnor
Coimbatore
E1 uru
Ernaku1 am
Hyderabad
Kohima
Kottar
Madras-Mylapore
Pond ic herry-Cudda1 ore
Raipur
Sivagangai
Trichy
Udaipur
Vishakapatnam
05
05
04
04
04
03
03
03
03
03
03
03
02
02
02
02
02
02
01
01
01
01
01
01
01
01
01
01
01
01
01
01
01
Total
70
Number of
Institutions
Nine
institutions did not specify
are a part.
the unit of
which
they
54.77. of institutions in regions with better health
status
participate
in these different units of CHAI and 45.27.
of
those in regions with poorer health status do so.
45.6Z of
less than 6 bed institutions participate in these units and
63.17.
of those from
more than 7 bed institutions
do
so.
This is a significant association.
-22-
Institutions
based
in
tribal
areas
have
a
greater
partici pation
(61 ^87.) , fol lowed by urban (57.17.) and
rural
institutions (47.57.) .
Some
of the Diocesan Health Units /groups
mentioned
have
been initiated by the respective Diocese or
others and not
by
CHAI.
Some are linked organisationa11y to State
level
units and some are more informal with regular or occasional
meetings.
The
regional and some of the State units
are
registered
societies.
All
have
regional
level
executive
boards
elected
by
the general bodies at the
State
level.
The
Kerala
Unit
is the oldest and was formed soon
after
the
Silver Jubilee of CHAI in 1968.
At that point formation of
regiona1/State units was given a priority.
The concept
of
forming secular Voluntary Health Associations in
different
States
then
evolved, with the Bihar VHA being
formed
in
1974.
There
was
therefore a lull in
the
formation
of
regiona1/State
units of CHAI members, since most
of
them
were
members of State VHA's.
Formation of
units
however
picked up again in the Eighties.
6.4
SUGGESTIONS REGARDING CHAI
UNITS/ THEIR ACTIVITIES
Interestingly,
66.17.
(269)
felt
that
based
on
their
experience there is a need for Diocesan Units, 32.97.
(134)
suggested
State Units and 26.3Z (107)
suggested
Regional
Units
(covering more than one State).
The largest
number
of
suggestions
regarding major activities that
could
be
carried
out by the different units were also for
Diocesan
Units (503), and smaller numbers for State Units (161)
and
Regional Units (151).
It
has been well stated by a member that
"Diocesan
Units
could
give concrete local expression to the objectives
of
CHAI".
Activities suggested
1.
for Diocesan Units were:
Promoting Better Interaction
(145 or 35.67.)
Diocesan Units could help create closer contacts and better
interaction
among member institutions (85), by
organising
regular
meetings
and
visits
(43).
Also
by
creating
opportunities
for
sharing
experiences
and
facilities
available
with each other (16),and supporting
each
other
(1)
.
-23-
2.
Providing Guidance, Training and Information (145 or 35.67.)
By
conducting seminars and courses (57),
providing
help,
guidance
and support (36), information on health
care
in
regional
languages (22),
and
organising other
training
programmes
(22).
They
could
produce
health
education
material and other publications in the vernacular (6),
and
conduct courses in health education (2).
3.
Commun i ty Hea 1th Deve lopmen t and Fami 1 y We 1 -fare (79 or 19.4Z)
Diocesan Units could undertake health awareness
programmes
(22),
organise community health programmes
(18),
village
extension programmes (15), community development activities
and
programmes
(13),
and
-family
welfare
programmes,
including natural -family planning (11).
4.
Co-ordination (50 or 12.37.)
The health work of member institutions at a Diocesan
level
could
be coordinated (34).
Supervision of
activities
of
members
(9), and coordination of outreach programmes
were
suggested
(5).
So also the exchange of
personnel
among
members as and when needed (2).
5.
A
few organisational issues were raised,
namely
studying
the
needs of members locally (4), building
linkages
with
other
organisations (2), searching for priorities
in
the
area
(1),
evolving policies suited to the
locality
(1),
representing
the diocese at the State/Nationa1 level
(1> ,
organising
diocesan
level
conventions
(1),
forming
associations
of different health workers (1),
undertaking
evaluation and planning (1).
6.
Other
activities
for
members
and
their
staff
were
suggested.
Provision of financial help to
needy
members
(15),
help with management aspects of member
institutions
(5),
arranging
doctors/nurses
for
small
dispensaries
especially
in rural areas (5), organising
annual
renewal
programmes
(5), working out a salary policy for
personnel
,
(2)
taking care of the spiritual needs of personnel
(1),
providing assistance to deal with medico-legal issues
(1),
and to solve local problems (1).
7.
Specific
hea1 th
and related services
that
could
be
promoted
at
the Diocesan level are:
pastoral
care
(5),
school
health
(4),
mother
and
child
hea1th/womens'
programmes
(4),
training
traditional
birth
attendants
(dais)
(1),
immunization
programmes
(1),
promotion
of
herbal
medicines/alternative
systems
of
medicine
Cl),
medico-ethical issues (1).
-24-
Promotion of social' justice (3), adult/nonforma1
education
,
(3)
income
generation
schemes
(2) ,
youth
welfare
programmes (1), and organising social awareness
programmes
(1),
were suggested.
Activities suggested for the State level units were
similar.
However additional points were:
a)
b)
c)
d)
e)
f)
largely
Linkages with Government and other State level organi
sations for the promotion of health.
Coordination of Diocesan Programmes.
State level training programmes and refresher courses.
Organising State level conventions.
Representing the State level needs to the Centre.
Discussing and dealing with the specific
medica1/hea1 th
problems of the State.
The
other new and specific areas mentioned for
the
State
level were the
promotion of a rational drug policy,
urban
health
and
programmes
to
tackle
drug
addiction
and
a1coho 1 ism.
Very
similar
activities
were
also
suggested
for
the
Regional
Units.
The
only
additions
being
need
for
discussion of problems and issues important at the regional
level and the solving of regional problems.
4.7
INTERACTION BETWEEN CHAI
CENTRAL OFFICE AND MEMBERS
In
order
to understand the level
of
interaction
and
contact between CHAI and its members the following
aspects
were studied:
a) Visits by CHAI staff/others to member institutions;
b) Receipt by members of Circulars from CHAI; and
c) Participation in special training programmes organised
by CHAI.
They
utilisation
by
members
of
the
services
of
the
different
major departments of CHAI is dealt with later.
4.7.1
Visits by CHAI
staff/others to member
institutions
13.8 per cent
(56)
institutions have
been visited during
the past 5 years period, i.e. 2.87. every year.
The Chi Sguare test shows an association between
and region, size of institution and location.
*
*
the visits
21.57. of institutions in regions with poorer
health
status
and
13.17.
in regions
with
better
health
status were visited.
28.47. of institutions with more than 6 beds and 9.47.
of institutions in the 0-6 bed category have
been
visited.
-25-
»
33.97.
urban, 16.97. tribal and
institutions have been visited
10.57. of rural
respectively.
the
56 institutions vis ited in the past 5
Of
by whom the visit was paid.
spec i fied
Details
be 1 ow •
Table
SI .No .
11 .
Detai 1s of
visits
paid
Visits conducted
by
01 .
02.
03.
04 .
05.
06.
07.
08.
09.
10.
11 .
12.
13.
to member
based
year-s,
42
are
given
institutions
Number of
Institutions
visited
7.
o-f
407
%
15
07
05
03
02
02
3.7
1.7
1.2
0.7
0.5
0.5
35.7
16.7
11.9
7.1
4.8
4.8
4.8
2.4
Community Health Dept.
Executive Director
Executive Board Members
Central Purchasing Serv ice
Membership Department
Asst.Executive Director
Office Bearers of
Regional Units
Pastoral Care Departmen t
Continuing Medical
Education Department
Documentation Department
HAFA Staff
Editorial Committee
Zonal Officer
02
01
0.5
0.2
01
01
01
01
01
0.2
0.2
0.2
0.2
0.2
Tota 1
42
10.0
o~
42
-
2.4
2.4
2.4
2.4
2.4
100.2
The purpose of the visits, as expressed by members, were as
■foil ows :
* courtesy
/liaison
visits
and
to
see/understand
the functioning of the centres (15);
♦ to
evaluate
the
community
health
work
(5),
for
training
and
orientation
seminars
(7),training
regarding alternative systems of medicine (1),training
regarding
rational
drug therapy (2),
regarding
the
writing of the CHAI-CMAI formulary (1),for consultancy
and
guidance (1),to
get personnel for
a
training
programme
(1), to assess the health situation of
the
area
(4),
to
organise exhibitions(1> ,
* to sell raffle tickets (5), for fund raising (4),
* to. assess project
proposals
(2),
to
sanction
the
proposal for a general ward (1),
* regarding membership issues(l), to collect
membership
fee (1),
» to assess pastoral care services (2),
* to enquire about purchases requested through CPS (1),
* for diocesan advisory committee meetings
(1),
* for exchange programmes (Indo-Phi1ippines) (1),
» to settle misunderstandings
(1).
-26-
The
Statewise ,breakup o-F
in the -following table.
Table
institutions visited
is
given
Institutions visited according to State
12.
SI .
No.
State
Visited
Not
visited
Do not
know
N.I**
Total
01 .
02.
03.
04 .
05.
06.
07 .
08.
09.
10.
1 1 .
12.
13.
14.
15.
16.
17.
18.
19.
20.
21 .
Andhra Pradesh
Assam
Bi har
Goa
Gujarat
Haryana
Karnataka
Kera1 a
Madhya Pradesh
Maharashtra
Manipur
Megha1aya
Mi zoram
Naga1 and
Orissa
Punj ab
Raj asthan
T ami 1nadu
T ripura
Uttar Pradesh
West Bengal
06
—
04
—
06
02
03
—
—
01
01
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
01
—
08
01
07
—
33
05
22
05
09
02
23
57
23
16
01
09
02
04
10
02
06
55
01
09
09
01
07
—
01
01
—
—
—
01
—
45
07
29
05
1 1
03
31
80
34
18
03
1 1
02
05
14
02
07
70
02
18
10
56
303
46
02
407
Total
(407)
02
—
03
14
08
—
01
—
—
—
02
—
—
01
05
09
03
02
01
02
—
CN.B.
*
Arunachal
Pradesh has
no
members,
Jammu
&
Kashmir
and
Himachal
Pradesh
were
not
visited
by
investigators, Sikkim and the Union Territories did
not
enter the sample. This applies to other statewise tables
a 1 so.
* * N.I. = No Information 3
31
(55.37.)
institutions
visited
were
in
the
-four
Southern
states
o-f Kerala,
Karnataka,
TamilNadu
and
Andhra
Pradesh,
while
19 (33.97.)
were
in
the
-four
Central
States o-f Bihar, Madhya Pradesh, Rajasthan
and
Uttar Pradesh.
4.7.2
Circulars
97.37.
(396) regularly receive the
mailed
circulars
-from
the
Executive
Director
o-f
CHAI.
Only
1.5’4
(6)
said
they
do
not receive these.
Thus there is a
channel
of
communication
between the central office of CHAI
and
the
members regarding the various activities and programmes
of
CHAI .
-27-
4.7.3
Participation
in CHAI
Special
Training Programmes
This includes programmes -for continuing medical
education,
spiritual
growth through clinical practice, pastoral
care
programmes,management workshops,diocesan and regional level
programmes. The programmes/ac tivi ties of other
Departments
are given seperate1y,1 ater in the report.
25.17.
(102)
member
institutions
have
participated
in/attended
the
above programmes during
the
past
five
years.
The
number is increasing over the years,
with
80
(78.07.)
having
participated
in 1990 and
1991.
It
is
possible
that this is related to the increasing number
of
courses that are being offered.
Some member
institutions
have
sent
their personnel to different
programmes.
The
total member therefore varies.
The
details
participated
sample are as
Table
13.
2.
3.
4.
5.
6.
7.
personnel
who
from this 20
per
Number of personnel who have participated
special training programmes
SI.No.
1.
of
the
number
of
in various programmes
follows:
Programme
Continuing Medical Education
a) Rational Therapeutics
b) Training
in Oral Rehydration
Therapy (ORT)
c) Use of Herbal Medicines
d) Others
Spiritual Growth through
Clinical Practice
Pastoral Care Programmes
Management Workshops
Diocesan Level Programmes
Regional Level Programmes
Others (Legal Aid, Women
and Health, Low Cost
Communication etc)
Tota 1
in
Number
of
Personnel
Total
26
18
22
08
23
36
24
91
50
25
323
-28-
have
cent
A
total
of
323 persons have participated
-from
the
102
institutions. '
Each
institution has sent
more
than
one
person
(3.2
on
an
average) -for one or more
programmes.
It
is
probable that having attended once, they
are
more
likely
to make greater use o-f such opportunities.
Larger
number
o-f
persons
(43.67.) or
141
have
attended
the
Diocesan
and
Regional level programmes.
The
number
o-f
institutions participating at these levels was 31 (see next
table).
But probably larger numbers o-f personnel -from each
institution
are
able
to attend.
Personnel
could
also
attend all/more than one programme conducted at this level.
This substantiates the earlier opinion o-f respondents
that
the Diocesan level o-f -functioning is preferable.
These are
optimal places to conduct these programmes as they are more
easily accessible (in terms o-f time, money, and travel) and
would
probably
be more relevant to the
local
situation,
besides o-f-fering an occasion -for members in the same region
to get know each other and build working relationships.
It
is
not
possible to say
-from
programmes are in greater demand.
table
this
which
The
annual
participation
o-f
institutions
in
different
special
training programmes -for the past -five years is
as
fol lows:
Table
14.
SI.No.
Annual
participation
Programmes
in idifferent programmes
1987
1988
1989
1990
1991
N.I.
Tota 1
01
03
02
—
04
07
03
01
—
—
01
02
—
02
08
03
01
—
02
02
01
01
03
—
07
14
20
06
01
02
01
07
09
—
20
01
—
01
02
—
01
—
01
06
01
—
—
—
02
01
01
01
12
18
13
18
11
19
139
1.
Continuing Medical
Education
alRational Therapeutics
btTraining in ORT
c)Use of Herbal Medicines
d)Others
2. Spiritual Growth
through Clinical
Prac tice
3. Pastoral Care
Programmes
4. Management Workshops
5. Diocesan Level Programs
6. Regional Level Programs
7. Others
11
Total
» NI:
No
information
26
regarding year of
02
01
—
05
03
05
04
02
10
1 1
04
05
02
12
34
46
participation.
139
respondent members gave their opinion
content
of
these programmes organised by
is given below in tabular form.
-29-
regarding
the
CHAI.
This
Table
15.
SI.No.
Opinion On con ten t of special
Programmes
Number
Useful
Continuing Medical
Education
a)Rationa' Therapeutics
b)Training in ORT
c)Use of Herbal Medicines
d)Others
2. Spiritual Growth through
Clinical Practice
3. Pastoral Care Programs
4. Management Workshops
5. Diocesan Level Programs
6. Regional Level Programs
7. Other
training
of
programs
Total
institutions
Not
Useful
No information
1.
07
13
19
06
Total
01
01
0
07
14
20
06
19
12
13
11
16
11
0
04
01
01
01
0
01
01
01
0
20
12
18
13
18
11
126
07
06
139
Overall,
a
majority
(90.77.) feel that
the
content
of
programmes
was useful .
Only four out of 18
(22.0Z)
who
responded
to
the guery
regarding
management
workshops,
specifically said that they were not useful.
This too is a
minority.
Feedback
programmes
Table
16.
SI.No.
from members regarding
is given below.
Methodology of Special
Programmes
Continuing Medical
Education
a)Rational Therapeutics
b) Training in ORT
c)Use of Herbal Medicines
d)Others
2. Spiritual Growth through
Clinical Practice
3. Pastoral Care Programs
4
Management Workshops
5. Diocesan Level Programs
6. Regional Level Programs
7. Others
the
methodology
of
the
Training Programmes
Well
Conduc ted
Poor 1y
Conducted
No
Total
In formation
1.
Total
—
—
—
—
—
01
02
—
07
14
20
06
18
11
17
12
17
09
01
—
—
—
—
—
01
01
01
01
01
02
20
12
18
13
18
11
128
01
10
139
07
13
18
06
-30-
Again
a
majority
o-f 92.07. have
programmes were well conducted.
expressed
that
the
Only
two
members
gave
additional
comments/suggestions,
namely:
(i)
CHAI
staff should be
available
to
conduct
seminars
on various topics in tribal
areas,when
regional
level
programmes
are organised,
(ii)
Accommodation
-for
participants should be ensured.
Analysis showed a significant association with
*
*
location viz.
43.757. o-f urban, 35.597. o
tribal and 27.387. o-f rura 1
based
institutions
have participated in
the
above
prog rammes,
Participation
is however independent o-f the size
o-f
poorer
health
institutions
and
region (better and
status) o-f the member ins itutions.
-31-
CONVENTIONS
4.8
CHA I
4.8.1
Participation;
(covering
the past -five years)
132
(32.47.)
of respondent member institutions
have
been
represented
at any one or more of
the
Conventions/Annua1
Meetings
of CHAI during the past five years .
264
(64.97.)
have not attended any.
9 (2.27.) do not know and
2
(0.57.)
did not respond to the question.
The Chi Square test shows an association between region and
size
of
institutions
and
participation
in
annual
conventions.
*
37.18
Z from regions with better health
status
and
24.4
7.
of
institutions from
regions
with
poorer
health status
have participated,
* 24.17.
of
the
0-6 bed
institutions
and
49.67.
of
institutions with more than 7 beds have
participated
in
conventions.
However, because
of
the
much
larger
proportion
of small
institutions
in
the
total
membership of CHAI, in terms of
numbers
64
or
48.57.
of participants were
small
institutions
out
of
the
132
who
attended
the
conventions.
Looked
at in
another way while 37.07.
of
members
(as per study findings) have more than 7 beds,
51.5Z
of
participating institutions in
the
conventions
are from this category.
-32-
*
Analysis by location shows that 39.17. of urban, 32.87.
of rural and 29.47. of tribal area based
institutions
have
participated in conventions during the
past
five
years.
However,
out
of
the
total
132
participating
institutions
during the
past
five
years
64.47.
(85)
were rural,
15.17.
(20)
were
tribal and 20.47. (27) were urban.
This is more
or
less
similar to the distribution by location of
the
total
membershi p , whic h is 67.87. rural, 15.67.
tribal
and
16.67.
urban.
There is thus
no
statistical
association wi th
location.
The
yearwise
breakup
attended the conv entions
Table
17.
Annual
of the
number
of
persons
who
from this sample is as follows:
Participation in Conventions
Year
Number of
persons who
attended
1986
36
Hyderabad,Hea1 th as
1987
58
Calcutta, Dur Health Care Mission
A Search for Priorities.
1988
80
Cochin, Our Hospitals:
Accountabi1ity.
1989
29
Hyderabad, Financial
Project Planning.
1990
77
Bombay,
Venue and
Women
Theme
if
People Mattered
:
Towards Greater
Administration and
in Health Care.
280
The
trend
shows an increase in numbers
attending,with
a
plateauing
after
1988.
In 1989, only
a
general
body
meeting
with a half day session was held, thus
accounting
for the drop in number.
It is also seen that a total
of
280 persons from 132 institutions have attended, that
is,
an average of two per institution.
-33-
4.8.2
The
designation of the personnel
conventions is as follows:
Table
18.
SI . No.
Designation
01.
02.
03.
04 .
05.
06.
07.
08.
Staff Nurse
Doc tor
Administrator
Community Health
Worker
Social Worker
Pharmacist
Laboratory
Technic ian
Staff (unspecified)
Total
CN. B:
Designation of Personnel
who
attended
the
attending conventions
1986
1987
1988
1989
1990
Total
15
03
06
19
02
09
34
01
16
09
—
04
42
02
06
119
08
41
01
—
—
—
—
01
—
01
03
—
—
—
01
03
—
01
05
03
—
—
01
01
—
—
—
01
03
—
—
25
31
The remaining did not answer or
57
02
15
they did not
54
182
know.]
The
majority
attending
are
nurses
(65.4Z)
and
administrators (22.57.), some of whom are also
nurses. This
would be useful to keep in mind when planning
conventions.
Conventions
do
not adeguately reach other
categories
of
health personnel.
Either greater efforts could be made to
involve them or other programmes could be more specifically
designed for them.
-34-
4.8.3 The
Statewise
breakup
of
institutions
personnel to the conventions follows.
Table
19 Statewise
1 ist of
institutions
State
Yes
No
01 .
02.
03.
04 .
05.
06.
07.
08.
09.
10.
1 1 .
12.
13.
14.
15.
16.
17.
18.
19.
20.
21 .
Andhra Pradesh
Assam
Bihar
Goa
Guj arat
Haryana
Karnataka
Kera1 a
Madhya Pradesh
Maharashtra
Man i pur
Meghalaya
Mizoram
Naga1 and
Orissa
Punjab
Raj asthan
T ami 1nadu
Tri pura
Uttar Pradesh
West Bengal
20
01
06
01
02
—
08
31
05
06
01
03
—
03
06
01
01
23
02
08
04
22
06
23
04
09
03
20
46
29
1 1
02
08
02
02
07
01
05
47
—
10
06
—
—
—
—
—
—
—
Total
132
264
08
CN.B:
have
sen t
represented at Conventions
SI .
No.
(407)
who
Do not
know
03
—
—
—
—
—
03
02
—
—
—
—
—
—
N. I
Tota 1
—
—
—
—
45
07
29
05
1 1
03
31
80
34
18
03
1 1
02
05
14
02
07
70
02
18
10
—
—
—
01
—
01
—
—
—
—
01
—
01
—
—
—
—
04
407
N.I.
= No In formation.
Also refe r note below
Table
12.3
[82
(62.17.)
were
from the four Southern
States
and
20
(15.17.) were from the fou r Central States of Bihar,
Mad hya
Pradesh, Rajasthan and Uttar Pradesh!
4.8.4 Feedback
on conventions:
A major ity of 80.27.
(150)
felt
that
the themes chosen were usefu 1, 17.67. did not
respond
to this quest ion and 2.17. felt the themes were not
u seful.
This question was asked i n the con text of their work.
Regarding the quality of the sessions 75.4 7. (141) expressed
that they were interesting, 20.87. gave no information ,
and
3.77. said that sessions were not interest! ng .
Regarding
the organisation of the conventions 75.97.
(142)
expressed
that
they were well organised.
3.77.
( 7)
felt
they were not well organised and 20.37. (38 )did not respond.
-35-
Additional' remarks made by a
annual conventions were:
few respondents
regarding
the
* Conventions are informative,
* There is poor attendence by lay people,
♦ Those who attend do not participate actively,
* There
is
lack of adequate
communication
and
dialogue
between members,
* Arrangements -for -food and accomodation are poor,
* There is canvassing to elect candidates -from a
particular
state by certain members.
4.8.5 A
picture of
the themes of
fol 1ows:
the fol low up undertaken by
institutions
the past five annua 1 conventions is as
on
1)
1986
14
institutions (3.4 7. of
407)
organised
some
follow
up
on the theme, "Health as if
People
Mattered".
This
included
sharing
of experiences
and
knowledge
of
conventions
with others (03); improving hospital
services
;
(2)
offering
person
oriented
services
(1);
starting
pastoral care services (1); details not given (7).
2)
1987 - 17 institutions (4.2 7. of 407) undertook some follow
up
on
the theme "Our Health Care Mission : a
Search
for
Priorities".
The
follow
up
included
:
sharing
of
experiences/knowledge
gained
with
others
(4);
starting
health
awareness programmes (1); starting community health
programmes
(1); adopting a preference
regarding
treating
the
poor
(2); starting practice of holistic
health
(1);
details not given (8).
3)
1988 9 institutions (2.27. of 407) initiated follow up on
the theme "Our Hospitals: Towards Greater
Accountability".
This
included:
sharing
experiences
with
others
(3);
conducting medical camps (1), details not given (5).
4)
1989 - 7 institutions (1.7 7. of 407) undertook some
follow
up
on
the
theme "Financial
Administration
and
Project
Planning".
Of
these
four did not
specify
details
of
follow
up and three said they shared
experience/know1 edge
gained with
others.
5)
1990 - 26 institutions (6.4 7. of 407) organised some follow
up
on the theme "Women in Health Care ".
This included
:
sharing of experiences/knowledge with others (5);
starting
womens'
awareness programmes (5); organising a seminar
on
women in health care (1); starting Mother and Child
Health
and
village health programmes for women (4); education
on
Natural Family Planning (3); details not specified (8).
-36-
During
the past -five years, the overall follow
up
on the
themes
of
the various conventions has been
poor.
This
may
not be
uncommon
after
meetings
and
conventions.
However
considering the large investment in terms
of
the
time
of CHOI staff, of the local organising committee
and
of
the participants and of money spent, the
purpose
of
the of annual conventions other than conducting the
annual
general
body
meeting
and business affairs
needs
to
be
reviewed.
Clarifying
goals
and
purposes,
using
participatory
methodologies
in
small
groups,
getting
feedback
from participants, evaluating the conventions
b>
the staff, Board and a small group, along with follow up by
CHAI may help to make this major activity more meaningful.
4.8.6
185
(45.4
7.)
of member
institutions
have
given
many
suggestions
regarding the conventions, which
are
broadly
grouped below:
a)
Venue:
It
was felt that conventions should
be
arranged
regiona11y/1 oca 11y
(64).
It is inconvenient/not
possible
to
travel
long distances and close
the
institutions
to
participate in the conventions (30).
Conventions should be
arranged
in
the North and South
alternately
(4).
They
should
be held at least once a year at the
central
level
.
(4)
Conventions
should be organised in
central
places
.
(3)
Two seperate conventions could be held for the
North
and the South (2).
Conventions could be conducted in
each
state
by
turn (2).Conventions should be
held
in
Kerala
every alternate year (1).
b>
Part i c i pan ts
and Partici pation:
The participation of
the
laity
should be encouraged (2).
Focus
should be
on
the
participation
from
each
of
the
diocesan
units
(1).
Representation
from all levels should be
encouraged
(1).
There is a lack of participation from rural health
centres
(1>.
Small
dispensaries
are not
given
due
importance
during
conventions (1).
Poor/ small
institutions
cannot
participate
in
conventions (1).
All
members
should
be
treated egually (1).
Participants are generally unaware of
what is taking place
during conventions (1).
c)
Preparatory work/Planning of conventions;
18 members again
expressed that conventions are useful and informative and 8
felt that they are not useful and are not worth
attending.
The
organisation of the conventions should be better
(5).
Group
sharing
should be introduced (8).
Input
sessions
should
be
given greater importance
(4)
There should be
time/space for raising regional issues (1).
An open forum/
platform
to express feelings and views should be
arranged
.
(1)
Seminars/courses could be arranged either before
or
soon
after
the
conventions (2).
It is
useful
to
have
exhibitions
during the conventions (1).
The
conventions
should
be
used as an occasion to
motivate
members
(1).
There is a need for proper planning ( 1 ) .
-37-
d)
Themes and foil aw up:
Upto date themes should be taken up
.(4)
Member's
should
be consulted
before
deciding
on
themes (2). It was felt that themes were not practical (2),
and are not applicable to smaller institutions (2).
There
should be time and space for raising regional issues (1). A
seperate convention could be held for leprosy workers
(2).
"Community
Development"
needs
to
be
taken
up
(1).
Spiritual values are not taken care of in conventions
(1).
Promote other systems of medicines during conventions (1).
CHAI
does ot help its members to follow up on
resolutions
.
(2)
There is poor follow up of resolutions (11.
Fol low
up
programmes
should be arranged
at
the
State/Diocesan
levels ( 1 ) .
e)
Time
factor:
The frequency of conventions should be
once
in two years (12).
They should be held once in three years
.
(1)
The conventions should be for more than a day (1).
f)
Financial aspec ts:
Conventions are very expensive (16).
CHAI should provide travel allowance to representatives from
poor
institutions (5).
Participants should be given
some
subsidy
(2).
It
was felt that
annual
conventions
are
conducted to mobilise money (1).
g)
An
additiona1
comment was that
"politics"
avoided in the election of office bearers (1).
-30-
should
be
4.9
4.9.1
a)
PUBLICATIONS
Hea1th Action
92.97.
(378) member institutions received
Health
Action
during
the
years
1988,
1989,
1990.
Only
19
(4.77.)
specifically
said
they have not received
the
magazine.
However,
this
number
includes
those
institutions
that
started after 1990.
10 institutions (2.47.) did not
know/
gave
no information.
This data relates to the year
since
it
was transformed from Medical Service to
Health
Action
and
during the years when it was sent to all
CHAI
member
institutions free, i.e., as part of their membership fee.
66.67.
(271) institutions from this sample
subscribe
to
Health
Action
(in 1991).
There is an
association
shown
by
the
Chi
Square
test at the
5
per
cent
level
of
significance
between the location
(urban,triba1,rura1)of
the
institution and subscription.
77.37 of urban
based
institutions, 77.97 of tribal area based institutions
and
62.37. of rural based institutions are subscribers.
Analysis according to size of institutions shows that 64.97.
of
smaller
institutions
(0-6
Beds),
T2.77.
of
social
welfare
centres
(including
Diocesan
Social
Service
Societies) and 71.37. of larger institutions ( more than
7
beds) subscribe to Health Action.
74.37.
(87/117)
of institutions in
regions
with
poorer
health
status and 64.67 (184/285) based
in
regions
with
better health status subscribe to Health Action.
-39-
b>
to Health Action
The Statewise subscription
next.
is given
Statewise subscription to Hea1 th Action
Table 20.
SI .
No .
State
Yes
No
Do not
know
N. I
Total
01 .
02.
03.
04 .
05.
06.
07.
08.
09.
10.
1 1 .
12.
13.
14 .
15.
16.
17.
18.
19.
20.
21 .
Andhra Pradesh
Assam
Bihar
Goa
Gujarat
Haryana
Karnataka
Kera1 a
Madhya Pradesh
Maharashtra
Manipur
Megha1aya
Mizoram
Naga1 and
□rissa
Punj ab
Raj asthan
T ami 1nadu
T ripura
Uttar Pradesh
West Bengal
34
04
21
03
10
03
22
42
24
13
02
10
—
1 1
03
08
02
01
—
—
—
—
—
—
—
—
—
—
02
—
45
07
29
05
1 1
03
31
80
34
17
03
1 1
02
05
14
02
07
70
02
18
10
05
407
Total
LN.8:
(407)
09
36
10
04
01
01
02
—
05
12
02
05
43
01
1 1
04
01
27
01
05
06
271
131
01
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
02
—
—
—
—
—
—
01
—
01
—
—
Refer note with Table.12.
141 ( 52.07.) o-F subscr i bin g member institutions are -from the
Central
-Four
Southern States and 61 (22.57.) -From the -F our
and
Uttar
Raj asthan
Madhya
Pradesh,
States
(Bihar,
Pradesh).
c)
o-f
An
enquiry was made rega rding the frequen cy o-F reading
regu1 ar 1y,
76.27. (310) read it
Health Action by members.
neve r read
it,
16.07. (65) read it occasi ona11y, 1 . 57. ( 6 )
4.87.
( 20 )
and 1.57. (6) did not respond to th is quest ion.
their
not
applicable ,
si nee
was
said
this
ques tion
the
period
■Formed or joined CHAI after
institution
was
This group a re also
not
when Health Action was sent -Free.
presently subscr ibers to the magaz ine.
-40-
An
idea
about
the different groups of
people
Health Action -is given in the table below:
Readership of Heal th Action
Table 21 .
SI .
No.
01 .
02.
03.
04 .
05.
06.
07 .
08.
09 .
10.
1 1 .
12.
13.
read
who
Ca tegory
Nurses
Admin istra tors
Doc tors
Sisters in the Congregation
Patients
Relatives
School Teachers
Community Health Workers
Office Staff
Student Nurses
Paramedical Staff
Social Workers
No information
Number of
institutions
7.
n = 407
293
220
138
137
30
29
06
06
05
02
01
01
07
72.0
54.0
33.9
33.7
7.4
7.1
1.5
1.5
1.2
0.5
0.2
0.2
1.7
d)
Members
gave their opinion about Health Action.
A
large
majority
of 95.67. (374) found its contents relevant,
1.57.
(6) found it not so relevant and 2.87. (11) did not respond.
Regarding
its
presentation,
90.3Z
(362)
said
it
was
interesting, 1.57. (6) found it was not so interesting, 4.27.
(17)
said
it
was too technical and
3.9Z
(16)
did
not
respond to the question.
e)
Comments
and
suggestions concerning Health
given
by
70.8 (288) of member institutions.
as fol lows:
Usefulness:
158
(38.87.) again reiterated
found Health Action useful and informative.
considered to be well organised (3).
Action
These
were
are
that
they
It was also
Language
and Presentation: (108 or 26.57.) 74 felt
that
it
should
be
published
in
the
vernacular
(nationa1/regiona1)
language.
Contents
should
be
presented in simple English (8).
Some considered it too
technical
for
ordinary people (7).
The
presentation
should
be easily comprehensible with the use of
charts
and
diagrams
etc (4).
The print was tedious
to
read
(3) .
There
is
need
for
greater
use
of
case
studies
(3).
Illustrations
were considered good (2).
Larger number
of
illustrations
are
required (1).
Greater
use
of
humour
(jokes
etc) was suggested (2).
Medical jargon
should
be
demystified, making it useful for ordinary people (1).
Thematic presentation should be continued (1).
Health and
disease
quiz
sheets
could be included to
make
it
more
interesting (1).
Advertisements should be minimised (1).
-41-
Con ten ts
19.97.) : .
-
Suggestions regarding spec i f ic
areas ;
(81
or
ft 1 ternative systems:
Information on herbal medicine/other
systems of medicine should be given (17).
Drugs:
Need for a column on banned/outdated drugs
(14).
Information
on side effects of drugs (9), essential
drugs
,
(2)
and drugless therapy (2) to be covered.
Rura1
Hea1 th:
Publish reports/artic1es on
rural
health
and development (8), covering also tribal areas (2).
There
could
be
a
column
for
rural
health
workers
(2),and
guidelines for training community health workers (1).
Diseases:
Specific illnesses should be
covered,
giving
symptoms
and
treatment (9).
Publish
detailed
articles
regarding new diseases (4).
Information on leprosy
should
be added (2).
Natura1 Fami1y P1anning and Mother and Chi Id Hea1th:
Should have a column on Family Life Education and
Natural
Family Planning (3).
Issues on women and child care to be
inc 1uded (1).
Others:
There is a need for coverage
on
medico-ethical
problems
(1),
adult education (1), problems of
old
age/
services that are available (1), and on mental
retardation
(1).
ft
column
on social problems
and
case
studies
of
so 1utions (1>.
Con ten ts
- Genera 1 Focus (40 or 9.8Z):
Focus
on
current
issues
in
health care (7).
Articles are not
upto
the
standard
(7).
Contents
should be
relevant
to
medical/
health
work done by members (4).
The medical
aspect
is
often
neglected in articles (4).
Articles should be
upto
date
(3).
Applicability
of
issues
to
the
village
situation
should
be included (3).
Wrong
information
is
given
at
times
(3).
The members
and
their
activities
should
be introduced to the readers through Health
Action
.
(3)
Contents
should be more oriented
to
the
medical
profession
(2).
It
should
be
responsive
to
the
interests
of
small
institutions
too.
It
is
more
practical,
rather than theoretical at present
(1).
One
page
could be used for practical hints (1).
The
articles
should reflect Gospel values (1).
Articles should focus on
preventive education (1).
Cost/Readership/Distr i but ion
(34
or 8.37.): It
should
be
sent
free
of
cost to members (19).
Some
said
it
was
expensive
(9).
There
is
a
need
to
subsidise
the
subscription
(2).
The
number
of
copies
sent
to
institutions could be increased according to the number
of
readers
(1).
Make more efforts to widen
the
readership
(1).
It should be made available to
non-catholics
also
(1).
(N.B.:This
is already being done)
Members
get
it
irregu 1 ar 1y (1).
-42-
4.9.2
Other priced
publications/productions
The
pattern
of purchase of
various
other
publications/
productions -from CHAI or HAFA (Health Accessories
-for All)
is given as -follows.
Tab le 22.
51 .
Purchase o-f other
priced
Purchase o-F
Yes
No
Publications
r
01 .
02.
03.
04 .
05.
06.
07.
08.
09.
publications/productions
pub 1ications
Do not know
No
7.
(n =
407)
Natrual Family Planning
(NFP) by Fr.Menezes
1 1 1
27.3
273
23
S 1 ide/cassette set on
Natural Family Planning
1 1
2.7
374
22
Health Care Products &
Services : A Buyers
Guide - 1987
77
18.9
310
20
Herbal and Home Reme
dies (1987) in Mala
yalam by Sr.Innocent
and Fr.Joseph Chittoor
86
21.1
305
16
Trainers Manual -for
Training Community
Level Workers (1987)
by Community Health
Department o-f CHAI
54
13.3
329
24
Herbal and Home
Remedies (1989)
Compiled by Sr.Julie
Plackal (loose leaf,
pictorial -format)
48
11.8
333
26
CHAI-CMAI Joint
Hospital Formulary
( 1990)
48
11.8
336
23
Music cassette on
Rights of the Child
09
2.2
378
20
Healing Music
16
3.9
372
19
cassette
-43-
Comments
regarding
the
usefulness
of
the
above
pub 1ications/productions are given below.
Percentages
are
calculated
based
on
the
number
who
purchased
the
publication/production.
Table 23.
SI .
No.
Comments about priced
Publi cations
Family Planning
publications/productions
Useful
Not
Useful
No in
forma
tion
Not
applica
ble
79.37.
(88)
06
17
296
Bl .
Natural
02.
S1ide/Cassette
set
on
Natural Family Planning
63.67.
(07)
01
03
396
03.
Health Care Products and
Services: Buyers Guide
67.57.
(52)
04
21
330
04 .
Herbal
(1987)
and Home Remedies
83.77.
(72)
04
11
320
05.
Trainers Manual
Community Level
79.67.
(43)
01
06.
Herbal
(1989)
and Home Remedies
77.17.
(37)
03
08
359
07.
CHAI-CMAI Joint Hospital
Formulary
72.97.
(35)
01
13
358
08.
Music cassette on Rights
of the Chi Id
66.7
(06)
01
03
397
09.
Healing Music
62.57.
( 10)
04
03
390
4.9.3
for
Workers
(cassette)
Publ ications sen t
10
353
f ree to members
Given below are -the numbers and percentages o-f members from
this
sample
who
have
received
the
publications
that
were sent free by CHAI.
-44-
Receipt of
Table 24.
-free publ ications
Publications
SI .
No.
Insti tuions who
received
the pub1ications
The Memorandum of Assoc
iation and Ru1es,Regu1ation and Bye-laws of CHAI
(1961 )
01 .
Health and Power to People
: Theory and Practice of
Community Health (1986)
by Community Health and
Development Team of CHAI
02.
Set of ten
Hindi *
03.
(N.B:
*
7.
7.
No.
7.
86
21.1
221
54.3
100
24.6
8.8
278 68.3
93
22.8
36
No .
No
booklets in
28
The CHAI Hospitals and
Other Health Care Insti
tutions: Health Policy
Guidelines (Draft)
1987-88
04.
Insti tutions
who did
not know
whether
they
received
Insti tutions
who did
not
receive
The denominator
62
-for
6.9
15.2
323
79.4
259 63.6
the percentages
56
13.7
86
21.1
is 407 >
The
set
of
ten booklets were
on
Bronchopneumonia
and
Pneumonia;
Common
Intestinal Worms-Round
Worm
and
Pin
Worm;
Po1iomyelits;
Ears;
Eyes;
Tuberculosis
and
its
Prevention; Teeth and Gums - Care of Teeth; Leprosy;Common
Skin Diseases and Scabies.
-45-
Comments
regarding
the
usefulness
of
the
publications
are
given
below.
Percentages
have
calculated
on
the basis of the number who
received
publications.
Commen ts about
Table 25.
above
been
the
-free publ ications
Publication
Useful
Not
Useful
No in
forma
tion
Not
Applicab 1 e
The Memorandum of Associa
tion and Rules,Regu1 ations
and Byelaws
69.87.
(60)
04
22
321
Health and Power to People
: Theory and Practice of
Community Health (1986)
72.27.
(26)
01
09
371
Set of
Hindi
71 .47.
(20)
01
08
378
69.37.
(43).
02
17
345
ten
booklets
in
The CHAI Hospitals and Other
Health Care Institution:
Health Policy Guidelines
(Draft) 1987-88
-46-
4.10
CENTRAL PUCHASING SERVICE
(CPS)
Ut i 1 i zation
4.10.1
24.67.
(100) institutions -from this sample had
availed
of
the
-Facility/
services
offered by CPS
o-f
CHAI
anytime
during the past.
The five year cut off period was not used
for the
CPS as purchases tnrough this unit could be
large
ones
made
only
once
in
several
years.
65.67.
(267)
institutions
had never availed of the services of CPS
and
9.87. (40) did not know if it had been used in the past.
Further analysis of
by region, location
the utilization of services of the
and size of institution showed.
*
an
association
at the 5 7. level
of
significance
with
size of institution.
42.47. of
larger
(more
than 7 beds), and only 20.17. of smaller institutions
of 0 - 6 beds size availed of these services.
*
There was also an association with location
(urban,
rural, tribal) 50 7. urban, 24.5 7. of rural and 13.87.
of
tribal
area based institutions availed
of
the
services of CPS respectively.
*
The
association with region was not significant
at
the 5 7. level.
However, 29.47. of institutions based
in
regions
with
better
health
status
availed of the
facility
offered by the
CPS,
and
21.97.
of those based in regions
with
poorer
health
status
did so.
Since
larger
numbers
of
members are in regions with better status, in
terms
of actual numbers this group is more.
The
Statewise
pattern of utilisation by
members
facility offered by CPS is given next table.
-47-
of
CPS
the
Table 26
Statewise uti1ization of CPS by members
SI .
No.
State
Yes
No
Do not
know
N.I
Total
01 .
02.
03.
04 .
05.
06.
07.
08.
09.
10.
1 1 .
12.
13.
14.
15.
16.
17.
18.
19.
20.
21 .
Andhra Pradesh
Assam
Bihar
Goa
Gujarat
Haryana
Karnataka
Kera1 a
Madhya Pradesh
Maharashtra
Mani pur
Meghalaya
Mizoram
Naga1 and
Orissa
Punjab
Raj asthan
T amiInadu
T ripura
Uttar Pradesh
West Bengal
19
—
04
01
04
01
09
25
08
02
—
20
07
23
04
06
02
20
47
24
14
03
08
01
03
07
01
06
52
02
10
08
06
—
—
—
02
—
—
—
—
03
—
03
02
—
—
45
07
29
05
1 1
03
31
80
34
18
03
11
02
05
14
02
07
70
02
18
10
268
36
03
407
Total
EN.B::
(407)
01
01
02
02
01
—
15
—
05
—
100
Refer note with Table
01
—
02
08
02
01
—
02
—
—
04
—
—
—
—
—
—
01
—
—
—
—
01
—
01
—
—
12. 3
f rom the
four
Southern
68
(68.07.)
institutions
-facilities
of
CPS,
wh ile
17
utilised
the
institutions fr om the fou r Cent ral states of Bihar-,
Pradesh, Rajasthan and Uttar Pr adesh did SO .
-48-
States
(17.07.)
Madhya
4.10.2
The y_earwise
given below.
Table 27.
Year
1960
1973
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
iterns
that were purchased
Yearwise items
purchased
through the CPS are
through CPS
Vehicles Equipment Pharmaceuticals Consultancy
<services
—
—
01
01
01
01
—
—
—
—
—
—
02
02
01
01
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
Total
03
02
05
02
02
06
06
02
05
04
10
13
15
16
02
02
01
01
03
05
09
09
—
01
01
03
02
01
01
01
01*
01»
01
01
04
02
07
04
03
07
06
05
06
05
14
19
27
28
04
94
40
09
02
145
01
—
—
—
—
—
—
01
—
—
—
—
—
—
—
C N ■ B : * CPS was started later, but these could have been
bought through CHAI.
Some institutions have made more than
one purchase through CPS, hence the larger total here.3
There
is
an
increase
in
the
number
of
member
institutions
who utilized the services o-f CPS
during
the
period
1988
1991.
It is important to
note
that
the
number
o-f non-members o-f CHAI who use the -facility of
CPS
much
greater.
Annually non-members account for about
80Z
of institutions making use of the services of the CPS which
is open
to any voluntary organisation working in the field
of health or development in India.
-49-
4.10.3
The overall details of items purchased
CHAI members from this sample are.
Table 2B.
I terns
purchased
through the CPS
through CPS
7.
n = 407
Number of
institutions
I tern
18.9
8.1
1.9
0.5
77
33
08
02
Vehic1es
Equ i pmen t
Pharmaceuticals
Consu1tancy
by
There is a discrepancy in totals as some
institutions have
availed
of
services of CHAI more than once and
for
more
than
one
item.
Some
have
also
bought
the
same
item/category of item more than once.
This is indicated in
the next table.
Table 29.
Frequency of
I tern
Vehic1e
Eguipment
Pharmaceuticals
Consu1tanc:y
10.4
purchase of
items
Once
Twice
Thr‘ice
65
29
08
02
06
02
—
—
04
01
—
—
through CPS
More than
three
02
01
—
—
The
purpose,
given by members, of
purchasing
different
types of items bought through the CPS are indicated below.
Vehic1es:
For outreach services (38), for mobile clinics
(15),
ambulance
(12), use
not
specified
(8),shopping/
conveyance (3), and no information (3).
Eguipment:
Hospital use (unspecified) (11),
refrigerator
(3),
incubators
(2),
air
(6),
storage
of
medicines
,
theatre eguipment (1),
conditioner (2), x-ray machine (2)
laboratory
eguipment
computer
(1), washing machine (1),
photocopier
(1),
and
no
,
(1)
kitchen
eguipment
(1),
information (4).
Pharmaceutical produc ts:
For distribution to the poor
people of the area (4), and no information (5).
Consu1tancy:
To buy books (2)
-50-
the services offered
4.10.5 The
opinion of members regarding
CPS was elicited.
*
113 institutions felt that services were useful
6 mentioned that they were not useful.
*
7 mentioned that services were efficient and
they were not efficient.
*
43
considered
efficient,
7
efficient
and
nor efficient.
and
said
that the services
were
useful
and
felt that they were
useful
but
not
1 felt that they were neither
useful
Some members did not
4.10.6
7
by
respond
to
this question.
Comments/suggestions about CPS are as follows:
Percentages
are
of
the number who
have
utilised
services of CPS.
the
Usefulness ( 34.07.) :
Services were considered useful and
helpful
(27),
and
particularly
helpful
to
poor
institution
(4).
The response to requests is
immediate
(3) .
Areas of probl ems (26 ■ 07.) :
There are too many procedures
to
be
followed
before
service
delivery
(6).
The
vehicles provided are not of good guality (5).
The rates
of
service
delivery
are
high
(3).
There
is
a
bureaucratic delay resulting
in late delivery.
The ser
vices
are
not
prompt
(4).
Applications
are
not
considered
according
to
priorities
(2).
There
is
favouritism in service delivery (2).
Services should
be
more
efficient and responsible (2).
Some
applications
are not considered and reasons for refusal are not
given
(1).
Follow up is unsatisfactory (1).
Suggestions
(14):
CHAI should arrange for
supply
of
drugs
from
foreign
countries
(4).
More
consultancy
services
should
be offered (3).
Help should
also
be
given for infrastruetura 1 facilities (2).
Members should
be kept informed of the possibilities, types of
services
and
methods
of availing of the services
of
CHAI
(2).
CPS should operate from Delhi (1).
It should operate
on
a
local basis (1).
It should get more involved
in
the
purchase/ distribution of pharmaceuticals (1).
“V ?■
-51-
£
S
ANO
■ CUMf ’•'>
4.11
MEDICINES/EQUIPMENT
FROM
THE
CATHOLIC
MEDICAL
BOARD (CMMB) OF THE UNITED STATES OF AMERICA
4.11.1
Receipt g_f consignments
MISSION
53.3
Z (217) institutions -from this sample
have
received
gift medicines/consignments -from the CMMB during the past 5
years.
40.5 Z (165) have not and 6.1 Z (25) do not
know
if they have.
Further
analysis
by
region,
location
and
size
institution and receipt of CMMB consignments shows:
*
of
64.4 Z (85) of institutions with a bed strength more
than
7, 52.8 Z (132) of smaller
institutions
(0-6
Beds) have received consignments.
* 64.2 Z of institutions in regions with poorer health
status
and
53.7 Z in regions
with
better
health
status received consignments.
*
4.11.2
58.7
Z of tribal (37),
56.7 Z (38) of
urban,
and
56.3
Z
(142)
of
rural
based
institutions
have
received
CMMB
consignments. As
mentioned
earlier
actual
members vary according to the proportion
in
the total membership.
Details
be 1ow:
of
Table 30.
type of gift consignments
received
are
given
Detai Is of CMMB Consignments
Consignments
Number of
Institutions
Z
(N=407)
Z
(N=217)
Medicines
Eguipment
Books
Bandages
214
17
10
02
52.6
4.2
2.5
0.5
98.6
7.8
4.6
0.9
A
consignment has a varying combination
types of supply.
-52-
of
the
different
The
yearwise
foilows:
Table 31.
Year
breakup
flnnua1
Medicine
of
the CMMB
consignmen ts
breakup of CMMB consignments
Equipment
Book
Bandages
—
—
Total
1987
1988
1989
1990
1991
N. I
15
38
45
59
54
1 1
03
02
07
0
05
0
02
01
01
04
02
0
01
0
20
41
54
63
62
1 1
Total
222
17
10
02
251
CN.I
= No
as
are
01
—
information]
There
is
an
increase
in
the
number
of
institutions
receiving
supplies
over the years.
Medicines
-form
the
major component o-f the supplies.
208
institutions who received medicines, did so only
once
during
the
past -five years,
-five
institutions
received
medicines twice and one institution received medicines -four
times.
Other
gi-ft consignments were received
only
once
during the past five years.
80.47. who received medicines found them useful.
15.97. said
they
were
not useful and 3.6 7. did
not
comment.
Simi
larly,70.67. receiving equipment found them useful and 29.47.
not useful.
70.0 7. receiving books said they were of use.
4.11.4
Comments regarding medicines
Feedback
was
elicited regarding
the
time
interval
between
the consignment reaching the institution
and
the
expiry
date.
43.6
7. said that
the
time
interval
was
sufficient, 35.6 7. mentioned that this was very short, 17.6
7.
said that the expiry date had already passed and
3.2
7.
did not respond to the question.
Problems
mentioned
regarding gift medicines
30.5Z of 407) were as follows:
(by
124
or
Some
drugs are not useful (68).
Non
essential
medicines
are
sent
(24).
The procedural
formalities
are
tedious
(12).
It is difficult to obtain utilisation/
distribution
certificates (6).
The response to requests is poor
(03).
The
doctors
do
not
prescribe
these
medicines
(2).
Quantities
of drugs sent are too large
(2).
There
is
a
long gap between the date of requests and
-53-
the despatch of the medicines (1).
Banned drugs are
sent
(1).
Unnecessary drugs are sent (1).
Old
bandages
were
sent
(1).
Institutions have to pay a
heavy
duty
(1).
Maintenance
of
records is difficult (1).
People
do
not
want CMMB medicines (1).
Usefulness:
is useful and
It was again mentioned
helpful (151 or 37.1Z).
that the CMMB
scheme
The
general
suggestions/comments
given
regarding
gift
medicines
(by
178 or 43.7Z) were:
Essential
and
useful
drugs for basic/common illnesses only should be sent
(45).
It
is
necessary
to assess the needs
of
members
before
sending medicines (33).
Medicines should be sent regularly
and
in
time
(32).
An
option
should
be
provided
to
institutions/they
should be consulted in the selection
of
drugs
(23).
There should be adequate time to utilize
the
drugs
(20).
We should discourage foreign
medicine
being
dumped onto our hands (4).
There is need for a variety
of
medicines
rather
than
large quantities
of
one
or
two
particular drugs (4).
Supply of books and equipment would
be
preferable to medicines (4).
Medicines
requested
for
should
be
given
(3).
Money
could
be
sent
and
the
institutions could buy the medicines that they require (3).
Information
regarding
the proper use of drugs
sent
also
could
be
given (2).
Annual supply of medicines
to
poor
institutions
would
be
useful (2).
It
should
be
made
available to every one (2).
Better administration of
the
schemes is required (1).
-54-
DISCRETIONARY FUND
4.12
This
is
a one time grant of Rs.5,000
to
Rs. 10,000,
that is offered particularly to small member
institutions
■for
health education, preventive health work and
primary
health care.
4.12.1
Utilisation:
27.5 7. (112) institutions -from this
sample
had
received grants -from this Fund during the
past
five
years.
61.9 7. (252) had not, 10.1 7. (41) did not know and
0.5 7. (2) did not respond to the question.
The Chi Square
test showed an association between size o-f institution and
receipt o-f the grant.
36.4
7.
of
0-6 bed
institutions
and
24.8
7.
of
institutions with more than 7 beds received the
grant.
Since
more than 60 7. of members are in the category
of
small
institutions,
in terms of
actual
numbers,
the
number of small institutions receiving grants is in
the
majority, in keeping with the objectives of the fund.
* Analysis by location shows that 36.8 7. of tribal, 30.9 7.
of
rural
and 24.6 7. of urban based
institutions
have
received grants.
* There was no difference according to region.
31.0 7. of
institutions in
regions with better
health
indicators
received grants, while 30.3 7. of those in regions with
lower health indicators did so.
However since larger
numbers
of
members
are in the
better
health
status
regions, in terms of actual numbers there would be more
from these regions.
*
4.12.2
The
Fund
year wise receipt of grants from
the
by member institutions is given below:
Table 32.
Yearwise Uti1isation of
Year
1987
1988
1989
1990
. •
1991
No information
Total
Discretionary Fund
Number of
Institut ions
14
22
26
25
26
05
-
Discretionary
(N=407)
(N=l19)
3.4
5.4
6.4
6.4
6.4
11.8
18.5
21.9
21.9
21.9
4.2
118
CN.B:
6 institutions received the fund twice during
past
5 years.]
There is an increase from 1987 to
after which it has remained the same.
-55-
the
1989
Statewise utilisation of discretionary
Table 33.
fund
SI .
No.
State
Yes
No
Do not
know
N. I
Total
01 .
02.
03.
04.
05.
06.
07.
08.
09.
10.
11 .
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Andhra Pradesh
Assam
Bihar
Goa
Guj arat
Haryana
Karnataka
Kerala
Madhya Pradesh
Maharashtra
Mani pur
Megha1aya
Mi zoram
Naga 1 and
Orissa
Punj ab
Raj asthan
T amiInadu
T ripura
Uttar Pradesh
West Bengal
16
01
06
01
03
02
09
15
15
04
02
05
01
01
05
01
—
18
02
03
02
28
06
17
04
07
01
17
56
19
12
—
01
—
—
—
—
—
—
—
—
—
—
14
06
01
02
—
—
45
07
29
05
1 1
03
31
80
34
18
03
1 1
02
05
14
02
07
70
02
18
10
112
252
39
04
407
Total
tN.B:
(407)
04
01
01
07
01
06
45
—
Refer note with Table
06
—
01
—
05
09
—
01
01
01
—
03
01
—
—
07
—
01
—
01
—
—
01
—
01
—
—
12.3
58
(15.87.) of institutions from the four Southern
States
have
utilised the Discretionary Fund and 24 (21.47.)
from
the four Central States (Bihar, Madhya Pradesh, Rajasthan,
and Uttar Pradesh) have done so.
-56-
4.12.3
The
purpose
-for
which the grant was
used
by
members
is
given below (percentages are of 112 who received
the
grant > :
*
*
*
to -furnish the dispensary and to buy drugs (74 or 66.17.)
to buy a refrigerator (36 or 32.17.)
to buy hospi ta 1/d ispensary equipment (14 or 12.57.).
Others (9 or 8.07.):
To
open a laboratory in the centre (2), to buy
a
slide
projector for awareness programmes (2), for
immunization
programs
(1),
to start a mobile clinic
(1), to
buy
a
generator (1), to conduct a women's development camp (1),
and
to start a community health centre (1).
3
gave
no
information.
Possibly
purpose.
4.12.4
a
few
institutions used
it for more
than
Comments/suggestions about the Discretionary Fund
were
given
by
41 Z (167) of the
institutions
sample.
These are summarised below.
one
Scheme
in
the
Usef u Iness (109 or 26.87.):
The scheme is useful (82),
especially for poor institutions (26).
It is more useful
than the CMMB Scheme (1).
Prob 1 ems
(34
or 8.37.):
It takes years to get
a
grant
(21).
The members are unaware of such a scheme (6).
The
amount
given is too little (2).
Some applications
are
not considered (2). Applications should not be
summarily
rejected
(1).
The objectives of this fund do not
serve
the
objectives of CHAI (1).
CHAI refuses to give
funds
for community development programmes (1).
Suggestions
(57
or 14.07.):
It should be offered from
time
to time to the poor institutions (27).
The
amount
of
the
grant given could be increased for
these
small
institutions (21).
The
‘discretion' should be based on
some
parameters
(2).
Priorities should be specified while asking for and
considering
applications
(1).
Priority
should
be
given
to
rural areas (1).
The needs
of
the
locality
should be the priority (1).
Grants should be given
only
to
small/poor institutions (1).
Another suggestion
was
that
the
grant
should
be
given/
made
available
to
everyone (1).
The system of maintaining registers should
be avoided (1).
Another felt that it would be better to
give medicines, rather than money (1).
58.9
per
cent
(240)
institutions
did
not
comments/
suggestions regarding the Discretionary
More than one suggestion have been given by some.
-57-
give
Fund.
4.13.
PROJECT PROPOSALS PROCESSED BY CHAI
4.13.1
During
the
past
-Five
years, the
number
of
project
proposals from member institutions to funding
agencies
that have been forwarded/sent through CHAI or referred to
CHAI by funding agencies is 39 ( 9.67.1.
The
yearwise
distribution of
sent/referred are as follows:
Table 34.
Annua 1
pr pressing of
projec t
proposa1s
Number of project proposals
sent/ referred
Year
1987
1988
1989
1990
1991
03
03
05
1 1
19
Total
41
Proposals
twice.
4.13.2
project proposals
from
The purpose of
three institutions
had
been
the project proposals were as
sent/referred
follows:
* To buy vehicles (11),
* for supply of medicines (free) to the poor (B),
* for rural development (6),
* for purchase of refrigerators (5),
* for purchase of equipment (3),
* for construction of building of dispensary (1),
* for the building of a general ward (1),
* for purchase of an X-Ray machine (1 ) ,
* to provide food for participants of a seminar on
hea1th care (1 ) ,
* to start a dispensary (1), and
* for a community health and development project (1).
Two
institutions did not specify
proposa1s.
the purpose of
project
The
majority
are for building of
infrastrueture,
much
smaller
numbers for free curative service and
none
for
training.
-58-
4.13.3
The response of CHAI
was as -Follows:
to
the requests as
stated
by members
* They screened the proposal and sent recommendations (19),
* they visited the institution and gave recommendations (3)
* CHAI provided a consultancy (3),
* no response (12), and
* negative response (1).
Four institutions did not comment on the response of CHAI.
18
• -.’embers
said
that
the
response
of
CHAI
was
helpful
to their planning.
25
(61.07. or 41)
mentioned
that
it was not helpful to their planning and seven
did
not
respond.
The total of 50 responses here
is
larger
than the earlier total of 39.
It is possible that:
a) some
who have sent project proposals more
than
five
years ago, have given comments here.
b) institutions could have sent more than one project
proposal,to which there may have been varied responses.
c) some members have not responded to the earlier question
but have responded to this one.
It is noted that there was no response from CHAI to 30.07.
of requests, and 61.0Z found that the response was not
helpful to their planning process.
4.13.4
Comments and suggestions by 64 (15.77.) members
the system operating with regard to project
proposals are given below:
regarding
Usefulness (27 or 6.67.):
The system is good and helpful
(26).
It is useful and efficient (1).
Problems ( 17 or 4.27. ):
Lack of awareness among members
about the scheme (6).
Great
delay in getting a response
(5) .
There
was
no
response
hence
there
is
a
dissatisfaction with CHAI (2).
Repeated requests have
been neglected (1).
There is favouritism in considering
applications (1).
Small institutions do not benefit by
this system (1).
CHAI is taking an unnecessary burden on
its shoulders by asking for all applications to be routed
through them (1).
Suggestions (14 or 3.47. ):
CHAI should provide informa
tion to members about funding agencies (3).
CHAI should
forward
project proposals without delay (3).
It
should
keep
applicants
informed
about
the
status
of
their
application (2).
CHAI should study the needs
adequately
before
giving comments (2).
There is a need for
better
planning
and
organisation
in this
regard
(1).
CHAI
should
give guidelines to members regarding
writing
of
project
proposals
(1).
CHAI should
get
donors
when
members apply for
projects
(1).
Priority should should
be given to proposals from rural centres (1).
-59-
4.14
COMMUNITY HEALTH DEPARTMENT
(CHD)
4.14.1
Partic ipation/Utilisation of
training services
8.6
7.
(35)
of
institutions
from
this
sample
have
participated
in
training
programmes
organised
by
CHD
during
the
past 5 years.
84.3 7.
(343)
have
not
participated ,
6.9 7. (28) are not aware of
participation
by their institution and 0.3 7. (1) did not respond to the
question.
The Chi Square test revealed an
location and participation.
association
between
* A greater proportion (19.3 7.) of institutions in tribal
areas have participated, as compared to the urban (7.9 Z)
and rural based (7.17.) institutions.
*
10.1 7. of smaller institution
institutions with more than 7
(0-6
beds
beds) and 7.6 7. of
have participated.
*9.1
7.
of institutions based in
regions
with
better
health
status
and
9.6 7.
of
institutions
based
in
regions with poorer health status have participated
in
training
programmes organised by the Community
Health
Department.
Both these differences are not significant
statistically.
Since the overall number and percentage of participants
is very small too many conclusions should not be drawn
regarding differences etc.
4.14.2
The
statewise
breakup
of institutions
who
have
personnel
for training programmes organised by the
as given in the next table.
-60-
sent
CHD,
Statewise participation of CHD programmes
Table 35
SI .
No.
State
Yes
No
Do not
know
N. I
Tota 1
01 .
02.
03.
04 .
05.
06.
07.
08.
09 .
10.
1 1 .
12.
13.
14 .
15.
16.
17.
IS.
19.
20.
21 .
Andhra Pradesh
Assam
Bihar
Goa
Gu j arat
Haryana
Karnataka
Kera1 a
Madhya Pradesh
Maharashtra
Mani pur
Meghalaya
Mizoram
Naga1 and
Orissa
Punj ab
Raj as than
TamiInadu
T ripura
Uttar Pradesh
West Bengal
06
02
02
—
05
—
—
—
—
—
01
03
04
04
01
01
02
01
01
02
—
—
03
01
01
—
34
05
26
05
09
02
25
71
29
14
02
08
01
04
10
02
07
63
—
17
09
—
01
—
—
04
01
—
01
—
—
01
—
—
—
—
01
—
—
—
—
—
—
45
07
29
05
1 1
03
31
80
34
18
03
11
02
05
14
02
07
70
02
18
10
Total
35
343
27
02
407
CN.B:
(407)
Refer note with Table
01
—
02
—
03
05
01
02
—
01
—
—
—
—
—
12 . J
The
four Southern States account for 45.77. (16) and
four Central States (B ihar, Madhya Pradesh, Rajasthan
Uttar Pradesh) f or 207. (7) .
4.14 .3
the
and
persons who
have
par ticipated
in
the
The
number
of
the
past
different
programmes organised by CHD, during
five years (1987 -91 > i s given in the ne xt tab1e.
-61-
Table 36.
Participation o-f
5.
6.
7.
in different CHD Programmes
Prog ramme
81 .
No .
1 .
2.
3.
4.
personne 1
Total
Orientation seminars
Short term training
Workshops
CHOPAM Course
(Community Health
Organisation, Planning
and Management,organised
jointly with VHAI)
Exchange programs
Long Term Training
Others
number o-f
persons
17
63
04
36
04
0
26
150
Total
Eac h institution
being 4.
has sent more
than
1
person,the
average
We
received
incomplete
responses
to
the
question
regarding
the
year
in
which
members
participated.
However, the incomplete data indicates a peak in partici
pation in the years 1988 and 1989.
4.14.5
The
opinion o-f members who have participated
in
above
programmes, about
the content and
methodology
training is given below:
Table 37.
the
o-f
Views on Content and Methodology of CHD Programmes
Orienta
tion
seminar
Con ten t
Useful
Not useful
No information
Short- Work
term
shops
train
ing
CHOPAM Excha
nge
prog
gram
Others
03
01
—
—
02
—
—
1 1
—
01
10
—
—
03
—
16
—
—
Methodo1ogy
Well conducted
Not so wel1
conducted
11
10
03
15
01
02
—
—
—
01
. —
—
No
01
—
. —
03
—
—
information
-62-
The
majority
-found
the
sessions well conducted.
4.14.6
content
the
and
useful
The
CHAI -CHD vision had a definitive thrust during
the
last
decade.
The following data indicates the level o-f
awareness
o-f members about the vision o-f
the
Commun i ty
Hea1 th Department.
This information pertains to all
the
407 functioning member institutions in 'the sample.
Table 38.
Awareness of members about
the vision of
7.
n = 407
Number of member
institutions
Level of
know1 edge
Fully aware
Partly aware
Totally unaware
No information
30
341
06
30
Total
407
CHD
7.37
91.1
1.5
7.4
100.0
The
numbers
of members who
identified
the
different
aspects ofthe vision of community health are given below.
medicine and
a>
The distribution of
of sickness (165).
b)
Process of enabling people to exercise collectively
their responsibilities to maintain their health (261).
c)
Providing
personnel
better health service facilities and
to the community (222).
d)
Starting
income generation
e)
Promoting rational drug therapy and
systems of medicines (90).
f)
A process of making people aware of their real needs,
making
use of available resources in and around
them and getting themselves organised for appropriate
action
(304).
(N.B:
Items b,e and
f
-63-
prevention
programmes
trained
(42).
alternative
represent the vision
of CHAI-CHD)
who
find
Relevance of vision;
The number of members
the
Community
Health
Department
vision
(their
understanding of it as it was not given in the
proforma)
relevant to their work is as foilows.
7.
n = 407
100.0
have said
of this opinion with
association
The
institution and location is as follows:
the
region ,
i
in
. .
that
i
1
majority
(84.87.)
A
b ig
re 1 e vant to their work .
1
407
1
Tota 1
vO
345
38
02
22
1
Is re 1 evan t
Is not relevant
Una ble to judge
No in formation
1
Number
institutions
s . coJi.
of
1
Relevance
to their work
1
CHD vision
1
Relevance of
(JI W CD
Table 39.
1
4.14.7
vision
is
size
of
* 96.6 7. of institutions based in regions with poorer
health
status
and
87.1 7. of those
in
regions
with
better health status find the vision relevant.
*
92.0 7. of 0 - 6 bed institutions and 86.4 7. of
institutions with more than 7 beds find the vision
re1 evan t.
The associations of
*
4.14.8
both
the above are significant.
94.1
7. of tribal, 90.0 7. of rural
based
institutions
find the CHD
their work.
and 86.4 7. of
urban
vision
relevent
to
Reasons for relevance:
Reasons regarding why the
vision
was
considered
relevant
to their work
were
given
in
response to an open ended question.
They are
summarised
be1ow:
1)
2)
The vision is consistent with the vision and mission of
the member institutions (108).
It fosters self reliance of people as far as health is
concerned
(44); it stresses that peoples' needs can be
met
by
their own organisation (19);
it
focusses
on
-64-
3)
4)
5)
6)
7)
8)
9)
10)
health
being the responsibility of the people (7);
it
helps
people
to
maintain
their
own
health
both
personally and collectively
(8).
It
promotes total health, i.e., it is wholistic in
approach (36); it aims to improve the total well
being
of human beings (19);
It helps to foster peoples' participation in health
ac tion
(15).
It is the grave need of the time
(11).
It focusses on conscientising people (11); it analyses
the
root causes of illness (1);
it covers much
more
than
service
systems (1); it
encourages
work
with
oppressed sections of society (3);
it provides social
and health awareness (4).
It emphasises that prevention is better than cure (7);
it helps make people aware/en1ightens people regarding
their
health
needs
(8); it is
essential
to
build
healthy communities (1).
The
healing
ministry is made
more
meaningful
and
effective through community health (3).
It helps out reach to needy people (12); it motivates/
helps people working in villages (4); it is a sort
of
help
to
the poor (4); it takes greater
interest
in
peoples'needs (1).
It is more practical where there are minimum facilities
(3);
it
is cost effective (4);
it
helps
provide
better
health
services
(5);
it
helps
to
spread
rational
drug
therapy
and
alternative
systems
of
medicine (1); it helps in developing a better approach
in
the
treatment
of
out-patients
(1);
it
is
a
guideline and a great support (1).
48 institutions (out of 345) did not specify the reason
why they think the CHD vision is relevant to their work.
The
reasons given by a large majority
articulate
ideas
that are consistent with the spirit of the CHD vision.
4.14.9
Reasons
were also given as to why institutions
stated
that the vision of the Community Hea1 th Department
was
not relevant to their work.
These were given by 21 one
out
of 35 who said that the vision was
not
relevant.
The
remaining
17 did not specify the
reasons.
They
were as follows:
Lack
of
a
community health
programme
(15),
lack
of
personnel making it impossible to start community health
programmes
(5), it is not practical in
all
situations
(3),
it is not practical in its approach (02),
lack
of
time for outreach programmes (2),
our thrust is curative
treatment
(1>, CHAI itself is not sincere regarding
the
community
health vision (1), lack of know-how
makes
it
impossible
to
practice (1), illiteracy
of
the
people
(01), and financial constraints (1).
-65-
4.14.10 Comments and suggestions regarding Community Hea1 th
(CHD)
department
'(
CHD) .
Many points are inter—related. They
have been put together into categories for easy grasp.
226
(55.57.1 have contributed suggestions.
93
(22.87.)
1th workers and
personnel
-from
member institutions (47).
Seminars should be conducted at
the diocesan level (33),
Provide training in methods of
community development (5) .
Provide training for animators
and grass-root level work ers (4).
Organise CHOPAM courses
ly (2) .
refresher courses for doctors and
(2) .
b)
I n formation and Guidance:
92 (22.67.)
CHD should provide the necessary information, expertise
and
guidance to help members implement community
health
activities (46).
They should visit village based
member
institutions and offer help and supervision to the work
(32).
They should study the needs of the
locality
and
offer help accordingly (5).
They should provide informa
tion on different methods of treatment (4).
They should
let
members
know of the facilities available
with
the
Department
(3).
Provide information
about
successful
community
health
programmes which cou 1 d
be
repljicated
(1).
Provide
help
or
organise
rura 1
hea1th
care
programmes (1).
c)
Health Education:
56 (13.87.)
Provide
health
education material
in
vernacular/'local
languages (50).
Supply health education material to rural
institutions (5).
Make use of mass media to propogate
health (1).
d )
Assistance :
48 (11. B7.)
Arrange
free
drugs
for
rural
areas
(21).
Provide
financial
assistance
to
institutions
who
train
and
appoint
community
health workers
(20).
Make
common
drugs
available for rural areas (2).
Provide
planning
and material help for income generating schemes in
rural
and
tribal areas (2).
Look into the staffing of
health
personnel in member institutions (2).
Arrange
personnel
for community health work in institutions (1).
e)
Spec i f ic areas of work : 14 (3.47.)
Establish
a
few
model
community
health
centres
in
interior villages (4).
Develop new methods of handling
problems in community health (2).
Coordinate community
health workers (2).
Conduct evaluations (1).
Help members
-66-
to
organise
income
generation
schemes
as
part
o-f
community
development
(1).
Start
medical
insurance
schemes
(1).
Work
on
preventive
programmes
-for
communicable
diseases
(1).
Start programmes
-for
drug
addicts
(1).
Take
up the problem
o-f
cancer
in
the
communities (1>.
■f )
Reports and Publ ications:
9 (2.27.)
Provide
literature
on community health
(5).
Support
members
with
documents, reports, materials
(1).
Send
summary
reports of training programmes to
members
(1>.
Publish books on village development (1).
g)
Genera 1 comments: 12 (2.97.)
Be
more available to members especially in
rural
areas
(3) .Be practical in appraoch and practice the
philosophy
(3).
There should be concrete action (3).
There
is
a
need
to
be
more
effective
in
their
service
(2).
Services should be extended to all institutions (1).
-67-
4.15
MEDICAL MORAL AFFAIRS
This
question
was
introduced
because
medico-moral
af f airs/med ica 1
ethics was an important reason
-for
the
■Formation
of
CHAI .
It
was
therefore
considered
worthwhile to elicit members views on this issue at
this
j uncture.
4.15.1
85.5
7.
(348)
member
institutions
from
this
sample
expressed that CHAI should have a Department of Medical
Ethics.
1 1.8 7. (48) said it was not neessary, 0.2 7. (1)
was unable to say and 2.4 7. (10) did not respond to the
question.
4.15.2
60.9
7. (248) members identified the following
important
areas
that
should
be dealt with
by
this
Department.
These
areas
were chosen based on their
experiences
of
medica1/hea1th work.
a.
Beg in inq of life and re 1 a ted issues (254 or 62.4Z):
Medical Termination of Pregnancy (MTP) (144), family
planning methods,other than Natural Family Planning (81)
Natural Family Planning (NFP) (26), and artificial
insemination (3).
b.
Women's Issues (26 or 6.4Z):
Female foeticide (12),
sex determination tests (4),abuse of women (3), unwed
motherhood
(2), sexual abuse (2), temple
prostitution
,
(1)
rape (1), and problems faced by nurses (1).
c.
Marriaqe/Fami ly Life (29 or 7.17.):
Premarital sex
(10),child marriage (6), divorce (5), sex education (4),
marriage guidance/counsel1ing (2), and family life (2).
d.
Therapeutic Zmed ica 1 prac tices (61 or 15.07.): Rational
therapeutics, avoiding unnecessary diagnostic tests, and
unnecessary
surgery, need for a rational
drug
policy
(31), euthanasia (21), malpractices in the medical field
(4), commercialisation of the medical field (3), and
organ transplantation (2).
e.
in
in health care (24 or 5. 97.):
Moral va1ues
Va1ues
in
care
(17), promotion of
Christian
va1ues
heal th
medical practice (3), seeing and healing the patient as
a person (3), and pastoral care (1).
f.
Patient Care (16 or 3.97.):
Medico legal cases (7),
care of the old and sick (4), discussions regarding
controversies/disputed questions in medical practice
,
(2)
confidentiality (1), issues regarding professional
blood donors (1), and doctor patient relationship (1).
-68-
g.
Specia 1 groups (16 or 3.97.):
AIDS (11), drug addiction
,
(3)
alcoholism (1), and rights of the child (1).
h.
Others
Need -for t r a i n ing/or ien tat ion courses for
medical
personnel
on medical ethics
(1).
Need
for
formulation
of common Catholic policies
for
Catholic
health
care
institutions
(1).
Need
for
good
publications in this area (1).
100
respondents who stated the need for a
Department
of
Medical
Ethics, did not specify the areas that could
be
covered by this Department.
Several
have mentioned more
than one area .
-69-
4.16.
VIEWS ABOUT OTHER SERVICES/ACTIVITIES OF CHAI
4.16.1
Members opinions about the Drug Qua 1ity Assurance
Central
Testing
Laboratory
that CHAI
is
planning
to
start,
to support the network of producers o-f
low
cost
essential drugs, were as follows:
a>
b)
c>
d)
e)
f)
g>
h)
i)
It
It
It
It
It
It
It
It
No
is useful <150).
is
not useful (7).
is necessary (40).
is not necessary (7).
is useful and necessary (183).
is useful but not necessary (9).
is not useful but necessary (1).
is not useful and not necessary (2).
information < no response to this guestion)
In
summary
the large majaority of
would be usefu1/necessary or both.
4.16.2
feel
that
it
Members views were also elicited about the usefulness/
necessity
of
the model integrated hea1 th
centre
being
p1anned at the CHAI farm■
It is to have community health
programmes and various income generation programmes (like
poultry, ■ fruit
production, agriculture etc).
It
will
also
be used as a training centre.
Their views were
as
fol 1ows:
a) 11 is useful (191 ) .
b) It is not useful (9).
c) It is necessary (19).
d) It is not necessary (13).
e) It is useful and necessary (140).
f) It is useful but not necessary (13).
g) It is not useful nor necessary (10).
h) No response to this guestion (12).
Again a large majority of 89.07. felt
was usefu1/necessary or both.
4.16.3
94.07.
(8).
that such a
project
Member
institutions based in urban areas were
asked
in
what
way the new unit on Urban Health could assist
them
in carrying out community heal th programmes in slums.
30
out
of the 70 urban based institutions in the
20
7.
sample gave suggestions which are given below:
a)
b)
Provide members with health education materials
Train member institutions to organise health
programmes in slums (5).
-70-
(9).
c)
d)
e)
f)
g)
h)
i)
j)
k)
1)
m)
n)
Help in organising health awareness programmes (4).
Train urban slum based health workers (3).
Help members to run -free clinics in slums (3).
Help through supply of medicines (3).
Help in implementation of government projects (2).
Develop methods of working in slums (1).
Offer training courses for members (1).
Provide personnel to undertake preventive work (1).
Help promote home remedies (1).
Arrange doctors to work in urban slums (1).
Get projects sanctioned (1).
Extend support and help (1).
Implicit
in
the suggestions
are
different
approaches
to
health
/
medical work.
There is
thus
scope
for
orientation
and training for community health work
with
the urban poor.
4.16.4 Members
gave their views as to how
the
Documentation
Department
of CHAI cou1d support their work.
The views
of
the
163 (40.07.) who responded to
this
question
are
given below:
Collect
and
circulate
information
about
new
diseases and their treatment among members (95).
b) Communicate the latest health information
and
new
developments to members (41).
c)
Send charts,posters and books to members (7).
d)
Provide health information
in
1 oca1/regiona1
1anguages (5).
e)
Open a 1ibrary/documentation unit in every Diocese
for reference by members (4).
f)
Be a source for providing new/uptodate books/
periodicals etc (3).
g)
Send information on homeopathy (1).
h)
Bring out a newsletter covering activities
of
the
CHAI office and the departments at least every six
mon ths (1) .
i)
Make case studies and circulate to members (1).
j)
Circulate a profile of member institutions (1).
. k) Be available to members (1).
1) Conduct research (1).
m) Such a Department was not considered useful (4).
The
information needs of members
have also been
brought
out in the expectations
and
general suggestions given by
members.
a)
-71-
4.16.5
Members
also gave their views as to how the
1ow
cost
communication media unit could support their work.
178
(43.77.1
of
respondent institutions
gave
suggestions
which are given below:
a)
b)
c.
d>
e)
f)
g)
h)
i)
j)
Provide low cost materials -for health education (131).
Provide health education material in vernacular
1 anguages (19).
Provide training to the staff of member
institutions (17).
Provide information about banned drugs (3).
(there seems to be a slight confusion here)
This should help people to understand the importance
of hea1th (2).
The unit should help in conducting awareness
programmes (1).
It should operate in a mobile style (1).
It should provide gadgets for local use (1).
It should provide small leaflets (1).
it is not useful (1).
-72-
4.17
FINANCIAL ASPECTS OF CHAI
4.17.1
28Z
(114)
member
institutions -from
this
sample
have
participated in raising Funds For CHAI (besides payment
oF
their subscription/membership Fee).
70.0
Z
(228)
have
not participated , 0.2 Z (1) are not aware
if
they
have and 1.0 Z (4) did not respond.
There
is an association between size oF institution
and
Fund
raising.
41.3 Z oF institutions, with more than
7
beds
participated
in
>und
raising
and
21.6Z
of
institutions with 0-6 beds did so.
Since the majority
oF
institutions are in the 0-6 bed category in terms
of
actual numbers participating in fund raising, this
would
be the larger group.
4.17.2
The
methods
foilows:
a)
b>
c )
d )
of
participation in
fund
raising
were
as
85
26
Through the Raffle
By donation to the Corpus Fund
By contribution towards the
Golden Jubilee Fund
Not specified
08
05
124
10
4.17.3
institutions have
Suggestions
for
participated
financial
in more
than one way.
seif-reliance
45.7
per
cent of members offered
several
suggestions
as to how CHAI could become financially self-reliant.
A.
Methods to generate/increase income
(172 or 42.3Z)
From members (61 or 15.0Z):
By contributions from
members (45).
Through a membership campaign (9).
By
raising the membership fee (7).
From external sources (52 or 12.8Z):
Through a
raffle (18).
Through donations from benefactors (18).
Through foreign funding agencies (7). By tapping govern
ment resources (6).
By contributions from Bishops (3).
Through its services (35 or 8.6Z):
By charging for
services
offered (11) for eg, CPS and CMMB
medicines.
By bringing out more publications (8). Through seminars
and
courses
(7).
By getting more
subscriptions
for
Health Action (3).
By producing television programmes
on health and health care (3).
By producing
cassettes
(2).
By starting a herbal garden (1).
-73-
B.
C.
Through commercial means ( 7B or 19.27.):
Through income
generation projects (32).
By starting a drug
company
(11). By starting a business -firm (8).
By constructing
buildings and renting them out (7).
Through the supply
of
low
cost
drugs
to
hospitals
(5).
Through
advertisements in its publications (3).
By
conducting
exhibitions
(3).
By
starting
a
hospita1/medica 1
college
(3).
By buying a rubber
plantation
/estate
(2).
By
starting training
centres/nursing
colleges
(2).
By
running co 11eges/schoo1s
(1).
By
selling
unnecessary CMMB drugs in the market (1).
Genera 1 (16):
Through -fund raising (13).
By
improving its own local resources (3).
Methods to reduce expenditure 27 (6.67.):
By avoiding
luxuries
and
comforts
for CHAI
officers
(21).
By
cutting down the number of office staff and economising
on the
infrastructure at the central office (5).
By
proper financial management (1).
An alternative view
There is no need to be selfreliant
as it will lead CHAI to forget its
objectives
and its members (2).
-74-
4.18
MAJOR PROBLEMS FACED BY CHAI MEMBER INSTITUTIONS
MEDICAL/HEALTH WORK
IN THEIR
As
CHAI
prepares its plan of action
-For
the
next
decade,
it
was
felt
that
it
would
be
important
to
understand the professional or work related
problems
faced by its members in the field.
The
specific
question received a very
large
response
during
the evaluation study, with
1,117
institutions
or
79.0 7. of the 1,415 respondents sharing their
views.
The
broad
categories
of
common
problems
are
given
below
in
descending
order of
priority.
As
detailed
strategies
of
intervention for the future
are
worked
out by CHAI at the national and regional level, it
would
be necessary to keep these in mind.
4.18.1.
Poor or inadequate faci1ities: These include:
Lack
of basic facilities of electricity and water;
poor
infrastructural
facilities
and lack
of
transportation
making
it
difficult
to
reach
out
the
villages
and
undertake
extension
work;
and
lack
of
facilities
affecting
medical
work,
for
example,
laboratory
equipment, health education material, ambulance, and even
telephones.
48.25
per
cent (539) of the 1,117 respondents
to
the
question mentioned this particular problem.
4.18.2.
Hea1 th personnel-related issues:
Mentioned were the non
availability of trained,efficient and service oriented
personnel to work, especially in rural areas.
Specific
mention
was
made
regarding need for
doctors
and
for
personnel
trained to undertake preventive and
promotive
work; it was also difficult to get specialist doctors
to
work
in
such
situations; there is
a
lack
of
senior
doctors available for consultation; there is a high turn
over of doctors and health workers; doctors often
demand
high salaries.
Bribing or luring doctors with offers
of
higher
salaries
by
other
medical
institutions
also
sometimes takes place; a few mentioned lack of commitment
and
sincerity of staff; lack of competence in
diagnosis
and
treatment particularly of difficult cases; lack
of
cooperation
and understanding from
higher
authorities;
poor job satisfaction and burnouts.
43.24 7. (483) out of the 1,117 respondents to the
question expressed these problems.
-75-
4. IB.3 .
Financial
Issues:
Financial constraints were
mentioned
specifically
by
37.33
7.
(417)
out
of
the
1,117
respondents.
In
addition
this factor
would
also
be
responsible
for
the lack of
basic
medical
facilities
mentioned in the first point.
4.18.4 •
Social Issues;
Social issues operating
at
the
local
among
the
people,
affect
the
utilization
of
level
services
and
the
work in several
ways,
for
example,
poverty, caste stratification, illiteracy, ignorance
and
superstitions,
customs,
exploitation,
gender
discrimination, social stigmas and political
disturbance
in certain areas.
37.38 per cent (417) out of the 1,117
respondents raised
this issue.
4.18.5
Problematic expectations/responses from the people:
Mentioned here were the expectation/demand by people for
free
medicines
/treatment; unwillingness of
people
to
accept changes in the method of healing/new methods being
used,
and
unwillingness
of people
to
accept
natural
remedies;
people
demanding injections/tonics
for
all
illnesses;
people seeking medical help only
at
crucial
situations/1 ate
stages;
low treatment
adherence
rate;
(perceived) unjust interference from Consumer
Protection
Forum; and the demand for round the clock service.
15.48 7. (173) members out of 1,117 who responded to the
question raised these points.
4.18.6
Heal th and Hea1 th Care Problems:
This included
difficu 1 ty/inabi1ity to follow up cases; large number
of
patients coming with communicable diseases, for
example,
tuberculosis; mushroom growth of private clinics,
health
centres,
fake doctors and use of
irrational
practices;
lack
of
wellequipped
referral
facilities
to
send
patients
with
complicated
medical
problems;
lack
of
cooperation
from other medical
facilities;
competition
among
hospitals; bribing doctors with promise of
higher
salaries by other institutions.
12.8 7. (143) of the respondents raised these points.
-76-
4.18.7
Druq-rel a ted issues;
The increased costs of drugs,
non-availability
o-f low cost drugs and
non-availability
of drugs against 1eprosy,tubercu1osis etc were mentioned.
10.11 7. (113) of the 1,117 respondents raised this issue.
4.18.8
Problems re 1ated to being " reliqious ";
The frequent
transfer
of sisters and other religious
hinders
health
work
(9).
So
also
lack of
knowledge
of
the
local
1 anguage (28) .
There
is
lack of cooperation because
the
work
of
'religious'
is
misunderstood as
being
for
conversion
(8).
Problems
due to the RSS (8) and
the
unfavourable
attitude of people towards Catholic institutions (7)
was
also
mentioned.
Insecurity
of
sisters
working
in
isolated places is increasing (1).
The
religious
structures and time schedules
were
felt
to
be
hindrance to medical work (1).
The
demand
for
sterilization
after
the
second
delivery
(also
goes
against
religious
beliefs)
(1).
There is
a
lack
of
support from CHAI (1).
In
all
5.5
per
cent
(62)
out
of
the
1,117
respondents mentioned these issues.
4.18.9
Problems concerning community based hea1 th care:
There
are
difficulties in
carrying
out
extension
programmes
and in village based work (14).
People
are
unable
to attend health education and
other
programmes
(07).
On
the
other hand there is a
lack
of
health
education
material
(5).
Preventive
health
work
is
difficult (6).
It
is
not easy to motivate people to
become
selfreliant (5).
There are ideological clashes with
others
working
for
development (3).
Migration (1),
lack
of
cooperation
from people (2) and
unfavourable
attitudes
of
people
towards small dispensaries
makes
this
work
difficult.
There
is
also a feeling of incompetence
to
understand
the
problems
of
people
due
to
an
institutionalized
training (1).
4.0
per cent
points.
(45)
of
the
-77-
1,117 respondents raised
these
Environmental problems:
These included lack of
sanitation
and hygiene (12), polluted air (1)
and
presence o-f wild animals in remote areas (5).
1.6 per cent members mentioned these points.
4.18.10
the
Other medical/heal th service related problems:
Lack
o-f cooperation and support -from
the
Government
(10). Dependency on the Government to run hospitals
(1)
and
delay
in
release o-f
Government
-funds
(1)
were
problems -faced.
So
also
were
the
lack
o-f
opportunities
-for
rehabilitation
(2)
and
lack
o-f
social
support
to
rehabilitate
unwed mothers (1).
Pressure -from
people
to treat medico-legal cases (1) and the non-availability
o-f blood for transfusion.
1.57. (17) members mentioned these points.
4.18.11
Several
questions
can be raised
in
attempting
to
respond to these problems that have been raised by large
numbers of CHAI members
* What
methods
could
be
evolved
collectively
and
individually to address the problems relating to health
personnel ?
This, incidentally was an issue even when
CHAI was formed fifty years ago !
* The
challenge of strengthening
motivation,
knowledge
and skills of health personnel working under
difficult
conditions
is
before
all
of
us.
Could
a
better
dialogue
and
link-up
between
institutions
training
health
personnel
and the remote
health
services
be
activated?
S
Could trainers internalise those non-textbook, but real
life problems of the
health
workers
of
today,
into
training and continuing education programmes?
* For
instance,
could an
analytical
understanding
of
social
issues
and
of the rising
cost
of
drugs
be
introduced?
This may help not only in coping with
the
situation, but more importantly in evolving alternative
strategies and linkages with groups already working
in
these areas.
-78-
4.19
STRENGTHS OF CHAI
The
major
strengths
of
CHAI
in
descending
order
of
priority, as identified by members are given below.
This
question
was
posed
to all members
through
the
mailed
questionnaire
and the interview schedule. 62.0
7.
(878)
members out of 1,415 responded.
Several members expressed
more than one strength.
Percentages given in this section
are of the 1,415 active member who were respondents to this
study.
1.
Support, concern and service for its members
(29.27. - 414).
It is "a hand to hold on" in the words
of a member.
2.
"Health Action"
3.
Training
4.
Meetings and correspondence with members
(7.47.-105).
5.
Organisational
(11.57.-163).
That
well
the
(94).
and other
programmes,
publications
seminars and courses
structure and
association
(17.87.-252).
functioning
is organised
and
is
(11.17.-158).
functioning
The
dedicated
and
efficient staff
(20)
and
efficient
administration
(13)
were appreciated.
So also
was
its
coordinating
function (9) and the resource personnel
who
were made available for programmes (8).
Other
strengths
identified in this area
were:
Periodic
evaluation
(5); solid organisational
structure(3);
well
defined objectives (2); attempts to decentralize through
regional
units
(3);
and the
constitution
(rules
and
regulations) of CHAI (2).
Also
mentioned
were
the
enthusiastic
Executive
Director(l);
planning
for
the future
<1>;
courage
in
taking the initiative to change (1) and the confidence
of
members in CHAI (1).
-79-
India-
6.
The large number of members spread throughout
that it is a national level body (84-5.97.).
7.
It
is
a network
imparting
education
hospitals and dispensaries (67-4.77.).
8.
It is a forum for unity,
come together (63-4.47.).
9.
Conventions and
10.
Community health policy
11.
Issues taken up in its work (45-3.07.): Members were
appreciative
of
the
preferential
option
for
the
poor/margina1ised
and
involvement
in
social
issues
(20); CHAI's involvement in the promotion of a Rational
Drug
Policy
(9)
and its influence
in
the
national
health arena (9).
where
to Catholic
like-minded
similar meetings
people can
(47-3.37.).
(46-3.2 7.).
Also
appreciated were the focus on small
institutions
(3);
the
holistic
health
campaign
(2);
and
the
promotion
of alternative systems of medicine
(1);CHAI
was
considered
a
potentially
effective
instrument
against
evils in the field of health care (1).
These
issues were mentioned by 3.27. (45) of the respondents.
12.
Various
Other
Activities/Departments:
The
following
were also identified as strengths of CHAI by 3.17
(44)
of
respondents: Linkages with Government
and
other
organisations
(18); Central Purchasing
Service
(CPS)
(12);
Pastoral Care (7);
Communication/Media
efforts
(3); Publication of the Drug Formulary (2);
Production
of
Health
Education
Material (1);
and
coverage
of
Medical Ethics (1).
13.
Dedication
14.
Alertness to the needs and signs of
15.
Philosophy and
16.
Finance
to health work
(15 -
vision
(42-3.07.).
(22).
1.37.)
-80-
the times
(25).
Its
sound
-financial
position
(7) ;
linkages
with
foreign
partners and the deemed export scheme
(5);
its
credibility
with funding agencies <2); and being
in
a
position to help its members financially (1).
17.
Others
(27 or 2.47.): These are: Helping members to
apply
the
principles
of
Christianity in
patient
care
(8);
CHAI's
glowing
history (7); that it is
a
spokesman
of
Catholic institutions (7); its inspiration to members (3);
the
opportunity it provides to work for people
(2);
and
the establishment of a Catholic medical college (St.John's
Medical College, Bangalore (1).
Thus the activities and services of CHAI and the
general
support and concern for members has been appreciated by
a
large
proportion of members.
This has been expressed
in
the specific feedback given regarding each Department
and
it has been reiterated in this section on the strengths of
CHAI.
To
make
its
presence
felt
through
positive
contributions
to
health
centres,
hospitals
and
other
members
in
different
parts of such a
vast
country
is
indeed
very
creditable.
A
good
tradition
has
been
established
which
can only be further
strengthened
and
built upon.
-81-
4.20
WEAKNESSES OF CHAI
Given
below are the weaknesses of CHAI, as mentioned by
the
members
in the study.
This question also was posed
to
the
entire
membership through the mailed questionnaire
and
the
interview
schedule.
45.0
7.
(640)
member
institutions
responded
to the question.
Percentages in this section
are
o-f the 1,415 -functioning member institutions.
1.
Re 1 ationship with Members:
Poor in terac tion between CHA I and its members - (231 (16.37.).
There is poor personal contact and communication. A sense
o-f
alienation
was
expressed.
CHAI is
a
distant
reality
to
members.
1.2 I nadequate -focus on rura 1 based members and their
activities
(90 - 6.47.) .
1,3 CHA I
is not aware/does not -f u 1 -f i 1 1 the needs o-f i ts
members
and does not look into their problems (64- 4.57.).
1.4 CHA I prog rammes are out o-f reac h to many members in terms
o-f
their
cost and location, especially -for the
smaller
member
institutions (60- 4.27.).
1.1
Issues
(220 -
2.
Organisational
2.1
Central Administration and i ts -functioning (92 - 6.5X)
Inefficient administration and inactive -functioning (33); the
Central
office
is
not easily
approachable
(8);
lack
of
professionalism.
It
is run as a
religious
association.
There is a lack of qualified personnel, with knowledge in the
medica1/hea1 th
fields
to
guide
members
(8);
too
preoccupied
and
worried about
itself
and
not
bothered
about
member institutions (8); poor
system of communication
with
members
(7); administrative problems
in
the
central
office
affect
service to member institutions
to
a
great
extent (3); religious sisters have inadequate representation
in the administration (3).
-82-
15.57.)
Lack
of
co-operation
and genuineness among
staff
of
the
central
office and an indifference to the policies of
CHAI
(3);
CHAI has grandiose attitudes, overlooking
the
members
(3);
absence of periodic evaluation (3); CHAI is
interested
in
taking
from members rather than giving to
members
(3);
members have no voice in planning and decision
making
(21;
CHAI is interested in controlling member institutions
rather
than
supporting them (2);lack of adequate representation
of
all
regions
in
the
central
office
(2);
it
is
highly
hierarchical in its functioning (1); frequent change of staff
(l);lack of proper planning (1); and takes up too many
tasks
at the same time ( 1).
2.2
Re 1 ationship between the Centre and Regional/State Units
(463.27.):
Poor functioning of regiona 1/state
units
and
lack
of
interest by the central office in the
State
units
(23);
no
decentralisation
of power
(16);
differences
in
vision between the Central office of CHAI and the State Units
(3);
neglect
of
Diocesan
units
(2);
the
Constitution
encourages
centra1isation of power (1); problems related
to
autonomy of State Units (1).
2.3
Accountability
(30
-2.17.1:
CHAI does
not
stand
for
its
objectives (S); it is not sincere about its promises and
the
decisions that are taken (6); it does not circulate
internal
audit
reports
and
accounts
before
the
convention
(4);
malpractices
in the Central and State Units (3); spending
a
lot of money unnecessarily (3); financial mismanagement
(2);
the
performance does not equal the resources spent
(2);lack
of
accountability <1>; lack of proper responses to
requests
for heIp (1).
2.4
Organisational Struc ture (other aspec ts) (29 -2.07.): There is
a
lack of initiative by CHAI members in its
activities
and
functioning
(9);
dependence
on
foreign
money
(9);
poor
organisational
structure (4); very few representatives
from
lay
people,
clergy dominated (2); no control
over
members
(1); too much power vested in the Executive Director (1); too
an big organisation/association and too vague (1); difference
of
ideology within CHAI (1); it is not a strong
association
( 1 > .
-83-
2.5
Execut ive
Board and e1ec tions/conven ti ons (13 - 0.97.):
The
executive board is not representative of its members.
Only a
particular lobby manages to come to power (4); domination
o-f
the
South
in conventions, during which elections
are
held
(3);
the
existing election procedure does not
bring
-forth
suitable/
deserving of-fice bearers (2);
unhealthy
politics
and
groupism
takes
place
(2);
the
President
and
VicePresident
do not have powers (1); craving -for power
in
the
top of-fice bearers (1).
2.6
Linkages
(11-0.87.):
Poor
relationship
with
the
Catholic
Bishops Conference of India (CBCI) (4); lack of collaboration
with
St.John's
Medical College (4); lack
of
co11 aboration
with governmental organisations (3).
3.
Regarding Ser vices Zac tivi ties
213 (15.27.)
Besides
the
issues raised in po ints 2, 3,
and
4,
weaknesses
mentioned regarding se rvices/activities of
are given be 1ow:
other
CHAI
3. 1
Services : genera 1 80 (5.67.) ::
11 is not practical in its
approac h
(28); the se rvices offer ed are meagre and
are
not
worth
the
charge of the membership fee (17);
there
is
no
scientific basis in its service delivery system, for example,
they are not based on proper study of needs (17); there is
a
concentration
of
programmes in the South (9); it
does
not
take up important health issues in the country (5); there
is
a lack
of a nationa1istic outlook in its activities (3); the
health
efforts
of CHAI often run opposite to those
of
the
government (1).
3.2
Services- regarding its members 58 (1.47.):
Concentration
on
bigger hospitals (27); discrimination between members
in
its service (in terms of religious and lay, medical and
non
medical personnel and between institutions) (18); services do
not
reach
the grass root level (3); CHAI does not
take
an
interest
to study the reguests made by members (2); it
does
not
guide members (2); the most needy institutions
are
not
informed
about
its services (2); members are
not
informed
about
CHAI's
activities/ services adeguately
(2);
it
has
failed
to reach member institutions (1); CHAI is unknown
to
many small health care institutions (1).
-84-
3.3
Services- spec i f it
54 (3.87.)
Training
(11): There is a lack of training
programmes
in
vernacular/
local
languages (4); there is a lack
of
State
level
programmes
(2); does not take an
initiative
to
get
religious trained as doctors (2); there is a lack of diploma/
certificate
courses (1) straining programmes are
inadequate
(1); lack of effective training programmes (1).
Pub 1ications
(22):
Charging
sma11 er/poorer
institutions
for
Health
fiction
(11);
lack
of
publications
in
1 oca 1/vernacu1 ar
languages (7); Health fiction is
irregular
(2);
Health Action is not relevant to smaller
institutions
(1); lack of health education material (1).
Pro ject Proposa1s (5) :
The felt needs of members are not
made known to the funding agencies (3); inefficient
handling
of project proposals (2).
Commun i ty
Hea1th (5):
Over emphasis of
community
health
and neglect of problems of hospitals (2); alternative
health
programmes
are not promoted actively (2); CHD team
is
very
rigid in their stand (1).
Spiritua1 depth not given to staff (3) .
Nedico-mora1 issues not taken up adequately (2).
Convention themes are inappropriate (1).
Membership Department functions poorly (1).
Curative
treatment
is emphasised on too
much
(2);hospital
type
of
medical work is over emphasised (1); CHAI
has
not
succeeded in providing doctors for rural areas
strategica11y
( 1 ) .
3.4
Services - the overa 1 1 approach (21):
There
is a bureauticratic delay in the delivery of
services
(8); there is no supervision or follow-up of the services and
programmes (6); the programmes are poorly conducted (4);
the
monitoring system is poor (1); lack of consultancy facilities
(1); there is poor recording of services (1).
4.
Other weaknesses
(12 -0.87.)
The
public
is ignorant about CHAI (5); lack
of
unity
and
cooperation among members (3); difficulty in reorienting
the
larger institutions (2); unhealthy competition among
members
(1); no coordination of activities of members (1);
-85-
5.
CHAI
has no weaknesses
30
(2.17.)
A
fairly
large
proportion
(45.07.)
of
respondents
have
identified
weaknesses
of CHAI.
This is a healthy
sign
of
interest
shown
by
members
in
the
further
growth
and
imporvement
of the association.
The important
points
that
have emerged are:
The
need
to
focus on members and
their
needs
in
the
various
services
offered by CHAI.
The first
4
points
relate
directly to the relationship with members.
These
have been raised by 31.47. of respondents. The contribution
of CHAI to the health situation in the country is
through
its
members.
Thus
building
on
their
strengths
and
enhancing
their capability to respond creatively
to
the
current
health
problems
and
needs,
given
the
newer
approaches
that
are developing in the spirit
of
CHAI's
vision and objectives is its contribution.
b) Points
regarding
services- general and
specific,
have
been
raised
by
213 (15.27.) of
respondents.
This
is
inspite of the fact that feedback on each service/activity
has already been given before.
Making services accessible
to
all
members
especially
those
in
greater
need
is
important- viz.,to the smaller,
more remote
rural/tribal
area based institutions.
The quality of services are also
important.
All services and activities of CHAI would need
to
relate
to the situation and realities in
the
field.
Thus
there would be need for a1 ertness,updating,
ongoing
evaluation and appropriate change.
c) Weaknesses
relating
to organisationa1
functioning
were
raised
by
220
(15.57.)
of
respondents.
Strengthening
itself
internally,
in
its
organisationa1
structure,
central office and regional units through improved methods
of
functioning
and internal management
would
make
it
possible
to play the above role more
effectively.
This
aspect has also been raised by Delphi panelists.
a)
-06-
4.21
EXPECTATIONS OF MEMBERS FROM CHAI
This question too was posed to
per
cent (978) members out of
their expectations from CHAI.
an
open
ended question and h.
groups.
Certain broad based .
be Iow:
1 .
the entire membership.
69.0
1,415 respondents have
shared
They were given in response to
ve been
clubbed
together
in
reas have emerged as is
given
Guidance/TraininqZ I n-format ion/Pub 1 ic at ions
(607 or 42.97.)
1.1.Training and related points
(246 - 17.47.)
CHAI
should organise training programmes at the State
level
in
1 oca 1/regiona1
languages.
Resource
personnel
to
be
available at the regional level.
Courses, seminars on labour
laws,
legal
issues, social analysis,
and
management
are
needed.
Contact programmes/meetings/group discussions to be
arranged to enrich personnel -from member institutions.
CHAI
should
organise
Continuing
Medical
Education
(CME)
programmes, including programmes -for upgrading nurses skills.
It could make arrangements -for more Sisters to be trained
as
doc tors.
CHAI should: Have resources -for consu 1 tancy/train ing .
Foster
understanding
between teaching institutions who are
members
of
CHAI.
Organise
training
for
dais
and
in
practical
immunization.
Help nurses with many years experience to get
licences as RMP's (Registered Medical Practitioners ).
Start
courses in Pharmacy, Laboratory Technology and Physiotherapy.
Get
the
Nurse Anaesthesia Course recognised by
the
Indian
Nursing Council.
Prepare a textbook for nursing students on
moral
and
ethical issues.
Catholic
training
institutions
should
not
take capitation fees- CHAI should
work
towards
this.
Should
help
standardise
admission
procedures
in
member institutions that run training courses.
Should
start
short vocational courses for rural youth.
1.2.Guidance
and
Support
from the central office
member
institutions is expected, especially to
ones 191 (13.57.).
87
of
CHAI
to
the
smaller
1.3
In -formation Needs
(88 - 6.2 Z)
CHAI to provide information to improve health work (64).
It
should
also
provide information as to how it can
help
its
members through its programmes and projects.
It could inform
members about up-to-date events in Christian medical work.
1.4
Publications
(82 - 5.8 Z)
Produce
more health education materials in
vernacu1ar/1 oca 1
languages.
Should have more publications to
refresh/update
the
knowledge
of
medical
personnel.
More
vernacular
publications.
Provide Health Action free of
cost.
Health
Action should carry information on the latest developments in
the
medical
field.
There
should
be
publications
in
preventive
medicine.
Publish
a
directory
of
all
CHAI
members.
Publications should reach members in time.
2.
CHAI
2.1
Better Interaction between CHAI and its Members (235-16.6Z)
through
visits,
and
more
personalised,
and
prompt
correspondence.
CHAI
could
be
less
hierarchical
and
institutional and more accessible to members.
2.2
Help in times of Members Needs
76 (5.4 Z)
CHAI should: Be ready to help members out of their
problems.
Provide
advice
on
legal issues and
support
during
legal
crises.
Study the problems and needs of members and
offer
help
accordingly.
The Executive
Director
should
arrange
meetings
at a local level to study the problems of
members.
Have a department which studies the problems and difficulties
of members.
3.
membership
Material
1inkaqinq
(387 or 27.3Z)
Assistance to Members
(36B or 25.4Z)
3.1
Financial Assistance (222 - 15.7 Z)
CHAI
should
recommend
the financial needs
of
members
to
sponsoring
agencies.
It should help mobilize resources
for
members.
Financial assistance to be given
to
participants
attending programmes.
3.2
Supply of Medicine (138 - 9.7 Z)
CHAI
should supply medicines to members on a regular
basis.
Have
an
effective system for delivery of
drugs
through
a
central pharmacy.
Distribute homeopathic medicines as
well.
Arrange
for
supply of medicines available in
the
country.
Simplify the procedure to get foreign medicines.
-88-
165
4 .
Organisational
4.1
Regional Functioning
(64 - 4.5 7.)
CHAI
should:
Strengthening
regional
units.
Hold
State/regiona1
level
conventions
and
meetings.
Start
a
hospital
in
Tripura/
Mizoram
which could
be
used
as
a
referral centre.
Make its presence -felt in the North, through
conventions
etc.
Create
core
units
at
the
regional
1 eve 1Zappoint
regional
representatives .
Board
members
should
be elected -from different States.
Should throw
away
regional
interests
-for
national
interests.
Resource
for
to
be
identified
1 e ve 1
personnel
at
the
regiona1
utilisation of their services.
structure
(11.77.)
(54 - 3.8 7.)
4.2 Policy and Planning
care
and
CHAI
should: Uphold Catholic princ i p1es in health
the
Have
a
say
in
practising
them.
guide
members
in
Be
Be faithful to its obj ec tives.
national health poli cy.
practical
in
its approach.
Coordinate the
activities
o-f
members.
Have more effective policies.
Involve members more
in the administrative aspects.
Evolve a common health policy
for
Catholic
hospitals.
There
should
be
effective
implementation of plans and policies.
Targets set should
be
met
and objectives should be realised.
CHAI must
plan
for
the
future.
CHAI
should
be
a
spokesman
of
Catholic
institutions.
Instead of taking too many activities, take
a
few and do them effectively.
It should become an
effective
and strong Association.
Encourage non-catholic institutions
too to be members.
4.3
Linkages/Cooperation
32 (2.3 7.)
CHAI
should: Encourage and foster mutual
cooperation
among
members.
Competition
especially between members is
to
be
avoided.
Provide
a forum to fight
for
minority
rights.
Cooperate with Government and take up recent developments in
the
health
field.
Provide
mediation
/linkage
between
Government
and
members.
Network
with
like
minded
governmental and non-governmental groups.
Evolve a forum
of
health activists under CHAI.
Have a better relationship with
CBCI.
Take up issues at the level of the CRI (Conference
of
Religious of India). Organise inter—institutional programmes.
4.4
Financial Aspects of its Functioning
(13).
CHAI
should:
Provide services and training at a
low
cost.
Utilise
its finances for a better cause.
Open an
industry
which produces hospital equipment.
Tap government
resources
and
resources from business organisations.
Use
innovative
programmes for fund raising.
Strive for financial stability
and self sufficiency.
Should not demand financial help from
members.
-89-
4.5
Other (08)
CHAI
personnel
should
undergo a true
orientation
to
its
philosophy.
The
staff
of CHAI should
be
appointed
-from
different
regions.
There should be
no
favouritism.
All
should be treated equally.
Need for efficient administration
at
the
Centre.
Give a report of
its
activities
before
conven ti ons.
5.
Community Hea 1 th/RuraI
5.1
Community Health
(80
- 5.6 7.)
CHAI
should:
Support/promote community
health
programmes.
Organise training for community health workers.
Help conduct
health
awareness
programmes
in
rural
areas.
Give
orientation
in
primary health care.
Coordinate
different
training
programmes
in
community
health
and
community
development.
Set
up
a
model
community
health
centre.
Study
the problems of rural health centres and
offer
help.
Adopt small health centres and offer help.
5.2
Focus
on rural health/pooer sections of society (78 5.57.)
CHAI
should:
Have
a greater focus on
rural
areas.
Work
should
focus
on
weaker sections of
society
for
example,
women.
Reach
out to the poor and marginalised.
Give
new
direction
to members.
Programmes to be community based
and
people oriented.
6.
Other areas
6.1
Help with Health Personnel for member institutions 74 (5.27.)
CHAI
should:
Arrange
for doctors
who
are
efficient
and
service
minded
to
work
in
member
institutions.
Arrange
doctors from bigger institutions for the outreach
programmes
of smaller institutions.
Look into the appointment of
staff
and
regulation of their salaries.
Handle staffing
problems
in
member institutions.
Help solve the problem
related
to
the
registration of nurses caused by transfers from State to
State.
Organise camps for nurses.
6.2
Work on Drug Pol icy/Al ternative Therapies (45 - 3.2 7.)
CHAI
should:
Promote low cost
drugless
therapy.
Promote
alternative systems of medicine and alternative health
care.
Start
a
drug
quality control
laboratory.
Work
for
and
promote
a rational drug policy at the national level and
to
make
the marketing of drugs under generic names
a
reality.
Fight against exploitation by multinational companies.
Hea 1 th
for focus of work
-90-
(158 or
(154 or
11.27.)
10.97.)
6.3
Specific Activities/Issues to be Taken
- 37 (2.6 per cent)
CHAI should: Offer consultancy services on management issues,
labour issues, -foreign -funds etc.
Have more action oriented
activities.
Promote low cost communication media.
Discuss
the Consumer Disputes Redressal Act.
Take up relevant health
issues
in
the country.
Evolve a policy
of
action
during
disaster
relief.
Work
on AIDS
control.
Promote
school
health
programmes.
Youth
welfare
programmes.
Hold
conventions
in
different places
with
appropriate
themes.
Look
after sp'ritual needs of workers (for example
retreats
for sisters).
Undertake research.
Set up a special cell in
member institutions to help poor patients.
Thus,
a
very
large
proportion
of
members
(69.07.)
from
respondents
to the study have expressed
their
expectations
from CHAI.
The Association infact is already working or
has
worked
at some time on several of the points
raised.
How
these could be strengthened/revived, developing methods which
they could reach all member institutions and the
utilisation
of
the
strengths and resources of the
member
institutions
themselves in these areas, are tasks that lie ahead.
-91-
4.22 SUGGESTED FUTURE THRUSTS FOR THE ASSOCIATION
This important issue, which was also one of the key objectives of
the
study
was
put
as a
question
to
the
total
cnstituent
membership.
55.0 per cent (775) of the member institutions,
out
of 1415
respondents to the study, shared their views as to
what
should be the priority areas of focus for CHAI in the 1990's
and
beyond.
The
large number of views have been
grouped
together
into
smaller
categories.
There
is
some
overlap
that
is
unavoidable.
When there has been a sufficiently large number of
points
regarding a subunit of a larger point,it has
been
given
seperately.
The suggestions regarding future thrusts are
given
below.
Percentages are based on the denominator of 1,415.
1.
Rura 1
Heal th/Community Heal th/Health for All
(847 or 59.87.)
Many
dimensions relating to this overall thrust were
by a very large proportion of respondents.
raised
1.1
Rural Health 329 (23.2 7.)
CHAI
should
focus on rural and tribal
areas,
particularly
towards the total development of these areas.
It should give
assistance to institutions working for rural health and study
the work and needs of dispensaries in rural areas.
It should
arrange doctors for rural hospitals and focus on services for
nurses
working
in
rural areas.
Graduates
from
St.John's
Medical College should be motivated to opt for rural service.
The villages of North India need greater emphasis.
It
could
start referral hospitals in rural areas.
1.2
Community Health (in general)
215 (15.2 7.)
CHAI
should
promote Community Health and
Development.
It
should strengthen Community Health and Development programmes
in all Diocese, and encourage all religious congregations
to
take up community health work.
1.3
Components of Community Health
114 (8.0 7.)
CHAI
should
promote mother and
child
health
programmes;
family
welfare
programmes;
natural
family
planning,
and
population
control;
eradication of
communicable
diseases;
health work with urban poor; more outreach programmes;
youth
welfare
programmes; school health programmes;
immunization;
nutrition
programmes; community based rehabilitation of
the
disabled; and public health in general.
92
Rehabilitation
of
refugees should
raised for preventive health work .
be
taken
up;
and
funds
73
(5.2
achieve
1.4
CHAI
should work towards Health for All by 2000 AD
)7. .
It could work in cooperation with government to
this goa1.
1.5
Health Education/Awareness
79 (4.9 7.)
CHAI
should promote health education and health
awareness.
It
should
produce
health
education
material
in
nationa1/regiona1/vernacu1 ar
languages. Government could
be
motivated
to
introduce
health education
into
the
school
curriculum.
1.6
CHAI
should promote a preferential option for the poor
social
justice
in
the
healing
ministry.
This
is
underlying faith dimension for the above.
2.
CHAI
internal dynamics and services
(276 or
and
the
19.57.)
A smaller but significant proportion of members raised points
related to the internal functioning of the Association.
2.1
CHAI functioning
137 (9.7 7.)
There
is
a
need
for
greater
institutions through visits etc.
to members in all activities.
interaction
with
member
Support should be extended
There is a need for better coordination and interaction among
member
institutions,
so as to develop better
health
care.
The
relationship
between members needs to
be
fostered
by
CHAI.
Membership should be open to all Catholic health
care
institutions.
Income generation for self-reliance is needed.
Coordination
with
foreign
donor
agencies/hea1 th
agencies
is
also
important.
Poorer
and smaller institutions could
be
given
assistance according to need in their work.
Equal amount
of
money to be spent for basic needs.
Proper use and allocation
of funds is necessary.
There
is
a need for efficient management
of
the
central
office.
Health
Action
and CHAI
services
could
be
made
systematic.
Equal
importance
needs
to
be
given
to
institutional
and
non-institutiona1
health
programmes.
Bureaucratic
delay in delivery of services needs to
be
cut
down.
CHAI should become more easily accessible
and
more
flexible.
It
should
use
the
vernacular
language
for
communication
with members.
It should select staff with
an
understanding of the medical field.
t93-
CHAI hould be -faithful to its objectives.
Objective One
of
CHAI
could
be
stressed.
Objective Two of
CHAI
was
also
considered
important.
It should abide by
decisions
taken.
Periodic evaluations should be conducted.
The relationship with CBCI was considered important.
2.2
Regionalised Functioning
54 (2.6 per cent)
Regional planning and action should be undertaken in
keeping
with the vision of CHAI.
State level units should be started
with
decentralisation
of power.
State
level
conventions
could be organised.
CHAI
could
cooperate with diocesan
programmes
and
social
services.
It could motivate
church
leaders
to
cooperate
with the work of members in each diocese.
It could
organise
regional renewal programmes.
Programmes
and
more attention could be given to
the
North
East.
2.3.Training and Information Services
85 (6.07.)
This
is emerging as a key strategy for CHAI in
the
future.
CHAI should organise training programmes on different aspects
of
health
care
and
conduct
seminars/
courses
to
help
personnel
working in member institutions.
It could
provide
information
to members on advances in health care and
bring
out publications in the medical field.
It could provide Continuing Education and provide consultancy
services
to
members.
It could
also
help
with
starting
courses (for example MBBS , Nursing,Laboratory Technology)
in
member
institutions.
CHAI could help get
more
religious
trained as doctors and nurses.
Other
suggestions included providing guidelines
to
members
regarding
collaboration with government; forming a panel
of
resource
personnel for training of members;
training
local
people
for health work; organising exchange
programmes
for
doctors
and
nurses;
organising
follow-up
programmes
for
conventions,
seminars
etc
to
implement
resolutions;
organising
scientific
sessions
during
the
conventions;
providing
information to members regarding
foreign
funding
agencies and publishing a "Health and Medicine Guide".
It
was
felt
that
CHAI
experiences and discussing
2.4
Others (5)
voluntary
research.
should
be
a
forum
issues and problems.
for
sharing
CHAI could support NGO ' s (Non-governmental or
organisations), promote networking and
undertake
-94-
3.
Important
12.77.)
3.1
Promotion of Wholistic Health
51
(3.5 7.)
The integral development of people should be
emerging
issues in
hea1 th to be taken up
(180
or
the goal.
3.2
Women's Issues
4 1 (2.9 7.)
Specifically
mentioned were: womens development
programmes;
social issues like child marriage, prostitution etc, and
the
need to promote the rights of the girl child.
3.3
Values in health care/spiritua 1 dimensions 22 (1.57.)
There
is a need for CHAI to take up medico-moral issues
and
help
members to establish pastoral care
departments.
Also
mentioned were the need to impart moral values to people
and
to improve moral standards of members!
3.4
Health problems and issues - 66 (4.6 7.)
CHAI
should work on
prevention of AIDS/ Cancer/ Mental
ill
health and
Alcoholism / Drug Dependence.
It could also work
on
Geriatric Health (of the aged and
elderly);
Environment
and
health issues; and Consumer issues (Consumer
Protection
Act);
In general the important problems faced by the country
should be tackled.
4.
Medical/Heal th care-
4.1
Medical/Health care (48 or 3.47.)
CHAI should promote alternative systems of medicine, and low
cost
health
care
through
use of
low
cost
medicine
and
drugless therapy.
4.2
Drugs (medicines) 38 (2.77.)
CHAI
should
help
with
free
medical
supply.
Supply
of
medicines
should
be pooled from Indian companies.
On
the
other
hand it was felt that CHAI should promote
a
Rational
Drug
Policy.
It should
promote/give
publicity
regarding
banned
drugs
through
the
media,
and
counter
the
commercialisation of medicine.
CHAI could start a pharmaceutical company and a drug
quality
assurance laboratory.
4.3
Health Policy Issues (29 or 2.07.)
CHAI
should
be
involved in health
policy
making
in
the
country. It should prevent the proliferation of sophisticated
hospitals in towns.
It could evaluate the health
programmes
of
members and evolve a policy for just wages to
class
IV/
support staff.
-95-
policy issues
(77 )
Other suggestions included:
need to take a stand against the
medical and health policies of the
government; to
encourage
religious to work in government institutions; to support need
•for
well
equipped hospitals; to work
towards
safeguarding
patients
rights; strive to regulate salaries of doctors;
to
organise a network of blood banks; give greater importance to
hospital
management; to emphasise collective
responsibility
to
promote health, and to work on labour issues
in
member
ins t i tuti ons.
5.
Catholic aspects
29 (2.0 per cent)
CHAI
should
support
members
to
practise
Gospel
values
through
the healing ministry.
It could advocate the
rights
of
minority community hospitals and look into the safety
of
religious
personnel
working in
medical
institutions.
It
could
represent Church related institutions in the
national
arena and reach out to non-christian doctors with its
vision
and philosophy.
-96-
4.23
GENERAL COMMENTS/SUGGESTIONS
25.6 per cent (362) respondent member institutions, out
of
the
1,415
respondents,
gave
other
comments/suggestions
regarding
CHAI.
These have been grouped together and
are
given
below.
They reiterate some of
the
points
raised
earlier.
However, some suggestions are new and valuable.
Concerning members/membership 148 (10.57.)
Member
institutions
should be visited
and
personalised
contacts
and communication developed
(84).
CHAI
should
be
helpful to members in times of crisis and
need
(14).
CHAI should have a department which visits members, studies
their needs and refers recommendations to other departments
(10). It is better to do something for its members,
rather
than
spending
money on frequent
evaluations
(5).
CHAI
should
open
its
doors
(membership)
to
non-christian
institutions as well (4).
CHAI is far beyond the reach of
members (4). Make the facilities available with CHAI, known
to members (3).
Develop mechanisms to motivate/inspire and
influence
members
(3).
Members should be
involved
in
decision making (2).
Members
involvement
for
the
cause of
CHAI
has
to
be
focussed (2).
Members do not imbibe the philosophy of CHAI
(2).
CHAI
is
of
the rich and for
the
rich
(2).
A
directory
of
the
membership
should
be
published
(1).
Prepare
a calendar of activities for a year and
circulate
it
to
members (1).
Members have
a
very
insignificant
benefit from CHAI (1).
Institute awards for
individuals/
member institutions who have a remarkable success to
their
credit
(1).
Give awards/certificates to those working
in
rural
areas
for
fifteen
to
twenty
years
(1).
CHAI
activities
should
be channelised by
member
institutions
(1).
Membership fees should not be increased (1).
Help
should
be extended to larger member institutions too
(1).
Create an enviornment where small member institutions
also
have
a feeling of belongingness (1).
CHAI services go
to
the
urban and bigger member institutions (1). CHAI
should
be
more
interested in its members (1).
Take
efforts
to
make
all Catholic health care institutions
join
together
(1). Show more concern for the members, rather than for the
central office (1).
2.
Concerning
CHAI organisational structure and functioning
52
( 3.77.)
State
units
should
be strengthened
and
enriched
(26).
Organise
State/Regiona 1
level meetings,
discussions
and
conventions (15).
Amend the Constitution of CHAI so
that
-97-
it
gives
greeter
importance to
State
units
(3>.
The
Executive
Board should be -formed by
representatives
from
regional
units (2).
Conduct conventions in each State
by
turn
(1).
Change the name from Hospital
Association
to
Health
Association (1).
The organisationa1 structure
has
to
be relooked at during the annual conventions (1).
The
Presidents
of
State/regiona1 units should be
given
more
powers for quick action (1).
Board meetings are held in "
convenient
" places, with ulterior motives behind it
(1).
CHAI should be under the control of CBCI (1).
Concerning
3.
CHAI
activities 230
(16.27.)
1
Training and information service
55
There
is
a
need
for more
seminars
and
courses
(23).
Provide
training
programmes
free
of
cost
for
small
institutions (5) .Col 1aborate with St.John's Medical College
(5). There is a need for follow up of courses and
training
programmes
(4).
Try
to get the rural
bond
system
for
medical
students mandatory (3).
Make efforts to
reorient
medical education (2).
There is a lack of training centres
for promotive health care (2). CHAI should train nurses
in
community health and development (2).
Should pave the way
for
Catholic Medical colleges (1).
CHAI should
take
the
initiative
to train the rural poor to undertake
the
MBBS
course
(1).
Should start a nursing school (1).
A
good
library
is
required
in the central
office
and
at
the
regional
centres
(1).
Start courses to
equip
religious
personnel to work as Registered Medical Practitioners
(1).
Need
for
training
village
leaders
to
impart
health
education
(1).
Need for health training
programmes
for
high
school students (1).
Need for more trainers in
the
development
field
(1).
CHAI
should
start
exchange
programmes at the Diocesan level (1).
3.2
Publications and productions
40
Publish
health education material in vernacular
languages
(18). Make the public aware about CHAI and its publications
(4),
Need for publications in vernacular
languages
(3).
Health
Action
should
be sent free
of
cost
to
smaller
institutions (3).
Publish Health Action in vernacular (2).
Subscription should not be demanded from small institutions
(2).
Use-Health Action as a medium in the national
health
arena
(2).
Publish a handbook on Community Health in
the
Jubilee
year (1).
Publish a medical guide for the use
of
small
institutions
(1).
Use
mass
media
for
village
education
(1).
Publish
the
availability
of
trained
personnel for community development programmes (1).
There
are too many circulars and nobody reads them (1).
Produce
cassettes in local languages (1).
-98-
3.3
Concerning Material Assistance
52
Financial assistance to be given to small institutions on a
regular
basis
(24).
Make arrangements
-for
institutions
getting medicines they really need (15).
CHAI could import
■foreign
drugs
(8) .
Need -for -free medicinal supply
on
a
regular
basis (4).
CHAI should have a project to pay
the
health workers of member institutions (1).
3.4
Concerning Meetings and Conventions
6
Conventions
to
be conducted in each State
by
turn
(1).
(given earlier as well)
The participation of the laity in
annual
conventions to to be encouraged
(1).
Conventions
should
be evaluated
(1).
Illiteracy should be the
theme
of
the next annual convention (1).
The meetings
are
too
centralised
in
cities
(1).
Since
the
meetings
are
conducted
in
English,we are unable to express
our
views
( 1 ) .
3.5
Rural Health / Outreach / Community Health
27
C N ■ B: The section on training is also related to this! CHAI
should promote more health centres in rural areas (10).
It
should arrange health personnel to work in rural areas (6).
CHAI should recruit doctors for rural mission
institutions
(3).
CHAI
should adopt a village in every diocese
or
at
least
one
in
a region and have
model
community
health
activities which could be replicated by members (3).
Need
to give importance to the rural areas of the North (2).
It
should enable all the larger institutions to start outreach
programmes
(1).
It should encourage rural hospitals
(1).
It
should concentrate on the problem of fishermen
in
the
coastal areas (1 ) .
3.6
Concerning Medical Care
47
Less
importance
should
be given
to
big
hospitals
and
sophisticated
treatment
(28).
Fix a
salary
policy
for
Catholic hospitals (3).
Low cost drugs to be promoted (2).
It should enable institutions to start herbal gardens
(2).
It
should promote integrated health care systems
and
all
systems
of
medicine
(2).
It
should
start
one
referral
hospital
in all States (2).
It should
have
an
influence
in the national health arena (2).
CHAI
should
work for population control (2).
It should concentrate
on
leprosy
eradication
(2).
AIDS awareness
programmes
are
necessary
(1).
It
should
provide
help/
support
to
psychiatric
rehabilitation
facilities
(1).
Central
Purchasing
Service does not suit small
institutions
(1).
CHAI
should
make arrangements for
service
contacts
for
equipment bought (1).
-99-
3.7
Other activities/departments
3
Membership
department
-functions
poorly
(1).
No
more
raffleswe
have
had enough and more of
it
(1).
Stop
planning
about
the
Drug
Quality
Assurance
Control
Laboratory ( 1 ) .
4.
General thrust and approach
(35)
CHAI should reach out to the poor in a major fashion
(14).
CHAI
should
believe in action and practice
the
preached
philosophy
(6).
CHAI should work for social
change
(4).
Focus
on member institutions ideologies.
They
should
be
service
oriented rather than commercial (4).
CHAI
should
work for the realisation of its objectives (3).
"Give more
and
ask
for
less" policy should be
adopted
(2).
CHAI
should
have a sense of poverty (1).
Should cater
to
the
spiritual growth of people (1).
5.
Suggestions
(24)
CHAI
should focus on producing low cost drugs (10).
CHAI
should collaborate with government (4).
CHAI should have a
consultancy
cell (2).
The Executive Director should
have
discussions
with CRI to solve issues related to
personnel
and
funds
(2).
CHAI should have a legal
aid
cell
(1).
Programmes/projects of CHAI should continue irrespective of
the
interests of individual persons working in the
office
(1). CHAI should take action against mismanagement of money
(1).
CHAI
should not duplicate the work
done
by
other
voluntary
organisations
(1).
CHAI
should
safeguard
Christian
and
moral
values (1).
Should
take
care
of
evangelisation through patient care (1).
6.
Administration/management
(15)
Efficient
administration is required (7).
Proper
office
management
is
required (2).
CHAI should have
more
lay
people in the administration (1).
Politics should not
be
mixed
with administration (1).
The central
office
staff
should have field experience (1).
There should be
better
planning
(11.
The
Bishops
should
have
a
hand
in
administration
(1).
CHAI
should
improve,
taking
this
evaluation as a base (1).
7.
General feedback
(16)
CHAI's work is
rather
satisfactory and
helpful (5). CHAI
should
avoid a 'difficult to practice' attitude (3).
CHAI
enjoys
comfort at the top level at the expense
of
others
(2).
CHAI is more institutionalised than people
oriented
(2).
CHAI performance does not equate the resources
spent
(1).
CHAI is of the rich and for the rich (1).
CHAI
is
trying
to concretise an outside ideology and is
not
need
oriented (01).
CHAI is a white elephant (1).
-100-
5.
5.1
DISCUSSION,
CONCLUSIONS AND RECOMMENDATIONS
It
has
been
a
courageous
and
timely
decision
by
the
Executive Board,the Executive Director and others in CHAI to
undertake a reflective evaluative study of the
Association.
Put
simply
the main question was 'where are we
and
where
should
we
go'.
Since
CHAI
is
a
large
and
diverse
Association,
with a long history, functioning in a
complex
and rapidly changing situation it was considered appropriate
not
to use a quick "external evaluation"
approach,
though
that would have been easier. The question itself was seen as
part of a process of generating change.
Therefore a
multi
pronged
approach was used with the involvement
of
members
and others.
It
was decided to draw on many perspectives
same
entity namely CHAI and a feedback from
the
present.
Important
among these
were
members.
regarding
the
members
about
the
views
of
MEMBERS
VIEWS
Delphi
panelists
views
CHAI
1943 - 1993
evaluative
study reflection
Views of Executive
Board members
and representatives of
regional units
Staff
views
Views of the
study team
Views of friends
and people
involved with CHAI
Views of the
financial
consultant
Views of different groups of people were sought, because
it
was felt that based on their experience and expertise points
would
emerge that would be of use to CHAI in
its
planning
and action in the future.
Thus, the purpose of the exercise
was
to
get a sense of direction for future
action
and
a
feedback from members about the present.
LIBPAHY .^<^4-381
nnrtJM, RATION
<
5.2
This
report
deals
with the view* of
the
constituent
or
institutional
members
of CHAI.
This
large
group
infact
constitutes
CHAI.
They have the power
to
determine
its
direction.
They also interact with the executive
part
of
CHAI, its central office, the various departments and
their
activities
and
services.
The views
of
this
group
are
therefore of value.
Since a scientific methodology was used in the study
design
and
in the drawing of the 20 per cent sample,
taking
into
consideration the diversity of its membership, the
findings
from
this group are generalisable to the total
membership.
The
response
rate
to the mailed
questionnaire
was
also
large.
Put
together
we
have
data
from
1,472
member
institutions or 64.87. of the total membership.
57 of
these
institutions
were closed/not functioning
presently,
hence
the
actual
data
derives
from
1,415
(62.37.)
member
institutions.
As
has been mentioned
the
key
evaluative
questions
were
put to the total
membership.
Sufficient
information
and
feedback
has
therefore
been
generated
regarding
the
key
questions
on
strengths,
weaknesses,
expectations, future thrusts etc.
Data concerning the respondents from the member institutions
show
that they are a trained, responsible
and
experienced
group
of people representing the experiences and
views
of
their
institutions.
Thus, the findings are
important
for
consideration by the Association.
5.3
Feedback has been obtained about:
a) the objectives of CHAI;
b> the organizational structure of CHAI.
Both these are of importance as CHAI revises its
Memorandum of Association and its Rules, Regulations
and Byelaws;
c) the levels of interaction with CHAI;
d) the different activities and services of CHAI, and
e) views regarding the strengths, weaknesses, expectations
from and suggested future thrusts for CHAI.
5.4
Numbers
and percentage* have been given as
a
quantitative
measure.
However the qualitative dimension of the
feedback
and
suggestions given are equally important.
While
major
thrusts
have
emerged using the quantitative
measure,
the
wisdom
and experience of the decision makers of CHAI
would
help to make choices and decisions regarding the many
other
suggestions, some of which are also very useful.
-102-
5.2
Thi*
report
deal*
with the view* of
th*
constituent
or
institutional
member*
of CHAI.
This
large
group
in-fact
constitutes
CHAI.
They have the power
to
determine
its
direction.
They also interact with the executive
part
o-f
CHAI, its central office, the various departments and
their
activities
and
services.
The view*
of
this
group
are
therefor* of valu*.
Since a scientific methodology was used in the study
design
and
in the drawing of the 20 per cent sample,
taking
into
consideration the diversity of its membership, the
finding*
from
this group ar* g*n*ralisable to th* total
m«mb*rship.
The
response
rate
to the mailed
questionnaire
was
also
large.
Put
together
we
have
data
from
1,472
member
institutions or 64.87. of the total membership.
57 of
these
institutions
were closed/not functioning
presently,
hence
the
actual
data
derive*
from
1,415
(62.37.)
member
institutions.
As
ha* been mentioned
the
key
evaluative
questions
were
put to the total
membership.
Sufficient
information
and
feedback
has
therefore
been
generated
regarding
the
key
questions
on
strengths,
weaknesses,
expectations, future thrust* etc.
Data concerning the respondent* from the member institutions
show
that they are a trained, responsible
and
experienced
group
of people representing the experience* and
view*
of
their
institution*.
Thus, the findings are
important
for
consideration by the Association.
5.3
Feedback has been obtained about:
a) the objectives of CHAI;
b) the organizational structure of CHAI.
Both these are of importance as CHAI revises its
Memorandum of Association and its Rules, Regulations
and Byelaws;
c) the levels of interaction with CHAI;
d) the different activities and services of CHAI, and
e) views regarding the strengths, weaknesses, expectations
fron and suggested future thrusts for CHAI.
5.4
Number*
and percentage* have been given a*
a
quantitative
measure.
However the qualitative dimension of th*
feedback
and
suggestion* given ar* equally important.
While
major
thrusts
have
emerged using the quantitative
measure,
the
wisdom and experience of the decision makers of CHAI
would
help to make choices and decisions regarding the many
other
suggestions, some of which are also very useful.
-102-
5.5
The report is lengthy inspite of the process of condensation
after the analysis.
The number of respondents was large and
it
was felt necessary to give atleast some detail for
each
of
the Departments/activities so as to be useful for
their
planning
processes and to do justice to the feedback.
5.6
The distribution pattern of members is predominantly (82.8Z)
rural/tribal in keeping with tt.e rural/urban distribution of
the
population.
The
proportion
of smaller
0-6
bed
institutions
(65.67.)
to
the
larger
more
than
7
bed
institutions is 2il.
A later overview table summarising the
pattern of utilization of CHAI services/participation in its
activities shows that the smaller and the rural institutions
do
not
utilise
services/participate
adequately.
Future
departmental
goals
and
strategies need
to
work
towards
reaching these member institutions proportionately and later
preferentially.
70.87.
of the 20 7. sample are in regions with better
health
status
presently.
It
could be
possible
that
when
the
institution
started
this
was not the case.
It
is
also
possible that they may be located in District/Taluks
within
better
health
status
regions that
may
still
be
under—
developed.
This
aspect- cannot be commented upon
in
this
study.
However, during further investments in newer
health
centres
or
expansion
of
present
institutions,
priority
should be given to areas with greater need.
5.7
Data
regarding
the year of joining CHAI
shows
a
marked
increase
in
membership
of CHAI in
the
Seventies
(23.57.
joined at this time).
This showed an even greater
increase
in
the
Eighties upto the study period (1991),
with
40.67.
having
joined during this period.
Data regarding year
of
establishment of member institutions shows a roughly similar
pattern.
Thus
there is an continuing
active
process
of
growth
in numbers and also of membership in CHAI.
One
of
the
areas
in
the
ten
point
programme
of
1983
was
a
"Membership
drive
for
strengthening
the
organisation".
While
no specific targets were set,study data reveals
that
this goal has been attained.
Information from the
Catholic
Directory of 1990 however
shows that there is still further
.scope
as
there are institutions listed here
who
are
not
members of CHAI.
Life
membership
which
was
also
introduced
during
the
Eighties
is already 23.77. in 1991 and has
since
increased
even further, also indicating sustained interest by
members
in the Association.
-103-
With
this
consolidation
the
scope,
advantages
and
limitations of other types of membership could be
explored,
eg.,associate
membership,
membership
of
lay
groups
and
individuals.
This could reflect the increasing focus on the
role
of
the laity in the Church in general.
It
may
also
strengthen
the
movement
towards
community
health
(an
identified
major
thrust)
which builds on
people
and
on
networking.
5.8
The
majority of members have joined the Association
with
the
expectation
of gaining something,either
in
terms
of
training,information
and guidance or in terms
of
material
assistance.
Others join from a sense of duty because of its
Catholic
nature.
A
relatively
smaller
proportion
have
joined for togetherness, solidarity and cooperation
towards
a common cause or because of its objectives.
There
is
scope
for
changing
this
'givei—receiver'
relationship
and
making it more an Association
of
equals
with
debate
and
action,
greater
taking
up
of
responsibilities
by members for CHAI and pooling of
skills
and
resources
for
the
cause
of
improved
health
of
people,particularly the poor.
5.9
The number of suggestions regarding change of objectives
is
small but important points have been raised.
Since such
an
exercise
of
reformu1ating
objectives
is
not
undertaken
frequently
the points raised by members need to be kept
in
mind.
The
first
two
current
objectives
are
replicas
of
the
objectives
of the CHA of U.S.A, formulated more than
three
decades
years ago.
We need now particularly to
relate
to
the realities and needs of the Indian situation, with
focus
on
the poor and margina1ised.
The ideas generated by
the
Delphi
panelists
especially
regarding
underlying
philosophical
assumptions of health would be useful.
They
infact
reinforce
the points raised by
the
members
here.
They
have
also
suggested that the
change
of
objectives
should
have the concurrence of members.
The
proposed
new
objectives
and other major changes could be mailed
to
all
members
with agree/disagree boxes as a referendum.
Study
findings
show that the attendance at General Body
Meetings
is
not
representative and for an important issue as
this,
views of all members need to be sought.
Efforts also need to be made to make the objectives known to
members,
staff
and
others.
They could
be
given
in
an
attractive
form in its pamphlets, in all issues
of
Health
Action,
and other CHAI publications.
Colour
posters
with
pictures/i 1 lustrations
regarding
the
philosophy
and
objectives
could
be placed in the CHAI office as
well
as
distributed to members.
-104-
Currently
as part of the management process,
even
secular
professional
teaching institutions have
goal
and
mission
statements and objectives that are widely disseminated. More
important
however i* the ongoing process
of
internalising
the
philosophy, objective and thrusts, e.g. the
ten
point
programme, at all levels of the association.
5.10 While the majoritv of respondents have opted for status
quo
as
regards
the
organizational
structure
of
CHAI,
a
significant
minority
in
the
study
feel
the
need
for
decentralisation.
This has been also raised in the sections
on
weaknesses,
expectations, future thrusts
and
comments
/suggestions.
This has been coming out more strongly during
the
regional
meetings.
The important
points
that
have
arisen and that need to be considered are:
a)
That
the
Diocesan
level
is
the
most
practical
and
feasible for members to function in a collective
manner,
meeting
regularly
(2-3
monthly),
implementing
programmes, and relating to local needs.
Participation
in
special
training
programmes
reveal
larger
participation of personnel in Diocesan level programmes;
b)
State/regional level units also are an important level in
the
structure
of
the
Association.
Organizational
efforts, liaison work and major training inputs could
be
made through this level;
c)
The
question
of
different
regions
addressed.
5.11 Regarding
levels
of
office and members:
a)
elections
and
type
interaction
and
representation
of
members
needs
between
the
CHAI
to
from
be
central
A very high proportion receive the circulars sent by
the Executive Director from the central office.
There
however seems to be some discrepancy between
this
fact
and
the
lack
of
knowledge
about
the
various
services,
as
expressed
by
members
during
regional
meetings.
There
is
possibly
a
difference
between
receiving
and reading the circulars.
The circulars
are
also
sometimes
not
circulated
within
the
member
institutions.
Since Health Action is not subscribed to by all
members,
the suggestion of a regular newsletter could be seriously
considered. This could cover both, the activities of
the
CHAI central office/other units and also news
and
views
from members.
-105-
b>
The urban based, larger institutions, situated in regions
with poorer, health status are visited more ‘frequently
by
CHAI
staff/others.
The total number
of
visits
to
members
however
is low.
Perhaps
during
the
frequent
travel
of
some of the CHAI staff and
executives,
they
could
make
it
a point to visit members or
to
call
a
meeting
of members who are geographically close by.
If
the programmes of the coming year are planned in advance,
best
use
could be made of such
occasions,
with
input
sessions with and for members as well.
c)
The
participation
in the
special
training
programmes
listed
has
been gradually increasing
over
the
years.
Again
urban
based institutions
have
a
significantly
higher
participation
than
rural
and
tribal
based
institutions.
Note
must
be
taken
of the
fact
that
a
substantial
proportion
(43.0%) of those who have
participated
have
attended Diocesan level programmes.
This could probably be the best level for organizing
the
bulk
of
training programmes in the future.
This
will
help
make
the
much
needed
training
accessible
and
available to members in different States of the
country,
in
rural/tribal areas, and particularly to
the
smaller
health centres/projects.
5.12 a)
The
average annual participation by member
institutions
at
the conventions is fairly low at about 6.0%
of
the
membership.
The
number
of
actual
participating
individuals
is higher.
The average is also low
because
during
the past five years, the larger conventions
have
been
held
only in alternate years.
If the
conventions
are
seen as primarily for continuing education
purposes
through
the input sessions, the number of
participants
would
be considered good.
However
since
conventions
are also occasions for
the annual general body
meetings
at which decisions of policy and direction are made,
and
elections
held
for
three positions
in
the
Executive
Board,
the
representation is
small.
There is
also
a
significantly
greater
representation at
these
General
Body
Meetings/conventions by institutions
from
regions
with better health status and from larger institutions.
Several
suggestions
have
been
coming
up
from
the
regional meetings regarding elections.
Some of these are
about
the need for representativeness, by
region,
size
and
type
of
membership;
federal
structure;
whether
elections
could be held once in two years;
longer
term
for
executive
board
members;
postal
ballot;
lay
membership etc.
-106-
The
system
of
annual
general
body
meetings
with
elections,
to
which conventions were added
later,
was
instituted
since the formation o-f the
Association.
At
this
time the number of members was very small and
they
were mainly hospitals.
Now with a very large membership,
with
the
majority
being small,
rural
health
centres
alternative
methods
need
to
be
explored
regarding
elections.
CHAI
could draw on the
experience
of
its
previous
Board
members
and also that
of
other
large
natio- al level associations for ideas in this regard.
b)
Individual participants at the conventions are
primarily
nurses
(65.47.1 and administrators (22.57.1, some of
whom
are
also
nurses.
Planning of themes,
technical
input
sessions, should keep this in mind.
Organizing a variety
of
pre and post convention workshops in
smaller
groups
for different health personnel/ on different themes would
make
participation in the
conventions
more
attractive
and fruitful.
Methods to reach other health personnel in
member
institutions should be thought
of,
particularly
for
multi-purpose workers, auxiliary nurse midwives
and
other allied health professionals.
c)
The
question of follow up on convention themes needs
to
be
considered.
Different aspects/topics related to
the
same theme could be taken up at intervals, working groups
could
be set up, inclusion of the topic/theme
into
the
training
programmes of CHAI, organizing
diocesan
level
programmes
on the same theme,having a column
in
Health
Action
in
the year preceding and
following
the
theme
could
be considered.
The findings show that
both
the
quantity
and the quality of the follow up
is
extremely
low.
d)
Several suggestions have been given by members
regarding
the
conventions.
These need to be
considered
by
the
Board
and
Executives for
future
conventions
possibly
through
the
formation
of
a
convention
committee
(technical).
It has often come up in the past that
the
conventions
should be evaluated.
While findings of
the
study
could
be
utilised,
an
evaluative
exercise
by
participants
could be built into each convention.
This
could
cover the usefulness/relevance of the
theme,
the
contents
of input sessions,exhibitions etc, feedback
on
methodology,
use of audiovisual aids,
participation
of
members,
comments regarding the planning,
preconvention
information, background papers, comments on
organization
aspects,
accomodation
and food, suggestions for
follow
up etc.
-107-
5.13 a)
The
Health
Action
magazine ha*
received
the
highest
appreciation
from member* for it* content,
presentation
and
usefulness.
Findings
show
a
greater
equality
according to region, urban, rural and tribal location and
size of institution in the subscription to Health Action.
Currently
(June 1993) a little over 50.07. of
the
total
membership are subscribers to the magazine.
Going
back
to
history
we
find
that
one
of
the
3
resolutions of the first meeting in July 1943 was "
That
the
CHA publish a pamphlet or magazine".
The
'Catholic
Hospital' was published regularly since 1944.
In the new
constitution passed by members in 1958 and registered
in
1961
this
activity
was introduced into
the
Aims
and
Objects of CHAI viz., "3. To print, publish and circulate
matter setting forth or dealing with, or relating to
the
aims
and objects of the Association."
The
reasons
for
the
magazine
were to keep members in touch
with
each
other
and
to
keep them updated on new
trends
in
the
medical/heal th
and
related fields.
These
reasons
are
relevant
even today.
Publication of this magazine
for
members
has
been a constant feature
during
the
fifty
years.
While
making it available to non-members
is
a
progressive
step, the original purpose of such a
medium
of
communication between members is still important
and
should not be the lost sight of.
While
a newsletter could serve this purpose,it would
be
useful if all members could also get Health Action.
The
overall
feedback
during regional meeting
is
that
the
magazine
should have a seperate subscription and
should
not be part of the membership fee. A special subscription
drive among members especially those based in rural areas
could
be made.
The need to keep upto date and
informed
could
be
one of the selling points
for
the
magazine.
Offering
a gift subscription to members
who
contribute
an
article could be considered.
A drive
among
Bishops
and
superiors
to
take subscriptions
for
the
samller
health centres in their diocese/congregations could
also
be attempted.
In the section on expectations and reasons
for
joining CHAI the information need* of
members
have
come
out
rather high.
Health Action could
well
serve
that need.
b)
The readership
of Health Action is quite diverse.
This
reiterates
the
findings
of the
readership
survey
of
Medical
Service
(1987-88). Greater efforts to
make
it
known
and
available
to relatives of
patients
in
the
hospitals, to teachers, high school and college students,
and possibly through Diocesan and Parish levels could
be
made.
-108-
c)
Bringing
out
the
magazine in
the
national
language,
Hindi, needs to be seriously considered and perhaps later
in one or two other major Indian languages.
A number of interesting suggestions regarding content and
presentation
have
been made by members
that
could
be
taken up by the editorial committee.
The
order o-f preference o-f readers -for various items
in
the
previous
readership
survey
rated
’reports
about
various
experiences
very
high,
-followed
by
-feature
articles, editorials, medical ethics forum and CHAI
news
and notes.
5.14 a)
Regarding the other publications and productions for sale
by CHAI and HAFA ( Health Accessories For All) the number
of member institutions that have purchased them is
small
between 2.27. and 27.37. with an average of 12.57. (51).
It
seems
unlikely
that purchases by non-members
would
be
high.
The
members views regarding
usefulness
of
the
different
publications
ranges between 62.57.
and
83.77.
for
the
different publications, i.e.,
they
have
been
found
useful
by
most.
The
production
of
such
publications
should
be
cost
effective
and
more
importantly
should reach people,especially
from
member
institutions, to whom they would be of use.
Wider sales
promotion
is
needed,inc 1uding
through
other
health/
medical
journals, for example Health for
the
Millions,
Christian
Medical Journal of India, mfc bulletin,
FRCH
Newsletter etc.
Advertisements in Christian
newspapers
and general newspapers could also be tried.
There
could
also
be guidelines/ a policy regarding choice of
topics
for
publication of books by CHAI, style of
presentation
and
promotion
of the publications.
One or two
of
the
editorial
committee
members of Health Action
could
be
asked
to
give
their
comments
before
publication.
Alternatively
a
person from the field
covered
by
the
topic of the publication could give their comments.
This
would
introduce the concept of peer review,
which
will
improve standards.
b)
Regarding
the publications that have been sent
free
to
all
members,
including the Memorandum
of
Association,
again
only
a small number seem to have
received
them.
This varies from 6.9 Z to 21.1Z with an average of 13.0Z.
There
may
be different reasons to explain
this,
20.57.
said
they
do
not
know
whether
they
were
received,
probably
since most were circulated several
years
ago.
Changing personnel too could be a reason.
-109-
Members
were
requested by the
investigators
to
check
their -files particularly -for important documents like the
Memorandum
of Association and Health Policy
Guidelines.
However,
inspite
of this, 66.47. stated
they
have
not
received
these
documents.
Whatever
the
reason
the
situation
needs
to be looked into
and
improved
upon.
Because
besides the financial implications, the
desired
impact
of disseminating such information
(for
example,
Health Policy Guidelines) will not be realized.
5.15
A quarter of member institutions in this sample have ever
utilised
the services of the Central Purchasing
Service
(CPS).
The utilization has been significantly
more
by
the
larger and the urban based institutions.
There
has
been
an increase in the number of members utilising
the
facilities of CPS from 198B.
Suggestions and feedback by
members
have been given, which need to be considered
by
CPS
and
by CHAI.
Methods by which CPS
facilities
and
know
how could be made useful and accessible to
smaller
and rural based institutions need to be thought of.
The
study
shows that many of these institutions
lack
basic
equipment
for
medica1/hea1 th work.
Sources
where
low
cost
appropriate
technology
within
the
country
is
available could be made known to members.
For
instance,
kerosene and other refrigerators for storage of
vaccines
in
health centres without electricity, simple
equipment
for
basic
laboratory
work
and
equipment
for
sterilization.
5.16
No
comments are being made about the feedback
regarding
the
Catholic Medical Mission Board gift supplies
(CMMB)
as the scheme is already in the process of change on
the
basis of experience and feedback already received.
While
study
findings support earlier impressions, it
must
be
noted
that
inspite of many problems the
majority
have
found the CMMB scheme useful.
Mention
is here made of a question raised as to
whether
CMMB
money
(when
it is available) could
be
used
for
purchase
of
homeopathic medicines and
those
of
other
systems of medicine as well.
The
question
may
also be
raised
whether
such
money
could/should be used for the range of primary health care
work,
including
health
education,
starting
herbal
gardens, training of community health workers etc.
-110-
5.17
Regarding the discretionary ‘fund, 27.5 7. of members
have
utilised
the
fund during the past five
years
with
an
annual average of 5.67..
There is an increase in
numbers
over the years.
It is good to note that a
significantly
larger number of smaller institutions have used the
fund
and
also
that these have been more in
the
tribal
and
rural areas.
These seems to be a positive discrimination
in favour of the above, which is what the purpose of
the
fund
was.
Greater efforts though could be made so
that
it
is utilised more in regions with lower health
status
of people.
Two-thirds of recipients used it for purchase
of
drugs
or equipments
for
the
dispensary/laboratory
(excluding
refrigerators) .
While curative care is
part
of
primary health care, which is the purpose
for
which
the
fund
is to be used, greater emphasis
needs
to
be
given to other aspects of primary health care.
There
is
scope
for making known
to
members
and
all
concerned, the policies on which the fund operates and to
use
the
policies
and
objectives
of
the
fund
as
a
yardstick
to
evaluate it annually.
This
is
necessary
because
of the large sums of money involved.
It
could
also
be
considered whether CHAI could
allot
different
proportions
to
the different
regions,especia1ly
those
most
in
need.
Some
more
detailed
and
concrete
suggestions/guidel ines
to members as to how
they
could
utilise it for primary health care/community health
work
could
be
drawn up in consultation
with
the
Community
Health
Department.
This needs to be made
available
to
members in the introductory pamphlet/note about the fund.
In the absence of this knowledge it may
continue to
get
utilised mainly for curative work.
5.18
Project
proposals
from
nearly
10.07.
of
member
institutions have been processed by CHAI during the
past
five
years, making an
average of about 2.07.
per
year.
In
most cases a desk review was done and a fairly
large
proportion
of members (647.) have mentioned
that
CHAI's
response
was not helpful to their planning.
It must be considered how this activity could promote the
goals,objectives
and vision of CHAI
and of
the
member
institutions
and
if
it could be used as
a
method
of
learning
and growing, rather than just
being a
service
to funding partners.
-Ill-
5.19
It w<* found that only a vary small proportion <8.6%>
of
members
have
participated
in
tha
various
training
programmes
organizad by tha Community Haalth
Department
during
the past five years. Feedback about
the
content
and
methodology
have been given good. However,
a
very
large
proportion of members (91.0Z) are partially
aware
of
the vision of the
Community Health Department
which
was
articulated in 1983.
Again a big
majority
(84.87.)
find
the
vision relevant to their
work.
This
higher
level
of awareness could be attributed to
CHAI
through
Health Action, conventions etc.
But it could equally
be
due
to a similar thrust given by other associations
and
organizations,
for
example
the
Voluntary
Health
Association
of
India
(VHAI),
Caritas,
Indian
Social
•Institute (ISI) etc.
The
reasons given for relevance of the vision
to
their
work
indicates
a good level of
understanding
of
the
vision
and
are
fairly similar to the
ideas
given
by
Delphi
panelists
regarding underlying
assumptions
for
health
work and indicate a deeper understanding
of
the
concept.
The phase of orientation thus needs now to give
way to skill training and actually trying out the various
approaches and ideas in the field.
Promotion
of
community health and
family
welfare
was
included
as
an
objective of the
Association
in
1978
through an amendment of the Constitution after many years
of discussion.
"Promotion of Community Health Programmes
according to our new vision" was also the first
priority
in
the
ten
point programme for
the
next
decade,
as
articulated
in
1983.
This
8.67.
therefore,
is
an
extremely
small
number
of
members
reached.
Since
members
and
Delphi panelists have now
rated
Community
Health again as being of highest priority particularly in
rural
areas,
there
is
an urgent
need
to
get
more
training
programmes and other inputs off the ground.
A
planned approach through the regional and diocesan
units
could be tried rather than the present one of
responding
to requests as and when they come.
This would also
help
in
time
and
resource
management.
A
few
designed
programmes could also be offered at the central
level/in
different centres.
A quick brainstorming should help to
evolve training approaches suited to different regions of
the country and for different categories of member health
institutions.
They could build on the modules
developed
in
the
past
as
well as on
the
approaches
of
other
training
groups developed in the voluntary
sector
that
have already been documented.
-112-
As has been brought out by the study, diocesan and
State
level
training programmes are most
suitable.
Regional
resource
personnel could be used.
These could
be
from
member institutions,previous Community Health
Department
staff members of CHAI, Delphi panelists,persons from
the
voluntary and government sector, and medical and
nursing
college
staff.
Ideas
are aplenty, there
is
now
an
urgent need for implementation.
The many suggestions and feedback given by members
could
be
considered by the Community Health Department
as
it
undertakes its ongoing planning and evaluation.
5.20
Some
of the key questions on which
evaluative
feedback
from
members
was
crucial, was
put
to
the
entire
constituent
membership, through the
interview
schedule
covering the 20 7. sample, and the mailed questionnaire to
the remaining 80 7..
As has been mentioned earlier these
covered the following areas:
— reasons for the institution joining CHAI;
- problems faced in medical/health work;
— strengths and weaknesses of CHAI, based on their
experience and interaction during the past five years;
- expectations of the institutions of/ from CHAI;
- future thrusts i.e., priority areas of focus for CHAI
in the 1990's and beyond;
- other comments and suggestions regarding CHAI.
There
was
a
difference
in
methodology
and
probably
therefore in the quality of response, in that for the
20
7.
sample
institutions, feedback was
generated
through
discussions
and in the questionnaires members
wrote
in
their
responses.
Our experience
with
the
interviewed
sample
was that some of the feedback was
written
down,
but
some
was not.
This we elicited
during
debriefing
discussions
with
the investigators. Those
not
written
were
often
related
to
the
more
negative
feedback.
However,
the
important points that
emerged
have
been
raised
in
the
twenty issues given
in
the
Discussion
Document.
There
would
also probably be an
additional
difference
between
the response of the two groups.
Findings
from
the
20
per cent sample are more representative
of
the
membership
in terms of region and size
of
institution.
However,
at
this
stage the two groups
have
not
been
analysed seperately.
For academic and other reasons this
could be undertaken later only if considered necessary.
-113-
Even in response to
general open-ended questions certain
areas have been identified by large numbers.
we have not
taken
quantitative
cut
off points
to
prioritize
the
issues.
This could be done for example, by rating issues
raised
by more than 15.07. of the respondent
members
as
being very important/of highest priority, those raised by
10
14.97.
as important, between 5 9.97.
as
fairly
important,etc.
However we have, in this
document
given
points raised by even one or two members.
This was
done
because: a) in a democratic group all the views should be
made known;
5.21
b)
some
of
the views raised by smaller numbers
were
more
specific and some were very useful.
It is also
probable
that
individuals who have had a closer interaction
with
CHAI by being on the Board or staff previously or in some
other
way or who may be more involved in certain
health
issues
may
give more insightful suggestions
which
are
valuable;
c)
the
decision whether to consider the view and
to
take
action
also was felt to be rightly with the
Executives,
the
Board
members and the
different
departments.
We
therefore
have
not taken the option of
deleting
views
based on a quantitative or qualitative yard stick.
d)
this
is
also
the
internal
document
containing
the
detailed
backup
information
to
be
available
for
reference/use for by the Association and the Departments.
Therefore at the cost of being lengthy, details have been
given.
The
response
fol lows:
rates to these crucial questions
were
Response
Number
7.
n«l. ,415
Question
1.Reasons for joining CHAI
2.Problems in medical/
health work
3.Strengths of CHAI
4.Weaknesses of CHAI
5.Expectations from CHAI
6.Future thrusts for CHAI
7.Other comments/suggestions
-114
-
1,004
71 .0
-
1,117
878
640
978
775
362
79.0
62.0
45.0
69.0
55.0
25.6
as
Percentages
are
from
the
1,415
-functioning
member
institutions
who participated in the study.
There is
a
■variation in the response to different questions,
though
on the whole the response in high, especially in terms of
actual
numbers.
This
indicates
an
interest
in
the
association.
Members
have
filled
in/given
views
in
response to questions at the end of lengthy (and
tiring)
questionnaires.
The interview schedule
was
twenty-four
pages and the mailed questionnaire fourteen pages !
It
is the problems faced by members in their
work,
the
expectations
from CHAI and the ideas for future
thrusts
that are most important for CHAI's planning.
5.22
An
important
factor to be kept in
mind
when
planning
programmes
and during interactions with members are
the
problems
that
they face jn their
medical/health
work.
These
vary according to region and size of
institutions
and will also change over time.
Programmes may need
to
include
methods of handling these problems or to
evolve
methods of functioning inspite of these problems.
For instance many health personnel in member institutions
have to diagnose and treat cases of tuberculosis, malaria
etc.
These are most often done without basic
laboratory
facilities
(see problem one).
Referral
facilities
are
also not always available close enough.
Possibilities of
making ' a wrong diagnosis are very real.
Misdiagnosis of
TB
occurs even with laboratory facilities.
Can
putting
doubtful
patients
of
TB on
prolonged
treatment
with
potential
side effects be justified?
How can CHAI as
a
national
level
health
association,
help
in
such
a
si tuation?.
Similarly a very large number of member institutions lack
communication
facilities
of
telephone
and
transport.
While
this
may
be
essential
only
in
the
case
of
relatively
rare
emergencies
like
severe
post-partum
haemorrhage
etc,
it can not only effect
the
lives
of
people
but
also the confidence and credibility
of
the
institutions and their health personnel.
The problems relating to getting health personnel to work
in
rural/
difficult
areas
have
existed
since
the
inception
of
the
Association.
In
keeping
with
the
medical
developments and thinking of those days
members
set up nursing schools, worked towards establishment of a
medical college and towards standardizing the training of
pharmacists
and
laboratory
technicians.
It
was
a
great
-115-
contribution, the benefits of which are felt to this day.
However
because of the rapid increase in the
number
of
health
centred in remote areas, the need
for
personnel
continues
to be felt.
Additionally, is the
vital
need
for
personnel adequately trained and equipped
regarding
the newer approaches in community health that have
grown
in the country and internationally.
Could CHAI help in promoting greater dialogue and link up
between
institutions
training
various
categories
of
health
personnel
and
health
centres
and
services
functioning
particularly in remote
rural/tribal
areas.
This
would
be
in
addition
to
CHAI's
own
work
of
orientation
and
training,particu1 ar1y
skill
training.
Through
this
dialogue, could trainers
internalize
the
real
life problems of people and of health workers
into
their
training
and
continuing
education
programmes?
Resources within the CHAI membership need to be
utilised
more.
There are nursing tutors and others who have
left
their
training institutions and hospitals and
opted
to
work
in
remote health services.
Their
experience
and
expertise could be drawn upon.
Introducing
an
understanding
of
social
issues
and
societal analysis into the programmes of different health
personnel
run
by institutions could also
be
promoted.
Thus
the
experience of the CHD training
team
and
the
methodologies
developed during the past decade could
be
spread .
Joining
hands
with secular and other groups
who
raise
issues
like the campaign for a rational drug policy
and
against
irrational
therapeutic
practices,
issues
of
womens' health etc could be strengthened at the national,
regional
and
local levels.
Active
participation
and
contribution
in the All India Drug Action
Network,
the
Lok
Swasthya
Parampara Samvardhan
Samiti,
the
medico
friends
circle, womens and environmental groups,
Bhopal
victims
solidarity groups, citizens for secularism,
and
the
many
local
issue raising
and
action
groups
and
peoples
movements is of great importance.
CHAI and
its
members could, through such linkages, contribute more
to
improving peoples health and grow from this involvement.
Interaction with CBCI, CRI, Caritas, with
congregational
decision
makers and with Diocesan structures and
Social
Service
Societies
etc is also a msjor
role
for
CHAI,
keeping
in mind the fact that most
member
institutions
are run by religious personnel.
-116-
Several
of the above points have already been
initiated
in
the past'by CHAI, but will need to
be
strengthened.
Provision
needs
to
be made at
the
central,
regional
levels in terms to personnel, time and other resources to
do this effectively.
5.23
The many strengths of CHAI that have grown over the years
have
been
identified and appreciated by
a
substantial
proportion
of
members. 62.BZ
have
mentioned
specific
areas of strength.
These ares-
*
»
»
»
*
*
»
support and service to members;
Health Action;
training programmes;,
meetings;
the functioning of the Association;
various services
and activities; and
the issues taken up.
Large
numbers have mentioned the first two —
29.0Z
and
17.8Z respectively in response to an open ended question.
The training programmes and organisational structure
and
functioning
come
next with 11. 1Z and
11.5Z
mentioning
them.
The remain are mentioned by smaller numbers. These
have
been
developed
with
much
effort,hard
work
and
sacrifice
by the executives, staff and others, with
the
support of the Board and members.
The Golden Jubilee
is
the most appropriate moment to pay a tribute to the large
number
of people who have nurtured the
association
and
also
to recognize the positive contributions
that
CHAI
has made.
With this long tradition and commitment to the
health of the poor in India and with the guidance of
the
Spirit it can prepare itself for greater involvement
and
still
greater
contributions, building
further
on
its
existing strengths.
5.24
The section on the weaknesses of CHAI highlights specific
areas on which further work is required.
There is a fair
degree
of
internal
consistency
between
weaknesses,
expectations,
ideas
for
future
thrusts
and
general
suggestions
expressed by members.
It would be good
if
the
departments
of the CHAI central office,
the
whole
staff and the -Executive Board study these issues and
use
them
as
a plank for developing their
future
plans
of
action.
Each will have to relate the points
raised
to
their own work and roles.
-117-
As
identified from the list of weaknesses the areas
worked
on further by CHAI are i
to
be
a)
Improved interaction with members, with services of
CHAI
relating
to
their problems
and
needs
and
greater
focus
on
the
rural
based
and
smaller
institutions;
b)
Organizational issues such as:
* improved
internal
management
and
functioning
within the CHAI central office;
* some
issues regarding organizational
structure,
especially
relationships
between
the
central
office
and
the Regional/ State
Units
and
the
elections of the Executive Board members.
♦ issues concerning accountability and linkages.
c)
The focus,
offered.
and quality,
including content,
of services
Additional
feedback
regarding
training,publications,
project proposals, community health and other services have
again
been raised, besides those already given under
each
departmen t.
5.25
The
expectations that member institutions have
from
CHAI
have been expressed clearly by a large proportion of
69.07.
of
respondents.
They have been grouped together
and
the
main points that have emerged are:
a)
Interaction
between
the CHAI central
office
and
its
members
has emerged as CHAI's major strengths
(29.27.),
its
major weakness (16.37.) and the highest
expectation
(16.67.) of member institutions.
The management and
all
departments need to make efforts to keep this vital link
functioning well.
The turnover rate of senior staff
in
the
central
office
of
CHAI
plays
a
role
in
this
relationship,
as does to a lesser extent
the
changing
personnel
in member institutions.
If
different
staff
could be given greater responsibilities for liaison work
with certain States/regions , rather than respond to
the
whole country, it would help strengthen contacts.
They
could
also
work
more
closely
with
the
concerned
executive committee members of those regional units.
-118-
b)
CHAI needs to clarify whether meeting -financial needs o-f
members
is
its role as a
health
association.
Could
members
be
'enabled',
to
utilise
other
resources,
including
those -from government and local sources,
and
to
utilise
low cost,people building methods
in
their
hea1 th work.
Health care -financing in India is slowly emerging as
an
area
in
which experience has been
gained.
Dialogue
could be held with the concerned resource people/groups.
An analysis o-f approaches that are useful and those that
are
counterproductive
to
the
community
could
be
discussed.
c)
The
supp1y of medicine (foreign gift supplies)
has
a
fairly
long
history
with
CHAI.
This
could
be
reconsidered.
Indian manufacturing capability and local
availability of drugs has increased immensely during the
past
decades.
However with the new drug
and
economic
policies
costs are escalating and some essential
drugs
are
not always easily available.
There are also now
a
small number of low cost, essential drug
manufacturers.
However, only 13.47. of members in the study ( of
1,415)
purchase medicines from them.
CHAI has been
supporting
the
network
of lowcost drug
manufacturers
and
could
promote
them more actively among its members.
Helping
smaller
dispensaries,run
by
nurses,with
methods
of
planning
purchase
of drugs according
to
their
needs
could
be done by the CHE Department.
36.07. of
members
(509
out
of
1,415) presently
use
other
systems
of
medicine
(Herbal
Medicine,
Ayurveda,
Naturopathy,
Homeopathy etc) with or without allopathy. Thus a
major
shift
is
taking
place in
the
therapeutic
practices
requiring other forms of indigenous support systems.
d)
The
need
for
guidance
and
support,training
and
information
could
be
taken
together.
They
are
consistent with the reasons given by members for joining
CHAI.
It is important to keep in mind that 57. 17. (B08)
of
members
are health centres with less than
6
beds,
that 83.47. are in rural/tribal regions, and that a large
proportion of these are run by sister nurses.
The needs
of
this group for training, information and support
to
play their roles effectively, is great. In contradiction
the access of these groups to such services is
minimal.
The basic training for nurses, doctors, auxiliary
nurse
midwives,
etc are conducted
in
hospitals/institutions
that
do not prepare or equip personnel
adequately
for
the challenges in the field.
-119-
Therefore
meeting these needs emerges as the
most
key
role/strateg’y
of
work
-for CHAI in
the
-future.
The
section
on
-future thrusts identifies
specific
areas
that
members
feel
are important.
They
need
to
be
covered
by
the training and
information
services
of
CHAI.
Delphi
panelists
have
also
rated
continuing
education
for
members as the
highest
priority
among
strategies
of work to be adopted
by CHAI.
They
have
also identified areas to be covered by such
programmes.
This
is given under 'Important health problems
of
the
country and components of health care/health action that
need
to
be
promoted
by
CHAI'.
The
expectations
regarding
community
hea1 th,therapeutics
and
specific
activities/issues would be covered by the above.
e)
5.26
The
other expectations of members relate to
key
areas
concerning
of
the mechanisms of functioning
of
CHA I .
These include regional functioning,buiIding linkages and
cooperation,
the financial aspects of the
Association,
policy and planning and help in times of members needs.
Given
the large range of expectations, an assessment
will
have
to
be made by the Executives/Heads
of
Departments,
based
on discussions within their own departmental
teams,
as
to
how they could be internalized into
the
plans
of
action of the departments and of CHAI.
These
expectations will have to be linked with
the
ideas
given
by
members
and
Delphi
panelists
regarding
the
possible future policies thrustt/roles that CHAI could play
in the predicted future scenario (socio-economic-politicalhealth)
of the country.
Reports of the Regional
meetings
and members rating of ideas generated by the Delphi
Method
should
also be considered.
Since this is a complex
task,
the
later
stages
of
converting
them
into
plans
and
mechanisms
of actions could best be undertaken by a
small
group.
5.27
CHAI is already working on several of the areas
mentioned.
Other groups too are active in these areas.
Personnel from
CHAI
member
institutions
are
also
members
of
other
Associations/groups
and
make
use
of
their
facilities.
Resources of other groups could be utilised through further
col laboration.
-120-
For
instance
the major expectation of
members
regarding
need
for
guidance and support, training
and
information
could be addressed throughi
a)
b)
c>
d)
e)
f)
g)
h)
i)
CHAI
Christian Medical Association of India, New Delhi and
their
member
institutions,
including
Christian
Medical
College,
Vellore and
Ludhiana,
and
Miraj
Medical Centre.
Voluntary Health Association of India, New Delhi, and
its State level branches.
St.John's Medical College and Hospital, Bangalore.
The
member
training
institutions
for
nurses
and
allied health professionals.
The
large
group
of
alternative
community
health
trainers
of middle level health workers.
There
are
fifteen major groups and other smaller groups.
Other
specialized resource groups in the
voluntary/
quasi-government sector.
Government
institutions
and
personnel
including
medical colleges, nursing schools,District and
Taluk
level facilities and Primary Health Centres.
Professional
Associations, like the
Trained
Nurses
Association
of
India, Indian
Medical
Association,
Indian Hospital Association etc.
CHAI
could
have
a
unit
(
the
Continuing
Medical
Education
Unit) that could
undertake ongoing
liaison
to
collaborate
in
training/learning
activities
that
are
developed
to
serve the need of
different
categories
of
health
personnel in member institutions.
Upgradation
of
the
professional knowledge and skills of health
personnel
would
be the goal.
The
existing faci1ities/resources
in
the country could be utilised,
particularly in the area of
curative
medicine
which is a major
activity
of
several
members.
However, CHAI needs to focus only on those member
institutions who are not reached by or who cannot avail
of
available
facilities.
For instance, the
nurse
sisters
working
alone in small 0-6 bed health centres in
remote
rural/tribal areas find it difficult to close their centres
and
also to pay for courses/trave1 etc.
They may need
to
be
reached
by
distance education
methods.
The
course
design
would have to be broad covering curative
medicine,
including simple diagnostic methods, rational therapeutics,
indigenous
alternative
systems and
methods
of
healing;
community
health,
management of
health
centres;
social
analysis;
community
development,community
organization;
basic legal literacy concerning medio-social issues etc.
-121-
The
cell/unit
could also possibly be part
of
a
working
group
for
evolving
methodologies to
improve
the
basic
training
of
religious
sister
nurses
to
make
it
more
. relevant
to
the needs of the situation in which
most
of
these
sisters
have
to
function
in
their
professional
capacity.
Field
visits and
several
discussions
during
regional
meetings
indicate that many centres are
run
by
nurses who may have been trained anytime during the past 30
years.
They need a lot of support and training inputs
on
the topics mentioned above.
5.28
CHAI
would also have to make a greater effort in
training
and
in
promotion
of
newer areas
/
areas
of
priority
according
to its goals and objectives and in
areas
which
need
to
be
developed further
based
on
the
experience
already
gained.
This would be in the areas
of
community
health according to CHAI's vision, family welfare,
womens'
health,
pastoral
care
and
medical
ethics,
alternative
systems
of medicine, mental health, wholistic
health
and
disability.
Training modules to equip personnel to initiate and sustain
grass-root level work have to be developed and used.
The
need
for developing and publishing
health
education
material, particularly in Indian languages had been raised.
Hindi could be a starting point.
Responding
to
requests
for
financial
assistance,
and
material
assistance (for medicines/ equipment
etc)
would
need to be done with discernment.
The focus should be only
on small/ remote health centres.
Infact the overall
shift
should be away from equipping buildings and
infrastructure
and towards equipping personnel with knowledge, skills
and
attitudes
so
that they in turn could
enable
people
and
communities among whom they work.
5.29
Members
views
regarding
the
future
thrusts
of
the
Association
have
also
emerged
clearly.
They
have
identified
priority areas of focus for CHAI in
the
1990s
and beyond. There is a resonance between ideas suggested by
them and by the Delphi panelists.
They are broadly in
the
areas of rural and community health.
a)
Points relating to rural and community health
have been
also
raised as highest priority by Delphi panelists
as
components of health care/health action that need to be
-122-
promoted by 'CHAI.
This was intuitively or prophetically
determined way back in 1969 at a meeting in Bangalore of
health professionals from the voluntary sector.
It
was
introduced
as
an
objective of CHAI
in
1978
and
as
priority number one in its ten point programme in
1983.
This
relates a lot to the work of the Community
Health
Department.
However the number of member
institutions
reached
by training programnmes of the CHD is very
low
as has been mentioned earlier.
b)
There
is also much scope for the Media Unit to
produce
material
for Health education and Education for
Health
in
English, the national and major regional
languages.
Slides
and videos are powerful means that can
be
used
where
slide projectors and VCR's are available.
These
are
useful audiovisual aids during training
programmes
for health personnel from member institutions which
are
conducted
in
centres
which
usually
have
these
faci1ities.
However,
given the lack of even basic facilities
in
a
large proportion of members, training and utilisation of
traditional and low cost communication methods would
be
able
to
be used by a
larger
number,especia11y
those
working
in areas of greater need.
Posters and
use
of
pictorial
forms for children and those unable
to
read
and write also still play a role.
c)
There
is
similarly much scope
for
the
Documentation
Department
to respond to information needs
for
health
action
by
members.
In
this
context
it
must
be
remembered that about fifty per cent of CHAI members
do
not
get
the
Health
Action
magazine
presently.
Supporting the formation of Regional/State Documentation
Units
(
and
perhaps one or two Diocesan
Units
as
a
trial)
could
be considered in collaboration
with
the
Regional
Units. Other health resource
centres
already
exists,
for
example
the Foundation
for
Research
in
Community Health, (FRCH) Bombay, Centre for Health
Care
Research
and
Education
(CHORE),
Rajagiri,
Kerala,
Community
Health Cell, Bangalore etc.
Initiatives
for
new
Documentation Units could be in regions where
such
centres do not exist.
Members could also be
encouraged
to utilise the existing centres more. Regional
language
documentation
and
information is
also
important
and
could be undertaken by Regiona1/State Units.
-123-
d)
5.30
a)
It
could
be
considered if a separate
unit
could
be
formed to w.ork on the spiritual dimension* of health and
wholistic health.
A majority of members have
expressed
the
need for a unit on medical ethics.
Pastoral
Care
Program
was also need to be continued.
To
start
with
these could be covered by one overall unit, which
could
gradually
grow.
Modalities of the what, how
and
who
need to be worked out.
IN SUMMARY SN OVERVIEW OF THE 1
* levels of interaction with CHAI,
» participation in its activities, and
♦ utilisation of services by members and their analysis by
region,
size,
location
and
State
is
given
in
the
following tables.
-124-
Table 40.
Overal1 levels e± inter«ction/p«rticioat ion/utlli»etion fey.
members of different services #nd activities e£ CHAI
during the past five years.
1.
Visits by staff/others
-
2.
Receipt of Circulars
- 97.37.
(396)
3.
Participation in special
training programmes (Continuing
Medical Education, Spiritual
Growth, Pastoral Care,
Diocesan and Regional level)
- 25.17.
(102)
4.
Annual
- 32.47.
(132)
5.
CMMB gift medicines/
consignments
- 53.37.
(127)
6.
Discretionary Fund
- 27.57.
(112)
7.
Project Proposals
(to funding agencies)
-
9.67.
(39)
8.
Community Health Department
(all training programmes)
-
8.67.
(35)
9.
Receipt of Health Action
in 1908, 1989, 1990
- 92.97.
(378)
Subscription to Health
Action (1991)
- 66.67.
(271)
Receipt of publications
sent free by CHAI
—
10.
11.
Convention
Purchasing Service
12.
Central
13.
Participation
in
fund
raising
13.07.
(56)
in
5 years
1991
13.07. whenever sent
- 24.67. (1,100) any
time during the past
- 28.07.
For
an
Association of its nature,
these
services/activities
not
mentioned,
form
an
1 ist.
(114)
and
other
impressive
There
is
further
scope
for
increased
outreach
to/
utilisation
by
members
of the services/ training by
the
Central Purchasing Services, Community
Health
Department
and
other
training
programmes
(Continuing
Medical
Education,
Spiritual
Growth
through
Clinical
Practice,
pastoral
Care, Management and Diocesan and Regional
Level
Programmes.)
-125-
b) The overview analysis of utilization of services
size and location is given below.
Table 41
by region,
utilisation of different services of CH6I analysed by cegiau size
and location nf aeaizer institutions
Urban
■Rural
Tribal
28.4%
33.9%
10.5%
16.9%
29.4%
36.0%
43.7%
27.4%
35.6%
37.2%
24.1%
49.1%
39.1%
32.8%
29.4%
74.3%
64.6%
64.9%
71.3%
77.3%
62.3%
77.9%
21.9%
29.4%
20.1%
42.4%
50.0%
24.5%
13.8%
64.2%
53.7%
52.8%
64.4%
56.7%
56.3%
58.7%
30.3%
31.0%
36.4%
24.8%
24.6%
30.9%
36.8%
9.6%
9.1%
10.1%
7.6%
7.9%
7.1%
19.3%
26.9%
29.0%
21.6%
41.3%
34.8%
29.4%
17.6%
Less than 6 Dore than 7
bed insti- bed institutions
tutions
Services of the
different
departments
Poorer
■ Health
Status
Better
Health
Status
1.Visits by Cmi
Staff/others
2.Participation in
programmes (Con
tinuing Ftedical
Education,
Spiritual Growth,
Pastoral Care,
Diocesan and
Regional)
3.Annual Conventions
4.Heal th Action
(1991)
5.Central Purchasing Service
(CPS)
6.CHIB medicines/
consignments
7.Discretionary
Fund
8.Community Health
Department (CHD)
9.Participating in
Fund Raising
13.1%
21.5%
9.4%
27.2%
33.5%
24.4%
CbLBl Points 1, 2, 3, 6, 7, 8, and 9 refer to a five year period
Point 4 refers only to 1991, and
Point 5 to the time since CFS started functioning
-126-
The
subscription to Health Action is more or
less
evenly
distributed
and
so
is
the
distribution
of
CMMB
consignments.
The
Discretionary
Fund is
used
more
by
smaller and tribal area based and rural institutions.
The
training
programmes o-f the CHD are also utilised
slightly
more by smaller institutions and more by tribal area
based
institutions.
Visits by CHAI staff are also more
frequent
in areas where health status is poor.
On
the
other hand, visits are more to the
larger,
urban
institutions.
Participation in training
programmes
-from
larger, urban institutions situated in regions with
better
health status.
The utilisation o-f CPS has the same pattern
and so does the participation in -fund raising.
The
number o-f activities and services o-f
the
Association
are -fairly large and continuously growing.
Changes and new
thrusts are already occuring and developing in the areas of
social
need
and
relevance.
These
can
be
further
strengthened and expanded through:
♦ regional, State and diocesan level units;
* improved
functioning
at the central
office
with
enhance
capacities
in
the
area
of
training,
networking
and
collaborative work with
the
many
resources
among
members,
in
the
Church
and
voluntary sector in the country;
* greater focus and interaction with members
>
An
overview of the Statewise pattern of utilisation
services is given in the next table.
-127-
of
CHAI
Table 42.
Statewise pattern of utilisation Of (KAI services
State
Visits by
Cmi staff/
others
Partici
pation in
conventions
1.Andhra Pradesh
2.Assam
3.Bihar
4.Goa
5.GuJarat
6.Haryana
7.Karnataka
8.Ke-ala
9.Madhya Pradesh
10.(Maharashtra
11.Manipur
12.Meghalaya
13.Mizoram
14. Nagaland
15.Orissa
16.Punjab
17.Rajasthan
18.Tamilnadu
19.Tripura
20.Uttar Pradesh
21.West Bengal
6
4
2
3
14
8
—
1
—
2
—
8
1
7
0
20
1
6
1
2
8
31
5
6
1
0
—
3
6
1
1
23
2
8
4
34
4
21
o
10
3
22
42
24
13
2
10
—
5
12
2
5
43
1
11
4
19
4
1
4
1
9
25
8
2
1
1
2
2
1
—
15
56
132
271
Total
Health
Use of
Action
CPS
subs
cription
Partici
pation in
CHD programs
Functioning
members in
20Z Sample
6
2
5
-
16
1
6
1
3
2
9
15
15
4
2
5
1
1
5
1
18
2
3
2
2
1
3
4
4
1
1
2
1
1
2
3
1
1
-
45
7
29
5
11
3
31
80
34
18
3
11
2
5
14
2
7
70
2
18
10
100
112
35
407
-
A cosparision erf the utilisation/participatiori by the four
Southern States (Kerala, Karnataka, Tamilnadu and Andhra
Pradesh) and the four Central States (Bihar,
Madhya
Pradesh, Rajasthan and Uttar Pradesh) has been done and is
given overleaf.
-128-
Use of
Discre
tionary
Fund
Table 43.
Comparision of util isation/participatjon in CHAI
activities between Southern and Centra 1 States
4 Southern
States
226 (55.57.)
CHAI activity/
Service
4 Central
States
88 (21.67.)
Total
participation
1.
Visits
by CHAI
Staff/others
31
( 55.37.)
19
( 33.97. >
56
2.
Participation
in conventions
82
(62.17.)
20
(15.17.)
132
3.
Subscription to
Health Action
141
(52.07.)
61
(22.57.)
271
4.
Use of CPS
68
(68.07.)
17
(17.07.)
100
5.
Use of Discre
tionary Fund
58
(5.187.)
24
(21.47.)
112
6.
Participation
CHD training
programs
16
(45.77.)
7
( 20.07.)
35
in
There
is a some disproportion viz., a larger
number
-from
the
-four Southern States, in comparision to their
overall
number
and
percentages
in
the
sample,
participate
in
conventions
and
use CPS.
This would have some impact
in
the
election
of Executive Board members.
The
number
of
larger institutions is more in the South and hence also the
use
of CPS.
The utilisation of other services by the
two
State
groupings
is roughly proportional
to
the
number/
percentage of members in these States respectively.
-129-
IN CONCLUSIONS
In
conclusion
this report gives
detailed
re-flections
and
■feedback
-from
members on CHAI and its
functions.
For
its
various
services and activities this relates to the
past
5
years
in
most
cases.
Information
about
the
involvement,interaction,
participation
in
activities
and
utilisation of services is available.
Members
expectations
from
CHAI, their suggestions regarding various
aspects
and
views
regarding
possible
future
roles
have
also
been
articulated.
Follow
up
has already been initiated through
regional
and
profesional
group
meetings.
This emphasizes
the
process
dimensions
of this entire exercise of evaluative
study
and
reflection.
We
are confident that the
equally
important
component
of continued action that has also
been
initiated
will evolve.
We would like to end by expressing our gratitude to CHAI
for
giving
us this opportunity to conduct this
research
study.
We also remember the words of Sir. A.Bradford Hill,
" All
scientific
work
is
imcomplete
whether
it
be
observational or experimental.
All scientific work is liable
to
be upset or modified by advancing knowledge.
That
does
not
confer
upon
us a freedom to ignore
the
knowledge
we
already
have
or to postpone the action that it
appears
to
demand at a given time."
-130-
6.
BIBLIOGRAPHY
1.
Young, P.V., 1988,
Scientific Social Surveys and Research, Fourth Edition,
Prentice Hall of India, Pvt Ltd, New Delhi.
2.
Ramachandran, P., and Coutinho, M.A.,1989,
Towards
Integrated
Human
DevelopmentReport
India,Silver
Jubilee Research Project, Caritas
Centre, Ashok Place, New Delhi-110 001.
3.
McGilvray, J.C., 1981,
The Quest for Health and Wholeness,
German Institute for Medical Mission,
Tubingen.
4.
Panachikavayali1, T.S., OFM.Cap., 1989,
Healing Presence of the Church,
Good Tidings Publications, Bangalore 560 054.
5.
CHAI Golden Jubilee Evaluation Study, 1991-92,
A note on aims, objectives and methodology,
Community Health Cell, Bangalore, October 1991.
-131-
on
Caritas
India,
CBCI
7.
APPENDIX
List pf background papers prepared -for
< the training pf) investigators.
1.
CHAI Golden Jubilee Evaluation S~.idy, 1991-92,
A note on aims, objectives and methodology.
2.
The interview technique - a
3.
A note on medical
4.
A brief
5.
A brief overview of
1980 onwards.
6.
A note on CHAI
membership.
7.
Organizational
structure of CHAI.
8.
What is Health.
(Extract from a report of a study conducted by the Christian
Medical
Commission
of the World Council of
Churches.
The
report
is titled "Healing and Wholeness- The Churches
Role
in Hea1 th" ) .
terms used
history of CHAI
brief overview.
in
the interview schedule.
(Part-I).
the thrusts and activities of CHAI
-132-
from
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