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PARTICIPATORY STUDY—REFLECTION ON KSSS-CHDP
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This is a consolidation of the interactions between the
KSSS-CHDP team, the CHC team and the Study team spread
f
over the past two years, recorded under the following
heads :
1) The Background and Process
2) Appendices of
a) Reports generated during the process and
b) Bibliography of KSSS-CHDP reports / records
(
(
in the process.
THE BACKGROUND AND PROCESS
A letter dated 26.01.89 from the Co-ordinator KSSS-CHDP
requested the CHC to
a) help in evaluation of their work, and
b) help them "look ahead" after 16 years of
efforts in the field.
The CHC proposed a brain-storming to evolve a process with
the CHDP team about the idea, methodology and type of
evaluation. It also clarified the concept of ’’participatory",
as participants of a common process and not as outside
consultants or experts.
A study of all the past evaluations
was proposed to start with and build-up on the past.
Observations :
There has been a variance in the understanding of the
with the CHC proposal despite repeated clarifications.
The KSSS-CHDP has been expecting an "evaluation” even quite
ksss-CHDP
late in the process.
At a meeting of the support group on 8.2.90 discussing the
KSSS-CHDP ’evaluation1, it was an unanimous decision that
the focus of ir*- rest was on the project, its team members
and the people of the area, and not on the needs of any
• •2
2.
funding agency. Hence/ the terms •evaluation* was sought
to be changed to •Participatory-Study-Reflection” on the
KSSS-CHDP.
The Process involved/
a) Brain-storming sessions at CHC
b) Reports/minutes of these sessions and the reactions of
the KSSS-CHDP personnel and grass-root workers at the
MMs to these
c) A visit of the ’study-team’ consisting of Dr. V. Benjamin/
Ms. Bhanumathy Vasudevan and Dr. Shirdi Prasad Tekur from
16th to 21st April 1990.
d) Reports of the visit prepared at various stages of the
process
and
e) A final meeting of the KSSS-CHDP team with the study
team / CHC team at Bangalore on 3rd January 1991.
The process then started with a brain-storming session of the
KSSS-CHDP and CHC team on 29th and 30th May 1989.
The session evolved a set of questions looking at the broad
aspects of KSSS—CHDP/ mainly/
- ites long and short-term goals
- internal democratic processes in the KSSS-CHDP
- the issue of CRS food and its effects on their working/
- the Staff, C.O.S/ Village level workers/ Mahalir mandrams
and their dynamics
- the training needs and
- record keeping
For details - Appendix •A’
______ _____ <^3
Note : Through out the report/ the following abbreviations have
been used.
M.M. - Mahalir Mandrams
C.O. - Community Organisers.
J.
The KSSS-CHDP team initiated a process of gathering views and
opinions of the KSSS-CHDP staff, the Executive Committee of
the MM Staff, as a follow-up of this session.
The questionnaire addressed 4 questions* viz..
1) Is there a need for evaluation?
2) Why there is a need?
3) Whose need is it?
4) Which aspects of the programme needs evaluation?
A non-edited version of the replies to the questionnaire was
sent to CHC, which was not clear about the needs.
For details - Appendix ’B’
In a subsequent interaction, the ideas expressed earlier were
clarified, and suggested areas of "evaluation1 to start with
were sent to CHC.
They were.
- the specific health services in relation to the whole
programme.
- the evolution of concepts in community health and how far
an integrated approach was reached.
- regarding personnel; the understanding of community health.
- how far is the goal of social health reached, related to the
understanding of the workers and the people (beneficiaries
and members).
- a critical constructive assessment of these aspects and any
other aspects needed.
For details - Appendix ’C*
Meanwhile, a second brain-storming session at CHC on 18th July 1989
was held after perusing KSSS-CHDP reports of the past, produced
a collation of ideas, views, reactions and questions which were
transmitted to KSSS-CHDP for reactions.
..4
4.
The issues highlighted were.
1) The project since inception, the original vision, its
evolution, directions, reasons thereof and the programmes
this was translated into. A plea for assessment of
interactions with other KSSS and non KSSS groups, the
resources available and why a focus on social health was
also made.
2) The components of the project were tackled under the heads
of
a) personnel and their understanding / influence on
KSSS-CHDP.
b) Mahalir mandrams, composition, expectations,
participation in and activity directed towards
the KSSS-CHDP goals.
c) Relevance, need and utilization of Documents and
Records.
d) CRS food and its impact.
e) Savings programme, other programmes and
f) Exploring of funding avenues.
Comment :
The ideas that emerged at this session were shelved by the KSSS-CHDP
and the suggestions from the earlier interactions was projected as
a need.
For details - Appendix ’D1
Brain-Storming session - 20th October 1989
At this stage it was suggested by the CHC team that the KSSS-CHDP
should form a committee from their staff with enough powers to
look into all matters raised by the above questionnaire. The
steps they would follow would be prioritization from the list,
assessment and mobilization of resources and fixing a time frame.
• •5
5.
Other suggestions given were, consolidation of all internal
evaluation reports at all levels, and considering the insecure
arrangement of CRS food supplements urgently not necessarily
linked to a larger evaluation effort.
If, at this stage, external assistance was required to look
into specified areas, other resource groups / persons could
be contacted.
It was now understood that the task was primarily their own,
with CHC acting only as a facilitator.
For details * Appendix •£•
At the subsequent request for a further involvement, a study
team consisting of Dr. V. Benjamin, Ms. Bhanumathy Vasudevan
and Dr. Shirdi Prasad Tekur was formed, with the others who
interacted so far supporting the effort in brain-storming
and background work.
For details - Appendix ’F1
The support group and study team met on 8.2.90 at CHC and
some important points which emerged were.
- the study to be focussed on needs of the people and project not the interest of funding agencies.
- discomfort with the term •evaluation1, which could be
modified to •participatory-study-reflection1.
- need for looking at CHDP’s goals for a start.
- perusal of all reports / studies of KSSS-CHDP by the study
team.
a field visit to be finalised by the study team after
Dr. V. Benjamin’s initial visit.
Further Brain-storming meets of the study-team and support
group with other resourcers were held at CHC, and an outline
of the aspects of KSSS-CHDP needing study was compiled.
For details - Appendix •Gt
• •6
6.
A meeting of the support team on 28th February 1990 looked into
the areas of KSSS-CHDP which needed studying.
For details - Appendix tHt
Dr. V. Benjamin paid a short visit to KSSS-CHDP and met Sr. Leive,
Fr< James, and other members of the KSSS-CHDP. Specific areas to
be looked into were divided between the three members of the study
team visiting KSSS-CHDP.
For details — Appendix ’I1
This was followed by a visit to KSSS-CHDP between 16th to 2xsf^
April 1990, by the study-team consisting of Dr. V. Benjamin,
Ms. Bhanumathy Vasudevan and Dr. Shirdi Prasad Tekur.
During the five days at KSSS-CHDP, Nagercoil, field visits were
made at random to village health centres, keeping in mind that
coverage of coastal, plain and hill regions was fulfilled. In
addition, sessions of interactions with the COs, Central Committee,
Doctors, MM Staff as well as members, was organised. Meetings of
MMs were also attended, a couple of sessions of training programme
was attended by the team members, records / reports in the office
were perused and library visited.
The outcome of this visit were reports on the Health Services
and Social dimensions of the KSSS—CHDP by Dr. Shirdi Prasad
Tekur and Ms. Bhanumathy Vasudevan. Dr. V* Benjamin deferred
his report till there was a reaction to the above from KSSS-CHDP
and also since some changes were on, to allow them to stabilize.
The report on the Health Services dimension initially records
the concepts and understanding of KSSS-CHDP and its origins
among the staff and MM members. The observations are then
recorded — at the village level / the Doctor and his role, and
at the central committee, training and co-ordination. The
strengths, weaknesses and opportunities are explored in these
areas.
For details - Appendix •J*
• •7
1.
The social dimension has been explored under the headings, strengths,
blocks, opportunities followed by recommendations.
For details - Appendix ’K*
A feed-back to these reports with the evolving changes at KSSS-CHDP
was sent to CHC,
for details - Appendix ’L1
The reflections of Dr. V. Benjamin based on his visits, the earlier
reports and response of KSSS-CHDP to these reports was compiled and
sent, dated 30.11.90.
For details - Appendix ’M1
Following this, a report of the evolution of CHOP with details of
decentralization was compiled and sent to CHC dated 13.12.90, This
could form part of the historical study.
for details - Appendix 1N*
Three members from the KSSS-CHDP then visited Bangalore and interacted
on all the earlier reports on 02/03 January 1991. They sent back
their understanding of the interactions at CHC, Bangalore.
For details - Appendix ’O*
A compilation of all interactions so far was suggested to form this
Participatory-Study reflection report.
It is upto the KSSS-CHDP now, to look at the various ideas emerging
in this process and utilize them in their evolution towards social
health.
Place
Date
:
Bangalore,
for STUDY TEAM,
» 0^
mi: •5 PRASAD TEKUR,
), -f
bibliography of ksss-chdp
reports
and records utilized
in the study.
- Copies with KSSS-CHOP and CMC.
REPORTS FROm COWUNITY HEALTH & DEUELFIPWENT PROJECT (CHOP)
OF KOTTflR
SOCIAL SERVICE SOCIETY (KSSS)
A List of Documents uith CHC
■)
1. KSSS Annual Report, 1974
» /3
2. KSSS Annual Report 1976-77
3. A report on the CHOP of KSSS, Nagercoil, Tamilnadu by WHO/UNICEF
Joint Committee on Health Policy - Primary Health Care, 1976
4. KSSS - Development at the grassroots : The organisational imperative
by John Osgood Field, The Nutrition Institute, Tufts University,USA
1978-79 (KSSS Publication)
So KSSS — An Approach to Community Health, 1981 (KSSS Publication)
6. The evolution of a Community Health Programme from the womens'
point of view,” by Nalini Nayak 1987
7« Longitudinal Cohort Study of malnutrition, morbidity and mortality
interaction of children 0—2 years — a study proposal by
Dr Vanaja Ramprasad, Dr P M Mulkarni, Dr S Carbin Joseph,
Dp J John Christdas, V Gaspar Mary and Sr S Christy.
8. Report uith particulars of the decentralisation of the CHOP — 1985
9C KSSS-CHDP Annual Report 1985
10. KSSS-CHDP Annual Report 1986
11o KSSS-CHDP Annual Report 1987
12® KSSS-CHDP Annual Report 1988
- *
Syllabus for Women Animators Training
-.
1989
14. Syllabus for Women Animator cum
cum Technical Training - 1986 / 1988
13.
15. Syllabus - Health Guide Training Course
16. Syllabus - Four month training for Community Health Educators
17. Syllabus - Five month training course for Community Health Workers
18. CHOP - Health returns proforma
19. Schedule for Training Programmes, Seminars and Meetings for 1990.
/
bl /■
‘A;
2
•t
I
APPENDIX
CHDP Evaluation
/
Long term goal : Social Health for social change
Short terra goal : Education, people*s participation mobilization
(Health programmes - Preventive, social
Analysis, Meetings
r
Semrinars, Camps, Local
it
1
issues etc)
Have we achieved the policy of short term goal*
Are we in the
line of our long term goals?
2a It not why?
Is so, where to go from here?
3. Present reality of CHDPr What prevents CHDP from chaieving
democracy?
4o Is
there a need tor a * Central Committee * for Community
Health development programme?
If so what will be the role ot such a committee to promote
democracy and participation of the people at all levels?
5
CHDP’s policy is to become a movement for social change, but
in reality CHDP remains a Community Health development programme
Why?
6.
We understand that CRS supplementary food has been a great in
centive and a means to organise women of the community.
But
the same CRS has become a block for growing awareness among the
community.
Often CHDP’S involvement appears as if it is for the
maintenance of the staff, and the staff are depending more than
the community on the CRS, very much on CRS food.
In the absence
of the CRS food, staff are affected more than the community.
What alternative or remedy and strategy can be worked out?
.•2.ee
/
\
•4
5
1
.
2 ••
con:<u:nTY ohisers
of the role of community organisers
ne need an evaluation
feel they are functioning as
in the CHPP. At present we
supervisors and inspectors.
i.
VILLAGE LEVEL
1.
J
2O
J
3.
with and for the felt need of
Health Team: Is it working
th> activities that are
the community/ or just implementing
decided by the CHDF Committees?
that exist between the community
of
relationship
The type
; of the community and availability
and the staff (acceptance
the confi
Have the staff gained
communi
ty
)
of staff to the
dence of the people?
and the Health team aware of the process
7\re the community
in community es;-ecially tfahila Mandrams
that are taking place
and CHPL, so on.
Staff enable them
Does the Training given by CHDI to the
f the community.
to identify the felt n^eds/procc.• e;
4
f:
Mandram L.evel
Manila Mandram consists of representatives of the
mov. far the Pahila I'andram are functioning vith
erroc
1.
to identify, analyse and
and to
to decide
decide and make policy for the
needs of‘the community etc
What nrevents
prevents them lor being
democratic?
2.
3.
4.
Se need to know the process
that we have taken up,
study ror certain
rojects
■ Training given to the village staff hy C>I)F allow
Poes the
the community ana work with tae co. rt. ity
r.hem to oe one a. >ong
towards * e lone term goal?
Relevance ofc- reco'ft keeping at all levels of CHDP.
I
■
-t
!
APPENDIX
• B*
KtS.S.S. COMMUNITY HEALTH DEVELOPMENT PROGRAMME
Views and oginions^re^arding^C^H^D^P^^Evaluation:
Collected from:
- the Executive Committee members of Mahalir Mandrams
the staff of
Mahalir
Mandrams
I
C.H.DoP. staff
The method used:
The Community Organisers were communicated of the need for
collecting views and opinions. They in turn contacted each Mahalii
Mandram executive committee and its staff at each village and
communicated and collected the views. Finally it was consolidated
at CaH.D.P. Centre.
20% of the women
have not understood the point
10% of the Health team
- There should be a different method used for clear communication.
The questionnaire given by C.H.D.P. Central Committee for the
collection of opinion as follows:
1- Is there a need for Evaluation ?
2- Why there is a need ?
3- Whose need is it ?
4- Which aspect of the programme needs evaluation ?
Quest ions from Community Organisers:
1. C.H.D.P. Training who’s need ?
2. Cohort is to be co-ordinated by Central Committee ?
3. Is it possible to have CRS and Democratic Mahilar Mandrams ?
4. How long can we work in the area where other organisations is
working ?
r
2
5. (five community organisers) Evaluation not needed, because
there is a regular evaluation held periodically.
6. Have the people become aware of the long term goal of CHDP/N.No
7o To critically evaluate our yearly evaluation,.
Views and Opinions of M«,McWpmen
Reasons tor Evaluation
Whose Need
Aspects for Evaluation
-To know the strength and
C.H.D.Po activities
staff.
- People’s participation
limitation of C.H.D.P.
mahalir Mandrams.
- To know whether the
benefits reaches to the
needy
in villagelevel activities
M.M. Social Health partici- Staff of Mahalir
Mandrams
- People’s need
- To assess the need of the
people to plan a better
programme, thus develop
CoH.D.PoCentre and
people C.H.D.P. Staff
- pation of people.
- Training of C.H.D.P.
- C.H.D.P. activities
the method used to conduct
seminars and meetings and
women *s activities.
—fche women’s need and
All the aspects. Local
- For the total development
mothers.
of CHDP
staff and women of M.M,, is- ues and the ways people
are mobilised.
- To find the ways to reach
the long term goal.
C.H.D.P. staff. Central
- To find out the Democracy
Committee, M.No ExecuHome visit
present in existing M.M.s
tive committee.
• M.
C R S activities
- 17 years activities and its Staff.
M.M.activities.
need for continuation.
- For more radical commitment
- Those in authority need.
All the staff.
"
generation
- Need to evaluate the activities
C.H.D.P. Co-ordination
- Ways that are used to
generate awareness among
womeno
and commitment of all the staff
since C.H.D.P asked.
- Role of Community Organi
sers.
- Joint work of MoMewithin
M.M. General body and exe
cutive.
..c.3o..o
...
3
.e.
Views and opinion of M.M. staff
Reasons for Evaluation
— Know C.H.D.P.’s deve
lopment
Find the ways for job
Whose need
Which aspect needs evaluation
- C.H.D.P. staff
- Health activities
- M.MoStaff
- Beneficiaries
security
- To have more knowledge of
health
- To know who are the most
affected mpeople.
- Fair price shop
- Training of CHDP
- CRS & M.M
- Doctors
- Relationship between M.M. &
C.H.D.P. staff & women.
- Community organisers
M.M. Women
- To plan new policy
- To know whether we are
-
reaching our motto”
social Health for
- Community Organisers
Social Change”
- MoM.Women and staff
- To find out an alternative
for CRS
- To know CHOP’S historical
evaluation
- Accounts
activities- seminars
and meetings
- Implementation of CHDP
- Relationship between M.M.
staff and beneficiaries.
- People’s need
- C.H.D.P.
- To know the present acti
vities
M.M. Staff.
All the
aspects.
- Income generation.
- To know the present democratic
function and develop it.
-C.H.D.P. adminis- To know whether our existing
tration.
short term goal is towards
the long term goal.
- Executive committee
formation.
- CRS activities
- Relationships :
•- To know the laternative for
CRS
■ To realize whether CRS has
enabled us for politicaliza
tion.
- C.H.D.P. & M.M.
- C.H.D.P. & M.M. Staff
- M.M.Staff and M.M.
CoH.D.P. staff & M.M.
To know the need for CHDP
Central Committee.
• «0 • @ 6 • •
•• 4
Views of C.HoD.p.
Reason for Evaluation
STAFF
Whose need
Aspects which needs
evaluation
• Role of Community
organiserso
Development of people
through our programme.
To know the opinion of people
about C.H.D.P. & m.M.
To know the role of train
ing Centre.
•
To know who is benefiting
staff, people.
- Training programme
- Health programme
- MoM.activities & women•s
participation
- Income generation
- Centre level activities
- C.H.D.P. is making policy
- M.M. Policy
- Evaluation.
i
. JL
\
APPENDIX
■c
CHOP,
Letter from _Christyx_Co-ordinator£_LML>
In continuation with the discussion we had with some of
your Health Cell members we are fully aware that the proposed
field of Evaluation are varied and include many aspects of our
services®
Me also see more and more the urgent need for an evaluation
and further guidance©
During this year the treands emerging are organisational work
among the women for strengthening the larger movements and secondly
to give importance to alternative training for women where resources
are still available or could be revived as
Construction work
- Roof water harvesting
- Rubber tapping
- Briquitte making
- Fish paste
- Bee keeping
- Carpentory
These all do not seem part
of a health programme, but seen from
the aspects of resource preservation and women1s employment they
should contribute to the integrated aspects of health
Me wanted to communicate this to inform you that all the same
time the direct health services and all other aspects of the programme
are at present very little related.
This is because of the attitude
- 2 -
of the two medical doctors with whom there is practically little
communication, therefore no
team work*
We are making all efforts to
improve this situation, but
we are convinced that'&n revaluation on these aspects is most
urgently needed*
We would suggest that, to start with you evaluate’
- The specific health services in relation to the whole
programme
— The evolution of concepts in community Health and how
far did we reach an integrated approach
- Regarding to personal: The understanding of community
Health
How far is the goal of social health reached, related to
theunderstanding of the workers and the people (beneficiaries and members)
II
A. critical constructive assessment would help us for further |
planning and work*
We do request you from your side to conduct
these evaluation
at the realiest©
Ofcojjrse it is left to you to include any aspect you feel
needed and we do thank you in anticipation for
your early and
favourable response*
)
appendix
1 D•
K.S.S.S. - C.H.D.P. - Evaluation Planning
This is a collation of ideas/ views/ reactions/ and questions
emerging out of - the 'brain-storming' session with the CHOP team,
- a study of the annual reports of CHOP with us, and
- individual as well as group reflections.
It is presented for convenience of reporting as.
The Project
II The Components of the Project
I
III Exploring avenues
I
The Project:
Since its inception in 1971/ the KSSS-CHDP has encompassed a wide
l extensive documentation
range of activities/ whose organisation and
The project's
for a project ot this magnitude is .remarkable indeed,
evaluate its various
deep commitment is expressed by the need to
Some actions
aspects at different points ot time in its evolution,
which could help in this evaluation are.
a) the original vision of the CHDP
the present stage with positive
b) the process of its evolution to
and negative aspects considered
c) the pattern of development to locate
- points where rapid expansion took place
- directions of expansion
- points of crisis and how it altered/weakened or strengthened
original commitments.
in Community Health over the years
d) the evolution of concepts
they weretranslated into
e) the long and short term goals and how
programms
’ends * or1 means * - are they
t) whether programmes were meant! *
leading towards planned or desired goals?
...2...
J
■I
.••2 ...
relationships with and the
2. A study of the interactions,
attitudes of CHOP towards
- other K.S.S.groups like the • various co-operativesgi and
other non-health related activities
- Governmental agencies. and
-other non K.S.S.S services organisations in the area, and
also in any other part of the country.
to Understand:
a) how much of their resources were available/ tapped/ utilised
b) i^J this can be quantified, and
interact with or underc) how these above agencies react to,
stand the work ot CHOP
3e
The activities of CHDP are predominantly oriented towards Social
health, with the physical and mental aspects of health given
lesser importance.
- Why ?
- any other studies/ data which might help in considering these
aspects ?
II
Components;
1. Personnel
Considering all personnel of the project from decision making level
to field staff, it would de relevant to look at the tollowing.
i) the understanding of community health toward KSSS-CHDP goals
ii) the proportion ot acitivity directly related to health
iii) how participatory within themselves and the ‘beneficiaries 1
are the decisions
how rlexible are the decisions made ?
E.g. Can 98 ditterent views from 98 different Mahila Mandrams
be accommodated.^?
z
4.
G.R.S. Food
- its impact on preventing malnutrition
- is it needed for the people?
- how consistent is it with KSSS- CHOP goals?
- have alternative Ibcal solutions been explored?
- hasit promoted ’dependence??
Savin^s^rogramme
5
fo CHOP outlay
- its magnitude in comparision
>
■ be tapped for Community Health work?
- can this resource
Any other^Prograrranes
6
- which have been s topped/dele ted and why ?.
- have National Programmes, tor e.g„ TB/ Leprosy/Immunization/
Malaria/ Fileria etc., been taken up before ?
- what is the scope for utilising available National Programmes
for health in KSSS- CHOP areas?
III Exgloration_Avenues
1. Funding:
Since funding by the Community is an essential fa tor tor CommuniV
development and independence of Health activity, the following
y
be considered :
* involvment
of dther Co-operatives etc with health activities
of KSSS-CHDP
* can the "25-raise scheme" which was successful earlier be
tried agatn for health?
2. Will more empbasis on physical
physical and
and mental health in addition to
social health be helpful towards CHOP goals?
certain activities and
<
step into other areas where more development is needed-without
3.
Can KSSS-CHDP be able to withdraw from
affecting the programme already initiated?
4. Can CHOP evolve a newer vision by incorporating the needs and
aspirations of the local
population.
5. Can criteria for admission to Mahilar Maddrams be enlarged to
encompass a larger number of people including non-beneficiearies.
6.
What is the scope tor 'Kutumba Mandrams' to enable men, women
and children to be involved in health together.
ill
III
APPENDIX
Community Health & Dovelopment Programme of Kottafc=Social Service Society
Summary of discussion held on 20th October 1989
between CHOP
team, consisting of Sr Christy, Ms SaMasam and Ms Ambrosia and
CHC team consisting of Gopinath, Mani and Shirdi at CHC office
-2£h2£21Jnd
CHC team had previously held a 'brainstorming' session with the
CHOP team, subsequent to this they circulated a questionnaire
among their team members and the Community they were serving to
develop a framework for an avaluation that they were intending
to undertake.
CHC.
A non edited summary of the responses was sent to
Discussion summary
CMC team requested the CHOP team to go over the events that took
place after the last meeting, as the reportviews and opinions
Dsgarding CHOP evaluation^ sent by them was confusing.
CHOP team narrated that on the basis of the discussion with CHC
the Central Committee of CHOP prepared a questionnaire to obtain
information/reaction from the various groups of people involved
in the project, namely Nahila Mandrams (MM) members, MM staff.
CHOP staff and Community Organisations,
were asked
The following questions
1. Is there a need for evaluation?
2. Why is there a need for evaluation?
3. Whose need is it?
4. Which aspect of the programme needs evaluation?
(This questionnaire did not take into account the report ’KSSS-CHDP
Evaluation Planning’ sent by CHC as it was
was received late)
The questions were discussed by Community Organisers who then
communicated them to the various groups of the project mentioned abfcve
....2
•E'
2
and brought back their responses. The non-edited summary of these
responses is the report ’vieus and opinions regarding CHOP evaluation’
Annexure.
To the first question - ’Is there a need for evaluation’, majority
felt there was a need. There were diverse responses to the
remaining three questions. These responses were read out and
clarified in thq4iiscussion, during which process some aspects
of the structure and functioning of the MMs and CHOP team also
became clear.
The CHC team pointed out that a large list of areas to be evaluated
has been suggested in these responses. The next step was for a
committee with enough powers to prioritize this list of areas to
be evaluated taking into account the resources. CHOP could mobilise
for an evaluation and the time duration during which the evaluation
sas to be completed.
?
Another suggestion was to consolidate the reports of evaluations
in the various subsectors made over the years and make decisions
on the basis of that, namely
1. yearly facilitation done by l*ls Nalini
2. C.O’s evaluation
3. Health Guides training ^valuation
It was also pointed out that some aspects that were brought out,
for example the insecurity related to possible stoppage of CRS food
assistance, needed to be looked into more urgently, without being
necessarily linked to a larger evaluation.
After these steps were taken if CHOP Committee felt external
assistance was needed in particular areas to be evaluated, they
were to communicate with Hani Kalliath of CHC or other resource
persons/group involved in CH support wotk in India.
Sr Christy of CHOP said at the end of the discussion that they now
understood evaluation in a different perspective, whereas initially
they had understood
perform c
that it was a talik that CHC will take over and
3
They now understood it is a task that was primarily their own with
CMC acting only as a facilitator. Hence the CHOP team would have
to sit together and reflect through their experience using questions
raised by CMC team as pointers and their own internal audit,
exploring and discovering new directions for the future.
APPEKDTX
' F'
10th Jan 1989.
KSSS » CHOP Evaluation
Discussion with Dr V.Benjamin at CHf
a minute
with
«n*”ed j°^e inv°i''ed • ^t would iik8 to work
Besides himaei? 9
U?uld 8uffice for the field visit,
are
, J*1® uould include Dr Shirdi Prasad of CHC. We
sciance1^1^ 1O°^i2? f°r 8 third Person - a women with a social
science background fluent in Tamil as KSSS is largely a womens
She9?.""”* J*?1 Nara*an contact Valli Seshan in this^egard.
H^aiir^hJ i?MrthfnJ in KS?r
already has 8everal comittments
next f.u
,er thB idea and contact us during the
k
days. She also knows a Dr Saraswathi (?) in Madras
“J0 ha» a good background for the sort of work? She is due to
be in Bangalore in the next week and may contact CHC.
2. A rprocess.
This
We
will
also
try
and
visit
Kottar and meet some of the Central team members for
discussions. Also Sr Lie.e and Fr James if possible, preliminary
contact
address in Trivandrum is - C/o. Hr. C Titus 43 “Tagore His
Gardens,
Trivandrum - 11. He will bewAti^g to Ms ftalini
11..1 and Kottar in
this regard.
iinr°rmal
4.
A meeting of the
2nd of Feb 1990,
the evaluation.
_brainstormingJ group will be held at CHC on the
FFriday
‘
at 10.00 am. to draw up a framework for
5. Dr Benjamin will be free between
the 4th
18th of
to work
between the
4th — 18th
of March
March to
work
intensively
on
Ct.!!., dlt.. .‘J:
for thr.e day.,
dates etc to be worked out by mutual consultation of
the team.
6. Thelma Narayan^written
to Sr Christy / Sr Lieve about these decisions for their reactions
..j and also asked for some reports (refer
letter)
7. Ue will also try and find (out if anybody currently in ISI was
involved with KSSS and try and meet'them.
8’ 2£dBal8omon the1??^8''^1^1^
®an9alore tin the 13th of January
ano also on the 22nd and 23rd of January and then on the 1st of
Y
February. He will return the MHO -KSSS report before the 13tt/
r
APPENDIX
•G*
CORHUNITY HEALTH CELL
Baungalore
u«te: 8->2-199G
Ksss-CHDP
EylyUon
Reetino of the support group on the JCSSS-GHDP evaluation
held on 2-2-90 at Community Health Cell - a minute
Those present at the mevtlng were Ur* Ve Senjamin* Valli Jeshan,
dhsnuraathy Vasudevan* Hani *aliath* Shirdi Prasad Tekur and Thelma-
Narayan*
Valli expressed her inability to participate in ths entire
study as she already had several committments during the coming
months*
She introduced to the group* 8anu* an applied social
scientist with training in Anthropology and Personnel Renagement
who baa baan working with
Govt* and NCC
on human raaourca development•
groups conducting workshops
She has also been involved in ths
evaluation of large health project in Karnataka*
There was a brief discussion about CHC and its activities v
CHzP and its functions and as to how
KSt.3 * CHOP ovaluaticn process*
we got involved with the
A background note regarding the
evaluation of the process during the past year has been circulated*
-ome important points that emerged during
the discussion ware:
a) The importance of keeping in mind in whose interest the study/
evaluation is being undertaken*
It was unanimously felt that
the focuse of interest was on the project* its teaw members
and the people of the area end not on ths needs of any funding
agency*
*•**?*
b)
There was a discussion ss to whether it should be csll.d
an •evaluation? People felt <mor. comfortable with the te®» !
‘participatory aaao^sment• (Perhaps ’Participatory studyroflection on CHOP’ would convey the meaning of the effort
being made )•
tiasicallyt we are getting involved in a
common eearoh with CHOP
reflecting on the experience ofthe
past 17 years of its existence, trying to understand th«
present situation as it prevails in the region and brain-
storming around what could be the future directions the
project could take. This process would be guided <»nd
structured
draw upon
by o rciontific spirit of enquiry which could
experiences and approaches from the field of
community haalth and social and behavioral sciences®
c)
A* B Btarting
point wo jnould n»-..d to look at the goals of
Th. long t.r» goal of "social health for social
change'1 is very broad.
U® would n«:d to clarify
was / le meant by social health —
as well as by us.
whet
tcth by the Crh f' group
Whnt would bs ths indic'itorc of social
that one would try to look for both quantitative
limitations of thcr
and aualit<tlvet keeping in mind the
The goup would collect inforeation/p.^pvr^ on thia
health
sama*
area,
a
’da would also try and meet
r.
araewati frore Madras,
friend of Valli’s, whose research interact is in this
This would possibly b« on the 12th or 13th ..f f eb.
area •
^~I3O
19-^7
commumpy HEaith Cc(x
32b, V Main, I Block
^orambngala
Bangalore-560034
India
<
.*•>
■
■
■
■
■
‘
'■
' ‘API ■:
d)
A nwbsr of annual reports/studies of CHDfWCSS> are available
at CHC for the mobers of the group to read,
After going
through these, each of us would write down our thoughts about
the objectives and methodology of thia participatory aseesoesnte
We will mtioain on Rondav. the 12th of February at 10 >00**
it CHp ta werfc en dotaile of tbe fraeewoyk that w* art going
■■
to UM*
'
•^•■^4..^.
....
uasod with the CHDo group when
Thia will then ba dig^u
-
,..
Dr. Benjamin visits Kottar for preliminary discussioni on
23rd/ 24th of Februsry.
•' U"'
•)
‘
'
‘
V
’
■■
\7
The following throe person would be going for ths fisld visit
Dr. Shirdi Prasad Tekur and Rs.Bhanuaathy-
Or. V* Bsnjaain,
Vasudovan.
Dates convenient to ell three wore in the Asst
week of March.
Ue or* to contact CHOP to find out if these
dato* ar* suitable
for thoa.
It was also considered whether
a second visit in April would be necessary^
This will b*
finalised on th* 12th of February.
r
f)
At CHDP'o request, we also need to workout tha financial
T
implications of the study.
Hr. Gopinathan
Ue will enlist the help of
of CMC to work on th* draft budget, which
will ba finalised with CHOP during Dr. Benjamin’s preliminary visit.
ThalM Narayan*
i"
CO
- J- I Y H
I ' H CuU.
316, 'v Main, I biwck
Koramongala
Bangs lore-560034 " ' r
lodia
/
/
APPETTDIX
<t0MRUNITY HEALTH CELL
No 47/1 St Nark1® Road
Bangalore S60 001•
28 February 1990
STUDY^REFLECTION ONTHE COHHyNJTY HEALTH DEVELOPHENT PROGRAHHE (CHOP)
OF KOTTAR SOCIAL SERVICE SOCIETY(KSSS)
An outline of the various aspects of the CHOP that could be looked
at during the study has been given* The group can decide how much
of this is necessary/feasible and also work out details of methodology*
frameuork/structure
This note is primarily for discussion and to evolve a C_
for the study*
It Background • an Introductory note on how this study came about
2. General objectives
a * To study the conceptual understanding of community health (CH)
as it has evolved in the CHOP of KSSS over the years.
b. To study the implementation of the community health programme
in all its dimensions by the CHOP in the context of the overall
programme of KSSS.
c . To study the perceptions of the community of the CH work of CHOP,
d. To suggest further developments in the community health
programme for the future.
3. Specific Objedtives
A. Concegtual^understanding^of^Communitjf^Health
ta. To Study:
- the definitions and parameters of CH as understood by CHOP
- the long and short term goals^ and
- the strategies/methodology adopted to achieve these goals.
b. To study the evolution in this understanding over the years
i.e what were the changes that occured^ howf why and when
did they occur.
c. To study the present understanding of CH by different people
participating in the programmet viz.9
- Mahila Mandram(Mrt) members
- CHOP staff at MH/village level
.2
I____
A
z
CHOP training staff
•CHOP CentiriL Comaittse
e fishermen’s sangaras
- Other KSSS programme members i.
potters’ sangams
B. Implementation Of Community He«ith-£*23EagSH
To .tudy the
ond.r.t.ndln, end ,o.l. into
proorammee/etr.teoims of action
a.1 long term goals and strategies
a.2 short term goals and strategies
b. To review the various aspect, of sctivi y
chop
historically
-Mnnfil structure and
o. To —» understand th. present operetionel
style or functioning of
functioning of
1 Tn Mtudv the functioning of the rm,
v . at this level and their linkages with
***^ ’health workers at tnis
CHOP staff and programmes
c,2 To study th. dsy-to-d.y functions/!... respcnsltllltle.
of CH staff, viz.,
- Health workers
- Health guides
- Health educators
- Community organisers
- Medical Officers
» CH training staff
c.3 To understand the functioning of CHOP in the area, of:
- physical health
- mental health
- social health
- primary health care
around health issues
raising community awareness
in health programmes
- community participation
....3
3
'HS
r.
«.
C
c9
: ■ ■. j
c.4 To undervtand/«vol'v*
^,c.5 to look at the tioe ape nt by CHDP’s staff on different aspects
of their work.
c .6 To study the records maintained by CHOP staff and the uee
that is made of them in the running of the programmes.
C • 7 To review lt\ detail the "training programmes in CH (looking
)
at content and methodology) for all the staff.
orientation session
- Health workers
- Health guides and educators
— Community organisers.
y j
■
•
’ ’
C
c.9
To study efforts In continuing education on conwunity health
issues for all staffs
To understand the dynamics of team functioning of CHOP
. c.1O
• sharing session
- use of feedback from the field
- decision making
- choice of priorities
• division of responsibilities
To look at the personnel management aspects of the CHOP staff
c«8
To understand linkages between CHOP and Government health programmes.
8. To understand linkages between CHOP and other KSSS programmes.
f. To understand the role of CRS supplementary food and its impact
on the CHOP programme.
To understand linkages between CHOP and other NGOs - health and
non-health in the region*
h. To explore linkages with other health groups in the country
VHAI/TNVHA
CHAI
RFC
AIDAN
LSPSS
ACHAN, etc
7
/
/
\
Ce To study perceptions of the cowiunity regarding CH work of
CHOP Vix.f froel
- members of MM
- current beneficiaries of supplementary feeding
- past benaficiariss of supplementary feeding
• non—members of MM
women end men
• youth
* who have attended camps
* those who have not
- previous staff of CHOP now residing in the area
- school teachers
- pancheyat members
- doctors>in the area
•
■
,
i.
-
■
■
-j
■.
■
■■
methodology
Only general points are suggested •
out in greater detail
This will need to worked
!• Literature review
- All CHDP-KSSS Annual Reports, Training programmes curriculu,
Evaluation reports*
Reports of studies on various aspects of KSSS
(sea list given in background note)
- other literature on health programmes and their evaluation^
2. Field Visit
a» Data Collectton
- existing records eg«, from CHOP and analysis made from them
- data from local PHCs, DHOs on health indie tors ?
- demographic data from District Census Handbook
be Focus 2rou2 discussion
on certain areas with a chcoklist of questions for
different groups*
c. Questionnaire^?
X I
I
APPENDIX
KSSS-CHDP
•I ’
EVALUATION
Minutes of meeting of study team — 03 March 1990
Members attended :
0r« V Benjamin
(VB)
Ms* Bhanumathy Vasudevan
(BV)
Dr* Thelma Narayan
Dr* Shirdi Prasad Tekur
(TN)
(SPT)
A gist of the proceedings
1)
Or* V Benjamin acquainted the team about his meetings
with Er* Oames, Sr. Loive, Gaspar Mary and some other
members of the KSSS~CHDP, and his impressions*
2)
A field visit of five days duration would be adequate if
proper planning is done
3)
The team would be able to meet the central committee^
Mahalla Mandrams, other CHOP team members, participate
in activities which are on during that period and evolve
plans for a future visit if needed during these 5 days.
The field visit dates agreed upon were,
— leaving Bangalore on 15 April 90 to ?2nd morning
— at KSSS-CHDP 16th evening to 22nd morning
— leaving Nagercoil 22 April 90 morning
The field team would consist of Dr. V Benjamin, Bhanumathy
Vasudevan and S.P. Tekur.
4)
The areas of responsibility during field visit to focus
study on was,
VB — Personnel/Management/Administration/Training in Health
BV — Women’s Groups and Activities/ Social Health
SPT- Child health and Health related activities in general.
2.
A
The team at Bangalore would Interact for 2 more sessions
(9 and 10 April 90) In thoimfterncon at CHC prior to field visit
and later,
5i
depending uhat evolves from the visit.
The budget for the v evaluation uas agreed upon (copy attached)
A short study of available haalth data/related data/history
of K KSSS-CHDP to be prepared before next meet.
... 5 dfh =
7)
*' j v
-SFiVi
Methodology for participation involvement of KSSS-CHOP personnel
in the i evaluation to be evolved by individual members and brain-
stormed at next meet#
8)
Inform KSSS-CHDP of visit dates and any other requirements for the
study
9)
To contact Ha. Nalini Nayak at Bangalore during field visit.
APPENDIX
•J’
OBSERVATIONS ON THE HEALTH SERVICES OTMENSinNS OF KSSS-CHOP*during
the visit of the study team between 16th to 20th April 1990«
OBJECTIVES : The objectives of this exorcise were,
aj to understand the role of the Health services in the KSSS-CHDP
long term goal of 'Social health for social change.1
b) to understand the strengths, weaknesses and opportunities
available in these services.
METHODOLOGY t
Field visits were made to Village health centres picked up at
random by the study team* Coverage of ell four taluks of Kanyakumari
district representing coastal, hills and plains regions were ensured,
to understand any variations among these areas.
CONCEPTS / UNDERSTANDING OF THE STAFF:
The following concepts/understanding of the health services were
picked up from the enmbers of the central committee, community organisers
and village health teams.
- The health services component started in 1972 in Kanyakumari
district through a few dispensaries, mainly as a maternal and child
health program.
- it started with the felt-need 4n Diarrhoel disease management.
- the focus from the beginning has been on women, utilising Health
Education as an entry point to wording with them.
- all staff, except the Doctor have been women.
- the services expanded rapidly to cover 126 villages from 92
Mahalir mandram centres.
OBSERVATIONS :
The observations of the study team are recorded at the following
levels 1) the village level,
2) the Doctor and his role, and
3) the central committee, training and co-ordination.
The strengbhs, weaknesses and opportunities at these levels are explored.
...2
-J.
1) Th« village level :
Strengths :
a) all health related activity takes piece from the Rahalir eandram
centres which are located in Church premises of the village* This
gives e certain official sanction to their work*
b) the village staff are usually a teen of 2 to 3 women • a Health
- * ^’uide (training one yaar)t a Health Worker (training six months) and
\^van Animator* Despite designation^ their areas of work overlap and all
are equally competent and mutually supportlvec) the health team members are resident in the same or adjoining
village ae the Hehalir mandram/Health centre*
d) the team are employees of the.Rahalir mandram with a salary
ranging between Re 600 to Rs 000 and working experience between 6 to 9 yrs.
e) they are involved in all activities of the Rahalir mandramt including
. ..^V^-|CRs food distribution, running of fair-price shops, tailoring classes
C/
y
and other Income generating activities*
f) despite lack of CRS food supplies in the past few months (which
is the main source of the Rahalir mandram income^ hence their salaries)
they have a positive approach to their work*
g) they feel competent to tackle minor ailments and render first-aid*
They handle simple drugs in their day to day activity and relate well
to the doctor*
h) they enjoy'a good reciprocal relationship with the local Govt*
health staff and utilise Govt, health facilities for immunisationt
major ailment treatment and National health programs*
i) in addition to the above9 other health related activities include9
- Health Education to mothers during pregnancy and after delivery,
- Identification and monitoring of malnutrition in children,
including nutrition education ±o mothers9
- House visits and Health education during visits,
- Organising health check-up, diagnostic and therapeutic camps
with the doctor,
— Encouraging the sanitary—latrine concept through inputs from
the CHOP, and
- Conducting camps and seminars for youth on social-awareness
issues*
-3Weaknes—ai
a) Being employees of the Mahalir nandraros, they are not members end
do not take part in decision making processes.
b) The flexibility seen in their working hours is limited to an 8 to 4
or 9 to 5 pattern, when working women of the village may not be able
to take part in their activities.,,
c) Their focus of activity is restricted to members of the Mahalir
mandram and directed more towards CRB beneficiaries.
d) Drugs supplied to patients are free or on payment, depending on
CHDP directives and not on patient needs.
e) There is no formal arrangement for referrals for major ailments.
Hence no responsibility is taken beyond minor ailment treatment and
the. patient la left to fend for herself/hlmself.
f) They are not trained in Health promotion or Rehabilitation aspects
of preventive health care and do not initiate any such activities^
g) A large part of their working time is taken up in maintaining
extensive records/reports/returns (23 books and 6 reports per month)
the importance of which they do not perceive.
h) They feel the need for security, formal recognition and Incentives
in their work.
e.g. - they are employees of the Mahalir mandram, while their
activities are directed and supervised by the CHDP. They are answer
able to both.
- their salaries are dependant on CRS food supplies and other
income generating activities of the Mahalir mandram which are not
always dependable.
- they are supervised by the community organisers whose focus
of activity is on social awareness, while the Doctor is clinically
oriented , with very little time devoted to on-the-job learning or
teaching as well as encouragement at the village health centre.
i) they are looked upon by the peopj>e more for Initiation of social
action and not for health related work.
e.g. they are approached more for water/womens/employment problems
than for community health problems.
2. The Doctor t
There was only one Doctor during the study-team visit, the other
having recently left for alternative en^loyment.
The Doctor's activities are predcminantly diagnostic and curative
during visits to health centres. He is able to visit one to three
centrea «very day on a monthly plan submitted to the CHDP. He is
also involved in health camps with a diagnostic/curatlve orientation
depending on the local demands.
...4
STRENGlHSt
a) The Doctor is responsible for all technical (health) training
of the village health workers, and is responsible for all their
health activities. This puts him in a position of having a good
overall view of health activity in the CHDP.
b) He works in a milien where social awareness is already high
and mechanisms for social action are functioning.
c) He enjoys a good rapport with the health workers, and hence9
support in health related activities.
d) He has popular people’s support for diagnostic and curative
health camps.
WEAKNESSES t
a) The area of responsibility is large geographically and
technically for only one or two persons to handle. The spacing
of visits to cover all 126 centres, leads into depth of local
? health needs.
b) Good co-operation and proper co-ordination is required at
all levels for the Doctor to be able to discharge his
responsibility.
e.g.tt when the study team visited a village health centre on the
2
2schedule,j there was nobody at the health centre
Doctor’s planned
lack
of
information to health staff from the community
due to 1
-------organiser.
c) The Doctor expressed diffuculty in trying to balance health
activity with social awareness activity at village level, since
the ultimate implementors of either would be thevillaqe health
staff. They would not be able to undertake too many things
simultaneously.
d) The mushrooming of commercialized private enterprise in
health in Kanyakumari District puts excessive demands on his
technical skills and ability to move towards more rational and
cost-effective means of health care.
e) The lack of a formalized r ferral system limits his
responsibility to tackling of minor ailments only, and adds to
his inability to cater to health demands of the people.
f) Being involved only in the technical aspects of health
training of the village team, predudes from a wider understanding
of their needs.
g) The Doctor feels marginalised in the CHDP central committee
where social awareness activities dominate over health matters.
Even here, his expertise is restricted to -allopathy'’.
e.g., the central committee decision to train health workers in
"siddha* system of medicine was based on the popularity of this
system amongst people, and not related to their disease pattern
and health needs.
• •5
5.
3< THE CENTRAL COMMITTEE, TRAINING AND COORDINATION:
The Central Committee of CHDP has 11 members including the Doctor,
Co-ordinators of Training and Nutrition, representatives of the
Community Organisers and the Executive Director of K.S.S.S.
Strengths:
a) The central committee plans, executes, monitors and supervises
all -activity of the CHOP related to Health, Social awareness and
CRS food supplements.
b) The facilities for training of health workers are good and time
tested,
c) Members of the central committee get indirect feed back
through community organisers, while roost cf them also directly
interact at the village level - to a limited extent.
d) Members of the central committee attend seminars/courses/
workshops regularly as a method of staff development, which
encorages cross-pollination of ideas.
e) They organise regular formal meetings where decisions are
taken jointly.
Weaknesses:
a) Training
—The initial pattern of training of Health Workers was based on
that of the Government health services. This has not changed.
-Innovations in training methodology and modifications suitable
to emerging local needs have net been explored.
-Continuing training programs are social-awareness oriented and
not adequately linked to health.
-The Doctor is used as only a technical trainer for health and
does not form part of oth-?r training activity.
-The introduction of trail ing in "Siddha" system has not been
directed towards specific health needs of the people.
b) Co-ordination:
-The co-ordination of health activity is considered secondary to
other activity. It is predominantly related to making of reports,
returns and time-tables.
c) Nutrition:
-The "Health Mix" has too many ingredients which makes it costly.
More appropriate cost-effective methods of supplementation have
not been explored.
d) Other aspects
-An inadequacy of leadership in health matters as well as
planning of need-based focussed programs in health wa s put
health matters to secondary ’mportance.
-Utilization of health statistics, reports, and returns as well
• •6
/
6.
as the studies conducted to update and modify health programs
is not explored.
—The health aapeet of the CHOP
J^xme ap roach
decentralized in r ractice, wnich entails a tiexinr
i
to felt needs of the community served.
-co-ordination of health
?S“e.“«Unr^U^l^tU.l.on at the central level.
RECOMMENDATIONS:
a)
Forming of
of Health Committees representatives
a) rorndng
health workers, people, the ^or^----^
Il_ ►-
into the
Health‘ne^ds at local level and adopting flexible approaches
be explored.
— team
’ —i at the central level it,h representatives
b) Forming of a Health
as detailed <above
---- to be considered.
—i to enable identifying of health
c) Revamping of Recording systems
at the periphery to be
needs and also to reduce paper work
vo
explored by Health Committees.
d) Revamping of Training ™®thods/content and continuing education
- -by- a teani
--- 1 with
in health
“■ representatives from all levels (trainers
to trainees) to be considered.
salaries/security needs
workers
e_) Delinking of village level
generation
activity to be
from CRS based and other income
i
r
considered.
f) Health Education methods to b undated and more ^phasis on
ProSStive, Preventive and Rehabilitative aspects of Health to be
explored and tailored to local needs.
g> A mldai. level cadre of health pe:-on™“
^““teSal’and
acceptance by the people.
-xxxxxxx xxxxxxxxxxxxxxxxxxx-
7
AFi-r/TH- < ’I '
A
STATE OF ART OF PROJECTS ADDRESSED TO WCMEN_AND SOCIAL HEALTH
(development process)in ksss-chdp and emerging recommendations.
Since social health andwomen’s movement are inter-linked in any
rural development process, the paper is addressed to deal wit
them simultaneously.
For a fair understanding of the •state of art1, the observations
and comments are picturised under three headings-strengths, blocks
and opportunities, followed by recommendations.
I, CORE STRENGTHS:
1. A very obvious and evident strength is the name/rerute CHDP has
earned today ir rural development and women*s work through its
solid, massive and intensive work for 2 decades, culminating in a
network of 92 registered MMs for rural women and their associated
processes. This can be claimed by very few organizations in India
today. This can be compared to a torrential waterfal1/river which is
available and has the potential either to waste aaway, falling/
running or put to use to transform the drier areas into fertile
pastures bringing life and work as energy multipliers.
2. The above strength of KSSS-CHDP has resulted in the development
anc growth of emotionally and professionally developed vil age
staff, who possess skills in delivery of MCH and have also gaineo
th- confidence of the local population, who consult then even after
consulting the PHC or a local doctor. Besides, these women
Genuinely have a very keen interest to work with and for people in
the areas of conscientizaMon, education and economic freedom and
have a flair for activist work, In '•ur sample villages the tear
witr. ssed these factors vividly. Provided even 50% of the 92
NHs have such staff, it is a com endable achievement in the area
“
of transformation and such a strength is now •like
a3 new found t
*
*
►
interviewed
had
not received
treasure. Everyone of them whom we :---- for
nearly
three
months
and
in
spite
of
it they were
their salary 1
in high spirits/morale generally.
3. The process and development of delivering MCE’ over the years
has resulted in a kind of women’s special clinics in these villages
where they can find their space socially, emotionally and
psychologically. This is one of the unique ano special features
of the programme which is also a great asset to the project.
4. During the course of the project, the leadership of tr.Leivc
has motivated a large band of wemer. who have the fire, zeal and
y for women.
4 This has been witnessed during our
commitment to work
field work. CHDP
(--- has built up gradually a tear that believes ir.
commitment to women9 relentless hardwork, and who possess a convictin
*
that women need to stand together despite
differences., Thi s has
friendly,
supportive
atmosphere
where each others
Given rise to a *----------- 2/
cep ts
This tear has clarity of cor
concepts
mistakes are tolerated/accepted.
anJarc willing to reflect/introspect for any
on social health andarc
required future course corrections.
..2
2.
strongly manifests is that the entire project work Is Looked
upon as diocese work and hehce God's work. The very fact that
the project is held by a diocese team to bring in acceptance of
the local population due to the rural religious fervour and
sentiments, though the work of the project has a feminist and
activist orientation. There seem to be a general sanctity and
sanction due to this for the MMs to exist and function, (that
most of the MMs are housed inside th- church compound is a
revealing expression of this factor).
6. Rural women in these villages by virtue of their association
with CbDP have become aware of their rights and responsibilities
and generally moved fretp a fatalistic attitude to one of
awareness of the possibilities before them. They are ccnscientised
not only on health related matters but also in their social realm.
CHDP has achieved this over 2 decades ana now it is one cf the
most powerful strengths in hand.
II, BLOCKS TO CONTINUED GROWTH TN THE QUALITY OF THE PROGRAMME, A M2
A CAUSE FOR THE CURRENT STAGNATION.
1. At present) there is a visible lack of leaders who have the
vision and the capability of leading the organization in new
(creative) oaths towards its goals, those who can operate with a
feminist orientation and perspective timpered with diplomatic and
strategic skills, objectivity and co-ordinating and net-working
‘his is the need of the hovte at CHDP. This block
strengths. Thi
,_J to stagnation blocking the flow^new energies
has perhaps .feted
y
2 j In our observation and field
within and outside the organization,
routine
is
well attended to so that the
work, we saw that work i-----organization can sustain its functioning. In terms of har.aling
situations which need confrontation, itaking charge, risk taking
and decision making, it is everybody's forte and nobooy*s
responsibility. Since Sr.Tieve is weaning off and
ana Sr.Christie has
tics
given her resignation and is awaiting clearance (attending to re tine
and administrative jobs) and Gasper Mary has not positioned
herself in a co-ordin ter's role (prefering to be back-stage),
there is an apparent confusion on whe is to lv-ad, or ca- - e all
lead? In such circumstances, the nen-voeal members remain at the
periphery with almost nil-contribution in a given situation and the
vocal animators occupy th< stage. The animators v,ork being
conscientizaticn of rural workers and MM members and helping to
conduct camps, debates and training programmes, most of the worr in
in the nr ject is only in these directions presently. In short,
the animators work becomes the agenda of the project and the rest
of the w. rk takes back-stage. This is leading to a situation
where the persons who arc accountable for the performance
(co-ordinator) cf the project are not aware cf their personal
accountab lity and therefore feel that the central committee will
take care of all that is needed to be don and looked into. Ine
nature of the work cl mate being what it is-(friendly atmosphere
..3
rv
.3
where mistakes are tolerated/aecepted and a strong belief that
as women we need to be united and bury our differences at any
cost) it perpetuates such un-professional, subjective and
non-functional situations* Further, though the animators as a
group are of e militant feministic orientation they seer to
lack the pexspective (context/frame ot reference) to translate
it into their organisational work ethos (character!stic/spirit)
in S'hrnad^frWSi^h^jitngrftTT'ttTrT the environment, oggaiisatioail
handicaps and strengths and the ultimate target and goal of
develcpment of the rural population especially women.
2e Alienation of village staff (wh< aia referred to as one of
the corsestreugths) gradually fr--i» iia a^instream of CHDP is
gathering mometitura presently. An intr^uing process, perhaps
tWc*~**
the last 2—3 years, xs v.st inspite of the
strict reporting/controlling
and annual learning
inputs through training progranmes/refresher courses, there is
a consistent message given to them that they cannot emotionally
belong to CHDP but to the MMs, since MMs are in ’letter1 their
• employers’< Another interesting process happening alongside
is the current attitude and action of CEDP/central committee who
feel they have nothing to do with vil age staff except
supervision of their work and record maintenance of CRS food.
An ambivalent (co-existence of contradictory feelings about an
action) process that is happening alongside is the village staff
emotionally possess a sense of belonging to CHDP and look upon
them as an organization that cares for them and wishes to
nurture their growth and, development. .There is a big gap between
CHDP and village staff in the way they perceive each others work
relationship.
3. A wide gap between belief in people’s participation in the
project and’ the way it is implemented/translated in the project
and organizational processes. It is evident for example in the
controlling relationship between CHDP and the village staff
(more in tune with a corporate office dealing with their units
an industrial model), non-representation of village staff and
MMs in the central committee as a participatory step in decision
and policy making processes, the inclusion of a clause in the
bye-laws of MMs which says MMs should be under the control
CHDP and the very process of decentralisation at CHDP which has
retained decision making power at the centre witr. responsibility
down below.
4. At present an excessive pre-occupation of CHDP central
committee (especially animators, co-ordinator and com-unity
organisers) on debates on women’s issues like dowry,rape etc*,
seems to be blocking the organization from evolving creative,
alternate approaches at the grass root level for social health
and emancipation of rural women. Besides CRS food, MCH awareness
• •4
<•
and debates, youth camps are undertaken by the respective MMs
and they also possess the capability of drawing up local
resource as well whi<sh was apparent in our field work.
5. Certain attitudes that seem to be operating in CHDP central
committee-women members also might be contributing to
stagnation. To mention a few of them which remain as unexamined assumptions:
1) In the work-related areas
-Decentralisation means decentralising work load and retaining
decision making and authority at centre.
-The higher the authority invested in the ranks of the central
committee members, the lesser field work or nil field work is
in order, (e.g., the co-ordinator and nutrition-coordinator
have no field connections responsibility necessitating field
visits, but this is only optional if they choose to). Invariably
because of higher administrative work load, they do not find
enough time to visit vil ages and do so only rarely during organized
meetings.
—CHDP has to act as ’brain and power centre1 for l<Ms.
-Application of uniform rules and regulations are essential with
MMs and village staff irrespective of regional/cultural, socio
economic differences in each region, for e.g., 9 A.?., to 5 P.M.
working hours in a village, where mothers go to work during that
period (especially the poorest of poor) and would be free only
later in the evenings.
—CRS food and ongoing linkage and partnership with KSSS is the
cause for a lot of problems in CHDP. If both are removed, CHOP
will not have much problems.
11) Working as a group of women In central committee
As a team of, women-unity means burying differences, objectivity,
tolerating the colleague for all mistakps/shortfalls even if it
affects the organization. A friendly andsupportive atmosphere
car. be built at the cost of the task. We can be aggressive,
rebellious but not confront each other whenever thereis a need
since it would be considerea unfriendly.
-Following this, with a lack of ol jactivity, the assumption that
seems to be operating is that the organisaticnal structure is
on paper and for operating purposes it car be shelved and we can
together do everything. Perhaps since we are women it is not
necessary for us anJ we can operate like a family where tasks are
carried on somehow whether each one contributes, feels accountable
or otherwise.
-Observation of joint meetings of CHDP and village wome. seen to
reflect the current attitude of the central corrrlttee that
e
re working for wome* and not so much with womer . One example of
this is MM members are not given enough space to voice what they
• •5
5.
feel but given opportunity only to answer the questions put
forth by the animator and almost forced to answer them to
prove their participatior.
-Another assumption following t is could be that allowing
more space for rural women to talk freely would mean inviting
problems and therefore suppression is a better strategy.
-For any socio-economic project for rural women, a large
amount of capital is required and non-examinati n of the
process of encouraging rural women to start rricrc-enterprises
and become entrepreneurs.
Opportunities before C.HDF as of now
A tremendous scope exists for converting the strengths menti ned
into channelised energy.
-For creating a rural women’s movement in socio-political areas
-To bring forth economic freedom to the poor rural women
-To network with other women’s organization
-To learn from each ether and work together
-To utilise state and central government schemes to the naximum
-To utilise the doctors
-To train health guidesphealth workers, and
-To devise training programmes for other women outside CHDF and
the 92 villages since talents are readily av ilable.
The opportunities before KSSS-CHDP are » nliniited.
-xxxxxxxxxxxxxxxxx :
> xxxxx> x—
Mrst Bhanuroatny vasudevan
X.
RECOMMBK. NATIONS
To Build an Effective Professional Work Culture:
As a team of central committee (CC) members make efforts to
1.
include the doctors and the KSSS representative and Chairman,
maintain objectivity.
up for the CC.
A team building programme should be taken
member be present all through the three days. These 3 days woul
not deal with their organizational structure, responsibility and
the like out their personal attitudes, beliefs, agendas tha
influence CHOP’S functioning as an organization. This would also
need an external process consultant so that the task declared to
the event and the objectivity can be maintained. This
should also result in personal action plans and commitment fro
effectiveness.
the individual for the organization’s effectiveness.
3. Women in the central committee together look at what are their
feministic orientations and how do
c_ they
--- translate it tor the
development ot rural women, in economic, social, political and
personal realms?
II. in the Area of social Health and V.cmen's Development
-3 tc what
1. Take stock ot the na*-ure ot memb' rship In each MM' as
fixed
income
through
their
is the percentage ot women who nave a
need
to
earn
a
wage
to
husbands/sons in the family, women who
—
-j
ot
1
fulfill their basic needs (poorest ot poor} and percentage
and
commitment
leaders who can take initiative, and have a concern <---to work tor the poorest ot poor women in their village.
Ac-ordlnalV/ develop a lair balance of all kinds ot members by
conscSusli recruiting these who need the benefits and those who
can be pro-active.
2 cover 2W of these members in all categories through a short
survey ot specific 2 or 3 guestions (open ended} as to wnat
direction the? would like O'Di tc -ovc, wha else they would like
..2
■2.
CHDP centr
CHDP to dof besides CRS food and health. None of the CHDP central
committee members should be part of this survey. The MM should
independently conduct the survey. Besides, MM should also conduct
the same survey with 20% of non-membersin their village. This
would give a fair direction for CTTJP and in what direction they
need to move to fulfill the needs of the people they are working
with and be aware of the specific current rural realities of each
village^
3. CHDP central committee to examine the nature of women’s issues
they are taking up in meetings, training programmes, and debates.
Cur observation suggests it is getting very rhetorical^ a
streotyped way of conscientising, almost an overdose to the same
group repeatedly. For e.g., the songs generally sung by groups
as women’s special sonms reflect self-pity, inability to assert,
powerlessness and helplessness instead of being motivating,
empowering, hope-building, dealing successfully with everyday problems.
Another .point of view could be if dowry/rape is not an issue with
poor rural families in a village, over-importance to this issue Is
futile and mere activity. There may be specific burning issues of
women in a particular village and perhaps dealing with that issue
in forums would be functional. Since CHDP has become a large
organization coveriAc 92 MMs their training programmes, the issue
being dealt with, the way of functioning need not become one single
way/direction but build In flexibility in' these areas to deal with
specific issues of a particular village, and adopt functioning
methods and programmes accordingly, e.g., in a particular village
women may not get the same wages as men irrespective of the work
being same. Perhaps such issues need to be addressed too.
4. Dealing with specific realities of rural women is a sensitive
and delicate work requiring perseverance, couragement and diplomacy
on the part of CHDP. To enable themselves to work in these areas,
it is very impbrtant to build local support-the parish, locally
respected and ’powerful* men and women, and local NGOs and
Government agencies as friends and well wishers of the project.
Very consciously linkages and bridges shot:Id be built so that the
conrrunlty in the village looks at women’s work as relevant and
meaningful in their minds, as ultimately development of the village
is brought forth through these women. Our observation suggests
that CHDP almost works in isolation In villages, whereas MM staff
arc aware of building Jinkages as a natural way of support system.
b. If the philosophy of collaboration is adopted, rather than
working in isolation, it would be a greater strength to CHDP to
counter communalism spread through RSS and such forces.
Collaboration with central agencies like CAPART, Central Social
Welfare Board. Appropriate technology forums, other UGCs operating
in the area with similar ideology and objectives is the imilnent
need of CHDP now. This would also bring in ’development' orientation
..3
3.
in the place of ’activity* orientation. Ine possible cause of
•staanation' the central committee is talking about in our field
work could be due to this ’activity orientation* where there are
lots of activities visible but growth is relatively low. CHOP
needs to explore the process of their uork and what orientation
they are moving to perhaps very Unconsciously• For
conscientisation helps women to become aware of what is happening
and her rights and responsibilities for developing herself ana
to live as a respectful human being* Now that, this has taken
place in the last 2 decedes of CHDP’s work, the present question
is- where do they move from here to translate their awareness ano
understanding in her personal, social, political and economic life.
It would then mean asserting in the employement market, taking
visible authority positions in society, socially and politically,
becoming self-employed enterpreneurs, etc* For this at the CHOP
central committee, there are no examples. May be they shy away
from such positions. Due to extensive and intense work with women
are very much aware, trying to unshackfee the societal pressures
on women and now there is a strong possibility that this can be
converted with less efforts and support into a women*s movement
itself*
6. CHDP may explore the possibility of decentralising their training
programmes and debates at village level in collaboration with MMs.
This would enlist more men, women andyouth to take part, if they are
conducted in the villages* This would also bring more contacts with
field realities for the central committee members. Already MMs
have started taking initiative and conduct debates, youth programmes,
etc*, this can be further developed so that MMs start operating as
change agents besides delivery of MCH services. This would also
relieve many central committee members and give them more time to
work with people. This is a possibilitf where the village staff
and the existing body of MM (which are few of the core strengths
of CHDP) can hear a multiplier effect.
7* Cur observation suggests that CHDP will have to address itself
to socio-economic programmes for women* This xfi came up very
are very eager now in the
strongly in our fifeld visits* Women
t
•
villages to gain economic freedom and consistent• income
., One
necessary.
Work with
possibility is networking projects wh reevei
—‘
central and local institute for entrepreneurs and small business
development in the region, local depart'ent of industries ano
corrr.eree, so that rural women can experiment, e*r lore to become
micro-entrepreneurs individually or engage as a group of local
women in an economic venture*
I
-xxxxx.- xxxxx xxxI
J-( C
'.a/-.
^7
OK 1’i.L ;
o-Ua ? ’K .S LY
i
a;-, ol YOl.lR Pk^LEKIhakY KLrOAT
Oh Thh HLrvLTh
1 J. j
C • J i • 1). X .
SErtVICES DUnirc THE VISIT GF YOUR STULY
ic..r t.xifY c.o.;..:
LAST /xPAIL 1990
mentioned already in our letter date-
21.9.’90 we have been working
your various papers and therefore it has taken
time to get the feedback
from all sides, In the meantime situations
and circumstances of which
will -ive more details below have already helped us together with your we
with
observations a,, recommendations
recommendations to
to make
make a major transition in the approach
of Health services
-- ‘
and activities.
To be able to give the feedback of what we
have been able to consolidate
from the various discussions, we keep to the order
of your reports.
1• First part observations
>ve feel that this part gives a few
very short observations of the objectives, methodologies -.nd concepts and we
agree that it is difficult to put
the history of nearly two decades in a few lines,
aS foi’ example the
initial goals were never thought of diaroheal disease
management, out
primary especially in the coastel villages on the f<lt need of hygiene
sanitation, nutrition, education, women's employment etc.
1 • 1x1 the village level weaknesses;
v.e do appreciate your observations and they have helped us
already
in radical transition of our approach.
Especially to:-
0)
/or kin
hours.
It has taken quite some discussions and adjustments
to reach an agreement of working hours according to the needs of
the women, for example r.iost of the Sundays are
are working days
now.
Sa also evening programmes and other adjustments.
c) till
f) will be reacted on later as we give the new experiment and
work plan.
g) While agreeing on your observation we wish to say that most of the
records are required by C.R.S. and also registrar.
From our own experience we wish to add that unless data and
reports on various activities are maintained,
Maintained, ho follow-up and
valuable continuation can be expected, since we don't have profess#
ional people among us, but all have started as village community
workers.
We wish to give you also a clarification to the overall observations
you made regarding job security etc ... All of us started
as
voluntary workers, ani^d one of tne initial goals was, to make use of
the hi a percentage/educated young girls in our district by training
them for future life, inservice to the larger community.
Uptill the early 80,
hundreds of young educated girls have been
trained and served as health workers and health guides uptill they
got married when they left the programme and others were taking their
p1ace.
2 -
It was at a time of decentralisation and registration of the local
blahalir liandrams that rightful demands were made for continuation of work
What was first intended as a ’’Preparation for life inservice
to the larger community” had to be adjusted with all the unforeseen tensions
after marriage.
and demands this might involve, and there hxxh were plenty which have helped
us towards the present transition, We hope this clarifies many of your
observations.
2. The doctors
I
Most of us do not think that you have been able to understand the lack of
collaboration of the doctors with the comraunity health workers.
During all these years it was the first time that we experienced this
Dr.Mani will surely confirm this.
tense relationship.
This last few
years the iirst negative experience. The doctors exclusively stressing
curative care and the goals of the programme being preventive and
promo tive.
Also very much the dimension of social health, the total
well being of the person, This attitude has confused the health teams
and Community organisers.
Last April one doctor resigned and Dr.John also resigned in June,
since both got Government employment.
Since then we have been able to
clarify our objectives and we have appealed to the P.H.C. doctors to
help in the different areas and also with the service of two part-time
doctors of different health systems we try the approach of more integrated
health services through different activities.
The Central Committee
Training and Co-Ordination
In the process of transition, having very much in mind your valuable
observations and recommendations the above committee is not functioning
and we are working on a modified work plan of which we will give more
details below. We have been trying to get the service of a public health
nurse and tl;e last enquiry gave a positive response.
Feed back on the report of Mrs.Bhanumathy Vasudevan
1. Recommendations
This report has been mostly appreciated and recommendations studied,
related to the first part we said already above that in the transition
experiment the Central committee is not functioning.
Having in mind the
given recommendations we found it better to integrate ourselves in the
different units of the present activities.
management skills,.
help of dr.Lieve.
Still we need badly to
We had a fevz intensive worksho s with the
She has accepted to help us till we hc’.ve the night
committed person.
II.In the area of Cocial health and Womenfs development
We are in the process of taking stock of the nature of membership in
the Mahalir Mandrams.
The survey papers of a fevz areas have come in,
but we have noh studied yet the trends.
much in
Any way we keep tnis very
mind and see the need to which direction
we should move.
- 3 all the other points have helped
us very much in the
planning of an
experimental transition we are
working
out
are
now.
111 • As a response to
your paper as the last
part of your preliminary
report with its
I
Core strengths
II
Blocks
We have taken time to study the same and since June '90
we are
attempting on all together
different approach, We had several
sessions to work ouij*' the work plan and the
staVt has not being <easy.
V/e are all happy with the
new orientation and we give here below
a summary of:-
V/ork plan of new phase of Health Services
k Womens Activities in
C.Ii.p.g.
Introdue tipn:
All C.H.D.P. activities are wprked_out^n<L iniplemented through
ocal organisations mainly through Mahalir Mandrams.
1.- Mahalir Mandrams are organised by C.H.D.P.
Community Organisers
- The members of Mahalir Kandrams
are not related to C.H.S. Programme
but open and responsible for
all activities, and have a concern
and interest in the continuity of the Mahalir Mandrams.
- Therefore, though Mahalir Mandram members may be eligible for C.B..S.
food for period, they will not be accepted as Mahalir Mandram
I
members if not interested in a continuity of membership before
and
after their eligibility of C.k.S. supplementary food.
For the period they are eligible for
C.R.S. food, they will not
oe eligible to be elected as President
or Secretary of the
Mahalir
Man dr a ms .
2r Mahalir Mandrams conduct local activities, take up issues and link
take
up with larger movements with the help,
support and follow up of the
C.H.D.P. Community Organisers.
C.H.D.P. 0 Community Organisers collaborate with other
groups and
organisations having a similar vision, goals and objectives:
" B«C.C. (Basic communities)
Mainly for Health education and services and issues
on women,
family, village.
C.
(Centre for Appropriate Technology)
women’s employment schemes.
for
alternative
- implementing scheme in appropriate technology for
women etc.
at village level.
!
- 4 " ^--rect: Organisational movements of women - workers
for dnvironment, ecology, polution, protection of natural
taking up issues, struggles demands for
- All activities are people oriented,
any political party.
resources etc.,
their basic rights;
therefore not directly related to
her. „ a Growth awor.ne.s .1 th. distr...i„s reality of th. .ttuatlon
of ».«, in the family, the villa,,, and .ooi.ty, th. continued ure.nt need
for preventive and promotive health, the destruction of material
and the need for education and participation in activities
resources
to protect
and preserve nature, specially related to water■and water
management, fuel
a nd alternatives, basic needs, and alternative employment for
women.
Taking up women's issues and organisational
work in the fields of discrimination of women and workers’ movement.
The C.H.jj.L. has entered a major transition,
making; efforts to take up
these needs.
1. The C.k.S. applied Nutrition Programme which
was till now a sustaining
incentive to many of our health programmes and women activities, hasalso
made the same dependent on it's continuity.
In view of facing out
gradually this programme, a transition is made to work with and
the local organisations of people, specially of women.
also giving
through
The C.H.D.P. is
it's support to the growing number of Basic communities
to
ensure the continuity of preventive and promotive health services.
At present there are about 450 basic communities
of some JO families each,
There is a voluntary health worker, also a woman promoter in each of the
communities. The urgent task is to give these health workers and
promoters a basic training through short courses and sessions, which has
already started.
An experience has been made in some villages in what is called
’’health camps”, these include home visits, health
surveys, evening
s-essions, audio-visual shows, exhibitions of native therapies, sharing
on home remedies, cultural items etc.
I
The C.H.b.P. has also made efforts for some integrated health
services making use of different health systems and a herbal garden
has been started.
Unfortunately we are having a severe drought and a
tremendous scarcity of water, therefore consequently most of the plants
of the herbal garden have dried up.
A Nursery teacher’s training is also very much stressed and asked
for by the women’s associations.
More women are aware of the need of
pre-school education, and therefore nurseries and
need of working women.
creches answer the
2. The C.H.D.P. has made experiments in alternative training and employment
for women and would like very much to pursue this in the coming years
in collaboration with C.A.T. (Centre for Appropriate
Technology).
A first experiment in masonry training has been made.
participated in the preliminary course and it
)
20 women
was foreseen to construct
1
“ 5
4 low cost houses wirn
latrines in
with latrines
in the
the respective villages of the
One of the houses has been successfully completed and the
’women.
three others
have/ been delayed by C...T. due to financial constrains.
But it is
assured that the other three houses will be constructed within
the year.
Last '’ear we made an initial break through with trainin,
of women in
rubber tanrinr. Pre-judices
to be overcome,
but this experience has
brought a new awareness of women's potentialities,
The 49 women who
followed the training last year have been followed up and 37 of them
are working as rubber tappers and another 7 are workin occasionally,
They are earning ks.216/- to Rs.JOO/- per month accordinp- to the
number of trees they are allotted for tapping.
With this incentive the training in rubber tapping and the follow-up
of women will be continued.
Initial studies have been made for bricket making from the waste of
the coconut fibre, All alonC the coastal belt there are small cottage
industries in rone and mat makiny. The waste is piling uP, polutes the
area and is a health hazard to the people. The C.a.T. has made an
initial study, During the coming year an experiment will be made to
process this waste into brickets as an alternative fuel for firewood,
The women will profit in both ways, making use of the fuel and a
possibility of employment.
3.
Some of the C.h.D.P. Community Organisers have started exploring
situations of women working in the tourist sector, handicraft business
etc., and also touched the tremendous problem of accute water shortage,
it’s causes and need for action specially in the area of Cape Comorin
which is a fast developed tourist area with all it’
s consequence of
people’s especially women’s discrimination, They will further work in
this line in view of building up awareness among the oppressed women,
organise them for possible action, in other areas and sectors of the
District.
They will also support movements organising the most oppressed,
specially the fishworker community and collaborate with all efforts
taken to protect
and renovate the environment from destruction,
polution, etc., specially related to the accute water problem.
Zie
The C.H.D.P. will also collaborate and take initiatives in the non
formal education programme launched by the Government mainly through
the voluntary organisations aiming at 100% literacy in the District.
In service of all these health, End education, awareness and employment
programme, cultural groups will be trained from among the youth and
women
who participated
in camps and seminars.
Songs, short social
dramas, street theatre and role plays have ^proved to be very effective
and appreciated, these will also be used in the basic community meetings.
6.
C.H.D.P. will also continue to conduct seminars, and meetings for women,
youth and children and closely follow up these grouns at the village
level.
These have been effective in creating *
village communities.
awareness in the larger
-e7. Also the Sanitation Programme remains
remains a
a priority in C.H.D.P. An evaluation
shows that up to 60% of the people are conscious of the need of private
latrines and there is demand for the continuation of the sanitation
programme in the coming years. As before the procelain sets with pipes
will be given as incentive after the construction has been done.
Different Activities
• Integrated health services
a) Make an assessment of local needs through interaction
with members
of Mahalir Mandram, Basic communities.
b) Start Herbal garden at Thirumalai C.H.D.P. Training centre.
c) Organised short & long training
programmes in above services for
interested volunteers of Mahalir Mandrams & Basic communities.
d) Make the services available in the different Mahalir Mandrams &
Programme
As said above C.R.S. programme will be gradually faced out. Therefore
a
minimum of six C.H.D.P. Community Organisers will continue to work in
this section and make all efforts for a valuable transition.
III•Collaboration with Basic communities
Six C.H.D.P. Community Organisers will give their services which
as already
been specified above, with special stress of building up
an infrastructure
to provide the'needed health services in collaboration
with the Mahalir Mandrams as the members of both are very often the same
persons.
IV.Collaboration with Centre for Appropriate Technology
delated to all activities tff
alternative employment and preservation
of natura-1 resources.
Training and follow-up of
- Masonery
- C-arpentory
- Smokeless chulas
- Water management
- Bricket making
V. Direct Organisational work
Eight C.H.D.P. Community Organisers will be responsible for
stuping
and taking un social evils and issues related to women.
- Women^children1s discrimination
- Dowry problem and issues
- Alcoholism
- Wife beating etc ...
- Organise v/omen's solidarity groups to give temporary protection
and if needed shelter to battered women till a possible solution is found
Link up with
larger movements for women, protection of environment,
ecology, natural resources and human rights.
7 3
6 Any other initiatives
coming up at the village level.
IV• Cultural Groups
4 C.H.D.P. Community Organisers will be responsible for
organising
and training interested young girls and women,
area wise in cultural
activities.
— Songs and short plays
- Street corner plays
and dramas.
They will make themselves available in/ different
activities of
C .H.D.p. for:
- Awareness building
- Education process
- Celabrations.
Burmg
the transitory period for atleast six months weekly
day meetings
will be held for the different groups of C.H.D.P.
half
workers according to the proposed involvements, to assess, evaluate
and plan the work.
All C.H.D.P. Community Organisers and coAordinators are responsible
for strengthening, organising and w-orking
with Mahalir Mandrams,
Hasic communities, women and people's movements.
They will submit their monthly work schedule and work report.
Conclusion:
As quoted in the introduction the C.H.D.P. Community Organisers
are involved
in various activities but all aiming at strength/ening
the women's organisations and the larger women's and people's movements
towards participation in the process for better health and life and for
having a share in the basic human needs required.
In the past, much of our work has been directed on working through
C.k.C. programme.
But realising the need of building up valuable
women’s programmes and activities independant of C.R.S. food, we have
divided our
involvements and responsibilities in different activities
organisations may emerge in their own rights and we
may work with them:., on a participatory basis.
so that women’s
The different activities are complementary in a mutual support of
the same vision of "Social Health for Social Change"
We hope that our above feedback will give you some clarity as to
the radical transition the C.H.D.P. is trying to make and we will be
happy and grateful for your interaction on this efforts.
Caz^aJL
C.H.D.p. Co-Ordinator.
Thirumalai
1.10.1990
Consultant.
-- .
....
JF
APPENDIX
•M*
'©t MW Wl 1 ag« - level*
....r.__
Reflections of Dr. V. Benjamin on aspects of a) Personnel,
b) Administration and Management, and c) Training, based on
ti-i*?
i-.’.F J ti
ni ’
• 2-^
the visit of the Study-team during
April to Z) April 1990
- - r x.
■ gm ...
•
' •■^*7.:
and the response of the CHDP to earlier reports by Ms. Bhanumathy
Vasudevan and Dr. Shirdi Prasad Tekur from the study-team.
<reassert w.-i
t-.
1
This issue is ^esit wlth at the three levels of Mshsllr
Mandrams
Ccm!mmity <>rgenfsers end Central Committee.
<
:‘.'t ?n. .,
a)
Staff end BeC,
•
« need meaavres to ensure Jeb^aecurity in terms of pay/leave
facilities and other benefits.
■— watched with the responsibility of work they undertake.
deciaiODMsakinq powers are to be delegated to these
staff.
• this* in other words eeana that there is a need for vore
£reedcss to innovate, with adequate backing by the CHDP.
» M.M. Staff should be aenbera of the Mahalir Kandran with
no voting rights to help more active involvement in M.M.
activities.
■
'
'■
■>■■■
b) CoCTnunjty Organlaogf •
• need akllls in community-heal th fnanageiaent to be able to
plan/monitor/evaluate work in the MMs.
- need akillmtraining in areas of promotion of paxticipation
and methods of identifying the needy in, and, needs of the
community.
— need not; iw nembers/holters of responsibilities in Mahellr
MandraiM<
\
«» need to take major responsibility in the field in matters
related to Accounting / reporting / co-ordinating activities
..2
4
2.
at the village level#
2
Central Committee / Mana<yB»ent / ^ctoini&txdtlon t
- needs adequate representation frexr all levels in addition
to tue present team forming the central committee (viz#,
CQfWfiunlty organisers / Medical officers / Co-ordinators
only)
- needs frequent meetings to solve internal tear, problems
satisfactorily, to develop a team-spirit and evolve group
leadership with management skills - so that problens
inherent in individual leadership are avoided in the
future.
- needs to decentralize respensibilities with adequate
decision making powers within the team itself.
- the accounting, record-keeping and reporting responsibilities
should be well distributed, preferably to staff separate from
other activities.
• a committee to be formed to study the oast records of at least
one to three years - to identify problems and problem areas
which require more attention.
- These should be prioritized and put into the action plans
of the next year.
- now, since fairly permanent staff are at the village level,
immediate steps tc be Initiated to ensure job-security.
there does not seen to oe a need for a Doctor to visit the
village clinics.
• A panel of local doctors can be formed to advise and help,
solving health-issues at the village.
- A good and satisfactory liaison should be developed with
local government and voluntary agencies for medical problems curative purposes.
3. Training Programs s
All the training pro rams need to I*? looked into by a corm? it tee
..3
I
i
<hlch focuses on
- need for training / relwanee,
< v *?
- content of training,
• training methodologies and evolving / integrating
newer r^ethodology.
• pre and post evaluation of training.
• on-going training,
training personnel other than CHOP staff. '
’ 8cope
- and any other relevant aspects.
’ft<r tMs «»t adequate Interaction for training can
** iS
This should font part of the next year’s plans.
teke place.
4. Reactions tc. the resp^uie
chop
to .arlior reports of
MR. Bhanuwathy Vasudevan and Dr. S.P. Tekur, and work
new phase in ChDP.
lan of
This follows the fox/nat of the response s
Page 3
y
Item No. 2
- Mahalir Mandtams conduct 7local activities
for only facjlltatory functions
and look
"■«■■ i J ftr**1* the community organisers*
Page 4
I
- Dlrec
r
“ *
0;
anlsational Mi vements
f w,
n W<
kers
- the MahalIr Mandrams should take up mainly local issues and
concentrate for sometime on them till some progress is made.
For example, a struggle for basic rights in
relation to a
specific pollution problem can be pursued till
a satisfactory
solution Is found* 1while
“ “ doing this, other general ecological
problems may be highlighted,j but need not be attended to
immediately*
Page 4
Item Not 1
* emphasis is required to accelerate the process of wearing
off CRS food through active steps taken so far.
..4
1
Iteir; No, 2 (contd,)
Page 5
- With reference to training women to take up activities generally
carried out by men, competition and confrontation is to be avoided;
rather, we should look for other areas where there is good employment
potential*
eg* Recycling of coconut—fibre wastes is worth pursuing as a major
women’s activity.
Page 6 »
Item No* 1 - Integrated Health Services >
- initially a prioritization of health problems has to be done.
Then, a planned intervention with Integrated Health Services
is to be promoted to solve specific problems.
Item Np, IV i Collaboration with C.AtT, i
Page 6
- items related directly to women's problems like smokeless chulas /
water—management / Bricket making and sanitation should get a
priority*
J tern Eo, IV : Cultural groups
Page 7
t
- this should form a major focus of M*M* activity, with popular!sution
of folk media, and encouraging people to •specialist in various
art-forms to carry health messages.
Place
:
Bangalore,
Pate
i
Jo N<^90
-
-
DR. V. BEKJAMIN.
APPEi.’DIX
•N’
COEEbNITY HBALTE DEVELOPMENT PBOGRAKKB
Reiport on the EVOLUTION OF C.H.D.P. with details of DECENT* A LIS ATIO N
A short summary of the history and the ongoing structural change
will show that the programme has continously adjusted itself to the needs
of the people,
At it’s stage this has been studied and evaluated, and
has been a preparation leading to the decentralisation towards local
Women(s Associations.
- The programme started in 1971 with an intensive preparation of village
surveys with the help of the voluntary services of local educated young
girls and women.
- By April 1972, the first under 5 clinics with a C.R.S. applied nutrition
programme were organised through Mobile Health teams
coastal villages.
mainly in the
Short training courses were held during the weekends.
- By October 1973, we were feady to start the first 5 months Residential
Training course for health workers.
•
- Since it became more difficult to obtain the services of qualified
nurses, from August 1975i the already trained health workers continued
their training as H-ealth Guides following the syllabus of the
Government A.N.M. (Auxiliary Nurse Midwife) with additional subjects
leadership - Village situation etc to
as -Community Organisation -
prepare them as team leaders in the H-ealth centres.
With the 25 paise scheme of which details follow below, Health
Education
not only to the women but to the you&h, children was the
felt need.
To answer this need a training course of 4 months prepared
the
already trained H-ealth workers or unemployed graduates for giving
health education in schools, nylon net webbing and other craft centres.
This was temporary since after a few years it was felt that the teachers
themselves were the right persons to do this and on the contrary made
use of the C.I1.D.P. Health Educators to take for themselves, more free
time and leave.
With the mechanisation of nylon net webbing all this
coastal women lost their employment and these centres closed down one
by one.
With the evaluation of the programme towards more awareness/
education and looking for income generating activities
same time answered a need in the village^
which at the
the course for Women Animators
was conducted from 1986 onwards.
- From October 1973 till 1980
215 followed the five month’s health worker training course.
- From August 1973 till December 1983
299 were trained as Health
Guides (a course of one year duration)
- From 1975 till June 1979
91 Health Educators participated in a
months training course.
2
- From February 1986 till December 1989
/’j Jonen animators followed a nine months course.
L'-c- follower a course for A’ursery teacher
70p followed one O the
different courses.
2y July 1974, after 2 years of health and nutrition education, the need
was felt to do somethinp about it, from which originated the <25 pai6e
s^eme-.
nil the women pooled together 25 paise twice a month.
The
Women's contribution was around Bs.l8,000/- a month which was divided in
o votes so that 6 Health Centres at a time could start with the
implementation of the most needed development
The women themselves
drainages
programme related to health.
decided on uhe priorities - cleaning of public wells,
latrines
Community centres etc.... After the first round
of all the votes in the villa/;es trie 25 puise scheiae continued
us
’the villa e development fund'
- ?rom 1976 the villa e development fund and an additional fee of 50
raise per clinic (twice a month) made it possible to start working
wita residential health Teaflis
in the villages. This answered the
need of a continuous presence for preventive health
care and education,
by January 1978 there were Residential health teams in all
the villages.
During this period there were Jp9 trained full time workers and an
Cti e.oie.12
average of 3 or 4 centrethere were about 3ZK) voluntary village workers,
After 2 to 3 years of inservice training, the voluntary village workers
followed one of the Lon£; training courses.
There has hever been any
appointment node in the history of SHJB since the goal was to rive a
preparation for life to as many as possible educated youth in service
to the larger cor.iwunity. At the time of rn-arriage tx.e health workers
of all catagories l^ft the programme and were continuously replaced
by the inservice trainees.
- By 1930, different factors pointed to a further move for more direct
participation/ of the wo ue n #
Through the transfer of the funds still pooled together to their own
local centres.
The programme so far was served by un-raarried educated
young women who
followed the training courses in preparation of their future life
and in service to the community, they were living in small groups of
p to 5 in different localities in rented houses or community centres.
Due to the worsening economic conditions of the people which affected
mostly the women, so that even without employment, there v/as little
chance of a marriage partner, the Health team meters then in service
demanded to be allowed to continue their service after marriage. This
could only be possible through local i*ahalir Mandrams and on a basis
of self reliencp. TH
f-ie first health Guide who wanted to continue a er
service postponed her marriage till the local
nahulir Mandram was
1
- 3 registered.
It was at that time that all
Health team members signed on
agreement (resignation letter)
that if they continued to work after their
marriage they would be the employees of their local hahalir handram
and
De relieved as KCSD- CnDP health workers.
The Ci-.Dp section co-ordinators and
community organisers continued
their service directly uncxer ICSoS—CxIDP since
they were not related to
any Kahalir Mandram.
During this transition period the
animators, and Community Organisers
evolution.
presence of the GULP Co-Ordinators,
was essential for bringing about this
This Decentralisation took nearly 4 years from July 1980 till
March 1984 to be completed and to start a
PHASE
of Community
Health and '.‘/omen 's Organisation through ’Women’s Association ’
and from
that time no new Health workers have been taken in the
programme.
ixs on 30.6.1990 there are: 136 Health Guides
73 Women Animators and
12 Health workers
24l Total Health team
members are working
in 85 teams, under 92 registered liahalir Mandram.
We hope this above report gives the evolution
of the C.H.D.P.
specially related to the workers at all levels,
All of them know
very well about the conditions and possibilities of work
—and we are
sure that our creative social health services onld
^can earn the credibility
and support of the people-^-
\z (SasIv'Cc^l
13.12.‘90
C.H.D.P. Co-Ordinator.
APPENDIX
J
•O'
COMMUNITY HEALTH DEVELOPMENT PROGRAMME
A UNIT OF KOTTAR
SOCIAL SERVICE SOCIETY
NAGERCOIL
THIRUMALA?
ASHRAM
SOCIAL
CENTRE
CHUNKANKADAI P.
p. 0..
o.. 629807
TAMIL NADU, S. INDIA
Date
CONSOLIDATED REPORT OF THE MEETING WITH THE COMMUNITY HEALTH
CELL AND C.H.D.P. ON JANUARY 2 & 3rd JANUARY 1991 AT BANGALORE
The team from Community Health Cell were:
1. Dr.Shirdi Prasad Tekar
2* Dr.Benjamin &
3. MsrThelma Narayan.
The C.H.D.P. were:l.P.Sarasam
2. C.Alphonsal
3. Sr.Tresa.
On the whole it was an informal session with sharings, questions
and clarifications in connection with the visit of Community
Health Cell to C.H.D.P. in K.K.District# More clarifications
and discussions on the following topics were done.
- Decentralization
of C.H.D.P.
- Functioning of Mahalir Mandrams
-Job Security for village Health Teams
- cohort study conducted by C.h.D.P.
Two days dialogue was summarised under three main headings:
1. Mahalir Mandrams and its functions
2. Health Programme and its perspectives
3. C.H.D.P. - the Central staff and its task
1* Mahalir Mandrams:
- Strengthen Mahalir Mandrams with regular classes on history
goals, and strategies of CHDP to have a common understanding.
- Initiate them to Income generating programmes: Mahalir
Mantrams or co-operatives.
J
/'
%
- 2 -
- Classes to be organised for Mahalir Mandram committee members
and representatives in the village level as well as in the
central level*
- Select the active Mahalir Mantrams and give special guidance
and support to their programmes*
- Mahalir Mandram membership should not be related to CRS
beneficiaries as they are only temporary in the programme «
Also there has to be an equal representation of working women
and House wivies*
- Need a followup of all ex-trainees of CHOP and participate
them in and Mahalir Mandram activities in order to
utilise their training for the people.
— At least 2 representatives from Mahalir Mandrams have to
be included in the core group of CHOP.
- Each Mahalir Mandram can concentrate on one important issue
their area and work towards solving the problem with
the help of other Mahalir Mandrams as and when needed.
- Two or three Mahalir Mandrams can join together to start
co-operatives or work on interested projects like kitchen
garden, small saving scheme. credit union etc*
Make a survey of Mahalir Mandram members with a short
questionnaire on women’s needs, problems and suggestions to
solve it*
— Mahalir Mandram health teams also need updating and ongoing
education in health and other programmes of ^ahalir Mandrams.
- There is a need to have common perceptions for Maftalir
Mandrams and its workers about the programmes *
11• Health Programmes
Evaluate the medicine supply in each centre by the followup
of 2 weekk medicines given; how it is used, its
effectiveness and other sources X utilised for the same.
Introduce wholistic health programmes for preventive and
promotive health*
j
A
3
Innunization has to be made available
to the people by
constant contact with PHCs and organise protest rallies
when needed.
Introduce school health programmes. Check the healthy
atmosphere in the schools, class room, ventilation,
clean water supply. Latrines, play grounds, library etc.
Find out interested teachers and train them as health
promoters in the schools.
- Make known CHDP’s g±x goals and the present work, to the
Government hospitals, privatei hospitals, and other
health officials for referal icases.
Instead of being satisfied with one part time doctor,
have contact with a team of doctors who have the social
orientation, including a Gynacologist.
Form a cultural group for education and conscientisation.
Investigate the possibilities of reducing the price of
"Health mixM with few grains of nutritive values.
III• Community Health Development Frogramme
(G.H.L.P.)
group, Community Organisers
Proper documentation and reports on all activities have
to be maintained in the central1 level. i.e. Leprosy
patients contacted. Filariasis study report, Mahalir
Mantram participation in local issues etc.
A small group has to be
given responsibility to study
three years reports and draw out emerging trends.
Three days seminar has to be arranged for CHOP for
management skills and group building by an outside resource
person. This will facilitate open dialogue, sharing and
a new leadership has to emerge from the group to fill the
gap, of leadership. The names suggested as resource
persons are Ms. Bhammathy and Ms. Valli.
CHOP has to find a better net-work of relationship
wi tn
other organisations and groups of same orientation
4
(specially health).
The present work with CAT and PHD
(Programme for human development) is appreciated much.
Tap the Government resources: Central, State, District
and block.
Ongoing education and training of CHDP Community Organisers
has to happen within CHDP and with other organisations.
Also CHDP Community Organisers can be resource persons
for other agencies#
Pre-planning and post evaluation is a must for all training
programmes.
New methodologies and scientific datas has to be introduced in the training programmes - especially in health,
Build up a healthy relationship wicnin
within we
the aiocese,;
diocese.
explain the vision, goal and strategies of CHDP wherever
needed*
CRS Programme and KSSS seems to be hindrance in the growth
of CHDP into an independent women's movement.
(There is
a lot of paper work and other records to be maintained
by CRS which does not free the Mahalir Mandram teams for
other involvements.
CHDP Community Organisers need to come up with new ways of
growing together, standing together in solving problems.
CHDP has to emerge into women’s movement with linkages of
state and national women’s movements#
Position: 4700 (1 views)