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Organisational Capacity -F
Women’s Health
16 -22 July 1993
' Bangalore ■
1
What is ‘WAH’!
The ‘Women and Health Training Programme' (WAH!) has its genesis in a
consultation of NGOs representatives and experts from training institutes held
at Surajkund, (Haryana) during November, 1992. The Surajkund consultation
examined the health care scenario in India and women’s access to the health
care system. It was felt that women’s experiences in health needed to be
located both in the context of gender relations and macro level socio-political
economic realities.
The ‘WAH’ group sees the need for synthesis of the following components'
within women's health care programmes :
*
i
expanding the definition of women’s health beyond just maternal and child
health
*■
■
examining the gender relations within health rather than focusing on women
in isolation
*;
'
an appreciation and commitment to build on local health traditions, self help
and capacities
*
organising gender-sensitive management training to help health managers
especially, women to manage health programmes.
To promote this synthesis 'WAHI' is initiating a long term phased training
programme on “Women and Health" for persons working in NGOs.
Membership in the group has been evolving, women and men who have been
working in any (or many) of the above four areas or are concerned about
them are part of this network.
(The Core Group formed at Surajkund completed its task of compiling the
three modules and has now been reconstituted to take the task of organising
the long term training programme ahead. The new core group members are
mentioned in the report).
WAHI’s Aspiration/Aim/Expectation/Intention
“In five years, WAHI aims for multiple womens health programmes being
implemented in various regions with feminist perspective and in which'
traditional practises are valued and used in programmes which are
managed and even headed by women”.
2
A REPORT OF
THE EXPERT MEETING ON BUILDING NGO’S
ORGANISATIONAL CAPACITIES FOR WOMEN’S
HEALTH
JULY 16 - 22, 1993
INSTITUTE OF ADVANCED STUDIES
BANGALORE
INDIA
WITH
A REPORT OF THE SUBSEQUENT “WAH!” CORE
GROUP
MEETING AT BOMBAY
AUGUST 17 - 18, 1993
“WAH!” Secretariat
CHETNA (Centre for Health Education,
Training and Nutrition Awareness)
Lilavatiben Lalbhai’s Bunglow, Civil Camp Road, Shahibaug
Ahmedabad - 380 004, Gujarat, India
Phone : 866513 : 866695, Gram : CHETNESS
Telex : 91-121-6779 CEE-IN and 91-121-618 RASA IN
Fax : 91-272-866513 and 91-272-420242
f (j Z
“In Co-operation with DSE”
Ki
Deutsche Stiftung fur Internationale Entwicklung (DSE)
German Foundation for International Development
Breiie StraBe 11, D—10178 Berlin (Mitte), Germany
Phone : 23 11 92 20
Telex : 2627-308120=DSEBLN, Fax : 49-030-23 11 92 22
23 11 91 11
October, 1993
3
,
- I
oocu^AT'° 7^ /
J’L—•
TABLE OF CONTENTS
1.
OVERVIEW
1
1.1 Background of the workshop (concern of DSE (ZG) and groups)
1.2 Surajkund workshop: November, 1992
1.3 Core group meeting at Ahmedabad, April, 1993
2.
THE WORKSHOP AT BANGALORE; JULY, 1993
3
2.1 Core Group Meeting
2.2 Expert Group Meeting
2.3 Task group follow-up meeting
3.
COMMENTS/SUGGESTIONS ON
“PERSPECTIVE” AND “MODULE OUTLINES”
3.1
3.2
3.3
3.4
3.5
5
The Feminist Perspective on Women’s Health
The Module on Women’s Health Concerns
The Module on Building Women’s Capacities to Preserve Health
The Management Module
Integration of Modules
4.
FINALISATION OF THE MODULE
11
5.
IMPLEMENTATION STRATEGY
12
6.
SELECTION OF COLLABORATING NGOS
13
6.1
7.
Suggested criteria for selection of collaborating NGOs
ORGANISATIONAL DETAILS
7.1
7.2
7.3
7.4
14
Core group
Core group composition
Regional group : Role/Need
Resource group
8.
FINANCE
17
9.
FEEDBACK AT BANGALORE : THE EXPERT MEETING
18
10.
CONCLUSION/FUTURE DIRECTIONS
19
11.
AFTER THE BANGALORE WORKSHOP....
20
LIST OF ANNEXURES
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
Surajkund Core Group Composition
List of Participants
Perspective Paper
Module on Women's Health Concerns
Module on Building Women’s Capacities to Preserve Health
Module on Management of WAH!
Programme schedule
National level Core Group Meeting at Bombay
4
22
23
29
40
56
71
79
81
ABBREVIATIONS USED
AIDS
- Acquired Immuno Deficiency Syndrome
ANC
- Ante Natal Care
ADS
- Academy of Development Science
A1KYA
- (Unity) Field Based Training Organisation
C1NI
- Child In Need Institute
CHETNA
- Centre for Health Education, Training and Nutrition Awareness
DSE
- German Foundation for International Development
DDS
- Deccan Development Society
ERT
- Estrogen Replacement Therapy
IIHMR
- Indian Institute of Health Management and Research
IW1D
- Initiatives: Women In Development
ISM
- Indigenous System of Medicines
JAGORI
- Training and Documentation Centre
LSPSS
- Lok Swasthya Parampara Samvarthan Samity
LHT
- Local Health Traditions
MASUM
- Mahila Sarvangi Utkarsh Mandal
MFC
- Medico Friend Circle
NGO
- Non Government Organisation
NIN
- National Institute of Nutrition
PNC
- Post Natal Care
PR1A
- Participatory Research in Asia
STD
- Sexually Transmitted Diseases
SEWA RURAL - Society for Education Welfare And Action - Rural
SEARCH
- Society for Education, Action and Research in
Community Health (Gadchiroli)
SHSD
- Society for Health and Social Development
SEWA
- Self Employed Women's Association
SNDT
- Smt. Nathiben Damodardas Thackersey University
SWDF
- Sadguru Water and Development Foundation
SWACH
- Sanitation Water and Community Health
SAHAJ
- Society for Health Alternatives
T.B.
- Tuberculosis
UTI
- Urinary Tract Infection
UNNATI
- Organisation for Development Education
WHODSIC
- Women Households Development Studies information Centre
ZG
- Public Health Promotion Centre of DSE
5
1.
OVERVIEW OF THE PROGRAMME
1.1
Background of the Workshop (Concern of DSE/ZG and groups)
The German Foundation for International Development (DSE), Public Health
Development Centre (ZG) regularly conducts dialogue and training programmes
in Primary Health Care in many countries.
Since the important role of women in the development process and especially,
in Primary Health Care Services has been more and more recognised, DSE
also organised several events on behalf of “women in development”.
In 1988, a conference, entitled “Towards Progress in Women’s Rights and
Social Status in Developing Countries” was organised and in 1989, another
conference was held on “Women in the Development Process”, which focused
on three problems.
- strategies and programmes for women in the agricultural sector
- the effects of modernization process on women and the counter strategies
developed by the women’s movement and by government organisations and
- the impact of debt and crisis management on women with special reference
to the subsistence work of women in the informal sector.
The main consequence for DSE was drawn out of the finding that there are
urgent requirements for training of women the field of management and
organisation building.
Subsequently at the end of 1989, in an expert meeting an analysis and
assessment of training programmes for women was made, in order to develop
programmes to strengthen the organisational and management capacities of
women.
To specify the training needs of women in non-governmental organisations in
India and Nepal, in 1990 a needs assessment was done by Ms. Asha Kachru
to identify specific requirements.
In 1992, it was decided to develop a long term training programme for women
in Non-Governmental Organisations (NGOs) linked with Primary Health Care
(PHC). Though India has accepted the PHC-strategy as a guideline for health
policy, the practical implementation has been hampered by a number of
difficulties which are mainly the lack of political decision-making power at health
infrastructure, insufficient education and training of health personnel being other
responsible factors.
1.2
Surajkund Workshop ; November, 1992
Based on the needs assessment, a planning workshop ' on 'Management of
Primary Health Care Programmes’ was held at Surajkund, Haryana, during
November 1992. The main objective of the workshop was to elaborate a
framework for designing a comprehensive training programme aimed at
strengthening the organisational and management capabilities of women in non
governmental organisations which are conducting Primary Health Care
Programmes with a focus on women’s health services and activities.
1
During the deliberations of this workshop, specific topics which should form the
training programme were finalised, which were later incorporated into three
training modules. These were :
- Women’s Health Concerns
- Building Women’s Capacities to Preserve Health
- Management of Women’s Health Programmes
A broad outline of the framework for the above modules was discussed, in
which specific objectives, perspectives and topics were suggested for each
module separately. Strategies and methods for the training programme were
also elaborated in general.
At the end of the workshop, a core-group was identified to build upon the
process of module development, to keep contact and exchange information.
In addition, three task groups were also formed to develop the first draft of the
detailed training module, identify participant NGO groups, collect relevant
resource materials, and identify resource persons. Task group co-ordinators also
collated the suggestions received by the participants/resource persons.
The core group was constituted by including the co-ordinators of the task
groups and some other resource persons (for list see Annexure - 1).
The task groups were co-ordinated by Ms. Mirai Chatterjee, SEWA (Women's
Health Concerns), Vd. Gangadhran, LSPSS (Building Women’s Capacities to
Preserve Health) and Ms. Renu Khanna, SAHAJ (Management of Women’s
Health, programme). The overall co-ordination of the core group was done by
Ms. Indu Capoor from CHETNA. The other task group members who
contributed to writing the modules are given Annexure - IA).
The following decisions were also taken at Surajkund:
- After the first draft of the training module outlines was ready, a core group
meeting would be convened by Ms. Indu Capoor at Ahmedabad, to discuss
the module drafts.
- A second Core-group meeting would be organised with DSE in Bangalore
immediately prior to an expert group meeting.
- An expert group meeting would be organised in Bangalore with DSE,
comprising of persons with experience and background in the fields of
women’s health, management and traditional Indian medicine.
1.3
Core group meeting at Ahmedabad; April, 1993
The first core group, comprising of the task group co-ordinators, met on 26 28th April 1993 at Ahmedabad to discuss the draft of the module outlines, so
that they could be prepared for the experts meeting.
CHETNA team members (Ms. Pallavi, Ms. Jyoti and Vd. Smita Bajpai) also
joined the meeting. A tentative list of participants to be invited for the experts
meeting at Bangalore was finalised. Along with the outline of refined modules,
the list was shared with Ms. Erika Fink of DSE for inviting the experts.
The module outlines were shared with the various expert invitees and other
core and task group members so that they could come prepared with
comments and suggestions at the Bangalore workshop.
2
2.
THE WORKSHOP AT BANGALORE; JULY, 1993
The Expert Meeting on Building NGO's Organisational Capacities for Womens
Health was arranged at Bangalore in the form of a three day workshop bringing
together about 36 persons of diverse experiences in the fields of health,
education, womens development and management. This workshop was
proceeded by a two day preparatory Core Group Meeting of the Women and
Health Group (WAHI) and followed by a two day winding up session by core
and task group members.
The objective of the whole three-part week-long experience was to continue
and concretize a process initiated in November, 1992 at Surajkund, in co
operation with the (ZG) of Germany (German Foundation for International
Development). The process launched is an initiative to develop a long term
training programme for India and Nepal, involving NGO’s in Management
Training for Women in Womens Health.
The specific aim before the experts was to develop and substantiate three
training module drafts prepared by three task groups in Surajkund and take up
other logistics of the planned programme so it could begin by early 1994.
The basis principles and contents of the modules were discussed in the initial
core group meeting. After incorporating their comments and suggestions, the
enriched modules were presented to the larger forum of Experts. The
participants discussed the content and implementation strategy of the modules
in large and small groups which subsequently resulted in finalisation of the
modules, the draft perspective paper and implementation strategy.
After exhaustive deliberations, discussions and debates, the comments were
incorporated in the modules. The budget/finance could not be.finalised in the
expert meeting due to time constraints.
2.1
Core Group Meeting at Bangalore
This meeting was held on 16-17th July 1993, prior to the expert meeting. The
objective of the meeting was to discuss the perspective and deliberate on the
modules prepared, to be presented in the expert group meeting.
This meeting constituted mainly of the core members alongwith some experts
on the subject. In the core group, the draft of the ‘Perspective Paper’ and the
outlines of the modules on ‘Women’s Health Concerns’, ‘Building Capacities to
Preserve Health' and 'Management of Women’s Health’ programmes were
discussed at length and enriched for the presentation in the expert group
meeting.
2.2
Expert Group Meeting
In this meeting, 36 experts representing the areas of health, nutrition, women’s
development and management participated. It was a mixed group of men and
women (see Annexure - II).
Ms. Erika Fink, who had been involved as a representative of DSE from the
initial planning stages of programme warmly welcomed the participants and
explained the aims, objectives and activities of the German Foundation for
3
International Development (DSE). Ms. Indu Capoor, co-ordinator, presented the
detailed background information on the process since the workshop in
November 1992 at Surajkund and, the objectives of the present Experts
Meeting.
Objectives of the Experts Meeting
The main objective of the expert meeting was to discuss the draft of the
perspective paper and enrich the three modules on Women's Health. The
specific objectives were :
- To develop the three training modules
- To shape the long term dialogue and training programmes
- To identify NGO participant group for different programmes.
2.3 Task Group Follow-up Meeting
The objectives of the task/core follow-up meeting was :
To identify resource persons for the training.
To suggest methods of monitoring and evaluation.
To elaborate on the time schedule.
To plan financial requirement for the programme.
To set the tone for the meeting and to know each other, participants introduced
themselves, their background and work experience.
4
3.
GOMMENTS/SUGGESTiONS ON “PERSPECTIVE AND
MODULE” OUTLINES” :
The suggestions/comments given by the core group as well as the experts
group are as follows, based on which, the small groups worked to further
enrich the perspective and modules.
3.1 Th? Feminist Perspective on Women’s Health :
Dr. Mira Shiva and Ms. Asha Kachru had prepared a draft perspective paper
which was discussed in the core group prior to the Expert Meeting.
Suggestions of the core group
- The. perspective paper was seen as a connecting thread between all three
modules to guide the development of the training-programme. - " • ---•
- The perspective was expected to focus on the broader scenario of health
situation and then narrow down to specific aspects.
-
Health perspective should be seen within the dynamics of class, caste,
gender, patriarchy, division of labour and ecological aspect.
-
More additions to the content such as the feminist definition of health,
militarism, violence, effect of family and education, sexuality were suggested.
— Appropriate reorganising and sequencing of the perspective content was
suggested.
Suggested Diagramatic Representation of the Perspective on
- Women’s Health
\/|OLENCE
Based
on
the
above
comments from the core
and expert group the
perspective was enriched
(See Annexure-III).
5
3.2
The Module on Women’s Health Concerns :
Suggestions of the Core Group
-
Many topics were suggested by the members so as to develop/enrich the
content of the module.
-
It was felt that the module should begin with the presentation of a
conceptual understanding of gender and patriarchy and its impact on health.
- The “Girl Child” phase was sub-divided according to age and socio-health
issues were dealt with accordingly. It was suggested that health and nutrition
related factors such as public distribution system, water politics, women and
workload, environmental factors (such as pesticides) emotional stress, medico
legal aspects, traditional food practices, taboos, should also be included.
- The topic of “reproductive" health and sexuality was discussed at length. Its
multiple facets, such as population politics, population control, contraception.
MTP, fertility awareness, sexual abuse, sexual assault, control of womens
sexuality and sex practices were incorporated. That women are aware of
their right to demand, initiate and assert their rights in the area of sexuality
was also debated.
A sequence for the framework of working on the perspective was suggested as
follows :
*
Problems - present status of women's health
*
Analysis - causes, concerns
*
Perspective - definition
*
Issues of women’s health in development theories (analysis)
*
Feminist perspective of women’s health
*
Approach to address the causes (issues)
Dr. Mira Sadgopal and Ms. Abha Bhaiya volunteered to work on the Feminist
Perspective and present the same to the larger group of experts.
Suggestions/Comments of the Expert Group
The experts provided more insights to ensure a complete picture of the
perspective on women's health. The entire experts group together, went
through the refined perspective presented by the core group members and they
discussed and debated on various issues. The following was the outcome.
General
- The perspective highlighted a macro picture of the problems. There was a
need felt by the participants to “flesh it out” so as to make it useful for
policy analysis, e.g. In the policy of Child Survival and Safe Motherhood
(CSSM), some policies meant for women, sometimes worked against women,
g. contraceptives usage was encouraged only for women rather than male,
e.
though they are more safe. These were considered crucial concerns to be
addressed.
6
Specific
-
In addition, inclusion of few more topics was suggested :
a. Details of feminist strategies, research, process, women's struggle for
various causes
b. Micro level case studies and its analysis
c. Regional case studies, highlighting realistic situations
d. Assertion and image building
e. Psychological process
f.
Economic and social marginilisation
g. Politics of health
-
Legal aspects related to maternity rights and benefits and division of labour
were incorporated.
-
Negative portrayal of women by media, unnecessary surgical interventions,
Hormonal replacement Therapy (HRT) were some of the topics suggested by
the core group members.
The module enriched by the core group ensured an inclusion of an overall
comprehensive picture of all the issues related to women's health. The
suggestions made by the core group members were related with content,
ideology, social conditions, legal aspects, violence - especially family violence,
ecological destruction and demystification of medicine. This module was later
presented in the expert meeting to receive more inputs in the larger group.
Comments/Suggestions of Expert Group
- It was felt that the module must identify research areas where enough
knowledge does not exist, it was also felt that it should also provide a
feminist critique of the health policy and health delivery systems.
- Other topics suggested to be included in the module were, addressing
emotional health during adolescence and aging, endometriosis and
tuberculosis and their link with fertility and other diseases, child abuse and
battering. Women and disability, women and work were suggested for
inclusion by the group.
This was further enriched in the small group which met to discuss the strategy.
The enriched module is enclosed (see Annexure -IV).
3.3
The Module on Building Women’s Capacities to Preserve Health
Suggestions/Comments of Core Group
This module focused on the traditional methods of preserving health and
strengthening of women's self help potentials. Water and sanitation was also
included as it was considered an important aspect of health preservation. The
other comments on the module were as follows :
- In order to make the objectives of the module more clear, it was suggested
7
to include a brief background on the importance and rationale of using
traditional systems of health care. In this context it was agreed that the role
of indigenous health practises are viewed in perspective in terms of training
and focusing on aspects which are beneficial and rejecting the sexist,
superstitious practises.
Since alternative health care system included a range of healing approaches
which are region and culture specific, the module needed to be flexible to
incorporate this diversity and drawing upon these varied sources be it
homeopathy, herbal medicine, accupressure, Marma Vidya, meditation etc. It is
necessary to have a holistic approach. This does not mean having an
aggregrate of healing components. It involves diagnosis and work with global
perspective of the person as a total being situated in her/his specific socio
economic physical and psychological context.
It was also felt that the module needed integration of :
a. Allopathic practices with Ayurvedic & Traditional practices
b. Areas that are overlapping, with the module on women’s health concerns.
Dr Shanti Ghosh cautioned the group to also keep in view the limitations of
traditional medicine in acute and emergency cases and not get carried away by
its usefulness. Dr Veena Shatrughna expressed her doubt regarding the
integration.
Comments/Suggestions of the Expert Group
A general consensus was that, knowledge of traditional sciences expower
women to look after their own health and that of their families and
communities. Based on this view, the following was suggested.
- The module focused on curative aspects as, it was organ based. It was
suggested that, an attempt should be made to integrate preventive concepts
like self help approach and useful local health traditions.
- The perspective should clearly highlight, that the reason for promoting
traditional practices was not because of its alternative status but because it
led to the empowerment of women.
- Anatomy & physiology should be described as 'body structure & function' &
should be based on the “chatras” & “meridian” approach to understand
traditional practices like reflexiology, accupressure etc.
- Apart from the use of traditional medicine, folk dancing, body awareness,
rhythm & meditation, yoga, spiritual health, humour should be encouraged.
-
It was cautioned that it is necessary to evolve a decision making criteria so
as to be able to appreciate the limitations of traditional and allopathic
systems.
- The module must also focus on the harmony of themind & body, specifically
evolving
a
healthy
healer-healee
relationship
and
prevention
of
commercialisation of indigenous systems.
These comments
Annexure - V).
were
incorporated and the
8
modified
module
is
in
(see
3.4 The Management Module
It was felt that values of the feminist perspective of Management should be
reflected throughout the training programme. The group discussed the feminist
management principles at length and some outcomes expected in a women's
health programme were accountability, demystification, value of shared decision
making and, mutual respect for everyone concerned. Other criteria were listed
as follows :
’
Collective functioning
’
Shared leadership
’
Shared responsibility
*
Decentralized
’
Opportunity for development of human potential
*
Empowerment of women
*
Non-gender division of labour
*
Connection/Harmony with nature
(a) Decision making
(b) Control of Assets
In addition there was a need to address/change the duality of masculine and
feminine principles to bring about an equilibrium between :
Mind
Body
Rationality
Emotion
Competition
Harmony
Qualitative change
Profit and Production
Process
Target
There was a strong plea by the experts present that these values must be
incorporated in the :
*
Design and delivery of the module
Process of selection of NGOs to minimize the conflict and duality that could
arise out of differences between organisation and programme management,
when women become articulate.
Suggestions/Comments of the Core Group
Due to time constraints, this module could not be discussed in detail. However,
the core group felt that the module has to be viewed from a feminist
perspective which appeared to be lacking.
The members worked on the module based cn the suggestions and then it
was presented during the experts group meeting.
Comments/Suggestions of the Expert Group
Managing women’s health programme was identified as one of the crucial areas
for which women's capacities had to be developed. The design and the layout
9
of the module needed to be altered. It was suggested that the design of the
module should begin with understanding self and others, managing group
processes and proceed to project and programme management. The
management of external environment should be taken up last.
Specific comments were as follows :
-
Each concept should be redefined and analyzed from a feminist perspective.
-
Experiences of women's groups as managers needs to be included.
- There should be an appropriate balance between idealistic and realistic
vision.
- The module must also address the conflicts between the women’s health
programmes and organisation and, their interfacing with the government
health system.
- It should be kept in mind that as women are more comfortable with the oral
form of communication, for which appropriate documentation should be
ensured.
- Gender issues in all areas of management should be clearly focused.
- A planning of the follow-up activities should also be included.
- An attempt has been made to incorporate
addressed both to men and women.
in
the
module
should
be
An attempt has been made to incorporate all the above suggestions in the
module, (see Annexure - VI)
3.5
Integration of Modules
It was felt that several content/concepts in the three modules were overlapping
with each other. A need was expressed to integrate them so as to avoid
repetition.
The members suggested the integration of the module on health concerns with
that of building capacities and later on, with some parts also with the module
on management. Common areas identified were, anatomy and physiology of
the human body and its function, socio-cultural factors, nutrition, maternal
health, reproductive health and sexuality, misuse of modern medicines, etc. It
was felt that this would avoid repetition and reduce the time-period required for
the training.
10
4.
FINALISATION OF THE MODULE :
The participants were divided into four groups based on their expertise and
preference. These groups worked at length on the guidelines given to them and
the following was the outcome :
a.
Finalisation of the Content :
The groups scrutinized the content
appropriate additions to the content.
b.
of
the
module
in
detail
and
made
Sequencing :
The members organised the topics of the module ensuring continuity and inter
linkages.
c.
Prioritisation :
The essential areas to be covered on a priority basis were also identified.
d.
Time estimation :
The time required to cover the content of each module, topic wise, was
estimated.
e.
Integration :
Areas overlapping amongst modules on Women’s Health Concerns and
Preserving Women's Health were identified for integration, e.g. Nutrition,
Maternal Health and Reproductive health concerns.
11
5.
IMPLEMENTATION STRATEGY :
The participants felt that the programme should be implemented in a phased
manner. It was suggested that the phases could include:
*
Phase 1
- Feminist Perspective/
Approach Process
Understanding of self &
Others (Co-operation)
Overview of Programme.
*
Phase II
- Women's Health Content
(Women's Health Concerns
& Building Women’s capacities to
preserve health).
*
Phase III
- Management Skills
Management/organisation of
women's health programme.
However, it was stressed that there should not be a gap of more than three
months between each of the phases. Regularity of participants in each phase
was essential. It was suggested to divide the training programme into three
phases. The integration of the women's health perspective was considered
important in each phase.
There was a lot of debate and discussion on the implementation of the training
programme' whether to start at the National level or at the Regional level.
Majority of the participants felt that as the expected trainees from the NGOs
participants would be more familiar with the local language it would be more
effective to start the training at the Regional level. The experiences of the
regions could be later shared at the National level.
The participants also debated on whether to mention the word “feminist
perspective” in the title of the programme and it was decided not to do so
strategically, as it may keep away individuals/organisations who do not have a
clear idea of feminism.
It was suggested that NGO participants must be contacted individually to
enquire whether they would like participate in the programme. Based on
individual needs, the course could also be condensed into smaller modules.
12
6.
SELECTION OF COLLABORATING NGOs
Since the effective implementation of any programme depends on the
organisation implementing it, it was suggested that a careful selection of
collaborating NGOs is essential.
6.1 Suggested Criteria for selection of collaborating NGOs
To ensure that women’s health programme is implemented with the correct
perspective at the grass-root level, it is important that appropriate selection of
the participant NGOs is done. To facilitate the regional groups to be able to do
this selection objectively and effectively, a list of criteria were suggested by the
experts.
The suggested criteria based the order of priority/rank are as follows :
-
Should have an experience in women’s issues
- Should have an experience in women's health
- Should be committed to women’s health and empowerment
- Should have credibility
- Should have an experience in community health
- Should have
programme.
an
experience
in
implementing
socio-economic
education
- Should have training and organising capacities
— Support organisations
preferance.
with
based
field
experience
- Grass-root level groups should have been formed.
13
should
be
given
7.
ORGANISATIONAL DETAILS
A core group was formed as a central body to assess the progress of the
activities of the programme. Regional core groups were also formed, headed
by co-ordinators, who would carry out the implementation at the regional level.
Resource task groups were formed who would work on the content of the
modules, identify areas which could be integrated and suggest resource
persons.
7.1
Core Group
Expected task of the core group
- Co—ordinaie/take the process ahead at the National level and Nepal region.
-
Review and finalise a design based on suggestions made by the regional/
resource groups.
-
Develop and suggest integrated training designs
-
Create and provide pre/post training design support
- Conduct on going review of the implementation of the regional courses.
-
Prepare a time frame and an action plan for the training courses.
-
Suggest Budget implications/financial planning for the implementation of the
courses.
It was suggested that the core group co-ordinator would co-ordinate/
interact with :
-
Relating with DSE (Erika Fink)
-
Relating with Regional/Resource Groups (including Nepal)
-
Relating with core group members
7.2
Core group composition
Co-ordinator
Ms Indu Capoor, CHETNA, Ahmedabad
Members
Ms Ranjani IWID, Madras
Mr Gangadharan LSPSS, Coimbatore
Ms Anu Wakhlu, Pragati Foundation, Pune
Ms Renu Khanna, SAHAJ, Baroda
Ms Philomena Vincent, SHSD/AIKYA, Bangalore
Dr Mira Shiva, VHAI, New Delhi
Dr Sharad Onta, Nepal
Dr Mira Sadgopal, Pune
Since the Expert Meeting completed, the core group met on August 17/18 at
Bombay (for details see Annexure - VIII)
14
7.3
Regional Group : Role/Need
As it was expressed that initially the programme should be implemented at the
regional level it was decided to form a regional group that would have the
following responsibilities.
Responsibilities
-
Identification of NGOs in their region
- Integration /modification of the module based on regional requirement.
- Choosing and adapting of design based on the need of selected NGOs.
- Meet regularly to assess the progress of implementation at the regional
level, (atleast once in three months)
1. Maharashtra Region
Co—ordinator
Ms Anu Wakhlu
Members
Dr Mira Sadgopal
Ms Manisha Gupte
Ms Marie D’Souza
2. Western Region (Gujarat/Rajasthan
Co-ordination : CHETNA, Ahmedabad
Members
Dr Pal, IIHMR, Jaipur
Mrs Chandra Bhandari, Sewa Mandir, Udaipur
Mr Binoy, UNNATI, Ahmedabad
Ms Renu Khanna, SAHAJ, Vadodara
3. Southern Region (Tamil Nadu, Kerala, Karnataka)
Co-ordinator : Ms Philomena Vincent, AIKYA, Bangalore
Members
Ms Ranjani K Murthy, IWID, Madras
Vd Gangadharan, LSPSS, Coimbatore
4. Eastern Region (Orissa, Bihar)
Co-ordinator : Ms Soma Parthasarty, New Delhi
Member
Ms Ranjani K Murthy, IWID, Madras
5. Nepal Co-ordinator : Dr Sharad Onta
15
I
7.4
Resource Group
It was felt that apart from the regional groups, formation of resource groups
was essential to finalise and integrate the modules and, to identify additional
resources.
Responsibilities
- To suggest priorities in the content and the methodologies
- To suggest and finalise a tentative design for the modules
- To finalise the content and to integrate the modules
- To identify and collect appropriate resource material
- To identify resource persons and get their commitment
- To identify NGOs and assess their specific needs
It was suggested that the resource groups complete the following tasks by
December, 1993.
-
Identification of resource persons
-
Identification of NGOs
-
Identification/collection of training material
Composition of Resource group for ‘Management Module’
Co—ordinator : Ms Philomena Vincent, SHSD/AIKYA, Bangalore
Members
Ms Soma K P - Responsible for material collection
Dr Nirmala Murthy
Anu/Arun, Pragati Foundation
Mr Stephen, SEARCH
Ms Renu Khanna, SAHAJ
Composition of Resource group for Integration and finalisation of the
Modules on “Women’s Health Concerns and Women’s Capacities to
preserve Health’’
Co-ordinator : Vd Gangadharan, LSPSS, Coimbatore
Members
Vd Smita/Ms Pallavi, CHETNA
Dr Mira Shiva, VHAI
Ms Manisha Gupte
Ms Renu Khanna, SAHAJ, Baroda
Ms Philomena Vincent, SHSD/AIKYA, Bangalore
Dr Mira Sadgopal, Pune
Sarojini/Abha Jagori
(This group met at Ahmedabad on September 29 - 30th, 1993 and apart from
outlining the principles of intregration of modules also prepared the tentative
training design for the 1st phase of the training programme).
16
8.
FINANCE
DSE Budget
DSE has planned until end of 1994 ,a budget for implementing three training
programmes on women’s health. After the pilot phase, DSE plans for an
implementation for decentralised courses for the following years. However, since
it has a limited budget (enough for one training in 1993 and for two trainings in
1994), the following was suggested.
- to transfer the funds available for the year 1993 to 1994 as it seemed
difficult to conduct a training programme during 1993.
- to start with training programmes in a phased manner, region wise, so that
there is no gap in-between training programmes.
- to use the training budget economically so that instead of only one training
in a region, several trainings can be organised for different regions.
Organisations like CHETNA and AIKYA also showed willingness to subsidize/
support partial training costs from within their organisation’s funds for organising
workshops, including sensitization workshops for heads of NGOs.
For the implementation of the training programme to take place smoothly, it is
important that DSE maintains the flow of funds on a timely basis.
17
9.
FEEDBACK AT BANGALORE THE EXPERT MEETING
The workshop was fruitful as it fulfilled its objectives. Assistance from local
organisations enabled its smooth functioning. The venue and the physical
arrangements were appreciated by the participants as they provided an ideal
environment for sharing of experiences both, formally and informally.
Suggestions made for improvement in future
-
It was felt that the core group should lay down and follow more clear norms
for managing the roles and responsibilities of the various groups involved as
core and expert enabling the process to be more effective.
-
Due to diversity of the experiences of participants, sometime was wasted in
unnecessary arguments.
-
For the successful outcome of the workshop, the role of participants and
that of resource persons should be clearly communicated, prior to the
workshop.
-
Invitation letter to the resource persons and participants should be sent
atleast 3 months prior to the workshop to enable them to plan and confirm
their participation. A reminder should be sent atleast one month prior to the
workshop.
-
Role of the resource persons and participants should be clarified in the
invitation letter itself.
-
Networking between organisations andindividuals was considered essential.
- A name for the above network of organisations was suggested as WAH!
(meaning-Women & Health). WAH! is an expression of appreciation in
several Indian languages.
- The workshop co-ordination could be better in terms of providing direction to
the proceedings and managing group dynamics and group processes.
- The core group should meet on a daily basis to provide feedback.
-
Report writing should be a collective responsibility to be shared amongst the
participants.
- Cultural programme should be held on the first day itself.
- Core group should know about all the related information
participants.
. 18
sent to the
10.
CONCLUSION/FUTURE DIRECTIONS
The meeting was fruitful in achieving its objectives of developing and enriching
the draft perspective and finalising the modules on women's health concerns,
capacity building to preserve women's health and, management of women’s
health programme from a feminist ideology.
It also succeeded in exploring the possibilities of integration of the three
modules. The formation of the core groups at the national and regional level
and. resource groups would further ensure the integration and finalisation of the
modules.
The decision of initially starting with trainings at a regional level, instead of
national level was also taken unanimously, by the experts.
The tentative plan for 1993 is :
:
Finalising report of the experts meeting, sharing of
responsibilities
and
role
clarification
of/among
resource and regional groups.
October/December, 1993 :
Integration of the modules into a long term training
programme including design, details of content and
identification of probable participants & resource/
resource persons.
August/September, 1993
19
11.
AFTER THE BANGALORE WORKSHOP....
In continuation to the tasks completed at the Bangalore workshop, the urgent
need expressed by DSE to start the initial training workshop during 1993; was
considered during a National level core group meeting held at Bombay during
17718th August, 1993 (see Annexure - VIII) and it has been decided to launch
the first training programme in the Southern region from 6 - 16th December,
1993 which would be co-ordinated by Ms Philomena Vincent of AIKYA/
SHODHINI/SHSD. The financial requirements for the programme were worked
out after the Bangalore workshop.
PROCESS OF BANGALORE WORKSHOP
The workshop brought together different people with different expertise and
lengths of experience. Some had experience in gender issues while others had
experience in indigenous healing systems or health care management. Quite a
significant section of the gathering consisted of women who had been
associated with the women’s movement in India, at sometime or the other.
Out of the thirty six participants, only six were men. Some of the participants
had been associated with this (WAH!) effort since the beginning, while majority
of the people present were joining for the first time.
This diversity was both enriching as well as problematic. For instance in the
first core group meeting comprising of about 12 persons, there could be
genuine dialogue between the feminists and others from disciplines of
management and traditional medicine. Many of the latter expressed that their
understanding of feminist perspective on health was strengthened significantly.
However, this same understanding could not be satisfactorily promoted in the
larger expert group perhaps because of the size of the group. This
communication gap manifested itself in statements like “the NGOs with whom
we are working will reject this philosophy!" or “we are being too radical”.
Despite these limitations, the group did proceed to effectively evolve the three
modules. However, after the work on the modules, the group found it difficult
to reach a consensus about how to proceed further and operationalise these
modules.
For instance, in a classic chicken or the egg situation, the discussion kept
going on round on whether to first select the collaborating NGOs and finalise
the design of the training programme or whether to design the training
programme first and use this to initiate dialogue with the NGOs. Another point
where a long discussion took place was whether to launch the training
programme at the national level or at the regional level.
These frustrating moments were, by and large overcome by the seriousness
and commitment of the persons present. At various times, individuals articulated
their personal vision, and this was inspiring.
A large group has its own dynamics depending on the background and the
history of their relations due to different background and experience.
And lastly, a factor which seriously impaired the proceedings of the workshop
was the lack of clarity on roles and responsibilities. For instance, as mentioned
20
earlier, the entire meeting was divided into three parts; the core group, expert
group and task group. The boundaries between these three groups overlapped
leading to some problems.
Rather than using the expert group as a sounding board for ideas and basing
the decisions on these by the core group, there was a tendency to expect the
expert group to take certain decisions. Another problem caused by overlapping
boundaries between the three groups, was a lack of continuity in distinct
participation and changing discussions to a natural closure.
(The purpose of documenting the process of the Bangalore meeting was not
just self flagellation but to draw out lessons for the future).
Heterogeneity of the group made it at times difficult to reach a common
understanding. In the process it had to be cleared and decided upon how and
in which institutional frame work the curriculum would be implemented.
Annexure - I
SURAJKUND CORE GROUP COMPOSITION
Co-Ordinator:
Ms. Indu Capoor. CHETNA
Members
Ms. Mirai Chatterjee. SEWA
Vd. Gangadharan
Ms. Renu Khanna
?
Co-ordinators
of Module Writing
task groups
Dr. Meera Chatterjee
Dr. R. K. Pal
Annexure - IA
Resource persons who contributed in Draft Module Writing
1.
Feminist Perspective on Health
- Ms. Asha Kachru
- Dr. Mira Shiva
2.
Womens Health Concerns
- Ms. Sarah Chanda
Ms. Mirai Chatterjee,
SEWA Health Team
Ms. Indu Capoor
Ms. Pallavi
Ms.. Jyoti Gade
CHETNA Team,
Ahmedabad
Dr. R.K. Pal and Sunita
Nigam - IIHMR, Jaipur
3.
Building Womens Capacity to preserve health
- LSPSS Network
- Vd. Smita Bajpai,
CHETNA
- Dr. R. K. Pal and
Sunita
Nigam, IIHMR, Jaipur
4.
Womens Health Management Module
- Ms. Renu Khanna
Dr. Nirmala Murthy
Ms. Ranjani, IWID
Annexure - II
LIST OF PARTICIPANTS
Name and Organisation Address
Personal Address
MS ABHA BHAIYA
JAGORI
C-54 SOUTH EXTN 11
NEW DELHI.110 049
PHONE. (011) 4619510
B4/140 SAFDARJUNG ENCLAVE
NEW DELHI. 110 029
PHONE. (011) 6872001.605648
MS ANU WAKHLU
PRAGATI FOUNDATION
11, GANESH KRUPA
ITI ROAD. AUNDH
SANEWADI
PUNE. 411 007
PHONE. (0212) 337773
6, AMIT APARTMENTS
BANER ROAD
PUNE. 411 007
PH 0212-387838
MR ARUN WAKHLU
PRAGATI FOUNDATION
11, GANESH KRUPA
ITI ROAD, AUNDH
SANEWADI
PUNE. 411 007
PHONE. (0212) 337773
6, AMIT APARTMENT
BANER ROAD
PUNE. 7
PH 0212-387838
MS ASHA KACHRU
FREELANCE COSULTANT
POST OFFICE
RANJHOLE
MEDAK DIST,
A.P. 502318
SAME AS ALONGSIDE
MR BINOY ACHARYA
UNNATI
7.PAYAL PARK SOCIETY
SATELLITE ROAD
AHMEDABAD. 380 015
PHONE.(272) 465145
NO.12, ASHOKWADI APTS
PANCHVATI MARG
ELLISBRIDGE
AHMEDABAD.380 006
(272) 442854
MS CHANDRA BHANDARl
SEVA MANDIR
FATEHPURA
UDAIPUR. 313 001
PHONE.(0294) 60047
16, BOLD FATEHPURA
UDAIPUR. 313 001
23
Name and Organisation Address
Personal Address
MR DARSHAN SHANKAR
FOUNDATION FOR REVITALISATION
OF LOCAL HEALTH
TRADITIONS
4, SARAS BAGH, DEONAR
BOMBAY.(022) 400 088
SAME AS ALONGSIDE
PH. (022) 5561846(BOMBAY)
(0812) 336909:334167
(BANGALORE)
MS DEEPA DHANRAJ
FREELANCE CONSULTANT
27, VIVIANI ROAD
RICHARDS TOWN
BANGALORE. 650 005
PHONE. (0812) 570583
SAME AS ALONGSIDE
MR F. STEPHEN
SEARCH
219/26, 6TH MAIN
JAYANAGAR, 4TH BLOCK
BANGALORE. 560 011
PHONE.(0812) 6442261,642461 (OFF)
600, 21ST MAIN
JAYANAGAR, 4TH BLOCK
BANGALORE. 560 011
PH. 646973
(0812) 646941 RES.
MR G. G. GANGADHARAN
L S P S S
P.B. NO. 7102
COIMBATORE.600 045
PHONE. 0422-214132
FAX 2131800
GRAM. CHIKITSA
THEVAR BUILDING
RAMODERPURAM
COIMBATORE. 600 045
PH.(0422) 213188
MS INDU CAPOOR
CHETNA - LILAVATI LALBHAI
BUNGLOW, CIVIL CAMP
ROAD, SHAHIBAUG
AHMEDABAD. 380 004
PHONE. (0272) 866513, 866695
FAX.91-0272-866513
GRAM. CHETNESS
A-12, VISHRUT FLATS
MEMNAGAR
AHMEDABAD. 380 054
GUJARAT
0272-480431
MS JYOTI GADE
CHETNA - LILAVATI LALBHAI
BUNGLOW, CIVIL CAMP
RD., SHAHIBAUG
AHMEDABAD. 380 004
PHONE. (0272) 866513, 866695
FAX.91-0272-866513
29/1 BIMA NAGAR
SATELLITE ROAD
OPP.UMIYA-VIJAY
AHMEDABAD.380 015
PH.(0272) 648556
24
Name and Organisation Address
Personal Address
MS KAMALA BHASIN
FFHC/AD
FAO
55 MAX MULLFER
NEW DELHI. 110 003
PHONE.(011) 4628877/4627702
4, BHAGWANDAS ROAD
NEW DELHI.110 001
PH.011-385042/385270
DR KARUNA ONTA
FAMILY PLANNING ASSOCIATION
OF NEPAL
P.B. 486 KATHMANDU
NEPAL
PHONE. 977 (1) 524440, 272611
GHA 1-452-7
BALAJU RING ROAD
KATHMANDU
NEPAL
MS MANISHA GUPTE
MASUM
11, ARCH ANA
163, SOLAPUR ROAD
HADAPSAR. PUNE - 411 028
PHONE. (0212) 675058
SAME AS ALONGSIDE
MS MARIE D’SOUZA
JANSEVA MANDAL
KORIT ROAD
NANDURBAR. 425 412
PHONE. (02564)22032
SAME AS ALONGSIDE
DR MIRA SADGOPAL
MEDICO FRIEND CIRCLE
C/O A PHADKE, 50 LIC
QUARTERS, UNIVERSITY
ROAD, PUNE. 411 016
RENUPRAKASH
3RD FLOOR,
817.SADASHIV PETH
PUNE.411 030
PH.0212-446130
DR MIRA SHIVA
V H A I
40. INSTITUTIONAL
AREA, SOUTH OF IIT
NEW DELHI. 110 016
PHONE. (011) 668071/72, 665018
MEDICO FRIENDS
CIRCLE(DELHI 81)
A-60 HAUS KHAS
NEW DELHI. 110 016
PH.011-665003
DR NIRMALA MURTHY
FRHS
6 GURUKRUPA
188, AZAD SOCIETY
AHMEDABAD. 380 015
PHONE.0272-640437
E-7, IIM CAMPUS
BANNERGHATTA ROAD
BANGALORE-560 076
PH.(0812)-633492
25
Name and Organisation Address
Personal Address
MS PALLAVI
CHETNA - LILAVATI LALBHAI
BUNGLOW, CIVIL CAMP
ROAD, SHAHIBAUGH
AHMEDABAD. 380 004
PHONE. (0272) 866513, 866695
FAX.91-0272-866513
GRAM. CHETNESS
322 SARASWATINAGAR
VASTRAPUR
AHMEDABAD - 380 015
GUJARAT
PH.0272-640140,642607
MS PHILOMENA VINCENT
AIKYA
377, 42ND CROSS
STH BLOCK, JAYNAGAR
BANGALORE. 560 082
PHONE. (0812) 645930/621930
105,65, 43RD CROSS
(UPSTAIRS)
OFF VITH MAIN
JAYANAGAR V BLOCK
BANGALORE. 560 041
MS POORNIMA VYASULU
PRAXIS CONSULTANTS IN HUMAN
RESOURCE SYSTEMS
BANGALORE. 560 041
PHONE. (0812) 640 957
SAME AS ALONGSIDE
DR R. K. PAL
I I H M R
1, PRABHU DAYAL MARG
SANGANER AIRPORT
JAIPUR. 302 011
PHONE. 550700, 550065
FAX. 91-141-550119
TLX.0365-2655 IHMRIN
HOUSE NO.395
BLOCK A
MALAVIYA NAGAR
JAIPUR
PH.-0141-516525
MS RANJANI K. MURTHY
INITIATIVES WOMEN IN DEVELOP
MENT, E2, B BLOCK,
IV FLOOR, PARSN
PARADISE APTS.,109 G N
CHETTY ROAD, T NAGAR,
MADRAS. 600 017
FAX.8254376
16, SRINIVASAMURTHY
AVENUE, ADYAR
MADRAS. 600 020
PH.(044) 415429
MS RENU KHANNA
SAHAJ
1, SARTHI TEJAS APTS
54 HARIBHAKTI COLONY
OLD PADRA RD.,BARODA.390 015
PHONE. 0265-324023
SAME AS ALONGSIDE
Name and Organisation Address
Personal Address
VD S.S. KOPPIKAR
R.A. PODAR MEDICAL
COLLEGE (AYUR)
DR. ANNIE BESANT RD
WORLI, BOMBAY. 400 018
4. HARGUN HOUSE
DP ANNIE BESANT ROAD
WORLI.
BOMBAY 400 018
MS SAROJIN! NANDINI PALEA
JAGORI
C-54, SOUTH EXTN. 11
NEW DELHI - 110 049
A-132, NITI BAGH
NEW DELHI
DR SHANTI GHOSH
5, SRI AUROBINDO MARG
NEW DELHI. 110 016
PHONE. 011-6851088
SAME AS ALONGSIDE
DR SHARAD ONTA
RESOURCE CENTRE FOR
PRIMARY HEALTH CARE
KATHMANDU
P.O. BOX 117
PHONE.225675
FAX.977(1)226820
ATTN. RECPHEC
GHA 1-452-7
BALAJU RING ROAD
KATHMANDU
NEPAL
DR SHUBHADA KANANl
DEPARTMENT OF FOODS AND
NUTRITION, FACULTY
OF HOME SCIENCE
M.S. UNIVERSITY
BARODA. 390 002
201, ANAND VIHAR
P.O. EME
BARODA. 390 008
PH.(0265) 22537
MS SHUMITA GHOSE
URMUL TRUST
LOONKARANSAR.560 041
BIKANER, RAJASATHAN
SAME AS ALONGSIDE
VD SMITA BAJPAI
CHETNA - LILAVATI LALBHAI
BUNGLOW, CIVIL CAMP
ROAD. SHAHIBAUG
AHMEDABAD. 380 004
PHONE.(0272) 866513, 866695
FAX.91-0272-866513
GRAM. CHETNESS
93/4, "CH" TYPE
SECTOR. 28
GANDHINAGAR
GUJARAT
Name and Organisation Address
Personal Address
MS SOMA KP
FREELANCE CONSULTANT
A-111, SHIVALIK
(NR. MALVIYA NAGAR)
BUS STOP, NEW DELHI
PHONE.011-6853918
SAME AS ALONGSIDE
DR SUNEETA SHARMA
I I H M R
1, PRABHU DAYAL MARG
SANGANER AIRPORT
JAIPUR.302 011
PHONE.(0141) 550700
83, PRATAP NAGAR
NR. GLASS FACTORY
TONK ROAD
JAIPUR. 302 015
PH.(0141) 512521
DR VEENA SHATRUGNA
NATIONAL INSITUTE OF NUTRITION
HYDERABAD. 500 007
PHONE. (0842) 868909
B-l.F-13, HIG
BAGH LINGANPALLY
HOUSING BOARD QUARTERS
HYDERABAD. 500 044
In co-operation with DSE
MS ERIKA FINK
DEUTSCHE STIFTUNG FUR
INTERNATIONALE ENTWICKLUNG
BREITE STRABE III
10178 BERLIN (MITTE)
PH.23 11 92 20
TELEX.2627-308120=DSEBLN
FAX.(030)-23 11 92 22
OFFERBACHER STR 6
14179 BERLIN
PH. 8222563
28
Annexure - III
A FEMINIST PERSPECTIVE ON WOMEN’S HEALTH
A feminist perspective implies an alternative outlook originating from the
experience of women living in a society dominated by sets of values and
institutions which are “male-structured”. It was felt relevant and necessary to
develop a feminist perspective on women's health to guide the DSE-supported
"WAH!" (Women and Health!) Programme for training of women in management
skills relating to women’s health.
The perspective presented in this paper was elaborated during trie DSfi—organised
Expert Consultation at bangalore in June iu93, through a group process. The
whole group of approximately forty persons was mixed, including those who had
never before internalised the meaning and significance ol feminism. Therefore,
several sessions were devoted to the process of exploration and elaboration. This
resultant paper* is intended to guide the development of the training programme
with inclusive regard to aims, approach, methodology and materials. It is
presented in three parts:
1. The first part outlines the status of women's health in Indian society, including
the impact of so-called development” on women.
2. The second presents a critique of present health care systems in India from
a feminist perspective. It introduces a theoretical framework of patriarchallystructured gender relations, and analyzes the interlocking of gender with other
oppressive relations.
3. The third part highlights the contributions of women to health, and their
struggles for health, in order to convert the distorted image of women as only
victims and to help find positive strategies.
I. STATUS OF WOMEN’S HEALTH
Women’s health status in general is abysmally poor. This is directly related to
their low status in society as opposed to men. It is reflected in overt statistical
trends like
- falling sex ratio (currently 929 females per 1000 males) and - persisting high
maternal mortality (estimates ranging from 300 to 900 deaths per 100,000
births, compared to low two digit figures in developed countries),
- 278 per cent increase in rapes of minor girls in the city of Delhi alone in the
last year,and in daily newspaper reports of domestic violence, murder and
suicide. Even so, most harassment and violence against women remains
invisible to society and is even hidden from other women. Studies now show
that roughly seventy percent of violence against women including persons who
are not strangers.
In fact, the combined result of sex pre-selection technology, use of amniocentesis
leading to female foetus abortion, rising female infanticide, nutritional and medical
neglect of girl children, severe sexual and physical assault of girls and women,
reproductive over-exploitation, hazardous contraceptives and sterilization abuse,
dowry and domestic murders, overwork of underfed women, all aggravated by the
29
effects of the price rise spiral, amounts to a picture of no less than genocide of
the female sex.
Leaving aside mortality, morbidity (debility and illness) is even more pervasive.
Most Indian women are semi-starved and anemic, making them prone to various
infections including tuberculosis. Gynecological illnesses are silently rampant,
notably sexually transmitted infections, contraceptive-induced disorders, and
cancers. Particularly, the incidence of cancer of the cervix in Indian women is the
highest in the world. Post-tubectomy syndrome (PTS) is now a medically
recognised term, validating women's long reported ailments following sterilization
opera tions. Widely experienced menstrual bleeding disorders add to previously
existing anemia. In turn, in pregnancy anemia puts women at higher risk for
developing fatal toxemic eclampsia (fits) and hemorrhage. Childhood undernutrition
can leave a girl to grow up with an undetected contracted pelvis, resulting in
obstructed child-birth and tragedy.
Among the poorest, high birth rates (40-50 births per 1000 population per year)
are always a sign of people waging (through their women’s bodies) desperate
struggles to survive and grasp control of life in the absence of food, employment,
old age and other social securities. In all social strata infertility of couples
(approximately 30% man-related, 40% woman-related, 30% both or undetermined)
causes untold suffering, cruelty and desertion, as the entire blame gets thrust on
women. To ensure biological offspring as heirs, new reproductive technologies
(NRTs) like in vitro fertilization (IVF or test-tube baby) flourish. /Amniocentesis and
ultrasonography is widely used to determine sex and enable selective female
foeticide by abortion.
Adding to this unhealthy picture, the Government Health Services have become
blatant vehicles for population control aimed mostly at the rural and urban poor.
Despite women’s constant, long standing demand for safe contraceptive methods
which they themselves can control, the government is accelerating its policy of
introducing invasive, systemic, long-acting, provider dependent methods of socalled “family planning”, namely injectable and surgically implanted contraceptive
hormones and anti-fertility vaccine (AFV).
Promoted with jargon of women's empowerment and reproductive rights, these
methods further remove the control of reproduction from women. Not only that,
through enhancing men’s free sexual access, women report that such methods
often doubly aggravate their subjugation.
Behind this global intervention into women's lives are the multinational commercial
interests. These fortify pressures by rich Northern governments and global
agencies upon third world countries to adopt stricter and stricter measures to
control population (read women). Complications which women face include a
sevenfold rise in incidence of pelvic inflammatory disease (PID) due to IUD
insertions and and to mass sterilizations (Bangladesh study, 1989), and
involvement of women without informed consent in large field-based trials of
methods like NETEN, NORPUANT and AFV.
The economic context of these stresses upon women's health is the global and
national trend towards privatisation and structural adjustments. In the Government
health care system, whatever supports for women existed are being undermined
and dismantled. What had begun happening even since the sixties is now
30
accelerating under the “New Economic Policy” (NEP). Pressures on Government
to take stricter population control measures are knit into the NEP, as can be seen
by the proposal to limit access to the public distribution system (PDS) through
ration cards to families with two or fewer children.
Women suffer the worst effects of the NEP. Their burden of work in the family
increases. Middle class women depend on procuring cheaper food in rawest and
crudest form and home-processing il for consumption, whereas poor women
forego even essential nutritious food to help ensure that men and children do not
suffer or starve. Increasingly marginalised from the organised and unorganised
labour sector by unemployment, women are being pushed back into exploitative
home-based piece-work or into fulltime unpaiqi domestic labour.
At home, women as wives, mothers, sisters and daughters carry actual
responsibility for holding the family physically and emotionally together, including
keeping up in-law relations and religious rituals. The stress of double burden on
women who also work outside the home can result in breakdown. Women who
become ill receive resentment more often than sympathy. For instance, if a
woman falls sick with tuberculosis, she does not receive the care and attention
that a man does. Hence, for her, hav.ng the same disease as a man is not at
all the same experience. Additionally, women at home are occupationally prone
to suffer certain ailments besides anemia such as backache, headache, tiredness
or exhaustion, stomach acidity pain, eye complains due Io cooking smoke, pain
during intercourse, etc., and from emot.onal states of depression, anxiety,
loneliness, irritability, restlessness or heartache wnich can't be expressed.
Sexuality is a severely distorted and aoused area of women's lives. The middle
class woman bears the most distortion, beginning from her childhood upbringing
which instills a sense of shame, distaste for and separation from her own body
and which discounts her intellect, too. At puberty she may be literally contained
in the home until marriage can be arranged and carried out. As a rule, no
information is conveyed to her in advance to help her understand and cope with
menstruation and with sexual relations in marriage, not to speak of knowing her
rights to say yes or no to sex. While poor and dalit women may be freer to
express sexuality, they are more prone to sustain blunt male violence. For a
single woman, never married, abandoned, widowed or divorced, sexuality is
unspeakably taboo, at the cost of being switched or dismissed into the category
of “prostitute” where she becomes free game for men.
Sexual abuse is ubiquitous - at home, on the street, at the workplace. Needless
to say, it never gets the warranted attention from civic bodies and labour unions.
At home, it is indulged in by male relatives and acquaintances on vulnerable
children and, women, blind to their categories, especially when men are confident
that those they abuse won’t or can’t speak about it. Molestation and rape of
mentally and physically disabled women is virtually expected.
While women suffer all forms of emotional stress and illness, they often get
labelled or parcelled away as mentally sick simply because they are reacting to
injustices and cruelty. Field investigation now suggests that hysteria in young
unmarried and married women is almost always an unacknowledged response to
sexual abuse. The phenomenon of possession by a female deity is a sanctified
means for temporary physical and sexual liberation, and a safety-ya-lve-tQ help
31
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maintain a woman's sanity intact. Devaluation of aging and aged women, including
the misunderstand ing of menopause, is growing.
It explains the failure to address the specific health problems of older women,
such as arthritis, osteoporosis, cancers, malnutrition and loneliness. Sexuality of
older people is discounted along with other positive aspects of aging such as
wisdom and freedom from reproduction. Further, the devotion of women’s whole
lives to maintaining and preserving society and culture is simply taken for granted.
AIDS (Acquired Immuno-Deficiency Syndrome) has emerged as a global public
health threat. Its profound socio-economic impact could be especially destructive
in our country because of the various factors affecting health status already laid
out. Preventive strategies are women-focussed, particularly on women sex workers
(prostitutes). While sexual contact is the major route of HIV (Human Immuno
deficiency Virus) transmission, it is not acknowledged that it is the men, not the
women, who are the main vectors of transmission. That is, among persons
involved in the practice of prostitution, men (as clients) are far more numerous
and mobile than women. Rather than being labeled the most “high risk" group,
sex workers are the most “at risk”. Biologically, uninfected women are ten to thirty
times more prone to AIDS infection at any given contact, because the vagina is
a large exposed surface of virus penetrable membrane, and because condom
leakage still protects a man but not a woman. Prior STD infection like gonorrhea
or syphilis further increases the risk factor to three hundred times.
Legislation at present provides little relief for women in terms of general health
protection. Much legislation still views women as exploitable and discountable in
both production and reproduction spheres. Some legislation is grossly out-dated
and inhumane, such as a clause permitting a man divorce of a woman who has
epilepsy, leprosy or mental derangement. Divorce, maintainance, child custody,
inheritance and land property rights are in the domain of personal law of the
various religious communities. While not being uniform, all the codes subject
women to forms of patriarchal injustice adversely affecting women's status and
health. Rape Law contains many lacunae and injustices, such as requiring semen
presence to establish rape. Domestic violence is often not recognised, unless it
results in death, and even then it is often covered up. Legislation to contain
harrassment and punish murder connected with dowry is a victory for women's
organised struggle, but has not resulted in reduction and sucn deaths continue.
Employment service guarantees, including paid leave, child-care creches and
maternity benefits are unavailable to most women Maternity benefit is never
sanctioned in case of child adoption.
The MTP Act (Abortion Law) passed in 1975 made medical abortion legal but has
not succeeded in making it available for most women. There are five to six million
unsafe pregnancy terminations per year according to official estimate. No
legislation protects the sexual and reproductive rights of women. The legal right
to abortion is secure only on account of population control interests. Accordingly,
the health budget allocation to ‘family welfare’ has increased significantly, in
absence of legal protections for women in case of contraceptive abuse and
complications.
The dynamics of patriarchal control over women resulting in their poor status of
health can be conceptualised as in the diagram of triangular force accompanying
this paper. (Refer Page 5)
32
II. CRITIQUE OF HEALTH CARE IN INDIA
Actually speaking, in India a number of health care systems operate at the same
time, occasionally side by side, sometimes vastly separated. Let us take stock of
these systems:
1. The western medical system (allopathy) which was introduced through British
colonial rule, forms the basis for the post- independence Government health
services and the bulk of lucrative private practice.
2. Culturally more pervasive and much older are the indigenous health systems.
These are further divided into two streams:
a. the widespread Folk (or Local) Health Traditions (alsoknown as LHTs, or
Lok Swasthya Paramparas), characterised best by their diversity and spirit
of self-reliance, and
b. the classical (shastriya) systems known as Indigenous Systems of Medicine
(ISMs),including Ayurveda, Siddha, Tibbia and Unani. In their development,
the ISMs have drawn much from the LHTs, and vice-versa, over one to
three thousand years or so.
3. Originally developed in Germany, Homeopathy has taken deep root in India
over the last century. We have the largest numoer of homeopathic practitioners
in the world.
Although widely prevalent, the indigenous systems and homeopathy are virtually
ignored by the dominant western system.
THE DYNAMICS OF PATRIARCHAL CONTROL OVER WOMEN RESULTING IN
THEIR POOR STATUS OF HEALTH
Triangular Force Diagram developed by WAHI (Refer Page 5)
(Women and Health!) Training Programme, 1993 .
Hence, the Government has established a western-oriented programme of primary
health care to treat emergencies, prevent and control communicable diseases,
extend supplementary care to mothers and children, and promote “family planning”.
In addi tion, institutions have been set up to render specialised cura five care
which are usually urban-based.
Inherant in each system of health care is a specific attitude towards people and
their bodies. The allopathic system tends to view people as composed of distinct
mechanistic organ systems like the gastro-intestinal tract, the cardio-respiratory
system, the uro-genital tract, the nervous system, etc. The Indian indigenous and
homeopathic systems, in contrast, see human health more in terms of balances
and flows of vital humours’ and energies. They are less concerned with the
physical boundaries and connections of organs. The allopathic approach to
medical treatment is characterised by attempts to fight, remove or eradi cate
causative agents (germs, allergens, defective parts) and to suppress symptoms.
On the other hand, the indigenous and homeo pathic systems, aim towards
The word 'humour’ is not a satisfactory translation ol the ayurvedic term ‘dosha’, but only an
approximation.
33
restoring balances and flows in the person without considering the parts
separately. The latter approach is called holistic. Realistically speaking, each
approach has certain strengths and weaknesses.
Whatever the particular health system, the healer (doctor, vaidya, hakim, vaidu)
can exploit his (or rarely her) power over the sick person (patient) and relatives,
and often does. Even when benevolent, the relationship is usually patronising. It
is doubly so with women who are sick, tn this respect, there is little difference
between practitioners of the holistic and non- holistic systems. Women sometimes
tend to prefer the holistic approaches, perhaps because allopathy is understood
to be too “strong” and invasive. However, this comparable gentleness is no guard
against patriarchal attitudes which have become embedded even in holistic health
systems.
Patriarchal values and behaviour in society exert control over women’s labour,
reproduction and sexuality. The basic social unit of patriarchal control is the family
through mar riage. Inheritance is patrilineal through father to male off spring, and
hence biological motherhood is necessary. Most existing religions are patriarchal
and reinforce the patriarchal bias in the health systems.
The Dominant Health System’s Stance towards Women
Patriarchy is a fundamental undercurrent in the dominant health system. Women
themselves are seen as problematic They are considered ignorant, irrational,
emotional, dependent, superstitious, unhygienic, etc., rather than as resources who
are intelligent, practical and knowledgeable. Women are generally allocated identity
and social worth in relation to the notion of motherhood rather than womanhood.
Medical treatment first takes stock of a woman's relationship with family and
childbearing.
Hence, single women’s gynaecological problems have little sanctioned place in
health care. Problems during other parts of women’s life-cycles, like osteoporosis
in older age, are neglected.
Hence, the system does not locate the health problems of women in the real
context of oppressive man-woman relations. Treatment ignores the need to
change these relations. Ill- effects to women’s health arising out of such relations,
such as reproductive tract infections or injury and mental trauma, are not treated
seriously enough. The effect of gender division of labour on women’s health is
unrecognized, including the health costs of invisible work at home and in the
informal sector.
Under sanction from patriarchy, medicalisation of health has occurred at women’s
expense. Whereas pregnancy was viewed as a part of life, it is now treated as
a disease. Thus, people are led to believe that doctors, hospitals, medicines and
high technology are necessities for achieving heaitny birth. Infer tility has also
become a disease to be cured at any cost.
New reproductive technologies flourisn pandering to the craving for biological
offspring, despite the more sensible path of child adoption. Health and
reproduction are becoming like market commodities which one can buy if one has
money. In the commodit isation process, the pharmaceutical industry has played
the greatest role. There seems to be no end to its tampering with women's
34
bodies, as in the promotion of ERT (estrogen replacement therapy) to postpone
menopause indefinitely. In case of hormones used for oral, injectible and
implantable contraception, never before have so many women been given potent
medicine continuously to suppress a condition (fertility) that is not a disease.
In this process, women’s indigenous knowledge of health care has been
marginalised or lost, and their continuing role in maintaining the health of their
families and communities has been devalued Self-help measures and remedies
that address women's ailments, passed oown through generations, are being
replaced by mystified pharmaceutical ana hign-tech paraphernalia. Not sur
prisingly, this leaves women with a sense of separation from their own bodies.
The dominant health care system virtually revolves around statistics. This
introduces certain automatic biases. For instance, statistics give importance to
rates rather than reasons. Hence, they give legitimacy to population control in
place of development of health services. People are looked at as numbers and
targets rather than as persons.
The Government Health Care System
States by nature are always more or less patriarchal. The patriarchal nature of
the Indian State is reflected through all its institutions including the Government
health care system. As everywhere else, patriarchy does not operate in isolation,
but interlocks with all other oppressive and discriminating systems such as class,
caste, ethnicity, religion, race, etc.
Within the health care system operated by the Government, o:_6 there is a
peculiar dichotomy of attitude towards two types of women. Women patients
receive benefits only as mothers or repro ducers, and the nurses (ANMs) who
provide care are treated as sex objects, lowest in the health service heirarchy.
Higher up, women doctors are pressured to operate within a male-structured
value system which devalues and abuses women and people from oppressed
caste and class. Further, women are viewed by the family planning programme
as either targets or traitors to the national cause if they do not accept
contraception.
In another variant of relationships, the patriarchal role pattern of the family gets
replicated within medical institutions, witli the doctor (typically but not always a
man) playing the role of father, the nurse (usually a woman) acting as wife and
the women patient playing the child.
Government Health Policy and Population Control
It is important to identify who decides what is important in health, and how health
expenditure gets allocated. Multi-lateral aid agencies, the Indian government, large
pharmaceutical indus tries, health administrators and doctors determine the priori
ties. Today, these inevitably represent the interests and per ception of western
society, the rich, the powerful, the Indian upper class and caste, and the male.
Population control in the dishonest guise of a family planning programme receives
priority, neglecting development of the health care system and other social
necessities and supports for women. The programme is technology-based, placing
no faith in the resources of people to control their own fertility, given adequate
35
education, safe contraceptive options, and support through assuring survival of
themselves and their children. It selectively targets the poor and women. Rather
than guaranteeing women’s freedom from oppression, it accepts and
accommodates unequal man-woman relations. Rather than rendering support to
women, incentives and disincentives undermine relations between the people and
the health services. ♦
International Aid and Population Control Agencies
International agencies construct gender in several ways. For example, the W.H.O.
considers women to be “vulnerable". Looking at what vulnerability really means
and at what makes women vulnerable is generally avoided. Women’s health is
sub sumed in the term “safe motherhood".
Fear is expressed that population growth of the poor and in third world countries
threatens the future of all on our planet. In reality at present, the rate of resource
consumption and toxic pollution is much higher in the rich developed countries
than in the poor developing countries. The problems of improving general health
status in the third world and of curtailing consumption levels of the first world are
intertwined with and in no way less important than fertility control. Yet the rich
countries are seeking to force population control upon the poor who have no
guarantee of health, without curtailment of their own wasteful lifestyle and
consumption levels.
This has led to a sophisticated culture of deceipt International aid agencies seek
to legitimise blunt population control programmes under guise of slogans like safe
motherhood, reproductive rights, right to abortion (as in Nepal, where abortion is
illegal), environmental awareness, etc. The massive scale of funding and publicity
given for AIDS prevention undoubt ably belies the ulterior motive of controlling
population through universalisation of “safe sex” (condoms).
The Non-Allopathic Systems
A feminist critique of these systems has not been evolved by women health
activists. Neither has it been possible for us to make much headway while
preparing this perspective paper. One problem is the confusion from assuming that
holistic systems are kinder to people in general and to women in particular. This
may be true in many instances, but it is not necessarily so in practice. Another
reason is that few women well educated in these systems have identified with the
modern women's liberation movement, initially inspired by western feminists.
Hence, at present we offer a few superficial and tentative observations as
experienced so far by women among us.
As noted before, patriarchal biases exist in these systems as they do in allopathy.
In the LHTs the authority of patriarchy tends to be less, but is apparently still
there, as in tribal communities and in the matrilineal Nayar community of Kerala.
Patriarchal attitudes can appear when considering white discharge, menstrual
disorders, and food restrictions. Classical ISM physicians are usually male, and
rarely if ever perform internal physical examinations, but reportedly can diagnose
gynaecological disotders by pulse alone. This may be hard to fathom and accept
for some women health activists oriented by the western system and committed
to demystification and self-exam.
36
It has been suggested to us that, particu'arly in ayurvedic tradition, there are
certain specific “women-strengthening" features. We would like to know more
about this possibility, and whether these are not cryptic ways of again
accommodating to and strenghthening women's subjugation under patriarchy.
In the ISMs, it is said that there are areas of misinterpretation and superstition
overlaid upon the original pure teachings of the ancient physicians. Until these
areas are cleared up by vaidyas and hakims themselves according to common
agreements, it will not be possible for lay people to know the difference. In
addition, modern indigenous practitioners have the task of addressing new
phenomena, such as air pollution, pesticide poisoning and AIDS, never imagined
by the original physicians.
The ISMs have arisen from non-commercial tradition where looking after the
health of fellow beings was considered the duty of learned persons. The ayurvedic
text Vagbhata warns a physician that he should better swallow molten iron than
take a fee from a suffering person. Today, the ISMs are prone to mimickry of
allopathic form and co-option into the western commercial mode. As this process
continues, much stands to be lost further. Still the majority of our people think and
believe in terms of the ISMs and LHTs, even though they often spend and
depend on dramatic allopathic cures.
We realise the importance of the holistic essence in these systems, which in
general do not split the human mind and body from itself or from surrounding
nature and universe, in contrast to allopathy’s (and western culture’s) tendency to
do this. Feminists concerned with health must focus more attention on compre
hending the strengths and limitations of the non-allopathic systems.
III.
WOMEN’S CONTRIBUTIONS, STRUGGLES AND STRATEGIES
Focussing so acutely upon the low status of women’s health may send us into
a state of numbness and pessimism. Women are victimised, yes, but women are
not only victims. In this section, the intention is to demonstrate that not only can
women be victors, but they are also characteristically creators and sustainers of
life, bounty, beauty, peace and joy. Even when sick themselves, they continue to
contribute fundamentally to the health and preservation of society and the
environment.
Women’s contribution to health is traditional as well as innovative. Traditionally,
they have been healers (herbalists, massage experts, midwives, counsellors for
emotional problems), nurturers (food-processing, feeding, comforting, sympathising),
and health educators (training eachother and the next generation). They have
carried the brunt of reproducing the next generation. They have traditionally played
a large role in farming, invisible to patriarchy, particularly in the production of food.
Maintaining a clean and fresh home environment through fetching water, fuel and
fodder and carrying out daily tidying and repairs provides the necessary
background for their families' health. In rural areas, while pursuing these functions
they preserve and maintain the forests and fields which provide the sources of
life support. As part of work and life they create music, art and dance to lift the
spirits of themselves and others. Their personal faith and religious observances
tend to link holistically with all of women’s functions.
37
In contrast to men, women's names are few in the recorded history of health, and
one has to search for them. Despite Indian women’s direct and crucial
involvement in health, the reasons for their namelessness could be :
Women’s oral culture, ignored by literate brahminical tradition,. their less
competitive, more participatory nature, being relatively unconcerned about being
named and famous, and their marginalisation and devaluation as healers and as
persons, with expropriation of their healing authority under patriarchy.
From western medical tradition, one only thinks of Florence Nightengale and Marie
Curie amongst hundreds of men of medicine, although the women's movement in
the west has unearthed other women’s names and histories. It is an uncompleted
task to raise up the names of women who have contributed outstandingly in
Indian health tradition.
However, we can think of some very current names of women who have suffered
specifically for their role in struggles for health and the right to healthy life. The
following three women were gang-raped in different incidents within the last one
year:
Bhanwari, a saathin of the Women’s Development Programme, Rajasthan, in
retaliation lor her work against child mar riage (September 22, 1992), Satto, a
sakhi of the Mahila Samakhya Programme, Saharanpur, U.P. (May 1993), and
Budiben, an activist of the Narmada Bachao Andolan, at Antras village in Madhya
Pradesh, for opposing the dam and for refusing to leave her village (April 4,
1993).
These women have not given up their struggles. In commemoration of their
bravery and in attempt to call attention to the viola tion of women's human rights
22 September 1993 was observed all over India as National Protest Day against
Violence on Women.
Still, as we write these words, we see before us the expressive faces of countless
women healers of today, working constantly to reduce suffering and impart
strength - women like Balnagam ma in Andhra Pradesh, Sukhabai from Gujarat,
Siddamma of Karnata ka and Bhagwati of Madhya Pradesh.
As part of the women’s liberation movement, women’s groups in Government
programmes, in NGOs, in mass movements and mass organisations, partyaffiliated and non-party, are struggling for health rights and trying to build new
alternatives for health care. From Madurai to Manipur, Arrakkonam to Ajmer, Dalli—
Rajhara to Delhi, Goa to Gadchiroli, Tehri to Tirupati, women are taking steps to
paint a new picture of health over the old background of exploitation, abuse and
servitude. Many of these initiatives include anti-alcoholism struggles, targetting the
liquor contractors and merchants who benefit, pulling men in line, and pressurising
the Government. In health care, women are reclaiming authority and knowledge
through self-help ap proaches, using new scientific information and validating old
indigenous remedies and herbal medicines, as in the Shodhini Network.
In the cities like Delhi, Calcutta, Madras and Bombay, with the spectre of AIDS
growing, health activists working among sex workers (a new name replacing
“prostitute") have enabled these women to convert their imposed self-image of
being “highest risk" to “most at risk" from men infected with HIV and other
sexually transmitted diseases. With life and death at stake, and stereotypes to
38
break, health care initiatives among sex workers in the major cities may well form
a cutting edge of the new women's health movement in the coming decade.
On another front is the struggle against coercive Government population control
policies and programmes, particularly against the pushing of “long-acting, invasive
and systemic" contraceptive methods at the cost of women's health and
undermining the func tioning of the government health care system. Despite stiff
resistance from women's groups, but with heavy international pressure and funding
from population control agencies, the Gov ernment is going ahead with its
programmes to launch NORPLANT (below-skin hormonal contraceptive implant)
and AFV (anti—fertil ity vaccine) at mass level. At the same time, expansion of
facilities for IUD insertion and for the terminal method of laparascopic sterilisation
continues.
Slower to start but soon to accelerate is the initiative of local women's
organisations and networks to teach the use of “barrier contraceptive methods",
which are safe. Particularly interesting are those controlled by women (unlike the
male condom, or Nirodh) such as the diaphragm, cervical cap, vaginal spermicidal
sponge, and female condom. Since the Government has so far resisted including
these methods in the “family planning" programme, channels of supply may have
to be opened up from elsewhere, arid indigenous manufacture tested for feasibility.
These developments are linked with the sharing of information about reproductive
biology and training of fertility awareness skins. I he initiative squarely questions
men's rights over women's bodies and chaiiunges mon to participate equally in
the
CONCLUSION
The sphere of health management in NGOs as well as in Government is largely
dominated by men and by male-structured thinking and relationships. Management
itself carries with it an ideological history which has not always been kind to
people's or to women's interests, intuitions, and capabilities. Successful women
managers, like women doctors, have always been forced to adopt male styles to
succeed. New trends in management acknowledge this, and much has begun to
change. The challenge to women is net only to enter into management of health
successfully, but to do so in solidarity with the interests of women. Additionally,
they may identify and explore management forms and techniques known to our
people traditionally, attempting to correct the biases of western style management
as it dominates today.
Self-Help and Self Reliance are passwords of a new wave in the women's health
movement. In this evolving context, training in women's health management skills
assumes great importance. We look forward to collaboration with friends and the
fruitful implementation of the WAHI Programme with excitement and hope.
Members of the Perspective Task Group: Abha Bhaiya, Asha Kachru, Sharad
Onta, Veena Shatrughna, Ranjani Murthy, Mira Sadgopal, G. G. Gangadharan,
Smita Bajpai, Philomena Vincent.
39
Annexure - IV
MODULE - WOMEN’S HEALTH CONCERNS
Introductory Note :
The outline of this module was discussed and it wasjelt that tne contents of
the perspective paper should be integrated throughout the module and four sets
of factors
Technology, social/cultural, legislation and -mlf/lu-lp jppuach should form the
basis of the discussion on each conceal.
I.
Role, Status and Contribution of Women
Objective :
To understand and appreciate the role, status and contribution of women in our
society.
Expected Outcome :
To understand how “patriarchal structures" and systems influence the status and
health of women.
Concept/Content :
1. Social reality in terms of the present health situation and trends in society
(rise of fundamentalism, new economic policy, population and health policy).
2. Women's contribution and women's place m health care system.
3. Concept of patriarchy and gender.
4. Life cycle approach to women’s health.
5. Critic of health system from feminist perspective, western approach of health.
6. International network on Reproductive Rights and National level on Women
& Health
Methods
-
Lecture/handouts
Discussion
Small group discussion
Structured exercises
Resource Material
-
Film “ARMAAN/PRATIKSHA (UNICEF)
-
'Sasuraal - Piyar' “Trilogy” (Meena Diwan's)
-
Something like a war (JAGORI)
Resource/Resource Persons
- Abha/Sarojini, Jagori
-
Ms.Nandita Gandhi
- Ms.Nandita Shah
- Dr. Mira Shiva
- Ms.Asha Kachru
- CHETNA
- Ms.Renu Khanna
- Ms.Maith Krishna Rao - SNDT
- Dr.Mira Sadgopal
- Dr.Meera Chatterjee, Ms.Ranjani, IWID
- Sabla, Kranti
Estimated Time Required : 3 days
41
II.
Conception : Birth and Infancy
Objective :
To understand and recognise the beg.nnmg of discrimination against girls from
birth and before.
Expected Outcome :
Should be able to understand and recognise uiscrimmaiiori ag.ur.st girl chiid
from birth and before.
Concept/Content :
1.
2.
3.
4.
Sex Ratio
Determinants of gender
Role of modern technology
Discrimination of girl babies despite biological superiority, high mortality of
girl child-infanticide /neglect
5. Discrimination in nutrition (breast feeding, feeding practices).
6. Social, cultural supports for mothers, for child care, maternity benefits,
creches at work place.
7. Adoption issues, rights of adopted childAaw for adoption of child.
Method
- Lecture/handouts
- Discussion
- Reading
- Action Research for feeding pattern of child/rest of mother, baby food (Girl
and boy)
Resource/Resource Persons
- Dr. Meera Chatterjee
- Dr. Mira Shiva
- Dr. Shanti Ghosh
- VHAI
- CHETNA
- JAGORI
- Vimochana Women’s Centre
- Janet Chawla
Reference Material
- Books
- You and your child, Dr. Shanti Ghosh
- Adoption - Dr. Mira Shiva
- Pakistani Video Serial “Ahaat”
Estimated Time Required : 2 days
42
III.
The Girl Child and Adolescent
Objective :
To understand and recognise the specially disadvantaged status of the girl child
in our society.
Expected Outcome
- Should be able to understand and recognise the discrimination faced by girl
children in all spheres of their lives like education, nutrition, health.
- Should be able to understand how girls are socialized into stereotypical
roles.
- To be able to identify signs of sexual abuses and how to prevent it.
Concepts/Concerns
(1-5 years)
- To understand and reorganise social, cultural factors
mortality rate in girl child.
- Understand how girls are socialised in stereo-typical roles.
-
influencing
high
(6-10 years)
Discrimination of girl child in education, self esteem, physical and sexual
abuses, emotional health (factors affecting under-nutrition).
(11 - 15 years)
1. Understanding their own body
2. Understanding and preparing for marriage or its options
3. Sexual abuse
Methods
- Lecture/handouts
- Discussion
- Reading
Resource Material
- Pakistani Serial ‘Ahaat’ (Video fiirr)
- Ghanashyam and Punki
- Armaan
Resource Persons
- Ms.Manisha Gupte
- Dr. Shanti Ghosh
- VHAI
- CHETNA
- JAGORI
- Dr.Meera Chatterjee
- Dr.Mira Shiva
- Vimochana - Women’s Centre
- PRERNA
- Ms.Shalini, ISI, New Delhi
- VHAI
- Kamala Bhasin
- Sarah Chanda
Estimated Time Required : 3 days
43
IV.
Adult Women’s Health
Objective :
To know and understand the different integrated elements of women’s health
and their interaction.
a. Nutrition
Expected Outcome :
- Should be able to identify critical areas of women's health concerns.
- Should be able to identify critical areas of women’s nutrition and on its
nutritional status.
Concept/Content :
- Food and politics of food within the family and society - Public Distribution
System (PDS)
- Water, politics of water
- Gender division of work and its effect on women's health.
- Women’s work Vs. Calorie intake.
- Anaemia/Feeling tired.
- Food during pregnancy and lactation.
- Deficiency (nutritional), Vitamin A/Calcium/lodine.
- Food taboos and food taboos related to control of sexuality.
— Toxic adulteration and contamination including pesticides, colouring agents
and preservatives.
Method :
- Lecture/handouts
- Discussion
- Reading
- Lecture/handouts
- Videos
- Role Plays
- Survey in the field
Resource/Resource Persons :
- CHETNA
- Dr. Shanti Ghosh
-
Dr. Veena Shatrughna
Dr. Mira Shiva
-
Dr. Mira Sadgopal
- Ms. Vanaja Ramprasad, LSPSS
- Sabla Sangh/Action India
Estimated Time Required : 1 - 1/2 day
44
b. Occupational Health
Objective :
To know and understand the different integrated elements of women's health
and their interaction.
Expected Outcome :
- Should be able to understand the “impact of work" on women's health
Concept/Ccntent :
- Contribution of women in organised and unorganised sector
- Working environment and condition of women workers at home and outside
the home
- Legislation (equal wages for equal work)
- Occupational health problems of women
- Working postures
- Repetitive strain
- Injury (RSI)
- Gynaecological problems
- Stress
-
Exposures to toxic and irritants
Effect on foetus
Effects of technology on women’s work
History of resistance and strength against occupational health hazards
Focus on large occupation groups
CSW (Commercial Sex Workers)
- Women health workers (ANMs)
Methods
- Discussion
-
Reading
-
Lecture/handouts
- Videos
- Role-plays
- Survey in field
Resource/Resource Persons
- Dr. Mirai Chatterjee, SEWA
-
Ms. Suneeta Dhar
-
Dr. Mira Sadgopal
-
Ms. Veena Shatrughna
-
Ms. Vanaja Ramprasad, LSPSS
- Mr. Binoy Acharya, UNNATI
45
-
Ms. Sujatha Gothesker
- Ms.Elina Sen
- VHAI
- Dr. Shyama Narang
c.
Emotional Health
Objective
To know and understand the emotional health concerns of women and towards
equality/balance.
Expected Outcomes
1. Discuss the role of family in precipitating stress and violence.
2. Debate the assumption that home is a safe environment for women.
3. Recognise and encourage positive family support to women
4. Discuss alternatives of support for women e.g. encouraging other forms of
living eg. community living other than marriage and family.
Concept/Content
- Sexual harassment at home, at work and community
- Family rape, incest and history of sexual abuse
- Marital Rape.
- Social pressures e.g. Dowry).
- Multiple roles.
- Overwork.
- Discrimination at home and work place.
-
Battering and other violence
- Suicides, murders
- Accidents and stove bursts
- Women as witches
- Depressions (Schizophrenia and other psychological disorders)
- New structures and spaces
- Concealing
- Women and spiritually
methods
- Lecture/handouts
- Discussion
- Videos
-
Profiles of women
Films
46
Resource/Resource Persons
- Ms. Manisha Gupte
- Ms. Renu Khanna, SAHAJ
- Ms. Abha/Sarojini, JAGORI
- Vimochana Women’s Centre
- Dr. Mira Sadgopal
- Ms. Gita Thadani
- Eyes of Stone (Film)
- Ms. Flavia, FAOW
d.
Other Health Problem of Women
Objective :
To recognise other health concerns of women not covered specifically under
earlier sub-themes.
Expected Outcomes
- To realise, the importance of those problems which worsen women's overall
status.
- To question the medicalization of women’s condition for profit.
Concept/Content :
- T.B. including its relation to infertility and ecotopic pregnancy
- Cervical and breast cancer
- Aids
- Headache
- Lower backache
- UTIS
- Acidity, restlessness
- Unnecessary medical intervention
- Cosmetic surgery
- Hormone therapy
method
- Lecture/handouts
- Discussions
- Self-help
- Group discussions
- Slides
- Videos
- Pictures
Resource/Resource Persons
- SEWA
- Dr. Rani Bang, SEARCH
- Dr. Mira Shiva, VHAI
Estimated Time Required : 2 days
47
V.
Sexual Health and Sexuality :
Objective :
To understand women’s sexuality and sexual energies
Expected Outcome
- To understand women's (and men's) sexuality
- To discuss the construction of sexuality and sexual roles of men and women
- To assert women’s right in the expression of their sexuality/sexual preference
- To understand and initiate self help as a way to learning and training
- Challenge myths regarding sexual behaviour
Concept/Content
1. Question stereotypes of masculine/feminine.
2. Right to say yes/no.
3. Right to abstinence and sexual activity.
4. Sexual labels like frigidity (Is it a form of showing disinterest or resistance).
5. Right to sexual preference and reject heterosexuality.
6. Myths related to masturbation/other socially unaccepted sexual behaviour.
Methods
- Use of speculum
- Body awareness
- Self examination of breasts, cervix, menstrual charting, etc.
- Small group discussion
- Personal sharing
- Role-play
- Demonstration
- Body mapping
Resource Material :
- AVEHI, Bombay - Video
- NIROG, Gujarat
- CHETNA - Child Birth Picture Book and Slides
Resource/Resource Persons
- Ms. Manisha Gupte
- Abha/Sarojini, JAGORI
- Ms. Kamala Bhasin
- Dr Mira Sadgopal
- Ms.Kranti, Sabata
- Ms. Mallika
- Dr. Shyama Narang
Estimated Time Required
3 days
48
VI. Gynaecological Health
Objective :
To know and understand the gynaecological concerns of sexually active and
celibate women.
Expected Outcome :
- Should know and understand the range of GTI concerns of women including
STDs
- To understand the social implications on women’s gynaecological disorders
(e.g. Painful intercourse, infertility, related to desertion and violence, etc.)
- To encourage self help approach in identifying gynaecological disorders
Concept/Content
1. Care during menstrual period
2. Menstrual problems
3. White discharge
4. Upper and lower genital tract infections
5. Painful intercourse - how to prevent it, frigidity
6. Sexually Transmitted Diseases (STDs)
7. Accquired Immuno Deficiency (AIDS)
8. Problems precipitated by Contraceptives
9. Prolapsed uterus
10. Endometriosis/fibroids/cysts
11. Cervical, uterine and breast cancer
Method
- Lecture/handouts
- Use of speculum, home remedies
- Discussion
- Demonstration
- Body mapping
- Action Research
Resource Material
- SHODHINI Report
Resource/Resource Persons
- Dr Rani Bang
- Dr Daxa Patel (ARCH)
- Dr Mira Shiva
- Dr Mira Sadgopal
- Dr Veena Shatrughana
- Ms. Manisha Gupte
- Sarojini/Smita Bajpai/Philomena, (SHODHINI Network)
- Dr. Shyama Narang
Estimated Time Required : 4 days
49
VII. Reproductive Health :
Objective :
To know and understand the politics of reproduction and its effect on women’s
health.
Expected outcomes
1. To understand conception and reproduction.
2. To encourage fertility awareness.
3. To discuss women's reproductive rights (Choice, Control).
4. Problems related to reproduction.
5. To meet women’s need to make safe and effective contraceptives available
to women and to resist the testing and peddling of harmful contraceptives.
6. To create options to invasive reproductive technologies
Concept/Content
1. Menstrual charting and knowledge of conception
2. Contraception and rational contraceptivechoices and after care.
3. Targets in family planning
4. Coping with infertility
5. Abortion and law related to it
6. Lower Reproductive Tract Infection (RTI)
7. Ectopic pregnancy
8. Unnecessary medical and Pharmaceutical interventions
9. Adoption as reproductive choice
10. Low access to medical technology
11. Post tubectomal problems
Method
- Lecture/handouts
- Case studies
- Data collection and documentation
- Action research
- Demonstration
- Films
- Videos
Resource/Resource Persons
- Dr Rani Bang
- Dr Veena Shatrhghna/Dr. Shyama Narang
- Dr Mira Shiva
- Dr Mira Sadgopal
- Dr Daxa Patel
- Manisha Gupte
- Kalpana/Lakshmi, SAHELI
- Abha/Sarojini, JAGORI
Estimated Time Required : 3 days
50
VIII. Maternal Health
Objective :
To know, recognise and understand the elements of maternal health.
Expected Outcomes
- To facilitate access of women to health care during and after pregnancy.
- To facilitate access of women to nutrition during and after pregnancy.
- To facilitate access to care and rest during and after pregnancy.
- To increase men’s participation in child care and during pregnancy.
- To increase women’s access to Maternity Benefits
Concept/Content
1.
Maternal Morbidity
2.
3.
Mortality (Extent and rates by region)
Maternal Nutrition during pregnancy, lactation
4.
Anaemia
5.
Calcium/lodine, Vitamin A, under-nutrition (Nutritional Deficiencies)
6.
7.
8.
9.
Toxemia
Eclampsia
Unattended Child Birth
Need for Ante Natal Care/Post Natal Care (ANC/PNC)
10. Lactation failure
11. Overwork, need for rest
12. Multiple burden
13. Sharing household work
14. Paternity leave
15. Looking after children
16. Creche facilities
17. Maternity leave (even after adoption)
Resource Material
Poster -’Meri Bibi Kaam Nahi Karti’
Methods
- Lecture/handouts
- Role play
- Simulation
- Posters
- Chans
LIBRAR
-d
documentation ) y
\ X.
V.,'„■ ■■■"..'
- Videos
- Films
- Discussions
- Case Studies
51
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I
Resource/Resource Persons
- Dr Shanti Ghosh
- Dr Pal
- Dr Rani Bang
- Dr Veena Shatrhghana/Dr. Shyama Narang
-
Dr Mira Shiva
- Dr Daxa Patel
- CHETNA/Ahmedabad
- SEWA Rural, Gujarat
- CINI, Calcutta
- CHETNA, Ahmedabad
Estimated Time Required : 3 days
52
IX.
Older Women
Objective :
To understand and recognise the concerns of older women.
Expected Outcomes
- To understand the health concerns of older women
- To question the denial of basic rights to older women.
- To question over-intervention or underutilization of medical technology.
- To create and promote networks/support groups of older women.
Concept/Content :
-
Menopause
Sexuality
Nutritional Deficiencies
- Poverty and neglect
- Oesteoprosis
-
Freedom from reproduction
-
Backache
- Postural problems
- Arthritis
- Loneliness (Widowed and within family single women)
-
Legal protection (property rights)
- Exploitation and abuse
- Lack of social and cultural support
- Lack of health care
- Estrogen Replacement Therapy (ERT)
- Increase social interaction
- Spirituality and faith
Methods
- Lecture/handouts
- Discussion groups
- Sharing of experiences
Resources/Resource Persons
- Ms. Abha Bhaiya, JAGORI
- Ms. Asha Kachru
- Dr. Shanti Ghosh
- Dr. Veena Shatrughana
- Dr. Mira Sadgopal
- Ms. Chandra Bhandari
53
X.
Organising for Women’s Health
Objective
To learn and facilitate the discussion about
programmes for addressing women’s health concerns.
possible
solutions/action
Expected Outcome
- Should know about different approaches to solving women's health problems
(actual programmes from the field).
Concept/Content
- Different approaches to women’s health (examples of action oriented, grass
root and other intiatives options/strategies available from real experiences).
- Use of media
- Formation of resource groups, lobbying, networking.
- Creating spaces and alternatives : self-help, services network/structure
systems
- Initiatives
- Other experiences of women organising around issues like water, politics of
water etc
Methods
- Lecture/handouts
- Action research to generate needed data
- Case studies
- Reading
- Video
- Discussion
- Workshop
Resource/Resource Persons
Ms.. Abha/Sarojini, JAGORI
Dr. Mira Sadgopal, MFC
Ms. Nirmalben, SARTHI
Ms. Renu Khanna, SAHAJ
Dr. Rani Bang, SEARCH, Wardha
Ms. Sabia and Kranti
Ms. Manisha, MASUM Mahila Samaj Utkarsh Mandal
Ms. Fatima Bernad
Dr. Veena Shatrugna, ANVESHI
Ms. Uma Maheshwari, DDS
SEWA
Sadguru Water and Development Foundation
CHETNA
SUTRA
URMUL
Ms.Srilata Batliwala
SAHELI
Sabia Sangh/Action India
Estimated Time Required : 3 days.
54
Annexure - IV (a)
TIME FRAME - MODULE ON WOMEN’S HEALTH CONCERNS
1.
1.
Role, status and contribution of women
2.
Conception, birth, infancy
2 days
3.
Girl child and adolescent
3 days
Total days
I!.
:
8 days
1.
Sexual Health
2.
Reproductive Health
:
3 days
3.
Gynaecological Health
:
4 days
4.
Maternal Health
:
13 days
:
3 days
:
2 days
:
4 days
3 days
Total days
111.
3 days
:
(a) nutrition
(b) occupational
1.
Adult women -
2.
Other health problems
(c) Emotional health
(d) Older women
2 days
Total days
IV.
1.
Doubly disadvantaged women
2
Policies and registration related
to women’s health
3.
Organising women
11 days
:
3 days
:
3 days
3 days
Total days
Total days : 41 days
55
:
9 days
Annexure - V
MODULE : BUILDING WOMEN’S CAPACITIES TO
PRESERVE HEALTH
Introduction :
This module is designed for training of Managers and Supervisors of women’s
health programmes. This module was discussed amongst the experts and in
small groups of specialists.
It was felt that the feminist perspective should be the connecting thread
common to all the objectives. At many places
it was felt that the module can be integrated with that of women’s health
concerns and management. This could be discussed at later stage.
It was felt that the module may not limit itself to ayurvedic systems but should
also incorporate other systems like homeopathy, siddha, unani, reflexology,
yoga, meditation, accupressure, etc. Most important of all, it should be based
on people’s knowledge, system of traditional practices and, culture.
It was also thought necessary to organise a meeting with resource persons who
would conduct the sessions. The group also felt that before undergoing this
training the participants should be familiar with the local traditions, culture, food
habits, crops, medicinal plants, etc. Hence a “home work” sheet will have to be
duly filled by them before coming to the course which couldbe discussed under
relevant topics during the training.
Participatory methodology shall be used to impart the training.
Overall Objectives of the Module :
a) Understanding, accepting and building a positive attitude towards self as a
woman.
b) To sensitise women on the current social, political, economic, environmental
and “developmental” impact on health.
c) To build the capacities of co-ordinators and promoters of women's health
programmes using traditional knowledge systems as a tool for empowerment.
d) To recognise, preserve and strengthen traditional knowledge systems and
skills.
56
I. General
Objectives :
To sensitise individuals on the role and importance of traditional knowledge
systems.
Expected Outcome :
Should be able to understand, recognise, preserve, strengthen and communicate
traditional knowledge of community medicine and skills.
Subject/Content
- Introduction to Local Health Traditions (LHT) and Indigenous System of
Medicines (ISM).
-
Health care system, gender perspective, traditional technology.
- Orientation in traditional health care.
- The philosophy, approaches, concepts and methodologies.
Categories in Traditional Medicine.
- Community medicine, preventive and promotive health.
- Role of multiple healing systems like yoga, folk medicine, accupressure,
dance, meditation, etc.
Methodology/Teaching Aids
- Home work done by the Participants, sharing of LHT
- Group exercises
- Role play
- Photo language
- Lectures
- Notes
- Books
- Simulation exercises
- Slides
- Video
Resource/Resource Persons
- Mr Darshan Shankar, ADS
- Vd G.G. Gangadharan, LSPSS
- Vd Smita Bajpai, CHETNA
-
Dr Mira Sadgopal, MFC
- Mr Balasubramaniam, Sree Chakra Foundation
- Mr MM Kumarswamy, SHSD, Pune
Estimated Time Required : 2 days
57
II.
Body Structure and Function
Objectives :
To provide an understanding on body structure and function
Expected Outcome :
Should know the basic structure and function of human body (male and
female).
Subject/Content
- Personal perceptions
- Basic structure and function of human body
- Digestive, respiratory, excretory, nervous, cardio- vascular and reproductive
systems, the five senses
- Mind and emotion in relation to well being
- Broad understanding of Prakriti (constitutional type)
Methodology/Teaching Aids
- Body marking, drawings, pictures
- Self help
- Models
- Charts
- Books - (Pictures)
- Phad/exhibition
- Games
- Video, slides
Resource/Resource Persons
- Philomena, Sarojini, Renu Khanna - SHODHINi Network
- Vd S. Koppikar
- Vd Varsha Walavalkar
- Vd Smita Bajpai, CHETNA
- Vd Surabhi Adbe
- Vd Radhika
- Sabla//Kranti
Estimated Time Required : 2 days
58
111.
Nutrition
Objectives :
Tc understand the gender discriminatory practices related to food.
- To understand, preserve and encourage the utilisation of positive local food
practices.
- To encourage the regeneration and utilisation of local food crops.
- To develop an understanding of a balanced diet, locally available foods.
Expected Outcome :
- Should be able to identify and know the nutritional locally available plants
and crops.
- Should know about sound food preservation and processing techniques.
- Should know about need of seasonal variation infood habits.
- About personal constitution (Prakriti) and its relation to food and health and
also compatible food combinations,its hazardous effect on health.
Subject/Content
- Sharing of knowledge of local food practices and acknowledgment of positive
practices and, exposure to distorted practices.
- Seasonal variation in food practices.
- Concept of hot and cold, incompatible food combinations.
- Social aspects of nutrition including Public distribution System.
-
Encourage growing of nutritional plants adapted to specific area.
Methodology/Teaching Aids
- Lecture/handouts
- Module on Nutrition in life cycle developed by CHETNA
- Demonstration
Practicals
- Herbarium
- Charts
- Colour photographs
- Audio visuals
- Reference books from
- VHAI
- CHETNA
- LSPSS
- ASTHA
- Vd Ramesh Nanai
- Pathyapathya
- Calendar
59
Resource/Resource Persons
-
LSPSS
Prof Tara Mehta, M.S. University, Baroda
SHODHINI Network
Dr Veena Shatrughna, NIN
Uma Maheshwari, DDS
- Pallavi/Smita, CHETNA
-
Ms Vanaja Ramprasad
-
Ms. Sarojini, JAGORI
- Ms. Padmasuri, Asuri,Bangalore
Estimated Timo Required : 3 days
60
IV.
Promotion of Health
Objectives:
To provide information on factors helping to maintain and preserve positive
health.
Expected Outcome
- Should know how to prevent communicable diseases, promote positive health
Should also know the traditional practices of Rasayana which improves
resistance to diseases
- Should be aware of environmental pollution
-
Subject/Content
- Knowledge of rational and irrational products in the market
-
Preventive
- Positive health
- Rasayana
-
Harmful effects of pesticides, chemical fertilisers, pollutants, etc.
- Greening of environment
- Meditation
Methodology/Teaching Aids
- Lecture/handouts
- Demonstration
- Video film
- Audio visuals
Resource/Resource Persons
- Ms Chandralekha
- Dr. Mira Shiva
- Ms Asha Kachru
- Vd H.B. Singh
- Vd Pathod
- Mr M.M. Kumarswamy, SHSD
- Mr Vasudevan
- Vd. G. G. Gangadharan
- Vd. Tathed
Estimated Time Required : 2 days
61
V.
Simple Skills for Diagnosis
Objectives :
To make the woman self-reliant in a holistic approach to diagnosing illness.
Expected Outcome
- To inculcate a compassionate, intuitive and holistic approach towards
individuals.
- Should be able to diagnose common ailments using simple techniques and
should be able to refer cases wherever necessary.
- Should be able to diagnose PHC components like
' Gynaecological health and ailments
■ Maternal health
* Antenatal Care
* Postnatal Care
* Child Care
’ Emotional disturbances
Subject/Content
- Socio-economic cultural factors affecting health
- Understanding stress, strain
- Basic principles, Dosha, Dhatu, Roga marga
- Simple methods of diagnosing common ailments
- Traditional Medicine and Primary Health Care and Women’s health
- Good healer - patient relationship i.e. listening, touching, counseling, etc.
Methodology/Teaching Aids
- Sessions
- Video slides
- Notes, charts
- Demonstration
- Clinical exposure
- Practical
- Exchange of views
- Traditional Birth Attendant (dais’s)
- Folk practitioners
Resource/Resource Persons :
- Vd. Gangadharan - LSPSS
- Vd. Smita Bajpai, CHETNA
- Vd. Ramesh Nanai
- Vd. S. Vilas Nanai
- Vd. S. Koppikar
- Dr. Marie D’souza
- Dr. Rani Bang
- Ms. Janet Chawla/Shyama Narag
Estimated Time Required : 4 days
62
VI
Disease Management
Objective
To provide information and knowledge of managing different common ailments
using local resources and alternative healing systems such as yoga, reflexology,
meditation, etc.
Expected Outcome
Should be made aware of harmful beliefs and practices
Subject/Content
Practical demonstration of alternative healing practices
Methodology/Teaching Aids
- Clinical sitting
- Practical Demonstration of alternative healing practices
- Notes
- Manuals and classes
Resource/Resource Persons
-
Dr Shyama Narang
-
Vd Sanjay Dakhore
Vd Varsha Walavalkar
Vd Vanita Rage
Vd Vanelana Vaidya
Vd Illa Deshpande
Vd Shubada Velankar
Vd Usha Deshmukh
Ms Asha Kachru
Estimated Time Required : 5 days
63
VII.
Maternal Health
Objective
To provide information regarding various aspects of maternal health.
Expected Outcome
- Should know the needs of a pregnant mother
- Should know of sound delivery practices
- Should know to diagnose a complicated presentation
- Should know safe abortion techniques, contraceptive methods and hazardous
reproductive technologies
- Should be able to refer cases at appropriate time
- Should know the components of ANC PNC, diet, regimen
- Should know about the food and plants useful in improving/increasing
lactation
Subject/Content
- Maternal Health
- Diet
- Massages
- Herbs
- Regimen in pregnancy and lactation
- Drugs and technologies used in contraception
Methodology/Teaching Aids
- Sessions
- Clinical presentation
- Demonstration
- Audio-visuals
- Manuals
- Exhibition
- Homework on collection of local practices
Resource/Resource Persons
- Vd Varsha Walavalkar
- Vd S Koppikar
- Vd Smita Bajpai/CHETNA
- Vd Durga Paranjpe
- Vd Ila Deshpande
- Vd Mahashabde
- Vd Usha Deshmukh
- Vd Manda Bahulkar
- Vd Mrs Mhaiskar
- Dr Rani Bang, SEARCH
- Sabla and Kranti
- Dr Shyama Narang
- Ms Janet Chawla
Estimated Time Required : 3 days
64
VIII. Child Health
Objectives
To provide information on various aspects of child care.
Expected Outcome
- Should be able to manage low birth weight babies
- Should be able to understand different aspects of child health like breast
feeding, weaning, nutrition, common ailments, etc.
- Normal stages of child development and how to identify abnormalities.
- Improving immunity and understanding emotional needs of the child.
Subject/Content
-
Infant care
-
Needs and importance of breast feeding
-
Massage
-
Bal-ghutti and other types of immunisation
- Traditional toys
- Traditional story telling
- Identification of risk symptoms
- Child labour, legislation and linked diseases
Methodology/Teaching Aids
-
Lectures/handouts
Manuals and Audio-visual aids
Practicals
- Picture books
- Charts
-
Posters
Resource/Resource Persons
- Vd Durga Paranjpe
- Dr Shashi Vani
- Vd B.V. Sathye
- Dr Shanti Ghosh
- Ms Tripta Batra
- Vd Koppikar
- Dr Bhangale
- Ms Nandana Reddy, Lawyer (Bangalore)
- Ms Manjari Dingvani (Delhi)
- Ms. Uma Kulkarni, MSK, Bangalore
Estimated Time Required : 2 days
65
IX.
Water and Sanitation
Objectives :
1. To sensitise individuals on the traditional methods of water harvesting,
recharging and conservation methods
2. To provide skills in organising women to improve access to drinking water
3. To provide knowledge on techniques to make drinking water clean and safe
4. To understand and act upon women’s needs for sanitation according to local
conditions
5. To provide knowledge about links between illnesses, women and, water and
sanitation
Expected Outcomes
- Should be able to plan, decide and take action for easy accessibility to
potable water
- Should be able to appreciate the need for traditional water harvesting
methods and organise people
- Know the methods of water purification at home and community level
- Be able to identify water borne and water related diseases and its linkages
to impure water
Subject/Content
- Traditional water harvesting, conservation and purification techniques for
utilisation and skills of repair hand-pumps.
- Plants used in water purification, effects of herbs in water
- Methods for physical purification and its limitations
- Herbs that can be used to give cooling effect to the water
— Herbs used for aromatic carminative and digestive properties
- Water for regular drinking
- Boiling water, reasons for its advice
- Different types of water, well-water, the difference and physiological effect
- Drudgery saving devices
- Illnesses associated with water-borne diseases and with carrying water
Methodology/Teaching Aids
- Lectures/handouts
- Practicals
- Demonstrations
- Coloured photographs of plants
- Manuals
Resource/Resource Persons
- Ms. Alka Shrimali, SWACH, Udaipur
CEE, Ahmedabad
- Ms. Rima Nanavati, SEWA
- Ms. Madhavi and Art! - U.P. Mahila Samakhya
- Ms. Madhu Sarin
- Aga Khan Rural Support Programme, Gujarat
- Sewa Mandir, Udaipur
Estimated Time Required : 3 days
66
X.
Identification of Medicinal Plants
Objective :
To provide an understanding of varieties, identification methods and uses of
local medicinal plants
Expected Outcome
- Should know the list of medicinal plants used commonly in the country/state/
local level.
- Should know how to identify the local species used in the particular area.
- Should know about the medicinal plants useful in Primary Health care.
-
-
-
Should know about the plants that are rare and endangered species and be
able to protect the existing plants and linkage with environment
(deforestation)
Should know how to make on herbarium sheet for identification purpose.
Should be able to protect the existing plants and linkage with environment
(deforestation).
Subject/Content
Identification of medicinal plants :
a. Local or area specific
b. National scenario
Methodology/Teaching Aids
- Assessing the home-work on list of plants available in one's own area.
- Field visit to the nearby forest area with Vadus
- Folk practitioner
- Local Vaidyas
- Botanists
- Video
- Slides on medicinal plants
- Practicals
- Demonstration
- Lecture/handouts
Resource/Resource Persons
- Ms Indira Balachandran, Kottakai
- Ms Gangamma, Mahila Samakhya, Karnataka
- Ms Bhanvar Dhavai, Jagran Janvikas Samiti
- Vd Unniyal, CCRAS, Ranikhet
- Mr Chavda, Government Ayurvedic College, Gujarat- Mr Abdul Karim, LSPSS
- Dr Mrs.Ghate MACS, Pune
- Ms. Uma Maheshwari, DDS, Bangalore
Estimated Time Required : 2 days
67
XI.
Propagation of Medicinal Plants
Objectives
To provide knowledge and skill on plant propagation techniques.
Expected Outcome
- Should have adequate knowledge propagation techniques of medical plants.
- How to plan a home garden
- Should know the different aspects of propagation of locally available species
- How to plan a community herbal garden, nursery and seed bank
- Should be able to be aware of dangers related to commercialisation of
medicinal plants
Subject/Content
-
Plant Propagation Nursery
-
Seed-bank
Methodology/Teaching Aids
-
Lecture/handouts
-
Field visit to herbal garden
Demonstration of kitchen garden
-
Community garden
Classes on different aspects of Nursery
Resource/Resource Persons
- LSPSS
- Dr Pushpangadan (TBGRI)
- Prof Panikar
- Mr Arumukam
- Mr Abdul Karim
-
Shree Ram, LSPSS
- Dr Marie D’Souza
- Philomena Vincent, SHODHINI, AIKYA
- Ms Vandana Shiva
- Mr Venkat, DDS, Hyderabad
- TBGRI (Tropical Botanical Research Institute)
Estimated Time Required : 2 days
68
XII.
Processing of Medicinal Plants
Objective :
To provide knowledge and skills on various self-help techniques in processing
plants.
Expected Outcome
Should know how to prepare medicine using self-help techniques.
Subject/Content
Self-help technique to prepare medicine like Kwath, Choorna, Kalka, etc. (See
Appendix I for details).
Methodology/Teaching Aids
- Lecture/methods
- Demonstration
-
Manuals
Practicals
Resource/Resource Persons
-
Vd Sanjay Dakhore
-
Dr Manjunath, VHAI
- Ms Gangamma, Mahila Samakhya, Karnataka
- Ms Halamma, Mahila Samakhya, Karnataka
- Ms Savitri with Philomena Vincent, AIKYA
-
Ms Nirmalben, SARTHI, Gujarat
LSPSS Network
-
Uma Maheshwari, DDS, Bangaore
Estimated Time Required : 1 day
69
Annexure - Va
TIME FRAME - MODULE ON BUILDING WOMEN’S CAPACITIES
TO PRESERVE HEALTH
A.
General Introduction
B.
Human Body Structure and Functions
C.
Nutrition
3 days
D.
Promotion of Health
2 days
E.
Simple Skills for Diagnosis
:
4 days
F.
Disease Management
:
5 days
G.
Maternal Health
:
3 days
H.
Child Health
2 days
1.
Water and Sanitation
3 days
J.
Medicinal Plant Identification
2 days
K.
Propagation of Medicinal Plants
L.
Precessing of Medicinal Plants
2 days
:
:
Total
70
:
2 days
2 days
1
day
31
days
Annexure - VI
MODULE : MANAGEMENT OF WOMEN’S HEALTH
A.
An Alternative Perspective on Management
Expected Outcomes
Should be able to understand:
- The processes, roles, tasks and functions of Management
- Values and practices of management for development
including that of women's groups
or social
action
Content/Concept
-
Management Processes
Values : equity, justice, democracy, participatory functioning
Concepts of Patriarchy, Power and Subjectivity
An organisational framework, from the feminist perspective
Overview of the module
Methodology
-
Lecture/handouts
-
Exercises on understanding values, value classification, and sexual biases
Roleplays
-
Diads, Triads, Groups
Emphasis : Manager
Resources
- IWID, Madras
- PRIA, New Delhi
- SEARCH, Bangalore
- AIKYA, Bangalore
- JAGORI, Delhi
- Mahila Samkhya Programme
Estimated Time Required : 2/3 days.
71
B. I. Understanding Self and Others
Expected Outcome
- Should be able to analyse and understand self in terms of needs, wants,
values, attitudes, aspirations, motivations and thinking patterns.
- Should be able to distinguish between her various roles compatible in the
gender relations framework.
- Should be able to analyse and improve own communication patterns with
colleagues at different levels and with peers.
- Should be able to analyse dynamics of interpersonal relationship between
men and women.
Content/Concept
- Personality
- Transactional Analysis
- Creativity
- JOHARI window
- Erik Erikson's Eight Stages (Gender Perspective)
Roles and role conflicts
- Sub personalities + Psychosynthesis
- Communication theory
- Patterns of women's communication : Oral Vs. Written
- Active listening, Articulation
- Assertiveness training (with reference to gender and cultural aspects)
- Stress Management
Methodology
a. Sociocultural Content
- Analysis of women’s lack of self worth in the historical context of class,
caste and gender and in relation to Who am I?
- Sources of power, strength and selfimage
b. Emotional Content
- Creativity
- JOHARI window
- Erik Erikson's Eight Stages
Managing Self
Simulation,
drama
exercise,
roleplays,
small
Emphasis : Manager/Supervisor
Resource
- SHAKTI
- SEARCH
- AIKYA/SHSD
Estimated Time Required : 4 days.
72
groups,
meditation,
songs,
dance,
B.
II Small Group Processes
Expected Outcomes
- Should be able to analyse group dynamics and develop skills to manage
them
- Should be able to apply all the above principles to developing a good, well
functioning team
- Should be able to develop flexible leadership styles to match individuals in
team
-
Should be able to resolve conflicts within the team
-
Should be able to appreciate the importance of counselling in management
of women's team
-
Should be able to build skills of effective counselling for women team
members
Content/Concept
- Theory of group dynamics
- What motivates women?
- Teams and team building
perspective)
-
(with reference to gender and expowerment
Enhancing capacities of team members
Leadership theory
- Shared and collective leadership
- Conflict resolution
- Giving and receiving feedback
- Counselling frameworks
Methodology
- Lecture/Handout
- Exercises : case study, role plays, journal/diary writing
- Games, reflection
-
Exercise to identify own leadership style
Small group processes
Simulation, exercise, roleplay, small groups, meditation, songs, dance, drama,
group exercises
Emphasis : Manager, Supervisor
Resource
- SHAKTI
- SEARCH
- AIKYA
Estimated Time Required : 2 days.
73
C.
Project Management
Expected Outcomes
- Should be able to apply principles of management to plan out the objectives,
staffing, sequence of activities required for women's health programme.
- Should be able to apply all the above to developing a good, well functioning
team.
- Should be able to develop flexible leadership styles to match the individuals
in team.
- Should be able to resolve conflicts within the team.
- Should be able to apply principles of problem solving and decision making.
- Should be ale to prepare a budget for the women’s health programme.
- Should be able to prepare a project proposal.
Content/Concept
- Participatory planning processes based on community & community
participation , women’s priorities related to objectives, staff, activities,
resources, time
- Teams and team building (reference to gender andempowerment
perspectives)
- Enhancing capacities of team members.
- Conflict resolution
- Giving and receiving feedback
- Building : fixed/variable cost analysis
- Use and preparation of budget
Methodology
- Lecture/handouts
- Exercises : case study, role plays, journal/diary writing
- Games
- Handout on budgeting
- Case studies incorporating gender sensitive ways of managing
- Field visits
Emphasis : Manager
Resources
- SEARCH, Bangalore
- PRIA
- VHAI
- Dr. R.K. Pal
- AIKYA/SHSD
- “Management Process in Health Care" Book by VHAI
- IWID
Estimated Time Required : 5 days.
74
D.
External Environment
Expected Outcomes
— Should be able to relate effectively with the external environment
- Should become an effective community organiser manager
—
Should become an effective resource mobiliser and manager
- Should become an effective women’s health advocate
Content/Concept
- Role as a boundary manager (define boundary manager)
- Gender aspects of becoming an effective boundary manager
- Community participation
- Organising and mobilising
- GO and NGO relations, Value of Government infrastructure
- Role vis-a-vis Government infrastructure
- How to do intersectoral coordination
- Relationship with funding agencies
- Ways of mobilising funds
- Advocacy on women’s health issues
- Networking with women's groups
- Networks, coalitions, federations
- Framework for policy formulation and planning from a gender perspective
Methodology
- Exercise on mapping significant others
- Exercise on listing methodologies for relating with community and identifying
skills required
- Roleplays, case study
-
Handout on Advocacy for women’s health
External Environment
Developing cognitive level skills Field visits, Interviews, AVs of case studies,
role play, practise sessions, role model and simulation.
Emphasis : Manager
Resources
- PRIA
- SEARCH
- Advocacy Network
- AIKYA/SHSD
- IWID
Estimated Time Required : 2 days.
75
E.
Programme Management
Expected Outcomes
- Should be able to apply principles of management to plan out objectives,
staffing, sequencing of the activities, resources required for women's health
programme and manage time.
- Should be able to understand and practise humane, empowering personnel
management (support, collaboration, sexual division of labour).
- Should be able to understand,
* the difference between monitoring and evaluation
’ the philosophy and concepts of self and participatory evaluation
* develop indicators to evaluate
- Should be able to facilitate the collection and analysis and, use data
-
Should be able to document the process and outcome of work
Content/Concepts
- Overview of management process
- Planning
: How to state and prioritize objectives, plan for staff required,
schedule activities, resources required.
-
Staffing
-
Statutory aspects of personnel management
-
Monitoring : According to schedule of activities, quality of work, process of
work to uphold values outlined in section-1, costs and expenses
-
Evaluation : Why evaluate, What to evaluate, How to evaluate, Participatory
evaluation, Quality of care indicators as applied to women’s
health
: What kind of staff, how many, job descriptions roles, reporting
relationships, delegation (risk taking)
- Quantitative indicators
-
Data Management :
Why (including dangers of collecting unnecessary data), what
kind (including social) and gender aspects of women's health),
Participatory methods of data collection and analysis
Methodology
-
-
: Planning, staffing with exercises on developing their own job
descriptions,
monitoring
and
evaluation,
quantitative
indicators, data management.
Game on planned and unplanned activity in 2 groups.
Handouts on
- Exercises on : Planning a programme for women’s health, staffing,
developing indicators, reports and records, data management.
- Case study, Tentative formats of records and reports.
- Field visits
76
Emphasis : Managers
Resources
- SEARCH, Bangalore
- PRIA, New Delhi
- VHAI, New Delhi
- Dr. R.K. Pal
- CEDPA materials
- WHAC ( M.S. University, Vadodara)
-
Ford Foundation
IIMA, Pachod
- AIKYA.SHSD
- IWID
Estimated Time Required : 5 days.
Examine all tools, materials, methods, values to be applied from a feminist
perspective.
* Methodology
-
Process Oriented
-
Experiential, Participant Centred
Participatory
- Collective responsibility for learning programme non- gendered, division of
labour
- Action focus
- Informal, Flexible (space for reflection)
-
Balanced (mind/body, emotion/rationality)
Integrated
- Joyous/fun
- Nonjudgemental
-
Respect for self and others
77
Annexure - Via
TIME FRAME - MODULE ON MANAGEMENT OF
WOMEN’S HEALTH
A.
Management Perspective
B.
Understanding
i.
:
Self and Others
2/3 days
4 days
:
ii. Small group processes
2 days
C.
Project Management
5 days
D.
Managing External Environment
2 days
E.
Programme Management
5 days
Total
78
21 days
Annexure - VII
Programme Schedule
Expert meeting to finalise training programmes for “Building NGOs organisational
Capacities for Women’s Health"
16/17 July 1993 in Bangalore - Core Group Meeting
Prior to the expert meeting
16th July 1993
17 th July 1993
I
Morning
Arrival of core group members
Afternoon
Report of activities after Surajkund
workshop
(Indu Capoor)
Activities from DSE
(Erika Fink)
Discussion/modifications on feminist
Perspective of Women's Health
Morning
Strategies for the finalising of three
modules Summarizing, feed back
Afternoon
Strategies and perspectives Frame
of Reference for the meeting
79
1
18 to 22nd July, 1993 in Bangalore
1
Objective
I.
Consultation with individuals and organisations working on women's health
concerns both those who were and were not at eariier meeting at
Surajkund, Haryana.
17th July 1993
18th July 1993
Morning
Arrival of participants
1
Introduction
Background, information What happened
since our meeting in November 1992 in
Surajkund
■
“
(Ms. Indu Capoor, CHETNA
Ms. Erika Fink, DSE)
20th July 1993
fl
a
■
Presentation of revised perspective
(Dr Mira Sadgopal)
Discussion on the perspective
19th Juiy 1993
■
fl
Afternoon
Prsentation of three modules Discussion
Morning
Division into 4 working groups to work
on perspective and modules
Afternoon
Working Group Continue
Morning
Reports of working groups in plenary
■
•
|
session and discussion continue
Afternoon
Taking on responsibilities to develop the
training further
fl
Task group working session
_
Objective : Development training design and taking the process further
■
21st July 1993
Morning
Afternoon
22nd July 1993
Morning
Afternoon
Design
for
training
and
dialogue
programmes
1993/94
(goals,
target
groups, contents, methods)
Finalise concepts Methodology, resource
persons for programmes
Time schedules
Financing Methods
evaluation
of
1
"
a
I
and
■
■
Finalising working plan for training and
dialogue programmes
_
|
80
monitoring
I
Annexure - VIII
A REPORT OF WAH! CORE GROUP MEETING
HELD AT BOMBAY
AUGUST 17 - 18, 1993
This was the first core group, follow-up meeting, after the Bangalore Expert
Meeting on Building NGO Organisational Capacities for Women's Health held
during July 18 - 22, 1993. The following members were present during the
meeting.
1. Ms. Indu Capoor, CHETNA, Ahmedabad
2. Ms. Pallavi Patel, CHETNA, Ahmedabad
3. Ranjani Murthy, IWID, Madras
4. Vd. Gangadharan, LSPSS, Coimbatore
5. Ms. Philomena Vincent, AIKYA, Bangalore
6. Dr. Sharad Onta, Nepal
7. Ms. Anu Waklu, Pragati Foundation, Pune
8. Dr. Mira Sadgopal, Pune (only for one day)
9. Ms. Renu Khanna, SAHAJ, Baroda
*
Dr. Mira Shiva could not participate (she telephonically communicated and
conveyed the reasons for not being present).
*
Ms. Manisha had an injured knee, due to which she could not participate,
she sent her comments and suggestions.
AGENDA
1. To finalise the draft report of the Bangalore meeting
2. To review the Core Group (CG) decisions taken at Bangalore and progress
on the task assigned.
3. To discuss Erika’s letter regarding organising first training at Maharashtra.
4. To differentiate/clarify the role/tasks of core group, regional groups and
resource group. To also establish norms of functioning and communication.
5. To workout the action plan, time frame budget
programme including pre/post training concerns.
for the
pilot training
6. To fix dates/venue/agenda. for the next meeting.
7. Other decisions related to programme
An important agenda which emerged in between the Bangalore meeting and
the core group meeting was a discussion on Erika's letter about the urgency
related to the initiation of the programme during 1993.
81
Proceedings :
1.
To finalise the report....
Few core group members had send suggestions on the draft report. The
members present during this CG provided their suggestions verbally.
2.
To review the Core Group...
2.1
Decision taken
At the core group meeting held on the last day at Bangalore although a few
members remained present, certain important decisions were taken.
Importance of modules
*
Composition of core group
‘
Implementation strategy for the module
2.1.1 Integration of modules
Initially module 1 and 2 would be integrated by few members for which co
ordination would be done by Vd. Gangadharan. The meeting for this would be
held at Ahmedabad during
- 30th September, 1993. Finally, Ms. Renu
Khanna would co-ordinate the integration of three modules in a design form .
"2.1
2.1.2 Ms. Renu clarified the composition of the core group and
group diagramatically.
resource
Co-ordinators and
members of task/
resource group
Regional
Co-ordinators
Core group
2.1.3 Implementation strategy for the module
It was decided during the Bangalore core group meeting that the programme
can be implemented in 3 phases: (refer to the main report (3.6) in form of
process, content and skills. It was further clarified that :
Phase 1
: Would consist of Feminist perspective on Health,
Managing Self and Others; and partial content of module on
Women’s Health concerns.
Phase 2
: Combined module on Women’s Health Concerns with capacity
building for women' health.
Phase 3
: Management and Organisational Skills
82
There was a discussion on how the management module would be imparted
through this training programme. It was suggested that the management
module should not be handled in a isolated way but integrated within the
module of women's health concerns and capacity building for women. It was felt
that this will help to build up the skills of participants as managers. Apart from
this during the training phase III, they would emphasis on management
components to develop their skill as overall programme managers.
During the Present Meeting
To have a further clarification
feasibility study took place.
in
implementation
strategy
discussion
on
Feasibility Study :
It was expressed that the feasibility study done by Ms. Erika and Asha is
largely based on Income generation Programmes. In this process the focus of
DSE project has shifted to health. In this context, the feasibility study doesn’t
fulfill the objective. Mira felt strongly that for WAHI programme a feasibility
study in context to women’s health concerns must be done to ascertain prior
to the training whether the training is a recognised need of the NGOs or not.
Therefore it was decided that a feasibility study is conducted region wise prior
to the training to ascertain the following:-
(a) Do NGO’s feel that Health management skills/training is required and in
particular in relation to women's health?
(b) Do NGO’s believe that women should take on a more assertive role in
Health management within their organisational context? This can be done
through the 1 - 5 scale.
(c) Do the NGO’s meet the criteria for participating the WAH! programme? (as
in point 4.1 of main report)
(d) Do the NGO’s have the time and priority for participating in the women's
health programme?
(e) What is the organisational ‘set up’ in NGOs?
(f) What would be the participation for the
contribution/follow-up commitment?
NGO’s
in
terms
of resource
In response to Mira’s point, CHETNA mentioned that they had done a needs
assessments of NGOs in Rajasthan. It was felt that the findings may help in
context to WAH! programme. The findings indicates that NGOs need their
supervisors/trainers to be trained on basic training skills and content knowledge
related to women's health topics.
Inspite of the above, CHETNA is not able to commit itself to extent the
support for WAH! programme during 1993, due to other commitments and time
and resource constraints to extent support at NGO level as a follow-up of the
training.
83
For
other regions, h w.-.j
uiat kmsiBIMy Utfia uiiuuiu be obligated/
reconfirmed by directly meeting NGOs/partictpants.
Discussion on Erika’s letter about organising first training at Maharashtra
Ms. Erika of DSE had requested the regional groups to start the pilot
programme before 1993 on the last day of the core group meeting at
Bangalore. At that time, all the regional groups including CHETNA showed their
incapability to initiate the programme. Through a letter, Erika approached the
Maharashtra region with a request of initiating the pilot programme.
The point was discussed in the core group meeting :
Both Mira and Manisha (who had sent a message) from Maharashtra felt that
due to their prior work commitments they could not take the responsibility for
launching the programme in Maharashtra before december, 1993.
A possibility to initiate a pilot project for Hindi speaking area (Maharashtra,
Rajasthan and MP) was discussed, it was felt that for Hindi speaking areas,
there is a need to include many more NGOs and individuals to join in the
process which is not possible at this stage of programme and initiate the pilot
project. It was jointly agreed that there is no possibility to initiate the pilot
project, at Maharashtra as well as for Hindi speaking area.
Philomena mentioned that after assessing the situation in her area, it may be
possible to take up the pilot project in South India provided the others can
commit some support. Ranjani (IWID) and Gangadharan (LSPSS) stated that
they were willing to help and support in every possible way. The core group
wholeheartedly welcomed the southern regional groups initiative.
It was decided that pilot project will be initiated in Karnataka and Tamil Nadu
after the feasibility study of the area. The core group reaffirmed all support to
Philomena, Ranjani and Gangadharan in terms of preparation of design, making
resources available collection of material etc.
Philomena made it clear that she arrived upon this decision as an interested
member of southern region and not due to any outside pressure.
the
4.
Clarification on
resource groups
4.1
Norms set for core group
Role/task
of
core
group,
regional
During the Bangalore meeting, the need to set the norms for the core group
was felt. Following norms were set.
1. The core group member should attend all the days of meeting.
2. If the member remains absent for 2 consequent meetings the core group
can decide to ask the member to leave after ascertaining the commitments
of the members.
3. The decision in the core group to take the process ahead needed to taken
on the basis of majority.
4. This core group composition of will remain as it is for next 18 months till
the pilot phase to over. After that it is subject to change.
84
5. The member who is absent during the core group meeting should get
clarification on decisions/discussions made prior to the next meeting,
workshop on the basis of minutes send to them.
6. The suggestions on the reports can be send to the concerned persons in
writing and not shared during core group meeting.
4.3
Resource /Task group
This group will work on integration of module assisting in finalising the design
of training under the guidance of the co-ordinator
5.
Action Plan, Time frame,
programme
budget for the
pilot training
Prior to beginning discussion on the pilot training, it was felt important to clarify
the understanding about the WAHI programme.
5.1
Time frame
It was jointly decided that WAH! programme will be planned for a minimum for
5 years.
5.2
Vision for WAH! Programme
Ms. Renu articulated a 5 year vision for WAH! programme
“In the five years, WAH!, aims for multiple women’s health programmes being
implemented in various places with feminist perspective where traditional
medicines being valued and used in programmes which are managed and even
headed by women”.
5.3
Participants of WAH! Training
It was clarified that for WAH! project the women’s health programme managers
(co—ordinator) and supervisors can participate. The WAH! programme does no|
aim to address the needs of health care providers.
It was discussed that at the organisational level, the organisation structure is :
Main Health Programme
Co-ordinator WAH! Programme
J,
Middle Level Manager/Supervisor
I '
Health Care Provider
In small organisations, the main health programme co—ordinator may be absent
and the role of manager and supervisor is played by a single person. For
WAH! programme the manager and supervisors both would be invited to
participate as follows :
Co-ordinator/Manager : Partially for first and second phase and fully for third
phase
Manager/supervisor
: All three phases
85
Pre-requisite for the pilot training phase
5.4
It was strongly felt that a pilot project requires a lot of support in terms of pre
preparation. Following needs to be ensured to make WAHI prcgra, me more
effective.
1. The evaluation and monitoring of pilot project should be done o.ongoing basis and systematically.
an
2. Documentation of pilot project in local language and also in English for
learning of other regions is essenti I
3. The pilot project should include a feasibility study prior to initiation of the
training.
Training
5.4
The training tasks were diviced int
-
three phases :
pre-training
- during training
- post training
5.5.1
pre-training
Some of the
follows:-
pre-training
tasks/a itivities identified
by the group were as
1. Conducting a feasibility study for identification of NGO’s who could
participate in the programme. Or, a of the ways to de this could be through
an introductory workshop. The end result of the stud\ would be :
- Identification of NGO’s for parti ipation in the programme, through personal
visits for obtaining their full tier 1 commitment.
2. Identification of resource persoi s/material aid o- ler
programme such as funds/materia’s/training/ver je etc.
resources
for
the
3. Developing a working team for taking the pregram le ahead at the regional
level.
4. Conducting workshop/s to sensitise heads of NGO’s on prospective about
the programme.
5. Development of an information brochure about the programme.
6. Conducting at least 1 core group meeting prior to the launch of the pilot
workshop.
7. Finalising the integrated training design.
5.5.2 During Training
Actual conducting of training. It was felt that the regional group would assess
the activities required in the training period.
86
5.5.3. Post Training Task
1. Monitoring
2. Evaluation
3. Action plan
These would be discussed during next core group meeting.
5.5.4 Objectives
Prior to working on the training design, it is important that objective of the
overall training and of different training phases is done. The following objectives
were finalised.
Overall objective of the WAHI training programme
“To strengthen knowledge, attitudes and skills of those working an NGO's
especially women, so as to :
(a) Effectively co-ordinate women's health programme with a holistic gender
perspective
(b) Enable women to assume leadership in women's health programme”
Within this overall objective, the specific objectives of each phase were
discussed.
5.5.5 Phase - 1
“Overview of WAH!”
To provide :
- An overview of the WAH! programme and opportunity to
perspectives related to gender and Local health Traditions (LHT)
strengthen
- An overview of issues in women’s health/LHT and opportunity to reflect on
these objectives in context of self, organisation.
- An opportunity to strengthen knowledge and skills related to issues in
women’s health
- opportunity to sensitise women on the current social, political, economic,
environmental and developmental impact on health
-
Understanding and building a positive attitude towards self.
Topics to be covered
1. Overview of health scenario in India
2. Feminist perspective of health
3. Perspective of LHT in empowering women
4. Understanding self and others in context of family, personal, organisational
and society.
It was felt that the phase should end with some actual skills/content being
imparted to participants with enough “home assignment" to carry out for the
next phase.
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5.5.6 Phase II :
“Holistic Health Approaches and Management of Women’s Health”
Objectives:
- To enable participants to acquire knowledge and skills so as to integrate
different approaches to women;s health.
- To build the capacities of co-ordinators and promoters of women’s health
programmes using traditional
knowledge systems
as
a
tool for
empowerment.
- To recognise, present and strengthen knowledge systems and skills.
Contents :
1. Women’s health concerns
2. LHT
3. Management of health programme - as in Annexure III & IV of the main
report.
5.5.7 Phase III :
“Managing Women’s Health Programmes”
Objectives
- To enable participants to acquire skills to manage women’s
programmes including relationships with external environment.
health
- To help the participants and their organisation to plan for their future
programme as a follow up of this training programme.
Content
Annexure V of main report.
Role of the Core and Task Group In the Pilot Training Programme
at the Southern Area :
5.6
1. Core group will not make any decision for the regional programme but help
to draw the principles.
2. The WAH! Core and other programme members can observe and contribute
in the pilot programme at :
-
in the planning and at the- co-ordination level
-
as an observer and for documentation, training and evaluation
- an a training resource
3. The task group will finalise the integration of the module and share it with
the core group.
4. Core group meeting needs to be organised to finalise the design after the
feasibility study is done by southern group.
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5.7
The Norms for involvement of consultants and core groups members
in the pilot phase :
1. It was decided that a fixed honorarium of Rs.500/- be paid for each training
per day and Rs.350/- day to a resource person for consultation/compiling
material etc.
2. It was felt that many resource persons may ask for more honorarium, then
agreed upon by core group. It was decided that it is better to keep this
amount standard as it has a question of value, it will help to attract the
right kind of resource persons.
3. The other approach that can be explored was that of honorarium being in
terms of long term and short term involvement of consultant.
4. The payment of honorarium should be done by cheque especially for the
individuals who drawn a salary from organisation as it will go in
organisation and will help in the growth of organisation.
5. It was also decided that in case the consultant has to travel overnight than
she/he will travel by train of it is more than that, Air travel can be re
imbursed.
5.8
Observer :
This discussion was initiated with a decision that observers can be involved in
the pilot training programme. It was than thought of that there should not be
more than 2 observers in each training session and it would be fruitful if one
observer is out of WAHI programme which cab be a regional person. The
regional organizer will decide upon the observer.
The following norms were set for observers:1. The observer will come with commitment for the whole process and not just
as and where she/he gets time.
2. Observer will not disturb during training session and demand for translation
during sessions.
3. The observer will come in the capacity of participant and not as that of an
evaluator.
4. A Steering Committee to evaluate everyday training can be set up which
included trainer, and volunteers from participants to evaluate the day's
programme. The observer can be involved in this committee to share her
views.
5. The final norms, about observer can be decided upon by the regional trainer
along with observer.
6. If there is difference of opinion among the observers and trainer, it should
be discussed face to face, rather than take it outside the programme.
7. Whether the observer would be man or woman which may depend on
module and session. It would be decided and by regional group and task
group.
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8.
If the observer/resource person has been asked to participate based on
needs of regional group, he/she will be paid but if an observer participates
with a view of learning no honorarium will be paid.
5.9 Finance of the Programme :
WAH! group would like to have a commitment and support for this programme
for a minimum of 5 years from DSE. It would not approve a short term
support from DSE for the pilot project only.
If DSE is unable to make this kind of commitment WAH! group would not like
to take financial support from DSE. It will continue the programme with full
commitment and try to get funds from other resources which may not be
difficult.
5.10 Time frame of Pilot Training Programme
As decided for three modules the total number of days for training would be
90 days (3 months) spread over 6 months - 1 year. The first phase would be
of 10 days. The date is fixed is 6 - 16 December, 1993. Prior to this the
sensitisation workshop would be held on 18 October, 1993 at Bangalore.
Dates/Venue/Agenda for the next Core Meeting.
The next Core meeting would be organised at Ahmedabad on 27th October,
1993. The major agenda for meeting would be to finalise the design of pilot
training programme and workout the implementation strategy in light of WAH!
group support.
7.
Other Decisions Taken :
DSE was planning to sponsor a young woman from Nepal for internship to
CHETNA for WAH! programme. DSE could now send her to AIKYA as they
are initiating the pilot phase in 1993.
- Manisha due to her other commitments would not like to be a member of
the core group. It was accepted by the core group.
- The copy of correspondence done within core group members needed to be
send to the co-ordinator - CHETNA even if it is handwritten note so as to
keep her informed and the communication channels open.
-
Misunderstanding of Dr. Mira Shiva during the last day of the Bangalore
meeting was clarified among the group.
-
Dr. Mira Shiva on phone mentioned the use of the module of the women;s
health concern separately by the NGOs. Pallavi has asked her to write
about it to the co—ordinator WAH! and then can be discussed during the
next meeting.
-
Since the pilot phase is now going to be initiated in the Southern area, Indu
proposed to shift of responsibility of the co-ordination to Philomena. It was
decided that Indu will continue to co-ordinate the overall project.
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Centre for Health Education, Training and Nutrition Awareness
Lilavaliben Lalbhai's Bunglow, Civil Camp Road, Shahibaug, Ahmedabad-380 004
Gujarai, INDIA Phone : 866513, 866695 Gram : CHETNESS Telex : 91-121-6779
CEE IN & 91-121-618 RASA IN Fax : 91-272-866513 & 91-272-420242
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