Ranu Sharma - final_Hindi Report.pdf
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2012-2013
Community Health Learning Fellowship Programme
Ranu Sharma (CHLP fellow)
SOCHARA-SOPHEA, Bangalore,
India
Team mentor Mr. As Mohammad
Field Mentor - Mr. Ajay Pandit
Contents
Topic
S.No
I.
Why did I join CHLP ?
Page No.
1
II.
Acknowledgements
2
III.
Learning objective in CHLP
3
IV.
Over All Learning for CHLP
4
1- Orientation
V.
Organizations visited and projects Undertaken
VI.
My experience at the field
1- Field experience of SLUMS in Bhopal
8
9
MUSKAAN ,Bhopal Organization profile
2-Field experience of RURAL in Harda
17
SYNERGY, Harda Organization profile
VII.
Research study project
39
VIII.
Overall conclusion
67
IX.
Reading list
68
X.
Photos
69
I.
Why did I join CHLP ?
lkekftd dk;Z ¼ M.S.W ½ ds vUrxZr esjs }kjk e/; izn’s k ds foHkUu ,u-th-vks- ds lkFk
vkfnoklh leqnk; esa dk;Z fd;k x;kA tgkW eSua s ik;k fd xzkeh.kksa dks LokLF; fd lsok,W fBd ls ugha
fey ik jgh gSa ] leqnk; dks LokLF; ds fo"k; esa tkudkjh ugha gS]a ’kkldh; foHkkxksa }kjk Hkh LokLF; ds
eqÌks ij leqnk; dks iq.kZ tkudkjh ugha fn tk jgh gSa ] MkWDVjksa ds }kjk yksxksa dk lgh bZykt uk djds
bZykt ds uke ij vf/kd :i;sa fy;s tk jgs gSAa
esjs ifjokj o iMksl esa 3& 4 yksx Ykdok ls xzLRk gS]a mu yksxks dks le; ij Lkgh bZykt ugha
fey ldk] bl dkj.k oks fBd ugha gks ik;s gS]a ;s ckr eq>s ges’kk ijs’kku djrh jgrh gS]a fd eSa bu
yksxks ds fy;s dqN ugha dj ik jgh gqWA
/kkj ftys esa rky laLFkk ds lkFk xa/kokuh Cykd esa 2 o"kZ 6 ekg cky vf/kdkjksa ij dk;Z
fd;k] ;gkW ij ge cPpksa ds vf/kdkj ds vUrxZr LokLF; ds vf/kdkj ij Hkh dk;Z djrssa Fks] ij eq>s
LokLF; ds fo"k; ij T;knk tkudkjh ugha FkhA bl dkj.k leqnk; fd LokLF; leL;kvksa dks gy djus
esa iq.kZ :i ls enn ugha dj ikrh FkhA
bl fy;s eq>s vglkg gqvk fd eq>s LokLF; fo"k; ij viuh tkudkjh dks vkSj c<+kuk ds t:jr
gSAa 2011 esa eq>s SOCHARA fd QSyksf’ki ds ckjs esa irk pyk]tuojh 2013 esa essjs }kjk Qsyksf’ki dks
TOkkbZu fd;k x;kA bl QSyksf’ki ds ek/;e ls Lo;a fd {kerko/kZu djrs gq,] leqnk; dk LokLF; ds
eqÌks ij {kerko/kZu djus esa lgk;rk dj ldqxhA
1
II.
Acknowledgements - vkHkkj
MkW- jfo ukjk;.k vkSj MkW- Fksyek ukjk;.k ftUgksus bl QSyksf’ki fd ’kq:okr fd vkSj eq>s
bl QSyksf’ki esa lfEEkfyr gksus dk ekSdk fn;k A esjs Vhe esVa j Jh vkl egksEen lj ] izkx
s zke
dks&vksMhusVj MkW- ;qojkt ] MkW- vkfnR;k] Jh dkfrZd ] Lkkspkjk& cSx
a yksj Vhe lnL; ,oa lkFkh QSyks] dk
lg;ksx jgk gSAa Community Health Learning Fellowship Programme ds nkSjku esjh {kerk
dks c<+kus ds fy, le; & le; ij izkRs lkfgr o ekxZn’kZu fn;k x;kA fluthZ LkaLFkk ]fQYM esVa j
Jh vt; iafMr] fluthZ Vhe lnL;ksa }kjk dk;Z {kS= esa dk;Z djus esa fo’ks"k ekxZn’kuZ o lg;ksx fn;k
x;kA blds lkFk fg esjs Hkfo"; dks mTooy cukus esa esjs ifjokj dk egRoZiq.kZ ;ksxnku gSAa
2
III.
Learning objective in CHLP
1- LokLF; D;k gSa \ le>uk
2- lkoZtfud LokLF; iz.kkyh dks le>uk ¼ Understanding the Public Health System ½
3- LokLF; yksxksa ds thou dks dSls izHkkfor djrk gSAa le>uk
4- ’kgjh o xzkeh.k Lrj ij LokLF; lsok,W fd fLFkfr dks le>uk
5- O;fDrxr fodkl ¼ Personal growth ½ &
•
•
•
•
tkudkjh dks ,df=r djuk ¼ Collection of information ½
v/;;u djuk o MkVk dks ,df=r djuk ¼ Research and data collection ½
leL;kvksa fd igpku djuk ¼ problem identification ½
dkS’ky - ¼skill ½
izLrqrhdj.k
¼ Presentation ½
izfrosnu ys[ku ¼ Report writing ½
6- ,u-vkj-,p-,e- ds lkeqnk;hd dj.k dks le>uk
3
IV.
Over All Learning for CHLP
1. Orientation 1-1 LokLF; ds lkekftd fu/kkZjd & ¼ Social Determinats of health ½
LokLF; ds lkekftd fu/kkZjd ,d vkfFkZd vkSj lkekftd fLFkfr gS]a fdlh Hkh O;fDr dk tUe dgk
gqvk gS]a ;g fu/kkfjr djrk gS]a fd mldk fodkl dSlk gksxkA mlds lkekftd Lrj ij fuHkZj djrk gSa
fd mldk LokLF; dSlk gksxk] LokLF; dks izHkkfor djus esa lkekftd fu/kkZjd ,d cgqr cM+h Hkqfedk
fuHkkrs gSAa ifjokj dks LokLF; j[kus ds fy, ekW fd f’k{kk cgqr egRoiq.kZ gSAa
xjhch
i;kZIr [kkuk ugha
dqiks"k.k
Social Determinats of Health Pathway
izfrjks/kd {kerk esa deh
cSDa Vhfj;k
Vh- ch
voyksdu & LokLF; ds lkekftd fu/kkZjd esa Hkksiky fd >qXXkh cLrh;ksa esa ik;k fd] ;gkW ij yksxksa dks
’kq) ikuh] vPNk okrkoj.k] jgus dk LFkku] iq.kZ :i ls izkIr ugha gks ik jgk gSaA cPpsa o efgyk,W f’k{kk
o LokLF; fd iq.kZ lqfo/kk,W dk ykHk ugha ys ik jgs gSaA ml {kS= esa gksus okyh fdlh Hkh ?kVuk ij iqfyl
okyksa ds }kjk xaxkuxj ls cPpksa dks Fkkuk ys tkrs gSa ] ;gkW ’kjkc] xqVds dk lsou vf/kd fd;k tkrk gS]a
bl dkj.k yM+kbZ o fgalk gksrh jgrh gSAa
4
1-2 lkekftd U;k; & ¼ Social justice ½
gj O;fDr dks thou thus ds fy;s eqyHkqr lqfo/kkvksa fd vko’;drkvksa gksrh gS]a ijUrq orZeku
lekt vehj vkSj xjhch ds nks Hkkxksa esa cVk gSAa xjhcksa dks viuh eqyHkqr lqfo/kk,W ugha fey ik jgh gS]a
muds lkFk lkekftd vU;k; gks jgk gS]a jgus ds fy;s ?kj ugha] [kkus ds fy;s [kkuk ugha ] igus ds fy;s
diM+s ugha] fodkl ds fy;s f’k{kk o LokLF; fd O;oLFkk ugha gSAa
voyksdu & ‘’kgjh o xzkeh.k {kS= esa lkekftd U;k; dks ns[kus ij ik;k x;k fd xjhcksa ds fy;s
tks Lkqfo/kk,W nh tk jgh gS]a mldk oks iq.kZ :i ls ykHk ugha ys ik jgsa gSAa ljdkjh vLirky rks gS]a ij
LVkQ dk O;ogkj fBd ugha gksus ds dkj.k leqnk; ljdkjh lsokvksa dks ugha ys ik jgs gSAa ch-ih-,ydkMZ tkss cus gS]a mlesa dqN vehj yksx ds cus gSAa bldk ykHk ftUgas ¼t:jreUn½ feyuk Fkk] mUgsa iq.kZ
:i ls ugha fey ik jgk gSAa
1-3 efgyk LokLF; o tsM
a j & ¼ Women’s Health and Gender ½
voyksdu & ’kgjh o xzkeh.k nksuks {kS= esa efgyk ds LokLF; ds fo"k; esa ik;k fd efgykvks dks LokLF;
ls Lkac/a kh vusd leL;k,W tSl&
s ,uhfe;k] detksjh] ?kjs: fgalk ds dkj.k ekufld ruko ] ekgkokjh
lac/a kh leL;k,W] ;kSu lapkjh jksx] iq.kZ iks"k.kkgkj ugha vkfnA blds lkFk efgykvksa ds LokLF; ij tYnh
ls /;ku ugha fn;k tkrk gS]a efgyk,W viuh bu leL;kvksa dks ifjokj ds LknL;ksa dks ugha crk ikrh]
LokLF; lqfo/kkvksa esa Hkh efgyk MkWDVj ds uk gksus ds dkj.k bUgsa le; ij bZykt ugha fey ik jgkA
efgyk & fd’kksjh LokLF; ds fo"k;ksa ij [kqy dj ckr ugha gksrh gSAa iq:"k iz/kku lekt gksus ds dkj.k
efgyk,W vius QSlys Lo;a ugha ys ikrh] mUgsa viuh NksVh & NksVh vko’;drkvksa ds fy;s iq:"k ij
fuHkZj jguk iM+rk gSAa
1-4 etcqr leqnk; ¼ Building community ½ &
leqnk; esa izR;sd O;fDr dh viuh & viuh lksp o vko’;drk gksrh gS]a :fpdj yksx fdlh leku
mÌs’; ds fy;s ,d= gksrs gS]a rks mls fg leqnk; dgrs gSAa
fdlh Hkh u;s dke dks ’kq: djus ls igys ml {ks= fd leL;kvksa dks tkuus ds fy;s
dksly yqi Mk;xzke ds ek/;e ls eqy leL;k fd igpku djs] mlds ckn leqnk; fd vko’;drkvksa dks
5
ns[kdj fg fdlh dk;Z fd ’kq:okr djuk pkfg,] u;s mÌs’; ds lkFk leqnk; dk fuekZ.k djuk gksxk]
leqnk; dks cukus ds fy;s igys yksxks ls vPNk O;ogkj gksuk pkfg;s]fdlh Hkh dk;Z dks djus ds fy;s
yksxks dks rS;kj djuk gksxk] leqnk; dks ugha A
1-5 lp
a kjh vkSj xSj lapkjh jksx & ¼Communicable & Non communicable Disease ½
leqnk; dks lapkjh ¼ tSls & dq"B ]Vh-ch-],p-vkbZ-oh- ½ vkSj xSj lapkjh jksxks ¼ dSalj] e/kqegs ]
vLFkek]ekufld ruko ½ ds ckjs esa cqfu;knh tkudkjh fd deh gS]a ljdkj dss }kjk bu jksxksa ij vusd
uhfr;kW ¼policy ½ cukbZ x;h gS]a ij LokLF; foHkkx ds }kjk te+huh Lrj ij leqnk; o vk’kk izsjdks fd
tkudkjh dks c<+kus ds fy;s dksbZ Bksl dk;Zokgh ¼dk;Zdze½ ugha fd tk ugha gSAa eq>s yxrk gSa fd bl
fo"k; ij leqnk; o vk’kkvksa dks tkudkjh nsuk cgqr vko’;d gS]a D;ksdh gesa LokLF; jgus ds fy;s
fcekjh;ksa dks vkus gh ugha nsuk gSAa
1-6 i;kZoj.k LokLF; ¼ Enviroment Health ½&
’kgjh {kS= esa ik;k x;k fd ;gkW ij ukfy;ksa vkSj dpjs dk mfpr izca /a k ugha gS]a bl dkj.k i;kZoj.k
iznqf"kr gks jgk gS]a yksxksa dks iznqf"kr ty fey jgk gS]a bl dkj.k vusd tytfur chekjh;kW ¼Water
borne disease ½ tSls & eysfj;k] VkbZQkbM ] Mk;fj;k ¼ Malaria , Typhoid, Diarrhoea½½ ls yksx
isj’kku gks jgsa gSAa xzkeh.k {kS= esa Hkh iznq"k.k gS]a ;gkW o"kkZdky esa eysfj;k]Mk;fj;k o [kqpyhZ ls T;knk yksx
fifM+r jgrsa gSAa
xzkeh.k o ’kgjh {kS= esa O;olk; yksxks ds LokLF; dks izHkkfor dj jgk gS]a [ksrh esa vf/kd jklk;fud
[kkn o nokbZ;ksa ds iz;ksx ds dkj.k [ksrh esa dke djus okyks dks Ropk o lkl lac/a kh jksx vf/kd gks jgsa
gS]a ’kgjks esa cLrh;ksa ls uxj ikfydk ds vUrxZr dpjk o ukyh lkQ djus okys yksxks dks [kqpyh o
lkl lac/a kh fcekjh;kW T;knk gks jgh gS]a lkFk fg okguksa ls fudyus okys /kq,W ds dkj.k vusd LokLF;
lac/a kh leL;k fnu ij fnu cM+rh tk jgh gSAa
1-7 vk;q"k"k ¼ AYUSHS½½
“euq"; dk vkfLrRo mlds vUnj gksrk gS]a iapHkqr fd ek=k cjkcj gksus ij dksbZ fcekjh ugha gksrhA ”‘
ouLifr Kku ds }kjk ?kjs: mik;ks ls izkFkfed LokLF; ns[kHkky ¼ Primary health care ½ vklkuh ls
]o de [kpZ ij fd;k tk ldrk] orZeku esa ijEijk detksj gksrh tk jgh gS]a vkSj blds LFkku ij
Medical care ds uke ij nWokbZ;ks dks c<+kok fn;k tk jgk gS]a tks xyr gSAa
6
gesa lkekftd LokLF; ¼ social health ½ ij dke djuk gS]a uk fd Medical care ij A
LFkkuh;
lalk/ku ] oS| ] nkbZ ] o`)ks ]nknh ekW ds uqLdks dks c<+ok nsdj ]leqnk; esa cnyko ykus ds fy;s gesa
ldkjkRed :i ls dke djuk gksxkA
1-8 vuqal/kku ¼ Research ½ &
xq.kkRed vuqal/kku ls fdlh Hkh leL;k ds eqy dkj.kks dks tkudj mldk gy fudkyus esa lgk;rk
feyrh gSAa la[;kRed vuqal/kku esa fdlh Hkh {kS= fd fLFkfr ds ckjs esa la[;k ds :i esa tkudkjh feyrh
gSAa blls ge ml eqÌs ij vkxs dk;Zokgh djrs gSAa
1-9 ekufld LokLF; ¼ Mental Health ½ &
e/; izn’s k esa xzkeh.k o ’kgjh nksuks {kS=ks essa ekufld LokLF; ij vHkh cgqr dk;Z djus fd vko’;drk
gS]a tehuh Lrj ij ekufld LokLF; ds fo"k; esa NksVh & NksVh ckrksa fd tkudkjh vk’kk- ,-,u-,evkWxuokM+h dk;ZdrkZ ds ek/;e ls Lo lgk;rk leqg ] Ldqy Lrj o iapk;r Lrj ij yksxks dks nsuk
gksxhA ljdkjh fufr;ksa o lqfo/kkvksa esa ekufld LokLF; ij vkSj lq/kkj djuk gksxkA
1-10 jk"Vªh; xzkeh.k LokLF; fe’ku ¼ N.R.H.M ½ &
LokLF; ds lkeqnk;hdj.k esa vk’kk izsjd] xzke lHkk LoLF; xzke rnFkZ lferh] ftyk Lrj ij jksxh
dY;k.k lferh fd egRoiq.kZ Hkwfedk gS]a ijUrq tehuh Lrj ij bl dk;Zdze esa vusd dfe;kW gS]a
tSls & vk’kk izsjdks dks dk;Z ds nkSjku vusd pqukSfr;kW] LokLF; foHkkxks }kjk eqYa ;kdu o lg;ksx fd
deh] rnFkZ lferh ds lnL;ks dks iq.kZ ftEesnkjh dk Kku u gksukA bu dfe;ks dks nqj djus ds fy;s
fuf’pr j.kuhfr gksuh pkfg;sa ]ftlls jk"Vªh; xzkeh.k LokLF; fe’ku ds mÌs’;ks ij iq.kZ fd;k tk ldsA
1-11 iSjoh ¼ Adovocacy ½ & lwpukvks ds ek/;e ls LFkkfu; Lrj ds lalk/ku dk mi;ksx djds
]lekt esa yksd LokLF; ds eqÌks ij O;ofLFkr ifjorZu ykuk gksxkA yksd LokLF; ds fy, tehuh Lrj ds
fy;s iSjoh fd vfr vko’;drk gSAa mnkgj.k ds fy,] jktLFkku esa iz;kl LkaLFkk ds }kjk eqQr esa
nokbZ;ksa ds eqÌs ij iSjoh fd x;h Fkh A vkfn
7
Organizations visited and projects Undertaken
•
V.
1- The Green Foundation, Bangalore April 2013
2- Basic Need India , Bangalore April 2013
3- FRLHT, Bangalore July, 2013
4- The Assocition of People with Disability(APD),Bangalore Octomber 2013
5-
KARUNASHRAY,Bangalore Hospice Trust, November 2013
6 - TRICHY Tamil Nadu , December 2013
Conferences & meeting attended
1- KARUNA Trust , The PLASTIC COW Bangalore Jan, 2013
2- MFC , Hederabad February, 2013
4- State level consultation on “Ban on Tobacco Advertising, Promotion and
Sponsorship” July, 2013
5- Transation analysis, Octomber 2013
6- The 4th Annual Conference of The Karnataka Chapter of the Indian Academy of
Geriatrics on “Identifying solutions to challenges in Geriatrics”, December 2013
mijksDr laLFkkvksa ds voyksdu esa ;g tkuk fd nf{k.k Hkkjr fd laLFkk,W LOkkLF; ds eqÌks ij
cqfu;knh Lrj ls dk;Z dj jgh gSAa blls og okLRkfod t:jr ean yksxks dks lsok,W igqWpk jgh
gSAa bu LkaLFkkvks ds ek/;e ls leqnk; esa tkx:drk ds fy;s vusd dk;Zdze fd;s tk jgs gSa ]
LokLF; fd f’k{kk dks c<+kus ds fy;s f’k{kk dk;Zdze ds vUrxZr Nk=ofr ]izf’k{k.k fd;s tk jgs
gS]a tks ,d vPNh igy gS]a bu dk;Zdzeks ds }kjk leqnk; esa dk;Z djus okyks dks t+ehuh Lrj
fd tkudkjh nh tk jgha gSAa
;gkW ij Conferences & meeting esa lh[kk dh vusd ,sls LokLF; ds fo"k; gS]a ftuds
fo"k; esa eSus dHkh xgjkbZ ls ugha lkspk Fkk] mu ij le> cuh & o`)] i;kZoj.k]Hkkjr ds
fofHkUu xSj ljdkjh laxBuks ds lkFk fg ]ljdkj] o vU; ns’kksa tSls & ikfdLrku vkfn ls tqM+
dj bu fo"k;ksa ij ckr dj lek/kku [kkstus fd dksf’k’k fd tk jgh gSAa ;s lc esjs fy;s cgqr
mi;ksxh gSAa
8
VI.
My experience at the field
1-Field experience of SLUMS in Bhopal (Feb. to March 2013)
1.1 MUSKAAN ,Bhopal Organization profile -ifjp;%& eqLdku laLFkk ,d jftLVj ¼28@2268½
laLFkk gS tks 1998 ls Hkksiky esa ’kgjh oafpr cfLr;kas eas f’k{kk] LokLF;] vkthfodk] tsM
a j ds fo"k;ks ij
dke djrh gSA laLFkk dk dk;Z{ks= Hkksiky dh ’kgjh cfLr;k gSAa eqLdku fo’ks"kdj dqN [kkl leqnk;ks ds
lkFk dke djrk gS ftles xksM
a ikj/kh] nfyr] catkjk o dpjk chuus okys yksxks ds lkFk dke djrh gSAa
eqLdku laLFkk ds dk;Z
f’k{kkdk;Zdze
lkeqnkf;d dk;Zdze
thou f’k{kk
ckyokM+h
vkolh; dsEi
Ldwy l’kfDrdj.k
yk;cszjh
igy lsUVj 8
8
1 o"kZ esa 4
25 Ldwy
1
LokLF;
cpr
vk;oZ/kd
ts.Mj
LokLF; foHkkx
vkbZ-lh- Mh-,lleqnk;
9
1-2- ’kgjh efyu cfLRk dk;Z vuqHko&
ko& ¼ slums field experience½½
1-2-1 fMLisUljh& LVkQ 1 esfMdy vkfQlj ] 3 ,-,u-,] 2 LVQ ulZ ]1 ysc Vsdfuf’;u] 1 vk;k] 1
okMZ ck;] 1lQkbZ dehZA fMLisUljh ls fudyus okys dpjs dks vk;k }kjk fMLisUljh ds eSnku esa [kqys esa
Qsd fn;k tkrk gSa ];gkW xÏs esa ugha Mkyk tkrk vkSj ugha bls tyk;k tkrk gSAa ftlls ifjlj esa xanxh
gksrh gSa ]o vU; fcekjh;k QSyus gksus dk [krjk c<+ tkrk gSAa
fMLisUljh ls jsQj izfd;k & xaHkhj voLFkk esa ’kkldh; vLirky & dkVtw o 1250 esa jsQj fd;k
tkrk gSAa ;gkW ij izlo ugha fd;s tkrs gSa ]nksuks ljdkjh vLirky dkVtw o t; izdk’k ¼1250½esa jsQj
fd;k tkrk gSAa
LokLF; leL;k & bl {kS= esa dksbZ fo’ks"k fcekjh ugha gS]a lkekU; rkSj ij lnhZ]cq[kkj gksrk jgrk
gS]a LokLF; ls lacfa /kr dks cM+h leL;k ugha gSAa
deyk uxj fMLisaljh Hkksiky]vkS"kf/k vkSj fpfdRlk fd vkiwfrZ
¼ Kamla nagar dispensary, Bhopal, Drug and Vaccing supply and Distibution½
fMLisUljh
•
•
•
•
•
nWokbZ [kRe gksus ls 15 fnu igys 2 izfr;ksa esa ysVj
t;izdk;’k ’kkldh; vLirky esa flfoy ltZu dks
LVksj
LVksj ls fMLisUljh dks nWokbZ nh tkrh gSa
ysVj ds 15 fnuksa esa nWokbZ;k vk tkrh gSAa
1 ckj esa 5000 rd nWokbZ;k cqyok;h tkrh gS];gkW 70 izdkj fd nWokbZ;k gSAa
1-2-2 LokLF; lqfo/kkvksa rd igqWp &‘
LokLF; lqfo/kkvksa rd igqWp
¼ Health services Apporoch½
dauke
la[;k
dz-a
uke
la[;k
izdkj
1
2
/kUoUrjh
[kq’khyky
02
01
vk;qosZnhd vLirky
vk;qosZnhd vLirky
8
9
uV[kV
gd
01
01
izk;osV vLirky
izk;osV vLirky
3
dkVtw
01
ljdkjh vLirky
10
lkabZ
01
esfMdy
4
t; izdk’k
¼1250½
efu"kk
’kkjnk
gtsyk
01
ljdkjh vLirky
11
fejk
01
esfMdy
01
01
01
izk;osV vLirky
izk;osV vLirky
izk;osV vLirky
12
13
izdk’k
fot;
01
01
oS|
gÏh
5
6
7
izdkj
L=ksr &deyk uxj fd fMLisUljh esa MkWDVj]Mªx nsus okyk] o vk;k ls ;g tudkjh izkIr gqbZ ekpZ 2013
10
1-2-3 ’kcjh uxj ls LokLF; lqfo/kkvksa rd igqWp dk ekufp= %&
uV[kV
1250 8 fd-eh
5 fd-eh
dVtw 4 fd-eh
gd 3fd-eh
‘’kkjnk 2 fd-eh
gstyk 2½ fd-eh
izdk’k oS/k ¼2 fd-eh½
lkabZ ckck 1 fd-eh
usg: uxj PkSjkgk
1 fd-eh
/kUoUrjh 1½ fd-eh
efu"kk ½ fd-eh
fejk ½ fd-eh
fot; gÏh tksMu+ k
‘’kcjh uxj
[kq’khyky vk;qosZfnd
2
k.m
11
1-2-4-1-xkSre uxj cLrh dk bfrgkl%& bl cLrh esa jgrs gq, yksxks dks djhc 30&35 lky gks x;s
gSAa cLrh esa eq[;r%vkfnoklh xksM+ leqnk; ds yksx jgrs gSa] tks cSrqy ]gks’kaxkckn] bVkjlh ls dke dh
ryk’k es vkdj jg jgsa gSAa
2-xkSre uxj cLrh%&
cLrh%& xkSre uxj cLrh dLrqjck uxj dkyksuh ds chpks & chp fLFkr gSAa ;g
cLrh 60 fQV pkSM+kbZ o 80 fQV yEckbZ dh izk;osV txg ij clh gqbZ gSAa ftlesa djhc 50 ifjokj
fuokl djrs gSAa orZeku esa dqy tula
ula[;k 220] efgyk 117 o iq:"k 103 gSAa izk;osV txg ij cls gksus
ds dkj.k dHkh Hkh mtkM+ nsus dk Mj ges’kk ccuk jgrk gSAa blh Mj ds lkFk ;gk ds yksx vyx &vyx
vkthfodk ds lk/ku viukdj viuk thou ;kiu dj jgsa gSaA
;g cLrh dkQh le; ls clh gSA fQj Hkh ;gk ds yksxks ds ikl jk’ku dkMZ o oksVj dkMZ ugha
gSAa cLrh esa uxj fuxe }kjk
kjk yxk;s x;s 2 ihus ds ikuh ds uy ggS]a ftu ij cLrh ds yksxks dks vkfJr
gksuk iM+rk gSAa lkFk fg fctyh dh dksbZ O;oLFkk ugh gksus ds dkj.k yksxksa us ikl ds fctyh ds rkj
ij viuk rkj Mkydj fctyh tykrs gSAa
3-O;olk; dh fLFkfr%&
fLFkfr%& bl cLrh ds vf/kdre yksx isIlh] dksdk& dksyk dh nqdkuksa es yksfMax
]vuyks
uyksfa Mx dk dke djrs ];gkW nqdkusa cLrh d
ds ikl gksus ds dkj.k bUgsa nqdkuksa esa dke vklkuh ls fey
tkrk gSAa ;gkW dke u feyus ij nwj dke djus ds fy;s Hkh tkrs gSAa blds vykok bl cLrh esa 5&6
ifjokj ihik ]ckYVh lq/kkjus ds lkFk Vhu ds lkeku ¼flxM+h] pwYgk] iM+yk½ cukdj csprs gSAa blds
vykok lHkh ifjokj dpjk chuus dk dke djrs gSa];s ifjokjksa dh vkenkuh dk eq[; L=ksr gSAa ftlesa
efgyk,sa o cPpksa dh la[a ;k T;knk gS]a 50 ifjokjks esa ls 15 ifjokj uxj fuxe ds vUrZxr ?kj&?kj
tkdj dpjk mBkus dk dke djrs gS]a 1 ?k
?kj ls efgyk vkSj iq:"k nksuks tkrs g]SS bUgs izfr ifjokj dks
6000 : osru feyrk gSAa
4-jk’ku nqdku dh nqjh%&
h%& cLrh ls djhc vk/kk fdyksehVj nwj jk’ku nqdku gSa ftles yksx
tkdj jk’ku ysrs gS
5-jgus dh fLFkfr%&
fLFkfr%& ckal ydM+h vkSj iksfyfFku ls cuh
10 fQV yEckbZ vkSj 10 fQV pkSM+kbZ dh >qXxh cukdj
jgrs gS]a Q’kZ dPpk gksrk gS]a ckjh’k ds fnuksa esa cLrh esa
dkQh dhpM+ gksrk gS] D;ksafd >qXxh ikl&ikl
ikl
gksus ds
dkj.k ty fudklh dh dksbZ txg ugh gSAa ftlls
xanxh Hkh cgqr gksrh gSAa ?kj ,d & nqljs ds cgqr ikl
gS] fBd ls fudy Hkh ugha ikrs gS] bl cLRkh esa xanxh
cgqr T;knk gSA bl dkj.k ;gkW fcekjh;kW Hkh vf/kd gSAa
6-’kkSpky; dh fLFkfr%&
fLFkfr%& bl cLrh esa ,d Hkh ’kkSpky;
ugh gSa cLrh esa cgqr de txg gksus ds dkj.k yksx
cgqr eqf’dy
y ls >qXxh esa jg ikrs gSa vkSj cLrh ds ikl
esa ukyk gksus ds dkj.k yksx ckgj ’kkSp
a djus tkrs gSAa bl cLRkh ds nwj & nwj rd lkoZtfud ’kkSpky;
12
ugha gSAa ckgkj ’kkSp ds fy;s tkus ds dkj.k efgykvkSa o yM+fd;ks dks vusd ijs’kkuh gksrh gSAa 1&2 ckj
NsMd
+ kuh dh ?kVuk Hkh gks pqdh gSAa
7-lkekftd fLFkfr%&
fLFkfr%& bl leqnk; ds yksx vkil esa cgqr fey tqydj jgrs gSa vkSj dksbZ Hkh
lkekftd dk;Zdze ¼’kknh] cPpsa dk tUe o /kkehZd dk;Zdze½ esa lHkh dh Hkkxhnkjh gksrh gSAa ,d nwljs
dh lkekftd o vkfFkZd :i ls enn djrs gSAa
8-f’k{kk dh fLFkfr%&
fLFkfr%& bl leqnk; esa dsoy 2 ifjokj gh i<+s fy[ks og Hkh cgqr de blds
vykok bl leqnk; esa dksbZ i<+k fy[kk ugh gSAa fiNys 10&12 lkyksa esa eqLdku laLFkk ds iz;kl ls ;gk
ds cPpas fu;fer i<+kbZ dj ik jgsa gSAa vkt ;gk ds cPpsa 5oh] 8oh o 10oh fd rS;kjh dj jgsa gSAa cLrh
ls djhc 10 ls 15 cPpsa jkst eqLdku Ldqy es vkdj i<+kbZ djrs gSAa bu cPpksa dks i<+kbZ ds vyx &
vyx rjhds ls tksMd
+ j j[kk tkrk gSAa
9-cLrh ls LokLF; lsokvksa nwjh o fLFkfr%&
fLFkfr%& bl cLrh ls djhc 1 fdyksehVj nwj turk DokVZj es
vkaxuokM+h bl dkj.k ls cLrh okyks dh vkaxuokM+h rd igqp
a ugh gS Ablds lkFk fg ;gk ikl esa dksbZ
fMlisaljh ugh gS]a bl dkj.k bu ifjokjksa dks dksbZ LokLF; lsok ugha fey ikrh gSA bl cLrh ls
’kkldh; t;izdk’k vLirky ftyk vLirky 4 fdyksehVj nwj gSa ]ftleas t:jr iM+us ij bZykt djkus
tkrs gSAa
vkaxuokM+h uk gksus ds dkj.k cPPksa dks iks"k.k vkgkj] Vhdkdj.k] xHkZorh ekrkvksa dh tkap o
fd’kksfj;ksa dks iks"k.k lgh lss ugha fey ik jgk gSAa dHkh & dHkh dk;ZdrkZ cLrh esa vkdj iks"k.k vkgkj]
nsrh gSAa cLrh ds yksx vf/kdre bZykt djkus ds fy, izk;osV vLirkyksa es tkrs gS tks vUukuxj]
gchcxat] es tkrs gSAa eqLdku laLFkk }kjk cLrh es ckyokM+h pykbZ tkrh gSA ftlds rgr cPPkksa dks
iks"k.k vkgkj fn;k tkrk gS ]fd’kksfj;kas o efgykvksa ds lkFk muds LokLF; ij ppkZ dh tkrh gS ALokLF;
lsokvksa rd igqWpkus dk iz;kl fd;k tk jgk gSAa cLrh esa ppkZ ds nkSjku efgykvksa us crk;k fd
2007&2008 esa tc Å"kk dk;ZdrkZ¼eqLdku fd vkSj ls½ ldzh; :i ls dke djrh Fkh] rc t;izdk’k
vLirky es fMysojh;ka gqbZ FkhA mlds ckn ls vHkh rd fMysojh ?kj ij gh gks jgh gSa AvLirky esa ulZ
o MkDVj Bhd ls O;ogkj ugh djrs ]blfy, Hkh ge vLirky fMysojh ds fy, ugh tkrsAa
1010-de mez esa ikfjokfjd ftEesnkjh%&
kjh%& cLrh esa yM+dh & yM+ds dh mez 17&18 lky dh gksrs
gksrs gh ’kknh r; gks tkrh gS]a blds lkFk fg yM+ds ikfjokfjd ftEesnkfj;ksa es yx tkrs gS]a yM+fd;kW
fd’kksjh gksrs gh i<+kbZ NksMd
+ j ?kj laEHkkyus yx tkrh gSAa
1111-jk’kudkMZ fxjoh j[kuk%&
j[kuk%& bl cLrh es yksxks dks iSalks dh t:jr iM+us ij jk’ku dkMZ cLrh
esa fdlh iSls okys ds ikl ;k cLrh ds ckgj fdlh ifjfpr ds ikl viuk jk’ku dkMZ fxjoh j[k nsrs
gSAa 1000 ls 3000 rd :i;s jk’ku dkMZ ls m/kkj ysrs gSAa jk’ku dkMZ yksx vyx& vyx ifjfLFkfr esa
j[krs gS ftlesa dtZ pqdkus ds fy,] ifjokj es dksbZ fcekj lkyksa es laLFkk }kjk fd;s x;s iz;klksa ls 8
fxjoh j[ks x;s jk’ku dkMZ NqM+k,sAa
13
12-enn
enn leqg %& cLrh vk/kkfjr efgykvksa dk laxBu gS blesa tks ifjokj cgqr vkfFkZd
ijs’kkuh ls xqtjrk gSAa mu ifjokjksa dks leqg }kjk :i;s¼ 500 ls 1000½ :i;s m/kkj fn;s tkrss gS mu
:i;s ij 1;k 2 izfr’kr C;kt ysrs gSAa blls yksxks dks viuk jk’ku dkMZ fdlh ds ikl fxjoh ugha
j[kuk iM+rkAviuh
Aviuh cLrh ls gh :i;s ysrs gS] vkSj izfrekg
kg viuk jk’ku Lao; gh ysrs gSAa
1-2-5- cLrh dh orZeku fLFkrh %&
• xanxh vf/kd gS&
a cLrh ds dqN ifjokj vkSj cPps dpjk chuus dk dke djrs gSa
dpjk chudj ?kjks esa ykrs gS] vkSj dpjs dh NVuh ?kj esa gh djrs gS A ftlls xanxh gksrh
gS]yksx lkQ&lQkbZ fcydqy ugh
ugha djrs gS ]cLrh esa ?kjks ds chp esa nqjh ugha gSAa bl dkj.k
gok] lqjt dh jks’kuh Hkh fBd ls ugha igqpW ikrh A ladze.k okys jksx 1 ?kj ls nqljs ?kj
?k esa
Qsy jgk gSAa
• uf’kys inkFkZ dk lsou vf/kd %&’kjkc dk lsou vf/kd gksrk gS ftldss dkj.k yM+kbZ >xM+s
vf/kd gksrs gSAa ;gkW efgykvksa }kjk Hkh ’kjkc @rEckdw dk lsou fd;k tkrk gSAa
• efgykvksa ij fgalk %& ’kjkc ds dkj.k vk;s fnu iq:"k efgykvks ls yM+kbZ ]og
og ekjihV djrs gSa
• fd’kksjh yM+dh;k lqjf{kr ugha gS& ’kjkch;ks ds chp jgus o ckgkj ’kkSp ds fy;s tkus ds
dkj.k os vius dks vlqjf{kr eglql djrh gS
• ljdkj }kjk vuns[kh&
kh& bl cLrh ds fy;s dksbZ Hkh ewyHkwr lqfo/kkvksa dh O;oLFkk ljdkj }kjk
ugha dh tk jgh gSAa ’kkldh;
kkldh; ;kstukvksa dk ykHk Hkh ugha fey ik jgk gSAa
• LokLF; leL;k & mYVh ]nLr cPpksa dks gksrs jgrs gSAa 3 O;fDr;ksa dks Vh
Vh-Ckh- dh fcekjh gSAa
• xanxh ds dkj.k [kqpyh dh chekjh gks jgh gS]a bl
blls
ls 4 ifjokj vf/kd izHkkohr gSAa
• lkQ fius ds ikuh fd O;oLFkk ugha & nks ljdkjh uy gS] ftlesa ls fnu esa 1&2 ?kVsa ikuh
vkrk gSa ;s uy ukyh ds chpks & fcp yxk gS]a cLrh okyh efgyk,W ;gh ij diM+s /kksrh gSgAa
L=ksr & xkSre uxj ds efgyk o iq:"k ls ppkZ ds vuqlkj ekpZ 2013
14
1-2-6- fd’kksjh;ksa ckfydkvksa fd fnup;kZ %&
lqcg & 6 ls 7 cts m<+uk]dke ij tkuk &7 ls 10 rd]okil vkuk & 11 rd
?kjsyw dke& & 12 ls 6 ¼NksVs HkkbZ& cgu dks lEHkkyuk]O;fDrxr dk;Z& [kkuk ]ugkuk]lksuk ½
vU; dk;Z &[kkuk]lksuk
1-fd’kksjh ckfydk MkbZV pkZV
O;fDrxr tkudkjh
efu"kk &izdk’k
fnu
lqcg
le;
7 cts
MkbZV
1 di pk;] 2 VksLV@cszM
mez& 13 o"kZ
nksgij
12 cts
½ lCth ] ½ nky ¼eqx
a ]rqoj½]
2&3 jksVh¼eDdk]xsgwW½
1 di pk;] 2 VksLV@cszM
½ lCth ] ½ nky] 2&3
jksVh]pkoy
jk’ku dkMZ& ch-ih-,y ’kke
jkr
LFkku & ckcq uxj
4 cts
10 cts
fjekZd
2-fd’kksjh ckfydk MkbZV pkZV
O;fDrxr tkudkjh
jks’kuh &egsUnz
fnu
lqcg
le;
7 cts
MkbZV
1 di pk;] [kLrk
mez& 10 o"kZ
ch-ih-,y
nksigj
‘’kke
12 cts
4 cts
½ lCth ] ½ nky]1 jksVh
1 di pk;] [kLrk
LFkku & ckiw uxj
jkr
8&9 cts
½ lCth ]1jksVh
fjekZd
;gkW >kjk leqnk; ds yksx yM+dh;ksa dks T;knk ugha i<krs] 8 ls 10 lky fd de mez esa fg lxkbZ dj
nsrs gS]a bl dkj.k ;s yM+dh;kW i<+kbZ ugha dj ikrhA de mez esa fg bu ij ?kj fd ftEesnkj vk tkrh
gSAa ;s viuh ekW ds lkFk dke ij tkrh gSaSA
L=ksr & ckiq uxj esa efu"kk o jks’kuh ls ppkZ ds vuqlkj Qjojh 2013
15
1-2-7-dsl v/;;u
2-7-1- f’k’kq e`R;q leh{kk dsl v/;;u & ¼ Infant Death review case study ½
ifjp; & e/; izn’s k fd jkt/kkuh Hkksiky ds ckiq uxj esa dkyw dk ifjokj fiNys 35&40 o"kZ ls
fuokl dj jgk gSAa
ek;ds fd fLFkfr & lqeu dk ifjokj usg: uxj esa jgrk gSa ]ifjokj esa ekrk &firk]5 cgu o 6 HkkbZ
gS]lqeu frljs uEcj fd gS]a ;s lHkh etnqjh djds viuh vftohdk pykrs FksA
oSokfgd fLFkfr & lu~ 2000 esa dkyq dk fookg Hkksiky ds usg: uxj esa jgus okyh lqeu ls gqvk A
tc budk fookg gqvk FkkA rc lqeu fd mez &16 o"kZ o dkyw fd mez &22 o"kZ Fkh A dkyw >kjk cukus
dk dke djuk o etnqjh djrk gSAa bl ifjokj dk ch-ih-,y dk jk’ku dk;Z gSAa lweu ¼30o"kZ½ o dkyw
¼35o"kZ½ us 5 cPpksa dks tUe fn;k ]orZeku esa buds 4 cPpsa gS]a vfdar & 11 o"kZ] vfer & 09 o"kZ]eksfgr
& 05 o"kZ] jksfgr & 02 o"kZ] jksfgr ls igys ,d cPpsa fd e`R;q tUe ds 2 fnu ckn gks x;h FkhA
xHkkZoLFkk & lqeu us pkSFkh lUrku ds le; vkaxuokM+h ls iks"k.kkgkj iSdVs le; & le; ij fy;k
]fu;fre ,-,u-,e- ls psdvi djok;k o]1 Vhdk Hkh yxok;k Fks ]lqeu us bl le; xsgwW fd jksVh ]gjh
lCth;ks]a o ekSleh Qy dk lsou fd;kA
’kkldh; LokLF; lsok & izlo fiM+k gksus ij ifjokj okys cLrh fd nkbZ dks lkFk esa ysdj ’kkldh;
vLirky dkVtw ys x;s ];gkW ,-,u-,e- }kjk ns[kdj dgkW x;k fd vHkh izlo esa le; yxsxk] 1& 2
fnu ckn vkuk] vLirky esa HkrhZ u djus ds dkj.k lqeu dks ?kj okil ys vk;sA
jkr esa lqeu dks izlo fiM+k gksus ij nkbZ us izlo djok;k ]lqeu us yM+ds dks tUe fn;k] cPpsa fd
uky nkbZ us iqjkuh CysM+ ls dkVh ]uky fBd ls ugha ca/kh bl dkj.k mlesa ls [kwu fudy jgk FkkA ?kj
okyksa us ml ij T;knk /;ku ugha fn;kA tUe ds iqjUr ckn lqeu us cPpksa dks nq/k fiyk;k]vxys fnu
cPpksa dks cq[kkj vk x;k]?kj okyksa us mls lkekU; fy;k ]MkWDVj dks ugha fn[k;k]oks fnu iqjk fudy x;k
nqljs fnu Hkh cq[kkj jgk ]’kke dks 6 cts ds yxHkXk cPpksa fd e`R;q gks x;hA ?kj ij izlo gksus ds dkj.k
cPpksa dks le; ij Vhds ugha yxs]ifjokj }kjk cq[kkj dks lkekU; le>k x;k vkSj cPpksa dk le; ij
bZykt ugha] djok;k bl dkj.k lqeu us viuk cPPkk [kks fn;k Ajksfgr dss le; lqeu us izlo vLirky
esa djok;k]o cPpksa dk cgqr /;ku j[kk] cPpksa fd rch;r dkss ysdj iqjk ifjokj pkSduk gks x;k] cPpksa
dks dqN Hkh gksus ij iqjUr MkW- ds ikl ys tkrs gSAa L=ksr& lqeu ls ppkZ ds vk/kkj ij ekpZ 2013
16
2-7-2 dsl v/;;u & efyuk dh eqf’dy
tuuh lqj{kk - e/; izn’s k ’kklu }kjk izlo vLirky esa gks ftlls ekr` o f’k’kq dh lqj{kk gks o ekr` o
f’k’kq e`R;qnj esa deh ykus ds fy;s tuuh lqj{kk ;kstuk dk lapkyu fd;k tk jgk gSAa
ifjp; & e/; izn’s k fd jkt/kkuh Hkksiky ds ckiq uxj esa lksdrvyh dk ifjokj fiNys 8 o"kZ ls
fuokl dj jgk gSAa lksdrvyh eqyrg% fcgkj dk jgus okyk gSAa dke fd ryk’k esa ;s Hkksiky vkdj
jgus yxs gSAa bl ifjokj esa lksdrvyh ¼35 o"kZ½]ifRu efyuk ¼30 o"kZ½]cPpsa veu & 7 o"kZ]jktw& 5o"kZ
]js’kek & 3 o"kZ ]vetn & 2 ekg dk gSAa
ifjokj ds vk; ds L=ksr &lks
& drvyh nSfud etnqjh djrk gS]a ;g izfrfnu ds 150: dekrk gS]a ;gkW
dke u feyus ij ;s iyk;u djrs gSA12 &25 fnuksa ds fy;s fcgkj tkrs jgrs gSAa
xHkkZoLFkk & efyuk us xHkkZoLFk ds le; vkaxuokM+h ls iks"k.kkgkj iSdVs le; & le; ij fy;k
]fu;fre ,-,u-,e- ls psdvi djok;k o]Vhdk Hkh yxok;k A
izlo fd fLFkrh & efyuk us ’kkldh; vLirky dkVtw esa 27 tuojh 2013 dks yM+ds dks tUe fn;kA
cPpk o ekW nksuks LoLF; FksA 3 fnu ckn efyuk dh vLirky ls NqVVh gkss x;h A tuuh lqj{kk ;kstuk
ds vUrxrZ efyuk dks 1000 : dk pSd fn;k x;kA
a [kkrk u gksus
:i;s izkIr djus esa dkSu & dkSu lh leL;kvksa dk lkeuk fd;k &efyuk ds uke ls cSd
ds dkj.k oks pSd ls :i;s ugha fudky ik jgsa gS]efyuk dk ifjp; i= o jk’ku dkMZ uk gksus ds dkj.k
cSd
a esa [kkrk ugha [kqy ik jgkA efyuk o mlds ifr ckj & ckj uxj fuxe] cSd
a ds pDdj yxk jgk
gSAa ij vkt ¼23-3-2013½nks efgus gksus ds ckn Hkh budk ifjp; i= o jk’ku dkMZ u cuus ds dkj.k
[kkrk ugha [kqy ik jgk gSAa 3 efgus ds ckn pSd
a fd oS/krk [kRe gks tk;sxk oks Hkh 1 leL;k
gSAa lksdrvyh 6 ls 8 ckj ifjp; i= o jk’ku dkMZ o [kkrsa ds fy;sa x;s] tuuh lqj{kk ds :i;s ls
T;knk rks og viuh etnqjh ¼150X8=1200½ o fdjk;k ¼30X8=240½ dqy &1440 :i;s xok pqdk gSAa
vkSj ekufld :i ls Hkh ijs’kku gqvk A
L=ksr& lksdrvyh o efyuk ls ppkZ ds vk/kkj ij ekpZ 2013
17
2. Field experience of RURAL in Harda (1st May to june 2013, 2nd Aguest to
September 2013)
fluthZ laLFkku izkQ
s kbZ & ¼synergy ,Harda Organization profile ½
fluthZ laLFkku ;qok lkfFk;ksa }kjk xfBr ,d LoSfPNd laLFkk gSA laLFkku foxr 7 o"kksZ ls
e/;inz’sk ds gjnk ftys xzkeh.k {kS= esa lkekftd fodkl gsrq dk;Zjr gSA fiNys lkr o"kksZ esa lLaFkku
izeq[k :i ls cky vf/kdkj ,oa fodkl] ;qok lkekftd m|ferk ipak;rjkt ,o a efgyk usrR`o]vkink
izcz/aku ,oa LokLF;] ds enqnks ij ize[q k :i ls dk;Z fd;k gSA laLFkku us vius y{; dks /;ku esa j[krs
g, lenqk; vk/kkfjr fodkl] vf/kdkjks dh tkx:drk] iSjoh]] izf’k{k.k vkfn dks vius dk;ksZ esa izeq[k
:i 'kkfey fd;k gSAfotu ,d ,sls lekt dk fuekZ.k djuk tgkW lHkh LoLF;] f’kf{kr] 'kks"k.k ls eqDr]
leku] ,oa 'kakfriowZ thou ;kiu dj ldsa A”
lLaFkk }kjk lpakfyr ifj;kstuk o dk;Zdze &
•1- ;qok Lo fodkl ,oa lkekftd m|ferk L=ksr dsUnz
•2- pkbYM ykbu 1098
3- vukSipkjhd f’k{kk dsUnz dk lapkyu
•4- dqiks"k.k dsUnzhr lexz fodkl dk;Zdze
•5- LokLF; dk lkeqnkf;dj.k esa vk’kk izsjd izf’k{k.k
•6- efgyk usr`Ro dk;Zdze
•7- ehfM;k laons uhdj.k
2-2-1 xzkeh.k
eh.k fQYM vuqHko ¼Rural field experience½½
vk’kk izf’k{k.k
’k{k.k ekWM;yw 6 ,oa 7 ds izFke pj.k fnaukd & 8 ls 13 ebZ 2013] LFkku & ,l-,l-th-chLdwy]gjnk esa izf’k{k.k esa 30 vk’kk izsjdks us Hkkx fy;kA
eq[; mÌs’; &
1-vk’kk ds vfuok;Z dkS’ky o Lruiku ij vk’kk dks tkudkjh nsuk
2-dqiks"k.k D;k] y{.k o igpku ] D;k &D;k lko/kkfu;kW j[kuk gksxk bl ij vk’kk dks tkudkjh nsukA
3-nLr jksx] Toj o ’okal jksx] eysfj;k ]fVdkdj.k ij vk’kk dks tkudkjh nsuk A
4-fQYM foftV &uotkr f’k’kq ds ?kjks dk nkSjs djds QkeZ Hkjuk o vk’kk ds vfuok;Z dkS’ky dks
djukA
18
vU; ppkZ ds eqÌs &
1- vk’kk dh Hkfwedk dh Li"Vrk vkSj dk;Z dks O;ofLFkr djuk
•2- vk’kk ds dk;Z dks Ekkiuh; ifj.kke ls tksMu+ k
•3- leqnk; esa efgykvksa ds lkFk ckrphr
•4- izlo iqoZ ns[k Hkky o xHkkZoLFkk esa [krjs
•5- izlwrk lkFkh ds fy;s vfuok;Z tkudkjh
•6- uotkr f'k'kq dh tkpa vkSj ?kjksa dk nkSjk
•7- gkFk /kksuk] uotkr f'k'kq dk otu ekiuk] uotkr f'k'kq dk rkieku Kkr djuk
•8- Vh-Ckh]ekufld LokLF; & uotkr f'k'kq dks xeZ j[kuk
ifjokj dks ijke’kZ & vk’kk izsjdks dks 3 yM+fd;kW gksus ij eerk dks o mlds llqjky okyks dks
ijke’kZ nsus ds fo"k; esa crk;k o bl fLFkfr esa efgyk ekufld jksxh Hkh gks ldrh gS]a blfy;sa
efgyk dks bl le; T;knk ns[kHkky fd t:jr gksrh gSA bl dk egRo crk;k
2-2-2 xzkeh.k
eh.k leqnk; dks le>uk ¼understanding community½
cjdyk xkWo &
;g xkWo yxHkx 400 lky igys clk gSa] ;gkW nks izkphu ’kdaj o guqeku eafnj gS]a ifjokjks dh l[a;k &
216]tkfr O;OkLFkk &xzke cjdyk esa orZeku esa fuEu tkfr ds ifjokj fuokl djrs gS&
a xqtZj &60
]dkNh&50] gfjtu &]66 fl[kj&2] eqfLye&20 ] yqgkj&2] xkSM&2]+ dksj[k&w 1 ] ekyh&5 ]ukbZ&1]
czkgkEk.k&2 ]/kksch &4 ]lqrkj &1A ’kkSpky; dh fLFkfr%& bl xkWo esa yxHkx 200 ?kjks esa ’kkSpky; cus gSa
] 16 ?kjks es ’kkSpky; ugha gSAa
19
xzkeh.k
eh.k lgHkkfxrk eqYa ;kdu &
1- ekSleh dsy.s Mj & Mansoon Calender
ekSleh dsy.s Mj &xzkfe.k lgHkkfxrk eqYa ;kdu fd ,d i)fr gSa] blls xzke cjdyk fd 12 efguks esa
dkSu &dkSu lh Qly dc &dc cksbZ o dkVh tkrh gSA ;gkW fd eq[; Qly exaw ]lks;kchu] xsgWw
gSAa 12efguks esa dkSu &dkSu lh fcekjh dk izdksi T;knk gksrk gSa ]bl xkWo esa ekpZ ls
Mk;fj;k]mYVh]eysfj;k]cPPkksa esa fueksfu;k ]ekpZ esa ekufld jksfx;ksa dks leL;k,W vf/kd gksrh
2- le; js[kk & Time line
le; js[kk & xzke cjdyk ds bfrgkl ds fo"k; esa irk pyk o LokLF; ds fo"k; esa tkudkjh izkIr
gqbZ]xkWo okyksa ds vuqlkj 5& 10 lky igys ls fcekjh;ksa dk [krjk cM+krk tk jgk gSa ]tSls &Vhch]
fiyh;k ] vVSd ] ekufld jksxh ]CyM iz’s kj dSalj vkfn Abldk dkj.k iqNus ij irk pyk fd [ksrks
esa T;knk jklk;fud [kkn] o nokWbZvksa ds iz;kxs ls bu fcekjh;ksa fd l[a;k fnuksa & fnu cM+rh tk jgh
gSAa
20
3- fjys’kl esi &Relation map
xzke ljipa dks e/;e es j[kk x;k gS a
1----------------------ljipa & ipak;r lfpo] ,u-,-,e ]f’k{kd] xzke pkSdhnkj o vk’kk ls fujUrj liaZd gksrk
gSAa
2-&&&&&&&&& ljipa &ipa] vkxauokMh+ dk;ZdrkZ] izk;oVs Ldyw f’k{kd ]leqnk;] xzke rnFkZ lferh
]efgyk leqg]’kkyk izcU/ku lferh ]nkbZ] oS| ls dksbZ fujUrj liaZd ugh a gSAa
2- lHkh ds vkil esa lEcU/k dks n’kZ;krk gSAa
3- vk’kk leqnk; esa LokLF; ds {ks=+ esa egRoiq.kZ Hkfwedk fuHkk jgh gS]a bl fy;s ;gkW ij vk’kk ds vU;
ykxks ls lca/ak dks uhys jxa ls n’kkZ;k x;k gSAa
4-&&&&&&&&& ipa] ipak;r lfpo] ,u-,-,e ]f’k{kd] ipa]leqnk;] xzke rnFkZ lferh] leqnk; ls
vk’kk dk flQZ bUgh ykxks ls fujUrj liaZd esa gSaA
5------------------------- vkxauokMh+ dk;dZrkZ] izk;osV Ldyw f’k{kd]lsYleus ]nkbZ] oS|]]efgyk legw ]’kkyk izcU/ku
lferh] xzke pkSdhnkj vkfn ls feyrh rks gS]a ij LokLF; lca/akh eqÌksa ij tks tkudkjh mijksDr lHkh dks
nsuk pkfg, ] o iq.kZ :i ls ugha fn tk jgh gSAa vxj vk’kk bu lHkh ls LokLF; lca/akh eqÌksa ij ppkZ vkSj
xgjkbZ ls ckr djs rks vk’kk dks leqnk; esa dk;Z djus esa bu lHkh dk lg;ksx feysxkA
21
4-pikrh fp=.k & Chapathi Diagram
-pikrh fp=.k ds ek/;e ls xkWo esa o xzke ls fdruh nqjh ij LokLF; lsok gSAa bldh tkudkjh gks jgh
gS]a bl xkWo ykxs ikjEifjd oS| ds ikl bZykt cgqr de djokrs gS]a pkj[ksM+k esa izk;oVs Mk-W lksudj ds
ikl bZykt djokrs gSAa izklo ds fy;s 7 fd-fe fVejuh ys tkrs gSAa xaHkhj voLFkk esa 11 fd-fe gjnk
ftyk vLirky ys tkrs gSA
22
5- xkoW fd orZeku fLFkfr&
dz-a
1
2
3
4
5
6
7
8
uke
jes’k] lhrkjke] fnus’k] eq’a kh
Jherh foeuk xjhcnkl
--------------------& 75 o"kZ
ykyh &;’koUr & 2 o"kZ
v{kjk ]vu’kqy
vuqjk/kk 8 o"kZ
lUrks"kh
lquhrk 18 o"kZ
oS|
nkbZ
,p-vkbZ-oh $
+ Vh-ch
Vh-chxHkZorh
dqiksf"kr
ekufld foadykx
ekufld jksxh
foadykx
la[;k
4
1
1
1
15
2
1
1
1
23
2-2-3 vaxuokM+h dk;ZØe fd xfrfo/kh;ksa dks le>uk &
vaxuokM+h dk;ZØe N% o"kZ ls de mez ds cPpks ij dsfUnzr ^^,dhd`r lsokvksa ds vUrxZr fuEu eq[;
lsok,W iznku fd tkfr gSa &
1- iwjd iks"k.k
2- c<r+ dh fuxjkuh vkSj izkRs lkgu
3 iks"k.k vkSj LokLF; f'k{k.k
4- Vhdkdj.k
5- LokLF; lsok,
6- lanHkZ lsok,@a Ldwy iqoZ f'k{kk
fjQysDlu & bl vkxauokMh+ esa cPpksa fd mifLFkfr u ds cjkcj gSa ]otu e’khu Bhd ls dk;Z ugha dj
jgh gS] vkxauokM+h dsUnz ij flQZ eaxyokj dks fg efgyk,W o cPpsa vkrs gS]a ml fnu iks"k.kkgkj ds iSdVs
dk forj.k dj ds mUgsa ?kj Hkts fn;k tkrk gSAa dUsnz ij tks egRoiq.kZ tkudkjh tSls & iks"k.kkgkj]
dqik"sk.k ]xHkZoLFkk esa lko/kkfu;kW o fVdkdj.k vkfn fd tkudkjh tks feyuk pkfg, o ugha fey jgh gSA
fd’kksjh ckfydkvksa dks dUsnz ij izfrekg ugha cqyk;k tk jgk gS] mUgsa fd’kksjkoLFkk ] iks"k.kkgkj] ,fufe;k]
,p]vkbZ-oh ,Ml ]egkokjh ds fo"k; esa fdlh Hkh izdkj fd tkudkjh ugha nh tk jgh gSA fQYM ds nkSjku
vkxauokMh dsUnz ij fd’kksjh;ks fd cSBa d djus dk Iyku 2 ckj cuk;k ij lgkf;dk o dk;ZdrkZ us
fd’kksfj;ksa dks lqpuk ugha fg ugha nh] bl dkj.k ;gkW cSBa d ugha gks ik;hA 5&7 fd’kksfj;ks ds lkFk
feydj mUkls ckr fd x;h rks tkudkjh izkIr gqbZ fd vkxauokMh+ dk;ZdrkZ dk O;Okgkj fBd ugh gSA oks
ckfydkvksa dks iq.kZ tkudkjh ugha nsrh gSAa dHkh &dHkh Cykd esa fefaVx gksus ij bUgsa cqykrh gSA
xzke cjdyk dk vkWxuokM+h dsUnz &ebZ 2013
24
2-2-4 fof’k"V tkudkjh &
ipak;rh jkt O;oLFkk fd le>& xzke cjdyk esa fo’k"sk xzke lHkk gksrh gSa ] xzke lHkk esa leqnk; ds
lHkh okMZ ls yksx vkrs gSAa ipak;r Hkou esa izfrfnu lgk;d lfpo caSBrs gSaSA leqnk; ds yksxks xzke lHkk
dk egRo le>rs gSaA ipak;rh jkt laLFkkvksa o ’kklu fd fofHkUu ;kstukvksa ds fo"k; esa xzkfe.kksa dks
tkudkjh gSAa ;gkW dk ljipa o lfpo xzke ds dk;ksZ dks bZekunkjh ls djrs gSA
fjQysDlu & bl xkoW ds yksxks tkx:d gS] leqnk; dks yxHkx lHkh ;kstukvksa ds fo"k; esa tkudkjh
gSa ]ykxss fd tkx:drk ds dkj.k lHkh O;OkLFkk fBd ls gSAa bl xkWo ds tSls vU; xkWo esa Hkh lfdz;
yksx vkxs]vkus yxsxs rks lc dk;Z vklkuh ls gksxAs
2-2-5 jk"Vªh; xzkeh.k
eh.k LokLF; fe’ku dk lkeqnkf;dj.k &
tuuh lqj{kk ;kstuk ds ckjs esa tkudkjh izkIr fd xbZ] ts-,l-ok; ds vUrZxr xzkfe.k Lrj ij 1400
: o ’kgjh Lrj ij 1000 : dk izo/kku gSAa tuuh ,Dlizsl fd Hkh O;oLFkk gSAa ts-,l-ok;- dk eq[;
mÌ’s; lqjf{kr izlo ekr`& f’k’kq e`R;q nj esa deh ykuk gSA okLrfodrk esa vLirkyksa esa izlo ds le;
tks lqfo/kk gksuk pkfg, ]oks ugha gSA bl ;kstuk dk xjhcks dks tks ykHk feyuk pkfg,] oks iq.kZ :i ls
ugha fey ik jgk gS] blesa jk’kh pSd ds ek/;ke ls izkIr gksrh gaS] cSd
a esa [kkrk [kqyokus esa vuds
leL;k,W vkrh gSAa
tSls & igpkku i= ] jk’ku dkMZ] vk/kkj dkMZ vkfn u gkus ds dkj.k [kkrk [kqy ugha ikrk] ;fn ;s
dkxt gksrs gSa ]rks [kkrk [kkysus ds fy;s 500 ls 1000 : yxrs gSA 5 ls 6 ckj [kkrs ds fy;s cSd
a esa
tkuk
iM+rk gSAa xzkeh.k Lrj ij cSd
a u gkuss ds dkj.k Cykd esa vkuk iM+rk gSAa cSd
a es [kkrk [kqyokus ds dk;Z
ifjokj ds iq:"k dks djuk iM+rk gaS]ftlls og 5 ls 6 fnuksa rd vius dk;Z ij ugha tk ikrsa vkSj 600
ls 750 : vius ikl dss :i;s fdjk;s esa yx tkrs gSAa vxj ts-,l-ok;- fd jkf’k [kkrk [kqyus ij fey
Hkh tkrh gSa ] rks mldk mi;ksx efgyk o cPpk ugha dj ikrs]a ifjokj okys vU; dkeksa esa [kpZ dj nsrs
gSA
jkjk-xzk-LkkLkk-fefe- ds leqnkf;dj.k esa vk’kk fd Hkqfedk cgqr egRoiq.kZ gSa] oks xzkeh.kks rd LokLF; lqfo/kkvksa
dks igqpkW jgh gSA vk’kk vius Hkfo"; dks ysdj fpafrr gSaSA mUgsa irk ugh fd muds Hkfo"; D;k gksxk]
leqnk; ds yksxks dks vk’kk ds dk;Z ls cgqr ykHk gksrk gSA muds }kjk crk;k x;k fd gekjs xkWo esa
25
igys fVds fu;fer ugh yxrs Fks A vc fu;fer yxus yxs gS] gesa cq[kkj fd yksxh o ]vks-vkj-,l-]ekyk
Mh-@,u] vkfn dHkh Hkh fey tkrh gSA vk’kk gesa izlo ds le; iq.kZ lg;kxs djrh gSAa
2-2-6- ekufld LokLF; ij leqnk; fd le> dks tkuuk & ¼ Mental Health ½
bl xkWo esa ekufld LokLF; ds fo"k; es dksbZ fo’k"sk tkudkjh ugha gSAa A.N.M.&ASHA,AWW
dks Hkh ekufld LokLF; ij vf/kd tkudkjh ugha gSAa ekufld jksxh;ksa dks ?kj o leqnk; ds yksxks }kjk
ikxy dgk tkrk gS]a mUkds ij /;ku ugha fn;k tkrk gSAa
ekufld fodykxksa dks dkSu& lh lqfo/kk feysxh] is’a ku ds fy;s D;k dkjuk gksxk ];s
tkudkjh ’kkldh; deZpkjh o ifjokj okyksa dks ugha gSAa ekufld jksxh;ksa o ekufld fodykxksa ds fy;s
ftyk vLirky gjnk esa bZykt ds fy;s dksbZ lqfo/kk ugha gS]a ]ifjokj okyks dks bZykt izk;oVs vLirky
esa djokuk iM+rk gS]a ;k fQj Hkksiky vLirky esa djokuk iM+rk gSAa ftlesa [kpZ cgqr vf/kd gks tkrk
gSa ] blds dkj.k ifjokj okys fujUrj bZykt ugha djok ikrs A ¼xzke cjdyk & ebZ 2013½
2-2-6-1 ekufld jksxh dsl v/;;u & ¼ Mental illness ½
uke & lUrks"k [kys]
mez & 45 o"kZ ]
fuoklh & cjdyk
dkj.k & 21 o"kZ fd mez esa lUrks"k ds NksVs HkkbZ dks pksjks us xksyh ekj nh Fkh] ml ?kVuk us lUrk"sk dks
cgqr izHkkfor fd;k] tc ls lUrks"k fd ;gh gkyr gSa A
bZykt & 15 o"kZ igys ukxiqj ljdkjh vLirky esa bZykt djok;k ]mlds ckn Hkksiky 5 &6 o"kZ
izk;oVs vLirky esa bZykt pyk A
orZeku fLFkrh & orZeku esa lUrks"k dk bZykt cUn gSSa ] tc lUrks"k th ls blds ckjs esa tkuuk pkgk ]
rks mUgksus crk;k fd tc os nWokbZ ysrs gS]a rks mUgsa ?kcjkgV o cSpus h gksrh gSa ]bl dkj.k esa nWokbZ ugh
ysrk gwWA ifjokj okyks }kjk mUgsa ckj &ckj nokbZ;ksa dks ysus ds fy;s ncko cuk;k tkrk gSAa vkSj ;s
,glkg djok;k tkrk gS]a fd os ikxy @fcekj gSAa ifjokj okyks dks crk;k fd oks fBd gks ldrs gSa
]mUgsa lgh bZykt vkSj ifjokj dk I;kj o lg;ksx fd t:jr gSAa mUgsa fuEgkul ]cxaSyksj dk irk Hkh
fn;k x;k A ¼L=ksr & lUrks"k o ifjokj ds vU; lnL;ksa ls PkpkZ ds vuqlkj twu 2013½
26
fjQysDlu &e-iz- o cSx
a yksj dks ns[kus is ik;k x;k fd cSx
a yksj esa ekufld LokLF; ij xSj ljdkjh
laxBuksa ds }kjk cgqr vPNs ls dk;Z fd;k tk jgk gSAa leqnk; esa ekufld LokLF; ij yksxksa dks
tkudkjh gSa ]nqljk ;gkW fuEgkul vLIkrky gksus ds dkj.k bZykt dh vPNh lqfo/kk gSAa blds foijhr e-izesa ekufld LokLF; ij bruk /;ku ugha fn;k tk jgk gSAa vxj ljdkj o xSj ljdkjh laxBuks ds }kjk
bl fo"k; ij xEHkhjrk ls /;ku fn;k tk;s ]rks leqnk; o vU; Lrj ij Hkh tkudjh c<+x
s hA
2-2-6-2 ekufld foadykx & Mental retardation
uke& vuqjk/kk lstdj
mez & 8 o"kZ
ekrk & jtuh lstdj
mez & 28 o"kZ
firk & X;kjljke lstdj
mez & 35 o"kZ
X;kjljke lts dj eqy :i ls jkeiqjk dk fuoklh gSAa ftldh nqjh cjdyk ls 30 ls 40 fd-fe
gS]a jkeiqjk esa etnqjh u feyus dss dkj.k ;s 5 o"kZ igys cjdyk esa vkdj cl x;s A
xHkkZoLFkk & jtuh us xHkkZoLFkk ds le; iq.kZ fVds yxok;sa Fk]s l;qDar ifjokj gkus ds dkj.k o etnqjh
u feyus ds dkj.k jtuh dks iks"kd vkgkj ughsa fey ldk]vuqjk/kk dk tUe gjnk vLirky esa gqvk]
tUe ds le; otu 2-5 fd-xzk- Fkk A vuqjk/kk ds bl gkyr ds ckjs esa ifjokj dks 6 ekg ckn MWkDVj ls
irk pyk] vuqjk/kk dk izk;oVs vLirky esa bZykt djok;k] izfrekg dk [kpZ 1000 ls 1500 rd gksrk
Fkk] ifjokj fd vkfFkZd gkykr fBd u gksus ds dkj.k bZykt fu;fre ugha djok lds A
vuqjk/kk fd i’saku ds fy;s 5 ekg igys ipak;r esa vkonsu fn;k ij vHkh rd dqN ugha gqvk A jtuh
orZeku esa 8 ekg fd xHkZorh gSA
¼L=ksr & Jherh jtuh lstdj ls PkpkZ ds vuqlkj twu 2013½
27
2-2-7 fd’kksfj;ksa o efgykvksa dh cSBa d & Adolescent / woman meeting
cjdyk esa fd’kksfj;ksa o efgykvksa ds LokLF; ls lac/kh ppkZ fd x;h & ftlesa fd’kksfj;ksa dks
LokLF; ls lca/akh dkSu & dkSu Lkh leL;k,W dk leuk djuk iM+ jgk gSAa rks dqN yM+fd;ksa us crk;k
fd gessa pDdj vkrs gSa ]Hkw[k ugha yxrh gSa ] fijh;V ds le; isV o dej cgqr nnZ fdlh dkjrh gSa
]fijh;V cgqr tYnh vk tkrk gSa ]vkSj vf/kd le; ij leL;k jgrh gSa Age viuh leL;k,W fdlh dks
ugha crk irsa A
efgykvksa dks LokLF; ls lac/a kh dkSu lh leL;k,W gSa &lkekU;r%g efgykvksa dks pDdj
vkuk]detksjh vf/kd eglql djrh gSA ijh;V ds le; iVs o dej cgqr nnZ djrk gS]a 40&45 o"kZ fd
efgykvks dks fijh;V ds le; cgqr leL;k jgrh gS]a fijh;V cgqr tYnh vk tkrk gS]a o 9&12 fnuksa rd
jDr L=ko gksrk jgrk gSAa lQns ikuh fd leL;k Hkh gSAa efgyk MWkDVj uk gksus ds dkj.k efgykvksa dks
tkWp fd leL;k,W vkrh gSa] tc rd fcLrj uk idM+ ys ifjokj okys MWkDVj ds ikl ugh] ys tkrsA
xHkZorh efgykvksa dks [kqu fd deh] >Vds vkuk]fiyh;kW ]otu uk c<u+k]vkfn leL;k,W gksrh gSAa
fjQysDlu & xzke Lrj ij efgykvksa o fd’kksjh;ks dks LokLF; fd vusd leL;k,W gS]a ;s vius LokLF;
¼ekgkokjh],l-Vh-Mh½fd leL;kvksa dks fdlh vkSj dks ughaa crk ikrh ]efgyk MkWDVj uk gksus ds dkj.k oks
viuk bZykt ugha djok ikrh gSAa ifjokj ds yksx efgykvksa ds LokLF; ds izfr ykijokg gS]a lkekU;
fcekj gksus fd fLFkrh esa mUgsa MkW- ds ikl ugha ys tk;k tkrk gSAa
L=ksr & cjdyk fd efgyk,W o fd’kksjh ckfydkvks ls ppkZ ds vuqlkj &tqu 2013
2-2-8 sub - center observation & supply of Medicines
daz1
2
3
4
5
LokLF; dUsnz pkj[ksM+k
xkWo dk uke
fuekpk[kqnZ
cjdyk
ekyksuk
pkj[ksM+k
f[kM+dhokyk
dqy tul[a;k
tul[a;k
1196
1391
1360
1239
1619
6805
mi&LokLF; dsUnz izfrfnu 10-00 ls 3-00 cts rd [kqyk jgrk gSaSAmi&LokLF; dUs nz pkj[ksM+k esa 27
izdkj fd nokbZ;kW gS]a jsQjy iz.kkyh & xHkZorh efgyk;ksa dk jsQjy dkMZ gSa ]vU; ykxks dks ekSf[kd
28
lykg nsdj fVejuh o gjnk jsQj fd;k tkrk gSAa oSDlhu vkiwrhZ & A.N.M- }kjk ekWx i= B.M.O
lkeqnkf;d LokLF; dsUnz fVejuh dks fn;k tkrk gSa ]lkeqnkf;d LokLF; dsUnz ij naokbZ;kW miYc/k gkuss
ij ns nh tkrh gSa ] vkSj miYc/k u gksus ij B.M.O }kjk ekWx i= dks ftyk vLirky ]gjnk dks yVsj
ns fn;k tkrk gSAa ftyk vLirkky gjnk }kjk lkeqnkf;d LokLF; dsUnz fVejuh dks nokbZ;kW iWgqpkbZ
tkrh gSA A.N.M }kjk lkeqnkf;d LokLF; dsUnz fVejuh ls nokbZ;kW izkIr fd tkrh gSAa
2-2-9. Asha profile
uke% e/kq lqj’s k xqtZj]
eksckbZy uEcj% 090098&48001
xzke% cjdyk] fodkl[k.M fVejuh] gjnk e/; izn’s k
mez%z% 43 o"kZ
ifjokj fd orZeku
eku fLFkfr & e/kq ds ifjokj esa muds ifr o 2 csVs o 1 csVh gSaA csVh dk fookg 2 o"kZ
iwoZ x;k gSa A vkfFkZd fLFkfr &buds ifjokj esa d`f"k Hkweh ugh gS]a bl dkj.k etnqjh djds viuh
vkthfodk pykrs gSaA bl ifjokj fd okf"kZd vk; 25 gSAa budk jk’ku dkMZ ,-ih-,y gSAa vk’kk dk p;u
&2006 o"kZ esa vkxauokMh+ dk;ZdrkZ nhnh us QkeZ Hkjk o tek djokus esa lgk;rk fd FkhA
• vk’kk ds
ds dk;Z &
1-?kjks dk nkSSjk djuk
2-fjdkMZ j[kuk
3-miLokLF; dsUnz ij tkuk
4-xzke LokLF; xzke iks"k.k fnol esa lgHkkfxrk nsuk
5- xzke Lrjh; lferh fd cSBa d djuk
• vk’kk
vk’kk ds izfrfnu ds dk;Z &
1- ?kjksa dk nkSjk djuk o xHkZorh o /kk=h ]f’k’kqorh] dqiksf"krksa dks ijke’kZ nsukA
2- vkjksX; dsUnz esa tkuk
3- fjdkMZ j[kuk
29
• izfrekg ds dk;Z &
1-Vhdkdj.k esa lgHkkfxrk
2- Cykd Lrj ij cSBa d esa tkuk
3- xkWo dk Hkzze.k
4- xHkZorh efgykvksa ds [kkrk [kqyokuk ] xHkZZorh ]/kk=h o f’k’kqorh fd tkudkjh
• vk’kk
vk’kk }kjk j[ks tkus okys
okys fjdkMZ &
1-nokbZ jftLVj
2- okf"kZd ifjokj losZs
3-fVdkdj.k jftLVj ¼xHkZorh o f’k’kq ½
4-tUe & e`R;q iath;u jftLVj
5- y{; niafRr jftLVj
6- 0& 5 o"kZ dss cPpksa fd tkudkjh jftLVj
7- fd’kksjh ckfydk tkudkjh jftLVj
izf’k{k.k dkSSu &dksu ls izkIr fd;k &
25 tuw 2005 dks izFke izf’k{k.k Cykd Lrj ij 7 fnolh; ] 3 vU; izf’k{k.k & vk’kk ds dk;Z ]
fjdkMZ ] xHkZorh o f’k’kq fd ns[kHkky] xzke lHkk xzke rnFkZ lferh] ftyk Lrj ij 7 ekM~~;qy rd
izf’k{k.k A
• izf’k{k.k ls D;k & D;k fl[kk &
• xHkZorh o f’k’kq fd ns[kHkky djuk
• f’k’kq dk otu ysuk
•
izlo ds le; lko/kkfu;kW
• fVdkdj.k
• vk’kk ds dk;Z
• vk’kk ds dkS’ky
• dEcy esa cPpksa dks yisVus k
•
okeZ cSx
a esa cPpksa dks j[kuk
• cPpsa o f’k’kq dk rkieku
30
leqnk; esa dk;Z djus esa D;k& D;k leL;k,W vk jgh gSa &
• vkjksX; dsUnz ij nokWbZ;kW u gksuk]
• xHkZofr;ksa dk [kkrk [kqyokus esa ijs’kkuh gksuk
• xzke lHkk xzke rnFkZ lfer fd izfrekg fd cSBd
a esas lnL; vkuk ialn ugha djrs gSAa
• fufp’r ekuns; u feyusa o T;knk dke gksus ls ifjokj okyks ds }kjk vk’kk ds dk;Z dks u
djus ds fy, dgkW tkrk gSAa
• ljdkjh vLirky & izlo ds le; ,-,u-,e dk O;Okgkj fBd ugha gksrk gS]a bl dkj.k izlo
djokus esa lEkL;k vkrh gS Aa
• MkWDVj & izlo ds le; flfj;l fLFkrh esa MkWDWDVj 500 ls 2500 : vyx ls ysrs gSAa
ugha ns ikus fd fLFkrh esa izk;osVs vLirky esa jsQj dj nsrs gSAa
• izlo ds ckn tuuh lqqj{kk fd jkf’k dk pSd
a cSd
a esa Mkyk tkus dk fu;e gSA ij cgqr lh
efgykvksa dk [kkrk cSd
a esa dkxt¼ifjp; i=]oksVs j vkbZ &Mh]vk/kkj dkMZ] jk’ku dkMZ esa uke ½
ughas gksus ds dkj.k ugha [kqy ikrs vkSj fgrxzkzkgh dks jkf’k ugha fey ikrh ]bl dkj.k efgykvksa
ds ifjokj okys lkjdkjh vLirky esa izlo djokusa esa f>>drs gSa A
leL;k,W dk lkek/kku dSls
ls djrs gks &
vLirky ls nokbZ;kW u feyus ij vkjksX; dsUnz ds fy;s nokbZ;kW xzke lHkk xzke rnFkZ lferh ds ek/;e
ls nokbZ;kW esfMdy ls 100 ls 500 :i;ks rd [kjhnh tkrh gSAa vU; leL;kvksa dk lek/kku ge vdsys
ugha dj ldrs gSa
incentive & dk;Z ds vuqlkj :i;s feyrs gS] vfUre ekpZ 2013 esa 730 :- izkIr gq, gSAa rnFkZ lferh
fd jkf'k &izfro"kZ rnFkZ lferh esa pSd
a ds ek/;e ls [kkrs esa jkf’k vkrh gS ]bl o"kZ gekjs xkWo fd
lferh esa 10]000 : izkIr gq,] rnFkZ lferh fd cSBa d &gekjs xkWo esa izfrekg rnFkZ lferh fd cSBa d
gksrh gS]a ij lferh ds lkjs lnL; cSBa d
a esa ugha vk jgs gSAa
•
31
vk’kk dk utfj;k &
,u-vkj-,p-,e- ds ek/;e ls vk’kk ds }kjk fd;s tkus okys dke ls leqnk; esa vklkuh ls fd;k tk jgk
gS]a u;h & u;h tkudkjh ls xkWo esa tkx:drk vk jgh gSaS] fiNys 6 o"kZ esa ekr` &e`R;q ]f’k’kq&q&e`R;q ]o
xHkZikr ugha gq,A
eksfVos’ku
sku &
tc gesa izf’k{k.k fn;s x;s rks gesa vius dk;Z ds fo"k; esa tkudkjh izkIr gqbZ ]ge tks dk;Z dj jgs gS]a
og efgyk o f’k’kq ds fy;s vfr vko’; gS]a blls gesa vkxs dke djus fd izsj.kk feyrh gSAa
•
vk’kkvksa dk laxBu &
fVejuh Cykd easa vk’kkvksas ds laxBu fd ’kq:okr 1 o"kZ iqoZ gks pqdh gS]a lxaBu fd v/;{k
Jherh lq/kk ikjs gSAa vxj vk’kkvksa dk laxBu gksrk gSAa rks orZeku esa tks leL; vk jgh gS] mudk
lek/kku vklkuh ls gks tk;sxkA
L=ksr & Jherh e/kq xqtZj ¼xzke cjdyk vk’kk izsjd½ ls izkIr tkudkjh dss vuqlkj twu 2013
32
2-2-10
Adolescent Meeting in charuwa -
fnaukd &03-06-2013
LFkku & gfjiqjk pk:ok] Cykd f[kjfd;k ftyk gjnk ¼lekos’k LkaLFkk dk dk;Z {kS= ½
mÌs’; &fd’kksjkoLFkk dk foLRk`r tkudkjh ckfydkvksa dks nsuk o iks"kgk.kkj fd fLFkrh ns[kukA
mifLFkrh &
ckfydk
ekfgyk
dqy
36
02
38
izfd;k & loZizFke mifLFkr yksxks us ifjp; fn;k ]blds mijkUr iqu% vkt fd feafVx dk mÌs’;
crk;k x;kA bl dk;Zdze esa 2 xkoW gfjiqjk o pk:ok fd ckfydk,W ,df+=r gqbZ FkhA
ppkZ ds fcUnq &
• fd’kksjkoLFkk D;k gS-a & fd’kksjkoLFkk 9 ls 18 o"kZ ds e/; gksrh gS]a bl mez esa rsth ls ’kkjhfjd
fodkl gksrk gSAa
• ckfydkvksa fd vkUrfjd lajpuk & csVh djs loky ,dYkO; laLFkk]Hkksiky esa n’kZ; x;s fp=ks ds
e/;e
• fd’kksjkoLFkk esa gksus okys ifjorZu &¼’kkfjjhd] ekufld]O;Okgkfjd½
• ekgkokjh &¼D;k]dSl]s D;qW foLrkj ls½ lko/kkfu;kW &
• ekgkokjh ds le; gksus okyh leL;k,W& dqN ykM+fd;ksa crk;k fd bl le; eq>s isV esa nnZ
vf/kd gksrk gS]a [kkuk Hkh ugha [kk ldrh]4&6 ykM+fd;ksa uss crk;k fd gekjh dej cgqr nnZ
djrh gSAa 2&3 ykM+fd;ksa us dgkW fd gekjk fifj;V le; ij ugha vkrk gSAa
• fd’kksjkoLFkk esa fo’kks"k iks"k.kkgkj fd vko’;drk D;qW& bl le; gekjs ’kjhfjd dks vfrfjDr
iks"k.kkgkj fd vko’;drk gksrh gS]a iks"k.k fd deh ls ’kjhj detksj gksrk gS ftlds dkj.k
detksjh] pDdj vkuk vkfn LokLF; leL;k,W gksrh gSa Hkkstu esa vadqfjr vukt] ekSleh Qy
]vkfn t:j ysuk pkfg;ksa A
33
•
cky fookg& cky fookg ,d lkekftd cqjkbZ]yM+dh ds fookg fd lgh mez 18 o"kZ o yM+ds
ds fookg fd lgh mez 21 o"kZ gSAa cky fookg ds dkj.k yM+ds & yM+dh o nksuks dks
‘’kkjhfjd] ekufld ]vkfFkZd]lkekftd leL;kvksa dk lkeuk djuk iM+rk gSA yyhrk us crk;k
fd bl lky gekjs xkWo esa 7&8 yM+dh;ksa ds cky fookg bu nksuks xkWo esa gq,W gSAa
• ckfydkvksa }kjk O;fDrxr vuqHko crkuk &
•
dk;Zdze dk fQVcsd &mifLFkr yM+dh;kssa us crk;k fd vkt gesa vius ckjs esa cgqr lh
tkudkjh feyh o dqN ckrsa ftudss dkj.k gesa Mj yxrk Fkk]vkt irk pyk fd ;s rks izkd`frd
gSA ;s tkudkjh ge viuh lHkh lgfy;ks dks crk;sxAs
• fjQysD’ku & ;gkW fd’kksjh;ksa dks LokLF; ds fo"k; esa T;knk tkudkjh ugha gS]a vk’kk o vkWxuokM+h
dk;ZdrkZ }kjk lEiq.kZ tkudkjh ugha nh tk jgh gS]a bu yM+dh;kssa esa fdlh Hkh u;h tkudkjh dks
irk djus o mlds ckjs esa vkSj tkuus fd bPNk gSAa ;gkW xkWo esa yM+dh;kssa dks vdsys dgh Hkh ugha
vkus &tkus fn;k tkrk gS]a yM+dh;kssa fd i<k+bZ chp essa NqMok fn tkrh gSAa bldk dkj.k tkuus ij
tkudkjh izkIr gqbZ fd blds nks dkj.k gSaA
• igyk &orZeku essa ns’k o nqfu;k esa yM+dh;kssa ds lkFk tks ?kVuk,W gks jgh gS]a nqljk dqN yM+dh;k
?kj okyksa fd bPNk ds f[kykQ o lekt ds ckgkj ’kknh dj jgh gSAa bl dkj.k ifjokj okysa bl
Mj ls yM+dh;kssa fd ’kknh 16 &17 o"kZ fd mez esa djus yxs gSAa
L=ksr & fd’kksjh ckfydkvks ls ppkZ ds vuqlkj twu 2013
34
2-2-11 Youth Meeting
fnaukd &04-06-2013
LFkku & pk:ok vkoklh; Ldqy]Cykd f[kjfd;k ftyk gjnk
mÌs’; & f’k{kk dk egRo crkuk o mu ifjfLFkrh dks tkuuk ftlds dkj.k os viuh i<+kbZ iqjh ugha
dj ik jgh gSAA
mifLFkrh &
ckfydk
55
dqy
55
izfd;k & loZizFke mifLFkr ckfydkvksa us ifjp; fn;k ]blds mijkUr iqu% vkt fd feafVx dk mÌs’;
crk;k x;kA bl dk;Zdze esa pk:ok fd vkkoklh; Ldqy esa ckfydkvksa ls bl eqÌs ij fuEu fcUnqvks ij ppkZ
fd
ppkZ ds fcUnq &
f’k{kk D;Ww t:jh gS &
ckfydkvksa lss iqNk x;k fd f’k{kk gekjs thou esa t:jh gS D;k ]rks ckfydkvksa us dgk gkW i<+us lss gesa
cgqr lh u;h & u;h tkudkjh gksrh gS]a vkt dss le; esa i<+uk cgqr t:jh gS]a vxj ge i<+kbZ djrs gSa rks ge
vkxs c< ldrs gSAa ckfydkvksa dkss f’k{kk dk egRo crk;k fd vkt ds le; esa i<+kbZ cgqr t:jh gSa ?kj ds
NksVs & NksVs fglkc ge vklkuh dss dj ldrs gS]a fdlh tkudjh dks fy[k dj ge lqjf{kr j[k ldrs gS]a vxj
gejs ifjokj ls dksbZ xyr dkxt ij lkbZu djokrk gSa rks vki mls i<+ dj vius ifjokj dks lkbZu djus ls
euk djds] fdlh cM+h ijs’kkfu ls cPkk ldrs gSAa
i<+kbZ djdss vki vius iSjks ij [kM+s gks ldrs] ukSdjh djdss vius ifjokj okyksa fd enn dj ldrs gS]a
vki i<+s fy[ks gks rks vki nqljks dks Hkh i<+k ldrsa gks]vids xkWo ls lhek ]Ykyhrk jhuk T;ksrh nhnh Hkh rks
vkt 12 oh ikl djds dkyst esa i<+kbZ dj jgh gSAa rc ckfydkvksa us dgk ge rks i<+kbZ djuk pkgrs gSa ij
dqN dkj.kks ls ge i<+kbZ ugha dj ik jgs gSAa
35
i<+kbZ fu;fer u j[kus ds dkj.k &
dz- uke@firk dk mez xkWo dk i<+kbZ fu;fer u j[kus dk dkj.k
uke
uke
10
d{kk
tgkW
rd
i<+bZ
fd
tkedksj
NksVs HkkbZ dks lEHkkyus ds fy;s esjh 3 jh
i<+kbZ NqM+ok nhA
tqukikuh ifjokj okyks us [ksrh esa eÌ djus ds 4 Fkh
fy;s esjh i<+kbZ NqM+ok nhA
xksikyiqjk NksVs HkkbZ dks lEHkkyus ds fy;s esjh 2 jh
i<+kbZ NqM+ok nhA
lkoy[ksM+k 4 &5 efguks rd cq[kkj vkus ds 4 Fkh
dkj.k eq>s i<+kbZ NqMu+ h iM+A
tqukikuh firk fd e`R;` ds ckn ekW us ?kj ds 5 oh
dke o NksVs HkkbZ & cgu dks
lEHkkyus ds fy;s esjh i<+kbZ NqM+ok
nhA
xksikyiqjk ifjokj okyks us ?kj ds dkeksa esa eÌ 5 oh
djus ds fy;s esjh i<+kbZ NqM+ok nhA
fjekdZ
1
xtjh &jktkjke
2
laxhrk &vksedkj 11
3
jkuh &lhrkjke
09
4
f’kokuh&djek
11
5
js[kk &Nrjflg
13
6
vk’kk & yPNwjke 14
7
lquhrk
&y[kuyky
14
xksikyiqjk
Ldqy nqj gksus ds dkj.k eq>s i<+kbZ 6 Vh
NqMu+ k iM+h
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
8
jkte.kh dhj
16
gfjiqjk
eSa vkxs i<+uk pkgrh
gwWA
9
o"kkZ dhj
16
gfjiqjk
ikfjokj esa dke djus okyks dksbZ 8 oh
ugha gS]a bl dkj.k eq>s i<+kbZ NksMu+ k
i<+kA
ikfjokj okyks us esjh i<+kbZ NksM+ok 3 jh
nh
10
euh"kk nk;ek
17
gfjiqjk
11
izhrh dhj
16
gfjiqjk
12
uhrw dhj
18
gfjiqjk
eSus 8 oh rd i<+kbZ jsxqyj fd vkxs
ikfjokj okyks us jsxqyj ugha i<+us
fn;kA
eSus 8 oh rd i<+bZ fd ij esjs 8 oh
ifjokj fd vkfFkZd fLFkrh fBd ugha
gSa bl dkj.k eSa vkxs ugh i<+ ik
jgh gwWA
ikfjokj okyks us esjh i<+kbZ NksM+ok 9 oh
nh
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
vkoklh; fctz dkslZ
esa i<+kbZ dj jgs gSAa
eSa vkxs i<+uk ugha
pkgrh gwWA esjh mez
vc T;knk gks x;h
gSa
vc eS izkbZoVs 10 oh
i<+ jgh gWAw
eSa vkxs i<+uk pkgrh
gwWA
eSa vkxs i<+uk pkgrh
gwWA
36
vkxs i<+kbZ fu;fer djuk pkgrh gSa &
xtjh &jktkjke] laxhrk &vksedkj] jkuh &lhrkjke] f’kokuh & djek ]js[kk &Nrjflg js[kk &Nrjflg
lquhrk &y[kuyky ] pk:ok fLFkr vkoklh; fctz dkslZ esa i<k+bZ dj ds viuh NqVh gqbZ i<+kbZ djds
vius &vius xWko esa fu;her Ldqy tkus yxsx
s hA
jkte.kh dhj & vkxs i<+uk pkgrh gSa blds fy;s lekos’k laLFkk esa dk;Zjr lhek dks mlds
ifjokj ls feydj jkte.kh fd i<
i<kbZ dks ysdj ckr djusus fd ;kstuk cukbZ gSAa
o"kkZ dhj & mez T;knk gksus ds dkj.k o"kkZ vkxs i<+uk ugha pkgrh gwWA mls crk;k fd okss
euh"kk nk;ek fd rjy izk;osV ¼5 oh fd ½ ijh{kk ns ldrh gSAa
izhrh dhj & izhrh vkxs i<+uk pkgrh gSa ]bls d{kk 9 oh pk:ok essa ,Mfelu djok;k tk ldrk
gSa izhrh ds ifjokj ds ikl ch
ch-ih- ,y dk jk’ku dkMZ gS]a bl vk/kkj ij ljiap ds ek/;ke ls
Ldwy dss izkpk;Z dks fQl ekQ djus ds fy;s vkosnu fn;k tk ldrk gSAa
uhrw dhj & vkxs i<+uk pkgrh gSa blds fy;s lekosl laLFkk dk;Zjr lhek dks mlds ifjokj ls
feydj
dj jkte.kh fd i<bZ dks ysdj ckr djus fd ;kstuk cukbZ gSAa
fctz dkslZ& fctz dkslZ esa 3 ekg ds fy;s ckfydkvksa dkss i<k+;k tkrk gSA i<k+bZ ds lkFk &lkFk vU;
xfroh/kh;kW Hkh djokbZ tkrh gSa
L=ksr & xzke pk:ok ds vkoklh; fctz dkslZ gfjiqj o pk:ok fd ckfydkvks ls ppkZ ds vuqlkj twu 2013
37
2-2-1212- NRC Observation in Timarni -a
dqiks"k.k
k.k ds dkj.k & lk/kuk ’kekZ U;wVªhf’k;u ls tkudkjh izkIr gqbZ fd ;gkW dqik"sk.k ds eq[; dkj.k
1- Mk;fj;k o fueksfu;k
2- ekW fd vuns[kh
3- xjhch
ijke’kZ & dqiksf"kr cPpksa dks ,u-vkj-lh- esa ijke’kZ fn;k tkrk gSAa
1- O;fDrxr lQkbZ
2- iks"k.kkgkj Lruiku
5-- de [kpZ ij iks"k.kkgkj &
3- ds;j
1- xqM o QqVkus]
2- jksVh o rsy]
4- vkxauokMh+ dk iks"k.kkgkj
3-vkVs dk miek
,u-vkj-lh- esa HkrhZ fd izfd;k & yEckbZ ]ÅpkbZ]otu ]vksfMek fd tkWp djuk ] Test - H.B,X-Ray
vkxauokMh+ ls izkIr otu o ,u-vkj-lh- ds otu esa vUnj vkrk gS]a vkxauokM+h dk otu 700 ls 900
xzke rd T;knk fudyrk gaSA
tuojh 2013 ls twu 2013 rd HkrhZ cPpksa fd tkudkjh
dz
1
2
3
4
5
6
dqy ;ksx
ekg dk uke
tuojh
Qjojh
ekpZ
vizSy
ebZ
twu
ckyd
02
04
04
06
03
05
24
ckfydk
06
06
06
05
&
03
26
o"kZ 2009 ls tuw 2013 rd HkrhZ cPpksa fd tkudkjh
dz
o"kZ dk uke ckyd
ckfydk
1
2009
94
85
2
2010
121
112
3
2011
129
133
4
2012
93
94
5
2013
24
26
dqy ;ksx
461
450
dqy
08
10
10
11
03
08
50
dqy
179
233
262
187
50
911
fjQysDlu & bl ,u-vkj-lh esa fd jgus fd O;oLFkk fBd gSa A nqljk tks cgqr egRoiq.kZ gS]a ekrkvksa dks
?kjs: iks"k.kkgkj ijke’kZ fn;k tk jgk gS]a A cPpksa dks iks"k.kkgkj fBd ls fn;k tk jgk gSAa ij mudh
ekrkvksa dks isV Hkj ds Hkkstu ugha fn;k tk jgk gSAa
L=ksr & lk/kuk ’kekZ U;wVªhf’k;u ds vuqlkj tqu 2013
38
VII
Research study project
Final Report
of the
Community Health Learning Fellowship Programme
A study on challenges faced by ASHA’s working in Harda
District, Madhya Pradesh in fulfilling their roles
Submission to
SOCHARA, Bangalore
39
A study on challenges faced by ASHA’s working in Harda District (rural area) Madhya Pradesh in fulfilling their
roles
CHLP fellowship 2012-13
Compiled by:
Ms. Ranu Sharma,
Fellow, Community Health Learning Programme
SOCHARA , Bangalore,
India
Contributors :
SOCHARA Team – Mr. A.S. Mohammed, Dr. Adithya Pradyumma, Dr. Rahul
A.S.G.R
Synergy Team, Harda – Mr.Ajay Pandit, Mr.Vimal Jat, Mr.Vishan
Acknowledgement:
ASHA’s from the 10 villages
ANM / AWW / GSSGTS from the 10 villages
BCM Timarni
40
Table of Contents
Topic
Page no.
1. Background……………………………………………………………………….. 43
2. Objectives…………………………………………………………………………. 47
3. Methodology
3.1. Study Design……………………………………………………………… 48
3.2. Study Setting ………………………………………………………………….
48
3.3 Sampling design and Study Area………………………………………. 49
4. Results
4.1. Results of the Quantitative Study……………………………………… 51
5. Discussion ………………………………………………………………………….. 61
6. Conclusion …………………………………………………………………………… 63
7. Limitations of the Study……………………………………………………………. 63
8. Future Areas of Research…………………………………………………………. 64
9. Reflection & suggestion ……………………………………………………………. 65
10. References …………………………………………………………………………… 66f6666C
41
LIST OF TABLES
Table No
Table Details
Page
No.
1.01
Harda District At a Glance
47
3.01
Selection of study Area
48
3.02
Study Population
49
4.1.1
Socio Demographic Profile of ASHA respondents
51
4.2.01
Frequency distribution of monthly number of visits ASHA’s make to
55
health centres
Fig 3.01
Map of HARDA Districts in Madhya Pradesh
49
Fig 3.02
Timarni Block Of Harda District
50
Fig 3.03
Map of Health Facilities in District Harda Madhya Pradesh
50
Fig 4.2.01
Training Status Distribution of ASHAs
52
Fig 4.2.02
ASHAs Monthly sure Amount
54
Fig 4.2.03
Work related problems faced by ASHAs
57
Fig 4.2.04
Problems faced by ASHA at Gram Arogya Kendra
58
Fig 4.2.05
Support for ASHAs at Gram Aarogya Kendra
59
42
1. BACKGROUND (पृ ठभूम):jk"Vªh; xzkeh.k LokLF; fe’ku (Nation Rural Health Mission- NRHM) dh ’kq:okr 12 vizSy
2005 dks dh x;h Fkh A xzkeh.k {ks=ksa esa jgus okys yksxks]a [kkldj efgykvksa o cPpksa rd xq.koRrkiq.kZ LokLF;
ns[kHkky lsokvksa rd igqWp ikuk fe’ku dk fo’ks"k mÌs’; gSAa ¼1½
vk’kk ds ckjs esa %& jk"Vªh; xzkeh.k LokLF; fe’ku esa leqnk; vk/kkfjr dk;Zdrkvksa ds izc/a k dk izLrko
j[kk x;k gSAa fe’ku fd ’kq:okr esa Hkkjr ljdkj us leqnk; vkSj lkoZtfud LokLF; ra= ds chp ,d dM+h
ds :i esa leqnk; vk/kkfjr dk;Zdrkvksa ¼vk’kk½ izekf.kr lkekftd LokLF; dk;ZdrkZ ¼Accredited Social
Health Activist½ dks izLrkfor fd;k x;kA vk’kk ds ek/;e ls ?kj &?kj Lrj ij LokLF; ns[kHkky igqpkus
dks fe’ku dh ,d eq[; j.kuhfr cukbZA
;s LokLF; dk;ZdrkZ ¼vk’kk½ vius leqnk; dks xzke Lrjh; LOkkLF; ;kstuk cukus ds fy, laxfBr
djus vkSj orZeku esa izkIr gks jgh LOkkLF; lsokvksa ds mi;ksx ds fy, izfs jr djus rFkk leqnk; vius
tokcnsgh le>sa bl fn’kk esa dk;Z djsxhA ¼2½
o vk’kk p;u %&
• izR;sd xkWo esa 1000 fd tula[;k ij 1 vk’kk dk izko/kku gSAa vkfnoklh @igkM+h bykdksa esa izR;sd
Vksys es vk’kk gks ldrh gS]a vk’kk dk p;u xzke lHkk dh cSBa d esa fd;k tk;xk A
• vk’kk mu efgykvksa esa ls pquh tk;sxh tks ’kknh’kqnk @fo/kok @ifjR;Drk vkSj 25 ls 45 o"kZ dss chp
dh gks ]mlh xkWo fd jgus okyh gks o d{kk 8 oha rd dh i<+kbZ fd gkss
• vk’kk iapk;r ds izfr tokcnsg gksxh ] vk’kk vkaxuokM+h dss ek/;e ls dk;Z djsxh
• vk’kk ,d voSrfud Lo;alsod gS ]vk’kk dke ds vk/kkj ij izkRs lkgu jkf’k izkIr djus dh gdnkj
gksxh] leqnk; ds fy;s vk’kk dh lHkh lsok,a fu%’kqYd gksxh ¼1½
o vk’kk fd Hkwfedk ,oa ftEesnkfj;kW %&
LokLF; dk vf/kdkj vk’kk ds dk;Z dk vfHkUu fgLlk gSa ftlds vUrxrZ LokLF; esa lq/kkj vkSj
LokLF; lac/a kh lsok,W izkIr djus ds fy;s leqnk; dks izfs jr djus rFkk LokLF; dk;Zdzeksa esa yksxksa dh
Hkkxhnkjh c<+us ij fo’ks"k /a ;ku nsuk gksrk gSaSA
43
o ftEesnkfj;kW %&
leqnk; dsk iks"k.k o LoPNrk ds ckjs esa tkudkjh nsuk A
xHkZorh efgykvksa dk iath;u djuk o ch-ih-,y izek.k i= fnyokus esa enn A
izlo iqoZ ns[kHkky ]lqjf{kr izlo] Lruiku ] xHkZfujks/kdks]a ;kSu ladze.k ]iztuu vaxksa ds
ladze.k o f’k’kq dh ns[kHkky fd lykg nsuk] iw.kZ fVdkdj.k dks c<+kok nsuk
NksVh chekjh;ksa ds fy;s izkFkfed LokLF; ns[kHkky miyC/k djokuk]blds fy;s vk’kk dks 1
fdV fn;k tk;sxk ftlesa vke vk;q"k o ,yksiFs khd nokbZ;k gksxh A
vkaxuokM+h dk;ZdrkZ ],-,u-,e ]Lo;a lsoh lewg ds lnL;ks ds lkFk xzke LOkkLF; lferh ds
usr`Ro esa xkWo LokLF; ;kstuk cuokuss vkSj fdz;kUOk;u esa enn djukA ¼3 ½
vkWxuokM+h lg xzke vkjksX; dsUnz %&
NRHM ds vUrxZr ]LokLF; ds lkeqnk;hdj.k dh izfdz;k dks lqn<` + djus ds fy, yksd
LokLF; ,ao ifjokj dY;k.k vkSj efgyk ,ao cky fodkl foHkkx ]e/; izn’s k ’kklu ds leUo; ls izn’s k ds
izR;sd xzke esa xzke vkjksX; dsUnz dh vo/kkj.kk dks ewr:
Z i fn;k tk jgk gS]a dsUnz [kksyus ds fy;s xkWo ds
vk¡xuokMh+ dsUnz] iapk;r Hkou] lkeqnkf;d Hkou vkfn dk p;u fd;k tkrk gSA
vkjksX; dsUnzksa ds ek/;e ls nks Lrjh; dk;Z
1- xzke Lrj ij mipkfjr gksus okyh
2- yksxksa dks LokLF; f'k{kk ,oa ldkjkRed O;ogkj ifjorZu
chekfj;ksa dk xkao ij gh mipkj dj xaHkhj
dh izsj.kk nh tk jgh gSA blds fy;s izR;sd xkWao esa xzke lHkk
:i /kkj.k djus ls jksdk tk jgk gS
LoLF; xzke rnFkZ lfefr;ksa dks xfBr dj mudk izf’k{k.k fd;k
ftu fcekfj;ksa dk mipkj xzke Lrj ij
tk jgk gSA ;g lfefr;k leqnk; vkSj 'kklu ds e/; lsrq dh
laHko ugh gS] mUgsa mPp LokLF; dsUnz Lrj
rjg dk;Z djrs gq, xzke vkjksX; dsUnzksa ds lqpk: fdz;kUo;u esa
rd jsQjy djus dk dk;Z fd;k tk jgk
xkWao ds LokLF; lsok iznkrkvksa dks lg;ksx dj] leUo; vkSj
gSA
fuxjkuh dk Hkh dke djrh gSAa
44
xzke vkjksX; dsUnz izeq[k mn~n's ; %&
• xkWo@leqnk; Lrj ij LokLF; r=a dks etcwr cukukA
• xkWo Lrj ij gh yksxsa dks LokLF; vkSj iks"k.k lac/a kh t:jh lsokvksa dks miyC/k djukA
• xkWo Lrj ij LokLF; lsok iznkrkvksa ds dke esa leUo; djukA
• LokLF; lsokvksa esa leqnk; dh Hkkxhnkjh c<k+uk A
xzke vkjksX; dsUnz esa gkssus okyh izeq[k xfrfof/k;k¡
• xzke LokLF; ,oa iks"k.k fnol dk vk;kstu] xHkZorh ,oa izlo i'pkr~ efgykvksa dh tkWp
a ] xHkZorh
efgykvksa ,oa cPpksa dk Vhdkdj.kA
•
chekj ejhtksa dh tk¡p] [kwu dh tk¡p ]nok forj.kA
• xzke lHkk LoLFk xzke rnFkZ lfefr] fd'kksjh ckfydkvksa] LokLF; f'k{k.k vkfn dh cSBdsa vkfnA¼4½
xzzke lHkk LoLFk xzzke rnFkZ lfefr&
e/; izn’s k iapk;r jkt ,ao xzke Lojkt vf/kfu;e]1993 ¼dz-1lu~ 1994½ ds fu;e 3 ds mifu;e
,d ds vf/ku xfBr xzke lHkk dh ,d rnFkZ lferh gksxh tks xzke lHkk LoLFk xzke rnFkZ lferh ds uke ls
tkuh tk;sxh A
lferh dk xBUk&
• rnFkZ lferh esa U;wure 12 o vf/kdre 20 lnL; gksx
s ]s ftuesa U;wure 50 izfr’kr efgyk lnL;
gksxh]] ftldk uke xzke iapk;r fd ernkrk lqph esa gks
• xkWo fd lHkh efgyk iap ]vk’kk],-,u-,e- vkxauokM+h dk;ZdrkZ ]ekr` ≶ksfxuh lferh dh
v/;{k ]{ks= esdfs ud ;k lgk;d esdfs ud] ,e-Mh-,e- fd v/;{k lnL; gksxAsa
• efgyk lnL; lferh dh lHkkifr gksxh rFkk lferh ds [kkrsa ds fy;s 1 vyx dks"kk/;{k gksxhA
yksd LokLF; foHkkx ls lacaf/kr dk;Zdzeksa ds fy;s vk’kk dk;ZdrkZ dks"kk/;{k gksxh] budk p;u
vke lgefr ls fd;k tk;sxk] lfpo & xzke iapk;r dk lfpo ]lferh dk lfpo gksxkA
jk"Vªh; xzkeh.k LokLF; fe’ku ¼NRHM½
jk"Vªh; xzkeh.k is;ty dk;Zdze ¼PHE½
efgyk ,ao cky fodkl foHkkx¼ICDS½
xzke lHkk LoLFk xzke rnFkZ lferh
45
vkWx
a uokM+h lg xzke vkjksX; dsUnz ds ek/;e ls lapkfyr fofHkUu LokLF; lsokvksa vkSj xkoa esa dke dj
jgs deZpkfj;ks tSl&
s vk’kk] ,-,u-,e] vkWxuokMh+ ,oa mudh xfrfof/k;ksa dh fuxjkuh djus dh ftEesnkjh xzke
lHkk LoLFk xzke rnFkZ lfefr dks lkSia h xbZ gSA muds dke esa lg;ksx] leUo;] ekxZn’kZu vkSj xzke LokLF;
;kstuk cukuk vkfn lfefr ds izeq[k dke gSAa ¼5½
leL;k dk dFku ¼Statement of the problem½%&
½%&
Hkkjr esa vk’kk izsjdks dks xzke Lrj ij LokLF; fd eq[; dM+h ekuk x;k gS]a vusd v/;;u vk’kk
izsjdks ¼lkekftd LokLF; dk;ZdrkZ½ ij fd;sa x;sa gS]a LokLF; fd lqfo/kkvksa o leqnk; dks xzke Lrjh; LokLF;
;kstuk,W cukus ds fy;s laxfBr djuk o leqnk; viuh tckonsgh dks le>s bl fn’kk esa dk;Z dj jgha
gS]a xzke Lrj ij vk’kk izsjdks dkss viuh Hkqfedk dks iq.kZ djus ds fy;s vusd pqukSfr;ksa dk lkeuk djuk iM+
jgk gSAa
‘;gW v/;;u gjnk ftys ds HkkSxksfyd o lkaLd`frd :i ls fHkUu {kS= fVejuh Cykd ds vUrxZr vkus
okys 10 xzkeksa esa vk’kkvksa dks viuh Hkqfedk dks iq.kZ djus esa fdl izdkj fd pqukSfr;ksa dk lkeuk djuk iM+
jgk gS]a bl v/;;u ls le>us esa enn~ feysxh ]bl v/;;u ds ek/;e ls vk’kk izsjdksa dh pqukSfr;ksa dss
lek/kku esa lg;ksx izkIr gksxkA
bl {kS= fd vk’kk,W dks vius dk;ksZ ds nkSjku tkfrxr O;oLFkk] HkkSxksfyd fHkUurk o foHkkxh; Lrj
ij vusd pqukSfr;ksa dk lkeuk djuk iM+ jgk gSAa
46
Table No.1.01
Harda District at a Glance -
daz-
Item
lkaf[;dh
1
HkkSxksfyd {kS= lkaf[;dh
2644-32 oxZ fd-eh
2
Cykd
3 ¼ gjnk] f[kjdh;k Vhejuh ½
3
rglhy
6 ¼ gjnk]f[kjdh;k Vhejuh lhjkyh ] jgVxkWo]
gkf.M;k ½
4
dqy iapk;r dh la[;k
211 xkWo iapk;r
5
dqy xkWo
571 xkWo
6
tual[;k (2011dh tux.kuk ds vuqlkj)
dqy
xzkfe.k
’kgjh
¼ Rural ½
¼ Urban ½
570,302
450936
119,336
7
efgyk
275,094
217,320
57,774
8
iq:"k
295,616
233616
61592
9
gjnk ftys fd dqy vk’kk o vk’kk lg;ksfxuh
10
fVejuh Cykd fd dqy iapk;r
69 iapk;r
11
fVejuh Cykd ds dqy xkWo
168
12
fVejuh Cykd fd vk’kk o vk’kk lg;ksfxuh
vk’kk 145 + vk’kk lg;ksfxuh 09
vk’kk
450
+
vk’kk lg;ksfxuh 27
reference-(7)www.cencus2011mp.com and BCM Timarni
2. Study Objective: - ¼v/;;u
v/;;u mÌs’;½
HkkSxksfyd o lkaLd`frd fLFkrh ds vk/kkj ij vk’kkvksa fd pqukSrh;ksa dk v/;;u djus ds fy;sA
xzke LRkjh; lsok iznkrkvks]a LokLF; foHkkx o xzke lHkk LoLFk xzke rnFkZ lfefr }kjk vk’kkvksa fd
pqukSrh;ksa dk v/;;u djus ds v/;;u djus ds fy;s
47
3. Methodology 3.2 Study Design:- bl v/;;u dk Study Design cgqLrjh i)fr ¼ Multi-stage ½ dk iz;ksx fd;k
x;k gS]a bl v/;;u esa la[;kRed (Quantitative research) dk vf/kd iz;ksx fd;k x;k gS]a lkFk fg
xq.kkRed (qualitative) dk Hkh iz;ksx fd;k x;k gSAa la[;kRed i)fr esa cross-sectional survey dk iz;ksx
lsok iznkrkvksa (Provider-level) ds Lrj ij fd;k x;k] ftlesa
mRrjnkrk
bl izdkj gSa & izekf.kr
lkekftd LokLF; izsjd vk’kk] ulZ ] vkWxuokM+h dk;ZdrkZ] xzke lHkk LokLFk xzke rnFkZ lferh ds lnL;ksa
3.3 Study Setting:jkT; izkQ
s kbZy & e/; izn’s k jkT; Hkkjr ds e/; Hkkx esa fLFkr gSAa 2011 dh tux.kuk ds vuqlkj]
e/; izn’s k fd xzkeh.k vkcknh 52,537,899 ’kgjh vkcknh 20]059]666 dqy vkcknh 72]597]565 gSAa e/;
izn’s k dk fyax vuqikr xzkeh.k {ks= esa 936 vkSj ’kgjh {ks= eas 1000 iq:"kksa ij 916 efgyk,W gSAa jk"Vªh;
xzkeh.k LokLFk fe’ku o"kZ 2006 ls e/; izn’s k jkT; ds 50 ftyksa esa vk’kk dk;Zdze dk;kZRed gSAa (6)
3.4 Sampling Design And Study Area :bl v/;;u esa uewuk fMtkbu (sampling design) cgqLrjh i)fr ¼ Multi-stage ½ dk iz;ksx
fd;k x;k gS]a bl v/;;u esa e/; izn’s k ds ueZnkiqje laHkkx ds gjnk ftys dk p;u fd;k x;k] blds
ckn gjnk ftys ds rhu Cykd f[kjfd;k] gjnk] fVejuh] esa ls txay {kS= gksus ds dkj.k fVejuh Cykd dk
p;u fd;k x;kA blds lkFk fg HkkSxksfyd n`f"V ls fHkUu o ftys ls nqjh ¼ 6 k.m To 60 k.m ½ds vuqlkj
xkWo dk p;u fd;k x;kA ;g losZ vxLr o flRkEcj 2013 dks fd;k x;kA vkdM+ks dks ,df=r djus ds
fy;s losZ izi= o lk{kkRdkj fd fo/kh viukbZ x;h A iz’ukoyh dk igys izh&VsLV fd;k x;k] iz’ukoyh
ds iz’u cUn o [kqys ¼Question open ended & close ended ½izdkj ds gSAa
Table No.3.01 & p;uhr v/;;u {ks= ¼ Selection of study Area½½
jkT;
e/; izn’s k
ftyk
gjnk
Cykd
Vhejuh
ftys ls 10 xkWoks fd nqjh fdfd-eh esa
9 fdfd-eh
25 & 35 fdfd-eh
4 xkWo
2 xkWo
¼gkbZos ½
40 & 45 fdfd-eh
55& 60 fdfd-eh
2 xkWo
2 xkWo
¼ lM+d ls nqj ½
¼QkjsLV½
48
Table No.3.02 Study population --
dz-a
in
la[;k
dz-a
in
la[;k
1
vk’kk
10
6
vU; lnL;]
02
2
,-,u-,e-
01
7
vk’kk lg;ksxhuh
01
3
vkWxuokM+h
02
8
xzke vkjksX; dsUnz
10
dk;ZdrkZ
4
iapk;r lfpo
01
9
ch-lh-,e
01
5
efgyk iap
01
10
rnFkZ lferh v/;{k]
02
15
dqy
dqy
dqy ;ksx
16
31
Fig 3.01 - Map of HARDA Districts in Madhya pradesh
49
Fig 3.02 - Timarni Block Of Harda District
Fig 3.03 - Map of Health Facilities in District Harda Madhya pradesh
50
4. Results ¼ Results of the Quantitative Study ½
Table 4.1 . Socio Demographic Profile of ASHA respondents
Frequency
Percent
25-29
2
20.0
30-39
6
60.0
40-45
2
20.0
5 th
3
30.0
8 th
3
30.0
10 th
2
20.0
12 th
1
10.0
BA
1
10.0
2006
5
50.0
2007
3
30.0
2010
2
20.0
Variable
Age
Educational
Status
selection Year
vk;q fLFkrh %& vk’kkvksa ds vk;q leqg ls tkudkjh izkIr gqbZ gSa ]fd 25 ls 29 o"kZ ds e/; vk;q leqg esa
20% vk’kk,W gS]a 30 ls 39 o"kZ ds e/; vk;q leqg esa 60% vk’kk,W gS]a vkSj 40 ls 45 o"kZ ds **e/; vk;q leqg
esa 20 % vk’kvksas gSAa ]f’k{kk fd fLFkrh %& 30% vk’kkvksa izsjdks }kjk izkFkfed Ldqy f’k{kk izkIr fd xbZ] 30%
vk’kkvksa izsjdks }kjk fefMy Ldqy rd f’k{kk izkIr fd xbZ] 20% vk’kkvksa izsjdks }kjk gkbZ Ldqy rd f’k{kk
izkIr fd xbZ] 10% vk’kk izsjd }kjk gk;j lsd.s Mjh rd f’k{kk izkIr fd xbZ]10% vk’kk izsjd }kjk ch-,- rd
f’k{kk izkIr fd gSAa p;u o"kZ %& 50% vk’kk izsjdks dk p;u 2006 esa gqvk ] 30% vkSj 20% vk’kk izsjdks dk
p;u 2007 o 2010 esa gqvkA
51
izf’k{k.k %& vk’kkvksa izsjdks ds izf’k{k.k esa Kkr gksrk gSa fd 20% vk’kk izsjdks dks ekM~;y
w 5 rd izf’k{k.k izkIr
gqvk] 70% vk’kk izsjdks dks ekM~;y
w 6&7 rd izf’k{k.k izkIr gqvk] 30% vk’kk izsjdks dks xzke lHkk LoLF; xzke
rnFkZ lferh dk izf’k{k.k izkIr gqvk] vkSj 10% vk’kk izsjdks dks xzke vkjksX; dsUnzz dk izf’k{k.k izkIr gqvk]
¼uksV &4-01 blesa tks izfr’kr n’kkZ;k x;k gSa oks izR;sd dk 100 % esa ls gS½a
Fig 4.01 Training Status Distribution of ASHA
80%
70%
70%
60%
50%
40%
TRAINING status of ASHA
motiva's
30%
30%
20%
20%
10%
10%
0%
Module 5
Module 6-77
Gram sabha Gram aarogya
Swasth gram krendrCategory
Tatharth samiti
52
4.2 Challenges faced by ASHA’s respondents
4-2-1 vk’kk izsjdks fd lkekftd
lkekftd Lrj fd pqukSfr;kW %&
vk’kk izsjdks dks leqnk; esa dk;Z djus esa lekt esa O;kIr tkfr izFkk dk lkeuk djuk iM+ jgk gS]
ftu xkWo esa vk’kk izsjd fUkEu tkfr fd gSa ]ogkW mPp tkfr ds yksx bu vk’kkvksa ds cqykus ls feafVx esa ughaa
vkrs vxj vk Hkh tkrs gS]a rks oks budh ckr ugha lqurs vkSj buds gkFk yxk gqvk ikuh o uk’rk Hkh ugha
ysrAsa mPp tkfr ds yksx ;kstukvksa ds YkkHk esa dsoy xHkZorh efgykvksa o cPpksa dk Vhddj.k djokrs gS]a vk’kk
9 ekg rd xHkZorh efgyk fd ns[kHkky djrh gS]a ifjokj okys izk;osV vLirky esa izlo djokrs gS]a bl
dkj.k vk’kk dks izlo fd izkRs lkgu jkf’k ugha fey ikrh A
tkfr o tkfr ds vk/kkj ij HksnHkko fd fLFkrh %& tkfr ds fo"k; esa Kkr gksrk gSa fd mRrjnkrkvksa esa ls
20 % vk’kk izsjd vuqlfw pr tkfr (SC) fd gS] 20 % vk’kk izsjd vuqlfw pr tutkfr (ST)fd gS vkSj 60 %
vk’kk izsjd fiNM+k oxZ (OBC)ls gSa A
20 % vk’kk izsjd vuqlfw pr tkfr (SC) ls lac/a k j[krh gSa ]buds lkFk leqnk; ds mPp tkfr ds
yksxks }kjk tkfr ds vk/kkj ij HksnHkko fd;k tkrk gS]a mPp tkfr ds yksxks }kjk bu vk’kkvksa dks ?kj ds
vUnj tkus o fdlh Hkh lkexzh dks gkFk ugha ykxkus fn;k tkrk gSAa ftlds dkj.k ;g vk’kk,W uotkr f’k’kq
o ekrk fd ?kj ij ns[kHkky ugha dj ikrh gSAa mPp tkfr ds yksxksa }kjk bl izdkj dk O;ogkj ls bu
vk’kkvksa dks viuk dk;Z djus esa vusd leL;kvksa dk leuk djuk iM+ jgk gSa A (NRHM) ds vuqlkj vk’kk
ds ek/;e ls ?kjks ij LokLF; ns[kHkky iWgqpkus dh fe’ku dh ,d eq[; j.kuhfr Fkh] vkSj vk’kk vkiuh Hkqfedk
dks iq.kZ esa ,d dk;Z & ?kjksa dk nkSjk Hkh djrh gSA
4-2-2 vk’kkvksa izsjdks dh p;u izfd;k %& ¼ ASHAs Selection process ½
vk’kkvksa izsjdks us viuh p;u izfd;k dss le; vkiuk vkosnu QkeZ fdls fn;k bl fo"k; ij tkudkjh
izkIr gksrh gSa fd ]mRrjnkrkvksa esa ls 30% vk’kk iszjdks us LokLF; foHkkx esa QkeZ tek fd;k] 30% us viuk
QkeZ xzke lHkk esa tek fd;k ]vU; 30% us viuk QkeZ ,-,u-,e- dks fn;k] vkSj 10% vk’kkvksa }kjk QkeZ
vkWxuokM+h dk;ZdrkZ ds ikl tek fd;k A
30% vk’kk,W dks ;s tkudkjh gSa fd mudk p;u xzke lHkk ds }kjk gqvk gS] ysfdu vU; 70% vk’kvksa
dks yxrk gSa fd gejk p;u LokLF; foHkkx ds }kjk gqvk gSAa vkSj ge foHkkx fd dk;ZdrkZ gS]a blesa ;g irk
pyrk gSa fd jk"Vªh; xzkeh.k LokLF; fe’ku fd xkbZM ykbZu ds vuqlkj vk’kk izsjdks dk p;u ugha gqvk gSAa
53
fe’ku esa Li"V :i ls dgk x;k gSa fd vk’kk ,d voSrfud Lo;alsod gS ]mijksDr ifj.kke dks ns[krss gq,
dgkW tk ldrk gS]a fd mls vk’kk izsjd ds LFkku ij vk’kk dk;ZdrkZ cuk fn;k x;k gSAa
4-2-3
vk’kk izsjdks fd vkfFkZd pqukSfr;kW %& vk’kk izsjdks dks vius dke ds nkSjku vusd vkfFkZd
pqukSfr;ks dks lkeuk djuk iM+rk gS]a
• fdlh xkWo esa ,d ls vf/kd vk’kk gksus ds dkj.k Hkh mUgsa tks Hkh izkRs lkgu feyrh gS]a ml jkf’k dks lHkh
vk’kk izsjdks esa cjkcj ckVuk iM+rk gSAa
• ftl xkWo fd tula[;k 300& 500 ds yxHkx gSa ogkW ij Vhdkdj.k nks ekg esa ,d ckj gksrk gS]a vk’kk
izsjdksa dks Vhdkdj.k ds 150 : nks ekg esa ,d ckj fg fey ik jgsa gSAa
• izkRs lkgu jkf’k ¼izlo jkf’k½ vk’kk izsjdks dks fn tk jgh gSAa oks ,d ckj esa ugha nh tkrh ftlds fy;s
vk’kkvksa dks 3&4 ckj lkeqnkf;d LokLF; dsUa nz tkuk iM+rk gSa ]ftruh izkRs lkgu jkf’k mUgsa ugha fey ikrh
mlls vf/kd jkf’k os viuh tsc ls ml izkRs lkgu jkf’k dks ikus esa [kpZ dj nsrh gSAa
• vk’kk izsjdks ds }kjk xHkZorh efgyk dks izlo ds fy;s vLirky ys tkrs le; izlo vxj xkM+h esa gks
tkrk gSa rks ml izlo fd izkRs lkgu jkf’k vk’kk izsjdks ugha fn tkrh gSAa
• vk’kk izsjdk dks fuf’pr izkRs lkgu jkf’k cgqr de fey ik jgh gSAa ¼ Fig 4-2-01½ izfrekg vk’kk izsjdks dks
fuf’pr izkRs lkgu jkf’k ds fo"k; esa Kkr gksrk gSa fd mRrjnkrkvksa esa ls 50 % vk’kk izsjdks dks izfrekg 300
: jkf’k fg fey ikrh gS] 20 % vk’kk izsjdks dks izfrekg 450 : jkf’k fg fey ikrh gS] 10 % vk’kk izsjd dks
izfrekg 500 : jkf’k fg fey ikrh gS] 10 % vk’kk izsjd dks izfrekg 600 : jkf’k fg fey ikrh gSA
Fig 4.2.02 ASHAs Monthly sure Amount:ASHA Monthly Sure Amount
6
5
5
4
3
2
2
2
ASHA Monthly Sure
Amonut
1
1
0
300 Rs
450 Rs
500 Rs
600 Rs
54
4-2-4
vk’kk izsjdks ds vR;f/kd dke ds cks> fd pqukSfr;kW %&
•vk’kkvksa dks VkjxsV vk/kkfjr ¼ifjokj fu;kstu& ulcanh ½dk;Z djok;s tk jgsa gS] vk’kk izsjdks ds fy;s ,d
cgqr cM+h pqukSrh gS]a blh dkj.k xzke Lrjh; lsok iznkrkvksa ds chp esa erHksn cM+ jgk gS]a vk’kk }kjk ckj &Ckkj
ulcanh vkijs’ku dk dgus ij leqnk; ds yksx muds ikl tkus ls fgpfdpkrs gSAa
•vk’kk izsjdks ls lHkh foHkkx ds vf/kdkjh viuk dke djokrs gS]a mnk- ifjp; i= dk dk;Z]vk’kkvksa dk dguk
gSa fd gesa flQZ vk’kk ds dk;Z fg djok;sa vU; dk;Z u djok;sAa
• vk’kk izsjdks dks xHkZorh efgykvksa ds cSd
a esa [kkrsa [kqyokus esa vusd leL;k vk jgsa gS]a xHkZorh efgykvksa
ds ikl iq.kZ dkxt u gksus ds dkj.k cSd
a vf/kdkjh [kkrsa ugha [kksyrs] vkSj vxj [kkrk [kqy tkrk gSa ]rks 500
: yxrs gS]a vkSj dbZ ckj [kkrsa u [kqyus ds dkj.k fgrxzkgh dks pSd
a rks fey tkrk gSa ij :i;s ugha fey
ikrs gSa ]bl dkj.k ifjokj okys ljdkjh vLirky esa izlo dkjokus ds fy;s ugha ys tkrsA
Table No.4.2.01 - Frequency distribution of monthly number of visits ASHA’s make to health centres
Number of Visits
Health Centre
Sub-center
CHC
District Hospital
0
10%
10%
50%
2
50%
50%
30%
4
10%
10%
10%
6
10%
10%
10%
8
10%
10%
0%
Total
100%
100%
100%
Table No.4.2.01 ls tkudkjh feyrh gSa fd vk’kk izsjdks dks 3 izdkj fd pqukSfr;ksa dk lkeuk djuk iM+ jgk
gSa
•igyk mu ij vkfFkZd cks> iM+ jgk gSa vk’kk izsjd dks 1 ekg esa mi& LokLF; dsUnz] lkeqnkf;d LokLF;
dsUnz] o ftyk vLirky ij xHkZorh tkpW] Vh-oh- dq"B ds efjtksa fd tkpW o nokb;kW vkfn dss fy;s tkuk
iMrk gS]a ftldk mUgsa izkRs lkgu jkf’k o ;k=k fdjk;k fn;k tk jgk gSAa
55
•nqljk mu ij dk;Z cks> iM+ jgk gSa yxHkx ,d vk’kk izsjd dks 1 ekg esa 12& 15 ckj vius ?kjksa ls
ckgkj tkuk iM+rk gSa vkSj mudk iqjk fnu blh dke pyk tkrk gS]a oks vius ?kj dk dke Hkh ugha dj ikrh
gSAa
•rhljk HkkSxksfyd Uktfj;ksa ls ns[ks rks dgk tk ldrk gSa fd mi& LokLF; dsUnz] lkeqnkf;d LokLF; dsUnz]
o ftyk vLirky fd nqjh vf/kd gksus ds dkj.k xzkfe.kksa fd LokLF; lqfo/kkvksa rd igqWp ugha gks ik jgh gSAa
vkSj vk’kk izsjdks dks fgrxzkfr;ksa dks bruh nqj ys tkus ds fy;s rS;kj djus esa cgqr ijs’kku gksrh gSAa
4-2-5 vk’kk izsjdks dks dk;Z djus esa foHkkxh; ls gksus okyh pqukSfr;kW %&
1 •LokLF;
LokLF; foHkkx %& vk’kkvksa }kjk tc izlo ds fy;s efgykvksa dks ys tk;k tkrk gSa rks vLirky esa
ulZ]vk;k] MkW] dk O;Okgkj fBd ugha gksrk] izlo fifM+r efgyk dks ulZ psd ugha djrh] nokbZ;kW esfMdy ls
[kfjnus ds fy;s dgkW tkrk gSAa cPpk gksus ij :i;ksa fd ekWx fd tkrh gSAa uk nsus ij vk;k]ulZ }kjk
vi’kCnksa dk iz;ksx fd;k tkrk gSAa ¼uksV & fo’ks"kr; ;g gjnk ftyk vLirky esa fd;k tkrk gSAa ½
•foHkkx }kjk ckj&ckj feafVx fd tkrh gS]a vk’kkvksa dks dk;Z djus ds vkns’k o leL;kvksa dk lek/kku
dsoy ekSf[kd fd fd;k tkrk gSAa fyf[kr u gksus ds dkj.k vk’kkvksa fd TkYnh lquokbZ ugha gksrh A vkjksX;k
dsUnz ij nWokbZ;kW le; ij ugha nsrs A
•Logistic - vk’kk izsjdks dks tuuh lqj{kk ds okgu o 108 ds le; ij u vkus ds dkj.k xHkZorh efgyk
dks vLirky ys tkus esa ijs’kkfu gks jgh gSAa xHkZorh efgyk dks ys tkus ds fy;s ljdkjh okgu uk vkus ds
dkj.k izk;osV okgu esa ys tkuk iM+rk gSAa vkSj dHkh & dHkh vk’kkvksa vius ?kj ls :i;s ys dj izk;osV okgu
fd O;OkLFkk djuk iM+rk gSAa
2•iaiapk;r %& iapk;r o xzke lHkk ds }kjk vk’kk izsjdks fd leL;kvksa ds lek/kku esa lg;ksx ugha fd;k
tkrk ]LOkkLF; fu/kh fd jkf’k ¼vu VkbZV QaM½ dks ysdj Hkh vk’kkvksa ij ncko Mkyk tkrk gSAa
3- efgyk o cky fodkl foHkkx %&xz
%& ke Lrj ij vkxWuokM+h dk;ZdrkZ vk’kk izsjdks ds dk;Z esa iq.kZ :i ls
enn~ ugha djrh]¼mnk- Vhdkdj.k ds fnu efgykvksa dks cqykus dk dke flQZ vk’kk fg djrh gS]a lgkf;dk
cqykus ugha tkrh gS]a dqiksf"kr dk otu igys vkWxuokM+h dk;ZdrkZ djrh ij vc vk’kk dks djuk iM+rk gSa
D;ksdh vc dqiksf"kr cPpksa dks ,-vkj- lh- esa HkrhZ djus fd jkf’k vk’kk dks feyrh gS]a vkxWuokM+h dk;ZdrkZ dks
ugha ½
56
¼ Fig 4.2.03 ½ ls Kkr gksrk gS fd vk’kk izsjdks dks dk;Z esa dgkW fdruh leL;ksa dk leuk djuk iM+rk gSa
100 esa ls 80% vk’kkvksa dks LokLF; foHkkx ls leL;k gS]a 100 esa ls 10% vk’kkvksa dks leqnk; ls leL;k
gS]a 100 esa ls 20% vk’kkvksa dks xzke lHkk o iapk;r ls leL;k gS]a 100 easa ls 10% vk’kkvksa dks xzke lHkk
LoLF; rnFkZ lfer ls leL;k gS]a 100 easa ls 20% vk’kkvksa dks dk;Z djus esa fdlh Hkh izdkj dh dksbZ leL;k
ugha gSAa
Fig 4.2.03 - work related problems faced by ASHAs
90%
80%
70%
60%
50%
40%
work related
problems
80%
30%
20%
10%
20%
20%
10%
10%
Department community Gram sabha
GSSGTS
0%
No problem
57
4-2-6 vk’kk izsjdks fd vkWxuokM+h lg xzke vkjksX; dsUnz fd pqukSfr;kW %&
• izf’k{k.k %& vk’kk iszjdks dks vkjksX; dsUnz ij dSls dke djuk gSa blds fy;s 20% vk’kk us dgkW gesa
izf’k{k.k izkIr gqvk gS]a 80% vk’kk us dgkW gesa izf’k{k.k izkIr ugha gqvk gSAa
• vkfFkZd pqukSrh %& vkjksX; dsUnz ij fdlh Hkh izdkj fd dksbZ jkf’k izkIr ugha gksrh lkexzh [kjhnus ds fy;s
vu VkbZV QaM dk mi;ksx fd;k tkrk gSAa 100% vk’kkvks dk }kjk dgk x;k fd vkjksX; dsUnz ij dk;Z
djus ds fy;s gesa vyx ls dksbZ ekuns; ugha fn;k tk jgk gS]a
•ikfjokfjd
ikfjokfjd pqukSrh %& 70% vk’kkvks dk }kjk dgk x;k gesa izfrfnu vkSj vyx ls ekuns; u nsus ds dkj.k
ifjokj okyksa }kjk gesa vkjksX; dsUnz ij tkus ls euk fd;k tkrk gSAa
•le;
le; fd vf/kdrk %&izfrfnu vkjksX; dsUnz ij 60% vk’kkvksa 3 ls 6 ?kVsa vkjksX; dsUnz ij cSBa jgha gS]a
30% vk’kkvksa 1 ekg esa pkj ckj 5 ?kVsa vkjksX; dsUnz ij cSBa jgha gS]a 10% vk’kkvksa ,d ekg esa 1 ckj 3 ?kVsa
vkjksX; dsUnz ij cSBa jgha gS¼a uksV&izfrfnu vkjksX; dsUnz ij cSBa uk gS ],slk fyf[kr :i esa vk’kkvksa dks ugha
fn;k x;k gS½a
Fig 4.2.04 - Problems faced by ASHA at Gram Arogya Kendra
120%
100%
80%
60%
Gram aarogya kendra
Problem
100%
40%
70%
60%
20%
0%
Economic
family
More Time
58
• Fig 4.2.05
ls Kkr gksrk gSa fd xzke Lrjh
Lrjh; lsok iznkrkvksa o rnFkZ lfefr }kjk vk’kk izsjdks dks xzke
vkjksX; dsUnz ij dk;Z djus ds fy;s ,,-,u-,e- }kjk 100 % lg;ksx fd;k tkrk gSAa vkWxuokM+h dk;ZdrkZ }kjk
50 % lg;ksx fd;k tkrk gSAa ch-lh
lh-,e- }kjk 10 % lg;ksx fd;k tkrk gSAa xzke lHkk LokLF; xzke rnFkZ
lferh }kjk 10 % lg;ksx fd;k tkrk gSAa vkSj vk’kk lg;ksxhuh }kjk 10 % lg;ksx fd;k tkrk gSAa
¼uksV & n`’kk;s x;s izfr’kr esa izRs ;d dk 100 izfr’kr gSAa ½
Fig 4.2.05 - Support for ASHAs at Gram Aarogya Kendra
120%
100%
100%
80%
60%
50%
G.A.k. support
40%
20%
10%
10%
10%
0%
ANM
Work
Help
AWW
BCM
Gram
Asha
sbha Sagyogini
swasthy
samiti
59
4-2-7
xzke lHkk LokLF; xzke rnFkZ lfefr ls pqukSfr;kW %&
vk’kk dks xzke Lrj ij dk;Z djus esa xzke lHkk LokLF; xzke rnFkZ lfefr ¼ GSSGTS ½ ls Hkh dqN
pqukSfr;kW vk jgh gSAa vk’kk ds dk;ksZ esa lferh lfdz; :i ls Hkkx ugha ys jgha gSAa leqnk; dks LokLF; ds
lsokvksa izfr tkx:d djus esa fdlh Hkh izdkj dk lg;ksx ugha fd;k tk jgk gSAa izfrekg feafVx esa lnL;
ugha vk jgs gSa ]vkjksX; dsUnz ij Hkh lnL;ksa }kjk vk’kk izsjdksa dks lg;ksx o ekxZn’kZu ugha fn;k tk jgk gSAa
4-2-8 xzke lHkk LokLF; xzke rnFkZ lfefr ¼ GSSGTS ½ds lnL;ksa dks viuh ftEesnkjh ds fo"k; esa %&
• 50% lnL;ksa us dgkW izfrekg lferh fd cSBa d gks jgh gS]a 50% us dgkW izfrekg cSBa d ugha gks jgh gSAa
• lferh ds eq[; dk;Z dkSu &dkSu lss gS]a bldh tkudjh 10% lnL;ksa dks gS]a 90% dks tkudkjh ugha gSAa
• bl o"kZ LokLF; fu/kh ls fdruh jkf’k lferh dks izkIr gqbZ] bldh tkudjh 80% lnL;ksa dks gS]a 20% dks
tkudkjh ugha gSAa
• xzke LOkkLF; ;kstuk ds fo"k; es]a 10% lnL;ksa dks tkudjh gS]a 90% dks tkudkjh ugha gSAa
• xzke vkjksX; dsUnz ds lac/a k esa 10% lnL;ksa dks izf’k{k.k feyk gS]a 90% dks izf’k{k.k ugha feyk gSAa
• xzke vkjksX; dsUnz ij dksbZ MkWDVj vkrs gS]a bl fo"k; esa 100% lnL;ksa us dgkW tkudkjh ugha gSAa
rnFkZ lferh ds lnL;ksa dks lferh ds eq[; dk;Z ds fo"k; esa tkudjh ugh ds cjkcj gS]a lHkh
mRrjnkrkvksa dk dguk Fkk fd lkQ &lQkbZ o LOkPNrk dk dk;Z lferh dks djuk gSAa bu 10 mRrjnkrkvksa
esa ls lferh ds fo"k; esa vf/kd tkudkjh ,-,u-,e- vkWxuokM+h dk;ZdrkZ] iapk;r lfpo]vk’kk
lg;ksfxuh]f’kf{kr lnL; dks gS]a vkSaj efgyk iap] lferh dh v/;{k] QkjsLV esa jgus okyh efgyk lnL;ksa dks
lferh ds fo"k; esa uk ds cjkcj tkudkjh gSAa
bl vk/kkj dk dgkW tk ldrk gSa fd lsok iznkrkvksa dks xzke lHkk LoLF; xzke rnFkZ lferh ds fo"k;
esa tkudkjh gSa vkSj leqnk; ds yksxks dks lferh ds fo"k; esa iq.kZ tkudkjh ugha gSAa
tc lnL;ksa dks lferh ds dk;ksZ o viuh ftEesnkjh o drZO;ksa ds fo"k; esa iq.kZ tkudkjh ugha gksxh rks
oksa vk’kk izsjd dk lg;ksx ekxZn’kZu vkSj LokLF; lsok iznkrkvksa ds e/; leUo; o LokLF; lqfo/kkvksa rd
leqnk; ds yksx
s ks fd iWgqp dks dSls lqfUkf’r dj ldsxsa \
60
5. Discussions bl v/;;u }kjk lcls igys vk’kk izsjdks dks viuhs Hkqfedk o ftEesnkjh;ksa dks iq.kZ djus ij vkus
okyh pqukSfr;ksa ds fo"k; esa tkuus dk iz;kl fd;k x;k gSAa bl v/;;u }kjk vk’kk fd pqukSfr;ksa ds lek/kku
gsrq lq>ko fn;s x;s gSAa
• vk’kk izsjd fd p;u izfd;kW lgha rfjds ls gksuk pkfg;s]a dqN LFkkuksa ij vk’kkvksa dk p;u fu;kekuqlkj
ugha gqvk gS]a dgha ij vk’kk,W ncax¼mPp tkfr] jktukSfrd½ ifjokj ls bl dkj.k os vk’kk,W nqljs xkWo eas
fuokl djrh gS]a vkSj leqnk; dks iq.kZ :i ls lsok,W ugha ns jgh gSAa
• vk’kk izsjdksa dks dk;Z djus esa izf’k{k.k fd eq[; Hkqfedk gS]a izf’k{k.k ljy o yksdy Hkk"kk esa fn;k tkuk
pkfg;sA vkSj le; & le; ij blds Qkyksvi fd;k tkuk pkfg; A
• tkfr ds vk/kkj ij vk’kkvksa ds lkFk HksnHkko fd;k tk jgk gS]a blds dkj.k mUgsa leL;k vk jgh gS]a fUkEu
tkfr fd vk’kkvksa ds lkFk mPp tkfr ds yksx ds }kjk HksnHkko fd;k tkrk gS]a vius gh leqnk;¼ ST/SC ½ ls
vk’kk dk p;u gksus ls mUgsa leqnk; dk lg;ksx feyrk gSa fdlh Hkh izdkj ls dksbZ HksnHkko ugha fd;k tkrk
gSAa fuf’pr izkRs lkgu jkf’k ek= 300 : ls 600 : izfrekg izkIr gks jgs ] jk"Vªh; xzkfe.k jkstxkj X;kjUVh
Ldhe ¼MNREGS ½ esa izfrfnu 122 : nsuk fd X;kjUVh gSa ijUrq ;gkW vk’kkvksa dks izfrfnu 10&20 :i;s fd
fey ik jgsa gSAa vk’kk izsjdks dks bl vkfFkZd pqukSfr;kW ls xqtjuk iM+ jgk gSAa
• vk’kk izsjdks dks vk’kk dk;ZdrkZ cuk fn;k x;k gS]a mu ij dke dk vR;f/kd cks> c<+rk tk jgk gS]a izR;sd
foHkkx ds deZpkjh vk’kk ls viuk dk;Z djokrs gS]a vkSj mUgsa vyx ls dksbZ jkf’k Hkh ugha fn tkrh gSAa
• vk’kk izsjdks dks foHkkx ls gksus okyh pqukSfr;kW ds dkj.k mUkds dk;ksZ dks lh/kk izHkkfor dj jgk gS]a LokLF;
foHkkx o xzke Lrjh; vU; fOkHkkxksa ls lg;ksx u feyus ds dkj.k vk’kk,W leqnk; dks iq.kZ LokLF; lqfo/kk,W
nsus esa Loa; esa vlgk; ik jgh gSAa XkHkZorh efgykvksa dks lkeqnk;hd LokLF; dsUnz o ftyk vLirky ij izlo
ds fy;s ys tkus ij vk’kkvksa ds :dus dh dgh Hkh O;OkLFkk ugha gSAa
• e-iz- esa vkWxuokM+h lg xzke vkjksX; dsUnz dk fopkj cgqr vPNk gS]a blds ek/;ke ls yksxks dks xzke Lrj
ij gh LokLF; fd lsok,W miYkC/k djok;h tk jgh gSAa xzke vkjksX; dsUnz ij efgykvksa }kjk T;knk la[;k esa
v
a kdj lqfo/kkvksa dk ykHk fy;k tk jgk gSAa ijUrq xzke vkjksX; dsUnz ds fy;s dksbZ fuf’pr ifj;kstuk rS;kj
ugha fd xbZ gSAa blds fy;s :i;ksa dk dksbZ izko/kku ugha gS]a xzke vkjksX; dsUnz ij dkSu lsok,W nsxk] foHkkxh;
61
leUo; fdl izdkj ls gksxk ;g Li"V :i ls r; ugha gS]a xzke vkjksX; dsUnz ij vk’kkvksa dks fdlh izdkj fd
pqukSfr;ksa dk lkeuk djuk iM+ jgk gS]a bldk Qkyksvi Hkh ugha fd;k tk jgk gSAa
• xzke lHkk LoLFk xzke rnFkZ lfefr ds ek/;e ls lapkfyr fofHkUu LokLF; lsokvksa ]leqnk; vkSj 'kklu ds
e/; lsrq dh rjg dk;Z djrs gq, xzke vkjksX; dsUnzksa dks lqpk: :i ls pykus esa ]xkWao ds LokLF; lsok
iznkrkvksa dks muds dke esa lg;ksx] leUo;] ekxZn’kZu vkSj xzke LokLF; ;kstuk cukuk vkfn A
lfefr ls bu izeq[k dk;Z dks iq.kZ djus fd vis{kk FkhA lferh ds lnL;ksa dk izf’k{k.k vPNs ls ugha
gksus ds dkj.k lferh ds lHkh lnL;ksa dks lferh }kjk D;k&D;k dk;Z djuk gSa ] bl fo"k; esa iq.kZ tkudkjh
ugha gSAa vk’kk izsjdks dks lferh ds lnL;ksa ls iq.kZ :i ls lg;ksx ugha fey ik jgk gS]a leqnk; ] iapk;r og
foHkkxh; Lrj ij vkus okyh leL;kvksa ij dksbZ dk;Zokgha ugha fd tk jghaA
,d vU; igyw ;g gSa fd lferh esa v/;{k xkWo fd dksbZ efgyk gksxh ijUrq iq:"k iz/kku lekt gksus
ds dkj.k vusd LFkku ij ik;k x;k fd efgyk dks in flQZ [kkukiqfrZ ds fy;s fn;k x;k gS]a mu efgykvksa
ds dk;Z ¼cSBa d esa tkuk] :i;ksa fd tkudkjh½ muds ifr;ksa ds }kjk fd;s tk jgs gSAa bl dkj.k efgykvksa esa
tkudkjh dk Lrj de gSAa vU; efgyk lnL;ksa ds lkFk Hkh ;gh gksa jgk gSAa bl dkj.k dbZ ckj lferh fd
v/;{k vk’kk izsjd ls vuVkbZV QaM esa ls :i;ksa fd ekWx djrh gSAa
bl v/;;u ls iqoZ Hkh cgqr ls v/;;u fd;s x;sa gSa mUesa o bl v/;;u esa dqN pqukSfr;kW feyrh gSa
tSl&
s 6 JOURNAL OF GLOBAL HEALTH CARE SYSTEMS/VOLUME3, NUMBER 2, 2013
7 Final Report Evaluation of ASHA Programme in Karnataka April 2012
vksMhlk jkT; esa gq, bl v/;;u esa vk’kk izsjdks dks gksus okyh
vkfFkZd & vkfFkZd pqukSfr;k izkRs lkgu jkf’k ¼incentive½ dks ysdj vk jgh gSAa
rkfdZd & ¼ Logistic ½ esa tuuh lqj{kk og ,EcqyUs l dks ¼108½ dks ysdj pqukSfr;Wk vk jgh gSAa
dk;Z fd vf/kdrk & nksuks ¼ vksMhlk o dukZVd jkT;½ v/;;uksa esa vk’kk izjdks dks dk;Z fd vf/kdrk ls
gksus okyh pqukSfr;ks tSls & le; fd vf/kdrk o tula[;k (Working Hours and population coverage) ds
ckjs esa tkudkjh izkIr gksrh gS]a
bu rhuksa jkT;kksa vksMhlk ]dukZVd o e/; izn’s k esa vk’kk izsjdks dks ,d leku gh pqukSfr;ksa dk
lkeuk djuk iM+ jgk gSAa
62
bl v/;;u ls vk’kk izizsjdks fd dqN vkSj u;h pqukSfr;kW fudy ds vk jgh gSa %&
1- tkfr ds vk/kkkj %&
2- foHkkx Lrj fd pqukSfr;kW%& ¼xzke Lrj] Cykd Lrj ]ftyk Lrj ½
3- vkWxuokM+h lg vkjksX; dsUnz fd pqukSfr;kW %&
4- xzke LkHkk LoLF; xzke rnFkZ lferh fd pqukSfr;kW %&
5- HkkSxksfyd Lrj fd pqukSfr;kW %&
6. Conclusion :jk"Vªh; xzkeh.k LokLF; fe’ku dk eq[; mÌs’; vk’kk izsjdksa ds ek/;e ls iq.kZ gksrk gqvk utj
vk jgk gSAa vk’kk izsjdks ds }kjk xzke Lrj leqnk;hdj.k ds fy;s tks dk;Z fd;s tk jgs gS]a oks iz’a klk ;ksX; gS]a
vk’kk izsjdks dks vius gh leqnk; ds fy;s dk;Z djus esa cgqr [kq’kh fey jgh gS]a vk’kk dk dk;Z djrs gq, xkWo
esa mUkdh ,d vyx igpku cuh] mUgsa LaOk; ¼igyss ifr ds uke ½ mUkdss uke ls leqnk; esa tkuk tk jgk gSAa
Hkkjr esa yxHkx 9 yk[k vk’kk o e/; izn’s k esa 56,188 vk’kk izsjd gSAa buds ek/;e ls ekfgykvksa o cPpksa ds
ekRk` &e`R;q ]f’k’kq &e`R;q esa deh vk jgh gSAa leqnk; dks xzke Lrj ij fg LokLF; lsok,W izkIr gks jgh gSAa
xzke lHkk LoLF; xzke rnFkZ lferh
vkaxuokM+h lg vkjksX; dsUnz
vk’kk izsjd bu rhus esa
xgjk lac/a k gS]a ;g ,d & nqljs dks dk;ksZ dks izHkkfor djrk gSAa
7. Limitations of the Study:-
bl v/;;u esa losZ la[;k ¼31½ de Fkh A
-
le; vkHkko gksus ds dkj.k leqg ppkZ o Cykd esfMdy vkfQlj o ftyk LokLF;
vf/kdkjh;ksa ls lk{kkRdkj ugha gks ik;kA
-
HkkSxksfyd {kS= o izkd`frd ifjfLFkrh;ksa ¼vf/kd o"kkZ ½ us dkj.k p;fur xkWoks esa losZ ugha
dj ik;sAsa
63
8. Future Areas of Research:• vk’kk izsjdks }kjk leqnk; dks fn tkus okyh LokLF; lsokvksa fd xq.kOkDrk ds Lrj dks tkuus ds fy;s
• leqnk; o LokLF; foHkkx }kjk vk’kkvksa dks fn;s tkus okys lg;ksx fd izfdz;k dks tkuus gsrq ]v/;;u
djuk A
9. Reflection & suggestions:1-xzke lHkk LoLF; xzke rnFkZ lferh
2- vk’kk izsjd
3-vkjksX; dsUn
1- xzke lHkk LOkLFk xzke rnFkZ lferh & ;g ,d LorU= laLFkk gS]a bl lfefr ds ek/;e ls leqnk; vkSj
ljdkj ds chp dM+h dh rjg dk;Z djrs gq, ] xzke vkjksX; dsUnzksa dks lqpk: fdz;kUo;u esa xkWao ds LokLF;
lsok iznkrkvksa dks lg;ksx dj] leUo; vkSj fuxjkuh ]og xzke LokLF; ;kstuk cukus dk dk;Z lkSia k x;k gSAa
;g ,d cgqr egRoiq.kZ dk;Z gSAa blesa lfdz; :i ls dk;Z djus okys lnL;ksa o vPNs ls izf’k{k.k gksuk
vo’;d gSAa rHkh ;g lnL; viuh ftEesnkjh o dk;Z & fuxjkuh ]eqYa ;kdu dks dj ik;sxAs vk’kk izsjdks] ulZ
o vkxWuokM+h dk;ZdrkZvksa dks muds dk;Z esa lg;ksx Hkh djsxAs
2- vk’kk & xzke lHkk LOkLFk xzke rnFkZ lferh ds lnL;ksa }kjk vPNs ls dk;Z o lg;ksx djus ls vk’kk izsjd
dks viuh ftEesnkjh iq.kZ djus esa lg;ksx izkIr gksxk o leqnk; esa dk;Z djus esa de pqukSfr;ks dk lkeuk
djuk gksxkA xzkfe.kksa rd LokLF; lsok fd igqWp gksxh ] xzke Lrj ij lsok iznkrkvksa ds chp vPNk leUo;
gksxk A
64
3- xzke lHkk LOkLFk xzke rnFkZ lferh o vk’kk ds etcqr leUo; ds dkj.k vkWxuokM+h lg xzke vkjksX;
dsUnz ij lHkh lqfo/kk,W miyC/k gksxh A xzkfe.kksa dks xzke Lrj ij fg LokLF; lsok,W izkIr gksxh A
Suggestions:1- vk’kk izsjd ¼ izekf.kr lkekftd LokLF; izsjd½ dks izsjd fg jgus nks vk’kk dk;ZdrkZ ¼ izekf.kr lkekftd
LokLF; dk;ZdrkZ½ er cukuksa ]izf’k{k.kksa esa vk’kkvksa dks viuh Hkqfedk o ftEesnkjh;ksa ds lkFk fg Social
Activist ds fo"k; esa vk’kk dks crk;sa vkSj leqnk;] xzke Lrjh; lsok iznkrkvksa o foHkkxksa dks Hkh bldh
tkudkjh nsuk pkfg;sa A
2- tkfr izFkk dks de djus gsrq leqnk; Lrj ij lkeqfgd dk;Zdzeks o xfrfo/kh;ksa dks c<+kok nsuk pkfg;sa
]tgkW ij lHkh ,d lkFk feydj Hkkx ysA
3- vk’kk izsjdks dks izfrekg fuf’pr ekusn; nsuk pkfg;sA
4- vk’kk iszjd dks dke ds lac/a k esa vkus &tkus ij cl fdjk;k dk Hkh vyx ls izko/kku gksuk pkfg;sA
5- ,d xkWo esa ,d lss vf/kd vk’kk gksuso tula[;k de gksus ij lHkh dks leku ykHk o volj nsuk gksxkA
6- vk’kk dks vU; foHkkxksa }kjk dk;Z ugha nsuk pkfg;s]a flQZ mls NRHM fd xkbZM+ ykbZu esa fy[ks dk;Z gh
djokuk pkfg;sAa
7- vk’kk dks Lo lgk;rk leqg] efgyk eaMy ] fd’kksj & fd’kksjh;ks o Ldqy Lrj ij cPpksa dks LokLF; ds
fo"k; esa tkudkjh nsus ls leqnk; esa vklkuh ls tkudjh dks QSyk;k tk ldsxk A
8- xHkZorh efgykvksa ds [kkrsa [kqyokus gsrq vk’kkvksa dks LokLF; foHkkx o xzke lHkk ds }kjk cSd
a dks fyf[kr
ysVj nsuk pkfg;sa ]ftlls vklkuh ls [kkrssa [kksys tk ldsA
9- LOkkLF; foHkkx ]efgyk cky fodkl] iapk;r lnL;ksa o vk’kk fd =Sekfld laokn cSBa d xzke Lrj ij gksuk
pkfg;sA ftlls ,d & nqljs ds dk;Z ds fo"k; esa tkudkjh o eqYa ;kdu esa vklkuh gksxh] A
10-vkWxuokM+h lg xzke vkjksX; dsUnz fd ,d fuf’Pkr dk;Z;kstuk cukuk pkfg;sa ¼fuxjkuh ] ftEesnkjh] ctV]
lg;ksx vkfn½
11- xzke lHkk LoLF; xzke rnFkZ lferh esa LokLF; ds izfr :fp ysus okys O;fDr;ksa dk fg p;u djuk
pkkfg;s] izfrekg cSBa d fd fuxjkuh foHkkxksa }kjk djuk gksxh A izf’k{k.k ds Lrj esa lq/kkj djuk gksxk A
12- Cykd o ftyk Lrj ij vk’kk izsjdks ds fy;s jsLV :i ¼foJke x`g ½ dh O;oLFkk djuk pkfg;s A
11-vk’kk izsjdks dk chek ljdkj }kjk fd;k tkuk pkfg;sA
12- xzke Lrj ij vkDlfed jkf’k fd O;oLFkk djuk pkfg;s ftlesa tuuh lqj{kk ds okgu ds uk vkus ij ml
jkf’k ls vU; izk;osV okgu fd O;oLFkk fd tk ldsA
65
13- vk’kk dk;Zdze o vk’kk ls lac/a khr lHkh iqLrdks esa vk’kk dks izekf.kr lkekftd LokLF; izsjd fy[kk
tk;s] izekf.kr lkekftd LokLF; dk;ZdrkZ ughaA
14- vk’kk iszjdks dks lapkjh & xSj lapkjh ¼ communicable - Non communicable Diseases ½jksxks ]
ekulhd LokLF; ij izf’k{k.k nsus dh cgqr vko’;drk gSAa
15-vk’kkvksa ls VkjxsV vk/kkfjr ¼ifjokj fu;kstu& ulcanh ½ dk;Z ugha djokuk pkfg;sA
¼ jk"Vªh; xzkeh.k LokLF; fe’ku & ,d fo’ys"k.k vkSj fd;kUo;u lrZdrk tu LokLF; vfHk;ku ewy &vaxzth 2005 fgUnh
laLdj.k ekpZ 2007 ladyu o ;ksxnku vHk; ’kqDyk & tks oxhZl esa i`"B dz- 10&11 esa ij /;ku ] RCH ifjokj fu;kstu
dk;Zdzeksa ds foijhr izHkko dh laHkkouk esa & ifjokj fu;kstu &vk’kk ds dk;Z ij gkoh gksus dh ckr dh x;h Fkh ½
10. References %&
1- LokLF; lsokvksa esa lq/kkj ds fy;ss lkeqnkf;d fuxjkuh &fdz;kUo;u ekxZnf’kZdk izdk’kd & e-izfoKku lHkk ,ao lkFkh lsgr ekpZ 2008 lEiknu &MWk- vt; [kjs
2 - jk"Vªh; xzkeh.k LokLF; fe’ku & ,d fo’ys"k.k vkSj fd;kUo;u lrZdrk tu LokLF; vfHk;ku ewy
&vaxzth 2005 fgUnh laLdj.k ekpZ 2007 ladyu o ;ksxnku vHk; ’kqDyk & tks oxhZl
1- 2 - LokLF; lsokvksa esa lq/kkj ds fy;ss lkeqnkf;d fuxjkuh &fdz;kUo;u ekxZnf’kZdk izdk’kd & e-izfoKku lHkk ,ao lkFkh lsgr ekpZ 2008 lEiknu &MWk- vt; [kjs
w 6 & n{krk,W tks thou j{kk dj ldsa
3- vk’kk ekM~;y
4 - www.communityactionmp.org
5 & jk"Vªh; xzkeh.k LokLF; fe’ku dk lkeqnk;hdj.k & xzke lHkk LoLFk xzke rnFkZ lferh & e/; izn’s k
okWyUVªh gsYFk ,lksfl,’ku o iSDl dk;Zdze
6 JOURNAL OF GLOBAL HEALTH CARE SYSTEMS/VOLUME3, NUMBER 2, 2013
¼CanASHA be the ray of hope for providing MCH services in Odisha, India? Exploring through a qualitative
study ½
7 Final Report Evaluation of ASHA Programme in Karnataka under the NATIONAL RURAL HEALTH
MISSION April 2012
66
VII. Overall conclusion esjk lkspkjk dk ;g ,d lky dk lQj esjs fy;s cgqr egRoiq.kZ gS] lkspkjk us eq>s vius ifjokj dk
fgLlk cuus dk ekSdk fn;k A SOCHARA dk lh-,p-,y-ih dk;Zdze ds vUrxZr 6 ekg cSx
a yksj esa
fofHkUu eqÌks ij vuqHkfo;ksa ds }kjk gekjs l= ¼sessions½ fy, ftUgsa cgqr xgjkbZ ls NksVh & NksVh ckrksa
ds fo"k; esa crk;k vkSj ;g LokLF; dks dSls izHkkfor djrk dk bldk lac/a k fn[kk;k] lkspkjk dk fl[kkus
dk okrkoj.k nksLrkuk gS]a ;gk cgqr fg vPNs rjhdks ¼Methods½ ls eqÌks dks crk;k x;k] SOCHARA
dk ;g dk;Zdze o budk fl[kkus ¼learning½ dk rjhdk vU; laLFkkvks ls vyx gSAa lkspkjk flQZ Hkou
] lkexzh ij dk;Z ugha dj jgk] ;g ekuo lalk/ku dks c<+kus ij dk;Z dj jgk gS]a bl Fellowship ds
ek/;e ls lkekftd dk;ZdrkZvksa fd {kerkvkssa dk fodkl dj jgk gS]a ftldk ykHk dk;Zdrkvksa ds ek/;e
ls leqnk; ds t:jr eUn yksxks dks gksxkA
6 ekg fQYM ds nkSjku esus tkuk fd flQZ ;kstuk,W cukus lss dke ugha pyrk ]mu
;kstukvksa dk fBd ls fdz;kUOk;u o eqYa ;kdu gksuk vko’;d gS]a t+ehuh Lrj ij vHkh Hkh yksxks fd igqWp
LOkkLF; lqfo/kkvksa ij ugha gSa ]vU/kfo’okl ds dkj.k vusd fcekjh;ksa tSls & ekufld jksx ]d`"B ] dks
iqjkus tUe dk iki ekuk tkrk gS]a bl fcekjh;ksa ij MkWDVj dks uk fn[kkdj tknq & Vksus esa fo’okl fd;k
tkrk gSAa
ljdkj fd bruh ;kstukvks o fofHkUu tkx:drk dk;Zdze ds ckn Hkh leqnk; esa tkudkjh
fd deh gS]a nqljh vkSj izk;osV ifCyd ikVujf’ki ¼PPP½ ds uke ij izk;osV vLirkyks ds }kjk bZykt ds
uke ij ’kks"s k.k fd;k tk jgk gSAa vk;qosZfnd vkSj ?kjs: mik;ksa dk mi;ksx cgqr de fd;k tk jgk gSAa
fons’kh nWokbZ;ks dk mi;ksx fnu ij fnu cM+rk tk jgk gSa A jklk;fud bu nWokbZ;ks ds T;knk mi;ksx ls
yksxks esa vusd fcekjh;k gks jgh gSAa vkt bl fLFkfr dk eq[; dkj.k yksxks fd thou ’kSyh o [kku&
iku esa cnyko gSAa
gesa leqnk; esa ldkjkRed :i ls t+ehuh Lrj ls dk;Z fd ’kq:okr djuk gksxh ] vk;q"k dks cM+ok nsdj]
fons’kh nWokbZ;ksa dk iz;ksx ls gksus okys uqdlku ls yksxks dks ifjfpr djokuk gksxk] leqnk; dks LOkkLF; ds
lkeqnk;hdj.k esa T;knk ls T;knk lgHkkfxrk ds fy;s izfjr djuk gksxkA
67
VIII. Reading lists 1- vk’kk lg;ksfxuh izf’k{k.k jk"Vªh; xzkeh.k LokLF; fe’ku jktLFkku]2009
2- vkWxuokM+h lg xzke vkjksX;k dsUnz] www.communityactionmp.org
3-LokLF; lsokvksa esa lq/kkj ds fy;ss lkeqnkf;d fuxjkuh &fdz;kUo;u ekxZnf’kZdk
izdk’kd & e-iz-
foKku lHkk ,ao lkFkh lsgr ekpZ 2008 lEiknu &MWk- vt; [kjs
4- jk"Vªh; xzkeh.k LokLF; fe’ku & ,d fo’ys"k.k vkSj fd;kUo;u lrZdrk tu LokLF; vfHk;ku
ewy
&vaxzth 2005 fgUnh laLdj.k ekpZ 2007 ladyu o ;ksxnku vHk; ’kqDyk & tks oxhZl
6 vk’kk ekM~;y
w 6 & n{krk,W tks thou j{kk dj ldsa
7-vk’kk ekM~;y
w 7&
8
jk"Vªh; xzkeh.k LokLF; fe’ku dk lkeqnk;hdj.k & xzke lHkk LoLFk xzke rnFkZ lferh & e/; izn’s k
okWyUVªh gsYFk ,lksfl,’ku o iSDl dk;Zdze
9-. www.communityactionmp.org
10. JOURNAL OF GLOBAL HEALTH CARE SYSTEMS/VOLUME3, NUMBER 2, 2013
¼CanASHA be the ray of hope for providing MCH services in Odisha, India? Exploring
through a qualitative study ½
11. Final Report Evaluation of ASHA Programme in Karnataka under the NATIONAL RURAL
HEALTH MISSION April 2012
12. National Health programmes of india,Fourth Edition- J. Kishore Community process Guidelines
2013
13.National population policy -Hindi
14. A study of interface of ASHA with the community and the service provider in Eastern 2008-9
Department of community Medicine (SPM) BRD medical college, Gorakhpur Uttar Pradesh
15. A study on ASHA -a change agent of the society Indian Journal of Community
Health, Vol. 24, No. 1, Jan. 2012 - March 2012
68
IX.
Photos -
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