Shekhar Saha 2005-FR 27.pdf
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CPHE
15
A Report
On
Community Health Fellowship Learning Visit
At
J
West Bengal Voluntary Health Association
Conducted By
Community Health Cell
Bangalore
Supported By
Sir Ratan Tata Trust
Duration: -1st JuneOS to 13th AugustOS
Presented By: - Shekhar Saha
Guided By: - Mr. D. Poddar
Executive Director of WBVHA
And
Respective Project Director of WBVHA
1
Final Report on fellowship
Introduction:This is continuation of the first phage fellowship programme on community health. After evaluation of
first phage as per my both mentor’ (local level & overall) recommendation & official recognition CHC
has decided to give me opportunity to continue my fellowship for next 6th month. I was very happy to get
this and was trying to utilize this opportunity as my level best. Right now I am going to finish this
valuable moment through this report, it is the last lap. It will be finished on 20th April’Ob. Here I am trying
to make my last & final report regarding my fellowship doing & learning activities. I think programme
scheduled will be helping others to understand when, where & how I had able to act as a community
health fellow during the last phage. So here mention first my programme scheduled then explain it in
details.
Programme schedule for 2nd & last phage of Community health fellowship as follows
Period
Place
01-10-05 tol5-10-05
To Share about To participate as a
Assam experience learner
cum
and questing and facilitator of he
suggesting regarding orientation
the subject which are programme for 3rd
discussed
during batch CHF scheme.
orientation?_______
Dr. Sunil kaul
To take
a) survey on
MMR& IMR
Managing Trustee
responsibility as
Bongaigaon,
b)
health worker
an associate cum
Assam
training
facilitator
c) follow-up the
health programme
CHC, Bangalore
Dr. Thelma Narayan a participator
To share the
Karnataka
Coordinator
cum learner
previous
CHC
experience in
northeast
SDRC, Vellore
Mr.S.J. Chander
As a participator To learn about
Chennai
CHC___________
the new things
cPDOO
Dr. Sunil kaul
a) health worker
To take
training
Managing Trustee
responsibility as
Bongaigaon,
b) follow-up the
an associate cum
Assam
health programme
______________ facilitator________
Leave due to take the responsibility as a father of new born child
Dr. Sunil kaul
a) Office and library
To take
management
Managing
Trustee
responsibility
as
Bongaigaon,
b) follow-up the
an associate cum
Assam
health programme p
facilitator
16-10-05 to 20-01-06
21-01-06 to 25-01-06
26-01-01 to 31-01-06
01-02-06 to 02-03-06
03-03-06 to 31-03-06
1-04-06 to 20-04-06
CHC, Bangalore
Karnataka
Under
the
supervision of
Dr. Thelma Narayan
Coordinator
CHC
Important role
<
Activity in short
4
Contents
Subject
Page No
1) Preface
1
2) Acknowledgment
,2
3) Abbreviation
,3
4) A letter to Executive Director of WBVHA
4
5) A Report on Urban Health project & “WIN”
a) Few Words about Urban Slum
b) ‘WIN’at a glance
c) Women Empowerment and Pre & Postnatal Care
d) Strategy for Case Management
e) Few Findings
f) Conclusion
6) Basic Health Care Project in Sunderban
a) Introduction & Area profile
b) Few words about partner NGO’s
c) At a glance Basic Health Care
d) Key Learnings
5-10
11-16
7) Adolescent and HIV/AIDS Programme at Darjeeling District...17-19
a) Introduction & Area profile
b) Few words about Adolescent
c) Few words about HIV/AIDS
d) Key Learnings
8) RCH programme at Jalpaiguiri District
.
a) Introduction & Area profile
b) Few words about FNGO’s
c) Few words about RCH & Key Learnings
20-23
2
Report in short on 3rd batch orientation:
After finished my first phage of fellowship I came to CHC, Bangalore to participate as learner cum
facilitator of the 3rd batch (new batch) fellowship orientation programme where from I have been started
2nd & last pha^e journey as a community health fellow through this scheme. As per training scheduled it
was start from the day of 15th September’05 but according to my 2nd phagfe programme I was attending the
orientation programme from day of 3rd October’05 and came to an end on 15th October;05. Through the
programme Community Health Cell had offered this opportunity to share various ideas & experiences
regarding health & health alignment issues towards policies & implementation for all. It was very useful
to fellows to learn about lot of aspect of health. According to programme scheduled of Last 15th days of
this orientation has focused on presentation by fellows and also discussed of health for all.
This is the platform where fellows were getting the freedom to learn new things and sharing with others to
get new ideas and facilitate it through implementation. To days burning issues of health is that need an
environment where everybody will have to get their fundamental right to health care. So it is no doubt that
this community health fellowship programme has been trying to sensitize fellows to learn more and more
about real meaning of health for all. We enjoy the programme though group Discussion and presentation.
We could learn lot of knowledge and idea’s of that very subject. It was motivated us to take the
responsibility to create an environment for healthy society. All fellows were presenting their experience
what ever they had got information regarding community health & broader determinant of health. As a old
fellows I was presenting the my last 1 month understanding of the health situation in Assam & how the
NGO named
has been trying to over come the situation and make to establish the right of health
care in the newly formed district called Chirang.
Report on Study placement: - As discussed with my mentor, I had decided to go Bongaigaon (Assam)
and to continue my study placement under the super vision of Dr. Sunil Kaul, the managing trustee of
NGO called
Here I am trying to look back and share my learning cum doing episode.
At a glance Chirang districtis is the part of BODO land movement, It is the newly formed district. After the formation of Bodo-land territorial council as a district Chirang
has been carved out of Kokrajhar & Bongaigaon. There are two subdivisions in the Chirang. They are at
Kajalgaon & Borobazer. It is bounded by Bhutan on North, by Kokrajhar district on the West, by
Bongaigaon district on the South by Baksha district on the East. There is dense forest in the foothills of
the Royal Bhutan. Total population of the Chirang is 3, 43,626 (Approximate). The Manas national wild
life park is the centre for tourist attraction of the district. It was declared as national park in 1990, located
at the foothills of the Bhutan with unique Bio-diversity. The economic development is dependent on
agriculture and allied activities and also weaving. Near about 90% of the population is engaged in
agriculture. The area consists of a multi ethnic culture including the Adivasis, the Koch-Raj-Banshis and
the Bengali Muslims in addition to the predominant Bodos. ON February 20, 1993, a memorandum of
settlement was signed between the representatives of the All Bodo Students' Union and the Bodo People's
Action Committee (ABSU-BPAC), which had led a sustained and often violent agitation for the creation
of a separate state of 'Bodoland' comprising nearly one-third of Assam. The accord, however, was on the
creation of an 'administrative authority within the State of Assam', called the Bodoland Autonomous
Council (BAC) and not of 'Bodoland'. It is to provide maximum autonomy within the framework of the
Constitution to the Bodos for social, economic, educational, ethnic and cultural advancement.
The Bodos have rich traditional of festivals. They have contributed a lot in the field of festivals and
ceremonies. The festivals & ceremonies of the Bodos can be classified in to religious and seasonal. Both
are closely connected with agriculture. Garja, Kherai & Marai are associated with the Bathow worship.
The dances are essentials and inevitable part of kherai festivals. The dance represents the activities and
behavior of gods and goddess. The kherai dance strictly restricted to the women folk. Men are allowed to
play various musical instruments, yet they have to maintain the honorable distance within precinct.
Baisagu and Domashi are seasonal.
3
If we look back to the recent past history of the Bodos it is always found that the Bodos never
compromised their identity and never allowed the others to denigrate their dignity. They always tried to
protect and preserve their rich culture, language, literature and colorful tradition keeping peace with the
developing of human civilization It was on the February 15, 1967 is scared day in the history of Bodo
community, the all Bodo student union, shortly known as ABSU was founded uniting all the students
community of Bodo people living in India and abroad. The emergence of ABSU is the beginning of the
emergence of political consciousness among the Bodos as well as the tribal of Assam. The first political
parties also came into being in 1967 only under the initiative of the ABSU. It has big role in the
awakening of lingmstic and socio-culture movement of plains tribal people of Assam. Irony of the fact
ABSU is a known as non political student body. During the period of 1972 to 1980 the ABSU led the land
tribal bX
t0 get back the land form illegal immigrants who occupied the tribal land in the
. bal belts. The union closely associated with every activity of Bodo Sahitya Sabha (BSS) It took an
active part in the language movement. In 1986 ABSU led a direct political movement demanding a
iSTBodo f°r ?d°tS| Wh'Ch IS P°PularIy known as Bodoland movement. After a strong movement8in
Councn?RTAn°P
8et-
administrative power called Bodoland Territorial Autonomous
The Boro people are one of the indigenous ethno-Iinguistic groups of present North Eastern India
belonging to Indo-Mongoloid origin of Tibeto-Burman language family. Though spread in different parts
this region as well as, in the neighbouring countries, majority of their population is found in Assam
The Boro p he Boro society is a patriarchal one, father being the fountainhead, sole authority and the
mplete owner of the family property. However, the mother and the other female members of the family
are not neglected. In fact, the patriarchal Boro Society is intrinsically inter-woven with matriarchal traits
. In the household concern, the mother has no complete control that the father or the husband has
Sometimes this lineage may further be testified by at least two types of marriages, in which, the man
comes to live with the woman in her establishment is called ‘Gwrjia’ in Boro language. In other words
1S egalltanan in character so far as sharing of properties; access to education and other
developmental opportunities; are concerned. People form the largest indigenous group in the present
demography of the region.
Source: - website document.
Littlie bit about
ggaa
As a pioneer NGO “ANT” (Action for North-East Trust) has been working for last five years to improve
e ifestyle of rural people through the women empowerment. Set up by a group of professional
committed to rural development, the ANT focuses its work to the poorest and disadvantaged sections of
northeast region of India. It is situated at Bongaigaon District of Assam and working at the rural areas of
Chirang district. “Self-help group” for women and strong commitment of ANT’s associates have made a
3troag hope to reach the mission and also they had made plan to start another mission is being to solve
rural health problem under the leadership of self-help groups. It is also running a successful weaving
jogramme which has been sustained as a separate organization of the weavers called Aagor Dagra Afad
. eople rights programme takes another responsibility to meet the people requirement trough awareness
- mpaignmg and grass root level bare foot pharmacist system is treated as direct intervention for health
are programme. Use the low-cost technology and get the better result” is one of the methodologies of
he organ’zatmn. Explore the Eri plantation and Entrepreneurship Development Programme is another
najor activity of said organization
immunity Health programme through Bare foot Pharmacist.-This is the direct community health
programme for rural areas of newly formed Chirang district run by
As discussed with my
nentor as a community health fellow I had taken the responsibility for health programme as an associate
d organization for last phage of fellowship. From the month of September ’2005 to last day of
sllowship I was involved in the said programme. Most of villages of the same district have not found any
Ses'tr
Tproblem.
T' “Tf
pe<,pleto Ofgo,halin's town
villa8esforaretreatment
deP“<i“tdue
»” to poor
akes for T;
their5"™?
medical
TheyVOiCeleSS
are unable
4
medical care m their village. Near about 40 villages has been getting basic medical service as essential or
ratmna^ medicine to cure from common diseases through the said programme. All medicines are produced
by a NGO called locost pharmaceuticals based in Baroda, Gujarat. It is not free of cost programme
because said organization is believe that it is very difficult to sustain any programme for long time with
in limited resource with out the community contribution. Good quality at low-cost medicine helps the
““
W,
thCy Were eXpl°ited by 10Cal racist and untrained rural medical
practitioners (locally called quacks)
During the monthly (September’05) updating cum sharing meeting I had interact with health worker’s
those were trained few years back by the leading of Dr. Sunil Kaul. Then I made a action plan to work on
community health m this area with the help of well trained village pharmacist. Among them two Bodo
women named Puspa & Mitinga had agreed to help me as health team supervisor. Then I took a bicycle &
went around the remote area where Soo
has been working for last 4years. I was able to reach 30
villages. Though this mission I did my learning trips with the methodology as individual interaction &
shZso'anTde"'
Pe°Ple especially male Person had found to gossip in tea
stvT ThiTw^ th 1 m my. mind tha* 11 Was best way t0 talk with village people about their life & life
hXlth?
t
6 Pe°P WCre Sharing about their social economic condition including
area With helnof
"
V S’deiI,made lnStant Questionnaire to find out the real heath situation in said
ZutS?Sth? t'C°“lty health W0*er’s 1 also did foeus group discussion with women to know
oeoo e a o heS Tl ’
h"8 ““ & Child health SyStem
individual interaction wdb village
people also helps me to learn about community health.
Health worker’s meet in every month is basically an initiative to recall knowledge & practice whatever
Si 7
7 bar7f°Ot PharmaCiSt training Pr°gramme- 1 t00k sharing isio/ with them as a
bv daTto^STk
able t0 °Ver CUm the language problem and improved myself day
lan8“a8e W"h helP Of
" iS 'h'
“ I-" —■
a'' °f-TrSe 1
As a resource person cum facilitator I conducted the health workers meet on recall the heath information
tearnW
particiPatory methods- That was the opportunity me to share my
learning experience with them and also got the knowledge about their ideas on community based
foTeirTlucatio " 7 ^al’Ze health practices of bodo tribes and migrate Bengali Muslims. According
alsSheirSo
t mOt / h7 n°n matnculation but their knowledge level are in satisfactory level and
o their commitment towards society is appreciable rather than local ANM or ICDS workers Presently
hey are handling the barefoot pharmacist system without help of others and they made plan to eTpaM
nouZ Pr°gramme oth- -uiote areas of Chirang district. But it is truth that this programmes not
7uld be mk
“mprehens,ve healtb ^vices. I think as organizational commitment point of view it
n ole n 7 a 71° Stm 3 COmprehensive health care programme first then expand the programme
iistrici
d SldC
S'de SenSltlZC the 80Vt SeCt°r t0 impr°Ve the health Care system in Chirang
■acFalANM s actlvlt|es m the rural the said area’s According to supreme court orders in 2001 is that
-ach and every hamlet should have a ICDS center and each & every children under 6 including pregnant
CDS cent"8 m°fther are gettlng the supplementary nutrition form the ICDS center. But here not a single
DS centre is found to distribute supplementary nutrition among the children and pregnant women or
dlewth1 b6'5' 118
6 °f P°Or g0Vernance and ramPant corruption. And Angwadi worker’s point
f view they were never receives any food items for regular nutrition management programme So they
re doing then-job as only the teacher of pre-school educational. After several discussions with few ICDS
vorkers and the ANT associates I had made a plan to take initiative to linkup with them to improve the
■tuation. But unfortunately it was not happened in reality due to misunderstanding of people rights
rogramme which was run by Soo ^33. After that we were trying to sensitize them that purpose of the
teatre show on neoole riaht had-not to blame to Anewadi workers but blamina the ooor aovernance of
5
said department. So we need your help to improve the situation of ICDS system Chirang district. At lastly
they are not agreed to extend their hands towards improvement of health system. My perception is it is not
because they are in under institutional pressure; it is the question of lack of motivation.
Ideologically Auxiliary Nurse Midwife (ANM), Sub center. Primary Health Centre (PHC), block Primary
Health Centre (BPHC) or Rural Hospital is .the backbone of rural health care system. If you would like to
see the just opposite scenario for rural health care system, I think it is the right place where dose not has
any single health care system (govt.) is found to run properly. Most of areas do not have sub-centre ANM
has not found to work in village, PHC & BPHC is found to run by night guard (Choukider), these are real
“ion of said district So it. is the opportunity for local pharmacist or untrained rural medical
practitioners (locally called Quacks) to exploit the poor people through the mal practice. In other hand
vi lage people do not have any option to avoid the quakes. That means quacks are the backbone of said
Si,?,)
S’
7s""’' A”lher Pa'h"'C faC' ' h'ard fr"’ ,lM voi“ of few '“““"S "'"•I'e'S of
different village. All are very poor in terms of economical condition. They all are delivered child in home
just few months ago and the home delivery had conducted by the night guard of nearest PHC and the
guard had taken Rupees 3 thousand to 4 thousand from each family for said service. Antenatal care
postnatal care or chdd immunization programme is never found to see in here. So inactive ANM or non
functional PHC or BPHC made them unhappy to see maternal mortality or child mortality in regular basis
So here intervention by Oao
through the village pharmacist programme is very appropriate and
helpful for the rural people. But this intervention not enough to decrease the MMR or IMR and made
them happy to see the good health care system.
Transportation and existing health pharmacies: - There are the places under the district of Chirang. Assam
where! did my fellowship through the organization called. Last 6Ih month I was unable to see any active
govt, health care system in these areas for the basic health care services because not a singe sub centre
including PHC and BPHC has been working in proper way. Most of them are non-functioning and there is
only one civil hospital has been working like some thing is better than nothing. It is 40 to 50 km far from
the remote villages of the said district and side by they do not have any motor transportation to reach
qu>ckly and take the chance to save their life from serious illness. So they have only one option to use
Thela ambulance with the hope of survives. This is another cause of disgrace death. I think nothing needs
?l 10W t 6 VI a£C P^armac^sts work- Given bellows two photographs are showing the real picture
ot health care system.
H
6
Wrove the hfe style through the health care & livelihood support heath care system. As community
focls ? ouZ d
3 SUrVey T M2R/,IMR ,n 20 Vi'lageS Of said district- 1
used the methodology as
worker? The ST?"
u 1"teraCtlOn with the helP of barefoot pharmacist cum health
workers. 1 he statistical report has given below-
Vital Statistics on MMR & IMR
Area:-Chirang District
Period:- Dec’04 to Dec05
c
©
73
S
^5
©
©
G
.©
©
(Z?
*5-1
□
Name of Village
iZ)
W)
©
©
Oh
©
©
Z
1
J.
_3_
4
_5_
6
7
8
9
10
11
12
13
14
15
16
17
Bhabanipur
Amaguri(choto)
Udalguri,Laidopara
Thangabari
Dwimuguri
Khanthalguri
Palangshiguri
Gaibari__________
Simla bari_______
Dogor para_______
Uttar Rowmari
Khagra bari_______
Lowzuri para_____
Dolha para_______
Habru bari________
Dima pur_________
Palasguri_________
Khatri bari
M
65
70
66
34
100
110
70
110
40
40
42
45
40
23
48
42
33
550
600
400
300
600
700
450
700
250
300
300
300
300
150
300
AQ0_
250
r:o
g
c
c
OS
"S
©
x:
+-
No of child Birth
a-
jy
©
©
O
©
Z
F
5
4
1
2
4
~5
3
0
6
5
6
5
3
2
1
3
3
2
1
1
•4_
5
2
i
4
I
I
2
4
0
1
0
1
1
0
0
0
1
T
~3
4
3
5
7
1
3
3
5
4
2
5
_5
8
3
8
1
3
3
2
0
0
3
3
0
3_
2
Q
cs
</}
0
1
4
0
0
_2
2
1
0
1
0
0
0
0
0
0
0
2
2
2
2
o
i^
F T
o
0
2
2
3
0
1
1
_0_
1
1
2
__5
__6
__5
__0
_2_
__4_
_1_
_1_
_1_
;_o_
2
7
J8
Bandwguri
Sona
pur
Ji.
20
Kairabari
At a glance
41__
32
85
1136
300
250
650
7950
4
4
7
73
4
1
12
69
MMR1 :-SaharaBegam w/o Roujan, village of khairabari
MMR2:-Rosonara begam w/o Harun, village of Simla bari
JMMR3 :-Lomoti Bramha w/o Bien Kr. Bramha, village of Dwimuguri
MMR4:- Janela Goyari, w/o Amritlal Gayari, village of Dwimuguri
MMR5:-Mishri Basumatari, village of Khanthalguri
MMR6:- Chaya w/o Sobaram Basumatari, village of Khanthalguri
2
1
10
68
0
1
2
18
_0
£
±
7
0
1
0
20
0
2
3_
45
MMR:-4000
IMR:-130
|
I
It is truth that 20 villages survey report not enough to establish the maternal
.
------- mortality rate as per
definition of MMR but there is no hesitation
I
to say that above mentioning MMR or IMR is the result of
one the most poorest health functioning system in Assam and it is the indicator that our health care system
is too tar from the concept of comprehensive health care. After submission my survey report, Sao
as
organization had decided to take an action on it through peacefill campaigning on the celebration of
international women day, 8 march 2006. Signature campaigning & national high way blocked were
ing as peaceful methodology. Near about 300 hundred women came from villages & stepping together
towards m front with placard on the disgrace death. Question is how long we will wait to get the right to
health care for all. I think need a strong movement all over India and must be linkup with other’s right
ITVT ' H°Pe.'r5 camPai8ning W111 helP to others to take initiative in North east. I was very happy to
hH tow! TP,0"8 ' 'ty t0 thare my contr>bution for this campaigning as a community health fellow. Given
bellows photographs are the representative of said movement.
3atdj AaQj Y'i0
"a^a1 Pa\ eAjfrfAj =a[Aia,??
A
FU "a[Oia &AjiKaij eda-a1
&Ou "^aU1 S0[tjna/ Aj1a1 ju
They demand that:
1. As per Government of India rules there be two health workers
every 3000 population; all
vacancies to be filled up
8
2. ANM should visit every house every two weeks to check up and give care to pregnant women
3.
"u,ri,ious "”a'daiiy ,o every preg"a"1 Md
4. Free evacuation facilities be available during emergencies and that the
government makes such
facilities available free of cost as per RCH guidelines
Report on MSS:During the days of 17,h December to 19th December’06, I had gone to Kumarikata, under the District of
Baksa, Assam to parUmpate the Women Peace Corps (Mahala Shanti Sena) organized by TAGS
96?U P|Ur An?ha ? Grramda,n Sangh)'11 ,s the one of the oldest NGO in al over Assam It was initiated in
1962 and registered as Gramdan Sangh in 1966. It aims at changing the existing economic sZem to bri^
about a casteless & classes free society free from exploitation. From the beginning TAGS Khad!
programme is taken up as the important basis for economic empowerment of the rural poor Ph^ot
beds for livelihood through Khadi. Soil & water conservation; Irrigation; bio gas plant low Lt latrine
smokeless chulahs; drinkmg water well’ cooperative granaries in village’ health service for wlmen &
providing supplementary nutrition for children are the other activities taken up. It has always taken up a
I cmild le 6 m CaSeS.°f calamltles by Providing much needed relief service. Through the MSS programme
ould learn useful idea to motivate the women groups towards any movement. It is based on clndhian
ology. They are saying that world today is hungry for peace. The Women Peace Corps will be a carrier
niakTIL
’IL redlUm °f rCVealing the P°wer of peace. The very fast task of the MSS will be to
noLvinfo 8 PeacefuL 11 ‘s a moral force. It will always be free because it is related to the spirit of
of TAGS"bofoZe1!'"dRammUrtl °f Sramabharati Khadigram & Mr. Ravindra Nath Upadhyay
groups
8
1111851011 Wlth
h°pe °f ChanSing the society under *e leading womel
Today, throughout the entire world, there are many national, sub-regional and regional women's groups
that are actively advocating peace and creating alternative communication networks that are opening neL
spaces for non-v.olent resolut.on of conflict and new forms of solidarity both between wome Land men k
X'ther ™nZ10
— d*^ “d
™nheahhyLSrld
from thLe lb
L
meqULy’ rampant P°Verty unemployment malnutrition etc. who suffering most
a l lS1 possLZIL WOhen' YeLWe
3 peaC£ ful1 WOrld where there is love-respect -dignity fo
foL L
h
yeS’ T 1S
LOt °f aCti°n had been done and lot °f aetion has been going on and
Mnk Basic Lea of MSS is i
b^11^ Sti1' n°W theS6 are inCreasing evervwhere. I
think Basic idea of MSS is to start social movement to change the society under the leading women
.roups and it is one of the ways to reduce the gap between violence and non-violence and it is th! another
lurinTthLf ll0111^ t0 1
lmtlatlVe 10 eS‘ablish their rightS’ When 1 was Pfesenting the concept of MSS
tang the fellowship meet, most of them sharing dteir ideas about this movement in negative beeause
hey tae ahead J'm
™l“
"f" Pla!form f°r ««<” 10 take
<»*• »"<1 P^ently
ney have aheady m under pressure of over burden. No doubt it was the good criticism of said
logramme. But I think if we are able canalizing this programme in right way may be it will be help the
vonien to reduce their burden and enjoy their rights.
*
. This was the OppOrtunity for yd batch of al| fe|lows to
ring each other whatever they could learn about various aspect of health programme It was three
ys programme (23-01 A)6 to25-01-06) and conducted by CHC under the guidaLe Dr lavi Na™ &
• helma Narayan.
Morning session of first day we were utilize as group discussion on fellowship
™ dJm
‘"™"E P0“s
2 “s“n was
pr“el'“i»"
StaZd I™S5
resent fd
p]es'"l!“,.lon “ Posl T™nami inlervenuon in tsunami affected areas. And through this
^entatmn we were getting the lot of information regarding the real situation of those areas whele low
its people were not able to get proper facilities. They are exploiting by the system till now This
Kpenence alert us how the casttsystem. is affecting the development for all Then Arun did his
resentation on how the daht people are exploited by the so called upper caste 2nd day Dr. Thelma
9
was cxplajn to
;!;7; "i"»urprese„,a7„S™al r“™' "aaire m, •
mission including ASH A
d R i0'1 xeSSi()n w,len I came to
exPerience
1-. -'""°nhe
asrlt>v''/',,f'»l“. lhe,'land
• Ravi Narayan. All India f)ru?"°W ,n ^tail
,
* Au,on Network by a
✓
* 1111 u'
o
77*.
"re la«<i 7. , "
fa« »f l>Se»
rr ■ saJe tf>e land
m t K
f fact of basic health
gIVen
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theHvelihood
Care for a11
■ Infectio-n>
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No food
^omon^y
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belter
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for
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malnutrition
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)islXe
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-iean lahnr »
^ucie(.no
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a
enough
money.
vmce during thee'
k No treatment
2 basm health cared'scussion
fo7a77 that no
no ^.bt thi.
Death.
f a11’ unt11 unless need -jis topic ir
“ retired ta ,1 is
to
a strong action
pro
"
U» M of energy
oJ ■
i
hs ^uTr
rnot,oniy in
^ZicT1 mci
=SP=‘'=B=S7SSS
as able to perform
v
°ice
of local r...y
r
a""ae„511feelhemioM
•’eaceful action to enicw th ' OpPOrtunity m
u enJ°y their right.
I
10
Lhg ant at a glance through SWOT as a analytical point of view.
d Sy°y ana ysls ’S an instrumental framework in Value Based Management and Strategy formulation to
dentify the Strengths Weaknesses, Opportunities and Threats for a particular organizffion The SWOT
hagram is a very good tool for analyzing the (internal) strengths and weaknesses of a corporal on and SI
external) opportunities and threats. It analysis helps us identify ways to mininS^ Xt of
veaknesses in otnbusiness while maximizing our strengths. Traditionally, a SWOT confines strengths
xterSLXviXlm H0"830!123110!"’5 intemal W°rkingS While °PPortunities and treats refer only to the
xterna environment. Here, I am trying to get a better look at the big picture, consider both internal and
’he^NTX5 'yhen ancoverlng opportunities and threats of the pioneer voluntary organization called
he ANT where I had done my community health fellowship study placement.
Strengths:0 spr^ Of Volunteerism:-All associates of this organization have educational capacity to earn more
ney rom others secure job for self-development but their high level volunteerism sprit is help them to
itm low”'
P°Or Within th£ limited reS°UrCe- They
haPPy t0
the simPle hfe
) Motivatiom-They have strong commitment on su.stainable
‘ ' ’ ' development
‘
for poorest to the poor people.
□ their motivation towards work and responsibility help them to carry the mission in right way? ‘ ‘
) Mpmpfwork: - This is the platform where each and every worker has a right to establish his or her
eas of development for poor and also start new project.
) Selection procedure: - There is the way to get right person for right work. Not only staff & community
lecfionrSAe d
“ejary’s. setection system is very good for sustainable work. Interims of staff
remot vi^l
f
ground ls not enough to work with them and also need positive attitude to work
Xer Fo the 7 f°Or r’P
t0 makC healthy relationshiP Wlth ^hers staffs as like family
mmnnitv anJ f th
°f COmmumty volnnteers and beneficiaries, it should by the community, of the
mmumty and tor the community.
J
Low cost structure:-As per my understanding if we would like to sustain the programme within limited
■ources in community level it should be at low cost otherwise it is very difficult to sustain the
’Sechme|SUCCeSSfully' S° said organization always has been trying to utilize good quality at the low
vCvIlllOlO cl y .
Need based approach:-Most of organizations are depended
depended c:
on project but this is the organization
/ays trying to understand community and. then start a programme; on what the community needs.
V^Lof.community assessment: - Before start any programme they should have done enough study
h the community and to make with them a good relationship to asses the community need.
Re^dy to accept the challenge: According to organizational point of view there is nothing impossible to
/e the any problem which is relate with development for poor, because their understanding is problem
ins challenge and they are always ready to accept the challenge.
t
c
a
n
tr
ac
di
to
sh
be
Di
No
In
No
san
(caf
Infe
So
cone
Tom
tlirou
oppo:
seen a
and tl
syster
their i
in dec
ensure
organi
commi
have a
Assam,
inform
11
I) Transparency. There is place where I found 100% transparency regarding any matter especially in
monitory disbursement. I think it is the very strong column for any institution.
J) Partmjpatory approach: - This is the very important methods for any organization to create healthy
atmosphere in work place and it is very helpful to worker of the organization to do their level and enjoy
their work with more satisfaction. Here I have seen the real participatory approach
K)Slow but steady: - They are believed in character or life style of ant, so they do not have any plan to
become elephant like so called big organization but they would like to reach poorest to the poor of said
district with in their limited resource. I think it will be help the any organization to sustain their
programme for long time.
L) Publication cum library:-They have lot of books or training materials and news letter etc. regarding
health issues or other developmental issues. This is the opportunity of the workers to learn more about,
various issues which is help them to can-■y their journey smoothly and it also helpful for others those are
wanted to learn about the said subject.
Weakness:
a) Staff strength not sufficient: - Presently Qe©
has been running various developmental
works through the cluster wise within limited staffs. As per my realization most of workers are
under pressure of overload work.'Fortunately Strong motivation is help them to accept the situation. But I
think if it is possible to increase staffs for same programme, may be it will be helps the existing staffs So
it has to need more paid workers to carry the mission smoothly.
bl Lack of full time coordinator: - It is the very important for any organization to link up with one
programme to another programme and it is very useful to make an environment where every beneficiaries
or workers has able to get the near about same satisfaction. That is why need a fulltime and efficient
coordinator who is able to take responsibility to make healthy bridge between one programmes to another.
£1. ack of 2 line leadership: - This is one of the most valuable issues to sustain the organization for long,
t is truth that five years not enough to meet this requirement and it is long time process but I think here
need to start this process. Though I don’t how it is possible.
,d)
work11^ system not in satisfactory level: - If you would like to see the
the comprehensive
comprehensive
evelopment in your area, it should have needed a good and strong networking system whether it is with
government or NGO sectors. Because it is very difficult for one NGO’s to meet the all kind requirement. I
now that here it is not easy to make healthy relationship with govt, sector or and others NCOS, cpoa©
has been trying to their level best but it is not reached in satisfactory level.
e2 r-Qt has ei10Ugh moneV to start a comprehensive health care programme: - we know that money is one
o the important factors to do some thing better than where you are. Same problem is happened here. They
lave an urge to start a comprehensive health care programme but not in vain due to lack of long term
funding.
&
?). Pogr record keeping & financial management system: - These are other important criteria to go ahead
owar s sustainable and quick service. It is no doubt to say that they are doing well their best but I think it
s not enough to go in satisfactory level.
h)
Librarv and office management system: - Sa©
has lot of book to use as library but they do
^sa2Jt!ry lew]380111611'
maintain pr°perly *n regular basis' And also office management is
i) No_separate training wing: Training is a process or methodology to improve skill for those who are
avo ved in community work at any level. Bur they do not have any separate training wing to work on it
ONojnotpr vehicle to save the time to reach in village.-Motor vehicle is not the symbol of aristocracy
nd most of the time it is helpful for all to do the more work in short time. But here I could not understand
teir philosophy about motor bike for the staffs. They thought there is no need to use motor vehicle
12
because it will be felt guilty to work with poor. But I think no need to worry about it because more
intervention in same time made them happy to give more time for people.
Opportunities:a) Scope to expand the area of work or reach to more people
b) Other NGQs realize gradually to come forward towards need of strong network:c) Rjght based approach will be help to create a platform to sensitized the village people to wards govt,
roles and responsibility for poor:d) Most of SHG called Jagruti groups are ready to start self business
e) .Lpcal youth groups (ABSU-A11 Bodo Student Union) are ready to cooperate.
nNgtyyork with newly formed autonomous body called BTC (Boro territorial council)
g)Insurgency is over and day by day improves the situation:-
a) Poor governance
b) Poor road construction
c) Collapse the govt, health system in remote area
d) Poor socio-economic condition of Migrate Muslim community
e) Flood or erosion
f) Village fund system
g) Mal functioning of ICDS
h) Mal practice of RMP
i) Mal practice of PHC’s guard
k) Corruption in govt, sector
l) Male dominated village development committee:-.
Over all comments on the matter of study placement:
As discussed with my mentor dr. Thelma Narayan, last lap of my fellowship I was in Assam under the
supervision of dr. Sunil Kaul the managing trustee of a voluntary organization called Soo
and
during my study place I was working with Soo g§SS as an associate. It was the great opportunity me to
carry my placement study in said NGO..No doubt to say that it is useful platform to learn about
community participation not only in community health but also in life hood programme which is very I
close to broader determinants of health. Here I specially learn the reality of commitments towards the
programme to improve the quality life of poor and also learn how poor governance and mal development
policy for few has been affecting- the whole system all over Assam. As a young organization it has been
trying to their level best to improve the life style and reduce their medical expenditure for common &
easily curable diseases. But my point of view in the matter of community health programme as an
organization their achievement is not in satisfactory level. Though we know that five years are not enough
to reach in satisfactory level under the authenticity of unhealthy situation in Assam and due to this as a
community health fellow I was really unable to learn in through the practical intervention on
comprehensive health care programme, like Jemkhed or Search. It is my perception that in future may be
5 to 10 years after as an organization
will have to become a platform by which people of
Chirang district will get the facilities of comprehensive care service.
f- A
13
Over all comments in relation to Community health fellowship scheme: There is no doubt that concept of semi structure fellowship programme is far better than formal structure
and it will be helping fellows to take the responsibility to spread the practical situation in community
health all over India as well as abroad and also motivate them to take an initiative to linkup the
community health programme with the broader determinants of health through the right based approach. It
is the great opportunity of those people who would like to see picture of healthy society where there is
people will have to enjoy their fundamental as right to live, right to health right to food & so on with
dignity. All right, But my point of view there are lot of scope to reach more and more well wishers of
community health programme through this scheme, that means I think to need little modification of the
said fellowship programme as followsa) It should be minimum one year and maximum three years.
b) It should be spread out through the news paper or any popular publication in regular basis.
c) It should be generate within the 30 to 50 students at a time.
d) It should be certify as academic value.
e) It should be linkup with academic cum professional institutes those are very close to
Community health Work
f) It should be have specific course content and to give more attention on each topic.
h) It should behave long orientation training programme, minimum two months and midterm
for one month and end term for two months.
i) It should have a mechanism to involve the number of the expert regarding subject of said
courses.
I) It should have a system to introduce the all field level mentors during the orientation
Programme.
k) It should be take initiative to involve the govt, sector to sensitize them about the purpose of
this mission.
^Acknowledgement:There is an endless list of those to whom I am greatly indebted; with out whom I could not have learned
so much more during my fellowship in community health. I express my sincere gratitude again to Dr.
Thelma Narayan, Ravi Narayan and Dr. Francis who have given me a opportunity to study in community
and also sincere thanks to Ratan Tata trust for kind fellowship. I express my sincere thanks to all
community health fellows for the sharing their experience and extending their cooperation as friend. And
also I would like to express my gratitude to all staffs of CHC
owe an especial debt of gratitude to Dr. Sunil Kaul the managing trustee of Seso
for his kind
acceptance by which I got opportunity to do my fellowship placement study in Assam. His valuable
guidance helped me to make a good plan to utilize this opportunity. I am also indebted to all staffs of S)ao
for sharing with me their years of experience in their respective field. I am also indebted to weaving
earn of Udanshree Dera for their valuable cooperation. While muchfif my time was spent in discussion
vit local people including barefoot pharmacists and SHG members who gave their valuable time and
jescribed me the challenges they faced and provided their interpretations of what was going on in their
'i lage. I express my thanks to all of them. At last but not least I would like to convey my gratitude to my
amily for their support to carry my learning episode on community health. At lastly sincere thanks to the
members of ant to accept me as your family members and guided me as a friend.
1
Preface
As a pioneer organization The Society for Community Awareness Research and
Action has been working through Community Health Cell, Bangalore with the sprit of
voluntarism boom on primary focus to improve health and access to health care of the
poor and marginalized for over two decades. CHC’s efforts have been directed
towards strengthening community processes through empowerment for health, by
working in partnership with NGOs and also engaging in policy dialogue and
participatory preprocesses with government in a spirit of critical collaboration It has
organizationally committed itself to working for the people health movements at
local, national and global levels and to actively promote the people charter for health.
CHC has made a plan to work gradually increase the number of student placement,
internship and fellowship in order to support young persons who are making an option
for community health. That is why CHC has been offering the Community health
fellowship scheme from April, 2003. It has developed into semi structured alternative
learning experience in community health. It is also offering young professionals who
are interested in community health an opportunity to develop perspectives rooted in
the social paradigm, to experience field realities through placement in community
health projects and to be touch like minded people. Sir Ratan Tata Trust has given
finically support to the fellows to carry this mission efficiently through the
Community Health Cell. Fortunately I have got this facility to learn more in
community health for 6lh months (6th May’05 to 5th November’05).
After valuable discussion with my mentor Dr. Thelma Narayan, coordinator of CHC,
Bangalore and Mr. D.P Poddar, Executive Director of WBVHA, West Bengal and Dr’
Sunil Kaul, Managing trustee of ANT, Assam, both of them agreed to allow me to
study in community health in their organization. Then I have decided to «o first at
WBVHA and after that I will go at ANT. Here I would like to share my learning
experience at WBVHA under guidance of Mr. Poddar. As a friend philosopher and
guide he has made schedule for me how to reach my mission step by step. So I have
started my ongoing learning through various projects in different places of West
Bengal like urban health in Kokata, basic health care project in Sunderban, adolescent
& HIV/AIDS in Darjeeling District and RCH project in Jalpaiguri District.
Shekhar Saha
Community Health Fellow
Community Health Cell
Bangalore
Date: - 16/08/2005
2
Acknowledgment
There is an endless list of those to whom I am greatly indebted; with out whom I
could not have learned so much more during my fellowship in community health. I
express my sincere gratitude to Dr. Thelma Narayan, Ravi Narayan and Dr. Francis
who have given me a opportunity to study in community and also sincere thanks to
Ratan Tata trust for kind fellowship. I owe an especial debt of gratitude to
Mr. D. P. Poddar, the Executive Director of “WBVHA” for his kind acceptance by
which I got permission to do my fellowship study in WBVHA. His valuable guidance
helped me to make a good plan to utilize this opportunity. 1 am also indebted to
respective staff of CHC, WBVHA, WIN, DAMRI, FPAI, Ram Krishna LokSeba
Kendra, Human Development centre, Sunderban Social Development centre, Indra Narayan Pur Nuzrul Smriti sangha, Indian Institute of training & Development centre,
Prerana, Palli Sathi, Asurali GramUnnyan Parishad for sharing with me their years of
experience in their respective field of work I am also indebted to ICDS & PHC staff
of respective area’s for their valuable cooperation.
While much of my time was spent in discussion with local people including pregnant
women and adolescents who gave their valuable time and described me the challenges
they faced and provided their interpretations of what was going on in their village. I
express my thanks to all of them.
At the end, I express my sincere thanks to the CMOH of Darjeeling District,
Superintendent of District Hospital and Secretary of Red Cross Society of Darjeeling
District for their kind helps.
Shekhar Saha
Community Health Fellow
Community Health Cell
Bangalore
Date: - 16/08/2005
3
Abbreviation
1) ANM
Auxiliary Nurse Midwife
2) ANC
Ante Natal Care
3) AIDS
Acquired Immune Deficiency Syndrome
4) BCC
Behavior Change Communication
5) BPHC
Block Primary Health Center
6) BMOH
Block Medical Officer of Health
7) BPL
Below Poverty Line
8) CBO
Community Based Organization
9) CMOH
Chief Medical Officer of Health
10) DAMRI
Doars Alternative Medicine Research Institute
11) FPAI
Family Planning Association of India
12) FNGO
Field level Non Government Organization
13) HIV
Human Immune-deficiency Virus
14) ICDS
Integrated Child Development Scheme
15) NGO
Non Government Organization (Non-profit)
16) PHM
People Health Movement
17) PPNP
Pre & Post Natal Project
18) PHC
Primary Health centre
19) RCH
Reproductive & Child Health
20) SHG
Self Help Group
21) STD
Sexually Transmitted Diseases
22) TBA
Traditional Birth Attendant
23) VHC
Village Health Committee
24) WIN
Women in Need
25) WBVHA
West Bengal Voluntary Health Association
4
To
The Executive Director
Mr. D. Poddar
WBVHA
Kolkata, West Bengal
Date:-13-08-2005
Dear Sir,
It gives me immense pleasure to inform you that I have just finished my
placement journey from 1st June05 to 13th August05 as a Community health Fellow
through the study visit in your organization. I take this opportunity to gratefully thank
You & all the team members of ‘WBVHA’ for having provided me to explore the
option of Community health, with a true learning experience & motivation. This study
visit helped me to learn more on community health. I have made report on it which is
enclosed with this letter. I would like to have your valuable feedback on it.
One thing is very clear to me that most of activities are project based and
implemented by the direction of funding agency. But as per my understanding health
is fundamental right of all human beings and it should be maintained by the people,
for the people and of the people. It is one kind of community needs based long term
process. It does not matter of what the funding agencies wish; it is a matter of real
needs of community. I think that is why we need a strong community health
movement to establish the right to proper health care including Allied services
regarding health, like free access to water and sanitation etc. During this visit as a
fellow I have realized that ‘WBVHA’ has a strong advocacy and network system with
others NGO and Govt, sector in West Bengal and that strength should be able to do
some action regarding “People health movement”(PHM) because with out
collective manner is not possible to do success this mission. I would like do work on
it under your guidance. I hope, your valuable ideas and guide lines will help me to
learn more about “People Health Movement” and do appropriate work.
So, therefore, with a big hope I will wait for your valuable comments on about my
idea regarding “People Health Movement”.
At the end I would like express again my sincere gratitude to you and all the family
members of‘WBVHA’.
With Best Regards
Shekhar Saha
Community Health Fellow
Community Health Cell
Bangalore
NB- Email: - shekharmun@rediffmail.com
5
Introduction
Voluntary action has long and rich tradition in our country. It entails individual &
collective initiatives for common public good. Voluntary organizations have been
experimenting with new ways of promoting more sustainable development through
flexible and risk taking experimentation. They have been able to develop methods
models and equipments that have been widely adopted by others NGO and Govt’
sectors. “West Bengal Voluntary Health Association” is like that type of voluntary
organization. It is also associated with voluntary Health Associations of India As a
pioneer NGO WBVHA is committed to make the ideal of comprehensive health care
service at ground level a reality. It gives equal emphasis to preventive, curative
promotive and rehabilitative aspect of health.
1WIN’ should be able to win the heart of urban poor
Introduction:-On behalf of community health cell, as a community health fellow I
started my learning placement at WBVHA from Is' June’05 through the Urban Slum
‘WRVHA^n1^ 1 uS rUn by WIN (Women In Need)> a sister organization of
fJ 8reat gU'danCe °f MrS' Kathakali Das Pandey> ^e coordinator
of WIN I decided to go slum areas to see real condition of slum dwellers & during
his study. I was able to interact with 120 people (approx) including pregnant women
and adolescents. Now here I try to look back at my experience in WIN.
Fgw words about urban slum: Everybody knows the slum is a worldwide
urban phenomenon. Increasing industrialization and urbanization have created slums
in the ci y. Indian slums are Indispensable part of almost all towns and cities Even
the small and medium towns have slums. The slums dwellers live in horrible areas
I heir living conditions are really unfortunate. The low paid workers live in slum
areas. Slums consist of sub-standard, ill ventilated, inadequate water supply
unsanitary, unhealthy and poorly lighted houses. Congestion and poor living
onditions are distinct features of slum areas. The absence of inadequate of proper
drainage and sewage system is among the major problems of urban slum areas. Apart
from environmental problems, it causes serious situation, which pose the treat of
malaria, jaundice, encephalitis, dysentery and so on.
The mission for enhanced livelihood opportunities has led to large-scale migration
and the mushrooming of the slums in several Indian cities. But sorry to say, a large
section of the urban poor do not have access to many of benefit of the urban
development Much of the challenge of delivering services to the marginalized groups
les in identifying them and effectively approaching them, so that limited resources
are utilized well and programs address real needs. There is a presence of the public
sector as well as NGO in Urban areas. The growing necessity for health services for
urban poor, owing to rapid urban population growth, necessities thinking about the
collaborative approach of the public and non profit sector for health services in urban
areas As the urban poor are at the connecting point between underdevelopment and
industrialization, their disease patterns reflect the problems of both. Three main
groups of diseases have been identified. The first, most directly related to poverty
includes infectious diseases and malnutrition. The second includes cardiovascular and
mental diseases that, together with accidents, are mainly related to the man-made
conditions of the urban environment. The third group consists of disorders that are a
result of the social instability and insecurity that have become characteristic of life in
manyt urba" areas- They '"elude alcoholism, drug addiction, venereal diseases, and the
effect of different types of child abuse and women harassment.
6
Few words about ‘WIN-WIN- Women in need” is one of the pioneer
NGO, working in the field of urban Poor to improve the Living condition of them
since last 8 years. It is committed to work for women empowerment & child
education & health through the comprehensive care & support programme. It is a
sister organization of West Bengal voluntary health association. Presently the
organization reaches 4 different slums areas of west Bengal.
WIN.
TOLIGUNGE
DHOBI A TOLA
■
GOBINDAPUR
Type vvork:1) To provide basic health care facilities through clinic for urban poor,
2) To offer academic facilities for adult women through non formal
education system.
3) To facilitate women for their self development through the saving & micro credit
programme.
4) To provide self employment opportunity to women through the various training
programme like Tailoring, knitting, paper pulp & soft toys.
5) To provide creche facilities for children through the PPN project.
6) To provide academic facilities for student through the sponsorship programme.
7) To provide ante natal & post natal care for pregnant women through the PPN
project.
8) To generate awareness to the women regarding reproductive & child health through
the street corner meetings.
9) To provide food to improve the nutritional status for women & children through the
PPN project
10) To provide free of cost medicine for patient through clinic service.
11) To provide Kindergarten facilities for the children through sponsorship
programme.
12) To provide Coaching class facilities for the student through sponsorship
programme.
13) To provide hostel facilities for student through sponsorship programme.
14) To provide rational drug for the patient through clinic service.
15) To provide referral service as per need.
7
Few words about women einpovverment:Where women are weak, society can never be strong, where women are strong,
society can never be weak. That is why WIN is committed to work for disadvantage
slum’s women those are deprived of their fundamental right to life, health, education,
thinking and action. WIN always trying to enable them through the adult women
literacy programme. It is very difficult job to motivate the women to attend this
programme. Few of willing women come to literate about basic education. They are
happy to get this opportunity from here. It is one kind of ongoing process. Micro
credit and saving is another programme for women which run by WIN It is possible
to do through formation of Self help group (SHG). Economically women are very
poor rather than man, so WIN already started another programme for through self
employment strategy. Needy women getting opportunity to strengthen their economic
condition through various training programme like Tailoring, knitting, paper pulp &
soft toys etc. these processes are also helping them to gain confidence to undertake
activities which they need for daily survival, and through the confidence they
developed through these activities such as savings and credit, they get accreditation
from the community and move on to seeking more gender equity on other issues.
Few words about Pre and Post Natal Project
Food is the chief source of essential materials which the body needs for its well-being
Ihese essential materials called ‘nutrients’. Good food is indispensable for health at
all stages of life and satisfactory growth during infancy, child hood and adolescent in
adequate quantities is no less important for pregnant and nursing women since they
undergo a severe nutritional stress. Child bearing imposes a great stain and it is
important that would be mother leads a healthy life throughout pregnancy one of
major factor that promotes health and wellbeing both of the mother & the baby in the
womb, is wholesome, nourishing food.
Women suffer from under nutrition because of nutritional protocol in the family of
who eats first and how much. Women in general and pregnant women in particular
have special nutritional needs. They need 3 times more iron than man to replace the
iron lost during menstrual bleeding. Pregnant and breast feeding women need 20
times more iron. Pregnant also demand an extra 150 calories per day in the first 3
months, an extra 350 calories per day in the next six months and about 550 calories
during breast feeding. Women require more iodine for their own health and that of
their children, insufficient iodine especially in an already deficient mother can result
in poor foetal bram development which leads to the birth of mentally sub normal
children etc. that means need proper support & Care for women children those are
poor. So through previous experience WIN could relies regarding this subject & has
started new programme, called PPN- Pre & Post Natal Care. The programme is
carried out for the benefit
and lactating
& their
new born
--------- of
-- the pregnant
pregnant and
lactating women
women &
their new
born
babies. Who is real poor & needy? Is it possible to find out them? Win is able to solve
this problem through the selection criteria. It--------------has been fixed
—. These are
a) She (Pre?nant w°men) should be in B.P.L. category.
b) Up to 2nd pregnancy.
c) After through socio-economic survey.
d) Women delivered a baby in last one year are not allowed to enter but WIN
should provide facilities for first child.
8
Strategy:-Case management & Behavioral change communication.
Second step is provided
x.
----------------------------- IThem food & medical care
First step is enlisted pregnant women
I
Academic,
Food and medical
Provided
care
_______ facilities for children
Provided crdche facilities to
children for working mothers
Provided food & medical care for
children & Self employment facilities
for mothers______________________
Provided food & Medical care for Lactating
mothers
Behavioral change
communication through
Street corner meetings &
individual counseling
V
9
Through these programme pregnant women to learn she should eat to safeguard her
health, undergo an uneventful pregnancy and deliver a strong and healthy baby.
Mothers have realized about care of children & creche facilities help them to improve
their heath status. Here I am showing a table on Nutritional status among few children
through the Random selection.
r
Nutritional Status Among 37 Children
Age 6 Months To 5 Years
50%
-•
BSi, i' ' ''
40%
20%
10%
0%
□ Normal
1
30%
■ '■ ’
___
I
□ Grade 1
□ Grade 2
□ Grade 3
SSSSShBII^^
Source WIN health card.
As a community health fellow my few findings are given below:Positivea] 90 % people are happy to get support from WIN.
b] Awareness level regarding institutional delivery (95% to 98 %) is good
c] 95 % Children are immunized properly
d] A
Thinking regarding
spacing (8
(80° %
%P
people
ng SpaCmg
e°Ple are using contraceptives) is satisfactory,
e] Hospital (within 1 km.) is very near to them.
are happy With g071, hea,th service> except inadequate medicine.
gj Most of women (95 %) are involved in out side work, so creche facility is very
helpful to them.
J
Negativea] Alcohol addiction rate (85% to 90% adult male) is
io oso high among male person.
b] Domestic violence against women is very common.
c] No ventilation in house (near about 100 %).
d] Inadequate supply of drinking water (70 % people are saying).
e] Sanitation facility is not sufficient (only 30 % people are getting this facility)
iJ Hygienic condition is poor.
g] 90 % Male persons are not sensitized towards women and child health
Key learning’s:A] To need awareness and local initiative programme on anti alcohol campaigning
BJ Proper housing is required for them.
C] To strengthen the women empower and need to enable them about their right to
health care and equity for survival.
D] With out male involvement is very difficult to solve community health problem.
EJ Creche facility is very good for working mother.
10
As a conclusion
ffeed For a strong Awareness Programme &Community involvement
The provision of water supply and basic sanitation facilities would not automatically
improve health. The availability of such facilities should be accompanied by intensive
health education campaigns for the improvement of personal hygiene, the economical
use of water and the sanitary disposal of waste in manner that will improve individual
and community health The extremely high rates of population growth; the
multiphcity, nature, and scale of the needs; the apathy, hostility, and neglect often
exhibited by governments; and the insufficiency of the resources engaged all suggest
that it will never be possible to grapple with the problems of the poor in slums and
squatter settlements without the initiative and the active participation of the people
themselves. In many instances little will be done for them unless they call for action,
and in almost every case no lasting benefit will ensue without their active support,
understanding, and participation. One purpose of the community organization is to
enable slum dwellers to gain organizational and managerial skills, including the
confidence to choose who should participate, to work with and use government and
non-governmental organizations, and to build mechanisms that demand responsibility
and accountability from the resource holders as well as from community beneficiaries
So, there is a need to create a process whereby communities equip themselves to
participate in the articulation of their problems in the city. What is special about the
process is that it helps communities create space for women to participate centrally in
the process of transformation, not only in the articulation of problems and finding
solutions of it.
Conclusion:As community health Fellow I have got an opportunity to learn about health situation
of poor urban slum people through the WIN project. During my learning period I have
been trying to find out what are real facts behind urban health problem. As per my
understanding if we really desire to work for their healthy life, we need a strong
health movement with the help of all.
Acknowledgment:I am grateful to Mr. D. P. Poddar, Executive Director of WBVHA for providing me
an opportunity to learn about urban health situation. A special thanks to
Mrs. Kathakali Das Pandey, coordinator of WIN for her guidance & also thanks to
Mrs. Dipali Chackraborty community health worker of WIN for her kind help to me
to communicate with Slum people. Finally a note of acknowledgement to the slum’s
people for their active sharing & cooperation.
Date: - 23-06-2005
11
Report on Basic Health Care & support system.
Introduction:-West Bengal Voluntary Health Association as a leading NGO has a
strong networking system with other NGO all over West Bengal. Most of projects
have been working with the collaboration of others small NGOs. It is based on
partnership concept. WBVHA gives technical support to the partners for
implementing project in reality. Basic health care project is one of them. Access and
affordability become the most important factors both for basic needs and inevitable
medical needs. At present, the health picture depicted by health indicators like infant
mortality rate, crude death rate, nutritional status among women and children,
maternal mortality rate, institutional delivery and couple protection rate etc, is
unsatisfactory. This is more so in rural areas. In fact, in general, morbidity and
mortality in rural areas is more than in urban. So the unit aims towards building
community with active involvement & participation of local NGO’s to improve the
accessibihty to quality health care of the people in general. Through this project
WBVHA has been trying to make bridges to reduce the gap of underserved and un
served areas in the fields of community health care. As a community health fellow
through my field visit I have been trying to understand what is real situation in health
of southern part of West Bengal (Sunderban areas) and how basic health care &
support programme is implemented by 8 partners NGO under supervision of
VHA. As per my understanding I have made a report on basic health care &
support which is given bellowWorking area profile
“THE SUNDERBANS"
The Sundarbans is the largest remaining contiguous block of mangrove forest in the
worId It is shared by India and Bangladesh. The Sunderbans area in the southernmost
part of West Bengal, mostly in South 24 Parganas and some blocks of North 24
Parganas, is a special region with an exceptionally fragile environment of mangrove
forests and estuaries. It has a wide variety of flora and fauna. Many people migrate to
the Sunderbans m hopes of earning income through wood cutting, grass cutting, honey
ha7uSt-.nJ and fishlng' 11 is also a maJ°r source of logging, construction of settlements
and building of embankments of shrimp culture of West Bengal. 3.5 million People
live in the areas surrounding the Sunderbans. The population continues to increase
along with the exploitation of resources from honey collecting, fishing and wood
cutting. The people however need the forest as one-third of the population live in
poverty. The average household has about 6.3 persons. The people live in conditions
with unsafe drinking water, poor education and poor access to health facilities. People
were brought in to the Sunderbans for jungle clearing and land reclamation from places
like Ranchi Hazanbagh and Orissa. After some time, these people began to make
settlements there. The agriculture plots are being turned into aqua culture ponds so
that these people can be provided with job opportunities. The groups that make up the
community in the Sunderbans are the bawalis (wood cutters), mouals (honey
collectors), Krishak (farmer) and jailas (fisherman).
The population of this area is very heterogeneous, with a rich history of in-migration
especially in the post-independence period with new migrants (often displaced people
from the east) pushing into a relatively harsh natural environment, clearing forests for
habitation and cultivation. This process of uncontrolled population growth has
12
reduced the per capita cultivable land, and created overcrowding and high rates of
disguised unemployment in agriculture, as well as overexpansion of pisciculture and
brackish water shrimp farming which have created a range of ecological and socio
economic problems in the region. The consequent difficulties in ensuring livelihood
have also led to high rates of out-migration, especially among young male workers.
The Sunderbans region has high representation of minorities and other disadvantaged
social groups. Scheduled Castes comprise nearly 40 per cent of the population are
concentrated in Basanti, Gosaba and Pathar Patima blocks. The economy of the region
suffers from very substantial structural under employment. A large part of the
population is basically dependent upon rain-fed monocropping (boro rice) and
whatever subsidiary activities are available. About half of the households are those of
landless laborers. The limited possibilities of extending cultivation and the features of
the area, have led to an increase in dependence upon fishing and the collection of
bagda prawn seeds. The over-extraction of this local resource (bagda prawn) is one of
the most significant problems in the region today. It results from the serious
underemployment and low wages, which make this activity (performed mainly by
women and children) essential for household survival. However, brackish water
fisheries and such collection have created overexploitation and thus scarcity of this
prawn species as well as other fish species, making it a highly unsustainable activity.
Since the work entails standing in waist-deep or deeper water for many hours, it
involves numerous health hazards, including skin diseases and bites from various
water species. In addition, there are real risks of being eaten by crocodiles or sharks.
For this reason male household heads rarely do this work, since they are seen as the
primary earners. Instead, children are kept out of school to engage in this activity
along with their mothers. There have also been some reports of child trafficking
within the Sunderbans involving cross-border trade.
Infrastructure is poorly developed in this area. There are only 42km of railway line
and around 300 km of metalled roads, around half of which become inaccessible in
the rainy season. The basic means of communication between islands is water
transport which is not well-organized and mainly in private hands. There is an acute
shortage of pukka jetties. Because of inaccessibility, most of the inhabited areas still
do not have conventional electricity supply. Access to potable water is a major
problem for residents. In addition, there are some major environmental problems in
the region, some of which are natural while others are created by human activity. One
of the important changes relates to the reduced flow of sweet water, because of the
shift of the fresh water flow from the Hooghly River into the Padma. This has meant
that the major fresh water rivers of the area, such as the Matla and the Bidyadhari,
have got cut off from fresh water sources and are now mostly tidal rivers. The
resulting increase in salinity has changed the vegetation pattern, affected irrigation for
culti vation and caused the formation of saline banks inside the islands. The entire area
is disrupted by frequent cyclones and floods and the resultant soil salinity deters
agricultural production, the prime source of livelihood for the local people. Control
over agricultural resources is vested in the hands of larger landowners. A large section
of the local womenfolk commute to Kolkata to serve as domestic maids.
Consequently the children are left to fend for themselves. They either go to work to
supplement meager family incomes or stay home to look after younger siblings. In
either case, they remain deprived of basic education and health facilities. For girl
children the risk of getting trafficked looms large. Muslims comprise about 45% of
the community and the status of women among them is comparatively low.
Source: - West Bengal Human development Report 2004
13
Few words about Partner NGOs
As implementing agency 8 partners are working on basic health care & support
project under the management of WBVHA through their existing system. Most of
them are working at rural belt of sunderban. Gosaba, Diamond harbor and
Patharpratima block of South 24 Parganas district are located in the southernmost tip
of West Bengal.
Name of partners are 1) Ram Krishna LokSeba Kendra 2) Human Development
centre 3) Sunderban Social development centre 4) Indra -Narayan Pur Nuzrul Smriti
sangha 5) Indian Institute of training & Development centre. 6) Prerana 7) Palli Sathi
and 8) Asurali GramUnnyan Parishad.
They have lot of experience regarding community development activities. More than
20 years experience, self motivation, dedication and commitment towards community
made,them to work for the community, of the community and by the community. Few
years back they had been started their work as community based organization;
presently they are closely working with state level NGO. They have well acceptance
from the community to do some thing for sustainable development for not only health
but also improve socio-economic status. It is truth that with out community
involvement not a single programme became success in reality. So, they had started
their any programme with the collaboration of community and got a fruitful
achievement. One of very interesting subject is that they are all different NGO in
different places but their working activities are mostly similar. These are Self-Help
Groups formation, Micro credit & Income Generation Programme, Integrated
community health programme, to participate on national health programme like pulse
polio, Malaria control programme etc, Awareness programme as per need of
community, Sanitation programme, prevention programme for the Trafficked Women
& children, Arsenic Mitigation programme, special medical camp as per requirement
of community like Eye Operation.& Dental clinic etc, educational programme for
children & adult persons and also Basic Health Care & Support Programme.
Few words about primary health care:A basic goal of development is to improve the quality of people, an important
indicator of which is the health status of the population. Health is not only an end
product of development. It is also a major contributor to it is as it helps to increase the
productivity of the work force. Today, there is general agreement that health is an
essential constituent of human resource which plays such a crucial role in
development. Most of the developing countries of the world including India, the
better-off sections of society are in a position to avail the benefits of modem medial
science & technology, while the majority of the disadvantaged, especially people
living in rural areas, are poorly served and at best receive only rudimentary health
care are familiar with the various cycle wherein poor health causes low productivity
and reduce income. The lack of income brings in inadequate nutrition & a
deteriorating environment that further perpetuates poor health. India, being a
signatory to the Alma- Ata declaration is committed to providing primary health care
for all. Improvement in the health status of people requires coordinated efforts of the
health sector and supportive activities of other sector such as nutrition, education,
housing, water supply and sanitation.
14
The first primary health centre (PHC) was established in 1952 as part of the
community development programme. The major functions of the PHC were spelt out
as medical care, control of communicable diseases, promotion of maternal and child
health including family planning, environmental sanitation, school health, health
education and collection of vital statistics. The general aim of the 2nd five year plan in
the field of health was to expand existing health services, to bring them increasingly
with in the reach of all the people and to promote a progressive improvement in the
level of national health. Then the health survey and planning committee appointed to
review the development of the service in India. The Bhore & Mudaliar committee
recommended consolidation of extant service rather than expansion. In 1975, the
Shrivastava committee recommended the creation of large bands of part- time semiprofessional workers from among the communities to provide promotive and
preventive services and medical care. Community Health volunteers scheme launched
in 1977, as part of the Rural Health Scheme, these workers were to act as a link
between the health services and the people. The Government of India became a
signatory to the Alma Ata Declaration in 1978 on health for all by 2000 A.D. Primary
health care was visualized as the nucleus of the country’s health system to make
essential health care universally accessible. Now, what is primary health care?
According to the Declaration Primary health care is essential health care based on
practical, scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through their full
participation & at a cost that community can afford to maintain at every stage of their
development in the spirit of self-reliance & self-determination. The Declaration goes
on to say that primary health care addresses the main problems in the community. It
comprises providing promotive, preventive, curative & rehabilitative services.
AT A GLANCE BASIC HEALTH CARE
Each project with have a specific goal & for the realization of such goal. It will
mobilize them and coordinate them in an efficient manner. Basic Health Care one of
them. It has a specific goal and goal is making a bridge between Govt. Health system
and community through the awareness programme for community & linkage or
advocacy with Govt, sectors. According to previous evaluation report it is found that
PHC s have failed to deliver the goods as expected and the health care delivery of
PHC’s is abysmally low. They have taken care of only 8 percent of morbidity. They
have more or less failed in all the essential services they expected to provide. Further,
the PHCs were originally expected to provide the essential health services by entailing
the community involvement and participation. As Anju Bajpai and Gurpreep kaur
note, the very idea of community involvement in the health care delivery of the PHCs
has not taken proper steps. The whole system has been over bureaucratized in
practice. Community participation has remained a sale word in policy documents. The
bureaucrats have hijacked the primary health care system, the community
participation could have access to PHCs.
15
National health policy aims at universal provision of primary health care services
There is already an extensive infrastructure for making health services available at the
grassroots level, which is being continuously extended. However, the services and
delivery system has so far not been able to improve the health status of the rural
masses to a satisfactory level. This is due to various reasons, including the urban
hospital based, curative approach to health services, low priority to public health
programmes, lack of medical staff willing to work in remote areas, unsatisfactory
delivery system, irregular supply of medicine and limited access of the poor to health
care services. So this needs to corrected, otherwise impossible to achieve the real
mission towards public health.
Above these scenario is going to be change through lot of intervention by NGO &
Govt, combined efforts but not to reach in satisfactory level. Basic health care support
& programme is very useful to overcome above these situations and have a
opportunity to improve quality health service and increase the accessibility for
unserved & underserved Community. That is why WBVHA as an experienced NGO
have taken an important role through Basic Health care & support project with the
collaboration of 8 partners, funded by MEMISA Belgium.
Basic concepts of this project are:1) To make a village health committee and others committee.
2) To strengthen Village Health committee, central health committee and through
technical inputs on education and health, so as to enrich community
participation.
3) To build capacities of Mahila Mandals on health related issues immunization, ante and post natal care, health & hygiene and government
schemes.
4) To network with local Panchayats and Block level functionaries to ensure
actwatrnn of relevant committees and access to government provisions.
5) To campaign against child marriages through awareness building on relevant
issues for youth clubs, Mahila Mandals and community people.
6) To utilize the existing self-help groups as community well-wishers to take an
important role in favor of community health development.
7) To improve basic health services at sub-centre, PHC and BPHC level through
advocacy & linkage with ANM, Medical Officer & BMOH
8) To make a Doping Centre for adolescent to aware them regarding their health
related problem through family life education.
16
Key Learnings: A) Good net working with other NGO is valuable way to reach the unserved
area s and easy to take action for community health.
cO|?uTlt^ParticipatiOn is essential forthe success of any health programme.
C) Seli-Help Groups have emerged as one of the major strategies for women’s
empowerment and strong women’s groups could contribute substantially to
the development and convergence of services and activities.
D) Need to strengthen Govt, health service in rural areas
End Notes:Community participation in the program was reflected in the activation of village
health committees and adolescent groups. The VHC’s included representations from
Panchyat members, women’s groups, youth groups, village level government
func lonanes [Anganwadi worker, ANM etc] as well as community opinion makers
the VHC s were involved in monitoring the development of all aspects of the villages
education, health care as well as infrastructure. The youth clubs performed cultural
activities with a view to spread awareness among their peers as well as among the
larger community on issues of health, hygiene, sanitation and education
Acknowledgement:I wish to acknowledge the valuable assistance, cooperation and support received from
a number of people those are belongs to TEA, ICDS Panchyat and Govt. Health
Functionaries I express my gratitude to all staff of partner organizations. I am also
obliged to staff of WBVAH. I express my sincere thanks to Mr. Bishwanath Basu the
Project director of basic health care Project for his kind cooperation
Date:-18-07-2005
17
Adolescent/ youth --------health and HIV/AIDS prevention unit
Introduction: Adolescents constitute an important segment of society. Yet until
recently, the special needs of this group have not been sufficiently addressed. There is
increasing recognition now that reproductive health needs of the adolescents have to
be articulated in terms of information and services. So that they can make informed
choices leading to improvement in their health status. Adolescent reproductive health
re ers to physical and emotional well being of adolescents and includes their ability to
remain free from unwanted pregnancy, unsafe abortion, STD including HIV/ AIDS
effect I?"?8 °f St6XUaJ VI01ence & coerc<on. However, experience in India regarding
effective intervention for young people is very limited. The HIV/AIDS epidemic is a
new & complex phenomenon in the world today. It is challenging accepted ways of
understanding health and human development in our societies and demanding new
forms of holistic responses. It is raising conceptual, ethical and programmatic issues
many of which still need to be named, all of which need to be raised for discussion
HIVMIdT-1011' WBXHA has been directly working °n adolescent/ youth health and
HeX and ‘hiv/a3 n«arD ,ng dlStnCt Of West Bengal through the Ad°lescent/ youth
Health and HIV/AIDS Prevention unit. As community health fellow I could learn
more through my field visit.
Working area profilei-Darjeeling district is the northernmost district of west Bengal
It is located on the lap of the Himalayas. The district comprises of four subdivisions
namely, Darjeeling Sadar, Kalimpong, Kurseong and Siliguri. Darjeeling Himalaya
orms a part of eastern Himalayan ranges and is bounded by Sikkim, Nepal and
utan on the north, west and east respectively. It consists of the first three
fAbfdh-nsio"s ofJhe.dlstrict whlle Sihguri is mainly characterized by the tarai and
oothills of the district. Darjeeling Himalaya consists of a portion of the outlying hills
of ower Himalayas and a stretch of territory lying along the base of the hills known
R JhffyTeramR1Ver TCeSta 1S th£ maSter Stream in the area while the Rammam and
Rangit are the hvo important tributaries of the Teesta. Besides, numerous rain fed
rivulets in the hills become the most dominating factor of environmental control
™d fa,ny SraS°^
U,riSm iS 3 climate-based industry while tea plantations that
earned fame for Darjeeling Himalaya is largely a contribution of the climate.
nvironmental conditions play a major role in conditioning the livelihood and
economy of the people in Darjeeling Himalaya. The topography, climatic variations,
soil condition have all influenced human occupancy. Subsistence agriculture
ivestock forestry, plantations and the deep-rooted poverty, and ignorance have
become chronic over the period of time. Besides, the people are living in a very
underdeveloped infrastructure. As one may do in many parts of the country the
economic structure cannot be analyzed in the Queen of the Hills merely by observing
e owns and roadside developments. A house-to-house survey in the rural villages
will reveal the real picture as to how people are struggling for their livelihood. That
e infrastructure is unsatisfactory is evident on seeing the poor of remote villages still
trudging a daylong walk for shopping in the towns. It means many villages are
without proper transport and communication facilities. The rural folks have to walk
day long to sell their produce in the nearest town. The situation becomes worse during
the rainy season when frequent large-scale landslides and other forms of mass wasting
take place m the hills. During this period a large number of villagers lose their lives
Safe drinking water, educational institutions, primary health centre, power supply etc
face similar fate in the rural hills.
18
Few words about Adolescent/Youth health HIV/ AIDS programme.
Adolescent:-World Health Organization has defined ‘Adolescence’ as the period
between 10 & 19 years, encompassing the entire continuum of transition from
childhood to adulthood. The International Conference on Population and
Development in 1994 placed fresh emphasis on the need to ensure comprehensive
reproductive health for women including adolescents. During this period significant
changes occur in the body, both internally and externally. It is also period of deep
emotional changes. Adolescents need to be reassured that physical, mental and
emotional changes are a normal process of development. They are necessary for them
to move into adulthood. It is only after they have crossed the adolescent phase would
be able to take adult responsibility including earning their livelihood and getting
married & having children. It is, therefore, necessary that their misapprehension,
misconception and resultant confusions regarding physical as well as sexual attributes
be removed. Nutrition is a major health issue for them. Sexuality is the next important
issue for adolescents. It is important to explain the functional link between sexuality
and reproduction. It is also must be emphasized that to undertake reproductive
function, full physical development is essential. It is preparatory phase and any
premature action may jeopardize their future health and development and may rfave
life long disadvantages. Development of their earning capacity is also crucial at this
phase. They must utilize this period in learning how to become responsible adults
including acquiring means of livelihood. A large number of adolescent populations
are at the middle or high school level. Teachers, therefore, necessarily play a crucial
role in the development of adolescents. The teachers need to be urged to be actively
involved. Their imparting knowledge requires up-gradation and support. Parents
family and community at large also play a vital role in the development of
adolescents. Lack of adequate information on dealing with the requisite patience and
understanding hampers smooth transition. It is, therefore, necessary to generate
awareness among them too. WBVHA has been working with adolescent/youth to
improve their life skill through school and community based awareness programme.
Peer Educators play the important role to share the information regarding adolescent
health and life skill with others student. It is very easy to reach those adolescent are
student but question is how to reach the left. That is why this unit made a plan to
reach them through the self-help group. Presently both methodologies are highly
accepted to adolescents or youth.
19
HIV/ AIDS:-It would be easy to underestimate the challenge of HIV/AIDS in India.
India has a large population and population density, low literacy levels and
consequently low levels of awareness, and HIV/AIDS is one of the most challenging
public health problems ever faced by the country. HIV/AIDS is still largely
concentrated in at-risk populations, including commercial sex workers, injecting drug
users, and truck drivers, the surveillance data suggests that the epidemic is moving
beyond these groups in some regions and into the general population. It is also
moving from urban to rural districts. The epidemic continues to shift towards women
and young people. It has been estimated that 38% of adults living with HIV/AIDS in
n la as of the end of 2003 were women. In 2004, it was estimated that 22% of HIV
cases m India were house wives with a single partner. The majority of the reported
S cases have occurred in the sexually active and economically productive 15 to
age group. The predominant mode of HIV transmission is through heterosexual
contact, the second most common mode being injecting drug use. Previously blood
transfusion and blood product transfusion were also major causes, but blood safety
measures are now in place to prevent such transmission.
Awareness P^gramme is only way to fight against the Deadly virus
IV and save the human beings. WBVHA has been working directly on it in area of
d,StriCt through the various activities. Here Adolescent peer groups, Leader
ot Self help Groups and Nodal Teachers play important role to extend the proper
knowledge to others.
Key Learning’s:A) The life skills approach is an interactive educational methodology that focuses on
acquiring knowledge, attitude and interpersonal skills. It ails to enhance young
people’s ability to take greater responsibility for their own lives by making healthy
choice, gaining greater resistance to negative pressures and avoiding the risk
behaviors
B) Peer educators are backbone of the mission.
C) Income generation programme for dropout youth is very useful.
D) Life skill education has played a key role in improving adolescent health.
E) SHG is helping people to agree things and to speak together, giving people a
stronger voice in decision-making and in negotiating with more powerful forces.
Acknowledgement: - I express my gratitude to all staff of Adolescent/ youth
Health and HIV/AIDS Prevention unit of WBVHA for their helping attitude. I express
my sincere thanks to CMOH of Darjeeling Districts, Superintendent of District
Hospital and Secretary of Red Cross Society for their kind help.
Date:-05-08-2005
20
Reproductive &Child Health Programme
Introduction:-WBVHA was recognized as a mother NGO in 1996 by the
Ministry of Health & Family Welfare, Govt, of India and was entrusted with the
responsibility of capacity building of field NGOs (FNGO) in implementing the RCH
programme in 8 districts of West Bengal. WBVHA disburses funds to the small
organization on behalf the government, disseminates information on RCH issues
among the FNGOs and is actively involved in organizing training for the members of
the FNGOs through its training unit and also guided them to improve their skill to do
better performance on public health through this programme. As a nodal agency
WBVHA has been implementing this programme through the FNGOs in underserved
and unserved areas. As community health fellow I have tried to learn about FNGOs
activities regarding community health through my field observation in area of
Jalpaiguri district in West Bengal.
Working area profile
The district of Jalpaiguri in West Bengal flanks the foothill of the Himalayas. The
area forms a part of what is well known in literature as the ‘Terai’ or ‘Dooars’ and has
lately been subjected to large scale human interference and its consequential hazards
mainly river shifting, deforestation, water quality and also social problem. From the
geological point of view the soil of this district is mainly the product of weathering of
fluvial clastics. It has developed on the Quaternary deposits of the Himalayas, which
is well within the sub topical climate environment. Geomorphologic, hydrological and
physical set up of the Quaternary terrain comprising the interfluves area of the
Mahananda, Teesta, Torsha, Jaldhaka, Sankosh and other rivers provide evidences of
parallel transverse faults. The drainage pattern, topography and groundwater are
controlled by the neotectonic movement. Topography of this district and its environs
is characterized by uneven. Elevation of this region varies from 62 m to 350 m. Slope
of the region is going towards north to south direction. The land use pattern has also
been changing from natural land to man made structure. The main land use of this
district is forest (30%), tea garden (20%) and cultivated and non-cultivated land
(35 /o) and other (15%) (Source: LISS-111 image, March, 2001). Jalpaiguri district is a
land of culture which has multi languages, castes and traditions. This district with a
population of 3403204 (Census 2001) is the house of many tribes and communities.
The percentage of SC and ST is 36.99 and 21.04 of the total population respectively.
Most of the people are directly or indirectly related with tea garden and agriculture.
The district has developed dramatically from last decade in different views. Literacy
rate is increased from 45.09% to 65.61% but literacy rate is 21.50 % in tea garden
belt. The percentage of Below Poverty Line (BPL) families have decreased from
62.01(1997) to 59.53(2002). Education, birth rate control, health condition, drinking
water facility and other infrastructures have been improving. Some groups of women
have established themselves by setting up Self Help Groups resulting in the upliftment
of socio-economic pattern. Malaria, Diarrhoea and other water- borne diseases are
acute problems of the tea garden belt in the monsoon period due to the
contamination of drinking water .The tube wells or wells used as the source of
drinking water do not have any concrete platform in tea garden belts. Aquatic life also
faces the problem of contamination of surface water. All environmental hazards
directly or indirectly effect of the health condition of tea garden belts compare to
other part of district. The Diarrhoea, Malaria, and others water-bone disease are
Acute Problem of the tea garden belts in the monsoon period in every year
21
The primary causes of the poor health are 1) Poor drinking facility due to the contamination of ground and surface water and
waste management of tea garden belts because do not have concert platform of tube
well and deep tube well.
2) Land use pattern, geomorphology, hydrology condition and drainage networks all
are directly or indirectly related with marshy land which are more favorable condition
tor malaria disease.
The secondary cause of the poor health condition a) Literacy
b) Lack of awareness
c) Poverty
Literacy:
Literacy is one of the prime factors of human interference hazard and creating
awareness. Health and literacy both are complementary step for better future But
unfortunateJy hteracy rate is very poor in the tea garden area compare to the district.
In 2001 census literacy rate is 63.62% in whole district where as 37.48% in tea garden
area.
Lack of Awareness:
Bemg a backward district Jalpaiguri is confronted with a very major social problem
which is a great concern for the programmed of eradication water-borne diseases like
malaria, Diarrhoea. The entire problem is alarming in this region due to lack of
awareness about their health. The rural families, majority of whom are living under
P^eoJo/lnf lhe^ are aware abollt their sanitation- As Per the 1991 census report,
only 24.96/o of the households in Jalpaiguri have access to toilets. In the tea garden
areas, this figures is such at 10.43%
Poverty of the Tea Garden belt area:
More than 70% of the total populations in Tea garden area are working as dailySin2 tpe^^8^fBC'0W P0Verty Line <BPL) families have ^^ased from
62.01(I"7) to 59.53 (2002) in all over the district. But the percentage of BPL
families in Tea Garden area is 67.07%.Tea garden labourer gets minimum wage in
relation to labours of other spheres. The feudalistic character of tea garden
management still treats them as their bonded labours. The amenities are to be
provided as per rule to the labours which is absent in almost all tea gardens. The
development and living-standard of the people of village of West Bengal is induced
y anchayeti Raj since 1978 but the tea garden people were deprived. Since 1997 the
tea gardens were brought under Panchayet system. But Panchayet could not provide
any development or make any expenditure for the betterment of the people, as the tea
gardens are bind by Tea-Plantation Act. The contradiction of the two rules i.e. T.P.Act
and the Panchayeti system if not resolved immediately, no development of the tea
garden people and their spouses can be achieved, which ultimately may lead to a
regional imbalance even within the district.
22
Few words about FNGQs
As community health fellow I went to visit two FNGOS in Jalpaiguri District in West
Bengal to learn their approach towards community health on account of RCH
programme. So here I am trying to highlights few words about them.
DAMRI: - “Duars Alternative Medical Research Institute” has been working on
various development issues regarding health & education through few project in small
area of Jalpaiguri district. At a glance activities are School Health programme, firstAid training for secondary student, career guidance, community medical service, free
coaching centre, need based awareness programme, self-help group formation, need
umvu31" camP> family counseling and RCH programme under supervision of
WBVHA. It has strong advocacy & rapport with Govt, health functionaries, ICDS
Panchyat Members and Local CBO. Strong commitment made them to work with
under-served people those are not getting need based facilities from others side.
FPAI: - “Family Planning Association of India”, Kalchini Branch is one of leading
NGO of North Bengal has been working at kalchini Block of Jalpaiguri drastic on
various issues regarding community health under guidance of Mumbai Head Quarter
of FPAI and also guided by WBVHA only on RCH programme. It is nationally
reputed and has an experience of over 47 years. The branch is covering a tribal
population of nearly 80,000 living in slum, forest and tea gardens. Mostly inhabitants
belong to Rava, Meeh, Dukpa, Santal and Nepali community etc. It is presently work
on five ‘A ‘that means 1) Advocacy 2) Adolescents 3) AIDS 4) Abortion and 5)
Access. Overall mission of this organization is an endeavor to strengthen a voluntary
and non-governmental commitment to promote sexual and reproductive health &
rights including family planning. It strives support a woman’s right to opt for legal &
safe abortion, reduce the spread and impact of STD/ HIV/ AIDS and protect people
especially adolescent and youth from unprotected sex, unwanted pregnancy, violence
discrimination and abuse.
Bharnabari and Gangotia tea-estate where government health services including RCH
are still left untouched, but presently scenario is going to change through the
Commitment of FPAI Kalchini Branch. It has made strong net working and linkage
with others those are working on community development in same area. Here Govt,
health functionaries, Trained Birth Attendant; local clubs or CBOs, ICDS and
Panchyat has been working together to fulfill the mission and improve the health
status of that community.
The govt, of India has been promoting NSV (No Scalpel Vasectomy) with latest
technology for last 7 years. It is hoped that at last men will come forward to shoulder
their responsibility for contraception. They have come in droves in some places like
Jalpaiguri District of West Bengal. It is the one of success story of FPAI.
“GO FOR HEALTH CLUB” is good idea to address to develop needs of adolescent in
a holistic manner. It is like a youth club where the youth doing something for their
development. Here everything has been maintaining regularly from the beginning by
peer groups. It is strongly used for as information and counseling centre regarding
adolescent health including STD/HIV/AIDS. They are also getting the way of earning
through the income generation programme.
°
23
Few words about RCH:-In 1994 when the International Conference
on
Population and Development in Cairo recommended that the participant countries
should implement unified programmes for Reproductive and Child Health The RCH
approach seeks to underline that “people have the ability to reproduce and regulate
their fertility, women are able to go through pregnancy and child birth safely, the out
come of pregnancies is successful in terms of maternal and infant survival and well
being and couple are able to have sexual relations free of fear of pregnancy and of
contracting diseases. The Govt, of India followed up international endorsement with a
national programme on RCH in 1997. The concept of RCH is to provide need based
client centred, demand driven, high quality and integrated RCH services to the
beneficiaries. The RCH programme aims to bring all RCH services within the easy
reach oh community. This Programme incorporates the components covered under
the Child Survival and Safe Motherhood Programme and includes an additional
component relating to reproductive tract infection and sexually transmitted infections,
n order to improve maternal health at the community level a cadre of community
level skilled birth attendant who will attend to the pregnant women in the community
is being considered. Reduction of maternal mortality is an important goal. The
Department of Family Welfare has taken several new initiatives, during the current
Ninth Plan period, to make the programme broad based and client friendly. The focus
was, accordingly, shifted from individualized vertical interventions to a more holistic
and integrated life cycle approach giving more focused attention to the reproductive
health care. The National Population Policy 2000 recommends a holistic strategy for
bringing at the grass root level and involving the NGOs, Civil Societies, Panchayati
Rqj Institutions and Women’s Group in bringing down Maternal Mortality Ratio and
Infant Mortality Rate.
Trted in the year 1997-98 had end bythe March 2005. From
i April, ZUU5 RCH 2 phase has been beginning and some where it is going to start.
l he tocus of the programme will be to reduce the Maternal & Child Mortality &
Morbidity with emphasis on rural health care. This time more flexibility have been
given to the States for planning their own interventions for achieving the goals,
accordingly the states have been requested to make their own project implementation
plan with indications for achieving the desired milestones. So WBVHA has Given
opportunity to FPAI & DAMRI to perform better on account of RCH II
Key Learnings: a) Improvement of general educational level along with awareness generation in
reproductive health through Information Education & Communication by the
help of mass media & health workers are of utmost importance.
b) If people are involved in planning, implementing and monitoring, they have
ownership of the programme and this is important for its success.
c) A strong partnership between the service provider and the community will
reduce the unmet need and improve the health status.
d) If implemented in an integrated manner, the RCH programme will go a long
whole0^8 lmpr°Ving the °Veral1 health of women and that of society as a
Acknowledgement:-! express my gratitude to Project co-ordinator & Health
I°r£
&pFPA‘
th6ir helping attitUde- 1 eXPresS my sincere ‘hanks to
Mr. Mithun Nath, the Project director of RCH Project for his kind cooperation.
Date :-13-08--2005
A Report
°n
Community Health Fellowship Learning Visit
At
The Action for North East Trust &
Rural Volunteers Centre in Assam
Conducted By
Community Health Cell
Bangalore
Supported By
Sir Ratan Tata Trust
Duration: -16,h August’05 to 27th SeptemberO’05
Presented By: - Shekhar Saha
Guided By: - Dr. Sunil Kaul,
Managing Trustee of the ANT
And MR. Rabindra Nath Director of RVC
At A Glance
Self-Help Groups & Action for Community Health
Through th 6 ANT
Introduction:As a pioneer NGO “ANT” (Action for North-East Trust) has been working for last five years
to improve the lifestyle of rural people through the women empowerment. Set up by a group of
professional committed to rural development, the ANT focuses its work to the poorest and
disadvantaged sections of northeast region of India. It is situated at Bangaigoun District of
Assam and working at the rural areas of same district. “Self-help group” for women and strong
commitment of ANT s associates have made a strong hope to reach the mission and also they
had made plan to start another mission is being to solve rural health problem under the leadership
of self-help groups. Community Health Cell”, Bangalore has provided me an opportunity to
learn more in community health through the community health fellowship programme My
mentor Dr. Thelma Narayan, coordinator of CHC has guided me to go in Assam where lot of
opportumty to gather new experience in community health and also explained me how Dr Sunil
Kaul, Managing trustee of the ‘ANT’ as social activist has been working at the'really
underserved areas of Bangaigoun District of Assam with his strong volunteers groups. So after
inished my study visit at West Bengal Voluntary Health Association in West Bengal I came to
Assam and met with my new mentor Dr. Sunil Kaul and discussed with my study visit and
started my journey here fromlbth August’05 for one & half month. Through this report I am
lying to present my feedback on account of learning mission in community health.
Little bit about Assam: - T//e Assamese The population of Assam is a broad racial
intermixture of Mongolian, Indo-Burmese, Indo-Iranian and Aryan origin. The hilly tracks of
Assam are mostly inhabited by the tribes of Mongolian origin. This broad racial intermixture is
ic native of the state of Assam, called their language and the people "Asomiya" or "Assamese"
which is also the state language of Assam. Assam is a land of about 25 million people situated in
e northeast corner of India. The principal language of Assam is Assamese although a large
°f
a'lgUages are sP°ken- Assam comprises an area of 78,523 square kilometers
(30,3 8 square miles). Except for a narrow corridor running through the foothills of the
imalayas that connects the state with West Bengal, Assam is almost entirely isolated from
ande
"’i"11’61' °f tribeS with‘n their Variety in traditi°n, culture, dresses,
unfan
d
lfet, M°St tnbes have their own languages; some of their traditions are so
Miri M h'176i686
W°nder t0 °therS- B°r0 (0r KacharT Karbi, Kosh-Rajbanshi,
Min, Mishimi and Rabha are also among these tribes exhibiting variety in tradition, culture
dresses, and exotic way of life. The national festival of Assam is the Bihu which is celebrated in
three parts during a year with great pomp and grandeur by all Assamese, irrespective of caste
fo^loVdh6^1011!- Bengall'sPeaklng Hlndus and Muslims represent the largest minorities^
followed by Nepalis and populations from neighboring regions of India. About a quarter of the
population is Muslim. Most Muslims are recent settlers from Bangladesh, although there have
been some Muslims in Assam for several centuries. The older Muslims are well-integrated with
the society.
w
,
rr caving is the traditional craft of the Assamese, and the women of almost every household
take pride in their possession of a handloom. They use their handloom to produce silk and (or)
o on clothes of exquisite designs. The Eri, Muga and Pat are the important silk products of
Assam.The most important social and cultural celebrations are the three Bihu festivals observed
wi great enthusiasm irrespective of caste, creed and religious affinity. The Bohag Bihu
celebrated in mid-Apnl, is the most important one. It is also known as Rangaali Bihu ("rang1'
means merry-making and fun). It is observed by dancing and singing in open spaces as well as in
e houses. The second important Bihu, Magh Bihu, is a harvest festival celebrated in midanuary It is, celebrated with community feasts and bonfires. It is also known as the Bhogaali
Bihu ( bhog means enjoyment and feasting). The third Bihu festival is observed in mid
October. It is also known as the Kangaali Bihu ("kangaali" means poor) because by this time of
the year which is before the harvest is brought home, the stock of foodgrains is low in a common
man s house.
Jn terms of life expectancy, literacy, infant mortality, drinking water etc. One finds that in terms
o life expectancy at birth (table 9.1), the figure for Assam for male population (58.96) as well as
female population (60.87) falls below the national average of 63.87 and 66.91 respectively
m nt
J
f°r the StatC in 2002 is 62 While the national average is 64. It is to be noted
at in 2000, the infant mortality rate for female in the state was 83 compared to 69 for all India,
n j IS,rather striking because among the major states numbering 15, only the states of Madhya
Pradesh, Orissa and Uttar Pradesh has higher female infant mortality rate. And then we think that
ere is comparatively less male bias in the Assam vis-s-vis the national scene! In the case of
male infant mortality rate, Assam does better than just four other states, namely, Madhya
Pradesh, Orissa, Rajastan and UP.
y
Source:-Website-www.assam.org
Focusing areas of work:—g weaving programme: - It is one of income generation programme for poor rural tribal
women of the north Bongaibaon in Assam. The women of almost every household take pride in
their possession of a handloom. They use their handloom to produce silk and (or) cotton clothes
of exquisite designs. It is fully community based and maintained by weavers. This wavers
amT tk 1S 8uin!-t0 breathe a life f its own- Presently only technical support has given by the
AN I. Through this programme more than hundred families are surviving and improve their
lifestyle because they are getting proper wedges and healthy atmosphere.
) Village pharmacist:-Most of villages of the same district have not found any basic health care
services from govt, sector. Voiceless people of that’s villages are dependent on untrained Quakes
for their medical problem. They are unable to go in town for treatment due to poor
communication and long distance. Keep in mind this real situation of villages, the Ant made a
plan to do a health programme for people, by the people and of the people. That is called village
p armacist. Women selected from the villages by the villagers were trained to handle 25 to 30
medicines, thus providing basic medical care in their village.
3)YES> Youth for Educating Society is a concept to mobilize the youth through the training
piogramme for forming self help group and involving them in community work. Presently it is
going on full swing .lot of social campaigning has been carried out by this groups.
I
Entrepreneurship Development Programme: - It is one of income generation programme for
poor rural people. The Ant has been to create special training on entrepreneurship to improve the
business skill of poor people.
5) Essential Drugs: - Drugs are most important part of modern medicine but the prevailing
concept of pill for every ill may not hold true rather it is detrimental to our health. Rational use
o drugs is the process of providing essential drugs to those people who need those most, in right
time in right dose and right cost. So this NGO trying to introduce rational and essential drugs
with low cost allover the north east region. They are regul arly organizing workshops on it.
6) Right for fight: - Due to poor governance of Assam govt, and lack of information, voiceless
poor people are unable to getting lot of facilities which are sanctioned for them. So the Ant
volunteers have committed to take action on it through awareness propgramme and bring out
magazine.
&
7) Net working: - Recently the Ant has made a plan to work with other NGO’s in same district
through the strong net working system. The aim of this mission is sharing and helping each other
to do the best action for community development.
8)_Awareness programme: - The Ant has committed to stop the death due to Malaria in same
district because here rampant Malaria is real big health problem. Through their active
intervention presently the scenario is going to change. It has made possible due to strong
awareness drive with the help of street play, posturing, leaflet and also proving proper low-cost
medicine through the well trained village pharmacist.
9) Jagruti Groups: - structurally it is Self- Help Groups (SHG) but it is deference from generally
own SHG because they are committed to work for community development. Through this
action trying to build up their capacity to do dynamic action according to community need.
Presently the Ant has made near about 50 groups with over 700 members those are well trained
to maintain their groups and have ability to work for community.
Few words about SHG:-A way to start working that helps to build up the social connections
which people find useful in support of their livelihoods objectives & Helping people to agree
things and to speak together, giving people a stronger voice in decision-making and in
negotiating with more powerful forces. It is also a way of increasing the effectiveness of local
actions and providing easier access to micro-credit and other resources and services. Self-Help
Groups are a real way to build social capital. Building networks and connectedness to increase
the ability of providers and users of services to work together or to strengthen links among
individuals with shared interests, and increase their chances to be part of wider institutions, such
as political or people’s organizations. Exchanging information, working on things together,
cooperating and reducing the effort involved in doing something which may provide the basis for
informal safety nets among the people. This can be people and also groups helping each other
and may eventually take the form of federations of Self Help Groups. A federation of Self-Help
Groups is good for building links with service providers, including extension and other
government and NGO services, the rural banking sector, suppliers of materials and links to
markets. Self-Help Groups raising eri culture, banana plantation & fishery etc. in rural
Bangaigoun District has been especially successful. They have the highest savings and therefore
have tended to receive larger loans. The formation of Self-Help Groups gave people the strength
and confidence to ask for and get the support they need. Bringing together Self-Help Groups Eri
culture and flexible rural credit have improved food security and lowered indebtedness for the
villagers.
Key Learning’s:1) Utilize local resource and made community development is the way to improve the
socio-economic status of so called marginalized and poor rural people. That is why here
SHG and weaving programme are very useful for really needy people especially poor
women.
2) The concept of villages Pharmacist is the way to improve the minimum health facilities
in remote area’s where govt, health facilities are not available.
3) With out community action it is impossible to improve the Government health service
and ICDS programme in all over Assam.
4) Concept of Jagruti (Awakening) groups is the way to motivate the people to take action
for their own development and make them self-reliant.
5) Strong commitment, dedication, energetic, self confidence and positive thinking of the
volunteers of this organization really help me to improve my motivation on account of
community work towards community health.
Acknowledgements I wish to acknowledge the valuable assistance, cooperation and support
received from a number of people those are belongs to Village Health Pharmacist, SHG, Youth
groups and members of villages development committee. I express my gratitude to all staff of
The ANT. I express my sincere thanks to my mentor Dr, Sunil kaul, Margining trustee of same
NGO for his kind cooperation and guidance.
f
I
4 days study visit at RVC
From 15-09-05 to 18-09-05
Introduction:-“Rural Volunteers Centre” has been working for rural development with a
common eomnutment to up-liftmen of rural people through the community involvement since
1993. It is situated at Akajan, a small & interior village of Dhemaji District under the state of
Assam From the beginning it (RVC) has been trying to find out what are the real problem &
need of community and then taking lot of action as need as best. Presently lots of activities are
going on throughout surrounding of Dhemaji District, Lakhimpur District and river basin area of
Bramhaputra. It has covered 40 villages directly and more than 100 villages under her control
through strong river basin net working system. Main focusing areas are disaster management for
erosion and flood, land issues, income generation programme through the micro credit system,
action oriented programme as per need of community, awareness programme on various issues
and providing medicine for minor illness through the barefoot doctors etc. through my 4 days
study visit I am trying to understand how they are working with community and what strategy
they are made for future action.
Type of work: 1) To create awareness among the community for their basic right and motivated them to take
action to get for their right in democratic way, like discussion with respective authority signature
campaigning and dharna etc.
2) To provide training among the villagers how to safe and sound themselves during disaster.
3) To create urge among the people how to make self-help group for their better future and how
they properly use their money.
4) To establish Goun Bikash kebang (Village development committee) with the community of
the community and for the community to shoulder the responsibility of community development.
Presently 26 no of GBK are functioning throughout the 26 villages.
5) To build the linkage with respective govt, development agencies and sensitize them to take
proper responsibility for their respective job and also help them to do the task efficiently.
6) To form ANM and Barefoot doctor to facilitate a system for the community to get medicine
for minor illness with low-cost.
7) To organize various training programme, like agriculture, hand pump repairing, bamboo
craftsmanship, poultry farming and basic health care etc.
Key Learning’s:1) Village Development committee is best way of community participation. Here it is
functioning very well with strong commitment for betterment of their life.
2) Idea of Barefoot doctors system is very useful to community health because they are selected
from the village by villagers.
3) Need community action regarding primary health care and ICDS issues due to poor
functioning.
4) Movement oriented programme on land issues really touch me to learn how community
involvement in action has made a path to do something for the real development for all.
Acknowledgement:I wish to acknowledge the valuable assistance, cooperation and support received from a number
of village people those are belongs to Village development committee, ICDS, Self help group
and bare foot doctors (community health worker). I express my gratitude to all staff of RVC.
♦
Over all Remarks: - I am very fortunate to get the opportunity to study in
community health through the Community health cell which is supported by Sir Ratan
Tata Trust. Before start my fellowship I have been working at one of pioneer national
NGO called CINI- Child In Need Institute on community health development programme
through Life cycle Approach in West Bengal for last 4 years. During that period I could
learn regarding community involvement towards basic health care and how to improve
the govt, health system through the linkage strategy with Panchayat (local govt.), Block
primary Health Centre and ICDS.I could also learn theoretical knowledge on account of
community health and how to sensitize the people to take proper steps for their healthy
family, like reproductive & child health including nutrition , life skill education for
adolescent, family planning and STD/ HIV/AIDS etc.
But here during my fellowship not only I improve my communication skill in English and
presentation skill but also I learned lot of new things and ideas in community health as
broader determinant. As an example when we were working with malnourish children in
in
rural area of west Bengal that time we are trying to solve the problem through the
Nutritional education programme child care programme for community and also
introduce the low cost food which are locally available and sensitized them to take each
and every Govt, provided Vaccine in proper time and also given advice to them to
maintain the spacing between 2 children etc. so during that time my idea was that what
are causes behind the Malnutrition. Here I try to show it.
Malnutrition
(Child)
Q
A) Lack of food and nutrition
B) Lack of Knowledge on child care & health and hygiene
C) Inappropriate breastfeeding practices
D) poverty
E) Lack of awareness on family planning
F) Poor govt, health services and ICDS
G) Chronic Infection like diarrhea and Skin diseases etc.
H) Superstition
I) Anemic lactating mother
J) Low Birth weight
K) Worm infested.
L) Biological approach towards malnutrition.
M) Vaccination not done in proper time etc.
Now I trying to mention given below what I could learn more through this first 6th month
fellowship programme.
1) Low budget in Govt, health sector and 75 % has gone for staff salaries
2) Development for Urban and rich people.
3) Corruption
4) So called community involvement.
5) Top-down Approach
6) National & International Policies towards health and health related issues
7) Privatization
8) War and conflict
9) Project oriented work by Most of NGO’s rather than Process oriented.
10) Issue based campaigning not enough for real development need movement
oriented process. Like people health movement.
11) World Bank and World Trade Organization.
12) Open Market policies.
13) Health for Few not for all
14) Not access to health care for poor and so called marginalized people.
15) Health is a fundamental right but still now not implemented because that kind of
movement not reach to grass root level due to unorganized so called marginalized
and poor people etc.
So lam really thankful to this fellowship progranmme and also touch me whatever I
could lean more towards community health and it is also motivated me to do some thing
towards reaHiealth_development wherever I will work in future. Already I have finished
my first phage of fellowship. After discussion with my overall mentor Dr. Thelma
coordinator Community Health Cell and present mentor Dr. Sunil Kaul, managing’trustee
of the action for North East trust I planning to work in Assam for next 6th month.
4
In the context of health situation in Assam is very poor as compare to other sate of India
Through previous experience I could see here govt, health system in rural area like most
of subcentres and ICDS centre not functioning and voiceless rural people not only
unaware about this and buf.nothing to do against it. Basic health care system fully
collapsed here. Keep in mind this situation; I have made plan to work on it which are
given below.
Firstly I shall be tiying to understand more how the Ant working towards community
health with village pharmacist and low cost village Pathology system and side by I
involve in it and also I am trying to become a active associate of the ANT in others
activities according to need.
^^Ocndly 1 Sha11 be trying t0 sensitize the rural people towards poor govt, health and
ICDS system and their right towards the heath for them then trying to orgamzed a
movement on it with the strong participation on same people.
• ''' /
be trying t0 learn & understand more and more in new public health
Shehar Saha
Community health fellow
Community Health Cell
Date:-17-10-2005
II f
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