Preeti Verma CHFP-2009-5-FR-120.pdf

Media

extracted text: *

I.
i
I.
I

Community Health Fellowship

I

2009-2011

■1

■r

By
SOCHARA

I

ib
■

II
«■'

it

$

■

#;

r

ft,

t

%

■

SOCHARA

I
CPHE Mentor

Fellow

Field mentors

Mr. Prasanna Saligram

Preeti Verma

Mrs. Lorry Benjamin (SAHAMAT)

Mr.Jinu John(World Vision India,)
Mrs. Ajita (world Vision India, Bhopal)

I

I

I
■.

INDEX

Content
ft

I
■ I

page No

Introduction of CPHE

05

Introduction of the fellow

06

Chapter 1
1-Communitization

07

1.1 work with ASHA
To know about ASHA

08-10

1.1.2 Capacity building of ASHA

11-12

1.2VHSC Reformation and strengthen , capacity building

12

r

1.2.1 Meeting with VHSC members

13-14

■

1.2.2 Discussion about their work

15

1.2.3 VHSC reconstitution

16

1.3

17-18

1.1.1

I

I -

VHND

Chapter 2
n

2.0 Malnutrition

18

2.1 Work with NRC

19

2.1.1 To understand the admission process

19-20

2.1.2 Staff orientation /Sharing with staff

20-21

2.2

21

Work on community level
1

I

f-

• .
■

-s.

K

I
?■

2.3.2 Time spending with mothers

22-23

2.3.3 Work with adolescent

23

2.3.4 Meetings with mothers and girls

24

2.4 PD-Hearth

25

2.4.1 Community meetings

25

2.4.2 Primary and secondary data collection

25-26

2.4.3 Formation of volunteer group Training of volunteer

26

2.4.4 PD-enquiry and sharing with the community

27

2.4.5 Family identification

27

K

4"

. &

&■.

I

I•
■

Chapter 3
3.0 Work with adolescent girls and school dropouts on different issues

28

3.1 meetings with them and group formation

28-30

3.2 introduced different issues to them

30-31

3.3 different activities in the group

31-33

3.4 Work on the dropouts with in the adolescent

34

Chapter 4
4.0 Work on disease

34

4.1 Identification

34

4.2 Prevention

35-37

I' '

Chapter 5
5.0 Networking with different NGO

37-38

I M

.ij,-

2

I

ft'

i■

Annexures

39-59

f"

1. Work Plan
r.

2. Trimester report

&.

I

II

3. Essay on ASHA

4. A small write up on myself and working area for Yearly Report

■

5. LFA on Malnutrition
6. Adolescent card

hv
h

7. Questions prepared for quiz competition in PD-Hearth program
JI

8. Lucknow workshop report

iT' tH’!

I
ft •

I'

I

a '

I

I
■

I

3

% tfX

%

Abbreviations

i

ASHA

Accredited Social Health Activist

AWW

Anganwadi Worker

AWC

Anganwadi Center

ANC

Ante Natal Care

NRC

Nutrition Rehabilitation Center

PD-Hearth

Positive Deviance Hearth

VHND

Village Health Nutrition Day

VHSC

Village Health Sanitation Committee

it

II
t

i
I

II
I
r
a

I

I!?
I? '

!

i

4

i?

I
■

I& *

CPHE (Center for public health and Equity ) INTRODUCTION

I

The Centre for Public Health and Equity (CPHE) is a functional unit of the “Society for Community
Health Awareness, Research and Action” (SOCHARA)1. It works predominantly in the areas of public

health education and policy advocacy. It promotes a new public health paradigm focused on health
equity; social justice; underlying social determinants of health including gender; inclusive and responsive

J

f
■

health systems; and health policy development.
CPHE’s work can be divided into four broad themes.
Strengthening global and national policy commitment to Health for All with comprehensive

1.

primary health care as an approach.

Strengthening the social and community dimensions in public health education, with focus on

2.

1

I

capacity building.

I

- £&

Promoting a community paradigm in public health research, including engagement with civil

3.
society.
4.

Supporting the global and national Peoples Health Movement (PHM) and simultaneously
catalyzing a public health alliance of professionals from multi-disciplinary backgrounds that can be

f

I

supportive of the Health for All movement.

Centre for Public Health and Equity inaugurated its Resource Centre for Public Health in Madhya
Pradesh on 29th October 2010. The CPHE Bhopal office is consolidating and building on the experience
of supporting public health policy processes and community action for health by SOCHARA in MP. These
have included the response to the Bhopal Gas Disaster, the Rajiv Gandhi Health Missions, the Jan

I

Swasthya Rakshak Programme evaluations, support to the Madhya Pradesh Human Development

Report and active involvement in the second National Health Assembly of the Jan Swasthya Abhiyan in

I

Bhopal in 2007. It also uses and builds on the approaches of SOCHARA, CHC and CPHE.

■

Presently

fV

the

centre

is

facilitating

the Madhya

Pradesh

Community

Health

Fellowship

Programme (MP-CHFP) and developing a network for community health and public health. The evolving
It;,

network has started with NGOs and others working with communities and the health system on health

and development, with civil society organizations, peoples’ movements and academics.

The first Community Health Fellowship program was started on 4th November 2009. 20 fellows were
selected in the first batch and were placed in 14 districts of Madhya Pradesh.

L

i

1 www.sochara.org - SOCHARA

5

i

jr.

f’

i
Introduction of the fellow
■

I am Preeti from Lucknow. Rorkee (Uttarakhand) is my home town.I have done graduation from
Lucknow University with Economics in year 2009 and doing MSW(master in social work) from
Ruhailkhand University Bareilly .This is my first time I am working in social field and a good
experience working with Sochara.And I believe in doing not in saying. I strongly wanted to do
something for the women and children and in the health field that’s why I joined this fellowship.

I
■

I

II'
&■

i

K

Work in NSS and adjudged the best volunteer and was a member of editorial team of college
monthly magazine YUVAPATH. participated in number of kala Jathas and was a member of Mid
Day Meal project conducted survey and contributed in report preparation I am the member of
BGVSUP for last 6 years and engagaed in health movements in Uttar Pradesh and Uttarakhand
as an activist of Jan Swasthya Abhiyan UP.Working as Community Health activist with BGVS
and JSA for last 6 years. Personally feel motivated to work for Rights based issues in health in
general and Women Health in particularly.

1

Participated in various awareness campaigns of Jan Swasthya Abhiyan UP. Also attended in
various training conducted by JSAUP on NRHM. Was a part of survey work for PRHW in UP.
Involved in various report preparations of BGVS UP.I am part of all health programs of BGVS
UP being implemented presently. Have been an active team member at district level in the
UNDP- Funded Community Health Project, A MULTI SECTORAL APPROACH TO HEALTH

I

I
ft

■

I -

I

I

Ambition : I have an ambition to work as a Community Health Expert with a Rights based
approach. For that I have to continue the work that I have been doing all these years. I need to
further develop my skills to achieve this objective.

I

••

I

I
I

ft’. I-

I

6

1-Communitization

$
$
M,

I

'iI
It

F

Communitization means “community ownership” of community based services. Community
monitors the services and participates in it and at last community takes its ownership on the
services that is called communitization and in that situation communitization works according
to the needs of the community. After Alma Atta declaration the primary health system of
community participation become a main method of achieving health for all, and health is not
only medicine and the absence of diseases but its all the social, economical and physical
well being2.Same in our country the main focus was on communitization of health services
and for its development different components were introduced like ASHA, VHSC etc, and to
connect communitization to the ground level we performed different activities. The first step
in the community was work on the communitization and to strengthen the component of
communitization. This started with ASHA (accredited social health worker)

i

&'

1.1ASHA
■

■

■

I
K-'

In the NRHM a component named ASHA was introduced as a link between community and
health system .ASHA represent herself as a community health worker in the system ,she is
a support for ANM and to share her burden and as a last to bring change of health system
.ASHA will be a women from the community .should be a married .divorcee, widow and will
be selected by the community by Gram Sabha she will be responsible for panchayat a non
payable volunteer but will get incentive for her work ,her all duties will be charge less and will
be trained for mother and child health '.

ASHA is the new and very important chain between the health system and community .she
was the first person with whom we met and started our work .there was different things we
worked on with her, all were to understand her, her work .connection between her and
community etc. different steps were taken for that;

I

■

I'
.r.
K

7

4
.j

I

1.1.1 To know about ASHA

r

I
If

II
I
3

III
i&'i

5

I
I

To know about ASHA and her work; To know about her economical and
Objective
Social condition.
Process and Methodology

First developed a understanding with ASHA and her family collected many other information
and done in several visits .when ASHA become friendly with me I interviewed her with her
permission ,l don’t force her for anything but in a normal manner she answered me .during
our interview she was doing her other work too and was not feeling any pressure .In the
starting observation was done of ASHA and her work .during my field visits and personal
visits .theses visits were done at hospitals and community where I came to know about her
work .after that several interactions were there in those interactions discussions on personal
level .discussion with family and community was involved. And there was interview done with
ASHA to know her with deep information and from the very close view, in the interview many
things were involved related to her work .economical condition family etc. This was not direct,
there were many home, village visits before that in the visits personal meeting with ASHA
.her family .community were involved .personal visits helped a lot in the relationship building
and bounding between us. These visits planned according to ASHA whenever she free from
her work or gets time. Before interview several home visits were planned with ASHA
according to her schedule, home visits play an impotent role which helped a lot, due to
theses visits ASHA become friendly and comfortable with us like a friend. First one month
was spent in this process .In the starting I started with formal discussions with ASHA and
community in which I took the help of SAHAMAT staff.

Table no.1 Source -by interview done in February 2010
Name
of
ASHA
Radha

Village

Class

Selected
by

husnabd

Jalikheda

5

majdoori

Tribal

Manish

Bhumkapura

5

Direct by
ANM
Do

Do

Meera

Dhansai

8

Do

PANCh
of
the
village
Farming
and
majdoori

8

Incentive

Cast

Do

I
ir

I

Findings
Thru interview we come to know so many information her background economical condition ,her
interest in her work .family etc.

r

ft-.
■

tI
I

I

K

I

ti
i

i

I

|

I
II
■

Through these activities many things come out from the visits her family condition and
community connection ,her work and selection method s know by these .As she is the new in
the community ASHA is selected from the village or within the community there are some
reasons behind that, she can understand community and its need with a better way , she is
one from the community that’s why community will accept her easily and will trust her .third
directly connection of the health services .information about the changes or health services
so that the gap between community and services could be fulfill. But during our interview we
came to know that she is facing some problems in her own community, by the system and
family which are hurdles in her work and the main objective of ASHA is blurred in the smoke
of these problems
After her selection ASHA became a main and special person in the eyes of her community, it
becomes a reason for the joy for some people in the community and sorrow for others
.community think that she is having some personal interest and receiving salary from the
government that’s why she asks them to come to her and get treatment that’s why she faces
bad comments from the community , some time when pregnant ladies used to go to
hospital for their ANC etc and by chANCe they faces any problem or experience any kind
pain .family or husband connects it to the checkup and starts quarreling with ASHA and
threats her in bad words like “if my wife or my child gets any problem because of your advice
I will kill you and you won’t be able to stay in the village these things are faced by her in my
presence . Some families don’t listen her and laughed at her after her leaving, she keep
saying them and they even don’t look at her and keep them self busy in their work. Now in
the community she is working as a depot holder too and as a link between community and
system but the she is facing negative and positive both kind of situation.

The families showed different interest in the ASHA, they think and having expectation about
the permanent post of the ASHA .this thought is available in all the families and due to this
they agreed to sent their daughter in law in the community . her husband also thinks the
same way .with this she is facing some other things like in some villages ASHAs work is not
noticed with respect by the in-laws, and during their fight they verbally express their feelings
.a ASHA need to go to home visits, meetings .and in the daily routine other people like
BMO.BPM.MPW other system people comes in her contact, she rushes at any time with the
pregnant ladies it may be night day any time .but this is not allowed by her family and her
family and husband rises questions about her work etc.

L
!

I

9

I

-I

I
Her relation with department and their behavior also a finding of this step, a common thing
about the behavior of the department came out . Although she is not a government servant
but the system treats her that way. A supervisor compliance about her with the words that is
you will not work we will select another one and will compliant against you

i

During my field placement I took the interview of three ASHA but done interaction with 12
ASHA in the field ,62 during the ASHA training in district hospital ,In the interview I came to
know that all three were selected by the ANM without any process and in the starting they
told that they have to work on the delivery only and have to distribute medicine in the village
,all were educated till 8th class ,the tribal community and tribal area may be the one reason of
their education ,and may be due to this ANM selected the women whose education was
higher than others . and in this discussion and interview they expressed their feeling also the
feeling was about the post of ASHA ,they thing that this is a government job and we will get
a permanent position after few years. Some of them were supported their family and
husband were doing they daily Labor.

I'
■

ill

I
■

I

I

Conclusion

i
■

*

|

S'
■

in the community before the selection of ASHA no one was there for the community and they
have to go so far for any small help as ASHA is new in the community she is a supporter for
those who are happy with her selection and for some other s she not useful for them ,due to
some miscommunication they concept of ASHA could not delivered properly . she is working
in the community but confused within many things .sometime she has to face her family and
community with many difficulty things .other hand department taken her as a govt employ
and treats her that way, with many threats and complaints people tried to make her
discomfort ,and ASHA thinks herself as a employee too that’s why she never protest for that
if we want to improve her and want to do her capacity building a transparency is compulsory
and a supportive structure is needed .where ASHA and community could understandI the
clear meaning of ASHA and her work, where ASHA could share her thought and work related
problems

I

I
ft*

I

I
t
I’
I

10

1 •1 ■ 2_Capacity Building of ASHA
l*:

I

I
I

Objective

S XTmate

a“re ab0U* h“ rate - ~ ’■

Process and Methodology

For a feeling of empathy a plan was made to work or to follow ASHA in her sohedule so that
close understanding could be developed about her. Generally our one or two dav 4 5 hour

fl*

t'il.

■

fI
■

period she could do all the thinas bv her 86 109
W'th the fam'ly but after a time
period she changed her view abou/her
’ a"d.after comPletin9 this time and during this
about her and her work .Trainina wa<s d
Yf
.husbands ’theV also changed their mind
the department personal level trainina °ne
W° eVS' 006 'S personal and the second is in
my Visits in the stX I
th
.
W'thin
C°mmUnity thiS Was done dud"9
community health worker artide XoXr^XT ™
°Ur trainin9 and the
chance to give training to 62 ASHA and I han'd'l d 7d ytme 0(1 department level 1 9°* the
my own experiences and in thk tr ■ ■
S
3y rain'n9 ' taught them module with
the theory
P th'S
Were practical experiences involved more than

Findings

ttto kh™J

X7"stZ\XCsOm?dnh“H and i,S View ab0U'ASHA ■™s steP

a

information observed in that period Where0ASHA is'belono*dT"9 ,h6 Sh0,' ''iSi,S ,0“°™"9

11

■

II
Ki,

p'

I

welfare of the community and her wife also having almost same thinking that's why it was a
positive thing in the favors of the community .

1

Different from above in a village ASHA was extra innocent she works according to the ANM
and helps her in the immunization day and works according to the comfort of the people
.with that innocence she was full with patience and used to deal people with patience .

Learning
About ASHA

Her economical and social condition that the ASHA of Kesla block were from the tribal
families and all families were depend on daily wages. Their first impression about the ASHA
was as a job and permanent post. In the community she gets different identification, as a
helper .depot holder ,as ASHA, ANM helper etc.

1-

5
I

I
I

Conclusion

If she provided support by the community and system ASHA could be a great link and
support for the community .like the trust and faith of the community and family was needed
for her capacity building .

!

-

I

I
g

I
r

T

I

t

1.2VHSC reformation and strengthen, capacity building
VHSC formation is a step to increase community participation in the health services and in
community level organizations .it’s a step towards developing a ownership within the
community 3.During the work period we found that the VHSC is present in the area it is
positive but its was sad that it was running only in papers or the a proper implementation
was absent

I
I

I
i

■i

I

3 VHSC Guidelines

12

I
I

ir

I
I

&■

I

I

1.2.1 Meeting with VHSC members of three villages
Introduction
A meeting planned with the members so we can introduce our self to the members and could
get an idea about the members and their work etc
When we started our work in that area it almost past one year of VHSC formation which
increased the hope of a better functioning and implementation of VHSC

Objective

r

I"

I
i

i

To give them idea about their hidden power or the authority; To get an idea about their
familiarity with VHSC;To know the members,

Process and methodology
The first interaction about VHSC and ASHA was done with BMO ,he told about the formation
and functioning of VHSC in his words ,VHSC was formed in all villages and a group of 10-12
members is formed in every village, accounts and fund release is in process in some villages
and other

M

I
J
t"
I

II

I
JI

After BMO the further interaction made with ASHA .according to ASHA the groups are
formed but till now we don’t arranged any meeting of the group that’s why members don’t
recognize each other .fund is arrived in the account and ANM told us to bring some furniture
and mats etc with that fund and time to time we have to full the road with mud , AWW said
that I don’t have any idea about the committee but I listen from ANM about it .that it is a
committee in which 12 people will be permanent members ASHA will be sectary and PRIs
member will be sub sectary after that nothing new come about its work and meetings etc
ANM and MPW told it’s a work of ASHA and PRIs member we can guide them because we
are the members only but main power is in the ASHAs and PRIs members hand
Then I approach the other members of the group ,l got the names and address from the
register but in that register the list was incomplete .with that we visit to those people whose
named was present in the list .and this visit was one to one level visit means we interact with
them to them one by one not in group, the words of the members were shocking because
they said we don’t know about any kind of committee named VHSC .they remained confuse

.even were not recognizing their sign in the register. then ASHA stimulated them and tried to
make them rethink about the process which was conducted by ANM and MPW .them few
people said yes one year back ANM took our signature in a register and told that we are the
members of a village committee and I am writing your in in the member list . in this process
we tried a lot to make them rethink about their names and signature after a long time they
succeed in it. A meeting planned with the members so we can introduce our self to the
members and could get an idea about the members and their work etc

When we started our work in that area it almost past one year of VHSC formation which
increased the hope of a better functioning and implementation of VHSC
13

'■'r

■i

IV

I
t'

I

I

I

Village health and sanitation committee was formed on the village level so that the health
and sanitation services and their presence could be make sure .Let o ing and mon, or e

Sr

9

could be handled by the community etc

I
I

monitoring

VHSC was formed earlier but (he problem was that people who were the members of the
LTason 0fevHSC fhaVet,he kn°’,led9e a"d i"f°'™tion about their membership, second
o heLrouos
"as ,Ota"y abSent from ,lle community ■“
“d" as the

When asked about this committee people could not recognized

the name then process

thaMn
'h h001 °f the Pe°P'e and by that they Said y6S they have S|gned something like
that
which there are 10-12 member and ASHA is the Sectary in that. ASHA showed that

I

I

oeonl
h'6 the Sh'n9ed
‘aken by the ANM and MPW ’We called a meeting wi‘h those
people who were having their name in that paper that was the first meeting of VHSC this was
done in two village first in Jalikheda second

Finding

ir,

The guidelines and actual knowledge of the people about VHSC is different
After completing one year the group is not connected with each other

The malfunctioning starts from the top

Learning
Monitoring and renovation is must if positive results are accepted Ownership is the tool bv

IS n°' 'am"iar and W','’0U," COmmUnlly

and up liftment is not

Conclusion
Being a single officer in the CHC BMO of that block done a great job of the formation of VHSC a
small mistake or careless behavior of the implementers changed the concept of this committee in
he eyes of the community and the members which has proved that the a confused system will not

<o

o, °wnerehip wi,hi",he —»- »«

14

I
I
L
1.2.2Discussion about their work and why this committee
importance of the group

formed,

ii

ft,

After finding the actual situation we started our work as a facilitator in the strengthen the capacity of
VHSC and its members

• &

Objective

I"

5
is'

"I

To orient the VHSC group so that they can get the actual idea about VHSC;To strengthen the group
and capacity building ;To encourage the communitization process and introduce community and
VHSC to this word

Process and methodology
A regular interaction process was developed from the starting, by which I tried to bring clarity about
VHSC and its role within the community .these interaction developed a atmosphere of good
understanding between me and the community and VHSC members, and the role of every member
was clear because of guidelines and they come to know about their involvement in the VHSC
When all the members come to know about their names as the members of VHSC they asked me
about the work and their role in the committee .and what will happen for the village thru this step it
was a positive thing for me which showing their interest to work. After that the first meeting of VHSC
and date were decided by the members and facilitated by me.

Findings

pi

K

After the first meetings I came to know that the paper were s
singhed by the ANM directaly and there
ws no meeting ,no information about VHSC .even members were surprised by their name they said
that it ANM said your name is written in this paper and it’s; a paper you have to sign it,we thought its
any scheme like other schemes and we have to sighn it.

t

Although some mismanagement was there but thank god VHSC was formed .after a first introductory
meeting it was decided by the group that they we sit for the discussion on every 10th of every month
and will discuss work to be done and work done.

I

Conclusion

l«r

When community understands its power anything can be performed by it that’s why there is need for
a facilitator and rest is depend on community .actually community needed a facilitator only otherwise
community is best medicine for its own .

|

I
I

I

I
rI

15

I

I

■

■

1.2.3Reconstitution of VHSC
Uj: B

■I

ffl':

Objective
To Develop the ownership within the community

i

Process and methodology

I-

I
I

i'r

.

they come to know about their involvement in thVvHSC

C'ear beCaUSe °f guidelines and

I
I

I
Findings
VHSC members were present in the list but members were i '
not aware about their
membership and work: on the other hand VHSC presented with
'a common committee in
front of the community

SgSWWsS
VHSC and its implementation get effected .

‘0 thSSeS k'nd °f differences the

J
Conclusion
it that's wt,y there is

“e"

facilitator only otherwise community Is be"!' mOe"dio°n™™s o™"13"7 COmmu",l>' "eeded a

16

»kl

if

1.3 VHND

Objective

I

To increase community participation in the health services; regulation of health services

Process and methodology

hen attended their VHND after that I planned things which I need to change in the or need to format
m eir schedule . first I discussed with the people who were doing this in the community VHND
was performed in the community but was not in a proper way ,1 discussed all the things with
doTthA vJnh" ASHA’ANM’ MpW,AWW and the plan about the changes which we are going to
ao in the VHND process.
a

*

4

Discussion on the organizing VHND in a proper way and what will be needed for it I
facilitated all the process .in this meeting the discussion were made by the VHND
organizers, like who will call the community and will give information about VHND place to
organize VHND and the things which will be needed in this process. Before that’ I trained
them for this process and a movie was present on VHND organizing in front of them.

h38
VHSC members and informed t0 the community .this process was
d'“b®cause everyone was supposed to come to the where VHND was organized that’s
^cont t
'nteraCt With the COmmunity before one week
continually stayed in
they to"d thaTtMA
they convinced PeoP'e for their presence in that day and
they told that this is organized for everyone in the community .VHSC members facilitate by

A^V XnTZ Wh!?
Were faCinS any Pr°blem ' Facilitated ‘hem about the method
•AWW prepared the adolescent girls for the VHND and that day all girls attended VHND.
!

Xe“,S and ,hey °r9aniZed °,her ,hi"9S ,Or 11 'ike “le , chair

ir

Findings
f

&

VHND was organizing in the community but due to some reasons the process was not

I

I
I1'.

I

I

organized properly .After movie presentation they tried to do all the process in a proper
manner and the first VHND organized by them in proper and useful manner. The task to
VHSC Was useful
mXeZZbg00 ' place its very difficult but 3a facilitation t0to VHSC

17

they

*

In the first VHSC the community shared many problems and

&

Conclusion

If we mange things with a little information and guideness thigs could be better and many
community problems will be solved easily .this will be useful for those people who are far
from the services and resources.

I
2.0 Malnutrition

dr'

I

L
nr
■s-

Kesla is an Adiwasi block ,in this block there are small villages situated in the interior of the
jungle .people earn their livelihood by daily labour .migration to other cities ,and small lands
,etc. who are having small pieces of land they grow Gram .Corn, Soyabean, etc in their
fields .other then poultry through SHG, goat etc are kept in the homes it’s a good thing but
due to open homes they can’t develop kitchen garden etc, second the distance of the
market from the village is too much and transportation facilities are not connect to village
and main road which makes difficult to reach to market and get food items daily, during my
visit in three villages of Kesla few things were noticed like, the whole family use to go to out
for the earning it may be elder person or children, young kids look after by their siblings due
to these things children usually don’t receives proper food and care at home and not at
AWW, and noticed that the weight of the children is coming down in the presence of M\I\N
and NRC after seeing that I decided that I should choose malnutrition as a key topic and
should start work on that.

u.

Ii

I

a.

Objective

To introduce community to the word malnutrition and its effects on their children; How they
can prevent and treat malnutrition on community level and aids other then community; What
was done; first village visits, AWC visits weight data collection and the close observation
done to find out the actual situation of the children
2.1-Work with NRC

2.1.1 Understanding the work of NRC

i

Introduction of NRC

• -

I

I

I
I.. ■

&

18

i|

!■

• 66-

i

Sr

I

J

I
w
.

Jg'

! .
is

i

j

Ij'
i
<•

It.
SI- ■
W':

B'

t

I
I'

0*'
4-

)■

ffiift.

NRC is a government setup which is organized for those children who are suffering from
severe Malnutrition and need medical support. In this setup the child gets 14 day
residential treatment and training for their mother on health care and child health, nutrition4.
Objective

To understand NRC in a better way its actual objective and work

Process and methodology
took the help of the reading material in knowing NRC .its guidelines etc. interaction on NRC
with AWW , frequent visits to NRC was done to develop a good understanding between
NRC staff and me. First interaction was done with AWW , what she knows about NRC in
her words NRC is a hospital in which children gets treatment for the low weight and
weakness,
in NRC the interaction and discussion was done with the ANM .dietitian .cook etc. a normal
process was used ,l use to go to NRC during the working hour .asked them about their
work and NRC and what is the objective of NRC, things I came to know from them are,
NRC is a place where we admit the severe malnourished children for fifteen days .any care
taker is supposed to stay with the child, the care taker gets counseling and teaching about
child care and child nutrition .there is provision for 65rs per day to be given to the care
taker or the mother of the child so that they can fulfill there lose of daily wages there are
four follow up checkups in the interval of fifteen days etc .

Findings...
NRC full with all technical support, trained staff but one sided structure .A child is very
precious for the parents, special for a tribal community a child is everything, but if
something is disturbing their daily routine and livelihood they don’t allow it and focuses on
their plan only.Very costly and high tech structure couldn’t be helpful in helping vulnerable
until the “reaching to the unreached” and “bottom to top approach” will not be adapted A
close relation is very important to understand something with its actual situation a
appreciable structure but not practical

Conclusion
Conclusion , a family based in the interior area .for them is not a easy task to go out from
the village and to stay in NRC for 15 days . first they fight for earning their daily food which
'S-thT 'rnfport^nt for them for this/hey don’t focus on their health too and keep working
wi h that . for them today is more important than tomorrow, second they don’t understand
w y they have to focus on their children in their growing age .why they are registered in

I'

f'

4 NRC guidelines

19

i

I

n
n1

Anganwadi etc. Anganwadi is not meeting that point because of her business third NRC is not a
bottom to up structure again in this the planning is done by observing the cover only otherwise this
kind of unfitted structured was not developed ,all is good but if the one for whom its developed
couldn t use it .nothing is good . Actually If it’s for the community then there something should for
the motivation of the community which can help them to understand about the importance of the
health of their child and NRC.

I

■

I.,

I

2.1.2 To understand the admission process

7

Introduction

W;

« •

ia.

Admission process in Anganwadi and NRC is totally different .And NRC process is slightly
confusing .

I

Objective

To make a comparison between the Anganwadi criteria and NRC; to find out the
acceptance and adoptive chances of the criteria within the community

I
•

f

Process and methodology

This was done by the visits and interaction, and observation in the NRC. First I interact with
the community and people who has the experience of NRC and AWW Because I heard
that their mothers returns back from the NRC and even their child is underweight they
could not understand why they don’t admitted to the NRC . after that I visit to the NRC to
interact to the staff and they told me verbally that they admit children with UNICEF
slandered in which we take weight and Height and MUAC tape measurement etc .after that
I started close observation by spending time in the NRC it was for one month .

■V

!’■

S'
Findings

The admission process was different from the AW which was making it difficult to admit
children . because in the NRC UNICEF's standard is followed .in this standard they take
Height and Weight of the children with it they measures MUAC (mid uppur arm

li- ■

if
!.►

■■■

I

I

th'ng fr°m d0esn,t match with the standard they don’t admit the child
in the NRC. People
faced
.
I rmany problems due to this thing . and another thing is this
standard is not clear to
-AVWV' or the motivator .that why they could not understand about
20

a-

1I
the children ,to whom they should take to NRC and whom should not that’s why the carry
all the children with them if the child is under weight . in the community people told their
experience that they felt very discouraged and its very difficult to go far from the village and
returning from there.

I

Conclusion
s.

I

This thing discouraged people very much and admission process is not fit for those who
are living in the remote area and could not reach easily to the NRC.

lli
&'•

2.1.3 Staff orientation/ sharing with staff

!

Objective
To share the condition of field and things we learnt from training; to increase their
involvement with devotion in the NRC and Mothers counseling

I

Process and methodology

!:r

ft

I

;r

Si
ft

-

During my visits they showed their interest in my work and said that I should share with
them about the field experience ,1 felt the same thing that’s why I planned my visits
accordint to that J shared my reading material and notes field collection with them and we
used to disscuss with them ,and they use to share NRC experience with me about the
mothers and children even about their staff.

ii-i

I•

I

2.3Work on community level

ft

I

The problem of malnutrition was present in whole community that’s why I started work with the
community on different level .so that the community could get an idea about malnutrition and its
impact on their children, how they can cope up with malnutrition in the initial phase ,how the can
identified malnutrition by some signs etc.

2.3.1Work with and counseling of Mother

Objective

I

Iu-

II-

To make mothers more aware and more concentrate on the child and her/his health; To
handle and recognize malnutrition on primary or initial level.

Process and methodology
This activity was focused on mother and to orient her on malnutrition and her child ,several
visits and meetings were held with mother at her home where I get time to spend with her
and to know the care practices in depth so that I can understand the nature of inputs
which is needed in that situation . with it I participated in their home work etc and tried to
21

■■

f

I
r
&

‘

f1

I

I• s

IJ

I

b. •.

'I

s-i .

i
wr

spend maximum time with them so that I can observe the habits and their care practices .
this was not enough for knowing them so I planned other activities like by organizing some
programs at AWW and conduct discussing with them on the topics related to them etc. by
visiting to their fields because if were keep doing things with same methods it could make
them bored and irritating that’s why I changed venue and interaction methods .

Findings
Mother behavior for the child care During this I came to know about so many things this
which was not possible by the outer observation, children are grow up by their own
because in the tribal community all the family members goes for the labor work or field
work .some time they carry their children with them and we can imagine that what kind of
care the children gets in the field and in the absence of their parents. Mothers tries to give
best care and nutrition in the available resources and in their view they are giving the best
care and food. Knowledge on Malnutrition of the family in the family people treats children
with same attitude as they treats the elder people in the family .in the discussion of
malnutrition first they were not recognize it but letter they came to know by the name Under
weight and they take this as a normal thing thought that the child will recover by own self.

ft’’*

5

I
I
;■

|

I'

ffi

lr'

Traditional thinking about the food habit and child care how they look after their children And AWC
is a food distribution center for the community .After this work few families which were in my contact
they started thinking about the health and Malnutrition and started asking questions ,and
community and AWW interaction increased a lot, mothers use to visit AWC and keep asking
questions about Anganwadi facilities and about their children .

Conclusion
Something is missing from the community that’s why after the implementation of ICDS and
NRC community is not able to tell about their child and why we should give more attention
to the child ,why he is not like the elder people .
During this orientation a thing become clear that the children are not getting fully attention during
their growing period due the different reasons.

2.3.2 Work with family

I

Introduction

B

I
22

I
•

k'.;.

I
|
I!;;

Some time whole family look after the child and follow their traditional methods .it may be
positive or negative, if we will get success in the orientation of the family the more than half
problems of the children will be no more .

Objective
-

To increase the participation of family in child health and malnutrition; to give them
ownership

Process and methodology

■-

I .
ft'-

I
■

I■
jap.

I

r

I
I

Family involved in this process interaction and discussion done with all the family
members, first interaction done one by one with all the family members and then in the
group things discussed were how they look after their children and practices which are
following in their families . generally most families said that they don’t given any special
attention to their children and all brought up by the same method ,and we give the same
food to which we used to eat in our home and in the age group below 6month mother feed
the child with her milk only when the child starts crying etc

Conclusion
The mind set up of the families and community needed time to change .

2.3,3Work with adolescent girls
Adolescent girls are the future mothers and first of all they are girls and generally they
ignore their own health and nutrition. Even in the growing age they don’t get that much of
attention and nutrition which is required by their body, that’s why they become
malnourished and gives birth to malnourished children this cycle is an unending cycle if not
watched5

Objective
Adolescent age malnutrition prevention thru this to make girls aware about this ;To prepare
girls for the malnutrition awareness and future
5 UDDAN a book of adolescent girls .

23

t

I
4

I
I

J

a

I

■i
Si

I
I

I

I
I

I

Process and methodology
A group of adolescent was formed in the community in this groups girls from different age
group and classes were involved ,there were different objects behind bind forming this
group but thru this group work and activities .sharing different things on malnutrition was
done .initially the health and nutrition of adolescent girls was the main focus in the group. In
this group we discussed about the health and nutrition of girl and what is their views on this
,what they think about this etc .Then the connection of malnutrition to the health and future
impact on human being ,if not cured what could be the impact on children etc were
discussed .these activities done in different meetings and sessions .these girls involved in
the AWC’s activities which done for mothers and children .in these activities girls
performed as vole enters and delivered MSG on malnutrition and its impact. Identification
of malnutrition ,how to tell it to people these things taught to them and they discussed it
with mothers .

Findings
During this process I came in the contact of many girls who had left their education in the
mid and who are dedicated to their families . but all were interested in school and further
education but due to their family condition they were not able to go to school and were
helping to their families in their earnings .

Learning’s
In the community there are many people who are having interest for so many things and
this interest can make a change, only there is need for a initiative .

Conclusion
A adolescent girl group was formed in this activity .in the group there was many girls who
has dropped their school due to some reasons .after the formation of the group a little
push make them active and they showed their interest in study that’s why they participated
actively and were keen interested to learn about health and nutrition .because of this
interest they delivered the message of malnutrition in a better way and made their
understanding on it .this shows the volunteer groups can make a difference if they get good

24
■

I

4:
■ir •

i

i|

I

II
I

2.4PD-Hearth
It was a sub activity, done for malnutrition and its prevention PD-hearth is an activity which
preformed on community level for those children who are surfing from moderate malnutrition6,

2.4.1community meetings

ft

Objective

&

to introduce the programmed in the community

U'

I

I

■ ■

'SV

i

I

Process and methodology
We planned this activity with the support of AWW and ASHA that’s why ASHA and AWWs
orientation was the initial step .I cleared to ASHA and AWW the objective of the programmer. four
meetings done with them and discussed PD-Hearth .planned meeting with community .many
meetings were orzanized for the final meeting and ASHA,AWW, ANM all helped in this process
and they spread the message about PD-Hearth meeting and coordinated with all members . many
time we failed to organize the meeting then again tried to invite them in the second try we added
the information about the programmer and malnutrition etc and this thing developed interest in their
mind, with the community support we done this meetings

Findings
Community was frustrated with these kind of activities that’s why it was difficult to call them
for the meeting. There are present many differences within the community. It was difficult to
manage a meeting in the community.

i

2.4.2Primary and Secondary DATA collection from AWC

t'

Objective

If
■

IIII
■

J

f;

To know the actual nutrition and malnutrition states of the village; To know families and number of
children ,0-6 month and 6mt-5yrs; to know the actual DATA of malnutrition

Process and Methodology
In the starting I took data from the AWW records and due to the incomplete data some efforts made
to complete the records .then the data about families information .birth .data according to age
.underweight children .malnourished children etc were collected . Several visits made to Anganwadi
and time spend with AWW to make her complete her records

■

(4:

I
I

i

6 PD-Hearth Book

25

I
ar-

I

I1

I

Table no2 Source Jalikheda AWC 2010

Findings

I

Great efforts by AWW even she is having so many engagements; A\/\I\N was a SAHAMAT worker
that’s why her tackling capacity was good.

r1

With a busy life style AWW maintaining activities but not able to fill her registers on time .it was
difficult to collect the Data.

|
i-i •'

2.4.3 Formation of Volunteer group in the community and their training

i

Objective

H

I

, il

i'

I?
IF
i

23 families were surveyed in which 06 were 06 month children, 6mt- 3yrs 18 children ,out of them
11 were boys and 13 were girls

Conclusion

To develop community level worker in the community; to Introduce volunteer so that we
could fulfill our gap after our withdrawal

Process and Methodology
I started with those girls who were in my adolescent age group and they already had a
exposure on Health and community that’s why I select them as volunteer. I select those

Families
surveyed

0-6
month
s
childr
en

6-3
yrs

Boys

Girls

23

06

18

11

13

Or

r
d-i-

I

who were more
active in the group
about health issues
and who were
interested in this
work.

Finding

i■
LV

Due to their

orientation the group handled many things.

26

if.
it'.

I*

■

I-

I

2.4.4 PD-Enquiry and sharing with the community

I?;'"

Objective
To know the Malnutrition status and Care practices within the community; to share the
findings with the community so that community could understand to the program and
condition of their children

■

•'ii

I

Process and Methodology
PD-enquiry started with the help of the volunteer group .first we done group discussion
which was facilitated by me and conducted by ASHA and Volunteers. This process was
done with 23 families and these family data was taken from AWC, about those families
which are having children 0-5yrs old. Then the family level enquiry started in this process
Volunteers participated in the first two days and after that they went for their earning out
from their village that’s why I Took the help of Anganwadi Sahika and ASHA. We
completed this process in 6 days and three days in its analysis which was done by me.

I

II
.I
I’

Findings

•

I
I

By this we came to know that the 23 families achieved full immunization and mothers were
aware about immunization and they handled the immunization card properly. Care
practices were normal in all families. A similar thing which was present in all families that
they don’t give any extra care and attention to the child, the use to give the same food to
the child which was consumed by the other members of the families .only three mothers
were aware about the ORS and its use ,but homemade ORS was not introduced to the
community.

j

Conclusion

i

2.4,5 Identification of the families

t

Objective
To involve them in the PD process

1

Process and methodology

‘r

r

I
H

I
1i

First the analysis done of the PD enquiry process and with it analysis the weight taken on
primary and secondary level and then focused on those children whose weight was same
from the last five months and were in the moderate malnutrition, besides it we include
those children who don’t get admission in NRC and were in severe condition plus children
who were coming to the border line of moderate malnutrition
27

I?!

1,

3.0 work with adolescent girls on different issues

Because of a tribal block and an interior area girls could not get proper facilities and cant
fulfill their needs etc. and their education also restricted due to this problem .when I was
working in Kesla and SAHAMAT I got this idea to work with adolescent girls even in my
field area so many girls were there who left their school and involved in other work for
earning, during my visits they use to meet me and talk with me about the work which I am
doing and why I am doing, some time they helped me in arranging the meetings and any
program in the M\I\N and in the community.

Objective
To prepare volunteers on community level; to divert them toward health issues; Make
them aware about the own health

3.1 Meetings with them and group formation
Introduction
During the working period in Kesla I come in the contact of SAHAMAT Hostel girls .that
time I used to take classes of them on their subjects and I realized that there is need to do
something with them about their health and I can do that because I was working in the
health field . I felt that they need an orientation so that they could understand something
different which is not related direct to their class etc, and there were 65 girls it was an
opportunity to share my learning with them.

Objective
To make the girls aware about the health etc

Process and methodology

I used to take classes in the SAHAMAT hostel, this hostel is run by SAHAMAT and there
are 65 girls who are in class 9to12 .during my placement I got the opportunity to work with
them ,and used to help them in their study .most of the time I was with them that why I
thought that I should work on adolescent health .

28

1;

i
|

To perform this activity I discussed with them and told about plan that we will form a group
from each class and on every Sunday will have a meeting on the health and problems
faced by the girls during the growing age etc. we had four meeting before the group
formation in the hostel .and this activity was done in the community too where many
meetings were organized for the group . this process was interesting because the girls
were very interesting in theses meeting and were sharing their views .

t

■

In the hostel we done the meeting with little efforts but in the community it took time .in
theses meeting girls shared their quires and questions about the group etc .after
completing the phase of meetings we formed the groups according to the age class and
mix groups . According to the age groups was formed in the hostel and mix groups were
in the community, in the starting groups was identified according to the age and class but
after some time we formed cards like identify card which were for their own knowledge so
that they develop interest in their health and health issues .these cards contained name,
village blood group, height weight and their photo etc. cards made according to the groups
like there were two types cards pink and blue,pink for small age group and blue for big
age group.

These cards developed by their choice and interaction and discussion

Findings
t

By this activity we come to visit so many girls who were very talented but due to some
reasons they left their education and working with family , girls started thinking towards
the health and they were discussion with each other about the health. Meeting bring them
close to each other and in the community girls started to think about themselves and felt
they should give time to these activities
Hostel and community girls were slightly different from each other .girls living in the hostel
were having a lot of time for themselves but girls in the community busy all the day and
hardly get time for them, Hostel girls were not that much shy but in the community we
made a lot of efforts to bring out their thought or their view .In hostel I spent a lot of time
with them due to this the meetings and relation development was easy but in the
community it took time to develop a good attachment with the girls,

i.

E

29

K-

I'

I
Learning

■

II
I

I’-.

r

How we can manage a group of adolescent girls and to understand their mentality, to
conduct a meeting in both situation an organized and well planned situation and
unorganized situation.
Conclusion
A small amount of time was spent with the group and they become very active by the
inputs no other distraction was there ,if they will get something in a continues way they will
enjoy it and will get something good for their life .

3.2 Introduced different issues to them

First there was the introduction with the bases health and then the focus brought on the
specific issues

I

t■

Objective

I

To tell them Why health is important, Health is not only medicine, What is adolescent
health and what is necessary for them in the growing age ;
Process and methodology

I;

i

After formed the group many meetings were organized and interaction done with the
groups about the health issues and tell them that the health is not related to medicine
only its was not easy but I tried to do the best . but I started with small things like their
personal hygiene and their living style .like in the hostel girls was using a tank for their
drinking water and that not much safe for their health ,and they usually getting diarrhea
after some meetings I discussed with them about the safety of the water and that they
should wash their tank daily and should refill it with fresh water ,they followed this things
same thing done with the group which is present in the community they were using water
pots for the water but some time they left it open but when we stared the work on health
some girls changed their habits and taught their family also . with this we added
adolescent health because we were working with adolescents ,in this first we discussed
about their age height weight etc .then tried to connect the food habits and health with
each other . this discussion was done in both level community and hostel on community
level we include different topics in the discussion like their food habit at their home and at
hostel ,in community we observed and discussed with them about their habits
Observation done to know the actual condition and their liking for food, life style etc.

30

l

-

Findings

By the above process we come to know about their behavior etc, like in the community
group girls usually don’t give importance to the food and their health there are many
reasons like they work continuously with the family and they alone migrate to other
places for the work and in this busy schedule they ignore their health etc ,on the other
hand girls in the hostel gets the attention and care from the warden and in charge that’s
why they can give more attention on the food, and health care also given by the hostel .

Learning

i

The hostel also running between the community but the difference in care and attention
made a difference of lot , the girls from the community is not able to come to the hostel
because they are managing their home and earnings .there is a lot of confusion between
the community about the health of the girls ,and some time the girls are supposed to earn
the money for themselves or for their marriage

Conclusion

I

There were two groups from the different belongings and the effect can be seen on them ,
the hostel girls could manage themselves and their thinking also developed in that way
but the group present in the community was totally different from the hostel group . the
frankness and openness in the hostel group was present but not present in the community
group

V

3.3 Performed different activities with them
Objective
To make them comfortable with the group ; To show them with the practical learning; So
that they could perform as a capable volunteer within the community after our withdrawal

Process and methodology

The activities were planned according to the groups and according to their interest and
what we want to teach them etc , the activities performed with group discussion ,film,

31

outing , by including them in the community activities like VHND and weighing ,and by
taking their weight and height etc.

Outing or picnic
This was done with both the groups and taken them near their village where they can
enjoy as they want and they collected the money, manage the food by them self this was
for four hours .

Film showing
During the hostel stay showed some films to them on different issues, the mix films social
issues VHND movie, and some time filmy movie which could give them learning to the
girls . we make the plan for the movie watching day and before that day they complete
their work and then sit for film with the group and after watching movies they do free
discussion and enjoy it.

In this I got less time to show movies to the community girls but shown them few
interesting and knowledgeable movies and they liked it
Discussion

When in the free time we use to sit I conduct discussion on the issues in which they take
interest and let them free to talk and after finishing the discussion I use to ask them about
the experience ,what they felt ,they learnt and will like to have it again or not. I was so
excited by seeing their interest in group discussion and interaction because they
participated without any force . I used to start talking about any kind of word and asks
their views with this the other girls took interest and started joining group all use to discuss
about the issues and they discuses whatever they know and others used to watch it ,this
discussion keep them active and they keep discussing the thing within they group and if
any new thought comes in their mind they used to share it with me .

Their participation in VHND etc
In the community these girls participate indifferent activities with their own interest and
they enjoy it .like they participated in VHSC in its organization and in motivation to the
community ,and during the weight taking of the children in the community they collected
children and helped them in weighing process etc.

Weight and height taking activity with the girls
we done many activities with the girls which are related to their health and nutrition one of
them was about their height and weight .In this activity we taken their height and weight
32

I
F’

and discussed with them about the weight and their age. In which age group they should
have how much weight and height .With this we discussed about nutrition and what food
they should eat ,why this is important.

About their feeling and changes occurred during growing age
this activity done by giving them the audio CD and after that we held a question and
answer round .Besides it we use to discuses about their feelings and what they want and
what kind of mood they are in ,and problems facings by them .Theses things were done
by indirect method and observation .

Findings
Outing was a things which they experienced first time in their life period , actually they
gone out for so many time but a entertaining and interesting outing was the first time,
because in this outing they took out time for themselves and enjoyed according to their
choice .Their experience was different .they discussed their thoughts and liking In this
outing they became very close to me and with each other and they planned that they will
come frequently for this kind of picnic .many of them like to sit and dance with their
classmates etc .By showing different films they felt good and enjoyed every movie .asked
questions about the movies and hero heroines . Their learning shows their interest in the
films etc. they tried to learn English words and sentence from the film and used to ask me
about their meaning even they used those words within their group. By a film they learnt
that we should not be a repeated parrot but we should understand things and practice it it
will be stay with us for life long . through this film showing I learnt that it’s an interesting
method to teach them by the films and meaning full documentaries . There activeness
came out by the discussion and a big group was there to talk about anything after some
time they start using this method in their studies and keep discusioning about their
lessons and results .they were very interesting in their work and participation in the
community activities and learnt many things from these activities, they observe everything
and tried to do those things by themselves. They started recogning all the health worker
and if any activities were not done on its day they used to ask me and even to the health
worker. They stared calculating their and others weight and height and discussed it with
their friends and circle . all the activities brought them out from their shyness and a active
group was there in the community and in the hostel.

33

I
■

r
U

-

i

3.4 Work on the dropouts within the adolescent girls and adolescent
boys
Objective
To know the reasons of their dropout; to motivate them for the further education; To
provide non formal education.

Process and methodology

IH

In the group of adolescent girls there were many girls who left the school due to some
reasons and wanted to go for further education and few boys were there . we used to
discuses in the group about the education and health and planned to do different things .in
that process one topic was related to eduction ,in this we used to ti group discussion
within the given time and I was a facilitator in the group. By these activities and interaction
we came to know many things .

Findings
We came to know that in this village and near villages children boys and girls both were
very helpless in confine their education that’s why so many children droup their school.
There were many reasons for this family condition , due to a tribal and displaced villages
.most of the people were labour in the area they treat children as their extra hand an
except that their children should follow them in the daily labour so that they can earn
something for the family .And the school is available till high school and other schools are
situated at very distance .and its very difficult to reach to the school without any
transportation and by crossing a large Forest.
j1;

P.'1

Conclusion
In this kind of area if children are interested in education and are not able to go to the
school non formal education could be helpful. Because many talented children left out
due to this reason and their talent becomes useless for them and they leads a life which is
full of burdens .

4.0 Work on diseases
4.1 Identification of the diseases
Objective
To make them able to identify the diseases;

Process and Methodology

t.

I asked them about the seasonal diseases and what they do to identified the diseases and
note down their words and experience .some of them told we follow the traditional method
34

L

I

I?

i
1
?•

>

I’i

£

which is taught by their parents etc and some said if the condition is getting poor we take
help of the doctor but go very rarely to the doctors. After knowing their views and
experience I made a list in which I noted those diseases which I can tell them and they
could understand easily
,and I finalized Malaria, TB, Diarrhea, Worm .anemia
.Malnutrition ,by smoking so on. I taught them with the help of charts and pamphlets by
reading the charts and pamphlets within the group and organized a discussion on the
findings with this pasted picture posters in the Anganwadi ,in front of the school. Where
ever I got the chance I used that and discussed with the community about the
identification of the common diseases . in the Anganwadi, In VHSC meetings even in the
schools I discussed with the teacher and children .Adolescent girls groups ,in the group
and on one to one level .in the discussed about the symptoms .causes .primary indicator
of the diseases with them On the other hand tried with the real patients and by sharing
their experience within the community they told about their experience when the diseases
started in their body .for this I arranged some session of the ANM and MPW for them
because community believes on them as a doctor and will follow what they will say and
distributed books to those who know reading etc .In Urban area people keep contact with
the nearest doctor .during my work period in the Slum I came to know about their thought
and sharing about the same topic was made with them too.

Findings
People falls in bad condition due to the delay or laziness and when they feels to get any
treatment it becomes very late .these things runs through generation to generation . due
to their atmosphere no one could understand about the problem because all are facing
the same thing that’s why they don’t asks each other but in the slums if people noticed
anything abnormal they starts asking to everyone in the community .sharing on these
issues is done within the Urban area. In the rural are due to electronic problem people
can’t see the TV or radio that’s why they misses anything which is presenting any
information about diseases but in Urban area people are having reach to every means of
communication and information.

Conclusion
Due to lack of the proper mediums and system rural community is far from the latest
updates that’s why minor problems becomes very big and difficult .Rural community
discusses all most everything but theses kind of information or discussion on these kind of
thing hardly made because they are not able to identify so many things .

4.2 Work on prevention
To bring down to the infections in the community; to make them aware about Prevention
on their level.

35

..

i

Process and methodology
When I was working in Kesla block on community health I noticed that the itching problem
is present in the community and it is spreading all over day by day ,even new born babies
were effected with it. Then I thought something is needed to do at this movement ,but
what should I do and what can I do these question were in my mind .when I noticed that
its spreading is very fast an idea came in my mind about its prevention. This will be a long
term problem and I should do work on its prevention and to introduce best methods of its
prevention within the community. I started visiting to their house and discussion with their
family about their condition and living style ,how many people are living in a house .who
are suffering from the problem ,what they are using for this problem .and seeing any effect
on their body or not, the history of the problem and in which season it becomes active all
that were asked by me .
after collecting all this information I started group activities
.group discussion .one to one level discussion . because this was spreading very fast so
everything happened very fast . in the discussion and interaction I told them that they
should use neem leaves for the daily bath and should wash their cloths in its water, they
should keep their cloths in the Sun light for most of the time and their bedding etc should
be kept in the Sun light because .the Bacteria dies in the sun light and it prevent other
from the infection .the itching place should be covered and protected from flies etc.

For their learning I give them a live example and with a practical, with this I told them
about the TB and how they can prevent to other people from the patients.
*

Findings
In the community this problem happens every year and all families got effected with it but
community was using a paste and Genca Violet for its cure and was not used by whole
family members but they were appling only on the small children etc. many person living
within a small house and all the things were used normally without any change in them
that why this was spreading in whole family and in whole village . in any diseases
community keep themselves neutral and thinks that this will be cure by itself and ignores
every effect till the condition gets worse. People don’t mange their hygiene and sanitation
because they went to their fields and stays there for long time or till night after coming
back they becomes very tired and don’t think about the hygiene etc. their life style is very
tight if they don’t reach on time they have to loose their salary or daily wages

36

f
IIt

Conclusion
Its becomes very difficult to control those things which have been ignored from the past
and their impact becomes very problematic and dangerous.
5.0 program attended by me in different Organization

Objective
To experience different program and issues; To understand to program of different level

Process and Methodology
Roualkela Fourth convection on right to Food
We got the chance to attend different program on different issues through CPHE. On
different places. First was in Roualkela in Orissa , this program was Fourth Convection on
Right to food. This was organized in Meera bhawan on 6th August to Sth August 2010. In
this convection participant came from 18 states of India .in this convection the focus was
on Right to food. Hunger, food insecurity its determinants, water, forest, and land rights,
food bill, food and livelihood related government’s schemes all were discussed. And the
workshops were organized separately in every workshop there was conducted
discussions and the plan made by hearing other people.

Findings
This was the first program which was organized on a large level and attended by me .the
way of discussion and to collect the thought of the people I learnt from this program .there
were different workshops organized on different issues .which was a new experience for
me . from the discussion of AWW and AW functioning I came to know that the condition
and the problems are same in all India and there are so many NGOs working on this
issues, and community is facing problem in both area Urban and Rural area.

Lucknow Workshop on MMR
Second I got the chance to attend a workshop on MMR and its prevention organized by
UPBGVS in Lucknow. This workshop was organized for the introduction about a project
which is based on the controlling of MMR in Aligrah district of UP.

Findings
In the workshop I came to know about the MMR condition of Aligrah district. Which is 570
on with it got information about the different program which are running for controlling
MMR.

37

I
J

ri"
Lakhnadawn Workshop on prevention of MMR and IMR
1

Objective
To orient the staff on Malnutrition and anemia; to understand training Method
The workshop was for three days and there was need to orient the staff in Malnutrition
and anemia so that they could find out in their field and could work on these cases .

■

!

I

;■

P-

-

38
‘ai

SOCHZ

Annexure-1

Annexure
1 Community health fellowship programme
Action plan from 10 November 2010 to January 2011

SI
no.
1

2

3
4

5

6

7

Activities
Work with
asha,A WW,
and NRC
To complete
the other
activities of
PD Hearth
To do final
PD Hearth
Involvement
with kishori
group on the
health issues
Problem
analYsis for
research
propose
Sharing with
sahmat staff
Reading and
writing
,dailY dairy

No of
act.
3

1

1
1

About
The activities_________
These are the continues
activities to know them
better and to their wirk
Have to complete the 11
points to do PD Hearth.

Final PD Hearth with
community_______________
To make them aware about
their health and about other
health issues

3

To know the main problem
of the communitY for the
further research on it

1

Sharing about the issues
which we are learning from
our training etc.___________
To complete dailY doirY and
reading of the given reading
material.

1

W2

W3

tV4

Y

Y

Y

Y

Y

W1

\N2
Y

IV4

\A/3

\N2

\N3

W4

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

Y

39

Y

Y

Y

Y

Y

Y

Y

Y

Y

Annexure-2

2. Three month report
•I

District Hoshangabad

Block Kesla
(Jalikheda, Dhansai)

Report from 18 July to 15th October 2010
What

• Total orientation of ASHA, AWW, and NRC.
• To mobilize people and to make them participating in the PRA
• To do PRA
• Participated in PRA training in Bhopal.
• Went to Rourkela for the right to food program.
• Meeting and awareness about VHND thru VHSC.
• To do VHND
•
•

Community mobilization for PD-Hearth and to do all the process.
Formed a Kishori group and get to involve with it.

How
As I wanted to know abut the ASHA, AWW and NRC and their work how they work in
the community I involved my self with them for one week.

First I started with ASHA, and went everywhere where she went in her field. To visit
pregnant ladies, lactating mothers and during her visit after PNC care.

40

Annexure-2

And I came to know the field realities how people behaves with her how she handles
them, when she asks from the husband of the pregnant lady orto her family member

they mostly ignores her and give her reply "that you are getting money that's why

you are asking and we don't have time and money to take her hospital, you do your
business."
i'

"If there occurs any problem with the pregnant lady her husband treats ASHA as a

bad person and says "agar meri wife ko kuch hua to me tujhe village se bahar nikalwa

dunga"
And still she has to work for them .and I tried to make it easy and talked to the people

that she is not getting any salary and she is for you here not for her own benefit.

With AWW

I worked with the Sahika and AWW in there daily work like in collecting the children
from their homes and helped in their cleaning

Mobilization of the community

There was the plan to do PRA, VHND, Group formation of kishori. For these activities
first we need to mobilized the community and to do this process I adopted different

methods. Like, discussion on one to one level, this happens with the people at their
homes, on the way, in their fields, etc and discussed the issue.

In the groups, in Anganwadi, within the Kishori group in meetings of SHG.etc.
Meetings with the kishori group and discussed different issues in the group i.e
Education and its importance, their views about their future, about their growth

period.

41

Annexure-2

VHND
Like PRA VHND performed with the excellent efforts by ANM, MPW, AWW, and

community. In this we got the support of AWW supervisor too.

Innovation
Work with ASHA, AWW NRC with a new method.

First time PRA VHND
Formation of Kishori group .and developed a Kishori card.
Given session to Sahamat staff.

Meeting with the field mentor.

SWOT

S
In these three months work there was the different situation and the full time work
with Anganwadi, ASHA, and NRC and continues visits to the field helped a lot in
understanding all theses.

W
These three months were very busy months for the people and due to this we were
not able to contacts everyone in the village.

O
This kind of work in the village will help to for a strong base and helpful to

understand the community and to become close to them.

42

Annexure-2

T
Absence of the people in the village due to farming sessions and migration.

We should know about the period of migration and farming.Should have the

information about their time table, when the community is busy and when they will
be able for the meetings and activities.

Conclusion
As this trimester was very fruitful but still there were few things which are

decreasing the percentage of the achievement.
Like everything with the field mentor and the community ordered in the positive

way but migration and the farming time was just like a uninvited villain, whose role
is very important in the film but entry is in a wrong cine. With the reflection of all

these points we need to do preplanned all the activities and need to match with the

plan of the community too.

Well past is a reflection, Present is a infection and future is a reaction.

43

Annexure-3

3. Essay on our Asha
(With the comparison of the present condition and the articles of David Warner)

Introduction

The concept of the asha is taken from the word health worker.in the world she

was known as the village health worker, helper etc.the concept of the lady health
worker was initiated by the federal govt in 1994 to provide child and maternal

health services.
Her main work is to help the people and to give them knowledge about their

health and how they can use their home remedies to cure their problems.

In her qualification, she should eight pass and married women, or divorcee etc.
health worker selected from the community and receives short duration training .

View of the society about the asha
According to the articles
Asha is a health worker works for the community an its up liftment, she is the top

of the health system, and she is selected from the community.
According our society or present condition Asha is like a servant and she is worker

whose work is to tackle the delivery and to provide the money to the mother.
She can't raise her voice against any bad behavior of the society and system.
She don't know her duties or the purpose for which she is selected and her

selection mode, her qualification and criteria of selection.
She is being treated badly by society and the doctors.
44

Annexure-3

This is the one phase of ashas
Second is

She is a wife of respected person like the head of the kishan sansthan and any

head like panch.

In some cases she is the only 5th class pass lady that's why she is being directly
selected by ANM and there she don't get any basic training .when we used to ask

something to those asha they look at us like a helpless and hopeless person, they

give answer in this format" Hume nahi pata hai anm bai ayi thi hume bole turn

asha ho tumhe pregnant ladies ko aspatal le jana hai o 7 din ki training hogi usme
ana."
People recognize them as the govt employ and says

"jab sarkar unhe paisa de rahi hai to logo ki madat karni chahiye unhe"

She fights with her husband but he don't allow her to go in the night and she is

totally over burden with house work, farming and managing with the people over

the cases and on the other hand people don't rely on her very easily.
Her status in the society

In the articles she is having the potential to participate in the society and she can
be a great source of spreading awareness and she can teach a lot of things to the
neighbor and to the villagers, means she is a very important person of the society
and doctors are only for her help not to command her and her duties.

But in the present system she is a helper, and people take her as granted they
don't think about her importance and both, the society and doc says that she is
doing this work only for money.

If we will treat her according the articles she will be an important pillar of the

health system.

45

*

Annexure-3

$

Because a doctor follows the 8 to 2 timetable, but a health worker doesn't provide
any limited or time bound service, he or she is there for forever for the community

and his people
.Some time she is tortured on the name of the religion and cast etc.

her functioning or working style
i.

r

if'.1:

In the article she is a free bird and there is no any other pressure on her, she is free

from the social bounds and limits. She is getting respect for her and her work,
besides giving them health tips she is helping the community in improving their

knowledge about health and their rights.

But in our present condition she is surrounded by the social rules and family
condition, misbehavior of the doctor and community. All these factors don't allow
her to think beyond the deliveries and medicine etc.
I5’-

I ■
Method of selection

According to the article she should 8th pass and selected by the community.

But in our block mostly asha are selected by the ANM,without any process and
planning. Even vhsc's are ready in the paper and asha don't know about it and its

fund.
Conclusion
Her concept is just opposite of the articles, people still think that she is working for
her benefit and she is getting salary from the govt, even doctors are like this, to
I

improve this situation everyone needs to go through these articlesfdoctors, asha,

society whole health team).

I

46

r."

hi'

Annexure-4

4. A brief introduction of yourself
• I am Preeti from Lucknow. Rorkee (Uttarakhand)

is my home town.
?•

• I have done graduation from Lucknow University

I
L . ... 1

I

with

Economics

in

year

2009

and

doing

MSW(master in social work) from Ruhailkhand

University Bareilly .
• This is my first time I am working in social field

1

and a good experience working with Sochara.
• And I believe in doing not in saying.

I strongly

wanted to do something for the women and
children and in the health field that's why I joined
this fellowship.
*

Any personal story of your life that will inspire the reader

Actually I don't have any story especially which will inspire the readers because to
have any inspiring story it's a long way or a long distance we need to go.
Still I will not leave the lines blank.

As I have told that I am a new comer in this field that's why I was not feeling

comfortable and was terrified to go in a area like Kesla, but I took it as a challenge
and starte working .in the first phase it was difficult to settle down with them and
without water and electricity it was difficult. And when I saw the condition of the

people who are facing these problems from the years, I thought I will be a good

experience to know about their life style and how they fight with their problems
and it really helped me a lot to come closer of the people of that village.

47

Annexure-4

But it's really difficult to get closer to them because they think that every stranger is
their enemy and they keep a distance from him because they are exploited by the

many officers who are working in the ordinance factory.
When I started to go to the people and I share about the Anganwadi and it's

functioning in the village they were not comfortable to telling about the Anganwadi
because they were afried from the Anganwadi worker. But I keep doing the process

and gave information about their rights then they get comfortable with me and

become friendly with me and shared a lot of about AWW and this activity, going to
the village and talking with the people made an effective change people become

active and the start doing questions to the AWW and Sahika from that time the
Anganwadi is opening regularly . in both the villages now Anganwadi are functioning

well and now they are happy to talk to me and welcome with the smile .in the

starting it was difficult to make a place for me but the continues visit and patience

bring this result.
If we want to have a place in the community and want to do work then we need a

lot of patience, because some time we face anger of the community and they refuse

to talk to us but still we have to talk with politeness and smile.

And if we easily overcome of all these then no one can refuse to talk to us and we
will reserve a place among the community for ever.

- Your work - giving insights into the kind of area/geography/culture that you
work in. If you are working in the adivasi area, throw some light on that too

At present I am placed in Hoshangabad district .And the area in which I am working

is an adivasi area, in Sahamat organization with Lorry Benjamin in Kesla block which
is in the interior and far from all the facilities and services. In this block you will find

korku and Gond adivasi population.
In this area there are many problems like electricity, water,schools, health services
and transportation. And this area is also effected by the dam (tawa dam ) and
besides it people are still fighting to get stable themselves.

48

*■

r
Annexure-4

Here people are depend on the faith healers and they don't want to go to any
hospital or medical store because they are not satisfied with the services .in the

adivasi community you can see that they treat boys and girls equally and, they are
like their assets .forest products are main source of income for the people who are
belong the adivasi community and they worship the forest like their God. Its a
different and fantastic experience for me to work in this area because I have learnt

fe.

so many things from here and this is excited form me because its my first time ,that

i.

I am working in this field (socia I field) and lamina learning process.
Here I am working in the three villages of Kesla block and my main focus is on

malnutrition and nutrition with Anganwadi and Asha, NRC.

- What the CPHE fellowship has given you - your reflections

w

I was looking for some thing which can give me a strong base so that I can have
good understanding and knowledge about health and community health. Because I
wanted to have a carrier in the health field. And within the small period we gained a

lot of things from the fellowship, we got an identity within the community, health

department, many organizations, and developed the confidence to go in the
community and to deliver our message, interact with the people who are related to
the health department.
■

First of all it's an amaging thing to have so many people who are at top in their

fields and enriched whit the knowledge and they are sharing it with us.

Second there are twenty people who are related to different areas and different
kind of work that is also interesting because we are getting different taste on a one
place and we are learning from each other.

And for me every one is like a resource to learn something , and I feel lucky to have
■

‘

19 people who are more experienced then me because am a beggnier and got a

place where everyone is having something different and am learning from them.

49

Annexure-4

- What have you benefited from the fellowship? How will that help you and the
country in the work that you will do

Got a plat form which is helping us, so that we can make ourselves capable to help

I

and to do something for the community. Now we know about those things and

health issues from which we were not familiar .Within the 10 months of the
fellowship we developed a large circle of the people and it increased our

confidence.
This will help us to know the ground reality and what exactly needed to improve the

situation and if we focus on the country level we can say now we are twenty fellows
and everyone is connected with 100 people in their district that 100 will change into

one thousand .that means if a fellow is spreading the message in one thousand
people then we can imagine about one thousand people and their reach. Actually

that is my view.

And how it will help to the country, what we are learning in this fellowship we will

work on that learning and in the begging we will be able to do something in a very

small area but with the time we can make a team which will work on the idea which

is taught by this fellowship. And if we can work and change something in our district
then it can reach to the country level too.

As we are facing the things in the field we can work on those things and can make

change for the people who are always out of the focus and out of those schemes
too which are made on their names.

Even we all the twenty fellows can do something which can bring a big change in

the country, actual it's a big word (country) and we need a big idea to make change
in it.

50

J
Annexure-5

5. LFA = by Preeti Verma

Impact 1
Reduce the
30%malnutrition
witnin the
children of age 03yrs with the
community
participaction in
the period of 2
yrs___________
Out cornel.1
-care practices
increased within
the family about
the children

I
Output 1.2
1.2.1 -feeding
practices ,1.2.2 gnp
1.2.3 - care and
bringing up
practisec of
children and food
practses

Indicators

Mov

l.a malnutrition will
be reduced by 30%
in the children of
age 0-3 yrs ol d in 2
yrs

1 data comparision of
the malnutrition

l.a 30% women got
educated within the
1 % year.
l.b 30% women
breast fed to their
child within one
hour of the birth
l.c 30% women
exclusively brest fed
to their children
l.d 20% families will
start cooking in iron
pots_____________

1 to compare the pre
and post condition of
mothers
1-pre and post views
comparision

1.2.1. a

1-participation
records

1-pre and post

30% women will get
involve in the
session

1.2.2. a
30% families will be
in the GNP

1-ragisterd or the
entry in the records
of the families

1.2.3. a

Activity 1.3

I.

Activity 1.2.1.1

1.2.1.1.a

Conselling of the
mothers about
the early and
exclusive breast

30% mothres will be
involved in the
counseling of 2 days

1-no of the mothers
in the register

51

Assumption

1 -if the families are
depend on the
Migration fortheir
earning etc

'■

Annexure-5

r;.

I
>'i
i

■

ft'

feeding.
1.2.1.2
Workshop on the
benefits of
feeding practices
and
demonstration
1.2.1.3
To prepare the
IEC material on
feeding practices
and booklets

1.2.1.4

1.2.1.2a

1-no of workshops

5 workshops will be
organized of 3 days

1.2.1.3.a
Soo booklets and
IEC material will be
prepared withing 2
months

1-no of booklets
prepared

1.2.1.4.a
6 counselling session
of 2 days

Counseling of
mothers

s
Ii..’’

L

I

■'

52

I

Annexure-6

V

6. A card designed for the Adolescent girls group for their general
information about themselves

k'

I
53

i

S'1
I

I'I'

Annexure-7

7- Questions prepared for the quiz completion in PD-Hearth at Anna
Nagar slum in Bhopal

L

1-how will you protect a new born baby from the outer temperature?

2-the importance of vitamin -A
3-the sources of vitamin -A

V',-

4-by what time after birth we should start breast feeding to the child
5-till how many months we should continue breast feeding to the child
6-the number of breast feeding to the child in a day

I

7-what is dirreha?

$'lr

8-what factors are responsible for dirreha?

I

9-what will you do if your child is having dirreha ,at first aid

10-when will you take your child to the doctore during dirreahe
A

11-what is immunization?
12-explain the immunization of a pregnant lady with the months?

13-what is malnutrition?how does is happens?

14-0-6 feedind or the food for the child of the age of 0-6 months?
15-if the child is having malnutrition what kind of problems can be develop in that child?
■

16-is malnutrition spreads by touch or is malnutrition is a communicable diseas?

17-if the child is having dirrea we should stop giving food to the child?
18-malnutrition can be develop from the womb of the mother in the child?
19-in dirreha the boiled water should be used or the simple water?

20-what is malnutrition cycle?
21-prevention from the dirreha?
22- what is RTI?

54

I.
Annexure-7

23-if a adolecentgirl is malnourished what will be the impact on her future?

24-we should treat our children in different manner if there is a gilr and a boy(discreminet)
»!•

25-if the mother is malnourished child will be malnourished too?

26-how will you recognize malnutrition?

i

27-how many ifa tabs should be taken by a pregnant lady?

gr

I

28-how will you recognize the lack of blood or anemia?

29-why we should eat ifa tablets
30-is mothers milk is enough for a child who is above six months?

31-who needs more nutrition boy or girl?
32-what isSHG?

I
33-we should wash the vegetables after cutting and peeling?

34-the child should given food in small amounts and with the little gaps or whole food in one

instament?
35-physical and mental development of the child age?

I

36-how we can prepare ORS?

37-if the ors packet is not present at home how will you prepare that at home?

■

r

I
-i

i
I

55

I
K
Annexure-8

8 Lucknow Workshop report

Workshop on
"Preparedness for birth plan"

II

Agenda of the three day workshop

J

1-

Focus and discussion on the high MMR of Aligrah District of UP.

I

2-

Material preparation for the training of health workers at block level to improve the

II:

29th, 30th and 31st March 2011 Lucknow (U.P.)

quality of training
3-

To make participants aware about the project soon to be started in Aligrah.

Special features of the workshop
!.i

1-

presence of experts from various organization at national level

Rajasthan

Mr. Tiwari ji (Dholpur ,Mangalam),Anvar

(National ASHA trainer 6th,7th module NHRC)

ir

Haryana

Mr. Suresh Kumar

1

Madhya Pradesh

DR. Shelendra Patne (MPVS)

Uttaranchal

DR. D Budekoti

Uttar Pradesh

DR. Jamal

I
■

2-

(BGVS)

(UNICEF)

sharing of experiences for the improvement of the forthcoming project with the

different inputs

Why

The workshop was conducted to develop an understanding about the upcoming project)) and to

ii

I

make familiar to the participants about it and its reason.

56

&

I
Annexure-8

■■

How
■

ii,

tv

People from the different states of India were called to participate in the workshop and to give

input in the implementation of the programme.
Plan shared by the BGVS and UNICEF, this is a 1 /4 years project which is focused on the

■

emergency transportation and a help line which will help in the reduction of MMR in Aligrah

. B:

District of UP. This will be implemented in 12 blocks with 12 full timer block coordinators and one
District coordinator; there will be one voluntary worker who will be selected from the village

I

In a long discussion many important things were noticed they were related to our health system
and community ,in brazil out of pocket expenditure on health is 5%, in India it is 60% which shows

that the maintenance and implementation of health services is not proper ,per capita expenses on
health is much but the priorities are less with this expenditure, the informal loans is very high due

to health system .

I,

With the reference of Aligrah District, sick new born care and health facilities are available but the

I

things are worst, for the improvement of this improper functioning we need to find out the gaps

p-'

within the community and services.

■■

On village level the role of PRIs is very important and use of untied fund ,role of ASHA , and with
■

:

tI

the improvement of health facilities if we want have a safe delivery and mother resource
mapping is a strong tool for the better delivery ,post -natal care is very important ,and male
participation for a better birth preparation ,in the end media involvement is needed if we want to
know about the actual MMR.
Conclusion

If we want to improve health services first we need to develop a connection between community

and health services and its involvement in handling the MMR is very important.

I
First day, 29th march 2011

ft:

■

Activities
Welcome address by

Mr. Sanjeev Sinha -BGVS securatry

Over viewed by

Dr. CS Verma

Objectives by

Dr Gur^v Arya

57

I

*

if.

I
I

I

Annexure-8

Inputs from participants
After welcome address by MR. Sanjeev SinhaDR Arya from UNICEF discussed about the objectives

of this project (strengthening birth preparedness and developing transport referral system

helpline) the objectives are follow
i) ensure the registration to make birth plans

ii) to know about the causes of maternal death
to

iii)to develop the referral transport helpline
all the above objectives are for the reduction of MMR in Aligrah District (517/100000 CSR ) then

S'
H

■i

with the following schedule

different experiences were shared

by,

Mr. Ashok Tiwari

(mangalam),Vr Shelendra patne (MPVS, Bhopal),Mr.Tejram Pithoragrah ,Preeti (CPHE, Fellow

from Bhopal). After the long discussion many important things were drawn out from it.
Dr Gaurav Arya told that the following things leads to maternal mortality they are, post partum
hemorrhage, unsafe abortion, sepsis, pregnancy induced hypertension such as pre-eclampsia.

I

With the suggestion he said we don't need to go in the medical causes and technical things we

need to connect the community with system and services that is the best thing can be taken on

our own level.
■

MR Tiwari from Dholpur District shared his experiences about how they started a help line named

“matrtav swasttt' and said that we need to handle the three delays to control MMR if we can get
success in handling theses delays we can easily control MMR.

g

I;1
I

Second and third day outcomes

There were the inputs from different people on second and third day of the workshop, how we
can prepare better training material to make things happen.
We need to connect with ASHA, ANM, and VHSC to make this project successful .they will be

important components of this project.
■

In this project we can coordinate with other government programmes and can plan for a effective

helpline ,things for Dai can be design so that we can get benefits from her experience which is
very important and her knowledge will guide us in getting the things correctly she can be a good
J

I

support for the project a Dai and ASHA can work together if we want to have the transport at

that time when we need it,because a Dai can tell the time when we have to take the pregnant
lady to hospital.
To have a good and effective transportation we need to use manpower on right place.
58

Annexure-8
:■

from Haryana Mr. Suresh Kumar shared very important thing "if we are providing a good
transport and went to the nearest health center and reach at 2;30 but no one presents there

then what we need to do?"
we need to develop and to prepare people for the future so that they can ask or can be

I

i

My reflection

Being a young participant in the group it was a fantastic experience for me .
"first time it made me to feel comfortable to share with the people who are working on big

level and I shared with confidence which helped me to develop confidence on my experience

and things I learned from field and fellowship"

J

After this workshop I realized that the condition of MMR need more attention, everyone need

to think about it. And after knowing about the MMR state of Aligrah and the health services of
Aligrah it is clear that there is need for effective participation of community.
first I came to know about ,how we make the plan for a project and LFAflogical frame work )

and to discuss it with the other people.

J

II
I

I got the chance to share my field experiences about ASHA and Dai, needs related to a pregnant

lady who is living far from the health center.
How we can convert a simple idea in a helpful and useful process , influenced by the "Matratav
suwasth Help line" statred by Mangalam organization in Rajasthan .
In simple detail I can say that I learnt from this workshop the following things
i) Other programs and implementation and the results ,(mangalam )

ii) How to give inputs and how to share things
iii) About the health services and problems of other places and about ASHA ,and Dai and

I'

there places in the community and the thinking of others about them.

r'

■

I*t
59

I

Not viewed