FRCH NEWSLETTER VOL.13-No. 1-JAN -FEB-1999.pdf
Media
- extracted text
-
The F oundation for R esearch in community Health
NEWSLETTER
Vol. XIII, No. 1
Jan. - Feb. 1999
Panchayati Raj, Women
and Primary Health Care
In this pamphlet prepared by Vaijayanti Aphale for the Foundation for Research in Community Health
it is explained how the primary health care needs of a village community are best served by
women under the Panchayati form of Government
Primary health care means the exposition of the real
with the analysis of demographic and epidemiological
meaning of health to the community, health education and
scenario of the locality. Health care needs to be integrated
induction of health culture utilising the resources available
with a movement for social justice and economic upliftment
within the community. Only 10% of primary health care has
of the target section of the population. For example, family
a curative part. The rationale of health care is to reach the
welfare programmesneed to be integrated with women's
health input to the doorstep of the people against the
liberation and enhancement of female literacy. All this can
prevailing situation where the ailing people come to the
never be possible without community participation. Hence,
deliverer of treatment and beg or purchase their health. The
the role of Panchayat becomes vital in planning for and
delivering effective primary health care to the people.
health input includes provision of reasonably clear water,
sanitation facilities, transport, immunisation and sample
Powers of the Panchayat
remedies like ORT etc. along with health awareness. It is
common knowledge that these activities are generally
The 73rd and 74th amendments to the Constitution have
managed by women, making them the basic health care
delegated 29 subjects to be taken care of at the village level
providers in the family. Also, the bulk of the health problems
under the Panchayat Act, due to which, the following health
at the village level are related to women and children. Thus,
related functions will come under the purview of the Panchayat:
to improve the health culture of a people it is necessary to
* Preparing the draft development plan and performing the
bring-health awareness to the community in general and to
civic functions of village local government (the mandatory
women in particular. The community must be made aware
functions listed in Panchayat Acts).
about the infrastructure created for them
* Performing the coordinating functions
including information about the units, personnel
In this Issue .
regarding preparation and implementation of
and their respective functions. It is necessary ♦ Panchayati Raj, Women and Health
development schemes by Village Panchayats.
to gather indigenous knowledge on health
Vaijayanti Aphale
Making recommendations to the State or
already existing within the community and ♦ Women and
District Governments in the interest of village
, accommodate it in the framework of health care
Women & TB Project Research Team
development.
delivery. The effective implementation of ♦The ANM
primary health care is preconditioned by the
assessment of morbidity rate and pattern along
Vaijayanti Aphale is a Postgraduate in Economics
and the Editor of FRCH Newsletter
Seema Deodhar
♦ Samyak Swasthya Uplabdha Kaise
Hoga (Article in Hindi).................10
Dr. Bhushan Patwardhan
♦ Invasive Devices Increase Risk of
Infection................... ...........12
Stephanie Swafford
* Management and proper use of water for
various functions. Implementation of drinking
water schemes involving supply to individual
households as well as to other areas.
Preparation. maintenance and management of drinking water
sources at the village level.
* Poverty Alleviation Programmes.
* Welfare of the weaker sections including implementation
of programmes for economic and social development.
* Education including primary and secondary education,
technical training and vocational education as well as adult
and non-formal education.
* Women and child development including management of
maternity and child care centres, monitoring of Integrated Child
Development Programme (ICDP), implementation of preschool
children's feeding programme, enlisting local contribution for
mid-day meals in primary schools and elimination of child
labour and violence against women and children.
* Family Planning measures.
* Above all, control of the public health care services from
the Gram Panchayat up to the taluka level including 1)
establishment and management of local dispensaries, primary
health centres and sub-centres and even district hospitals if
it comes under the Panchayat area, 2) managing public health
activities like control over communicable diseases,
immunisation and vaccination services, health education,
environmental hygiene etc., 3) campaign against use of narcotic
and psychological drugs, alcoholic drinks and tobacco.
As part of health care management it is the duty of the
Panchayat to:
i) Link primary health care with regionalised services at
the national level.
ii) Undertake community orientation of education and
training of health workers - socialisation of community health
workers can best be undertaken at the village level.
iii) Take care of logistics in the form of drugs, equipment,
other supplies, transport etc.
iv) Undertake supervision - provide technical support
guidance and encouragement to workers at health centres and
at the village level. Report lapses of governmental health care
to the proper authorities.
v) Entail participation of the community with government
efforts.
vi) Arrange discussions on public health problems with the
health caretakers of the village health sub-centres within the
Panchayat area and assign appropriate tasks to the members.
vii) Assist in conserving the health centres of the Gram
Panchayat and help the health workers in their work.
viii) The Panchayat members should consult other Samities
and Zilla Parishads to seek their cooperation and submit their
progress reports to the latter.
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. '99
Community Participation
- To tackle the village health problems, along with utilising
the help of village level health functionaries like CH, GS, local
health workers, multipurpose health workers and social health
workers, the Panchayat should entail community participation
in the following areas through liasoning with various groups
within the community and canvassing among the people:
Medical Care:
Community members may be encouraged to make
maximum use of self-care procedures through continued use
of various home remedial measures. Services of locally
available practitioners of various systems of medicine should
be used as a supplement. Another supplementary community
resource can be created by providing training to community
selected primary health workers, who are specifically drawn
from among the weaker sections, especially women, who can
make available home remedies as well as remedies from the )
indigenous and western systems for meeting the medical care
needs. Services of full-time health auxiliaries may be used
only to tackle more complicated cases needing specialised
skills.
Maternal and Child Health:
Here too the key workers should come from the
community itself - the family members assisting in child
birth and child rearing and the traditional birth attendants. The
birth attendant or any other member selected from the
community can be trained as a primary health worker to work
with the members of the community to improve the work
that is already being carried out there and to provide assistance
when called for. They, in turn, can be backed-up by a full
time auxiliary health worker and a primary health managerial
physician and other referral services. Panchayat members
must ensure that a disposable delivery kit is used by traditional
birth attendants/family members.
Malnutrition can be tackled by increasing community
efforts for production of crops, vegetables, eggs, fish and
fruits and ensure their equitable distribution. A record of
village food trade should be maintained and effort should be
made to increase local production with special attention to
fruits. The community should be encouraged to help the
community health workers in monitoring the nutritional
quality of the people's diet. Mothers can be trained to monitor
the weight gain of their children, so that the health workers
can provide nutritional supplements as required.
In problems like severe diarrhoea the community health
workers can help the mothers to undertake oral rehydration
themselves. ORS packets can be kept in sufficient amounts
for distribution at Grampanchayats.
2
(0,
”
Control of Communicable Diseases:
r
Even within the existing framework of vertical
programmes for communicable diseases, primary health
workers and other community level personnel can take over
many of the duties carried on by specialised medical
personnel. Surveillance of malaria and smallpox, treatment
of cases of leprosy, filaria and trachoma, spraying of houses
with insecticides and water management including vector
control, are some of the duties that can be taken over by
the community. Demystification of diagnosis and
treatment of many communicable diseases like
tuberculosis will increase community participation in
controlling the diseases. The Panchayat should compile
epidemiological information of the village community
with its cooperation.
Family Planning:
Linkage of fertility regulation programme with rural
development programme will have a significant influence on
population figures - education of women, increasing their
social status, increasing age of marriage, curbing the dowry
system, opening up employment opportunities for them and
their participation in community activities ensuring greater
social justice and fall in the maternal and child mortality and
morbidity in particular are likely to materially change the level
of motivation for a small family norm in the community. Even
use of proper contraceptives can be better managed at that
level. Gram Panchayat can help the people by registering the
birth and death incidents primarily, to avoid inconvenience
due to late registration. The Panchayat should canvass the need
for such registration among the community so that each and
every birth and death incidence reaches the Gram Panchayat.
Environmental Sanitation:
Community involvement in environmental sanitation
) programmes through efforts of community health workers
and interdisciplinary research efforts to develop technologies
that are appropriate to the specific conditions in different
rural communities will contribute significantly in increasing
the cost-effectiveness of the programme. Supply of drinking
water including provision and maintenance of tube wells and
dug wells is the responsibility of the Gram Panchayat. A
community pond can be dug by the Panchayat under, the
Jawahar Rojgar Yojana. Local organisations exist The Zilla
Parishad can be contacted for information regarding local
organisations which impart training in cost-effective
construction of latrines. The Indira Housing project also
provides help in this regard: The Panchayat can simultaneously
monitor construction of biogas plants connected to latrines.
Women's Participation
As the majority of the health problems affect women and
3
children and as women are the main health care providers
in the family, it is especially necessary to entail women's
participation in inculcating a positive health culture. For this
the Panchayat and local health workers should liaison with
various women's groups at community level like Mahila
Mandals and Micro-credit organisations to spread health
awareness and increase community participation. This will
ensure their access to services. Training of women for health
provision will also increase access as well as provide
part-time jobs to many women at village level. It will allow
the women to actively associate with programmes at various
levels and set priorities among the programmes. As they
themselves will also be the main users of these services it
will lead to desired generation and utilisation of services.
Utilising the services of local women should also be expected
to create a more cooperative and respectable attitude towards
the female government health providers like ANMs working
in the village and attention to be paid to the problems they
face in carrying out their tasks. Many NGOs have already
successfully tried out this approach of training local women
to undertake basic health care of the community. This has
established that an affordable, accessible and effective health
care system is within the reach of the entire population
provided people understand their own health needs and plan
and implement their own programmes.
Financing under Panchayat Raj
Il should be ensured that along with various
responsibilities, corresponding finances are raised at the
village level through the following means:
i) A greater share in the existing budget and greater powers
to generate finances at the village level through leving of
taxes, collecting land revenue etc. Besides, creation of
permanent remunerative assets like shops, fish ponds,
nurseries etc. will help to increase non-tax revenue. Villagers
have also suggested innovative schemes like all households
being provided equal amount of water and the poor families
being allowed to sell water to the rich farmers for agricultural
purposes. The money collected by these households could
be utilised for their health care.
ii) Local health workers could also resort to differential
pricing - the poor being charged less and the rich being
charged more. Since the health workers would be familiar
with the socioeconomic status of the villagers this scheme
would be relatively easy to implement. Identification of poor
could be based on factors like their agricultural status whether they own land or work as farm labourers’on other
fields, their purchase and consumption of foods etc.
iii) A system could be worked out wherein the local health
workers are paid by the Village Health Committee either
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. *99
through Panchayat funds or with funds collected from the e
villagers as per their income levels, explicitly for the purpose.
iv) Another method of financing could be cooperative health
insurance wherein a village cooperative is formed which
insures its members against illness and simultaneously
provides health services through local health providers. The
insurance could cover those illnesses that are most likely to
occur at the village level unlike regular insurance which deals
only with catastrophes. Also, detection of genuine cases will
be relatively easy as the villagers themselves would run the
cooperative and it would be a comparatively small unit.
Panchayati Raj for Better Health Care
To conclude, the main features of health care through
Panchayati Raj are:
Physical accessibility:
Since it will be managed by the community itself it can be
physically accessible to the whole community and without
wastage of precious time, especially in emergency cases.
Special arrangements can be made like use of handset radios
to facilitate communication for those living in inaccessible
areas.
Cost-effectiveness:
Health care will be made cost-effective by using the available
records to cater to the basic health care needs of the majority
than the exotic needs of a few. Also, care will be taken to
incorporate home-based remedies and indigenous health
providers wherever possible so that existing resources are
optimised. For instance, judicious use could he made of
existing resources like training of midwives for conducting
deliveries, utilising herbs locally available etc. The village
community, with its own specifically trained community
health and paramedical workers would be able to cater to over
80 % of the health and illness problems which affect people
at the village level. Only a rational combination of drugs
will be utilised so that expenditure on unnecessary or
dangerous drugs is avoided making it not only cost-effective
but safer.
The Kerala experience demonstrates that the essential
elements of genuine human development can be achieved
without squandering enormous amounts of natural resources.
With less than 10% of the per capita resource availability
compared to the developed countries, Kerala has managed
to achieve high levels of human quality of life by making a
more judicious use of human labour and by developing a new
non-consumerist ethics. In contrast, the U.S.A., after spending
over a trillion dollars a year on 'health', finds that 15% of
its population, representing 40 million individuals, has no
access to any meaningful form of medical or health care.
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. '99
Demystification of knowledge:
Health will be provided not by overspecialised, indifferent
health providers from the cities but by trained local people
themselves who will be given basic knowledge and medicines
and who will be accountable to the village committee. The
health providers will also be responsible for spreading health
education and awareness in the village and training more local
people. Since they would already be familiar with the local
situation people would trust them and they will be able to
provide health more effectively. The role of the medical
profession and paramedics would be redefined as supportive
to, and not appropriative of, that of the people. As far as
possible the health providers would be women as women and
children comprise 70% of the population and 90% of the
health problems affect them. Also, women undertake the
majority of functions involving the family and local
community hence, involving women should automatically
improve the welfare of the whole family and even the
community.
Accountability and Responsibility:
Since the Panchayat members are elected by the community
itself they will be accountable to the people and also the
beneficiaries of any development in their village and hence,
better motivated to work for the development of their own
village. The Panchayat being a relatively small unit, the
members would be more accessible to the community and
in tune with local health and related problems. Even the local
health providers, since they will be accountable to the village
health committee or any committee formed exclusively for
the purpose, are not likely to monopolise the knowledge they
get or overcharge for their treatment.
Holistic Health Care:
The history of industrialised nations shows that their overall
health situation improved not due to innovations in medical 1
care but due to general improvement in hygiene and nutrition
and overall development. Health care at the village level can
easily be combined with other public services to make it more
lasting and part of the overall development effort. The major
pillars of health such as nutrition, education, water supply,
sanitation and environment can be assured by the people
only through their own political and social action. Health
care initiatives can be combined with other activites like
education, micro-credit and employment through use of
local resources.
Judicious Utilisation of Existing Services:
Health under Panchayati Raj provides not only a viable
alternative to the existing health care systems but would also
Contd. on page 6
4
Women and TB
The research team of the FRCH project "Socio-cultural Aspects of Tuberculosis Among Women Implications for Delivery of Services" comprising of Dr. S.N. Morankar, Dr. N.S. Suryavanshi, O.N. Patil,
A.M. Kudale & D.C. Deshmukh traces the methodological problems infield-based research on
gender differentials in Tuberculosis and offers some practical solutions
introduction
Centre, Pune were each to be interviewed by one male and
one female investigator.
Despite decades of research and effective treatment
ii) Community based patients: Mapping of all patients
strategies being available, the problem of tuberculosis remains
diagnosed as suffering from TB 3-4 months before the start
unsolved, taking its toll on society even today. The Government
of data collection or currently on treatment in the Parinche
of India is rehauling its National Tuberculosis Programme in
Valley, Pune District (FRCH's action-research area consisting
an effort to ensure the cure of TB patients by providing the
of 20,000 population) would be done by contacting all
most effective medicines and by direct monitoring of treatment
available formal and informal sources. The patients would
follow-up of patients. However, as with other such projects,
be interviewed by an FRCH researcher working at Parinche.
successful implementation of this programme would require
Information about these patients
xx community involvement for which it
would be collected by community
• is mandatory to study the disease in
TB Takes its Toll
* Approximately one third of the world's population is infected based women known as "tais" as
its socio-cultural aspect.
with Mycobacterium Tuberculosis.
per specific guidelines provided to
While much has been written * Tuberculosis kills over one million women each year.
them by FRCH staff. Tais would
about the influence of socio * About 80% of deaths due to tuberculosis occur in the
prepare case studies of the
economic and cultural factors on age group of 5-49 yrs. - the most productive years of life.
* The risk and prevalence of tuberculosis infection are similar patients and do a follow-up of
compliance with tuberculosis in males and females until adolescence, after which, they
their treatment behaviour for six
treatment, there is hardly any research become higher in males.
months. This would also allow us
done on gender differentials in * Tuberculosis is as prevalent in the rural areas as it is
to study the advantages/
in the urban concentrations.
tuberculosis and its control. Hence,
disadvantages of involving
FRCH has undertaken a study on the gender specific problems
community based female workers in a research process.
of help-seeking behaviour of women TB patients,
Hi) Non-affected persons : Non-affected persons would be
simultaneously providing them with useful information to
selected from 20 villages picked out from a list of villages
help improve their access and adherence to treatment.
from where come the patients registered at the DTC. These
Methodology
20 villages are within a radius of 50-60 kms from Pune city,
for the purpose of logistics and convenience of data collection.
The study methodology includes conducting interviews
() of TB patients and non-affected people with the Exploratory
Model Interview Catalogue (EMIC)* method, which is the-first
time such a method is used in data collection in studying TB.
The purpose of using EMIC in the present study is to
identify patterns of distress, perceived causes and the
preferences as well as past history of help seeking and
treatment. A section of the EMIC will be focussing on social
stigma attached to the disease, which has an important effect
on TB-related illness behaviour, to produce a stigma scale.
Selection of Patients and Interview Strategy
Initially, the following strategy for selection of patients
and their interviews was decided upon:
i) Clinic based patients : 80 rural clinic-based patients (40
male and 40 female) who have been registered for treatment
4-6 weeks prior to the date of interview at the District TB
5
iv) Health care providers : All health care providers in the
same 20 villages would be identified through discussions
with key informants from the villages and interviewed with
the help of a semi-structured interview schedule. This would
include all providers identified and visited by villagers including
traditional and folk healers for health and medical care.
v) It is proposed to conduct a focus group discussion (FGD)
in the evening after completing the interviews in each of
the 20 villages. In each village emphasis would be laid on
participation by a different socio-economic or gender strata
in the FGD so that all stralas would be covered. The Sarpanch
or members of the Mahila mandal were to be contacted to
help gather the kind of people we wanted for the discussion.
It has been our experience so far, that besides the target
group many others take part in the discussion and it is quite
difficult to stop them from interfering in the proceedings.
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. '99
Village Health Ethnographic Study
To understand the community's perceptions about health
it was decided to conduct a detailed study emphasising health
and related aspects of the village concentrating on stigma
related diseases such as TB. leprosy, HIV/AIDS etc. with
a focus on gender differentials. This study was to be conducted
by a village based local women researcher. This is an attempt
at developing methodology for collecting health information
using qualitative research methods with the help of a village
based local woman as an investigator by giving her appropriate
inputs.
Altering the Methodology
During pretesting we faced certain difficulties regarding
our methodology hence, after due discussion with members
of our research advisory committee, certain changes have
been made in selection criteria of patients as follows:
Clinic based patients: As Directly Observed Therapy
(DOTS) has been implemented in the whole of Pune district,
we had to take patients who came under DOTS treatment.
Not a single rural woman patient who attended the clinic
at DTC and who fulfilled our criteria could be interviewed
by us. The explanations given by medical staff at the DTC
and as understood by the researchers are:
* Even if a woman came to the DTC she is always accompanied
by her husband, brother, mother-in-law etc. and hence, is unable
to talk on these sensitive issues in their presence.
* She is in a hurry to go back home.
* Most of the patients, female as well as male, are transferred
to the nearest PHC for further treatment.
Hence, the criteria for interviewing patients was changed and
it was decided to visit rural hospitals and PHCs in rural areas
of radius 50-60 kms from Pune to cover the target.
Moreover, it was observed during pretesting that females
feel more comfortable with and talk more openly to female
researchers. So instead of one male and one female researcher
it was decided that female researchers would interview female
patients and male researchers, male patients. The same
strategy was followed in interviewing non-affected persons.
The qualitative information gathered in the interview is
immediately coded by the interrater method. The code is
mutually decided upon by the researchers.
Initially, we had planned to conduct FGDs in the evening
when all the women would be at home and had some time
• to spare for us but it was suggested by village women and
others in the community to conduct FGDs in the morning
on a weekly market day. The reasons given were: firstly, it
being the market day nobody would go for work and hence,
everybody would be available for group discussions and
secondly, in the evening most of the men folk in the
community came home absolutely drunk making it difficult
for women to come for group discussions. Incidentally, the
problem of alcoholism was prominent in 2 of the 4 villages
where FGDs were conducted.
After due discussion it was decided that as it would be
very hectic for the community based patient if s/he was visited 6
by FRCH researchers and again by tais for in-depth study
and follow up, instead, only tais would visit the patient and
take in-depth information form patients. When it was observed
that tais give more information orally than in writing, as
writing seems to be a constraint for them, we decided that
the one of the FRCH researcher would write whatever relevant
information the tais had gathered about the patients. The data
collected through this method has been purely qualitative
to date and will be analysed by the computer package popularly
used for qualitative data 'Text Base Beta'.
These were a few methodological problems faced by the
researchers in the present study and the necessary
modifications made to our strategy. We hope our experience
will benefit other researchers carrying out similar work.
Note : * EMIC: The Explanatory Model Interview Catalogue is a highly
appropriate method for acquiring information about social and cultural
determinants of illness, help seeking, treatment adherance and other aspects ()
of illness behaviour. Though rather lengthy and exacting, it is able to
simultaneously collect qualitative as well as quantitative information in depth
abput any particular illness.
EMIC has been developed in studies of tropical diseases and mental
health in India and used in Africa, East Asia, Europe and North America.
It has already been used for operational research studies of leprosy,
onchoceriasis and childhood diarrhoea.
•
Contd. from page 4
ensure proper utilisation of the existing public and private
health systems through health education, awareness of
individual rights, more economic resources to help them buy
better services, timely referrals to public/private providers
by the village health workers in complicated cases etc.
Empowerment of the People - Bottom-up Approach ":
It has been realised that no development initiative including
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. ‘99
basic health care can succeed unless people's participation
in the scheme is ensured. The 73rd amendment to the
constitution now offers people an opportunity to initiate
and plan schemes for their own development. The 33%
reservation provided to women and schedule castes in
Panchayats should ensure the participation of the weaker
sections of the society in the political process and give
them socio-economic empowerment.
□
6
The ANM Speaks
Seema Deodhar gives an account of the feedback given by Auxiliary Nurse Midwives (ANMs)
on "Aayushi" a journal for ANMs published in Hindi and Marathi by
the Foundation for Research in Community Health
The Foundation for Research in Community Health had
undertaken a project Training Support for Rural ANMs in
the States of Madhya Pradesh and Maharashtra' to provide
the ANMs in the states of Maharashtra and Madhya Pradesh
with information regarding technical, administrative and social
problems on a regular basis. For this, a monthly journal
Ayushi’ was published and distributed to ANMs.
The publication included two sections: i) One section
provided ANMs with technical information related to
common disease conditions, contraceptives, women’s and
children’s health problems and how to manage them, public
health issues, health care delivery, home remedies and so
on. The language was simple and illustrated with line diagrams,
photographs etc. ii) The other section dealt with real life
case studies of ANMs, short stories on women’s lives and
their predicament in the present society, commentaries on social
issues, letters from ANMs and other health workers etc.
A total of 37 issues containing 352 articles were
published. Following is the distribution of articles
according to their themes (Many articles have covered
all the three aspects and hence have to be included under
more than one theme):
Themes
Social
Technical
Administration
No. of Articles
% of total
303
143
103
86.00
40.62
29.26
In our attempt to distribute Ayushi to all the ANMs from
both the states we had to face two major kinds of hurdles:
* Inefficient Postal service in rural areas.
1)
* Irregular visits by ANMs to their sub-centres.
* Lack of initiative by the PHC Staff to disseminate
the journals which were reaching them; we usually recovered
journals from the Pharmacist’s cupboards or from Medical
Officer's tables.
Seema Deodhar has done B.Sc. Nursing and is the Principal
Investigator of the FRCH project "Training Support for Rural ANMs
in the States of Madhya Pradesh and Maharashtra"
7
2)
* Generally, the daily work schedule of ANMs does
not leave much time for reading.
* The ANMs are high school passouts with additional
18 months of course training. Most of them are first
generation educated women in the family and thus have not
really developed the reading habit.
Hence, our feedback is restricted to only those ANMs
who read Ayushi and whom we came in contact with personally
or through letters and/or questionnaires.
Impact Assessment
Four methods were employed to assess the impact:
1.
Informal feedback obtained through ANMs’ response
to letters and articles and response of the PHC and non-PHC
staff.
2.
.
Personal contact through Field Surveys conducted
by FRCH Staff.
3.
Feedback from ANMs through questionnaires mailed
to them or distributed in workshops.
4.
Discussions and specific exercises in workshops
conducted in the four socio-economic regions of
Maharashtra.
Response from ANMs
The total number of ANMs contacted was 2678 of which
2017 ANMs responded. There was no overlapping of samples
covered through each method.
1. Analysis of letters - 1002 ANMs out of 11500 ANMs
(8.66% of the total) responded to our publication through
letters from the four socio-economic regions of Maharashtra.
This could be considered as a reasonably good response as
compared to the average response to such exercises which
is 2-21/2 %. On later enquiry many ANMs said that they
did not respond as they were mentally not prepared to
give their opinions/experiences in writing.
Of the 1002 ANMs who wrote letters to FRCH, 97.1%
appreciated Aayushi; 2.2% did not like Aayushi; 90% found
it useful and 60% were ready to pay subscription. The articles
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. ’99
and poems sent by ANMs were regarding their work, problems ,
and interesting experiences.
ANMs from the Vidarbha region of Maharashtra gave
the most enthusiastic response as many of the ANMs therein
reside at the Sub-Centres and read Ayushi more regularly.
Only 6.6% of ANMs specifically demanded back issues,
though on personal enquiry, many more said that they would
be interested in reading them. 20 ANMs wrote to us pointing
out our mistakes, or what they did not like, as follows.
1
A cover photograph depicting a wrong method of
injection administration by an ANM. Actually, the method
that we showed was ideal, it is the ANMs who held a popularly
wrong notion.
2.
The dose of TB medication mentioned in an article
was wrong. It was actually a printing mistake and we
apologised for it.
3.
A few accused us of concocting the experiences
of some ANMs narrated to us which we had published.
Many ANMs wrote letters in praise of Ayushi. They said
they found the matter relevant and found useful tips which
helped them improve their rapport with the women during
home visits. Even other PHC staff was interested in receiving
Ayushi separately. The column ‘Bolake Patra* or open letters
to the editor was an opportunity for the ANMs to express
their feelings and state their problems. In this, the ANMs
wrote back showing their appreciation for other columns like
write-ups by David Werner, songs on the last page,
informative essays about children, women and poems. The
response through letters proves that Aayushi has indeed
made an impact on various categories of paramedical staff.
2.
Visits to PHCs and Sub-Centres - Of the 449 PHCs
and SCs visited by us, 433 were in Maharashtra and 16 in
Madhya Pradesh. The number of ANMs contacted were 551
and 31, respectively. As per their response 27.19% did
not read Aayushi; 65.69% read Aayushi; 65.69% preserved
the issues after reading; 61.08% found Aayushi useful;
58 .15% were willing to subscribe and 7.00% did not
respond.
a The opinion of ANMs was sought on the following points
1.
Did ANMs receive Aayushi regularly ?
2.
If yes, did they read it ?
3.
If yes, did they find the language easy to follow?
4.
What subjects would they have preferred to be
incorporated in the forthcoming issues of Aayushi ?
5.
Probable reasons, if any, for non-receipt of Aayushi
by ANMs.
It was found that if the issues were mailed to PHCs,
they were rarely distributed to the ANMs. Neither were the
ANMs allowed to take the issues home where they could
be read at length. Sometimes the other staff from the PHC
would keep the issues for their own reading, which though
indicating the wider appeal of Ayushi, did deprive the ANMs
of the issues. Thus, if the issues were mailed directly to())
ANMs they had better chances of receiving them. However,
most of those ANMs who did not reside in Sub-Centres,
were ignorant about Aayushi being meant exclusively for them
and hence, had not read the issues mailed to them. Quite
a few sub-centres have no building of their own. Hence,
chances of ANMs receiving Aayushi at these Sub-Centres
were remote. In such cases, either the issues were returned
to FRCH or delivered to Gram Panchayats, private medical
practitioners or even to banks!
ANMs in Nasik district positively affirmed that ‘Aayushi’
as a magazine fared better than ‘Arogya Patrika’ and ‘Centre’
- two health publications published by the Government, as
Aayushi was more informative and more useful to field workers.
When asked about the content of future issues of Aayushi,
the ANMs requested that subjects like AIDS, Cancer, Family
planning, TB, Leprosy, Malaria etc. be included. They also (T))
wanted the journal to contain more illustrations and sketches.
Methodology Used in Selection of PHCs and Sub-Centres:
We were also told that often the contents were read
out publicly in Mahila Mandals, workshops, training sessions,
ANMs' monthly meetings etc. In fact, a large number of PHC
staff, especially in Maharashtra, confirmed that Aayushi was
used during training courses for ANMs. The Medical Officers
and Training Officers used Aayushi along with the Government
Training manuals to facilitate training.
First, we selected a few districts from both the states
through random sampling. Thereon, we attempted to cover
the entire district by starting from the most backward/tribal
area PHC in the district and then spreading out to as many
adjoining PHCs/SCs as possible. All those ANMs present
at the time of our visit were then interviewed by us.
In some PHCs in Vidarbha Aayushi issues were bound
and preserved. Some MOs and DHOs felt that it was equally
useful to doctors. All of them insisted that they be individually
mailed a copy rather than through Sub-Centres as not to miss
any issue of Aayushi. They had voluntarily compiled a list
with names and addresses of those wanting Aayushi. Some
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. '99
8
ANMs said they even lent ii to their neighbours who found
it very interesting.
ANMs working in tribal or Adivasi areas claimed that
due to time constraints they could not devote enough time
to Aayushi but insisted that it be continued. They were keen
that the journal deal at length with the problems faced by
them in their work.
Majority of the ANMs were willing to pay
subscription from their own pockets, but they differed on
the amount to be paid. Two options were suggested by them
1) as much as Arogya Pairika, 2) between Rs. 20 to Rs. 50
per month.
ANMs from Marathwada informed us that they were
willing to pay even above Rs. 50 rather than see it
discontinued. A large number of ANMs fell that if they could
spend much more on luxuries they could easily afford a
subscription between Rs. 50 - Rs. 100 per month.
Unfortunately, in Western Maharashtra, Aayushi was not
received as enthusiastically as elsewhere.
3.
Questionnaires - To gauge the impact of Aayushi
a questionnaire was prepared and after field testing, was
mailed to ANMs along with the issues.
Only 120 out of total 11,500 ANMs returned the
questionnaire. The questionnaire was repeatedly printed in
three consecutive issues of Aayushi to reach all ANMs at
least once. The response to the questionnaire was 1 % which
is at the lower end of the average response of 1-2% received
for such exercises by popular publications.
The explanation given by ANMs for this low response
during our personal interaction with them was :
Questionnaires were a new concept to a lot of ANMs.
*
*
Some of them were scared of repercussions by the
authorities later on.
(Western Maharashtra). Gadchiroli (Vidarbha), Raigadh
(Konkan) and Lalur (Marathwada) each. In each region 40
ANMs were invited for the workshops.
The response of the 229 participating ANMs was :
93 .44% read Aayushi; 6.5% did not read Aayushi; 100% have
changed their perspective; 87.33% found Aayushi useful and
92% paid subscription for it.
The ANMs made the following suggestions regarding the
Publication:
Language - The language should be as simple as
possible; heavy academic language and superlatives should
be avoided; the dialogue form was easier to understand and
more appealing.
Content - The content should be straightforward - irony
is not easily understood; stories with tragic ends were not
appreciated, a positive outlook was preferred; the subject
matter should be relevant to their own life experiences. The
poems included should be women-oriented and based on
grassroot activities - poems on personal emotions or human
relations were not understood.
*
Text Layout - a sentence should not extend beyond
fourteen words; a paragraph should generally contain only
150 to 170 words; an article should not contain more
than 1800 to 2000 words; a three column layout per page
was easier on the eye and the font should not be too
artistic.
*
Pictures i)
Line diagrams were preferred over figures.
ii)
Urban stereo types were not appreciated.
iii)
Figures represented in a definite background were
easily contextualized and hence better understood.
iv)
Pictures that were too abstract or symbolic were
difficult to comprehend.
v)
Human figures represented in straight lines/square
forms were not appreciated.
*
Some thought the questionnaire running to two pages
was too lengthy and tedious to be filled in.
Conclusion
After our personal interactions with them through
workshops we received 244 completed questionnaires making
a total of 384. Our analysis is based on these 384
questionnaires.
2.
.
The journal, if it is to be effective, should be
based on personal interaction and rapport with ANMs through
workshops.
The impact of Aayushi as reflected through the 384
responses to our mailed questionnaires is: 92% read Aayushi;
69% find Aayushi useful; 92% preserve the issues of Aayushi
and 72% are willing to subscribe to it.
4.
Workshops - Four workshops were held in Pune
9
1.
A journal like ‘Aayushi* is necessary for ANMs.
3.
The length of the journal should not exceed 12 pages
since ANMs are short of time.
4.
Aayushi has proved to be successful among those
for whom it was meant. However, it is difficult to collect
the necessary amount of subscriptions from the ANMs to
keep such a magazine going.
•
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. '99
HHc sqN0 suae ahu BTT?
s. q10 vequs EII ferra TT a5 du, U.anv.n.yu GlT yoifid "fe ‘sngh
a wI94{ 1995 a aic # yoifr g3n SIT
Rod $8 qul 4 geiyat,
at 30^1 Haffch Jufei qd
clof fufctll goneft 2 foe wHa d4R e 751 % l angfc
sprit d qlx a torn saquc -I 43-HHAt, 56 furockil tono cl
m&a d R d “IT z 81"
qfH anuf sc cl as GHIA W 5^ ale goua TO sH8 seua
aTasc fafcHl gonel da BH8 tqe qdl3i c Pi nidi,
hoito gWRUH $Hc ft smeR t! wron si 6H aTfc
qha (ve) gonef aa torn da HH" RHic scich{ rgof tr2
fasoctll fasi ch 5u 4 vil-d 6, as aifhc af d yfor fasi
a aeq-l a 715 4 33 an To Rs usd 5 I YI amRat W chlg
=6 8, a as WMe algHafez fufocdl gonef W aana
urat =8 to ns-a amfrai to so1 aor l usd te/acc aa
fer far 9oo W
nalg, t as a a 3TPT 66421T, Hqns, hh-{ aa UsH wiet
facfd fasil % l sfi ar al 6H ud t
— f Uonyat HR HHR 4 Uo gHe fufcHl qonef 3 nu * HIPIT
Miki 0)7 goh % 1 fng 34 HR HHR # wHd sHc fazia H vi cT
g41 1 3 nStebe chlevi 4 faarf se ?hri" a ss
sHR ci?" 3 6u 4 ‘7th affar 4 Jdl aa cl wn 4 ocide
?IkT qos qhl % 1
satdf He s OUT W food Ueh aHRt 3 ferg fafr
snqadR,
^01^^5710^7 7^81
fce m JR 4 fq gel- chi HarT) an aid
‘ 51 H6r kd ("" vird) 51 fog ‘ o 619 d ses “ tom
45 JHIdAllei 50 d
8 de OTO 5 1 afo 05 g3 zbriq 07 so-
fuscich “H 801H HHs wid a l waf 31" wslq2 d JyuR chi
too anqfqi h s4-u otot a wor 8, se 07 vi ton vild 81
alci a AH 51H 864 cRT $9 de usT % 1 a Hie
too cizui di toH7 3700
qoiyat chi
8
OOT 30 07 W JeR fur
aasfc, mr sEeRIT ce at RHR a fufhefil yonei HHST
sh 98 chi To HHSI vita 1 81 arm 3e JHRcl n cTH’T use
vild m l Veiiga &RT HTRllcil o 31gHI ch ‘s che-l chi
dT
mhiHc «il 3ed {uiq A mo 81 AhuiV, 64421T, HfTT, c-
HI goffal ? wfldT a l oom a8 Hd engde, Uguat, arsc
07ft dHRal aR-a do3 diei daT vied d qos o el ale Oct
ferscHT, sef Kum fuseH qonferar 2 an 4 E 75T % I
81 shr 3000 Hga, Hg cl 3l6R-fsk, vild- k daT WRH{
too qu-arReT 4 qelsat Uo Hale fufeii qonieft 3
aldid?" d wA tom ch sid 8 1 3H7 shify 34 Zle i OT «
6u 4 facfd 55, asi W 3ld H9 RAeilAyi?- chi dec 3fcbdl h
81 *e 81-65 ama & to Uelldeft fre it chi ffae sh
Jcdl ch cl s H Wiilid furcl quliei chi 3? gohn c" % l
81 05 30 07 tigof tom MFO ORO 4 aa sld shdt 8 1
cin al aq fs ‘aHM? A git n8 ax ‘Higof tl‘ anfy l
qoiyat to) dHRf a 8 ce HI- ar Hifh qfxclo d
aHR 814 ci-ll a t1 Miki chil, 5- al-i aldi 4 vit H85 $
coin dieil 6 ah quis 4, 300 Tto 30707 6 t1 ch ft HcHa
$hc , as aq HHI- Hg * HH94 vHT % 1 ad cm $ farr 4
0050 wI 75T 8 1 ef afcizk: AHR 8 a 30707 &RT 3 Sic
31T 75 acelld ch 36y {6- 51, a 3Tgsc da WRid ain JR
chin ch otoor ch &RT it tl J sidl 8, te mw sid
c fatocHT gonef 4 ahielgeU acelld eg wI at JT4?WIT % I $-
818rf.cln.sftawie*Esmeez,eFttr6toved6T"TST-Tafi”Stt"FTNEY, MeTg
al gomfera 3 4W M^d sid falvi ? tel ch ‘El’ oRT
Hai? HId g gohia 5u d Er Z& ci ay HHn {- E |
it w 81
Rtod^
to 3W amoto ^8 w
si{ chi tale ch nit s ad on cfo- Eill 81
alssstgausazdgVWcqeafaRe tomr <rt8 q§t atom
50 9-4 07 Hd HH14214 anqaquR a ‘silifcc HsifT’
96 a3 at 3l0 3lld9acdl 5 1
fas tal 5o- a sexich &l?T soa T4T 3fpd sac-
chi WReu-l $ too Hd- acbdl fr 050T ahis 3794114 OTO
$H tef 4 30- necagof t * dched 8, "fieR * c afcia
qonfrar ch Uo ge mr oota or ntoM o HI-d § U. ge a to
ASlce alcur, vfr as HTaTu w-id ch tale ?8 at formanft d
‘Y ^^^30^tom wnai^tootl5O0toRvO0TQ6t^3mr
qr 4 Ha s l ga siat daR 46 c{ q R 61 anfg adHI
fafbcal guneft, i ac ?G ch{ aH? aa s 816 che ch ft
tort: aoitoT 4 it g5 to 564 die H w 05 m to go?
ERTeTlqwJ?1-1 ch sfe onto t GI-ieI 3wr n i Rtowi fasius i
fafya HR at afta chan ac fifd ?6 Ts % i chktdis 561 a
RTR § 387 s t teegeq Uenlsaic siat TO 300 0707FRI
afe aa HdHTru cft a
sufcil qonef CRT 3ooto can aid fasiust 5W3 it a to) ‘ru
arc garaf a w
duft a z
n81 50 uRoe-Il 4 tr sf 3 to, suda ef fufbce
tor’ wo o tto ‘tar‘ 08 sif «8 HI-ch ‘rigof tarez Rar'
ecaq epe afto
ws-Hf, yo frafaeict 3 tow 6
=a faxafacerq a yovflagfeq ahd 3 Het * Ei
FRCH NEWSLETTER, XIII NO. 1, JAN.-FEB. '99
6h1 si sh 1 50 4 3lcd H6cqyof OTO 8 gellseic siaez at yaa
6y d Hgm itor I set 3 OTO HITer, esec =6-1 tom,
10
cift HMesfH, aR a vfid- ft orw Sl-delai chT faedigo da
tirof a 34-fl-a-f fasuergr qezf,
H ft H ana94calg5q uifc (rigfei) STR op TR, ?hT
a a nic qRa= wi Jd- tieok a fufheel qolefii chl HHT49T
ferc aR qonet, a a a- a--HRUI aa eTaI fafar eRT
gle t I $- ar gonfera if cs de 2 anqadR Hfeid 8 l
aldeia-I, a=raf SRI JdR, zifenyat, allgee wet afqayuR
H anfecit qolft d
‘ar d it A53lid al a Jgueaz-fH4 JJa9R, frlg,
Jolleft 3 HI wil • quef ‘Wc‘ W * sugr ft 43, 3n Hq chi
solaal ayuaaz. vat IRR a fafr adid-fage W “ JdT 3d
9aM cenl, seuf Ueblod 5q H delAT TRIT chidchH chl 6 ^<1 HPT
JeR a ayczun eRT gal soar vild % l siauiaifthche quel if
‘Woh anqauaR fast-’ ara ‘bJHcHe? Asif’ 6 1 545 ‘dHR{‘
Hie qa uof 3 ald dqa ! sad tnaR, HAdR sfe
eRT HH149 sid % l fgd J9dR 4 sqg*f, irne adt, s-hrs,
cl fdR ceal ftt HScgof HI-II T4T % 1
etb uRcbeu- a fet Hd HTTo vid * dt 3c(el t 6t,
$635 alcllal $Ho H5c eRT
sict *t
w[" s, as
tidq a ald % l qeyat cRT &kguc q Jde ah vII-chi" H
anfe and 6 l sifonyaf # asHan mem ft it vIIT ale qarkal aa
an a JdR % l veuR if HAt,
zet, HI anfe chT gam soal
vid % l Hiic 39R if Hg9 ah Hicsac 4- Rstb cl viriRid CRT,
S1-IT ais aiq 24 anq ald H8 &, shg aHR 4 3ifH fed ah qf& H
? JUR 344 ufqalc-c WR sued aaV vid 11 5H if
‘Rrc HfHH’ q z, we H d J- yonfrar eRT aldridn ciHT
3y41H, 919, JlRM1440 ame eRT gap soal vild % l H-Huefcs
314944 Mdld sidl s I Uo 304- 4 Hfad chi fa % soh 3the Uo
aut 3 sidd qiadinfec, zlfznyar, ain Hf’T, HHv as eRT
srous ? FTTH al &R a affc 8ter clHle? nSf- af
H149 % I HHdR qunei if t’g-IT, HHs-I, a, ar thlsch
1Sice o*f HTHcfi far
and % l tde- JHR if naR, JdR, elaR 8 a gH?
ueen afqaqur eRT gam ahed t l
QUR, a-iufa JQuR, anvil ast, HT-T, auR
af4e auoly HRi chi H Jobifid Rui $ JJHR «T‘T co afRid
a ae
Sier, a Wo onadR OTToft w8 algdc, slegya, Eifenyat,
seaf a HI-H ?nfe 2 feg a a yafer at sie
aruf sealf eRT vl-chl? MM chin 25 50gch 8 ।
(3T423med/vft), aleis thieari vief qumfar eRT • sHHle Sid
aH66i He 6H ufuH eRT sial 20 chin 4 & aAd Hid
11 Hit a R faa if Jofeid fafcil yonfera at WIT TnHH
delangs I sioUs-aHRcbl d wI $u 341 as Hd 3, 38 aRo
qeen 3 &HUTe % 1 5H* afffr as gl2-ni2t WTT qefs i
H= sess usd % 1 $8 cii dt arh srige al 6hR yo ft usd
fec qst 11 $ ms ah a-f $6 fasaeg 81 $6-58 fmfa ft
d it Hse t, RHT 86 d • nit qohe ! Rig ter * sififcc
3= d as qef CRT aga 8
nsif-T, cifee? nsfn af 934 anqaquR a URcheI ch
aft a aufr ftm 4 81
Eie atT W % | so it 3-
ws ag3c ft fries 5q d t l qaTd: ^FT tef ft HRdgr KITT fa
5 mf qezfa CRT Hhfe sua? a{ 54 au-f tr Za
R q Age saT vTHT aifq aT, shg vid 45 WRccAT 9n: facoi
afuc mdr 6u 4 eRT Hha 8 l ca daT sH 66 do ain A qunef
cRt <3itr ft tiTT^ 8, KH 3H MT Tjegdch fadR ah? q" 6 I
Wgrb it, 46 sschetich &RT d sha 5UHT aift l Wo anqadR
an • EH fa # $H URceyAl 2 HHR ah ft age a
yunef ft 3Tas106 fufheIl chel Holef %, ^TIcRT • a 3T vIl-I
Hcha 11 5H3 feg g5 JHd: &3 it 29 if 9ch anqauR qoneft
s6? 81 &llqfc iter c HI-q I?R a, s6 if f fafa IRR
CRT Hafroguf 32H a{ $u Zi “f fafRa ch 3ll9uch % l
?- aa I shar at an JIIOR? sid 8, ad: ya fasus a
s6tdUeaTTT86qE=tcl 3lv faa if Jufid ffa snqauR
aaRkg if fnt Tg 39R Ha te H w Ed 8 I
yomfena at wI-hl&t cr? d-IT w? % 1 5H3 q2id it Hec eft
daqi cheTVITValtareIUeh YeTHetfrech fergesto
39-f 394 gfHrl daT 311494 bdlg6q fur dn if TRW it Hi1 II l
&lT Jae sohar 'Jim 3llq94c 81 me did it vid ais aHM Sic
H ft M" * fas- al WH ufyof nit 8, $H q wit
sid 8,5 tfl ‘tarr feci Hc- an ais Tief q ql sued 36 8,
fdRc fasus H6Hd 11 so SR ahis • fafeel qoneft qRguf
5Hchl Hed WIn ? l ta1 me 4 fg th sfar if qe 'ft Afhc
6 AI a Hoe l Hech 963 (fas-) a we af faraen 6,
iiHT Hecqyuf ald 81 Je Eh R it ‘Wo snqaeR, qunefr cht
aet61e-d ftt 81 sfife FT2 a ft^ft if fdR chrd HH86
af4c q9 mm it Ho'I da t12 cI mm ihn i
d fa onIq a afuch qararet aa uRqufe at
sidd: Uo HScqgf H6T as 8 f afacia Y6 anqaquR,
si wI4 ale it HOe %, ye farsusif a fae % i fufoce qe
ahin KTTT frfd a 8ft a avis ft $- JyuR gonfar ft ahs sisilf
cfit (& 4 ad a seislei fx ft $u aR fafctT qunefr Jauty
ae ferrazt fefeoctic * Mt titsa ft v 81 cis * areez s?
sinfaTIg
4 Huseid i i 51 Hd q qesat Heffcp ciof 8 1 gat guneit 8
Sic eRT 8ft at mu so ale at * c4t nf 8 l sffeq Md) ch as
*da fofcheel goneft I $4 angde, q=-t, ferez onf afac 81
a sad tiqt grasc viHcbift ihr * viel it vild 81
□
4g Is aft a d-f, wIqI-t, chifardt, frcd afqaaR cilofya
11 dat qonef 3 aidra qiama anquyar 3lld % l su Sehc
11
agal : if. gaic feoel
FRCH NEWSLETTER, XIII NO. I, JAN.-FEB. *99
Invasive Devices Increase Risk of Infection
This information has been supplied by Stephanie Swafford in the 24 May 1997 issue of BMJ
A patient is seven times more likely to acquire an
infection in hospital if an invasive device is used, according
to a report from the Public Health Laboratory Service.
women undergoing gyneacological procedures who have a
catheter inserted varies from 20% to 72% depending on the
hospital.
Invasive devices such as urinary catheters or
intravenous lines are used increasingly often and the report
found wide variation between hospitals in the use of such
devices and in the incidence of infection.
"Clearly such devices should be used with restraint",
said Professor Alon Glynn, study leader and former director
of the Public Health Laboratory Service's central public health
laboratory.
D
Data for the report Hospital Acquired Infection were
collected from 19 hospitals in England and Wales which were
clinically audited for infection control activity. Results of
the three year study showed over 2000 hospitals acquired
infections in over 80,000 admissions, giving a rate of nearly
three infections for every 100 admissions. Rates of infection
for intensive care unit, where invasive devices are used more
frequently, were nearly 20 for every 100 admissions.
There is a great disparity among hospitals in the
use of invasive procedures. For example, the percentage of
FREE ABSTRACTING
;
The contents of this newsletter may be
abstracted without prior permission. *
। However,
we
would appreciate
acknowledgement of the source and
copies of any abstractions
[
The views expressed in the articles are those of the
authors and not necessarily those of FRCH
BOOK-POST
(PRINTED MATTER)
If undelivered, return to :
The Foundation for Research in Community Health
3&4 Trimiti B Apts., 85 Anand Park,
Aundh, Pune - 411 007
Editor: Vaijayanti Aphale
Assistance : Jayashree Puranik
Publisher : Foundation for Research in Community Health
Mumbai/Pune
Printer: Abhyankar's TypeServe
Position: 5735 (1 views)