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£V- 10
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*
*
*
*
A
REVIEW
*
GF
PROCESSES
IN
CHILD
IMPLEMENTATION
SURVIVAL
AND
OF
THE
CHILD
DEVELOPMENT (CSCD) PROJECT
OF
THE
CHRISTIAN MEDICAL ASSOCIATION OF INDIA
*
*
*
**************** * * * * * * * ********** * *
Dr. Shirdi Prasad Tekur MDBS DCH Ex~Capt.AMC
(Co-ordinator, Community Health Cell - Bangalore)
Sri. Justin Jeba Kumar BSc MSW
(Programme Officer, CMAI - New Delhi)
Kum. Reena K. Nair BA MSW
(Associate, Community Health Cell - Bangalore)
***********************************
1
CONTENTS
Executive Summary
- 03
Bac kg round
-04
Process and Methodology
- 05
Appendix -A
- 07
Appendix -B
- 10
Appendix -C
— 22
Review of activities for CSCD - Field Observations
- 23
Review of Processes
-at CMAI HQs
- 26
-between CMAI HQs and CSCD Microprojects
— 26
-at CSCD Microprojects
- 28
-among people at CSCD microproject locations
- 31
Strengths, Weaknesses, Recommendations
- 33
Appendix -D
— 36
Individual reports of 22 Microprojects
2
EXECUTIVE SUMMARY
A PROCESS REVIEW of CMAI's Child Survival
and Child Development
project was done at the end of the current phase covering 25 micro—
projects,
between March and May 1996. Twenty two (22) of the
twenty
five
(25) fflicroprojects were visited and studied during this period,
with preliminary, quanti ative data analysis done in a two-month phase
The compiling, reporting, etc., was completed in the month
earlier.
following the field visits.
The service component
is well-tried, tested and
established
as a
workable model, addressing the varied needs of the poor scattered
all
over the country - at a low cost.
The
abililty
of
non-hospital-based
development
and
service
organisations to take up such work for children and mothers,
creating
awareness and promoting participation in services available from the
Government and Voluntary agencies in the area has been confirmed.
The
needed
training,
monitoring and technical support have been wellplanned and delivered.
The direct contact with people in need and raising of awareness levels
and participation
abililties have emerged as the highlights of the
project - as seen on field.
The microprojects implementing the CSCD project have also been enabled
to
identify and initiate other health-related activity depending on
local needs - eg. logical extension of child care beyond two years of
age / nan-formal
education of mothers for health
/ reviving of
traditional
and home-based remedies for minor ailments / nutrition
education, supplementation and other technical support, etc.
Discovering of
the complexity of
factors affecting health
and
promoting
action accord i ng J^p eop les ' needs has delayed microproject
initiatives towards sustainability of the CSCD component.
The working conditions at microproject level being far from ideal, the
three year phase of support planned for CSCD needs to be extended
for
a further period of two to three years to make
the efforts
truly
f ruitful.
Further training
and networking within the microprojects
and with
Government and Voluntary agencies is needed to meet the emerging needs
of
the people, in areas of - First-aid / Minor ailment management
/
Integrating into other development activity, etc.
Decentralization,
Communication
in regional/local
language
and
generation of locally relevant health education material are
logistic
problems which need to be addressed, considering the scattered
and
remote location of microprojects.
BACKGROUND:
The CHAI has taken up the Child Survival and Child Development
project
- as part of its broader approach to Community Health;
- to enable non-hospital based agencies working in other areas
development to take up health as an area of concern; and
- to evolve a demystified/simp 1e approach addressing the most
needy among people in an area of work that could make
a
visible/palpable impact on their lives - viz. in taking care
of their children.
This project is implemented through 25 micro-projects attached
to voluntary agencies who have taken up social-service as an
activity, all over the country.
An earlier phase covering 50 projects was tried, and monitored
between 1988 and 1991.
This was evaluated for suitability of
approach, and for learning in early 1991.
The present phase was started between 1993 and 1994, selecting
suitable organisations,
training the personnel
from micro
projects and monitoring their progress over 2 1/2 to 3 years.
A need to review the 'processes' generated by the CSCD project
was felt towards the end of the planned 3-year phase to deepen
the understanding of this 'intervention'.
The Community Health Cell was informed of this, and Dr. Shirdi
Prasad Tekur who had earlier been involved 1 in the 1991 study
evaluation, agreed to take it up between March to May 1996.
This
’Process-review'
is a study of
these projects
from
documents, field-visits and discussions with the micro-project
personnel and people at these locations.
4
PROCESS AND METHODOLOGY ADOPTED
Pre 1iminary activi ty:
An initial meeting in mid-February between the reviewing team
and CMAI personnel evolved a plan of action for the
review,
keeping
in mind the
review needs.
Over the week,
the
following were done a) A travel plan to cover 22 of the 25 projects between
18th
March '96 to 6th May '96.
b) An overview of
each project prepared
from available
documents, and
c) The most suitable methodology that could be
adopted to
cover the needs of the review.
While a)
and b) above were handed over to the Programme
Officer CSCD, c) was evolved by the reviewer in consultation
with colleagues and other library material on why? how? etc.
of such a review.
( Ref. Appendix - A )
By end February 1996, the Programme Officer CSCD CMAI had
- prepared overviews of each project which were studied,
- analysed all quantifiable data from the microprojects, and
- informed micro-projects about field visits and what was
planned, making necessary travel, stay and financial/adminis
-trative arrangements for the same.
( Ref.
Appendix -B for Map with project
locations, Travel
schedule, etc. )
Meanwh i1e,
and approved
format for the process review planned
was
made
Conf i rmat ion
and review of all the above was completed three
days prior to the field visits, which started on 18 march '96.
Field Visits;
Field visits were made as planned to all 22 micro-projects by
- the reviewer - Dr. S.P. Tekur; and
- the CSCD Programme Officer - Mr. Justin Jeba Kumar, and,
- Ms.
Reena K. Nair, a CHC Associate,
who accompanied and
helped the team during 8 project visits in South India.
During micro-project visits, the review team
- reviewed documents at the micro-project HQs, and discussed
problems faced in documentation/reporting,
- visited field areas covered by micro-project and interacted
with project personnel, people directly involved by the
CSCD project and others.
- discussed with the project implementors and
their Board,
and
- prepared concise notes for purposes of the report at the
end of each project visit.
5
PEOPLE/PERSONS MET/TALKED WITH during field visits
A.
C.
D.
E.
F.
-
-
YMCA Board members/others related to
the project not directly implementing CSCD
-
66
CSCD Project Executive members viz: CEOs and PMs -
31
CHVs employed part/ful1-time to implement
CSCD project
-
76
Other Health Professionals in area connected
or not to CSCD Project
-
19
Pregnant women and mothers influenced by CSCD
Proj ect
- 187
Other village persons not connected with
CSCD
- 192
TOTAL
- 571
Details of personnel
interacted with
and areas
of
questioning are in Appendix-C.
Details of observations, and discussions at the micro
projects are recorded separately for each project.
Appendix D -(Details of 22 micro-projects )
Reporting:
Following the project visits, ending 06 May
'96,
the
review team of Dr. S.P. Tekur, and CSCD Programme Officer,
Mr.
Justin Jebakumar met
- the Co-ordinator, Community Health Department,
- the Community Health team members, and briefed
them about
the
impressions gathered prior to finalizing the review
report.
The finalized report prepared by the reviewer was circulated in
draft form to all these members of the field review team to
consolidate
and confirm
- the format of reporting,
and
its contents,
- the completeness of the document, and
- to add to/modify/e1aborate on aspects which need mention
to
make this review - useful.
This process reached the last week of May 1996. The draft
circulated
to all
the review team members and CMAI,
finalised by end-June 1996.
6
was
and
APPENDIX 'A'
REMIEN DF PROCESSES OF IMPLEMENTATION OF CSCD PROJECTS
The CSCD project of CMAI has been conceived and implemented as
approach to Community Health
with
the
an
innovative
objectives of
introducing
simple,
low-cost
and
effective
health
intervent ions that can help women and children
in the
community.
- focussing on communities of
low socio-economic groups
predominantly in rural areas, and
- ensuring that all children born in the community reach their
second birthday.
-
The project is implemented in the current phase as 25 micro
projects across the country, each working with an
identified
community of
approximately 5000 or more population,
with
a
high Infant Mortality Rate and between 100-150 births occuring
each year.
The life of each micro-project is three years.
in an
A participatory study-evaluation of 50 minor projects
earlier phase was done in 1991 confirming the ability of such
attempts to address the objectives adequately.
The CSCD project is part of the CMAI's broader
Community Health
approach
to
- Believing that people have an important role to play in
their own health, and that
- non-hospital based Christian and Social
agencies already
working with people in various areas could take up health
work also even if they do not have any prior experience
in
health related activities.
The project focusses on these aspects in its approach,
design
and
implementation,
as seen
in the study of
1991 cited
earlier-
PROCESS REMIEN METHODOLOGY
A review of the PROCESS of implementation in the project's
current phase covering 25 micro-projects will be therefore
pre-dominantly qualitative, with quantitative data analyzed to
offer support or otherwise to it, since adequate quantitative
data is already available as part of the
implementing and
monitoring mechanisms of the project.
7
The Review will consider the processes between and within
following three key groupings of the project.
CMAI's CSCD
Pro j ect (1)
1-
(2)
C----- >
CHAIzs CSCD PROJECT;
CSCD
(3)
M icro-Pro j ects
(4)
<---- >
the
(5)
P eop 1e
to consider
a. Importance of CSCD project in its CH approach.
b. CSCD Program Officer - role, responsibilities
&
Processes set u.p to tackle
these.
2.
CHAIs LINKS WITH THE MICRO-PROJECTS
a. Process through the Program Officer like
~ identification of projects
- training of personnel at micro-projects
- reports, returns and follow-up on them,
b. Training, Support and Monitoring activities,
Co Any other - Resource mobilization and Networking.
3.
CSCD MICRO-PROJECTS
a. CEO's,
Project Managers - Roles,
Responsibilities,
act i v i t ies,
ba Community Health Volunteers,
c« Integration efforts into other activities of the micro
project *
d. Documentation, information sharing.
4.
MICRO-PROJEC T LINKS WITH PEOPLE
a. Community organisation and participation for Health How?
b. Information dissemination - modes and effectivity,
c. Services offered - nature, need and effectivity,
d. Steps taken for sustainibi1ity.
5.
PEOPLE
a. How people view and utilize the CSCD attempts,
b. Acceptance, Appropriateness of CSCD project,
c. CSCD impact/effect on
internal
processes
operating in the community.
already
In the above format, the process review will have to consider
persons and processes these persons are involved in from the
project and individual points of view.
8
Persons will
be interviewed in an open-ended manner
in
the
spirit of
a "shared interview', where both
interviewer and
interviewee make
a joint search
for a genuine,
hsared
understanding of the processes seen/evolved during
CSCD
project implementation.
All aspects of the CSCD project will be explored during the
interviews,
and evidence
looked
for
in quantitative
or
qualitative terms to substantiate the shared understanding,
eg. ,
1.
3.
4.
The history and evolution of the project.
The
Information and services planned,
provided
and
problems, solutions evolved etc.
The utility and effectiveness of links with CMAI and
the
people for the project goals.
Innovations, setbacks and other such variations seen
in
project implementation.
Specific other areas that will be covered during the interview
will include both positive and negative aspects of
- Evidence pointing to ENABLING AND EMPOWERING processes.
- Evidence pointing towards SELF-SUSTENANCE processes.
- Signs of commitment, cohesion and solidarity to CSCD goals.
- Improvement in Technical competence, and Managerial ability.
- Capacity for collective reflection, analysis and action.
- Flexibility in approaches to suit local needs.
These
are
likely to yield pointers on MECHANISMS
DIRECTIONS of the processes in the CSCD projects.
and
Apart
from these, the CSCD micro-projects attempts
influenced by
be
will
a. Other/External processes in the Community which
influence
the project
i-e., governmental/NGO activity in
the area
that help/retard project activity.
b. Processes within the Community itself which will be
influencing/influenced by the CSCD project.
Being
a
qualitative
review,
other
interesting
directions/process
independent
of
the
CSCD
p reject,
goals/intent ions which may have occured will also be
looked
for.
9
APPENDIX 'B'
TRAVEL SCHEDULE FDR CSCD PROJECT EVALUATION
DATE
TRAVEL DETAILS
18.3.96
Bangalore to Mysore by Bus
Visit Mysore Rural Development Project
Mysore to Bhadravathi by Bus
19.3.96
Visit YMCA Bhadravathi Project. Stay.
20.3.96
Bhadravathi to Davangere by Bus.Project visit.
Stay.
21.3.96
Continuation Project visit.
Davangere to Bangalore by Bus.
22nd St 23 rd
Bangalore - discussion & further planning.
24.3.96
Bangalore to Adoni by Bus
25.3.96
Visit Adoni Area Rural Development Project
Adoni to Hyderabad by Bus.Stay.
26.3.96
Visit YMCA - Narayanguda Project.Stay.
27.3.96
Hyderabad to Vijayawada by Train
Visit SAMATA project
28.3.96
Continuation of Project Visit. Vijayawada to
Vixag by Train.Vizag to Koraput by bus.
29.3.96
Project visit - YMCA Koraput
30.3.96
Koraput to Bhilai by Train
Visit YMCA - Bhilai. Stay at Bhilai
1.4.96
Bhilai to Amaravathi by Bus.Stay.
2.4.96
Visit Rural Evangelical Mission Project
Amaravathi to Nagpur by bus.
3.4.96
Return to DeIhi/Bangalore
10
II PHASE
15.4.96
Bangalore to Madurai by Train
16.4.96
Madurai Project Visit
Madurai to KanyaKumari by bus. Stay.
17.4.96
Visit YMCA Muilankinavilai & YMCA Moolanchal
18.4.96
Visit Vinnarasu Association.
KanyaKumari to Madras by Train.
19.4.96
Madras YMCA Boys' Town visit. Stay.
20.4.96
Madras to Calcutta by air & stay.
21.4.96
Calcutta to Silchar by air.
Silchar to Aizawl by bus.
22.4.96
Visit YMCA Tanhril. Stay
23.4.96
Visit Salvation Army & YMCA S.Hlimen
24.4.96
Visit YMCA Zemabawk & YMCA Lungdai
25.4.96
Aizawl to Silchar by bus
26.4.96
Silchar to Imphal by air
Imphal to Yaripok by bus. Stay.
27.4.96
Visit STNBA Project.
Yaripok to Imphal. Stay.
28.4.96
Imphal to Kohima by bus. Stay.
29.4.96
Kohima to Chizami by van.
30.4.96
Chizami to Dimapur. Stay
02.5.96
Dimapur to Calcutta by air.
Calcutta to Patna by train
03.5.96
Visit YMCA Patna. Patna to Delhi by train.
04.5.96
Stay at CMAI, New Delhi.
Consolidating Visit Reports.
06.5.96
Meeting with CMAI Community Health Team.
07.5.96
New Delhi to Bangalore by air
*************************************************************
11
- SELF AfrMlNlST£get>
FORMAT
-------- »•
<■
>
1
l
/
LftREA
J
.. r, ,
•
Training
Community Org.
& participation
Staff
3.
4.
Health Education
Health Servicaa
5.
Sustainability
6.
7. ;■ Development Prog.
MIS
B. .
9. • Financial Report
1.
2.
i:;V
•
i ■ ' :•
< 1 •
*’
-’ -
1 •’
1
i . •
i •’ ■
L
INDIVIDUAL SCORE
•
WEIBHTAOE
’
IO
12
!
10
9
51
9
24
4
3
•
2
1-23
20
15
1.2
1.11
0.196
1.11
0.416
2
1.66
12
10
IO
10
10
x 0
■10O
5- ••
The format
< i ' •
1 * J
•r
i. '
I : ■ .
i
f J
in detail
is enclosed.
Training
i a. •
Project co-ordinator/Managar attended
No review meeting
1 review meeting
2 review meeting
3 or more review meeting
>•
CEO attended meeting with CHAI
i H\
9 i•.
H-' • '■
3
1
J
3
0
1
none
one
al 1
,•
, i ‘
d.
«’ f.
0
1
- 507.
757.
1007.
Percentage of CHVe trained
'
. *■
!' H'"-
i
b I. !
■» »' •. i’F
n ’ .'
TOTAL
SCORE
’ •
•*
■
A " ’ *• I
:
••
•
• •• ,
• ,.
II.
a,
Project co-ordinator/manager trained
RUHSA / Jamkhed
No
Yee
’
&
Community per11cipat1 on/organi■*t1 on
Mahili Mandal or women** co-operative
)
Formed
Reg1 stared
I
b.
Naw • score
Multiply with
i
.
Other
*
at
•
functionary group*
12-
O
2
10
2
1
2
I
(eg. Youth/<armorb)
Formed
1
Active
2
I
1
•
I.J .*
t
*» VI
'
*
V.A•
f
, 'W
\
1
I
V
1
1 •1:
1 1
t
C.
•
Local advisory committee formed
Meets once a year
Meets twice a year
Meets twice or more per year
<1.
Representation of women in local .advisory committee
0
nil
upto 30%
1
2
,
31 % to 50%
3
more than 50%
i
—
12
Max. score
1
1
I
1 :
11
1
■
1
%
1
•
. Required 15
1
2
3
4
Multiply total score with 1.25
III. Staff
a.
Staff in position
t
50%
75%
1
b.
Staff continuing in the program since inception
50%
1
2
75%
o.
Percentage of staff skilled 50%
75%
d.
Project co-ordinator/managcr’s understanding of the
objectives
0
nil
1
fair
2
good
c.
CLIVs understanding of tholr role
nil
fair
good
i
.
max. score
multiply with
1
2
0
1
2
■ ‘ _
10
1.2
IV.
Health
a.
Topics covered in one year (expected 12 per year)
Education
Less than IbX
15 - 25%
26% - 50%
Moro than 50%
0
1
»»
3
**
-3b,
/
»
1
s
Health education uosalons held per month
(expected 4 per month per,CUV)
0
Lees than 10%
<
10%
- 25%
1
2
26% - 50%
3
more than 50%
1
t
c.
1t
Participants at the session 1
(Expected 10 per session
So, 10 x 4 = 40
per month per CUV)
loss than 2b%
26 - 60%
more than 60%
Max.score
Multiply with
t
1
1
,.• v.
a.
•
b.
1i
i
i
—
<
1
1
2
3
0
1.11
f!
*x
Health Services
Maternal caro
a professional
Women receiving 3 visits by
less than 30 %
0
30 - 49 %
1
50 - 74%,
2
75% and more
3
i
Women receiving full TT coverage
0
loss than 30%
1
30% - 40%
2
50% - 74%
more than 75%
3
i
\
Deliveries conducted by trained personnel
less than 30%
0
30 - 40 %
1
b0% - 74% ’
2
75% and more
3
i
Caro of under 1
Infant exclusively breast-fed upto 5 th mon th
1
40%
2
60%
3
90%.
Infants weaned a t 5 months of age
40 %
60%
90%
Immune
ion BCG coverage
1
2
3
i
1
1
1
1
i
i
<
i
i
i
i
i
40%
60%
90%
13
1
2
3
*
3 OL’V coverage
40%
60%
00%
3 DPT coverage
40%
60%
00%
1
2
3
Measles coverage
25X
60%
75%
1
2
3
Caro of under 2
Children with diarrhea
50
75
00
received ORS
- 74%
- 89X
% & above
1
2
3'
1
2
3\
Vit.‘A: supplementation given to
25 - 40%
50 - 74%
75 X & above
1
2
3
ARI cases identified and reported
Appropriate action ta^en
1
2
Growth monitoring
(Give maximum score only)
50 % childrdn weighed once In 3 months
75 %
50 X children weighed once In 2 months
75 X
1
2
3
4
Malnutrl tlon
50 X suffer from any degree of malnutrition 0
25 %
w
~
~
1
10 X
w ‘
~
2
Family planning s-
Women accepting family methods post delivery
( New acceptors )
25X - 30X
1
40X - 40%
2
50 X and more
3
Couples practicing temporary methods for moro than
10 months
(denominator - all uses of temporary method)
25
-
30%
40
- 4OX
50 X and moro
13-A
1
2
3
Govt, programme introduced
5 families benefltted
‘
? •.
•' :
•
10
1 .
• ‘
’
15
.
- •
1
2
3
Assistance available from other NGOs
/ ./•/•
5 families benefitted
1
2
3
io
15
Beneficiaries of loan or training employed or self
employed
•
0
Less than 25X
25 - 39 X
I1
40 - 49 X
2
3
50X and more
’.I
.
'
Adult education / nonformal education started
1
10 people benefited
15"
20
. 3
h.
Other developmental activities started Environmental
upgradatlon eg.
afforestation
smokeless chuln
construction of toilets etc.
1
5 families benefited
2
10
3
15
-
Max. score
Multiply with
VIII
24
0.416
MIS
a. ’/’.Registers maintained
1
b.’? '; Reports received regularly «
o.’•Ji- Quality of reports good ,
2
4
Hax. score
Multiply x 2
IX. - Financial Report
a ’ Report sent regularly
b
audited statement sent
Max. score
Multiply with
sh/kd
1
2
3
1.66
CSCD PROJECTS ANALYSIS DETAILS -
LOCATION
PERFORMANCE RANKING
POOR
TOTAL
GOOD
A. AVER
AVER.
RURAL
23
5
7
5
6
URBAN
2
-
1
1
-
25
5
8
6
6
RKMKL
STATES
A.P.
4
2
2
- !
—
T.N.
5
2
3
-
- ■
KARNATAKA
3
1
2
- .
-
MAHARASHTRA
1
-
1
-
-
M.P.
1
-
-
1
ORISSA
1
-
-
1
II.P.
1
-
-
1
-
RAJASTHAN
1
-
-
-
1
BIHAR
1
-
-
-
1
MANIPUR
1
-
-
NAGALAND
1
-
MIZORAM
5
-
25
5
TOTAL
0
1
-
-
1
-
-
3
-
6
6
---
C S C D
No -
DETAILS UF
PROGRAMME
Dates
TRAINING
No.
Par t i c ipants
Venue
No. o f
Days
1
1
1
09-13.03.93
05
Banga1 ore
23
2
06-10.08.93
05
Ai zaw1
34
3
24-28.08.93
05
Madras
56
4
07-10.11.93
04
Mussour i
26
5
21-22.03.94
02
16
6
22-24.10.94
03
New Del hi
(CEOs)
New Delhi
7
22-24.11.94
03
A izawI
29
8
23-25.02.95
03
V anyaKumari
41
9
25-26.10.95
02
New Delhi
(CEOs)
16
♦
t
t
t
t
t
t
t
*
t
t
t
t
Topics covered dur ing
&. Post
f
t
1
1
•
traininq
1
♦
f
1 1
*
for CSCD
I
*
♦
projec ts
test questionnaires administered
Primary Health Care and its principles
Community Based Health Care
02.
Ante-Natal Care
03.
Child birth and complications
04. •* AIDS and Community Response
05.
Post-Natal Care/Breast feeding/[mmunization/Diarrlioea/ORS.
06.
Chi IdDevelopment/Growth Monitoring
07.
Family Planning
08.
Community Organisation £ Participation
09.
Field Visits
10.
Community Health Volunteers
their resoonsibi 1 i ties
11.
Sustainability of CSCD Programmes
12.
Individual project assistance.
01.
Resources Used
- CMAI Staff Resource
- Local
resource
from
area
(Medical personnel on Medical topics)
- CSCD project CEOs sharing of experience.
16
CSCD PROJECT'S ANALATEMENT 1993 & 1994
199^
nSLfiNAMR OF PROJECTS
n
n ..
iNo. P 2^ i 3 AN No. B: lo. dei :BCGi BPT/0PV1 DPT/0PV2 IDPT/0PV3 iMeasi Vit
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a
CHINA
JAMMU 4 KASHMIR
India
lANOtOAUH
PUNJAB
CHINA
NEPAL
BHUTAN
RAJASTHAN
Puthk^
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nlAty.
lunv»o»' s_.J
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UTTAR
PR AD 1311
Uiab*d
«v<«% GUJARAT ’Ud‘’PU/ <•Modr>»it
‘"^•S.oehl
AJwr^<l»b*d
MAl|/|YA PRADESH
°niADi
0l>,
SomrMt/l
ORISSA
DIU
I1AMAN1
(GJ). & 0.) (GJ). I O.| A
l)Al)K
MAHARASHTRA
IJA r OP BLNGAi
I RADIAN
SRA
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SlAlf BOt’‘OAJW
Mingikx*
HAIIAIIAG1HA
IV.
MAiir.i n
l#O.LW
XI.
koiiapiit
vu.
INDIAN
H1ZOHAII
1“FHCA~™Thnlirll
2. YIICA
3. YIICA
4 . YIICA
5. The
II.P
viii. h.p
r7~vircA - iihiini
x 111.
AHDUA FHADKSn
It A J ST BAH
HeUivdls'. Church Hodor
YIICA - Uni Inwk Ina
1.
2.
Atlonl Arou Rural i>
ProJcc
YHCA - Hurnynn«udn
KAKHA I AKA
YIICA - DAVAIICEIIR
YIICA - Bhndravnlhl
yhca
3. GAHATA
2|
Aw/i'R
• XJ1A HAHAl-AU|)
'1. Chris Lion Enel Ink Schot’1
ML-JllHAQ.
I All I I, IIAIJU
7. ii mo bn wk
Luiwp.lo) ,
11ahi Pint
Association -
APPENDIX 'C'
DETAILS OF PEOPLE MET DURING FIELD VISITS
A - YMCA Board members/Others related
to project - not
directly implementing CSCD project.
B - CSCD Project Executive members — CEOs and PMs
C - CHVs employed part/full time to implement CSCD project
D - Other health professionals connected or not to CSCD
E - Pregnant women and mothers affected by CSCD project
F - Other village persons not connected to CSCD
G - CMAI's classification based on monitoring and self
administered questionnaire.
and
field
reali ties
H - Re-classification considering
processes evolved.
1
1
Name
A
B
C
D
E
F
£D
1
2
“T
4
5
8
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Mysore Rur Dev.
YMCA Bhadravati
YMCA Davangere
AARDIP Adoni
YMCA Hyd'bad
SAMATA Vijwda
YMCA Koraput
YMCA Bhilai
REM Mahar.
P.C.Centre Madurai
YMCA Mlnkvli KK
YMCA Moo1chi KK
Vinnarasu Assn
YMCA Madras
YMCA Tanhril
YMCA S.Hlimen
YMCA Zemabawk
. Salvation Army
YMCA Lungdai
STNBA Manipur
CES Chizami
YMCA Patna
—
5
4
4
—
2
3
3
—
4
5
2
—
—
—
1
2
20
10
20
15
—
25
20
5
8
10
5
->
6
10
4
5
5
5
10
Ji
—
—
—
4
5
1
—
—
26
6
1
1
1
2
o
1
2
1
1
2
1
1
1
2
1
1
2
2
1
2
1
2
50
15
10
10
6
7
6
4
5
8
8
1
5
12
15
5
AA
AA
G
G
G
AA
P
P
AA
AA
G
G
AA
AA
A
P
A
A
P
A
A
P
G
AA
AA
G
G
A
P
A
G
AA
G
G
G
G
G
P
AA
P
P
AA
AA
P
Total :
66
31
192
-
-
—
4
1
—
2
—
12
—
2
5
9
3
5
12
4
4
2
—
—
—
—
—
—
—
—
—
1
2
C
5
1
o
7
10
3
76
19
187
2
2
2
2
Total No. of people met : 571
CMAI' s classification:
Good - 5; AA - 7; Average - 5; Poor - 5.
Reel ass ification after rev i ew:
Good - 9; AA - 6; Average - 2; Poor - 5.
Classification remains unchanged in - 9.
Classification upgraded in
- 10.
Classification downgraded in
- 3
H
!
1
SI .No
REMIEN OF ACTIVITIES FOR CSCD ~ FIELD OBSERVATIONS
PROGRAMME OFFICER:
The CMAI considers CSCD project an important component
in
promoting the Community Health approach to make Primary Health
Care a part of peoples* activity.
The CSCD project is under
the Community Health Department of CMAI,
with a Programme
Officer taking all responsibility for the functioning of the
25 micro-projects across the country.
The Programme Officer
independently handles all problems of the micro-projects, from
funding,
to training and liaison to monitoring
and advisory
services.
The Programme Officer is supported with advice
from the
Community
Health Department during
their regular
staff
meetings,
when the status, problems etc. of the projects are
highlighted
and discussed.
Implementation processes receive
prominence during such meetings, with a global perspective of
the CSCD projects.
The Programme Officer works cut details
suitable to individual micro-projects.
1)
The present incumbent CSCD Programme Officer came
in as
the selection of projects had been completed. He has been
involved in
— visits to projects for on-site assessments;
- conducting training programs for project holders and staff
as per their needs;
- receiving reports/returns form projects as part of the
monitoring process, including advise; and,
- handling fund-related and administrative problems of the
p roj ects.
The
needed
liaison networking,
correspondence
and
documentation for the CMAI in this project activity are also
attended to by the Programe Officer.
As part of the Community Health Department of CMAI, he
is
also involved in other Community Health related
activities,
co-operating with colleagues of the department.
The
above processes have been educative and capability
building in nature for the Programme Officer providing a range
of perspectives in Community Health from the micro-projects.
The distribution of the microprojects across the country have
helped cross-ferti1ization of
ideas and
initiatives from
varied situations unique to each project/locaticn, yet useful
somewhere else.
The programme officer not being a medical
professional has helped promote community perspectives well,
though a handicap at tackling medically oriented project
initiatives is noticed.
He has effectively made use of
medical
expertise at local levels, which, to an extent has
'medicalized *
some projects, detracting from the Community
Health/Primary Health Care approach viusalized by CMAI.
2.
MICRO-PROJECTS a
The CSCD micro-projects have already been tried and tested
an initial round evaluated in 1991 as mentioned earlier.
in
The locations for micro-project work have been well chosen
areas of dire need and lack of access to health care.
in
The training programs, curriculum and resources for training
have been well selected and organised.
The mix of groups
trained,
locations for training and frequency have been well
planned,
to help the evolving micro-project,
with
adequate
attention given to the Community Health volunteers,
Project
Managers and Chief Executive Officers roles.
During field visits, the following observations were common to
all micro-projects.
a)
A request for further training programs to help them
beyond CSCD, to make CSCD sustainable.
b)
A request to help micro-projects identify other development
needs in their area which could mesh with CSCD and
Community Health perspectives.
c)
to help the micro-projects in conducting training programs
locally, in regional language, for a larger number to their
project personnel.
Language
facility and communication in English has been
as a major problem by micro-projects.
go
seen
This was observed during field-visits, when the micro-projects
have not been able to effectively communicate their work and
involvement through reports/returns, though adequate provision
for the same has been made.
A major implementing group have been the YMCAs, with 13 out of
25 micro-projects being held by YMCA.
4 of these YMCAs are
well
established, 2 are yet to be affiliated to the National
Council of YMCAs, and most have only CSCD as a project
in
health.
Ths
YMCAs
being similar in
terms
of
administration,
relationship to the National Council of YMCA,
and overall
perspectives in terms of the YMCA movement, the following have
been observed to affect the CSCD processes implemented by
them.
-
a) The YMCAs being governed by a Board of members, who are
otherwise
employed
and
involved
in numerous
other
activities,
CSCD is
just one of the
initiatives,
dependant on
a full-time Project Manager.
They are
handicapped when
a change of P.Ms occurs,
especially
when it is the transfer of a YMCA trained secretary for
project implementation.
-
b) Frequent changes in the elected Board,
and annual
changes as seen in the Mizoram projects changes the CEO
of the CSCD project as well.
- c)
A frank opinion expressed by the President of a YMCA was
- "We are all men here, and the CSCD related
to women
and children. We take time to really understand and work
to be effective in these circumstances".
This
lacuna
has been obviated in YMCA Patna, where women members are
also on the YMCA Board.
-
d) The newly established YMCAs have yet to make an
impact
in other areas of work, to support CSCD effectively.
They do find CSCD as a good initiative towards social
and community relevance of their work, and are happy to
be 'different' in their perspectives.
-
e) The YMCA projects are also caught in
the dilemma of
catering to some needs of their own membership,
while
promoting
a social concern like CSCD, which may entail
entirely different sets of activities.
5
I.
1.
PROCESSES INITIATED AT CHAI HEADQUARTERS
Evolving the Child Survival Child Development project as a
Community Health oriented initiative, focussing on Mothers
and Children, for the most needy areas of the country.
Developing this idea through trial, testing and evaluation
during
an earlier phase between
1988 to 1991.
This
includes a manual, methods of recording and reporting, and
information for technical support in a simplified
format
for implementors.
Selection of suitable
implementing agencies
(at
25
locations across the country) that are non-hospitai
based
Christian/Social Service organisations .
4.
Appointing a Programme Officer (P.O.) at CMAI headquarters
vested with full responsibility for all aspects of
the
project.
5.
Providing
adequate backing to Programme Officer
in
resource mobi1ization, training, networking
and
liaison
for implementation of the project.
6.
Monitoring of the technical aspects of project
activity
through the Programme Officer's reports at staff meetings
with
the Community Health Department team of CMAI.
The
administrative, and finance aspects being monitored by the
concerned departments at CMAI headquarters.
7.
Developing of an internal monitoring and advisory system
through
- regular monthly reports/returns from micro-projects
- evolving a self-administered questionnaire for the Chief
Executive Officers (CEOs) and Project Managers (PMs)
of
the implementing agencies, referred to as micro-projects
of the CSCD program.
II. PROCESSES BETWEEN CMAI-HQs and CSCD micro-projects
1.
Training programs for the CEOs, PMs and Community Health
Volunteers (CHVs) for
— Orientation
to the CSCD project philosophy,
Primary
Health Care concepts and Community Health approaches;
- Methodology for need-assessment and steps to meet
the
needs of the people of the area for CSCD; and
- Reports, returns, monitoring of the projects, including
technical, managerial and financial aspects.
(Details of training programs - numbers,
locations,
who
attended, curriculum and resource persons in Appendix-0)
26
2.
Visits of the Programme Officer from
monitoring/1iaison/advisory purposes; and
3.
Monthly reports/returns,
as well
as
the
Internal
monitoring exercise through a self-administrative
questionnaire.
(Refer Appendix-B)
CMAI—HQs
for
Observat ions/Comments:
(1) The Programme Officer of CSCD program at CMAI-HQs
primarily
responsible
for all
these
processes
consequent activities.
is
and
The extensive travel needs of the Programme Officer for
visits,
organisation and
implementation of
training
programs,
etc., keep the Programme Officer in a constant
shuttle between desk and field. It leads to a fairly rigid
'planning'
of activity.
The 25 micro-projects being distributed across the
country and being located in areas of difficult
access,
personal
contact between the micro-project
implementors
and the Programme Officer average once or twice a year.
The contact between micro-project holders is lesser,
despite proximity at a regional level.
Reports, returns and other correspondence are subject
to postal delays and also contribute to accumulation and
hold-up at the 'desk' at HQs.
These factors detract from the ability of the Programme
Officer to address the important and long-term CSCD needs
as opposed to the immediate and urgent administrative and
financial matters.
(2) The training programs are excellent in concept,
design,
content and execution - as reported by the micro-project
implementors.
The much needed renewal, reiteration and help at field
level
to translate these ideas to practice are slow
in
coming - since the micro-projects look forward to these
from the CMAI.
A positive effect of this has been the looking for and
finding
local medical resources to help them.
The other
side of
the coin
is a
'medicalization'
of
the CSCD
interventions being the local medical/health personnel who
are not familiar with Primary Health Care
and Community
Health approaches.
Ill
PROCESSES AT THE CSCD micro-projects
1. Appointment of CEO, PH and CHVs for the CSCD project.
2. Implementation of CSCD project, including
registration,
reports, returns and monitoring & providing services to
the Community, especially mother and children
3. Integration with Non-CSCD functions of the implementors.
4. Sustainability efforts.
Observations/Comments;
1.
The CEOs,
PHs and CHVs were appointed as per CMAI's
guidelines (ref. CHAI manual for CSCD) when the projects
started.
A majority (13 out of 25)
microproject implementors
being YHCAs, some common features affecting CSCD functions
noticed were,
- the secretaries trained and appointed by the National
Council of YHCAs were the Project Managers of CSCD.
Their
withdrawal
for further training or postings elsewhere
seriously hampered CSCD's functions.
- non-affi1iat ion to the National Council of two YHCAs
(S.Hlimen
and
Lungdai YHCAs) reduced
fund
and support
availability to supplement CSCD work.
— changes
in the YMCA Board locally affected
the CSCD
program, since CEOs changed and needed to be
re-oriented.
The CSCD program is for 3 years, while these changes occur
annually, or once in two years.
- the YHCAs being membership
organisations,
some
activities needed
to be designed for them at the urban
area — not necessarily heIpful/supportive
to
CSCD
activity.
- the Board of YMCA being
the contro111ing
authority,
bureaucratic delays and shifts in priorities depending on
YMCA needs affected CSCD functions.
- the members of the YHCA Boards being busy, were involved
more
in the high-profile 'medical' activity rather than
fieId/community-based work, which is left to the CHVs and
PHS. This naturally shifts the focus of interest of these
'employees' towards medicalization of CSCD efforts.
The process of Registration of mothers,
children and
filing of reports and returns has been well understood by
all
and takes place adequately for maintenance of CSCD
activity.
The personal
contact between people and members of
implementing organisation this generates is visibly
most effective component of the program.
28
the
the
This
'Direct contact'
as mentioned
in
the
activity
profiles of each organisation seems to be the underlying
reason why
- people recognise the CSCD effort
and participate in CSCD activities;
- CHVs are under pressure to learn more about
health and dissemination of information;
and - the implementing agency learns of people's needs
and has to evolve methods of tackling them.
Conversely,
the
lack of popularity of mass communication
methods both among people and
the organisations can
ve
understood in this context.
Health as it emerges is an intensely personal
and
family
activity,
best
addressed by direct contact
with
the
clientiele. Apart from a real need, the 'medicalization'
of
programs as commented on at several places,
could
be
attributed to the personal and direct contact provided there.
In agencies where community organisation already exists as
a basic strategy for other programs, the CSCD efforts are
being
integrated easily.
Also, the number of CHVs have
been
reduced
in most organisations to 2 or 3 from the
original 5 appointed for reasons of
- ease and familiarity of CSCD implementation
- weeding out of those CHVs who are ineffective, and
- difficulties
in payment for a larger number,
since
CHAI funds do not support salaries of CHVs.
The need for atleast one full-time worker to ensure CSCD
program effectivity is felt by all organisations, lasting for
full 3 years of the program.
This is acutely felt when such
persons
leave the job mid-way for various reasons and also
when continuity of program is disrupted whenever part-time
CHVs shift to other jobs.
This is a recurrent theme when the
ups and downs of the CSCD micro-projects are studied.
During
discussions at
various
micro-projects,
the
methodology of integrating CSCD goals with other development
activity in the area is not yet clear to the
implementors,
since
they still
perceive CSCD as a separate
activity
requiring Medical/Health professionals.
Many organisations,
especially YMCAs have activity which is membership
related,
and away from project location to enable integration.
Also,
focussing
on specific groups,
like orphans,
vocational
trainees, etc., makes integration difficult.
29
This
'Direct contact'
as mentioned
in
the
activity
profiles of each organisation seems to be the underlying
reason why
- people recognise the CSCD effort
and participate in CSCD activities;
- CHVs are under pressure to learn more about
health and dissemination of information;
and - the implementing agency learns of people's needs
and has to evolve methods of tackling them.
Conversely,
the
lack of popularity of mass communication
methods both
among people and
the organisations can
ve
understood in this context.
Health as
it emerges is an intensely personal
and family
activity,
best
addressed by direct contact
with
the
clientiele. Apart from a real need, the 'medicalization ' of
programs as commented on at several places,
could
be
attributed to the personal and direct contact provided there.
3.
In agencies where community organisation already exists as
a basic strategy for other programs, the CSCD efforts are
being
integrated easily.
Also, the number of CHVs have
been
reduced
in most organisations to 2 or 3 from the
original 5 appointed for reasons of
- ease and familiarity of CSCD implementation
— weeding out of those CHVs who are ineffective, and
- difficulties
in payment for a larger number,
since
CHAI funds do not support salaries of CHVs-
The need for atleast one full-time worker to ensure CSCD
program effectivity is felt by all organisations, lasting for
full
3 years of the program.
This is acutely felt when such
persons
leave the job mid-way for various reasons and also
when continuity of program is disrupted whenever part-time
CHVs shift to other jobs.
This is a recurrent theme when the
ups and downs of the CSCD micro-projects are studied.
During
discussions at
various
micro-projects,
the
methodology of integrating CSCD goals with other development
activity in the area is not yet clear to the
implementors,
since
they still perceive CSCD as a separate
activity
requiring Medical/Health professionals.
Many organisations,
especially YMCAs have activity which is membership
related,
and
away from project location to enable integration.
Also,
focussing
on specific groups,
like orphans,
vocational
trainees, etc., makes integration difficult.
29
4.
Sustainabi1i ty;
The sustainability of CSCD activity beyond the 3 years
planned
is related
to
integration
into other
non-CSCD
activity, which is yet to occur in most agencies.
A systematic,
continuously developing CSCD project
activity over two years could lend itself to implementing a
withdrawal
and handing over phase during the third year,
making it sustainable-
The practical
aspects of ups and downs in CSCD
functioning at micro-project level added to lag periods due to
postal, bureaucratic, fund-flow and information flow problems
has made this a difficult ideal to reach.
On the field, the actual conditions observed are,
- there
is adequate information
(knowledge)
dissemination,
with
attitudinal
and practice changes lagging behind and
needing the facilitatory activity of CSCD personnel.
- Adequate levels of community organisation to be able to hand
over the CSCD activity to people is yet to emerge
in almost
all
places,
except
two viz.,
Vinnarasu Association
at
Kanyakumari and AARDIP at Adoni, A.P.
— an
emerging need of the Community to be
able to handle
common/minor ailments and ability to recognise
serious
illnesses at peoples' level itself without complete dependence
on medical aid from outside.
(Utilization of safe herbal/home remedies knowledge already
available with
the community, but marginalized due to a
dependant attitude on Western medicine has been brought to the
notice
of executives/CHVs of
the micro-projects
during
discussions with them.
Also, the need to transfer demystified
medical
information on why diseases occur/what first-aid or
immediate help is needed, etc. has been discussed).
- the areas selected for CSCD implementation being
the most
needy in all aspects, more inputs in the following areas are
needed before sustainability can become a reality a) Social and economic programs to fulfil basic needs of
the community viz: employment, food security, safe
water and housing;
b) nutrition education/supp1 ementat ion
appropriate to
local conditions and needs; and
c) General education and awareness to overcome gender,
class/caste, cultural and other traditional biases
hindering development. Also, bringing into reach of
these people, various programs from the Government
and Voluntary agencies addressing these and for other
development purposes.
30
Considering these, the requests from most agencies to
continue the CSCD support to them for at least a year
or two more is justified.
A planned strategy to
effect withdrawal over a period of time is not yet
a
part of the micro-project thinking.
An oft-repeated question by the review team while
talking to people was - "We hear the CHVs are doing
good work with you.
We would like to take them to
areas where there is more need.
What do you feel?"
The peoples' reply was very telling - "We need them
for a year or two more - may be you could take them
away then.
We could help others too, after that!"
PROCESSES seen AMONG PEOPLE met at CSCD micro—project areas
« cm
n
Those related to CSCD projects.
Those related to non-CSCD/other initiatives.
Independent processes conducive
to positive
Health.
Community
l.a) The registration of mothers and children, regular follow
up and education for CSCD needs has
- created an awareness of their life situation and that
improvements
can
be made by
themselves,
with
Government and other voluntary agency help.
- focussed
their concerns on the needs of women
and
children in the community.
- made sense
locally of
the Government mass-media
efforts on Mother and Child Health, Immunization, ORS,
Family P1anning/We1fare, etc.
These, and most importantly the idea that other people are
concerned
about them has brought in a feeling of being
a
part
of
the
National
mainstream,
and
not
a
neg 1ected/ignored population.
-b) The frequent contacts with friendly CHVs has also helped
them voice concerns about other health matters which
they
feel important, like — tackling of minor/common health problems at their level
i tse1f
- avenues that can be explored for low-cost medical care
from surrounding areas, and
- promotive,
preventive
and rehabilitative
measures
related
to water-supply and sanitation,
nutrition
and
hygiene, care of the elderly and disabled, schooling and
non-formal education, etc.
-c)
The community have been enabled to understand the need
for participation in health related activity overcoming
caste/class and other social barriers.
31
oo
/^library
AND
documentation j r
UNIT
The communities being organised for other purposes on
political,
social,
ethnic, religious lines, do not yet
feel
the need
for Community Organisation for Health,
though they favour participation if/when others organise
for the same.
?.)
It
is only a feu, agencies that have well
established
Community
development
initiatives,
with
community
organisation.
Some
micro-projects
as
at
Adoni,
Bhadravathi and Vinnarasu Association Kanya Kumari,
have
communities organised for various reasons, ranging from
Survival imperatives, to political and statutory needs.
Host of these
are related to obtaining of
resource
benefits
from
the Government
and
other
Voluntary
Agencies,
though not averse and able to tackle
internal
conflicts,
evolve common goals and
lead
to combined
action.
They have histories of more than
five
to six
years.
Integration of CSCD activity into this framework
has been smooth and easy.
Community organisation for development and health
(also
CSCD) initiated at organisations in the past two to three
years are yet nascent and will need time to mature, since
people still view these efforts as the initiatives of the
voluntary
agencies concerned,
and not
their
own.
Developing
a sense of
'OWNERSHIP',
as seen by the
Hyderabad YMCA seems to be the stumbling block.
3)
People are upgrading 'Health" to a higher priority among
their basic needs and are willing to invest in it as a
resource for better life conditions.
This is manifested
in the following
- seeking and participating in health initiatives by the
government and voluntary organisations;
— exploring
low-cost,
self-help
and
appropriate
interventions to tackle morbidity;
- developing
an
awareness of
their
rights
and
responsibilities as consumers of the health industry.
- looking at health implications of occupation, education,
environmental degradation and development; and,
- expressing concern
in
various ways
for
those
marginalized
in
terms of health,
like
the
aged,
disabled, children and women.
32
A.
STRENGTHS / WEAKNESSES / RECOMMENDATIONS
AT CMAI HEADQUARTERS
STRENGTHS:
1) A well
conceived, planned, monitored
and
evaluated Health
project addressing the most-needy, for implementation
through
non-hospitai
based organisations with simplified,
demystified
methodology providing them adequate technical support.
2) Well
selected (development oriented)
implementing agenci es,
given appropriate
training to bring Health work
into their
amb it.
3) Low-cost,minimal and appropriate documentation, and ability to
establish
direct contact with people
are
the
projects'
highlights.
4) Non-medical Program Officer vested with full
responsibility
for all
aspects of the project, supported by the Community
Health Department of CMAI.
5) Transfer of ability to identify and
initiate Health Action
beyond project needs and in directions appropriate
to local
area.
WEAKNESSES:
1) Scattered distribution of micro-projects across the country,
varied
nature of populations addressed
and problems
of
communication with them makes for a fairly rigid,
centralized
planning
to
meet
their needs.
Hence,
responses
to
immediate/urgent needs and flexibility to suit micro-projects
evolution becomes difficult for a Programme Officer.
2) Extensive and tiring travel needs for training, monitoring and
follow-up of the Program Officer and Project holders makes for
less contact
than optimum between these persons - a key to
evolving appropriate solutions to emerging situations.
3) Medical and Public Health initiatives to suit the differing and
evolving natures of each micro-project(though not part of
the
project, yet affecting it)need technical support from the CMAI
HQs
(eg.
in endemic areas of Malaria,
Kala-azar,
etc.,
and
drought-prone or water-logged areas)
RECOMMENDATIONS:
1) Decentralized training, monitoring and follow-up facilitation
through regional CMAI membership adequately trained for project
needs.
Regional language usage will make them more appropriate
to peoples' needs.
2) Clustering of micro-projects
regional networking for them..
and
developing
of
adequate
3) Public Health advisory visits for technical support by Publilc
Health/Medical personnel
from or nominated by CHAI
HQs,
familiar with project goals.
4) Extending of support for a total period of 5 to 8 years to help
p roj ects:
- get over problems of understanding & implementation as they
need to work at the peoples' pace.
- develop
and implement a strategy for sustainibi1ity among
peop1e.
— support other health action initiated by micro-projects to
shift local needs and problems.
The present 3 year phase could be a mid-point to determine what
support the micro-projects need and taking appropriate action,
to
go beyond CSCD.
B.
AT THE MICRO-PROJECTS
STRENGTHS:
1) Recognizing Health work as a socially-relevant
initiative
bringing the organisations into closer and direct contact with
people and their needs.
2) Ability to demystify and innovate simple methods of
health awareness among the poor and needy.
spreading
3) Understanding and utilizing
the available Government and
Voluntary agency initiatives in Health in local needs, with
a
good coverage in Immunization, Family Welfare and Maternal
and
Child Health achieved.
WEAKNESSES:
1) Dependance
on
local medical
personnel for tackling minor
illnesses and endemic disease problems,
who
'medicalize'
interventions,
making
them
'c1 inic'-based,
rather
than
Commun i ty-based.
2) Difficulty
in mobilizing resources for peoples'
felt-needs
beyond
CSCD,
like Balwadis,
supplementary nutrition
for
children and mothers, etc.
3) Difficulty in liaison and networking with Govt.
agencies and
between regional CSCD/other Volag activity, and looking towards
CMAI for the same.
34
4) Paucity of motivated staff, staff turnover and other staff
related problems due to low honoraria offered and dependence on
training on CHAI mainly.
5) Giving
inadequate thought and action to make the project
sustainable as a people's activity, and finding ways and means
of addressing their immediate and emerging health needs beyond
CSCD.
6) Dependence on CMAI to sort out all issues which emerge out
CSCD activity.
of
RECOMMENDATIONS;
1) Evolve ways and means of tackling common/minor disease problems
using traditional/local/herbal knowledge already available with
people.
2) Utilize peoples'
participation emerging as outcome of
the
project
towards making
it a peoples'
activity which
is
sustainab1e.
3) Moving away from the ‘medical' and ‘curative' solutions which
are high-profile to preventive and promotive initiatives which
strike at the causes of health problems.
4) Network actively with Government and Local
towards combined action for Health.
Voluntary
agency
5) Integrate Health into all other development activity in
their
work,
from Non-formal Education to Income-generation, and not
keep them compartmentaiized as separate activities.
35
APPENDIX 'D' £ INDIVIDUAL REPORTS OF 22 CSCD MICROPROJECTS
CSCD MICRO PROJECT 1
1. Detai Is of the Project
a. Mysore Rural Development Project - Karnataka
Date of starting project - 1.1.1993.
b. This project covers 6 Villages, approximately 25 km from
Mysore City,a population of 6000 mostly SC and ST, with
75% below poverty line.They are Daily wages labour, Rural
-agriculture, and urban - construction work.The levels of
literacy are low and health conditions poor.There is one
PHU for medical needs in the area,and No other voluntary
agenc i es.
c. The CEO has implemented a CSCD project earlier in a Tribal
area at Periyapatna. Now, he has selected a nearer area with
similar problems for better implementation.
The difficulties he has faced are due to — new area,
recruitment of Local Health Volunteers and Fund-flow problems.
Interviewed:
1 CEO, 2 CHVs, 20 Mothers, 5 youth.
2. CSCD Activities
a. Registration of Mothers and Children, Follow up as per CSCD
guidelines being done,ensuring good direct contact with them.
b. Special efforts have been made to overcome Caste/Class
differences through education. Utilization of all services
from PHC, including an Ayurvedic Dispensary is promoted.The
credibility of staff is good with people,who participate well
in CSCD activity.
c. Record-keeping is adequate and reporting is regular.
CHVs are from local area and familiar with people.
Utilization of Growth-monitoring cards for education of
mothers needs to be promoted.
3 - Non-CSCD Activities
a. Non-Formal Education of mothers directly helpful to CSCD
activities.
Dispensary for minor ailments and Medical camps helpful to the
community, utilizing Government Medical personnel.
Balwadis supported by CMAI for a period of one year started
as a logical extension of the CSCD effort.This was handed
over to the Government, with people paying for the Teacher
employed.
36
b. Overcoming of Class/Caste differences in area through
special efforts in all contacts of staff with people,
despite separate Anganwadis run by Government for different
castes.
Community participation in project activities good due
to
direct contact with people.
Community Organisation still in nascent stage,
with the
Mahila Mandals recently formed (2 months)
and not yet
active.
4. Re 1 at ionsh ips / L i a i son
With Government -good -as mentioned above with the Health
Their credibility and
liaison
with
Social
Services.
Welfare Department/ I.CDS also very good.
b. Networking with Voluntary agencies outside area - yet
to
start. Help of Church related organisations - Diocese, CTVT, etc
is being taken.No other Voluntary agencies work in the area.
c. Community not yet ready to take over responsibility for Health.
a.
5.
Discussions/Suggest ions during rev i ew team visit
a.
The morbidity due to minor ailments is still high, despite
dispensary and PHC uti1ization.They are mainly,
seasonal
Respiratory, / G.I./ Skin diseases.
To explore local/herbal medicine initiatives as an enabling/
empowering process.
b. Focus on Community Organisation - to be able to hand
to people — the work being done by the project.
c. Consider organisation of youth and employment
for them to tackle economic problems.
over
generation
d. To focus on nutrition education.
e. Potential areas of development include
- School Health
- Adolescent/youth education ~ especially girls.
- Womens' Health.
f. CEO in process of planning for Integrated development work
in larger area of 31 villages with Diocesan and CTVT help.
To
consider all the above to add to experience already gained.
g. To utilize mass-education methods and Government Health
Education
resources as well as Voluntary agencies with
expertise outside the area.
37
6• Summary of Processes
a. CSCD activities systematic and with adequate understanding,
well organised and documented, good community participation.
b. Good liaison with Government agencies in health, social
welfare and ICDS (Child development).
c. Logical extension of CSCD into Pre-school. Anganwadi started
and handed over to Government.
d. Community Organisation - Mahila Mandals just
not yet estab 1ished/active.
e.
beginning
Require about 2 years to hand over activities to Government
or people.
CSCD Micro Project II
1.
Detai Is of the Project
a. Y.M.C.A. Bhadravathi.
Date of starting project 1.1.1993.
b. Work in two urban slum areas in Bhadravathi - Vellore Shed
and Zinc
line,
covering a population of
approximately
5000.A majority live on Daily-wages and areas like -Domestic
1abour/construction work/ factory labour/petty business,
vegetable
vending,
etc. The literacy and socio economic
levels are poor. The Zinc-line community is well organised,
being a large S.C. settlement.
c. This is a newly established YMCA, affiliated to the National
council.CSCD is their first project and their well- trained
Project Manager left after initiating this project. A new
Project Manager has been appointed recently - not yet well
oriented.
They have shifted from Fishermens colony to
Vellore- Shed slum, finding a greater need here.
e. Interviewed- YMCA Board members-6; CHVs-3; + 1 TBA,
Doc tors/Ni renal a Hospital Staff-3,Mothers/Peop1e-15.
2. CSCD Activities:
a.
Registration of Mothers,ChiIdren as per CSCD guidelines
being done. Immunization and follow-up adequate,though
Documentation not adequate/regular.
38
b. Weekly dispensary (Health Camp!) facility at each of the
locations
(Wednesday and Thursday) with doctor
from
Nirmala Hospital and private doctor - FREE OF COST.
Zinc
line Community have provided
a place
and
are
constructing a new room for medical activities as community
contribution.
People have adequate information/practice of immunization,
ANC and PNC.
They are well backed by Nirmala Hospital
(Catholic Hospital) for hospital based facilities. This has
led to Medical orientation of activity with Preventive
and
PHC Orientation minimal.
YMCA Board members cite Medical activity being used as
entry point for CSCD activity.
an
c. Records/Reports - not well p1anned/executed due to leaving
of Project Manager and new person not yet well oriented.
YMCA Board Members are also not well oriented
to this
activ i ty.
d. CMAI Classification - Above average.
3. Non CSCD Act iv it ies
—
-
NFE for women(is being assisted by CMAI),and Tailoring
activity for girls,
— Not connected/re1ated
to
CSCD
activity.
Seminars/Symposia for youth during vacations on
issues of
topical interest - separate from CSCD activity.
4. Re 1 at ionsh ip /Liaison s
a.
No
liaison
with
Government
agencies
formally.
CHVs/Grganisation helped in Pulse Polio campaign with good
success.
b. Good liaison with Nirmala Hospital and a Private doctor for
medical activity. They are able to obtain free/concessional
and necessary help
for needy people of
area.
TBA
in
Vellore shed also helpful in CSCD activity, as a volunteer.
c. Well organised community already at Zinc
lane.
Liaison
with them and obtaining of place/new room built freely as
community contribution to YMCA - CSCD activity.
Community participation good
at both
areas due
to
enthusiastic/committed activity.
They have good contact
community and are well accepted.
39
CHVs
with
YMCA Board members not deeply involved due
employment needs and need proper orientation-
to
their
own
5. Discussions during review team visit;
-
-
Staff orientation to Preventive and Primary Health care
concepts.
Introduction of Alternatives/Home remedies for tackling
minor ailments,
Education for Girl Child/Women on Health.
Socio-economic development activities, especially for youth
and their involvement in health.
Shifting from 'Medical* orientation to handing over activity
to people/peoples' organisations.
SUMMARY
1. CSCD activities good.
Participation good,
Recording
inadequate.
2. Newly established YMCA therefore few other activities helpful
to CSCD.
3. Good
relations for medical needs with Voluntary agencies
hospitals, Nil with Government.
4- Selected one area with good Community Organisation - have
to
utilize full potential for handing over health to people.
CSCD Micro Project III
1• Details of the Proj ect;
a. Y.M.C.A. Davangere.
Date of starting project 1-1,1993.
b. The selected population is Rural - 6 villages - with
approximate population 3,500 plus.
Access by road
is
difficult;
the population poor in socio-economic
and
health
terms,
involved
in
agricultural
labour
in
dry/irrigated areas. Selection is need based.
c-
This is the first project of this newly established YMCA,
affiliated to National Council.In addition they are operating
in urban slum area of 800 population,
where Tailoring
and
NFE Activities are conducted for women.They have
attempted
liaison with Government for socio-economic programmes
with
no success.
They had established a FREE Clinic at a village, which was
recently closed due to local political factors.
40
e.
Met 4 Board members,1 CEO/Medical team - 2 ductors/3 CHVs/2
AWWs/1 Government Health Inspector/20 mothers and 5 others.
2. CSCD Activities;
a.Registering of mothers/chiIdren as per CSCD guidelines with
good follow-up. Contact regular and good.Records and Reports
exemplary and simp 1fied/systematic.
b.Good rapport of CHVs with community.
Awareness levels of
people good. Activity restricted to CSCD project.
Activity of camps/c1 inics/dispensary medically oriented and
clinic recently stopped.
Have not been able to influence Anganwadi activity in Kuruba
locality.
Good
Liaison with upper classes of village who
permit CSCD activity with understanding of peoples'
needs,
despite local politics.
Well
c.
running CSCD with good recording,
especially growth
monitoring, immunization, etc.
3. Non-CSCD Activities;
a. Tai loring/NFE in urban area not related to CSCD activity in
rural community.
Nil other activity.
b. Attempted Income Generation Programmes of Government for
rural areas, with inadequate success.
4. Re 1 at ionsh ip/L i aison
Government Services: utilize Government Health Education
and Immunization services well for CSCD programme.
b. Voluntary Aqenc ies: Utilize advise and services of Doctors
of
Medical College for running of CSCD
programme,
especially of Community Health Department. Hence able to
have systematic and well documented programme.
CHVs also
well trained.
c. - Good level of awareness among people on CSCD, due to a
good direct contact and follow-up.
- Good liaison with members of different class/caste groups
- CHVs we 11-trained/enthusiastic/effeetive.
- YMCA board members unable to devote more time
required
for
the
programme due to personal work commitments.
'Medical'
approach is strong.
Involvement mainly in
Clinic approach to Preventive care.
Mass education
and
Community Organisation to be promoted.
a.
41
5.
Discussions
a) To focus on Community Organisation of Village Health
Committees/Youth groups/Mahi 1 a mandals etc.to enable local
decision making process.
b) Alternative systems/Herbal medicines for minor ailment
treatment.
c) Utilization of Government and other NGOs as resources
for development activities in area.
6.
Summary
a) Newly established YMCA with separate activity at Urban
level, not linked to CSCD program in rural area.
b) Good rapport of CHVs, with community.
Participation
and
awareness in community of CSCD activity good.
c) Excellent,
systematic,
simplified
documentation
of
academic standards,
with involvement of Community Health
Professionals from Medical College.
d) Local problems have restricted utilization of Government
programs,free medical clinic and such welfare measures in
the villages.
e) Community Organisation, Minor-ailment tackling with local
resources/herbal medicine.
CSCD MICRO-PROJECT IV
Details of Praject
a) Adoni Area Rural Development Initiatives Program.(AARDIP)
Date of starting program - 1.1.1993.
b) This project covers - 4 villages, around 25 kms from
Adoni town,a chronic drought affected area,with a Poverty
ridden/SC and ST population of landless labour -approx.
1900 fami 1i es/8000+populat ion.
c) Started as Integrated Development project for poverty
alleviation.
Have been tapping Governmental
and other
programs as available. Linking up with other NGGs and
programs
in district to build a good network of peoples'
organisations towards a peoples' movement.
d) CEO/PM;
2 CHVs, 2 Animators, 2 ANNS,
2 Activitists,
Others 25, wet.
2.
C.S.C.D■ Act i v i t ies
a) As per CSCD guidelines - Registration of Mothers/ChiIdren,
and Direct H.E./Immunization through Government.NEE for
mothers for Integration into non-CSCD activities.
42
b) Awareness of Mother & Child Health needs among CHV's and
mothers good. Activist approach to obtaining Health needs
from PHCs, to prevent alcoholism, obtain drinking water,
etc.
Heightened health awareness beyond CSCD, despite low
levels of literacy in area.
Measures
taken by community to facilitate safe home
deliveries and care, since far away from PHCs and sub
centres .
c) Records adedquate for program.
Reports/Returns regular.
d) CMAI c1assification - Good.
3.
Non-CSCD Ac t i v i t i es
a) Community-Organisation for participatory decision making
and
taking up of issues like water,alcohol ism,dowry and
child marriages, women's rights,
etc.
This
is
well
utilized to help CSCD.
Small savings in Mahila Sanghas to help community in small
enterprises (loans for) etc. DWACRA scheme of Govermnemt
being tapped for same (eg. Tea-shop of member).
Obtaining of land pattas and Government housing scheme
for the village.
Road improvement in village.
All
non-CSCD
activities well related
to CSCD work,
bringing
in good co-operation and participation
from
peop1e.
4.
Relat icnsh ip/Liaison
a) Obtaining immunization services from Government and help
in ANC.
Most deliveries at home, since hospital over 25
Kms. off, but people availing hospital services for first
and problem deliveries.
b)
5.
Nil other NGOs working in same
area.
Hence,no direct
liaison.
Networking with other NGOs on
issues of
the
taluk and District. AARDIP established leading
role
and
has good credibi1ity/track record as a network leader.
Discuss ions
To enhance Nutrition education program, since malnutrition
very common.
b) To
pursue Anganwadi/BaIwadi
program in
area
for
Supplementary nutrition for growing children with pre
school education.
c) To pursue school facilities for children, since
literacy
levels low. To link this with NFE efforts.
d) To promote utilization of peoples' health resources
like
tribal/herbal medicine
for minor ailments and
other
traditional/cultural practices which promote health.
a)
43
6.
Summary
a)
b)
c)
d)
e)
Project wholistic in approach for overall development
in
well selected area where people are still struggling
for
survival.
CSCD well
received and integrated
and part of other
development activity.
Community Organisation and participation - good,
with
leadership in networking of NGOs in the district.
Poverty and related problems of nutrition/
education
being tackled - needs a
long
time
despite
good
organisation and participation, due to lack of needed
resources.
To initiate measures to put Peoples's health in people's
hands by promoting
traditions/cu1tures conducive
to
health.
CSCD Micro project V
1.
Details of the project
a) YMCA Narayanaquda
Development
and
department
Hyderabad, Andhra Pradesh.
Date of starting project — 1.1.1993.
b)
Social
concerns
This project covers 8 villages as part of a larger set
24 villages.
of
Did not visit villages due to local YMCA problems & 2 CHVs
having shifted to other jobs.
Work stagnant for past 2
months.
I had visited these villages during the 1991 evaluation,
and Programme Officer CMAI twice in past 2 years.
This is a part of YMCA's plans for Comprehensive Sustainable
Rural Development near Secuderabad in 24 villages taken up
on criteria of backwardness. They are in 3 sets of 8
villages each,with work shifted to the next set
every 2
years. The 2nd phase of the program is nearing completion.
Fund
flow and
internal
problems of YMCA have
been
interfering with project.
d) CEO/PM — Mr. Boneventure
c)
CSCD Activities
a) CEO has utilized learning from earlier project.
A
approach is through schools and school children in
educating
the community.
44
major
The project has established Mahila Sanghas, where Training
& Education have been given importance. NEE, Tailoring,
Kitchen gardens,
Legal education for women and socio
economic programs.
They have
also initiated herbal-medicine use for minor
ailment management.
b) Special efforts have been made to build a sense of
"OWNERSHIP ’'
among people to make the development efforts
sustainable.
They have been transferring experience from
working with urban poor and street children to rural area,
effectively.
c) Records/Reports adequate.
d) CMAI's classification - GOOD.
Non-CSCD Ac t i v i t ies
a) Savings schemes in Mahila mandate and obtaining of DWCRA
support.
b) Interactive seminars on National Integration, Superstitions
and Social ills, Legal issues of poor and women,etc.and
celebration of events like Environment day, World Health Day,
etc. at village centres. Each-one-teach-one programs for
1iteracy,Vocational training for youth, Rotation Chick,
Baby show and other such innovative programmes etc.
4.
Re 1 at ionsh ips/1i aison;
a) Good relationship with Government Health Services/PHC for
immunization,
maternity and Health Education Services.
Also,
liaison with other Government agencies/programs in
Integrated development efforts.
b) Networking for combined action and solidarity with other
voluntary agencies on issues concerning poor.
Discuss ions
to enable networking at peoples' level
for transfer of
knowledge and processes.
to consolidate herbal medicine initiative- to tackle
all
minor ailments in area.
to involve volunteers from other systems of medicine
in
rural development work.
to help spread their experience and understanding to other
fledgling voluntary agencies in need.
45
CSCD MicroProj ect VI
1.
Details of Project
a) Society for Ameliorating Mass and Tribal Action.
- SAMATA, Vijayawada.
Date of starting project - 1.1.1993.
b) The project covers 10 villages in Mylavaram and A.Konduru
mandals
of Krishna district,
approx.
40
km.
from
Vi jayawada.
The former, with SC population and latter with tribal Lambadi
population, totalling approximately 8000.
c) This Voluntary agency started 7 years back
in well
identified area of great need.
CSCD
is their only project in area at present,
with no
other activity for health/development .
Work
related
to
fund flow.
Activity stopped since Dec '95 as CSCD project ended.
d) Met CEO/PM - 1; CHVs - 12; People-75.
CSCD Activities;
a) As per CSCD guidelines, in registering and follow-up.
b) CSCD messages have reached people,
though practice
is
inadequate.The CHVs employed are all male. Hence,
contact
with mothers for proper ANC/PNC not satisfactory.
Most ANC/De1iveries are at Government PHC facility 30 km
away.
People
incurring heavy medical
expenses in hands of
private practitioners
Kalajathas with CHVs done earlier to spread CSCD message.
Co-operative effort in Pulse polio very effective.
Their efforts have been mainly to try to create awareness
among people.
c) Records/Reports adequate - maintained upto Dec '95 only.
d) CMAI Classification - Above Average.
3.
Non CSCD Activities;
— Thrift programs and Mahila mandals have just been initiated.
— No other activities in area of development — to help CSCD.
- Land patta and housing schemes of Government - an awareness
being initiated.
Relationship/Liaison:
a) Co-operating with Government in Health care programs.
b) No other Volags in area.
5.
Discussions
a) To take up other development activities,
including
employment generation for youth.
b) Strengthen self care capabilities of Community with herbal
med ic ine.
c> To organise Community - towards handing over to people and
focus on social problems.
46
CSCD Microproject VII
1•
Details of Project;
~ YMCA - Koraput - Orissa
Four villages - 25 kms. and over from Koraput.
Tribal
population with high illiteracy levels and working as
agricultural
labour at low wages.
Villages cut off
from
road and Koraput for 4 months in
a year due to
main
flooding and bad access roads.
Considered poorest areas
of Koraput district which Prime Minister has also visited
~ no improvement despite such attention.
Now,
Koraput
district
(as large as Kerala) has recently been divided
into 4 districts.
Hence,
improvement
in
Government
activity in recent past.
YMCA started
in
1989, affiliated in
1993.
Nil
other
projects in hand, except CSCD.
CEO is LIC officer and
busy.
Homoeopathic doctor has joined the team and
is
helping in conducting clinics so far. No replacement found
as yet to YMCA project officer who left after starting the
project.
- Met CEO, PM (Homoeo Doctor) and about 35 people, target
non-target population.
CSCD Activities;
- as per CSCD guidelines.
Unable to cope up with work due to
lack of permanent staff.
- Immunization inadequate due to PHC being far off (> 25 kms.)
- Deliveries at home or Koraput - which is nearer and
easier
to access by bus/road.
- People i11iterate/unemployed.
Alcoholism rampant,
and
festivals celebrated far prolonged periods.
- Anganwadi/Primary school not attended - badly running.
Govt, building new premises for school.
- Homoeo Doctor conducts regular clinics and immunisation.
Non-CSCD Activities;
- Government housing program (Indira Awas Yojana
recently.)
- NFE for adults - started recently.
- Food for work programs on road building.
None of these integrated with CSCD activities.
Nil programs by YMCA.
47
started
and
4.
Re 1 ationsh ips/L i aison:
- With government agencies - improving with recent break up
of Koraput district into 4 for easier administration.
Government Health Services marginally touching village.
- Nil other Volags in area.
Networking etc. with others in Orissa not done.
5.
Discussions;
- Tribal medicine becoming extinct.
To revive the same
and
promote herbal
medicine for minor ailments which
are
rampant.
- To consider appointing a full-time worker to be able to do
regular work.
- to start other activities relevant to local needs and likely to
provide employment for youth, like carpentry,
traditional
crafts, etc.
- to make more frequent contact and conduct mass education
programs on health.
- to network with other NGOs and Government
to fulfill
identified needs of the people.
5.
Summary
Newly established YMCA has chosen area of work where
real
need
is present.
Permanent trained YMCA person needed to
continue work in a regular manner.
Improving life and living
conditions of people should be prime focus, with tackling of
minor ailments with local resources, and making people more
health conscious.
Starting of development programs and
tackling social
problems like
alcoholism needed.
With
improving Government administrative reach, better networking
with Government and other Volags will help.
CSCD Microproject Mill
Details of the Proj ect:
- YMCA Bhilai
- Rural - Covering 4 village areas with approximately 3000
population.
This village has been adopted by Bhilai Steel Plant
(BSP)
for Education and Medical support and
is a
'model'
village in Durg district with unanimously elected Sarpanch
who
is enthusiastic and active.
Villages clean with no
class/caste conflicts.
- Earlier villages selected were dropped due to political
interference problems. Also, Project Managers have changed
twice during the project period.
New incumbent is still
getting
a grip of the situation.
Peculiar nature of
Bhilai - always "outsiders".
48
-
4 YMCA Board members/IProject Manager/1 Doctor/4 village
leaders and 1 teacher/2 Village level workers/10 others.
2.
CSCD Activities:
- as per CSCD guidelines.
Adequate.
- Medicalized approach due to BSP support for medical camps.
Good NFE for women by Eswari Bai — a motivated woman of
the
village who has got national
recognition
and TV
coverage.
Government programs for immunizations/ORS/etc ,
well supported by BSP specialist camps spreading
awareness
through their nurses and students.
No TB.
Leprosy 30 pts.
under treatment. Malaria rampant.
- Records/Reports good/adequate.
— CMAI - internal monitoring status - POOR.
3.
Non-CSCD Activities:
- Nil in village area.
Those at HQ — more relevant to
its
membership and urban ethos.
Indira Awas Yojana, Jawahar Rozgar Yojana,
Rajiv Gandhi
library for neo-1iterates are Government programs well
utilized by active Sarpanch.
Integration of
CSCD
activities into these not explored.
- BSP support
to building of school
well
utilized
for
medical programs/camps of specialists - EYE/ENT/F.P., etc.
Enthusiastic school teacher available for help.
4.
Relat ionsh ips/L iaison:
- With Government agencies/programs good due to standing of
BSP and Sarpanch's initiatives.
- Nil other Volags in area.
Networking with others not yet
initiated— need not feltBSP
is the biggest Volag, since it has adopted the
village.
YMCA members being employees of BSP,
the
relationship is good.
5.
Discussions:
- School health program to become chiId-to-chiId and Child-tocommunity Health program ~ to be explored.
- Introduction
and promotion of Herbal medicine
for common/minor
ailments to be explored.
- To network with MPVHA.
- To start other development oriented programs with Diocesian support.
- To explore Anganwadi/Balwadi as logical extension of CSCD
program — Eswari Bai has already volunteered for same.
49
Bhilai YMCA's CSCD program is going on well despite
change
in Project Managers - due to BSP's medical
support
and
adoption of 'model village' for its activities.
Approach being 'medicalized', avenues of school,
anganwadi
and NFS programs available to project
for,
shifting
to
preventive, promotive and 'Health' approach.
Initiatives
to evolve methods for handling
over health
activity to people needed.
CSCD Microproj ect I X
1•
Detai Is of the Pro ject
a)
The Rural Evangelical Mission of India
Daryapur, Amaravathi - Maharashtra.
b)
Rural, covering population of approximately 8000 across
10
villages.
People
tribal,
scheduled castes
and
landless labour, 10 to 20 km. from Daryapur. One
village
recognised
as model village. Good Governmental
health
facilities which are being utilized adequately in
recent
past.
Literacy 60% for male and 40% for female, with
a
good degree of awareness of health.
c)
Related to fund flow.
Nil other funding/other projects of
REMI.
Depend on available Government programs and their
ut i1i zat ion.
d)
CMAI links through PC's visit/Training programs/Reports &
Returns.
e)
1 CEO/1 Pastor/5 CHVs/2 ANMs + 18 local people.
2.
CSCD Activities
- as per CSCD guidelilnes.
- Awareness of CSCD activities good.
Reach
facilities for mother and child - good.
— Occassional Health camps and co-operation
Eye & F.P. camps.
- Local
Dais
trained at CMAI and doing
deliveries.
CEO is Homoeo Doctor, his wife is ANM and
doctor employed.
Records/Reports - adequate.
CMAI's internal evaluation status - Above
3.
of
Government
with
Government
well
in
home
another Ayurvedic
Average.
Non-CSCD Ac t i v it i es;
- NFE for women and informal Women's groups meeting on
contemporary health issues.
— Health of Adolescents, Vocational training opportunities,
employment opportunities - publicised.
50
1
1
1
I
I
I
I
I
I
I
I
I
—
Government programs on Smokeless chulhas, latrines,
supply programs promoted.
- Balwadis for pre-school children being run.
water
Principal
approach through creating awareness,
co-operating
with
Government programs and maximizing utilization
of
available programs.
Utilized all training opportunities for different people
each
time from NIPCCD, FARMS INDIA, CMAI etc, creating a large base
of persons aware of Community needs.
4.
Re 1 at ionsh ip/L i aison;
- Good - with Government services - Health and Development.
- Nil other Volags in area, but utilizing training facilities
wherever possible.
Good relationship with PHC and its staff.
- Have not interfered with/influenced local
realities,
yet
co-operative with
all
bodies on health matters.
Good
relationship with Panchayati Raj
and utilization of
facilities.
5.
Discussions
a)
To encourage/promote local herbal remedies to help people
tackle minor i1Iness/aiIments by themselves.
b)
To organise community to take over CSCD activity for
sustainab i1i ty
c)
To liaise with/utilize other NGO programs in development.
d)
Frequent visits by the CEO/PM to the target area.
Summary
A well chosen rural community for project.
Utilizing all
available Governmental
programs in Health and Development.
Approach principally through creating awareness and maximizing
utilization of available programs,
doing well
in
CSCD
program,
and need to take steps to hand over same
to people
towards sustainability.
CSCD Microproject X
I
I
I
I
1.
Details of project
a)
Pankajam Caroline Clark Health Centre - Madurai.
b)c).
Seven
rural
areas,
covering approximately
7,500
population off Madurai town.
The centre is well known
for over 85 years for its work dedicated to the poor
in various rural areas around Madurai.
These areas now taken up are new, with SC, ST and tribal
population with low levels of literacy and
awareness.
51
f
(
ANO
DocuMe^T’ON )
d)
2.
They are daily wages labour in agriculture, construction
work
and
domestic
work.
Tuberculosis,
Anaemia,
Malnutrition and Skin diseases are common.
The approach
is 'medical' through a mobile weekly clinic in addition
to training of Dais and CHVs.
An orphanage and adoption
facility for rejected female infants is a unique on
going
activity of need in this area.
Supported by CSI
and Diocese of Madurai and Ramanad in its activity.
CEO; PM; Doctor; 9 CHVs; 10 Mothers; 6 others.
CSCD Activities;
- as per CSCD guide 1ines/adequate.
- NFE for women.
- Good communication through CHVs on womens' issues and CSCD
programs through charts (self-generated); Songs and street
theatre.
Focus on girl child due to female
infanticide
prevalence in this area.
- Medicalized
approach
for health needs through weekly
clinics.
Trained Dais deliver mostly at home.
- Free
medication for common
illness
like
scabies,
diarrhoeas, ARTIs, Tuberculosis and Leprosy prevalent, with
medication help being provided from other funds of Diocese,
and donated medicines.
- Orphanage and adoption facility for female infants.
Records/Reports adequate.
CMAI's classification - ABOVE AVERAGE.
3.
Non-CSCD Activities
- Orphanage and Adoption centre cited above.
- Creating awareness on Womens' issues/Girl child.
- Utilization of Government services on Housing, Water supply
and Immunization.
- Balwadi for pre-school children - started with CSCD help
and now shifted to other funding sources.
Nil other direct development
activities in
area
social/economic problems; Employment; Youth etc.
4.
5.
Re 1 at ionsh ip/L i aison
With government Services mainly on
immunization,
hous ing/water
- With other church related Volags. of Diocese, CSI.
of
and
Discussions;
- to encourage/promote self-help with herbal/local resoruces
for minor ailment management and wean off clinical approach
- to promote community organisation for handing over activity
to Community.
52
- to tackle sacial/economic/employment problems through other
Volags/approaches to get to roots of health problems.
— to
identify and promote other Government
aid programs
available/relevant to needs of people.
6.
Summary
A
well
established
and
recognized
Volag
with
'medical' approach to social, economic problems. Doing well in
areas
of
CSCD and female
infant/Girl
child
issues.
' Communicating well, and having good rapport with Community.
Need
to evolve methods of shifting responsibi1i1ty to people
and
enab 1ing/empowering
them to utilize
available/local
resources to tackle own problems.
CSCD Microproject XI
— YMCA - Mullankinavilai — Kanyakumari Dt.
- A well-established YMCA (since 1977) have taken up Nattalam
village
in Killiyoor Block with approximate population of
5000.
The
literacy level is about 587»,
though health
awareness
is equally
lacking
in both
literate
and
illiterate population.
- The YMCA has been working in areas of NFE for
adults;
Environment,
Water and sanitation programs;
Pre-school
education,
Youth talent promotion and summer schools;
in
addition to savings, socio-economic and income generation
programs
in
areas of spinning,
tailoring,
handicrafts,
fibre units and loan schemes.
Youth are trained in
type
writing and leadership.
All these are implemented
through
an organized
form of Village Development Committee.
The
CSCD program
is a welcome activity to their community
Health program where
liaison with Government
is
the
mainstay.
Help to rehabilitate widows is also undertaken.
All
these
are supported by the Community and
other
funders, with self-generated funds.
- CEG/PM; 3 CHVs; 5 mothers; 2 widows; 5 others.
CSCD Activities?
— as per CSCD guidelines.
Systematic and well-organised
through Community Health approach with 1 CHVs for approx.
500 population.
- Components of CSCD organized as part of Community Health
approach, utilizing only Government Services avaialable
in
area, and facilitating PHC activity with co-operation.
Direct
contact with people and utilization of Village
Development committee for support ensures good coverage.
— Activities — EXCELLENT.
Records/reports? GOOD.
- CMAI's classification - GOOD.
53
3-
Non—CSCD Activities;
- NEE of adults, youth, pre-school children.
- IGPs and loan/savings schemes'.
- Creating awareness of Environment, Water & Sanitation
as
already listed above.
- Widow rehabilitation & tackling of social problems.
- Medicalization of activity with camps and medications
for
aiIments.
- Logical extension of Child Development activities - Day
Care Centre.
4.
Re 1 at ionships/Liaison:
- With Govt. - good on health/medical
issues and maximal
utilization of services.
- With other voluntary agencies - in networking on
issues
relevant to area.
5.
Discussions
- to explore herbal medicine/local resources in tackling
minor/common ailments and enable people to take care of own
health.
- to integrate CSCD activity into all other programs to make
it sustainable.
- to promote nutrition education and Kitchen gardens for both
nutrition and herbal medicine.
- to
reduce
dependency
on
Western
medicine
and
1 medical'solutions
to health problems with "Education for
Health".
Summary
A well established YMCA with good credibility in areas of
socio-economic problem tackling and creating awareness in all
segments of population through specific programs.
Community
Organisation and participation good.
Needs to be handled over
CSCD
responsibility along with
integration
into
other
activities to make it sustainable.
CSCD Micro-project XII
Details of Pro j ect
- YMCA - Moolachal, Thuckalay.
- Rural - 6 villages under Vilavoor town panchayat covering
10,000 plus population.
80% of these landless labour below
poverty
line.
The YMCA has been
running
free Medical
clinics weekly and EYE/Dental camps 6 monthly.
Veterinary
help
for
livestock 3 loans and Poultry vaccination
are
undertaken.
Help
to deserving school students as fees,
uniforms and other expenses; encouragement too, in form of
prizes for best students are other activities.
- 3 YMCA Board members/CEO & PM/5 CHVs/ 6 others.
54
2.
CSCD ac t i vi ti es
- as per CSCD guidelines.
- CHVs had additional/continued training by Neyyoor Hospital
apart from CMAI's training.
— Doctor from Neyyoor Hospital conducts clinics/ camps.
- No Infant Mortality in past 1 year.
- Medicalization of approach with Clinic base.
Records/Reports — GOOD.
CMAI's classification
GOOD.
3-
Non-CSCD Activitiess
- Embroidery centre provides employment and generates funds
too.
- Tailoring training for girls/women.
- Creche for children (30) focussing on most needy with pre
school
teaching
and feeding of 3 meals/day undertaken.
Looking for donors, since need is for more than double
the
present strength.
- YMCA involved in Primary English Medium school construction
on own land.
4.
Relationships/Liaison s
~ Government - good for immunization activity.
- other socio-economic programs from Govt, to be
tapped.
~ Voluntary organisations
- KNH Hospital is functioning nearby.
— Network on local issues when needed.
- Utilize Neyyoor Hospital for all medical needs &
training needs.
5.
Discussions
- To explore herbal medicine to enable taking care of minor
ailments by people themselves.
- To explore possibilities of supporting creche
through
Government help/other Volag help.
- To organize Community to take over health care.
- To reduce
'medical' approach and shift to
'community'
approach.
6.
Summary
Well
established YMCA with good credibility
includes
CSCD
along with socio-economic
income
generating
and
education activity.
Utilizing Govt, resources and Volag.
Hospital
resources for medical needs of well
identified
population.
Need to shift to community organisation
and
exploring local resources towards sustainability.
55
CSCD Microproject X11 X
1-
Details of Project
- Vinnarasu Association — Marthandam - K.K. Dist. TN.
- Rural, covering 12 wards of entire Panchayat of Kappiyarai,
which
is one of the 8 village
areas covered by this
organisation.
Started work in these villages in 1973 and
registered in 1984 as an Ecumenical Christian Movement
for
Human Development.
Have a holistic approach to development
working
through small groups of 30 families each,
called
'Neighbourhood groups', with a leader.
Activities
include
- Leadership
training;
Help
to poor students;
Womens'
programs for self-help; Community based health care;
and,
Inter Faith dialogue for peace.
- CEO/PM, 12 CHVs, 10 others.
2.
CSCD Act ivities:
As per CSCD guidelines.
Well organised and executed as part
of Community Health program- CHVs trained by CMAI, and also by TNVHA as lay first-aiders
(LFAs)
— CSCD well understood and well integrated into program.
- Use herbal and alternative systems as part of program,
though dependant on Govt, health services.
- Approach
through
education creating
awareness
and
mobilizing for group action.
- Records/Reports - GOOD.
— CMAI's classification - Above Average.
Non-CSCD Activities
- Tailoring for girls/women; non-formal education at regular
group meetings; Credit-unions for savings.
- Creating awareness and utilizing all available Governmental
programs in area related to health and development.
Relationship/Liaison
- Good relationship with Government
for Health Services.
Able to utilize and co-operate with same.
- Nil other NGOs in area.
Network with other NGOs and TNVHA
on broader issues of the area.
Have been gradually developing the concept of
'neighbourhood
committees' and able to hand over most activities to Community
for discussion, decision-making and
implementation,
through
this simple method of Community organisation.
56
5.
Discussions;
- To strengthen herbal medicine/other self-help methods
in
the area of health and minor-ailment management.
- To evolve methods of tackling Bronchial
Asthma
in
a
wholistic
manner,
since
it
is a major
problem
in
Kanyakumari Dt.
Summary;
in
A well organised Volag. with the idea of putting health
peoples* hands through a wholistic approach to Development and
working through small groups of people - Neighbourhood groups
- consisting of 30 families each.
Approach through creatilng awareness and promoting necessary
action
for Community needs.
Need to give needed help/inputs
to make health a self-sustainable effort of the people.
CSCD Microproject XIV
1.
Details;
a) YMCA - Madras - Boys town.
b) Peri-urban/rural
area off Madras, covering two Panchayat
areas with population of over 5000.
Well
established
Volag. working with Orphanage, Vocational training centre
and School.
They have experience of working with CSCD
program in adjacent areas earlier.
- CEO/PM; 1 Doctor; 4 CHVs; 5 pregnant women; 5 mothers; 5
others.
CSCD Activities;
- as per CSCD guidelines.
CHvs are visiting area regularly
and have good rapport with people.
- Conduct NFE in addition to Health Education during direct
contact with mothers at home.
Community participation
enthusiastic.
- Approach medicalized and clinic based due to availability
of Gynaecologist as Doctor in clinic.
Well backed by VHS
services for de 1iveries/immunization and
liaison
with
nearby Catholic Hospital.
- Records/Reports and returns adequate - well maintained.
- CMAI's c1 assification ; Above Average.
Non-CSCD Activities;
- NFE for adults mentioned above.
- Vocational tralining, Orphanage and Formal School.
- Not integrated into CSCD activities.
Have developed good rapport with surrounding Community
good credibility for CSCD activity.
57
and
union
4.
Relationship/Liaison:
- With govt, agencies for immunization and F.P.
services.
Others related to Non-CSCD activity- With Volags like VHS and nearby Catholic Hospital
for
Medical needs.
5■
Discussion
- Alternative medicine/Herbal medicine avaialble with CHVs
and Community - not being utilized.
To promote selfreliance in minor ailment management.
- To proceed from vertical/compartmentalized medical
care
towards demystification and Community Health approach.
- To evolve methods of handing over health care
to
commun i t ies.
- School health programmes.
6.
Summary :
A
well
established
volag with good
rapport
with
community and
doing effective CSCD programMeed to shift
from
'Medical'
to
'Community'
approach,
with
enabling
dimensions
for self-help and eventual handing over
to
Commun i ty.
CSCD Microproject XV
1.
Detai Is:
a)
The Salvation Army - Aizawl - Mizoram.
c)A
b)
well known and well established organisation
focussing
on the poor in its activities.
They are
involved
in
Community Health activities through Community Health
Action
Network
(CHAN)
with key themes
of
Care,
Counselling, Training and HopeThe project works in four phases, I - Samaritan House for
female sex workers; II - Family counselling centre; III Mobile Health unit providing free medical care; and IV Vocational
training for rehabilitationFind need
for
medical
personnel
to be involved in CSCD and Health
Education programs.
Extensive activity in other areas
has affected CSCD work.
- IPM/CEC1/NFE teacher1;2CHVs;IMother;1 other.
- The CSCD financial assistance being small, the
interest and attention is minimal.
CSCD Activities:
- Initiated well, but ran into problems with trained CHVs not
able
to function well, migratory population in
taken up
area of work and
rapid urbanization of Aizawl
town,
bringing Government Health Services closer to area.
58
~ CHV upgraded to PM and handed over project — is unable
to
manage due to lack of medical knowledge.
- Plan
to shift area of work to 2 other needy areas and
recruit 2 new CHVs with nursing background.
- Records/Reports adequate.
- CMAI's classification Average.
Non—CSCD Activities;
- In areas of rehabilitation,
counselling and vocational
training.
Not integrated with CSCD activity.
- Professionalization and vertical approach to problems seen,
hence
expect
CSCD also to be
handled
by
health
professionals.
4.
Re 1 at ionsh ip/L i aison:
- Good, with Govt, due to credibility and standing.
Able
to
garner support for activities.
- No co-operation/networking with other Volags, mainly since
NIL other Volags in area, and Volag concept is new to them.
5.
Discussion;
- High
literacy levels in area needs more written/printed
material for use.
— Changing/dynamic nature of population in Aizawl area points
to taking up more interior and rural areas for work.
Summary;
A well recognised Volag involved in multiple Community
level activities in vertical, compartmentalized manner.
High
level
of professionalization occuring,
with problems of
implemnetation being impeded by paucity of same in CSCD area.
Feel need for written material, shift of location of work and
recruitment of professionals.
CSCD Microproj ect XVI
1-
Details of project;
a)
YMCA - Tanhril - Aizawl district, Mizoram.
b)
West of Aizawl, well connect by road to the city, approx.
45 mts. distance by road. Covers papulation of approx.
3000,
scattered
in the hilly terrain, with
local mud
roads and pathways for access.
YMCA in centre of town in a rented building used as a centre fo
most community activities.
People are all tribal/Christian,
involved in agricultural activity and domestic animal rearing.
Literacy
levels more than 90% with Primary,
Middle
and
High Schools in Tanhril.
Most houses made of bamboo and
thatch, with just enough water from a reservoir at higher
level
of hills. Nil industry in area, except
for petty
shops conducting business for daily needs.
59
c)
d)
2-
YMCA
recently estab11ished, and recognized
Council of YMCAs.
Met CEO/PM, 4 CHVs, 4 mothers and 8 others.
by
National
CSCD Activities;
a)
b)
c)
d)
As per CSCD guidelines, registering
and follow-up of
mothers and children being done regularly.
Deliveries conducted at nearby Health sub-centre or by
ANM at home.
Adequate ANC and PNC.
Good Health Education activity from Health Department,
the CEO being from same department.
H.E.
posters in Mizo language seen in most houses on
Mother
and Child care,
Breast-feeding,
ORS,
etc.
Innovative exercise seen in this area, is boards painted
with CSCD messages at highly visible locations on village
roads.
Records, reports adequate.
CMAI's classification - AVERAGE.
Non-CSCD Activities;
- N.F.E. program being utilized for CSCD promotion and other
community needs, since literacy levels are high. YMCA helps
as centre for marriages and other social activities.
- Weaving centre for women being supported by YMCA to help in
socio-economic development.
— Medical camps with Government & Pvt. Doctors for general
disease problems in area.
IDD well tackled with
iodized
salt being available and used in village.
— Local type of pit-latrine available at all houses, built by
community,
and has helped in good
reduction of worm
infestation among people of the village.
- People using herbal medicine to limited
extent.
Common
problems in area - Diarrhoeas and Respiratory
tract
infections.
4.
Re 1 at ionsh ip/L i aison:
a) Good relationship with Govt. Health services, with nearby
health
centre,
and CEO himself being
from
H.E.
department.
He also is available to help people during
medical emergencies and other medical needs.
Liaison and
work with VDP, HLIM etc., good - in community building
activities.
b) Nil other Volags in area.
Networking with volags outside
the area not done.
c)
Medicalized approach to problems due to high need in
this
area.
Water supply and sanitation being given
due
prominence with community
involved
in
evolving
local
solutions - eg. pit latrines. People noticed that mosquito
menace and rampant malaria is also due to pit latrines.
60
5.
Discussions;
People already using herbal medicine - to promote use
for common/minor ailments in area and reduce dependence on
medicines.
Respiratory
problems could be tackled
better
by
promoting chimneys in kitchens and smokeless chulhas.
Anaemia and nutrition problems to be highlighted to help
in bettering health status.
Programmes
for Youth
and their opportunity for
skill
training.
6.
Summary
Newly established YMCA that has taken up CSCD work
enthusiastically and
extended
into other areas of health
needs.
With high literacy, education and creating
awareness
is
the main
line of approach, with
innovative methods of
communication. Constant availability and creating facility for
social
activities
beyond CSCD and health
has
firmly
established
the
credibility of
this
organization
for
sustainable development work in the area.
CSCD Microproj ec t XVII
Detai Is of project
a) YMCA -Zemabawk, Aizawl District, Mizoram.
b)c)Peri-urban/rural
area north-east of Aizawl city,
with
newly established YMCA (1991) affiliated to National
Council of YMCAs.
Cover a population of approximately 3000,
scattered in
hilly terrain around the YMCA centre - 90/ST population.
Land donated
to YMCA by one of
its members,
but no
building as yet.
Office runs from premises of one of the
Board membersCSCD is the only project run by the YMCA
at present.
reports/ re turns
.
d) 1 CEO/PM; 5 YMCA Board members; 2 CHVs;
5 Mothers;
8
others.
CSCD Activities?
a) Following CSCD guidelines for registering/follow-up of
mothers and children.
b) Awareness of CSCD good
among people
as
YMCA-CMAI
initiative.
Utilization of Government services, for ANC,
Maternity and PNC, with immunization. Dependence on same
for disease problems in area.
H.E. efforts well received.
c) Reports/returns maintained, with delays due to change-over
of YMCA Board members, including PM/CEC of CSCD every
year.
CHV's part of YMCA network, also change.
d) CMAI's c1assification - AVERAGE.
61
3.
Non-CSCD Ac t i v i t i es:
a) NFE - not functioning as such, due to high literacy in the
area.
Being used to create awareness of health.
Nil other projects/activities . One YMCA Board member
is having a private enterprise of Silkworm rearing,silk
reeling and thread-making. He provides employment for
a no. of women in the area.P1anning to innovate on
weaving for local needs to meet marketing needs.Another
Another runs private school and is a member of political
group.
4.
Relationship/Liaison :
a) Good with government Health Services, especially in Primary
Care «
b) Nil other Volags in area.
YMCA members are also part of
other local organisations like VDA,
HMIP.
etc.,
and
influence better working of YMCA along with them.
c) Local shawl/clothing unit run by a member,
providing
employment to local people.
5.
Discussions;
a) To promote/uti1ize herbal medicine form locally available
herbs and knowledge to prevent dependence on hospital
med ic ine .
b) To enhance activity in H.E.
on
issues
like Anaemia,
nutrition,
safe water, iodized-salt etc., to help health
efforts.
c) To train CHVs regularly for CSCD/other health activity to
meet people's needs.
6.
Summary
Newly established YMCA (1991) with CSCD being the only
project
activity.
Good
liaison and utilization
of
government
Health
Services.
Suffering
delays
in
documentation due to changing of YMCA Board every
year and
consequent disruption of activity.
Need to develop selfreliance and sustenance measures for health activity.
CSCD Microproject XVIII
1.
Details;
a) YMCA - South Hlimen - Aizawl District.
b) Rural
area South of Aizawl city, connected by road —
approx. 45 mts. away.
People scattered in hills around
area. Nil industrial activity. Population agriculturists doing
Jhum cultivation.
Very similar in characteristics
recorded in other rural projects of Mizoram.
62
Health
The CSCD project team and YMCA board members were not
available during the evaluation team's visit to S.Hitmen.
Hence,
visits/meetings with CHOs,
people,
mothers and
children was not possible.
Five
members of the YMCA Board visited us at the hotel
the same night after receiving the message that we had
visited their location.
The following is from talks with
them:
—
-
—
-
YMCA South Hlimen is a newly established YMCA
(1991)
which has not yet been affiliated to the National Council
of YMCAs.
Regarding CSCD, they informed u.s that
All records/reports are being maintained, and had been sent
to YMCA Shillong for onward transmission
(CMAI-CSCD to
follow up).
They plan to conduct CSCD activities, even if YMCA support
for CHVs salaries was not available, since they found CSCD
helpful.
They are able to get all women delivered at the Government
Hospital
facility.
All children have been
receiving
immunization services from same, and the results have been
sat isfactory.
Their liaison with Government Health Department
has also
brought about 3 Medical camps in the past year to help the
peop1e.
Regarding NFE, they said that all the target non-1iterate
persons having migrated out for socio-economic reasons,
they find only a literate population left!
CMAI c1 assification — POOR.
CSCD Microproject XIX
1.
Details
a) YMCA Lungdai - Aizawl district — Mizoram.
b) A newly established YMCA (1991) yet to be
affiliated to
the National Council of YMCAs.
No prior experience with
any projects. CSCD taken up to help service ideas focussed
on Mother and Child.
Population covered - mostly scheduled tribes - approx.
3,500 people scattered in the hills. The literacy level is
about 50% and nearest Government Health Centre is over 25
kms. away.
c) The CEO/PM is the Headmaster of a School and busy with own
assignments.
CHV's find the training and work useful
to
them as well as people, but do not find adequate support
from YMCA.
63
The existing peoples* organisations like VDP
(Village
Defence
Party),
HLIM
(Women's group
organised
by
Government)
and political parties are serving most needs
of people.
The CEO/PM who is a YMCA Board member
expressed
a frank opinion of the people, that one more
organisation like YMCA is not needed in the area and hence
is non-functional.
d) CMAI links through POs visits/Training programs/Reports &
Returns.
e) PM/CEO, CHVs, 3 Mothers, 5 others.
CSCD Activities;
a) Registration and follow-up of mothers and children not
being done adequately, since there is no full-timer
to
take responsibility for same.
The evaluation team met
a
young girl educated at Bangalore, who was willling to do
the same.
We introduced her to the YMCA team.
b) - ANC, Maternity and PNC awareness present among people du
to Government Health efforts and CSCD efforts which are
not regular/consistent.
~ Immunization of children being done through Government
funct ionaries.
- Awareness of IDD not yet adequate.
So also,
regarding
Water, Sanitation, Disease problems, and nutrition.
c) Records/Reports not maintained.
d) CMAI's classification - POOR.
3.
Non-CSCD Activities;
NIL.
4.
Relat ionsh ip/L iaison;
a) Adequate with Government Health services to serve CSCD
needs.
Other health and socio-economic problems - nil
addressed.
b) Other Vol.ags. like VDP, HLIM etc. in area appear to be
strongly politically connected and interfering with YMCA
and CSCD functioning.
5.
Discussions
a) To revive CSCD work with literate girls/women of
area one of whom was identified by evaluation team.
b) To continue CSCD even if as non-YMCA project.
To consider
any other liaison with CMAI if possible.
c) The CHVs were very enthusiastic about
further training,
which had already helped them in CSCD work earlier.
To
sponsor suitable volunteers for CMAI training programs
for North-East India.
64
6.
Summary
- Newly established YMCA - not affililated as yet
to
National Council due to (?) local problems.
CSCD program
useful, but inadequate reports/records due to non-availability
of full-time worker and paid CHVs.
People and CHVs found
the
CSCD useful, but hampered by lack of initiative/support
from
YMCA.
CSCD Microproject XX
Details
a) South Tangkhul Naga Baptist Association (STNBA)
b) This
is an Association of 75 self-supporting village
clusters
working
for spiritual
and
socio-economic
development of
the villages since
1959,
covering
a
population of approx. 17,000 people.
The villages are
in
Ukhurl district of Manipur at Indo-Burma border in hilly
areas. Villages are on hilltops, consisting of 20 to 40
houses with fair-weather roads for transport.
The main
occupation
is agriculture, with dependence
on
Jhum
cultivation and
the monsoon.
The
literacy and socio
economic conditions are poor.
Medical
facilities -only
Govt.
sub-centres which function erratically and far away
for most of the people.
c) Education is an important need-based activity of STNBA,
with a school (upto High School) and boarding facility at
Irong, Yaripok, catering to 550 students. The CSCD project
has been taken up in remote villages, covering about 4000
population, SO kms, away from Irong, the HQ. 4 CHVs manage
this activity and find immunization reach from the Govt.
very difficult. Supervision is also difficult for reasons
of distance and access.
NEE is conducted for women
in
areas surrounding Irong, as a separate activity.
Local
tribal
problems between Kukis and
Nagas
restricts
continuous activity through the year.
d) Met 1 PM/1 CEO/2 CHVs/7 mothers and 12 others.
CSCD Activities;
- Initiated
as per CSCD guidelines,
with registration of
mothers/chiIdren and follow-up.
CHVs complained of irregularity of immunization activity
by Govt.
health centres,
and consequent difficulties.
Attempts
at
immunization
through voluntary
agencies
through medical camps being done to supplement Govt. work.
Awareness
of
nutrition,
sanitation
and
diarrhoea
management
adequate,
but
influenced by socio-economic
conditions of people.
65
-
-
—
Reports/Records adequateClarifications about utility
were done during the visit, since new PM and CEO have
taken over CSCD work.
Considering
shifting of CSCD activity to nearby areas
which have equal need and advantage of conducting of NFE
for adults in the same area.
CMAI's classification s AVERAGE.
3.
Non-CSCD Activities;
- Education both schools and NFE as listed above.
~ Community Organisation and Development,
Socio-economic
activities related to agriculture - horticulture,
poultry,
piggery, cardamom plantations etc. and vocational training.
CSCD and Health Education not being incorporated into these
p rograms.
4.
Re 1 at i onsh ips/I- iaison
a) Good with Government in Health and Development areas,
though erratic and limited nature of services due to local
and political problems does not address peoples'
needs
adequately.
b) Nil other Vol.ags. in area.
We visited Manipur VHA and
liased with Mr. Kuber Singh — the Secretary -for transfer
of material in local language for H.E.
5.
Discussions
a) To shift CSCD to villages nearer to HQ in areas of similar
need for better monitoring and implementation.
b) To continue CSCD activity in earlier distant villages and
secure adequate support locally, since it is useful
and
appreciated by people, ie., continue CHVs in old area and
train new ones for nearer villages.
c) To
incorporate
Alternative/Herbal
medicine
for
minor/common
illnesses to enable people to take care of
themselves.
d) To strengthen nutrition education and on Hygiene
and
sanitation in surrounding areas.
e) To start school health program,
evolve ChiId-to-chiId
program and progress to ChiId-to-Community program
for
health,
since
education upto High School
is a major
activity of the organisation.
66
CSCD Microproject XXI
1.
Details;
a)
Christian English School, Chizami, Nagaland.
b)c)Chizami
is a large village settlement surrounded by
smaller villages, 5 hours by road from the Capital
city
of Kohima, located in Phek district, bordering Burma and
Manipur
in hilly terrain.
The population
is about
11,000,
mainly agricultural
labour
in conditions of
poverty and
low literacy.
Chizami English School has
grown over past years into a high school.
It is
located
in the basement floor of the Baptist Church, with a good
support
from the people in its running.
Teachers from
various parts of the country are employed here, and
they
are
involved in Community development activity - one of
the schools with a social concern.
A nearby Government
sub-centre caters to immunization and minor medical needs
of the Community, though the services are
limited.
A
majority of deliveries occur at home by Traditional Birth
Attendants, with assistance from the Government nurse
in
case of problems.
A school and dispensary run by a
Catholic organisation also provides some health services
Hygiene and Sanitation are poor, with water-supply being
catered for at a Community level.
d)
CHAI links through PC's visit/Training programs/Reports &
Returns + Earlier CSCD project.
e)
PM/CEO, 26 Church elders, 12 Mothers & children, 1
local
nurse, 1 TBA, 25 others.
CSCD ACtivities:
a) - As per CSCD guidelines, Registration & follow-up of
mothers and children.
- CSCD messages passed through church
activities,
NFE
groups for women and direct contact.
b)
Good understanding of CSCD.
Community being organised by
church,
gives good participation
in health work
~
controlled by church elders.
c)
Records/Reports adequate.
d)
CMAI's internal evaluation classification - AVERAGE.
Non-CSCD Activities:
- Mainly revolve around education
and creating
awareness
through
school, church and NFE.
Have direct relation
to
CSCD activity.
- People hold
the church and the school
in high esteem.
Hence,
have good
rapport
in
all
activities
either
spiritual, educational or service. School teacher involved
in
running a school dispensary which also caters to
health/disease needs of the Community.
67
4.
Re 1 a t ionshi p / L i a ison
- Good with Government Health Services for medical
care,
immunization and Health Education.
- Liaison with Catholic School and dispensary for health
problems of the people which can be tackled by them.
5.
Discussions
a) To initiate and foster use of herbal medicine knowledge of
Community for minor/common ailment management.
b) To initiate school health programs, which can evolve
into
chiId-to-chiId and chiId-to-community programs later.
c) Organise youth wing of organisation to clean up the water
storage
tank,
since
the
incidence
of
water-borne
diarrhoeal disease will increase with onset of monsoon.
d) Create
awareness of community to needs of pre—school
child, Adolescents and elderly for a rounded-off Community
Health program.
CSCD Microproject XXII
a)
YMCA Patna - Bihar
b)c)Newly established YMCA (1991) affiliated to the National
Council of YMCAs. The YMCA Board is unique with
female
members on the Executive,
and have
a YMCA trained
secretary for implementing project CSCD.
An
earlier
selected rural area, 25 km. away has been given up due to
logistics of
transport and supervision. A new area in
peri-urban
fringe of Patna (4 kms from City) which is a
Harijan settlement has been taken up since the beginning
of this year.
This area has no medical/heal th care
facility working, nor any Vol.ags. in area.
A medical
approach with a weekly clinic, Doctor, 2 Nurses, etc. has
been
initiated
to gain a foothold for health work.
A
volunteer social worker,
Mr.
Ravi
Shankar,
who has
single-handedly made literate the children and elders, is
helping
the project.
The co-operation of
the Sarpanch
and a local lady CHV are also available.
d) 1
CEO/1 PM/6 YMCA Board members/1
Doctor,
2 Nurses,2
CHVs, 3 Mothers and 5 others.
CSCD Activities;
- Registration and follow-up of ANC,PNC mothers and children
has been initiated and needs to be completed.
- Good rapport with Community through the local CHVs,
active
use of medical support for CSCD activities by people
in
addition to minor ailment management.
— Records/Reports - initiated we 11/adequate.
- CMAI classification - POOR.
68
3.
Non-CSCD Ac t i vi ties;
- Nil initiated directly by YMCA.
Supporting the NFE work of
Mr.
Ravishankar
through provision
of
books,
etc.
Utilization of Hygiene and Sanitation
efforts of
this
volunteer to spread health messages.
— Co-operation with this volunteer and support of Panchayat
through Sarpanch auger well for a comprehensive Community
Health approach.
4.
Re 1 at ionsh ip/1i aison
- With government Health Services for
immunization and
problems of maternity.
- With civic authorities for water and sanitation.
Nil
other Vol.ags.
in area.
Networking with
other
volags/federations like VHA Bihar and DEVNET discussed.
5.
Discussions
a)
To emphasize preventive and promotive activities even
at
clinic.
b)
To shift from 'Medical' to
'Community'
approaches in
tackling health problems.
c)
To initiate ChiId-to-Community programs from nearby schools.
d)
To train
and strengthen skills of
local CHVs towards
Community Health approaches for Primary Health Care.
e)
To
liase with Bihar VHA and DEVNET
(
a group of
youngsters
involved in Education activity in Bihar)
for
new approaches to foster Community Health and Development
in selected area.
69
Position: 1821 (3 views)