1796.pdf
Media
- extracted text
-
CHRISTIAN MEDICAL ASSOCIATION OF INDIA
FA1RTI(CIIPATO®.Y EVALUATION" STUDY
OF CHILD SURVIVAL AND CHILD
DEVELOPMENT PROJECT OF
CHRISTIAN MEDICAL ASSOCIATION
OF INDIA
BY:
DR. SHIRIDI PRASAD TEKUR
O.C.H.. EK. CfiPT. fi.M.C.
COMMUNITY HEALTH CELL
BANGALORE,
TABLE OF CONTENTS
Chap.
Contents
1.
INTRODUCTION
2.
I. CMAI Policy
3.
Page No.
1
1
1)
Philosophy behind CSCD
projects.
2)
Objectives of CSCD.
II. Process of the Evaluation
3
3
23
1) Preparatory Phase.
2) Implementation of the
CSCD Programme.
3) Training
4) Reports and Returns
5) Files & Information at
CMAI.
6) Comments
7) Type of other development
work done.
8) Health Care Resources in area
9) Attendance of Training Sessions
remarks.
10) Field Visits
11) Understanding of role
and responsibility.
12) Problems faced with project
with CMAI
Contd.
I
13) Needs, Suggestions for
Innovations
14) YWCA - Nagpur
15) E.L.C. - Nagpur
16) YMCA - Hyderabad
17) YMCA - Madras
18) CTVT - Madras
19) CSI - Coimbatore
20) CSI - Mysore
21) YMCA - Shimoga
23 - 27
III. Recommenda t ions
1) Strengths
2) Weaknessess
3) Needs
4) Oppurtuni ties
5) Suggestions
a) CMAI
b) Project
c) Community
IV.
1) Memorandum of understanding
2) Bibliography of documents
3) Appendix
A
4) Appendix
B
5) Appendix
C
6) Appendix
D
7) Appendix
E
8) Appendix
F
0'7^
2
c
28
38
PARTICIPATORY EVALUATION STUDY OF THE CHILD SURVIVAL & CHILD DEVELOPMENT PROJECT OF
CHRISTIAN MEDICAL ASSOCIATION OF INDIA
INTRODUCTION:
The study follows the decision of the C.M.A.I
to
- look at how appropriate the CSCD project is,
assess the progress and effectiveness so far,
- obtain guidance on future involvement of C.M.A.I in
Child Survival and Child Development issues in India.
the
The details of
Appendix - 'A'.
memorandum
of
understanding
in
is
The format of presentation of the report is as follows:
1.
C.M.A.I.
- policy on community health
- philosophy behind CSCD project
- objectives of CSCD programme
2.
Process of the Evaluation Study
- expections of the C.M.A.I.
- preparatory phase
- field visits
3.
Observations
programme
and
recommendations
for
future
of
- to C.M.A.I.
- to project
- to community
I. The CMAI Policy
The CMAI is the official health agency of the National
Council of Churches in India, whose membership is primarily
open to all Protestant and Orthodox Churches in India.
The CMAI policy priorities,
appreciate
India.
that
health is not a reality for
1
many
in
is concerned with social justice in the provision
distribution of health services.
and
believes that people have an important role to play
their own health, and
in
recognises the right to health care.
The policy on community health is to create awareness,
understanding and support for the principles and practice of
community health with special emphasis on community based
care. In this context to work closely within the health
policy of the Government of India and to give priority where
the needs and problems are greater.
On
the
Basic
identifies,
Principles
Community
of
Health,
CMAI
Community participation as an essential component,
That community health services should be appropriate,
by
acceptable,
easily
available and
affordable
the community.
The importance,
relevance and need for utilizing
traditional,
indigenous
health practices and under
standing them in the context of cultural and socio
economic situation of the people.
Philosophy behind CSCD projects:
The CSCD project is an innovative
health aimed at:
approach
to
community
promoting health among people
going beyond the traditional role,clientele and member
ship of the CMAI to do so,
working; through the church and related agencies for a
more
imeaningful involvement in the healing ministry,
and
introducing the Church to a wholistic approach
making health and healing a reality for the people.
in
The CSCD is based on CMAI's belief that,
but should
health work can not be viewed in isolation,
related
be integrated with development and other
activities!
2
community
health work could be done
themselves towards a movement for health.
by
people
non-hospital based Christian and social agencies who
are already working with people in various areas could
take up health
work also even if they do not have
prior
experience
in health related activites.
any
we need to focus attention
to build a healthy nation,
on children of today.
survival o all children in a community upto two years
of age could be achieved with low-cost appropriate
interventions among pregnant mothers and children upto
two years age.
Objectives of CSCD:
The essential objectives of the CSCD Scheme is to introduce
simple, low-cost and effective health interventions that can
help women and children in the community.
It is meant to focus on communities of
groups predominantly in rural areas.
low
To ensure that all children born in the
their second birthday.
socio-economic
community
reach
II. PROCESS OF THE EVALUATION - STUDY :
The process included an intensive two day preparatory phase
at CMAI headquarters,
followed by field visits to projects
to study and sample ground realities, (refer Appendix 'A'.)
PREPARATORY PHASE:
During this phase, discussions with key persons in CMAI,
dealing with the CSCD project took place, and one of the
CSCD Project Managers who visited CMAI was also interviewed.
In addition, all files and documents relating to the CSCD
project were perused for information helpful to the Study.
(Appendix 'B' for list of documents/papers perused)
An understanding of the CSCD project obtained from the above
interactions as follows;
The essential objectives of the CSCD project focusing on
The
women and children was translated into a project-model,
plan offers 3 years of active support from the CMAI after
which the process is expected to be self-sustaining.
3
This project model at micro level is expected to:
cater to a population of 3000 to 5000 where all 150
pregnancies in a year are to be seen through safe
deliveries and the survival of all the children born
for a period of 2 years.
one CHV per 1000 population is identified for the
health work involved, with a project manager taking
overall responsibility for the CHV's work in the total
population.
The components of the project are;
1.
Identification
ANC services.
2.
Assurance of safe deliveries to all expectant
and
3.
Assurance of normal growth and development of all
children under 2 years of age through appropriate
services so that each new-born can live upto 2 years.
of expectant mothers and provision
CMAI's Child Survival Development Programme
following activites:
of
mothers,
involves
the
1. Identify
interested
Church
related
development
programmes keen on introducing a health component and
taking up this CMAI Scheme.
2. Through
CMAI's
programme development and
advisory
services to assist potential implementing agencies with
application and preparation for implementation,
This
will include site visits by programme staff of CMAI.
3. Each implementing agency who gets awarded a grant
CMAI under this scheme would be expected to,
served
from
(about
a)
Identify the local community to be
3000 - 5000 population).
b)
Give special attention to women and children,
This
would include Ante-natal care, child health and
family welfare services.
c)
Follow up all 150 children born in the communi ty
from mother's pregnancy to second
birthday
ensuring
there
is
proper
nutri tion,
education and health education to mothers and
immunization coverage for mothers and children.
4
I
d)
Develop simple, community based primary health care
services that emphasises FIONA (F : Family Welfare,
I : Immunization, 0 : Oral rehydration,N : Nutrition
of women and children and A : Vitatim A).
4. CMAI will provide advisory and follow up services to
implementing
agencies
which
includes
training,
monitoring,
evaluation and financial support.
Each
project will be followed up for at least 2 years
Implementation of the CSCD Programme:
The CMAI started the CSCD programme in 1987 by inviting
Christian/Social agencies working with people and interested
in including Community Health in their range of activities.
The implementation of the project started in 1988 with
Fifty-two (52) m cro-projects approved and selected for CSCD
intervention.
Twenty (20) projects did not fulfill the
requisite criteria and were not accepted of the total of
Seventy-two (72) applications.
thirty-one (31) are
Of the fifty-two (52) projects started,
at present operational, while twenty (20) were closed for
various reasons. One project completed three years.
The reasons for closure of these twenty (20) projects
mainly administrative, where the micro-projects had
problems linked to their
internal
staff
and area of work.
offices,
not
complied
required.
with
the
minimal
own
reports
were
organisation,
and
returns
not shown adequate interest and initiative towards the
presumed to be due to preoccupation with
CSCD programme,
other programmes they were involved in.
Training:
The CHAI organised an initial training programme of one-week
duration in
in 1988
1988 at three regional centres for Chief
Executive Officers (CEO's) and Project Managers (PH's).
This was followed by six (2-3 days) short-duration
regional workshops held during 1989 and 1990, where CEO's
selected
and Community Health Volunteers (CHV's)
and PM'
for the CSCD programme attended.
The training covered all aspects of the CSCD programme
pre and post evaluations.
5
with
Other activities of CMAI complementing CSCD program:
Publications from CMAI, like FIONA Plus, Diarrhoea dialogue
and Contact are sent to the microprojects to help them
As part of
understand
wider community health issue.
technical support, FIONA manual and "Where there is no
Doctor' are supplied to the microproject of CMAI.
Reports and Returns:
The
initial format used for reports and returns was
complicated and not understood by the particilpating micro
projects, and led to confusing initial reports, while
mystifying the simple steps involved in CSCD implementation.
CSCD Manual:
Considering this, a very concise "MANUAL FOR CHILD SURVIVAL
AND CHILD DEVELOPMENT PROGRAMME' was put out by the CMAI,
of
simplifying the CSCD message and also the format
This came into use from January 1990, after
reporting,
which, there is more coherence and understanding seen in the
project activity.
Feed back:
The system of acknowledging reports/returns and feed-back to
projects about their work has been streamlined, and seems
effective in the micro-projects performance.
FILES AND INFORMATION AT CMAI:
The CMAI maintains updated files on each of the projects for
financial
transactions,
corresondence
and
health
reports/returns.
In addition, registers prepared by the
project officer gives data at a glance.
This was very
useful for rapid assessment of project status.
From these sources, information was extracted on the 31
micro-projects operating all over the country, with the help
of a format.
- Appendix 'C'
The details looked for helped to look at variables in the
projects which could affect the objectives of the CSCD
programme .
The compiled master-chart is in - Appendix 'D'
In this context, it was interesting to note an office assessment of the CMAI about the projects as Good (G), Above
6
average (aA) and Average (A).
This classification is based on:
- the micro-projects understanding of CSCD programme,
- reliability and progress shown in
and returns,
micro-project
reports
- micro-project milestones in health,
- handling of finances by micro-projects, and
reports
staff.
from
field-visits to the micro-projects by
CM AI
This
classification corelated well with the
reported
progress
in
micro-project activities and is also
a
reflection of the experential assessment of CMAI Staff.
Hence it is used for data-analysis which is presented below:
ANALYSIS OF DATA COLLECTED FROM CMAI FILES
1.
Location:
Total
Rural
25
17
2
6
Urban
6
2
1
3
Maharashtra
8
5
Tamil Nadu
6
5
1
Andhra Pradesh
4
2
1
Kerala
3
2
Karnataka
2
1
Nagaland
2
2
Manipur
2
Madhya Pradesh
2
1
Himachal Pradesh
1
1
Orissa
1
aA
G
A
States
7
3
1
1
1
2
1
1
Comment:
a)
The Urban projects are not doing as well as the rural.
b)
The States.of Bihar / Uttar Pradesh / Rajasthan / Assam
have
Bengal <>o in the Northern belt do
not
West
national
in
micro-proiects
while
representation
micro-projects,,
statistics show a poor state of health in these areas.
c)
Projects in the relaatively well-off states (healthwise) of Maharashtra, Tamilnadu, Kerala, Karnataka and
Andhra Pradesh seem to be doing well, and also, number
of micro-porjets are more in these areas.
2.
Type of other development work done:
Social development
26
Economic development
20
Agriculture development
15
Water development
2
Vocational training
4
Educational development
5
Health development
3
Non-specific development
1
Multipurpose development
1
Comment:
- No significant correlation.
- The micro-projects with health and Educational development
programmes are doing better than others.
3. Duration of
work in area:
A
aA
G
Total
Less than 10 years
15
9
2
4
10 to 25 years
9
4
1
4
more than 25 years
7
6
8
1
Comment:
- No significant
correlation
The older or newer project seem to be doing
compared to those between 10 to 25 years of age.
4.
better
Year of CSCD project:
G
Total
aA
Second year
8
5
Third year
23
14
A
3
3
6
Comment:
- No significant correlation
- Projects in third year,
off.
5.
with more experience are better
Health Care Resources in area:
Total
aA
G
A
a) Nil in area with
resources more than
10 k.m. away
10
7
1
2
b) Nil in area or within
5 k.m. (Resources
5
10 k.m. away)
6
5
0
1
c) Others - with clinics
Private / Mission
hospitals Govt, health
resources in area.
15
7
2
6
Comments:
a)
Micro-projects with less health resource in the area
seem to be utilising the CSCD programme better.
6.
Access/roads/distance to nearest health resource
The access has been classified as Good or Poor depending
on the roads/distance and availability of transport
facilitios:
Total
A
aA
G
With Good access
15
8
2
5
With Poor access
16
11
1
4
9
Comment:
There is no significant correlation.
The areas with poorer access utilise the CSCD better.
7.
Attendance of Training Sessions:
All CEO's, PM's have attended the long-duration initial
training and either they or their field staff have
attcnde the short duration training sessions.
There is
no correlation to attendance at training sessions and
performance of the CSCD programme.
Remarks:
needy
From
this
analysis
it appears that
the
are
f rom health resources)
(rural/inaccessible/far from
taking up the CSCD programme are taking up the CSCD
programme more vigorously and having components of
health or. education in their development strategy helps
in their getting the CSCD message to the people.
Another factor which relates to poor performance is
where
the turnover of field staff has affected the
programme and when inadequate understanding of the need
to
record/report/assess the programme regularly is
present.
FIELD VISITS
Field visits were made to seven (7) micro-projects and one
Two simplified
(1) Training and co-ordination centre.
formats of questioning was employed, one for the CSCD
programme
implementing staff (CEO/PM/CHV) and one for the
are
group
from
the
people
(Mothers/Others)
who
"beneficiaries' of the programme.
- Appendix "E' & 'F'
10
as
The break-up of the interactions during these visits is
follows:
Staff
CSCD Micro-project
Mothers/Others
Total
1. YWCA Nagpur
CEO + 2 CHVs
3
6
2. ELC Nagpur
PM + 3 CHVs
15
19
3. YMCA Hyderabad
CEO
1
2
4. YMCA Madras
CEO + 3 CHVs
6
10
5. CTVT Madras
1 Co-ordinator
of CSCD projects (8)
1
6. CSI Coimbatore
1 CHV + 1 C.O
15
17
7. CSI Boodithittu
8. YMCA Shimoga
CEO + 1 HW + 2 C.O
+ 1 animator
CEO + 2 CHVs
21
16
26
19
9. MVM Nagpur
PM at CMAl Hqs
1
101
Total:
The field visits involved a major effort in learning of the
what, how, why, where of the CSCD programme implementation
areas, with minimal time spent in the office and files and
maximally in the field.
Constraints of a short-notice, distance of projects from
headquarters/offices and non-availability of staff/mothers,
did affect the process in some areas, but a reasonable
understanding of the projects was obtained.
The
of,
selection
of micro-projects was made covering
samples
micro-projects in their 2nd 3rd year of CSCD activity.
those labelled 'Good' and 'Average'.
states where more micro-projects were located.
urban and rural areas.
those not recently visited by CMAI staff and taking into
consideration time travel connections and constraints.
11
COMMUNITY HEALTH CEIL
326. V Main, I Block
Koramongala
Bangalore-56C034
India
A focus of attention was the people who were implementing
the
CSCD
programme,
their
problems,
feelings
and
understanding;
the people of the area,
their needs,
relevance of CSCD intervention and the impact of the
programme on children.
The responses collated from the prepared format
E ) is detailed below to appreciate the range
about the CSCD project.
(Appendix
of ideas
CEO
Understanding of role:
As coordinator
implementor CSCD activities.
Reaching the unreached.
Overall development of people of area (slum).
Infusing confidence among people about their capabilities
in tackling health.
Educator of people/trainer of CHVs
Co-ordinator and Liasion between Govt, and private agency
activities.
To establish good relationship with community.
To promote
women.
total.
health
of
children/adults/pregnant
To reduce IMR.
Understanding of Responsibility:
Awakening potential in women and children and building up
peoples confidence in themselves.
Record keeping.
Training of CHVs
Co ordinating all health related activities.
Implementing CSCD project.
Relating health to development.
Provision of
availab!e.
health faci1ities/camps
Impart health education to community.
12
e tc. ,
where
not
I
Understanding Future of Project:
Requires weaning over next 2 years.
Can be well integrated into other activity.
Requires educational support/technical support.
Requires good contacts with Govt./private health services
for good follow up.
Salaries for health staff.
Nearby hospitals will make this less effective.
In spreading message of health among mothers.
Ongoing even if CMAI withdraws.
Adopt more villages into programme.
CHV's
Understanding of role:
Motivation of people for better health.
Educating mothers and children.
As implementor of all health programmes.
ANC/PNC/lmmunization care takers of the community.
Co-ordinator of health resource in area.
Understanding of responsibility:
Education of mothers.
Recording pregnancy/births.
Monitoring health.
All problems of people.
For health of all children.
Co-ordination of health activities.
13
2. Problems faced with project:
Organising people.
Motivation of girls (adolescent).
No nearby health facilities/services.
Social/economical/cultural problems.
Superstition.
Resistance to change.
Training
CHVs.
CHVs staff and commitment versus mediocrity
Migration of CSCD
in
mothers at delivery time
Other voluntary agencies not co-oprating.
Private health enterprises.
Illiteracy.
Problems related to Vaccine supply by Government.
Accessibility and area of work distant.
Timings of field work due to different working hours
different people.
of
More CHV's needed for better coverage.
Problems faced with CMAI:
Pressurised for prompt reports/returns.
Earlier not clear in communication.
Delay in release of funds.
Social activities columns - not adequate need to fill-up.
Not willing to met salary/expenses of Health Workers.
3. Training so far - CMAI Workshops:
Training done apart from CMAI from local
VHAI/RUHSA/CSI/PIIC/Other Voluntary agencies.
doctors/
CEO's - not availed any other training apart from CMAI
14
CHV's
many local
training.
and other resources were
used
for
Needs in future
Health education for Mahila Mandals and people.
Nutrition.
Regional language needed for information transfer.
Training in financial management of project.
Balwadi / Day Care,Centres.
Adoption procedures
/ facilities.
T.B.A.
Small Scale Industries / Social and Economic development
programme.
Tackling diseasse in pregnancy and lactation.
Minor ailment treatmnt.
Supplementary nutrition programme.
Herbal medicines & drug / Non medical therapies.
CHV
training.
School-health .
Handicapped children.
i
Adult education
Conduct of Health Camps.
Immunisation training.
To support child till 5 years age.
Preventive health / Sanitation.
Further training in all aspects.
Suggestions for innovations:
Circulating library.
Adult education
Fund-raising activities.
15
1
1
To tag on to women's programmes.
Polio/disability rehabilitation for chiIdren/mothers.
Use transportation staff/other office staff
Education.
for
Heal th
Small scale industries /income generation programmes
generate income for CSCD.
to
Weighing Scale/bag.
Schools for drop-outs by youth.
Loans for economic development.
Small savings/Chits.
Co-operatives.
Mass health Camps + Social awareness and Social
Camps especially for immunisation.
Service
School teachers for health.
ConcentratiIng
FPAI inputs.
delivery spacing in 1st year project with
Rotating Chick" for income.
Training CHV's by local Doctors.
Interactions of CHVs with other organisations .
Extending project beyond 2 years upto school (5 years).
Folk media for health education.
Setting
up curative facilities
facilities not available.
when
other
heal th
Social awareness/Social Service Camps/Baby shows/Cultural
Programmes/Debates on health issues.
Below, are brief notes on each of the projects visited
not
covering the.aspects already covered in the analysis so far.
It is a qualitative,
observational, experiential account of
the visits and includes the responses from the people
recorded as "perceptions of the people".
"General Remarks’
at the end covers areas uncovered by the analysis.
16
1.
YWCA - Nagpur (Rural):
Programmes:
Women's
organisation,
socio-economic
programmes,
vocational training, schooling, adult education.
CSCD
tag on
Part-time doctor and clinic based approach/CHV's
field
with
to
Government ANMs and now familiar
record
utilised by ANMs for
conditions.
Partly
record-keeping
style different^ but all
keeping - hence
Good
laision with Government
information obtainable.
Have innovative ideas for CSCD
and Voluntary agencies,
extend
into
other
areas of activity.
services to t---Health needs/problems
Water/Sanitation/Herbal Medicine/Health Education/Social
orgainisation/TBA training.
People's perception:
for mothers and children,
A very useful programme
Should provide more services and education facilities.
Innovation:
' • adult
Weighing scales and bag/Circulating library for
rehabilitfacilities/planned
polio
iJeducation/adoption
ation centre.
2.
E.L.C. - Nagpur (Urban):
Programmes:
Social organisation, Women's organisation, Youth groups,
Health work.
CSCD:
PM
Part-time doctor for curative care at clinic.
One
CHV
very
under
utilised
.
trained Health Inspector
role in all problems of
dynamic and assumes leadership
1-If trained, can be
slum dwellers - overshadows others.
FS and PM if needed.
Utilise Government services well
and obvious better conditions of children registered
under CSCD seen.
Health needs/problems:
Water/Sanitation/TBA training/Minor ailment
Herbal or home remedies/Health education.
17
treatment/
People's perceptions:
Very useful at present for the slum-dwellers.
Needs
more facilities/services.
Requires some socio-economic
programmes to help people.
3.
YMCA - Hyderabad (Rural):
Programmes:
Social
organisation,
programmes and Schools.
Income
generation,
Women's
CSCD:
Field area distant,
but well connected by road.
PM
dependant on CHVs for contact with people.
One CHV on
maternity leave. Other managing alone. Other voluntary
agencies working in same area being well utilised,
like
UNICEF/FPAI, etc.
PM more familiar with schools and
introduced innovative health programmes for children.
Health needs/problems:
Minor ailment treatment/Herbal
Health education.
indigenous
medicines/
People's perceptions
Programme useful for women and children,
development into health care for all.
4.
See scope for
YMCA - Madras (Urban)
Programmes
In areas of schooling, vocational training, working with
disabled and adult education.
CSCD
Have part-time doctor for curative health care.
CHVs clinic/curative/medical oriented,
CSCD is only
activity with preventive/promotive health inputs.
buy own vaccines/medicines .
Not utilising nearby
VHS/Corporation and other voluntary/Govornment health
services well.
Health Care needs/problems
In areas of water supply,
sanitation, health education,
minor ailment treatment.
- temporary/i1legal nature of slum settlement.
18
migration of people in search of work.
People's perceptions
as a centre for minor ailment treatment
for mother and child.
and
advice
as a service providing centre which needs upgradation
to hospital facilities.
Innovations
Planning Balwadis to bridge gap between CSCD and School
in child care.
5.
C.T.V.T. -Madras
a co-ordinating agency for 8 CSCD projects in South
India.
- monitor CSCD programme along with other activities in
these
projects
- mainly in reports/returns
and
training areas.
indirect
contact with field
appreciate field problems well.
and
hence
do
not
have good contact and liasion with large voluntary
agencies and Government organisations utilised
for
health work.
believe
health
to be a good entry
development and utilise CSCD for this.
point
for
- feel CSCD should support children till 5 years age to
be
really helpful to people,
in technical and
financial aspects.
Also coverage of child population
could be increased with appropriate funding for health
worker.
- problems faced arein areas of staff turn-over
private medical enterprises with profit motive.
and
- feel need for trained worker exclusively for water and
sanitation hygiene.
6.
C.S.I.
- Coimbatore
Meetupalyam) :
(Rural
+
1
Urban
Centre
Programmes:
In areas of women s organisation,
socio-economic
development programmes,
education and
vocational
training.
19
CSCD:
Mainly educative on FIONA utilising local Government
and voluntary agency facilities.
Areas of work farflung,
but accessible by road/bus. Urban slum area at
Mettupalyam very far and methods effective in rural
areas not working.
Single health worker in charge of
these
areas and unable to adapt to urban slum
problems.
CEO was out of station but sent filled up
questionnaire.
Health care needs/problems :
sanitation,
nutrition, personal hygiene and
Water,
Need for TBSs and indigenous herbal
minor ailments,
medicine resources.
People's perceptions:
as an education to mothers in taking care of
children.
as an issue which engages all members of the
communi ty.
in the urban slum area,
the pressures of earning a
livelihood
take
priority
over
health
care
needs,though the effort is appreciated for its value.
7. C.S.I. - Boodithittu/Periyapatna - Mysore (Rural):
Programmes:
Schooling, vocational training,
social organisation,
socio-economic development programmes and organising
tribal population.
CSCD
- nearby IMA is the main source of medical support for
camps, immunization programmes, etc.
other voluntary agencies in surrounding areas also
co -operate in development efforts/CSCD efforts.
distance from headquarters in Mysore.is a
factor for adequate supervision.
well-trained active Field
a
recently left after marriage
pressure on the new incumbent.
Supervisor
has put a
limiting
having
lot of
- credibility of programme and CEO is high among
people, and is helpful for community organisation.
20
'.B
’■
I
Health care needs/problems:
- competent curative facilities to back the CSCD
nearer the area than the present Govt. hospital
which is 10 kms. away.
minor
ailment
treatments/indigenous
medicines/ trained birth attendants.
better connecting
facilities.
roads/bus
- pre-school children's care
and
other
herbal
transport
creche centres.
- supply of vaccines/drugs from voluntary
Since Govt, supplies unreliable.
agencies.
People's perceptions
as a good effort in health but
service inputs.
needs
curative
8. YMCA - Shimoga (urban)
Programmes
Women's
organisation,
socio-economic
activities, vocational training.
development
CSCD
CHV
Well trained,
efficient Field Supervisor left,
promoted to FS is not dynamic and has not understood
the CSCD programme well, No direct contact between PM
and people, hence dependant on CHVs.
Areas of work
selected are very needy. Other voluntary agencies and
Govt.
field staff to be co-ordinated with CSCD
activity for improvement.
Health care needs/problems:
Water/sanitation/nutrition/minor ailment treatment/low
cost curative care and all socio-economic problems of
urban slum populations.
People's perceptions:
Govt, hospital nearby
As a useful educative process,
puts pressure for curative orientation which they
believe in.
Suggestions:
Difficult to match CMAI contribution in funding.
Hence work to be taken as local contribution to CSCD.
21
^17%
r z?
COMMUNITY HEALTH CELL
326. V Main, I Block
Korarricngala
Bangalore-660034
India
General Remarks:
The remarks are based on observations in general, and
not applicable to particular micro-projects, staff or
CMAI. They have a bearing on the CSCD project and its
future.
1. The taking up of a health component by development
projects usually has a 'medical' connotation and
consequent 'a w e' in tackling it. The time period
for breaking this understanding and subsequently
reaching the people is very variable depending on
local conditions.
2. The tendency to employ a 'medical' person for
programme makes the process more difficult.
the
A need to confirm each step or innovation with
'medical' persons inhibits the capacity and freedom
in innovating for health.
3. Feelings of inadequacy in tackling health issues
diverts
their attention to 'activities' and not
processess.
Quantitative reporting methods add to
the confusion and become ends by themselves.
4. The need for relevant documentation useful for
periodical
assessments,
marking
milestones,
planning
and
evaluation
means
paper-work.
Development agencies in the urge to 'get-on' with
'work' usually neglect even basic documentation.
5. People view all new projects and activities as
temporary
phenomena
affecting
their
lives,
Planning for handing over people-oriented, people
directed programmes to the people requires strong
social organisation as a pre-requisite.
6. The knowledge and attitudes transferred at training
sessions usually suffer at the level of practice
due to the above factors.
7. Transfer of the health message orally by health
workers usually needs support with some health
education material - locally evolved,
This brings
up their credibility in the eyes of the people who
can understand logically why such interventions are
needed.
8.
Health activity is usually taken up
separately,
and not tagged on directly to development activity
(its effects not being clear) in order not to
jeoparadise
ongoing
work.
It
is
because,
involvement in health work raises many questions on
survival needs which may not be comfortable to face
22
upto.
It is only after some experimentation that
is added on to other activities.
health
9. Health activity finances are thought to be related
only to medical work and so, are apprehensive
about using funds for health activity.
III. RECOMMENDATIONS:
These recommendations are based on my appraisal of the
CSCD project of CMAI detailed so far,
and summarised
below
as
strengths,
weaknesses,
needs
and
opportunities .
The CSCD project is successful innovation in community
health oriented interventions, and presents the CMAI
philosophy, policy and objectives in a nutshell.
It
has been a new experience to CMAI promoting health
with non-health groups,
and also for the 'non-health'
groups who have not dealt with health matters so far.
Strengths:
The CSCD project has,
- been well conceived,
evolved with flexibility
conditions and needs,
in
response
to
field
helped
non-health' development agencies understand
their capabilities and role in promoting health.
put into action the philosophy
ministry towards wholistic life.
focussed
supports
and
of
the
heali ng
on national priorities in health
and
national efforts in a co-operative spirit,
- reached out to those who need it most.
Weaknesses:
CSCD expectations in health returns within
frame is ambitious.
a
time
The
pace
at
which
people
and
development
organisations work is dictated by local conditions and
variables - and consequence of this the progress in
CSCD project is variable.
Centralised
responsibility
23
for
training
and
monitoring health activitiy progress.
Needs:
The CSCD project needs,
to evolve qualitative and social process indicators
to
make
appreciate
the
quantitative
data
realistically.
to focus attention on poor performers in terms of
personnel/technical/administrative/financial/evaluation
help to learn from the experiences.
to evolve methods of taking local organisations,
language and socio-cultural problems
priorities,
locally
consideration to make the
CSCD
into
sustainable and grow.
to look into economic sustainability of the CSCD by
tagging it directly to economic activities for cooperatives, income generation activities, etc.
to look into the turn-over of health
their job security.
workers
and
to help evolving local health education
methods.
med i a
and
to
identify,
innovations.
encourage
an2
publicise
local
- to help development organisations in selecting areas
of CSCD/health intervention.
to help appraisal
health resources.
and utililsation of
all
local
- to obtain self-appraisal reports from micro-projects
for balanced assessment of programme progress.
to evolve networking arrangements at level of CHVs
for direct information transfer at field level.
Oppurtunities
The wider opportunities the CSCD project offers are,
like
getting into crucial areas of health care,
sani tation and personal hygiene to
sanitation
safe water,
the commonest problems of communicable
tack!e
disease.
extending the CSCD project to care for children
upto school age, viz., Balwadis and Anganwadl where
24
Government facilities are not available.
promotion of school health interventio; ns.
enlarging scope of activity into Rehabilitation
interventions for handicapped children.
intervention
in
maternal
Traditional Birth Attendants.
care
by
training
incorporating Minor ailment treatment of at
mother and child, and
promotion and indigenous,
health care.
least
herbal/home remedies for
In areas where these interventions are felt-needs and likely
to help the people.
The
best opportunity CSCD affords is its scope
for
developing into a Community Development programme through
Child Survival interventions,
to make a CHILD SURVIVAL and
COMMUNITY DEVELOPMENT Programme.
Suggestions to CMAI
1.
The CSCD project encapsulates the philosophy, policy and
priorities of the CMAI.
It is a successful innovative
approach
to
community
health
that
requires
encouragement.
,2.
To facilitate growth of CSCD into areas of community
health and development that respond to people's needs.
3.
To consider extension of CSCD into other
social agencies that are working with
interested in community halth.
4.
To consider provisions for extending the CSCD inputs
modified to suit children upto 5 years, (pre-school) and
later,
also in the school going years, since Child
development does not stop at 2 years of age.
5.
To
lobby
for CSCD type interventions
with
wh i 1 e
Government,
while
demonstrating its
utility
potential at micro-project level.
6.
To spread the CSCD message among other voluntary health
and non-health agencies at seminars, workshops and other
such meetings.
7.
To promote publications and other forms of informati on
dissemination on Commmunity Health and CSCD.
25
development/
people
and
the
and
Suggestions to the Project
1.
To consider incorporation of elements of other projects
like the CBPHC and Women's development programmes into
CSCD tobe able to respond to local needs.
2.
To focus on areas of Education for Health in
project, involving all age groups in the community.
3.
To consider extending the time period of the CSCD
project to five years, with staggered inputs to include:
4.
the.
a)
an initial one year period of incubation with
preparing of the micro-projects by selecting areas
of work, assessing capabilities, computing logistics
of
the
programme
and
understanding
of
aims/objectives responsibilities.
b)
followed by a three year period with an intensive
first
year,
consolidating
second
year
and
withdrawing third year of work.
The
resources
could be alloted according to needs of the phase,
with
weaning off over the third
yeaar.
An
additional period of one more year could be utilised
to tackle unforseen problems.
To strengthen the training component of
with.
the
programme
- additional inputs.
- decentralization to regional levels.
- utilisation of local resources, and
- adding
on of experiential
present projects.
perspectives
from
the
To enlarge the scope of training to include First aid, Minor
ailment treatment,
Indigenous herbal medicine inputs and
treatment,
training of Traditional Birth attendants.
5.
To consider the inputs of post-graduate students in
various
Health Care management in helping out in
problems of micro-projects as part of their training.
6.
To help ensure job-security and commitment for the
duration of support from field staff who are crucial for
proper utilisation of the CSCD idea.
7.
To help evolve a socio-epidemiological perspective in
micro-projects to make them self-sustaining
health
initiatives in the future.
26
Suggestions to the Community
1.
CMAI's initiative in promoting community health through
the Child Survival and Child Development project is a
departure from its traditional role and clientele in an
It
effort to make health a reallity to the common man.
needs to be well utilised.
2.
CSCD is people's health being handed back to people and
and
requires
the
innovative
approaches,
ideas
initiatives generated by practical living conditions to
make health a people's movement. It needs encouragement.
3.
The CSCD focus on Women and Children is a recognised,
tried and tested approach to ensure better health
It deserves a
conditions for future generations,
committed approach to succeed.
in- v
Place :
Date
:
DR. S
Bangalore
I
27
RDI PRASAD TEKUR
CHRISTIAN MEDICAL ASOCIATION OF INDIA
CHILD SURVIVAL AND CHILD DEVELOPMENT PROJECT EVALUATION
Memorandum Of Understanding
Christian Medical Association of India,
the official Health
Agency of Protestant and Orthodox Churches in India has
decided to study the progress and achievements of its Child
Survival and
and Child Development Programme in the field since
inception in
The over all goal in undertaking this
in 1987.
1987.
evaluation is to:
the
field .
1.
Assess the progress of the CSCD Projects in
and their achievements so far.
2.
Get guidance
guidance on the future involvement of CMAI in Child
Survival and Child Development issues in India.
3.
undertaken
To look at the appropriateness of the model
to
suggestions
its effectiveness and
at present,
improve.
Bangalore on
Dr.
Tekur
from Community Health Cell,
dialogue
with the
responded
and
had
a
invitation has kindly
General Secretary.
been
as
1)
The evaluation will be done during March 1991 with
final report available on 31/3/91.
the
2)
This process will be ’’Participator; y ” involving
CEO's of the projects and a staff working in
projects and the local community served.
CMAI,
these
3)
CMAI Expectations:
The agreement
follows:
on
the
’’terms of reference”
has
of Child Survival and Child Development
a) Review
contribution
Projects of CMAI to examine the role,
technical
assistance
of
CMAI
for
these
projects.
and t — •
z
b) Review of a sample of the projects to examine the
local processess, progress and performance.
c) Give suggestions
programme.
to
CMAI
on
the
- Within CMAI
- Within the Project
28
future
of
the
r
- Within the Community
- Within Churches
1.
Preparatory Phase:
Review and study of all papers and related
available with CMAI.
documents
Discussion and informal interview with key CMAI staff
involved in implementing this project.
II. Field Visits: A sample of few selected projects can be
visited with the following objectives:
- Meeting; with CEO's of implementing projects to assess
responsibilities and
their understanding of role,
future of the project.
Interviews with Project Manager and
involved in implementing the project.
other
staff
- Meeting with the Mothers who participated in
programme and get their feed back (Beneficiaries).
the
- Focus group discussions with:
- Teachrers
- TBA's
- Adolecent Girls &
- Others
The travel arrangements are to be made by CMAI whenever
Dr. Tekur undertakes.
CMAI will re-imburse all the
cost of his travel when he travels on his own in
relation to this evaluation.
The Field visits and the travel plan od Dr. Tekur
accompanied by Mr. K.A. Antony has been worked out.
Seven institutions are sclectedfor the field visit and
the schedule of visits are as follows:
29
H
Dates
Mode of Travel &
Transport
From
To
13-3-91
WED
FLT. TC 469 &
Taxi
Delhi
Nagpur
Institutions
visited
1) YWCA
of
Na u
Civil Line
Nagpur - 440 001.
2) Evangelical
Lutheran Church i
M.P. Civil Lin ■
Nagpur - 440 0
FLT.
Taxi
4-3-91
THU
IC
269
Nagpur
&
Hyderabad
Stop
for
“h
night - Hydera d
3) YMCA Developme
Social
Con^_r
Narayangunda
Hyderabad,
Taxi
Stop for the nigh
at Hyderabad.
15-3-91
FRI
16-3-91
SAT
FLT. IC 439 &
Taxi
Hyderabad
Madras
Train 6673 &
Madras
Coimbatore
Travel by night
5) CSI
Package
Devt. for Ru'"'l
Urban
Women
Coimbatore.
Taxi
Coimbatore
FLT. 534
Bangalore
17-3-91
SUN
18-3-91
4) YMCA, Madras
To., 233,
K
233,
porur High Rol^®
Madras - 600 041
Halt at Bang
at night.
o
Halt at Banga
•r
Bus & Taxi
Bangalore
Mysore
6) CSI
Bodit t
Project 2995, Fi
Light
Ci’rc
Church Road
Mysore - 570 _J1
Bus & Taxi
Mysore
Shimoga
Travel by nig
30
n
I
Bibliography
report
Documents/material used
of
the
31
CSCD
micro-projects
1.
Files
of
operation.
2.
CMAI - Set of policy statements.
3.
A manual for
Programme.
Child
to
Survival
and
Child
compile
this
currently
in
Development
Dr. Sukant Singh, CMAI.
4.
Report on the CS and CD programme October 1990 - CMAI.
5.
Child Survival and Child Development Programme - CMAI
25/1/91.
6.
Course outline - Orientation course for staff from CS &
CD projects - CMAI.
7.
Pre-test and post-test formats - training
CSCD projects - CMAI.
8.
CSCD Projects - Service coverage
1990.
9.
FIONA - A manual for the Managers of Community
1987.
Primary Health Care projects - CMAI
courses
report up to 30th June
Based
10. Job descriptions - Project Manager & CHV - CMAI.
31
I1
of
•■AO
1
1
APPENDIX 'C'
1.
Project Name
Address
2.
Rural/Urban
Location
Type of Work
4.
How long they have been working in the area.
lst/2nd/3rd
5. CSCD Project - Which year?
Date of completion of 3rd year.
6. Health Care resources in the area.
7. Access/Communications - Roads/Distance from the
Health facility.
nearest
32
f1
8. Training Sessions:
Who attended?
How many days?
Where?
*
9. Health statistics last report
BCG
POLIO
DPT
MEASLES
33
f1
VIT. A
TT
Good / Average
10. Classification:
1
34
f1
APPENDIX 'E'
CEO/Project Staff
Name of the Project
1)
2)
Understanding of
a)
Role
b)
Responsibilities
c)
Future of the Project
Problems faced with project
Problems with CMAI
3)
Training
so far
3 a)
Needs in future
35
J’
Training done apart
from CMAI
4)
M.I.S. Comments
5)
Contacts with other Voluntary/Government Agencies
6)
How do you relate the health component
components
7)
Suggestions for innovations/other models
to
Development
36
f’
APPENDIX
'F'
Questions to Mothers/Teachers/TBAs/Others
1)
What is your understanding of the CSCD Project?
2)
the Community?
What aare the benefits of this Project to
3)
Do you have any suggestions for improving the Project?
I
37
Not viewed