communication for health india network - cmai.org with health link worldwide ... muzzafarpur,...

Communication for Health India Network (CHIN) was launched in 1998. It comprises four partner organisations with strong foothold in working on health issues in India – Child in Need Institute (Kolkata), Christian Medical Association of India (New Delhi), Centre for Health Education, Training and Nutrition Awareness (Ahmedabad), Rural Unit for Health and Social Affairs of Christian Medical College (Vellore). In association with Health Link Worldwide (UK) a programme on ‘Participatory communication for improving access to public health’ was carried out.

Child in Need Institute Child In Need Institute (CINI) is a national NGO, registered in 1975, working towards sustainable development in health, nutrition and education and protection of child, adolescent and woman in need. It reaches out to more than 1.5 million people in both rural and urban regions in India. Apart from field based health interventions, the organization also offers a range of institution-based services within its premises focusing on clinical and counselling support. On the basis of its involvement in national policy related issues, strong regional and national presence and ability to respond to capacity building needs of other NGOs, CINI has been recognized as the Regional Resource Centre (RRC) for West Bengal, Jharkhand and Andaman & Nicobar Islands under the RCH programme of the Ministry of Health & Family Welfare, Government of India. It provides technical support to Mother NGOs (MNGOs) through capacity building, resource development, MIS, advocacy and networking. Being also a Mother NGO in West Bengal, CINI supports a network of grass root NGOs working in eight districts of the state on various aspects of the RCH programme.

Rural Unit for Health and Social Affairs (RUHSA) Department of CMC was established in 1977, as a comprehensive health and development project serving the needs of vulnerable groups in KV Kuppam block, covering around 120,000 population in Vellore, Tamil Nadu. RUHSA also has outreach health and development projects in Tsunami affected Sirkazhi in Nagapttinam and tribal development programmes in Tamil Nadu. Over the years, RUHSA has contributed significantly in malaria control in Odisha and Kala Azar control in Bihar and Jharkhand. RUHSA has 125 full time staff including doctors, nurses, allied health professionals, training officers and developmental personnel. Through its Consultancy, Evaluation, Research and Training (CERT) Unit, RUHSA has been working closely with the government and NGOs.

Centre for Health Education, Training and Nutrition Awareness (CHETNA) (an activity of the Nehru Foundation for Development, a public charitable trust) is a non-government support organisation based in Ahmedabad, Gujarat. Beginning its activities in 1980, CHETNA addresses issues of women’s health and development in different stages of her life from a “rights” perspective in Gujarat and Rajasthan. It supports government and non-government organisations through building the management capacities of education/health practitioners/supervisors/ managers enabling them to implement their programmes related to children, young people and women from a holistic and gender perspective and advocate for people centred policies. CHETNA develops need-based training and education materials, which are widely disseminated at the state, national and international levels. CHETNA’s Information and Documentation Centre (IDC) is a rich source of information for the needs of individuals, organisations, academicians, researchers and students working on health, education and development concerns. It has been identified as a Regional Resource Centre to provide technical assistance to NGOs to improve RCH, facilitate GO-NGO partnership, document and disseminate successful approaches and provide inputs to GoI to ensure effective implementation of policies.

Christian Medical Association of India (CMAI) started in 1905, is a national body of Christian healthcare work in India. It has over 330 member institutions including Christian Medical colleges at Vellore and Ludhiana, secondary care hospitals such as St Stephens and Holy Family Hospital in Delhi, Christian Hospital in Orissa and community programmes such as CRHP Jamkhed, Maharashtra. It also has over 10,000 health professionals as individual members, working in government, NGO and corporate sectors across the country. CMAI is the health agency of the National Council of Churches in India, which has 29 member churches. CMAI had managed 16 micro-projects in Chotanagpur and NorthEast India, and successfully completed 3-year projects in Madhya Pradesh (USAID - funded) and Gujarat. Since 1987, it has initiated multi-center projects in community- based family planning (1987-92, 24 micro projects), community based primary healthcare (1988-94, 60 micro projects), Child Survival and Child Development (1994-97, 39 micro projects), which have been followed by the present set of development projects. CMAI is currently involved in several other projects and partnerships namely Round 9 initiative of Global Fund projects for TB and Malaria being implemented in Meghalaya and Mizoram. CMAI is also building the capacity of 8 hospitals across the country to be excellent caregivers and trainers for HIV and AIDS. Through its training initiatives, 50 nursing schools train 1000 students every year which are accredited by CMAI. In Allied Health education, CMAI manages and accredits high quality training in over 40 centers running 9 different courses across the country. CMAI also conducts regular training programmes and workshops as continuing education and is continuously involved in evolving standards and guidelines for healthcare delivery. CMAI has its program offices in Bhubaneswar, Purnia, Muzzafarpur, Shillong, Indore, Nagpur and Bengaluru.

Healthlink Worldwide (established in1977) works to improve the health and wellbeing of disadvantaged and vulnerable communities in developing countries. Healthlink Worldwide is the specialist health and development agency that empowers through communication. We work to improve the health and well being of disadvantaged communities in developing countries. Healthlink’s approach goes far beyond vital health information provision to enable active participation in health development. This is done by mobilising innovative knowledge and communication processes. These empower people to voice their health needs and have those voices heard.

Let’s talk about healthParticipatory communication

for improving access to public health

Christian Medical Association of India, New Delhi and BhubaneswarChild in Need Institute, Kolkata

Centre of Health Education, Nutrition and Training, AhmedabadRural Unit for Health and Social Affairs of Christian Medical College, Vellore

January 2013

Copy right @ Participatory Communication Initiative (PCI) © 2013 CMAI – CHIN Initiative. All rights reserved. This book is only for private circulation; Use of any article in part or full can be done after prior permission and confirmation from CMAI.

Christian Medical Association of IndiaA - 3, Plot No 2, Local Shopping Center,Janakpuri, New DelhiDelhi - 110058IndiaPhone: +91 11 25599991/2/3; Fax: +91 11 25598150Email: [email protected]: www.cmai.org

Published by: CMAI – CHIN Initiative

Concept by: CMAI – CHIN Team

Photos by: Dr. Geom Abraham, CMAISpecial thanks to Ms. Ashley Thomas for the photos on Pgs 18 & 21

Designed & Printed by: FACET Design, New Delhi

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Acknowledgement“ What a consolation, Lord…

…to know that You do not require success – that You collect no triumphs…

But it may be that in our whole life

nothing is of more worth, in your sight, than the serene, tranquil, happy willingness to come to You

without a victor’s glory!

Teach me, O Good Samaritan………..how to cope and suffer with trampled hearts,

crushed souls, victims of [every] banditry”

Dom Helder Camara

With this poem, we place our sincere gratitude to Lord Jesus. Thank You for giving us the inspiration and wisdom to be part of Your work through this project. We thank You for the grace and strength to persevere and overcome many challenges and hurdles with love and goodness.

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We wish to personally thank the following individuals for their valuable contributions to this project through their continued support and efforts:Dr. Bimal CharlesDr. Priya JohnDr. Ronald LalthanmawiaDr. Abhijit SangmaMr. Babykutty NinanMr. Shaji JohnMr. S. PaulrajMr. Mrutyunjaya NayakMr. Manoranjan NaikMrs. Kantha DavidMr. Rajesh Lall

We wish to also personally thank the following individuals for their valuable contributions and efforts to this project and have now moved on to other responsibilities:Dr. Vijay AruldasDr. Joe VargheseDr. Sunita AbrahamMs. Julie Lakra-Hembrom

Mr. Anil T. VargheseMr. David Curtis, Ms. Moumita Saha and Ms. Shampa Nath from Healthlink WorldwideMs. Ila VakhariaMr. Rahil Subedar

Our heart felt thanks to Ms. Rukmini Dutta for helping us bring this concept into reality. Her efforts helped all our partners to capture stories that showcased this project’s efforts.

We specially want to thank all the finance and administrative teams of the CHIN partners for the smooth operation of programs and their valuable support.

We sincerely thank Bill and Melinda Gates Foundation for funding and supporting this initiative.

We acknowledge every support and contribution from all the ASHAs, AWWs, ANMs, PRIs, Village Forums, CBOs, SHGs and VHSNC members. They made these efforts worthwhile.

We also acknowledge the constant support from the various Mission Directors, NRHM, and State Health & FW departments and from respective CDMOs, DPMs, BPOs, Medical Officers and others.

We also express our sincere thanks to all the communities covered in the project areas for allowing us to learn from them and the opportunity to share in their lives’ journey. All this has been possible because of the hard work put in by each of our state and district partner project teams, both past and present – Our heartfelt gratitude to all our block link workers, district facilitators, MIS officers, documentation officers, training coordinators, project managers and heads of organizations.

It was an absolute joy to have partnered with you during this project.

SincerelyDr. Evangeline Dutta, Ms. Ashley Thomas, Dr. Geom Abraham

Let’s talk about health

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Message from General Secretary

Iam happy to learn that these stories of change and many other such initiatives are the outcome of dialogue, discussion and debate among the community and the health department at the grassroots level. It has given us new insights into community participation that can build capacity among service providers to reach out to

underserved and difficult areas. This requires innovation through such community led initiatives.

CHIN project is a step towards the larger vision of our stating that promoting health is in our hands. The CHIN project has given us several opportunities to have dialogue and discussion with the community and service providers and has contributed towards convergence in many line departments. I am happy that along with CHIN Partners all the District NGO partners have been able to mobilize the community to access NRHM services. CHIN thus complemented the efforts of NRHM in 7 states.

We are grateful to NRHM, Department of Health and Family Welfare, CHIN partners and the 40 District NGO partners for their support, guidance and hard work. The project has also built the capacity of different stakeholders involved in this project in West Bengal, Odisha, Gujarat, Jharkhand, Karnataka, Rajasthan and Tamil Nadu.

It is necessary that CHIN partners take these efforts forward in their states in collaboration with the state officials.

We are grateful to Bill and Melinda Gates foundation for their funding to pilot such an innovative project.

I congratulate the CMAI team who led this initiative.

Dr. Bimal CharlesGeneral Secretary, CMAI


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Message from the Project Director

Participation of the community in health and development programmes is often perceived as beneficiaries of the services of the public health care system. Community is seen as the users.

The project “Participatory Communication Initiative for Improving Access to Public Health Care Service for Rural Communities Under National Rural Health Mission “ see participation of the community as right. The community is not a passive participants but an active part of the process of change.

The book “Let’s Talk about Health” is a collection of different case studies depicting, capturing and showcasing participation as right in the context of the five pillars of participatory communication.

Dr. Evangeline R. DuttaProject Director


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Communication for Health India Network

Initially christened as the ‘Child Health Information Network’, CHIN’s first foray was in 1998 with a project aimed at increasing access to appropriate information about policies and applied practices to improve child health in India and South Asia. The project comprised of

• informationdisseminationthroughapublication, Child Health Dialogue

• Capacitybuildingofhealthfunctionariesoncommunication and documentation

• meetingsonthemebasedhealthissuesofimmediate relevance.

At the end of three years, CHIN reviewed its performance and found the need for approach modifications. Firstly, it needed to build the capacity of partners for participatory communication and advocacy. Secondly, it needed to incorporate innovative methods of effective communication for empowerment. There was also a realisation of the necessity to move from a bio-medical approach of health communication to a rights perspective approach recognising the importance of poverty, discrimination and marginalized as the priority areas.

Communication for Health India Network (CHIN), launched in 1998, comprises of four partner organisations with a strong foothold on health issues in the Indian community– Child in Need Institute (Kolkata), Christian Medical Association of India (New Delhi), Centre for Health Education, Training and Nutrition Awareness (Ahmedabad), Rural Unit for Health and Social Affairs of Christian Medical College (Vellore) and Health Link Worldwide-UK.

Overall, the need for CHIN to encompass a wider concern than child health was recognised. Issues at the intersection of poverty and health were the newly focused. Hence the network was suitably rechristened as the ‘Communication for Health India Network’.

Public Health is a discipline that evolved over centuries in the inter-phase between science and social action, where communities interpreted and communicated the conditions that impacted their health and their efforts to address them. CHIN entered its second phase in 2002 with the renewed focus on poverty and health,


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Health services in India reflect rigid bureaucratic order where power is concentrated in the expert system such that it alienates masses from public health services. The culture of health service, thus, formed and reflected in the organisational structures of health service department may often lack knowledge of the social and cultural context in which it functions. Unsurprisingly, the utilisa-tion of even the limited services available through public system was unsatisfactory.

However, conceptualisation and development of health strategies was effected by the overemphasis on disease control strategies which resulted in its failure to address interlinked social and environmental factors. Disease control programmes appears to have been initiated without an in-depth understanding of health, their underlying causes and inter-linkages. The need to be responsive to popular culture and expectations in health system interaction with the people seems to have been overlooked.

In 1983, in the decade following the first National Health Policy, rural health care received special attention. The Multipurpose Workers’ scheme and the introduction of village-level volunteers acknowledged the importance of community participation in health management. However, even as the health system tried to live up to the rhetoric of primary healthcare approach, it failed to deliver on the ground due to weak political commitment and the lack of interest of the

Communitisation of health

With the recognition of the importance of community mobilisation in public

health, policy makers have recognised the need and importance of communication techniques to support the provision ofdelivering health ser-vices interventions at scale. Recently, the lack of progress with the Millennium Development Goals and Primary Health Care in many low and middle income countries has led those in favour of comprehensive Primary Health Care to question whether the failure to communitise is the reason for poor sustainability and ineffec-tive scaling-up of public health interventions of proven efficacy.

India’s struggle with communitisation

The development of India’s institutional arrangement for public health governance

has had different ideological connotations, since independence. The Gandhian idea emphasized increased control of people over their own lives. The starting point for the Gandhian perspective was to create conditions for people to improve their own situation. It is significant to note that Gandhi’s perspectives sought to reinterpret both tradition and culture to devise a new social order[1].

redefining its goals within the frameworks of communitisation of health and the associated processes of communication for social change.

In 2002, CHIN launched a project which aimed at increasing the influence of vulnerable communities over policies, practices and public attitudes in health. It hoped to give more access to vulnerable communities to information and to increase their participation in health communication. It was premised on the core principles of communication for social change: ‘participation’ and ‘collective action’. Built on these principles, the project envisaged to challenge the power inequalities inherent in public health communication and to make space for the marginalised to be at the table for planning.

Participatory Communication InitiativeIn 2008, CHIN entered its third phase, with support of Bill and Melinda Gates Foundation for Participatory Communication Initiative to improve access to public healthcare services of rural communities in India. The Initiative was

conceptualised within the National Rural Health

Mission (NRHM) framework, in its

quest to attain the Millennium

Development Goals.


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powerful bureaucratic class. In the absence of local participatory institutions within the existing political and economic systems, there may not be appropriate scope for active community roles in all local development programmes.

Rediscovering community-centeredness

The decline of the public health practices raises questions about its basic premises

while highlighting the importance of the ‘Primary Health Care’ approach. Community participation was emphasised by facilitating self-help. This was contrary to the dominant paradigm of people being passive recipients of the fruits of medical technology and this led the move towards the perception of community being the prime movers for shaping their own health. It sought to strengthen the ability of people to survive with their health problems, building on their capacity developed over ages. It called for social control of the health services that are designed to strengthen people’s surviving capacity.

National Rural Health Mission

As quoted in the Mission document, “Recognising the importance of Health in

the process of economic and social development and improving the quality of life of our citizens, the Government of India has resolved to launch the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health care delivery system... The goal of the Mission is to improve the availability of and access to quality health care by people, especially for those residing in rural areas, the poor, women and children.”

Communitisation of health is one of the key strategies of NRHM. The concept of communitisation of health services is based on the strong belief that the entire health machinery is owned by the people. The strategy aims to stimulate demand, make planning process locally relevant, and bring more accountability by creating multiple channels for community participation. Several institutional mechanisms are being incorporated into the NRHM framework to facilitate institutionalization of community lead action in health. These include identification and deployment of Community Health worker (ASHA) to link communities with health department; Village Health Sanitation and Nutrition Committee (VHSNC) to plan and monitor health services; Rogi Kalyan Samitis (RKS) and community based monitoring (CBM) to create local accountability; and specific community based awareness and service delivery events such as Village Health and Nutrition Day (VHND) to increase demand for services.

NRHM is undoubtedly a positive step for better health management. However, many areas of lacunae have been identified in its implementation namely, quality of physical infrastructure, availability/quality of human resources linked with the accessibility to services, supply of medicines, awareness and utilisation of untied and maintenance funding. Meanwhile the mission acknowledges the importance of strengthening communication in order to reach communities in rural areas, it has not incorporated a focused communication strategy within. It speaks of empowering the community and its forums through communication initiatives but often compromised the agenda due to rigid bureaucratic structures. The diminutive regard for the culturally accepted local health traditions and practices causes disconnections between health service providers and people. Unfortunately there have been minimal efforts to reorient the service providers to address this socio-cultural gap.

Participatory Communication conceives development as a transformative process at both individual and social levels through which communities become empowered to initiate a process of change. The concern regarding communication in the implementation of NRHM is two-fold: communities are unable to commu-


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nicate their needs to health workers, and health workers, in turn, are unable to communicate effectively with the community. In an attempt to address this lacunae and building on the premise of communication for social change, the Partici-patory Communication Initiative of CHIN has worked towards enhancing access to and quality of public health services through a process of community mobilisation. It has complemented the efforts of the government in realising its commitments by strengthening communitisation efforts.

The Participatory Communication Initiative sought to build the capacity of both community members and service providers in 40 blocks of 40 districts of seven states of India namely; Rajasthan, Gujarat, Odisha, West Bengal, Jharkhand, Tamil Nadu and Karnataka. It has also helped empower panchayati raj institutions

Communication for social change

In contrast to the traditional understanding of the role of communication in development (and health management)

as one that mainly seeks to change individual behaviour, communication for social change, is defined as a process of public and private dialogue through which people define who they are, what they want and how they can

communication processes can become more comprehensive and open-ended rather than goal-oriented. Communication for social change addresses socio-structural issues and the root cause of the problem like poverty, gender inequality, lack of education and others rather than addressing or targeting the symptoms or manifestations of the problem.

for their health concerns, has been rare. Participatory communication goes beyond the traditional “‘Information-Education-Communication” (IEC) approach.

The expected outcome of the Participatory Communication Initiative was that 4 million people from marginalised rural communities will have regular dialogue with the public health machinery to demand and access quality health services.

Initially, a participatory need assessment was carried out to help establish the baseline for the Initiative. The participatory need assessment helped the CHIN team gauge and analyse the level of awareness and understanding among the community about their health rights and entitlements under NRHM. The need assessment was carried out in ten per cent of the revenue

to monitor the implementation of NRHM for greater effectiveness. In each of the project states, the CHIN partners selected 1 block from 5 to 10 districts characterised by low institutional child delivery, low antenatal care coverage, low immunisation coverage and high infant mortality. After selecting the districts, a meeting was conducted with the chief district medical officers to explain the purpose of the project and solicit their support.

40 District level NGOs were brought on board by CHIN members as partners who, in turn, coordinated the process of implementation in the selected blocks. While many interventions in the health sector have used message-driven processes, the use of participatory social change communication to enhance inclusion, involvement and long-term mobilisation of community members to identify solutions

get it. Social change is defined as a change in people’s lives as they themselves define it. It seeks particularly to improve the lives of the politically and economically marginalised, and is informed by principles of tolerance, self-determination, equity, social justice and active participation for all.

Communication for social change is premised on the belief that by including the voices of the marginalised and underprivileged,


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villages in the selected blocks and covered a range of respondents at all levels from hamlet to the district: all caste groups in the community, women (especially those who were pregnant and ‘new’ mothers), panchayat representatives, members of the Village Health and Sanitation Committee and other village forums, primary health centre

staff, Accredited Social Health Activist (ASHA), block extension educator, district collector. Service providers were also asked about their training needs for implementing NRHM. This assessment was also a means to understand the availability and usage of existing health services (especially sub-centre and primary health centre) from community

and service providers’ standpoints. Consequently, it gave pointers to understand the scope for communication to mobilise the community and strengthening the efforts of service providers.

After the participatory need assessment, consultation meetings were conducted with


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Mahalakshmi self-help group: agents of change

Bijapur, a district in the northern border of Karnataka is unique by contradictions. Rich with historical

and cultural heritage, it is developing into an education hub of the state. In its villages, however, severe droughts and poor health prevails along with poverty, illiteracy and practices of child marriage and the devadasi system where women are especially disadvantaged.

A team from VISHALA, the district partner NGO visited Malakana Devara Hatti, a village 50 kilometres away from Bijapur of around 300 families with poor connectivity to the nearest primary health centre located in the city. In June 2010, a community awareness meeting was organised to discuss health services and entitlements for maternal and child health under NRHM.

After the meeting, follow-up home visits were conducted to gauge how well the message was imbibed among the participants. During the visit, the VISHALA team identified 15 women who lived on the outskirts of the village and were not part of any self-help group. The team encouraged them to form a group and enlightened them to create this

the service providers like District and Block level health officials, ASHAs, ANMs, PRIs and the community, which provided a platform for dialogue amongst the group. Thereafter capacity building trainings were conducted for the health service providers at the state, district and block level which aimed to orient them on the health status of the block and the community’s aspiration to help them know their roles and responsibility and strengthen their work.

Also communication tools and strategy were developed in a participatory mode to help communicate the entitlements better to the audience. A communication audit checklist was developed to know the existing communication tools available in the community to further expand and use it to emphasise the utilisation

The communication audit revealed various existing practices like Temple festivals, Village

festivals, Villu pattu, Gramia Padal, Street plays, Naveena Nadagam, Theru Koothu, Thapattam, Inisai Kachari in Tiruvannamalai district which was used to communicate the NRHM entitlements. Also existing groups like Panchayat Group and others were strengthened to take the effort forward.

of existing resources. There were also forum meetings and engagements conducted with the local change agents to emphasize the entitlements and health needs to the community.

Pillars of Participatory Communication InitiativeThe Participatory Communication Initiative is built on five pillars in sync with the communication for social change framework: community participation, dialogic process, amplification of the voices of the vulnerable, creating ownership of and driven by internal change agents, and using culturally embedded means to communicate.

Community participationCHIN views community participation as an indispensable component of all public health initiative and an end in itself. It is a process in which the community (a group of people – sharing the same interest, culture, language and living in the same geographical area) participate by influencing and sharing the control over development initiatives, decision making and use of resources which affect them. A key to community participation is information and awareness. In the participatory need assessment carried out in Odisha it emerged that only 42 per cent of the respondents were aware of government health schemes and entitlements. The conversion of this to actually accessing entitlements and utilising services was drastically low – only four per cent of the women who


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platform to interact with each other and to be part of empowerment and awareness generation programmes of the village. Following which, a meeting was organised to form the self-help group. In the first meeting only six women showed up. The rest who didn’t participate were not convinced of the benefits of being involved in any village forum. They perceived it as an extra burden and additional responsibility. In some households, husbands discouraged their wives’ participation expressing that their household work would suffer. On one occasion, some inebriated men accused the VISHALA team members of polluting their wives’ minds by motivating them to get involved in activities outside the house.

This geared the VISHALA team to visit the women individually and persuaded them regarding the benefits of being part of villager forums such as Mahalakshmi self-help group. The team also spoke with their husbands about how the families could be benefited. After a month long regular interaction, the women agreed and ‘Mahalakshmi’ self-help group was formed.

Mahalakshmi self-help group proved to be different from the usual self help groups. Although savings and credit were integral activities, the group was a platform to talk about health issues, concerns and to disseminate information about maternal and child health

services under NRHM. Over time, the group not only got oriented but also contributed actively towards making other women of the village aware about the importance of good health and of seeking health services.

Initially, all members of Mahalakshmi group disseminated health-related information to their friends. Gradually, they started talking to women in market places and in the neighbourhood. They went beyond disseminating information to persuading people to utilise health services at the primary health centre. They motivated young mothers to send their children to the anganwari. They impressed upon people the importance of using toilets to reduce the risk of vector borne diseases. Starting by their own homes, they demonstrated how a small kitchen garden patch would help yield nutritious vegetables for the family.

For the ASHAs, the women of Mahalakshmi are of immense support. They not only provid ASHAs food and water during her visits but also helpe her in reaching out to women in remote, vulnerable situations. In one case, they motivated a mother, who had delivered three children at home, to have her fourth in the primary health centre.

In another family, a little girl of 12 was to be married away, against her will, to a relative, in keeping with the tradition of child marriage.

The family did not have the wherewithal to pay for her education or a large dowry that may be required if they tried to marry her off when she was older. The wedding was scheduled and dates were fixed. This came to the notice of the members of Mahalakshmi. Along with members of VISHALA, the group members visited the family and tried to reason with them to retialiate the family’s decision to marry off their daughter. Some of the women of the group who were married early spoke about their own experience of how their dreams had been crushed. Convincing the family was not easy, but finally the family agreed to put off the marriage.

Members of Mahalakshmi self-help group who, until less than a year ago were housewives in their own homes, are now change agents for the entire village. Their efforts might seem small in the larger scheme of things, but for the people of Malakana Devara Hatti they are a support structure they cannot do without. On hearing the achievements of the group, the neighbouring villages has contacted the VISHALA team to help set up similar self-help groups.

Malakana Devara Hatti village, K Siddapur panchayat, Bijapur block, Bijapur district, Karnataka


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had delivered in the six months before the assessment had received their cash incentive under Janani Suraksha Yojana. In Tamil Nadu¹ 93 per cent of the respondents had never heard of the untied funds, a fundamental component of community participation in NRHM. In Gujarat¹ only a quarter of the respondents were aware of government health schemes, while a mere two per cent reported to have ever used services at the sub-centre.

Within CHIN, the district NGO partners conducted community awareness activities to talk about NRHM entitlements and other health issues every month. This initiative has, evidently, enhanced the knowledge of the community on NRHM and increased the access of the community to the NRHM entitlements.

Increased number of mothers availed Janani Suraksha Yojana as a result

of awareness meetings. Self-help groups and Gaon Kalyan Samitis (VHSC) started organising awareness meetings

in their villages. In Gujarat, awareness activities

resulted in increased emphasis on the

celebration of Maternal and Child Health

Nutrition Day.

Peer pressure

Ponnammal studied till the tenth standard after which her father could not afford to school her anymore. Given

their poverty, she was married off at 17 to a daily wager. To reach their hut of clay and palm leaves in Kattuputhur hamlet, one has to walk a narrow path for two hours from Devanampattu village. Within four months of their wedding, Ponnammal conceived. Being unaware of the facilities available for pregnant women at the primary health centre and the importance of the services, she did not utilise any of them. Her family members could not provide any guidance either.

Towards the end of the ninth month of pregnancy, Ponnammal felt an acute pain. She started bleeding profusely sending her family into panic. Somebody from the neighbourhood called the 1-0-8 ambulance service and she was taken to the nearest primary health centre. Realising the extent of risk, she was referred to the community health centre at Thiruvannamalai. She was taken there at 4 am in the ambulance only to deliver a still baby.

Ponnammal was devastated! The staff at the health centre could feel her pain at the loss of her child, but they knew that if not for the ambulance service they would have lost Ponnammal too.

After a year of depression, Ponnammal conceived again. This time around she was fortunate to be at one of the community awareness meetings conducted by SINAM, the district partner NGO, where they were disseminating information about services available for pregnant women under NRHM, risks of mortality and how these risks can be reduced. Ponnammal recalled her own experience a year ago. She met the staff after the meeting and woefully shared her experience. However, she was convinced she had lost her child because she went to the health centre and the staff could not treat her well. Nonetheless, the NGO team were determined to help her at any cost.

SINAM staff visited her home often and spoke to her about the benefits of being linked with the health centre. They also introduced her to some women who had benefited through the services during their pregnancy. They showed her pictures of the latest technology available at the centre. This convinced Ponnammal to change her perception. Other women of the village finally removed the fear and anxiety from her mind and after 2 months of peer counselling Ponnammal finally agreed to go to the health centre with a staff member of SINAM. She was registered and underwent regular antenatal checkups. Over time, she realised the value of the health centre and its services.

With the birth of a healthy baby girl, the lost joy of Ponnammal’s family returned. She


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also received cash incentives under the Janani Suraksha Yojana and Dr Muthu Lakshmi Reddi Ammaiyar scheme amounting to nearly Rs 7,000.

Kattuputhur hamlet, Devanampattu panchayat, Thurinjapuram block, Thiruvannamalai, Tamil Nadu

Immunisation in six villages after six years

Banspal block is a remote part of Keonjhar district and reflects a poor performance on health indicators. Given the conditions,

even health service providers had been reluctant to stay and work there. Villages of Nayakote, Vejidihi, Narsingpur, Luhakala, Sudanga and Sagapali under the Nayakote sub-centre particularly have poor health conditions. Despite encouraging immunisation statistics of the district, these villages of Banspal have not seen any immunisation activity since 2004.

One of the root causes for this abysmal track record was the unavailability of an ANM since 2004. The geographical hardships notwithstanding, a little bit of interest on the part of the authorities may have helped to improve the immunisation statistics in Banspal and be somewhat at par with the rest of the district.

Prakalpa, the district partner NGO, was working in

this part of Banspal through village level awareness programmes. They used communication tools like leaflets and banners to generate awareness. Through these meetings, some changes were observed among the community regarding health awareness and services.

In a district level consultation meeting conducted by district partners in March 2010 where the government health officers across levels were present, community members strongly raised the issue of the absence of health officials and services. They also mentioned that they received no health inputs, including immunisation for their children. A decision was taken at the meeting that an auxiliary nurse midwife will be appointed within a month and that immunisation will be started. But, the officials did not keep their word!

In August 2010, Prakalpa consulted the Community Health Centre (CHC), Banspal and asked their staff to help carry out an immunisation drive. They also started mobilising people in the villages for immunisation. The immunisation could not be carried out on three designated days due to failed coordination with the CHC. Finally, in the third week of September, four villages were immunised with cent per cent coverage. The remaining two villages were covered in October.

Nayakote, Vejidihi, Narsingpur, Luhakala, Sudanga and Sagapali villages, Nayakote

panchayat, Banspal block, Keonjhar district, Odisha

The road to save lives

On a pleasant, sunny day of in July 2010 in a quiet and remote village, Siva and Balan went swimming in

a pond close to their village. They lost track of how deep into the water they had swum, until they realised they had run out of energy to make the return journey. They started drowning and shouted for help. Two men from the village heard them and rescued them to land.

Having consumed a lot of water, Siva and Balan found it difficult to breathe and were fighting for survival. The villagers thought it best to take them to a hospital and called for an ambulance. The ambulance arrived soon at the outskirts of the village. It could not drive in because the only entry to the village was a pathway one foot wide, enough to walk on. The boys were physically carried to the ambulance, but they both succumbed and died before they even reached the vehicle.

This dreadful incident was in Villusari village located on a mountain in Thiruvattur block of Kanyakumari. For the 48 residents of the village,


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the nearest hub from where they could access any transport facilities was ten kilometres away at Manalodai. Located on the top of a hill, the village was rendered virtually inaccessible. It had no electricity either. Residents were largely poor with low levels of literacy. The nearest school was 15 kilometres away and the nearest primary health centre (PHC), 13 kilometres away at Pechiparai. Asthma, allergies, body ache are common ailments for which people have to walk to the PHC. Even pregnant women had no choice but to walk this distance if they wanted any medical services.

People of Villusari and the neighbouring village of Puravillai, facing the same fate, sent many petitions for construction of road and for electric supply beginning December 2009. The last was sent in February 2010. Representatives from the Department of Power visited Villusari to assess the feasibility of setting up power supply lines. However, since there was no road leading to the village, they closed the file saying that a road

is essential for electric supply! In April 2010, the residents even went up to the district magistrate but did not get any positive response.

A team from Centre for Social Reconstruction (CSR) the district partner NGO visited the village from time-to-time to orient people on health concerns and solutions through community awareness meetings. After the meeting, the villagers would walk them out to ensure their safety – it was after sundown, there was no electricity and there was fear of wild animals. Sometimes the CSR team would go home the next morning since it was too risky to travel after dark.

Through a long dialogue process, CSR team impressed upon the community the need for good health. Over time, a Village Health Committee was formed with volunteers to come forward and work for the community. The Committee went through training over four months over which time it was strengthened to work for health benefits of the village. The Committee met every week. It emerged from discussions that transport facilities are essential to maintain good health. As a next step, in April 2010, they put up the issue to the district collector who gave a hollow promise. The group realised that depending on the government is time consuming because of procedures and formalities. Moreover, the response received till then was not very encouraging.

In September 2010 the Committee decided that the road would be built with the community’s own resources. The villagers agreed and took a unanimous decision to forgo their daily wages for three days. They brought whatever construction material they could. Men, women, elderly and youth from the village started building the road. They widened the narrow path and levelled it with stones so that vehicles could enter the village within a short span of time. The road has now been brought to a standard where vehicles can enter the village. People can hire vehicles to go to the health centre. There is hope for an ambulance in times of emergency.

Villusari village, Surulacode panchayat, Thiruvattar block, Kanyakumari district

When civil society and the State get talking

One of the crucial components in the NRHM is enhancing access of women to reproductive healthcare. The 1-0-8 free, ambulance service has been introduced mainly to transport pregnant women to the nearest health centre, when timely access to professional help is essential. However, many questions remain around the efficiency of the service and availability for all rural communities.


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The concerns surrounding operational issues of 1-0-8 were shared at a ‘training of trainers’ organised by CHETNA for its district partners, in February 2010. Findings that emerged from the participatory needs assessment conducted in five blocks were shared at a session attended by the Mission Director. The main issue that came to the fore was the fact that poor were discouraged from using the 1-0-8 service because further referrals (from the nearest health centre) had to be availed for a fee. Overall, the possibility of such a situation arising was discouraging women from opting for institutional deliveries altogether.

Top State NRHM officials followed up on the evidence immediately with a meeting of health officials and learnt that this was indeed a deterrent for poor, pregnant women all over the state. Within a week, on 6 March 2010, a government resolution was issued stating that any pregnant woman who is referred to the next health unity by a primary or community health centre will receive free referral transport support. In addition, the woman can also avail free transport service to return to her village from the health centre, after delivery.

Gujarat


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Dialogic processThe Participatory Communication Initiative was built around debates and negotiation to create linkages between different stakeholders of NRHM. The participatory need assessment indicated to a lack of access of rural communities to forums for dialoguing with service providers. In fact, there was low awareness among the service providers, regarding their role and responsibilities under NRHM.

Nonetheless, assessment had suggestions to strengthen the village level health service provision. Clearly, the community was not aware of any forum to communicate and discuss. In West Bengal, respondents articulated the need to facilitate dialogue between the community and service providers to increase utilisation. They asserted that the involvement of panchayat and Village Health and Sanitation Committee members is essential whose knowledge and

awareness levels on government health schemes need to be improved.

In the course of the Participatory Communication

Interface for health

Gabapal village situated five kilometres from the nearest PHC is surrounded by forests and hills. Nearly the entire

population is tribal, earning their living from agriculture labour and by collecting forest produce.

In September 2010, Professional Assistance for Voluntary Action (PRAVA), the district partner NGO, organised a community awareness programme in the village attended by 30 women – members of self-help groups, some pregnant women and mothers who had recently delivered. The programme comprised of presentations and discussions on basic government facilities. The women actively participated in the discussions and spoke about how they are deprived of primary facilities from the local health administration and other line departments. An issue of specific significance was the anganwari centre.

The anganwari worker who lived in a neighbouring village had not visited the centre in five months. The centre was closed and children could not be immunised. They were deprived of pre-school education and nutritional food that the centre is supposed

to provide. In fact, the anganwari building was damaged and the villagers’ demand

for repairing it fell on deaf ears. They requested the anganwari worker to at least regularise the centre’s functioning; she paid no heed to them. The villagers knew of no other means to get the centre up and running.

Soon after, the PRAVA team along with village representatives met the supervisor of Integrated Child Development Services (ICDS) and Child Development Project Officer (CDPO) at the block level. They narrated the dysfunctional status of the anganwari centre, and in turn, the adverse effect it was having on child development in the village. The CDPO assured them action would be taken soon to rectify the problem.

In a few days time, a meeting was organised in the Gabapal to discuss the issue further. It was attended by the ICDS supervisor, the ‘missing’ anganwari worker and helper, members of the panchayat, representatives of self-help groups, PRAVA representatives and some other village leaders. They met in the anganwari centre where the villagers narrated their problems. The ICDS supervisor gave strict orders to the anganwari worker to run the centre regularly and assured that repair work would be undertaken through the panchayat samiti.

Subsequently, the anganwari functioned regularly with education and health services being provided as they are proposed. The ASHA has


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also become more proactive and is providing her services along with the anganwari worker. The number of institutional deliveries has gone up since, and antenatal check ups and immunisation have been regularised.

Later minor repairs along with plastering and painting were done by the Panchayat from the block development fund.

Gabapal village, Krushnachandrapur panchayat, Nilgiri block, Balasore district, Odisha

A rupee of corruption

The men of remote Koothapakkam, Padirikuppam and KN Pettai villages in south India migrate out for wage

labour. Women work as wage labourers in the villages. This region of Cuddalore performs poorly on health and education indicators. When people do seek medical attention they go to Thiruvanthipuram PHC – a 30-bedded hospital with an average of 450 patients visiting every day and 20 deliveries every month. The PHC has all the necessary facilities to meet the health needs of the community and conducts special medical camps for school going children.

The staff of Bullock-cart Workers Development Association (BWDA) the district partner NGO

visited the area often to generate awareness about health issues. They would also visit the places where the women worked and speak with women about health issues, with the approval of the supervisor. In one such meeting, it came up that the staff of Thiruvanthipuram PHC took a rupee from each patient for registration. This is against the rule since all services in a PHC are free, and the collection of even a rupee was going against the basic idea of free public health services. However, the amount was small and nobody had given it a serious thought.

BWDA staff, however, was convinced that the issue needs to be taken up. They went to the PHC and confirmed, first-hand, that indeed people were being charged a rupee for registration. They spoke with the doctor of the Centre who confirmed that the practice has been ongoing for many years, but nobody brings it up since the amount is really negligible.

In February 2011, members of a self-help group in M Puthur village raised the issue in a community awareness meeting conducted by BWDA. Unlike in the other villages, the members wanted to stop the practice and sought BWDA’s support in taking the issue to the district level. In April 2011, the organisation team accompanied 20 members of the group to meet the medical officer of Cuddalore district. She was shocked to hear about the corrupt practice and confirmed

it for herself by checking with the health inspector.

She apologised to the group, appreciated its effort and assured them that the practice would be stopped immediately. The corrupt practice that had been going on unquestioned for years has now been stopped at Thiruvanthipuram PHC.

Koothapakkam, Padirikuppam,KN Pettai andM Puthur villages, Koothapakkam and Padirikuppam panchayat, Cuddalore block, Cuddalore district, Tamil nadu


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Initiative, efforts were made to enhance dialogues at different levels. Consultation meetings were held with district and block health officials to share the findings of the participatory need assessment. This was a useful exercise to lay the ground for work in the future. These consultations also helped garner support for the communication activities planned with communities and forums. Consultations were also held with state level officials briefing them on the initiatives of this project. Following this, the Mission Director of several intervention states sent out a letter to all district medical officers asking them to extend their support to the CHIN initiative.

Regular community awareness meetings were conducted by the district partners in all the forty intervention blocks. It has encouraged and led to the increased number of institutional deliveries and immunisation in the blocks. Simultaneously, regular sensitization meetings were held with Village Health and Sanitation Committees (VHSC) and other village forums namely Self-help groups, Farmers’ groups, youth groups etc. These meetings have led to an increase in regularised meetings and health being considered as an agenda in many places giving the community a space to air their concerns, including those about corrupt practices in the health service delivery mechanism.

Amplification of the voices of the vulnerableEvidently, an increased power and ability

to communicate is what poor people wish for themselves as much as the more tangible development benefits targeted by the Millennium Development Goals. In the Participatory Communication Initiative, amplification of the voices of the community as well as service providers was a core component. The initiative not only assisted members of the community to find a voice in appropriate forums, it also helped service providers address their concerns. This was possible through round table meetings which were designed as an open discussion forum where all the stakeholders are on equal footing in the backdrop of access to quality health care in the intervention block. In these meetings, various advocacy issues emerged like non-receipt of remuneration on time, lack of proper training inputs, etc. Efforts were made to gather evidence and put them up at forums like monthly meetings of primary health centres and ASHA sector meetings among others.

Creating Ownership of and driven by internal change agentsThe Participatory Communication Initiative has focussed on developing ownership of accessing NRHM entitlements from within communities and community forums. In this vein it has invested in building the capacity of village level functionaries and forums to play their part.

During the participatory need assessment in Gujarat, it came to light that only about ten

per cent of the members of panchayat and Village Health and Sanitation Committees were aware of government health schemes to some level of accuracy. They expressed the need for effective awareness programmes to be able to carry out their responsibilities better. In Odisha, although a number of training programmes had been conducted for service providers and Gaon Kalyan Samitis, many did not have the desired effect because of issues of language.

Similarly the Participatory Communication Initiative has played a significant role is in helping communities enhance their accountability towards the health and health-related infrastructure. In West Bengal, it was found that delivery facilities are not available in many primary health centres. Many anganwari centres needed repair and this poor infrastructure was having a detrimental effect on service

delivery and on the motivation of service providers

worsening the situation.


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Hope for ASHA

There are seven primary health centres in Khedbrahma block, Sabarkantha district of Gujarat. ASHAs have been

appointed for all villages that are covered by the health centres. They work hard to address maternal and child health related issues of the community. However, their work is full of obstacles and challenges.

Khedbrahma is one of the most remote blocks of Gujarat, populated by tribal communities. The health status of the block is low with primary health centres situated 10 to 15 kilometres apart and community health centres about 40 to 50 kilometres from villages. In addition, every house is over a kilometre away from the other making it difficult for the community have accress to the health services and health workers.

It came to light in 2009, during a training programme organised by Narrottam Lalbhai Rural Development Fund (NLRDF), the district partner NGO, that ASHAs despite their dedicated work, had not received their incentives for nearly eight months. Incentives work out to anything between a significant Rs 700 and Rs 1,200 per month. Understandably, they were feeling de-motivated. They did not, however, bring this to the notice of

government officials for fear of annoying them and risking the renewal of ASHA contracts the following year.

The NLRDF team convinced the ASHAs of the need to raise the issue with government officials and assured them of support to ensure that the renewal of their contract is not at risk. The team helped them contact the medical officer who, in turn, got in touch with the block health officer. Some ASHAs themselves spoke repeatedly with the officers over the phone. With repeated communication among the ASHAs, the NLRDF team, medical officer, and the block health officer, the issue was raised at the district level where an order was passed for immediate payment of the incentives. The instruction was to pay the incentive directly to the medical officers of the block. The entire process of ensuring the backlog of incentives and its payment took 15 days.

Lambadia panchayat, Khedbrahma block, Sabarkantha district, Gujarat

It’s not just a toilet!

The toilet in the anganwari centre of Sirsili was in appalling condition and was a source of concern for children at

the centre as well as women who visited the centre on Maternal and Child Health Nutrition

(MCHN) day every month. The community members, ASHA and anganwari worker repeatedly raised the issue with wardpanchs, the sarpanch, members of the Village Health and Sanitation Committee, but to no avail.

During a community awareness meeting on health facilitated by Shikshit Rojgar Kendra Prabandhak Samiti (SRKPS), the district partner NGO, the issue of the toilet came up. The auxiliary nurse midwife and ASHA spoke about how the attendance of children at the anganwari was adversely affected because of the toilet. Women expressed that they were also reluctant to visit the centre for MCHN day for the same reason.

In February 2011, with the help of the SRKPS team, this issue was raised at a panchayat meeting attended by all village level health and panchayat functionaries where the importance of MCHN day, complete immunisation and the availability of untied fund at the disposal of the panchayat was discussed. All the members also spoke about the need to repair the toilet. The sarpanch was convinced and agreed to utilise some of the untied fund for the repair. By the end of the month, the toilet was repaired along with other facilities which needed attention.

The sarpanch, having been enlightened about the importance of meeting health


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needs of the village, put the issue in the monthly meeting of the panchayat samiti at the block level. The block development officer asked the appropriate officials to ensure that all prescribed services were provided and maintained well at anganwari centres of each village in the block. All sarpanchs, and panchayat samiti members as well as zilla parishad members were asked to participate in MCHN day proceedings and to utilise the untied funds as required. With all these measures in place, the utilisation of anganwari centres is reported to have increased dramatically to almost 80 per cent.

Sirsili village, Sirsili panchayat, Churu block, Churu district, Rajasthan

The road less travelled

Narrottam Lalbhai Rural Development Fund (NLRDF), the district partner NGO, in partnership with CHETNA,

Ahmedabad and District Health and Family Welfare Department of

Sabarkantha is working in

Khedbrahma block to promote community access to quality health services.

Poor acceptance and utilisation of health services in the block is attributed to many a reason, remote location of villages being the primary. Located in the Aravalli hills, more than half the 250,000 population is tribal and lives in sparsely scattered settlements. A primary health centre (PHC) is located nearly 15 kilometres from the villages and a community health centre is at a distance of about 50 kilometres. On average, 19 villages are serviced by one PHC. Over 80 villages are severely inaccessible because of their location. Government and non-government health workers’ outreach is restricted to houses in the proximity of the PHC. The issue is further compounded by low levels of literacy (42 per cent among men and 32 per cent among women) and associated myths and misconceptions about medical treatments.

In order to reach out to the interior villages, NLRDF conceptualised a “road show” to be rolled out for two weeks in the month of June 2011. It envisaged that the road show would help share information about maternal and child health entitlements to residents of remote villages; it would help the organisation and the community understand the present status of health services in the villages; it would provide a forum for communities to share their concerns on accessing health services; it would allow the NGO to propose possible solutions to address health concerns of communities and motivate them to access the services. The idea was shared with the

block health officer who was encouraging and helped chart out a route map of villages that could be covered by the road show.

The road show began on 6 June 2011 with jeeps displaying banners of health entitlements and driving through villages. Announcements were made about entitlements on a public address system attracting community members to come and join the rally. Awareness meetings were organised with gathering crowds, pamphlets and stickers were disseminated as takeaways to reinforce the message. In the course of the road show, the NLRDF team spoke with ASHAs, pregnant and lactating women to gauge their understanding of maternal and child health services, and entitlements and experiences of availing them.

As the road show went from one village to another, volunteers, youth groups, members of self-help groups, health service providers and ASHAs began to join in to help mobilise the community and to create awareness. Community members carried out a signature campaign to highlight both concerns and possible solutions to health issues.

By the time the road show drew to a close after a fortnight, it had reached out to approx. 9,000 community members in the remotest and most inaccessible parts of Khedbrahma. Few weeks


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awareness was organised in the village by LEADS (Life Education And Development Support), the district partner NGO. Many villagers were present, including Rojalia. She put forth the issue of the hand-pump hoping to find a solution to the hard-ship of the women who had to walk long distances to fetch water. The LEADS staff asked the villagers if they had ever approached the panchayat repre-sentatives about allotting money from the untied funds to repair the hand-pump. They had not.

Rojalia was encouraged to take the lead in approaching the panchayat. She was nervous and unsure how the pradhan would react. She was accompanied by the sahiya for the first meeting in which they explained the situation, but got no assurance for redress. Rojalia was determined. She met the pradhan five times over a month, before peak summer set in. Finally, the pradhan agreed to release money from the untied fund.

When the hand-pump was repaired it was revealed that only a few nuts and bolts needed to be replaced costing no more than Rs 800. By the end of April, clean water was available for the residents of Pahadkanpu, close to their home.

The episode was a learning for everybody. The pradhan and panchayat members realised that they can use the untied fund for more than repairing roads. Pahadkanpu village, Garbudhni panchayat, Mahuadan block, Latehar district, Jharkhand

Health concerns and solutions put forth by the community

Concerns Solutions

Community members from 30 villages shared that for injections and for drips, money is being charged at PHC

Medical officers/block health officers ensure free access to health services, a health right of the community

In about 22 villages, timely receipt of JSY incentive was a concern

Ensure timely payment of JSY incentive to pregnant women for institutional delivery

Inappropriate utilisation of untied fundsSharing of information of utilisation of untied funds and its possibilities with community members

Problem with issuing health insurance card (Rashtirya Swasthya Bima Yojana) in Mamapipla village, Khedbrahma

Need for information sharing on the benefits of health insurance cards and the criteria for getting the cards issued

later, at a meeting in the block health office, concerns and solutions put forth by community members were read out. The block health officer assured the availability of adequate medicines at primary health centres, facilitation of regular disbursement of Janani Suraksha Yojana (JSY) funds to health centres the day they were received at the block. Thus, not only did the road show create awareness and outreach, it also helped open channels of communication with the health machinery at the block level.

Chandrana, Kheroj, Lambadia, Poshina, Amaigadha, Ajavas, Bedi, Bara, Chatraj, Mamapipla, Goland, Paliabia, Ambamahuda, Uchidhanal, Karunda, Kaikankad, Khedva, Gerna, Tadibedi, Delvada, Dotad, Dantral, Nada, Navamat, Piplia, Semblia, Hingadia panchayat, Khedbrahma block, Sabarkantha district, Gujarat

The determination of Rojalia MinjRojalia Minj is 32 years old, a homemaker involved in the regular household chores. Rojalia works in the field, looks after cattle, fetches water and takes care of her home and family of six. Her village Pahadkanpu is situated in undulating topography with bad communication provisions. The village is surrounded by forests and the main source of water is from ponds. In the summer, these ponds run dry and close to 15 families including Rojalia’s depend on hand-pumps for water.

In March 2011, the hand-pump also stopped working necessitating women of the families to walk long distances to fetch water. It lay unrepaired for close to two months. There did not seem to be any action towards repairing it either.

Around this time, a community meeting on health


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The Initiative conceives development as a transformative process at both individual and social levels through which communities become empowered to initiate a process of change. Communities themselves should be the main protagonists of social change process rather than the passive beneficiaries made by external players. The transformative process of participatory communication has enabled the communities in West Bengal to articulate their needs which resulted in better delivery of health services.

Regular awareness and sensitisation meetings conducted by district partners with village forums like self-help groups, farmers’ associations, youth clubs, etc. have brought about many visible changes in communities. Village Health and Sanitation Committees have been formed where there were none, and have been sensitised on the use of untied funds, and community members have set up alliances with ASHA and anganwari workers for better service delivery, among others. In many cases, sensitisation meetings have opened up avenues for motivated individuals to take on the mantle of facilitation of accessing health entitlement.

Community action for anganwari services

Parvati Devi and Phulmani Dhan have been appointed as anganwari worker and assistant, respectively, in Rolagutu.

The anganwari centre had not been operating regularly for a long time. Classes were not conducted everyday. In fact, the centre would be opened rarely, usually on the day that ration was to be distributed. This carried on for nearly six months, during which time the villagers, especially members of a self-help group, tried to convince the anganwari worker to address the situation, with no success.

Karra Society for Rural Action (KSRA), the dis-trict partner NGO, has been working in the area since June 2010, to raise community awareness about health issues and services, especially with those related to maternal and child health. They have been working closely with Laxmi Mahila Mandal (self-help group) and the Village Health and Sanitation Committee (VHSC).

In one such community awareness session, the villagers spoke about the unavailability of services at the anganwari centre. The block link worker of KSRA organised a meeting with members of Laxmi Mahila Mandal and VHSC and tried to motivate them to do something about the problem impressing upon them that it is the

community’s responsibility to monitor the services. The block link worker also met the mukhiya and sensitised him about the services of the anganwari, their significance and the existing status.

The mukhiya took the initiative and called for a meeting in May 2011 with members of the panchayat samiti, VHSC and Laxmi Mahila Mandal to discuss the concerns of the anganwari centre. Parvati and Phulmani, from the anganwari, were also present at the meeting. They were questioned about the irregular functioning of the centre and warned that they would be replaced if they did not change their ways. Neither of the two challenged the community’s questioning because they knew they were in the wrong and assured that they would open the centre regularly starting from the next day.Since then, the anganwari centre has been opened regularly. Further, members of Laxmi Mahila Mandal have taken the responsibility of regularly visiting and monitoring the centre. With help of the KSRA team, they conduct meetings with other villagers and share their monitoring feedback. The process of reviving the anganwari centre has also helped the self-help group realise its role beyond savings and credit and its responsibility towards facilitating entitlements for the community. There is potential for the group to be a source of inspiration for others in the region.

Rolagutu village, Meha panchayat, Karra block, Khunti district, Jharkahnd

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Information, the key to big changes

Amidst beautiful forest and mountains, as one drives from Tangarpalli on a rugged and rusty road, lies a peaceful

and isolated Kurla village. The population of 1,000 depends primarily on agriculture for livelihood. A low literacy rate, physical isolation, infrequent visits by health service providers all combine to a low level of awareness of entitlements under National Rural Health Mission (NRHM). Most deliveries are at home and people depend on unqualified medical ‘practitioners’ and healers for treatment. The residents of Kurla, however, are very peace loving and live in harmony and cooperation.

The primary health centre in Mangaspur formed a Gaon Kalyan Samiti in November 2008 and ever since they its meetings have been held regularly on the 20th of every month. The members of the Samiti, however, did not know their role or the purpose of the monthly meetings. They would attend the meetings, wait for resolutions to be passed, drink tea and go back home. They had not done any concrete work around utilising the funds at the disposal of the Samiti.

When a team from SEWAK (Self Employed Workers Association Kendra) the district

partner NGO visited Kurla, it was clear to them that Samiti members did not know their roles or responsibility. Having ascertained the poor health status of the village, they decided to have some rounds of discussion with elders, literate youth and members of the Gaon Kalyan Samiti. After a lot of persuasion, they agreed to organise a community awareness meeting in the village in November 2010.

The meeting was very well attended by members of the Samiti and other residents. The SEWAK team facilitated the meeting using participatory methods and different communication tools to ensure more effective understanding of the information. The issues covered included guidelines for the Samiti, rules of utilisation of untied funds at its disposal and preparation of village health plans.

The meeting was an eye opener for all, especially for the members of the Gaon Kalyan Samiti. Nobody knew about the availability of such funds or of their right to utilise it. They have not looked back since. They prepared a health plan for the village and have appropriately utilised untied funds for two successive years. The health wall, which was earlier bare, is now updated and monitored by community members. The ASHA

makes home visits, registers pregnant women and has ensured that most deliveries have been institutional ever since.

The Gaon Kalyan Samiti that earlier made no effort to include the auxiliary nurse midwife and PHC staff in its meetings, has begun to do so. With help from the SEWAK team, it has also submitted its progress report to the PHC as prescribed. With regular handholding by the NGO team, the Samiti has constructed a soak pit in the village to avoid water stagnation leading to breeding of mosquitoes; referred malnourished children, pregnant women at risk and other critical patients to the hospital; created a platform around a tube well; cleaned three village ponds; and organised camps and fairs to bring health issues in focus.

The Kurla Gaon Kalyan Samiti has been recognised as the most vibrant in the district. Considering it was one of the most inactive, before SEWAK’s intervention, this is indeed a significant achievement.

Kurla village, Mangaspur panchayat, Tangarpalli block, Sundargarh district,

Odisha



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Use of culturally embedded means to communicateIt emerged from the participatory need assessment conducted in all 7 states that although community members recalled seeing Information-Education-Communication (IEC) material related to health, most of them had poor recollection of the message they contained. Many said they were illiterate and were unable to read what was written on government communication material. In Thiruvannamalai, women went to the extent of saying that they did not see the relevance of such information dissemination because they could not read it in any case.

It was clear that community members were seeking information but through culturally appropriate means. In parts of West Bengal, information dissemination suffered because multiple languages were spoken, especially in regions where there was large migrant population from neighbouring states

Therefore, during the PNA, specific questions on the existing communication practices, occasions and places where villagers gathered were asked to the villagers. This information shone light on how community members saw the relevance of receiving information. They suggested means apart from posters and written documents like pictorial depictions, audio visual programmes, street plays and folk media etc. From West Bengal, majority of the villages received information through Baul songs and short plays.

Jharbari Mahila Mandal

Uttar Dinajpur in the northern part of West Bengal, bordered by the state of Bihar, district of Darjeeling

and nation of Bangladesh has a unique cosmopolitan mix of population with many ethnic races and languages – Hindi, Assamese, Santhali and Bhojpuri, among others. There are many migrants in the district. Close to 40 per cent of the population lives below the poverty line. The district performs poorly on health indicators – 23 per cent institutional delivery, 53 per cent total immunisation and less than 50 per cent female literacy. Karandigi block has a similar profile.

Jharbari village in the block, however, is well connected with health infrastructure. There is a sub-centre within a kilometre and primary health centre within five. There is an ASHA in the village. Surprisingly, access to entitlements under NRHM, including institutional delivery and immunisation levels are very low. One of the problems identified for this low level of access is that many migrant people speak different languages.

St John Ambulance Association (SJAA), the district partner NGO, has been working in the region since 2007 to promote maternal and child health entitlements under NRHM. They

conduct awareness programmes and meetings with different community-based forums, like self-help groups, youth groups and Village Health and Sanitation Committees about their entitlements, role and responsibility under NRHM.

Jharna Goswami, the leader of a self-help group (SHG), inspired by the meetings, took the initiative to organise a community meeting herself. She got together some of her fellow SHG members and proposed the formation of an association comprising various SHGs which would focus on health issues. Some other members of the community were also present. The SJAA team facilitated the process. Some showed an interest in forming such a health-based forum, while others asked if there would be any monetary remuneration for the work, especially since the role of SHGs was seen in the framework of income generation. Jharna Goswami and others helped make people aware of the social responsibility of SHGs. It was also impressed upon them that with the help of other community members this initiative would serve the health needs of their own families. Following 2-3 meetings, many people were convinced and joined the forum. Even the anganwari worker and ASHA also joined the forum.

The forum began working with the help of SJAA in creating awareness of health issues and entitlements. Different languages were used in


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awareness programmes to reach out the different language populations. Village level health service providers also participated in the process. A lot of information, education and innovative communication methods are used – quiz contests, debates, role plays, etc. By communicating in different languages the problem of some sections of the village not understanding the urban Bengali, hitherto used, was addressed.

They began reaching out to a large number of people in the village evident by the increased level of awareness in the community regarding NRHM. People began demanding services under the Mission much more than before, including institutional services for child delivery. The ‘health forum’ has also started showing the way to the Gram Unaoan Samiti on how it can carry out its functions.

It needs special mention that all this work is being done without any monetary compensation or even its expectation. It is being looked upon as a social responsibility. The initiative of the Jharbari ‘health forum’ is being upheld

as exemplary and district officials are keen to promote the model in other blocks as well.

Jharbari village, Karandigi-II panchayat, Karandigi block, Uttar Dinajpur district, West Bengal

No child’s play

Raichur, in north Karnataka, is famous for its rich history and is known as the ‘City of Kings’. Child marriages are common,

leading to the death of many young pregnant women during childbirth. Neither are they in child bearing age, nor do they get nutrients necessary to go through a healthy pregnancy. Many people do not opt for immunisation because of superstitions against them. Largely, they opt for home remedies over treatment at the sub-centres and primary health centres.

Janahitha, the district partner NGO, has been working in Manvi block of Raichur with a special focus on villages that come under Kurudi PHC These villages are some of the most remote in the block and have low awareness of health and

National Rural Health Mission (NRHM) entitlements. In 2008, only 25 per cent of the pregnant women went through antenatal and postnatal check-ups. Bad roads and poor transportation exacerbated

the situation.

Since October 2010, the Janahitha team has been conducting community awareness meetings in Kurudi village aiming to sensitise its people towards maternal and child health entitlements under NRHM. At first, the turnout at meetings was very good. Gradually, the numbers began to wane. On probing, it appeared that they were losing interest because no material benefits were received from the meetings. It was then that the Janahitha team received insight from Shrikantappa Soukara, the village head, that people would be more receptive if it was a loved one talking to them.

The team worked on this input and identified children as the ideal people to convince adults of the village to seek health services. The Janahitha team approached the government school in Kurudi and shared the concept of forming ado-lescent groups for health awareness. The teachers were supportive and identified 12 students from the eighth and ninth standards to be part of the group. Many parents had to be visited at home and convinced because they thought that this would be an additional burden for the children and affect their academic performance.

Creating awareness on health issues for adolescents is no easy task. The sessions would be held for an hour after school. The first few comprised only games and basic information on education and personal hygiene. Gradually,


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more advanced ideas of health entitlements were discussed using posters, songs, street plays and stories.

From February 2011, the children started conducting four or five community awareness sessions every month. They would read out NRHM related messages from ‘greeting cards’ and then post them in a ‘post box’ indicating that the message would be delivered to people. Rangoli and mehendi competitions were organised around NRHM messages.

Not only did parents come to listen to their children at the awareness meetings, they also asked friends and neighbours to accompany them. Over time, the benefits of using services at the government health centres became clear to the adults. They also realised the importance of registering pregnant women for antenatal and prenatal services.

The children’s effort was acclaimed by the sarpanch. The doctor at the primary health centre was enthused and offered weekly health education sessions for the school. Seeing these neighbouring villages of Gorkal and Sunkeswar also invited the Janahitha team to set up similar adolescent groups.

Kurudi village, Kurudi panchayat, Manvi block, Raichur district, Karnataka

Let the drums roll

Most villages in Anandpuri block had been performing poorly on maternal and child health indicators especially in terms of

low levels of antenatal check-ups and timely/early registration of pregnant women, incomplete or no administration of immunisation doses, among others. There was evidently low awareness of the benefits of institutional delivery and provisions of Janani Suraksha Yojna. There was low turnout of women at Maternal and Child Health Nutrition (MCHN) day celebrations, attendance at which is expected to enhance the status of maternal and child health in the region.

Under the NRHM there is provision for the utilisation of untied funds of Rs 1,200 per year by the Village Health and Sanitation Committee for promotion of MCHN day every month. However, due to lack of awareness about the criteria of utili-sation of untied funds, they were not being used in Anandpuri for promotion of MCHN day. This was picked up by a leading regional newspaper, Dainik Bhaskar in a story highlighting the poor utilisation of untied funds. It caught the attention of staff of ASSEFA, the district partner NGO working in the region. The organisation facilitated a series of meet-ings with members of the panchayati raj institu-tions in which they shared findings of health status assessment of the area, roles and responsibility of panchayati raj institution members in implementa-tion of NRHM, provision of untied funds.

Devilal Masar, a panchayat samiti member of Navagaon village, inspired by the meetings realised the importance of his role. He came upon the idea of using a traditional means of promotion for MCHN day. Beating drums, a traditional means to announce the celebration of events or to mobilise people, was introduced to announce MCHN day in four villages.

The initial response was slow. Women came out in small numbers. Those who did thought there was a celebration in the village but were not interested in MCHN day services. It took a lot of convincing to ensure that the initial curiosity generated by the beating of drums was converted into utilisation of services.

Furthermore, generating and sustaining the interest of panchayat members in issues of women and child health is never easy. Over time, the sarpanch of six more villages decided to follow suit and utilisation the untied funds under NRHM for MCHN day promotion using drum beating. In these villages, the number of women attending MCHN day celebrations and utilising services has begun to go up slowly, from four or five, to about ten and 15. It is envisaged that this trend will continue and all eligible women and children will be aware of the benefits of MCHN day and utilise them.

Navagaon village, Kanhela panchayat, Anandpuri block, Banswara district, Rajasthan


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In Tamil Nadu, street plays were a preferred means to disseminate special news or religious messages. Other means included Villu Pattu, Kathakali, Theru koothu, Naveena Nadagam.

Based on the information, the project partners along with help of artists and painters came up with innovative health messages which could be

shared using these communication practices. The tools developed were shared with community leaders and were then used in different occasions and gatherings to give out information about ailments and their treatment, government health schemes, services of health centres and entitlements under NRHM.

The partners also modified existing IEC material with inputs from community leaders and representatives making it more relevant and culturally appropriate. This also helped create more awareness and ownership among communities and empowered them to seek better health and services.


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Emerging models for public health

Access to Public Health” health communication is seen beyond a public health tool to dissipate knowledge but as a process – where rural communities participate, dialogue, create necessary linkages in order to achieve healthy potential of communities.

In the illustrations elaborated here, communication has played a role for negotiation of power – as reflected in the ability and resolve of rural communities to communicate their problems, discuss and dialogue and find solutions to the issues they faced with. The use of the principles of participatory communication for

social change facilitated the negotiation and dialogue. Infused with appropriate knowledge, negotiation and power, communities have been enabled to put forward issues it faced as barriers in accessing health services. It is about the process and outcome with which those without power gain knowledge, information, skills, confidence and thus take control over decisions of their lives.

Way forward Although participatory communication approaches may be considered cumbersome and time consuming, they emphasize the need

It has been clearly demonstrated that financial and technological inputs into health system will go under-utilized without having proper means of communication between major stakeholders (Silvia Balit, 2004). Communication is generally seen as a tool or a medium for sharing and dispensing information. However, it is rarely perceived as a process of negotiation of power. In the context of the experiences and learning of the project “Participatory Communication for Improving

for unhurried process necessary for engagement with communities. The project’s engagement with communities in varied rural settings, 40 blocks of 40 districts spread over 7 states demonstrates several valuable points for future consideration in the


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conceptualization and development of health programmes.

• Communitiesshouldbethemainprotagonistsof the processes of social change rather than “passive beneficiaries”. This value needs to be translated into a major pillar when public health interventions are designed.

• Healthofthepeople,especiallyofmarginalized communities is affected by social environment in which their personal behaviours are embedded. Hence, the forward momentum has to be generated from the within the communities and not from external agents.

• Developmentshouldbeconsideredasatransformative process at both individual and social levels through which communities become empowered.

Emerging ModelsBased on the experiences and learning of the project two emerging models have been identified:

Integration of Participatory Communication: Participatory Communication for social change is integrated as process and perspective in different areas of interventions of the project. Participatory Communication is integrated in the interventions right from assessment and awareness building to capacity


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building and developing or strengthening forums in which its principles and the processes were used.

Communitization of health: Community participation in public health services is generally limited as a user of services. In this project, community participation is beyond using services. Participation is seen as a right. The community played an active role in defining and deciding health services that needed reached their community. Institutionalizing community led action for health is one of the frameworks of NRHM. According to the government implementation plan, ASHA and the Village Health Sanitation play a crucial role in communitization of health care. Besides the two players instituted by the government at village level, community based groups like Self Help Groups are also associated in this purpose.

In this context, the project has conducted training programmes specific to ASHA and Village health sanitation committees on their roles in communitization of health care. In the next phase of the project, it is important to consolidate and sharpen the trainings imparted to ASHA and Village Health Sanitation Committee in order to facilitate sustainability of the changes achieved so far in the implementation sites. Gaon Swasthya Baithak or GSB was conceptualized as an effort in this direction.

Gaon Swasthya Baitaks (GSBs)A social experimentation towards addressing structural limitations in communitisation efforts under NRHM

Communitisation of health services is one of the key strategies of NRHM. The concept of communitisation is based on the strong belief that the entire health machinery is owned by the people. The strategy aims to stimulate demand, make planning process locally relevant, and bring more accountability by creating multiple channels for community participation. Several institutional mechanisms are being incorporated in the NRHM framework to facilitate institutionalization of community lead

action in health. These include identification and deployment of Community Health worker (ASHA) to link communities with health department; Village Health Sanitation and Nutrition Committee (VHSNC) to plan and monitor health services; Rogi Kalyan Samitis (RKS)and community based monitoring (CBM) to create local accountability; and specific community based awareness and service delivery events such as VHND to increase demand for services.

Although these efforts have appreciably contributed towards realizing people-centric health services (as compared to bureaucratic, top-down health department functioning), there


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are certain crucial structural lacunae which have become evident while facilitating rural health services. These issues need to be addressed for ensuring effective communitisation. These issues are

1. Creating conflicts –people versus health system equations Communitisation efforts, such as community based monitoring (CBM), place people at the centre of a process of regularly assessing whether the health needs and rights of community are being fulfilled. While it tries to address some of the issues such there is no formal space, pattern or structure to demand and realize right to health, this process can also create ‘people versus health department’ equation. For instance, the spaces created for exchanges between people and the health department under CBM such as public hearings are often designed to create conflict rather than appreciation of the progresses made, if any.

2. Not addressing the potential power imbalance in the society Communitisation efforts should take into consideration the multiple implications of operation of power in a society. The present communitisation mechanisms are advanced on the basis that health bureaucracy is more powerful than people which needs to be resolved by placing the local community at the centre of health services. However, people’s participation aims to minimize the power imbalance by

engaging the local elites including the upper castes/classes/male, the power wielders of Indian society. The local élites participating in such platforms leave out the voices of marginalized and vulnerable population unless special efforts are being made. Frontline health functionaries are often pitched against communities even though they are often incapacitated by the systemic faults at the district and higher levels.

3. Philosophy of engagement - Participation is seen as a means towards an end rather than an end in itself Very often community participation is advanced with other goals, such as increasing demand or ensuring quality of health services. It often looks at participation as a benefit but not as a right.

Thus GSB is proposed as an improvisation on the institutional mechanisms for communitisation in order to address some of the structural weakness explained above.

What is Gaon Swasthya Baitak?GSB means bringing together the different stakeholders in the community to discuss problems and find collective solutions in the backdrop of right to health in the intervention blocks.

Philosophy of GSBIt is expected to take place through a process of dialogue and debate based on notions of tolerance, respect, equity, social justice and active participation of all stakeholders. It is out of the realization that health issues cannot be addressed alone. It should create an environment for collective ownership. It aims to strengthen community links and amplify the voices of the vulnerable people by consciously appropriating the process of participation. It means bringing together the different stakeholders including vulnerable and marginalised members in the community to discuss problems and find solutions. It utilizes dialogue that leads to collective problem identification, decision making, and community-based implementation solutions to identified problems.

Rather than just community airing grievances against the frontline health functionaries, the dialogic process aim to identify collective


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solutions and action. It tries to bring together lower level health functionaries and members of the community to advocate to higher authorities and officials for common demands. The content of the discussion should go beyond the functioning of health department and should consider social norms, culture and general developmental context.

Composition of GSBThe ideal number of participant’s during GSB meeting is between 25 and 35 members of the community representing the following groups:• AllthemembersofVHSC• Representativesofeachhamlets• AlltheSHGleaders• ExistingCommunitybasedorganizations• Activeyouthgroupmembers• Schoolteachers• ReligiousLeaders• Representativesofthemarginalizedgroups• RepresentativesfromAdolescentgroups• Representativesfromserviceproviders

(AWW/ANM/PRI/ICDS/MO/MOIC/CDPO, ICDS supervisors/ANM)

• Pregnantwomenandlactatingmothers

Facilitator and Duration of the meeting:The ASHA/AWW will facilitate the meeting which will last for two to three hours. The GSB meeting can strategically use the existing community meeting and functions provided the objectives and purposes of the meeting are not altered.

Issues to be discussed in GSB meetings are as follows:• Health• Nutrition• WaterandSanitation• SocialDeterminantsofhealth• UsedofUntiedFund

The following are characteristics of good GSBPreparatory works for the meetings- • Setanagenda• Ensurethatrepresentativesofthedifferent

sectors of the community, especially the marginalized are present in the meeting

Participatory approach needs to be ensured in the discussions, decisions and action. The approaches that will be followed and observed will be non-threatening. The members and participants of the GSB will appreciative the efforts done by the existing health delivery mechanisms. The problems identified in the health delivery will be solved together by the community and the service providers.

Documentation of the minutes of the meeting is essential. The documentation will include the following:• Dateandplaceofthemeeting• Nameoftheparticipants• Issuesidentified• Decisionsandactionstaken• Dateofthenextmeeting• Reviewofthepreviousmeeting

1. Actions and decisions that were accomplished

2. Problems and issues were brought to the concern authority

3. Learning

Non- Negotiable in the functioning of GSB• Dialogueprocess• Consultationofthemostvulnerablegroupsto

decide on place and time of the meeting • Theweakestsectionofthecommunityis

represented in the meeting• Thereareatleast3to4membersofthe

service delivery machinery (HSPs, ANM, MPW, etc.)

• A‘problemsolving’approachtobefollowed• Blamingtheserviceproviderswillbeavoided,

instead appreciation of the goods things in the service delivery will be emphasized. The problems identified will be solved together by the service providers and the community.


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List of state and district partner organisations

State Partners Name Contact details

CHETNA, Ahmedabad Gujarat and Rajasthan [email protected], Vellore Tamil Nadu and Karnataka [email protected], Kolkata West Bengal and Jharkhand [email protected], New Delhi Odisha [email protected]

District PartnersGujarat

District/Block Partner Contact details/Email

Jamnagar/ Dwarka Gram Vikas Trust (GVT) [email protected]

Bhuj Kutch/ Abdasa Kutch Mahila Vikas Sangathan (KMVS) [email protected]

Tapi/ Valod Vedcchi Pradesh Sewa Samiti (VPSS) [email protected]

Vadodara/ Padra Shroffs Foundation Trust (SFT) [email protected]

Sabarkantha/ Khedbrahma

Narottam Lalbhai Rural Development Fund (NLRDF) [email protected]


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District/Block Partner Contact details

Udaipur/ Gokunda Alert Sansthan [email protected]

Banswara/ Anantapuri Aravali Sarva Seva Education Trust (ASSEFA) [email protected]

Karauli/ Karauli Education, Conscientisation, Awareness and Training (ECAT) [email protected]

Churu/Churu Shikshit Rojgar Kendra Prabandhak Samiti (SRKPS) [email protected]

Alwar/Tijara Akhil Bhartiya Gramin Utthan Samiti (ABGUS) [email protected]


Murshidabad/Suti - I Association for Social and Health Advancement (ASHA) [email protected]

South 24 Parganas/ Diamond Harbour - 1 CINI – Diamond Harbour Unit [email protected]

Paschim Midnapore/ Sabang CINI-Moyna Rural Health Development Centre [email protected]

Nadia/Krishnaganj Sreema Mahila Samity (SMS) [email protected]; [email protected]

Uttar Dinajpur/ Karandigi St. John Ambulance Association (SJAA)

[email protected]; [email protected]

Rajasthan

West Bengal


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Khunti / Karra Karra Society for Rural Action (KSRA) [email protected]

Latehar/ Mahuadan Life Education and Development Support (LEADS) [email protected]

Pakur/ Hiranpur Srijan Foundation [email protected]

Saraikela-Kharsawan/ Nimdih Tagore Society for Rural Development (TSRD) [email protected]

Ramgargh/ Gola CINI-Jharkhand Unit [email protected]


Cuddalore/ CuddaloreBullock-cart Workers Development Association (BWDA)

[email protected]

Coimbatore/ Valparai Coimbatore Multipurpose Social Service Society (CMSSS) [email protected]

Kanyakumari/Thiruvattar Centre for Social Reconstructtion (CSR) [email protected]

Dharmapuri/ Pappireddipatty Rural Integrated Development Organization (RIDO) [email protected]

Tiruvannamalai/ Thurinjapuram Sadayamodai Illaignar Narpani Mandram (SINAM) [email protected]

Jharkhand

Tamil Nadu


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Bagalkot/ Ilkal Bijapur Integrated Rural Development Society (BIRDS) [email protected]

Bijapur/ Bijapur VIshala [email protected]

Gulbarga/Aurad - B St. Luke Health Center [email protected]

Raichur/ Manvi Janahitha [email protected]

Gadag/Shirahatti Navjeevan Seva Mandal(NSM) [email protected]


Balasore/ Nilgiri Professional Assistance for voluntary Action (PRAVA) [email protected]

Keonjhar/ Banspal Prakalpa [email protected]; [email protected]

Kalahandi/ M.Rampur SEBAJAGAT [email protected]@hotmail.com

Ganjam/ Rangailunda Citizen’s Association for Rural Development (CARD)


Sambalpur/ Jujumura Bharat Integrated Social Welfare Agency (BISWA)

[email protected], [email protected]

Sundargarh/ Tangarpalli Self Employed Workers Association Kendra(SEWAK) [email protected]

Jharsuguda/ Laikera Social Education for Women’s Awareness (SEWA) [email protected]

Rayagada/ Ramnaguda Shakti Organisation [email protected]

Koraput/ Lamptaput Asha Kiran Society [email protected]; [email protected]

Nuapada/ Komna Banjari Akshyam Seva Kendra (BASK)


Karnataka

Odisha

Christian Medical Association of IndiaA - 3, Plot No 2, Local Shopping Center,

Janakpuri, New DelhiDelhi - 110058

Phone: +91 11 25599991/2/3; Fax: +91 11 25598150Website: www.cmai.org

Child in Need InstituteCINI Resource Centre

CINI Vill:Daulatpur, P.O.- Pailan, Via- JokaWest Bengal-700 104

Tel: +91 33 2497 8192/8206; Fax:91 33 2497 8241Email: [email protected] Website: www.cini-india.org

Centre for Health Education, Training and Nutrition Awareness (CHETNA)

B-Block, 3rd Floor, SUPATH II, Opp. Vadaj Bus Terminus

Ashram Road, Vadaj, Ahmedabad – 380 013, GujaratPh. No- + 91- 079-27559976/77,Fax: +91- 079-27559978

E mail: [email protected] / [email protected]: www.chetnaindia.org

RUHSA DepartmentChristian Medical College

RUHSA Campus P.O Vellore District, Tamil Nadu – 632209

Phone: 04171 246251-52/Fax – 04171 246255 Email: [email protected]

Website: www.cmch-vellore.edu/departments/ruhsa

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