A communications initiative for a balanced, planned and stable population
Making Change Happen
AMCHI promotes community participation in social development activities at the village level
Over the past few months, we have been sharing with you the impact of our various interventions involving the media, youth and community to promote a positive image of the girl child.
Simultaneously, we have also been making a difference in the lives of the villagers of 50 villages of the Shahapur block in Thane district through our AMCHI project. Action for Mobilising Community Health Initiatives (AMCHI) is our field-based primary health care project, which aims to:
- Mobilise communities to encourage preventive and promotive health care in families and communities
- Create demand for quality services from service providers
- Strengthen the communication skills of the service providers and reinforce their role as change agents
Shahapur is one of the six tribal blocks, which are extremely socially and economically backward despite their proximity to the metropolis.
Given the aims of the project and the abject poverty and backwardness of the area, we adopt intervention techniques that are participatory in nature and motivational in impact. The micro-planning process involves intense interaction at the community level, after eliciting the cooperation of all important players in the community and the five important grassroots workers at the village level viz., Auxiliary Nurse Mid-wife (ANM or health worker), Anganwadi worker (pre-school teacher), Sarpanch (representative of local self-government institution at the village level), school teacher and the sanitation worker.
The micro-planning process often leads to issues other than health as a priority for the villagers, such as quality of water, state of the school building, quality of teaching or implementation of the mid-day meal scheme in the Anganwadi centres. Though we try to keep our focus on health, it often becomes more of a village development programme, which is as it should be, because health cannot be pursued as a goal independent of overall development.
We measure our success by the emergence of local leadership and the revitalization of the local institutions. Only then are the action plans owned and pursued by the community on a sustainable basis.
We have been working in the villages since October 2006 and are proud to say that there has been a tremendous impact - measured quantitatively through decrease in malnutrition, increase in institutional deliveries and attendance in Anganwadis and schools and qualitatively through the community demanding services and accountability from authorities.
The results may not appear grand but are very satisfying and give us the incentive to pursue our efforts despite setbacks and heartbreaks. We are working on our experiences to streamline the processes and hope to soon standardize this model for replication across the country.
We share some of our success stories with you in this issue.
Making Motherhood Safe
Women avail Janani Suraksha Yojana Scheme in Chinchwadi
Chinchwadi is one of the villages adopted by Population First under AMCHI. One of the major problems identified during micro-planning was maternal and infant morbidity and mortality. 
The reason was that the villagers did not register pregnant women with the Primary Health Centre (PHC) for ante-natal care (ANC) nor did they go in for institutional deliveries. There was a mid-wife who assisted the deliveries if necessary at home.
The reluctance was due to the following difficulties faced by the villagers for availing the facilities at the PHC:
- Distance - it was 2km away and they needed a vehicle to get there and they did not have the money to pay for it
- Nobody at home to look after the kids during the hospitalization of women
- Expenses involved in hospitalization
- Lack of knowledge about the Janani Suraksha Yojana (JSY) under which the every pregnant woman is paid Rs. 100.00 on registration and Rs 700.00 on institutional delivery
- No ANM at the Dehne sub-centre, which caters to Chinchwadi
This was in June 2007
Resolving the issues
All the above issues were brought to the notice of the district authorities and the Medical Officer at PHC Dolkhamb, who assured the villagers that an ANM would be appointed shortly.
In August 2007, Ms. Desle joined as ANM. In the first week of September 2007, the first-ever meeting of all ANC and Post-Natal Care (PNC) women was held with the ANM. The benefits of pregnancy registration, blood tests, nutrition, rest, vaccinations and institutional deliveries were emphasised. The incentives offered by the Government under JSY were explained.
Dinesh Patkar in Dehne, a neighbouring village had a vehicle and he agreed to lend his vehicle when he was told that he would be paid for transporting the pregnant woman to the sub-centre/ PHC (under the National Rural Health Mission).
Another meeting of the ANM with the women was held last week of September 2007 where the women who were eligible for the incentive under JSY were paid accordingly and the telephone number of Mr. Dinesh Patkar was given to the women. In October 2007, of the six deliveries in the PHC, four were of women who had delivered their earlier children at home. In December 2007, all the four deliveries took place in the PHC. Dr. Dhere, Medical Officer, PHC Dolkhamb said “Your (PF) interaction with the villagers and counseling on health issues has greatly facilitated our work”
Today all deliveries are in the PHC.
Harbingers of Charge
The Women Self-Help Groups of Alyani
Alyani is a village under Kinhavali PHC in the Shahapur block, which already had eight Self-Help Groups (SHGs) when we began our work there. The micro-planning process revealed that the SHG groups had no understanding of the operational details of micro-financing. It was found that even though some of the SHGs had been in existence for more than two years they had received no grant or loan for lack of knowledge that this facility was available. Thus the SHGs were inactive and in some cases defunct.
It was clear that the villagers did not appreciate the concept and the benefits of SHGs. For empowerment of the women, it was necessary to revive and revitalize the SHGs. A melava (fair) was organized in Alyani in the community temple in August 2007. About 200 women from the 10 villages – Alyani, Devlichapada, Vithalgaon, Gegaon, Kahrivali, Gundyachapada, Chikhalgaon, and Vachkhole – participated in the melava.
The concept of SHGs, the benefits to the individual, group and community and how it can empower women was explained. Following intense discussion and thrashing out of issues and doubts, the SHGs of Alyani came forward and sought assistance in checking their records, understanding the records/ accounts and how to maintain them. This process revealed that there was misappropriation of funds in some SHGs. Vandana Walimbe, president of Mahalakshmi Group pointed out that this happened where there was interference from the men. Each woman was encouraged to understand and seek accounts and accountability from office-bearers and members. After the melava we were happy to see women come forward and ask the secretary for the records.
The process had been set in motion.
Some days later when the PF team visited the village, a group of men lead by Dilip Pashthe, president, Pani Purvatha Samiti threatened them saying “Why did you need to give all that information to the women? We are capable of managing our affairs.” We reported this to the Gram Panchayat members and Upa-Sarpanch who immediately reprimanded Pashthe and told him “whatever they (PF) are doing is at our behest and for our development. The effort should be supported by all.” The women of the village also confronted Pashthe and warned him against misbehaving with the PF team. The Extension Officer’s visit to the village motivated the women
“It is only because of the micro-planning process and efforts of PF that such a programme was held in our village and the Extension Officer, Panchayat Samiti visited our village for the first time. More such programmes should be organized by the Gram Panchayat” said Usha Godvinde, Membe of Mahalakshmi SHG.
More power to the women!
Saving Precious Lives
Community tackles child malnutrition in Chinchwadi
In April-May 2007, the micro-planning exercise in five villages (which includes weighing the pre-school children to detect malnourishment) identified malnourishment as a major issue. Unfortunately the Anganwadis which were entrusted with the responsibility of looking after cases of malnutrition were not working effectively and the number of malnourishment cases recorded by them in the official records was 
far less than what was observed by our team during public weighing of children.
We found that 38 children were in Grade III and IV i.e. severely or critically malnourished. Of these 38, 25 were from Chinchwadi. The reasons were many (our first story would have given you the general drift) but for the village and these children it was important to change the situation.
How was this done?
- Our team made home visits to each of the families.
- The signs and symptoms of malnutrition and the consequences were explained.
- The importance of the following were explained:
· Regular attendance at the Anganwadi
· The role of the Anganwadi worker
· Taking the children to the special camps organized by Health Dept., for malnourished children.
· They were told to demand and feed the children jaggery and peanut ladoos given free under the Integrated Child Development Scheme (ICDS).
“Because of your counselling, I admitted my child to Rural Hospital. Thanks to your efforts, he is getting proper attention and service from the medical staff of RH and his health is improving.” Janki Khair, Mother of a severely malnourished child
The weight of the children was regularly monitored and the improvement - very slow but steady – was sustained. In November 2007, the number of malnourished children in Grade III and IV was reduced to 4.
Ensuring a better tomorrow for the children
Anganwadi enrolment initiative in Vihigaon
While preparing for the micro-planning in Vihigaon, the PF team was walking through the village to observe the daily activities and get acquainted with the villagers. In the most interior portion of the village they observed that all the children who should have been in school or the Anganwadi were at home. During the survey, it was found that this part of the village is inhabited by Katkari Advisasis. They are basically agricultural labourers and barely earn enough to eke out an existence. Anganwadi, school, education had no meaning for them.
There were only 17 children in the Anganwadi on March 12, 2008 when we visited them.
To initiate the micro-planning process, it was decided to call the first meeting on March 13, 2008 in the adivasi pada. The villagers, pada workers, members of Gram Panchayat, Gram Sevak and youth groups attended the meeting. After explaining the objectives of micro-planning, our team presented the case study of Triyambak Ganga Bhoi and his family. He had three sons, all of whom were married and had 11 grandchildren between 3 and 7 years of age. But none of them had ever been to an Anganwadi or school.
Triyambak was asked whether he liked his work as a labourer. He replied in the negative adding, “Since I could not get a job I had no option.” When asked why he could not get a job, he said, “Because I was not educated.”
The same discussion was carried out with his 3 sons. Through this, the point was brought home to the villagers that education is necessary for understanding the environment, resources, opportunities, and for improving the standard of living. In their present condition despite 4 men in the family working as labourers, they were barely able to sustain the family. And by not educating their children they were perpetuating this cycle of poverty.
Information about the role of the Anganwadi and facilities available were explained in detail and the community was urged to utilise them for their benefit.
On March 14, 2008, there were 46 children in the Anganwadi and some children were even accompanied by their mothers.
Creating “Open Spaces”
The ARSH initiatives in five villages of Shahapur
Child marriages and early pregnancies are prevalent in tribal as well as non-tribal areas in Shahapur. They result in health consequences like:
- Premature babies
- Multiple pregnancies
- Anaemia
- Child mortality etc.
and socio-economic consequences like
- Lack of or very low education among women
- Poor workforce participation
- Inability to achieve any personal growth and development
The health consequences are compounded by the poor nutrition status of adolescent girls.
The PF team coordinates with Anganwadi workers to provide nutrition services to adolescent girls and pregnant and lactating women. Simultaneously we work at empowering the adolescents by providing them life skills and information about sexual and reproductive issues. Girls need to understand their anatomy to make decisions regarding their marriage, pregnancy, contraception and overall health.
With this objective, we conducted Adolescent Reproductive and Sexual Health (ARSH) sessions for more than 80 adolescent girls (13 – 19 years) in the Sakurli, Panchghar, Alyani, Devalichapada and Chinchwadi in October 2007.These workshops provided girls with not just the information but a social space which was non-judgmental, open and responsive to their needs. The girls expressed a desire to have more such workshops, which talk about their own lives and teach them how to deal with it. Issues to do with physical relationships, unwed pregnancies and contraception were the core areas of concern for the girls in many villages.
Usha, a teenager from Chinchwadi was married to the boy from neighbouring village at the age of 14. She was not ready for the responsibility that marriage had brought to her. Her husband being an alcoholic was just one of her marital problems. After six months of marriage Usha returned to her parents for good. Usha wanted to study further which she had left to look after her younger siblings. On learning about her from an SHG member our field staff contacted her in the village and informed her about the workshop on ARSH issues by Population First. “I had never attended such a meeting before! It was something that I couldn’t have imagined in the village,” Usha recalls. After attending the workshop she became more concerned for her friends who were sailing in the same boat and needed education on sexual and reproductive health issues. She initiated a dialogue with them in an informal way.
Usha feels that at this point of time she might not be in a position to counsel her friends on this issue but would like to work as a link between them and Population First.
Contact Us
Population First
Shetty House, 3rd floor, 101 M.G. Road, Mumbai 400 001, India
Tel: 91 22 2262 6672 / 76 Fax: 91 22 2270 2217
Email: info@populationfirst.org
Website: www.populationfirst.org
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