Details for Reform Option "Jeevan Suraksha Programme, Gujarat"
Self Employed Women’s Association (SEWA) has been working in Gujarat to improve the health status of women in the unorganised sector since the mid 70s. However, in its course of work and interaction with members, SEWA realised that simply curative services are not enough to improve the women’s health. It needs a change in the mindset of the women, who give the lowest priority to their own health. Therefore, the need was felt for health promotion services, especially in the area of reproductive and child health.
Under a tripartite arrangement between SEWA, United Nations Population Fund (UNFPA) and Government of India (GoI), Jeevan Suraksha Programme was launched for poor women in November 1999. Geographical coverage of the programme was limited to four districts—Kheda, Patan, Anand and Ahmedabad city. It was based on strengthening of the public system rather than creating a parallel system. The main focus of the programme was to protect the health of the members and their families by improving access to healthcare and also helping women to prevent or detect the diseases at an early stage.
Camps were organised for diagnosing Reproductive Tract Infections (RTI) and Sexually Transmitted Diseases (STD), for providing mother and child health and family planning services. Medicines were made available at a very low rate in the camps, subsidised by project funds. Camps were organised in collaboration with private practitioners or Medical Officers (MO) of the Primary Health Centre (PHC) in that area. A total number of 297 camps were organised in 2000, 333 in 2001 and 290 in 2002.
The presence of such a large gathering of women at these camps also gave an opportunity to build awareness among women and adolescent boys and girls on issues of reproductive health and gender. This education focused on simple, useful and basic lessons on reproductive healthcare, sexual hygiene.
UNFPA provided funding and technical guidance for the project.
Change in the mindset, which is evident through increased participation of men and adolescent boys in the health programmes and enhanced sensitivity of the government health service providers towards the poor. Figures are not available, but the demand for education on reproductive and sexual health resulted in the formation of a men’s cooperative; this cooperative plays an active role in immunisation programmes.
The cost per camp was up to INR 5,000. Government infrastructure was sometimes utilised with SEWA bearing the mobilisation cost. All other support was provided by UNFPA.
In four districts: Kheda, Patan, Anand and in Ahmedabad city in November 1999.
Approximately one year.
Awareness generation: Sensitisation of adolescents and pregnant women has helped in creating an environment conducive to delivery of health services.
Demand generation: Awareness generation has led to felt need, thus generating the demand for services, especially for treatment for RTI/STDs.
Male involvement: Participation of men was encouraged in the reproductive health programme; this makes the decision-making process on reproductive health issues easier for women.
Working women: Coordinating with the working women, to make an additional demand on their time, has posed a challenge to involve them in the programme.
Quality of service: Only identifying patients who need referral for complicated procedures is not enough. Linkages have to be made with a view to providing quality service to the referred patients.
Male participation: Changing their mindset and bringing them into the stream of reproductive health issue needs a lot of effort by health care providers. But once they get involved, they provide a new momentum to the health services delivery.
Agreement with the involved agencies (UNFPA and GoI).
Who needs to be consulted
Local Chief District Health Officer.
Primary Health Centre Medical Officers.
Donor agency representatives.
Certain key elements in the programme have been adopted for their lasting impact. For example: Project’s linkage with government programme rather than creating a parallel system.
Involvement of local private practitioners.
Involvement of men in decision-making.
Implementation through local associations or cooperatives.
Chances of Replication
The project was extended to all the blocks of Ahmedabad district.
In the unorganised sector, reproductive health is a neglected issue. Creating a felt need leads to a demand for services. Awareness generation and involvement of men in the decision making process are key factors here.
Dr. Anuradha Davey, Research Consultant, National Institute of Medical Statistics May, 2006.