Details for Reform Option "Training of community health workers, Maharashtra"
The District of Osmanabad is one of the most underdeveloped regions of Maharashtra. The region is drought prone and impoverished. The caste system is prevalent and the women have a low place in the society.
An earthquake rocked Latur and Osmanabad districts in 1993 which left nearly 10,000 dead and another 10,000 crippled for life.
It was at this time that HALO Medical Foundation (HMF) started training and working with women of the area to provide basic health services. Bharat Vaidyas, as these women are called, were given a basic residential training of 21 days followed by three 7-day refresher courses quarterly. The topics covered in trainings are quite vast- health aspects included the primary health care set up of the government; causative factors and treatment of common diseases like diarrhoea, pneumonia, fever and STDs, HIV/AIDS; antenatal, postnatal and neonatal care; pharmacology of 20 drugs. Other topics include water and sanitation; violence against women; training in formation of self help groups and communication skills.
Criteria for selection of Bharat Vaidyas are that they should be literate (educated at least up to middle school -class 8). They are recommended by self-help groups, villagers and the mahila mandal (women’s group). Preference is given to widows and women from oppressed classes.
She is self reliant because she collects charges directly from the community. HMF purchases drugs from LOCOST Baroda (LOCOST is a public, non-profit charitable trust that makes essential medicines for those working with urban and rural poor in India- for more on LOCOST, see link below). Every year, the list of drugs sold is prepared keeping a margin of 25%. This margin forms part of the women’s incentive.
Her duties include:
Treatment of minor and medium illness.
Registration of births and deaths.
Antenatal case registration, examination and immunisation.
Identification of high-risk cases and timely referral.
Conducting health surveys in the village.
Organising women and forming self-help groups.
Co-ordination with government health services.
Promoting micro-insurance in health.
In order to empower the village women and enable them to afford the fees of the Bharat Vaidyak, women are formed into self-help groups. The self-help groups generate income through various activities such as kitchen gardening, animal rearing, small businesses such as grocery shops, bangle selling, vegetable selling and tailoring.
HMF established the Sanjeevani Mahila Bachat Sangh (a collective of women’s savings groups). Each group has between 9-15 members where each member saves INR 25 per month and gets an annual interest rate of 10% on her savings. Loans are given to members from this fund for a period of 10 months at an annual interest rate of 24%, the rules and eligibility criteria for which are set by the members of the Sangh themselves.
The health programme is connected to other social mobilisation activities. Social education programmes through Kalapathaks (traditional folk dancers) and social animators is another important feature of the programme. Women’s self-help groups form the basic unit of mobilisation and community organisation and they act as the nodal points of awareness building and education.
Other initiatives undertaken by HMF include:
Savali Kendra (Women and Violence documentation and intervention centre).
Training of Adolescent girls.
Prevention of Mother to Child Transmission of HIV -Jeevanrakshan Project (AIDS awareness).
Life and health insurance scheme for self-help group members (see separate entry on the insurance scheme).
Presently (February 2005) 64 workers are working in 54 villages.
Report of the work done by Bharat vaidyas (1 January to 31 December 2004)
Total villages covered 42
Total Bharat vaidya workers 47
Total number of patients examined 12,950
Patients referred 474
Total expenditure of treatment INR 46,125
Average cost per episode of illness INR 3.50
Training cost is INR150 per day inclusive of lodging, boarding, educational aids, hon. & travel for resource persons.
Total cost inclusive of bag and drug kit in first 21 days training goes up to INR 5000.
Costs are borne by HMF through donor funds -Indian Express Citizens Relief Fund and OXFAM supported the training costs initially.
Tulajapur, Lohara and Omerga blocks in Osmanabad district, Maharashtra.
Community involvement: Village women selected by the community are trained.
Empowerment: Women’s empowerment through set up of self-help groups.
Acceptance: Because Bharat Vaidyaks are part of the village community, they have access to the people - particularly the women in the village.
Possible opposition: Stray examples of opposition from established quacks (also known as Rural Medical Practitioners or RMPs).
Willingness of the women, availability of an institution (such as HMF) to provide technical assistance and training facilities.
Who needs to be consulted
Government health staff, experts in community health who have practically worked in the area, local community.
Initial funds required to set up the training centres and provide training. Once trained the women collect fees for providing services.
Chances of Replication
Good and especially useful in places where there are no government health facilities. The programme should be designed as per the geographic location and local requirement. Linkages with the existing system are essential. It would not work if there is a duplication of services.
Sara Joseph, Researcher, ECTA, New Delhi, February 2005.