Details for Reform Option "Women Group Leader Programme: Sanjeevanis, Haryana"
It is estimated that only 17% of women in Haryana have institutional deliveries, resulting in a high level of maternal and infant deaths. The sex ratio of Haryana has also seen a declining trend and is at present 861females to 1,000 males (* see “References” box below), one of the worst in the country. This, coupled with a strong patriarchal structure and low education level, leads to the poor status of women in the State.
Based on the lessons learned from the Integrated Women Empowerment and Development Programme (IWEDP) Project (undertaken by the Department of Women & Child Development 1994), the Health Department under the EC-supported Sector Investment Programme (SIP) adapted the programme in three pilot districts of Ambala, Yamuna Nagar and Karnal. While the IWEDP took social development/welfare as the entry point, the SIP initiated a component on women leadership, taking health as the entry point. Women were trained to give health education lessons to women in their communities.
The Sanjeevani (named after an ancient herb that restores life) plays the role of an agent of change. She contributes towards the development of women with a focus on health, nutrition, sanitation, delayed marriages, small families and method of child spacing, along with generating awareness on available existing health schemes and facilities. She works voluntarily, mobilises women of the village into groups and functions as a friend and guide to women and adolescent girls.
The focal point for discussion of various problems is a group of 20 women from the village known as the Jagriti Mandali (literally “awakening group”) which is held at a specific time every week. They are paid INR 100 per meeting to cover the cost of travel and other incidentals. A contingency fund of INR 2,000 is also given immediately after training which is used for expenses on registers, pens, durries (mattresses) and other essentials. The block health educator also attends these meetings and updates the participants with the latest information on new schemes etc. The Sanjeevani makes reports of these meetings which she shares with the Swasthaya Kalyan Samiti of the area and maintains the accounts.
Selection criteria for Sanjeevanis:
(i) need to have basic education - matric (middle school) pass - as well as a strong sense of motivation, leadership qualities and communication skills.
(ii) should not be the wife of a government servant, not have more than three children and should be an active member of the Mahila Mandal (Women’s Cell) or the Mahila Swasthya Sangh (Women’s Health Group).
(iii) Selected by a committee consisting of the district training officer, the medical officer in charge of the concerned Community Health Centre (CHC) and the medical officer in charge of the concerned Primary Health Centre (PHC).
On selection they are given 10 days residential training (including legal literacy; health issues such as ante-natal, natal and post-natal care, immunisation, family planning methods, other common ailments, nutrition, sexually-transmitted diseases including HIV / AIDS; and accounts and record keeping) in batches of about 30 each at the CHC Mullana in Ambala district. The curriculum identified for the training (annexed in the “References” box below) has been developed into a printed module which acts as reference material for discussion on the topics in the Jagriti Mandali.
155 women were trained (10 days residential training) in Yamuna Nagar district between November 2001 and February 2003. A total of INR 9,26,900 has been paid to them through the District Health and Family Welfare Society.
112 women have been trained in Karnal and 171 in Ambala, giving a total of 438 trained.
Confidence levels of women have gone up. They assist the ANM in recording births and deaths and maintain immunisation records of infants in their villages.
Due to financing problems, the Sanjeevani programme was officially halted in June 2003, but meetings are still being held informally by Sanjeevanis who have already been trained. (See sustainability and replicability box for further details). The lessons learnt from the programme will now be put into the State's Accredited State Health Activist (ASHA) scheme under the Government of India's National Rural Health Mission.
Expenditure incurred for one year activities – INR 14,89,650 for the year 2001-02 including the honorarium and contingency expenses to Sanjeevanis, printing of the training module and salary of a training consultant INR. 20,000 per month. Funding stopped in June 2003.
Districts of Ambala, Yamuna Nagar and Karnal from November 2001 - June 2003.
Approximately one year to get the programme going.
Awareness generation: Spreads health messages to grass root level.
Direct link: The Sanjeevanis connect the community with their nearest public health service.
Personalised: Involves women in the health issues of their families as well as their own health concerns.
Client reliant: The endeavour is not an end in itself. Unless the women can take decisions based on what they have learnt, the expected outcome of reducing maternal and child mortality cannot be achieved.
Gender biased: Exclusively a women’s programme, lacks partnership with men.
Possible opposition: Mostly from within the system from those who do not understand the broader issues involved. The scheme can only work with supportive supervision from other health personnel.
Committed trainers: Without committed Non Government Organisation (NGO) trainers, the scheme will not succeed. There is a need for motivation.
Evaluation: To measure the impact of the programme, midterm qualitative and quantitive evaluation is necessary.
Goal incentive: Sanjeevanis should be given some measurable goals to work towards to incentivise them.
Long term process: Change will only be seen in the long-term.
A good conceptual understanding of gender and women’s issues, particular to the region is needed before any programme is started.
Consultation workshops with those having long-standing experience of documentation of processes, lessons learnt and best practices.
NGOs willing to take on training duties.
Who needs to be consulted
State Governments and any NGOs who have undertaken similar initiatives.
Initial funding is needed for capacity building and awareness generation. This was given by the European Commission's Sector Investment Programme (SIP). After that it was expected to take its own course through Panchayati Raj Institutions (PRIs) and other Community Based Organisations (CBOs) although this has not always happened.
The Sanjeevani programme was halted in June 2003, mainly due to the inability to recruit a suitable training consultant when the post became vacant. Lack of good NGOs in the State (who could take up this activity) and strong PRIs was also a barrier to its sustainability. Also the need was felt for the programme to be modified to include a clear conceptual and operational framework.
Chances of Replication
Haryana State Government plans to modify this programme under the National Rural Health Scheme/ Reproductive Child Healthcare II programme and implement it as a link worker scheme.
Sara Joseph, Researcher, ECTA, New Delhi, October 2004.