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Sahiyya Movement, Jharkhand
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Subject Area="Community participation." Objective="Community health workers."
Details for Reform Option "Sahiyya Movement, Jharkhand"
Summary

Background: Jharkhand is a predominantly rural state with a large tribal population living in highly inaccessible areas. There has been no tradition of Panchayat Raj Institutions (PRIs) in the villages resulting in little or no community organisation. In order to provide quality healthcare services to the ‘last person in the last household of the last village’ the Government of Jharkhand (GOJ) initiated the Sahiyya Movement after a pilot in 2004 to encourage community participation in delivering quality health care to the needy and empowerment of women. Action: Non-Government Organisations (NGOs) work in partnership with the State Government to organise Village Health Committees (VHCs) in every village. Each VHC is encouraged to start a Village Health Fund from community resources to help fund its activities which include identifying and addressing health issues in the village. It is also empowered to develop a Village Health Plan (VHP) with active involvement of the community. The programme aims to focus on women and children in marginalized sections of the community, particularly those in remote, unreachable areas. The key activity is the establishment of community health workers called Sahiyyas, democratically selected by the community and approved by the VHC. The eventual goal is to have one Sahiyya per hamlet. Criteria and job description of Sahiyya: (i) A woman of reproductive age who is resident in the village, is (preferably) married, is functionally literate and has good inter-personal communication skills and social acceptability. (ii) Selected by the community and VHC, paid by the community in cash or kind (no honorarium provided by GOJ). (iii) Acts as a link between the community and service providers and works alongside the Anganwadi Worker (AWW) and Auxiliary Nurse Midwife (ANM). (iv) Works to promote health education. Helps to prepare the VHP. (v) Facilitates integrated mother and child health care, encouraging Antenatal Care (ANC), institutional delivery and routine immunization. (vi) Provides family planning advice and first aid. (vii) Agent for institutional referral and follow up treatment. (viii) Village depot holder for all family planning techniques. Each Sahiyya is given 21 days training consisting of 7 modules and including preventive and promotive primary health care. The training is organised at block level. Every six months there is a Sammelan (gathering) for the Sahiyyas to share their experiences with other stakeholders including NGOs, faith-based organisations and departmental officials from health and other convergence departments. Future activities planned: (i) Strengthening of a Sahiyya Working Group which include officials from health department, NGOs and faith-based organisations. (ii) Involvement of other departments for example social welfare and education, to promote better convergence. (iii) Development of guidelines for Sahiyya as well as communication aids (IEC) for her use in the villages and training materials. (iv) Identification of more NGOs for implementation. (v) Orientation of district and block health service providers. Results: Approximately 1,000 VHCs have been formed and 1,000 Sahiyyas chosen (as of end January 2006). Seven NGOs have joined the scheme and are working in 34 blocks supporting VHCs and Sahiyyas, There is already better convergence between the health, social welfare, public health education and rural development departments.

Cost INR 10 lakh per block for 18 months. Funds are provided by Government of India (GOI), GOJ and also by European Union.
Place Jharkhand since 2004.
Time Frame One year.
Advantages

Empowering: Encourages the community to focus on their own health needs. Acceptance: Healthcare and advice provided by a woman the villagers know and trust. Cost effective: Ensures a wider reach of health services without great cost to the health department. Wide reach: This programme reaches all the villages in the State irrespective of its location and culture.

Challanges

Needs flexibility: The State has a very varied topography and cultures. Motivation: Perseverance is required to engage communities with rigid beliefs and practices. Education: Training of minimally educated Sahiyyas in local dialect. Self sustaining funds: Sustaining VHCs with community contribution.

Prerequisites

Capable NGOs working in the community. Motivated facilitators, cooperative community.

Who needs to be consulted

Government officials, NGOs and faith-based organisations.

Risks

Sustainability

Good as this is essentially a volunteer scheme. However sustainability will depend on the Sahiyyas’ motivation and on a continued commitment from the GOJ to pay for training, drug kits and materials. Training is now funded by the GOI and GOJ. Once the programme has taken off, VHC will contribute to the recurring expenditure from community contributions.

Chances of Replication

Should be replicable in any State which has capable NGOs and effective community leadership.

Comments

Jharkhand will continue to use this scheme rather than adopting the Accredited Social Health Activist (ASHA) scheme recommended in the GOI’s National Rural Health Mission.

Contact

Submitted By

R Gopa Kumar, ECTA State Facilitator, Jharkhand. February 2006.

Status Active
Reference Files
Sahiya Movement Jharkhand Presentation.ppt Powerpoint presentation: Sahiyya Movement: Government of Jharkhand. January 2006.
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