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RCH %26 SHG - A field experience |
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experl• nc
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The Reproductive & Child Health (RCH) programme of
the Government of India envisages that providing awareness
and services at the grass root level is of prime importance. The
Programme of Action sets out a number of time bound
Population and Development goals for a 20 year period from
1995 to 2015 as provision of universal access to reproductive
health services including family planning and sexual health,
reduction in infant, child and maternal mortality and provision
of universal access to education especially for girls. It stresses
the empowerment of women both as a highly important end in
itself and as a key to improving the quality of life for every one.
RCH programme is being implemented in the country
since 1997. The various strategies and approaches adopted for
its implementation through out the country has given positive
results to the programme in some places while in some other
places, RCH programme is yet to show its results. However,
over the period it could be realised that empowered women
have a better 'say' in any adoption practices than those who are
less or not empowered.
Self Help Group (SHG) is one such experiment,
sponsored by the Central Government, State Governments and
other agencies, which seeks to address the problems of
deprived women in a developing country by bringing them into
the mainstream of life. All over the country, SHGs of women
are formulated as a vehicle towards empowerment of women in
the marginalised sections of society. The women constituting
these groups are bound by common interest and are often faced
with multi-dimensional problems related to reproductive and
child health.
It has been seen in some areas that when women have
come together as an empowered group, they have been able to
mobilize resources and use them for activities like construction
of toilets, introduction of LPG smokeless stoves for cooking,
grain storage, opening shops, income generation activities, e.g.
food processing, toy making, plant cultivation, kitchen
gardening, candle making, tailoring, dairy farming, hotels and
livestock business. The SHG women are also involved in skills
building, village and school sanitation programmes, common
property management, organization of health camps,
addressing issues related to anti-dowry, child marriages and
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alcoholism. SHGs have also taken up training programmes to
artisans on design and technical development, rehabilitation of
fisher folks and livelihood support programme for small
artisans. Another interesting aspect is that in villages where
there was only one SHG operational 10 years ago, now have
many such groups of women who have come together
irrespective of caste, religion or social norms or hierarchy.
The concept of empowering women on RCH was
reinstated by the NGO partners of Population Foundation of
India (PFI)at the meeting held in 2002. It was felt that orienting
SHGs on RCH issues, providing SHGs a platform for discussion
on the issues and creating "change agents" at the community
level will go a long way towards enhancement of knowledge,
awareness and increasing access to basic RCH services.
This led to piloting six SHG projects with NGOs, who had
already established SHGs in the communities The following
partners of PFIwere selected
1. MYRADA, Bangalore has been working in three
southern states, namely Karnataka, Tamil Nadu and
Andhra Pradesh; with a major focus on building
grassroots institutions
2. Social Awareness And Development Organization for
Women (SAADOW), Dindigul District (Tamil Nadu) has
been working in Natham and Sanarpatti blocks in
Dindigul District and Kottampatti Block in Madurai
district.
3. National Institute of Applied Human Research &
Development (NIAHRD), Cuttack (Orissa) is working
with the tribals, the rural poor and of the urban slums
in Cuttack.
4. Centre for Rural Education and Development (CRED),
Madurai District-(TN) which has been working in
Vadipatty block of Madurai district.
5. Bal Niketan Sangh (BNS), Indore (MP)which has been
working in Jobat block of Jhabua District.
6. Voluntary Health Association of India (Aparajita
Project in Orissa) is working in the blocks of
Jagatsinghpur, Kendrapara and Puri Districts.
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The main thrust of these NGOs is to create awareness
among the rural women and implement the programme
through Self Help Groups. They have held a number of training
programmes on issues such as micro credit, health education
and leadership for their development and accomplishment of
goals.
Obiectives
f To identify and train one Animator from each SHG into a
resoUrce person for RCH issues as well as a community
based distributorfor basic health supplies.
f To empower existing SHGs on knowledge of RCH, make
SHGs as a platform for discussions on health issues of
women and children and take need-based action to
improve the same in collaboration with relevant
authorities.
:Six NGOsin five
states with
established SHGs
involved in the
proiect.
An Initial Interface Meet was held at PFI with all the SIX
partners to.
• Discuss in detail the training contents and methodology
to be used in the projectfortraining of Animators.
• Reach to a consensus on important aspects like
implementation strategy, modalities of monitoring and
evaluation after discussion.
• Facilitate interaction between NGOs involved in the
project, who are based in different regions/States of India
and encourage sharing of materials/experiences among
all to enrich the project.
The key strategy was to identify and develop Animators
who could impart knowledge to SHG women and promote
healthy RCH behaviour. Therefore, the Animators as resource
persons for SHGs were the vital link to the project. One
motivated member with good communication skills who could
also read and write was chosen as the Animator from each SHG.
However, the selection of the Animators was made with the
consent of the members of SHGs.
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With the technical assistance from PFI, the NGOs
developed the survey formats and conducted the survey to
assess the knowledge and practices of the Animators and SHG
women on RCH issues. Based on the assessment and keeping
the socio-cultural practices of target communities in mind, the
training content and methodology was finalized with each of the
NGOs. The Animators were trained intensively in a 4-day
workshop by the NGO with the help of resource persons. The
topics covered were-
#' Basic knowledge of reproductive functions of human
body, care of mother and child, contraceptive
methods, RTI/STI & HIV/ AIDS including myths and
misconceptions.
#' Basic skills in training, management of group,
motivational skills and record keeping.
#' Knowledge of specific RCH problems and whom to
approach for these.
The key strategy
was to identify
and develop
Animators to impart
knowledge on RCH
Since the Animators were to further train SHGs in the
communities, they were made to conduct mock/demonstrative
training sessions in the classroom. After initial intensive training,
refresher training was held from time to time to upgrade the
knowledge and skills of the Animators. The Animators under the
supervision and guidance of the NGOs carried out the following
activities -
• Generated awareness on RCH issues both in the SHGs
and other segments of villages, such as women
Panchayat members, Mahila Mandals etc through
fortnightly or monthly meetings.
• Maintained basic records related to RCH e.g. number of
pregnant women, number of contraceptives distributed,
children immunized, RTI/STDcases etc.
• Acted as depot holders and encouraged other members
of the SHGs to act as depot holders for contraceptives
and basic health supplies. As change agents they
motivated and distributed contraceptive and other
supplies at the doorstep in the communities.
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• As liaisoning agents, they built linkages with government
staff e.g. ANMs and other relevant authorities along with
Panchayat members, Mahila Mandai etc. for
improvement in provision of services.
The Animators were given small tokens of recognition
. and a kit containing basic health supplies for effective
functioning in the programme. NGO had an important role in
making supplies available, linking the Animators and SHG
members to services and in IEC programmes.
Cha engesfaced
• Difficulty in finding suitable women to function as
Animators
• Difficulty 'in addressing sensitive RCH Issues In the
community
• Health as such not having importance among SHG
members, created difficulties in initiating discussion on
the same
• Expectation of financial assistance by the SHGs from the
NGO
• Limited participation and cooperation of the government
officials, ANMs, Anganwadi workers etc. in the project.
• Animators needed more capacity building as they faced
lots of questions during interactions in the community.
The above-mentioned challenges were overcome by-
• Continued technical input and support by the NGOs to
the Animators to build their capacity to address sensitive
RCH issues in the community.
• Constant interaction of NGOs and the Animators with
SHGs and communities to address their myths and
overcome any resistance to the programme.
• Promoting Interpersonal Communication among SHG
women and the community.
• Organizing joint meetings with Government health
personnel and Animators by the NGOs.
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• Advocacy by the NGOs with Government health officials
and workers to support the programme.
• Planning for training programmes in collaboration with
the government and facilitating their involvement.
Outcomes
The expected outcome of the project was that as a result
of the project women in the SHG group would be empowered
with knowledge on RCH and take up reproductive child health
needs of the community as an issue to be addressed and
motivate people to take relevant action on the issue. The
implementing agency would also work towards linking these
women with effective service delivery system so that demands
generated in the communityfor RCH services could be met.
Some achievements have been -
• The Animators were able to take a number of sessions for
the SHGs on RCH issues with the help of the NGO who
supported them in terms of facilitating the sessions,
materials, teaching different techniques, e.g. role plays.
• In most cases, the Animators were able to stock and
distribute health products and contraceptives in the
communities.
• In some cases effective linkage was established by the
NGO with village Anganwadi Centres, PHCs, private
doctors, government departments, banks etc. for
contraceptive & health products, immunization, birth and
ANC registration, supporting health camps, Income
Generation (IG) activities, meetings and IEC activities in
the community, training and participation of SHGs in
campaigns like safe motherhood day, breast feeding day
and soon.
• There is a lot of demand from nearby villages for a similar
programme. Therefore, some Animators on their own
have visited and trained SHG women of neighbouring
villages on RCH issues and these SHGs have started
keeping contraceptive supplies.
• In some areas initial resistance of certain groups e.g.
Panchayat members, dais, RMPs etc. have been overcome
by regular interaction of SHG members with them.
Stock of health
products and
contraceptives
made available
with SHGs
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SHGs liaisoned
with health and
govt. departments
to influence
service delivery.
• In a numberofvillages, SHGs have been ableto influence
government for service provision e.g filling up of vacant
posts and regularising ANMs visits.
Sustainability
As awareness is the first step for a behaviour change, the
primary focus of the project was to increase awareness and
knowledge among the members of the communities especially
the women who are the direct beneficiaries of RCH programmes
in RCH and related government schemes.
The project also focussed on building capacities of
community members through Animators as change agents to
address basic RCH needs. The Animators were empowered
enough to carry on the linkages, dialogues and address the
demands generated with the Panchayat members and
government functionaries like anganwadi workers, ANMs etc.
and could continue to playa supervisory role. Training of the
Animators in social marketing provided communities to access
continuous supply of health products.
Since poor economic access, especially for women, has
always been an obstacle to seek health services and the health
seeking behaviour of the communities for preventive care is
much lower than that for the curative care, the project
highlighted the economic benefits of regular ANC check up,
immunization, importance of contraceptive devices over
abortions, early detection and treatment of illnesses. Most of the
SHGs were involved in income generation activities and micro-
credit. Thus, to an extent, the communities were empowered to
sustain basic RCH services by themselves
Lessons learnt
• The approach has supported the ANM in many places to
reach the community with ease hence made them more
effective.
• This approach in some places has also developed a
village level community based monitoring system for
ANMs and Anganwadi staff and made them more
accountable.
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• It has increased the interest of the women in RCH related
activities and has enabled increased use of health
products such as condoms, sanitary towels, pills etc.
• It was seen that even though the intervention was of short
duration generally there was improvement in knowledge
and practices on RCH issues like registration for ANCs,
awareness on use of contraceptives, immunisation and
prevention of childhood illnesses etc both among the
Animators and SHG women.
• It has been seen that women with less resources are in
need of more inputs in knowledge, in health and
continuous interactions and meetings helped break their
myths as well as increase the awareness level.
• The NGOs have gained knowledge and experience on
extending health care projects in the targeted villages. It
has helped the NGOs to collect data on health and
address the needs of the communities.
• Strengthening the existing VHC (Village Health
Committee) and encouraging its proper functioning to
utilize the existing resources such as PHC centers,
common places, availability of health workers etc. adds
to the overall development of the communities.
• It has also been seen that the NGO was able to link up the
Animators to state/govt resources, e.g. PRls,Government
etc. by arranging meeting between them. However this
was more frequent in SHGs who were more organized
and self sufficient.
• Involvement of local administration as well as other
community groups in order to address the Reproductive
Health issues in their concerned villages (this may be
done by providing special training to such groups) is
important.
• The women with leadership quality in the SHGs have
been taken into confidence by the community for any
collective or individual decision. Hence they have
complete information of the community with them. This
human resource can be utilised for other programmes.
• This approach is proving to be a low cost sustainable
method of not only reaching the community but also
providing an opportunity for an ongoing monitoring
system for RCH.
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POPULATION FOUNDATION OF INDIA
,&-28, Qutub Institutional Area, Tara Crescent, New Delhi-11
~one: 26867080 / 81 Fax: 26852766 E-mail: popfound@si
Web site: www.popfound.com