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Focus 1995 January - March English |
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DAMOH PROJECT IN M.P. MAKES HEADWAY
From June 1, 1994,
the
Po pu la ti on
Founda tion of Ind ia
this update, we present
here the salient features
and progress in the DaJl10h
(PFI) la u nch ed two
Project in Mr.
integr a ted projects to
"accelerate the pilce of
decline in infant mortality
Demographic
Features
a n d fertility through
strategic interventions."
('Focus' April- June 1994).
One of these-covers Darnoh
block of the district of
same name in a tribal
dominated area of Madhya
Pradesh (the other is
located in [aunpur block
of Tehri Garhwal district
of Uttar Pradesh). These
projects are a collaborative
effort
between
the
Popula tion Founda fion of
Ind ia a nd the I D RC, L-
Darnoh block covers all
area of 941 sq. krns and a
population of1,4R,041 (1991
Census) spread over 2J2
inhabited villages. The
district of Darnoh had a
high infant mortal ity rate
of 1R9 and an equally high
total fertility rate of n.21.)
(19H1 Census). With female
literacy rate of JO.4n, the
total literacy rate in the
district in 1991 was 40.27.
-.l
Canada born out of their earlier collaborative project
Implementing Agency
entitled" Infant Mortality and Fertility - An Enquiry The task of implementing the project was entrusted
into Infant Mortality in India and its Relationship
to all NGO - Grameen Navjagruti Yojna - with Mr.
with Fertility", designed to identify the proximate
Rajkamal David Lall of the Mid- lnliiil Chr istian
determinants of infant mortality in India. To incorporate
Mission, Darnoh, as the Project Director and Mr.
the area-specific variations, a coinprehensive study Harish Khanna, Executive Director of the PFI as
was conducted in five States of India representing
Coordinating 'Director. The PFI hils·· sanctioned a
hilly areas, rural areas, tribal ar.ea~ and ~r~an slums. .budget of Rs. ]2.72 lakhs for project activities spread
These projects (along with the' -Phulbani Project 'over: two, years.
initiated in Orissa on June 17, 1992) represent the
intervention stage of the study and are based on the Important Objectives
,.
premise that high
linked to fertility
drastically reduced,
fertility.
infant mortality is inextr icably
and unless infant mortality is
there will be little reduction in
The ma in objective are:
(i) to develop appropriate,
coordinated intervention
risk factors.
area-specific
and
strategies to reduce
While the project in Orissa is entirely funded by the
PFI, the projects in UP and M Pare
jointly funded by IDRC and PFI. In
PROJECT UPDATE
(ii) to implement the designed innovative
interventions
through the existing
government
infrastructure,
further
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streamlined
and
strengthened
DY
special training and
with the help of local
community resour-
ces including NGOs,
TBAs, CHVs, ANMs,
Anganwadi workers.
(iii) to augment software
inputs
such as
training, supervision,
communications and
information support.
(iv) to monitor
and
evaluate the efficacy
and effectiveness of
these interventions
for application on a
wider scale.
Initiation of the
Communication Channels: Folk songs and street plays heighten the awareness of the community.
Project
A base-line survey sched ule was developed a t the
Foundation in consultation with an expert. The
schedule was designed to assist in the census of
pregnant women in the block and identification of
pregnant women at risk. All registered women,
pregnant between six weeks and six months, are
followed-up through the term of pregnancy, and
three months post partum which covers the post-
natal phase requiring special attention to the newborns.
In addition to the project staff consisting of one
Project Assistant (a P.G. in Public Health), four
trained nurses with extensive experience in the area
Educa tor and an Administrative
Assi stant, active
support of five para-medic Counsellors working in
the Grameen Nav Jilgruti Yojna, has been enlisted to
assist in project activities like community mobilisation,
awareness generiltion, motivation arid counselling
from time to time.
Since Dais wield considerable influence illlll1ng the
local populace handling ~() per cent of the deli~eries,
206 Dais were identified with a view to first assisting.
field workers in baseline survey and subsequently as
mobilisers of health intervention for mother and
children and link workers to relate identified pregnant
women at risk to the block-level health facilities.
as Field Workers, one nurse tutor as Extension
Training Programmes
Trained Dais: Kit bag and uniform have given a new status and image in the
community to these grassroot level health workers.
Training, especially of Dais, is
(In essential component of the
project. So far, two three-day
Dai training p rograrnrnes have
been cond ucted for selected Da is-
150 in number. A pre and post
evaluation of Dais was done.
Dais who underwent training
were provided with a Dai Kit
bag and a uniform on an
experimental basis. It was found
that all this helped to improve a
Dais status and image in the
cornrnu nity, and her advice was
now taken more seriously. A
visit to five villages in the project
Mea showed that the Dais were
working very effectively, visiting
pregnant women and preparing
them for sa fe del ivery.
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National Family Health Survey Reveals
40 Per cent Women use Cotraceptives
Nearly 40 per cent of married
women in tlae country have
adopted family planning
measures - 36 per cent using
modern methods and fou r per
cent relying on traditional techniques,
according to the National Family
Health Survey (NFHS) 1992-93.
Conducted by the International
Institute for Population Sciences,
Bombay for the Union Ministry of
Health and Family Welfare, the
Survey covers 24 States and the
Union Territory of Delhi. Its
objective: to provide State and
National level estimates of fertility,
infant mortality practice of family
planning and MCH care services
and their utilisation. The information
is intended to assist the policy
makers and programme administra-
tors in formulating the strategies
for improving the family welfare
programme.
Among the major States, the highest-
ever use of any contraceptive
method was recorded in Kerala
(75 per cent) and lowest in Uttar
Pradesh (26 per cent). More than
70 per cent of women had used
contraception in Delhi, Tripura
and West Bengal and more than 60
per cent had used in Himachal
Pradesh, Punjab and Assam,
accord ing to the survey.
Only six per cent of currently
married women use modern spacing
method. The use of the modern
spacing method in urban areas
was 12 per cent, much higher than
rural areas which had a rate of 3
per cent. In Punjab, the use of
spacing method W<lS highest (17
per cent).
"In the two most populous States,
Uttar Pradesh and Bihar, less than
one-fourth of women were found
to be using methods of family
planning and the situation is only
slightly better in Rajasthan, Orissa
and Madhya Pradesh, the survey
pointed out.
Tr ad itiona l methods of family
planning, mostly periodic abstinence,
are used by only four per cent of
Indian women, ranging from a
low of less than one per cent in
several States. West Bengal and
Assam are characterised
by
unusually high p rev a lence of
tr a d i tiona I rne t.ho d s, w h ich
constitute 35 per cent and 54 per
cent of total contraceptive
prevalence, respectively.
According
to the survey,
Maharashtra
is the only State
where the prevalence rate of the
use of contraception W<lS higher in
rural areas (54 per cent) than
urban areas (53 per cent). However,
the urban-rural
differential W<lS
quite small in Tamil Nadu and
severa I other low fertil ity Sta tes.
The gap between the urban and
rural areas was substantial in
Bihar, Rajasthan, .Uttar Pradesh
and other small states.
.6-.H Club.
Rradersll;Meghalaya;Rajasthan
and Assam. Uttar Pradesh stands
jh~~~i2~t.D\\J.·.r~••*~~~g~7h i~n .a•.
feqiJitY·.mor~ than ..4•0 •p. e r.Genthi9.~Tr••.•.
.;.;.
'-:-:«.,:
..
In her address at the U.N. on
World AIDS Day, the then
Surgeon General, Dr. Joycelya
Elders of the USA, said far
too many children have
become members of "the 5-
H Club - hungry, health less,
homeless, hug less and
hopeless." And she said, a
sixth H now plagues their
future - the threat of HIV
infection. Elders said that
social ills such as violence,
substance abuse, and teen
pregnancy share the same
roots as HIV and AIDS -
poverty, lack of education
and lack of resources. Elders
solution to these problems
also included an "H" word -
"education, access to care
and hope."
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DAMOH PROJECT
(From Pg. 2)
Planned Health Interven-
tions
Planned health interventions are
being implemented by means of a
mobile health set-up, consisting of
a doctor, four nurses and an
extension educator moving from
village to village. All registered
women
had
been
given
irnmunisation,
urine and blood
examination
and iron folic
supplementation
where needed.
In case of any serious complication,
the cases were immediately referred
to the PHC/hospital.
Communication Support
Support communication
is an
important intervention. Communi-
cation material in the form of
audio and video cassettes, flip
charts, flash cards procured from
various sources has been made
available to the project team. The
mobile health unit which is provided
with a VCR and monitor has
already shown three films on
various health aspects of pregnant
women and newborn babies, in
each village. More films on relevant
topics <He being provided to the
Project Din: .tor.
A popular folk music group was
commissioned to develop folk songs
in Bundelkhandi, the local language.
Similarly, a street play group has
developed some street plays on
child survival and safe motherhood.
With the help of sarpanches, these
plays are organised in a central
location once a week. During a
recent visit, the PFI staff attended
one such programme which had at
audience of 15()() people. A random
on-the-spot survey showed that
the messages being communicated
had registered well with the
interviewees. "Many more such
progra mrnes to heighten the
awareness of the community are
on the anvil", says Mr. Har ish
Khanna who maintains a vigilant
eye on the progress of this and
other two projects in U.P. and
Orissa. According to him, their
successful implementation which
is being duly docu mented, is going
to establish the feasibil ity and
replicability of these alternative
interventions
which could be
incor porated in the national health
progr amrne.
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A Step Towards
Decentalising Fa~ily Plaftning
The Union
Welfare
introduce
Health
Ministry
for the
and Family
plans to
first time a
scheme. to implement fnrn ily welfare
programmes on a decentralised basis.
This follows the increasing real isation
that centralised planning is not pilying
dividends.
The Ministry has drawn up a plan for
four districts in four states on an
experimental basis, based on the premise
that the district should be the unit for
planning. The plan for farn ily welfare
programmes
will promote
lo ca l
planning. an area-intensive approach
and people's partici pa tion.
The fa m ily welfare programme, which
has been operating as a Central scheme
for the past four decades, has come in
for severe criticism from family planning
experts for the manner in which those
sitting in Delhi draw up plans for all
the states without
taking into
consideration specific needs. Though
rather belatedly, family welfare planners
today admit to the folly of such a "top-
down approach", saying this has resulted
in the programme having a "look of
uniform ity across a ll the sta tes".
Since this approach is being tried for
the first time and involves a host of
com plex issues, the fam ily welfare
department has decided to try it out
first in a few pilot districts.
The four districts picked for this
experiment are Meda k district in Andhra
Pradesh, Nagpur in Maharashtra, Dausa
in Rajasthan and Anna Dindigul in
Tamil Nadu ,
Draft plans for these four districts have
been drawn up by the district level
offic ia ls, community
leaders and
resource persons from local-level
institutions who were first sensi tised
with the issues concerned through
series of workshops. The draft plans,
which are now ready to be put into
operation, have taken into account the
needs of the different districts, family
welfare officials point out, adding that
it is likely that "this experience will
provide clues towards replicnbility of
these planning models".
The cost of implementing these plans,
which is also to be worked out by the
local-level officials and leaders, wi II be
shared by the Central government and
the United Nationals Pop ulatiori Fund.
"Mother-in-Law"
Approach to Family Planning
In Rajkot,
Us h a Ma ha nt
organises contests for mothers-
in- law who help to popular ise
family planning. So does Shani Advani
in Bangal ore.
Both the ladies have been working
for several years as representatives
of the Family Planning Association
of India (FPAI), striving to persuade
as many young couples as they can
to adopt family planning measures
of various kinds.
"We found that mothers-in-law were
the biggest hurdle for young women
who wanted to postpone the next
child", says Ms Mahant. "We thought
they would make the effort to
understand why it was important if
our material was presented to them
in the form of a competition,"
she
explained.
.
The response is overwhelming.
At
least 50 to 60 elderly women attend
the gathering and the really ancient
among them have even ca rried the
messClge to their grandchildren,
Ms.
Mahant said, adding such contests
are being held in different locations
at least five to six times a year for
the past four yea rs.
The "mother-in-law
approach" has
also worked wonders for Ms. Advani
of the Banga lore bra nch of FP A I.
"Near l y 100 farn i lies in different
villages have been persuaded
to
stop after just one <child each," Ms.
Advani said.
Side by side, she and her association
have also paid a lot of attention to
other public health measures in the
173 villages that they cover. "When
we starte-d working in Mahadi Mea
about seven years ago, there was not
a single balwa di." Ms Adv a ni
ernphasised. Now there are a number
of them.
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Environment and Population stresses
may germinate anarchy
The global agreement to stabilise earth's population provides that
there will be enough food in the next century, leading US
environmentalist Mr. Lester Brown, has said in his annual 'State
of the World' report.
The plan recognises both earth's natural limits and the need to respect
those limits, Mr Brown says.
The treaty signed in Cairo in September last by more than 100 countries
aims at stabilising the world's population at 8,000 or 10,000 million by
the middle of the next century.
These figures are among the most optimistic projections made by the
United Nations Population' Fund at the time of the Cairo Population
conference. Its estimate of population in mid 1994 was about 5,700
million.
Brown argued that land erosion, overfishing and a levelling of progress
in increasing agricultural yields would make it very difficult to feed this
40 to 75 per cent increase in population next century.
'i! think it is the question that may come to dominate concerns in the
world capitals," he said.
The natural resource base in a number of countries has been depleted
to the point where it can no longer support governments' ability to earn
enough to import foods they need for growing population, he said.
"The bottom line is that environmental unsustainability leads to political
instability", he argued. Environmental, agricultural and population
stresses can weaken governments. Those are some of the reasons for the
political and social breakdown in Afghanistan, Liberia, Somalia, Rwanda
and Haiti, and such anarchy could -happen elsewhere, he warned.
Rs. 1000-Crore Project to.
Combat Industrial Pollution
A Rs .. 1,OOO-crore project to
combat industrial pollution
in the country has been
given a green singal by the World
Bank.
The project, known as World Bank
Pollution Control Project Phase IT,
is mainly meant for providing
loans to industries for installing
pollution control facilities, including
common effluent treatment plants
and industrial water recycling
treatment, as also projects for
recycling municipal water for
industrial use.
The plan envisages various other
components
like providing
laboratory equipments to state
pollution control boards and
redressal of several other industrial
pollution problems.
According to Environment and
Forest ministry sources, phase one
of the project, prepared three
years ago by the ministry, was to
utilise World Bank support to
prevent and alleviate environmental
degrada tion caused by ind u strial
operations in the country. The
project, scheduled to be over by
1997, had been completed much
ahead of schedule and thus the
second phase of the project has
been sanctioned'.
As per the schedule, the second
phase will be from 1994 to 2001.
Integrating environment and
development concerns alone
will lead to the fulfillment of
basic needs, improved living
sptraonsdpaerrdosusanfdutuares.a•fer, more
- From'
Earth Summit Declaration
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ENVIRONMENT
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Private Sector to Help Fight AIDS
The Government's attempt
at curbing the galloping
.
spread of AIDS has met
with limited success. And after
nine years of trying to do the job
by itself, it has finally decided to
involve the private sector.
For the first time in the history of
AIDS management in the country,
the private sector has begun to
get seriously involved in ways of
handling the pandemic that has
already infected about 17,200 people
in the country.
In an international workshop of
AIDS prevention and care organised
by the World Health Organisation
(WHO) in the Capital in Jan. 95,
members of the corporate world
emphasised the need to define the
role of the private sector in the
matter.
Apart from the health admini-
strators, senior officials of TISCO,
the Confederation
of Indian
Industries (CIJ), Federation of India
Chambers of Commerce and
Industry (FICCI) and Sri Ram
Industrial Enterprises took part in
the workshop.
The participants recommended that
a national policy for Workplace
Response to AIDS/HfV be created
and information regarding AIQS/
HIV, especially the projected national
(including economic) impact, be
clearly developed and presented
in a business context.
According to WHO, 90 per cent of
those infected by HIV (the virus
causing AIDS) worldwide are in
the economically productive age
group. And waking up to the
serious implications this has in the
economic development of the nation,
the Government has recognised
the need for a multi-sectoral response
to meet the challenge.
Move to Abolish Child Labour
The Government is preparing
a comprehensive scheme to
divert two million children
engaged in hazardous industries
by 200() AD towards special schools.
Under the scheme, it is proposed to
raise the income levels of the parents
of children who are being removed
from hazardous occupations through
various programmes.
These programmes
included
Intergrated Rural Development
Programme, Employment Assurance
Scheme and jawahar Rozgar Yojana,
according to official sources.
The Government
has already
constituted a National Authority
for Elimination of Child Labour
pending creation of an autonomous
statutory body for those children.
The national authority, headed by
the Labour Minister, has Secretaries
of different
Ministries
and
Departments including Human
Resource Development, Textiles,
Rural Development,
Health,
Information and Broadcasting and
Family Welfare as the members.
The authority will lay down the :
policies and programmes
for
elimination
of child labour
particularly in hazardous employ-
ment and monitor the progress of
Implementation of programmes,
projects and schemes. It will also
coordinate implementation ofchild
labour elimination related projects
of various Ministries.
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On-the-Spot Study of Project Activities: Governing
Board Members Visit Lalitpur and Phulbani Projects
To form a firsthand impression
of the environment in which
some of the PFI-sponsored
projects are being implemented,
two teams of the members of
the governing board of the PFI
visited Lalitpur Project in Uttar
Pradesh and Phulbani Project in
Orissa.
The team which visited Nav Chetna
Project at Lali tpur in the fi rst
week of February 1995 comprised
Dr. D.P. Singh and Prof Ranjit Roy
Chaudhury while the team visiting
At Lalitpur (seated from right) : Mr Harish Khanna, Prof. Ranjit Roy Chaudhury,
Dr. N. K. Bachan and Dr. D. P. Singh.
Tikabali Block of Phulbani district
March 1995 consisted of Mr. B.C.
in Orissa in the first week of Verghese and Dr. B.K. Anand. Mr.
At Tikabali ( seated from left) : Mr. B. G.
Verghese and Dr. B.. K. Anand give an
intent hearing to the project expose.
Harish Khanna, Executive Director
of the PFI accompanied both the
teams.
The teams not on Iy observed action
but also talked to a variety of
people including project staff and
community
leaders to apprise
themselves of the Projects' special
needs and also to explore the
possibility
of developing
a
se lf-susta iu ing p r irna ry hea l th
care and reproductive health system
iter meshed with the government
system but· with a v itali ty of
its own,
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