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Popfocus 2007 October December English |
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4th Asia Pacific Conference on Reproductive and
Sexual Health and Rights
The Fourth Asia Pacific Con-
ference on Reproductive and
Sexual Health and Rights (APCRSH)
was held on October 29-31, 2007
in Hyderabad, Andhra Pradesh,
hosted by the India Consortium on
Sexual and Reproductive Health and
Rights. Mr A R Nanda, Executive
Director, PH was the Chairperson of
the India Organizing Committee as
well as the International Steering
Committee. The overall goal of the
conference was to enhance and
accelerate the process of
operationalizing the sexual and
reproductive health and rights agenda
in the countries of the Asia Pacific
Region.
The overarching theme of the
4th conference was, "Exploring
New Frontiers in Sexual and
Reproductive Health and Rights".
The conference provided a platform
for people with diverse perspectives,
expertise and experience to exchange
ideas, discuss and debate issues of
concern, and learn from each
other about sexual and reproductive
health and rights, with specific
reference to the implementation
of the Programme of Action of
the International Conference on
Population and Development (ICPD,
1994).
In the Asia Pacific Region,
conferences on sexual and
reproductive health (SRH) have been
organized once in every two years to
bring together multiple stakeholders
to take stock of progress and to
share experienceslbest practices. The
first conference was held in Manila,
the Philippines in February 2001.
The second was held in Bangkok,
Thailand in October 2003 and the
third in Kuala Lumpur, Malaysia in
November 2005.
The scientific programme of the
conference included parallel sessions,
poster presentations, plenary
sessions, symposia, satellite sessions,
and skillsbuilding and empowerment
workshops etc. Plenary sessions,
organized in the morning on all three
days of the conference, included
contemporary topics to reflect the
conference objectives. Distinguished
speakers, primarily from the Asia
Pacific Region, delivered lectures at
these sessions. Skills building and
empowerment workshops designed
to provide knowledge and skills to
participants were organized focusing
on strengthening their capacity in
methodologies, strategies and
technologies. Specific sexual
and rep(oductive health and rights-
related themes based on the six tracks
were displayed with a daily change
in the poster presentations.
Presenters provided information and
answered questions on their poster
presentations.
Scaling Up: Degree of
Simplification
... 4
The Global Fund Programme
on HN/AIDS
Round 4 and Round 6
... 5
Capacity Building for
Panchayati Raj Members
... 6
Reducing Reproductive Morbidity
in Married Young Women in
Rural Maharashtra
•.. 7
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1"m 'he £Ke,"'ive 1)i,ed,,', desk ...
Challenges of achieving full reproductive and
sexual health and rights
~e Asia Pacific Region has just seen the successful completion of
1 the 4th Asia Pacific Conference on Reproductive and Sexual Health
and Rights (APCRSH), held in Hyderabad, India, on October 29-31,
2007.
The Conference was organized with a goal to enhance and accelerate
the process of ope rationalizing the sexual and reproductive health
and rights agenda in the countries of the Asia Pacific Region. The
objective, clearly, was to develop newer discourses to inform future
research and programming to address sexual and reproductive health
needs from the perspective of young people including adolescents
and to engage multiple stakeholders in advocacy to reinforce the
centrality of sexual and reproductive health for the achievement of
the Millennium Development Goals.
With the Conference, however, it has become clear that we still have
a long way to go before the ultimate goal of ensuring reproductive
health and rights for all - is achieved in the region. The human rights
promises of the 1994 ICPD Programme of Action on Population
and Development, the commitments to gender equality from the 1995
Beijing Declaration on gender equality, and the practical adoption of
indicators for the Millennium Development Goals have all been
commitments accepted by virtually all the governments of this region.
These promises have also been reiterated in numerous regional and
national meetings. However, we are more aware than before that
there is still a long way to go and there are millions of women and
men who continue to suffer from entirely preventable maladies. Too
many of the girls born in 1987 on the dawn of the Safe Motherhood
commitments are today facing the same terrible threats to life and
well-being that their mothers suffered two decades ago. Young people
of the region and the children born today deserve better access to
sexual and reproductive health services that can save their lives,
irrespective of their poverty or marital status.
The Open Letter to Governments, presented at the conclusion of the
Conference, suggests, that the practical commitment of governments
to recognise the human rights of their citizens can make a difference.
Technologies are available to achieve a revolution in reproductive
and sexual health, but programmes need resources, which are not
beyond the scope of national budgets as the benefits of investment in
reproductive health are far greater than the costs involved. This needs
to be done through an urgent transformation of budget priorities in
favour of health, education and development of women and men.
As leaders of civil society, we need to continuously and relentlessly
work with our governments so that we can make a very practical
difference to catalyse the legal, programmatic, systemic and budgetary
reforms that are required to make reproductive and sexual health
services accessible to all. The utilization of funds needs to be carried
out in an institutional structure that facilitates efficient action.
At the core is the need to recognise reproductive rights including the
right of all people to accurate sexual and reproductive health
information appropriate to their stage of life and the right of women
to make decisions on their own reproductive lives in a context of
safety and social support. Integrated responses to HIV and AIDS and
reproductive and sexual health are required to realise these rights.
We require urgent action now to turn the rights that governments
have recognised in conventions and treaties into reality in the lives of
all citizens. This is the right of all citizens, and our shared responsibility.
A. R. Nanda
PopJOCUs
More than 1,250 participants from about 50
countries were present at the conference to discuss
and debate key sexual and reproductive health and
rights issues concerning countries of the Asia Pacific
Region. Stakeholders, representing policy-makers,
parliamentarians, donors, researchers, programme
managers, activists, NGOs and others reflected
diverse views, perspectives and experiences were
also present at the conference. There was an un-
precedent attendance and participation by youth at
the conference. Problems and perspectives of young
people were high on the conference agenda.
At the conference, the Population Foundation of
India organized three satellite sessions on the
following topics:
1. From Pilot to Programmes: Scaling Up
Innovations into Public Sector Systems
Governments and donors alike are increasingly
trying to effect large-scale change with limited
resources by funding innovative health pilot projects,
which they then hope will be implemented at scale.
This session, comprised of four speakers,
encapsulated lessons learned from scaling up of
NGO and government-led interventions to reduce
maternal and neonatal mortality and morbidity
within the public health system. The first two
presentations discussed the challenges in the
application of a management framework for scaling
up reproductive health projects in India. The second
presentation dealt with developing and scaling up a
community based health care model within a state
health system driven by political and civil society
activists. The last presentation focused on the
systematic building up of evidence for a model
for newborn care and the processes involved in
scaling up.
The session was chaired by Ms Poonam Muttreja,
Country Director, The John D. and Catherine
T. MacArthur Foundation.
The first presentation, on Scaling up Home-
based Newborn and Child Care in India:
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Swastha Aangan
PopJOcus
Swast~a Aangan, an initiative of
PFI In collaboration with Tata
Chemicals Society for Rural
development
(TCSRD) has
commenced for a duration of three
years from November 2007. The
project aims to achieve sustainable
improvements in RCH indicators
through consolidation of the gains
and lessons learnt from the earlier
programmes in the area and by
building mechanisms, processes and
linkages with community based
organizations and other institutions.
TCSRD had implemented an
intensive family welfare programme
in partnership with PH from April
2002 to March 2007 in Gunnour
block of Badaun District in Uttar
Pradesh. The programme covered 96
villages in two phases. The
programme aimed to build awareness
on Reproductive and Child Health
(RCH) and to provide services
through mobile clinics.
The current project is an attempt to
sustain the benefits of the intensive
family welfare programme and foster
more proactive community
involvement. It is to be implemented
in 40 out of the 96 villages in
Gunnour block covering a population
of 75,000. During the next three
years of the project, it is expected that
the consolidation of activities can be
initiated in the first phase by
increasing involvement of community
in management of their health affairs.
The target group of the project will
be women in the age group of
15-49 years and children in the 0-5
years age group.
The objectives of the project are to (i)
create community based mechanisms
and linkages for increasing access to
quality RH/FP services, (ii) bring
about desired behaviour changes
among eligible couples (women in the
age group of 15-49 years) through
integrated IEC package and
increasing involvement of different
stakeholders at the family level on
Family Planning/ Reproductive Child
Health, (iii)promote use of modern
contraceptives by eligible couple by
providing a basket of choice through
strengthening Parivar Kalyan Kendras
and appropriate referrals, and (iv)
document lessons learnt, processes
and promising practices for
replication and scale up.
A key strategy of the project is to carry
out community needs assessment for
RH services through ASHA in
close coordination with Village
Health Committees
(VHCs), Anganwadi
workers and ANMs
to assess the felt RH
needs of the villages
and make services
available based on
the community
consultation at the
village level.
Parivar Kalyan
Kendras (PKKs),
established in the first phase and run
by male volunteers (Swaasthya Mitra),
procure supplies for ASHAs who in
turn make available contraceptive
supplies as per the needs of the
community.
The village health committees would
be updated on facilities and schemes
available in the government sector
and they will be facilitated to carry
out advocacy with the government for
improvement in service delivery. The
project will make efforts to help the
community to avail the benefits of
Janani Suraksha Yojana. Linkages will
be established with the government
health system for services. In addition
RCH and family planning s~rvices will
be provided periodically at identified
points in the clusters of un-served and
underserved areas by using a mobile
van. Home-based delivery will be
taken care of by dais in collaboration
with ASHAs and ANMs.
BCC/IEC activities for involvement
of stakeholders and families will also
be done in the project area. The focus
would be to promote discussion and
decision-making on RH issues
between couples. Documentation,
dissemination of processes and
lessons learnt is another important
activity, which is envisaged to
contribute towards scaling up of such
community based models.
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PopfOcus
Scaling Up: Degree of Simplification
In the last two editions of the PopFocus, the Scaling Up team started a series on "Scaling Up Pilots and Innovations".
This is the third in the series of articles on Scaling Up. The third factor which is being identified as very important
while scaling up is, "Degree of simplification possible".
Inthe last two editions of the
PopFocus, we have discussed two
factors which are important for
scaling up. The 'Evidence of
impact' was identified as the first and
'Evidence of results in other
socio-demographic settings' was
the second of several factors that
influence the decision to go-to-scale.
The evidence of impact emphasized
the need to maintain the rig our of
research throughout the course of the
intervention. It also suggested the
involvement of an independent
agency for evaluation. Evidence of
results in other socio-demographic
settings derives that in order to collect
Successful scaling up
implies that the key features
of new interventions tested
and proven to be effective
remain intact during
expansion otherwise
pilot results
cannot be replicated.
information on the durability of the
model and to evidence that the model
is 'weather-proof', a second stage
multi-centric intervention is usually
recommended. The second stage of
interventions should explore all
variants in the model: different target
groups, different locations (with
different socio-economic features) and
intervention partners with different
capacities.
FACTOR 3:
Degree of simplification
possible
Successful scaling up implies that the
key features of new interventions
tested and proven to be effective
remain intact during expansion
otherwise pilot results cannot be
replicated. All the components of a
model should be enlisted and the
components which contributed the
most towards the success of the
model should be identified. These
components
are the essential
components of a model and without
which success would not have been
achieved. Therefore, the aspects of
the innovation that were central in
producing the desired results must be
identified. Clear identification of the
essential, "non-negotiable" features of
an innovation allows for streamlining
or simplification of the innovation, so
that it may be easier to understand
and install.
Answering the following questions
while reviewing the research results
can help to identify the features
central to the success of an
innovation.
1. Is there anything special or unique
about the context of testing that
affected the project's success?
(For example, cultural, ethnic or
religious values; distribution of
power; economic conditions.)
Do these factors need to be
present in any environment for
successful replication of the
innovation?
2. Which key organizational!
institutional features contributed to
the outcomes and need to be
retained and replicated? (For
example, staffing, management
styles, financial resources,
training, supplies and logistics.)
3. What values and underlying
concepts are embodied in the
innovation and are essential
for its success? (For example,
community involvement
in
decision-making, a commitment
to reproductive choice and rights,
elimination of discrimination
against people
HN/AlDS.)
living with
4. What are mInimum quality
standards for the innovation that
must be applied uniformly while
still permitting local adaptation of
interventions?
Models with fewer and
simpler components
are easier to scale up
whereas value or process
intensive models are
much more difficult
to scale up.
5. An analysis of the innovation and
the testing should also produce
documentation of "what has been
done, how it has been done and
why it has been done in this way" .
Concise descriptions of the
purpose of the innovation, the
objectives of the research to test it
and the results that were obtained
are also a part of presenting
credible evidence.
A model while being piloted may have
several components. But, the level of
attribution to success is different for
different components. Hence, it is not
only important to identify the
components
which are non-
negotiable but, at the same time it is
also important to see that if the
components
could be further
simplified. Models with fewer and
simpler components are easier to ;
scale up whereas value or process
intensive models are much more
difficult to scale up, as they tend to
be time consuming to implement and
also incompatible with large scale
systems.
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Po p./Ocus
The Global Fund Programme on HIV/AIDS
Round 4 and Round 6
Mr. Taufiqur Rahman, Team
Leader, South and West Asia
Cluster, The Global Fund visited the
states of Gujarat and West Bengal and
held meetings with the Principal
Secretary, Health and Family Welfare
and the Project Director, Gujarat State
AIDS Control Society in Ahmedabad
on 15t November and with the Project
Director, West Bengal State AIDS
Control Society in Kolkotta on 5th
November 2007. The issue of
coordination with the respective
SACS and the plans for setting up of
Community Care Centres in those
states were discussed during the
meeting.
November 2007 also saw the visit of
Mr. David Addison from the Office
of Inspector General, The Global
Fund to the PH office for programme
audit. He conducted a detailed review
of the programme, MIS and finance
of the Global Fund Round 4 and
Round 6.
The Executive Director of The Global
Fund and Chairman of The Global
Fund Board visited India during
18-21 December 2007 along with
other key members of The Global
Fund team. The team visited the state
of Tamil Nadu as part of their field
programme and observed the
activities under the Global Fund
Mr Hari Shankar Singhania, Chairman, PH briefing the visiting Global Fund
Executive Director Prof Michel Kazatchkine and his team during the reception
programme. The team also parti-
cipated in the NGO meeting
organized by SAATHI, INP+ and PH
in Chennai.
PFI participated at the two day
meeting on 'Private Sector
Partnership in the fight against
HIV/AIDS,
Tuberculosis
and
Malaria' organized by the Global
Fund in New Delhi on 13-14
December 2007. Participants in the
meeting included Global Fund
partners in the South and West Asia
cluster, NACO, CCM, UNAIDS, ILO
and representatives from the private
sector.
In Round 4 programme, MIS refresher
trainings were provided to 115 District
Level Networks (DLNs). A meeting
between INP + team and PFI took
place in Chennai to discuss the issues
specific to programme.
In terms of deliverables for quarter 2
(October-December 2007) of Round-
6 programme, Indian Network of
People Living with HIV/AIDS (INP+)
has set-up 10 District Level Networks
in the states of Uttar Pradesh,
Rajasthan and Madhya Pradesh. MIS
training for three State Level Networks
and 10 DLNs were conducted by PH
in November 2007. Catholic Bishops'
Conference of India (CBCI) has set-
up five community care centres in the
states of West Bengal, Bihar: and
Gujarat. Joint appraisals of Commu-
nity Care Centers were conducted for
the states of Bihar, West Bengal,
Gujarat, Uttar Pradesh and Madhya
Pradesh. The Joint Appraisal for
Chhattisgarh, Rajasthan and Orissa
will be conducted in January -
February, 2008.
Population Foundation of India
observed the World AIDS Day.
Nukkad natak, jingles through radio,
cricket match and programmes for
affected children were organized. •
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Pop.!bcus
Capacity Building lor Panchayati Rai Members
A series of capacity building
workshops on family planning
(FP) and reproductive health (RH)
were organized for Block Panchayati
Raj functionaries in Muzaffarpur
district of Bihar by PH in collaboration
with CENCORED, Patna in
December 2007. The purpose of the
training was to (i)build understanding
on reproductive health/ family
planning and other related issues
among PRI representatives at various
levels, (ii)ensure better co-ordination
among stakeholders at the state,
district and block levels, (iii)increase
interest of addressing RH and FP
issues at the Panchayat level, and (iv)
highlight the role of Panchayati Raj
institutions under NRHM.
There are 16 blocks in the district,
out of which 14 were covered during
this period. By the 31 st of December
2007,15 batches of orientation were
held in which a total of 885 PRI
members were oriented, including
Panchayat Samiti members and
Mukhiyas. In Bihar, elected women
leaders constitute approximately 55%
of the elected local self-government
f(Jt{RJ i/11frur ~ ~Ti1 ~ 31~rliia
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,rW'l"_ ~ <1;~ ?"f3ifq"", JRmS'- ~
~:-~.",.~rrrJtroi~
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~ -.iTcn ~
rd~"r:;c;1T
, "IkI/;fI, 7Fl
Mr R U Singh, Hony. Advisor of PFI for Bihar and Jharkhand at the
training in Paru, Bihar
leaders from the last Panchayat
elections of 2007, and therefore
emphasis was given on ensuring their
participation.
The topics covered in the workshops
were: (i) concept of health and its
determinants, (ii)goals of NRHM and
its components - role of ASHA/
ICDS/ ANM, roles and responsibilities
of PRIs in implementation of NRHM
(iii) status of reproductive and child
health (RCH) in the concerned
district, (iv)millennium development
goals and PRIs role, (v) stakeholders
and their roles and responsibilities to
achieve the goals of NRHM, (vi)
importance of registration of births
and deaths, delaying age at marriage,
ANC/INC/PNC, immunization, birth
spacing and permanent methods of
family planning, and (vii) facilities
provided under NRHM and action
plan for better implementation.
From the group discussion, issues like
the importance of mitigating diseases
like HIV/ AIDS, Kalaazar, Malaria
and Filaria etc also emerged. The
participants shared that this was the
first initiative of its kind in Bihar, and
requested PH to hold similar trainings
at the Panchayat level for the
Sarpanch and ward members. •
A planning meeting was held in Patna on December 27, 2007 with Bihar Voluntary Health Association and seven
field partners under the project supported by MOHFW/UNFPA Country Programme-6. Mr R U Singh, PH's
Honorary Advisor for Bihar and Jharkhand and Dr Mahaveer Prasad, former Director-in-Chief, Health Services,
Bihar were present. Presentations, highlighting the past experiences and suggestions for the future interventions,
were made by all the field operating partners. The meeting concluded with development of detailed action plans
for each partner, including formation and ratification of Village Health Sanitation Committees (VHSCs), conducting
facility survey, using PRA techniques for formulation of village health plans and continuous advocacy at all levels
with a focus on PRIs.
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PopJOcus
Reducing Reproductive Morbiditv
in Married Young Women in Rural Maharashtra
Population Foundation of India
(PH) and the Institute of Health
Management, Pachod (IHMP) have
joined hands to implement an
innovative operations research
project" Reducing Reproductive
Morbidity among Married
Young Women in Rural
Maharashtra" for improving the
reproductive health status of married
adolescents in five most backward
districts of Maharashtra. The project
is being implemented with financial
support from Sir Dorabji Tata Trust
(SDTT), Mumbai. The project has
the potential of providing critical
inputs to a State Policy for Adolescent
Reproductive and Sexual Health in
Maharashtra and serve as a model for
adoption by Government of India.
The Institute of Health Management
(IHMP), Pachod and PH will provide
technical support towards develop-
ment of MIS, research design,
capacity building of NGO project staff
in programme strategy, research,
advocacy and monitoring.
22 percent of the total population of
Maharashtra is the second most
populated state (Census, 2001) in
India. According to a study done by
IHMP in 1999, though the
contraceptive prevalence rate is
relatively high (60.9%), the Total
Fertility Rate (TFR-2.7) is still above
the replacement level of 2.1 children
per women. Contribution of married
young women 15 to 19 years, to the
total fertility rate in the state is 26
percent suggesting that most women
here get married quite early, attain
the desired family size by the age of
24 and that contraception is adopted
usually after achieving the desired
family size and composition. Low age
Maharashtra. Median age at marriage
in Maharashtra, for women age
20-24 years, is 17.1 for rural areas.
The proportion of girls getting
married before the legal age of 18
years is 62 percent in rural areas.
The study conducted in project
districts indicated that 90 percent of
currently married women under the
age of 19 years had achieved
motherhood. These women not only
face the negative consequences of
early child bearing, but also have
limited opportunities for education
and enhancing their social status,
making them one of the most
vulnerable groups in the society.
at marriage and non-use of The Relevance ...
contraception by young married
adolescents are the two critical
factors, which need to be addressed
to reduce fertility.
The issue of adolescent sexual and
reproductive health has received a
special focus in the RCH-2 policy
document of Government of India.
Why Married Young Women?
Maharashtra has been selected as one
of the states for the implementation
According to the study, young ..... of this programme during the RCH-
married adolescents constitute about 2 project period and yet very few
• Operational area of the project
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interventions are planned to address
their health needs. There are very few
successful programmatic models on
how adolescent health services can
be operationalized through the
existing public health system.
Strategy & Programme
Interventions
The project aims to demonstrate how
an integrated package of services
can achieve better Reproductive and
Sexual Health status for young
married women and their spouses.
The major components of the project
are:
1. Primary health care, nutrition,
education, detection and
treatment of anemia, ante-natal
care and advice regarding child
birth, easy and confidential access
to family planning, MTP, RTI/ STI
detection and treatment, HIV/
AIDS awareness and counseling
2. Organizing women's groups and
involvement of PRIs
3. Behaviour Change
communication (BCC)
4. Surveillance community based
system, and referral
5. Capacity building of implementing
agencies in development systems
and mechanisms to plan, monitor
and ~valuat~ th~ programme and
. build capacities for action research
and advocacy
Contribution of
married young women
15 to 19 years,
to the total fertility rate
in the state
is 26 percent.
The project will touch the lives of a
rural population of 1,00,000 and will
be implemented through 5 local
NGOs - Sanskriti Samvardhan
Mandai located at Nanded, Gram
Vikas Mandai at Beed, Apeksha
Homoeo Society at Amaravati, Youth
Welfare Association of India at
Buldana, and Late Shriram Ahirrao
Memorial Trust at Dhule - all districts
with some of the worst RCH
indicators. The project will be
operational in all the five districts and
each NGO will cover 20,000
population.
Expected Outcomes
At the end of the project period, the
project envisages to achieve:
PopJOCUs
1. Delayed age at first conception by
eM y~ar
2. Increased treatment seeking
behaviour for RTIs/post abortion
care/post natal complications in
married young women
3. Reduction in anemia in married
young women
6. Increased capacities of partners in
research, programme imple-
mentation and advocacy on
Reproductive Health.
Overall, the project focuses on
increasing the median age at first
conception, increasing contraceptive
use among married adolescents,
reducing prevalence of anemia
among young married women,
improving treatment seeking
behaviour for RTI, post abortion
complications and post natal
complications among married young
women, increasing utilization of
antenatal, delivery and post natal
services by young married women
and increasing utilization of Voluntary
Counseling and Testing Centres for
early detection and prevention of
HIV.
•
The Population Foundation of India's publication titled State of Health in Bihar was released at the 4th Asia
Pacific Conference on Reproductive and Sexual Health and Rights on 30th October 2007 at Hyderabad.
This publication brings out the realities of the
health and population scenario of the state of
Bihar based on reliable data. It reflects the current
context of the health status, and the gaps and
priorities, which need to be addressed in a
development-oriented approach. Providing a
holistic overview of Bihar, the book includes the
demographic and socio-economic status in the
state, assessment of its health situation, the current
health delivery system and district profiles. It
identifies areas of concern and explores policy
options, which may expedite improvement of
human development in the state. The publication
is meant to be a comprehensive reference for
policy makers, the state government, district
administration, planners, programme managers
and NGOs for the State of Bihar.
From left to right: Ms Nina Puri, Former President, IPPF;
Dr Wasim Zaman, Director, Country Technical Services team,
UNFPA - South and West Asia; Dr Almas Ali, Senior AdVisor,
PH; and Ms Saroj Pachauri, Regional Director, Population
Council
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PopJQcus
life Skills Education for Cadets
"'"rhe Child in Need Institute (CINI),
1 Jharkhand and the Population
Foundation of India, New Delhi in
collaboration with the National Cadet
Corp (NCC) designed a training
programme for Associated NCC
Officers (ANOs) on 'Mainstreaming
Life Skills Education in NCe' for
three days. The officers work as
teachers and lecturers in schools and
colleges and are in direct
communication with the NCC cadets.
Two batches of ANOs training were
completed in November 2007 - the
first was held in Jamshedpur, where
20 ANOs participated and the
second was held in Ranchi where 23
ANOs were present.
CINI, Catholic Relief Service,
PFI, FXB India Suraksha,
Government of Jharkhand and
NCC conducted a series of
Focus Group Discussions
(FGDs) amongst 335 adole-
scent boys and girls in rural as
well as urban areas. The
outcome of the FGDs reflected
that the adolescents were eager
to know about their own body
and the changes that are
common in this age. Following
the meetings and workshop
with teachers, meetings with
parents and local bodies were
organized. The community
unanimously voiced for the
need of a programme specially
designed for adolescents. On
this request, a module was
developed for adolescents, titled
"Adolescent Manual for the
NCC Training - Guidance for
Life Skills, Health and Hygiene
Awareness" by CINI and PH
The first section of the manual
talks about the universal values
that help in making of a good
human being, gender
sensitization and heterosexual
friendship, the second section
focuses on Reproductive Health
and Family Planning and the
third section focuses on general
health and nutrition.
The NCC in India, formed
with the National Cadet
Corps Act of 1948, is a
voluntary organization, which
recruits cadets from high
schools and colleges. The
cadets are given basic military
training in small arms and
parades with the motto of
"Unity and Discipline'. The
NCC aims to develop qualities
of character, courage,
comradeship, discipline and
leadership amongst the youth of the
country.
The objective of the training held for
the ANOs, was to build their
capacities as change agents, to be
able to bring about positive changes
in the health behaviour including
sexual and reproductive behavior of
the school/college going NCC
Cadets. The training was specifically
aimed at providing information
related to physical changes and myths
related to menstruation, conception,
masturbation, night fall, etc and to
increase awareness among the
adolescents· on issues like personal
hygiene, STD, HIV/AIDS, sexuality,
nutrition, early pregnancy, child care
and early marriage. The focus was
also on promoting gender equality
and targeting gender discrimination
and gender stereotypes.
The emphasis of the training was on
the needs and issues of adolescents
and how to address this critical age
group. It covered life skills in great
detail including their importance in
development of an individual. The
participants were made to co-relate life
skillswith their dailylives.A conceptual
clarity was built on adolescence and
the need for addressing issues of this
period in a conducive manner. Issues
like physical and psychological
changes, human organs and its
function were also covered in detail.
The training also dealt with the
importance of nutrition in
adolescence, the need to have a
balanced diet, anemia and its causes,
symptoms and ways of preventions,
causes and consequences of early
marriage and early pregnancy,
contraception and contraceptive
methods. Apart from the basic health
practices and personal hygiene, issues
like Reproductive Tract Infection (RTI)
and Sexually Transmitted Diseases
(STD),HN / AIDS, abuse and violence,
substance abuse and coping with abuse
and violence were also covered.
Even though it was a challenge to
capture the attention of the
participants on issues of reproductive
health in the beginning, the training
was well received by the ANOs who
appreciated information on topics
like RTl/STI and HIV and AIDS.
The participants felt that this
information is essential for
young people and must be
passed on to the NCC
cadets. The methodology
was participatory and
interactive with use of
group exercises and
presentations. As a future
course of action, the ANOs
have requested for support
from PH and CINI for their
future activities, like camps
with cadets.
•
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1.10 Page 10 |
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Pop.Jbcus
Experience and Lessons by
Dr Abhay T Bang, Director, Society
for Education Action and Research,
focused on the development of the
actual model and process that led to
its acceptance by the public health
system. The challenge now is how to
effectively transfer this method into
the National Rural Health Mission of
the Health Ministry and make the
HBNC available in 500,000 villages
of India by training ASHA, the new
community health worker of India.
The second presentation, on
"Scaling up the Community
Health Volunteer Programme in
Chhattisgarh: Experience and
Lessons from Mitanin" by
Dr Sundararaman,
Executive
Director, National Health Systems
Resource Centre, dealt with
developing and scaling up of a model
within a state health system driven by
political and civilsociety activists. The
Mitanin program was integrated with
a range of health sector reforms
especially strengthening the supply
side to be responsive to the demand
for services being generated. It
became the flagship of the health
sector reform agenda, leading to a
substantial increase in state
investment in public health. The state
in partnership with key constituents
of civil society established a State
Health Resource Centre, an
innovative and autonomous
institution outside the government
that guides and supports this
program. The challenge of the
Mitanin programme was to upscale a
community
health worker
programme in a limited time frame,
in a context of limited human
resource availability and weak
institutional structures. The attention
that the Mitanin programme attracted
provided the backdrop for the ASHA,
an integral component of the NRHM.
The third presentation made jointly
by Dr Richard David Kohl and Dr
Rajani Ved, Management Systems
International on "Scaling up
Successful Pilot Projects on
Maternal and Child Health:
Lessons from India",discussed the
challenges in the application of a
management framework for scaling
up reproductive health projects in
India. To deal with the challenge of
scaling up, MSI has developed a
strategic management approach to
the scaling up process, funded by
the MacArthur Foundation. The
framework serves as both an
intellectual structure for thinking
rigorously about scaling up and as a
strategic management framework for
actually scaling up.
2. 'Empowering People':
(' A Rights-based Effort for
Policy Advocacy in
Addressing Sexual and
Reproductive Health
in India
This particular session reflected the
experiences of ongoing efforts that
enable government and other
stakeholders to formulate policies and
programmes for reproductive health,
family planning and adolescent sexual
health. The main aim of all these
efforts is to involve the community,
especially young people, and building
their capacity to influence health
programmes at the state and local
levels. The objectives are to effect
change in Bihar, Jharkhand,
Chhatlisgarh and Orissa states where
the Government of India is making
special efforts.
The chairperson of the session was
Dr. Almas Ali, Senior Advisor, PFI,
where as the rapporteur was Mr Satya
Ranjan Mishra, Project Manager,
Population Foundation of India.
The session included three
presentations. The first on "People's
Health in People's Hand:
CommunityMonitoringof Health
Services under the National
Rural Health Mission" by
Ms Sudipta Mukhopadhyay, Project
Manager, Population Foundation of
India, shared the innovative approach
of working with the community and
the government at each level of the
public health system to improve the
planning and delivery of health
services. The programme is being
implemented in diverse settings in
nine states as a part of the National
Rural Health Mission. The second
presentation on "Rights-based
Policy Advocacy Experiences
from Bihar, Jharkhand and
Chhattisgarh" by Dr Sanjit Nayak,
Programme Officer, PFI also shared
the experiences of policy advocacy
in the states of Bihar, Jharkhand and
Chhattisgarh. It reflected the process
of community involvement in policy
advocacy at the village, sub-district
and district levels. The third
presentation titled "Let's play:
Involving Youth in Sexual and
ReproductiveHealth Programme
Assessment" by Ms Namrata Jha,
Programme Associate, the David and
Lucile Packard Foundation was an
experience sharing of working with a
group of young people to develop
their leadership in designing tools to
assess and analyze the reproductive
and sexual health programme.
The conclusion drawn from the
session was that people's health
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2.1 Page 11 |
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should be in their own hands. NRHM
has provided that opportunity by
involving the community at a very
basic level and also brought back
primacy of primary health care.
Policy advocacy is a trust building
process that is difficult and time
consuming where-in civilsociety must
playa critical role in shaping policies,
as reforms are about people and
processes. There is need to bridge
communication gap between
adults and young people by
directly involving young people in
programme assessment.
3. Care and Support
Programmes for People
Living with HIV/ AIDS
Mrs. Nina Puri, Former President,
IPPF and Member, Governing
Board, PH chaired this session, and
the rapporteur was Ms Aparna
Gurukuntala, Senior Strategic
Information and Evaluation
Associate, PH
PH is one of the principal recipients
of The Global Fund grants for Round
4 and 6 and is implementing a project
to enhance access to care and
treatment in six high prevalence
states of India. The main activities of
the project are: (a) capacity building
of project functionaries and NGOs;
(b)setting up of district level networks
(DLNs) for people living with HIV/
AIDS (PLHAs) and (c)advocacy with
the corporate sector to provide quality
services for antiretroviral treatment
(ART) at corporate health facilities.
On the basis of the programme needs
and experiences from the above
project, PFI has identified issues
needing attention and has conducted
eight special studies for providing
possible solutions. These studies were
seen as integral elements of the
programme and their results are
expected to feed into the programme
to improve its coverage and
effectiveness.
Four presentations were drawn from
the above operations research studies,
were made at the session, (al
Assessing PLHA expectations
about qualityof care and support
services with a view to strengthen
Popfbcus
district-levelnetworks of PLHAs by
Dr Phanindra Babu Nukella, Senior
Strategic Information and Evaluation
Manager, PFI (b) Setting up
guidelines for providing care and
support services including
palliative care for PLHAs by
Dr Mary Verghese, Project Director,
PH, (c) Cost of care and support
services: A study of selected
community care centres by
Dr Indrani Gupta, Professor, Institute
of Economics Growth, Delhi
University, and (d) Understanding
support group meetings of
PLHAs by Dr Venkatesan
Chakrapani, Policy and Research
Advisor, Indian Network for Peoples
Living with HIV / AIDS and the
Humsafar Trust.
•
The 4th APCRSH Youth Space grew from an idea of the Asia Pacific
Alliance (APA) secretariat to provide an internet and cafe area during
the conference. It was envisaged that young people could come and
receive accurate and up to date information and resources on sexual
and reproductive health issues relevant to them in their work and personal
lives in a youth friendly space. It was also hoped that youth focused
groups.could hold side events and young people could socialize in the
space when conference sessions weren't being held.
The Space, dedicated to youth and their colleagues, served as a mini-
Global Village for youth meetings, forums, lunchtime sessions, cultural
performances, art, resources and advocacy. The Youth Space served
as a place to highlight and showcase youth achievements in the global
response to sexual and reproductive health, and to facilitate networking
opportunities with youth and adults. It operated as a youth media hub
(online discussions, blogs, and audio pod casts) and a lounge. These
activities continued and built on the momentum from the Youth Pre-
Conference Orientation. In addition to the Youth Space programme,
young people evolved the space and spent their lunchtimes preparing
to direct and execute advocacy plans, support those who were acting as
youth rapporteurs and supporting knowledge transfer throughout the
Conference.
All in all, the positive outcome of having The Youth Space was that it
not only served as a place for young conference attendees to meet and
to connect, and build support systems at the conference, but also to
network professionally and form Alliances. Stronger networks and
alliances were developed and the Youth Space gave these groups a
place to meet, discuss and build statements, strategies and plans for the
future. The Space also played a strategic role in making all conference
delegates aware of the importance of generational activities at
International Conferences.
The Fifth Asia Pacific
Conference on Sexual
and Reproductive
Health and Rights will
be hosted in 2009 by
the Sociology of
Women and Gender
Research Committee of
the Chinese Associa-
tion of Sociology in
Hang Zhou city,
People's Republic of
China.
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2.2 Page 12 |
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The Return of the Karall;
Pophcus
The traditional Indian Karahi (wok/deep pan) made from
iron has found its way back into the kitchens of many
homes in some villages in Gurgaon. Enlightened women,
having discovered the benefits of cooking in iron karahis now
line up to buy them either from the local marketplace or
from the project staff of Sukarya, the NGO working in the
area.
This change in culinary behaviour can be attributed to a three
year intervention study among adolescents, pregnant and
lactating mothers to reduce the prevalence of anaemia - a
contributory factor of maternal morbidity & mortality, being
implemented by Sukarya with support from PH in 10 villages
of Gurgaon district in Haryana, covering approximately
30000 population.
Benefits of the Iron Karahi
According to a study by the Department of Studies in Food
Science and Nutrition,University of Mysore, the total and
ionisable iron contents of green vegetables, which ranged from
3 to 13 mg/100 g and 0.43 to 2.7 mg/100g, respectively,
increased to 9.7 to 17.5 mg/100g and 1.50 to 8.56 mg/
100g, respectively when cooked in iron utensils. The availability
of iron, in relation to total iron, of greens cooked in iron utensils
was either comparable or marginally higher than those cooked
in other metallic utensils. Since the total iron content of greens
cooked in iron utensils was high, the actual amount of available
iron also increased. The study hence concluded that cooking
in iron utensils increases the total as well as the available iron
content of greens.
The community that Sukarya works in consists of 90%
vegetarians. The iron from vegetables is less absorbable and
it is often observed in these villages that vegetarians eat less
iron than non vegetarians. Vegetarians can increase their
iron intake by adding iron-containing foods within their diet
and using iron pan and laddIe for cooking.
Promoting the Karahi
Information on the importance of the iron karahi and
counselling to use them is being provided extensively through
group meetings and one to one interactions. Nutrition
Demonstration Workshops (NDWs) have been a major
platform to build awareness on the usage of iron karahi and
iron laddIe. The mode and the process of effective cooking of
iron rich food are demonstrated in these workshops. The
participants were advised to cook food at a low flame, always
cover the food while cooking, not to fry the food too much
and to cook the food with sufficient amount of water. In order
to prevent the rusting of the pans, they are advised to wash
and clean the utensil with washing powder or bar immediately
after cooking and to wipe it dry with a dry cloth and keep it
in the sunlight or in the open space.
Many women of the project area, who realised the benefits
and were using the karahis regularly, brought in many other
women who purchased iron karahis from the market.
However, the women from interior villages like Bandhwari,
Waliaws and Gwalpahari, who go to the markets only for
specific occasions like marriages, requested to arrange iron
pans for them in the village itself. The Project Manager,
Ms. Nilanjana Das, took upon herself the task of arranging
the same for the village women. Sukarya has procured 350
iron pans @ Rs. 75 each. The full cost of iron pans is being
recovered from the beneficiaries. However, a subsidy is being
extended in exceptional cases where the women who come
from very poor families are unable to afford this cost. The
amount of interest shown by women in project villages is
evident from the fact that since the initiation of distribution
of iron karahis in August 2007, over 200 iron pans have
been sold and that too at full cost!
•
Mr Rakesh Kumar has joined the Foundation
as Sr. Project Manager for the project titled
'Scaling Up Reproductive Health
Interventions'. He has 14 years of experience
in the development sector, including over
9 years experience as an expert in
organizational development and programme
management in the field of reproductive health, HIV/ AIDS
and community development programmes.
We bade farewell to
Mr. K. G. Venkateswaran, who worked as Project Manager
in the project titled 'Scaling Up Reproductive Health
Interventions' in November 2007.
Editorial Guidance
Mr A.R. Nanda
Ms Sona Sharma
Editor
Ms Chandni Malik
Editorial Assistance
Ms Jolly Jose
Editorial Committee
Ms Usha Rai
Dr Almas Ali
Dr Kumudha Aruldas
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
Publish~d by
Population Foundation of India
8-28, Qutab Institutional Area
New Delhi-110016, India
Tel: 91-11-42899770, 42899771
Fax: 91-11-42899795
e-mail: popfound@sify.com
website: www.popfound.org