Participatory Communication Initiative for improving access to public healthcare services for rural communities in India under the National Rural Health Mission SEWAK is now a local partner to a prestigious national level heath network, the ‘CHIN’, standing for ‘Communicating Health India Network’ that seeks to address gaps in NRHM commitments.

Project Rationale

The Government of India launched NRHM, the ‘National Rural Health Mission’ in April 2005 with the objectives of securingpeoples’ universal and unrestricted access to integrated public health care services. It implemented measures to strengthen public health system and health manpower, andto decentralize health programs allowing for community participation and ownership. The national program focused on reaching out to people living in rural and remote corners of the country, so that good health and hygiene is within the easy reach of all, including the poorest of the poor.

However, it was soon realized that the impact of NRHM on the health of common people has not been as impressive as it was expected at the time of its launch. For instance,there were still poor indicators in respect of IMR, MMR and other ailment like malaria and tuberculosis. There were as usual home deliveries, neo-natal and infant losses. People in rural area still shunned public health officials and preferred rather well-disposed quarks or traditional healers over the doctors. There was little change in the efficiency and approach of service providers, and malpractices were still rampant. It was clear to perception that there still existed huge gaps at almost every level of NRHM commitment.

CHIN is a network of five national level NGOs led by Christian Medical Association of India (CMAI). It will survey and identify the areas where peoples’ expectations and NRHM commitments work at cross purposes and strive to transform the situation to one of coordination, professional excellence, and service. It will encourage and scale up public participation at community level and up, set up lobby and advocacy for NRHM commitments, provide effective BCC to service providers, side by side with pressurizing the local health system to be responsive and responsible to people it is supposed to care for.

Aims & Objectives

The full title of the CHIN project reads “Participatory Communication Initiative for improving access to public healthcare services for rural communities in India under the National Rural Health Mission”. The important objectives sought to be accomplished under the project are:

  • Development of a participatory communication strategy (including communication packages) to advocate for health entitlements of rural communities
  • Enhancing the capacity of the service providers, civil society organizations, media and PRI (Panchayati Raj Institutions) members on communicating and advocating for NRHM commitments
  • Promote community awareness on NRHM entitlements
  • Organizing forums and round tables among stakeholders to promote exchange of experiences, innovations, documentations and disseminations; and
  • Documenting and dissemination of key processes and learning
Launching Of The Project

SEWAK signed memorandum with CMAI on 30th January 2010 to implement the project in Sundargarh district of Odisha. Following due consultations at the level of CDMO and other health officials, Tangarpali Block was chosen to be the venue of the project. On 26th December 2010, the district level unfolding workshop, the introductory ceremony for most programs outlining the rationale, objectives and strategies to the concerned stakeholders in the governmental side, was held at the block conference hall, Tangarpali with the presence of CDMO, Chairman ZillaParishad, Sundargarh, District Program Officer, NRHM; BDO, Tangarpali Block; MO/IC, Mangespur CHC, Sarpanch, Tangarpali, and other participants namely ASHAs (Accredited Social Health Activist- a grass root level health service provider created under NRHM), AWWs (AnganWari Center) and ANM (Auxiliary Nursing Mid-wife ) etc. marking the lunch of the program in the area.

The Tangarpali Block area consist of 13 Gram Panchayats (GPs) and 73 villages. The villages are further divided into 179 wards coinciding with former hamlets, a majority of which are forest fringe settlements tucked up on small mounds and highland. The Total population of the block is 51462. The ST constitutes about 50.48% of the total population. There are 4 PHCs (N) at Nialipali, Sanpatrapali, Pithabhuin and Tangarpali and one CHC-II at Mangespur. Health infrastructure also includes 17 health sub-centers operating in different areas of the block. Six MBBS and five AYUSH doctors have been assigned to regulate and administer health services in the area.

Paricipants’ Need Analysis (PNA)

A baseline survey cum participants need analysis (PNA) was necessary to assess the general characteristics of the project environment for which seven (7) out of the seventy-three villages of the block were selected on random sampling and lot basis in the presence of the health officials and community leaders. The SEWAK CHIN project staff consisting of the project coordinator and two community organizers went through a spree of rapport building with doctors, Block officials, ANMs, ASHAs, AWW, PRI members, and community leaders to pave way for a series of forthcoming FDGs (Focus Group Discussion), KIIs (Key Informant Interview) and resource mapping of the selected villages. They also collected secondary data from block office, ANM, and AWW centers.

In the following months seven resource maps showing the relative locations of the houses, public and health infrastructure, and natural resource were drawn up. 127 community persons from various walks of life assisted the project staff in the resource mapping process. On the heels of it, the project staff conducted a total of 18 FGDs of vulnerable community (consisting of pregnant and lactating mothers), general community, PRI and VHSC (Village Health and Sanitation Committee) members, and ASHAs in each or most of the select villages. They also conducted KIIs presenting district health officials, doctors, block extension educators (BEEs) and ASHAs. Besides, they conducted a quantitative survey of 100 families in 10 villages of Tangarpali Block and 25 families of Lephripara Block to track the extent of deliverables articles and services received by the beneficiaries. The discussions and interviews resulting from the PNA process that reveals stimulating facts, claims, and counter-claims have been recorded and transcribed and preserved in the health documentation unit for future references.

Awareness Generation
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Awareness generation on NRHM by
village meetings.
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Sharing of ground level findings at the District level in the presence of CDMO Sundargarh.

Community awareness generation was another important component under the project. The awareness package provided for stuff to make people knowledgeable about the health sector fundamentals, including health infrastructure and initiatives in the country, and to arouse them to the entitlementscommitted by government under NRHM. During the first two years of the program, the project staff conducted 221 community awareness meeting registering an average of 25 to 40 participants per each. There were farmers, labors, job holders, pregnant women and their spouses, newly married people, persons with disability and forum members among the 6832 participants registered during these meetings. The degree of awareness being a causative factor in ensuring people’s level of actual involvement in the process, the organizers intensively made use of recaps and follow ups, pictorial presentations, real time sharing of case stories and quiz tests.

Sensitization & Training

In the subsequent months the project sensitized 2930 forum members representing working forums like GKS (Gaon Kalyan Samiti), WSHG, youth club, MahilaMandal, RKS (RogiKalyan Samiti), Farmers’ Associations and PRI. In addition, it trained 158 members, mostly service providers and CBO members on NRHM and NRHM entitlements.

Celebration of safe motherhood day.
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SEWAK staff cooperating for immunization.

The project aims totransformradicallythe perception of people on health issues and public health services. Though the government initiates several programs to ensure health and hygiene for its citizens, due to fissures in the implementing structure, as well as, prevailing top-down approach, the benefit does not reach adequately at the ground level. The situation is worse in rural and tribal area which reveals miserable health indicators. The blame for the situation could be laid on both the service providers, who lack honesty and purpose, and the community people, who pose to be passive and neutralvis-à-vis sweeping nation-wide developmental initiatives.

The scope of the intervention under CHIN existed even before the launch of NRHM. CHIN envisions a society where service providers have genuine motivations to serve people and where, people own and decently use the public health facility to maximum advantage. However, mere orientation of the stake holder is not enough. The project has to promote a broad event culture arising from numerous small and big daring cases and success stories of people who struggled for their right and achieved success. Such a culture could serve as strong bedrock for staging a new genre of health sector reforms.