Communication Health India Network (CHIN) in

Participatory communication for improving access to public health

CHIN, launched in 1998, comprises of four partner organisations viz. Child in Need Institute (Kolkata), Christian Medical Association of India (New Delhi), Centre for Health Education, Training and Nutrition Awareness (Ahmedabad) and Rural Unit for Health and Social Affairs of Christian Medical College (Vellore).

 Brief history

CHIN’s first foray was in 1998 with a project aimed at increasing access to applied and appropriate information about policies and practices to improve child health in India and South Asia. The second phase of CHIN initiated in 2002 with a renewed focus on poverty and health, redefining its goals within the frameworks of communitisation of health and the associated processes of communication for social change and aimed at increasing the influence of vulnerable communities over policies, practices and public attitudes in health.

Participatory Communication Initiative

In 2006, CHIN in its third phase in collaboration with the Bill and Melinda Gates Foundation worked for Participatory Communication Initiative to improve access to public healthcare services of rural communities in India. The Initiative was conceptualised within the National Rural Health Mission (NRHM)framework launched in 2005 by The Ministry of Health and Family Welfare, in its quest to attain the Millennium Development Goals.

The Participatory Communication Initiative sought to build the capacity of both community members and service providers in 40 districts of seven states of India. It has also helped empower local communities and institutions to monitor the implementation of NRHM for greater effectiveness. Read more.

Pillars of Communication For Social Change

The Participatory Communication Initiative is built on five pillars in sync with the communication for social change framework: community participation, dialogic process and amplification of the voices of the vulnerable, ownership by internal change agents, and using culturally embedded means to communicate.

·       Community participation

·       Spaces for Dialogue

·       Amplification of the voices of the vulnerable

·       Creating ownership of and driven by internal change agents

·       Use of culturally embedded means to communicate

• Community participation

CHIN views community participation as an indispensable component of this public health initiative. A key to community participation is information and awareness. In the participatory need assessment carried out in Odisha it emerged that only 42% of the respondents were aware of government health schemes and entitlement. In Tamilnadu, 93% of the respondents had never heard of the untied funds, a fundamental component of community participation in NRHM. Only 8% of the women surveyed in the state had accessed State health benefits. In Gujarat only a quarter of the respondents were aware of government health schemes, while a mere 2% reported to have ever used services at the sub-centre.

It’s never too late

CHIN along with their district NGO partners regularly conducts community awareness activities to talk about NRHM entitlements and other health issues every month. This initiative has enhanced the knowledge of the community on NRHM and increased access to entitlements. Mothers availed of Janani Suraksha Yojana as a result of awareness meetings. Self-help groups and Gaon Kalyan Samitis (VHSC) started organising awareness meetings in their villages. In Gujarat, awareness activities resulted in increased emphasis on celebration of Maternal and Child Health Nutrition Day.

• Spaces for Dialogue

The Participatory Communication Initiative was built around debates and negotiation to create linkages between different stakeholders of NRHM. The participatory need assessment indicated a lack of access of rural communities to forums for dialoguing with service providers. In Gujarat, less than half the respondents surveyed could identify their Accredited Social Health Activist (ASHA), the most critical link between the community and the State under NRHM. In West Bengal, respondents articulated the need to facilitate dialogue between the community and service providers to increase utilisation. They asserted that what is essential is the involvement of panchayat and Village Health and Sanitation Committee members, whose knowledge and awareness levels on government health schemes needs to be improved.

Helping Village Health and Sanitation Committee play its part

In Odisha, community awareness meetings were conducted in 10 intervention blocks. It is expected that they had a role to play in the increased number of institutional deliveries and immunisation in the blocks. Village Health and Sanitation Committee meetings have also been regularised in many places giving the community a space to air their concerns, including those about corrupt practices in the health service delivery mechanism. Similar trends were observed in all intervention areas.

Not just a rupee

•  Amplification of the voices of the vulnerable

Not being able to have a say in decisions that affected their lives was identified as a key element of poverty. In the Participatory Communication Initiative, amplification of the voices of members of the community as well as service providers was a core component. The initiative not only assisted members of the community to find a voice in appropriate forums, it also helped service providers address their concerns. In the round table meetings and service provider orientation trainings, various advocacy issues emerged like non-receipt of remuneration on time, lack of proper training inputs etc. Efforts were made to gather evidence and put them up at forums like monthly meetings of primary health centres and ASHA sector meetings among others.

The determination of Rojalia Minj

• Creating ownership of and driven by internal change agents

The Participatory Communication Initiative has focussed on developing ownership of accessing NRHM entitlements from within communities and community forums. During the participatory need assessment in Gujarat, it came to light that only about 10% of the members of panchayat and Village Health and Sanitation Committees were aware of government health schemes to some level of accuracy. In Odisha, although a number of training programmes had been conducted for service providers and Gaon Kalyan Samitis, many did not have the desired effect because of issues of language.

Another area in which the Participatory Communication Initiative has played a significant role is in helping communities enhance the health and health-related infrastructure. In West Bengal, it was found that delivery facilities are not available in many primary health centres. Regular awareness and sensitisation meetings conducted by district partners with village forums like self-help groups, farmers’ associations, youth clubs etc. have brought about many visible changes in communities. Village Health and Sanitation Committees have been formed where there were none, communities have been mobilised around the use of untied funds and community members have set up alliances with ASHA and anganwari workers for better service delivery, among others. 

Information, the key to big changes

• Use of culturally embedded means to communicate

Participatory need assessment has reflected that community members recall seeing information-education-communication material related to health, though most of them had poor recollection of the message they contained. Many said they were illiterate and were unable to read what was written on government communication material. Community members saw the relevance of receiving information and suggested means other than posters and written documents like camps, training programmes, pictorial depictions, audio visual programmes, street plays and folk media. Information was sought about ailments and their treatment, government health schemes, services of health centres and entitlements under NRHM. It was clear that community members seek information but through culturally appropriate means. In parts of West Bengal, information dissemination suffered because multiple languages were spoken, especially in regions where there were large migrant populations from neighbouring states. 

Let the drums roll

Christian Medical Association of India
Plot no 2, A-3 Local Shopping Centre
Janakpuri, New Delhi 110 058, India
Ph +91 11 255 9999 1/2/3
Fax +91 11 255 98 150