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
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.
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
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
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
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
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