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CHETNA’s Model of Health Care About CHETNA Historical background Rational Comprehensive Women’s Health To Achieve Comprehensive Women’s Health Needs— Empowerment CHETNA’s Activities for Empowerment Capacity Building Process Stakeholders involved in Capacity Building Processes Why Women and Health (WAH!) WAH! Triangular Force Diagram WAH! Training Processes Uniqueness and Strengths of CHETNA Constraints Faced CHETNA’sModel of Health CareCentre for Health Education, Training and Nutrition AwarenessLilavatiLalbhai’sBungalow, Civil Camp Road, Shahibaug, Ahmedabad-380004, GujaratPresented at the Forum of Federations conference onDecentralization of Health Care Delivery in India –New DelhiFeb. 8 to 10, 2004About CHETNAHistorical backgroundPhase-I (1980-84)Foundation yearsActivities in community health educationPhase-II (1984-88)Establishing credibilityPhase-III (1988-90)Taking stock of the work donePhase-IV (1991-94)Towards new horizonsPhase-V (1995-2000)Expansion, mainstreaming and advocacyPhase-VI (2001-2004)Advancing rights of children, adolescents and womenRationalWomen lack adequate health services. Receive health care solely because of child bearing role. Neglected non-child bearing, individuals, single, post-menopausal. Suffer discrimination throughout lives.“Women’s health cannot be separated from the society in which she lives and works”↓With this conviction CHETNA initiated its activities which envisages an egalitarian & just society, where empowered women live healthy lives.Women’s Health Concerns27 % women are married between the age of 15-19 years.More than one-fifth women are not consulted in all decisions about seeking health care for themselves.46.3% women are anemic. Estimated Maternal Mortality is as high as 380 per 100,000 live births.29 % of women Of Gujarat have at least one reproductive health problems.Sex ratio of Gujarat has declined by 50 points from 928 in 1991 to 878 in 2001.Comprehensive Women’s Health-WAH NetworkTo Achieve Comprehensive Women’s Health Needs—Dignity and equal status in society, freedom from violence.Assured and just income, safe working and living conditions and access to skill and employment.Adequate & clean food, water & shelter.Education including health, health care, contraception.CHETNA’sPrinciples of Comprehensive Health CareEmpowerment“I can empower myself by going through a process of developing my own space within a power structure based on my values and choices, but in collective efforts with the other actors in the power structure.”Advocacy for policies regarding the empowering of women and communityField follow up to provide field level support to initiate programmes for the empowerment of community. (Community level activities and replication and advocacy awareness for women’s empowermentConsolidation and documentation/ dissemination of experiencesEnable us toEmpowerment StrategyCHETNA’sActivities for EmpowermentCapacity Building ProcessStakeholders involved in Capacity Building ProcessesWhy Women and Health (WAH!)gender issuesspecific healthObjective→Process:1992: Review of primary health training needs1993: Core group formed, developed the training 1996: Pilot programme was initiated1998-99: CHETNA conducted the training process2001-02: Second phase conducted WAH! Programme covers 3 trainings phases of 30 days each.WAH! Triangular Force DiagramWAH! Training ProcessesWhy Men’s Active Participation?They should—Managing Health Care in a DecentralisedManner–“Due to my enhances management skills, I have taken the responsibility to organize awareness camps on health. To work in the life span approach, I have also started training programmes for adolescent health and development and awareness camps for adolescents. We are also focusing on the traditional healers to acknowledge their traditional knowledge so they will be more useful to the community. Due to enhancement of my training skills, I have been given the responsibility of conducting trainings not only at the community level but also for capacity building of our staff members. One of the positive results of these trainings is that previously male family members were very shy and hesitant to use a contraceptive (condom), now they are using”.Learning to function as a collective decision making, action, critical reflection, and accountability–“We have formed a health committee to improve women’s health. The committee has about 1,500 members, from which 25 women were selected to participate in a training that we conducted on women’s health and access to primary health care. These women are now facilitators for the groups in their own villages to take action on women’s health. We have also formed the YuvatiMandal”.Building Capacities of Traditional MidwivesEnhancing Capacity of TBAs–“ I was trained as a Dai by a local NGO. A family called me for a consultation when their daughter was seven months pregnant, for the first time at 17 years age. A look at the daughter and I could make out that she was very weak. I informed the family about the care to be taken and advised them for a hospital delivery. Respecting my suggestion the family did so and their daughter and her baby are healthy and happy”.–By a participant Trained in the TrainingDeveloping Education and Training MaterialNetworking and AdvocacyInnovative Training and Awareness Approaches of CHETNAImpact of GlobalizationPrivatization, Commoditization, Urbanization.↓Increased malnutrition, infant mortality, unemployment, illiteracy, poverty, lack of safe drinking water.Cuts in health care, education and other sectors.Destruction of farm land, crop failure, replacement of food crops by cash crops.Environment threats: Exposure to toxic substances, contaminated water, polluted air.Lessons learntDecentralization improves accountability, responsibility, enhances leadership & management capacities. Health should be a primary responsibility of state, with active partnership of NGOs.Model projects to address women’s health concerns need to be formulated and proposed. Necessary to develop capacity of field NGOs & GOs& strengthen women’s health networks.Attitudinal changes is as important as changes in the system.Need based, field tested IEC material plays an important role to enhance active community participation.Uniqueness and Strengths of CHETNAConstraints FacedRecommendationsPolicy Changes: Review of existing polices to make comprehensive with appropriate budget allocations. Radical changes in medical education. Ensure provision of Basic Needs Systematic and urgent research on traditional health systems.Priority on life skill education, health care, food and employment of women. Contraceptive centredpolicy should be holistic relationship with poverty and social realities. Programme LevelsMassive Training Programmes to transfer of skills to representatives of the community.Build organizations of women and weaker sections to demand for their health rights. Ensure active participation of community, local governance and village level functionaries. Gender Development and Violence Against Women, should integrate in all the programmes. Strictly monitoring to regulate the private sector.Strengthen the capacities of Government institutions.Modification in staffing service delivery norms to suit the requirements of the area.Immediate measures to ensure the access of the poor to adequate nutrition.Programme Level