EVOLVING GRASS-ROOTS LEVEL MODELS - A
REPORT ON THE FIELD VISITS BY NCP TEAMS -- Making Population
stabilization a Peoples' Programme |
Introduction |
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As envisaged in the NPP document, the involvement of elected representatives of PRIs, NGOs, Self Help Groups and Youth organizations active at the grass-root level is important to make population stabilization efforts a success. Delivery of an integrated package of essential services at the village and household level is also crucial for the success of family planning programme. Presently, many of the services and programmes of social sectors are not reaching the people at the field level in the desired manner. There is also a multiplicity of agencies and employees representing different departments working in the rural areas in an uncoordinated manner. Because of this, there is a need to think about achieving cooperation and coordination among various agencies for ensuring better delivery of services and supplies at the field level and for maintenance of the infrastructure facilities in sectors like health, family welfare and education. The involvement of PRIs and grass-root level organizations in the formulation and implementation of programmes can greatly help solve local problems. |
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Keeping
this aspect in mind and with a view to understand ground realities,
the NCP has organized field visits to Village Panchayats with the
cooperation of State Governments/District Administrations in the Mewat
region of Faridabad District (Haryana), Gwalior District (Madhya Pradesh),
Netra village of Jodhpur District (Rajasthan) and Maner Block of Patna
District (Bihar). Some members of the NCP and representatives of the
national level NGOs also participated in these visits. Brief details
of these visits are given below. |
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Points for action which emerged out of these visits include control and supervision of all village level functionaries by PRIs, training programmes for women members of PRIs, self-help groups, etc. to improve their awareness and empowerment, involving the practitioners of Indian System of Medicine and Homeopathy to fill the gaps in human resources, coordinating the functioning of all social sector field level workers and adoption of contract system of employment with performance related incentives for field level employees. |
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| Visit to Khilluka village, Mewat Region, Hathin Tehsil, Faridabad District, Haryana on 13th July, 2001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The village is a predominantly Muslim village with a population of about 2400 with seemingly very low levels of literacy among women and men. The primary occupation of the community is agricultural work. The socioeconomic status of most families also seemed to be very low. There is one primary school in the village (with 150 children enrolled with 30 girls and 120 boys) and one aganwadi centre. Each family has an average of six children with 109 children between 0-1 years of age. The nearest PHC is located 15 kms. away (at the tehsil) from the village with no public transport service to the tehsil. |
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Panchayati
Raj institution is working. Reservation for women is given in the
pancyhayat institution. The elected women members spoke of the problems
they are facing. After conversations with Jamila Devi, the Sarpanch
of the village, and some women in the community what was most obvious
was the low level of literacy among men and women, the large size
of families, as well as lack of access to water and health care. Most
women seem to have between 6-8 children and low levels of contraceptive
use. A deterrent, as suggested by one woman, was the fact that a woman
who had an IUD (copper T) insertion had been bleeding and had to be
hospitalized for the same. They also felt that they should not use
the pill as it creates ‘heat’ and that children were "Allah ki
den". Also they did not have much information about what contraceptives
to use as the nurse did not visit them often enough. On the other
hand, the ANM felt that it was
very difficult to mobilize the community to use
contraceptives. One ANM is assigned to look after |
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six villages and because of conveyance problem she faces difficulty
to reach every village. One of the obvious reasons for low or no contraceptive
use, besides the problems with access, was women’s lack of control
over decision-making. |
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The
women Sarpanch (who was earlier being prompted by her husband) spoke
up, but only about how the budget was spent and what the village needs
were, specifically water and transportation and the need for more
anganwadis. Though she did not focus on any issues relating to women,
what was important is that she stood up and spoke to an audience which
included many men. But, some of the women felt that it did not matter
if the Sarpanch was a woman as she did not interact with them anyway
and they could not share their problems with her. They felt that they
should be able to interact with her on a regular basis. According
to government functionaries, religion is the major hurdle to the development.
This can be removed only through proper IEC campaigns and advocacy.
Education also could play major role in reducing the religious flavour
in developmental activities. |
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It
seems that this community does not have access to even the basic services,
which is their immediate requirements. As the village could be representative
of the larger Mewat region in Haryana, there is a need for an assessment
of the ‘expressed need’ of the community through similar meetings,
besides the immediate need for basic services. There should also be
a focus on involving women in activities that could enhance their
status starting with access to basic health, reproductive health services
and sanitation. NGOs could be involved in adult literacy and in starting
self-help groups to disseminate appropriate messages, which would
also help women to have some control over their income. As girls’
level of enrolment is low, there could be a focus on their education
(formal or nonformal) and health combined with life-skills and training
to enhance their income generation skills. It would also be important
to disseminate information about specific schemes for girls. |
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NGOs,
like Rotary Clubs, Lion’s Club, straight away put aside the plan for
working in the villages. But they agreed to have a network of grass
root level NGOs who are working at the village levels. |
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| Following suggestions were made by the NCP team :-- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Visit of NCP Team to Magraura Village in Gwalior District, Madhya Pradesh on 19th July 2001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brief Description of Village – Magraura | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| The Chief Executive Officer of the Zilla Panchayat introduced the ‘Gwalior Concept’ with following strategies: | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Healthy and Happy Family Cards are given to couples and health workers in different colours in which achievements of health standards will be monitored at different levels. The health card is entered by the health visitor and the beneficiary. The first, second and third parts of the card consist of family planning, delivery and infants/children respectively. In Gwalior Concept there is a provision of registration of marriage keeping in view the family cycle starting from marriage. There is also a provision to give information to target couples regarding health and family planning and make them available contraceptives by the health worker. |
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| Benefits of this concept are as under |
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There
are 40,000 Private Medical Practitioners (PMPs) in Gwalior region
who are working in remote areas where government health services are
not reaching properly. For mainstreaming and utilizing the services
of these bare-foot doctors in family welfare programmes, the NCP has
funded the State Institute for Health Management & Communication
(SIHMC), Gwalior to undertake a pilot training programme for 300 Private
Medical Practitioners (PMPs) of Gwalior Division in ten batches. The
PMPs for the training have been registered with the Private Medical
Practitioners Association, Gwalior and Active Medical Society of Madhya
Pradesh. They were from Ayurvedic, Homeopathic and Electro-Homeopathic
branches of medicine. The practitioners were selected from remote,
unapproachable and areas which are out of reach of the field level
government functionaries. The training programme at SIHMC was inaugurated
by Smt. Krishna Singh, Member Secretary, NCP on 28th December, 2001. |
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| Following suggestions were made by the NCP team :-- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Visit of NCP Team to Netra Village in Jodhpur District, Rajasthan on 25th July 2001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Brief Description of Village Panchayat – Netra | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Netra village is under Ausia Panchayat Samiti situated 38 kilometers from district headquarters on Ausia – Falaudi road. |
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| Area of Netra village : 6242.91 Ha. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Decadal Growth Rate of Population during 1991-2001 is + 32.47%. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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People
of Netra village belong to Rajput, Jat, Vishnoi, Raika, Suthar, Devasi,
Meghwal, Bhil etc. castes. Main occupation of villagers is Agriculture
and livestock rearing. |
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Much
focus is to be made for the effective implementation of family planning
services as there are still 384 eligible couples in the village without
having adopted any means of family planning practices. Out of these
69 couples have had already more than 4 children. Such couples who
contribute to the ‘high fertility regime’ need to be convinced to
adopt effectively family planning methods as soon as possible. |
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A
majority of villagers rely on the RMP (Registered Medical Practitioners)
operating in the catchments area of the sub PHC of Netra. This is
due to non-availability of essential drugs and medical services at
the sub PHC. Distance is also found to be a limiting factor for the
villagers who otherwise can go to the PHC situated 7 km away from
the village. As far as family planning practices are concerned, r
e g u l a r arrangement of camps can be made in the village and effective
mobilization programme can be undertaken in collaboration with NGOs
and also female members of the SHGs. |
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The
women mass of the SHGs of Netra village have proved beyond doubt that
institutional constraints can be overcome if women’s needs and strategic
interests can be addressed by ensuring their social and economic security,
based on micro level planning, micro enterprises and micro credit.
A relatively higher couple protection rate among the
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member
of SHGs of Netra village shows the fact that population policies should
be rooted in the principles of social and gender equity and opportunities
for food, health, literacy and work for all. This will not only ensure
economic development but will also enable wider human choices and
hence further human development. |
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| Following suggestions were made by the NCP team :-- | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Visit of NCP Team to Maner Block in Patna District, Bihar on 16th and 17th October 2001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Situated
30 Kms away from the District Headquarters, in Danapur sub-Division
Maner block is important demographically whose population has grown
by 37.8 % over 1991 compared to overall growth rate of 28.43 % recorded
for Bihar for the period 1991-2001. The total population of Maner
as per the Census 2001 is 2,08,014 with literacy rate of 38.4 % as
against 33.7 % recorded in the Census, 1991. The improvement in literacy
rate is more noticeable in the case of females. The following information
is relevant while considering the social indicators / infrastructure
available. |
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Schools |
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Health Facilities No.
of Primary Health Centres – 01 |
Gram Panchayat No. of Ward Members
– 251 (75 Women) |
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The
NCP team was met by the SDM, elected Members of the Zilla Parishad,
Panchayats, Members of Self-Help Groups, doctor of the Primary Health
Centre, Anganwadi Workers and residents of different localities. It
may be mentioned that after a gap of 20 years, Panchayat elections
were held in Bihar a few months back. The elected representatives
of PRIs and other participants showed a high level of consciousness
about the various problems facing the people, which may be listed
as under: |
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The
Sub-Divisional officer pointed out that significant improvement at
the supervisory level is expected after the recent elections to the
PRIs. The members of the NCP team appreciated the enthusiasm of the
elected representatives of PRIs and hoped that full benefit of the
services of elected representatives would be taken for ensuring that
the initiatives being undertaken with regard to social sector programmes
have a better impact. Taking into account the infrastructure gaps
such as shortage of teachers, ANMs, Anganwadi workers etc., it was
necessary to devise strategies at the intermediate levels and to also
pursue with the concerned authorities for filling the gaps. A mention
was made by the Government functionaries as also some public representatives
as to how the distribution of 3 Kg of wheat per student had improved
the enrolment of children as also their attendance level to almost
80 %. Some public representatives, however, stated that the improved
attendance of children was only high at the time of distribution of
grains. These issues could be taken care of since the newly elected
Panchayati Raj Representatives take interest in their supervisory
role. |
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The
members of the team observed that without local initiative bringing
about improvements in the functioning of schools, health centres,
etc. may be very difficult. The members of the team expressed their
satisfaction about the functioning of Women Self-Help Groups from
which more than 8,000 people could take loans for meeting their requirements
at lower rates of interests. Some young girls belonging to the minority
community complained about non-availability of any facilities from
the Family Welfare Programme in their localities. They pointed out
that the ANM or other health workers never visited their localities.
The NCP members advised them also to take interest in getting the
due facilities from various governmental agencies. |
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Later
on the NCP team visited the primary health centre. Even though the
centre has enough space, rooms, etc. the overall upkeep and the cleanliness
seemed to be unsatisfactory. The situation can be improved with the
cooperation between the doctors and other government employees and
the local people without much additional financial burden. The delay
in the payment of salaries, release of funds, etc. also seems to have
affected the functioning of the health system in the rural areas. |
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The
overall impression arising out of the visit of the NCP team to Maner
on 16th October 2001 is one of hope for the future because
of the high degree of awareness among the elected PRI members and
the general people regarding the various problems. If the administration
at different levels make it a policy to involve the beneficiaries
in matters relating to the functioning of health centres, schools
and the implementation of various welfare programmes,
there is no reason |
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why significant improvements cannot be achieved in the immediate future.
The improvement in literacy, health care and availability of family
welfare services along with the increasing urbanization of Maner should
definitely bring down the rate of growth of population which seems
to have reached a peak level at present. |
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| Visit to East Loharipur Slum Area in Patna City on 17th October, 2001 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
East
Loharipur is a slum area with about 5,000 people living there. One
part of the slum has tenements built by the Patna Development Authority
with the help of HUDCO. These tenements have provision for toilet,
water supply, electricity meters etc. However, neither water supply
nor electricity has been given to them forcing the residents along
with the dwellers in unauthorized huts to depend upon common toilets
and illegal tapping of electricity. As the allottees of the HUDCO
tenements did not pay their loan installments, such a project to cover
the other parts of the slum was not taken up by HUDCO. |
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There
are three primary schools in the slum area. However, the attendance
in the schools are very poor due to the non-congenial atmosphere in
them, as stated by the residents. One of the schools visited by the
NCP team has no furniture. The students sit on the floor and the two
or three pieces of furniture used by the teachers were brought by
the t e a c h e r s themselves. It is also interesting to note that
some of the slum dwellers send their children to expensive private
schools because of the very poor state of affairs of the government
schools. It was also revealed during discussions with the residents
that about 25% of the students enrolled in the government schools
drop out every year. About 50% of the children of school-going age
are working as rag pickers in the city for eking out a living. |
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The
sanitation and hygienic facilities in the locality were bad especially
due to the ongoing strike by the employees of the Patna
Municipal Corporation. The residents mentioned that the
common toilets in the |
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slum areas were earlier satisfactorily maintained by the residents
themselves by paying Rs. 5 per month per slum unit and engaging a
Jamadar for cleaning etc. However, it appears that the PMC has auctioned
the maintenance of these toilets and a locally influential person
is now collecting about Rs. 120 per month per slum for using the toilet
facilities. As many people were not able to afford this high charges,
they are forced to go to the Railway Track or open places for easing
themselves. Later during the day, the Administrator of PMC stated
that the bad situation prevailing was basically due to the employees’
strike and that the PMC has not auctioned the toilets. However, it
may be mentioned that the introduction of contract system for maintenance
of sanitation facilities may adversely affect the interest of the
community without improving the municipal finances significantly. |
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The
members of the NCP team through their discussion with women living
in the slum area gathered that practically no health care or Family
Welfare services were reaching the residents. The conditions in the
Government hospital at nearby Rajender Nagar were stated to be so
bad that nobody ever wished to go to it. Most of the residents stated
that they either went to the costly private hospitals or Patna Medical
College hospital in case of serious illness. It was also indicated
by women residents that they would go for sterilization after having
three or four children if the health of their children is good. They
generally went to private hospitals for sterilization operations because
in Government hospitals they were often made to purchase the medicine,
peripherals etc. required for the surgery. Thus the number of children
each woman may wish to have, among other things, also depended upon
the probability of survival of her existing children, as assessed
by the parents. |
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An
important point noted by the NCP team is the absence of any initiative
from the residents of the slum for doing something for improving their
conditions. There was complete absence of any NGO activity there.
The slum dwellers entirely depend upon Govt. agencies to deliver the
goods even in matters like cleaning the accumulated dirt, ensuring
water supply, electricity maintenance of the toilet, running the local
schools etc. A minimum of interest and initiatives by the slum dwellers
as beneficiaries and possibly the involvement of a committed NGO can
dramatically improve the situation in all these fronts, the team felt. |
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Visit to Sulabh International Projects near Gandhi Maidan |
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| The NCP team also visited the Sulabh International project on the side of the Gandhi Maidan in Patna City. Though this project earlier had functional biogas generation plant attached to the Souchalaya facilities, which met the lighting requirements of Gandhi Maidan area, the same is not operational now. At present the centre is only providing latrine facilities for Re. 1 per head per visit. Cleanliness and upkeep of the place seemed to be satisfactory. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Discussions with representatives of NGOs |
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The
NCP team also held discussions with representatives of a number of
national, State and district level NGOs. The Deputy Director dealing
with NGOs in the Family Welfare Department of the State Government
also attended the meeting. She stated that 42,000 lady Mukhiyas were
nominated by the State Government. The State Government is organizing
a three-week training programme for them to equip them better for
discharging their responsibilities. Generally speaking there appears
to be lack of coordination between the State Government and most of
the NGOs working in the State. It was pointed out in the meeting that
selection of mother NGOs working in Bihar by the Central Government
should be done in consultation with the State Government. The NGO
representatives also generally agreed with the need for better coordination
between them and the State Government so that problems like doctors
and ANMs not attending their duties, non-availability of medicines,
distribution of medicines, contraceptives, etc. and the creation of
awareness about various programmes and policies can be tackled more
effectively. It is also important that due recognition should be given
to the contributions made by the NGOs working in different fields.
It was suggested that District Collectors, District Medical Officers,
etc. should convene periodic meetings of the representatives of the
NGOs working within their jurisdictions. The members of the NCP team
suggested that the Chairman of District Zilla Parishads should call
such meetings so that all the concerned officers could also be made
to attend them. |
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This
proposal was welcomed. Another member of the team suggested that it
would be very useful to fix a time and date for visit of the ANM/doctor
etc. to a particular centre/place and the same should be widely publicized
so that people needing their services can visit the sub-centre etc.
at the appointed time and date. This suggestion was generally welcomed.
There was also a feeling that State level meetings between the concerned
officers and the NGOs representative should be convened periodically
so that coordination and cooperation between the NGOs and the Government
can be brought about. |
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| Common Problems Identified During Field Visits By NCP Teams | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Suggested Action Points to Tackle Above Problems | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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