“No permanent improvement of public-health can be achieved without the active participation of the people in the local health programme…we consider that the development of local effort and the promotion of the spirit of self help in the community are as important to the success of the health programme as the specific services, which the health officials will be able to place at the disposal of the people….formation of village health committees and voluntary workers are needed who will need suitable training….” – Health Survey and Development Committee – India (Bhore Committee, 1946)
Community Health Workers: A Policy Overview
The community based village workers have long been the sheet anchor of the term community participation popularised by the Alma-Ata Declaration even though, we know it is just one of many innovations in the interface between the community and the primary health care system. A brief policy overview was undertaken when SOCHARA was invited by the Madhya Pradesh Government in 1996 as it sought to revive the village health workers scheme which had been experimented with in 1977 by the Janata Government with very mixed results. This policy overview which sets the context for SOCHARA involvement in the CHW revival in India became part of the subsequent JSR evaluations.
1997 to 2001
Jan Swasthya Rakshak Scheme and Its Evaluation
The Madhya Pradesh Government initiated a community health workers scheme (Jan Swasthya Rakshak) on 19th November 1995 under the Integrated Rural Development Programme (IRDP) for unemployed rural youth to provide round the clock curative, preventing and promotive health services in every villages of Madhya Pradesh. SOCHARA was invited to evaluate the JSR scheme in two phases as it evolved over the years. First in July to December 1997 when the JSRs were trained and were beginning to be deployed and second in July to November 2001 when the JSR Scheme had spread into all the districts of Madhya Pradesh with over 19000 JSRs trained. These two evaluations were interactive and early examples of health systems research. Both of them included a core team from SOCHARA and supported by SOCHARA associates from all over the country.
The team consisted of SOCHARA Research Team: Dr. Pankaj Mehta, Dr. Ravi Narayan, Dr. C.M. Francis, Dr. Shirdi Prasad Tekur, Dr. A. R. Sreedhara and Peer Review Team for JSR Manual – Dr. Dhruv Mankad, VACHAN, Nasik, Dr. Ashok Bhargava, IDEAL, Ahmedabad, Dr. Anant Phadke, MFC, Pune, Dr. Shyam Ashtekar, BVS, Dindori. Dr. Ulhas Jajoo, MGIMS, Wardha, Dr. Abhay Bang, SEARCH, Gadchiroli, Dr. Abhay Shukla, Dr. Prabir Chatterjee, CHAD, CMC-Vellore.
The team consisted of SOCHARA members Dr. Ravi Narayan and Prof. Mohammad and SOCHARA Associates Dr. Shyam Ashtekar, Dr. Dhruv Mankad, Dr. Shahikant Ahankari and Dr. Abhay Shukla.
2001 – 2005
The Mitanins of Chhattisgarh
The Chhattisgarh Government took a bold initiative to improve public health and access to health care through a state wide intervention which included a state health resource centre and a programme of health workers called Mitanins in 2001. SOCHARA was invited to coordinate the external evaluative study of the SHRC and the Mitanin programme.
An external evaluative study of the State Health Resource Centre (SHRC) and Mitanin Programme – Final Report December 2005.
The team consisted of Dr. Thelma Narayan and Dr. Rajani Ved who studied the SHRC and Dr. Shyam Ashtekar, Dr. Sunil Kaul, Dr. Deepti Chirmulay, Dr. Shashikant Ahankari, Dr. Rakhal Gaitonde, Mr. Amulya Nidhi and two Fellows of SOCHARA Dr. Vinay Vishwanath and Mr. Naveen Thomas.
A literature review regarding community health workers was undertaken as part of the SHRC/Mitanin evaluation mentioned above. This review was called CHW…paradigms, concepts and origins. This review was also included in the SHRC report above. An external evaluative study of the State Health Resource Centre (SHRC) and Mitanin Programme – Final Report December 2005.
CHW – Pedagogy and Practice
SOCHARA team members were key resource persons in a national workshop entitled – ‘Community Health Worker Training: Linking Pedagogy and practice‘ organized by ICICI Centre for Child Health and Nutrition in February 2007.