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At all ends of the age spectrum, the health of our people has been found to be poor and the women's health, in particular, worse. The links between population, gender, health and development are complex, and specific to historical and socio-economic-cultural contexts. This is all the more important for the Rajasthan state, where the major issue of concern for ensuring the right to healthcare and the right to livelihood is gender inequity.

A thorough and critical study of the women's self help groups (SHGs) had revealed that the loans taken by the women members of the SHGs had mostly been for purposes such as healthcare of the family members, education of children, marriages of daughters etc., and seldom for their own health or for that matter any such related expenses. With this backdrop the Ministry of Health & Family Welfare in association with the World Health Organisation (WHO) has been assisting the Centre to facilitate the processes of awareness generation and sensitisation for the leaders of women SHGs through various capacity building exercises.

Objectives & Framework

The state-level workshops conducted by the Centre intended to bridge the gap between the healthcare providers and seekers through effective deliberation as well as to carry forward well-argued viewpoints and grassroots concerns to the development community at large. The supplementary broad objectives of the workshops were to advocate for incorporation of the sensitive women issues in developmental health planning, facilitate integrated approach for micro-planning of state population policy and catalyse synergetic efforts towards promotion of Chittorgarh as a model district.

The two workshops addressed issues such as; availability and accessibility of government healthcare for the benefit of women; social and economic empowerment of women to demand health services, through sensitisation of various stakeholders. Broadly these workshops endeavoured to establish link between government services and social system with focus on community health and augmented the previous district-level workshops.

The First Workshop

To deliberate with government officials directly or indirectly associated with community health for making the health services people-friendly, the first workshop with the theme of "Government Services and Community Health" was held on 8th November 2001 in the Conference Hall of Krishi Vigyan Kendra, Chittorgarh. Illiteracy, lack of firm will power, insufficiency of resources, burgeoning population, and political pressure as well as differences were identified as the major contentious factors towards community health. That improvement in availability and quality of health services, people's participation and involvement of non-government organisations (NGOs) could facilitate in achievement of the proposed aim of 'Health for All', also emerged as the reflections of the workshop.

Among the four sessions, the group discussion-session on 'effective healthcare access of populace' was the highlight of the workshop. The group-contemplation on the social, economic and political reasons adversely affecting healthcare seeking and providing behaviour cited: inconsistent location of the health institution, lack of community-friendly component in health services and resources, poverty, high healthcare cost, political pressure/interference, absence of political willpower etc. as the dominant issues. Efficient delivery of health services, expand the ambit of education in villages to ensure effective people's participation, involvement of sensitised community members for wider awareness generation in the society, increased allocation of the healthcare budget, strengthening of MCH (Mother & Child Health)/RCH (Reproductive & Child Health) programme, extensive IEC (Information, Education & Communication) of National/State Healthcare programmes, establishment of health institutions on the basis of population, effective manpower deployment, increased self-employment opportunities and emphasis on technical/professional education, were specified as the effectual means for easier accessibility of health services in the community.

Dr. G. C. Shukla, Joint Director (Medical and Health department, Udaipur Zone) inaugurated the one-day workshop attended by 54 people, including the representatives of WHO & UNFPA (United Nations Population Fund), government officials from departments such as health, education & development, leaders of women SHGs, traditional birth attendants (dais), traditional healers (gunis), community leaders, social workers and NGO personnel.

The Second Workshop

On 22nd November 2001, the second workshop on "Social System and Community Health" was held in the Conference Hall of Krishi Vigyan Kendra, Chittorgarh. The objective of this workshop was to 'deliberate on the direct and indirect impacts of the social system on community health for making the social system conducive to better community health'. 75 people consisting of leaders of women SHGs, people's representatives (majority being panchayat members), community leaders, traditional birth attendants (dais), traditional healers (gunis), traditional folk artists, government officials, social workers and NGO personnel from Ajmer, Udaipur and Chittorgarh districts participated in the workshop, chaired by Ms. Bhagwati Jhala (Member of Chittorgarh Zilla Parishad).

Wider awareness generation, comprehensive information dissemination and extensive sensitisation of the community were identified as the keys to effective development of women's health. The participants also called for brining in balance between traditional and modern knowledge systems for complete physical, mental and social wellbeing. During the contemplating session, they emphasised on the need for identification and encouragement of socio-cultural customs/beliefs favourable to community health, such as; relaxation in the post-delivery phase, consumption of nutritious food by pregnant and lactating women, rest during menstruation period, adoption of traditional practices during social functions/cultural festivals (e.g. use of turmeric during marriage celebrations), widow marriage, concerted/cooperative approach to work, worship of trees with cultural significance. Child marriage, pervasive son preference coupled with female feticide, gender discrimination (in nutrition, education, healthcare etc.), gender inequity (specifically lack of decision-making power in determining family size and adoption of family planning measures), nata pratha (specially frequent remarriage of a woman), economic dependence of women on men (particularly inheritance of property due to prevailing structural system in the society), heavy work burden of women coupled with non-monetary valuation of the same (household chores and assistance in family occupation), preposterous beliefs concerning obstetric care (e.g. delivery on the cow-dung-pasted ground; putting pressure on the chest of the woman during delivery process; control on consumption of food of the woman; restrictions on colostrum-feeding etc.), divulging of sexual/gynecological diseases considered to be taboo were classified as the socio-cultural practices/beliefs adversely affecting community health. The participants indicated that the collective effort of women members of PRIs (Panchayati Raj Institutions) and SHGs in association with the community leaders could bring about reduction in these socio-cultural malpractices. Involvement, participation and representation in polity by women as well as education of girl children are crucial peripheral factors of overall development.

Background

Objectives & Framework

The First Workshop

The Second Workshop