THROUGH THE PENS OF GANDHIAN FOLLOWERS
Year : 2019 | Volume
: 149 | Issue : 7 | Page : 63--67
Village First: Community Empowerment on Health & Development Based on Gandhian Approach – An Experience of Working in few Villages of Wardha District, Maharashtra
Dr. Sushila NayYar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, India
Dr B S Garg
Director, Dr. Sushila Nayyar School of Public Health, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha 442102, Maharashtra
|How to cite this article:|
Garg B S. Village First: Community Empowerment on Health & Development Based on Gandhian Approach – An Experience of Working in few Villages of Wardha District, Maharashtra.Indian J Med Res 2019;149:63-67
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Garg B S. Village First: Community Empowerment on Health & Development Based on Gandhian Approach – An Experience of Working in few Villages of Wardha District, Maharashtra. Indian J Med Res [serial online] 2019 [cited 2019 Dec 8 ];149:63-67
Available from: http://www.ijmr.org.in/text.asp?2019/149/7/63/251659
“All other pleasures and possessions pale into nothingness before service,
which is rendered in a spirit of joy.”
– Mahatma Gandhi
India lives in its villages, and the development of villages will be critical if we want to close the gap between the “haves and have not's” for better human development. In the Human Development Report (HDR) 2014, India ranks at 135th place both for the overall Human Development Index (HDI) and the Gender Development Index (GDI), a rating classed by the United Nations as 'medium human development'.
Gandhian concept of Village Development
The word Swaraj is a sacred word, a Vedic word, meaning self-rule and self-restraint, and not freedom from all restraint, which 'independence' often means. Real Swaraj will come not by the acquisition of authority by a few but by the acquisition of the capacity by all to resist authority when it is abused. In other words, Swaraj is to be obtained by empowering the masses to a sense of their capacity to regulate and control authority. The Gandhian vision of an ideal village or village Swaraj is that it is a complete republic, independent of its neighbours for its own wants and yet interdependent for many others in which dependence is necessary.
According to Gandhiji, the making of an ideal village is very simple.
He says: “An ideal Indian village will be so constructed as to lend itself to perfect sanitation. It will have cottages with sufficient light and ventilation built of a material obtainable within a radius of five miles of it. The cottages will have courtyards enabling householders to plant vegetables for domestic use and to house their cattle. The village lanes and streets will be free of all avoidable dust. It will have wells according to its needs and accessible to all. It will have houses of worship for all, also a common meeting place, a village common for grazing its cattle, a co-operative dairy, primary and secondary schools in which industrial education will be the central fact, and it will have Panchayats for settling disputes. It will produce its own grains, vegetables and fruit, and its own Khadi. This is roughly my idea of a model village... I am convinced that the villagers can, under intelligent guidance, double the village income as distinguished from individual income. There are in our villages' inexhaustible resources not for commercial purposes in every case but certainly for local purposes in almost every case. The greatest tragedy is the hopeless unwillingness of the villagers to better their lot. My ideal village will contain intelligent human beings. They will not live in dirt and darkness as animals. Men and women will be free and able to hold their own against anyone in the world.”
Role of the Gram Panchayat
Gandhiji made it very clear that concentration of either economic or political power would violate all the essential principles of participatory democracy and thereby of Swaraj. To promote decentralization, Gandhiji suggested the institution of village republics both as institutions of parallel politics and as units of economic autonomy. Village being the lowest unit of a decentralized system, politically a village has to be small enough to permit everyone to participate directly in the decision-making process. It is the basic institution of participatory democracy.
Panchayat Raj is a system and process of good governance. The Ministry of Panchayati Raj has issued specific guidelines to make Gram Sabha a vibrant forum for promoting planned economic and social development of villages in a transparent way. It offers equal opportunity to all citizens including the poor, the women and the marginalized to discuss and criticize, approve or reject proposals of the Gram Panchayat and also assess its performance.
According to Mahatma Gandhi, utilization of local resources is quite fundamental to the development of the Panchayat Raj system. The Panchayats with the Gram Sabha should be so organized as to identify the resources locally available for development in the agricultural and industrial sectors. The Gram Panchayat elected annually by adult villagers, male and female, possessing minimum prescribed qualifications, will conduct the Government of the village.
The Gandhian ideas of Gram Swaraj and Panchayat Raj system can become vehicles for ushering in much-needed social and political change by including all the stakeholders in the process of decision-making and public policy formulation. As Gandhi said, “Panchayat Raj represents true democracy realized. We would regard the humblest and the lowest Indian as being equally the ruler of India with the tallest in the land.” Therefore, concerted, systematic and sustained endeavours are needed on the part of those for whom Gram Swaraj remains a cherished dream for the empowerment of people and for a participatory democracy.
Communitization of Public Health Services under NRHM and the role of Village Health Nutrition and Sanitation Committee (VHNSC) in Village Development
The National Rural Health Mission (NRHM) envisages the “communitization” of public health services, enabling both public health employees as well as local communities to develop ownership in the Public Health Service Institution. The process of communitization is expected to help in universal access to equitable, affordable and quality health care that is accountable and responsive to the needs of the people.
One of the approaches of NRHM for communitization is the constitution of VHNSC. The committee is expected to work collectively on issues related to health and social determinants at the village level. The VHNSC is particularly envisaged as being central to 'community action' under NRHM to support the process of Decentralized Health Planning. The committee, therefore, is envisioned to play a leadership role by providing a platform for improving health awareness and access to health services, addressing specific local needs and serving as a mechanism for community-based planning and monitoring. The committee functions under the overall supervision of Gram Panchayat.
The committee is formed at each of the revenue village level and should have a minimum of 15 members with representatives from elected member of the Panchayat, ANM, Anganwadi workers, teachers, community health volunteers and ASHA.
The objectives of VHNSC under NRHM are as follows:
To provide an institutional mechanism for the community to be informed of health programmes and government initiatives and to participate in the planning and implementation of these programmes, leading to better outcomes.To provide a platform for convergent action on social determinants and all public services directly or indirectly related to health.To provide an institutional mechanism for the community to voice health needs, experiences and issues with access to health services, so that the institutions of local government and public health service providers can take note and respond appropriately.To empower Panchayats with the understanding and mechanisms required for them to play their role in governance of health and other public services and to enable communities through their leadership to take collective action for the attainment of better health status in the village.To provide support and facilitation to the community health workers – ASHA and other frontline health care providers who have to interface with the community and provide services.
The VHNSC under NRHM needs to be revitalized; capacity building is a must for fulfilling their proposed role. This platform of VHNSC should be better used by converting to Village Development Committee, which should work as an arm of Gram Panchayat for the integrated development of the village.
Partnership With Community Through Intense Social Mobilization at Mgims Sevagram
The Department of Community Medicine (DCM), MGIMS, Sevagram is actively involved in social mobilization in approximately 90 villages with four primary health centres under its field practice area. DCM acts as a catalyst to form community-based organizations (CBO) and builds their capacity for health action. The community-based organizations being promoted by MGIMS, Sevagram in its field practice area are:
Women's Self-Help Groups: Women's Self-Help Group (SHG) is a very effective tool for not only women empowerment, but also overall development of the community. MGIMS fully appreciates the critical link between women empowerment and community development as it plays a catalytic role to add health action agenda to their primary micro finance function. With this, women have been empowered to determine health priorities and play a proactive role in health care delivery in their villages. The department has now achieved formation of 3–4 SHGs per village in all villages in its field practice area. A total of 275 Self-Help Groups are functioning in the adopted villages of the Institute.
Kisan Vikas Manch: Kisan Vikas Manch (Farmers' club) has evolved as a way to involve men in health activities at village level. The Institute provides learning opportunities for members to improve their agricultural yield and in turn improve their economical status. The health action agenda is added to the primary purpose so as to empower them to actively participate in the health program. Kisan Vikas Manch in the villages of Anji PHC area came together to form a federation. The federation engages experts in the agriculture sector for capacity building of the members of Kisan Vikas Manch, so that farmers can get better yield from their agricultural land.
Adolescent Girls' groups (Kishori Panchayat): The Institute has taken an initiative to form groups of adolescent girls in all the villages of its field practice area. At the village level, an elected body of the adolescent girls has been formed, which is known as Kishori Panchayat. An adolescent to adolescent education programme is undertaken in all villages through these groups. These groups have been oriented towards issues of adolescent health, maternal health, child survival, environmental health, family-life education, RTI/STD, HIV/AIDS, etc. In turn, these girls will train their peers and younger adolescents in their villages. A resource centre for Kishori Panchayat has been developed at the RHTC (Rural Health Training Centre), Bhidi. This includes a library of health education material for adolescents, with 5 satellite libraries at the school level and 10 satellite libraries at the village level.
Panchayati Raj Institutions (PRI) and Village Health Nutrition and Sanitation Committee (VHNSC): DCM continuously engages with PRI members in all villages in its field practice area. Orientation sessions are organized through the Rural and Urban Health Training Centres to empower the PRI and VHNSC members for health action at the community level. Due to its continuous engagement with VHNSC, in most of the villages in the field practice area, monthly meetings of VHNSC members are ensured.
Mahatma Gandhi Institute of Medical Sciences (MGIMS) has developed a community-led approach and ensures the provision of high quality and affordable health care with emphasis on maternal and child health, in partnership with local community and health system. The strategy is to empower the communities to manage and own village-based primary health care. The programme has initiated various community-based organizations in the villages – self help groups of women, adolescents groups (more than 60 in numbers) and empowered Village Health, Nutrition & Sanitation Committees (VHNSC) in every village in a systematic manner.
The programme uses the Integrated Model of Communication for Social Change (IMCFSC) to guide its BCC activities. IMCFSC uses an iterative process where 'community dialogue' and 'collective action' work together to produce social change. The VHNSC have been empowered for health planning, organization of Immunization Day, monitoring of the health functionaries, and they work in close collaboration with the local health system and democratic body. There is an effort to link health and developmental activities at the village level.
Formal interaction of medical and nursing students with community-based organizations is arranged during their village visit; they witness the activities of community-based organizations. This helps aspiring doctors understand the role of individuals, families and communities in preventing diseases, maintaining and promoting health, and improving health-seeking behaviour.
Partnership With District Health System and Integrated Child Development Services (ICDS) Scheme
Over the years, MGIMS, Sevagram has built a strong relationship with the District Health System and Integrated Child Development Services (ICDS) Scheme. Through RHTCs it not only supports delivery of routine healthcare services to the community, but also organizes training of frontline workers and supports capacity building for better implementation of national health programmes. DCM has developed a system of continued professional education through the regular monthly meetings of frontline workers at PHC level. On the request of the district health system, it has provided support for the investigation and control of epidemics. The partnership has been a culmination of delegating the management of two PHCs to MGIMS.
DCM has developed a close liaison with ICDS scheme. It has provided training to Anganwadi workers (AWWs) and its supervisors in Early Childhood Care and Development (ECCD) to build their capacity in the delivery of child health, nutrition and development services. At present, DCM, in collaboration with WHO & UNICEF, is working to develop a model for the promotion of ECCD through the strengthening of home visits by ASHA and AWWs, organization of mothers' meetings, and parenting workshops.
Strengthening the VHNCS – the need of the hour
VHNSC has a vital role in decentralized health planning and monitoring. NHM envisaged VHNSC to function adequately with the involvement of community members and to promote people's participation in the planning process. However, there should be a tool which facilitates in planning, implementation according to village-specific health plan, and community monitoring of health services at the village level. At MGIMS, we have evolved the VMI (VHNSC Maturity Index): a tool which could be easily administered to identify areas requiring improvement in VHSNCs and help in the proper delivery of healthcare services covering many of the social determinants of health.
Community-based organization will be the key to bring about the overall development of villages. Most importantly, communities need to control the process. The ultimate goal is for communities to have the confidence and competence to make informed choices from a range of appropriate options for sustainable and equitable development.
The need of the hour is to bring about a holistic change in the lives of beneficiaries among the villagers by uplifting their socioeconomic and health status through effective linkages through community, governmental and other developmental agencies. The VHNSC should be able to prepare an Integrated Village Development Plan with technical guidance from local organizations/agencies.
At the end of the day, we must remember a talisman given by Gandhi:
“I will give you a talisman. Whenever you are in doubt, or when the self becomes too much with you, apply the following test. Recall the face of the poorest and the weakest man [or woman] whom you may have seen, and ask yourself, if the step you contemplate is going to be of any use to him [Or her]. Will he [or she] gain anything by it? Will it restore him [Or her] to a control over his [her] own life and destiny? In other words, will it lead to Swaraj [freedom] for the hungry and spiritually starving millions? Then you will find your doubts and yourself melt away.”
– One of the last notes left behind by Gandhi in 1948, expressing his deepest social thought.
Source: Mahatma Gandhi [Last Phase, Vol. II (1958), p. 65]
Financial Support & Sponsorship: None
Conflicts of Interest: None
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