The Hindu Business Line : Healthy empowerment

If women are empowered with knowledge about basic healthcare and hygiene, and educated on the Right to Information, they go on to become much more than agents of change.

A community health worker with a medical kit at a tribal village near Visakhapatnam. - C.V. Subrahmanyam

We work to prevent diseases. We propagate the use of clean water. We are trained in Arogya (holistic health). We deal with micro credit, and we advocate a clean environment. We wanted to build toilets because there was a great need, so we went to our MLA and 18 toilets were built." So says Pushpa Jadhav, an experienced community health worker in rural Maharashtra. Ralegan Siddhi, a village in Ahmednagar district, about 85 km from Pune, is best known as the home of well-known social worker Anna Hazare. I had been working with my colleagues on the Mid Term Appraisal (MTA) of the 10th Five Year Plan. In 2004, the extensive consultations I had held in preparation of the MTA revealed that women volunteers had been trained and equipped for community-based work by several organisations. These included Agragami in Rayagada (Orissa), the Foundation for Research in Community Health (FRCH) in Maharashtra, and the Society for Education, Action and Research in Community Health (SEARCH), in Gadchiroli (Maharashtra).

These women are considered the daughters of the villages and responsible to their own people, including the panchayat. They have learnt preventive healthcare and simple cures. I wanted to see how it worked, and whether it could be replicated all over the country, and also wanted to know the effect of this exposure on the psyche of women. Fifteen years ago, an experiment began in Parinche, a village situated about 50 km from Pune. Dr N.H. Antia, a physician and plastic surgeon, had set up FRCH with the aim of addressing health-related needs through a preventive approach. Instead of increasing the number of doctors and nurses in villages, the idea was to empower village women and enable them to administer basic healthcare.

Women volunteers were invited from the villages to work as community health workers — as a tai (elder sister) or a sahyogini (friend). There was resistance and shyness on the part of women, and cynicism from the men initially, and so the idea took root slowly. However, today, FRCH is a well established programme. And the incidence of sickness, infant mortality and maternal mortality has significantly reduced in the areas where it is active.

On the day of my visit, 40 women sat in a circle under a massive peepal tree, a short distance from Ralegan Siddhi; their animated voices and discussion exuded a distinctly powerful energy. A majority of the women were young — trainees from villages nearby. The trainers were tais from Parinche — most of them with more than 10 years of experience — having been trained by FRCH. (At the end of their training, the sahyoginis receive certificates from the National Open School in Delhi.)

The training enables women to read a person's blood pressure, take a blood sample for testing the haemoglobin count, conduct pregnancy tests, dress wounds and administer simple medicines. The trainees also learn about ayurvedic and unani medicine, as well as home remedies. During my visit, the trainers demonstrated how herbs such as lemongrass could be boiled and used along with cinnamon for upper respiratory tract ailments.

Says Nirmala Jagtap of Parinche, "I have 10 years of experience — first as a sahyogini and then as a tai. I have studied till Class IV. In the beginning, I didn't like this work but then I realised that my knowledge about illnesses was helpful for my people because there are no doctors in my village. First, I used to approach people, now the people won't let me go. Now I really like my work. Even if the organisation withdraws, I will continue to do this work."

At the training site, notices were hung or pinned on to tree trunks — important facts on the Right to Information, and various kinds of information useful to women. Written in Marathi, they were clearly the simplest and most effective tools of empowerment.

Kaval, a tai from Ramvadi village, has a particularly empowering story to tell. "My village is isolated and there is no connecting road. Once I examined a woman who had returned after her delivery and found her in terrible pain. I realised that part of the placenta was still in her uterus. Her condition was critical. So I contacted the doctor and asked him to come and examine the woman or pay for the cost of transporting her from our village to his clinic. The doctor was very angry initially, and asked for my credentials. I told him that I was a certified tai. After an argument he actually said `sorry'. He then came to Ramvadi and treated the woman. My diagnosis was right. The woman's life was saved. I was much appreciated by her family and many others." Like Nirmala, Kaval has studied till Class IV.

As more women spoke, it became evident that this training has transformed village women into powerful members of the community. With this, existing power equations in their homes are being dismantled. Today, these women are a force, and their new avatar commands respect and deference from their men.

That visit reaffirmed for me the truth that if women are empowered with knowledge about basic healthcare and hygiene, and educated on the Right to Information, they go on to become much more than agents of change. They can also achieve — much faster — the targets of the 10th Five-Year Plan and the Millennium Development Goals.

Their knowledge enhances their self-image, and they also receive respect in the village. Their words are heeded not only by other women but also by men and the village panchayats. Some of the women told me that the boys and men in their homes have begun to help in the housework.

This is a case of social transformation which needs to be replicated on a much wider scale, so that there are thousands of Ralegan Siddhis and hundreds of thousands of tais working throughout the country.

Women's Feature Service

(The author is a Member of the Planning Commission, and is responsible for health and gender.)