Sherna Gandhy

Semi-literate women spreading the healthcare message — that's the approach in an innovative project run by the Foundation for Research in Community Health

"A few days after a private doctor dressed a wound in the foot of a young boy, the wound was infected with worms. What kind of doctor was he? That man didn't even clean the wound properly," snorts an indignant Laxmitai Barge.

"When the city doctor told me my daughter was anaemic, I told him there was no need to admit her to hospital and give her saline; I would just change her diet and she would be better. After all, diet is more important in anaemia," say a knowledgeable Nandatai Waghole.

Neither Laxmitai nor Nanditatai have been trained in a medical school. Yet they are perfectly capable of looking after the health and well being of their community. They and 50 other semi-literate women are part of a rural healthcare project run by the Foundation for Research in Community Health (FRCH), with financial support from the Sir Dorabji Tata Trust, for the past eight years in the Parinche valley, some 60 miles from Pune.

These tais, with their capacious handbags that contain a standard kit of basic drugs, are a familiar sight in Parinche, the headquarters of the project, and in some of the surrounding villages. They can diagnose and treat common ailments such as dysentery, fevers and diarrhoea, and perform routine pathological tests such as for haemoglobin, albumin, urea, pregnancy, blood groups and malaria. So successful has this project been in providing cheap and good-quality healthcare to this rural area that non-governmental organisations from other states have sent their representatives to train under the tais.

While healthcare is the focus of the project, there are several spin-offs: the formation of women's savings groups, play areas for children, and, most important of all, the transformation in the lives of the women volunteers at the heart of the project. These women, who had previously never set foot outside their villages, have travelled to states such as Kerala, Madhya Pradesh and West Bengal to train women like themselves.

Why women exclusively? "They are very hardworking and concerned about their community and families," says Dr N. H. Antia, FRCH's director, who in 1975 initiated the first project of this kind (in Mandwa across the harbour from Mumbai). A well-known surgeon working in Mumbai, Dr Antia had been struck by the number of poor patients from the hinterland who flocked to hospitals in big cities, something they could ill-afford.

"It was obvious to me that what was required was community-based healthcare, so that people could be looked after in their own environment by people they knew and were comfortable with," he says. A frequent visitor to Alibaug and Mandwa, Dr Antia, with the financial backing of the late industrialist Naval Godrej, set up a community-based healthcare project in Mandwa, training local women in the basics of healthcare. The project worked well until local politics derailed it. Convinced that the concept was a sound one, and increasingly attracted towards the neglected area of rural and community health, Dr Antia and his team began working in the Parinche valley in 1995.

From the original 17 tais, who volunteered with much hesitation for the training, to the present 50 confident women, the project has come a long way. The FRCH staff lived in the village as the training was given to the women in the village itself, usually under a tree or in a courtyard and at a time when the women were relatively free from household chores. They were encouraged to bring along children they could not leave alone at home. An elderly lady was paid to look after the children while the training was in progress. More advanced training was sometimes held at the FRCH office in Pune.

The tais who have been trained act as trainers for others who join in. They maintain case papers and prescribe over-the-counter drugs (some can even work on computers). They charge a small fee for their services and medicines, and are paid a modest monthly salary by FRCH. Difficult cases are referred to the district hospital or a trained doctor.

The training is given in three areas: education, health, and environment and social development. Consequently, the women also know how to construct soak pits, give some veterinary advice, and impart the importance of watershed management and other appropriate rural technologies.

Each tai caters to a unit of around 250 people. She has been taught to diagnose and give medicines for diarrhoeal diseases, fevers, respiratory problems, reproductive health problems and similar ailments that occur frequently. She conducts deliveries and gynaecological examinations and provides antenatal and immunisation services. She can also do pathological tests of various kinds.

Since it is still not always acceptable for women in rural India to work outside their homes, those who became part of the project had to win their families over. Babytai Takwale of Hargude village had to make a special effort to finish all her housework before setting off for the 10am-to-3pm meetings as her husband disapproved strongly. But she said she talked to him and for the first time tried to persuade him to see her point of view. Her children supported her, and today, she says, "we have all learned to adjust".

Pushpatai Jadhav's most staunch supporter was her mother-in-law, who, having missed out on an education herself, was keen that her daughter-in-law seize the opportunity. Ms Jadhav's husband, who is relatively well off and prides himself on being educated, sees his wife's participation in the project as proof of his and his family's progressive thinking.

The project is not without its critics. Not everyone in the villages is part of it, and private doctors have been scornful about how effective the tais can be. But Dr Antia firmly believes that medicine has been unduly mystified and that 70 per cent of a village's healthcare needs can be adequately met by the community itself. A joint report of the Indian Council for Social Sciences and Indian Council for Medical Research, in which FRCH had played a major role, made just this point way back in the 1970s.

Since several health policies over the years have simply not delivered good health to large parts of rural India, even as unaffordable, private 'super-speciality' hospitals spring up in towns and cities, alternatives such as these are worth following up. "Ill health is a disease of poverty," believes Dr Antia. Good, affordable healthcare will automatically see an upswing in the development index.

"FRCH works on the premise that a cadre of village health functionaries can help overcome the limitations that exist in providing comprehensive community healthcare," says Jasmine Pavri, senior programme officer, Sir Dorabji Tata Trust. "The Foundation has been able to implement a new people-based, decentralised village health and medical care model. This approach resonates with the Dorabji Tata Trust's thinking on the issue." The Trust has been working with FRCH for about 13 years and has given the organisation Rs 48.5 lakh during this period.

The big question is: will the Parinche project be self-perpetuating? FRCH cannot be involved here indefinitely. Dr Antia is depending on panchayati raj, which became law in 1993, to do the trick. Health is one of the 29 subjects that zilla parishads now control. In other words, village communities now have the resources to initiate their own healthcare systems. The tais of Parinche have shown just how this can be done.

Uploaded on March 2005