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2011 Conference Report




 Innovative Approaches to
Improving Health in Slums




           Organized by,
           Jan Kala Sahitya Manch Sansthan
           Médecins du Monde
http://www.jksms.org       http://www.medecinsdumonde.org



                       2
Innovative Approaches
                                    for
             Improving Health in Slums


        A thematic multi-session one-day Conference
                            Inaugurated by
            Shri Aimaduddin Ahmad Khan (Dhuru)
Honorable Minister of State for Health and Family Welfare, Rajasthan

                  Organized by JKSMS & MdM
                         On 4th April 2011
                  At OM Tower, Jaipur, India




                             Report Compiled by:

                   Roma Kaur Rana, Communication Specialist

                   Umesh Sharma, Project Coordinator, JKSMS




                                      3
Contents
Foreword ............................................................................................................................................................................... 5
Executive Summary ............................................................................................................................................................. 6
Conference Background .................................................................................................................................................... 7
Areas of intervention .............................................................................................................................................................. 7
    Target population .............................................................................................................................................................. 7
    Project Objectives ............................................................................................................................................................... 8
    Philosophy ........................................................................................................................................................................... 8
    Intervention Methods ........................................................................................................................................................ 8
    Results ................................................................................................................................................................................. 9
Welcome Address ............................................................................................................................................................. 10
Inaugural Address .............................................................................................................................................................. 12
The Necessity of Raising the Level of Health Knowledge in Slums....................................................................... 14
    Panel Members .............................................................................................................................................................. 14
Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues ................................................ 17
    Panel Members .............................................................................................................................................................. 17
Institutional Deliveries: Overcoming Obstacles in its Popularization ................................................................... 24
    Panel Members .............................................................................................................................................................. 24
RHC Conference Recommendations ........................................................................................................................... 26
Annexures
Conference Agenda..............................................................................................................................................................27
Conference Images...............................................................................................................................................................29
Conference Media Coverage...............................................................................................................................................33
Conference Attendees..........................................................................................................................................................................38




                                                                                               4
Foreword
                                       After almost four years of implementation, the present conference
                                       represented probably one of the most important milestones of the
                                       Reproductive Health and Child Care project.

                                        It all started four years ago, when Médecins du Monde and JKSMS
                                        decided to team up in order to respond to one of the most
                                        challenging health situations faced by the city of Jaipur: the
                                        extremely high level of maternal and child death in slums. Indeed,
                                        though the ―pink city‖ counts plenty of medical institutions (private
                                        and public) and though numerous schemes are available for the
most vulnerable, it is a fact that slum dwellers tend to avoid frequenting the medical institutions. If it is
true for common illness, it is also the case at the time of pregnancy.

The first phase of implementation of the project was ―bumpy‖: slum dwellers were reluctant to listen,
understand or even participate to our activities. Who could blame them? Health behaviour in slums has
been inherited from centuries of tradition and especially the nomadic culture which prevailed in the slum
dwellers communities until recently. And it is well known that nomads only rely on themselves, their
family or their community. This attitude has been reinforced all through by the lack of consideration and
great despise they often get from the environment surrounding them.

After month and month of project implementation involving the pregnant women, their friends and
relatives, changes were noticed: more and more women were willing to deliver at the hospital or to go
for the Ante Natal Check-up. It was probably due to a better understanding by the communities of
pregnancy related issues and schemes available. Or maybe was it also because, for the first time, these
marginalized communities had been listened, respected and accepted for what they are.

Capitalizing on its success, the project did not stop there: in order for the project to be sustainable
beyond its end, it was also important to train volunteer, within the community, to act as health worker.
We call them the Community Health Workers: they dedicate some time to help other women dealing
with health issues. A second step towards sustainability consisted in advocating the cause of the
vulnerable population living in slums as well as organizing events where awareness of the general public
and key stakeholders will be raised. The conference was one of these events meant at gathering people,
informing, proposing, exchanging and debating.

As Pandit Nehru said, ―Ignorance is always afraid of change‖. This is what this project is all about: fighting
ignorance, creating knowledge, bridging the gaps between vulnerable communities and medical institution
and last but not least, giving hope.



                                                                                            Willy Bergogné
                                                                                       General Coordinator
                                                                                        Médecins du Monde




                                                      5
Executive Summary
The Report highlights presentations and discourse which took place during the Conference on 4th April
2011 in Jaipur on ―Innovative Approaches for improving Health in Slums‖ organized by Jan Kala Sahitya
Manch Sansthan (JKSMS) & Médecins du Monde (MDM). This one-day Conference, an integral part of the
pilot-project to share best practices with State Health policy makers, health workers and Non-profit
organization working in the field of health in Rajasthan, was inaugurated by the Minister of State for
Health and Family Welfare, Shri Aimaduddin Ahmad Khan and consisted of three panel sessions
comprising of stakeholders like health practitioners, academicians, State Health representatives and slum-
dwellers (beneficiaries) themselves. The report highlights key points of the papers presented, outcome
from panel discussions and best practices established during the project and approved in the Conference.

The project intends to support policymakers in drafting appropriate policies as well as facilitate
implementation of policies & directives in the slum communities to ensure optimum results. The main
objectives of this conference were:

1. To present the findings of the baseline survey in selected slum areas
2. To initiate an open discussion on project findings
3. To create strategies for health improvement in less-privileged communities

Nearly 100 participants representing NGOs, State health department, medical profession, academia &
media gathered at the conference to discuss present health policies, participation of slum-dwellers in
State-sponsored health programs, general health awareness in the slums, prevalence of malnutrition in
mothers or children and exchange ideas and suggestions on pertinent health issues. The conference
opened with a plenary session followed by three panel discussion sessions covering the following topics:

    1. The necessity of raising the level of health-knowledge in slums
    2. Anaemia, malnutrition and vitamin deficiency in slums: the unspoken issues
    3. Institutional deliveries: overcoming obstacles in its popularization

With the release of Census 2011, which revealed that more than 50% of women in Rajasthan cannot read
or write and almost 0.65million girls are missing, there couldn‘t have been a better time to organize this
conference and bring forth such findings that are proportionally related to literacy rates. Low literacy
rates can affect general health knowledge which could affect the rate of institutional deliveries in a
community. In the absence of institutional deliveries, births often go unregistered which does, indirectly,
impact the instances of female foeticides in any community.

The conference was unique in the sense that there was an active participation of the beneficiary
community. Women representatives from the project area sat through the conference and shared their
stories with the participants. The conference highlighted the inadequacy of existing communication &
advocacy methods used by State Health departments and some other NGOs in slums because of low
literacy levels and cultural trends prevalent there.. Therefore, the need to develop communication tools
that will work with these communities was stressed by the speakers and supported by all participants. As
a best practice, JKSMS tabled the proposal to use Street Theatre and other innovative approaches to reach
out to the illiterate and vulnerable masses.



                                                     6
Conference Background
The Conference was organized as a milestone event of the pilot project on Reproductive Health and Child
Care (RHC), initiated by JKSMS and supported by MdM, in 11 slums of Jaipur to bring health knowledge to
low-resourced communities. During the past three years of the project period, JKSMS and MdM have
utilized various innovative strategies to reach out to the beneficiaries and create a means for sustainable
health development. The conference provided a platform to share best practices from the RHC project
with the attendees and now, through this report, to many more in the field of grassroots development.



             The project is implemented in Jaipur by Jan Kala Sahitya Manch Sanstha ( JKSMS). A
             non-profit organization founded in 1983 by a group of enterprising social activists, JKSMS
             works with vulnerable women and children across the state of Rajasthan for their
             development. JKSMS believes in democratic values based on secularity and community
             participation at all levels. The strategic aim of JKSMS is to ensure active involvement of
children in all issues that are pertinent to their existence and progress. It strongly advocates the right of
every child to have a full-fledge childhood, where the children have the right to existence, protection,
development and active participation in their growth and self respect.



             To implement the Reproductive Health and Child Care project, JKSMS is supported by
             Médecins du Monde (MdM), an international humanitarian organization providing medical
             care to vulnerable populations affected by war, disease, famine, poverty or exclusion.
             Originally established in France in 1980, the Médecins du Monde network now extends to 16
             countries in Europe, Asia and the Americas. MdM‘s work depends on efforts of nearly 3000
medical and logistics professionals who volunteer their time. Although MdM‘s primary aim is to provide
medical care, its work goes further to ensure long-lasting effectiveness.


Areas of intervention
11 slums located within the municipal city of Jaipur (Akbar Road, Amar Nagar, Bagrana, Bambala, Chokhi
Dhani, Galta Gate, Goner Mode, Idgah, Luharon ki Basti, Railway Station, Pratap Plaza). These slums are
all, except for Railway Station, in the vicinity of Jaipur. Only two slums among those previously
mentioned, are authorized slums. The others are not with the consequence that access to electricity,
drinkable water as well as social services and schools is an issue.

Target population
The target population in this project is 5000 inhabitants in 11 slums of Jaipur including almost 1250
women of reproductive age.




                                                      7
Project Objectives
To improve the health situation of the target population with a focus on pregnant women, pregnancy
related issues as well as children below five years by encouraging the utilization of the private and public
health services. By doing so, the program intends to participate in the Indian efforts to reach the
Millennium Development Goals (MDG) implemented by the United Nations, and especially the objectives
4 and 5, related to child health and maternal health.

Philosophy
In order to maximize the outreach of the project and foster the condition of its sustainability, all the
activities were developed with a high degree of involvement of the community. In addition to the
mainstream initiatives (community meetings, group/individual interactions), other innovative community
participation methods were implemented for the first time in Jaipur such as the utilization of traditional
story-telling tools (Kawad box), theater performances : ―oppressed‖ method and community mapping.

Intervention Methods
With the view to attain the project objectives, several activities have been implemented:

                                      These interactive sessions are led by the Social Worker whenever
 Health Education Sessions
                                      he/she is feeling a need to emphasize on a particular thematic with
the goal to deliver key messages and answer audience‘s questions. The duration of the sessions varies
greatly according to the subject matter and community participation. Specific groups (husband, mother-in-
law, local priests and so on) are sometimes targeted to deal with particular problems.

                                     Social Workers provide useful advice during interpersonal meetings
 Interpersonal Counseling           or group sessions. In both cases, topics are chosen by the participants
themselves. During these sessions, different visual tools are used such as posters or drawings created by
Social Workers and/or in some cases by members of the community (children), pictures from
pubications, IEC posters, preventive tools (according to the topic) and so on.

                               Meeting are organized in slums by the community on important subjects
 Community Meetings
                               related to their particular community. It is a good way to increase
community participation and let them play a role in their development.

 Capacity -building of CHW             CHW or Community Health Workers are recruited in each slum
                                      to encourage community participation in the RHC project. They
help spread disease-prevention messages and accompany people to the medical facilities. In addition to
the principle of ―peer education‖, voluntary CHW are trained to gradually take over the work-load of
Social Workers. In this case, the objective is not to ask them to fulfill the duties of the JKSMS Social
Workers but to create the conditions of sustainability of the program with minimum external support.




                                                     8
Results
                                                        As of        As of    As of
                                                        Dec08        Dec09    Dec10

 Evolution of % institutional deliveries                    32%         41%      45%

 Evolution of % Dai deliveries                              56%         49%      45%

 Evolution of % home deliveries                             12%         11%      10%

 Evolution of % of birth with the mother
 completing 3 ANC                                           24%         46%      69%

 Evolution of the % of baby going through NBC               11%         24%      31%

 Evolution of the % women going to PNC                          8%      9%       34%

 Evolution of the % of pregnant women covered
 by a Birth Preparedness Plan                               62%         70%      76%

 Evolution of the % of participation of male to
 health awareness session                                   19%         31%      34%

 Evolution of the % of institutionalized
 deliveries getting the JSY scheme                          33%         55%      61%

 Evolution of the % of deliveries getting the JSY
 scheme                                                     11%         22%      28%

 Total number of live births                                 128        125      155

 Total number of child death in the project
 slums(0-6)                                                     31      20       10

 Number of immunization encouraged                           214        321      416

 Total Number of Health Education Session                       73      147      772



ANC: Antenatal care

NBC

PNC: Postnatal care

JSY: Janani Suraksha Yojana (Pregnant Women Safety Scheme)




                                                    9
Welcome Address
By Shri Kamal Kishor, General Secretary, JKSMS

Honourable Minister of Health and Family Welfare, Shri Aimaduddin Ahmad Khan, Dr. Asha Pande,
Emmanuelle Ferblantier D'Souza from the Embassy of France in India, Isabelle Hainzelin from Medecins du
                                               Monde, Janet Chawla of Matrika Foundation and dear
                                               participants, I would first take this opportunity to
                                               welcome you all, on behalf of JKSMS, for sparing your
                                               valuable time to participate in this conference,
                                               especially honourable Health Minister, at a short
                                               notice. As you know our conference is focused on
                                               improvement of health in slums and therefore, we will
                                               be talking about the health issues of people living in
                                               the slums of Jaipur. Before we begin, I would like to
                                               share some information about JKSMS and its work.

                                                   JKSMS was launched in 1983 by a few of us friends,
                                                   studying at the University of Rajasthan, as we decided
to work for the underprivileged and backward people of the society to bring them into the mainstream.
Today, as we walk proudly into our 28th year, the organization has progressed manifold. We are working
in three main areas: Children, Health & Livelihood. Let me first share with you about our work with
children on the streets or in slums. We are working with almost 7000 such kids through 11 institutes for
street children, two shelters homeless children: Apna Ghar & Mamta Apna Ghar, where we take care of
children‘s health, education and professional development until they are 18 years old and when we are
convinced that they can fend for themselves and assimilate respectfully in the mainstream society. Apart
from this, we are running two counselling centers at the Railway station. In 1999, JKSMS established
primary schools in 19 slums with the help of five UN agencies and local community. After running
successfully for 5 years, these primary schools were finally handed over to the local government although
JKSMS counsellors and facilitators are still working in those schools to facilitate relationships between
government, staff and children for smooth operations. We are also running a 1098 child help-line number
where we provide help within 30 minutes of receiving a phone call from any child in need.

Talking about health, our most recent project was Reproductive health and child care in 11 slums where we
impacted 5000 women and children through our work. Our ongoing projects include AIDS/ HIV
programs with tribal people in 12 districts of Rajasthan including Ajmer. Over the years, we have realized
that in order to make development sustainable, we must ensure livelihoods in the communities we work.
Therefore, since 2001 we made Sustainable Livelihood our major thrust area. As a part of this program, we
have worked with 20,000 artisans who work in the costume jewellery industry in Jaipur, through JJADE (
Jaipur Jewellery Artisans Development Enterprises) program of SEEP Network. We help them in their
technical upgradation and marketing knowledge by collaborating with the American organization, SEEP



                                                    10
Network. The state government & UNDP have both
                                                accepted the Samode Town Livelihood Project as a model
     “JKSMS has received two national
                                                project and the model is being replicated in 178 other
     awards for its work on generating          villages around Rajasthan. While continuing to explore
  livelihoods for vulnerable communities:       livelihood possibilities further, we have worked for
    Best NGO in income Generation by            generating agriculture livelihoods for which we received
  Indian government in 2007 & CNBC’s            two awards in the area of Water Harvesting. JKSMS is also
      Best Income Generating Project            actively encouraging craft-based livelihoods: one in Bassi
  award for Samode town where almost            near Chittorgarh- by helping local artisans to continue
     25 % population of the town was            working on wooden handicrafts like Kawad; and another in
   helped through livelihood generation.”       Udaipur- by encouraging miniature painting artists in theme,
                                                color or design development and marketing strategies.
                                                Collectively, JKSMS is working in nine different cities with
27000 artisans for their sustainable livelihoods. The organization has received 11 awards so far in
recognition for for this work. At this point, let me make an honest and sincere confession, JKSMS and its
beneficiary communities have made progress only through your continued support and blessings.

I would also like to make a quick mention about our focus on social mobilization in all our projects
because we strongly believe that until we reach out to the most marginalized of the communities who are
least developed and bring them into mainstream population; until we make them aware about
development and let them assume responsibility for their progress, there won‘t be any sustainability in
our efforts and results. Therefore, we emphasize on social mobilization- on getting the communities
involved in what is being done for them. To this end, we use Street Theatre or Nukkad Nataks as they are
popularly called in India. JKSMS has its own theatre group called Caravan theatre. It is an excellent tool to
reach out to the uneducated people who don‘t have access to other information mediums. We have been
experimenting new techniques like Theatre for the Oppressed People in collaboration with international
theatre professionals. Caravan Theatre‘s popularity has travelled far and wide in the world. We have a
resource centre in the town of Rainwal where we hold training programs for other organizations or
individuals who would like to use Street Theatre in social mobilization. Today, JKSMS boasts of six Street
Theatre teams within the organization.

In the end, I would like to share with you that through all these efforts, we are trying to create a new
leadership in less-privileged communities in Rajasthan for the past 27 years. These are mostly minorities
or marginalised communities. We can now see a new ray of hope as these people are coming forward to
participate in their progress. They are the new Change Agents.

Once again, in profound appreciation, I must say that all this has been possible through the huge support
we have received from various government departments and our partner NGOs along with the local
communities. Let me take this opportunity to thank all of you, Honourable Minister, esteemed dignitaries
and dear participants for your gracious presence and continued support to JKSMS.

Thank You.

Kamal Kishor
General Secretary
Jan Kala Sahitya Manch Sansthan( JKSMS)



                                                     11
Inaugural Address
By Honorable Shri Aimaduddin Ahmad Khan
Minister of Health and Family Welfare,
Government of Rajasthan, India



Distinguished     dignitaries  and    dear
participants,
Reproductive Health is a major cause of
concern in the present health care system
in our country which impacts the general
lifestyle and future growth of our society.
And, it is most needed where it is lacking:
the vulnerable population that is affected
by poverty and illiteracy, the slum-
dwellers.

All and more important the government
has taken up the cause of reproductive
and child health at the grass root level.
The factor which most affects the reproductive & child health in slums is the lack of awareness of the
government sponsored schemes and basically problems of hygiene, nutrition, healthy lifestyle etc.
Anaemia, malnutrition and vitamin deficiency are the most prevalent in slums. The Government of
Rajasthan has taken various steps to compete these with more effective and active involvement of NGOs.
I‘ve been informed that this conference would mainly focus on three issues: mainly the need of improving
health problems in slums, anaemia, malnutrition or vitamin deficiencies and promoting institutional
deliveries in slums.

I‘m really happy to learn that the government‘s concern for reduction in IMR & MMR is finding room in
the thoughts of NGOs and their endeavour. Rajasthan has an infant mortality rate of 63/ 1000 live births
as against the national rate of 53/1000 live births. However, in the rural areas it is 68/1000 live births
whereas in the urban area it is 39/1000 live births. We have to bring it down to our Millenium
development goal of 27 and this is where the rural NGOs become all the more important by providing
technical support to the people living in the backward areas, making available the resources to the
government and spreading awareness about various government schemes at grass root level so that the
benefits of these schemes can reach them.

I‘ve been informed that JKSMS, along with MdM, France, organized street plays, one-on-one discussions,
group discussions, hospital tours and other publicity campaigns to enlighten citizens of the slums about
government health care facilities. The government is committed to making improvement in the public
health system in the rural as well as urban areas. And we strongly feel that reproductive health and child
care has an important role to play in raising the bar on health conditions in the state.


                                                    12
Over the years, rapid urbanization has led to a
haphazard rise of slums in and around Jaipur. While we      “The combined efforts of JKSMS
are becoming stronger economically, it is sad to know       and the Government of Rajasthan
that child mortality rate and sex ratio is not getting
                                                            have reaped fruits. Women have
much better. Women in the slum areas are still fighting
for basic survival because of poor health and economic      become more aware and more
conditions.                                                 children are brought-in to
I felicitate the efforts of JKSMS and MdM in carrying on    participate in the vaccination drives.
this research in the various slums of Jaipur district.      Lately, more and more women
These efforts will go a long way in bringing awareness      have come forward to volunteer.
about health, hygiene, institutional delivery, child care
                                                            Women have been taken for
and eliminating social evils prevalent in the society
among the underprivileged.                                  hospital tours so that they are not
                                                            scared to visit or take their children
I‘m happy to know about the emergence of Community
Health Workers in these slums. The two organizations
                                                            to a doctor. I’ve been informed that
have indeed taken a very positive step in bringing health   JKSMS and MdM have succeeded
awareness into the very homes of the people who have        in making this awareness campaign
long neglected the need for good quality of life. I take
                                                            fruitful.”
this opportunity to appeal to all other NGO‘s working
in this field to re-enforce their efforts in bringing
awareness in slum areas especially to educate children about basic health & hygiene. Our children are our
future and if we want to empower our future, we must ensure that they have a safe, progressive and
healthy childhood.

I congratulate the organisers on this occasion and believe that this will further pave way for improving
health in slum areas



God bless you all. Jai Hind!



Aimaduddin Ahmad Khan
Minister of Health and Family Welfare
Government of Rajasthan, India




                                                    13
Panel One
The Necessity of Raising the Level of
                                                                               “I had never imagined myself sitting
Health Knowledge in Slums
                                                                               in such an intellectual gathering and
                         Panel Members                                         sharing my story and that my story
                                                                               was even worth being heard. I am
                                                                               illiterate but JKSMS approached me
                                                                               to work with them as a Community
                                                                               Health Worker. I faced opposition
                                                                               but that didn’t deter my enthusiasm
                                                                               to help this project. I have understood
                                                                               how can I play an important role in
                                                                               bringing health awareness to my
                                                                               community despite my lack of
                                                                               education.
The Session was opened by Dr Bhupendra Sharma, the head of PSM
department who was moderating the panel discussion, with an                    When I began working with JKSMS, I
introduction to the low levels of health awareness in slums and                didn’t know anything about the state-
existing efforts made by the government and NGOs. He presented the             funded health facilities available to us.
first speaker: Alia, a Community Health Worker from Idgah Slum area
                                                                               Gradually, I started visiting clinics and
in Jaipur district. Alia shared her story with the participants highlighting
                                                                               health centers. Now, when I
the issues in her neighbourhood such as lack of interest in accessing
health facilities or learning about hygiene. She faced opposition from
                                                                               accompany pregnant women or
both, her family and community when she began supporting the cause             mothers, I am able to communicate
of maternal health and child care in the project initiated by JKSMS &          their problems to the doctors
MDM. It wasn`t easy for her to convince pregnant women in her area             confidently. It feels good to be a
to consult doctors in the health centers. Most families preferred to           change-maker, even if it is just for my
check with the Traditional Birth Attendants (Dai) who were neither             little neighbourhood. “
educated nor totally aware of health and hygiene criteria for safe
pregnancy and delivery. However, with persistence and determination,
Alia was able to win the support of both her family and community,
especially as she succeeded in generating some income by volunteering
to help women in the neighbourhood. For each visit to the health
facility, she charges a nominal amount of ₹5 whereas for the delivery
at the Health Center, the mother gives her ₹200 out of the ₹1000 she
receives from the government. Thus, the project has created health
awareness while empowering women in the community to create a
support structure and a unified front for the cause of reproductive                       Alia Khan
                                                                                Community Health Worker, JKSMS



                                                       14
health and child care. Alia is just an example from dozens of Community Health Workers who are now
 working in these slums; their training and activities supervised by JKSMS to ensure sustainable
 development.

 The second speaker in the session was Dr. R.P Jain, Reproductive & Child Health Officer with the
 Medical and Health Department of the Ministry of Health and Family welfare of Rajasthan who began his
 talk by stating the definition of Reproductive Health as accepted by the socio-medical fraternity: ―...a state
 of health in which people are able to reproduce and regulate their fertility......‖. He pointed out that
 Rajasthan fares really low when it comes to health awareness, especially Reproductive Health & Child
 Care. Dr. Jain further elaborated on the various State-sponsored schemes like Yashoda scheme which is
 not being accessed by the general masses in the slums. He emphasized the need for proper
 communication strategies that will help regularize fertility among the underprivileged.

 The final speaker in the first panel was Umesh Sharma, the Project Coordinator at JKSMS for RHC project
 with Médecins du Monde. Mr. Sharma has an in-depth understanding of the issues faced in the slum areas as
 he has been working on several development projects in urban slums. The presentation was an eye-opener
 for the participants as he shared the baseline survey findings of the project area. Mr. Sharma went on to
 expose the sad state of health affairs in these areas since the authority‘s general approach towards health
 awareness has been rather informative instead of educating.



 REPRODUCTIVE HEALTH & CHILD CARE: Project strategies & Approaches
                  Umesh Sharma, JKSMS

With the objectives to raise health awareness, scale up community participation and foster linkages between
slum communities and government services, the project employed five main strategies:

   1.   Avoid replicating efforts of other organizations
   2.   Encourage slum-dwellers to visit medical facilities
   3.   Sensitize slum-dwellers to appropriate hygiene standards
   4.   Focus on reproductive health & child care only
   5.   Create Community Health Workers from within the community

The project employed various innovative approaches like:

       Increased community participation
       Innovative outreach approaches (Kawad, Theatre etc)
       Mapping medical facilities
       Individual counselling
       Educating about government medical facilities


   These approaches have taken the form of best practices as they got the women and children interested in
   convincing their families to become conscious about their health and hygiene. The end result was that
   communities, who were earlier openly resistant to any kind of state interference in their reproductive
   health or child care, now support and participate in government policies and schemes.



                                                      15
Kawads- the traditional art of story-telling in Rajasthan




Educating Women in the Slums                     Medical Mapping for the Community




Street Theatre to Engage the Community        Group Discussions & Awareness Sessions

                     Images from the Project

                                         16
Panel Two
Anaemia, Malnutrition and Vitamin
Deficiency in Slums: The Unspoken Issues
                                         Panel Members




With the first session focused on raising the level of health knowledge in slums, the second session
highlighted the need for immediate intervention in the slum areas because of various unspoken issues like
Anaemia and Malnutrition. Most of the times, health workers or surveyors do not record some of the
understated but critical health concerns which have long term effect on reproductive health and child
care. This session, chaired by a very senior academician from the medical fraternity of Jaipur: Dr. TP Jain,
succeeded in bringing attention to pertinent topics like mineral and vitamin deficiencies and the innovative
supplements recommended by academicians. In countries like India, micronutrient deficiency, especially
iron, is most prevalent among children. Besides culminating into anaemia, the consequences of iron
deficiency are grave which affect the health as well as quality of life of the nation as a whole.
The first speaker to share her thoughts, research and recommendations was Dr Beena Mathur from
University of Rajasthan‘s department of Home Science. Dr. Mathur highlighted key statistics about
micronutrients deficiency among women, especially pregnant women or adolescent girls. She revealed
that the statistics are worst in the slums because of poverty and illiteracy. In her presentation, she
pointed out that because malnourished children suffer from an under-developed brain, lower immunity
and physical deformities or decreased stamina, they face higher levels of unemployment when they grow
up. She elaborated on the collective impact of malnutrition saying that it could lead to a huge population
becoming an economic burden on the society as they could be incapable of fending for themselves. She
informed the participants about government-run programs like ICDS Program, National Vitamin A
prophylaxis Program, National Nutritional Anaemia Control Program, Iodine Deficiency Disorder
Prevention Program, to name a few. However, the slum population refrains from participating in these
programs because of obvious reasons like lack of communication and awareness. Emphasizing, the
important role that NGOs like JKSMS & Médecins du Monde can play in eradicating Malnutrition from
slums, Dr. Mathur then recommended Leaf Concentrates as an effective solution to micronutrient
deficiency.




                                Leaf Concentrate’s Molecular Composition




                                                     17
Leaf Concentrates from Alfalfa are rich sources of, Iron, folic acid and beta carotene or pro-vitamin A,
good quality protein, other vitamins, fats and minerals.

COMPARITIVE CHART: Spirulina, LC & WMP                             Nutritive Value of Leaf Concentrate


                       Spirulina     Leaf Concentrate   WMP**      Nutrients              Value/100g basis
Nutrients

Moisture                 3-7%              8%            3%        Energy                        344 Kcal
                                                                   Protein                         60g
Protein                 55-65%           50-55%         26%
                                                                   Fat                            22.5g
Lipids                   4-7%             9-10%         26%
                                                                   Carbohydrate                   12.5g
pufa* (w3)           1,8% (1,0%)       6,4% (4,8%)       0,9%      Carotene                      86700ug
                                                        (0,2%)
                                                                   Folic acid                    330.0ug
Carbo-hydrates          15-25%           10-12%         38%        Iron                          99.0mg
Minerals                 7-9%            13-14%          8%        Calcium                      1865.0mg
Fibre                    4-7%             1-2%            -        Phosphorous                   604.0mg

*PUFA: Polyunsaturated Fatty Acids
**WMP: Whole Milk Powder
Dr. Mathur further shared the research that was conducted in a slum in Jawahar Nagar, Jaipur where3%
Alfalfa leaf concentrate was incorporated in the meals of the experimental group. The group comprised of
children aged 3-6 yrs and their initial haemoglobin levels, weight, height and morbidity profile were
recorded. For a duration of two years, there were quarterly follow-up and monitoring. The results were
as follows:



                                                                          The results showed a significant
                                                                          increase in the Hb levels of the
                                                                          experimental group while they
                                                                          decreased in the control group. The
                                                                          difference between the two groups
                                     Leaf                                 was statistically significant (p<0.01).
                                 Concentrate                              The morbidity profile of the
                                     as a                                 experimental group improved while
                                 Micronutrient                            remaining unchanged in the control
                                   Fortifier                              group. The anthropometric
                                                                          measurements did not show a
                                                                          significant difference between the
                                                                          two groups.




                                                                                   Dr Beena Mathur
                                                                                  University of Rajasthan


                                                              18
The second speaker in the session was Dr. Mukta Arora who began by talking
                       about the general efforts that are being made to manage malnutrition, highlighting
                       government schemes like Integrated Child Development Services (ICDS).
                       Launched in 1975 by the Ministry of Women & Child Development, ICDS
                       represents one of the world‘s largest and most unique programmes for early
                       childhood development with a strong focus on:

    -   Improving the nutritional and health status of children in the age-group 0-6 years
    -   Laying the foundation for proper psychological, physical and social development of the child
    -   Reducing the incidence of mortality, morbidity, malnutrition and school dropout
    -   Achieving effective co-ordination of policy and implementation amongst the various departments
        to promote child development
    -   Enhancing the capability of the mother to look after the normal health and nutritional needs of
        the child through proper nutrition and health education.

With reference to key findings about the health benefits of Leaf Concentrates & Spirulina, Dr Mukta
Arora pointed out the role of NGOs in supporting initiatives through the adaptation of research &
recommendations into the implementation of policies & directives of government programs like ICDS.
She elaborated on the current directions by Supreme Court that food supplementation distributed in
Anganwadis (State-sponsored Day Care Centres) should not be sourced from contractors. Instead, such
food should be procured by Self-help groups or community-based organizations in the area. While this
directive is a positive step in strengthening SHGs, the flipside is that such food lacks any kind of
micronutrient fortifiers. Dr. Arora suggested that NGOs can play an important role in educating the
community-based organizations or SHGs about naturally-available micronutrients and their integration in
food products provided at Anganwadis.
Through this recommendation, Dr. Arora stressed the role of convergence of different government
initiatives with non-profit efforts in effective malnutrition management. Next, she gave the example of
ASHA Sehyogani who can pursue community mobilization to fight malnutrition.


 The final speaker in this session was Manish Jain who is the Head of
Mission at Action Contre La Faim, India Chapter. Manish Jain enlightened
the participants about the various terms used to describe varying levels of
malnutrition like hunger, malnutrition, acute malnutrition, MAM & SAM.

 MAM: where the body is seriously undernourished, starts losing weight,
and is at increased risk of infection. For the body to recover, MAM
needs treatment using food that is high in energy and nutrients, otherwise
MAM worsens to SAM.

SAM: a stage when the body is so undernourished that the immune system becomes ineffective and main
internal control systems shut down. This is when people die. This requires urgent medical treatment
and therapeutic food. Types: Marasmus, Kwashiorkor and Marasmic Kwashiorkor.

Chronic Malnutrition: a condition that lingers on for a longer period, or result from several bouts of
acute malnutrition. A consequence of an inadequate diet often combined with an infectious disease.
People can die prematurely, can contract infections or have their growth stunted. It stops children
reaching their full mental and physical potential.




                                                    19
Talking about different cases of malnutrition, Mr Jain also shared that in some cases over-nutrition could
also be termed as Malnutrition. He cited the figures for Rajasthan that 7.3% children are severely acute
malnourished which means almost 6,20,000 children in the state. Nearly two million children under five
die every year in India – one every 15 seconds – the highest number anywhere in the world. More than
half die in the month after birth and 400,000 in their first 24 hours. These are the unfortunate
implications of malnutrition.




Mr. Jain not only talked about the implications of malnutrition but also the reasons leading to this
unfortunate situation. He pointed at the lack of exclusive breastfeeding in Rajasthan, customary burial of
colostrums, load of mother‘s responsibilities other than child care. He summed up his presentation by
calling attention to the ways to fight malnutrition:

     All lives are equal and children should not die of reasons for which remedies are known
     Further build malnutrition in societal and political agenda
     Community empowerment
     Prevent and treat
     Increased nutrition surveillance at district levels for better targeting
     Strengthen human resources and institutional vigour
     Innovate-in-delivery: openness to learning and adapt to local contexts. ‗…reject-accept-innovate-
      adapt…; deliver-the-innovation
     Increase use of MUAC
     On treatment of children with SAM: think of other solutions to improve the coverage, timeliness;
      - community based management of malnutrition (CMAM) where 85-90% children with SAM can
      get treated
     Not only manage from within, but managing across through concerted actions




                                                    20
Manish Jain then focused on the issues arising from maternal and child under-nutrition which is quite
common in underprivileged communities like slums. As indicated in the figure above, Mr. Jain also
described the various reasons leading to Maternal and child under nutrition like disease, low dietary
intake or simply household food insecurity. He summed up his presentation by calling attention to the
ways to fight malnutrition: Mr. Jain finished by sharing that there are shortcomings in the ICDS scheme as
well due to which the results are not as good as one would expect and hence, the Non-profit outfits
should continue to play their role by bringing in nutritionists at the centres and conducting regular follow-
ups with beneficiary families.




                                      Dr. TP Jain, as the moderator of this session, complemented the
                                      speakers for bringing research into the conference in a lay-out that
                                      can be easily understood by the participants. He urged the
                                      participants that these findings should be translated into change in
                                      present policies and implemented in the field. About the hurdles
                                      faced in policy implementation in low-resource communities, Dr
                                      Jain revealed that people are used to ―expecting from the
                                      government but not acting on their own‖. In his concluding note,
                                      he strongly disapproved the present trend among beneficiaries of
                                      being excessively dependent on non-profit organizations and
                                      government bodies instead of inculcating accountability for their
                                      situation and acting with self-respect.




   What is needed is Behavior Change whereby people become aware of their own
   responsibilities in maintaining good health in their families and hygiene in their
   neighbourhood. Instead of saying,
     “ what can you do for me?”, let them say “how can I improve my
   family’s situation?”
   Organizations working for development need to focus on changing health & nutrition
   behaviour of the community by introducing knowledge and positive changes instead
   of plain material help.
                                                                                              Dr TP Jain




                                                     21
Street Theatre
Nukad Natak or Street theatre, a form of theatrical presentation in outdoor public places with minimal
props or theatrical frills, is deeply rooted in Indian traditions as a form of grassroots communication to
propagate social and political messages. JKSMS has been using street theatre extensively in its projects to
reach out to the beneficiary communities and create social awareness. The biggest advantage of Street
theatre is that it breaks formal barriers between the actors & spectators by approaching people directly.
In the case of JKSMS street plays, the team likes to involve the audience in discussing the issues and pin-
pointing solutions. The final component of the second session was one such street play drawing the
participants‘ attention to various social challenges in implementing institutional deliveries in illiterate or
low-resourced communities.
With Aditya Sharma of JKSMS leading the performance, the rest of the team comprised of social workers
and project executives of the organization. They enacted a scene from a rural family illustrating how
women have to fight age-old traditions in order to bring changes. The focal point of the play was when
the spectators were no more mute spectators but participating actors! Aditya asked questions from the
participants as to how they would like to pick up roles in this play and make changes. This kind of
exercise helps change people who are taciturn props to become key players in improving social
situations.




1   Depicting negative family roles in institutional deliveries




                                                         22
23
Panel Three
Institutional Deliveries: Overcoming Obstacles in
its Popularization
                                         Panel Members




The third and the final session in the conference was focused on an important aspect of reproductive
health: pregnancy and deliveries in a hygienic and healthy setting. Dr K.K. Sharma who is a Medical
Consultant at JKSMS and has been supervising the medical components of this entire project on
Reproductive health and Child care was the moderator for this panel discussion. The session brought
forth the story of an indigenous birthing attendant turned trained birth attendant and a change-maker: Sharda
Dai; as well as some indigenous birthing tips by Janet Chawla, founder of Matrika.

The session opened with the motivating story of Sharda Dai where she shared her own experience of
how she started early in life as a traditional midwife but later became a trained Community Health
Worker. Sharda Dai learnt about indigenous delivery-facilitating techniques from her grandmother in the
village. As a traditional birth attendant, Sharda used to provide health care, support and advice during and
after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through
the traditions and practices of her community. The primary focus of Sharda‘s work was to assist women
during delivery and immediate post-partum. Occasionally, she would help with household chores too if
the family needed so. When JKSMS social worker approached her to learn about the health facilities
available to pregnant women, she was a little hesitant. However, the social workers continued to interact
with her and over a period of time, Sharda was convinced that she might have a role to play in improving
health outcomes in her slum because of her access to community and the relationship she shared with
women in her neighbourhood. Her contacts were valuable for the JKSMS social workers because the
slum women were otherwise unable to access government facilities on their own. Sharda underwent
training to learn about health care, hygiene, government facilities and responses to birth complications.
Now, she has emerged to be a confident birth attendant and community health worker. She prefers to
take her clients to the hospital for routine check-ups rather than judge their situation independently.
Sharda Dai confessed that she had never thought earlier that her work was so important to help reduce
peri-natal mortality but now, at the conference, she has realized the value of her role in the society. The
moderator, Dr Krishna Kant Sharma applauded her efforts, saying that CHW like Sharda or Alia have the
potential to become change-makers in healthcare of low-resourced communities.

The next speaker was the renowned social worker and founder of Matrika, which advocates traditional
birth techniques practiced by women around the world for centuries. Expressing her delight over JKSMS‘s



                                                     24
initiative to start an open dialogue to discuss options of optimizing health
benefits through maternal health and institutional deliveries, Janet advocated
the need to build bridges between indigenous and biomedical systems to
enhance health care in both rural and urban settings. She began by sharing
her thoughts: ―My basic advocacy point here is that we must understand the
sophistication of indigenous women‘s ―body knowledge‖ and not just solely
rely on a delivery of services approach—delivering western-oriented
biomedicine. Health is not a deliverable, nor are there quick-fix
technological solutions. We hopefully can build bridges between indigenous
and biomedical systems to enhance health care in both rural and urban settings.‖ Janet went on to share
her inputs on Dai‘s knowledge and practices from two perspectives: Best practices‘ and ‗Evidence-based
Biomedicine in US and Europe & Text-based Ayurvedic indigenous medicine.


           Dais (traditional Birth Attendants) use the following practices which are currently
            accepted as state of the art ‗evidence-based‘ practices during childbirth:
           Encouraging movement during labour, not restricting or enforcing to lie down
           Allowing easily digestible food and drink throughout labour if the mother desires
           No Prenatal preparation: (shaving and enema usually given in medical facilities)
           Continuous presence of a supportive person during labour
           Massage, encouragement and other comfort techniques
           No routine episiotomy—even with first babies—rather the massage and support of the
            perineum
           If the mother is able to sit for an upright or squatting position for birth
           No premature cord-cutting…allowing the pulsations to stop before cutting.
            (Traditionally dais throughout the subcontinent would cut the cord only after the
            placenta is delivered)
           From the Ayurvedic point of view both dais practice and Ayurvedic text reflect the
            following principles and therapeutics:
           Warmth: During both labour and post-partum the use of warmth/heating is essential.
            Hot drinks, heating herbs, warm oil rubs, warm room are all used to stimulate labour
            and comfort the mother. Postpartum use of warm compresses to contract uterus,
            warming and sweet food and drink, a warm room, keeping legs together to prevent
            hava/cold from entering vaginal area.
           Oil: Used during labour for massage, sometimes mother is given a drink containing ghee,
            oil is used to lubricate the birth canal for smoother delivery. Postpartum full oil massage
            is given with special attention to the head. Heating substances such a gur, gond, nuts are
            given to ‗cleanse‘ the body of ‗impure blood‘ or substances which need to be expelled.


After these two wonderful talks sharing personal experiences and traditional wisdom on birth-facilitation,
the final speaker and moderator of the Conference, (Col.) Dr KK Sharma highlighted findings from the
baseline surveys before the commencement of the project and how the solutions were planned for the
health issues in the community in his presentation and advocated the need for Institutional deliveries
especially in hygiene-lacking slum areas. He elaborated on slum conditions, discrimination against women
and other problems in these areas. Dr Sharma enlightened participants about the results of the pilot
project. There has been a marked improvement in the mortality rate and reproductive health of the
community now.



                                                    25
RHC Conference Recommendations
   I.   Non-profit organizations can play an important role in filling-up the gap
        at various stages between government Schemes and implementation
        results

  II.   Government scheme information can be disseminated to the uneducated
        people by grassroot communication strategies using experience and skills
        from non-profit organizations.

 III.   Traditional tools of communication like Kawad can be used for rural
        outreach.

 IV.     Participatory Theatre can be an effective tool in mobilizing uneducated
        communities and should be an integral part of communication strategies
        targeting illiterate population.

  V.    Communities need to be made aware of natural supplements like Spirulina
        or leaf concentrate’s role in micro nutrition.

 VI.     Spirulina/leaf concentrate products could be marketed/distributed in
        undernourished communities through self-help groups thereby providing
        livelihoods to many others.

VII.    Replicating CHWs for sustainable health programs by sensitizing,
        mobilizing & training potential CHWs though National Urban Health
        program with the help of experienced non-profit organizations.

VIII.   CHWs or community participation in planning process of any scheme or
        program before its launch is important

 IX.    Women should be able to make a conscious decision regarding their
        preferred facility/ environment when it comes to birthing/delivery.


   X.    Skilled birthing attendance should be made available regardless of where
        the delivery takes place.



                                        26
ANNEX 1: AGENDA of the Conference




  Innovative Approaches for Improving Health in Slums
                               OM Tower, Jaipur
                                     Agenda



       Day 1: 4th April 2010

9:30      Inaugural Ceremony: Lighting of the Lamp
9:40      Welcome address by Kamal Kishor, General Secretary, JKSMS
9:55      Introduction to Medecins du Monde by Willy Bergogne, General Coordinator, MDM
10:10 Film Presentation: Reproductive Health & Child Care in Slums by Umesh Sharma
10:30 Address by Hon. Shri Aimaduddin Ahmad Khan, Minister of Health & Family Welfare, Raj.
10:50 Thank You Note to the Chief Guest, by Dr. Asha Pande, Vice-President, JKSMS
10:55 Tea Break
11:00 Opening of 1st Session
The Necessity of Raising the Level of ―Health Education‖ in Slums
12 pm Open discussion & Recommendations
1 pm Lunch
2 pm Opening of 2nd Session
 Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues
3 pm Open discussion & Recommendations
3:30      Street Theatre by CaravanTheatre Group
3:45      Opening of 3rd Session
 Institutional Deliveries: Overcoming Obstacles in its Popularization
4:30      Open discussion & Recommendations
                  (Tea & Refreshments)




                                                27
Program Details



 Session 1: The Necessity of Raising the Level of “Health Education” in Slums

       Moderator:       Dr. Bhupendra Sharma, PSM Department

       Panelists:       RP Jain, RCHO, Jaipur
                        Alia Khan, Community Health Worker
                        Umesh Sharma, Project coordinator, JKSMS


Session 2: Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Non-Spoken Issues

       Moderator:       TP Jain, RVHA

       Panelists:       Dr. Mukta Arora, UNICEF
                        Manish Jain, Head of Mission, action Contre la faim
                        Prof. Bina Mathur, University of Rajasthan


Session 3:      “Institutional Deliveries: Overcoming Obstacles in its Popularization”

Moderator:      Dr. KK Sharma (Retd. Colonel), Medical Consultant, JKSMS

       Panel:            Janet Chawla, Matrika Foundation
                        Dr. Akhilesh Sharma, Health Sociologist
                        Sharda , Mid-wife/ Community health Worker


Day 2: 5th April 2010

       9:30 am to 12:00 pm      Field Visit (Idgah & Bagrana)   Facilitated by RHC Team




                                                    28
Annex 2: Glimpses of the Conference




                                      29
30
31
32
33
34
Annex 3: Media Coverage




                          35
36
37
Annex 4: Conference Attendees (Arranged in alphabetical order)



Nos.   Names               Organizations             Designation
   1   Aliya Khan          JKSMS                     CHW Idgah
   2   Alka Sharma         JKSMS                     Social Activist             9898638496
       Aimaduddin                                    Minister of State for
       Ahmad Khan                                    Health and Family
   3   (Dhuru)             Government of Rajasthan   Welfare
       Amarjit Singh
   4   Rana                Sikh Educational Board    Director                    9829055819   ranaamarjit@gmail.com
                                                     Social Worker Railway
   5   Bhanwar Singh       JKSMS                     Station                     9351409328
   6   Chanda              JKSMS                     CHW Toll Tax Bambala
   7   Daksha Parashar     JKSMS                     Jt. Secretary               9982628100
   8   Dr. Asha Pande      JKSMS                     Vice-President              9829055717   ashapande@hotmail.com
   9   Dr. B.D. Acharya    State Health department   Medical Officer            98299304711
       Dr. Bhupendara
  10   Sharma              SMS Medical College       Professor of Medicine       9414718374   drdpl979@gmail.com
  11   Dr. D.K. Sharma     Department of PSM         Senior Demonstrator         9166973143
       Dr. Dharmpal                                  Senior Demonstrator
  12   Bishnoi             SMS Medical College       (PSM)                       9636585959
       Dr. Dinesh                                    Additional                       0141-
  13   Dwivedi             SMS Hospital              Superintendent                 2351712
  14   Dr. K.K. Sharma     JKSMS                     Medical Consultant          9413134038   colkks@gmail.com
  15   Dr. Kamal K Bajaj   State Health department   CMHO (retired)              9314504060   kamalbajaj@gmail.com
  16   Dr. Kusum Garg      SMS Medical college       Assoc. Professor PSM        9460271172   drkusumgarg9@yahoo.com
  17   Dr. M.P. Sharma     PHOD, PSM                 Professor & Head            9929110045   sharmamaheshprashad@gmail.com

       Dr. Narendar        Health department,
  18   Kumar Sharma        Sanganer                  SMO, BCMO                   9314966083
       Dr. Nirmala
  19   Sharma              Resident Doctor           PSM department              9784405605
  20   Dr. R.P. Jain       RCHO                      M & H Department            9829122232   rpjjpur@yahoo.co.in
  21   Dr. S.D. Sharma                               Superintendant              9414278442   sdsharmajp@yahoo.co.in
  22   Dr. S.N. Mathur     (QI) ICDS                 Consultant                  9460068713
  23   Dr. Simple Gupta    MSM Medical college       2nd Year DPH                9468599383   simplegupta@Yahoo.co.in
       Dr. Sudhakar
  24   Sharma              SMS Medical college       Senior Demonstrator         9950989143   sudhakar_143@yahoo.com
       Dr. Sukhwant
  25   Singh               Department of PSM         Resident Doctor             9462238207
                           Rajasthan Voluntary       Ex-Professor Medical             0141-
  26   Dr. T.P. Jain       Assocciates               college                        2580507
  27   Dr. Vimla Jain      Mahila Chiktsalya         Supperident Hospital        9414047721
       Dr.Sweta
  28   Tikkiwal            SMS Hospital              Resident PSM                9252311297
       Emmanuelle                                    Child Protetection &
       Ferblantier                                   Inter-country Adoption
  29   D'Souza             French Embassy in India   Officer                     9718498858
                                                                                      0141-
  30   Ganpat Acharya      Child Welfare Committee   Chair Person, CWC              2000804
  31   Govind Pareek       M & H Dept. IEC           Public Relations Officer    9828012352   govindpareek@gmail.com




                                                       38
32   Isabelle Hainzelin   MDM                           Responsible of Misson                  isabelle.hainzelin@laposte.net
33   Jaya sashi Sharma    JKSMS                         Social Activist           9799693265   dnavajyoti@gmail.com
34   Jyoti Sharma         JKSMS                         Social Activist
     Kailash
35   Chaudhary            JKSMS                         Social Activist           9694091047
36   Kamal Kishor         JKSMS                         General Secretary
37   Karan Dudda          Saarthak                      Consultant                             karan@saarthakindia.org
38   Komal Varma          JKSMS                         Social Activist           9694091034
39   Kumkum Sharma        JKSMS                         Social Activist           9694091038
40   Laxmi Madhukar       JKSMS                         Social Activist           9351189884
41   Lokesh Sharma        Dainik Navjyoti               Reporter                  9024413110
42   Mamta Prajapat       ICDS                          Workar Angan Badi         7665122470
43   Manish Jain          ACF Action Control la Faim    Head of Mission India     9711200379   hom@in.mission-acf.org
44   Manju Sharma         JKSMS                         Social Worker Idgah       9928651489
     Mathura Prasad
45   Sharma               JKSMS                         Social Activist           9694091036
46   Maya Laporte         JKSMS                         MDM France                             maya.laporte@laposte.net
47   Mishra Ji            JKSMS                         CHW Bagrana
     Mrs. Nidhi
48   Sharma               ICDS                          Angan Badi                9414788225
49   Mukesh Kumar         JKSMS                         Social Activist           9694091016
     Nahid
50   Mohammed             Saathii                       Traning Officer           9314532436   nahid@saathii.org
     Narendra Kr
51   Mahawar              JKSMS                         Social Activist           9694091027
52   Neetu                JKSMS                         Social Worker Bhagrana    9929338979
     Poonam               Chitransh Education &
53   Dhamniya             Welfare Society               GNM                       9461500855
                                                        Social Worker Choki
54   Prabha Sinha         JKSMS                         Dhani                     9829705541
     Prabhakar
55   Goswami              I India                       Director                  9414048817   goswami10@hotmail.com
     Prof. Beena          PG Dept. Raj. University Of
56   Mathur               Home Scince                   Professor, Nutrition      9828366484
57   Raja Ram             JKSMS                         Social Activist           9694091020
                          Access Development
58   Rajesh Jain          Services                      Vice President            9414249226   rajesh@accessdev.org
59   Rajesh Sharma        JKSMS                         Social Activist           9887569816
60   Rajish Verma         JKSMS                         Social Activist           9314208424
61   Raju Sharma          JKSMS                         Social Activist           9887009601
62   Ramesh Paliwal       Taabar NGO Jaipur             Director                  9829850566   paliwalramesh@gmail.com
63   Ramesh Sharma        Taabar NGO Jaipur             Project Manegar           9462100211
                                                        Communications
64   Roma Kaur Rana       JKSMS                         Consultant                9829055819   romakaur@gmail.com
65   Rekha Sharma         JKSMS                         Social Activist           9694091033
                                                        Social Worker Khirni
66   Sangeeta Jadon       JKSMS                         Phatak                    9950350538
67   Sanjay               JKSMS                         Social Activist           9509556181
68   Smt Sanno            JKSMS                         CHW Bagrana
69   Santosh Saini        JKSMS                         Social Activist           9602423225
70   Satyen               VHAI                          Represention             09414076449
71   Shanu Kanwar         JKSMS                         Social Activist           9694091012




                                                          39
72   Sharda Dai       JKSMS                     CHW Bagrana
73   Kusum Nair       Department of PSM         PHM                 9829186096
74   Rukmani Dai      Dai/ Retd. Nurse                              9509556181
75   Sourash Sharma   Sewa Sandesh              Director            9413376076
     Sudharkar
76   Goswami          I India                   Coordinator         9928394598
77   Suntia Sahu      JKSMS                     Social Activist     8052913265
78   Sushila Yadav    JKSMS                     Social Activist     9982215081
79   Umesh Sharma     JKSMS                     Pro. Coordinator    9929070085   b_i_t_t_o_o@yahoo.co.in
80   Vijay Sharma     FXB India Surksha         Consultant          9351308920   vijay1659sharma@yahoo.co.in
81   Vikram Singh     JKSMS                     Social Activist     9929235724
82   Willy Bergogne   MDM                       Gen. Coordinator   09717799917   genco.india@medecinsdumonde.net




                                 For more information on
                                   the RHC project, visit


                                          http://www.jksms.org

                                                    or

                                http://www.medecinsdumonde.org




                                                  40

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Conference Report: Reproductive Health & Child Care Project in Jaipur, by JKSMS & MdM

  • 1. 2011 Conference Report Innovative Approaches to Improving Health in Slums Organized by, Jan Kala Sahitya Manch Sansthan Médecins du Monde
  • 2. http://www.jksms.org http://www.medecinsdumonde.org 2
  • 3. Innovative Approaches for Improving Health in Slums A thematic multi-session one-day Conference Inaugurated by Shri Aimaduddin Ahmad Khan (Dhuru) Honorable Minister of State for Health and Family Welfare, Rajasthan Organized by JKSMS & MdM On 4th April 2011 At OM Tower, Jaipur, India Report Compiled by: Roma Kaur Rana, Communication Specialist Umesh Sharma, Project Coordinator, JKSMS 3
  • 4. Contents Foreword ............................................................................................................................................................................... 5 Executive Summary ............................................................................................................................................................. 6 Conference Background .................................................................................................................................................... 7 Areas of intervention .............................................................................................................................................................. 7 Target population .............................................................................................................................................................. 7 Project Objectives ............................................................................................................................................................... 8 Philosophy ........................................................................................................................................................................... 8 Intervention Methods ........................................................................................................................................................ 8 Results ................................................................................................................................................................................. 9 Welcome Address ............................................................................................................................................................. 10 Inaugural Address .............................................................................................................................................................. 12 The Necessity of Raising the Level of Health Knowledge in Slums....................................................................... 14 Panel Members .............................................................................................................................................................. 14 Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues ................................................ 17 Panel Members .............................................................................................................................................................. 17 Institutional Deliveries: Overcoming Obstacles in its Popularization ................................................................... 24 Panel Members .............................................................................................................................................................. 24 RHC Conference Recommendations ........................................................................................................................... 26 Annexures Conference Agenda..............................................................................................................................................................27 Conference Images...............................................................................................................................................................29 Conference Media Coverage...............................................................................................................................................33 Conference Attendees..........................................................................................................................................................................38 4
  • 5. Foreword After almost four years of implementation, the present conference represented probably one of the most important milestones of the Reproductive Health and Child Care project. It all started four years ago, when Médecins du Monde and JKSMS decided to team up in order to respond to one of the most challenging health situations faced by the city of Jaipur: the extremely high level of maternal and child death in slums. Indeed, though the ―pink city‖ counts plenty of medical institutions (private and public) and though numerous schemes are available for the most vulnerable, it is a fact that slum dwellers tend to avoid frequenting the medical institutions. If it is true for common illness, it is also the case at the time of pregnancy. The first phase of implementation of the project was ―bumpy‖: slum dwellers were reluctant to listen, understand or even participate to our activities. Who could blame them? Health behaviour in slums has been inherited from centuries of tradition and especially the nomadic culture which prevailed in the slum dwellers communities until recently. And it is well known that nomads only rely on themselves, their family or their community. This attitude has been reinforced all through by the lack of consideration and great despise they often get from the environment surrounding them. After month and month of project implementation involving the pregnant women, their friends and relatives, changes were noticed: more and more women were willing to deliver at the hospital or to go for the Ante Natal Check-up. It was probably due to a better understanding by the communities of pregnancy related issues and schemes available. Or maybe was it also because, for the first time, these marginalized communities had been listened, respected and accepted for what they are. Capitalizing on its success, the project did not stop there: in order for the project to be sustainable beyond its end, it was also important to train volunteer, within the community, to act as health worker. We call them the Community Health Workers: they dedicate some time to help other women dealing with health issues. A second step towards sustainability consisted in advocating the cause of the vulnerable population living in slums as well as organizing events where awareness of the general public and key stakeholders will be raised. The conference was one of these events meant at gathering people, informing, proposing, exchanging and debating. As Pandit Nehru said, ―Ignorance is always afraid of change‖. This is what this project is all about: fighting ignorance, creating knowledge, bridging the gaps between vulnerable communities and medical institution and last but not least, giving hope. Willy Bergogné General Coordinator Médecins du Monde 5
  • 6. Executive Summary The Report highlights presentations and discourse which took place during the Conference on 4th April 2011 in Jaipur on ―Innovative Approaches for improving Health in Slums‖ organized by Jan Kala Sahitya Manch Sansthan (JKSMS) & Médecins du Monde (MDM). This one-day Conference, an integral part of the pilot-project to share best practices with State Health policy makers, health workers and Non-profit organization working in the field of health in Rajasthan, was inaugurated by the Minister of State for Health and Family Welfare, Shri Aimaduddin Ahmad Khan and consisted of three panel sessions comprising of stakeholders like health practitioners, academicians, State Health representatives and slum- dwellers (beneficiaries) themselves. The report highlights key points of the papers presented, outcome from panel discussions and best practices established during the project and approved in the Conference. The project intends to support policymakers in drafting appropriate policies as well as facilitate implementation of policies & directives in the slum communities to ensure optimum results. The main objectives of this conference were: 1. To present the findings of the baseline survey in selected slum areas 2. To initiate an open discussion on project findings 3. To create strategies for health improvement in less-privileged communities Nearly 100 participants representing NGOs, State health department, medical profession, academia & media gathered at the conference to discuss present health policies, participation of slum-dwellers in State-sponsored health programs, general health awareness in the slums, prevalence of malnutrition in mothers or children and exchange ideas and suggestions on pertinent health issues. The conference opened with a plenary session followed by three panel discussion sessions covering the following topics: 1. The necessity of raising the level of health-knowledge in slums 2. Anaemia, malnutrition and vitamin deficiency in slums: the unspoken issues 3. Institutional deliveries: overcoming obstacles in its popularization With the release of Census 2011, which revealed that more than 50% of women in Rajasthan cannot read or write and almost 0.65million girls are missing, there couldn‘t have been a better time to organize this conference and bring forth such findings that are proportionally related to literacy rates. Low literacy rates can affect general health knowledge which could affect the rate of institutional deliveries in a community. In the absence of institutional deliveries, births often go unregistered which does, indirectly, impact the instances of female foeticides in any community. The conference was unique in the sense that there was an active participation of the beneficiary community. Women representatives from the project area sat through the conference and shared their stories with the participants. The conference highlighted the inadequacy of existing communication & advocacy methods used by State Health departments and some other NGOs in slums because of low literacy levels and cultural trends prevalent there.. Therefore, the need to develop communication tools that will work with these communities was stressed by the speakers and supported by all participants. As a best practice, JKSMS tabled the proposal to use Street Theatre and other innovative approaches to reach out to the illiterate and vulnerable masses. 6
  • 7. Conference Background The Conference was organized as a milestone event of the pilot project on Reproductive Health and Child Care (RHC), initiated by JKSMS and supported by MdM, in 11 slums of Jaipur to bring health knowledge to low-resourced communities. During the past three years of the project period, JKSMS and MdM have utilized various innovative strategies to reach out to the beneficiaries and create a means for sustainable health development. The conference provided a platform to share best practices from the RHC project with the attendees and now, through this report, to many more in the field of grassroots development. The project is implemented in Jaipur by Jan Kala Sahitya Manch Sanstha ( JKSMS). A non-profit organization founded in 1983 by a group of enterprising social activists, JKSMS works with vulnerable women and children across the state of Rajasthan for their development. JKSMS believes in democratic values based on secularity and community participation at all levels. The strategic aim of JKSMS is to ensure active involvement of children in all issues that are pertinent to their existence and progress. It strongly advocates the right of every child to have a full-fledge childhood, where the children have the right to existence, protection, development and active participation in their growth and self respect. To implement the Reproductive Health and Child Care project, JKSMS is supported by Médecins du Monde (MdM), an international humanitarian organization providing medical care to vulnerable populations affected by war, disease, famine, poverty or exclusion. Originally established in France in 1980, the Médecins du Monde network now extends to 16 countries in Europe, Asia and the Americas. MdM‘s work depends on efforts of nearly 3000 medical and logistics professionals who volunteer their time. Although MdM‘s primary aim is to provide medical care, its work goes further to ensure long-lasting effectiveness. Areas of intervention 11 slums located within the municipal city of Jaipur (Akbar Road, Amar Nagar, Bagrana, Bambala, Chokhi Dhani, Galta Gate, Goner Mode, Idgah, Luharon ki Basti, Railway Station, Pratap Plaza). These slums are all, except for Railway Station, in the vicinity of Jaipur. Only two slums among those previously mentioned, are authorized slums. The others are not with the consequence that access to electricity, drinkable water as well as social services and schools is an issue. Target population The target population in this project is 5000 inhabitants in 11 slums of Jaipur including almost 1250 women of reproductive age. 7
  • 8. Project Objectives To improve the health situation of the target population with a focus on pregnant women, pregnancy related issues as well as children below five years by encouraging the utilization of the private and public health services. By doing so, the program intends to participate in the Indian efforts to reach the Millennium Development Goals (MDG) implemented by the United Nations, and especially the objectives 4 and 5, related to child health and maternal health. Philosophy In order to maximize the outreach of the project and foster the condition of its sustainability, all the activities were developed with a high degree of involvement of the community. In addition to the mainstream initiatives (community meetings, group/individual interactions), other innovative community participation methods were implemented for the first time in Jaipur such as the utilization of traditional story-telling tools (Kawad box), theater performances : ―oppressed‖ method and community mapping. Intervention Methods With the view to attain the project objectives, several activities have been implemented: These interactive sessions are led by the Social Worker whenever Health Education Sessions he/she is feeling a need to emphasize on a particular thematic with the goal to deliver key messages and answer audience‘s questions. The duration of the sessions varies greatly according to the subject matter and community participation. Specific groups (husband, mother-in- law, local priests and so on) are sometimes targeted to deal with particular problems. Social Workers provide useful advice during interpersonal meetings Interpersonal Counseling or group sessions. In both cases, topics are chosen by the participants themselves. During these sessions, different visual tools are used such as posters or drawings created by Social Workers and/or in some cases by members of the community (children), pictures from pubications, IEC posters, preventive tools (according to the topic) and so on. Meeting are organized in slums by the community on important subjects Community Meetings related to their particular community. It is a good way to increase community participation and let them play a role in their development. Capacity -building of CHW CHW or Community Health Workers are recruited in each slum to encourage community participation in the RHC project. They help spread disease-prevention messages and accompany people to the medical facilities. In addition to the principle of ―peer education‖, voluntary CHW are trained to gradually take over the work-load of Social Workers. In this case, the objective is not to ask them to fulfill the duties of the JKSMS Social Workers but to create the conditions of sustainability of the program with minimum external support. 8
  • 9. Results As of As of As of Dec08 Dec09 Dec10 Evolution of % institutional deliveries 32% 41% 45% Evolution of % Dai deliveries 56% 49% 45% Evolution of % home deliveries 12% 11% 10% Evolution of % of birth with the mother completing 3 ANC 24% 46% 69% Evolution of the % of baby going through NBC 11% 24% 31% Evolution of the % women going to PNC 8% 9% 34% Evolution of the % of pregnant women covered by a Birth Preparedness Plan 62% 70% 76% Evolution of the % of participation of male to health awareness session 19% 31% 34% Evolution of the % of institutionalized deliveries getting the JSY scheme 33% 55% 61% Evolution of the % of deliveries getting the JSY scheme 11% 22% 28% Total number of live births 128 125 155 Total number of child death in the project slums(0-6) 31 20 10 Number of immunization encouraged 214 321 416 Total Number of Health Education Session 73 147 772 ANC: Antenatal care NBC PNC: Postnatal care JSY: Janani Suraksha Yojana (Pregnant Women Safety Scheme) 9
  • 10. Welcome Address By Shri Kamal Kishor, General Secretary, JKSMS Honourable Minister of Health and Family Welfare, Shri Aimaduddin Ahmad Khan, Dr. Asha Pande, Emmanuelle Ferblantier D'Souza from the Embassy of France in India, Isabelle Hainzelin from Medecins du Monde, Janet Chawla of Matrika Foundation and dear participants, I would first take this opportunity to welcome you all, on behalf of JKSMS, for sparing your valuable time to participate in this conference, especially honourable Health Minister, at a short notice. As you know our conference is focused on improvement of health in slums and therefore, we will be talking about the health issues of people living in the slums of Jaipur. Before we begin, I would like to share some information about JKSMS and its work. JKSMS was launched in 1983 by a few of us friends, studying at the University of Rajasthan, as we decided to work for the underprivileged and backward people of the society to bring them into the mainstream. Today, as we walk proudly into our 28th year, the organization has progressed manifold. We are working in three main areas: Children, Health & Livelihood. Let me first share with you about our work with children on the streets or in slums. We are working with almost 7000 such kids through 11 institutes for street children, two shelters homeless children: Apna Ghar & Mamta Apna Ghar, where we take care of children‘s health, education and professional development until they are 18 years old and when we are convinced that they can fend for themselves and assimilate respectfully in the mainstream society. Apart from this, we are running two counselling centers at the Railway station. In 1999, JKSMS established primary schools in 19 slums with the help of five UN agencies and local community. After running successfully for 5 years, these primary schools were finally handed over to the local government although JKSMS counsellors and facilitators are still working in those schools to facilitate relationships between government, staff and children for smooth operations. We are also running a 1098 child help-line number where we provide help within 30 minutes of receiving a phone call from any child in need. Talking about health, our most recent project was Reproductive health and child care in 11 slums where we impacted 5000 women and children through our work. Our ongoing projects include AIDS/ HIV programs with tribal people in 12 districts of Rajasthan including Ajmer. Over the years, we have realized that in order to make development sustainable, we must ensure livelihoods in the communities we work. Therefore, since 2001 we made Sustainable Livelihood our major thrust area. As a part of this program, we have worked with 20,000 artisans who work in the costume jewellery industry in Jaipur, through JJADE ( Jaipur Jewellery Artisans Development Enterprises) program of SEEP Network. We help them in their technical upgradation and marketing knowledge by collaborating with the American organization, SEEP 10
  • 11. Network. The state government & UNDP have both accepted the Samode Town Livelihood Project as a model “JKSMS has received two national project and the model is being replicated in 178 other awards for its work on generating villages around Rajasthan. While continuing to explore livelihoods for vulnerable communities: livelihood possibilities further, we have worked for Best NGO in income Generation by generating agriculture livelihoods for which we received Indian government in 2007 & CNBC’s two awards in the area of Water Harvesting. JKSMS is also Best Income Generating Project actively encouraging craft-based livelihoods: one in Bassi award for Samode town where almost near Chittorgarh- by helping local artisans to continue 25 % population of the town was working on wooden handicrafts like Kawad; and another in helped through livelihood generation.” Udaipur- by encouraging miniature painting artists in theme, color or design development and marketing strategies. Collectively, JKSMS is working in nine different cities with 27000 artisans for their sustainable livelihoods. The organization has received 11 awards so far in recognition for for this work. At this point, let me make an honest and sincere confession, JKSMS and its beneficiary communities have made progress only through your continued support and blessings. I would also like to make a quick mention about our focus on social mobilization in all our projects because we strongly believe that until we reach out to the most marginalized of the communities who are least developed and bring them into mainstream population; until we make them aware about development and let them assume responsibility for their progress, there won‘t be any sustainability in our efforts and results. Therefore, we emphasize on social mobilization- on getting the communities involved in what is being done for them. To this end, we use Street Theatre or Nukkad Nataks as they are popularly called in India. JKSMS has its own theatre group called Caravan theatre. It is an excellent tool to reach out to the uneducated people who don‘t have access to other information mediums. We have been experimenting new techniques like Theatre for the Oppressed People in collaboration with international theatre professionals. Caravan Theatre‘s popularity has travelled far and wide in the world. We have a resource centre in the town of Rainwal where we hold training programs for other organizations or individuals who would like to use Street Theatre in social mobilization. Today, JKSMS boasts of six Street Theatre teams within the organization. In the end, I would like to share with you that through all these efforts, we are trying to create a new leadership in less-privileged communities in Rajasthan for the past 27 years. These are mostly minorities or marginalised communities. We can now see a new ray of hope as these people are coming forward to participate in their progress. They are the new Change Agents. Once again, in profound appreciation, I must say that all this has been possible through the huge support we have received from various government departments and our partner NGOs along with the local communities. Let me take this opportunity to thank all of you, Honourable Minister, esteemed dignitaries and dear participants for your gracious presence and continued support to JKSMS. Thank You. Kamal Kishor General Secretary Jan Kala Sahitya Manch Sansthan( JKSMS) 11
  • 12. Inaugural Address By Honorable Shri Aimaduddin Ahmad Khan Minister of Health and Family Welfare, Government of Rajasthan, India Distinguished dignitaries and dear participants, Reproductive Health is a major cause of concern in the present health care system in our country which impacts the general lifestyle and future growth of our society. And, it is most needed where it is lacking: the vulnerable population that is affected by poverty and illiteracy, the slum- dwellers. All and more important the government has taken up the cause of reproductive and child health at the grass root level. The factor which most affects the reproductive & child health in slums is the lack of awareness of the government sponsored schemes and basically problems of hygiene, nutrition, healthy lifestyle etc. Anaemia, malnutrition and vitamin deficiency are the most prevalent in slums. The Government of Rajasthan has taken various steps to compete these with more effective and active involvement of NGOs. I‘ve been informed that this conference would mainly focus on three issues: mainly the need of improving health problems in slums, anaemia, malnutrition or vitamin deficiencies and promoting institutional deliveries in slums. I‘m really happy to learn that the government‘s concern for reduction in IMR & MMR is finding room in the thoughts of NGOs and their endeavour. Rajasthan has an infant mortality rate of 63/ 1000 live births as against the national rate of 53/1000 live births. However, in the rural areas it is 68/1000 live births whereas in the urban area it is 39/1000 live births. We have to bring it down to our Millenium development goal of 27 and this is where the rural NGOs become all the more important by providing technical support to the people living in the backward areas, making available the resources to the government and spreading awareness about various government schemes at grass root level so that the benefits of these schemes can reach them. I‘ve been informed that JKSMS, along with MdM, France, organized street plays, one-on-one discussions, group discussions, hospital tours and other publicity campaigns to enlighten citizens of the slums about government health care facilities. The government is committed to making improvement in the public health system in the rural as well as urban areas. And we strongly feel that reproductive health and child care has an important role to play in raising the bar on health conditions in the state. 12
  • 13. Over the years, rapid urbanization has led to a haphazard rise of slums in and around Jaipur. While we “The combined efforts of JKSMS are becoming stronger economically, it is sad to know and the Government of Rajasthan that child mortality rate and sex ratio is not getting have reaped fruits. Women have much better. Women in the slum areas are still fighting for basic survival because of poor health and economic become more aware and more conditions. children are brought-in to I felicitate the efforts of JKSMS and MdM in carrying on participate in the vaccination drives. this research in the various slums of Jaipur district. Lately, more and more women These efforts will go a long way in bringing awareness have come forward to volunteer. about health, hygiene, institutional delivery, child care Women have been taken for and eliminating social evils prevalent in the society among the underprivileged. hospital tours so that they are not scared to visit or take their children I‘m happy to know about the emergence of Community Health Workers in these slums. The two organizations to a doctor. I’ve been informed that have indeed taken a very positive step in bringing health JKSMS and MdM have succeeded awareness into the very homes of the people who have in making this awareness campaign long neglected the need for good quality of life. I take fruitful.” this opportunity to appeal to all other NGO‘s working in this field to re-enforce their efforts in bringing awareness in slum areas especially to educate children about basic health & hygiene. Our children are our future and if we want to empower our future, we must ensure that they have a safe, progressive and healthy childhood. I congratulate the organisers on this occasion and believe that this will further pave way for improving health in slum areas God bless you all. Jai Hind! Aimaduddin Ahmad Khan Minister of Health and Family Welfare Government of Rajasthan, India 13
  • 14. Panel One The Necessity of Raising the Level of “I had never imagined myself sitting Health Knowledge in Slums in such an intellectual gathering and Panel Members sharing my story and that my story was even worth being heard. I am illiterate but JKSMS approached me to work with them as a Community Health Worker. I faced opposition but that didn’t deter my enthusiasm to help this project. I have understood how can I play an important role in bringing health awareness to my community despite my lack of education. The Session was opened by Dr Bhupendra Sharma, the head of PSM department who was moderating the panel discussion, with an When I began working with JKSMS, I introduction to the low levels of health awareness in slums and didn’t know anything about the state- existing efforts made by the government and NGOs. He presented the funded health facilities available to us. first speaker: Alia, a Community Health Worker from Idgah Slum area Gradually, I started visiting clinics and in Jaipur district. Alia shared her story with the participants highlighting health centers. Now, when I the issues in her neighbourhood such as lack of interest in accessing health facilities or learning about hygiene. She faced opposition from accompany pregnant women or both, her family and community when she began supporting the cause mothers, I am able to communicate of maternal health and child care in the project initiated by JKSMS & their problems to the doctors MDM. It wasn`t easy for her to convince pregnant women in her area confidently. It feels good to be a to consult doctors in the health centers. Most families preferred to change-maker, even if it is just for my check with the Traditional Birth Attendants (Dai) who were neither little neighbourhood. “ educated nor totally aware of health and hygiene criteria for safe pregnancy and delivery. However, with persistence and determination, Alia was able to win the support of both her family and community, especially as she succeeded in generating some income by volunteering to help women in the neighbourhood. For each visit to the health facility, she charges a nominal amount of ₹5 whereas for the delivery at the Health Center, the mother gives her ₹200 out of the ₹1000 she receives from the government. Thus, the project has created health awareness while empowering women in the community to create a support structure and a unified front for the cause of reproductive Alia Khan Community Health Worker, JKSMS 14
  • 15. health and child care. Alia is just an example from dozens of Community Health Workers who are now working in these slums; their training and activities supervised by JKSMS to ensure sustainable development. The second speaker in the session was Dr. R.P Jain, Reproductive & Child Health Officer with the Medical and Health Department of the Ministry of Health and Family welfare of Rajasthan who began his talk by stating the definition of Reproductive Health as accepted by the socio-medical fraternity: ―...a state of health in which people are able to reproduce and regulate their fertility......‖. He pointed out that Rajasthan fares really low when it comes to health awareness, especially Reproductive Health & Child Care. Dr. Jain further elaborated on the various State-sponsored schemes like Yashoda scheme which is not being accessed by the general masses in the slums. He emphasized the need for proper communication strategies that will help regularize fertility among the underprivileged. The final speaker in the first panel was Umesh Sharma, the Project Coordinator at JKSMS for RHC project with Médecins du Monde. Mr. Sharma has an in-depth understanding of the issues faced in the slum areas as he has been working on several development projects in urban slums. The presentation was an eye-opener for the participants as he shared the baseline survey findings of the project area. Mr. Sharma went on to expose the sad state of health affairs in these areas since the authority‘s general approach towards health awareness has been rather informative instead of educating. REPRODUCTIVE HEALTH & CHILD CARE: Project strategies & Approaches Umesh Sharma, JKSMS With the objectives to raise health awareness, scale up community participation and foster linkages between slum communities and government services, the project employed five main strategies: 1. Avoid replicating efforts of other organizations 2. Encourage slum-dwellers to visit medical facilities 3. Sensitize slum-dwellers to appropriate hygiene standards 4. Focus on reproductive health & child care only 5. Create Community Health Workers from within the community The project employed various innovative approaches like:  Increased community participation  Innovative outreach approaches (Kawad, Theatre etc)  Mapping medical facilities  Individual counselling  Educating about government medical facilities These approaches have taken the form of best practices as they got the women and children interested in convincing their families to become conscious about their health and hygiene. The end result was that communities, who were earlier openly resistant to any kind of state interference in their reproductive health or child care, now support and participate in government policies and schemes. 15
  • 16. Kawads- the traditional art of story-telling in Rajasthan Educating Women in the Slums Medical Mapping for the Community Street Theatre to Engage the Community Group Discussions & Awareness Sessions Images from the Project 16
  • 17. Panel Two Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues Panel Members With the first session focused on raising the level of health knowledge in slums, the second session highlighted the need for immediate intervention in the slum areas because of various unspoken issues like Anaemia and Malnutrition. Most of the times, health workers or surveyors do not record some of the understated but critical health concerns which have long term effect on reproductive health and child care. This session, chaired by a very senior academician from the medical fraternity of Jaipur: Dr. TP Jain, succeeded in bringing attention to pertinent topics like mineral and vitamin deficiencies and the innovative supplements recommended by academicians. In countries like India, micronutrient deficiency, especially iron, is most prevalent among children. Besides culminating into anaemia, the consequences of iron deficiency are grave which affect the health as well as quality of life of the nation as a whole. The first speaker to share her thoughts, research and recommendations was Dr Beena Mathur from University of Rajasthan‘s department of Home Science. Dr. Mathur highlighted key statistics about micronutrients deficiency among women, especially pregnant women or adolescent girls. She revealed that the statistics are worst in the slums because of poverty and illiteracy. In her presentation, she pointed out that because malnourished children suffer from an under-developed brain, lower immunity and physical deformities or decreased stamina, they face higher levels of unemployment when they grow up. She elaborated on the collective impact of malnutrition saying that it could lead to a huge population becoming an economic burden on the society as they could be incapable of fending for themselves. She informed the participants about government-run programs like ICDS Program, National Vitamin A prophylaxis Program, National Nutritional Anaemia Control Program, Iodine Deficiency Disorder Prevention Program, to name a few. However, the slum population refrains from participating in these programs because of obvious reasons like lack of communication and awareness. Emphasizing, the important role that NGOs like JKSMS & Médecins du Monde can play in eradicating Malnutrition from slums, Dr. Mathur then recommended Leaf Concentrates as an effective solution to micronutrient deficiency. Leaf Concentrate’s Molecular Composition 17
  • 18. Leaf Concentrates from Alfalfa are rich sources of, Iron, folic acid and beta carotene or pro-vitamin A, good quality protein, other vitamins, fats and minerals. COMPARITIVE CHART: Spirulina, LC & WMP Nutritive Value of Leaf Concentrate Spirulina Leaf Concentrate WMP** Nutrients Value/100g basis Nutrients Moisture 3-7% 8% 3% Energy 344 Kcal Protein 60g Protein 55-65% 50-55% 26% Fat 22.5g Lipids 4-7% 9-10% 26% Carbohydrate 12.5g pufa* (w3) 1,8% (1,0%) 6,4% (4,8%) 0,9% Carotene 86700ug (0,2%) Folic acid 330.0ug Carbo-hydrates 15-25% 10-12% 38% Iron 99.0mg Minerals 7-9% 13-14% 8% Calcium 1865.0mg Fibre 4-7% 1-2% - Phosphorous 604.0mg *PUFA: Polyunsaturated Fatty Acids **WMP: Whole Milk Powder Dr. Mathur further shared the research that was conducted in a slum in Jawahar Nagar, Jaipur where3% Alfalfa leaf concentrate was incorporated in the meals of the experimental group. The group comprised of children aged 3-6 yrs and their initial haemoglobin levels, weight, height and morbidity profile were recorded. For a duration of two years, there were quarterly follow-up and monitoring. The results were as follows: The results showed a significant increase in the Hb levels of the experimental group while they decreased in the control group. The difference between the two groups Leaf was statistically significant (p<0.01). Concentrate The morbidity profile of the as a experimental group improved while Micronutrient remaining unchanged in the control Fortifier group. The anthropometric measurements did not show a significant difference between the two groups. Dr Beena Mathur University of Rajasthan 18
  • 19. The second speaker in the session was Dr. Mukta Arora who began by talking about the general efforts that are being made to manage malnutrition, highlighting government schemes like Integrated Child Development Services (ICDS). Launched in 1975 by the Ministry of Women & Child Development, ICDS represents one of the world‘s largest and most unique programmes for early childhood development with a strong focus on: - Improving the nutritional and health status of children in the age-group 0-6 years - Laying the foundation for proper psychological, physical and social development of the child - Reducing the incidence of mortality, morbidity, malnutrition and school dropout - Achieving effective co-ordination of policy and implementation amongst the various departments to promote child development - Enhancing the capability of the mother to look after the normal health and nutritional needs of the child through proper nutrition and health education. With reference to key findings about the health benefits of Leaf Concentrates & Spirulina, Dr Mukta Arora pointed out the role of NGOs in supporting initiatives through the adaptation of research & recommendations into the implementation of policies & directives of government programs like ICDS. She elaborated on the current directions by Supreme Court that food supplementation distributed in Anganwadis (State-sponsored Day Care Centres) should not be sourced from contractors. Instead, such food should be procured by Self-help groups or community-based organizations in the area. While this directive is a positive step in strengthening SHGs, the flipside is that such food lacks any kind of micronutrient fortifiers. Dr. Arora suggested that NGOs can play an important role in educating the community-based organizations or SHGs about naturally-available micronutrients and their integration in food products provided at Anganwadis. Through this recommendation, Dr. Arora stressed the role of convergence of different government initiatives with non-profit efforts in effective malnutrition management. Next, she gave the example of ASHA Sehyogani who can pursue community mobilization to fight malnutrition. The final speaker in this session was Manish Jain who is the Head of Mission at Action Contre La Faim, India Chapter. Manish Jain enlightened the participants about the various terms used to describe varying levels of malnutrition like hunger, malnutrition, acute malnutrition, MAM & SAM. MAM: where the body is seriously undernourished, starts losing weight, and is at increased risk of infection. For the body to recover, MAM needs treatment using food that is high in energy and nutrients, otherwise MAM worsens to SAM. SAM: a stage when the body is so undernourished that the immune system becomes ineffective and main internal control systems shut down. This is when people die. This requires urgent medical treatment and therapeutic food. Types: Marasmus, Kwashiorkor and Marasmic Kwashiorkor. Chronic Malnutrition: a condition that lingers on for a longer period, or result from several bouts of acute malnutrition. A consequence of an inadequate diet often combined with an infectious disease. People can die prematurely, can contract infections or have their growth stunted. It stops children reaching their full mental and physical potential. 19
  • 20. Talking about different cases of malnutrition, Mr Jain also shared that in some cases over-nutrition could also be termed as Malnutrition. He cited the figures for Rajasthan that 7.3% children are severely acute malnourished which means almost 6,20,000 children in the state. Nearly two million children under five die every year in India – one every 15 seconds – the highest number anywhere in the world. More than half die in the month after birth and 400,000 in their first 24 hours. These are the unfortunate implications of malnutrition. Mr. Jain not only talked about the implications of malnutrition but also the reasons leading to this unfortunate situation. He pointed at the lack of exclusive breastfeeding in Rajasthan, customary burial of colostrums, load of mother‘s responsibilities other than child care. He summed up his presentation by calling attention to the ways to fight malnutrition:  All lives are equal and children should not die of reasons for which remedies are known  Further build malnutrition in societal and political agenda  Community empowerment  Prevent and treat  Increased nutrition surveillance at district levels for better targeting  Strengthen human resources and institutional vigour  Innovate-in-delivery: openness to learning and adapt to local contexts. ‗…reject-accept-innovate- adapt…; deliver-the-innovation  Increase use of MUAC  On treatment of children with SAM: think of other solutions to improve the coverage, timeliness; - community based management of malnutrition (CMAM) where 85-90% children with SAM can get treated  Not only manage from within, but managing across through concerted actions 20
  • 21. Manish Jain then focused on the issues arising from maternal and child under-nutrition which is quite common in underprivileged communities like slums. As indicated in the figure above, Mr. Jain also described the various reasons leading to Maternal and child under nutrition like disease, low dietary intake or simply household food insecurity. He summed up his presentation by calling attention to the ways to fight malnutrition: Mr. Jain finished by sharing that there are shortcomings in the ICDS scheme as well due to which the results are not as good as one would expect and hence, the Non-profit outfits should continue to play their role by bringing in nutritionists at the centres and conducting regular follow- ups with beneficiary families. Dr. TP Jain, as the moderator of this session, complemented the speakers for bringing research into the conference in a lay-out that can be easily understood by the participants. He urged the participants that these findings should be translated into change in present policies and implemented in the field. About the hurdles faced in policy implementation in low-resource communities, Dr Jain revealed that people are used to ―expecting from the government but not acting on their own‖. In his concluding note, he strongly disapproved the present trend among beneficiaries of being excessively dependent on non-profit organizations and government bodies instead of inculcating accountability for their situation and acting with self-respect. What is needed is Behavior Change whereby people become aware of their own responsibilities in maintaining good health in their families and hygiene in their neighbourhood. Instead of saying, “ what can you do for me?”, let them say “how can I improve my family’s situation?” Organizations working for development need to focus on changing health & nutrition behaviour of the community by introducing knowledge and positive changes instead of plain material help. Dr TP Jain 21
  • 22. Street Theatre Nukad Natak or Street theatre, a form of theatrical presentation in outdoor public places with minimal props or theatrical frills, is deeply rooted in Indian traditions as a form of grassroots communication to propagate social and political messages. JKSMS has been using street theatre extensively in its projects to reach out to the beneficiary communities and create social awareness. The biggest advantage of Street theatre is that it breaks formal barriers between the actors & spectators by approaching people directly. In the case of JKSMS street plays, the team likes to involve the audience in discussing the issues and pin- pointing solutions. The final component of the second session was one such street play drawing the participants‘ attention to various social challenges in implementing institutional deliveries in illiterate or low-resourced communities. With Aditya Sharma of JKSMS leading the performance, the rest of the team comprised of social workers and project executives of the organization. They enacted a scene from a rural family illustrating how women have to fight age-old traditions in order to bring changes. The focal point of the play was when the spectators were no more mute spectators but participating actors! Aditya asked questions from the participants as to how they would like to pick up roles in this play and make changes. This kind of exercise helps change people who are taciturn props to become key players in improving social situations. 1 Depicting negative family roles in institutional deliveries 22
  • 23. 23
  • 24. Panel Three Institutional Deliveries: Overcoming Obstacles in its Popularization Panel Members The third and the final session in the conference was focused on an important aspect of reproductive health: pregnancy and deliveries in a hygienic and healthy setting. Dr K.K. Sharma who is a Medical Consultant at JKSMS and has been supervising the medical components of this entire project on Reproductive health and Child care was the moderator for this panel discussion. The session brought forth the story of an indigenous birthing attendant turned trained birth attendant and a change-maker: Sharda Dai; as well as some indigenous birthing tips by Janet Chawla, founder of Matrika. The session opened with the motivating story of Sharda Dai where she shared her own experience of how she started early in life as a traditional midwife but later became a trained Community Health Worker. Sharda Dai learnt about indigenous delivery-facilitating techniques from her grandmother in the village. As a traditional birth attendant, Sharda used to provide health care, support and advice during and after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through the traditions and practices of her community. The primary focus of Sharda‘s work was to assist women during delivery and immediate post-partum. Occasionally, she would help with household chores too if the family needed so. When JKSMS social worker approached her to learn about the health facilities available to pregnant women, she was a little hesitant. However, the social workers continued to interact with her and over a period of time, Sharda was convinced that she might have a role to play in improving health outcomes in her slum because of her access to community and the relationship she shared with women in her neighbourhood. Her contacts were valuable for the JKSMS social workers because the slum women were otherwise unable to access government facilities on their own. Sharda underwent training to learn about health care, hygiene, government facilities and responses to birth complications. Now, she has emerged to be a confident birth attendant and community health worker. She prefers to take her clients to the hospital for routine check-ups rather than judge their situation independently. Sharda Dai confessed that she had never thought earlier that her work was so important to help reduce peri-natal mortality but now, at the conference, she has realized the value of her role in the society. The moderator, Dr Krishna Kant Sharma applauded her efforts, saying that CHW like Sharda or Alia have the potential to become change-makers in healthcare of low-resourced communities. The next speaker was the renowned social worker and founder of Matrika, which advocates traditional birth techniques practiced by women around the world for centuries. Expressing her delight over JKSMS‘s 24
  • 25. initiative to start an open dialogue to discuss options of optimizing health benefits through maternal health and institutional deliveries, Janet advocated the need to build bridges between indigenous and biomedical systems to enhance health care in both rural and urban settings. She began by sharing her thoughts: ―My basic advocacy point here is that we must understand the sophistication of indigenous women‘s ―body knowledge‖ and not just solely rely on a delivery of services approach—delivering western-oriented biomedicine. Health is not a deliverable, nor are there quick-fix technological solutions. We hopefully can build bridges between indigenous and biomedical systems to enhance health care in both rural and urban settings.‖ Janet went on to share her inputs on Dai‘s knowledge and practices from two perspectives: Best practices‘ and ‗Evidence-based Biomedicine in US and Europe & Text-based Ayurvedic indigenous medicine.  Dais (traditional Birth Attendants) use the following practices which are currently accepted as state of the art ‗evidence-based‘ practices during childbirth:  Encouraging movement during labour, not restricting or enforcing to lie down  Allowing easily digestible food and drink throughout labour if the mother desires  No Prenatal preparation: (shaving and enema usually given in medical facilities)  Continuous presence of a supportive person during labour  Massage, encouragement and other comfort techniques  No routine episiotomy—even with first babies—rather the massage and support of the perineum  If the mother is able to sit for an upright or squatting position for birth  No premature cord-cutting…allowing the pulsations to stop before cutting. (Traditionally dais throughout the subcontinent would cut the cord only after the placenta is delivered)  From the Ayurvedic point of view both dais practice and Ayurvedic text reflect the following principles and therapeutics:  Warmth: During both labour and post-partum the use of warmth/heating is essential. Hot drinks, heating herbs, warm oil rubs, warm room are all used to stimulate labour and comfort the mother. Postpartum use of warm compresses to contract uterus, warming and sweet food and drink, a warm room, keeping legs together to prevent hava/cold from entering vaginal area.  Oil: Used during labour for massage, sometimes mother is given a drink containing ghee, oil is used to lubricate the birth canal for smoother delivery. Postpartum full oil massage is given with special attention to the head. Heating substances such a gur, gond, nuts are given to ‗cleanse‘ the body of ‗impure blood‘ or substances which need to be expelled. After these two wonderful talks sharing personal experiences and traditional wisdom on birth-facilitation, the final speaker and moderator of the Conference, (Col.) Dr KK Sharma highlighted findings from the baseline surveys before the commencement of the project and how the solutions were planned for the health issues in the community in his presentation and advocated the need for Institutional deliveries especially in hygiene-lacking slum areas. He elaborated on slum conditions, discrimination against women and other problems in these areas. Dr Sharma enlightened participants about the results of the pilot project. There has been a marked improvement in the mortality rate and reproductive health of the community now. 25
  • 26. RHC Conference Recommendations I. Non-profit organizations can play an important role in filling-up the gap at various stages between government Schemes and implementation results II. Government scheme information can be disseminated to the uneducated people by grassroot communication strategies using experience and skills from non-profit organizations. III. Traditional tools of communication like Kawad can be used for rural outreach. IV. Participatory Theatre can be an effective tool in mobilizing uneducated communities and should be an integral part of communication strategies targeting illiterate population. V. Communities need to be made aware of natural supplements like Spirulina or leaf concentrate’s role in micro nutrition. VI. Spirulina/leaf concentrate products could be marketed/distributed in undernourished communities through self-help groups thereby providing livelihoods to many others. VII. Replicating CHWs for sustainable health programs by sensitizing, mobilizing & training potential CHWs though National Urban Health program with the help of experienced non-profit organizations. VIII. CHWs or community participation in planning process of any scheme or program before its launch is important IX. Women should be able to make a conscious decision regarding their preferred facility/ environment when it comes to birthing/delivery. X. Skilled birthing attendance should be made available regardless of where the delivery takes place. 26
  • 27. ANNEX 1: AGENDA of the Conference Innovative Approaches for Improving Health in Slums OM Tower, Jaipur Agenda Day 1: 4th April 2010 9:30 Inaugural Ceremony: Lighting of the Lamp 9:40 Welcome address by Kamal Kishor, General Secretary, JKSMS 9:55 Introduction to Medecins du Monde by Willy Bergogne, General Coordinator, MDM 10:10 Film Presentation: Reproductive Health & Child Care in Slums by Umesh Sharma 10:30 Address by Hon. Shri Aimaduddin Ahmad Khan, Minister of Health & Family Welfare, Raj. 10:50 Thank You Note to the Chief Guest, by Dr. Asha Pande, Vice-President, JKSMS 10:55 Tea Break 11:00 Opening of 1st Session The Necessity of Raising the Level of ―Health Education‖ in Slums 12 pm Open discussion & Recommendations 1 pm Lunch 2 pm Opening of 2nd Session Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues 3 pm Open discussion & Recommendations 3:30 Street Theatre by CaravanTheatre Group 3:45 Opening of 3rd Session Institutional Deliveries: Overcoming Obstacles in its Popularization 4:30 Open discussion & Recommendations (Tea & Refreshments) 27
  • 28. Program Details Session 1: The Necessity of Raising the Level of “Health Education” in Slums Moderator: Dr. Bhupendra Sharma, PSM Department Panelists: RP Jain, RCHO, Jaipur Alia Khan, Community Health Worker Umesh Sharma, Project coordinator, JKSMS Session 2: Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Non-Spoken Issues Moderator: TP Jain, RVHA Panelists: Dr. Mukta Arora, UNICEF Manish Jain, Head of Mission, action Contre la faim Prof. Bina Mathur, University of Rajasthan Session 3: “Institutional Deliveries: Overcoming Obstacles in its Popularization” Moderator: Dr. KK Sharma (Retd. Colonel), Medical Consultant, JKSMS Panel: Janet Chawla, Matrika Foundation Dr. Akhilesh Sharma, Health Sociologist Sharda , Mid-wife/ Community health Worker Day 2: 5th April 2010 9:30 am to 12:00 pm Field Visit (Idgah & Bagrana) Facilitated by RHC Team 28
  • 29. Annex 2: Glimpses of the Conference 29
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  • 35. Annex 3: Media Coverage 35
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  • 38. Annex 4: Conference Attendees (Arranged in alphabetical order) Nos. Names Organizations Designation 1 Aliya Khan JKSMS CHW Idgah 2 Alka Sharma JKSMS Social Activist 9898638496 Aimaduddin Minister of State for Ahmad Khan Health and Family 3 (Dhuru) Government of Rajasthan Welfare Amarjit Singh 4 Rana Sikh Educational Board Director 9829055819 ranaamarjit@gmail.com Social Worker Railway 5 Bhanwar Singh JKSMS Station 9351409328 6 Chanda JKSMS CHW Toll Tax Bambala 7 Daksha Parashar JKSMS Jt. Secretary 9982628100 8 Dr. Asha Pande JKSMS Vice-President 9829055717 ashapande@hotmail.com 9 Dr. B.D. Acharya State Health department Medical Officer 98299304711 Dr. Bhupendara 10 Sharma SMS Medical College Professor of Medicine 9414718374 drdpl979@gmail.com 11 Dr. D.K. Sharma Department of PSM Senior Demonstrator 9166973143 Dr. Dharmpal Senior Demonstrator 12 Bishnoi SMS Medical College (PSM) 9636585959 Dr. Dinesh Additional 0141- 13 Dwivedi SMS Hospital Superintendent 2351712 14 Dr. K.K. Sharma JKSMS Medical Consultant 9413134038 colkks@gmail.com 15 Dr. Kamal K Bajaj State Health department CMHO (retired) 9314504060 kamalbajaj@gmail.com 16 Dr. Kusum Garg SMS Medical college Assoc. Professor PSM 9460271172 drkusumgarg9@yahoo.com 17 Dr. M.P. Sharma PHOD, PSM Professor & Head 9929110045 sharmamaheshprashad@gmail.com Dr. Narendar Health department, 18 Kumar Sharma Sanganer SMO, BCMO 9314966083 Dr. Nirmala 19 Sharma Resident Doctor PSM department 9784405605 20 Dr. R.P. Jain RCHO M & H Department 9829122232 rpjjpur@yahoo.co.in 21 Dr. S.D. Sharma Superintendant 9414278442 sdsharmajp@yahoo.co.in 22 Dr. S.N. Mathur (QI) ICDS Consultant 9460068713 23 Dr. Simple Gupta MSM Medical college 2nd Year DPH 9468599383 simplegupta@Yahoo.co.in Dr. Sudhakar 24 Sharma SMS Medical college Senior Demonstrator 9950989143 sudhakar_143@yahoo.com Dr. Sukhwant 25 Singh Department of PSM Resident Doctor 9462238207 Rajasthan Voluntary Ex-Professor Medical 0141- 26 Dr. T.P. Jain Assocciates college 2580507 27 Dr. Vimla Jain Mahila Chiktsalya Supperident Hospital 9414047721 Dr.Sweta 28 Tikkiwal SMS Hospital Resident PSM 9252311297 Emmanuelle Child Protetection & Ferblantier Inter-country Adoption 29 D'Souza French Embassy in India Officer 9718498858 0141- 30 Ganpat Acharya Child Welfare Committee Chair Person, CWC 2000804 31 Govind Pareek M & H Dept. IEC Public Relations Officer 9828012352 govindpareek@gmail.com 38
  • 39. 32 Isabelle Hainzelin MDM Responsible of Misson isabelle.hainzelin@laposte.net 33 Jaya sashi Sharma JKSMS Social Activist 9799693265 dnavajyoti@gmail.com 34 Jyoti Sharma JKSMS Social Activist Kailash 35 Chaudhary JKSMS Social Activist 9694091047 36 Kamal Kishor JKSMS General Secretary 37 Karan Dudda Saarthak Consultant karan@saarthakindia.org 38 Komal Varma JKSMS Social Activist 9694091034 39 Kumkum Sharma JKSMS Social Activist 9694091038 40 Laxmi Madhukar JKSMS Social Activist 9351189884 41 Lokesh Sharma Dainik Navjyoti Reporter 9024413110 42 Mamta Prajapat ICDS Workar Angan Badi 7665122470 43 Manish Jain ACF Action Control la Faim Head of Mission India 9711200379 hom@in.mission-acf.org 44 Manju Sharma JKSMS Social Worker Idgah 9928651489 Mathura Prasad 45 Sharma JKSMS Social Activist 9694091036 46 Maya Laporte JKSMS MDM France maya.laporte@laposte.net 47 Mishra Ji JKSMS CHW Bagrana Mrs. Nidhi 48 Sharma ICDS Angan Badi 9414788225 49 Mukesh Kumar JKSMS Social Activist 9694091016 Nahid 50 Mohammed Saathii Traning Officer 9314532436 nahid@saathii.org Narendra Kr 51 Mahawar JKSMS Social Activist 9694091027 52 Neetu JKSMS Social Worker Bhagrana 9929338979 Poonam Chitransh Education & 53 Dhamniya Welfare Society GNM 9461500855 Social Worker Choki 54 Prabha Sinha JKSMS Dhani 9829705541 Prabhakar 55 Goswami I India Director 9414048817 goswami10@hotmail.com Prof. Beena PG Dept. Raj. University Of 56 Mathur Home Scince Professor, Nutrition 9828366484 57 Raja Ram JKSMS Social Activist 9694091020 Access Development 58 Rajesh Jain Services Vice President 9414249226 rajesh@accessdev.org 59 Rajesh Sharma JKSMS Social Activist 9887569816 60 Rajish Verma JKSMS Social Activist 9314208424 61 Raju Sharma JKSMS Social Activist 9887009601 62 Ramesh Paliwal Taabar NGO Jaipur Director 9829850566 paliwalramesh@gmail.com 63 Ramesh Sharma Taabar NGO Jaipur Project Manegar 9462100211 Communications 64 Roma Kaur Rana JKSMS Consultant 9829055819 romakaur@gmail.com 65 Rekha Sharma JKSMS Social Activist 9694091033 Social Worker Khirni 66 Sangeeta Jadon JKSMS Phatak 9950350538 67 Sanjay JKSMS Social Activist 9509556181 68 Smt Sanno JKSMS CHW Bagrana 69 Santosh Saini JKSMS Social Activist 9602423225 70 Satyen VHAI Represention 09414076449 71 Shanu Kanwar JKSMS Social Activist 9694091012 39
  • 40. 72 Sharda Dai JKSMS CHW Bagrana 73 Kusum Nair Department of PSM PHM 9829186096 74 Rukmani Dai Dai/ Retd. Nurse 9509556181 75 Sourash Sharma Sewa Sandesh Director 9413376076 Sudharkar 76 Goswami I India Coordinator 9928394598 77 Suntia Sahu JKSMS Social Activist 8052913265 78 Sushila Yadav JKSMS Social Activist 9982215081 79 Umesh Sharma JKSMS Pro. Coordinator 9929070085 b_i_t_t_o_o@yahoo.co.in 80 Vijay Sharma FXB India Surksha Consultant 9351308920 vijay1659sharma@yahoo.co.in 81 Vikram Singh JKSMS Social Activist 9929235724 82 Willy Bergogne MDM Gen. Coordinator 09717799917 genco.india@medecinsdumonde.net For more information on the RHC project, visit http://www.jksms.org or http://www.medecinsdumonde.org 40