ANNUAL REPORT 2010-1011 - Prayas ChittorPrayas: Annual Report 2010-11 3 About the organization:...

ANNUAL REPORTANNUAL REPORTANNUAL REPORTANNUAL REPORT

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PRAYAS

8, Vijay Colony, Nimbahera Road, Near Railway Station Chittorgarh-312 001, Rajasthan, India

Tel.: +91 1472 243788/250044 Email: [email protected] URL: www.prayaschittor.org

Prayas: Annual Report 2010-11

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CONTENTSCONTENTSCONTENTSCONTENTS

S.N.S.N.S.N.S.N. ContentContentContentContent Page No.Page No.Page No.Page No.

1111 About the organizationAbout the organizationAbout the organizationAbout the organization 2222

2222 Detailed progress report of the programmesDetailed progress report of the programmesDetailed progress report of the programmesDetailed progress report of the programmes

Jan Swasthya Sashaktikaran Abhiyan (Public Jan Swasthya Sashaktikaran Abhiyan (Public Jan Swasthya Sashaktikaran Abhiyan (Public Jan Swasthya Sashaktikaran Abhiyan (Public Health Empowerment Campaign)Health Empowerment Campaign)Health Empowerment Campaign)Health Empowerment Campaign)

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Quality Assurance and Quality Improvement Quality Assurance and Quality Improvement Quality Assurance and Quality Improvement Quality Assurance and Quality Improvement Interventions in Primary Health ServicesInterventions in Primary Health ServicesInterventions in Primary Health ServicesInterventions in Primary Health Services

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SSSStudy of the Trends in Out of Pocket Payments in tudy of the Trends in Out of Pocket Payments in tudy of the Trends in Out of Pocket Payments in tudy of the Trends in Out of Pocket Payments in Health Care During NRHM Period (2005Health Care During NRHM Period (2005Health Care During NRHM Period (2005Health Care During NRHM Period (2005----2010) in 2010) in 2010) in 2010) in Six States of IndiaSix States of IndiaSix States of IndiaSix States of India

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Community Health Fellowship ProgrammeCommunity Health Fellowship ProgrammeCommunity Health Fellowship ProgrammeCommunity Health Fellowship Programme 21212121

National Consultation on Right to Free Treatment National Consultation on Right to Free Treatment National Consultation on Right to Free Treatment National Consultation on Right to Free Treatment for All Indians: Requirements and Challengesfor All Indians: Requirements and Challengesfor All Indians: Requirements and Challengesfor All Indians: Requirements and Challenges

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Training of SHG Members on HIV/AIDSTraining of SHG Members on HIV/AIDSTraining of SHG Members on HIV/AIDSTraining of SHG Members on HIV/AIDS 26262626

Towards a Wage labour Exchange: Streaming Towards a Wage labour Exchange: Streaming Towards a Wage labour Exchange: Streaming Towards a Wage labour Exchange: Streaming Recruitment and Ensuring Social Security for Tribal Recruitment and Ensuring Social Security for Tribal Recruitment and Ensuring Social Security for Tribal Recruitment and Ensuring Social Security for Tribal Migrants to GujratMigrants to GujratMigrants to GujratMigrants to Gujrat

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Income Generation Activities: Income Generation Activities: Income Generation Activities: Income Generation Activities: Promotion of Income Promotion of Income Promotion of Income Promotion of Income Generation Activities for Local CommuGeneration Activities for Local CommuGeneration Activities for Local CommuGeneration Activities for Local Communities nities nities nities Around Sita Mata Sanctuary and Linking it up to Around Sita Mata Sanctuary and Linking it up to Around Sita Mata Sanctuary and Linking it up to Around Sita Mata Sanctuary and Linking it up to ConservationConservationConservationConservation

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3333 Overview of the Programmes Implemented During Overview of the Programmes Implemented During Overview of the Programmes Implemented During Overview of the Programmes Implemented During 2010201020102010----11111111

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About the organization:

Prayas is a voluntary organization, based in Chittorgarh district of southern Rajasthan and is

working for social, political, and economical development. Established in 1979, Prayas, as its

name suggests, is distinguished primarily by its evolving orientation. It has taken up many

kinds of issues and undertaken a variety of projects, sometimes divergent approaches. Now

Prayas has completed his excellent 32 years of service. Beginning from one dispensary in

Devgarh in 1979 to 76 permanent employee, 141 animators and many guest consultants,

Prayas has indeed come a long way.

The Beginning

Prayas was originally established in Delhi by Dr. Narendra Gupta with likeminded associates.

In 1979 Dr. Narendra Gupta, the founding spirit of Prayas and then the sole worker, arrived

in Devgarh. Since Most of its founder members had medical background and therefore the

organization began its operations by setting up a community health care programme. Work

was started in Devgarh panchayat of Devgarh Tehsil, Chittorgarh district, a predominantly

tribal area. A centre for this purpose was established at village Devgarh also known as

Deolia. This village is 12 kms west of Pratapgarh town in the midst of tribal population. The

selection of the area was based on its extreme remoteness and complete lack of infrastructural

facilities such as drinking water, roads, electricity, schools and health services. The selected

area had more than 95% tribal population living in poverty. Realizing this fact that working

alone on medical issues of people is not adequate to accomplish sustained health

improvements, gradually, the organization diversified to address the other concerns related to

people’s lives viz. access to education, improvement in economic status through different

livelihood options and above all for community empowerment to eliminate the historically

institutionalized discrimination imposed on them which has resulted into wide spread poverty

and general backwardness. Some of the specific activities undertaken were like setting up

schools for children not being able to attend schools, education centres for adults,

mobilization of villagers to seek recognition of their traditional rights for collection of non-

timber forest produce from the forest around them. Other activity on which Prayas intensively

worked was related to identification, release and rehabilitation of bonded labourers,

mobilization against corruption in public distribution system and other rural development


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programmes administered by different departments of Government. Recognizing the health

activities carried out by the organization, the Government of Rajasthan handed over the local

Primary Health Centre (PHC Rampuria) to it in 1982 for three and half years. Perhaps, it was

the first such attempt of its kind about collaboration between Government and voluntary

organizations. Now Prayas is working on many different projects of Gov. as well as private

funding agencies. The issues on which the organization’s activities are centred include human

rights, rights to health, natural resource management, ensuring safe childhood,

Universalization of education by alternative school, residential educational care for drop out

children’s, tribal awakening and bounded labour emancipation, prevention and care for

HIV/AIDS patients etc.

The Mission of Prayas

Prayas symbolizes a ‘continuing effort’. Its purpose is to work for equity and universality of

resources and services to the deprived community as their essential entitlement. Its mission

statement is- “revitalization of the self esteem of poor to bring about improvement in the

quality of life”.

The Vision of Prayas

The organization has a vision to work for removal of discrimination built on social, cultural,

economic, religious, and geographical and gender grounds.

The Principles of Prayas

The work of Prayas is guided by following principles: “Enable poor section of the society to

have opportunities for their equitable social, economic, physical and cultural growth without

any discrimination on grounds of religion, culture, economic status, geographical location

and gender. Facilitate creation of alternative body of knowledge and mechanism for

sustainable community development based on the principles of equity.”


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The Objectives of Prayas

Primary objectives of Prayas are to: Enable the poor to have opportunities for their social,

economic, physical and cultural Growth. Create alternative knowledge and mechanisms for

community development. Lobby to secure social, economic, political and cultural rights for

all. Respond to contemporary poverty related community needs and Campaign for gender

sensitive conduct and equity.

Focus of Prayas

Prayas focuses its work on Aadivasees (tribal community), Dalits and other rural poor people

in the community.

Structure of Prayas


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Programmes during the year 2010-1011

JAN SWASTHYA SASHAKTIKARAN ABHIYAN JAN SWASTHYA SASHAKTIKARAN ABHIYAN JAN SWASTHYA SASHAKTIKARAN ABHIYAN JAN SWASTHYA SASHAKTIKARAN ABHIYAN

(PUBLIC HEALTH EMPOWERMENT CAMPAIGN)(PUBLIC HEALTH EMPOWERMENT CAMPAIGN)(PUBLIC HEALTH EMPOWERMENT CAMPAIGN)(PUBLIC HEALTH EMPOWERMENT CAMPAIGN)

People’s Initiative for Health Security project was initiated in the year 2003 with the

objective to ensure safe, effective, rational and inexpensive health care services to people as a

matter of their essential rights. People’s Initiative for Health Security Project broadly

revolves around evolving a framework of health care security through community

mobilisation and public health education and social sensitization of government health care

providers.

The first phase (June 2003 to March 2005) of the project was carried out in 50 villages in

two blocks of Chhoti Sadri and Bari Sadri Blocks of Pratapgarh and Chittorgarh districts

respectively (Earlier both the blocks came under Chittorgarh district, but Chhoti Sadri got

included into Pratapgarh district after the new district came into existence in the year 2008).

Both these blocks are predominantly rural in their composition. People are generally

economically weak and because of this are also the most exploited. In this scenario where

there is no security with respect to basic requirements of healthy living, it is indicative that

the overall quality of life is not good and the health status is very low. These facts were

substantially proved and confirmed thorough baseline studies. The baseline studies conducted

in the project villages also revealed that nutritional deficiency in the form of chronic energy

malnutrition, anaemia especially amongst children and women, prevalence of sexually and

non-sexually transmitted reproductive tract infections in women & to some extent amongst

men and other communicable diseases are fairly common. Poor socio-economic status with

low self-esteem has led to state of affairs where health care is regularly denied to people in

the government health facilities in the form of non-availability of care providers, long

distances to cover and high cost of medicines.

The second phase of the project began in April 2005 for a period of three years to end in

March 2008 in Chhoti Sadari and Badi Sadari blocks. This second phase of the project was

in continuation but with expanding to 100 villages in the same two blocks with the same

objective to ensure safe, effective, rational and inexpensive health care services to people as a

matter of their essential rights.


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During second phase, to avoid duplication, Prayas limited activities of the project to only 100

villages in Chhoti Sadri block while there were 141 villages in all as IPD project was

implemented in rest of the villages and also because IPD activities were as well coordinated

by Prayas.

The third phase of the project is for the period from April 2008 to March 2011. The over all

objective of the project is “attainment of best health status of the community through

reduction in morbidity, disability and premature mortality”. In this phase, all 146

revenue villages* of Chhoti Sadri block was included as IPD supported programme continued

for about 9 months only. This strategy was adopted to evolve a demonstrable model at block

level, which is a significant unit of health delivery and local governance. A block is an

important tier of government development efforts, in between gram panchayat and district.

Objectives of the project during this phase are as follows: • Develop a critical understanding amongst the community on social, economic and cultural

determinants of health.

• Develop systems for promoting public action for monitoring of health equity and social

determinants of health.

• Develop systems to ensure that safe, effective, rational and inexpensive health care

services are available to people and community is able to access health care as its rights.

• Enhance information and awareness about health related practices and create an

environment so as to facilitate necessary behavioural changes for maintaining good health.

• Challenge and change age – old stereotypical beliefs and traditions that adversely affect

the health of the community especially women and children.

• Develop synergy and partnership between the public health services providers and

community for regular communication and coordination between them to enable better

delivery and utilization of health services.

The following basic principles have been adopted while framing the strategy and

undertaking the project activities:

• Recognizing health as a basic human right as the basis for all advocacy interventions.

• Examining health from the viewpoint of social determinants of health and extent of equity

in health and health care services.


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• Advocating for equity in access, participation and outcomes in health and health service

utilization and for reduction of inequities in health.

• Enabling people, communities and people’s organizations to participate in decision

making which impact on health.

Working in partnership with people, communities and organizations to ensure inclusion

across sectors, communities, stakeholders, individuals and organizations with specific focus

on women and marginalized groups.

Progress so far:

The year 2010-11 was marked by a number of intense activities involving various community

groups. It further consolidated the aim of making people aware of their health rights and

required actions to get it. Interventions to work with the health services providers to make

them more responsive, transparent and accountable especially on gender issues were

mediated through as also made through different activities. Efforts made have further

improved the health status of the families living in the project area.

Milestones were set to accomplish for every year. These milestones have been good

indicators to measure progress. Discussed below are some of the important achievements as

per the milestones set.

• More than three fourth of all families now have separate space for cooking in their homes

unlike the baseline record which showed that about 90% of the households had combined

space for cooking and livestock.

• 66.30% of the households now have private bathrooms against the goal to reach to 50% of

the households.

• 14.91% of the households now own private toilets. Progress though is not satisfactory.

• A total of 87% households have taken up the practice of washing hands by soap or ash to

maintain self hygiene.

• 41.79% of the households are using ladle for drinking water.

• About 93% of the women have received two shots of tetanus toxoid.

• About 91% of the deliveries are being held at institutions. These can be regarded as safe

deliveries.


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• Practice of providing artificial feed called gulla – a mixture of jaggery and goat milk to

new born has been almost eliminated from the project area. It was found that only 0.04%

of families indulged in practice of artificial feeding to new borne in the project area. While

during the baseline about 19% of the new-borne were found to have been indulged in this

practice.

• All the Aaganwaris in the region are functional and community based monitoring system

has been evolved. Efforts are being made to get anganwaris opened in villages where they

are not in spite of the Supreme Court of India’s direction that no child should remain

deprived from the ICD services.)

• Village health days called MCHN days are monitored through Village Health & Sanitation

Committees in the project area.

• Staff in health facilities has been appointed as per IPHS norms in the area with very few

vacancies in comparison to previous years.

• About 72% of the women suffering from RTI/STI are seeking treatment.

Many milestones could not be measured in quantitative terms in the absence of cross

sectional studies. An increase in overall awareness on health and sanitation would more

clearly be evident if point prevalence studies on these indicators are carried out.


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QUALITY ASSURANCE AND QUALITY IMPROVEQUALITY ASSURANCE AND QUALITY IMPROVEQUALITY ASSURANCE AND QUALITY IMPROVEQUALITY ASSURANCE AND QUALITY IMPROVEMENT MENT MENT MENT

INTERVENTIONS IN PRIMARY HEALTH SERVICESINTERVENTIONS IN PRIMARY HEALTH SERVICESINTERVENTIONS IN PRIMARY HEALTH SERVICESINTERVENTIONS IN PRIMARY HEALTH SERVICES

The Ministry of Health and Family Welfare, Government of India is actively involving in the

improvements in the quality of reproductive and child health (RCH) care provided through

the vast network of public health institutions, RCH/sterilization camps and outreach services.

Assessing and continuous improvement in the quality of RCH services is one of the thrust

priorities of the NRHM/RCH II programme. In order to establish and institutionalize quality

assurance and improvement in RCH services, an attempt was being made to set up a

functioning district quality assurance mechanism.

The reproductive and Child Health Programme (RCH) Phase II is being implemented in the

State of Rajasthan as a part of the National Rural Health Mission to meet the national

objectives. Under the various thematic interventions planned in the RCH-II PIP, emphasis has

been given to improve facility and also to the quality of services. Quality of services is very

critical to increase the utilization of the services related to the Reproductive & Child Health.

An analysis of the implementation indicates that the various strategies under the thematic

interventions of Maternal Health, Child Health and Family Planning etc. have been initiated.

Apart from thematic interventions, RCH is also strengthening institutions to deliver services,

building capacity of the human resources through skill development, establishing systems of

community monitoring and making special effort to address the vulnerable groups. With the

initiation of Janani Suraksha Yojana (JSY) scheme, the institutional deliveries have increased

compared to the previous year’s substantially. Now an all out emphasis on quality of the

services is required to enhance the utilization of the services and also bridge the service

delivery and demand gap.

The importance of quality of care in reproductive health programme has been widely

recognized in various platforms including the international agenda. The 1994 International

Conference on Population & Development (ICPD) held in Cairo, Egypt not only stressed that

the women have rights for reproductive and sexual health but also should have quality access

to it. Since then improving the quality of care is a part of health reform processes that are

under way in India. Policy instruments such as National Population Policy 2000 and RCH II

Project Implementation Plan 2005 clearly highlight the issue of quality of reproductive health


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services. Quality of care encompasses the access to services, adequate supplies and

equipment, application of evidence based clinical protocols, technical, managerial and

interpersonal skills of health staff to deliver services and sensitivity amongst health providers

on social, cultural, religious and economic influences of service receivers.

Quality Assessment

The quality assurance programme has two main components- Quality Assessment (QA) and

Quality Improvement (QI). The QA operational manual (2008) defines quality assurance

(QA) as – “mechanism/process that contributes to defining, designing, assessing, monitoring,

and improving the quality of healthcare”.Quality assurance (QA) process applies broadly to

an entire cycle of assessment which extends beyond problem identification, to verification of

the problem, identification of what is correctable, initiation of interventions / improvements,

and continual review to assure that identified problems have been adequately corrected and

that no further problems have been engendered in the process.

The main objective of the QA programme was to improve the quality of RCH services in

the primary health facilities and the specific objectives are:

1. Provide facility support to the district level health functionaries and district level

quality assurance groups in the four districts of Rajasthan in implementation of

quality assurance activities.

2. Build the capacity of quality assurance groups in the selected districts of Rajasthan to

undertake the various activities related to quality assessment and facilitate quality

improvements.

3. Facilitate institutionalization of systems in place to monitor the quality of services

through standardized tools, take remedial measures and ensure quality of health care

services with special focus on RCH services.

4. Facilitating the improvement of the quality of RCH services through untied funds

available at facilities and also reprogramming of flexi pool funds available at the

facilities level.

5. To strengthen the capacity of the community based groups to interface with the Public

health system and demand for quality health services.

Project Area and selection of Institutions


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The programme has initiated in four district of Rajasthan- Ajmer, Nagaur, Sikar and Udaipur

in 2008. In the first stage one block was from each district with at least one FRU declared

CHC. In the second stage, one CHC was identified from each block based on the

performance of CHCs in Institutional deliveries and IPD load (best performing). Five PHCs

from each block was identified based on the OPD load with 3 PHC s with good performing

and 2 PHC with average performing category. 25 Sub-centres from each block was identified

on the basis of the performance of immunization status (13 from good performing, and 12

from average performing).

Major Findings of the Quality Assessment of RCH services in the Primary Health

Institutions of Rajasthan

Under the quality assessment of RCH services, the assessment of the three tier health care

structure of the Indian rural health care system was covered in Rajasthan. This included the

CHCs, PHCs and SCs in the four selected districts of Ajmer, Sikar, Nagaur and Udaipur in

Rajasthan in several rounds of assessment visit to capture any noticeable improvement in the

quality of services. In this chapter, the major findings of the quality assessment exercise have

been discussed.

Quality Assessments in Community Health Centres In order to assess the quality of reproductive and child health care services in community

health centres (CHCs) in Rajasthan, four districts were selected and from each district, one

block was randomly selected. Subsequently, from each block one CHC was selected for

continuous assessment. In all, four rounds of assessments were undertaken in all the districts.

It was important to note that in the second assessment, Vijayanagar CHC in Ajmer was not

included due to renovation work at the CHC during the time of assessment, while in Nagaur

district, in two CHCs the fourth assessment could not be completed. Except the first and

third assessments, where all 16 CHCs were covered, in the second assessment and fourth

assessments, 15 CHCs and 14 CHCs were covered and considered for the analysis

respectively.

The assessments were carried out with respect to the following domains and indicators:


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Findings In the first assessment, nearly 6 percent of the CHCs were found to be in grade C and in the

subsequent assessments none of the CHCs were found to be in grade C. At the same time, the

percentage of CHCs categorized in grade A has increased from 18.8 percent in first

assessment to about 93 percent in fourth assessment in terms of overall performance of the

CHCs (Figure 1).

Percentage of CHCs categorized in different grades based on overall performance

Note: C-Grade- score value=26 to 50 percent, B-Grade- score value =51 to 75 percent, A –Grade- score value = 76 percent or more

1. Providers availability: Under the domain of providers’ availability, the following indicators were covered: Availability of trained medical officers in emergency obstetric care and RTI/STIs, to conduct MTP, for conducting C-section and trained technicians to conduct various tests including RTI/STI test, blood storage protocols and cross-matching.

2. Availability of equipment and supplies: Under the domain of Availability of equipment and supplies, the following indicators were covered: Availability of weighing scales, BP apparatus and stethoscope in working order, sufficient number of sterilized syringes and needles, oxygen cylinder, infection prevention supplies, lab equipment and supplies, essential drugs, etc.

3. Practices: Under the domain of Practices, infection prevention practices were covered.

4. Infrastructure : Under the domain of Infrastructure, the following indicators were covered: Cleanliness of the facility, essential amenities for client’s comfort, facilities in the centre and information and communication services at centre

5. Services: Under the domain of services, the following indicators were covered: family planning services, maternal health services, child health/immunization services


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From table 1 presented below, it is evident that, in the first assessment more than two thirds

of the CHCs were in Grade A, while in the fourth assessment, 71 percent of the CHCs were

found to be in Grade A in terms of providers availability. About 7 percent of the CHCs were

found to be in grade D in the first assessment, but in subsequent assessments neither of the

CHCs was found to be in grade D. In the case of improvement in infrastructure, in the first

assessment, a little less than one fifth (18.8 percent) of the CHCs were in grade A, while in

the fourth assessment, more than three-fourth (78.6 percent) of CHCs were found to be in

grade A. The percentage of CHCs with grade A has doubled from the second assessment to

third assessment. The possible explanation for it may be the improvement in Operation

Theatre/Procedure room to provide anesthesia and availability of CHC vehicle with

driver/outsourced vehicle on call. In the case of availability of essential protocols and job aid,

the CHCs show a remarkable improvement between the first assessment and the fourth

assessment. In the first assessment, more than half (56.3 percent) of the CHCs were

categorized into grade D whereas, only 12.5 percent of the CHCs were found to be in grade D

in the fourth assessment. In the fourth assessment, nearly 93 percent of the CHCs were found

to be in grade A and 7 percent were in grade B. Even though there was a slight decline in the

CHCs with grade A between second and third assessment, more than three-fourths (78.6

percent) of the CHCs were in grade A in the fourth assessment. No CHCs were categorized

as grade D or grade C in all the four assessments. There were more than half (56.3 percent) of

CHCs in Grade A in the first assessment, which has increased to 92.9 percent in the fourth

assessment

Quality Assessments in Primary Health Centres

In order to understand the improvement in the quality of services in primary health centres

regarding the availability of providers, infrastructure and various service deliveries and

practices, 20 PHCs from each of the study district were identified and four rounds of

assessment were carried out. However, due to some problems in the first assessment, 2 PHCs

from Ajmer districts could not be included, and in the second and the third assessment, one

PHC from Sikar district could not be covered under the assessment exercise, and in the fourth

assessment, one PHC from Ajmer and Udaipur district and 12 PHCs from Nagaur district

could not be covered. For the analysis purpose in the first assessment, 78 PHCs were

considered and for the second and third assessment 79 PHCs were considered and the results

of fourth assessment are based on 66 PHCs.


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In first assessment, 6.4 percent of the PHCs were in grade D. This has reduced to 2.5 percent

in the second assessment and in the subsequent assessments neither of the PHCs were found

to be in grade D on overall performance of the PHCs. It was also remarkable to note that the

percentage of PHCs with grade A has increased from 3.8 percent in the first assessment to

27.3 percent in the fourth assessment.

Percentage of PHCs categorized in different grades based on overall performance

Note: D- Grade = Score value less than 25 percent, C-Grade- score value=26 to 50 percent, B-Grade- score

value =51 to 75 percent, A –Grade- score value = 76 percent or more

From table five below, it was evident that nearly half of the PHCs were in grade D in the first

assessment with regard to provider’s availability at the centre, and it has reduced to a little

more than one-third in the fourth assessment. However, the percentage of PHCs categorized

under grade A has reduced from 3.8 percent in the first assessment to none in grade A in the

fourth assessment. The possible reason may be the unavailability of medical officer on

obstetric care and RTI/STI (in the first assessment 47 percent of the PHCs did not have a

trained medical officer on obstetric care and RTI/STI, whereas in the fourth assessment

nearly 67 percent of the PHCs did not have trained medical officers). In the case of

infrastructure, in the first assessment about a twentieth (5.1 percent) of the PHCs were in

Grade D, which has slightly declined to 4.5 percent in the fourth assessment. In the first

assessment, only 11.5 percent of the PHCs were categorized to be in grade A, while about a

little less than half of the PHCs (48.5 percent) were found to be Grade-A in the fourth

assessment. In the first assessment about 71 percent of the PHCs were in Grade-D, which has

reduced to 29 percent in the fourth assessment. In the first assessment, about 14 percent of


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PHCs were categorized to be in grade A, while only 4 percent of the PHCs was found to be

Grade-A in the second assessment. The possible reason may be the unavailability of the IUD

insertion/removal guidelines. However, in the subsequent assessments, 22.8 percent (third

assessment) and 37.9 (fourth assessment) percent of the PHCs were found in grade A. In the

first assessment 6.4 percent of the PHCs were in Grade-D, whereas, no PHCs were in grade

D in the fourth assessment with regards to infection prevention practices. In the first

assessment, nearly 31 percent of the PHCs were in grade A, but it had reduced to 17 percent

in the fourth assessment. It may be due to the reduction in proper disposal of waste as per

guidelines. The improvement in availability of equipment and supplies was quite evident

during the assessment period. In the first assessment, only 7.7 percent of the PHCs were

categorized to be in grade A, whereas, in the fourth assessment, more than half of the PHCs

(54.5 percent) were found to be in grade A.

Quality Assessments in Sub- Centres To assess the quality of various services provided in sub- centres 100 SCs from each district

has identified. Three rounds of assessments were completed and the fourth assessment is

under process. Since the first assessment was considered as pre-testing, the analysis was

based on the second and third assessment in Ajmer, Nagaur and Sikar. In Udaipur distrct the

fourth assessment was also completed hence, in the district wise analysis, fourth assessment

data was also used in Udaipur district. From figure 5, it is clear that the percentage of SCs

categorized to be in grade A has increased from 41.7 percent in the second assessment to

nearly two-thirds (65.7 percent) in the third assessment.

Figure 5: Percentage of SCs categorized in different grades based on overall performance


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Note: D- Grade = Score value less than 25 percent, C-Grade- score value=26 to 50 percent, B-Grade- score value =51 to 75 percent, A –Grade- score value = 76 percent or more

While observing the facility readiness in sub- centres, in the second assessment nearly 7

percent of the SCs were in grade D where as in the third assessment only 3.2 percent of SCs

was in grade D. At the same time the percentage of SCs categorized to be in grade A has

increased from about 17 percent in the second assessment to 30 percent in the third

assessment. With regards to the availability of essential protocols and job aids, there was a

reduction in the percentage of SCs in grade D between the second assessment and the third

assessment, nearly three-fourths of the SCs were in grade D in the second assessment and it

has reduced to 62 percent in the third assessment. In the case of infection prevention

practices, in the second assessment, 23.6 percent of the SCs were in grade D, and it has

reduced to 14.9 percent in the third assessment. While assessing the availability of equipment

and supplies, in the second assessment only 6.9 percent of the SCs were categorized to be in

grade A, while in the third assessment, nearly 17 percent of the SCs were in grade A.


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STUDYSTUDYSTUDYSTUDY OF THE TRENDS IN OUT OF POCKET PAYMENTS IN OF THE TRENDS IN OUT OF POCKET PAYMENTS IN OF THE TRENDS IN OUT OF POCKET PAYMENTS IN OF THE TRENDS IN OUT OF POCKET PAYMENTS IN

HEALTH CARE DURING NRHM PERIOD (2005HEALTH CARE DURING NRHM PERIOD (2005HEALTH CARE DURING NRHM PERIOD (2005HEALTH CARE DURING NRHM PERIOD (2005----2010) IN SIX 2010) IN SIX 2010) IN SIX 2010) IN SIX

STATES OF INDIASTATES OF INDIASTATES OF INDIASTATES OF INDIA

In most low income developing countries, expenditure relating to health care is

overwhelmingly borne through out of pocket. The consequence of this is that a significant

number of sick persons indulge into self medication and seek consultation only when the

ailments begin to turn into catastrophic forms. Studies conducted by the National Council of

Applied Economics Research, National Institute of Public Finance and Policy and National

Samples Survey Organisation (60th round) reveal that about 23% persons do not access care

in India only because of their inability to afford it and about 40% slide below the poverty line

after single hospitalisation. These are very shocking findings and impinge on the health status

of the country which is striving hard to reduce the high infant and maternal mortality. The

proposed study is essentially to assess the nature of out of pocket payments of households in

health care and examine its relationship with NRHM interventions

This is the study based on the objective to find out

Study Questions:

NRHM is a nationwide intervention rolled out simultaneously across all states in India from

2005 onwards. In 2010, NRHM has completed five years of its operation. This gives us the

opportunity to address the basic evaluation question:

� Has there been a reduction or increase in the out-of-pocket expenditure for households

on health care?

� Has there been a reduction or increase in the share of out-of-pocket expenditure on

health care in the total consumption expenditure of the household?

� Are there differences in the pattern of OoP payments across different

(a) social and

(b) economic categories

� How is implementation of NRHM related with the pattern of out-of-pocket

expenditure on health care?


19

Justification:

Public spending on health in India in proportion to gross domestic product of any country has

been one of the lowest and has been the significant barrier in affordability to quality

healthcare. Both the national and state governments in India have introduced number of

schemes and programmes for improving the access and one such very major initiative is

National Rural Health Mission which claims to have made an architectural correction in the

public health system as it is governed and operationalised. However, even after five years of

its implementation, it is not clear that how much has this impacted the out of pocket payment,

one of the most significant reason for lack of accessibility to health care and cause for

continuing high infant mortality rate and maternal mortality ratio. Findings of the study

would provide valuable information to understand the effect of NRHM on household

expenditure in health care.

Study objectives:

The major objectives of the study are :

• To assess the change in out-of-pocket (OoP) expenditure of households for health care

between 2004-10.

• To examine the change in OoP expenditure in various social and economic groups

• To examine the pattern of OoP expenditure in relation to various parameters of

NRHM implementation.

Scale of Study:

The study is being carried out in six states of India. The decision of number of states is based

on convenience and availability of required funds. While selection of some of the states is

based on the continuing work in these states through civil society organisations, others have

been chosen based on their geographical locations. The states where study is being done are

as follows:

� Assam

� Bihar


20

� Jharkhand

� Rajasthan

� Tamilnadu

� Uttaranchal

In each of these states, districts are selected (between two and five depending upon the

number of districts in the state) on the basis of regional diversity.

• For states with upto 20 districts : 2 districts to be selected.

• For states with 21 to 30 districts : 3 districts to be selected

• For states with 31 to 40 districts : 4 districts to be selected

• For states with 41 and above districts : 5 districts to be selected

Sampling strategy:

In the chosen states, districts have been selected through ‘probability proportional to size

sampling technique (PPS)’. PPS is a widely used standard sampling technique and is the

appropriate technique to use when the sampling units are of different sizes. Below is the list

of selected districts under OoP study:

S. No. State District

1. Kamrup

2. Sonitpur

3.

Assam

Cachar

4. Madhubani

5. Gopalganj

6. Banka

7.

Bihar

Aurangabad

8. Sahibganj

9.

Jharkhand

Purbi Singhbhum

10. Bharatpur

11.

Rajasthan

Nagaur


21

The sample size is 200 households per district. The sample is obtained by selecting 10

villages per district and 20 households per village. It has been ensured that out of the 20

households surveyed at least 7 in-patient cases are covered from each village.

Villages are randomly selected using the village directory of the 2001 Census and the

sampling is done by PPS technique.

Sample design can be summarised as :

Number of States : 6

Number of Districts : 18

Number of Villages : 180

Number of Households : 3600

12. Tonk

13.

Baran

14. Vellore

15. Coimbatore

16.

Tamilnadu

Virudhunagar

17. Tehri Garhwal

18.

Uttaranchal

Nainital


22

COMMUNITY HEALTH FELLOWSHIP PROGRAMMECOMMUNITY HEALTH FELLOWSHIP PROGRAMMECOMMUNITY HEALTH FELLOWSHIP PROGRAMMECOMMUNITY HEALTH FELLOWSHIP PROGRAMME

The objective of Community Health Fellowship was to strengthen community mechanisms

for improved reproductive health care as a part of the efforts to strengthen public health

system under the National Rural Health Mission. This effort would have a focus on the

health of young women and adolescent girls. SEARCH, in partnership with the Government

of India's National Health Systems Resource Center (NHSRC) and the Public Health

Resource Network (PHRN) selected around 45 young professionals in the state of

Rajasthan, Bihar, Orissa & Jharkhand to work at district and sub district levels to energize

community action through mentoring and supporting the ASHA, (a community level female

health worker) to facilitate access to reproductive health services through a process of social

mobilization.

The aim of the CHF was to create a number of public health professionals with the skills and

ability to mobilize the community, strengthen community health workers and engage with

the larger public health system in improving reproductive health outcomes.

Prayas has been serving as mentoring organization in Rajasthan for 6 Community Health

Fellows. The journey as a mentoring organization has not only been vibrant but also a great

learning experience for Prayas as an organisation. Although Prayas has been host to a

number of interns, fellows and other volunteers who keep coming to get grassroots exposure,

understand

developmental issues or to learn from various ongoing programmes being implemented by

Prayas, yet mentoring CHFs was quite a different game. There were certain major differences

in mentoring the two:

1. Most of the previous fellows/interns would come to the organization for a shorter period of

time while CHFs are to stay for a longer duration.

2. Earlier fellows were not linked to the government as such, while CHFs' work revolves very

closely around the government's paradigms.

3. Fellows/interns to Prayas did not have 'bringing about change' or 'finding solutions' as

their main objectives while CHFs are being seen as agents of change and are also mandated to

arrive at solutions to the problems. Most of the fellows/interns to Prayas would come largely

to research, enhance their understandings on various issues, lend services to organization or


23

expose themselves to problems/issues at the grassroots.

The six fellows being mentored by the organization had different backgrounds and were

involved into different kind of works. While all of them had this mandate of strengthening

VHSCs and ASHA as common theme, their approaches have been different. This variety in

approaches brought about different sides and views on an issue and enhanced the learning

experiences of the fellows. Frequent discussions amongst fellows were promoted and fellows

also kept on the discussions through mails and calls. Fellows were also promoted to

participate in various other activities of the organization depending on their interest which

only helped them get diverse exposure and thus diverse perceptions on issues.


24

NATIONAL CONSULLTATION ON RIGHT TO FREE TREATMENT NATIONAL CONSULLTATION ON RIGHT TO FREE TREATMENT NATIONAL CONSULLTATION ON RIGHT TO FREE TREATMENT NATIONAL CONSULLTATION ON RIGHT TO FREE TREATMENT

FOR ALL INDIANS: REQUIREMENTS AND CHALLENGESFOR ALL INDIANS: REQUIREMENTS AND CHALLENGESFOR ALL INDIANS: REQUIREMENTS AND CHALLENGESFOR ALL INDIANS: REQUIREMENTS AND CHALLENGES

Background:

Since its independence India has certainly made incredible advancement in the field of health,

medical science and medical education. Health indicators have also shown some promising

improvement and health systems also seem to have advanced considerably. What still

remains an irony despite all the progress made in the field of health and medical science in

the country is that people s access to treatment and health services is still abysmally low.

Total health spending in India is one of the lowest in the world, and most of it is private

expenditure in the form of out of pocket payments. It has been shown through several studies

that vast majority of citizens of the country have to spend up to 80% of health care

expenditure from out of their pockets. It has been amply established that out of pocket

expenditure is the biggest barrier in accessing health care from publicly financed institutions

and one of the major cause of continuing indebtedness and loss of assets especially of those

more than 50% citizens of this country whose daily income is less than Rs. 45.00. This is

largely because receiving care from Government health system still remains very expensive.

There have been some successful interventions in few parts of the country where established

systems have lead to availability of affordable medicines and treatment and enhanced people

s access to public health care services such as TNMSC and the Chittorgarh Model of Generic

Medicines. Yet, what still remains a huge challenge is replicating and establishing similar

models and systems in other parts of the country which has not been happening due to several

reasons, political will being one of the most important of them.

Despite all the challenges and issues it cannot be denied that the government will still have to

take the responsibility of making health care services available to all in the most affordable

and qualitative manner. In such a situation what seems like another way out is to make OPD

health services free to every one. Calculations based on the data available of the burden of

disease in India, unit cost of treatment of different ailments based on use of quality generic

drugs at prevailing lowest prices and management done through standard procedures show

that about Rs. 6000 crores are required every year to provide free treatment in OPD to all the

citizens. This requirement is after deducting the allocations made by the GOI for treatment of


25

ailments covered under various national health programmes. However this additional

allocation still will not increase the total public spending in health to even 2% of the GDP. It

is envisaged that once the OPD treatment is made free for everybody this would break the

nexus between pharma companies and the doctors, eliminate irrational prescription and

treatment practices and ultimately enable larger number of people to access health care

services. It was with this in mind that a Campaign on Right to Free Treatment was initiated.

The campaign essentially demands the government of India to make OPD health services

including medicines completely free for all the citizens of India in every public health facility

so as to minimize the out of pocket expenditure on health services and increase people s

access to public health care services. Keeping all the above into consideration there was a

need to mobilize different stakeholders, policy makers and policy influencers to sit on a

common platform and discuss and deliberate on different issues related to access to treatment

and medicines and identify systems and mechanisms which can be put into place to make

public health services more accessible and affordable to everyone in the country. Hence, a

day long consultation around the subject "Meeting Health Rights by Free Treatment to All

Indians - Requirements and Challenges" was jointly organized by Prayas, Jan Swasthya

Abhiyan, Centre for Budget and Governance Accountability (CBGA), Oxfam India, Centre

for Legislative Research & Advocacy (CLRA) and SAMA at Dy. Chairman s Hall,

Constitution Club, New Delhi on 4th May 2010.

Objective:

The objective of the consultation was to orient and sensitize members of parliament and other

important segments of policy planners about this very vital issue and evolve an economical

and social model to ensure free treatment to all citizens of India. More than 60 people from

different civil society organizations, people s networks, members of Parliament, experts on

pharma and medicines, academia, etc participated in the consultation. A poster related to the

issue was also released on the same day.

Brief outline of the consultation:

The consultation was carefully designed to cover most of the issues concerned with the

subject. It began with a key note address by Mr. Amarjeet Sinha who essentially provided the

government s perspective on the issue and different efforts that have been made by the


26

government to ensure health care services to all. He also focused on the challenges and

lacunae and suggested measures that different stakeholders may take to deal with the first

session of the day was essentially to develop a background for the consultation wherein the

speakers touched upon the major issues of health spending in India. This session was

important as a large chunk of discussions further during the consultation would have revolved

largely around the issues kept forward by the speakers. The second session was on Access to

Medicines . During the session the speakers focused on major issues related to making

medicines accessible in public health facilities.

The third session dealt with Free Treatment to all: Requirement and Challenges. During the

session the deliberations touched upon various aspects related to implementation of free OPD

treatment in public health facilities, the expenditure required and the major challenges.

The last session of the day was titled Challenges and Way Forward towards Universal Free

OPD Treatment . In the session it was discussed as to how the campaign for free treatment

can be strengthened and what could be the possible mechanisms to convince the policy

makers to go for it. All the sessions were moderated to stick by the time limit and have

focused discussions. Enough time was kept at the end of each session for open discussions

and sharing.


27

TRAINING OF SHG MEMBERS ON HIV/AIDSTRAINING OF SHG MEMBERS ON HIV/AIDSTRAINING OF SHG MEMBERS ON HIV/AIDSTRAINING OF SHG MEMBERS ON HIV/AIDS

The major objective of the programme was to equip SHG members with knowledge and

skills to effectively address vulnerability to HIV/AIDS and thus making their lives healthier

and safer. The following outcomes were expected out of the programme:

• SHG members have basic knowledge about HIV/AIDS

• SHG members are aware about how and where to seek support for issues relating to

HIV/AIDS

• Reduced stigma and discrimination in the community towards PLHA

• Enhanced negotiation skills in the areas of prevention

• SHG members act as peer educators

The trainings were conducted in seven districts of the state: Ganganagar, Barmer, Jodhpur,

Udaipur, Ajmer, Jaipur and Alwar.

It was envisaged to train about 1000 SHGs from each district. From each SHG two members

were to be trained. The training batch of 40 participants in each batch was considered the

best. Thus about 14000 SHG members from 7000 SHGs across the identified 7 districts were

to be trained in the state. Before the trainings of SHG members could start a team of trainers

was developed. These trainers served as District Resource Persons (DRPs). Considering the

number of trainings to be conducted in each district, a team of 9 DRPs from each district

were identified and trained as trainers. These DRPs then facilitated the SHG trainings in their

respective districts. Each SHG training was facilitated by at least two DRPs.

Outcomes of the training:

After the trainings in all the districts were over, the following where the major deliverables:

• 14178 SHG members from about 7161 SHGs were brought under orientation on issues

related to HIV&AIDS.

• 340 trainings in total were conducted in 7 districts of Rajasthan.

• 14178 SHG members who have been trained under the programme can serve as peer

educators in their villages. Thus there is a cadre of 14178 peer educators on HIV&AIDS

in 7 districts of the state.

• A team of 9 DRPs from each district was formed to undertake the trainings. We thus

have a cadre of about 63 people in 7 districts who can serve as trainers in future trainings

on HIV&AIDS in these districts.


28

• SHG members gained information on issues related to causes, prevention, treatment, care

and stigma and discrimination related to HIV&IDS.

• Several myths and doubts in the mind of the trainees were cleared. They felt more

informed and sensitized on the issue. Many of them accepted that they had become more

sensitive towards issues related to HIV&AIDS post training.

• SHG members became more aware about how one can keep safe and remain protected

from getting HIV infected. This certainly made them more confident.

• SHG members could develop understanding on how HIV&AIDS is a development issue

and why it is essential to put efforts towards its prevention.

• SHG members realized the important role that an SHG can play in supporting those

infected and affected by HIV&AIDS.

• The trainees felt pride and confident about the fact that they have an important role to

play in prevention of HIV&AIDS and supporting those infected and affected by it.

Most of them committed to spread the messages about HIV&AIDS amongst their peers and

family members and felt enthusiastic about raising issues related to HIV&AIDS in monthly

SHG meetings and other meetings of the village like that of the Village Health and

Sanitation Committees (VHSCs).


29

TOWARDS A WAGE LABOUR EXCHANGE: STREAMING TOWARDS A WAGE LABOUR EXCHANGE: STREAMING TOWARDS A WAGE LABOUR EXCHANGE: STREAMING TOWARDS A WAGE LABOUR EXCHANGE: STREAMING RECRUITMENT AND ENSURING SOCIAL SECURITY FOR TRIBAL RECRUITMENT AND ENSURING SOCIAL SECURITY FOR TRIBAL RECRUITMENT AND ENSURING SOCIAL SECURITY FOR TRIBAL RECRUITMENT AND ENSURING SOCIAL SECURITY FOR TRIBAL

MIGRANTSTO GUJRATMIGRANTSTO GUJRATMIGRANTSTO GUJRATMIGRANTSTO GUJRAT

The project seeks to mobilise and organise seasonal tribal migrants to plains of Gujarat for

enhanced wages and improved work conditions and social security. It operates in both - the

source areas from where workers come and the destination areas in Gujarat. It operates in

both - the source areas from where workers come and the destination areas in Gujarat.

District Resource Centres (DRC) operationalised by a network of NGOs undertake source

end mobilisation in the tribal areas of the three states from where workers migrate to Gujarat

plains. A Central Support Unit (CSU) head quartered at Ahmedabad anchors work in

destination areas across specific migration streams.

Key Features of the Model 1. Wage Labour Mapping in Source areas: Study the migration scenario and identify the

migration streams in source areas

2. Detailed study of migration stream in both source and destination areas

3. Identify the migration streams in which to intervene and the interventions

4. Undertake mobilization of workers leading to organization building in the specific

migration stream and struggle on wage and other issues

5. Policy advocacy through memorandum, specific events like Public Hearing to (i) create a

conducive environment (ii) put pressure on state to fulfill its statutory obligations

6. Service provision – Legal case work/ Health/ insurance/ ID card

The project visualized work over several migration streams over the period of three years.

Till date organisational work has started in four streams, namely, cottonseed production,

ginning and oil industry, brick-kilns and construction work. The wage labour mapping has

also been done in all the areas.

Cottonseed Production:

Migration for this stream starts in the month of July and continues for one month. The

interventions in this stream followed the old pattern. These consisted of

• Public campaign to mobilize community against sending children

• Border check posts as part of the District level Anti Trafficking Task Force to monitor

movement of children


30

• Operation of mobile teams

• Case work where needed for payment of wages, compensation on cases of death and

bodily injury, and other serious offences

The season this year was marked by entry of UNICEF through a

major project in Rajasthan and Gujarat. In Gujarat, Save The

Children (STC) has also set up a project to eliminate child labor in

cotton production. A new feature this year was filing of cases

against child traffickers under the Juvenile Justice Act and

sections of IPC. Till last year, the police used to claim

helplessness in filing cases saying that no relevant provisions

exist.

The main achievements of the campaign in the current year are

• Nine vehicles intercepted by the mobile team and check posts

• Totally 238 children below 14 years released, of these 103 are girls and 135 boys

• In Udaipur 212 children released while 26 children released in Dungarpur

• Nine FIRs filed in the two districts

In spite of the intensive campaign, a large number of children left for Gujarat. The Union

monitored the field situation and carried out surveys listing children who had left for Gujarat.

Brick kiln migration stream:

This migration stream comprises of nearly 100,000 migrant workers from Chhattisgarh,

Rajasthan, UP, and tribal parts of Gujarat who come to work in brick kilns of Gujarat. The

intervention strategy has comprised of mobilization of workers into an organization, wage

struggles, and dispute settlement. This year efforts were made to ensure provision of public

services like education, health, and ICDS at the kilns.

The work with brick kiln workers can be divided into three phases – first three months from

April to June when workers were at Ahmedabad, the second phase from May to October

when the workers go back to their homes and the action shifts to the homes of workers in

different states – Gujarat, Rajasthan, Chhattisgarh, and UP – and the last phase of November

to March when workers come back to work in kilns.


31

Lessons:

• It is possible to initiate services in brick kilns in destination areas. This model can be

replicated across all brick kilns.

• However to maintain an acceptable level of quality is more difficult, especially in

education. Thus quality of education being provided in Gujarat brick kiln schools is

very dubious because of a host of factors. Chief amongst these are constant interface

needed with local service providers, language barrier leading to non availability of

local teachers, and the very model that leads to setting up of temporary schools

instead of fully functional proper schools.

• There is also now a need to insitutionalise the interventions so that every year the

service is provided without the prodding of an outside agency.

• It has proved more difficult to open hostels for children in source areas. Only one

could be opened in Rajasthan in spite of intensive efforts. Departments baulk at this

approach as this is a costly alternative.

Cotton ginning/ Kadi:

This centre was set up to coordinate work in cotton ginning migration stream as Kadi is the

centre of the industry in Gujarat. However over the years, the Centre has focused on issues

related to local population like PDS and NREGA also. During the period under review, the

major work took place in PDS. A Public Hearing was organized at Aldesan village where the

ration dealer had not been giving rations to APL category families. An application was

moved under RTI to seek information on the stocks released to the dealer by the district and

entries in Sales Register (SR). The ration cards were collected from the villagers to cross

check the supplies received by villagers with the entries in the Sales Register. This revealed a

huge gap as shown in the following table. A total leakage of Rs. 4.63 lakhs was detected in

the village for one year alone.

Majdoor Adhikar Manch, the general workers’ union that spearheads the work in Kadi,

organized a Public Hearing at Aldesan village on 31st May to highlight the issue. The Hearing

was attended by a large number of villagers. Prominent members of civil society who

attended included Indira Hirvay, advisor to commissioner on RTF for state of Gujarat,

representative of state RTF coordination cell based in Anandi, Deputy Director of state

supply department, and a number of representatives of civil society. The villagers also

attended the meeting in large numbers. The Deputy Director took the matter in her own hands


32

after the enquiry and undertook an on the spot check of dealer shop. She immediately

detected irregularities. The District Supply Officer was also summoned by her to the spot.

Following the Hearing, the DSO ordered an enquiry of his own. The dealer was immediately

suspended for three months.

However the incident soon acquired political overtones. Kadi is a highly politicized block,

represented in the state assembly by a powerful Patel leader who is a cabinet minister. The

panchayat sarpanch is the brother of the dealer. He has recently changed sides to the ruling

combination. He got strong backing from the minister who immediately sent his people to the

village and brought pressure upon the bureaucracy not to penalize the dealer. On its part, the

Majdoor Adhikar Manch kept up the pressure by taking a delegation to meet the DM.

However news came in August that the dealer has been reinstated after three months. The

Manch sought permission for a dharna in Kadi. This was denied by the local authorities.

Then the Manch sought legal recourse. It took help of the lawyer to file an appeal with DM

who stayed the reinstatement order after a hearing. In the final order, the dealer has been

removed and a new dealer is to be appointed.

Construction:

In construction, a serious effort was made to undertake large scale mobilization in the year

2011. So far the mobilization had revolved around the choukhties and enrolment of workers

in the Construction Workers’ Board. For the first time efforts were made to focus on

construction workers in sites who come directly to the work sites from their villages. These

workers are normally paid a lower wage rate than workers from choukhties. The shift of

strategy paid dividends. The first meeting at Chandkheda was a success as almost 250

workers came for this meeting. This was followed by another meeting that too was very well

attended. It is now planned to undertake meetings all around Ahmedabad followed by a big

demonstration at Lal Darwaja, the heart of the city on June 1.

Shelter, along with sanitation, is emerging as the major issue around which to mobilise. Other

issues relate to wages, safety, ID cards, enrolment in Construction Workers' Welfare Boards,

other facilities. Most of the workforce comprises of tribal workers who are seasonal but long

term migrants. The workers stay on site in under construction sites and move with the sites.

The workers are mostly young between 18-40 years of age both male and female. They

constitute a floating but numerically stable population that will work in the cities in its youth


33

but will ultimately retire back to villages in old age (that begins as early as 40). This is the

dominant pattern of work force engagement across various informal sectors in the rapidly

growing cities like Ahmedaad and Surat across the country.

Wage Hike: The project was successful in ensuring a significant wage hike in Mahesana

area. The owners agreed to pay Rs. 390 per 1000 bricks to workers. The going wage rate

before this happened was Rs. 300 to Rs. 350. Thus a large number of workers benefited. This

wage rate gradually became acceptable in a large area of Ahmedabad and Gandhinagar. It can

be assumed that the project efforts were successful in ensuring an additional wage hike of Rs.

40 per 1000 bricks in the area. Assuming that the Union impacted wage hikes in 200 brick

kilns to this amount and further assuming that each kiln has 50 worker pairs and each pair

produces 1.5 lakh bricks in the season, the impact of wage hike can be assumed to be Rs. 60

million.


34

INCOME GENERATION ACTIVITIESINCOME GENERATION ACTIVITIESINCOME GENERATION ACTIVITIESINCOME GENERATION ACTIVITIES

Promotion of income generation activities for local communities

around Sita mata sanctuary and linking it up to conservation

There is an urgent need to provide inputs to insure sustainable harvesting of forest resources

as well as provide necessary alternatives for income generation to the people. The forest

produce is not only a source of livelihood but also a source of cash in difficult time like

drought. Therefore it is important to ensure that appropriate technology is provided to the

community and their skill enhanced for value addition and processing of honey, pulse,

cultivation of medicinal plants, fodder cultivation and raising of forest plants etc. Access to

markets and linkages also has to be assured as currently all the NTFPs are being marketed

through middlemen which gets them poor price. As most villages in the periphery of the

sanctuary depend on sale of firewood, bamboo and timber for income. We need to promote

bamboo cultivation, cultivation of medicinal plants and fodder crops etc. to reduce the

dependence on the forest, it is necessary to provide them appropriate and sustainable

livelihood.

Progress so far

Most of the Activities as listed bellow has been completed in the 2nd year 2009-10 and

Follow up programme have been taken in 3rd year 2010-11:

a) Safed Musli Cultivation : In the year 2008-09 and 2009-10, seed material of safed

musli was made available to the beneficiaries of the project area. Follow up programme

has been taken in the 3rd year 2010-11 by 11 cultivators using their own preserved seed

material in the situ. For this purpose intensive training right from seed preparation to

sowing and harvesting was imparted at Devgarh Head quarter on 20-06-10. Crop

preformed well when sown with pre mansoon showers. Those waited for sowing

suffered due to dry spell before active mansoon. Germplasm has suffered due to

sprouting before sowing and later on due to water logging conditions. Few cultivators

have preserved the produce of 2nd year in situ and has sown / sold in the 3rd year

mansoon season as seed material at RS. 200.00 per Kg.

b) Bamboo Nursery: Saplings of Bamboo were made available in 2nd year 2009-10 from

Devgarh based nursery. Failure of rains after planting restricted the development of


35

saplings, but in the 3rd year 2010-11 with onset of mansoon again sprouted the

rhizomes. Field survey made by the staff in January and march 2011 reported 65

percent survival.

c) Bee Keeping : This activity has been dropped in the 2nd year 2009-2010 due to massive

damage caused by Green Bird Bee Eater. Same has been discussed in the first review

meeting held at Mussoorie from 13 to 14 june 2009, decision was taken to drop this

activity.

d) Fodder Cultivation : Good response was received in first and 2nd year i.e. 2008-09 and

2009-10 where in high yielding certified seeds of Lucerne and Barseem was made

available to the beneficiaries of the project area. This programme has helped in

increasing the milk yield. Cultivators liked this programme very much accordingly in

the 3rd year 2010-11. Follow up programme of Green fodder cultivation was taken on

the fields of 18 cultivators of the project area. Intensive training was given for its

cultivation at Gyaspur on 31.08.10. 21 persons participated and out of this 18 persons

have taken the programme. For cutting procedure, irrigation, plant protection operations

and reservation of small plot for seed purpose, training was imparted on 03.12.10 and

28.02.11. At present crop of Lucerne is thriving well.

e) Bamboo Handicrafts: This activity was taken in the year 2008-09 and 2009-10. Efforts

have been made in the 3rd 2010-11 for follow up programme. Few artigens have

prepared toplas and articles of local daily use.

f) Dhaman Grass: This programme was under taken in the 2nd year 2009-10.

Establishment of dhaman grass will increase every year in the successive mansoos

season from falling over seed material in situ. It will help in providing nutritive grass

as dry foller and will also serve as bund for water and soil conservation.

g) Pulse Processing for value addition: Three diesel operated units have been established

in project area one each at mahua Fala of Bordi, gyaspur and Anopura. Establishment

was over in the 2nd year 2009-10. Mahila SHGs formed at Mahua Fala Bordi was

ineffective hence direction given by visiting team of WWF/ DST Dal Mill of Mahua

Fala Bordi was shifted to Bavdi pathar of Bordi on 18.12.10. For this, new Women

SHG has been formed. Registration has been done on 07.02.11 as vijan mata society by

vrehad Krishi bahu udhesiya sahkari samiti Devgarh (A/c NO. 10154). Procurement of

Gram produce has been done for Dal making (88 Kg.).


36

Gyaspur Dal Mill for URD: - Urad grain 137 Kg. has been purchased by Rosni

Mahila SHG and Dal will be prepared in few days. To strengthen the women SHG few

necessary changes are under way. Three Mahila members have died and 11 members

are active presently.

Anopura Dal Mill: - 125 Kg. produce has been arranged for Dal making from gram by

women SHG Jai sita mata. Produce has been cleaned for process. 11 SHG members are

actively working under this group.

Intensive training was organized for Dal making purpose on 21.04.11 at all the three places.

Observations made -

1. Foundation of these Dal mill units are to be strengthened to avoid breakage due to

vibrations.

2. Diesel operated units may be used as and when required, while electrical units suffer most

of the time due to interrupted supply of electric power. However diesel operated units cost

more with regards to power charges.

Use of Left Over Money of Bee Keeping Activity :

i. Revised Proposals for Water Harvesting Structures along with Fruit plants

plantation has been submitted amounting Rs.92350.

ii. 350 Mango, 50 Lemon plants have been purchased from Departmental

Govt. Nursery gaddhi (Banswara) and made available to the beneficiaries of project

area.

iii. Proposal worth RS. 7 thousand for papaya Nursery has been proposed to

DST.

Massive Training of WHS and fruit plantations has been given on 26.08.10 and 31.08.10.

Deflowering of mango inflorescence was done from 3.01.11 and 8.01.11.


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Overview of the programmes implemented during 2010-11

Name of Project Project Area Main Activities

Public Health Empowerment

Campaign Chhoti Sadri

Empowering people to ensuring

rights to health.

Promotion of Income Generation

activities for local communities

around Sitamata Sanctuary and

linking it up to conservation

Devgarh

Bamboo Handicraft, Bee Keeping,

Pulse Processing, Safed Musli

Cultivation, Fodder Development

Strengthening Women's Political

Leadership in Local Governance, in

Chittorgarh District of Rajasthan

Bhadesar

Training of women PRIs to

improve their understanding about

local governance

Training of SHG Members on HIV/

AIDS In 7 District of Rajasthan

Ganganagar,

Barmer, Jodhpur,

Udaipur, Ajmer,

Jaipur and Alwar.

Training of SHG members on

HIV/AIDS

Quality Assurance And Quality

Improvement Interventions in Health

Services

Ajmer, Nagaur,

Udiapur, Sikkar

Assessment and improvement of

health facilities

Out of Pocket Expenditure Study

Asam, Rajasthan,

Tamilnadu,

Jharkhand,

Uttrakhand, Bihar,

Analysis of data collected through

a set of survey schedule to see

measure the out of pocket

expenditure of people

National Consultation on MDGs Jaipur

Two day consultation on Process,

Formulation and Impact on

National Policies of Millennium

Development Goals (MDGs) with

Special Reference to Goals 5 & 6

on 14-15 September 2010

SKCC Applied Study Programme Chhoti Sadri

Exposure visit (selected girls from

Bihar) to oversee the development

programmes in Rajasthan.

Community Health Fellowship Empowering community group


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programme under NRHM

Pepole's Empowerment for

Accessing Rights to Livelihood in

25 Villages of Pratapgarh District of

Rajasthan

25 Villages of

Dhariyawad Block

of Pratapgarh

District

Ensuring implementation of various

Govt. activities at local level

through community action group

(CAG)

Workshop on District Health Action

Plan (DHAP) Ajmer, Sikkar

Tribal Self Rule Intiactive Programe

Arnod, Dhariyawad

and Pratapgarh

Blocks of

Pratapgarh District

Module Development for AWW

(MP TAST)

Module development and pre-

testing of the developed training

module

Asha for Education Bhadesar

Project on Wage Labour Exchange:

Organizing Seasonal Tribal Migrants

Rajasthan, Gujarat,

Madhya Pradesh

and Chhattisgarh

Preventing Child Labour and

ensuring Wages as per labour law

ANNUAL REPORT 2010-1011 - Prayas ChittorPrayas: Annual Report 2010-11 3 About the organization:...

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