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10 avril 2012 2 10 /04 /avril /2012 15:57

Un article du Times of India, New Delhi, du 8 avril 2012, qui m'a été envoyé par mon amie et correspondante Moushumi Chatterji. Et une information exceptionnelle sur un aspect du développement communautaire en inde.


Investing in community-based workers may just be the answer to India's massive healthcare problems. People at the grassroots, from illiterate adolescents to burkha-clad housewives, are already bringing in the changes we so desperately need

Madhavi Rajadhyaksha | tnn

Lata Ravikar doesn't have a medical degree. Nor does she have any experience of working in a hospital. But the 30-year-old house-wife knows a thing or two about healthcare. She can rattle off the ideal height-to-weight ratio for babies, coax new mothers to breastfeed their infants, and show them how to claim government's benefits. A mother of two, Lata doubles up as a voluntary community health worker for the Navi Mumbai Municipal Corporation, and she has now become a household name in a slum of Shivajinagar in Nerul, just outside the Maximum City. Thanks to her, the slum dwellers now go to doctors in the nearby public hospital when they need help.

Lata is one of the many ordinary women who are leading a silent revolution in urban slums and villages across the country. In many parts of India, teenagers and housewives are now donning the garb of health volunteers and convincing pregnant. women to deliver in hospitals, and not at homes. The invisible hand of these women has already improved maternal and child health indicators, according to a Bill & Melinda Gates Foundation-funded Initiative that has tracked their impact in two states. In Maharashtra, for instance, the proportion of hospital deliveries has gone up from 78% to 88% in four years in the communities where these workers have been active.

There are an estimated 8 lakh (I lakh = 100.000) Accredited Social Health Activists (ASHAs) under the Centre's flagship National Rural Health Mission. Many others have been roped in through local governments and NGOs The good work being done by these workers has proved that building hospitals and putting expensive machinery there is not enough, the government has to ensure that people know how to avail them. That's where these volunteers or the neighbourhood didis come into the picture.

But India needs more didis. And the government needs to give them more resources — they form the backbone of community-based healthcare — to save the public healthcare system, which always looks like it is on the verge of crumbling. Sita Shankar of voluntary organization PATH believes that didis can play an important role in reviving public health­care. "Mentoring and training these workers could yield multiple benefits as they change attitudes and behaviours from within communities," says Shankar, whose NGO has trained more than 380 workers like Lata in seven cities of Maharashtra and over 7,450 ASHAs in UP since 2008." Our evaluation in UP shows that the registration of pregnancies within 12 weeks in villages shot up from 78 % to 90% in four years and those seeking antenatal care nearly doubled," adds Shankar.

Medical officer Praveen Katke in Navi Mutoo, attributes much of the recent rush to civic hospitals to the motivation provided by the voluntary force. But health activists are not happy with government's attitude towards grassroots mobilization. They complain about the failure to properly implement community-based monitoring introduced in nine states to enable the public to demand accountability by maintaining report cards of government health services and staffers. "The government failed to fulfill its obligation," says A Bas, a member of the government's advisory team. Bas points out that the process could have helped restore faith in the healthcare system if done effectively. "In Orissa, the project was stopped as the new director did not see the need for it, while in Rajasthan an old grievance brought up against the nodal NGO was used as an excuse to stop the process," he says. Some states saw feedback from the community as NGO rabble rousing. Tamil Nadu and Maharashtra were the only success stories.

And the success has come despite several hurdles faced by didis. Each of them covers a village of 1,000 people or more and it's not easy to convey messages to people who are sceptical about medicines. "In my basti, women wouldn't take iron supplements as they believed that these would produce big babies and necessitate caesarean. It took months to convince them that these pills did no harm" says Archana Patade, a volunteer worker.

 It is not just the sheer volume of work that makes the didi's work tough. They also have to make people believe in hospitals and doctors. Das points out that years of dealing with dysfunctional hospitals has forced people to go to private doctors or seek shelter in faith-based systems. But the change in slum dwellings like that of 28-year-old Radha is a good sign. "All the children in my family have been delivered at home. But I got admitted to civic hospital for my daughter's delivery after didi told me me about infections 1 could catch at home" says Radha. In addition, she also got Rs 600 from the government's Janani Suraksha Yojana.

The didis' small steps can be a giant leap for Indian healthcare system.

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