Meghana Limaye: Strengthening Health Workers Training
SEPT 15, 2008 – MAR 15, 2009
STRENGTHENING HEALTH WORKER’S TRAINING
ANDUR, OSMANABAD DISTRICT, MAHARASHTRA
Meghana Limaye, August 2008 Fellow
HALO Medical Foundation
Background and Project Vision
HALO Medical Foundation was started in 1993 by Dr. Shashikant Ahankari and his wife Dr. Shubhangi Ahankari. They began their work by training village level health workers after a huge earthquake left the area devastated and vulnerable to health problems. Since then, they have trained health workers from many organizations and currently have 75 workers in 70 villages. After the health workers were established, HMF began working with women’s SHGs and built a federation. 2 years ago, they built a new hospital for the area and are starting a nurses’ college to be opened next year. My project this year is to strengthen the training for the health workers and expand the scope of their work. My vision for the project has been to help each health worker to see herself as a change agent in her village, not just a caretaker of SHG’s and a seller of basic medicines. I want her to create her own vision for her village and start on the road towards making it a reality.
Project Goals and Future Plans
The first thing I learned about my project and the women that I work with was the incredible amount that they already know. Each of the health workers (Bharat Vaidyas) at HMF has been working in her village for at least 6 years. She knows everything about the health systems in her village and health in general and has developed a good reputation in her village. The interventions that each BV has already made, such as improving antenatal care by examining pregnant women, and reducing child mortality by treating diarrhea, are high impact and have helped make a big difference in the villages. My original project plan had involved giving the women information about disaster management, maternal and child health, and information about HIV/AIDS, but I quickly realized that this would be somewhat unnecessary based on their already expansive knowledge. This is obviously a good thing, but I saw it as a hurdle because there seemed to be nothing left for me to do.
As I continued my time at HMF, I learned about the problems with the health worker program here. One huge hurdle I have faced is the lack of salary for the BV’s. 1 year ago, HMF decided to restructure and promoted 15 BV’s to ‘field worker’ status, giving them much higher salaries and responsibility for overseeing the work in 8 villages. The rest of the Bharat Vaidyas, who had been working for anywhere from 4-15 years, had their 500 Rs./ month salaries stopped. They were told that they were expected to continue working on a volunteer basis. While some BV’s continue to work without pay, many have stopped working and others resentfully do the bare minimum of work required. This is understandable because no one likes to work without pay when others around are receiving money, but getting these women to work again became the main focus of my project.
Along with this, my challenge is to help them see themselves as changemakers in their villages. It is very easy for the women to get caught up in the daily grind of health record-keeping, SHG meetings and microfinance record keeping without seeing the overall picture of what they do and what they can do. The people in the office, other than Dr. Ahankari, often see their work as solely keeping records and dispensing medicine. I want these Bharat Vaidyas to see themselves as empowered women who can change whatever they want in their village. I know this is a tall order. But these women are so much more powerful than they or anyone from the office understands. They can do anything they want in their villages and my project is to make sure they understand that and act on it.
Project Implementation Progress and Future Plans
After I arrived at HMF, I spent a long time getting to know the organization and trying to build relationships with the health workers. I went on field visits with supervisors as well as women health workers and tried to understand the nature of what is done here. The next step was a survey done to evaluate the impact of the Bharat Vaidya’s in their villages in the past 10 years. It was done in 6 villages with BV’s and 5 villages without BV’s in order to determine the impact that HMF and these women have had. I had expected the results of the survey to be used within the organization or to help me find BV’s to work more closely with, but the actual impact was simply helping me learn more about the health system in the villages and what the BV’s role in it is. Looking back, it was a very good way to see many different villages and get involved, but I was very frustrated afterwards that the results would not be used for anything. I used a ‘presentation’ of the results to Dr. Ahankari and the rest of the NGO staff as a chance to discuss what should be done in the future.
After I presented the survey results, we decided to hold a refresher training for the BV’s that are no longer paid in order to get them to start working again. The ASHA program in this district of Maharashtra was launched at the time that we began discussing this training. HALO Medical Foundation was able to help many of our BV’s get selected as ASHA’s, or government community health workers, in their respective villages. Their selection, and the fact that the selection process was helped by HMF, increased many women’s willingness to work for HMF again and also to attend a refresher training.
After creating a target list of women for refresher training, I started visiting each of these women’s houses to learn what the real issues were, to meet them, and invite them for training. Over the course of these visits, I discussed the idea of having them sell urine-based pregnancy tests in their villages to increase their profile in their villages. On March 11-13, I held a refresher training for 15 BV’s, many of whom had not been working for the last year. I was able to bring in a few elements of fun and entertainment, including team games, a movie, and picture drawing, as well as teach them new hard skills. Through this training we launched the urine based pregnancy test program, as well as urine albumin and sugar testing. The training itself was successful, but it is yet to be seen how much the women’s work will actually benefit from it, and how many women will begin selling the urine-based tests in their villages.
Currently, I am planning follow up for this training, including seeing if the women are actually using the tests and planning a surgical/diagnostic camp program in each of their villages. I am planning to repeat this training next month for 8-10 more BV’s who were not able to attend and for 10 women who were trained 2 years ago but have been uninvolved with HMF for a while. One great way for the BV’s to remain involved with HMF and learn new skills is to work at our NGO hospital for 3-5 days at a time so I have been trying to increase the number of BV’s who take advantage of this. So far, 2 women have come in for hospital duty and it has been very rewarding seeing this small impact of the training that I ran and my actions.
Another goal for my project is the capacity building of all of our health workers, including the ‘promoted’ field workers. I have not focused on this area very much, but I would like to devote more time to this in the upcoming months. In this area, I would like to improve communication between the women and their supervisors, including other field workers and the office staff. I am developing one hour sessions to be held during monthly meetings that will hopefully expand their knowledge as well as their soft skills, such as leadership and communication.
One other area I will be focusing on in the future is how to get my community health workers to have fun and enjoy their work with HMF. All of the women see their relationship with the organization as very serious. Obviously, their work is very important, but I would like to give them some time and space to have fun, through an event organized with HMF. Every woman has so much work to do at home for her children, her husband, and her in-laws, including washing the clothes, sweeping, washing dishes, cleaning the house, collecting firewood and cooking. Added to this is all the work that she does in and out of her village for HMF, including meetings, SHG formation and record keeping, and health work. She has no time for herself and no time to have fun. I have been recently considering how to bring resources and skills from my previous life, especially my dance experience, into my work here so I am thinking about holding a talent show or creating a dance in some way with the BV’s. I want them to express their creative side and learn what it feels like to be on stage, and just have fun with each other and with the people of HMF. I have not yet started planning for this but I would like to accomplish this in the next 5 months that I have here.
I am also trying to get more involved in the organization’s other projects and start some new ideas. I have met a lot of great college-age girls who are ambitious and interested in school but are going to get married and then decide what to do about a career. These are girls that could be really powerful in their communities and I want to work with them to create a group that pushes their expectations in life and enables them to work with each other to create change in their own lives, mentor younger girls, and become more involved in their villages and colleges.
My final goal is to live in villages for the rest of the year. I have one village and family picked out where I will be living for at least one month, and I hope to try living in a different village the month after that. My room is currently at HMF’s brand new hospital, and I do not think I can truly understand or experience my community without living with them. I also think that living in a village would give me a chance to try making a difference on a more basic level than what I have been doing so far.
Detailed Goal-setting & Implementation Planning
In the next two weeks I plan to:
1. Figure out how to get blood pressure monitors and stethoscopes to all women who requested them by buying new ones and getting the ones we have at the hospital fixed.
2. Follow up on hospital duty schedule with Nagesh bhou (who plans hospital duty) and with the women.
3. Write up plan for BV variety show/talent show.
4. Have meeting with Dr. Ahankari about future plans for project – talent show, diagnostic/surgical camps, next refresher training.
5. Select new batch of women to do refresher training by talking to Dr. Ahankari and office staff.
6. Planning for diagnostic/surgical camps in the villages – start visits next week.
7. Plan follow up visits to the 15 villages from which the women came for training
8. Write up plan for college girls’ group.
9. Start to plan movie showings in villages for adolescent girls and SHG’s
I have learned a great deal about development and healthcare in developing countries and I find myself questioning what the greatest needs in these areas actually are. For example, people in the villages here always wait to hear the price of treatment before deciding whether or not to receive some possibly life-saving drug or procedure. I ask myself every time I hear this why it is necessary. This is the reality of healthcare in India but does it have to continue to be this way? What would be a better system? What is an NGO’s role in this?
I have also learned about how interrelated all areas of development are. Education and women’s empowerment and financial independence and health are inextricably linked. No one working in development can work in only one area and this has impacted the work I do here as well as my view of development. The women health workers that I am training are involved in women’s savings groups, adolescent girls’ groups, their village governments, the local schools, and so much more. Health depends on so many things that working on just health could never be enough, for one person or for an NGO.
It is difficult to say how I have grown through this experience in India. Perhaps when I go back to the US and think about what I did in India and the person that I was before, I will understand what this experience has really meant. For now, I can say that being here has helped me become a more open person. I am more open to new ways of life, to seeing crazy or frustrating situations in a new light, and to meeting new people. Everyone has an interesting story and I am learning to try and hear them out and learn from all those around me.
I have also learned a lot about motivating myself and taking initiative. This project is all mine. I get a certain amount of direction from the staff at HMF and Dr. Ahankari, but how I implement my plans and how much effort I put into my work is all about me. I can spend 15 minutes planning a training and it will be run like the trainings that HMF always runs, or I can put a lot of time and effort into a training and truly make a difference in people’s lives and the way that HMF functions. I will not be fired if I don’t do my work and there are no negative consequences. There are only positive experiences to be had if I throw myself into my work and do everything that I can. The best way that I can learn from this year is to take full advantage of this and I am learning how difficult this actually is. It is much easier, on a Sunday, to sit in my room and read a book than go out into the community and push myself to do more and to be more and to make a difference. My biggest growth has been in learning what I need to motivate myself and how I can push myself to take more initiative.