On People's Participation in Community Health and Role of...

Report of

AHI Alumni Reunion Seminar

India 2013

On

People's Participation in Community

Health and Role of NGOs

Organized by:Karuna Trust, Plot No 81/82

Mysore Ooty Road, Pin 570025

Mysore, Karnataka, India

Jointly with

Asian Health Institute, 987-30 Minamiyama,Komenoki, Nisshin City, Aichi, Japan, 470-0111

AHI-Indian Alumni Reunion Seminar Report 2013

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Report of AHIAlumni ReunionSeminar in India 2013

held at Karuna Trust, Mysore, Karnataka from 20 to23 Nov 2013

Introduction:

The Asian Health Institute (AHI) Nagoya, a Japanese non-governmental voluntary

organization committed for the development of well-being and well-doing of

marginalized people in Asia has been providing leadership development training program

primarily for local leaders to promote community-based action for health and development.

As a part of this training so far AHI has trained more than hundred health workers of India.

The AHI trained Indian members have formed a group with a vision to strengthen their

network by sharing each other’s experience and expertise primarily for health movement

activity. Keeping this view, the first AHI-Indian Alumni reunion seminar was organized in

2011 jointly by CSSS (Comprehensive Social Service Society), Andhra Pradesh and CCD

(Centre for Community Development), Odisha. During that seminar it was decided to

organize the second reunion seminar at Karuna Trust in Karnataka state with an aim to

strengthen the networkingamong the alumni members and also to shareknowledge, skill,

innovations made by the alumni's during their work through the seminar.

The second AHI Alumni Reunion Seminar for India was hosted by Karuna Trust at Mysore

city in Karnataka state during 20-23rd November 2014 with the support and guidance from

AHI Japan. Although this reunion meet was exclusively for the Indian Alumni members only,

AHI encouraged the participation of prospective non alumni members from the alumni's

organization for this seminar and altogether five such non alumni members also actively

participated in the seminar.

The 2nd reunion seminar was organized with the following objectives:

• To strengthen the networking among the Indian alumni members

• To shareknowledge, skill and innovations made by the alumni during his/her work

• To learn the recent development of health policies of India from resource persons.

• To get the idea of Thai health systems, their innovations etc. which may be useful in

the work of alumni members.

Dr Ugrid Milintangkul, Deputy Secretary General, National Health Commission (NHC), Govt.

of Thailand, Ms. Sirithorn Orachai, Senior Officer, NHC, Govt. of Thailand, Dr. H. Sudarshan,

Hon secretary Karuna Trust & renown health activist of India were the key resource person

for the seminar. Two representatives from DASCOH, a Bangladesh based NGO, also

participated in the seminar as the observer.

This report contains the day wise detail activities made during the seminar period by the

alumni members and resource persons. This report also contains the details schedule of the

four days program, list of participants and their contact details at the end part of this report.


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DAY 1st, 20th Nov 2013

The Inauguration of the program started at 9.10 am.

Inauguration of the program for 50 minutes

� Welcome of participants and introduction of the guests and presentation of

mementos to guests

� Lighting the lamp by DrUgrid Milintangkul, Dr H. Sudarshan, Ms Kagumi Hayashi and

Mr. TN Sethulinkhan

� Self introduction of Alumni members

� Speech from Dr Ugrid Milintangkul, Deputy Sec-General, National health Commission,

� Speech from Ms Kagumi Hayashi, Secretary, Asian Health Institute, Nagoya, Japan

� Speech from Dr. H. Sudarshan, Hon. Secretary, Karuna Trust

Day 1: A. Technical session by Dr H. Sudarshan: " Reaching the unreached & Good

Governance"

Time 9.55 am to 11.25 am

Dr Sudarshan explained about the Indian Health Scenario which includes progresses made

by India after its 65 years of Independence. India has made progress substantially in most of

the issues including economic growth, but because of huge corruption development has not

taken as per expectation. India has more than 145000 medical sub-centres and 24000 PHCs

across the country to serve its population. At the same time we have MRI or PET or heart

transplantation, but in most of the rural areas we don’t have a simple microscope to

diagnose routine investigation in rural India. There is big gap in between the poor and rich

people.

Health budget was 0.9% of GDP which is now reached upto 1.9% of GDP. Govt has promised

to increase it up to 3-4% of GDP.

Dr Sudarshan started his work in 1978 after his medical graduation from Bangalore Medical

college and went to BR Hills to serve the Soliga tribal people. Initially started with curative

health services, he started community development work and gradually started the

Livelihood program for the Soliga tribe. He fought for the land right for the Soliga tribal

people of BR Hills. With the involvement of Soliga tribal people, he started the Vivekananda

Girijana Kalyana Kendra ( VGKK) with an aim for all round development of the Soliga tribes

as well as the tribal of India.

He has been working with tribal people of Andaman & Nicobar Island in India. These

primitive tribes have a population of 40 only. Dr Sudarshan is in the high power committee

of Govt of India to take care of health of these primitive tribal.


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Since VGKK was started for tribal development, Dr Sudarshan decided to start another

organization who can only work on health issues in the country. So in 1986, he started

Karuna Trust in 1986, is a public charitable trust, affiliated to the Vivekananda

GirijanaKalyan Kendra (VGKK), located in BR Hills, Karnataka, a southern state of India. The

Trust began as a response to the high prevalence of Leprosy (21.4 per 1000 population) in

Yelandur Taluk, Chamrajnagar district in Karnataka. Continuous promotive, preventive,

curative and rehabilitative efforts brought down prevalence of leprosy in the taluk to 0.28

per 1000 population in 2005. From Leprosy control, Karuna Trust diversified into epilepsy,

mental health, tuberculosis and eventually, management of Primary Health Centre (PHC) at

Gumballi in Karnataka. Over the years, the scope of the Trust’s has grown to include various

other health aspects as well to include integrated rural development.

For the first time in India, Karuna Trust has introduced the concept of Public Private

Partnership (PPP) in Primary Health Care in the year 1996 in the state of Karnataka. This

could be introduced because of the painstaking efforts by Dr. H. Sudarshan and his team of

dedicated workers in convincing the State Govt. to hand over the PHC to Voluntary

Organizations who will run the PHCs with lesser cost and also by the involvement of the

local communities. Within a span of 10 yrs, the Karuna Trust could see the fruitful results in

the form of expansion to 30 PHCs across Karnataka state and another 50 PHCs in other 8

states in India.

He explained about the innovations made by Karuna Trust including traditional medicine,

Emergency Medical service, Vision centre, LOCOST generic drugs promotion, ANM school etc.

Karuna Trust is involved in ASHA training of Govt of India and so far 3000 ASHAs have been

trained so far by the trust of 3 districts of Karnataka. ASHAs are the village level married

women who takes care the basic health issues in the villages. She is the link worker between

the village and health centre. Karuna Trust is the nodal agency in implementing the ASHA

program in the country.

He also showed the present status of health Infrastructure and human resources in India

which has a huge population with huge public health infrastructure but there is big gap.

He showed how good governance can help in getting good health indicators:

� Mere Technological Packages can improve the health outcomes marginally

� Good Governance can provide quantum jump in the health outcomes

Qualities for a leader:

o Concern and Empathy for the poor & marginalized

o Ability to understand their problem and find a solution.

o Will to put in to practice in spite of insurmountable obstacles

o Be & Make – Integrated personality – “Self –love”, “Self-hatred” & “Love for

others


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Transforming India through Quality Leadership

• Working as a team – Net working

• Living practitioners of Values – Human Resources for Development

• Inner strength - Moral/Spiritual

• “My life is My Message” – M K Gandhi

• “They alone live who live for others; others are more dead than alive” – Swami

Vivekananda

Question – answer session-

Questions are- (1) How to minimize corruption? (2) KT’s experience in Orissa? (3) How to

make a good relationship with Government? (4) What new points included in NRHM new

phase? Is Indian Govt following a unified health policy for whole country or different policies

for different states? (5) Dependence on doctors? (6) Dr Ugrid made additional input

regarding policy taken by Thailand Govt to control corruption.

11.25 am- 11.40 am: Tea Break

Day 1: B. Technical Session on: "Effort to Curb Malnutrition" by Mr Mahesh RV,

Spirulina Foundation, Bangalore

11.40 am to 12.30 pm:

Mr Mahesh RV, Founder President of Spirulina Foundation presented details on Spirulina.

He showed that Malnutrition and global warming are among the top global problems at

present. India has an exceptionally high level of malnutrition (2 out of every 3 malnourished

kids on the earth is an Indian, nearly 50% of India’s kids below 5 years is malnourished). But

Mr Mahesh believes that the answer to these problems is Spirulina.

Hence, linking the Problem (Malnutrition) and solution (Spirulina) is the key role of this

NGO which is trying to Eradicate Malnutrition from this country from the grass root levels,

by using highly cost effective, efficient and time proven Spirulina. Spirulina is globally

accepted and used as a key tool against malnutrition by UN and WHO. Spirulina was

declared as the best food for the future by the United Nations World Food Conference of

1974

Spirulina is a water algae grown in saline sea water and some fresh waters naturally under

sunlight, which is cultivated and consumed from centuries, by tribal to astronauts in Space

stations as a food and nutritional supplement.

“1 gram of Spirulina is nutritionally equal to consuming 1kg of assorted

fruits and vegetables”


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-As proven by NASA and led to the establishment of an International Institute at by UN and

WHO

Nutritional advantages of Spirulina

� Best source for proteins, vitamin A, vitamin B12 and iron.

� Contains 200 times more protein than meat

� Contains 25times more vitamin A than carrots and 100 time more than papaya.

� Contains 50 times more iron than spinach

� Very rich in calcium, magnesium, phosphorus compared to milk

Health Benefit of Spirulina:

Perfect food compliment for a healthy diet, particularly for vegetarians preventing iron

deficiency anaemia; good for pregnant women strengthening the immune system. Inhibition

of mother child transmission of HIV cancer prevention through provision of carotenoid,

lowering of the cholesterol level and blood-sugar,enhancing of natural cleansing and

detoxification (cleans pesticide, chemotherapy, radiation). Best food complement for

supporting malnutrition programs.

It can be used in many forms like Powder, capsule, tablets, mixing it with fruit juices,

sugarcane juices, rotis, chapathis, curries etc. Spirulina mixed fruit juices are already

available in many outlets in the country. Spirulina is safe for all age groups.

Its usage in the mid day meal program in Chennai for 5000 school children in 1990’s which

ran successfully for over 6 months but eventually stopped because of lack of supervision and

care. It has been given to the tribal people in 2009, 2010 near BR hills of Mysore.

Spirulina foundation went to Uttakhand state during the natural disaster where more than

25000 people were killed. Spirulina tablets were very useful for which people could survive

from their hungry.

Unemployed youth can take up the Spirulina cultivation so that they can earn lot of money

which may lead to develop entrepreneurship.

Session was closed with a 10 minutes video show where details of Spirulina were discussed.

He answered the questions raised by the participants.


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Day 1: C. Technical session on ''Community Monitoring Process in Present NRHM

Context'' by Bhupendra Prabhakar, Senior Consultant, PwC Consultant, Bangalore

Time: 12.30 pm - 1.30 pm

Indian Health System - Leadership and Governance: Origin / source

o Union list relate to port quarantine, research and scientific and technical

education

o Concurrent list includes prevention of the extension from one state to another

of infectious or contagious diseases or pests and other issues with wider

national ramifications such as food and drugs, family planning, medical

education and vital statistics

o State list includes all other public health and environmental sanitation

services

Article 47 of the constitution of India says:

• The State shall regard the raising of the level of nutrition and the standard of living of

its people and the improvement of public health as among its primary duties and, in

particular, the State shall endeavour to bring about prohibition of the consumption

except for medicinal purposes of intoxicating drinks and of drugs which are injurious to

health.’

The Union Health Department in India is known as Department of Health & Family which is

having four more departments:

• Dept of Health & Family Welfare,

• Department of Health Research,

• Department of AYUSH and

• Depart of HIV AIDS.

At state level, health department lead and govern health system of the state

There are three tier of health services in India,

• Primary care by PHC and subcentres

• Secondary care by community Health Centre, First Referral units

• Tertiary care by state hospital, Medical colleges

He showed that when India started its first five year plan, that time there was no subcentre

and no Community Health Centre, only 705 PHCs were there. But now the country has

23887 PHCs, 4809 CHCs and 148124 subcentres to serve the rural population.

In India, there are 19 health workers per 10000 population. So India stands 52nd rank out of

57 countries facing HRH crisis as per the world health statistics 2011. Because of this there

is regional balance and urban/rural imbalances in India.


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Health Financing:

• Health Expenditure as % of GDP is comparable to that of Sri Lanka, Thailand and

China (~4% - 5%) but per capita expenditure is far less

• Public health spending around 1.3% of GDP is among lowest in the world

• As a consequence of low public health spending, high burden on private out of pocket

expenditure – more than 65%

• Wide variation in health budget of different states

Community Participation In Public Health in India:

Community Involvement is the main focus of present health policy of India. Ensuring

community participation at various levels is another challenge under NRHM. In India

community participation is ensured by following programs:

• National Population Policy (NPP), 2000

• National Health Policy in 2002

• National Rural Health Mission (NRHM) in 2005

– Training and capacity enhancement of PRIs to own, control and manage public

health services

– Promote access to improved healthcare at the household level through the

Accredited Social Health Activists (ASHA)

– Health plan for each village through the village health committee

• 5% of Health budget to be spent through the involvement of NGOs in India as per

National health policy.

Following are the area where NRHM ensures participation of Community:

• Rogi Kalyan Samiti (RKS) / Patient Welfare Society (PWS)

• Accredited Social Health Activist (ASHA)

• Village Health and Nutrition Day (VHND)

• Social audit (Maternal and Child Deaths) &

• Community Monitoring

Govt of India gives more importance to Community monitoring process which was started in

9 states in India as a pilot basis from 2007-2009. It is a Mechanism to improve

accountability and enable better delivery of services. It provides a platform for community

feedback and dialogue with service providers and ultimately it leads to improved coverage

and accessibility of health services.It involves a systematic process through which

community members provide feedback about services to the providers. The feedback

includes parameters which are included within the range and quality of services that the

provider is expected to provide and the primary purpose of the feedback is to improve

service delivery.

Objectives of community monitoring:

• Regular and systematic info on community needs

• Provide feedback based on locally developed yard sticks


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• Feedback on- Fulfillment of entitlements, Functioning of Public Health System, Gaps

and deficiencies

• Community based organizations become equal partners in planning process

• Validation of data collected by public health functionaries - Triangulation

Key Institutions for Community Monitoring

• Village health and Sanitation Committee

• PHC planning and monitoring committee

• Block/Taluka planning & monitoring Committee

• District planning and monitoring committee

• State planning and monitoring committee

Role of Village Health & Sanitation Committee: This committee is formed in every revenue

village who takes care the health of the village.

• Reviews Village Health Register, Village Health Calendar

• Reviews performance of ANM/MPW/ASHA

• Reviews community experience as beneficiaries

• Sends Quarterly report to PHC committee

VHSC members are given orientation and training after formation from Govt side. After

training of members, they are given an untied fund of Rs 10000 per year per committee for

household surveys, camps, sanitation drives. This fund is also used as revolving fund for

referral and transport/ immediate financial needs of hospitalization for the needy people.

Role of PHC monitoring and planning committee:

Each committee ensures the participation of 30% involvement of health care providers, 30%

involvement of PRI ( Panchayat- local governance), 20% NGO/CBOs/ and 20% VHSC

members.

• Reviews and collates reports from VHSCs

• Assists NGO/PRI sub team in FGDs in 3 sample villages

• Visit PHC, review records.

• Discuss with RKS members

• Send quarterly report to block committee

Role of Block Monitoring and & Planning Committee: In this committee, 10% members will

be from RKS members of block hospital, 30% PRI members, 20% will be Medical officer of

CHC level i.e health care providers, 20% NGO representatives and 20% will be the non

official of PHC committee members.

• PHC report consolidation

• Review of PHC /SC progress

• Indicator analysis

• Physical resource monitoring

• Co-ordinate with RKS


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• Action on denial to health

• Quarterly report to District Committee

Role of District Health Monitoring & Planning Committee:

Members of this committee consists of 20% NGOs representatives, 30% Dist level Health

care providers including dist health authority officials, 30% Zila Parisad ( Dist level

panchayat members), 10% District hospital management committee members and 15% will

be non officials of VHSCs. Reviews and collates reports from all blocks

• Sub team visits one CHC, meets RKS

• Visit District hospital

• Financial reporting/solves resource blocks

• Action on reported cases

• Quarterly reports to state committee.

Like Dist committee, there is state level community monitoring committee who monitors all

the district level committees. This committee also ensures participation of 20% NGO

representatives.

Experience and Gains

Enhanced trust and improved interaction between provider and community

• Improvement in service delivery - ANC, PNC, immunization,

• Responsiveness of provider to community needs

• Improved provider attitude and behavior

Community based inputs in planning and action

• Active involvement of PRI members in planning and functioning of health facilities

• Local and need based planning, special groups / remote areas

• Appropriate planning and utilization of untied funds at VHSC, PHC and CHC

Reduction in out of pocket expenditure

• Reducing demands for informal payments

• Ensuring timely and full payments of Janani SurkshaYojana

• Significant reduction on outside prescription

How did this happen?

• Trained VHSC and RKS

• Community awareness on health entitlements

• Display of Citizen’s charter and service guarantees

• Collection of information and sharing of report cards reflecting community

experiences of health services ; based on this development of village health plans

• Active multi stakeholder Monitoring and Planning Committees at PHC, Block and

District levels& state level.

• Engagement with providers based on community evidence – periodic public dialogue

(Jan Samvad)


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Mechanism:

Service package: Services as per Indian

Public Health Standards including

Maternal & child health

Village Health &

Sanitation Committee

Mechanism of Enquiry

1. Group Discussion with Women

2. Group discussion with Mothers who delivered recently. The committee members

discuss on Maternal Health, Child Health, Quality of Care, Community Health

Volunteer functioning and Janani Suraksha Yojana

3. Group Discussion with Community. Here the committee members discuss on Disease

Surveillance, Quality of Care, Untied Fund Utilization, Community Participation.

Converting GD Results into Score Card

• Scoring Each sub-question that is discussed is given a score or a rank

• Traffic Light - All questions under one broad heading are scored together. All the

questions relating to maternal health is clubbed together and the scores added up.

This figure is divided by the maximum possible score for this section. If the answer is

more than 75% it is converted to a green Traffic Light, if it is between 50% and 75%

it is converted into a yellow traffic light, if it is less than 50% it is converted into red

traffic light.

Sharing of Score Card:

Village Sharing: The VHSC members will conduct a meeting in the village and discuss the

poor health services. After discussion in the village, they will discuss the poor indicators

with health care providers and with them the committee members plan for improved

service delivery system for the village.

Jan Samvad (Public Dialogue): Public hearing is conducted at block or district level where

the block/district level health department officials and monitoring committee members

participate. The committee will present the cumulative score card and there will be lots of

discussion on implementation of outreach services, improving facility level service

utilization.

Block Provider’s

Orientation

Jan Sanwad/Public

hearing

Community Enquiry Community sharing

Community Score

Cards


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Day 1: D. Technical Session: "Rights to Health from Grassroot to Tree Top’’ Experience

sharing by Dr Ugrid Milintangkul, Deputy Sec-General, National Health Commission,

Govt. of Thailand

Time: 2.25 pm - 4.15 pm

The presentation aims to provide information on following points on Thailand:

• Administrative Structure

• Dimensions of Health

• Social Determinants of Health

• Health System and Health Care System

• National Health Structure

Thailand Country Profile:

• Southeast Asia Region, Land area: 519,990 sq.km.

• Population: M 31.4 m. F 33.2 m. Total= 64.6 m. (July 2013)

• Census 2010 (preliminary): 65.4, (Thai 62.1 Non-Thai 3.3)

• Rural : Urban = 34.96:29.62 (1.2:1)

• Population Growth Rate 0.5%, (Civil Registration 2007-2010)

• GDP per capita USD 4,608

Thai Administrative areas (Dec 2010)

77 Provinces (incld. Bangkok Metropolitan)

927 Districts, 7,409 Subdistricts (Tambon), 74,944 Villages

THAILAND LOCAL GOVERNMENT

• Provincial Administration Organization (PAO) - 76

• Municipality - 1,241

• Tambon (subdistrict) Administration Organization (TAO) - 7,409

• Special Administration Organization:Bangkok Metropolitan Administration (BMA) and

Pattaya City

Previous Situation of Health Systems

• Philosophy in biomedical health narrow and fragmented

• New diseases :Diseases of affluence (NCD) vs. Diseases of Poverty (CD)

• Health care system problem :Access Quality and Equity

• Worsening relationship betweendoctors and patients

• Previous structure, system andmechanism is not adjustable tothe changing society.

Dr Ugrid showed that the Non-Communicable Disease has been alarmingly increasing in

Thailand from (59% to 71% of all death in 2002 to 2008). But at the same time there is

decrease in Communicable Disease (Diseases of poverty) in Thailand.


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Dimension of Health:

In Thai context, DrUgrid showed different dimensions of health which are interconnected to

each other. Without one, the other is incomplete. These four determinants are very crucial in

the development of the health of the country.These are:

• Spiritual

• Social

• Mental

• Physical

Although there is an universal definition of Health as per WHO in 1948, which says: Health

as a state of complete physical, mental and social well-being, and not merely theabsence of

disease or infirmity, but in Thai Health context Health is defined as below:

Health means the state of human being which is perfect in physical, mental, spiritual and

social aspects, all of which are holistic in balance. This was defined by the National Health

Act A.D.2007, Thailand. Here Spiritual Health means the comprehensiveknowledge and

conscience leading tokindness and sympathy.

National Health Alliances, Thailand:

To address the all health related issues in Thailand, following are the Govt. bodies involved

in Thai health care improvement:

1. Ministry of Public Health and Ministries

2. Health System Research Institute

3. Health Promotion Foundation

4. National Health Security Office

5. National Health Commission Office

6. Healthcare Accreditation Institute (Public Organization)

7. Medical Emergency Institute of Thailand

To trap the health system from grass-root level to tree tops, Govt of Thailand has tried to

reform the Thai health system with the following inclusions in the department.

a) National Health Act 2007

b) National Health Commission (NHC)

c) Triangle that Move the Mountain Strategy

d) Policies at All Level

a) Thailand National Health Act: Thai Govt adopted its new National Health Act in 2007 in

order to accelerate the universal health coverage. In this new act, a new definition of health

was developed where it was said that Health is well-Being. The National Health Act was

enacted and served as an effective tool to set guidelines on the national health development

in which all parties in society have a hand. The National Health Act is regarded as a key

instrument to create opportunity for everybody to make contribution to the national health

system.

Now they have aNew Governance Body beyondHealth Ministry: i.e. the National Health

Commission.


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In the new health act there are New Tools to Build PublicParticipation in the Policy Process.

These are:

• Health Statute - National/Local!

• Health Impact Assessment (HIA)

• Health Assembly

• Right to Health

About National health Commission:

The National Health Act gave birth to the National Health Commission (NHC) in order to

support the development of healthy public policies in cooperation with various sectors in

Thailand society. The commission also provides helpful advices to a government and state

agencies at both national and local levels to take the people’s well-being into consideration.

The National Health Commission is an organization that performs the duties of establishing

policy, direction, development, and solution for all areas relevant to birth, living, old age,

injury, and death for the happiness of all members of society.

NHC is chaired by The Prime Minister or the Deputy Prime Minister entrusted by the Prime

Minister and The Minister of Public Health as Vice Chairperson and not exceeding five

Ministers designated by the Prime Minister as members. Members of this commission are

from different allied departments like National Economic and Social Advisory Council,

National Human Rights Commission, representatives of the four local government

organizations, six health professional organizations, one healer under the Act of Art of

healing, and there are six non health experts.

Dr Ugrid showed that National health commission Thailand works ina triangle strategy

which Moves the Mountain with the involvement of following three factors. ( K factor, S

factor and P factor)

K-Factor: It is Knowledge, Professional knowledge in health / Other technical knowledge is

very important to show the path in right direction.

S-Factor: It is social power. It will ensure the participation of Civil Society Organization,

Private sector, Media, Traditional sector, Local wisdom.

P-Factor: It is Political Involvement where there is involvement of Politicians, Local

administrative organizations, Government services.

Three Health Assembly Models under the Same Principles

• National Health Assembly (NHA)

• Area-based Health Assembly (AHA)

• Issue –based Health Assembly (IHA)

Principles

1.Inclusive participation to build multi-sectoral action(GO-CSO-Academic)

2.Systematic Management

3.Knowledge based sharing tobuild trust and ownership

His presentation was ended with several questions from alumni members.


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Day 1: E. Technical Session on Solving Teenage Pregnancy by Health Assembly Process

A Case Study in Cheonsomboon sub-district , Lopburi Province, Thailand 2009-2012

teenage pregnancy" by Ms. Sirithorn Orachai, NHC, Govt. of Thailand

Time: 4.30 pm to 5.30 pm:

The Lopburi province of Thailand is ranked the top 5 of Thailand in case of teenage

pregnancy. The teenage pregnancy case in the Lobburi province was 19.36% during 2003-

2007 while it came down to 17.5% in 2009. But in the NongMuang district percentage of

teenage pregnancy is upto 33.3%during the year 2009-2010.

The Ministry of Health has set the target to reduce the teenage pregnancy i.e. pregnancy

below the age of 20 years to be less than 10 % but still this dist has recorded highest no of

cases in the country. Primary causes of this huge teenage pregnancy case are due to to

abortion, drug problems, thieving problems, etc.

Although Teenage pregnancy is an individual family problem but it become the major social

problem of the entire Lopburi province. Why “Teenage pregnancy?” How it has happened?

To understand the causes, all sectors should participate to find a solution and to eliminate

the problem and a sustainable mechanism to be developed.

As the Thailand health department has started the National Health assembly where there is

provision to have health assembly at province or local level, the problem of teenage

pregnancy in this province was the major issue to discuss towards a solution.

The province level health assembly was held to combat this problem with following

objectives:

� Find out the Root causes of the problem and immediate solutions

� Creating a model and then extend it to other places

� Formulate a Policy Cycle by

– Setting agenda

– Developing policy proposals

– Adopting the policy proposals on a consensus basis

– Implementing

– Evaluation

� Sharing and Learning

Elements of Healthy Public Policy:

• Data/information

• Knowledge management

• Leader a strong

• Mechanisms for policy facilitator

• Networks and capacity building

• Design in a systematic and comprehensive policy


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• The implementation of rigorous and continuous

• Communicate with the public

• Summarizing and evaluation

Mechanism and policy facilitator:

Role :To weave together all the powerful stakeholders

Composition :Local governance, state/province level governance, civil society, academician

and media.

Two main mechanisms:

– The committee at the district level

– The working group at the sub-district level.

4. Stages of implementation:There is a model-driven integrated into four stages

� The creation and push for the policy-The creation and push for the policy Creating

and push the policy.Fact finding leading to the development plan

� The drive-term growth. Expansion of the activity from 1 to 5 sub districts. In this

period, the committee at the district level established the working groups.

� Lead and drive towards: Govt. agencies support and scale up the work

� Powered term evaluation and lessons: Conducting an evaluation and lessons learnt to

improve the work and statistics found the teenage pregnancy cases decreased

continuously.

Key factors for success

After implementing the 4 years of ground work in the area, the working group found that-

• Integration of social power, knowledge power and policy power is very important. In

this line, there were several awareness programs involving spiritual leaders, and

knowledge sharing by many experts during the last four years.

• Problem solving should be based on the need and capacity of the community.

The approach adopted was top-down approach. This approach is not response to the need of

the community, because the community never shared their idea. Therefore, the solution

from the top-down approach is not successful and sustainable.

Results of implementation: Statistics shows that the teenage pregnancy decreased

continuously. In 2010 student pregnancy were 15which comes to18.5%, in 2011 students’

pregnancy 7 person or 14.8%, and in the year 2012 students pregnancy was only 1 person or

1.2%. It reflects the quantitative achievements by reducing teenage pregnancy by protecting

the local youth. Experience has been presented in the health district level and health

province level.

Day 1.F. Video on Health & Medical care system of Japan. The video was presented by

AHI team after the dinner where there was lots of curiosity among the alumni

members to know more about the Japanese health care system.

Time: 7.50 pm to 8.10 pm


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DAY 2nd, 21st Nov 2013

Second Day of the Reunion Meet started with a video presentation about North East India

which was brought out by DONBOSCO institute of Guwahati, Assam state. The video includes

all the tribal and non tribal population with their culture, traditions, customs and their

thinking towards the greater Nation Building was very impressive. The video was for 12

minutes.

Presentation from Alumni Members:

Day 2.A. Presentation on Psycho nutritional Cure & Emotional Body by Dr. Sr. Eliza

Kuppozhackel, Program Coordinator AYUSHYA Centre for Healing and Integration,

Kottayam (Dist) Kerala, India.

Time: 9 am to 10.30 am

Before starting her session Sr Eliza showed a practical exercise for body relaxation and mind

clarity. This includes Eye exercise, laughing exercise etc.

About AYUSHA: This is the first holistic health training centre and clinic in south India.

Vision of AYUSHA is as follows:

� To promote health healing and wholeness

� To develop a new health culture in individuals, families and society

� To enable persons to take self responsibility for one’s health

� An Integrated/Holistic approach in promoting physical, psychological, emotional,

social and spiritual well being.

� To promote herbal medicine

� Eco Farming and Cosmic spirituality

What is Holistic Health? Components of Holistic Health

� Physical fitness

� Nutrition Awareness

� Stress management

� Environmental sensitivity

� Self Responsibility

� Cosmic spirituality.

Illness means what?

� It is the Imbalance in the functioning of the whole system and

� Lack of integration in body, mind, spirit.

What is Health?

� We can say a person is healthy when there is Harmony and balance in the whole

system of the person.

� Body has its own healing power.

� Healing achieved through correcting and balancing


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o Meridian flow

o Yin and Yang

o Chakras

o Energy information field

o Inner /outer /and health aura

o Bioplasmic field

Basic concept of Ayurveda, how to know the body illness, the vital power (Immune system)

is more important for good health, the external microbes will not be so much harmful when

it enters the body if the body immune system is good. Food habit is not only the important

things for good health, at the same time Yoga or physical exercise is also very important.

Methods used

• Complementary and Alternative medicine

• Several non drug therapy healing modes from East and west

o Touch Therapy

o Non Touch therapy

Why Physical Exercise?

� Modern life style has reduce the labour or physical hard work---No exercises

� Sedentary life: Inactive/lethargic people

� Leading to chronic ailments: Lacking on above two points leads to non communicable

diseases.

These can prevented through the regular practice of followings:

o Daily exercises

o Prnanyama

o meditation

o relaxation

o Yoga

o Healthy food habits

o Healthy relationships

o Creative action

Stress management: Modern life style and food habit are also responsible for the stress

which we people face in our daily life. Stress management is very much crucial for survival

of a person. Stress can be reduced by

o Eustress and Distress

o When the body says no

o Biodynamic massage

o Deep drainage for Emotional release

o Psychotherapy and Emotional Body Health

Environment Vs Human body: Human body is sensitive to its surrounding environment. It

has direct or indirect impact on human health. There are two types of environment effect on

human body, external and internal. All these may cause for ill health:


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External affect:

� Our health is dependent on the environment in which we live.

� Hazards to health are pollution, pesticides, radiation, industrial wastes, electronic

waste, chemicals, smoke etc.

Internal Affect:

Internal = Thinking, Feeling and resultant behaviour. This leads to two types of human

personalities.

• Type A personality will be having Hypertension&

• Type B personality will be having characteristics with jealousy, passive

aggression, suppressed anger, hurt etc.

Psycho-nutrition: This new concept of healing approach can deal the chronic ailments such

as Asthma&Allergy, Hyper tension, Cholesterol, Diabetes, Heart ailments, Cancer, Obesity,

Addictions, Psychological problems.

How to get rid of above diseases?

� Receiving energy from- Air, Water, Sun, Akash, Earth

� Row food therapy- Fruits, vegetables, nuts, sprouts

� Yoga, pranayama, meditation, relaxation

� Stress management

� Music therapy, Laugh therapy

� Cosmic nutrition

� Cosmic spirituality

To get a health life, a healthy food habit is very crucial. AYUSHA believes in spiritual farming

which can be done without any investment.

� Natural Farming and simple living

� Producing Natural and healthy food crops

� Avoiding pesticides and chemicals

� Local cow urine and cow dung for manure- “Jeevamrutham”

� Promoting ecology and revitalizing the earth

� Preservation of earth at its biodiversity

� Being in touch with the earth and the cosmos

Programs in AYUSHA

� Healing and wellness Programme

� Psycho nutritional Cure camps

� Stress Management

� Psychotherapy and emotional Body Health

� Yoga PranaVidya (Pranic Energy Healing)

� Yoga and meditation

� Foot Reflexology

� Acupressure,

� Neuro -Linguistic Programing(NLP)


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� Bharat Sevak Samaj(BSS) Program

� One year diploma in Psychotherapy, Emotional Body work and Acupressure

� Six months certificate courses –in Reflexology and Acupressure; De-addiction by

acupuncture

� CHAI-AYUSHYA collaboration - one month course in Integrated Approach to Health

( Health , Healing and Wholeness)

� Mindfullness Meditation/ Planetary Meditation for Peace every Wednesday

� Brain Power yoga for children- balancing, harmonizing, integrating self - for

concentration, memory power

� Counseling, Psychotherapy, deaddiction, couples retreat.

� Oriental Medicine and Auricular Therapy

� Summer camp for children

� Women empowerment program

� Couples retreat, Couple counseling and family therapy

� Helping youth and children in self discovery and integration

� Religious candidate assessment and accompaniment in transition

� Psycho-spiritual integration through psycho spiritual assessment workshops.

� Codependent Anonymous(CODA) for group therapy

Day 2: Presentation from Ms Kagumi Hayashi: Secretary AHI on the update ofAHI

Time: 10.30-11.15 am

She briefed about all the update on the earlier office staff of AHI, their present location etc.

Currently there are 7 full time workers at AHI. Mr Saito is the chairperson of AHI from 2008.

He took the charge from Dr Kawahara. By profession he works in an University near Nagoya.

Shared also about the volunteers who have been working as volunteers but old and retired

persons.

AHI has three types of programs with the alumni members.

- Reunion meeting for experience sharing and networking

- International workshop with specific issues

- Collaborative community project

All these above program depends on the initiative of alumni members.

Showed the picture of AHI Nepal alumni meet which was held in Feb 2013.

There was an International Workshop in Cambodia on Peace Building through Community

Health and Development in March 2011, which was initiated by alumni organization.


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ANAK-NC , group of AHI alumni in New Corella, Davao del Norte, Phillipines. They were

promoting sustainable integrated are development (SIAD). They have also started the

healthy lifestyle promotion program 4 years ago. Village leaders, health volunteers are also

involved in this. They have conducted healthy life style festival. Many issues like how to quit

smoking, best food etc were discussed.

AHI works with its volunteers/supporters and with former participants for

• keep working

• towards learning relationship

• between people in Japan and people in different Asian countries

• who work to help themselves for their healthy community.

Day 2: C. Presentation from Kyoko Shimizu, reporton ILDC 2013:

Time: 11.30 am - 12

So far 6,116 persons have been trained by AHI from its inception in different training

courses from 25 countries in Asia. Among them total 636 persons have undergone ILDC

(International Leadership Development Course) in Japan.

About ILDC:

• 5 weeks in Sep-Oct every year in Nisshin, Japan

• 12-15 participants from 7-8 Asian countries: Multi-cultural/religious

• Participatory

• Live-in Style

She showed comparison of two photos in which a photo of 80's witnesses the demonstration

by a participant by paper and pen or pencil while the present (2013) picture shows the use

of LCD projector. There is difference in the floor carpet but most of the chairs are same.

ILDC is the method of learning where Participatory Training Principles is most prominent:

• Participants decide the contents and process

• Mutual learning by sharing experiences

• Process as well as Content

• Values and attitudinal change, not only knowledge and skills

• Social change starts from self.

Following are the key components of ILDC:

• helping each other’s learning through group work

• Individual learning/change/development and ultimately development in the

organization and the Society where they work or live


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• This course will lead to make their Plan of Action which they will do after returning

to their workplace after completion of ILDC.

Day 2: D. Presentation from UI Shiori on post Millennium Development Goals:

Time: 12.00-12.45 pm

What next after 2015?

In September 2000, total 189 Heads of the State endorsed 8 goals: 1990�2015. These

includes:

• Extreme poverty and hunger1/2

• Universal primary education

• Gender equity and empower women

• Child mortality i.e. under 5 MR 2/3

• Maternal health i.e. MMR 3/4

• HIV/AIDS, malaria and other diseases

• Environmental sustainability

• Global partnership for development

After the adoption of Millennium Development Goals, many more developing-countries

started planning at ministry level, hundreds of international agencies and thousands of civil

society organisations (CSOs)rallied for the development of all 8 targets. Together, they have

contributed to remarkable achievements;

• halfa billion fewer people in extreme poverty;

• about three million children’s lives savedeach year.

• Four out of five children now get vaccinated for a range of diseases.

• Maternalmortality gets the focused attention it deserves.

• Deaths from malaria have fallen byone-quarter.

• In 2011, total 590million children in developing countries – a record number–

attended primary school.

The MDGs target has been met, but 1.2 billion people in the world are still live in extreme

poverty. In case of South East Asia including India, more than 52% people were earning

$1.25 per day which decreased to 29% in 2005 and in 2010, it decreased to 22%. Although it

is decreasing, but still 22% people live in poverty. Under five mortality rate in 1000 live

births was 69% during 1990 in South East Asia including India while it decreased to 29 in

2011. Similarly Maternal Mortality rate was 410 in 1990 in South East Asia while it

decreased to 220 in 2000 and in 2010 it came down to 150.

This unprecedented progress was driven by a combination of economic growth, government

policies, civil society engagement and the global commitment to the MDGs. Some countries

achieved a great deal, but others, especially low-income, conflict affected countries, achieved


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much less. This shows a gap between reality on the ground and the statistical targets that

were set long back. So new MDGs must be built on the real experiences, stories, ideas and

solutions of people at the grassroots.

Significance of the MDGs:

� Set common global goals to tackle the issues for all the countries

� With simple measurable targets

� With time frame. Time frame is essential to make the target

� Promoted political commitment which-

• reflects in policy planning

• More financial allocation/Aid

• focus international institutions

� Some obvious achievements which are discussed above.

Factors affecting MDGs:

Changing Global Structure and Issues

� Financial crisis in 2009 which resulted decrease in aid. Official aid went for

business/private sector

� North-South disproportion- Heterogeneity in South

� Emerging middle-income countries

� Disparity within the country

� Aging population

� Climate change and frequent disasters

Process toward Post MDGs

2012- 9- High level panel discussion, 27 countries reps as individuals

*consultations with various sectors

2013- 5- High level panel report to GS, (12 goals and 54 targets suggested)

*consultations with various sectors

2013- 9- UN special events on MDGs

2015- 9- Decide Post MDGs in UN General Assembly

2016- 1- Post MDGs start Sustainable Development

Goals incorporated?

So what we can/should do?

� What are new? What are missing?

� What are your suggestions to make the post MDGs more relevant?

� Role of NGOs/CSOs in post MDGs/2015


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Five Transformative Shifts

1. Leave No One Behind

2. Put Sustainable Development at the Core

3. Transform Economies for Jobs and Inclusive Growth

4. Build Peace and Effective, Open and Accountable Public Institutions

5. Forge a new Global Partnership

After the presentation there was an open discussion on the issues on following Universal

Goals and National Targets. All 12 points were discussed and the missing

points/components were discussed.

1. End Poverty

2. Empower Girls and Women and Achieve Gender Equality

3. Provide Quality Education and Lifelong Learning

4. Ensure Healthy Lives

5. Ensure Food Security and Good Nutrition

6. Achieve Universal Access to Water and Sanitation

7. Secure Sustainable Energy

8. Create Jobs, Sustainable Livelihoods and Equitable Growth

9. Manage Natural Resource Assets Sustainably

10. Ensure Good Governance and Effective Institutions

11. Ensure Stable and Peaceful Societies

12. Create a Global Enabling Environment and Catalyse Long-Term Finance

Missing points or points to be emphasized identified were:

-domestic violence

-value education

-disability

-global warming and its impact on health

-waste disposal, esp. plastic waste

-rural people/rural area emphasis

-skill training for agriculture for more sustainability

-tackle land issue: protect land for local agriculture

-disaster risk management with solution to the cause

-conservation and preservation not only utilization

-accountability and transparency of private sector and civil society

-guarantee public communication devices

-education of public to demand and access to information

-control media regarding violence

-active dialogue with government and insurgent groups

-reduce and control of production and trade of weapons

-reduce military budget, and use for social economic development

-promote collaboration for human friendly technology

The need of NGO workers to be aware of new information which influence the government,

NGO and people and work for active advocacy in time was emphasized.


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Day 2: E. Sector Wide Approach to Strengthening Health SWASTH& Community Based

Approaches (CBA)by Dr Surendra Kumar Jena, ILDC 2006

Time: 12.45 pm-1.50 pm

Overall Goal and Purpose of SWASTH

Goal: The goal of SWASTH is ‘to improve the health and nutritional status of people in Bihar,

particularly the poorest and excluded’ SWASTH will achieve this goal by reducing maternal

deaths, child deaths and under-nutrition

Purpose: The purpose of SWASTH is ‘increased use of quality, essential health, nutrition,

water and sanitation services especially by poorest people and excluded groups’.

Statistics of Bihar:

• Under five Mortality - 85

• Boys 83; girls 108;

• SC 113; OBC 85;

• Muslims 109; Hindus 91

Implementation Arrangement

� A Project Steering Committee (PSC),

◦ Chaired by the Development Commissioner

◦ Members - Principal Secretaries of the DoH, SWD, PHED, PRD, Finance and

other stakeholders;responsible for convergence and coordination of program

inputs.

◦ Provide strategic oversight for convergence and coordination monitor

outcomes of SWASTH

� SWASTH Strategic Reform Co-ordination Group (SRCG),

◦ Headed by PS of DoH/SWD on rotational basis.

◦ SRCG members - reps. from key departments: BSHS, ICDS, and WDC, and will

have one nodal officer each for department. SRCG will oversee

implementation and also coordinate donor support to align all inputs toward

the common health goals of the state.

◦ Oversee implementation and coordinate donor support

Problems 1: Sanitation:

Over 60 million people defecate in the open every day in Bihar. Linkage of poor health

outcomes with sanitation has not been emphasized. Community concerns on sanitation not

addressed in govt. program. Approach of constructing toilet without awareness of health

impact and addressing behavior issues has not worked


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Intervention of SWASTH:

� Intensive door to door Community mobilization as a pilot, and fund scale up

� Capacity building of govt. staff, local bodies and CSOs

� Identifying national institutions/organizations to support govt. for community

mobilization

� Integrated campaign for influencing social norms and behaviors on sanitation

Pilot alternative sanitation technology in water scarce and flood prone areas, and fund scale

up.

Problem 2: Drinking Water: Everyday 30 million people in rural Bihar drink unsafe water


� Technical assistance for comprehensive road map to tackle water quality related

issues

� Revival of water bodies using traditional methods with modern dis-infection

technology

� Demonstrate effective and sustainable modern technology for arsenic and fluoride

mitigation- Fund its scale up

� Pilot various delivery mechanism to rural household

� Strengthening water quality testing mechanism at district level

� Provision of piped Water Supply to rural household

Problem 3: Malnutrition: 54% children under 3 are underweight and 1 mn severely

malnourished


� Strengthen care for U2s

◦ Innovative capacity building approaches for ICDS e.g. Promoting breastfeeding

practices,

◦ Community mobilization through women’s group

◦ Model AWCs: Pilot and fund scale up

� Community engagement to monitor performance of AWCs

� Introduce new technology for system improvement-e.g. Management Information

System (MIS)

� Develop state nutrition policy and establish State Nutrition Authority

Problem 4: Health: 150,000 children do not see their first birthday


� Demonstrate improved delivery of services in health facilities and scale up through

govt. resources

� Strengthen medical & Nursing education including continuing education

� Support reform of HR policies e.g. career progression, incentives, HR planning


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� Drug and Medical infrastructure corporation, warehousing, DMIS and drug delivery

Prescription audit

Community Based Approaches (CBA):

Reach women and their families as:

• Household Behaviours and practices impact Health indicators, Nutrition,

and WATSAN

• Community awareness of rights and entitlement will enable them to monitor quality

of services

• Complementary interventions to improve service delivery at community level

SWASTH- CBA Outcome Indicators

• Complete Ante Natal Care

• Initiation of breast feeding within one hour of birth.

• Initiation of complementary feeding on completion of 6 months (180 days)

• No. of households having access to and using toilet facilities

• No. of persons observing two key hygiene practices (hand washing with soap after

defecation and safe disposal of child excreta).

Integration of Participatory Learning and Action (PLA) and Community Led Total Sanitation

(CLTS) to engage women SHGs

Through:

– A series of structured fortnightly meetings

– Using story, role play, games to convey messages and explain concepts

For:

– Identifying, analysing and prioritising problems

– Finding local solutions, taking actions and monitoring change

Reiteration of Key Messages on:

- Improved nutrition, health, water and sanitation practices.

-Entitlements and demanding services

Benefit of using existing Platforms

1. Large presence of Self Helps Groups in Bihar

2. Easy to reach

3. marginalized and excluded

4. Easy to introduce health , Nutrition and WASH

5. Easy to promote peer learning

6. Educating a woman means educating a family

7. Demonstrate effects to a larger community

8. One local woman facilitator from the Self Help Group

9. Each facilitator is responsible for an average of 4-5 groups

10. Each group meet twice a month

11. Facilitators used manuals to guide their meetings


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Day 2: Presentation from Thailand Health Security System:The Overview

By Ugrid Milintangkul M.D. M.P.H. Deputy Secretary General, National Health

Commission, Thailand

Time: 2.20-3.30 pm

Prior to Universal Coverage Policy (2002), Thailand was having following Govt health

programs:

• Medical Welfare Scheme, MWC (Low-Income-Card Scheme, LICS)

–the poor, elderly, children < 12

• Civil Servant Medical Benefit Scheme (CSMBS)

–civil servants, retirees and dependents

• Social Health Insurance Scheme (SHIS) –Private employees

• Voluntary Health Insurance (Voluntary Card Scheme, VCS) - Publicly subsidized

– Informal Sector

National Health Security Systems (since 2002)

• Civil Servant Medical Benefit Scheme (CSMBS)

–6 mil civil servants, retirees and dependents (9% pop)

–General tax, non-contributory scheme

–Fee-for-Service Reimbursement Model

–฿60,000 m. ($ 2,000 m.) or ฿12,000 ($ 400) ea.(2008)

–Comptroller Dept., MoF

• Social Security Scheme (SSS)

–9 million employees (16% of total population)

–Tripartite contribution equally shared by employer, employee and the government

(1.5% of salary from each counterpart)

–Prospective Capitation Contract Model (Public Contracted)

–Capitation allocation ฿1,404 + 77 ($ 43.53) ea. (2009)

–Social Security Office, MoL

National Health Security Scheme (NHSS) - Universal Coverage, Gold Card Scheme, 30-Baht

Scheme

–Others 48 mil. pop (~75% pop)

–General Tax

–Prospective Capitation Contract Model (Public Unit Registration and Contracted)

–Capitation allocation ฿2,895 ($ 91.3) ea. (2014)

–Not cover by CSMBS or SHIS

–Cover previous government-subsidized health insurance scheme (Voluntary Health

Card, VHC), Low Income Card (LIC) scheme for the poor, the disabled, the elderly, children

U12 and the uninsured.

–National Health Security Office (NHSO)

Principles of Health Security System


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Health Security but not Health Insurance

Health Care but not Health Service

Health Promotion = Active not Passive

There are Health Care Elements

1) Curative

2) Preventive

3) Promotive

4) Rehabilitative

5) Palliative

Principles of Health Security System

Three Key Principles of Establishment

1) Relevant to Individual Health Needs

2) Without Financial Barrier

3) Equity Basis not Ability to Pay or Equality

There are five Principles for Sustainable Health Security

1)Safety

2)Efficacy

3)Effectiveness

4)Beneficial

5)Efficiency

Achievement of NHS Scheme

• Progressive financial incidence of general taxfinanced scheme

–The rich pay more

• Pro-poor health services provision

–Geographical coverage of community hospital and healthcenter

• Minimal incidence of catastrophic health expenditure

- POP 33% in 2001 to 27% in 2005

–Others 48 mil. pop (75% pop) majority coverage

• More equitable use of health services in districthealth systems

– by the poor&fully subsidized by government

Collaboration between NHCO and NHSO

In accordance with National Health Security Act, section 18, the commission has to organize

public hearing from service providers and service users on how to improve

National Health Security Scheme (NHSS) on the following issues

1. Improvement of quality of health service delivery standard

2. Specification of expenditures of health service delivery

3. Development of NHSS

Collaboration between Health Assembly and NHSS


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➢Health assembly is used as a tool forpublic hearing on improving NationalHealth Security

Scheme (NHSS)

➢Started in one province in 2011 andexpanded to one cluster (7 provinces)from 2012 until

now.

Day 2: Presentation from DASCOH: an NGO of Bangladesh: Sharing by Mr Modon Das

The purpose of his presentation is to share;

� The Health Service Options of Bangladesh.

� Community managed basic/essential health services.

� The role of “DASCOH” to ensure community peoples’ participation health services.

DASCOH’s Core Intervention Areas

• Strengthen Local Governance

• Promote Public Health

• Increase access to safe Water and Sanitation

• Organisational Development

• Livelihood, disaster risk reduction and climate change as cross cutting issue.

DASCOH works with 225 CCs in Rajshahi District under the GO-NGO collaboration

framework of RCHCIB of MoH&FW, Bangladesh In order to achieve the population of rural

area of Rajshahi district has access to and uses improved essential health care services

through well-functioning Community Clinics.

Community Clinic (CC):

• Land of CC donated by community.

• CC Building built by Govt of Bangladesh.

• One CC covers more or less 6,000 population.

• Health services closure to the community.

• HSP (CHCP,HA&FWA) are posted by Govt.

• Community Group manages CC.

• Local Govt. involves directly or indirectly.

• Govt. supplies medicines, furniture and equipments.

• Govt. provides Training, formulate policy & guidelines.

FUNCTIONS OF COMMUNITY GROUPS

• Land of CC donated by community.

• CC Building built by Govt of Bangladesh.

• One CC covers more or less 6,000 population.

• Health services closure to the community.

• HSP (CHCP,HA&FWA) are posted by Govt.

• Community Group manages CC.

• Local Govt. involves directly or indirectly.

• Govt. supplies medicines, furniture and equipments.


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• Govt. provides Training, formulate policy & guidelines.

FUNCTIONS OF COMMUNITY SUPPORT GROUPS

• Organize health awareness sessions

• Raise local fund and other resources.

• Organize bi-monthly meeting.

• Aware of community people about CC services

• Ensure 100% coverage EPI.

• Identify pregnant mothers and ensure 100% Check-up

Role of “ DASCOH”

• Establishing Community Groups.

• Build Capacity of Health Service Providers.

• Promote Community participation.

• Capacity building of LGI/Union Parishad.

• Facilitate CG/CSG local resource mobilization.

• Linkage and coordination with Health, Family Planning and local Administration.

• Advocacy with Central govt. on policy issues

• Facilitate CG and CSG to organises “Health Session”

Day 2: Presentation from Alumni Members: Sharing of work by Alumni Members:

1. By Mrs Chenenda Gangama: on her work with tribals.

2. Mr Sirappa Boyapati from Rural Development Trust: He presented organizational sharing

and also a video documentary film on RDT.

3. Orientation about the field visit by Anup Sarmah, ILDC 2009, the convenor of AHI-Indian

Alumni meet 2013. He briefed about the next day's program and what actually alumni

members can see and get the benefit from the field visit.

Video show on Community monitoring process and its impact in public Health. The

video was brought by the NRHM, Bihar state, Dept of Health & Family Welfare, Govt of

Bihar. This was a 40 minutes video.

Time: 7.00 to 7.20 pm

Video show “Mushroom Club”on Hiroshima Atomic Bomb reality and its impact on

future generation, brought by AHI team, for 40 minutes

Time: 7.25 to 8 pm


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Day 3: 22/11/2013, Field visit program:

Immediately after breakfast the team started from the TRC campus at 8.20 am. After 55 kms

from Mysore, the team reached the Karuna Trust managed First Referral Unit ( FRU) at

Santhemarahalli. It is a Community Health Centre with posting of 4-5 specialist doctor and it

the first referral unit above the PHC. The Maternal health care service of this Health centre is

being managed by Karuna Trust under Public Private Partnership program with the

Department of Health & family Welfare, Govt of Karnataka. The team were showed all the

component of the centre including the finance allocation for the centre by the state Govt

which was displayed in the PHC. Medicine availability in the PHC was also displayed with the

quantity. The Gynaecology department has nurses and doctors, pharmacist available round

the clock i.e 24X7.

Karuna Trust is managing the centre by putting gynaecologist who does the caesarean

section deliveries. To promote the institutional deliveries, the health centre provides baby

kits ( 19 items) to the motherafter the delivery. After the KT management, the number of

deliveries at this CHC rapidly increased.

After the CHC visit, the team visited HusurPHC in the same district which is managed solely

by the Govt. The poor attendance of the patient showed inefficiency of the PHC. There was

no doctor in the PHC and only one nurse was managing the PHC without much availability of

essential equipments and life savings medicines. Institutional deliveries are not taking place

in the PHC and indoor wards are not functional.

After the visit of Husur, the team visited the Gumballi PHC which is being managed by

Karuna Trust under PPP mode with the Karnataka state Govt since 1996. This PHC got the

National certification from the National Accreditation Board for Hospital & Health Care

provider (NABH). This the second PHC in India who got the NABH certificate due to its

quality health care service for its rural population. Dr Sarath gave a brief introduction about

the health programs carried out in this PHC. After tea and refreshment, the team visited all

the Department of the PHC which is the model PHC for entire Karnataka state. The PHC is

having following major health services:

a) 24 hours Emergency/Casualty Services

b) 6 days OPD service.

c) 10 functional beds.

d) Ante-natal care and Post natal care.

e) 24 hrs labour Room and Essential Obstetrics facility both normal and assisted.

f) Early and safe abortion services (including MVA).

g) Prevention and management of RTIs/STIs.

h) Essential New Born Care.

i) Routine immunization services

j) Family Planning services.


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k) Essential laboratory services, where all essential test like routine test, TB test,

Typhoid test are done.

l) 24 hrs Ambulance Facility, referral for emergencies.

m) Essential medicines as per Govt of India list

n) Participation in and implementation of National and State Programs of Health &

Family Welfare including, inter alia, NRHM, RNTCP, NVBDCP, NACP etc.

o) Outreach health program

p) Vision centre, eye hospital, cataract operation is also carried out

q) Dental unit.

The team could see the monthly meeting of Anganwadi workers who came to PHC for a

monthly meeting.

After the Gumballi PHC visit, the team visited a village near to Gumballi PHC to know more

about Community Health Monitoring process. They were taken to a Anganwadi Centre

( AWC) where the Village Health Sanitation and Nutrition Committee members along with

Anganwai worker, and ASHA ( Accredited Social health Activist) briefed them how

community monitoring is being carried out. Simple color code using yellow, green and red

colour code against each service is useful tool for rural village people who dont have much

educational background. Village Panchayat member Mr Raju and the Community Monitoring

Coordinator explained how the process is done. They also explained how the service before

community monitoring was and what the outcome of the monitoring process was.

The team visited Head office of Karuna Trust, i.eVivekananadaGirijanaKalyana Kendra

(VGKK) at BR Hills where Dr Sudarshan stated his work 32 years back. After the lunch at

Gurukana, the team visited VGKK campus. Gurukana is the tourism program initiated by

Karuna Trust for the development of Soliga tribes as well as to preserve biodiversity

program by involving Soliga community. There are several eco tourism cottages where

tourists come and stay inside the forest. The entire ecotourism program is managed by the

tribal people of BR Hills. After the lunch the team visited VGKK school, class roms, office

room, student hostels, vocational training centre, fruits processing centre, honey processing

centre, spice packaging unit, craft centre which are being managed by the Soligas of the BR

Hills. The alumni members also visited the 20 bedded VGKK hospital.

There is a big rock surface above which a small house where Dr Sudarshan used to live

during 80's. He stayed in this house for 20 years, and worked for the tribal people of BR Hills.

He used to treat them if they fall sick,he used to make microscopic slides also. As there was

no any school nearby, he started teaching the tribal children in this house and started a

small school. As there was no any income source for the people there, Dr Sudarshan started

income generation activities there through the sustainable harvesting of forest product.

On the way back to Mysore, the group enjoyed watching some wild animals in the park.

The team reached Mysore at 7 pm and had dinner at 8 pm.


34

Day 4th: 23/11/2013

The day started with a Japanese radio exercise. This was a 7 minutes video regarding the

exercises to maintain a healthy body. Alumni members also practiced various steps of the

exercise.

After the exercise, alumni members started sharing their organizational work by power

point presentation. These sharing included their organizational activities, their involvement

in the community/district/state/national level, innovations, specific projects etc.The

Organizational Sharing'swas done by the following alumni members.

1.Mr. A. Jagannadha Raju, ,Centre for Community Development, Odisha:

2. Mr Subhasish Ghosh, ND Society, PuroliaDist, West Bengal,

3. Dr.M.Kaliratnam, Thirupani Trust Association, MGR dist.,Tamilnadu

4. Sr. Rose Vypana,: Community Health Dept., IHM Hospital, Kottayam dist, Kerala

5. Mr.P.Balaram Naidu, Comprehensive Social Service Society, (CSSS), Srikakulam District,

Andhra Pradesh

6. Mr K. Kuppusami, Hemerijckx Rural Centre, Vanur Taluk, PO-605111, Villupuram District

7. Mr T.N Sethulinkhan, SIDAR, Karur, Tamil Nadu

8. Ms. Elizabeth Geroge, Andhra Pradesh. About her work in details.

9. Mr Tulasi Patnaik, non Alumni member who represented Poor people’s service society,

on behalf of MrPhalguna Rao who is the Alumni member, Kotturu via, Srikakulam District,

Andhra Pradesh

10. Ms Supriya Rani Naik, non Alumni member, on behalf of Dr GangadharNaik Alumni

member, HIRDA, KodPad, Dist: Koraput, Orissa

11. Mr Viswanath Prasad, PHC Coordinator, Karuna Trust Mysore who explained about the

activities of Karuna Trust Mysore office.

12. AnupSarmah, Coordinator Karuna Trust, convenor Alumni meet presented a brief note

on the recent update on Govt of India initiatives on health care system in India.


35

Day 4th: Open Discussion:Learning, Evaluation, Future Discussion

Feedback/learning from the last 4 days reunion seminar voluntarily shared by the

participants:.

1. Surendra Kumar Jena:

� More time is required to know more things. He suggested that reunion time should

be one week so that many more things can be discussed.

� We should focus on nutrition and sanitation as key determinants tohealth.Sanitation

and open defecation in our working areas. If we are working in a village, we must

address these issues although we work for other issues also.

2. Modon Das: Bangladesh

� Happy to know that some specialist doctors are doing voluntary service in Gumballi

PHC after their retirement.

� Happy to visit Karuna Trust who knows all policy level Govt. health program. Suitable

for learning centre for other NGOs

� Realized the limited scale of working with Govt. in own country, saw a model of

public private partnership here.

� KT team is well equipped with the policies of the country which he learnt a

lot.Important for implementing agency to understand health system, policies, and

data.

� The way Dr Sudarshan started his work is very much inspiring

� Good example of team work and ownership by host agency KT.

� Very much motivated to organize reunion seminar in Bangladesh.

3. Reazul Karim: Bangladesh

� The way of community monitoring carried out in each and every village is wonderful

to see.

� Along with health livelihood program undertaken by Karuna Trust in Gumballi PHC

and VGKK campus is worth to see.

� Each area has different issues, and should be solved locally.

� More understanding of PPP how it works

� Importance of advocacy to government

4. Sr. Eliza

� Got enough energy from this reunion meet

� Feel like friends group, widened circle where we can contact

� Inspired a lot after seeing the work of Dr Sudarshan


36

� Could learn from evolution of organizations and work, could see connections of how

each contribute to develop each other. All started with small work and how

developed , and face more challenges , very inspired by each other.

5. Enoch Dokibura:

� Ecotourism adopted by Karuna Trust to preserve the Biodiversity is very interesting.

It will lead to the sustainable development of the tribal of the area.

� Lacking of strong moderator, no time frame was set in sessions.

� Participatory involvement was lacking

� Alumni not only supported by AHI, but Alumni should support AHI.

6. Elizabeth George:

� Appreciated the efforts made by Convener Anup to make this reunion a success.

� All the presentations where the participants shared their work inspired her a lot.

� Especially interesting was a sharing by Sr.Eliza on healthy lifestyle.

7. Subhasish Ghosh:

� Got energy to see the lifelong commitment and dedication of Dr Sudarshan. He was

amazed to see how a man can transform a tribal society a self sustainable and self

driving unit.

� Reunion seminar is very good platform to discuss and exchange views, challenges

and strategies.

� The venue was havinga very nice environment.

8. Kuppuswami

� Venue is suitable for reunion meet which is having nice accommodation and training

hall facility and Karuna Trust has lot of things to share in the field as they have many

innovations at field level.

� As PHC Gumballi conducts OPD service on Sunday also where specialist doctor visits,

is surprising factor for him. He appreciated the way Gumballi PHC functions.

� Thailand health system impressed him a lot.

� Felt we were moving toward the common goal of AHI. After 30 years, no

organization to call alumni like AHI.

9. T.N Sethulinkhan:

� Got a new life after joining this meet.

� Learned how to collaborate withgovernment

� Very pleased to see the KT team with smiles, energetic and refreshing mood, and very

responsible for communication.

� There was very less free time for interaction with the participants for the tight

schedule

� A full half day is required to discuss on future plan and strategy.


37

10. Anil Ranavanme:

� Learning opportunity from other countries sharing. Could see different and same

issues from different dimensions.

� Next time our learning will be polished as we got many more knowledge from this

meet.

11. Balaram Naidu:

� Very effective management, monitoring, and documentation by KT.

� The commitment and the work/innovation of Karuna Trust is a challenge for the govt.

� Appreciated the Convener for organizing the meet successfully. He even said that the

reunion concept in India is the brain of AnupSarmah.

12. Kalirathnam:

� Got more knowledge particularly on health issues

� Thanks to DrSudarshan who worked the people centric development through Govt

cooperation

� Own program used to fight with government always. Could see how KT work

strategically with government.

13. Gangama:

� Thanks to Anup for his efforts to bring old alumni members

� Thanks to AHI for helping us to learn more things after ILDC

� Felt we alumni were in the same boat.

14. SrRosama:

� Appreciated the PPP model adopted by Karuna Trust

� This reunion meet spreads the message of peace, joy and love.

� Inspired a lot from the work of DrSudarshan

� Free time was limited, but meaningful sharing and exchange of views made.

15. Mrs A. Padma Raj

� DASCOH activities are good and impressive. She liked all the sessions

� Spirulina cultivation for entrepreneurship development is very much useful for her.

� Good experience of Thailand

� Impressed with tribal education development of KT

� Karuna Trust work, support of AHI is very much appreciated by her.


38

16. Jaganatha Raju:

� Learning from DrSudarshan work

� Feedback and guidance from AHI is inspiring

� Suggested state wise coordination member for alumni members

� Reunion meet helps us to know our old friends and also to help us to know their

work

17. Sarojinama:

� AHI newsletter makes closer to old friends and recent update on AHI

� All the work carried out of Karuna Trust is nice to see here.

� Not only India but could learn from Thailand and Bangladesh also.

18. Ugrid: Thailand

� Opportunity to learn the work of host organization

� Reunion seminar is not only to meet friends, but a good networking from different

batch, learn current and new activities, bridge across sharing among generations. It is

an opening window for networking.

� Learn the diversity in India. Local government has more power to make local policy,

strong self-governing.

� NHCO has worked to make policy from down to up. Need to make more efforts to

practice the policy at the grassroot.

After individual feedback from the AHI alumni members, the alumni group had some

discussion on future planning. The following decisions were made by the group after

discussion:

1. Next reunion seminar: It will be hosted by Sr Eliza in AYUSHA centre, Kerela, South India.

2. Moderators should come from not only from host agency but also alumni side as well.

3. Alumni side should be more responsible and relieve the burden of host agency:

• Alumni members should be very prompt in confirmation/cancellation of their

participation in the seminar

• Advance presentation preparation, and focus on new/update issues, not repeating

the same as previous reunion


39

4. State wise contact personsto have a better communication among the alumni members:

• Andhra Pradesh: Balaram Naidu

• Tamil Nadu: Sethulimkhan & Kalirathnam

• Kerela: Sr Eliza

• West Bengal: Subhasis Ghosh

• Orissa: Jaganath Raju

• Karnataka & NE states: Anup Sarmah

5. Nomination of Participants for ILDC

When alumni wish to nominate colleagues or partners for ILDC, recommendation letter

attachment is appreciated. After new participants are finalized, the information would be

sent to the State Contact Person, or alumni from that State. Then the Contact Person would

provide orientation on AHI/AHI course to the prospective participants

It is also good to invite prospective participants to the reunion seminar.

6. Documentation of this Reunion Seminar

Documentation package in CD will be sent to all the participants of the Reunion, as soon as

finalized. Report will be uploaded on AHI English website. Documentation package would

include:

-report

-actual program schedule

-contact list

-presentations

-videos

-selected group photos


40

AHI- Alumni Members' Reunion Meet India 2013

List of Alumni members who have attended the Reunion meet in Mysore

SI

No

Organization Name with Address Contact Details

1 Christian Fellowship Hospital,

Mr.SubbanVeluchamy, Community Health Supervisor, Christian Fellowship Hospital, Post: Oddanchatram, Dindigul District, Tamil Nadu, 624619

Contact: 09843486935 & 08012503464 Landline: 04553-242585 Email: [email protected]

2 Comprehensive Social Service

Society, (CSSS)

Mr.P.Balaram Naidu VrikshaMitraBhavan, Yasodha Nagar, Pathapatnam Srikakulam District, Pin 532213,Andhra Pradesh

Contact: 08946 256108, Mob. 09441853670 Email: [email protected]


Society, (CSSS)

Mrs.P.Sarojinamma VrikshaMitraBhavan, Yasodha Nagar, Pathapatnam Srikakulam District, Pin 532213, Andhra Pradesh

Contact: 09490390698 email: [email protected]

4 Centre for Community Development (CCD)

Mr.A.Jaganadha Raju Near check post, Sridhar Nagar, Lane-1 Parlakhamundi, Gajapati District, Odisha, 761200

Contact: 09437062516 Email: [email protected]

5 IHM Hospital Sr. Rose Vypana HOD: Community Health, Bharananganam PO. Kottayam dist, Kerala Pin: 686578


6 AYUSHYA, Center for Healing and Inteegration

Sr Eliza Kuppozhackel Program Coordinator, Veroor P.O, Changanacherry, Pin: 686104, Kottayam Dist, Kerala

Contact: 08547845448 & 04812720544 Email: [email protected]

7 AdivasiPrabhavithaPadam,

Mr Dokibura Enoch, AdivasiPrabhavithaPadam, Chinatapalli, visakhapatnam, Pin: 531111, Andhra Pradesh

Contact: 08937238275 & 9441210555 [email protected]

8 Thirupani Trust Association

Dr.M.Kaliratnam , 4/236, PavalaMalli Street, Poonganagar, Tiruvallur, MGR dist.,Pin 602001, Tamilnadu

9443661124 thiruppani@gmail .com

9 Association for Rural Peoples Education and Development (ARPED),

Mr.Sundram Joseph prabhu Association for Rural Peoples Education and Development(ARPED), CC Road, KK Nagar, Santhavasal, 606905, Thiruvannamalidist, Tamil Nadu

Contact: 9865606646 [email protected]


41

10 Hemerijckx Rural Centre

Mr K. Kuppusami, Hemerijckx Rural Centre, Rawattakuppam ThiruchitromBalom Post, Vanur Taluk, PO-605111, Villupuram District


11 SWASTH, Bihar Dr.Surendra Kumar Jena Contact Address :C-103, Lakshmi Heritage Apartment, Annandpuri, West Boaring Canal Road, PATNA- 800 001 ( Bihar)

Contact: 098771430270 (M) Email: [email protected]

12 ASHOKA CENTRE

Mrs C.M. Gangamma, ASHOKA CENTRE, No 230, 1st Main, 5th Cross, RR Layout, Vijinapoura, Ranvrlty Nagar, Bangalore 16,

Contact: 07795384283 Email: ganga.herbalcure.rediffmail.com

13 SIDAR Mr T.N Sethulinkhan 9-Pillaiyakovil Street 2nd cross Kongu Nagar, Yengamedu, Karur, 639006, Tamil Nadu

Contact: 09442220477 Email: [email protected] [email protected]

14 N.D. Society Mr Subhasish Ghosh Flat- J2/8, Labony Estate, Kolkota, West Bengal, Pin: 700064

Contact: 09433002282 Email: [email protected] [email protected]

15 Karuna Trust AnupSarmah Coordinator Vill: Khatarbari, P.O. Baranagabari SonitpurDist, Pin: 784172, Assam


16 Karuna Trust MousumiGogoi Mission Road, P.O/Dist: Golaghat, Assam


17 Karuna Trust Mr SatyaRanjanGoswami Vill: Dhapkata, infront of RRL PO. RRL Jorhat DistJorhat, Assam ( non alumni)


18 Poor people’s service society,

MrTulasiPatnaik ( non alumni) (On behalf of MrPhalguno Rao, Director) Poor people’s service society, Karaganda village, Korama post, Kotturu via, Srikakulam District, A.P.



Society, (CSSS)

Mr.TrilochanPadi VrikshaMitraBhavan, Yasodha Nagar, Pathapatnam Srikakulam District, Pin 532213, Andhra Pradesh



42

20 GWSHC Mrs. A. Padma Raj PG Hostel Road, Parlakhamundi, Gajapati District, Odisha, 761200


21 HIRDA Ms SupriyaraniNaik (On behalf of Dr GangadharNaik) Coordinator HIRDA Main Road, KodPad, Dist: Koraput, Pin: 764058, Orissa


22 ASHA Kiran Society

Anil RamchandraRananavare, Ashakiran, Prakashpur housing society, Miskin road, Tarakpur, Ahmednagar 414003 Maharashtra


23 ASHA Kiran Society

Alka Anil Rananavare, Ashakiran, Prakashpur housing society, Miskin road, Tarakpur, Ahmednagar 414003 Maharashtra

Contact: 08149047536

24 Rural Development Trust

Mr SirappaBayapatti Bangalore Highway, Anantpur, 515761, Andhra Pradesh

Contact: 9000555696 & 08554242666 Email: [email protected]

25 Ms. Elizabeth George 09963869569

26 National Health Commission Govt. of Thailand

Dr UgridMilintangkul, [email protected]

27 National Health Commission, Govt. of Thailand

Ms.SirithornOrachai, [email protected]

28 DASCOH, Bangladesh

Modon Das [email protected]

29 DASCOH, Bangladesh

Reazul Karim [email protected]

30 AHI, Nagoya, Ms.Kagumi Hayashi [email protected]

31 AHI, Nagoya Ms.UI Shiori [email protected] [email protected]

32 AHI, Nagoya Ms.Kyoko Shimizu [email protected]

33 AHI Supporter Ms Tateyama Kyoko [email protected]


43

DETAILS OF PROGRAM SCHEDULE

Indian-AHI Alumni Reunion Seminar 2013

DAY 1 (20/11/2013)

8.15 am - 9.00 am Breakfast at seminar venue

9.10 am - 9.55 am Introduction of participants & Inauguration of the program

9.55 am - 11.25am Presentation by Dr H. Sudarshan, Hon. Secretary Karuna Trust on Reaching the unreached and Good Governance

11.25am 11.40 am Tea break

11.40am-12.30pm "Effort to Curb Malnutrition" by Mr Mahesh RV, Spirulina Foundation,

Bangalore

12.30am-1.45 pm "Community Health Monitoring process in present NRHM Context": Mr Bhupendra Prabhakar, Senior Consultant, Community Health Program

1.45pm - 2.25 pm Lunch

2.25 pm – 4.15 pm "Rights to Health from Grassroot to Tree Top’’ by Dr Ugrid Milintangkul, Deputy Sec-General, National Health Commission, Govt. of Thailand.

4.15 pm – 4.30 pm Tea Break

4.30 pm – 5.30 pm "A Health Assembly: a case of teenage pregnancy". Ms. Sirithorn Orachai, NHC, Govt. of Thailand

7.50 pm - 8.10 pm Video documentary on Japanese Health System

8.10 pm - 9pm Dinner at the Center

Day 2 (21/11/2013)

8.00 am - 8.45 am Breakfast at seminar venue

8.45 am – 9.00 am Video show on North East India

9.00 am – 10.30 am Presentation on Psycho nutritional Cure & Emotional Body by Dr. Sr.

Eliza Kuppozhackel, AYUSHYA, Kottayam (Dist) Kerala, India.

10.30 am-11.15 am Presentation from Ms Kagumi Hayashi: Secretary AHI, The session was

on the update on AHI

11.15 am-11.30 am Tea break

11.30 am-12.00 Presentation from Kyoko Shimizu, update on ILDC:

12.00-12.45 pm Presentation from UI Shiori on post Millennium Development Goals:

12.45- 1.50 pm Strengthen service delivery through Community Based Approach and Community Monitoring : by Dr Surendra Kr Jena

1.50 pm – 2.20 pm Lunch

2.20 pm - 3.30 pm Presentation from Thailand Health Security System: The Overview

By Ugrid Milintangkul M.D. M.P.H. Deputy Secretary General,

3.30 pm-3.45 pm Tea

3.45pm - 5.00pm Sharing experience of DASCOH, Bangladesh based NGO-Mr Modon Das

5 pm – 5.15pm Sharing of work by Ms Chenanda Gangama, Karnataka, ASHOKA CENTRE

5.15pm - 6 pm Sharing by Sirappa Boyapati, Rural Development Trust, Andhra Pradesh

6. pm - 6.10 pm Orientation for next day field visit program by Anup Sarmah

7.00 pm to 7.20 pm Video on Community monitoring process and its impact in public Health.

7.20 pm-8 pm Video show on Hiroshima Atomic Bomb reality for 40 minutes

8 pm-8.30 pm Dinner at KT Training centre


44

Day 3: 22/11/2013

7.45 am-8.30 am Breakfast at the centre

8.30 am Started for Sathemarahalli CHC

Visit to Govt. PHC Honnur

Visit to Karuna Trust managed PHC Gumballi

11.30 am Tea and snacks

Visit to village to learn community Health Monitoring: Village YK Molli

1.15 pm Started for BR Hills to see the work of VGKK and Dr Sudarshan

2 pm Lunch

2.30-3.15 pm Visit to VGKK campus, school, hospital etc

4.15 pm Tea at Gumballi PHC

7 pm Dinner at Karuna Trust office

Day 4: 23/11/2013

9 am Organizational Sharing by Mr. A. Jagannadha Raju, CCD

9.35 am Organizational Sharing by Subhasish Ghosh, ND Society

9.50 am Organizational Sharing by Dr.M.Kaliratnam

10.10 am Organizational Sharing by Sr. Rose Vypana

10.35 am Organizational Sharing by Mr.P.Balaram Naidu

10.50 am Organizational Sharing by Mr K. Kuppusami

11.15 am Organizational Sharing by Mr T.N Sethulinkhan

11.30 am Tea Break

11.45 am Organizational Sharing by. MrTulasi Patnaik

12 noon Organizational Sharing by Ms Supriya Rani Naik

12.20 pm Organizational Sharing by Mr Viswanath Prasad

12.40 pm Presentation on recent update on Govt. of India initiatives on health care system in India by Anup Sarmah, Coordinator Karuna Trust

12.55 pm Feedback and learning sharing by participants

1.45 pm Lunch

2.20 pm Open discussion

3.30 pm Departure of the participants ( 15 nos)

3.30 pm Visit to Maharaja Palace 15 participants

********

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