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A community-based bacteriological study of quality of drinking-water and its feedback to a rural community in western Maharashtra, India.
Journal of Health, Population and Nutrition. 2008 Jun; 26(2):139-150.A longitudinal study of the bacteriological quality of rural water supplies was undertaken for a movement towards self-help against diseases, such as diarrhoea, and improved water management through increased community participation. Three hundred and thirteen water samples from different sources, such as well, tank, community standpost, handpumps, percolation lakes, and streams, and from households were collected from six villages in Maharashtra, India, over a one-year period. Overall, 49.8% of the 313 samples were polluted, whereas 45.9% of the samples from piped water supply were polluted. The quality of groundwater was generally good compared to open wells. Irregular and/or inadequate treatment of water, lack of drainage systems, and domestic washing near the wells led to deterioration in the quality of water. No major diarrhoeal epidemics were recorded during the study, although a few sporadic cases were noted during the rainy season. As a result of a continuous feedback of bacteriological findings to the community, perceptions of the people changed with time. An increased awareness was observed through active participation of the people cutting across age-groups and different socioeconomic strata of the society in village activities. (author's)
Differential community response to introduction of zinc for childhood diarrhea and combination therapy for malaria in southern Mali.
Journal of Nutrition. 2008 Mar; 138:642-645.Developing effective, affordable, and sustainable delivery strategies for the isolated low-income populations that stand to gain the most from micronutrient interventions has proven difficult. We discuss our experience with implementation of zinc as treatment for diarrhea in children less than 5 y of age over the course of 3 operational research studies in rural Sikasso Region, Mali, West Africa. The initial formative research study highlighted how malaria affects perceptions of diarrhea and its causes and that malaria and diarrhea are not necessarily viewed as distinct conditions. The second-phase pilot introduction demonstrated that, in introducing zinc treatment in malaria-endemic regions, it is especially important that both community and facility-level providers be trained to manage sick children presenting with multiple symptoms. The third-phase study on large-scale implementation detected that the experience with implementation of new treatments for malaria is distinct from that of diarrhea. To some extent zinc treatment is the solution to a problem that communities may not recognize at all. Interventions to improve case management of sick children must be integrated across diseases and nutritional problems at both the facility and community levels. Operational research can identify points where integration should occur and how it should be carried out. Programs targeting single diseases or single nutritional problems can have a variety of deleterious effects on health systems, no matter how well they are planned. (author's)
Marriage and Family Living. 1946 Winter; 8(1):13.It scarcely seems necessary at this time to discuss the need for sex education. Even the public has recognized the need. In June 1943 a national poll showed that in a cross section of public opinion 68% of those interviewed favored giving a course in sex education in high schools; in cities over 100,000 there was a 79% approval. Many parents of the teenagers seem relieved to hand over the responsibility to the schools. Such widescale approval is comparatively recent, and perhaps expedited by war problems such as broken controls, new independence of youth facing adult situations, and publicized delinquencies. A sudden awareness of dangers, with fear for their adolescent-age children, may have been a strong factor in this expressed approval for teaching sex education in the high schools. The facts are that while public opinion is more enlightened, we still a long way to go educationally to incorporate this subject matter in our schools on a broad scale. Over twenty-seven of our States have had a negligible amount of attention given to the subject; only about ten States have had encouragement on a State wide basis. Many of the States have had sponsorship from the community rather than the school groups, and even among those communities which favor such education, many do not have functioning programs. (excerpt)
Alliance News. 2001 Dec; (12): p..Increasing attention is being paid to the role of stigma as a major contributory factor in the global HIV/AIDS pandemic. Stigma associated with HIV/AIDS is especially powerful and pervasive because the disease is usually closely associated with such fundamental issues as life and death, sex and sexuality, and morality. (excerpt)
Round Table. 1998; 348:485-503.Contrary to the intentions of the Chinese government and despite appearances the May 1998 elections for Hong Kong's legislature failed to destroy the voters' attachment to political parties and to individuals committed to democratic reform. The outcome made it impossible for the government to maintain a minimalist rôle in managing Hong Kong's response to the major economic upheavals facing the entire region and within a month forced the introduction of a package of measures to relieve hardship and revive the economy. The article traces the approach to the question of democracy against the background of the complex negotiations that led up to the restoration of Hong Kong to Chinese rule and the shaping of the post-1997 political system. It outlines the efforts by Christopher Patten, Hong Kong's last Governor, to secure the post-1997 legislature for the supporters of democracy and the innate hostility of the Chinese leadership towards conventional democratic process. (author's)
Social, economic and health impact of the Community Based Integrated Rural Development (CBIRD) project: an evaluation report.
Nakhon Pathom, Mahidol University, IPSR, 1988 Aug. xvi, 77 p. (IPSR Publication No. 130)This study evaluated the impact (post-program) of the Community-Based Integrated Rural Development project among 40 project and 10 non-project villages during 1984-88 in Nang Rong District, Burirum Province, India. The summary of findings indicates that changes occurred in the economic and social infrastructure in all villages during the observed period. Improvements were evident in the access to electricity, in more paved roads, and in the possession of consumer durables. Sanitation improved. The number of community development groups, such as rice and fertilizer fund groups and women's groups, increased in both project and non-project areas. An increased number of household members worked in factories. Changes occurred in the percentage of households having one or more members engaged in a variety of economic activities. New farm and non-farm activities appeared. The trend was moving away from a subsistence economy. Levels of participation in income generation activities varied from moderate to high depending upon the activity. Adoption of agricultural technology varied depending upon the familiarity to villagers and level of investment. Technologies most likely to be adopted required smaller investments and were more familiar. Improvements were evident in health and nutritional status and greater in project villages. Both village types showed contraceptive use among married women aged 15-49 years to be about 68%. Fertility declined. Prenatal care services increased from 60% to 88% in project villages and 58% to 74% in non-project villages. Use of modern health service units increased, and the percentage of units using trained health personnel for delivery increased. Immunization increased and was greater in project villages. Local villagers, who were directly or indirectly involved in the project, rated the project highly and suggested continuation of those components that were less costly. One criticism was that some income generation schemes may not have helped poor families. Recommendations were made to expand coverage, particularly for income generation that attracts large numbers of people. Market outlets should be improved. The pattern of private and government cooperation might be used as a model for other development activities.
Dacca, Bangladesh, Ministry of Information and Broadcasting, April 1977. 41 p.Reports on a survey conducted to identify the formal and informal opinion leaders as perceived by the people of Bangladesh, and to assess their attitude towards family planning. Findings indicate that the contraception practice rate among opinion leaders is significantly higher than the average, and it is recommended that specific orientation and training in the skills of interpersonal and group communication be arranged for them to effect a transfer of motivation to the people in their locality. Also established is the fact that obstacles to family planning due to religious belief is more a function of the leaders' perception of people's attitude than a function of reality. Opinion leaders fail to identify population as the root problem, so that family planning education should be structured around the felt problems of food, unemployment, poverty, and so forth. The need for a greater degree of husband-wife communication about family planning is indicated, as well as a change in the traditional status of women. A family planning program with an incentive-disincentive aspect should be deemphasized. Finally, the survey reveals that the local leadership is not yet ready to take major responsibility in family planning communication.
Public communication campaigns in the destigmatization of leprosy: a comparative analysis of diffusion and participatory approaches. A case study in Gwalior, India.
JOURNAL OF HEALTH COMMUNICATION. 1998; 3(4):327-44.Findings are presented from a study conducted to determine the relative effectiveness of diffusion and participatory strategies in health campaigns and the effect of caste upon the dependent variables of knowledge, perception of risk, and behavioral involvement thought to contribute to the destigmatization of leprosy in Madhya Pradesh state, India. Multivariate analysis identified significant difference between the communication treatments upon the dependent variables. The discriminant analysis procedure used to locate the source of the difference identified cognitive-affective and behavior-affective dimensions as significant discriminant functions. Participatory treatment showed higher knowledge and lower perception of risk upon the cognitive-affective dimension, and higher behavioral treatment upon the behavior-affective dimension, but the diffusion treatment showed only lower self-perception of risk upon the behavior-affective dimension. This study found that participatory strategies which promote dialogue and interaction and incorporate people's knowledge and action component result in increased knowledge, lower perception of risk, greater behavioral involvement, and, therefore, destigmatization.
Amherst, New York, Prometheus Books, 1998. 334 p.The author of this book posits that humans are not acting responsibly towards "planet-imperiling" circumstances because of failure to take knowledge seriously enough to act. Seriousness of purpose and informed perception requires an examination of how humans evolved as a species, the social structures of humans, and ethical views that divide humans from nature. The author points out the incongruity of short-term public focus on, for instance, the survival of 3 whales trapped under ice in 1988, while 200 whales were commercially slaughtered without any public outcry. Regardless of the 1988 moratorium on hunting whales, Norway, Iceland, and Japan (for scientific purposes) continued hunting whales. The propensity to ignore harmful practices dates back to the first recorded history of poor farming methods that led to soil degradation and ruined irrigation systems in Mesopotamia. Rachel Carson's early warnings about the danger of pesticides for wildlife were ridiculed. People complain about welfare recipients' immediately spending the proceeds of their welfare checks, while ignoring their own wasteful consumption patterns. Current problems are so severe that nature is not able to correct human error. The author as professional architect believes that city planners and builders can bring about meaningful social change to improve the planet. The aim of this book is to stimulate interest in the limitations of human intelligence, the ethics and beliefs in modern societies, social organizations and government, and solutions. The key is a broad education about what happens when government fails, and the shallowness of materialistic status symbols. Trivia obscures real issues.
PUBLIC HEALTH. 1997 Nov; 111(6):399-404.South Africa's government has since coming to office in 1994 expressed its commitment to involving communities in designing and implementing health policies and programs. It remains unclear, however, how to translate that commitment into practical action at the local level. This paper discusses data collected in October 1994 in a national survey of health inequalities in South Africa. In the survey, 3796 men and women aged 16-64 years were asked to report their views on the involvement of communities in aspects of local public health services. The analysis of those data indicates that the South African public favors the involvement of communities in local public health services. There are, however, variations in the support for community involvement in health services with regard to which time to open clinics, the nature of the patient-provider relationship, staff recruitment, and the determination of service charges. Multivariate analysis shows that the level of support for community involvement is significantly low for Whites relative to other races, lower for rural residents than for city dwellers, and high for people with a very good health status. Additional research is needed to better understand the problems and policy options in community involvement in public health programs.
London, England, Taylor and Francis, 1994. viii, 179 p. (Social Aspects of AIDS)Community involvement in the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic has been central to helping to create the social, political, and cultural response to HIV/AIDS. At this point, no government or international agency HIV/AIDS program can be effective if it does not cooperate with and support grassroots responses. Moreover, the AIDS epidemic has been a powerful impetus to grassroots organizations of groups that have been marginalized as a result of gender, sexual orientation, race, or poverty. On the other hand, the emerging global AIDS industry has the potential to subvert traditional power structures and become isolated from those it claims to serve. Community groups can be co-opted into carrying out the agenda of this "industry" or they can continue to be subversive of the dominant social order. The central challenge facing the community movement is how to strengthen its political effectiveness without compromising its basis in grassroots participation and control. Of concern are emerging tensions within community-based organizations between activism and service provision, altruism and self-help, volunteer participation and management control, and fluidity of function and increasing bureaucratization. Another concern is the potential for effective community and nongovernmental organization-sponsored programs to take the pressure off of governments to provide or reform essential health services. Direct community sector involvement in the policy making process represents the best strategy for ensuring that national AIDS policies are responsive to those most affected by the epidemic.
Report of the ESCAP/UNDP Expert Group Meeting on Population, Environment and Sustainable Development: 13-18 May 1991, Jomtien, Thailand.
Bangkok, Thailand, United Nations, Economic and Social Commission for Asia and the Pacific [ESCAP], 1991. iv, 41 p. (Asian Population Studies Series No. 106)The 1991 meeting of the Economic and Social Commission for Asia and the Pacific considered the following topics: the interrelationships between population and natural resources, between population and the environment and poverty, and between population growth and consumption patterns, technological changes and sustainable development; the social aspects of the population-environment nexus (the effect of social norms and cultural practices); public awareness and community participation in population and environmental issues; and integration of population, environment, and development policies. The organization of the meeting is indicated. Recommendations were made. The papers on land, water, and air were devoted to a potential analytical model and the nature of the interlocking relationship between population, environment, and development. Dynamic balance was critical. 1 paper was presented on population growth and distribution, agricultural production and rural poverty; the practice of a simpler life style was the future challenge of the world. Several papers focused on urbanization trends and distribution and urban management policies. Only 1 paper discussed rural-urban income and consumption inequality and the consequences; some evidence suggests that increased income and equity is associated with improved resource management. Carrying capacity was an issue. The technological change paper reported that current technology contributed to overproduction and overconsumption and was environmentally unfriendly. The social norms paper referred to economic conditions that turned people away from sound environmental, cultural norms and practices. A concept paper emphasized women's contribution to humanism which goes beyond feminism; another presented an analytical summary of problems. 2 papers on public awareness pointed out the failures and the Indonesian experience with media. 1 paper provided a perspective on policy and 2 on the methodology of integration. The recommendations provided broad goals and specific objectives, a holistic and conceptual framework for research, information support, policies, resources for integration, and implementation arrangements. All activities must be guided by 1) unity of mankind, 2) harmony between population and natural resources, and 3) improvement in the human condition.
Ascertaining the user perspectives on community participation in family planning programme in Thailand.
[Bangkok], Thailand, Mahidol University, Institute for Population and Social Research, 1991 Dec. , 132 p. (IPSR Publication No. 156)A study of community members, family planning program staff and managers, community-based distributors (CBDs), and local leaders in 4 regions of Thailand was undertaken to determine the extent to which community members are willing to participate in family planning programs, and which activities they prefer. 400 married women aged 15-44, 100 of their spouses, with a contraceptive prevalence rate of 69% taken equally from 12 villages, 16 CBDs from 12 communities, 69 village leaders divided into 1 focus group per village, and 17 staff were interviewed from May to July 1989. 5 variables that determine attitudes were measured: sociocultural norms for participatory behavior, values and beliefs underlying norms, institutionalized participatory behavior, government policies, and the family planning program. Some of the responsibilities open for participatory activity were promotion of family planning in the community,k educating potential users, target-setting, selecting, paying, training and supervising CBDs, record keeping, storing commodities, identifying potential acceptors, and transportation to clinics. Staff and CBDs considered community participation a valuable strategy. Community members considered participation attractive if it were perceived as beneficial to the community. They liked the idea of having services locally, but showed some doubts about the competence of CBDs. They expressed hesitancy about participating in such a personal realm as family planning. Most thought that program staff would be better able to do IEC work. Community members would consider participating in transportation to clinics, selection of CBDs, identification of acceptors, and referral to clinics. Community members were strongly motivated to work in collective, social activities. Managers wanted to make community people more self-reliant and cooperative. No one wanted community participation to duplicate current programs, or to pass program expenses on to localities.
HEALTH FOR THE MILLIONS. 1991 Aug; 17(4):20-3.Until recently, the only sustained AIDS activity in India has been alarmist media attention complemented by occasional messages calling for comfort and dignity. Public perception of the AIDS epidemic in India has been effectively shaped by mass media. Press reports have, however, bolstered awareness of the problem among literate elements of urban populations. In the absence of sustained guidance in the campaign against AIDS, responsibility has fallen to voluntary health activists who have become catalysts for community awareness and participation. This voluntary initiative, in effect, seems to be the only immediate avenue for constructive public action, and signals the gradual development of an AIDS network in India. Proceedings from a seminar in Ahmedabad are discussed, and include plans for an information and education program targeting sex workers, health and communication programs for 150 commercial blood donors and their agents, surveillance and awareness programs for safer blood and blood products, and dialogue with the business community and trade unions. Despite the lack of coordination among volunteers and activists, every major city in India now has an AIDS group. A controversial bill on AIDS has ben circulating through government ministries and committees since mid-1989, a national AIDS committee exists with the Secretary of Health as its director, and a 3-year medium-term national plan exists for the reduction of AIDS and HIV infection and morbidity. UNICEF programs target mothers and children for AIDS awareness, and blood testing facilities are expected to be expanded. The article considers the present chaos effectively productive in forcing the Indian population to face up to previously taboo issued of sexuality, sex education, and sexually transmitted disease.
Medical Anthropology. 1985 Winter; 9(1):49-56.In order to make health services more accessible at the village level, the State of Karnataka began a Primary Health Care (PHC) Program involving Health Guides (HGs). These are local villagers who are trained in basic health services and who work in their own village. This research was conducted among village community members living in the Mysore District, where HGs had been working for 1 year. A total of 240 household members were interviewed using pretested, semi-structured survey instruments in 30 selected villages. Results indicate that 70% of the household members surveyed were aware of the HG scheme, and 58% said the HG was always or often available to them. According to the official guidelines set down by the State of Karnataka, the village community was requested to recommend 2 or 3 persons considered suitable by them to become HG candidates. However, survey results indicate that 99.6% had not been involved in the selection process in any way. When asked what the 4 most important functions of the HGs were, the household members responded overwhelmingly (98.3%) that the sole function was treating minor ailments. More of the household members surveyed went to the HGs to receive medical services than to any other persons. Of those who made HG contact, 52.2% reported that they were very satisfied and 44.4% said they had been partially satisfied by the medical services they had received. The vast majority of the community reported that they felt very little work was being done in the area of prevention (soakage pits, sanitary latrines, water supply, family planning and immunization). But these items were not perceived to be very important and seem to have little impact on the community's acceptance of the HG scheme and on its further continuation and expansion. A large majority of those interviewed wanted the HGs to visit their homes more often for health-related services. 20% of the community household members said they would be in favor of financing the HG honorarium or the HG drug supply, currently provided by the Government of India and the State of Karnataka. Finally, 92.1% felt the HG scheme should be continued in their area and 91.7% felt it should be expanded to other areas of the State. Suggestions are offered regarding ways to improve the community participation in this pilot area. Examples include regular home vistis by the HGs to all households using complete up-to-date household surveys; pictorial signs aroung the village area to advertise HG services; spending more time during training sessions on preventive aspects of the HG job and the adequate explanation of the philosophy of the HG scheme, with particular stress on the importance of preventive and promotive services. Such steps will ensure relevancy of the programs, ensure success of immediate activities, and pave the way for long-term changes in the communities themselves.
[Unpublished] 1978. Paper presented at National Workshop on Innovative Projects in Family Planning and Rural Institutions in Bangladesh, Dacca, Bangladesh, Feb. 1-4, 1978. 9 p.The concept of integration of family planning with other development programs has led to the innovation of a multisectoral approach to population control and family planning in Bangladesh. Population education through rural cooperatives is 1 such pilot project currently under implementation. Primary cooperatives are 1 of the few widespread, tangible, and viable rural institutions operating within the village. This paper summarizes the activities undertaken so far to create an awareness of the population problem among rural cooperative and other village leaders and to enlish their support in spreading the message of family planning. The Project has passed through the following stages: 1) The establishment of a viable working infrastructure; 2) The preparation for field activities by raising and formalizing support from locally relevant authorities. The Project team initiated a series of regular contacts through personal visits and correspondence; 3) The development and execution of a 4-month training module for the leaders (based on weekly classes) to achieve acceptability and committment by the leaders; to ascertain attitudes, values, and beliefs in order to gauge what motivational stimuli villagers will respond to; to discover links between previous experiences of change in response to the felt needs of communities and that of contemporary problems; to test various educational practices, materials and motivational approaches; and to help the cooperative manager to motivate his fellow members and counter arguments against family planning likely to be thrown at him. A description of the training sessions is provided. Phase 4 will consist of follow-up and Phase 5 will entail evaluation. The paper concludes with a detailed list of preliminary findings.
Ithaca, New York, Cornell Univ., Center for International Studies, Rural Development Committee, and South Asia Program, 1973. 61 p. (Rural Development Committee. Occasional Papers; No. 1)This report investigates the effects that different aspects of political economy have on the rural development of "Village India." More specifically it examines the consequences of a 1960 Indian Government decision to direct its rural development through 2 new local institutions: a cooperative economic system among Indian farmers and a new form of local self-government called "Panchayat Raj," or rule by Panchayats (local leaders). These 2 local institutions were created with the idea that local self-help and collective attacks on common problems coupled with cooperation between local agencies and the state government would improve the position of the farmer in Indian society. The evolution of government agricultural policy in India is examined. In particular, the author discusses the community development program initiated in India in 1952 and the reaction of the Indian community. 3 basic bodies of opinion are identified: The Civil Servants, The Gandhians and the Planning Commission economists. A description is given of the development of social and power structures of a "traditional" Indian village including the jajmani (landlord) system, the caste panchayat and the vilage panchayat. A picture is given of the current economic and political structure of India. Land is still the major source of economic power in India. The panchayat leader is not perceived by the Indian villages as having legitimate political authority or as their true representative. The villager sees the Pradhan as the conduit of private benefits. The outside world sees him as the leader of a progressive community. The villager might well wish that the panchayat leaders would act for the public good, but their experience is otherwise and the factional basis of electoral politics in the village inhibits such a stance.