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Introducing a Health-Care Scheme in a Village

M.J. Arul

A Test Case

Tulgaon is a village of 324 households with a total population of about 3,500. Two hundred and fifty-eight of the households are Muslim and the remaining are Hindu, mainly harijans.

The village teams not only with humans, but also buffaloes (rather small), pigs, goats, chickens and a few cows. Though not every household owns land or milch animals, agriculture and animal husbandry are noticeably dominant in Tulgaon. There are about 150 artisans, most of whom go to work in a nearby town. The village has been running a successful milk co-operative for over thirty years now. The co-operative has been instrumental in improving animal health in the village. When the Tribhuvandas Foundation became operational in early 1980, Tulgaon was chosen to be the first village in which to establish and test the Foundation's health programme.

Mrs. Mehta, an MBBS doctor, and Mr. Mehta, an expert in human nutrition (wife and husband, respectively) were the Foundation's first professional staff members, the former being its chief executive. On February 26, 1980, they went round the Tulgaon village, stopping off and on to talk to people. They noticed poverty and an overall absence of environmental sanitation. Children appeared malnourished and most of them had scabies and abscesses. Many others complained that the inadequate water supply was the cause of their problems. By the time the people with water taps at their homes had drawn off their supplies, there was little or no water in the community taps...

The doctors made three or four more visits and talked to more and more people of the village about sanitation and health. The people expressed their eagerness to have better water supply and a clinic there. The Chairman of the milk co-op was enthusiastic about having a clinic soon and offered for the purpose a room in the society's building. A little later, the panchayat also agreed to provide a small plot of land, on which the Foundation could build its own centre for its programme in the village.

On March 11, 1980, the Mehta's, together with their Chairman and some friends, called a meeting of mothers in Tulgaon. Dr. Mehta addressed the huge and chirpy gathering and spoke to the women, children (and also some men) about health, hygiene, sanitation and the aims of the Tribhuvandas Foundation.

Dispensing of medicines began on April 4, 1980, in the Society building, which still housed the clinic. The film "Manthan" was shown in the village on May 15. This film portrayed how exploitation of people could effectively be stopped by co-operation.

In one of the meetings, membership in the health scheme was discussed and over 300 families soon became members (membership fee, Re 1/- per month). A health-care sub-committee of the village milk Co-operative's Managing Committee was also formed, with two women members. The Sarpanch was also taken in as a member, but he never turned up for meetings. Later, the Milk Co-op's Chairman reported that the Sarpanch had been replaced in the health-care sub-committee.

One of Dr. Mehta's friends, an enterprising lady, who had accompanied the team on March 11, felt that there was a need for organising the women of the village in some way, so that they could gainfully use their free time, which was available in plenty. Accordingly, an informal "Ladies Club" was started--and the organiser was soon accompanying the health-care team whenever it went to Tulgaon, teaching the women sewing and knitting. The Ladies Club met in the panchayat building. The marketing of the shopping bags etc. that were produced by the ladies was taken care of by the organiser herself. The women and girls of Tulgaon were very enthusiastic and happy about this club, but their production soon appeared to be in danger of exceeding effective demand.

The Chairman of the Milk Co-op was an enthusiastic young man. He was doing his First Year Science at a nearby College. He was interested in (and had many ideas about) the improvement of the village. He had thought of organising economic activities, such as papad manufacturing, paper-bag making, etc. He also said that, if the village had a suitable kind of club, it could buy at a low price green grass, which grows along the canals and is auctioned by the government. This grass could be sold at a nominal margin to the families owning milch animals in the village. The profits from such economic activities could be used by the club to help the poorest children in their education, etc.

The Sarpanch was at the time a middle-aged man, living in a fairly big, electrified house. He was rarely found in the village; he made frequent trips to the taluka town, on tasks related to the panchayat. The panchayat members seemed to have little faith in him. People said that the Sarpanch was interested only in his own welfare and used his position to that end; that he siphoned off money from the panchayat fund in the guise of some common expenditure, which the village never incurred. Once, they said, he took the signatures of the nine panchayat members under an estimate for expenditure of Rs.200 on filling in the many puddles in the village. Members of the Panchayat say in private that the puddles never got filled. When asked about this later by the members, the Sarpanch told them, "Didn't you see they were all filled? They need filling again"!

The village street lights had been off for a very long time. Pending bills had to be paid, together with an application to the Electricity Board to have the lights restarted. The money was collected and the Sarpanch was to do the needful. Months had passed and the streets continued to be dark each night.

Some of the villagers asked their young, energetic milk co-op's Chairman to do something about the street lights, but the Chairman said that his signature would not be valid for matters of this nature. "The Sarpanch knows," people say, "that we all depend on him; he alone can do certain things. So he feels great and does not bother about the village."

Most of the inhabitants of Tulgaon were happy about the recent developments in their village: the clinic, the ladies club, the first-ever conducted tour for the women members to their co-operative dairy plant, etc. Some people said, however, that four or five individuals in the village had been spreading rumours, aimed at marring the image of persons involved in such activities: "What is this young chairman doing with the women in the clinic room and the ladies club? What is happening to the women of this village? They will be contaminated and spoilt by going out..."

Mr. Farooq (the milk co-op chairman) had once organised a Jagruti Mandal (Wake-up Association) for the betterment of Tulgaon. Not much activity had taken place when some of the mandli members took away some money from the fund and squandered it on movie-going. Learning of this, Mr. Farooq called a meeting of the mandal, but the attendance was extremely poor. That was the end of the Mandal: "Jagruti mandal so gai ("The Wake-up Association has gone to sleep"), lamented the chairman.

Asked whether he was thinking of starting any youth club, Farooq said, "Yes, I thought of it--but it won't work. You see, there are "groups"--some of which are always out to thwart any such effort, some not interested, some interested only in the fringe benefits of belonging to such clubs and not in doing work, ..."

"Was there any interference or objections from the Sarpanch?"

Farooq, along with a friend of his and a member of the panchayat replied, "The Sarpanch never interferes with these activities; neither does he support them. He is clever enough not to raise objections himself to any developmental activities initiated by anybody. But he does it through a handful his chamchas (henchmen). He knows that people support such developmental activities and he cannot take any credit for them. He does not do anything for the village and yet wants to make sure that he doesn't lose his position to the up-coming leaders."

"Why don't you members refuse to sign documents which you know are false?"

"In fact I did refuse once," says one woman member of the panchayat, "but I was subsequently coaxed into signing. You see we are relatives--most of us are at least distantly related in this village--and as such, we cannot really afford to fight. Further, we are not sufficiently educated to scrutinise his bungling. He shows us some figures and gives some explanations.. and we often acquiesce."


The Tribhuvandas Foundation ("TF") had obtained some extra funds for improving Tulgaon's public water supply. Its plans were well advanced for building a modest, practical "Centre" in the village, between the Balwadi and the milk co-op's building (which was also to incorporate an AI Centre). The TF's Centre was expected to be the facility used by its health workers, as well as acting as an infant day-care centre and a young farmers' club.

The TF saw many opportunities and some problems ahead: for example, the village pond could be the basis for a fish production co-op, but the Panchayat has leased it out to a private individual for 10 years for Rs.250 yearly rent... Village youth could be employed in levelling TF's small plot, on which its Centre is to be built. But, on the other hand, there were doubts as to whether the youth would come forward--"Considering that so many households include at least one artisan who earns Rs. 15 daily in the town", as one "TF staff member put it", "are the youth likely to accept less?"


From the view-point of the overall structure of the NDDB's Integrated Rural Development Project, the TF was the implementing agency for the Project in Kaira District. Other such agencies were expected to be formed, as the project spread to other milk fed districts.

NDDB's role in the Project was expected simply to be that of a "facilitator": that is to say, NDDB was to be the channel for outside assistance to each district's "TF" until it becomes self-supportive (target: within 7 years); NDDB was to help each TF in planning, monitoring and reporting on each of TF's activities; it was also to identify and make available consultants in such fields as environmental sanitation -- should a TF desire it... However, "Our first task is to help get the project going and, in the process, learn how to implement it", as one concerned NDDB staff member remarked: "We still have only half the budgeted funds; TF is amassing data on village households, health status, employment etc., but what seems to be needed (at Tulgaon, for example) is a comprehensive economic-cum-employment plan..."

Some further thoughts on "Introduction of a Health-care Scheme in Tulgaon"

NDDB's original proposal for its integrated rural development project summarised the six "action items" which were to comprise the project as follows:

Action Item 1: Maternal and infant care, curative and preventive medicine:

This is the Programme's core Action Item, to be initiated first, as each village decides to participate in the Programme. It will include treatment of simple cases by each village's Village Health Worker plus regular visits to each participating village by the Programme's Mobile Health-Care Teams.

Action Item 2: Supplementary Feeding:

For babies and infants under five, who are identified as malnourished during the implementation of Action Item 1--to provide them sufficient food to put them into a pattern of adequate growth and development.

Action Item 3: Young Farmers Centres:

To provide a focus of learning and action for village youth who wish to contribute practically to their village's development.

Action Item 4: Family Viability:

To enable families (especially those with infants suffering from malnutrition) to achieve economic and domestic viability.

Action Item 5: Infant Day-Care Centres:

To provide, in villages where it is needed and desired, a facility to help look after pre-school infants, especially those whose mothers have to work in the fields during the day.

Action Item 6: The 100% Village:

To help each village which musters community support for it to implement its own programme for improving the village's services and environmental sanitation.

The first Action Item is to serve as the core of the programme and its conduct will be a continuing commitment for the sponsors of the Programme and for villages which commit themselves to participate in the Programme. The remaining Action Item will be implemented to the extent that funds are available--and to the extent that each participating village expresses a desire (and shows the ability) to play its part in mobilising the resources needed.

Because all action items except the first were to be implemented in each participating village only when that village opted to do so, it was difficult to make projections of costs, number of villages covered by action items 2-6 etc. Nevertheless, projections had to be made, in order to ensure adequate funding.

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