1. Community Approaches for Health System Strengthening & addressing the Social Determinants of Health Dr. Thelma Narayan Centre for Public Health & Equity, SOCHARA Bangalore ITM Antwerp, 2008 Primary Health Care in the 21 st Century New Challenges & Opportunities for the First Line

2. Nutritional Status of Children under 3 years: shift from NFHS-2 to NFHS-3 Source: National Family Health Survey 3- 2005-06, NFHS2-1998-99

3. Anemia Prevalence Among Under 3’s in India Source: National Family Health Survey 3- 2005-06 Anaemia Prevalence State Anaemia prevalence more than 70 percent Bihar Madhya Pradesh Uttar Pradesh Haryana Chhattisgarh Andhra Pradesh Karnataka Jharkhand Anaemia prevalence Less than 50 percent Goa Manipur Mizoram Kerala

4. 56% of married and 59% of pregnant women are anaemic. Source: National Family Health Survey 3- 2005-06

5. Percent of Household Having no Toilet Facilities Source: National Family Health Survey 3- 2005-06, NFHS2-1998-99, NFHS1 1991

6. Percentage of House Holds by Source of Drinking Water Source: National Family Health Survey 3- 2005-06, NFHS2-1998-99, NFHS1 1991

7. Common forms of Violence against married women Source: National Family Health Survey 3- 2005-06, NFHS2-1998-99, NFHS1 1991

12. The People’s Charter for Health “ Health is a social, economic and political issue and above all a fundamental human right.”

18. Community Participation Policy Statements to System Development in India (before Alma Ata - 1978) Local Self Governance / Village Health Committee Community as Resource For Health Care COMMUNITY PARTICIPATION Community Organization Community Health Worker

21. The International Conference on Primary Health Care calls for urgent action by all governments, all health and development workers, and the world community to protect and promote the health of all the people of the world by the year 2000. The Primary Health Care Movement towards Health for All by 2000AD Alma Ata, 1978

26. RECOGNISING THE CRISIS IN INDIA-1990’S

30. Less Food, No water, No jobs!!! Listening to People!

31. The People’s Health Resource Books in India -2000AD “ These books are the best expressions of primary health care concepts and its politics that I have ever read. They are the bible of primary health care, a glorious milestone on the tortuous road to primary health care….” Halfdan Mahler,DG Emeritus, WHO .

35. The People’s Charter for Health Dec 2000 “ Promote, support, and engage in actions that encourage people’s involvement in decision making in public services at all levels….. …… Demand that people’s organizations be represented in local/ national and international fora that are relevant to health”

37. People’s Charter on HIV/AIDS Bangkok 2004 “ HIV and AIDS is a development issue calling for social and political action. It is also a public health issue that requires people-oriented health and medical interventions. Such responses require democracy, pro-people inter-sectoral policies, good governance, people’s participation and effective communication… rooted in internationally accepted human rights and humanitarian norms .”

38. Corporate led globalization, Neo-liberal economic reforms, Negative macro-policies Adversely affect the social majority, nationally & globally Livelihoods, Incomes, Food security, Increased conflict, War and violence, Access to water, Access to health care, Environmental degradation, The New Challenge to Primary Health Care and Community Participation in 2000 AD

39. Right to Health Movement : India 2003 Primary Health Care and Health for All

43. Rediscovering Community Participation and Civil Society engagement , India NGO- CHW Experience 1980’s – Health Workers The Janata Experiences The JSR’s of Madhya Pradesh The Mitanins of Chattisgarh National Rural Health Mission ASHA’s ; VHSC’s; Community Monitoring NGO- CHW Experience – 1990’s – Health Activists Lessons in Community Participation through Community Health Worker Programmes in India The Sahiyas Jharkhand PHM India

44. Revival of Interest in State level Community Health Worker and Community participation Evaluated by Civil Society Researchers Jaa Swasthya Rakshaks (JSR) Madhya Pradesh 1991 Mitanin Programme, Chattisgarh -2001

46. The new Health Worker as Health Activist ASHA Training Programme of NRHM- India 2004 “ A new band of community based functionaries named as Accredited Social Health Activists (ASHA ) who would be a health activist and mobilize the community towards local health planning and increase utilization and accountability of existing health services”.

47. Accredited Social Health Activist Training Manuals ASHA – Workers of Hope!

48. COMMUNITY PARTICIPATION THE PARADIGM SHIFT – 2000 & beyond Source: CHC 2008 Approach Biomedical, deterministic, techno managerial model Participatory social/ community model Link with community As passive client or beneficatory As active empowered participants Dimensions Explored Physical and technical Psycho- social, cultural, economic, political, ecological Focus of Participation Resources, Time/ Skills Leadership, Ownership, direction setting, Monitors. CHW Role Service provider, educator, organiser, data collector ( lackey ?) Mobilisor, activist, empowerer, social auditor, monitor. (Liberator) Research Community participation as means Community participation as ends

49. Recognition of Globalization of Solidarity for Health from below “ This movement is engaged in what amounts to ‘globalization from below’ as it builds support for its global ‘Health For All Now’ strategy, lobbies at the global level and mobilizes a grassroots based campaign to realize the vision and achieve the goals of the People’s Charter for Health.” Richard Harris and Melinda Seid, 2004, The Globalization of Health

51. Health for All, Now ! JOIN US THANK YOU

52. For further information visit www.sochara.org www.phm-india.org www.phmovement.org www.ghwatch.org www.iphcglobal.org www.mohfw.nic.in/NRHM