Hindus and Muslims Work Together for Health
By Annmarie Christensen
Director of Publications
Global Health Council
AHEMADABAD--Muslims and Hindus in the Indian state of Gujarat are navigating through trying times since riots erupted in February over a religious dispute regarding a temple being built on the site of a former mosque.
But health centers started by Aga Khan Health Services, India, in 26 villages of Sidhpur have brought a common denominator to the different religious factions, providing the glue that unites the communities despite the civil unrest that killed 700 people during the past two months.
Encompassing 54 villages in Sidhpur and Junagadh with a population of 86,500, Aga Khan Health Service's Gujarat Health System Development Project was started in October 1998 with grants from USAID and the Aga Khan Foundation. A week before the recent violence in Gujarat began, Dr. Sidhyartha Mukherjee drove from his office in Ahemadabad 130 km north to the Sidhpur project along two-lane dusty roads filled with trucks and camels close to the Thar Desert. He is the senior manager, responsible for implementing the Aga Khan health programs in India.
When asked during the three-hour ride if Aga Khan Health Services centered only on the Muslim population, Dr. Mukherjee said initially many of the projects focused on the followers of Aga Khan. But now the mission has expanded to encompass both Hindus and Muslims.
"Even before the health centers started, we said it is a learning lesson and we can achieve a lot more together than we can individually," he said.
In Sidhpur, Dr. Aziz Popatiya, Sidhpur project coordinator, said baseline surveys of the rural communities revealed that the people were seriously underserved by medical facilities, morbidity and mortality were high, and health awareness was low. The survey also found that water and sanitation was a major problem, illiteracy was rampant, and socioeconomic conditions were poor. Women of childbearing age and children under three were the most vulnerable segment of the population.
People in Sidhpur, for the most part, are economically dependent on farming in the extreme climatic conditions and subscribe to traditional beliefs and practices. Women seemed "voiceless" in their families and society, Popatiya said.
The task was large: to show sustainable improvement in the health status of the communities, giving special attention to the health needs of children below three years and women in the reproductive age group, he said.
The programmatic issues to be dealt with were perinatal mortality, non-communicable diseases, accidents, mental health and HIV/AIDS, which is a growing problem.
Aga Khan's approach was to be systemic and realize its strength lies in the professional management of services. Financial sustainability and affordability were major concerns, with organizational sustainability as the end goal. Capacity building of individuals was seen as a part of organizational sustainability, and high priority was given to human resource development.
Community participation is not just a catchword but a reality at the project, Popatiya said. A visit to the villages confirmed this. The first village of Methan, population 3,300, was built mainly of bricks and housed a thriving community of Muslim and Hindu dairy farmers. In March, Aga Khan Health Service gave the seven-member local Health Sector Management Committee complete authority over the health center that the village built. One member of the committee proudly said that the health center would be sustainable after Aga Khan leaves. The dairy cooperative is giving 15,000 rupees (US $313) per year in support, and fees paid by clients for services will subsidize the rest of the costs. Villagers will pay Rs.2 for a visit to the health center, and Rs.3 if they see a doctor.
While men make up the health committee, it is the women who volunteer their services as health workers.
What is the most important work they do? "We do immunizations for children," one health worker said. "We've had no disease for many years." Also, antenatal checkups rank right up there in order of priority, the women said.
Energy exudes throughout the community over its new health center -- it's a pride of ownership and responsibility to chart the village's course over its own health. Before, if there was a problem with a birth, a woman would have to travel to Sidhpur, 17 km away. And if there was a general emergency, villagers would have to go to the government's primary health center in Kakoshi.
About a dozen women, dressed in the colorful saris of Gujarat, sat on mats and talked of their work. Since the baseline survey stated that women seemed "voiceless" in the community, I asked what reaction they received from the men when the project first started.
"When we started, men were opposed," one woman said. "But now they see we are doing a very good job and they are very supportive."
Another woman says, "Still some people say, 'Why are you doing this?' And, I tell them we like this work and know the importance of this work."
Dr. Mukherjee said Methan is a success story. "It's a model community," he said. "The committee has total authority here and works with the village leaders."
Volunteers spend two to three hours a days at their work. They divide the village into six segments and two women volunteers travel together, visiting all households once in 15 days.
Making people aware of the benefits of a healthy lifestyle has paid off, one volunteer says, especially in the lives of the children. Now, the village sees children who are vaccinated, take daily bathes, and have improved nutrition. And, because the village is healthier, the economy is good also, one volunteer says. "Now that health has improved, the economy is also improved."
In the village of Vaghrol, with a population of 2,700, nine committee members and six volunteers oversee their new health facility that was started on August 27, 2001. Even though the clinic is only one room, it opens up a whole world to them of healthy living. Again, the same enthusiasm was exhibited, the same spirit of accomplishment, and a bounty of pride. The committee comes together every month to meet, and the discussion encompasses not only health but other vital developments in the village.
"People from other communities praise us for starting this facility," said Mr. Seliya, one of the village elders. "And we feel a sense of pride."
"The work we are doing for women in the village is important," said one of the women volunteers. "If they are healthy, they can take care of the children and the family."
"We want people to understand it is better to take preventative action," said a member of the health committee. "Because prevention is better than cure."
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