Village Health Workers improve access to health services

2The poorest and most marginalized populations often have limited access to quality health care. This is certainly the case in rural Rajasthan where health indicators remain tremendously low. Within rural communities in the Thar, poor nutrition and sanitation lead to an overall lower health status. Chronic diseases like malnutrition are present among children and women lack access to gynecological and obstetric services. GRAVIS works extensively to improve the health status of communities in the region. On such intervention is the training of Village Health Workers (VHWs), who as a result of their work improve access to health services at the community level.

VHWs bridge the service gap by providing community health services including, health awareness training, immunizations, antenatal care, and performing deliveries, to villagers that would otherwise have limited or no access. VHWs are initially trained in first aid, disease recognition, pregnancy complications, maternal services, and hygiene. Later on, they continue to build capacity by learning new skills and information. VHWs are intended to function as a primary link between the community and the formal health care system.

In rural India, women are the most likely to need health care and the least likely to seek it out. A woman’s first interaction with a doctor may not be until she gives birth. VHWs are one way of linking women to formal health institutions. With VHWs providing care and support, women have the potential to be linked into a lifetime of formal healthcare.

VHWs also serve a very important role as point people for the dissemination of important health information to their communities. Through individual communication with community members or through attendance at gatherings such as SHG meetings, VHWs provide the community with information about immunizations, seasonal diseases, pregnancy, and medical camps. As long-time village residents, they are highly trusted and can communicate easily with their peers.

This trust can go a long way in terms of accessing quality health care. I recently met one VHW in Nayagon village, an elderly woman who is proud of her role as a conduit between her community members and formal health institutions. She told me a story of one woman who fell ill and went to the nearby clinic seeking help. When she didn’t receive the services she needed, she requested the help of this VHW who returned to the clinic with her. With the VHW’s assistance, the woman received the tests she needed to confirm a diagnosis of malaria. She’s now receiving proper care and is expected to have a swift recovery.

VHWs constitute an essential link between GRAVIS and the village in terms of health interventions. By supporting local health workers, GRAVIS is also inherently supporting the sustainability of healthcare services for village residents.

Mia Schmid

Mia Schmid is an intern at GRAVIS and is currently completing a Masters in Public Administration from the Middlebury Institute of International Studies at Monterey. Previously she has worked for the Firelight Foundation in Santa Cruz, California where she contributed to the organization’s learning management systems. Her work at GRAVIS focuses on women’s empowerment through Self Help Groups and skills training. 

The many ways that Self-Help Groups empower women

Women's self-help group (multi-caste) meeting in desert village, discussing healthcare & 1st aid issues with village health worker and two male NGO staff Bhojon Village, Bap (aka. Baap), nr. Phalodi, Jodhpur District, Thar Desert, Rajasthan, India implemented by Gravis (Gramin Vikas Vigyan Samiti),
Women’s self-help group (multi-caste) meeting in desert village, discussing healthcare & 1st aid issues with village health worker and two male NGO staff
Bhojon Village, Bap (aka. Baap), nr. Phalodi, Jodhpur District, Thar Desert, Rajasthan, India
implemented by Gravis (Gramin Vikas Vigyan Samiti),

Given the social structure and gender barriers that exist within Rajasthan, it is particularly critical that female participation be a priority in development interventions intended to facilitate change in the Thar. In light of the social barriers that exist for women, GRAVIS has had a particular emphasis on women’s empowerment through its Self Help Group (SHG) intervention.

The SHG model was first formulated in India in the 1990’s. It has since been adopted by women and NGOs around the world and continues to grow in popularity. In essence, SHGs are comprised of 10-15 women who carry out collective savings by contributing an agreed upon amount every month. The groups have their own rules for management of funds and the members can access loans from these funds. The savings are also deposited in the bank, which is used to secure micro-credit loans.  Group members take out loans to meet a variety of needs including supporting their own income generation, through the purchase of a sewing machine or a flour mill, or contributing to her family’s agricultural assets through the purchase of livestock or equipment.

Apart from savings and loans, SHGs are also platforms for empowerment and social change. SHGs focus on several areas of empowerment, including: financial literacy, mobility and visibility, decision-making, skill building, economic security, and community engagement.

I recently visited with SHGs in the villages of Nayagon and Kan Singh Ki Seed. The women are about to take part in artisan skills training as part of economic empowerment of the SHGs. They are eager to improve their skills in sewing as a means of generating an income for their families.

In light of the deeply entrenched gender roles that exist within the social structure of Rajasthan, women are faced with the challenge of having a double burden of both productive and maternal work, without the ability to have their voices and problems heard. This structure leaves women with little time or ability to develop relationships outside of their immediate family. Women who join SHGs experience the rare opportunity to step out of their homes and be part of something that they themselves chose to be a part of.

In addition to an increase in mobility, SHGs provide a new opportunity for women to meet together and converse. The simple act of meeting with other women and conversing during meetings can go a long way. Women often discuss general day-to-day life, personal health issues, family conflicts, and other problems during group meetings. High levels of trust are built amongst SHG members. This trust and problem solving, combined with a regular time for meeting, provides members with a new social network, where they can share their burdens and problem solve collectively, that did not exist in their lives prior to membership. These small changes are important steps on the path toward individual and collective empowerment.

Mia Schmid

Mia Schmid is an intern at GRAVIS and is currently completing a Masters in Public Administration from the Middlebury Institute of International Studies at Monterey. Previously she has worked for the Firelight Foundation in Santa Cruz, California where she contributed to the organization’s learning management systems. Her work at GRAVIS focuses on women’s empowerment through Self Help Groups and skills training. 

A Roadmap to Combat Silica-tuberculosis

WorkshopFB - 1 of 32The relationship between silicosis and tuberculosis is complex and often challenging to address. Both lung diseases gravely affect communities throughout India and while many of the symptoms are similar, the causes and treatment plans for each are distinct. Tuberculosis is an infectious bacterial disease and unlike silicosis, can be treated with proper medication, whereas silicosis can only be managed, never cured. Conversely, silicosis is entirely preventable. The illness develops due to unhealthy exposure to silica dust, and so limiting this exposure dramatically reduces the likelihood of an individual developing the disease.

However, throughout mining communities in Rajasthan and Gujarat, a lack of awareness about silicosis combined with insufficient safety measures puts thousands of mineworkers at risk, many of which develop the disease and eventually are forced to stop working and die decades younger than otherwise projected. According to a number of national laws (the Workman Compensation Act of 1923, the Mine Act of 1952 and the Silicosis Rule of 1955) mineworkers have a right to a healthy and safe working environment, and workers who develop occupational lung diseases, like silicosis, are owed compensation by their respective state government. Therefore, unlike TB, a silicosis diagnosis ascribes responsibility for the health issue onto the mine site and the government.

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Silicosis is often confused with TB and miners are frequently misdiagnosed. Moreover, TB and silicosis are often co-occurring diseases—together named silica-tuberculosis—as silicosis significantly increases a patients vulnerability to contracting TB. This creates two key problems: 1) it makes it possible for a patient who has silicosis or silica-tuberculosis to be misdiagnosed as someone who only has tuberculosis, which voids their ability to access compensation for the occupational health hazards from which they are suffering; and 2) it further exacerbates the spread of TB, a disease that infects 9 million new patients annually and has been declared a global health emergency by the World Health Organization for nearly 30 years. Considering this, a joint approach is essential to properly address both silicosis and TB.

GRAVIS has worked to treat and prevent silicosis and TB for many years, and as part of their effort to advocate for better health in Rajasthan, especially within mineworker communities, GRAVIS organized a two day long workshop in partnership with the International Union Against Tuberculosis and Lung Disease in Jodhpur on July 6th and 7th to address the link between these diseases. The workshop joined together over 50 professionals from a variety of backgrounds, including medicine and public health, government and politics, non-profits and community organizing, and the mining industry, to share expertise and develop a roadmap to combat silica-tuberculosis.

Into the Field with Gravis

Field Visit - 1 of 1

Last week part of the GRAVIS team visited the field and met Gorakhram Bishnoi, the Sarpanch, or leader, of Mansagur Village in Osian Tehsil of Jodhpur District. His village consists of 566 households and nearly 3,000 people. As Sarpanch, Gorakhram Ji also acts as the president of one of GRAVIS’s 825 VDCs, which is comprised of about a dozen community representatives, almost half of which are women.

We spoke to Gorakhram about a number of topics, from Prime Minister Modi and crop failure compensation to the future of traditional drought mitigation technology. Generations of indigenous knowledge equip Gorakhram’s community with a variety of strategies for coping with drought, including storing emergency water supplies, grain and fodor as well as predicting drought patterns based on historical trends. However, Mansagur village also incorporates modern technology, like weather monitoring systems, that allow farmers to record the information necessary to prove their crops were damaged in order to receive compensation from the government. More remote villages who either do not have access to government data or whose local weather is inaccurately represented by that data (for example, if there is rain where the governments monitoring system is but not in a more remote part of the Thar) are unable to prove they are owed compensation when their crops fail. To help improve crop-failure reporting and communication between rural farmers and government officials, VDCs advocate for farmers in their village and ensure those who are owed compensation receive it.

GRAVIS is a unique non-profit in a number of ways, but their focus on community empowerment and the way Gram Swarajya—Gandhi’s principle of village self rule—is integrated in all of their programming is an essential ingredient to their success. Village Development Committees are a key component to GRAVIS’s commitment to this philosophy. Every village where GRAVIS works has a VDC, a group comprised of various community representatives that acts as an intermediary between GRAVIS and the rural community. VDCs have a range of responsibilities including managing village funds, selecting development initiatives, supervising projects and allocating wages and materials. 

The Future of Preventing Silicosis

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On June 23rd GRAVIS organized a comprehensive day-long workshop on Silicosis in partnership with the United States-India Educational Foundation (USIEF). A series of expert speakers discussed the nuances of the disease and its effects while specifically focusing on prevention and intervention strategies. The presentations covered a range of topics, from the link between Silicosis and TB to the way the disease affects female mineworkers as well as the best ways to prevent the disease from developing. The day concluded with a round-table discussion where workshop participants shared experiences from the field and opinions regarding the most effective preventative strategies.

Silicosis—a debilitating and ultimately fatal respiratory disease caused by inhaling silica dust and irreversible scarring lung tissue—threatens the lives of roughly 300 thousands mineworkers living in Rajasthan. Those working in stone mines are especially at risk to the disease because their working conditions consistently expose them to high quantities of silica dust. Consequently, silicosis is the result of the mining industry’s failure to adequately protect the occupational health of its workers. Once developed, there is no cure for silicosis, and patients suffer from shortness of breath and eventually become unable to work due to the illness. Although many workers are aware of the negative health effects of the mining conditions, they do not have the agency to leave their job because there are no alternative employment opportunities. Furthermore, drought and water insecurity force many villagers—who generally depend on agriculture for their livelihoods—to work in the mines despite the threat to health.

For the past two decades GRAVIS has worked extensively with mining communities in the Jodhpur and Nagaur districts, and during this time, silicosis has been a major health concern and an important focus of the organization’s development work. To combat the disease, GRAVIS programming provides diagnostic and curative medical services to at risk community members and organizes awareness trainings for workers, employers, medical professionals and government agencies. GRAVIS also advocates for the occupational health safety of mineworkers in Rajasthan and has been an essential actor in securing workers’ compensation for patients who have been disabled because of their exposure to silica while working in the mines. Some of GRAVIS’s major achievements in the past 5 years include providing medical care to over 68,000 lung disease patients, organizing over 500 medical outreach camps and over 130 advocacy seminars, establishing a major rural hospital in the Thar along with 4 satellite clinics, and conducting 3 research studies on silicosis and tuberculosis (GRAVIS’s most recent report can be found here).

World Health Day at GRAVIS: Collective voice for right to health


World Health Day at GRAVIS: Collective voice for right to health

Healthcare is a major priority for GRAVIS, in the health services deprived region of the Thar Desert. It addresses healthcare challenges at various levels with a strong focus on public health perspectives related to prevention and education, as well as research. Through a holistic and comprehensive programme on rural health, which includes interventions in the spheres of ageing, eye care, maternal and child health, nutrition, HIV and TB, lung diseases and non communicable diseases, GRAVIS combines qualitative medical services delivery with community-based health education, training and capacity building and research. On an important event like the World Health Day, GRAVIS wishes to deepen its commitment towards public health interventions with a long term vision, and aimed at creating community based models to be replicated in needy settings across the world. The event was organized by GRAVIS on 7th April in Bap town of Jodhpur District. It was addressed by Block Chief Medical and Health Officer and attended by Senior Medical Officer of Bap Government Hospital. Pradhan and Sarpanch from local government and various representatives from Village Older People Association and like minded organization have gathered at same platform to raise their voice to generate greater awareness about health of common man.

World TB day at GRAVIS: Solidarity Against the Disease


Globally, tuberculosis continues to be a severe public health issue. In India, the threat is even more alarming. India accounts for over a quarter of global TB burden. Over 2 million new TB cases are detected every year in India, with nearly nine million people in the country living with the disease. Hence, TB is a critical health challenge in India and needs a comprehensive approach to solve the problem. Continue reading “World TB day at GRAVIS: Solidarity Against the Disease”