A presentation of our findings with the relevant stakeholders
I remember what my co-founder Anupama once told all of us during our induction training at India Fellow, “Humility is in accepting that you don’t know everything.” I think more than anything this quote has helped me to stay humble all the way into this fellowship. One, because it helped me to take a step back and understand that I am not aware about each and everything and second, at the time of self-doubts it also comforted at times realizing that it is okay if I don’t know everything. Because let’s be honest, how can one be aware of everything? It’s practically impossible to know everything. I feel we all are selectively aware. It depends upon the amount of exposure we get or experiences we have in our lives or the level of interest we have in a particular topic.
Working at the grassroots, one thing that I have realized so far is that the easiest way to problem solving is to put it on the community. Every discussion comes down to community awareness. Got to a village, talk to a Sarpanch or a community leader or even a teacher and they will give you a list of 10 pointers showing that how people here don’t understand. “Madam ji yahan ki dikkat bass yahi hai ki log jagrut (aware) nahi hai”– a sarpanch of a village who is technically a Sarpanch sasur (father in law of a lady sarpanch) telling me how the people in his community are unaware.
I just feel frustrated to hear this every time. “Community is unaware” is what I want to stress here, because in many ways we all are ignorant. Unknowingly or knowingly we all are unaware about a lot of the trends we have fallen trap into. We are all aware of the things which concern us. So let’s just call all of us selectively aware and also it is okay, if our community is not aware about each and everything.
After a women’s health study conducted by Aajeevika Bureau, we tried to bring up this issue in front of the authorities. We planned to conduct a workshop at the block level consisting officials from different departments and various NGOs working in the region. The study’s objective was to understand the social, health (maternal) and entitlement status of women migrants from four Panchayats of Kushalgarh. We shared our insights with them in order to get their input and also to suggest our recommendations. People validated our findings and some of them also pointed out how corruption is responsible for such poor conditions. But there is also an issue with narrowing down this to one element.
In systems thinking, a ‘cloud problem’ has many forces working as a system. Therefore, by focusing on a single element, one can’t reach to an effective solution. My co-fellows and I tried to address and map one such cloud problem where we tried to find out the forces causing low literacy levels among the tribal population. When we tried to put all the elements on a map, the internal/motivation of kids to go to school, came out to be the element with maximum number of connections and the awareness among the community was lying in some remote corner of it. But still, if you ask a school teacher working in the community, they will very conveniently blame it on the parents and students and say “Ye bache shiksha ka mahatva samjhte hi nahi hai”.
Even in the workshop we conducted about our health study this was prevalent. A doctor explained to us that people themselves don’t want to use any other mediums of contraception other than hysterectomy. He further added how they are not aware that the white water discharge is a pelvic disease, primarily a bacterial infection and is not related to uterus infections which could lead to hysterectomy. What the doctors didn’t point out was that the Aanganwadi workers get incentives for each and every sterilization operation done through them, (this is further a flawed system of payment for ASHA’s and Anganwadi’s based on incentive rather than fixed amount).
India has committed 48 million additional women to reach under the umbrella of family planning by 2020 London Family Planning Summit in 2012. The document says that the target based approach was replaced by decentralized community needs assessment based approach, but on-ground the picture looks a little different. The larger percentage of meeting numbers still lie on the female sterilization operations.
Our health systems have failed in developing trust among the community, our survey also validated this, except during delivery time, people do not prefer going to government hospitals. Around 80% women visited private institutions (clinics, bhopa, Bengali) for any kind of illness. Institutional deliveries in government hospitals has escalated in the past only due to Janani Suraksha Yojana in which the delivery is free and money comes to the mother’s bank account after the delivery. This points more towards an economic benefit rather than trust in the system. The worrying trend of hysterectomy in Kushalgarh has a lot layers to it and there are many different perspectives. Factors such as lack of empathy among the authority and staff members, trust for government health systems among people, the corruption involved etc. All these factors need to be addressed in conjunction with each other. Because then only we would move towards the first step of solution finding – understanding the issue.