3. Innovative Approaches
for
Improving Health in Slums
A thematic multi-session one-day Conference
Inaugurated by
Shri Aimaduddin Ahmad Khan (Dhuru)
Honorable Minister of State for Health and Family Welfare, Rajasthan
Organized by JKSMS & MdM
On 4th April 2011
At OM Tower, Jaipur, India
Report Compiled by:
Roma Kaur Rana, Communication Specialist
Umesh Sharma, Project Coordinator, JKSMS
3
4. Contents
Foreword ............................................................................................................................................................................... 5
Executive Summary ............................................................................................................................................................. 6
Conference Background .................................................................................................................................................... 7
Areas of intervention .............................................................................................................................................................. 7
Target population .............................................................................................................................................................. 7
Project Objectives ............................................................................................................................................................... 8
Philosophy ........................................................................................................................................................................... 8
Intervention Methods ........................................................................................................................................................ 8
Results ................................................................................................................................................................................. 9
Welcome Address ............................................................................................................................................................. 10
Inaugural Address .............................................................................................................................................................. 12
The Necessity of Raising the Level of Health Knowledge in Slums....................................................................... 14
Panel Members .............................................................................................................................................................. 14
Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues ................................................ 17
Panel Members .............................................................................................................................................................. 17
Institutional Deliveries: Overcoming Obstacles in its Popularization ................................................................... 24
Panel Members .............................................................................................................................................................. 24
RHC Conference Recommendations ........................................................................................................................... 26
Annexures
Conference Agenda..............................................................................................................................................................27
Conference Images...............................................................................................................................................................29
Conference Media Coverage...............................................................................................................................................33
Conference Attendees..........................................................................................................................................................................38
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5. Foreword
After almost four years of implementation, the present conference
represented probably one of the most important milestones of the
Reproductive Health and Child Care project.
It all started four years ago, when Médecins du Monde and JKSMS
decided to team up in order to respond to one of the most
challenging health situations faced by the city of Jaipur: the
extremely high level of maternal and child death in slums. Indeed,
though the ―pink city‖ counts plenty of medical institutions (private
and public) and though numerous schemes are available for the
most vulnerable, it is a fact that slum dwellers tend to avoid frequenting the medical institutions. If it is
true for common illness, it is also the case at the time of pregnancy.
The first phase of implementation of the project was ―bumpy‖: slum dwellers were reluctant to listen,
understand or even participate to our activities. Who could blame them? Health behaviour in slums has
been inherited from centuries of tradition and especially the nomadic culture which prevailed in the slum
dwellers communities until recently. And it is well known that nomads only rely on themselves, their
family or their community. This attitude has been reinforced all through by the lack of consideration and
great despise they often get from the environment surrounding them.
After month and month of project implementation involving the pregnant women, their friends and
relatives, changes were noticed: more and more women were willing to deliver at the hospital or to go
for the Ante Natal Check-up. It was probably due to a better understanding by the communities of
pregnancy related issues and schemes available. Or maybe was it also because, for the first time, these
marginalized communities had been listened, respected and accepted for what they are.
Capitalizing on its success, the project did not stop there: in order for the project to be sustainable
beyond its end, it was also important to train volunteer, within the community, to act as health worker.
We call them the Community Health Workers: they dedicate some time to help other women dealing
with health issues. A second step towards sustainability consisted in advocating the cause of the
vulnerable population living in slums as well as organizing events where awareness of the general public
and key stakeholders will be raised. The conference was one of these events meant at gathering people,
informing, proposing, exchanging and debating.
As Pandit Nehru said, ―Ignorance is always afraid of change‖. This is what this project is all about: fighting
ignorance, creating knowledge, bridging the gaps between vulnerable communities and medical institution
and last but not least, giving hope.
Willy Bergogné
General Coordinator
Médecins du Monde
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6. Executive Summary
The Report highlights presentations and discourse which took place during the Conference on 4th April
2011 in Jaipur on ―Innovative Approaches for improving Health in Slums‖ organized by Jan Kala Sahitya
Manch Sansthan (JKSMS) & Médecins du Monde (MDM). This one-day Conference, an integral part of the
pilot-project to share best practices with State Health policy makers, health workers and Non-profit
organization working in the field of health in Rajasthan, was inaugurated by the Minister of State for
Health and Family Welfare, Shri Aimaduddin Ahmad Khan and consisted of three panel sessions
comprising of stakeholders like health practitioners, academicians, State Health representatives and slum-
dwellers (beneficiaries) themselves. The report highlights key points of the papers presented, outcome
from panel discussions and best practices established during the project and approved in the Conference.
The project intends to support policymakers in drafting appropriate policies as well as facilitate
implementation of policies & directives in the slum communities to ensure optimum results. The main
objectives of this conference were:
1. To present the findings of the baseline survey in selected slum areas
2. To initiate an open discussion on project findings
3. To create strategies for health improvement in less-privileged communities
Nearly 100 participants representing NGOs, State health department, medical profession, academia &
media gathered at the conference to discuss present health policies, participation of slum-dwellers in
State-sponsored health programs, general health awareness in the slums, prevalence of malnutrition in
mothers or children and exchange ideas and suggestions on pertinent health issues. The conference
opened with a plenary session followed by three panel discussion sessions covering the following topics:
1. The necessity of raising the level of health-knowledge in slums
2. Anaemia, malnutrition and vitamin deficiency in slums: the unspoken issues
3. Institutional deliveries: overcoming obstacles in its popularization
With the release of Census 2011, which revealed that more than 50% of women in Rajasthan cannot read
or write and almost 0.65million girls are missing, there couldn‘t have been a better time to organize this
conference and bring forth such findings that are proportionally related to literacy rates. Low literacy
rates can affect general health knowledge which could affect the rate of institutional deliveries in a
community. In the absence of institutional deliveries, births often go unregistered which does, indirectly,
impact the instances of female foeticides in any community.
The conference was unique in the sense that there was an active participation of the beneficiary
community. Women representatives from the project area sat through the conference and shared their
stories with the participants. The conference highlighted the inadequacy of existing communication &
advocacy methods used by State Health departments and some other NGOs in slums because of low
literacy levels and cultural trends prevalent there.. Therefore, the need to develop communication tools
that will work with these communities was stressed by the speakers and supported by all participants. As
a best practice, JKSMS tabled the proposal to use Street Theatre and other innovative approaches to reach
out to the illiterate and vulnerable masses.
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7. Conference Background
The Conference was organized as a milestone event of the pilot project on Reproductive Health and Child
Care (RHC), initiated by JKSMS and supported by MdM, in 11 slums of Jaipur to bring health knowledge to
low-resourced communities. During the past three years of the project period, JKSMS and MdM have
utilized various innovative strategies to reach out to the beneficiaries and create a means for sustainable
health development. The conference provided a platform to share best practices from the RHC project
with the attendees and now, through this report, to many more in the field of grassroots development.
The project is implemented in Jaipur by Jan Kala Sahitya Manch Sanstha ( JKSMS). A
non-profit organization founded in 1983 by a group of enterprising social activists, JKSMS
works with vulnerable women and children across the state of Rajasthan for their
development. JKSMS believes in democratic values based on secularity and community
participation at all levels. The strategic aim of JKSMS is to ensure active involvement of
children in all issues that are pertinent to their existence and progress. It strongly advocates the right of
every child to have a full-fledge childhood, where the children have the right to existence, protection,
development and active participation in their growth and self respect.
To implement the Reproductive Health and Child Care project, JKSMS is supported by
Médecins du Monde (MdM), an international humanitarian organization providing medical
care to vulnerable populations affected by war, disease, famine, poverty or exclusion.
Originally established in France in 1980, the Médecins du Monde network now extends to 16
countries in Europe, Asia and the Americas. MdM‘s work depends on efforts of nearly 3000
medical and logistics professionals who volunteer their time. Although MdM‘s primary aim is to provide
medical care, its work goes further to ensure long-lasting effectiveness.
Areas of intervention
11 slums located within the municipal city of Jaipur (Akbar Road, Amar Nagar, Bagrana, Bambala, Chokhi
Dhani, Galta Gate, Goner Mode, Idgah, Luharon ki Basti, Railway Station, Pratap Plaza). These slums are
all, except for Railway Station, in the vicinity of Jaipur. Only two slums among those previously
mentioned, are authorized slums. The others are not with the consequence that access to electricity,
drinkable water as well as social services and schools is an issue.
Target population
The target population in this project is 5000 inhabitants in 11 slums of Jaipur including almost 1250
women of reproductive age.
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8. Project Objectives
To improve the health situation of the target population with a focus on pregnant women, pregnancy
related issues as well as children below five years by encouraging the utilization of the private and public
health services. By doing so, the program intends to participate in the Indian efforts to reach the
Millennium Development Goals (MDG) implemented by the United Nations, and especially the objectives
4 and 5, related to child health and maternal health.
Philosophy
In order to maximize the outreach of the project and foster the condition of its sustainability, all the
activities were developed with a high degree of involvement of the community. In addition to the
mainstream initiatives (community meetings, group/individual interactions), other innovative community
participation methods were implemented for the first time in Jaipur such as the utilization of traditional
story-telling tools (Kawad box), theater performances : ―oppressed‖ method and community mapping.
Intervention Methods
With the view to attain the project objectives, several activities have been implemented:
These interactive sessions are led by the Social Worker whenever
Health Education Sessions
he/she is feeling a need to emphasize on a particular thematic with
the goal to deliver key messages and answer audience‘s questions. The duration of the sessions varies
greatly according to the subject matter and community participation. Specific groups (husband, mother-in-
law, local priests and so on) are sometimes targeted to deal with particular problems.
Social Workers provide useful advice during interpersonal meetings
Interpersonal Counseling or group sessions. In both cases, topics are chosen by the participants
themselves. During these sessions, different visual tools are used such as posters or drawings created by
Social Workers and/or in some cases by members of the community (children), pictures from
pubications, IEC posters, preventive tools (according to the topic) and so on.
Meeting are organized in slums by the community on important subjects
Community Meetings
related to their particular community. It is a good way to increase
community participation and let them play a role in their development.
Capacity -building of CHW CHW or Community Health Workers are recruited in each slum
to encourage community participation in the RHC project. They
help spread disease-prevention messages and accompany people to the medical facilities. In addition to
the principle of ―peer education‖, voluntary CHW are trained to gradually take over the work-load of
Social Workers. In this case, the objective is not to ask them to fulfill the duties of the JKSMS Social
Workers but to create the conditions of sustainability of the program with minimum external support.
8
9. Results
As of As of As of
Dec08 Dec09 Dec10
Evolution of % institutional deliveries 32% 41% 45%
Evolution of % Dai deliveries 56% 49% 45%
Evolution of % home deliveries 12% 11% 10%
Evolution of % of birth with the mother
completing 3 ANC 24% 46% 69%
Evolution of the % of baby going through NBC 11% 24% 31%
Evolution of the % women going to PNC 8% 9% 34%
Evolution of the % of pregnant women covered
by a Birth Preparedness Plan 62% 70% 76%
Evolution of the % of participation of male to
health awareness session 19% 31% 34%
Evolution of the % of institutionalized
deliveries getting the JSY scheme 33% 55% 61%
Evolution of the % of deliveries getting the JSY
scheme 11% 22% 28%
Total number of live births 128 125 155
Total number of child death in the project
slums(0-6) 31 20 10
Number of immunization encouraged 214 321 416
Total Number of Health Education Session 73 147 772
ANC: Antenatal care
NBC
PNC: Postnatal care
JSY: Janani Suraksha Yojana (Pregnant Women Safety Scheme)
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10. Welcome Address
By Shri Kamal Kishor, General Secretary, JKSMS
Honourable Minister of Health and Family Welfare, Shri Aimaduddin Ahmad Khan, Dr. Asha Pande,
Emmanuelle Ferblantier D'Souza from the Embassy of France in India, Isabelle Hainzelin from Medecins du
Monde, Janet Chawla of Matrika Foundation and dear
participants, I would first take this opportunity to
welcome you all, on behalf of JKSMS, for sparing your
valuable time to participate in this conference,
especially honourable Health Minister, at a short
notice. As you know our conference is focused on
improvement of health in slums and therefore, we will
be talking about the health issues of people living in
the slums of Jaipur. Before we begin, I would like to
share some information about JKSMS and its work.
JKSMS was launched in 1983 by a few of us friends,
studying at the University of Rajasthan, as we decided
to work for the underprivileged and backward people of the society to bring them into the mainstream.
Today, as we walk proudly into our 28th year, the organization has progressed manifold. We are working
in three main areas: Children, Health & Livelihood. Let me first share with you about our work with
children on the streets or in slums. We are working with almost 7000 such kids through 11 institutes for
street children, two shelters homeless children: Apna Ghar & Mamta Apna Ghar, where we take care of
children‘s health, education and professional development until they are 18 years old and when we are
convinced that they can fend for themselves and assimilate respectfully in the mainstream society. Apart
from this, we are running two counselling centers at the Railway station. In 1999, JKSMS established
primary schools in 19 slums with the help of five UN agencies and local community. After running
successfully for 5 years, these primary schools were finally handed over to the local government although
JKSMS counsellors and facilitators are still working in those schools to facilitate relationships between
government, staff and children for smooth operations. We are also running a 1098 child help-line number
where we provide help within 30 minutes of receiving a phone call from any child in need.
Talking about health, our most recent project was Reproductive health and child care in 11 slums where we
impacted 5000 women and children through our work. Our ongoing projects include AIDS/ HIV
programs with tribal people in 12 districts of Rajasthan including Ajmer. Over the years, we have realized
that in order to make development sustainable, we must ensure livelihoods in the communities we work.
Therefore, since 2001 we made Sustainable Livelihood our major thrust area. As a part of this program, we
have worked with 20,000 artisans who work in the costume jewellery industry in Jaipur, through JJADE (
Jaipur Jewellery Artisans Development Enterprises) program of SEEP Network. We help them in their
technical upgradation and marketing knowledge by collaborating with the American organization, SEEP
10
11. Network. The state government & UNDP have both
accepted the Samode Town Livelihood Project as a model
“JKSMS has received two national
project and the model is being replicated in 178 other
awards for its work on generating villages around Rajasthan. While continuing to explore
livelihoods for vulnerable communities: livelihood possibilities further, we have worked for
Best NGO in income Generation by generating agriculture livelihoods for which we received
Indian government in 2007 & CNBC’s two awards in the area of Water Harvesting. JKSMS is also
Best Income Generating Project actively encouraging craft-based livelihoods: one in Bassi
award for Samode town where almost near Chittorgarh- by helping local artisans to continue
25 % population of the town was working on wooden handicrafts like Kawad; and another in
helped through livelihood generation.” Udaipur- by encouraging miniature painting artists in theme,
color or design development and marketing strategies.
Collectively, JKSMS is working in nine different cities with
27000 artisans for their sustainable livelihoods. The organization has received 11 awards so far in
recognition for for this work. At this point, let me make an honest and sincere confession, JKSMS and its
beneficiary communities have made progress only through your continued support and blessings.
I would also like to make a quick mention about our focus on social mobilization in all our projects
because we strongly believe that until we reach out to the most marginalized of the communities who are
least developed and bring them into mainstream population; until we make them aware about
development and let them assume responsibility for their progress, there won‘t be any sustainability in
our efforts and results. Therefore, we emphasize on social mobilization- on getting the communities
involved in what is being done for them. To this end, we use Street Theatre or Nukkad Nataks as they are
popularly called in India. JKSMS has its own theatre group called Caravan theatre. It is an excellent tool to
reach out to the uneducated people who don‘t have access to other information mediums. We have been
experimenting new techniques like Theatre for the Oppressed People in collaboration with international
theatre professionals. Caravan Theatre‘s popularity has travelled far and wide in the world. We have a
resource centre in the town of Rainwal where we hold training programs for other organizations or
individuals who would like to use Street Theatre in social mobilization. Today, JKSMS boasts of six Street
Theatre teams within the organization.
In the end, I would like to share with you that through all these efforts, we are trying to create a new
leadership in less-privileged communities in Rajasthan for the past 27 years. These are mostly minorities
or marginalised communities. We can now see a new ray of hope as these people are coming forward to
participate in their progress. They are the new Change Agents.
Once again, in profound appreciation, I must say that all this has been possible through the huge support
we have received from various government departments and our partner NGOs along with the local
communities. Let me take this opportunity to thank all of you, Honourable Minister, esteemed dignitaries
and dear participants for your gracious presence and continued support to JKSMS.
Thank You.
Kamal Kishor
General Secretary
Jan Kala Sahitya Manch Sansthan( JKSMS)
11
12. Inaugural Address
By Honorable Shri Aimaduddin Ahmad Khan
Minister of Health and Family Welfare,
Government of Rajasthan, India
Distinguished dignitaries and dear
participants,
Reproductive Health is a major cause of
concern in the present health care system
in our country which impacts the general
lifestyle and future growth of our society.
And, it is most needed where it is lacking:
the vulnerable population that is affected
by poverty and illiteracy, the slum-
dwellers.
All and more important the government
has taken up the cause of reproductive
and child health at the grass root level.
The factor which most affects the reproductive & child health in slums is the lack of awareness of the
government sponsored schemes and basically problems of hygiene, nutrition, healthy lifestyle etc.
Anaemia, malnutrition and vitamin deficiency are the most prevalent in slums. The Government of
Rajasthan has taken various steps to compete these with more effective and active involvement of NGOs.
I‘ve been informed that this conference would mainly focus on three issues: mainly the need of improving
health problems in slums, anaemia, malnutrition or vitamin deficiencies and promoting institutional
deliveries in slums.
I‘m really happy to learn that the government‘s concern for reduction in IMR & MMR is finding room in
the thoughts of NGOs and their endeavour. Rajasthan has an infant mortality rate of 63/ 1000 live births
as against the national rate of 53/1000 live births. However, in the rural areas it is 68/1000 live births
whereas in the urban area it is 39/1000 live births. We have to bring it down to our Millenium
development goal of 27 and this is where the rural NGOs become all the more important by providing
technical support to the people living in the backward areas, making available the resources to the
government and spreading awareness about various government schemes at grass root level so that the
benefits of these schemes can reach them.
I‘ve been informed that JKSMS, along with MdM, France, organized street plays, one-on-one discussions,
group discussions, hospital tours and other publicity campaigns to enlighten citizens of the slums about
government health care facilities. The government is committed to making improvement in the public
health system in the rural as well as urban areas. And we strongly feel that reproductive health and child
care has an important role to play in raising the bar on health conditions in the state.
12
13. Over the years, rapid urbanization has led to a
haphazard rise of slums in and around Jaipur. While we “The combined efforts of JKSMS
are becoming stronger economically, it is sad to know and the Government of Rajasthan
that child mortality rate and sex ratio is not getting
have reaped fruits. Women have
much better. Women in the slum areas are still fighting
for basic survival because of poor health and economic become more aware and more
conditions. children are brought-in to
I felicitate the efforts of JKSMS and MdM in carrying on participate in the vaccination drives.
this research in the various slums of Jaipur district. Lately, more and more women
These efforts will go a long way in bringing awareness have come forward to volunteer.
about health, hygiene, institutional delivery, child care
Women have been taken for
and eliminating social evils prevalent in the society
among the underprivileged. hospital tours so that they are not
scared to visit or take their children
I‘m happy to know about the emergence of Community
Health Workers in these slums. The two organizations
to a doctor. I’ve been informed that
have indeed taken a very positive step in bringing health JKSMS and MdM have succeeded
awareness into the very homes of the people who have in making this awareness campaign
long neglected the need for good quality of life. I take
fruitful.”
this opportunity to appeal to all other NGO‘s working
in this field to re-enforce their efforts in bringing
awareness in slum areas especially to educate children about basic health & hygiene. Our children are our
future and if we want to empower our future, we must ensure that they have a safe, progressive and
healthy childhood.
I congratulate the organisers on this occasion and believe that this will further pave way for improving
health in slum areas
God bless you all. Jai Hind!
Aimaduddin Ahmad Khan
Minister of Health and Family Welfare
Government of Rajasthan, India
13
14. Panel One
The Necessity of Raising the Level of
“I had never imagined myself sitting
Health Knowledge in Slums
in such an intellectual gathering and
Panel Members sharing my story and that my story
was even worth being heard. I am
illiterate but JKSMS approached me
to work with them as a Community
Health Worker. I faced opposition
but that didn’t deter my enthusiasm
to help this project. I have understood
how can I play an important role in
bringing health awareness to my
community despite my lack of
education.
The Session was opened by Dr Bhupendra Sharma, the head of PSM
department who was moderating the panel discussion, with an When I began working with JKSMS, I
introduction to the low levels of health awareness in slums and didn’t know anything about the state-
existing efforts made by the government and NGOs. He presented the funded health facilities available to us.
first speaker: Alia, a Community Health Worker from Idgah Slum area
Gradually, I started visiting clinics and
in Jaipur district. Alia shared her story with the participants highlighting
health centers. Now, when I
the issues in her neighbourhood such as lack of interest in accessing
health facilities or learning about hygiene. She faced opposition from
accompany pregnant women or
both, her family and community when she began supporting the cause mothers, I am able to communicate
of maternal health and child care in the project initiated by JKSMS & their problems to the doctors
MDM. It wasn`t easy for her to convince pregnant women in her area confidently. It feels good to be a
to consult doctors in the health centers. Most families preferred to change-maker, even if it is just for my
check with the Traditional Birth Attendants (Dai) who were neither little neighbourhood. “
educated nor totally aware of health and hygiene criteria for safe
pregnancy and delivery. However, with persistence and determination,
Alia was able to win the support of both her family and community,
especially as she succeeded in generating some income by volunteering
to help women in the neighbourhood. For each visit to the health
facility, she charges a nominal amount of ₹5 whereas for the delivery
at the Health Center, the mother gives her ₹200 out of the ₹1000 she
receives from the government. Thus, the project has created health
awareness while empowering women in the community to create a
support structure and a unified front for the cause of reproductive Alia Khan
Community Health Worker, JKSMS
14
15. health and child care. Alia is just an example from dozens of Community Health Workers who are now
working in these slums; their training and activities supervised by JKSMS to ensure sustainable
development.
The second speaker in the session was Dr. R.P Jain, Reproductive & Child Health Officer with the
Medical and Health Department of the Ministry of Health and Family welfare of Rajasthan who began his
talk by stating the definition of Reproductive Health as accepted by the socio-medical fraternity: ―...a state
of health in which people are able to reproduce and regulate their fertility......‖. He pointed out that
Rajasthan fares really low when it comes to health awareness, especially Reproductive Health & Child
Care. Dr. Jain further elaborated on the various State-sponsored schemes like Yashoda scheme which is
not being accessed by the general masses in the slums. He emphasized the need for proper
communication strategies that will help regularize fertility among the underprivileged.
The final speaker in the first panel was Umesh Sharma, the Project Coordinator at JKSMS for RHC project
with Médecins du Monde. Mr. Sharma has an in-depth understanding of the issues faced in the slum areas as
he has been working on several development projects in urban slums. The presentation was an eye-opener
for the participants as he shared the baseline survey findings of the project area. Mr. Sharma went on to
expose the sad state of health affairs in these areas since the authority‘s general approach towards health
awareness has been rather informative instead of educating.
REPRODUCTIVE HEALTH & CHILD CARE: Project strategies & Approaches
Umesh Sharma, JKSMS
With the objectives to raise health awareness, scale up community participation and foster linkages between
slum communities and government services, the project employed five main strategies:
1. Avoid replicating efforts of other organizations
2. Encourage slum-dwellers to visit medical facilities
3. Sensitize slum-dwellers to appropriate hygiene standards
4. Focus on reproductive health & child care only
5. Create Community Health Workers from within the community
The project employed various innovative approaches like:
Increased community participation
Innovative outreach approaches (Kawad, Theatre etc)
Mapping medical facilities
Individual counselling
Educating about government medical facilities
These approaches have taken the form of best practices as they got the women and children interested in
convincing their families to become conscious about their health and hygiene. The end result was that
communities, who were earlier openly resistant to any kind of state interference in their reproductive
health or child care, now support and participate in government policies and schemes.
15
16. Kawads- the traditional art of story-telling in Rajasthan
Educating Women in the Slums Medical Mapping for the Community
Street Theatre to Engage the Community Group Discussions & Awareness Sessions
Images from the Project
16
17. Panel Two
Anaemia, Malnutrition and Vitamin
Deficiency in Slums: The Unspoken Issues
Panel Members
With the first session focused on raising the level of health knowledge in slums, the second session
highlighted the need for immediate intervention in the slum areas because of various unspoken issues like
Anaemia and Malnutrition. Most of the times, health workers or surveyors do not record some of the
understated but critical health concerns which have long term effect on reproductive health and child
care. This session, chaired by a very senior academician from the medical fraternity of Jaipur: Dr. TP Jain,
succeeded in bringing attention to pertinent topics like mineral and vitamin deficiencies and the innovative
supplements recommended by academicians. In countries like India, micronutrient deficiency, especially
iron, is most prevalent among children. Besides culminating into anaemia, the consequences of iron
deficiency are grave which affect the health as well as quality of life of the nation as a whole.
The first speaker to share her thoughts, research and recommendations was Dr Beena Mathur from
University of Rajasthan‘s department of Home Science. Dr. Mathur highlighted key statistics about
micronutrients deficiency among women, especially pregnant women or adolescent girls. She revealed
that the statistics are worst in the slums because of poverty and illiteracy. In her presentation, she
pointed out that because malnourished children suffer from an under-developed brain, lower immunity
and physical deformities or decreased stamina, they face higher levels of unemployment when they grow
up. She elaborated on the collective impact of malnutrition saying that it could lead to a huge population
becoming an economic burden on the society as they could be incapable of fending for themselves. She
informed the participants about government-run programs like ICDS Program, National Vitamin A
prophylaxis Program, National Nutritional Anaemia Control Program, Iodine Deficiency Disorder
Prevention Program, to name a few. However, the slum population refrains from participating in these
programs because of obvious reasons like lack of communication and awareness. Emphasizing, the
important role that NGOs like JKSMS & Médecins du Monde can play in eradicating Malnutrition from
slums, Dr. Mathur then recommended Leaf Concentrates as an effective solution to micronutrient
deficiency.
Leaf Concentrate’s Molecular Composition
17
18. Leaf Concentrates from Alfalfa are rich sources of, Iron, folic acid and beta carotene or pro-vitamin A,
good quality protein, other vitamins, fats and minerals.
COMPARITIVE CHART: Spirulina, LC & WMP Nutritive Value of Leaf Concentrate
Spirulina Leaf Concentrate WMP** Nutrients Value/100g basis
Nutrients
Moisture 3-7% 8% 3% Energy 344 Kcal
Protein 60g
Protein 55-65% 50-55% 26%
Fat 22.5g
Lipids 4-7% 9-10% 26%
Carbohydrate 12.5g
pufa* (w3) 1,8% (1,0%) 6,4% (4,8%) 0,9% Carotene 86700ug
(0,2%)
Folic acid 330.0ug
Carbo-hydrates 15-25% 10-12% 38% Iron 99.0mg
Minerals 7-9% 13-14% 8% Calcium 1865.0mg
Fibre 4-7% 1-2% - Phosphorous 604.0mg
*PUFA: Polyunsaturated Fatty Acids
**WMP: Whole Milk Powder
Dr. Mathur further shared the research that was conducted in a slum in Jawahar Nagar, Jaipur where3%
Alfalfa leaf concentrate was incorporated in the meals of the experimental group. The group comprised of
children aged 3-6 yrs and their initial haemoglobin levels, weight, height and morbidity profile were
recorded. For a duration of two years, there were quarterly follow-up and monitoring. The results were
as follows:
The results showed a significant
increase in the Hb levels of the
experimental group while they
decreased in the control group. The
difference between the two groups
Leaf was statistically significant (p<0.01).
Concentrate The morbidity profile of the
as a experimental group improved while
Micronutrient remaining unchanged in the control
Fortifier group. The anthropometric
measurements did not show a
significant difference between the
two groups.
Dr Beena Mathur
University of Rajasthan
18
19. The second speaker in the session was Dr. Mukta Arora who began by talking
about the general efforts that are being made to manage malnutrition, highlighting
government schemes like Integrated Child Development Services (ICDS).
Launched in 1975 by the Ministry of Women & Child Development, ICDS
represents one of the world‘s largest and most unique programmes for early
childhood development with a strong focus on:
- Improving the nutritional and health status of children in the age-group 0-6 years
- Laying the foundation for proper psychological, physical and social development of the child
- Reducing the incidence of mortality, morbidity, malnutrition and school dropout
- Achieving effective co-ordination of policy and implementation amongst the various departments
to promote child development
- Enhancing the capability of the mother to look after the normal health and nutritional needs of
the child through proper nutrition and health education.
With reference to key findings about the health benefits of Leaf Concentrates & Spirulina, Dr Mukta
Arora pointed out the role of NGOs in supporting initiatives through the adaptation of research &
recommendations into the implementation of policies & directives of government programs like ICDS.
She elaborated on the current directions by Supreme Court that food supplementation distributed in
Anganwadis (State-sponsored Day Care Centres) should not be sourced from contractors. Instead, such
food should be procured by Self-help groups or community-based organizations in the area. While this
directive is a positive step in strengthening SHGs, the flipside is that such food lacks any kind of
micronutrient fortifiers. Dr. Arora suggested that NGOs can play an important role in educating the
community-based organizations or SHGs about naturally-available micronutrients and their integration in
food products provided at Anganwadis.
Through this recommendation, Dr. Arora stressed the role of convergence of different government
initiatives with non-profit efforts in effective malnutrition management. Next, she gave the example of
ASHA Sehyogani who can pursue community mobilization to fight malnutrition.
The final speaker in this session was Manish Jain who is the Head of
Mission at Action Contre La Faim, India Chapter. Manish Jain enlightened
the participants about the various terms used to describe varying levels of
malnutrition like hunger, malnutrition, acute malnutrition, MAM & SAM.
MAM: where the body is seriously undernourished, starts losing weight,
and is at increased risk of infection. For the body to recover, MAM
needs treatment using food that is high in energy and nutrients, otherwise
MAM worsens to SAM.
SAM: a stage when the body is so undernourished that the immune system becomes ineffective and main
internal control systems shut down. This is when people die. This requires urgent medical treatment
and therapeutic food. Types: Marasmus, Kwashiorkor and Marasmic Kwashiorkor.
Chronic Malnutrition: a condition that lingers on for a longer period, or result from several bouts of
acute malnutrition. A consequence of an inadequate diet often combined with an infectious disease.
People can die prematurely, can contract infections or have their growth stunted. It stops children
reaching their full mental and physical potential.
19
20. Talking about different cases of malnutrition, Mr Jain also shared that in some cases over-nutrition could
also be termed as Malnutrition. He cited the figures for Rajasthan that 7.3% children are severely acute
malnourished which means almost 6,20,000 children in the state. Nearly two million children under five
die every year in India – one every 15 seconds – the highest number anywhere in the world. More than
half die in the month after birth and 400,000 in their first 24 hours. These are the unfortunate
implications of malnutrition.
Mr. Jain not only talked about the implications of malnutrition but also the reasons leading to this
unfortunate situation. He pointed at the lack of exclusive breastfeeding in Rajasthan, customary burial of
colostrums, load of mother‘s responsibilities other than child care. He summed up his presentation by
calling attention to the ways to fight malnutrition:
All lives are equal and children should not die of reasons for which remedies are known
Further build malnutrition in societal and political agenda
Community empowerment
Prevent and treat
Increased nutrition surveillance at district levels for better targeting
Strengthen human resources and institutional vigour
Innovate-in-delivery: openness to learning and adapt to local contexts. ‗…reject-accept-innovate-
adapt…; deliver-the-innovation
Increase use of MUAC
On treatment of children with SAM: think of other solutions to improve the coverage, timeliness;
- community based management of malnutrition (CMAM) where 85-90% children with SAM can
get treated
Not only manage from within, but managing across through concerted actions
20
21. Manish Jain then focused on the issues arising from maternal and child under-nutrition which is quite
common in underprivileged communities like slums. As indicated in the figure above, Mr. Jain also
described the various reasons leading to Maternal and child under nutrition like disease, low dietary
intake or simply household food insecurity. He summed up his presentation by calling attention to the
ways to fight malnutrition: Mr. Jain finished by sharing that there are shortcomings in the ICDS scheme as
well due to which the results are not as good as one would expect and hence, the Non-profit outfits
should continue to play their role by bringing in nutritionists at the centres and conducting regular follow-
ups with beneficiary families.
Dr. TP Jain, as the moderator of this session, complemented the
speakers for bringing research into the conference in a lay-out that
can be easily understood by the participants. He urged the
participants that these findings should be translated into change in
present policies and implemented in the field. About the hurdles
faced in policy implementation in low-resource communities, Dr
Jain revealed that people are used to ―expecting from the
government but not acting on their own‖. In his concluding note,
he strongly disapproved the present trend among beneficiaries of
being excessively dependent on non-profit organizations and
government bodies instead of inculcating accountability for their
situation and acting with self-respect.
What is needed is Behavior Change whereby people become aware of their own
responsibilities in maintaining good health in their families and hygiene in their
neighbourhood. Instead of saying,
“ what can you do for me?”, let them say “how can I improve my
family’s situation?”
Organizations working for development need to focus on changing health & nutrition
behaviour of the community by introducing knowledge and positive changes instead
of plain material help.
Dr TP Jain
21
22. Street Theatre
Nukad Natak or Street theatre, a form of theatrical presentation in outdoor public places with minimal
props or theatrical frills, is deeply rooted in Indian traditions as a form of grassroots communication to
propagate social and political messages. JKSMS has been using street theatre extensively in its projects to
reach out to the beneficiary communities and create social awareness. The biggest advantage of Street
theatre is that it breaks formal barriers between the actors & spectators by approaching people directly.
In the case of JKSMS street plays, the team likes to involve the audience in discussing the issues and pin-
pointing solutions. The final component of the second session was one such street play drawing the
participants‘ attention to various social challenges in implementing institutional deliveries in illiterate or
low-resourced communities.
With Aditya Sharma of JKSMS leading the performance, the rest of the team comprised of social workers
and project executives of the organization. They enacted a scene from a rural family illustrating how
women have to fight age-old traditions in order to bring changes. The focal point of the play was when
the spectators were no more mute spectators but participating actors! Aditya asked questions from the
participants as to how they would like to pick up roles in this play and make changes. This kind of
exercise helps change people who are taciturn props to become key players in improving social
situations.
1 Depicting negative family roles in institutional deliveries
22
24. Panel Three
Institutional Deliveries: Overcoming Obstacles in
its Popularization
Panel Members
The third and the final session in the conference was focused on an important aspect of reproductive
health: pregnancy and deliveries in a hygienic and healthy setting. Dr K.K. Sharma who is a Medical
Consultant at JKSMS and has been supervising the medical components of this entire project on
Reproductive health and Child care was the moderator for this panel discussion. The session brought
forth the story of an indigenous birthing attendant turned trained birth attendant and a change-maker: Sharda
Dai; as well as some indigenous birthing tips by Janet Chawla, founder of Matrika.
The session opened with the motivating story of Sharda Dai where she shared her own experience of
how she started early in life as a traditional midwife but later became a trained Community Health
Worker. Sharda Dai learnt about indigenous delivery-facilitating techniques from her grandmother in the
village. As a traditional birth attendant, Sharda used to provide health care, support and advice during and
after pregnancy and childbirth, based primarily on experience and knowledge acquired informally through
the traditions and practices of her community. The primary focus of Sharda‘s work was to assist women
during delivery and immediate post-partum. Occasionally, she would help with household chores too if
the family needed so. When JKSMS social worker approached her to learn about the health facilities
available to pregnant women, she was a little hesitant. However, the social workers continued to interact
with her and over a period of time, Sharda was convinced that she might have a role to play in improving
health outcomes in her slum because of her access to community and the relationship she shared with
women in her neighbourhood. Her contacts were valuable for the JKSMS social workers because the
slum women were otherwise unable to access government facilities on their own. Sharda underwent
training to learn about health care, hygiene, government facilities and responses to birth complications.
Now, she has emerged to be a confident birth attendant and community health worker. She prefers to
take her clients to the hospital for routine check-ups rather than judge their situation independently.
Sharda Dai confessed that she had never thought earlier that her work was so important to help reduce
peri-natal mortality but now, at the conference, she has realized the value of her role in the society. The
moderator, Dr Krishna Kant Sharma applauded her efforts, saying that CHW like Sharda or Alia have the
potential to become change-makers in healthcare of low-resourced communities.
The next speaker was the renowned social worker and founder of Matrika, which advocates traditional
birth techniques practiced by women around the world for centuries. Expressing her delight over JKSMS‘s
24
25. initiative to start an open dialogue to discuss options of optimizing health
benefits through maternal health and institutional deliveries, Janet advocated
the need to build bridges between indigenous and biomedical systems to
enhance health care in both rural and urban settings. She began by sharing
her thoughts: ―My basic advocacy point here is that we must understand the
sophistication of indigenous women‘s ―body knowledge‖ and not just solely
rely on a delivery of services approach—delivering western-oriented
biomedicine. Health is not a deliverable, nor are there quick-fix
technological solutions. We hopefully can build bridges between indigenous
and biomedical systems to enhance health care in both rural and urban settings.‖ Janet went on to share
her inputs on Dai‘s knowledge and practices from two perspectives: Best practices‘ and ‗Evidence-based
Biomedicine in US and Europe & Text-based Ayurvedic indigenous medicine.
Dais (traditional Birth Attendants) use the following practices which are currently
accepted as state of the art ‗evidence-based‘ practices during childbirth:
Encouraging movement during labour, not restricting or enforcing to lie down
Allowing easily digestible food and drink throughout labour if the mother desires
No Prenatal preparation: (shaving and enema usually given in medical facilities)
Continuous presence of a supportive person during labour
Massage, encouragement and other comfort techniques
No routine episiotomy—even with first babies—rather the massage and support of the
perineum
If the mother is able to sit for an upright or squatting position for birth
No premature cord-cutting…allowing the pulsations to stop before cutting.
(Traditionally dais throughout the subcontinent would cut the cord only after the
placenta is delivered)
From the Ayurvedic point of view both dais practice and Ayurvedic text reflect the
following principles and therapeutics:
Warmth: During both labour and post-partum the use of warmth/heating is essential.
Hot drinks, heating herbs, warm oil rubs, warm room are all used to stimulate labour
and comfort the mother. Postpartum use of warm compresses to contract uterus,
warming and sweet food and drink, a warm room, keeping legs together to prevent
hava/cold from entering vaginal area.
Oil: Used during labour for massage, sometimes mother is given a drink containing ghee,
oil is used to lubricate the birth canal for smoother delivery. Postpartum full oil massage
is given with special attention to the head. Heating substances such a gur, gond, nuts are
given to ‗cleanse‘ the body of ‗impure blood‘ or substances which need to be expelled.
After these two wonderful talks sharing personal experiences and traditional wisdom on birth-facilitation,
the final speaker and moderator of the Conference, (Col.) Dr KK Sharma highlighted findings from the
baseline surveys before the commencement of the project and how the solutions were planned for the
health issues in the community in his presentation and advocated the need for Institutional deliveries
especially in hygiene-lacking slum areas. He elaborated on slum conditions, discrimination against women
and other problems in these areas. Dr Sharma enlightened participants about the results of the pilot
project. There has been a marked improvement in the mortality rate and reproductive health of the
community now.
25
26. RHC Conference Recommendations
I. Non-profit organizations can play an important role in filling-up the gap
at various stages between government Schemes and implementation
results
II. Government scheme information can be disseminated to the uneducated
people by grassroot communication strategies using experience and skills
from non-profit organizations.
III. Traditional tools of communication like Kawad can be used for rural
outreach.
IV. Participatory Theatre can be an effective tool in mobilizing uneducated
communities and should be an integral part of communication strategies
targeting illiterate population.
V. Communities need to be made aware of natural supplements like Spirulina
or leaf concentrate’s role in micro nutrition.
VI. Spirulina/leaf concentrate products could be marketed/distributed in
undernourished communities through self-help groups thereby providing
livelihoods to many others.
VII. Replicating CHWs for sustainable health programs by sensitizing,
mobilizing & training potential CHWs though National Urban Health
program with the help of experienced non-profit organizations.
VIII. CHWs or community participation in planning process of any scheme or
program before its launch is important
IX. Women should be able to make a conscious decision regarding their
preferred facility/ environment when it comes to birthing/delivery.
X. Skilled birthing attendance should be made available regardless of where
the delivery takes place.
26
27. ANNEX 1: AGENDA of the Conference
Innovative Approaches for Improving Health in Slums
OM Tower, Jaipur
Agenda
Day 1: 4th April 2010
9:30 Inaugural Ceremony: Lighting of the Lamp
9:40 Welcome address by Kamal Kishor, General Secretary, JKSMS
9:55 Introduction to Medecins du Monde by Willy Bergogne, General Coordinator, MDM
10:10 Film Presentation: Reproductive Health & Child Care in Slums by Umesh Sharma
10:30 Address by Hon. Shri Aimaduddin Ahmad Khan, Minister of Health & Family Welfare, Raj.
10:50 Thank You Note to the Chief Guest, by Dr. Asha Pande, Vice-President, JKSMS
10:55 Tea Break
11:00 Opening of 1st Session
The Necessity of Raising the Level of ―Health Education‖ in Slums
12 pm Open discussion & Recommendations
1 pm Lunch
2 pm Opening of 2nd Session
Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Unspoken Issues
3 pm Open discussion & Recommendations
3:30 Street Theatre by CaravanTheatre Group
3:45 Opening of 3rd Session
Institutional Deliveries: Overcoming Obstacles in its Popularization
4:30 Open discussion & Recommendations
(Tea & Refreshments)
27
28. Program Details
Session 1: The Necessity of Raising the Level of “Health Education” in Slums
Moderator: Dr. Bhupendra Sharma, PSM Department
Panelists: RP Jain, RCHO, Jaipur
Alia Khan, Community Health Worker
Umesh Sharma, Project coordinator, JKSMS
Session 2: Anaemia, Malnutrition and Vitamin Deficiency in Slums: The Non-Spoken Issues
Moderator: TP Jain, RVHA
Panelists: Dr. Mukta Arora, UNICEF
Manish Jain, Head of Mission, action Contre la faim
Prof. Bina Mathur, University of Rajasthan
Session 3: “Institutional Deliveries: Overcoming Obstacles in its Popularization”
Moderator: Dr. KK Sharma (Retd. Colonel), Medical Consultant, JKSMS
Panel: Janet Chawla, Matrika Foundation
Dr. Akhilesh Sharma, Health Sociologist
Sharda , Mid-wife/ Community health Worker
Day 2: 5th April 2010
9:30 am to 12:00 pm Field Visit (Idgah & Bagrana) Facilitated by RHC Team
28
38. Annex 4: Conference Attendees (Arranged in alphabetical order)
Nos. Names Organizations Designation
1 Aliya Khan JKSMS CHW Idgah
2 Alka Sharma JKSMS Social Activist 9898638496
Aimaduddin Minister of State for
Ahmad Khan Health and Family
3 (Dhuru) Government of Rajasthan Welfare
Amarjit Singh
4 Rana Sikh Educational Board Director 9829055819 ranaamarjit@gmail.com
Social Worker Railway
5 Bhanwar Singh JKSMS Station 9351409328
6 Chanda JKSMS CHW Toll Tax Bambala
7 Daksha Parashar JKSMS Jt. Secretary 9982628100
8 Dr. Asha Pande JKSMS Vice-President 9829055717 ashapande@hotmail.com
9 Dr. B.D. Acharya State Health department Medical Officer 98299304711
Dr. Bhupendara
10 Sharma SMS Medical College Professor of Medicine 9414718374 drdpl979@gmail.com
11 Dr. D.K. Sharma Department of PSM Senior Demonstrator 9166973143
Dr. Dharmpal Senior Demonstrator
12 Bishnoi SMS Medical College (PSM) 9636585959
Dr. Dinesh Additional 0141-
13 Dwivedi SMS Hospital Superintendent 2351712
14 Dr. K.K. Sharma JKSMS Medical Consultant 9413134038 colkks@gmail.com
15 Dr. Kamal K Bajaj State Health department CMHO (retired) 9314504060 kamalbajaj@gmail.com
16 Dr. Kusum Garg SMS Medical college Assoc. Professor PSM 9460271172 drkusumgarg9@yahoo.com
17 Dr. M.P. Sharma PHOD, PSM Professor & Head 9929110045 sharmamaheshprashad@gmail.com
Dr. Narendar Health department,
18 Kumar Sharma Sanganer SMO, BCMO 9314966083
Dr. Nirmala
19 Sharma Resident Doctor PSM department 9784405605
20 Dr. R.P. Jain RCHO M & H Department 9829122232 rpjjpur@yahoo.co.in
21 Dr. S.D. Sharma Superintendant 9414278442 sdsharmajp@yahoo.co.in
22 Dr. S.N. Mathur (QI) ICDS Consultant 9460068713
23 Dr. Simple Gupta MSM Medical college 2nd Year DPH 9468599383 simplegupta@Yahoo.co.in
Dr. Sudhakar
24 Sharma SMS Medical college Senior Demonstrator 9950989143 sudhakar_143@yahoo.com
Dr. Sukhwant
25 Singh Department of PSM Resident Doctor 9462238207
Rajasthan Voluntary Ex-Professor Medical 0141-
26 Dr. T.P. Jain Assocciates college 2580507
27 Dr. Vimla Jain Mahila Chiktsalya Supperident Hospital 9414047721
Dr.Sweta
28 Tikkiwal SMS Hospital Resident PSM 9252311297
Emmanuelle Child Protetection &
Ferblantier Inter-country Adoption
29 D'Souza French Embassy in India Officer 9718498858
0141-
30 Ganpat Acharya Child Welfare Committee Chair Person, CWC 2000804
31 Govind Pareek M & H Dept. IEC Public Relations Officer 9828012352 govindpareek@gmail.com
38
39. 32 Isabelle Hainzelin MDM Responsible of Misson isabelle.hainzelin@laposte.net
33 Jaya sashi Sharma JKSMS Social Activist 9799693265 dnavajyoti@gmail.com
34 Jyoti Sharma JKSMS Social Activist
Kailash
35 Chaudhary JKSMS Social Activist 9694091047
36 Kamal Kishor JKSMS General Secretary
37 Karan Dudda Saarthak Consultant karan@saarthakindia.org
38 Komal Varma JKSMS Social Activist 9694091034
39 Kumkum Sharma JKSMS Social Activist 9694091038
40 Laxmi Madhukar JKSMS Social Activist 9351189884
41 Lokesh Sharma Dainik Navjyoti Reporter 9024413110
42 Mamta Prajapat ICDS Workar Angan Badi 7665122470
43 Manish Jain ACF Action Control la Faim Head of Mission India 9711200379 hom@in.mission-acf.org
44 Manju Sharma JKSMS Social Worker Idgah 9928651489
Mathura Prasad
45 Sharma JKSMS Social Activist 9694091036
46 Maya Laporte JKSMS MDM France maya.laporte@laposte.net
47 Mishra Ji JKSMS CHW Bagrana
Mrs. Nidhi
48 Sharma ICDS Angan Badi 9414788225
49 Mukesh Kumar JKSMS Social Activist 9694091016
Nahid
50 Mohammed Saathii Traning Officer 9314532436 nahid@saathii.org
Narendra Kr
51 Mahawar JKSMS Social Activist 9694091027
52 Neetu JKSMS Social Worker Bhagrana 9929338979
Poonam Chitransh Education &
53 Dhamniya Welfare Society GNM 9461500855
Social Worker Choki
54 Prabha Sinha JKSMS Dhani 9829705541
Prabhakar
55 Goswami I India Director 9414048817 goswami10@hotmail.com
Prof. Beena PG Dept. Raj. University Of
56 Mathur Home Scince Professor, Nutrition 9828366484
57 Raja Ram JKSMS Social Activist 9694091020
Access Development
58 Rajesh Jain Services Vice President 9414249226 rajesh@accessdev.org
59 Rajesh Sharma JKSMS Social Activist 9887569816
60 Rajish Verma JKSMS Social Activist 9314208424
61 Raju Sharma JKSMS Social Activist 9887009601
62 Ramesh Paliwal Taabar NGO Jaipur Director 9829850566 paliwalramesh@gmail.com
63 Ramesh Sharma Taabar NGO Jaipur Project Manegar 9462100211
Communications
64 Roma Kaur Rana JKSMS Consultant 9829055819 romakaur@gmail.com
65 Rekha Sharma JKSMS Social Activist 9694091033
Social Worker Khirni
66 Sangeeta Jadon JKSMS Phatak 9950350538
67 Sanjay JKSMS Social Activist 9509556181
68 Smt Sanno JKSMS CHW Bagrana
69 Santosh Saini JKSMS Social Activist 9602423225
70 Satyen VHAI Represention 09414076449
71 Shanu Kanwar JKSMS Social Activist 9694091012
39
40. 72 Sharda Dai JKSMS CHW Bagrana
73 Kusum Nair Department of PSM PHM 9829186096
74 Rukmani Dai Dai/ Retd. Nurse 9509556181
75 Sourash Sharma Sewa Sandesh Director 9413376076
Sudharkar
76 Goswami I India Coordinator 9928394598
77 Suntia Sahu JKSMS Social Activist 8052913265
78 Sushila Yadav JKSMS Social Activist 9982215081
79 Umesh Sharma JKSMS Pro. Coordinator 9929070085 b_i_t_t_o_o@yahoo.co.in
80 Vijay Sharma FXB India Surksha Consultant 9351308920 vijay1659sharma@yahoo.co.in
81 Vikram Singh JKSMS Social Activist 9929235724
82 Willy Bergogne MDM Gen. Coordinator 09717799917 genco.india@medecinsdumonde.net
For more information on
the RHC project, visit
http://www.jksms.org
or
http://www.medecinsdumonde.org
40