The
main task of the Health Trainer is to equip a team of Village Health
Workers with adequate and appropriate skills to address local community's
health concerns in a sustainable manner. These VHWs will become
the interface between the client communities and the service providers.
Non-violent
resistance to British colonialism in the sub-continent led to independence
for India in 1947 and divided the secular state into India and Pakistan,
forming the Republic of India in 1950. Later in 1971, after disagreement
between the two countries, East Pakistan (now Bangladesh) also became
a separate nation. Located in southern Asia, bordering the Laccadive
Sea area of the Indian Ocean (near important trade routes), Arabia
Sea and Bay of Bengal, the country has a large area of 3,287,590sq
kms adjoining Bangladesh, Bhutan, Burma (aka Myanmar), China, Nepal,
and Pakistan. The terrain varies between upland plain (Deccan Plateau)
in the south, flat to rolling plain along the Ganges, deserts in the
west and Himalayas in the north. The climate is extremely varied. The most influential feature is the wet season, or monsoon. This breaks on the far south Keralan coast at the end of May, working its way across the country over the following month and half. During this period, the regular downpours, interspersed with sunshine hold down temperatures. This produces a pervasive humidity. The monsoon causes flooding in parts disrupting communications and transport services. In the Himalayan foothills landslides are frequent. In winter the north of India, including the capital New Delhi, can be affected by chill winds blowing off the Himalayas and freezing fog, while the south plains are still baked by the post-monsoon sunshine. In recent years the East Coast has been hit by severe cyclones that caused a high death toll, severally affecting homes, basic services and agriculture. The extremes of weather and an incomplete infrastructure combine to produce unpotable water, insanitary conditions and endemic malaria. India has natural resources of coal (fourth largest in the world), iron ore, manganese, mica, bauxite, titanium ore, chromite, natural gas, diamonds, petroleum and limestone. Manufacturing industries include textiles, chemicals, food processing, steel, transportation equipment, cement, mining, petroleum and machinery. It exports textiles, gems and jewellery, engineering goods, chemicals and leather manufactures. There is a strong demand for the high technology exports. India is the dominant economic power of the sub-continent with an expanding economy, encompassing traditional farming and modern agriculture that produces rice, wheat, oilseed, cotton, jute, tea, sugarcane, potatoes, cattle, water buffalo, sheep, goats, poultry and fish; handicrafts; a wide range of modern industries; and a multitude of support services. English enjoys associate official status but is the most important language for national, political, and commercial communications. Hindi the national language is the primary tongue of 30% of the people and there are 14 other regional, official languages. Transport between towns and cities is cheap, extensive and provides a choice of trains, planes, buses and even boats. The train network covers almost the entire country and is composed of inter-city, local passenger, super-fast, and steam locomotive services. Buses go almost everywhere, more frequently than trains in daylight hours, but are less comfortable and conditions vary. Driving is not for the beginner, expect the unexpected and other drivers taking liberties. Car hire vehicles come with a chauffeur. Transport around towns varies between buses, suburban trains, taxis and bikes. With a population of over a billion, India has over 35 million living in poverty. Despite having made commendable strides in economic growth and reduction of poverty through aggressive economic and trade policies under its Structural Adjustment Programme, in 1998 India was still ranked number 128 in the United Nations Development Programme (UNDP) Human Development Index. The incidence of rural poverty at 37% is higher than that in the urban areas which shows a figure of 31%. Among those ravaged by economic poverty, women and children and indigenous communities, especially in rural areas, are the most disadvantaged. A different version of poverty - a socio-political one, arising mostly out of caste-based discriminations and denial of fundamental rights - makes their status even worse. Gender bias, which cuts across communities, exacerbates the already disadvantaged positions of women and girl children. In India average life expectancy at birth is 62.9 years, the adult literacy rate is 55.7% (39% for women, indicating low enrolment for girls consequent to gender inequalities in access to education) and the GDP is US$2,077 per capita. But behind these global figures there is a very uneven distribution of wealth and development. 99% of the country's wealth is concentrated in the hands of 3% of the population. Overall figures for Human Development Indicators remain significantly low in the case of women and indigenous communities, implying that poverty is invariably exacerbated by caste and ethnicity. The overall development picture is compounded by regional disparities: in the poorest states, such as Bihar, Jharkhand, Orissa, Madhya Pradesh, Rajasthan, Uttranchal and Uttar Pradesh, millions of people live in abysmal conditions of poverty, malnutrition, ill health and illiteracy. These millions are in the position of poor food security or marginal livelihoods. In the area of health there are extreme regional variations in health status. For example in 1996 the Infant Mortality Rate (IMR) varied from a low of 13 deaths per 1,000 live births in Kerala to a high of 97/1,000 in Madhya Pradesh. Madhya Pradesh has a maternal mortality rate of 711 maternal deaths per 100,000 deliveries compared with a national average of 460/100,000). There are also local disparities between the health status of people living in rural and urban areas. For example, the infant mortality rate (IMR) for rural areas was 87/1000 live births whereas it was 53 in urban areas. Gender-based violence is fast becoming a major cause of concern and is evident with the rise in infant mortality rate (IMR) in states where female infanticide is rampant (eg. Tamil Nadu, Rajasthan, Punjab). Female foeticide continues to be on the rise even in states like Haryana and Punjab which are rich with natural resources and have a thriving farm economy, indicating that gender-based violence is cutting across economic barriers, though poverty is found to be aggravating such violence. As per the Population Census of 2001, Sex Ratio has been found to be lowered over the last decade in many states, some of these states being new entrants to the list of those accounting for the missing females . It deserves mention here that there is an astounding 75 million females missing in South Asia. Policies to ensure social justice and equity have been found to be inadequately addressing the question of land rights and equitable distribution of land and other natural resources like water. Denial of rights of women and children in all sectors of development has remains a critical concern, in spite of the Indian sub-continent's achievements across other sectors like trade, Information Technology, defence and nuclear advancement. India is a signatory to a number of international treaties and declarations, including the Alma Ata Declaration of 1978 promising 'Health for All' by the year 2000 and the UN Convention on All Forms of Discrimination Against Women (CEDAW). Yet application of the provisions and clauses therein are still a distant dream, countered by poor implementation and dis-investment policies affecting social and health sectors. Unlike
many of the South Asian countries, India does have commendable systems
in place to ensure the rights of the people. These include: the National
Human Rights Commission (NHRC); the National Commission for Women;
the National Scheduled Castes and Scheduled Tribes Commission and
the National Minorities Commission. All these mechanisms are also
meant to provide added protection to women and children. The crux
however lies in the fact that information regarding these protective
mechanisms and access to them is rarely within the reach of the genuinely
disadvantaged people. Thus bridging such information and access gaps
is a critical factor in empowering the disadvantaged. In contrast to the agrarian economy that characterises India, Maharashtra stands out, with the highest level of urbanisation of all Indian states. The mountainous topography and soil are not as suitable for intensive agriculture as the plains of North India; therefore, the proportion of the urban population (38.69 per cent) contrasts starkly with the national average (25.7 per cent). The state has one metropolitan city, two mini-metropolises and many large towns. Mumbai is the state capital, with a population of approximately 9.926 million people. The other large cities are Pune, Nasik, Nagpur, Aurangabad and Kolhapur. Malik Ambar, the Prime Minister of Murtaza Nizam Shah II, and the then ruler of the Deccan (central parts of Southern India) founded Aurangabad in 1610. The city has a population of about 0.593 million people. Aurangabad derives its name from Prince Aurangzeb (who later became a Mughal emperor), who made it his regional capital when he was Viceroy of Deccan. His legacy is reflected in the architecture of the city. Even today, Aurangabad is a hub of culture and history in the Marathwada region. The Bibi-ka-Maqbara is the only example of Mughal architecture in the Deccan plateau. His son built it in 1679 as a tribute to Aurangzeb's wife, Begum Rabia Durani. Close to the city of Aurangabad are the famous Ajanta and Ellora caves, an architectural marvel. Through the caves, visitors can trace the evolution of three great world religions - Buddhism, Hinduism and Jainism. Aurangabad is famous for Paithani saris, himroo shawls and bidri work (zinc with silver embedding). The social
reform movement of 19th century Maharashtra was the result of the
impact of Western education on the elite of Mumbai and Pune. Reformists
tried to examine critically their social system and religious beliefs
and gave priority to social reform as against political freedom. Women's
Movement in the Sate gained strength too when Pandita Ramabai (1858-1922)
founded the Sharada Sadan in 1890 to help high-class widows. Maharashtra
will always remain proud of Dr. Bhimrao Ramji Ambedkar (1891-1956),
the chief architect of the Indian Constitution and the creator of
a social and political awareness among the scheduled castes of India.
The social reform measures brought about a renaissance and social-awakening
in Maharashtra. The efforts of DK Karve to improve women's education,
those of Bhaurao Patil, Dr Babasaheb Ambedkar and Dr. Panjabrao Deshmukh,
who championed the downtrodden people, as well as those of Tarabai
Modak in Vidarbha and Anutai Wagh in the Adivasi areas, have set an
example for other States. It is believed that this social reform Movement
has contributed much to the progress of Maharashtra.
Desirable
Placement
Information The project area is characterised by extreme states of poverty, which has resulted due to social inequalities, low agriculture productivity, climatic instabilities and lack of public policies in favour of development of this region. Currently
ISLD is working in villages around Aurangabad City and also in urban
slums within the city. The rural communities have an agricultural
economy. Drought and low water tables ensure that income poverty is
rather high among these communities, especially tribal and lower castes.
Resultantly, children's education and nutrition and health care have
remained low priorities. Lack of awareness in general aggravated low
health indicators. Accountability: Terms
and Conditions: Environment Managerial
responsibilities: Date
of Completion: September 2002
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