Apart from this focus in the area of Pazahverkadu, the Community Health Cell team in Chennai also took part in the activities as well as strengthening the Tamil Nadu chapter of the People's Health Movement- Makkal Nalavazhvu Iyakkam.

The Facilitation of the Pazhaverkadu Action Network.

One of the CHC team members, Mr. Ameer Khan was the convener of the Pazhaverkadu Action Network (PAN). In preparation for a large project on Community Based Disaster Preparedness, Ameer Khan attended training on “Community Based Disaster Risk Management (CBDRM)”. This training was organized by RED R and was held between the April 8 -12, 2006. Through this training there was a clearer appreciation of the various components of CBDRM. This enabled the participants to gain enough skills to do trainings for others involved in CBDRM.

Ameer Khan also was part of a visit to Nagapattinam between April 18 – 20, 2006 that was organized by Tamil Nadu Tsunami Resource Centre (TNTRC). The main aim of the visit was to understand the successes and gaps in the Tsunami rehabilitation after 15 months of the disaster. It was also meant to facilitate a network formation among the various district resource centers, which was established during the visit.

During this period PAN obtained funding for a large project titled, “Community Based Disaster Preparedness (CBDP)”. This project which was being coordinated by PAN, saw each of its constituents taking charge of one component of the project. In addition PAN also partnered with Loyola College, one of the premier educational institutions in Chennai, who was looking at the rejuvenation of the eco-system of the area as part of this project.

Ameer Khan facilitated a five day workshop on Community Based Disaster Preparedness for NGO staff members between June17 – 21. 35 participants from the local NGOs underwent the training.

During the month of August there were meetings to finalize the formation of a District Resource Centre under the aegis of PAN. The District Resource was inaugurated on December 27, 2006.

Ameer & Asha also attended three major meetings facilitated by the Government of Tamil Nadu – on Stock-taking in Disaster responses on April 30, 2006, State level consultation on Disaster Risk Management on September 7, 2006 and a workshop titled “Social Equity in Disaster Responses” on August 29, 2006.

During the month of November there was a visit from the CordAid financial team to review the financial management aspects of the project that was being implemented by PAN. Ameer as the convenor of the network was involved in the two day meeting held between November 7-8, 2006. The Community Based Disaster Preparedness (CBDP) project review was conducted by the CordAid team on December 17-18, 2006. On March 17, 2007 Ameer Khan met with Ms. Maja Pavlov a consultant with CordAid who has been requested to strengthen management systems in the project, and who will advise the project till the end of April.

CHC through the inputs of Mr. Ameer Khan and others in the Tsunami Project team in Chennai have been supporting the Network in the implementation of the project as well as in the smooth running and strengthening of the Network. Apart from the meetings and programs described above, Ameer visits Pazhaverkadu on a regular monthly basis specifically for PAN related activities. The various support activities include regular visits, monitoring various activities, attending Project Core Committee meetings as well as facilitating the smooth functioning of the 7 member network through regular communications and network building activities.

Mr. Ameer Khan also initiated steps to create alternative leadership in preparation for a withdrawal phase beginning from June 2007 when the present tsunami project ends. Apart from this, the implementation of the CBDP project that PAN is implementing was also reviewed and certain mid-term changes were made in the project management for the efficient completion of the project. PAN organized a CBDP workshop on. January 11 and 12, 2007. On January 23, there was a PAN meeting to review the developments and the implementation of the CBDP project. This was attended by all the PAN members and the convener. On February 9, there was a joint meeting between the Loyola team and the CBDP implementation team. This meeting focused on the review of the project and further discussed its implementation.

Training of NGO staff as Health Activists.

Based on the expressed interest and need from the various NGOs, CHC initiated a series of sessions that provided community health inputs for a few selected NGO staff, last year. Based on the success of these sessions, and after a few rounds of discussions with both the staff as well as the directors of the various NGOs, it was decided to initiate a formal and modularized training as part of our community health inputs into the region. The overall objectives of the training programme were as follows:

1. To train a group of health activists who would be nodal persons for health in their communities, who would be involved in identifying and counselling vulnerable groups, organizing community led monitoring of public sector facilities, develop two volunteers from the community to support them and incorporate health and the broader determinants and the principles of community health in their routine work.
2. To facilitate the development of community level workers volunteers who would support the health activist in her / his activities. This was to be done in partnership with the health workers.
3. To network among the various NGOs active in Pazhaverkadu and to facilitate the inclusion of health components into their respective agendas.

In the training sessions the following trainings were imparted:

Knowledge of Community Health:

1. Basic understanding of common illnesses and home-remedies and first-aid for common injuries and accidents.
2. Basic understanding of significant public health problems including communicable, non-communicable and environmental issues.
3. Basic understanding of women's issues and child care.
4. Understanding the public health system and the ICDS and other welfare schemes of the Government – both health and non-health related.
5. Understanding the structure, functioning and functions of the local self government apparatus as well as the public administrative system.

Attitude on the determinants of health and critical issues:

1. To appreciate the broader determinants of health.
2. To appreciate the importance of community processes as not merely 'means' but as a legitimate 'end' in itself.
3. To develop critical thinking / questioning of the status-quo.
4. To develop a sense of team-spirit and facilitate collective action.

Skills to address community health:

To develop the following skills:

1. Communication skills.
2. Decision making and problem solving skills.
3. Training skills.
4. Motivating and skills to convince the community about the benefit of the health messages.
5. How to perform a community based needs assessment.
6. The importance and basic skills regarding recording and documentation.

Based on these learning objectives, a training curriculum was developed after three rounds of discussions with the NGO program managers, the trainees themselves and internal team meetings in CHC.

After the finalization of the curriculum in June 2006, CHC initiated the training program with weekly half-day sessions and field visits. Some of the results of such training were obvious from the following examples,

? Many of the health activists reported that they were more confident in giving health related advice / counseling. There were also many instances where their appropriate advice had led to proper diagnosis and cures.
? Most of the health activists reported using the messages learnt, in their families and among their close friends.
? When there was a large outbreak of chikungunya, all the health activists took a keen part in the work of their NGOs during vector control campaigns and to spread the main messages of prevention. They all took part actively in the campaigns.
? They had come up with a demand for more inputs on planning community level work and planning interventions for the prevention of common diseases. Among the two diseases chosen were Diarrhea and Tuberculosis. Towards this end, it was planned to initiate a community based survey on the prevalence of risk factors for diarrhea as well as to initiate community based monitoring of TB treatment facilities under the Revised National Tuberculosis Control (RNTCP) Program.

Apart from this there were detailed lesson plans developed, handouts and reading lists developed. A brief list of the training sessions held and the topics covered in them are given below:

Sl. No. Date Topic
1. June 8 & 9, 2006 Child health & adolescence health along with Aid India Resource Persons
2. July 6, 2006 Orientation and preliminary discussion on curriculum
3. July 20, 2006 Orientation and preliminary discussion on curriculum
4. July 27, 2006 Disease causation / inflammation / cold and cough
5. August 3, 2006 Finalization of curriculum – distribution of notebooks / importance of recording
6. August 10, 2006 PHM / Health Movements / Community health concepts
7. August 24, 2006 Field visit by CHC staff
8. August 31, 2006 Review of field visits / feedback
9. September 21, 2006 Approach to fever
10. September 28, 2006 Diabetes
11. October 12, 2006 Chikunguniya
12. November 2, 2006 Hypertension
13. November 23, 2006 Stomach Pain – Gastritis, Appendicitis, Gall stones
14. November 30, 2006 Stomach pain (cont’d.), Dysmenorrhea, Painful urination.
15. December 7, 2006 Social Determinants of health
16. December 14, 2006 Water borne diseases
17. December 21, 2006 Diarrhea
18. January 4, 2007 Orientation and preliminary discussion Tuberculosis.
19. January 11, 2007 Review on Tuberculosis and focus on the National Program.
20. January 25, 2007 Jaundice, Cholera, Finalization of the survey questionnaire.
21. February 1, 2007 Parenting skills training – Resource person Ms. Prema Daniels.
22. February 8, 2007 Review of Jaundice.
23. February 21, 2007 Open session with invited community members.
24. March 1, 2007 Cancers

During January to March 2007 there were three major developments in the training of the Health Activists. These were:

1. Training in simple community needs assessment / survey techniques.
2. The involvement of community members in the training and the subsequent initiation of training sessions for the community by the health activists themselves.
3. Facilitating the linkages of the health activists with the larger People's Health Movement at the district and the state level.

During the months of January and February there were regular discussions on the methods of assessing the risk of the community the health activists were working in for diarrheal diseases. Towards this end, the group collectively developed a simple questionnaire covering the various risk factors and pilot tested the same. It is hoped that this exercise would impress upon them the importance of a thorough design and planning of surveys, as well as give them a feel of real life research and also an opportunity to follow up on the results of their research.

There was a demand from the trainees to take the lessons they learnt in the classes to the communities they work with. Towards this end, in February and March 2007 there were sessions where community members from the hamlets where the activists worked were invited to attend a session, and subsequently there was a session where activists had mock teaching sessions and then went to three villages / hamlets in the area to take a class for the community. This was greatly enjoyed by the activists as not only were they learning new skills of communicating to larger groups, but also the response of the community added great enthusiasm to the whole training process. It was decided to conduct such exercises more often from then onwards.

The CHC team had always felt that for the long term sustainability of the activists and their work in their respective communities, it was important to link them with the larger health movements. With this in mind, the CHC team linked the health activists and their NGOs to the district and state level People's Health Movement. As part of these linkages some of the health activists got involved in the pre-state health assembly and district level activities. In addition most of the activists also attended the 2nd State Health Assembly in Chennai, where they were exposed to the work of health activists from all over the state. These linkages both with their communities as well as with the larger health movement had infused great energy in the whole process.

Leadership among Youth of Pazhaverkadu.

CHC had initiated a program for the youth of Pazhaverkadu last year itself. This program consisted of three main components:
? Regular weekly meetings of the students.
? Monthly perspective building sessions.
? Financial support for their textbooks and travel to College.

The goals and objectives of this program were clearly set out at discussions within the team and the students themselves. The goal was to develop a group of leaders who will be focal points for critical change. The sessions with the youth were with the following learning objectives:

Knowledge:

? To be aware of the history of the various social reform movements in Tamil Nadu.
? To know the history of the various student movements in the state of Tamil Nadu.
? To have a preliminary knowledge of Gandhian and other alternative economic thought.
? To develop an understanding of the different religions.
? To have an introduction to different political ideologies.
? To be introduced to a caste based analysis of society and social issues.
? To be introduced to a gender based analysis of society and social issues.
? To be introduced to the concept of an Alternative media and entertainment sector.
? To understand the concept, the components and the impacts of Globalization.

Attitude:

? To develop a questioning spirit.
? To appreciate the concept of religious tolerance and plurality.
? To develop a tolerant attitude.
? To appreciate literature.

Skills:

? Critical analysis.
? Communication skills.
? Information gathering.

The issues addressed by the youth were,

Campaign against Water privatisation: Subsequent to a session of the privatization of water and the various issues surrounding this on August 11, the students decided to conduct a campaign against water privatization and to focus on Coke and Pepsi as examples of improper management of water resources. The meeting on the September 8, was dedicated to developing the material for the campaign. The campaign and rally was held on September 9. This was reported widely in the local press.

Addressing local transportation issues: On September 29, the students met to discuss the problem of local transportation. The local transport connecting Pazhaverkadu to the local town was notoriously irregular. This put the students, local businesspersons and the localities to great trouble. The students took the initiative in going around the town, talking to all the stakeholders, collecting signatures on a petition and then submitting it to the relevant authorities. They also extracted a commitment from the transport department for regularization of the transport timings. The various activities of the campaign were conducted during the months of October and November 2006.

Other issues taken up: Apart from the above activities the following were also done to facilitate various essential skills among the students, these include,

? Collecting used textbooks from those who had passed the yearly exams.
? Making lists of textbooks required.
? Making lists of transport requirements.
? Dividing responsibilities for actually going to the nearest town to purchase the textbooks.
? Maintaining accounts of all the money they handled.
? Preparing monthly account statements for the funds for transport.

All these activities increased their confidence as well as taught them important skills in management of time, human power and finance. The inputs from CHC team especially by Asha and Ameer were largely in facilitating the meetings, guiding the office bearers and supporting decision making processes. Towards this CHC team members attended at least one meeting of the student club every month.

The above two campaigns show very clearly that the students club and the activities have certainly increased their confidence, and have begun inculcating leadership qualities in them.. Perspective building sessions and the initial phase of consolidation of the students club, the textbook purchases and the accounts submission have been completed.

After these campaigns, members of the CHC team attended 3 more meetings of the students club. These were on the January 13, January 25 and February 8, 2007. During this period one session was arranged as a perspective building session, where a leader of a district level youth federation addressed the students on topics of immediate interest.