SOCHARA was never meant to be an institution as such but a resource centre creating a network of community health enthusiasts and activists. It was an idea of a space for collectivity, dreaming, innovation of ideas, projects, programmes, and processes towards Health for All.
We were inspired by at least seven stimuli from the 1970s and 1980s:
- The experience of a decade’s community orientation at St. John’s as faculty (1974-83)
- The idea of a ‘tap turner off – not a ‘floor mopper’ approach to health action and ‘balloonist’ not ‘intra-cellular’ in health research – during PG studies (1974)
- The idea of a friends circle in health and development – as members of medico friend circle – MFC (from 1976)
- The Janata manual of community health workers exhortation to ‘go to the people, live among them, learn from them, love them, start with what they know, build on what they have’… of the best leaders…., when the task is accomplished, their work done, the people are remark, – ‘we have done it ourselves’ (old Chinese poem). We use this manual as a text for a CHW training initiative at St. John’s. (1977).
- ICSSR-ICMR Health for All report (1981) ‘Health for All Goal depends on three things –
- To reduce poverty and inequality, and spread education
- To organise poor and underprivileged groups to fight for their basic rights and
- To move away from the counterproductive, consumerist, Western model of healthcare and replace it with the alternative model based in the community.
- Ideas inspired by a ‘Bharat darshan’ of two co-initiators (1982). (See ‘Notes on a year of travel and reflection’.)
- The definition of ‘Community Health’ we evolved with others – ‘Community Health’ is a process of enabling people, to exercise collectively their responsibility for their own health and demand health as a ‘right’ (1983)
SET-1
Q: What are the positive aspects of our institution?
• We have celebrated collectivity and working together for over three decades without any major crisis.
• We have taken the ‘health is not medicine’ idea seriously and created a space for all types of people from all types of backgrounds beyond medicine, nursing, dentistry, and AYUSH to get involved in health action (truly multidisciplinary and beyond the Bio-medical preoccupation with health or the control of the health sector by the medical profession).
• We have celebrated diversity and inclusiveness without focusing on identities and hierarchies but are sensitive to the diversity plurality and inequalities of our society.
• We have made our space inter and transgenerational often with up to 4-5 generations in dialogue with each other (see SOCHARA members and team list and its analysis).
However, over the years as we matured and engaged with Health for All opportunities we gradually moved from an informal catalyst resource centre and a networker to a training centre and a mix of catalyst ethos and programme initiatives. In 1998, this was accelerated and in 2003, we began a more structured fellowship (CHLP in Bengaluru and CHFP in Bhopal).
Q: What Human values do we demonstrate?
We believe and have tried to practice the following values which we have listed in a document that is shared with all team members during annual staff retreats and staff development workshops. Voluntarism; non-hierarchical functioning; participatory management; accountability; transparency; quality; collectivity over individualism; inclusivity; engagement for empowerment. We believe values have to be lived and caught, not professed or taught.
So only visitors, fellows, and younger team members can tell you if we demonstrate these values. ASK THEM. A few years ago. in our engagement with RGUHS – RG Institute of Public Health, MPH Honours Course recognized by UGC, we managed to introduce a module in MPH for the first time in the country – Value Orientation in Public Health (Five credits – three weeks).
These include Equity, Right to Health, Gender, Integrity, and Ethics and Quality.
Q: What are the positive things we do?
For every health or development problem or societal issue our team members get involved in when they work with us – we suggest the following action:
- Creating awareness of the problem (awareness in the community)
- Deeper analysis of the problem and contextualization – we call it S-E-P-C-E analysis – social, economic, political-cultural-ecological context analysis.
- Engagement with community-level action to begin with, (action)
As we grow in this competency with diverse opportunities and engagement, we encourage members to:
- Evolve training strategies at different levels to share the experience knowledge skills and attitudes from the community experience; (training)
- Introduce an aspect of reflection review, learning, and evidence gathering; (research)
- Engage with NGOs, networks, decision-makers, and policymakers to promote this action/initiative/programme; (policy action)
- Document and disseminate the same in a spirit of learning/sharing; (documentation)
We have over the years done these in a range of health challenges – women’s health, street children, tobacco and alcohol addiction, TB, HIV-AIDS; vector-borne diseases; people with disability, mental health, disaster response, and environmental & occupational health (see ‘What We Do’ section in the website)
Q: How do these help us achieve our objectives?
Over a period then all the five objectives we set ourselves get addressed not all together but sequentially. Also, as our name signifies we encourage involvement in awareness, research, and action.
In some areas, we have experience of all five, and in many areas, we are getting there, in some new ones we are learning through initial action and engagement (e.g., sanitation and waste disposal; community action for nutrition; community action for health including monitoring; and climate change).
Two additional strategies have evolved but are not necessarily stated as such because we believe in the idea of collectivity, health as a social movement, and a countervailing power – a groundswell from below that makes change happen.
We always network and bring groups together. We make collective charters, declarations, and recommendations and advocate with them.
Q: How do these benefit various stakeholders?
- We don’t use the word stakeholders as such though we understand the concept.
- Over the years we have had six broad groups that are linked to us and in various ways, we share all that we do and learn with them.
- Team members through regular team meetings, annual staff retreats workshops, and other events.
- Every team member who leaves is called an extended team member and wherever they work or reach in their journey, we try to keep in touch and involve them / connect with them to the extent possible.
- Associates – In every group we work with or involve a resource person we call them Associates.
- For every funding partner – project or solidarity – we call partners and try to ensure that at least one person in the agency or the organisation is specifically informed and involved.
- Individual donors are called ‘friends’.
- Since CHLP / CHFP started we have both fellows and field mentor networks. We share with all of them through websites; publications; clic; e-newsletter action initiatives; annual reports, and regular larger gatherings.
- We have a continuous stream of visitors to the SOCHARA Sarai seeking our support, solidarity, advice, and assistance.
As a resource centre, these are our stakeholders and through them, we reach the larger community to enable and build health.
Many of our stakeholders have wondered whether a community health system development process and a community empowerment strategy through health as a movement – can go hand in hand. We believe that they are complementary like the ‘yin’ and ‘yang’ of the new public health, which we call ‘community health’. After the CHLP and CHFP initiative, we have evolved a term that describes this combination i.e., activist professionals and/or scholar-activists.
SET-2
Q: What have been significant events in the journey of our institution that has resulted in reaching here?
We have had so many significant events in the last 30+ years that is difficult to prioritise which is more significant than the other, but I will describe some thrusts/events by phases.
1984-90 – Phase 1: CHC informal, formation phase.
Four co-initiators started the Cell; found 6 more to become a pioneering team and with six other professionals formed the Society by 1991 (Community Health Forum initiated for regular discussions with all people interested in the idea) – see Red Book ‘Community Health – the search for alternative process’.
1991-1994 – Phase 2 (RN as C/S)
The phase of experimentation of different ideas especially at the first four objective levels – community health awareness; action; training strategy and research level.
1994-1998 – Phase 2 continued with new C/S – SPT
During this phase, two major thrusts were health with non-health groups and training in the vernacular (Kannada, Tamil, Telugu, and Malayalam).
1998-2003 – Phase 3: with new C/S – TN Phase I
Based on the 1998 reflection and review three new thrust areas began. Health movement creation – JSA/PHM; SOCHARA’s response to tsunami (creating CEU in Chennai); health policy action (Karnataka Task Force and policy and MP JSR evaluations, etc.) and women’s health empowerment training – state and district level.
2003-2008 – Phase 4: with C/S TN Phase II
Start of CHLP (by TN); continuation of research and policy action. SOCHARA also hosted the Global PHM Secretariat on behalf of the India region and was active in JSA and state units. (The creation/facilitation of health as a social movement – JSA/ PHM was a very significant event in 2000 AD – see Red Book ‘Social Justice in Health’.
2008-2011 – Phase 5: with C/S – EP (representing new generation)
Health as a right orientation; CHLP Phase II and CHFP in Bhopal including the start of Bhopal CPHE.
Another interesting development in SOCHARA’s history is the free-standing initiatives and projects that started in SOCHARA or with SOCHARA’s involvement and became independent entities – CHESS, CFTFK, CHATA, CBR Forum, AIDAN, DAF-K, etc. (separate list with links will be sent later).
Q: What did we learn from these events?
- Each of these ideas has evolved gradually and only the emergence of ‘collectivity’ has sustained them.
- There is a need to be responsive to changing situations and challenges and therefore the inevitable degree of institutionalisation, legalisation, etc. is necessary but needs to be nimble, creative, and flexible with the focus on the software of human resources and the processes of interaction/involvement/participation/learning without preoccupation with hardware of building, structures, equipment, and technology which may be needed but must not dominate.
- There is phenomenal goodwill, willingness to participate; eagerness to engage in the system in government health system and policy; civil society, and the not-for-profit private sector and traditional sector. So, flexible and catalytic engagement and partnership are more important than going it alone and building and owning projects and structures.
In all these events, apart from the growth of a huge network of community health enthusiasts/practitioners including team members, Society members, associates, partners, friends, fellows, and field mentors – two concrete innovations stand out:
- the Community Health Learning Programmes (CHLP and CHFP and flexi fellows) and
- health as a social movement. (JSA/PHM/MNI/JAAK7 JABU/IPHU/GHW/WHO Watch etc.)
SET-3
Q: What would we like to continue in the new leg of our journey and why?
- The SOCHARA story is really the story of over 25 – 30 individuals from different backgrounds, disciplines, perspectives, and experiences coming together and participating in action, decision-making, governance, and of late, sharing and learning facilitation through CHLP. These personal journeys are the most precious legacy of SOCHARA and need to be collated and made available to the new generation to inspire them to do likewise, (these personal stories are very powerful!)
- There is a wealth of experience, experimentation, and contribution to SOCHARA processes, initiatives, and credibility – much of it documented but perhaps in an ad-hoc and dispersed format. This needs to be archived and made available/ accessible to inform the next phase and to be digitalized as well for easier access to a digital generation.
- Focusing on Human Resource development has been the single most important contribution of SOCHARA and the networks – formal and informal that link. The future SOCHARA team must see this as a legacy/resource and tap into it proactively (SOCHARA Sarai etc.). Our fellows and field mentors linked to the CHLP network are the biggest resource for the future, especially in many states.
- The first 25 years were marked by open-ended and responsive initiative/innovation in community health action at many levels (see objectives) and many themes. The next-generation team must continue this interactive, responsive innovation/initiative without the weight of history or the inflexibility of older SOPs.
- Explore, and recreate awareness of the present situations; be reflective with learning reviews of all that you do (research) and then act with this idea (action)/innovation/initiative at the 5 levels based on our objectives. Continue the process in an open-ended way.
Q: What would we like to leave behind and why?
- We may have overemphasized the anxiety of owning property, and the fear of the inflexibility of institutionalization including financial and other securities due to a Gandhian conviction that small is beautiful and catalytic.
- Times have changed and the next team needs to revisit these convictions and promote the sustainability of resources, structures, and frameworks with other approaches, without losing the shared values listed earlier. Even values must be revisited, reviewed, and collectively endorsed.
- However, all changes and ‘leaving behind’ should be informed by past experience and learning and collectively formulated for the future.
SET-4
Q: What would we like to stand for as an institution?
- Health for All is not just Health for many more or Health for those who can pay!
- Health is not medicine but physical, mental, social, and ecological well-being, and so every citizen, every profession, and every section of society can be involved in community health action. Therefore SOCHARA must continue to be plural, multidisciplinary, and multisectoral and those from the so-called medicalized health background must not allow the ‘white coat and stethoscope’ and see the community as ‘user, client, beneficiaries’, mentality to dominate or distort.
- Health For All by All!
- Recently I have placed seven propositions to the government – informally when the concept of UHC was promoted in the last few years.
- Health is not medicine and hence HFA/UHC is not universal medical coverage only.
- HFA/UHC includes systems beyond primary medical care including housing, nutrition, water and sanitation, livelihoods, education, environment, etc.,
- HFA/UHC For All is different from HFA/UHC for many more or for those who can pay.
- HFA/UHC systems and policies need people, the public, and the community as core participants.
- HFA/UHC needs technological innovation but not all technology is relevant for these goals.
- HFA/UHC should be plural and integrated building on all Health and Healing traditions.
- HFA/UHC is not all about hardware – finances, structures, systems, and technology – but requires the software of human resources, community-level action on social determinants, and health promotion.
We should promote them if the new post-transition team continues to believe in them.
Q: What goals are we setting for ourselves?
The new core team which will emerge at the end of this transition phase 2016-2019/20 possibly at the AGBM 2019 should be setting the new goals.
My answers to the questions earlier are only indicative and signposts from SOCHARA’s first 25 years.
My only suggestion would be that the new core team could be informed/oriented to the initiatives of the last few decades and the learning reviews conducted from time to time on most of them and the papers and publications that evolved from them – so that goal-setting while being contextual must be informed by history and past learning.
Q: How would we like various stakeholder groups to perceive us?
Stakeholders need to be encouraged to:
- See us as equal partners / learning together and not as users, clients beneficiaries, or only project or grant holders.
- We have resisted ‘funding muscle’ all these years and management jargon like SMART objectives and definitive log frames. We use them but creatively in our way reflecting process rather than project. We are basically into enabling and empowering communities to evolve health action – (see axioms particularly the first two so just input/output approaches etc., or provision and distribution of services cannot apply to our work. For, providing vaccines or latrines to people is very different from getting communities to value vaccines or latrines and participate in accepting building them. We are involved in the latter, not just the former).
- Enabling and empowerment will include providing goods and services active communitization of the programme and getting active participation involvement and ownership are what we are trying to do (the NRHM has now coined and accepted the term communitization which includes seven components – village committee, ASHA’s, community monitoring, Jan Samvad, Jan Sunwai, local account, partnerships with CBOs. SOCHARA along with many others helped in this acceptance through pro-active involvement in NRHM task forces.
- We must dialogue with stakeholders to appreciate this and in the past, we have had wonderful experiences of such partnership. The NRHM-AGCA (above), the Madhya Pradesh JSR reviews, and the Misereor external evaluation (Quo-Vadis) are three good examples of government and funder partnerships and stakeholders requesting us to become review partners of their programmes.
Q: If you had three wishes for the institutions, what would they be?
- Structural and technical support to build up the ‘Health for All’ archives / CLIC. We have a wealth of archives, documents, and publications of lived experiences not yet digitally available to an increasingly digital generation (the SIMS project was one such idea – which needs to be built upon actively).
- Setting up the Health for All Learning Centre – or SOCHARA Sarai – as a more organized version with multiple storytellers of lived experiences linking SOCHARA innovators of the past with community health innovators of the future.
- Active mainstreaming of core ideas from the CHLP/CHFP experience into mainstream academic / research and policy initiatives by facilitating, dialogue and active engagement with the system. The transformation of the Website into an active online interactive learning centre would be one way of doing it.
SET-5
Q: How will we get the goals that we set ourselves?
We need to organise a series of reflective, planning meetings to evolve this by an informal team. The process is already going on for a 5-year plan – to start with a revival of the CHLP within it – but it has gone on with fits and starts and changing leadership. A time may have come to move from purely in-house exercise to a planned, facilitated, expert-driven, serious process initiative with evidence gathering not just ideas – but context and praxis. The background data gathering for the marketing story could be part of this beginning – building further on the two meetings held earlier. (See Draft plans)
The focus must be on the full-time team and new EC as the core of this process of discovery and development.
Q: What sacred ritual(s) do we have in the institution that honours the work that we do?
- Collective, interactive, non-hierarchical discussions in a circle rather than a classroom – at the core.
- Sharing a meal and making culture part of the gathering – singing, visuals, non-pedagogical methods, storytelling, celebration, and personal journeys are also a must. Since the CHLP initiative, these have been a great bonding the motivating experience reminding us that community health is a celebration!!
- A serious and continuing effort – that celebrates diversity and plurality as a team experience – to be lived and practiced and not as an intellectual exercise to be discussed and debated.