The enthusiasm of villagers partnered with CRHP combined with an eagerness to share the knowledge they had learned led to on-going project expansion through genuine grassroots mobilization and bottom-up community development. CRHP was especially keen on helping establish community-based health and development projects in the tribal areas of India where health care facilities are meager and opportunities for socioeconomic advancement are extremely poor. The condition of tribal peoples throughout India is best described as that of marginalization. Surveys of health conditions and access to educational and government resources reveal wide disparities and a disproportionate share of poverty.

          In recognition of the success of the Jamkhed model at achieving sustainable community-based health and development, CRHP began working with various state and foreign governments at their request. The project does not view the process of scaling up from an organizational perspective. Rather, CRHP is working in the role of a trainer and facilitator to enable other community-based organizations and government agencies to implement such projects in areas where the need is apparent. This is achieved through extensive residential and mobile training by CRHP of staff and grassroots workers at all levels of the health system. Our training programs emphasize the need for community involvement at all levels of decision making and project implementation., using real life stories and examples from Jamkhed.

Bhandardara

              In 1990, a group of village health workers (VHWs) along with CRHP field staff traveled to a mountainous region called Bhandardara, a tribal area of Maharashtra state about 250 Km from Jamkhed, to facilitate a participatory process of primary health care and development as had been accomplished in Jamkhed. The villages of Bhandardara are mostly inhabited by a tribal population that has traditionally depended on forest resources for their livelihood. The main occupations in this area are primitive agriculture and selling forest products. Village health workers from 40 villages with a combined population of 30,000 were selected by their communities and trained by CRHP and the Jamkhed VHWs. Although the region is well endowed with natural beauty, health and development in this area lags far behind other communities in relative vicinity. Malnutrition, diarrheal and other communicable diseases, scabies and other skin infections were the prevalent and highly visible health problems affecting this population.

             Through extensive community discussions, a number of potential, locally acceptable interventions and strategies were devised to tackle the most pressing economic and health problems as identified by the communities themselves. The involvement of the Jamkhed VHWs was an essential component in CRHP’s attempt to establish rapport and a sense of trust among the people of this area. This process underlies the very essence of comprehensive community-based primary health care (CBPHC) through grassroots mobilization.  

Adivasi Utthaan Program

In light of the success of the work in Bhandardara, CRHP was approached by the state government of Maharashtra in 2004 to develop similar CBPHC programs in seven other tribal districts. With a focus on tribal populations, this program is covering well over 150,000 people. The main objective is to promote holistic health through both preventive and curative approaches to health care with particular emphasis on vulnerable groups including women and children. 

This program utilizes the same multi-tier approach to community health as in the CRHP project villages with community health workers providing the majority of primary health care and health education at the grassroots level. More complicated medical problems requiring in-patient treatment are referred to the government hospitals and PHC clinics because CRHP does not operate secondary care facilities in these areas. Through this program, 500 grassroots workers have received training in basic health knowledge either at the CRHP training center or in their own communities by the mobile training team . Topics for training include child health, nutrition, safe deliveries, and hygiene. Community health workers are also trained on how to recognize patients with illnesses such as HIV/AIDS, tuberculosis, and leprosy so as to refer these people for appropriate treatment at the district hospital. In addition, CRHP has trained project field supervisors, paramedical workers, social workers, and about 900 school teachers working at the tribal schools in each of the seven districts. These residential schools have been made a focal point for community development through this program.

The tribal health program of CRHP involves other development activities aimed at holistically improving the tribal communities’ health and living conditions. These include the formation of self-help groups for women’s empowerment, education programs for adolescent girls, agricultural and economic development projects, and primary education. CRHP also works to promote local awareness of government schemes for tribal development and the effective functioning of the Panchayat Raj (village government). 

ANDHRA PRADESH – S.E.R.P.

           At the request of the state government of Andhra Pradesh, CRHP embarked on its most ambitious training operation to date. Through the Society for the Elimination of Rural Poverty (SERP), the government is sending project coordinators, health professionals and grassroots workers from every district in the state of over 76.2 million people for 10-14 day training at the CRHP training center in Jamkhed. Since the initiation of this program in 2004, 1400 people have received training on the principles and practices of comprehensive community-based primary health care with an emphasis on how to incorporate the strategies and lessons learned in Jamkhed to the particular rural areas of Andhra Pradesh from which these health workers come.

Exporting the Jamkhed Model

          Over the past 30 years CRHP has trained over 100,000 community health and development (grassroots) workers. Currently, the training center receives 2,000 trainees per year from NGOs and government agencies from nearly every state in India and about 100 other countries. Experience has shown that such an approach to scale up is more powerful and far more cost-effective to achieve a more significant and sustainable impact on community health than attempts to initiate remote branches. These, mostly female, community health workers are being empowered to serve the primary health needs of their own communities and promote positive socioeconomic development, often supported by other organizations established in those areas. An example is the state of Arunachal Pradesh from which CRHP has currently received 150 community health workers on behalf of another NGO working in that area. Establishing these partnerships ensures that existing resources are maximized without unnecessary reduplication of efforts. Follow-up training at Jamkhed and by CRHP through mobile training helps reinforce the concepts and principles that community health workers and NGO field staff require to promote effective health education, prevention and basic health care.