Policy interventions for achieving long term objectives

Empowering Women

Empowerment of women is essential to achieving development objectives. The role of women in society is influenced by a complex set of traditions, customs, and values. Since they hardly wield any power, women face disadvantages relative to men in all spheres of life. In addition, they are often victims of gender-based violence that directly affects their reproductive health, and they suffer silently by adjusting to the situations as dictated by cultural norms. In Jharkhand, 22% of women were either beaten or physically mistreated since they were age 15. Women living in rural areas and with low-income levels are more likely to experience domestic violence than women living in urban areas.

There are several approaches followed to enhance the status of women and to improve their access to and control over resources. These include (1) the financial sustainability approach that concentrates on generation of additional income; (2) the poverty alleviation approach that stresses improvement in the quality of life; and (3) the empowerment approach that deals with gender inequalities and mainstreaming gender in the developmental processes.

To improve, the status of women and empower them, the Government of India has launched several schemes. The Balika Samriddhi Yojana (BSY) has been launched with the specific objective of changing the community's attitude towards the girl child. A mother of a girl child born on or after 1 5th August 1997 in a family below the poverty line in rural or urban areas is given a grant of Rs 500. Five national awards known as Stree Shakti Puraskar have been instituted. The awards will be given to those who have fought for the rights of women. Several other initiatives include establishing the National Commission for Women and Rashtriya Mahila Kosh and setting up the National Creche Fund, Indira Mahila Yojana, Balika Samriddhi Yojana, and the Rural Women's Development and Empowerment Project.

  • The department will work in collaboration with the State Commission for Women on issues relating to safeguarding women's rights and promoting their empowerment.
  • Discrimination against women in any form in reproductive health service delivery will be removed.
  • Mobilization of grass-roots women's collectives, street theatres, and local methods of dispute resolution will be tried out to effectively deal with violence against women.
  • Women's self help groups will be involved in the provision of reproductive health services, particularly emergency obstetric care.
  • Linkages will be established among the various departments and projects aiming to improve status of women, sponsored by either thee central or state government to achieve synergy.

Involving Men

Men hardly play any role in contraceptive use. Out of the 24.9% modern contraceptive method users in Jharkhand, only 2% were users of male methods, such as male sterilization and condoms. Male responsibility in reproductive health issues is essential to decreasing HIV/AIDS and other STIs. Men play a dominant role in decision-making with regard to health issues and contraceptive use. Contraceptive use and continuation is higher when husbands and wives discuss and agree to use contraceptives.

  • Provider bias against male methods will be removed by reorienting all health functionaries.
  • J Male sterilization, particularly non scalpel vasectomy, which is simpler, safe, and less expensive than other, methods will be promoted.
  • Condom use that offers dual protection against pregnancy and HIV/AIDS will be encouraged with the help of appropriate marketing strategies.
  • Efforts will be made to improve men's understanding of reproductive health issues and their responsibility for contraception and protecting health.

Involvement of Non-Profit Organizations

The state government accords a high priority to involvement of non-profit organizations in RCH care delivery, especially to enhance access and availability of reproductive and child health services in remote areas. NGOs play an important role in developing local approaches and strategies, innovations and alternative models of healthcare, and participation of the community. Jharkhand has several reputed NGOs working in both the health and development areas.

  • Involvement of NGOs in the delivery of RCH care and implementation of other development activities will be actively promoted after careful assessment of their capacities.
  • NGOs in the state will be networked to ensure their active participation in programme implementation and advocacy and to provide a forum for sharing their experiences with successful interventions.
  • Capacity building of NGOs will be done to improve their skills in planning and implementation of RCH care, management of resources, community involvement, and behaviour change communication.
  • Sufficient financial resources will be allocated for promoting NGO involvement and participation in RCH care delivery and other development activities.
  • NGOs and Field Activists will be involved in
    • Training Module design
    • Field tests
    • Identification of Key Village Health Workers
    • Information sharing

Community Involvement

Involvement of the community in reproductive healthcare is crucial to addressing the needs and aspirations of people and ensuring optimum utilization of reproductive health services. Community involvement relates to problem identification and decision-making, collaboration in planning for reproductive health care delivery, and active participation in the implementation of RCH care programmes-essentially local control of services to improve the health of individuals and of communities. Community involvement leads to empowerment of communities. However, community involvement differs from one setting to another depending on socio-cultural, economic, geographic, educational, and gender differences that exist across specific settings.

  • Special programmes and interventions, developed in collaboration with community-based organizations, will be implemented for empowerment of communities so that they can identify and set priorities for their own health needs.
  • Communities will be involved in planning, implementation, and monitoring of reproductive healthcare including family planning at the local level, through community-based organizations such as self-help groups, village health committees, and youth clubs.

Behaviour Change Communication

To increase the demand for reproductive health and family planning services, the efforts made so far have been very limited, sporadic, and fragmented. Behaviour change communication has a major role to play in improving knowledge levels, in changing traditional attitudes and practices, and in dispelling myths.

  • Behaviour change communication will be an integral part of all RCH service delivery systems.
  • An appropriate structure will be created with competent professionals to prepare comprehensive plans and programmes for behaviour change.
  • An IEC Bureau will be established as part of the State Institute of Health and Family Welfare. RCH care providers will be trained in interpersonal communication and counselling skills.
  • Formative Research will be promoted.

Coordination with Other Departments

Reproductive health objectives cannot be achieved without the involvement of other departments. The departments dealing with education, panchayati raj, women, child development, and rural development have several common objectives and overlapping functions. These departments also have grass-roots workers who regularly interact with villagers. Coordination linkages between health and other, departments would help to achieve synergy and contribute to achievement of development objectives.

  • School health programmes, a collaborative effort between the health and education departments, will be revitalized to provide child health services.
  • Women's self-help groups will be involved in reproductive health and family planning services.
  • Convergence of services between female health workers and anganwadi workers will be encouraged.

Urban Health Systems

Jharkhand has about 20% of its population in urban areas. Urban growth rates will be much. Higher than rural growth rates. Nearly 40% of the urban population lives in urban slums, which lack basic amenities such as safe drinking water and sanitation. Since the density of population in urban slums is high, there is always a danger of epidemics. Urban health systems have only secondary and tertiary hospitals; primary healthcare' institutions to provide basic reproductive health services are non-existent.

  • Mapping of all urban slums in each town ofiharkhand will be carried out with the help of municipal corporations and municipalities.
  • The reproductive and child health needs of the urban slum population will be identified, and services will be provided through an active partnership of public and private institutions and NGOs.
  • Primary health care institutions for the urban slum population will be launched to provide reproductive health services with an emphasis on the care of women and children.

Role of Panchayat Institutions

The enactment of the 73rd Constitutional Amendment Act has brought to the fore the significance of grass-roots democratic processes. People's direct participation, initiative, and involvement are essential to achieve growth and development. The new panchayat system has been created as a model of self-governance.

As a result of the demands and needs of the tribal communities, the Panchayat (Extension to the Scheduled Areas) Act, 1996 was passed. The most significant aspect of this amendment is therecognition of the need to safeguard and preserve the traditions and customs of the tribal population! communities, their cultural identities, and their customary modes of social relations, including their customary modes of resolution for personal and community disputes. Jharkhand is yet to conduct elections to panchayat bodies and define the roles and responsibilities of elected representatives.

  • Panchayat members will be given orientation training on RCH issues and the roles and responsibilities of health institutions in providing these services.
  • Elected members will be involved in planning and implementation of reproductive health programmes at the community level.
  • Elected members will be encouraged to provide active support to the organization of integrated RCH camps.
  • Health camps, for awareness generation and service provision, will be organized with the help of elected members of gram panchayats.