Sanitation and protected water supply

The intervention in sanitation and protected water supply is one of the core activities in community health. Over 80% of instances of morbidity and mortality in rural areas can be traced to water borne diseases. Since 1992, Gram Vikas has carried out a programme in which each family in the village builds their own toilet and bathing room, with piped water supply from a common water tower to which water is lifted by pumping from open wells or deep bore wells or from perennial springs through gravity flow water supply. The sanitation and water supply systems ensure access to protected piped water to all families all through the year.

These conditions have spurred processes of collective work and collaboration within the villages. Work for establishing water supply systems is undertaken only after completion of construction of toilets and bathing rooms by all families. Gram Vikas provides all technical support in establishing the water supply systems. Villagers arrange for electricity and are responsible for operations and maintenance of the system. They are trained by Gram Vikas in undertaking minor repairs and maintenance and as we find in villages where have set up these systems, the local people are able to take complete responsibility and manage the systems.

Together with toilets and bathing rooms, drainage systems are developed to ensure that wastewater does not accumulate. In several villages, banana and papaya planted around the soak pits have helped to leach excess water and keep the pits dry. Cleanliness drives are carried out in all villages to motivate villagers to ensure that the surroundings are unpolluted and clean. Children are also encouraged to partake in maintaining village cleanliness.

Community Health

In our efforts to understand the root causes of poverty and backwardness we found that lack of access to safe drinking water is a major cause of ill health and loss of productivity. It is perhaps the principal cause of life-threatening diseases among infants and children. Access to safe drinking water and a healthy living environment are therefore key aspects of Gram Vikas' approach to community health.

Gram Vikas motivates and enables communities to access government health services for basic medicines, immunisation of eligible children and antenatal and postnatal care of mothers. Timely detection and treatment of leprosy and tuberculosis and malaria control also form part of Gram Vikas' interventions in community health. Gram Vikas runs project level dispensaries with trained health staff in remote adivasi areas of Rudhapadar in Jagannath Prasad block, Ganjam; Koinpur in Rayagada block, Gajapati and Kumudabahal in Thuamul Rampur block, Kalahandi, to provide essential medical facilities.

Community health management

Village health committees comprised of elected men and women monitor health status in the villages on a periodic basis, with special focus on sanitation and timely intervention during the outbreak of diseases. Periodic growth monitoring of children to arrest malnutrition is also carried out. Kitchen gardens with banana, papaya and drumstick are promoted to improve the nutrition status of village communities, especially children.

Project staff assist the health committees to liase with the anganwadi worker, Auxillary Nurse and Midwife (ANM) and the local Public Health Centre (PHC) to procure medicines and vaccines for immunization of eligible children and antenatal mothers. Over 80% immunisation coverage of eligible children was achieved in the past year. The coverage is better in the non-tribal areas in the plains at 90% and 70% in remote, hilly adivasi areas. In adivasi areas of Ganjam, Gajapati and Kalahandi, Gram Vikas project staff and health committees take responsibility of informing and bringing children and antenatal mothers to a common place where immunisation is conducted periodically.

Health camps, catering to clusters of villages are organised to promote awareness of common diseases and preventive measures. Government health officials were actively involved in these camps. To ensure that basic care is readily available at the village level, regular training of village health workers and traditional birth attendants are organised. The health workers are responsible for running drug distribution centres in the villages, while birth attendants play a crucial role in ensuring safe deliveries and post natal care.

Efforts are being made to revitalise traditional knowledge in medicines and use of local herbs for treatment of common ailments. Herbal gardens have been developed for demonstration in adivasi areas of Rudhapadar, Ganjam and Thuamul Rampur, Kalahandi. Villagers are motivated to develop a small patch of medicinal herbs near the houses.