Swasthya Program
A Community Health Partnership

Mission Statement
Swasthya aspires to utilize a feminist approach to generate dialogue among local community women and health and medical professionals, and to support local action for health promotion. Through this process of dialogue and mutual exchange, we hope to: foster a greater sense of solidarity among women; encourage sensitive and empathic clinical and public health practices; and participate in the creation of an environment in which women and men have the tools and resources necessary to make and act upon informed, independent health care decisions.

The Partnership
Swasthya functions within a 30 km radius of Sringeri town in Chickmagalur District, Karnataka State. Through a unique collaboration between the Sharada Dhanvantari Charitable Hospital (SDCH) in Sringeri, an international student group, and local village women, Swasthya aims to generate dialogue among local community women and health and medical professionals about health, and to provide health care services to the women and men of the Sringeri community.

The impetus for Swasthya came from a group of Indian and American students of medicine and public health who had independently been considering the possibility of working in India. In July 1997, under the aegis of VISIONS Worldwide, Inc., a student-run non-profit organization in the United States, they forged a partnership with the Sharada Dhanvantari Charitable Hospital and women residing in villages served by the hospital. Thus, Swasthya, which is derived from Sanskrit and means "comprehensive well being," came into existence.

The hospital and the students have identified five local women, the Swasthya Community Health Workers (CHWs). The CHWs have undergone training in nursing and are participating in an ongoing training program on public health, community mobilization, and group facilitation. Now, each Swasthya nurse works in her own village community, promoting health awareness through dialogue and action.

By linking local resources and training local women, the Swasthya partners have made Swasthya a permanent, self-sufficient health promotion program based in Sringeri.

The Swasthya Kendras: "safe spaces"
The partners teamed up to establish Swasthya Kendras (health centres) in the native villages of the Swasthya CHWs: Kigga, Vidyaranyapura, Addagade, Hanumanthanagar, and Kalkatte in Sringeri Taluk and Guddethotta in Koppa Taluk.

Based at these centres, the nurses' activities include:

Daily fieldwork: The CHWs provide personal outreach services tailored to the needs of individual women and families by making daily home visits. Through this fieldwork, the CHWs ensure that continuous care is accessible to families in remote areas. These regular visits have made the CHWs a trusted resource in the community, enabling them to build open dialogue with women and to provide holistic care to families. The CHWs also organize small group discussions, presentations, and workshops on health-related issues for women, adolescent girls, and entire villages. These activities take place in homes, schools, and community spaces.

Daily provision of primary care and counseling: The CHWs focus on providing gynecological and obstetric care for women. They also engage in counseling women (and some men) on antenatal care, contraception including condom negotiation, alcoholism and domestic abuse. These services are provided in homes, community centres, SDCH, and the Swasthya Kendras.

Weekly outreach clinics: A team from SDCH including a Medical Officer and nursing assistants visits each Swasthya Kendra once a week. The Swasthya CHW refers all individuals requiring consultation with a physician to this clinic.

Swasthya’s outreach activities and the regular physician visits have helped to institutionalize the Swasthya Kendras in their respective villages. In order to further operationalize the concept of the Kendras as "safe spaces for women, we are attempting to do the following:

• organize group activities for women, such as knitting classes for adolescent girls, rangoli sessions, and participatory development of health education pamphlets;
• furnish the Swasthya Kendras with health information materials such as pamphlets, books, and games;
• stock the Swasthya Kendras with other supplies such as condoms, community resource information (government development schemes, resource directory, etc.), and basic medications.

Swasthya Programs: generating dialogue and promoting local action
Raising health awareness: In the last year, health awareness efforts have focused on the socioeconomic aspects of such health issues as alcoholism, smoking, and violence, as well as nutrition and oral hygiene. Moreover, by examining factors such as economic instability, gender, occupation, food availability, and local practices related to smoking and tobacco, the CHWs are able to understand the relationship between prevention of illness and social environment. Swasthya CHWs have worked with local organizations to develop new workshops to raise awareness and promote community discussion using audiovisual aids, role plays, street theatre and story telling.

Educating children and adolescents about health: The Swasthya team is developing and implementing comprehensive health awareness workshops in schools and junior colleges. In these workshops, interactive, participatory learning methods are utilized to increase understanding about the growth and development of the body. The CHWs create an environment that allows youth to discuss specific health issues such as pregnancy, contraception, HIV/AIDS, sexual abuse, etc.

Swasthya Programs: encouraging sensitivity and empathy
Counseling services in the community and at SDCH: In the last year, efforts to make health care more inclusive have encouraged the development of a counseling program. During the CHWs' fieldwork, they encounter women experiencing depression, anxiety, abuse related to alcoholism and other forms of violence. In response to the needs of these women, the CHWs have received training on counseling and on providing support services to women and families. These services are offered on-site in the villages, as well as in SDCH patient wards. Through these efforts to address social and mental health, the CHWs encourage and support women to bring about healthy changes in their own lives and in that of their families. Counseling services at SDCH are available to anyone requiring them, but are specifically extended to women seeking prenatal and postnatal care; women seeking medical termination of pregnancy; women undergoing surgical procedures such as tubal ligation, hysterectomy; women experiencing domestic abuse; individuals with diabetes and/or hypertension; and individuals diagnosed with tuberculosis. By offering counseling support to clients of SDCH, the CHWs not only improve the quality of hospital care, but also assist in the healing process.

Providing preventive and curative gynecologic care: The CHWs run "Well Woman Clinics" in villages and estates in Sringeri and Koppa Taluks. They provide comprehensive women's health exams, including health history, anemia screen, thyroid, breast and pelvic exams. The Swasthya team makes a special effort to ensure that the exams are conducted in a private space, and in a sensitive manner. Each exam takes approximately forty minutes as it includes a pre-exam and post-exam counseling session during which women's concerns and problems are addressed. These clinics have considerably enhanced the CHWs' esteem in the eyes of local women and health providers. Women residing in rural villages in Sringeri have very little access to gynecologic care and hence, are most grateful for the nurses' new knowledge and services.

Research: past experiences and future efforts
Village Profiles: The Swasthya CHWs have collected in-depth information on the villages in which they work. These data are currently being entered and analyzed by Mr. Michael Walsh, a doctoral student in Epidemiology at the University of Pittsburgh. The team plans to use this information to assess community needs and to plan health promotion programs. Currently, we are implementing a new form of documentation to ensure continuity of care and proper follow-up for the communities around Sringeri. Family folders have been designed for every family the CHWs visit/care for. By documenting medical health history, the CHWs are able to cater their preventive health education according to each individual and family need. The relevant health details of a family, including pregnancy, the growth of young children, contraceptive decisions, the presence of alcoholism, and illnesses such as diabetes, HIV/AIDS, and tuberculosis can all be confidentially recorded and incorporated into the care and counseling the CHWs give women and families.

The Swasthya Baseline Survey: The Baseline Survey was conceived of and coordinated by Dr. Suneeta Krishnan, an epidemiologist and Project Director of Swasthya. The aims of the this survey were to: 1) create a socioeconomic profile of households in the project areas; 2) assess women's and men's knowledge of reproductive health issues including pregnancy, contraception, and sexually transmitted diseases; 3) assess the prevalence of specific health problems including certain infectious diseases (which may be sexually transmitted), domestic violence, and hypertension, and diabetes. Analysis of these data are currently being undertaken. Both treatment and prevention programs will be planned based on the results of this survey.

Study on the Prevalence and Risk Factors for Anemia among School-going Adolescents in Sringeri: A survey of 12 schools in Sringeri was undertaken between June and July 1999 to assess the prevalence and risk factors for anemia among adolescent girls and boys. The survey was designed by Mr. Vivek Murthy, a medical student at Yale University, who led a team comprising the Swasthya CHWs and members of the SDCH laboratory. The survey is being followed up by an anemia prevention awareness program.

Diabetes Counseling - Developing A Context-specific Training Protocol: Between May and July 1999, Ms. Christy Haywood-Farmer, a graduate of University of British Columbia at Vancouver, developed a diabetes counseling training protocol taking into account the local economic and sociocultural environment. The curriculum may be used for training community health workers, counselors, and primary care physicians. In addition, Christy developed case sheets for documenting counseling and clinical interactions with diabetic individuals. The Swasthya CHWs have undergone this training program and are beginning to provide follow-up care and counseling to diabetic individuals in their communities. In addition, the SDCH-based Swasthya CHW will provide counseling at SDCH.

Oral Hygiene and Dental Care: A program of oral health education, oral hygiene promotion, and dental care was initiated in September 1999 by Ms. Sandhya Srinivasan of Harvard Dental School. Under her supervision, dental camps were conducted at Swasthya Kendras and at schools. CHWs regularly conduct education with school children and this will continue into the next year.

Understanding alcoholism in the family and community: The CHWs' current training on expanding awareness of alcoholism provides ample possibilities of researching the prevalence of alcoholism in Sringeri and surrounding areas and its effects on the family and community, specifically the spread of violence against women. Further, analyzing the physical and mental health risks associated with alcohol, as well as the socioeconomic factors of alcohol abuse, will enable the CHWs to better assist individuals and communities dealing with alcoholism. Moreover, Swasthya is researching the potential of conducting rural deaddiction camps in collaboration with a regional organization, and this will cultivate opportunities to research local deaddiction efforts, their methodologies, success rates, and progress.

In order to maintain the expenses of nurses' salaries, materials, transportation, and equipment, we welcome donations and resource assistance. For more information, please contact swasthya@yahoo.com or Swasthya, External Communications Coordinator, Sharada Dhanvantari Charitable Hospital, Sringeri 577139, Karnataka State, INDIA.

Swasthya Community Health Partnership is an affiliate of Visions Worldwide, Inc. (USA) and Vedantha Charities (India).