By Rupal Shah
Today it is not hard to find references in the media and elsewhere to individuals, groups and communities that are described as empowered. One place to observe achievement of women’s empowerment is in the semi-arid rural villages of Maharashtra in India. It was back in mid-January 2011, Asif the representative from Comprehensive Rural Health Project (CRHP) who was born in the Julia Hospital, the first hospital at CRHP, and Ismail the designated driver, picked me up from Pune. The 200km drive from Pune to Jamkhed was surprisingly a smooth ride. As we drove through sundown I could see communities living in scanty homes, herding goats and cows, travelling by oxcart and growing sorghum (staple food).
It’s a sunny Thursday morning, and a stream of 50 high-spirited women draped in brightly coloured saree’s wearing red ‘bindis’ at the center of the forehead, carrying knapsacks make their way by bus, in rickshaws, on foot, or by hitching a ride to CRHP’s training centre in Jamkhed taluka (block level), in Ahmednagar district, Maharashtra State, India. At first glance these women seem like ordinary village women in their mid-thirties who sell fruits, vegetables and spices at the local bazaar (weekly market) or work assiduously on farmland, but they are remarkably different from their village peers. You realise this when they make eye contact with visitors like myself and greet with a sincere, ‘namaste’, when they talk in ‘marathi’ (Mother tongue) amongst themselves, and the confidence they exude while speaking in the weekly training sessions. These women, many of whom have been coming to CRHP for over two to three decades, are the respected village health workers (VHWs).
Today’s topic is on abortion and all the VHWs have gathered round in a circle. Suddenly, the room breaks into a piercing sing-song and clapping of hands. Monica, a bubbly woman in her 40s is one of the enchanting social workers at CRHP, with chocolate skin, black hair, gleaming white teeth and a beautiful smile. She kindly translates the opening song for me. “They’re singing about women coming together to get out of the house to progress further,” Monica explains with a soft voice. “How women can exercise power to solve problems”. “Now they’re saying that our responsibility is not only looking after the children and cooking, we have to go out of the house and do more”, she interprets.
These weekly VHW training sessions indicate that with sustained training and exposure to new information, people and ideas, women start becoming assertive and begin to challenge the status quo. With the support of CRHP’s dedicated social workers, VHWs facilitate women’s Self-Help Groups and income-generating groups by addressing various social injustices against women in today’s villages. Traditionally, a VHW was a woman from the lowest caste or socio-economic stratum, illiterate, in her early to mid-thirties, and married with a couple of children or widowed. Today, there are a handful of young, dependable and active VHWs aged 18 to 30 years old, all married, and who take the initiative in keeping their communities healthy.
Within the highly complex Indian society, such women are often the most oppressed and marginalised due to prevailing rigid socio-cultural structures. Patriarchy manifests in many different forms in India and across South Asia, evidenced in the low status placed on women and girls. “Gender discrimination and violence starts in the womb” said late Dr Raj Arole, as I sat intently in the CRHP training room with a group of graduate public health students, mostly female from Australia’s Nossal Institute for Global Health. “In a rural household, women are better at bringing the entire income home without spending a penny whereas men have a tendency to spend all the money on alcohol and tobacco”, he continued.
Yamunabhai (meaning the sacred river in sanskrit) is a slim, wise, rather jubilant woman with long black hair streaked with grey tied in a neat pony-tail. She is one of the older VHWs, from the very first batch. The Urban Land Ceiling Act passed in 1976 captured 70 acres of land and left her with a measly 5 acres. The Farmers Group selected her for VHW training and during her first session she ran away. A wide-eyed Yamunabhai says, “I used to come all the way from Ghodegaon to Jamkhed and reach the gate of CRHP, but did not have the courage to go inside”. Today, all her children are educated and she owns a piece of land. With teaching and with help starting her business, impoverished women like Yamunabhai can earn money, support and educate their families.
Empowerment lies at the heart of CRHP; it is a dynamic process. Founded in 1970 by public health physicians late Drs. Mabelle and Rajnikant (Raj) Arole, CHRP initially targeted women and children. However, the Aroles had long realised that empowerment is not only a gender issue but also concerns a whole host of marginalised groups, encompassing a range of social differentiations such as caste, ethnicity, religious beliefs and disability.
Involvement in the far-reaching ‘Jamkhed Model’ has offered women access to invaluable information and learning opportunities, provided incentives and financial support through participation in village health worker training programme, and changed female VHWs’ status in their village communities. The results of the integrated community-based development model are impressive and the model is being replicated in Central and South America, and promoted by UNICEF the United Nations (UN) Children’s Fund in other low-income countries. The international community has recognised that the ‘Jamkhed Model’, where women are powerful catalysts for change, leads to poverty reduction in rural communities.
On a personal level, the time I spent in Jamkhed opened my eyes to community-based health and development at the grassroots level, filled the missing pieces in my public health journey, and it was a life-changing experience. I discovered that authentic rural development is about working at the grassroots and that you must dedicate copious amounts of time in the field to understand people and communities. Empowerment should come through self-reliance and communities will experience change when individuals begin to adopt change. I met and embraced strong women, who are resilient, selfless and optimistic; qualities that have enabled them to survive domestic violence, droughts and to remain the cornerstone of their families and communities.
The multifaceted injustices that stifle women in low income countries are of paramount importance, and strategic investments in advancing gender equality and women’s empowerment by official development assistance and non-governmental organisations, sustained over many years, will yield major social and economic benefits for generations, breaking the cycle of ill health, gender discrimination and poverty, while upholding essential human rights. Women play an integral role in achieving the new Sustainable Development Goals as evidenced by the ‘Jamkhed Model’. It is a moral obligation; a global responsibility to ensuring healthy lives and promoting wellbeing for all.
CRHP’s pioneering comprehensive approach to community-based primary healthcare (also known as the Jamkhed model) continues to shine through the hands of the village health workers who assist the founders’ son Ravi Arole (Director) and daughter Dr Shobha Arole (Director). The Jamkhed International Institute for Training & Research run a 3-week practicum/experiential course on sustainable development. Graduate students are encouraged to apply, and details of the 2017 summer course (17 June to 7 July, 2017) can be found here: http://jamkhed.org/training/.
Disclaimer: The opinions expressed in this article are the author’s own and do not reflect the official policy or view of Manchester Global Foundation. An earlier version of this article appeared on the author’s personal website.
Photo: Yamunabhai, a Jamkhed community health worker listening intently during a weekly training session. © Rupal Shah