Technical

Education

National

Integration

Health

Major Projects are:- 

1. Composite Targeted Intervention Programme among core and non-core groups for prevention of AIDS. From Dec. 1^st 2005 to June 30, 2007

2. Adolescent Reproductive Health; using cultural sensitive approaches for communication and advocacy in under-served areas. [Sundernager, Distt. Mandi, HP]January 1^st 2006 to Dec. 30, 2006 Back Ground and Justification

Life is not just being alive but being well and healthy. The Second major field of the organisation in which the organisation is engaged since it came in existence is health. Because for health is the second blessing that we mortal, are capable of a blessing that money cannot buy. The society has worked on much health related issues. Like the organisation continually running an anti-smoking campaign among the youth of the society.

The organisation is monitoring the physical environment in rural as well as urban areas. It includes preventive medical interventions such as nutritive diets, immunization schedules, environmental sanitation, personal hygiene, safe water and better time interval between child births. These are ideal aspects of physical healthy environment advised by the health cadres to their respective clientele. For instance, as malnutrition proves detrimental for both adolescent girls and pregnant mothers by restricting their life expectancy, propagating nutrition have been a major preventive health care concern of the organisation.

Another feature of the organisation activities on health are the constant awareness raising effort through group discussions, nutrition demonstrations, education, condom demonstrations, Health camps, motivation, RTI/STI treatment, counselling, Training and material development workshops, Songs, dramas, role-plays, puppet shows and materials such as charts and posters, booklets, pamphlets are some of the effective instruments of consciousness raising in these workshops. The salient features in the preparation of such communication materials are that it is done by the women or targeted groups themselves. Such efforts are thus a step towards empowering the women making them awar of the double load of drudgery they go through.

Our projects also make an attempt to create public opinion that the child bearing role of the women should be treated as a social role with both men and women being equally responsible for rearing up of the new born child. The organisation efforts to resist the idea of women alone are becoming responsible for children. They are conscious that they already too through the major load of pregnancy, child bearing and child rearing. In recent times, they are also fully aware that they have become the primary target for the adoption of family planning measures (more than men) as substantiated by statistics in India.

Our Health projects are also have great concern over the fast degrading environmental situation that results in the abysmal living situation for the far-flanged rural areas of Himachal Pradesh. There are constant social action programmes such as marches and demands to state/district/block governmental officials to activate the municipalities/Panchayats to help poor women to remove garbage, set right drainage facilities, carry out anti-malarial measures, establish safe drinking water facilities and improve housing and other environmental conditions.

1.      Composite Targeted Intervention Programme among core and non-core groups for prevention of AIDS. From Dec. 1^st 2005 to June 30, 2007

India’s epidemics are even more diverse than China’s . Latest estimates show that about 5.1 million (2.5-8.5 Million) people were living with HIV IN India in 2003. Serious epidemics are underway in several states. In Tamil Nadu, HIV prevalence of 50% has been found among sex workers, while in each of Andhra Pardesh, Karnatka, Maharashtra and Nagaland, HIV prevalence has crossed the 1% mark among pregnant women. In Manipur, meanwhile an epidemic driven by injecting drug use has been in full swing for more than a decade and has acquired a firm presence in the wide population (UNAIDS/WHO2003).

HIV prevalence measure at antenatal clinics in the Manipur cities of Imphal and Chura Chand has raised from below 1% to over 5% with many of the women testing positive appearing to be the sex partners of male drug injectors. Several factors look set to sustain Manipur’s epidemic, including the large proportion (about 20%) of female sex workers who inject drugs and the young ages of many injectors surveyed in 2002 were under 25 years of age (MAP, 2004). This is self-evident that HIV/AIDS spreading like wild fire in India.

HIV/AIDS epidemic is about 18 years old in INDIA and 13 years in Himachal Pradesh. Within this short period, it has emerged as one of the most serious public Health problem in the country. The initial cases of HIV/AIDS were reported among brothel bassed commercial sex workers in Chennai and Mumbai and Injecting Drug Users in the north eastern state of Manipur. The infection has since then spread rapidly in all the states of the country. However the over all prevalence in the country is still low, a rate much below than any other countries in the Asia Regions. But the available data indicates that HIV Infection is prevalent and spreading rapidly in almost all parts of the country. It may BEAT not only the Asia Regions, but even the world as mentioned by the Director General, NACO, New Delhi. During the recent years it has spread from Urban to rural areas, High Risk Groups to the General population, among women attending ante-natal clinics.

The attributable factors for such rapid spread of the epidemic across the country today is labour migration and mobility in search of employment from economically backward to more advanced states, low literacy levels leading to low awareness especially among the potential high risk groups, gender disparity, sexually transmitted infections and reproductive tract infections both among men and women.

The social stigma attached to STD also hold good for HIV/AIDS. The effects of stigma are divesting discrimination against people Living with HIV/AIDS denies them access to treatment, services and support. It creates a climate to take well planned action from the Government, NGOs as well as by the Community.

In Himachal Pradesh the problem of HIV/AIDS started with the identification of HIV positive case in Hamirpur District during 1992. This was followed by occurrence of many cases in all the districts of Himachal Pradesh except Lahul & Spiti.. 1186 cases were founded as HIV positive, which includes 236 as AIDS cases. The data revealed that the preponderance i.e. more than 90% HIV infection in the age group of 15-44 years. Male and Female ratio is approximately 2:1. More than 95% of HIV infection has resulted from sexual mode of transmission. According to sentinel Surveillance Survey, it is estimated that there may be around 3500-4000 HIV positive cases in the state of Himachal Pradesh. As per cited facts, the HIV infection in the hilly state of HP has not yet reached at a critical state, but with the opening of VCTC facilities at the various district HQs has reported large numbers of new infection among the High Risk Groups. Then it becomes essential to prevent and control the spread of new infection among the targeted population.

The Targeted Interventions are a specific set of interventions in AIDS Control Programme. The central purpose of TIs is to provide services that targeted populations need to practice safe behaviour that minimises the transmission of STD and HIV/AIDS.

The organisation submitted its proposal to HP State AIDS Control Society describing the key Technical Strategies of STDs and HIV/AIDS its prevention and control project to be Implemented by us among the more vulnerable and high risk group and among their families residing in District Mandi. The project proposal submitted for grant-in-Aid to HP State AIDS Control Society. Specially refer to intervene with the people living with risk. i.e. mainly with female sex workers, men having sex with men, Truckers and migrant workers in the most sensitive area of Himachal Pradesh i.e. Distt. Mandi. Targeted population as expected while starting the project.

The purpose outcome of the project was

i)                    Behaviour change towards safe sexual practices among these high risk groups.

ii)                  Larger awareness generation capacity among the target population in the area of operation i.e. Mandi district.

iii)                Greater Treatment Seeking behaviour for STD/ISD/RTI and HIV/AIDS.

iv)                Greater use of condom almost in every inter force

v)                  Improve abilities of free as well as social marketing of condoms

vi)                Greater motivation for Voluntary Testing and Counselling Services.

vii)              Development of effective communication to folk media, print and electronic media.

viii)            General awareness towards the means of spread of the HIV

ix)                To create enabling environment by involving Secondary Stakeholders by organising Advocacy workshops.

x)                  Networking of PLWAs.

xi)                Formation of Self-Help Groups of FSWs to involve them in commercial activities to reduce the chances of earning through sexual activities.

Taking these objectives as target the organisation designed a highly energetic, hardworking and sincere team to achieve these targets under the headship of Mohammed Khan the Gen. Secretary of the organisation. Following Target/Goal oriented Activities have been decided by the team to reach the target.

Activities Conducted:

1. The targeted population made aware of STD and HIV/AIDS implication and providedthem with the necessary tools for protecting themselves like condoms and its correct usage

2. Efforts have done to Control STDs among vulnerable sections together with promotion of condoms to use as a preventive measure regularly and tried to make it a habit.

3. Reinforced the traditional Indian moral values among the young and impressionable groups of population.

4. Created an enabling socio-economic environment so that the target population especially FSWs can restrain themselves from indulging in the sex trade they were indulged earlier and to resist themselves to become a HIV spread tool.

5. Constituted a Project Advisory Committee for the smooth functioning of the project.

6. Created awareness among the primary and secondary stake holders by using mixed-media approach.

7. Created a favourable and congenial environment among the influencers. Advocacy and sensitization workshops have been conducted regularly for the secondary stake holders.

8. By conducting regular workshops with different communities and targeted groups the NGO Promoted a networking within the communities which became very useful to debate dialogued on issues of concern and evolved ways of addressing it.

9. PLWA have been identified and they have been provided preparative services.

10. Community mobilization has been achieved by ranging focus group discussion among the target as well as among the communities’ influencers.

11. Self Help Groups have been formed for communities’ mobilizations.

Goal: Awareness Generation and Behaviour Change Communication:

Objective: Main objective of  Behaviour Change Communication (BCC) was to familiarise the targeted population which were FSWs, IDUs, MSMs, Migrants & Truckers and their families with the spread of infection its tools of spread and its techniques to prevention. For the BCC following activities have been conducted.

Activities:

i)                    Inter personal Communication IPC: IPC have been contacted by our field staff by Out Reach Workers, by Peer Educators & by Councillors in drop-in-centre. There were 8 Out Reach Workers and 12 peer educators are active in the field besides a councillor in the drop-in-centre. Our staff made a

dialogue with the targeted population in the field at their work places and discuss their problem with them and provided appropriate counselling/solution to them. The peer educators identified the person from targeted groups and Out Reach Workers provided them counselling and helped them. Other project staff also contacted the identified targeted population One to One as well as in groups and educates them about the disaster of the HIV/AIDS and how can oneself be prevented from this menace.

a.      The STD patients have been identified and morally supported by the staff and also be referred to the drop-in-centre/STD Clinic, Health camps organised by the organisation and govt. Hospital for STD treatment.

b.      Condom demonstrations have also been done during IPC to the targeted population to correct use of condoms.

ii)                    Mass-Media Approach: A grass root level media have been developed to aware the people regarding HIV/AIDS.

a.       A Drama unit have been contacted to create a drama on the theme ALL INFORMATION ON HIV/AIDS IN HUMOURS STYLE. The Nukad play became a success and people not only liked it very much but also get information in easy and simple way.

b.       Informative posters/brouchers /stickers have also been prepared and distributed at a large scale among the general masses including the targeted population.

c.       Workshops/ Group discussions with Migrants, Drivers, School & College Students, Rural folks & General Masses have been organised with the help of peer educators and Out Reach workers.

d.      Counselling services have also been made available in local fairs and festivals e.g. Mahashivratri in Mandi Town, Nalward Fair in Sunder Nager Town and all other fairs in the area on panchyat basis.

iii)               Peer Education: Peer Educators played a vital role in the success of the intervention through BCC. Peer educators were main inter-communication agents of the organisation with the targeted population for intervention and helped them to educate and made them aware about the STD/HIV/AIDS. The Peers were selected from the targeted population and have been given proper training by the organisation to work among his/ her community.

a.      Monthly orientation meetings have been organised with the peer educators and their targeted intervention community.

b.      Peer educators have been provided proper feed back by the Out Reach workers, Drop-in-Centre and other project staff.

Goal: Make people/Targeted population regular condom user

Objectives:

i)           To make targeted as well as General population a habitual and regular condom user.

ii)          To educate them the benefits of the use of the condoms.

iii)         To educate them the correct use of the condom.

Activities:

i)          Free condom depots have been established on all the petrol pumps, All Dhabas where drivers halts for eat and dine., all barber shops, All Taxi unions of the targeted area., All Truck Unions of targeted area, bus stands and some other public places like main markets, General Toilets etc.

ii)         The peer educators, Out Reach Workers and councillor in Drop-in-centre educated the targeted population about the use and benefits of the condoms. During meetings and events free condoms also been distributed to the participants.

iii)        Social marketing of good quality and variety also been done of condoms on company rates. This money have been circulated again and again.

Adolescent Reproductive Health; using cultural sensitive approaches for communication and advocacy in under-served areas. [Sundernager, Distt. Mandi, HP]January 1^st 2006 to Dec. 30, 2006 Back Ground and Justification

Progress of reproductive and sexual health in India has achieved notable success over the decades but its reach and sweep have not been uniform across all regions and communities. On an average, India has recorded substantial improvement in reducing infant and child mortality and morbidity, in fertility rate, provision of services to regulate fertility and family planning. Efforts to promote millennium development goals to improve maternal health, reduce child mortality and to combat diseases are to continue, but an overarching programme to address common factors needs to be supplemented by catering to local cultures. Addressing the issue of reproductive health and simultaneously achieving the millennium development goal, would necessitate understanding of different communities across regions, religions and socio-economic placements which vary in their cultural beliefs and normative patterns to impact on reproductive health, Muslims Scheduled Castes/Scheduled Tribes, Jains show different trends in terms of achievements regarding reproductive health parameters. For instance, among the Muslims, neo-natal, infant and child mortality rates for the age of children below 5 years is among the better rates, while the same situation does not exist for maternal use of trained services and utilization of health services by mothers. In terms of spacing immunization, ante-natal and post-natal check-ups the Muslim and SC/ST population continues to lag behind. Similarly, in terms of family planning and fertility rates, the Muslims average rate is higher (3.59) in comparison to the Hindus (2.78) with the Jains (1.90) being the lowest (see table 1). Disaggregate data on caste, education, age, residence and standard of living index show effect on fertility rates. Improvement in socio-economic conditions reflected isomorphic changes in fertility rates.

In a multicultural context, usage of reproductive facilities would, however, be vulnerable to inter-community politics and assertions. There continues to be a general perception that Islam is against family planning and this affects Indian Muslims response to adoption of family planning practices and resistance to  small family norms. Family planning practices in India, according to Third All India Survey, 1998, found that the acceptance of family planning among the Muslims (all India) was 33.8% which was much lower than the Hindus (45.5%), The Christians (61.6%), the Sikhs (63.2%) and the Jains (65.3%). These are figures for couples currently using and family planning method for sterilization, the figures are even less flattering. The average fertility rate of the Muslims is sharply influenced by its share of representation in the economically backward states of Uttar Pradesh and Bihar which constitute 39% of the total Muslim population in the country. The overall fertility rates in these states is much higher that the Indian average for all religious and caste communities. Among the Muslims fertility rates for 1990s vary from 3.1 in Tamilnadu to 7.2 in Haryana.

Muslims or Scheduled Castes/Scheduled Tribes, thus do not form a homogeneous group in terms of fertility or even reproductive health. Moreover, ignoring the cultural specific contexts may also make invisible other aspects of reproductive health.

Female reproductive health also varies on different parameters. For instance, while 49.6% of Muslim women are found to be anaemic, the rate is higher among Hindu women at 52.4% neo-natal mortality is highest among SCs/STs (53.3 and 53.2) while age at first cohabitation is much younger among Muslim women and also extent of reproductive tract infections vary. Factors contributing to uneven delivery of service may have been low levels of literacy, poverty, adolescent’s taboos to reproductive health issues, cultural beliefs and patterns as also women’s empowerment. Variation in fertility regulation, maternal health, child health use of family planning methods and overall female reproductive health point to the need for a community local cultural strategy for addressing specific needs to achieve behavioural change towards reproductive health issues.

Since family welfare has been addressed as a national problem, region and community specific needs have not been properly analysed. As a result only one-size fits all approaches have been attempted. Reproductive health services are being promoted as a national programme making health infrastructure and services available across the board, however to ensure their accessibility to a specific population and furthermore a valued utility, delivery of services needs to be built around cultural values and normative patterns. An important lesson the science of marketing (more specifically, social marketing) has taught us is that the audience is a heterogeneous whole consisting of several smaller segments with different needs and perceptions. These have to be specifically understood and addressed, if the communication programmes are to succeed. Nowhere is the need for segmentation approach more relevant that in reproductive health practices. NFH Surveys have pointed out glaring differentials among communities. Analysis have pointed out that these issues are closely intertwined with cultural milieu and closely associated with the value system of the community and the level of awareness, both individual and collective in particular there is a need to build strong evidence based input for strategic investment in adolescent reproductive health and rights. Among this age group taboos and practices in regard to sexuality such as early marriages, social distancing among the unmarried, restricted mobility, pose barriers to accessing information and support of reproductive health services, it is this age group that requires enabling conditions to access the reproductive and sexual health system. Inability to resist sexual advances, negotiate safe sex and lack of support from guardians and community gatekeepers adds to their vulnerability to disease, lack of control over fertility and use of family planning methods.

The scope of this project was not to detail the factors that impinge on reproductive health but to call out those that pertain to the Muslim community based in different regions of the country. The assumption being that community segments have different needs adn perceptions. Recognition of these cultural specificities have been articulated by grass root Muslim organisations. Moreover Muslim Ulemas have reinforced the need to formulate region and culture specific strategies to address the issues related to reproductive health among Muslims.

Thus a communication strategy for underserved muslim areas of reproductive services  be evolved using culturally sensitive approaches for advocacy. Thrust areas of the project were family planning, safe delivery, immunization and new born care. To start with a pilot project for giving informed choices to the Muslims audiences who do deserve a special consideration in the light of their low levels of literacy, income and awareness, besides cultural predilections. These sections have been left out because the programmes and messages aimed at the general population and failed to address them or they chose ignore it as it was not in sync with their ethos and way of life.

Reproductive Health in Islam

Health of mother and child and reproductive health of women has been taken care of among Islamic scholars who have interpreted the Holy Quran and the Prophet’s words. Islam has considered the family as the basic social unit of Islamic society and has emphasised the family formation as a responsibility of couples. Family relations are specified in Islamic jurisprudence to achieve the welfare and useful life of its members. Health, naturally, is an important part of the concept. The companions of the Prophet were allowed to practise coito interrupt us (Al-azl) toward off health, social and economic hardships. The Muslims all over world know that Islam is not merely a religion of worship but is also a social system, a culture and civilisation. It is a religion of ease and not hardship and deals with human needs activities and concerns.

The scholars refer to three verses in the Quran in this connexion:

The Islamic theology Scholars take these three verses together and infer that while procreation is an expectation in marriage, it is not for its exclusive purpose. When procreation takes place, it should support and endorse tranquillity rather than disrupt it which means that sexual relations are not merely to produce, children, they say.

And one of (Allah’s) signs is that he has created for you mates form yourselves, that you may dwell in tranquillity with them, and has ordained between you Love and Mercy

Parents, according to Islamic theologies are responsible for the social, cultural and moral training of children and for their physical and health care. The Quran calls marriage a solemn covenant and not a casual arrangement:

 Imam al-Ghazali (d.AD 1111) argues on the basis of above verse that since marriage can be postponed by some Muslims, so can be getting children. He has used this argument to support his legality of al-azl as a method to avoid pregnancy. Al Ghazali allows al al-azl for health and economy reasons and even to preserve a women’s figure and beauty for continued enjoyment of her husband. He felt that fewer children would protect against economic embarrassment which in turn is good for piety. Al-Ghazali’s views were elaborated by Imam Zabidi and many other scholars have agreed with them. Most scholars of Islamic theology accept the concept of al-azl if it is with the consent of wife. Among these schools are both Sunni and Shia. There is almost consensus of the jumhour position of allowing al-azl subject to wife’s consent. Some of the reasons offered by theologians for which it is permissible are:

•  To avoid health risks to a suckling child from milk of a pregnant mother.

•  To avoid maternal health risks to mother from repeated pregnancies, short intervals and young age.

• To avoid transmission of disease to the progeny form parents.

• To avoid pregnancy in an already sick wife.

• To preserve a wife’s beauty and physical fitness for continued enjoyment of husband and for marital happiness.

• To avoid economic hardship and save parents exhaustion in earning a living.

• To allow education, proper rearing and religious training of children which is possible with proper spacing and fewer number.

• To keep the tradition of separate sleeping arrangements for children.

It must be noted that risk of pregnancy at very young age, that is, in adolescence, and risk to mothers by repeated pregnancies are important factors considered by Islamic scholars, even by the authorities in Islamic nations. Also taken into account are risk to mother and child from short birth interval and transmission of infectious diseases.

The Islamic concern has confirmed by the modern system of medicine. The justification for use of modern contraceptives today includes:

      Young age of wife and inability to sustain a pregnancy because of a small uterus.

      Disease of defect in the uterus.

      Weakness in the bladder and fear of incontinence due to pressure of the head of he fetus during labour.

      Presence of disease that could be exaggerate by pregnancy or labor leading to death of mother.

The Quran recommends breast feeding for two years and pregnancy during this period is discouraged. The scholars infer by it child spacing. Some Islamic scholars feet that al-azl was permitted in early days as there was no concept of other contraceptives then.

Challenges & Tasks:

Why adolescent population is priority area?

      They are a large section of the population.

      They are most risk prone and vulnerable.

      They have special needs.

      They are a productive force who mould future fo nation.

      They can be used as change agents.

      Healthy adolescents mean healthy adults of future.

Key adolescent issues or problems:

      Mental health issues.

      Psychological issues.

      Sexual and reproductive health issues.

      Nutritional issues

      Pubertial changes.

      Body image issues

      Gender issues.

      Career guidance.

What we did in the project.

      We provided Advocacy with concerned sectors including decisions makers.

      We Sensitised key stakeholders adolescents and youth, parents, teachers and other significant adults.

      We tried to build up a capacity of providers in all sectors like health, education etc.

Personality type we involved in this project for effective functioning:

      School administrators.

      School Teachers.

      Panchayat Pardhan.

      Senior persons of the community.

      Youth leaders.

      Local social workers.

      Clinical psychologists.

      Spritual leaders like imam of mosques etc.

      Nutritionist.

We achieved following Goals in the project.

      Fostered more responsible and equitable relationships between young people before, during and after marriages.

      Created an environment of avoiding pregnancy before complete maturity.

      Reduced the rate of exposer and contraction of STD.

      The status of women in the community improved.

      General Health & reproductive health standerds improved.

      We achieved these goal by following activities.

      We provided proper training to key persons with influence on adolescents and adolsscents themselves.

      We provided training to peers in counselling and communication skills.

      Provided alternatives to early childbearing for young women including through better education.

      Improved access to services to meet young peoples need.

      Promoted multi-sectoral actions for adolescent health and development.

      Involved young people in the design, planning, implementation and evaluation of measures to improve their health.

We faced following difficulties while working on the project.

      Non active involvement of youth in reproductive health programmes.

      Lack of knowledge among young people about their own development especially in regard to their sexuality, changing relationships and inability to communicate.

      Lack of information on effect of experimentation with drugs etc.

      Lack of skills to address their needs even when they know them.

      Service providers lacking skills or training to deal with adolescent development as well as interpersonal skills.

We are thankful for following persons, institution for helping us in the success of this project.

      Management of Molana Azad Sr. Secondary School.

      Moulana Noor Ahmed Nadwi.

      Mohammed Aslam Pardhan Gram Panchyat.

      Quasim Ali

      Salma Begum.

      Abdul Hameed Sb.

      Moulana Abdul Haleem Sb.

      Suleman Ansari

      Mr. Abdul Gafoor Shaikh

      Yousuf Ansari

Activities Under Health Programmes:

Workshops: Weekly, Monthly and periodically workshops are being conducted regularly on various issues and topics with different groups i.e. MSMs, Migrants, Truckers, rural folks, working women, Taxi Drivers, Housewives, Yuva Mandals, Mahila Mandals, Panchayat representatives, Doctors, Health workers, etc. on different issues.