HEALTH PROGRAMMES

MASUM's women's health programme is unique in the sense that it focuses on women's health concerns with a feminist perspective and works with a rights based approach to health care. It enables the most deprived sections in the community to get access to basic health services. The women's health programme is built on the self help principle, which aims to empower women with knowledge of their own bodies and addresses unequal relationship between the provider and receiver because of the possession of knowledge and skills with the provider, by sharing information. It recognises the emotional, social and environmental factors that affect health and works towards addressing these issues. It assists women to recast their self image and confidence, by validating their experiences and knowledge and creates a space for women to ventilate their problems and share their feelings. It promotes women's sexual and reproductive health in a broader perspective and helps women understand their own bodies and sexual practices. It addresses the issue of access to health care with the class, caste and gender perspective and presses for government and social accountability for health concerns of women.

The health centres – block level feminist health centre and the village based health centres

Socio-cultural barriers and taboos inhibited women from expressing any problem even remotely associated with reproduction and sexuality. These problems were often neglected or left untreated. Most women were shy and afraid to talk to or be examined by male doctors present at the local primary health centers or the rural hospitals. Nurses and paramedical workers were not trained to deal with gyneacological and sexual disorders lacking both knowledge and sensitivity. Recognising this need MASUM initiated the block level feminist health centre (FHC) at Saswad the block level headquarters of Purandar, in 1994 and the village based health centres known as the Sadaphuli Kendras (Sadaphuli literally meaning ever blossoming flower – vinca rosea) in 1995. At present there are 11 village based health centres located in Purandar Block. The FHC is routinely accessed by women from the villages of Purandar Block as well as from the town of Saswad.

At the FHC, a senior health worker and at the village based health centre, the community based health workers (called the Sadaphulis) provide a range of related to primary health care. The health workers are trained to conduct breast examinations as well as speculum and bi manual examinations for detection of reproductive tract infection and other gynecological problems. In addition to this, at the FHC pap smear test are conducted to detect cervical cancer. High risk pregnancies are identified and necessary precautions are suggested. Reproductive tract complications and infections are also identified and women are encouraged to initiate a dialogue with their partners about sexual health. Each woman receives individual attention and care and is made to feel at ease. A detailed life history is collected before examination, whereby the health worker understands the woman's problem. Women are motivated to examine their own bodies and understand bodily processes. Women are treated with a combination of allopathic medicines, herbal remedies, pertinent exercises and dietary regulation.

Women approach the centre with a wide range of ailments like cough cold, fever, skin problems, piles, bodyaches, headaches, weakness, toothache, wounds, indigestion, acidity, arthritis and gynecological problems like infections, sexually transmitted diseases, uterine prolapse, menstrual problems, heavy bleeding, breast lumps and so on.

Many of the women who approach the centres seeking health services are victims of domestic violence. This violence has an impact on women's physical and mental health. This has led MASUM to strengthen the linkages between the women's health programme and the interventions in domestic violence programme. These women are referred to MASUM's counseling centre located in the same premises as the FHC as well as the village level para legal workers.

The FHC also works closely with the rural hospital at Saswad and the District general hospital – Sassoon at Pune.

The rational drug counter was started in the village of Malshiras by MASUM in 1991. The need for this counter was felt because it was observed that the availability of essential drugs in the villages especially in emergency situations was difficult. The PHC health staff was often not present at the health centre and the villages were left without proper treatment and care and hence in March 1991, the rational drug counter was started in the village of Malshiras by MASUM.

This drug counter provides basic medicines, under generic names, at low cost and operates on a no-profit, no loss basis. A local woman specially trained in pharmacology and ethics dispenses the medication and explains its purpose, the dosage, the side effects (if any), contra indications and drug food interactions to be expected as well as measures of controlling them. It is also approached by people from neighbouring villages. People pay for medicines but not for consultations.

As part of the Women's health programme MASUM initiated the adolescent empowerment programme in 2000. This programme works with groups of adolescent girls and boys between the age group of 12 to 18 years. The lack of space for girls to come together and discuss issues of their concern and the magnitude of preventable illnesses that women suffer as well as issues of violence women face prompted MASUM to work with this group. It aims at developing a feminist perspective among adolescents, empower them with knowledge that would enable them to stand up for their rights and work towards creating an environment conducive to the development of harmonious relationships. It intends to nurture their emotional and physical health and provides space for adolescents to recast their self-image, evolve a self-affirming sexuality and create an environment conductive to the development of harmonious relationships. This programme is in 8 villages at present.