Community Rural Health Project (Jamkhed, Maharashtra, India)

“At Jamkhed, the Aroles nurtured a process unique in community action in one of the best primary health care projects in the world. It is unique in truly getting people’s involvement. They believed that the very poor have a great capacity for change and can effecitively take positions of leadership if given a chance and some support. As in other social changes, they are turning the customary academic order upside down. Rather than starting with what is considered academic excellence, they are starting with the ultimate truth, which is that the future belongs to the people.”
~Dr. Carl E. Taylor, a professor emeritus at the John Hopkins Bloomberg School of Public Health, father of the modern-day community, & mentor to Drs. Aroles

“When I started, I had no support from anyone, no education, no money. I was like a stone with no soul. When I came here they gave me shape, life. I learned courage and boldness. I became a human being.”
~Sathe, CRHP Village health worker

One of the most coveted desires of the Government of India is its abandonment of its third world label. As increasing media attention on the country’s child undernutrition crisis prevents this from occurring anytime in the near future, the Community Rural Health Project’s (CRHP) rights-based approach to child hunger may be the country’s most promising solution to curbing the epidemic. I decided to first journey to the rural villages of Jamkhed, Maharashtra for one month in order to tangibly learn how to effectively address child undernutrition through the lens of human rights from true global heroes, CRHP’s village health workers (VHWs). Due to the VHWs’ tireless public health, clinical, and child rights advocacy work, they have succeeded in reducing their villages’ child undernutrition rates from 46% in 1971 to less than 0.1% today. These VHWs are women who at one time experienced gross human rights violations on their own personal accord: some were former leprosy patients who were denied the right to health care; most were once young girls who were stripped of their right to a primary education; and then others were wives who experienced gender-based discrimination through domestic abuse and lack of land rights. And yet, their resilient spirits brought them to CRHP in order to advocate for the rights of future generations of villagers, in an attempt to cease, or at least slow down, the vicious trajectory of poverty, disempowerment, and social injustice in their villages. As Dr. Carl E. Taylor assessed, “Illiterate and outcaste women could become leaders who would address international conferences and advise India’s Prime Minister.”


A group of CRHP village health workers and I during a focus group session on child undernutrition and human rights. I was fortunate to share their cultural, linguistic, and religious background, which provided me the opportunity to establish relationships with them based on mutual trust and interest in each other’s lives. They began to treat me like their daughter, and each moment that I spent with them was filled with love and inspiration!

Since 1971, CRHP’s mission has been to approach community-based primary health care as a universal human right by eliminating cultural, social, and economic injustices which deny all people access to this right. By mobilizing and building the capacity of communities, CRHP’s primary goal is to ensure the access to health care and freedom from poverty, hunger, and violence for all Jamkhed citizens through a value-based approach to health and justice. Serving over 250 rural villages and 500,000 individuals for the past four decades, CRHP has partnered with village communities in order to elevate local knowledge and resources, and to effectively meet the immediate and long-term social and health needs of India’s most vulnerable populations: women, children, impoverished families, indigenous tribes, and low-caste individuals. Furthermore, CRHP specifically focuses on addressing human rights violations that are rooted in harmful cultural and religious traditional practices, such as dowry deaths and female infanticide. CRHP was founded by world-renown physicians and global health experts Dr. Raj Arole and Dr. Mabelle Arole, and is now directed by their surgeon daughter Dr. Shobha Arole. CRHP engages in primary and preventive health care for its target villages through its village health workers, provides secondary medical care at its comprehensive hospital managed by physicians and surgeons, and engages in social and economic transformation of its villages through the formation of Farmer’s Clubs, Women’s Clubs, and its Girls Adolescent Program.

Since CRHP’s renowned reputation among the global health community has attracted the attention of students all over the world, I was fortunate to be accepted into its one-month student course along with 14 other public health and medical students from the U.S. and Bhutan. We were blessed with the opportunity to participate in application-based lectures by the Aroles and VHWs, village visits, leadership development workshops, and group presentations. My research project focused on interviewing its village health workers by leading focus groups, as well as documenting my experiences in government schools, CRHP’s schools, and village-based nutritional rehabilitation feeding centers. I was able to witness first-hand the processes, successes, and challenges faced by government-sponsored child nutrition programs, such as the Integrated Child Development Scheme’s Midday-Meal Programme. During my village visits, I observed how CRHP’s nurse tests for anemia among adolescent girls, a ubiquitous sign of micronutrient deficiency among India’s young female population.

I also observed how the VHWs monitored the status of their villages’ child nutritional status through their UNICEF weighing scales, community growth charts, and individual child growth monitoring graphs. In terms of the assiduous human rights work that the VHWs engage in, no other form of insight is better than the words of CRHP’s VHWs themselves, and I have included some of their thoughts from my focus group sessions below:

“In our village, we are giving them [villagers] knowledge about the
human rights. For example, we
educate them that each child should go to school, and if their families are below the poverty line, they must receive free housing from the government. We also give education to the young women in the Adolescent Girls’ Program, the Farmer’s Club men, and the Women’s Groups about human rights. We advise the government that our villages must be given clean water. All the village health workers come together to contact the government officer that is in charge of the issue we are fighting for.”

“Through the national and [local] Maharashtra government, taking care of children’s health and education is very important for us. But we believe we first must empower parents at home so that they can be educated and fight for their rights with their own voice. We teach parents that education is free for girls from the 1st to 10th standard [grade]. We also visit schools regularly and check the children’s blood, hemoglobin levels [for girls], height, and weight. We educate children about nutrition and personal hygiene using flashcards in the 1st standard, and we give health education to all children up to the 10th standard. We have excellent coordination and good relationship with the government and CRHP mobile health team workers. If the teacher or nurse of a school or nutrition rehabilitation center does not come regularly, we will report their absence to the village officer. Most importantly, people listen to VHWs more than government officials since we are one of them. The government is coming from the outside, and so they spend less time and attention on their relationships with these people. This is the reason why the VHW’s role is very important.”

“When we were young, we were very poor, so there was no food to eat… so forget about nutrition. When I was a young girl, no one gave special attention to me because I was a girl. So for me, human rights meant I had no rights because I was a girl, and so I was the last to be given food. I received no education either because everything went to my brothers. ‘Just let her die,’ my parents said. ‘Do not give milk to her since she is a girl; her birth has no purpose.’ My parents never thought about human rights because they were never informed about them. I married at 11 years of age, and no one was there to tell my parents about all these things like child rights until CRHP came, then I understood human rights.”

“The Indian government has organized programs for child nutrition in primary schools, so that two meals are given to children daily. But the quality of the food is very poor because they are giving food without much care. Many times, the food is finished before all children are fed, and if the local government runs out of money, the food stops coming into the schools for 3 or 4 days at a time. There are many drawbacks to these government schemes. When we started our work at CRHP 20 years ago, we saw the benefits of these government programs. Children were given milk, wheat, oil, halva [semolina-like grain porridge], and other foods that were good for their health. But that was 9 or 10 years ago. I would say that only 50 percent of the child undernutrition problems today benefit from these government programs. In some places, where government funding is sufficient and there are good doctors, nutrition will be good. Voluntary agencies, the Indian media, newspapers, parents, and children understand the importance of nutritious food. The VHWs are the most important people in the village and they talk regularly about nutritious food to families. Everyone [in the CRHP target villages] now has enough money for grains, vegetables, and eggs, due to the social transformation CRHP started. So now, in all the project villages, almost no malnourished children exist.”

*Suggested readings:

1) Community Rural Health Project website:
http://www.jamkhed.org/index.htm

2) “Necessary Angels” (National Geographic, 2008):
http://ngm.nationalgeographic.com/2008/12/community-doctors/rosenberg-text/9

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