Mahatma Gandhi had said, ?Only when the people themselves become actively responsible for their own and their community'shealth, can important changes take place?.
Community'shealth and well-being depends upon the involvement of not only medical fraternity and the government, but also of nearly everyone. In a large sense, a community health worker is anyone who takes part or motivates others in making his or her village/mohalla or city a healthier place to live.
World Health Organisation recently released a study showing 2.6 million annual deaths in India due to poor sanitation. This is alarming and shocking for us. Yet, the cause is hardly acknowledged or addressed seriously. These death figures have wide range of sub-causes: water-borne diseases like cholera, typhoid and dysentery, vector-borne diseases like malaria, dengue and chikungunya, encephalitis and other viral infections.
One child out of ten children in Bangalore city dies of diarrhoeal diseases due to infection. Hookworm lurks everywhere in our villages and major cities due to the lack of sanitary facilities. Indians have to change themselves. They sadly lack civic sense. Garbage is usually dumped outside houses, which is an eyesore for foreigners, but not for Indians, why?
We all know very well that we throw rubbish on the streets, without battling an eyelid, the same Indians, when reaches Singapore, are on guard and may not commit public nuisance or throw rubbish on the streets.
In progressive and health conscious state like Kerala, nearly 15,000 people are suspected to have chikungunya due to unsanitary conditions. This speaks very poorly about public sanitation and hygiene sense in India. More than 70 per cent of the targets of ?health for all? in India depends upon sanitation with proper sewerage disposal, clean water supply, personal hygiene of people and ?vaccination drive? for six children diseases. For improving the standard of public health, just three important environmental health concerns need to be urgently addressed i.e safe drinking water, waste disposal and no open latrines. All these are doable tasks and can be more easily addressed by public-private partnership projects but unfortunately not done even after 60 years of Independence.
A public campaign to create awareness on how to maintain clean surroundings is immediately necessary as is done in developed society. Resident Welfare Associations, local clubs and community and religious groups, schools and colleges could play an important role towards this sanitation campaign. It should not become political stunt and token gesture. We see photographs of politicians appearing in media and crores of rupees from public exchequer going down the drain by government machinery and still the results are nil. If we Indians don'tbecome serious, this neglect on public sanitation and clean water supply would result in ?disease for all? in next 50 years, unless we wake up from our deep slumber and prejudices against public-private partnership.
There are many ways to motivate people in working together to meet their common needs. Here are a few ideas:
1. A village health committee: A group of able, interested persons can be chosen by the village to help plan and lead activities relating to the well-being and health of the community. For example, digging garbage pits or making latrines. The health workers and public servants should share knowledge and responsibilities with other persons and make funds available.
2. Group Discussion: Mothers, fathers, school children, young people, traditional opinion makers and other groups can discuss the needs and problems that affect health sanitation. Their chief purpose can be to help people share ideas on what they already know and how to take care of sanitation which can save life of millions. Collectively when they show results, they can get government prizes/funding.
3. Work festivals: Community projects such as putting in water system or cleaning up the village go quickly and can be fun if everybody helps. Games, races, refreshments and simple prizes help turn work into play. Use imagination.
4. Cooperatives: People can help by bringing prices down, by sharing tools, etc. Group cooperation can have a big influence on people'swellbeing.
Poor country has poor people, from where will they get funds to execute the work on public health? It is really strange that sincere social workers are demotivated for want of funds and many ?NGOs on papers only? are flourishing under patronage of politicians and bureaucrats and that is why visible results are not seen inspite of the money spent.
Setting goals often helps people work harder. Government officers should also see that funds are made available and progress is monitored to see the visible change. There is urgent need to bring a sense of accountability in bureaucracy.
One should always remember that working ?collectively? can bring better results as people can share their experience while working.
Perhaps the most important thing of collectively working scheme is to awaken our people to their own possibilities, to help them gain confidence in themselves and to improve health of people around them.
Lastly, as a deterrent, heavy fines could be imposed on those littering at public places. Licenses ought to be cancelled of industries pumping toxic waste into water bodies. And more sincere public-private partnerships ought to be started to create infrastructure like toilets, clean drinking water outlets, working drainage systems and garbage removal services. There are many success stories that need to be shared. Lastly, the government must understand transparency of accounts and public awareness of funds allocated for sanitation is the only way to go if India wants to clean up its villages and cities thus providing basic amenities to its citizens.
(The author is secretary general of Delhi Gynaecologist Forum)
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