Social Justice, Women Village Health Workers, and Participatory Primary Health Care

The World Health Organization Report on the Social Determinants of Health (2008) emphasized as a first principle improving living conditions and well being of girls and women. Yet, the Lancet (2008) emphasized that policy makers and health experts who promoted neoliberal top-down models of the last 30 years have largely failed to solve the problems of the vast inequality of health care. In contrast, one primary health care model, in the tradition of Alma Alta, has succeeded where others have failed. Begun in 1970 by Drs. Mabelle and Rajanikant Arole, Comprehensive Rural Health Project (CRHP), a participatory community based model changed the health profile and well being of hundreds of thousands of impoverished villagers in India. Based on underlying principles of equity, integration and empowerment, CRHP addresses basic social and economic factors specifically focusing on issues of gender and caste inequality. The key to this unprecedented 40 years success was the recognition that health and social justice begins with what women do. CRHP trained local rural women to be Village Health Workers (VHWs) in their home communities. METHODS: Anthropological ethnographic methods and life histories are used to compile data of women's lives and to examine generational change. Over three years, 34 VHWs (each representing one village average pop. 1600) of 132 eligible (26%) completed the full interviews. RESULTS: In one generation local women VHWs transformed themselves from sequester wives to respected community leaders instrumental in radically improving the health profile, economic life, and gender and caste equity of rural villages.