Empowered communities continue to identify new priorities: The Jamkhed, India, experience

Comprehensive Rural Health Project (CRHP), Jamkhed, India, has pioneered principles and practice of community-based primary health care since 1970. Sustained impact has been dramatic on health status e.g. IMR (176 to 20), CBR (40 to 15), prenatal care and safe deliveries (.5% to 98%), malnutrition (40% to <5%), TB (18 to 1/1000) and general well being, especially for women, poor and marginalized. Key is developing the capacity of communities. Root causes are addressed, such as poverty, caste system, women's status, harmful traditional practices. CRHP helps communities by giving them ‘tools' that enable them to do for themselves. Primary change agents, village health workers (VHWs), are selected by their communities and trained by CRHP in various health topics as well as development issues, with focus on personal development and relationships within the community. Their main role is health education. CRHP facilitates organizing groups around self-interest, which learn to identify their problems and resources, analyze problems, and develop appropriate solutions, building community that works together. Economic development is an important component. Social and cultural issues are addressed through community groups. Through this empowerment process, villagers have recently identified non-communicable diseases (e.g. diabetes, hypertension) and mental health as new priorities. VHWs learn about prevention, early detection, management and share information with community members, especially those at risk. Together they identify possible cases and support patients in treatment and rehabilitation (e.g. physical, emotional, social, economic). This presentation will describe the process and share information on its community work on diabetes and hypertension.