Description

For the 1,500-people community living in Dingerheri, a village located in northern India at about two and a half hours from New Delhi, attaining health care was more of a hassle than a routine activity. The one health centre in the village was constantly out of drugs, children were not receiving their immunization, and pregnant women had to seek traditional delivery methods. Perhaps the major problem though was that community members were not aware of their rights and what standards to expect from the local clinic.

World Vision’s approach called Citizen Voice and Action (CVA) transformed the relationship between the community and their local government as well as the health services provided at the clinic in Dingerheri.
CVA is an advocacy methodology aimed at empowering communities to become knowledgeable of what their local government should be providing, then evaluate those services, and finally press for action from government authorities.

Through CVA, people of Dingerheri learned about several benefits to which they were eligible.
They did not know that pregnant women could receive services at a hospital, and an ambulance would pick them up at their homes. They were also unaware that the Indian government gives about $29.00 as an incentive to women that choose to use hospitals. Due to the lack of information, women were paying for traditional delivery methods at the village that were risky for both mother and baby’s life.

Before introducing the CVA methodology, villagers said that when got sick, they would simply wait to see if they got better, or use natural medicine and visit traditional doctors in the community. The downside to these methods was that at most of the times, their health conditions got worse. Community members also said that when they did not have a way out of the situation, they would travel about three miles to a private hospital. Those trips were not frequent, especially because it would cost them a small fortune. In order to finance the expenses and treatments, they would borrow money at high interest rates – not a good solution, but the only one about which they knew.

As World Vision introduced the CVA approach in Dingerheri, villagers participated in meetings and other community gatherings. They learned about local government commitments, and were empowered to monitor those services and demand improvement when needed. As a result, drugs were stocked up at the local clinic and children got their immunization. Community members started requesting appropriate services from local health workers, Auxiliary Nurse Midwives (ANM) and Accredited Social Health Activists (ASHAs), who are the first point of contact for health care. Before, villagers said that health workers were “only for show,” but after learning about their duties, they were able to hold them accountable.

At school, children also received the benefits of living in a knowledgeable and empowered community. In 1960 the Indian Government instituted the Midday Meal Scheme to battle student hunger and to encourage enrollment in schools. However, in Dingerheri, the Midday Meal was actually one of the negative aspects of the local school. The food lacked nutritious ingredients and the students complained that they ate the same thing over and over again. Through the CVA approach, community members were able to demand change and monitor the quality of the meal. The initiative increased the nutritional intake of children, who now enjoy a variety of 16 meals. In addition, the school received new stocks of clean cutlery and plates.

“We are very poor families that can’t afford nutritional meals so it’s good that they can get that quantity of vitamins and minerals at school,” said a parent.

The CVA methodology has played a key role in the changes that villagers of Dingerheri have been experiencing. Positive results have been especially seen in regard to the maternal, newborn, and child health care situation.

Currently, World Vision’s Area Development Program phased out of the area, but the regular monitoring activities of CVA are still carried out by the community. This is the evidence that the CVA approach has produced change and cultivated sustainability.