The Kamanves slum in the town of Mijar (Maharashtra State) is an impoverished area of about 2500 people, most living in 1-room mud-walled houses. About 70% have either no or only nominal education, and more than half are only informally or temporarily employed. The average income amounts to less than $0.85 per day for an average family of 5. In 1974 a group of Kamanves residents formed a committee, backed by the Director of the Department of Community Health of the Miraj Medical Center, to try to alleviate some of the area's problems. Through community discussions, the 1st priority of the committee was held to be to provide for the nutritional needs of the children (about 35% of the population). The group tried to raise money internally, but when this was seen to be impossible, funds were sought from outside (Terre des Hommes in Germany, and the National Committee for People's Self Development of the United Presbyterian Church in the U.S.). Steps were taken to build an extension of the local school, and the local school board was used as the legal base for the organization of a public trust, with its own bank account and constitution (later revised to cover additional projects). The 1st projects were provision of a morning meal for some 150 children under 5, and an evening meal for older children, with special supplementary foods for those suffering from nutritional diseases. The meal includes rice and meat twice a week and fruit 3 times a week. Health care is provided through monitoring of weight, regular medical examinations, treatment of worms and minor ailments. Personal hygiene is taught. A very small fee is charged for each child weekly. Additional projects later included a communal meal for the very poorest adults and expansion of the kitchen (run on a rotating basis by community mothers under management of specially trained women) to help feed the poorer patients at the Miraj Medical Center (this project will undergo evaluation by the community to see if they can continue it). Self-help activities led to the registration of the program as an Institute of Self Development, providing vocational training (in sewing 1st and later in other crafts), a cooperative to finance small enterprises, a modest recreational program, tutoring and night classes, educational loans for those in need to help keep them in school or go beyond the primary education system, and a health education program.
Zambia, formerly 1 of the more prosperous of developing nations, has fallen on hard times due to political problems of its neighbors and the depressed market price of copper, its main export product and largely the basis for its prosperity. The country is currently (1978) trying to shift its economic base to agriculture -- meaning that surplus crops go to export rather than to the crowded urban areas of Zambia itself (35 to 40% of the population). Zambian squatter settlements, traditionally self-reliant, are the target of a pilot project planned by UNICEF and The American Friends Service Committee, which hopes to encourage this self reliant tradition by expanding the practice of urban agriculture. The project hopes to develop ways to raise the productivity of urban agricultural areas by finding the most suitable crops and creating irrigation so that agriculture can be practised year round. This is the start of a planned "Urban Agriculture and Nutrition Service" to be funded by the above groups, with the Zambian government and, hopefully, other agencies, aimed at providing: 1) Kitchen gardens on residential plots. 2) Cultivation of road reserves, green belts, and other reserved areas throughout the city and on its outskirts. 3) Rainy season cultivation of all idle land in the urban area. 4) Raising of poultry, rabbits and other small livestock on residential and communal plots. 5) Cultivation of small holdings in the urban periphery by low income residents on a cooperative basis. 6) Eventual resettlement of some urban residents on farms in the urban periphery. There will be, in addition, a small-loan fund, 1st for individuals and later for cooperative ventures, and a program to improve technical skills. It is hoped that by 1980, when the pilot project is completed, the service will be self-supporting.
The Chinese government has organized a family planning program on a voluntary basis under state guidance. The program is adapted to conditions in different areas, e.g., birth control and late marriage are encouraged for high density areas with high birthrates and population growth is encouraged in low density, especially national minority, areas. As a result of the program, the national birthrate has dropped every year as grain production has risen. The program supplies contraceptive drugs and devices, abortion, and sterilization operations free of charge. Commune-run clinics and barefoot doctors spread family planning in the rural areas. Peking has more than 800 neighborhood-run health centers which, combined with family planning programs in state-run hospitals and factory clinics, provide family planning advice and services for the urban population. Volunteer workers publicize the program and distribute free contraceptives. Maternal and child health programs are of the highest importance, to ensure that the children who are born will have the best chance of surviving. China is also succeeding in rejecting traditional notions of the superiority of men and traditional preference for male offspring.
This case study reports on a project to improve health care delivery in Miraj, a rural district of Maharashtra State, by building on existing institutions and personnel. The planning meetings were designed to involve the leadership of the 58 villages concerned and the district public health agencies. The Health Minister of Maharashtra State approved the plan and agreed that all government health workers would participate in the project. Financial support was obtained from the Ecumenical Council of Churches. The project started with a 1-week course for trainers, who, in turn, trained 173 of 186 traditional midwives in hygienic techniques of childbirth, danger signal of pregnancy and family planning motivation; enlarged the role of village health aides by teaching them how to diagnose pregnancy, contagious diseases and nutritional deficiencies, distribute simple medication, iron and folic acid tablets and contraceptives and motivate family planning acceptors; and retrained all other existing unipurpose personnel to serve as integrated health workers, with responsibility for maternal, infant and child care, health education and prevention and treatment of common diseases. After the initial courses, all workers undergo 1 day per month of ongoing training. Geographic and administrative reorganization helped to distribute health services more widely and more efficiently. The communities became involved in the maintenance of sanitary conditions, mass vaccination, selection and housing of health workers and so on. A significant and cost-effective reduction in mortality and morbidity was observed in a 1976 evaluative survey, when compared to a 1974 baseline survey.
This paper describes the development and activities of the Sarvodaya Movement, a grass-roots mutual-aid movement based on traditional Buddhist social values. Started by high school students and teachers in 1947 as a community-service organization the Movement is open to all individuals and has attracted thousands of volunteers in 1200 villages. Sarvodaya Shramadana emphasizes improvement in the standard of living through the development of local resources by the community itself, strengthening of the family and the village unit, discouragement of large-scale industrialization and removal of forms of exploitation, such as caste, race discrimination, large-scale land ownership, and so on. Key to all of the Movement's activities is the concept of self-reliance, self-realization, nondependence at both the individual and the village level. The mutual sharing of labor not only accomplishes the work of the community, creating the physical infrastructure for economic improvement, but serves as a revolutionary technique to awaken people to their own potential. The movement organizes villages into functional groups by age and occupation and trains community workers who are chosen by the villages themselves. In each village, work starts on short-term strategies to relieve debt, provide health care and educate the population and long-term strategies to generate sustained, unified community spirit and sufficient income to avoid use of outside credit. The Movement's specific projects include surveys of nutritional deficiencies, the community kitchen program, preschool program, day care centers, children's library service and community health programs. The Movement is now changing from a centrally-coordinated organization toward decentralized organization based in 52 Extension Centers and run, at the national level, by an Executive Council of 35, a 6-man board and 9 coordinators. The Movement was self-financed by members for the 1st 10 years but has used outside financing in the last 10 years. Through establishment of economic activities, the Movement hopes to be self-reliant by 1985.
