“You ask us to wash hands, to use soap. Where is the water? Do you know the cost of soap?”
When doctors Mabelle and Raj Arole began working in the Jamkhed community in the 1970s, the idea of a comprehensive preventative health organization began forming in their minds. They knew that preventative programs would help them achieve their goals of reducing infant mortality rates, maternal morbidity and mortality, and crude birth rates as well as controlling chronic diseases. They soon discovered that a key ingredient to the success of preventative health programs is community involvement. In the beginning when they began working to build rapport with local communities, they realized that “health was not a priority for the poor at all” because “the majority of people were preoccupied with their very survival” (Arole, 75).
Dr. Mabelle and Dr. Raj realized that these basic needs must be met first; health was not going to be a simple fix. The most pressing threat to survival at this time was the scarcity of both food and water. This lead CRHP to begin drilling tube wells and starting nutrition programs that became vehicles for further health and social changes within the communities. The basic tenements of engaging with the community, encouraging participation, and responding to needs beyond health still remains guiding principles in CRHP’s work today where you can see foci of mental health, diabetes, cancer, high blood pressure, organic farming, and water resource management.
CRHP first identifies the needs of a community through community-based participatory research methods. This begins with qualitative and quantitative data collection from villagers. House-to-house surveys and focus groups led by social workers allows CRHP and the community to engage in conversation that helps identify not only the symptoms of a problem, but the deeper root causes. This methodology is central to CRHP’s assess, analyze, and action approach. As important as it is to have the community participate in the ‘action’ step, it is equally important to have their engagement and support at the ‘assess’ and ‘analyze’ steps.
In the beginning, doctors Raj and Mabelle had to think outside of the box for ways to engage the community. In one such attempt to bring people together to discuss village problems, they planned a volleyball game which became a forum for cooperation and discussions about village problems. These informal groups led to the establishment of Farmers’ Clubs (Arole, 107). Today, community engagement is made easier as Farmers’ Clubs, Women’s Self Help Groups, and Village Health Workers have long been established. These groups serve as platforms where larger village problems can be discussed and vehicles through which other villagers can be reached.
The key to improving health conditions of a community will always lie within that community. Through this process, and by adhering to these principles, CRHP has found that over the past 49 years “individuals and communities have gained in self-esteem and self-confidence and have realized that they have the capacity within themselves to determine their own lives” (Arole, 252).
Arole, Mabelle, and Rajanikant Arole. Jamkhed: a Comprehensive Rural Health Project. Comprehensive Rural Health Project, 1994.