Monday, April 30, 2007
Key findings – snapshot
Total monetary value of petty corruption put at Rs 2,017 crore a year
59% of rural and 51% of urban households sought services of government hospitals. All India figure: 55% (11.3 crore) households
Of those who interact with government hospitals, 26.5% (3 crore households) paid bribes – 19% in rural areas, 49% in urban; average bribe paid per household: Rs 663
Irregularities like non-availability of medicines and unethical practices by doctors are much lower in southern parts of the country
43% of respondents felt quality of service in government hospitals was poor. In low performance states, 53% felt service was poor.
67% felt corruption was widespread in government hospitals.
45% said hospital staff frequently demanded bribes
Use of services
Location of Households using Government hospitals
In Himachal Pradesh and West Bengal, a significantly higher percentage of people was availing the services of government hospitals. In Bihar, considerably lower number of people were availing the services of government hospitals.
Is There Harassment?
In low performance states, only 38% of the respondents received treatment or consultation compared to 66% in the high performance states. Overall 23% said they did not receive any treatment or consultation during a visit to a government hospital
Reasons for repeated visits
Doctor not available in previous visit-39%
Failed to get appointment -21%
Admission to ward not available-14%
Operation theatre was not free-13%
Diagnostic lab failed to take sample -12%
Perceptions about Government Hospitals
Service: Perception about quality of services
Neither Poor/ Nor Good-26%
Very Good -3%
Prevalence of Corruption
There is widespread corruption in hospitals
Strongly Disagree- 6%
Disagree Somewhat- 9%
Neither Agree Nor Disagree- 18%
Agree Somewhat- 38%
Strongly Agree- 29%
In the high performance states, 62% felt that there was corruption in government hospitals, against 77% in the low performance states.
Medicines unavailable- 52%
Doctors suggest a visit to their private clinic -37%
Doctors refer to private diagnostic centers-31%
Over-prescription of medicines-24%
Bribes demanded by staff-20%
Diagnostic tests are done even when unnecessary-18%
Doctors are absent-13%
In low performance states, 66% said medicines were never available in government, against 29% in the high performance states. Possible reasons: genuine shortage, diversion of medicines to private medical shops, doctors deliberately prescribing medicines which were not available in the dispensary. Long waiting time for getting consultation or treatment is might basically be due to low capacity of the hospitals, but creates an opportunity for corruption by giving hospital staff the power to provide required service out-of-turn, and for doctors to ask patients to get diagnostic tests from a particular private laboratory, which pays them referral commission.
One study says: overall, 63.33% of the prescriptions were found to be irrational (i.e. flouting established norms of treatment). This figure was the highest for prescriptions from unqualified sources (81.8%) like registered medical practitioners, and lowest (44.44%) for public sector hospitals. In southern states of Andhra Pradesh, Tamil Nadu, Kerala and Karnataka, these irregularities exist at a much lower scale
Experience of Interaction with Hospitals
Ways to bypass normal process
By paying bribes -54%
By using influence- 42%
Reasons for Using Alternative Process
Save time- 38%
Could just not get work done in normal way- 23%
To get better care and treatment- 39%
30% of respondents had to take recourse to “alternative methods” like paying bribe or using influence, to get faster (out of turn) treatment and for better care (like consultation with senior doctor, not juniors, clean bed-sheets and better food for in-patients).
Though the system is largely free of middlemen, there were cases of people going to middlemen (mostly hospital staff or ex-staff or their relatives). In the low performance states, the prevalence of bribery is higher than in the high performance states.
What do people pay bribe for?
To get medicines- 29%
To get admission- 22%
For consultation or treatment -17%
To avail diagnostic services -13%
For operation- 11%
For blood- 7%
Getting proper food- 1%
Who Gets the Bribe?
Other hospital staff- 75%
Service Providers’ Perspective
Pressure on infrastructure: Despite capacity constraints Govt hospitals are forced to admit patients because of pressure from co-doctors or local politicians. So, the hospital is almost always working beyond capacity, resulting in low quality of service.
Lack of resources: Lack of resources/funds often means diagnostic instruments are not in working condition, forcing doctors to ask patients to get tests done from private laboratories.
High workload: Acute shortage of manpower hence, they are not able to attend to all the patients, resulting in long queues and delays
False charges of negligence: People come to the government hospital as a last resort, after trying to get treatment in local nursing homes or doctors, by which time, in most cases, the patient’s condition is critical. Any adverse eventuality is blamed as negligence on the part of the hospital.
RKS model of Madhya Pradesh: appears to be sound.
Suggestions to reduce corruption
Users’ Committees should be constituted to take up citizens’ grievances.
Provision of diagnostic services: The diagnostic services can be outsourced to private players, where they receive payment from government on per-patient basis. This is already being conducted to some extent in some hospitals in Delhi.
Medicine supply: Patients often fail to get medicines from government dispensaries, either due to actual shortage or diversion of supplies. To check for the second possibility government dispensaries should display the drugs received every month and furnish daily stock position.
Sunday, April 29, 2007
Heartburn is a painful or burning sensation in the oesophagus, caused by the regurgitation of gastric acid. The pain often rises in the chest and may radiate to the neck, throat but has nothing to do with the heart. It is so called because of a burning sensation of the breastbone, although some heart problems have a similar sensation to heartburn. If left untreated, it can lead to ulcers or bleeding of the oesophagus and may be at later stage to cancer of the food pipe. As per the study conducted in eight cities by Health Care Welfare Society (HCWS) of Ahmedabad, among 400 respondents in these cities aged between 25-55 years, who reported heartburn or acidity at least once a month. People of Bhopal reported 71 % prevalence of the heartburn which was among highest three. Delhi recorded the highest at 82 per cent and others were as follows –
1. Kolkata 68 per cent
2. Lucknow 65 per cent
3. Mumbai 75 per cent
4. Chennai 66 per cent
5. Ahmedabad 68 per cent
6. Hyderabad 72 per cent
Irregular timing of meals was found to be a major cause for the ailment. The survey had over 57 per cent of respondents blaming irregular eating habits as the main reason for their frequent bouts of heartburn. As per HCWS heartburn is becoming the single most important factor behind the rise in gastro oesophageal reflux disease, which is at present affecting three out of every five urban Indians.
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Chendu, a tribal from Alirajpur in Jhabua district, beat his wife to death. Reason? She asked him to stop drinking. In the same block, another young man killed his brother with an arrow when the latter tried to extract toddy from the palm trees owned by him. Often the reasons for murders or fatal assaults here are as mundane as someone's hen entering the neighbour's territory or someone's refusal to lend a 'bidi' (leaf rolled cigarette) to a friend. In all these crimes, either the killer or the victim or both are high on alcohol, reports Grassroots features.
Alcoholism is taking a heavy toll on the socio-economic life of the tribal population. According to an official from the department of tribal development, the age-old problem of excessive drinking in tribal areas is affecting the new generation too. "One can see teenagers brewing 'arrack' (local brew) in front of their houses. There is lack of conscious effort from the community to prevent youngsters from becoming hard-core addicts," he said. This reflects on the literacy rate and high dropout percentage in the district, the highest in the state. "The attendance in schools also comes down especially during October to March when toddy tapping starts in certain regions of the district. Several students show up for classes drunk while others sneak off for a nip or two of toddy from the nearby palm groves," said Sanjay Solanki, a teacher. Efforts are underway to counter alcoholism among tribals, though the progress is not very encouraging. Since alcoholism is also associated with starvation and unemployment, the district administration tried an innovative method to make use of toddy to generate gainful employment. The project started in November 2004 in Bhavari village in Alirajpur. "We gave training to one Bhim Singh and his family, who owned 10 toddy palms, to make palm gur (sugar) out of toddy," said Rajkumar Pathak, the district collector of Jhabua. The logic of the administration was - a family with 10 toddy palms involved in making gur can earn up to Rs.16,000 a season, while through sale of toddy it can earn only less than half that amount. The officials in the district administration thought that since gur making was more profitable, more and more tribals would change over from the toddy business. "This would not only improve their financial situation but also reduce the number of crimes in the area," said Pathak. However, this did not happen. Although Bhim Singh is very happy with his newfound enterprise, there are not many takers for it among his community. The district administration has managed to convince only three more families to pursue gur-making. One reason for the failure of this project was the tribals' love for toddy. "No one wants to leave toddy," said Shankar of Khedut. But many people feel that if effective marketing strategies were in place the new enterprise could have done better. In states like Orissa and Karnataka, it is catching up well.Despite the setback in the gur-making project, the district administration has not lost hope. It is encouraging tribals to sell fresh, unfermented toddy for making 'neera', a health drink. Unfermented toddy is very sweet and healthy. But fermented toddy contains 50-60 percent alcohol, making it a highly intoxicating beverage. "We are working on this project. Our effort is to encourage more and more people to sell toddy for making neera so that there is a shortage of toddy for making alcohol," said Pathak. The administration has approached the Khadi and Village Industries Commission (KVIC) for processing and marketing neera.Sources in KVIC say that it is working on the proposal. With suitable technological intervention as prescribed by the Pune-based National Chemical Laboratory, neera's shelf life can be enhanced to six months. "Neera contains a number of minerals and salts; acids like ascorbic acid, nicotinic acid and riboflavin; proteins and vitamin C. It has less calorific value, apart from being sweet and delicious.
It can give mineral water a run for its money," said A.K. Sharan of KVIC.According to Sharan, neera can enhance the income of a farmer. One palm tree yields four litres of toddy a day. So if a farmer has 100 trees it would become 400 litres. The same could be sold at the rate of Rs.10 a litre, amounting to Rs.600,000 for the season lasting five months. Although it makes a lot of economic sense, weaning away the tribals from the toddy business is an onerous task. "It all depends on the commitment on the part of the administration. If the government really wants to counter alcoholism then it should stop promoting foreign liquor also," said Shankar.
Alcoholism is linked to high incidences of crime in the district. According to the state crime records bureau, in 2005 there were 124 murders in the district -- the highest among all districts in the state. "In more than 50 percent cases, alcohol was a factor," said Avinash Sharma, the assistant superintendent of police, Jhabua. "Tribals are very simple people. But once they consume alcohol they get violent even on trivial issues and use fatal weapons against each other."The crime rates are very high in certain blocks, especially Alirajpur and Jobat. Toddy palms are found in abundance in these blocks. A survey by the Adivasi Sewa Shikshan Samiti in 2004 revealed that 10 percent of the tribal population in the district could be termed "heavy drinkers". About 80 percent of the addicts in the district are below poverty line. "An average tribal family spends between 60-70 percent of its income on alcohol. It was found that if a person is a 'desi' (local) liquor addict, he spends a minimum of Rs.400 a month on it. But for a person addicted to foreign liquor, his bills touch up to Rs.3,000-3,500 a month," said Benedict Damor, secretary of the samiti. Even poor families spend huge amounts - to the tune of Rs.25,000-30,000 on alcohol alone during marriages.
The alcohol industry is the only flourishing business in this district. In 2007, the contract for the sale of liquor in Jhabua district was auctioned at Rs.100 million. For Jhabua, where 47 percent of the population is below the poverty line and 85 percent is tribal, this is a huge sum. The officials in the excise department say the turnover from the sale would be anywhere between three to four times this amount. Besides, toddy and desi liquor (almost like a cottage industry) are available freely and cheaply. However, Benedict Damor, who campaigned extensively against alcoholism, feels that prohibition is not a solution to this problem. "Alcohol is an integral part of tribal culture. But consuming alcohol as part of rituals or festivities is different from alcoholism. Alcoholism is linked to illiteracy, impoverishment and many other factors. But there should be a concerted effort from within the community to do away with such evils and to return to our roots," he said.
Exposing the Madhya Pradesh Government’s apathy on water shortage, a 14-year-old girl has dug a 22-feet deep well, so that her mother does not have to walk miles to fetch water. People in the town of Harda watched as a frail Reshma lowered herself into the well with a rope. Her efforts paid off finally when she stepped into a pool of water at the bottom of the well.
"My parents were really worried due to water shortage in the area. The lone hand pump in the area was too far off and it was always crowded. People used to fight for water. So, I thought of digging a well to resolve the crippling water shortage," says Reshma.
She worked for over seven hours a day for the last two weeks to find the water.
Hazrat Bi, Reshma's mother is the happiest of the lot. It was for her convenience that her teenage daughter decided to go ahead with the task.
"She used to dig the well one-arm deep or one and a half arm deep every day. We used to measure the depth every day. And the day the water sprung up… it was the fourteenth day…we were so happy…I almost dropped the bucket I was carrying. Even Reshma cried in happiness. All the children were really happy," said Hazrat Bi.
While Reshma's father thought the job would be too tough for his daughter, Narayan Sharma, a neighbour and family friend encouraged her to go ahead.
"I told the girl that she should go ahead and I would help her. I used to come to her every day and guide her, but she was already doing good work," said Sharma.
The shortage of water during the summer months is a perennial problem in several regions of Madhya Pradesh, and the growing population has only added to the woes. In extreme conditions, people have to draw water from small water holes. Thousands of villagers trek for miles in search of water and sometimes they even enter into a brawl. ANI
Saturday, April 21, 2007
According to the survey conducted jointly by HRD ministry, UNICEF and the National University of Educational Planning and Administration (NEUPA), only 37.42 percent of schools in India have girls' toilets.
"Though the percentage of schools having girls' toilets has increased from 28.24 percent in 2003 to 37.42 percent in 2006, yet the situation is quite dismal," said Arun C. Mathur, chief researcher of the report.
Among the states, Meghalaya is at the bottom of the tally with just 7.71 percent of schools having girls' toilets. Only 9.58 percent schools in Assam, 9.81 percent in Chhattisgarh, 11.69 percent in Arunachal Pradesh, 11.78 percent in Bihar and 12.4 percent schools in Orissa have separate toilets for girls.
Shockingly, the study found that less than 25 percent schools in 13 states have separate girls' toilets.
However, Chandigarh tops the chart with 89.19 percent of its schools having toilets for their female pupils. While Delhi stands second with 87.82 percent, 80 percent schools in Pondicherry and 69.41 percent schools in Uttar Pradesh have toilets for girl students.
NEUPA vice chancellor Ved Prakash said: "In the 21st century, these figures are startling. I hope the government and the private sector running these schools would take up the issue seriously. Our girls need separate toilets, and that is the reality." The survey, Elementary Education in India, covered over 1.1 million primary and upper primary schools across 604 districts of India.
Apart from toilets, tens of thousands of schools lack basic teaching facilities like blackboards and a building. Leave aside computers, a total of about 88,000 schools (nearly eight percent) in the country still do not have a blackboard in their classes.
While 36.65 percent of schools in Sikkim do not have a blackboard, nearly 26 percent in Jharkhand and 30 percent schools in Arunachal Pradesh need blackboards. In the Indian capital, 10.8 percent of schools do not have a blackboard.
However, all schools in Nagaland have blackboards. The figure is 99.5 percent in West Bengal, 99.46 in Assam and 98.61 percent in Maharashtra. As much as 97.8 percent schools in Uttar Pradesh have blackboards. Nearly five percent of schools in India don't have school buildings - and about 97 percent are government schools.
Wednesday, April 18, 2007
Bilaspur, (Chhattisgarh) April 17:
In a mockery of the Board exams, under-qualified teachers are checking the copies of the students, Sahara Samay sources said.Albeit, these teachers lack any degree or knowledge in the subject, the evaluation of the copies is in full swing.The incharge of the evaluation process also admits the loopholes in the process but assures that no evaluators are unscrupulous enough to spoil the future of the students.The teachers have also managed forge certificate of merit in the subject to become eligible for the evaluation work and are minting money.
Sunday, April 15, 2007
The funds for undertaking these activities are to be transferred to Community & Capacity Development Unit established in the State. This release is for plan expenditure. The funds are to be utilized for the purpose for which it is released and as per the terms and conditions. The release is on the basis of norms for each activity as per the guidelines.
More money / funds for IEC. important is their utilisation not allocation which is key issue which state has no reponse ?
Where does this funds go ? Many districts of state suffer from water quality issues ?
By Sanjay Sharma, IANS, [RxPG] Bhopal, April 14
Madhya Pradesh is using an auspicious day in the Hindu calendar to crack down on child marriages.The government has unveiled 'Raksha Sootra Bandhan' programmes under its special action plan to check mass child marriages that take place on 'Akshay Tritiya' day April 20. On that day, minor children will tie a band on their parents' wrists with a message that they should not marry off their adolescent children.Akshay Tritiya generally falls in April or May and is considered auspicious for Hindu marriages. Wedding ceremonies, including child marriages, take place on this day in Madhya Pradesh, besides Rajasthan and Chhattisgarh.The plan envisages the holding of camps and rallies to generate awareness among the people in Madhya Pradesh.
These events would be organised at district and block headquarters and main villages.NGOs say nearly 20,000 children were married off last year on this day in Madhya Pradesh alone.Child marriages normally take place within the Tawar Rajputs, Lodhas, Sodhiyas and Dangi communities. Yadavs and Gujjars also join the cult.Madhya Pradesh comes second to Rajasthan as far as marriage of minor girls is concerned. While the average age of marriage for an Indian girl is 20 years, it is 17 in Madhya Pradesh.
The Unicef's state of the children report for 2007 states that the average age for marriage of girls has been increasing during the last 20 years, but 46 percent girls are still married off before they reach 18 years.The reason for early marriage of girls is not only financial. People also feel that by getting their daughters married off early the girls could be saved from sexual harassment and getting pregnant prior to marriage.
As per Unicef's 'The State of the World's Children 2007', girls marrying before 15 years have five times more chances of dying while giving birth. The state already has a high maternal mortality rate.Realising that such malpractices cannot be curbed through government efforts alone and there is a need to generate awareness in the society, Chief Secretary Rakesh Sahni has instructed district collectors to follow the plan guidelines to make the campaign against child marriage successful.Sahni has asked the collectors to chalk out their own strategy and take action against the 'culprits'.The collectors have been directed to organise awareness camps at every block headquarters, where influential people should be invited.
Thursday, April 12, 2007
With its attention riveted to “War-on-Terror”, the world is yet to wake up to the HIV (human immunodeficiency virus) crisis that threatens to cripple a large section of the youth in India.
Thanks to a recent study by the Indian branch of Population Council, many startling facts have emerged. The study has been supported by the U.K.’s DFID (Department for International Development). “Most children are diagnosed as being HIV positive after they are two and a half years or older, and most often they are tested when one or both parents report positive.
“The study acquires special significance as an estimated 80,000 of the 27 million birth that take place in India every year could be HIV-infected.”
Wednesday, April 11, 2007
The theme of World Health Day on 7 April was 'Invest in Health – Build a Safe Future'. The above theme is more relevant in Madhya Pradesh, central part of India. The State urgently needs to invest in health to help save lives of its own people especially women and children.
The State of Madhya Pradesh has the highest rates of malnutrition among the children in India. As per the latest National Family Health Survey 60 % of its children in age group of 0 – 3 years are under nourished. Similarly as per the growth monitoring drive undertaken by the state 78,000 children in the state are severely malnourished, meaning they need immediate care. Though the state has set up nutritional rehabilitation centers in some of its districts to provide for medical and nutritional care and support to the parents of severely malnourished children but need is of more efforts in this direction or else many may die.
Madhya Pradesh has the highest infant mortality rate and 3rd highest maternal mortality ratio in the country. 76 out of every 1000 children born in the state die before their first birthday and approximately 24 women die everyday in the state. Though the state has introduced many schemes to help combat the same, but due to bureaucratic hassles and corruption the schemes are not yielding the desired results for children and women.
As per state's health department web site Madhya Pradesh for its population of 60.38 million (as per 2001 census) has the following health infrastructure:
- District hospitals 48
- Civil hospitals 54
- Community health centers 270
- Primary health centers 1149
- Sub health centers 8834
- Sanctioned beds in district hospitals 8945
- Sanctioned beds in civil hospitals 2775
- Total licensed blood banks by state 41
A NGO namely Collective of Advocacy research and training which advocates on the issues of maternal and infant survival has been calling the issue to attention. They had undertaken an analysis of rural health infrastructure versus the population in the state. As per their statement there is just 'one bed per 5.6 villages' in the state which is alarming!. It is not only the issue of beds or buildings. Even where there are structures or health centers they lack basic minimum facilities as needed and defined by rules and are not sufficient enough to save lives or provide for better health care to its people.
As per Reproductive and Child Health District level household survey (2004) data, out of the 386 primary health centre's surveyed in the state only 224 had drinking water facility. This means that only 58.3 percent primary health centre's had drinking water while others have no such facility. Similarly in case of community health centre's out of the 46 surveyed only 10 had facility of drinking water.
In case of vehicles like ambulances out of the 386 primary health centers surveyed only 35 had vehicles which were in running condition and out of 46 community health centre's surveyed 31 had vehicles in the running condition.
Infrastructure investment does not only mean building equipments etc. Human resource which is core in health needs to be focused upon. Not only to fulfill the vacancies of doctors, para-medics, nurses but also providing them with facilities to provide care for the people.
When one raises concern on the issue of health there are numbers of different issues which impact lives of people including women and children in the state which needs attention. Probably state needs to revamp and transform its health system and look at the whole issue more holistically. The State needs to peg health of its people as priority number one, transform on immediate basis which is not only limited to public proclamations and announcing schemes but also delivering results at ground level.
(All views expressed in this piece are personal opinion of the contributor)
The worldwide pneumonia data collated by the WHO shows that India has the maximum 44 million episodes of pneumonia cases every year. "Pneumonia mortality perhaps leads to a quarter of all under-five deaths in India. We have broadly accepted the WHO guidelines for reducing the Acute Respiratory Infections (ARI) in children under five," Prof B K Paul of the Pediatrics Department of AIIMS said.
The report 'Pneumonia - The Forgotten Killer of Children' said India has the largest percentage of undernourished children, which is implicated as one of the main reasons of pneumonial deaths among children. About 47 per cent of children under five years of age in India are undernourished and among these 18 per cent fall in the severly underweight category, it said.
"The biggest population of underweight children in India makes them highly vulnerable to pneumonia. We are now focusing on the implementation of effective preventive measures," he said. The trends in India shows that only 67 per cent of under-fives with pneumonia are taken to an appropriate health care provider.
Tuesday, April 10, 2007
CREW will arrange film shows on birds and their importance as barometers of environment and as crucial agents for seed dispersal and the pollination process. Members of CREW team informed the blog that will be screening the films titled "Water Birds of Bhopal" and "Backyard Birds of Bhopal" which has been produced and directed by Raajshri and Lalit Shastri in Bhopal and across Madhya Pradesh in Central India with the help of the State Education Mission.
CREW will make special B-rolls available to NGOs, environmentalist, schools and colleges to disseminate vital information on Migratory Birds underlining their ecological and environmental importance.
For moe information please visit the web site www.globalwarmingeurasia.com
Friday, April 06, 2007
01 April 2007, Sunday
Conventional strategies which focus on the individual’s behaviour change may not work, these have to be more broad-based, which address the wide range of determinants in the individual’s environment and settings.
‘Meaning is not something that is delivered to people, it is made by them’. A perspective paper by Panos Institute, 1998 had mention of this statement, which still is true. Lot of debate and discussion is held in recent times on the issue on communication and in the meetings on the subject one often hears a term i.e. behaviour change communication.
The experts say that this is it. It is the need of the day especially in the states like Madhya Pradesh in India, which has challenges like high rates of malnutrition in children under three years of age, infant mortality, and has large incidences of diarrhea especially in children. Many of these could be addressed to great extent by following simple practices. The need is to communicate these practices in form of simple messages, in a manner wherein this acquired information turns into a positive action. It is well known today that, that colostrum feeding and exclusive breast feeding can help reduce infant mortality and malnutrition, hygiene practices can help prevent diarrhea, simple precautions can help prevent respiratory tract infection to the new born, but still somehow we are unable to get these across to all including people in rural and tribal areas.
Fact is that we are lagging behind. May be it is easier said, than done. May be individual wanting to make changes in his life, does not feel the need for that change or even if the urge is there but it is not so strong to turn it into motivation for action, or face resistance from family, peers and community. Many a time’s services are often inadequate for their needs or insensitive to their situation. The system often fails them. ‘I want to take my child for vaccination but health centre is closed’ said one mother in Sidhi district of Madhya Pradesh, similarly ‘I want to go to school but teachers sent us back after taking attendance’ - a young boy of 10 years mentioned it in the gram sabha in Shivpuri district . They may also face religious, cultural, economic, or social pressures or a lack of structural and legislative support-that constrain their freedom to choose healthy and safe options.
Strategies designed to improve individual lives focus only on the “individual” pushing them to change practices by defining them as wrong and right. Such strategies ‘many a times’ ignore that there exists an environment and the forces within the society which push them following practices or doing things that undermine their health or health of their child. For example in case of just creating awareness on prevention of HIV/AIDS may not work, if we do not take into account the social determinants, cultural sensitivities and deep seated inequalities within the system. One may need different strategies, which is possible and there may be threats but may be that is the reason why working for change on both macro and micro level would help. When strategies for behaviour change are formed we therefore need to think in much broader terms, keeping the real picture in mind and think beyond the individual behaviour change.
Conventional strategies which focus on the individual’s behavior change may not work, these have to be more broad-based, which address the wide range of determinants in the individual’s environment and settings. One cannot push for hand washing if there is no water, or they cannot afford the soap.
May be that is the reason rather than focusing on ‘individual behaviour change’ need of the day is to focus on social change. For communication professional the focus needs to be communication for social change, may be the individual issues would get diluted, in actual they may not be the real problems, may get addressed in the process for social change.
In the process of this kind of communication for social change such “enabling” strategies would intend to remove barriers or constraints to positive action or conversely could erect barriers or constraints to behaviour which one should not practice. A combination of approaches is therefore necessary to promote the individual’s capacity for action within a supportive environment and community.