Cluster Programs and Activities

Health Training Certificate for health care workers:

• Details: This distance education health training aims to equip NGO workers like teachers, social workers and missionaries serving in rural India to get basic Primary Health knowledge and skills. It is a one year course, including 3 x 20 days contact programs to be undertaken at Herbertpur. The remainder of the course is part time by correspondence supported through the Cluster. The certificate is accredited by CMC Vellore but is being delivered locally by the CHGN Uttarakhand Cluster in Collaboration with Herbertpur Christian Hospital EHA.
  
  Dates: Applications for 2011 are oversubscribed and next year’s applications will open in Jan 2012 and the course start in July, 2012 Expressions of interest:
  
  Please enquiries and interest to the cluster training officer,
  
  Mrs Kalsang Soreng
  Email : kalsangsoreng@yahoo.in
  
  
  Cost: The cost is 7000 rupees. However, part or full scholarships available through written request to the Cluster Training Officer.
  
  To apply for this course please download the application form PDF [341KB] and the 2 annexes.

[Annexure_1 [PDF 201KB] and Annexure_2[PDF 69KB]

For further information please download the course brochure [PDF 337KB]

We wish to thank Entrust foundation for sponsoring this training program.

 

DRAFT ACTION PLAN

1. Internal Networking/linking:
   
   • A cluster l2l E-group is established to assist in communication, sharing of ideas, encouragement and requests for assistance.
   
   
   • A cluster newsletter is published every 6 months.
   
   
   • Updated and complete address list distributed to all members (email, E- newsletter)
   
   
   • A directory of Uttarakhand community health programs is compiled and distributed to members.
     
2. Outreach beyond existing program areas:
   
   • Identify underserved areas (Mapping activity)
   
   
   • An outreach training tool is developed. For example interested villages, Pradhans, village health committees in new areas would send a small group to a cluster programme to learn, catch the vision etc which would then lead on to a "programme" being generated in the new area (Actionee: Nathan and Bobby Zach).
3. Training:
   
   • A simple model is developed using a skills transfer SALT tool. 10 core competencies are decided upon. Each core competency is covered by one program consultant through a 2 day SALT practicum and consultant teaching (Actionee: Nathan to further develop and presented to the Feb workshop). This will facilitate the transfer of visions and skills and build relationships.
   
   
   • Refresher workshops and training are convened as part of each cluster workshop (ideas include SALT methods, disaster management)
     
4. Ongoing Cluster Meetings and fellowship: The secretariat to coordinate cluster meetings for fellowship and training on an ongoing basis. The next meeting will be planned for February/March L2L Cluster meeting and will include SALT training by a consultant (Bobby Zachariah or Major Suresh Parwar), a public launch of the “QUIT Gharwal DVD”.
   
   
5. Resources Actions:
   
   
   1. Members to join CHGN to make full use of the resources
   
   
   2. A resource workshop is planned and developed for late next year
   
   
   3. E-group to ask for resources
   
   
6. External Networking/linking:
   
   
   1. Everyone encouraged to register as members of CHGN: as individuals and/or organisations


7. Advocacy and Melas for a public health issue:
   
   
   1. Rajesh Kumar is engaged to produce an “QUIT Gharwal DVD” for the use of all cluster CH programs of the Gharwal.
   
   
   2. A “QUIT Gharwal DVD” public launch is held in conjunctions with the next workshop. Madhu, Joseph to invite MLAs, Health minister etc.
   
   
   3. In follow up we will organise a mela or “Pad Yatra” to coincide with World no Tobacco Day.
   
   
   4. Every year a new public health issues is considered to advocate on and a new DVD could be commissioned.
   
   
8. Nathan to prepare a Cluster budget and attempt to apply for some external funding. In the meantime we need a commitment
   
   

TOBACCO UNGASED: The Uttarakhand ‘n Gharwal Anti-Smoking Educational DVD

Cluster anti-tobacco DVD

Media Coverage March 2009 [PDF 8.7MB]

DivDx - Anti-Tobacco Performance [anti-tobacco_performance.avi]

DivDx - Address by Cluster Doctor [cluster_doctor.avi]

DivDx - Address by Health Minister [health_minister.avi]

DivDx - DVD Credits [dvd_credits.avi]

The UKC collaboratively commissioned and produced an awareness DVD to raise awareness about the dangers of smoking. This was a great example of what a network can achieve when they work together. It had local actors, local dances, and global message to QUIT. The DVD drew on different skills from different programs. One cluster program was involved in videography, another program in song writing, another program helped with the links with the government, and still another with the actual health message.

On March 18, this DVD was launched at a high level event in Dehradun to which the State health secretary, Dr Anil Sharma, and other senior figures attended. The anti smoking campaign was covered in 10 newspapers and on 2 TV channels. This best practise example demonstrated how small programs, by networking, can undertake significant projects, produce substantive public health materials and effectively engage the formal government sector.

AN INITIATIVE OF THE CHGN UTTARAKHAND CLUSTER

Worldwide smoking kills 6.3 million…more than HIV, Malaria or TB. Smoking in India 10 lakh people die from smoking each year and this is growing. Smoking will kill 33-50% of people that smoke on an average of 15 years early and is the leading preventable cause of death in Australia, the UK and other western countries. As the epidemiological transition takes place smoking in India will grow as a cause of death. Already in India more people die from chronic diseases and accidents than from infectious diseases.

Western countries have introduced tough anti-smoking laws. This has squeezed tobacco companies but they have been able to compensate and target poor and developing countries like India. Nationally, India has grasped the gravity of this threat and on October 2 banned smoking in public places. However, the rural communities where we work have a low level of awareness and are particularly vulnerable to tobacco companies and marketing. In terms of community health we all know that immunizations save lives. How many? Well we have to immunize about 150-300 kids to save one life. In tobacco control we only need to help 2-3 people quit to save one life. Now that is great return on an investment of resources. Given this background the CHGN Uttarakhand decided to commission the production of a Anti-Smoking Educational DVD particularly for the use of the Christian programs of Uttarakhand state.

Objectives of the DVD

• To decrease smoking initiation and therefore incorporate an element of primary prevention (stopping people starting)


• To raise awareness about the various dangers of smoking and the importance to health and wellbeing of quitting smoking. That is secondary prevention (helping people quit)


• To incorporate Christian principles and values in the DVD in order to help facilitate this program


• To create a culturally appropriate and targeted resource for the regions of the Gharwal and Uttarakhand (language, culture, setting, and actors to come from the Ghrawal)


• To provide a useful and contextually appropriate resource for each of the programs to be able to use in conjunction with other materials and approaches to decreasing tobacco consumption


• To Launch the DVD at the March 2009 meeting and therefore raise awareness about smoking and also raise the profile of the cluster and Christian programs



The Target group:

The cluster feels that the target group should be particularly at the younger generation. The video should therefore be appropriate for young adolescents, teenagers and middle school kids.

Ownership and Usage of the DVD

The DVD would need to be a resource that can be used in conjunction with other anti smoking activities and programs. It would be a useful adjunct or starting point for anti smoking campaigns and not a substitute for other activities. The DVD is being commissioned by the cluster and would therefore be owned by the cluster. The cluster would be able to distribute it see fit.

Specific Guidelines for the production of the DVD

• The DVD should draw on Christian principles whilst still being appropriate for the use of non-Christian programs (eg created in God’s image)


• To be launched at the next cluster meeting in March


• To include song, music, acting and other creative audiovisual arts


• To be produced in Hindi and dubbed into Gharwali (eg Jaunpur, Parwi and Tehri)


• The amount of money allocated to this project is 15000-20000 rupees. A deposit has already been provided to Rajesh


• The story board or content needs to be developed in consultation with the secretariat and senior advisors

AUSAID Tobacco Control fellowships

Nossal Institute for Global Health (Melbourne University), in partnership with Department of Health, QUIT Vitoria, CBRC, Cancer Council Victoria and VicHealth has developed a training program in Tobacco Control.

This is being funded by Ausaid and three cluster nominees were accepted to come in July 2010 to Melbourne. Congratulations to Lawrence Singh, Rajkumari Singh and Surender Singh!

The fellows will come to learn from Victoria’s significant expertise as an international leader in Tobacco Control. The program will help the fellows develop the Uttarakhand Cluster’s anti-tobacco program.

The will work on the following objectives of the:

Cluster Tobacco Control Initiative (CTCI)

Objective 1 Training focus: To adapt an internationally recognised tobacco control training program to train, within 3 years, 3,000 CHWs, AHSA workers, volunteers or teachers on raising awareness and assisting people to overcoming tobacco dependence.

Actions:

1) The master trainer, RaajKumari and PHFI ALA, will adapt an internationally recognised tobacco control educator training program to the context of Uttarakhand

2) They will train 40 master trainers in the first 2 years of the program

3) The 40 master trainers will be responsible for training 3000 teachers, volunteers, ASHA workers, and CHWs in their area over the 3 years of the program.

4) This will be followed up by further training for those who are particularly motivated (all cluster programs)

5) M and E to determine if we have decreased the rate of tobacco usage in Uttarakhand

Objective 2 School focus: Reduce the uptake of smoking by delivering a school education program, developed by the cluster, to 1000 schools by July 2012.

Actions:

1) Surender and the PHFI ALA, will develop a ½ day school training module on tobacco control utilising program materials from Aust.

2) Train in 1000 private, public schools from 6th - 12th standard

3) Develop appropriate IEC materials for the school program

a. DVD

b. Role plays

c. School lesson plan

d. Puppet shows

e. Competitions

4) Develop and disseminate materials to target parents of school children

5) Monitor and evaluate the program to determine if the knowledge, attitudes and practises have changed

Objective 3 Village focus: To increase awareness, prevent initiation and encourage cessation by undertaking awareness activities in 2000 villages; including a implementing a quit incentivisation program to engage 5000 quitting champions over a year period and showing the anti tobacco DVD in 2000 villages.

Actions:

1) A master trainer, Lawrence, will be sent to Australia to develop a quit incentivisation course

2) Attend PRI meetings to raise awareness, gain support and engage the CHVs, ASHA workers, Angwadi workers and other interested groups in each village

3) Contextualise IEC material from other settings such as Australia (posters, brochures etc) and display in 2000 villages

4) 10,000 current tobacco smokers from 2000 villages are recruited into a quit-to-win program through offering in-kind incentives to quit tobacco usage for at least 6 months

5) These quit to win programs will be promoted through Mela’s to promote tobacco control and cessation in each target village

6) Establish Quit Brigades of children to animate about quitting

7) Monitor and evaluate the program to determine if the champions have successful overcome their tobacco addiction and to determine if the knowledge, attitudes and practises have increased in the village

WORLDWIDE TOBACCO FACTS

Tobacco is the leading preventable cause of death in the world. It causes 1 in 10 deaths among adults worldwide. In 2005, tobacco caused 5.4 million deaths, or an average of one death every 6 seconds. At the current rate, the death toll is projected to reach more than 8 million annually by 2030 and a total of up to one billion deaths in the 21st century.

Tobacco use is one of the biggest public health threats the world has ever faced.

• There are more than one billion smokers in the world.


• Globally, use of tobacco products is increasing, although it is decreasing in high-income countries.


• Almost half of the world's children breathe air polluted by tobacco smoke.


• The epidemic is shifting to the developing world.


• More than 80% of the world's smokers live in low- and middle-income countries.


• The story board or content needs to be developed in consultation with the secretariat and senior advisors.


• Tobacco use kills 5.4 million people a year - an average of one person every six seconds - and accounts for one in 10 adult deaths worldwide.


• Tobacco kills up to half of all users.


• It is a risk factor for six of the eight leading causes of deaths in the world.
  

Because there is a lag of several years between when people start using tobacco and when their health suffers, the epidemic of disease and death has just begun.

• 100 million deaths were caused by tobacco in the 20th century. If current trends continue, there will be up to one billion deaths in the 21st century.


• Unchecked, tobacco-related deaths will increase to more than eight million a year by 2030, and 80% of those deaths will occur in the developing world.



TOBACCO USAGE IN INDIA


http://www.who.int/tobacco/mpower/en/index.html

In India, 1 million deaths per year are caused by tobacco










DISABILITY




Cluster Disability Program:




The cluster has decided to take on disability as a key area for the cluster. In March 2009, the cluster decided to work more in disability and to produce some materials to help promote awareness about disability. The disability unit at the Nossal institute produced a disability situational analysis for this meeting.

Disability is a significant health issue in India. In Uttarakhand there are 1,94,769 persons are living with disability. This is thought to be a significant underestimate. 10 per cent of the world’s population lives with a disability—the world’s largest minority. This number is increasing because of population growth, medical advances and the ageing process (WHO). It is estimated that 20 per cent of the world’s poorest people have a disability (World Bank).


Disability workshop :




The Nossal Institute helped the cluster to organise a training and awareness program for the Uttarakhand Cluster members. 25 people from different programs attended the workshop which was held in February 2010. Mrs Sana Haidry and Ms Tamara Jolly, as volunteers of Nossal, assisted the development of this training module. A full report of the training is available.


Cluster Disability DVD resource (2010) :






As an output of the cluster meeting and workshop the Cluster decided to use their combined skills and resources to commission another public health resource similar to the anti-tobacco DVD that was used so extensively in 2009. Each of the 30 Uttarakhand Cluster programs will contribute in some way or other to the production of this DVD.


The objectives of the Disability DVD are 4 fold:

1) To produce a contextually specific and culturally appropriate resource to raise awareness about disability, and about responding to disability, in Uttarakhand

2) To produce a resource that forms a repository of resources available for assisting programs to work in disability in Uttarakhand state

3) To animate the cluster programs around disability so to grow the interest of the members to work in disability

4) To increase the visibility of the cluster’s program on disability so to garner wider support and interest from various stakeholders locally, regionally and internationally

DVD launch - World Disability day (3rd December) :




The DVD will be launched on World Disability Day (Dec 3, 2010) at the Aketa Hotel. Invitees will include political figures, health department representatives, national program figures, Indian Medical Association, cluster members and other NGO programs.

The Uttarakhand Cluster will monitor how extensively this DVD is used over a 4 year period. This will be done through a twice yearly survey and yearly focus groups discussions.

OTHER TRAININGS




S.A.L.T TRAINING OVERVIEW



Examples of the power of SALT (shared by Bobby Zach)


http://aidscompetence.ning.com/video/salt-visits-stimulates
http://aidscompetence.ning.com/video/a-champion-among-truckers http://aidscompetence.ning.com/video/a-salt-visit-helps-community http://aidscompetence.ning.com/video/how-acp-changed-my-life

S.A.L.T methodology Training




(This training took place in March 2009)

S.A.L.T is an acronym used to describe an appreciative mindset and a team approach in entering local communities. It stands for Support & stimulate, Appreciate, Learn, Transfer & team. It can also be thought of as a Support And Learning Team. A S.A.L.T visit is done by a small group of three or four people to a neighbourhood and homes.(also called the dynamic interaction of 3 environments –home , neighbourhood, centre) Questions are explored by the team about the community concerns, hopes and ways of responding. (also called ‘strategic questioning’) SALT places the visitors into the stance of respect and learning which will allow a relationship of reciprocity to form. When a team enters community as S.A.L.T, the human strengths of community will be seen and reflected back. Some of these strengths include capacity to care, to change behaviour and attitude, to build community belonging, and to hope. (also called ‘transferable concepts’) If the team is consistent in looking for human strengths and speaking those strengths back to the community, the community reaction will change. Where communities have previously waited for programmes or handouts to resolve their problems, they will now begin to reflect on their own resources including relationship, culture, faith and experience. When they begin to recognise the ways they act for themselves, they can become more intentional to use their strengths. The process of accompanying a community through this process is called local facilitation, and is most effective when done in a ‘S.A.L.T’ team which mirrors the principle of relationship as the primary strength of community.

S.A.L.T can help a community to become self-aware and active. When a community is aware of their potential, or capacity for response, any member of that community can transfer their vision, and ways of working , and interest to another community, through natural links and ties, or through planned interactions. If a community in a geographic area ‘wakes up’ and becomes active on any issue, the idea of transfer can be stimulated and encouraged, and the experience of transfer can be mapped. (also called ‘transfer mapping’) Transfer occurs in a spectrum from spontaneous, even unnoticed ‘word of mouth’, to learning events supported by organisations.

Transfer itself is a human strength, and together with care, change, community belonging, and hope, these are called ‘transferable concepts’ which can be seen and stimulated to develop in any context.

Deep mutual respect can develop through a relatively short visit if the hosts are briefed that the purpose is for the visitors to learn about local response, and if there is a ‘bridging’ person in the team who is known to the hosts.

Each team needs to prepare itself by practising the strategic questioning approach , and each team needs to debrief after the visit , often with then local community people who have been visited . Some core questions for the team include: What strengths for response did we find?’ and ‘How did we function as a team?’ Application to the work place for each team member follows

SALT is a way of thinking and relating ourselves to a situation.

Foundation Principles	S is for Support, Stimulate, Share A is for Appreciate, Analyse L is for Listen, Learn, and Link T is for Transfer and team
	A SALT visit contains: 1. Invitation or opportunity to visit, in teams of 3-5 people, each with a ‘bridge’ person, who will link the team to the situation. The bridge person is someone who is known in the situation. 2. Preparation to visit, by hearing something of the context, and reviewing the approach 3. A visit, in which the team introduces itself as people who are there to learn, and each member introduces themselves as a person, not by title. 4. Reflection as a team after the visit, about what was learned, what might be next steps, and how the team could improve its practice of SALT.
Appreciate	The foundational attitude is APPRECIATION of what people in a community are already doing, and their lives. So as a team enters a community, the first attitude is not one of looking for all the problems and weaknesses, but rather one of appreciating what is working.
Learn	The second foundational attitude is LEARNING. The visiting team is in the community to learn, to understand, and again to appreciate, the strengths of people to manage their own lives.
Support	The third foundation is SUPPORT, not by bringing material or technical things, but by encouraging people. As the visiting team appreciates and learns more about the strengths, it is possible to encourage people by mentioning the strengths to them. Often people are not aware of their own strength, and this is true for all of us!
	A team develops these foundations by observation and conversation in the community. Conversation will focus on the hopes and concerns of people, and the way they already work together on those hopes and concerns. The team works to identify and name strengths.
The other attitudes and practices of SALT will come next:;
Stimulate	Specific themes emerge through the concerns, and the team is able to STIMULATE reflection by community members, on the connections between their concerns and the major issues affecting the community. The team listens carefully in order to ANALYSE what is heard, and asks questions to encourage community members to ANALYSE as well. For example, if a concern is expressed about young people being ‘careless’, it is possible to ask questions to explore how that is connected to risk issues of HIV, or other specific issues.
Probing	Here it is important for the TEAM to LEARN, and SUPPORT each other, to ask questions about the connections, rather than point them out or attempt to ‘enlighten’ the community about the connections as the team sees them. This phase of the process is very important, to keep the responses in the hands of the community and not take over as ‘knowledgeable’ persons.
Analyse	The team will continually ANALYSE and STIMULATE analysis as the community gradually opens up discussion on significant issues, and acknowledges the underlying roots, such as HIV. It will become natural to reflect on what the community itself can do in response.
	SALT should normally happen as a series of visits, not only one.
Link	The LINK function will be expressed when the team begins to ask themselves the question, ‘who is not in this discussion?’ For example, if discussion happens mainly with elders in a first visit, the team will find a way to meet youth. If discussion happens with the ‘upright’ citizens of a place, the team can seek a way to talk to ‘troublemakers’. If men are the first to discuss, then the team will want to discuss with women. This does not happen by criticising those who are already active, but by always including others. And as discussion opens with different people in a community, the team will help to create opportunities to LINK the different conversations together.
Transfer	TRANSFER is a function of the team members, to take something back to their own communities and organisations, and apply the approach there. TRANSFER also happens when community members link to others outside their own community, and influence change in other places. For example, as stigma is reduced in one neighbourhood, the idea that it is possible to live well with HIV will be shared to other places, through extended family links, and sometimes more systematically as well. The SALT team can encourage TRANSFER from one community to another.
	SALT team visits are a method which is learned by doing it. Once people have the general idea, it is possible to go and try. However, it is important to do this within an ACTION-REFLECTION cycle.
Action & Reflection	Action-reflection means that the team should prepare by remembering what SALT means, and the main topics of discussion, which are: Strengths, Concerns, Hopes, Ways of working: how do the family and community now respond to the concerns and hopes mentioned? How could they respond? During a SALT visit, the team should help each other to follow the SALT approach. After a SALT visit, it is very important that the team immediately (before going home) discuss what they have learned from the experience, and how they could do better as a SALT team.









Barefoot solar




These cheap and reliable solar panels are being made available at wholesale prices to the cluster. The idea is that cluster NGOs (or their CHVs, SHGs etc) on-sell them. It is a social enterprise: as it is both a social good and helps strengthen cluster programs. There was interest from programs and the cluster decided to appointed a lead NGO,  Hope Program. The lead NGO will open a bank account, receive orders for further lights and coordinate shipments. 

You can watch a brief online at:
http://www.abc.net.au/tv/newinventors/txt/s2947240.html




Training a Cluster Disability Liaison Officer / RAD tool


On the back of the DVD launch a number of other discussions were had around the cluster’s future involvement in disability. Prior to the launch Cluster members had been asked for expressions of interest in nominating for the ALA program in Australia. Three members programs nominated the following staff members Robert Kumar, Jubin Varghese and Pratima. If successful these three people will go to Australia to develop policies, trainings and modules in disability so as to help cluster members. On their return they will teach the 34 cluster members. If successful the cluster will explore sending one person from each program for training in how to implement a Rapid Assessment in Disability tool (an action research approach developed internationally).




CMC Community Lay Leaders Training Program


This new one year distance education course (for 10+2 education level) matches the cluster objectives for low cost contextually appropriate health training. The Uttarakhand Cluster is exploring becoming the local node for Uttarakhand and seeks expressions of interest for the position of “master trainer”. The master trainer will be sent to CMC Vellore for six months training and then be responsible locally, with a team of two others, for delivering the course locally. The cluster hopes to fund this position, at least part time.  

The People’s University


An opportunity to undertake, by correspondence, a Public Health Certificate course (with possible upgrade to MPH) has been made available to the cluster. It requires eight modules at $50 each over two years. The cluster agreed to sponsor one candidate through their first year of studies.

The PMs 15 Point plan for minorities


Sisters Madhu and Rajkumari shared how Rev Satish John offered to help cluster programs to avail themselves of the benefits associated with registering schools, projects and other activities as “Minority status”. As a member of the committee he is able to advise and write referral letters.