Health care in India has a long tradition of voluntarism. For centuries, traditional healers have taken care of the health needs of their own community as a part of their social responsibility. Public health is community health. It has been said that "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time.

Beneficiaries

	Children from classes 1 to 7 from the sponsored schools – 6yrs to 14yrs
	Children from communities –Children in the age group of 0 to 14 yrs
	Children living on the streets
	Social Division children ( Care givers for the children )
	Pregnant & lactating women
	Community women
	Village health committee members
	Adolescent groups ( Boys & Girls )
	Community Members

The overall objective of the health sector is as under

	Reducing child and maternal morbidity through accessibility and affordability to health care facilities
	Enhancing mental status
	Promoting health through the organized effort and informed choices of society.  Increased access to appropriate medical guidance, facilities and development of a system of positive behavior amongst the children to help them cope with HIV/AIDS

The process that we follow to achieve the above mentioned objective across all programme areas same and are are as under

Activity: Conducting health screenings and providing appropriate medical attention for children.
To reduce morbidity among children through increased access to curative care is main objective of this activity. Through conducting health screening in all sponsored schools and giving medical assistance to social division health cases with major complaints, health sector has been taking efforts to accomplish this objective. School health committees have been formed in schools to make positive impact to reduce the morbidity level among the children. Support groups have been formed to help them in coping better with the situation. Renovation and construction of toilets in the school premises to provide better hygienic conditions to the school children. Provisions have been made in the school premises for pure drinking water. A report will be made at the end of the year with detailed health status of all children, assistance to severe ill children & generate awareness amongst children on different issue & built capacity of teachers on mental health issues.

Activity: Improving reproductive and child health in the community.
To reduce reproductive morbidity through appropriate health practices and timely intervention in the community is the main objective of this activity. Research methodologies have been used to know the status of reproductive and child health in the communities. Village health guides and community health workers have been appointed as community participation to help them to help themselves. Auxiliary Nurse and Midwife also helps in identifying cases for referral services through regular home-visits in the communities. In order to reach out health facility to the people at their door steps we conduct satellite health clinics in the community.

Primarily the community health worker, ANMs and supervisors through their visits, identify women and children with health problems. Regular sessions with the community women are organized to sensitize them on various issues such as pre natal and anti natal care. Monthly meetings are conducted with health committees formed in the communities to talk about the health issues existing in the community and develop a mechanism for resolving the issues. Exposure visit are periodically organized for the women we work with, which helps them get a new perspective towards and understanding of women's health. Health fair has been planned which will provide a platform for the community women to share their experiences and their knowledge that they have acquired throughout the year.
Activity: Reducing incidences of trauma due to domestic and sexual abuse.
To reducing incidences of trauma due to domestic violence, addictions, abuse is the main output of this activity. Study on domestic violence has been conducted in communities to know the present status of domestic violence. Continuation to that, awareness sessions and regular meetings have been planned with community members to generate the awareness. Referral services also have been provided to the needy.

Activity: Imparting sex education amongst adolescents.
To Increase psychosocial and mental adjustment and awareness among adolescents is main objective of this activity. This helps to reduce incidences of trauma and suicidal ideation among beneficiary groups. It also helps to reduce the level of exploitation and infections towards HIV/AIDS. Our first step towards achieving our objective is to organize the groups which are being done by the formation of adolescent groups. Sensitization meetings are first organized with the parents of the concerned adolescents to brief them about the activities that will be conducted throughout the year. Regular group sessions will be conducted throughout the year. A two-day workshop will be conducted for the groups in all the communities. The evaluation will be done in the form of group discussions, quizzes, role-plays and a short test.

Activity: Strengthening Institutional and human resources of public health system
Improved services of public health system are main expected output of this activity. Initial meetings will be conducted with the members of the villages and communities Health guidance centre, health committees have been formed in the communities to provide health services and guidance for accessing quality health care. The Health Committee are responsible for the overall health issues in the community and monthly meetings with the Health committee members will give them the platform to address health issues existing in the community. General health checks up camps have been conducted and regular meetings and sessions have been planned to generate awareness regarding their health rights towards public health system. Survey will be conducted to understand the drawbacks in the existing public health system in order to strengthen the existing health care system by revitalizing the entire network of public sector

Activity: Transit home for HIV /AIDS Orphans
To improve quality of life through rehabilitation and residential care for HIV infected children is expected outcome of this activity. To reduce the stigma and discrimination awareness programs have been planned in the communities. In addition, counseling sessions have been planned for psychosocial support for infected and affected children.

Under school health program we have completed health screening in 91 sponsored schools, 6 balwadies, 4 Child right centers and 30 CLC activity centers. Total 45272 children were screened by panel of doctor. Total 34 new social division health cases were treated for various diseases related to Cardiac, ENT, Neurology, Orthopedic and problem related with eye. Medical assistance has been given to 30 health cases which had came for regular follow-ups. To generate awareness among students about health and hygiene eight health committees have been formed and regular sessions are conducting with them. To impart sex education for boys and girls from 6th and 7th Class, awareness sessions have been conducted with them with the help of resource person and supervisor.

To know & improve the state allied with Reproductive and Child Health, we have conducted research related with RCH in 7 communities which helps to organize our work according to particular need. To look after various issues related with RCH in the communities, we have appointed 5 Community Health Workers. Supplementary nutrition has given to Pregnant and lactating women from 3 communities. ANM has also appointed to look after this issue and to conduct regular session related with RCH for women.

To reduce the incidences of trauma due to domestic violence, sexual abuse and addiction initially we have conducted study to know the present status in 7 communities and after that we have conducting awareness sessions in each community with the help of resource person.

To impart sex education among the adolescent, at present we have working with 13 adolescent groups of boys and girls. Three health committies have been formed in three communities to look health and hygiene of community people. Awareness sessions are conducted in the communities to raise the knowledge of HIV/AIDS to reduce the stigma and discrimination related with HIV/AIDS. Counseling session has been conducted for enrolled infected children and his / her family members.

Village health committee

In Velhe the health sector has started work since 2004. Initially we have started work in Panshet Dam Area with the help of village health guide meant to strengthen existing Public Health System. We have appointed 32 Village Health Guide (VHGs) to support the various government Health programme. We are providing medicine’s to prevent common & seasonal diseases .It organized various Health check camps for community people, schools.

Velhe block is only 60 km away from Pune city. The area is located amidst hills and forests with very poor communication and transportation facilities

Many health related problems came into limelight in Velhe block while working with school children. This mainly attributed to the unhygienic condition that the child come from and hence suffer from skin diseases, heart problem, cancer. Due to ill health the scholastic performance of child remained very low. That means drop out, absenteeism ratio was high. The children come from poor socioeconomic background & due to that the family can’t afford proper treatment to child in case of major illness & for minor illness the primary health centers are away from their villages so they can’t access that also. Due to severe illness child mortality rate was also very high. Due to lack of public health system the problem cannot be diagnosed on time. In the school the drinking water & toilet facility is not in proper condition. Due to that the child has to face so many health related problems. In city area the parents & school authorities are able to take proper care of their children as they are aware Child’s health. But in rural area due to illiteracy & ignorance the health of the children are given proper care. We have appointed 40Village Health Guide (VHGs) to support the various Government’s Health programmer. It has organized various Health check camps for community people and schools. It has given referral service to poor and needy through which it helps to minimize the level of morbidity as well as mortality also. In the communities health sector has conducted eye check-up camps (Cataract camps), Gynac Camps & General health check-up camps from 2005 to till 2009.
Health Committee: After preliminary meetings with the schools, the concept of the school health committee was introduced to the children. The roles and responsibilities of the committee were explained to them to encourage nomination for representation to the health committee from their classes. Each representative of the student health committee has close to 10 students from an entire classroom. Children from the classes 5 – 7 are a part of this committee. These students will be entrusted with the roles of looking after the health aspects such as Personal hygiene, community hygiene, cleanliness in the classroom and awareness on different communicable diseases.

Village Health Committee: Health Committee formed is e responsible for the overall health issues in the community. The health committee consists of members from the community who are interested in health activities, the community based health worker and the ANM shall compulsorily be a part. The health committee looks into registration of births and death and implementation of schemes funded by the government (Immunisation, Leprosy). The committee also acts a tool to inspect work undertaken by the community based health workers.

Village Health Guide: Village health guide is from that community & is nominated by community members. She should have good communication with all community people and should be able to read & write. VHGs are trained to identify reproductive and other minor infections based on presence of symptoms in women.

VHGs are trained to counsel and give BCC (Behavioral Change Communication) to women with respect to certain illnesses such as RTI. In such a case, the CHW / VHGs give information to the woman about personal hygiene and cleanliness and keep a follow up with the concerned woman.

Relevant situation & Need
The population of the block is 55894 & for this population only 3 PHCs are available at Panshet, Pasali & Velhe area. There are 16 sub centers which are located in different areas .There are 6 private clinics near the road side villages but having lack of resources .One rural hospital is existing at Velhe but they are providing treatment only on primary level .There are 11 doctors who give medical assistance to the entire population . Due to lack of communication within public health system & general population, there exists a gap in the Velhe. Lack of efforts taken by public health system to introduce the health programs to general populations, lack of trust ,low level of personnel in the set up, illiteracy in community etc. are causes that hampers the proper functioning of Public Health System. There are no doctors catering the problems related to mental health, pediatric and gynecology. . Existing staff of PHC’s is not sufficient to cater the needs for 126 villages. Therefore most of beneficiaries remain isolated from the health delivery system.
Process
Activity:Conducting health screenings and providing appropriate medical attention for children
We are working for curative, preventive, promotive & rehabilitative aspects of health care. .We have conducted school health screenings of all children under our intervention area and given reports to the school. In the screening process any child with minor health related problems were referred to the government PHC whereas others with severe problems were medical assistance. We have formed school health committees in school. Health education is given through peer groups and through conducting regular sessions with them. Information on personal, school & community hygiene, nutrition and Communicable diseases are also imparted to them . School health screening was conducted in 48 Zila Parishad Schools of velhe. 2244 children had undergone screening in the year 2008. From the screening several children with chronic ill cases & some other with major ill cases were found. Under Medical Assistance programme we have taken care of 45 children with different illness. Most of the cases are related to heart, ENT & Eye problems from 2006 till date.

From the school health data analysis we found the prevalence of water borne diseases amongst children. Therefore we have planned to install water purifiers in schools after conducting the preliminary investigations. Sufficient numbers of urinals are not present in the school to cater the needs of the students. If present they are not inproper condition. This aggravates the chances of spread of RTI / UTI infections.

Activity: Improving reproductive and child health in the community.
To ensure people’s participation we have appointed village health guides in 40 villages. These village health guides carry out regular home visits & collect data from each & every household regarding their health status, anemia cases, RTI , UTI & STI, reproductive health, child health & family planning status of that community, also collect data of pregnant & lactating women, birth & death registration . We have conducted health camps in villages like Gynecology camps, Cataract screening camps .Through public private partnership the public health system will be strengthen and people can get access to it. From 2006 to till date we have conducted 6 different health camps in villages & covered around 500 beneficiaries. From 2008 till date we have provided supplementary nutrition to 300 pregnant & lactating women.
Activity: Imparting sex education amongst adolescents
In villages we have formed 24 groups for adolescent boys & girls. We are conducting regular sessions with them on reproductive health issues like body mapping, male and female reproductive system, menstruation, STI ,UTI ,RTI, abortion & some other issue pertaining to health. Special focus is being given to this group as they are the future/ forthcoming parents. At the end of the year especial workshops are arranged for them. This group needed psychosocial guidance at the onset of puberty.

Activity: Reducing incidences of trauma due to domestic and sexual abuse.
We have conducted mental health sessions for community members specially women. These sessions are based on concept of having a comprehensible mental health status, stress management, healthy coping patterns, stress due to domestic violence incidences & addiction. We have conducted sessions with pregnant women who are in need of psychosocial support. The public health system needs to be strengthened as we are working with different stakeholders and taking care of their health. In our effort to public health system we have formed village health committees in villages.

Activity: Transit home for HIV /AIDS Orphans
HIV/AIDS awareness campaigns are carried out on a regular basis in the community. People are constantly seen migrating to cities from here to work at the market yard, as auto rickshaw driver and as casual laborer. They might indulge in unsafe sex thereby carrying the virus and infecting their wife in the villages. Therefore the women are at high risk of getting infected with the deadly virus and needs to be educated.

Nasik district is considered primarily to be a tribal district. Especially in the rural region these groups remain isolated, live in remote and hilly areas far from civilization. Majority of them have poor health status, peculiar health needs, less access to institutional health check up and a wide prevalence of red blood cell genetic disorders that complicates their health problems further. Moreover, the inadequate health infrastructure in tribal areas to deal with such complicated health problems is a matter of grave concern. These tribal groups differ from each other in various aspects. They differ in the language they speak, in their cultural pattern and socio-economic categories. As the majority of these tribals living in the remote areas remain isolated, untouched by civilization, they are largely unaffected by the developmental processes going on in the rest of the State. Therefore, these groups remain backward, particularly in health, education and socio-economic aspects. We are working in the field to enhance the level of tribal health as the health problems of the tribal population in the district. While working with the community to enhance and fulfill society's interest in assuring conditions in which people can be healthy through the public health system three aspects is taken care of firstly assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; secondly formulation of public policies designed to solve identified local and national health problems and priorities and lastly assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care.

The Health Sector is operational in this region since 2006. We are working in 4 urban and 21 rural communities at present. For the last 5 years we are working with the 60,000 children of all 159 sponsored schools, pregnant and lactating women in the rural and urban community, adolescent boys and girls, and with community members for the approach to medicine that is concerned with the health of the community as a whole.
Our interventions aims at facilitating the access of children suffering from serious health concerns to requisite health care and to tackle the issues of reproductive health amongst women living in slum and rural communities to reduce child and maternal morbidity and mortality

Secondly our focus is to address the needs of children from communities, adults (women and men), and adolescents. In this project we are working directly with the beneficiaries, for example, adolescents and from members the community. We have given special emphasis on stress management, addiction and its impact on psycho-social health, puberty and related issues and skills to keep one mentally healthy.

We are trying to promote quality health through organized efforts and informed choices of society. Our emphasis is to help the beneficiaries access the services and help to make use of existing schemes and concessions. Demystification of medical procedure since many times people get unnecessarily intimidated by medical systems and remain deprived of facilities. In addition to the poor public health system in our country, spread of HIV/AIDS in India has been diverse, the epidemic being most extreme in the southern half of the country and in the northeast, Maharashtra being one of the most prevalence state in India. Therefore we are working to create awareness regarding prevention and cure for HIV/AIDS. This is done through different approaches- firstly, through direct intervention with the children, preventive, curative, rehabilitative, one to one intervention, networking & collaboration & capacity building of teachers.

Process
Activity: conducting health screenings and providing appropriate medical attention for children
We have successfully carried out health screening of all the 60,000 students in all 159 sponsored schools, 7 Balwadi and street children. The screening reports were then analyzed. These reports helped us to identify the severity of disease and then referring the child to the hospitals. We have also provided medical assistance for severe illness, providing pre treatment and post treatment counseling for adherence to treatment.

Special efforts are taken to build rapport with hospitals and health care setups support systems for the medical aid program and developing a network amongst the care givers. We have generated awareness amongst children & teachers through training on First-aid. School health committees have been formed to monitor health condition amongst the students in the school. Rubella vaccination was administered for the girls from 5th to 7th standard.
Activity: Improving reproductive and child health in the community
The concept of RCH was first introduced to the community members. Community Health workers and Village Health Guides have been appointed for enhancing the present health conditions. To maintain and monitor regular ANC and PNC, satellite clinic and fortnightly community level clinics for pregnant and lactating women have been organized. Exposure visit for women's groups from the community was organized to facilitate the development of a new perspective towards public health. We have also established a health library in the community and organized fair on women’s day. We are providing nutrition to 180 pregnant and lactating women in 4 urban and 10 rural communities

Activity: Reducing incidences of trauma due to domestic and sexual abuse.
For the people suffering from the trauma due to domestic violence, addictions & abuse we have conducted general meetings and awareness session with the community members and various groups regarding impact of violence on mental health through various modes of media. Networking with agencies working in the area of mental health has also been done. Facilitating coping mechanism for the people suffering from mental stress due to domestic violence, sexual abuse and addiction are dealt in details in the awareness sessions
Activity: Imparting sex education amongst adolescents
For imparting sex education among the adolescents introductory regular and follow up meeting with adolescents were carried out. Two Workshops focusing on developing life skills and reproductive and sexual health for adolescents have been organized. These workshops are considered as platforms by the adolescents to express their feelings which otherwise go unidentified

Activity: Strengthening Institutional and human resources of public health system
In an attempt to strengthen the Public health system, we have formed health guidance center to cater the needs of people from villages. Health committees have been formed in the community to conduct meetings to handle health issues. We have also collaborated with the government agencies to understand the public health system and to enhance the existing health care system.

Introduction
The health sector of Awakening Jagriti has been working in Nagercoil for the past 5 years. Awakening Jagriti has rendered humanitarian assistance immediately after the Tsunami disaster in 2004 in Kanyakumari District. Health care services were one of the important interventions of Awakening Jagriti for securing the lives of the Tsunami victims of Muttom coastal village in Kanyakumari district. After that it has expanded health care activities for the poor children who are studying in Government schools in Nagercoil. Currently Awakening Jagriti has been working with 42 Government schools and 3 management schools in Muttom coastal village.

In general the Government services in Nagercoil that are dispensed through urban health centers and sub-centers are not properly utilized by people because of lack of appropriate infrastructure, disinterest and even absence of skilled personnel and poor treatment procedures. The current scenario depicts a depressing picture where the poorest and most vulnerable groups residing in Nagercoil urban are outside the ambit of any public health coverage. As a result, children suffering from serious and complicated illnesses do not have access to appropriate health services. In some cases the child doesn't receive timely requisite medical intervention leading to irreversible damage or even death.

Reproductive Health Services are one of the basic health services to be provided by Government health system as women in the reproductive age and pregnant women are one of the most vulnerable victims of dysfunctional health system. Due to poor socio economic condition many times poorest and most vulnerable women in the urban slum communities in Nagercoil, not able to get proper care for their reproductive health problems. According to UNICEF’s latest State of the World’s Children’s report, India has the worst indicators of child malnutrition in South Asia. It claims that 48 percent of under fives in India are stunted, compared to 43 percent in Bangladesh and 37 percent in Pakistan.

Adolescent is a period where a person experience drastic physical, mental and social change during puberty and sexual debut. In the process of dealing with these changes and establishing their own identity-including gender identity they are susceptible to mental health difficulties, which can include depression and anxiety disorders. The aforementioned scenario presents a need; to improve people's access to medical services, facilitate this process, also to deal with reproductive health problems with greater direction and focus on the adolescent mental health to prevent behaviors that lead to sexual and reproductive problems in young people.
Process
Activity:Health Screening and Medical Aid

Health screening in schools

The school Children from all of the classes from 1st to 8th standard are covered in the health screening. Doctor have a close diagnosis of the ailments related to ear, nose, throat, teeth, eyes, digestive system, respiratory system, central nervous system and cardio vascular system of each child. All of the data are then entered into the health card. Information regarding the nearest free, medical aid centre run by the government is printed on the card or on the Intervida prescription pad by the doctor so that the parents can avail this facility. School wise graphical morbidity report of school and Health screening cards will be delivered to the respective school, after data entry analysis.

Supervisor from the health sector conducts a home visit to the children who are suffering with major diseases. This home visit allows the supervisor to assess the socioeconomic situation of the family as well as record the child's case history. Based on the child's early reports and diagnosis the child is referred to the appropriate specialist. The supervisor counsels the child's family and explains the child's condition to the family. We would provide the medical aid to these children. So for we have provided medical assistance to 54 cases. 5 children with heart diseases underwent surgeries and 12 undergoing regular follow up. 8 children with nervous system diseases undergo regular follow up. Critical cases such as brain damage case, acute kidney failure case and liver case were taken to appropriate hospital for timely treatment.
Activity:Provision of pure drinking water mechanism
In order to have pure drinking water facility in schools we first assess the quality of drinking water by testing the water from the schools. During this year (2009) we have conducted need assessment and water samples have been taken for testing in 10 schools. Two schools were identified to possess impure drinking water quality. These schools will be provided with pure drinking water facility for this year. The objective is to make water safe through disinfection and safe storage at the point of use. The maintenance of the purifier will be taken care of by the school authority.

Activity:Construction / Renovation of toilets in schools
In the schools in Nagercoil many a times the toilets constructed are not in good condition and in some cases there is no toilet facility and children are seen urinating in the school premises. In order to have good hygienic conditions we would renovate existing toilet blocks and construct new toilets in schools. So for we have renovated 3 existing toilet blocks and 2 toilet blocks were newly built in our sponsored schools in Nagercoil

Activity:Improving reproductive and child health in the community
Reproductive health has received recognition in India only very recently. Consequently work in this area has also remained limited. According to our research finding in the project area in Nagercoil, 50% of pregnant women not registered their pregnancy in hospitals, of this only 25% of the ante natal care cases visit hospital for check up during first trimester. Currently the target community people go to hospital for deliveries but earlier few deliveries were done at home by their untrained relatives. We found that 7% of child died after birth and still birth in the community we are working with. 13% of women have faced abortion in our project areas.
Most of the women in the slum community in Nagercoil are facing menstruation problems and only few of them are taking treatment for their menstrual problems. 80% of the women are not aware of causes and symptoms of reproductive tract infections. More than 70% of the women have faced problems during pregnancy of which 68% women face problems such as severe breathlessness, obstructed / prolonged labor, premature rupture of membrane, excessive bleeding, large perineal tear, retained placenta. Conscious attempt has been made made to improve the reproductive health status of the women in the community. We have intervened already to improve the nutritional status of the antenatal and postnatal care women in the community through provision of supplementary nutrition. We have been providing supplementary nutrition to more than 13 ANC/PNC cases in Praikangal slum community in Nagercoil. We have been creating awareness about the ante natal care and post natal care among the women in the urban slum community.

Activity: Imparting sex education amongst adolescents
Adolescents constitute 22.8% of the population of India. Adolescents in the urban community in Nagercoil have been made aware of the drastic physical, mental and social change during puberty and sexual debut. They are guided to deal with these changes and establishing their own identity-including gender identity. Adolescents are also more likely to engage in risky sexual behavior, substance abuse and violence owing to mental health difficulties. These can lead to unintended pregnancy and STIs including HIV infection. We educate them to improve their awareness level on sexual and reproductive health. Therefore attention to mental health is necessary to prevent these and other behaviors that lead to sexual and reproductive problems in young people. We have educated 20 adolescents in urban slum community on sexual health.