Participatory approach to comunity health: Sustainable strategy from India

In social development and health sector, India’s performance is still lagging behind many Sub-Saharan African countries. There are also disparities between the urban and rural sectors and between privileged upper class and the socially disadvantaged groups. Widespread illiteracy, avoidable morbidity, premature mortality and deep-seated inequality of opportunity are still prevailing in India. India’s achievements in dealing with life expectancy, elementary education, nutritional well being, protection from illness, social security and consumption levels has been substantially and systematically out passed by many other developing countries. Compared to other countries, social sector expenditure is negligible in India, especially when compared it with UNDP recommended ratio. In the case of Indian state we can see that accelerated growth rate does not to have led to a corresponding change in living condition of rural poor. Here lies the importance of participatory mode of approach. The provision of social security cannot rely exclusively either on market forces or on the state initiative. There is an urgent need for participation in the distribution of social security measure. The move towards participatory growth calls for an integrated view of the process of economic expansion. The UN has defined community participation as ‘the creation of opportunity to enable all members of a community and the larger society to actively contribute to and influence the development process to share equitable the fruits of development’. This participatory mode of development views village community as the site for intervention. In this process it has to mediate through agencies working at that level. This is most commonly done through NGOs. In this broader context of Indian state’s commitment to liberalization, present paper attempts to study the participatory intervention of NGO in community health. For a detailed study, success story of AWARE - NGO working among the marginalized people in rural Andhra Pradesh is selected. The paper does not project NGO as viable alternative to fill the space vacated by state. But it only tries to establish that the objective of “Health for All” can be achieved only through community participation. The present paper is divided into 4 parts. The first part briefly outlines health sector performance and trends during the post reform era and its outcomes. The second part analyses the status of health sector in Andhra Pradesh, major indicators and initiatives. The third part in detail discusses the sustainable strategy of AWARE and its impact on health sector in rural Andhra. The final part contains major findings and concluding remarks.