The Editor's desk

Children of Sonia Vihar in the Handwashing Day Celebrations, 2008- A way towards Change...

In the last two years, the Chotton Ki Asha program has fought its way to bring itself to a status it is in today. I should say that it is a heartfelt feeling to be writing for this program which has seen nothing but “Change” in the last two years of its functioning.
The word today is “Change” and what better simile do I have then relating it to the world famous campaign of the new President-elect of the United States of America, Mr. Barack Obama. We talk about alteration in systems every day of our life or maybe in instances where the present system doesn’t yield much for us. But in this change that we talk about, a question arises as to what do we desire and what is our role in that “Change” that we want to see?

Though it may be a bleak comparison to bring a campaign which created history to a program in the millions such as this, running around the world, it is but an encouragement no less worth working for.

In his memorable winning speech after the poll results, Obama said “Its been a long time coming, but tonight, because of what we did on this date in this election at this defining moment, change has come to America”

Deriving a substantial degree of encouragement from the same lines, I would like to see a ‘Change’ in this cocoon like place that we are working in, with a population of approximately 200,000 people. It may defy many arguments, but the longest campaign for the Presidential elections of USA has found ‘Hope’ for many in their daily life and in their struggles in life. And in penning down the first editorial page for the Chotton Ki Asha blog, there is nothing more then his win over all odds that is a lesson for us.

For the program, Chotton Ki Asha, it gives the hope that change is inevitable whether it comes today, in two years or even years after the program has left this place. From having no authorised medical facilities in the area to the first Public-Private Partnership in Sonia Vihar, things have changed for better. It is hope against odds that the time has come to see the “change” we want to, even in the remotest places of the urban and rural habitations.

The endless instances of struggle everyday in running the program with the support of our partners both public and private, has helped us bring hope for many. It is laudable when I think of all, who form the part of this family called “Chotton Ki Asha”, of how they are integral to the success of this program and to the ‘Change’ that they believe they will be able to see.

When I talk sometimes to people in the area and ask them about how they find the program being here for the last two years and continuing to be, they give me a short and straight answer which I will term as ‘productive’. They say it has given them an ‘alternative’ to choose if I may interpret it in the most lucid way possible. It is an option to ward off the hindrances and hope for better health which was absent in the past.
I would like to end the note with a near perfect example from the pages of Obama’s speech. He addressed the American public saying ‘The road ahead will be long. Our climb will be steep. We may not get there in one year or even in one term. But, America, I have never been more hopeful than I am tonight that we will get there. I promise you, we as people will get there’

What better statement can I find in the present context, then what he made out there in the middle of 1,25,000 crowd and many more millions watching him from across the world including America.

I hope the same hope lies for us ahead while working in this program and for the people of this area.

Mark Templar, CEO, HOPE foundation, writes:

"Chotton Ki Asha" (CKA) for HOPE foundation/HOPE worldwide is the culmination of a dream we've had since we started the organization in 1991, bandaging the wounds of leprosy patients in Delhi, and running a mobile medical clinic in the slums of Chennai.
India's cities are crowded with slum-dwellers who come to the city seeking opportunity, trying to earn money to send home to their families in the villages. The few hundred rupees that they are able to send home each month can mean the difference between life and death for those they love back home. For this reason many are willing to endure terrible conditions in urban slums, living in crowded, tiny spaces, in places without proper water supply, sanitation, or roads, without good quality healthcare or schools nearby.

Often these migrants bring their families, and so the children end up being raised in these difficult conditions. Without adequate health care, it is impossible for a poor person to grasp the opportunity to improve their family's lot in life. With all of its success in the global marketplace and as a rising political power, malnutrition in India is still higher than that in sub-Saharan Africa. We see this suffering every day, and we want to make a difference.
This is why "Chotton Ki Asha" is so encouraging to us at HOPE worldwide. We ran mobile medical clinics in the 1990s for about 7 years, serving 5 major slums in both Bangalore and Chennai, treating thousands of people every month (hundreds of people daily in each city). These programs also were accompanied by health education. Eventually the city opened primary health care facilities to take care of these people, and so our programs served as a bridge that made a difference before the government stepped in.
But the CKA program takes this idea a step further. Through the excellent mentoring of USAID and partners like the University College of Medical Sciences at GTB Hospital, and the MCD IPP VIII program, HOPE worldwide has learned how to put together a state-of-the-art "child survival" program, using sophisticated techniques like PD Hearth, BEHAVE framework BCC, KPC baseline and midterm surveys using LQAS, and volunteer and community mobilization on a large scale. Coupled with powerful partnerships with both MCD and the Delhi Government, the CKA program has been able to leverage government resources to allow the opening of 3 health posts in Sonia Vihar and Rajeev Nagar, which provide immunization and ANC services (with help from UCMS doctors). CKA has also opened, in a historic public-private partnership with DHS of Delhi Government, a Primary Urban Health Center (PUHC) right in the community. This PUHC already treats 5000+ patients per month. It has a lab, and provides innovative drug management and crowd control techniques that make it one of the most user-friendly PUHCs in Delhi.
In addition, since our program began the Delhi Government, at our encouragement, has established over 70 ICDS anganwadis in Sonia Vihar and Rajiv Nagar, as well as opening a new "seed PUHC" in Sonia Vihar to provide health services. These initiatives are promoting sustainability in our efforts.
The program also features an exciting holistic approach that adds other services to the community, following HOPE worldwide's "Center of HOPE" methodology. These include a primary school for young children, vocational training for youth in computers, beauty skills, tailoring, and financial literacy (through GE Money), as well as micro-credit sponsored by Project Redwood. Through the wonderful work of our team over 77 Mahila Arogya Samitis have been formed with 850+ volunteers, as well as several Basti Vikas Manch that deal with health and sanitation issues in the community.
We are working with both Muslim and Hindu leaders to make this program successful at the grassroots level.The government is listening to the "lessons learned" from this program. We have met with DHS officials of the Delhi Government as well as officials of both NRHM and NUHM to share our insights.
I am personally very grateful to Marilyn Patton (who is our "technical backstop" at HOPE worldwide in the US) and Rachna Sujay (Program Director) and the whole CKA team--Saji, Ashish, Prashant, Bina, Sylvia, Satyender , Sarika , Ajay Soni, Kamlesh, and others--who are doing a wonderful job making this happen. I'm also very grateful to donors (some anonymous) like Tomoko and others who have given generously to help us meet our "cost share" requirements and also go beyond that to meet many needs.

The departments of CKA

Training and Communications (T&C) department:

• Campaign: The Chotton Ki Asha program believes in behaviour change of the community towards adoption of positive health practices in every day life. The campaign strategy of the CKA program is focused towards impact at the base and addresses the issue in concern to make a difference. The past campaigns have been able to impact the community with their innovative ways of presentation and mass appeal. It is an integral part of the Department’s strategies towards dissemination of messages in the community and an essential one

• Communicate: The T&C team communicates with the people in the area everyday with the help of the field staff. The Department prepares the materials and the message for dissemination in the community with the inputs from the experts on the issue and this is then communicated in the field in the best possible way with the strategies designed for the purpose
  

• Connect: The department understands the need to connect with the field in every possible situation to give the right message and in the most appropriate way. It is one thing to prepare messages and information for the field and it is another thing to design the materials or the strategies, keeping in mind the local health behaviourial needs of the community.
  

• Collaborate: Being one of its kinds in the state of Delhi and one of the few programs in India working in the urban setting, we understand that it is essential to learn from our predecessors. Their experiences both in the rural and the urban setting will be a lesson learnt for us to do better in our program. Also our learning’s as documented and our experiences will be information important for other projects working on the same lines. Moreover the program believes it is better to collaborate then reinvent the wheel. Collaborations have therefore been established with organisations such as UNICEF, POUZN, VHAI, BPNI and our other Partners for both technical help and communications materials.
  

• Converge: Convergence of all our efforts towards positive health behaviour is an essential part of the program. The different components of the program are linked to each other closely and so communication between them to achieve the best results becomes a necessity. The communications team tries to achieve this in the regular activities of the team with the help of the other managers in the program. The convergence of the field, communication and the monitoring team goes hand in hand to explain the numerous activities carried out to achieve the targets set for the program.
  

• Convince: The communication team makes sure that the activities, campaigns and all other events planned for the program are able to convince each and everyone with the effect it has towards the program goals. The element to convince comes from the minute activity of counselling a mother to adopt a healthy behaviour to convincing our partners and the funding agencies. It seems as if convincing along the way. If seen in the most logical analysis, every program running across the world have to convincing in its approach, ideas, techniques and the objectives for which it stands. And that is exactly what the Chotton Ki Asha program and the T&C department tries to achieve.
  

• CHANGE: For all the C’s that comes into play for the Training and Communication team as enumerated above, Change is what is desired by the team and as a whole by the program. The Change may be subtle or insignificant to the audience but it is still something worthwhile for every step more that we have to take

• Train: The only objective for the team in the training department is to be able to train the field workers including the management on the interventions of the program. Since the program relies on the best and updated recent information on the interventions of the program; it therefore becomes the responsibility of the team to ensure this through constant updating and research on the subject
  

• Teach: The dissemination of the technical information in the simplest of forms and then teaching the field team as how to spread it in the community is another responsibility of the training team. The complex information in the simplest form is the idea and then how the field team should initiate discussion on the topic is the objective for the team
  

• Tasks: The replication of the information given in the training into action is the last objective of the training team. Knowledge without practice is of no use and which therefore culminates into the Communications and the Training being one entity for the program

Monitoring and Evaluation Team:

• Respond: The response of the Monitoring and Evaluation Team to the program activities and the events is of prime importance. The monitoring of the field activities and the evaluation of the strategies applied is a pre-requisite to any program to be successful. It is an essential part to measure the extent of impact of the program interventions in the community. This necessity is filled by the M&E Department of the Chotton Ki Asha program; a task so complex being made easy everyday for each and every person linked to the program
  

• Review: The review of each strategy and the activities under it to achieve the objective is monitored in the individual level by the respective departments. But with the individual planning and monitoring, the input from the M&E dept to make it more accountable and effective is provided by the team responsible. They ensure that the reviewing of the plans is able to scale up the strategies accordingly and provide better results at the end
  

• Report: The reports of the program activities to be represented in both quality and quantity to our partners and others concerned especially the USAID is being provided by the M&E team.

Field Team:

Action: There is nothing which describes the field team better then the word ‘Action’. The base of the Chotton Ki Asha program is our field team which reaches out to the community and interacts with them at the day to day level. They are the ones who influence the behaviour of the people towards the information provided and therefore their utmost necessity. Their management and everyday hand handling for best results is being looked after by the Field Management team.


Program Management Team:

Challenge: To make things happen in the area where Chotton Ki Asha operates is definitely a challenge for the Program Management Team. Starting from scratch in an inaccessible area to what it is now, the Program Management team has done their best and are striving to make things better everyday for the program. The Challenge is to keep things ‘Chalu’(in working condition) in everyday life is what they specialize in