Rural Health and Environment Programme The Rural Health and Environment Programme (RHEP) is an integrated rural development intervention being implemented by Gram Vikas in very backward and poor villages of Orissa. The mission of RHEP is to improve the quality of life of the rural communities in terms of both physical conditions of living as well as economic opportunities, to engineer a process of ‘reverse migration’ from urban centres to villages. In the long-term: RHEP aims to enable convergent community action through the provision of services and resources to overcome the inertia that has been caused by the long spells of marginalisation and deprivation suffered by rural communities. RHEP also aims to transform the momentum created through such community action into sustainable community owned and managed development systems. RHEP’s primary focus is on adivasi, dalit and poor and marginalised sections like landless, small and marginal farmers. In every village covered more than 70% population belong to the category of Below Poverty Line (BPL) families. RHEP was initiated in 1992 in five pilot villages covering 337 families in the districts of Ganjam and Bargarh. Gaining from this experience, in the first phase of implementation between 1995-98, all 3,000 families in 40 villages spread over 11 districts of the state were covered. The second phase of implementation (1999-2001) saw the spread of the programme to 27 villages (2,008 families) in clusters around first phase villages. Simultaneous identification and motivation of new villages is underway. The RHEP concept The concept of RHEP rises from the aggregation of the experiences Gram Vikas gained as an implementer of the Biogas programme. During this period Gram Vikas constructed nearly 60,000 biogas plants in around 6000 villages, thus coming into contact with a large number of poor and backward communities all over Orissa. On examining the reasons behind their poverty and backwardness, Gram Vikas struck upon a very intriguing factor – the widespread morbidity and high mortality caused by water borne diseases. On probing deeper it was found that the people were using the same source of water, normally the village pond, for all their water needs. Very few villages had access to any safe source of drinking water. The habit of defecating in the open resulted in large-scale spreading of water-borne diseases. Altogether, unclean habits of sanitation and absence of protected drinking water were affecting not just the health of people, but each and every aspect of their life. Gram Vikas realised that any development intervention in these villages would first have to address these problems. The core thrust of the RHEP is to harness the physical capital, natural capital, social capital and human capital in every village/ habitation through convergent community action, to create a spiralling process of development. The sanitation infrastructure and supply of piped drinking water for 24 hours, all through the year to all houses is only the entry point and the May 2001 Rural Health and Environment Programme 9
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The Rural Health and Environment Programme (RHEP) is an integrated rural development intervention being implemented by Gram Vikas in very backward and poor villages of Orissa. The mission of RHEP is to improve the quality of life of the rural communities in terms of both physical conditions of living as well as economic opportunities, to engineer a process of ‘reverse migration’ from urban centres to villages.
In the long-term:
RHEP aims to enable convergent community action through the provision of services and resources to overcome the inertia that has been caused by the long spells of marginalisation and deprivation suffered by rural communities. RHEP also aims to transform the momentum created through such community action into sustainable community owned and managed development systems.
RHEP’s primary focus is on adivasi, dalit and poor and marginalised sections like landless, small and marginal farmers. In every village covered more than 70% population belong to the category of Below Poverty Line (BPL) families. RHEP was initiated in 1992 in five pilot villages covering 337 families in the districts of Ganjam and Bargarh. Gaining from this experience, in the first phase of implementation between 1995-98, all 3,000 families in 40 villages spread over 11 districts of the state were covered. The second phase of implementation (1999-2001) saw the spread of the programme to 27 villages (2,008 families) in clusters around first phase villages. Simultaneous identification and motivation of new villages is underway.
The RHEP concept The concept of RHEP rises from the aggregation of the experiences Gram Vikas gained as an implementer of the Biogas programme. During this period Gram Vikas constructed nearly 60,000 biogas plants in around 6000 villages, thus coming into contact with a large number of poor and backward communities all over Orissa. On examining the reasons behind their poverty and backwardness, Gram Vikas struck upon a very intriguing factor – the widespread morbidity and high mortality caused by water borne diseases. On probing deeper it was found that the people were using the same source of water, normally the village pond, for all their water needs. Very few villages had access to any safe source of drinking water. The habit of defecating in the open resulted in large-scale spreading of water-borne diseases. Altogether, unclean habits of sanitation and absence of protected drinking water were affecting not just the health of people, but each and every aspect of their life. Gram Vikas realised that any development intervention in these villages would first have to address these problems.
The core thrust of the RHEP is to harness the physical capital, natural capital, social capital and human capital in every village/ habitation through convergent community action, to create a spiralling process of development. The sanitation infrastructure and supply of piped drinking water for 24 hours, all through the year to all houses is only the entry point and the
May 2001 Rural Health and Environment Programme 9
core rallying element to bring the people together, cutting through barriers of patriarchal systems, caste and politics. RHEP goes against the prevalent paradigm, which believes that such interventions can work only through subsidies. The intervention is time bound and has clear mechanisms of withdrawal of Gram Vikas in a phased manner. As a development intervention RHEP has distinctive features, based primarily on the following aspects.
1. Coverage RHEP firmly believes that unless all families in a village agree to be part of the programme it should not be implemented. This is because of the fact that the sanitation aspect can be addressed only if everybody adopts safe sanitation practices. Without 100% participation environmental pollution and resultant health hazards cannot be prevented. From the start of the intervention the insistence is that all adult men and women in the habitation must subscribe to the programme and participate in it. Women infact have taken the lead in ensuring that the programme is completed in a time bound manner and is sustainable even after Gram Vikas withdraws.
2. Articulation of sustainability
The most important factor that governs successful implementation of RHEP is the ‘village corpus’. The corpus is created with cash and kind contributions from all families in the village. As a norm, RHEP insists that each family contribute on an average, Rs.1000 to the corpus, where the better off pay more and the poorer families pay less. Creation of the corpus is a pre-requisite for Gram Vikas to start contributing to the activities under RHEP. The corpus is invested, and the interest income is to be used by the Village Executive Committee (which has equal representation of men and women) to extend the RHEP facilities to new families that may come up in the village in future, ensuring 100% coverage at all times to come. Creation of the corpus with the involvement of each family in the village is the critical test of the eagerness and motivation in the village to undertake the programme. In the creation of infrastructure itself, of a cost of Rs.7, 000 per unit of toilet and bathing room, Gram Vikas contributes Rs.2, 500 while people generate the rest through local materials, their physical labour as well as cash contributions.
3. Maintenance of facilities
Maintaining all facilities created by the programme is the responsibility of the villagers. For this, systems are built right from the beginning. Villages are encouraged to undertake and develop community income generation activities like pisciculture in the village pond now freed from the pressures of catering to household needs and free from pollution as well. Horticulture plantations, consisting of a mixed variety of timber, fuel, fodder and fruit trees are raised on village common lands and wastelands. Income from the ponds and plantations is used for paying electricity bills, repairs and maintenance of pumps and salaries of the pump operator, balwadi (crèche) teacher, facilitators for day school, etc.
4. The bathing room
The usual understanding of sanitation infrastructure seldom includes a bathing room. However, in Gram Vikas’ experience, having a bathing room in addition to a separate toilet is
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very important. Primarily, it provides the women with a private space to bathe. They do not have to wait for certain fixed hours of the day when the pond will be free for them. Our studies confirmed the prevalence of a number of gynaecological and reproductive health problems in women, related to unhygienic sanitation practices. Secondly, a number of skin diseases spread rampantly during the summer months when the water level in ponds goes down and people have to bathe in turbid water. The bathing room with protected piped water supply thus reduces the incidence of skin diseases. An additional advantage is that the village pond, now free of humans using the water source for washing, cooking, bathing, can be used for pisciculture.
5. Women and Children To enable women overcome generations of subjugation in patriarchal systems, a separate forum is created at the start of the intervention, wherein they are initially encouraged to save on a regular basis. Once their savings are substantial, they are linked with credit through financial institutions or government schemes. This gives them an opportunity to gain confidence and to articulate their views and opinions. Issues related to women’s gynaecological and reproductive health are also discussed in these fora. Gram Vikas provides professional support where necessary. Antenatal and postnatal care as well as immunisation of children is managed by the women's groups. Mothers also play a vital role in motivating dropout children to go back to school. In some villages special education centres have been set up to address this need.
6. Enabling infrastructure – Individual In most RHEP villages Gram Vikas has also supported families to construct better houses. The traditional houses are of about 100 sq ft, and prone to disasters. We assist people build permanent disaster proof houses without any subsidy, with people contributing through labour and local materials about Rs.15, 000 out of an estimated total cost of Rs.46, 500 for a two-room house with a kitchen and veranda in an area of about 45 sq.m. The remaining Rs.31, 500 is facilitated by Gram Vikas as a soft loan from housing finance companies. For the people, building and living in a permanent (disaster proof), spacious and comfortable home it is a matter of great pride and dignity. It also prompts them to think bigger, gives them the confidence to move ahead in life and finally come out of the cycle of poverty and backwardness.
7. Enabling infrastructure – Community The community is also supported in developing infrastructure like roads, drainage systems, community hall, grain bank, etc. Here as well the contribution by the people is clearly defined in the terms of local materials like stone, aggregate, bricks, unskilled labour, etc. The habitation approach leads to an improvement in living conditions and enhances their pride as well.
8. Livelihoods support Limited employment opportunities and dwindling returns from local resources due to successive droughts are forcing the poor, especially the youth to migrate. To address this,
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Gram Vikas motivates the community to undertake land and water development measures. Water harvesting units and irrigation infrastructure are developed to ensure food security and generate surpluses for better incomes. We focus on the marginally unemployed, seasonally unemployed and totally unemployed poor in the livelihood interventions. One area of intervention is skill development - training men and women in masonry, stone cutting, wire bending, carpentry, etc. Equipped with these skills they command better employment opportunities, which in turn enhances their pride and dignity. We also promote village industries involving value addition to local agricultural and forest produce; brick making using energy efficient technology, etc.
Implementation of RHEP
The motivation process Given the socio-economic situation of the villages where RHEP is implemented, the time taken for motivating the communities is quite long. Gram Vikas staff members establish contact in the village, identify key opinion leaders and work through them to initiate discussions among all the households. There are certain conditions that the community needs to agree to at the beginning of the process. These are: Full participation of all households in the village
Creation of corpus fund with contribution from all families
Developing of monitoring systems to ensure full usage of facilities
1. Village level organizations
Implementation of RHEP in a village begins with the execution of an agreement between the villagers and Gram Vikas with the norms clearly spelt out. This is followed by organisation of the village general body. There are separate general bodies of men and women, consisting of all male and female heads of households in the village. This is essential in the initial stages as the separate body provides women in the village with a forum to come together and discuss issues of common interest. In the patriarchal societies that the programme is implemented, it is difficult to get the women to come forward to sit together with men and discuss common issues from the beginning of the programme. While in some villages, progress in this regard is fast, in many others, it is a slow process. The separate General Body of women serve as the first step in their integration with the larger community. Interactions in this forum provide women with the necessary confidence and skills to enlarge their scope of interactions.
The two General Bodies nominate/select four men and four women from amongst them to form the Village Executive Committee. In all villages, the Village Executive Committee is registered under law, as Societies. This enables the committee to become a legally recognised entity and this helps in dealing with external agencies, especially government agencies.
The Village Executive Committee assumes all decision-making powers with respect to the programme in the village. The committee lays down the procedure for collecting the corpus fund and oversees the collection. It constitutes various sub-committees to oversee the implementation of various components of the programme. The various sub-committees formed in a village, and their functions, are the following:
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Sanitation sub-committee – To ensure timely and proper completion of construction of facilities, ensure proper use of facilities, detect and punish persons who violate rules set by the General Body regarding use of toilets and bathing rooms, ensure cleanliness of toilets and bathing rooms and village surroundings Water sub-committee – To ensure proper and timely completion of water supply mechanism, monitor proper use of water, operation and maintenance of the system
Pisciculture / Social Forestry sub-committee – To plan and monitor the utilisation of village common resources as the case may be. To ensure proper utilisation of the resource and monitor income flows.
2. Sharing of Costs The following table provides a picture of Gram Vikas’ and people’s contribution in RHEP ‘hardware’: Gram Vikas contribution People’s contribution
Toilet & Bathing room construction
Required quantity of cement, bricks, aggregate, sand, steel, materials for roof, ceramic pan, water seal, foot rests, door for the toilet, skilled labour.
Required quantity of stone for up to the plinth level, mud for joining the bricks, centering materials and all unskilled labour, door for the bathing room, construction of two soak pits with covers and whitewashing.
Construction of water tank & piped water supply
Required quantity of cement, brick, aggregate and steel for the overhead tank. Pipe for the main pipeline and Motor pump. Part cost of digging well. Skilled labour for laying main pipeline and all construction.
Required quantity of stone for the foundation. Unskilled labour for the foundation, construction of overhead tank, laying of water distribution system and cost of pipes to take water from the main pipeline to individual houses, toilets and bathing rooms.
Drainage
Required quantity of brick and cement. Skilled labour.
Required quantity of stone, aggregate, sand. All unskilled labour.
Social Forestry
Rs.5,000 of the total cost of Rs.9,300 per hectare (including nursery raising, plantation and post plantation activities, over three years) for fuel-fodder trees. For horticulture plantations, saplings and support of Rs.4,500 per hectare (of a total cost of Rs.8,400/hectare)
Raising of nursery, digging of pits, site cleaning and planting, watch and ward are the main activities of the people. People’s contribution per hectare is Rs.4,300 over 3 years for fuel-fodder trees, and Rs.3,900 for horticulture plantations.
Pisciculture
Bank finance is arranged by Gram Vikas for deepening the pond/ tank, strengthening embankments and to meet working capital requirements. Village committee is the loanee. GV arranges training programmes.
Obtaining long term lease for the pond/ tank is the responsibility of the community. Village community arranges labour for the work, maintenance, watch and ward. Proper utilisation of funds and timely repayment of bank loans
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The RHEP software The implementation of ‘software’ aspects of the programme begins simultaneously with the ‘hardware’ activities. Training programmes are conducted for members of the Village Executive Committee to orient them to the various facets in Rural Health and Environment Programme and to enhance their capacities in managing the programme. Various leadership development modules are also conducted for leaders (both men and women) from the communities. The village societies registered in each village are made active in directly accessing development funds from the government and banks, bypassing the tradition of contractors and middlemen. This enhances their self-reliance and self-esteem.
Various economic and capacity development activities, especially for women are important components of RHEP. Savings groups of women are formed and are encouraged to undertake collective and individual income generating activities. Gram Vikas facilitates linking up of these groups with government schemes (like the Development of Women and Children in Rural Areas Scheme) and banks. To individuals who are not eligible for bank credit, Gram Vikas provides loans for undertaking small business activities.
To improve the literacy standards of the people Gram Vikas facilitates the running of Non-formal education centres and adult education centres.
A new phase After a review of the programme in 1998 we decided to expand the coverage of RHEP into new villages. In Phase-2 of the programme, the focus was on developing clusters around Phase-1 villages, so that a visible impact and momentum is created at the local level. Phase-1 being more of experimental in nature, the villages were scattered over a large area. This served both as learning about how the intervention works in different socio-economic conditions as well as creating a demonstration impact. In Phase-2, in addition to covering new villages, it was also decided to strengthen interventions in the livelihood sector in Phase-1 villages. Having created a conducive atmosphere for collective community action through the process in the construction phase, it was felt that the same could be utilised for taking up further steps towards improving the quality of life of the people. The demographic profile of the villages covered under RHEP is presented at the end of the document.
The way forward The Rural Health and Environment Programme (RHEP) aims to create an enabling environment for development processes to take off by establishing a threshold level of sustainable community owned processes and products, for a critical mass of deprived and marginalised people.
RHEP is designed to utilise and enhance the natural resources of communities whilst improving the village conditions in an ecologically and environment friendly manner, creating sustainable, self-supporting and replicable development models. It is focussed towards making a qualitative improvement in the living standards of communities, enhancing local economic opportunities and equipping them with the skills to be masters and in control of their own development.
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Gram Vikas realises that an isolated intervention in development of health and sanitation infrastructure alone, is not the most appropriate development strategy. Instead, a holistic intervention, with Education, Health, Infrastructure development, Secure Livelihoods and Self-governance as the key sectoral strategies, is critical to enable the rural communities to realise a threshold level of existence, and to charter sustainable development processes towards improving their quality of life.
1. Threshold level of quality of life The “threshold level of quality of life” refers to a situation where communities have satisfied the most crucial basic needs of life and are in a position to dream of further improvements. This naturally requires that issues like food and income security, health and medical care, education and literacy, safe and hygienic habitations, basic infrastructure etc., be addressed effectively.
Thereafter, for these communities to move ahead, it is essential to influence the external environment and gain a favourable bargaining position vis-à-vis the State or the Market. This position can be gained only if a large number of communities unite and demand it. This united movement will have the "Critical Mass" necessary to force governments, political organs, private sector enterprises and other civil society organs to react to communities’ demands.
2. Critical Mass The experience in development action for nearly two decades makes Gram Vikas believe that to make a significant impact in development interventions and policies, it is essential to reach out to a larger number of people, over a concentrated geographical area, constituting a ‘critical mass’. The critical mass is the minimum size required to achieve a given set of expectations. In the context of Gram Vikas’ work, we could define it as 1% of the total population of Orissa. We are talking about a time period of from eight to ten years - around AD 2007-2010; the population of Orissa will then be around 40 million and one percent of the population will mean 400,000, i.e., about 80,000 households.
Given Gram Vikas’ concentration on the poorer sections of the population, the ‘critical mass’ would constitute about 100,000 households of scheduled tribe, scheduled caste and other economically backward communities from the poorer regions of Orissa. The advantage of a ‘critical mass’ is that it affords the communities effective bargaining positions, in relation to plans and policies, directly affecting their socio-economic milieu.
In line with this overall strategy of Gram Vikas, the focus of the second and subsequent phases of RHEP is to concentrate on poor tribal and dalit communities in the hinterland of Southern and SouthWestern Orissa. This will be effected through extension of the programme in clusters of predominantly poor tribal and dalit communities, where Gram Vikas has already established contacts through interventions in community mobilisation, education and livelihood development. Gram Vikas also proposes to network with smaller organisations that have already realised cluster level cohesion in these areas, to extend the outreach of RHEP.
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3. Networking – forging alliances Gram Vikas realises that achieving the ‘critical mass’ is not a goal that can be achieved, single-handedly. It will need to collaborate with a number of organisations that share a common vision and approach to expand the coverage and reach the Critical Mass. There are indeed about 100 such organisations working in different parts of Orissa, which were formed with support from Gram Vikas and who maintain a very healthy relationship with it are the collaborators who will join Gram Vikas in the quest for the Critical Mass.
Gram Vikas reckons that if each of these organisations can cover, over the eight-ten year period, about 700-1000 households (which roughly means between 12-15 habitations), in addition to the 25,000 or 30,000 households Gram Vikas will reach, the target of 80,000 to 100,000 households is very much an achievable one.
In the realm of development interventions addressed at poor and marginalised people, RHEP defines a new approach to development taking aspects of existential needs of a people. And growing from that need, slowly and continuously redefining the threshold quality of life, while making the critical mass definitive and quantum wise more visible through a people's movement. A movement with political overtones, which aims to create an enabling environment for a politically assertive community. A people’s movement capable of assuming an identity where each individual in the community is represented and where they can assert for themselves in the Panchayati Raj (local self-governance system). Demographic profile of villages in RHEP Phase 1 (1995-98) Sl. District Village No. of BPL Category
No. H.H. SC ST GEN
Corpus fund (Rs.)
1 Patrapalli 48 40 6 2 40 59,028
2 Chandipalli 50 29 17 2 31 81,935
3 Kujapalli 49 14 1 12 36 70,036
4 Old Gouditikira 65 42 2 20 43 111,748
5 New Gouditikira 119 78 3 12 104 172,400
6
Bargarh
Banaharatikira 25 8 1 0 24 66,130
7 Dumerpalli 56 50 4 8 44 110,845
8 Lokapada 50 46 12 24 14 73,392
9
Bolangir
Bangabahal 88 83 20 4 64 90,000
10 Souripalli 50 50 19 0 31 58,339
11 Kumerkelli 71 69 16 9 46 81,674
12
Boudh
Dimirimunda 50 46 20 3 27 74,472
13 Buruding 45 33 0 45 0 89,136
14 Padmapur 50 50 2 13 35 86,136
15
Gajapati
Anandpur 24 24 0 24 0 65,239
16 Samiapalli 76 76 72 0 4 210,026
17 Sarakumpa 79 79 14 0 65 80,000
18 Gobudi 47 47 0 0 47 64,243
19 Mathakukundapur 60 58 5 0 55 90,422
20 Lauput 41 41 0 0 41 50,005
21 Dengapadar 251 130 30 0 221 337,626
22 K. Samantarapur 170 170 5 0 165 241,046
23 Sunamuhi 229 219 6 0 223 391,501
24
Ganjam
Tamana 82 66 0 82 0 90,000
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