Conversations with Health Officials
MASUM’s Udaan project, in partnership with research partner CEHAT, is an effort to strengthen the readiness and ability of the health system to address and prevent domestic violence against women. Implemented in two intervention blocks--Gangapur and Paithan--in collaboration with the District Health Department, Chhatrapati Sambhajinagar, Udaan seeks to improve women DV survivors’ access to health and support services by improving the readiness of health-care facilities (HCFs) in the intervention blocks through training and capacity building.
We sought to have conversations with the Health Officials who are associated with this project and still harbour an objective view so as to speak about their evaluation of the project and provide suggestions on how to take the Udaan initiative forward effectively.
Interview with Civil Surgeon--Dr Kamalakar Mudkhedkar
There is a need to scale up Udaan’s work to address domestic violence.
Many of Udaan project’s activities had already been initiated when I joined my current post and began participating in the project. When I initially joined, I observed that doctors and health workers were being trained under the project and were actively participating in the activities of preventing and addressing domestic violence against women. The training programs were of good quality and the impact of the training was visible in the field.
Currently, Udaan is being implemented in Paithan and Gangapur Talukas, but these activities should be scaled up and carried out all over the district. If the whole district learns about this project, then it will prove more effective. Some Talukas may have a larger number of DV cases while others may have fewer cases. Therefore, the activities should cover all Talukas. In this project, the role of ASHAs is very important as they are connected to the villages and homes in the community. They are able to establish rapport with women in the community. Participation of ASHAs is therefore extremely essential.
The project needs to be implemented in inaccessible areas as well. While it is currently being implemented in Paithan and Gangapur, it needs to be implemented in Talukas like Ajantha, Vaijapur, and other such remote places where DV issues are likely to be prevalent. These areas are inaccessible and therefore we are not familiar with the situation there. We need to expand our reach so that people in these areas also receive information on the activities.
We often say “Prevention is better than cure,” and this also applies to the issue of domestic violence faced by women. DV should be prevented rather than addressed after it happens. We need to work toward ensuring that mental or physical violence should not happen at all as this does not just concern a person’s health but a person’s whole quality of life.
Women need to come forward to achieve this and, on our part, we should also be present to provide a supportive hand. It may not be possible to directly reach each and every woman, therefore a system needs to be set up whereby woman can be contacted easily. If women can contact a specific number for assistance or there is an assistance centre, then women can receive immediate help in emergencies as well.
Dr Kamalakar Mudkhedkar, Civil Surgeon, Ch.Sambhajinagar
Interview with Resident Medical Officer---Dr Prashant Bade
This is a public-health issue not just a social issue.
Often, the health system views domestic violence (V) as a social issue. However, we tend to overlook that the issue also relates to public health. DV has a serious effect on the health of people, more so on the physical, mental and reproductive health of women. A woman who visits the health facility after being physically beaten is often regarded just as a case--a ‘Medico-Legal’ case. With Udaan being implemented, we can see how the health workers from Paithan and Gangapur have developed the skills and understanding to assist women DV survivors.
The MASUM Udaan initiative is working towards modifying the mindsets of health-care professionals (HCPs). MASUM’s training programs helped sensitize HCPs. The training has made the HCPs realize that DV is not merely a social issue but is a public-health issue. HCPs now understand how DV towards a woman doesn’t just affect her physical health but affects her mental and emotional health, self-confidence, sexual and reproductive health, conception and pregnancy, health of the children in the family, and the quality of life of the entire household. This is why it has become clear that the health system needs to pro-actively deal with and address the issue of DV.
Training and the role of the health system:
Training is a very important aspect of this project as it awakened HCPs to the seriousness of the issue of domestic violence. Trained HCPs now understand that DV against women is a widely prevalent issue with a serious impact on women’s health and the health system can play a major role in its prevention and redressal. The training not only provided information but also sensitized the HCPs and imparted them with skills to handle DV cases. The training taught them how to interact with DV survivors, what questions to ask them, how to counsel them effectively, how to document the cases, and how to refer them to support services.
The project began as a research initiative with Paithan and Gangapur as intervention blocks and Kannad and Vaijapur as control blocks. At that time, it was felt that the exercise would be limited to doing research but when the actual activities in Paithan and Gangapur began, their positive impact became clearly visible. MASUM-appointed Counsellors began a dialogue with women in the community and extended a helping hand to them. The Counsellors also provided support and guidance to the HCPs. The Counsellors were able to identify DV survivors and provide them with counselling and referrals for the necessary support services and thus help them. This has demonstrated that this effort is not limited to being a research exercise but can be implemented on a large scale.
The OPD has a large number of patients and doctors are unable to carry out longer interactions with every patient. To be able to identify a woman patient as a DV survivor requires both sensitivity as well as sufficient time for enquiry. This is why trained HCPs and Counsellors are needed for identification of DV survivors. The RKSK Counsellors can be given additional responsibility and they will be able to effectively handle initial counselling, registering the case, and providing guidance to the survivors. It may be hard to create new posts but one can optimally use the existing human resources available in the system.
Scaling up implementation and future directions:
Many important learnings happened when working on this project over the last two years. DV survivors can be helped by the HCPs. Gangapur and Paithan’s experience shows that HCPs can identify DV survivors and assist them through counselling and providing referrals to support services. However, if this project has to be scaled up, certain modifications would be essential.
At the community level, the role of ASHAs, ANMs, and Anganwadi Sevikas (Triple-A) is extremely crucial. All three have regular interactions with women in the community. They are
able to reach pregnant women, undernourished mothers, and mothers with undernourished children. Triple-A have quick access to information about a woman’s household situation, nutrition, stress, and possible violence. Of these, the ASHAs and ANMs in this project have received training on DV. It will be good to also include Anganwadi Sevikas in the training so that they too are able to identify and aid DV survivors.
It is important to create trust among DV survivors so that they actively seek help. Many women tolerate violence but do not find the courage to seek help. Therefore, it is essential to raise awareness through posters and banners and other means so as to widely disseminate information about Helpline numbers, available counselling centres, and Toll-free services. Some women received counselling and legal aid, others could find shelter and rehabilitation, and others received skills training to start a new chapter in their lives.
Consistently disseminating information, use of social media, video bites, reels and public campaigns will help keep this subject in the public eye and increase the discourse on this issue. This will help bring to the forefront, the issue of DV as a public-health problem.
Dr Prashant Bade—Resident Medical Officer, Ch. Sambhajinagar
Interview with District Maternal and Child Health Officer—Dr Vishal Bendre
Udaan (flying high) of the health system for tackling domestic violence
In the process of operating the health system in rural parts, the Health Department observed that there are no concrete guidelines or principles for handling domestic violence. Despite seeing the health issues women face, the health system did not possess the readiness, in terms of: the ability to understand the violence underlying these health issues, the skills to respond to these issues in a sensitive manner, and the ability to refer these women to necessary services.
This was the context in which the Udaan project was initiated in Ch. Sambhajinagar’s Gangapur and Paithan Talukas. The objectives of the project were to sensitize the health system to the issue of domestic violence, to empower the system to actively participate in the issue, and to enable the system to recognize domestic violence and address and prevent it.
Through the training, workshops, and continued dialogue through Udaan, the health workers, Medical Officers, Nurses, ASHAs, and other workers were able to look at domestic violence with a new perspective. Since the Health Department is now working alongside MASUM and other support agencies, the health system’s work in this regard has gained seriousness and credibility.
Since this is a research project, this effort would enable the administration to understand the extent of this problem in society. Domestic violence affects a woman’s physical, mental, social, and financial health. The research study will possibly be able to establish how domestic violence has far-reaching adverse effects and how addressing it will have a positive impact.
The conclusions of any research should be comprehensive. If the interventions are effective at all levels, then the conclusions from the study can be applied to society as a whole. If the study is able to establish the importance of addressing issue for society, then the administration will definitely take this issue seriously. The conclusions arrived at from the study will be very important for scaling up the project.
Health-care providers (HCPs) have responded positively since the beginning of the project. Several lady Medical Officers and nurses from Gangapur and Paithan Talukas have given positive feedback about the training. They said that the training has helped them to identify DV survivors, establish rapport with the survivors, and provide them with assistance and referrals.
However, a one-time training is not effective. It is essential to have refresher trainings and to constantly have discourse on the issue. Health services tend to constantly have changes in the health staff. New staff join after transfers. Therefore, continued trainings will have to be conducted. When new Medical Officers and other health staff join the facility, including them in such trainings will prove beneficial.
Like other projects of the Health Department, it is essential to have a regular overview along with review meetings on this issue as well. The programme can be made more effective through quarterly trainings, discussion during regular meetings, evaluation based on indicators and district-level overview.
When looking for solutions for prevention of DV, education, financial independence, and social progress are important. Whether it is an illness or a social problem, the society’s educational, economic, and social progress are extremely important. Just economic progress is not social progress. Worldwide, it is believed that a truly progressive society is one where women and children are safe. Treating women with respect, treating boys and girls equally, and providing equal opportunities to girls are essential for a society to be considered progressive. Discrimination against girls and women in nutrition, education, health and care are all forms of violence.
Coordination, continuity, and evaluation during the project are important. Those who participate should be acknowledged and where there are deficiencies in work, these should be identified through evaluation. This will make the program better. Through this project, it is clear that the perspective of looking at domestic violence is changing at the health system, administration, and society level. The health system is stepping forward for providing women with lives of dignity and safety. This is the best part of the project.
Dr Vishal Bendre, District Maternal and Child Health Officer
Interview with District Health Officer—Dr Abhay Dhanorkar
Preventing violence against women is not the responsibility of just one Department, it is the collective responsibility of the entire society and we are sure that the health system can play a major role in this.
When working in the Health Department, I have closely seen many types of illnesses, problems, and social issues. However, domestic violence against women is an issue which is often not seen even though it is right in front of us. Many women do not understand that physical beating, mental harassment, financial control, or insulting behaviour are all forms of violence. Women do not recognize these as violence at all. Therefore, when we received the proposal to work on this topic, I felt that this was not just a project but an opportunity to bring about social change.
Since our health workers go from village to village and house to house, I am sure that the health system can be effective in understanding the problems of women and providing them with guidance. This is why we have supported this project.
To begin with, our doctors, Nurses, Lab Technicians, Pharmacists, health staff, and ASHA workers did not have much knowledge on this subject. Many of them believed that their work was limited to providing treatment and medicines. Through the training, we explained that if a woman keeps visiting the facility frequently with complaints like headache, weakness, insomnia, worry, or other such issues, then domestic violence could possibly be the underlying cause for the issue. At such times, just providing them with medicines is not sufficient, but it is important to understand the circumstances and situation affecting the women.
Today, one can witness the positive impact of this training. Health workers and staff have developed sensitivity and empathy. Many of the women have now begun to confide in the ASHAs, Nurses, or other health-care providers (HCPs). Due to receiving counselling and proper guidance, there have been positive changes in the lives of many of the women.
Additionally, this project has broadened the perspective of the health system. Now, we do not view domestic violence just as a social issue but a serious public health issue which affects women’s physical and mental health. Therefore, alongside providing treatment to the women, we also emphasize prevention of violence, providing counselling and connecting these women to the necessary support services.
In places where these interventions were implemented, we have received a very motivating response. Therefore, such interventions need to be implemented in more and more Talukas, Districts, and states. For this, the health system, the local administration, non-governmental organizations, and the community must all work together.
Dr Abhay Dhanorkar, District Health Officer, Ch. Sambhajinagar
