Community action on social determinants of health
The Sarvodaya Movement works at the grassroots to support communities to improve their own health. This is not health in a narrow sense. This is an approach that realises that education, employment, living conditions, cultural well-being and social empowerment play a crucial role in health. Vinya Ariyaratne, Executive Director of the Sarvodaya Movement, shares his experiences.
Community health training
The Sarvodaya Shramadana Movement has a basic needs approach to social development. It emphasises economic and social needs, and also spiritual, moral, and cultural needs such as cultural programmes and village libraries. It considers important: a clean and beautiful environment; adequate provision of clean drinking water; minimal supplies of clothing; adequate and balanced nutrition; simple housing; basic health care; basic communication facilities; a minimal supply of energy; holistic education; and the satisfaction of intellectual and cultural needs. This list illustrates Sarvodaya’s comprehensive approach to social development and its close relationship to the social determinants of health approach.
Sri Lanka is a developing nation with exceptional achievements in health and educational indicators. In contrast to most other developing countries, Sri Lanka has made significant progress in reducing communicable diseases (cholera, typhoid, polio, tetanus, malaria etc.) aided by steps to improve educational opportunities and public health facilities. A widely distributed free education system has achieved literacy rates among both males and females, which are far superior to those of other South Asian countries. The freely available outreach preventative and primary care facilities of the public health system boast of maternal and child health indices and immunisation coverage rates that serve as a model for other developing nations.
Despite a seemingly extensive health infrastructure, ill-health continues to take a heavy toll in Sri Lanka. Better living standards and changes in lifestyle resulted in drastic increases in the prevalence of chronic non-communicable diseases such as high blood pressure, high blood cholesterol, heart disease, stroke and diabetes. This has given rise to the peculiar situation where Sri Lanka is at a crossroads, with communicable diseases as well as non-communicable diseases of equal importance in the national health priorities. A comprehensive project on community health in Sri Lanka would require that equal attention be given to both the communicable and non-communicable disease burden.
In addition, the armed conflict which had affected Sri Lanka for over two decades has also given rise to a gamut of health challenges ranging from physical and psychological trauma, disability, child combatants, and the effects of disrupted normal health services. It is also documented that the nutritional status of children in war affected areas is significantly impoverished, requiring special interventions.
It is well accepted that no amount of effort by Government health services or health workers alone is likely to bring any substantial effect. Sarvodaya’s approach has been to create a village level infrastructure base where an integrated self-help programme of development can take place in the most deprived and underprivileged communities in Sri Lanka. This is not to imply that certain medical interventions, such as immunisation or oral rehydration therapy, are not important (Sarvodaya Movement has promoted all of them actively in its programmes), but rather that, the full value and benefits of such interventions in terms of improving health status can only be realised within a much broader socio-economic and political framework.
Sri Lanka needs a more comprehensive understanding of community health problems and there needs to be more active participation by communities in planning interventions. The most effective approach is to make community organisations responsible for their own village health programmes. The emphasis should be for communities to develop partnerships; with the Government, NGOs, and the private sector to support their own efforts to improve health care.
Sarvodaya Shramadana Movement is based on the empowerment of village communities. Selected villages evolve through five stages in order to reach their full potential:
Stage 1: Inquiry from the village and organisation of an introductory shramadana (sharing of labour) camp for the village, during which problems are analysed together and needs are identified;
Stage 2: Establishment of various groups (children’s, youth, mothers’ and farmers’ groups) and the construction of a child development centre, and training of staff;
Stage 3: Programme for meeting the basic needs and setting up institutions (including the founding of the Sarvodaya Shramadana Society, which is responsible for the village’s development initiatives);
Stage 4: Measures to produce income and employment; the establishment of complete self-reliance and self-financing, and
Stage 5: Support for other village communities.
The approach is designed in such a way that ten villages are always grouped around a pioneering village (known as gramswaraj or self governing village) that has already reached the fifth stage. Villages should be able to manage themselves as a community – to be organised, self-reliant and able to act independently. The community plays the primary role in their own health programmes, but also relies on others, especially the government for important complementary services. There should be a balance between curative and preventive programmes.
Sarvodaya now has a network covering 15,000 villages. Over 100,000 youth have been mobilised for peace-building under Shanti Sena (peace brigades). It has the country’s largest micro-credit organisation (Sarvodaya Economic Enterprise Development Services, or SEEDS) with a cumulative loan portfolio of over one billion Sri Lankan rupees. It is also a major welfare service organisation serving over 1,000 orphaned and destitute children, underage mothers, and elders (Sarvodaya Suwa Setha); and has 4,335 pre-schools serving over 98,000 children.
At a time when the country is facing a major humanitarian crisis resulting from the civil war, Sarvodaya continues to work on the ground to meet the health and social needs of internally displaced people (IDPs). It also works at another level to bring about a lasting peace in Sri Lanka by addressing the psychological, economic and governance related determinants of war.
Vinya Ariyaratne, Executive Director, Sarvodaya Movement, Sri Lanka
www.sarvodaya.org
Filed under: social determinants of health
