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MAANASI - A sustained, innovative, integrated mental healthcare model in South India

JAYARAM, Geetha
GOUD, Ramakrishna
CHANDRAN, Souhas
PRADEEP, Johnson
2019

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Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas.

A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term.   Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. 

As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930.  Empowerment of treated clients is the final outcome, assisting them in self-employment. 

Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.

 

Disability, CBR & Inclusive Development, [S.l.], v. 30, n. 2, p. 104-113, Oct. 2019

 

 

Learning From Experience: Guidelines for locally sourced and cost-effective strategies for hygiene at home for people with high support needs.

World Vision/CBM Australia
May 2018

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This learning resource is the result of a partnership between World Vision Australia and CBM Australia that aims to improve inclusion of people with disabilities in World Vision’s Water, Hygiene and Sanitation (WASH) initiatives, including in Sri Lanka. The guidelines are based on experiences and observations from World Vision’s implementation of the Rural Integrated WASH 3 (RIWASH 3) project in Jaffna District, Northern Province, funded by the Australian Government’s Civil Society WASH Fund 2. The four year project commenced in 2014. It aimed to improve the ability of WASH actors to sustain services, increase adoption of improved hygiene practices, and increase equitable use of water and sanitation facilities of target communities within 11 Grama Niladari Divisions (GNDs) in Jaffna District.

To support disability inclusion within the project, World Vision partnered with CBM Australia. CBM Australia has focused on building capacities of partners for disability
inclusion, fostering connections with local Disabled People’s Organisations, and providing technical guidance on disability inclusion within planned activities. World Vision also partnered with the Northern Province Consortium of the Organizations for the Differently Abled (NPCODA) for disability assessment, technical support and capacity building on inclusion of people with disabilities in the project.

HYGIENE AT HOME FOR PEOPLE WITH HIGH SUPPORT NEEDS
This document is one of two developed in the Jaffna District and describes strategies that used to assist households and individuals in hygiene tasks at home. The strategies were designed to be low cost and were developed using locally available materials and skills in the Jaffna District of Sri Lanka.

NOTE: The development of this learning resource was funded by the Australian Government's Civil Society WASH Fund 2.

Learning from experience: Guidelines for locally sourced and cost-effective strategies to modify existing household toilets and water access

WORLD VISION
CBM Australia
2018

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This learning resource is the result of a partnership between World Vision Australia and CBM Australia that aims to improve inclusion of people with disabilities in World Vision’s Water, Hygiene and Sanitation (WASH) initiatives, including in Sri Lanka. The guidelines are based on experiences and observations from World Vision’s implementation of the Rural Integrated WASH 3 (RIWASH 3) project in Jaffna District, Northern Province, funded by the Australian Government’s Civil Society WASH Fund 2. The four year project commenced in 2014. It aimed to improve the ability of WASH actors to sustain services, increase adoption of improved hygiene practices, and increase equitable use of water and sanitation facilities of target communities within 11 Grama Niladari Divisions (GNDs) in Jaffna District.

To support disability inclusion within the project, World Vision partnered with CBM Australia. CBM Australia has focused on building capacities of partners for disability
inclusion, fostering connections with local Disabled People’s Organisations, and providing technical guidance on disability inclusion within planned activities. World Vision also partnered with the Northern Province Consortium of the Organizations for the Differently Abled (NPCODA) for disability assessment, technical support and capacity building on inclusion of people with disabilities in the project.

HOME MODIFICATIONS FOR WASH ACCESS
This document is one of two developed in the Jaffna District and describes the strategies which were used to assist people with disabilities to access toilet and water facilities at their own home. The strategies were designed to be low cost and were developed using locally available materials and skills in the Jaffna District of Sri Lanka. Houses and toilet structures in the region were made of brick and concrete. No new toilets were built and modifications involved only minor work to existing household structures, water points and toilets.

NOTE:
The development of this learning resource was funded by the Australian Government's Civil Society WASH Fund 2.

The promise and the reality: a mental health workforce perspective on technology-enhanced youth mental health service delivery

ORLOWSKI, Simone
LAWN, Sharon
MATTHEWS, Ben
et al
October 2016

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Digital technologies show promise for reversing poor engagement of youth (16–24 years) with mental health services. In particular, mobile and internet based applications with communication capabilities can augment face-to-face mental health service provision. Results of in-depth qualitative data drawn from various stakeholders involved in provision of youth mental health services in one Australian rural region are described. Data were obtained using focus groups and semi-structured interviews with regional youth mental health clinicians, youth workers and support/management staff and analysed via inductive thematic analysis. Six main themes were identified: young people in a digital age, personal connection, power and vulnerability, professional identity, individual factors and organisational legitimacy. 

 

DOI: 10.1186/s12913-016-1790-y

Human Rights

www.macao-tz.org
December 2014

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Malezi AIDS Care Awareness Organization (MACAO) is a non-profit organization reaching out to neglected Indigenous people in Ngorongoro District, Arusha Region of Northern Tanzania.  Macao founded in 2003, Macao is a humanitarian organization that provides assistance to approximately 200,000 Indigenous Maasai community in Ngorongoro district for addressing needs of water and sanitation, food security, health Care Research, Education, Research environment, Maasai Traditional Research, Human Rights and sustainable economic development by strengthening their livelihoods.  In addition to responding to major relief situations, MACAO focuses on long-term community development through over 4 Area Development Project. We welcome the donors and volunteers to join us in this programs, we are wolking in ruro villages.

Closing the gap in a generation : health equity through action on the social determinants of health|Final report of the Commission on the Social Determinants of Health

WORLD HEALTH ORGANIZATION (WHO)
2008

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This is the final report of the World Health Organization’s Commission on the Social Determinants of Health (2005-2008). The report gives three main recommendations: 1 improve daily living conditions 2. Tackle the inequitable distribution of power, money, and resources 3. Measure and understand the problem and assess the impact of action. The Commission was created to provide evidence on policies that improve health by addressing the social conditions in which people live and work. The report is addressed to WHO, national governments, civil society, and other global organizations

Taking critical services to the home : scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya

MWANGI, Annie
WARREN, Charlotte
2008

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This publication is the report of a project to scale-up a community-based model, in Kenya, that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. The findings of the project were that community midwifery contributed to increasing the proportion of women assisted by skilled attendants during birth in the four districts in which the scheme was trialed, amounting to just under half of all skilled attended births in the districts. Although the skilled birth attendant rate in these districts was well below the national average of 42 percent, there was a steady increase in the proportion of attended deliveries since CMs were introduced in 2005. The districts also reported an increase in postnatal assessments in the first 48 hours and increase in immunization coverage

A community-based health education programme for bio-environmental control of malaria through folk theatre (Kalajatha) in rural India

GHOSH, Susanta K
et al
December 2006

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Kalajatha is a popular, traditional art form of folk theatre depicting various life processes of a local socio-cultural setting. It is an effective medium of mass communication in the Indian sub-continent especially in rural areas. Using this medium, an operational feasibility health education programme was carried out for malaria control. This study was carried out under the primary health care system involving the local community and various potential partners

Village phone replication manual : creating sustainable access to affordable telecommunications for the rural poor

KEOGH, David
WOOD, Tim
2005

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This manual draws from the Grameen Village Phone programme in Bangladesh and Uganda, and contains how-to guidelines for replicating the experience in other countries. The programme helped poor women purchase mobile phones and sell the use of them on a per call basis. It allows for sustainable and affordable access to telecommunications, particularly useful in rural and remote areas. The manual provides a comprehensive discussion of all the steps that need to be taken. Topics covered include: business planning, stakeholders and partnerships, microfinance, company structure, training, human resources, monitoring and evaluation

Addressing HIV/AIDS through agriculture and natural resource sectors : a guide for extension workers

BISHOP-SAMBROOK, Clare
2004

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This guide aims to help extension workers and development agents combat HIV and AIDS through agriculture and natural resources sector initiatives. In predominantly rural economies the epidemic has a particularly negative impact on the labour force, undermining their ability to earn an income and to maintain acceptable levels of nutrition: it is predicted that at least one quarter of productive adults in Southern Africa will die within the next five to ten years. The adoption of a new approach by the extension services could make a considerable difference. Part 1 presents some key facts about the disease and the risks of infection in rural settings. Part 2 details participatory tools which enable extension workers to understand the disease. Part 3 describes the contribution of the agriculture and natural resources sectors in the response to HIV/AIDS challenges

Effects of the HIV/AIDS pandemic on rural communities in ACP countries : a reader

BOTO, Isolina
WESSELER, Gesa
BERKHOF, Irene Prins
Eds
2004

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This reader synthesises information from a number of sources on the impact of HIV on rural communities. It focuses the effects in the agricultural sector, and the implications of 'crusscutting issues' of gender and youth. It explores possible mitigation strategies, and information and communication strategies; and identifies 'urgent actions' which include improving the use of and access to ICT

Community based organisations : the emerging force within the third sector, strengthening the human rights capacity of community based organisations (CBOs) : a survey of 9 southern African countries, January 2004

FAHAMU
CENTRE FOR ADULT EDUCATION (CAE)
2004

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This is the report of a survey to gather information about community-based organisations (CBOs) in southern Africa, The survey findings show the kinds of work CBOs do; the nature of the organisations; how are they constituted; the extent to which they seek to protect and promote human rights; their priorities; their strengths and weaknesses as organisations; the training that they access and the training would make a difference to their work; the sources of information they use and the kind of information they need. It also looked at what access to computers and the Internet the CBOs have

ECD in changing rural realities [whole issue]

2003

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This edition contains a selection of the articles produced by participants at a meeting in Alcázar do Sal, Portugal, in December 2002. Twelve participants from Bernard van Leer Foundation-supported projects in four Latin American countries (Colombia, Mexico, Peru and Venezuela) and four European countries (Scotland, Spain, France and Portugal) identified and reflected on a broad spectrum of themes and problems around growing up in these two rural environments, analysed the new rural challenges and related them to the work of their own ecd projects. They explored the important contextual realities of the environments in which they operate; explained the conceptual frameworks that underpin the responses that they have devised and put into practice; and identified a number of significant themes for programming

Communities facing the HIV/AIDS challenge : from crisis to opportunity, from community vulnerability to community resilience

HSU, Lee-Nah
DU GUERNAY, Jacques
MARCO, Marissa
July 2002

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Rural households are managing as best they can in a rapidly changing and often threatening world which makes them vulnerable to the risk of HIV infection and ill equipped to cope with the effects of AIDS. Their chances of managing can be improved if they function in a supportive environment. However, in many cases this supportive environment does not exist and communities have to build their own resilience if they are to prove effective allies for rural households. Despite the difficulties of such a task, as shown in this paper, it is feasible. Certain conditions have to be met and pitfalls avoided in order to set up processes leading to sustainability and benefit all households as stakeholders. Such awareness is important for the communities themselves, but also for those providing outside assistance in order to trigger the building of community resilience and sustainability for all households, including in HIV/AIDS prevention and mitigation. This paper also reviews from a South East Asian perspective some of the lessons to be drawn from the global and African experiences and highlights some of the specificities and challenges of the region

Equal opportunities for all : promoting community-based rehabilitation (CBR) among urban poor populations. Initiating and sustaining CBR in urban slums and low-income groups

ASSOCIATION AMICI DI RAOUL FOLLEREAU (AIFO)
October 2001

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Most CBR experience has come from rural areas in developing countries. However, even in large cities specific population groups - such as people living in slums or low-income areas in the urban peripheries - may face difficulties in accessing rehabilitation services. To address this, the World Health Organization set up a number of pilot consultations and projects in seven countries (Indonesia, India, the Philippines, Brazil, Bolivia, Egypt and Kenya) in 1995. This document gives a report of a final meeting of representatives of these pilot projects.

Overcoming resource barriers : the challenge of implementing inclusive education in rural areas

MILES, Susie
2000

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This paper examines inclusive education in rural areas and presents case studies highlighting potential barriers and solutions and lessons learnt. The summary of lessons learnt includes the following point: to embrace the whole school approach; to ensure specialist support is at national level; to ensure access to information for teachers; and to develop teacher training and create community involvement. This paper is useful for people interested in inclusive education in rural areas
A Symposium on Development Policy "Children with Disabilities and the Convention on the Rights of the Child"
Bonn, Germany
27-29 October 2000

The paradigm of communication in development : from knowledge transfer to community participation : lessons from the Grameen Bank, Bangladesh

FUGELSANG, A
CHANDLER, D
1997

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This case study describes in some detail the communication methodologies in a cooperative bank in Bangladesh, which relies on the participation of landless people. The paper describes and analyzes the bank's approach to external and internal communication and information processing, its methods of information, management and decision-making - features of the Bank's organization and functioning which have played a significant role in its success

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