Nandi Sulakshana, Schneider Helen
Public Health Resource Network(PHRN), 28, New Panchsheel Nagar, Near Katora Talab, Civil Lines, Raipur 492001, India and School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa 7535 Public Health Resource Network(PHRN), 28, New Panchsheel Nagar, Near Katora Talab, Civil Lines, Raipur 492001, India and School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa 7535
Public Health Resource Network(PHRN), 28, New Panchsheel Nagar, Near Katora Talab, Civil Lines, Raipur 492001, India and School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa 7535.
Health Policy Plan. 2014 Sep;29 Suppl 2(Suppl 2):ii71-81. doi: 10.1093/heapol/czu074.
The Mitanin Programme, a government community health worker (CHW) programme, was started in Chhattisgarh State of India in 2002. The CHWs (Mitanins) have consistently adopted roles that go beyond health programme-specific interventions to embrace community mobilization and action on local priorities. The aim of this research was to document how and why the Mitanins have been able to act on the social determinants of health, describing the catalysts and processes involved and the enabling programmatic and organizational factors. A qualitative comparative case study of successful action by Mitanin was conducted in two 'blocks', purposefully selected as positive exemplars in two districts of Chhattisgarh. One case focused on malnutrition and the other on gender-based violence. Data collection involved 17 in-depth interviews and 10 group interviews with the full range of stakeholders in both blocks, including community members and programme team. Thematic analysis was done using a broad conceptual framework that was further refined. Action on social determinants involved raising awareness on rights, mobilizing women's collectives, revitalizing local political structures and social action targeting both the community and government service providers. Through these processes, the Mitanins developed identities as agents of change and advocates for the community, both with respect to local cultural and gender norms and in ensuring accountability of service providers. The factors underpinning successful action on social determinants were identified as the significance of the original intent and vision of the programme, and how this was carried through into all aspects of programme design, the role of the Mitanins and their identification with village women, ongoing training and support, and the relative autonomy of the programme. Although the results are not narrowly generalizable and do not necessarily represent the situation of the Mitanin Programme as a whole, the explanatory framework may provide general lessons for programmes in similar contexts.
“米塔宁计划”是印度恰蒂斯加尔邦政府推行的一项社区卫生工作者项目，于2002年启动。社区卫生工作者（米塔宁）始终承担着超越特定卫生项目干预措施的角色，积极参与社区动员，并针对当地优先事项采取行动。本研究旨在记录米塔宁如何以及为何能够针对健康的社会决定因素采取行动，描述其中涉及的推动因素和过程，以及有利的项目和组织因素。在恰蒂斯加尔邦两个县中，特意挑选了两个“街区”作为成功范例，对米塔宁的成功行动进行了定性比较案例研究。一个案例聚焦营养不良问题，另一个案例聚焦基于性别的暴力问题。数据收集工作包括对两个街区的各类利益相关者（包括社区成员和项目团队）进行17次深度访谈和10次小组访谈。采用一个宽泛的概念框架进行主题分析，并进一步完善该框架。针对社会决定因素采取的行动包括提高权利意识、动员妇女团体、振兴地方政治结构以及针对社区和政府服务提供者开展社会行动。通过这些过程，米塔宁在当地文化和性别规范方面以及确保服务提供者问责方面，树立了变革推动者和社区倡导者的形象。成功针对社会决定因素采取行动的因素包括该项目最初意图和愿景的重要性，以及这一意图如何贯穿于项目设计的各个方面、米塔宁的角色及其与农村妇女的认同感、持续培训与支持，以及该项目的相对自主性。尽管研究结果无法广泛推广，也不一定代表整个“米塔宁计划”的情况，但该解释框架可能为类似背景下的项目提供一般性经验教训。
