The Mandwa project: an experiment in community participation.

The project at Mandwa was designed to study the problems of health in rural India and the delivery of health care by the existing public and private health systems. The results demonstrate the important role of socioeconomic and political factors not only in vital areas such as nutrition, water supply, sanitation, and housing, but also in the delivery of health services. The private sector showed a predominantly curative and monetary orientation, while the public sector demonstrated a lack of accountability to the people it was designed to serve. Under these conditions, an attempt was made to test the possibility of training local women in self-help with a minimal supportive service. The results reveal that adequate knowledge and technology exist for most of the prevalent problems of health and illness in developing countries, and that semiliterate villagers have the capacity to use these effectively if they are provided in a simple manner. This experiment also demonstrates the opposition from local vested interests to any change of the status quo, even in the relatively noncontroversial field of health.