DIR has three types of activities, all of which are aimed at improving the ability of the poorest of the poor to improve the quality of their own lives. All of our projects may be classified to fall under one of three headings, HEALTH, EDUCATION or INCOME GENERATION.
Under the DIR model, each group of 200 contiguous households is called a Unit. If possible, a person from each Unit is given full-time paid employment as a Health Promoter (HP). If a suitable person is not available in a Unit, a suitable person is recruited from as near as possible. There is no rigid educational perquisite to become a HP, but each must be able to read and write. He or she should be an intelligent person who is respected in the community.
In initial training, each HP has two academic hours of instruction each day. The first hour is devoted to Health/Medicine and the second to Nutrition. In all cases, education is relevant to the immediate environment. This means that Medical courses deal only (after introductory instruction in anatomy and physiology, etc.,) with diseases and risks that exist in the slum, and it means that all Nutrition classes deal with local nutritional problems and their solution.
From the first day of employment, HP learn on the job. They start the day with academics and then spend five-and-a-half hours making home visits in their individual Units. They must do well in monthly written academic examinations to retain their jobs.
Every Health Promoter (HP) must visit every family in his/her Unit at least once a month. In the last impartial evaluation of DIR Programs, it was discovered that HP visited homes on an average of 4.2 times per month.
In the homes, they weigh children, counsel and educate parents, and assist in any way possible to help the people improve their own living conditions.
Because malnutrition is such a common problem in slums, and because of the serious problems caused by malnutrition, the subject is given high priority. Every child under the age of 60 months is weighed by a HP at least once each month. The weight is recorded on a weight-for-age chart, and parents are instructed on the relationship between weight and health, and are informed on how they may make improvements with locally available low-priced ingredients.
Each month, DIR Nutritionists provide a cooking demonstration for the HP of a new recipe of a nutritious meal which must cost no more than the equivalent of five US Cents per serving. The HP then give demonstrations in the homes within their individual units in this program which is becoming increasingly popular. Many parents had informed us that they are now spending less on food than formerly, and the food they are serving now is having better results than was their earlier diet.
As is common, the population groups at greatest risk of death and disease are children under the age of five years and women giving birth, and one of the most effective means of reducing preventable diseases is through immunization. Accordingly, DIR Health Promoters maintain exhaustive records of the immunization status of all young children as well as all pregnant and lactating mothers.
Using these records, the Health Promoters ensure that the individuals at risk appear for their “shots” when the Health Department’s immunizers come to the DIR building every Wednesday. Under this program, in which there is close collaboration with the government, DIR staff have achieved record statistics. At one period they had achieved 100% coverage. That is to say, every person had had all the shot s/he should have to-date. This percentage was reduced when 250 new residents arrived. They had been displaced from an illegal slum which the government had just bulldozed. Improvements are being made and presently over 90% of all possible shots have been given.
THE CASE PROJECT
C.A.S.E. the Child Activists for Social Empowerment project provides after-school programs for children aged 9 through 15. Participants meet weekly for organized games, contests, and learning opportunities.
Each team is led by a Health Promoter, under the direction of the Assistant Director. They learn new games, develop team spirit, hone skills in sports they already know and become educated about practical matters, such as better hygiene, improved nutrition, looking after a young sibling, avoiding malaria, dengue fever, dysentery, etc. Since preventable illnesses take such a heavy toll on the poor and uneducated, effective health education empowers families to improve their living conditions and lead healthier lives.
They create educational street plays, puppet shows and songs about health for their neighbors in the slums of Chandigarh, India. Last summer, they gave 110 street performances, all of which were well attended.
Last year, CASE children competed in a four-month contest to see who could do best in reducing malnutrition for a group of 181 children, under the age of five, who were classified as Severely Malnourished. Each competitor was assigned to specific severely malnourished young children in their neighborhood. In this innovative program (to the best of our knowledge slum children have never before been organized in a program to reduce malnutrition) competitors exerted efforts to educate parents, and to get them to change family eating habits by every means they knew.
At the end of the contest, 59 target children had so improved that they were no longer classified as severely malnourished. Eleven children had (almost miraculously) become of “normal” weight. And all but three had made significant improvement. The motivating factor was the promise of a brand new bicycle for each of the ten competitors who brought about the greatest improvement. Runners-up were presented with a re-chargeable electrical emergency lamp which is considered a useful possession in a slum which has frequent power “cuts” daily last for hours.