1. An Integrated Approach to Disability Intervention
Intervention for the disability has been an integral component of the DPIP in Andhra Pradesh. While the activities relating to the disabled are confined to three to five mandals in all the DPIP districts, they are extended to all project mandals in Mahaboobnagar district, justified by a relatively higher proportion of the disabled in the district when compared to others. The intervention for the disabled in Mahaboobnagar is unique in the sense that an integrated approach has been adopted to bring about an overall improvement in the living conditions of the disabled through effective convergence not only with the line departments but also with the NGOs and other concerned agencies working in the field of the disabled. Since the DPMU could successfully integrate the varied services for the disabled in a holistic manner, the intervention for the disabled could be considered as one of the best practices in Mahaboobnagar district.
The intervention for the disabled focused on preventive and curative aspects as well as activities directed towards capacity building of the disabled for self-management. Self-help groups of the disabled were promoted at the grassroots level, which were facilitated to federate at mandal and district levels, based on the principles of peer support and collective strength. The disabled were helped to contribute to their household income through the special CIF-SPs sanctioned to them, following the Community Based Rehabilitation (CBR) approach. This brought about a remarkable change in the life of the disabled, which can be attributed to their enhanced productivity, and resulted in increasing their self-esteem on one hand, and the changed attitude of the family towards the disabled on the other hand. Family members lent a helping hand in the process of formation and functioning of the SHGs for the disabled. The disabled organized in SHGs were also provided housing facility under the government of India scheme called Indira Awaas Yojana (IAY). Simultaneously, efforts were made to collaborate with the NGOs and other agencies concerned to arrange surgical operations and procure the requisite appliances which helped in the effective functioning of the different categories of the disabled.
Besides, the creative talent and potential of the disabled could be identified and channeled into livelihood opportunities for them. Kalajatha teams were formed specifically for the disabled, which gave performances in the district aimed at creating awareness about preventive measures of disability. Another key factor in this intervention is the promotion of a cadre of social workers called Community Development Workers (CDWs) from among the disabled for implementing different activities in their respective clusters. As a result, the CDWs could find a source of livelihood, which, in turn, boosted their self-esteem.
The adoption of an integrated approach to dealing with problems of the disabled yielded the desired results and the DAPs (differently abled persons) in the district today function with more dignity and respect than ever before. What is of crucial importance here is that there was a thorough planning that took place to encompass all aspects of the disabled. Each of the steps is an indication of the project's commitment towards the disabled. The process signifies the conviction of the staff involved in the planning and implementation of the intervention. The details of the intervention described below would explain the process adopted and the activities undertaken.
Lessons from the Earlier Initiatives
In addition to the large-scale prevalence of the disabled, the earlier work done by an NGO called COMMITMENTS, which successfully adopted the CBR approach to deal with the problems of the disabled, appears to have influenced the DPMU to lay special emphasis on the problems of the disabled. Lessons drawn from the experiences of this NGO formed the basis for the planning of interventions in this respect. The guidelines from the SPMU to introduce the health, nutrition and disability (HN&D) component into the project for implementation as a pilot in 3-5 mandals of all DPIP districts provided the needed impetus to proceed further in this direction. In Mahaboobnagar too, the work with the disabled was first initiated in five pilot mandals, viz., Kodangal, Makhtal, Utkoor, Peddakothapalli and Pangal, in collaboration with COMMITMENTS. It was later extended to all the project mandals in a phased manner. The process started with a survey to identify the disabled.
Survey of the Disabled
The first step in the intervention was the conduct of a district-wide survey for the identification of the disabled. To start with, it was the CCs and the CRPs in the five pilot mandals who conducted the survey, as they were already working in those villages and were familiar with the communities and the households. A seventeen-column format designed by the project was used to conduct the survey. The survey facilitated the desegregation of data based on sex, age, type and extent of disability. About 61,000 disabled persons with different forms of disability such as orthopedic disability, visual impairment, speech and hearing disability, and mental retardation were identified. The survey clearly brought out the socio-economic problems of the disabled.
As an activity, the survey was considered a value addition by the line department, in view of the rich database on the disabled made available in the district. The line department used the data in planning its strategies and interventions. Yet another aspect of the contribution of this activity is the convergence with the line department in all activities that followed the survey.
Identification and Capacity Building of CDWs
The survey in the pilot mandals revealed that there were a good number of young boys and girls among the disabled who were educated up to 10th class and above. It struck the DPMU that some of these youngsters could be trained and involved in the implementation of activities relating to the disabled. It was hoped that, being disabled, they would work with empathy while dealing with the problems of the disabled. The expectation was proved right with these people turned out to be a cadre of best workers in the project. The selection of the disabled youth as Community Development Workers (CDWs) was done by the VOs and MMSs, with the help of the CCs and the APMs. One CDW was placed in each CC cluster and was expected to work in coordination with the CCs and other project staff. About 165 CDWs were brought into the fold of the project in this manner.
The selection of the CDWs was followed by their capacity building through a well-planned training strategy. They were inspired to feel motivated to work with the disabled. The training consisted of both the classroom sessions and field placement. While the classroom sessions focused on the knowledge base, roles and responsibilities, strategies to be adopted, activities to be undertaken, the related processes, etc., the field placement provided an opportunity to put into practice all that was learnt in the classroom session. This was considered by the CDWs as an important contribution to their success as development workers. The trained CDWs conducted the survey in the next phase mandals and identified DAPs for selection. The process continued until all the mandals were covered.
Organization of DAP-SHGs, MVSs and ZVS
Once the survey was completed and the list of DAPs prepared, the next important task of the CDWs was to organize the DAPs into SHGs. The purpose was to have a homogenous group in order to access peer support. It was more of helping them with self-management skills than promoting micro finance (savings and credit) as in the case of SHGs of women. The SHGs of the DAPs were, however, encouraged to save as much as they could, as this was considered to be one of the key factors for the sustainability of the groups. The common factor that was taken into account for group formation was disability. The other factors like age and sex really did not matter, and therefore, DAPs of all ages and of both sexes, were brought together in the village in the DAP-SHGs. The need for separate DAP-SHGs was felt in view of the special needs of the disabled and to provide an opportunity for an overall development, which would not be possible in a general group. The DAPs, it was felt, would never be able to take up key roles and responsibilities in the general SHGs. Above all, the SHG membership provided the DAPs an opportunity to come out from the closed environment and interact with others on a regular basis. This is particularly true of the mentally retarded. On the whole, nearly 20,000 DAPs were organized into about 1300 SHGs in the district.
The SHGs of DAPs were later motivated to join the VOs and MMSs, and the process was facilitated by the CDWs. It was later realized that the DAPs could not find place either in the EC or any of the committees. It was, therefore, proposed to have a separate samakhya for the DAPs at the mandal level. The same was facilitated in all the project mandals and named as the Mandala Vikalangula Samakhya (MVS). Unlike the existing MMSs, the presidents of SHGs were the members of the MVS. In view of the small number of SHGs in a given village, no separate VOs were promoted. The DAPs and their SHGs were, however, members of the regular VO in a given village. In order to build an organic linkage between the MVS and the MMS, the office bearers of the MVS attended the monthly meeting of MMS. Further, the president of the MMS was the ex-officio member of the MVS. The MVS had an independent budget and the leaders were trained both in institution building and accounting systems.
All the MVSs were facilitated to federate into the Zilla Vikalangula Samakhya (ZVS) at the district level. The presidents of the MVSs are the members of the ZVS. The ZVS EC meets once in a month to plan for various activities in partnership with the NGOs and review their implementation. Rights based approach is adopted to access the government programmes by constant interaction with the district and state level officials.
It appears that the strategy of having separate institutions for the DAPs has facilitated the capacity building process of the DAPs.
Livelihoods for the Disabled
Steps were initiated in the project to promote the livelihood opportunities for the DAPs. A part of the CIF amount allocated to the VO was set aside for the DAPs. Separate sub-projects were sanctioned to DAPs on individual and group basis. A total of 4136 persons from about 670 SHGs were provided with CIF to the tune of Rs.3.5 crores. The comprehensive strategy adopted by the project has improved the status of the DAPs within the family and outside. More significantly, the strategy opened up new livelihood opportunities to the DAPs.
Multi-purpose Medical Camps for the Disabled
About 32 multi-purpose medical camps were conducted for the benefit of the disabled in collaboration with the Department for the Welfare of Disabled and District Medical Board in which nearly16000 DAPs were provided with the disability certificates and bus passes to those who needed them.
Besides, division-level special camps were conducted for the benefit of the mentally retarded with the help of SV Medical College hospital, in which about 1600 mentally retarded persons were provided with certificates, bus passes, etc.
One mega camp for the mentally retarded was organized in April 2006 in collaboration with ten national and state level organizations and NGOs in which about 2000 persons were benefited in the form of not only certificates and bus passes but also assessment, treatment, rehabilitation toys, school admissions, etc. There was a convergence with government programmes such as NSS, DPEP, Sarva Shiksha Abhiyan in organizing this event in which NGOs like COMMITMENTS and Satya Sai Seva Samithi and Rice Millers Association contributed financial and other help.
Provision of Aids and Appliances and Tricycles
An assessment of the need for aids and appliances was also undertaken at the multi-purpose camps. The needed appliances were provided free of cost to the DAPs with the support of the Department for the Welfare of the Disabled and Bhagavan Mahaveer Seva Samithi, Hyderabad. The NGO provided the suitable aids and appliances to all the DAPs who were in need of them. The Amputee cases were provided with artificial limbs, while some others got calipers and crutches. The staff trained the DAPs in the use of these appliances to overcome the initial teething problems. The intervention received much appreciation from the DAPs and their families. A good number of DAPs with disability in the lower limbs could walk for the first time and were immensely happy. Besides, over 1500 tricycles brought from ALIMCO, Kanpur and APVCC, Hyderabad were distributed to the disabled in the district.
The multipurpose health camps helped in the identification of a larger number of DAPs who required surgical corrections. By themselves, the DAPs were not in a position to get the surgery done in view of the limited knowledge and resources available with them. The DPM (HND) could identify a suitable institution in the BIRRD hospital, Tirupati, which provides free medical care and support. The DPMU approached the Director of BIRRD, through the District Collector, who had readily agreed to provide the service. The local SVS hospital was approached for the use of operation theatre and nursing facilities. A local NGO called Rogi Sahayatha Trust provided the medicines, while the DPMU met the costs of the travel and food. The CDWs were trained for the post-operative care, and were required to provide these services under the guidance of the PHC doctors. The surgical camps were conducted four times so far benefiting 528 DAPs. The success rate reported was 99 per cent and those who underwent surgery were given a fresh lease of life, as they could walk now with the help of Calipers and Crutches.
In addition, a Cleft Lip surgery camp was conducted at the government hospital with the help of UNICARE organization, in which 56 cases were selected for surgery at Hyderabad. These persons could be set right and were extremely happy.
Besides, the DPMU organized Plastic (Reconstructive) Surgery camp in collaboration with the Aakar Foundation, SVS hospital and Apollo hospital, in which 244 cases were selected for surgery.
Houses, Land and School Admissions for the Disabled
The DPMU, as part of improving the socio-economic status of the DAPs, facilitated the sanction of houses for the DAPs under the IAY. Accordingly, a resolution was passed in the ZP meeting. Following the decision, the CDWs had identified the DAPs with house site but without a house and prepared the list. The government approved for the construction of houses for 624 DAPs, all women. While the expenditure for laying the foundation was met from the social CIF-SP, the rest came from the IAY. Technical guidance and support was provided by the APM (Engineering) and the progress of the work monitored by the local CBOs.
The DPMU also facilitated the provision of land to the landless DAPs under land purchase scheme. So far, 16 DAPs were provided with land in their villages.
Also, 97 children with disability were admitted into the schools in the five pilot mandals. These included some who never joined schools and some others who dropped out from school.
Awareness on Causes and Prevention of Disability
Yet another activity taken up by the DPMU was the training of some disabled with creative talent into Kalajatha teams, which conduct awareness campaigns on the causes and prevention of disability, rights of the disabled, and other social issues like children's rights, child labour, and general health in the pilot mandals.
The ZVS took steps for the formation of a Kalatarangini (Orchestra) team comprising 17 disabled persons with the creative ability, which was provided intensive training by eminent masters. The team members could give performances in the district and earn some additional income, out of which the artistes could retain 60 per cent and 40 per cent would go to the ZVS.
Newsletter for the Disabled
The ZVS started publishing a newsletter called Palamur Vikalangula Vijayasaradhi which brings out the rights issues and a few success stories of the disabled in the district.
The integrated approach adopted for the rehabilitation of the disabled in Mahaboobnagar district can be replicated in other districts as well. The replicability of the approach, however, critically hinges on the support of the local resource organizations and the willingness of the line departments to support the intervention. As the DRDA has good rapport with the NGOs and coordinates with the line departments/agencies, replicability of the approach should not be a problem.
2. Comprehensive Food Security Instituted for the Chenchus
The chenchus, a primitive tribal group, have a considerable presence in Mahaboobnagar district. Their living conditions are much below the acceptable minimum standards of living. The Chenchu habitations are not only small but widely scattered. Known as 'Pentas', there are 91 widely scattered habitations of Chenchus in the district. Located in interior forest areas, the 'Pentas' do not have minimum facilities. In view of the pathetic situation of the Chenchus, the Mahaboobnagar DPIP laid a special focus to provide sustainable livelihoods to these poorest of the poor sections, including food security.
The efforts to organize them into SHGs at the grassroots level yielded desired results, even though there were teething problems in the initial stages, but their integration into the village/GP and mandal level institutions posed severe problems. Leaders of the SHGs, who were supposed to participate in the VO-EC meetings, hardly attended the meetings and not a single Chenchu became the leader of the VOs. They hardly attended any MMS meeting and some of them were not even aware of the MMS. It was at this stage that the DPMU felt the need for a special strategy to build their capacities and submitted a proposal to form separate institutions for the Chenchus at the village and mandal levels, i.e., VOs and MMSs. The SPMU supported the proposal, justified by the need for special focus on the poor tribals. The idea was put into action immediately and the institutions of the Chenchus came into being. Hence, the organization of separate institutions for the chenchus at the village and mandal levels in all the five mandals of the district could be considered as an innovative feature of Mahaboobnagar DPIP. The DPMU sanctioned a separate budget to the Mandal Chenchu Samakhyas and facilitated the launching of food security scheme on a sustainable basis.
Institution of a comprehensive food security system for the Chenchus through their own self-managed CBOs in Mahaboobnagar district could be considered as one of the best practices since it comprised the elements of the assessment of felt needs though micro level planning, coverage of a wide variety of food items, democratic decision-making, implementation in regular cycles, convenient repayment schedule and the potential for sustainability. The comprehensive food security scheme is being operated in addition to the grain bank scheme for the chosen households in the Chenchu habitations. The process and the components of the scheme are examined here, taking into account the case of Amrabad Chenchu Mahila Samakhya, Mannanur at the mandal level (MMS) and Parasurama Chenchu Aikya Sangham, Padara at the village level (VO).
CIF for Food Security Scheme
The Amarabad Chenchu Mahila Samakhya was sanctioned a CIF of Rs.1454955 during 2005-06 for food security scheme meant for about 604 Chenchu households from 64 groups located in 10 Chenchu VOs. The distribution of CIF ranged between Rs.57690 for Uppunutala VO comprising four SHGs to Rs.280760 for Macharam VO comprising 11 SHGs. The CIF amount provided was in addition to 800 quintals of rice worth Rs.720000 supplied to 10 Chenchu VOs. The CIF would be released to the concerned VOs, based on the consolidation of the micro level plans pertaining to all the SHGs in each VO, submitted to the Chenchu MMS for sanction.
Preparation Micro Level Plan for Food Security
A micro level plan is prepared for each SHG detailing the requirement of different food items, taking into account the number of family members, total requirement of rice, availability of food grains through Annapurana Antyodaya Yojana (AAY) cards or white ration cards from the PDS, additional requirement of rice indicating the quality/variety, requirement of other food items such as groundnut oil, tamarind, onion, ginger, garlic, sugar, tea powder, red chilly powder, red gram, etc. Besides, the requirement for other consumer items such as bathing soaps, washing soaps and coconut, which are important from the point of view of personal hygiene, are also listed out in the recent plans.
Purchase of Food grains and other Consumer items
At the VO level, there would be a purchasing committee comprising one member (active, articulate) from each SHG. In the case of Parasurama VO, this committee comprised seven members. The purchase committee would visit the nearby town and enquire with four or five dealers regarding the quality and price of different items and collectively decide to buy the items. Rice is purchased from the rice millers at the wholesale price. They would then engage a van or auto to transport the items purchased to their VO at which the distribution would be arranged to the SHG members as per the micro plan. The transport cost would be met jointly by all members participating in the scheme.
Repayment of Food Security CIF
The repayment norms including the rate of interest and repayment schedule for the food security CIF were collectively evolved in the MMS meeting in which it was decided to fix the repayment schedule at 6-8 installments from the member to the SHG, 12-18 installments from the SHG to the VO and 100-120 installments from the VO to the MMS. The rate of interest was fixed at 12 per cent per annum (Rs.1) from member to the SHG, 3 per cent per annum from the SHG to the VO (25 paise), and 3 per cent from the VO to the MMS (25 paise), with the SHG to retain 6 per cent per annum (50 paise).
Benefits from the Scheme
The important benefits from the scheme include the feeling of security of women with regard to availability of essential food grains at home, ability to devote full concentration on their respective vocations, and good health and nutrition status of children, besides the savings to the members due to price differential when compared to local markets.
One important indirect benefit pertaining to food security, owing to their membership with the SHG, was the access to small loans with which they could purchase the full quantity of rice on AAY / white ration cards from the PDS dealers at a time. Earlier, they were purchasing only partial quantity of rice allotted to them because of their inability to purchase the entire quantity at a time from the dealer; some were selling a portion of their allotment to others, while some others were leaving it to the dealers who used to make money by selling the same in the open market for higher price. As a consequence, members did not have adequate food grains at their homes due to which they had to go without proper food some times, which adversely affected the health of their children. Thus, another major benefit appears to be their ability to utilize the government subsidized scheme of rice through PDS to the optimum extent.
Besides, some members at the MMS meeting opined that they were able to purchase even better quality of rice at higher price now when compared to the past because of the improved livelihoods brought about by CIF-SPs; they normally purchase 'Hamsa' variety of rice, but some members now prefer 'Sona' variety.
Recovery of Food Security CIF
The records at the VO level and MMS level indicate that the recovery of the Food Security CIF was as per the agreed schedule. All the SHGs were making regular repayments to the VO and the VOs to the MMS. For instance, The Amrabad Chenchu MMS could recover Rs.483826 including an interest of Rs.51717 during 2006-07. Fresh loans were provided for food security from the recovered amount to the tune of Rs.196932.
Recycling of the Scheme and Its Sustainability
The food security scheme is being recycled once in three months at the VO level. The recycling of the scheme on a regular basis underlines the felt-need, realistic assessment of the requirements, coverage of a wide variety of items, convenient repayment norms, and the usefulness of benefits - crucial for its sustainability.
The comprehensive food security system has been instituted in the Chenchu CBOs on sound lines because of its main features, especially the felt needs of the community, democratic decision-making and adherence to the evolved norms. Its sustainability is an indication that the scheme could be replicated in other districts provided the basic principles are adopted.