Reproductive Health
Reproductive Health
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Tata Steel in India by D K Dey . |
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Introduction
Recognizing the potential impact of HIV/AIDS on its employee. their families and the company's business, the Tata Iron and Steel Company (TISCO) realized that it had to take preventive actions.The company also realised that in a traditional community like Jamshedpu addressing HIV/AIDS may be difficult due to the sensitivity surrounding the issue. Despite this, TISCO felt confident because of the credibility it has gained through its existing family welfare programs Thus, STD and HIV/AIDS services were integrated into the family welfare programme in early 1993. Health and Family Welfare Programme TISCO's commitment to the welfare of its employees and their families began in the early fifties when it launched the health and family welfare programme (see Annex 1). In this framework, TISCO chooses a family approach and emphasize quality of care in order to effectively meet the diverse health needs. It also encourages community participation and makes efforts to involve the community at all levels of programme development and implementation. Health Services TISCO operates an extensive maternal and child health programme including nine family welfare centres as well as nine child clinics in the town and peripheral areas. Although mothers and children are the primary targets of these clinics, health services for other members of the community are also offered. To further serve the community, mobile medical vans provide general health services to population living outside the town centre. In addition, TISCO helped the community establish and manage seven community-based clinics (see Annex 2 for details). The community provides the infrastructure and volunteers while TISCO makes available medical and paramedical staff, medicines, vaccines and contraceptives. A decision making committee, representing members of the community, was set up to ensure community participation. The conscious effort to involve the community in all activities, and the provision of quality services, contributed to the success of the family welfare programme. Educational and Motivational Activities Educational and motivational activities targetted at all age groups employee, spouse, parents, in-laws, youth, and children - support the health services. These activities are carried out at the clinics, in the factories and other contact points. Table 1 gives a summary of the activities. Table 1. Educational and motivational activities.
Incorporating STD and HIV/AIDS Prevention Activities Concerned with the rapid increase of HIV prevalence in India, TISCO wanted to take urgent preventive actions. The strength of its family welfare programme gave TISCO the credibility and the confidence to introduce STDs and HIV/AIDS services to the community. Hence, in early 1993, TISCO began interactions with the World Health Organization (WHO) and the National AIDS Control Organization (NACO) to assess the feasibility of incorporating these services into the existing health and family welfare programme. Situational Assessment As a first step, the felt need of different target groups was assessed through a survey and focus group discussions. 'This approach was taken because rather than impose a strategy from above, we want to generate a response from the community in designing IEC materials and services which will meet their needs', says D K Dey, Director for Family Initiatives and Social Services. Half-day focus group discussions were organized for different target groups and a rapid assessment on a random sample of employees was conducted to obtain information on their STD/HIV/AIDS knowledge, high risk sexual behaviour patterns and condom use. The assessment provided evidence that the general awareness level amongst employees and the general community was very low. On the other hand, the felt need for information was high. With this information at hand, the challenge therefore is to reach as many people as possible with STDs and HIV/AIDS education. Consequently, a reorientation of activities was undertaken to accommodate STD and HIV/AIDS information in all existing activities. Reorientation of Activities Training of staff. Training of staff was given top priority. The training aimed at enhancing knowledge of STD and HIV/AIDS and sensitizing staff to provide non-judgmental services to patients infected with STD and/or HIV/AIDS. Today, in nearly all health outlets, staff are able to impart information and to answer clients' queries about STD and HIV/AIDS prevention. Generating male involvement. Men's involvement is crucial preventing STD and HIV/AIDS. While they need to be more responsible for their health and that of their spouse and family, they must provided with the information and services which will enable them do so. To achieve these objectives, TISCO has initiated health set ices for men at several of the existing clinics. Male clients at the clinics are served by male doctors and paramedical workers. The presence of male clients at these clinics gives staff the opportunity to educate them on STDs and HIV/AIDS. Men are also encouraged to jo their wives in group discussions held at the clinics. Condoms are distributed free of charge at all health outlets. The demand for condoms has increased since the STD and HIV/AIDS activities started. It is encouraging to note that female clients are getting condoms for their husbands. However, conclusions about the actual use of condoms cannot be made because evaluation has not yet beei carried out. Motivational activities. Topics on STDs and HIV/AIDS have been included in all the motivational activities described in Table 1.A specialist from the Tata hospital is often present at these activity where he encourages the community to seek STD treatment and HIV/ AIDS counselling at the hospital. Tata Steel has a unique system of management-union interaction in a forum called "Joint Departmental Council" (JDC). Every departrnent has a JDC meeting once or twice a month where work related issues are discussed. The HIV/AIDS programme seizes this opportunity and delivers STDs and HIV/AIDS lectures to the employees a the Union Committee members. The motivation activities have created increased community interest in seeking further information and many are willing to act as peer counsellors. Reaching youth. A
special programme for youth was develop to educate them about health,
hygiene, nutrition, sexuality, and reproductive health. The programme
is a collaborative effort between TISCO and the Family Planning Association
of India where cola students and their professors, street youth and
young employees reached through various IEC approaches, the most popular
being dance and drama. Plans to expand this project through peer counselling are in the pipeline. Training for youth counsellors in consultation with local college professors are being explored . Information, Education and Communication The introduction of STD and HIV/AIDS services was complemented by the development of relevant IEC materials and activities. The community was actively involved in this process, thus ensuring the development of IEC materials that meet their needs and perspectives. Posters. Young artists from the School of Arts in Jamshedpur produced posters with STD and HIV/AIDS messages. It has been proposed to convert the posters into playing cards for wider distribution. Funding for this idea is being explored. Booklet. Arising from the felt need expressed at the orientation meetings, a handout which provides essential information on the 'How, Dos and Don'ts" on HIV/AIDS was completed and distributed. Street Theater. A street theater programme focussing on how the HIV virus can be contracted, its consequences, its prevention, and on positive attitudes towards those infected with the virus is popular and effective. To highlight the HIV/AIDS problem as also an issue for women, this activity is now presented from women's perspectives. Dance Drama 'CHETNA'. Using music and dance as a communication tool, reaching the community with STD and HIV/AIDS information has become a reasonably easy task. In line with the comprehensive approach of TISCO's health and family welfare programme, the 45 minutes performance presents topics not only on family welfare, STDs and HIV/AIDS but also topics such as early marriage, literacy, nutrition and hygiene. The performance has been and will continue to be staged in different regions in India. APANI BATEIN. APANI BATEIN (Our matters) is a programme that encourages young people (9-27 years old) to meet at TISCO's Centre for Family Initiatives (CFI) to discuss diverse themes - child-parent relationships; physical and emotional development; developing self-esteem; sexuality; family; reproductive health; and relationships. Presently, facilitators initiate discussions but eventually the facilitator's role will be assumed by members of the groups. Subsequently, based on the experience of the group discussions, telephone counselling facilities at the CFI will be launched. Policy In addition to the integration of its programmes, TISCO is also developing a policy related to HIV/AIDS and the workplace within the WHO parameters which include the following: Screening. Since an infected person cannot infect co-workers casually and the infection by itself does not affect a worker's ability to perform, pre-employment blood testing is unnecessary. Confidential record. Like all medical records, information on HIV/ AIDS status should be kept confidential and there should be no obligation for an employee to inform the employer about his or her HIV/, AIDS status. Work arrangements. Since HIV infection by itself does not limit fitness to work, no changes in working arrangements or assignments are necessary until the employee becomes impaired by illness. When this happens, reasonable alternative work arrangements should be made to help the worker stay on the job. Dismissal. Persons with HIV related illness cannot be dismissed as long as they are fit to work. Discrimination. Workers with HIV infection or who are believe( to be HIV infected, must be protected from any stigmatization by co. workers, unions, employers and clients. Education. Workers and their families should have access to STD and HIV/AIDS information and educational programmes. These programmes must be complemented by appropriate counselling. Workplace policy. Workers should be consulted by employers i the development and implementation of policy related to HIV/AIDS STDs and HIV Case Management TISCO is making efforts to develop adequate case management services at the point of first contact with the health care services. Women can now access STD diagnosis, treatment and counselling at existing clinics. Similar services are also available at the obstetric and gynaecological department and the skin, leprosy and anti-rabies clinic. The latter is necessary for patients who wish to avoid stigmatization of seeking STD services. Those who are infected with STDs are encouraged to bring their spouses for treatment and counselling. The hospital has a policy of non-discrimination against HIV/AIDS patients. The patients are admitted to the general ward and treated in the same manner as other cases. There are no isolation wards for these patients. However, safety procedures to prevent infection at the clinical level are strictly observed. Counselling is an important element in this programme. Every patient receives one-to-one counselling while privacy and confidentiality are maintained. At the end of each session, patients are encouraged to "drop-in" at any time for further counselling. A large number of patients counselled, in turn, become education disseminator and peer counsellors. All donated blood is tested for HIV. Infected donors are informed of the result and counselling is offered. On the patient's request, counselling for the immediate family is also given. People interested in undergoing HIV testing are counselled and advised of the implications should the test comes out positive. Tests are given only after the above procedure has been observed and consent of the client obtained. Management Organizational Structure The STD and HIV/AIDS activities are implemented within the framework and structures of the existing services provided by the Centre for Family Initiatives and the Social Services and Medical Division. A committee of three doctors from the existing workforce, each with a specific function, was formed. One is in-charge of STD and HIV/AIDS case management, another is responsible for surveillance while the third person coordinates the STD and HIV/AIDS awareness activities. Currently, the existing structure of the health and family welfare programme is able to accommodate the programmatic and budgetary aspects of these activities. With the help of community volunteers in carrying out IEC activities, there has yet to be a need to recruit staff. However, additional staffing and a separate organization structure will be considered when the need arises. At that stage, the issue of cost will have to be considered. Linkages The implementation of STD and HIV/AIDS activities within the current organizational structure renders the linkages with the different functionaries of the Steel company and the community crucial. These linkages have not only facilitated smooth implementation but also allowed greater coverage. Efforts to establish similar linkages with outside agencies within the city and region has been less successful. Two reasons contribute to the difficulties - lack of commitment and non-existence of effective organizational structure on the part of outside agencies. Sharing the Lessons During the three years of programme implementation, TISCO has learnt several lessons:
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