At the CCIH 2016 Annual Conference, Lavanya Mahhusudan discusses the Jamkhed model of community empowerment for wholistic health. She explores how to measure empowerment and what it means for communities.

1. Comprehensive Rural Health Project, Jamkhed, India
Jamkhed International – North America, Carrboro, NC
Empowerment in Jamkhed
(individual & community)
What is it? What are indicators? How to measure.
Lavanya Madhusudan, MSW, MPH
(Lavanya.Madhusudan@gmail.com)
June 18, 2016 CCIH Annual Conference

2. Why Jamkhed?
* Heard about Jamkhed’s success
* Wanted to see how it was achieved
* Learned that the key is community
empowerment - not just providing services
and health education
* Empowerment was the ultimate goal of CRHP
from the beginning – a steadfast commitment by
Drs Raj & Mabelle Arole (CRHP founders)

3. Goals of the Study
* Understand and document the processes and
outcomes of empowerment as occurring through
CRHP’s model.
* Develop indicators to measure empowerment
through quantitative and qualitative tools, for both
individuals and villages as a whole.
* Develop a definition of empowerment that reflects
empowerment as occurring through CRHP’s model.

4. What is Empowerment?
• Depends on who you ask!
• Subjective; shaped by worldview, values and
experiences
• Context-specific
• Multiple disciplines contribute = many perspectives
▫ Internal vs. external process
• Differing notions of “power”  differing notions of
“empowerment”
• Is developing a “universal”, functional
definition of empowerment even possible or
appropriate?

5. Definition of Empowerment
Dr. Raj Arole:
▫ improving self-esteem and gaining self-confidence
▫ developing critical assessment and analysis skills
▫ identifying with others as a member of a community
▫ participating with others in organizing for
community change
▫ realizing environmental and political change

6. Empowerment & Health
▫ “Empowerment necessarily addresses the social,
cultural, political and economic determinants that
underpin health, and seeks to build partnerships with
other sectors in finding solutions” (WHO, n.d.)
▫ Emphasis on transforming power relations
(Laverack, 2009)
▫ Empowerment improves the outcomes of health
programs (more relevant, meaningful, and
sustainable) (Tsey, 2009)

7. Measuring Empowerment:
Considerations
• Unit of measurement?
▫ Individual, family/group, community
• Important domains to measure?
• “Universal” indicators vs. context-specific?
▫ Generalizability vs. accuracy and relevance
▫ Who is deciding what empowerment is?
• Use of quantitative vs. qualitative indicators?

8. Measuring Empowerment:
Considerations (cont’d)
Selection of conceptual framework/theory of empowerment?
▫ Individual agency + opportunity structure (Alsop &
Heinsohn, 2005)
▫ Conscientization (Freire, 1970)
▫ Developing sense of self + critical comprehension of
environment + cultivation of functional competence to reach
goals (Lee, 2001)
Measuring empowerment as a process, outcome, or both?
Empowerment as a means to an end, an end in itself or both?

9. Answers?
 The answers lie with the community.
 They are the experts of their own lived
reality, and know best how to define
and measure it.

10. Strategies from Literature
• START WITH THE COMMUNITY.
• IT IS THEIR EMPOWERMENT.
▫ Develop a definition of empowerment
▫ Identify process(es) of empowerment
▫ Identify important domains to measure
▫ Develop process indicators
▫ Develop a tool to track indicators
▫ Set up an ongoing review mechanism

11. Strategies (cont’d)
Use context-specific indicators
▫ Goal should be to track the progress of own
program, not compare with other programs
Important to measure empowerment as a
process and an outcome
▫ Empowerment is a moving target (context,
priorities and behaviors which define appropriate
indicators change with time)  better to measure
as a process, but outcomes also needed

12. Participatory Evaluation
• Evaluation: a process of reflection and assessment
• Goals:
▫ Assess outcomes (of empowerment)
▫ Understand why/how a program works (process of
empowerment)
• Participatory:
▫ “shifting power in favor of those who are being
studied” (Springett, 2003)
• Evaluation should itself be empowering!

13. Participatory Evaluation
Process at CRHP
 Phase 1: Understand CRHP model and how
to measure empowerment
 Phase 2: Understand villagers’ view of
empowerment and most important changes
 Phase 3: Develop indicators to measure
empowerment

14. Initial Findings of
Empowerment at CRHP
• Values in action = foundation of empowerment
▫ Health knowledge and skills
• Process of empowerment: role models and agents
of change:
▫ Primary: Aroles → VHWs → villagers
▫ Secondary: Aroles → Mobile Health Team →
VHWs/villagers
• 2 pathways:
▫ CRHP → health → empowerment
▫ CRHP → empowerment

15. Areas included in Study:
 Domains
 Outcomes/Impact of specific domain
 Processes of empowerment in specific domain
 CRHP organizational impact
 VHW role
 MHT role
 Villagers’ role: SHG role, ABP/AGP role, FC/MM
 Factors outside of domain that facilitated empowerment
 Current issues / Future goals

16. Top 5 Domains in Which
Empowerment Occurred
 Health
 Gender Equality
 Economic Status/Empowerment
 Education
 Cleanliness

17. Domain: Health (example)
 Domains = areas in which empowerment occurred
 Outcomes/Impact of empowerment in health
 Processes and actors that contributed to empowerment
in health
 CRHP organizational impact
 VHW role
 MHT role
 Villagers’ role: SHG role, ABP/AGP role, FC/MM
 Factors outside of health that facilitated empowerment
 Current issues / Future goals

18. VHW as primary pathway for
facilitation of empowerment

19. VHW Training for Transformation
 Imparting knowledge skills, attitudes, values,
behaviors and practices
(e.g. health, environment, social, economics, spiritual principles,
relationships among all people based on love & unity)
 Integrate values with practical strategies
 Development of identity and self-worth
 Confidence building and co-creation of knowledge
 Developing a culture of caring & sharing
 Empowering oneself in order to empower others
 3 CRHP principles: equity, integration, empowerment

20. VHW Quotes
“Money is not important in my point of view, but humanity is
very important. Because if I don't have money, I can work
hard, and somehow I can get it, but humanity should be in
every person.”
– Rambabai, VHW from Sharadwadi
“Because of this work, there is benefit for me also, village
people also. Village people benefit because I am doing medical
and health things for them, and benefit for me because I get
satisfaction from the work. For example if I am serving a
patient, I think God is there, and serve the God, because each
and everybody has a God. I feel happy in my mind also doing
all these things.”
– Rekha, VHW from Rajuri

21. Empowerment
- Social Outcomes
Changed Power Relationships, Collective Action,
Community Identity, Discussion, Equality, Freedom,
Fulfilling Responsibilities, Gender Equality, Good
Village Leadership, Helping, Independent, Literacy,
Addiction, Child Marriage, Others Listen, Participation,
Peace, Respect for and from Others, Self-Decisions,
Spirituality, Think of Others, Together, Trust in Others,
Understanding

22. Empowerment
- Psychological Outcomes
Confidence, Courage and Strength,
Fearlessness, Forgiveness, Happiness,
Hard Work, Identity, Respect for Others,
Satisfaction, Self-Worth, Solve Own
Problems

23. Empowerment
- Physical Outcomes
Access to Healthcare Services, Access to
Information, Access to Water, Assets, Basic
Amenities, Cleanliness, Community Facilities,
Food Sufficiency, Government Linkages,
Greening and Beautification, High-Yield Farms,
Housing, Improved Health, Jobs and
Businesses, Money, Roads, Schooling,
Technology, Toilets, Transportation

24. Lessons Learned
Empowerment starts with individual  spreads to community
▫ “empowerment is contagious”
Relationships, trust, love, role modeling, showing, teaching,
supporting
True community development/health programs should be
empowerment programs
Everything is related; can’t compartmentalize people’s lives
VHWs should be community organizers just as much as
they are health workers
▫ Community groups are extremely important
Adolescent programs are essential

25. Key Aspects of CRHP Approach
that Led to Empowerment
 Strong foundation in values
 Driven by community priorities
 Focus on end goal of empowerment
 Comprehensive approach
 Integrated sharing of values and knowledge
 VHW as a key facilitator of empowerment
 Belief in human potential

26. Implications
• Need more focus on values as the foundation
for health and social programs.
• Many benefits of community empowerment;
need more focus and investment on
community empowerment.
• Need more studies on empowerment in the
context of health programs to identify best
practices.

27. Drs Raj & Mabelle Arole:
“Empowerment is not a one-way process.
It is not that we, that one set of people ‘provide’
empowerment for others who receive it.
Rather, like water from a well dug in a fortunate
spot, the power flows in many directions and
sustains those who may set the process in motion
as well as those disempowered for such a long time.
It is a dynamic process which once set in motion
transforms us, persons and communities.”

28. CRHP Definition of
Empowerment
“Sharing knowledge openly
with a foundation in human values
through insider relationships built on
love and trust improves quality of life
physically, psychologically and socially for
individuals and communities as a whole.”

29. Report of Study
If you are interested in receiving an e-copy of
this study, please email the author:
Lavanya.Madhusudan@gmail.com