The effectiveness of our community health work largely depends on whether our whole approach is treatment oriented or whether it is oriented towards health education and prevention. It is imperative that the present day treatment oriented health service delivery system is changed.It is not important so such the ‘Targets achieved’ but rather the “Process established” which should help us to asses the effectiveness of our work. The further criteria to determine our success should be whether the people are utilizing the services in large numbers and whether they are actually using or putting into practice the health related knowledge received by them.
To work in the villages we have to think in terms of the existing structure of the villages which are divided into a variety of clusters based on caste and inequity. The inter-relations between these clusters (Tolas) depend upon the caste – land equation in which usually the relatively lower castes are oppressed and are prevented from treading on the pathways of progress. Further, our issues and messages do not appeal universally to people with different psychological backgrounds. All slogans and semantic games are decided or designed by a class. The message does not spread because there is no communication (among the different groups of people).
Under such circumstances, if the health centre is located amidst the upper castes then the beneficiaries would be largely from these very castes. But, if the centre is situated amidst the lower castes then the upper castes will make use of it and so will the lower castes to a sufficient extent. However, it is important to reflect upon the questions pertaining to the learning about illness – prevention methods and to the use of health education in daily life. In the hierarchical feudalistic village societies, health workers from the upper class or caste do not like to work and to undertake educational activities in particular, amongst the so called lower castes. We make a distinction between ‘providing information’ and ‘education’ and would like to assert that health education does not merely involve the dispensation of information but is a takes entailing a deeper and comprehensive education of the people. And if the health worker belongs to a lower caste group then the upper castes usually do not like to listen to her/him especially when she/he talks of things which are different from the established traditions or customs. Hence in the context of health education, separate arrangements need to be made for the separately located different communities within the village. In the contemporary context ‘indirect’ messages will not be effective. The worker must belong to that very community/society where the work has to be done. Otherwise the worker cannot establish rapport with the people on account of inadequate communication resulting from economic and social gaps. Such a worker either gives orders or gives messages quite unrelated to life. For these very reasons, the community is unable to assimilate or imbibe the messages and it looks upon the efforts of the worker as a mere performance of paid or remunerative service.