What does empowerment mean? There are different definitions and perspectives to this term. From a purely sociological viewpoint, empowerment could be understood as – “the degree of autonomy and self-determination in people and in communities. This enables them to represent their interests in a responsible and self-determined way, acting on their own authority”.1 Oxford Dictionary defines empowerment as “ the process of becoming stronger and more confident, especially in controlling one’s life and claiming one’s rights”. It sounds good in theory. But how often do we get to see an empowered individual in action? What does empowerment entail beyond autonomy, self-determination, confidence and control? What happens when an individual is empowered?
From a historical perspective, there is ample evidence to show that (ironically) maternal deaths (still) occur owing to preventable causes. These causes are often attributed to systemic lacuna and broader social contexts like poverty, ignorance, culture, tradition and so on. What needs to be understood is that these factors are strong, unyielding and will continue to remain in the scheme of things. So what can we change? An immediate response to this question would be – knowledge, behaviours, attitudes, perceptions. We are all too aware about the Herculean nature of this change-making process. Nevertheless, a majority of civil society organizations, including ARMMAN, are change-makers, and In the process we have created agents of change – the Arogya Sakhis.
Through ARMMAN’s Arogya Sakhi Home-based Antenatal and Infancy Care program we have been working very closely with community-based health workers and helping them evolve into health entrepreneurs by enhancing their capabilities. Arogya Sakhi literally translates as – Health Friend. These Arogya Sakhis go through a comprehensive 22-day training program and are thereby enabled to reach out to mothers and children in one to two villages each. One of the objectives is to identify high risk pregnant women and take timely action where required so as to prevent mortality and morbidity. Our training for Arogya Sakhis is quite comprehensive and helps them perform simple medical tests that have a far-reaching impact on maternal health. These include testing blood for haemoglobin (Hb) levels, checking weight and height, monitoring blood pressure and blood sugar, and also keeping track of fetal heartbeats. All of this is apart from the much needed counseling that every pregnant woman requires from her healthcare provider. We give the Arogya Sakhi an incentive for each visit whereby they are able to generate an income for themselves and their families.
Empowerment ought to eventually lead to some transformation and change. How has this unfolded within the Arogya Sakhi program? ARMMAN as a change-maker has empowered the Arogya Sakhis who have in turn empowered mothers in communities. When visualized, the following is what emerges –
Going back to the beginning of this narrative, the Arogya Sakhi’s work is a perfect example of ‘applied empowerment’. When we train an Arogya Sakhi we strengthen her to an extent where she not only saves lives, but also brings about a shift in behaviours among families. She is a respected member of the community who has been given the authority to facilitate decisions that lead to positive health outcomes. She is viewed as a trusted advisor who ought to be listened to. Through her actions, she enables women in communities to demand care, to demand services. She becomes an agent of change.
The trajectory of change that we have observed among our Arogya Sakhis has been awe-inspiring and humbling. She is a resident of a remote tribal block and walks for miles on end, carrying her medical kit, no matter what the weather. What drives her is her unshakeable determination of not losing a single mother or child. As she sits in her house and speaks to us, we see shining steel pots and pans in a spotless, airy room, with mud floors and thatched roofs. We also see smiles and sinews in a woman who articulates intelligently and makes statements that have strategic implications on her work. When she buys a wardrobe, a settee or a television set, it is not the actual object or her possessing it that matters to her; it is the fact that she was able to purchase it that instills in her a sense of pride. She retains her composure and communicates effectively with family members and government health functionaries alike, maintaining good relations with everyone she works with, thereby ensuring she can continue providing her services to mothers and children.
What does this indicate? Is an Arogya Sakhi only saving lives? Is empowerment confined to autonomy and control? Or is it that an agent of change has emerged to ensure that individuals are made aware of their fundamental rights and their ability to exercise them? When empowerment leads to agency building and ownership, this transformation has the power to impact communities, societies and even the nation at large. In our constant quest to socialize the issue of maternal, newborn and child health, the Arogya Sakhi program is a true example of how a relevant and important stakeholder is taking charge of carrying the baton and sustaining our efforts to go much, much beyond saving lives by contributing to create a systemic change.
1 ‘Empowerment’ (2020) Wikipedia. Available at https://en.wikipedia.org/wiki/Empowerment