(Volume 4) - Mental Health Disorders - Vula - University of Cape Town

In each village a Village Organisation (VO) is formed by the poorest villagers.Activities of the VO members include awareness and advocacy for humanrights, and the initiation of a compulsory savings programme. BRAC staff trainmembers of the VO in different trades (such as village health worker, poultryvaccinator, and so on), who then provide for the members of the VO and selltheir services to other villagers for a small fee. After a month of membership,VO members may apply to BRAC for an individual loan, which is granted foruse in income-generating activities, or for housing.Several studies have been conducted to evaluate the programme and foundthat BRAC members’ financial status improved after joining the project, andthat BRAC households spent significantly more money on food and hadgreater amounts of money left over for other expenditures than non-BRAChouseholds.BRAC families also had lower rates of malnutrition, improved child survivalrates, and improved mental health. The effect on physical violence againstwomen was mixed: members who had savings and credit without trainingreported more domestic violence compared to non-members, but those whohad savings, credit and training reported significantly less violence than nonmembers(Chowdhury & Bhuiya, 2001).Ahmed & Chowdhury (2001) also reported an increasing prevalence of“emotional stress’” shortly after receiving micro-credit, which then reducedafter training was given to the loan recipients. The authors argue that theincreased emotional stress was due to the challenging of traditional gendernorms, which in turn resulted in increased domestic violence (as above).In this instance, more attention should be paid to involving men in the projectsuch that a forum to ameliorate potential gender tension is created. The othersignificant effect of providing credit without training is the stress that canresult from the lack of skills to effectively manage the loan, hence theimportance of providing training and support to loan recipients is highlighted.The Comprehensive Rural Health Programme (CRHP) is a similarintervention that aims to improve health and well-being in impoverished ruralvillages in India. It is a multi-faceted intervention which brings togethergroups of people (farmers’ clubs and women’s’ groups) to define and addressthe problems of the village.Community members identify a woman in their community suitable fortraining as a village health worker who is then trained in locally relevantprimary health care as well as in “programme skills”, including techniques formobilising community support, income-generation, and small-loanmanagement (Arole et al, 2005). The village health worker then shares thisknowledge with the community groups.The outcomes cited by the World Health Organisation include: improvedphysical health; nutrition; gender equity; social support; skills acquisition;financial autonomy; and social empowerment (Arole et al, 2005). Theevaluations are clearly of a pre-post nature but how the outcomes have beenassessed is not clear. The programme was first implemented in 1970 and withits successes has expanded to over 300 villages with a combined populationof 500 000 people (http://jamkhed.org/History.shtml. Accessed 22 January 2007).37