"The woman was asking Shubha for our help because she was concerned that her daughter-in-law, who was about sixteen and was six months pregnant, had refused to see a doctor," says Barin. "Her mother-in-law was very worried because she hadn’t received any prenatal care, vaccinations, or medications. So she took us to her home where we saw her daughter-in-law, who appeared malnourished. We began talking with her, telling her that if she didn’t seek care now, she was risking her life and that of her baby. We were able to eventually convince her. I have a video of her squirming while getting her first vaccination as all the villagers cheered: The mobile health team had successfully spread awareness and vaccinated all the pregnant women that village."
From interest to action
Barin became interested in reproductive health issues early in her college career. As a freshman majoring in medical anthropology, she attended a symposium at the School of Public Health and was immediately hooked. "I was so fascinated that I instantly scheduled an appointment with the undergraduate adviser to put me on the waiting list for the public health major," she recalls.
Her public health coursework and an internship with Physicians for Reproductive Choice and Health in San Francisco further convinced her she had found her calling. But when as a junior she discovered the new Global Poverty and Practice minor, offered by the UC Berkeley Blum Center for Developing Economies, a whole world of new opportunities to pursue her interest opened up.
In addition to coursework, the cornerstone of the minor is an experience that allows students to connect the theory and practice of poverty and its alleviation. To fulfill this requirement, Barin applied for and received a competitive Tata International Social Entrepreneurship Scheme fellowship offered through Tata Group, one of India’s largest corporate conglomerates.
"The fellowship is a collaboration between UC Berkeley, Cambridge University, and the Tata Group," says Barin. "The fellowship allows five or six students from each school, UC Berkeley and Cambridge, to work on various community development projects throughout India."
With her interest in women’s health issues, Barin found the perfect project with Tata Chemical Society for Rural Development (TCSRD), a department within Tata Chemical that works to improve the lives of villagers in the area surrounding its main plant in Uttar Pradesh. Barin joined the health team to conduct research on the effectiveness of local Village Health Committees (VHCs) in promoting maternal and infant health.
Maternal health by committee?
Because India’s enormous, diverse, and still primarily rural population makes it difficult to administer top-down programs, the government has supported a decentralized approach to addressing public health issues. It has tried to weave health program administration into the existing village and regional governmental system by encouraging the creation of VHCs within the councils that lead most villages. These VHCs are supposed to build and maintain accountability mechanisms for community-level health and nutrition services provided by the government. To help them succeed, the National Rural Health Mission offers guidelines on the committees’ framework, functions, and responsibilities, as well as 10,000 rupees (about U.S. $250) in funding to support local initiatives.
"For example," says Barin, "pregnant women in a particular village might be concerned if they don’t have accessible transportation to a hospital. So their VHC discusses the issue and tries to find a way to address it. In this case, the VHC might be able to find someone who has a vehicle in that village or a nearby village and arrange to have it accessible for women when they need transportation to a hospital."The VHC can also address village needs to higher level authorities. If there’s a polio outbreak, the VHC members can notify the government authorities and say, ‘We need more vaccines distributed here.’"
A number of Indian organizations and corporations, including the TCSRD, have initiated programs to support the development of VHCs. But administrators of these programs often lack data about the committees’ effectiveness. So for her research project, Barin traveled with TCSRD’s mobile health clinic and conducted surveys of VHC members in 30 villages as well as regional governmental officials who administer the broader government health services.
What she found was a number of large challenges that can limit a VHC’s ability to really improve a village’s health programs. "For one thing, they have this dependence on TCSRD," says Barin. The committees often will only meet when prodded by the corporation.
Other issues revolved around lack of incentives and financial oversight. "Some VHC members are unmotivated because they’re not financially compensated to participate," says Barin. "There is the government money. The problem is, there’s no regulation of how this money is allocated and who’s checking up. When I visited one village I was invited to the home of the village leader, the pradhan. It was a pretty nice, big house in a very poor and rural village. Why is that? Because the pradhan pockets the government money for all these programs. There are high levels of corruption both within and outside the government."
Finally, Barin found that the VHCs tend to be very male dominated—women’s voices are often excluded from their meetings. In the 30 villages she studied, only 16 percent of VHC members were female. "The fact that VHCs are mostly men trying to discuss women’s health issues—there’s a problem there," says Barin.
After eight weeks, a good start
At the conclusion of her summer research, Barin presented her findings, as well as suggestions for improving VHC effectiveness, to a Tata senior management team in Mumbai. She recommended adding leadership positions especially for women to the VHCs, as well as third-party oversight of how the government funding is spent. She also encouraged TCSRD to invest in more training and community health awareness activities in the villages it serves.
Barin realizes, however, that the problems with VHC effectiveness can’t be solved overnight. "All these recommendations come with additional challenges," she says. "Definitely not something a Berkeley undergrad can solve in eight weeks."
Her experiences in India and in the Global Poverty and Practice minor program have shaped Barin’s future goals, however. After she graduates in May, she hopes to gain more public health experience abroad, either in the Peace Corps or as a research associate with a public health organization back in India. She also has longer-term plans to return to graduate school for a master’s in public health.
One thing is certain: She wants to continue finding ways to address maternal and child health issues. "Whatever I’m doing, that’s the arena I want to remain in," she says.