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The Comprehensive Rural Health Project, Jamkhed (CRHP)

Dr. Raj Arole, Mabell Arole

CRHP works by mobilizing and building the capacity of communities to achieve access to comprehensive development and freedom from stigma, poverty and disease. Pioneering a comprehensive approach to primary community-based healthcare (also known as the Jamkhed Model), CRHP has been a leader in public health and development in rural communities in India and around the world.

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CRHP began in 1970 under the leadership of Drs. Rajanikant and Mabelle Arole in a severely impoverished and drought‐prone area of central India. These doctors saw the potential that illiterate women had to address the health problems of women and children in their communities when given appropriate training and support. CRHP identified talented and committed women of lower castes to carry out village-level health work. Community Health Worker (CHW) services included health education, diagnosis and treatment of simple conditions, promotion of key messages such as family planning, and referral of patients’ need of higher-level medical care. CRHP also facilitated the formation of Farmer’s Groups that met monthly and supported the CHW with village level problem solving and later Women’s savings and Loan groups. CRHP provided each CHW with training that made it possible for her to earn a livelihood -- usually some kind of income-generating activity unrelated to her work as a CHW.


CRHP’s objectives

To achieve access to comprehensive development and freedom from stigma, poverty and disease.

Another more specific objective of the project was to integrate mental health into the primary health care setting, with a strong focus on women. By using trained volunteers, the intervention works with groups of women from the community to build competences and self-esteem, and to increase perceptions of personal control. 


The Aroles reached out to donor agencies that funded food-for work programs. Citizens were employed as daily wage laborers to build dams and were paid one bag of grain per week. Health and wellness lessons, and discussions of home-based, low cost prevention and care programs to enhance children’s nutrition, prevent diarrhea, and control pneumonia were provided in conjunction with these construction projects. By providing basic medical care to workers and their children, the Aroles established an initial trust with the residents of Jamkhed. From there, the Aroles were able to start their mission of instituting trained health workers in the villages.

The intended scope included individuals (as citizens play an important role), there was also an emphasis on families (implementing home-based, low cost prevention and care programs) and the community (by training health workers on the different villages).

There has been a great number of external evaluations of the CRHP project, with several prominent  scientists and organizations such as UNICEF and WHO involved in its evaluation (Kermode et al, 2007, 2008, 2009, 2010; Mann V. et al., 2010; UNICEF, 2008).

Having focused on a diverse range of issues such as the environment, sanitation, social and cultural practices, economic and political conditions in addition to health, CRHP has been able to observe a significant and readily measurable impact that is both quantitative and qualitative. CRHP takes an interdisciplinary approach to everyday barriers that are at intersections of multiple issue areas.

From the initial 30 villages in 1970, the project had expanded to a region of over 250,000 people for the first 25 years. Infant mortality fell from over 176 per 1,000 births to 23 per 1,000 (and at its lowest to 17 per 1,000 for some villages).

The impact of the project on mental health has also been evaluated by Kermode et al., 2007. This evaluation of the project indicated that the intervention had a positive impact on mental health. Many women acknowledged how the opportunity to engage independently in the labour market had benefited them and their families. Furthermore, the women felt they had a greater participation in decision making and freedom of movement, which gave them a sense of competence and control and improved their domestic relationships. These changes in lifestyle and circumstance improved their mental health.


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