Since 1999, the efforts are being made to develop a grass root level health system and link it up with the Government managed health service delivery system. In 49 villages, village level Women Health Workers (WHWs) and Traditional Birth Attendants – Dais (TBAs) are trained who are responsible for dealing with primary health care issues and safe deliveries respectively. Apart from this, Mahiti Trust has been organizing Medical Health Camps including health check-ups by inviting profession health practitioners from Primary Health Centers and public charitable / private hospitals. Linkages are being made for better referrals and reaching out widely to the communities through Mahiti Trust’s own Medical Cum Emergency Transportation Services. Till the year 2009, Mahiti Trust has so far trained 105 WHWs and 130 TBAs in 72 villages. Mahiti Trust is also being expanding this activity of training and capacity building of WHWs and TBAs in other villages where community health program did not reach.

Till the date, a cadre of village level Women Health Workers (WHWs) trained and supported by the Mahiti Trust’s health team spearheaded Mahiti Trust’s efforts with regard to Preventive and Promotive Health in 49 coastal villages. In effect, Mahiti Trust’s efforts at the community level required a parallel system of community health care to be created and supported. Concerns about the sustainability of such an effort led to this initiative being rolled back in 2006. An evaluation of Community Healthcare Program implemented during 2003 – 2005 was carried out to find gaps and health needs across all the areas that Mahiti Trust worked in. The results of the program evaluation coincided with the National Rural Health Mission (NRHM) being implemented in the country by the Government and also suggested further expansion of community healthcare program with an additional component of Adolescent Youth’s Health and Development.

Recently another project “Training and Capacity Building of 116 Village Health & Sanitation Committees” has taken up to further strengthen the existing government efforts and to take advantage of opportunities that the National Rural Health Mission (NRHM) presented and expand the community healthcare program in all the villages where health program does not reach. This project is supported by Ministry of Health & Family Welfare, Government of Gujarat in association of Jan Swashthya Abhiyan (JSA) – Gujarat. Each committee has prepared a plan for the health needs of their population and the health committees are currently implementing these plans. Further, Mahiti Trust has commenced supporting the ASHAs and Health committee members in these Village Panchayats in 4 blocks of Ahmedabad and Bhavnagar district by assisting the government health service delivery system. Over 70% of the members of these committees are women and the top two issues that the Village Panchayats seek to address include women’s health, safe delivery, anemia and water borne diseases.

Mahiti Trust has taken up another initiative in 2009 and that is intervention regarding awareness creation among single male industrial migrant workers. Gujarat State AIDS Control Society, Ahmedabad had given a targeted interventions program on HIV – AIDS with single male migrants coming from other states in Changodar industrial area, Sarkhej Chokdi and Sanand Chokdi (Chokdi is a Gujarati colloquial word for cross roads) areas as an implementing support agency. The organization was given responsibility of identifying the class of people having high risk behavior from industrial estate. The organization did not have much experience in this work but we have taken up this work from a long-term view point because Government of India and Government of Gujarat want to develop Bhal region as a Special Economic Zone and Special Investment Region. In such circumstances there may arise a need to carry out such work with workers coming to these SEZ area. Mahiti Trust should be equipped to handle such work. Moreover, quite a good number of people from Bhal region come to work as industrial labor in Changodar area and Mahiti Trust is concerned regarding the condition and if possible, to improve their condition. With this view Mahiti Trust got involved in this work.

During the study the organization realized that more than 5000 single male migrants coming from other states live in this area among which 65 % have high risk behavior. This study covered various aspects like profile of the area, socio economic profile, estimation of high-risk behaviors and its vulnerability, classification of target group, sexual network, awareness regarding HIV – AIDS, need for number of condom depots and also strategy for work under this project.

Changodar to Sarkhej is industrial area having 500 small and big industrial units manufacturing steel, medicines, plastic, chemicals, paper, tiles, and other such products. This are having been declared as industrial zone. Along with manufacturing units’ large storage godown are also there in the estates. Single male migrant laborers from Bihar, Rajsthan, Orrissa, Hariyana, Uttar Pradesh, Zarkhand state come here to work. Quite a number of patients suffering from health-related problems like skin diseases, water borne diseases, sexual transmitted diseases, joint pains, kidney stone, and especially hydrocele were found during the survey. Besides this living condition problem like water scarcity, sanitation problems, lack of education facilities for children of migrants living with their families, problem of having a ration card, identity card also were quite in abundance. Majority of make workers have migrated alone for work and many of them go for sexual relationship to sex workers. As they have no women in the house to look after them their residence clothes, lack of cleanliness. They usually do not get any living accommodation from their companies. Usually, four to five males stay together in rented accommodation. As a part of the program medical camps, HIV testing camp, street plays for HIV / AIDS awareness raising, stakeholder’s advocacy meetings are being organized along with condom demonstration programs.