A literacy program for women in China - the key to improving health
Case Study
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| Teacher's Notes | Student Activities |
| Introduction |
The literacy and health project seeks to improve the literacy of 600 women in Nandan County, China. By improving literacy, the project aims to increase awareness of maternal and child health issues. Part of this involves ensuring 300 of these women reach a level of literacy that will enable them to qualify for further health training. It is anticipated that the children of these women and approximately 3,000-4,000 households will benefit by having increased access to village health care workers in the future. The two year project is funded by the Australian Government's overseas aid program and designed and implemented by CARE International in China (managed by CARE Australia), in partnership with the All China Women's Federation. It is estimated to cost $265,756. Aside from this, a local contribution by project partners includes the costs for hire of the training venues.
| Background |
The program is being implemented in three townships of Nandan County, a mountainous and remote region of northwest Guangxi Zhuang Autonomous Region of Provincial China. Nandan County has a mixed population of 220,000, representing a range of ethnic groups; many of which are minority ethnic groups. The County is one of the poorest in China. There are enormous social problems as villages in the County are remote and inaccessible, often without electricity or safe water. While the local governments try very hard to access and direct funds to those in need, in many areas the education system remains poorly resourced and there are few health facilities. More than 90% of all women with children under five have been identified as being illiterate. This high rate of illiteracy and lack of access to health services are considered to be the major reason why women are not aware of healthy hygiene practices.
| The health situation |
Village women from several of these minority groups have high birth rates and high maternal, infant and child mortality rates. More than 50% of deaths result from poor and unhygienic birthing practices. Child tetanus mortality rates are high and there is no access to antenatal and postnatal care or to supervised hygienic deliveries. A high incidence of kinship marriages greatly increases the rate of inherited diseases, birth abnormalities and birth trauma.
Anemia, intestinal worms, diarrhoea and acute respiratory infections, particularly pneumonia are common childhood illnesses. Drinking water is rarely boiled as households often have only one cooking utensil and the villagers do not like the taste of boiled water. Infectious diseases are common due to a lack of immunization. There tends to be a reliance on 'spirit doctors' (traditional healers, similar to shamans, who exorcise evil spirits from people's bodies). The traditional healing methods of the spirit doctors bear little relation to traditional Chinese medicine and none to western science.
In Nandan County the Government health bureau and CARE operate training programs for 'barefoot doctors' (BFDs) or primary health care workers. Few women however have the opportunity to be involved as their low levels of literacy disqualifies them from the training. Therefore most of the BFDs working in the area are male and very few speak the language of these minority groups. The women tend to be very shy and private, and many refuse to seek treatment for women's health problems, especially reproductive health problems from the male health workers.
 Teacher with a student in a 'formal class' setting, Baixiu Township, Nandan County, China |
| Program description |
In order to determine the content and teaching materials needed for the program, a six week workshop with 12 adult educators from the Nandan County Health Bureau has been undertaken. Teaching techniques emphasising group work, practical language use, reading and conversation were encouraged. Simple arithmetic was also included to enable women who wished to become barefoot doctors to learn the required mathematical skills. The women participants were selected through a whole village participation process facilitated by the ACWF.
Six literacy courses consisting of five classes in each course are being conducted over a two year period. Women are able to attend the training at one of three township centres nearest to their home village. Each full course is conducted over a two month period with up to one hundred participants. The women are required to 'live in' for the duration of the course, to avoid having to walk for several hours each day to attend the course.
 Some students in a 'formal class' setting, Baixiu Township, Nandan County, China |
Classes do not operate during the peak farming season (end of January - early March) as most women needed to tend their farms during this time. During the course, the suitability of the course content and teaching methods are evaluated and modified as necessary. Environmental safeguards are also included in the program such as the safe disposal of syringes, medicines and other medical wastes.
By increasing the literacy levels of women it is anticipated that their knowledge of personal and family hygiene will increase and the women and children in the villages will benefit from increased availability of health care knowledge and services. The number of children being vaccinated against infectious diseases will also increase and there will be more pregnant women seeking assistance from the barefoot doctors for child birth. By increasing the number of women eligible to become barefoot doctors, it empowers the role and raises the status of women within their communities, which in turn contributes to the economic advancement of women. While men were excluded from the program due to cultural considerations, they will benefit from the promotion of health related messages and increased availability of barefoot doctors.
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