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Dawa-Dua: How medical treatment complements prayer for people with mental illness in India

Varalakshmi Vemuru's picture
Devotees at Erwadi Dargah (Photo by DMPH Erwadi)
Devotees at the Erwadi Dargah in Tamil Nadu, India. (Photo: DMPH Erwadi)
Last month I blogged about how mental illness is curable, treatable, and preventable. Today, let me take you to a town in Tamil Nadu called Erwadi, where faith and medicine now go hand in hand to address mental illness.
 
Erwadi is known for its 550-year-old Badusha Nayagam Dargah—“Erwadi Dargah,” one of the biggest shrines in India. Every day, numerous devotees of different faiths visit the shrine from surrounding villages, states, and countries. Among these visitors is a large number of people who suffer from mental illness and have come to pray for a cure. Some of them see the Dargah as their first and only hope—guided by the magico-religious belief that illness is caused by the possession of evil spirits or the performance of wicked magic—while others have turned to the shrine as a last resort after receiving ineffective treatment.
 
When I visited Erwadi Dargah in 2013 and met with a team working on a local program called District Mental Health Project (DMHP), an important partner of the World Bank-supported Tamil Nadu Mental Health Project, they expressed an urgent need to help the devotees affected by mental illness. Their subsequent discussions with representatives of the shrine revealed a lack of information on potential treatment options and strong resistance to medical interventions among the devotees. At that time, the team knew of a similar circumstance in another part of India—the state of Gujarat—so they invited the representatives of Erwadi’s religious community to learn from peers in Gujarat about complementing religious rituals with medical treatment.
 
And thus started a unique experiment called “Dawa-Dua,” or prayer-treatment.

Against all odds - What is driving poverty reduction in Nepal?

SaileshTiwari's picture
Father and son
“Today is the happiest day in my life. I never thought my son would be going to a boarding school in the city.” - Tsering Tejaba, Sankhuwasabha (Photo Credit – Stories of Nepal)


The year 2015 was rough on Nepal. The catastrophic earthquakes that struck the country in April/May caused widespread destruction of life and property and was followed by disruptions in the south that brought cross-border trade with India to a complete standstill for 4 months. As dramatic as these recent shocks have been, Nepal is no stranger to conflict and fragility. A 10-year violent Maoist conflict ended in 2006 but the ensuing years of drafting a new constitution were turbulent; politics often dominating the discourse as opposed to economics. But despite these unfavorable odds, Nepal made rather surprising progress on improving living standards and reducing poverty.

Between 1995 and 2010, absolute poverty – measured as the proportion of people living below the national poverty line of Rs.19,261 per person per year – declined steadily by around 2.2 percentage points a year. This helped the country meet the MDG target of halving income poverty by 2015 quite comfortably. Living standards improvements were realized not just based on income or consumption but also along multidimensional measures of well-being that take into account access to essential services such as education, health and drinking water and sanitation. What was behind this progress on poverty reduction Nepal achieved amidst a violent conflict and a tumultuous post-conflict recovery?

Youth in Pakistan plug into digital jobs of the future

Anna O'Donnell's picture
Omer Ahsan, a program trainee who is now successfully freelanacing online as a professional content writer. Photo Credit/Waleed Abbas

Omer Ahsan is a chartered accountant in the making from Waziristan. He first heard about the Youth Employment Program, a free digital skills program offered by the Khyber Pakhtunkhwa Information Technology Board, from discussions on a group chat over Whatsapp, and applied immediately. Within two weeks of completing the digital skills program, Omer has built an online profile and has successfully earned money as a professional content writer.

Pakistan’s Khyber Pakhtunkhwa province is emerging from decades of instability and conflict, and would seem an unlikely place for digital workers to thrive. But with nearly 16 million youth in the province, and few available jobs locally, there is a pressing need to think outside the box in terms of equipping young people with the skills, knowledge and capabilities to take on the future.

In 2015, together with the World Bank, a series of pilot programs were conducted to test a model of digital skill training for youth. Growing connectivity, cloud technology, and the emergence of new business outsourcing models have lowered the barriers to entry for global employment, even for youth in remote parts of Pakistan. The key ingredients to accessing this employment: access to the internet, basic skills, and awareness, and the pilot program tested different approaches to supporting youth to develop online work skills.

Land records go digital in Punjab, Pakistan

Mary Lisbeth Gonzalez's picture

Pakistan land records

The Government of Punjab started computerization of rural Land Records with the overall objective to improve service delivery and to resolve the overall dispersed nature of land records. The transaction costs were very high for the poor during the old days of patwari system. Women were denied their land rights and the low mobility of land markets contributed to preserving the highly unequal distribution of land and, therefore, opportunities to improve people’s livelihoods.
 
Before the Land Records Management Information System (LRMIS) was set up, the Board of Revenue (BOR),​Government of Punjab, operated a land record maintenance system which involved several levels of administration: the district, Tehsil, Qanungo circle, and Patwar circle. At the lowest administrative level of the records system – the Patwar Circle – are the Patwaris, who were not only responsible for preparing community maps and issuing land records, but also for many social, political, and administrative tasks. Administrative tasks included keeping weather records, collecting crop harvest information, reporting crimes, and updating the voter registry. Imagine 8,000 Patwaris maintaining the land records – usually very small holdings -- of about 20 million land owners. The Patwaris, who were the custodians of these confidential and important records, kept this information in a cloth bag called Basta.
 
LRMIS has been performing really well. The Project was rolled out in all 36 districts of Punjab. The Project has successfully tested linkages between the land records system and the deeds registration system. The biggest achievement of the project is that the time required to complete transactions has been reduced from 2 months to 45 minutes. Land record services are now provided on an automated basis throughout all 150 Tehsil Service Centers. There are many contributing factors to the success of the Project:

“Teach a man to fish…” - Sustainable Solutions in Afghanistan’s Rural Economies

Mohammad Shafi Rahimi's picture
An Afghan woman uses her skills to make artificial flowers for sell. Photo Credit: Rumi Consultancy/ World Bank.

Earlier this year, I visited a meeting of a Village Savings and Loan Association in Doghabad village and was impressed with the confidence and leadership women showed. Addressing the association, Karimi, who is a member, said: “Do not wait for men to come and decide for you, be the makers of your own community.” She encouraged women to take an active role in the association’s weekly meetings, and come prepared with business proposals and requests for loans. Like Karimi, numerous individuals who have participated in the Afghanistan Enterprise Development Program (AREDP) programs act as inspirational leaders in mobilizing people and gaining trust in the program.

It’s possible to end poverty in South Asia

Annette Dixon's picture



October 17 is the international day to end poverty. There has been much progress toward this important milestone: the World Bank Group’s latest numbers show that since 1990 nearly 1.1 billion people have escaped extreme poverty. Between 2012 and 2013 alone, around 100 million people moved out of extreme poverty. That’s around a quarter of a million people every day. This is cause for optimism.
 
But extreme poverty and the wrenching circumstances that accompany it persist. Half the world's extreme poor now live in sub-Saharan Africa, and another third live in South Asia. Worldwide nearly 800 million people were still living on less than $1.90 a day in 2013, the latest year for which we have global numbers. Half of these are children. Most have nearly no education. Many of the world's poor are living in fragile and conflict afflicted countries. In a world in which so many have so much, it is unacceptable that so many have so little. 

Who is poor in Pakistan today? Raising the basic standard of well-being in a changing society

Ghazala Mansuri's picture
Photo credit: Visual News Associates / World Bank


Over 80 percent of Pakistanis consistently report that their economic wellbeing has either deteriorated or remained the same. Only 20 percent, disproportionately concentrated in the very top of the distribution, feel that they are better off and similarly small numbers believe that economic conditions have improved for their locality. If we took a poll today, it is possible that many of you would say that extreme poverty has risen rather than fallen.

But in fact, the national data tells a completely different story! According to the national poverty line set in 2001, Pakistan has seen an exceptional decline in poverty—falling from nearly 35 percent in 2001 to less than 10 percent by 2013-14. Moreover, these gains were not concentrated among those close to the poverty line. Even the poorest 5 percent of the population saw an improvement in living standards.

In Bangladesh, an experienced – yet struggling – worker becomes an entrepreneur

Tashmina Rahman's picture
Nikhil Chandra Roy, who received certification through the Skills and Training Enhancement Project (STEP),
Nikhil Chandra Roy, who received certification through the Skills and Training Enhancement Project (STEP),
Skills recognition is changing the lives of informal workers in Bangladesh

In 2014, Nikhil Chandra Roy was struggling to find and keep regular employment. He had extensive experience dating back to 1977, doing the work of an electrician. But because he had no formal training or certification, Nikhil couldn’t win the confidence of employers in Bangladesh to give him anything more than episodic, relatively low-paying work.

At age 55, just as he was giving up hope for career progress, Nikhil saw an advertisement that ended up turning his outlook and life around. The ad introduced him to the Recognition of Prior Learning (RPL) program, aimed especially at people like Nikhil, who have real skills and experience in a particular occupation but no formal, independently recognized qualifications.

Not long later, Nikhil participated in a three-day program, which entails one day of assessment and two days of training. That led to the recognition he had long awaited and needed to boost his career: a Government-endorsed skills certification from the Bangladesh Technical Education Board (BTEB) in electrical installation and maintenance.
 
A blog series to celebrate Bangladesh’s progress
toward #ProsperBangladesh 


“From that point on,” Nikhil said, “there was no looking back. With my years of experience, knowledge and now skills certification, I was ready to progress my career from just an electrician to an entrepreneur.

Nikhil was one of the many vulnerable informal sector workers in Bangladesh who have no regular jobs and who work on ad hoc opportunities, making it difficult to sustain livelihoods. These workers, with enough experience to perform the technical work well but not the credential many jobs require, improve their employability and bargaining power in job markets when they get the proper certification. And with that certification, workers gain social status in their communities.

The RPL program, which evaluates the skills level of workers and issues government certification to workers who pass an assessment, has operated since 2014 as a pilot activity under the Skills and Training Enhancement Project (STEP). STEP aims to give more Bangladeshis the technical skills they need to compete successfully in domestic and international labor markets.

The demand for RPL certification has been enormous. Since its inception, RPL has assessed more than 9,000 applicants from all over Bangladesh. Every month, RPL offers 600 applicants certification trainings in electrical installation and maintenance; IT support; block, boutique and screen printing; sewing machine operation; tailoring and dress making; motorcycle servicing; plumbing; and welding.

Mental illness is curable, treatable, and preventable: a story of hope from India

Varalakshmi Vemuru's picture
On World Mental Health Day, here’s a fact to reflect on: people with mental illness are among the socially excluded and marginalized groups in society. They are often misunderstood, ignored, or simply invisible.
 
In India alone, an estimated 70 million people—or 5% of the population—suffer from mental illness. The southern state of Tamil Nadu, for instance, has one million people living mental disorders—about 3-5 cases per village. Meanwhile, the country faces a severe shortage of psychiatrists and psychiatrist nurses, and clinical care is scarce in rural India. Due to deep social stigma related to mental illness, such serious issues are largely invisible at the community level.

That’s why, in 2012, we launched a comprehensive social and clinical care program with the government of Tamil Nadu to inform and educate local communities on mental health issues, as well as to encourage families and people affected by mental illness to seek treatment. Working with leading local health practitioners, we based the campaign on a core message that was simple, powerful, and resonated with the community:
   
Through a poster on do’s and don’ts of addressing mental illness, the campaign advised the community to
1) seek help from a psychiatrist, 2) start medication, 3) attend counseling sessions, and 4) join self-help groups. (Image: TNEPRP / World Bank)

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