I was lucky enough to spend a few weeks in November working at Manthan Kotri with another AIF Clinton Fellow, Denise, and luckier still to get to see the work of an organization that works so passionately on something close to my own heart, community-based and -led development for rural communities.
Manthan is perhaps best known for its efforts to address one of the biggest difficulties of the Sambhar Lake region: the intensely saline, fluoride-ridden ground water. People in the region, particularly members of marginalized and excluded communities, are reliant either on long walks to potable water sources, expensive water tankers whose contents are not necessarily potable, or hand pumps, which provide saline water and often break. A a result, a significant part of the population drinks saline, contaminated water, which leads to health effects such as skin lesions and bone deformities. Health effects are also widely visible in the people who flock to work in the salt flats of the region for a relatively steady wage, their feet and hands exposed to and deformed by the salt and heavy metals.
But the region faces other issues, which Manthan seeks to address through its plethora of programs: gender inequity, extremely limited electrical access, education barriers, families without shelter or blankets, poverty, and tremendous labor difficulties. These, as well as the difficulties of living in the salt flats, are felt particularly keenly by populations who are marginalized or stigmatized along axes such as caste or gender. For this reason, Manthan places particular importance on engaging with these communities, and their work is focused on Dalits, women, nomadic tribes, small farmers, and other communities facing particular barriers in having their basic needs met and rights ensured.
It is too easy to see here how social determinants of health function: on top of the physical effects of drinking and working in salt water, girls fall prey to infection during their menstrual cycles because they have little access to education about their own bodies, families in tremendous poverty risk their lives in the winter without homes and blankets, children get lifelong lung complications when dirty fuels are used for light and cooking, women risk assault walking to a field to relieve themselves, people who cannot find paying labor cannot afford to get food (much of which must be purchased and transported from Kishangarh or Roopangarh, because most crops will not grow in the salted land).
But what is equally visible is the necessity of health for enjoying other rights: how can someone who is ill labor long hours in the salt flats to support a family? How can children attend school if they are stricken with fevers and malnutrition? How can a woman make the long journey to a potable water source when she is unwell? Ill health further hinders the ability of marginalized, impoverished populations to enjoy other human rights–the right to labor, to education, to self-determination.
Manthan recognizes that health is a fundamental part of realizing the agency of individuals, families, and communities. Many people, within and outside of the field of development, see efforts to ensure health as the building and support of health facilities, distribution of medicine, and other efforts directly related to supporting and amending a healthcare system. In this sense, Manthan is not a health organization. But realizing the right to health, “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” especially for rural populations who are not well-reached by health systems, means addressing a plethora of determinants of health–education for children and adults, installing solar energy systems, building RO systems and water containers, involving local governance in community change–like Manthan’s programs do.
