ASHWINI

Annual Report 2002

1.0 Introduction

The year 2002 has been very eventful for ASHWINI. It has been a year of serious introspection and reflection on our progress, a year in which we debated our achievements and strengths in detail, analysed the unfulfilled tasks and finalised the focus of our work for the coming years. We did this throughout the year through numerous meetings in which the health staff, animators of AMS, the professionals associated with ACCORD and our friends from our present Donors (Paul Hamlyn Foundation, Skillshare International and Sir Ratan Tata Trust) participated. Today, we are clearer in many of the nitty-gritty details of our programme, particularly with respect to the issues of the community health programme, financial sustainability and tribal management. This has been possible only due to the contributions of many people mentioned above. At the outset, we would like to thank everyone for having been active partners in this unique health care programme of the adivasis in Gudalur.

The strengths of our health care system are the community-centred approach, the stress on training local people and improving the awareness of the community and providing good quality health care, which is accessible and affordable to the tribals, with the focus being on sustainability and management by the tribals themselves. When the various health care models were analysed during our year-long review process, we realised that this model is quite unique, effective and truly comprehensive. This system has been built by a collective effort of lots of people over the past 10 years through constant reflection on the needs of the people and the gaps in our services. In the process, we have managed to successfully address many of the health problems of one of the most neglected communities of the country. Today, the indicators of the health status of the tribal community in Gudalur have shown significant improvement, often bettering the national averages.

The year started positively with the financial support of Paul Hamlyn Foundation, U.K., for a period of three years from January 2002. After having gone through three years without assured funding, it was a very welcome change and we could plan our activities on a more sound footing. The thrust area of the community health programme may vary according to the needs and health problems of the community. However, we feel that we should continue our intensive interaction with the adivasis in the villages on a one-to-one basis for some time to come. If we wish to consolidate the gains achieved in the past decade and to ensure that the changes brought about by our work in adivasi villages is not reversible, then we ought to have structured programmes and mechanisms to sustain this movement. This has to be the broad focus of our work for the next three years or so, and this was one of the major thrusts identified by us during the last one year. We would like to present the report of the activities during 2002 in this background.

2.0 The Community Health Programme

Spreading health awareness and training on specific health inputs got sustained momentum during this year with the involvement of Drs. Bharat and Deepa Gadhvi with the Health Animators and village health guides / volunteers. During the course of the year, the emphasis of the training programmes has, in fact, shifted from the Health Animators to these health guides and volunteers. This is explained in more detail in sections 2.4 and 2.9.

2.1 Antenatal Care

Number of pregnant women registered	470
Total number of deliveries	303
Number of women who had 3 check-ups	244	80.5%
Number of women who received complete immunisation	262	86.5%
Normal deliveries	276	90%
Stillbirths	7
Caesarian sections	10
Hospital deliveries	136	45%
Neonatal deaths ( 0-28 days )	5

The number of women who registered for antenatal care increased by 15% compared to the last year. This may have been due to the increased efforts of the Health Animators to detect pregnant women earlier. The high percentage of normal deliveries is, in part, a reflection on the effectiveness of the antenatal care provided. 45% of all deliveries were conducted in the hospital. The neonatal deaths have come down from seven last year to five this year. However, 41 pregnant women did not get full immunisation and 59 women did not get at least three antenatal check-ups, because:

• Government nurses do not visit some villages regularly.
• Some women are registered only at the 8th or 9th month of pregnancy, or indeed, are not registered until after delivery, so they did not get full antenatal care.
• Some women do not yet have adequate knowledge about the importance of good antenatal care and have not received appropriate advice.
• Some villages are very far away, hence the women of such villages did not receive immunisation and antenatal care.
• Some women become pregnant before marriage and are ashamed, so they did not come for immunisation or antenatal checks.
• Some women are afraid of immunisation.

2.2 Immunisation of children under 5

We have worked hard to make sure our immunisation recording systems are good, since we identified this as a reason for lower coverage figures in previous years. We have also not seen any recent acute cases of illnesses such as polio, pertussis or tetanus. Such illnesses presented to the hospital regularly when our work first started. We are pleased with this generally high level of coverage but have set ourselves a target of 90% primary and full immunisation coverage for the coming year.

2.3 Growth Monitoring of Children

 

Health animator Janaki is seen talking to two young mothers in a Kattunaickan village called Yellamalai, deep in the forest. She is explaining to them that their children are badly malnourished and thus are more prone to serious illnesses. She explains what locally available cheap foods can be given to them to improve their nutritional status.

   

Total number of children weighed	1225
Number of children weighed 6 or more times	789	64%
Number of children weighed less than 6 times	436	36%
Children of normal weight	399	32.5%
Grade I Malnutrition	447	36.5%
Grade II Malnutrition	329	26.9%
Grade III Malnutrition	50	4.1%

The percentage of children who are suffering from grade III malnutrition dropped from 4.6% (last year) to 4.1% this year. Nevertheless, more than 30% of children remain grade II and grade III malnourished. In addition, malnutrition among pregnant women and the elderly and disabled remains a significant problem and is a reflection on the poor economic situation of tribals in the Nilgiris at present.

We have been distributing, and will continue to distribute ragi to severely malnourished children and adults. In Devarshola area, with the help of the team, ragi seeds for planting were given to 45 families, in an effort to improve the nutritional status of the local tribal children. We hope to repeat this in other areas. For the coming year we have devised a comprehensive grade 3 malnourished children’s register to be updated and analysed every month. For each child we will look into the specific reasons for being underweight, since by understanding the causes, we can plan appropriate interventions for each case. Reasons might include the following:

• Some underweight children may, in fact, have TB.
• Since there are more than 4 or 5 children in some houses, they do not all get adequate nutrition.
• Since some parents are unemployed, the children do not get good food.
• Since some parents are themselves only very young, they may not have good knowledge about nutrition and hence their children may be underweight.
• The birthweight of some children is very low.
• Some parents go to work leaving the small children at the care of older siblings or village elders.
• In the case of some malnourished children one parent may have died.

2.4 Training of Health Staff / Volunteers

Number of Health Animators in the eight areas	13
Training sessions for the health animators	21

We have adapted our training for the Health animators to include some of the newer emerging health problems identified, such as diabetes, hypertension, mental illnesses and Hepatitis B. We have also had refresher sessions on important topics such as antenatal care and diarrhoeal diseases. The Health animators had a full day workshop on drama skills, as village health education and training of others often involves the use of role-play and skits. Occasionally, we have taken opportunities to give the Health animators some clinical bedside teaching in the hospital. In addition, we have spent a great deal of time talking as a group about our reporting systems, planning and evaluation.

Number of health guides	148
Number of youth volunteers	250
Number of training sessions for them	73
Number of villages represented	93

Our longer-term aim is to have a trained individual in each village responsible for health problems. They would work on a voluntary basis, supporting the present Health animators. In the coming few months we have planned to bring back our old village health workers, who were trained when our community health programme first started during the late 1980’s, as well as holding more training camps for the newer village health guides / volunteers.

2.5 Health Education

 

Health Education sessions during village visits	1220
Evening health Education sessions conducted in villages after properly planning and assembling 50-60 people	46
Health Education sessions for school children	61

During this year we emphasised the importance of educating school age children with some basic health messages, regarding, for example, hygiene, diarrhoeal illnesses, scabies and TB. As a result, there was a rise in the number of education sessions for school children (from 19 last year to 61 this year). These sessions were held at various venues, such as in schools, subcentres or in the villages themselves. In Devala area, the team decided this would be a regular activity, and twice a month, on their school leave day, they gathered around 15-20 school-age children at the subcentre for a health class and other educational activities and games.

2.6 Village Visits / Sub-Centre Work

Total number of villages covered	210
Number of village visits by Health animators	1420

Our team is now visiting 210 villages, as compared with 204 last year, as some areas have begun to expand their work to other villages which we had not previously been visiting. On average, in each area, our Health animators visit around 15 villages per month, meaning that they cover all the villages in that area every 1-2 months, depending on the area’s size.

 

Outpatients
Number of patients seen in the sub-centres	5635
Number of patients seen in the villages	2289
Amount collected in the sub-centres	Rs.11,257
Number of patients referred to the hospital	166

Subcentre utilisation has increased from around 4800 to over 5600 patients seen over the past year. We have done an area-wise analysis of the amount of money generated from subcentre outpatients and discussed how we can improve on this over the coming year. We hope to define targets for each area, with regard to insurance premium collection and money collected when people are seen by our Health animators at the subcentres and in villages.

2.7 Family Planning Activities

 

Number of eligible couples in sangam villages	1216
Number of people using Family Planning methods	252

Subcentre utilisation has increased from around 4800 to over 5600 patients seen over the past year. We have done an area-wise analysis of the amount of money generated from subcentre outpatients and discussed how we can improve on this over the coming year. We hope to define targets for each area, with regard to insurance premium collection and money collected when people are seen by our Health animators at the subcentres and in villages.

2.8 Chronic Patients

In our sangam villages we have identified 283 patients with chronic illnesses, such as diabetes, hypertension, heart disease and mental illness. Such people require long term regular medication, closer monitoring and sustained inputs to ensure treatment compliance so that they do not develop complications. Such conditions are being seen much more now than in previous years. Our Health animators keep individualised “chronic cards” for such people, so as to ensure regular monitoring. By training more village-based health workers we aim to have resource people in each village who can carry out this kind of surveillance.

2.9 Deaths

Total number of deaths	123
Neonatal deaths	5
Infant deaths	8
Deaths aged 1 to 5 years	5
Deaths above 5 years	105

The number of deaths increased from 113 last year to 123 this year. Whilst neonatal deaths, infant and child deaths fell, deaths of people above age 5 rose this year from 89 to 105. Main causes of death among adults included suicide (often associated with mental illness), stroke (secondary to uncontrolled hypertension) and cancer (primarily smoking-related). We have thus targeted mental illness, the importance of taking regular medicines for chronic illnesses and smoking as core issues for future health promotion activities.

2.10 Other Important Events

13 cents for 13 villages Adivasis from Verkadavu and several surrounding villages would walk upto 10 km to access medicines. In addition, village youth and children had no real community meeting place. ACCORD and AMS approached Verkadavu’s sangam leader, Kutty, to discuss this problem and find a solution. Collectively, the village gave 13 cents of land and youth members helped construct an area centre. Tribals from 13 villages can now access medicines twice a week whilst youth and school children finally have a meeting place.

• In Srimadurai area, screening for Sickle Cell Anaemia was done in two villages and one patient was identified.
• Health animators Bindhu, Lakshmi and Shanti, and hospital nurse Sita all had new babies!

2.11 What Next? The Future of the Community Health Programme

In the month of November, all the health staff met in Gudalur for a day to discuss the outcome of the Insurance study (described in more detail below) and to deliberate on the focus of the community health programme in the coming years. It was agreed that we have achieved significant success with respect to the health status of the adivasi community due to our sustained efforts in the last 10 years. Particularly, the maternal deaths have been almost eliminated and infant mortality rate has also been reduced considerably. The indicators of the immunisation status, health awareness in the villages, prevention of illnesses at the village level itself, care of patients with chronic illnesses and communicable diseases etc. are quite healthy and we can take heart in the progress made by the adivasi community.

However, there are some areas of concern still persisting. First of all, the intervention that has been made over the years cannot yet be considered to have reached a stage of sustainability and there is a danger that some of the indicators mentioned above may fall back if we lessen our concerted efforts. Second, we have not yet addressed the problems of malnutrition, smoking and alcoholism successfully, even though we are making efforts in this direction. Combined with the slump in the local economy and shift to cash crops, these indicators point to a dangerous trend. So, the team felt that we have to put our renewed attention in these sectors in the coming years.

In short, it was agreed that the focus of the community health programme in the coming years has to be in increasing health awareness in the villages, encouraging people to take responsibility for their health and welfare and accessing health care when needed. More organised training sessions for the village health guides, volunteers, and adivasi boys and girls will be conducted either in the area centres or in Gudalur to raise the level of consciousness of the community on these issues. The Health Animators and the Area Teams need to play a major role in identifying suitable people in the villages and in coordinating these training sessions. The Doctors at Gudalur Adivasi Hospital can play the role of resource persons.

3.0 Gudalur Adivasi Hospital

Our 20-bedded Gudalur Adivasi Hospital is the First Referral Unit for our comprehensive health care system. This is not only an important element of the health care system providing emergency hospital care to the patients, but has also been functioning as a Resource and Training Centre for the Health Animators and other health volunteers.

We were very fortunate to have a number of doctors during this year. Dr Gail Webber, a GP from Canada finished her one year stint with us in April. We were very happy to have Dr.Mridula join us in 2002 and Dr.Ravi, a young doctor from Bangalore spent three months at GAH. His brief stint with us has motivated this young doctor to plunge head along into the Community Health field and he is currently working with Tribal Health Initiative, (a Public Charitable Trust working with the tribals of Dharmapuri district in Tamil Nadu). In addition, Ms.Suni, a non-tribal staff nurse also joined the team in the hospital this year. The training of the Nurse Trainees continued throughout the year. The senior nurses and the doctors take theory classes for the students regularly, and they are given regular duty schedules in the hospital along with senior nurses.

Despite the disruption caused by the construction activities in the hospital, the total number of inpatients treated during 2002 was almost the same as that of last year. The utilisation of the hospital services by the adivasis, particularly the premium paid sangam members is also significant. The other statistics related to the hospital activities are given in the following table.

 

INPATIENTS
Total number of patients admitted as inpatients	901
Number of Tribal Patients [IP]	797	88%
Number of Non-Tribal Patients [IP]	104	12%
Number of Tribal Patients who are AMS members	716	90%
Number of Tribal Patients who had paid Insurance premium	587	74%
Total number of deliveries conducted in the hospital	157
Number of deliveries (tribal women)	129	82%
Number of deliveries (non-tribal women)	28	18%
Total number of surgeries performed in the hospital	122
Number of surgeries (tribals)	80	66%
Number of surgeries (non-tribals)	42	34%
OUTPATIENTS
Total number of patients treated as outpatients	8261
Number of Tribal Patients [OP]	4177	51%
Number of Non-Tribal Patients [OP]	4084	49%

During the year, we have made significant improvements in our data management and administrative systems. Though we had already computerised the inpatient details, we have designed some interesting reporting formats during the year 2002 to analyse these data with the field health staff. It was heartening when a consultant from BASIX, Hyderabad, congratulated us on having an organised way of collecting the data and possessing a ‘wealth of information’ on the health interventions.

Besides the routine activities, there were some significant events in the Gudalur Adivasi Hospital. Some of these activities have already been explained in our six monthly report sent earlier. Just to recollect, we are describing them here briefly.

Dental Clinics : The hospital has been continuing the dental clinics with the assistance of the dental surgeon, Dr.Venkatesh, who visits every Friday. Since this programme has been continuing on a regular basis, we are able to address the oral health needs of the tribals and the local population effectively.

ENT Clinics : Dr.Ramesh, though at present working with St.John’s Medical College, Bangalore, visits our hospital once in a month on a voluntary basis. Since the dates of his visit are fixed in advance, it is advertised and coordinated in such a way that the maximum number of patients get benefited from his visit.

Mental Health Activities : We have made important interventions concerning the mental health problems of the tribal community in some villages with the help of Dr.Seetha, a Psychiatrist from Bangalore, during the first seven months of this year. Dr.Seetha visited the tribal villages and treated the patients identified by the Health Animators to have a possible mental illness. Having a qualified Psychiatrist made a tremendous difference in many of these cases and for us, it was a miracle that some of the patients that had been almost abandoned could lead normal lives again.

Awareness about AIDS : We coordinated a special programme to create awareness about AIDS in the adivasi villages with the help of Dr. Amar Fettle, a pioneer in the Anti-AIDS Campaign in Kerala, and Dr.P.G.Premila, a previous health trainer and good friend of ASHWINI and ACCORD. The duo conducted six sessions in six centres, where the adivasi youth from the nearby villages had been assembled by the Health Animators. It is quite amazing that we have not yet detected any tribal patient in our hospital testing HIV-positive. However, the vigil must continue in the future, and we must particularly target the younger generation – especially as the unemployment issue is prompting more young people to venture beyond the local area as migrant labourers.

Government TB Control Programme : During this year we have been successfully undertaking the Tuberculosis Control Programme with the help of the State Government of Tamil Nadu. We received a grant of Rs.50,000 from the State Government for this programme, with which we purchased medicines and laboratory materials for diagnosing TB patients. This programme has helped many patients, since their hospitalisation expenses were subsidized. In addition, this will have an impact in the health of the community if we can effectively control this serious communicable disease. This year, 52 patients were identified to have Tuberculosis and started the treatment regimen.

Diabetes Control Programme : We have constituted a Diabetic Fund with the financial assistance of Charities Adivisory Trust, U.K. The interest from this Fund has been used towards the treatment charges of tribal diabetic patients free of cost. This year, 23 tribal patients were diagnosed with Diabetes and were treated in the hospital. Besides this, there were many non-tribal diabetic patients who were treated both in the outpatients and as hospital inpatients.

Training health staff of another NGO : Health Auxiliaries of Tribal Health Initiative (THI), Sittilingi visited us in May to learn from our experience. Our health animators met with them, took them to some of our tribal villages and explained the concept of our health programme. The visit was a motivating experience for these tribal health workers from THI .

 

Accessing Health Care from interior forest villages Shanthi, a Paniya woman of about 16 or 17 years of age from Mandakkara, a village 5 miles inside the Mudumalai wildlife sanctuary, walked into the Gudalur Adivasi Hospital with her one week old baby. She had high fever from a huge breast abscess and she had walked 5 miles to reach the nearest town and taken a bus to the hospital. Antibiotics and drainage of the pus soon cured her illness. It was heartening to see the effort taken by this young girl to get medical care. A decade ago, this would have been an impossible even to think of such an initiative for many adivasis in this region. Today, since the credibility of the health care system and the faith of the adivasis in the hospital firmly established, it is a welcome change that even people from interior areas are also accessing health care immediately.

Health volunteer from Arunachal Pradesh : Mr. Phyoosa is a young tribal social worker from a remote adivasi area of Arunachal Pradesh. The inaccessibility of that area is a major hurdle for his people and reaching health care from outside is almost impossible in light of the huge distances involved. So he decided to learn some basic medical skills personally and contacted us. He and his wife, Daki, are currently with us in Gudalur, and are spending four months in the hospital and community health work to learn the basic elements of primary health care.

Patients’ Mess in the Hospital : It is a well known fact that hospitalisation expenses are one of the critical reasons for the indebtedness among the poor and rural population. Besides the medicine costs, the incidental expenses for transporting the patients and the food expenses of the patients / by-standers is also a significant amount and causes a major drain on the people. We have been running a mess in the hospital premises providing food at economical rates to the patients. There were some people who could not afford even these costs and thus we have mobilised some funds to subsidise the food expenses for such needy patients. This step is also in line with our motive to remove many of the hurdles in the health seeking behaviour of the tribals.

4.0 Insurance Programme

There were many developments this year in our Insurance programme front. In July 2002, Sir Ratan Tata Trust, Mumbai sanctioned a project to be a partner of ASHWINI in this health insurance programme and has agreed to extend financial assistance to ASHWINI towards covering the costs of premium and some administrative expenses. However, when the policy got expired in March 2002, the New India Assurance Company had indicated that they could not continue the scheme under the present terms. Our efforts to renew the policy have not been fruitful, primarily due to the policy changes in the insurance sector at national level. Meanwhile, a detailed study was proposed as part of the Tata Trust funded project to critically review the present insurance scheme and to evolve a suitable insurance scheme for ASHWINI. This study was conducted by four external consulants with experience in the fields of Health Financing, Actuarials, Community Health Care & Insurance and Health Policies. They were :

• Dr.N.Devadasan, National Professional Officer, WHO, New Delhi.
• Prof.Sanjiv Phansalkar, Management Consultant, Nagpur.
• Mr.D.Sattaiah, BASIX, Hyderabad
• Mr.Sunil Nandraj, National Professional Officer, WHO, New Delhi.

Besides the above people, Ms.Vartika Jaini of Sir Ratan Tata Trust and the senior staff of ASHWINI and ACCORD participated in this study conducted in the second week of October 2002. The major findings of this study were as follows:

• It is clear that as the community healthcare programme is essentially a welfare programme, the financial support for it must come from a welfare-oriented donor, or from the community itself.
• The outpatient costs need to be fully met. Currently there is a significant subsidy involved in the OP charges.
• Even non-tribals served in GAH are basically persons with limited means and include some very poor people. Nevertheless, in remaining consistent with ASHWINI’s desire to serve the underserved, there may be merit in examining the feasibility of raising the outpatient charges to reduce the burden of subsidy.
• When the cost of inpatients (about Rs. 6.4 lakhs) is apportioned over the 12,000 AMS members who are expected to benefit from the scheme, the per member cost comes to about Rs. 53 or so. If it were possible to obtain an insurance cover from any insurer at a premium rate less than this value that can cover the full cost of inpatients, then ASHWINI should sign such an arrangement. It is clear, however, that insurers will not want claims to exceed premium payment on a continuing basis. Thus, insuring with an external insurance agency would be a tactical arrangement worth entering into only because it helps ASHWINI reduce the total cost of health care.
• Nothing contained above detracts from the possibility and continuing need for mutual insurance arrangement among tribal members of the AMS. Whilst overall the community looks after itself, there is every merit in striving to put in place durable arrangements by which community members look after each other’s health care expenses through a mutual insurance arrangement. The basic logic is, that whilst approximately 5% of people are bound to fall sick and need hospital care each year, for a specific tribal family the need is only a matter of ill luck. Thus if each family pays a certain sum, then the sum total of the contributions may meet a large part of the total hospitalisation cost for those who need it.
• Therefore, what is needed is a combination of a strong and well designed mutual insurance scheme strengthened by reinsurance for ASHWINI to cover low-probability, high cost treatments. The latter may be chosen from among all options in such a manner that the ratio of premium payments to claims is optimal for ASHWINI.

Subsequently, we have contacted insurance companies such as Royal Sundaram and Oriental Insurance company, besides the New India Assurance Company in order to design a suitable package for the sangam members of AMS. If this tie-up is possible, we may continue this scheme with an external insurer. Otherwise, we will have to start a mutual insurance scheme whereby each tribal pays a premium to be decided by the AMS and the balance medical cost is sought to be met out of donor funds. Essentially, this will amount to partial cost recovery. Charges, particularly for non-tribals may be fine-tuned to eliminate all subsidies to them, without significantly changing the policy of keeping GAH as a tribal hospital.

This study has helped clarify many issues involving our health insurance programme. Significantly, it has helped to look at the programme holistically, along with the expenses of the entire health programme. We have already started exploring the various possibilities mentioned above and have started sharing the financial details of the health programme with the sangam members through our Health Animators and the sangam animators. For example, we have prepared the costs incurred by us on the inpatients and the amount paid by them for the year 2002. This data has been presented in the form of village-wise graphs for all the eight Areas individually. Besides this, area-wise meetings were conducted in seven Areas in December 2002 to assist the Area Teams to identify the health priorities of their villages and explain the various issues concerning the health insurance programme.

We hope that this effort of making the sangam leaders and members aware of the financial details of the health programme will help motivate them to participate in the programme with their contributions, financial or otherwise.

5.0 Exposure Visits

We feel it is important that our health team has an exposure to other projects and work carried out by other voluntary organisations. An exposure visit serves many important functions; as a team-building exercise, it gives our team new ideas and impetus and it helps them to realise the importance and value of the work they themselves are doing.

This year, with the support of one of our other partners, Skillshare International, we took 2 teams, comprising of health animators, nurses, nurse trainees, doctors, office and other health staff, children and all, on 2 separate exposure trips. The first trip was to see the work of an organisation called Grameena Mahila Okkutta (supported by Gram Vikas), working with womens’ sangams in Kolar, Karnataka and Tribal Health Initiative, a health project working with adivasis in Sittilingi, Dharmapuri district of Tamil Nadu. The second batch visited Pondicherry, and the medical teaching hospital JIPMER. In addition, they saw the work of another health project in Auroville and G.R.R.C. (Gandhi Rural Rehabilitation Centre), Alampundy, which works with in disability, rehabilitation and herbal medicines.

6.0 Building Construction

We have managed to successfully complete the long-awaited construction, modification and repair work in the hospital building. The Gudalur Adivasi Hospital is being run in the premises of ACCORD since early 1997. Previously, though the condition of the wards and the office declined, we could not allocate adequate resources towards maintenance due to severe financial constraints.

During this year, we were able to raise the required funds from some of our friends and took up a massive exercise of renovating the buildings, partitioning the rooms to suit the hospital operations and adding a new hall to accommodate the office needs. Besides this, we built a proper room for the Balwadi – a creche / ‘day-care centre’ for the children of the Nurses and other staff. This is a tremendous help for the nurses, allowing them to concentrate on their work and not worry about their children. The new-look hospital, with its compact wards and proper pharmacy area is more patient-friendly and more conducive to the Gudalur climate, particularly during the monsoons and winter.

7.0 Conclusion

In short, the year 2002 has been an important year in our work. There were many positive developments and some significant policy decisions taken. There were two new partnerships, due to which we already feel enriched. We have identified the unfulfilled tasks and drawn up plans for the coming years. We are hopeful that we will be able to reach our goals with the continued cooperation of all our partners in the coming years.