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In 1997, flooding in North and Central Gujarat districts of India was immediately followed by Falciparum Malaria. The most common impacts on affected communities were loss of livelihood and malnourishment. The burden of health and family care fell on women, even as they suffered themselves. Up to 100 deaths were acknowledged by the Government of Gujarat while local women's organizations estimated 400 dead.

To combat the epidemic, help from NGOs was requested by the Government of Gujarat. DMI coordinated relief efforts with women's groups: Banaskantha DWCRA Mahila SEWA Association (BDMSA), Ahmedabad Women's Action Group (AWAG) and Grama Shakti Shramajeevini Sangathana (GRASS). Preliminary needs assessments in the communities were initiated by the women. Arrangements were then made to meet basic relief requirements of nutrition and medicine. Livelihood relief did not attract any donors' attention. Though somewhat late, the Government machinery also geared up, and the epidemic's spread was checked.

The relief operations that reached about 11,000 malaria victim families explored ways of building NGO-to-NGO, victim-to-victim and Government-to-NGO links. It was one of the first initiatives where women had a say in relief distribution and supplies, highlighting issues of acute malnutrition, lack of adequate medical infrastructure and need for better preparedness. More importantly the role of women in health emergencies increased many-fold. The experience proved to be a capacity-building exercise for both relief recipients and workers, as well as these women's organizations.

In April 1998, DMI conducted a participatory evaluation writing session for the malaria victims to review the NGOs' relief operation. Those who could not write teamed up with those who could. The main objectives were to audit the management of malaria relief from the viewpoints of victims and NGO volunteers, and to get their feedback on the operation.

Women from three categories were invited: victims, those who experienced family deaths and NGO volunteers who distributed relief. DMI prepared and distributed a manual containing sections for each category. Based on their experiences, they filled in information on reasons for the epidemic, responsibility for its occurrence, importance of relief, relief requirements, role of women, level of coordination between GOs and NGOs, indicators of performance, impacts, selection of beneficiaries, duration of illness and effectiveness of the relief operation.

The majority of participants said that government negligence was responsible for the epidemic's relapse. However, they also felt that community members themselves were equally responsible as many neither took medicine regularly nor finished the required course. The major impacts of malaria, according to the participants, were on income, health and eating habits. The family, health and work responsibilities of the women increased many-fold during the epidemic.

The all-women NGOs reached about 75-100% of the victims in the relief distribution. NGO relief was more effective as NGOs, unlike the government, had devised a pre-planned women-led distribution methodology. The NGO relief provided victims with nutritious food to help them withstand high doses of medicine and increase their ability to cope with the epidemic. The health recovery and increased ability to earn and repay debt were long-term benefits of the relief. Coordination between GOs and NGOs was moderate. Officials did not take women seriously as lead relief workers. Bottlenecks or limiting factors included unsuitable amounts of relief grant, difficulties in documentation and inability to provide relief during the relapse period. Participants suggested that the government and NGOs increase the effectiveness of malaria relief through planned distribution, operational flexibility and gender audit.

The lessons from this account indicate the need to employ appropriate techniques to ensure the benefits of relief operations reaching women, and to get feedback that makes relief more effective from women's viewpoints.

-- Madhavi M. Ariyabandu, ITDG, South Asia