01 Apr 2015 - 30 Mar 2016
01 Apr 2015 - 30 Mar 2016
Bihar is one of the poorest states of India. With an unfavourable Human Development Index, the health infrastructure in the state is in shambles. Gross deficiency of physical and human resources only adds to the people’s woes. Large number of posts of Medical Officers, Specialists and front line health workers has been vacant for last several years. Poverty, migration, illiteracy, poor health delivery system makes people vulnerable to illness. There are 8,858 Health Sub centres (HSCs) in the state instead of the sanctioned 14,959 HSCs.
Bihar has only 530 Primary Health Centres (PHCs); whereas it should have 2489 HCs. Those excluded do not get any benefits promised under government schemes like Janani Suraksha Yojana (JSY) at many places. Distance and cost involved in accessing these facilities nullify any benefit they are likely to receive. Acute shortage of Referral Hospitals/ Community Health Centres (CHCs) has adversely affected the accessibility of services. There are only 70 CHCs in the entire state.
The project is located in two blocks of Patna district. According to the Annual Health Survey (AHS) the sex ratio at birth of rural Patna is 903 as compared to 919 of rural Bihar. A majority of Muslims and Dalits in the district fall under the lowest two quintiles of wealth index. Sizable section of Muslims and Scheduled Castes are poor and a substantial number of them are landless labourers and artisans.
Government health services have failed to reach most Muslims and Dalits in the district. The consumption of IFA tablets by the Muslim and Dalits was abysmally low and the women were subjected to unfriendly behaviour by health and Integrated Child Development Service (ICDS) providers. Many a times SC and Muslim women are not included in the list of beneficiaries of Angan Wadi Centres (AWCs). Even when included they are denied the supplementary nutrition.
The project aims to enhance the uptake of health and nutrition entitlements by Dalits, Muslims and women and to strengthen demand for improved delivery of health and nutrition services. The project plans to:
•Assess determinants of social exclusion that impedes accessibility of basic health and nutrition services.
•Organise, develop capacity and increase the awareness amongst Dalits and Muslims towards their rights and entitlement to basic services.
•Sensitisation of opinion leaders, policy makers and media about discrimination faced by Dalits and Muslims in accessing services and benefits.
•Advocacy with administration to make them pro-active in delivering basic services to Dalits and Muslims, in order to reduce maternal and infant mortality and raise nutritional status of children.
•Strengthening of community processes, Village Health & Sanitation Committees and Rogi Kalayan Samitis, under NRHM for community based monitoring.
These achievements were due to CHARM work in the project area with a set of strategies. The project facilitated the formation of Community Bases Organisations (CBOs), Nari Sabha/Khatoon Majlis; Kishori Mandal/Dosheeza Majlis, and empowered them on their health rights and entitlements. CHARM worked with RKS, VHSNCs towards better functioning. Public dialogues at PHCs were held; this helped establish accountability of service providers towards the community and brought improvement in governance. The project also raised awareness of the community on health seeking behaviour with the help of a flip book. Field visits by high ranking officials, especially from Planning Commission and National health Mission, facilitated by CHARM, in the project area also helped them in doing better advocacy with block, district and state level health functionaries. Building evidence through CBMDR and its sharing with the government officials and policy makers also paved the way for improvement in health services. Team CHARM was able to push holding of CBMDR in eight hot spot districts of Bihar and got it incorporated in PIP of state Health Society, Bihar for the year 2014-15. Although, the state is yet to implement the same in the state, organization along with JSA has been pushing the state on a regular basis.
•67% eligible women receive benefits under JSY.
•76% deliveries are institutionalised.
•90% of children between 12 to 23 months are fully immunised.
•60% of households use government health facilities.
•Reduction in malnutrition of children 0-2 years by 45%.
•100% eligible and lactating women receiving supplementary nutrition from AWC.
•25% increased access to ANC services & 10% increased access to PNC services.
•Community-based monitoring has improved; 40% increase in better functioning of VHSC; 100% RKS functioning improved; a Public dialogue on health services was held in both PHCs.
•A meeting with legislators from all political parties was held and citizen’s charter on health shared; legislators promised to support implementation of health rights.
•The utilisation of untied fund through VHSNCs has shown a remarkable improvement. The PRI members and members of the communities with support from project staffs are involved in the process.
•The project has been able to engage with service providers meaningfully to enhance the coverage of underserved area.
•CHARM has been associated with other networks as well. They are part of Right to Food Campaign in Bihar. They also made a visit to Saharsa after a hunger death and successfully exposed the false claim of the government that it was an illness related death. CHARM was also instrumental in suggesting the government through Governor of Bihar that a SOP should be developed for Mid Day Meal at schools after the tragic death of students in a school of Saran district.
•On the PIL filed by CHARM in Patna High Court on improving maternal health in Munger district, the bench has ordered District Judge to visit the health facilities in the area and report to the High court on the status of maternal health services.
•CHARM is on the core committees on preventive health and integrated health policy of Government of Bihar.
Quotes of Beneficiaries:
“Girls should be sent to school and should not get married at a tender age. Hygiene should be maintained at house and community level” Shabnam Khatoon, represents her Khatoon Majlis (women’s group) in the Federation of Khatoon Majlis formed at block level now.
Case Studies/Human stories:
Shabnam khatoon W/O Md Akaber Ansari, resident of Isopur Nahar village, age- 32, lives with 14 members of her family. Her husband is mason and she depends on daily wages earned by husband. She belongs to an orthodox Muslim family.
Her house is made up of plastics and sacks. There are 14 members live in the small house and her living condition is pitiable. Her husband drinks and abuses on daily basis. She used to tolerate all the difficulties given by husband. She was unaware about the government services and programmes. One of the project staffs visited her home and discussed her story of their life. She also shared the work of CHARM with her. Her eldest child aged 13 and youngest child aged 1 year and the youngest child was Severe Acute Malnourished (SAM). Project staff suggested her to send the child at Nutrition Rehabilitation Centre (NRC). But her husband refused to send the child to NRC and told that there is no improvement after spending Rs- 30000/- so now I will not spend any money.
With support of project staffs, she went to the NRC with child. Her husband started abusing her as well as CHARM project staffs over mobile phone.
He asked her wife to come soon at any cost. She told will come after completion of full treatment. Whatever you will do I don’t care now. It was very courageous step because she left 11 children in her house. There was nobody to cook food for her children at home. Husband did not cook food for them. Eldest son and next to him cooked the food and served their younger siblings.
When she returned from NRC she was happy with the improvement of her child. Now she has become federation member of Khatoon Majlis.
Now she avails government services without paying a single penny. If anybody asked for bribe she has agitated. She started to aware the nearby community about the health and nutrition services provided by government. She also educated the community about immunization. She started to learn about the program of health and nutrition. She also awaked the nearby community about cleanness. She is active member of federation. Now she did not want to give birth of any child. But unfortunately she became pregnant and started becoming ill. Again she contacted Anjum and Shakila and informed about her pregnancy. They suggested her to visit Phulwarisharif PHC to terminate pregnancy. She visited the PHC and Doctor told that abortion facility is not available here. If you want to do so you will have to pay Rs 1800/-. She had no money so again she informed Anjum & Shakila. They informed to district project coordinator to help her. Mr. Zaki contacted the Civil Surgeon and discussed the story of Shabnam. He suggested going Gardanibagh Hospital. Zaki informed Shabnam to visit that hospital. She visited that hospital and wants to get abortion. Doctor told her we will not do so. They suggested to opt permanently sterilization and advised to do necessary checkup and come on Monday for sterilization. She reached hospital on Monday for sterilization and met doctor. Doctor told that today your sterilization will not take place because anesthetic is not available. She was in fasting but doctor refuses to surgery. Now she was start to weeping. She informed to CS to give order to operate operation but no result. Then she informed Project Coordinator of CHARM. He reached hospital and met deputy superintendent and will know status of Shabnam. Superintendent told that we will not do sterilization without anesthetic so come another day. Project Coordinator suggested her take the date on prescription so that you will not suffer. She agreed and takes the date on prescription. Shabnam reached on that day and operation took place.
Shabnam changed community behavior and thus was also felicitated by Oxfam India as agents of change for 2014-15.