Bihar Gram Vikas Parishad (BGVP)

Project Theme

Health

Target Group

Others

Project Period

01 Apr 2015 - 30 Sep 2015

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Introduction

The Issue:

Maternal health care encompasses family planning, pre-conception, prenatal and postnatal care. A mother is all compassionate and ever sacrificing and in the event of her death, one child is left orphaned. So it is time that we must wake up to address this terrible reality about maternal health care.

Maternal health care is one of the important aspects to reduce infant and mother mortality rate. But in Bihar, there are various problems which jeopardize the effects to improve  maternal & child health, these are-

•Shortage of skilled frontline health personnel (ANM, MHW, ASHA) to provide timely and quality ANC & PNC services.

•The public health facilities providing obstetric & gynecological care at district and sub-district levels are inadequate

•Mismatch in supply of essential items such as BP machines, weighing scales, safe delivery kits and their demand

•Shortage of gynecologist, obstetricians and anesthetists to provide maternal health services in peripheral areas.

•Shortage of beds in health facilities 

•Lack of knowledge about ante-natal, pre-natal and post natal care among the community especially in rural areas.

•Marriage below 18 years of age resulting in unwanted pregnancies and difficult deliveries, anemic mothers etc.

•Low level of female literacy results in unawareness about maternal health services and care 

•High prevalence of malnutrition (anemia) among women in the reproductive age group 

The child health indicators of the Bihar reveal that the state’s IMR is lower than the national average. Morbidity and mortality due to vaccine-preventable diseases still continues to be significantly high. Similarly, child health care seeking practices in the case of common childhood diseases such as ARI and Diarrhea are not satisfactory. The child health scenario is worse for specific groups of children, such as those who live in rural areas whose mothers are illiterate, who belong to Scheduled Castes, and who are from poor households. Issues affecting child health are not only confined to mere provision of health services for children, but other important factors such as maternal health and educational status, family planning practices and environmental sanitation and hygiene – all of which have adverse bearing on child health. This is more than evident in the case of Bihar where child health continues to suffer not only because of poor health services for children but due to issues such as significantly high maternal malnutrition, low levels of female literacy, early and continuous childbearing, etc. 

 

The Project: 

The project aims to improve awareness and access to improved quality, affordable maternal health services and package of entitlements through a social determinant approach. Leveraging the government programmes like NRHM, ICDS, PDS et al, empowering frontline service providers and building citizen’s bodies and capacities to engage with the system as monitors and collaborators would be the best way forward. Through all these interventions, prioritizing women and their needs and capacitating them to exercise choices would be the cross-cutting theme.

 

The interventions are expected to help reduce the MMRs of Sitamarhi district. Currently, as per NFHS III, the MMRs of Sitamarhi is 319 (and for the state its 261). The project will thus contribute towards realization of three of the Millennium Development Goals (MDGs): MDG-5 (improve maternal health); MDG-3 (promote gender equality and empower women); and MDG-4 (reduce child mortality).The project will benefit 14653 women and 15660 men and indirectly reach out to 66226 women and men, majority of them are Muslims, Dalits and OBCs.

 

The specific outputs of the project are 

•Community capacity to advocate for women’s access to a wholesome balanced diet

•Women have improved and increased access to obstetric care including referral services in project intervention areas

• Women with increased awareness and knowledge on legal age of marriage and contraception methods

•Increased engagement of CSOs in monitoring and planning of the Government health  delivery services through identification of policy gaps at all levels.

 

The Impact:

Oxfam India along with its partner initiated the process of strengthening the civil society movement towards realizing the entitlements on maternal health. We have so far - 

•Village Health and Sanitation Committee (VHSC)  & VHSC federation formed and strengthened for better accountability through CBM process adopted by them. This has led to improved services at the government hospitals thereby reducing the maternal deaths drastically.

•WASH mela in all intervention villages to sensitize the community on nutrition, anemia, locally available vegetables to increased intake of iron, importance of full ANC and PNC.

•Interface meetings with the district and state officials regarding fully costed referral transport system for pregnant women.

•Social audit of Health, ICDS and PDS services. 

•Jan Sunwai (public hearing) at district and state level on the findings of the social audit.

•Campaign on under age marriage in all intervention villages of Bihar (70 villages).

•Sensitization meeting with the community and PRI members on MH entitlement, Institutional and safe delivery.

•Training and meeting with Adolescent groups in all 38 intervention villages on anemia, health and hygiene, problems and solution of adolescence.

•Post mapping reaching to the marginalized households who have been denied entitlements from ICDS and PDS services. 

•Meeting with relevant stakeholders to include the names of the most marginalized identified above.

•State level meeting with the RTF network regarding better provisioning of entitlements under PDS. 

 

Quotes of Beneficiaries:

““Instead of fixing the number of pregnant women beneficiaries (eight at a time) in a Ward, it (services) should be given to all the pregnant women”. One of the Village Health and Sanitation Committee (VHSC) members.

Case Studies/Human stories:

Vijay Kumar, 28 years old, belongs to a relatively well to do family background. He is a member of one of the other backward communities. Mr. Kumar is a successful farmer, who owns more than 10 acres of cultivable lands. Farm outputs are enough to meet the food and non-food (farm products) needs of the family. Father of Mr. Kumar, who gets pension after retirement from Bihar Police Service, supports the family to meet all its monetary requirements.  Mr. Kumar has a semi-pucca tiled roof house with adequate number of rooms for dwelling and cattle rearing. Though Mr. Kumar is having a toilet but due to lack of proper hygiene education of the family members, it is not properly maintained. He has his own source of drinking water (hand pump) and solar lighting system for lighting purposes. On enquiry about why despite having electric lines connected, there is no electricity with his house; Mr. Kumar said that Transformer is out of order for last couple of months. It was shocking to learn from him that despite meeting the unofficial monetary demands, the responsible electricity Department Official is lingering the process for the reason not known to him. Mr. Paswan was unhappy with the poor performances of the electricity department personnel.    

The village Lohasi is a revenue village of Lohasi Gram Panchayet under Belsand Block of Sitamahi district in Bihar. Belsand Block and PHC are situated at about 7 Kms distance in the South-West of this village and the district HQs is situated at about 15 Kms from this village. The Health Sub-centre at Partapur is located at about 3 Kms distance from the village. 

Until recently (till the present intervention was made),, villagers of Lohasi remained fully unexposed to modern health care, hygiene and sanitary habits and their due entitlements under government food security and other welfare programmes. This was primarily due to ineffective functioning of the local governance (PRIs), VHSNC and apathy of the government service providers towards discharging their due responsibilities. Probably due to remoteness and lethargy on the part of the government officials responsible for monitoring and evaluating the performances of the government programmes, the government service providers remained carefree in discharging their duties until the present formation and functioning of the VHSNC. Due to improper functioning of the government run health, sanitation and food security programmes, the villagers had to depend largely on health services provided by the private stakeholders including the village quacks and healers. Normal feature of the village with regard to sanitation is still worse. Roads at the outskirt of the village are dirty because most of the villagers (in absence of sanitary latrines) evacuate on the road sides. Roads within the villages are also not clean because cattle are kept tied and the household wastage are dumped. Womenfolk still maintan their tradition by keeping their heads partially or fully covered with shari. 

Mr. Vijay Kumar feels pride for being elected by the villagers as a team leader of the VHSNC. Now he feels responsible (voluntarily) to perform dual roles in improving the health and sanitary status of his family as we;; as of the villagers, especially of the pregnant mothers and lactating women and the children.  Functioning of the VHSNC under his able leadership brought a new hope among the teeming millions who earlier felt that none other than God could protect their interests.  Mr. Kumar and his members were exposed to perform their social responsibility through training under the present project and the trainees were indeed most eligible to grasp the essence of the training. As a result, the VHSNC team members took up the programme activities in the similar spirit and temperament as they did in performing their own tasks; which resulted into motivating all the stakeholders (from service providers as well as service recipients) to participate in the ongoing programme activities voluntarily. 

 

The Change

The present intervention brought about lots of change in the pre-intervention situation. In one hand,  change in the perspective of the service providers (AWWs, ANMs, Doctors, PDS dealers and other related workers) made them more sincere and responsible in perfuming their duties as per the norms  and also brought them more closer to their service recipients; on the other hand the changed perspective of the service recipients developed confidence in them with the government system so they now have started thinking positively towards participating in government programmes by discarding their due roles and responsibilities voluntarily.