Bihar Voluntary Health Association(BVHA)

Project Theme

Health

Target Group

Others

Project Period

01 Apr 2015 - 30 Sep 2015

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Introduction

The Issue:

The health and demographic indicators of the Bihar shows that Maternal Mortality Ratio (MMR)- Bihar 261as per SRS 2007-09 is much higher than the all-India level and reflect a poor health status in the State. The Human Development Index (HDI), a composite of literacy, life expectancy and per capita income, has increased for Bihar like the rest of India. In view of the large population size, high poverty ratio, and high decadal growth indices in the State, Bihar is one of the States covered by the National Rural Health Mission. The indicators primarily relates to primary health care infrastructure and reproductive and child health care, the State ranks 35th in the country. On a similar basis, the districts in Bihar have also been ranked lower amongst the districts which are lagging behind in the State are i.e. Seohar, Supaul, Samastipur, Kishanganj, Jahanabad, Nalanda, Khagaria, Araria, Sitamarhi, and Pashchim Champaran. Out of 10 districts, two districts Kishanganj & Supaul are operational areas under this project. During the period BVHA will intervene on maternal health care specially focused on marginalized & unreached community within the project operational area. 

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 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 the two districts - Kishanganj and Supaul. Currently, as per Annual Health Survey 2010-11, the MMRs of Kishanganj and Supaul is 377 and 286 (and for the state its 261) respectively. 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 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.

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

•Training and meeting with Adolescent groups in all 32 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.

 

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:

Sri. Jawaharlal Yadav. Age 55 yrs. Male, Mahingao, Kishanganj. He belongs to middle level family. The HSC Mahingao was not functional and ANM used to open it rarely. Most of the time, it remained lock.  The village residents never took any enquiry and action against this situation. Thus the condition of HSC went poor to worse. Resident of the surrounding used to hang cloths and mattress on the boundary and gate of the HSC. People were not aware about their health rights nor were they concerned about it. They were not conducting any meetings of VHSC nor were the members known to each other as a result the funds coming from government for VHSC and other activities were unutilized and returning back to govt., which results in to the loss of society at large. Even for the treatment of common illness, people had to visit Kihanganj sadar Hospital situated 10 KM for from the village. 

When BVHA with the support of Oxfam India launches the GPAF Program in Kishanganj block all the VHSC members were identified and then a series of personal interaction with each members was done by the Panchayat Motivators and they were counseled and aware about their health rights and finally they agreed to come to common platform to have a meeting in each Panchayat about VHSC activities, they were given the IEC material and shown the letters issued by the govt.

 

The Change

Initially individual contact was needed for every meeting but people started doing the VHSC meetings and were aware about their health rights and untidy fund. Now the VHSC members of Mahingao Panchayat have became active and started meeting with the ANM and started monitoring the untied fund also. Sri Yadav and VHSC decided to intense advocacy to get the Mahingao HSC functional. 

Results started coming slowly and now it was the efforts of VHSC team and President of VHSC that for the first time in Mahingao Panchayat from the untied fund of VHSC the building of HSC got renovated and painted. Regular efforts of Sri Yadav resulted that concerned ANM was ordered by PHC for regular opening of HSC. Sri Yadav also aware the community to support service provider at HSC in maintaining the cleanliness in the surrounding.  Required equipments and logistic arrangement were done with the help of untied fund. Now, Now the Mahingao HSC  opens regularly, full ANC is ensured and untied fund is use as per the village health plan.