Centre for Health and Resource Management (CHARM)

Project Theme

Health

Target Group

Others

Project Period

01 Apr 2016 - 31 Mar 2017

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Introduction

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 in two blocks of Patna district in Bihar. Vast majority of Dalits and Muslims in the district fall under lowest two quintiles of wealth index. Sizable section of Dalits and Muslims are acutely poor and substantial number of them is landless labourers, daily wage earners and artisans. The target area of the project constitutes of 5 Panchayayts/Nagar Parishads and 14 villages/habitations/municipal wards in Phulwarisharif and Maner blocks of Patna district. The project target population is 15175 Dalits and Muslims in 2442 households. 

The state of Bihar has poor human development indices. According to the National Family Health Survey IV (2015-2016) less than 59% population of the state have access to electricity; only 25% of households are using improved sanitation facility and a meager 12% households are covered by any health scheme or health insurance. Half of the women in Bihar are illiterate. More than 58 percent women of reproductive age (15-49 years) are anaemic; 39% of women in Bihar married before 18 years and 12% of them are teen mothers (women age 15-19 years); the total fertility rate of the state is 3.6, which is one of the highest in the country. Health infrastructure is poor. It continues to be deficient in terms of physical and human resources. Large number of posts of Medical Officers, Specialists and front line health workers is lying vacant for last several years. According to Annual Health Survey (AHS) the Sex Ratio at Birth of rural Patna is 903 as compared to 919 of rural Bihar. It is in this context that the project will strive to enhance uptake of health and nutritional entitlements by Dalits and Muslims women and children.

 

The Project: 

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. 

 

Objectives:

  • To examine the extent of exclusion among Dalits and Muslims by the health system and to find out the discrimination if any in the sector of health and nutrition.
  • Organize, develop capacity and increase the awareness amongst Dalits and Muslims towards their rights and entitlements as regards to basic services.
  • Sensitization of opinion leaders, policy makers and media on different forms of 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 among them.
  • Strengthening of communitisation processes (Village Health & Sanitation Committees and Rogi Kalyan Samitees) for community based monitoring

 

The Impact: 

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. Building evidence through CBMDR and its sharing with the government officials and policy makers also paved the way for improvement in health services. 

  • Nari Sabha/Khatoon Majlis empowered – increase in demand and collective bargaining for better services.
  • Institutionalized deliveries increased.
  • Training of TBAs as SBAs(Using Five steps of safe delivery)
  • Decrease in malpractice in distribution of JSY amount in service delivery.
  • Demand generated has started showing signs of improvement in service delivery.
  • Illegal gratification in JSY and immunization has been checked.
  • Linkages with NRC (Nutrition Rehabilitation Centre) established.
  • Involvement of PRIs in strengthening VHSCs.
  • 85% pregnant women are availing ANC.
  • PNC has been improved comparatively.
  • 206 SAM children has been sent NRC.
  •  Functioning of RKS and VHSNCs has been improved.
  • Government has started keeping data of maternal deaths.
  • Improvement in IYCF (Infant & Young Child Feeding) practices in children under two years.
  • Government initiates process for free access to drugs and diagnostics and verbal autopsy of Maternal Death
  • Access to free drugs and diagnostics is incorporated in the election manifesto of political parties
  • Early initiation of breastfeeding greatly improved, exclusive breastfeeding also improved and age specific complementary feeding showing improvement
  • Minimize number of malnourished children through IYCF practices
  • Issue of Social exclusion shared with member planning commission & GoB.
  • Developed Citizen Charter on health under JSA.
  • Prepared road map for CBMDR for GoB- CBMDR in 10 hot spot districts in 2014- 15.
  • CHARM & Oxfam India on core committees on preventive health and integrated health policy, MVM of GoB.
  • Strengthening of communitisation process in NHRM.

 

Quotes of Beneficiaries:

“We were not aware of our health rights but now we know and will keep demanding at our own from the service providers” Matoran Khatoon, represents her Khatoon Majlis (women’s group) in the Federation of Khatoon Majlis formed at block level now.

 

Case Studies/Human stories:

Matoran Khatoon is one of the members of Khatoon Majlis of Bhusaula Danapur from Phulwarisharif block. Her daughter, Baby Khatoon was married 6 years back to Md. Aftab of Piplawan village. She went to Phulwarisharif, PHC for delivery of her 5th child along with her mother. She delivered an underweight baby in the hospital. She was informed by the ANM that the baby was born dead and when asked for the body, she replied that she has kept the baby in the waste bin. Matoran got angry and asked for the body as there has to be last rites followed.  The ANM cleaned the baby and handed over to her, on which she took her in the lap for some time. After some time she realised that the baby is alive. She told her daughter to breastfeed the child. She took this matter to Doctor and lodged a complaint against the ANM. The Doctor apologised and assured of taking action on her. Now the baby is healthy,