Bihar Gram Vikas Parishad (BGVP)

Project Theme

Health

Target Group

Others

Project Period

01 Apr 2016 - 31 Mar 2017

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Introduction

Bihar is arguably one of India’s poorest and most backward states. In 2007-08, the Human Development Index Value (HDI) of Bihar was 0.367 when the national HDI was 0.467. In a total of 23 states, Bihar’s rank is 21 (UNDP 2011). Health Infrastructure and HR is completely in shambles with lack of equipment and medicines. Many posts in PHC and APHC are vacant and HSC is not functional.  Furthermore, key health indicators in Bihar reveal that the state lags behind considerably owing to a high fertility rate, maternal mortality ratio and infant mortality rate as compared to the country (Table 1). The state average of IMR is 48 with a majority of the districts falling in the category of 40-50 (AHS 2013). Sitamarhi is one of the two districts having the highest IMR of 64 and 60, respectively. As per the latest Sample Registration Survey figures, the national MMR is 167 while for Bihar/Jharkhand, it is 208 (SRS 2013). Region-wise AHS data on MMR reveals that Purnea region with including Sitamarhi has the highest ratio of 349. As per the AHS 2012-13 data, nearly half of the currently married women were married before the legal age of 18 years in the state.

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 & gynaecological 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 gynaecologist, obstetricians and anaesthetists 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, anaemic mothers etc.
  • Low level of female literacy results in unawareness about maternal health services and care 
  • High prevalence of malnutrition (anaemia) among women in the reproductive age group 
  • Gaps in access to free medicine and diagnostics

 

The Project: 

The project aims to focus on restructuring the VHSNCs to increase the women membership and their increased participation in decision making body. Besides, strengthening the federation of VHSNCs at block and district level will also be done with support of JSA, with a focus on access to free medicine and diagnostics. This will facilitate in raising issues related to women and adolescents and thereby resolving the same more judiciously. Strengthening of VHSNCs and its network through linkages with PRI members and panchayat level VHSNCs will be done along with building capacity of relevant stakeholders on community based monitoring process. Engagement with women and adolescents towards building capacity on disadvantages of early marriage, their role in CBPM and entitlements on health and nutrition will be ensured this year. Target communities will also be in focus on sensitizing and mobilizing them on the issues of access to free medicines and diagnostics. Further, building capacities of frontline workers and RKS towards performing their role effectively is also in the plan. On advocacy front, case stories on maternal deaths will be developed and shared with district administration towards putting more emphasis on community based maternal death review. Also, on strengthening the grievance redressal system related to health and focusing on CEA Act 2010 at district level will be ensured through JSA during the project period. With the support of JSA and network partners, there is a plan to collect evidences on discrimination against marginalized communities focusing on women in health and nutrition services from the project area and share the same with the respective state functionaries to take action and improve the services. 

Objective:- 

  • To increase awareness of the marginalised community specially women on health and nutrition and government schemes and entitlements.
  • Strengthening of communitisation processes (Village Health Sanitation and Nutrition Committee and Rogi Kalyan Samiti) for community based monitoring.
  • Strengthen the service delivery through building capacity of frontline health workers towards increased responsiveness focusing on health and nutrition.
  • Strengthen grievance redressal mechanism through increased involvement with the government system.

 

The Impact:

Oxfam India along with its partner initiated the process of strengthening the civil society movement towards realizing the entitlements on maternal health. So far, the achievements for the year are - 

  • Tangible change in the health seeking behavior of the pregnant women, lactating mothers and adolescent girls were observed in the project intervention villages. Most of the targeted beneficiaries were able to recognize their health and nutritional rights and started striving towards realizing their entitlements.
  • Through CBM, pressure was built on service providers towards organizing VHND sessions on a regular basis providing ANC/PNC and health checkup services and also providing consultative services to pregnant women, lactating mothers and adolescent girls on ANC/NC/PNC, Child Care, Immunization, Nutritional Care, Family Planning (use of contraceptive measures). All PDS and ICDS centers now function properly and services listed under them are provided regularly. 
  • Through campaign on disadvantages of underage marriage and laws related to it, awareness on the same among the communities has risen. As a result of which, child marriage - a normal social phenomenon among the vulnerable communities has been checked and no case of such marriage has been reported in the project area. Two cases of underage marriage, one each from Runnisaidpur and Belsand blocks were stopped by the Federation members.  
  • The village heath plan of 22 villages has been included in district PIP.
  • With the effort of VHSNC and Federation members, full usage of untied fund in both the intervention blocks was observed.
  • 416 Families has been included in “Rashtriya khadya Suraksha Yojana” by the effort of Federation Members.

 

Quotes of Beneficiaries:

“TT, Iron and Poshahar hai hamara Adhikar” meaning we have right to get TT, Iron folic tab and nutrition. Rukshana Praveen, Dhanushi village, one of the members of adolescent group from project area.

 

Case Studies/Human stories:

Bishwanath Ram, a Mahadalit, is 42 years old and resides in Belahi village of Belahi Nilkanth Panchayat under Runnisaispur block of Sitamarhi district (Bihar). He is landless laborer. He is a daily wage earner and sole bread earner of his family. He got his education up to Intermediate level.  His family is consists of nine members including his mother, wife, three children, two daughters-in-law and one grandchild. The family falls under BPL category. He lives in semi-pucca thatched roof house. Overall status of the family is not good. The family members are still debarred from adequate education. 

House of Bishwanath Ram is located at Belahi Nilkanth village on the brick-soled road side. The village Belahi is located at a distance of 5km in the west of NH- 77 Thumha Chowck. The PHC at Runi Saidpur is at a ditance of 12 kms from the village and the Health Sub-centre is located at a distance of 9 kms from the village. Due to inadequate health facilities at the sub-centre, most of the villagers go to the block PHC to avail health services. The village road connectivity is badly affected during the rainy season hence it becomes very difficult and costly for the villagers to avail health facilities during this time. Biswanath Ram came to know about the Oxfam India sponsored project implemented by BGVP, Sitamarhi, he became the  member of the VHSNC and later on shouldered the responsibility of implementation of the project activities as a barefoot auditor. He started taking active part in almost all the programs with utmost sincerity. In training, he learnt that adolescent girls need to be immunized with TT vaccination because it prevents them from tetanus. He also learnt that at time of starting of menstrual period, there is possibility of developing infection into tetanus because of which TT injection is prescribed. About six months back, adolescent girl Rubi Kumari, daughter of Awdhesh Pashwan, died of tetanus. This haunted the mind of Bishwanath Ram. He realized that the training provided by BGVP staff on health & hygiene was correct. He then decided that henceforth he will work towards minimizing the risk if tetanus in all adolescent girls in his panchayat. Bishwanath Ram took the initiative to aware all adolescent girls of his panchayat about the benefits of taking TT shot and its implications. He met the CDPO and MOIC to ensure that TT injection are made available to all ANMs so that it is administered during VHSNDs to all adolescent girls. As of now all adolescent girls are given TT vaccination. Before this intervention, none of the adolescent girls were vaccinated with TT injection. Initially, the adolescent girls were hesitant to take TT vaccine. But later when they realized its significance, they all agreed to take it. They were also convinced that IFA tabs are essential to combat anemia. This intervention motivated the adolescent girls to take active part in the VHSNC meetings. They gradually broke all inhibitions that hindered them to share their problems related to personal hygiene with the ANMs.

Belahi village is inhabited by people belonging to SCs and OBC communities. The village has 7200 population. Due to lack of awareness, the adolescent girls of the village were never covered under TT vaccination. This resulted into occurrences of deaths due to tetanus ever since adolescent girls started taking TT vaccination and IFA tablets. The project intervention was successful in motivating the adolescent girls towards good health and hygiene practices thereby improving their health and reduction in deaths due to tetanus.