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Location

17 villages in Motihari Sadar block of East Champaran district, Bihar
Thematic Intervention: Health and Nutrition


Background of the Project:

CHARDS has been working on the issues of children, women and farmers since 2004. The project holder, Sashi Prasad B Lall, has dedicated his life to working for underprivileged communities since his schooldays. His inspiration came from his uncle who was involved in the social reform movement of the country at the time led by Jai Prakash Narayan. CHARDS started its work by building awareness on health and hygiene in two Panchayats of Motihari Sadar and went on to build its expertise in the areas of health and nutrition rights for children.

Problem Statement:


In the 17 villages of the operational there are 3776 families, all of whom are from the dalit, mahadalit and other backward caste communities.
The status of health and nutrition of children in 17 villages is extremely poor and one of the main reasons is the lack of access, availability and quality of health services. The main barrier of accessibility is the distance from the villages and poor quality (lack of medicines, non availability of doctor, irregular ANM, lack of bed and facilities for institutional delivery in APHC, infrastructure not as per IPHS 2012). This means that families have to travel to Motihari town to avail of any treatment. Due to non accessibility and low quality of public health care services, a majority of the community turn to the local Quacks as their first choice of care which is dangerous since quacks are expensive, often unregulated and variable in quality. This situation has meant that home deliveries are prevalent thus increasing risk for mother and child at birth. The issue of child mortality is also alarming in the operational area. From January to June 2018 alone, 15 child deaths have been reported. Post facto analysis by the project team concluded that the families were not able to avail any kind of government facility treatment. Moreover in one village of Mushahar’s community, diarrhoea spread due to consumption of some contaminated food.

Parents and community are unaware of preventive measures/symptoms of illness and it has been observed that in case of minor illness or onset of any illness they do not take proper care. The health seeking behaviour of the parents is also low. There is high seasonal migration in the area and it also affects the children as female members are reluctant to go alone for treatment. The children of the project area suffer from common deadly diseases like- Pneumonia, TB, diarrhoea etc.
There is also a dearth of adequate number of ICDS centres in the operational area and thus a large number of children are out of services. The regular growth monitoring rarely happens thus the growth of the children is not known and malnutrition is not arrested at the early stage. For treatment of severely malnourished children, state government has been running nutritional rehabilitation centre (NRC) but it carters only 20 children at a time and not covering all the blocks of the district at a time. Presently, NRC is functional in Chakia block which is far away from the operational villages. The problem of colostrums feeding is a significant challenge in the community as due social beliefs and age old practices. Likewise lack of exclusive breast feeding practices also affects the health of children.
The Musahars, Dalits and Mahadalits are at the bottom of the social rung in India. For generations, they have suffered lack of economic opportunity, access to healthcare, education and nutritious food. Caste, poverty and patriarchy continue to be overarching factors that affect the rights of the children in the operational area.

Achievements & Impact


Key Result Area: Access and quality to free, primary health care in our intervention areas
Key Result Area: Reduction in MMR, CMR, IMR, maternal and child morbidity in our intervention areas

Program Activities Planned Progress and Achievements

* Follow up on the assurance for new Health Sub-Centre (HSC) and Additional Primary Health Centre (APHC) from Minister of Health and Executive Director, State Health Committee.
* Strengthen Rogi Kalyan Samiti (RKS) to monitor health services at Primary Health Center(PHC).
* Engage with health officials on provisioning standards of service under Indian Public Health Standards (IPHS) and advocating for improvements.

* Children were given the following immunization dosages,
    a) BCG, OPV & HIB - 334 children
    b) Pentavalent-1 & OPV - 376 children
    c) Pentavalent 2 & OPV - 348 children
    d) Pentavalent 3 & OPV3 - 397 children
    e) Measles & JE- 529 children
* Institutional delivery increased from 53% to 62% during the review period
* 210 women availed of the Janani Surakhsa Yojana (JSY).
* 309 Pregnant women were monitored for Antenatal Care and 229 women for Prenatal Care (Out of 695 pregnant women).
* No maternal death has been reported in this period.

Achievements & Impact


Key Result Areas: Reduction of Child Malnutrition in 17 Hamlet of 2 Panchayat.
Key Result Areas: To ensure in 17 interventional tolas ICDS, NRCs, PDS are fully functional.

Program Activities Planned Progress and Achievements

* Monthly meeting of Self Help Group (SHG), community and sharing importance of complete immunization, health check-up, Institutional delivery, and Preventive measures.
* Carrying out special sensitization drive in the community where home delivery is prevalent.
* Discussion with Mukhiya and Panchayat members on finalizing the document verification of 3 selected ASHA workers.
* Sensitization meeting with health and ICDS workers and discussion on their roles and responsibilities in collaboration with National Health Mission
* Staff capacity building on village health sanitation and nutrition committee and guideline adopted by Bihar state.
* Orientation to the members of Village Health Nutrition and Sanitization Committee (VHSNC).

* 103 meetings with self help groups and mata samitis (mother’s committee) were held during the period.
* 5 Village Health Nutrition and Sanitization Days (VHSND) were organized in which pregnant and lactating mothers took the necessary vaccination and children were assessed for their nutritional status against their age.
* 25 Severely Acute Malnourished (SAM) children were referred to the Nutrition and Rehabilitation Center (NRC) and 21 children were admitted for treatment.
* 9 malnourished children were brought back to normal through community processes and counseling.
* Around 100 women planted Moringa (drumstick which is rich in protein) plants in their premises.
* 194 children participated in a wall magazine event in seven schools and they express their thoughts/learning on paper under the theme of health and nutrition.
* Adolescent girls are oriented on regular basis on reproductive health and hygiene issues, which enables them to practice hygiene and spread awareness on same amongst their peer groups.

Capacity Building:


  • A five day residential program was conducted at IITD Kolkata for the project team. The module included sessions on self esteem, self empowerment, self confidence, identity, group identity, thematic issues like education, protection, health and nutrition etc. The team found it very useful in terms of capacity building and directly engaging with children of all age group.
  • Two members from CHARDS attended a health conclave at Raipur, Chhattisgarh. The main objective of the event was to understand various health related issues.s

Update on major events /campaigns:


During the nutrition week, in the community meetings, food demonstrations were done to suggest to the community to include diverse nutritious food into their menu. Emphasis was given on use of Moringa leaves and its fruits. Moringa is a locally grown leaf that is of tremendous nutritional value and can act as supplementary food for other protein contained food. The method of preparing moringa powder and its use in different food items were shared with the community. The resource person shared the recipe of ‘Poshan Laddoo’, (Nutritious Mix) which was prepared on spot of the event. After initial hesitation, the community along with all children enjoyed the taste and also started preparing the ‘Poshan Laddoos’ at their homes. After the live demonstration, 50 women started preparing this nutritious food at their homes.

Engagement with the Government:


In the year 2018, CHARDS carried on from last year’s efforts with respect to seeking sanction for a sub center in Bardaha GP and for an upgraded PHC in Madhubani ghat GP. They adopted multi-pronged strategies to take this further. At district level they met with the District magistrate, District project officer etc. and followed it up with a meeting with state level officials. The process is still on and the project team is hopeful that consistent engagement will lead to outcomes. In another initiative, last year 5 new ICDS centres were sanctioned but the process of recruitment happened in 2018 and the CHARD team regularly followed up with the concerned officials to ensure the recruitments.

Plans


Key Result Areas Program Activities Planned

Access and quality to free, primary health care in our intervention areas

* Community level awareness program on the Indian Public Health Standards (IPHS) norms mentioning the availability of the health service institutions.
* Engagement with the government stakeholders to work on various health issues and gaps identified.

Reduction in MMR, CMR, IMR, maternal and child morbidity in our intervention areas

* Continuous tracking of pregnant/lactating mother and children for antenatal/prenatal/immunization.
* Linking pregnant women and lactating women with the government health workers. Sensitization meetings and support to be provided to ASHA and AWW towards pregnancy care and identification of high risk pregnancy.
* Work towards building model VHSND site in six selected ICDS centers based on identified indicators.

Key Result Areas Program Activities Planned

Reduction of Child Malnutrition in 17 Hamlet of 2 Panchayat.

* Identification and tracking of children (Severely Acute Malnourished/Malnourished) and their follow up through institutional process. Linking them to ICDS centers.
* Generating awareness in the community to enroll their child to ICDS centers in the changed context of universalization.
* Motivating parents to take their underweight girl children in Nutrition and Rehabilitation Centers (NRCs) and ensuring growth chart plotting for each child in 6 ICDS.
* Community level awareness on health and hygienic practices, issue of open defecation, community managed diarrhea.
* In the community meeting raise the issue of gender based discrimination in food access, breast feeding, child marriage etc.
* Regular interface meeting with 10 adolescent groups. Formation of one new adolescent group and sharing information about locally available nutritious food.

In 17 Interventional tolas ICDS, NRCs, PDS are fully functional.

* Mata Samittee (Mother’s Committees) to organize meetings for participation in strengthening ICDS centers.
* Capacity building of the mothers on importance of Growth Monitoring Chart (GMC) and empowering them.
* Sharing of GMC report with Mata Samities to highlight the importance of the chart.
* Working towards building of 6 model ICDS centres in 3 Panchayats.

Key Result Areas Program Activities Planned

Improved understanding developed on children at Partner and CRY level on their age appropriate development, views and reality and Work with parents and families to develop perspectives.

* Capacity building session of adolescent group on child centre module.
* To enable adolescent groups to compile contents for annual magazine that would be published.
* Meeting with the parents and discussion on child participation and orienting them on child’s need and development.

Financial Summary: January to December 2019


Budget Breakup 2019

Health

6,918

37%

Nutrition

6,918

37%

Administration

4,817

26%

Total Grant Approved

18,653

100%