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Location

District Munger, Bihar
Thematic Intervention: Health, Nutrition, Participation


Background

Disha Vihar was registered in 2003 to work among the marginalized, exploited and Dalit communities; and to bring them in the mainstream socio-political processes in order to build a just society. Disha Vihar has closely worked with the people in Diara land who were displaced by river Ganga flood and fishing community in Munger district. The organization has taken up work on women rights issues and local governance issues in the operational area. The Project Holder, Mr. Abhay Kumar Akela, has been involved in the Ganga Mukti Andolan, the Munger Movement and the Rashtriya Seva Dal. He was actively involved in the Bihar Pradesh Lok Samiti. He played an important role in ensuring that peace resumed after the Bhagalpur riots by organizing various communal harmony programmes in Munger district. The organization is currently working on health and malnutrition issues in partnership with CRY.

Munger district, located in the southern Bihar, is famous for its natural resources - forests, hills and rivers. The district experiences both droughts and floods which affect the agricultural activities of Bhinds, Kumhars, Banias and Dhobi communities. As a result people migrate from the villages. The health service delivery systems are not functioning properly which leads to low level of birth registration, and immunization of children & pregnant women. Due to financial constraints and lack of livelihood options children discontinue education and get engaged in shops, hotels or in domestic labor. Children are directly engaged in labor work in the area and most of the children have migrated to other places working as labor. Girl child marriage is another issue prevailing in the area. The reasons behind this are social taboo, traditions, fear of girl child safety and poverty.

Situation

  • Major issues related to child health in the intervention area such as under 5 mortality (63 per thousand), maternal mortality (35 per lakh), low birth weight, poor ANC(Ante Natal Care)/PNC(Post Natal Care) coverage (37% three ANC), prevalence of anaemia among adolescent and women, incomplete immunization (only 43 % complete immunization) and proper health check-up (Ref. AHS 2010-11: Bihar).
  • Lack of awareness among community, behavioral issues leading to poor health particularly among women, and high dependence on quacks.
  • Poor health services delivery, quality of health services, infrastructural gaps compared to need.
  • Undernutrition among children in project target communities. The percentage of children with birth weight less than 2.5kg is 21.9% (AHS 2012-13: Bihar); the percentage of underweight children is also very high.
  • Birth spacing, proper care of pregnant women, low intake of nutritional food and lack of breastfeeding which contribute to higher malnutrition among infants.

Objectives

  • To ensure access of ICDS (Integrated Child Development Services) services for all children women and adolescent girls,
  • To improve nutritional status of children under 5 years of age,
  • To ensure routine immunization, health care services to all children
  • To reduce the health implication caused by child labor and early marriages.

Achievements & Impact in the Review Period


Disha Vihar as an organisation was previously working with a holistic approach on child rights issues, focusing on education, dropout children, child labor, child marriage, child health, adolescent health, vaccination, institutional delivery, child participation etc. However, with the shift in approach from holistic to thematic focussed intervention on issues of health & malnutrition, the organization’s identity in public domain has been redefined.

  • The team worked on building the capacity of the project staff on NHM(National Health Mission), NRC(Nutritional Rehabilitation Centre) and health services; and ways of generating demand for quality health services from community.

  • A re-organized community sensitization strategy was carried out through women’s collectives and village level meeting / information sharing.
  • Community processes for awareness building on health rights, need of institutional delivery, duties of services provider & health service institutions, and means to access the same.
  • Strengthening relation with government officials, ensuring their participation in institutional process. The organization collected data on health institution, conducted finding sharing event, and demanded improved services in Anganwadi centres, improvement in health infrastructure, Ambulance services etc.
  • In the due process, the organization succeeded in terms of regularization of ambulance, delivery services in health service centres and regularization of health service provider.
  • The community engagement process with children resulted in improved full vaccination, improved linkages of malnourished children to Anganwadi centres and health checkups.

Plans


Disha Vihar is working in 30 villages of 3 blocks of Munger & Lakhisari district and has plans to intervene on health and nutrition aspect. Major activities planned for the coming year under broad result areas are:


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

Community Mobilization:-

  • Awareness building on the IPHS (Indian Public Health Standards) norms of the health service institutions, availability of Sub-Centre, PHC(Primary Health Centre), CHC (Community Health Centre) and services available therein, and the 6 services of Anganwadi centres
  • Awareness campaign on JSY(Janani Suraksha Yojana), JSSK(Janani–Shishu Suraksha Karyakram), RSBY(Rashtriya Swasthya Bima Yojana) to build confidence among community on government health services
  • Ensure Village Health, Sanitation and Nutrition Committee (VHSNC) generates demand for better health & nutritional security services
  • Adolescent girls’ linkages with AWC(Anganwadi centre )/Health centre for IFA and Vitamin tablets.

Capacity building:-

  • Capacity building of the Project Team on:
    • National Health Mission
    • Primary health delivery systems
    • Communication skills & strategy to convince community
    • Communication skills & strategy to dialogue with government officials Capacity building of adolescent girls on health and hygiene (focus on anaemia, nutrition issues, implications of early marriages, early motherhood etc.).
Advocacy:-
  • Advocacy with district level officials for starting delivery service at Sadar PHC(Primary Health Centres )
  • Liaison and networking with NHM(National Health Mission) officials (DPM, BPM) in District Health Society for placing new health Sub-Centre in operational area.

Model Building:-

  • Working towards building of 3 model Anganwadi centres in 3 different Block.
Reduction in MMR (Maternal Mortality Rate) , CMR (Child Mortality Rate) , IMR (Infant Mortality Rate) , maternal and child morbidity in the intervention areas:

Community Mobilization:-
  • 1st trimester registration and linkage of pregnant women with ANM (Auxiliary Nurse midwife)/ AWW (Anganwadi workers) for ensuring complete antenatal care;
  • Due list preparation for every Village Health, Sanitation and Nutrition Day session (village wise) and track the child and the mother’s access to the services
  • Tracking of pregnant women and mothers for 1000 days from pregnancy confirmation, and linkage with health workers of the high risk pregnancies
  • Ensure 2nd Antenatal care by a medical officer for each pregnant woman
  • Identification of malnourished children and its referral
  • Meeting with mothers on exclusive breast feeding, colostrums feedings and complementary feeding after 6 months.

Capacity Building:-

  • Capacity Building of the project team on high risk pregnancy, basic mother and child health issues, and immunization
  • Capacity building of the pregnant women and lactating mothers on different mother and child health issues, and ante-natal care
  • Training of the staffs on malnutrition, prevention and management by resource organization.
Advocacy:-
  • Advocacy with ANM (Auxiliary Nurse midwife) and ASHA (Accredited Social Health Activists) on 1st trimester registration, recording of birth weight in MCPC, regular home visit.

Ensure children's voices are recognized as significant and unique in issues that affect them

  • Regular meeting with Munna Munni Manch emphasizing on aims, objectives and task roles
  • Providing opportunity to children to speak in community meeting and other platforms
  • Organizing Bal Mela and ensuring children play active/ leadership role in organizing it
  • Support Kishori Manch members in publication of annual magazine
  • Empowering adolescent girls of children collectives so that they can discuss issues affecting them openly with parents for good cause and take decision
  • Meeting with parents/ guardians for promoting children’s participation in children collective processes.

Annual Financial Summary: January to December 2017

  • Right to Education
    $4,179
  • Right to Protection
    $5,595
  • Right to Participation
    $1,283
  • Administration
    $5,624
  • Total Grant Approved
    $16,681