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Location

30 villages in Shahbad block of Baran district in Rajasthan
Thematic Intervention: Health and Nutrition


Project Context

Prayatn Sansthan was founded in 1992 with an objective of empowerment of communities to respond to changes and enable them to change their situation of inequality and injustice. It has also developed expertise on child rights issues like declining sex ratio, child education, and child marriage over the period of time. Most of the interventions of Prayatn under execution now across the states of Uttar Pradesh, Madhya Pradesh, Rajasthan and Orissa have specific components focused on child rights protection as per child rights situational analysis of the intervention area. Prayatn is recognized as a leading organization in the state which is working on child rights issues and is equipped with the ability to work directly with community, in addition to competency of conducting research, networking with stakeholders, and liaising with the governments and administration.

The Project Holder is Mr. Malay Kumar, whose major area of expertise has been child rights, specifically protection related issues. He has wide experience on pre-conception and prenatal Diagnostic Techniques (PCPNDT) Act, trafficking issue, research etc. The current project aims at addressing the issue of health and malnutrition through development of indigenous community based systems and mechanisms. For this community based institutions called Child Protection Committees (CPC) and Bal Manch (children’s forum) have been formed in each of the villages and various steps have been undertaken for their capacity building.

Problem Statement:


Baran is the only district in Rajasthan with significant size of Saharia tribe population (categorized as Particularly Vulnerable Tribal Group, earlier also known as primitive tribal group). They have very low achievements in human development indicators. The child health and nutrition scenario of the intervention areas is abysmally very poor. The Saharia tribes who were largely forest dwellers, and have been largely depending on forest produces for survival have been seriously impacted due to deforestation as well as increased government control over forest resources in the name of wildlife sanctuary and forest conservation. Lack of livelihood avenues for the Saharia tribe further escalated the issue of hunger and malnutrition among community and children in the areas.

Apart from the issue of livelihood and food security issues, community level prevailing belief system, social custom and tradition including high consumption of alcohol, tobacco, child marriage, myths with regards to immunization and breast-feedings have serious impact on maternal and child health. Colostrums are not given to children both due to lack of understanding on its importance as well as health status of the mother. Illiteracy, lack of awareness among community, and above all culture of silence has led the community to lesser interaction with other people, or even seeking support provided through various government schemes and programs. Most of the families are debt ridden.

Though Baran is one of the focus districts of government under different schemes and programs including Integrated Child Development Services (ICDS) mission, the implementation of the same is very poor. There is absence of required infrastructure and staff as per norm under ICDS Mission and thus, coverage of children is low. The supply under supplementary nutrition program (SNP) and service of hot cooked food in ICDS Anganwadi centers has not been regular in intervention areas. There is no Pediatric in Malnutrition Treatment Centre (MTC) for special care and treatment of Severely Acute Malnourished (SAM) children referred to centre. Community members are reluctant to approach the centers for facilities and services as the attitude of service providers towards community is insensitive. The support structures like School Management Committee (SMC), Village Health Sanitation and Nutrition Committee (VHSNC) and Panchayat Raj Institutions (PRI) are inactive and not competent enough to deliver the desired roles and responsibilities. Migration has also been identified as one of the major challenge which causes malnutrition among children as children accompanying parents in migration hardly get access to hygienic environment, timely quality food and health care.

Achievements & Impact


Key Result Area: Stronger community ensuring proper health care, nutrition and food security of Sahariya women and children

Program Activities Planned Progress and Achievements

? Conduct sensitization meeting of the community and separately with adolescents, using IEC material, on the issues of mother and child care.
? Facilitate regular meetings in all the adolescent collectives in 29 habitations.

? 4,702 males and 2,988 females participated in 607 sensitization meetings in the community on the issues of adolescent girls, mother and child care.
? 427 adolescent girls were provided sanitary napkins, chlorine tablets were distributed in 11 villages.

Key Result Area: Children under the age of 5 years have access to all age-appropriate health and nutrition services entitled for them

? Ensure frequent tracking of children, monthly basis for SAM children, bi-monthly basis for MAM and once in a quarter for normal children.
? Micro Level Plan and child led indicators would be prepared in BM and CPC.
? Support for developing kitchen garden keeping seasonality in mind.

? New ICDS Anganwadi center has been sanctioned for Ranipura Villages. New building of Anganwadi was built in Guwadi village and the center in Chaurakhadi Village was repaired, all of which together benefitted 196 children.
? 2,303 children in age-group of 6 months to 6 years were enrolled in 27 Anganwadi centers.
? 2 teachers were appointed in Ranipura and Khushalpura.
? Advocacy efforts with the Chief District Medical Officer (CDMO) ensured 149 children receive their birth certificates.


Key Result Area: Ensure safe deliveries and effective administration of ANC and PNC programs in all the villages

Program Activities Planned Progress and Achievements

? Track births to women aged 15-19 years and secure all necessary supports.
? Ensuring regular tracking of pregnant women and registration in ICDS centre. Ensuring Mother and Child health card (MCH) is issued to all the pregnant women.
? Sensitize community on importance of ANC and immunization of pregnant women. Also ensure antenatal screening is done for anemia and malaria.
? Spread awareness among community about the JSY and JSSK scheme, and assist opening of bank accounts by eligible clients.

? 221 Institutional deliveries took place due to regular sensitization to the pregnant women.
? 120 pregnant women received their Mother and Child Health Cards.
? 36 children were referred to malnutrition treatment centre.
? The parents of Severely Acute Malnourished (SAM) children were counseled by Child Protection Committee (CPC) and 10 SAM children were sent to Malnourishment Treatment Center (MTC).
? 51 women registered in last year and 149 women registered this year received financial JSY benefits under JSY scheme. Also, 215 women received benefits of Rajshree scheme and 19 pregnant women got their bank accounts opened.


Key Result Area: Effective functioning and quality services being provided by the government institutions related with health, nutrition and food security to the communities

Program Activities Planned Progress and Achievements

? Orientation of members of committee formed to monitor Maa Wadis on their role and responsibilities at village level.
? Ensure availability of vitamin K injection at all delivery points, and fully functional New Born Stabilization Units (NBSUs), Special Newborn Care Units (SNCUs) with the requisite personnel in blocks / district.

? 77 members participated in AAA (Anganwadi Workers, ASHA & ANM) interface which was conducted during the period, with an objective of capacity building of the duty bearers, and coordination with stakeholders for better services.
? Ration was supplied in 30 Maawadi (Mother Care) centers due to regular follow up by the supervisor. The food is given according to menu.
? 52 families received ration card and 81 are in the process of receiving.
? 1,728 got registered under Mahatma Gandhi National Rural Employment Guarantee Act (NREGA) for jobs.


Key Result Area: Community awareness and action on other aspects of health among Sahariya tribe like seasonal diseases, hygiene and availability quality drinking water etc

Program Activities Planned Progress and Achievements

? Organize sensitization meeting for community based management of preventable disease.
? Liaising with health department for availability of medicine at PHC & CHC, and organizing medical camp in Gram Panchayat.
? Analyzing the implementation gaps in the vertical programs such as malaria eradication, diarrhea, pneumonia and cholera prevention etc.

? Team members had initiated the discussion with pregnant and lactating mothers to provide colostrums to make their children healthy.
? Food demonstrations were organized in villages to enhance the understanding of the community members, pregnant women, and lactating mother so that they can utilize the take home ration in many ways.

Highlights of technical and capacity building inputs:


In addition to scheduled guidance and monitoring, CRY had organized below inputs to the project:
? A training health and nutrition was organized with technical support of resource agency Vikas Samvad from Bhopal for the project team. The training also included orientation of team on usage of BCC materials for orientation and sensitization of community.
? A workshop was organized with technical support of resource agency Vikas Samvad from Bhopal for adolescents on RCH issues and life skills. The objective of the workshop is to empower the adolescents with essential knowledge of life issues that they are going to face and ways to handle the same.

Highlights on community action and government interface:


? Awareness Campaign in 30 villages: The project launched a campaign to sensitize community members so that they raise their voice against poor malnutrition and health care services 30 villages. Child Protection Committee members, adolescent girls, members of children groups participated in Kala Jhatta shows and awareness walks. The duty bearers such as ASHA, Anganwadi Workers and ANM also participated. They conducted sessions on seasonal diseases and provided the information on why and how the ORS is prepared and given to person affected from diarrhea. They also appealed the people to maintain basic hygiene around them.
? Advocacy for malnourished children: A list has been prepared of 106 malnourished children and submitted to Block level CMO to ensure double diet for the children who are under the SAM (severely acute malnourished) category. The CMO has considered the request and ordered the team to provide the same to these children. It is being monitored by the team members and at the same time the parents of children are motivated to send their children every day.
? Advocacy for L1 Facility at CHC: The assessment of the Community Health Center (CHC) at Shahbad was undertaken and found that CHC is not equipped with L1 facility and lacking the facility of blood transfusion. As per norms, minimum 45 staff should be there but at present only 27 persons are present. The CHC do not have facility to connect with other hospitals to seek the blood in case of emergency. Further, there is no facility of ultrasound and sonography. The BCMHO was approached and requested to upgrade the CHC with L1 facility. Few case studies of pregnant women were also shared with them, one of whom died as she was referred to district hospital because CHC was lacking the infrastructure to handle the complicated delivery.

Plans


Key Result Areas Program Activities Planned

Stronger community ensuring proper health care, nutrition and food security of Sahariya women and children.

? Orient and sensitize community members through activities like community meetings on varied issues such as immunization, safe delivery, importance of breast feeding etc.
? Ensure fortnightly meetings of committees and women groups are held regularly.
? Explore scope for developing platforms / forums and opportunities to facilitate Jan Samvad / interface for community members with government depts.

Ensure safe deliveries and effective administration of ANC and PNC programs in all the villages.

* Ensuring timely check-up, immunization, IFA tablet consumption and proper care of pregnant women through tracking and counseling during household contact and at Anganwadi centers.
? Share the list of 85 women who had delivery at home with concerned authorities and facilitate access to Janani Suraksha Yojana (JSY) benefits.
? Ensure children being weighed at birth and identify the low weight children and sensitize mothers about the same.



Key Result Areas Program Activities Planned

Children under the age of 5 years have access to all age-appropriate health and nutrition services entitled for them.

? Counsel parents of SAM children to ensure timely access to treatment.
? Ensure Village Health and Nutrition Day (VHND) are regularly and proper organized, with due participation of mothers and children.
? Organize food demonstrations on usage of locally available nutritious food in selected villages.

Effective functioning and quality services being provided by the government institutions related with health, nutrition and food security to the communities

? Organize interface meetings with concerned government officials to fulfill the gaps identified in mapping of the infrastructure and services in institutions related with maternal and child health care and nutrition.
? Organize government community interface meetings at cluster level to address issues identified during village development plan preparation.
? Ensure easy access to entitlements and benefits under various government schemes and programs by Sahariya tribe families.



Key Result Areas Program Activities Planned

Community awareness and action on other aspects of health among Sahariya tribe like seasonal diseases, hygiene and availability quality drinking water etc.

? Sensitize community on ill effects of open defecation and facilitate access to government schemes viz. Swatch Bharat Abhiyan to address the same.
? Organizing health awareness and treatment camps with the support of health department at cluster level.

Financial Summary: January to December 2018


Budget Breakup 2018

Health

8,974

30%

Nutrition

8,974

30%

Administration

11,812

40 %

Total Grant Approved

29,760

100%