PROJECT: Khushali Project
Integrated health, sanitation, remedial education, skill development and income generation interventions towards improving the quality of life of the urban and rural poor
Phase 1: 2012–2015
Phase 2: 2015-2018
Locations: low income, urban resettlement colony, Madanpur Khadar, New Delhi; 10 villages of Mocharim and Bakraur panchayat, of Bodhgaya block; 7 wards of Bodhgaya town, Gaya District, Bihar.
This comprehensive community development project had 3 pillars, health and sanitation, education for children and skill development for income generation. It covered the 75,000 inhabitants of Madanpur Khadar resettlement colony of New Delhi, and about 35, 000 rural beneficiaries in Bodhgaya.
The health component addressed adolescent, maternal, neonatal and child health, emphasizing the adoption of healthy behaviour, as well as improved access to and utilization of primary health services. Balanced attention was paid to family planning, antenatal and post-partum care for mother and newborn, nutrition, growth, and immunization of children under two. For maximum impact, individuals were addressed at especially needy, vulnerable, or impressionable stages of the life cycle- in infancy and early childhood, adolescence, during pregnancy, in the post-partum period,
Capacity building, support supervision of government front-line workers – anganwadi workers, auxiliary nurse midwives and ASHAs was a key input for improving availability and quality of essential primary health services at the community level. Mahila Arogya Samitis in Delhi worked closely with community health workers to ensure optimal utilization of these services. In Bodhgaya, Agragami re-formed the two village health and sanitation committees (VHSNCs) in the intervention area and also formed ten Nigrani Samitis through participatory processes so that the VHSNC and Nagrani Samiti members understood that they had a vital role to play in improving the status of health, nutrition and sanitation of the community. Government front-line workers- auxiliary nurse midwives, ASHAs and anganwadi workers were trained to communicate on antenatal, post-partum and neonatal care; childhood immunization, and family planning. They received continuing supportive supervision and feedback for performance improvement from Agragami’s trainers.
Activities in sanitation and hygiene included education on hand-washing with soap, purification of drinking water, use of toilets, avoidance of open defecation, and appropriate disposal of household garbage. Community engagement occurred through the formation and strengthening of Mahila Arogya Samitis/street sanitation groups whose members took responsibility for calling municipal authorities to request the sanitation services that were needed and to give feedback on services being rendered. In both Delhi and Bodhgaya, this resulted in marked improvement in street sanitation and improvement in the delivery of municipal sanitation services. Sanitation, door-to-door garbage disposal, tailoring classes, beauty culture classes were introduced to enable adolescent girls and young women to acquire skills for income generation.
The non-formal education component Children’s activity centres in both Madanpur Khader and Bodhgaya offered children membership in libraries with books of different levels of difficulty to encourage children to read and grow in reading ability and self-expression. Craft, dance, and games were a routine part of the curriculum, and attracted children to join the activity centres. In Madanpur Khader, a pre-school prepared children from families where parents were not literate, for admission to primary school. Primary school children who were unable to keep up with school received remedial inputs in Hindi and arithmetic, so that they could better keep up in class.
Skill development and income generation:
In Madanpur Khader the project trained girls in tailoring and beauty culture so that they could earn from home. Over 250 Girls have been trained to date and most of them are using their skills to earm from home.
In Bodhgaya, two hundred poor families from the 10 intervention villages received inputs to increase family income. The selected families received inputs for improving returns from crops, kitchen gardening, and mushroom growing. Linkages were improved between farmers and government farm extension services resulting in information to farmers on better farm practices, and access to subsidized, high quality seed. Market linkages were developed to enable sale of mushrooms. Over 40% of the beneficiary households increased their income by about 20,000 a year because of project inputs.
Reducing infant mortality in Bihar through optimal infant feeding practices
Duration: 2012 - 2015
Location: 303 villages in 6 blocks of Samastipur district in Bihar
Coverage: Over 100,000 mothers and their infants under 2 years of age
The project aimed to reduce neonatal and infant mortality through improving breastfeeding and complementary feeding practices for children up to the age of two years. A strong behaviour change communication program was implemented through 150 women and men drawn from the community who played the roles of peer educators and supervisors.The project mobilized and empowered mothers and care-givers to adopt good infant and young child feeding (IYCF) practices. Peer educators supported mothers in overcoming infant feeding problems. The project coordinated with block and district health and ICDS authorities to involve government community health workers- ASHA and anganwadi workers- in project activities. 158 community health workers supervisors were trained by the project on IYCF to address IYCF issues as a part of their routine responsibilities. The focused behaviour change communication efforts of this project targeting a specific area of health practice achieved impact. In its three years of implementation, the project reached and changed infant feeding behaviour over 100,000 mothers from the poorest and most marginalized communities through 106,980 group meetings and 154,849 home visits.
PROJECT: MATERNAL AND CHILD HEALTH
Strengthening maternal, newborn and child health and nutrition (MNCHN) services
Location: Mohanpur block, Gaya district, Bihar
Coverage: 59,010 people in 60 villages
Save the Children conducted an assessment of the MNCHN situation in Mohanpur block prior to the start of the intervention. The results showed a great need for an MNCHN intervention: 48% of pregnant women had not received the recommended three antenatal visits during pregnancy; only 23.1% of mothers had taken at least 90 capsules of iron and folic acid during their last pregnancy; and only 62.4% of women in Mohanpur block gave birth in a hospital. 38.4% of children under three years of age were stunted (too short for their age), and 46% were underweight.
The project designed by Save the Children and implemented by Agragami India put pregnant and lactating women, neonates, infants and children under the age of 2 years at the centre of the intervention and focused on improving survival, health and nutrition outcomes for children from conception up to the age of two years.
Three convergent approaches were used: strengthening the capacity of government’s front-line health workers such as auxiliary nurse midwives, ASHAs and anganwadi workers to deliver MNCHN services and to report data on delivery of key MNCHN services; mobilizing community groups and instituting processes to stimulate the block level health system to improve service-delivery; and advocating with block and district health systems to improve service delivery and the quality of services.
Changing social norms related to child marriage
Duration: October 2014 - December 2015
Location: Mohanpur block, Gaya district, Bihar
Coverage: 3960 adolescents aged 13 to 20 years, in 66 villages
This project designed by Save the Children and implemented by Agragami sought to change social norms related to child marriage using a multi-pronged approach. It formed and strengthened child protection committees at the district level, chaired by the District Magistrate; trained selected members of the child protection committees to speak up for and support children in resisting child marriage; built the capacity of adolescent aged 13 to 20 years to be discussion leaders who built awareness in communities about the ills of child marriage. Adolescent discussion leaders were supported in this task by front-line community health workers of government who were also trained by Save the Children to conduct community meetings to discuss the issue of child marriage.
Result: Discussion sessions and other project events led to increased awareness and sensitivity of adolescents to issues in their own lives. Changes in girls were noteworthy. They reported increased confidence in and ability to discuss and negotiate with parents on issues of mobility outside the home. Several reported negotiating with parents to continue their studies and delay marriage. They participated in large numbers in social and community events organized by the project. Adolescent girls also reported increased discussion with their peers on reproductive and sexual health issues and on their rights. Even mothers of adolescent girls reported a heightened awareness of their tendency to discriminate against girls and demonstrated greater comfort in allowing daughters to participate in project sponsored activities.
PROJECT: PARIVARTAN 2013-14
Capacity building of 4500 Sahelis and Cluster Coordinators to communicate and catalyze collective action on key health issues
Location: East and West Champaran, Khagariya, Saharsa, Begusarai, Samastipur, Gopalgunj, and Patna districts
Coverage: 4500 Sahelis and Cluster Coordinators
The goal of the PATH-PCI Parivartan project was to strengthen community structures and catalyze collective action to change social norms and increase the adoption of those behaviours that would have the greatest positive impact on the health status of the community: birth preparedness, safe home delivery, institutional delivery, post-partum and neonatal care, early and exclusive breastfeeding, complementary feeding till the child is two years old, post-partum family planning, routine immunization, hand-washing, safe storage and handling of drinking water, access to and use of toilets, and safe disposal of waste.
Agragami’s role in the Parivartan project was to build the capacity of the project’s 4500 Sahelis and Cluster Coordinators, to communicate with members of self-help groups and with the community at large on these issues and to encourage the adoption of healthy behaviour. Capacity building went beyond class room training to on-site observation of on-the-job performance as they communicated with and mobilized their communities to adopt healthy behaviour, and mentoring and support for performance improvement.
PROJECT: PARIVARTAN 2014-16
Strengthening Village Health Sanitation and Nutrition Committees
Location: Khagaria and Saharsa districts of Bihar
Coverage: 102 gram panchayats
The goal of this PATH-PCI project was to revitalize and strengthen Village Health Sanitation and Nutrition Committees (VHSNCs) in Bihar through training and technical assistance. At the start of the project, an assessment of VHSNCs was carried out in the two project districts using in-depth interviews with Mukhiyas (village headmen), ward members, Auxiliary Nurse Midwives (ANMs) and the Lady Health Supervisors of the Integrated Child Development Services (ICDS) department. The findings of the assessment were that most of the VHSNCs existed only on paper as their members had either retired or had been transferred.
Agragami helped to reconstitute the 102 VHSNCs in the intervention areas of the two districts, and also formed 220 Nigrani Samitis through a participatory process that made each member of the committees/samitis understand that he/she had a distinct and important role to play in contributing to improving the status of health, nutrition and sanitation in the community. Agragami’s master trainers bridged the gap between the committees and the members of the community, and made the committees understand the intentions of the Government. Members of the VHSNCs and Nigrani Samitis were trained to take collective decisions during monthly meetings. 581 monthly meetings were held and 145 village health action plans were developed.
The committees/samitis were familiarised with the systems that they should follow in order to effectively utilize the small untied funds given to each village by the Government for minor village works. All VHSNCs were assisted in opening/reviving bank accounts where the Government’s untied funds could be received and withdrawn for spending. This required liaison with bank managers and with the Medical Officers of the Primary Health Centres, so that lists of authorized signatories could be updated (for already existing accounts) or put in place (for newly opened accounts). Untied funds were spent, spending was properly documented, and utilization certificates were submitted to government.