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.