Reflection - Sector Wide Approach To Strengthening Health .

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reflectionUpdates from SWASTH - BTASTSector Wide Approach to Strengthening Health in Bihar (SWASTH), Government of Bihar InitiativeSupported by Department for International Development (DFID), UKSeptember 2015In this issueqSHGs ushering a silent revolution in Bihar through Gram Varta2qGiving a push to the development agenda in Bihar3qBihar PHED launches cell for monitoring grievances4qBihar provides dialysis service at half the market rates5qUddeepan Kendras boost health and nutrition of women and children in Bihar6qConnecting the dots: Linking Bihar’s SWASTH to SDGs8qPanchayat to run water treatment plant in Bihar village9qBihar needs integrated solutions like SWASTH: Prakash Kumar of BTASTBihar Technical Assistance Support Team (BTAST)10Knowledge Product Developed byOneWorld Foundation India

Featured UpdateSHGs ushering a silent revolution in Bihar throughGram VartaThousands of women from rural areas gather in Patnato share how the Gram Varta initiative has brought abouta change in health, nutrition and sanitation aspects oftheir lives.Patna, Bihar: Asserting that Self Help Groups (SHGs)are crucial for women empowerment, Bihar ChiefMinister Nitish Kumar said that they are ushering in asilent revolution in the state.Kumar was speaking at a state level event held inJuly this year to showcase the successful adoptionof Participatory Learning and Action (PLA) approachthrough their intervention – Gram Varta for improvedHealth, Nutrition and WASH outcomes.The event was jointly organised by the WomenDevelopment Corporation (WDC) and Bihar TechnicalAssistance Support Team (BTAST).Assuring government’s continued support to women’sempowerment, Nitish Kumar said that SHGs wereplaying a catalytic role in sweeping a social change atthe grassroots level and tackling issues like malnutrition,child marriage, hygiene and sanitation.Applauding Gram Varta for spreading awareness aboutHealth, Nutrition and Sanitation, Nitish Kumar saidthat if Self-Help Groups are sensitised and women areempowered to take up these three key areas, entirecommunities can hope to become healthy.Kumar asked the Managing Director of WDC to scaleup the Gram Varta programme across the state.The event highlighted the change brought in the rolesof rural women through Gram Varta, a programme thathas helped them to negotiate new practices with familymembers, share information among their family and peernetworks, and foster community support for action.The community mobilisation approach has promotedhealthier family practices, raised demand for primaryHealth Nutrition Water & Sanitation (HNWASH)services, and stimulated local action for change.The workshop also aimed to reflect the need forintersectoral coordination among various departmentsfor ensured delivery of services to fulfil the demandgenerated through Gram Varta.2The event also intended to draw attention of thebureaucrats and policy makers on the potential of GramVarta to address the social determinants of health, andthe social norms and power dynamics that influencecare practices and health care access, particularlygender and social exclusion.The event was inaugurated by the Chief Ministerof Bihar, Nitish Kumar, and attended by Minister ofSocial Welfare, Health and Rural Development, seniorgovernment officials, members and representatives ofdonor agencies, DFID including members of SHGs.Approximately two thousand women from variousdistricts attended the event. Women from communityshared their experiences eloquently at the event andpresented how Gram Varta had brought about a changein them and their families.Dr Vijaylakshmi, Managing Director, WDC, addressingthe audience in the opening session briefed thegathering about the intervention and informed with asense of pride as to how in a short span of time GramVarta had spread across 14 districts, covering eightythousand SHGs. Taking the lead from the intervention,she shared the department’s vision to bring women inlead role to take charge of their health, nutrition andWASH issues for combating malnutrition. She alsospoke about the evidence from large scale trials in Indiaand other countries which showed that women’s groupsworking through PLA approaches can improve maternaland neo-natal health in fairly short time.

Based on a Participatory Learning and Action (PLA)technique, the aim of Gram Varta is to improve thehealth and nutrition status of rural people throughcommunity mobilization, through a series of meetingsand interactive sessions. These Gram Varta sessionstake place approximately every fortnight, in a 20-meetingcycle, and use PLA techniques like role plays, games,discussions, problem tree analysis, and so on.Dr Ellen Wratten, Country Head, DFID-India, hailedGram Varta for empowering women and said it wasa promising approach. She said the confidence andknowledge that the women had shown in talking to alarge audience at this meeting was the real evidence initself of the extent to which change has been achievedthrough Gram Varta. qGram Varta is implemented through the Self HelpGroups (SHGs) of JEEViKA, WDC and the Bihar MahilaSamakhya. It primarily involves women members ofthese SHGs who meet regularly to engage in thesesessions. These women undertake community needsassessments, identify and prioritise local issues,draw up a community action plan to respond to theseissues, implement the solutions as well as monitor theprogress.Watch VideoIt also includes non-SHG members, men and women,adolescents, the wider community, and frontlineworkers –- in some of the sessions and wider meetings-- to encourage collaborative learning and action. TheGram Varta PLA cycle encourages local communitiesto become aware, recognise problems and act onissues such as good nutrition for pregnant women,complementary feeding for infants, family planningmethods, birth-preparedness, harmful effects of opendefecation and many other topics.Bihar’s Chief Minister Nitish Kumarspeaks at Gram Varta workshopNote: To watch this video, please scan the QRcode using your smart phone’s QR code reader.other updatesGiving a push to the development agenda in BiharBTAST’s knowledge sharing meet brings together crosssectoral experts to give a fillip to development in the state.Patna: The Bihar Technical Assistant Support Team(BTAST) held a Cross-sectoral Knowledge Sharingmeeting on 8th of July 2015 with the Government of Bihar(GoB) and other development partners working in thestate on various issues related to health, nutrition, andwater, sanitation and hygiene (WASH). This meetingwas called to set up an institutionalised commonplatform within the state for discussions and exchangeof knowledge.The workshop was attended by stakeholders like theExecutive Director of State Health Society (SHS);Managing Director of Women Development Corporation(WDC), Director of Integrated Child DevelopmentServices (ICDS), officials from Public Health EngineeringDepartment (PHED), UNICEF, UNDP, WHO, UNFPA,CARE India, NIPI and others.3Several large and small scale studies are beingundertaken in Bihar, supported by development partnerssuch as DFID, BMGF, UNICEF, WHO etc. Usually thepurpose of these surveys and studies is to monitorthe progress of the state against certain developmentindicators, assess the effectiveness of specificprogrammes and policies, and/or identify ways tostrengthen existing programmes and develop new ones-- with the ultimate aim of pushing development in Bihar.At various discussions and meetings between BTASTand development partners, the usefulness and theappetite for a structured opportunity for programmes toshare knowledge, experiences, challenges and lessonslearnt were identified. This was seen as important fortwo reasonsMultiple synergies could be achieved from collaborativeworking in, for example, study design, tools, andproducts, which would help in achieving better studyoutcomes.

This meeting helped to set in motion the process for suchsharing. Presentations about some of the large surveyslike the Concurrent Monitoring Survey being undertakenby BTAST, findings from surveys done by UNICEF andothers were discussed with the Government counterparts.This Cross-sectoral Knowledge Sharing Group wasrecognised as a useful mechanism for not only supportingknowledge sharing amongst development partners butalso stakeholders from three Government departments –Heath, Social Welfare and Public Health Engineering.The Group is also expected to connect members as acommunity to strengthen the collective capacity on surveyand research in Bihar, and provide co-ordinated support toGoB policy and programming that is based on emergingevidence.Information sharing based on large and small-scalesurveys, state level planning and evidence-baseddecision-making could be facilitated better with GoB.Subsequent meetings would be held on a quarterly basisthrough the year and the group would take up activitieslike discussions on methods including sampling, toolsand implementation; analysis plans; dissemination andutilisation of results; sharing of knowledge and lessonslearnt from large and small-scale surveys, and so on. qBihar PHED launches cell for monitoring grievancesThe PHED-CGRC is also developing a mobileapplication for the officers to view the complaint.New Delhi/Patna: To make the government systemmore responsive towards people, the Bihar PublicHealth and Engineering Department (PHED) has setupa Centralised Grievance Redress Cell (CGRC) on17thJuly 2015. The Call Centre was inaugurated by the ChiefMinister, Nitish Kumar by making a call and registeringa complaint.CGRC has been designed to provide a centralisedcontact point for easier access to information relatedto PHED’s numerous schemes and services. The cellwill also provide a platform to citizens for registeringtheir grievances and feedback.The Bihar TechnicalAssistance Support Team (BTAST) is providingtechnical assistance to CGRC. BTAST is an initiative ofBihar Government supported by DFID-UK to implementthe Sector Wide Approach to Strengthening Health(SWASTH) in Bihar.The CGRC initiative of PHED aims at making theadministration of the department more citizen-friendly.Over the course of time, CGRC shall also develop acitizen charter for defining the timeline required to addressgrievances falling under various categories and sub-4categories. The CGRC system is equipped to assign, storeand track unique complaint IDs. It allows defining targetTurn-Around-Times (TATs) against each category and subcategories of complaint based on the citizens’ charter andmeasure the actual TATs on all complaints.

The CGRC application has a built-in escalation matrixfor resolution of grievances in a time-bound fashion. Thiswill provide control to PHED for online monitoring of thegrievance redressal procedure. The application will havethe ability to classify different complaint types from differentsources based on pre-defined customizable rules.The CGRC system is conceived to facilitate setting upof alerts for an open complaint nearing the assignedtime, as well as committed turnaround time. The systemshall facilitate feedback to the complainant, and provideinformation to the PHED on the quality of serviceand efficiency of the system. CGRC has introduceda centralised Toll-free number (1800-123-1121) forpeople to register their complaint. For their grievance,people can also reach out to the department by writingan email or visiting its website. A complainant receivesan acknowledgement after registration of the complaintor grievance. A text message containing a brief info isshared with a complainant and based on the grievanceredressal matrix, a text is sent to the action takingofficer. This reduces the delay caused while reachingout to the officer concerned.CGRC generated unique complaint ID is used to trackthe progress of the complaint resolution. Citizens cantrack the status of the complaint by visiting the websiteor by calling the grievance cell. GCRC is capable ofsending summary of complaints to mid and/or seniorlevel officials through SMS/eMail. The PHED-CGRCis also developing a mobile application for the officersto view the complaint and/or update the status ofthe complaint along with viewing the managementinformation system (MIS).CGRC cell would also house a dashboard for all levelof officials who are part of the grievance redressalapplication. The dashboard with its intelligent graphics,tabular and trend analysis would help the decisionmaking authority for taking corrective measurestowards improving the efficiency and effectiveness ofthe system. qBihar provides dialysis service at half the market ratesSpecial camps are being organised in the state at publichealth facilities where haemo-dialysis sessions arebeing provided at half the market price.Patna / Bhagalpur: In its bid to move towards makingthe health services more affordable in Bihar, campsfor dialysis sessions catering to kidney patients arebeing organised in the state. The special camps beingorganised from August 4th - 8th, 2015, at Hemo DialysisCentres (HDCs) will provide dialysis sessions at halfthe market rates with the facilities to be available in 13district hospitals and four medical colleges located inseventeen districts.To provide quality hemo- dialysis services at affordablecost, government district hospital and medical collegesare providing round-the-clock HDCs at 17 locationsacross the state in partnership with B Braun-India, asubsidiary of German company.The HDC initiative is said to be the first of its kindPublic Private Partnership (PPP) for providing low costservices to kidney patients in Bihar. Patients registeredduring these five days would be getting lifetime dialysisservices at government approved rates. The State HealthSociety, Bihar and Bihar Technical Assistance SupportTeam (BTAST) are providing technical assistance tothese centres in the form of identification of privatepartner for running the dialysis centres. BTAST is aninitiative of Bihar Government supported by DFID-UK toimplement the Sector Wide Approach to StrengtheningHealth (SWASTH) in Bihar. BTAST is also supportingthe project in conducting special health camps to attract5kidney patients and link existing patients to thesecentres. According to the incidence rate of end-stagerenal disease in Bihar, there are more than 22,000patients who are suffering from kidney related ailments.Dr R C Mandal, Superintendent, Jawaharlal NehruMedical College and Hospital, Bhagalpur, said thatthese camps would lead to greater awareness amongpeople about the renal diseases.According to Sandeep Kumar from BTAST, theavailability of low cost dialysis sessions will result inlonger life of people suffering from kidney ailments.“Repeated dialysis sessions result into a family beingpushed below the poverty line. Generally, a dialysissession costs around Rs 3000 while these centreswould provide the same service for approximately Rs1500. Not just that, the patients would also avoid thepain of travelling away from their homes in search ofbetter medical facilities,” Kumar explained. q

special featureUddeepan Kendras boost health and nutrition of women and children inBiharAnganwadi Centres that have been upgraded as‘Uddeepan Kendras’ at the Panchayat level areemerging as model centres for delivering qualityservices, and encouraging nearby Anganwadi Centresto strengthen their work.Jyoti Kumari, stands proudly outside her UddeepanKendra (nodal Anganwadi Centre) in Chapi Panchayat ofPurnia district. Appointed as an Uddeepika in November2014, her role is to make her Uddeepan Kendra a modeland resource for other Anganwadi centres within thePanchayat. Working alongside the Anganwadi workersand helpers, she provides on-the-job training, adviceand mentoring, building their confidence to enable themto provide a high quality and full range of services underthe Integrated Child Development Services (ICDS) tochildren (0-6 years), pregnant women and lactatingmothers in the community.Jyoti is from the same Panchayat where she currentlyworks and understands local people and theirissues. Initially, families were hesitant to accept her6recommendations, but over time, Jyoti has gainedtheir respect and confidence. At 25 years of age, shehas a post-graduate degree and is able to draw on hereducation and training to enhance community servicesand fulfil her desire to serve and improve the lives oflocal people.Describing her work, Jyoti says, “I am responsiblefor observing daily activities of an Anganwadi centreand supporting Anganwadi workers on how to makeimprovements. I accompany Anganwadi workers onhome visits where I directly interact with the community,and I support the Anganwadi workers in impartingcounselling . I advise pregnant and lactating mothers onfood habits, the importance of weighing and the servicesavailable at the Anganwadi centre”. Her first job asthe Uddeepika was to jointly work with the Anganwadiworkers in her area to assess the basic hygiene andsanitation of the kitchen and surroundings, and plan forits improvement. She has also been working to ensurethat Anganwadi workers update the registers regularly,eliminating delays in data entry.

Jyoti regularly carries out regular home visits andis recognised as a guide within the community. AsMilan Devi, mother of two, said, “My baby was bornunderweight, but we did not realise this until Jyotiadvised us to check the weight, using the weighingscale at the Anganwadi centre. When we realised thatthe baby was underweight, we took her to the nearestprimary healthcare centre.”Usually, people from well-to-do families and those wholive close to the Anganwadi Centre are more likely toaccess its services, and the system often fails to servicethe poorest. Jyoti recognises this, saying, “Often thebenefits of ICDS are availed more by the rich in villages.After home visits, I was able to identify households that arecomparatively richer than others. I convinced them that thepoorer households have a greater requirement for ICDS,particularly supplementary nutrition, so they were willing toshare the benefits of the system to ensure those most inneed are helped.” Jyoti is aware that it is difficult for familiesto afford nutritious food such as fruits, and tries to suggestless expensive alternatives that are easily available in thevillage, and are equally nutritious.Voices from fieldUsually, well to do families and thosewho live close to the AnganwadiCentre can access its services,and the system often fails to reachthe poorest. The Uddeepika says“After home visits, I was able toidentify households that are comparatively richer.I convinced them that poorer households have agreater requirement, particularly of supplementarynutrition, so they were willing to share the benefitsof the system and help those in need”Uddeepika, Chapi Panchyat, Purnia, Bihar7Jyoti’s Kendra along with its kitchen is in a permanentbuilding. The equipment includes a water filter, dari(mat), chart papers, chairs, table, storage drum,teaching and learning materials, almirah, mirror andnail cutter. Efforts are ongoing to install a toilet andhand pump for water. She has also inspired otherAnganwadi workers in her Panchayat to improve theircentres, displaying their charts properly and cleaningthe kitchens. She organises weekly cluster meetingswith them to discuss identified subjects, share ideasand experiences and look at areas for improvement.She, along with the Anganwadi worker and the helper,also organises monthly community meetings to provideinformation on issues such as malnutrition, health andhygiene. These meetings are an opportunity for thecommunity to give their feedback on ICDS, whether theservices are helpful and how they could be improved andare important in fostering community participation andownership, ultimately leading to behaviour change.Jyoti is satisfied that the Anganwadi workers accepther advice and support her. She says that now thecommunity is more aware of ICDS and there have beenchanges in food habits and breast feeding practic

services at government approved rates. The State Health Society, Bihar and Bihar Technical Assistance Support Team (BTAST) are providing technical assistance to these centres in the form of identification of private partner for running the dialysis centres. BTAST is an initiative of Bihar Government supported by DFID-UK to

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