Hundred Block Plan Visit

1
Hundred Block Plan Visit

• HBP Gaya Update
• Visit to BGVS Manpur
• December 25-27, 2004
• Madhulika, Balakrishnan
• AID Austin

2
Outline

• HBP-Brief Description
• Training Camp Outcomes
• Phase 1, 2, 3 in June 02
• Balajis Update in March 03
• Results of first weighing in June 03
• Dec 03 Visit by Madhu and Bala
• Latest Update Feb 04

3
Public Health Structure
CHC
PHC
PHC
PHC
4
HBP-Objectives

• Measurable improvement in child and womens
  health status
• Improve utilization of Govt. health services
• Organize support network for women to build a
  womens movement
• Build skills in the panchayat for local health
  planning

5
VHA The key person

• Measure malnutrition in children(lt6)
• Give personalized suggestions to the mother

How is she identified? But how can she do this
all by herself ? Does she feel confident and
empowered? What level of literacy is
required? What is the level of health awareness
required? Does she get paid? What is the
motivation?
Health Activist
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Training
HA
HA
HA
HA
HA
Cluster Resource Persons
Cluster Resource Persons
Cluster Resource Persons
Block Coordinators
Block Coordinators
State Resource Persons
State Coordinator
7
Health Activists Role

• 4 step information collection
• Food nutrition
• Immunization records
• Any sickness in the past few months
• Appreciates and respects the mothers wisdom
• Tries to understand why the mother cant or wont
  follow her advice

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Who is a VHA and why is she motivated?

• Background
• From the village
• Poor social background
• Low level of education
• Motivation
• Recognition of her work
• She is honored in village meetings
• Praised in front of the mother
• Is not blamed for weak children (weak training is
  assumed)
• Trainers lead by example in field training

9
History

• Initiated by TNSF in 1996 in 60 villages
• Dept of Health (GoI)
• 2 blocks in 1997
• Dept of Science Technology
• 7 blocks in 1999
• UNICEF
• Study in April 2001 in 197 villages
• Unicef ranked Arogya Iyyakkam as one of the top
  ten health programs worldwide
• TN Govt. incorporated the experiences into Govt.
  programs

10
Understanding HBP in local contexts

• Bihar Jan Swastya Abhiyan
• Tamilnadu Arogya Iyakkam

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Questions? Questions?

• Why is the volunteer called activist?
• Is a health movement activism?
• Is health not controversial by nature ? Or are we
  refusing to see the controversies?
• Can improvement in health take place in
  isolation?
• Do we have a consensus on what can be done?
• Do we even debate?

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Some things to remember..

• VHA Village Health Activist
• SHG Self help group
• SFT State Full Timer
• BFT/CRP Block Full Timer/ Cluster Resource
  Person
• PHC Primary Health Center
• ANM Auxiliary Nurse Midwife

13
State Camp June 2002

• 4 days
• Organisers insisted for 60 womens participation
• Invited 5 people from each block
• Day 1
• Health problems in each block
• Day 2
• Study on health issues Health activists role
• Malnutrition its relation to poverty
• Field training
• Action plan

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State Camp -June 2002

• Day 3
• Discussion of the health program
• Understanding the public health infrastructure
• Understanding the problems the ANM faces and
  empathizing with them
• Day 4
• Discussion of indicators
• Input, process, impact
• Different phases of the program

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State Camp Phases of HBP

• Preparatory (Sept 2002)
• Formation of block committees
• Identification of full timers, VHAs
• Formation of SHGs
• Block level training
• Phase I (Oct Dec 2002)
• Zonal training of block activists Full timers
• Opening of health registers
• Reaching every household
• Compilation of data regarding Dais
• Block level training
• Documentation of problems

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State Camp Phases of HBP

• Phase II (Jan Mar 2003)
• Complete weighing of children
• Compilation of list of children and grades
• Coordination with ANM Aaanganwaadi
• External evaluation of a smaller sample
• Next (?)
• Was to be decided

17
Manpur Block

• 68 villages and 150 sporadic settlements
• BGVS started with Kala Jathas (street plays) in
  1991-1992
• Programs continued until 1995-1996 but have
  slacked since
• Severe resource crunch
• BGVS village committee in almost every village
• 12 village panchayats some a little better
• HBP started in Oct. 2002

18
Balajis Update March 2003

• Manpur block - Organization
• Block coordinator Binod Kumarji
• State resource person Saritaji
• State Coordinator Dinesh Prasadji
• 7 cluster resource persons
• Implementation
• Villages 45
• 1st phase weighing 32 doing
• Vital events not started after the survey
• SHGs 5

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Balajis comments

• Good start in all the blocks
• Insufficient state training
• Low levels of literacy
• Delay trying to get weighing machines from
  Aanganwadis cost cutting
• House to house talking not started in most blocks
• Insufficient training about talking to mothers
• Need to concentrate on Govt. services utilization
  womens health- can be deferred until the child
  health pregnant women components are solidly in
  place

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Results of 1st weighing June 2003

• Children 3995 (M) 3538 (F) 7533
• Children weighed 5798
• Grades
• Normal 2182
• Grade I 1941
• Grade II 1195
• Grade III 371
• Grade IV 33

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H HBP District
H
H
H
H
H
H
H
H
H
H
H
H
H
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Madhu and Balas Visit

• Status before the visit
• First phase of weighing in 60 villages completed
• Second phase of weighing in progress
• Only 3 state resource persons
• Saritaji - 5 blocks
• Sadanandji 7 blocks
• Sheila Mani 2 blocks (Jharkhand)
• Manpur block 6 cluster resource persons
• Each handling 10 villages
• 2 women and 4 men

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Preparing for Dec 2003 Visit

• Wanted to see
• House to house talking by each person
• Village Health Activist
• Cluster Resource Person (block full timers)
• Block Coordinators
• State Resource Person
• Registers
• Self Help Groups
• Participation of women in the program

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Bodhgaya
25
Dec 2003 Visit

• Visited 3 villages in Manpur and 1 in Jehanabad
• Nauranga, Ganjas and Mehermanchak
• Nauranga
• House to house talking and weighing
• Ganjas
• Meeting with cluster resource persons
• Meeting with SHG
• Lunch
• Mehermanchak
• House to house talking
• Gorapur (Jehanabad)
• Weighing, talking and meeting with SHG

26
Nauranga Village

• VHAs Renu Devi and Raju Kumar
• Went with Saritaji, Binod Kumarji, Rekhaji
• Looked at registers
• House to house talking and weighing
• Renuji, Rekhaji and Saritaji talked
• Mixed response from the villagers

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Rekhaji weighing a child
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Rekhaji and Renuji talking to a mother
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Children very interested in what Madhu was
talking in Hindi!
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Binod Kumarji showing the register
31
Ganjas Village

• Meeting with block full timers (cluster resource
  persons)
• Wanted to know their experiences/problems
• Events undertaken in the last few months
• Number of training camps they attended
• WomenMen VHAs
• Change in VHAs new training given?
• Interaction with Panchayat and PHC
• SHGs
• They wanted to know our
• Background, interest, fundraising methods
• Thoughts on the program
• Had photos sent by Nishant/Gayathri

32
Meeting with cluster resource persons
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Discussion with Cluster Resource Persons

• 43 men and 15 women as VHAs
• No change in VHAs
• Need CRPs to go house-to-house
• Advantages of having men as VHAs
• Mobility (transportation)
• Help in weighing
• Disadvantages
• Difficulty in talking to the mother
• Events
• Kala Jatha in Baradih Village
• 3 new SHGs formed
• Initial meetings for SHGs in 2-3 villages

34
Discussion..

• Interaction with Govt. Health Services
• Everybody used aanganwaadis weighing machine
• VHA helped arrange immunization in 1 village
• Complained about ANM
• Transferred and new ANM appointed in Khaiyya
• No action taken in Bhadeji and Bikhi villages
• Recording Denial of Health Care cases
• Plan to present in health march in Patna in April

35
Discussion..

• Problems
• Getting weighing machines from aanganwadis
• Language problem in muslim localities
• Need to know urdu
• Superstitions
• Immunization will lead to childlessness
• Immunization will cause fever
• Difficulty in lifting weighing m/cs when both
  VHAs and cluster resource persons are women
• Some VHAs complain that they dont have time

36
Ganjas Village Meeting with SHG members

• Started with a song
• 16 women contributing Rs 20 for 9 months
• Meet once a month only to give money
• No bank account
• Some women were not comfortable
• Advantages (according to the women)
• Emergency loans at very low interest
• Can use funds for daughters marriage
• Saritajis suggestions
• Can use this forum to discuss health hygiene
• Meet more often and deposit Rs 5 per week

37
Meeting with members of the SHG
38
Meharmanchak Village

• Very low development level
• Apparent caste divide
• Lower caste people migrant labourers - were
  not present
• 2nd round weighing not yet started
• People remember Nishants visit
• House-to-house talking
• Health activist was male
• Binod Kumarji Saritaji talked
• Madhu talked to a pregnant woman

39
Gorapur Vilage

• Jehanabad Block
• SHG meeting
• Women were more vocal
• Met a naxal lady
• Weighing and house-to-house talking

40
BGVS Jehanabad team
41
Discussion with Saritaji and Dineshji

• Would it be helpful if we send computers ?
• Not at this moment
• Honorarium for VHAs ?
• Not at this time
• VHAs should completely understand the importance
  of program
• Should not feel talking to mothers is trivial
• What else can we do to motivate the VHAs?
• Certificates of appreciation
• More site visits and more training

42
Discussion with Saritaji and Dineshji

• Future Plans
• Training Camp in Feb.
• Try to get more women VHAs in phases
• Exclude villages from program where women dont
  come forward as VHAs

43
Summary

• Registers maintained well
• More training required for cluster resource
  persons and VHAs
• Need to adapt this program more to Bihar
• Increase involvement of AID volunteers

44
Latest Update

• Talked with Dineshji on 2nd Feb.
• Block coordinators meeting on 20th
• Meeting on 12th of every month
• Monthly bulletin about each block
• Weighing completed in 45 villages
• Bank a/c opened for 10 SHGs
• March 13-15th Gaya Health Activist training
• Training for 4 blocks already 70 women