Popfocus 2009 July September English PFI :: PFI Publication :: KNOWLEDGE MANAGEMENT CENTRE PORTAL, POPULATION FOUNDATION OF INDIA

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Popfocus 2009 July September English PFI

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Popfocus 2009 July September English PFI

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Volume XXII; No.3 July – September 2009

THE POPULATION FOUNDATION OF INDIA NEWSLETTER

Babli Boli....

A joint initiative of NACO, UNDP and PFI

P“ roduction & Management

of a Radio Programme

for Rural Women & related

Community-based Activities” is a

project being implemented in five

districts in Rajasthan (Ajmer, Alwar,

Jaipur, Jodhpur & Barmer) and two

districts in Bihar (East Champaran

and Sitamarhi) with support from

UNDP, India and the National AIDS

Control Organization (NACO), New

Delhi.

The Process

A 52 episode radio drama series titled

Babli Boli is being produced by

PFI in association with Swar Sudha

Entertainment Pvt. Ltd. An integral

part of the programme is community

mobilization in the seven selected

districts aimed to increase the reach

of the radio programme through

formation of listeners’ clubs called

Babli Clubs. PFI has partnered

with one NGO in each district for

the community based activities. The

programme is broadcast directly

A role play by group members

by NACO in

Rajasthan, Bihar,

Uttar Pradesh,

Madhya Pradesh,

Himachal Pradesh,

Uttarakhand,

Jharkhand &

Chhattisgarh,

using the All India

Radio network.

The duration of

the project is 15

months.

Formative

Research &

Pre Testing

Dr RND Purohit, Project Director, RSACS inaugurating the ToT

Formative research along with pre-

testing of the programme was

conducted to determine the design of

the programme and the approach in

community level activities to ensure

that the programme is engaging and

relevant to the needs of the target

audience. The purpose of the

formative research was to understand

behaviours, attitudes and practices of

target groups and explore behavioural

determinants. A pre-test of the first

three episodes was also done to check

the comprehension and appeal of the

programme.

Inside

World Population Day

... 3

Ranking of Districts in Uttar Pradesh

for Area Specific Planning and

Programme Intervention

... 4

Strategic Communication Training

for Advocacy on Reproductive Health

and Family Planning

... 4

Advocacy Workshop on Home Based

Newborn and Child Care

... 5

The HIV/AIDS Programme

... 6

End-line Evaluation Reveals

Important Lessons for Reducing

Anaemia

... 8

Capacity Building Workshop on

Declining Sex Ratio

... 9

Jharkhand Youth Policy

Implementation: Regional Level

Consultations

... 11

Improving Institutional Delivery:

An Attempt at Convergence

... 12

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From the Executive Director’s desk...

Community radio is a subject that is gaining popularity

in the world of development and social

communication. The top-down communication models of

the nineteen seventies have lost their sheen considerably

and the new key words are inclusion and participation.

Given the fact that the mainstream media is unable to cater

to the true information needs of the community, as it is

primarily market driven and run with profit maximizing

motive, the question of alternative media comes to mind,

which definitely has to have space in terms of localization

of content, participation and involvement of the community.

The importance of community media for community

empowerment and democratization is now well known.

And voice based media are especially relevant in the Indian

context, given the poor literacy levels in rural areas. It can

also play a vital role in narrowing down the differences

between the broadcaster and the audience. With a growing

number of community radio stations in the country so far,

this medium is seen as addressing small communities and

meeting an individual’s day-to-day concerns and local needs

in a significant way. Community radio is aimed at educating

and entertaining the community using their own idioms

and language.

It is with this spirit that PFI has launched the project titled

“Production & Management of a Radio Programme

for Rural Women & Related Community-based

Activities” in five districts in Rajasthan and two districts

in Bihar.

“Babli Boli” (the title of the radio programme) is a step

towards integration of RCH and HIV/AIDS issues by

including messages on reproductive health and family

planning services together with information on HIV/AIDS

to increase awareness about risk and motivate behaviour

change among the vulnerable and general population,

especially among women and youth. The principal target

audience of Babli Boli is rural women. While the key

audience segments would include young rural women in

the age group of 15 to 29, vulnerable groups of women

including wives of migrant laborers, sex workers etc., people

living with HIV/AIDS (PLHAs), especially pregnant women

in rural areas will also be addressed through this

programme. The secondary audience will be service

providers, influencers, opinion shapers and leaders including

media and faith based leaders.

The overall approach of the 52 episode programme is of

Interaction, Participation and Entertainment mode

interwoven in a drama format. Community mobilization is

being taken up in 100 villages per district of the two states

which comes to 700 directly supported listeners’ clubs in

these two states. Intensive local pre -publicity of the radio

programme & awareness drive on the issues are also

planned in nearby villages for maximum outreach.

Networking will also be done with the active support of

local State AIDS Control Societies and its Targetted

Intervention NGOs along with its other IEC activities.

A. R. Nanda

These were undertaken as part of the inception phase of

the project, which helped in identifying and understanding

certain characteristics like interests, behaviours and needs

of the target population groups that influence their

decisions and actions towards responding to the situation

of STI / HIV / AIDS.

Design Document Workshops

Recognizing the need to be technically accurate as also

sensitive while developing the programme, a five-day

design document workshop was organized by NACO from

April 21 – 25, 2009 where all Producers, Script Writers,

Directors and Project Coordinators of three agencies

including PFI, participated. Two major outputs from the

workshop were the design document for first 25 episodes

and a story outline for the same. The design document

formed the basis of the scripts for Babli Boli. The second

design document workshop was also organized by NACO

from September 29 – October 1, 2009 to finalize the

content and approach for the rest of the episodes.

Partnership with Local NGOs

As part of the community mobilization initiatives, expression

of interest was invited from NGOs working in the concerned

districts having relevant experience in community

mobilization on health and/or livelihood-especially with rural

women. NGOs were selected in consultation with the State

AIDS Control Societies in both states.

District level partners selected are: In Bihar, Jan Nirman

for Sitamarhi district and Shaktivardhini for East

Champaran. In Rajasthan, Bal Sansar Sanstha, Human

People to People India, CEOCOEDECON, GRAVIS and

SURE were selected for Ajmer, Alwar, Jaipur, Jodhpur

and Barmer respectively.

State Level ToT

A state level training of trainers workshop of Project

Coordinators and Field Coordinators of two states was

organized in State Institute of Health & Family Welfare,

Jaipur to update their knowledge levels on various issues

of HIV/AIDS and train them as master trainers for the

training of 700 Listeners’ Club Leaders in Bihar and

Rajasthan. The ToT also aimed to build their capabilities

as Radio Reporters for sending in field bytes to be included

in every episode. The workshop was inaugurated by

Dr. RND Purohit, Project Director, Rajasthan State AIDS

A Club Leaders’ training in Barmer, Rajasthan

Contd. on page 7

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World Population Day

T o commemorate the World

Population Day on July 11,

2009, PFI organized events in

collaboration with the SMILE

Foundation in Delhi and with the

office of the Director General, Family

Welfare, Chief Medical Officer,

Lucknow, NRHM, SIFPSA and

Population Research Centre (PRC),

Department of Economics, University

of Lucknow in Lucknow.

In Delhi

As part of the World Population Day

eve celebrations on July 10, 2009,

SMILE Foundation and PFI organized

a “Walkathon” from Tolstoy Marg to

7, Jantar Mantar Marg. The theme

was “Beti Bhi Apni Hai”.

The Magsaysay awardee, Dr. Kiran

Bedi, (IPS) and Master Akshat, Child

Artiste and winner of National Child

Award for exceptional achievement

in Performing Arts joined the

advocacy campaign as Chief Guest

and Special Guest respectively.

The Walkathon continued with a

street play performance at Patel

Smarak sensitizing people on

“Female Foeticide”.

The Hindu, The Statesman, CNEB

and Sahara Samay joined in from the

media. The celebrations were telecast

in CNEB’s news bulletin on July 10,

2009.

In Lucknow

Two programmes were organized on

this occasion:

Dr. Kiran Bedi (IPS) leading the Walkathon in Delhi

Awareness Rally

The rally was organized by Chief

Medical Officer, Lucknow and around

700 children and teachers from 11

schools participated in the rally.

T-shirts and caps, sponsored by PFI

were distributed among the children.

Mr. Chandra Bhanu, District

Magistrate, Lucknow, flagged off the

rally in front of Vidhan Sabha,

Lucknow. Director General, Family

Welfare; Director General, Health and

other officers from the Health

department participated in the rally.

The rally culminated at Parivartan

Chauk where Dr. Almas Ali, Senior

Advisor, PFI along with DM,

Lucknow, and other eminent persons

addressed the gathering. In addition,

CMO office had also arranged debate

and poster painting competitions for

school children in their respective

schools. The prizes for these events

were sponsored by PFI.

World Population Day Event

with Population Research

Centre

It was organized with PRC, University

of Lucknow at Malviya Hall,

University of Lucknow. The

programme was chaired by Dr. C. B.

Prasad, Director General, Family

Welfare. Two posters: socio-

development indicators and IMR of

districts of UP prepared by PFI and a

leaflet on selected indicators of all the

districts of Uttar Pradesh (DLHS III)

were released on this occasion.

A snapshot of Awareness Rally organized in Lucknow

Two research papers: Gender Gap in

Education and Poverty Situation in

Uttar Pradesh by Dr. Rajesh

Chauhan, Joint Director, PRC and

Demographic Scenario and

Population Stabilization in Uttar

Pradesh by Dr. Subroto Mondal,

Sr. Advisor cum Research Manager,

PFI were presented. The programme

was attended by about 170 repre-

sentatives from government

departments, university and voluntary

agencies. The programme was well

covered by the media and became the

top story in almost all the newspapers

on the next day.

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Ranking of Districts in Uttar Pradesh

for Area Specific Planning and Programme Intervention

With the implementation of

Reproductive and Child Health

(RCH) programme, districts have

become the focus of attention.

The inter district disparities have a

strong bearing on the regional

disparities in development across the

states. The District Level Household

Survey (DLHS-3, 2007-08) provides

a set of key indicators for all districts

on reproductive and child health.

The Census, 2001 also provided

some indicators at the district level.

A combination of RCH and Census

based indicators help in assessment

of the overall socio-demographic

development of the districts. It will

also help the policy makers, planners

and programme managers to

formulate better strategies.

Understanding the need to develop

area specific planning and

programmatic intervention, an

attempt has been made by

Population Foundation of

India (PFI) to compute a composite

index ‘Socio Demographic Develop-

ment Index’ for Uttar Pradesh.

Methodology

A composite Index, Socio

Demographic Development

Index (SDDI), is developed by taking

into consideration of four Census

based indicators and six District Level

Household Survey (DLHS-3) based

indicators. Due to non-availability of

full ANC figures in the recently

released DLHS-3 fact sheets, three or

more ANC visits were used as a proxy

indicator. Similarly for safe delivery,

institutional delivery was used as a

proxy indicator. Three or more ANC

is considered as a better programme

monitoring indicator as compared to

full ANC. A full ANC includes three

or more ANC check ups, two TT

check ups and 90 or more Iron Folic

Acid. Across districts, it was observed

that the supply of IFA is irregular,

which on the other hand impact on

consumption of IFA and ultimately

it reduces the full ANC figure.

The following indicators were taken

into consideration, while preparing the

Socio Demographic Development

Index. Dimensional index for the ten

variables were developed. The SDDI

is an average of these ten individual

dimensional indices.

Indicators

For the individual dimensional index,

actual, maximum and minimum

values of these 10 indicators were

taken into consideration.

Census, 2001

1. Female literacy

2. Gender disparity in literacy

3. Child sex ratio

4. Proportion of population (0-6)

DLHS-3 (2007-08)

5. Girls marrying below the age of

18 years

6. Percentage of birth order three

and above

7. Currently married women using

any family planning methods

8. Instititutional delivery

9. Full immunization

10. Three or more ANC visits.

Findings

Out of the 70 districts in Uttar

Pradesh, 17 districts are having

composite index score of less than

50. The six bottom districts in terms

of the composite index are Budaun,

Shravasti, Bhraich, Balrampur,

Sahajahnpur and Etah. These districts

are also not performing well in terms

of other demographic and health

indicators such as child sex ratio,

contraceptive prevalence rate, ante-

natal care, institutional delivery, full

immunization and girls marrying

below 18 years of age.

Strategic Communication Training for Advocacy on

Reproductive Health and Family Planning

PFI, being a lead organization for

disseminating strategic advocacy

communication tool for India (known

as SMART CHART), has been

conducting workshops with NGOs in

Bihar, Jharkhand and at the national

level. The aim of this effort is to

enhance the capacity of NGOs for

undertaking effective advocacy with

Government on access to key health

services with special focus on

reproductive health and family

planning. As part of the initiative,

PFI conducted a series of trainings for

the past two years in building the

capacity of NGOs. 41 NGOs in Bihar,

27 NGOs in Jharkhand, 5 NGOs at

the national level, 3 NGOs each from

UP and Rajasthan, 2 NGOs from MP

and 8 NGOs from Nepal were trained

on the smart chart tool in 10 batches

of orientation programmes.

Considering the entire experience,

PFI has developed the “India Smart

Chart Trainer’s Manual”. The manual

was pilot tested during a three day

workshop organized at Patna.

Selected trainees from the past

trainings were invited to the training

programmes. Suggestions and

feedback received from the trainees

were considered to finalize the

trainer’s manual. Eight master trainers

were identified to carry out the future

training programmes with NGOs in

Bihar. The Foundation has planned

to test the final version of the module

with participants of Jharkhand in

October 2009 and to print the

module both in Hindi and English

languages.

The Foundation hopes that the

manual would be helpful to the master

trainers to help other NGOs in

preparing their advocacy planning

processes and strengthening

organizational efficacy for under-

taking advocacy on reproductive and

family planning issues.

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Advocacy Workshop on

Home Based Newborn and Child Care

The Home Based Newborn and

Child Care (HBNCC) model

pioneered by SEARCH, Gadchiroli

has now been accepted as one of the

key interventions to improve

neonatal, infant and child

health indicators in the country.

The HBNCC model, delivered

through a community level health

worker, is a composite of community

participation, high quality training,

intensive supervision, well functioning

procurement and logistic structures

and efficient monitoring and

evaluation systems.

Currently the scaling up of the

HBNCC model is envisaged entirely

through the public sector health

service system (except in the West

Bengal and Andhra Pradesh pilots).

The public sector envisages the

ASHA as the worker to deliver

HBNCC. Scaling up of HBNCC

offers a valuable opportunity to

significantly strengthen the role of

ASHA, the training structure, training

systems, monitoring and evaluation

methods. Currently there is a high

level of interest from the Planning

Commission as well as senior

leadership of the Ministry of Health

and Family Welfare, necessitating

to leverage interest to advocate

for programmatic and fiscal

commitments to HBNCC linked with

ASHA training at the central level.

To advocate for the scaling up of

HBNCC in various states, SEARCH

along with PFI/MSI had organized a

Dr Abhay Bang facilitating the workshop

Advocacy workshop in progress

two day strategic planning workshop

at New Surajkund, Haryana. The

participants of the workshop joined

hands to become members of the

national partnership for scaling up of

HBNCC and committed strongly for

advocating scaling up of HBNCC in

their respective states. It was agreed

that PFI would work as the secretariat

until a mechanism was evolved to

sustain it. As a follow up of the

workshop, a half day advocacy

meeting of the partners was held at

PFI, New Delhi office on August 7,

2009. During the meeting, it was

suggested that the representatives

from partner organizations would be

trained by Dr. Abhay Bang so that

they could become effective

advocates of HBNCC in their

respective states. In view of the above,

a one day advocacy training on

HBNCC was organized at PFI,

New Delhi on September 9, 2009

which was facilitated by Dr. Abhay

Bang and Dr. Rajani Ved. Dr. Bang

presented the details of the HBNCC

model with the participants and

Dr. Rajani Ved made a brief

presentation on the district level

implementation of HBNCC.

After the presentations and

discussions by both Dr. Bang and

Dr. Rajani, the participants paired

themselves for practicing the

HBNCC advocacy presentation. Each

participant was given 45 minutes

to prepare the presentation. The

presentations were prepared keeping

in view that the target audience would

be key government officials such as

NRHM Mission Director, Health

Secretary, etc. It was found very useful

by the participants as they could learn

the skills hands on. They also

benefited from Dr. Bang’s input on

their presentation.

Overall, the participants expressed

confidence that they could make the

presentation independently but all felt

that an initial meeting at the state level

with the Secretary (Health) and the

Mission Director should be facilitated

by Dr. Bang.

Future Planning

After the practice session on HBNCC

advocacy, the participants

reassembled as a large group where

they shared their future plans/ next

steps for taking HBNCC advocacy

forward.

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The HIV/AIDS Programme

Expositions are a good medium to

bring people together for

experience sharing. Keeping this in

mind, the state units of PFI HIV/AIDS

program organized state level

expositions for PLHIV in the high

prevalence states in India.

It provided a platform for PLHIV

involved in the program to share their

experiences to a broad range of

stakeholders. Representatives from

District Level Networks (DLNs),

Positive Living Centres (PLCs),

Community Care Centres (CCCs),

Comprehensive Care and Support

Centres (CCSCs), ART Centres, State

AIDS Control Societies, senior officials

of various government departments,

colleges, banks, NABARD, NGOs and

media participated in these events.

These state expositions were

conducted not only to share the best

practices and to motivate the PLHIV

but also to recognize the efforts and

hard work of the staff of the service

delivery points. To encourage them,

various competitions were organized

such as games, slogans, posters,

music, rangoli, nutrition role plays and

quiz. The participants actively

participated in the competitions and

were appreciated by prize, token &

certificates.

Andhra Pradesh

Population Foundation of India-State

Coordination Unit had organized an

exposition on July 14 –15, 2009 at

Vishakhapatnam. The theme of the

exposition was “Children & Care-

takers – A platform to discuss about

children living with HIV/AIDS Issues,

Challenges and Solutions”. Parallel

sessions were organized for CLHIV

and caretakers. Challenges faced and

possible recommendations by care-

takers were advocated to the district

government authorities and other

stakeholders working with the issues

related to CLHIV. Many of the CLHIV

came to know about their status, many

caretakers came to know that children

knew about HIV before coming to the

program and were surprised with their

knowledge. Capacity of caretakers

with respect to some important

aspects pertaining to CLHIV was

Manipur Exposition (Left to Right): Mr Hegin Lupho, General Secretary, Network of

PLHA Manipur, Mr Sushil Huidrom, State Coordinator, UNAIDS, Dr. Kh. Pramod

Kumar Singh, Project Director Technical, MSACS and Mr Abhiram Mongjam,

Joint Director, MSACS

increased. District AIDS Control

Society has agreed to take up

suggestions given by caretakers.

Karnataka

PFI-state unit of Karnataka conducted

a three day Exposition from July 20–

22, 2009 at Kudalsangama of

Baglkot District, Karnataka. The core

participants were PLHIV especially

positive women and men who

are working as Volunteer Peer

Educators in the program. About 96

PLHIV from different districts

participated in this three day

exposition. The theme was “Women

– Being the change makers in health

and development”. This was an effort

to educate and sensitize participants

on issues like reproductive tract

infection, cervical cancer prevention,

second line ART, gover nment

schemes, low cost nutrition –

preparation and demonstration,

gender and enhancing health seeking

behaviour among the women.

Medical camp was organized and

medical test like blood group and Hb

were conducted for the participants.

Manipur

The theme for exposition in Manipur

was “Empowerment through

Participation”. The broader goal of

the expositions was to address the

economic needs of the PLHIV in the

state. Keeping this in mind, along

with sessions on issues related to

HIV, capacity building sessions on

available schemes and facilities were

conducted by resource person from

NABARD, Social Welfare, AMEA

(All Manipur Entrepreneurs

Association), and a proprietor of a

small scale industry – Romi Bag

Industries.

Nagaland

PFI-Nagaland unit organized the state

level exposition programme at

Dimapur Town Hall in collaboration

with the Nagaland State AIDS

Control Society (NSACS) and

Network of Naga People Living

with HIV/AIDS (NNP+) on August

25–26, 2009. The theme of the

exposition was “Empowering

People, Strengthening Net-

works”. About 120 participants

attended the exposition. The

participants were widow/widower

and clients from District Level

Networks, Treatment Support

Centre, Positive Living Centre and

Community Care Centre of

Nagaland. This exposition provided

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an opportunity to PLHIV to get

information on issues related to

HIV/AIDS and livelihood. Service

delivery sites established under the

program shared their experiences

and lessons learned, approaches

and practices. NABARD and SBI

have shown their interest to support

the training on SHGs and IGPs.

Tamil Nadu

The Tamil Nadu State Programme

Coordination unit of Population

Foundation of India presented the

Report of Exposition on “Change

Makers – 2009” held on July 29 –

31, 2009 at Mamallapuram.

The exposition in Tamil Nadu

focused on the theme“Change

Makers 2009”. Around 100 staff

participated in the exposition.

The expositions promoted good

practices and provided PLHIV an

opportunity to relax. Rewards,

recognition and capacity building

were the major tools used in the

exposition towards motivation.

Darkness to Dawn

Suraj, (name changed) belongs to a

lower middle class family. He was very

fond of dancing and dressing like

females. He got sexually involved with

men and soon had multiple partners

and enjoyed their company. His health

condition deteriorated and he started

losing weight rapidly and had recurrent

fever. He consulted a private doctor

who referred him to a private lab for

HIV testing. He was not counseled on

the implication of the test result. The

test revealed that he was HIV positive.

He was told that he had AIDS and

would die soon. The medical report

always kept flashing in his mind. He

could not share this with anyone and

hence was very disturbed. After a lot

of hesitation, he disclosed his status

to his mother and sisters. His mother

and sisters were shocked and kept his

status under wraps. The entire family

had lost hope.

Once he got an opportunity to

participate in a support group

meeting organized by DLN. The peer

educator, after hearing his case, took

him to the ICTC. He was screened

for HIV and counseled. The ICTC

referred him to the ART centre where

his CD4 count was found to be

91/ml and he was initiated on ARV.

The ART center referred him to the

CCC. During his 5 days stay at the

CCC, comprehensive counseling was

provided to him on myths associated

with the HIV/AIDS, positive

prevention, treatment adherence and

how to live a healthy and happy life

with HIV. Suraj slowly developed a

positive attitude.

The CCC helped him to update his

knowledge and cleared his myths and

misconceptions. He motivated his

friends to get tested for HIV. The

CCC linked him with a targeted

intervention project. Today he is

working as a peer educator for the

MSMs and ‘Kinnar’ (transgender)

group.

Contd. from page 2

Control Society as Chief Guest and

attended by Mr. Ashok Raisighani,

Project Officer-SMU, RSACS and PFI

officials, Ms Sona Sharma, Joint

Director (A&C), Ms Chandni Malik,

Programme Officer (A&C) and

Mr. Manoj Kandher, Programme

Associate (A&C), who are also the

programme coordinators for this

project. Resource persons from

RSACS, HLFPPT, RNP+ facilitated

sessions on different issues of

HIV/AIDS. The participants were

also trained by Swar Sudha and PFI

on the basics of radio reporting and

A Club Leaders’ training in

East Champaran, Bihar

handling the recorder to enable them

to record and send audio bytes from

the field. Recorders were provided to

each district at the end of the training.

District/Block Level Trainings

of the Listeners’ Club Leaders

District/Block level trainings were

organized for the Club Leaders of the

Babli Clubs in the seven districts of

Rajasthan and Bihar. The basic

objectives were to enhance their

knowledge levels on various issues of

HIV/AIDS, clarify the role and

activities of the listeners clubs and to

build their capabilities as Radio

Reporters.

In Bihar, the training programmes

were conducted from September

7- 9, 2009. Jan Nirman organized it

in Parihar Block of Sitamrhi.

Similarly, it was organized by

Shaktivardhini in Raxual and Adapur

blocks of East Champaran district.

In Rajasthan, the training workshops

were organized from September

6-9, 2009 in Jodhpur and Barmer.

GRAVIS organized it in Osian block

of Jodhpur where as SURE

conducted in Danta block of Barmer

district. In Jaipur, the workshops were

organized by CECOEDECON on

September 6- 7, 2009 and in Ajmer

at Sambal CCC in Kisangarh by BSS

on September 7-8, 2009.

A few episodes were played for the

Club Leaders during the workshops

and their suggestions, views were

invited. The response from the Club

Leaders was extremely positive and

they related well to the storyline

and characters in the drama. The

technical information presented by

the master trainers was closely

monitored by the external persons

from PFI, who attended the

workshop. Most districts also invited

the ICTC counselors as resource

persons for the workshops.

The programme is broadcast on

every Wednesday and Thursday

from 12:30 – 1:00 pm on Vividh

Bharti and from 1:30 – 2:00 pm on

FM Rainbow apart from the local

radio stations, as per the availability

of time in the afternoons.

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End-line Evaluation Reveals Important Lessons

for Reducing Anaemia

P revalence of anaemia (any

anaemia) in pregnant women

and adolescent girls has been a major

reproductive health concern in India.

As per the National Family Health

Survey (NFHS)-III, 56.2% of ever

married women in the age group of

15-49 and 57.2% of pregnant

women were found to be anaemic.

The figures for the state of Haryana

were higher at 56.5% for ever

married women and 69.7% for

pregnant women. According to

WHO, a level of haemoglobin below

11g/dl during pregnancy is an

indication of anaemia.

The main reasons for Iron Deficiency

Anaemia (IDA) have been determined

to be inadequate intake of iron, low

bioavailability (1-6 percent) of dietary

iron from plant foods [Rao et al 1983]

due to inhibitory factors, low levels

of absorption enhancers in the diet,

repeated pregnancies, increased

needs during growth and

development among children and

adolescents, parasitic infestations and

chronic blood loss. Poverty

compounds these factors through

inadequate access to dietary diversity,

safe water, knowledge about safe food

handling and proper feeding practices

[FAO 1997].

The three year intervention project

on “Assessment, Prevention and

Control of Iron Deficiency Anaemia

Among Adolescent Girls, Pregnant

and Lactating Women” or “Khoon

Bane Na Paani Pariyojna” was

launched in April, 2006 by Sukarya

(Gurgaon) in ten villages of Gurgaon

district in Haryana. It was mandated

to reduce anaemia in some selected

target population and work towards

bringing about behaviour change and

dietary practices and other related

lifestyle changes.

The strategy involved baseline

assessment of the current dietary

behaviours, culinary practices,

prevalence of anaemia among the

target groups and health seeking

behaviours; networking with and

influencing important stakeholders;

Blood test being conducted under intervention

capacity building of project staff and

stakeholders; conducting intensive

behaviour change activities; providing

regular ‘assessment and treatment’

facilities and evaluating the impact at

the end of the project period.

The project ended in June 2009 and

an endline evaluation was carried out

during May 2009 – June 2009.

Development Facilitators (DF), a Delhi

based research agency was

commissioned to conduct the endline

evaluation. The study objectives were

to (i) estimate the endline status of

prevalence of anaemia among

the target groups, (ii) ascertain

behavioural changes brought about by

project interventions, and (iii) identify

and document best practices and

lessons learnt.

389 randomly selected target

respondents from seven project

villages were interviewed, of which

210 were unmarried adolescent girls

(14-20 years), 99 pregnant women

and 80 lactating mothers. Both

school going and non-school going

adolescent girls were covered.

Qualitative information was collected

through in-depth interviews and

focus group discussions with the

target groups and the important

stakeholders.

Key Findings

• Prevalence of moderate anaemia

among different target groups after

the intervention was noted as 2.1%

among pregnant women, 12.7%

among lactating mothers and 4.6%

among unmarried adolescent girls.

• No pregnant woman was noted

as severely anaemic after the

intervention. Only 1.5% among

unmarried adolescent girls and

3.8% among lactating mothers

were severely anaemic.

• Roughly 59% of unmarried

adolescent girls were aware about

anaemia before intervention and

after intervention 82% of them

were fully aware of anaemia and

its adverse effects.

• Of the two women target groups,

an increase of 24% awareness

among pregnant women and 33%

among the lactating mothers was

noted. While 55% pregnant

women knew about anaemia

before intervention, it increased up

to 79% after intervention. In case

of lactating mothers, it had

increased from 52% from baseline

to 85% during endline.

• Overall, while barely half of the

project population had knowledge

and awareness on anaemia before

intervention, it considerably

increased up to 80% after the

intervention.

• Before intervention, only 7%

adolescents had knowledge that

Contd. on page 10

1.9 Page 9

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Capacity Building Workshop on Declining Sex Ratio

Voluntary Health Association of

Punjab, Chandigarh and

Population Foundation of India,

New Delhi organized a one day

capacity building workshop for the

stakeholders/social change agents on

declining sex ratio on August 4 , 2009

at Fatehgarh Sahib. The aim of the

workshop was to train the grass root

change agents to work for the cause

as a catalyst and develop a

mechanism which can bring positive

and deliberate changes in the existing

patterns. The main objectives of the

workshop were to (i) sensitize the

social change agents on the

concerning issue and motivate them

for acting as a force for fighting with

the menace of sex selective abortions

and also with the impact of the sex

selective abortions on the community

at a large, (ii) develop and promote

self sustained approach and network

to deal with the issue concerned, (iii)

empower the grass root change

agents by building capacities in a

holistic manner, and (iv) provide

supportive mechanism to the change

agents for making them prepared for

larger roles.

About 50 participants from 10

intervention villages including

Sarpanches, Panches, Mahila Mandal

Members, Aanganwadi workers,

ASHAs and Youth groups as well as

members of Self Help Groups were

present at the workshop.

Mr. Jasvir Singh, Project Coordinator,

VHAP, in his welcome address, gave

an overview of the campaign against

declining sex ratio, reasons for

initiating such campaigns in the area,

objectives of the workshop, grim

pictures of the menace, scenario at

the national, state and district levels

and the role of Sarpanches, Panches,

ASHAs, ANMs and Aanganwadi

workers and the informal leaders as

they can preach and exercise

authority in the community.

Dr. Satwant Bhalla, CMO of District

Fatehgarh Sahib inaugurated the

workshop. While portraying the grim

realities, she said that there are ten

districts in India which have the lowest

Workshop in progress at Fatehgarh Sahib

sex ratio and the District Fatehgarh

Sahib is one among them. Sex ratio

is not in favour of girls primarily

because of sex selective abortions.

While highlighting the possible

consequences explored during various

researches, Mr Manmohan Sharma,

Executive Director, VHAP added that

if there will be no girls or less girls in

the society and the equilibrium of the

society gets tilted, there will be no

brides for many boys and to some

extent the discrimination and gender

based violence will become more

prevalent.

While sharing her view points,

Ms Krishna Atri, CDPO Sirhind said

that improving sex ratio is necessary

to change the mindset of the people

regarding girls so that the coming

generation would solve this problem.

As it is difficult to break the norms

and systems of the society by the

women, there is need to work with

the community as a whole. The

existing government initiative(s) in the

form of pro-girl child schems like

‘Dhan Lakshmi’ should be promoted

for the empowerment of the girl child.

Mr Sudhir Kumar, District Gender

Coordinator, Sarva Shiksha Abhiyaan,

Fatehgarh Sahib shared various

schemes for the girl child. Pendu

Shiksha Vikas Committee will be

formed in every village in which

sarpanch, school incharge, two

members from SC category, social

workers, two members from parent

teachers association, retired teacher or

headmaster/headmistress or police

personnel will be the members of

that committee, whose primary

responsibility will be to promote and

ensure education to all children

especially the girl children.

Ms. Sneh, District Welfare Officer for

Women, Fatehgarh Sahib explained

the effective role of Self Help Group

Members as well as Mahila Mandal

Members in eradicating the menace

of sex selective abortion from the

society. She said, “Ek Ladki Mamta

Ki Poonj Hoti Hai” highlighting that

a girl is a combination of kindness and

affection. The society has to give

equal respect to the woman as she is

the only one who makes the biggest

contribution towards the family

members and the society at a large.

In order to explore the perceptions

of the stakeholders, an open

discussion was facilitated. Some of the

main points that emerged from the

discussion were:

• The root cause of this evil is dowry

because of which people are scared

to give birth to a girl child.

• Biased mindsets against girls

reflected in various attitudes like

girls can’t be equal to boys in any

field.

• Origin of a new trend such as if a

couple has one male child then

they will not take second chance

for conception because of the fear

of having a girl child.

Some of the suggestions of the

participants were:

Contd. on page 10

1.10 Page 10

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Contd. from page 8

less intake of nutritional foods

cause anaemia, whereas 64% of

the adolescents after intervention

possessed sufficient knowledge

that lack of it causes anaemia.

• Use of less green leafy vegetables

in food causing anaemia was known

to 7% lactating mothers and 12%

unmarried adolescent girls and no

pregnant women had such

knowledge before intervention.

Significantly after intervention,

more than 70% across target

groups had complete awareness

that use of less green leafy

vegetables in food causes anaemia.

• Among the project population, not

only awareness and knowledge

regarding the type of food to be

consumed to reduce prevalence of

anaemia was increased but also

corrective practices were suitably

adopted by them after the

intervention.

• Prior to intervention, project

population had known that less

intake of nutritional food prevent

anaemia and knowledge of non-

vegetarian food preventing

anaemia was rarely known

(12% among unmarried adolescent

girls, 15% among pregnant

women and 13% among lactating

mothers). But after intervention,

24% unmarried adolescent girls,

19% pregnant women and 21%

lactating mothers had acquired

knowledge that non vegetarian

food also prevents anaemia.

• 64% adolescent girls had never

eaten non vegetarian food before

intervention, such proportion of

population was reduced to 17% after

intervention; similarly, percentage of

pregnant women was reduced from

58% to 18% and lactating mothers

from 56% during baseline to

19% at the endline.

• Eating fruits especially lemon

every day in their diet

considerably increased after

the intervention. 26% more

unmarried adolescent girls,

20% more pregnant women

and 28% lactating mothers

more than the baseline were

noted to be consuming fruits

especially lemon in their diet

every day.

Lactating mothers participating in healthy

baby show

• After intervention, people were

noted to be hygienically very alert

which was not the case before

intervention. While barely half of

the population used to wash their

hands before intervention, 63%

were noted to be washing their

hands before taking food after the

intervention of the project.

Promising Practices

• Formation of self help groups

among target groups to ensure

increased participation in project

activities was one of the most

pertinent strategic interventions

that was adopted under the

intervention to qualitatively

improve collective participation in

project activities.

• Networking with the local schools

instantly accrued desired

stakeholders’ support to project

operationalisation and facilitated

institutional back up support as well

as legitimacy to the project

initiatives.

• One of the most effective IEC

interventions noted was the

documentary film “Jab Jago Tab

Savera” which was shot in the

project villages.

• Nutrition

demonstrations

organized under the project had

adequately motivated the target

groups to adopt healthy eating

habits and develop the habit of

regular intake of iron and vitamin

rich food so as to keep themselves

anaemia free and healthy.

• Concerted efforts to motivate

target groups to switch over to

swasthya namak or double fortified

salt had been one of the most

desired interventions under the

project to reduce prevalence of

anaemia.

• Popularisation of iron pan or iron

karahi for cooking green leafy

vegetables proved quite beneficial

for the project population, majority

of whom were vegetarian.

• Networking with educational

institutions, ICDS functionaries,

community health providers such

as ANMs etc significantly increased

the efficacy of the project and set

out excellent example of

convergence under the project.

• Strategic documentation, both

processual and end-effect-oriented

was one of the effective practices

that ensured the success of the

programme to a considerable

extent. “Janani Record Book”,

“Recipe Book” on iron and vitamin

rich food items and “Process

Documentation” may be cited as

examples.

Contd. from page 9

• Seminars must be organized at the

grass root level.

• Promotion of the pro girl child

schemes.

• Active involvement of the youth

especially in the Youth Welfare Clubs.

• Active participation of Sarpanches

and Panches to sensitize the

people on the issue

• Promotion of the efforts for

making girls self reliant.

• Ensuring strict implementation of

the laws like PCPNDT Act, Dowry

Prohibition etc.

• Counseling services should be

provided for both mother and

father when they plan to give

birth of a child and even after

conception.

• Proper registration of pregnancies

must be done in villages.

2 Pages 11-20

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2.1 Page 11

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Jharkhand Youth Policy Implementation:

Regional Level Consultations

Young people are the key players

and important contributors to

reconstruction and development of

the nation. In India including the State

of Jharkhand, youth forms the largest

segment of the population.

Recognizing the need of ensuring

overall development of young people

in the State, the Jharkhand Youth

Policy of the State Government came

into existence in 2008. The policy is

a commitment of Jharkhand

Government to promote holistic

development of youth in the state in

consonance with the National Youth

Policy. The state draft policy was

widely disseminated on July 30,

2007 using web as a medium, and

approved by the State Government

Lighting the lamp: Mr R U Singh, Hon. Advisor for Bihar and Jharkhand, PFI;

Mr Aditya Swarup, Secretary, Social Welfare; Mr R S Verma, Secretary,

Department of Youth Affairs, Government of Jharkhand.

on February 12, 2008.

implementation plan through a region (Betla) and South Chotanagpur

Population Foundation of India (PFI)

facilitated the process of bringing

together the civil society in

developing this Youth Policy. As a

follow up to the efforts and

suggestions made in the state

dissemination workshop towards

implementing the Youth Policy and

on request of the State Government,

PFI organized regional consultations

in collaboration with the Department

of Art, Culture, Sports and Youth

Affairs, Government of Jharkhand.

The consultations focused on the

involvement of young people, civil

participatory approach.

The initiative of PFI to develop a

feasible implementation plan for the

State Youth Policy has been initiated

with the partnership of State

Government through five regional

level consultations. Each consultation

is being held at the Commissionary

headquarters covering all the districts

of the region and coordinated by local

organizations working on youth issues

in the region. A fair representation

from district administration, NGOs,

civil society, training institutes, media,

academia and youth based institutions

region (Ranchi) between July –

September 2009. The objectives of

the consultations were to identify the

issues and concerns of the region,

draw an implementation strategy

and region-wise composite imple-

mentation plan.

The Foundation is now in the process

of compiling the region specific

reports to come up with a

consolidated report for submitting to

the Government of Jharkhand along

with the individual region specific

report for further action. The State

Government will then send the report

society organizations, media, elected

representatives and government

functionaries at the regional level to

working on health, livelihoods, rural

development, young adults (male/

female, educated/ drop outs/illiterate,

to the respective Departments for

budget allocation so as to include the

activity in the respective department’s

get feedback on designing the youth leaders, SHGs, married, annual Programme Implementation

unmarried) is ensured Plan.

in such consultations.

Two regional level

workshops were held

for Kolhan region

(Jamshedpur) and

North Chotanagpur

(Hazaribag) during

January – March

A dissemination meeting will be held

to share the Implementation Plan

(both the regional level consultations

and the collated plan) at the state

level with the participation of

representatives from different

government departments, NGOs,

youth based organizations, youth

2009 and three and academics in the state.

regional level work- The feedback/recommendations

shops were held for emerging from the regional

Participants presenting the proposed Implementation Plan Dumka

region

of Chotanagpur

(Dumka), Palamu

consultations will be presented at the

state dissemination workshop.

2.2 Page 12

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Improving Institutional Delivery:

An Attempt at Convergence

Adarsh Nav Yuvak Mandal, a field

NGO working under NRHM

through Mother NGO scheme for

improvement of complete ante-natal

care/post natal care, institutional

delivery and immunization coverage

at Dongargaon Block of Rajnand-

gaon district of Chhattisgarh State,

has made the convergence attempt

successful. The organization has a

project area covering more than 14

underserved villages in the block and

they have been putting their efforts

to meet the objectives of the

programme. Transportation being

the major hurdle for poor institutional

delivery in the project villages, the

organization initially concentrated