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Bhubaneswar Conference Report 2010 PFI |
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Population, Health and Social Development
in Bihar, Jharkhand, Orissa and West Bengal
Conference Report
February 16-17, 2010
Bhubaneswar
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Population,
Health and Social Development
in Bihar, Jharkhand, Orissa and West Bengal
Conference Report
February 16-17, 2010
Bhubaneswar
POPULATION FOUNDATION OF INDIA
NEW DELHI
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© Population Foundation of India, 2010
Editorial Guidance
Mr. A.R. Nanda
Dr. Arundhati Mishra
Compilation & Editing
Ms. Sona Sharma
Ms. Mohini Kak
Ms. Chandni Malik
Contributors
Dr. Subrato Mondal
Dr. Mary Verghese
Dr. Lalitendu Jagatdeb
Mr. Nihar Ranjan Mishra
Dr. Shalini Verma
Ms. Nikita Sinha
Ms. Lopamudra Paul
Mr. Manoj Kandher
Ms. Mridu Panday
Mr. Matish Kumar
Mr. Sanjay Kumar Singh
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Foreword
The Population Foundation of India has been organizing state and regional level
conferences for several years now, with the aim of highlighting the issues and challenges
on health, population and social development in the state/region. The conferences provide
a platform for reflection on the issues resulting in a set of recommendations with policy or
programme implications for the state/region.
To commemorate the 40th year of PFI’s existence, this effort is being intensified to include
three regional conferences culminating in a National Conference at the end of the year. The
first in the series was a Regional Conference organized in Bhubaneswar on February 16-17,
2010 for the eastern Region: Bihar, Jharkhand, Orissa and West Bengal.
We are thankful to Mr. Prasanna Acharya, Honorable Minister for Health and Family
Welfare, Government of Orissa, for taking time off his busy schedule to inaugurate the
conference.
We would also like to thank all the Government officials, NGOs, national and international
institutions, social scientists and scholars from the national level and the four states, who
participated in the conference and contributed to meaningful discussions. The media deserve
special mention and appreciation as they have provided wide and intensive coverage to the
event and the issues discussed therein.
This report summarizes the presentations, deliberations and recommendations that have
emerged during the conference. We hope this will be a useful document for policymakers,
programme managers and civil society.
A R Nanda
Executive Director
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Regional Conference on
Population, Health and Social Development
in the Eastern States:
Bihar, Jharkhand, Orissa and West Bengal
February 16-17, 2010
Bhubaneswar
Background
Population Foundation of India (PFI) has always been at the forefront of non-government efforts
to address Reproductive and Child Health, Population and Health and Social Development issues.
Entering its 40th year of existence in 2010, PFI seeks not only to commemorate and draw strength
from its achievements till date but also re-invigorate its commitment to ‘promote, foster and inspire
sustainable and balanced human development with a focus on population stabilization through an
enabling environment for an ascending quality of life with equity and justice’.
Towards this end, three Regional Conferences: Eastern, Western and Northern, followed by a
National Conference on ‘Population, Health and Social Development’ are planned with the aim of
bringing out region specific priorities and recommendations on these issues.
The first Regional Conference on ‘Population, Health and Social Development in the
Eastern States – Bihar, Jharkhand, Orissa and West Bengal’ was organized at Hotel
Swosti Premium, Bhubaneswar on February 16 – 17, 2010. Mr. Prasanna Acharya,
Honorable Minister for Health & Family Welfare, Government of Orissa, inaugurated the
conference as the Chief Guest.
The conference brought together on one platform, administrators, social scientists and scholars,
national and international institutions and NGOs concerned with these issues from the Eastern
Region.
Senior government officials, who participated in the conference included Ms. Anu Garg,
Commissioner-cum-Secretary, Health and Family Welfare, Government of Orissa; Mr. Ravi Parmar,
Secretary, Health and Family Welfare, Government of Bihar; Mr. K. K. Pathak, Principal Secretary,
Human Resource Development, Government of Bihar; Ms. Bharati Ghosh, Joint Secretary, Panchayati
Raj and Rural Development, Government of West Bengal; Dr. J.M. Chaki, Dy. Director, Department of
Health and Family Welfare, Government of West Bengal; and Dr. Manju Kumari, Director, Department
of Health and Family Welfare, Government of Jharkhand.
The inaugural session was presided by Shri Hari Shankar Singhania, Chairperson, Governing
Board, PFI. Mr. B.G. Deshmukh, Vice-Chairman of the Governing Board of PFI, and other distin-
guished Governing Board Members of PFI including Mr. B.G. Verghese, Mr. J.C. Pant, Ms. Nina Puri,
Mr. K. L. Chugh and Dr. Abid Hussain graced the conference with their participation.
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The specific objectives of the conference were to:
• Get a clear perspective of the demographic and health transition in Bihar, Jharkhand, Orissa and
West Bengal
• Draw attention to the reproductive health issues among young people (10 – 24 yrs) and develop
effective strategies to address them
• Recapitulate initiatives by State Governments in the area of population and health
• Draw out key recommendations with policy and programmatic implications at the state and
regional levels
Inaugural Session
Chief Guest
Mr. Prasanna Acharya, Honorable Minister for Health & Family Welfare, Government of Orissa
Dignitaries on the Dais
Mr. Hari Shankar Singhania, Chairperson, Governing Board, PFI
Mr. B.G. Deshmukh, Vice-Chairman, Governing Board, PFI
Mr. A.R. Nanda, Executive Director, PFI
Dr. Arundhati Mishra, Additional Director, PFI
Dr. Almas Ali, Senior Advisor, PFI
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Mr. A.R. Nanda, Executive
Director, PFI welcomed the
dignitaries on the dais and
expressed his gratitude to the
Honorable Minister for Health
& Family Welfare, Government
of Orissa for accepting PFI’s
invitation to inaugurate the
conference. He also welcomed
state government representatives
and participants from the four
eastern states: Bihar, Jharkhand, Orissa and West Bengal.
Outlining PFI’s 40th year celebration plans, he stated that the focus was on intensive advocacy
efforts to promote rights-based and gender-sensitive strategies to achieve population stabilization.
A number of events including three Regional Conferences and one National Conference were planned
in this respect.
He stated that the Eastern Region Conference was the first Regional Conference to be held and
in a way the launch of PFI’s 40th year celebration. He concluded by sharing the expectations from the
conference:
“…to bring out region specific priorities, issues and recommend strategies that would help in
improving the status of population, health and social development in the region.”
Mr. Hari Shankar Singhania, Chairperson, Governing Board, PFI extended a warm welcome to the
participants. Tracing the history of PFI and its journey over a period of 40 years he stated that, since
its inception, PFI had widened its canvas to view population stabilization within the overarching
umbrella of health and social development. In addition, PFI had also widened its outreach and
multiplied its staff strength from a handful of people to a staff of over 100.
Highlighting the relevance of the conference, he stated that it was an attempt to bring forth the
issues and challenges unique to the states of Bihar, Jharkhand, Orissa and West Bengal. He drew
attention to the fact that despite being in the same region, the four states were facing different
demographic and health challenges, some of them being:
• The challenge of reducing high total fertility rate (TFR) in Bihar (3.9) and Jharkhand (3.2) and
reducing high infant mortality rate in Orissa
• The challenge of reducing fertility rate in rural areas in West Bengal and Orissa, which was still
above replacement level; although urban fertility in these states had reached near replacement
level
• The problem of an increase in elderly population in the states of West Bengal and Orissa
• Barring the State of West Bengal, the challenge of addressing the unmet need for contraception
in Orissa, Bihar and Jharkhand, where the unmet need was higher than the national average
• The challenge of reaching out to young people with correct health messages
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Outlining PFI’s efforts at working on community needs, community participation and capacity
building to help communities take charge of their own health, he stated that these initiatives would
help PFI to play a complementary and supplementary role in government programmes. Referring to
PFI’s current role as Secretariat of the Advisory Group on Community Action (AGCA) of the National
Rural Health Mission (NRHM), he emphasized the need for PFI to best utilize this strategic position
to take forward the challenge of communitization in health systems.
He concluded by requesting the Honorable Chief Guest Mr. Prasanna Acharya to release the following
PFI publications:
• Wall Chart ‘Population, Health and Social Development in Bihar, Jharkhand, Orissa and West
Bengal’
• Publication ‘Population, Health and Social Development in Bihar, Jharkhand, Orissa and West
Bengal’
• Advocacy Papers on Population Issues
• Corporate Social Responsibility: A Module on RCH for Corporate Sector
Inaugural Address: Mr. Prasanna Acharya, Honorable Minister for Health and Family
Welfare, Government of Orissa
Mr. Acharya welcomed the delegates to the
two-day conference and congratulated PFI for
40 years of meaningful contribution towards
population stabilization in the country. Empha-
sizing the role of population stabilization in
improving quality of life he lauded PFI for its
efforts in organizing the regional conference
focusing on these issues.
He stated that while some progress had
been made in the area of population stabiliza-
tion and in improving key health indicators, a
lot more remained to be done to achieve the goal of ‘Health for All’. He asserted that India’s rapid
population growth rate posed a big challenge for the country, especially since it meant that about
2.4% of global area was supporting 17% of the world’s population, which was second only to
China. India’s population was larger than big countries like Canada and almost three times the
population of the United States of America.
Highlighting the consequences of this vast population he stated that it resulted in
“needs being more than available resources”. An example of this was the food problem
in India, in spite of the green revolution.
He identified four northern states Uttar Pradesh, Madhya Pradesh, Rajasthan and Bihar as being
the major contributors to the increase in population and listed early marriage (below the age of 18
years) as being one of the major contributors to poor health indicators. Early marriage affected the
health of a woman, impacting indicators such as MMR, IMR and fertility. He acknowledged Orissa
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as having high levels of both maternal and infant mortality and stated that efforts should be made
to ensure that girls stay in school for a longer duration, thereby preventing early marriages. He also
stressed on the need to inform the younger generation on health and population issues, empowering
them to adopt positive health behaviors.
Dr. Arundhati Mishra, Additional Director, PFI made a presentation on PFI’s journey across four
decades from 1970 to 2010. Tracing the history of PFI since its inception, she highlighted various
landmarks and achievements along the way. Outlining PFI’s response to the challenges and changing
perspectives on issues of population, health and development both on national and international
fronts, she demonstrated how the organization had broadened its focus over the years. From being a
pure family planning research organization, PFI had become one of the leading organizations in the
field of sustainable human development.
Keynote Address: Demographic and Health Transition in the States of Bihar, Jharkhand,
Orissa and West Bengal: Dr. Almas Ali, Senior Advisor, PFI
Dr. Ali’s presentation commenced with a description of the demographic evolution and its three
stages: the first stage being high birth rate and high death rate, second being high birth rate and low
death rate and the third being low birth rate and low death rate.
He stated that India had gone through the first phase of demographic transition during the earlier
part of the twentieth century and was currently passing through the second phase of demographic
transition (high birth and declining/low death rates). This high growth phase was expected to be
completed by the year 2030.
He shared that the presentation would focus on the four Eastern States of India: Bihar, Jharkhand,
Orissa and West Bengal, which constituted around 12.75 percent of the total land area of the country
and 22.1 percent of its total population (Census 2001). These states were among the most backward
states (except perhaps West Bengal) in India, lagging behind in many social and health indicators.
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Highlighting key statistics, he presented an analysis of population trends and their implications:
• West Bengal had achieved TFR of 2.1 in 2003 while Orissa achieved TFR of 2.1 recently in 2010
(Projections made by the Registrar General of India, 2006)
• Jharkhand was yet to achieve TFR of 2.1, and was expected to achieve it by the year 2018
• The situation in Bihar was the most grim and it was expected to achieve replacement level of
fertility only by the year 2021
• In all these states, there was a decline in percentage share of unwanted fertility rate to total
fertility rate between the two successive National Family Health Surveys. Yet, more than 25
percent of fertility in these states was unwanted, which could be averted to have an impact on
the total fertility rate (TFR)
• Fertility decline in the states of West Bengal and Orissa was resulting in the states experiencing
the phenomenon of population ageing. There was a substantial increase in the elderly population
(60 and more years) in these two states
Furthermore, Dr. Ali stated that the fertility transition had been achieved overwhelmingly through
an increase in the use of modern contraceptive methods, primarily female sterilization in these four
states. He highlighted contraceptive prevalence figures from the four states:
• The contraceptive prevalence rate (CPR) in the four states ranged from 71 percent in West Bengal
to a low of 34 percent in Bihar (NFHS-III, 2005-06)
• While the unmet need for contraception had declined in all four states, the decline in Bihar was
minimal (22.8 to 24.5 between the last two National Family Health Surveys)
• Among the four states, the use of modern contraceptives in Bihar (28.9%) and Jharkhand
(31.1%) was lower than the national average (48.5%)
• While the use of contraception was higher in West Bengal, a majority (21.3%) was the use of
traditional methods
• The use of contraception among youth (15-24 years) was highest in West Bengal (54%) followed
by Orissa (19%), Jharkhand (15%) and then Bihar (13%)
• Barring West Bengal, the unmet need for contraception for the three eastern states was higher
than the national average. Jharkhand (23.1%) had the highest unmet need followed by Bihar
(22.8%)
Highlighting the issue of unmet need for contraception, Dr. Ali emphasized its relevance
in achieving replacement level fertility and provided a glimpse of the existing situation
in the four eastern states:
• The unmet need for limiting methods was higher than that for spacing methods in Bihar, Jharkhand
and Orissa, as well as for India as a whole
• Both Bihar and Jharkhand had a large unmet need for both spacing and limiting methods. While
in Bihar, there was greater demand for limiting methods, in Jharkhand, the demand for spacing
methods was greater
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Concluding his address, Dr. Ali proclaimed that population stabilization as a major and vital chal-
lenge for the states of Bihar and Jharkhand. He emphasized that the attainment of replacement level
of fertility in Bihar and Jharkhand would largely depend on their ability to meet the unmet needs of
contraception. He also listed age at marriage, delaying first birth, spacing and quality family planning
services as issues that required urgent attention by these states.
Some Key Recommendations
• Population stabilization can be
ensured by increasing the age
at marriage and cohabitation,
especially for girls
• The strongest impact on age
at marriage can come through
increasing the number of years
of schooling for girls
• Proper education can lead to the
development of right attitudes
among the vast population who
are yet to enter the fertility age group
• The younger generation needs to be fully informed about the future. They need to be educated to
help them lead a planned adult life
• In order to achieve population stabilization in the states of Bihar and Jharkhand, (the two most
challenging states) efforts need to improve for increasing age at marriage, delaying age at first
birth, providing quality family planning services, meeting the unmet needs and promoting spac-
ing between two children
Vote of Thanks: Mr. B. G. Deshmukh, Vice-Chairman, Governing Board of PFI thanked
the Chief Guest Shri Prasanna Acharya, Hon’ble Minister for Health & Family Welfare,
Goverment of Orissa, for gracing the occasion with his presence, for his inspiring inaugural ad-
dress and for releasing the conference publications. He also expressed his gratitude to all partici-
pants and hoped for stimulating discussions over the next two days.
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SESSION I
Demographic and Health Transition in Bihar
Chairperson: Mr. B.G. Verghese, Member, Governing Board, PFI
Co-Chair: Mr. R.U. Singh, Honorary Advisor, PFI (Bihar and Jharkhand)
Presentations
1. Keynote: Strategies to Meet the Challenges of Demographic and Health Transition
in Bihar, Mr. Lester Coutinho, Senior Programme Advisor, Packard Foundation, New Delhi
2. “Policies and Programme Initiatives of Bihar Government on Population/RCH”,
Mr. Ravi Parmar, Secretary, Health, Department of Health and Family Welfare, Government of Bihar
3. The Youth Perspective – Policy Initiatives in Bihar, Ms. Sona Sharma, Joint Director,
Advocacy and Communication and Mr. Matish Kumar, Coordinator, PFI, Bihar
4. The Youth Perspective – Initiatives by Civil Society, Mr. Bishwajit Mukherjee, Team Leader,
Pathfinder International Patna
5. Promoting Access to Care and Support for PLHIV in Bihar, Dr. Mary Verghese, Project
Director, Global Fund Project, PFI (New Delhi) & Mr. Rajiv Singh, Assistant Programme Coordinator,
Global Fund Project, PFI (U.P.)
Summary of Presentations
Keynote Address: Strategies to meet the Challenges of Demographic and Health Transition
in Bihar: Mr. Lester Coutinho, Senior Programme Advisor, Packard Foundation, New Delhi
Mr. Coutinho structured his presentation into three sections: 1. Understanding demographic transitions,
2. Key population growth trends in Bihar, and 3. Potential strategies for Bihar’s transition.
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1. Understanding Demographic Transitions
Displaying a world map with clearly demarcated age structure, Mr. Coutinho pointed out that most
parts of Asia were in the transitional demographic stage with most countries in Central Africa and
some parts of Asia having a large young population. He underlined the relevance of the age structure
of a country as playing a significant and quantifiable influence on the state’s security, democracy
and development. He stated that transitional age structure countries had a clear opportunity to
experience the greatest economic benefits of the demographic transition. The progress along the
demographic transition into the transitional age structure category occurred when death and birth
rates made significant declines.
He commented that when population structures began to stabilize, the share of dependent children
and adolescents became slightly larger than or equal to that of working-age adults, creating
opportunities for the countries’ economic and social development. Being in the transitional age
structure category, India needed to make the most of these opportunities with relevant strategies.
2. Key Population Growth Trends in Bihar
Analyzing population growth trends in Bihar, Mr. Coutinho highlighted key state demographics:
• Population growth rate in Bihar was still very high compared to the country average with the
maximum population (over 50%) being in the age group of 15-59 years – a young population.
In the year 2001, 41 percent of the total population of Bihar was in the age group of
0-14 years.
• There was an improvement in under five mortality (from 112 to 83), infant mortality (78 to 58),
3 ANC visits, institutional births, maternal mortality (371 to 312), contraceptive prevalence rate
(34%), full immunization coverage (12% to 33%) from NFHS-II to NFHS-III. However, the total
fertility rate and the number of underweight children had worsened.
• High fertility continued to be a concern with the mean age of marriage being 17.6, (up from
DLHS 2) which resulted in momentum driven growth. There was however, a slight drop in girls
marrying before 18 years of age (from 56.5% to 46%).
• Unwanted fertility was very high in the state – 40 percent of the total fertility being unwanted.
Reflecting on these
statistics, Mr. Coutinho
commented that while
awareness of contraceptive
methods was almost
universal for male and
female sterilization that
for spacing methods was
variable. Awareness of pills
and condoms was high,
whereas IUD was relatively
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less (79% among women) and almost equivalent to that of injectables. Awareness of female
condoms and emergency contraceptives was also limited. Pointing to the low contraceptive use and
the high unmet need for family planning, he stated that the major concern was that awareness did
not translate into practice.
He went on further to present the situation of youth in Bihar:
• Of those aged 20-24, as many as 46 percent of young women were married before age 15 and
77 percent before age 18. In rural areas, 82 percent married before age 18
• Contraception at any time during marital life was limited, reported only by 23 percent of young
men and 20 percent of young women
3. Potential Strategies for Bihar’s Transition
Drawing on the demographic challenges presented in the earlier section, Mr. Coutinho put forward
key principles for addressing these issues. He emphasized on the need for treating health as a human
right; adopting a sector-wide approach and developing a systems approach that included communities
in the production of health. He reiterated the importance of building meaningful partnerships and
focusing on women, poor and the socially vulnerable in the delivery of health services.
He further outlined a few potential strategies for Bihar in the area of population and health:
• Improvement in state health systems at district and state levels – including PPPs, recruitment of
doctors and upgrading hospitals
• Developing linkages with new development partners to improve implementation of health
programmes
• Effective strategies to ensure birth and marriage registration, combined with educational
opportunities for girls
• Creating stronger social security for the poor, to prevent health shocks leading to further poverty
• Empowering PRIs, especially elected women leaders, to monitor health and social development
programmes with a focus on vulnerable populations, women and adolescent sexual and
reproductive health
He concluded with a take home message that when couples chose to have smaller families, more
children, especially girls, attended school, and more women were able to work thereby increasing their
families’ income.
Policies and Programme Initiatives of the Bihar Government on Population/Reproductive
and Child Health: Mr. Ravi Parmar, Secretary, Health and Family Welfare, Government
of Bihar
Mr. Parmar began by stating that the population of Indian States matched that of large countries
around the world with the population of Bihar being more than that of unified Germany. Bihar was
the third most populous state in the country even after its bifurcation. The population of Bihar had
increased over four fold from 21.2 million in 1901 to 90.5 million in 2009. At the current growth rate,
it was estimated that Bihar would reach the replacement level of fertility only after 20-25 years.
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He drew attention to four important
demographic indicators which
summarized the gravity, the challenges
and opportunities for population
stabilization in Bihar – high TFR, high
unmet need, low use of contraceptives
and low age at marriage.
• Bihar had the highest TFR (total fertil-
ity rate) in India (3.9, as per NFHS-
III) with a staggering 67.6 percent of
eligible couples being non-users of
contraceptives (DLHS III)
• There was low male participation in family planning (estimated around 11.8%)
• On an average child bearing started within the age group of 15-19 years and was the highest in
the age group of 20-24 years (NFHS III)
• There was a high unmet need of almost 37 percent (DLHS-III) in the state. This posed a very great
opportunity, where the government could reach out to the people with required services
He expressed the belief that concerted efforts from the government and non-government
organizations would enable Bihar to achieve the goal of population stabilization before the projected
period. Towards this end, he highlighted the State Government’s initiatives aimed at population
stabilization and social development.
• The state had formed a Bihar State Population Council under the Chairmanship of Chief Minister,
a State Co-ordination Committee under the Chairmanship of Chief Secretary and similarly a
District Co-ordination Committee headed by the District Magistrate
• Chapters on population stabilization had been included in school books, incentives had been
given to ASHA (Rs.100/- per family planning operation) in 2010-11 and films on Family Planning
had been developed for showing in cinema halls
Policy Initiatives for Youth Issues in Bihar: Mr. Matish Kumar and
Ms. Sona Sharma, PFI.
The presentation commenced with Mr. Kumar and Ms. Sharma outlining key youth related data
for Bihar with the objective of establishing the need for a Youth Policy in Bihar.
• Bihar had over 44 percent of its population in the age group (10-34 yrs) and over 16 percent in
age group (15-24 yrs)
• Around 68 percent of currently married women aged 20-24 years were married before 18 years
of age
• Bihar had the highest TFR (total fertility rate) in India and 67 percent of eligible couples were non
users of contraceptives (DLHS-III)
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To alleviate this situation, PFI
with support from the Packard
Foundation had been advocating
for the formulation of a Youth Policy
in Bihar. Outlining the processes
adopted to bring about this policy
reform, Mr. Kumar and Ms. Sharma
stated that these efforts were aimed
at creating a supportive programme
environment for young adult’s sexual
and reproductive health (YASRH) in
Bihar. The processes included:
• Participation of young people,
NYK, NSS, NCC, Government line
department officials, PRIs, NGOs and civil society, academia and training institutes
• Adoption of a comprehensive approach for including all major concerns of youth
• Ensuring gender balance in the process and contents of policy
• Convergence between different sectors and actors
• Coherence with National Youth Policy and National Plan of Action for Youth
• Documentation and sharing at each level
They highlighted PFI’s efforts in conducting six regional level consultations covering all 38 districts
of Bihar, to ensure adequate reflection of youth concerns in the Youth Policy, especially on YARSH
issues. Sharing the findings and recommendations of the consultations, they stated that the same
had been shared with the State Government as well. The thrust areas in policy formulation were:
education and capacity building, health and nutrition, environment and science and technology,
leadership and sports, art and culture and livelihood, employment and migration and emphasis on
traditional treatment and naturopathy (yoga, exercise, pranayam etc.).
They concluded by stating that the policy document was not an end, but a means to mainstream
youth issues in the overall development process.
The Youth Perspective - Initiatives by Civil Society:
Mr. Bishwajit Mukherjee, Team Leader, Pathfinder International, Patna
Mr. Mukherjee detailed the interventions from Pathfinder’s “Prachar” project titled “Promoting
Change in Reproductive Behaviour in Bihar”. He stated that the key objective of the project was to
develop and test a hybrid Government-NGO delivery system (PPP) for delivering youth reproductive
health (RH) and fertility programmes at scale. The project had facilitated state government ownership
from the outset through intensive efforts at advocacy with policymakers, donors, government and
NGOs. Aimed at significantly impacting youth fertility by delaying and spacing births in Gaya district,
these efforts focused on motivating various stakeholders to invest in programmes that addressed
these issues. More importantly, the focus was on strengthening involvement of civil society in
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implementation and monitoring
of programmes.
He concluded his presentation
with the recommendation that
an ‘adolescent only’ intervention
model should be developed and
evaluated to assess its cost effec-
tiveness and impact vis-à-vis the
comprehensive model.
Promoting Access to Care and
Support for PLHIV in Bihar:
Dr. Mary Verghese, Project
Director, Global Fund Project, PFI (New Delhi) and Mr. Rajiv Singh, Assistant Programme
Coordinator, Global Fund Project, PFI (U.P.).
Dr. Verghese and Mr. Singh shared the status of Bihar as a state highly vulnerable to HIV/AIDS and poor
in preparedness for care and support of People Living with HIV (PLHIV). These vulnerabilities arose due to
factors such as very high migration, illiteracy and poverty. They stated that being a border state (sharing a
border with Nepal) not only increased the incidence of migration but also increased the practice of use of
injectable drugs through shared syringes, making the youth vulnerable to contracting HIV.
Highlighting the efforts of the Global Fund Project, they outlined the project objective and shared
some of its good practices. The objective of the project was to increase access to care, support,
treatment and counseling via setting up community based care and support centers of PLHIV. And
some of the good practices included coordination meetings with ART centers and BSACS, tracing of
lost ‘to follow up cases’ and regular advocacy meetings.
In the end, they shared some of the challenges faced by the project such as development of infra-
structure to facilitate access to care, support and treatment services, and follow up of clients.
Open House Discussion
Some important points raised during the open house discussion were:
• The need to strengthen efforts to increase male involvement in family planning
• The need for greater dissemination and sharing of the Youth Policy to enable advocacy and sup-
port for its implementation
Concluding Remarks by Chairperson
Mr. B.G. Verghese thanked all the presenters for sharing their views and suggestions. He stated
that it was quite apparent that there was a sheer lack of political will in Bihar. Although the current
Chief Minister had been a driving force in bringing about transformation in the state, he questioned
the extent to which this had percolated to different political levels. He questioned the vibrancy in
support for population and health issues among all MLAs, Ministers, local representatives and the
administration. He concluded by reiterating the relevance of political will in driving population and
health programmes – in both the government and non-government spheres.
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Key Recommendations
The following recommendations for improving Reproductive Health (RH) services emerged from
the deliberations during the session:
• Mechanisms to shift accountability to the community, such as demand side financing, wherein
each pregnant woman gets a voucher (redeemable in private and government institutions) to
avail RH services, should be developed
• Early marriage has a direct impact on the number of children a woman has in her life-time. Strategies
to address early marriage and early pregnancy need to be developed and implemented
• Efforts to strengthen health education should be made. This is expected to positively impact
decision making by women for planned parenthood
• Specific strategies for increasing male involvement in reproductive health should be developed
and implemented
Recommendations also centered on improving infrastructure facilities for improving quality of
care, since cases of institutional deliveries and sterilization were going up. These included:
• The need to develop a concrete policy to increase infrastructure for medical education to address
the shortage of health providers in the state
• The need to increase civil society involvement in order to fill the current gaps in service provision
• The revival of mid-wifery schools for meeting the human resource gaps in service provision
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SESSION II
Demographic and Health Transition in Jharkhand
Chairperson: Mr. K. L. Chugh, Member, Governing Board, PFI.
Co-Chair: Mr. Lester Coutinho, Senior Programme Advisor, Packard Foundation, New Delhi
Presentations
1. Keynote address: Strategies to Meet the Challenges of Demographic and Health
Transition in Jharkhand: Dr. Subrato Mondal, Senior Manager, PFI
2. Presentation on Public Private Partnership: Dr. H. Sudarshan, Founder Director, Karuna
Trust
3. Policies and Programme Initiatives in Jharkhand on Population/RCH: Dr. Manju
Sharma, Director, Department of Health, Government of Jharkhand
4. The Youth Perspective: Initiatives by Civil Society: Mr. Ajay Srivastava, Project Officer, CINI,
Jharkhand
5. Corporate Initiatives in Jharkhand: Col. S. Rath, Special Advisor, Krishi Gram Vikas Kendra
(Usha Martin Limited)
Summary of Presentations
Opening Remarks by Chairperson: Mr. K. L. Chugh welcomed the participants and shared
his past experience of Bihar and Orissa. He stated that at one time Bihar and Orissa were the
knowledge capitals of the world. However, the poor current health indicators reflected a state that
had lost its way.
He observed that a state basically comprised of people. What drove people was the confidence
that ‘they can do it’ and what gave them hope was their achievements. However, while developing
policies and strategies, the heart of the people was often missing. While he acknowledged that a
lot of work had been done till date, he stated that it was time to question what had been done and
evaluate whether we were on the right path.
Keynote Address: Strategies to Meet the Challenges of Demographic and Health
Transition in Jharkhand: Dr. Subrato Mondal, Senior Manager, PFI
Dr. Mondal began by elaborating the different health indicators in Jharkhand. He pointed out
that Jharkhand had decreasing trends of birth rate, IMR and MMR and increasing trends in life
expectancy, and therefore an increasing older population. He further stated that Jharkhand suffered
from the prevalence of all types of communicable and non-communicable diseases.
Given this situation, he stressed on the need to strengthen the health system to address inequities
and suggested a number of possible strategies in this regard:
• Focused engagement of the public health system, civil society and the private sector
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• Focused engagement of the
community, including marginalized
sections, through the empowerment
of village health and sanitation
committees, thereby promoting
community planning and monitoring
on health
• Strengthening the capacities and sup-
port to the community health volun-
teer “Sahiyya”
• Greater focus on primitive tribes
• Focus on infrastructure improvement, recruitment of human resources, improvement in the supply
of drugs and commodities at all levels and provision of mobile health units for hard to reach
areas
Public Private Partnership: Dr. H. Sudarshan, Founder Director, Karuna Trust
Dr. Sudarshan started his presentation by describing the meaning of public-private partnership.
He stated that accessing private sector services by public provisioning was not privatisation. He
also stated that ‘partnership’ did not mean being ‘contractors’ for implementation of government
programmes. True partnership, he asserted, included involvement in policy formulation, planning, im-
plementation, monitoring, evaluation, training and research. Public-private partnership (PPP) elimi-
nated duplication in service provision in resource constraint areas and promoted cross learning.
Sharing the success story of PPP models implemented by Karuna Trust (KT) in different states
like Karnataka, Andhra Pradesh and Arunachal Pradesh, he outlined the processes followed in their
implementation and listed their major achievements:
• 100% headquarter stay of all staff in PHC
• All buildings and equipments in place
• Specialist and referral services available with availability of 24 hour ambulance services
• Women friendly PHCs
• Rational drug use/essential drugs available
• Chronic disease prevention and treatment programmes in place
He also highlighted the salient features of the health insurance scheme being implemented by KT in
Karnataka.
• The scheme had a premium of Rs.22/- (First Year Rs. 30/-) per person per year
• Premium costs could be shared by community, milk co-operatives, SHGs and Gram Panchayats
• There were no exclusions i.e. the scheme covered all age groups and hospitalization due to any
illness
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• An amount of Rs. 50/- was paid to the patient for daily wages lost and Rs. 50/- to the hospital
for extra drugs per day of hospitalization
In the end, he concluded by stating that technological packages could only improve health outcomes
marginally and only good governance could provide a quantum jump in health outcomes.
Policies and Programme Initiatives in Jharkhand on Population/Reproductive Child Health:
Dr. Manju Sharma, Director, Department of Health, Government of Jharkhand.
Dr. Sharma highlighted
the Jharkhand Government’s
commitment to health and
population concerns by outlining
the mission and goals of the
Jharkhand State Health Policy. The
aim of the policy was to achieve
population stabilization by 2020;
achieve birth spacing landmark
up to 90 percent through modern
contraceptive methods and
increase contraceptive prevalence
rate to 60 percent by 2015. She stated that through its efforts the government aimed to reach the
last person of the community living in unreached settlements in the state of Jharkhand.
Mapping key demographic and health indicators of Jharkhand, she acknowledged that the state
was lagging behind in most indicators as compared to the national average. She pointed out that the
indicators which were the most cause for concern were institutional deliveries, ANC coverage, MMR
and IMR. Poor health infrastructure and human resource gaps further added to these problems.
She stated that the government had increased focus to address these issues and listed their
achievements in this regard:
• Up-gradation of 122 health facilities all across Jharkhand
• Enhanced focus on spacing methods along with terminal methods
• Further up-gradation of skills among all levels of service providers
• Identification of partners to scale-up promising programmes/interventions and increase their
coverage
She also outlined the state’s broad strategy for population stabilization for the year 2010-11:
(a) Terminal Methods: Fixed Day Sterilization at 122 upgraded health care facilities all across
Jharkhand. Camps for male (once a month) and female sterilization (twice a month) at all CHCs,
District Hospitals and two PHCs of each district.
(b) Spacing Methods: IUCD service in the camp mode; provision of reimbursement to mo-
tivators; beneficiaries and providers for IUCD services; social marketing of condoms; and OCP
through Sahiyya, ANMs and other link workers.
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(c) Capacity Building: Contraceptive Technology Update for providers; TOT and training of
Laparoscopic Surgeons; training of paramedics (ANM, Nurses etc.).
(d) Public Private Partnership: Outsourcing of PHC; involvement of faith based organiza-
tions and NGOs; and involvement of corporate agencies under the CSR.
Policy Initiatives for Youth Issues in Jharkhand: Mr. Satya Ranjan Mishra and
Ms. Sona Sharma, PFI
Mr. Mishra and Ms. Sharma began their presentation by laying emphasis on the fact that reforms were
not just about the technical content of policy but were also about people and processes. PFI in its work
on policy formulation thus focused on processes aimed at involving the people concerned, especially the
youth. They shared the various strategies adopted in this bottom up approach to policy advocacy:
• Piloting ARSH advocacy from block to district and state levels
• Multi stakeholder meetings/orientation to exchange views and experience on youth issues
• Formation of sub committees to work on core areas of policy – participation of CSOs, financial
institutions, corporate and academia
• Technical support to the government for formation, approval and implementation of the Youth
Policy
• The participation of young people at all levels
Stating that the Jharkhand Government had formally adopted the Youth Policy in July 2007, they
revealed that PFI had further supported the Government in the formation of Youth Policy Implemen-
tation Plans by facilitating regional consultation workshops. They concluded by highlighting the need
for continuing support to the Government in ensuring the quality implementation of these plans.
The Youth Perspective: Initiatives by Civil Society: Mr. Ajay Srivastava, Project Officer,
CINI, Jharkhand
Mr. Srivastava stated that CINI’s youth programme began by analyzing the youth for their strengths,
weaknesses and needs. The program aimed at providing the youth with a mission orientation geared
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towards national integration with deeply imbibed moral and ethical values. It focused on mass
literacy, skill development, self employment and information and communication technology.
He commented that the mainstay of civil society efforts was on creating a youth friendly
environment which included youth friendly community and youth friendly health services. Civil
society had undertaken several initiatives in this regard through NYK, NSS, NGOs and CBOs. Majority
of these initiatives included formation of youth clubs, youth leadership camps, knowledge and skill
enhancement, formation of village youth adult committees to discuss youth issues etc.
Outlining CINI’s community level initiatives to address ANC/PNC, safe delivery, family planning,
obstetric care, HIV and AIDS, nutrition and IFA distribution, he stated that the key approach used
by CINI was intensive community participation in the identification and in the solution of the
problem.
He concluded by emphasizing the need for positive synergy between the community and the
Government for sustaining public health systems.
Corporate Initiatives in Jharkhand: Col. S. Rath, Krishi Gram Vikas Kendra
(Usha Martin Limited)
Col. Rath began his presentation by giving a brief background about KGVK. He shared that KGVK
was promoted by the Usha Martin Group of Industries as its social responsibility wing in 1972. It was
later registered under the Societies Registration Act in April 1977.
Highlighting key demographic and health indicators of Jharkhand, he stated that KGVK was
implementing the concept of Total Village Management (TVM) in five districts of Jharkhand. The
eight pillars of this concept were Natural Resource Management; Health; Nutrition & Sanitation;
Education; Renewable Energy; Livelihood; Capacity Building and Resource Mobilization &
Infrastructure Development.
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He further shared details of other projects being implemented by KGVK which included a hospital
network for preventive and curative health care services; mobile health care services; a systems
strengthening programme focusing on reducing malnutrition among adolescents and reducing
incidence of early marriages; promotion of standard days method; low-birth weight project and the
PFI supported intervention on improving the RCH status of tribals.
Open House Discussion
Some important points raised during the open house discussion were:
• The introduction of ‘SAHIYYA’ as the community level health worker was a successful initiative
in Jharkhand, which has contributed to the efforts to improve the status of maternal and child
health
• An area which Jharkhand needed to focus on was corruption in data collection. A study showed that
newborn mortality rate was close to 60 or more than 60. Maternal mortality was also estimated to
be double in the underserved areas (700). Huge amount of data fudging was taking place. It was
suggested that donors support centennial sites in the state for accurate data collection, especially
in the underserved areas
• Institutional deliveries in the state were still only 20 percent and it was unlikely to be 100 percent
in the near future. It was therefore, important to ensure that home deliveries were safe. In the
absence of training to mid wives, this was a challenge
• The repeated changes in government in the state had led to a lack of continuity in programme
implementation
• Health problems caused by industrial pollutants need to be a focus and working with labour and
pollution board could be a strategy
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Comments from the Co-chair
Mr. Lester Coutinho thanked all the presenters for their informative presentations. He remarked that
the words often used through the various presentations were partnership,governance,decentralization,
innovation, inclusiveness, participation, youth involvement, community engagement. All these words
represented processes, which were important but more important was that these processes lead to
outcomes. He further commented that the levels of scaling up were questionable when a project was
working in 35 villages or 70 villages and there were 33000 villages in Jharkhand.
Raising a key question on partnership with the government at a time when the Jharkhand
Government was being rocked by one of India’s largest financial scandals, he asked “what does
partnership mean for civil society at a time like this?” Dealing with the vast diversity of political
elite in the newly formed state, he believed, was one of the biggest challenges for civil society in
Jharkhand.
Citing the youth survey car-
ried out by International Institute
for Population Sciences IPS and
Population Council, he stated
that compared to all the other
six states surveyed, 11% of girls
in Jharkhand were engaged in
pre-marital sex and these were
not tribal girls alone. In terms of
moving towards demographic
transition, Jharkhand was ahead
of Bihar, and there was a need to challenge existing partnerships and interventions and look at
things anew. This was especially so, since some of the biggest corporates in India had their corporate
social responsibility interventions in Jharkhand.
Mr. Coutinho also reminded the audience that there were a number of positives in the state to be
proud of. Jharkhand was the only state in the country that held on to life skills education when many
large states had banned it. 1400 schools in Jharkhand today provide life skills education. Jharkhand
was also one of the few states which put safe abortions as a priority across all its districts. He com-
mented that this reflected boldness, courage, leadership and heart, but there was an urgent need to
start looking at some of the outcomes as well.
He concluded by saying that a critical mass of civil society had been created in Jharkhand and
the policies were in place. The need now was to focus on bridging the gap in between to be able to
make a difference.
Concluding Remarks by Chairperson
Mr. K. L. Chugh stated that a number of issues had been brought on the table for the state of
Jharkhand. There was now a need to take the lead in solving the problems by fighting, correcting and
improving the system and standing firm. A lot of good work had been done and a lot more remained
to be accomplished. He stressed on the need for industry to play a larger role, supplementing the
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efforts being made by civil society and the government. He commented that the collective network
of industries was many times more than the state’s and that there were good examples of corporate
involvement in other states. Corporate engagement was an area with potential that needed to be
tapped.
Recommendations
• Innovative strategies and interventions being implemented in the state need to be systematically
reviewed and scaled up
• Evidence based programming needs to be introduced such that processes adopted lead to health
outcomes
• Traditional leaders in tribal communities should be engaged and motivated to promote positive
health seeking behavior among their community
• There is an urgent need to look at solutions for safe home delivery in addition to promoting
institutional deliveries, as there is a high prevalence of home deliveries in rural areas
• Adolescent needs should be first understood and then addressed through larger programmes
• Innovative ways need to be explored to strengthen human resources and overcome human
resource shortages at all levels in the health delivery system. Some recommendations include:
w The training of a second line of health providers in hospitals with 125 beds
w Promoting effective traditional indigenous health care. Indigenous knowledge of tribal people
should be tapped through research for its standardization
w There is a need to improve the quality of data collection – a process that can be supported by
civil society organizations and donors to minimize data fudging and inconsistency
w Industries should come forward to address health issues – both, within their factories and
within the community
w Efforts need to be made to increase political commitment in implementing health programmes
w Good Governance is essential for improving health outcomes and requires strengthening.
A study to find out the extent to which corruption contributes to maternal mortality should
be undertaken.
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Session 3
Demographic and Health Transition in Orissa
Chairperson: Dr Abid Hussain, Member, Governing Board, PFI
Presentations
1. Keynote: Strategies to Meet the
Challenges of Demographic and
Health Transition in Orissa: Prof.
Bhagban Prakash
2. Policies and Programme Initiatives
in Orissa on Population/RCH: Ms.
Anu Garg, Commissioner-cum-Secretary,
Health and Family Welfare, Government
of Orissa
3. The Youth Perspective: Dr. Prafulla
Kumar Sahoo, Chairman, CYSD,
Bhubaneswar
4. Promoting Access to Care and Support for PLHIV in Orissa: Mr. Deepak Ranjan Mishra,
Assistant Regional Coordinator, Global Fund Project, PFI
Summary of Presentations
Opening Remarks by the Chairperson: Dr. Abid Hussain began by stating that Orissa, which
was earlier backward in many indicators, had started showing signs of speedy development. He
however, stressed on the three M’s – malnutrition, malaria and maternal health – as being important
issues for Orissa. Emphasizing the need for NGO’s to be made more effective, he underlined the point
that the state had its own role to play and NGOs could not be a substitute for the Government.
Keynote Address: Strategies to Meet
the Challenges of Demographic
and Health Transition in Orissa: Prof.
Bhagban Prakash
Prof. Prakash structured his presenta-
tion into four broad sections: an overview
of Orissa’s demographic indicators; key tran-
sition challenges; a reminder of Orissa’s Vi-
sion 2010 and suggested strategies.
He emphasized the huge need for ade-
quate provision of reproductive health serv-
ices in Orissa, taking into consideration that
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Orissa had reached the third stage of demographic transition. This meant that birth and death rates
were low and there were a large number of young people in reproductive ages.
Outlining the decadal growth rate in Orissa (15.94 percent which was less than the national
average of 21.34 percent) he stated that the transition in the state had been a slow and steady
process. MMR and IMR, however, still remained challenges for the state. Orissa had a high MMR at
358 per 100000 live births and while the IMR had reduced considerably, there were pockets of grey
areas within the state.
He highlighted some of the transition challenges being faced by the state which included large
numbers of home deliveries (2 out of every 3), a rapidly growing young population whose needs were
required to be met, the alarming status of child malnutrition and the lack of adequate infrastructure.
He asserted that the Orissa Vision Document for 2010, aimed at addressing some of these chal-
lenges by focusing on substantially reducing communicable and non-communicable diseases; mak-
ing deliveries safer for women and children; enhancing community participation and ensuring the
provision of quality services.
He concluded by proposing some strategies to address population and health challenges in the state:
• Ensuring access to quality care during antenatal, delivery and postnatal period
• Standardization of service quality, increasing access to services, ensuring 24x7 emergency obstetric
care services and improved access to MTP, especially in difficult to reach and tribal areas
• Strengthening state maternal and child survival cell
• Sensitizing service providers and programme managers
• Promoting evidence based decision making
• Conducting institutional death audits
• Undertaking facility audit of blood banks and storage units
• Addressing determinants of ill health, i.e. income, poverty, nutrition, water supply, sanitation,
communicable diseases etc
Policies and Programme Initiatives in Orissa Government on Population/
Reproductive and Child Health: Ms. Anu Garg, Commissioner-cum-Secretary, Health,
Government of Orissa.
Ms. Garg stated that a review of the health progress of Orissa over the years (till January 2010)
revealed that most of the trends were very positive. MMR had decreased to 303 witnessing a 55
point decline, full immunization coverage had reached 74% and above all institutional deliveries had
reached 76%. However, the state was still facing some challenges which included high population
of disadvantaged groups, services not reaching hard to access areas, high unmet need for contra-
ception, lack of availability of skilled human resource, lack of community participation and frequent
natural disasters.
She highlighted the need for a holistic approach that included aspects such as co-ordination
and convergence with other departments, public private partnerships, strengthening community
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processes, decentralization of
planning to respond to these chal-
lenges.
Mentioning the RCH programme
as one of the efforts that adopted
a holistic approach and followed
a continuum of care model cov-
ering adolescent, maternal and
newborn health, she outlined
some initiatives undertaken by the
Orissa Government in this regard:
• Village Health and Nutrition
Day (VHND) sessions on the
occasion of Mamta Diwas
• Distribution of mother and baby kits
• Mo-Mashari - an initiative to protect special groups such as pregnant women and residents of
tribal residential schools
She underlined the success of the Janani Suraksha Yojana scheme (JSY) and declared that the
state government was also planning to introduce a voucher scheme to cover transportation costs.
She further detailed various child and family welfare initiatives being undertaken by the state
government:
• Integrated Management of Neo-natal and Childhood Illnesses (IMNCI) scheme and other
initiatives that involved neo-natal care at the sub centre
• Fixed day static family planning services
• Camps in low performing pockets of RCH focus blocks
• Signages and Citizens’ Charters at the Health Centres
• Convergence with the Women and Child Development Department through the mobilization of
women’s self-help groups on reproductive health, nutrition and gender
The Youth Perspective: Dr. Prafulla Kumar Sahoo, Chairman, Civil Society Initiatives in
Orissa, Bhubaneswar.
Dr. Sahoo began by highlighting the implications of large youth populations for India, the
developing world and the world as a whole. Giving a brief overview of the demographic and SRH
scenario of the state, he outlined the agenda of civil society organizations in the area of youth
engagement. He stated that most organizations focused on:
• Addressing knowledge and practice gaps related to reproductive and sexual health
• Addressing under-nutrition and anemia
• Addressing early marriage; high fertility and high maternal mortality
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• Addressing unplanned births
and unsafe/induced abortion
• Addressing quality in sexual
and reproductive health serv-
ices; and
• Addressing issues on violence
and sexual abuse
In these efforts they faced a
number of challenges and bot-
tlenecks including, inadequate
resources to address availability
and quality; chronic shortage of doctors and paramedics in backward regions; massive illiteracy
and ignorance; limited Panchayati Raj and community participation; limited community oversight
in the management of primary health services; very weak referral to secondary and tertiary cen-
tres for emergency response; and widespread poverty that restricted the use of costly private
sector services.
Emphasizing the potential of the youth, he stated that they had the ability to be proactive and
responsible citizens, act as catalysts for inclusive development, fight social evils and harmful practices
and make the best use of limited opportunities. The youth could make important contributions by
shunning violence and illegal activities and joining the crusade against HIV/AIDS, illiteracy, corruption
and upholding the cause of deprived and vulnerable communities.
He proposed various strategies to capitalize on the potential of the youth. These included:
• Strong civil society interface and networking on youth issues
• Multimedia campaigns/IEC for mass awareness
• Development of community based change-makers networks to facilitate active participation of
adolescents and young people
• Dissemination of sexual and reproductive health information through peer learning and life skills
education
• The implementation of an innovative youth development model that was based on five ‘Cs’ -
Character, Competence, Confidence, Cooperation and Contribution
Promoting Access to Care and Support for PLHIV in Orissa: Mr. Deepak Ranjan Mishra,
Assistant Regional Coordinator, Global Fund Project, PFI.
Providing an overview of the HIV and AIDS scenario in Orissa, Mr. Mishra outlined the main fac-
tors driving the HIV epidemic in the state. These included vulnerability factors like out-migration, low
literacy and poverty, particularly in tribal areas. Recurrent floods and droughts in the southern and
western parts of the state, further caused distress migration.
Highlighting PFI’s role in overcoming existing gaps in HIV/AIDS care and support, he stated that
prior to the Global Fund Project minimal interventions had existed on the ground. Care and support
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activities had been accorded the lowest priority, there was no network in the State, there existed high
stigma and discrimination, there were insufficient number of Anti-Retroviral Therapy (ART) centres
and Community Care Centres (CCCs) and there was a lack of intra-sectoral coordination among
stakeholders.
He also drew attention to the challenges faced in implementing the programme, which included:
• Ensuring adequate coordination among the partners/stakeholders
• Establishing and making functional more ART centres and CCCs
• Reaching the unreached
• Extending network and linkage
with CCCs
• Strengthening ASHAs through
capacity building on HIV and
AIDS
In the end, he outlined some
activities that PFI had initiated
to strengthen their existing
interventions:
• Monthly stakeholder coordination meetings to share the programme progress
• District Level Advocacy Programmes for Zilla Parishad Members and Block Chairpersons
• Joint monitoring visits with Orissa State AIDS Control Society and the implementing agency
Open House Discussions
Some important points raised during the open house discussions were:
• The need to focus on home based care, given that the highest proportion of infant mortality was
within the 1st week and 1st month of life. Evidence had shown that home based care provided
after excellent training could reduce neo-natal deaths by 50%
• Interventions aimed at improving the nutritional status of adolescent girls and delaying age at
marriage were required to reduce both maternal and child deaths
• Providing information on the right kind of food was important in overcoming malnourishment
among children and adolescents
Concluding Remarks by Chairperson
Dr. Abid Hussain emphasized the need to reflect on how best to make youth the spearhead of
society. He stated that unless they were provided with the required knowledge and their charac-
ter developed with a commitment towards society and the country, results would be minimal. He
commented that while a holistic approach was important, it was essential not to forget that each
individual had a key role to play. He observed that ‘knowledge was power’ and that not only did
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knowledge need to become powerful in society but that the powerful had to become more knowl-
edgeable to be able to move forward.
Key Recommendations
• Reduction in IMR was a key concern for Orissa which needed focused and holistic interventions:
w Focus on adolescents to improve the nutritional status of prospective mothers
w Delaying age at marriage to prevent early pregnancy
w Convergence between health and education departments to address adolescent issues and
delaying age at marriage
w Introduction and promotion of home based newborn care interventions
• Sexual and reproductive health (SRH) services for youth were crucial to improve the SRH status
of the State. This was especially important given the large number of young people in the
reproductive age in Orissa who were also marrying at very young ages.
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Session 4
Demographic & Health Transition in West Bengal
Chairperson: Dr. Nina Puri, Member, Governing Board, PFI
Presentations
1. Policies and Programme Initiatives in West Bengal on Population/ Reproductive and
Child Health: Dr. J. M. Chaki, Dy. Director, Department of Family Welfare, Government of West
Bengal
2. PRI Initiatives in Health (CHCMI): Ms. Bharati Ghosh, Joint Secretary, Panchayat and Rural
Development, Government of West Bengal
3. Taking Technology to Primary Health Care: Prof. Sujoy K. Guha, IIT, Kharagpur
4. The Youth Perspective: Mr. Ranjan Panda, Programme Manager, CINI, West Bengal
5. Promoting Access to Care and Support for PLHIV in West Bengal: Ms Pritha Biswas,
State Coordinator, CBCI, West Bengal
Summary of Presentations
Opening Remarks by the Chairperson: Dr. Nina Puri began on an optimistic note by
pointing out that the socio-demographic indicators in West Bengal differed positively from the other
three eastern states. Quoting the keynote address by Dr. Almas Ali, she gave the example of high
contraceptive prevalence rate (CPR) in West Bengal which had been achieved primarily through the
high use of traditional methods, bringing down the fertility rate.
She stated that, experiences from the other three sessions suggested that they were on the right
track for improving population, health and social development indicators. Sharing her international
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experience, she remarked that unlike the French Government, where the Health and Education Min-
istries were considered vital, in India the tendency was to consider these Ministries as unimportant.
While stressing on the need to change this perspective, she also expressed her pleasure at seeing
Indian Government officials participating in civil society platforms – a fact that was inconceivable at
one stage. She asserted that it was essential to continue this process of marrying civil society with
the government for the betterment of overall development.
Policies and Programme Initiatives in West Bengal on Population/Reproductive and
Child Health: Dr. J. M. Chaki, Dy. Director, Department of Family Welfare, Goverment of
West Bengal
Dr. Chaki highlighted the importance of indicators like MMR, IMR and TFR in understanding
population stabilization in the country and emphasized the need to ensure sustainability of achieved
TFR in West Bengal. He stated that while reduction of IMR to 35 was relatively easy, bringing it down
further to less than 30 was more difficult and required increased focus on neo-natal care.
He shared that the West Bengal Government was laying considerable emphasis on convergence
of RCH with the department of education, social welfare and PRIs to strengthen health initiatives.
The engagement of PRIs ensured convergence of health, family welfare and ICDS workers at the
field level and facilitated joint planning and implementation of maternal and child care, health and
nutrition services.
Pointing out the lack of infrastructure as one of the primary lacunae in quality provision of health
care, he stated that reduction in MMR required the practice of 48 hrs stay at the PHC, which neces-
sitated quality health infrastructure and facilities. Other challenges included shortage of Medical Of-
ficers and capacity building of field level workers (ASHAs) on diseases like pneumonia, malaria, etc.
Affirming the state government’s commitment to address these challenges, he outlined some of
the government’s success stories and initiatives. These included:
• Ensuring a minimum of three ANCs with the 4th ANC being delivered at home by the ANM
• Promoting delivery at sub-centres where the 2nd ANM was available
• Providing disposable delivery kit and delivery table to increase institutional deliveries
• Undertaking periodic behavior change communication activities
• Including the private sector in health care through the empanelment of private health institutions
under the Ayusmati Scheme
• Promoting PPP initiatives in institutional delivery in North 24 and South 24 Parganas
PRI Initiatives in Health (CHCMI): Ms. Bharati Ghosh, Joint Secretary, Panchayat and
Rural Development, Government of West Bengal.
Ms. Ghosh began with a brief description of the Community Health Care Management Initiative
(CHCMI) being implemented by the Department of Panchayati Raj in West Bengal. The initiative
aimed at engaging Panchayats in health care management, thus ensuring community ownership
of health care. She stated that the emphasis of the programme was on preventing health hazards
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through awareness generation and engagement of the community in issues such as safe mother-
hood and nutrition. Self Help Groups (SHGs) were also engaged for regular monitoring, ensuring
early registration of mothers, awareness generation and behavior change.
Emphasizing the role of Panchayats in improving the quality of life in rural areas, she pointed out
that Panchayats had resources at their disposal which could be channelized for strengthening health
systems. These resources could be used for:
• Infrastructure development like building an Anganwadi Centre (AWC)
• Construction and maintenance of PHCs and CHCs
• Implementation of the sanitation programme
• Awareness generation on issues like early marriage, multiple pregnancies and even specific things
like the date of health check ups
Re-affirming their relevance, she stated that Panchayats had the advantage of local knowledge
and could therefore focus on local issues as well as address concerns of access and remoteness,
which often prevented health care outreach.
Listing capacity building of Panchayat representatives and SHGs as the primary challenge,
she acknowledged that the lack of quality training often prevented Panchayats and SHGs from
undertaking required monitoring and support activities for strengthening health care.
She declared that the institutionalization of the 4th Saturday meeting every month at the Panchayat
level was one of the most significant achievements of the programme. It had ensured inter-sectoral
convergence and planning between the Health and Family Welfare and ICDS departments.
Taking Technology to Primary Health Care: Prof. Sujoy K. Guha, Professor of Biomedical
Engineering, IIT, Kharagpur.
Prof. Guha highlighted the different ways in which technology could be used to support health care.
He outlined five key approaches that could be adopted to improve delivery of health services, briefly
describing each:
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• Development of supportive low cost equipment for use at the primary health care centres. For
example, easy to carry health kits for the ANMs. These could greatly improve the quality of care
and service
• Use of interactive communi-cation for addressing health issues. Giving an example of this, he
shared glimpses of the interactive software that had been developed for the Department of
Health and Family Welfare. The software aimed at providing information and answering questions
and concerns of adolescents on health and social interaction. He stated that a similar software on
MCH was also being developed for the department’s website.
• Use of tele-medicine for facilitating outreach health services. He declared that technology was
available for connecting remote rural areas through wireless or telephone communication that
allowed specialists sitting in distant places to examine patients. He commented that even the
sound of a foetal heartbeat could be heard through such technology, enabling delivery of quality
service to far flung areas.
He also put forth an updated version of the concept of ‘bare foot doctors’ wherein a motorcycle
or bicycle could be used to help either take the patient to the doctor or the doctor to the patient
in remote rural areas.
• Development of health booths for recording health information. He shared the concept of a
health booth i.e. a booth equipped with basic recording equipment where a person could go and
get their weight, height, temperature, etc. recorded. The information so recorded could be saved
on a centralized computer (along with patient details) and updated automatically on each visit
by the patient. This would allow for mapping trends in basic health indicators for each individual,
thereby providing relevant information for preventive action if required.
• Lastly, he shared information on the Development of new methods of contraception such as
Reversible Inhibition of Sperm Under Guidance (RISUG).
The Youth Perspective: Mr. Ranjan Panda, Programme Manager, CINI, West Bengal
Mr. Panda stated that CINI adopted a holistic, rights-based approach in all its interventions and shared
details of their programme which aimed at providing adolescent friendly health services. Through provid-
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ing technical assistance, capacity building, networking and advocacy, he asserted that CINI had been
successful in creating an environment conducive for scaling up youth health issues and interventions.
Stating that their efforts primarily focused on ensuring that the youth themselves generate the
demand for health services among their peers, he listed some of the approaches adopted by them to
bring this about. These included youth friendly service delivery, peer advisors, collaboration with PRIs,
etc. He further highlighted their most recent initiative – the launch of a teen-line to provide telephonic
counseling on reproductive health, career counseling, and emotional counseling to adolescents.
Acknowledging the support provided by the government for these initiatives, he asserted that the
GO-NGO collaboration for adolescent health was increasing.
In the end, he underlined the four guiding principles adopted by CINI for the PRAYASH (Promoting
Rights-Based Action to Improve Youth and Adolescent Sexual & Reproductive Health & HIV AIDS in
India) project, which formed the basis of their work on adolescent health:
• Rights based approach that empowers youth to take individual and collective action
• Youth-adult partnership which seeks to strengthen community capacity and commitment to
ensure improved access to services and an enabling environment for youth development
• Youth-empowerment, developing youth as leaders through their involvement in programme
design, implementation and monitoring, making them key partners in the process of change
• Sustainability: working in partnership with and building the capacity of community structures,
local self-government institutions, and government service provision agencies to integrate
reproductive and sexual health and HIV/AIDS within their mandate and make it more gender
sensitive and youth-friendly
Promoting Access to Care and Support for PLHIV in West Bengal:
Ms. Pritha Biswas, State Coordinator, CBCI, West Bengal.
Ms. Biswas highlighted the various factors that increased vulnerability to HIV in the State of West
Bengal such as high migration and the large presence of female sex workers in border districts of the
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state. She mentioned that
there were four A and four
B category districts in West
Bengal, with the district of
Darjeeling having more than
2% HIV prevalence among
ANC clinic attendees.
Sharing details of
initiatives being undertaken
by the Global Fund
Programme, she stated
that the programme was
currently providing Anti
Retroviral Treatment (ART)
clinic services and running
13 Community Care Centres (CCC) for people living with HIV (PLHIV) in 19 districts of West Bengal.
The ART centres had about 2000 registered clients.
She stated that some of the key challenges in ensuring quality care and support were limited
availability of beds at the ART clinics and the fact that many clients who availed ART services did not
necessarily register at the CCCs. She also stressed on the need to give special attention to PLHIV
especially orphans abandoned by the family.
She concluded by showcasing some of the good practices initiated by the Global Fund Programme
in West Bengal:
• Ensuring ration cards for PLHIV
• Mobilizing support from local MPs to provide ambulance support for the clinics
• Income generation and fund raising at the CCCs through activities such as painting exhibitions.
The money generated is given to clients registered in CCCs
Open House Discussions
Some important points raised during the open house discussions were:
• The relevance of telemedicine in rural India was questioned due to bandwidth problems which
made it difficult to use. The need to improve the technology was emphasized
• The need to engage traditional birth attendants in all RCH efforts was stressed upon, as home
deliveries were still prevalent in rural India
• The engagement of elected representatives (PRIs) was helpful in addressing issues of outreach,
ensuring that specific local needs are addressed and also in bringing about linkages with other
development programmes and departments
• The need to develop and strengthen adolescent health clinics to provide social counseling as
well, was emphasized
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Concluding Remarks by Chairperson
Dr. Nina Puri stated that the deliberations were very relevant for improving and formulating
programmes and planning for population, health and social development. Given that health
indicators in West Bengal were good, she observed that there was now a need for expanding the
focus to other health concerns like smoking, HIV/AIDS etc. She also highlighted the emerging issue of
rapid urbanization and increasing migration in West Bengal, and stressed on the need to strengthen
rural development as one of the means of reducing migration to cities.
In the end, she concluded by stating that West Bengal was definitely a leader in social indicators
in the eastern region and that the other three states should learn from the lessons of West Bengal
and from each other. There should be a concerted effort not to repeat mistakes and to emulate
success stories.
Recommendations
• An increased focus on reducing
neo-natal mortality is required in
West Bengal
• The gap in manpower allocation
at the government level needs to
be addressed
• Joint monitoring of health, water
and sanitation and women and
child development activities of
Gram Panchayats should be un-
dertaken at the Block level. There
is also a need for convergence of planning and monitoring at the state and district levels
• Adequate capacity building and mentoring of SHGs is required if they are to be effective in ad-
dressing health issues
• The process of providing health services for adolescents at CHC, PHC and also at the school level
needs to be hastened
• There is a need to provide more mobility to the health care providers and provide low cost tech-
nology for health care to all
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Closing Session
Conclusions and The Way Forward
Chair person: Mr. B.G. Deshmukh, Vice Chairman, Governing Board, PFI
Other dignitaries on the dais: Dr. Nina Puri, Member, Governing Board, PFI, Mr. B G. Verghese,
Member, Governing Board, PFI, Mr. A. R. Nanda, Executive Director, PFI
The session started with a presentation by Dr. Arundhati Mishra, Additional Director, PFI, who provided
a summary of the recommendations that emerged from the two day deliberations. These have been
included in the last section of the report.
Comments from the Panel
Dr. Nina Puri stated that a key aspect and an integral part of the reproductive health and family plan-
ning was HIV/AIDS. She commented that it was closely related to the issue of migration and should
be focused upon within the wider context of social development.
She asserted that sexual and reproductive health services were human rights issues and should be
advocated by civil society in a united manner. Particularly for West Bengal, sexual violence (which
came within the purview of human rights) was a major issue that needed to be addressed.
Commenting on the issue of male involvement, she emphasized the need for developing a common
understanding that male involvement was not just taking up NSV or male sterilization. It included
the whole support system, both economic and social, from supporting the woman in family planning
choices, to taking her for regular ANC check-ups etc.
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Open House Discussions
Some important points raised during the open house discussions were:
• The need for a customized population stabilization programme for tribals aimed at addressing
their specific problems
• The relevance of adopting a holistic approach even if it meant focusing on issues which prima
facie did not seem to appear directly linked to population stabilization such as agricultural devel-
opment, technological development, health education and enhancement of irrigational facilities.
All these issues had the potential of adding to the efforts of population stabilization. For exam-
ple, industrial development could help tackle the problem of migration, especially in states like
Bihar and Jharkhand
• Scaling up successful interventions and projects was important. To enable this, it was essential
to evaluate the projects to identify processes and strategies that had worked and those that
had not
• Capacity building programmes should also include a sensitization component which aimed at
teaching field level workers how to communicate and the ‘why’ part to the beneficiaries i.e. why
they should adopt a particular behavior
• The importance of community participation was emphasized
• Essential care at home for neo-nates required greater focus, as it could help save the lives of
many newborns
• The need for engaging with and building capacities of Traditional Birth Attendants (TBAs) and
Rural Medical Practitioners (RMPs) was stressed upon, as they were the first point of reference in
times of emergencies and during disasters like floods.
Closing Remarks by the Chairperson
Mr. B. G. Deshmukh pointed out that the states under discussion in the conference reflected many
differences despite being from the same region. The demographic conditions and transition in all the
states showed different trends, which clearly pointed to different socio-cultural backgrounds in each
state. He commented that this
diversity echoed the need for
local planning and problem
solving.
Identifying some basic
issues that required immediate
action, such as generating
political will, ensuring good
governance and improving
quality of delivery, he
emphasized the role of civil
society in taking these forward.
He further highlighted the
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shortage of manpower as a key issue and encouraged civil society organizations to support the
Government in its initiative to introduce shorter courses.
He observed that the deliberations had also brought forward the close relationship between
health and education and stated that the proper allocation of resources for both was extremely
important. He remarked that youth issues and the engagement of PRIs was also an area that required
immense efforts at capacity building. This would enable the youth and the PRIs to be more proactive
in accessing and monitoring services leading to improvement in quality of health services.
He concluded by thanking all the participants and dignitaries on the dais for sharing their valuable
views, suggestions and reflections in the conference.
Mr. S. Ramaseshan, Secretary & Treasurer, PFI gave the Vote of Thanks to conclude the
conference.
Key Recommendations for the Eastern Region
The following recommendations emerged from the deliberations during the two day conference:
• Achieving replacement level of fertility and population stabilization in the states of Bihar and
Jharkhand requires focused interventions on:
w Increasing the age at marriage and cohabitation especially for girls. This is because girls who
marry early are likely to have more children in their life-time
w Increasing the number of years of schooling for girls. This prevents early marriage and ensures
proper education, which helps develop the right attitudes among the vast population, who
are yet to enter the fertile age
w Holistic and coordinated efforts that take into account the wider socio-economic development
context; because Family Planning programmes cannot be addressed in isolation
• Improving reproductive health outcomes requires the adoption of some new strategies and
innovations, such as:
w Innovations that shift accountability to the community such as demand side financing
w Focused interventions on improving quality of care
w Empowerment of PRIs especially women leaders, to monitor health and social development
programs with a focus on vulnerable populations and women
w Identification of the special needs and concerns of tribal populations, especially tribal girls,
and including specific provisions based on these needs in all relevant programmes
w Focused advocacy to increase political commitment for quality implementation of
programmes
• Addressing the concerns of youth/adolescents requires:
w Interventions aimed at addressing adolescent sexual and reproductive health and nutritional
needs of adolescent girls
w Provision of life skills education
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w Provision of youth focused quality SRH services
w Development of interactive software for educating adolescents on reproductive and sexual
health
• Reduction of high IMR and MMR requires strategies aimed at:
w Preventing motherhood at immature young ages by delaying age at marriage
w Introducing and promoting home based newborn care interventions, as a large number of
deliveries take place at home
• The shortage of human resources is essential to overcome. The possible ways of bringing this
about are:
w Training a second line of health providers in hospitals with 125 beds
w Promoting effective traditional indigenous health care practices (especially of tribals) which
exist in the region. Promoting their research and its standardization
w Instituting a concrete policy to increase infrastructure for medical education
w Reviving mid-wifery schools
w Providing more mobility to the health care providers and providing low cost technology for health
care to all
• Good governance is essential to ensure quality health service delivery. One way of bringing this
about is by evolving a robust system to obtain good quality data and building strong monitoring
systems. The role of civil society in this process is very important.
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A Cultural Feast for the Participants
A cultural programme comprising a rich milieu of traditional and classical dance forms by Guru
Gangadhar Pradhan Foundation was organized for the conference participants in the evening of
the first day of the conference. Guru Gangadhar Pradhan, one of the foremost exponents of Odissi
dance is the Founder-Director of the Foundation, Konark Natya Mandap and Orissa Dance Academy.
The programme included fascinating performances of Odissi, Gotipua, Sambalpuri and Chhau dance
forms which were greatly appreciated by the participants.
Odissi classical dance evolved as a spiritual
expression of devotion to the higher being. It is
distinguished and differentiated from the other
schools of dancing by its elaborate grace and
charm. It is full of sculpture like poses known
as Bhangis.
Gotipua is the precursor of Odissi dance.
The Odissi dance has evolved from the Gotipua.
The word ‘Goti’ means one or single and ‘pua’
means boy. The dance is performed by young
boys dressed as females. This dance is acrobat-
ic as the boys perform breathtaking steps and
poses.
Not yet classified as a classical dance, three
varieties of Chhau viz. Mayurbhanji, Purulia and
Seraikhela are performed, of which Mayurbhanji
portrays the most intricate and complex body
movements.
Dalkhai is the most popular folk-dance of
western Orissa. The dance is performed in devo-
tion to the Goddess “Dalkhai”. It is performed by tribal women of Western Orissa in which men join
in as drummers and musicians.
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Media Coverage
The conference received wide coverage in both print and electronic media, bringing the health,
population and development issues of Orissa, West Bengal, Bihar and Jharkhand to the forefront.
Sl. No.
February 16, 2010
1
DD Oriya
2
ETV-Oriya
Media
3
OTV
4
Naxatra News
5
Kanak TV
Time/Page Nos.
7.00 PM - Regional News
6.00PM - Mahanagar News, 7.00PM - Amari
Odisha News, 9.00PM - National News
6.30PM - Twin City Round Up, 7.00PM -
Pratidin, 9.00PM - News@9
News Headlines every one hour,
9.00PM - 9PM News
Special Panel Discussion on IMR, MMR MMR
& Orissa at 8.30 PM
6
www.orissadiary.com
7
www.timesofindia.indiatimes.com
February 17, 2010
8
Times of India
9
New Indian Express
10
Pioneer
11
Hindustan Times (Patna)
12
Statesman
Hindi Dailies
13
Sanmarg
14
Dainik Jagran
Oriya Dailies
15
Amari Katha
16
Anupam Bharat
17
Khabar
18
Matru Bhasa
19
Odisha Bhaskar
20
Paryabekshyaka
21
Samaj
22
Samay
23
Sambad
24
Sambad Kalika
25
Suryaprabha
Page 3
Page 2
Page 2
Page 2
Page 3
Page 3
Page 3
Page 3
Page 2
Page 3
Page 1
Page 3
Page 2
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Electronic Media
26
DD Oriya
27
OTV
28
ETV
29
Kanak TV
30
Kamyab TV
WEB MEDIA
31
www.expressbuzz.com
32
www.orissaindia.com
February 18, 2010
33
New Indian Express
34
Pioneer
35
Statesman
Hindi Dailies
36
Sanmarg
Oriya Dailies
37
Ajikali
38
Anupam Bharat
39
Dharitri
40
Dhwani Pratidhwani
41
Paryabekshyaka
42
Pragatibadi
43
Prajatantra
44
Pratidina
45
Samaya
46
Suryaprabha
February 19, 2010
47
Dainik Jagran
48
Matru Bhasa
49
Samaj
50
Paryabekshyaka
7.00 PM - Regional News
6.00PM - Mahanagar News,
7.00PM - Amari Odisha News,
6.30PM - Twin City Round Up, 9.00PM
- News@9
7.00 PM - Regional News
9.30 PM
Page 2
Page 2
Page 11
Page 3
Page 1
Page 4
Page 5
Page 2
Page 6
Page 3
Page 3
Page 1
Page 12
Page 11
Page 3
Page 7
Page 9
Page 2
On day one of the conference, the inaugural session got adequate coverage in prime time news and
hourly news bulletins on DD-Oriya, ETV-Oriya, Naxatra News and Kanak TV. In addition to glimpses
of the conference, the coverage included interviews of the Chief Guest, Chairperson, Governing
Board, PFI and senior PFI officials. It also included a panel discussion on the topic under discussion
in the conference.
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The web media www.orissadiary.com and www.timesofindia.inditimes.com also covered the event
with detail reports.
The coverage was mainly in the print media on day two, where detailed news articles on the first
day’s deliberations and the inaugural session were covered. The event was reported in around 18
English and vernacular dailies with a prominent place on pages 2 or 3.
The key discussions on day two were also reported in the electronic media by DD-Oriya, OTV, ETV and
Kanak TV. Interview bytes of Dr. Abid Hussain, Mr. A.R Nanda, Dr. Almas Ali and Ms Sona Sharma
were telecast. Another 24x7 Oriya news channel Kamyab TV telecast a panel discussion where Dr.
Almas Ali participated.
The event also received good coverage in the web media on www.expressbuzz.com and www.oris-
saindia.com.
Following the conclusion of the conference on February 17, 2010, the coverage continued on Febru-
ary 18th and 19th, with the deliberations of the second day reported by around 14 national and
local dailies.
Overall the media provided immense support in bringing critical issues pertaining to health and
population stabilization in the eastern region to the fore.
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Snippets from the Press
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List of Participants
Sl. No. Name
Organization
Designation
1.
Saupriya Satyarath
SOVA Koraput
Programme Manager
2.
Dr. Deepa
UNFPA
State Prog. Officer
3.
Dr. R U Singh
PFI
Hony. Advisor PFI,
4.
B. N. Singh
C/o. PFI
Ex. Professor, Patna Univ.
5.
L. K. Nanda
ASRA
Vice President
6.
A. Biswas
Tagore Soc.
Director
7.
B. Bismil
NGO International
Chief Coordinator
8.
Md. Ziauddin
CEDPA
State Prog. Coordinator
9.
Almas Ali
10. Ved Prakash Gautam
11. Suman Maity
PFI
Sr. Advisor
Grove Development South
Asia Regional Office
Project Manager
Ashaar
Project Coordinator
12. Mukul
Seva Kendra
Project Coordinator
13. Mr Swapan Mazumdar
BVHA Patna
Executive Director
14. Pradip Kumarr Jha
Welfare India
Secretary
15. Ajay Kumar Jha
GPSVS Madhubani Bihar Programme Officer
16. Debashish Sinha
IPAS
State Prog. Officer
17. Rajendra Kumar Choudhury LEPRA society
PC CCC
18. Pratheep Jose
Jyothi
PC
19. Dr. Saraswati Swain
NIAHRD
Sect. General
20. Alok Kumar
NIAHRD, Cuttack
PC
21. Shakti Rajapati
IDSP, NRHM, Orissa
Epidemiologist
22. Ashish Biswas
Tagore society
Director
23. Anu Garg
Secretary
H & FW
24. Sunkant Kumar Raut
ORPHAN
-
25. Sudha
Shakti Vardhini Patna
Dir- cum-Secretary
26. Chandan Kumar Nayar
Astha CCC
Project Coordinator
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27. Pritha Biswas
CBCI HC
State Coordinator
28. Dr. P. K. Rubin
29. Nihar Ranjan Patra
30. Dr. B. Tirkey, Jharkhand
31. Ashish Kumar
Bhoruka Bhalokasha
LEPRA Society
Health Directorate
Govt. of Jharkhand
Medical Officer
Resource Information
Officer
Dy. Director Health
Services
Urban Health Consultant
32. Dr. Deepa
UNFPA
SPO
33. Dr. M. K. Mohanty
HDF, Bhubaneswar
Head, HRU
34. Shubhir Grahacharya
Mission Directorate NRHM,
Orissa
State Prog. Manager
35. B. B. Hota
PRC BBSR
Former Director
36. Dhirendra Kumar Roy
HDF
Executive Director
37. S. S. Singh
OSCARD, Orissa
Executive Director
38. Ajaya Kumar Khuntoo
ASRD cuttuck
Secretary
39. Nandita Nayar
40. Omkar Prasad Pattanaik
41. Manoj Jena
Care
Team leader
Kalinga Social Cultural As-
sociation
Member
VSP
Secretary
42. Deepak Mishra
PFI
-
43. A. B. Biswal
Utkal Sevak Samaj
Secretary
44. Dr. U. K. Tripathi
OSACS
Consultant
45. K. L. Chugh
PFI
Governing Board Member
46. Dr. Saraswati Swain
NIAHRD
Secretary General
47. Baidhyanath
Vishwa Jeevan Seva Sangh Secretary General
48. Dr. Manmath K Mohanty Health Resource Unit, HDF Head
49. Dr. A. K. Satpathy
Ministry of H & FW
Sr. Regional Director
50. Dr. N. P. Dash
Ministry of H & FW
CBTT, Faculty
51. Dr. Bijoya Mishra
MAMTA
Director
52. Dr. Tapulata Dwivedy
MAMTA
Member
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53. Ved Prakash Gautam
Gronpe Development
Project Manager
54. Sasai Kanta Nayar
Lepra Society
Project Coordinator
55. Mary Verghese
PFI
Project Director
56. Bibhu Kalyan Mohanthy
SAMBANDH
Executive Director
57. Debabrata Bhuniya
IRH
State Representative
58. Ashish Kumar
Govt. of Jharkhand
Urban Health Consultant,
Govt. of Jharkhand
59. Tarun Kumar
Arthik Atma, Samajik Vikas
Abhikaran Patna
Managing Director
60.
Ram Chandra Choudhary
Gram Nirman Mandal,
Sarvodaya Ashram, Bihar
General Secretary
61. Sashimani Panda
OMRA
Project Director
62. Satya Narayan Thakur
Smile Foundation
Programme Officer
63. Dr. Ambuj Mohapatra
Development Facilitators President
64. K. K. Swain
Odisha VHA
President
65. Ram & Mohapatra
OMRAH, Cuttack
Office Assistant
66. Nina Puri
PFI
Governing Board Member
67. A. R. Nanda
PFI
Executive Director
68. S. K. Mondal
PFI
Sr. Manager
69. Manakesh Sankar
Pratichi Trust
Research Associate
70. Tanmay Kar
TSRDS, Gopalpur
Unit Head
71. Ashutosha Panda
TSRDS Beshapur
Project Coordinator
72. Ajay Das
73. Buddhadda Chaudhuri
74. Barudmarah
ORPHAN
CARID & Calcutta
University
HDF
-
Professor
-
75. Akshay Kumar Dash
76. Subrat K. Rout
77. Ganesh Reddy
TSRD, Orissa
Project Officer
Human Development
Foundation
Programme Manager
Citizens Foundation
Secretary
78. Alok Mohanty
CYSD, BBSR
Research Associate
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79. Dr. R. Behura
80. Antripaty
81. S. P. Dash
82. Dr. S. K. Sasamal
83. Sanjay Pandey
84. Nikita Sinha
85. Lalitanjali Das
86. Pravat Kumar Satapathy
87. Baudhbrata
88. C. R. Indu
89. A. Prout
90. Sr. Cleius
91. Sr. Denin
92. Pinki Sinha
93. Subir
94. Murari Choudhury
95. M. D. Ziauddin
96. Paresh C. Dash
97. Lalit kumar Nayak
98. Sagarika Subhadarshwni
99. Dr. D. K. Samuel
100. Dr. J. Chanti
101. Sujoy K. Guha
102. Paromita Halder
103. Prasanta Tripathy
104. Maitree Padhi
105. Ajay Das
CARE
Team Leader
CPSD
Secretary
FPAI, Bhubaneswar
BM
SJA
Lecturer
PFI, New Delhi
EOP (HUP)
PFI
SPO
JMS Kendrapara, Orissa Secretary
Universal Service
Executive Secretary
Vishwa Jeevan Service
Secretary General
MAS
CE
ULL Ekjut
Lecturer
JMJ CCC Sambalpur
Director JMJ Hospital
JMJ CCC Sambalpur
Coordinator JMJ CCC
Engender Health
Consultant
Dept. of Health & FW
State NGO Coordinator
NEEDS
-
CEDPA
State Programme Coordi-
nator
Rotary Club
PP
ASRA Cuttack
Vice President
Swabhiman BBSR
Project Office of Advocacy
The Medics
Director
H & FW
Dy. DHS
IIT Kharagpur
Professor
Pratichi (India) Trust
Research Associate
Ekjut
Secretary
Kalinga Institute of Social
Sciences (KISS)
Lecturer
Change
Chairperson
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106. Sailabala Mishra
107. Ajay Srivastava
108. Ranjan
109. Indu Sinha
110. Dr. S. K. Kar
111. Dr. A. S. Acharya
112. Dr. A. K. Satpathy
113. Dr. N. P. Dash
114. Dr. M. Kumari
115. Dr. U. K. Tripathy
116. Col. S. Rath
117. Digambar Shatapathy
118. J. P. Josuah
119. Dr. Bijaya Mishra
120. Dr. Sukat
121. Mohit Ahuja
122. Dharitri Dwively
123. Ashok Sahay
124. Ananda Pattanaik
125. N. P. Patro
126. Sucharita Patro
127. K. Mohapatra
128. Gaurav Mohapatra
Divya Jyoti Sevashram
President
CINI
Project Officer
CINI
Programme Manger
CENCORED, Patna
Executive Director
ICMR
Director
ICMR
Statistician
Regional Office for Health
& FW (GoI)
Sr. Regional Director
Regional Office for Health
& FW (GoI)
Faculty Member
Dept. of Health Jharkhand
Addl. Director, Health
Services
OSACS
Consultant CST
Usha Martin/ KGVK
Special Advisor
TSRD, Orissa
Liaison officer
MAC
Executive Director
Mamta
Director
DF
State Coordinator
Plan International
Programme Coordinator
RGVN
Regional Manager
ASRA
Joint Secretary
Vaidyanath Pattnaik Chari-
table Trust
-
Dibya Jyoti Sewashram -
Dibya Jyoti Sewashram -
Prakalpa
Chief Operating Officer
Jana Swasthya Abhiyan,
Orissa
State Convener
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