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Popfocus 2007 July September English |
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Dissemination of Jharkhand Draft Youth Policv
The Department of Art, Culture,
Sports and Youth Affairs,
Government of Jharkhand in
collaboration with Population
Foundation of India organized a
Dissemination Workshop on the
Jharkhand Draft Youth Policy at Hotel
Yuvaraj Palace, Doranda, Ranchi on
July 30, 2007. The Honourable
Deputy Chief Minister, Jharkhand,
Shri (ProL) Stephen Marandi was the
Chief Guest and Shri Bandhu Tirkey,
the Honourable Minister Art, Culture,
Sports and Youth Affairs and
Human Resource Development,
Jharkhand, was the Special Guest
for the event. Shri R. U. Singh,
Honorary Advisor, Bihar, Jharkhand,
Population Foundation of India
welcomed the Chief Guest and
Special Guest to the workshop and
thanked them for their presence and
valuable time.
Shri A. R. Nanda, Executive Director,
PFI in his address mentioned that the
process of development of Jharkhand
lif
Department
Date - th July 2007
Hotel Yuvraj Palace
Organil.ed by
of Art, Culture, Sports & Youth Affairs
Government of Jharkhand
Paclutatea 6y
•
ulation Foundation of India
Mr. A. R. Nanda, Executive Director PH, Prof. Stephen Marandi,
Deputy Chief Minister Jharkhand, Mr. Bandhu Tirkey, Minister HRD, Sports and
Youth Affairs, Mr. R. S. Verma, Secretary Dept. of Art, Culture, Sports and
Youth Affairs, Mr. P C. Mishra, Director, Dept. of Art, Culture, Sports and
Youth Affairs (from Left) leading the discussion on youth policy
Youth Policy started in April 2006
and elaborated on the committees
and sub-committees, block, district
and state level co-ordination
processes in drafting the Youth
Policy.
National Workshop on Community
Monitoring of Health Services
under NRHM
Envisaging Improved Health Services -
An Advocacy Effort
The Global Fund Programme on
HIV/ AIDS Round 4 and Round 6
Two Years of NRHM - A National
Stakeholders' Consultation
Ensuring Reproductive and
Sexual Health of Women -
The Empowerment Approach
Towards Better Reproductive and
Child Health Status of Tribals
in Jharkhand
Scaling Up - Building on Evidence
Naya Savera: Annual Review Meeting
And the Award Goes to ..
Release of Publication
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'"m Ihe £xeculive 1)ired,,', desk...
The 4th Asia Pacific Conference on Reproductive and Sexual
Health and Rights facilitated a review of the progress that the
Asia pacific region has made in fulfillingthe challenges and promises
of achieving full reproductive and sexual health and rights. It also
reiterated the importance of moving forward with a holistic
perspective and integrating the different streams like livelihoods,
employment, education and health that affect the very dynamic
and transitional group of young people.
There are over one billion young people (aged 15 - 24) in the world
today, which accounts for some 18% of the world's total population.
Even though the term "youth" varies in its significance and age
range, this period is viewed as a very specific stage between childhood
and adulthood, when people have to negotiate a complex interplay
of both personal and socio-economic changes in order to manoeuvre
the 'transition' from dependence to independence, take effective
control of their own lives and assume social commitments.
The countries, especially of our region, encompass a richly layered
mix of cultures, religions, languages, racial and ethnic groups, and
economic and political systems. Although the region has varied
settings with regard to many aspects of adolescent sexual and
reproductive health, there are also important commonalities. Most
adolescents throughout the region have little if any accurate
information about their bodies and their sexual and reproductive
health. The pronounced difficultiesyoung people experience in terms
of their socio-economic, political and cultural inclusion in an ever
volatile world are the subject of wide-spread concern at national
and international levels.
Since the ways in which these challenges are addressed by policies
will not only shape the present but also profoundly determine the
future of any country, the need for adequate policies relating to
young people arises as one of the highest priorities of s9ciety.
As was reiterated in the "open letter" to Governments, read at the
closing session of the 4th APCRSH, "Today, young people face
significant barriers to sexual and reproductive health and information,
resources and services. In some countries, young people represent
half of all new HN infections. Programs and policies have not proven
effective to stop or even decrease the problems related to the issue.
These must be reassessed and that re-assessment should include
the meaningful involvement of young people themselves. It is
essential that young women and men have access to age appropriate
comprehensive sexuality education that is evidence based and non
judgemental. Also, members of this age group must be recognised
as autonomous individuals who have the right to make decisions
regarding their own lives."
The ongoing and future demands created by large young
populations, particularly in terms of health, education and
employment, represent major challenges and responsibilities for
families, local communities, countries and international community.
To meet the special needs of adolescents and youth, especially young
women, the challenge is to give due regard for their own creative
capacities, and to provide social, family and community support,
employment opportunities, participation in political processes, and
access to education, health, counselling and high quality reproductive
health services.
PopJOcus
The Chief Guest, Professor Stephen Marandi
~ pr~ sed the eed for orgg i4~d skill building
training for youth and giving them exposure for
better outcome. The policy should have components
of preserving rural tradition and history of
Jharkhand. Policy in itself is not sufficient; it should
be supported by an implementation plan, which
should be developed in consultation with relevant
agencies and institutions and young people.
Special Guest, Shri Bandhu Tirkey expressed his
happiness on drafting of the policy and focused on
the practical implementation mechanism of the
policy. The policy would take care of the personality
development of the youth that can be undertaken
through training and camps, training of teachers
and enhancing college and youth clubs through
timely release of grant in aid. The Youth Affairs
department should take initiative and promote
formation of youth clubs in rural areas to make
them aware of the government policies and plans.
Shri Tirkey requested the department to finalize the
policy at the earliest so that it can be put forward
for approval.
Shri Ravi Shanker Verma, Secretary, Department
of Art, Culture, Sports and Youth Affairs,
Government of Jharkhand highlighted the need for
the policy. The policy intends to create opportunity
for youth in the field of education, health, livelihood,
art and culture and protection from all kind of abuse
and exploitation. He specially acknowledged the
efforts of Population Foundation of India and other
stakeholders including Government and non-
Government support in formulating the youth
policy.
Shri P. C. Mishra, Director, Department of Art,
Culture, Sports and Youth Affairs, Government of
Jharkhand focused on the salient features of the
policy. Apart from the thrust areas, objectives and
principles of the policy, he highlighted the
commitment of the state towards Art, Culture,
Sports, Education and Livelihood and its strategic
directions. He emphasized that the policy adheres
to preserve and promote traditional art, culture and
heritage. He ended his deliberation by stating that
a detailed operational plan would be prepared for
each component of the policy.
In the open session, the stakeholders expressed their
suggestions and feedback on the draft policy and
suggested the following five major policy initiatives
in the implementation plan:
./ Creation of a database on youth issues at
Panchayat level
./ Formation and encouragement of youth self
help group
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Pop-fOcus
National Workshop on
Community Monitoring 01Health Services under NRHM
The Government of India's
flagship programme, the
National Rural Health Mission
(NRHM), launched on April 12,
2005, focuses on enhancing the
access of rural population to safe,
rational, effective, affordable and
quality health services including
reproductive and family planning
services in the eight EAG states, the
eight north eastern states, Himachal
Pradesh and Jammu & Kashmir.
The guiding principles as laid down
in the implementation framework of
the Mission are to promote equity,
access, efficiency, quality and
accountability, decentralize and
involve local bodies, recognize the
value of our traditional knowledge
base, promote innovations, methods
and process development and
enhance people oriented and
community based approach. One of
the strategic shifts that the NRHM
wishes to bring about is in the
monitoring framework by involving
communities in planning and
monitoring programmes.
In order to further the objectives of
ensuring community monitoring
processes in NRHM, the Union
Ministry of Health and Family
Welfare initiated a pilot project for
Community Monitoring of Health
Services under NRHM to be
implemented in 9 states of Assam,
Chhattisgarh, Jharkhand, Karnataka,
Madhya Pradesh, Maharashtra,
Orissa, Rajasthan and Tamil Nadu for
a period of eleven months from
March 2007 to January 2008.
The entire process of Community
Monitoring is being implemented as a
partnership between the State Health
Department and the Civil Society
Organisations, which is supervised at
the national level by an Advisory
Group on Community Action (AGCA)
and at the State level by a joint State
Community Monitoring Mentoring
Group set up specifically for this
purpose. The AGCA plays the role of
facilitation and support to the entire
process, working with the mentoring
teams and organizations at the state
level. PFI is the National Secretariat for
operationalization of this pilot project
on community monitoring in these 9
states with the active involvement and
guidance of the members of the
AdvisoryGroup on Community Action
for NRHM and the MissionDirectorate.
The Centre for Health and Social
Justice (CHSJ), New Delhi co-supports
the National Secretariat.
In the first phase, Community
Monitoring will cover a selected
number of districts in each state
(depending upon the size of the state).
In each of these districts, three blocks
willbe covered and within each block,
3 PHCs will be covered and within
each PHC area, 5 villages will be
covered. This will lead to a total of
1350 villages, 270 PHCs and 90
blocks being covered for Community
Monitoring in the first phase.
As part of the programme, the
National Secretariat organized a
three-day National Workshop on
Community Monitoring from
July 19-21, 2007 atthe India Habitat
Centre, New Delhi with all the
state programme partners to share
experiences and develop a common
working principle for the programme.
Objectives of the workshop were:
(i) increase knowledge about
entitlements and mechanisms for
community participation and
ownership within NRHM, (ii)develop
operational protocols for capacity
building on community mobilization
and community monitoring, and
(iii) develop efficient administrative
and financial systems, including
reporting mechanisms for effective
implementation of the project
Over 50 civil society representatives
from all nine states of the programme
debated and discussed over a period
of three days to chart a detailed road
map and guiding principles for the
programme at the state level.
A participatory learning process was
adopted at the workshop to discuss
some of the key issues covered in the
workshop such as introduction of
NRHM with focus on health
entitlements, reviewing of existing
health services by analyzing
secondary data, details of the process
of community monitoring, review of
tools for community monitoring and
future plans for each state.
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PopfOcus
Envisaging Improved Heallh Services -
An Advocacv Enorl
Evidence Based Advocacy for
Maternal and Child Health
Amongst the Urban Poor of
Vadodara city in Gujarat State is a
project initiated in collaboration with
SAHAJ, an NGO based in Vadodara,
for a period of 18 months. The
project is based on SAHAJ's
experience of advocating with the
Municipal Corporation of Greater
Mumbai (MCGM) to start gynecolo-
gical OPDs in health posts of urban
slums. The current programme of
initiating evidence-based advocacy is
proposed in urban slums of Vadodara.
The objectives of the project are:
i) To determine the maternal (ANC,
safe delivery and PNC) and
children's (upto three years old)
health status in the slums of
Vadodara city.
ii) To examine the quality of health
services being used by the urban
poor for the above purposes and
ascertain the approximate cost
incurred in using these services.
iii) To use the data for advocacy at
the city as well as the state level
in order to strengthen the related
public health programmes and
schemes, and improve the quality
and accessibility of the services.
iv) To increase communities'
awareness on health issues and
the government health services
that they are entitled to.
v) To identify and train a community
health worker in each basti to
provide basic health education,
primary services for common
illnesses and link the community
with the public health delivery
system in the city.
vi) To increase communities' access
to quality health services through
the municipal corporation's
service delivery system.
The methodology comprises of
three key strategies, namely
Participatory Action Research (PAR),
Advocacy and the Community based
programme.
Participatory Action Research (PAR)
is a process of learning by the
communities and taking action to
address the issues identified by them.
By involving the communities right
from the beginning PAR also involves
advocacy from the beginning as it acts
as an empowering process for the
people to raise their concerns
themselves.
Based on evidence, the advocacy
efforts focus on policy makers, health
service providers within the public and
private sectors; members of local
government at the ward, district and
corporation levels; civil society
organizations working on similar
issues; academicians and researchers;
media. At the community level,
individual women, men and children,
as well as families and other social
groups are targeted. Mobilization and
involvement of such diverse groups
would facilitate not only the
formulation of appropriate policies
and programmes but also their
effective implementation and regular
monitoring.
The community based programme
involves training one Community
Health Worker (CHW) in each of the
15 bastis on maternal and child
health. They would also be given basic
medicines for common illnesses.
The CHW also creates awareness
amongst the community members on
preventive aspects, use of public
health services and people's right to
access quality and affordable health
care. It is envisaged that CHWs would
help to link the community with the
public health system and ensure that
larger proportion of women get
ANC, safe delivery, better post-natal
care and neo-natal care services.
The CHWs may later be linked with
the urban RCH programme under
which a similar cadre of community
workers is being planned.
The Advisory Committee comprising
of representatives of Urvi Shah
Population Research Centre, United
Way of Vadodara, PSM Dept.
Vadodara Medical College will be
constituted and the project will
be reviewed every 6 months. The
programme is envisaged to throw up
a replicable model of advocacy for
health services, which can be taken
up in other urban slums in the
country.
•
,/ Promotion of traditional crafts
amongst Primitive Tribal Groups
and provide marketing linkages
,/ Career counseling centre for
youth to be set up at block/
district levels
,/ Development of social security
scheme/credit facilities for youth
in unorganized sector
The dissemination of the Jharkhand
Draft Youth Policy was a culmination
of a three-year bottom up,
participatory approach in policy
advocacy on youth issues in the state
by PH PFI began its effort through a
pilot project on advocating for
adolescent reproductive and sexual
health (ARSH) issues in Ranchi and
Hazaribagh districts in Jharkhand.
This pilot programme covered every
block of the two districts and involved
various government and non-
government stakeholders including
young people to share their
suggestions and recommendations on
developing strategy for ARSH issues.
The learnings from this pilot
programme defined PH s technical
assistance to Government of
Jharkhand in developing the youth
policy for the state. PH facilitated a
similar participatory, inclusive and
grassroots process of developing the
youth policy. It ensured involvement
of various stakeholders, built evidence
on youth issues from status papers
and secondary data and conducted
meetings at various levels and
facilitated dissemination of infor-
mation to various agencies towards
shaping the draft policy.
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Pop}bcus
The Global Fund Programme on NIV/AIDS
Round 4 and Round 6
The Global Fund Round 6
Programme on HIV/ AIDS -
"Promoting Access to Care and
Treatment - PACT" is a five-year
programme initiated since June
2007. The programme focus is on
scaling up access to ART and building
care and support through Community
Care Centres.
PH has set-up three regional offices:
in Lucknow for the states of Uttar
Pradesh, Bihar, West Bengal and
Orissa; in Bhopal for the states of
Madhya Pradesh and Chhattisgarh
and in Jaipur for the states of
Rajasthan and Gujarat for effective
coordination and management of the
programme.
An orientation programme on
Procurement and Supply Manage-
ment (PSM) for the sub-recipients of
this programme (Indian Network for
People LiVingwith HIV/ AIDS (INP+),
Hindustan Latex Family Planning
Promotion Trust (HLFPPT) and
Catholic Bishops Conference of India
(CBCI)was organised on 16-17 July,
2007 in Delhi. The orientation on
programme, monitoring and
evaluation framework, PSM and
administration/finance was also held
from 18-19 July, 2007 in Delhi. The
Round 6 team members along with
Round 4 team participated in this
programme.
Programme orientation meetings
have been held with the officials of
SACS in the states of Uttar Pradesh,
Rajasthan, Gujarat, Madhya Pradesh,
Bihar, West Bengal and Orissa.
Project Director, SACS, senior
officials of SACS and the sub-
recipients for the Round 6
programme (INP+, HLFPPT and
CBCI) have actively participated.
State specific plans for the project
were shared and discussed
with respective SACS in the
orientation meeting. The meeting of
Chhattisgarh SACS is scheduled in
the first week of October 2007.
National AIDS Control Organization
(NACO) convened a coordination
meeting of all the Principal Recipients
and Sub-Recipients for The Global
Fund Round 4 and Round 6
programme under the chairman-
ship of the Additional Secretary
and Director General, NACO
on 29 September, 2007. The
programmatic issues and future plans
for the Round 6 programme were
discussed in the meeting.
As part of the deliverables for quarter
1 (June-September 2007), INP+ has
set-up three state level networks for
the states of Uttar Pradesh, Rajasthan
and Madhya Pradesh.
Under the Round 4 programme, a
workshop on Common Minimum
Programme (CMP) and IEC with state
level networks of INP+ was held on
11-12 July, 2007 in Chennai. The
workshop brought out key activities
associated with the service delivery
points and the key messages for
communication materials to be
produced in the Phase II of the
programme.
PMU Orienting Global Fund Round 6 Sub-Recipients on Management
Infomation System
As part of the deliverables, one
community care centre has been set-
up in Dimapur, Nagaland for providing
care and support services to people
living with HIV/ AIDS. Th~ centre
has been set-up by Development
Association of Nagaland (DAN), an
NGO based in Dimapur.
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Pop}Ocus
Two Years of NRHM - A National Stakeholders' Consultation
The National Rural Health Mission
was launched in April 2005 by
Government of India to provide a
new and integrated direction to
the implementation of health
programmes in the country. The
Advisory Group on Community
Action, a standing committee under
the NRHM in partnership with Centre
for Health and Social Justice,
organised a Stakeholders Consulta-
tion on August 8, 2007 at the India
International Centre, New Delhi,
to share experiences of the
implementation of NRHM across
different states. Over one hundred
participants attended the consultation.
Representatives of civil society from
13 states across the country, public
health experts, representatives from
national NGOs and international
organisations shared their experiences
and opinions. The consultation was
attended by Dr Syeda Hameed,
Member Planning Commission;
Mr G. C. Chaturvedi, Mission Director
NRHM; Mr Amarjeet Sinha, Joint
Secretary, MoHFW; Dr N. K. Sethi,
Senior Advisor Health at Planning
Commission and Dr Tarun Seem,
Director NRHM, MoHFW, Govern-
ment of India.
Structure of Consultation:
The consultation was structured
around thematic panel discussions.
In each panel there were
presentations on behalf of the
Government, experiences from the
community as well as opinions of
public health experts. This was
followed by discussion and questions
from the floor. Some key issues that
were discussed were as follows:
• Selection, Training and
Functioning of ASHAs
• Implementation of RCH 2 in
NRHM
• Integration of components
(different National Health
Programmes) and health
determinants
(nutrition,
sanitation, water etc.) in NRHM
• Strengthening Services
• Decentralisation
and
Community Ownership
Concerns and Recommend-
ations: Some key recommendations
that emerged from the consultation
are as follows:
Public health infrastructure
needs strengthening for effective
service delivery:
• Doctors should be trained for
community health orientation,
empathy and gender sensitivity.
• Essential drug lists must be
available in all the health facilities.
Medicine kit must be available with
the ASHAs, which must also be
refilled timely.
• Roles and functioning of AYUSH
department within NRHM needs
to be defined.
• Much·resource goes into the pulse
polio -programme and it continues
to affect regular service delivery at
the periphery but polio has not yet
been eliminated. The pulse polio
programme thus needs a serious
and careful review.
• A transfer policy must be
formulated to prevent frequent
and regular trans-
fers of providers
and other key
functionaries.
• Complete infor-
mation about
various NRHM
programmes and
schemes (eg Rogi
Kalyan Samiti,
Indian Public
Health Standard)
should be available
with all the Medical Officers and
ANMs.
• To ensure a regular presence of
health staff in peripheral/remote
areas special steps such as providing
incentives for health workers
serving in rural/difficult areas and
revamping the cadre of male health
workers need to be taken.
Strengthening RCH services
under NRHM
• Not all areas related to RCH
services are addressed adequately
in the Programme Implemention
Plans (PIPs); some areas that must
be dealt in more detail are -
- Adolescent reproductive and
sexual health issues.
- Gender training for health care
providers needs to be
introduced.
Equity and access issues for
underserved
population,
including the urban poor.
• Issues related to maternal health
care that need attention include:
- Emphasizing that the JSY
support is for nutritional and
other support and not for
service delivery costs
Promoting institutional delivery
without first addressing or
improving the quality of care in
these institutions is leading to
serious cases of denial of care and
the strategy needs to be revisited
- Harmful practices like
unsupervised use of oxytocin
injections before delivery has to
be addressed in the programme
Contd. on page 10
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PopJOcus
Ensuring Reproductive and Sexual Health of Women -
The Empowerment Approach
Delhi can boast of being one of
the states with the highest
female literacy rate in the country.
However, the growing incidences of
violence against women - sexual
harassments, rape and physical
violence, sex selective abortions and
dowry deaths paint a different picture
of the status of women in the capital.
Moreover, almost 20 percent of the
city's population lives in slums under
abject poverty - devoid of proper
sanitation, drinking water and other
basic amenities including access to
appropriate Reproductive and Child
Health Services, which makes women
in these areas particularly vulnerable.
It is, therefore, crucial for women and
adolescent girls (12-18 years) to be
suitably prepared and oriented to be
able to lead a more meaningful and
healthy life.
It is with this aim that the Population
Foundation of India has launched a
three year project "SWABHIMAN -
Urban Reproductive and Develop-
ment Project with an Empowerment
Approach" in four slums of the
capital in partnership with Smile
Foundation along with four local
NGOs - Adhaar Society, Sahyogita
Samaj Vikas Samity, Nav Saristi and
Health and Care Society, reaching a
population of about 80,000.
Specific Objectives of the Project are:
• Generating awareness on issues of
gender, Reproductive and Sexual
Health and HIV-AIDS among
adolescent girls
• Imparting Life Skill Education
(LSE) including communication
and negotiation skills to empower
women and adolescent girls
• Providing Reproductive and Child
Health Services through a Mobile
Health Clinic
The project strategy involves
generating awareness among
adolescents on issues of reproductive
health, women's reproductive rights,
violence against women and linkages
with different institutions for referral
networks through a cadre of trained
adolescent SWABHIMAN Health
Volunteers (SHVs) (one each for a
population of 2000) who would be
guided and supervised by Community
Health Educators (CHEs). Each CHE,
a resident of the area, covers a
population of 8000 - 10,000. These
CHEs are imparted extensive training/
orientation by Smile Foundation's
SWABHIMAN Team, on the various
aspects/issues surrounding gender,
rights and legal issues, Family life/ life
skills education, Reproductive and
Child Health, sexual health, HIV/
AIDS etc. to emerge as Master
Trainers in the community.
In addition to group meetings and
inter personal communication by
SHVs and training sessions by CHEs,
the project activities include various
IEC activities like publication of
newsletter, development
of
educational materials, posters,
banners, audio visual aids, indoor
games, street plays, slogans, wall
writing, articles and features in the
press, video documentation etc. to
enhance community awareness
and generate demand for quality
RH services.
A fully equipped mobile clinic
designed to deliver RCH services in
slum population having facilities for
examination of women visit the
project areas at specified intervals.
Linkages are established with the
government system in the area to
seek their support for the services as
well as supplies.
The project has been initiated since
May 2007.
•
Under the SWABHIMAN project, Smile Foundation celebrated Girl Child Week 2007 across the communities of Delhi. About 5,000
adolescent girls and women from various communities participated in the week long event. The celebration included various awareness
rallies, street plays, poster competition and slogan competition among young girls and boys. Young girls and women came forward in
good numbers to be part of every session including experience sharing on gender discrimination, sex selective abortions, dowry, and
domestic violence. The event celebrated between 17th and 21st of September culminated with celebration of International Girl Child
Day on 24th of September 2007.
"I feel that women are the greatest creation of God because all human beings need love and affection to grow in life and these qualities
are in abundance in all women. I am very happy with the work of SWABHIMAN because the programme has evoked self confidence
in all girls and amongst women and now they are becoming independent," expressed Ms. Nita Malhotra, ACP - Crime Against Women
Cell, Delhi, the Guest of Honour on the Girl Child Day celebration.
Speaking on the occasion, Dr. Lalitendu Jagatdeb, Joint Director (M & E), Population Foundation of India (PFI) emphasized, "We are
very worried regarding the figure of census which clearly indicates that the number of girls is coming down drastically and this will have
a large scale impact on our social structure but at the same time efforts such as these are very encouraging."
Ms Meena Batra, Programme Director - SWABHIMAN informed that this was just the beginning of the project efforts. The project aimed
at empowering women to fight against all the odds in the society and seek their rights, be it for health or other aspects in life.
Speaking on the occasion, Sangita - a young girl from the community articulated that "Every girl should get all the opportunity to grow
because they have equal potential and given the opportunity they do their best to excel in public life. All girls should also get respect in
the society."
Another girl Kiran questioned, "I do not understand why some parents do not want their daughters to study. Although I am young I
have counseled one family and now they are sending their daughter to school."
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Pop}bcus
Towards Bener Reproductive and
Child Health Status of Tribals in Jharkhand
The state of Jharkhand ranks
lowest among the eight
Empowered Action Group (EAG)
states in India. More than 60 percent
of its population live below poverty
line. Illiteracyis rampant with very low
female literacy. The reproductive and
child health indicators for the state
are very poor. Only 42 percent of the
pregnant women receive any ante
natal care, only two in ten deliveries
can be considered safe deliveries.
Contraceptive Prevalence Rate (CPR)
is just 28 percent. With this scenario,
high infant and maternal morbidity
and mortality rates in the state are
an obvious outcome.
The Noamundi block of West
Singhbhum District is predominantly
a tribal district, 'Ho' being the main
tribe. The tribes rely mainly on black
magic and shamanism for treatment.
Most deliveries take place at home
attended by untrained persons. The
tribals are totally ignorant of modern
methods of contraception. Immuni-
zation coverage is very low with only
17 percent children fully immunized.
The block has very poor health
facilities and low awareness levels
in reference to reproductive and
child health issues. Neonatal mortality
rates are one of the highest in the
country.
The five year project, titled
"Improving Reproductive and Child
Health Status of the Tribals in
Noamundi Block, West Singhbhum
District of Jharkhand" was initiated
by Population Foundation of India,
New Delhi in partnership with Krishi
Gram Vikas Kendra (KGVK), Ranchi
- the Corporate Social Responsibility
arm of Usha Martin Ltd. KGVK set
up in 1977 and started work in health
from 1985. Now it is a member of
Jharkhand Health Society (JHS) and
a Mother NGO under the RCH
Program of Government of India.
The project covers 36 villages of
Noamundi block of Singhbhum
district and will benefit a population
of about 30,000.
The main objectives of the project
are:
• Generating awareness among
eligible couples on use of
contraception
and other
Reproductive Health issues
• Increasing use of modern
contraceptives by eligible couples
by providing a basket of choice
• Creating community based
mechanisms and linkages for
improved health service delivery
• Building capacities of adolescents
in contraception and neonatal care
and sustaining positive health
seeking behaviour
Key strategies under the project
include selection and training
of Saahiyas (ASHAs) or village
health volunteer, networking with
government health service providers
and provision of outreach and referral
services. The project willform Village
Health Committees to provide an
effective forum to discuss and address
the health needs of the villages.
Capacities of various stakeholders will
be built with a focus on training of
Traditional Birth Attendants (TBAs).
Since, among Ho tribe, deliveries are
conducted by husbands, a component
of enhancing male involvement has
been incorporated, with appointment
of male health volunteers. In order to
build capacities and enhance
involvement of adolescents, Kishore-
Kishori Groups will be formed,
IEC material will be developed
and focused activities will be carried
out for them. The concept of
Social Marketing will be adopted
for improving accessibility to
contraceptives and other health
products like Oral Rehydration
Solutions (ORS), Disposable Delivery
Kits with Saahiyas acting as Depot
Holders.
Since many sub-health centres in the
region are in poor condition, an
attempt will be made to make them
operational by carrying out minor
repairs and renovations. It is hoped
that by the end of the five-year period,
the project willbe able to significantly
improve maternal health service
coverage including Ante Natal Carel
Post Natal Care, increase the
proportion of safe deliveries and
contraceptive use, immunization
coverage and reduce neonatal
mortality rates.
•
Ms. Jivanti, Project Coordinator in an interaction with the community
at a sub-centre
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PoPJQcus
Scaling UP- Building on Evidence
The first article of a series on "Scaling Up Pilots and Innovations" was published in the previous issue of Popfocus
(April-June, 2007). This is the second in the series detailing the factors to consider while scaling up interventions.
In the previous edition, the
importance of gathering quality,
scientific evidence on impact of the
approach was discussed. 'Evidence of
impact' was identified as first of
several factors that influence the
decision to go-to-scale. The article
emphasized the need to maintain the
rigour of research throughout the
course of the intervention. It also
suggested involvement of an
independent agency for evaluation.
Some of the considerations that were
listed as essential while gathering
evidences were:
1. Consistency of indicators for
intervention with those used
nationally or globally
2. Degree of change in indicators at
the end of intervention over the
baseline
3. Degree of change in indicators
over the control sites (if any)
4. Ability to attribute change to
individual components of the
approach
5. Acceptance of the results within
the scientific and development
community
FACTOR 2:
Evidence of results in other
socio-demographic settings
Most operations research projects
face a limitation in population
coverage. High degree of monitoring
and supervision and the need for
treatment and control sites often
limits these interventions to a small
population, usually less than 35,000-
40,000. The population of the pilot
model is usually homogeneous and
the processes used may be specific
to the target group.
When the models are discussed with
policy makers and programme
implementers at state and national
level, one of their key concerns is the
efficacy of the model in other socio-
cultural and socio-demographic
settings.
If a pilot intervention was effective
with rural population of Andhra
Pradesh, willit be as effective in Bihar
or Jharkhand? If the model showed
results with tribal communities in
Maharashtra, will it be effective in
non-tribal communities or say tribal
communities in other regions? If the
model worked at place where health
systems support was there, willit work
in places where health systems are
not effective? If the model
intervention was led by technical
expert (likedoctors), willit work where
technical resources are not available?
Several such questions are most often
left unanswered in a pilot
intervention. In order to collect
information on the durability of the
model and the evidence that the
model is 'weather-proof', a second
stage multi-centric intervention is
usually recommended.
The second stage of interventions
should explore all variants in the
model: different target groups,
different locations (with different
socio-economic features), inter-
vention partners with different
capacities. Choices one may make
are:
a) Target group:
a. by location: urban vis rural
vis tribal
b. by age and sex: married
adolescent, unmarried
adolescent, eligible couples,
men
b) Location:
a. Same state, districts with
different population profiles
b. Diff~l'ehtstaMs
c) Partners:
a. NGOs with similar capacities
b. NGOs with different capacities
c. Government systems
d. Private organizations/
Corporate Sector
This can be another kind of second
stage. Usually the pilot has several
components to it. In order to test
efficacy of each component!
process, a second stage multi-
centric intervention may be done,
where the population profile is
kept same but the processes are
tested independent of each other
or in a group of 2-3 processes. This
kind of multi-centric study helps
simplification of the model, and
improves the model's effectiveness
and efficiency, when it is taken to
operate at scale.
In multi-centric interventions where
variations from (a) to (c) are tried,
the threads of intervention design
and monitoring and evaluation
mechanism should be common to
the pilot.
A recent example is the Home Based
Newborn Care (HBNC) intervention,
which was first piloted by SEARCH
in Gadchiroli, Maharashtra, and later
tested with seven different NGOs in
Maharashtra. This second stage
(ANKUR Project) interventions tried
efficacy of the model with NGOs that
had capacities different from
SEARCH and with population whose
profile was different from those in
Gadchiroli. This model underwent a
third stage pilot, where the model was
tested by the ICMR in five different
locations, one each in five states of
India, and was tested with different
partners - medical colleges, NGOs,
ICDS and health systems. The three
stages of trials strongly positioned the
feasibility and the first two pilots
proved effectiveness of HBNC in
different socio-demographic and
socio-cultural settings.
•
II
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PopJOcus
Nava Savera: Annual Review Meeling
Annual review of "Naya Savera"
- a corporate social responsibility
project implemented by JK Lakshmi
Cement Ltd (JKLC) was held
on 5th September 2007 at PFI,
New Delhi. A five-member team of
JKLC including Managing Director
Mrs. Vinita Singhania and Whole
Time Director Mr. S. K. Wali was
present at the meeting. Dr. Kumudha
Aruldas, Additional Director, PFI
welcomed the JKLC team and briefed
them about PFI and its various
divisions. Dr. Vikram Gupta,
Rajasthan State Co-ordinator, PFI
made a presentation on the strategy
and approach of PFI and its
partners.
In his presentation, the JKLC Project
Director, Mr. Dinesh Pandya
highlighted the objectives of the
project, strategies, activities and
achievements - training programmes
of stakeholders, VLMs, dais, group
IEC activities like video shows, mahila
mandai meetings etc. He explained
the awareness generation modalities
of the project like nukkad nataks using
folk art, health melas, and formation
of 14 adolescent groups and details
of training programmes in schools.
He further shared that the mobile
clinics cover nearly 23,000 people in
the project area, ANM is making
home visits to cover the women and
children, who do not come to the
mobile clinics. He shared that 5,000
household visits have been made so
far especially to the tribal community.
The Naya Savera team shared that
child survival has improved,
pregnancy rate in eligible couples has
gone down, and so has the IMR.
The number of safe deliveries has
gone up. They recommended that it
is necessary to
(i) Promote sub-centres
(ii).Strengthen VLMs, ASH A
(iii)Use innovative media such as
magic shows
(iv)Take additional villages for further
strengthening the project.
The presentations were followed by a
discussionon some of the keyissuessuch
as ANM's home visits, health system
involvement, female foeticide, value of
the girl child and building capacities of
Kishore-Kishorisgroups etc.
Mrs. Vinita Singhania shared her
views, reiterating that a wider area
needs to be taken up for expanding
and strengthening the programme .•
- Dai's / TBA playa critical role
in facilitating access to health
services which has to be
acknowledged and suitable
capacity building and
empowerment of dais has to be
encouraged in remote and
underserved areas.
Community mobilization and
community participation
• Expand IEC activities at the village
and community levels to provide
information about available health
services, schemes (including JSY)
and other entitlements under
NRHM, including the role of
ASHA for improving community
health.
• Ensure ASHA training as
envisaged and regular evaluations
of ASHA's work.
• Information about membership,
roles and responsibility of Rogi
Kalyan Samiti, Village Health and
Sanitation Committees etc. must
be provided to all stakeholders
through a public notice.
Regulatory Systems -
Governance and Monitoring
Mechanisms
• Grievance redressing mechanisms
and medical and social audits of
adverse events and experiences
must be instituted and publicized
extensively.
• Departmental
monitoring,
oversight and accountability
mechanisms still needs to be
developed
further
and
strengthened for meticulous
implementation.
• Monitoring should include
regulation and performance
assessment of NGOs and private
providers as well.
• Community monitoring and social
audits should be introduced at the
earliest for responsible functioning
of the public systems.
•
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PopJOcus
And the Award Goes to...
The Children Education Awards
were given away by
Mr A R Nanda, Executive Director
at a function organised on the 27th
of July 2007 at PH for the Academic
Year 2006-07. These awards were
constituted by the Foundation to
encourage children of PH staff to
excel in their academic performance
and motivate them to do better in
the coming years. The awards, every
year, are presented to children, who
score a minimum of eighty percent marks in their final
examinations. A three member "Children Education
Award Committee" has been constituted, which shortlists
applications according to the eligibility criteria and
nominates the winners.
In the current academic year, the children who scored 90%
and above were Pratyush Ramesh (97. 5%), son of
Ms Prema Ramesh, Urvashi Paul (90.76%), daughter of
Mr P K Paul, and Aakash Rawat (Grade A, 90% and above),
,
son of Mr Mohan Singh. They
received cash awards of
Rs 1000/- each, a certificate of
merit and a trophy.
Children scoring more than 80%
or passing with grade 'A' for their
performance in I to V standard
received certificates of merit,
trophies and gifts. The children in
this category were Amrutha SNair,
daughter of Ms Usha S Nair with
"A" Grade, Nishtha Neogi, daughter of Dr Sharmila Ghosh
Neogi (88.7 5%) and Harikrishnan P, son of
Mr P Narayanan (88%).
Master V Satyanarayanan, son of Mr K Venkatachalam,
awarded for his outstanding performance in VIIIstandard
(89.67%) received a cash award of Rs 2000/- and
Ms Manisha Sekharan, daughter of Mr P. J. Sekharan
received a cash award of Rs 4,000/- for her excellent
performance in XII standard (91.2%). Both children also
received trophies and certificates of merit.
•
The Regional Resource Centre (RRC) organized regional
workshops on 'Quality of Care (QoC)' in Reproductive and
Child Health Services in three different regions of Bihar
namely, Aurangabad, Bhagalpur and Begusarai on 17th
September, 26th September and 27th September 2007
respectively. The participants from seventeen districts of Bihar
participated at the workshops. The objectives of the
workshops were to orient and sensitize various stakeholders
such as policy makers, planners, programme functionaries,
media, public-private health care providers, NGOs, PRls and
women's groups on different aspects of QoC in reproductive
and child health services and to suggest effective and
sustainable approaches for achieving quality in health services.
The perspective of District Magistrate, district health functionaries, MNGOs/ FNGOs/ NGOs and other
stakeholders' were built on quality of care in reproductive and child health services and regional plan of action for
improving the quality of health services in maternal health; child health and family planning are being developed.
Contd. from page 3
The participants were divided into six
groups and shown a film, Citizens
without rights, which included
three case studies. Two groups of
participants were asked to focus on
one case and identify gaps in access,
affordability, acceptability and quality
that were evident in the film and also
discuss mechanisms that can be
adopted to rectify these gaps.
The three-day workshop provided
conceptual clarity on the need and
processes of community monitoring
in India. It also brought forth
various innovations in community
approaches in health that currently
exist in India as revealed by the case
studies presented by the participants.
One of the achievements of the
workshop was to bring together all
the state/civil society partners under
a common platform to discuss the
project components in detail. The
workshop ended with the preparation
of detailed guidelines and tools for the
project and particularly for the states.
Participants expressed that in future
such workshops, related to the
programme, should involve govern-
ment functionaries and stakeholders
at the national level and from the
pilot states.
•
II
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2.2 Page 12 |
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Release of Publication
PoPJbcus
Prof. M. K. Premi, Retired Professor, CSRD, JNU,
New Delhi, Mr. S. K. Sinha, Director General, NSSO,
Mr. D. K. Sikri, Registrar General & Census Commissioner,
India, Mr. R. C. Sethi, Additional Registrar General, India,
Dr. 0 Roy Choudhury, Deputy Registrar General (Census
& Tabulation) and Dr. Shivraj Singh, Managing Director,
Constella Group.
India'spopulation passed the one billion mark in 2000
and this year, celebrated its 60th year as an independent
country. Its population is likely to surpass China's as the
World's largest within 20 years. All of this leads quite
naturally to the question: how large might the population
of the world's largest democracy become? This is the
question that the Population Foundation of India and the
Population Reference Bureau, Washington D.C. have
addressed in a research exercise to project India's
population for the long term. This exercise culminated in
the form of a publication 'The Future Population of India:
A Long Range Demographic View.'
The Publication was released by Mr. A. R. Nanda, Executive
Director on 29th August, 2007 at a dissemination seminar
held at PH, New Delhi. The participants were from diverse
backgrounds; academicians, civil society organizations,
researchers etc. Amongst them some of the key dignitaries
were:
Mr. Carl Haub, Senior Demographer, PRB, Washington,
Mr. O. P. Sharma, PRB India representative,
~\\ Data from various secondary sources, such as Census and
Sample Registration System has been used for preparation
of the publication. The exercise provides glimpses into
India's long-term population future by projecting
population from 2001 to 2101.The projections were
performed using standard cohort-component method and
logistic projections of fertility and mortality assumptions
Le., projecting population by sex and individual age
groups.
In this publication,
two scenarios
of India's future
population are
presented. Both
assume that fertility
will decline conti-
nuously to the point
where couples have
average two children each, the goal of India's National
Population Policy 2000.The scenarios differ in one respect:
one assumes that states with higher current fertility will
decline to the "replacement level" of 2.1 children,
a common assumption in projections. The second assumes
that the decline will continue to 1.85 children, near the
level observed in states like Kerala. The first scenario results
in an India of two billion population while the second falls
short of that mark and results in eventual population
decline.
•
Published by
Population Foundation of India
B-28, Qutab Institutional Area
New Delhi-110016, India
Tel: 91-11-42899770, 42899771
Fax: 91-11-42899795
e-mail: popfound@sify.com
website: www.popfound.org
Editorial Guidance
Mr A.H. Nanda
Editorial Committee
Ms Usha Hai
Dr Almas Ali
Dr Kumudha Aruldas
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
Editor
Ms Sona Sharma
Editorial Team
Ms Chandni Malik
Ms Jolly Jose