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Popfocus 2008 January March English |
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1.1 Page 1 |
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Gearing Communities to Save the Girl Child
G ur khaveen punee katti,
aap na aayee veere nu
katti (Eat jaggery, spin cotton, you
don't come back, send your
brother) ... was what families chanted
while taking a female child for
cremation in the days preceding the
much maligned ultrasound machines,
when female infanticide was rampant.
Ladka chahe latth mare,
chahiye ladka hi (Even if the son
hits us with a stick or treats us badly,
we still want a son only)... is the
general attitude in societies where
the female child has always been
considered a burden and the son an
asset. The advent of any new
technology to avoid the burden
would be most welcome in such
communities and they would be hand
in glove with the propagators of such
crime thereby making it complex to
implement any law against sex
selective elimination of female
foetuses.
It is in an attempt to tackle this root
cause of the girls going missing, that
the project in the states of Haryana,
Himachal Pradesh and Punjab is
focusing on gearing communities to
save the girl child.
The Population Foundation of India
has been implementing the project on
Missing Girls in partnership with the
Voluntary Health Association of
Punjab (VHAP) and SUTRA in two
districts each of Punjab, Haryana and
Himachal Pradesh since 2005. The
main objectives of the intervention are
to (i) involve the community directly
and generate awareness at thl2
grass roots level through formation of
community support groups, and
(ii) facilitate integration of various
schemes launched by various
government departments like Health,
Women & Child, Panchayati Raj
and Education in the three states.
The project supported by the Ministry
of Health and Family Welfare, Gol
and UNFPA Country Programme 6
(CP6), is currently in its third phase.
Forty new villages in four districts of
Haryana and Punjab and twenty six
new Gram Panchayats have been
added on in the current phase and
hence the current intervention covers
a total of eighty villagesin four districts
of Haryana and Punjab and fiftyGram
Panchayats in Himachal Pradesh.
Participatory Planning
Four stakeholders' meetings were
organized (one each in four districts)
in Punjab and Haryana in January
2008. The objectives of the meetings
were to (i) review the intervention
since inception, (ii)carry out mapping
of the new villages; (iii)involve various
government departments and (iv)
develop a strategy for the formation
of community support groups known
as Beti Sneh Samooh (BSS).
Launch of the SATHI Programme
in Maharashtra
Scaling Up: Legitimization of
the model
The Global Fund Programme on
HN/AIDS - Round 4 and Round 6 .•. 5
Initiatives for Scaling up Pilot Projects
- An Update
... 6
Advisory Group Meeting on
Community Action
NRHM and Panchayat:
A Pilot Programme in Muzaffarpur
district, Bihar
... 9
KGVK Project: Review Meet
... 10
Ambulance Increases Access to
Far-flung PHCs
... 10
Swabhiman Project Rolls on ... ... 11
Reaping Fruits through Male
Participation
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',,,m Ihe txecufive f)ir,d", desk...
Towards ensuring Population Stabilization and
Better Quality of Life
The Family Planning Programme was launched in India in 1951 with the
objective of reducing birth rates to the extent necessary to stabilize
population at a levelconsistent with the requirements of the national economy.
During the first decade of its existence, family planning was considered more
a mechanism to improve the health of mothers and children than a method of
population control. Clinic-centred family planning service delivery, along with
health education activities, was promoted during this period.
As is well known, the target-oriented approach initiated in 1966 became
coercive during the Emergency period (1975-77). The National Population
Policy 1976 called for a "frontal attack on the problems of population" and
inspired state governments to "pass suitable legislation to make family
planning compulsory for citizens" and to stop childbearing after three children,
if the "state so desires". The backlash of the coercive approach compelled
subsequent governments to stress the voluntary nature of family planning
acceptance.
However, even in the 1980s, the time-bound, target-oriented approach was
continued and efforts to encourage the use of reversible methods were
initiated. Incentive payments were vigorously promoted during this period,
leading to the violation of women's rights in some cases.
One can say that Family planning in India has experienced significant growth
and adaptation since its inception in 1951. The 1990s witnessed dramatic
changes in the family welfare policy and programme in the country.
The passing of the 72nd and 73rd Constitutional Amendments and the
Panchayati Raj and Nagar Palika Acts in 1992 set in motion the process of
democratic decentralization. The International Conference on Population
and Development in 1994 and the Beijing Women's Conference in 1995
further catalyzed the process of policy change. In 1996, the government
took the radical decision of abolishing method-specific contraceptive targets
that had been used to guide, monitor and evaluate the programme for
decades, replacing it with what was called the "Target-free Approach", where
the course of action would be determined by needs identified at the community
level, rather than centrally-assigned.
This new approach represents a dramatic change in the culture of the Family
Planning Programme in India, where attention has now been focused on
gender concerns. It is in this context that population stabilization got a new
dimension, namely reproductive health, which recognizes the diversity of
the special health needs of women before, during, and beyond child bearing
age, as well as the needs of men and the quality of life of the people involved.
Considering this new emphasis, it is evident that population stabilization
programmes and reproductive health go hand in hand and are interdependent
and the focus has shifted away from vertical family planning services towards
the provision of comprehensive integrated reproductive health care at all
levels of the health sector.
The National Population Policy, adopted in February 2000, further legitimized
the paradigm shift to "client-centred" services. The National Population Policy
affirms the government's commitment to the provision of quality services,
information and counselling, and expanding contraceptive method choices
in order to enable people to make voluntary and informed choices.
Human health, safe motherhood, women's development, child health and
development, adolescent sexuality, adolescent education and health, effective
choices of family planning, prevention and management of reproductive
disorders, infertility, STD's, genetic disorders and reproductive health care
of the aged person are all very vital aspects of holistic reproductive health.
Unless each aspect is taken care of, there cannot be a successful family
planning programme. It is important to reach out to the most poor,
marginalized groups and develop programmes that reflect needs of the
community and uphold their rights. One must remember that values like
right to choice and gender equality lead to better quality of life and population
stabilization. It is of utmost importance that the Government as well as civil
society partners let go of the notions of yesteryears and march on the new
way forward. The new way focuses on rights of individuals, needs of the
community, quality of care, inclusion of marginalized and underserved groups
and bridges the gender gap to ensure holistic development and actual success
of population stabilization programmes.
PopJOCUs
Continuing the efforts, eighty BSS consisting
10-15 members, have been formed in all the eighty
project villages. The members of the BSS include
frontline health workers, members of SHGs, mahila
mandals, village youth volunteers, PRI members and
members from NYK. Four capacity building
workshops were organized in the four districts. Apart
from the selected members of the BSS groups, the
workshops were attended by frontline health
workers, PRI members and block level government
officials representing various departments like
health, women & child development and education.
The workshops were aimed at a) orienting the
selected members of the BSS groups on various
schemes of the governments being currently
implemented to improve the child sex ratio and
promote girl child, b) elaborate on factors
responsible for and implications of declining
child sex ratio and c) to formulate an advocacy
action plan to involve the community at the micro
level.
At the workshop, government officials from various
departments made presentations and discussed the
welfare schemes being implemented for the girl child
like Ladli Scheme, Ladli Social Security Pension
Scheme, Sarvotam Mata Puraskar Scheme etc.
Group exercises were undertaken to learn how
to fill official forms for application in various
schemes.
The participants also developed a detailed plan of
action for generating awareness amongst the
villagers to save the girl child. The plan included
monitoring of pregnancy, birth and death
registrations, access to health services and
implementation of various Government schemes,
particularly those promoting the value of a girl child.
Activities such as painting competitions, awareness
meetings at village level, street plays etc. have also
been planned to further involve communities.
Gram Panchayats in Himachal Pradesh were
identified as strong platforms for advocacy on the
issue of missing girls. PH along with its state partner
agency, SUTRA identified 50 Gram Panchayats
(GPs)spread over two districts in Himachal Pradesh.
The objective of the intervention is to involve the
PRi members by sensitizing them to take up the
issue in their work agenda and motivate them to
declare their respective villages as 'Kanya Bhroon
Hatya Nished Gaon '.
As part of the intervention, community support
groups called Kanya Bachao Samiti (KBS) have
been formed in all the GPs. The KBS includes
health workers, members from SHGs, Mahila
Mandals, PRls and village volunteers.
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PopJOcus
launch of the 51THI Programme in Maharashtra
Population Foundation of India in
collaboration with Institute of
Health Management, Pachod, with
funding support of SDTT will be
implementing
a project titled
"Reducing Reproductive Morbi-
dity in Married Young Women
in Rural Maharashtra" for a
period of 3 years in 5 districts of
Maharashtra. The project aims to
implement intervention focused on
RH issues of married adolescents
covering a population of 1,00,000
(20,000 in each district).
The project aims to build capacity of
5 implementing NGOs namely:
- Sanskruti Samvardhan Mandai,
Nanded
- Gram Vikas Mandai, Beed
- Apeksha Homoeo Society,
Amravati
- Youth Welfare Association,
Buldana
- Late Shriram Ahirrao Memorial
Trust, Dhule
The launch of the Safe Adolescent
Transition and Health Initiative
(SATHI) programme, a multi site multi
sectorial intervention programme in
ARSH took place at a workshop on
Adolescent Reproductive and Sexual
Health (ARSH), conducted at Central
Institute of Road Transport Bhosari
Pune on 4th and 5th January 2008.
Institute of Health Management,
Vote of thanks delivered by Prof. Tara Kanitkar. Also seen Mr. B. G. Deshmukh
and Prof. Ashok Dyalchand
Pachod and the Dept. of Health
Services and Government
of
Maharashtra conducted the workshop
jointly. There were eighty seven
participants
in the workshop,
including Government represen-
tatives and civil society delegates.
The objectives of the workshop
included facilitating the sharing of
experiences of formative research
undertaken in ARSH in Maharashtra
and formulation of recommendations
for designing interventions for various
aspects of ARSH as well as finding
areas for further research.
Dr. Shireen Jejeebhoy, Population
Council, New Delhi delivered
the keynote address. Mr. B. G.
Deshmukh, Vice Chairperson, PH
participated in the valedictory
Function and delivered a speech
offering his full support to the project
initiatives. Eminent participants
including Dr. Poonam Muttreja,
Country Director, MacArthur
Foundation,
Dr. Beena Joshi
(NIRRH), Dr. Aparna Shrotri,
Gynaecologist Pune, Dr. Shalini
Bharat, Professor & Dean, School of
Health Systems Studies (TISS,
Mumbai) and Dr. Ravi Verma,
Regional Director (ICRW, New Delhi)
contributed significantly in making the
workshop a success.
The SATHI programme will provide
surveillance, BCC and services for
married adolescents in eleven districts
for Maharashtra.
•
Jharkhand Youth Policy Approved
It is our pleasure to announce that the Jharkhand Youth Policy has been approved by the State Government of Jharkhand.
It is indeed good news for the youth in Jharkhand and a concrete step forward towards ensuring due attention to the
needs and concerns of this vibrant group. PFr facilitated the process of developing the youth policy in collaboration with
the Department of Youth Affairs and Sports, Government of Jharkhand and other civil society organizations in the state.
Formulation of the Youth Policy in Jharkhand was an innovative process spread over a period of two years. During this
period, PFI adopted a participatory bottom-up approach in building consensus and priorities for youth issues in Jharkhand.
What began as a pilot initiative in two districts for identifying recommendations on adolescent reproductive and sexual
health issues, was soon expanded to include discussion on other key issues related to youth. District level consultations
were held across the state to invite suggestions for including recommendations on youth issues in the Policy. These
consultations provided the opportunity to bring together the youth, district government representatives and civil society
members from different regions to discuss and advocate for various issues of concern for youth. Simultaneously, a policy
steering committee was formed, which commissioned various issues based on position papers that provided information
from the secondary sources on the status of education, health, livelihood and employment for youth in the state.
The status papers and the district level consultations provided the basis for the priorities in the Youth Policy. Any Policy
is only as effective as its implementation - with this in mind, PFI plans to adopt a similar participatory approach to build
awareness among the young people about the Policy and facilitate the development of the implementation plan in
collaboration with various civil society organizations and the state government.
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PopJOcus
Scaling Up:legitimization of the model
In the last three editions of the PopFocus, a series on "Scaling Up Pilots and Innovations" featured. This is the
fourth in the series of articles on Scaling Up. The fourth factor which is being identified as very important while
scaling up is, "Legitimization of the model".
Inthe last three editions of the
PopFocus, factors which are
important for scaling up were
discussed. The 'Evidenceof impact'
was identified as the first, 'Evidence
of results in other socio-
demographic settings' was the
second and 'Degree of simplifi-
cation possible' was the third of
several factors those influence the
decision to go-to-scale.
Legitimization of the model
Before scaling up can begin, the
changes implied by scaling up must be
viewed as legitimate and imperative.
For this to be the case, the issues or
problems addressed by the model must
be seen as important and urgent,
existing responses must be
acknowledged as inadequate, and the
newly piloted or demonstrated model
must be credible and regarded as the
best available solution. Inertia and the
status quo are formidable obstacles to
change. To acquire legitimacy,
influential people and opinion leaders
must thus come to believe - and must
assert publicly - that change is
necessary. Because change often
represents a significant break from
tradition and requires shifts in attitudes
and actions, it is important that the
"legitimizers" or "champions" enjoy
widespread credibility. These
individuals can come from either the
public, non-profit or private sectors;
however, if policy adoption is the
chosen method of scaling up, it is
essential to attract high-level
government involvement and support
at the earliest feasible date.
The task of legitimization is critical
for getting agreement by adopting
organizations. Legitimization is
essential for getting policies
approved, budgetary priorities
adopted, and developing the broader
and deeper base of support needed
for implementation by bureaucratic
institutions and others. More
generally, it is key for attracting
potential adopting organizations,
for persuading funders to provide
support, and for ensuring a warm
reception of the model among
new locations, client populations,
and potentially
competing
organizations.
To acquire legitimacy,
influential people and
opinion leaders must thus
come to believe -
and must assert publicly -
that change is
necessary.
Experience suggests, and the
literature on scaling up confirms, that
there is a systematic tendency to
underestimate the importance of this
task. This is in part because donors
are often impatient or uncomfortable
with political or consciousness raising
activities and prefer to focus on
capacity building and/or service
delivery. Numerous case examples
clearly indicate, however, that
inattention to legitimization often
results in either failed efforts or in a
need to return to this task later.
Hence, the capacity for legitimization
is very important for scaling up. •
Contd. from page 2
A workshop was held with the PRI
members of the Dharampur and
Nalagrah blocks of Solan district in
February 2008. 30 PRI members
attended the workshop apart from
government offiCials,mahila mandals
and SHG members. Various schemes
of the government to promote girlchild
like "Indira Gandhi Balika Suraksha
Yojna" and the role of PRls in
improving the child sex ratio were
discussedat the workshop. Some broad
suggestions from the workshop were:
• The issue on missing girls should
be considered on priority basis not
only at the Women Gram Sabha
but also at the General Gram
Sabha.
• Panchayats should be given the
responsibility by the Health
Department to keep a check on
the clinics in their area which
indulge in sex selective practices.
• The birth of the girl child should be
celebrated at the Panchayat level.
• The "Kanya Bachao Samitis"
should be formed at the Block level
as well.
•
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PopJbcus
The Global Fund Programme on HII/AIDS
Round 4 and Round 6
Advocacy Workshops with
PRIs, Health and ICDS
The aim of the Global Fund Round-
6, project is to "create an
enabling environment for multi-
sectoral convergence to main-
stream, converge and integrate
gender, reproductive health and
HIV/AIDS". In line with this
advocacy workshops were organized
by the Population Foundation of India
in Seoni and Balaghat districts of
Madhya Pradesh on March 12-13
2008 for district and block level health
services, Integrated Child Develop-
ment Scheme and Panchayati Raj
Institutions (PRIs) to mainstream
HIV/AIDS and focus on reducing
stigma and discrimination.
The main objectives of the advocacy
workshop were to (i) build an
understanding on HIV/ AIDS issues
among stakeholders, (ij) explore
avenues of coordination among
stakeholders at the district, block and
community levels, and (iii)to develop
interest among PRIs to address the
issues related to HIV/ AIDS at various
tiers of the Panchayat.
During the meeting, strategies under
NACP-III, issues on care and support
for people living with HIV and
avenues for inter-departmental
coordination were discussed. It was
followed by the discussions on how
PRis could playa more potential role
in addressing the issues of HIV/ AIDS
at the institutional and community
levels. Participants identified the key
action points, which would be taken
by each department as a follow up of
the meeting.
Monitoring and Evaluation
(M&E)Module Development
M & E training module, which aims
to support Programme Access
to Care and Treatment (PACT)
programme for team managers and
implementers in monitoring and
evaluation, has been finalized by the
Strategic Information and Evaluation
(SIE) unit. The module includes an
overview of the programme, system
for monitoring and evaluating care
and support interventions, and
indicators for monitoring and
evaluation of various components of
the programme. The module would
help to develop a uniform, complete,
accurate understanding of M&E
for the PACT programme to
the Programme Managers and
implementers.
State Level Programme
Coordination Committee
Meetings
The second round of State Level
Programme Coordination Committee
meetings under the Global Fund
Round 6 project were organized with
State AIDS Control Societies in the
states of GUjarat, Rajasthan,
Chhattisgarh, Madhya Pradesh,
Uttar Pradesh, Bihar and West
Bengal. The purpose of the meetings
was to discuss the key programme
co-ordination issues at the state level.
Civil Society Consultation for
Enhancing Civil Society
Participation to Access Global
Fund Grants
A series of consultations were
organized to identify the priority areas
of the civilsociety organizations prior
to the submission of proposals for
The Global Fund Round 8. These
consultations were held in New Delhi
Jaipur (Rajasthan), Bhubaneshwa;
(Orissa) and Bangalore (Karnataka).
Population Foundation of India and
India HIV/ AIDS Alliance as civil
society organization Principal
Recipients supported this consultation
in partnership with Indian Network
for People Living with HIV/ AIDS,
Centre for Sustainable Health
and Development, CARE and
ACTIONAID along with The Global
Fund Developing Country NGO
Board Delegation and Secretariat.
The main objective of the consultation
was to provide support in enhancing
the quality, and focus on reducing the
disease burden and making the
process of the forthcoming Round 8
proposal submission more demand
driven. It also emphasized on the role
of the civilsociety as an equal partner
and to evolve strategies to focus on
unaddressed needs of key commu-
nities within the national framework.
State Review and Planning
Meeting
A four-day Review and Planning
Meeting for the Global Fund Round
4 project "Access to Care and
Treatment - ACT" and Round 6
project "Promoting Access to Care
and Treatment - PACT" Programme
II
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PopJOcus
Initiatives for Scaling UP Pilot Projects - An Update
Copious pilot projects on
reproductive and child health
and adolescent health exist in India,
many of them extremely successful
in their own little catchments, all of
them hoping that their success story
would be replicated at scale to be able
to make a difference in critical health
indicators at state or national levels.
The successful pilots usually manage
to get the attention of various
stakeholders. and everyone still
'hopes' that they will get scaled up.
The catchword here being 'hope' -
there has been a lot of expectation
for that magical scale up to happen,
unfortunately, systematic planning
for actual scaling up has been lacking.
The intermediary steps required to
ensure that scale up does happen,
are often missing and hence there is
a recognized need for an
intermediary to bridge the gap.
In recognition of a need for a
systematic approach and an
intermediary to scale up pilot
initiatives, Mac Arthur Foundation
has been supporting Population
Foundation of India (PH) since 2006
on "Scaling up Pilot Projects on
Reproductive Health in India"
with the objective of building
capacities within PH to work as an
intermediary between the originating
and adopting organization and be
able to facilitate scaling up of models
in the areas of maternal and infant
mortality reduction along with
adolescent health. Management
Systems International (MSI),provides
technical support to PFI on the
process. A Scaling up Management
Framework, developed by MSI,
which includes a set of tools and
techniques to facilitate scaling up, has
been adopted to facilitate scaling up
of projects in India.
In addition to identifying and
facilitating scaling up of successful
models on reproductive health in
India PH is also mainstreaming the
scaling up components in its grant
making and project management
process. A pool of trainers is being
nurtured and developed for the
II
purpose through series of training
programs as well as hands on
mentoring by Dr. Richard Kohl, MSI.
The team is going through a series of
scaling up practice exercises, applying
scalability assessment tools and
looking at aspects that would
strengthen the scalabilitycomponents
of PH funded projects. In addition to
this, a documentation workshop is
also planned during April - June
2008 to help the team articulate their
experiences and develop themselves
as a strong resource for scaling up in
India.
Some new initiatives on scaling up
are described below:
Model on Public-Private Partner-
ship: A promising model to improve
the access to health care in many
backward districts in India is the
Karuna Trust Model on Public-Private
Partnership. Karuna Trust, a
Karnataka based NGO has been an
implementing partner of PFI.
In agreement with state government,
they undertak~ government PHCs
on contract and, upgrade their
infrastructure as well as their
accessibility and availability within
their catchments. In addition to the
expected role of a primary health
centre, they also introduce various
other value based services that
include community health insurance
model, empowering the community
through self help group ( SHG )
formation, expert opinion through
telemedicine, developing herbal
gardens at each PHC's, and
formation of farmer's club. While the
state government offers only 75% of
its budget allocated to run a PHC,
Karuna Trust has been able to bring
in significant changes in terms of
demand creation and supply at the
community level. PH has partnered
with Karuna Trust to add on value
based activities including training of
manpower. The scalabilityassessment
tool was applied to this model and it
scored very high. An external
assessment is currently being carried
out to support evidence based
advocacy for scaling up this model.
Community Health Care
Management Initiative (CHCMI)
under Department of Panchayat
and Rural Development,
Government of West Bengal: In
West Bengal, department of
Panchayat and Rural Development
initiated Community Health Care
Management Initiative (CHCMI) to
help Panchayati Raj Institutions (PRIs)
analyze and monitor key public health
indicators. Over last four years
CHCMI, complemented by the deep
rooted panchayat system in West
Bengal, has also been able to involve
Self Help Groups (SHGs) as a key
partner. CHCMI has a committed
financial resource from Department
of Health and Family Welfare under
National Rural Health Mission
(NRHM) for the formation of Village
Health and Sanitation Committee
(VHSC).
While senior officials from the
department have been very keen on
the "Home Based" component of the
HBNCC model of SEARCH, they are
also eager to incorporate "Mitanin"
model of community care from
Chattisgarh. The Government of
West Bengal has requested PH to
help with designing and
implementation structure of this
model in all the districts of West
Bengal. PFI in collaboration with
Management Systems International
(MSI) and National Health Systems
Resource Center (NHSRC) is
planning a series of consultations both
at the field and state level to design
and develop the structure of the
model to be implemented at scale.
Scan of successful models on
Adolescent Reproductive and
Sexual health (ARSH) in India:
Continuing with its commitment to
improve reproductive health of
people, especially young adults, PH
is initiating a process of scanning of
successful models in India on ARSH
which have a potential to scale. There
are set of indicators being developed
to help scan and identification of
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Golden Peacock Award for
Corporate Social Responsibility
Justice P N Bhagwati, former Chief Justice of India,conferred
the Golden Peacock Award on JK LAKSHMI CEMENT LTD
for Corporate Social Responsibility (CSR) on 15th February
2008. Established by the Institute of Directors in 1991, the
Golden Peacock awards are considered as the Holy Grail of
corporate excellence and its guidelines provide a checklist
for improvement and self-assessment in areas of quality,
innovation, training, governance, environment management
and corporate social responsibility.
One hundred sixty institutions from the public, private, non-
profit, government, business, manufacturing and service
sector had applied for the award. Twelve were short-listed
and consequently made presentations to a jury led by Justice
Venkatehaliah in Banglaore. After a gruelling process over
4-5 months, JK Lakshmi Cement was adjudged the winner
for its "Naya Savera" project and the Award conferred at a
glittering ceremony in Lisbon, the capital city of Portugal.
Naya Savera is a four-year (2004-2008) Integrated Family
Welfare project implemented by JK Lakshmi Cement Ltd.
in collaboration with Population Foundation of India. The
project is operational in 10 revenue villages of Pindwara
tehsil of Sirohi district in Rajasthan. PH provides financial
and technical assistance to the project.
Pop}bcus
these models. These models are
scanned from both Government as well
as NGO sector. Two of the best models
from Government and NGO sector
based on these indicatorsshallbe further
assessed for their scalabilityand based
on the evidences and potential shall be
facilitated for scaling up.
Model for addressing repro-
ductive health concerns of
married adolescent girls: Institute
of Health Management, Pachod
(IHMP) has been working with the
married adolescent girls to address
various aspects of reproductive and
child health including anemia and
delay in marriage and birth of the first
child. In addition to this, the model
has been also adopted and
implemented by government of
Maharashtra in ten districts.
PH is working closely with IHMP to
explore scaling up of this model at the
national level. Some of the key
strategies in the process include
identifying states with special needs/
gaps/ interest on young peoples'
issues; analysis of existing youth policy
at different levels, identification of
gaps therein and organizing a national
consultation to review various
existing models addressing married
adolescents.
While several new initiatives have
been taken up by PFI during this
quarter, continued support to the
models identified earlier and their
scaling up process is moving with a
sustained commitment.
•
A project titled "Increasing awareness of and access to contraceptives for married adolescents, awareness on
Reproductive and Sexual Health and Reduction of Iron Deficiency Anaemia among Adolescent Girls of Ganjam
District of Orissa" will be implemented by Multi Applied Systems (MAS), Bhubaneshwar, Orissa for a period of 3 years in
25 villages in Ganjam Block of Ganjam district of Orissa covering a population 25000.It aims to address awareness on RH
issues/ family planning and anemia in adolescent girls aged 12-19. The project also aims to increase access of contraceptives
among married adolescents.
A new project titled "SAMWEDNA- Sub-centre as Agency for Maternal Well-being, Empowerment Demonstrated
through NGO Assistance" will be implemented in Rajasthan by two partners, namely Sikshit Rojgar Kendra Prabandhak
Samiti (SRKPS), Jhunjhunu, Shiv Shiksha Samiti (SSS), Tonk in Rajasthan and ARTH (Action Research and Training for
Health) will serve as the Technical Support Agency. The duration of this project is 2 years starting from April 2008, and it
covers a population of 30,000. The project aims to demonstrate an NGO managed model sub centre providing comprehensive
health services with emphasis on safe motherhood and undertake advocacy for repositioning the role of sub centres in primary
health care through public private partnership.
II
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1.8 Page 8 |
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Popfbcus
Advisorv Group Meeting on Communitv Action
The Advisory Group on
Community Action (AGCA), a
standing committee set-up by the
Government of India, has been
facilitating the pilot project on
Community Monitoring programme
under NRHM at the national level and
at the state level through a joint State
Community Monitoring Mentoring
Group set up specifically for this
purpose. The Population Foundation
of India (PH) is the national secretariat
for the AGCA.
The 10th meeting of the Advisory
Group for Community Action under
NRHM took place at Population
Foundation of India on March 14
2008. Mr. G C Chaturvedi, Mission
Director, NRHM, Dr. Tarun Seem,
Director, NRHM, and Dr. Hamid
Khan, Consultant, NRHM from the
Ministry of Health and family Welfare,
Government of India, participated in
the meeting. The meeting was
chaired by Prof. Ranjit Roy
Chaudhury, Member, Governing
Board of PH
A presentation of annual state-wise
updates of the community monitoring
programme and the status report of
the National Secretariat was made at
the beginning of the meeting followed
by a sharing of state-wise innovations
by the AGCA members who were
part of the state mentoring groups,
for their respective states.
Dr. Abhay Shukla, shared that in
Maharashtra, a public report card in
the form of a poster has been
developed and is being printed for use
by the Village Health Committees,
which would be marked and publicly
displayed in the village. A state
convention
on community
monitoring was also organised by the
State Health Mission in Mumbai on
12th March 2008, which was
attended by the Secretary, Family
Welfare, State Mission Director, state,
district, taluka and PHC health
officials along with NGO / CBO
representatives from the five first
phase districts. The objective of this
convention was to promote positive
interaction between government and
civilsociety, to send a strong positive
message to undertake monitoring at
all levels and to jointly plan the next
phase of community monitoring
activities.
Mr. Sudarsan Das mentioned that in
Orissa, the programme has already
generated discussion on community
action. Overall, there has been
excellent support from the state
government. However, there stillexists
administrative bottleneck such as
mandatory registration of all VHSCs,
which is delaying the process at the
grassroots level. He also shared that
all 180 VHSCs have been formed in
the state and are currently undergoing
the process of registration.
Dr. Abhay Shukla presenting on
behalf of the state nodal NGO,
Madhya Pradesh Vigyan Sabha
shared that in Madhya Pradesh the
training of block facilitators has been
completed. The VHSC formation has
also been completed in the state.
Currently the process of orientation
of VHSC members has begun.
An important highlight was that in
many places ASHAs are being
actively involved, including as block
facilitators,
for community
monitoring. A Jan Sunwai was also
organized on a voluntary basis by a
people's organisation involved in
monitoring in Khetia PHC in Badwani
district, where the issue of illegal
charging for basic health services was
raised.
Dr. Thelma Narayan mentioned that
all the preparatory activities have been
completed at district level in
Tamilnadu. The state nodal NGO has
initiated dialogue and discussion at
various levels to create a space to build
bridges between community and
the government through this
programmme. Dr. Thelma also
mentioned that various block level
meetings are being organized with
PRis to build awareness on NRHM
and hold the PRis accountable.
Dr. Abhijit Das made a presentation
on the overall structure, process
and implementation process of
the programme on Community
Monitoring of Health Services under
NRHM. He also highlighted the
positive processes as reported from
various states including introduction
of the process of community
monitoring as part of state
Programme Implementation Plans
(PIPs).
Mr. G. C. Chaturvedi, Mission
Director, NRHM mentioned that the
Mission is in full swing and currently
in the middle phase of imple-
mentation. He appreciated the
exhaustive processes and shared that
community monitoring is being
branded as a unique feature of
NRHM. He hoped that the process
would initiate enquiry and sensitize
the community to ask questions and
demand services, introduce quality
checks for each state and
institutionalize the proposed
structures of community monitoring
and planning.
Some key actionable points that
emerged from the deliberations are:
1. The current quarter should focus
on the process of initiating the
formation of the various structures
for monitoring and planning at the
state, district, block and PHC
levels.
2. National convention to be held for
sharing the experience of the
programme with state Mission
directors and civil society
representatives from the 9 states.
This should be organized at the
earliest to facilitate further state
level processes. MoHFW to
propose the dates for the
convention.
3. Gol is to send the clarification
letter to the states that it is not
mandatory for the VHSCs to be
registered in order to conduct
monitoring.
•
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1.9 Page 9 |
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PopJOcus
N8HM and Panchavat: A Pilot Programme in
Muzanarpur district, Bihar
The Population Foundation of
India over the past eight months
has been implementing a pilot
initiative on orientation of members
of Panchayati Raj Institutions (PRls)
on reproductive health and National
Rural Health Mission (NRHM) in 16
blocks of Muzaffarpur district in Bihar.
The programme was implemented in
collaboration with an NGO,
CENCORED. A total of 570 PRI
representatives (Panchayat Samiti
Members - 204 and Mukhiyas - 366)
were oriented through a two-day
programme at the block level.
Among the participants, almost 50%
were women elected representatives.
PFI developed training manuals,
posters and pamphlets in Hindi for
the trainees. The significant learnings
of the efforts were:
• It was the first time that the
participants particularly women
members were participating in
such type of training.
• Pre-training assessment revealed
that the most of the members were
not aware of the specific role and
responsibilities of PRI members in
NRHM implementation
• It was suggested that the ward level
capacity building efforts on roles
-~-~
::,.A.::?-':;
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and responsibilities of PRI
members should be undertaken
across the selected panchayat.
• Separate workshops in building
knowledge on Reproductive
Health issues should be conducted
with women members particularly
at the Gram panchayat level.
The programme generated lot of
interest among the members. Based
on strong recommendations from
participants, it has been decided
that such efforts should be followed
up by building knowledge and skills
of PRI members through a
cascading training methodology
over a period of time. Other
agencies working on training of
PRI members on NREGA and
other issues should come together
to develop some common
strategies for Bihar.
•
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I
was conducted at Bangalore during
January 3-6, 2008. The national, state
and regional programme teams of
Round 4 and Round 6 participated at
the meeting. The purpose of the
meeting was to share the experiences
and progress of R-4 and R-6 teams and
to learn lessons from each other.
Sessions on basics of HIV/ AIDS,
counseling, care and support and stress
management were also undertaken.
Exposition
The PFI state unit of Maharashtra
along with Maharashtra Network of
People livingwith HIV/ AIDS (MNP+)
organized an exposition to celebrate
International Women's Day by
involving Women Living with
HIV/AIDS (WLHA). The concept
was to bring women together and
provide them a platform, where they
receive information on the issues
related to HIV and its treatment. 100
WLHA from the 26 districts level
networks (DLNs) of Maharashtra,
were participated at the exposition.
Many of the DLNs enacted street
plays and cultural events. Also they
activelyparticipated in the rangoli and
poster competitions and in the display
of handicrafts. Ms. Surekha Salunke,
city corporater was the chief guest.
Workshop on grant negotia-
tion and implementation of
the Global Fund grants
WHO South East Asia Region
organized a workshop at Bangkok to
address capacity development in grant
negotiation and implementation in
collaboration with Global Fund South
West Asia cluster. The rationale
behind organizing such a workshop
was to address problems in grant
negotiation and implementation and
causes of delay of signing of grants
after approval due to negotiation
processes that some of the countries
were facing.
Representatives from the countries
of Afghanistan, Bangladesh,
Bhutan, Iran, Nepal, Pakistan,
Sri Lanka, Maldives, and Thailand
attended the conference. Population
Foundation of India and Tata Institute
of Social Sciences as NGO Principal
Recipients also participated at the
workshop.
•
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1.10 Page 10 |
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KGVKProject: Review Meet
PopfOcus
The first annual review meeting of
the Krishi Gram Vikas Kendra
(KGVK)project was organized on March
20, 2008 at the Foundation's office.
Baseline survey findings and the
progress of the project were reviewed
at the meeting attended by the staff of
KGVK and PH
The project is being implemented in
34 villages of two blocks, namely
Noamundi and Manoharpur, of West
Singhbhum district in Jharkhand, a
mining area of TATA, Usha Martin Ltd,
SAIL etc. The entire project area is
divided into six clusters. This remote
area is surrounded by Saranda forest.
The government health care service is
very poor and irregular and the low
access to health care services is even
attributed to poor infrastructure and
communication facilities. Extensive
mining activities in the area increase
the risk of health hazards. It was against
this backdrop that the project was
conceptualized
and is being
implemented in association with
KGVK. The main objectives of
the project are to (i) empower the
community through village health
volunteers and formation of vibrant
village health committees; (ii) increase
access to services through partnerships
between govern-ment, corporate
and the community, and (Hi)to
develop a scalable model for
government and other agencies.
The baseline survey conducted in
the project area revealed that the
mean age at marriage is 16 years.
Majority of the women were
illiterate (80%), around 90% of the
population belong to SARNA
community (Tribal). Full ANC
coverage is very low (2.5%). Most
of the deliveries are taking place
at home which accounts for 90% A PHC Sub-centre
of the total deliveries. Most of the
home deliveries are assisted by the
husband of the pregnant women.
Institutional delivery is merely 9.1 %. Safe
delivery by trained Dais and ANMs is as
low as 15.3%. Awareness on five cleans
is an abysmal 3.65%. Breast feeding
knowledge and practices are good with
60%. However, around 60% of infants
under 6 months are also provided
supplementary feeding. The full
immunization is also very low at 24.6%.
villages. SAHIYAAS are hamlet based
out reach volunteers of the project, who
are trained on assessing the health need
of their respective areas. Orientation
training has been given to all the selected
SAHIYAAS in the project. The project
is collaborating with the government for
improving access to reproductive health
services and supplementing in areas
where reach is poor through mobile
clinic. User friendly registers for
The project has organized gram sabhas
in each village and has been successfully
able to form 34 Village Health
Committees (VHCs). Each committee
has selected 2-3 SAHIYAAS in their
recording community level data has been
evaluated by the project. Some
government sub-centres have been
renovated in the area with community
support.
•
Ambulance Increases Access to Far-flung PHes
Population Foundation of India
provides support to Karuna Trust,
Bangalore in managing seven Primary
Health Care Centres under their public
private partnership initiative. One of the
main objectives of PFI support to
Karuna Trust is to ensure 24 hour
availability of medical services to the
catchment population. However, as the
three of the seven PHCs namely,
Kohinoor, VK Salgar and Chandra
Bandha are situated in the northern
most (remotest) area of the state and
with the nearest First Referral Unit
(FRU), CHC Basavkalan, being 45 kms
away, merely ensuring 24 hour
availability of medical staff at PHC was
not sufficient. Transporting patients in
critical conditions was challenging in
view of the sparingly developed local
transport system. Sensing the critical
need for transportation, an (lmbulance
was provided to Karuna Trust by PFI,
which can be used for transporting
critically ill patients as well as for
outreach and IEC activities. The
decision to include a van in the
project proved to be insightful, as the
van turned out to be a savior to many a
life, saved by timely shifting to
appropriate centers where services
were available.
Some cased benefited by ambulance
were: (i)Ms. Kavitha, who was brought
to the PHC Kohinoor with non
progressive labour after rupture of
membranes. She was sent to Mantal
hospital in the ambulance where she
delivered and the baby's life was saved
by immediate resuscitation, and (ii)
Mrs. Surekha, wife of Ashoka, was also
lucky to have a ready ambulance with
qualified staff accompanying her when
she reported with a breech presentation
(baby with feet down), which could not
be managed by the staff nurse. She was
sent to Mantwala, where her condition
was effectively managed.
Besides being useful in the above
mentioned cases, the van has been
instrumental in furthering the cause of
public health in the area. The van has
been effectively used to contain
Japanese Encephalitis in the catchment
area of PHC Kohinoor, where as many
as 40 cases had been reported between
January - March 2008. The mobile van
is providing an indirect boost to family
planning objectives of the project as well
by ensuring transportation to medical
teams for conducting sterilization
camps. The availability of ready
transport has also greatly improved
outreach services, conducting health
camps, school health check up camps,
pulse polio campaigns, other IEC
activities etc. More over, there is a
psychological advantage amongst the
population of the catchment area that
they are now confident of the 24-hour
availability of emergency transportation
facility.
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PopJOcus
SWABHIMAN Project Rolls on...
SMILEFOUNDATION, New Delhi
with financial and technical
assistance from PH is implementing
a three-year Reproductive and Child
Health Care through SWABHIMAN
PROJECT in four slums in Delhi
through four local partners.
Persistent efforts of SWABHIMAN's
team to bring about awareness on
reproductive and child health issues,
health rights of adolescent girls and
women in general, providing life skill
education and extending full support
to victims of marital violence and
other forms of gender based violence,
have resulted in enhanced confidence
among hundreds of hitherto diffident
women in the community. Many of
them have now joined SWABHIMAN
as volunteers to help other women
to come out of their social confines.
These community volunteers are so
motivated that they have now become
role models for other women and
adolescents in the community. Cases
in point are of eighteen year old
Sona, a victim of child marriage
and constant marital violence, and
26-year-old Reena who have both
raised their voice against violence and
exploitation and have become self-
dependent with support, training and
counselling.
Kiran Bedi meets the
role models on the eve of
International Women's Day
On the eve of International Women's
Day, SWABHIMAN organised a
meeting of role models from the less
privileged community with an
internationally renowned personality
and a role model for women's'
empowerment - Ms. Kiran Bedi,
Ex DGP, Delhi Police for exposure
of these role models to a larger canvas
of possibilities and opportunities.
The meeting was organised with
the objective of enlightening these
active women volunteers about
various issues concerning women
including the legal ones to motivate
them to work with increased vigour
and determination on woman
welfare.
Ms. Bedi emphasised that if we want
to give our future generations a society
based on equity, balance and order
projects like SWABHIMAN need to
be supported by all and sundry.
Building Capacities to
empower ...
SWABHIMANcompleted the second
phase of training for the Community
Health Educators and the Health
Volunteers during the quarter. While
the 15t phase of the training focussed
on Life Skills Education and Gender
Issues, the 2nd phase focused on
Adolescent Sexual and Reproductive
Health. Various participatory
techniques such as role plays, group
presentations, simulation exercises,
mock sessions, case studies, brain
storming sessions along with relevant
ice breakers were included in the
sessions to facilitate the learning
processes. The participants have also
been provided with IEC material on
relevant topics.
Mobile Health Van gets a
new look ...
The mobile health van provided under
the project got a refreshing new look
to reflect the basic themes of the
project. The project does not take the
Health Van as a substitute to the
existing government health facilities
but rather a means of increasing
access to quality health-care in un-
served and under-served areas. The
van delivers Reproductive and Child
Health and immunization services to
women and children mainly with
focus on health communication,
counseling and referrals in case of
high risk pregnancies, issues
concerning abortions or IUD
insertions, RTI/STI etc. The health
team strives to bring about a positive
change in health seeking behavior
among the vulnerable women and
adolescent girls in the community .•
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Pop}Ocus
Reaping Fruits through Male Participation
Male participation in family
health, immunization & check-
ups is found to be negligible,
especially in rural areas. A unique
intervention on promotion of family
planning processes that calls for
greater male participation has been
initiated in Rajgarh Block of District
Mirzapur in Uttar Pradesh.
One way where men can get involved
in family planning is by having Non-
Scapel Vasectomy (NSV) which is
easy, less complicated and simple
method of permanent family
planning but is seldom accepted by
men. Male link workers in the project
areas have been instrumental in
providing information for the same.
It was found that only two men had
come forward for vasectomy in this
block, one of them being the Male
Link Worker (MLW) of the project,
Mr. Nidhayehak. As part of the
intervention, MLWs work directly
with the men folk, seek their support
and involvement in the family health
care and support. To increase male
participation in Reproductive &
Child Health (RCH) program,
Mr. Nidhayehak, MLW called a
meeting of men folk in the
community at Parathmik Vidyalay,
Biyahur Gram Sabha, on 17th
January 2008.30 males participated
in the meeting.
The agenda of the meeting included
discussion on male involvement in
family health care and support. Some
participants opined that since men
went out to work, and women stayed
at home, they should take up the
responsibility of pre and post natal
check ups, TT immunization,
children's immunization and family
planning etc.
Mr. Nidhayehak explained to the
participants that men and women are
both equally responsible for family
health care and they should play an
active role in seeking the same. Family
planning related issues were also
discussed and the male members were
motivated to go forward for NSV.
During the discussion, some of the
questions that came up were:
- Should men participate in taking
care of their wives during
pregnancy?
- Should they play an active role in
family planning?
- Should male members take their
children to the doctor, when they
fall sick?
- Should they know about the
immunization and routine check
ups?
The issue of men shying away from
sterilizationcame up. The MLWstrived
to demystify issues and erase
misconceptions and myths such as
vasectomy leads to weakness. In fact
women themselves might choose to
undergo tubectomy and discourage
their husbands to opt for vasectomy
due to belief in the same myth.
Mr. Nidhayehak shared
his own life example
where he had under-
gone vasectomy several
years back and is
completely healthy. He
encouraged
male
participants to consider
vasectomy in lightof the
new information and
with an open mind.
Similar meetings were
held at Gram Sabha
Bhagoti Dei, Nuwan, Khutaha that
encouraged male participants towards
greater involvement in health related
issues leading to better family health.
Number of men from these areas
underwent NSV at PHC Rajgarh.
Consistent dialogue with the
community, especially with the male
members has resulted in increased
involvement in family health care and
support. So far nine additional cases
of NSV have been done taking the
total to 11. Seven other men have
given their consent for NSV in the
coming month, which is very
heartening and encouraging.
•
Dr. Sanjit Nayak worked with PFI
as Programme Officer (Regional
Resource Centre). He has joined as
Health Adviserfor Sectoral Reforms
(Health)for United Nations in former
Yugoslavian Republic of Macedonia
and Kosovo.
Mr. Deepak Gera, Accounts
Officer worked with the Global Fund
Project unit at the PFI, in March
2008. He has joined in Educomp
SolutionsLtd. as Manager Corporate
Affairs.
Editorial Guidance
Mr A.R. Nanda
Ms Sona Sharma
Editor
Ms Chandni Malik
Editorial Assistance
Ms Jolly Jose
Editorial Committee
Ms Usha Rai
Dr Almas Ali
Dr Kumudha Aruldas
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
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