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Location

17 villages in Motihari Sadar block of East Champaran dist., Bihar
Thematic Focus: Health & Nutrition


Background of the Project:

CHARDS has been working on the issues of children, women and farmers since 2004. The project holder, Mr. Sashi Prasad B. Lall, has dedicated his life to working for underprivileged communities since his school days. His inspiration came from his uncle who was involved in the social reform movement of the country led by Jai Prakash Narayan during 1970’s. CHARDS started its work by building awareness on health and hygiene in two Panchayats of Motihari Sadar block and went on to build its expertise in the areas of health and nutrition rights for children.

Problem Statement:


In the 17 villages of the operational there are 3776 families, all of whom are from the dalit, mahadalit and other backward caste communities. The status of health and nutrition of children in 17 villages is extremely poor. One of the main reasons is the lack of access, availability and quality of health services. The main barrier of accessibility is the distance from the villages and poor quality of services due to lack of medicines, non-availability of doctor, irregular attendance of ANM, lack of bed and facilities for institutional delivery in APHC, (infrastructure not as per Indian Public Health Standard (IPHS) norms 2012). This means that families have to travel to Motihari town to avail of any treatment. Due to non-accessibility and low quality of public health care services, a majority of the community turn to the local Quacks as their first choice of care which is dangerous since quacks have no qualification and are expensive, often unregulated and variable in quality. This situation has meant that home deliveries are prevalent thus increasing risk for mother and child at birth. The issue of child mortality is also alarming in the operational area.

Parents and community are unaware of preventive measures/symptoms of illness and the health seeking behaviour of the parents is also low. There is high seasonal migration in the area and it affects the children as female members are reluctant to go alone for treatment. The children of the project area suffer from common deadly diseases like- Pneumonia, tuberculosis, diarrhoea etc.
There is a dearth of adequate number of ICDS (Integrated Child Development Service) centers in the operational area and thus a large number of children are out of service. The regular growth monitoring rarely happens thus the growth of the children is not known and malnutrition is not arrested at the early stage. For treatment of severely malnourished children, the state government has been running a nutritional rehabilitation center (NRC) but it caters only 20 children at a time and is not covering all the blocks of the district at the same time. Presently, NRC is functional in Chakia block which is far away from the operational villages. The problem of colostrum feeding is a significant challenge in the community due to social beliefs and age old practices. Likewise lack of exclusive breast feeding practices also affects the health of children.
The Musahars, Dalits and Mahadalits are at the bottom of the social rung in India. For generations, they have suffered lack of economic opportunity, and poor access to healthcare, education and nutritious food. Caste, poverty and patriarchy continue to be overarching factors that affect the rights of the children in the operational area.

Achievements & Impact


Program Activities Planned Progress and Achievements

Result Area: Access and quality to free, primary health care and reduction in maternal, infant and child mortality and morbidity in our intervention areas

* Community level awareness program on the IPHS norms and the availability of the health service institutions and services.
* Community meeting on awareness generation for revival of Health Sub-center at new habitation Harajpur.
* Engagement with the government stakeholders to work on various health issues and gaps identified.
* Continuous tracking of pregnant women & lactating mother, and children for antenatal /prenatal health checkups and immunization.
* Linking pregnant women and lactating mothers with the government health workers such as ASHA (Accredited Social Health Activist) & AWW (Anganwadi Workers), and capacitating the latter on pregnancy care & identification of high risk cases.
* Work towards building model VHSND (Village Health, Sanitation and Nutrition Day celebration) site in six selected ICDS centers based on identified indicators.

* 20 awareness programs were held on the IPHS norms mentioning the availability of the health service institutions and services in accessible distance.
* 11 adolescent groups organized sensitization sessions on anemia in the period.
* 60% of villages are having access to safe drinking water.
* 75% villages organized VHNSD during the period in which 99% of participants were women.
* 347 out of 577 pregnant women and lactating mothers were linked to one or more health schemes through sensitization meetings.
* 67% of the women had institutional delivery during the period.
* 91% of children (aged 9-12 months) have been completely immunized during the period.

Achievements & Impact


Program Activities Planned Progress and Achievements

Result Area: Reduce of Child Malnutrition and ensure all ICDS Centers, NRCs, PDS are fully functional in 17 interventional Tolas.

* Identification and tracking of children (Severely / Moderately Acute Malnourished) and their follow up through institutional process. Linking them to ICDS centers.
* Generating awareness in the community to enroll their child to ICDS centers in the changed context of universalization.
* Motivating parents to take their underweight girl children to Nutrition and Rehabilitation Centers (NRCs) and ensure growth chart plotting for each child in 6 ICDS.
* Community level awareness on health and hygienic practices, issue of open defecation, community managed diarrhea.
* In the community meeting, raise the issue of gender based discrimination in food access, breast feeding, child marriage etc.
* Regular interface meeting with 10 adolescent groups. Formation of one new adolescent group and sharing information about locally available nutritious food.
* Mata Samittee (Mother’s Committees) to organize meetings for participation in strengthening ICDS centers.
* Capacity building of the mothers on importance of Growth Monitoring Chart (GMC) and empowering them.

* CHARDS organized a capacity building program for ASHA on home based newborn care (HBNC). It has been emphasized that all children including non-institutional delivery should be measured (weight) within 24 hours from the birth. Few ASHA workers have started following the HBNC format and now taking the birth measurement for non-institutional child birth as well.
* 129 meetings were organized on child feeding and nutrition.
* Exclusive breastfeeding has been practiced by 69% of mothers of 6-9 months children and 64% of mothers of 9-12 months of children who initiated complementary feeding in the 7th month.
* 93% of children were enrolled in ICDS centers.
* 48% of identified SAM children were referred to NRCs by ICDS workers.
* 73% of SAM children recovered after being referred to and treated in NRC.
* 30% of ICDS workers can plot the weight of the child on a growth chart to identify SAM or MAM children.
* One Mini-Anganwadi center has been initiated with full time Anganwadi Workers.
* All Anganwadi Centers are providing cooked protein rich foods.

Update on major events /campaigns:


CHARDS have carried out a week long anti child marriage campaign along with small community consultations on child marriage. The discussion on ill effects of child marriage also happens to be the part of regular adolescent meeting. One element in the campaign was showing video film depicting impact of child marriage on adolescent’s life. More than 500 community members attended the program or participated in the discussions. This was done keeping in view the child marriage prevalence in operational areas of CHARDS, which had affected the nutrition of the adolescents quite adversely.
In the year 2019, CHARDS have incorporated gender components in their regular activities. In the ambit of nutrition, gender preference matters considerably, especially in the context of Bihar where females always have had to play second fiddle. From household visits to community level awareness programs, animators not only initiated discussion on gender but also oriented/sensitized them on the need of gender equity as the requirements of adolescent girls with regards to nutrition is different in comparison to their counterpart.

Engagement with the Government:


A preliminary assessment has been done with all ICDS centers for the requirement of weight machines. On the basis of this, a demand letter from Anganwadi Vikas Samiti (AVS) has been submitted to the Child Development Project Officer (CDPO). The CDPO took cognizance of the same as a result of which weighing machines were deployed in 4 ICDS centers.

Plans


Key Result Areas Program Activities Planned

* Access to quality and free primary health care services in the Project area.
* Reduction in maternal, infant and child mortality and morbidity in project areas.

* Conduct 20 sensitization meetings with the community on health and nutrition of pregnant women, lactating mothers and children.
* Organize 150 mothers group meetings on issues like exclusive breastfeeding (EBF), complementary feeding, IFA intake, ante-natal and Postnatal care. Ensure 80% of mothers are motivated to take part in the meeting and sensitize other women also.
* Linking 11 adolescent groups with WIFS program (weekly iron folic acid supplementation program)
* organize model Village Health Sanitation and Nutrition Day (VHSND) in eight villages.
* Conducting sessions on health/nutrition with the children of 7 middle schools along with wall magazine.
* Organizing model VHSND/ Arogya Diwas celebration in 12 selected ICDS, with specific performance parameters such as health check-up of Pregnant women & lactating mothers, providing IFA, immunization, family planning guidance, GMC for SAM identification, advice to mother of SAM/MAM children, identifying high risk pregnancy etc.
* Ensuring 70% institutional delivery in the project area.

Key Result Areas Program Activities Planned

* Reduction of Child Malnutrition in 17 Hamlet of 2 Panchayat.
* In 17 Interventional tolas ICDS, NRCs, PDS are fully functional.

* Conduct three workshops each in 2 Gram Panchayats with members of Mata Samity on child feeding and nutrition.
* Organize breastfeeding week celebration and small meetings for sensitization on importance of Growth Monitoring Chart.
* Interface meeting with ICDS workers and pregnant and lactating women for self-care, nutrition management for SAM/MAM children.
* Ensure 30% of AWCs have clean drinking water availability, functional toilets and kitchen within/ close to the premises.
* Conduct training of ASHA/AWW on correct home management of MAM.
* Liaoning with the govt. officials to ensure infrastructural needs of the Anganwadi centers under ICDS is provided.

Financial Summary: January to December 2020


Budget Breakup 2020

Health

6,742

37%

Nutrition

6,742

37%

Administration

4,980

26%

Total Grant Approved

18,464

100%