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Location

20 villages in Motihari Sadar block of East Champaran district, 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 20 villages of the operational area there are 4,300 families, all of whom are from the dalit, mahadalit and other backward caste communities. The status of health and nutrition of children in the 20 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 doctors, irregular attendance of ANM, lack of beds and facilities for institutional deliveries in APHC (infrastructure not as per Indian Public Health Standard (IPHS) norms 2012). This means that families have to travel to the town of Motihari to access any treatment. Due to the non-accessibility and low quality of public health care services, a majority of the community turns to the local quacks as their first choice of care which is dangerous since quacks have no qualifications and are expensive, often unregulated and variable in quality. This situation has meant that home deliveries are prevalent, further increasing risks for mothers and children at birth. The issue of child mortality is also alarming in the operational area.

Parents and the community are unaware of preventive measures/symptoms of illness and the health seeking behavior 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 to seek treatment. The children of the project area suffer from common deadly diseases like- pneumonia, tuberculosis and diarrhea etc.
There is a dearth of adequate numbers 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 monitoring of the children is not known and malnutrition is not addressed at an early stage. For treatment of severely malnourished children, the state government has been running a Nutritional Rehabilitation Center (NRC) but it caters to only 20 children at a time and is not covering all the blocks of the district at the same time. Presently, the NRC is functional in the 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 a lack of economic opportunity, 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

Health: 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 post-natal care. Ensure 80% of mothers are motivated to take part in the meeting and sensitize other women also.
* Linking 11 adolescent groups with the 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-ups of pregnant women and lactating mothers, providing IFA, immunizations, family planning guidance, GMC for SAM identification, advice to mothers of SAM/MAM children and identifying high risk pregnancy etc.
* Ensuring 70% institutional deliveries in the project area.

* 20 sensitization meetings were conducted on health and nutrition where pregnant women, lactating mothers and children participated.
* 84 out of 150 sessions were organized with the mother's group during the period. The rest could not be held due to Covid restrictions.
* 12 adolescent groups organized sensitization sessions on Sexual and Reproductive Health and/ or Anemia in the last quarter.
* 9 out of 12 Village Health and Nutrition Days took place during the period.
* 99% of mothers of 0-36 month old children attended at least one Village Health and Nutrition Day (VHND) in the last 3 months.
* 347 out of 577 pregnant and lactating mothers were linked to one or more existing health programs.
* 50% women in 2nd/3rd trimester received 2 TT Injections,
* 58% women in the 2nd/3rd trimester received 100 IFA tablets.
* 33 out of 36 grass root functionaries (ASHA, AWW or ANM) were trained on health service delivery.
* Around 80% women underwent institutional delivery during the period.
* 95% of children within 9-12 months old were completely immunized.

Achievements & Impact


Program Activities Planned Progress and Achievements

Nutrition: Reduction of Child Malnutrition in 17 Hamlets of 2 Panchayats. In 17 Interventional tolas ICDS, NRCs, PDS are fully functional.

* Conduct 3 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 meetings with ICDS workers and pregnant and lactating women for self-care and nutrition management for SAM/MAM children.
* Ensure 30% of AWCs have clean drinking water availability, functional toilets and kitchens within/ close to the premises.
* Conduct training of ASHA/AWW on correct home management of MAM.
* Partner with the government officials to ensure infrastructural needs of the Anganwadi centers under ICDS is provided.

* 1,840 out of 2,240 mothers of 0-36 month old children reported having been attending at least VHNDs during the reporting period.
* 129 meetings of mothers’ groups were organized on child feeding and nutrition.
* 48 awareness generation sessions on nutrition organized in the reporting quarter.
* 93% of children within 6-36 months were enrolled in ICDS centers.
* 48% of children were reported to be Severely Acute Malnourished (SAM) and referred to the NRC. There has been an increase of SAM children due to Covid and floods in the operational area.
* 74% of children recovered from SAM after treatment at NRC.
* 100% Anganwadi Center is having full time Anganwadi workers.
* 100% Anganwadi workers are providing cooked protein rich food.

Positive efforts during the Pandemic:


In 2020, the CHARDS team engaged more on COVID related work, in addition to focus on spreading awareness against child marriages and its implications on health of children in small community meetings. The team as well conducted life skill sessions with adolescents during pre and post Covid-19 phases. Through their intensive efforts they did better than last year and managed to stop 19 child marriages. Growing cases of child marriage suggest to keep on making the effort to sensitize the community on the ill effects of it on health and nutrition of children/adolescents. The team can now use the success stories to sensitize other vulnerable families.
Despite Covid-19 and floods, CHARDS conducted the survey along with various other activities. The Knowledge Attitude Practice (KAP) study included around 100 lactating mothers out of which around 78% of mothers admitted that they fed colostrum to the child just after birth and 84% of mothers practiced exclusive breastfeeding until six months after birth. Around 70% of mothers started feeding supplementary food after six months of breastfeeding.
In 2021, the team will increase the sample size for the KAP study to 200. The team will follow up with those mothers/families which require proper orientation.
CHARDS has ensured around 80% delivery this year in institutions. For this, the team has adopted a multi-pronged approach. During household visits, they focused on sensitizing families especially mother/father-in-laws so that they do not take any chance at the time of delivery. During floods, the CHARDS team performed exceptionally well and provided their relief boats to take high risk pregnant mothers to the hospitals. Out of 449, a total of 356 institutional deliveries happened this year. The team has suggested to do an analysis on finding out the reasons for each and every case of home deliveries. After this, the team will focus on addressing those reasons. The team will also do a follow up with stakeholders who run the ambulance service for its hassle free services.

Struggles during the Pandemic:


Covid-19 has affected intervention with SAM children very much and only 4 SAM children out of a total 43 SAM could be referred to the NRC prior to the Covid-19 outbreak. However, 15 children have become normal with home based care. Due to the pandemic, NRCs and the ICDS were closed and the tracking of children became irregular. The team is following up with the NRC coordinator about its opening and resuming its services as early as possible.
A total of 12 VHND could have been organized during the period. A total of 261 pregnant women participated in ANC and 112 pregnant women and 343 children underwent vaccinations. A total of 407 children were tracked in the Growth Monitoring Chart. After Covid, vaccinations were affected due to severe side effects in one village. However, CHARDS will run an awareness drive on Adverse Event Following Immunization (AEFI) to bring the situation back to normal.

Emergency Response during the Covid-19 Outbreak:


As an emergency response measure, the CHARDS team identified migrants and organized Covid-19 tests for them after discussion with health officials at district level. They have visited quarantine centers and informed migrants to stay there for 14 consecutive days. The nutrition of children from migrant families was at stake, so CHARDS did an extra effort to link those families with PDS and other social security programs. The ration cards of 680 families were prepared with the help of the CHARDS team. CHARDS has distributed dry ration kits to 410 poor families and sanitary kits to more than 300 adolescent girls. A vulnerability assessment in April 2020 also helped them in identifying families who need support. In the coming year, the team will keep an observation on the nutrition status of children from those vulnerable families and prioritize them for the Growth Monitoring Center (GMC) and other services to minimize the gap.

Plans


CHARDS will work towards following KRAs, outcomes and activities through the next year:

Key Result Areas Program Activities Planned

* Health: 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.

* Awareness generation to pregnant and lactating women on existing health programs
* To promote institutional deliveries, an ambulance service would be made more available after discussion with the implementing agency
* Preparing a case study for every home delivery that happens in village and preparing strategies after the analysis of the study
* Monitor the use of the revolving fund for the benefits of pregnant women which they use for institutional deliveries
* Training of Anganwadi workers / Auxiliary Nursing Midwives (ANM) on the Growth Monitoring Chart (GMC) plotting and common symptoms of malnutrition
* Awareness generation on AEFI (After-Effect Following Immunization) in the community
* Partnering with block/district level health officials for new Health Sub-Centers (HSC) / Primary Health Centers (PHC) and other health and nutrition related services

Key Result Areas Program Activities Planned

* Nutrition: Reduction of Child Malnutrition in 17 Hamlets of 2 Panchayats.
* In 17 Interventional tolas ICDS, NRCs, PDS are fully functional.

* Sensitization programs with the community on the health and nutrition of pregnant and lactating women
* Identification and registration of pregnant women in ICDS centers during their first trimester of pregnancy
* Awareness generation activities with mothers’ group on health and nutrition related issues of pregnant/lactating women and children
* Organizing hemoglobin (HB%) testing to 100 adolescent girls and provide counseling to the identified anemic girls
* Developing model Village Health and Nutrition Day (VHND) in 8 villages of the intervention areas consisting of the quality indicators of VHND
* Conducting Panchayat wise 3 workshops with Mata Samity (Mother’s collective) on child feeding and nutrition
* Celebration of World Breastfeeding week (1-7 August)
* Celebration of National Nutrition Week (1-7 Sept)
* KAP[1] Study with 200 lactating mothers on exclusive breastfeeding and colostrum feeding
* Interface meeting with ICDS workers and pregnant/lactating women on nutrition management of Severely Acute Malnourished (SAM ) / Moderately Acute Malnourished (MAM) children
* Celebration of Bachpan Diwas and Annaprashan Diwas (Rice Ceremony) in ICDS centers for promoting nutrition to children.

Case Story:


20 year old Kavita Devi (name changed as per policy) from Motihari, East Champaran lives below the poverty line. With a baby on the way and existing family struggles, her husband found work in Haryana, leaving her in the care of her mother-in-law. When Kavita felt weak and noticed inflammation in her feet during her pregnancy, she brought it up with her mother-in-law, who dismissed it and told her not to worry. The community due to poverty, poor health infrastructures, lack of amenities, doctors etc. have started believing in traditional approaches. They rather approach quacks and untrained midwives for deliveries. This affects the health conditions of pregnant women quite adversely. Child and maternal mortality rates go up with these traditional approaches adopted by the community. They do not register pregnant women in Anganwadi Centers and often avoid going for ANC and PNC which is not a good sign to keep a child and a mother healthy. Further, it has been observed that in the community some people falsely think to avoid certain fruits like papaya and vegetables, which is not at all corroborated by medical science. Likewise, if a pregnant woman gets ill, they go to either a quack or to the person who can do a magic based treatment. These non-scientific interventions keep the pregnant women in danger and lead to cases of high risk pregnancies.
CRY’s partner in the area, CHARDS, conducts regular home visits in the community. Aware of Kavita’s pregnancy, one of the staff members visited her as well, only to realize that she was anemic. The staff member immediately escorted Kavita to the nearest Anganwadi Center and registered her for a check-up and services afforded by the Center. She was diagnosed with severe anemia and referred to a nearby hospital. Once she was back from the hospital, the Anganwadi worker and Auxiliary Nurse Midwife (ANM), along with our CHARDS staff carefully followed Kavita throughout her pregnancy to ensure that she was healthy. Things changed drastically when floods hit their area. Their village was completely submerged, leaving the entire community to take shelter in a nearby elevated narrow strip of land. In the late stages of pregnancy at the time, Kavita began feeling labor pains and it seemed to her mother-in-law that the only delivery option was a home delivery.

Thankfully, CHARDS was notified of Kavita’s situation and they began thinking of alternatives to get her to the district hospital. They were cut off from all sorts of ordinary transportation and communication and options were limited. The team discussed among themselves and managed to get a boat and transported her to the hospital. Reaching just in time, Kavita gave birth to a baby girl. The baby was underweight at birth. CHARDS ensured proper nutrition counseling so that the baby obtained normal weight within one week!
Kavita’s experience has become a lesson for everyone in their community where home births and malnourished young mothers are still a reality.


Total amount disbursed in 2020: $18,186


Financial Summary: January to December 2021


Budget Breakup 2021

Health

6,980

47%

Nutrition

3,267

22%

Protection

297

2%

Participation

1337

9%

Admin

2970

20%

Total Grant Approved

14,851

100%