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Hundred Block Plan Visit

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Phase 1, 2, 3 in June 02. Balaji's Update in March 03. Results of first ... Zonal training of block activists & Full timers. Opening of health registers ... – PowerPoint PPT presentation

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Title: Hundred Block Plan Visit


1
Hundred Block Plan Visit
  • HBP Gaya Update
  • Visit to BGVS Manpur
  • December 25-27, 2004
  • Madhulika, Balakrishnan
  • AID Austin

2
Outline
  • HBP-Brief Description
  • Training Camp Outcomes
  • Phase 1, 2, 3 in June 02
  • Balajis Update in March 03
  • Results of first weighing in June 03
  • Dec 03 Visit by Madhu and Bala
  • Latest Update Feb 04

3
Public Health Structure
CHC
PHC
PHC
PHC
4
HBP-Objectives
  • Measurable improvement in child and womens
    health status
  • Improve utilization of Govt. health services
  • Organize support network for women to build a
    womens movement
  • Build skills in the panchayat for local health
    planning

5
VHA The key person
  • Measure malnutrition in children(lt6)
  • Give personalized suggestions to the mother

How is she identified? But how can she do this
all by herself ? Does she feel confident and
empowered? What level of literacy is
required? What is the level of health awareness
required? Does she get paid? What is the
motivation?
Health Activist
6
Training
HA
HA
HA
HA
HA
Cluster Resource Persons
Cluster Resource Persons
Cluster Resource Persons
Block Coordinators
Block Coordinators
State Resource Persons
State Coordinator
7
Health Activists Role
  • 4 step information collection
  • Food nutrition
  • Immunization records
  • Any sickness in the past few months
  • Appreciates and respects the mothers wisdom
  • Tries to understand why the mother cant or wont
    follow her advice

8
Who is a VHA and why is she motivated?
  • Background
  • From the village
  • Poor social background
  • Low level of education
  • Motivation
  • Recognition of her work
  • She is honored in village meetings
  • Praised in front of the mother
  • Is not blamed for weak children (weak training is
    assumed)
  • Trainers lead by example in field training

9
History
  • Initiated by TNSF in 1996 in 60 villages
  • Dept of Health (GoI)
  • 2 blocks in 1997
  • Dept of Science Technology
  • 7 blocks in 1999
  • UNICEF
  • Study in April 2001 in 197 villages
  • Unicef ranked Arogya Iyyakkam as one of the top
    ten health programs worldwide
  • TN Govt. incorporated the experiences into Govt.
    programs

10
Understanding HBP in local contexts
  • Bihar Jan Swastya Abhiyan
  • Tamilnadu Arogya Iyakkam

11
Questions? Questions?
  • Why is the volunteer called activist?
  • Is a health movement activism?
  • Is health not controversial by nature ? Or are we
    refusing to see the controversies?
  • Can improvement in health take place in
    isolation?
  • Do we have a consensus on what can be done?
  • Do we even debate?

12
Some things to remember..
  • VHA Village Health Activist
  • SHG Self help group
  • SFT State Full Timer
  • BFT/CRP Block Full Timer/ Cluster Resource
    Person
  • PHC Primary Health Center
  • ANM Auxiliary Nurse Midwife

13
State Camp June 2002
  • 4 days
  • Organisers insisted for 60 womens participation
  • Invited 5 people from each block
  • Day 1
  • Health problems in each block
  • Day 2
  • Study on health issues Health activists role
  • Malnutrition its relation to poverty
  • Field training
  • Action plan

14
State Camp -June 2002
  • Day 3
  • Discussion of the health program
  • Understanding the public health infrastructure
  • Understanding the problems the ANM faces and
    empathizing with them
  • Day 4
  • Discussion of indicators
  • Input, process, impact
  • Different phases of the program

15
State Camp Phases of HBP
  • Preparatory (Sept 2002)
  • Formation of block committees
  • Identification of full timers, VHAs
  • Formation of SHGs
  • Block level training
  • Phase I (Oct Dec 2002)
  • Zonal training of block activists Full timers
  • Opening of health registers
  • Reaching every household
  • Compilation of data regarding Dais
  • Block level training
  • Documentation of problems

16
State Camp Phases of HBP
  • Phase II (Jan Mar 2003)
  • Complete weighing of children
  • Compilation of list of children and grades
  • Coordination with ANM Aaanganwaadi
  • External evaluation of a smaller sample
  • Next (?)
  • Was to be decided

17
Manpur Block
  • 68 villages and 150 sporadic settlements
  • BGVS started with Kala Jathas (street plays) in
    1991-1992
  • Programs continued until 1995-1996 but have
    slacked since
  • Severe resource crunch
  • BGVS village committee in almost every village
  • 12 village panchayats some a little better
  • HBP started in Oct. 2002

18
Balajis Update March 2003
  • Manpur block - Organization
  • Block coordinator Binod Kumarji
  • State resource person Saritaji
  • State Coordinator Dinesh Prasadji
  • 7 cluster resource persons
  • Implementation
  • Villages 45
  • 1st phase weighing 32 doing
  • Vital events not started after the survey
  • SHGs 5

19
Balajis comments
  • Good start in all the blocks
  • Insufficient state training
  • Low levels of literacy
  • Delay trying to get weighing machines from
    Aanganwadis cost cutting
  • House to house talking not started in most blocks
  • Insufficient training about talking to mothers
  • Need to concentrate on Govt. services utilization
    womens health- can be deferred until the child
    health pregnant women components are solidly in
    place

20
Results of 1st weighing June 2003
  • Children 3995 (M) 3538 (F) 7533
  • Children weighed 5798
  • Grades
  • Normal 2182
  • Grade I 1941
  • Grade II 1195
  • Grade III 371
  • Grade IV 33

21
H HBP District
H
H
H
H
H
H
H
H
H
H
H
H
H
22
Madhu and Balas Visit
  • Status before the visit
  • First phase of weighing in 60 villages completed
  • Second phase of weighing in progress
  • Only 3 state resource persons
  • Saritaji - 5 blocks
  • Sadanandji 7 blocks
  • Sheila Mani 2 blocks (Jharkhand)
  • Manpur block 6 cluster resource persons
  • Each handling 10 villages
  • 2 women and 4 men

23
Preparing for Dec 2003 Visit
  • Wanted to see
  • House to house talking by each person
  • Village Health Activist
  • Cluster Resource Person (block full timers)
  • Block Coordinators
  • State Resource Person
  • Registers
  • Self Help Groups
  • Participation of women in the program

24
Bodhgaya
25
Dec 2003 Visit
  • Visited 3 villages in Manpur and 1 in Jehanabad
  • Nauranga, Ganjas and Mehermanchak
  • Nauranga
  • House to house talking and weighing
  • Ganjas
  • Meeting with cluster resource persons
  • Meeting with SHG
  • Lunch
  • Mehermanchak
  • House to house talking
  • Gorapur (Jehanabad)
  • Weighing, talking and meeting with SHG

26
Nauranga Village
  • VHAs Renu Devi and Raju Kumar
  • Went with Saritaji, Binod Kumarji, Rekhaji
  • Looked at registers
  • House to house talking and weighing
  • Renuji, Rekhaji and Saritaji talked
  • Mixed response from the villagers

27
Rekhaji weighing a child
28
Rekhaji and Renuji talking to a mother
29
Children very interested in what Madhu was
talking in Hindi!
30
Binod Kumarji showing the register
31
Ganjas Village
  • Meeting with block full timers (cluster resource
    persons)
  • Wanted to know their experiences/problems
  • Events undertaken in the last few months
  • Number of training camps they attended
  • WomenMen VHAs
  • Change in VHAs new training given?
  • Interaction with Panchayat and PHC
  • SHGs
  • They wanted to know our
  • Background, interest, fundraising methods
  • Thoughts on the program
  • Had photos sent by Nishant/Gayathri

32
Meeting with cluster resource persons
33
Discussion with Cluster Resource Persons
  • 43 men and 15 women as VHAs
  • No change in VHAs
  • Need CRPs to go house-to-house
  • Advantages of having men as VHAs
  • Mobility (transportation)
  • Help in weighing
  • Disadvantages
  • Difficulty in talking to the mother
  • Events
  • Kala Jatha in Baradih Village
  • 3 new SHGs formed
  • Initial meetings for SHGs in 2-3 villages

34
Discussion..
  • Interaction with Govt. Health Services
  • Everybody used aanganwaadis weighing machine
  • VHA helped arrange immunization in 1 village
  • Complained about ANM
  • Transferred and new ANM appointed in Khaiyya
  • No action taken in Bhadeji and Bikhi villages
  • Recording Denial of Health Care cases
  • Plan to present in health march in Patna in April

35
Discussion..
  • Problems
  • Getting weighing machines from aanganwadis
  • Language problem in muslim localities
  • Need to know urdu
  • Superstitions
  • Immunization will lead to childlessness
  • Immunization will cause fever
  • Difficulty in lifting weighing m/cs when both
    VHAs and cluster resource persons are women
  • Some VHAs complain that they dont have time

36
Ganjas Village Meeting with SHG members
  • Started with a song
  • 16 women contributing Rs 20 for 9 months
  • Meet once a month only to give money
  • No bank account
  • Some women were not comfortable
  • Advantages (according to the women)
  • Emergency loans at very low interest
  • Can use funds for daughters marriage
  • Saritajis suggestions
  • Can use this forum to discuss health hygiene
  • Meet more often and deposit Rs 5 per week

37
Meeting with members of the SHG
38
Meharmanchak Village
  • Very low development level
  • Apparent caste divide
  • Lower caste people migrant labourers - were
    not present
  • 2nd round weighing not yet started
  • People remember Nishants visit
  • House-to-house talking
  • Health activist was male
  • Binod Kumarji Saritaji talked
  • Madhu talked to a pregnant woman

39
Gorapur Vilage
  • Jehanabad Block
  • SHG meeting
  • Women were more vocal
  • Met a naxal lady
  • Weighing and house-to-house talking

40
BGVS Jehanabad team
41
Discussion with Saritaji and Dineshji
  • Would it be helpful if we send computers ?
  • Not at this moment
  • Honorarium for VHAs ?
  • Not at this time
  • VHAs should completely understand the importance
    of program
  • Should not feel talking to mothers is trivial
  • What else can we do to motivate the VHAs?
  • Certificates of appreciation
  • More site visits and more training

42
Discussion with Saritaji and Dineshji
  • Future Plans
  • Training Camp in Feb.
  • Try to get more women VHAs in phases
  • Exclude villages from program where women dont
    come forward as VHAs

43
Summary
  • Registers maintained well
  • More training required for cluster resource
    persons and VHAs
  • Need to adapt this program more to Bihar
  • Increase involvement of AID volunteers

44
Latest Update
  • Talked with Dineshji on 2nd Feb.
  • Block coordinators meeting on 20th
  • Meeting on 12th of every month
  • Monthly bulletin about each block
  • Weighing completed in 45 villages
  • Bank a/c opened for 10 SHGs
  • March 13-15th Gaya Health Activist training
  • Training for 4 blocks already 70 women
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