Sector Wide Approach to Strengthening Health ( SWASTH )

Bihar Technical Assistance Support Team (BTAST)
Government of Bihar initiative supported by Department for International Development, UK


From our archives: Gram Varta - Helping Communities to Help Themselves

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1. Malnutrition

A Cycle of Poverty and Lack of Access: In villages across Bihar a combination of poverty, lack of knowledge, inadequate health and nutrition services and lack of essential water and sanitation fa-cilities translates into widespread under-nutrition and consequent poor health outcomes, particularly among women and children and minority groups. Breaking this cycle of disadvantage often requires only basic knowledge and community level action, but this may require initial external facilitation.

2. “Village Talk” to Generate Community Action

Gram Varta (literally “village talk”) was piloted under the DFID supported SWASTH programme, in partnership with Ekjut and the Women’s Development Corpora-tion (WDC), from September 2011 to May 2013 in Maner block, Patna district (87 groups), and scaled up in 14 districts (48,058 groups). Participatory Learning and Action (PLA) approaches were used to strengthen and mobilise existing self-help groups to bring about positive change in their communities. Selected group members were trained to facilitate a cycle of 20 fortnightly meetings. Each facilitator is re-sponsible for 10 to 12 groups, enabling them to identify and work on key issues related to maternal and child health care, nutrition, water, sanitation and hygiene (WASH). The groups learn to assess their local situation, decide on action, take action and review progress. Non-members are also invited to meetings, to further spread awareness and involve key stakeholders in actions.

3. Changes Observed at Community Level

At a review meeting in May 2013 and during field visits, facilitators reported a range of changes resulting from the programme. Initially they encountered resistance from Anganwadi Workers (AWW), who were concerned at a possible increase in their work burden, but in fact the reverse has been true as more women now know about and appreciate services and activities at the Anganwadi Centre (AWC) and come of their own accord, where previously the AWW had to take more time going house to house to talk with them individually. This has promoted a positive and mutually sup-portive relationship between facilitators and AWWs. Behavioural changes among families reported by fa-cilitators in Maner include:
•Pregnant women now eat green vegetables, go for ANC check-ups and take their iron tablets, where previously they discarded them.
•New mothers exclusively breastfeed their babies up to six months and then introduce supplemen-tary foods.
•Mothers get their children immunised, de-worm them and insist they eat green vegetables.

“My neighbour didn’t use to give complementary food [to her baby] and I called her to the meeting. She was reluctant to come and said that AWC does not give proper services. However, she was convinced and came to the meeting where we told her to give it rice and vegetables from her kitchen garden as a nutritious food source. She now admits it was good advice.”
•Families are using toilets and washing hands with soap and water (instead of using mud) before eat-ing and after defecation.
•Families place greater value on their adolescent daughters, understanding the cycle of malnutrition from young under-nourished mother to child.
•Early marriage is less practised and communities understand the risks of early marriage.

“A 16 year old girl was pledged to be married but her mother returned the baarati on the day of cheka after seeing the pictorial depiction of malnutrition life cycle. She was reprimanded by her husband that she doesn’t care for family dignity but she said my daughter’s life is precious and both she and her baby will be affected and her life will be spoiled if she is married before 18 years. I will not let that happen.”​