Sector Wide Approach to Strengthening Health ( SWASTH )

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


Empowering women spurs change at the grassroots in rural Bihar

Gram Varta or Village Dialogue spreads awareness among women on health, nutrition, water, sanitation and hygiene.

“Ghar Ghar alakha jalaenge hum, hum badalenge zamana. Sab se banaenge mitti ko sona, jeevan banega upwan salona. Seejhake pull banaege hum, hum badlenge zamana…”

(We shall transform the times by enlightening our society. Together we shall transform sand into gold, life would be like a beautiful orchard. Together we shall build a bridge and transform our society…)

This powerful song wafts through villages as women, with the aid of facilitators, begin to engage in dialogues on a range of issues that shape their everyday lives. Struggling to provide adequate and appropriate food to their infants, having no access to toilets, facing killer diseases like diarrhoea and malaria, lack of access to necessary healthcare are some of the realities that women in many rural areas of Bihar have lived with over the past several years. While there are many factors that are responsible for this situation, it is also true that women themselves had little access to much needed knowledge and were therefore deprived of many rights.

But much of this is changing now. In the heart of Bihar, an unseen revolution is taking place through Gram Varta. Started under the Sector Wide Approach to Strengthening Health (SWASTH) programme in the state, in collaboration with the Bihar Technical Assistance Support Team (BTAST), Gram Varta (or Village Dialogue) adopts a Participatory Learning and Action (PLA) technique to educate women through a 20-meetings cycle on health, nutrition and sanitation. It uses interactive methods to enable women to identify and prioritise problems related to poor nutrition and health, find local solutions, promote behaviour change and adopt appropriate actions for themselves, their children and families.

Testimonies of three women whose lives have been transformed as a result of Gram Varta are presented here.


Becoming a leader...

Thirty-five year old Shirmani, the mother of a teenage girl, is from Makhdumpur in Jehanabad district. For years she has led the life of any other rural woman trapped in the vicious circle of social taboos and poor health practices. Not just her, but her family too was steeped in traditional ways of healthcare behaviour due to the prevalent social and cultural practices.

But unlike several other women, Shirmani broke age-old barriers – thanks to Gram Varta. When her daughter attained puberty, Shirmani refused to let her be treated as ‘dirty’ during the period and strongly insisted on her to adopt hygienic practices. Her daughter now uses sanitary napkins, something unheard of a few years ago in villages of Bihar.

Shirmani says: “After attending the trainings by Gram Varta, I became conscious and took the initiative to talk to my daughter. I was concerned about the effect on her health if she did not follow the correct personal hygiene practices.”

A Master Trainer for Gram Varta, Shirmani says: “I have been associated with Gram Varta since its inception in Jehanabad. Initially, I joined as a facilitator but after completing 2-3 years, I was promoted and I became a Master Trainer.” As a Master Trainer, she is constantly addressing the challenging task of bringing changes in the knowledge, awareness and practices amongst the SHG members and within her community.

This helped Shirmani not only break boundaries, but also helped her emerge as a leader within her own community. She is beginning to see the results of her perseverance herself. “It took me three years to make half the village free of open defecation, especially the areas inhabited by the Mahadalit community. I used to conduct five group meetings in a month for all the phases at different places,” she says.

Shirmani confides that participating in Gram Varta makes her feel empowered, “Being a facilitator, I see myself as a person who supports the well-being of individuals. I am trained to deal with the problems of the community and find solutions in consultation with them. I am respected and admired for my work. I am someone who is looked up to with high regard in the family. I feel privileged to be a part of such an initiative. It should be continued for prolonged impact.”

Mamta Devi

Fighting against all odds...

Gram Varta has come as a big game changer for many other women. Mamta Devi from Kalanour village joined the local village Self Help Group (SHG) in 2012 and thereafter became a part of the Gram Varta meetings.

Through the Gram Varta meetings, she learnt about the benefits of cleanliness, hygiene and the importance of building toilets in every household.

Mamta says that when she became aware that open defecation can lead to diseases and ill health, she decided it was high time for her family to build a toilet in their house.

However, she found it difficult to persuade her husband and in-laws about constructing a toilet, who felt it was unnecessary. The cost implications were also to be considered. “Finally when they did not relent, I thought of going against the wishes of my family and construct a toilet for my children and myself. I went to the leader of my SHG and asked for a loan to build the toilet,” she says. With help from the SHG, she took the initiative and went ahead to get a toilet constructed in her house.

A confident Mamta proudly says that now even her husband appreciates her bold step as there has been a positive impact on their overall health. “Now, I am spreading the message further by propagating, ‘Jis ghar me shochalay banana, usi ghar me beti byahana’ (Marry your daughter only in a house that has a toilet).”

Gram Varta inspired many other women in these villages to take up issues like sanitation in their areas despite opposition from family members.

Saroj Devi

Ensuring a healthier tomorrow...

Most villages in Gaya district of Bihar are going through various phases of Gram Varta meetings. Several meetings in the cycle focus on nutrition and health check-ups to identify malnourished children. Severely malnourished children are then referred to a Nutrition Rehabilitation Centre (NRC) for intensive care and rehabilitation.

Saroj Devi, a 22-year-old mother of two, had been regularly attending the Gram Varta meetings. Here, she learnt about how children’s growth can be monitored and why it is important to do so regularly. She was then keen to get children measured for their weight and height. Much to her shock and despair, one of her children was identified as chronically malnourished. With the help of a local Anganwadi worker she took the child to the NRC for treatment.

After her visit to the NRC, her child was put on an increased diet and she has been taking care of the child as advised at the NRC. “I was shocked to know that my child was malnourished. The NRC provided milk along with balanced meals four times a day. I also learned to keep the surroundings around my children neat and clean. The weight of my child increased after the visit,” she says.

Whether it’s Shirmani, Mamta or Saroj, each of these doughty women is bringing about change on the ground in rural Bihar, and what binds them as change-makers is the Gram Varta initiative. Neena Sharma from BTAST feels that Gram Varta has played a crucial role in enhancing the decision-making power of rural women. She is excited at the level of awareness generated by Gram Varta. “The success of Gram Varta shows that it has helped rural women take decisions related to health, nutrition, and hygiene not just for themselves but also for their families. It has brought social change, generated livelihood opportunities, and increased their knowledge and awareness, truly empowering the community,” she says.

Gram Varta is implemented through the Government of Bihar’s Women Development Corporation, JEEViKA (a rural livelihoods project) and Bihar Mahila Samakhya. It reaches out to nearly 800,000 women and their families through 78,300 Self Help Groups, which have a membership of around 10 - 12 women per group.



The SWASTH programme aims to improve the health and nutritional status of people of Bihar by increasing access to better quality health, nutrition, and water and sanitation services, particularly for the underserved groups. The focus of this programme is to strengthen the systems through better planning, organisational strengthening and human resource management, decentralisation and convergence among key departments. The programme also uses community level processes to manage, demand and monitor services.

Disclaimer: SWASTH is supported by the Department for International Development (DFID)-UK and implemented by the Government of Bihar, in collaboration with the Bihar Technical Assistance Support Team. However, the views expressed in this report do not necessarily reflect either DFID’s or Government of Bihar’s official policies or views.