Sector Wide Approach to Strengthening Health ( SWASTH )

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


Social audits help improve Anganwadi services in Bihar's villages

Communities take on an active role to scrutinise records and give feedback on the government run Anganwadi Centres that provide health services to women and children.

TWICE a year village communities in Bihar get an opportunity to review and raise any queries about their local Anganwadi Centre (AWC) and the services provided by it. Pregnant women and mothers of newborn babies in the village Chapi now monitor and comment on the services that they receive. Just two years ago, this would have not been possible. 

AWCs are meant to offer a set of services to pregnant women, new mothers, adolescent girls and children till the age of 6 years. In Chapi, the AWC had not gained much trust from the local community and therefore the uptake of services was low. Community members felt that the Anganwadi Workers (AWWs) and Anganwadi Helpers (AWHs) were working for their own interests and were providing services only to a select group of people who were known or related to them. This had not only limited the reach of the centres, but also created hurdles in the daily work of AWWs and AWHs due to the trust deficit.
Social audits have been a way of improving governance and service delivery of AWCs. This is a process by which citizens (beneficiaries) participate in activities such as planning, implementation, and monitoring and evaluation. Local communities monitor the AWC services on an ongoing basis, thereby helping set up a direct feedback mechanism between the service providers and users. This also helps strengthen community voices. This mechanism was introduced years ago across the state. While it has been successfully implemented in some areas, it
has been a challenge in others. Difficult relations as seen in Chapi had meant that social audit processes could not flourish.
However in 2014, the processes were renewed when the Chapi AWC was designated as a nodal Anganwadi Centre (n-AWC) or the Uddeepan Kendra. The Uddeepan Kendra is a model AWC, wherein an additional worker or Uddeepika supports AWWs and AHWs to build their capacities so that they are able to provide better and regular services. One of the purposes of deploying the Uddeepika is to ensure enhanced community participation and organise social audits with the help of AWWs. As social audits give the community unhindered access to the reports and record registers of the AWC, it is important these are regularly and correctly maintained. In Chapi, over the last two years, AWWs and AWHs with support from the Uddeepika have maintained the records, growth charts, roster registers and other statistics crucial for making the social audit successful. The emphasis has been on ensuring accuracy of documentation.
Better maintenance of records has helped in making the process of social audits more transparent and systematic. The local community is now not only aware about the benefits they can avail from the AWC, but also able to appreciate the challenges faced by AWCs. Rishikesh Kumar, a nutrition trainer of frontline workers, says, “The data-enabled social audit process has helped in bridging the trust gap between the frontline workers and the end beneficiaries.”
On the designated day, the AWC at Chapi becomes the hub of activity. Community people are invited to participate in the social audit process. All the registers that maintain a record of beneficiaries are open to scrutiny, the monthly progress reports are shared, and the beneficiaries and community in general are asked to express their opinions and give a feedback on the services provided at the AWC. 
This open process, apart from serving as an occasion through which people get to know about all kinds of services available at the AWC, is also a tremendous opportunity to reinforce public trust in the centre. Nand Kishore, District Programme Officer, Purnea, says that social audit is helpful in clearing the doubts of villagers about the provisions of the centres. “In the absence of social audit, people harbour all kinds of misconceptions about the AWWs and even raise questions on their integrity. But with the records out in the open for public scrutiny, most of such apprehensions are dispelled.” This is particularly important because the AWC services are fixed per centre for a limited number of beneficiaries. The Integrated Child Development Services (ICDS) Supplementary Nutrition Programme in Bihar is limited to 40 eligible children between the ages of 6 months to 3 years, 40 eligible children between the ages of 3 to 6 years, and 8 pregnant women and 8 lactating women. If this is not clear to the community, those who not eligible or cannot be included can cry foul.

Social audits have been useful for the ICDS as well, to identify any anomalies and address them systemically. Several problems that surface during the social auditing are rectified by the AWWs within the next six months before the next social audit takes place. Saurav Tiwari, District Programme Officer, Bihar Technical Assistance Support Team (BTAST), says, “The data collected through the social audit is fed into the government system. Based on it, we get a feedback from ICDS regarding the key points that have to be rectified.”
Rajni Gupta, ICDS Child Development Programme Officer of Block Dagarua in Purnea, elaborates, “We ensure that the problems that come to their notice during the social audit, say in June, are corrected before the scheduled audit after six months. That builds the efficacy of the system and the confidence of the communities.”
Several communities like that of Chapi are building relationships with the local services and monitoring them too, which in turn benefits their own children and women. Uddeepikas placed in several of these AWCs have catalysed this, and AWWs are working to make these continuous quality improvements. Community involvement, monitoring and ownership, as seen in many other cases, is a proven mechanism that contributes to service improvements.
The Sector Wide Approach to Strengthening Health (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.
The Bihar Technical Assistance Support Team (BTAST) provides technical assistance to the SWASTH programme. It works closely with the ICDS - a centrally sponsored scheme. The Uddeepan strategy is one of the SWASTH flagship interventions implemented through ICDS. Read more about it here: BTAST has also supported the social audit processes and helped conduct social audits in several areas through its District and Block programme officers. 
This story was written by Ashok Kumar at OneWorld Foundation India.
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 Govt. of Bihar’s official policies or views.