Sector Wide Approach to Strengthening Health ( SWASTH )

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


Uddeepan Kendras boost health and nutrition of women and children in Bihar

Anganwadi Centres that have been upgraded as ‘Uddeepan Kendras’ at the Panchayat level are emerging as model centres for delivering quality services, and encouraging nearby Anganwadi Centres to strengthen their work.

Jyoti Kumari, stands proudly outside her Uddeepan Kendra (nodal Anganwadi Centre) in Chapi Panchayat of Purnia district. Appointed as an Uddeepika in November 2014, her role is to make her Uddeepan Kendra a model and resource for other Anganwadi centres within the Panchayat. Working alongside the Anganwadi workers and helpers, she provides on-the-job training, advice and mentoring, building their confidence to enable them to provide a high quality and full range of services under the Integrated Child Development Services (ICDS) to young children, pregnant women and lactating mothers in the community.

Jyoti is from the same Panchayat where she currently works and understands local people and their issues. Initially, families were hesitant to accept her recommendations, but over time, Jyoti has gained their respect and confidence. At 25 years of age, she has a post-graduate degree and is able to draw on her education and training to enhance community services and fulfil her desire to serve and improve the lives of local people.

Describing her work, Jyoti says, “I am responsible for observing daily activities of an Anganwadi centre and supporting Anganwadi workers on how to make improvements. I accompany Anganwadi workers on home visits where I directly interact with the community, and I support the Anganwadi workers in imparting counselling . I advise pregnant and lactating mothers on food habits, the importance of weighing and the services available at the Anganwadi centre”.

Her first job as the Uddeepika was to jointly work with the Anganwadi workers in her area to assess the basic hygiene and sanitation of the kitchen and surroundings, and plan for its improvement. She has also been working to ensure that Anganwadi workers update the registers regularly, eliminating delays in data entry.

Jyoti regularly carries out regular home visits and is recognised as a guide within the community. As Milan Devi, mother of two, said, “My baby was born underweight, but we did not realise this until Jyoti advised us to check the weight, using the weighing scale at the Anganwadi centre. When we realised that the baby was underweight, we took her to the nearest primary healthcare centre.”

Usually, people from well-to-do families and those who live close to the Anganwadi Centre are more likely to access its services, and the system often fails to service the poorest. Jyoti recognises this, saying, “Often the benefits of ICDS are availed more by the rich in villages. After home visits, I was able to identify households that are comparatively richer than others. I convinced them that the poorer households have a greater requirement for ICDS, particularly supplementary nutrition, so they were willing to share the benefits of the system to ensure those most in need are helped.” Jyoti is aware that it is difficult for families to afford nutritious food such as fruits, and tries to suggest less expensive alternatives that are easily available in the village, and are equally nutritious.

Jyoti’s Kendra along with its kitchen is in a permanent building. The equipment includes a water filter, dari (mat), chart papers, chairs, table, storage drum, teaching and learning materials, almirah, mirror and nail cutter. Efforts are ongoing to install a toilet and hand pump for water.

She has also inspired other Anganwadi workers in her Panchayat to improve their centres, displaying their charts properly and cleaning the kitchens. She organises weekly cluster meetings with them to discuss identified subjects, share ideas and experiences and look at areas for improvement. She, along with the Anganwadi worker and the helper, also organises monthly community meetings to provide information on issues such as malnutrition, health and hygiene. These meetings are an opportunity for the community to give their feedback on ICDS, whether the services are helpful and how they could be improved and are important in fostering community participation and ownership, ultimately leading to behaviour change.

Jyoti is satisfied that the Anganwadi workers accept her advice and support her. She says that now the community is more aware of ICDS and there have been changes in food habits and breast feeding practices. The community holds Jyoti in high regard, depending on her to ensure they receive the services they need from Anganwadi centres. And as she has said, Jyoti is beginning to see tangible benefits already: growth monitoring of children is more regular and the community is adopting better sanitation and hygiene practices.

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.

ICDS is a centrally sponsored scheme to improve the health and nutrition of children across India, implemented through the States and Union Territories on a cost sharing basis. The central point of delivery of the services is the Anganwadi Centre, with Anganwadi workers and helpers as frontline functionaries. To enhance the effectiveness of ICDS and overcome some of the challenges, the Government of Bihar has introduced the Uddeepan strategy under SWASTH in nine priority districts through a total of 1,731 n-AWCs. The priority districts are Purnea, Araria, Kishanganj, Madhepura, Supaul, Madhubani, Jamui, Sheohar and Banka.