Village Health Sanitation and Nutrition Days make a difference in Bihar
Pregnant women and lactating mothers along with children and adolescent girls are provided with need-based integrated health and nutrition solutions on village health, sanitation and nutrition days (VHSNDs) on assured basis in Bihar
For mothers in Vishwaspur village in the Dagarua block of Purnea district, the fourth Friday of every month is a much awaited day. On this day, designated by the Government of Bihar as the VHSND (Village Health, Sanitation and Nutrition Day) for that village, pregnant women, new mothers along with children and adolescent girls are provided with integrated health solutions as per their needs at the local Anganwadi Centre (AWC).
VHSNDs are slated to be organised at the village AWC once every month on a designated Wednesdays or Fridays. This day has emerged as the interface between the community and the health and nutrition system and its services providers, as well as the main platform for providing a package of essential services to the local community. On the designated day, ASHAs, AWWs, and other frontline workers mobilise the villagers, especially women and children, to gather at the nearest AWC. VHSNDs allow villagers to interact freely with the frontline workers and avail basic services and information.
VHSNDs are the key platforms for tracking and providing essential vaccines to pregnant women and children. The frontline workers - Anganwadi Workers and Accredited Social Health Activists (ASHAs) have a list of pregnant women and children who are meant to receive vaccination and they visit the respective families, meet with pregnant women and new mothers to inform them about the VHSND well in advance. On the VHSND, the Auxiliary Nurse Midwife (ANM) and ASHA along with the AWW work together and provide the various services.
VHSNDs also serve as a day when not only health checks done and weights are taken of pregnant women and children but also where women are counselled about essential nutrition for themselves and their children. Counselling can include the importance of consuming iron supplements and vitamins, tips on hygienic and scientific cooking practices as well as on family planning. Adolescent girls and pregnant women are checked for anaemia and are advised accordingly.
VHSNDs are proving to be a very useful vehicle to provide services as well as raise awareness, as many of the reports from the communities show. Rukhsana, a young mother says that she had never bothered much about her own health until she attended the VHSND. “I visited the Anganwadi centre for the immunisation of my child. And, when I went there, I was also told by the AWWs about the kind of food I should take and what I should do to maintain my health," she reports.
Pinky Devi a resident of a village in Purnea reports she was earlier reluctant to get her child weighed. “I had a belief that weighing my child will reduce his weight. But when the ANM explained to me the importance of getting children weighed, I was ready to shed my fears,” Pinky says.
Frontline workers play a key role in making the VHSNDs a success. It is the rapport they have with the local communities and the regular home visits that they make which encourage women to attend the VHSNDs and avail services. Gunja Devi, mother of an eight-month-old child recalls how the ANM and the AWW visited her home on the VHSND and counselled her about the importance of regular check-ups and precautions. “They told me that my child’s name was there in the register. When I myself could not visit them, they came home to do the needful. I am grateful to them for asking me if my child had been administered polio drops. The ANM also suggested to me to feed the child only with breast milk for the initial six months,” she said.
The Bihar Technical Assistance Support Team has been monitoring VHSNDs since 2013 through regular observations and feedback to various government stakeholders at the village, block, district and state levels. Over the years, it has been seen that the reach and quality of VHSNDs in Bihar has been improving. While in 2013, the VHSNDs could deliver only 3 or 4 of the key services on an average out of the stipulated package of services, in 2015 the VHSNDs provide about 8 – 9 services among those identified as important (see box).
The spread of services has meant that now even teenage girls are receiving services and information which was earlier highly improbable. Lalita Kumari, a teenager from Chapi village, says that on the VHSND, the ANM not only advises young girls about the dangers of early marriage but also on the usage of sanitary napkins. “The ANM said tome that I could avail sanitary napkins from the AWW. She also gave me tips on better menstrual management. She also cleared my doubts about using the iron tablets and its consequences,” she says.
BTAST’s ongoing monitoring and support has also helped in strengthening reporting on VHSND. The ANMs and AWWs now meticulously prepare various reports like Maternal and Child Health (MCH) register, Mother and Child Protection (MCP) Card, and the VHSND Tally Sheet for matching the beneficiaries and those registered on the due list. The tally sheet helps them to draw a due list for the next month.
Monitoring data from BTAST also shows that the presence/attendance of all the three frontline workers - ANM, ASHA and AWW – at VHSNDs has improved over the years; and that participation of women from the disadvantaged sections of the society like the Dalits and Mahadalits has also improved.
The improvements in VHSNDs in rural Bihar are a result of several other coordinated efforts by the BTAST and the government at various levels. Officials in the key government departments such as Department of Health, the Public Health and Engineering Department, the Integrated Child Development Scheme – had to be sensitised to the need for convergence and co-ordinated action, which was essential for the convergence to happen at the ground level.
Regular sharing of analysed observation data at the district level committees which are formed of the District Magistrate, Civil Surgeons, Child Development Project Officer (CDPOs) and other key stakeholders, to enable evidence-based decision-making, has helped significantly to make the improvements. Any gaps identified through these data are also discussed at monthly meetings of the District Quality Assurance Committees (DQAC) and the Block Quality Assurance Committees (BQAC) set up under the National Health Mission. Thus, the gaps filled through the process of fact finding, analysis and action on the feedback have strengthened VHSNDs in terms of service delivery quality and coverage.
Sector Wide Approach to Strengthen Health (SWASTH) is a Government of Bihar Initiative Supported by DFID, UK.
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, decentralization and convergence among key departments. The programme also uses community level processes to manage, demand and monitor services. BTAST is an initiative of the Bihar Government supported by DFID-UK to implement the Sector Wide Approach to Strengthen Health (SWASTH) in Bihar.