Sector Wide Approach to Strengthening Health ( SWASTH )

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


Bihar needs integrated solutions like SWASTH: Prakash Kumar of BTAST

Prakash Kumar, Team Lead, Bihar Technical Assistance Support Team (BTAST), a health sector reform programme in Bihar supported by DFID-UK, in an interview to OneWorld South Asia, says that convergence between health, nutrition, and water and sanitation makes sense for Bihar as it is one of the most populous state and optimum use of available resources and holistic planning is necessary for development. Excerpts from the interview with Prakash Kumar:

OneWorld South Asia: What differentiates SWASTH-BTAST from other similar programmes?

Prakash Kumar: SWASTH is a Government of Bihar’s initiative to improve the health and nutrition status of people in Bihar, particularly of the marginalised sections. It is a very unique and innovative approach with an inbuilt concept of convergence between health, nutrition, and water and sanitation and all facets of Women empowerment from concept to policy and its delivery.

The prevalent government system by its design, works in silos, but SWASTH is promoting change for the greater good of people through better coordination, integration and convergence.We have seen many such programmes that have failed due to the absence of linkages.

Convergence is a tool for mass behavioural change, optimal resource utilization and now we can see how it is playing a transforming role at the village level. Convergence of issues of nutrition and WASH with health awakens people to the preventive side of health care.

SWASTH supports the Bihar government in two ways. Financial assistance is routed through the budgetary support system and technical assistance is provided for innovative approaches and also to the flagship programmes of government in health, nutrition and water and sanitation and women empowerment.

OWSA: How is convergence between health, nutrition and WASH brought about?

Kumar: For a state like Bihar, which is resource constrained, convergence makes more sense to avoid duplication of programmes.

Convergence at all levels is important to raise the awareness of community on nutrition, health and WASH issues and will be the main approach not just in all the states in India but also in other developing countries.

In SWASTH, convergence is happening at the highest level.The programme has a steering committee which is headed by the Development Commissioner of Bihar and draws members from various departments like Health, Social Welfare, Public Health Engineering Departments (PHED), Finance and Planning.

The committee provides a platform for decisions to be taken at the highest level so that convergence and integration can happen at all level down to panchayat and villages.

OWSA: How has SWASTH led convergence of health, nutrition and WASH delivered better results in Bihar?

Kumar: Most of the health issues have wider linkages with nutrition, sanitation and poor water supply and also inequality and gender.The main objective of SWASTH is to converge all the departments on the basis of agreed common minimum programme.

The programme also focuses on raising awareness among women and creating demand for nutrition, health and WASH services and linking this demand to the supply side, especially to the government departments.

OWSA: Can you name some of the demand side interventions generated by SWASTH-BTAST?

Kumar: Some of the notable demand side interventions generated by the programme is Gram Varta (Village Dialogue), which is a process wherein Self-Help Groups (SHGs) of women raise their understanding and awareness on issues of nutrition, health and WASH. Currently, the programme is working with 80,000 women SHGs in the state.

Gram Varta is the largest convergence model in the world planned to reach 10% of Bihar’s population. Bihar needs programmes with a potential of being scaled up for another 15-20 years. Behavior change communications requires sustained efforts for a long time. Community led total sanitation is another example of raising awareness of community to make entire village open defecation free.

It is very important for a programme that works on complex issues of health, nutrition and WASH to create demand and then link it to the supply side for a better response and long term sustainability.

The result of demand side interventions could be seen in the fact that earlier only 10% of the Village Health Sanitation & Nutrition Day(VHSNDs)were being organized and now about 90% of the VHSNDs are happening in the state. SWASTH is now engaged in the task of improving the quality of sessions in VHSNDs across the state.

OWSA: How can SWASTH become a guiding tool for such interventions outside Bihar, too?

Kumar: Through this programme, knowledge has been created and evidence has been produced which can serve as advocacy tools to explain how different departments need to converge to deal with the complex issues of health and better understand its linkage with nutrition and WASH.

BTAST has a presence in all 38 districts of the state with core teams on health, nutrition and water and sanitation. Besides, we have multi-disciplinary specialists on training, gender, human resources, finance, PPP, IT, monitoring & learning and knowledge management.

We have embedded offices and supporting critical human resources in the ICDS, Department of Health & Family Welfare, State Health Society, Women Development Corporation, Jeevika, Nutrition monitoring unit in Saksham, BMISCL, Social Welfare and PHED, providing technical assistance in various forms.

OWSA: What has been the contribution of DFID-UK?

Kumar: BTAST, supported by the DFID-UK, is the first large bilateral programme in the state with a grant budget of (£145 million).Before DFID-UK very few bilateral agencies were active in the state at this scale with an objective to work closely with the Bihar Government.

Many of the development agencies eluded Bihar as conducive environment did not exist for a long time. The programme has been successful mainly because of the active involvement of the government departments. Besides SWATH, DFID is also supporting programmes on Urban Development and Governance in the state. Recently, DFID has commissioned programmes on attracting private sector investment through the GROW project while the other programme commissioned is aimed to improve performance in agriculture sector.

The DFID support is very holistic in nature and covers almost all the sectors critical for the development of the state. This is a very timely support coming in from DFID as the state is on the development trajectory. I am sure with the success of SWASTH many development agencies will be willing to now work in Bihar and contribute to its social and economic development.