Parivartan: Bihar Community Mobilization Project · Ananya, Project Concern International (PCI) – in partnership with PATH and the Foundation for Research in Health Systems (FRHS)
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Transforming Lives:Sustaining the Improvement of Family Health and Sanitation in Marginalized Communities
Improvement of maternal and child
mortality and morbidity outcomes, in a
high-burden state like Bihar, are critical for
India and its ability to achieve its goals of
contributing to Millennium Development
Goals (MDG) 4 and 5. To this end, the Bill and
Melinda Gates Foundation (BMGF)
supported the Ananya initiative and
partnered with the Government of Bihar
(GOB) to accelerate improvements in a
broad range of priority health outcomes –
emphasizing, maternal, neonatal and child
health (MNCH); nutrition; key infectious
diseases; and sanitation and hygiene. Within
Ananya, Project Concern International (PCI)
– in partnership with PATH and the
Foundation for Research in Health Systems
(FRHS) – is implementing a community
mobilization and social accountability grant
(Parivartan). Parivartan provides a platform
for empowering 8 high innovation districts
to engage in processes that catalyze support
networks and enable a shift in behavior and
social norms, which contribute to improved
and sustainable health and sanitation
outcomes in Bihar.
Promoting Behavior Change on
Key Health and Sanitation
Parivartan: Bihar Community Mobilization Project
Behaviors:
Working with Most Marginalized
C o m m u n i t i e s f o r S o c i a l
Accountability and Equity:
Parivartan mobilizes,
organizes, and builds community groups in
Biharwith a focus on: a) strengthening their
ability to shape social norms, promoting
behavior change, and driving demand for
services critical to maternal and child health,
sanitation and hygiene; b) strengthening
accountability and monitoring mechanisms
through community structures for health,
sanitation, and welfare services and
schemes to advance equity and service
access and; c) establishing sustainable
institutional structures and frameworks to
support the state-wide scale up of
community mobilization interventions
focused on maternal, neonatal, child health
and sanitation (MNCHS).
P a r i v a r t a n w o r k s w i t h t h e m o s t
marginalized communities to address
equity issues related to caste, gender, and
other social variables, which can be
determinants of MNCHS outcomes.
Providing Linkages for Sustainability and
S c a l e : F u r t h e r m o r e , P a r i v a r t a n i s
collaborating with the Bihar Rural
Livelihood Project (Jeevika)-to create a
sustainable scale up across the state, and
provides support to 8,000+ matured Jeevika
community groups (see Page 5, on how
Parivartan has collaborated with Jeevika)
Issue October 2013
Health and Nutrition, My Right..A story on how women in a village in
Samastipur submitted an application to
demand the opening of an Anganwadi
Center in their area…..Page 7
Parivartan is currently working in 64
blocks from within 8 high innovation
d i s t r i c t s i n B i h a r, n a m e l y : P a t n a ,
Begusarai, Samastipur, East Champaran,
West Champaran, Gopalgunj, Khagaria,
and Saharsha (See map on the left-hand
side). These blocks were selected using a
vulnerability index, calculated based on
three indicators: percent of Scheduled
Castes and Tribes (SC/ST) population in a
block, literacy rates among women, and
proneness to flooding. Of the 64 blocks, 43
are designated as B-50 (bottom-50) and 21
as T-50 (top-50). B-50 blocks are those
where the percentage of the SC/ST
population is high, female literacy rates are
low, and the areas are more disaster-prone.
In these blocks, Parivartan created 18,000
community groups in more than 2,250
villages. Each community group typically
contains 15-18 women of reproductive age
group. Each village has approximately 5-6
community groups
Issue October 2013
OUTREACH
Parivartan reaches out to
women in
reproductive age group (WRA)
through community
groups in approx
villages. These groups are supported
by Sahelis.
280,000
18,000
2,250
2,600 Mobilizing Most Marginalized
According to the 2011 Census, Bihar (the 3rd
most populous state in India with a
population of 103.8 million) has the highest
decadal population growth rate at 25. Bihar
has 23 castes under the SC category,
constituting 16 percent of the total
population. Among these, Chamar and
Dusadh constitute about 60 percent of the
SC population. Four other castes: Musahar,
Pasi, Dhobi and Bhuiya constitute an
additional 30 percent combined. The
remaining 17 castes constitute about 8
percent of the SC population. Paswan is one
of those smaller castes. They are now
referred to as the "creamy layer" meaning
that they are economically better off
(relative to the other castes) because of the
political patronage they have received. As a
result, there was a political move to create a
group called Mahadalit (In Bihar, the term
‘Dalit’ is used to denote all SC) excluding
Paswans from the Dalit i.e. SC category. The
Mahadalit Commission was formed to serve
the needs of the Mahadalits (excluding the
Paswans). The Parivartan project, however,
remains focused on all SC (Dalit) including
Paswans – who form a very small percentage
of the SC population – and the Pasmunda
Muslims
Patna
Samastipur
Begusarai
Khagaria
Saharsa
West Champaran
East Champaran
Gopalganj
2
Issue October 2013
Sahelis Performance Assessment Criteria
At the grassroots level, Sahelis (village
volunteers) act as catalysts of change and
play a critical role as conduits of information
for the target women. These Sahelis were
selected from among the women in the
target communities with a basic level of
education, leadership and communication
skills, and a willingness to work on the
project. These Sahelis are being trained (on
an ongoing basis) on communication and
leadership skills and key maternal and child
health and sanitation related issues. Sahelis
conduct community discussions on 12 key
maternal and child health and sanitation
related behaviors within community groups.
Sahelis uses various tools such as picture
cards, stories, games etc. to initiate and
moderate discussion in the community group.
A team of 8 District Resource Persons
(DRPs) and 140 Master Trainers (MTs) were
recruited. These DRPs and MTs not only
conduct district trainings, they also visit field
sites to observe Sahelis conducting
community group meetings. MTs use a
standardized checklist to assess the skills
and performance of Sahelis. This checklist
captures data on the quality of the trainings
by Sahelis. The monitoring tools assess the
Sahel is ’ communication ski l ls , the
engagement of training participants, the
Sahelis’ handling of training materials, and
participant learning as evaluated by pre- and
post-training test scores.
Based on analysis of the scores, Sahelis are
categorized into three categories as per
their performance level.
Preparation/operation
Preparation and assessment of target
audience
Developing learning tools
Testing learning tools
Execution of learning tools/roll out
Confidence
Perceived confidence to deliver the
training at the field - before and after.
Learning
Retention of the information/
knowledge, increase in knowledge
from before to after the learning
experience:
Skill and Performance
Communication skills
Use of Information material
Message delivery
Involving women in discussions
Response to quires
Feedback from the trainee
Women attention retention
Challenges and opportunities
Experiences of difficult situations and
the role of training in overcoming
these situations
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A team of 140 Master Trainers train
Sahelis on ongoing basis, and provide
onsite hand-holding and technical
assistance
Sahelis Performance and Skill Monitoring System
Structured interview Obervation
One time information During training On the job
Quantitative data is collected in pre coded structured tool on monthly basis
1 2 3
} Basic information
of trainees
} Identification
} Social profile
} Perception
} Confidence
} Knowledge and
learning
} Preparation
} Skills
} Application of
knowledge
Master Trainers
Sahelis
GroupMembers
DistrictResourcepersons
3
Issue October 2013
ParivartanCompendiumThe Parivartan Compendium consists of
thirteen training modules pertaining to
antenatal care, birth preparedness,
postpartum and newborn care, exclusive
breastfeeding, complementary feeding,
routine immunization, postpartum family
planning, sanitation, village entry, group
formation, equity, social advocacy, and
a cc o u n t a b i l i t y. T h e m o d u l e s w e r e
developed by the Parivartan core team,
which included members from PATH and
PCI. The core team worked on the content,
language, methodology for disseminating
messages, and the collective action (to be
undertaken by the group members to
ensure behavior change and facilitate
service access). The team did a literature
review of the technical content, tested the
appropriateness of the messages in the
context of Parivartan groups, developed
messages with other Ananya grantees (such
as CARE and BBC Media Action), and
finalized the modules.
The modules are used to train community
group members through community
cadres. It is expected that after receiving
training, community members (particularly
pregnant and lactating women) will practice
appropriate behavior – related to maternal
and child health, nutrition, and sanitation –
and access health services from nearby
facility and service platforms. The Equity
and accountability modules are designed to
generate community demand and make
service providers and institutions, such as
Integrated Child Development Scheme
(ICDS) and health facilities, accountable.
The village entry and group formation
modules have been helpful with establishing
rapport and in mobilizing communities to
form groups in about 2300 villages in the 64
blocks of the eight Parivartan intervention
districts. The group formation modules are
introduced to form groups in line with the
Jeevika concept. The group formation
modules have been developed in line with
Jeevika modules so that Parivartan groups can
easily be transitioned into the Jeevika fold.
Snapshot of Parivartan Modules
4
Issue October 2013
Working Collaboratively withJeevikaJoint Planning Exercise:
Joint Capacity Building Activities:
Transitional
process of the Parivartan Groups into the
Jeevika project has been initiated. For this,
the Parivartan and Jeevika teams had a
joint planning exercise that included the
mapping of the groups and clarifying the
roles and responsibilities of Parivartan and
Jeevika staff at the state, district, and block
level.
Parivartan and Jeevika have been jointly
implementing capacity building initiatives.
As per this, Parivartan trained 120 of
Jeevika’s Sahelis while Jeevika supported
the training of the Parivartan’s Block and
Community Coordinators. A Total of 873
coordinators were trained on group
formation and PanchSutras. Specific input
was given on maintaining the books of
accounts and record keeping.
Parivartan has signed a Memorandum of
Cooperation (MOC) with Bihar Rural 1Livelihoods Promotion Society (BRLPS) ,
for health and sanitation integration with
BRLPS’ project Jeevika (Bihar Rural
Livelihoods Project). Jeevika aims at
enhancing the social and economic
empowerment of the rural poor in Bihar by
creating self-managed community
microfinance institutions or self-help
groups (SHGs) at the village level and
enhancing income through sustainable
livelihoods. Parivartan will help Jeevika to
advance a health, nutrition, water and
sanitation agenda within their community
institutions.
Parivartan is focusing on the process
wherein all the Parivartan promoted
c o m m u n i t y g r o u p s w i l l b e c o m e
incorporated into the Jeevika framework
with the retention of the ongoing Health
and Sanitation Agenda. The transition
process, initiated in the month of August
2013, would aim to cover all 18,000
community groups by June 2014.
H o w e v e r, b e f o r e g r o u p s c a n b e
incorporated within Jeevika, Parivartan
has to work towards nurturing groups to
practice f ive essential elements,
(Panchsutras) as prescribed by Jeevika,
namely: (1) weekly meetings, (2) weekly
savings, (3) inter loaning, (4) timely
repayment of loans, and (5) book-keeping
at the group level; in addition to educating
group members on health, nutrition and
sanitation behaviors
Supporting Bookkeeping
Sharing Modules:
Community Resource Person (CRP) drive
- Jeevika has
committed to support Parivartan promoted
groups to equip them with books for record
keeping and accounting. This will help the
community to streamline financial records
and facilitate in opening bank accounts.
Jeevika has supplied SHG
modules to Parivartan, which emphasize the
formation of SHGs, the importance of
Panchsutras, and institutional building.
-
Jeevika is organizing a CRP drive, within
Parivartan areas, to strengthen institutional
building among Parivartan groups and
provide inputs on the importance of financial
services available for the community groups.
The Community Coordinators and Sahelis
will be working very closely with the
Community Mobilizers and CRPs.
5
Issue October 2013
Monitoring, Learning and Evaluation
Baseline Survey Results:
MIS Outcome Indicators Tracking:
K n o w l e d g e M a n a g e m e n t
Framework:
Linking Data to Google Map:
Parivartan’s
baseline survey is complete and key results
and recommendations for each of the
twelve family health and sanitation
b e h a v i o r s h a v e b e e n p r e s e n t e d .
Furthermore, the baseline study also
recommended actions for strengthening
community mobilization, which is the key
mechanism through which Parivartan seeks
to bring about an improvement in maternal
and child health and sanitation behaviors
among the most marginalized women in
rural Bihar. The data has been disaggregated
a t t h e d i s t r i c t l e v e l t o d e v e l o p
recommendations for implementation
Parivartan is currently working on finalizing
a mechanism to track 30 outcome indicators
on a quarterly basis. Of these, 12 would get
collected through project MIS. The GSAP
registers have been modified at the
grassroots level, staff have been trained on
data collection, and reporting on the 12
outcome indicators will begin as of Oct 2013.
Furthermore, a system is being finalized for
the collection of 18 additional outcome
indicators
Parivartan drafted a
knowledge management framework, which
outlines the strategy for building a system of
knowledge transfers for the Project. The
goals are to synthesize knowledge by
connecting various stakeholders with a
focus on the community and to improve
organizational learning by assessing impact.
In
August, Google volunteers helped the
Parivartan team to link the Excel based
Parivartan database with google maps.
Web Based
Parivartan MIS
PortalParivartan created a web based portal,
www.pciparivartan.org, to enable direct
data entry at the district level by
implementing NGOs. The data is then
collated for project level analysis.
In addition, the web portal contains
information on all group members
involved in the project, including socio-
economic and personal details such as
age.
The s i te a ls o con tain s database
information on Sahelis and the grassroots
cadre of Parivartan
Group Attendance Registers
GSAP- Group Service Access
Platform
Data Validation Process
Each group maintains basic SHG registers such
as meeting and attendance registers. Now, as
per the transition plan, saving registers are
being introduced at the group level.
To monitor and report on outcome
indicators, information is collected on group
members using the12 key maternal and
child health indicators at the group level and
reported through a web based Management
Information System (MIS) portal.
Parivartan’s MIS team undertakes a
validation exercise in close coordination
with the program team to validate the MIS
data and report on a monthly basis
Scan the following barcode to go to www.pciparivartan.org
MIS REGISTERS AT GROUP LEVEL
6
Issue October 2013
Collaboration with Bihar Mahadalit Vikas Mission
Since Parivartan works closely with the most
marginalized communities, it is working
closely with the Bihar Mahadalit Vikas
Mission to link the Mahadalit communities
with basic services and empower them
socially, economically, and culturally to
ensure their participation in developing a
strong society. Parivartan established
partnerships with the Bihar Mahadalit Vikas
Mission and coordinated to link the
community groups with the schemes
promoted by the Mission. This will be a
valuable addition to the community groups
especially from a health and sanitation
related input. From the long menu of the
schemes Parivartan is initially focusing on:
1. Mahatma Gandhi National Rural
Employment Guarantee Act (MGNREGA)
cards & Smart Cards
2. Mahadalit Toilet – Construction Scheme
3. Mahadalit Anganwadi
4. Mukhyamantri Nari Jyothi Program
5. Mobile Public distribution system
6. Construction of Community Hall/ Work
Shade
Intensive efforts are being made to link the
community groups with the above-
mentioned schemes. The response from
the departments is very encouraging. The
Principal Secretary has issued letters to all
districts for supporting the Parivartan
team. The Joint Response Plan is being
developed at the block level after arranging
interface meetings with the community
cadres of Parivartan and the Mahadalit
Vikas Mission.
Strengthening Village Health, Nutrition and Sanitation CommitteesPCI has initiated efforts to analyze the
functional status of Village Health, Nutrition
and Sanitation Committees (VHSNCs) and
work to help them effectively address the
health needs in the village level health plan
developed by the VHSNC at the Revenue
village level.
With the above mentioned objective, PCI
has entered into a service agreement with
Praxis to work towards strengthening the
functionalities of VHSNCs among the 8
priority districts in Bihar, covered under the
“Ananya Program,” as a strategy towards
effective community-led action for better
health outcomes.
Health and Nutrition Services,
my rightMala Devi, member of the Radha
Community Group, Samastipur district,
shared her tragic story: “Despite already
having 4 children, I became pregnant once
again and delivered a low birth weight baby
having only 2 kg of weight. The baby died
within one month because of poor
nourishment as I was very weak and unable
to produce enough milk and there was no
AWC (Aanganwadi Centre) in my ward of
residence to get nutrition supplementation.
Since I come from a Dalit community,
neither the ASHA [Accredited Social Health
Activist], nor the Aangandwadi Worker
provided me with any services nor
counseled me for family planning and it was
quite difficult to benefit from AWC facilities
about 1 km away from my residence.
After associating with the Radha group,
under the Parivartan program, I came to
know that we are entitled to seek help
from AWC facilities. I feel that I wouldn’t
have experienced the tragedy if I had had
proper access to the AWC. Hence, we the
members of the Radha group have
approached the Child Development and
Protection Officer (CDPO) to request for
the opening of an AWC in our ward with a
population of about 1100 people (consisting
mainly of Dalit/Mahadalit communities).
We are firmly determined and will
continuously work to get this center opened in
our ward so that my story won’t be repeated
with any of our community members.”
7
Issue October 2013
ParivartanPartners
P C I i s t h e L e a d
P a r t n e r a n d
r e s p o n s i b l e f o r
overall program implementation and
compliance with Bill and Melinda Gates
Foundation (BMGF) grant requirements. PCI
also serves as a clearinghouse and
synthesizer of lessons learned and
promising practices. PCI leads the
c o m m u n i t y - b a s e d a c t i o n b e i n g
implemented by 8 local NGOs, focusing on
district-wide interventions to foster and
strengthen community groups and
community-based actions (CBA).
PATH serves as the
Technical Advisory
Partner, leading the
efforts related to: learning, the transfer of
learning for sustainability and scale up (KAT
stream), and the collaboration with MLE
partners to document and disseminate
knowledge and learning. PATH advises and
guides the CBA stream on proven models
and interventions, such as Sure Start,
assimilating knowledge and learning and
transferring lessons and best practices to
stakeholders to achieve sustained impact
across Bihar.
FRHS functions as
the Implementing
Partner for Research,
and focuses on implementing operational
research pilots at select villages for
strengthening community groups
For Further Information, please contact:
Parivartan Project Office
Dr Vikas Aggarwal
Chief of Party, Parivartan
Nirmal House 2 & 3rd Floors,
Nalanda Nagar,I.E.Road, Kurji,
Patna, Bihar – 800010
Tel:+91-612-2270211/12
Fax:+91-612-2270207
vikas@pciindia.org
PCI International Office
Janine Schooley
Senior Vice President
5151 Murphy Canyon Road,
Suite 320
San Diego, CA 92123
Office: 858-279-9690, ext 311
jschooley@pciglobal.org
PCI India Country Office
Edward Scholl
Country Director
C32, Panchsheel Enclave,
New Delhi–110017
Tel: +91-11-46058888
Fax:+91-11-26187545
escholl@pciindia.org
Parivartan Information Booklet © PCI
Main Contributors: Vikas Aggarwal, Dr. Nirmala Murthy,
Rajshree Das, Sanjeev Bhanja, Brijesh Rao and V J Rao.
Editors: Ed Scholl and Jennifer Keller
Photo Credits: Ed Scholl, Janine Schooley, Vikas Aggarwal,
Rajshree Das and Brijesh Rao
Design and Concept: Vikas Aggarwal and Ajith Kumar
8
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