Integration of Health Nutrition and Sanitation Agenda in JEEViKA 01.08.2014

Integrating Health, Nutrition and Sanitation in JEEViKA Institutions: A Proposed Model

2014

Draft 0 – Comments and Feedback Integrating Health, Nutrition and Sanitation in JEEViKA Institutions: A Proposed Model

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Integrating Health, Nutrition and Sanitation (HNS) Agenda in JEEViKA Institutions Bihar Rural Livelihood Promotion Society (BRLPS) is implementing a project JEEViKA, which aims to build a multi-tiered, self-sustaining, model of community based institutions who self-manage their own development processes. In addition to providing livelihood security to the poor communities, JEEViKA has one of its strategies to safeguard poor communities from malnutrition, and drainage of savings on health related expenditure by promoting improved access of the communities to health, nutrition and sanitation (HNS) information and services. To facilitate this, and to integrate and institutionalize HNS within JEEViKA supported community institutions, a model is being proposed, which is based on learning and experience of Project Parivartan1. This HNS integration is a part of Memorandum of Cooperation (MOC) which PCI signed with BRLPS for the Project JEEViKA and which will provide a framework to empower and enable the members of JEEViKA community institutions to review, plan and take collective action to address issues related to equitable access of quality HNS information and services. This model specifically focuses on issues related to maternal, new-born & child health (MNCH) and nutrition and also promote collective action through community groups where members and leaders would be involved in a series of processes to influence and drive change in behaviours and practices on specific 8 health, water and sanitation behaviours2 to reduce maternal and child mortality and improve key nutrition and health outcomes.

Health Nutrition Sanitation Board Issues Covered

Maternal, new-born and child health (1000 days cycle - from pregnancy to child up to 2 years)

Nutritional needs of women and child during pregnancy and till 1 year of age of child

Safe water storage, hand-washing so as to prevent diarrohea episodes, and reduce diarrhea related mortality and morbidity

Issues that are covered

Antenatal checkups and care, birth preparedness, institutional delivery/ skill birth attendance, immunization, prevention of hypothermia of the new born (skin-to-skin care and delay in bathing), postnatal care and checkup, family planning

Early and exclusive breastfeeding till 6 months. Complimentary feeding after 6 months

Hand washing- particularly at three critical points such as (1) after defecation, (2) before meal, (3) before feeding child and also Safe Storage of Water

The model offers strategies and activities that would be implemented over a period of 18 months, which are based on the overarching principle of evidence based community led solutions that are planned and executed through participatory and learning approach. These proposed activities are not only limited to Self Help Groups (SHGs), but also aims at institutionalizing HNS issues at

1Within 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, referred to as Parivartan, which provides a platform to empower communities to engage in processes that catalyse support networks and enable shifts in behaviour and social norms, contributing to improved and sustainable health and sanitation outcomes in Bihar. The Parivartan Project is currently being implemented in 55 blocks of 8 districts (Patna, Begusarai, Samastipur, East Champaran, West Champaran, Gopalganj, Khagaria, and Saharsa) of Bihar to address equity issues related to caste, gender and other social variables which influence health and sanitation outcomes under the Ananya Programme. At the grassroots, the project reaches approximately 275,000 women in the reproductive age group in the most marginalized communities through 18,000+ SHGs created by Parivartan. In addition, Parivartan reaches out to approximately 150,000+ women belonging to 10,000+ JEEViKA SHGs in three districts of Patna, Khagaria and Saharsa. 2 P1 – Introduction and Context of Parivartan Project, PM1 – Antenatal Care and Birth Preparedness, PM2 – Postpartum and New-born Care, PM3 – Early, Exclusive, Breastfeeding and Complementary Feeding, PM4 – Routine Immunization, PM5 – Family Planning, PS1 – Personal hygiene, and storage of potable water and PS2 – Use of toilet and safe disposal of waste


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much wider scale by integrating HNS at the level of Village Organizations (VO), Cluster Level Federations (CLF) and Block Federations (BF). The core activities of this HNS integration include:

Support design and implementation of health integration within JEEViKA, capacity building of field staff, Sahelis and other community cadre to drive behaviour change communications on health and sanitation (by suggesting appropriate training strategy, methodology and materials)

Provide technical support for activities/pilots that would integrate health through SHGs and VOs based on learning from Parivartan project

Support and develop suitable MIS for monitoring health integration within JEEViKA M&E mechanisms

Build linkages with Technical Support Unit within State Health Society for improved linkages between SHGs and front line workers (ASHAs and AWW).

The following graphic depicts how different strategies/activities would act at different JEEViKA

institutions.

For implementing the Parivartan Program, JEEViKA will follow the below mentioned steps in a

phased manner. Through the below mentioned activities, PCI aims to ensure integration and

institutionalize the agenda of Health, Nutrition and Sanitation and also strengthen the mechanism

of review and monitoring systems in JEEViKA institutions. The following table elaborates the activities that would be undertaken at various levels under the proposed HNS integration model.

HNS Integration

institutionalisation

Sahelis

Leadership

skills on HNS

Participatory Self

Review and Planning

Solution

Mapping

Advocacy for

HNS services

Engaging SHG members on

HNS issues

SHG

VO- SAC

CLF

Prepatory PhaseImplementation

PhaseConsolidation

PhaseIntegration of HNS

in JEEViKA


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Phase Month Activities at the SHG level Activities at the VO level Activities at the CLF level

Activities at the Block level Major Milestone Means of Verification

Preparatory Phase Implementation Phase Stage 1: Orientation of Staffs and Training

0-4 Months

Meeting with the State JEEViKA Team Agreement with JEEViKA on scale and scope of HNS integration in place

Meetings held with the district and block level JEEViKA teami. Basic information obtained, planned shared Staff recruitmentii at the district level, block level initiates, Development of Job descriptions

Target area is in place MoM

Interactions with the VO starts. Identification of potential Sahelis

MoM

Recruitment of Sahelis completed; Sahelis will start dialogue with concerned community group for building rapport to create an enabling environment for community involvement

Health Mobilizeriii in place Block Health Nutrition Sanitation Integrator (BHNSI)iv in place Training of Sahelis on Basic Facilitation Module and her specific roles and responsibilities and reporting HM Induction BHNSI Induction

Community Cadre and BHNSI are on board and oriented

HR Records

Saheli will start meeting the groups to collect Base data of each SHG in the format provided by the project

Saheli will attend the concerned VO meeting and collect the base data (details of SAC3 members also) in the format provided by the project

HM starts participating in CLF and selected VO meeting and collects the base data in the format provided by the project Meetings with the AWC and other FLWs in the villages – facilitated by HM Mapping of the AWCv and other service access points (to be done by the HM under supervision by BHNSI)

Block level staff participates in the monthly meeting of JEEViKA Block level staff HM participates in the Block health meeting (e.g. HSCvi meetings); introduction to the block and district NRHM officials Review and supervision meeting at the block levelvii

Base data of SHG, VO and CLF obtained Plan developed with JEEViKA BPM

Project data base MoM

1 Micro- planningviii for AWC platform (to be done by the HM under supervision by BHNSI)

Sahelis Training on P1 ix(Basic Parivartan) and PM1 (Antenatal care and Birth Preparedness) and SSF (Swasthya Samiksha Form) for 3 days in house training and radio episodes (4 no’s) of KMW (to be conducted by the Trainers and BHNSI)

Training on 1st and 2nd module completed

HMIS Report

3 The Social Action Committee (SAC) comprises of 3 members of VO. The members discuss issues related to social entitlements and motivate the families in the village; Parivartan is using the platform for the Khirki Mehendi Initiative and address the issues related to Health, Nutrition and Sanitation.


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Stage 2: SHG level activities start

2 Rolling out P1x Module – Introduction and Context of HNS and SSF

Roll out of KMW- Episodes 1-2 (spacing and birth preparedness)

AWC platform Activity starts 1st Module- Birth preparedness (HM shall facilitate at CHNCC/AWCs) Sanjha Samajhxi (SS) Activity carried out by the HM at the panchayat level Onsite Supervision and monitoring support to Sahelis by HMxii

Participation on the Block health meeting; Review and supervision meeting at the block level

Roll out of the Parivartan compendium starts

MIS Data

3 Rolling out PM 1 (Antenatal care and birth preparedness)

KMW-Episodes 3-4 (Birth preparedness) Training of the SAC members on community based review and monitoring planning (on how to analyse data from SSF)

AWC platform Activity - 2nd Module- Complementary Feeding. Training of the SAC members on the PE1 and PE2 Sanjha Samajhxiii (SS) Activity carried out by the HM at the panchayat level

Review and supervision meeting at the block level Participation on the Block health meeting; Review and supervision meeting at the block level Training of Sahelis on PM2 and PM3 and KMW- part 5 to 8

Training of SAC members starts

Training Reports/ Records

Stage 3: Community Based Monitoring and Planning Starts

4 Roll out of Module PM2 (Post-Partum Care and new borne care) Review of Collective Action with the help of SSF on PM1

Roll out of the KMW Episode 5- JSY and Institutional delivery, Epidsode-6- Safe delivery at home

AWC platform Activity - 3rd Module- FP and Spacing between births.

Training of the Sahelis and HM on how to conduct Anganwadi platform (AWP)xiv

SSF rolls out the group level

SHG Minutes/ SSF forms

Stage 4: CLF level activities start

5 Rolling out PM 3 - Early, exclusive breastfeeding and complementary feeding Review of Collective Action with the help of SSF on PM2

Roll out of KMW-Episodes-7- Complication during pregnancy and identification of danger sign and Episodes-8- New borne care

Solution mappingxv at the cluster level

Training of the Sahelis and HM on PM4 and PM5 and KMW part- 9-12

Completion of AWC Activity CLF members undertake solution mapping for improving access of the women to HNS services Data from SSF getting entered into the HMIS computer

HMIS CLF records


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Stage 5: Inter-linkages with FLW and service access points starts

6 Rolling out of PM4 Review of Collective Action with the help of SSF on PM3

Roll out of the KMW Episodes 9 and 10 (new borne care)

Training of Saheli on concept of VHNSD/ Gup-Shup Potlixvi

Routine Immunization initiatives rolled out

7 Rolling out of PM5 Review of Collective Action with the help of SSF on PM4

Roll out of the KMW Episodes 11 – EEBF and KMW-12- postpartum complications and proposed action

Training of Sahelis on PS1 and PS2 Modules - PS 1 (Personal hygiene, and storage of potable water) and PS 2 (Use of toilet and safe disposal of waste) KMW -13 to 16

Stage 6: Local level Advocacy/ accountability mechanism sets in

8 Roll out of the PS1 Review of Collective Action with the help of SSF on PM5 VHNSD promotion activities at the village level- through FLW inter-linkages

Anganwadi platform activity; joint planning of ASHA and Saheli to promote VHNSD Promotion of VHNSD (Gup-Shup Potli) Roll out of the KMW – Episodes 13- Identification of postpartum complications and Part 14- Precautions to be taken after premature Delivery

Solution Mapping

Family planning initiatives rolled out

MIS

Stage 7: Secondary stakeholders (males/ Mother-in-law) involvement starts

9 Roll out of the PS2 Review of Collective Action with the help of SSF on PS1

Anganwadi platform activity Special initiatives to hold discussions with Male cooperatives, discussions with “men” at the village level Roll out of the KMW – Episodes 15- thermal care for premature baby and Episodes 16- identification of danger signs among New born and prevention of Infection among premature baby

Solution Mapping Micro-planning at the CLF, especially focusing on FP Special advocacy efforts to promote FP services Special initiatives to hold discussions with Male cooperatives, discussions with “men” at the Panchayat level

Refreshers Training of Sahelis through different batches

Special initiatives to involve “secondary stakeholders”

Project record

Stage 8: Sanitation related activities start

10 Review of Collective Action with the help of SSF on PS2

Anganwadi Platform in place Activities at the VO level Roll out of the KMW – Episodes 17 - Permanent and temporary methods of FP and Episodes 18 - Selection of FP methods after spouse communication

Advocacy related activities Training on special initiatives on sanitation/ market led solutions or linking with sanitation welfare schemes Refreshers Training of Sahelis through different batches


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Phase III - Implementation stage ends – Consolidation Phase

11 Development of the SHGs and the VO members as “Health CRPs”- who could help to “scale up” or “roll out” in the adjoining area

Roll out of the KMW – Episodes 19 - Birth Spacing And Episodes 20-Birth Spacing and FP

Special initiatives to connect with the market driven sanitation solution or sanitation related welfare scheme

Refreshers Training of Sahelis through different batches

Completion of rolling out of Parivartan HNS compendium Health CRPs in place

Project MIS JEEViKA MIS

12 Development of the SHG/ Village as the “immersion site”

Roll out of the KMW – Episodes 21- FP Methods and Episodes 22- Permanent method of FP

Immersion sites developed

Project records

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Roll out of the KMW – Episodes 23-Copper-T Method and Episodes 24-Injectable Contraceptives- Uses & benefits

Start Transition Process

14 Rollout of KMW 25 Importance of Breast feeding and KMW 26 and 27 - Routine Immunisation

1. JEEViKA uploaded SHG details in google drive

15 Roll out of KMW 28-Complete Immunisation and KMW 29- Complementary feeding to the baby after 6 months

2. Transition Started

16 Roll out KMW 30-Right method of Breast feed and KMW 31- Advantages of Breast feeding

3.

17 Roll out of KMW 32- Increasing the Volume of food to the baby and KMW 33-Taking appropriate steps in the right time

4.

18 KMW 34-Change in the food of the baby, KMW 35-Feeding frequency and quantity for the child and KMW 36-hand washing with Soap

5. Complete of KMW Rollout and Transition completed. Consolidation of learning. Sharing with JEEViKA


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Monitoring and review of the HNS integration: Through the above activities, PCI aims to ensure integration and institutionalize the agenda of Health, Nutrition and Sanitation and also strengthen the mechanism of review and monitoring systems in JEEViKA institutions. JEEViKA is working on a large scale hence it is very essential to have a foci M&E system that measure the programme on tangible terms. The programme has a fleet of Sahelis, Health Mobilizers and BHNSI are in place who are working continuously with coordination for achieving the objectives of the programme. Based on the modules roll out and subsequently the changes taking place at the group level will be measured at group level to see the changes and one at a quarterly level to help the programme team to take informed decisions. This data is collected on key indicators from 1/3rd of groups of every HM in a quarter. The source of the document will be Health Outcome register at group level, a repo0rtimng sheet at HM and BHSNI level. The below matrix explains the different indicators

Indicator Rationale Who will collect

Frequency of collection

Data Analysis Plan Sharing with JEEViKA

# groups where Health Module rolled out

The number of groups where health modules are rolled out. This gives a clarity on groups the module rollout due and plan accordingly

Health Mobilizer

Once in a quarter

This data will be used to triangulate with Health behaviours over time and changes impacted with module rollout.

The data will be shared with JEEViKA on quarterly basis and analysis will shared on six monthly basis.

% Registered for ANC % registered for ANC in first Trimester % women received for IFA % women consumed IFA % institutional Delivery % of Couples using Family Planning % mothers providing EBF (0-6 Months) % of mother providing semi solid food (7-12 Months)

These indicators are measured to understand the changes in the health behaviours (service seeking / practices ) at the group level

Health Mobilizer

100% at the starting of the programme. 1/3rd groups every quarter. 100% at the end of two years.

The first 100% data will be used as a baseline. The quarterly data collected over the groups will be compared with the baseline data and progress in the health behaviours is triangulated. At the end of two years 100% data will be recollected and compared with baseline as well as quarterly data to understand the impact of modules

Outcome Indicator Study: On a quarterly basis from all the blocks data will be collected on key indicators, to understand the status of the block on each health behaviour and help then programme team to plan accordingly for improving the programme. For this purpose LQAS4 methodology will be used and 19 sample will be selected from the block to assess the same. This exercise to be seen as a cue for informing the programme at the filed level about the status and take ground level decisions.

4 Lot Quota Assurance sampling is a technique used to understand the quality of the lot by selecting a sample


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Annex 1. Activities at the Group Level undertaken by PARIVARTAN:

MONTH WISE ACTIVITIES WHY WHO ARE RESPONSIBLE

TOOLS LEADING TO

PRE – IMPLEMENTATION PHASE MONTH 0 1. Developed Job Description of Sahelis. Sahelis must be at

Least 8th class passed women from that particular village and also she should be very vocal and active 2. After their acceptance and understanding of their roles & responsibilities, Parivartan issued job letters to Sahelis 3. Complete the Recruitment Process and Sahelis on Board

Sahelis are the one who will roll out the Parivartan modules in the group for better health outcome

Parivartan State and District Team & Recruitment Agency

Job Descriptions

Start Implementation Process

IMPLEMENTATION PHASE

MONTH 1 1. Orientation of Sahelis on Basic Facilitation Module for Group Level Meetings through 3 days in house training 2. Sahelis will start dialogues with concerned community group for building rapport to create an enabling environment for community involvement, engagement and participation

1. Capacitating of Sahelis on basic Parivartan Modules and developing facilitation skills - So, they can roll out the health modules in Groups 2. In community mobilization process, it is very important to involve local communities to mobilize the target community for involving them in decision making process

Master of Trainers, Block Level and Community Cadres

Basic Facilitation Modules

Rolling Out All Health Modules

MONTH 2 1. Orientation of Sahelis on Basic Facilitation Module for Group Level Meetings and Mobilize targeted communities 2. Rolling out P1 Module – Introduction and Context of Parivartan Project

Master of Trainers, Block Level and Community Cadres

Basic Facilitation Modules, P1 Module, Flex Poster & Flip Cards

1. Specific messages through modules to group members in weekly meetings to enable them for collecting actions 2. Facilitating collective actions through Sahelis and CCs

MONTH 3 Introduce Swasth Samiksha Form (SSF) in the Group Level which cover all the MCHNS indicators. Group Members will fill the form every month and Sahelis will help them

To assess the health status of individual, family & community level

Sahelis and Group Members

Forms & Pictorial Formats

The SSF will sensitize the group members to be influencers on health & sanitation and will empower them to lead their communities to improve family health behaviour

MONTH 4 Sahelis will conduct community meetings for rolling out the P1 Module in all Parivartan Groups. Through this process the target community will aware on group concept and benefits of associating with Parivartan. The target community will show interest in this community mobilization processes. At the same time, Sahelis will get training on PM 1 (Antenatal care and birth preparedness) and PM 2 (Postpartum and newborn care) Modules.

MONTH 5


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MONTH 6 Rolling out PM1 Module – Antenatal care and birth preparedness and also PM2 - Postpartum and newborn care

The women have to understand the issues related with antenatal care, birth preparedness, postpartum care and new born care which help them to be more responsible for taking actions and care of the new born

Sahelis Booklet, Flex Poster and Flip Cards

The targeted community will understand issues related with antenatal care, birth preparedness, postpartum care and new born care

MONTH 7 Sahelis will conduct community meetings for rolling out the PM1 and PM2 Module in all Parivartan Groups. Through this process the target community will understand issues related with antenatal care, birth preparedness, postpartum care and new born care. At the same time, Sahelis will get training on PM 3 (Early, exclusive breastfeeding and complementary feeding) and PM 4 (Routine Immunization) Modules. From this month onwards, Sahelis will help the group members to take collective actions.

MONTH 8 Rolling out PM 3 - Early, exclusive breastfeeding and complementary feeding & PM 4 - Routine Immunization Modules

Increase awareness among marginalized women group on the benefits of RI and early, exclusive & complementary breastfeeding.


These discussions lead to increased levels of participation which, over time, evolves from the low end of passive listening to the high end of collective action that ultimately results in adoption of MNCHS behaviors at the individual and collective level.

MONTH 9 Sahelis will conduct community meetings for rolling out the PM3 and PM4 Module in all Parivartan Groups. Through this process the target community will understand issues related with early, exclusive breastfeeding and complementary feeding and routine immunization. At the same time, Sahelis will get training on PM 5 (Family Planning) Module.

MONTH 10 Rolling out PM 5 – Family Planning Increase awareness and use of modern spacing methods among women to improve birth spacing and reduce unwanted pregnancies.


SHG women will understand that Family Planning is a personal and a community development issue and they will opt for any modern contraception method

MONTH 11 Sahelis will conduct community meetings for rolling out the PM5 Module in all Parivartan Groups. Through this process the target community will understand issues related family planning. At the same time, Sahelis will get training on PS 1 (Personal hygiene, and storage of potable water) and PS 2 (Use of toilet and safe disposal of waste) Module.

MONTH 12 From this month onwards, all the Sahelis will get Refresher Training through different batches and in all modules till Month 18

MONTH 13 MONTH 14 Rolling Out PS 1 (Personal hygiene, and storage of potable

water) and PS 2 (Use of toilet and safe disposal of waste) Module and also Sahelis will get refresher training

Understanding issues related to personal hygiene and use of


Increase awareness on personal hygiene and use of toilets among women


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toilets and safe disposal of waste

MONTH 15 Sahelis will conduct community meetings for rolling out the PS1 and PS2 Module in all Parivartan Groups. Through this process the target community will aware on personal hygiene and use of toilets. At the same time, Sahelis will get refresher training.

POST IMPLEMENTATION PHASE

MONTH 16 Parivartan already rolled out all the Parivartan Modules related to MCHNS behaviour. Sahelis will get refreshers trainings on all the modules for better follow-up which will help targeted beneficiaries to take actions on health, nutrition and sanitation behaviour at individual and community level. MONTH 17

MONTH 18 MONTH 19 MONTH 20

Annex 2. Activities at the Village Organization Level undertaken by PARIVARTAN: Parivartan will integrate the agenda of health, nutrition and sanitation by involving the Village Organization with special emphasis on the members of the Social Action Committee5. Under Parivartan, a participatory and pictorial tool is being prepared for reviewing the MNCHS related issues. This tool is named as Swasthya Samiksha Form which will be filled at the group level but will be consolidated and reviewed at the VO level. Based on the status, bottlenecks will be identified and the follow up will be planned by the Social Action Committee. They will also be given input on influencing positively the Health Risk Fund for utilizing for the mother and child linked issues. At the Village Organization (VO) Level, Sahelis will compile the Swasth Samiksha Form (SSF) on a monthly basis to assess the health status of the targeted groups. The members of Social Action Committees will be trained on two modules prepared under Parivartan - PE1 (Equity & Health) and also on PE2 (Social Accountability & Advocacy). This module will orient the members to have understanding on equity, empowerment and entitlements in the context of health, nutrition and sanitation.

Activities Why Who are Responsible Tools Leading To

Rolling out PE1 (equity and health) and PE2 (social accountability & advocacy) module in the VO level. The modules covers topics related to importance of equity in context of health and social accountability & advocacy

Enhance the knowledge on accountability & equity of health and sanitation services in the intervention districts

Master Trainers Modules (booklets), flex and flip cards

Better knowledge on accountability & equity of health and sanitation services

At the VO level – Parivartan will roll out Khirki Mehendi Wali6 (KMW) for the VO members to understand positive health practices and also to adopt during pregnancy and motherhood through the Social Action Committee. The whole 36 episodes will complete within 18 months. For this, Parivartan would use audio-visual materials, which already

5 The Social Action Committee comprises of 3 members of VO. The members discuss issues related to social entitlements and motivate the families in the village; Parivartan is using the platform for the Khirki Mehendi Initiative and address the issues related to Health, Nutrition and Sanitation. 6 VO members will listen the radio Programme ‘Khirki Mehendi Wali’. In an entertaining format, the Programme delivers key messages on positive health practices to adopt during pregnancy and motherhood. The radio programme centres around three main characters – Mehendi (centre), who’s the anchor of the show; her friend and guide – Dr.


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been developed by other agencies on MNCHS related issues. To maintain parity of the messages that are being given by Parivartan, Parivartan will use audio-visual materials that are developed by BBC Media Action for promotion of MNCHS behaviors. Parivartan is also strengthen the mechanism of review, monitoring process at the VO level and coming up with appropriate solutions at the VO and CLF level.

Annex 3. Activities at the Cluster Level Federation undertaken by PARIVARTAN: At the Cluster Level Federations (CLF), Parivartan will help the VO members to share the Swasth Samiksha Form (SSF) and the consolidated SSF will be analyzed and a solution mapping will be done. This process will be initiated by the health mobilizer. In the CLF, The health mobiliser will review and collate the Swasthya Samiksha Form (SSF) coming from various VOs. All the issues which will be red category will be analyzed to learn the causes. The Health Mobiliser will help the CLF to come up with local solutions with the ownership of VOs of the cluster and create an enabling environment for the community mobilization activities.

Annex 4. Human Resource Support: For implementing the Parivartan Program, there is a proper implementation structure and reporting arrangements at the State and District/Block level. At the Districts Level:

Designation Place of Posting Key Responsibility Block Coordinator At Block Level At Each Block, one Block HNS Integrator will be appointed

who would be responsible for all aspects of the intervention including planning, day to day management of the activities; capacity building of Supervisors and Facilitators jointly with Master Trainers. He will work closely with District Manager who will be immediate reporting authority.

Anita (left), who delivers key health messages and Phunti (right), who adds comic relief. Designed in ‘a show within a show’ format, the programme has 36 episodes. Through dramatic enactment of her life stories, Mehendi presents key family health issues. Dr. Anita contributes her crucial knowledge of positive health practices.

Episode 1 & 2

Episode 3 & 4

Episode 5 & 6

Episode 7 & 8

Episode 9 & 10

Episode 11 & 12

Episode 13 & 14

Episode 15 & 16

Episode 17 & 18

Episode 19 & 20

Episode 21 & 22

Episode 23 & 24

Episode 25 & 26

Episode 27 & 28

Episode 29 & 30

Episode 31 & 32

Episode 33 & 34

Episode 35 & 36

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Care During Pregnancy and Birth Preparedness

Postpartum and New Born Care Early and Exclusive Brest feeding and

Complementary Feeding Immunization Family Planning

Sanitation &

Hygiene


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MIS At Block Level MIS will be appointed at each Block who would maintain the MIS of the intervention.

Cluster Coordinator At Panchayat Level On an average, one Supervisor will be placed to support the facilitators to ensure the quality as well as handholding support to Sahelis. Each Supervisor would be responsible for capacity building of SHG groups during their weekly meetings at the village level.

Sahelis At Panchayat Level One Sahelis would be engaged for 1 Panchayat who would function as facilitator and will mobilize SHGs for the weekly meetings. Each facilitator would be paid a monthly salary for mobilizing communities in different aspects of health, nutrition and water and sanitation.

At the State Level: At the State Level, Parivartan established a Health Technical Group (HTG) within JEEViKA to support its efforts to implement integration of health within SHGs and VOs. The overarching role of the support is primarily to act as a think tank, support and advance the strategic and operational aspects of health integration within JEEViKA community platforms to achieve health outcomes. The team would be embedded within JEEViKA and work under the guidance of CEO, JEEViKA. The specific focus of HTG would be to transfer knowledge and expertise from Parivartan project districts and accelerate the integration of health in other districts within Bihar where JEEViKA has matured groups and VOs. The core activities include: (1) Support design and implementation of health integration within JEEViKA, capacity building of field staff, Sahelis and other community cadre to drive behavior change communications on health and sanitation (by suggesting appropriate training strategy, methodology and materials), (2) Provide technical support for activities/pilots that would integrate health through SHGs and VOs based on learning from Parivartan project, (3) Support and develop suitable MIS for monitoring health integration within Jeevika M&E mechanisms, (4) build linkages with Technical Support Unit within State Health Society for improved linkages between SHGs and front line workers (ASHAs and AWW).

Notes: i The discussions would happen at two level - one at the state level, and another at the district level ii Assumption: Staff at the state office is already in place iii HM – Health Mobiliser - In the CLF, The health mobiliser will review and collate the Swasthya Samiksha Form (SSF) coming from various VOs. The Health Mobiliser will help the CLF to come up with local solutions with the ownership of VOs of the cluster and create an enabling environment for the community mobilization activities. iv BHNSI – Block Health Nutrition Sanitation v Mapping of the AWC vi HSC – Health Sub-Centre vii Block level supervision meeting conducted by the BHNSI viii Micro-planning at the CLF level ix Parivartan compendium: 13 Modules x Rollout of the module xi: Sanjha Samajh: Sajha Samajh, a Hindi term generally referred to as “shared understanding,” facilitates self-reported views of collaborative activities among Parivartan workers and other institutional stakeholders in an acute service-delivery setting. xii Onsite mentoring and supervision by HM xiii: Sanjha Samajh xiv AWP – Anganwadi Platform xv Solution Mapping xvi VHNSD Day and Gupshup Potli

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Integration of Health Nutrition and Sanitation Agenda in JEEViKA 01.08.2014