REFLECTION Updates from SWASTH - BTAST Sector Wide Approach to Strengthening Health in Bihar (SWASTH), Government of Bihar Initiative Supported by Department for International Development (DFID), UK NOVEMBER 2015 Bihar Technical Assistance Support Team (BTAST) Knowledge Product Developed by OneWorld Foundation India q Village Health Sanitation and Nutrition Days make a difference in Bihar 2 q BTAST workshop rejuvenates key stakeholders in Bihar 4 q BTAST trains supply chain professionals on Aushadhara to improve efficiency 5 q Patna workshop advocates for more local ownership of ODF initiative 6 q Factsheet - Jehanabad 7 q Communities find knowledge through community radio 8 q Making an Indian village open defecation free 10 IN THIS ISSUE
Transcript
reflectionUpdates from SWASTH - BTAST
Sector Wide Approach to Strengthening Health in Bihar (SWASTH), Government of Bihar Initiative Supported by Department for International Development (DFID), UK
novemBer 2015
Bihar Technical Assistance Support Team (BTAST) Knowledge Product Developed by
FormothersinVishwaspurvillageintheDagaruablockofPurneadistrict, the fourthFridayofeverymonth isamuch awaited day. On this day, designated by theGovernment of Bihar as the VHSND (Village Health,SanitationandNutritionDay)forthatvillage,pregnantwomen,newmothersalongwithchildrenandadolescentgirlsareprovidedwithintegratedhealthsolutionsaspertheirneedsatthelocalAnganwadiCentre(AWC).
VHSNDs are slated to be organised at the villageAWConceeverymonthonadesignatedWednesdaysor Fridays. This day has emerged as the interfacebetween the community and the health and nutritionsystemanditsservicesproviders,aswellasthemainplatform forprovidingapackageofessentialservicestothelocalcommunity.Onthedesignatedday,ASHAs,AWWs, and other frontline workers mobilise thevillagers,especiallywomenandchildren, togatheratthe nearestAWC.VHSNDs allow villagers to interactfreelywiththefrontlineworkersandavailbasicservicesandinformation.
VHSNDs are the key platforms for tracking andproviding essential vaccines to pregnant women andchildren. The frontline workers -Anganwadi WorkersandAccredited Social HealthActivists (ASHAs) havea listofpregnantwomenandchildrenwhoaremeant
FeATUreD UPDATe
village Health Sanitation and nutrition Days make a difference in Bihar
to receive vaccination and they visit the respectivefamilies,meetwithpregnantwomenandnewmotherstoinformthemabouttheVHSNDwell inadvance.Onthe VHSND, the Auxiliary Nurse Midwife (ANM) andASHAalongwiththeAWWworktogetherandprovidethevariousservices.
VHSNDs also serve as a day when not only healthchecksdoneandweightsaretakenofpregnantwomenand children but also where women are counselledabout essential nutrition for themselves and theirchildren. Counselling can include the importance ofconsuming iron supplements and vitamins, tips onhygienicandscientificcookingpracticesaswellasonfamilyplanning.Adolescentgirlsandpregnantwomenarecheckedforanaemiaandareadvisedaccordingly.
VHSNDs are proving to be a very useful vehicle toprovideservicesaswellasraiseawareness,asmanyofthereportsfromthecommunitiesshow.Rukhsana,ayoungmothersaysthatshehadneverbotheredmuchabout her ownhealth until sheattended theVHSND.“IvisitedtheAnganwadicentrefortheimmunisationofmychild.And,whenIwentthere,IwasalsotoldbytheAWWsaboutthekindoffoodIshouldtakeandwhatIshoulddotomaintainmyhealth,”shereports.
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.
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PinkyDeviaresidentofavillageinPurneareportsshewas earlier reluctant to get her child weighed. “I hadabelief thatweighingmychildwill reducehisweight.ButwhentheANMexplainedtometheimportanceofgettingchildrenweighed,Iwasreadytoshedmyfears,”Pinkysays.
FrontlineworkersplayakeyroleinmakingtheVHSNDsa success. It is the rapport they havewith the localcommunitiesandtheregularhomevisitsthattheymakewhich encourage women to attend the VHSNDs andavailservices.GunjaDevi,motherofaneight-month-old child recalls how theANM and theAWW visitedher home on the VHSND and counselled her aboutthe importanceof regularcheck-upsandprecautions.“They toldme thatmy child’s namewas there in theregister.WhenImyselfcouldnotvisitthem,theycamehometodotheneedful.Iamgratefultothemforaskingmeifmychildhadbeenadministeredpoliodrops.TheANMalsosuggestedtometofeedthechildonlywithbreastmilkfortheinitialsixmonths,”shesaid.
The Bihar Technical Assistance Support Team hasbeenmonitoringVHSNDssince2013 through regularobservations and feedback to various governmentstakeholdersatthevillage,block,districtandstatelevels.Overtheyears,ithasbeenseenthatthereachandqualityofVHSNDs inBiharhasbeen improving.While in2013,theVHSNDscoulddeliveronly3or4ofthekeyservicesonanaverageoutof thestipulatedpackageofservices,in2015theVHSNDsprovideabout8–9servicesamongthoseidentifiedasimportant.
Thespreadofserviceshasmeantthatnoweventeenagegirls are receiving services and information which wasearlierhighlyimprobable.LalitaKumari,ateenagerfromChapivillage,saysthatontheVHSND,theANMnotonlyadvisesyounggirlsabout thedangersofearlymarriagebutalsoontheusageofsanitarynapkins.“TheANMsaidtome that I could avail sanitary napkins from theAWW.Shealsogavemetipsonbettermenstrualmanagement.Shealsoclearedmydoubtsaboutusing the iron tabletsanditsconsequences,”shesays.
BTAST’s ongoing monitoring and support has alsohelped in strengthening reporting on VHSND. TheANMs and AWWs now meticulously prepare variousreportslikeMaternalandChildHealth(MCH)register,Mother and Child Protection (MCP) Card, and theVHSNDTallySheetformatchingthebeneficiariesandthoseregisteredon thedue list.The tallysheethelpsthemtodrawaduelistforthenextmonth.
Monitoring data from BTAST also shows that thepresence/attendanceofall the three frontlineworkers-ANM,ASHAandAWW–atVHSNDshas improvedovertheyears;andthatparticipationofwomenfromthedisadvantagedsectionsofthesocietyliketheDalitsandMahadalitshasalsoimproved.
The improvements in VHSNDs in rural Bihar are aresultofseveralothercoordinatedeffortsbytheBTASTandthegovernmentatvarious levels. Officials in thekey government departments such as Department ofHealth,thePublicHealthandEngineeringDepartment,theIntegratedChildDevelopmentScheme–hadtobesensitisedtotheneedforconvergenceandco-ordinatedaction, which was essential for the convergence tohappenatthegroundlevel.
Regular sharing of analysed observation data atthe district level committeeswhich are formed of theDistrictMagistrate,CivilSurgeons,ChildDevelopmentProject Officer (CDPOs) and other key stakeholders,to enable evidence-based decision-making, hashelped significantly to make the improvements. Anygaps identifiedthroughthesedataarealsodiscussedatmonthlymeetingsof theDistrictQualityAssuranceCommittees(DQAC)andtheBlockQualityAssuranceCommittees(BQAC)setupundertheNationalHealthMission.Thus, the gaps filled through the process offactfinding,analysisandactiononthefeedbackhavestrengthened VHSNDs in terms of service deliveryqualityandcoverage.q
BTAST, shared the roles and responsibility as well asSWASTH mandates towards VHSND strengthening. HealsodiscussedtheroleofVHSNDmonitoring.
Sharing the overview of the Current Health Nutritionscenario of Banka, Dr Ashok Kumar, Monitoring andEvaluation(M&E)expert,BTAST,saidthatVHSNDplaysanimportantroleinimprovinghealthindicators.
Dr Kumar through his presentation highlighted the keyindicators for the success of VHSND. Some of the keyindicators include the Maternal Mortality Ratio (MMR),Under5Mortality(U5MR),ContraceptivePrevalenceRate(CPR),under-weightchildren(0-5years)andpercentageofpregnantwomenage15-49withanaemia.
Citing figures to support his view, Dr Singh said that theinstitutionaldeliverieshaveincreasedfrom12.1%(1992-93)to22%(2005-06)to27.7%(2007-08)65.3%(2014-15).
Similarly, the antenatal care has increased from 15.9% (1998-99) to 26.4% (2007-08) to 32.8% (2014-15).
Full Immunization coverage has alsoincreased from 10.7 % (1992-93) to53.8% (ISB, 2009) to 60.4% (2014-15).
Even the use of contraceptives hasincreased from 23.1 percent (1992-93)to28.4percent(2007-08)to41.2%(2014-15).
Waquar Anjum, Regional Manager,BTAST, shared the issues andexperiences that have surfaced atdifferent forums. He also discussedthe advocacy made by BTAST teamregarding strengthening of VHSNDservices regarding their quality andapproach.
Anjum stressed that VHSND is the onlyplatform where all stakeholders come
Banka:With the aim of improving quality and coverageofVillageHealthSanitationandNutritionDay (VHSND),aworkshopwasorganised for the key stakeholders lastmonthinBanka,Bihar.
The VHSND District Training-of Trainers (TOT) wasorganisedwith thesupportofBiharTechnicalAssistanceandSupportTeam(BTAST)atthelocalhospitalinBanka.
BTAST workshop rejuvenates key stakeholders in BiharThe workshop was conducted with the underlined idea that promoting community participation could enhance the efficacy of VHSNDs.
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BTAST trains supply chain professionals on Aushadhara to improve efficiency
Patna:Withtheaimofstrengtheningprocurementandsupplychainmanagementofhealthcarecommodities,the State Health Society, Bihar, organised trainingon the use of Aushadhara, software for inventorymanagementandstorage,forsupplychainmanagementprofessionals. The trainingofpharmacists, storekeepers,monitoring& evaluation officers and data entry operators wasorganisedin10districtsofJamui,Banka,Kishanganj,Katihar,Madhepura,Purnia,Supaul,Araria,Seohar,and
MadhubanifromMaytoSeptember2015athealthcarefacilitiesattheblockanddistrictlevels. Apart fromdisseminatingstudymaterials,participantswere trained on various aspects including InventoryManagement Tools & Techniques, Good Practicesof Storages of Healthcare Commodities etc. Theparticipants were also provided hands-on training onusingAushadharapertainingtoForecasting,Indenting,ReceivingandIssuingofHealthcareCommodities. Withtherealisationthatpharmacist/storekeepers,dataentry operators and block monitoring and evaluationofficersareworkinginisolationratherthanasateam,theparticipantswerealsomotivated towork togetheras a team for better results. The training programmeonusingAushadharaisexpectedtohelpprovidebetterhealthcareservicestopeople. Thecapacitybuildingexercisewasexecutedwith thesupport of Bihar Technical Assistance Support Team(BTAST) - a consortium of development partners ledbytheBihargovernmenttoimplementtheSectorWideApproachtoStrengthenHealth(SWASTH)inthestate.The goal of the SWASTH programme is ‘to improvethe health and nutritional status of people in Bihar,particularlythepoorestandexcluded’.q
Aushadhara is software to help pharmacists, storekeepers, and monitoring & evaluation officers strengthen procurement and distribution of healthcare commodities.
together on a common platform. He further added thatVHSNDcanbestrengthenedbyadvocacyatdifferentlevels,inter-sectoral convergence and by promoting communityparticipationatdifferentlevels.
Manoj Kumar Choudhry, Executive Engineer, PHED,discussedabout theroleandresponsibilityofPHED.Hereiterated his commitment tomonitoring support by BC-SBM and provision of water test kits for all UddeepancentresandIECrelatedtosanitationandhygiene.
TheworkshopdwelledonvariousissuesincludinglackofinvolvementofPanchayatiRaj Institutions (PRIs),PublicHealthandEngineeringDepartment(PHED),VikasMitraat VHSND. It also discussed challenges related to theshortcoming of monitoring matrix and feedback sharingmechanismandavailabilityofwatertestingkits.
The other issues discussed include lack of utilization ofVHSNC fund for IEC, shortage of VHSND Tally sheet,
growthmonitoringofchildandlackofavailabilityofANCTable and proper space for ANC. Some of the majorrecommendations that emerged during the workshopinclude conducting convergence meeting with linedepartmentatdistrictlevelonquarterlybasisandaswellasblocklevelonmonthlybasis.Theotherrecommendationsinclude orientation of various stakeholders on VHSND,qualityandtimelymeetingofVHSNC,adequatesupplyoflogistics,vaccine&medicine,availabilityofequipmentsforqualityANCcareandmonthlyreviewbyAYUSHDoctorsatAPHClevel.
VillageHealthSanitationandNutritionDays(VHSNDs)areoneoftheflagshipinitiativesoftheNationalRuralHealthMission and have been implemented in Biharsince 2011. Support to VHSNDs in each district hasbeenmultifacetedandnon-uniformandisvisibleasacombination of various government and developmentpartnerinitiatives.q
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Patna workshop advocates for more local ownership of oDF initiative
The workshop deliberated to strengthen the state guidelines for ODF verification.
Patna: ThesustainabilityoftheOpenDefecationFree(ODF) initiative can be ensured only if it becomes apeople’sprogrammewithproactivehelpbylocalbodieslikeGramPanchayats (GPs),saidSunilRay,Directorof Patna-basedA N Sinha Institute of Social Studies(ANSISS).Raywasspeakingata two-daystate-levelworkshop,‘ConsultationWorkshopforDevelopmentofODF-GPVerificationMechanismfortheStateofBihar’organised by the Bihar TechnicalAssistance SupportTeam(BTAST).
BasedontheGovernmentofIndia’s(GoI)guidelinesforODFverification,Bihar’sPublicHealthandEngineeringDepartment (PHED) has prepared draft guidelinesto suit local requirements. The draft guidelines haveevoked a positive response from the people andagencieswhohavebeencampaigninginruralareasofBihartoconvertitintoanODFstate.
BTASTrecognizedtheneedforhavingadiscourseonthedraftstateguidelinesforODFverificationbyinvitingopinions fromboth the grassroots and the specialistsworkingwithgovernmentagencies.Theworkshophelpedachieveconsensusamongstakeholders,includingthegovernment and development organisations on howGramPanchayatsshouldbeassessed.
Welcoming the support offered by ANSISS, DrPrabhakarSinha,DirectorofWASH(Water,SanitationandHygiene)atBTAST,said thatANSISScouldplaytheroleofaKeyResourceCentre(KRC) in thestateforimplementingtheSwachhBharatMission(SBM).Dr
Sinhapointedoutthatunlikeotherstates,BiharlacksaKRCofitsown.TheparticipantsdiscussedtheprocessandcertificationofdeclaringaGramPanchayat (GP)asODF.The success of SBMdepends on theGramPanchayatas it is thesmallestunit in thecleanlinessdrive by the Indian government. The governmentrepresentatives acknowledged the pioneering role tobe played by institutions likeGPsand localNGOs inmakingIndiafreeofopendefecation.SharinghisviewsonfirmingupthestateguidelinesonODF verification, Ashok Kumar, Executive Engineer,PHED, said that voices from rural areas routedthrough the Swachh Bharat Mission (Gramin) orSBM-Gcoordinatorswould provide themuchneededinformationforstrengtheningtheseguidelines.
MSJawaid,ExecutiveEngineer,PHED,andDirector,Programme Management Unit, Swachch BharatMission,Bihar,saidthatthefocusforODFverificationwouldbeonthewardswhicharethebasiccomponentsofaGP.Referring toNirmalGramPuraskar,hesaid:“WeareworkingatthewardlevelandatthelevelofGP.Earlier,theGPswouldclaimtobeNirmalwithonly20percentavailabilityoftoilets.Thesituationhaschangednowand theGPs are beingmore responsible beforedeclaringthemselvesasODF.”
Saying that theprocessadoptedat theward level forverificationshouldbethoroughbecausethePanchayat’sdecision is dependent on them, Jawaid added thatfrontlineworkers likeAccreditedSocialHealthWorker(ASHAs)andAnganwadiWorkers(AWWs),couldplayabigroleintheentireprocess.
Watch Video
Ek Anoothi Pahal:AfilmdocumentingtheexperiencesfrompilotofCommunityLedTotalSanitationapproachNote: To watch this video, please scan the QR code using your smart phone’s QR code reader.
RajayaNandBar,AssistantDirector, IntegratedChildDevelopment Services (ICDS), impressed upon theneed for gaining the confidence of villagers duringthe verification process. “Villagers are suspicious ofgovernment officers.Once they gain confidence fromtheteam,agoodresponseisensured,”hesaid.
Dr Sinha of BTAST also called on the participants tothinkofwaystomaketheprocessmorepractical.“WeneedtoascertainthenumberofstepsrequiredforODF
verification. We need to see the need of doing it atthevillage,blockordistrictlevel.Weneedtoseehowefficientlyacommitteecanbeformed,”hesaid.
Theparticipantsalsodeliberatedonhowtoovercomethe shortcomings in the state guidelines for ODFverification. There was unanimity that public utilitieslikeAWCsandschoolsshouldhave toiletsandwaterfacilities should be provided for making a PanchayattrulyODFalongwithindividualhouseholds.q
InFoGrAPHIc
The fact sheets profile those eleven districts of Bihar where BTAST has been working since 2010. In addition to key demographic details, it takes into account health, nutrition and WASH indicators of each district. Data has been sourced from Census 2011, the Annual Health Survey and other secondary sources. We will be producing a new set of district factsheets based on SWASTH District Level Survey data and present these profiles one by one.
Note: To read this infographic, please scan the QR code using your smart phone’s QR code reader.
Factsheet - JehanabadJehanabad is located at the confluence of the Dardha and Yamuna rivers. The district is richly endowed with ancient and medieval sites, mounds and ruins of archaeological remains of importance.
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SPecIAl FeATUre
Communities find knowledge through community radioThe radio station at KVK Barh has generated considerable awareness among people on issues like seasonal diseases, safe childbirth and the importance of using toilets
“Community radio is the voice for the voicelessCommunity radio is the repository of knowledge and scienceThrough the community and through their languageCommunity radio provides solution to the social problems.” - Radio jockey at community radio station, KVK Barh
This motto guides Krishi Vigyan Kendra (KVK) Barhcommunityradio,basedinPatnadistrictofBihar,whichwas initially set up on May 17, 2011 to disseminateinformation on agriculture-related issues but is nowbeingincreasinglyusedtoairprogrammesonissuesofhealth,nutritionandhygiene,throughsupportfromtheBiharTechnicalAssistanceandSupportTeam.
The station runs on 91.2 FM radio band withprogrammes aired for four hours in a day. One andhalfhoursofprogrammesareairedinthemorningandtwo and half hours in the evening. Swasth Charchais a half an hour programme that airs dramas, talks,discussions and interviews on health, nutrition andhygienewithaspecial focusonwomenandchildren.Discussionsareusuallyon topicssuchascontagiousandseasonaldiseases,ante-natalcare,safechildbirth,post-natalcare,newborncare,infantandchildnutrition,VillageHealthSanitationandNutritionDay (VHSND),sanitationandhygienepracticesandsoon.
These programmes have played a positive role insensitising the community on various aspects. Forexample,lackoftoiletsandtheirdisusewhenavailable,isahugeissueinBihar.Thisisknowntoleadtoschooldrop-outs and poor attendance, particularly amongstgirls who have attained puberty. One of the primaryschools in theareawhere theprogrammesarebeingaired has a pucca toilet within its boundary, but thisremained locked-upandwasmeant for teachers’useonly,aspertheschoolrules.ThissituationwasbroughttothenoticeoftheradiojockeysrunningtheSWASTHsupportedcommunityradioprogramme,andwasthendiscussedandairedonthelocalcommunityradio.
community strongly felt that students and especiallygirlsshouldbeallowedtousethetoilet.Agroupoflocalinfluentialpeoplefromthecommunityvisitedtheschoolauthorityandadvocatedforthetoiletstobeaccessedbystudentsaswell.Recognisingthedemandfromthecommunity the school subsequently now allows thestudentstousethetoilet.
Mritunjay– the radio jockey motivates members fromthelocalcommunitytojoinasspeakersatthestation.Local people gather regularly at the station to recordprogrammesonwomen’seducation,healthandotherdevelopmentissues.TheyarejoinedbytheSarpanch(village headman), ANMs (Auxiliary Nurse Midwife),ASHAs(AccreditedSocialHealthActivists)andsocialworkerstodiscusshoweducationcancreateawarenessamongwomenonissuesofhealthandhygiene.
Interviews with doctors and experts are viewed ascredible sources of information by the community.SimilarlytheinvolvementofANMsandASHAshelpstoestablishthattheinformationprovidedthroughtheradioprogrammesisauthentic.Thespeakersgobacktotheirown villages and encourage the villagers to listen totheprogramme.BothHindiandMagahilanguagesareusedtodevelopradioprogrammesbyparticipants.
Sudha-anANMinthearea,observesthatthecommunityradiostationhasbeenabletocreategreaterawarenessamong the community about mother’s and children’shealth.Shesaysthatevenwhenthereareothersourcesofentertainment, radioscontinue tobepopular.Manyolderpeopleinthecommunityusuallyhaveradiosetsthattheyusetolistentocommunityradioprogrammes.“IhavenoticedthatnowthecommunityisawareoftheservicesavailableatVHSND.TheyknowthatVHSND
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is held at the Anganwadi Centre every week whereadvice isprovidedon issuessuchas immunisationofchildren,feedingpracticesandfoodhabitsforpregnantandnewmothersandchildrenbetweentheagesof0-6years. I have also participated in radio programmes.Theprogrammehadfocusedonante-natalcare,”saysanexcitedSudha.
The community radio station in Barh has developedlistener groups among communities. A group ofhigh school girls say, “We use ourmobile phones tolisten to radioprogrammes.We regularly listen to theprogramme-SwasthCharcha,whichadvisesusaboutthe importanceofsafedrinkingwater,washinghandsbeforeeating,andotherhygienepracticesandtheneedforincludingfruitsinourdiet.Thegirlshadbeeninvitedtoparticipate ina radioprogrammethatwasairedonanti-tobacco day. One of them enthusiastically sangthe jingle she had developed for the programme. Intheirownwords,theylikelisteningtotheradiostationbecause, “we get to hear our own people speakingthroughthis radiostation.This is thebest thingaboutthisradiostation.”
Another popular programme is Dr Chacha, whichfocuses on the subject of drug addiction. It deliverspowerful messages that create awareness on the ill-effects of drug abuse. Such radio dramas generatelistener interest through an engaging and interesting manner.Giventhecontentandthepresentationoftheprogrammes,it islittlewonderthattheradiostationisemergingasacatalystforpositivechangeinruralBihar.Communityradioofficialsreportthattherenowseemstobeabetterawarenessamongcommunitymemberson issues like femalefoeticide,colostrumfeedingandtheimportanceofusingtoilets.
BiharisoneofthefirststatestoconstituteacommissionforthepoorestamongDalits,calledtheStateMahadalitCommission.The state distributed six lakh radio setsamong Mahadalits to make information on variousgovernment schemes accessible to marginalisedgroups. In Bihar, the success of community radio
dependsnotonly to theextent towhichtheradiohasbeen able to include the Mahadalit communities inlistenergroups,butalsoonhowactivelyithasinvolvedthem in producing radio programmes. In 2011, KVK,startedwith approximately 40 listener groups in Barhand 10 more new groups were started in 2014. TheradiostationatKVKBarhhasbeensuccessfulreachingout to some of thesemarginalised communities, withtargeted health, nutrition and water and sanitationrelatedknowledge.
Successhereseemstobedrivenbysomekeyfactors.Whenthecommunityhearsitsownpeoplespeakingtheyareabletoeasilyconnecttheirreal-lifeexperienceswiththediscussions.Secondly,theprogrammesalsoraisetheprofileofthefrontlineserviceprovidersbymakingtheirworknotonlymorecrediblebutalsoaccountableand hence generates interest from the providers too.The community not only participates in recording theradioprogrammesbutisalsobeginningtomanagetheradiostation,whichisimportantforbuildingtheinterestandinstillingasenseofownership.q
Voices from the fieLdCommunity radio is the voice for the voiceless, community radio is the repository of knowledge and science. Through the community and through
their language, community radio provides solution to the social problems
Radio Jockey at Community Radio Station, KVK Barh
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BloG
For the residents of Ahrauli village in Buxar district,early mornings and late evenings these daysbring averydifferentscenefromwhattheyhavebeenusedtosince times immemorial. Everymorning and evening,government officials, members of the Panchayat andsome local people stop and dissuade fellow villagersfromdefecatingintheopen.Oncethisisdone,theygototheopenfieldsandthebanksoftheriverGangatocover-uphumanexcretawithsoil.
On the way to the river, they chat with people theyencounterandsharetheirknowledgeandviewsaboutsanitation, hygiene and building toilets. For many inthe villagewho actively oppose open defecation, thishasbecomeadailyroutineoverthepastfewmonths.ASwachhBharatMission(CleanIndiaMission)bannerin the village too proclaims the serious intent of thevillagersandthegovernment.
Pioneered by Dr Kamal Kar, a water and sanitationexpert from the Community Led Total SanitationFoundation (CLTSF), the CLTS campaign hasbeen successful in discouraging many villages andcommunitiesfromdefecatingintheopen.Thecampaignhasalsogeneratedademandfromthesecommunitiesforconstructinglow-costtoiletsinthevillage.
Ahrauliseemstobethenextcommunityonthevergeof becoming open defecation free. The frenziedconstructionactivityinthevillageiscleartobeseen.Allthroughouttheday,tractorsplybricksandconstructionmaterialswhilemasonsarebusyconstructinghundredsof toiletsonawar footing.Thevillagehasa target tomeet- itwants tobedeclaredopendefection freeonthisWorldToiletDay–November19,2015.
High ranking government officials are taking their jobseriously.TheDistrictCoordinator forSwachhBharatMission(SBM)andofficialsfromthePublicHealthandEngineering Department (PHED) are in the village.The village headman Brij Kishor Upadhyaya himselfis supervising theprogressof thevillage in itsmarchtowards the ODF certification. Representatives of alocalagencymonitor thequalityof toilets constructedbytrainedmasons.
TheBuxardistrictadministrationhassanctionedfundsto construct toilets in eachhousehold and thedistrictmagistrate Raman Kumaris taking a keen interest inthe initiative. To spur behaviour change and improvesanitation standards amongst its people, the Bihargovernment is contributing Rs 12,000 per householdtowards the construction of a toilet in the householdpremises.
TheBiharTechnicalAssistanceSupportTeam(BTAST)formedthroughaconsortiumofCareIndia,IPEGlobalandOptions,UKhaveadopted thehard-hittingCLTSapproach to educate villagers about the ills of opendefecation.
Advocacy experts from the team are sensitisingvillagers to crucial sanitation and hygiene issuesthroughrealdemonstrationsshowingfaecalmatterandhowhousefliescontaminatefoodandwaterwithit.Inhighlygraphicdemonstrations,aCLTS facilitatorputshumanhairinexcreta,takesitoutandputsitinaglassofdrinkingwater,urgingpeopletodrinkthewater!Thereaction isobvious–everyonerefuses.The facilitatorthencomparesthesixlegsofahouseflytohumanhairthattransmitbacteriatofood.
Shashi Bhushan Pandey, a CLTS expert who workswith BTAST, says: “People are shocked to see suchdemonstrations and many decide to construct toiletsrightaftertheCLTSsessionisover.”
Such in-your-face demonstrations work well in India,where, according to the UNICEF, 47 percent of thepopulationdefecateintheopen.Bihar,oneofthepooreststatesinthecountry,hasalargepercentageofpeopledefecatingintheopen,leadingtohealthchallengeslikediarrhoea,cholera,jaundiceandmalnutrition.
ThesuccessoftheCLTSapproachliesinitsabilitytoeffectivelymobilisepeopleandmakeitintoapeople’scampaign. The sanitation revolution inAhrauli villageis due to people’s participation and peer pressure.Efforts likethesewillhavetobereplicatedacrossthecountry.q
making an Indian village open defecation free
Ahrauli village in Buxar, perched on the banks of the mighty Ganga in the north Indian state of Bihar is on its way to becoming open defecation free (ODF). Villagers here are taking their task of dissuading neighbours and fellow villagers from defecating in the open, very seriously.
Sector Wide Approach to Strengthening Health (SWASTH)Government of Bihar Initiative, Supported by DFID, UK
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, organizational strengthening & human resource
management, decentralization and convergence among key departments. The programme
also uses community level processes to manage, demand and monitor services.
Bihar Technical Assistance Support Team (BTAST) Knowledge Product Developed by
