Hundred Block Plan (HBP)

Association for India’s Development (AID)

Visit to Manpur Block, Gaya District

December 25th – 27th  2003

 

Prepared by

Madhulika

Balakrishnan

(AID-Austin)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Purpose of the visit

 

We have been reading quite a bit about the Hundred Block Plan (HBP). Everything about it seems great - the concept, the framework, the timelines, the minute details in the documents, the reports.  The curiosity to see how all this works, the desire to meet the people who are actually doing the work, derive inspiration from them, and to understand the obstacles that had to be overcome at different stages were the primary reasons for our visit. Our limitation was the time we could afford to spend with the team. Overall, it was a very fruitful and inspiring visit.

 

Travel to Gaya

 

Sanghamithra express reached Patna at 2:00pm, five hours behind its scheduled time. Dinesh Prasadji who is the state coordinator for HBP in Bihar was waiting for us at the station with the sign “Welcome, AID volunteers”. Apparently, that was the third time he came to the station for us that day.  After a nice lunch at the railway station, the jeep raced on the bumpy Bihar roads and reached Gaya city at 6:00pm in the evening. On the way one of the state resource persons, Saritaji, joined us at Jehanabad.

 

It was then too late to go to any village. We had lost half a day because of the delay. We spent the evening chatting with Saritaji & Dineshji. Binod Kumarji, the Manpur block coordinator joined us for a little while. With Saritaji’s help, we learnt the organizational and training structure for the program.

 

Currently, there are three state resource persons for the 14 blocks in Bihar and Jharkhand

 

·      Saritaji: 5 blocks in Bihar

·      Sadanandji: 7 blocks in North Bihar

·      Sheelamaniji: 2 blocks in Jharkand

 

 

When the program started in October 2002, there were six state resource persons. Manpur block has six cluster resource persons (block full timers). Four of them are men.

 

Planning for the trip

 

Before the visit we had discussed with Nishant, Balaji & Ravishankar about what we want to get out of the visit. And at Manpur, with the help of Dineshji & Saritaji we came up with the list of things we wanted to see on the next day

·      House to house talking by each person

§         Village Health Activist (VHA)

§         Cluster Resource Person (Block Full Timers)

§         Block Coordinators

§         State Resource Person

·      Registers

·      Self Help Groups

·      Participation of women in the program

Based on what we wanted to see, we chose 3 villages. Dineshji suggested we go to Nauranga village to see the weighing and house-to-house talking, Ganjas village to meet all the cluster resource persons and the members of a Self Help Group (SHG). We wanted to go to Mehermanchak, which Nishant had pointed out in his report as a very backward village with a deep caste divide.

 

The first day: Dec. 26th 2003

 

Dineshji couldn’t accompany us the next day. So, we set out with Saritaji & Binodji on our expedition for the day. Like all visits to Gaya, ours too started with the pilgrimage to the temples in Bodhgaya. We were impressed by the architecture of the temples built by different countries in their own regional artistic style.

 

Binod Kumarji, Saritaji & Bala in BodhGaya

 

After a refreshing morning, we went to Nauranga village where we met the VHA, Renu Devi and the block resource person Rekhaji.

 

Nauranga

 

We looked at the registers and visited four houses in the village along with Renu Devi and Raju Kumar (village health activists), Rekhaji (cluster resource person), Saritaji and Binod Kumarji.

 

We had a different response from each house we visited. At the first house, the lady had nine children out of which five had died. The lady said she took some medicine from a local quack to have a boy child and she had a baby boy after that.

The quack told her 35 other people did the same and they all had boys. All of us including Saritaji were dumbfounded and didn’t know how to react. We didn’t discuss this further, but went on to other things. Saritaji talked to her about the child’s food habits and preferences. Taking into account the family’s financial position and available resources, she suggested a couple of things that could be added to the child’s diet. In one house, the mother enquired Saritaji about the stomach problem her little boy had been having for quite a few days. In another, the lady was not very cooperative. She said “tholna aapka kaam hai! Karke jao!” One young mother with her two weeks old daughter was very enthusiastic about knowing what she can and cannot feed the child.                                                            

                                                                                     Rekhaji weighing a child

 

 

Binodji showing the register

                                                                

We realized that winning the confidence of the mother and persuading her is not as easy as following a sequence of steps listed in literature. The village health activist who shares the same values and superstitions as every mother in the village needs to overcome many preconceived notions and things and this needs a significant effort from herself and the resource people who impart training.

 

Ganjas

 

In Ganjas, we met the cluster resource persons for Manpur block. The team had four men and two women. We had a brief introduction session followed by interesting discussion about JSA (Jan Swasthya Abhiyan as HBP is referred to in Bihar) and AID. They were very curious to know our background, interests, and the fundraising methods of AID. They had our photos (from Zakir Hussain’s concert last year) sent by Nishant and were trying to identify the people they knew. They were interested to know our thoughts about the program. We told them that until that point, we had only read about the program and were very excited to see it in action. We wanted to understand their experiences and the problems they faced. So, we asked each of the resource persons to talk about

 

•        Their experiences/problems

•        Events undertaken in the last few months

•        Training camps they attended

•        Percentage of women VHAs

•        Change in VHAs – new training undertaken?

•        Interaction with Panchayat and Primary Health Center (PHC)

•        Self Help Groups

 

 

Meeting with the cluster resource persons

 

 

 

 

This is the summary of the discussion we had:

 

•        For the 60 villages in Manpur block, there are 58 village health activists.  43 of them are men and 15 of them women

•        They do realize the difficulty of the men VHAs in talking to the mothers, but men had the advantage of being able to cover distant areas easily

•        In the areas where the cluster resource person and VHA were both women, they had difficulty in lifting the weighing machine when they couldn’t find the hook to hang it. Having men around helped in such situations

•        There has been no change in VHAs between the first round and the second round of weighing.

•        The VHAs need the cluster resource persons to accompany them on house-to-house visits. They are not confident enough to go by themselves.

•        Events during the last six months

–         Kala Jatha in Baradih Village

–         3 new SHGs formed. They had problems problem in opening new bank accounts

–         Initial meetings for SHGs in 2-3 villages

•        Interaction with Govt. Health Services

–         All the VHAs used the aanganwadi’s weighing machine. Because of the initial reluctance of the aanganwadi workers to help, the weighing got delayed.

–         In one village, the VHA helped arrange immunization camp

–         In a couple of villages, they complained about the Auxillary Nurse Midwives (ANM) who were charging for immunization. One of them got transferred (Khaiyya panchayat). but there was no action taken in the other (Bhadeji and Bikhi villages)

–         They were recording “Denial of Health Care” cases in the PHCs and plan to present it during a health march at Patna in April this year

 

•        In some Muslim localities, communication was a problem since people spoke only Urdu

•        They had to deal with superstitions like “immunization causes fever and leads to childlessness in future”

•        Some VHAs complain that they don’t have time.

•        The VHAs have been questioned about the monetary benefits they got from the program even by the village heads.

•        In one locality, the activists were chased by the parents when they went for weighing. Apparently, the aanganwadi worker had weighed the child the previous week and the child had become sick after that.

 

While we were discussing with the cluster resource persons, the members of the self-help group had assembled near us. We talked with them next.

 

Meeting with the members of the SHG in Ganjas

 

The meeting started with a folk song by the women of the SHG. The SHG had 16 women contributing Rs 20 each month for the past 9 months – they showed us the registers they were maintaining. They meet once a month to deposit the money. Some of the women were uncomfortable since they didn’t have a bank account and asked Binodji about it. Binodji announced that they were going to open one the very next week.

 

The women recognized the advantages of SHG (Emergency loans at very low interest, can use funds for daughters marriage). Saritaji then talked to them and encouraged them to continue meeting and use the forum to discuss other issues like health and hygiene. She suggested that they should meet more often and deposit smaller amounts each time. After a nice lunch at Sakithaji’s house, we left for Meharmanchak village.

 

 

Meeting with the members of SHG

 

 

Meharmanchak

Before the Jan Swasthya Abhiyan, BGVS had little or no presence in Mehermanchak village. The lower caste people lived in a separate area. Apparently, they are migrant labourers and were not present during our visit. At the time of our visit, the second round of weighing had not yet started there. We accompanied the VHA (who was male) on house-to-house talks and saw Binod Kumarji talk to the mothers.

 

The village didn’t have safe drinking water source and the villagers were planning to have a tube well installed. They wanted to know if AID could help in any way. We asked them to talk to BGVS volunteers and, if necessary, write a proposal to AID. It was already late evening by then, so we thanked the villagers and the health activist, and headed for Gaya railway station.

 

Discussion with Binodji at Gaya Station

 

At the Gaya railway station, we had a short discussion with the block coordinator Binod Kumarji. We told Binodji that we want to communicate frequently with the block, understand the different activities being taken up and actively participate in all the ways we can. We set up a time for telephone call every month. We also wanted to get a copy of the monthly report from the block. Bala left for Delhi from Gaya that evening. Saritaji and Madhu proceeded to Jehanabad in the jeep.

 

Gorapur Village (Jehanabad Block)

The next day, we (Madhu, Saritaji, Dineshji & Dharmendarji) went to Gorapur village in Jehanabad block. The village had three self-help groups. After a short meeting with the women of the SHGs, we went on house-to-house visits. The area had a strong presence of naxalites. We met a woman naxalite who was asking for donations to build a statue of one of her comrades who had killed a village sarpanch. Initially the naxalites were against the work BGVS was taking up in the area. But now, they are neutral about it.

 

BGVS Jehanabad team

 

From Gorapur, we left for Patna railway station. After a two hour wait at the station, Dharmendarji helped me get into the crowded compartment of the Brahmaputra mail.

 

Discussion with Dineshji & Saritaji

 

While traveling from village to village, we got a lot of time to chat with Dineshji and Saritaji. Since AID Austin was doing the computer drive, we asked Dineshji if there was a need for computers. He said currently, there are very few people who can handle and work with computers. According to him, the program hasn’t reached a level where the computers can be put into effective use. Also, they wanted to be able to give a computer to every block at the same time.

 

In the couple of days we had, Saritaji helped us both get a better understanding of the program. We were inspired by her ability to explain things clearly without dismissing even the silliest of the questions. We asked Saritaji her thoughts about remuneration for the VHAs. She said it should not be an option at this point. Unless the VHAs realize the importance of the program and know that talking to mothers is not a trivial job, they won’t be able to appreciate the significance of their role. If they are paid, they will probably just maintain registers and visit houses for the sake of the remuneration. The larger goal of health program will then be at stake. She said a better way would be for AID to award them with certificates for the training.

 

Future plans

·      Second round of weighing will be completed soon and the results will be analyzed.

·      Training camp will be held in February 2004.

·      In phases, BGVS team would try to replace men in the program by women. The villages in which women don’t participate in the training would be removed from the program.

·      The state team and the block team will started using the monthly status report format sent by Balaji to record the activities.

 

Some thoughts

·      The registers are being maintained well. The program seemed be progressing steadily, though a little slowly.

·      There seemed to be a need for more resources at the state level. The state team has reduced to three from six. Handling five to seven blocks is a humongous task for the state resource persons.

·      The VHAs, cluster resource persons or the block coordinator didn’t seem confident enough talking to the mother. Saritaji had to help them out. More frequent and rigorous training is necessary.

·      Currently, 60% of the VHAs in the block are men. There should be more efforts to get women involved in the program. Working on starting more self-help groups would be a good idea.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Acknowledgements

 

We are grateful to all the individuals who encouraged and helped us in our visit to Manpur and gave us an opportunity to have such a rewarding experience.

 

We are very thankful for the opportunity to meet health activists like Renu Devi & Raju Kumar whose services are the most vital for enabling people to take control of their health. We thank them for sparing their valuable time and showing us the key aspects of the program. We thank all the cluster resource persons Sakitaji, Rekhaji, Awadheshji, Kamleshji, Sashiji, and Sureshji for sharing their experiences and inquiring ours with equal enthusiasm.

 

We are extremely grateful to Saritaji, for being with us throughout the trip, for her patience in trying to make sense of Madhu’s Hindi, for her tireless enthusiasm in explaining things and helping us understand everything that was happening.

 

We thank Dineshji and Binodji, for coordinating our visit and making sure we got to visit and see all we wanted to, Dharmedarji, for his remarkable company and help at the Patna railway station, and Balaji and Ravishankar for helping us plan for the visit.

 

Special thanks to Nishant for his amazing support and guidance at every step, from hurrying us to make reservations, helping us get the program goals clear, being very enthusiastic and appreciative of our experiences and our improved perception, encouraging us to write the report and even making the slides for the presentation.

 

Finally, we are thankful to all the AID-Austin volunteers (esp. Devashree) for showing earnest interest in learning about our visit and bugging us for the report and presentation.