Professional Documents
Culture Documents
Creating Awareness to
Improve Maternal Health in Jharkhand
no. 4 | march, 2015
Jharkhand, formed in 2000 after separating from the Increased demand for nutritional
state of Bihar, is the fifth least-developed state3, with supplements and temporary contraceptives
historically alarming levels of poverty, hunger and ill
health. The poverty ratio of Jharkhand is 45.3 per cent 19 out of 24 PHCs now have referral
(national average of 37.2 per cent), but a broader definition transport compared to 5
PHCs earlier
of poverty suggests that 74.8 per cent of the state is poor. * Global Poverty Action Fund
The health indicators too show a dismal picture: 43 per
cent women in Jharkhand have a Body Mass Index (BMI)
Oxfam has partnered with Child In Need Institute (CINI) in
below normal4.
two districts of Jharkhand Ranchi and Hazaribagh. CINI,
According to the Annual Health Survey (AHS) 2011-12, established in Kolkata in 1974, has since worked on health
Jharkhands MMR at 267 lagged behind the national figure and nutrition in West Bengal, Jharkhand and Chhattisgarh13.
of 1785. The Infant Mortality Rate (IMR) was only marginally In health, it has been working for long in the regions
better, at 38 deaths per 1000 live births, as against the lending technical support to the National Rural Health
national figure of 446. The 2012-13 AHS data showed Mission (NRHM)14 by providing training modules for the state
some improvement for Jharkhand - MMR was at 2457 and Accredited Social Health Activist (ASHA or Sahiyya).
IMR at 368. Infant and child mortality rates, however, are
In 2013, Oxfam partnered with CINI in Jharkhand in 70
disproportionately higher within the state among the
villages covering 15 Gram Panchayats in two blocks of
adivasis and poor households; adivasis consisted 28 per
Churchu (Hazaribagh) and Ormanjhi (Ranchi). These villages
cent of the states population9.
are a mix of Adivasi, Dalit and Muslim families. An integrated
Jharkhand lags behind in other health-related parameters approach is necessary to have an impact on issues related
as well only Bihar and Rajasthan rank lower than to nutrition and maternal health, said Faiz Ahmad, project
Jharkhand in terms of proportion of child marriages10. coordinator, CINI.
Integrated Approach to Nutrition and
Maternal Health
J panchayat polls were never held and Panchayati Raj
harkhand, till 2010, was the only Indian state where the village level. It acts as a sub-committee of the Gram
Panchayat with a minimum of 15 members led by an elected
Institutions (PRIs) continue to be in their infancy. Ranjan panchayat member. Potentially, all those working in the
Panda of CINI feels that since PRIs are still in the process of village around health related services would participate
being built, the health monitoring systems do not always in its meetings16. Till recently, VHSNCs have been more
work the way people normally expect them to. While on paper and not been very active in the project areas.
strengthening the PRIs has been a challenge for activists However, things have changed in recent years. The VHSNCs
forming the Village Health, Sanitation and Nutrition are now a pressure group within the Gram Sabha and the
Committee (VHSNC) under the ambit of PRI compound it block. At the district level, VHNSC federations are being put
further. in place.
Oxfam focused on leveraging and activating existing In the villages, VHSNCs comprise of 15-25 members. Women
village-level institutions like the VHSNC and strengthening participation in general has remained low in the past, for
capacities of the community to ensure better delivery of instance, in Gram Sabha meetings. Powerful and influential
health and nutritional services. This was complimented by men would often hold Gram Sabha meetings at night and
formation of Village Health Resource Centres (VHRC) that circulate the register the following day at the womens
provided the village a library with Information, Education SHG meetings for them to sign, essentially leaving the
and Communication (IEC) materials, posters and calendars poorest and weakest out of the decision making process.
to build community awareness on health and nutritional However, VHSNC guidelines mandating 50 per cent women
aspects. Mass awareness campaigns were organised to membership improved their participation both in the Gram
underline the importance of nutrition to maternal and Sabha and VHSNC in the last three years. For instance, out
child health. of the 25 VHSNC members at Palu village in Ranchi district,
only four are men.
The VHRC also acts as a repository of information on
existing government schemes. The centre offers useful Now, the VHSNC and Gram Sabha meetings are well
information to the community, particularly pregnant / coordinated. In Ormanjhi block, for instance, Gram Sabhas
lactating mothers and adolescent girls. It hosts regular are held on the 19th of every month and, in all the 35
meetings of adolescent girls, VHSNC, and womens SHGs of villages, VHSNC meetings precede them. This is to ensure
the village and displays the outcomes of these processes that decisions taken at the VHSNC are shared with the
prominently at the Centre. VHRCs are run out of community Gram Sabha for implementation. Decisions are taken
centres or attached to the Anganwadi or Sub Centre. In democratically and CINI played a key role in facilitating this.
some cases, the house of the Barefoot Auditor15 becomes Most of the villages were unaware of the provision of untied
the VHRC. funds, of Rs 10,000 provided to the VHSNC
VHSNCs were formed as part of NRHM to take collective Training by CINI ensured better planning and spending
actions around health and its social determinants at of the untied funds on sanitation, drainage, hand-pump
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