community action for health case study from bihar and jharkhand, india

7/27/2019 Community Action for Health Case Study from Bihar and Jharkhand, India

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Community Action for HealthCase Study from Bihar and Jharkhand, India

SRC Publication, April 2008


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Cnit Actin fr HealthCase Std fr Bihar and Jharkhand, India

AthrsPeter Eppler, Aitabh Shara and Neeraj Labh

Std Design

Verena Wieland

EditingElena Krlva

FtsPeter Eppler

Swiss Red Crss Pblicatin, April 2008

The case study was co-funded by the Swiss Agency for Development and Cooperation (SDC).

This case study from Bihar and Jharkhand is part of an international study of Swiss Red Crosscovering experiences from projects in Ecuador, Eritrea, India and Kyrgyzstan and providing an in-depth analysis of individual country experiences and of cross-country comparison with regards tocommon course, differences and lessons learned.


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FoREWoRD

Since the early 1980s the Swiss Red Cross (SRC) through its international cooperation has beenimplementing various projects (mainly in remote rural areas in South-America, South and South-East Asia) that are known as Community-based Health Projects. The World Health OrganisationsDeclaration of Alma Ata of 1978 on Primary Health Care and the later adopted Ottawa Charter for

Health Promotion have been serving as point of reference for these interventions.

From the very start SRC put special emphasis on working at the community level and mobilisingpeoples participation. Strengthening self-help abilities and the local resource base, along with theempowerment of community-based organisations are among the central concerns of SRC projects.General coordination with the official health system was always considered a precondition for avoidingduplication and building of parallel structures. Little systematic research has been conducted on theimpact of different interventions in community-based health. This study contributes to filling in thisgap and to enriching the conceptual discussion of approaches to community-based health.

India has made tremendous improvements in its economic and social development in the past two

decades and is likely to realise even faster growth in the years to come. And yet there is a wide gapbetween the rich and the poor, a disparity which has only increased over the years, hurting anti-poverty efforts and possibly fuelling social unrest. For this reason, there is a dire need to reduce thehigh degree of income inequality and high incidence of poverty, especially in rural areas, throughfaster and more inclusive growth.

In North-Bihar and Jharkhand SRC has been addressing the needs of poor and vulnerable communitiesin some 202 villages for more than sixteen years, a humble but nevertheless important contributionto improve the living conditions of thousands of families belonging to the deprived section of society.Community Action for Health, Case Study from Bihar and Jharkhand describes and analyses somesalient features and experiences of the SRC supported development programme implemented by

a network of local NGOs. To its credit, the programme could claim considerable progress in healthindicators, despite adverse initial health conditions including high rates of child malnutrition andincidence of communicable diseases. However, after some time it was realised that a sector specificapproach alone was not sufficient to improve peoples living conditions and achievements in thehealth sector could only be sustained by addressing other relevant development components as well.

As a result, the programme emphasised increasingly on equal access to services, enhancement ofgender and social equity, capacity building of local communities, resource mobilisation and incomegeneration, and strengthening of local governance.

Social inclusiveness is particularly relevant in a society divided by caste, religion and ethnicity, and- as in Jharkhand - where tribal people constitute a significant minority. Fortunately, there is growingpolitical concern and commitment to build infrastructure, particularly rural areas, to make governmentagencies more accountable and to improve their services in favour of a large segment of poor people,and to enhance local government institutions which are vital for inclusive development. It is hopedthat these efforts will be continued and make development happen in near future.

Margrit Schenker

Head of Europe and Asia DepartmentSwiss Red Cross


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Community Action for Health4


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Case Study from Bihar and Jharkhand 5

TABLE oF CoNTENTS

Abbreviatins i

Eective sar 1

1 Cntet descriptins 3

1.1 Bihar and Jharkhand poverty in the lands of plenty 3

1.2 Health system in India 4

1.3 Community profiles 5

2 Gal, apprach and prcesses 6

2.1 Selection and coaching of partner organisations 62.2 Linking health and poverty alleviation 6

2.3 From service delivery to empowerment 6

2.4 Advocacy and empowerment for collective action 7

2.5 Process extension and outreach through SHGs 9

3 Achieveents 10

3.1 Improvement of health situation 10

3.2 Linkage building and resource mobilisation 11

3.3 Conflict resolution 12

3.4 Towards pro-poor governance 12

4 Sccess factrs, liitatins and challenges 15

4.1 Success factors 15

4.2 Limitations and challenges 15

5 Cnclsins and lessns learnt 17

References 19

Brief prfile f cllabrating partner rganisatins f SRC 21


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ABBREVIATIoNS

BF - Badlao Foundation

BMVS - Bhusra Mahila Vikas Samiti

CDP - Community Development Programme

CBOs - Community Based Organisations

CEP - Community Empowerment Programme

GVP - Gram Vikas Parishad

IIDS - Initiatives in Development SupportNFHS - National Family Health Survey

NGOs - Non Governmental Organisations

PNDSS - Patna Notre Dame Sisters Society

PRIs - Panchayati Raj Institutions

SHGs - Self Help Groups

SRC - Swiss Red Cross

SSVK - Samajik Shaikshanik Vikas Kendra

i


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Deprived rural communities of 202 villages inNorth Bihar and in Jharkhand, which was partof Bihar until 2000, have been supported by theSwiss Red Cross (SRC) from 1990 till 2006. Inthese years the programme has gone throughprogrammatic changes and repositioning.

Community Development Programme (CDP): Inthe first phase covering 1990-95 the programme

was guided by a service delivery model by whicha cadre of trained people provided for motherand child health care, non-formal education andincome generation support. The programmein its second phase (1995-2000) explored thepossibilities of making the sectoral servicessustainable by encouraging beneficiaries to payfor services rendered in education and health.But the approach did not have many takers as thetarget groups were either disinclined or lacked theability to pay for the services that had been free

till then under CDP. It was realised that parallelstructures for delivering health and educationservices had little scope to become sustainablethrough community financing. As it was theresponsibility of the state to make available theseservices to its citizens, a more viable and preferredoption was to figure out ways and measures tomake the state fulfill its commitment.

Community Empowerment Programme (CEP): Itwas the above mentioned premise that brought

about a paradigm shift in the SRC programmeand moved it from a sectoral approach into anempowerment approach, applied in the lastseven years (2000-06). This case study highlights

some key issues of the programme, with specialemphasis on the past seven years.

The community empowerment goals, apart fromstrengthening community based organisations,mainly targeted objectives related to:

equal access to health care, education andother government services

social equity and justice especially with

regard to gendered vulnerabilitiessustainable resource mobilisation andincome generationright to information and participation inlocal governance.

Experience proved that without securefoundations in these basic prerequisites sustainableimprovement in health would remain elusive.

Despite extremely difficult socio-economic

conditions, hundreds of self help groups (SHGs)and their federations have been empowered andthe lives of thousands of women and men andtheir families have been considerably upgraded.Though community-based health care was themain entry point and catalyst of change, theproject outcomes also contributed considerablyto improved economic and educational statusand tremendously enhanced the self-respect andconfidence of local communities. It is noteworthythat two self-help group members, Tiliya Devi

and Amrika Devi, who were trained and havebeen part of the project right from its inception,were among the 1,000 women nominated forthe Nobel Peace Prize 2005.

The sun has not changed; the moon has not changed,but our women leaders have changed our lives.

Song of mahila sangham (womens group)

ExECuTIVE SummARy


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1.1 Bihar and Jharkhand pvert inlands f plent

In 1917 Mahatma Gandhi arrived in Champaran

in North Bihar to lead an agitation againstextortionist British indigo planters. Ninety yearsafter his visit to Bihar and sixty years after Indiasindependence the area is still poverty strickenwith large sections of society being exploited andhaving to ensure survival under the most difficultconditions.

From 1990 till 2006 SRC has been addressingthe needs of marginalised communities in 202villages of Bihar and Jharkhand. In this period the

programme, which has been co-funded by SwissAgency for Development and Cooperation (SDC)and for some years by Interchurch Organisationfor Development Co-operation (ICCO), has gonethrough programmatic changes and repositioning.

At the outset it is worthwhile to provide a briefdescription of the geographical area.

Located in the very fertile gangetic plain of easternIndia, Bihar is the third most populous state inIndia, with a total population of 83 million.1 In

terms of development it is the most backwardstate, with a very high proportion of the populationliving below the poverty line (44% in rural areas2).

Also with respect to health3, literacy rate and mostof the other development indicators the state faresvery badly.

The states low development status, besides being anoutcome of the poor economic performance of bothagricultural and industrial sectors, is equally relatedto the iniquitous and exploitative socio-economic

structure, lack of political leadership and almost totalcollapse of the administration, and law enforcementmachinery - to the point where it is said that in

Bihar the state has withered away. Add to this thedisaster proneness of the state, especially the almostannual recurrence of floods in North Bihar wherethree of the four SRC partner Non GovernmentalOrganisations (NGOs) are located. These conditionshave created a milieu of non-development in whicheven large-scale poverty eradication programmeshave had little impact.

Jharkhand, which was carved out of southern Biharand became an independent state in November2000, has a population of 26.9 million.4 Most of

Jharkhands agricultural land is not irrigable butrain-fed. Additionally, there are large forestedareas inhabited by a predominantly tribalpopulation. With around 40% of Indias mineralsthe newly created state can be considered asenormously rich in natural resources and as havinga phenomenal economic development potential.Quite in contrast to the wealth in minerals, theNational Sample Survey in 1999/2000 assessed49% of rural poverty5 (rural population livingbelow poverty line). Despite some progress in thepast seven years Jharkhand remains a state withone of the highest poverty rates in India.

Looking at the present health situation in bothstates, the health related Millennium DevelopmentGoals cannot be reached if the present healthoutcomes and coverage of priority services6 arenot being considerably improved. The importantissues which would have to be addressed are:grossly inadequate and inefficient public healthinfrastructure, substantial lack of essentialrequirements in terms of manpower, equipment,drugs and consumables in the primary health care

institutions, the poor accountability of health careproviders, and lack of equitable access to healthcare.

1 CoNTExT DESCRIPTIoN

1 Office of the Registrar General & Census Commissioner. Census of India 2001; Total Population. New Delhi: Office ofthe Registrar General & Census Commissioner.

. 19.04.2008.

2 Government of India Planning Commission 2006. National Human Development Report 2001. Table 2.21; New Delhi:Government of India Planning Commission: 166.

3 For health related indicators of Bihar and Jharkhand refer to table 2 on page 9.

4 Office of the Registrar General & Census Commissioner. Census of India 2001.

5 The World Bank 2007. Jharkhand, Addressing the Challenges of Inclusive Development. Report No. 36437- IN.Washington: The World Bank: i.

6 For health related indicators of Bihar and Jharkhand refer to table 2 on page 9.


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In Bihar and Jharkhand economic growth and socialservice delivery have been far from being inclusive.Dalits, the scheduled castes, other backwardcastes and tribal communities were the least ableto benefit from development programmes andhad uneven access to the distribution of assets. In

Jharkhand there is even evidence of an increasing

inequality in rural landownership in recent years,especially in tribal areas.7 These are favourableconditions for extreme left mobilisation andviolence. The so called Naxalite movement hashad an upsurge during recent years. Today mostof the districts in both states are infested by leftistextremism. As there are daily reports of sparkingviolence across a wide swath of India, includingBihar and Jharkhand, Prime Minister ManhohanSingh described the underground movement asthe single biggest internal security challenge ever

faced by our country.

1.2 Health sste in India

The constitution has made health care serviceslargely a responsibility of state governments interms of service delivery but has left space for thecentre to provide for national health policy andplanning framework. The current governmenthealth care system comprises curative andpreventive health services, from primary to tertiarylevel, throughout the country and free of cost to theuser. As far as expenditure is concerned, state andlocal governments incur about three-quarters andthe center about one-quarter of public spendingon health. Wide variations in state income andcapacity levels result in large disparities in healthfunding and outcomes. While some states suchas Kerala and Tamil Nadu approach the standardsof developed countries, others, such as Bihar and

Jharkhand have health indicators that are amongstthe worst in the world.

The public health delivery consists of a tieredsystem that was originally intended to refer usersto the most appropriate level of care. Facilitiesinclude front-line sub-centers (village level)intended to be staffed by two multi-purpose healthworkers; primary health centers (block level) thattake referrals from the sub-centers; community

health centers with a small number of in-patientbeds and district hospitals (district level).

Though India pledged, along with other WorldHealth Organisation member nations, Health for

All by the Year 2000 at Alma-Ata in 1978, Indiasachievements in the field of health have been lessthan satisfactory. Annually 2.1 million childrenunder five die from preventable illnesses,8 100,000mothers continue to die of pregnancy relatedcauses every year,9 and halfa million people die

of tuberculosis10

. Diarrhoea and malaria continueto be killers while 2.5 million people are sufferingfrom HIV/AIDS,11 and the overall burden of diseaseamong the Indian population remains high.

Many of these illnesses could be prevented ortreated cost-effectively with primary health careservices for which an extensive governmentinfrastructure exists. However, implementationhas fallen short of the goals and varies widelyfrom state to state. On average the performanceof the public health care system is rather weak.

As a result 70% households in urban areas and63 % households in rural areas,12 have to resortto expensive health care services provided by thelargely unregulated private sector. Not only do thepoor face the double burden of poverty and illhealth, but the financial burden of ill health canpush even the non-poor too into poverty. Despitethis situation, India spends only 0.9% of its GrossDomestic Product on public health13, which isgrossly inadequate.

7 The World Bank 2007: vi.

8 Gareth Jones, Werner Schultink and Babille Marzio 2006. Child Survival in India. Indian Journal of Pediatrics, Volume 73,No. 6: 479.

9 Ministry of Health and Family Welfare, Department of Family Welfare no year. Maternal Health Programme. . 19.04.2008.

10 Mihai S. Jalba 2004. Forum. Indian Journal of Tuberculosis 51: 113.

11 National AIDS Control Organisation 2006. HIV Data. New Delhi: National Aids Control Organisation. . 19.04.2008.

12 International Institute of Population Sciences 2006. National Family Health Survey (NFHS 3) 2005-06, Volume I. Mumbai:International Institute of Population Sciences: 436.

13 Bajpai Nirupam, Jeffrey D. Sachs and Nicole Volavka 2004. Reaching the Millennium Development Goals in South Asia,CGSD Working Paper No. 17. New York: The Earth Institute at Columbia University: 15.


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1.3 Cnit prfiles

The programmes activities are in favour of ruralcommunities across three districts of Bihar and onedistrict of Jharkhand. The communities comprisethe most disadvantaged sections of the society,i.e. Dalits and tribal people along with populace

coming from the backward and the extremelybackward castes. Their poverty is largely due tostructural inequities (caste and class inequities)which limit their access to, and control over, assets,education, health care and other constitutionallyordained entitlements.14 Furthermore, thesecommunities have been historically marginalisedwith literally no opportunities to participate indecision-making processes. Their exclusion evenmanifests spatially as they reside on the peripheryof the settlements. The influence of the politically

and economically powerful local elites coupledwith the hard struggle of the poor to meetsurvival needs, hardly allow these communities toorganise and to resort to development initiativescollectively.

Marginalised communities usually live in separatehamlets consisting of 75 80 households (400 550 inhabitants) on average in Bihar and 40 50households (220 275 inhabitants) on average in

Jharkhand. The discrepancy between the two statesis due to the higher population density in NorthBihar compared to Jharkhand. In Jharkhand, tribalcommunities (26.3% of the total population)15comprise an unusually high proportion of

the society. In both states most households ofmarginalised communities are landless anddepend on daily labour. As opportunities to workfor big landholders, social government schemesor commercial enterprises are rather scarce; menoften depend on seasonal migration to biggercities or other states to secure their livelihood. For

most of the year, predominantly women, childrenand elderly people are left in the villages. This isone of the reasons why SRC supported NGOs areconcentrating on women oriented projects inthis context community empowerment meansmainly womens empowerment.

The literacy rate of women in both states is belowthe national average.16 For hardly educated,unskilled women of low social status it is difficultto survive on their own in a male dominated

society with feudalistic tendencies. And yet,while their husbands are often far away, they arethe backbone of their families struggling hard tosustain their lives with quite often a good numberof children to feed.17 As there is little incomeopportunity, purchasing any type of private healthservices is out of scope or results in debts. Onthe other hand, free government health servicesalso remain underused as they are perceivedto be of poor quality and difficult to access.

According to National Family Health Survey 3(NFHS-3) the percentage of households that donot generally use government health facilities isa record breaking 93.3% in Bihar and 77.7% in

Jharkhand.18

14 The World Bank 2005. Bihar Towards a Development Strategy. Washington: The World Bank: 1-2.

15 Office of the Registrar General & Census Commissioner. Census of India 2001. Scheduled Caste & Scheduled TribesPopulation. New Delhi: Office of the Registrar General & Census Commissioner. . 19.04.2008.

16 Female literacy rate for women is 37% in Bihar and 37.1% in Jharkhand, the average female literacy rate for India is 55.1.International Institute of Population Sciences 2006. NFHS-3 2005-06, Volume I, Table 3.4.1: 62.

17

Fertility rates of women in the 15-49 years age group are still astoundingly high in both states. Bihar with a fertility rate of4% has the highest of all states in India. In Jharkhand the fertility rate is 3.31%. International Institute of Population Sciences2006. NFHS-3 2005-06, Volume I, Table 4.3: 83.

18 International Institute of Population Sciences 2006. NFHS-3 2005-06, Volume I, Table 13.13: 438.


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2.1 Selectin and caching fpartner rganisatins

The Community Development Programme (CDP)

19901999 and the Community EmpowermentProgramme (CEP) 20002006 which had acumulative life span of sixteen and a half yearsowed their origin to the 1988 earthquake whichaffected much of North Bihar and parts of CentralBihar as well. After a relief and rehabilitationphase, SRC decided to assist the poorest within theframework of long-term, sustainable developmentefforts for improving their living conditions- including health, education and incomegeneration as key areas - and strengthening their

self-esteem and self-help capacity.

On the recommendations of a project identificationmission set up by SRC to identify local NGOs,development cooperation was initiated witha set of five local NGOs in July 1990. Althoughall organisations comprised committed anddedicated staff, they partly lacked the particularskills necessary for effective and efficient projectimplementation. The NGOs themselves said thatthey would be interested in SRC taking an active

role to support them, not only with financial inputsbut also by assisting them in the training of staff,and in getting consultancy on organisational andtechnical aspects as well as in conducive projectcycle management. Therefore, SRC decidedto designate local experts and to set up a SRCProgramme Coaching Unit which later became aregistered legal entity - Initiatives in DevelopmentSupport (IIDS). A brief organisational profile ofthe SRC supported partner organisations is givenat the end of the case study.

2.2 Linking health and pvertalleviatin

The project viewed good health as an integralcomponent of human wellbeing and an importantsocial benefit. It is a fundamental human capacitythat enables every individual to achieve her/his potential to participate actively in social,economic and political processes.19In this sense,there is a close link between health promotion

and empowerment and economic developmentobjectives. It is understood that a heightenedawareness about health and preventive measureswill have a positive impact on the morbidity

profile of the region, thus salvaging the poor frombeing hurled deeper into the trap of poverty.

2.3 Fr service deliver tepwerent

The SRC approach over the years was designedto address both demand and supply constraintsrelated to the health sector. There is a lack ofdemand for health services in the state due tolow awareness levels of communities regarding

the states responsibilities and the entitlements ofsocio-economically deprived communities. Alsothe poor quality of health services, the limitedaccess to these services and the influence oflocal cultural factors have severely dampeneddemands for public health services in the state.On the supply side there is a need for developinga coherent framework-based policy and a strategicplan that reflect the needs of the beneficiaries,the responsibilities of the service providers andthe state, and which addresses key delivery

constraints.

In the first ten years, as a response to the weakperformance of public health care, the primaryobjective of the programme was to equip localNGOs in cooperation with Community-BasedOrganisations (CBOs) in delivering an effectivePrimary Health Care package with special focuson mother and child health. Services (suchas ante/neo/post natal care, vaccination ofpregnant women, identification of complicatedpregnancies, growth monitoring, counsellingon health issues, etc.) were delivered through avillage health post manned by a trained healthcadre. This service delivery component went handin hand with health education wherein villagehealth volunteers were trained to disseminatehealth messages and to mobilise people for healthinitiatives. Over the years the responsibility forcurative and preventive health care initiatives wasgradually handed over to CBOs with committedand capable leadership.

2 GoAL, APPRoACH AND PRoCESSES

19 Government of India. Special Task Force 2007. Bihar: Road Map for Development of the Health Sector. New Delhi:Government of India: 7.


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Since 2000 the SRC programme has beencharacterised by a shift to an empowermentapproach wherein the communities wereadequately enabled to develop appropriate

structures and strategies.20

They were also endowedwith sufficient information to demand from thestate the legitimate services for the poor andvulnerable. The empowerment approach cruciallyhinged on engaging the community in monitoringthe process and achievements so that it had first-hand experience of the changes brought about bysuch services and were reasonably convinced thatthese were essential for their well being.

The realisation of the paradigm shift also

depended on promoting and strengthening CBOssuch as issue based committees, SHGs and theirfederations. These CBOs served as platformsto provide developmental inputs in health andeducation as well as to optimise economic andlivelihood opportunities. This paradigm shiftbenefited from changes in the macro policywhich favoured creation of SHGs as instrumentsfor financial intermediation, an approach which

combines access to low cost financial services witha process of self-management and developmentfor women who are SHG members. In India, byMarch 2006 an estimated 33 million women

had been linked to banks for financial servicesthrough 2.2 million SHGs.21 In the context of theSRC programme in Bihar and Jharkhand SHGsand their federations also became active in villageand development affairs, stood for local elections,and addressed crucial social issues.

2.4 Advcac and epwerent frcllective actin

Advocacy was promoted in the empowerment

phase to make governance accountable,transparent and need oriented. The set of actionscomprised the following three steps:

Step 1: All NGOs gathered relevant informationon government health facilities, such as healthinfrastructure, deployment of personnel in theseinstitutions, facilities to be made available atvarious delivery points, equipments and drugs

SHG members in Madhubhani district, 2005

20 A more detailed description of this process has been published under: Eppler Peter 2004.Vom Gesundheitsprojekt zum

Empowerment von Frauengruppen in Jharkhand, Indien, Der lange Weg aus der Unterdrckung, in: Bulletin of MedicusMundi Schweiz, Nr. 94, pp 8-11.

21 National Bank of Agriculture and Rural Development (NABARD) 2006.Annual Report 2005-06. Mumbai: National Bankof Agriculture and Rural Development. 5.


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to be available at such institutions and the roleof the state in promoting health. In a later stagethe NGOs trained so called community resourcepersons to collect the necessary information ongovernment outreach programmes.22

Step 2: Facilities, resources and services as

committed by government rules and regulationswere compared with the actual status on theground. The findings were disseminated anddiscussed in village meetings and other appropriateplatforms.

Step 3: Supported by their respective NGOs, theCBOs resorted to enter into dialogue with therelevant authorities, articulating the dichotomybetween government commitments and the groundreality. If this did not yield any results, the CBOs

eventually resorted to petitioning, demonstrationsand sit-ins to highlight the malpractices andshortcomings within the government healthsystem and force the authorities to undertakeimprovements.

Though community health comprised a keyadvocacy objective, the initiatives were broader andcovered issues related to education, governmentdevelopment and welfare programmes,participation of deprived communities in localgovernance institutions, right to information,land rights and other relevant community issues.However, it needs to be mentioned that it isnot just lack of political will and administrativeefficiency that impedes proper implementationof government programmes and schemes but theincompatibility between values enshrined in theconstitution and traditional socio-cultural practices(such as adherence to caste system) and religiousvalues (such as fatalism) can be held equallyresponsible for the lacuna in the implementationof government programmes and policies. Hence,

empowerment was perceived from an holisticsocial change perspective in which advocacy wasconceptualised as a tool meant to go beyondmere public policy influence to the larger arenaof influencing societal attitudes and practices soas to transform the oppressive value system to amore just and humane worldview.

These attempts met with a measure of success theextent of which can be gauged from the followingcase studies compiled by external evaluators duringthe course of programme evaluation in 2003.23

Case Std 1: Gvernent gives in t

cllective pwer f wenBhusra Mahila Vikas Samiti (BMVS) supportedfederation members once put up a protest atthe Gaighat Public Health Centre to protestagainst the humiliation inflicted by the doctorto a member patient with tuberculosis.Following the incident, a local womens groupheld an emergency meeting to decide upon thefuture course of action. A three-point charterof demands was presented before the authorityand the lifting ofgherao (demonstration in

front of government office) was made subjectto compliance with all of them. The demandswere as follows:

l Sustained treatment and eventual cure of allTuberculosis patients in the area

l Regular service delivery by Auxiliary NurseMidwife and doctors of Primary HealthCenter

lFamily planning camps to be held at additionalsub-centre

These demands were accepted and necessarycorrective measures were initiated. Somethinglike this was previously unthinkable and suchsuccess imparted dynamism to group buildingprocesses.

Instead of implementing the health and educationprogramme vertically, the singular focus of allNGOs in the empowerment phase has beenmainstreaming with the government facilities,and transforming the role of NGOs into that of awatchdog to ensure that people are receivingthe services. In addition, CBOs were involved inoverall development of the villages and not justin the interests of their members. The reasonscited by the SHGs for their formation are veryinteresting: greater strength in fighting socialinjustice and accessing rights and entitlements;resolution of problems/conflicts through group

22 The Right to Information Act, 2005 gives citizens the right to access government owned information on documents and

records, including all information on development and welfare programmes. Government of India. Right to Information Act2005. Obligations and Responsibilities. New Delhi: Goverment of India. . 22.04.2008.

23 Neupane Ram and Kishore K. Singh 2003. Evaluation of Bihar Community Development Programme. ProgrammeDocument. Bern: Swiss Red Cross.


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community volunteers has been set up at eachNGO to collect and disseminate information ondevelopment schemes and programmes and onmicro-loan schemes of financial institutions. Itemerged that, within a year of its constitution, atleast 200 families accessed information from theresource centres regarding various government

schemes and programmes. Capacity constraintsand lack of economic support are some of theoperational difficulties encountered by thesecentres. The possibility of levying a user fee forthe resource centre services is being explored.

2.5 Prcess etensin and treachthrgh SHGs

The SHGs are distinctly characterised by strongautonomy in managing their affairs, taking decisions,

resolving conflicts locally, eliciting cooperationof group members in sharing responsibilities andsubscribing to common norms and rules of the group,enhancing resource mobilisation, and federationbuilding. This has earned them legitimacy with mostof the key stakeholders in the local context. Processextension has been characterised by a significantincrease in the membership base of the SHGs,across 202 villages where the programme has beenoperational. The following table gives a comparativeestimate of the increase in SHGs, which more than

doubled over a span of 3 years; this shows a highdegree of process extension:

Table 1: Increase of SHGs in three yearperiod24

NGosSHGs inAgst

2003

SHGs inDece-ber 2006

Badlao Foundation (BF) 100 107

BMVS 121 245

Gram Vikas Parishad(GVP)

215 552

PNDSS 85 144

Samajik ShaikshanikVikas Kendra (SSVK)

20 97

Ttal 541 1145

Federation building has also witnessed a similarincrease in geographic outreach and in enhanced

representation of SHG members at all levels (fromvillage to district level).

action; improvement of economic standard bycreating employment opportunities throughincome generation activities and reduction ofdependency on mahajans, village money lenders.

A key outcome of mobilising target group membersinto CBOs, including SHGs and their federations,

has been the optimisation in resource use. Despitea progressively declining programme budget andreduced NGO staff outlay, the gains accruing tothe communities have multiplied manifold dueto their organised initiatives for asserting theirrights, securing their entitlements and taking partin decision making. This can be best illustrated bythe following case study.

Case Std 2: District agistrates essageakes SHG wen ride tractr

On 15th March 2003, eight hundred membersof SHGs facilitated by Patna Notre Dame SistersSociety (PNDSS) participated in a function or-ganised by the National Bank of Agriculture andRural Development. Interactions with a numberof district officers and bank managers about thebenefits of SHGs brought a new confidence and,indeed, was a memorable experience for theparticipants. The District Development Com-missioner dwelt upon the opportunities thatmight come their way in the forms of differentdevelopment programmes. Overwhelmed bythe confidence of the SHG members, the districtmagistrate wished that a day will come when abus owned by these women will be on the roadtransporting people from Jamalpur to Bengalwa.SHG members of PNDSS took this message toheart. They went back to their villages and mo-bilised others to discuss the matter with the SHGfederation. During the meeting the membersidentified the need for a tractor as most urgent.They reasoned out that the possession of a trac-

tor by the SHG would enhance the efficiencyof sharecroppers who tilled the lands of othersfor their livelihoods. So they took the decision topool all their savings and negotiate with bank of-ficials for the loan. On the 1st of July 2003 SHGsofPanchayat Federation bought their own tractorworth Rs. 300000. They formed a ten membercommittee to look after the management of thetractor. This year, for the first time, they had theirfields tilled on time and are very happy.

In order to provide information to CBOs/SHGs and individuals, a resource centre run by

24 Eppler Peter, Neeraj Labh and Amitabh Sharma 2005.Assessment Mission Report 2005. Bern: Swiss Red Cross.


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25 Schth Tobias and Anil Chaudhary 1999/2000. Evaluation of Community Development Programme, Bihar/Jharkhand. Bern:Swiss Red Cross.

26 International Institute of Population Sciences 1999. National Family Health Survey(NFHS-2) 1998-99.

27 The figure here indicates actual number of maternal mortality cases in the project villages during 1998-99 and not the MaternalMortality Rate.

28 The figure here is from NFHS-3 2005-06. The earlier NFHS-2 1998-99 did not compile data on the basis of 3 ante-natal check-ups. From the trends it can be safely assumed that the figures must have been lower for 1998-99.

3.1 Iprveent f health sitatin

Cnit-based health care

One of the key contributions of the programme

was to create a trained cadre of health personnelat the village level. The programme investedheavily in building up capacities of health workers,health promoters and traditional birth attendants.

Almost the entire cadre belongs to villages wherethe programme has been operational: hence, thecadre would remain in the villages and sustainablyrender services even after the conclusion of theprogramme. Further, the project has generated aconvincing level of awareness among the peopleon health issues leading to a definite decline in

superstitious practices.

Village health committees have been at thevanguard in terms of monitoring health activities.They have also been responsible, in addition tothe health promoters, in disseminating health

Table 2: Comparison between working and non-working area

IndicatrsCnslidated data

fr prject villages fr

5 NGos (1999)25

Bihar* (NatinalFail Health

Srve 1998-99)26

Infant Mortality Rate (per 1000 live births) 14 72.9

Child Mortality Rate (under 5 years of age per 1000 livebirths)

22.3 105.1

Maternal Mortality Rate (per 100,000 live births) (17)27 451

Ante-natal check up from a health professional (3 or morecheck-ups)

75% 19%28

Percent of children who received all vaccinations 74.6% 11%

Birth attended by skilled staff 89% 23.4%

Percent of children severely malnourished 5% 24.5%

Percent of children with diarrhoea who received OralRehydration Solution

73% 15.4%

*Jharkhand was still part of Bihar at the time of the survey.

3 ACHIEVEmENTS

messages and taking up health issues in groupmeetings.

Due to cultural factors the programme encountered

difficulties in the initial phases in terms of identifyingpregnant women and persuading them to availthemselves of health post services; gradually,however, women were helped to understand howante/neo and post natal care are essential for thehealth of both mother and child. Eventually thiscomponent proved to be a resounding success withalmost all pregnant women and lactating mothersvoluntarily taking advantage of the services offeredby the health post. The acceptance and appreciationof health post services are corroborated by the fact

that women were, in many instances, willing topay a notional user fee.

Compared with average health indicators forBihar the programme area shows a much bettersituation which is set out in the table below:


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increasing articulation of the demand aimed atpersuading or pressurising the state to deliverwhat it has committed itself to as part of itspolicy. The sustained pressure by communitiesand increasing instances of interface betweencommunities in association with NGOs andrelevant authorities has achieved reasonable

success in shaking the government healthinfrastructure and service providers from amode of inertia to a reactive mode. Making thegovernment machinery pro-active still remainsan elusive goal. Now at least the communitiescovered by the project have been able tosecure a relatively more stable presence ofhealth personnel at the sub-centre and primaryhealth centre levels. Medicines are also ingreater supply at these delivery points and aredisbursed to the needy. A really noticeable

change has been the establishment of regularimmunisation camps in the villages with a wellmaintained cold chain by the authorities toensure the efficacy of the vaccines.

3.2 Linkage bilding and resrcebilisatin

In the arena of empowerment, linkage buildinghas become increasingly institutionalised over theyears. CBOs have been able to pursue linkage

building efforts on their own and in a manner thatit does not require mediation by the project. Anatural consequence has been the reduction ofthe role of NGOs in this pursuit. Trained NGOworkers are staffing government programmes,such as the Integrated Child Development Schemeand disaster preparedness training. Communityinitiatives have made considerable headway insuccessfully laying claim to entitlements throughregular interface and exchange of informationon government schemes/programmes and in

accessing institutional finance such as bank loansas well as government subsidies and loans.

Another key feature has been enhanced internalresource mobilisation. The NGOs have deployedinnovative strategies to enhance the capacities ofCBOs towards greater mobilisation of physical,financial and human resources. The strategiesdeployed entail building up corpus fund;introducing higher rates of savings; linking CBOswith banks/financial institutions; introducingmembership fee and improved management andmarketing systems. Through savings alone groupshave enormously increased their resources. Thefollowing table depicts the status:

Overall the strategy of village health postsand voluntary health promoters has beeneffective. The main role of the village health postshas been the extension of health education,support to pregnant mothers and growthmonitoring of children backed by counsellingof mothers of malnourished children. Beyond

that they supplied basic treatment with thesmall number of drugs they kept in store.Two evaluations (1999/00 and 2003) haveconfirmed the appropriateness of the healthmessages. Communication skills in healtheducation were also found to be adequate.Health prevention, which was completelyabsent at the onset of the project, was nowwell internalised by the majority of the targetgroup and put into practice. The communitieswere involved to varying degrees in these

health programmes. All households providedfinancial contributions or unpaid volunteers.No community health post was able to recoverall the costs, although the best ones came close.Village health committees were supervisingthe village health posts and some committeemembers even took part in monitoring exerciseswith the staff.

Deand creatin

However, the most significant outcome of theproject has been demand creation amongsta critical mass of villagers for essential healthservices. The last five years have witnessed an

Village health post attended by paramedic


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Table 3: Comparative status of savingsmobilisation in Indian Rupees29

PartnerNGos

SHGssavings in

2005

SHGssavings in

2006

% in-crease

BMVS 1711265 2049000 19.74

PNDSS 1229530 1453171 18.19

SSVK 758997 833643 9.83

GVP 5151860 5945916 15.41

Ttal 8 851652 10283736 16.18

3.3 Cnflict resltin and legalspprt

The ability to effectively resolve conflictsis perceived as one of the most significantbenefits emanating from getting organised. Thisis particularly relevant across all working areas.Community representatives are unanimous intheir opinion that SHGs and their federationshave come to command adequate legitimacy toresolve household and village conflicts. Sanctionsranging from suspension to cancellation of

group memberships have been put in placeto make contesting parties abide by groupdecisions taken in this regard. With groupshaving internalised the need to create a winwin situation for conflicting parties, SHGs rarelyresort to imposing such sanctions. Diminishingtrend in instances of domestic violence, greateracceptance of women in the role as a leader,declining expenditure pattern on legal cases, anddecreasing trend in number of court cases aresome of the indicators that reflect the enhanced

conflict resolution abilities of CBOs.

Individual members of marginalised groups oftenfind it impossible to appeal for justice. Onlybacked up by group solidarity and collectivesupport can the individual hope for a fair trial.The following event, of the hundreds taking place,provides an example of the role of women SHGsin this regard.30

Case Std 3: Wen accessing scialjstice

In Ramnagar, one of the project villages, SoniDevi, a scheduled caste woman experiencedthe wrath of people belonging to the dominantcaste of the village. Soni Devi, one day ventured

into the orchard of a rich landlord, to collectfirewood. The landlord along with his sonpounced on the poor woman and thrashedher so badly that she almost died. Onhearing about the incident, a member of thevillage federation of SHGs promptly reportedit to Prema Devi, the federation leader. She,along with other group members, rushed tothe spot at once. After sending the victimto Gaighat hospital for treatment, the groupcontacted the village committee and the

village Mukhiya (headman) to set strategy forfurther action. The group swung into actionimmediately and called for an emergencymeeting of the village federation which wasalso attended by local politicians. It wascollectively decided that, apart from a publicapology, the culprit would have to pay Rs.3500 as penalty to the victim to compensatefor the loss of her wages on account of herinjury. The culprit was forced to offer anapology and pledge not to repeat behaviour

of this kind in future.

3.4 Twards pr-pr gvernance

As part of taking democracy to the grassroots,Bihar, through the revival of Panchayati RajInstitutions (PRIs) has, since 2001, developeda three tiered local governance structure fromthe district level down to the village level. Thevarious bodies of governance at the district,block and village levels are entrusted withplanning, implementation and monitoring ofdevelopmental functions as provided for in theBihar PanchayatiAct. The health infrastructureroughly corresponds to these levels ofgovernance and their functionality falls withinthe purview of the respective governanceinstitutions. This has created an institutionalisedspace for articulation of the voices of the poorto improve social sector outcomes in areas suchas health and education.

29 Swiss Red Cross 2006. Report for Humanitarian Foundation. Bern: Swiss Red Cross.30 Neupane/Kishore 2003.


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Amrika Devi: Once you have knowledge, why should you depend on what others say?You start thinking for yourself.

In a bid to make the PRIs more effective, theSRC supported awareness programmes and

capacity building measures aimed at conductingfair Panchayat elections and having communityrepresentatives elected to these local bodies.It subsequently built capacities of electedrepresentatives of PRIs. CBO and SHG memberswere encouraged to select and support suitablecandidates from amongst themselves.

As a result of sustained campaign andcapacitation, in the 2006 elections the totalnumber of elected members hailing from

CBOs and SHGs of the programme area hastaken a quantum leap when compared to theoutcome of the 2001 elections. Whereas 137target group members in all were elected tovarious offices of the PRIs in 2001, a total of427 members were elected in 2006. Table 4delineates the details of achievements attainedin the 2006 elections in the working area of fourNGOs in Bihar.31

Across all NGOs out of a total of 1490 seatsat various levels of PRIs, target group memberscontested 803 seats and were able to secure

election to 427 seats (53%). Out of the 427successful candidates, 90% were women (with the

exception of SSVK, the other three organisationswork exclusively with women and had fieldedonly women candidates).

The Bihar Panchayat Act, 2006, provides for 50%reservation for women in PRIs. The increasingparticipation of women in these institutions oflocal governance will in the long run necessarilyensure reduction in gender disparity in generaland gender induced vulnerabilities in the areaof health and education in particular. As of now,

the enhanced participation in PRIs has had adefinitive impact in inducing improved deliveryof social sector services. For instance in health,

Auxiliary Nurse Midwives, the first line healthservice providers, undertake regular village visits,the absenteeism of doctors and para medicalstaff shows a downward trend, and medicinesare made available. However, due to limiteddevolution of financial powers to the PRIs, theyhave hardly any role in financial planning whichcontinues being the prerogative of the stategovernment.

31 So far no PRIs elections were held in Jharkhand.


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32 Swiss Red Cross 2006. Report for Humanitarian Foundation. Bern: Swiss Red Cross.

33 A Ward member is an elected representative of the hamlet within the revenue village, entrusted with developmentfunctions of the hamlet, who also assists the Mukhiya in his functions.

34A Panch is an elected representative of the hamlet within the revenue village, entrusted with judicial functionspertaining to the hamlet, who also assists the Sarpanch in his functions.

35 The Mukhiya, along with the Sarpanch, is heading the Gram Panchayat (village council), which is the primary unitof PRIs. The Mukhiya is entrusted with administrative/developmental functions and the Sarpanch with quasi judicialfunctions.

36 Panchayat Samitis, secondary units of PRIs, are responsible for planning, execution and supervision of alldevelopmental programmes in the block. They also supervise the works of Gram Panchayats within their

jurisdiction.37 Zila Parishad, the apex body of PRIs, is entrusted with execution of development schemes, providing civic functionsin the district and looking after the duties of the government delegated with regard to certain departments as perguidelines.

Partner NGOs

BMVS

total seats / seats

contested / seats

won

PNDSS

total seats / seats

contested / seats

won

GVP

total seats / seats

contested / seats

won

SSVK

total seats / seats

contested / seats

won

Wardmember33 53 / 41 / 28 143 / 29 / 25 210 / 93 / 61 220 / 163 / 95

Panch34 53 / 32 / 28 143 / 10 / 09 210 / 93 / 67 220 / 171 / 54

Mukhiya35 04 / 04 / 01 09 / 15 / 00 14 / 11 / 05 16 / 12 / 02

Sarpanch 04 / 02 / 01 09 / 09 / 01 14 / 11 / 08 16 / 14 / 05

Panchayat

Samiti3630 / 13 / 01 56 / 00 / 00 66 / 42 / 27 60 / 26 / 07

Zila Parishad37 03 / 02 / 00 03 / 02 / 00 05 / 05 / 01 03 / 03 / 01

Total 147 / 94 / 59 363 / 65 / 35 519 / 255 / 169 461 / 389 / 164

Table 4: Performance of target group members in local elections in 200632


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4.1 Sccess factrs

Some of the key factors that contributed tothe success of the programme and/or to the

achievements are highlighted below:

The programme addressed the actual needs of thecommunities and applied a participatory strategywhich gradually adopted an empowermentmode. This strategy ensured the willingnessof local communities to improve their healthand overall living conditions through voluntaryengagement in self-help initiatives. Leaders andvolunteers of CBOs, SHGs and their federationsrealised the benefits of their efforts for the larger

community and this added to their self esteem.Their key role, which became a driving forcewithin the programme, entailed extending supportto SHG management, information dissemination(pertaining to rights and entitlements forgovernment programmes and schemes) andforging linkages with relevant institutions. Further,they acquired capability to mobilise both externaland internal resources with minimal dependenceon external agencies, thereby enhancing theirown sustainability.

Significant inroads were made towards ensuringpro-poor governance by having a greaterrepresentation of target group members in the PRIs.It is expected that these elected representativeswill take up and further the cause of the deprivedand the marginalised.

An advantage has been the implementationthrough locally well established and credibleNGOs coordinated by IIDS as SRC ProgrammeCoaching Unit. The NGOs have concentrated

on skill consolidation in areas of their corecompetence, which has definitely helped themcarve a strategic niche for themselves. Thecapacitation inputs were designed in a mannerconducive for facilitating the emergence ofBadlao, GVP, PNDSS and BMVS as self-helppromoting institutions. The programme hashelped these NGOs to consolidate their corecompetences. In addition, the NGOs haveacquired new capacities through workshopsorganised and facilitated by IIDS as well as their

internal training programme. The workshopsalso led to practical experience sharing amongmanagement and staff of the different NGOsand helped to create a common vision.

After the Bihar assembly elections in 2005, thechange of government has created a milieu ofdevelopment with a more positive orientationtowards NGOs and civil society organisations.

4.2 Liitatins and challenges

The organisations continue to confront limitationsand challenges inspite of significant advancesmade by the project in the area of health, groupformation and consolidation and empowermentof the target communities. The challenges andlimitations require priority action both on part ofthe NGOs and the government if the achievementsand gains of the projects have to be sustained.

With regard to health intervention, there stillremain critical issues to be addressed in a morecomprehensive manner. This is especially true withregard to promotion of family planning measureswhich have not yielded the desirable results. Thisgets reflected in both field level experiences aswell as in the crude birth rate, which overall isnot declining. Hygiene and appropriate sanitationpractices and behaviour are other weak areaswherein very little is discernible in terms ofproject impact. Latrine use and hand washingpractices have significant bearing on healthprofile of communities. Although these issueswere addressed through the health educationcomponent the results did not show a significantreversal in trends of latrine use and hygienepractices.

The challenge for interventions designed around ahealth post strategy is to strike a balance betweenhealth post activities and preventive measures suchas health education and awareness campaigns

which are not essentially health post centric. It hasto be admitted that there has been a tendency tofavour attention on health post activities.

Though the SHGs have witnessed expansion intheir resource base through forging linkages withfinancial institutions, the coverage by incomegenerating programmes still calls for improvement.On the supply side a major challenge is thestate of financial institutions in Bihar which areseverely wanting in terms of meeting credit needs

of the SHGs, as bank officials still have not beensensitized enough to the potential of microfinancing through SHGs and womens role indevelopment. Moreover, since CBOs and SHGs

4 SuCCESS FACToRS, LImITATIoNS AND CHALLENGES


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are still young, the process of empowermentneeds to be continued. This in large part woulddepend on proper enforcement of existing pro-poor policies and on promotion of new inclusiveprogrammes and policies. Towards this end theNGOs have to be vigilant and ensure that theseget effectively translated into grassroots action.

Local NGOs because of weak networking havefailed to optimise on fund raising opportunitieswhich have increasingly come to favour networkfunding. In order to remain competitive especiallywith regard to fund raising and resourcemobilization the organisations also require to havea more nuanced understanding of the changinglarger development scenario, its bearing on keystakeholders and steps required to meet theprevailing challenges. Documentation remains

another weak area with most of the NGOsand this has hindered capturing key processes,experiences and learning generated throughthe project. Weak documentation also impedeseffective showcasing of achievements and resultswhich otherwise can be effective in mobilizingresources.

Flood proneness of North Bihar, where three outof five NGOs have their operational area, remainsan overarching challenge. The increasing trendregarding frequency and scale of floods overthe past decades is alarming. In 2007 alone, 21million of people got affected. Given the absenceof strategic flood coping mechanism in place thishas a serious impact on the overall developmentand also robs grass root level developmentinitiatives of some of its gains.

Flood affected hamlet, North-Bihar 2007


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Cnit-based health care

During the first ten years (199099) CBOs, SHGsand their federations were capacitated and became

functional in disseminating preventive healthmessages and organising village health posts. Thisbalanced effort to promote healthy behaviourand provide essential care yielded very positiveresults. According to the programme evaluation in1999 important health indicators in the workingarea were far better than the average situationin Bihar (see table 2). This proved that throughtraining of local health promoters and villagehealth committee members and the provision ofbasic infrastructure (materials for village healthposts) it was possible to achieve relevant impacton health even under unfavourable conditions.

The improvement in the health situation waspossible through continuous support over agenerous time period of ten years. Although therewere some set backs, it created a new awarenessabout health problems, their causes and thebenefits of preventive measures, and led tobehavioural changes, especially among women.Curative services as part of the village healthposts were in high demand for mother and child

health but community financing was weak andthe services could barely be sustained withoutexternal support.

Fr service deliver twards epwerent

In 1999 it was realised that in the long termperspective there had to be other ways to bringhealth services to under-served villages in asustainable manner. According to the communityempowerment strategy, introduced in 2000, localcommunity members and their organisations wereendowed with sufficient information38 to demandfrom the state the services that it is supposed torender the poor and vulnerable. During the lastfive years (2002-06) local communities, throughunrelenting pressure, achieved reasonablesuccess in influencing health care and otherservice providers to become more accountableand effective in addressing peoples needs.

A long-term vision prior to the initiation of thedevelopment programme could have helped

to achieve the current results in less time.Due to participatory planning and also to

effective strategies for moving towards self-reliance the empowerment phase has beenmuch more effective in terms of visible resultscompared to the previous years. Therefore, it

would be wise to strike a balance right at thestart of the programme in terms of investing incommunity based service delivery, at the sametime allocating adequate resources for capacitybuilding of the CBOs, promoting self-help forhealth initiatives, and establishing institutionallinkages with government agencies. Such astrategy would be a more sustainable optionthan creating parallel programmes without anyconvergence. Measures to address demand andsupply constraints pertaining to essential services

should be incorporated in a singular programmephase instead of being spread over severalphases.

CBOs, SHGs and their federations could begradually developed as a common forum forall development activities. These organisations,which initially managed health and educationactivities, are now capable of addressing a broaderrange of development issues by networking withgovernment agencies and other development

actors. Skilled community resource persons playan important role here. However, to what extentthe work of community resource persons and thefunctioning of community resource centres canbe sustained without external support is still anunresolved question.

Ince generatin

Experiences have shown that only economicallyempowered community members or groups canaddress health, education and other development

issues with full commitment. Besides, economicwellbeing is an important aspect of theempowerment concept that allows the poor toget out of the poverty trap and increase theirabilities to cope with social problems. Thus, SHGsand their federations should gradually evolve intoforums for broader development issues, includingeconomic ones, instead of limiting themselvesto health and education. Apart from that,income generation proves to be instrumental inchallenging traditional gender relations and in

raising the status of women within their familiesand the society at large.

5 CoNCLuSIoNS AND LESSoNS LEARNT

38 Based on the Right to Information Act.


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Sstainabilit f CBos and SHGs

The participatory and need-oriented approachenhanced the willingness of local communitymembers to engage themselves on a voluntarybasis in development initiatives. This commitmentwas reinforced through the realisation of positiveachievements resulting from these initiatives. Apartfrom peoples commitment, the sustainability ofCBOs, SHGs and their federations depends toa large degree on their institutionalization, theirorganizational capacities and their financial self-reliance.

Institutionalization implies recognition bycommunities and local actors, as much as well-established relations with public organisations,governmental bodies and non-governmentalstakeholders. In terms of organisational

capacities, autonomy in handling their affairs,internal governance and management, capacityof conflict resolution, ability to keep memberscompliant with established norms and rules, aswell as potential for building linkages and networkson their own prove to be central. The financialself-reliance of those grass-roots organisationsimplies their abilities to mobilise local resources,which depend on access and linkages to localfinancial institutions, governmental and non-governmental development programs, as well

as a certain degree of up-scaling that allows forbetter efficiency and more leverage.

Although CEP has brought about significantimprovements regarding the above mentionedfactors of sustainability, these organisations arestill young and the process of empowermentneeds to be continued. It will also largely dependon the further emergence of pro-poor policiesand programmes which are geared to supportthis process. The establishment of PRIs in Bihar

with a 50% quota for female representatives,pro-poor government programmes, the conceptof SHGs and favourable conditions for accessingbank loans and the Right to Information Actare some important improvements which inrecent years have led to better conditions forgrassroots organisations. It is hoped that thepositive momentum that has been created willbe continued.

Gd gvernance and inclsin f arginalisedgrps

The empowerment approach is incomplete ifit does not build on mechanisms of long-termgovernment accountability and internalisation ofgood governance skills. The major mechanismsapplied by CEP include the following: partneringof CBOs and SHGs with the government andsupporting community initiatives in laying claimsto entitlements regarding governmental schemesand programmes; assisting communities incontesting exploitative acts of the local powerstructures; encouraging participation ofcommunity members in various bodies created bythe government for monitoring its programmes;and preparing community organisations forincreasing their representation through electionsin various bodies of PRIs.

The election of female representatives ofmarginalised communities into the variousoffices of PRIs gave them a strategic position forarticulating their interests, making governmentbodies and their policies more pro-poor andsecuring development and welfare entitlementsfrom the government. The elected representativesrequire further orientation and capacity buildingfor discharging their functions effectively andmaximising opportunities to influence local

development plans and allocations.

Development initiatives such as CEP may provideimportant lessons for improving the situation inresource poor and poverty infested areas and forthe empowerment of marginalised communities.However, they can only create pockets ofimproved grassroots level development unlessthere will be stronger partnership between thegovernment and the civil society guided bydesirable changes in the macro policy framework.

While it is encouraging that the present centralgovernment envisages increased spending foreducation and health, higher spending shouldalso be coupled with administrative and politicalreforms. Decentralization from the state to thelocal levels in these areas could lead to better accessand control, and ultimately, to accountability ofgovernment officials, such as teachers and healthpersonnel, especially in rural areas.


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Bajpai Nirupam, Jeffrey D. Sachs and NicoleVolavka 2004. Reaching the MillenniumDevelopment Goals in South Asia, CGSD WorkingPaper No. 17. New York: The Earth Institute at

Columbia University.

Eppler Peter, Neeraj Labh and Amitabh Sharma2005. Assessment Mission Report 2005. Bern:Swiss Red Cross.

Eppler Peter 2004. Vom Gesundheitsprojekt zumEmpowerment von Frauengruppen in Jharkhand,Indien, Der lange Weg aus der Unterdrckung,in: Bulletin von Medicus Mundi Schweiz, Nr. 94,pp 8-11.

Gareth Jones, Werner Schultink and Babille Marzio2006. Child Survival in India. Indian Journal ofPediatrics, Volume 73 (No. 6): 479-487.

Government of India. Right to Information Act2005. Obligations and Responsibilities. NewDelhi: Goverment of India. . 22.04.2008.

Governemnt of India. Special Task Force 2007.

Bihar: Road Map for Development of the HealthSector. New Delhi: Government of India: 7.

Government of India Planning Commission 2006.National Human Development Report 2001. Table2.21. New Delhi: Government of India PlanningCommission.

International Institute of Population Sciences2006. National Family Health Survey (NFHS-3)2005-06, India Volume I. Mumbai: International

Institute of Population Sciences.

Mihai S. Jalba 2004. Forum. Indian Journal ofTuberculosis 51: 112-115.

Ministry of Health and Family Welfare,Department of Family Welfare. Maternal HealthProgramme. . 19.04.2008.

National AIDS Control Organisation 2006.HIV Data. New Delhi: National Aids ControlOrganisation. . 19.04.2008.

National Bank of Agriculture and RuralDevelopment (NABARD) 2006. Annual Report2005-06. Mumbai: National Bank of Agricultureand Rural Development.

Neupane Ram and Kishore K. Singh 2003.Evaluation of Bihar Community DevelopmentProgramme. Bern: Swiss Red Cross.

Office of the Registrar General & Census

Commissioner. Census of India 2001. ScheduledCastes & Scheduled Tribes Population. NewDelhi: Office of the Registrar General & CensusCommissioner. . 19.04.2008.

Office of the Registrar General & CensusCommissioner. Census of India 2001. TotalPopulation. New Delhi: Office of the RegistrarGeneral & Census Commissioner. .19.04.2008.

Schth Tobias and Anil Chaudhary 1999/2000.Evaluation of Community DevelopmentProgramme, Bihar/Jharkhand. Bern: Swiss RedCross.

Swiss Red Cross 2006. Report for HumanitarianFoundation. Bern: Swiss Red Cross.

The World Bank 2005. Bihar Towards aDevelopment Strategy. Washington: The WorldBank.

The World Bank 2007.Jharkhand, Addressing theChallenges of Inclusive Development. Report No.36437- IN. Washington: The World Bank.

REFERENCES


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Initiatives in Develpent Spprt

Initiatives in Development Support (IIDS) wasregistered as a partnership firm in 2002. IIDSowes it origin to the SRC Programme CoachingUnit which consisted of local experts mandatedby SRC to provide consultancy to collaboratingpartner NGOs on organizational and technicalaspects as well as in project cycle management.Over the years IIDS has acquired experience ofworking in diverse contexts with various NGOsof repute. Besides working with a numberof organisations in Bihar, it has providedmanagement and technical support to NGOssuch as Self Employed Womens Association(SEWA), URMUL Trust, South Indian Federationof Fishermen Societies (SIFFS) and Social NeedEducation and Human Action in the state ofGujarat, Rajasthan, Tamil Nadu and Pondicherryrespectively. IIDS has its headquarters at Patnaand regional offices in Ahmedabad, Gujarat andKaraikal, Pondicherry.

Badla Fndatin

Badlao Foundation (BF) was registered as atrust in 1982. The long association with thesocialist movement in general and the studentmovement led by the Indian freedom fighterand political leader Jayaprakash Narayanin particular, prompted the organizationalleadership to work for the upliftment of thedeprived tribal population. The displacementof the tribal population in the villages of

Jamtara block, due to the building of a damin the region, attracted the organizational

leadership and BF started work in these villagestowards alleviating the plight of the displacedtribal population. The initial focus was on thedisplaced Sauria Paharia tribe. The objectivewas to enhance the socio-economic status ofthese tribals and promote tasar silk spinningfor income-generation. The organisation hassince moved on to other community projects,establishing womens groups, called mahila

sabhas, as micro-credit channels and thriftgroups to promote and support entrepreneurial

programmes. The foundation has succeededin bringing about greater awareness of rightsand entitlements amongst tribals. It is presentlyworking, primarily with the deprived tribal

population, in 445 villages in the six districts ofJamtara, Dumka, Deogarh, Godda, Pakur andSahebganj in Jharkhand.

Bhsra mahila Vikas Saiti

Bhusura Mahila Vikas Samiti (BMVS) was registeredas a society in 1988. The organizational leaderhad his initiation into social work as a staunchfollower of the Ghandian Sarvodaya movementin 1966. BMVS stands for the economic, socialand political empowerment of the poor to ensuretheir effective and equitable participation in thesocietal mainstream. The organisation is at present

working in 210 villages in Muzaffarpur District ofNorth Bihar. The target group of the organisationprimarily consists of the socially and economicallyexploited women and children particularly fromthe scheduled and backward castes. BMVS isworking in the area of income generation, savingsand credit programmes through SHGs, motherand child health care, education (non-formal andadult education),panchayati raj, and disaster riskmanagement.

Gra Vikas Parishad

Gram Vikas Parishad (GVP) was registered as asociety in 1987. The organization aspires for theestablishment of an egalitarian society based onthe principles of equity (including gender equity),

justice and fraternity wherein collective endeavourhas the potential of actualizing humane ends. GVPhas been one of the pioneers of SHG movement inBihar and has carved a niche for itself as a self-helppromoting institution in the region. It provides thenecessary support to a network of 11 NGOs inthe area of self-help promotion. GVP is working in275 villages of Madhubani & Darbhanga districtof North Bihar. It is working with Dalits and otherbelow-the-poverty-line caste groups, especiallywomen and children, and on socio-economic,educational, political and health issues.

Patna Ntre Dae Sisters Sciet

Patna Notre Dame Sisters Society (PNDSS) isa Catholic congregation with headquarters at

Patna. Though the society is primarily concernedwith running educational institutions, thecollaboration with SRC occasioned a shift tofacilitating programmes oriented at community

BRIEF PRoFILE oF CoLLABoRATING PARTNERoRGANISATIoNS oF SRC


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development and empowerment. Through itssister organisation located at Jamalpur in Mungerdistrict of Bihar, the organisation has beenworking with the Dalit and tribal population inthe region with special focus on women andchildren hailing from these communities. Theorganisation is at present working in 45 villages

of Munger district and is engaged with groupformation, income generation, mother and childhealth care, education, educating communitieson their entitlements and building linkages withgovernment programmes.

Saajik Shaikshanik Vikas Kendra

Samajik Shaikshanik Vikas Kendra (SSVK)was registered as a society in 1986. Theorganizational leadership had its initiation into

social commitment in the course of the 1974students movement that broke out all over Bihar.Consequently, SSVK was formed with a vision of

establishment of an egalitarian society, devoid ofany kind of discrimination and exploitation basedon caste, class, gender, race or religion. Thetarget group of the organisation primarily consistsof below-the-poverty-line Mushar families. Inaddition, commitment is also to other below-the-poverty-line groups coming from other scheduled

castes and depressed backward classes. Theorganisation is at present working intensively in1399 villages in Madhubani, Saharsa, Darbhangaand Supaul districts of North Bihar. Besidesworking in the area of mother and child health,non formal education, eradication of child labour,the organisation has been engaged in supportingentitlement oriented movements, especiallywith regard to the land and water rights of thecommunity. The formation of SHGs has not onlyreduced dependence on local money lenders but

also enabled members to sustain many a strugglefor their rights.


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Swiss Red Cross

International Cooperation

Rainmattstrasse 10

3001 BerneSwitzerland

www.redcross.ch

Initiatives in Development Support

A1/50, Vivekanand Path

North S.K Puri

Patna 800013Bihar

India

[email protected]

Authors

Peter Eppler, Amitabh Sharma and Neeraj Labh

Study Design

Verena Wieland

Editing

Elena Krylova

Fotos

Peter Eppler

Swiss Red Cross Publication, April 2008

The case study was co-funded by the Swiss Agency for Development and Cooperation (SDC).

This case study from Bihar and Jharkhand is part of an international study of Swiss Red Crosscovering experiences from projects in Ecuador, Eritrea, India and Kyrgyzstan and providing anin-depth analysis of individual country experiences and of cross-country comparison withregards to common course, differences and lessons learned.

community action for health case study from bihar and jharkhand, india

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