Distict Name: Bihar

Jamui, Bihar

Jamui, Bihar

Consultant: Shiv Shankar

Data theme: Health and Nutrition

Objectives: 

  1. Regularize Adolescent Friendly Health Clinic services and allocate dedicated trained counselors  in six Primary Healthcare Centers
  2. Improve coverage of sanitary napkin provision through budget advocacy at the district level 

Key Outcomes: In Jamui,  the intervention conducted a series of discussions with adolescents, their parents, and frontline workers like ASHAs, anganwadi workers  to increase awareness about Adolescent Friendly Health Clinics. A group of 60-70 adolescents from an area served by six primary healthcare centers signed a demand letter asking for regular AFHCs to be set up. 

Six primary healthcare centers designated dedicated rooms for AFHCs. This was a huge win, which would ensure that the adolescents who come to the clinic can talk about their concerns privately and confidentially. A board showing the services was put up at the clinics, which were equipped with condoms, IFA tablets, contraceptives, sanitary napkins, and government pamphlets on SRHR, etc. Each AFHC has also been designated an RKSK-trained ANM to act as a counselor.

To increase the use of sanitary napkins, adolescent girls and their parents were made aware of the Direct Beneficiary Transfer (DBT) scheme. Simultaneously, the DBTs were regularized and now are put in adolescent girls’ accounts. An order was issued by the District Education Department to schools so that they ensure steady supply of sanitary napkins. A verbal commitment was  also made to increase budgetary allocation for sanitary napkin procurement in the district

Process:  This intervention focused on data related to access to Adolescent Friendly Health Clinics (AFHCs) and on sanitary napkin usage. The data related to access to AFHCs in the UDAYA study corroborated the on-ground experience that there are several gaps in the smooth running of AFHCs. Similarly,  many adolescent girls were not able to use sanitary napkins even though they were getting Direct Beneficiary Transfers (DBT) to buy them. This was largely because they didn’t know they were receiving this money or what it was for. Medical officers and the District Health Society (DHS) consulted at the beginning of the intervention also supported the use of UDAYA data to increase awareness about these services. 

Frontline workers like ASHAs and ANMs usually do not have the time to talk to adolescents about their health because they have several other responsibilities to fulfill in limited time. As a result adolescents and young people don’t have anyone to talk to about issues like menstrual hygiene, contraceptives, sexual health, nightfall, etc. Using the UDAYA data, the intervention engaged adolescents, frontline workers like ASHAs, anganwadi workers, and parent groups. The data were shared as diagrams on chart paper to start conversations, specifically on issues about sexual health that are treated with secrecy. A series of FGDs were also conducted, sometimes with parents and young people together, to share their issues and concerns related to adolescent sexual reproductive health and rights.

Eventually, 60-70 adolescents were mobilized as advocates. They put forward recommendations to make regular AFHC services available at 6 PHCs in Jamui district. The set up of AFHCS at six primary healthcare centers is a huge win for adolescents.  Three of these PHCs also have peer educators who sit at the clinic every Saturday. They will also encourage adolescents to visit the clinics. 

“We have started the conversations, now we must work hard to ensure access. For instance, it is still difficult for girls to come to AFHCs because they are often 10-20 kms away from their houses,” says Shiv Shankar, the consultant who supported the intervention.

Another advocacy focus was to increase the use of sanitary pads in the communities. Many girls continue to use cloth pads because they don’t have money to buy pads. However there are funds to make sure sanitary pads are available at subsidized rates through schools, and through Direct Beneficiary Transfers. Many adolescents were getting the Direct Beneficiary Transfers but they didn’t know it because the money was often clubbed with other schemes, like the cycle scheme. So girls and their parents weren’t aware what the money was for.

A crucial advocacy effort was to raise awareness about these transfers, and to make them regular and clear. Now when they don’t receive it, the girls are quick to ask for it. There are still some challenges. For example, one girl called the consultant  to tell him that her mother used the money to buy fertilizer. So, the conversation with the mother of the young girl was to negotiate these two needs, and to convince her that buying sanitary napkins was as important as fertilizer, because it was about her daughter’s health. 

Additionally, youth clubs are being formed at PHCs. This will encourage adolescents to continue to talk about their health issues with peer educators even after the project is over. Many of the adolescents involved in the current project have started talking about adolescent SRHR issues after understanding the data that was disseminated. This created a ripple effect because young people were excited to talk about these issues and to involve their parents in these discussions

Madhubani, Bihar

Consultant: Ramesh

Data theme: Health and Nutrition, Entitlements.

Objectives: Improve Weekly Iron Folic Supplements program coverage at the school level by addressing distribution barriers; Improve access to information and counseling on nutrition specifically on risks of anemia, importance of diet diversity, IFA supplementation.

Key Outcomes: The project engaged adolescents at five high schools and 10 Anganwadi centers.

At least 100 people including adolescents, Anganwadi centers, school teachers and other stakeholders were made aware of the Weekly Iron Folic Supplements programme. 

School youth committees have been formed to address adolescents’ health concerns and increase awareness about different services.

The medical officer in-charge (MOIC) organized a health screening, and IFA distribution for adolescent girls in the select schools. The MOIC and the Block Resource Coordinator also further committed to procuring IFA tablets on a regular basis, by issuing official letters for this.

Process:  The focus of this project was to improve the in-school implementation of RKSK, specifically the Weekly Iron Folic Supplements programme (WIFS) programme, by addressing distribution barriers and improving access to information and counseling. The primary concern here was that Iron Folic Acid (IFA) tablets were not being given out to adolescent girls. Additionally during field visits, it was seen that many schools didn’t have girls-only toilets; they often shared toilets with boys. These issues were addressed through meetings with school teachers, block department officials, Anganwadi workers and frontline workers like ASHAs and ANMs. 

The meetings and consultations revealed that IFA tablets weren’t being given at schools because the relevant staff weren’t aware of this aspect of the WIFS scheme; they thought that Anganwadi workers and FLWs should provide adolescent girls with IFA tablets. However, on learning about their responsibility the teachers responsible and medical officer in charge were quick to take action. They have committed to regularize WIFS service components at the selected schools and anganwadi centers. A letter was also issued by the District Health Society to scale up school-based awareness activities and regularize WIFS in all schools  

To ensure that out-of-school adolescent girls also get IFA tablets on time, further conversations are being carried out with the Child Development Programme Officer (CDPO) in-charge of anganwadi centers. Another success of the project has been the formation of school youth committees to address adolescents’ health concerns and increase awareness about different services. These have peer educators and one male and female focal point teacher who act as counselors to help them. Additionally, many schools have repaired their toilet facilities so that girls have access to clean toilets — an important step to keep girls in school.

Nawada, Bihar

Consultant: Bharat Bhushan

Data theme: Entitlements, Health and Nutrition, Agency Community and Citizenship

Objectives: To improve nutrition information and service coverage under Scheme for Adolescent Girls (SAG) in select blocks of Nawada district 

Key Outcomes:  The project engaged girls from 11 kishori samuh (adolescent girls’ groups) in 10 villages of Nawada District. Through awareness camps, they learnt about the services available under the Scheme for Adolescent Girls (SAG) including the distribution of Weekly Iron Folic Supplements, and how to access them. From this larger group, 15 girls were selected as yuva netas (youth champions). These girls went through leadership training and also understood how to monitor and advocate for the delivery of the SAG.

A petition was delivered by 15 girls to the Medical Officer in Charge (MOIC) asking that adolescent clinics be opened once a week, so that they could avail of Weekly Iron Folic Supplements and other services like counseling. As a result the Block Development Officer has issued a letter, and now the clinic is open every Tuesday and Thursday of the week. The Block Development Officer has assigned duties to ANMs to be available. The girls now regularly access the clinics at the primary healthcare center, and take others from the community with them.

To ensure that adolescent health issues are addressed at the Village Health Sanitation and Nutrition Days (VHSND), several meetings were conducted with the VHSND Committees and Panchayati Raj Institutions. This has resulted in a verbal commitment that ANMs will take out time to hear adolescent girls’ concerns privately.

Process: This intervention used data on adolescent girls’ nutrition levels and on anemia from the UDAYA data. The primary concern was that young girls were not receiving the Weekly Iron Folic Supplements as prescribed under the RKSK programme. The intervention focused on preventing malnutrition and anemia amongst adolescent girls, as this would improve several other health outcomes.

The data were used at two stages of the project. First, it was used in the awareness sessions and training conducted with adolescent girls. This helped the girls visualize what the problems in their communities with regards to health and nutrition are and what they should look out for while monitoring the schemes later. Secondly, the data were used to start conversations with government officials who were being engaged through the project. The officials saw that the data as an opportunity to improve service delivery. 

One big achievement was that the girls delivered a petition to the Medical Officer In Charge (MOIC) asking that adolescent clinics be opened once a week at the primary healthcare center. 

“The girls had demanded only one day but looking at how passionate they were when they delivered their petition, the MOIC went further and allocated two days a week. It is amazing to see that these young girls, who normally didn’t even step out of home, are now empowered to seek their rights,” says Bharat Bhushan, the consultant who supported the intervention.

A related strategy of the project was to make sure that adolescent health issues are addressed at the Village Health Sanitation and Nutrition Days (VHSNDs). With the long agendas the ANMs and doctors must cover at the VHSND, adolescent health issues were left out, especially counseling. Young people were not getting the privacy they wanted while talking about their concerns and questions. For this, meetings with Village Health Sanitation and Nutrition Committees and Panchayati Raj Institutions have resulted in a verbal commitment that ANMs will take out time to hear adolescent girls’ concerns privately. At a few of the VHSNDs that happened during the project, the yuva netas assisted the ANMs and also took the opportunity to monitor the event. They monitored how many women came, and what services were given.

The adolescent girls now regularly visit the local primary healthcare center  and take others from their community. This goes a long way in generating demand for services, and eventually making sure that services are made available. When services aren’t available, they’re quick to call the consultant  to ask what further steps they can take, including visiting government officials. The aim of the project is to make sure that the girls feel equipped and confident to deal with these issues themselves. This will make sure that even when the project is over, the capacities that were built will stay with the community for a long time to come.

Vaishali, Bihar

Vaishali, Bihar

Consultant: Akhtari

Data theme: Health and Nutrition, Entitlements, Agency Community and Citizenship

Objectives:

  1. Improve quality of adolescent health services at Adolescent Friendly Health Clinics (AFHCs) and Village Health and Nutrition Days (VHND) 
  2. Increase in budget allocation for Information Education Communication/Behavior Change Communication for AFHC services

Key Outcomes: This project focused on 10 panchayats in Bhagwanpur block.  

A survey was undertaken with 50 frontline workers from the 10 panchayats to understand what they know about adolescent health issues and schemes. The findings highlighted that no Adolescent Friendly Health Clinics were being run and no health days being organized. These were mapped against findings from the UDAYA study and shared with frontline workers. Based on this, frontline workers in 10 panchayats organized kishori swasthya camps (adolescent girls health camps) in their panchayat anganwadi centers. Here they conducted a health screening of the girls including checking weight, oxygen levels; shared information about menstrual hygiene; and distributed IFA tablets.

A series of advocacy workshops were organized with adolescent girls across the 10 panchayats, where the UDAYA data was shared with them and they were made aware of their entitlements under the Rashtriya Kishor Swasthya Karyakram. From this group, 55 girls drafted a list of recommendations and signed a demand letter. They asked for more information dissemination about RKSK and schemes related to their health; and also for ASHAs and ANMs to be trained to provide adolescents the health support they need. The letter was presented to block level health officials at the primary healthcare center on the day of a health camp. 

The District Health Society has accepted these recommendations and issued a letter to regularize Adolescent Friendly Health Clinics at the primary healthcare center. Currently it has started opening once a month, and an ANM sits there as a counselor.

Process: The project used two main data points. One was the status and implementation of the RKSK programme, especially AFHC clinics. The second point was the implementation of the Scheme for Adolescent Girls, especially the delivery of Weekly Iron Folic Supplements (WIFS). These data points were chosen because they reflected that adolescents did not have access to critical SRH information and services. For instance, there were no AFHCs being run and no health days being organized. The intervention prioritized the perspective of adolescent girls.

The data were used to start conversations with frontline workers like ASHAs and ANMs; with block level health officials and with adolescent girls themselves. For the frontline workers and block level health officials, looking at this data helped them see the gaps in the service delivery, and indeed the acknowledgment that they had missed out on providing vital services to adolescents. They were receptive to the data and were eager to address gaps in service delivery. Frontline workers especially reflected that they had been very focused on providing services to pregnant women and new mothers, letting adolescent health fall behind. At various meetings, data from the UDAYA study was used by simplifying it by illustrating it with local examples that the community could relate to.

 The project mapped UDAYA’s findings, especially those that highlighted adolescents’ perspectives, against what frontline workers said. A small survey was undertaken with 50 frontline workers from the 10 panchayats to understand what they know about adolescent health issues and schemes. Then at a meeting for frontline workers, findings from this survey and UDAYA data were shown and it helped them realize that indeed there were many gaps in services related to adolescent health.. This process encouraged each of the frontline workers to make a plan in their panchayat and organize kishori swasthya camps (adolescent girls health camps) in their panchayat anganwadi centers.

Simultaneously, workshops were organized with adolescent girls to map their levels of knowledge about services through RKSK. The girls largely only knew about the fact that they should be given IFA tablets; they said these had stopped during COVID-19. They didn’t know about any other services they are entitled to and said that neither their parents, nor frontline workers share information about healthcare or sexual and reproductive health. These adolescent girls rarely sought healthcare services at the primary healthcare center (PHC) because people often treat going to the hospital with great curiosity or shame. Especially for young girls, it involves community members casting aspersions on their behavior. After the workshops the girls resolved that they would start going to the PHC, and also talk to ANMs and ASHAs when they needed information or services. The kishori swasthya camps also presented an opportunity to start these conversations and connections between frontline workers and adolescent girls.

The third step in the project was to bring the adolescent girls to the PHC. The health officials had organized a day’s health programme after seeing the UDAYA data. The health officials at the PHC were truly excited to be conducting the event. They made sure that all the girls got a health screening done; some even got a COVID test and vaccine.