Raising awareness among women on health, nutrition and WASH services

Friday, 12 Feb 2016
A community based initiative in Bihar, India is educating and empowering women to take ownership of the health and hygiene of themselves and their families, leading to healthier communities.

“Ghar Ghar alakha jalaenge hum, hum badalenge zamana. Sab se banaenge mitti ko sona, jeevan banega upwan salona. Seejhake pull banaege hum, hum badlenge zamana…”
("We shall transform the times by enlightening our society. Together we shall transform sand into gold, life would be like a beautiful orchard. Together we shall build a bridge and transform our society…")

This powerful song floats through villages as women begin to talk about issues that impact their lives every day. Struggling to provide adequate and appropriate food for their children, unable to access toilets, facing killer diseases like diarrhoea and malaria, lack of access to necessary healthcare are some of the realities that women in rural areas of Bihar have lived with for years. Many factors contribute to this situation, including the fact that women have little access to vital knowledge and are therefore deprived of many rights.

But much of this is changing. In the heart of Bihar, an unseen revolution is taking place through Gram Varta (or Village Dialogue), an initiative to mobilise women’s self-help groups and communities around health issues. Started under the Sector Wide Approach to Strengthening Health (SWASTH) programme in the state, in collaboration with the Bihar Technical Assistance Support Team (BTAST), Gram Varta adopts a participatory learning and action technique to educate women through meetings on health, nutrition and sanitation. It uses interactive methods to enable women to identify and prioritise problems related to poor nutrition and health, find local solutions, promote behaviour change and adopt appropriate actions for themselves, their children and families.

Shirmani: Becoming a leader...

Thirty-five year old Shirmani, the mother of a teenage girl, is from Makhdumpur in Jehanabad district. For years she was trapped in a vicious cycle of social taboos and poor health practices, like many other rural women. Due to strong social and cultural practises, she and her family were steeped in traditional ways of healthcare behaviour.

But unlike other women, Shirmani broke this cycle – thanks to Gram Varta. When her daughter reached puberty, Shirmani refused to let her be treated as ‘dirty’ during her period and strongly encouraged her to adopt hygienic practices. Her daughter now uses sanitary napkins, something unheard of a few years ago in villages in Bihar.

Shirmani says: “After attending the trainings by Gram Varta, I took the initiative to talk to my daughter. I was concerned about the effect on her health if she did not follow the correct personal hygiene practices.”

As a master trainer for Gram Varta, Shirmani says: “I have been working with Gram Varta since it started in Jehanabad. Initially, I joined as a facilitator but after completing 2-3 years, I was promoted and became a master trainer.” As a master trainer, she is constantly addressing the challenging task of teaching knowledge, awareness and changing practices amongst the self-help group members and within her community.

This helped Shirmani not only break boundaries, but also emerge as a leader within her own community. And she is beginning to see the results of her perseverance. “It took me three years to make half the village free of open defecation, especially the areas inhabited by the Mahadalit community. I used to conduct five group meetings a month at different places,” she says.

Shirmani says that participating in Gram Varta makes her feel empowered, “Being a facilitator, I see myself as a person who supports the well-being of individuals. I am trained to deal with the problems of the community and find solutions in consultation with them. I am respected and admired for my work. I am someone who is looked up to with high regard in the family. I feel privileged to be a part of such an initiative. It should be continued for prolonged impact.”

Mamta Devi: Fighting against all odds...

Gram Varta has also become a game changer for many other women. Mamta Devi from Kalanour village joined the local self-help group (SHG) in 2012 and then became a part of the Gram Varta meetings.

Through these meetings, she learnt about the benefits of cleanliness, hygiene and the importance of building toilets in every household.

Mamta says that when she became aware that open defecation can lead to diseases and ill health, she decided it was high time for her family to build a toilet in their house.

However, she found it difficult to persuade her husband and in-laws to construct a toilet as they felt it was unnecessary and costly. “Finally when they did not relent, I thought of going against the wishes of my family and to construct a toilet for my children and myself. I went to the leader of my SHG and asked for a loan to build the toilet,” she says. With help from the SHG, she took the initiative and went ahead to get a toilet built in her house.

A confident Mamta proudly says that now even her husband appreciates her bold step as there has been a positive impact on their overall health. “Now, I am spreading the message further, ‘Jis ghar me shochalay banana, usi ghar me beti byahana’ (“Marry your daughter only into a family that has a toilet in their house”).”

Gram Varta inspired many other women in these villages to take up issues like sanitation in their areas despite opposition from family members.

Saroj Devi: Ensuring a healthier tomorrow...

Most villages in Gaya district of Bihar are taking part in Gram Varta. Part of the initiative focuses on nutrition and health check-ups to identify malnourished children. As a result, severely malnourished children are referred to a Nutrition Rehabilitation Centre (NRC) for intensive care and rehabilitation.

Saroj Devi, a 22-year-old mother of two, had been regularly attending the Gram Varta meetings. She learnt about how children’s growth can be monitored and why it is important to do so regularly. She was then keen to get her children measured for their weight and height. Much to her shock and despair, one of her children was identified as chronically malnourished. With the help of a local Anganwadi worker she took the child to the NRC for treatment.

After her visit to the NRC, her child was put on an increased diet and she has been taking care of her child as advised at the NRC. “I was shocked to know that my child was malnourished. The NRC provided milk along with balanced meals four times a day. I also learned to keep the surroundings around my children neat and clean. The weight of my child increased after the visit,” she says.

Whether it’s Shirmani, Mamta or Saroj, each of these brave women is bringing about change on the ground in rural Bihar, and what binds them as change-makers is the Gram Varta initiative. Neena Sharma from BTAST feels that Gram Varta has played a crucial role in enhancing the decision-making power of rural women. She is excited at the level of awareness generated by Gram Varta. “The success of Gram Varta shows that it has helped rural women take decisions related to health, nutrition, and hygiene not just for themselves but also for their families. It has brought social change, generated livelihood opportunities, and increased their knowledge and awareness, truly empowering the community,” she says.

The SWASTH programme aims to improve the health and nutritional status of the people of Bihar by increasing access to better quality health, nutrition, and water and sanitation services, particularly for the underserved groups. The focus of this programme is to strengthen the systems through better planning, organisational strengthening and human resource management, decentralisation and convergence among key departments. The programme also uses community level processes to manage, demand and monitor services.

Options in partnership with CARE and IPE Global is supporting the SWASTH programme through the DFID-funded Bihar Technical Assistance Support Team (BTAST), which is providing timely and focused technical expertise in strategic planning, and design of services. BTAST is helping ensure that services reach excluded or marginalised groups, and also monitoring progress towards better health services.

BTAST supported Gram Varta which is implemented through the Government of Bihar’s Women Development Corporation, JEEViKA (a rural livelihoods project) and Bihar Mahila Samakhya. It reaches out to nearly 800,000 women and their families through 78,300 self-help groups.

This story was originally published by BTAST on the SWASTH microsite.

Disclaimer: SWASTH is supported by the Department for International Development (DFID)-UK and implemented by the Government of Bihar, in collaboration with the Bihar Technical Assistance Support Team. However, the views expressed in this report do not necessarily reflect either DFID’s or Government of Bihar’s official policies or views.

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