| HBP Bihar-Jharkhand Annual Report 2005 - Page 1 |
Page 13 of 13 4. Challenges and LessonsFirst, such a large-scale activity of targeting malnutrition among children in over 500 villages across two remote and underdeveloped states in North India is a unique experience for AID and is a very exciting development. The logistics to implement the program exactly as planned were very challenging and significant hurdles were encountered. As a result, where weighing-counseling and follow up weighing had to be time-bound and done in a relatively short span of time of a couple of months, it actually took much longer. As a result, it is not clear whether the measured improvements were due to the specific interventions of this program or due to other variables that we did not consider as part of this effort. Inability to complete the weighing-counseling-weighing cycles in a time bound manner as planned has lead to a lot of introspection. It was found that not all blocks had the optimum resources to undertake these tasks. Moreover, spreading the existing resources too thin was an issue. After substantial discussion between our grassroots partners and AID volunteers, it was decided that the next phase would focus on a smaller number of villages and there would be more support for the program in the form of training, monitoring on the job and intensive feedback and coaching. This effort is currently underway. Some volunteers from the US have returned to India with a specific goal to help this program keep on track. However, it is very encouraging that quantifiable improvements can be demonstrated over a relatively short period of time. This program has emphatically shown to AID volunteers in particular and to all who are interested in public health in India, the grave proof for rampant malnutrition in our villages. Nearly 2/3rds of children in this sample of 500 villages were malnourished. This finding echoes other studies on childhood malnutrition in the past. Lastly, while making a measurable improvement in children's nutritional status is a primary goal, there are a number of positive fallouts from the way this program is implemented. For example, bringing together women in weekly meetings to discuss health-related issues has helped the women of Madangundi (Koderma block, Jharkhand) to confront drunkenness and domestic abuse in their village. Similar strength in numbers enabled Muneja Khattoon of Pipra Di village, a brave village health activist to stand up against fundamentalist forces in her community. Counseling villagers about the available services from the local primary health center has encouraged the villagers to take advantage of these while building some pressure on the healthcare providers. It is now more common to see the health worker show up in the villages, doing rounds more regularly than before. Such positive developments are commonly encountered by our volunteers who have kept up with the grassroots and constitute an extremely encouraging aspect of this program. |
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