GRAMIN EVAM NAGAR VIKAS PARISHAD

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Background
GENVP in partnership with PATH has implemented a PATH Convergence Project on the issue of HIV/AIDS. A large number of populations are at risk of HIV and unintended pregnancies. Such young men and women, people who sell sex, and people with HIV are not able to access the HIV and SRH services they need. Young women and sex workers have difficulty accessing family planning services. Services for family planning, maternal and child health (MCH), sexually transmitted infection (STI), HIV, and abortion are provided separately and often target different populations. Consequently, there are several missed opportunities for providing a better response to HIV and SRH. A convergence of HIV and SRH services refers to a very wide range of activities or processes, which are undertaken with the broad objective of capturing these missed opportunities by adding on services or paying attention to the overlap areas in HIV and SRH.

Activities
Liaison with State Level Stakeholders
Regular interactions and consultation with the different state level stakeholders in the form of regular liaison meetings has been done. The liaison meetings with BSACS, SHSB and the Bihar Department of Health and Family Welfare benefited the organization to identify and strategic planning to address the bottlenecks in the project implementation.

Mapping of Stakeholders
Mapping of stakeholders working on HIV prevention, treatment, care and support, sexual and reproductive health and rights were done in Patna and Muzaffarpur districts in the Bihar state. The mapping exercises involved participatory sessions in the districts where information related to the number of sex workers, people with HIV and young men and women were collected.

Coordinate and provide support to partner organizations
Support were provided to the partner organizations for holding regular meetings with these groups, collecting information from them and tabulating them, paying honorarium to the individuals for fieldwork and meeting attendance and covering the incidental costs for doing demand generation activities. GENVP has successfully facilitated these meetings. Apart from this organization has supported Patna Network of Positive People (PNP) to organize focused meeting with HIV positive people to discuss SRH needs and issues. Afterward the series of meeting have been conducted several times to identify the intervention needs among the real stakeholders. GENVP has been committed and facilitated these meetings.

District Level Stakeholders Meeting

District-level stakeholders meeting on HIV-SRH Convergence was organized in Patna and Muzaffarpur to share the progress of the HIV and sexual and reproductive health (SRH) Convergence project in Bihar.
The objectives was to share a common understanding about convergence of HIV and SRH services, discuss the initiatives of PATH in HIV-SRH convergence, share key approaches to HIV-SRH convergence, share the project activities and underline lessons learned and challenges faced and to discuss the role of partner organization and stakeholders.

State Level Workshop of Stakeholders

State level workshop of stakeholders on HIV-SRH Convergence was organized to illustrate the convergence of HIV and SRH services and discuss the PATH initiatives in HIV-SRH convergence. The workshop also involved the sharing of the key approaches to HIV-SRH convergence, the project activities and underline lessons learned and challenges faced and to discuss the role of partner organization and stakeholder. Support PATH Media consultants and assist their role with the media to get articles on or interviews about the initiative published in Bihar News Papers.

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Introduction
Immunization of children is important issue for improving the health status of the community. The focus of PHC and Sub centre in general is more on pulse polio, thus the service providers pay lesser attention for immunization of children. With the support of Hope for Children, GENVP is carrying out immunization health checkup programme in Patna district.

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Background
In orders to understand and implement policies to make abortion safe, it is important to map and study the availability of safe abortion services both in public and private sectors understand and comprehend the reasons for utilization pattern of safe abortion services as well as the social and economic factors associated with the same.

The experiences of organizations working in the different districts of Bihar clearly shows that stigma and lack of awareness on part of the community on one hand and practice of unsafe abortion on the other, has contributed to the situation.
Given the present scenario, various civil society organizations have developed strategies to address the gaps including the service provision and community awareness of health behaviors. Currently the work around abortion in Bihar is mainly around capacity building of formal providers on clinical aspects and also located in the service delivery mode. However raising community awareness and rights realizations around safe abortion is still a farfetched idea or only happening at a miniscule level.

GENVP is carrying out advocacy programme in three districts of Bihar which are Patna, Nawada and Muzzafarpur.

Objectives:

• * To understand women’s perceptions on abortion services and need for abortion in 5 villages of select blocks each in 3 districts of Bihar.
• * To understand perceptions of formal, non-formal providers and key informants on women’s need for abortion services in 3 select blocks of 3 select districts of Bihar.
• * To map the availability of abortion services in 3 select districts of Bihar from secondary data and interviews with women, providers and key informants.
• * To initiate community and district level advocacy on safe abortion through meetings and IEC material on the basis of the evidence.

 

Activities:

• * Meeting with three identified partners to launch the project
• * Setting up ethics guidelines and questionnaire used during the mapping
• * Develop and discussed the mapping guidelines
• * Conducted field testing of the guidelines
• * Formation of local investigation team
• * Two days capacity building workshop on ethics and mapping exercise for the local investigation team at Patna before starting field investigation
• * Identified the villages within the reach of a government health facilities including a PHC or wherever upgraded to CHC
• * Setting up a coordination mechanism between common health and implementing agencies
• * Included regular exchange of information and support as required
• * Mapping of service providers and different services available at district level including secondary data collection and analysis
• * Group meeting with senior women in the age group 40 years and above
• *  Interview with key informants consisting of ANM, INGO/NGOs working on health issues
• * Interview with the providers wherever available formal, informal, profit, Non Profit at PHC or CHC, MTP trained doctors, DPM under NRHM Gynecologists, Surya Clinic, Meri Stop Clinics, Private Clinics, Charitable Hospitals,PMCH, Dais, Rural Health Care Providers such as Jholachap Doctors and RMPs
• * Consolidated of information from three districts and preparation of draft reports
• *  Developed relevant information, education and communication materials emerged out of the learning from mapping of exercise
• * Shared the findings of the mapping exercise at community and district level and created awareness in the community on safe abortion

 

The Major learning from the programme:

• * The women in the project area perceive that there are many reasons behind the grave situation of maternal health worth mentioning a few like nonexistence of hospital or health center in the area, absence of proper counseling facility by Doctor, non-availability of the means of transport on time, carelessness, less conscious of food and their own health, lack of awareness, no prenatal checkup in time and poor economic condition.
• * The women in the project area understand the fact that abortion is a grave issue in the area and it is solely connected with the maternal health problems. Unsafe abortion has serious impact on the maternal health like anaemia, weak conception, prone to severe diseases, poor health, pain in uterus, inflammation in uterus, disability, pale appearance, loss of facial charm & beauty.
• * Locally abortion is termed as Dholaiya and Kacha Darha
• * Women terminate pregnancy under circumstances like Preference of son over daughter, having more number of children and unable to feed the mouth, if the child is deformed or disabled and the mother is at risk
• * There is no infrastructure and trained professional in the area for conducting safe abortion and providing abortion care. Women have to go to the nearby town Daniyama, Fatuha, Patna for terminating pregnancy
• * Many of the women, girls and widows prefer to abort in the village with traditional Dais or RMPs
• * Though Government PHC is available in Daniyama and Anganwadi worker, ASHA worker are operating in the villages but they are not competent to handle abortion cases
• * Most of the married women pursue private clinic for termination of pregnancy
• * Girls and widows pursue non-formal services from Dais and RMPs
• * It has happened that the woman seeking abortion goes to the clinic and after diagnosis male child is confirmed, husband and other family members put pressure to abstain aborting.
• * Most of the women have a perception that abortion is legal but they are totally ignorant of the appropriate law and act associated with abortion
• * Women come for abortion from 1st to 6th months

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Background

The project titled “Link Worker Scheme” initiated from the month of Jan, 2012 in Nawada district by Gramin Nagar Evam Nagar Vikas Parishad. All 14 community development blocks including 150 targeted revenue villages have been marked under this project. This particular scheme is essential for Nawada because pace of migration in rural areas are more than that of urban slum, around 35-40 percent population migrate in different states like Kolkata, Chennai, Delhi and Ahmadabad for the search of job. The major observation is the Youth population [the age group of 20-35 years of age] who migrates for the period of 9-12 months and back to their home during festival or harvesting seasons. The cases relating to STI & Tuberculosis are most common among the people living in the rural areas. While outreach activity cum meeting with stakeholders – it has been reported that the cases of HIV positive people is there, but the social stigma is one of factor which hide it strongly.

About 150 revenue villages have been mapped under this scheme and as per the findings and prevalence of cases like STI/TB/HIV & AIDS 100 villages have to be identified for implementation of Link Workers Scheme in operation district Nevada in Bihar. The vulnerability may notice as per the increasing rate of STI/RTI and Tuberculosis in rural areas in the district. The cases of HIV transmission may increase if – PPTCT is done in all the PHC’s as it is reported that the PPTCT is not done in most of the PHC’s of the district.

Key Achievements and Major Learning

• - Mapping of 150 villages in the operational district of Nawada district.
• - Rapport building.
• - Identification of 150 volunteers, the perspective Link Workers.
• - Laisoning at block and district official and their line agencies.
• - Mapping exercise has been conducted in 150 different villages of 14 blocks of Nawada district.
• - Orientation cum training of district team by Plan India Patna.
• - Basic learning about Link Workers Scheme during induction, survey format sharing & budget analysis and modular training – I organized by Plan India, supported by BSACS N-NACO.
• - Learning through meetings with various key stakeholders, at village –block and district officials.
• - Learning through community people, youth and health service providers during visits at village and hard to reach pockets in Nawada.

 

Specific Achievements:

A total of 38,000 people participated in different activities organized in Red Ribbon Express in Nawada and ranked one in terms of people participation compared to other districts of Bihar and ranked two at the country level. A total of 700 people were test for HIV out of which 6 were found HIV positive. This became possible only due to huge efforts of link workers

Total Coverage

Sl. No.	Typology	Total line-listed	Unique individuals (head-counts) contacted (through one-to-one or group sessions or condom or N/S only)	Unique individuals (head-counts) covered (through any clinical services)	Unique individuals tested for HIV only	Number diagnosed & treated (Symptomatic cases) for STI
1	FSW	1273	1273	852	593	259
2	IDU	65	65	43	23	21
3	MSM	94	94	62	18	45
4	TG	5	5	2	1
5	Migrant	22796	5670	4972	442	525
6	Trucker	2519	1977	1630	1130	496
7	Other-Vul. Pop	104721	7867	4305	4140	1055
8	TB cases	839	56	13	15
9	ANC	45	45	45	45
10	PLHIV	52	52	4

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Background
The project titled Re-vitalizing and Re-energizing Teen Clubs being facilitated by NYKS and GENVP in Gaya and Purnea districts having visions of providing adolescents with a space to discuss their concerns and create an enabling environment and youth friendly communities. It is a very thoughtful intervention working with the youth of these 10 blocks of two districts, especially in rural villages, where exposure to information related to proper growth and development of Adolescent is limited. Actually, there was huge misinformation about aspects of adolescent health, education and young people showed a lot of inhibition in expressing themselves and their needs. One of the major challenges faced by adolescents in the project areas has been their inability to access reliable information about their growth and issues surrounding their period of adolescence. This project is aiming towards providing reliable information on adolescent health, along with essential life skills, for young people to navigate their adolescence more effectively. The project is primarily targeted at out-of-school adolescence, which is often left out of the reach of the development programmes, despite being the group most in need of information that can help prevent them from risky behavior as well sustainable growing.

Goal
Restructuring and revitalizing Teen Clubs for meaningful and vibrant interaction

Activities

• 1. Initiation of village contact drive

The foremost activity for starting the rapport building efforts and sharing project objectives with communities, parents, village opinion leaders, youth groups, important key persons like PRIs, ANMs, AWWs, school teachers, senior citizens,

GENVP have implemented the following activities in this quarter:

• A. Village community meetings

Village community meetings (Aam sabha) were organized in all 60 selected revenue villages of Gaya and Purnea districts. All concerned BTFs and APVs were facilitated the meetings and ensured the success of meetings in each village with support and coordination of DPOs and DTFs of concerned district. The core concern of these village level meetings is to mobilize people on project objectives for the betterment of adolescent and enable them towards recognizing their aspirations and work towards realizing them. In all meetings, parents, community members gave their consent to PE selection (name of probable PEs in the villages). In all meetings, major discussions were on taking unanimous view and consent from community on PE selection. While meetings, project team also conveyed the selection criteria of PEs selection, necessity and benefits of Teen club, roles and responsibilities of TC and PE etc. In addition to that, project team also discusses the requirements of support from community in teen club formation especially from parents and key change agents like AWWs and youth groups. This is our observation that in each village community reacts with proactive acceptance and eagerness towards the project. Time to time suggestions and feed backs from concerned DYC and PD, GENVP also helped a lot in organizing this meetings at fullest.

• B. Meetings with key stakeholders of the project i.e. ANMs, PRIs, AWWs, youth groups

While organizing meeting at village level, the project team including DTFs and DPOs, also tried to meet and establish coordination and support with key stakeholders of the society viz; ANMs, PRIs, AWWs, youth groups etc. Almost in all villages, participation of above said stakeholders in village meetings were ensured by APVs and BTFs. Besides this, project team also met with them in their houses, working places and discussed the project objectives and need of their support in effective implementation of activities. Adding to this few village meetings were organized with the leading help of teachers, ANMs and AWWs. These efforts will strengthen our future course of action and viewing this, project team is in continuous process to establish good rapport and relationship with these stakeholders. We believe that also very beneficial for our target beneficiaries in tapping institutional deliveries in long run as well establish coordination with TC and peer educators in convergence process.

• 2. Selection of Peer educators

As depicted above, the selection of peer educators has been done as per the guideline and with the consent of community in village meetings. In all village meetings, project team including DPOs and DTFs validated that all names of peer educators (4 final and 4 waiting) has to come from community side with essential eligibility of PE. Also in some places, AWWs and youth groups suggested the names of active boys and girls for probable PE. Also APVs and BTFs met with parents of selected PEs and oriented them towards the program as well took permission for selecting their children as PE. Till date, all PEs are identified in selected villages of 10 blocks of Gaya and Purnea. During selection process, time to time monitoring visit and facilitation were given by PD, GENVP as well DYCs of both districts.

• 3. Capacity building of BTFs and APVs

Before the inception of periodic training of peer educators in both districts, brainstorming sessions and training workshops were organized in Gaya and Purnea district for all BTFs and APVs. The basic aim behind organizing these events is to increase the efficiencies and skills of BTFs and APVs so that they can deliver qualitative sessions of training to peer educators. In these workshops DPOs and DTF of related districts also participated and facilitated the whole process with practical exercises that how to take training sessions of PEs. Also, in these all BTFs and APVs were prepared themselves with learning and teaching materials of trainings such as chart diagram, stones, pictures, ropes and other important tools of training. Each training, practical classes were taken by BTFs and APVs as mock drills under the supervision of DTF and DPOs. Also shortcomings and gaps were explored and solved within the training program. DYCs and PD, GENVP also participated in one of the session and supervise the whole process with feedbacks and suggestions.
In Gaya district and Purnea districts, the whole day orientation programs were organized at NYK premises on 10th to 11th June,2014 and in Purnea it was organized thrice on 18 to 20 May,2014, 24 to 25 June, 2014 and 3rd to 6th July, 2014. Adding above, sessions were distributed to all BTFs and APVs as well practicing sessions were organized for plays and acts as prescribed documents and module provided by PRAVAH. Along with this the dates of PE training as well responsibilities to taking PEs from their villages were also discussed decided and distributed to all BTFs and APVs with the help of DPOs and DTFs in both districts. Further, it has been also observed that there is a gradual need of capacity building of APVs and BTFs. So, we are also planning to organize these orientation programs on periodic intervals.

• 4. Formation of Teen Clubs

Because of PE training program at regular intervals, the formation of teen club is not at fullest. The training of PEs are going on and after completion of training in Gaya and Purnea districts, the formation and strengthening of TCs will be commenced on prime basis. However, till date with efforts of APVs and BTFs with effective monitoring and supervision of DTFs and DPOs, 42 teen clubs were formed in Purnea district and in Gaya, strengthening of existing TCs are going with 120 teen clubs and 30 new TCs were formed in this quarter.

• 5. Meeting of Teen clubs

In this reporting quarter total 22 meetings were held in different blocks of Purnea district i.e. Purnea east- 6 meetings, K. Nagar- 3 meetings, Dagarua- 4 meetings, Banmankhi- 5 meetings and in Kasba- 4 meetings with the support of concern APVs and BTFs with constant monitoring of DPO and DTF. In Gaya District, no meetings were organized due to busy schedule of PE training program. But in the month of July, it will be considered strictly.

Achievement

• - Total numbers of 1200 adolescent boys and girls from Gaya and Purnea district got the training on Prayas Apna Mannual and became peer educators and have started to rollout the project.
• - Teen club members have completed their training on the first module of ‘PRAYAS APNA MANNUAL’ and the training is being continued on the second module of the same in all 150 teen clubs.
• - Teen club members have celebrated Health action projects in 150 villages in two districts which were focused to the respective health issues of those villages. It had been a one day engagement to generate awareness on various health issues like Malaria, Anti Alcoholism, Health & Sanitation and many more by engaging community people.
• - Cluster level meeting is a monthly activity which is aimed to unite all the members related to the project in order to evaluate the project activity along with the planning ahead. Total No. of 135 Cluster Level meeting has been conducted in Gaya & Purnea District as of now.
• - Peer Educator has also been trained up to third phase of “ Prayas Apna Mannual”  to promote active participation of out-of-school adolescents in the teen clubs. The total number of trained peer Educators is 1200.
• - Up to 16th meeting according to “ Prayas Apna Mannual” have been conducted with all the members  of teen club in each Gaya & Purnea District.
• - “Health Mela” a one days union of all the teen club members from one cluster, has also been celebrated in 9cluster of Gaya and Purnea District. where the teen club members engage related government departments like ICDS, Health Department, Mahila Samakhaya, Education Department others development partner along with the community people. The whole objective is to promote the best health practice in community, sharing the journey of each teen club and success story in a healthy competitive environment. 
• - Capacity building training has been conducted over the period to enhance the capacities of project staff, state-based NGOs and NYKS officials on the key themes on youth health and well being as well as supporting the peer educators and monitoring project progress. All the APVs and BTFs have been taken part and trained in the same.  
• - Monitoring and evaluation has been an inseparable part of this project. Monthly review meeting has been conducted in each month in two districts.  All the project stuff took part in order to review the activity along with plan further.
• - A Health survey has been conducted in all 150 villages of Gaya and Purnia district which was aimed to fact-finding at village level to identify the major diseases and its impact as well substantial issues and consequences of alcoholism in the villages.

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Background
In the recent years developmental discourse has gained momentum in Bihar state and much increase has been seen in political will as well as policy environment. The State’s road map to effective family planning (NRHM State
PIP, Bihar 2012-13) aims that “all women and men will have knowledge of, and access to a comprehensive range of family planning services, therefore enabling families to plan and space their children to improve the health of
Women and children”. However PFI commissioned study has shown that the budgetary allocation and utilization has been very low. In the given context itis important to explore setting solution livers through effective advocacy with the State Government and networking effectively with all possible family planning champions in the state.
Looking the priorities and need, the organization is implementing advocacy support program with the support of Population Foundation of India (PFI) for fulfillment of the objectives of advocacy for reducing Total Fertility Rate (TFR) by addressing unmet needs, increasing contraceptive choices and improving quality of Family Planning services in a rights based framework, and to make aware men & women that they will have knowledge of & easy access to the comprehensive range of family planning services, as well as to strengthen the implementation, monitoring & supervision of Family Planning Program at district level for Advance Family Planning in the state.

Goal
Improved quality of family planning services and increased contraceptive choices in a rights based framework leads to a reduction of TFR in Bihar.

Objective:

• - Strengthening spacing methods by increasing the number of providers trained.
• - Emphasis on post-partum Family Planning Services by strengthening post-partum IUCD services.
• - Strengthening sterilization service delivery by increasing the pool of trained service providers.
• - Strengthening quality of service delivery by strengthening Quality Accreditation Centers (QAC) for monitoring/review, disseminating following existing protocols/ guidelines/ manuals and monitoring of the family planning indemnity scheme.
• - Focus on using private sector capacity for service delivery.
• - Strengthening program management by establishing new structures for monitoring and supporting the program, and strengthening program management support to state and district levels.
• - Development of BCC/ IEC tools highlighting the benefits of family planning specially with spacing methods.

 

Achievement:

• - District Level Family Planning working group has been formed in Jehanabad and the same has been initiated in other four districts.
• - Budget allocation and expenditure details have been analyzed by GENVP and has been shared with Dist and state level.
• - Smart tool on family planning has been incorporated
• - Template/ checklist for Quarterly review mechanism prepared
• - Enabling atmosphere created among the officials and stakeholders
• - Comprehensive plan for family planning program roll out under PIP by September 2014 in 5 districts namely Patna, Gaya, Jahanbad, Nalanda and Nawada.
• - Findings shared with district officials and inputs incorporated for the PIP roll out plan level
• - District profile of all newly assigned districts was prepared which includes Total Population, Average House hold, Sex Ratio,
• - Crude Birth Rate, Rate of Literacy, Status of Marriage, Fertility Rate, Family planning Practices, unmet need of Family Planning,

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