Integrating Health, Nutrition and Sanitation in

JEEViKA Institutions: A Proposed Model

2014
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Integrating Health, Nutrition and Sanitation (HNS) Agenda in JEEViKA
Institutions


Bihar Rural Livelihood Promotion Society (BRLPS) is implementing a project JEEViKA, which
aims to build a multi-tiered, self-sustaining, model of community based institutions who self-
manage their own development processes. In addition to providing livelihood security to the poor
communities, JEEViKA has one of its strategies to safeguard poor communities from malnutrition,
and drainage of savings on health related expenditure by promoting improved access of the
communities to health, nutrition and sanitation (HNS) information and services. To facilitate this,
and to integrate and institutionalize HNS within JEEViKA supported community institutions, a
model is being proposed, which is based on learning and experience of Project Parivartan
1
.

This HNS integration is a part of Memorandum of Cooperation (MOC) which PCI signed with
BRLPS for the Project JEEViKA and which will provide a framework to empower and enable the
members of JEEViKA community institutions to review, plan and take collective action to address
issues related to equitable access of quality HNS information and services. This model specifically
focuses on issues related to maternal, new-born & child health (MNCH) and nutrition and also
promote collective action through community groups where members and leaders would be
involved in a series of processes to influence and drive change in behaviours and practices on
specific 8 health, water and sanitation behaviours
2
to reduce maternal and child mortality and
improve key nutrition and health outcomes.


Health Nutrition Sanitation
Board Issues
Covered
Maternal, new-born and child health
(1000 days cycle - from pregnancy to
child up to 2 years)
Nutritional needs of women
and child during pregnancy
and till 1 year of age of child
Safe water storage, hand-
washing so as to prevent
diarrohea episodes, and
reduce diarrhea related
mortality and morbidity
Issues that
are covered
Antenatal checkups and care, birth
preparedness, institutional delivery/
skill birth attendance, immunization,
prevention of hypothermia of the new
born (skin-to-skin care and delay in
bathing), postnatal care and checkup,
family planning
Early and exclusive
breastfeeding till 6 months.
Complimentary feeding
after 6 months
Hand washing- particularly
at three critical points such
as (1) after defecation, (2)
before meal, (3) before
feeding child and also Safe
Storage of Water

The model offers strategies and activities that would be implemented over a period of 18 months,
which are based on the overarching principle of evidence based community led solutions that are
planned and executed through participatory and learning approach. These proposed activities
are not only limited to Self Help Groups (SHGs), but also aims at institutionalizing HNS issues at

1
Within Ananya, Project Concern International (PCI), in partnership with PATH and the Foundation for Research in
Health Systems (FRHS), is implementing a community mobilization and social accountability grant, referred to as
Parivartan, which provides a platform to empower communities to engage in processes that catalyse support networks
and enable shifts in behaviour and social norms, contributing to improved and sustainable health and sanitation
outcomes in Bihar. The Parivartan Project is currently being implemented in 55 blocks of 8 districts (Patna, Begusarai,
Samastipur, East Champaran, West Champaran, Gopalganj, Khagaria, and Saharsa) of Bihar to address equity issues
related to caste, gender and other social variables which influence health and sanitation outcomes under the Ananya
Programme. At the grassroots, the project reaches approximately 275,000 women in the reproductive age group in the
most marginalized communities through 18,000+ SHGs created by Parivartan. In addition, Parivartan reaches out to
approximately 150,000+ women belonging to 10,000+ JEEViKA SHGs in three districts of Patna, Khagaria and Saharsa.

2 P1 Introduction and Context of Parivartan Project, PM1 Antenatal Care and Birth Preparedness, PM2 Postpartum
and New-born Care, PM3 Early, Exclusive, Breastfeeding and Complementary Feeding, PM4 Routine Immunization,
PM5 Family Planning, PS1 Personal hygiene, and storage of potable water and PS2 Use of toilet and safe disposal
of waste
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much wider scale by integrating HNS at the level of Village Organizations (VO), Cluster Level
Federations (CLF) and Block Federations (BF). The core activities of this HNS integration include:

Support design and implementation of health integration within JEEViKA, capacity
building of field staff, Sahelis and other community cadre to drive behaviour change
communications on health and sanitation (by suggesting appropriate training strategy,
methodology and materials)
Provide technical support for activities/pilots that would integrate health through SHGs
and VOs based on learning from Parivartan project
Support and develop suitable MIS for monitoring health integration within JEEViKA M&E
mechanisms
Build linkages with Technical Support Unit within State Health Society for improved
linkages between SHGs and front line workers (ASHAs and AWW).

The following graphic depicts how different strategies/activities would act at different JEEViKA
institutions.
























For implementing the Parivartan Program, JEEViKA will follow the below mentioned steps in a
phased manner. Through the below mentioned activities, PCI aims to ensure integration and
institutionalize the agenda of Health, Nutrition and Sanitation and also strengthen the mechanism
of review and monitoring systems in JEEViKA institutions. The following table elaborates the
activities that would be undertaken at various levels under the proposed HNS integration model.


HNS Integration
institutionalisation
Sahelis
Leadership
skills on HNS
Participatory Self
Review and Planning

Solution
Mapping
Advocacy for
HNS services
Engaging SHG members on
HNS issues
SHG
VO- SAC
CLF
Prepatory Phase
Implementation
Phase
Consolidation
Phase
Integration of HNS
in JEEViKA
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Phase Month Activities at the SHG level Activities at the VO level Activities at the CLF
level
Activities at the Block level Major Milestone Means of
Verification
Preparatory Phase






























Implementation
Phase


Stage 1: Orientation
of Staffs and
Training

0-4
Months
Meeting with the State JEEViKA Team Agreement with JEEViKA
on scale and scope of
HNS integration in place

Meetings held with the district and block level JEEViKA team
i
. Basic information obtained, planned shared
Staff recruitment
ii
at the district level, block level initiates, Development of Job descriptions
Target area is in place MoM
Interactions with the VO starts.
Identification of potential
Sahelis
MoM
Recruitment of Sahelis
completed; Sahelis will start
dialogue with concerned
community group for building
rapport to create an enabling
environment for community
involvement
Health Mobilizer
iii
in place Block Health Nutrition Sanitation
Integrator (BHNSI)
iv
in place

Training of Sahelis on Basic Facilitation
Module and her specific roles and
responsibilities and reporting HM
Induction
BHNSI Induction
Community Cadre and
BHNSI are on board and
oriented
HR Records
Saheli will start meeting the
groups to collect Base data of
each SHG in the format
provided by the project
Saheli will attend the concerned
VO meeting and collect the base
data (details of SAC
3
members
also) in the format provided by
the project
HM starts participating in
CLF and selected VO meeting
and collects the base data in
the format provided by the
project

Meetings with the AWC and
other FLWs in the villages
facilitated by HM

Mapping of the AWC
v
and
other service access points
(to be done by the HM under
supervision by BHNSI)
Block level staff participates in the
monthly meeting of JEEViKA Block level
staff

HM participates in the Block health
meeting (e.g. HSC
vi
meetings);
introduction to the block and district
NRHM officials
Review and supervision meeting at the
block level
vii

Base data of SHG, VO and
CLF obtained


Plan developed with
JEEViKA BPM

Project data
base


MoM
1 Micro- planning
viii
for AWC
platform (to be done by the
HM under supervision by
BHNSI)


Sahelis Training on P1
ix
(Basic
Parivartan) and PM1 (Antenatal care
and Birth Preparedness) and SSF
(Swasthya Samiksha Form) for 3 days
in house training and radio episodes (4
nos) of KMW
(to be conducted by the Trainers and
BHNSI)
Training on 1
st
and 2
nd

module completed
HMIS Report

3
The Social Action Committee (SAC) comprises of 3 members of VO. The members discuss issues related to social entitlements and motivate the families in the village;
Parivartan is using the platform for the Khirki Mehendi Initiative and address the issues related to Health, Nutrition and Sanitation.
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Phase Month Activities at the SHG level Activities at the VO level Activities at the CLF
level
Activities at the Block level Major Milestone Means of
Verification
Stage 2:
SHG level activities
start

2 Rolling out P1
x
Module
Introduction and Context of
HNS and SSF


Roll out of KMW- Episodes 1-2
(spacing and birth
preparedness)
AWC platform Activity starts
1
st
Module- Birth
preparedness
(HM shall facilitate at
CHNCC/AWCs)

Sanjha Samajh
xi
(SS) Activity
carried out by the HM at the
panchayat level

Onsite Supervision and
monitoring support to
Sahelis by HM
xii

Participation on the Block health
meeting;

Review and supervision meeting at the
block level
Roll out of the Parivartan
compendium starts
MIS Data
3 Rolling out PM 1 (Antenatal care
and birth preparedness)



KMW-Episodes 3-4 (Birth
preparedness)

Training of the SAC members on
community based review and
monitoring planning (on how to
analyse data from SSF)

AWC platform Activity - 2
nd

Module- Complementary
Feeding.

Training of the SAC members
on the PE1 and PE2

Sanjha Samajh
xiii
(SS) Activity
carried out by the HM at the
panchayat level
Review and supervision meeting at the
block level
Participation on the Block health
meeting;

Review and supervision meeting at the
block level

Training of Sahelis on
PM2 and PM3 and KMW- part 5 to 8
Training of SAC members
starts
Training
Reports/
Records
Stage 3: Community
Based Monitoring
and Planning Starts
4 Roll out of Module PM2 (Post-
Partum Care and new borne
care)

Review of Collective Action with
the help of SSF on PM1
Roll out of the KMW Episode 5-
JSY and Institutional delivery,
Epidsode-6- Safe delivery at
home
AWC platform Activity - 3
rd

Module- FP and Spacing
between births.

Training of the Sahelis and HM on how
to conduct Anganwadi platform (AWP)
xiv

SSF rolls out the group
level
SHG Minutes/
SSF forms
Stage 4:
CLF level activities
start
5 Rolling out PM 3 - Early,
exclusive breastfeeding and
complementary feeding

Review of Collective Action with
the help of SSF on PM2



Roll out of KMW-Episodes-7-
Complication during pregnancy
and identification of danger sign
and Episodes-8- New borne
care

Solution mapping
xv
at the
cluster level


Training of the Sahelis and HM on PM4
and PM5 and KMW part- 9-12





Completion of AWC
Activity

CLF members undertake
solution mapping for
improving access of the
women to HNS services

Data from SSF getting
entered into the HMIS
computer
HMIS



CLF records
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Phase Month Activities at the SHG level Activities at the VO level Activities at the CLF
level
Activities at the Block level Major Milestone Means of
Verification
Stage 5:
Inter-linkages with
FLW and service
access points starts
6 Rolling out of PM4

Review of Collective Action with
the help of SSF on PM3
Roll out of the KMW Episodes 9
and 10 (new borne care)






Training of Saheli on concept of
VHNSD/ Gup-Shup Potli
xvi


Routine Immunization
initiatives rolled out

7 Rolling out of PM5

Review of Collective Action with
the help of SSF on PM4

Roll out of the KMW Episodes
11 EEBF and KMW-12-
postpartum complications and
proposed action
Training of Sahelis on PS1 and PS2
Modules - PS 1 (Personal hygiene, and
storage of potable water) and PS 2 (Use
of toilet and safe disposal of waste)
KMW -13 to 16

Stage 6:
Local level
Advocacy/
accountability
mechanism sets in
8 Roll out of the PS1

Review of Collective Action with
the help of SSF on PM5

VHNSD promotion activities at
the village level- through FLW
inter-linkages

Anganwadi platform activity;
joint planning of ASHA and
Saheli to promote VHNSD

Promotion of VHNSD (Gup-Shup
Potli)

Roll out of the KMW Episodes
13- Identification of postpartum
complications and Part 14-
Precautions to be taken after
premature Delivery
Solution Mapping



Family planning
initiatives rolled out
MIS
Stage 7:
Secondary
stakeholders
(males/ Mother-in-
law) involvement
starts
9 Roll out of the PS2

Review of Collective Action with
the help of SSF on PS1

Anganwadi platform activity

Special initiatives to hold
discussions with Male
cooperatives, discussions with
men at the village level

Roll out of the KMW Episodes
15- thermal care for premature
baby and Episodes 16-
identification of danger signs
among New born and
prevention of Infection among
premature baby
Solution Mapping

Micro-planning at the CLF,
especially focusing on FP

Special advocacy efforts to
promote FP services

Special initiatives to hold
discussions with Male
cooperatives, discussions
with men at the Panchayat
level
Refreshers Training of Sahelis through
different batches
Special initiatives to
involve secondary
stakeholders
Project record
Stage 8:
Sanitation related
activities start
10 Review of Collective Action with
the help of SSF on PS2
Anganwadi Platform in place

Activities at the VO level

Roll out of the KMW Episodes
17 - Permanent and temporary
methods of FP and Episodes 18
- Selection of FP methods after
spouse communication
Advocacy related activities Training on special initiatives on
sanitation/ market led solutions or
linking with sanitation welfare schemes

Refreshers Training of Sahelis through
different batches

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Phase Month Activities at the SHG level Activities at the VO level Activities at the CLF
level
Activities at the Block level Major Milestone Means of
Verification
Phase III -
Implementation
stage ends
Consolidation Phase
11 Development of the SHGs and
the VO members as Health
CRPs- who could help to scale
up or roll out in the adjoining
area
Roll out of the KMW Episodes
19 - Birth Spacing
And Episodes 20-Birth Spacing
and FP
Special initiatives to connect
with the market driven
sanitation solution or
sanitation related welfare
scheme
Refreshers Training of Sahelis through
different batches

Completion of rolling out
of Parivartan HNS
compendium

Health CRPs in place
Project MIS
JEEViKA MIS
12 Development of the SHG/ Village
as the immersion site
Roll out of the KMW Episodes
21- FP Methods and Episodes
22- Permanent method of FP
Immersion sites
developed
Project records
13




Roll out of the KMW Episodes
23-Copper-T Method and
Episodes 24-Injectable
Contraceptives- Uses & benefits
Start Transition Process
14 Rollout of KMW 25 Importance
of Breast feeding and KMW 26
and 27 - Routine Immunisation
1. JEEViKA uploaded SHG
details in google drive

15 Roll out of KMW 28-Complete
Immunisation and KMW 29-
Complementary feeding to the
baby after 6 months
2. Transition Started
16 Roll out KMW 30-Right method
of Breast feed and KMW 31-
Advantages of Breast feeding
3.
17 Roll out of KMW 32- Increasing
the Volume of food to the baby
and KMW 33-Taking
appropriate steps in the right
time
4.
18 KMW 34-Change in the food of
the baby, KMW 35-Feeding
frequency and quantity for the
child and KMW 36-hand
washing with Soap
5. Complete of KMW
Rollout and Transition
completed. Consolidation
of learning. Sharing with
JEEViKA






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Monitoring and review of the HNS integration: Through the above activities, PCI aims to ensure
integration and institutionalize the agenda of Health, Nutrition and Sanitation and also strengthen
the mechanism of review and monitoring systems in JEEViKA institutions. JEEViKA is working on
a large scale hence it is very essential to have a foci M&E system that measure the programme on
tangible terms. The programme has a fleet of Sahelis, Health Mobilizers and BHNSI are in place
who are working continuously with coordination for achieving the objectives of the programme.
Based on the modules roll out and subsequently the changes taking place at the group level will
be measured at group level to see the changes and one at a quarterly level to help the programme
team to take informed decisions. This data is collected on key indicators from 1/3rd of groups of
every HM in a quarter. The source of the document will be Health Outcome register at group level,
a repo0rtimng sheet at HM and BHSNI level. The below matrix explains the different indicators

Indicator Rationale Who will
collect
Frequency of
collection
Data Analysis Plan Sharing with
JEEViKA
# groups where
Health Module rolled
out
The number of groups
where health modules
are rolled out. This
gives a clarity on
groups the module
rollout due and plan
accordingly
Health
Mobilizer
Once in a
quarter
This data will be used
to triangulate with
Health behaviours
over time and changes
impacted with module
rollout.
The data will
be shared
with JEEViKA
on quarterly
basis and
analysis will
shared on six
monthly basis.
% Registered for ANC

% registered for ANC
in first Trimester

% women received
for IFA

% women consumed
IFA

% institutional
Delivery

% of Couples using
Family Planning

% mothers providing
EBF (0-6 Months)

% of mother
providing semi solid
food (7-12 Months)
These indicators are
measured to
understand the changes
in the health
behaviours (service
seeking / practices ) at
the group level
Health
Mobilizer
100% at the
starting of the
programme.
1/3rd groups
every quarter.
100% at the
end of two
years.
The first 100% data
will be used as a
baseline.

The quarterly data
collected over the
groups will be
compared with the
baseline data and
progress in the health
behaviours is
triangulated.

At the end of two years
100% data will be
recollected and
compared with
baseline as well as
quarterly data to
understand the impact
of modules

Outcome Indicator Study: On a quarterly basis from all the blocks data will be collected on key
indicators, to understand the status of the block on each health behaviour and help then
programme team to plan accordingly for improving the programme. For this purpose LQAS4
methodology will be used and 19 sample will be selected from the block to assess the same. This
exercise to be seen as a cue for informing the programme at the filed level about the status and
take ground level decisions.





4
Lot Quota Assurance sampling is a technique used to understand the quality of the lot by selecting a
sample
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Annex 1. Activities at the Group Level undertaken by PARIVARTAN:

MONTH WISE ACTIVITIES WHY WHO ARE
RESPONSIBLE
TOOLS LEADING TO
PRE IMPLEMENTATION PHASE
MONTH 0 1. Developed Job Description of Sahelis. Sahelis must be at
Least 8th class passed women from that particular village
and also she should be very vocal and active
2. After their acceptance and understanding of their roles
& responsibilities, Parivartan issued job letters to Sahelis
3. Complete the Recruitment Process and Sahelis on Board
Sahelis are the one who will
roll out the Parivartan
modules in the group for
better health outcome
Parivartan State and
District Team &
Recruitment Agency
Job
Descriptions
Start Implementation Process
IMPLEMENTATION PHASE
MONTH 1 1. Orientation of Sahelis on Basic Facilitation Module for
Group Level Meetings through 3 days in house training
2. Sahelis will start dialogues with concerned community
group for building rapport to create an enabling
environment for community involvement, engagement and
participation
1. Capacitating of Sahelis on
basic Parivartan Modules and
developing facilitation skills -
So, they can roll out the health
modules in Groups

2. In community mobilization
process, it is very important to
involve local communities to
mobilize the target
community for involving them
in decision making process
Master of Trainers,
Block Level and
Community Cadres
Basic
Facilitation
Modules
Rolling Out All Health
Modules
MONTH 2 1. Orientation of Sahelis on Basic Facilitation Module for
Group Level Meetings and Mobilize targeted communities
2. Rolling out P1 Module Introduction and Context of
Parivartan Project
Master of Trainers,
Block Level and
Community Cadres
Basic
Facilitation
Modules, P1
Module, Flex
Poster & Flip
Cards
1. Specific messages through
modules to group members in
weekly meetings to enable
them for collecting actions
2. Facilitating collective actions
through Sahelis and CCs
MONTH 3 Introduce Swasth Samiksha Form (SSF) in the Group
Level which cover all the MCHNS indicators. Group
Members will fill the form every month and Sahelis will
help them
To assess the health status of
individual, family &
community level
Sahelis and Group
Members
Forms &
Pictorial
Formats
The SSF will sensitize the
group members to be
influencers on health &
sanitation and will empower
them to lead their communities
to improve family health
behaviour
MONTH 4 Sahelis will conduct community meetings for rolling out the P1 Module in all Parivartan Groups. Through this process the target community will aware on group
concept and benefits of associating with Parivartan. The target community will show interest in this community mobilization processes. At the same time, Sahelis will
get training on PM 1 (Antenatal care and birth preparedness) and PM 2 (Postpartum and newborn care) Modules.
MONTH 5
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MONTH 6 Rolling out PM1 Module Antenatal care and birth
preparedness and also PM2 - Postpartum and newborn
care
The women have to
understand the issues related
with antenatal care, birth
preparedness, postpartum care
and new born care which help
them to be more responsible
for taking actions and care of
the new born
Sahelis Booklet, Flex
Poster and
Flip Cards
The targeted community will
understand issues related with
antenatal care, birth
preparedness, postpartum care
and new born care
MONTH 7 Sahelis will conduct community meetings for rolling out the PM1 and PM2 Module in all Parivartan Groups. Through this process the target community will understand
issues related with antenatal care, birth preparedness, postpartum care and new born care. At the same time, Sahelis will get training on PM 3 (Early, exclusive
breastfeeding and complementary feeding) and PM 4 (Routine Immunization) Modules. From this month onwards, Sahelis will help the group members to take collective
actions.
MONTH 8 Rolling out PM 3 - Early, exclusive breastfeeding and
complementary feeding & PM 4 - Routine Immunization
Modules
Increase awareness among
marginalized women group on
the benefits of RI and early,
exclusive & complementary
breastfeeding.
Sahelis Booklet, Flex
Poster and
Flip Cards
These discussions lead to
increased levels of participation
which, over time, evolves from
the low end of passive listening
to the high end of collective
action that ultimately results in
adoption of MNCHS behaviors
at the individual and collective
level.
MONTH 9 Sahelis will conduct community meetings for rolling out the PM3 and PM4 Module in all Parivartan Groups. Through this process the target community will
understand issues related with early, exclusive breastfeeding and complementary feeding and routine immunization. At the same time, Sahelis will get training on PM 5
(Family Planning) Module.
MONTH 10 Rolling out PM 5 Family Planning Increase awareness and use of
modern spacing methods
among women to improve
birth spacing and reduce
unwanted pregnancies.
Sahelis Booklet, Flex
Poster and
Flip Cards
SHG women will understand
that Family Planning is a
personal and a community
development issue and they
will opt for any modern
contraception method
MONTH 11 Sahelis will conduct community meetings for rolling out the PM5 Module in all Parivartan Groups. Through this process the target community will understand issues
related family planning. At the same time, Sahelis will get training on PS 1 (Personal hygiene, and storage of potable water) and PS 2 (Use of toilet and safe disposal of
waste) Module.
MONTH 12 From this month onwards, all the Sahelis will get Refresher Training through different batches and in all modules till Month 18
MONTH 13
MONTH 14 Rolling Out PS 1 (Personal hygiene, and storage of potable
water) and PS 2 (Use of toilet and safe disposal of waste)
Module and also Sahelis will get refresher training
Understanding issues related
to personal hygiene and use of
Sahelis Booklet, Flex
Poster and
Flip Cards
Increase awareness on personal
hygiene and use of toilets
among women
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toilets and safe disposal of
waste
MONTH 15 Sahelis will conduct community meetings for rolling out the PS1 and PS2 Module in all Parivartan Groups. Through this process the target community will aware on
personal hygiene and use of toilets. At the same time, Sahelis will get refresher training.


POST IMPLEMENTATION PHASE
MONTH 16 Parivartan already rolled out all the Parivartan Modules related to MCHNS behaviour. Sahelis will get refreshers trainings on all the modules for better follow-up which
will help targeted beneficiaries to take actions on health, nutrition and sanitation behaviour at individual and community level. MONTH 17
MONTH 18
MONTH 19
MONTH 20

Annex 2. Activities at the Village Organization Level undertaken by PARIVARTAN:

Parivartan will integrate the agenda of health, nutrition and sanitation by involving the Village Organization with special emphasis on the members of the Social Action
Committee
5
. Under Parivartan, a participatory and pictorial tool is being prepared for reviewing the MNCHS related issues. This tool is named as Swasthya Samiksha Form
which will be filled at the group level but will be consolidated and reviewed at the VO level. Based on the status, bottlenecks will be identified and the follow up will be
planned by the Social Action Committee. They will also be given input on influencing positively the Health Risk Fund for utilizing for the mother and child linked issues. At
the Village Organization (VO) Level, Sahelis will compile the Swasth Samiksha Form (SSF) on a monthly basis to assess the health status of the targeted groups. The members
of Social Action Committees will be trained on two modules prepared under Parivartan - PE1 (Equity & Health) and also on PE2 (Social Accountability & Advocacy). This
module will orient the members to have understanding on equity, empowerment and entitlements in the context of health, nutrition and sanitation.

Activities Why Who are Responsible Tools Leading To
Rolling out PE1 (equity and health) and PE2 (social
accountability & advocacy) module in the VO level. The
modules covers topics related to importance of equity in
context of health and social accountability & advocacy
Enhance the knowledge on
accountability & equity of
health and sanitation services
in the intervention districts
Master Trainers Modules
(booklets),
flex and flip
cards
Better knowledge on
accountability & equity of
health and sanitation
services

At the VO level Parivartan will roll out Khirki Mehendi Wali
6
(KMW) for the VO members to understand positive health practices and also to adopt during pregnancy and
motherhood through the Social Action Committee. The whole 36 episodes will complete within 18 months. For this, Parivartan would use audio-visual materials, which already

5
The Social Action Committee comprises of 3 members of VO. The members discuss issues related to social entitlements and motivate the families in the village; Parivartan
is using the platform for the Khirki Mehendi Initiative and address the issues related to Health, Nutrition and Sanitation.
6 VO members will listen the radio Programme Khirki Mehendi Wali. In an entertaining format, the Programme delivers key messages on positive health practices to adopt
during pregnancy and motherhood. The radio programme centres around three main characters Mehendi (centre), whos the anchor of the show; her friend and guide Dr.
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been developed by other agencies on MNCHS related issues. To maintain parity of the messages that are being given by Parivartan, Parivartan will use audio-visual materials
that are developed by BBC Media Action for promotion of MNCHS behaviors. Parivartan is also strengthen the mechanism of review, monitoring process at the VO level and
coming up with appropriate solutions at the VO and CLF level.


Annex 3. Activities at the Cluster Level Federation undertaken by PARIVARTAN:

At the Cluster Level Federations (CLF), Parivartan will help the VO members to share the Swasth Samiksha Form (SSF) and the consolidated SSF will be analyzed and a
solution mapping will be done. This process will be initiated by the health mobilizer. In the CLF, The health mobiliser will review and collate the Swasthya Samiksha Form
(SSF) coming from various VOs. All the issues which will be red category will be analyzed to learn the causes. The Health Mobiliser will help the CLF to come up with local
solutions with the ownership of VOs of the cluster and create an enabling environment for the community mobilization activities.

Annex 4. Human Resource Support:

For implementing the Parivartan Program, there is a proper implementation structure and reporting arrangements at the State and District/Block level.

At the Districts Level:

Designation Place of Posting Key Responsibility
Block Coordinator At Block Level At Each Block, one Block HNS Integrator will be appointed
who would be responsible for all aspects of the intervention
including planning, day to day management of the activities;
capacity building of Supervisors and Facilitators jointly with
Master Trainers. He will work closely with District Manager
who will be immediate reporting authority.

Anita (left), who delivers key health messages and Phunti (right), who adds comic relief. Designed in a show within a show format, the programme has 36 episodes. Through
dramatic enactment of her life stories, Mehendi presents key family health issues. Dr. Anita contributes her crucial knowledge of positive health practices.
Episode
1 & 2
Episode
3 & 4
Episode
5 & 6
Episode
7 & 8
Episode
9 & 10
Episode
11 & 12
Episode
13 & 14
Episode
15 & 16
Episode
17 & 18
Episode
19 & 20
Episode
21 & 22
Episode
23 & 24
Episode 25 &
26
Episode
27 & 28
Episode
29 & 30
Episode
31 & 32
Episode
33 & 34
Episode 35
& 36
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8

Care During Pregnancy and Birth
Preparedness
Postpartum and New Born Care
Early and Exclusive Brest feeding and
Complementary Feeding
Immunization Family Planning
Sanitation
&
Hygiene
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13 | P a g e

MIS At Block Level MIS will be appointed at each Block who would
maintain the MIS of the intervention.
Cluster Coordinator At Panchayat Level On an average, one Supervisor will be placed to support the
facilitators to ensure the quality as well as handholding
support to Sahelis. Each Supervisor would be responsible
for capacity building of SHG groups during their weekly
meetings at the village level.
Sahelis At Panchayat Level One Sahelis would be engaged for 1 Panchayat who would
function as facilitator and will mobilize SHGs for the
weekly meetings. Each facilitator would be paid a monthly
salary for mobilizing communities in different aspects of
health, nutrition and water and sanitation.

At the State Level:

At the State Level, Parivartan established a Health Technical Group (HTG) within JEEViKA to support its efforts
to implement integration of health within SHGs and VOs. The overarching role of the support is primarily to act
as a think tank, support and advance the strategic and operational aspects of health integration within JEEViKA
community platforms to achieve health outcomes. The team would be embedded within JEEViKA and work
under the guidance of CEO, JEEViKA. The specific focus of HTG would be to transfer knowledge and expertise
from Parivartan project districts and accelerate the integration of health in other districts within Bihar where
JEEViKA has matured groups and VOs. The core activities include: (1) Support design and implementation of
health integration within JEEViKA, capacity building of field staff, Sahelis and other community cadre to drive
behavior change communications on health and sanitation (by suggesting appropriate training strategy,
methodology and materials), (2) Provide technical support for activities/pilots that would integrate health
through SHGs and VOs based on learning from Parivartan project, (3) Support and develop suitable MIS for
monitoring health integration within Jeevika M&E mechanisms, (4) build linkages with Technical Support Unit
within State Health Society for improved linkages between SHGs and front line workers (ASHAs and AWW).

Notes:

i
The discussions would happen at two level - one at the state level, and another at the district level
ii
Assumption: Staff at the state office is already in place
iii
HM Health Mobiliser - In the CLF, The health mobiliser will review and collate the Swasthya Samiksha
Form (SSF) coming from various VOs. The Health Mobiliser will help the CLF to come up with local solutions
with the ownership of VOs of the cluster and create an enabling environment for the community
mobilization activities.
iv
BHNSI Block Health Nutrition Sanitation
v
Mapping of the AWC
vi
HSC Health Sub-Centre
vii
Block level supervision meeting conducted by the BHNSI
viii
Micro-planning at the CLF level
ix
Parivartan compendium: 13 Modules
x
Rollout of the module
xi
: Sanjha Samajh: Sajha Samajh, a Hindi term generally referred to as shared understanding, facilitates
self-reported views of collaborative activities among Parivartan workers and other institutional
stakeholders in an acute service-delivery setting.
xii
Onsite mentoring and supervision by HM
xiii
: Sanjha Samajh
xiv
AWP Anganwadi Platform
xv
Solution Mapping
xvi
VHNSD Day and Gupshup Potli