Evidence for Sustainable Change

Transcription

1 Through the Self-Help Group Model of RGMVP RGMVP Core Functions/Program Rajiv Gandhi Mahila Vikas Pariyojana (RGMVP) is the flagship poverty reduction and empowerment program of the Rajiv Gandhi Charitable Trust (RGCT). Established in 2002, RGMVP works in the poorest and most backwards areas of Uttar Pradesh (UP), India. The mission tries to address fundamental gender and caste-based barriers that restrict the poor from accessing entitlements, finance and health benefits through its three-tier community-based empowerment model. RGMVP was strategically reconceptualized in 2007 with the help of Society For Elimination of Rural Poverty, a World Bank recommended model of poverty reduction. The motivation behind this reconceptualization was build an enabling system to address the gap between the poor and government and entitlements. RGMVP started building a three-tier institutional model in order to provide a systematic community platform to reach out to the last mile population Women are organized into Self-Help Groups in their neighborhoods (habitations) and are strategically federated at Village and Block Levels, where the cutting-edge service delivery systems operate. RGMVP has modified the SHG model by expanding and pulling the focus away from mere financial inclusion and has encouraged the SHG institutions to build various development programs such as health, education and livelihoods in a holistic manner. RGMVP s autocatalytic community operating system is based on the principle of self-help with a focus on social and organizational ownership. RGMVP is currently mobilizing women from poor households in over 250 blocks spread across 41 of the most backwards districts in UP. The community institutions of RGMVP enables direct delivery of various services such as savings and bank linkages, livelihoods, agriculture, education, health and nutrition and rights and entitlements. The Tata Institute of Social Sciences (TISS), a reputable leader in the field of social sciences has intensively studied the various processes of RGMVP s model over the last year and has recently accredited the model as an effective, innovative and more nuanced model for building community leadership. *See Annex 6 - TISS Accreditation of RGMVP Through the Self-Help Group Model of RGMVP 1

2 *Based on RGMVP MIS Data as of March 2013 RGMVP Functional Areas RGMVP s mandate to empower women and reduce poverty in Uttar Pradesh is achieved through improvement in various functional areas that have been deemed important for the poor to break the shackles of poverty. Each functional area caters to poverty elimination in their own unique way by promoting financial stability, creating livelihood opportunities, providing health related benefits, etc. RGMVP Support Programs Key Performing Initiatives Outreach and Impact 1. Financial Inclusion (See Annex 1 - Credit Utilizations Data for 10,000 Groups) 1. SHGs Linked to Banks 2. Savings Corpus 3. Debt Swapping between SHG members 4. Promoting Livelihoods and Addressing Social Needs 5. Innovative concept of Cash Credit Lines 1. SHG Linkage with 17 Nationalized Banks 2. Access to $46 million of loan achieved 3. $8 million total Savings Corpus Through the Self-Help Group Model of RGMVP 2

3 RGMVP Support Programs Key Performing Initiatives Outreach and Impact 2. Health (See Annex 2 - Graphs and descriptions of health-based projects undertaken & Annex 5, based on information collected from VOs) 3. Nutrition (See Annex 3 - Case-study attached) 4. Agriculture (See Annex 4 - Graphs depicting increase in productivity of wheat and rice) 1. Maternal and Child Health 2. Reducing Tuberculosis 3. Increasing Availability of ORS and Zinc 4. Addressing Health of Adolescent Girls 5. Collecting robust baseline information to ensure targeted intervention, impacting the most marginalized and vulnerable sections of the population 1. Nutrition Surveillance Pilot Intervention 1. Women farmers exposed to the best sustainable agriculture practices 2. Women farmers exposed to System of Rice and Wheat Intensification Methods 1. Scale-up project in 160 blocks across 41 districts of UP 2. Impacted 50 blocks in 12 districts, achieved 89% institutional delivery in SHG households and significant behavior change in various health practices 3. Identified 7,321 Maternal and 16,623 infant deaths out of 733,927 target households spread across 41 districts under the current BMGF grant 4. Over 40% of the pregnant women identified have benefitted from ORS and Zinc 5. Promoting Menstrual Health Awareness in 50 blocks, directly impacting young women in over 35,000 SHG households (work scaled up to Amethi and Raebareli districts) 6. 60,000 people educated on the effects of Tuberculosis 1. All the Angawadi (Healthcare) Centers in Gauriganj block of Amethi region were provided with weighing scales and growth monitoring charts 2. Program has been scaled up to entire blocks of Raebareli and Amethi districts 1. More than 35,000 women farmers are taking forward the initiative to promote sustainable agriculture 2. 25,000 farmers have increased wheat and rice productivity through SRI and SWI Through the Self-Help Group Model of RGMVP 3

4 RGMVP Support Programs Key Performing Initiatives Outreach and Impact 5. Dairy 1. Dairy Training conducted by experts from the University of Wisconsin 2. Promoting Market Linkages 3. Additional income for Dairy farming families 4. NDDM set up Bulk Milk Coolers in project areas (capacity of 2,000 liters each) 6. Sanitation & Hygiene 1. Lead Implementation Partners in a Research Project funding by BMGF 2. The Project focuses on promoting toilet use, safe personal hygiene practices and menstrual health management among women and adolescent girls. 1. 2,800 women have been trained on the best dairy practices ,000 liters of milk procured daily (Rs /liter) and marketed in Delhi 3. Families are able to generate a total income of $80,000/day (Rs. 4 million) Bulk Milk Coolers have been set up 1. The initiative will be tested in Sultanpur district before it can be scaled up to the remaining program blocks 7. Panchayati Raj Institutions (Local Governance) 1. Federating women PRI members to promote active governance amongst existing and future political leaders 1. At the rate of 180 members/ block in the existing 204 blocks 8. Rights & Entitlements 1. MNREGA Job Card Holders 2. Convergence Platforms ,813 MNREGA Card Holderʼs details 2. Federations ensure better convergence and accountability, creating a synergistic system between the demand and supply side *Based on RGMVP MIS Data as of March 2013 Through the Self-Help Group Model of RGMVP 4

5 Annex 1 - Summary of Credit Utilization Data Financial Inclusion: Financial Inclusion (FI) is the process of linking poor and marginalized communities to institutional credit. In the context of RGMVP, FI is inculcated through weekly savings, internal lending, debt swapping and credit linkages through bank accounts. SHG members are encouraged to internally lend to each other to increase and sustain their savings corpus. After 3 months of its formation, an SHG is eligible for its Cash Credit Limit (CCL). A minimum amount of Rs. 100,000/- is cumulatively given to the SHG members to engage in livelihood activities and fulfill their social needs like health and education. Based on available data from RGMVP s current Management Information System (MIS) of 10,428 SHGs, one can see the following results (Annex 1): SHG Details RGMVP MIS Data Total No. of Members 118,474 (A) No. of members who have availed loans for livelihood from savings Total amount of loan availed for livelihood by SHG (A) No. of members who have availed loans for social needs from savings Total amount of loan availed for social needs by SHG (A) No. of members who have availed loans for Debt Swapping from savings Total amount of loan availed for Debt Swapping by SHG (B) No. of members who have availed loans for livelihood from CCL 1 & 2 (B) No. of members who have availed loans for social needs from CCL 1 & 2 (B) No. of members who have availed loans for Debt Swapping from CCL 1 & 2 (A) 57,949 (B) 51,822 $20,735,520 (Rs. 1,036,775,983) (A) 18,885 (B) 12,990 $4,091,865 (Rs. 204,593,277) (A) 8,056 (B) 5,933 $169,441 (Rs. 84,822,040) *See Attached Annex 1 - Credit Utilization Data Excel Sheet for more information Through the Self-Help Group Model of RGMVP 5

6 Annex 2 - Evidence from Community-Based Healthcare Interventions RGMVP s major Community-based Healthcare program is designed to address the issues that surround Maternal and Neo-Natal Health. It uses a Behavior Change Management approach to bring about a shift in existing knowledge, attitudes and practices within communities. The health program adopts a self-help and convergence approach. So far, RGMVP has introduced and is encouraging interventions such as- Skin to Skin Care (STSC), Exclusive Breastfeeding and Safe Hygiene Practices, as well as promoting institutional registration and deliveries, and accessing rights and entitlements for the mother and child. The following health data has been collected from 1,250 villages spread across 50 Blocks in Uttar Pradesh, India for a project specific MIS, exclusive to the intervention blocks. This data shows the progressive increase in area coverage from October 2011 to January This implies that the RGMVP MIS data s sample size changed each month, due to an increase in outreach as a result of increase in SHGs that were mobilized came into the ambit of the program. Figure 2.1: RGMVP Area Coverage Through the Self-Help Group Model of RGMVP 6

7 Figure 2.2: % of Fully Immunized Children Under Age Five (With Measles and Vitamin A vaccinations) *Out of a total of 31,583 children under five, 43% have been fully immunized. Figure 2.3: Total Number of Pregnancies Registered *Out of a total of 9,521 women, 100% women registered their pregnancies. (According to the Annual Health Survey , 56.8% registered their pregnancies). Through the Self-Help Group Model of RGMVP 7

8 Figure 2.4: % of Institutional Deliveries in the Last Three Months *Out of a total of 1,758 deliveries that took place, 78.6% were institutional deliveries. (According to the Annual Health Survey , 42.9% women had institutional deliveries.) Figure 2.5: % of Women exclusively breastfeeding for six months and % of Newborns breastfed (colostrum) within one hour of delivery *Out of a total of 31,583 children, 18% were exclusively breastfed. Through the Self-Help Group Model of RGMVP 8

9 Figure 2.6: % of Birth Registration *Out of 31,583 deliveries, 100% children were registered at birth. (According to the Annual Health Survey , 56.8% registered their pregnancies.) Figure 2.7: Total Number of Women Receiving IFA Tablets *Out of a total of 3,829 pregnant women, 9.9% received 100 IFA tablets. Through the Self-Help Group Model of RGMVP 9

10 Figure 2.8: % of Women who have Received Two Doses of TT *Out of a total of 5,182 pregnant women, 54% received 2 doses of TT. Figure 2.9: % of Women Visited by AAA (Asha/ANM/AWW) Within One Day of Delivery *Out of a total of 1,758 women, 37% were visited by the ASHA worker, Anganwadi Worker and Auxiliary Nurse Midwife within one day of delivery. Through the Self-Help Group Model of RGMVP 10

11 Figure 2.10: % of Childhood Diarrhea Cases Treated With ORS/Zinc Within Two Weeks of Delivery *Out of total of 2,3975 new borns, 18% percent were treated for diarrhea with ORS and 6% were treated with zinc. Figure 2.11: Total Number of Women Practicing Skin to Skin Care (STSC). The data comes from 413 villages, spread across 21 blocks in 8 districts. RGMVP collected data independently to assess the impact of Skin to Skin Care (STSC) intervention. *Out of 1,221 mothers, 84.02% practice STSC. (From December January 2013.) *See Also Attached Annex 2 for Baseline Information of SHG Households on Maternal and Infant Deaths Through the Self-Help Group Model of RGMVP 11

12 Annex 3 - Gauriganj Block Case Study (Amethi District) Background In Uttar Pradesh, one of the daunting problems that runs parallel to extreme poverty, is malnutrition among infants and children. This is aggravated by the other factors such as lack of community awareness and failure of government schemes to reach out to the poor, especially in the rural areas. For example, the Anganwadi Centers (Healthcare Facilities) that were set up close to 40 years ago in 1975 as a part of the Integrated Child Development Services have not been able to make an impact to the extend that they were intended to. Poor maintenance, limited knowledge of Anganwadi staff members and skewed community outreach has made this government system of addressing the problem of health fairly ineffective. RGMVP as a mission believes in working with the poorest of the poor population and with health as one of the key mandates, infant and child nutrition directly falls under the purview of the same. Therefore, to address the problem of malnutrition, RGMVP through trainings and capacity building, developed a simple evidence based mechanism that would correlate low birth weight to nutrition. Using a growth chart devised by the World Health Organization (WHO), as the medium, the intention was to make the community self-sustainable in analyzing the level of risk a child was facing due to lack of proper of nutrition. While, the project primarily aimed at Nutrition Surveillance that monitors the growth of children between 0 and 5 years to prevent low birth weight and subsequent malnutrition, it has also made communities aware of the importance of getting access to their rights and entitlements. The case study displays the power of the community to mobilize and fight for itself in a peaceful and well thought-out manner. Process The Gauriganj case study has the potential to be described as the story of community empowerment. It is about the strength of numbers and community federations. Gauriganj is a RGMVP Phase II block where work kick-started in the year 2009 after the strategic reconceptualization of the organization in In September 2012, when the RGMVP health-training program was implemented in the block, it was discovered that there was no supplementary food for children and, pregnant and lactating mothers, and no appropriate equipment at Anganwadi Centers. This was a major problem, as all the Anganwadi Centers were mandated to provide these services. Therefore, during implementation many operational issues were brought to the surface. It is said that only a poor community can truly bring itself out of the series of problems that its members face. The only assistance that one is demanded to give in a participatory development setting is to ensure that right channels of information are opened up and linked together. With this ideal in mind, the women of Jailodhi Baba Mahila Gram Sangahthan of Bisoondaspur, Gram Panchayat got together to demand from the their village Pradhan (Village Headman), the appropriate equipment in their village Anganwadi Center. This led to procurement of all the necessary apparatus to run the Healthcare Center. Through the Self-Help Group Model of RGMVP 12

13 This measure led to a collective action that was taken up at the Block Level. Observing what the women of Bisoondaspur had done, the block was motivated to demand the weighing scales for the entire block of Gauriganj. 25 Village Organizations (Gram Sangathans) got together to write a letter to Child Development Program Officer for the Integrated Child Development Services (ICDS). As a result, within a month, all the 25 GPs were equipped with weighing scales. This incident has also affected the block as a whole where as of date there is appropriate AWW equipment in all the 57 Gram Panchayats of Gauriganj. The second hurdle was that while weight machines were made available, the Anganwadi Workers (AWW) did not know how to use the growth monitoring charts. The Block s Child Development Program Officer (CDPO), requested RGMVP to conduct a training program for all the Anganwadi Workers on how to use the growth chart. These trainings were conducted by RGMVP s ISCs along with minimal hand-holding support of RGMVP facilitators and trainers who took the lead on how to engaging with government functionaries. It is also important to keep in mind that these women who are categorized as Internal Social Capital (ISCs) are also extremely poor women from the community, therefore promoting community outreach and involvement. They work day in and day out to mobilize women to strengthen and connect networks of women to each other. Results The following are some of the important outcomes of this intervention and community mobilization: G o v e r n m e n t s y s t e m s w e r e m a d e accountable through the collective strength of the women. The Mukhaya Sevika (Village Program In- charge), Block Child Development Program Officer (CDPO) and the District Program Officers along with Front Line Workers of the AWW centers were individually and collectively held accountable by the women of Gauriganj. The number of healthy children who were either bordering malnourishment or were malnourished went up from 761 to 1067 out of the 1109 children who were tracked. There was also a clear increase in the number of SHGs that were formed because of the intervention. It from 860 as of 30th September 2012 to 968 as of 31st January The intervention was scaled up to reach out to all the blocks of Amethi and Raebareli. Today all the blocks of the two districts have weighing machines. Through the Self-Help Group Model of RGMVP 13

14 In Gauriganj Block, out of 1,109 children who were tracked in each of the Gram Panchayat s Anganwadi Centers and sub-centers, as a part of the nutrition surveillance, in the first month 761 children were in the green zone as of October However, by the end of January 2013, 1067 children successfully moved to green zone of the growth chart. Figure 1 depicts the progress. Figure 1: Nutrition Surveillance Data Charting Children Over Four Months Conclusion In conclusion, Gauriganj block has not only been able to reduce malnutrition but also display the strength of taking collective action in large numbers. It has shown that by providing basic training and disseminating relevant and useful information, the community has the ability to address its own problems and become self-reliant. Moreover, in this case, one can also observe that government systems are usually supply driven, often limiting access to these services by the community, who they are trying to address. RGMVP tries to work from the demand side using a simple bottom-up approach where the poorest of the poor are given the basic facilitative help they need and deserve. Therefore, with very little help from the organization and through their shared spirit and strength, women of Gauriganj were able to articulate the need for their rights and entitlements making government systems like Anganwadi Centers accountable for themselves, their families and their community. Through the Self-Help Group Model of RGMVP 14

15 Annex 4 -Increase in Production of Wheat and Rice Through SRI and SWI Through a System of Wheat and Rice Intensification, the production of rice and wheat in targeted regions of the RGMVP Program Area, has doubled. Wheat Productivity - SWI Impact Kg/ha India Punjab Uttar Pradesh Raebareli Sultanpur Avg. Productivity Avg. Productivity Avg. Productivity Avg. Productivity/ SWI Avg. Productivity/ SWI 2,619 4,179 2,627 2,058/2,819 2,580/5, year Intervention 2 year Intervention *Source: as per Data; SWI Data as per crop cutting experiment (n=35) Rice (Paddy) Productivity - SRI Impact India Tamil Nadu Uttar Pradesh SRI Intervention 2,393 4,179 2,358 4,480.2 *Source: as per Data; SWI Data as per crop cutting experiment (n=35) Through the Self-Help Group Model of RGMVP 15

16 Annex 5 - Member Wise Data With a Special Focus on Health The following information has been collected since March 2013 from 63,283 members in 5,753 Self- Help Groups spread across 8 different CRDCs in the program area. The data reports that RGMVP has been able continuously able to impact health outcomes both within and outside the fold of SHG federations. *See attached Annex 5 - Member Wise Data of 5,753 SHGs Across 8 CRDCs Excel Sheet for reference A summary of the available data according to RGMVP MIS is as follows: 1. 1,117 pregnancies have been identified from within SHG members households pregnancies have been identified from outside the SHG fold deliveries were recorded within SHG members households deliveries were recorded outside the SHG fold. 5. Accredited Social Health Activist (ASHA) and SHG member jointly visited 2,056 pregnant women both within and outside the scope of the SHGs. 6. Out of 63,283 members and households beyond the purview of the SHG federations, only 1 maternal death was recorded. 7. Out of 63,283 members and households beyond the purview of the SHG federations, 0 infant deaths were recorded. The above mentioned indicators form an integral part of the monitoring, evaluation and learning process from a health perspective. The information acts as a necessary tool to: 1. Review SHGs who are federated at the Village Organization level. The review is conducted by VO members themselves 2. Ensure that the PMO and the field functionaries are able to provide handholding support whenever necessary 3. Increase accountability and ownership of community institutions Through the Self-Help Group Model of RGMVP 16