Thursday, 15 October 2015
Following from Sagar Atre:
Updates from the GV Evaluation Qualitative survey
The usual narratives of rural Bihar are of lawlessness, abject poverty and living conditions far below standards considered acceptable. For many years now, Bihar has been considered one of the ‘sick’ states of India. Sini Varghese, an MA student of the Indian Institute of Technology Gandhinagar (IITGN) recently visited the Madhepura district of Bihar for a survey. The survey was part of an impact evaluation of a project called Gram Varta, that a team from IITGN is conducting.
Gram Varta is a program aimed at improving vital aspects of villagers’ life such as the health and nutrition of women and young children, sanitation practices, and use of clean drinking water, among others.
The project is being implemented by Jeevika, an autonomous society of the Government of Bihar and is funded by the Department of International Development (DFID) of the Government of UK. A team of researchers led by researchers from the University of Gottingen, Germany and IIT Gandhinagar and Harvard University have been tasked with conducting an external impact evaluation of this implementation. The results of the impact evaluation will be used to assess the replicability of this program in other regions.
The theory behind Gram Varta is simple. A facilitator from among the members of SHGs in the villages of Bihar will conduct 20 meetings with the frequency of one meeting every month. Some meetings will be conducted with the entire village. At every meeting, the facilitator will initiate activities and discussions and use interactive games to inform and inspire SHG members about the importance of adequate nutrition, proper sanitation, maintaining clean water supply, daily practices of hygiene and the importance of nutrition for women, adolescent girls, young children and the dangers of malnutrition.
By the time 20 meetings are completed, the program aims to get the community together, to enable it to deliberate and analyze its own problems, know the solutions, apply them and monitor success. For improvement in use of government facilities like the Primary health centers, Anganwadi centers and ASHAs, Gram Varta seeks to empower the community members to demand for these services and compel the government to fulfill those demands.
Varghese’s survey was aimed to understand the knowledge and attitudes of women in rural Bihar about their health, their rights as women, their importance in the family among some other parameters. She found that there are vast disparities in the attitude of women in rural Bihar as compared to many urban women of India. While urban women are now shaking off the many forms of male subjugation and violence, domination by husbands and family members is a normal state for women in Bihar. She notes, “Few women even think that they deserve something better than what they have. For them, getting beaten by their husbands occasionally, eating when everyone else is done and not being able to even speak to their fathers-in-law is a usual phenomenon. Their nutrition, health issues are often noticed only when they are very severe.”
The medium of SHGs, the main vehicle of change for Gram Varta however, is proving to be a boon for the women according to Varghese, “They are a place where women share their thoughts and concerns and can speak openly without fearing family members. Many women shared their newly acquired abilities of being able to operate bank accounts due to the SHGs, a hugely empowering experience for women who had not travelled outside their own areas. The SHGs are a great source of financial help instead of banks and predatory private money lenders.” The SHGs have hence given women an important platform to get out of their routines, save for the family and improve their own financial security.
Although money and financial security are major motivations for families to approve of women being part of SHGs, the women themselves say the SHGs are one activity where the usually strict familial norms are much less stringent since the groups are all attended by women from their own village and indulge in constructive activities for their families and the village.
The attitudes and beliefs of community members are an important hurdle to cross while seeking to bring about change in any community. Unlike the middle class in cities, where basic knowledge about health and sanitation is often assumed, knowledge and attitudes about health can be drastically different in villages. Varghese found that toilets were built and used only in some households, and hand-washing too was not a regular practice. Other health-related aspects like breastfeeding, not marrying off women until marriageable age is attained, the importance of adequate nutrition for women, adolescent girls and children are not areas where knowledge can be assumed. Varghese says, “Women’s health and nutrition are especially not given priority. Nor are their health needs fulfilled promptly. For example, it is considered unsafe for women to go out of homes to go to toilet in the fields after dark and women are dissuaded from doing so. This causes women to be denied the simple privilege of going outside their homes after dark. Moreover, the attitude of blaming women for assaults because they were out late at night further restricts their rights.”
Finally, even though the government seeks to provide health services in rural areas, few people trust the system. “People said that the government dispensaries and primary health centers are always understaffed, they don’t have the resources or medications and if they do have staff, the staff are rude and dismissive of the patients’ complaints. People go to private doctors or quacks and seek treatment. They feel they get better care from them because they pay money and are treated with some semblance of dignity. Of the three villages I visited, women of only one village stated that their local ASHA (the village health worker) and other health centers were working properly. Residents of the other two villages reported absenteeism.”
Health programs earlier have sought to address health programs from the supply and administrative side of the process. The Gram Varta program however, seeks to make people the main agents of change in this process. An earlier implementation of this program in Odisha by an organization called Ekjut, which implemented it with the state government was very successful. The program envisions that an empowered, informed and united village will be able to get much more done and will demand health and ancillary services from state, district and block level officials, and that this bottom-up demand for services and care will ultimately improve the health and living conditions of the villagers of rural Bihar.