Child care – Seva Setu

03 Jan

2016 at a glance

2016 has been a fun year at Seva Setu. We eagerly look forward to 2017 to bring about changes on ground, Seva Setu style 🙂

Looking back, 2016 was a year of consolidation and introspection at Seva Setu. We were not focused on expanding our services and scaling our operations in different regions. Instead, we were keen on strengthening and streamlining our internal processes. We focused on ensuring the data we collected on the field was rigorously maintained and indexed. We also identified and integrated technology in programs where we thought it would greatly help scaling them. Doing so has prepared us to aggressively expand our portfolio of services in 2017 as well as replicating them across geographies. We want to strongly establish our brand presence as well on the field in addition to having polished operations. 2017 is also the year Seva Setu turns three. With this, we now want to be formally involved with local governments in executing various projects in our areas of expertise. 2016 has thus been a year of preparation for the high amount of activity we hope to see in 2017!

We highlight here some of our posts from the year before –

Citizen care: We worked primarily on three pension schemes – for the disabled, for senior citizens and for widows. The second half of the year saw our focus shift towards the disabled, and covering three districts in parallel. We learned a good deal about the processes and challenges in ensuring people received their benefits from the government. [Our opinion piece]
Mother care: After seeing a lull at the beginning of this year, 2016 saw a swanky-revival of its Each one, Reach one program. We got good coverage from the press and got on board urban mothers from varying professions and backgrounds to befriend peers from rural Bihar! We now have a fully automated tool to schedule and manage phone calls. We have begun receiving feedback from urban mothers and are resolving escalations raised by them. [Web-based software] [Press article]
Child care: 2016 saw a tough year for our Child care program. We fought tooth and nail in ensuring that the NRC in Patna, which was shut down without notice, was reopened in two months’ time. We also faced resistance from families in Patna in going to the centers. On a positive note, most families in Vaishali obliged and realized its significance. Our opinion piece of issues in the current setup also got press coverage. [Related post] [Press coverage]
IT training: We completed four batches of skill training this year. We were pleased to see the warm response we got from the people of Vaishali in participating in this program. Basic computer literacy as a skill has high returns in our growing knowledge economy. We want to see how we can get those we train employed in local markets. [Related post]
Audits of public services: We also spent time on auditing existing facilities and liaisoning with the government to rectify issues we had spotted in them. We audited Anganwadi centers – to ensure basic facilities like weighing machines, growth charts etc. were available at the centers; and health centers – health subcenters in villages and block-level primary health centers. The audits of Anganwadi centers led to several fruitful meetings with the CDPOs and the health center audits led to action being taken after we filed complaints with Bihar’s Lokshikayat center. [Health center report]
Sewing training and creating markets: We continue to operate sewing training centers in which get batches of 20-30 young women trained in sewing and related skills. Towards the end of 2016, we were able to liaise with local vendors in ensuring their produce got into the local markets. We are very optimistic about this program taking off full-steam, given the successful pilots we’ve seen thus far. [Related post]
Technology and processes: 2016 witnessed an emphasis on technology. By rigorously maintaining internal data stores and making our code-bases public, we restructured our operations to make it amenable to disciplined data collection and analyses. We are now on GitHub and have a dedicated community of 5-6 developers who are involved in designing and maintaining our software-related tools! [Each one, reach one software] [Our live stats from citizen care]

With this, we really look forward to 2017! We thank our team of field executives, employees, and volunteers who’ve worked shoulder to shoulder in getting us here. We think we’re better prepared in facing challenges that this space will throw at us and we’re optimistic that our experience in this domain thus far will help us be more efficient and impactful!

Hello 2017!

18 Nov

A ray of hope in fighting malnutrition..

Last month we shared with you the difficulties and hurdles we were facing in admitting malnourished kids to Nutritional Rehabilitation Center (NRC). We cited the reluctance of parents coupled with the distance of NRC from the villages as the primary reason for our failure in admitting kids. On one hand, we could see a number of kids suffering from severe malnourishment and on the other hand almost 15 out 20 seats remained vacant in NRC. This ironical and unfortunate status quo always acted as an impetus for us to put our extra efforts in this direction. We are pleased to announce that we managed to overcome the hurdles to some extent and succeeded in admitting 11 kids to NRC in the last couple of weeks. Considering the poor ratio of admission in the last month, this is a big number and it will indeed encourage us to make further strides in this direction. We would like to share the credit with our field workers who proactively convinced the parents to get their kids admitted in NRC. Our field workers apprised them of the benefits of NRC and at the same time cautioned them about the long-term impacts of malnourishment on their kids. As we already mentioned about the distance of NRC from their villages, Seva Setu also hired an auto for the kids and parents who were unable to afford travel expenses.
All the admitted kids are now under the supervision of NRC staffs and are getting the required nutritional diet and care. We hope that all of them come out as healthy kids and shape their future without being obstructed by any health related issues. This is eventually the ultimate goal of Seva Setu.

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13 Oct

NRC – A way to eradicate malnutrition

In a time when the world is striving to explore the possibility of life on Mars, there are still 795 million people across the world who go to bed hungry every night. The whopping number itself indicates the disparity in the overall growth and development. The biggest victims of this hunger are kids. Hunger results in the deficiency of essential nutrients in their body which eventually leads to malnutrition. Malnutrition, if not cured in time can cause an irreparable damage to a kid.

India, a home to one-third of the total malnourished kids across the world is struggling to combat this issue. In India, 44% of kids under the age of 5 are malnourished. When it comes to Bihar which is one of the least developed states of the country, the situation is even more deplorable. More than 55% of the kids in Bihar are suffering from malnutrition. Like in the case of any other issue plaguing the nation, we train our guns on the government for malnutrition as well. But while working on the issue of malnutrition, we came across a watershed initiative named Nutrition Rehabilitation Centre (NRC) which has been started to combat the issue of malnutrition. It is established in each of the 38 districts of Bihar to minimize the cases of malnourished kids in Bihar. Children are admitted as per defined admission criteria and provided with medical and nutrition therapeutic care. Once discharged from NRC, the child continues to be in the nutrition rehabilitation program till he/she attains the defined discharge criteria from the program.

During our field surveys, we came across many malnourished kids in the villages of Patna and Vaishali districts. True to our name, we admitted more than 400 kids in NRC and thus acted as a bridge between the government-sponsored schemes and beneficiaries. We followed up these kids until they regained health and started leading a normal life.

But in the last few months, we are finding it bit difficult to convince parents to get their undernourished kids admitted in NRC. Some of the reasons which we managed to figure out while discussing with the parents are:

Ghar me aur 2-3 chotte bacche hain. Agar hum waha chale jaayenge to un logo ka khayal kaun rakhega?
Agar hum 20-25 din NRC me hi rahenge to kamaayenge-khaayenge kaise?
NRC ghar se bhut dur hai. Jaane aane me bhut dikkat hoti hai.
Mere bacche ko koi pareshani ni hai. Wo ekdum thik hai.

It is ironical and unfortunate that a state where more than half of the kids are suffering from malnutrition, most of the beds of the NRCs remain vacant. We are making every effort to ensure that such a noble initiative of the government reaches its desired beneficiary. We invite you to come up with ideas and suggestions and help us in achieving the desired results.

16 Sep

Seva Setu at a glance

04 Sep

Notes from our fight against malnutrition [Part 2]

[This is the second of a series of posts which Seva Setu shall publish during the National Nutrition Week (1-7 September)]

September 1-7 has been declared as the National Nutrition Week in India. As highlighted in our previous post, Seva Setu takes this opportunity to convey to a larger audience some notes on how we have engaged in this fight against malnutrition.

NRCs – how to empower them

In our previous post, we spoke of the challenges in the functioning of the Nutrition Rehabilitation Centers. We discussed four key challenges in its functioning –

Location
Capacity and utilization
Relapse, and
Social concerns

All four issues, when looked at closely, hint at a common root – a sense of unfamiliarity which an inaccessible service breeds. If it were a service being provided right next door, one wouldn’t have to bother about operational worries such as having to travel and stay at an unknown site while not having a grip of one’s home. From what we have seen, we strongly believe that if the whole NRC model is decentralized and if location and accessibility is preferred to capacity, it would make this one very compelling model of change. For instance, dedicating one ward (containing around 5-10 beds) in each Primary Health Center (PHC)(which is located in every block – a block being a collection of 10-15 panchayats) could be a first step into having a practical solution for these concerns. This way, parents could be given an option of visiting the clinic everyday for an hour or so after the first two-three days of getting them to stay over at the clinic. Such a model would hopefully ensure a higher utilization of this service and will also be easily marketable to the residents of nearby panchayats.

Dedicate a 5-10 bed ward at each PHC to handle cases of malnutrition instead of having one clinic per district. A dedicated clinic should not handle all cases of diagnosis and care. Instead, have them for only specialized treatment and tertiary care.

As far as the matter of relapse is concerned, the problem of such a monitoring mechanism reeks of a technology-based intervention. Having a phone-based monitoring system is a sure step towards ensuring beneficiaries of this program are kept in touch with and monitored closely. Having such a system will also act as a forcing function to ensure patient-data is available in a format where such electronic tracking is made possible. Skeptics might call this far-fetched, saying it would be just another useful sounding system on paper. To prove them wrong, we at Seva Setu embraced technology in such monitoring and intervention tasks long ago! Our mother care program has a fully automated system that anyone can be a part of which helps young, pregnant mothers in rural India enjoy a safe motherhood. Check out the nifty system here!

Have a technology-driven monitoring system. This will force the system to have digitized data, making it amenable for further monitoring and analysis. Seva Setu has set up one such system in its Mother Care program.

Related programs

Community Management of Acute Malnutrition

We aren’t the first to be enlightened by these simple yet effective interventions at ensuring the existing system works better. The concept of decentralizing the role of the NRCs has been acknowledged even by Doctors without borders (Médecins Sans Frontières) in Bihar’s Darbhanga district. Referred to as the Community Management of Acute Malnutrition model, the program shifts the onus of primary care for malnutrition to the PHCs and ensures that there’s more door-to-door monitoring that happens to avoid relapse. They don’t adopt a technology approach towards relapse prevention – a step which can easily be integrated into their current model. Go through their full study here.

Sneha Shivirs

This idea has also been embraced by the bureaucrats who have designed Bihar’s Integrated Child Development Service’s Program implementation plan for the year 2015-2016. Recognizing the problem at hand and with an aim to fast-track bringing down the malnutrition rate in Bihar below the 30% mark, the government had in 2014 instituted the Bal Kuposhan Mukt Bihar (BKMB) campaign. As part of the 2015-16 efforts, the government has planned on implementing Sneha Shivirs (nutrition camps). One such camp would be setup for every 4-5 Anganwadi centers and will run for a period of 30 days – the first 12 days would involve feeding the malnourished kids along with sensitizing the residents of the issue, which would be followed by 18 days of door to door monitoring of children’s health. This promises to result in close to 40,000 such camps being organized throughout Bihar. The idea again is to make such care and service localized and accessible. The success to such camps would be its execution month on month for a good period of time, which does not seem to be part of this year’s implementation strategy. This year’s plan speaks of only one such camp being held at the centers with a proposal to scale operations up based on the results of the pilot. Read the year’s implementation plan here.

Role of the media

While having mentioned these suggestions and tweaks to existing programs, one must not forget the role of the media in directing a nation’s conscience towards this pressing matter. We have seen media campaigns go viral in the past (e.g. the Pulse Polio campaign) which have made topics of importance a household name. Even if the layman does not understand the nuts and bolts of what an issue is all about, the fact that it plays on every TV screen and is the “trending topic” usually brings it into the realm of coffee table conversations. Unfortunately for us, the media has failed to pick up malnutrition as one such topic. What the nation seemingly wants to know this week is how rains have inconvenienced a visiting dignitary or how the vision of digital India is being fulfilled by a telecom operator. Debates and discussions around malnutrition, which the nation ought to know about, are missing. When we looked around, we found very few mentions of it in the popular media, most covering vegetable carving ceremonies to mark the national nutrition week! [link] If this is the seriousness with which this dialogue is carried forward, we are simply a long way away from being anything close to a nation conscious of a problem destroying its infants.

Addendum: The Times of India has carried out a piece on 6 September 2016 on the seriousness and extent of malnutrition plaguing our country. This was the only piece we could find which covered this issue.

Up next

In our subsequent post, we shall talk about other programs by the government and the prevention mechanisms which can help in addressing this issue in the long run. Help spread the word and stay tuned until then!