In November 2015, the Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India (POSHAN) published an implementation note on the Parivartan initiative, which was launched in 2011 by Project Concern International (PCI) in partnership with PATH and the Foundation for Research in Health Systems (FRHS). The objective was to increase the adoption of health, nutrition, and sanitation (HNS) behaviours among women of reproductive age in the most marginalized communities of Bihar. This project was launched due to awareness that in much of India, the targets for ensuring optimum growth and development of infants and children are not being reached. Indeed, in an assessment of complementary feeding practices in Bihar, researchers found that only 58 percent of children received any complementary foods at six months.
Parivartan focuses on creating self-help groups in 8 districts of Bihar to strengthen complementary and age-appropriate feeding. These self-help groups typically meet four times a month on a weekly basis and are used as a platform for women in local communities to learn and develop health, nutrition and sanitation (HNS) behaviors. During these meetings, modules are presented and discussed. Each module includes games and activities, key information, and actions that are related to a specific HNS behavior. The modules on complementary feeding address the following topics: early initiation of breast feeding, exclusive breast feeding, and diet diversity, quantity, and frequency. Sahelis, who are paid members of local communities, facilitate one of these four weekly SHG meetings and are supported by ‘master trainers’ and ‘health mobilizers.’ Once the module is completed, an action plan is developed to support implementation; in subsequent meetings, Sahelis follow up with group members about their actions and any successes and challenges in accomplishing these.
A major part of Parivartan is its collaboration with the Bihar state government’s rural livelihoods project (Jeevika) which helps to enhance the social and economic empowerment of the rural poor in Bihar through the creation of self-managed community microfinance institutions or self-help groups at the village level. PCI’s partnership with Jeevika enables the women’s groups formed under Parivartan to be enrolled in the Jeevika program. It also allows Parivartan to extend its reach by introducing its modules to established Jeevika savings groups.
As of 2013, Parivartan had reached 275,000 women through over 18,000 created self-help groups. An additional 150,000 women belonging to Jeevika-formed groups are also currently being reached with health and sanitation interventions during two-hour weekly meetings. A mid-line pre-post evaluation by PCI in 2014 showed the following improvements among group members: the feeding of solid/semi solid or soft foods for children age six to eleven months increased by 5.4 percent, complementary feeding during sickness increased by 3.8 percent and exclusive breastfeeding increased by 27 percent. When comparing self-help group members who had participated in the modules with those who had not in terms of accessing food from their local Anganwadi Center (centers that provide local nutrition and health support services) the study found that 60 percent of the group members who had received the modules accessed the food provided by the center, while only 42 percent of non-group members accessed the food. The implementation note highlights that peer pressure among members of the self-help groups was a significant success factor for the gains that were made.
The POSHAN implementation note identified a number of challenges to the program’s success. These have been the low literacy level and limited facilitation skill of the sahelis, and the need to repeatedly follow up and intervene at the family level. From these experiences the implementation note suggest that in order to ensure functional self-help groups there needs to be a focus on capacity building and the sahelis and master trainers need extensive training in observing sessions, taking corrective actions and tracking performance.
In conclusion, Parivartan’s findings and field experiences suggest that self-help groups can also be mobilized for better health nutrition and sanitation outcomes. Although the findings reported are not based on a rigorous experimental evaluation design, they are indicative of positive trends on key behaviors emphasized by the groups. The implementation note highlights that more investments in research are needed to better understand the reasons for different responses in different communities to complementary feeding and to strengthen the evidence base for the use of self-help groups in improving nutrition behaviors.
The Implementation note can be found here.
By: Bas Paris, IFPRI