Community managed Health and Nutrition interventions in

A.P

Society for Elimination of Rural Poverty

Department of Rural Development Govt. of Andhra Pradesh

A.P – poverty eradication through empowerment of rural poor women

(Indira Kranthi Patham) Focus: comprehensive poverty eradication -

economic and social building self sustaining institutions of poor Rs.2100 crores Project - financed by State

Government, World Bank and communities to cover all rural poor in the state (80 lakh

families, special focus on 26.0 lakh ultra poor)

builds on the decade long, statewide rural women’s self-help movement in A.P

Indira kranthi patham – women’s empowerment for poverty

eradication

Raise Poor people income and improve quality of life

Organize rural women’s groups

& their federations

Knowledge & awareness

Investment support

Government departments

Financial institutions

Panchayat raj institutions

Markets and other non-govt institutions

To enable each poor family in the state, to improve their livelihoods and quality of life and come out of poverty.

Comprehensive food security Earn Rs.5000/- per month, from 2-3 stable livelihoods. Economize on house-hold expenditure through collective

buying. Experience good health and nutrition status Attain good education status – especially the young Social Security – risks to life, health, assets and incomes are

covered Have decent shelter.

In our experience, this requires investment of Rs.100,000per family and 6 to 8 years, and continuous nurturing andsupport by C.B.Os - S.H.Gs, V.Os and M.M.Ss

A.P - vision for each poor family

Social networks of the poor

SHGs

•Thrift and credit activities

•Monitoring group performance

•Micro Credit Planning•Household inv plans

• E.C -2 from each S.H.G, 5 Office bearers

•Strengthening of SHGs

•Arrange line of credit to the SHGs

•Health committee, Social action

•Village development

•Marketing and food security

•Support activists

• E.C -2 from each V.O, 5 Office bearers

•Support to VOs

•Secure linkage with Govt. Depts.

fin institutions, markets

•Auditing of the groups

•Micro Finance functions

10 - 15

SHGs SHGs SHGsSHGs SHGs

V.O

150 -200

MMS4000 6000 -

Z S3,00,000

4,00,000

Coverage

• 22 rural districts of A.P– 2000 : 6 districts ( Srikakulam,

Vizianagaram, Chittoor, Ananthapur, Mahabubnagar & Adilabad)

– 2002: 16 districts

What have we achieved – from 2000 onwards?

Outreach: to cover all rural poor• As on date 87,00,00rural women organised into

6,88,000 S.H.Gs (upto March 2006)• Own savings : Rs.1232 Crores, Corpus : Rs.

2640 Crores. • Almost 90% of rural poor are organised• 27,350 VOs and 910 MSs formed

(coverage of poor - highest in the country)

Target for 2006-07: universal coverage

Financial support to poor – S.H.G –Bank linkages• Rs.100 crs to Rs.2001 crs in 6 years

• 2005-06: 2.88 lakh groups - Rs. 2001 Crores bank credit (Rs.69000 per group)

• Repayment rates in excess of 95%

• 2006 – 07: to reach 2.7 lakh S.H.Gs and 3900 V.Os – amount Rs.3500.0 crores

• Operation 100% repayment – Community based recovery mechanism

• New loan products: Financing through SHG federations, livelihoods, food security financing and health financing

FOOD SECURITY

Comprehensive food security for all:• Covered 10.0 lakh rural poor families till date• At present mostly rice credit line

Future plan• to cover 30.0 lakh families by 2007 March, 80.0 lakh

families by 2009-10• Broaden food security - rice, pulses, edible oils,

chillies, tamarind – on credit• Paddy purchase at harvest time and milling by the

CBOs to ensure 3 – 6 months food security

Benefits:Self-respect, better nutrition, better health for all, 10 – 20% reduction in costs, increase in wages, children have breakfast before they go to school.

Best practices in the project1. Targeting – community based targeting.2. Focus on the poorest of the poor and vulnerable:women,

disabled 3. Power of scale – bringing all the poor in the state into

social networks 4. Scaling up through community resource persons5. Institutional design – SHG – V.O – M.S – Z.S6. Large scale mobilization of bank finances for poor 7. Large scale livelihoods promotion8. Community managed food security9. Social issues as an agenda for collective action10. Social risk management11. Community managed health and nutrition interventions12. Convergence with all line departments S.E.R.P’s dynamic role – changes in tune with the changes

in the demands of the C.B.Os

S.E.R.P’s Health strategy

Our core belief: People’s health in people’s handsOur gurus:

Dr.Arole, Dr.Sudershan, Dr.Abhay Bhang• 90% - people’s sector, 10% - ‘doctor’ sector,

interface with private and Govt. health service providers

• Primary challenge: optimise ‘people’s control over their health’, as contrasted to ‘supply’ focus

• Opportunity in A.P: statewide network of empowered poor people’s organisations

2nd belief: empowered communities bring efficiencies, accountability in public and private service providers

Health interventions - universal

• Thrift and Credit groups - consumption smoothening• Livelihoods promotion – income enhancement• Larger loans available for more serious health needs –

Micro credit planning • Food Security credit• Empowerment – holding village level functionaries

accountable – ANM, AWW • Greater voice of the poor in Panchayats • Knowledge – whereto seek health help, how to access

Government services better• Risk Management: death, disability &Health risks-

community managed insurance

Focused Health and Nutrition interventions – 45 pilot mandals spread over the state

Empowered communities: Demand and access services especially among

POP and poor. Improve household behaviours that helps

maternal &child survival and control of communicable diseases

Provide financial support during illnesses Reduce of expenditure on health

Strategies

• Continuous capacity building

• Convergence

• Community Investment Fund (CIF)

• Communication for capacity building

• Case Managers

Health Human Resources

• VO level: Health Activist(1), Health sub Committees(3-5)

• MMS level: Health Sub Committees(5), Master Trainers(2), HN CC(1)

• ZS level : Health Sub Committee(5),DPM(HND)• State level: Project Manager(1), Regional field

coordinators(8)

CEO: Overall in charge of the Organization

Health force!Community health capital• HAs: 1400• VO Health sub committees: 6000• MMS Health sub committees: 225• ZS Health sub committees : 110• Health CRPs: 150MMS Staff• HN CCs : 45• Master Trainers: 90ZS staff• DPM(HND)• State level: 10

Focused Interventions

• Health as agenda in S.H.G / V.O / MMS – from coping to planned interventions

• Health activists – regular training, paid by and accountable to V.Os

• Training and monitoring of health sub committees at VO,MMS & ZS

Nutrition and Health Days- Health Risk Fund

• Fixed NHDs

– Greater accountability of AWW / ANM to V.Os – M.S – PHC interface

• Health Risk fund

– Health savings – H.R.F for emergencies

• Next steps:- Mapping health service providers and negotiating service delivery standards and costs – C.B.Os have better financial strength

Nutrition Centers

• Most heartwarming intervention• Pregnant & Lactating mothers• Outcomes: healthy children and safe deliveries• Funding:

o F. S. Credit, Community Contribution, Govt.( Rs. 1000/- JSY), Interest from HRF,

o V.O’s margin from credit and non-credit activities• Monitoring by V.Os• Health monitoring by ANM / AWW• Next Steps:- 2 years nutrition support to infants• Day care centers• Nutrition support to adolescent girls • Dovetailing ICDS funds  

Health assurance

• Partnership with private medical colleges Karimnagar model• Community managed Health Insurance, Vizag

Issues

• Are we focusing adequately on the demand side? or only lip service.

• ‘De-centralisation’, ‘involvement of people’, involvement of P.R.Is – only footnotes

• Where’s the people’s voice in our strategising?• Decades of focus on ‘supply’ side – how effective has it

been – ‘pouring’ more into a leaky system• Developing/strengthening ‘demand’ – cannot be through

mere good intention statements- has own processes, logic, sequencing - requires investments, time

Core requirement: belief in people’s capabilities • If done properly- most cost effective and sustainable

So, we look partnerships for :

• Empowering the CBOs on Preventive and Promotive health care measures with appropriate technology.