Working together for the public good
A.L. Sharada, Thane, Maharashtra
September 26, 2017

An NGO demonstrates that working with the government is not an impossibility and that, in fact, the joining of hands brings greater transparency and accountability to the implementation of development programmes, with the active participation of the community

It is often said that it is easier to work independent of the government than work with it. Inefficiency, corruption, and lack of commitment are often cited as reasons for creating parallel structures, which tend to further weaken the government system.

The experience of Population First, an NGO working on population and health issues within the framework of women’s rights and social development, has, however, been different. It has been working in close collaboration with the government for the past nine years and has been able to build bridges between the government and the people. In doing so, it has ensured that social development programmes are implemented with greater transparency and accountability, with the active participation of the community.

A mother and child in a pre-intervention paediatric ward.

One interesting case is Population First’s engagement with the Block Level Planning and Monitoring Committee (BLPMC). Population First was co-opted into the committee by the government based on the work it has been doing in Shahapur.

Dr Deepak Sawant, the Health minister of Maharashtra, had invited the Population First team to discuss the malnutrition status of children in Shahapur Block, one of six blocks in Thane District. We were requested to survey a few villages, weigh and grade the children and give a report on their malnutrition status. The discrepancies in data provided by Population First and the government were too vast to ignore, indicating under-reporting of cases at the village level.

This issue was raised by the TMO (treating medical officer), Dr. Mahesh Nagre, at a BLPMC meeting attended by the block development officer (BDO), Thane medical officer, Child Development Project officers (CDPOs), Health Committee members, NGO representatives, gram sevaks (panchayat secretaries, usually) and health supervisors.
Dr Nagre stressed that there was an urgent need to tackle the malnutrition situation in Shahapur. The supervisors and CDPOs suggested that a review meeting be held to understand why the malnutrition problem was not managed adequately.

Sangita Tribhuwan, programme manager, AMCHI (Action of Mobilization of Community Health Initiatives, Popultion First’s field intervention), was made responsible for documenting the proceedings and suggesting remedial measures. A meeting was organised with representatives of Van Niketan (the mother NGO in Thane) and all block level officers, who were asked to share their views and experiences. 

One major perception that emerged from the discussion with service providers was that the problem of the children’s malnutrition was rooted with the parents. These people, from tribal communities, had large numbers of children, were illiterate, unaware and not willing to change – that was what was stated. “We are doing everything but the problem is with the parents,” went the refrain.

Doctors and nurses on their rounds in the post-intervention paediatric ward.

Based on Population First’s experience in villages, Sangita questioned the assumption and raised questions on the efficacy of the anganwadi (mother and child care) centres, their timings, the activities children are exposed to, the food that is provided to the children, the assistance in cash and kind that is given to self-help groups to provide the food, the sanitary and hygiene conditions at the anganwadi centres and the villages, the follow-up on the packed nutrition distributed to children for home use, and the hospitalization and follow-up care of children with severe malnutrition.

As a result of the discussion about these questions, a number of issues surfaced, leading to the formulation of a concrete action plan at the ground level during a follow-up meeting. It was decided that the BDO would write to the civil surgeon to organise a health check-up camp to identify severely malnourished children and hospitalise them, if necessary. Prior to the camp, committee members visited the sub-district hospital since it was pointed out by the participants at the meeting that the paediatric ward was so bad that children hospitalised there were getting worse.

The insanitary and unhygienic conditions were brought to the notice of the civil surgeon, Dr Shinde, by the visiting team. As a result, a cheerful, neat and clean ward was created. All the malnourished children from 15 villages were sent to the camp, which had a paediatrician and a nutritionist attending on the children. Twelve children were admitted and the parents were counselled.

The most important change made in the organisation of the camp by Population First was that all the requirements of the parents were met in the same place. Registration, check-up, counselling and dispensing of medicines were made available in the ward.

This was much appreciated, as the parents who belong to tribal communities face various kinds of handicaps in terms of language, ability to deal with paper work etc, and feel intimidated if they have to go from one department to another to seek different services. Providing food and water to the attendants and children also made the camp a comfortable experience for both parents and children. More parents are now willing to admit their children in the hospital.

It was pointed out at the meeting that 12 anganwadi centres did not have toilets. The BDO took the responsibility of getting toilets constructed within eight days and successfully implemented the plan in the given timeframe. Steps were taken to make run-down anganwadi centres more habitable and cheerful looking, using the Rs 10000 budget available for the upkeep of such centres.

Apart from these steps, government officials and agencies are now engaged more actively in addressing service delivery issues at the ground level. Community awareness and participation, and a positive attitude and orientation of health officials are together responsible for the change that is happening in Shahapur. A more open equation among the health system, the NGOs and the community seems to be the key to inclusive and people-driven development.

(The writer is director, Population First.)

August 2017