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.100,000 per family and 6 to 8 years, and continuous nurturing and support 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 SHGs V.O MMS Z S 3,00,000 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 Crores. Almost 90% of rural poor are organised 27,350 VOs and 910 MSs formed (coverage of poor - highest in the country) Target for : universal coverage

Financial support to poor – S.H.G –Bank linkages Rs.100 crs to Rs.2001 crs in 6 years : 2.88 lakh groups - Rs Crores bank credit (Rs per group) Repayment rates in excess of 95% 2006 – 07: to reach 2.7 lakh S.H.Gs and 3900 V.Os – amount Rs 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 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 project 1.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 persons 5.Institutional design – SHG – V.O – M.S – Z.S 6.Large scale mobilization of bank finances for poor 7.Large scale livelihoods promotion 8.Community managed food security 9.Social issues as an agenda for collective action 10.Social risk management 11.Community managed health and nutrition interventions 12.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 hands Our 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 2 nd 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: 150 MMS Staff HN CCs : 45 Master Trainers: 90 ZS 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: oF. S. Credit, Community Contribution, Govt.( Rs. 1000/- JSY), Interest from HRF, oV.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.