ISSNIP Bihar ( )

Transcription

1 Annual Action Plan ISSNIP Bihar ( ) State Project Management Unit (SPMU) Directorate of ICDS Department of Social Welfare Government of Bihar 1

2 Contents Section 1: Introduction and overview... 3 Section 2: Review of Annual Action Plan Section 3: Annual Action Plan Component 1: Institutional and Systems Strengthening Review/ refinement of policies guidelines/ procedures: Strengthening and Expanding ICDS Monitoring Systems Strengthening Training and Capacity Building Strengthening Convergence with NRHM Innovations & Pilots Implementation Support at District and Block level Component 2: Community Mobilization and Behaviour Change Communication (BCC) Activities to Enhance Community Mobilization and Participation Assessment of capacities of Civil Society Organization (CSOs)/ Community Based Organization (CBOs) Behaviour Change Communication (BCC) Designing, pre-testing and implementation of mid-media activities - folk and film shows Component 3: Piloting Convergent Nutrition Actions Component 4- Project Management, Technical Assistance, Monitoring & Evaluation Project Management Monitoring and Evaluation Summary of funds required for Section 4: Template for Annual Action Plan (Annexure A) Procurement Plan (Annexure B) Section 5: (Annexure C) Result Framework of Phase Health and Nutrition Scenario in Bihar: A Demographic Snapshot Details of Oational Blocks and Anganwadi Centre Current District Wise Beneficiary Data 53 Map of ISSNIP Districts State Innovations and Good Practices Contact Details of State and Districts Project Team Status of Immunization and Vitamin- A Supplementation in ISSNIP Districts

3 Section 1: Introduction and overview Integrated Child Development Services (ICDS) is world's largest outreach child health, nutrition and development scheme. Anganwadi Center (AWC) is the level of delivery of child development services in ICDS, at the community level, and all other levels above are meant to support and manage formance of AWCs. With the scale of presence (about 14 lakhs AWCs across the country) and having two people responsible to deliver services in each AWC, ICDS is often recognized as having largest staffing for outreach community development programs. ICDS by design is expected to deliver 6 identified services for health, nutrition and development of children and their mothers. However, growing concern is being about ineffective or complete lack of delivery of some of the services, which greatly reduces ability of ICDS program to achieve its objectives. With continued burden of malnutrition in the country, the Government of India has introduced a number of new initiatives in ICDS and most of them focus on states and districts with higher burden of malnutrition. With assistance of IDA, government of India has launched a project named ICDS Systems strengthening and Nutrition Improvement Project (ISSNIP). This is a two-phased, seven year project with the overarching goal to improve nutritional outcomes of children in India and is being implemented in 8 select states. During the first phase of three years, a number of systems in ICDS will be strengthened and new approaches and pilots will be tested in selected areas. Phase II will be implemented over a iod of four year and will support scale up of successful pilots and lessons learnt during Phase I. Bihar is the third most populous state in the country and its population of million (As census 2011) is being reached through more than 90,000 AWC in 544 projects. Bihar is one of the poorest state in India it also has high rate of childhood malnutrition compared to several other states. The state has recorded an impressive economic growth over last 5-6 years and there are significant improvements in infant and neonatal survival over the last decade (SRS data). However the child mortality does not reflect similar reductions and also the last available reliable estimates (NFHS 3) of nutrition status also indicate a grim picture. As NFHS 3, nearly 54% of children under 5 in the state are malnourished (-2sd) and about 8% are severely malnourished (-3sd). Recent estimates (AHS) of service coverage and practice of optimal feeding behaviors also indicate need for intensive programming at least in priority pockets. (Annex 1 provides a summary of key indicators from NFHS 3 and AHS for Bihar compared to other similar states). Overview of the project ISSNIP has been designed to add value to ongoing ICDS program by offering flexibility to try new approaches to improve key program components, and scope for eximenting to bridge some of the program gaps. The first phase is mainly focused in establishing innovative and improved systems to prepare ground to deliver evidence based nutrition interventions during phase 2, at the same time the scale of reach during first phase is also quite significant. While districts with higher burden of malnutrition are identified for supporting at district and block level for system strengthening, several state level initiatives are included in ISSNIP that will contribute to better management and program delivery in non-issnip districts as well. In the state of Bihar, 19 districts are chosen to be part of ISSNIP and there are 281 projects/blocks in these districts. 3

4 Project Development Objectives (PDOs) of ISSNIP: While the overall goal of the project is to contribute towards improving the child development outcomes including the nutrition and early childhood education outcomes, Phase 1 will be formative and preparatory in nature. Outcomes intended for Phase 1 of the project are related more process and output focused and relate to system strengthening and deriving learnings from pilots/ innovations, that will be useful for scale up and achievement of population level nutrition improvements during phase 2 of the project. Specific objectives articulated for phase 1 of the project include the following: a. To strengthen the ICDS policy & planning framework, systems and capacities at the national level and in 8 selected States to deliver quality services, and facilitate better community engagement - to ensure greater focus on under 3 children b. Strengthen coordinated and convergent actions for improved nutrition outcomes Key outcomes of phase 1 of the project are related to strategic learning and systems strengthening, which will shape future strategies that can be implemented in phase 2 to address programme outcomes at large scale. Activities and interventions proposed in phase 1 are expected to lead to following broad outcomes: Strengthened ICDS policy and programme framework Revised monitoring system to measure effectiveness of ICDS programme in project districts fully oational A mechanism for incremental learning and capacity building within ICDS established at district and block levels in project districts Viable approaches and models of community participation identified in project States based on analysis of existing or past examples and outcomes of innovation pilots Effective BCC strategy and its implementation plans focusing on feeding and care of under-3s developed and rolled out in the state Replicable models of convergent action for improving nutrition outcomes established in at least one district in the state Project Components: To achieve the above outcomes, project is designed to undertake activities under 4 components during phase 1. Component 1: Institutional & Systems Strengthening This component aims at strengthening the existing systems in ICDS focused on the following six key areas: o Review and refinement/development of guidelines, standards, protocols and procedures in ICDS (related to aspects like human resource policy, decentralized planning, strengthening supplementary feeding) o Strengthening and expanding ICDS monitoring systems, including roll out of the revised MIS o Strengthening training and capacity building systems, focused mainly on establishing innovative mechanisms for ongoing (incremental) capacity building o o Strengthening convergence with NRHM Innovations and pilots including testing flexible models for urban ICDS and testing approaches like second worker model in limited scale 4

5 o Implementation support through additional contractual staff at district and block levels to enhance technical and oational capacities of ICDS staff and to bring focus on critical interventions in ICDS Component 2: Community Mobilization and Behaviour Change Communication Primary focus of the project is to oationally align ICDS towards nutrition and health requirements of under two children. Reaching out to families with children in this age group and changing prevailing norms about child feeding and caring practices require structured community mobilization and behaviour change communication. Outreach activities like home visits are known to be effective for inter-sonal communication with the parents and other caregivers in the family. To hasten the process of social norm change, it is important to supplement the IPC component with one-to-group communication and other mass media channels. Community mobilization for supporting norm change as well as to hold service delivery systems accountable is one of the areas in which the project intends to pilot and prepare ground for scale up. A number of community mobilization and BCC efforts are envisaged under the project and some of the major ones include the following: o Activities to enhance community mobilization and participation: Main activity envisaged is aimed at leveraging existing CBOs and CSOs participation in ICDS, for which orientations of members of CBO/ CSOs like women SHGs, mothers committees, Mahila Mandals etc will be undertaken during phase 1. Other activities include piloting models for community engagement, community monitoring like social audits, private public partnership and engagement of local NGOs in ICDS for carrying out community mobilization. o Behaviour Change Communication: Activities are proposed to strengthen Intersonal Communication through home-visits by AWWs and synchronized conducting of other media activities in the community based on a comprehensive BCC strategy that is responsive to local context. Component 3: Piloting Convergent Nutrition Actions Recognizing multiple determinants of nutrition, it is proposed to address problem of child malnutrition through a comprehensive multi-sectoral response to influence some of the underlying causes. Forming state and district level bodies to coordinate multiple sectors that have contribution to nutrition outcomes is one key priority of phase 1. Designing and pilot testing community level pilots for multi-sectoral convergent nutrition actions is another priority to prepare ground for scale up. Component 4: Project Management, Technical Assistance, Monitoring and Evaluation Establishing state project management units, oationalizing the new component of technical assistance agency at state and sub-state level and undertaking innovative program monitoring approaches like Rapid Assessments and LQAS surveys through suvisory levels are some of the activities proposed under this component. These are aimed at creating a stronger management system, enhance technical skills and build results focused data driven management system in ICDS. Project Coverage: In the state of Bihar ISSNIP will be implemented in 281 Blocks/ Projects in 19 high burden districts. Details of districts and blocks are as below: 5

6 Sl. No. Districts No. of Blocks/ Projects Sl. No. Districts No. of Blocks/ Projects 1. Gopalganj Munger Buxar Muzaffarpur Jehanabad Purnia Bhagalpur Saharsa Darbhanga Samastipur East Champaran Sitamarhi Jamui Supaul Lakhisarai Vaishali Madhepura West Champaran Madhubani 21 Sl. No Total Project Allocation: The total project outlay for Bihar is Rs Lakhs of which Rs Lakhs is estimated for Phase- I, with a cost share of 90:10 between GoI and GoB. The detailed component wise allocation for ISSNIP in Bihar has been provided in table below. Project Component Institutional and System Strengthening Community Mobilization and BCC Piloting Convergent Nutrition Action Project Management, TA and M& E Phase 1 Year- 1 Year- 2 Year- 3 Total (Phase 1) GoI State Total GoI State Total GoI State Total GoI State Grand Total

7 Triggers for Phase 1 As the project agreement, the indicators of Intermediate Results (IR) for Phase 1 (Triggers) are as below: - 50% of project blocks reporting information using the revised MIS in ICDS (KEY) 1 - Guidelines for four of the six identified key areas of ICDS systems strengthening developed and disseminated - 50% of project districts having established and trained district resource groups to implement the incremental capacity building system (KEY) - State having conducted at least one pilot to test the effectiveness of a system of joint planning and review by ASHA, AWWs and ANMs at the health sub-centre level in improving quality and coverage of health and ICDS services (KEY) 2 - At least 1 project district in the state having developed convergent nutrition action plans for piloting at district level (KEY) - Completion of baseline data collection for Phase 2 of the project in the state Section 2: Review of Annual Action Plan While the state has progressed in obtaining approval from Planning Empowerment Committee and the state Cabinet and has initiated process for recruitment of state and district level consultant positions during FY , timing of completing some of these procedural requirements was a bit delayed and by end of the year most of the key processes are streamlined. Following table summarizes some of these details: 1. Status Of All Project Related Approvals by the Competent Authority: Sl. No. Particulars Issuing Authority Date Approval of Project- ISSNIP Cabinet Approval Approval of and No Objection of Procurement Plan for first 18 Months Resolution (SANKALP) Recruitment of Consultants for SPMU/DPMU and Project/Block Planning Empowerment Committee, Govt. of Bihar vide letter no: 244 Cabinet, Govt. of Bihar vide file no. ICDS/80010/ Govt. of India and World Bank through letter no. 3-2/2013- WBP ICDS Directorate vide letter no Department of Social Welfare, Govt. of Bihar vide file no. ICDS/80010/5-2014/ While this is an indicator set at the project level (and needs to be met by efforts across 8 states), in Bihar this may be construed as translating to at least 141 projects using revised MIS. However a system like MIS makes meaningful sense when rolled out across the state and not in a fraction of it, because analysis and action from state as well as reporting upwards from state level make sense when a uniform system is used. Hence the state will make efforts to implement revised MIS in entire state than in a part of it, merely to meet this trigger. 2 Health sub-center level convergence between front line workers of health and ICDS is an innovation that was initiated 2 years back in Bihar and currently it has been scaled up to entire state (38 districts). Hence the state contributes significantly to meeting of this trigger at the national level. 7

8 2. Physical Progress in Respect of Implementation of Activities against the Approved Annual Action Plan : Due to the delay in obtaining mandatory approvals and financial clearances for new projects; inability to conduct state orientation; lack of timely guidelines for key components from central level, as well as due to delayed on boarding of TA agency, most of the activities planned and approved in the annual action plans could not be undertaken. Some roll-out efforts were undertaken at the state level so as to orient different stakeholders on project priorities and plans. One day State Level Orientation workshop of DPOs and 2 CDPOs from each of the 19 ISSNIP districts was organised in Patna on 15 th January 2014 where representatives from Central Project Management Unit (CPMU), The World Bank, TA Agency and State Level Officials from Department of Social Welfare and ICDS as well as from the Development Partners participated. One day orientation for district level staff of Development Partners, (UNICEF, DFID - BTAST, BMGF - CARE and BBC Media Action) was organised in Patna. In this workshop participated development partners are requested to come together and extend their support for effective implementation of ISSNIP in the state. One day orientation for DPOs and CDPOs of all 19 ISSNIP districts was organised in 3 different batches on 11th, 12th and 13th February in Patna. All DPOs and CDPOs were oriented on ISSNIP. District level plan of action prepared by the participants. 8

9 3. Financial Progress: State Govt. received Rs Lakhs and subsequently Rs Lakhs from Govt. of India in FY & respectively. The total fund Rs was available for the financial year under the ISSNIP program. The state had provision of Rs Lakh in financial year ( ) for ISSNIP. The budget head (C ) and (C ) was created for central and state share respectively. However a sum of Rs Lakhs was available for implementation of program but could not be drawn from treasury due to some unavoidable circumstances which affected the implementation in the state. The expenditure incurred under the ISSNIP programme is being paid by ICDS general fund and will be adjusted later on. An IUFR (Unaudited financial report) has been submitted to Govt. of India for Rs Lakhs/- vide Letter No: 3073 Dated: 29/03/2. Revalidation of the fund is under process. Request has been send to MoWCD. Support required for the ministry to expediting the revalidation process, so program implementation could be initiated at all levels. 4. Status of Procurement of Goods for SPMU and DPMU: Process of procurement initiated by SPMU. An assessment committee was formed comprising three members including procurement officer to assess the requirement for SPMU on 24/02/2014 vide letter no: ICDS/25010/ /1387. The committee submitted a report, clearly mentioning the goods approved in Annual Action Plan , may be purchased through shopping method and the furniture required for SPMU may be purchased after the approval from Central Project Management Unit. Specification of electronic equipment and rates are obtained from BELTRON dated: 27/03/2014 vide letter no: 1812/14. Quotations with rates from different reputed agency are being obtained. Procurement committee of ICDS Directorate will review the rates and order will be placed. Assessment Committee assessed some additional items (Commuter table, shelf, office chair and tables etc) need to be purchased but these items are not approved in AAP It has been decided that few items which is already available at directorate may be utilised for the same purpose and remaining items must be incorporated in next annual action plan for further approval from CPMU. Procurement process for SPMU will be completed within June Process of procurement for DPMU will be initiated shortly. 5. Status of Establishment of SPMU and Hiring of Project Consultants: The current status is as under: i. Notification for establishment of SPMU and Director ICDS as the Project Director- ISSNIP Issued vide letter no: ICDS/80010/ /687 dated: 28/01/2014. ii. Notification for deputation of two Joint Project Coordinators (JPCs) issued vide letter no. ICDS/80010/ /1575 dated: 05/03/

10 i. Hiring of Project Consultants: The progress is as below. Sl. No Activity Time Line Remarks Advertisement appeared in State and National Daily News Pas, Receiving of online application, Receiving hard copy of application along with relevant certificate and exiences, Scrutiny & Short listing of Applications for the position of Consultants in SPMU and DPMU Completed Under process 3. Interview of SPMU Consultants & DPMU Consultants May 2014 Planned 4. All Consultants will be On board (Both SPMU & DPMU) July,2014 Planned 6. Details of Proposed Pilots: As mentioned above, due to the delay in obtaining clearances, having guidance of GoI and mobilizing TA agency s support in the state, none of the project activities including pilots could be initiated on the ground as part of ISSNIP. However as part of other development partner s effort, especially of BMGF-CARE s project in 8 districts (4 of them being ISSNIP districts), incremental learning and sub-center meetings for convergence between health and ICDS (which are pilots proposed under ISSNIP) are being implemented and scaled up across the state. Monthly meetings of AWWs, ASHAs and ANMs are being organized through this project of CARE in all sub-centers of 8 districts since Structured review, planning and ongoing capacity building are undertaken through ANMs supported by external facilitators as required. Timelines of implementation of all other pilots that were planned as part of annual action plan are being moved to annual action plan Details of each pilot are provided in respective section below. Section 3: Annual Action Plan Component 1: Institutional and Systems Strengthening Strengthening key systems in ICDS to deliver nutrition and child health outcomes at scale, especially in the high burden states and districts is one of the key mandates that ISSNIP has taken on itself. This is a very important component for Phase 1 so as to prepare ICDS systems to implement innovative and context specific interventions in phase 2 of the project. Streamlining policy and program environment related to HR, finance management systems; establishing decentralizing planning and review system; improving monitoring system; strengthening training systems are some of the components that will impact entire ICDS beyond the project districts. Testing out innovations, pilots to solve some of the contextual problems like urban areas; service provision to migrants etc will be implemented in project districts. To undertake the project initiatives and to support different kinds of pilots, institutional support to implementation is being provided through contractual staff at district and block levels. Following sections provide a description of how the state plans to implement some of these components in the project areas. Review/ refinement of policies guidelines/ procedures: As planned in ISSNIP guidelines, frameworks and strategies related to some of the key components of ICDS will be reviewed and refined by CPMU. State project team will contribute to 10

11 these review and refinements and will work to adapt them appropriately for the state contexts. While adapting the guidelines, frameworks and strategies, care will be taken to ensure that their core components are not compromised. Along with the 5-6 areas in which CPMU would review and refine policies/ guidelines, the state proposes to undertake a review and refinement of current IYCF guidelines so as to prioritise critical ones for state context. Following adaptation, district and block officials will also be oriented on these guidelines and future action plans prepared in consultation with them. A state level task force will be constituted to provide guidance to implementation of the policy framework as well as programme implementation. Formal meetings of this task force are proposed to be undertaken bi-annually, however the state project will draw on its extise in an ongoing manner. Following steps are proposed for adaptation of refined policies and guidelines in the state: - Organizing about 10 consultation meetings with key stakeholders for discussion of draft policy/ revised guidelines/ procedures at state level state task force to play key role - Undertaking modifications as appropriate to state context incorporating recommendations from the consultations and finalizing the same in discussion with CPMU - Dissemination of revised guidelines/ procedures to all districts and blocks in the state Activities Budget ( ) Timeline (1) Adaptation of national guidelines, frameworks and strategies to suit state contexts TOTAL 5,00,000 5,00,000 Upon receipt of refinements from CPMU Strengthening and Expanding ICDS Monitoring Systems While the state level master trainers have been trained earlier, due to delay in printing of new registers, because of a judicial matter, roll out of revised MIS is still pending in the state. While state is exploring alternate channels like development partners support to get registers printed for use at least in some districts, it recognizes that the best situation will be to have uniform revised MIS across the state so that program management and reporting get streamlined. Anticipating that the judicial issue related to printing will be resolved during the early part of , state proposes to initiate process of roll out, especially preparing trainers up to block level using resources available in ISSNIP. It also plans to leverage the presence of number of development partner-staff in all the districts and up to block levels in several districts. Following activities are proposed to roll out revised MIS in the state (while some of them are planned for all 38 districts, which are mostly to be done at state level, some are limited for 19 ISSNIP districts only). Roll out of revised MIS - Organize the 4 days refresher training for SLMTs and expand the current SLMT by adding new members so as to reach all districts in a short span of time. SLMT with about 15 members will be constituted and effort will be made to include Regional Managers of TAA; SPMU staff and representatives from DPs who have ability to support in DLMF trainings in multiple districts and for suvising roll out in their assigned districts. These refresher/ SLMT trainings will be organized at state level with support from central team trainers, some of who are also involved with Bihar programs of development partners. - Constitution and training of DLMFs for all 38 districts will be organized at ISSNIP cluster locations and the SLMT members (including RMs of TAA and SPMU staff of ISSNIP) - Training of lady suvisors will be undertaken in 19 ISSNIP districts as the schedule suggested in induction training guidelines. 11

12 - Induction of revised MIS at AWC level in 19 districts is also proposed to be programmed under ISSNIP. Though resources for the induction trainings are provided by GoI under ICDS general funds, considering the availability of unutilized resources under ISSNIP and need for flexibility to hasten roll out in the 19 districts, state project team proposes to utilize ISSNIP resources for this purpose. A summary budget for these activities is as indicated below: Sub-tasks / Steps/ Processes Estimated cost Timeline Refresher training on revised MIS Of SLMTs (4 days training) 200,000 June and July 2014 DLMTs training on all 38 Districts 475,000 July and Aug 2014 LS training at District level by ISSNIP fund (Training Guideline- induction plan) 4,560,000 Aug/ Sept 2014 (depending on printing of registers) Review on progress of roll- out of revised MIS State and District level Review on progress of roll- out of revised MIS State and District level L.S 475,000 Sept and Dec ,140,000 Oct 2014 and Jan 2015 Level one training on revised MIS 43,929,000 Sept to Nov 2014 Piloting mechanisms to ensure AWC services to migrants Bihar is known to be a state with significant level of out migration, both within and outside the state. Rural to urban migration within the state is high in some pockets and a number of districts have unusually high level of out migration to other states/ cities all across the country. In recent past international migration has also increased manifold among rural communities. Most of the migration is of semi-skilled or un-skilled labourers and often the intra-state migration involves entire family migrating. In order to ensure that the migrant families receive services in their source and destination locations in a seamless manner, ISSNIP proposes to pilot an innovation. To begin with this pilot will be focused on intra-state migration and based on exiences and support from GoI inter-state pilot could be considered in later years of the project. While further details of the pilot will be developed in consultation with multiple stake holders the basic design being considered now involved some of the following elements. - Identification of source and destination locations to be included in the pilot (preferably within same district but one to be in ISSNIP districts) - Developing system to track beneficiaries of selected source location (using unique identity number/ provision of special cards if required) - Establishing a system of communication between source and destination locations - For implementing this pilot a baseline survey will be conducted in both source and destination locations to measure level of nutrition behaviours and service coverage. With inputs of key stakeholders a robust pilot design and implementation plan will be developed. After an implementation iod of about 9-12 months, an end line survey will be conducted and improvements in service coverage and behaviour change will be measured. Ongoing process documentation will be undertaken and lessons for dissemination and scale up will be drawn based on process analysis and pre-post evaluation results. TA Agency will support in designing of pilot, preparation of required manuals, monitoring and tracking tools in consultation with CPMU and state based development partners and any academic institutions of relevance. 12

13 Though the selection of site for pilot is not yet finalized, one of the major urban areas like Patna, Bhagalpur or Muzaffarpur will be considered as destination locations. Implementation will be started by August 2014 and a lump sum amount of Rs. 15 lakhs has been budgeted for this purpose. Details of activities and budgets will be developed by SPMU and state TAA once the design gets finalized. Training of ICDS functionaries (Suvisors/CDPOs) on using Web- based MIS The state is planning to organize this activity for all 19 ISSNIP districts with location of training being the four cluster locations of TAA, Muzaffarpur, Vaishali, Darbhanga and Bhagalpur. Initially training is to be provided to DPOs and CDPOs on basic use of computers and web based systems and then training of lady suvisors will be conducted. LS training will be conducted only after finalization of NIC module and upon roll out of revised MIS. In this activity the state will identify or select the master trainers and trainings will be conducted in the above mentioned four locations to all block officials and suvisors. Task/ sub-task Budget ( ) Timeline Training of DPO/ CDPOs on use of computers and 1,350,000 Aug-Sept 2014 web-based systems Training of staff for Web based MIS roll- out 3,420,000 Upon roll out of revised MIS Strengthening Training and Capacity Building Strengthening the training and capacity building systems in ICDS is one of the major areas of systems strengthening that ISSNIP intends to undertake and it is directed towards improving current training system and to build innovative approaches to build capacities. Training Needs Assessment (TNA) State will work closely with CPMU and state level development partners to undertake Training Needs Assessment (TNA) in ICDS across different levels of staff. While different DPs have undertaken TNA at specific levels focused on specific intervention areas, state proposes to do a comprehensive assessment under ISSNIP. As the guidance from SPMU, state will engage services of appropriate external agency to collect data for TNA from field level using tools and methods finalized in consultation with CPMU and DPs. Incremental learning as an approach for ongoing capacity building in ICDS In 8 districts of the state (4 of which are part of ISSNIP), one of the development partner projects funded by Bill and Melinda Gates Foundation and implemented by CARE has already piloted the approach of incremental learning in ICDS since This pilot is now scaled up to all 38 districts of the state jointly by NRHM and ICDS. This innovative approach has been designed based on earlier exiences of CARE, which are also the base for the design proposed in ISSNIP. As discussed in later section, the incremental learning approach adopted in the state, also brings in ASHA and ANM of health department and all 3 frontline workers come together at health subcentre (HSC) level every month and undertake planning, review and ongoing trainings as envisaged under convergence with NRHM under ISSNIP. However these HSC meetings mostly cover topics that are of relevance to both health and ICDS staff and some of the themes exclusively focused by ICDS are not covered in these meetings. Some of such topics include, growth monitoring and promotion; supplementary feeding; pre-school education and early childhood care and development as well as other priorities of ICDS workers like SABLA, IGMSY etc. In this context, building on the exiences of HSC meetings, state proposes to adopt a modified approach to implement incremental learning in the state. While the HSC meetings and the convergent learning at these forums on overlapping topics would continue (across the state with 13

14 budget support from NRHM), ISSNIP proposes to undertake incremental learning for AWW (on ICDS specific themes) by arranging sector level meetings and will improve quality of HSC meetings in project districts through the lady-suvisors and external facilitators to support them. Following is description of activities and summary of related budgets for this improvised approach of ongoing capacity building in ICDS. - Identification and training of District and Block Resource Groups (DRG/ BRG): State will guide the districts and blocks to identify appropriate members for DRG and BRGs, who will undertake incremental learning sessions up to sector suvisor level and will also support LS in conducting sessions at sector level. - While the DRGs will consist of some ICDS and health officials, district coordinators of ISSNIP, district level staff of DPs and external resource sons like master trainers of IMNCI/ Vitamin-A Supplementation program etc will also be drawn. About 8-10 DRG members will be selected and trained in each district, depending on the number of blocks in the district. Approximately one external DRG members 2-3 blocks will be ensured so that they can support BRG orientations in all blocks. - Similarly BRGs will be constituted with representation of about members in each block (on an average about 5 LS exist presently in each block and an equal number of external resource sons, including block coordinators or ISSNIP, DP staff at block level and/ or master trainers at block level will be included in BRG). Attempt will be made to ensure that each sector has at least one external member of BRG to support the LS in conducting incremental learning at sector meetings and to facilitate SHC meetings in that sector. - DRG and BRG members will be given structured trainings twice a year on technical and oational issues in ICDS in a cascading approach. A state level resource group consisting of RMs of ISSNIP, state level staff of key DPs, SPMU staff and some external resource sons will be formed to undertake the trainings and handholding of DRGs. Support will be sought from CPMU to get the state resource group oriented and functionalized in the state. - About 5 external exts will be included in state resource group, who will also travel to districts to monitor and support DRG as required. Financial provision for their travel and honorarium is also made in the project budget, under incremental learning component. - After the initial structured trainings of DRG and BRG, a six-weekly cycle of incremental learning will be established and themes for these cycles will be decided at the beginning, and required modules and teaching aids will be designed at the state level. - Six-weekly meetings of DRG and BRG members will be organized to prepare them for undertaking incremental learning sessions. - Sector level meetings of AWWs will be organized at a six-weekly interval (these will be specifically designed for incremental learning and focused program review and will be separate from any other sector meetings that the state would organize for other purposes). - External members like master trainers of IMNCI/ Vitamin- A supplementation program etc, who are not associated with any organizations and are included as members of DRG and BRGs will be paid honorarium for the days on which they participate in project activities. Payment of such honorarium is linked to accomplishment of activity and resources are included in the activity budgets. Learning visits and leadership trainings for key officials Cross visits for learning on specific components will be organized within and outside the state. District, block and state directorate officials will be included for such learning visits. Through an internal effort places and themes for such learning will be identified and emphasis will be placed on identifying best practice states/ sites for key program components. Leadership building and programme management training for officials: To strengthen program leadership and management abilities of key block and district officials, with guidance of CPMU 14

15 and state based DPs, leadership trainings will be undertaken. More details of these trainings will be developed during the initial 3 months of the year. Activity Unit cost Total budget Hiring of an external agency for conducting the first TNA Study Identification and training of DRG and BRG Formation & training of State Resource Organize ongoing capacity building sessions at district level on identified theme (6 weekly cycle) Organize ongoing capacity building sessions at Block level on identified theme (6 weekly cycle) Organize ongoing capacity building sessions at Sector level on identified theme (6 weekly cycle) Inter and intra state learning visits for key officials Leadership building and program management trainings 10,00,000Lumpsum Details in the budget sheet 1000 day, 5 days month, travel cost 10,000 month, lodging etc district 3000 block 500 sector theme Lump sum 10,00,000 Lump sum 5, ,000,000 18,000,000 1,380,000 3,591,000 5,058,000 4,215,000 1,000, ,000 Strengthening Convergence with NRHM Most significant role in addressing nutritional outcomes, other than the MWCD, is by the Ministry of Health and Family Welfare (MoHFW). The MoHFW spearheads the National Rural Health Mission (NRHM) through which it provides a number of crucial services to pregnant women and infants. Most of these services are provided in collaboration with the MWCD through the AWW and often at AWC. However, the effectiveness of this collaboration mostly depends on the relationship between field functionaries of the health and WCD departments and is not necessarily regularized or monitored. What is thus required is systematic effort at institutionalizing, sensitizing and building capacities of both health and ICDS functionaries to work together towards shared outcomes. Towards this end, project proposes to build and strengthen various forums for improving the collaboration between health and ICDS. The primary objective of this collaboration is to ensure convergent and effective service delivery and universal outreach. And as discussed in earlier section on incremental learning, the state already has a mechanism of convergence of front line workers at HSC platform, which will be further strengthened in the project districts. Formation and strengthening of State, District and Block Level Convergence Committees with NRHM for Review and Planning As envisaged in the project design, state will coordinate with NRHM and issue a joint directive, constituting convergence committees at State, district and block levels. It will provide guidelines and broad agenda for meetings of these convergence committees at a quarterly interval. Resources for preparation and conduct of quarterly meetings will be provided under project budget. Representation of other related departments and programs as well as DPs in these meetings will be ensured as requirements of the agenda. 15

16 Piloting/scaling up of Sub-Centre level meetings of ASHA, AWW and ANM As mentioned earlier, these HSC meetings are being done already through NRHM resources across 38 districts of state. Project plans to strengthen these meetings by engaging BRG members (external members of BRG, who will also be called Sector Level Facilitators, SLFs) to facilitate the HSC meetings. For each HSC meeting facilitated by SLF/ BRG member they will be paid honorarium for that day. Resources for this honorarium payment is planned under sub-centre meeting budgets. Joint training of Health and ICDS functionaries on common themes Joint training on common themes will be conducted for block level staff of NRHM and ICDS through DRG members. Similarly structured joint trainings of ASHAs, ANMs and AWWs by BRG members will be organized once during the year. These trainings are additional to the incremental learning sessions and will act as forums for bringing different interventions together and to create causal thinking and result orientation among staff. Some of the selected themes will include growth monitoring and promotion, maternal health, family planning, IYCF, new born care, Routine Immunization, Referral Services (especially focused on IMNCI), micronutrient supplementation, Adolescence Anaemia. Different DPs, NRHM exts, technical specialists of SPMU and CPMU will be drawn to design modules for these trainings and to facilitate critical sessions. Engagement of PRI s for strengthening convergence During FY , state proposes to undertake sensitization of PRIs at block level on health and nutrition issues and to undertake orientation on issues of ICDS implementation, VHSND and their role at Panchayat level. Modules and materials for conducting sensitization sessions at block level as well as for orientation at Panchayat level will be developed and rolled out through ICDS functionaries. Through this engagement with PRIs state will enhance effectiveness of VHSNDs in the project districts. For increasing effectiveness of this particular activity, convergence with NRHM and PHED will be ensured. Piloting successful models of convergence Based on receiving guidance of CPMU, different existing models of convergence will be evaluated and appropriate model for the state will be piloted in one of the project districts to understand oational nuances. Activity Cost details Total budget Formation of State, district and block level convergence committees with NRHM for review and planning Details in budget sheet 3,250,000 Sub-center level meetings Improving effectiveness of HSC meetings - honorarium to SLF/ BRGs Joint training of Health and ICDS functionaries on common themes Honorarium to BRG (SLF) Rs. 300 sub-center meeting (+Rs.100 travel cost) Rs. 55,000 block year (2 trainings) 13,488,000 7,727,500 Rs block 7,165,500 16

17 year for 2 rounds Engagement of PRI s for strengthening convergence Rs block year 1,405,000 Rs panchayat year 10,000,000 Piloting models of convergence Lump sum for one district 1,500,000 Innovations & Pilots One of the main aspects of ISSNIP is to create flexibility in ICDS so as to try innovative approaches to address specific gaps in implementation. A number of pilots and innovations are planned in the project and these will add value to current ICDS implementation and improve overall programme functioning. Some of the areas in which the state proposes to design and implement innovations and pilots are discussed below. Though most of these pilots will be designed based on guidance from central level, initial thinking at the state level is presented below as appropriate and the state proposes to share more detailed design and implementation plan for each pilot during the first 4 months of Context specific pilots in select high burden districts Utilizing the untied funds provided under ISSNIP, 4 selected districts will be given opportunity to design and implement context specific pilots during the next financial year. Attempt will be made to generate ideas from all project districts and 4 best of them will be selected for implementation. One of the themes for pilots will be related to supportive suvision of IYCF implementation and this will be undertaken with inputs from DPs including UNICEF. A budgetary provision of Rs.25, 00,000/=00 for each district is proposed and detailed breakup of the budget will be developed once the theme/ district are finalized. However, for all pilots proposed under ISSNIP, a pro baseline and end line (with counterfactuals where appropriate) and a strong process evaluation component will be designed. State recognizes that only through such rigorous process, any pilots will be of use to generate lessons applicable to scale programs like ICDS. Design and implement urban pilots in ICDS Considering rapid urbanization and distinct situation in urban areas because of which the current design of ICDS (which is more appropriate for rural contexts) does not often fit completely, state will design and implement a pilot to arrive at variant models of implementing key ICDS program elements in urban areas. While the state will follow guidance to be provided by CPMU through urban strategy, it will also design innovative approaches to solve distinct urban problems in ICDS implementation. For this pilot Muzaffarpur city is selected as this is the largest urban area in ISSNIP project districts and is also cluster location, where one of the RMs will be based. A provision of Rs.25, 00, 000 is budgeted for the urban pilots for the financial year. More details of the budget will be developed as the pilot design gets finalized. Piloting stimulation and cognitive activities for preschool children To strengthening the cogitative stimulation activities of the children attending the pre-school education at AWCs each child in the age group of 3 to 6 years will be provided age specific activity books to promote early joyful learning for an average of 40 children AWC. Piloting will in about 10% of AWCs in project district. Budgetary Rs. 2,000 AWC year for the procurement of activity books. Piloting second worker model Considering the need for developing oational approaches, implementation guidelines etc for implementing the second worker model in ICDS, the project proposes to pilot implementation of second worker model in about 5% of AWCs. While selection of AWCs for piloting will be done after designing of the pilot, presently state proposes to do this pilot in few blocks (complete block) 17

18 so as to see the impact at population level over a iod of time. With support from CPMU and DPs within the state, attempt will be made to design a robust pilot with counterfactuals to test effectiveness of second workers intended for different purposes. One cluster of villages will be chosen to have II workers focusing on ECCD, other cluster on IYCF practices, third cluster on reaching out only to Maha-Dalit population and a separate cluster with II worker focused on gender and women empowerment issues. Project resources will be used for selection, training, payment of honorarium of workers and for conducting baseline, end line surveys and process evaluations. For now a lump sum amount of Rs. 4 crores proposed for the state (as admin guidelines). Further details of the pilot design will be developed during first quarter of the year and shared with CPMU along with a detailed budget. Implementation Support at District and Block level Provision of additional human resource support to ICDS at district and block level is one of the key implementation support being provided under ISSNIP and this component will increase capacity of ICDS systems to delivery complex interventions and to undertake multiple pilots in an effective manner. However key lies in getting this large number of contractual employees on board quickly and in getting them to deliver in an effective manner from the beginning. As project design, district and block coordinators and program assistants at district and block level will be recruited. As reported earlier, the process of recruitment for district level positions has already begun and state aims to bring block level support by August For all positions ToR provided by CPMU is being followed and budget provisions are made as administrative guidelines. Office establishment and running expenses for district office and office expenses at block level are planned as admin guidelines. Similarly travel expenses for district and block staff, provision for vehicle hiring at district level are all budgeted for the financial year as admin guidelines. Care has been taken to budget only for the months during which staff will be on board. Activity detail Untied funds for high burden district to pilot context specific innovations in ICDS Design and implement urban pilots in ICDS Piloting stimulation and cognitive activities for pre- school children Piloting second worker model Scale of implementation 4 districts One city Select AWCs Budget 10,000,000 1,875,000 9,800,000 5% AWCs in project area 40,000,000 Implementation support at district and block levels All costs included for the project 61,174,000 Component 2: Community Mobilization and Behaviour Change Communication (BCC) ICDS by design is expected to be a community centred program with a greater level of community participation than what exists today in several contexts. While there have been some small scale efforts of DPs and their grantees to enhance community participation in ICDS, none of them are scaled up. As part of phase I of ISSNIP a number of different kinds of initiatives are being proposed for community mobilization and engaging different community based stakeholders in ICDS mainly to bring about nutrition and health behaviour change. 18

19 In the last decade there has been a great increase in community mobilization at scale in the form of women SHGs mostly focused on livelihood promotion but these mobilized groups are rarely channelized to deal with health and nutrition issues of the community or to hold service providers at community level accountable for regular functioning. In Bihar there are large scale community mobilization efforts through NRLM/ BRLP (JEEVIKA); Women Development Corporation and other local agencies. Project plans to leverage this large scale mobilization effort and to enhance community participation in ICDS as well as engage the groups to bring about social-norm change related to nutrition and health behaviours. Household level behaviours, especially feeding practices are the key factors determining nutritional status of children and also important are health seeking behaviours of the community. Behaviour change communication (BCC) is one of the key components of ICDS program and is subsumed under the service of Health and Nutrition Education. There are several approaches that ICDS staff have adopted for BCC (IEC being one of them). Latest research in communication field has contributed significantly to developing newer approaches that are more scientific and have known level of influence on behaviour change. A combination of Inter-Personal Communication (IPC) and one-to-group communication is known to bring about behaviour change and help create a social norm change. State proposes to undertake activities towards this objective. Activities to Enhance Community Mobilization and Participation Assessment of capacities of Civil Society Organization (CSOs)/ Community Based Organization (CBOs) For carrying out community engagement and BCC initiatives at the community level, project will identify and map out possible civil society stakeholders, including NGOs, academic institutions, SHGs, Mahila Mandals, youth groups etc. and carry out a detailed assessment of their capacities and if required the implementation of capacity building programs for bridging their capacity gaps. State proposes to publish an advertisement seeking expression of interest from NGOs and other institutions. And will work at the state level with agencies like JEEVIKA and WDC to identity potential CSOs (like SHG federations etc) and then assess their capacity and suitability to partner with the project for intended purposes. These activities will be implemented by TAA staff, DPO and CDPO with support from DP teams where available. Guidance of CPMU will be required to design and undertake this assessment. Piloting models of community engagement One of the community engagement models for pilot will be selected out of recommendations from CPMU and will be implemented in one of the project districts. With a robust design, pre and post evaluations, such pilot will be implemented for about 9-10 months and its impact on service up take, behaviour change and AWC formance will be measured. State also proposes to design and implement a pilot on creating mother support groups to enhance IYCF practices (with participation of women PRIs and leveraging VHSND as a platform). Lessons from different contexts will be drawn in designing this intervention with mother support groups and linkage with technical exts like doctors from medical colleges etc will also be established so as to hasten the behaviour change. This pilot will also be implemented in one of the project districts with a robust evaluation design and process documentation. Capacity building of CBOs/CSOs for engaging in ICDS In order to engage community groups in ICDS in a systematic manner, the state will undertake a iodic orientation training of leaders and members of CBOs/ CSOs like SHGs/ Mahila Mandals etc in the village, twice during Through such structured events, their ongoing participation will be mobilized and specific action plans will be drawn up for intervening months. State will design and share orientation modules and materials and plans to undertake the first 19

20 orientation through lady suvisors and the subsequent one through block coordinators. During these orientation meetings, SHGs/ Mahila Mandals and other such CBOs will be informed about upcoming community level events (describe below) and their support will be sought to organize them effectively. Through these community orientations, state anticipates to increase effectiveness of VHSND implementation as well. Organization of community based events for sensitization on key health and nutrition issues While one-to-one IPC contacts for BCC are being planned through AWWs during their home visits (described below), structured and systematic opportunities for one-to-group communication, which is known to be critical for modifying deeply rooted social norms, will be created through organizing community based events. Exience of organizing such community based events, especially ones built on traditional practices, exists in ICDS in different states (for ex: GODBHARAI/ ANNAPRASAN etc). Building on such exiences, state proposes to use the community based events for BCC with segmented group of mothers and family members on specific nutrition and health behaviours, appropriate to the life cycle. While leveraging traditional practices will be a primary focus, new events will be designed around key life cycle contact points to bring about norm change related to new behaviours. For ex, while ANNAPRASAN will be appropriate traditional event to initiate complementary feeding and focus on age appropriate CF, a new concept like birthday celebration can be used to track children completing one year receiving full immunization, to emphasize on regular growth monitoring and promotion and to offer choices for spacing methods if not adopted by then. Similarly a new event at about 3 rd month of the child could be useful to emphasize on exclusive breastfeeding, reiterate immunization, prepare for adopting spacing methods etc. SPMU will develop detailed guidelines and fund-flow mechanisms for organizing such community events in an ongoing manner. AWWs will be informed about upcoming events and will be trained to organize the same during their sector meetings and HSC meetings, which are also opportunities for incremental learning. Attempt will be made to synchronize content of incremental learning with upcoming community events and the mid-media events to be conducted in coming month (discussed in section below on BCC). State will develop a calendar of community events covering all key life- cycle contact iods. Altogether 8 events (2 quarter) will be implemented during FY While budget norm indicated in the administrative guidelines is proposed to be followed, based on exience an upward revision may be sought to ensure effective use of the platform. Implementation of Social Audit and other community monitoring pilots There have been some initiatives to establish social audit in the state and the exience has been diverse. A more systematic approach to social audits that have a greater community participation and clearly linked action-possibility is required. Based on the guidelines to be provided by CPMU state will engage appropriate NGOs/ external facilitating agencies to organize and facilitate social audits in ICDS with in ISSNIP districts. For this purpose and also to support organising community events and mid-media events, partnerships with local NGOs or CSOs (like SHG federations etc) will be developed as discussed below. Training of such NGO/ CSO partners will be undertaken and through a continued engagement, social audit and other possible forms of community monitoring (lessons from NRHM will be drawn) will be evolved in the state. Partnership with local NGOs/CSOs Partnership with NGOs for supporting in implementation is entirely new exience for ICDS in the state. While there are some examples of NGO partnerships to run ICDS projects in some of the other project states, Bihar has exience of engaging local NGOs in other welfare programs that often use ICDS platform for implementation. However the proposition under ISSNIP to partner with local NGOs for supporting community mobilization and behaviour change activities at village level will be a unique exience and state is planning to leverage this opportunity to enhance its community level presence. 20

21 Through the initial assessment exercise (mentioned in above section) SPMU will identify NGOs and/ or CSOs eligible to meet project requirements for each district. Formal mechanism to involve DPs and key district ICDS officials in identification and selection of NGO partners will be established. With guidance from CPMU and DPs within the state, clear scope of work for the NGO partners will be drawn up and in consultation with other departments/ programs a formal contracting system will be established. DPO and CDPOs with support from the district and block coordinators will be made responsible to manage the NGO partnerships. Formal six-monthly reviews of formance will also be established. Activity detail Scale and cost norm Budget Mapping and assessment of NGO/ CSO/ CBOs in each district Piloting 2 community engagement models Orientation training of CBO/ CSOs (SHGs, Mahila Mandals and other groups) 19 districts Rs. 10,000 district 2 districts Lump sum Rs. 25 lakhs year for both AWCs Rs. 250 / AWC (twice a year) 190,000 2,500,000 24,607,500 Organization of traditional events to sensitize on key health and nutrition issues Implement social audit and other community monitoring mechanisms through NGO/ CSOs Partnership with NGOs/CSOs for community mobilization and sensitization activities AWCs Rs. 150 AWC (8 times a year) 59,058,000 Select locations as CPMU guidance 562,000 Rs. 2,50,000 district All 19 districts 15,000,000 Behaviour Change Communication (BCC) As discussed earlier, this will be an important component of ISSNIP to establish a strong system of BCC that is effective and leading to change in nutrition and health behaviours. Building on current exiences and ongoing programs by different DPs, the state proposes to strengthen IPC through home visits and supplement it through mid-media activities using folk-shows, film-shows etc. Materials and skills for frontline workers for effective IPC will be provided and effort will be made to create trained troupes to form mid-media activities at scale in each district. Adaptation of national level BCC strategy and development of state-specific BCC plans In order to have a state BCC strategy that helps prioritize behaviours, communication channels and also helps to harmonize ongoing efforts and plans of different stakeholders, state with guidance of CPMU, will adapt the national level BCC strategy and will develop BCC action plans for the state. External consultants to undertake a formative research to fine tune the BCC strategy to support in adaptation of national strategy as well as to carry out widest possible consultations with stakeholders as well as to review existing materials/ methods will be engaged through project resources. 21

22 Strengthening Home Contacts As reiterated in earlier sections, IPC through home contacts by AWWs is recognized by the state as most important aspect for BCC. As part of the BMGF supported program in the state, CARE and other grantees of BMGF have undertaken several initiatives to strengthen home visits of AWWs (and also ASHAs). Establishing a system of home visit planners (which is also part of revised MIS) has been rolled out across the state through this DP program and in 8 districts the home visit planners are being used by AWWs since last 3 years. Results of this initiative measured by the DP and its grantees show an encouraging improvement in home contacts by front line workers (FLW) at key life cycle contact points and there is an increasing trend in service utilization as well as behaviour change in these areas 3. ISSNIP in the state will build on this exience and provide space for further innovation to strengthen these efforts. Some of the activities proposed include the following: - Adaptation of communication materials for AWW to support in prioritizing home visit and to guide her at the time of counselling (Home visit planners have been distributed to all AWWs in the state). A lump sum amount of Rs /- (Rs. Twenty five lakhs only) year kept for this purpose - Adaptation and printing of materials with common package of messages for AWWs and ASHAs for use in home visits. As the home visits using a planner are already initiated in the state in all districts, the state proposes to use resources available in the project to distribute printed BCC material to 100% AWCs in year itself, instead of 50% in year 2 and 3. - Implementation of pilot on incentivizing home visits in selected districts will be a high priority for the state during FY In the same BMGF/ CARE project in Begusarai district, a team based goals and incentives (TBGI) pilot has been implemented (as a randomized control trial, RCT) for more than one year, where in AWWs (and ASHA/ ANMs) are provided incentives for completing pre-defined set of activities, some of which include home visits. Evaluation of this RCT indicates that most nutrition behaviours and FLW communications about those behaviours have increased over time 4. Building on this exience and bringing in extise from CPMU, the state proposes to design and implement an incentives pilot for promoting home visits by AWWs. A lump sum budget provision is made for this pilot and more details of the budget as well as activities will be worked out during first quarter of the year in consultation with CPMU and local DPs in the state. Designing, pre-testing and implementation of mid-media activities - folk and film shows Through ISSNIP initiatives, the state proposes to create a pool of trained and skilled band of formers of local artists who have complete and correct orientation about nutrition and health issues and are available for districts and blocks to undertake mid-media activities as and when required. State also aims to create options to undertake large scale media shows like film shows or a combination of folk and film shows to mobilize communities on nutrition issues. Activities under this task will include the following: - In order to achieve this, state will identify and bring together formers, senior artists, script writers and lyricists etc for developing content and shows for mid-media (Folk arts and film-shows) for BCC events. Identification of senior artists; script writers/ film creators etc will be done through development partners and from exiences of other departments - Prasar Bharati and other public sector people will also be included as appropriate. A series of workshops with such senior communication people will be arranged to orient them on issues to be addressed and to get content developed. 3 Details of this intervention and results measured in initial 8 districts are available on request. 4 More details about the RCT design and the results may be provided up on request. 22

23 - Identification and training of troupes of formers for each block/ districts and pretesting of materials. Performing artists will be selected by the district coordinators and DPOs and trainings will be provided at regional/ cluster level. Rs /- (Rs. thirty five thousand only) is budgeted for each training event. - Implementation of mid-media BCC interventions will be done with support of local CBOs and local artists. Mid media activities will be designed in a manner to consist of folk art forms and film shows to be delivered through a mobile team (in a Poshan-Rath) and effort will be made to synchronize the content with that of the community events being organized during the same iod at AWC level. Initially Rs. 1,80,000/- is proposed for each district, and based on early exiences, state proposes to request for additional resources if required. Advocacy and knowledge sharing Under this activity, event will be organized to mobilize and create political and Administrative commitment on Nutrition policies and plan of action to address malnutrition and highlight IYCN practices at all level through iodic meeting and conference with MPs, MLAs and District Administrative officers. One meeting each in State Assembly, State legislative Council and one meeting in each District Panchayat will be organized, in at least 9 districts by March Lump sum amount of Rs. 3, 00,000/- is proposed for these meetings. Activity detail Develop state BCC strategy and state-specific BCC plans (formative research and consultations) Scale and Cost norm Rs. 500,000 Lump sum (+100,000 for consultations) Budget 600,000 Adaptation of communication materials for AWW to support in home visits Rs. 25,000 25,000 Printing of BCC/ communication materials for AWW for use in home visits AWCs Rs. 150 AWC + Rs. 50/ AWC 9,843,000 Implementation of pilot incentivizing home visits in selected districts. Steps involved Selected blocks of one district 1,250,000 Designing, pre-testing and implementation of mid-media initiatives such as folk theatre and film shows Norms as in detailed budget 8,670,000 - Organize design workshops - Identification and training of troupes of formers for each block/districts - Implement BCC interventions with support of local CBOs and local artists 23

24 Advocacy and knowledge sharing conferences and meetings for mobilization of political and administrative commitment to nutrition policy and plan of action to address malnutrition and highlight IYCF practices Lump sum of 3 lakhs for all meetings 300,000 Component 3: Piloting Convergent Nutrition Actions State recognizes the importance of multi-sector convergent action for achieving nutrition outcomes and it plans to utilize the flexible opportunity available under ISSNIP to innovate and learn to inform the multi-sectoral nutrition project (MSNP), which is recently initiated by Government of India. While realizing that the entire area of multi-sector convergent action is very new, very few or no exiences of convergence of multiple sectors on this issue, state looks for guidance and support of CPMU on this component. Constitution and regular meetings of state and district coordination committees As the project design, SPMU will facilitate constitution and initial meeting of state and district level coordination committees under the leadership of Development Commissioner and the District Magistrate, respectively. These coordination bodies will be common for MSNP and component 3 of ISSNIP and will bring in key sectors for planning, coordinated implementation and result oriented review. Based on the guidance of senior officials of state government and inputs from different DPs, some of the following sectors will be included in the state: - Health and Family Welfare - Water and Sanitation - Urban development - Agriculture - Horticulture - Animal husbandry/ poultry and Fisheries - Rural development and Panchayati Raj - Labour Closer engagement with some of these sectors will be ensured and others will be brought in as and when required. SPMU will draw specific terms of reference for each of these bodies with clear identification of roles of each sector. Development of State specific convergent Nutrition Action Plan and designing of pilot Depending on the national level guidelines received from CPMU state will develop a state convergent nutrition action plan, that takes care of programs of different departments listed above. A pilot reaching up to community level, in a selected pocket of geography, will be designed with inputs from different departments and DPs associated with those departments. Role of local NGOs/ CBOs in implementing the pilot will also be considered at the planning stage itself. Some of the following activities are proposed under this activity: - Identification of districts/ project Block/ Panchayat for pilot through a consultation workshop with officials of line department in state and if needed at district & Project. - Designing and preparation for the implementation of pilot as the National guideline. - Orientation of stakeholders involved in piloting work at all level. - Selection of local NGO or other institution as implementation partners - Developing modules, oational tools, facilitator guidebook, monitoring and evaluation tools as the national guideline. - Seeking advice and Co-oation from development agencies. Implementation of multi-sectoral pilots in one district Implementation of pilots may cover multiple Panchayats in the selected district as the design adopted by the state in alignment of national guideline. Though the actual design of the pilot will emerge from the national guidelines and state plan, broad contours being discussed currently are 24

25 more focused at ensuring convergence of different sectoral programs/ projects at household level and AWWs functioning as conduits to identify needs of most vulnerably households (vulnerable to nutrition and health challenges) and to link them to relevant sectoral programs. Community as a whole or through the Panchayat being able to plan and review reach of inputs from different sectors to needy households in timely manner and such data getting collated at block and district level to help the inter-sectoral coordination committees at district and state levels to steer the program implementation. As in case of other pilots, a robust design including baseline, end-line surveys with scope for adequate process evaluations will be developed along with details of costing and submitted to CPMU for inputs by end of second quarter of Component 4- Project Management, Technical Assistance, Monitoring & Evaluation Project Management As mentioned in earlier sections, SPMU has been set up and recruitment for technical specialist positions is currently underway. Procurement of equipment and furniture could not be completed within the timeline approved in annual action plan , due to delay in budgetary provision by finance department. Now the fund has been received by the directorate and all procurement activities will be completed. Currently two assistant directors of ICDS are notified as JPCs. Department of General Administration Government of Bihar has been requested to provide two full-time JPCs for the project on deputation basis. State level Orientation/ training of SPMU staff and TA agency together on the technical and program issues will be held in the month of July 2014 once the SPMU positions are filled. As plan the district coordinators will be recruited by June 2014 and their technical and program orientation and training on decentralized planning will be held in two batches (District Coordinator and Project Assistant separately) at State level. Funds for these trainings are budgeted as norms indicated in the administrative guidelines. Recruitment of Block Coordinator and block level Project Assistant will be complete by August- Sept 2014 and their training orientation will be organized at district level in October Monthly Planning and Review Meeting at State Level: Planning and review meetings with district team at state level (a) one meeting month for one day duration. Rs. 10,000/ meeting for 9 meetings. Similarly monthly Planning and review meeting at district level with block teams are planned and a budgetary Rs. 5,000/ meeting is made for 6 meetings. Administrative Cost (Rent, Electricity, Security, Telephone and other administrative unseen needs.): Considering the provision for year 1 and year 2 allocation in Admin Approval. The budget has been kept under this head to meet all requirement of administration. Stationeries: Budgetary Rs. 50,000/ month. Vehicles for SPMU- Two vehicles for SPMU are planned for and a budgetary provision of Rs. 40,000/ month/ Vehicle (this is more than the norm indicated in the administrative guidelines as the cost of vehicle hiring has increased in the state compared to 2011, when the project proposal was formulated) All travel of SPMU staff (including consultants) is planned in the Annual Action Plan and possible visits to Delhi (to attend review/ Planning meeting/ Workshop) and visits within the state for monitoring and program guidance purposes are included as the norms indicated in the administrative guidelines. 25

26 Contingency costs are also budgeted as the norms indicated in the administrative guidelines. Training workshop on De-centralized Planning In order to get planning for FY done in the project districts and blocks in a decentralized manner, one training in each district is proposed. Resources are also planned for conducting planning meetings at block levels, as the norms indicated in the administrative guidelines Monitoring and Evaluation District level rapid assessment and ongoing internal assessment at sector level using LQAS approach As mentioned in earlier sections, BMGF/ CARE project in the state has been using LQAS approach to measure progress in ICDS and NRHM in 8 districts and are planning to scale it up similar measurement approaches to entire state as part of their project plan, which also has concurrence of GoB, including ICDS. Building on this exience and the proposed plans, state will come up with innovative monitoring and evaluation approaches for ISSNIP. Presently state proposes to undertake district level rapid assessments through external agency which will undertake data collection, analysis and report writing as well as dissemination of finding and planning program responses. Procurement of agency will be as the procurement guidelines of the project. Rs 50,000 districts has been kept for this purpose for five districts and expenses for conducting meeting at state level and in selected districts as the norms indicated in the administrative guidelines. Social Assessment and ethnographic studies in SC/ST/minority areas State has a high burden of poverty among most marginalized population groups, called Maha- Dalits. ISSNIP in the state proposes to conduct ethnographic studies among SC/ ST and minorities to understand their social-cultural practices, health seeking behaviours and to understand barriers they face in achieving better health and nutrition status. Inputs from different DPs and guidance of CPMU will be leveraged to design and conduct such study. Based on the findings of the study, appropriate communication strategies, outreach approaches and communication material will be developed to facilitate universal reach to these communities and to addressing issues of exclusion due to social and cultural differences. This study will be an integral part of communication action plan to be prepared by the State. For doing this study a local agency will be contracted and coordinated. 26

27 Summary of Funds Required for Components/Sub-Components Estimated Budget for (in Rs.) Component 1: Institutional and System Strengthening 1A: Review/refinement of policies, guidelines/procedures 3,70,000 1B: Strengthening and expanding ICDS monitoring systems 5,70,49,000 1C: Strengthening training and capacity building 3,47,44,000 1D: Strengthening Convergence with NRHM 4,45,36,000 1E: Institutional support for innovations and pilots 6,16,75,000 1F: Implementation support at district and block levels 7,67,52,000 Sub-Total (Component 1) 27,51,26,000 Component 2: Community Mobilization and Behaviour Change Communication (BCC) 2A: Activities to enhance community mobilization and participation 10,19,67,500 2B: Behaviour Change Communication (BCC) 2,06,88,000 Sub-Total (Component 2) 12,26,55,500 Component 3: Piloting Convergent Nutrition Actions 3A: Development of State-specific convergent nutrition action plans and designing of pilots 32,00,000 3B: Strengthening inter-departmental coordination mechanisms - 3C: Implementation and documentation of pilot - Sub-Total (Component 3) 32,00,000 Component 4: Project Management, Monitoring and Evaluation 4A: Project Management 1,76,71,000 4B: Monitoring and Evaluation 35,40,000 Sub-Total (Component 4) 2,12,11,000 Grand Total 42,21,92,500 Joint Project coordinator (JPC) ISSNIP State project Director ISSNIP 27

28 Sl. No A Componen t/subcomp onent/acti vity (as Administr ative Approval) Template for Annual Action Plan Annexure A: ICDS System Strengthening & Nutrition Improvement Project (ISSNIP) Template for Annual Action Plan for State: Bihar Sub-tasks /Steps/Processes Unit Cost Norms (wherev er applicab le) Component - 4: Project Management, Monitoring & Evaluation Physic al target (as applica ble) Estimated cost (Rs.) Level of implem entatio n (State/ District /Project /Sector/ AWC) Timeli ne Remarks (if any) 4A: Project Management 1 Activity-1: Setting up of SPMU - Purchase of furniture and office equipments as Administra tive approval 2 Activity-2: Staffing of SPMU - Salaries/Ho norarium 1) Procurement plan for 18 months (to be attached with the AAP) 2) Purchase of office equipments/furniture as Procurement plan 1) Notification of Joint Project Coordinators (JPCs) assigned to project - Payment of Salaries JPCs Rs. 50,000 month Account Rs. 40,000 Per month Technical Specialists (Consultants) 1,500,000 State June,1 4 No. 2 JPCs 1,200,000 State Apr14 to Mar 15 Rs. 60,000 Per month Project Associates Rs, 25,000 Month Secretarial Assistant Rs. 15,000 Per month 6 position s for 10 months 2 for 10 months 1 for 10 months 400,000 State June 14 to Mar15 3,600,000 June 14 to March ,000 June 14 to March ,000 State June 14 to March 15 Detailed in Procurement Plan (Annexure B) attached. As the Procurement Plan (Annexure B) attached 28

29 4 Activity- 3: Staff training and orientatio ns Data Entry Oator (DEO) 1) Orientation training of SPMU Staff on project and AAP and field visits 2) Deputation of SPMU Staff to the Training on World Bank procurement procedures at ASCII/Hyd or NIFM/Faridabad Rs. 15,000 Per month No. of training- 01 (20 People x 7000) 1 for 10 months 2 official s 150,000 June 14 to March ,000 State July, ,000 Nationa l June- Oct 2014 Training by ASCII at Hyderabad 3) Training orientation of District level support staff (19 x 2 Batches ) on decentralized planning - district annual plans No. Of training- 01 Rs Participa nts x 4 days 38 (DC and PA) 304,000 State July, Activity-4: Monthly planning and review meetings at State and district levels 6 Activity-5: Administra tive costs 7 Activity-6: Monitoring & suvision visits - travel expenses 4) Training of Block coordinator / assistant 2 days Rs 3000/pro ject State level Meeting 10,000 meeting District level Meeting 5,000 meeting 1) Rents, electricity, security, telephone, etc (as applicable) 562 (BC and PA) 9 meeting s 06 Meetin gs district (6 months ) 843,000 District Oct,14 Rs 3000/project /block 90,000 State July 14 to Mar ,000 District Oct 14 to March 15 2,520,000 State April 14 to March 15 2) Stationeries 600,000 April 14 to March 15 3)Hiring of vehicles for SPMU 1) Visit to Delhi to attend review/planning meetings/ workshops vehicle month 40,000 vehicle month Meeting 54,000 training for two son 2 vehicle s 06 meeting s 960,000 State April 2014 to March ,000 nationa l level April to March, 2015 The amount for vehicle rental needs to be increased vehicle month. Propsing for 2 vehicles for 12 months in the year 29

30 2) Monitoring & Suvision visits within State Intra state travel for about 5 days days in a month by SPMU Officials (including Consultant s) Rs son visit [3 visits month for 5 days visit - 2 officials together] 300, ,000 June 2014 to March, 2015 Hotel and other local expenses during travel to districts Rs day son for 5 days field visits trip 450, Activity-7: Contingenc y Expenses for utilities and other consumables for day to day office oations 10,000 month 120,000 9 Activity-8: Training workshop on Decentralized Planning 10 Activity-9: District and Block annual planning meeting Training workshop on De-centralized Planning De-centralized Annual planning meeting for all district at District level 4B: Project Monitoring and Evaluation 1 Training in each districts 1 Meeting at each district Rs district Rs. 1,00,000 district 19 districts 19 districts 950,000 1,900, Activity 1: District Level Rapid Assessmen ts and ongoing internal assessment s at sector level using LQAS approach 12 Activity-2: Social Assessmen t and ethnograph ic studies in SC/ST/min ority areas Hiring of agencies for data collection, analysis and report writing Dissemination of finding and planning programme responses Hiring of agency for conducting assessments 5 Districts Rs. 5,00,000 district year Rs meeting at State and Rs at District 1 Study Lump sump 5 District s Sub-Total-1 (Component-4) 21,211,000 2,500,000 District Oct-14 40,000 State/Di stricts 1,000,000 State/Di stricts Jan- Mar 15 Oct14- Mar15 30

31 B. Component 1: Institutional and Systems Strengthening 13 1A: Review/refinement of policies guidelines/procedures Adaptation by the State Activity 1: State level adaptation and disseminati on of revised/ refined policies guidelines/ procedures including state IYCN policy 14 Activity 2: State level task force on ICDS Steps will involve: - Consultation meeting with key stakeholders for discussion of draft policy/ revised guidelines/ procedures at state level - Undertaking modifications as appropriate to state context - Dissemination of revised guidelines/ procedures Bi-annual meeting of state level task force 50,000 consultation 2 meetings Rs /- meeting 6 Events 300,000 State Sept 2014 to March , fund available - Most of the revisions are expected to happen at CPMU. Hence timelines are dependent on the progress at national level. State proposes to refine and adapt a IYCN policy 1B: Strengthening and expanding ICDS Monitoring system 15 Activity-1: Support to roll-out of revised MIS across all districts/pr ojects in the State Refresher training on revised MIS of SLMTs (4 days training) DLMTs training on all 38 Districts LS training at District level by ISSNIP fund (Training Guidelineinduction plan) training (propose to add more trainers in SLMT) training batches 2 batches district Rs x15 people x 4 days Rs. 500x 38x5x5 days Rs.500 day 30x2x 19x 8 days 200,000 State Antici pate to undert ake MIS roll out 475,000 Clusters of ISSNIP (other districts to attend in these cities) 4,560,000 district level (only in 19 districts ). 2 batches district from Augus t 2014 and compl ete (at least in ISSNI P district s) by Nov While the printing of registers in the state is pending, the state anticipates to complete this during early part of State and district level ToTs are planned for all 38 districts and Suvisors' trainings are planned for all 19 ISSNIP districts. - Propose to engage an external support (in the form of BRG- one sector- to 31

32 Review on progress of roll- out of revised MIS State and District level Review on progress of roll- out of revised MIS State and District level L.S Level one training on revised MIS one meeting 1000 son ( for AWW in 4 phases, 10 - days)) 5000 son/ meeting 100 son 475,000 State level event for all 19 districts (SLMT also particip ate) State- 15, District - 19x 5= 95 1,140,000 district level events where LS are reviewe d by DLMF1 9x60= ,929,000 Sector level support roll out of revised MIS and also for facilitating IL at sector meetings and sub-centre meetings (being held by SHS funds) Training of AWWs on revised MIS: Funds for this are provided under induction training and the Admin Guidelines do not provide for this activity under ISSNIP. however considering the fund availability and need for quick and effective roll out in ISSNIP districts, the state proposes to use ISSNIP resources for this activity as well. 32

33 16 Pilot for ensuring ICDS services to migrants 17 Activity-2: Training of ICDS Staff on use of MIS and data analysis (Webbased reporting on revised MIS) Steps will include: Pilot designing with guidance from CPMU and assistance of TAA, selection of district/ blocks for the pilot (Preferably, origin and destination districts/ places within the state); Conduct of baseline survey, implementation of intervention; process assessments and documentation; endline survey and dissemination of findings to inform scale up decisions. Organize trainings of DPO/ CDPOs on use of computers (Fundamentals of MS office; internet use and other basics of using computers) and Training of staff for Web based MIS rollout District 1,500,000 selected blocks/ AWCs of Origin and designat ion of migrant s 1500 son 180,000 District 1,350,000 Trainin gs will be organiz ed at cluster level for better oversig ht of RMs of TAA 3,420,000 57,419,000 Desig n by June and imple mentat ion from Augus t 2014 Interventions may include provision of additional SNP to migrants in destination sites. Mechanisms like ID cards (card readers) to track movement of migrant families; short term human resource support to enroll migrants, orient migrant families and ICDS/ health staff in origin and destination sites about pilot interventions. Costs of baseline/ endline and process assessments to be covered as part of the pilot. Initial training on basics will be only for DPOs and CDPOs and the training for all DPO, CDPO And suvisors will be after finalization of NIC module 1C Strengthening Training and Capacity Building 18 Activity-1: Training needs assessment s Hiring of an external agency for conducting the first TNA Study 10,00,0 00Lump sum 1,000,000 State July to Nov 2014 TNA will be conducted soon after receiving tools and guideline from CPMU 19 Activity-2: Piloting incrementa l capacity building approach 1) Identification of DRG (8 district) and BRG (10 block - 5 LS and 5 external resource sons) members as guidelines/ criteria to be shared by CPMU 2) Organize orientation trainings for DRG/ BRG members (DPOs being part of DRG and CDPOs in BRG) - to be facilitated by SPMU and TA teams (State Master trainers) - one round in the year, of 3 days duration District / Project 19 distric ts 281 block s - 5 DRG s in each distric t and 10 BRGs in each block 18,000,000 State/ cluster level training of DRGs and district level training of BRG members - two rounds of trainings of 3 days each for DRGs and BRGs during the year July 2014 to Sept 2014 Incremental learning of AWWs and ASHA on common themes is already underway in the state through a joint directive of departments of health and social welfare at subcentre level meetings, with financial support of SHS. Hence the other activity proposed under ISSNIP (sub-centre meetings - in about 50% of sub centers) is also getting implemented across 33

34 Formation / training of State Resource Group for training of DRGs and field monitoring as required. (SRGs to consist of about 5 exports local institutions) 2) Organize ongoing capacity building sessions at district level on identified theme (6 weekly cycle for all the following activities) State 1000 day, 5 days month, travel cost 10,000 month, lodging diem month district theme 19 distric t 1,380,000 3,591,000 - Rs.2000 day DRG and Rs day BRG District Augu st 14 to Mar % areas in the state. - In light of these two facts, the State proposes a modified approach of 1) implementing incremental learning (focused only AWWs) through sector meetings and 2) providing facilitation support to sub-centre meetings through external BRG members (each sector will be provided a external facilitators, who will support LS in conducting IL for AWWs in sector meeting and support ANM in conducting IL for ASHA and AWWs in sector meetings).these BRG members will be paid a honorarium of about Rs. 300 meeting they facilitate Themes will be as Growth Monitoring, Supplementary Nutrition, Home visit planning, IYCF and etc ( )*5*12 these are as admin guidelines (only 6 cycles will be possible by March 2015) 3) Organize ongoing capacity building sessions at Block level on identified theme 4) Organize ongoing capacity building sessions at Sector level on identified theme Block sub 3000 block 500 sector theme 281 Block s 4800 Sub- Centr e 5,058,000 4,215,000 Block Augu st 2014 to Marc h 2015 Augu st 2014 to Marc h 2015 these are as admin guidelines (only 6 cycles will be possible by March 2015) Assuming 5 sectors block and 5 BRG sons (one sector). Costs to increase based on # of sectors. 34

35 20 Activity-3: Inter and Intra-State exposure/le arning exchange visits by the Project Team/other ICDS functionari es 21 Activity-4: Leadership building and programme manageme nt training for officials Identify best practice sites (within and outside States) and Organize exposure visits Lumps um 10,00,0 00 Lump sum 5, ,000, ,000 a.. Visit with in state- Care, BBC, B- TAST and UNICEF best practices b. Visit outside of state- Tamilnadu- Functioning of additional AWW A.P- Best practices West Bengal- Community level events Chhattisgarh- Community level events U.P IYCF and Growth Monitoring Purpose Sharing of exience and findings 34,744,000 1D Strengthening Convergence with National Rural Health Mission (NRHM) 22 Activity-1: Strengtheni ng/formatio n of State, district and block level convergenc e committees with NRHM for review and planning 1) Issue joint directive (health and ICDS) about constitution of convergence committees at State, district and block levels (if it does not exist). 2) Provide guidelines and broad agenda for meetings of convergence committees 3) Ensure quarterly meeting of committees at all levels State / District / Block Rs. 15,0000 meeting State l & 5,000 district & 2,500 Block 19 Distri ct, 281 block 3,250,000 State / District Quarterly meeting costs 35

36 21 Activity-2: Piloting/sca ling up of Sub-Centre level meetings of ASHA, AWW and ANM for joint planning and implementa tion (in 20-30% Subcenters in Year-1) This is being done through NRHM resources across 38 districts of state. Hence we are proposing to add this fund into the next activity 23 Activity-3: Joint training of Health and ICDS functionari es on common themes (in 10-20% AWCs/proj ects in Year 1) Joint training on common themes) Common themes - Growth monitoring and promotion, maternal care including FP, IYCF, NBC, RI (Routine immunizati on, Referral services (MNCI), Micro Nurturance - Vit-A, Iron, Adolescenc e anemia, (Work on Sub-center meetings are already happening in 100% area as part of NRHM PIPs. ISSNIP proposes to leverage these meetings as further incremental learning opportunities. Project funds are proposed to be used to pay honorarium to sector level facilitators (BRG members attached to each LS) to facilitate sub center meetings in all 19 districts. Joint training of LS and LHV/ BHM/ BCM etc by DRG members on selected themes (IYCF as an important theme) Organize training of ASHAs, ANMs and AWWs by Block Resource Group on common themes Blocks (5 sectors block and about 4 subcenters sector) Honorarium to BRG (SLF) Rs. 300 sub-center meeting (+Rs.100 travel cost) Block Rs. 55,000 block year (2 trainings) Project Rs block year for 2 rounds 6 roun ds of subcente r meeti ngs after BRG s are on board (each BRG to facili tate 4 meeti ngs in the secto r 281 block s 281 block s 13,488,000 7,727,500 7,165,500 Subcenter level Block level Dec to Jan 2015 each BRG (SCF) to be attached with a LS to facilitate all sub center meetings in that sector proposing to conduct one round across all blocks during the year One round during

37 modules and other exts). 24 Activity-4: Engagemen t of PRI s for strengtheni ng convergenc e Sensitization of PRI members on nutrition aspects and their possible role at community level Orientation of PRI members on nutrition concerns, motivating them to support VHND and the AWC and help mobilize the community Piloting successful module and conversations (CPMU) Block Rs block year Panchaya t Rs panchayat year 281 block s Appr ox panc hayat s 1,405,000 10,000,000 One District 1,500,000 Block level Block level (Rs year, orientat ion) Sept March 2015 Sept 2014 to March 2015 New activity proposed to be undertaken at block level to create sensitization at higher levels of PRIs This will be the responsibility of sector suvisor to organize the meeting and coordinate with PRI members and =(5000*1000) This will be initiated after receiveing guidance of CPMU 44,536,000 1.E Innovations & Pilots (Funds are budgeted for year 2, but preparations needed in year 1) 2 5 Activity 1: Preparatory activities to initiate innovations/pi lots beginning in year 2 Untied funds for high burdern district to pilot context specific innovations in ICDS Design and implement urban pilots in ICDS Piloting stimulation and cognitive activities for prschool children (up gradation of activity and play kits). Activity book (Designing, printing and distributing for 10% of AWCs in each phase) 4 districts 25 lakhs pilot district Pilot 25 lakhs pilot district (75% costs for FY ) AWCs Rs 2000 AWC for activity books 4 distri cts 1 distti ct 10% of AWC s 10,000,000 State / distri ct level 1,875,000 city level Design by August 2014 and initiate pilots by Oct 2014 Design by June and imple mentat ion from August 2014 One of the pilots proposed will be related to supportive suvision of IYCF implementation (in one district) (Darbhnaga, Vaishali, Sitamarhi, Bhagalpur) Propose to implement in one city - Muzaffarpur. Pilot design to be based on needs and opportunities identification. Baseline survey, process documentation and final evaluation after about 12 months of implementation. 9,800,000 Approximately 10% of area Rs AWCs year 37

38 Piloting second worker model 5 % of AWCs. Cost of selection, training, orientation, monitoring and evaluation of the modela lump sum amount of 4 cr for year 2. Further details to be planned in a concept note 1F: Implementation Support at District and Block level Lump sum of Rs 4 crores proposed for the state (as admin guidelin es). Details of costs and norms will be shared for approval as part of concept note by May % AWC s 40,000,000 selec ted bloc ks/ AW Cs Design to be comple ted by May and imple mentat ion initiate d by Octobe r 2014 i. Training of second level workers 4 lakhs for first year, ii. Orientation of second level workers- 4 lakhs for second year, Conduct base and end line survey, Selection criteria, a. Mahadalit Tolas, b. Hard to reach areas1 2 5 Activity-1: Establish district and block level support structure Additional Human Resource support to ICDS District Office to provide support to project implementation District Coordinato r - 1 district (30000*19 *10) Project Assistant - District (1 Rs. 30, month 10 Mont hs 10 Mont hs 5,700,000 District June 14- Mar 15 2,850,000 June 14- Mar Additional Human Resource support to ICDS Block Office Block Coordinato r - one in each block (Salaries) on Rs. 12,000 son month 8 Mont hs 26,976,000 Block Aug 14- Mar Project Assistant - Block (1 Rs month 8 Mont hs 17,984,000 Aug 14- Mar Office running expenses- District District level office running expenses budgeted only for 10 months =(100000* 19)+(1000 0*19*10) 3,800,000 District June 14- Mar Travel expenses- District Hiring of vehicles for- District 19 Rs month 19 Rs /- meeting 10 Mont hs 4,750,000 District June 14- Mar 15 5,700,000 District June 14- Mar

39 Office running expenses- Block District level office running expenses budgeted only for 8 months (8000*281) Rs month block 2,248,000 Block Aug 14- Mar Travel expenses- Block ,744,000 Aug 14- Mar ,427, Sub-Total (Component-1) COMPONENT-2: COMMUNITY MOBILIZATION AND BEHAVIOUR CHANGE COMMUNICATION (BCC) 2A Activities to enhance community mobilization and participation Activity-1: Assessment of capacities of Civil Society Organization (CSOs)/Com munity Based Organization (CBOs) for carrying out community engagement and BCC initiatives Identify and map NGOs, academic institutions, SHGs, Mahila Mandals, youth groups and conduct assessment of capacities of CSO/CBO for community mobilization and BCC (to be done by teams of RMs and DPO/ CDPOs) for all NGOs and academic institutions and for a sample of CSO/ CBOs (SHG federations etc) - NGOs are ffor partnerships for community mobilization (can also consider academic institutions) - All agencies are meant for conducting community events and District Rs. 10,000 district NOG s/cb Os data base for all 19 distri cts 190,000 State June to Sept ~ EOI to be published and application sought from NGOs/ institutions and CSOs. - State level identifies to work with either Jeevika or WDC groups and then districts assess a sample of them. - State TA agency to design assessment tools and methods 39

40 2 7 Activity 2: Piloting models of community engagement Community engagement models to be selected out of recommendations from CPMU (State proposes to pilot a model of Mother Support group to promote IYCF practices - pilot will be designed and implemented jointly with UNICEF) - Design of pilot for select areas in 2 districts. - conducting baseline, process monitoring and end line in intervention and control sites. - implementing trainings and review mechanisms as the pilot design Further cost details will be worked out based on the design of the pilot as suggested by CMPU Lumps Rs. 25 lakhs year 2,550,000 2 districts Sept to Mar ch Pilot will be implemented for a iod of about 6-9 months and all data collection and process evaluations will be conducted through consultants/ agencies hired by concerned districts. - Propose to pilot models with SHGs (mother support groups) and with PRI/ VHSNCs Activity 3: Capacity building of CBOs/CSOs for engaging in ICDS Activity-4: Organization of community based events for sensitization on key health and nutrition issues: Village wise listing of CBO/ CSOs (SHGs, Mahila Mandals etc) in all districts - Developing orientation modules and materials for use at AWW level (two rounds in year 2) - ensure linkage of these orientations with themes and actions of upcoming community events Develop guidelines for organization of traditional events to sensitize on key health and nutrition issues - Organize intervention specific events as opportunities for oneto-group communication with pre-identified segment of beneficiary population. - A detailed event calendar of community events covering all key lifecycle contact iods (critical behaviors) will be drawn up at the beginning of the year. AWC Rs. 250 / AWC bi annual AWC 150 AWC AWC s AWC s 24,607,500 AWC Oct ober to Mar ch ,058,000 AWC Apri to Mar ch First round of orientations will be held with ICDS suvisors being primary facilitators and basic content will be rolled out. - second round of orientations will be facilitated by the block coordinators 8 events (2 quarter) will be implemnted durinf FY

41 Activity 5: Implementati on of Social Audit and other community monitoring pilots Activity 6: Partnerships with local NGOs/CSOs for supporting community mobilization and behavior change activities Adaptation of social audit guidelines (Developed by CPMU) to suit state requirements - Including implementation of IYCF and management of malnutrition in social audit and other community monitoring mechanisms. Identify and partner with NGOs/CSOs with extise in community mobilization and sensitization activities Block or Sector level 50% of districts for 6 months 2,50,00 0 district 562,000 Social audit will be implemented through NGO partners. Either AWC wise audits or a collecgive audit of 4 different AWCs at Sector/ Block level will be organized. Attempt will be made to identify other models/ mechanisms of community monitoring. During social audits will be held in blocks that will have NGO partners 15,000,000 Sept to Mar ch ,967,500 Process of NGO contracting is proposed to done for 6 months during hence state proposes to have partnerships in 50% of districts in the current year. Sub-component 2B: Behavior Change Communication (BCC) 3 1 Activity 1: Adaptation of national level BCC strategy and development of statespecific BCC plans Conduct formative research to finalize locally appropriate communication material and to refine BCC strategy (as developed at national level) Undertake stakeholder consultation to finalize state specific BCC plans State level (One/ two agency to be contracted) two meetings Lump sum Samp led distri cts 500, ,

42 3 2 Activity 2: Strengthening home contacts Adaptation of communication materials for AWW to support in home visits (Home visit planners have been distributed to all AWWs in the state. This adaptation is of BCC materials) Printing of BCC/ communication materials for AWW for use in home visits(as the home visits using a planner are already initiated in the state in all districts, the state proposes to use resources available in the project to distribute printed BCC material to 100% AWCs in year itself - instead of 50% in year 2 and 3) Implementation of pilot incentivizing home visits in selected districts. Steps involved - Review of exience of Team based goals and incentives (IFHI - CARE in Begusarai) and its results in increasing home visits - Design of pilot on incentives (monitory and non-monitory) for home visits - conduct of baseline, process evaluation and end-line evaluation of the pilot - implementation with different leaveat-home BCC materials and incentive 25,000 state 150 AWC + Rs. 50/ AWC AWC s select ed block s of one distri ct (scale to be decid ed based on final desig n of the pilot) 25,000 9,843,000 As home visit planners are already distributed in the state, Rs.50/ AWC (meant for printing it) is proposed to be added to the BCC material printing (150+50=200/ AWC) 1,250,000 To be designed by June 2014 and implemented from August 2014 (Baseline survey in July 2014). 42

43 3 3 Activity 3: Designing, pre-testing and implementatio n of midmedia initiatives such as folk theatre, film shows etc Organize design workshops with senior artists, script writers and lyricists etc for developing content and shows for mid-media (Folk arts and film-shows) for BCC events. - 2 initial workshops (one day each) to orient and assign work to participants- 3 subsequent workshops (lesser number of participants) to review and finalize content and shows/ design of shows (2-3 days each).costs of travel of participants; workshop venues; meals/ incidentals to be covered State / workshop / worksho p 500,000 total 5 worksh ops June to Aug ust Identification of senior artists; script writers/ film creators etc will be done through development partners and from exiences of other departments - Prasar Bharati and other public sector people will also be included as appropriate Identification and training of troupes of formers for each block/districts and pre-testing of materials (2 trainings district) Implement BCC interventions with support of local CBOs and local artists - Mid media activities will be designed in a manner to consist of folk art forms and film shows to be delivered through a mobile team (in a Poshan-Rath) and effort will be made to synchronize the content with that of the community events being organized during the same iod at AWC level. District / Training 35,000/ worksho p District 1,80,00 0 district 1,330,000 2 training district 6,840, districts - 2 rounds ~ Sept - Oct Nov to Mar ch forming artists will be selected by the district coordinators and DPOs and trainings will be provided at regional/ cluster level These will be done in 100% of districts over last six months of the year at least 2 rounds in the six months (instead of 25% as admin guidelines). as the community events will be occurring in all 19 districts it is important to have mid-media events in as many places as possible 43

44 3 4 Activity 4: Advocacy and knowledge sharing Organization of conferences and meetings for mobilization of political and administrative commitment to nutrition policy and plan of action to address malnutrition and highlight IYCF practices at all levels - One meeting in State Assembly - One meeting in State legislative Council - One meeting in each district panchayat (at least 9 districts by March 2015) lump sum of 3 lakhs for all meetings (details to be develope d) Sub-Total (Component-2) 20,688, ,000 2 meeting s at state level and in about 9 districts in Component 3 - Convergent Nutrition Action Sub-component 3A: Piloting convergent nutrition actions 3 5 Activity 1: Developme nt of state specific convergent action plans and designing of a pilot based on the national guidelines Designing of multi sectoral pilots - Identification of district/ blocks and Panchayats for pilot - Organize consultation with officials of different departments in Patna and in the selected district to orient and brainstorm on possible piloting ideas - Orientation of field staff of different departments and PRI functionaries of selected Panchayats to understand each others programs, to refine the pilot and to develop plans for implementation of pilot - one workshop at state level (one day) - two workshops at district level (one day each) workshops at Panchayat level (1-2 days each, depending on progress being made) State/ district and Panch ayat level Lump sum 5,40,000 (f urther details of budget will be worked out) 540,000 June 2014 to Sept 2014 for completi ng the consultati ons/ orientatio ns and design of pilot Support of development partners to be drawn and some of the local NGOs active in other departments (like agriculture/ RD) will be co-opted to support. Close engagement with implementation of multi-sectoral nutrition project will be ensured to avoid duplication and to build synergy and mutual learning. 3 6 Activity 2: Strengtheni ng interdepartment al coordinatio n mechanism s Will integrate with the state and district level coordination bodies to be created under Multi-sectoral nutrition program of GoI. - No additional resources may be required for the meetings under ISSNIP. - However a lump sum amount of Rs. 160,000 is proposed to be kept aside under this head to meet any additional meetings' related costs 160,000 April March

45 3 7 Activity 3: Implement ation of multisectoral pilots in one district ~ pilot to cover multiple Panchayats in the selected districts, as the design adapted in the state- Costs will include conduct of baseline, process evaluation and end line evolution with about 18 months of implementation at lowest levelsome of the other costs include (not exhaustive)- cost of training FLWs of different departments on the pilot interventions, conducting village level planning/ beneficiary-needs identification; establishing monitoring systems; organizing regular community driven monitoring review meetings; providing resources for any gap-filling (if no departmental program is able to meet a particular nutrition related need of a community/ family) Lump sum 25 lakhs for the current FY (more details will be developed as the design of the pilot gets worked out in early part of by June 2014) Sub-Total (Component-3) Grand Total 2,500,000 3,200, ,192,500 June 2014 onwards Baseline to be conducted in July Orientation and design of pilot to be completed up to village level by Sept Implementation of pilot to begin by Oct/ Nov

46 Refere nce Descript ion of Item Quantities Unit Cost Annexure B: Procurement of Goods Estima ted Cost Total Estimate d Cost (INR)@ Estim ated Cost (USD Equiv ated) Method of Procure ment Revi ew by the Ban k Expec ted Date of Purch ase Order (PO) Expect ed Date of Deliver y Comments / Remarks SPMU G01 SPMU G-2 SPMU G-3 SPMU G-4 SPMU G-5 Desktop Compute r Printer & Scanner Desktop Computer with Printers & Scanners- 10 Color Printer-2 Printer cum Scanner (Multi function Machine) Shopping Post Laptop Shopping Post Photo copier EPABX System Fax Machine LCD Projector LCD Monitor Compute r Table Office Chair Executiv e Chair Secretari al Table Shopping Post Shopping Post Shopping Post Shopping Post Shopping Post Shopping Post Shopping Post Almirah Shopping Post Drawer Box BSNL Connecti on Broad Band (Wi-Fi) Grand Total Shopping Post Shopping Post Shopping Post th June14 5 th June1 5 th June1 5 th June1 5 th June1 15 th June th June th June th June th June 14 Under Process Under Process Under Process Under Process Under Process Approval from CPMU required 46

47 Referenc e SPMU. OC.01 & OC.02 Descripti on of Item Quant ities Unit Cost (INR)@ Oating Costs- Non- Consulting services Estim ated Cost (INR )@ Total Estimat ed Cost Estimat ed Cost (USD Equivat ed) Metho d of Procur ement Revi ew by the Ban k Expec ted Date of Purch ase Order (PO) Expec ted Date of Delive ry Comme nts/ Remarks (for 1 Hiring of Shoppi 1 st Under 2 (for Post June June Vehicle ng Process months) month ) SPMU. OC.03 Maintenan ce of office equipment s (Purchase against DGS&D rate contract) 5000 month (for 12 month) Shoppi ng Post June, 14 Refere nce SPMU. IC. O1 Description of Item Annexure B: Procurement Plan for Consulting Services I. Individual Consultant No. of Positi on Total Monthly remunera tion in INR Estima ted iod in month s Estimate d cost in INR Estimat ed Cost (USD Equivat ed) Sel ecti on Me tho d Expec ted Date of On Board Revi ew by the Ban k Comme nts/ Remark s Technical Rs Jun-14 Post DPMU Project /block 40, Jun-14 Post Project Rs. 25, Jun-14 Post Secretarial Rs. 15, Jun-14 Post Data Entry Rs. 15, Jun-14 Post District Rs. 30, Jun-14 Post Project Assistant@ Rs. 15, Jun-14 Post Block 12, Aug-14 Post Project Assistant@ Rs. 8, IC Aug-14 Post Under Process (Online Applicati on and Receving of Hard copy of Applicati on has been complete d) Applicati on process will be start after hiring of SPMU & DPMU consulta nt. 47

48 Hiring of External Agency Reference Estimated cost in INR Estimated Cost (USD Equivated) Estimated iod in months Expected Date of Selection Review by the Bank Selection Description of Item Method Hiring of agencies for data collection, analysis and report writing District Level Rapid Assessments and ongoing internal assessments at sector level using LQAS approach Hiring of agency for conducting Social Assessment and ethnographic studies in SC/ST/minority areas Hiring of an external agency for conducting the first TNA Study on Training needs assessments Hiring of an external agency for Conduct formative research to finalize locally appropriate communication material and to refine BCC strategy Hiring of an external agency for Printing of BCC/ communication materials for AWW for use in home visits EOI 3 month Oct Post EOI 6 month Sep Post EOI 5 month Jun-14 Post EOI 3 month Sep-14 Post EOI Aug-14 Post Comments/ Remarks Joint Project Coordinator ISSNIP State Project Director ISSNIP 48

49 Indicator 1 Indicator 2 Indicator 3 Indicator 4 Indicator 5 IR 1.1 IR 1.2 Percentage of project blocks reporting information using the revised ICDS management information system (MIS) Percentage of project districts that have implemented the incremental capacity building system Number of project districts that have implemented and evaluated at least one community engagement pilot Percentage of Anganwadi Centers (AWCs) implementing the Inter- Personal Communication (IPC) activities focused on IYCF practices, as defined in the state BCC Action Plans Number of project Districts in which pilots of convergent nutrition action have been implemented and evaluated in at least one district Intermediate Result Indicator Guidelines for the identified key strategic areas of ICDS systems strengthening developed by MWCD and disseminated to the participating States and Districts Percentage of project districts generating estimates of caring/feeding behaviors using a system of iodic rapid, population- level assessments Result Frame Work Annexure- C Unit of Measure Cumulative Target Value Yr 1 Yr 2 Yr 3 Component 1: ICDS Institutional & System Strengthening APL Trigger 1 Achievable target for Yr 2 is 75% (25% of Yr % of Yr 2), as yr 1 target was not achieved due to late initiation of the project at state level Pilots may be restricted to a few ICDS project blocks (two or more) in a district Pilots may be restricted to a few ICDS project blocks (two or more) in a district to develop a Multisectoral action plan for underlying causes of malnutrition Remarks The six identified strategic areas for which guidelines are to be developed are: a) Decentralized (district) annual planning; b) HR Reform; c) Special strategies for urban areas; d) Engagement of Civil Society Organizations in ICDS; e) Public-Private Partnerships in ICDS; and f) Strengthening Supplementary feeding. The system could involve LQAS or other innovative population survey tools IR 1.3 Number of project Districts that have adopted the oational guidelines, including a set of facilitators manuals, developed by MWCD for incremental capacity building Adopted implies adaptation (with or without piloting), translation and reproduction of materials for use by districts IR 1.4 Percentage of project districts with district resource groups established and trained to implement the incremental capacity building system APL Trigger 3 Achievable target for Yr 2 is 75% (25% of Yr % of Yr 2), as yr 1 target was not achieved due to late initiation of the project at state level 49

50 IR 1.5 IR 1.6 Number of project Districts that have conducted at least one pilot to test the effectiveness of a system of joint planning and review by AWW, ASHA and ANM at the Health subcenter level in improving quality and coverage of health and ICDS services Number of project Districts that have conducted at least one pilot to test the impact of introducing a second worker at the Anganwadi level in improving the quality and coverage of ICDS services APL Trigger 4 Conducting a pilot includes design, implementation and rigorous monitoring and evaluation of the pilot Pilots may be restricted to a few ICDS project blocks (two or more) in a district to conducted a pilot on the impact of introducing a second Anganwadi worker IR 2.1: IR 2.2: Component 2: Community Mobilization Behavior Change Communication Percentage of project districts that are working with a CSO partner on community engagement activities Number of project districts that have adopted the IPC guidelines and materials developed by MWCD for use by Anganwadi workers (AWWs) Achievable target for Yr 2 is 75% (25% of Yr % of Yr 2), as yr 1 target was not achieved due to late initiation of the project at state level "Materials include newly produced or approved lists of messages and communication materials meant for IPC, in the state language. Guidelines include instruction manuals, training materials, etc that lay out how the materials should be used by frontline communicators IR 3.1: No. of project Districts in which convergent nutrition action plans for piloting at district level have been developed Component 3: Convergent Nutrition Action APL Trigger 5 Convergent nutrition action plans must be approved by relevant district administration & restricted to a few ICDS project blocks IR 4.1: IR 4.2: Percentage of proposed project staff at Central, State and district level that are in position and trained Baseline data collection for Phase 2 of the project completed in all project states Component 4: Project Management and M&E Project Directors, M&E, FM and procurement staff must be in position at all times APL Trigger 6 baseline indicators are identified, sampling design finalized, data collection outsourced and data collection completed by external agency 50

51 Health and Nutrition Scenario in Bihar: A Demographic Snapshot Demographic and Health Indicator SRS 2012 Bihar India Birth Rate Death Rate Decadal Growth Population Density (Per Sq. KM) Total Fertility Rate (TFR) Infant Mortality Rate (IMR) Neo-Natal Mortality Rate (NNMR) SRS ( ) Demographic and Health Indicator Bihar India Maternal Mortality Rate (MMR) Maternal Health Indicators (%) DHLS- 3 ( ) Bihar Girls married below age Mothers who had three or more ANC Institutional Delivery Safe Delivery Mothers who received post-natal care within 2 weeks Mothers who received financial assistance for delivery under JSY Children under 3 years breastfed with in one hour at birth Children age months exclusively breastfed for at least 6 months Children months fully immunized Current use of family planning methods (Any Modern Method) Nutrition Indicators (%) NFHS-3 ( ) Bihar Pregnant women age who are anemic Children under 3 years who are stunted Children under 3 years who are wasted Children under 3 years who are underweight Social/Gender/Education/Economic Indicator Census-2011 Sex Ration at Birth Child Sex Ratio (0-6 years)\ Total Literacy Rate Literacy Rate (Male) in centage Literacy Rate (Female) in centage India India 51

52 Sl. No. Female Work Participation Rate (%) Per Capita Income Growth (%) Table I: Details of ICDS Blocks and AWCs Manpower position* Name of District Number of Projects Number of AWCs Suvisors Sanctioned Oational Sanctioned Oational Sanctioned Manpower position Inpositi on Sancti oned AWWs Inposition 1 Bhagalpur Buxar Darbhanga Gopalganj Jamui Jehanabad Lakhisarai Madhepura Madhubani Munger Muzaffarpur Pashchim Champaran Purba Champaran Purnia Saharsa Samastipur Sitamarhi Supaul Vaishali Total

53 Sl.No. Name of District Population* Table II: District wise estimated Benificiary Averag Estimated Estimated Decadal e Populatio Populatio growth Annual n n 0-3 yrs rate** growth 15 Childern rate Estimated Populatio n 3-6 yrs Childern Total Beneficiar y (0-6 Yrs) Estimated Pregnant Women 1 Bhagalpur 3,032, Buxar 1,707, Darbhanga 3,921, Gopalganj 2,558, Jamui Jehanabad Lakhisarai 1,000, Madhepura 1,994, Madhubani 4,476, Munger 1,359, Muzaffarpur 4,778, Pashchim Champaran 3,922, Purba Champaran 5,082, Purnia 3,273, Saharsa 1,897, Samastipur 4,254, Sitamarhi 3,419, Supaul 2,228, Vaishali 3,495, Total 55,283, Selected ISSNIP Districts in Bihar 53

54 State Innovations and Good Practices: Health Sub-Centre Meetings: It is realized that Health and ICDS Department has a shared vision and to achieve the objectives of this vision both the departments has to establish coordination at all the levels to provide better services related to Maternal and Child Health and Nutrition, to the families. The exience in eight districts in Bihar in the last two years has demonstrated that a formal monthly meeting at the Health Sub-centre level, where all ASHA and AWW participate, can be a useful platform for supporting and suvising the work of the ASHA and AWW. The meetings are jointly facilitated by the ANMs of the concerned sub-centre and the concerned ICDS Lady Suvisor. Such meetings provide a platform for ongoing coordination on all matters related to maternal health, neonatal and child health, nutrition, immunization and family planning: Ongoing training and skill building of ASHA and AWW Regular planning and review of the work of ASHA and AWW from month to month Ensuring coordinated action between the ASHA and AWW An opportunity for supportive suvision of the ASHA and AWW, in addition to the opportunities that ANM and LS have during village visits The exience has shown that, to maximize results, it is necessary to provide adequate support to all concerned workers: Ongoing training and support to the ANMs and the LS through the BHM, MOIC and CDPO at the block level Involvement of the BCM in providing support to ASHA during monthly block level meetings of ASHAs as well as through ASHA facilitators Appropriate tools and other materials to the ASHA and AWW, such as home-visit planner and health education materials Materials to the ANMs and LS necessary for conducting HSC meetings, such as agenda and detailed content for each meeting. The main advantages of the sub-centre platform over other existing meeting platforms are: The group of functionaries at a sub-centre is usually not more than 20-25, which is an ideal size for program planning and review Bringing together of ASHA and AWW regularly, which helps them work closely with each other It enables both, Health/NRHM and ICDS programs to methodically track progress on small units of population, such as covered by a sub-centre. While it is currently being used for accelerating progress in the areas of maternal and child health, nutrition, immunization and family planning, the Sub-centre Meeting platform is a delivery platform that can be used for rapidly and reliably delivering any interventions for either Health/NRHM or ICDS. Mobile Kunji: Innovative Mobile Health Solutions Shaping Demand and Practices- The explosive growth of mobile telephony has opened up new avenues for communication. A mobile landscaping study in Bihar has revealed more than 85% of frontline health workers (FLWs) have access to Annual Action Plan , SPMU, Bihar mobile phone and find it indispensable for their work. Therefore, mobile technology serves as a platform to reach our key target population for health communication. Mobile Kunji (M K)-Mobile Kunji is an audio-visual job aid designed for FLWs to use when interacting with families. Using a printed deck of laminated cards on a steel ring and an audiobased mobile service, Mobile Kunji delivers multimedia content without the need for expensive 54

55 hardware. The phone-sized cards are illustrated with key messages on family health and planning, pregnancy and postnatal care for children up to two years old. In addition, each card has a unique mobile short code that corresponds to a specific audio message that can be played to the family which is delivered by a character Dr Anita created especially, for this service. The Mobile Kunji is a toll-free service which can be accessed by any health worker in Bihar from any mobile handset, across five of the largest mobile networks in India Airtel, Vodafone, Reliance, Idea and Tata. Calls are toll free for frontline health workers and cost an average of 40 paise minute. The three-day IPC training focuses on using the Kunji And improving the intersonal and negotiation skills of FLWs is organized. The data from our auto generated MIS based on the call logs of Mobile Network Oators indicate that approximately 44% of ASHAs and AWWs in eight districts are using the Mobile Kunji IVR content on a monthly basis. Currently, content related to birth preparedness, family planning, complementary feeding and post natal care are being accessed more often. Field level interactions with FLWs indicate that Dr. Anita s voice helped to enhance their credibility and acceptance at community level. They are not only seen as a health worker carrying Dr. Anita s wisdom but also as someone who provides health tips to families which are similar to the ones told by Dr. Anita over phone. In close association with State Health Society, Bihar and Directorate of ICDS (Dept. of Social Welfare), BBC Media Action and Pathfinder International have jointly delivered this threeday training to 38,512 ASHAs and Aanganwadi Workers (AWWs) in eight priority districts (Patna, Begusarai, Khagaria, Saharsa, Samastipur, East Champaran, West Champaran and Gopalganj) under Ananya. UDDEEPAN Kendra: The word UDDEEPAN means "to kindle, excite or stimulate". UDDEEPAN is a process to stimulate especially under two children through activities at AWCs. AWCs will be clustered under Gram Panchayat and upgraded to create an enhanced resource centre and opportunity for learning. One AWC will be selected to become as Nodal Centre, within 8 10 closely located centers. The objectives of UDDEEPAN Kendra are to promote cooation, support, peer-learning and diffusion of best practices. UDDEEPAN Kendra will encourage stronger focus on services for under threes (children, pregnant and nursing mothers) and will be a meeting and sharing platform for AWWs. This Kendra will facilitate data collection and use of information which intern will improve understanding and coverage of services. Regular interactions with CDPOs and LSs, meeting with PHED staffs and supportive suvision through these Kendra will support systematic capacity building of AWWs. Main feature of this Kendra will be an Uddeepika, additional Worker. She will Coordinate activities of the AWCs in the cluster, Bring focus on the under threes children, P&L mothers, organize monthly learning meetings at the GP nodal centre, liaise with Health, water and sanitation workers to bring about convergence. Process indicators: Complete listing of all beneficiaries in catchment area; Coverage of services this will include o supplementary feeding (hot cooked meal and THR); o growth monitoring and counseling; o follow up and care of critical cases (malnourished, advanced cases of pregnancy) through home visits and group meetings; o immunization maternal and infants; o preschool education; o participation of beneficiaries in VHNDs & mothers meetings; NHED sessions 55

56 No. of pregnant women contacted each month No. of mothers of children 0-6m contacted/ provided services; Records of Daily, weekly monthly activities of AWC MPR prepared on time and linked with records; (regular data validation process) Gram Varta: Evidence from large scale trials in other parts of the country have shown that self help groups can be sensitized and mobilized to improve health outcomes of infants and women; drawing on lessons and exience from such studies SWASTH has already initiated an integrated community based approach named Gram Varta which literally translates to Village dialogue; it is a process of sensitizing women to issues of malnutrition, health, water and sanitation and helping them to find local solutions and adopt appropriate actions for their children and families; the dialogue is carried out during the fortnightly meetings of SHGs. The technical content is delivered using participatory techniques such as role plays, games and storytelling. Through participation in the meetings, women are facilitated to identify and priorities local health problems, and develop strategies for action. The group meetings take a reflective approach which nurtures women s self-confidence, and solidarity among the group. This helps women to negotiate new practices with family members, share information among their family and peer networks, and foster community support for action. In so doing, the community mobilization approach promotes healthier family practices, raises demand for primary HN WASH services, and stimulates local action for change. The process involves recruiting local women from the community as facilitators. Each facilitator will be responsible for facilitating seven to twelve women groups, who will meet on a fortnightly basis (separate to their existing weekly meetings). The facilitators receive training and support to facilitate meetings in a participatory manner and they are provided with a manual to guide them through the nutrition PLA cycle. The group members are actively encouraged and supported to evaluate their progress and identify areas for Gram Varta the village dialogue SWASTH a Government of Bihar and DFID initiative. A single, relatively simple intervention that strengthens existing self-help groups/community can change behaviors related to health, nutrition and WASH and promote community under-standing of the links between the three sectors. This is more cost effective than creating new institutions. The PLA tools were appreciated by facilitators and easily understood by participants, who remembered the innovative and enjoyable games and the lessons they taught. Facilitators suggested one change to the programme, to increase the time allocated for contraceptive information, as they feel this is important and there is a lot to cover. Sustainability rests on the sonal development of facilitators that has occurred and will remain. New family behaviors will become the norm due to reinforcement through the continuing work of groups and AWCs. PLA Meeting: Each process of PLA cycle development involves extensive literature review on the subject matter, deciding topics for the PLA meetings under its four generic phases of Identification and Prioritization of Problems, Planning Strategies for solving the prioritized problems, Acting Together and evaluating their action. The designing of the cycle also involves deciding the content of different meetings, deciding on appropriate pedagogy for facilitation of the meeting e.g. role play, story-telling, picture cards etc., piloting and field testing and finalization of context specific meeting manual. In the process, it also organizes consultation 56

57 with different stakeholders and community members. Each meeting builds on the previous meeting in such a way that they are interlinked. Scale up: Scaling up has begun through WDC, Bihar Mahila Samakhya and JEEViKA, which will eventually cover the 14 districts where self-help groups and block level federations exist. For other districts a different model is proposed, using NGOs who will work with other existing local bodies, such as mothers committees. This will need to be reviewed in the light of exience to see if adjust-ments are required, and it is hoped that it may also encourage the formation of additional self-help groups. Low Cost Iodized Salt through PDS: One innovative pilot project supply of low cost non-subsidized quality Iodized salt through PDS to provide iodine nutrition to BPL family. This is being done under PPP mode in all six districts (Muzafferpur, Vaishali, Sitamarhi, Champaran East, Champaran West and Sheohar) of Tirhut division. The progress is being monitored by State USI (Universal Salt Iodization) coalition comprising member from Health. ICDS. WDC, Food and Civil supply, Institutions like AIIMS, Patna, PMCH and development partner such as UNICEF, ICCIDD, GAIN, MII etc. In this regard the effort made by the state has been appreciated by Department of Salt, GoI and Department of Community Medicine, AIIMS, New-Delhi. Food Fortification: Providing fortified food is being proposed by GAIN with collaboration with BRLP and NIDAN at Khagaria and Begusarai districts. It is expected that production will be started from April, Provision of Micro Nutrient: A pilot project is proposed under IFHI project (BMGF & CARE) at Champaran West to provide daily dose of all essential micronutrient (Vitamin A, IFA, Iodine and Zinc) to the all children. SABLA: The Rajeev Gandhi Scheme for Empowerment of Adolescent Girls (SABLA) was launched in Bihar in March 2011 in 12 districts. The scheme among various other things aims at improvement of the nutritional and health status of adolescent girls in the age group of years and empowering them by providing education in life-skills, health and nutrition. With UNICEF s support a state level review mechanism was initiated for SABLA in the state, various issues were identified like: 1. Lack of program monitoring and review at state and district levels. 2. Not regular supply and procurement of IFA tablets at district and block levels. 3. Irregular and incomplete MPR reporting for SABLA. 4. Non procurement of SABLA Kishori kits by most of the districts. 5. Planning, celebration and monitoring of Kishori Diwas. Thereafter, strengthening of SABLA services occurred through focus on the following key areas- 1. Establishing and strengthening a regular program review mechanism- 2 review meetings held in July and December District level review mechanism initiated in first quarter of 2014 where 10 districts held district review meetings for SABLA with focus on quality MPR reporting, planning and 57

58 monitoring of Kishori Diwas in the districts. 3. Strengthening the data management and reporting system by initiation of online SABLA MPR reporting by the Directorate and capacity building of Data entry oators on MPR filling and online data entry. This orientation occurred at State and District levels and all DEOs of District and project were trained. 4. Strengthening of Kishori Diwas was done through various interventions asa. Developing the state Kishori Diwas guidelines. b. Orientation of all CDPOs on Kishori Diwas celebrations and planning for organizing and monitoring January 2014 Kishori Diwas with all the CDPOs from these districts. c. Monitoring of Kishori Diwas activities. In January 2014, total 1031 planned Kishori Diwas were monitored and at 65% sites Kishori Diwas was found to be held. 31% sites monitored were in Mahadalit tolas. SABLA kits was available at 32% sites monitored. IFA tablets were available at 48% of sites monitored. Albendazole was available at 40% of sites monitored. BMI was being calculated in 34% of sites monitored. Kishori cards were available in 45% of sites monitored. The monitoring report was shared on weekly basis at the state level. As a result of these interventions, the status of SABLA activities has shown improvement in term of quality of Kishori Diwas activities, SABLA MPR reporting, regular review mechanism established for SABLA in the state. Contact Details of State Team Sl. No. Name Designation Contact No. Mail id. 1 Mr. Rajit Punhani Secretary, Secysw-bih@nic.in Department of Social Welfare, Govt. of Bihar 2 Ms. Neelam Gupta State Project Director dir.icds-bih@nic.in 3 Mr. Ashok Kumar Joint Project Coordinator asst.dir.icdsbih@gmail.com 4 Mr. Sunil Kumar Jha Joint Project Coordinator Ms. Nirupa Kumari Special Officer spo@icdsbih.gov.in Contact Detail of Technical Assistance Team Sl. No. Name Designation Contact No. Mail id. 1 Mr. Mantreswar Jha State Team Leader m.jha999@rediffmail.com 2 Mr. Prakash Singh Regional Manager prakashsingh_pat@rediffmail.com 3 Mr. Rohit Kumar Regional Manager rohit84kumar@gmail.com 4 Mr. Shiv Shekhar Anand Regional Manager shivshekharanand@gmail.com 5 Dr. Suparna Tat Regional Manager drsuparnatat@gmail.com 58

59 Contact Detail of District Team Sl. Name Designation Name of Contact No. Mail id. No. District 1 Ms. Sudha Gupta DPO Bhagalpur dpo.bhagalpur@icdsbih.gov.in 2 Mr. Ajit Kumar Jaiswal DPO Buxar dpo.buxar@icdsbih.gov.in 3 Mr. Nandkishore Sah DPO Darbhanga ; dpo.darbhanga@icdsbih.gov.in 4 Mr. Satish Chandra Srivastava DPO Gopalganj dpo.gopalganj@icdsbih.gov.in 5 Mr. Santosh Kumar DPO Jamui dpo.jamui@icdsbih.gov.in 6 Mr. Ashutosh Kumar DPO Jehanabad ; dpo.jehanabad@icdsbih.gov.in 7 Ms. Manju Prasad DPO Lakhisarai dpo.lakhisarai@icdsbih.gov.in 8 Mr. Rakesh Kumar DPO Madhepura ; dpo.madhepura@icdsbih.gov.in 9 Mr. Ashwini Kumar Sinha DPO Madhubani ; dpo.madhubani@icdsbih.gov.in 10 Mr. Rajendra Das DPO Munger dpo.munger@icdsbih.gov.in 11 Mr. Monoj Kumar DPO Muzaffarpur dpo.muzaffarpur@icdsbih.gov.in 12 Mr. Sashi kant Paswan DPO Pashchim Champaran 13 Mr. Praveen Kumar DPO Purba dpomthicds@gmail.com Champaran 14 Mr. Anand Prakash DPO Purnia dpo.purnia@icdsbih.gov.in 15 Mr. Virendra Narayan Pandey DPO Saharsa ; dpo.saharasa@icdsbih.gov.in 16 Mr. Akhilesh Kumar Singh DPO Samastipur ; dpo.samastipur@icdsbih.gov.in 17 Mr. Balakant Pathak DPO Sitamarhi dpo.sitamarhi@icdsbih.gov.in 18 Mr. Ramesh Kumar Ojha DPO Supaul ; dpo.supaul@icdsbih.gov.in 19 Mr. Ajay Kumar Singh DPO Vaishali ; dpo.vaishali@icdsbih.gov.in Status of Immunization and Vitamin- A Supplementation in ISSNIP Districts Immunization Status of ISSNIP Districts* SL.No Name of District % of Fully Immunized Children under 2 years 1 Bhagalpur Buxar Darbhanga Gopalganj Jamui Jehanabad Lakhisarai Madhepura Madhubani Munger Muzaffarpur Pashchim Champaran Purba Champaran Purnia Saharsa Samastipur Sitamarhi Supaul Vaishali 70.3 Ref: Annual Health Survey

60 Graph - 1: % of Fully Immunized Children under 2 * Figure 1 shows the Data of Fully Immunized Child under 2Yrs. From which it is clear that Madhubani district have the highest centage of fully Immunized Child (82.8%) contrary Jamui having the lowest centage (38.8%). SL.No Status of Vitamin-A Supplementation in ISSNIP District* Total Children Name of District Administrated (09 % of Coverage months to 05 years 1 Bhagalpur Buxar Darbhanga Gopalganj Jamui Jehanabad Lakhisarai Madhepura Madhubani Munger Muzaffarpur Pashchim Champaran Purba Champaran Purnia Saharsa Samastipur Sitamarhi Supaul Vaishali Ref: State Health Society, Bihar, Vitamin-A Bi-annual Programme, Round-II (2013) 60