Editor’s note: PATH friends and board members traveled to India to see programs that improve children’s nutrition, immunize children against the deadly Japanese encephalitis virus, and help women’s groups save and borrow money to bolster their families’ health, education, and earnings.
Thursday, November 13—To meet the women of Anjani village in Bihar State, we walked narrow dirt alleys between their homes, stepping among cows and children.
We passed cakes of cow dung slapped on the walls next to us like rows of cookies baking to dry out and use later for cooking fuel.
A widow waved us into her home, eager to show us where she hosts meetings of a local women’s group. The dark, mud-brick shelter had a woven cot in a small room that sleeps five people. An adjoining room was for the family’s water buffalo that provides their livelihood, she told us, and a third room held fodder for the animal.
“In Bihar, we have a very strong caste system. Within that, we work with the most marginalized people,” said Tarun Vij, PATH’s country leader in India. “The families from the lower caste have all kinds of deprivations imposed upon them.”
Bihar is one of the country’s poorest states, with very high rates of maternal and newborn mortality and a literacy rate of just 64 percent. Anjani village sits along a tributary of the Ganges River and is home to some 500 families who work the nearby rice paddies.
Once a week, groups of 10 to 15 women gather to pool their money—each contributing 40 rupees (the equivalent of US$.66)—in order to grant one another loans. PATH works through these “self-help groups” to provide the women health tips on pregnancy, childbirth, family planning, nutrition, and sanitation, and to inform them of their rights to government services.
“We help them learn how to take collective actions and help other women,” Vij said. “If individually, you don’t have negotiating power or courage, you need to come together and access those services that you are entitled to.”
In Anjani, dozens of women gathered on the ground next to a temple to tell us how the groups have affected them. A 32-year-old mother of four said that she had delivered her first three children at home. When pregnant with her fourth, group members encouraged her to give birth in a facility where trained health workers offered best practices for her newborn’s health and development.
One woman said she joined the group to learn information that will help her children get into a better level of society, and to learn about sanitation and cleanliness so that her children will not get diseases.
“Coming to the group is like being together,” another said. “We feel happy that we come together and we get more information. Among us, unity has also improved.”
Such groups have been used successfully in many countries. What’s unique about PATH’s work in Bihar, which has the potential to transform lives for the state’s poorest people, is the use of data from the program to inform the government’s plans for 1 million self-help groups in the state.
“We have started to decode what is needed in this population. There’s a certain art to it,” said PATH’s Nityanand Deepak, who oversees knowledge management for the program. “They are starting to catch up to the higher caste level.”
Surveys of 3,800 group members in 2013 and 2014 found an impressive increase in key health indicators, such as immunization, breastfeeding, mothers’ skin-to-skin care for newborns, and delivering their children in institutions with health care providers instead of in homes.
“We need to sift the data, break the data down geographically, and try to understand the patterns,” said Dr. Lysander Menezes, team leader for maternal and child health and nutrition. “PATH is in the sweet spot of being the organization that can solve this for the country.”
In five years, the work of PATH and our partners* has reached 225,000 women in 17,000 self-help groups across Bihar. PATH trains the trainers of the women who facilitate the groups, and oversees community monitoring to track facilitators’ performance.
PATH also supports community health workers to strengthen village health committees to hold the health system accountable for services.
“We have lots of learning. Now it’s important to give that information to the government so they can scale up across all of Bihar,” said Deepak.
The PATH Journeys program offers donors an opportunity to experience firsthand the health innovations they support and to meet the people whose lives they are changing.
* PATH works closely with Project Concern International (PCI), the prime on the Parivartan project described here. PCI and PATH have a long association of mutual consultations and collaboration in the community-driven development programming space, arising from PATH’s Sure Start project and continuing with the collaboration on the Parivartan project.
- Lynn Heinisch is the director of Public Health Communications at PATH.