The year 2010 presents a crucial moment to assess the ground covered over the last decade and the distance that remains to be traversed over the next five years. In fact, that is just what the United Nations General Assembly will do when it meets this September. How well is India placed to catch the MDGs bus? The Government of India has just done its own assessment. And the picture that emerges in this document, entitled the 'Millennium Development Goals: India Country Report 2009', is a very mixed one.

According to the Report, as many as 25 States/Union Territories in India are likely to have halved their 1990 levels of poverty earlier or around 2015. There is optimism that the country will be able to achieve universal primary education by 2015 and eliminate the enrolment gap between boys and girls by then. The government also claims that it is on course in controlling the incidence of HIV/AIDS, malaria and tuberculosis and expects to achieve the MDGs target for sustainable access to safe drinking water by the designated year.

Ground for some cautious cheer? Well, there are many who would contest even the basic assumption that India will be able to peg down its poverty levels in a meaningful way. On one issue, however, everybody agrees, including the government: Among the gravest challenges facing India today is its persistently high Infant Mortality Rate (IMR).

Change on this score has been tragically sluggish. The Report estimates that going by present trends, the country would have achieved, by 2015, an IMR of only 46 per 1000 live births, as against the required 26.7 per 1000 live births. It also notes that the "incidence of neo-natal deaths has not changed over the last seven years in the heartland states".

Expectant mothers in the country are not doing too well either, although things have improved immeasurably since 1990, when the country's Maternal Mortality Rate (MMR) was 437 per 100,000 live births. According to the Country Report's projections, India is expected to bring down its MMR to 135 per 100,000 live births by 2015, which falls short of the required 109 per 100,000 live births.

The deaths of these innumerable children and mothers are a severe indictment of the country and point to significant and overlapping inequalities of gender, class, caste and region. Not surprisingly, it is the poorest states - like Bihar, Jharkhand, Chhattisgarh, Madhya Pradesh, Orissa and Uttar Pradesh - constituting India's heartland, and the most marginalised communities - whether Dalits, Tribals or the Minorities - that report the highest mortality levels.

If India's IMR and MMR are to be pegged down, the country will have to focus urgently on three central concerns: hunger/malnutrition; health care; and sanitation. Malnutrition is directly related to poverty and food security. According to the National Family Health Survey - 3 (2005-2006), about half the children in India are stunted, and more than a third of our women have a Body Mass Index below 18.5 per cent, an indicator of serious nutritional deficiency and the inter-generational transfer of malnutrition from mother to child.

Health care remains another huge concern. According to a recent Planning Commission assessment, the shortfall of primary health centres and sub-centres in 2008 has remained almost the same as in 2005, and the number of auxiliary nurse midwives has, in fact, decreased over the same period. Today, there is a 50 per cent shortfall in trained health workers, radiographers, lab technicians and doctors. At the existing rate, only 62 per cent deliveries will be attended by skilled personnel by 2015 - with rural areas being particularly under-serviced.

Sanitation, unfortunately, has never been a policy priority for India despite that fact that drinking water contaminated by faecal matter is a major cause of child deaths. The Report admits that India has the lowest sanitation coverage in the world - in 2007-08, an estimated 66 per cent of rural households did not have toilet facilities.

"The more we wait, the more difficult it will be to address such concerns and achieve the MDGs," predicts Siba Sankar Mohanty, National Campaign Coordinator, Wada Na Todo Abhiyan (Keep the Promise movement), a national campaign to hold the government accountable for its promises, that involves more than 4,000 civil society organisations across 29 States and Union Territories in the country.

Mohanty argues that since the Suresh Tendulkar Committee has assessed the actual population living below poverty in India at 37 per cent instead of the earlier figure of 27 per cent, it means that achieving the targets will be that much more difficult. He also argues that the government needs to get back to delivering basic services, like health and education, instead of linking their access to the vagaries of the market.

According to Bhopal-based Yogesh Kumar, Executive Director of the Samarthan Centre for Development Support, there has been a huge governance failure. "My state, Madhya Pradesh, has the highest level of malnutrition in the country, especially among Scheduled Castes and Scheduled Tribes, but the government has just not woken up to the issue. Forget additional resources, even the resources that are available are not being put to best use. As for the affected people, they are so disempowered they do not even know they have the right to demand better government accountability," says Kumar.

The irony, according to Alok Vyas of the Jaipur-based CECOEDECON, a group working for the last 27 years among Rajasthan's farmers, is that while agriculture continues to be the main source of livelihood for at least 60 per cent of Indians - in Rajasthan the figure is around 70 per cent - there has been precious little investment in the sector. "Farmers have been squeezed out, and many have sold their assets to become migrant workers in the cities. Nobody in government is taking agriculture seriously," he says.

India is still awaiting its tryst with its developmental destiny. The MDGs represent a web of overlapping deprivations. Achieving them will not only change the face of the country, it could go some way in addressing the million mutinies that are raging, or will rage in the near future. All insurgencies, after all, are fuelled by a sense of grievance and powerlessness among ordinary people, whether in the Northeast or in Chhattisgarh.

In September the governments of the world will meet at the UN to present their assessments on the status of MDGs in their respective countries. Annie Raja, General Secretary of the National Federation of Indian Women, wants the Government of India to make the effort to understand the concerns of civil society. "Before the Government of India makes its presentation on MDGs at the UN, we demand that our views be taken into consideration," says Raja.

The clock is ticking. If India does not get its act together now, 2015 will go down as the year of broken promises.

By Pamela Philipose
© Women's Feature Service

Orai, Uttar Pradesh (Women's Feature Service) - Orai, the nondescript headquarters of Jalaun district in Uttar Pradesh (UP), has an amazing story to tell the world. Lying in the neglected Bundelkhand region, Orai, which has a large Dalit ('downtrodden') population, not only experiences acute water scarcity, its literacy levels are low and unemployment levels, high.

Yet, it is in this unlikely environment that the Dalit community here is asserting its right to education. Children who have been denied schooling over generations are now waving Right To Education cards before the faces of the authorities. In a region where daughters have never been sent to school, there is a spirited campaign focusing on girls’ education.

Spearheading this unique social inclusion movement is Kuldeep Kumar, 21, a Dalit student. The son of a mason, who is preparing for his Bachelor of Education degree, Kuldeep decided to do his bit. For two years now, he has been taking the message of universal education to the people through his organisation, the Prayaas Jan Uthan Samiti.

Kuldeep was 18 when he participated in an international research project and observed the plight of the local people. The experience stayed with him. Today, sitting in a two-room rented apartment in Jalaun, which functions as an office-cum-hostel for the girls in the group, he observes, "The root cause of poverty is illiteracy and unemployment. The best way to empower the poorest is to give them access to education."

Popularising the idea of education was, however, a huge task, and Kuldeep realised it could not be done alone. That is when he set up Prayaas Jan Uthan Samiti with a core team of nine youngsters, including three girls. Most of the volunteers are less than 30 years old, come from very poor Dalit households and have experienced discrimination at first-hand.

Support for Prayaas first came in the form of Baldan Singh and his wife Alka, who work on issues of anti-Dalit violence in Orai. Soon other groups, such as the Aasha Mahila Adhikar Manch and Dr B.R. Ambedkar Yuva Samaj Sudhar Samiti, came forward. Together they formed the Bundelkhand Dalit Manch (BDM), an umbrella body of Dalit NGOs which had the twin agendas of education and employment. Presently, there are nearly 35 organisations that work as part of BDM.

Convinced that lasting social awareness can stem only from "informed" communities, this larger team began chalking out ways by which Dalit children could be brought into the educational mainstream. Supported by National Confederation of Dalit Organizations (NACDOR), they soon came up with the idea of Right to Education rallies. India, incidentally, has committed itself to ensuring that all children, boys and girls, get primary schooling by year 2015 under the Millennium Development Goals (MDGs). If this has to happen it is in places like Orai that children should be in schools.

Organising these meets proved far tougher than anticipated. "The area of our work was the tribal belt, where ignorance, disparity and discrimination were huge," says Kuldeep. But the youngsters were optimistic. A team of 21, including five girls, representing three regions of Jhansi, Jalaun and Lalitpur in Bundelkhand, was trained for three days before they embarked on a month long journey to spread literacy awareness here. NACDOR volunteers from Delhi provided the training. The first rally was at Hiya village in Jhansi.

While Kuldeep personally visited 20 villages, his team ended up covering a whopping 103 villages! Instead of one, they visited three villages in a day with their message: Every child had a right to education. The team members found that many children had been denied school admission outright. Others were admitted but were not attending classes largely because of the caste discrimination they encountered, both from teachers and upper-caste students. Cattle grazed in the premises of many schools, and the dispensing of mid-day meals was irregular.

"First we had to tell people that education was their children's right and that they cannot be denied it because of their caste or religion. We had to build up confidence in both parents and children," reveals Baldan Singh.

The children who were refused admission were handed Right to Education cards. They were told to show these cards to any school authority that denied them admission. Taking caste prejudices head on worked. Recalcitrant school officials found themselves cornered. In one instance, children demonstrated outside the home of an absentee teacher, holding placards that read, “Teacher, aao aur padho” (“Teacher, come and teach.”). When storerooms for the mid-day meal provisions were found locked, Prayaas members had them opened and ensured that meal schedules were followed. They left behind their mobile numbers so that they could be contacted if there were such disruptions again.

In most places, the team also noticed that parents and teachers blamed each other. While the parents argued that teachers were absenting themselves, the teachers accused the parents of not sending their wards to school. To solve this problem, triangular Parent-Teacher-Student associations were formed, where everybody could together sort out their differences.

The team also wrote simple slogans on village walls: 'Ghar ghar vidya deep jalao' ('light the lamp of education in each home'); 'Bachcha bachee sabhi padhao' ('teach both son and daughter'); Padhee likhee ladki roshni ghar ki ('an educated girl is the light of a home') were just some of the inspiring messages.

Information on education was combined with entertainment. Skits, highlighting the importance of schooling, were enacted for local communities. Public discussions on school education were conducted, so that views could be freely expressed or countered. This was followed by a two-month-long Dalit Shiksha Jagrukh Abhiyyan (Dalit Education Awareness Campaign).

The female members of the team were entrusted with a special task of acting as motivators for girls' education. Explains Shilima Gautam, 23, a Prayaas member, who is preparing for her Bachelor of Education exam, "Take Pattipura village in Jalaun. It has a 100 per cent Dalit population and none of the girls went to school. So we spent a lot of time here stressing on the importance of educating daughters." Shilima, who has three sisters, works as a 'kisaan mita' (friend of farmer — a semi government post — who provides local farmers with information about good farming practices) and earns Rs 1,000 (US$1=Rs 44.6) per month. With this she supports herself and her college-going sister, Neelima, who dreams of becoming a police officer. The sisters - trained as motivators - live independently in Jalaun in a rented room about 55 kilometres away from their village, Gohan. They are fortunate to have an enlightened father. Says Shilima, "My father, a watch repairer, supports girls' education. He believes that no development - whether individual or national - is possible without education."

Interestingly, not only has Kuldeep helped to motivate teachers, parents and students, he has inspired many youngsters like him. Sometimes Kuldeep is a bit embarrassed by the attention. But he is clear that school education is the first step to addressing growing social disparities and poverty. "I ask everyone just one question: How many officers put their children into government schools? I tell them that in this question is hidden the answer to improving government schooling and ensuring the Right to Education of every child," he says. It is precisely such awareness raising that will help in the implementation of the newly passed Right to Education Act, in both letter and spirit.

Young Kuldeep is confident that Orai is slowly moving towards achieving Millennium Development Goal Two: Universal primary education. Because it is only when the poorest, most socially disempowered communities access schooling can there be lasting change. By flashing their Right To Education cards and demanding that the lamp of education be lit in every home, Orai’s children are signalling change in a forgotten region of the country.

By Kulsum Mustafa
© Women's Feature Service

Bhubaneswar (Women’s Feature Service) – In her ninth month of pregnancy, Laxmi Bhatra from Orissa’s Anchala village in the tribal dominated Kosagumuda block of Nawrangpur district, suddenly felt unwell. On seeing his wife’s condition, Kamlochan, a landless worker, got on to his bicycle, tied a hapless Laxmi loosely to him, and peddled 15 kilometres along a hilly pathway to a six-bed health facility. When he got there, instead of admitting the visibly suffering woman, the local doctor gave her some medication and sent her home. Laxmi delivered a stillborn male child soon after, and died a week later.

Laxmi’s story is so common in a state with one of the highest levels of infant mortality in India that it hardly figures as the tragedy that it is. But it is a reminder that if India is to come closer to achieving the Millennium Development Goal (MDG) of reducing its under-five mortality rate by two-thirds by the year 2015, it must focus urgently on child mortality.

In September, heads of state will gather at the United Nations to review progress on the MDGs – the set of promises they made in the year 2000 to eradicate extreme poverty and its root causes by 2015. As UN Secretary General Ban Ki-moon recently observed, “We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world.” He was speaking about people like Laxmi, in regions like Orissa. More babies die in this state than almost anywhere in the country. The state has an Infant Mortality Rate of 71 deaths per 1,000 live births — as compared to the national figure of 55, with neonatal deaths (those that occur in the first four weeks of life) accounting for 69 per cent of these deaths, according to the 2008 Sample Registration Survey 2008. Most babies, especially those born into tribal communities, have a very low birth weight (less than 2,500 grams), indicating widespread malnutrition and the high anaemia levels of their mothers.

Poverty and malnutrition make a deadly combination. Majhibani Sikaka, 50, a panchayat ward member from Sargipayu village, Rayagada district, says “malnourished pregnant women continue to work right till the day of delivery, sometimes bearing heavy loads on their heads.” Sikaka estimates that at least three out of ten newborns die in her Dongria Kondh community. Mini Majhi, a Trained Birth Attendant, adds that “families in tribal regions are so poor they cannot afford to miss a day’s earnings to visit health centres for regular check ups. They also have no money to spend on childbirth.” Majhi should know. She has been working for 10 years in the interiors of Kandhamal, another predominantly tribal district.

Making the situation more complex is the general illiteracy. Pregnancy complications are generally treated by the local ‘bejuni’ or witch doctor. He dispenses herbal potions and chants magic words to chase away the evil eye believed to have caused the problem. But this dependence on the ‘bejuni’ is in itself a comment on the poor health delivery system.

In fact, improving mother and child survival in poverty-stricken regions was a central objective of the National Rural Health Mission (NRHM) when it was set up in 2005. Its key human resource is the trained female community health activist, called the Accredited Social Health Activist (ASHA). ASHAs are recruited from the villages they serve and are expected to visit expectant mothers, explain the benefits of giving birth in a health institution, and impart advice on immunisation, sanitation and nutrition. Financial incentives are also meant to play a part. After delivery, a mother is supposed to receive Rs 1,400 (US $31) to compensate for lost wages and general expenses.

But even the best plans go awry when faced with administrative failure. Health facilities in rural Orissa are poorly equipped and understaffed, with even the health workers on the rolls choosing to live in nearby towns rather than at their supposed place of work. Sushanta Garada of the Nawrangpur Democratic Action, a member group of the community-based monitoring of health services under NRHM, says “if there is some risk, doctors at the first referral at block levels will not even touch these patients. They are referred to the district hospital.”

Garada cites the example of a primary health centre in his area where a notice on the wall reads that the doctor will be available for three hours, two days per week. “Childbirth does not wait for a doctor’s availability,” comments Garada.

As in Laxmi’s case, topography also contributes to this familiar tragedy. Nawrangpur is hilly and has only fair weather roads or footpaths. These too turn risky during the monsoons, and can be navigated only by foot or at best by bicycles. Garada explains, “In Nawrangpur, which has one of the highest IMR levels in Orissa, women nearing their delivery date, even if they have complications, have to sometimes travel 70 kilometres to the district hospital through terrain that can be crossed only on foot and could even entail crossing rivers. There exists no other mode of transport.”

In such a situation, the role of the ASHA can make all the difference between life and death. According to Pramila Swain, president of the Bhubaneswar based National Alliance of Women, ASHAs have contributed to bringing down the number of neo-natal deaths, but the system needs improvement. There are problems in the selection of these women. The village panchayats that take these decisions are often influenced by vested interests. The recruits are sometimes too young, with little knowledge about child bearing. They also find it difficult to travel long distances to isolated hamlets in order to accompany patients at night to health facilities. Petty corruption is a problem, too. In the Daringibadi block of Kandhamal, for instance, cases of women having their deliveries at home but getting their names into hospital registers in order to get the Rs 1,400 given for institutional deliveries have surfaced. Doctors and health workers also sometimes connive to cheat bona fide patients of their dues.

In Orissa’s capital city, Bhubhaneswar, Dr P.K. Senapati, State Maternal Health Programme Manager, believes things are improving despite the odds. For instance, institutional childbirths have risen in Orissa from 23 to 39 per cent between 1999 and 2006. Says Dr. Senapati, “While institutional childbirths are rising, we realise that a poor state like Orissa has to also focus on home delivery and strengthening home-based care by training grassroots health workers.” According to Dr. Senapati, health workers are also being instructed to keep track of pregnancies – from inception to delivery – for the timely detection of complications.

Such efforts are paying off. The Infant Mortality Rate dropped 20 points between 2001 and 2008, according to reliable data. The pace of change, however, needs to be urgently hastened. The Government of India estimates that, at the present rate of change, the country is likely to fall short by 28 percentage points on its MDG commitment to reduce child mortality.

In fact, South Asia is one of the worst performing regions in the world when it comes to child mortality and maternal mortality, according to the ‘Millennium Development Goals Report, 2009. In September, when the international community reviews progress on the MDGs, the concern of babies dying because of poverty and lack of medical care will once again come on the global radar.

This is why Laxmi’s story – and the lessons learnt from it – are so important.

By Manipadma Jena
© Women's Feature Service

Indore (Women's Feature Service) - Madhya Pradesh (MP), a state that projects itself as India's heartland, is also the region that witnesses the highest number of maternal deaths in the country. For decades, women here continued to die from pregnancy and childbirth-related causes, with the media and the state government largely ignoring the issue.

In the year 2000 India pledged to bring down its Maternal Mortality Rate (MMR) to 109 per 100,000 live births as part of its Millennium Development Goals. But making maternal mortality a public concern in MP took effort.

Recalls Sachin Jain of the Vikas Samvad, an MP-based advocacy organisation, "Five years ago, when the Maternal Mortality Rate (MMR) was around 498 per 100,000 live births in Madhya Pradesh, it was just a number for many of us. Then some activists, after working it out, put out information that 13,000 women in the state died every year, during and after delivery. That was when the issue began getting public attention. Local organisations and networks like Jan Adhikar Manch and Jan Sangarsh Morcha, Mandla, began raising the concern."

Media tracking done by Vikas Samvad showed the steadily rising graph of news reports: In 2007, there were 654 reports and features on maternal and child mortality in national and regional newspapers. By 2009, the figure had touched 1,256.

This media focus led to two important developments. One, maternal deaths became a political issue. Observes Jain wryly, "Earlier no politician talked about it. Now the state assembly discusses maternal mortality at least three or four times every session! What's more, in the 2008 assembly election, it was an election issue." This unprecedented attention forced the state government to act. Earlier this year, the state government announced that the Janani Express - a free service to transport pregnant women to government health facilities for delivery - would be expanded to cover all 50 districts of the state.

The other impact was at the level of public awareness that brought about significant attitudinal shifts: People's right to proper health care became a community issue. May 2008 saw a campaign led by the Jagrut Adivasi Dalit Sangathan and Cehat, in the predominantly tribal Pati block of Badwani district. Some 1,500 local people - disillusioned with the local health services - undertook a monitoring of the Pati Community Health Centre. They sat in at the premises of the health centre for four days and went through the records. In the end the administration was forced to sign an agreement promising better facilities and care.

"That agreement was put up in the Pati Community Health Centre so that people got to know about it. Information is clearly the key in addressing the big gap between government claims and existing realities," observes Jain. He adds, "When we in Vikas Samvad heard that one Shivkali Baiga in Mandla district had died because of negligence during her delivery, we alerted journalists and widely circulating Hindi newspapers like 'Dainik Bhaskar', 'Dainik Jagran', as well as the English daily, 'The Hindustan Times', covered the story. Shivkali's father has now filed a Public Interest Litigation in the Madhya Pradesh High Court. We hope to keep the pressure on."

If information generation with evidence based social action is a game changer, so also is local expertise. While MP has an estimated 57,000 'dais', or traditional birth attendants, the state government has kept them out of the maternal health delivery regime. But in another region of MP, interesting evidence has surfaced about how, when poor local women are trained and empowered to deliver on maternal and reproductive health, they can make a huge difference.

Suguna Solanki, a Bhil tribal 'anganwadi' helper, lives in Jeet Nagar - a shanty town on the outskirts of Indore, Madhya Pradesh's financial capital. She is a health worker and came into the sector almost by accident. Suguna describes that moment, "Once, a few years ago, I took a 16-year-old unmarried girl from our slum, who was five months' pregnant, to a doctor who was actually a quack. He gave her a potion, pressed hard on her lower abdomen and aborted the foetus. Later, the girl began to bleed profusely. We rushed her to a government hospital where her uterus was removed and she was saved."

The experience helped Suguna understand the obstacles that poor women living in her neighbourhood faced. The problem was two-fold. Not only were women ignorant about their right to health care, they also knew very little about the state of their own bodies.

The first challenge then was to break the culture of silence, whether it was about health entitlements or tabooed topics like sexuality and menstruation. Suguna joined an initiative undertaken by the Urban Health Resource Centre (UHRC), New Delhi, in 75 slums in Indore, in collaboration with five local NGOs, with funding from USAID. The programme, which began in 2003, focused on assisting local communities to gain access to the government's reproductive and child health services.

Suguna, along with a few other 'anganwadi' workers from adjoining slums like Rajeev Gandhi Nagar, Bhavana Nagar and Pavanpuri, were trained as community workers in reproductive and child health. They were also given the task of mobilising local communities to seek better health services. The women organised monthly health camps in which doctors conducted regular check ups and provided free medicines.

In time the women realised they needed to do more if their work was to have an impact. Says Rekha Patode of the Rajeev Gandhi Nagar slum, "Menstrual hygiene is a big problem here, for instance. In most cases women use the same pieces of cloth after washing them, and since the rags are not dried properly because their public display is tabooed, women end up suffering from various infections, including pelvic inflammation."

At this point, the UHRC decided these field health workers should be made to form their own organisation, so that they would be able to carry on working for the community even after the project ended. Recalls Urmila Javre, a field worker from Pavanpuri slum, "Seven women field workers came together and helped to form and register an NGO by the name of Parivar Sahayog Samiti (PSS) under the Madhya Pradesh Societies Act. We were given training on how to run it and we told the trainer about our desire to work on women's reproductive rights."

Soon, the monthly health camps began to be reoriented towards treating gynaecological infections. The local women welcomed these initiatives. For the first time, they were being properly examined in privacy by trained doctors, given appropriate medication and sanitary napkins. The results were heartening. Incidence of pelvic inflammation came down markedly, and there was also a reduction in anaemia levels. This led, in turn, to the better health profile of the pregnant women.

In 2009, the funding for the project ended. But Suguna and her colleagues are determined to carry on. The PSS is a remarkable example of how local expertise can make a real difference on the ground. They also understood intuitively the connections between maternal and reproductive health. Millennium Development Goal 5 - that seeks to improve maternal health - recognises this very link.

According to ‘The Millennium Development Goals Report 2009’, brought out by the United Nations, maternal mortality levels in South Asia are among the highest in the world, next only to sub-Saharan Africa. If this has to change, India would have to do better, and for India to do better a state like Madhya Pradesh would have to bring down drastically its MMR, currently at 335 deaths per 100,000.

The information driven campaign of the Vikas Samvad, and the local expertise inherent in the PSS model could be important pointers to the way forward in a state that has long neglected its expectant mothers.

By Subhadra Khaperde
© Women's Feature Service

Patna (Women's Feature Service) - Access to safe drinking water is an important Millennium Development Goal but in Bihar, which is ironically enough blessed with innumerable rivers, it is proving to be a huge concern.

The evidence from the ground is compelling. Take Shankar Yadav, 44, of Tilathi village in Saharsa district. He may have enough land to feed his family but is still very troubled. "Earlier our water used to be clean. The root cause of our present health problems is impure water," he says. The water in Yadav's well has traces of iron. As if that is not bad enough, the swamp adjoining his home is a breeding ground for flies and mosquitoes, and diseases like kala azar (visceral leishmaniasis) and malaria are common.

The groundwater in this region straddling the River Ganga is the main source of drinking water. But it has become contaminated with arsenic, fluoride and iron as shallow and middle-level aquifers get overexploited. Anindo Banerjee, head of Programme Initiatives, Praxis, a Patna-based NGO, estimates that women in certain pockets have to walk at least five kilometres to find safe drinking water. "If they don't do this, they will have to depend on stagnant water in nearby ponds," says Banerjee.

If one travels along the embankment of the River Kosi, where about one million people live spread across about 384 villages, it's common to see children and cattle bathe in the same water, even as women wash their clothes and utensils nearby. But this water is unsafe. According to Ashwini Choube, State Public Health Engineering Department Minister, out of 38 districts in Bihar, 13 are affected by arsenic contamination, 12 by fluoride and 10 by iron.

The World Heath Organization's permissible limits allow for 10 ppb (parts per billion) arsenic in drinking water supplies. But in 2008-09, Dr Ashok Ghosh, professor-in-charge of the Environment and Water Management department at Patna's A.N. College, found in a study he conducted that there was 1,861 ppb arsenic in Panday tola, Bhojpur district, while in Khagaria and Supaul districts drinking water contained 300 ppb and 250 ppb, respectively. Says Dr Ghosh, "In groundwater 87 per cent of the arsenic is in trivalent form, which is very harmful."

The three common sources of arsenic poisoning are drinking water, water used for irrigation which enters the human body through food, and the burning of cow dung cakes. Dr Ghosh makes the connections, "The fodder given to cows has been irrigated by arsenic contaminated water, so the cow releases arsenic-laced dung. When cow dung cakes are burnt, arsenic is released as arsine gas."

It is the women who are largely affected by this. Not only do they drink contaminated water, they spend most of their time in unventilated kitchens inhaling the smoke from the cow dung cakes used as cooking fuel. Infants imbibe the toxins with their mother's milk.

"What people are actually drinking is not groundwater but flood water," says Eklavya Prasad, of the Megh Pyne Abhiyan (MPA). Since the level of the water table is high here, hand pumps go down only up to 15 to 20 feet, which raises the possibility of the water getting contaminated by arsenic and iron - even pesticides thanks to the careless spraying of agricultural crops.

At Patna, the Mahavir Cancer Sansthan (MCS), a cancer facility, is teeming with women patients. "They are mostly from the Gangetic plains and they suffer from cervical, breast and ovarian cancers," says Dr Akhileshwari Nath, head of the research centre of MCS. In regions like Ara, Buxar, Vaishali, Bhojpur, Hajipur and Bhagalpur, where these women live, drinking water has become gravely contaminated and sanitation facilities remain negligible.

"The basic sanitation problem is because of cultural attitudes. But it is also a poverty issue," says Dinesh Mishra, an MPA activist. Open defecation is a big concern in Bihar, with dirty surroundings becoming the breeding ground for the sandfly, which causes kala azar. It is the poorest who are the worst hit. Dr Ashok Kumar, a private practitioner in Khagaria, estimates that 90 per cent of his kala azar patients are Dalits, mostly 'mushahrs', who are among the lowest of the low castes in Bihar.

Clearly, rural Bihar is paying a high price for the lack of clean water and proper sanitation. But there are some innovative responses to the crisis. The MPA, for instance, has spearheaded two initiatives. They began by convincing local communities to undertake rainwater harvesting. Recalls Prasad, "At first activists were met by a lot of resistance because of a local belief that they could get goitre if they drink rainwater. The question of proper storage also arose. We learnt from the local villagers in Supaul district about the 'matka' filter. We further developed it by using bamboo and waterproof cement to protect it from secondary contamination."

The second initiative involved better sanitation. This too was challenge because people resisted the idea of toilets. Says Mishra, "They just could not adjust to confining themselves to a 3 ft x 3ft cell even for a while!" But things are slowly changing. Some villages now have the ecological sanitation system known as the 'faidemand shauchalay' (beneficial toilets). "These are dry latrines. The excreta is used for manure and urine for urea," explains Prasad.

The state government has introduced a slew of measures to improve access to drinking water. Some 200,000 handpumps have been made functional across the state and an additional 100,000 will be dug between 2012 and 2015. There are plans to set up 200-500 new mini water plants in areas with 1,000 to 1,500 inhabitants. The state government has also promised to make access to drinking water and sanitation a fundamental right.

Another welcome move is the construction of dugwells. The administration plans to construct 600 dugwells. Observes Dr Ghosh, who is trying to develop solar powered arsenic mitigation technology suited to Bihar, "An open dugwell could have bacterial contamination but its effects can be controlled through antibiotics and the like. There is no medication for arsenic poisoning." In such a situation, dugwells are useful. Even if dugwells are covered by an iron sheet or mesh there is sufficient air to oxidise the ionic arsenic, thus reducing its capacity to cause harm.

There is also a growing understanding about the importance of sanitation. The government has coined slogans emphasising general health and social dignity, especially that of women. One of these slogans goes: 'Ghar ghar mei ho sauchalay ka nirmaan, tabhi hoga laali betiya ka kanyadaan'(a toilet in the house is the right wedding gift for one's dear daughter).

Khagaria District Magistrate (DM), Abhay Singh, has taken the initiative of getting dry toilets and dugwells constructed under the Mahatma Gandhi National Rural Employment Guarantee Act. After monitoring MPA's success in the area, the DM has implemented the model in the 'mahadalit' areas where the extremely backward among Scheduled Caste communities, including 'mushahrs', live. He too is convinced water from dugwells is safer to that of handpumps.

The efforts of people like Singh are being carefully watched by the world as it prepares to review progress on the Millennium Development Goals in September. According to its MDG commitments, India is to halve the proportion of people without sustainable access to safe drinking water and basic sanitation by 2015. According to government projections, while India is on course to meeting its target on safe drinking water, basic sanitation for all is still a distant prospect.

But Singh says he will strive on, "The most important factor in this effort is social acceptability. We are going ahead with our plan wherever villagers willingly accept it."

By Bula Devi
© Women's Feature Service

New Delhi (Women's Feature Service) - Right to Information emerged as an embryo of a notion thrown up over 20 years ago from the hot, dusty plains of Rajasthan when the Mazdoor Kisan Shakti Sangathan (MKSS) was working to ensure a minimum wage for workers on government worksites. That small, significant idea now moves files in the highest corridors of policy making in India.

Call it the power of people's voices, which when linked with social action can challenge the power of political interests and confront administrative corruption and inertia.

As the global community prepares to review its progress on the UN Millennium Development Goals (MDGs) this September, many civil society activists in India see the process as an opportunity to make visible the growing economic disparities in a country that accounts for a third of the world's poor and to push for changes in government policy.

This rainbow of interventions has many dimensions. It seeks to work among people and capture their realities through social audits, articulate key concerns through public hearings, and force government accountability by engaging directly with decision makers. The process straddles the entire spectrum of issues - from employment and food security to water and sanitation - which comprise the eight MDGs that India has committed itself to achieving by 2015.

Many activists find that the potential for policy change is directly related to the government's assessment of its own interests. Observes Anil K. Singh, Secretary General, South Asian Network for Social and Agricultural Development (SANSAD), "Our experiences have differed from state to state. We have been, for instance, more successful in Bihar than in Jharkhand. In Bihar, when we organised 25,000 farmers to congregate at Gandhi Maidan, Patna, after floods had ravaged their fields last year the state government undertook to distribute free seeds almost immediately because it did not want to be seen as insensitive to farmers' interests with an impending election."

Social change is a complex phenomenon. Amitabh Behar, Convenor, National Social Watch Coalition, explains, "It is difficult to say what has worked. Something like the Right To Information movement, while it was inspired and anchored by the MKSS, had the participation of senior journalists like Prabhash Joshi, bureaucrats like Harsh Mander, judges like Justice P.B. Sawant who actually helped draft laws. So this is really about weaving together a winning combination of actions and actors."

Behar believes that if today the government is discussing the Right To Food Bill, it is because hunger has been flagged as a major concern, helped by social activism, recent election verdicts and international commitments like MDGs.

"Today, if the consensus is that extremism can only be addressed by ensuring that marginalised communities have access to food, education and sustainable livelihoods, it is because of movements on the ground," says Behar.

Social audits, which empower local people to scrutinise records of programmes designed for their welfare, have become an important tool of this process. Annie Raja, general secretary of the National Federation for Indian Women (NFIW), the women's wing of the Communist Party of India, is just back form a social audit exercise conducted in nine gram panchayats in Thrissur, Kerala, that scrutinised the working of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). Says Raja, "Ordinary people should get the information to ensure that government initiatives and benefits actually work for them. An effective social audit can help greatly to ensure this."

One of sectors where India is clearly lagging behind in terms of its MDGs commitment is with regard to child mortality (MDG 4) and maternal mortality (MDG 5). Raja's organisation, the NFIW, is now conducting social audits on the Janani Suraksha Yojana, a government programme to address the distressing fact that too many Indian mothers continue to die in childbirth or of childbirth related causes.

Dr Usha Shrivastava, a Delhi-based epidemiologist and public health expert, who has been associated with the NFIW exercise, says, "We want to acquire fresh data on maternal health delivery in some of India's poorest regions by involving the people themselves. Initiatives like this defy the top-down approach of the bureaucracy. People's voices make a huge difference. Take the recent Ruchika case. It was because of public pressure that the guilty police official was brought to justice, even though it took 19 years."

The NFIW's social audit on the Janani Suraksha Yojana involves the training of data collectors - mainly college students - who develop questionnaires, visit earmarked villages, interact with local communities and officials and assess how the system is working. Says Dr Shrivastava, "The data they bring back will be compiled and the gaps in health delivery identified. The report based on this new data with our recommendations will then be presented to the health authorities at various levels, including the director of the National Rural Health Mission."

Such campaigns have a political dimension because they help change the nature of popular discourse. Argues Ashok Bharti, of the National Conference of Dalit Organisations (NACDOR), "Parliament is the embodiment of the voices of the people and we consider it the top tier of government. Its power stems from the people and it is the people's voices, which should be influencing policies; people's concerns should, in fact, be at the heart of policy-making."

But he also realises that this will only happen if there is pressure from below. Bharti recalls how in 2006, after the MGNREGA came into force, the then Uttar Pradesh government under the Samajwadi Party, was resisting its implementation. "Our organisation, NACDOR, took up the challenge and began the Rozgar Adhikar Yatra, or Right To Work rally, from four districts marking the four corners of the state: Lalitpur, Lakhimpur Kheri, Kaushambi and Chandauli. The yatra covered 22 districts and mobilised hundreds of thousands to go to the local block offices and demand their job cards. Before long the government was forced to act."

Stirring the government into action often requires new and innovative approaches. Earlier this year, the Wada Na Todo Abhiyan, a national network to enforce government accountability, spearheaded a people's mid-term appraisal of India's 11th Five Year Plan. For the first time government planning was put under the scanner by over 3,000 groups from every state in India, with the deputy chairman of the Planning Commission himself participating in the final conclave. "With that campaign we managed to create some space for civil society organisations to hold the government accountable on existing policies. But the bigger challenge is to transform these policies themselves," says Behar, who was one of the organisers.

Changing policy-making demands sustained vigilance and concerted action. Anil Singh believes that the first Manmohan Singh government, which had come to power in 2004, was more responsive to people's issues, than the present one. "Now we are pinning our hopes on the newly-constituted National Advisory Council chaired by Congress President Sonia Gandhi," he states.

As the September global review of progress on the Millennium Development Goals draws closer, both the Indian government and civil society organisations are busy working on their own assessments. NACDOR, in association with local partners, is even planning a Millennium Yatra to focus on the MDGs, specifically education, hunger, child mortality, maternal mortality and the diseases of the poor, like malaria and tuberculosis.

This is about amplifying new voices, bringing in the excluded and unleashing fresh ideas. Young Farha Inam, a graduate in Social Work from Delhi's Jamia Millia, who recently participated in a campaign against child labour, puts it this way, "The government just announces programmes and forgets about them. We want to tell the government: We are watching."

By Pamela Philipose
© Women's Feature Service

Shahpur Jot, Baraich (Women's Feature Service) - It could be any one of the thousands of sleepy villages that dot the rough rural outback of Uttar Pradesh, India's largest state. But Shahpur Jot, in Baraich district, is by no means conventional, and it has a President's Award to prove this.

In 2006, Shahpur Jot achieved total sanitation coverage. How did this poor, predominantly Muslim, village manage this? After all, according to Government of India projections, the country is unlikely to achieve its Millennium Development Goal of halving, by 2015, the proportion of people without sustainable access to basic sanitation. What did Shahpur Jot do right?

It all began with one woman in the village and one civil society organisation, the Baraich-based Development Association for Human Development (DEHAT), a UN Millennium Campaign partner. Recalls Jitendra Chaturvedi, Chief Executive, DEHAT, "I was shocked to see that the distance between the makeshift dry latrines that were in most homes earlier and the kitchen hearths was just three feet apart. What was worse, the excreta was disposed manually, with no proper sewage or plumbing. Sweepers had to perform this demeaning task. The filth was dumped in a nearby pond, which was just 30 feet deep and the dirty water inevitably seeped into drinking water sources, contaminating them as well."

Change of any kind seemed impossible because those who had the highest stake in clean surroundings because it impacted directly on their lives and the health of the children - the women - could not play an active role in public life. Women observed 'purdah' and stayed within the four walls of their homes. Chaturvedi and his colleagues, however, were convinced that if Shahpur Jot had to be transformed, the women had to play a pivotal role.

So Chaturvedi approached Shakila Bano, 45, who was the 'pradhan' (village head) in 2000. She was reluctant at first but once she understood the import of DEHAT's plans, she talked to other women in the village and got them to attend the initial meeting at the local 'musafir khana' (rest house). He recalls, "It was a strange sight. I was the only man standing amidst this sea of black burqa-clad women, who even refused to sit on chairs since tradition dictated that women could not take a position that was higher than men - literally! I thought to myself that more than the change in the surroundings we had to work for an attitudinal change - and Shakila Bano was the key to this."

Today Shakila, sitting in her home in Shahpur Jot, recalls how she had to make a very important personal decision first, "I was chosen the 'pradhan' so I knew people trusted me and would follow what I say. But I also realised that it was a huge responsibility on my shoulders to work for the welfare of the village - one that could not be fulfilled if I remained in 'purdah'. So I made the decision to step out of 'purdah'. I gave up my 'burqa' when I went to the next public meeting. From then on I met all government officials visiting the village without a veil, and even went on inspections dressed in a salwar-kameez."

She visited people's homes without her 'burqa' to set an example, hoping all the while that the gamble would work and it would have a positive impact on the women. "The women gave me full support and joined in the campaign, even giving up the 'purdah' while they worked," says the dynamic leader.

Once the idea that they could make a difference caught on, Shakila and her band of women were eager to do everything they possibly could to transform their living environs. The situation was indeed dismal. The open drains were full of blood and refuse from local slaughter houses and the pond was overflowing with faecal matter.

Slowly, the urge to see this village of 2,500 people clean and healthy became everybody's goal. Shahpur Jot's 300 homes all have a toilet today. In fact, one family which has a physically challenged daughter has built a special toilet with handles so that the child would have no problem in using it. The sewage system is similar to the flush toilets in urban homes, with septic tanks to collect the waste.

The impact of this initiative on the local administration was quite considerable. The authorities were taken aback when DEHAT informed the officers who came to inspect the sanitation facilities that it had cost a paltry Rs 500 to construct one toilet per home.

"The DM could not believe that it could be done so cheap. We assured him that it could even be done totally free. In a village that thrives on farming vegetables and fruits, each household contributed Rs 3,000-4,000 (US$1=Rs 46.8) for the toilets. We also received support from the government under the Samagra Gram Vikas Yojna (a state-funded scheme that gave grants to villages through the local MLAs) so that our campaign could carry on undeterred. A sum of Rs 10,00,000 was allocated for this purpose," says Chaturvedi.

Better hygiene had an immediate impact on general well being, especially that of children. Medical bills of local families started coming down. Outbreaks of cholera, diarrhoea and jaundice, which were routine earlier, came down markedly. Gynaecological problems caused by poor sanitation and the inability of the women to relieve themselves whenever they wished to, because of the lack of privacy, increasingly became a thing of the past.

Eight Self Help Groups were created and women were informed about child care, personal hygiene, and how to help keep their surroundings clean. Discussions on these issues figured in the monthly meetings held in the village and a Health Day was observed in the local school, together with projects on the importance of proper sanitation.

Noor Alam, 42, the present pradhan of Shahpur Jot, who took over from Shakila in 2005, puts it this way, "Earlier we used spent thousands on medicines and doctors fees but since we cleaned up the village and ensured that every home had a toilet, cases of water borne diseases have come down considerably. In fact, one of the biggest problems we had faced earlier was the slaughtering of animals in the lanes of the village, which filled the open drains with blood and brought in swarms of flies. This was the first problem we tackled when we began our sanitation work. We banned open slaughter and covered up the drains."

Change always brings in more change. Today, every girl in Shahpur Jot attends school. In order to encourage girls to study further, bicycles were bought and the girls trained to ride them. Many of the older girls now cycle together in groups to attend high school in an adjoining village. Interestingly, they have also taken a pledge not to marry into homes that don't have their own toilets!

To Noor Alam, the biggest transformation has been at the attitudinal level, "Now women even come up to me directly and speak about issues like house allotments, BPL cards, and even scholarships for their children. I am touched by this new self-confidence."

The recently released UN's Millennium Development Goals Report, 2010, notes that most progress in sanitation has occurred in rural areas. Sanitation coverage in rural areas in South Asia has doubled from 13 per cent to 26 per cent between 1990-2008. But there is a very long way to go. The Report notes that South Asia, along with Sub-Saharan Africa, has the poorest access to sanitation in the world.

In such a scenario, Shahpur Jot's efforts to create a brave new world for itself could prove inspiring for other villages in a region where poverty, illiteracy and orthodoxy continue to stymie progress.

By Anjali Singh
© Women's Feature Service

Alirajpur, Madhya Pradesh (Women's Feature Service) - Jashmabai is working under the punishing sun on an earthen dam in her village of Darkali, in Madhya Pradesh's Alirajpur district, being built under the government-funded Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA). She candidly explains why she labours thus, "Our men are wastrels, spending their time drinking or looting someone. So we decided to do something about it and found work here."

This woman from the Bhilala tribal community speaks for many other women like her living in extreme poverty in a drought-prone region. A local organisation helped Jashmabai and her companions access the government work site, and today they are at least able to keep their families fed. They have few livelihood options. The land cannot support most families here, because the soil in these small, fragmented homestead plots is poor and unproductive. The mahua trees and toddy palms that dot the region only serve to provide the local men with ample sources of liquor. Poverty and alcohol form a lethal cocktail, which manifests itself into crime and violence. Women, as always, emerge from such a situation as the worst sufferers.

In Darkali, the MGNREGA is nothing short of a lifeline for the local women, helping them to battle both poverty and male oppression. According to the recent UN Millennium Development Goals (MDGs) Report 2010, poverty rates in India are expected to fall from 51 per cent in 1990 to 24 per cent in 2015. A government intervention like the MGNREGA has helped this process. Its greatest advantage is that any group of job card holders can prepare a work scheme and present a demand for it to be implemented to the panchayat (village council). If the panchayat does not accept this application, the applicants can go to the local panchayat office, deposit the application there and get a receipt. After that it becomes mandatory for work to be started within 15 days and a total of 100 days of work has to be provided to each of the applicants at the daily wage rate of Rs 100 (US$1=Rs 46.7).

What helps women like Jashmabai is that the MGNREGA emphasises the employment of women in such projects, so that their wages can help augment the meagre resource base of their families. Local social activists, having realised the potential of the MNREGA to achieve this, are now working to mobilise and assist local communities to demand work and get their full entitlements.

Explains Retli Ajnaria, who gave up her job as an 'anganwadi' worker under the Integrated Child Development Scheme of the Madhya Pradesh government to become a full-time activist with a local group, the Khedut Mazdoor Chetna Sangath (KMCS), "This scheme allows women to apply for work in a group of their own and then the payments are made directly into their bank accounts. With one stroke women get the work they want and also the money without the involvement of any intermediaries. This gives them a tremendous sense of power."

Earlier, Ajnaria had devoted her energies to organising women in Self-Help Groups of 10 or 12 members. She tried to introduce them to the idea of micro-credit, but their extreme poverty meant that they could save very little. Things changed drastically with the implementation of the MGNREGA. Apart from the employment it generated, it also helped create water and soil conservation structures, which have in turn resulted in higher agricultural productivity. This has meant more agricultural work for both men and women.

Gamtibai, also of Darkali village, comes straight to the point, "Its biggest advantage for us is that men have now got some work to occupy themselves and keep them from fighting and looting each other. Only last year there was a murderous fight between two groups in our village and many men got seriously injured and landed up in jail. Now they are all working together on the same earthen dam."

The path to this relatively happy situation was by no means smooth. Initially, local officials like sarpanches (village council heads) and panchayat secretaries actively dissuaded people from putting in applications for work schemes. Jashmabai recalls, "The local sarpanch, Ugar Singh, refused to accept our application for work, as did the panchayat secretary, Chandar Singh. Then we went along with Retli bai, to the local office to file our application there."

Even after the work was officially sanctioned, the sarpanch refused to initiate it. That was when Retli decided to go to the work site with the women, and start the work herself by carrying the soil dug out from the site on her head, along with the other workers. After three days of working like this, the sarpanch had to concede to the demand of the women. Now the situation has settled down and all the wage payments barring the final installment for the last fortnight of work which has just been completed have been made into the bank accounts of the workers. They even succeeded in getting a creche to look after the children of the workers, with two women being paid to look after them.

Development projects in rural India have long been a source of corruption, with funds being regularly siphoned off at various levels by bureaucrats and politicians. The MGNREGA has tried to address this by instituting checks like social audits and making it mandatory for wages to be paid directly into bank accounts. But corruption still seeps in, with those in charge sometimes devising ingenious ways to cheat poor workers of their dues, either through personal intimidation or by manipulating registers.

"This is why it is extremely important that those seeking work on government job sites be better informed," says Yogesh Kumar, Executive Director, Samarthan, a civil society organisation working on issues of participatory development and governance, based in Bhopal, the capital of Madhya Pradesh. In Panna, another impoverished district in the state, Samarthan - with assistance from the Government of India and United Nations Development Programme (UNDP) - is conducting functional literacy interventions in 13 villages.

Explains Kumar, "The idea is that the workers of MGNREGA, especially the women, are able to comprehend the entries on their own job cards and bank books and be able to read related numbers and words like 'mazdoor' (worker), 'kaam' (work), 'daam' (prices)."

The results, according to Kumar, are encouraging. Small groups of women workers have been formed to deliver these lessons in basic literacy to others in the community and a primer has been developed for this purpose. This informal teaching has another benefit: It facilitates discussion about people's experiences in accessing work under the MGNREGA and general working conditions.

If poor, largely illiterate workers are to get their entitlements under the MGNREGA - widely regarded as the world's largest employment generating state initiative for the poor - they also need to be better informed and supported. Initiatives like those run by the KMCS and Samarthan in Madhya Pradesh, arguably India's poorest state, are therefore extremely important.

In September, leaders from various countries will gather at the United Nations to assess the progress the world has made on the MDGs, including on the key challenge of halving, between 1990 and 2015, the proportion of people living in extreme poverty. There is little time to be lost with the deadline for achieving this pivotal goal just five years away. According to the new multi-dimensional Poverty Index of the UNDP, 55 per cent of India's population is poor and they number about 645 million. Employment for women like Jashmabai is therefore crucial for giving their families a better deal in life.

By Rahul Banerjee
© Women's Feature Service

East Singhbhum, Jharkhand (Women's Feature Service) - If little Manisha Kalindi did not have the good fortune to receive the attention of a local anganwadi worker, hers would have been one more name in the long list of newborn deaths of Pathergora village in Jharkhand's East Singhbhum district.

East Singhbhum is predominantly tribal with high levels of poverty. Manisha, weighing just two-and-a-half kilogrammes, was already underweight at birth. Instead of gaining weight as most babies do, her weight dropped to one kilogramme a couple of months later. With her undernourished mother unable to breastfeed her or take her to a hospital, she hovered dangerously close to death. It was at that point that a village anganwadi worker took charge and gave her a new lease of life.

Considering that close to 50 per cent of newborn deaths in India occur during the first seven days of birth, Manisha is lucky to be alive. Although the two-year-old continues to be underweight and is susceptible to periodic illnesses like diarrhoea and malaria, her chances of growing up normally are bright thanks to a new approach of infant care adopted by her carer: The integrated management of neonatal and childhood illness (IMNCI) approach.

The IMNCI was adopted by the Jharkhand government as the central strategy under the Reproductive and Child Health Programme, a five-year programme of the National Rural Health Mission. It offered a package of preventive, promotive, and curative interventions. The Jharkhand government is being aided by UNICEF in this programme which is currently being implemented in 28 states and 145 districts across the country.

The Government of India assesses that India will fall far short of its Millennium Development Goal target of achieving an Infant Mortality Rate of 26.7 deaths per 1000 live births by 2015, and the idea behind programmes like the IMNCI is to achieve a faster pace of change.

As part of this effort, frontline health workers like auxiliary nurse midwives and anganwadi workers are trained to focus on the prevention, treatment and management of malnutrition and minor childhood diseases like measles, malaria, pneumonia, and diarrhoea, in a holistic manner. A key component of IMNCI is a home visit to promote best practices for infant care, with mothers and families being counselled on the importance of breastfeeding. Low-birth weight babies are monitored at the village level, with serious cases being referred to local health centres.

Jharkhand has a neonatal mortality rate of 49 per 1000 live births - higher than the national average - and the IMNCI approach is making all the difference between life and death. In East Singhbhum, for instance, where many severely undernourished newborns like Manisha die because mothers are extremely malnourished and do not have sufficient knowledge of the importance of practices like breastfeeding, 1,455 anganwadi workers and 312 auxiliary nurse midwives have been trained so far. These frontline workers have been able to reach over 26,592 newborns within 24 hours of birth in the span of four years (2006-09).

The challenges of course were many. Making women aware of the importance of breastfeeding and the correct way of doing it was initially difficult in Pathergora. Santhi Hanoda, an anganwadi worker of Pathergora, recalls, "Breastfeeding was not considered crucial for a newborn. Women would wait until religious ceremonies were conducted before breastfeeding their babies. They didn't realise this could have fatal consequences. Information about the benefits of breastfeeding soon after birth has now brought about some change in feeding practices."

Hanoda realised that getting women to listen would be easier when they all congregate with their children during the Village Health and Nutrition Day, an event held every second Wednesday of each month. During this event, a broad range of services are provided, including delivering rations for pregnant and lactating women, immunising babies and administering Vitamin A and iron supplements.

While Hanoda has been an anganwadi worker for the last 11 years, it was only in 2008 that she received IMNCI training. She could not help but notice the difference the programme made. "It helped me understand better the correct way of breastfeeding and also recognise the danger signs of imminent illness that mothers often overlook. When I counsel them about health, pregnancy care and nutrition, I ensure that they understand the importance of breastfeeding. They don't feel shy because I come from the same community of Santhals as they do," says Hanoda.

Currently, 47,707 children under five years of age in East Singhbhum have been assessed for feeding problems, undernourishment, diarrhoea and serious infections.

Geeta Kumari Mahato, an auxiliary nurse and midwife, has been coming to the village since 2002. She believes that attitudes of women have changed ever since they became more aware about newborn care. "They see the difference in their children's health by following the right nutrition and immunisation practices. Which mother doesn't want a healthy child?" she remarks.

In the nearby Lovekeshra village, the IMNCI colour coded booklet classifies symptoms and severity of illness in three colours: Red, yellow and green. It has helped an anganwadi worker like Yamini Made take the right decisions. She knows that symptoms related to improper breastfeeding are marked in green - green, in fact, indicates mild health conditions that require simple home care. So when Mukti Saber's three-month-old underweight daughter kept falling ill, Made showed her the right way to breastfeed. When children display symptoms similar to those mentioned under the red code, she knows their illnesses are serious enough to warrant a visit to a health facility.

Additionally, another home care solution that Made learnt about was to keep the infant warm through the 'kangaroo care' method, named after the marsupial, which carries its young close to itself. It was initially developed to look after premature infants in areas where incubators were unavailable. Explains Made, "Since people here don't understand what a kangaroo is, I substitute it with a monkey. For instance, I told Mukti to hold her baby close to her chest, like a monkey does and she knew immediately that she needs to clasp her baby to provide it with warmth. She followed the suggestion and now her daughter no longer falls ill," explains Made. Saber beams in agreement. She is simply delighted that her daughter's weight has increased to four kilogrammes.

According to Arun Kumar, UNICEF IMNCI supervisor, every month a review meeting is held to see whether protocols are followed. "If kangaroo care has been given to anyone I visit the mother to verify details. We also check to see whether they (anganwadi workers) have been able to diagnose the problem correctly and can tell whether the illness needs home-based remedies or requires treatment in an institution. This way, they always have their thinking caps on," claims Kumar.

The encouraging results have ushered in other innovations. The Jharkhand government plans to rope in M.S. Dhoni, the Indian cricket team captain, and former Indian women's hockey captain, Sumrai Tete, to join in its awareness campaign. Celebrity endorsement is expected to give health awareness campaigns a higher profile.

Hopefully, this combined effort will help Jharkhand's babies to win the match of life! They desperately need to win: The Millennium Development Goals (MDGs) Report 2010 notes with concern that while child deaths are falling, especially after the year 2000, they are not falling quickly enough.

As India prepares for the September review of the world's progress on the MDGs and plans its blueprint for meeting its targets by the year 2015 - the deadline year for MDGs - it will do well to keep in mind the lessons learnt from the story of little Manisha. She is alive today because of timely, focused and planned care.

By Swapna Majumdar
© Women's Feature Service

Vijaypura (Women’s Feature Service) - It was from the state of Rajasthan that the Right to Information (RTI) movement emerged as an idea that went on to capture national attention. But few panchayats (local self-government village bodies) in the state have used the RTI to change the lives of people as effectively as Vijaypura in Rajsamand district.

Vijaypura, which roughly translates as “victorious region”, has, in fact, emerged victorious on two fronts. It has been able to implement the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) with a degree of transparency, accountability and efficiency, rarely witnessed elsewhere. What is less known is that it has also been able to help many single women living in extreme penury to derive real benefit from the government’s food and social security schemes, something they had not been able to do all these years.

In fact, Vijaypura panchayat could well be a model for how India can work towards achieving its targets under the UN Millenium Development Goal 1, which seeks to pull people out of extreme poverty and halve the number of those suffering from hunger. Its performance is particularly creditable given that hunger may have actually spiked in the recent past in many vulnerable regions of the world because of the global food and financial crises, as noted by The Millennium Development Goals Report 2010.

The credit for Vijaypura’s success should rightly go to the dynamic young Kaluram Salvi, who decided to make use of the RTI Act to ensure that people got their entitlements. It helped, of course, that Salvi was a full-time member with the Mazdoor Kisan Shakti Sangathan (MKSS), the organisation that began the RTI movement in India.

Significantly, although Salvi is a Dalit and was entitled to a reserved seat, he successfully stood for the sarpanch’s post from a general seat with just Rs 695 (US$1=Rs 46.6) by way of campaign funds. The election slogan? "Na daru, na murga, na lenge hum note, imandari se denge vote (no alcohol, no chicken, we won't take notes, with honesty we'll cast our votes)." Salvi’s integrity was the key to his electoral victory. He also promised the community that if he won, all the information relating to the panchayat will be made available to them.

Salvi kept his word. One of the first things he did after he became the sarpanch of Vijaypura was to put up boards all over the panchayat that read ‘Vijaypura Gram Panchayat mein apka swagat hai, yahan ki suchnayen sab ke liye khuli hain’ (Welcome to Vijaypura Panchayat, Information Here is Open to All).

Women’s equality was an important principle for Salvi. As a first step, he advocated women sitting on par with men on the ‘hathai’ – a raised common platform where public meetings usually take place. He began this practice first in his own village of Narayan ka Bida. Though women were reluctant initially it was Maani Bai, 70, who finally broke the old, discriminatory traditions.

Supporting her frail body with a stick, she boldly ventured to sit on the platform. Once on it, she called out to each of the women in the village by name and invited them to join her. This symbolic break with the past was the beginning of a campaign to mobilise the women of Vijaypura to participate in panchayat activities.

Salvi also dealt firmly with dishonesty and fraud. When the villagers of Keeton ka Badiya complained that their ration dealer did not open his shop on time, or indeed provide rations on time, Salvi promptly sent him a notice asking him to be present at the panchayat’s meeting. When the dealer refused to accept the notice, Kalu slapped a fine of Rs 200 on him for contempt of the gram panchayat’s orders under Section 62 of the Panchayati Raj Act. He also decreed that if the fine was not paid, a penalty of Rs 10 per day would be added to it. The dealer had no option but to fall in line.

That was how the public distribution system in Vijaypura was reformed. Salvi himself encouraged people in his panchayat to use the RTI Act against ration dealers if people did not get their rations on time. In fact, he framed the draft of the RTI application himself. The impact of the move was instant and extremely effective.

Today, Salvi is no longer the sarpanch. His wife Rukmani has taken over his responsibilities. But the flow of RTI applications has not diminished in any way. At least 40 women have used the RTI Act to get their entitlements. Take Patasi Devi, 60, who lives in Cheta Aasan village. This is how she recounted her story: “I am a widowed woman, who was not getting any wheat from the ration shop, although I would keep going there. Salviji advised me to write to the local ration dealer, Ashok Jain, under the RTI Act. He drafted the letter for me. Questions were posed: Why was I not being given wheat? What was the problem? What are the names of those who did receive wheat? The ration dealer read the letter and asked me who had written the letter for me. I told him it was Salviji. From then on, I began getting wheat regularly. Since my name is also on the Below Poverty Line (BPL) list, I get 25 kilos of wheat a month.”

Sahu Bai, who lives in the same village as Patasi Devi, has a similar experience to share. She too is a single woman living separately from her son. Since her name is on the BPL list, ever since she applied for information under the RTI Act she has been getting 25 kilos of wheat every month.

Teju and Dakhu Bai are both widows living in Narayanji ka Bida village in Vijaypura. Dakhu Bai had married one Netaram, while Teju happened to be his elder brother’s wife. According to local custom, after his elder brother’s death, Netaram took Teju under his wing (symbolically, with an offering of bangles) and thereby she too acquired the status of his wife. With Netaram’s death, both were widowed. They are 70-plus years old, bent over with wrinkles on their faces that speak of lives full of struggle. They had received a widow’s pension just once, and then it stopped coming. When they made an application under the RTI Act, their pensions magically resumed. Today, they proudly display their documents, which are carefully preserved in files.

Then there is Champa, wife of the late Goma Bagariya, who lives in Kamli Ghat in the same panchayat. She is also an elderly woman. After applying under the RTI Act, she received a sum of Rs 2,250 as pension for the months of April, May and June 2010.

The RTI movement had emerged from this very soil. The MKSS, also based in Rajasthan’s Rajsamand district, had campaigned in this region on the slogan, ‘Hum Janenge, Hum Jiyenge (We Will Know, We Will Live)’. But it is because of spirited people like Kaluram Salvi, and their relentless struggle, that the RTI Act could emerge as a powerful tool in the hands of the poor. For the single and marginalised women of Vijaypura panchayat, it is nothing less than a lifeline.

Vijaypura is a long way from New York, USA, where world leaders will gather in September to mark the progress on the Millennium Development Goals. Yet, the effective way in which it used the power of information to change the lives of many faceless women, could inspire others living in pockets of deprivation, neglect and corruption elsewhere in the world.

By Mamta Jaitly
© Women's Feature Service

New Delhi (Women's Feature Service) - Among the various definitions of "noise" is this one: "Something that draws public notice". And "Making Noise" is precisely what groups all over India are doing, or planning to do, in the days ahead in order to wake up the government to its promises. In the year 2000, India was among the countries that had signed on to achieve, by 2015, the United Nations Millennium Development Goals (MDGs). These goals straddle eight core concerns, including the foundational one of reducing poverty and hunger. In many ways, this process is the world's most ambitious social development intervention, in both intent and scope.

On September 20, leaders from all over the world will gather at the UN headquarters in New York for the global summit to review the progress made on these goals. Meanwhile, in India, the 'Stand Up Take Action/Make Noise For The MDGs' campaign will be flagged off on September 18 by 100 musicians performing and urging action on the MDGs against the majestic backdrop of Delhi's Purana Qila (Old Fort).

Celebrities such as Bollywood film stars Rahul Bose and Ranbir Kapoor are part of this campaign, and may pop up on television screens to make their appeals of action. But it is in among India's poorest states that lie in its heartland -believed to do even worse than sub-Saharan Africa on many human development indices - that the real test of the Indian government's MDG commitments will play out. This is also where, incidentally, civil society groups are holding public hearings and launching rallies to "make noise" and put crucial issues on the front burner.

The National Confederation of Dalit Organisations (NACDOR) is one of these groups. Says NACDOR's National Convenor, Ashok Bharti, "Our basic demand is that the MDGs should be approached in a holistic, people-centric manner, rather than be addressed in bits and pieces. If people are not central to a programme, it fails. Take the Right to Education Act that was recently passed. The Act left out pre-primary education from its ambit and thus undermined its very purpose."

NACDOR is presently organising a Millennium Adhikar Yatra in rural Uttar Pradesh, which will mobilise the poorest and most marginalised communities, raise awareness and pressurise people's representatives to get the government to deliver. Later this year, on December 5, NACDOR plans to organise a large public meeting in Delhi to demand that the government provide a blueprint on how it aims to achieve the MDGs.

The rights to food and employment are regarded as central to achieving MDG 1, which sets out to eradicate extreme poverty and hunger. Several campaigns on these twin objectives are well underway. Annie Raja, General Secretary, National Federation for Indian Women (NFIW), explains, "We at NFIW have decided to focus on Goal 1. On the 18th, which has been designated as Make Noise Day, we will demand the universalisation of the Public Distribution System." NFIW members will submit a memorandum on the issue to the local authorities, both at the district and state level.

A memorandum is also coming the way of the Madhya Pradesh chief minister, on the failures of his government in implementing India's most ambitious employment guarantee intervention - the Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA), regarded as a lifeline for many who lack sustainable livelihoods. "We are linking right to employment with the right to life," says Sachin Jain, director of the Bhopal-based Vikas Samvad. His organisation is coordinating an effort involving several Madhya Pradesh groups that have fanned out to 16 districts of the state and are holding public hearings on the MNREGA. "The insights generated by these hearings will be shared at a state-level public hearing later this month at Gandhi Bhavan, in Madhya Pradesh's capital city of Bhopal, and a joint statement will be submitted to Chief Minister Shivraj Chouhan," reveals Jain.

Wada Na Todo Abhiyan (WNTA), an umbrella organisation of groups from all over India, has been holding consultations on each of the MDGs, including a recent one on Goal 4 focusing on child mortality. It has also staged a series of women's tribunals in states like Jharkhand, Uttarkhand, Tamil Nadu, Gujarat, and Maharashtra and Karnataka. According to Suman Dasgupta, Programme Coordinator, WNTA, "The attempt is to engage with various concerned stakeholders - especially among disadvantaged groups - so that the MDGs process is owned by and driven by people."

Interestingly, many who otherwise don't figure in the development discourse of the country are also seizing this moment to register their presence. In Karanataka, WNTA organised a tribunal for transgenders, while in Maharashtra de-notified and nomadic tribes will come together to 'make noise' by playing their traditional instruments like the 'shankh' (conch), 'shehnai', 'been' (snake flute) and 'tasha' (kettle drum) at Mumbai's sprawling Azad Maidan and later at Delhi's Jantar Mantar. Reveals Pallavi B. Renake, National Coordinator, Lok Dhara National Alliance for De-notified and Nomadic Tribes, "De-notified and nomadic tribes, who number around 110 million people, don't figure on the government's map. Yet, 94 per cent of them are landless, 72 per cent do not have ration cards and 28 per cent are actively excluded from society. Since they don't have education, they don't get jobs, documentation or access to loans. They find themselves in very dire straits but are totally overlooked."

These are not articulations of despair; these are new assertions of rights - a trend that the MDGs process has helped to galvanise. According to Bharti, the problem is that the government routinely adopts an aggregate rather than inclusive approach, so that socially excluded groups - whether they happen to be de-notified tribes or Dalits - continue to be outside the loop. "If India does not achieve the MDGs, the world will not achieve the MDGs; and if Dalits and tribals do not achieve the MDGs, India will not achieve the MDGs. So we need to get our priorities straight," he remarks.

The idea, as Minar Pimple, Regional Director, Asia and the Pacific, United Nations Millennium Campaign, pointed out when he was in Delhi recently, is really for all citizens to hold governments accountable. With the world in the last lap of the race to achieve the MDGs, Pimple does not underestimate the challenges ahead but remains hopeful. As he put it, "We can still make it - provided there is political will at all levels of government; provided MDGs are fully adopted at the national, state and local levels; provided delivery systems are fully functional and accountable to people; and provided that over the next five years citizens become the core element of the MDGs process."

By Pamela Philipose
© Women's Feature Service