for Bhopal-draft

1. Good DRR Practices in Health by
PRIs
Session objectives:
At the end of this session participants will be able to advocate
• Adoption of best practices in health for effective DRR
Key learning points of the session:
• There have been some useful practices undertaken in different areas
• Some of these good practices include- Institutional Delivery -Referral Transport,
Collection of Water, Keno Parbo Na, DOTS, Fever Depots
Handout for the session:
Are you aware that Rs 10000/- is allotted to your Village Health and Sanitation
Committee (VHSC) as an untied fund? How has it been spent this year? Last year?
How has it been spent in previous years?
Good Practice Need Covered Benefit
Rural Ambulance - from Referral Transport Pregnant Women
modified Van Rickshaws
Keno Parbo Na Nutrition 0-3 children
Local solutions for Water Collection All
Collection of Water

2. Oral Rehydration Therapy Diarrhoea All
(ORT) Corners
Directly Observed TB All
Treatment Shortcourse
(DOTS)
Fever Depots Malaria All
Local Life Jackets made by Drowning Flood Prone
Self Help Groups/ SHGs
Table: 1 Good Practices
Rural Ambulance converted Van Rickshaws
Modified Van Rickshaw in 24 Parganas Sunderban area- use of van-rickshaw as a rural
ambulance that could save hundreds of lives by only being able to transport patients
from the households to the local clinic, in the specific region of rural West Bengal
Figure 1: Rural Ambulance
 The main feature of this conveyance is that its base/platform is at a considerably low
height from the ground level than a common rickshaw van. This arrangement is made to
create more space and reduce the vibration, which otherwise cause discomfort to the
patient in a rugged terrain of an unpaved road.

3.  A stretcher is placed on one side, with proper shock absorbing arrangements. This
helps in avoiding jerks due to bad road conditions. The stretcher can be removed while
using the conveyance for a purpose other than carrying ailing patients.
 Just opposite to the stretcher, the sitting arrangement is made for at least two
attendants.
 An oxygen cylinder is kept at one corner so as to meet the exigencies.
 Likewise, a first-aid-box is also kept at one corner.
 A wash basin is placed beside the stretcher.
 Arrangements for saline, drinking water, adequate lighting, are made.
 Battery operated hand mike set is fitted on the top of the vehicle.
 Provisions for life jacket, life line, stuff, small tent, extra rope, folding ladder, blankets,
etc. are there for using the vehicle during calamities.
 The top of the vehicle is tin-roofed and the sides are also fenced with tin sheets and
nets are placed in between to ensure adequate ventilation.
It can be used both for delivery patients AND OTHER TYPES OF PATIENTS
Hand washing

5. Nutrition - Keno Parbo Na programme
Figure 1: Positive Deviance Mascot
Monitoring is done by mothers using the Mascot. Each limb represents a step in
protecting the child- such as Measles Immunization

6. Figure 2: Community Map
A positive deviant child is a healthy and developed child in a poor, disadvantaged
and distressed family. A positive deviant family is a family which has PD children
The special practices of a PD family which enables a child to grow and develop well

7. inspite of poor socioeconomic conditions are called PD practices
The attempt is to find out these practices in the community and formulate strategies and
activities which motivate all families with children to adopt these best practices through
participatory learning.
Making Malnutrition Visible to the families and community through weighing of children
and using colour-coded charts, maps and other tools
Finding out prevalent child care and feeding practices in the area – both good and bad
and identifying young children who have good (normal nutrition) or bad (severe acute
malnutrition) nutritional status as a result of these practices
Bringing the moderate to severe malnourished young children (0-3 years) and their
care-givers regularly to the AWCs (Angan Wadi Centres) for the Nutrition Counseling
and Child Care Session-NCCS. AWWs (Angan Wadi Workers) along with community,
positive deviant mothers & SHGs and teach them the correct feeding and care practices
through hands-on demonstration and urge them to follow the same care practices at
home
Close monitoring and follow up
Monitoring is done by mothers using the Mascot. Each limb represents a step in
protecting the child- such as Measles Immunization
Local solutions for Collection of Water
Collection of Rain Water by community in jars/ kolshi and using filters of sari cloth have
saved many lives. These are local practices that need to be copied and propagated.
Scientific studies have shown how many bacteria are trapped when plankton get stuck
in the cloth.

8. Figure 3:
Post Aila Water Collection
ORT Corners
At Gosaba Ghat we saw a newly literate man poring over a little booklet on what to do
in emergencies. He was reading very slowly- dis..in..fect…….ten…litres..of…water
with…a 40…milligram ta…blet..of Hala…zone.
Figure 4: ORT Corner Gosaba

9. A little further on, at the ticket office we found Swapna Barman explaining how to make
Oral Rehydration Solution to a man with a small child. After she had finished a
government Male Health Worker checked that the man had understood exactly what
she had said. Meanwhile Dipankar Dalui gave them the ORS he had just made in a
bottle they provided.
At the local Primary Health Centre Indrajit Hazra was also preparing stock solution to
disinfect water. He and Sanjeeb John Makhal had talked to 79 in patients, out patients
th
and visitors on 10 July. Saturday is a busy day in Gosaba- it is Market Day and there
are people here from as far away as Choto Mollakhali. Mollakhali is three hours ride by
launch from Gosaba.
Swapna is a local volunteer from Manmathanagar working with Anwesha, a local NGO.
Dipankar from Satjelia and Sanjeeb from Bali are with Palli Unnayan Samiti (Rural
Development Society). Indrajit has been working in West Bengal’s Nadia District for the
Catholic Charities there and has been deputed to Gosaba to take part in the relief work
beside the local volunteers after the devastating cyclone Aila that struck West Bengal
th
on 25 May 2009. They are all literate young people from rural areas.
Figure 5: ORT Corner Sarberia
Gosaba is a block town and administrative headquarters for 11 inhabited islands in the
th
Sunderbans. It was first settled in the 19 century by a man called Daniel Hamilton, who

10. bought three islands and turned them into an estate. He brought settlers from
neighbouring districts and they started the first agriculture here. Now Gosaba is a
bustling town of around 50000 people. The islanders also cultivate prawns and catch
th
fish for a living. The cyclone on 25 May broke the protective embankments around the
islands. Sea water has flowed into the fields and fresh water ponds and many have lost
their homes and farms. The storm also destroyed the water pipeline to Gosaba. Many
th
were forced to drink contaminated water and a diarrhoeal outbreak started around 30
May and continued for over a fortnight. There are still a few diarrhea patients coming in
from the further off islands.
TB- DOTS
Raiganj- A Panchayat Prodhan followed up a [patient who had been treated under
RNTCP. After 2 courses of treatment the man was declared resistant to TB. The
Prodhan followed up and filled in a form that was sent to Swasthya Bhavan, The patient
was admitted to the Jawaharlal Nehru Hospital in Kalyani for DOTS Plus treatment.
Fever Treatment Depots
Dooars- Indian Tea Association has set up Malaria clinics in the remote gardens. These
are a support to the Fever Treatment Depots where ICDS workers keep Malaria
medicines and can take blood for tests
Local Life Jackets made by SHGs
During the CBDP programme in Uttar Dinajpur Self Help Groups learnt how to make
cost effective life jackets using commonly available materials.
Source of the Reference material:
Skills That Save Lives ASHA Module 6 NRHM
Keno Parbo Na- http://www.positivedeviance.org/from_the_field/voices-nutrition.html
http://www.unicef.org/india/nutrition_1557.html

11. Van Ambulance-
http://wn.com/InnoAid__Rural_Ambulance_Project__Sunderbans__the_local_rickshawm4v
ORT Corners UNICEF Press Report
Session plan:
Start the session with explaining objectives of the session and the significance of the
session for the entire training programme.
Running time Description of specific activities of the session
First 10 mins Brain Storming/ Listing. Ask- What are the good practices you
have seen?
11-50 mins Presentations (6 mins each): either of their own success stories
or of examples provided
51 to 60 mins Discussion on good practices by PRIs.
Methods:
Handouts, Presentation of case studies of good practices highlighting the scope of DRR
in Health sector and the role played by PRIs
Material required:
Pre-designed visual aids on Case Studies. White board, white board markers, flip charts
Annexure-
Case Study on Positive Deviance/ Keno Parbo Na

12. PD Practitioner: Rupali Haldar (Anganwadi worker)
Location: Mala Village, West Bengal
Date: February 2005
My name is Rupali Haldar. Initially when I started my work as an AWW (Anganwadi
Worker), and used to weigh children, then many mothers refused to allow me to weigh
their children. Many used to make faces, many used to say if you weigh my child the
weight will go down but I still didn’t lose hope. Whenever I used to go to the village, the
villagers used to snub me by saying, “There she goes, once again she will try to weigh
our children.” Many used to comment, “She gets money so she comes here, she must
have some purpose.” Again, some used to say, “Even though some people get money
they don’t work, they don’t come to advise us”.
Slowly, I became much closer to them. My first session started at 1.6.02. There were 14
children then. The programme was not initiated in the centre but in a mothers’ house. It
takes 10 minutes from the centre to reach that house. The programme stopped for a
month due to heavy rains. By 28.8.02, a number of Grade IV, III, and II malnourished
children moved to Grade I and Normal. Their mothers were so happy. They started
feeding the meal at home as well.
Another aspect of joy was that the grandmothers used to bring the children to the
centre. If the mothers did not want to come the grandmothers used to persuade them to
attend. The grandmothers also reported the cases of mothers who did not prepare the
meal at home. In the PD programme, the Hindu and Muslim mothers prepared the meal
together. The programme started in a Hindu family, but then it also took place in the
Muslim families. Even the mothers of the normal children have supported and
participated in the programme wholeheartedly. Once I asked a normal child’s mother,
“Why do you want to attend regularly?” She said, “I want my child to remain healthy and
not lose weight and besides my child loves to eat with all the children.”
Initially the Panchayat people did not help me. They wouldn’t even behave properly. I
supplied the fuel till the 8th session. From the 9th session, the mothers’ contributed the

13. fuel. One of the fathers refused to give polio drops to the child but the grandmother
came to me to give the child the drops secretly. I was so happy.
My CDPO and Supervisor told me to work well to get good results. Today I am very
happy. Now even the Panchayat have come forward. Earlier they wouldn’t listen to me,
now they do. Earlier those who would make faces and wouldn’t talk to me, now
consider me as their own. This is my biggest gift. My work is for mothers and children,
and to reduce child deaths. If I am aware, then I can create awareness in others. I feel
AWWs should have a mentality of maternal love and affection. I feel even if there is a
VHC (Village Health Committee), to back up the AWW, she has to give her best effort.
Whenever there is a problem the mothers must be consulted, this helps in
understanding what each mother wants to say. Once while facing the fuel problem, I
said I don’t get any money for fuel, how long can I keep arranging for it? The mothers
were quick to answer “Didi, these are our children who have the food, so we will arrange
the fuel, don’t worry.”