Introducing a health, nutrition and sanitation program within microfinance groups: a systems-level mixed methods analysis from rural India

Abstract Background: Bihar has been lagging behind Indian national averages in maternal, neonatal and child health development indicators, primarily due to lack of knowledge on healthy lifesaving practices and where to seek services. Hence, a successful pilot project was scaled up as the JEEViKA Technical Support Program (JTSP), to support the state rural livelihood mission, JEEViKA, to increase demand for and link rural families to existing health, nutrition and sanitation (HNS) services. Program activities were geared in reaching those engaged in JEEViKA’s microfinance-based self-help groups (SHGs). This paper presents the results of the output evaluation following 18 months of program implementation. Methods: A mixed-methods study was conducted from August-November 2017. Sixty-five in-depth interviews were conducted with program, state, district and block-level officials. Quantitative surveys (678) were carried out among lower level staff, including village-based community mobilizers (CMs) who convene SHG meetings and support SHG-related activities.Results: JEEViKA layered HNS onto its existing system. The block health, nutrition and sanitation integrator (BHNSI) was introduced within JEEViKA to support the layering of HNS work at the block level. CMs were being trained on HNS topics to be shared during SHG meetings. JEEViKA funded the trainings and paid additional remuneration to trained CMs. HNS indicators were routinely collected by CMs and data were analyzed and used across JEEViKA. JEEViKA was supporting new mechanisms for SHG families to procure food while linking them to existing health and nutrition schemes and services. CMs with HNS trainings were more likely to have higher levels of knowledge on HNS topics and were more likely to carry out HNS-related activities, such as interacting with BHNSI for guidance and support, collecting HNS data routinely and spending time weekly on HNS activities. Conclusions: There is greater awareness within JEEViKA on the importance of addressing HNS issues to assist families in reducing economic shocks from health emergencies, improve nutrition and raise families out of poverty. Stronger integration of HNS programming within JEEViKA will be possible through the presence of decentralized staff to solely support these activities and a closer examination of the CMs’ time to integrate HNS activities more coherently.