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Working with mothers and influencers, SMNet fights diarrhea and malnutrition in UP
" Through friendship and constant communication, SMNet staff like Shabnam has managed to embed itself deeply in the community and help them to participate in government’s programmes. "
diarrhoea Shabnam
Photo Credit:UNICEFIndia/2015/Manpreet Romana

By Shreya Ray

GAUTAM BUDH NAGAR, India, 09 September 2015 - A group of mother’s with small babies huddle up in a circle in the parking lot of an influential man’s home in an otherwise poor mohalla (neighbourhood). In the centre, there is one woman, the only one without a baby, confident, smiling and giving first-aid instructions about how to manage a child with diarrhoea. 
Nobody in the group says a word, despite her efforts to make them ask questions. “I need to know whether you have understood,” says the Community Mobilisation Coordinator of the village, Shabnam Rohilla. “If nothing, at least sing me a song,” she tells them with a smile. A little later, one of the women gets up and starts asking her how many ORS packets she must give her child each day. 
The meeting is in Chauthayiya Patti, a village marked out as ‘high-risk’ in the Jevar Block of Gautam Budh Nagar district, Uttar Pradesh. The village has been marked ‘high risk’, because of high population of migrants and people living under poverty line.

Behind the Formula 1 Glamour 

Gautam Budh Nagar (GB Nagar) is a world that ensconces many others. While one part of the district has the shiny new homes of Greater Noida, including the country’s glitziest venue, the Budh International Formula 1 Racing Track, and cars zipping on the flawless Greater Noida expressway; the other side, along the banks of the Yamuna river, shows a different reality.  

In many of the villages of GB Nagar, diarhoea is a major issue. In the past, Polio has been too. A quick glimpse at Chauthayiya Patti reveals why. Like most villages in this district, this is constructed with open drains running parallel to all homes. Hygiene is challenging, and practices like breastfeeding use of Zinc tablets or ORS solution need constant reiteration. 

The Diarrhoea Scare

Shabnam takes us to the home of one of the residents, a mother whose child has constantly been suffering from diarrhoea. The house is surrounded by open drains. Flies and mosquitoes from the drain easily fly in and out of the house. 
The open courtyard-cum-kitchen is right next to the bathroom. Right in that space, a hand-made cloth swing, fixed from the ceiling, has the baby sleeping. Despite the precautions she takes as she makes the ORS for the child, the unhygienic conditions of the home reveal why the child has consistently been getting sick. 
Diarrhoea is a big killer. In India, this disease, which is linked to open defecation and poor hygiene practices, causes the death of around 1000 children every day. 
As Community Mobilisation Coordinator of the village, Shabnam pays regular home visits to understand the living conditions and promote behavior change. She is the first link in a network of mobilisers that has worked closely with the community and persuades them to participate in government’s immunization drives. 

The Social Mobilisation Network (SMNet), a UNICEF-supported initiative which mobilizes the community at every level – village, block, district, region and state, was started in 2002 as part of the Government’s anti-Polio campaigns. In 2014, after India was declared Polio free by the World Health Organization (WHO), SMNet started to support Routine Immunization programmes, Diarrhea Management, malnutrition, hygiene/sanitation and breast-feeding, all of which are critical to keeping Polio at bay. 

The SMNet’s programme in GB Nagar works in all of the district’s four blocks Jevar, Dankour, Dadri and Bisrak, and across each of its villages. Of these, about 15 villages have a population of over 1 lakh.  
Most of these are high risk areas, and among them particular high risk groups include: nomads, construction workers, brick kiln workers and slum inhabitants. While every village has a Community Mobilisation Coordinator, who is always someone from the village, such as Shabnam, some of these high-risk areas with nomadic population just have Block Mobilisation Officers, who work closely with ‘informers’ or ‘influencers’ in order to get close to the community. 
Informers or influencers could be anyone from a grocery shop owner, to a school teacher, who has a lot of interaction with the migrants, and therefore is also in a position to communicate information like ‘dates of the next immunization drive’. Influencers are well accepted people from the community who are given a quick course in polio vaccines, hygiene practices, and are sensitized about these key issues. 

“There are approximately 90,000 migrants. Thus, it is extremely difficult to interact with all of them. The and the only way we can do this is through the informers/influencers,” says Irfanul Haq Khan, District Mobilisation Coordinator, SMNet. 

Also schools have classes for the students to get familiarized  with government programmes such as Routine Immunization. 

The main tools employed by SMNet coordinators include mother’s meetings, interpersonal communication, community meetings, and influencers’ meetings. In all of this, the agenda is clear, build channels of communication with the community so that they understand the process of immunization, accept key messages and respond to the calls to action by the mobilizers.  
In the time that she’s been here for instance, Shabnam has made the community revisit several of its traditional practices. “The community has always followed a practice called Doodh Dhulana (washing out the milk), wherein they did not feed the first ‘yellowish’ milk, colostrum, from the mother’s breast, which actually is so nutritious for the child, it’s almost a vaccine in itself,” she says. Through friendship and constant communication,  SMNet staff has managed to embed itself deeply in the community, and help them participate in government’s programmes. 
“The monitoring data from WHO revealed that of all these children in GB Nagar, only one per cent have been left out of immunization programmes, which actually translates into a 99 per cent coverage,” says Khan. Despite the fact that mobilizers and coordinators have a long way to go in addressing diarrhoea prevention through zinc and ORS as well as other related issues, this can be consider an important achievement. 
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