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Programming Inclusion: Taking Vitamin A to the Excluded Children of Bihar
" The catch-up round was organised by State Health Society with support from UNICEF to take Vitamin A to more than 10 million children of Bihar between 9 months and three years old. "

Sudha Devi travels by boat to the cut-off area near Phulwaria dam to take Vitamin A to the children of villages where regular heath services do not reach.


By Farhat Saiyed and Anupam Srivastava

Rajoli, Nawada: As the manually rowed boat touches Suarleti village in Rajoli block of Nawada district, health worker Sudha Kumari jumps off with her cloth bag. She is visiting the area under her charge after a gap of many weeks. The health department currently does not reach out to the nearly 20 villages on the other side of the reservoir of the Phulwaria dam. Sudha Kumari has specially travelled to the cut-off area, inhabited mostly by the socially and economically backward communities, for the first time in months. She has made this journey for the Vitamin A catch-up round. "We carried out a special micro-planning exercise which took months to identify and map each hard-to-reach area where mostly poor or marginalised communities live. This was to make sure that no one is left out when it comes to receiving Vitamin A," says Nawada Civil Surgeon B.N. Singh.

The catch-up round was organised by State Health Society with support from UNICEF to take Vitamin A to more than 10 million children of Bihar between 9 months and three years old. The focus of the catch-up round, for the first time, was therefore on the inclusion of the hard to reach, the socially excluded children. UNICEF Bihar State Representative Bijaya Rajbhandari says, "What we are seeing now is the programme reaching the unreached, building in the element of social inclusion. It is our strategy to reach out to those children whose families are often not covered by the regular services, children who belong to communities that are hard to reach and socially excluded. We feel that exclusion can be turned into inclusion through programming such as what we have just done."

A child gets Vitamin A dose in Suarleti village in Rajoli block of Nawada village.


Vitamin A has been reaching a sizeable proportion of Bihar's children -- more than 80 per cent of children between nine months and three years are reported to have received Vitamin A in the last round conducted earlier in 2006. However, it was felt that certain communities -- particularly the poor and deprived sections and geographically unreacheable -- were being left out repeatedly. Finding them required searching hard in rural Bihar and urban settlements where services simply did not reach. There was a great emphasis on planning. UNICEF's District Field Monitors in all the 38 districts of Bihar worked closely with the Civil Surgeons and Medical Officers in the districts to create microplans that had every household in every village mapped. "It is a plan that recognises people wherever they live, whichever community they belong to. It is a plan that does not leave anyone out," says Mr. Rajbhandari.

As Sudha Kumari moves around vaccinating children in an area where people can not respond to any emergency, Vitamin A will ensure that children will have greater immunity to fight diseases and stay healthier. "I am very happy that you have come here with this," says Sheetla Devi, a mother who knows that her children will get protection from blindness if they take Vitamin A. Suarleti has reported a case of blindness in the past. "Thanks for including my area in the micro-plan. Vitamin A has given me a reason to come here and earn the goodwill of people," she says.

As thousands of vaccinators like Sudha Kumari gave Vitamin A to millions of children in Bihar, it was sometimes the only health service to reach many villages and communities. Buoyed with the success of the strategy, the State Health Society is planning to include it in the other upcoming campaigns. "It is a whole new way of programming. It is translating the discussion and understanding on social exclusion into programmatic action," says Mr. Rajbhandari.

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