Keystone IV

A B I - M O N T H LY R E S E A R C H P U B L I C AT I O N F RO M WO R L D V I S I O N I N D I A

I S S U E N O. 4 | AU G U S T- S E P T E M B E R 2 0 1 7

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World Vision India

Table of contents

Keystone | August 2017

Foreword

Page 01

Evaluation Report – ACCESS Project

Page 02

Impact Report – Arpana ADP

Page 10

Research Paper – Barriers to Complementary Feeding

Page 17

Impact Report – Indore ADP

Page 24

ForewOrd

Towards building evidence

Building evidence for the impact we create as an organisation serves three important functions. The first is to influence policy, the second is to inform programming decisions and the third is to engage our donors and sponsors.

place at three levels community, cluster (group of communities) and project levels. This bottom-up approach enables us to have monitoring data collected at community level, which is the primary evidence of change happening in the community.

At the heart of evidence building, lies developing of consistent and quality data that depicts the before and after (programme implementation) situation in a community. Thus having a baseline (with control groups in 26 locations) was World Vision India’s essential first step. This was an extensive exercise, collecting primary data across 119 locations where we work. The uniformity of programmes implemented across these locations was a great advantage.

There is a strong impetus built in the organisation towards impact reporting in the place of traditional activity reporting. Impact reporting is based on the baseline and monitoring data that is available in the projects. Apart from the regular evaluation reports that extensively capture life time impact of a project, short term impact study reports are also serving as important instruments designed to capture impact.

Another significant contributor towards building evidence is monitoring data.

The three tier monitoring mechanism that has been introduced in World Vision India is an important step in this direction. As the name suggests, monitoring in this mechanism takes

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Finally, in addition to strengthening the DM&E processes , focus on research in the organisation is another important step in building evidence. Operational research that is built in to the project models like Care Group Model in Maternal & Child Health and Nutrition programming will lead to building evidence of the effectiveness of such models.

The Institutional Review Board (IRB) contributes substantially to strengthen the scientific and ethical rigour of our research, which in turn ensures the scientific soundness of our evidence. The research papers produced by research teams within the organisation enrich the evidence building process as well.

Keystone publishes the research findings on a regular basis to ensure that these findings are made available to the end users for programmatic decisions and engagements. This issue of Keystone contains a research paper, an evaluation study and two impact reports. We are proud to have already produced three issues of Keystone in FY 17, and we hope you would benefit from this last issue of the year as well. Thank you for your year-round support and contributions.

Happy Reading!

Dr Prasad Talluri Strategy and Research Management

World Vision India

Authors: T. Steve Daniel, Reeta Massey, P. Subramania Siva

Impact of World Vision India’s disability-focussed ACCESS Project This report highlights the change brought by the ACCESS (Accelerating Core Competencies for Effective Wheelchair Service and Support) Project funded

by USAID, successfully implemented over a period of 3 years, serving more than 1300 people with disabilities.

Keystone | August 2017

Through trainings for rehabilitation professionals, formation and capacity building for Disabled Persons’ Organisations (DPOs), improving social accountability through Citizen Voice Action (CVA) and working with other CSOs, the project addressed issues around disability

inclusion in the communities.

Acknowledgements: Enisha Sarin (External Consultant)

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IMPACT REPORT OF ‘ACCESS’ PROJECT: World Vision India’s special project on disability Abstract In India, Uttar Pradesh has the highest number of people with disabilities- 16% of the total disabled (69%) in the country.

Lack of appropriate wheelchairs to PWD results in lack of opportunities in education, work and social life.

Additionally, an appropriate wheelchair improves the physical health and quality of life of the users. World Vision India implemented the ACCESS (Accelerating Core Competencies for Effective Wheelchair Service and Support) project for a period of 3 years with partners Mobility India and Motivation India to strengthen the wheelchair sector along with five wheelchair service centers situated in Uttar Pradesh and Uttarakhand.

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The project designed to build capacity of local service centers by training their rehabilitation professionals through Mobility India on the WHO Wheelchair Service Training Package (WSTP).

TOT course conducted by Motivation UK to provide support for the WSTP and ensures appropriate service at the respective centers on needed tools and equipment, and putting in place systems to ensure appropriate wheelchair service is sustainable. Service providers, Motivation, referral actors and World Vision India envisaged every 6 months follow up.

At the same time, World Vision India formed Disabled Persons’ Organisation (DPO) and trained them in Citizen Voice Action (CVA) methodology for social

accountability as well as engaging with stakeholders from other local NGOs, CBOs, and DPOs in the issues around disability inclusion in their community.

The project has served 1157 PWD (product provisions + product improvement) and 266 CWD, has trained 328 rehabilitation professionals, raised awareness & oriented 3081 professionals & students (40% women) and strengthened 78 service delivery and academic institutions. Over a period of 3 years in the communities we serve, there was a reduction in two time points measurements yielded significant difference across all items of the scale and increase in proportion of WC users expressing feelings of

World Vision India

Background withstand rough terrain5.

World Health Organisation (WHO) Guidelines suggests appropriate wheelchair with proper assessment, prescribed fitting and monitoring of follow up needs6.

PWD in India constitute 2.2% of the total population, totalling 2.68 crores or 27 million people. 20% of them have disability of movement1.

A higher proportion of males (56%) are disabled than females (44%) and the majority of disability is found in the age group 10-19 years, thus indicating a very young population which lives with disabilities. The number of children with disabilities aged 0-6 years is about 21 lakhs - a matter of concern as it shows that 1 in 100 children in the age group suffer from some

type of disability2.

Project Partners

Objectives

Method -ology

Implementing Agency: World Vision India, John Snow, Inc., Research and Training Institute (JSI)

Foster an enabling environment toward effective wheelchair service and management through stakeholder engagement and mobilisation, and local and national level advocacy efforts

Study: Qualitative research and Quantitative research

Funding Partner: USAID Technical Partner: Mobility India, Motivation India Service centre: Kiran society, BCM hospital, Kalyanamkaroti, Herbertpur Christian Hospital, Mangalam

There is a lack of accurate statistics on the number of people with disability of movement requiring wheelchairs. However, there are indications that only a minority of those in need of wheelchairs have access to them and of these very few have access to an appropriate wheelchair.3 Motivation, a wheelchair expert organisation, estimates that at least one million people in India need a properly fitted wheelchair that can

Provide Wheelchairs and build capacities Conduct Wheelchair service training package (WSTP) trainings

Tools: Focus Group Discussion (FGD), In Depth Interview (IDI), Monitoring/output data by the Project.

Period of the study: November 2016 to June 2017 Area of Study: Uttar Pradesh and Uttarakhand

What aspects of Social Inclusion, Capacity Building and WSTP training are sustainable?

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Study Sites Two slums in Kanpur and three villages in Sitapur district (in World Vision India’s operational area)

were selected for the evaluation. Additionally, a non-operational area in Sitapur was also selected to

represent wheelchair users for comparison.

were selected purposively based on willingness to participate, ability to articulate well and availability. In total, 20 IDIs and 11 FGDs were conducted across the two study sites. Among WC users, both older (above 40 years)

and younger (18-25 years) participants were selected. In addition, four children were interviewed through their parents.

Sample The sample included both male and female wheelchair (WC) users, parents of WC users, ACCESS project staff, service centre managers, CVA group members, external stakeholders and physiotherapists. Samples

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World Vision India

Data Analysis Recordings were transcribed and translated into English.

Transcripts were then transferred to ATLAS. ti, a software for analysing qualitative data. Interviews were re-read and recordings heard to get the essence of

each interview. Code lists related to categories of participants were prepared in advance and these codes were applied later to relevant sections of individual transcripts during analysis.

Codes were compared across

cases, and memos were written to capture the main themes emerging out of the interview segments.

key FINDINGS Physical benefits: Participants, who used a different wheelchair previously, reported that with the current one they no longer had backache or hand pain and were able to travel long distances without feeling tired. Parents of wheelchair users talked about how the customised seat helped in keeping their children’s back and legs straight and “helping in blood circulation.” There were other benefits as well for example, a child who was earlier unable to walk, now ambulated herself by pushing about her wheelchair and reported to have developed strength in her legs. By holding the handle of the wheelchair, another child could open up his fist, which previously was inward turning. Parents reported that much of their physical burden in carrying the child is now eased due to the WC. Psychological benefits: Psychological benefits encompassed feelings of independence, self- reliance, and self-confidence. “When we have to go to any family function, we use this WC. When we are there, people

Keystone | August 2017

say that it the WC is very good. It feels very good to hear that,” says a male WC user from Kanpur. “The WC boosted my self-confidence.

Now I do not need to depend on anyone. If I don’t have oil in my home I take my cycle and go buy,” says another male WC user from Kanpur. .

Educational benefits: CWD enrolled in schools and colleges have begun to attend these regularly as they could cover distances easily using tricycle. As a girl WC user from Sitapur reported, “The speed of the WC is good.

Due to this, we never get late to school. We always reach on or before time.” Another child used to be carried by his father to school. Now he uses wheel chair and has started going to school. However, in the villages, the condition of roads sometimes limits mobility. But young women who had stopped going to school earlier did not appear to be motivated or interested in starting education again despite the WC

new wheelchairs, as evidenced in the responses of the participants. Especially male WC users provided with the tricycle could now travel long distances and secure a job or run a business. This male WC user from Kanpur reports, “I do business with the help of the WC. Earlier I used to sit in temples to beg and get Rs 100. Now I sell mats and TV covers from my WC and get Rs 200 every day”. The same was true of female WC users who studied in colleges or were already running a business such as stitching clothes and providing tutorial classes to children.

Economic benefits: Increase in mobility was an outstanding contribution facilitated by the

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Comparison of quantitative social inclusion results with qualitative results Source: 54 wheelchair users interviewed through IDI and FGD: 24 female and 25 male WC users in both study sites. Out of this, 15 belonged to a non-ADP site and 4 were parents of children.

A further 22 WC users, representing CVA members participated in FGD

Demographic Characteristics

Baseline (%)

End line (%)

Female

25.0

81.0

Male

25.8

74.5

1-18

24.0

68.0

19-40

29.0

81.0

>40

23.0

77.0

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Age

60 50 40 30 Baseline Endline

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World Vision India

Recommendations In order to continue coverage of appropriate wheelchairs to a wider population of PWD, it is recommended that a new project, should there be one, focus on WSTP training to senior management of Orthotics in public and private hospitals, as well as government training institutions. This will ensure the establishment and continuation of WHO protocol practices in providing appropriate and customised wheelchairs.

Refresher training for service centre personnel is required to reinforce the learning of the WSTP courses.

Female WC users require training to lead CVA groups in order to motivate other women to join and to secure rights and entitlements.

In order not to lose the momentum of CVA efforts, and to strengthen such groups, it is highly recommended that one of the tasks of WV India field staff should be dedicated to meet these groups at least once a month and provide them with necessary support in linking them with block development officers or local panchayat

leaders. Similarly, WV India ADPs must continue to lend support in participating in meetings and contributing to plans and strategies of the national NGO forum. ADPs must include disability as one of the focal issues.

In any future project, better coordination between wheelchair service centre, ADP office and WC experts should be ensured, through proper monitoring

by WV India.

As the new wheelchairs, though appropriate, are occasionally liable to damage, follow up with clients is necessary in order to address it. The admirable efforts of WV India towards looking at solutions to this problem should continue with renewed support.

To that end, training is required for cycle repair mechanics to build skills in repairing wheelchairs.

The project must address the issue of spare parts of wheelchairs. In addition to providing and transporting wheelchairs, it is imperative that spare parts are easily available in markets near the project areas.

prescribing an appropriate wheelchair will address social inclusion among women, as they will benefit more from a WC, which increases their mobility and participation in vocational and educational activities.

Psychological assessment requires referring women who may be depressed or feel isolated. Similarly, assessing their interest in vocational training as well as assessing the availability of a companion or attendant will lead to the prescription of an appropriate wheelchair.

It is apparent that children, especially girls, with congenital disability are excluded largely from education in the absence of family support, and poverty. Any new project or the WV India disability department can make this vulnerable group a focus for facilitating mobility and further engagement in education.

CVA and the National NGO forum should address corruption by service providers in providing disability certificates to PWD.

Assessing individual needs of PWD before

References 1. Census of India. 2011 2. Government of India. Social Statistics Division. Ministry of Statistics and Programme Implementation. Disabled persons in India. A statistical profile 2016. www.mospi.gov.in 3. S, Jacobs NA, eds. Report of a Consensus Conference on Wheelchairs for Developing Countries, Bangalore, India, 6–11 November 2006. Copenhagen, International Society for Prosthetics and Orthotics, 2007 http://homepage.mac.com/eaglesmoon/ WheelchairCC/WheelchairReport_Jan08.pdf

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Conclusion Overall effectiveness of the project in addressing the The project successfully addressed the physical, needs of PWD psychological, educational and economic needs of PWD. However, similar levels of needs were not met among certain groups like uneducated young and older women, and older PWD in rural areas. Factors such as gender, educational level, family support, and infrastructural support affected social inclusion.

Overall effectiveness of the project in building capacity The project successfully increased the capacity of of stakeholders service providers in providing appropriate wheelchairs to PWD along the continuum of WHO 8 step protocol.

Capacity in certain steps of the protocol such as modification and repairs, and follow up varied according to the nature of the service centre, location of service centre, geographical distance from clients, and working relationship with ADP office.

Effectiveness of CVA efforts on community participation CVA participation differed in rural and urban areas, with of wheelchair users the latter showing more active participation. The effects of CVA on community participation were not obvious except for a few isolated cases of engagement in trade or business due to CVA encouragement and efforts.

Effectiveness of WSTP training in capacity building The WSTP training was highly effective in the application of knowledge to service provision among ACCESS partners. For those outside ACCESS, the training had limited effect as following the guidelines required institutional support. Also, there was little scope in the project to follow up on practical effects of training for non-ACCESS partners.

Effectiveness of WV India’s outreach efforts in alleviating WV India smoothly facilitated the initial screening, stress on service providers, streamlining the outreach referral and organising of outreach camps. Limiting preparation, and ensuring quality service for all clients clients to within ADP areas might have affected coverage of PWD served by service centres. Regular follow up of clients after receipt of wheelchair took the burden off service providers and ensured identification of problems in wheelchair and redress of the same.

Sustainability of social inclusion activities CVA groups spearheaded by WV India are sustainable within ADP areas with support of ADP manager and community field staff. The national NGO forum has the potential to lead and continue CVA efforts and to achieve this, the support of ADP is necessary.

Sustainability of capacity building activities The application of knowledge of WHO protocol in providing wheelchairs is likely to continue in the service centres, with the support and willingness of senior management of service centres, and provision of appropriate wheelchairs with Motivation India.

4. World Bank. Poverty and Equity. Regional dashboard. South Asia. http://povertydata.worldbank.org/poverty/region/SAS 5. Motivation India. Reaching the most marginalised and vulnerable. https://www.motivation.org.uk/india 6.World Health Organisation. Fact sheet on wheelchairs.WHO.Regional office for SE Asia. 2010. http://www.searo.who.int/entity/disabilities_injury_rehabilitation/wheelchair_factsheet.pdf

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World Vision India

Authors: Sudipta Ranjan RAM, Bestin Samuel

IMPACT REPORT: Impact of World Vision India’s work through Arpana Area Development Programme This report records the impact in the lives of more than 70000 people from the most vulnerable communities living in 12 slums and 45 villages in Guntur District of Andhra Pradesh. By improving

Keystone | August 2017

agriculture practices, farmers clubs, providing access to credit and livelihood options and improving the status health, nutrition and education status of children, the project was able to bring changes. This

report highlights the areas for improvement, which could serve as a lesson learnt for other interventions.

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Introduction India’s Andhra Pradesh covers an area of 160,205 sq. kms., and has a population of around 49.67 million as per the 2011 Census. The state has 13 districts, of which Guntur is the 2nd most populous. The district has a geographic area of 11391 sq. kms. and 728 revenue

villages, and is known for its production of chillies and tobacco. World Vision India’s programme, Arpana Area Development Programme (ADP), has been working in Guntur since 1996. The details of the impact made by World Vision India through Arpana ADP have been compiled

from an End of Programme evaluation process, which considered the entire life span of the programme. This report gives a summary of the impact that World Vision India had in the communities we worked with, and what we learned.

World Vision INDIA Target Area

Map of guntur district (Map not to scale)

Breadth of Impact World Vision India’s Arpana Area Development Programme is working in 45 villages of Guntur Mandal and 12 slums of Pedakakani and Tenali Mandals of Guntur district of Andhra Pradesh, India. This programme has been working among 9733 households, covering 11

a population of 73541 including 25857 children.

The project started in 1996, and is scheduled to close in September 2017.

Arpana ADP has been working among people belonging to the most backward classes, covering the Scheduled

Castes, Other Backward Castes and the Backward Class. The ADP works among meagre income farmers, landless, agricultural labourers, slum dwellers, unskilled workers, families of people living with HIV / AIDS (PLHIV) and people with disability (PWD).

World Vision India

Depth of Impact 3.1 Economic Development One of the key goals of our work is to improve the economic status of the households in the ADP target areas. Arpana ADP has been working among the most vulnerable communities including meagre farmers, landless households, women and children and focusing on the poorest of the poor households through various initiatives. There has been a significant change in income among the households and it was evident that more families (91.7%) have moved upwards during the last 10 years in the economic ladder. A meagre 1.4% is stagnant and another 1.4% had moved downward during these last 10 years. Increased awareness, capacity-building programmes, participation in SHGs, trainings, access to varied Government schemes,

assistance and support for income generation have significantly helped the community move up the ladder.

Arpana ADP targeted the meagre income group of farmers and provided them a package of initiatives for transfer of technology and input efficiency, promoting appropriate investment opportunities and creating a favourable and enabling economic environment. These are done by bringing them together through Farmers’ Clubs and empowering them for collective bargaining, and establishing bank linkages and value addition. It is found that only 15% of the total families surveyed have own (9.67%) or leased (5.33%) a land. Out of the total households (HHs) owning agricultural land,

54.44% own less than 1 acre and another 35.56% own 1 – 2.5 acre of land.

Arpana ADP was able to bring in 15.56% of the farmers’ HHs as a part of Farmers’ Clubs.

These Farmers’ Clubs have been engaged in transferring knowledge and technology to other farmers of their village due to which the impact is also seen among the larger group of farmers. As per the Household Survey 2017, 62.92% of farmers say that due to enhanced knowledge and changed practices there is a change in cropping pattern. It is found that only 17.33% of the households report any income from animal husbandry. However, it was evident during the field validation that more HHs are having livestock including cows and buffaloes as milch

3.2 Self-help Groups and Access Arpana ADP has been extensively engaged in working with the SHGs, building their capacities through trainings to mobilise and manage resources for improved livelihood.

Concurrently, the ADP supported them for various trades and livelihood options.

Women’s participation in family income has improved.

Simultaneously, their negotiation and leadership skills have been enhanced.

As per the HH Survey 2017, the involvement of the HHs

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in SHGs is 68.5%. The ADP worked with 1208 SHGs, building their capacities and awareness on livelihood opportunities, business management, resource mobilisation and marketing.

These SHGs are a small group of women (10-15) who come together to find their own solution to common problems. Micro credit is routed through the SHG, helping them to invest in small income generating initiatives and eventually moving them out of poverty. This initiative

is state-sponsored, and is working in all the districts of the state where World Vision India has collaborated with the Govt. for this purpose. As per the SHG Assessment Tool, 5/6 SHGs have scored more than 180 points out of 200 points.

Arpana ADP has been working with the youth to increase their employability through skills and entrepreneurship development. As per the HH Survey 2017, 35.94% of youths were trained and 39.49% of

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youths got a job or are self-employed.

The role of different actors has been crucial in the development of these households. These households have access to multiple schemes, programmes and activities from various agencies, departments and institutions. Therefore,

increased access to these schemes due to awareness, trainings and support from World Vision India has helped the households.Various Government Schemes including National Rural Employment Guarantee Scheme (NREGS), Housing for poor households, Scholarships for children, and Public Distribution System (PDS) are helping the poorest to fulfil

their basic needs from the schemes and focus on their improvement. Simultaneously, schemes like Development of Women and Children in Rural Areas (DWCRA), ShtreeDhan, Shree Nidhi and Andhra Pradesh SC Cooperative Finance Cooperation are yielding good results.

3.3 Maternal & Child Health and Nutrition Arpana ADP has focused on the Health & Nutritional needs of children through various initiatives targeting children below 5 years, adolescent children, pregnant & lactating mothers and their families. There has been a significant reduction of the proportion of underweight among children aged 0 – 59 months as per the Household Survey 2017. As per the data, underweight among children 0 – 59 months has been reduced from 40.4% (TDI 2006) to 35.30% (Household Survey 2017) within the last 11 years.

This indicates change in the behaviour, knowledge, food accessibility and their income.

Simultaneously there is a decrease in the percentage of children stunted from 62.6% (DSI 2014) to 58.4% (Household 2017). Increased awareness and training programmes, improved access to Government Services and follow-up has contributed to this.

in the status of Colostrum feeding. Over a period of time, Colostrum feeding rates have increased from 51% (Baseline 2003) to 96.97% (Household Survey 2017) which is noteworthy.

The awareness level of mothers has improved through awareness and training programmes, which has contributed to the reduction of underweight among children below 5 ?. Improving the Anganwadi facilities, UMANG feeding initiatives (40 Centres) by World Vision India and continuous monitoring of the children helped in the reduction of malnutrition.

World Vision India has renovated 25 Anganwadi centres, which motivated the children to come more frequently.

Another significant change, which is evident from the data, is the improvement

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World Vision India

3.4 Healthcare and sanitation Notably, it is seen that proportion of deliveries attended by a skilled birth attendant or at a Health facility is 97.06%. The women have good access to the local PHCs and District Hospital, which encouraged institutional delivery.

Facilities like Ambulance for pregnant women, continuous counselling and follow-ups by

ANMs, ASHA and Anganwadi workers, provision of Delivery Kits, and food and medicines during childbirth has helped improve this status.

All children below 59 months who had suffered pneumonia in the past 2 weeks were taken to an appropriate health care provider. Similarly, 69% of children aged 6 –23

months with diarrhoea during the past 2 weeks received ORS or Zinc Tablets (11.7% - TDI 2006), which is a good improvement.

Access to sanitation facilities increased from 40% (2003) to 99.20% (2017), a remarkable achievement for the community.

3.5 Education and Child Protection It was found that the enrolment of children in school is very high. The enrolment rate of children aged 6 – 11 years is 98.59% and children aged 12 – 17 years is 97.18%. The efforts of World Vision India in encouraging the children for education through various initiatives has paid dividends.

The ADP has established 55 Children Clubs with 2638

Keystone | August 2017

children participating in it.

They have also trained 3850 children on Child Rights. The ADP was engaged in providing Life Skill education to seven Government schools who adopted the curriculum and are using it. Simultaneously, other activities including recreational programmes, exposure trips, Life School for Transformational Development (LSTD) etc. has helped children participate,

build their leadership qualities, and motivate them to come up in life.

In the area of protection, according to the data, 83.3% parents feel that their children are safe most of the time and 13.7% say that they are safe some of the time (Total 97%) as per the HH Survey 2017.

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Sustainability of Impact Arpana ADP has been working with CBOs and other stakeholders to achieve its goal to ensure Child Wellbeing. Some of them include Village Development Committees (VDCs), SHGs, Farmers’ Club, Children Clubs, Government Departments and Service Providers. VDCs and SHGs are actively involved in the operation of the ADP. It is seen that in some villages, SHGs (mainly women) are playing a major role in leading the development process of the village. Due to the continuous leadership development initiatives, the confidence of these CBOs has improved and they are able to take major roles in planning as well as operationalising the plans.

The ADP had a network with the followings: Primary Health Centres (PHCs) and Health Sub Centres Education Department and Schools Veterinary Doctors National Skill Development Corporation ESTAH (NGO) Sangam Milk Producer Company Ltd Andhra Pradesh SC Cooperative Finance Cooperation

with for future engagement and partnership.

At the household level, the community has been quite empowered to access the resources and benefits through different schemes and programmes by the local government and other development actors. However, the Sustainability Framework Rating shows that most CBOs are falling under “Medium” and “Low” Category. It was also found that the initiatives for children were totally World Vision India driven and enough sustainability plans are not in place for long-term engagements.

This has helped the community to work with multiple actors whom they can now directly associate

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World Vision India

QUALITY OF EVIDENCE The impact of World Vision India’s work in Guntur has been measured through a detailed and deliberate evaluation process, involving different methodologies including quantitative and qualitative data collected from various identified sources.

Data Triangulation was done for data collected from different sources including quantitative, qualitative, secondary and staff opinion on which conclusions were made.

All the identified indicators which were relevant for the Household Survey, were

measured through HH Survey consisting of various tools.

This was done through 30 Cluster Sampling Frame resulting in choosing 600 Households from 57 villages.

Standardised tools , translated into the local language along with trained local volunteers were used to conduct the survey, . A database was prepared to enter the data and generate reports using EPI Info. In addition, a lot of controls were used to minimise errors and produce quality data. The quantitative data went through a threephase cleaning process before finalising it to generate

reports. This quantitative report was used for field validation and questions were included based on the findings of the quantitative survey.

The field validation was conducted in March 2017 , using exercises and tools including River of Life (ROL), Most Significant Stories (MSC), Focus Group Discussions (FGDs), Key Informant Interviews (KIIs), Ladder of Life, Sustainability Framework, and tools for assessing Children’s Clubs, CBO grading and SHG assessment.

CONCLUSIONS Apart from the major achievements listed above, there were a few areas of concern. They include the lack of irrigation for agriculture, reluctance on the part of community members to report their income from animal husbandry (this had resulted in the proportion of households having income from animal husbandry as showing less), irregularity of member participation in SHG, alcoholism, social discrimination across classes, the tradition of dowry, and ill health.

In health, there were certain areas which required improvement as well. Wasting had increased slightly from 13.1% (2014) to 19.9% (2017).

Keystone | August 2017

Additionally only 31.25% of mothers of children under 6 months reported that they exclusively breast-fed their child.

In the area of children’s participation, it was found that though 47% of the children were participating in the Children Clubs the rest (53%) of the children were not participating in any of the Children Clubs. Of the 47% , only 18% of children aged 12 – 18 years were able to articulate three personal safety methods. Similarly, as low as 15.83% of the children are able to express three sources of help in case of possible danger.

evaluation process, there were some key points of learning as well. Longitudinal data is critical for an Evaluation, and could affect the quality.

Engagement with the old staff of the programme is highly beneficial during evaluation.

We also realised that it is not desirable to have a mix of different populations (rural and urban, for example) under one programme. Since each will have its own dynamics, we run a risk of not identifying it and thus excluding it from plans.

From the point of view of the

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Authors: Grana PuSelvi, Sherin Daniel, Aditi Roy,Vipin Mashi, Savita Dennyson, Grace Gangte, Ramila Gohil.

RESEARCH PAPER: Barriers to Complementary feeding Exclusive breast feeding and timely initiation of appropriate complementary feed are essential elements for growth and development

of infants. This research paper investigated the barriers that prevented mothers from introducing timely complementary feeding,

from 103 responses from 8 locations across the country.

The findings and related discussions are presented in this paper.

ABSTRACT

Barriers to timely introduction of semi-solid food to infants 6 - 7 months.

BACKGROUND Exclusive breast feeding and timely initiation of appropriate complementary feed are essential elements for growth and development of infants.

And therefore it is important for mothers to introduce and practice complementary feed in a timely manner.

There are risks involved in children getting diarrhoeal outbreaks from exposure to contaminated weaning food or by growth faltering if weaning feeds are inappropriately delayed.

METHODS This paper attempts to learn what is preventing mothers to timely introduce appropriate semi-solid complementary feed to infants in 6-7 months through a barrier analysis survey. It is a doer and non-

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doer study. A doer is defined as mother of child who started to feed their children semi solid food at 6-7 months and a non-doer is the mother of the child who did not start to feed their child with a semi solid feed at 6-7 months.

RESULTS Mothers who hadn’t introduced semi-solid feed to their infants in 6 - 7 months felt that training and counselling on introduction of complementary feed would have helped them to introduce semi-solid feed.

Moreover for those with a first child felt that having an experience of a first child would have made it easier for them to introduce complementary feed. Mothers who introduced semi-solid feed felt that health workers, anganwadi workers and

doctors approve them of timely initiating of complementary feed.

CONCLUSIONS Barrier analysis helps to design the behaviour change framework and formulate activities to address the barriers identified in timely initiation of appropriate complementary feed.

Problems that are important to address concerning complementary feeding are both on what to advice and how to change the habits of mothers.

KEYWORDS Doer; Non-Doer; Barrier Analysis;

World Vision India

Keystone | August 2017

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INTRODUCTION Unique nutritional value of mothers’ milk makes it the most cost effective and readily available food for infants. After a certain age, mothers milk alone can no longer supply all the essential nutritional requirements and complementary foods are needed to ensure adequate nutrition and growth[1].

Complementary feeding for infants refer to timely introduction of safe and nutritional foods in addition to breast milk which include clean and nutritionally rich foods introduced at about six months of infant age[4].

Children in developing countries are poorly breast fed (Only about 39% of infants in the developing countries are exclusively breast-fed for the first six months[5].)and

complementary feeding is inadequate or inappropriate and delayed which contribute to long term deteriorated physical growth[6]. At the same time growth faltering, micronutrient deficiencies and infectious illnesses are common among children between 6-24 months [2], [3]. It is also critical from a public health perspective to understand the age at which breast-fed infants are first given complementary foods.

The risk of diarrhoeal diseases are high from contaminated weaning foods and they turn out to be potential risk of growth faltering [7]. Nutrition education or social marketing strategies have been used to improve complementary feeding practices in several developing countries[8].

Appropriate complementary

foods will differ between populations due to differences in availability of foods and differences in culture.

understand the determinants, a barrier analysis survey was planned to identify factors preventing mothers to timely introduce semi-solid food to infants 6 - 7 months. A field tested barrier analysis questionnaire was used with two sections. Section A is to screen the study participants as doer or a non-doer of the behaviour. Section B included the research questions to study the barriers to timely introduction of semi-solid

food to infants 6 - 7 months.

A group of eight participants trained in barrier analysis were involved in the study. A doer is defined as mothers of children 6-7 months who started to feed their children semi solid food and a nondoer are mothers of children 6-7 months who did not start to feed their children semi solid food. Quality improvement verification checklist was maintained for the doer/non doer interview.

Complementary feeding strategies improve not only the quality and quantity of these foods but also improve the feeding behaviours[4].

Formative research is essential to assess current practices and beliefs to determine the acceptability and feasibility of introduction to complementary feed[8].

Most nutrition and health educational approaches also focus on the individual caregiver, and assume that as mothers receive new information about childcare, they will modify their behaviour[9].

METHODS This paper aims to study the most influential barriers to timely introduction of semi-solid feed to infants 6 - 7 months. Determinants studied include perceived self-efficacy, perceived social norms, perceived positive consequences, perceived negative consequences, access, and cues for action/reminders, perceived susceptibility, and perceived severity, perceived divine will, policy, culture and universal motivators. To

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World Vision India

STUDY GROUP DESCRIPTION A total of 103 responses (equal doers and non-doers) were collected from eight geographical locations which include Bardhaman in West Bengal, Bhuta and Barabanki in Uttar Pradesh, East Khasi Hills in Meghalaya, Nalanda in Bihar, Perambalur in Tamil Nadu, Bhopal in Madhya Pradesh and Dangs in Gujarat of which 55 were doers of the behaviour and 48 were non-doers of the behaviour. The age range of the mothers was between 16 -35 years. Their source of income is mainly agriculture and livestock, earning a daily income between Rs 100 to 300 depending on their skills and efficiency. The participants

were from both rural and urban settlements and they speak local languages such as Avadhi, Khasi, Bengali, Kannada, Tamil, Hindi, Shadril, Santhali etc. Most of the older women are illiterate but those who are new mothers between 18-25 years of age are schooled. Majority of the population are Hindu followed

by Muslims, Christians, Buddhist and Jains. The major ethnic groups are Kannadigas, Tamilian, Saharaiya, Maltos, Bihari etc.

During the day most of the mothers engage in agriculture and look after their animals.

They milk their cows or

buffaloes and clean them, arrange fodder and drinks and also help their husbands in the agriculture work and other chores. In summer the mothers get engaged in agriculture and clear weeds in the field and in winter those residing in hilly terrain engage in plantation of crops.

In autumn they engage in paddy, wheat, pulses and potato harvest and in selling them. In spring they plant potato in plain area. Their life circles around their livestock, cultivation, harvesting and selling of crops.

RESULTS Mothers who haven’t introduced semi-solid feed to their infants in 6 - 7 months (33 %) felt that having an experience of a first child would have made it easier for them to introduce a complementary feed (OR: 0.24 [95% CI: 0.090.69]) (p=0.005). However those that practiced were 5.4 times more likely to give the response that they received training and counselling on introduction of complementary feed (OR: 9.20 [95% CI:1.12-

Keystone | August 2017

75.52]). Mothers who practice timely introduction of complementary feed felt that their children would be healthy (OR: 2.45[95% CI: 1.08 - 5.57]) and they felt good, relaxed and got more sleep.

Mothers who introduced semi-solid feed felt that health workers, anganwadi workers and doctors approve them of initiating a complementary feed. They responded 2.8 times more than those who did not feed(OR: 3.23 [95% CI: 1.41-7.40]). However 15 percent of mothers who failed

to initiate complementary feed felt that their husband or father in law disapproves them from starting semi-solid feeds.

Mothers who failed to initiate complementary feed felt that the timely introduction of semi-solid feed is very likely to prevent her child becoming malnourished. About 65 percent mothers who did not initiate a complementary feed felt that their gods do not approve them of initiating complementary feed (p=0.001).

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DISCUSSION Inadequate breastfeed and complementary feed coupled with frequent infections, are the principal proximal causes of malnutrition during the first two years of a child’s life[2]. Nutritional tradeoff between breast milk and complementary foods depends on the quality of the complementary feed.

Introduction of semi-solid food to infants 6 - 7 months and its consumption are influenced by a number of independent factors, such as the child’s appetite, the caregiver’s feeding behaviours, and the characteristics of the diet[8]. About 33% mothers who did not initiate semisolid feed felt that having a second child makes it easy to introduce complementary feed.

In these cases it is important to carefully advise mothers on how to change their habits[10].However those that practiced introduction of complementary feed were more likely to say that the training and counselling they received helped them to introduce complementary feed to their children. Studies confirm that the effect of complementary feeding interventions depends on the types of foods promoted, the target age range, the initial nutritional status of the infants, and the degree to which other nutrition and health messages are included in the programme[8].

Children mostly during their second year of life

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are physically positioned to consume those that are readily available at home but most infants from 6 to 11 months require special foods with liquid or semisolid consistency[8]. Mothers who practice timely introduction of complementary feed felt that their children would be free from any ailments and they even felt relaxed and were comfortable of getting more sleep at night. Complementary feeding approaches encompass wider interventions structured to improve not only the quality and quantity of the feed but also on improving feeding behaviours[4].

Mothers who introduced a semi-solid feed felt that health workers, anganwadi workers and doctors approved them of timely initiating a complementary feed. Mothers who initiated complementary feed responded that good contacts with service providers like anganwadi workers and ASHA workers helped them.

WHO/FAO requirements consider that there is deficient intake of vitamin A, vitamin C, folate, thiamine, and calcium in many developingcountries[8]. In India, plantbased complementary feeds are promoted predominantly, which by themselves are insufficient to meet the needs for certain nutrients (particularly iron, zinc, and calcium) during the period of complementary feeding[8].

Moreover complementary

feeding may sometimes unintentionally compromise breastfeeding therefore a comprehensive approach is necessary to address the full range of child-feeding practice.

Under nutrition is an indirect cause of childhood mortality and morbidity in low and middle income countries[4].

Mothers who did not practice complementary feeding appear weak or anaemic and lacked confidence. Some mothers felt that child’s health will be at risk if they start complementary feed in 6 month. Mothers who failed to initiate complementary feed felt that their husband and father in law disapproves the starting of semi-solid feeds.

However they strongly felt that timely introduction of semi-solid feed is very likely to prevent her child becoming malnourished. Children might even have adverse effects on their nutritional status if the food is contaminated and are vulnerable to greater morbidity. It is therefore essential to inculcate a behaviour of addressing factors associated with sub-optimal complementary feeding practices. This include maternal characteristics such as age, occupation, and education level; antenatal and maternal health care; health education and media exposure; socioeconomic status and area of residence; and the child’s characteristics including birth weight, method of delivery, birth order, and the use of

World Vision India

pacifiers[5]. The influence of old family members in the family (like mother in law or father in law) and their poor knowledge about complementary feeding also prevents the mothers from practicing the behaviour. About 65 percent mothers who did not initiate a complementary

feed felt that their gods do not approve them of initiating complementary feed. Some women started to give complementary feed like tea, milk and biscuits before 6 months. But they failed to start semi-solid food as they believe that the child may fall sick or get diarrhoea. Mothers who

participated in the study felt that complementary feeding is important but they also felt family support is needed to do so.

CONCLUSION Uncertainty still exists on how to improve nutritional status among children in their critical age of growth between 6-24 months. Barrier analysis helps to design the behaviour change framework and formulate activities to address the barriers identified.

It is also important to carefully address mothers and family

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members on the need to introduce complementary feed timely. Cultural differences and availability of food are also specific areas for behavioural change communication. On identifying nutritionally optimal and culturally acceptable complementary feeds, there is a need to develop strategies for implementing such diets.

Collective involvement of personnel from the fields of health education and social science and community members will make a difference in overcoming the identified barriers.

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[1] K. G. Dewey, “Nutrition, Growth, and Complementary Feeding of The Breastfed Infant,” Pediatr. Clin. North Am., vol. 48, no. 1, pp. 87–104, 2001.

[2] D. K, “Guiding principles for complementary feeding of the breast-fed child.”Washington D.C. Pan American Health Organisation [PAHO] Division of Health Promotion and Protection Food and Nutrition Programme [2002].

[3] K. G. Dewey and S. Adu-Afarwuah, “Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries,” Matern.

Child Nutr., vol. 4, no. s1, pp. 24–85, Apr. 2008.

[4] A. Imdad, M.Y.Yakoob, and Z. A. Bhutta, “Impact of maternal education about complementary feeding and provision of complementary foods on child growth in

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developing countries,” BMC Public Health, vol.

11, no. Suppl 3, p. S25, 2011.

[5] E.W. Kimani-Murage, N. J. Madise, and J.-C. Fotso, “Patterns and determinants of breastfeeding and complementary feeding practices in urban informal settlements, Nairobi Kenya,” BMC Public Health, vol. 11, no.

1, p. 396, Dec. 2011.

[6] L.T. Hop, R. Gross,T. Giay, S. Sastroamidjojo, W. Schultink, and N.T. Lang, “Premature complementary feeding is associated with poorer growth of vietnamese children.,” J. Nutr., vol. 130, no. 11, pp. 2683–90, Nov. 2000.

[7] R. J. Cohen, K. H. Brown, K. G. Dewey, J. Canahuati, and L. Landa Rivera, “Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras,” Lancet, vol. 344, no. 8918, pp.

288–293, 1994.

[8] K. G. Dewey and K. H. Brown, “Update on Technical Issues concerning Complementary Feeding of Young Children in Developing Countries and Implications for Intervention Programmes,” Food Nutr. Bull., vol. 24, no. 1, pp. 5–28, Mar. 2003.

[9] R. Bezner Kerr, L. Dakishoni, L. Shumba, R. Msachi, and M. Chirwa, “‘We Grandmothers Know Plenty’: Breastfeeding, complementary feeding and the multifaceted role of grandmothers in Malawi,” Soc. Sci. Med., vol.

66, no. 5, pp. 1095–1105, 2008.

[10] K. F. Michaelsen and H. Friis, “Complementary feeding: a global perspective,” Nutrition, vol. 14, no. 10, pp.

763–766, 1998.

World Vision India

Authors: Praveen Kumar, Sarojitha Arokiaraj

IMPACT REPORT Impact of World Vision India’s work through Indore Area Development Programme

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This report highlights the changes that were brought about in 27 slums of Indore city through World Vision India’s work from 2007-2016.

The results of this report

would be able to guide our response to poverty in other urban locations. By improving livelihood options, engaging the youth, improving access to healthcare and the quality

of education provided, building community based organisations and working with other partners, the project was able to bring sustainable changes.

Introduction Madhya Pradesh is the second largest state in India. 27.63% of its total population lives in urban regions with Indore being the most populous and largest city. According to Census 2011, the Indore Metropolitan Region had a population of 2,170,295.

World Vision India started working in the slums of Khajarana area in the city of Indore in 2007. These slums,

besides being in the periphery of the city, also faced major infrastructural challenges.

Communities were living in poverty situations as their sources of livelihood was irregular. Their main sources of income were from petty businesses, home-based enterprises, daily wage labour and income from child labour. Lack of access to healthcare, education and other services like water,

sanitation, electricity and proper roads made them even more vulnerable.

Through interventions in the areas of health, education and economic development, World Vision India was able to journey with the community till 2016 to improve the well being of children and bring about changes.

What did World Vision India do in Indore?

Since the initiation of its work in Indore, World Vision India has worked in these slums so that boys and girls, their families and the communities move towards achieving fullness of life with dignity, justice, peace and hope. This was achieved by focussing on the following: Enhanced economic well being of the families Children well nourished and protected from disease

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Children accessing and completing basic education and children reading, writing and using numeracy skills Communities having a protective environment, ensuring child well being, survival and development These goals were achieved through partnering with various Government departments, Civil Society Organisations (CSOs), Community based organisations, Self Help

Groups, Children’s clubs and Corporates. The first two years were spent in assessing the local situation, talking to the communities and to the local Government to identify the nature of interventions that were required to promote child well being.

In 2009, a baseline survey was conducted to assess the status of households so that the progress made can be measured. Periodic monitoring was done to track the progress made against the baseline status.

World Vision India

Stories of change Weconomy: A new start to empowerment “Earlier I never went to the market for shopping alone.

Most of us were afraid to go out alone and so we used to go in a group of 4 to 5.

But now I go to the market by myself and buy things”, Mariam B said. The confidence in her voice would make one believe that here is a woman who has finally found her place in her family and society.

mechanic and earns around Rs 3000 per month. When faced with urgent, financial challenges they had to borrow money at very high interest rates. “After we started the SHG, we have stopped borrowing money from them.

Now we help each other through the SHG. I am also able to earn and support my husband,” she said.

These days 50-year-old Mariam often goes to the market to buy raw materials like clothes and jewellery products. Mariam is the president of Khwaja Garib Nawab self-help group (SHG) in Manseb Nagar, Indore.

As part of the ‘Weconomy Start’ programme, the SHG is engaged in making different products like folders, cloth bags, laptop bags, clothes, photo frames, jewellery, etc.

Weconomy Start is a global innovation programme for Finnish companies and low-income communities, to facilitate interaction and co-creation between them

by World Vision Finland in collaboration with Aalto University and Finpro. It helps companies and low-income communities to build and grow sustainable business that solves economical, ecological and social challenges and creates profits. Companies develop new service and

Mariam’s husband is a

product business models together with end users, facilitated by top specialists in this field.

Talking of the programme, Mariam said, “we have sent our first sample products to Finland and we are very excited about it. The opportunities and hope it can bring to our community will be big. If we get more business, we will also invite many other women in the community to join us and live a better life.”

“We are willing to learn more skills and undergo trainings so we can produce better products that can not only compete in Indian market but abroad also. Through Weconomy, women like us and many more in the community will find selfconfidence and economic stability,” Mariam asserted.

Impact of interventions To measure the impact World Vision India has made in the nine years of its work in these communities, an evaluation was undertaken. The following are the results / impact that the evaluation process has measured. Using appropriate

Keystone | August 2017

tools, the evaluation sought to look at four aspects - Health, Education, Child Protection & Participation and Livelihood development, which had the most investment of time and resources over the years - in order to carry out a

meaningful investigation in the given time frame. Outcome level indicators were measured and were reported along with baseline values.

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Breadth of Impact World Vision India worked with the women, young persons and the children in 27 slums in Khajarana Area, Indore city covering approximately 43,000 people. The communities predominantly belonged to the Muslim and Hindu religions, In these slums, the ADP worked with the most

vulnerable children, especially girls, women, young people, people living with HIV and AIDS, persons with disability, households led by women and families below poverty line.

The ADP addressed the issues affecting the communities by working with 90 Self Help Groups, 65 Children clubs and 3 Child protection units. 44 remedial

educational centres catered to the educational needs of children. They also worked closely with 16 Anganwadi centres, 8 government primary and middle schools, Anganwadi workers, ANM, and school management committees, Disabled People’s Organisation and other NGOs.

Depth of Impact Health

Some of the issues regarding health that were identified when WV India started its work were malnutrition, poor immunisation, poor access to health care services, dependence on quacks for health care treatment, inadequate health workers and infrastructure and poor access to clean water and sanitation. As per the baseline data in 2009, only 26% of children were immunised and more than 50% of children were malnourished.

Through activities like capacity building of healthcare and anganwadi workers, TTC ; PD Hearth, Health camps for children, Infrastructural improvement of anganwadi centres, nutrition supplement for malnourished children, providing access to water and distribution of mosquito nets, the project was able to make substantial changes in the health status of the communities.

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Changes observed: Timed and targeted counseling (ttC) refers to a one of the core approaches of World Vision’s Global Health and Nutrition Strategy known as 7-11. This is built around evidence-based, cost effective key interventions for pregnant women and children under two that, when taken together, can significantly reduce maternal and infant/young child morbidity and mortality.

PD/Hearth is a communitybased rehabilitation and behaviour change intervention for families with underweight preschool children. The ‘positive deviance’ approach is used to identify behaviours practiced by the mothers or caretakers of well-nourished children from poor families and to transfer such positive practices to others in the community with malnourished children.

There is a significant increase in the coverage of immunisation of children below the age of 24 months by 53.13% over a period of 7 years of programme intervention.

There is a 11% point increase over the same period (from 82% to 93%) among those who opted for Institutional delivery during their last child’s birth.

There is considerable reduction in Stunting (13% points), Wasting (39% points) and Under-weight (22% points) between the period 2009 & 2016.

There is an increase (13% points) in the use of ORS by mothers or caregivers when children under 5 yrs. had an episode of diarrhoea.

World Vision India

Education Being in the fringes of the city, the community had poor access to good education.

High rates of drop out, gender discrimination in providing education, early marriages, lack of community participation, poor quality education, high cost of private education and poor infrastructure, difficulty in transitioning from Urdu medium to Hindi for higher education, presence of highway causing challenges of crossing the road etc, contributed to poor education status of children in this community.

assistance and special coaching assistance, set up Remedial Education Centres, provided financial assistance for higher education through Self Help Groups, strengthened child protection units, organised camps for children and improved infrastructural facilities in the school.

25% points increase between 2013 & 2016, among children who complete at least six years of primary schooling in a structured learning environment.

More than 80% of the youth are enrolled in a school or pursuing technical / skill education.

Changes observed: 30 % point increase in school enrolment in the age group of 6 to 18 yrs, 31% point increase in school enrolment (12-18yrs), 30% point increase in school enrolment (6-11yrs). After class 5 drop out decreased by 17% points for both boys and girls.

World Vision India created awareness on education, provided educational

Between the years 2009 to 2016; 471 Youth have been trained in various skills, 1382 children had undergone career guidance and 305 children were supported with special coaching for better performance.

School Enrollment (%) 93 79 63 48

2013 2016

Children ages 6-11 years Children ages 12-17 years

% OF CHILDREN AGES 12 - 18 YEARS COMPLETED AT LEAST SIX YEARS OF PRIMARY SCHOOLING IN A STRUCTURED LEARNING ENVIRONMENT 87

62

Baseline 2013

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Endline 2016

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Child Protection Community was not aware of various vulnerabilities that the children were exposed to. Child labour, child sexual abuse, early marriage were some of the issues that the community were confronted with. Initiatives like formation of Child Protection Units, Life School for Transformational Development, Children Clubs, awareness education on child rights, networking with Government and other partners have contributed to increased protection for children.

Some of the changes seen were; 90.5% of the Youth (I2-18 yrs.) know of the presence

of services and mechanisms to receive and respond to reports of abuse, neglect, exploitation or violence against children.

89% of children between 12-18 yrs. are able to express three personal safety methods & three sources of help if they are in danger.

58% of youth have a strong connection with their caregiver. 70% of the parents or caregivers feel that their community is a safe place for children.

system of informal or formal protection or justice systems are functional.

43% points increase of HHs who have said that there is a functional system like CPU (Child Protection Unit) in the community to protect their children and respond to violation of children’s rights.

SHG and CPU members are aware of child rights and Child line facility and services provided.

99.59% of the community members reported that

Livelihood The communities were mostly daily wage labourers.Young people lacked needed skills and children dropped out of school and began work early to supplement family income.

Lack of access to credit sources meant depending on money lenders. Awareness regarding Government services was also poor.

The interventions to improve their livelihood made tremendous changes in their lives. Economic assistance for starting small businesses, training for youth, efficient Self Help Groups, networking with Government and corporates improved the standard of living of these communities.

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There is considerable decrease (46%) in HHs who earlier worked as casual labourers.

Percentage of HHs involved is petty business has increased (14% Points) There is an increase (26% points) in HHs with Skilled labour.

There is also a clear trend in increased income of HHs in the target communities.

About 56% of the HHs who had annual income between Rs.15,000/- to Rs.90,000/moved to an enhanced amount of Rs.90,000/- and above, inclusive of 43% of

HH who earn an annual income of Rs.1,00,000.

The ladder of life exercise conducted in the communities of Indore ADP, indicates a massive reduction of poorest households (62% to 34%).

Access to credit reduced the dependence on money lenders and families resorted to formal sources of credit (Government schemes & Banks)

World Vision India

IMPACT OF ECONOMIC ASSISTANCE

HHs having increase in the no. of earning (%) HHs having increase in annual income(%)

GRAPH

HHs habing increase in income source (%) HHs having an increase in production of goods(%)

HHs having alternale sources of income to rely on (%) 0

20

40

60

80

100

120

SHIFT IN LIVELIHOOD AS A RESULT OF ECONOMIC ASSISTANCE (%) Before recieving assistance After recieving assistance

55

53

33 27 19 9

Causal labour/Daily wage worker

Petty/ Small business

Skilled labour

Sustainability of Impact Many families are able to provide medical treatment, clothing and food for children. The communities have begun seeking medical treatment from the improved government services. The families now use their income for children’s education, repaying loans and improving their living conditions.

Enrolment in schools has improved and the young

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people now have access to skill training through Skill India programme. Many are pursuing professional courses. The SHGs and Child Protection Units are strong and have continued to respond to various issues that the children and communities face. They have utilised facilities like Child Line and there are many instances where the communities

and the CPUs have acted upon issues of child right violations and violence against women. Children clubs are also connected with Child Line. The communities are linked with the Government services providers and are aware of sources of help.

The communities expressed confidence.

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Child Protection Unit rescues children.

Six year old Shiva and his four year old sister Archana from Dheeraj Nagar were kidnapped when they went to dispose garbage in a nearby bin. Since the children were missing for some time, the local CPU quickly acted and along with Child Line and Local Police Station. Through efficient action of the Police, the children were rescued in another city, Ujjain, 50 kms away from the community.

A big racquet of kidnappers was disclosed by this incident.

Finally both of the children were saved and parents are very happy. The active presence of Child Protection Unit has enabled the protection of many children in the state of Madhya Pradesh.

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World Vision India

Quality of Evidence The methodology comprised of three parts, first a household survey, second

a validation by carrying out qualitative data collection, and then triangulate with opinion

from staff and validation comment from the community.

Quantitative data includes the following: House hold survey: A quantitative survey of 450 households using the 30 cluster sampling methodology was carried out.

Also a 30% sample of the HHs who had received economic development assistance was interviewed using a tailor made questionnaire tool to gauge the impact.

Other Tools: FLAT Tool & YHBS Tool

Qualitative data collection tools are: Focus Group Discussions; Key Informant Interviews; River of life, Ladder of Life, Most Significant Change Stories, Stakeholder meetings.

Conclusions World Vision India’s presence in these communities in the last nine years has left behind sustainable improvements.

Initiatives to create a steady source of income, creating better access to services for children’s health and education and creating more income generation opportunities for the women and young people have led them to create a better life for their households and communities. Working

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closely with the community based organisations, the Government service providers and other organisations have contributed to the process of change. An NGO Alliance has been newly formed on the initiative of WV India and this has enormous potential to leverage resources and services from like-minded NGOs and Govt, to raise the issues of community with greater support.

A deliberate effort to measure the progress at critical stages meant that the organisation along with the communities was able to constantly learn and improve. Relevance of initiatives to community needs and working through the community based organisations, other CSOs and Government has ensured more sustainable change in the lives of children.

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ABOUT US World Vision is one of the world’s leading child-focused humanitarian organisations.

Through development, relief and advocacy, we pursue fullness of life for every child by serving the poor and oppressed regardless of religion, race, ethnicity or gender as a demonstration of God’s unconditional love for all people. With nearly 65 years of experience in India, World Vision works in 185 districts impacting 26 lakh children and their families in over 6200 communities spread across 26 states of India.

Strategy and Research Management, World Vision India For feedback and queries, contact: bestin_samuel@wvi.org

World Vision India, #16 VOC Main Road, Kodambakkam, Chennai, Tamil Nadu 600 024 www.worldvision.in | twitter.com/wvindia | fb.com/worldvisionindia | worldvision.in/blog | instagr.am/worldvisionindia | youtube.com/worldvisionindiaweb

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World Vision India