India
India's population comprises approximately 17.23% of the world's population in only 2.4% of the world's land area, making it the largest democracy in the world. Economic reforms in 1991 transformed India’s economy into the twelfth largest and one of the fastest growing economies in the world. Despite this financial growth, malnutrition is rampant as 46% of children under 5 are underweight. The steady growth of the Indian economy has also been uneven among its 28 states, varying social groups, and between urban and rural areas.
LDM India focused much of its work in the eastern states of Bihar and Jharkand. These rural states are among the poorest in India, as 85% of the population lives in villages. Significant contributing factors for Bihar and Jharkhand’s slow progress include persistent poverty, complex social stratification, lack of infrastructure and poor governance.
The 2009 Global Gender Gap ranked India as 114 of 134 countries in equitable distribution of resources allocated to males and females. This low status of females is also reflected in a low female adult literacy rate and a mere 8% female representation in the 2004 Parliament.
Reproductive Health
The sexual and reproductive health situation in India has experienced major changes during the beginning of the 21st century. The government’s previous approach that focused solely on using family planning to control population growth shifted to an approach encompassing a broader orientation of sexual and reproductive health and rights. This movement has contributed to the following positive changes in India:
- Decreased unmet need for family planning
- Decreased infant mortality by over half
- Enhanced access to skilled attendance at delivery
While urban women have attained replacement fertility, the rate for rural women stands at an average of three children per family. In Bihar, where the majority of the population is rural and over half is under age 25, a critical need for access to family planning services remains.
Critical issues of concern include:
- Stagnating levels of maternal mortality
- Increased spread of HIV
- Compromised exercise of reproductive rights, especially by women and underserved young people.
Progress in Bihar and Jharkhand
Improving Bihar and Jharkhand’s circumstances will require raising public awareness, sensitizing administrators and encouraging private sector involvement in service delivery. Since the launch of the National Rural Health Mission (NRHM) in 2005, the Government of India’s health program for several targeted states, a relatively positive working environment between the government and NGOs exists. The state governments are willing to work with NGOs despite the frustrations inherent in cross-sectoral collaboration and increased public-private partnerships have emerged. While the government is intent on expanding services, there are basic structures that need to be put in place in order for expansion to be successful. The challenge remains for Leadership Fellows to continue to advocate for improved structures that can support the demand for family planning and reproductive health services long after LDM comes to an end.
Leadership for Change
The LDM program in India built a diverse network of over 150 Leadership Fellows from all levels and sectors of Bihar and Jharkhand states. These Leadership Fellows raised awareness, linked demand with service delivery, promoted public-private partnerships for improving the efficacy of reproductive health programs and addressed the underlying causes of poverty. The leaders also engaged in advocacy efforts. They emerged as a strong network that sought and promoted solutions. Leadership Fellows in Jharkhand held a series of awareness raising campaigns on the need for adolescent family planning and reproductive health information and services. Leadership Fellows also gained approval from the Health Department to declare Friday as the “youth friendly service day” in the East Singhbhum district of Jharkhand.
The LDM Program worked to increase consolidation and collective action through embedding individual and organizational leadership training within organizations. LDM supported the efforts of institutions, like Xavier Labour Relations Institutes (XLRI) in Jharkhand, to design and deliver a leadership program for district level public servants who could take a stronger lead to improve reproductive health for women in Jharkhand state. LDM also supported the Network for Enterprise Enhancement and Development Support (NEEDS) in Jharkhand to start work on community leadership programs for youth and GPSVS in North Bihar to create a network of women leaders for leadership development and organizational effectiveness. Furthermore, through partnership with Bihar State Women Development Corporation, LDM institutionalized leadership development training for women leaders at a community level.
Leadership Fellows established three Regional Information Resource and Advocacy Centers (IRACs) to facilitate greater empowerment and self-sufficiency. These Resource Centers were the hubs around which all thematic, institutional development and capacity building activities were planned and managed in collaboration with the LDM Program management. Over the years IRACs coordinated monthly regional meetings of Leadership Fellows to discuss and plan action for various policy implementation related issues, such as strengthening of Village Health & Sanitation Committees (VHSCs), 24x7 PHCs, training of ASHA workers, and youth friendly services. Resource Centers were responsible for managing the RH network website and the publication of bimonthly newsletter “Impression”.
The LDM Team has tried to capture the Leadership Journey of the LDM program in a video, Leadership Journey of Fellows in Bihar & Jharkhand, facilitated by Institute of International Education under the LDM program:
Learn more about India’s Leadership Fellows
To learn more about Leadership Fellows in India, visit Information Resource and Advocacy Centers (IRACs)
Sources:
- The World Bank (2009)
- Population Reference Bureau (2009)
- Wikipedia (2009)