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EXPERIENCE SHARING AND

LEARNING WORKSHOP STOP DIARRHOEA INITIATIVE

May 30, 2017

India Habitat Center, New Delhi

Experience Sharing and Learning Workshop Page 2

Table of Contents

S. No. Session Topic Page

Number

1 Acronyms 3

2 Executive Summary 4-5

3 Welcome Address and Context Setting 7

4 Stop Diarrhoea Initiative - Mid Term Progress 7-8

5 National Perspective on Diarrhoea Management 9-10

6 Special Address 10

7 Closing Remarks 10-11

8 Panel Discussion - I

Low coverage to Zinc- Key challenges and possible solutions 13-16

9 Panel Discussion –II

Current challenges in achieving ODF and possible solutions 17-20

10 Taking the SDI forward and Vote of Thanks 20

11 Key Recommendations 21

12 ANNEXURE A: Mid Term Progress in Key Performance Indicators 22-23

13 ANNEXURE B: Agenda – Experience Sharing and Learning Workshop 24


Acronyms ANM Auxiliary Nurse Midwife

ASHA Accredited Social Health Activist

AWW Anganwadi Worker

BCC Behaviour Change Communication

CHAI Clinton Health Access Initiatives

CLTS Community Led Total Sanitation

CMO Chief Medical Officer

CSO Civil Society Organization

DUSIB Delhi Urban Shelter Institutional Board

FLW Field Level Worker

GoI Government of India

GP Gram Panchayat

IDCF Intensive Diarrhoea Control Fortnight

IEC Information Education Communication

IMR Infant Mortality Rate

M&E Monitoring and Evaluation

MCD Municipal Corporation of Delhi

MGNREGA Mahatma Gandhi National Rural Employment Guarantee Act

MO Medical Officer

MoHFW Ministry of Health and Family Welfare

MoWCD Ministry of Women and Child Development

NFHS National Family Health Survey

NGO Non-Government Organization

NHM National Health Mission

ODF Open Defecation Free

ORS Oral Rehydration Salt

ORT Oral Rehydration Therapy

PRI Panchayati Raj Institution

RB Reckitt Benckiser

SBA Swachh Bharat Abhiyan (Clean India Mission)

STC Save the Children

TAG Technical Advisory Group

U5 Under 5 children

UP Uttar Pradesh

VHNSC Village Health Nutrition and Sanitation Committee

VWSC Village Water and Sanitation Committee

WASH Water, Sanitation and Health


Executive Summary

Context

The experience sharing and learning workshop was organized by Save the Children with the objective to

share the mid-term progress and learning under its Stop Diarrhoea Initiative project with key

government departments, various civil society organizations, NGO partners etc.

Save the Children partnership with Reckitt and Benckiser (RB) was highlighted for a program especially

focused on Water, Sanitation and Hygiene in 2012, which further provided the genesis of Stop

Diarrhoea Initiative project in 2015, focused on WHO-UNICEF 7 Point Plan to prevent and control

diarrhoea.

A brief introduction about Stop Diarrhoea Initiative and the progress made by the programme by mid-

year of the period was shared with the participants. Various facts related to childhood mortality due to

diarrhoea globally as well as in India were highlighted with the participants. States with high prevalence

of diarrhoea as per National Family Health Survey (2015-16) were also focused.

Midterm progress against targets of key performance indicators (KPIs) were shared with the participants

and key priorities and challenges were discussed like i) Zinc and ORS coverage; ii) Roll out of Rotavirus

vaccine in SDI project locations; iii) Behavior change methods for community to attain ODF; iv)

Integration and synergy between major departments for combating diarrhoea effectively.

Key speakers of the inaugural session, Dr. Ajay Khera from MoHFW and Dr. Dinesh Chand from

MDWS shared the perspective of ministries on diarrhoea prevention and control. Dr. Khera shared

about Intensified Diarrhoea Control Fortnight (IDCF), a specific campaign on diarrhoea prevention and

control through which GoI was able to reach 56 million children last year. GoI efforts for availability of

Zinc tablets for every child and the new specific guidelines to strengthen the hospital for hospitalization

of children with dehydration and pneumonia were discussed. GoI perspective on expansion of Rotavirus

vaccine in the country in phased manner was also explained.

Dr. Chand emphasized that diarrhoea prevention and control is not just the task for Health department,

but all the related departments should get together with a common objective. He shared that MDWS is

planning to have solid waste management system in place especially in rural areas. However, for

behavior change of the community, which is a key task, NGOs and other agencies efforts are required.

Key Discussion

Two panel discussions with the themes i) Low coverage to Zinc- Key challenges and possible solutions and ii)

Current challenges in achieving ODF and possible solutions were organised during the workshop. Key issues

and concerns raised by the panel members of the following panel discussions were:

Low coverage to Zinc- Key challenges and possible solutions

a) Full compliance of zinc is a problem. It doesn’t prevent dehydration as ORS does; hence the

condition of the child does not significantly affected by zinc. Neither does zinc effectively help the

child to regain energy nor does it stop diarrhoea immediately. On the other hand, perceptions

about antibacterial and anti-diarrhoeal drugs helps to stop diarrhoea immediately is high and is

readily available over the counter and prescribed by local/ private practitioners.

b) Supply of zinc all year round in the state and compliance of zinc for 14 days by mothers were

identified as the key problems in zinc usage.


c) Mothers who have children suffering from diarrhoea want the diarrhoea to stop immediately, hence

medical officers encourage the usage of antibiotics and anti-diarrhoeal drugs.

d) Requirement of regular training of the frontline workers on diarrhoea management and usage of

ORS and zinc.

e) Usage of mass media on specific messaging over zinc.

f) Concern raised on remuneration of ASHAs by GoI on diarrhoea case identification and ORS and

zinc compliance

Current challenges in achieving ODF and possible solutions

a) Both hardware and software were focused for effective sanitation. b) Significance of solid waste management was discussed to keep the drains in slums free flowing which

are generally blocked by solid waste from households

c) Requirement of certain processes was explained to change the social acceptability of OD which is

being practiced since long period.

d) Challenges due to which OD is happening i.e. 1) Availability of enough infrastructure 2) Community

mindset to accept OD were discussed.

e) Various success stories on ODF in Uttar Pradesh, Rajasthan, and Uttarakhand were shared with the

participants. Uttarakhand is going to be declared 4th ODF state in the country.

Key Recommendations

Following key recommendations were provided by the panel members as well as the audience.

Correct communication and usage of mass media to increase the acceptability and compliance of

zinc.

Looking into available evidence of zinc inducing vomiting in children older and six months,

communication around the same may help in increasing compliance.

Problems of procurement and supply as well as promotion around zinc needs to be addressed.

Medical officers to prescribe zinc for children in cases of diarrhoea.

Counseling of mothers on zinc by FLWs.

Making zinc available in the rural areas all-round the year.

Remuneration of ASHA for ORS and zinc compliance can be looked.

Compliance of zinc syrups better than zinc tablets. GoI may look into the same for a change in

strategy, if feasible.

Innovative technologies around mobile toilet settings can be used in urban slums where setting up

permanent structured toilets are not possible

Structures provided to households should be of improved quality as per the family needs for better

usage. Counseling on usage is very important

Engagement with children as change agents as they are the best advocates for their parents and

community


Inaugural Session


Welcome Address and Context Setting:

All the dignitaries and participants of the workshop especially from Government departments, Civil

Society Organizations, Implementing partners etc. were welcomed by Ms. Bidisha Pillai, Director Policy,

Programme Impact, Save the Children India. She first focused about the strategy, adopted by Save the

Children in 2016, to achieve following 3 breakthroughs, aligned with SDGs, for children by 2030.

a. To ensure that no child dies of preventable causes under the age of 5 years;

b. To ensure all children have access to and learn quality basic education;

c. To ensure violence against children is no longer tolerated.

She shared the following key points

1) Emphasized on the severity of diarrhoea

making it the 2nd major cause of under-

five child hood mortality in India as well

as globally.

2) Highlighted on partnership of Save the

Children with Reckitt and Benckiser

(RB) in 2012 with a program especially

focused on Water, Sanitation and

Hygiene which was very much focused

on access to clean drinking water,

access to sanitation and promotion of

good hygiene practices. However, Save

the Children realized that WASH could not be sufficient to control diarrhoea related deaths

thus this provided the genesis of Stop Diarrhoea Initiative project in 2015 which was focused on

WHO-UNICEF 7 Point Plan to prevent and control diarrhoea.

3) Pointed out the need to focus on Zinc which has a major concern of availability and supply.

4) Expressed gratitude to Government for being very supportive and collaborative to Save the

Children especially ministries of Health and Family Welfare, Education, Panchayati Raj etc.

5) Assured that SDI would not be just an intervention but would be ensured that it becomes the

part for the next generation and adults and spreads much wider.

Mid Term Progress – Stop Diarrhoea Initiative

A brief introduction about Stop Diarrhoea Initiative and the progress made by the programme by mid-

year of the period was shared by Dr. O.P. Singh, Team Leader, Stop Diarrhoea Initiative, Save the

Children India.

Dr. Singh highlighted the following key facts and issues:

1. Almost 64 children die per hour globally while it is 13 in India.

2. Eighty percent of these children die before 2 years of life.

3. Focused on States with high prevalence of diarrhoea as per National Family Health Survey

(2015-16)


4. Current trend of usage of Zinc and ORS is

not much encouraging, thus require more

efforts on it.

5. Explained each approach of 7 point plan i.e.

Treatment with ORS and Zinc, breastfeeding,

immunisation, hand washing with soap,

community wide sanitation, access to safe

drinking water attributing to reduction in the

prevalence of diarrhoea.

6. Shared the results of midterm progress against targets of key performance indicators.

Access of households to improved source of drinking water has increased from 42.1% in year I to 55.1%

in year II

Access of households to improved latrine/ flush toilets has increased to 57.9 % in year II from 39.4% of

year I.

Knowledge and practice of community workers on WASH according to national guidelines has shown an

increase from 42.9 % to 47.1 % from year I to II.

Percentage of front line health workers managing diarrhoea according to Government of India guidelines

has shown an increase from 72% in year I to 77.2% in year.

Percentage of fully immunized children as per the EPI schedule has gone up from 21% in year I to 62%

in year II.

Treatment of children under five suffering from diarrhoea with both ORS and Zinc has also shown a

slight increase from 7.1% in year 1 to 7.8%.

Percentage of households who could identify diarrhoea and its associated risk factors is 69.1% in year II

as against 48.7 % in year I.

Percentage of schools with effective participation of children has increased from 23 per cent in year I to

47.3 per cent.

Percentage of health plans & programme documents developed with active participation and

consultation from community Ward Health Committee/WASH committee and CSOs increased from

28.9% in last to 52.5%.

7. Highlighted the key priorities and challenges:

a. Zinc and ORS coverage:

b. Roll out of Rotavirus vaccine in SDI project locations

c. Open Defecation Free: Need to work on longer behavior change methods for

community for changing their behavior and practices.

d. Integration and synergy between major departments like Health, Education. Women and

Child Development, Drinking Water and Sanitation and Panchayati Raj which would really be effective in combating diarrhoea.


National Perspective on Diarrhoea Management

Government of India perspective on diarrhoea management was shared by Dr. Ajay Khera, Deputy

Commissioner, In-charge Child Health, Ministry of Health and Family Welfare.

Dr. Khera first congratulated Save the Children to take up an initiative to address the issues of

diarrhoea. He focused on the following key points:

1) Despite number of efforts in direction to

reduce the prevalence of diarrhoea, which brought

substantial changes in child mortality, still around

lakh of children attribute to diarrhoeal deaths.

2) Availability and usage of ORS and Zinc

during diarrhoeal episodes is a challenge. If this

can be achieved for every child, than elimination of

deaths due to diarrhoea can be easily achieved.

3) To address diarrhoea, comprehensive and

holistic approaches are required. It has very close

association with malnutrition. It impacts overall cognition and child development. Thus, in

addition to survival of children, Government of India is now focusing on quality survival of

children.

4) Issues of diarrhoea cannot be dealt only by the health department, thus engagement of other

departments like drinking water and sanitation, Panchayati Raj, engagement of community and

school children would be more effective and would have multiplier effects.

Government of India perspective on Diarrhoea Management

a) GOI has been able to introduce specific campaign on diarrhoea named as Intensified Diarrhoea

Control Fortnight (IDCF). Under this campaign, ASHA visits all the under-five children in her

areas, delivers ORS and provides desired information and counseling. Through this campaign,

GoI was able to reach 56 million children last year, which is 55-56 percent coverage of all under

five children.

b) ORS and Zinc corners were established to demonstrate mothers, the correct process of

preparing ORS as many of them don’t know the correct way of its usage.

c) GoI is making efforts for availability of Zinc tablets for every child once he/she gets an episode

of diarrhoea. This would prevent future episodes of diarrhoea and reduce overall episodes of

illness.

d) Major issues around zinc are related to logistics and supply. GoI would be interested in knowing

whether the issues are related to availability or acceptability of zinc as many of the private

practitioners do not prescribe Zinc. For this awareness and dedicated counseling for health

professionals will be critical to increase zinc usage rate.

e) GoI has come up with specific guidelines to strengthen the hospital for hospitalization of

children with dehydration and pneumonia.

f) Rotavirus vaccine has been introduced in the country and will be expanded in the country in

phased manner. However, campaigns on measles and rubella vaccine (MR vaccine) are going on,

which would have impact on diarrhoea control.


Dr. Khera further shared that GoI is keen to minimize deaths due to diarrhoea and learning from Save

the Children India would be very helpful in strategizing while PIPs are sanctioned.

Special Address by Dr. Dinesh Chand, Additional advisor to Ministry of

Drinking Water and Sanitation

Dr. Chand focused on following key points:

1) Diarrhoea prevention and control is not just the task for Health department, but all the related

departments should get together with a common objective.

2) People residing in many states especially

Uttar Pradesh, Bihar, Madhya Pradesh,

Rajasthan are mostly dependent on hand

pumps and thus disease burden in such

states is high due to mishandling of water.

Even storage of water is a big problem, thus

MDWS has introduced the scheme “Har

Ghar Nal ka Jal” to improve the piped water

supply in households.

3) Save the Children could be an intermediary

organization between MDWS and

Panchayats and community.

4) MDWS has been engaging with other departments like MoHFW and Education department for

these issues.

5) MDWS is also planning in a big way to have solid waste management system in place especially

in rural areas. Government can address the issue of processing the waste and constructing

infrastructures but for behavior change, NGOs and agencies efforts are required.

Closing Remarks

Closing remarks were given by Dr. Rajib Dasgupta, Professor, Center of Social Medicine and

Community Health, JLN University, Delhi.

Dr. Dasgupta raised the following key issues:

1) Access to treatment for acute

diarrhoeal disease is still a problem.

Diarrhoeal deaths still remain a

problem.

2) Lack of access to health services is a

very crucial factor in diarrhoea deaths.

3) Despite the large number of services

being provided under National health

Mission, pockets of exclusion remains,


towards which all the government departments, civil society organizations need to collectively

address the problem. Existence of such pockets means the weak or inadequate accountability

mechanism, which is required to be strengthened.

4) By the end of project, we will be able to document learning from the project and able to come

up with somewhat differently tailored strategy to address the problem in rural and urban areas

differently as similar approaches do not work.

5) It is envisaged that after project period, a system is left with inbuilt strengths and capabilities.

Dr. Dasgupta concluded by focusing on demonstration of some workable multi-sectoral model in SDI

intervention areas and leave the system strong over and above achieving, what has been sought to

achieve.

Play performed by School Children and Key material displayed in workshop

A very creative play was performed by school children. It was based on strengthening the

communication and messaging with the community for prevention and control of diarrhoea.

An exhibition stall was also set- up displaying various key materials about the project and IEC materials.

School Children performing play

IEC material displayed in the workshop


Panel Discussions


Panel Discussion – I: Low coverage to Zinc- Key challenges and possible

solutions

Chair:

1. Dr. Sila Deb, Deputy Commissioner, Child Health, Ministry of Health and Family Welfare,

Govt. of India

Panelists:

2. Dr. Samiran Panda, Scientist- F and Senior Deputy Director, Indian Council Of Medical

Research (ICMR)- National Institute of Cholera and Enteric Diseases (NICED)

3. Dr. Anil K. Verma, General Manager Child Health, National Health Mission, Uttar Pradesh

4. Dr. Vinod Anand, Technical Advisor, Health, Save the Children, India

5. Dr. Naresh Trikha, Clinton Health Access Initiative (CHAI), India

6. Dr. Praful, MO I/C, Laksar, Haridwar, UTK

Dr. Sila Deb first introduced the panelists and moderated the panel discussion.

Key points highlighted by the panelists are as follows:

1. Key points highlighted by Dr. Samiran Panda :

a) Defining of target audiences i.e. children and mothers.

b) Three things that matters most to the mothers whose child is suffering from Diarrhoea

a. Condition of the child should not deteriorate

b. Child should regain energy

c. Diarrhoea should stop


In line with the above perceptions, Zinc

doesn’t prevent dehydration as ORS does;

hence the condition of the child does not

significantly affected by zinc. Neither does

zinc effectively help the child to regain energy

nor does it stop diarrhoea immediately.

Hence the full compliance of zinc is a

problem.

On the other hand the perceptions about

antibacterial and anti-diarrhoeal drugs helps

to stop diarrhoea immediately is high and is

readily available over the counter and

prescribed by local/ private practitioners

c) Zinc being a new entrant in the market its availability in public and private facilities is a

challenge.

d) Treatment modality in case of diarrhoea need to be reemphasized and male participation

needs to be encouraged.

e) Cochrane review in December 2016 cites, although zinc supplementation probably shortens

the average duration of diarrhoea by around 16 hours it increases the risk of vomiting

(moderate certainty evidence) in children older than six months

f) Hence communications around zinc needs to be relooked to avoid the mothers not giving

zinc to their children in spite of having access to it.

II. Key points highlighted by Dr. Anil K. Verma

a) Emphasized on the utility of zinc in diarrhoea

and challenging problems of procurement and

promotion of zinc.

b) Management of acute and moderate to severe

diarrhoea.

c) Acknowledged the challenge of Medical

officers on counselling and prescribing zinc.

d) Emphasized on the importance of counselling

of mothers through frontline health workers.

e) Supply of zinc all year round is an issue in the

state, and compliance of zinc for 14 days by mothers

are also identified problems.

f) Acceptability of zinc tablets at the field is low, zinc being dispersible tablet hence may

breakdown easily if not properly handled.

g) Taste masking of zinc was also proposed to ensure better compliance.

h) Suggested AYUSH medical practitioners to be inducted in IDCF to attain larger coverage and

acceptability.


III. Key Points highlighted by Dr. Praful

a) Mothers not willing to comply with zinc especially for 14 days;

b) Counselling of mothers is key for compliance on ORS and zinc;

c) Availability of zinc is still a challenge in the rural areas all year round.

IV. Key points highlighted by Dr. Naresh Trikha

a) Shared his experience of the diarrhoea

management programme, implemented by

CHAI

b) Cognitive understanding of diarrhoea

low among mothers and caregivers

c) Zinc tablets should be dispersed

within 60 seconds in water which is generally

not the case with from the Govt. supplies.

d) Care seeking pattern of the mothers

and care givers with the local RMPs

e) Zinc is not seen or perceived as

treatment by the mothers and caregivers

f) He emphasized on usage of mass media on specific messaging over zinc

g) ASHAs not currently remunerated by GoI on Diarrhoea case identification and ORS and zinc

compliance

h) Zinc syrup compliance is better than zinc tablets where mothers complain about its taste and

tendency of the children to vomit

i) He also share an internal survey result where about 47% mothers who had their children

suffering from diarrhoea could not identify zinc tablets

V. Key Points shared by Dr. Vinod Anand

a) Mothers who have children suffering from

diarrhoea want the diarrhoea to stop,

which ORS and zinc are not capable of;

hence medical officers encourage the usage

of antibiotics and anti-diarrhoeal drugs.

b) He emphasized on the messaging and

communication with mothers that clearly

state the purpose of ORS and zinc not as

medicines that will stop diarrhoea but will

not deteriorate the child’s condition. It will also help the child recover faster and avoid future

relapses. However, supply issue needs to be addressed by the government.

c) Regular training of the frontline workers required on diarrhoea management and usage of ORS

and zinc.


Dr. Sila Deb summarized the discussion points

and concluded the discussion

a) She acknowledged the fact of noncompliance

of zinc due to long treatment schedule;

b) She emphasized on the correct

communication strategies on zinc, importance

of correct messaging.

c) Acknowledged the role of the informal sector

in promotion of ORS and zinc

Dr. Deb thanked all the panelists for their rich inputs regarding issues around diarrhoea and concluded

the session with a vote of thanks.

Panel Discussion – II: Current challenges in achieving ODF and possible

solutions

Chair:

1. Prof. Vijayaraghavan M Chariar, Professor, IIT Delhi

Panelists:

2. Mr. Sanjay Singh Chauhan, Consultant- Panchayati Raj Dept, Uttar Pradesh

3. Mr. S.K. Mahajan, Chief Engineer, DUSIB

4. Dr. Nabaneeta Rudra, Technical Advisor, Plan India

5. Mr. Shailendra Singh Bisht, Programme coordinator, Swajal, Uttarakhand

6. Col. Prabhat Chaturvedi , Retd. Chief Engineer, DUSIB


Dr. Chariar welcomed all the panel members on the dais. He briefly introduced all the members to the

audience.

Key discussion points highlighted by the panel members are as follows:

I. Mr. Sanjay Singh Chauhan highlighted the following key points:

a) Stressed upon two important things in

sanitation: hardware and software.

b) Mentioned that from last one year, SBM in UP is

gearing up and focusing on CLTS. Many families

in districts like Bijnor and Sahranpur have left

the incentives to construct toilet. They are

constructing the toilets on their own and are

also using them.

c) Shared that around 7000 GPs in Uttar Pradesh

have become ODF till now. From last one year, people are coming forward and behavior change

is actually seen happening on ground. Shamli is the first district in UP which has become Open

Defecation free. In a recent meeting at Varanasi, Hon’ble Chief Minister declared about making

30 districts ODF in this year. However State Government and Central Government do not

have enough funds for it, so it will be done through community incentives.

II. Key Points highlighted by Dr. S.K. Mahajan

a) Shared about the DUSIB’s work in JJ Basti. Last year, a research study was conducted to know

the actual number of open defecation spots in JJ Basti. Study results revealed that there are as

such 253 OD spots in the area. On the basis of this study, gap analysis was done. On an average

there is a ratio of 1:25 toilet for women and 1: 35 toilet for men, so on an average of 1: 30 ratio

was taken and thus the gap of 17000 seats in that area was identified.

b) Slums have been provided with almost

all basic amenities by different departments.

They have been allotted individual water

connections at their doorsteps. After gap

analysis DUSIB started constructing community

toilet complexes (CTC) and rehabilitating

insanitary CTCs. But the big issue in front of

DUSIB was about the usage of these facilities.

DUSIB has created an app and online

monitoring system to strengthen the

monitoring mechanism.

c) Discussed about importance of solid waste management to keep the drains in slums free flowing

which are generally blocked by solid waste from households.


d) Out of total 675 slums, DUSIB has decided to make 52 slums as model slums. Karotiya camp is

the first model slum where people have come forward to make it clean. He concluded by

stressing upon community involvement in making any movement successful.

III. Key points shared Dr. Nabaneeta Rudra

a) Shared that OD is socially acceptable and

being practiced since long period hence

certain processes are required to change it

which needs time and monitoring.

However, open defecation is also happening

at places which have been declared ODF.

b) Mentioned two challenges due to which OD

is happening. 1) Availability of enough

infrastructure 2) Community mindset to

accept OD.

c) OD is ultimately leading to diarrhoea hence it is important to control factors which are

responsible for diarrhoea.

d) Shared about Plan India’s initiatives in Udaipur and Bikaner and their engagement with

community to reach to the root cause of problem.

She concluded by mentioning that behavior change is important in sanitation and retaining behavior

change is further more important.

IV. Key points shared by Mr. Shailendra Singh Bisht

a) Highlighted that India is the largest open defecation country in the world. Around 60% of

population in India is defecating in open. Nigeria is on second position.

b) Shared the problem of non-usage

starts with the kind of facility provided to

them. If people have been provided with

good toilet facility they tend to use it. He

mentioned that two years back, sanitation

coverage in Uttarakhand was 70%. Now,

after Sikkim, Kerala and Himachal,

Uttarakhand will be the fourth state going

to be ODF.

c) Uttarakhand has constructed 5 lakh

80 thousand toilets in last two years. IEC,

IPC and BCC are the key aspects of sanitation and sustainability is equally important. He

stressed upon, to see the socioeconomic and educational profile of any state before launching

IEC for any state. The biggest challenge in ODF is convergence of different departments. To

make Uttarakhand ODF, they adopted multi-pronged strategy.


d) Mentioned four issues which came up during the process were 1) As per baseline, the toilet

construction figure was 5, 90,000; 2) Left out HHs in population growth 3) Defunct toilets

4) who have taken the subsidy under other programme but not constructed toilet.

e) Tapping CSR fund to construct toilets for left outs was also a good strategy according to him.

He mentioned that Save the Children is also constructing toilets, though in small amount, which

helped the Government to reach the goal of ODF.

f) Shared the process of Government’s success in making Uttarakhand ODF. The government

designed a strategy divided into three parts. Statistics were shared with PRIs about their

position in OD at district, block and village level which made them to think to improve their

position. Literate representatives of PRIs were Uttarakhand’s advantage. After 3 months of

continuous rigorous work Uttarakhand is about to be ODF. Uttarakhand prepared a local logo

for SBM, SWACHATA KI UDAAN to bring impact on local people.

g) The strategy of sending post cards to all five lakh families which were addressed by Chief

Minister created wonders. Bulk SMS, documentaries were supplemented in their communication

strategy. Motivation was given to Pradhan and they played an important role in this journey.

Uttarakhand is in state of ODF + now.

h) Providing proper infrastructure is a key to usage as because defunct infrastructure leads to non-

usage.

V. Key points highlighted by Col. Prabhat Chaturvedi

1) Shared about his engagement with Save the

Children since last 5 years. He stressed upon

preventive factors for diarrhoea like

breastfeeding and hand washing.

2) Mentioned 3 suggestions to improve on

WASH:

Engagement with children as they are the

best advocates for their parents and

community.

Engagement with school children to bring

water efficiency. Tell children to prepare

projects to save water

Construction of Sewage treatment plants to treat the sewage coming out from slums

Prof. Vijayaraghavan M Chariar summarized the points shared by the panel members.

a) He focused on identifying the triggering factor for community to make Swacch Bharat Mission

successful. Understanding the context is important before planning any intervention for any

area.

b) Shared that lot of work is required to be done on software side so that hardware can be

utilized.


c) Stressed upon more networking between

CSOs to improve the sanitation status of country and

also significant role of academia.

He concluded the session with Jack smith quote who

heads World Toilet Organization “Toilet is the

cheapest medicine”. Hence everyone should move

towards toilets and more sustainable use of toilets.

Taking the SDI Forward and Vote of Thanks

Dr. Rajesh Khanna, Sr. Technical Advisor, Health and Nutrition, closed the session with his vote of

thanks to all the participants for their participation and involvement in the workshop and making it

successful.

He expressed his gratitude to all the panel members

for presenting their views on burden of diarrhoea in

India and its prevention and control through

engaging and provoking panel discussions.

He shared the vision of Save the Children and

rationale behind implementation of Stop Diarrhoea

Initiative.

He also emphasized on the following key points of

the programme and takeaways from the day

discussions:

a) Comprehensive and integrated approach for diarrhoea prevention and control;

b) Involvement of children as agents of change;

c) Evidence based sustainable, context specific behavior change;

d) Supply side innovations;

e) Involving private sectors;

f) Scale up learning from the project;

He extended a Vote of thanks, for the participants who have travelled from the states and project

locations. He extended his heartiest thanks for representatives from the ministries: Dr. Ajay Khera,

Dr. Sila Deb and Dr. Dinesh Chand. He also extended his gratitude towards Government officials from

the States, Dr. Anil Verma, Mr. Sanjay Singh and participants from Uttarakhand, Delhi and West Bengal.

He thanked all the NGO partners who are directly or indirectly working with Save the Children to

combat diarrhoea and lastly the Stop diarrhoea Initiative project team for their efforts to reach where

they are now. In last, Dr. Khanna promised the gathering to get back to them after the completion of

the project to share project updates and key learnings.


Key recommendations from the panel discussions:

Key issues discussed Key recommendations from the Panelists

1. Low coverage to

Zinc

a. Correct communication and usage of mass media to increase the

acceptability and compliance of zinc.

b. Looking into available evidence of zinc inducing vomiting in children older

and six months, communication around the same may help in increasing

compliance.

c. Male participation needs to be encouraged.

d. Problems of procurement & supply, promotion and phobia around zinc

needs to be addressed.

e. Medical officers to prescribe zinc for children in cases of diarrhoea.

f. Counseling of mothers on zinc by FLWs.

g. Taste masking of zinc tablets to ensure better compliance.

h. Making zinc available in the rural areas all-round the year.

i. Remuneration of ASHA for ORS and zinc compliance can be looked.

j. Compliance of zinc syrups better than zinc tablets. GoI may look into the

same for a change in strategy, if feasible.

2. Achieving ODF and

possible solutions

a. Innovative technologies around mobile toilet settings can be used in

urban slums where setting up permanent structured toilets are not

possible

b. Key focus on personal hygiene behaviors can work wonders if

interventions are planned keeping in minds, local customs, behaviors,

beliefs and practices.

c. Structures provided to households should be of improved quality as per

the family needs for better usage. Counselling on usage is very important

d. Multi-pronged strategy for achieving ODF should be very specific,

considering socio economic, cultural and educational profile of the

community

e. Engagement with children as change agents as they are the best

advocates for their parents and community


ANNEXURE A

Mid Term Progress in Key Performance Indicators

Outcome 1: Access to quality diarrhoea prevention and control services for at least

80% of households in target areas of nine districts by the end of the programme

Outcome 2: Community Awareness and Practices for Prevention and Control of

Diarrhoea in target areas improved

42.1 39.4 42.9

72

21

7.1

60 55 55

75

55

45

55.1 57.9

47.1

77.2

62

7.8

% of householdswith access to

improved source ofdrinking water

% of householdswith access to

improved latrine/flush toilets

% of communityworkers with

Knowledge andpractice on WASH

% of front linehealth workers

managingdiarrhoea

according to GoIguideline

% of children underfive children fullyimmunised as perthe EPI schedule

% of children underfive with diarrhoeatreated with both

ORS and Zinc

Year 1 achievement Year II Target Year II achievement

48.7

23

55

30

69.1

47.3

% o f h o u s e h o l d s w h o c o u l d i d e n t i f y d i a r r h o e a a n d i t s a s s o c i a t e d r i s k f a c t o r s

% o f s c h o o l s w i t h e f f e c t i v e p a r t i c i p a t i o n o f c h i l d r e n i n s c h o o l h e a l t h c l u b s a n d

c o m m i t t e e s

Year 1 achievement Year II SDI Target Year II SDI Achievement


Outcome 3: Provincial, district and community commitment, accountability and

ownership for increased access to diarrhoea prevention and control and scale up at

all levels enhanced by the end of the programme

28.9

22.2

50 50 52.5

55.6

P e r c e n t a g e o f h e a l t h p l a n s & p r o g r a m m e d o c u m e n t s d e v e l o p e d w i t h a c t i v e

p a r t i c i p a t i o n a n d c o n s u l t a t i o n f r o m c o m m u n i t y W a r d H e a l t h C o m m i t t e e / W A S H

c o m m i t t e e a n d C S O s

P e r c e n t a g e o f w a r d s / b l o c k s m a i n t a i n i n g m i n i m u m s t a n d a r d s M I S d a t a q u a l i t y

a c c o r d i n g t o n a t i o n a l g u i d e l i n e

SDI Year I achievement SDI Year II Target SDI Year II Achievement


ANNEXURE B

Stop Diarrhoea Initiative – Experience Sharing and Learning Workshop

Indian Habitat Center, New Delhi

May 30, 2017

Agenda

Particulars Time Speakers

Registration 09:00 AM – 10:00

AM

Inaugural Session

Welcome Address and Context Setting 10:00 AM - 10:10 AM Bidisha Pillai, Director, Policy, Programme and Impact Save the Children,

India

Stop Diarrhoea Initiative - Mid Term Progress 10:10 AM – 10:30 AM Dr. O.P. Singh, Team Leader, Stop Diarrhoea Initiative, Save the

Children, India

National Perspective on Diarrhoea Management 10:30 AM - 10:45 AM Dr. Ajay Khera, Deputy Commissioner, I/C Child Health, Ministry of

Health and Family Welfare, GoI

Special Address 10:45 AM – 11:00 AM Dr. Dinesh Chand, Additional Advisor, Ministry of Drinking Water and Sanitation, GoI

Closing Remarks 11:00 AM - 11:15 AM Dr. Rajib Dasgupta, Professor, Centre of Social Medicine and

Community Health, Jawaharlal Nehru University, Delhi

High Tea and showcasing state wise project interventions – Exhibition display 11:15 AM- 11:45 AM

Discussion Session

Panel Discussion - I

Low coverage to Zinc- Key challenges and

possible solutions

11:45 AM – 12:30 PM

Chair – Dr. Sila Deb, Deputy Commissioner, Child Health, Ministry

of Health and Family Welfare, GoI

Panelists

1. Dr. Samiran Panda, Scientist-F & Senior Deputy Director, ICMR-

NICED

2. Dr. Anil K. Verma, General Manager, Child Health, National

Health Mission, Uttar Pradesh

3. Dr. Praful, , Medical Officer, Laksar, Haridwar, Uttarakhand

4. Dr. Vinod Anand, Technical Advisor, Health, Save the Children,

India

5. Dr. Naresh Trikha, Clinton Health Access Initiative(CHAI), India

Panel Discussion –II

Current challenges in achieving ODF and

possible solutions

12:30 PM – 01:15 PM

Chair – Prof. Vijayaraghavan M Chariar, Professor, IIT

Delhi

Panelists

1. Mr. Shailendra Singh Bisht, State Coordinator SBM,

Dept. of Drinking Water and Sanitation, Uttarakhand

2. Dr. Nabaneeta Rudra, Technical Advisor, WASH,

Plan India

3. Mr. Sanjay Singh Chauhan, State Consultant, SBM,

Department of Panchayati Raj, Govt. of Uttar Pradesh

4. Mr. S.K. Mahajan, Chief Engineer, DUSIB

5. Col. Prabhat Chaturvedi , Retd. Chief Engineer,

DUSIB

Way Forward

Taking the SDI forward 01:15 PM – 01:25 PM Dr. Rajesh Khanna, Sr. Technical Advisor, Health and Nutrition

Vote of Thanks 01:25 PM – 01:30 PM Dr. O.P. Singh, Team Leader, Stop Diarrhoea Initiative

Lunch 01:30 PM – 02:30 PM


Documents

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