Over one million children under the age of five die in India every year. Diarrhoea and pneumonia continue to be major contributors to childhood mortality, representing 36% of under-five deaths in India. Approximately 10% of total under- five deaths (123,668 deaths) are attributed to diarrhoeal diseases resulting in 338 child deaths every day. 80% of these deaths occur in the first two years of a child’s life. The Coverage Evaluation Survey (CES 2009) by the United Nations Children’s Fund (UNICEF) reported that 15.5% of acute diarrhoea cases and 1.7 episodes of diarrhoea per child occur in children under the age of two.

There are an estimated 312 million diarrhoeal episodes in India each year of which 6.7 million are severe episodes. Each episode of diarrhoea contributes to malnutrition in children. In India, around 48% of children are suffering from various degrees of malnutrition, which are largely associated with diarrhoea. These deaths contribute to India’s inability to achieve the Millennium Development Goal (MDG) four target, to reduce deaths to 42 per 1,000 live births by the end of 2015. India’s child mortality is currently at 55 per 1,000 live births. In order to achieve MDG four India needs to address diarrhoeal diseases urgently in children under the age of two.

The World Health Organization (WHO) estimates that 88% of deaths from diarrhoea are attributable to four issues: consumption of unsafe water; inadequate sanitation; poor personal hygiene and the lack of access to childhood immunization as a preventative measure. While India has made considerable progress in increasing access to drinking water sources and immunization through various government programmes, the vast majority of the rural and urban slum population are still drinking unsafe water, and are unaware of the benefits of immunization for their children. For example, the coverage of exclusive breastfeeding of children under the age of six months in Uttarakhand is only 44.8%. The Global Plan of Action Plan for Diarrhoea and Pneumonia (GAPPD) recommends 80% at district level in order to make an impact. Furthermore, poor c

1.3% of children with diarrhoea were treated with Zinc and ORS in rural areas, whilst only 39% of children with diarrhoea in rural areas and 52% of children in urban areas were treated with Oral

Rehydration Salts (ORS).

life-saving treatment measures. For example, only

hildren do not have access to the necessary

This is far off the WHO recommendation that all diarrheal

episodes should be treated with both ORS and Zinc.

To sustainably tackle these issues and eliminate diarrhoea as a public health burden, the WHO and UNICEF have proposed a 7 point plan for diarrhoea prevention and control. The plan is focused upon providing adequate coverage of interventions necessary to eradicate diarrhoea as a public health problem that results in the unnecessary deaths of children under-five. The plan comprises:

1. Treatment package:

•   Fluid replacement to prevent rehydration;
•   Zinc supplementation.2. Prevention:

•   Rotavirus and measles vaccinations;
•   Promotion of early and exclusive breastfeeding;
•   Vitamin A supplementation;
•   Promotion of hand washing with soap;
•   Improved water supply quantity and quality and community wide sanitation promotion.To assist the GoI to tackle diarrhoea as a public health challenge and reduce the number of children who die from this preventable disease, Save the Children, in partnership with the GoI and RB – aim to implement the WHO/UNICEF 7 point plan as a Signature Programme.We envisage the successful delivery of the programme will contribute to:

•   At least a 50 % reduction in the prevalence of diarrhoea amongst children under five by the end of the programme;
•   At least a 50% reduction in the incidence of acute diarrhoea among children under five by the end of the programme from three to four episodes to less than two per year;
•   An estimated 80% reduction in diarrhoea Case Fatality Rate (CFR) in clinics in under five deaths by the end of the programme;
•   13 % across intervention reduction in diarrhoea related deaths amongst children under five by the end of the programme.

With this view Save the Children is working in partnership with IMPART at Udham Singh Nagar district. IMPART is implementing the programme in Sitarganj block of the district. The programme is being implementing phased manner so in this financial year 2016-17 we were working in working 40 gram panchayats of Sitarganj block. The programme is implementing in convergence with different line departments such as health, education, ICDS, panchayati raj institute, swajal, jal nigam & jal sansthan. Through this programme the organization has formed mothers groups, children groups, WASH committee, paraprofessional to achieve the overall goal to reduce the incidences of diarrhoea through community participation and involvement and also strengthening the various committees such as VHSNC, SMCs, etc.

The organization has organized various activities through various social & behavioral approaches like nukkad natak, meetings, participatory trainings, campaigns. The IDCF was one of the major campaign for this programme which was celebrated in collaboration with government departments. Apart from this Global Handwashing Day, World Toilet Day & World Water Day has also been celebrated with the departments as well as with different stakeholders. The children were the major focus for each and every activity so that they can play a vital role of change agent for the community at large.

The output wise details of the activities with coverage are given below:

Output 1.1: Access to safe drinking water increased to 80% of households in the target areas

Save the Children have been trying to established/revitalise the water and sanitation committee in the intervention areas of both the districts. As there is no formal WASH committee formed in the villages so the existing VHSNC is being formalised as a WASH committee in the villages. The project team has identified the non-functional water sources in the intervention areas and based on that 20 sources has been rehabilitated. The water test kits has been procured to test the water points of our intervention areas and also to aim to aware the community based on the results of test.

Further, it has been decided that the laboratory technicians and community workers would be trained on water quality test. After getting the training by LTs and Swachhata Dhoot of the community so that they would be involved in the community for further testing the water points and results have been shared with the community itself and saying not to use the contaminated water.

For which 2 educational campaign has been conducted in both the districts with the aim to make the community aware about the safe water, treatment, chlorination and water handling.

Output 1.2 Access to adequate sanitation increased in at least 80% of households in target areas

After the rapport building with the community and different stakeholders in the new intervention areas Save the Children has started identifying the areas where hardware activities could be started. For this purpose, the community

consultation/meeting, meeting with school authorities & SMCs and Swajal has been conducted so that we could start the hardware activities in the intervention areas. During this reporting period the following construction work has been –

o 5 pilot latrines for the community
o 5 school toilet rehabilitation
o 3 new school sanitary blocks
o 20 individual toilets for most marginalised and disabled communities

However, for doing so Save the Children has motivated &/or convinced the beneficiaries for donating the land for constructing the community managed toilets wherever required. There were many hygiene education meetings with mothers group has been conducted on safe disposal of child faeces and promoting the handwashing with soap so that the community is being aware about the importance of proper disposal of child faeces.

Further, it has also been tried to make the community aware about the importance of ODF. They have been told how the village can be converted as ODF, what is role of community member in this regard. There were 22 such community meeting/nukkad natak has been conducted. Rigorous IEC and BCC has been done for the same which resulted ten gram panchayat has been taken by the Government for declaring as ODF by the effort of Save the Children.

Output 1.3 Knowledge, skills and practices of health facility and community workers improved on diarrhoea prevention and treatment in target areas are improved

Initial assessment of the intervention areas through village survey the information was gathered. Based on this, Save the Children could able to listed out information on various service providers of the community such as laboratory technicians, hand pump masons & mechanics, local engineers, paraprofessional and which has also been checked through meeting with the community and interaction with local panchayats. After the listing Save the Children has discussed with Swajal & Jal Nigam for their support for conducting capacity building of the service providers of the community.

During the reporting period several capacity building training has been conducted such as one training on operational & maintenance of community WASH facilities of local engineer, 4 trainings for handpumps mason & mechanics and also 140 para- professional has been trained on WASH issues and water quality monitoring. These capacity building training helped the beneficiaries working on WASH issues with clear understanding. They have been engaged in our programme through different ways like handpump masons & mechanics been engaged in hardware activities. The local engineers has given the responsibility for O&M of all the WASH facilities which has been constructed and available in the community. The para-professional has been involved in doing the water quality monitoring in the community. This has helped us identifying the water points which is good and which is bad, accordingly the community has been intimated not to use the water point which is bad.

Output 1.4: Access to and utilisation of immunisation (measles and RV and Vitamin A supplementation) services increased for at least 85%

During this reporting period Save the Children could abled negotiate with health department for helping them in different ways like during VHND sites, capacity building of frontline workers on breastfeeding, counselling. In collaboration with block officials the VHNDs have been helped for conducting the ORS demonstration, counselling to mothers on breastfeeding. The frontline worker been trained on IYCF module and counselling on breastfeeding so that the breastfeeding could be started as early as possible after birth and also its proper steps of breastfeeding and its importance. The local private practitioners has been trained on prescribing of ORS & Zinc, the aim of conducting such training was to target the local practitioners as they are the first contact for the community related to any health issues.

It has also been supported the health department for AVDS where they cannot reach in hard to reach areas. So that none of the children been unvaccinated in the operational areas. There were 30 mother to mother support group has been formed in the intervention areas with the objectives to train and aware them about the issues of diarrhoea under 7 point plan.

Save the Children has displayed some IEC materials at the health facilities as well as AWCs on 7 point plan. So that the people can be awared on the issues of diarrhoea. There has been a trained conducted on outreach planning for the ANMs which helped them for making proper planning. The aim of doing such activities is to help them to plan accordingly so that none of the children is unvaccinated in the operational areas.

Output 1.5 Access and utilisation of ORS and Zinc increased to at least 80% in the target areas by the end of the programme
While working the community it is very important to understand the areas properly on diarrhoea as we are working on the issue. For which there was a vulnerability mapping has been conducted on seasonal diarrhoeal outbreak which helped us understanding the areas in more specific ways. Save the Children has conducted ORS demonstration corners both in communities as well as facilities so that the people understand the importance of ORS & Zinc.

Further, the IDCF has been conducted along with it’s followed up. During the event several activities has been conducted such as nukkad nataks, ORS demonstration corners, breastfeeding counselling, wall writing, tabloid with displayed IEC materials, sensitization meeting with the stakeholders and culmination events at the block.

Output 2.1 Community awareness, knowledge and practices on diarrhoea prevention and control improved for at least 80% of households

Based on the trained para-professional in the intervention areas they have been engaged in the concerned villages for meeting or one to one interaction with communities with the objective to make their knowledge improve and aware about the safe water handling, water quality issues as well as community wide sanitation and hygiene.

However, three events has been organised such as Global Hand Washing Day, World Toilet Day and World Water Day. The main aim to organise such events in the intervention areas are to make the community aware regarding the issues so that the incidence of diarrhoea could be reduce. The meeting were also

organised with the mothers group of AWC so that they have been informed about the 7 point plan of diarrhoea prevention and control. There were a huge gathering among all the groups which has been formed in the operational areas such as mothers group, user group, CHHCs and other community stakeholders where they have shared their experiences working with us on WASH issues and also gathered ideas & knowledge how the others are doing.

Participatory training has been organised for the staffs as well as ICDS supervisors. This would helped them to understand approaches of community participation and mobilization while working with the community.

Output 2.2: Effective Participation of Children as Agents of Change for Diarrhoea Prevention and Control increased in at least 80% of villages in target urban and rural locations increased.

Based on the gathered information about the schools, Save the Children conducted several meeting with school authorities and SMC for establishing the CHHCs at the schools. Accordingly the CHHC has been formed in 20 schools of the intervention areas. The purpose of forming these group is to promote the WASH components in the schools. The member of the group has further break in small small groups and given responsibility in each small group.

In the same ways the children from the community gathered together to form CCHCs in the operational areas. The aim is to strengthen and promote the WASH issues in the community itself. As the children could be the main change agent for the community. However, there was a get-together among all the children especially CCHCs, CHHCs and other school children so that they can appraise the other group activities. The idea is to promote the WASH issues in the community through the children.

Output 3.3: Community structures strengthened to influence planning and decision-making at all levels in target districts operationalised

It took some time to access in various department. But after several interaction it could only possible to get access to various stakeholders of the departments and build a good relation with the departments. We have also conducted the capacity building of the VHSNCs on their roles and responsibilities in diarrhoea prevention and control including the importance of ODF. They have been helped in preparing the village plan in the operational areas.

Several entitlements related to health & WASH has been displayed through wall writing. The purpose of doing is to make the community aware about the health & WASH issues. We have also conducted meetings with user group for community managed toilets and SMC for promoting the WASH issues in the school as well as in the community.