Eye care and health are critical issues concerning the basic needs of rural society and need to be addressed as a priority. The vast majority of those living in rural areas continue to lack access to eye care and basic health facilities and services. They are also largely unaware of the services and benefits the government provides and those that they are entitled to. NBJK aims to address this issue by facilitating improved access to eye care and health services, while simultaneously advocating for improved health services in rural areas and influencing policies. NBJK also strives to generate awareness among the rural population.

	Lok Nayak Jai Prakash Eye Hospital
	Mental Health
	Adolescent Health
	Disability Program
	Community Leadership Program

In the state of Jharkhand, there is a large gap between the availability of eye care services and the need for such services. The government is unable to provide an eye surgery facility in most districts and the private sector is also limited in its provision of these facilities. There is only one eye hospital for every one million people. In response, NBJK has established, and continues to manage, two eye hospitals in under-developed regions of the state where 46% of the population is living below the poverty line and 76% live in rural areas and base their livelihood on rain-fed agriculture.

With the support of Sight Savers International, NBJK established the Lok Nayak Jai Prakash Eye Hospital in 2005 in the Bahera village of the Chouparan block in Hazaribag, providing patients with access to high quality eye care services at a minimal cost. This modern facility is well equipped and is managed by a qualified and trained medical staff and experienced doctors. This 40-bed hospital is capable of serving a large population of those in need. Due to the hospital’s location, those from the neighboring districts of Bihar are also able to access the services offered.

In April of 2008, NBJK established the Lok Nayak Jai Prakash Eye Hospital in the Santhal Pargana region of Dumka. With the support of CBM, the hospital provides a wide range of eye care services at a minimal cost. In the Dumka district, charity operations for cataracts and glaucoma are also performed. NBJK also organizes screening camps in remote areas of Jharkhand and Bihar and a satellite center is currently operating in Hazaribag town.

This program has been hugely successful. Each year, the Lok Nayak Jai Prakash Eye Hospitals perform more than 7,000 surgeries, with a success rate of 99%. More than 25,000 OPD services are also performed annually and 150 screening camps are organized.

Giridhar Prajapati is a 60 year-old man residing in the Atka Kumbha village in the district of Churchu. He was working as a hawker in his village and the surrounding areas when he was forced to reduce his work area due to his loss of eyesight. This dramatically restricted his customer base and, as a result, his ability to generate an adequate income to support himself and his business. When Girdihar went to the Lok Nayak Jai Prakash Eye Hospital in Chouparan to have his eyes examined, it was discovered that he was suffering from a very severe case of vision loss due to bilateral cataracts. He had no more sight than the ability to tell light from dark and the general direction of a light source. Following his surgery on August 20th, 2010, Girdhar’s vision was restored to a level of 6/36, a life changing improvement. Giridhar is very thankful and is now able to resume his work on a larger scale.
 

Mental health is an issue that is often not addressed, due to stigma and a lack of awareness. NBJK, with support from Basic Needs India, has developed a mental health program in 16 districts of Jharkhand and Bihar. Under this program, two mental health camps are organized each month, in which medication is distributed free of charge. One is held in Hazaribag and averages an attendance of about 1000 people. The other is held in Kharsawa in the district of Saraikela and is attended by roughly 700 people. Community sensitization efforts are also being made.

The community, parents, and caregivers are provided with information regarding mental health issues in order to raise awareness of mental health. This program also assists those who have recovered from mental illness in livelihood promotion. RINPAS, government of Jharkhand, supports these initiatives through the provision of medications, logistics, and specialists. Private psychiatrists have also contributed their services.
Since the program’s onset, 5860 people with mental illness have been identified, 3489 have been treated, and 3979 have been stabilized. NBJK’s mental health program has also ensured the livelihood of 666 people since its initiation.

Usha Kumari is a twenty-year-old woman residing in Bajania village in the Koderma district. During her final examination of higher secondary, Usha was struck with a severe headache. A marriage was arranged for Usha a few months later and she went to live in the home of her bridegroom and his family, where she took over domestic responsibilities. All was well for approximately one year before Usha became very aggressive. She reportedly abused the family members and tore her clothes. As a result Usha was sent to live with her parents and was locked in a small room in an attempt to conceal her illness. When NBJK staff found Usha, she was in a pathetic condition. She was carried to the mental health camp in Bilharsharif and within one month, her condition improved. Usha was later stabilized and received economic support of 8000 rupees from NBJK in order to establish her own general shop. Usha has also been selected as an Aganwadi Sevika. As a result of NBJK’s intervention, Usha is now a successful, independent woman.
 

The adolescent population is a very vulnerable sector of society when it comes to sexual and reproductive health. Child marriage and premature pregnancy is still prevalent in Jharkhand. Adolescents are also at an increased risk for contracting HIV/AIDS and other sexually transmitted diseases. Many do not have access to accurate information concerning sexual and reproductive health and are often uncomfortable discussing it further with their parents. PHCs and district hospitals do not offer any adolescent friendly training or counseling. Thus, many young people are not provided with vital information.

NBJK has taken great effort to address this issue. The Prayash program was initiated in April 2007 and aims to reduce poverty through the improved sexual and reproductive health status and reduced vulnerability to HIV/AIDS of children and young people, aged 10 to 24, in Jharkhand. Training and capacity building are crucial components of this program. Young people from rural communities are being trained as peer educators in order to disseminate important information throughout their communities. They are trained on topics such as reproductive health, sex and sexuality, and gender and rights. 1400 Peer Educators have already been trained. Self Help Groups and Registered Medical Practitioners are also provided with training on these topics.
Advocacy is another very important aspect of this program and Youth Advocates are trained to represent their communities and to effectively communicate with the government concerning issues resulting from a poorly functioning health care system. Youth Resource Centers are also established in participating villages, in order to provide an environment in which the youth can organize and discuss sexual and reproductive health issues. Different contraceptive methods are available at these centers. 450 Youth Advocates have been trained and 90 Youth Resource Centers have been established.
NBJK has also implemented the Jagriti program; a sustainable community program for improving the sexual and reproductive health of young adults aged 15-30 years. Community motivators and self-help groups were trained and assisted in raising awareness on a number of issues. User cards were also distributed among the target population in order to collect and monitor information concerning sexual and reproductive health.
As a result of NBJK’s adolescent health program, there has been an increase in awareness in the project areas concerning sexual and reproductive health. More people are now informed on the topics of HIV/AIDS, contraceptive use, early marriage, and family planning. This has led to an increase in the use of contraceptives. There has also been an increase in those seeking antenatal and postnatal care. The rate of institutional delivery has also increased. Correlated with these results, is the decrease in infant and maternal mortality rates.

Rekha Devi is a young woman that was married in 2006 to Pradeep Prasad. The couple is living in the village of Harlee in the Hazaribag district, a Jagriti intervention area. Rekha attended an open group discussion on the topic of mother and child health that was organized under this program. She found the information to be very useful and became a regular participant in such SHG meetings, where she learned about hygienic practices and the anatomy and functioning of human reproductive organs. A community motivator also helped Rekha and her husband with family planning. When Rekha became pregnant, she received the proper prenatal care, including immunizations and iron supplements. Her family was very well prepared and took Rekha to the Sadar hospital, 15 km from their village, when she went into labor. The delivery went well and both mother and baby are healthy. As a well-informed mother, Rekha is aware of the immunization schedule and proper nutrition for her child. She is also conscious of the benefits of birth spacing.

A major component of NBJK’s disability program is focused on assisting people with disabilities (PWDs) to access their rights and entitlements under the Persons With Disabilities Act, 1995 (PWD Act). The PWD Act accords many rights and services to PWDs, including free education to the age of 18 years and a 3% quota in government employment. However, there is minimal awareness of these rights and entitlements among the population, including the PWD population. Therefore, NBJK aims to raise awareness of the PWD Act and to enable PWDs to obtain the disability certificate, which allows access to the benefits provided under the act.

 Since the program’s onset, more than 40,000 people have been surveyed, almost 7,000 PWDs are in the process of certification, and more than 2600 people have received certificates. Awareness and advocacy are also important aspects of NBJK’s disability program. A variety of activities, such as street plays and discussions at schools, are arranged to increase awareness and sensitization within the community. In order to advocate for themselves and their rights, PWDs are organized in federations at the block, district, and state level. Aids and appliances and micro credit loans are also provided under this program. 436 aids and appliances have been distributed in the past year, as well as almost Rs. 4,00,000 in loans.
NBJK is also working to establish sustainable services for deaf/blind children in 15 villages in Hazaribag. The objective is to assist these children in becoming more independent in their daily lives. A resource center has been established where the children come for two to three hours, two times a week, for therapy and various other activities to. The staff also provides therapy at the children’s homes two times a week. The parents, who have been trained by the staff, are responsible for working with their children the remaining three days of the week.

Surendra, 13 years-old, dropped out of school after class VII dues to the fact that the high school was located 6 km away from his village of Sagarpur in the Bodhgaya block. Surendra suffers from polio and both of his legs are almost completely defunct. Thus, he was in need of a means of transportation if he was to continue his education. NBJK field workers met with Surendra through a home contact program and were able to convince him to return to school. He was provided with a tricycle and his self-esteem increased. When Surendra and his parents went to the government high school in Bodhgaya to enroll him in class IX, the headmaster rejected his admission, claiming that enrollment was closed. NBJK contacted and obtained the approval of the district education officer but the headmaster held his position. Surendra’s problem was discussed at a federation of people with disabilities meeting. The federation aligned in support and organized a meeting with the headmaster to protest his decision. Surendra was granted admission and now attends high school on his tricycle. In the past year, 370 other children with disabilities have also been enrolled in school as a result of NBJK’s disability program.

The government currently provides a number of public health services but there is a large gap between the needs of communities and service delivery. In an effort to contribute to the development of a self-sustaining model of a quality health service delivery system, NBJK has launched the Community Leadership program. The Jamshetti Tata Trust, Mumbai provides financial support and XISS, Ranchi contributes technical inputs to the CLP. The program strives to facilitate 400 volunteer community leaders, four from each participating panchayat, at the grassroots level to increase the quality and availability of family planning and reproductive health services.

After the completion of the 30-day training program, the community leaders will be well equipped with the knowledge of what health services are available to them and how to demand the provision of these services, enabling them to achieve advancement in the National Rural Health Mission (NHRM) by reducing infant and maternal mortality rates and increasing access to public health services. This program has been implemented in 10 blocks in the Deoghar, Koderma, and Palamu districts of Jharkhand.

Annu Devi, a 26 year-old woman from the Katthadih village of Koderma, has proven herself very courageous. Annu is an active participant of the Community Leadership Program, regularly attending the organized activities. She is also functioning as a Sahiya and assists the women in her community in matters related to reproductive and child health. Annu assists in health center deliveries, immunizations, and blood sample collection for the detection of malaria. After receiving training on the topic of accessing government schemes, Annu took the initiative to have a defunct hand pump in her village repaired. She first applied to the department of public works at the district headquarters to no avail, in spite of persistent follow-up inquiries. She eventually obtained a helpline number and was able to lodge her complaint of behalf of her fellow village members. The hand pump was repaired within two days of the phone call. The people in her village now regard Annu as a community leader.