Stakeholder Analysis under Stop Diarrhoea Program
The objective of the analysis was to map the govt. agencies, public health institutions, civil society organizations (CSOs) and other relevant individuals and organizations that have an interest in diarrhoea prevention and control and assess their positions to influence policy/ interventions in this area.The stakeholder analysis exercise through primary and secondary research, has mapped all major players who are engaged in programmes related to diarrhoea prevention and control and whose support is critical to the success of the intervention nationally and in the five states, namely Bihar, Jharkhand, Uttar Pradesh, Uttaranchal (Rural and Urban) and West Bengal (Urban).
The methodology adopted for this exercise was purely qualitative in nature where the identified stakeholders working in field of health, ICDS and water and sanitation were interviewed at national, state, district, block and village levels.This report is an analysis of information collected through interviews with over 160 respondents and a review of several policy documents, implementation plans, approach frameworks, evaluation reports, minutes of meetings and documents written on or about various organizations working in the identified state/ district on diarrhoea, WASH and child health.
- Many stakeholders considered Integrated Global Action Plan for Pneumonia and Diarrhoea as the preferred framework to the 7-point plan.
- There is still a lot of gap between the MOHFW guidelines on inclusion of zinc salts in treatment of diarrhoea and its implementation on ground.
- Rotavirus vaccine is not yet included in the Universal Immunization Programme.
- Staffs in SPMU and DPMU expressed concerns of possible resistance from health workers and community leaders to inclusion of a new vaccine in UIP.
- Except some of the stakeholders outside Govt. working on diarrhoea but there exist no forum for coordinated advocacy or coordinated programming in Diarrhoea.
- Zinc is not considered in the essential drug list, as a result of which it is not mandatory for health facilities to ensure round the clock availability of Zinc salts.
- There is poor availability of Zinc salts across all states and limited to no availability of ORS in some states, due to continued reliance on central procurement, limited supply capacity vis-à-vis requirements, delayed stock ordering and unplanned procurement.
- While the SBM (Urban) roll out has been initiated capacity building and skill development in water and sanitation related areas are not in place yet.
- Many district or block level officials were not updated on guidelines related to child health or WASH.
- MOHFW, MOWCD and MODWS have very deep training infrastructure at national and state levels. The next level of training resources is however weak infrastructural as well as in human resource capacities.
- None of the five State Water and Sanitation Missions (SWSMs) have a comprehensive strategy or a training calendar for its cadres.
- There is urgent need for capacity building and orientation vis-à-vis diarrhoea treatment and WASH practices among implementing functionaries.
- The HMIS is not actively collecting information on diarrhoea incidence.
- All stakeholders from national to state to district expressed the need for intersectoral coordination and sought external assistance to play a catalytic role.
- Swachcha Bharat, Swachcha Vidyalaya campaign is a big initiative being undertaken by Department of School Education to engage children and converging the agenda of Health WASH and Education.
- There is lack of forum for coordinated advocacy.
- Save the Children (SC) engages with primary stakeholders in implementation of IAPPD, like MOHFW, UNICEF and WHO to ensure that the 7-point plan is recommended for diarrhoea programming in the country.
- SC to align MOHFW and SPMUs right from the stage of conceptualising the project.
- SC should initiate evidence based advocacy for inclusion of Zinc in the essential drugs list and in ASHA, AWW and URBAN FLW kit.
- SC should advocate inclusion of rotavirus vaccination in UIP & can also propose to participate in supporting Government do the first level of on ground roll out of rotavirus vaccination.
- SC needs to engage key direct stakeholders working in diarrhoea in India from start.
- SC should engage in building capacity for health facility based staffs in inventory management and procurement, with focus on ORS and Zinc procurement.
- SC can assist Swachcha Bharat Mission, National Rural Drinking Water Project, NUHM put together state specific BCC strategy.
- SC should assist CCDUs to develop training strategy, calendar and materials in community sanitation, safe drinking water and hand washing.
- SC should build on guidelines and design a comprehensive training agenda aligning all the three departments and health workers as well.
- SC should engage NHCRC in NIHFW and build its capacity and roll it down SIHFWs
- SC should consider helping the in states production of IPC tools and job aids on diarrhoea.
- SC should work with the Government systems from national to district levels to strengthen monitoring and feedback system for diarrhoea incidence.
- SC should extend assistance to Swachcha Bharat Mission in enabling the structural correction it is undertaking.
- SC should engage with the Ministry of HRD, Department of School Education, to work as technical partner for strengthening technical and communications component of Swachhcha Bharat, Swachcha Vidyalaya campaign.
- SC should place high priority in its proposal to facilitate intersectoral convergence from national to state to district level and play a catalytic role in facilitating it.
- SC should consider joint advocacy with MI for scaling up “combi-packs” or build a “stop diarrhoea pack” which has all materials a health worker needs to use to address diarrhoea.
- SC should consider taking lead in aligning various related departments at national, state and district levels, and ensuring a fully integrated IDCF is done in 2015.
The stakeholder analysis found that Save the Children is among the very few non-UN and non- bilateral agency that is working in child health, child nutrition and water and sanitation, giving it a unique advantage of facilitating a more comprehensive approach to diarrhoea control programme in the country. Save the Children will be more effective in its project if it is able to align all the three key Government Ministries – MOHFW, MOWCD and MODWS - and the promoters of IAPDP – UNICEF and WHO to its project mandate. There are clearly huge opportunities for Save the Children to align various stakeholders to advocate for increasing commitment to Zinc supplementation and for inclusion of rotavirus vaccine in UIP, as there are opportunities to help state and district health and WASH strengthen their planning, implementation, monitoring and integration of programme components in diarrhoea, their communication plans and their training strategies.