In South Asia, almost 10 percent of children under the age of five die each year from easily preventable causes such as diarrhoea, pneumonia, and malaria.In South Asia, almost 10 percent of children under the age of five die each year from easily preventable causes such as diarrhoea, pneumonia, and malaria. These children do not survive because of parental ignorance or because communities in remote regions do not have access to affordable and effective lifesaving interventions like oral rehydration solution (ORS) for diarrhoea, antibiotics to treat respiratory infections, and antimalarial tablets. Safe motherhood and child survival initiatives have long been top priorities of healthcare agencies of the Aga Khan Development Network in India.
AKDN programmes support low-cost and highly effective tools to prevent and treat these conditions. To combat illness in children, young mothers are taught antenatal, postnatal and neonatal care, rural midwives are trained to conduct safer deliveries, communities in remote areas get access to quality health interventions and community-driven health initiatives are encouraged and made sustainable.
Launched in 2001, the Aga Khan Foundation’s ‘Partnering for Child Survival Programme’ was implemented by the Department of Community Medicine, Mahatma Gandhi Institute of Medical Sciences (MGIMS), in Wardha district, Maharashtra State. The programme focused on developing a decentralised, community-owned health system, ensuring the provision of high quality and affordable child survival and health services for rural families.
To improve the well being of children under three and women in the reproductive age group, the programme involved private and public providers, village institutions and women’s self-help groups. It reached almost 40,000 beneficiaries.
Safe motherhood and child survival initiatives have long been top priorities of healthcare agencies of the Aga Khan Development Network in India.Since October 2003, the programme, now re-named ‘Community Led Initiatives for Child Survival,’ has been scaled up to more than double its reach to impact a population of over 88,000 across 67 villages in three sectors of Anji, Gaul and Talegaon in Wardha district. Children under three, women in the reproductive age group (15 - 44 years) and adolescent girls are the primary beneficiaries. The development of a community-led approach ensures the provision of high quality and affordable child survival and health services for rural families.
Adolescent girls’ health in particular, is a cause for concern since the origin of many risk factors of maternal morbidity and mortality can be traced to this phase of life. Adolescents form a receptive audience for key health messages related to reproductive and child health in the programme framework.
A Social Franchise Model for Health
Drawing on the involvement and experience of 138 women’s self-help groups, a social franchise model for healthcare delivery is being implemented. The model mobilises the private sector, sets the standard of care and promotes the rapid expansion of services. It tests the central role of village institutions in the delivery of health care. At the same time, the model supports the decentralisation policy of the national and state health authorities and has the potential to sustain activities at the close of donor support. Activities related to income-generation and health have been initiated, including: the marketing of basic personal health and hygiene supplies; developing group members’ entrepreneurial skills; facilitating linkages with banks; sanctioning loans; and providing training.
In addition, parenting workshops inform parents about the skills required to enhance early childhood care and development. Training programmes and continuing education sessions improve the capabilities of health workers. Communication sessions are organised for village groups, especially adolescent girls and youth, to increase their knowledge about hygiene, nutrition and reproductive health. In terms of objectives the Programme is seeking to:
The Vidharba region of Maharashtra, of which Wardha is a district, is the poorest region in the state. Located in a rain-shadow region of the Deccan Plateau, it is characterised by low rainfall and a degraded environment and is prone to droughts. Health indicators in the region are particularly dismal and are among the poorest in India. Some of the key issues that the programme is addressing include:
Partnerships with Public and Private Health Providers
The Department of Community Medicine is improving the health status of rural communities in Wardha district by working in partnership with private and public heath care service providers (district health authorities and the Integrated Child Development Service Scheme); as well as with local village-level organisations such as self help groups and Panchayats. The Department is also building its capacity and that of its partners to implement new methods and techniques for both, organising communities and addressing their health needs in ways that are effective and sustainable.
Working with target communities, programme staff works to scale up the capacities of villagers who then work with MGIMS in the development and management of health services. This process will eventually lead to community “ownership’ of healthcare activities and infrastructure. MGIMS appreciates the critical link between women’s empowerment, maternal and child health status and considers the involvement of women’s self-help groups and other community-based organizations as critical to the success of the programme.
The process begins with a ‘health needs assessment’ to determine health issues of relevance in the village. This is followed by community mobilisation in the form of community based organisations (CBOs) such as self-help groups, adolescent girls’ forums and farmers’ development organisations. Till date, almost 400 CBOs have been formed and many are now also engaged in savings and micro-credit activities. These organisations, representing specific segments of the community or village, band together to form a representative body called the village coordination committees (VCC). At this point, MGIMS enters into a social franchise agreement with each VCC. The implementation of the franchise agreement is carried out by/through the VCCs that serve as the nodal agency responsible for decentralized health care delivery at the village level.
Health needs and related priorities and plans would vary from one VCC to another across all 67 villages. However, key technical interventions that the programme will focus on are:
To ensure that grassroot level activities of implementation and inter-personal communication with community members is optimised and sustained, intensive capacity building exercises along with behaviour-change-communication strategies have been devised. These include parenting workshops, family life education through school & kishori panchayats (forums for adolescent girls) and campaigns related to safe motherhood and child survival.
Quality Healthcare Service Delivery at Grassroots Level
To ensure and maintain quality healthcare standards, doctors, paramedics and field-level health care workers like auxilliary nurse midwives and village health workers work in conformity to exacting benchmarks set by the programme. Village or community health workers serve as the ‘first-level’ care providers, particularly for management of respiratory infections and diarrhoea. Antenatal and postnatal care is also managed by them. Key methods to be used to ensure proper maternal and child care at the household level include negotiation of behaviour change communication messages, appropriate home-based management of sick children and referrals to a health facility. The community health worker will also identify children who have not been immunised and follow up with their families to ensure that are immunised.
In villages where assuring safe home deliveries emerged as an area of priority during the health needs assessment, VCCs are encouraged to identify a practicing Trained Birth Attendant (TBA) to work with the programme. She should be acceptable to the community and also have the requisite training and experience required. The primary task of the TBA is to attend to births that occur in homes or in a maternity hut.
Mahatma Gandhi Institute of Medical Sciences
MGIMS, established in 1969 is a rural medical college, established with an objective of developing a pattern of graduate and post-graduate education best suited to meet India's predominantly rural population’s healthcare needs.
The Department of Community Medicine at MGIMS has been implementing community-based projects to enhance health care services to the rural communities in and around Wardha district. The department has created a model for rural and community health care. Collaborations with other institutions having a similar mission facilitates the process leading to the improvement of health status of villagers.
MGIMS admits 64 students per year and has turned out about 1800 graduates and about 600 post-graduates in different disciplines so far. It is mandatory that after completion of their internships, new graduates have to serve rural populations for two years. They can do this either by working with non-profit organisations approved by the Institute or in health centres of the Central Government or State Government of Maharashtra or of any other state.
The Department of Community Medicine aims to:
Sustainable Community-Based Approaches to Livelihood Enhancement (SCALE)
(Brief - English, 655KB, PDF)
Please also see:
Early Childhood Development (ECD) Programme (Brief - English, 1MB, PDF)
Community-based Savings Groups (CBSGs) (Brief - English, 1MB, PDF)
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