EMPOWERMENT
SHGs and Rural Maternal & Child Health - An Impact Assessment
Andrew Adelman & Dr. Shashikant Ahankari
Andrew Adelman & Dr. Shashikant Ahankari
One morning, Rasika Chandnshiwe, a resident of the Habbu Wasti area of Solapur city, saw red water flowing from the bathroom drain of her neighbour Sumita’s house. Knowing Sumita was pregnant, Rasika immediately rushed to her house. Sumita was in pain and had been bleeding since the previous night. Rasika, the leader of the local women’s self-help group, was trained as a community volunteer under the maternal and newborn health project run by the Halo Medical Foundation in Solapur. She immediately knew to rush Sumita to the nearby hospital. Although Sumita had an abortion, Rasika’s timely intervention saved her life.
This story, and many like it, demonstrates successful accomplishments of the Sure Start Solapur (SSS) project run by the Halo Medical Foundation (HMF). Working in 80 slums with a population of 180,000, the SSS ensures that each pregnant woman within its network receives adequate prenatal and antenatal care. Research shows the 80% of maternal deaths are preventable if women have access to essential maternity and basic health services (UNICEF 2008).
The key to this program is the utilization of women’s Self- Help Groups (SHGs) in Solapur’s slums. These SHGs "adopt" pregnant women and encourage them to take advantage of government services (i.e. iron-folic acid tablets, tetanus vaccinations, and free antenatal examinations). Currently, 176 SHGs, which include over 1300 members, have been trained in maternal health care and have adopted 3600 pregnant and postnatal women. Community volunteers from each SHG take charge of finding pregnant women within their community and are teaching them about maternal health. These community volunteers, some of them illiterate women, are the main drivers of the Sure Start Solapur project. This project started in February 2007 with support from the international organization PATH (Programme for Appropriate Technology in Health) and funding from the Bill and Melinda Gates Foundation. HMF has motivated disadvantaged people to become partners in health, in order to create a sustainable movement in health care. By identifying existing SHGs, and creating new ones where needed, HMF has been able to reach its entire target population. The main project activities include: menstrual surveillance of eligible couples to identify antenatal cases, tracking of antenatal and postnatal women, implementation of behavioral change for a healthy pregnancy, and organization and training of groups of adolescent girls to educate about reproductive health and sex.
The success of the SSS project is significant, with notable achievements in maternal and child health. By 2009, the number of home deliveries within Sure Start’s area decreased from 8.13% to 1.8%. The percentage of live births was 93%. Women increasingly carried out their postnatal care check-up within 48 hours, with an improvement from 40% in August 2008 to 90.5% in June 2009. Knowledge regarding the Janani Suraksha Yojana (JSY) scheme, a government program for pregnant women below the poverty line, increased substantially. Other improvements were shown by: a decrease in the time-gap between delivery and breast feeding, higher utilization of tetanus injections and iron-folic acid tablets, increased awareness of women’s health, and positive impacts on the age of marriage.
SHG leaders and volunteers have been motivated and enthusiastic components to this project. Sure Start facilitators initially trained them in maternal and neonatal health care. Once antenatal cases were identified, SHG volunteers adopted them under their care. These volunteers are able to provide information and knowledge through behavioural change material, monitor the health of the antenatal case, and provide psychological and social support. The health of the soon-to-be mother is extremely important, and volunteers are able to motivate mothers to undergo routine medical care, provide information on proper food and nutrition, and survey of danger signs.
Although originally geared for savings and credit activities, the ability for SHGs to transform and empower women within their communities is immense. In the context of this project, SHGs are neighborhood groups that have intimate knowledge of the local community. Through the Sure Start project they play a dual role: providing social change and social service. Social change includes dissemination of vital knowledge and information, changing attitudes and behaviors, empowering women and girls, and changing gender relations. The social service dimension comprises the extension of social and psychological support to pregnant women and mothers, linking with the existing heath systems, and acting as a civil society action group.
An important component of this project has been the creation of linkages with the existing heath system and government schemes for pregnant women. At the most basic level, the services of Auxiliary Nurse-Midwives and anganwadis (pre-primary schools) provided the closest mandate to care for antenatal and postnatal women. With the implementation of the SSS project, these service providers were compelled to complete their job sincerely and be accountable to the community. Sure Start also ensured that women who qualified for the Janani Suraksha Yojana (JSY) scheme received proper benefits.
Both SHG’s and volunteers are supported by HMF staff which consists of facilitators and coordinators. The staff ensures that initial and refresher training is regularly provided to the volunteers to keep them updated on new information and innovative techniques. This democratization of health care aspires to counteract the existing one way process of health care delivery. HMF emphasizes that health should be as accessible to the illiterate woman as to the educated one, and therefore provides training that uses flash cards, visuals and is kept free of jargon. The Sure Start model paves the way for community ownership of health care provision.
The Halo Medical Foundation began almost 30 years ago when a group of medical students felt that medical care was significantly inadequate for the poor. Since then, HMF’s success has been based on creating a cadre of barefoot doctors to improve community health in the rural Marathwada region of Maharashtra, India. The program works towards creating sustainable health care by training local rural women to deliver basic health services in their own villages. HMF believes that 70 to 80% of diseases can be treated and prevented at the village level. HMF translated its successful policies to the slums of Solapur, using SHGs to facilitate improved health status for ante- and postnatal mothers. A key goal of this success is the use of volunteers to promote the sustainability of the project. Community volunteers from local SHGs, as well as student volunteers from local colleges, help to ensure the long-term sustainability of the project. College volunteers come from V.M Medical College, Vaishampayan Medical College, Samaj Karya Mahavidyalaya, Mahila Mahavidyalaya and Solapur Vidyapeeth. HMF believes that this project can provide sustainable and lasting impacts to the slums of Solapur.
Works Cited UNICEF, 2008. The state of the world’s children 2009. UNICEF, New York.
Authors: Mr. Adelman, a graduate in Public Health and Development Studies from University of California presently in Anadur, Osamanabad on a study stay. Dr. Ahankari, President of Halo Medical Foundation, at Anadur, Osamanabad, Maharashtra
This story, and many like it, demonstrates successful accomplishments of the Sure Start Solapur (SSS) project run by the Halo Medical Foundation (HMF). Working in 80 slums with a population of 180,000, the SSS ensures that each pregnant woman within its network receives adequate prenatal and antenatal care. Research shows the 80% of maternal deaths are preventable if women have access to essential maternity and basic health services (UNICEF 2008).
The key to this program is the utilization of women’s Self- Help Groups (SHGs) in Solapur’s slums. These SHGs "adopt" pregnant women and encourage them to take advantage of government services (i.e. iron-folic acid tablets, tetanus vaccinations, and free antenatal examinations). Currently, 176 SHGs, which include over 1300 members, have been trained in maternal health care and have adopted 3600 pregnant and postnatal women. Community volunteers from each SHG take charge of finding pregnant women within their community and are teaching them about maternal health. These community volunteers, some of them illiterate women, are the main drivers of the Sure Start Solapur project. This project started in February 2007 with support from the international organization PATH (Programme for Appropriate Technology in Health) and funding from the Bill and Melinda Gates Foundation. HMF has motivated disadvantaged people to become partners in health, in order to create a sustainable movement in health care. By identifying existing SHGs, and creating new ones where needed, HMF has been able to reach its entire target population. The main project activities include: menstrual surveillance of eligible couples to identify antenatal cases, tracking of antenatal and postnatal women, implementation of behavioral change for a healthy pregnancy, and organization and training of groups of adolescent girls to educate about reproductive health and sex.
The success of the SSS project is significant, with notable achievements in maternal and child health. By 2009, the number of home deliveries within Sure Start’s area decreased from 8.13% to 1.8%. The percentage of live births was 93%. Women increasingly carried out their postnatal care check-up within 48 hours, with an improvement from 40% in August 2008 to 90.5% in June 2009. Knowledge regarding the Janani Suraksha Yojana (JSY) scheme, a government program for pregnant women below the poverty line, increased substantially. Other improvements were shown by: a decrease in the time-gap between delivery and breast feeding, higher utilization of tetanus injections and iron-folic acid tablets, increased awareness of women’s health, and positive impacts on the age of marriage.
SHG leaders and volunteers have been motivated and enthusiastic components to this project. Sure Start facilitators initially trained them in maternal and neonatal health care. Once antenatal cases were identified, SHG volunteers adopted them under their care. These volunteers are able to provide information and knowledge through behavioural change material, monitor the health of the antenatal case, and provide psychological and social support. The health of the soon-to-be mother is extremely important, and volunteers are able to motivate mothers to undergo routine medical care, provide information on proper food and nutrition, and survey of danger signs.
Although originally geared for savings and credit activities, the ability for SHGs to transform and empower women within their communities is immense. In the context of this project, SHGs are neighborhood groups that have intimate knowledge of the local community. Through the Sure Start project they play a dual role: providing social change and social service. Social change includes dissemination of vital knowledge and information, changing attitudes and behaviors, empowering women and girls, and changing gender relations. The social service dimension comprises the extension of social and psychological support to pregnant women and mothers, linking with the existing heath systems, and acting as a civil society action group.
An important component of this project has been the creation of linkages with the existing heath system and government schemes for pregnant women. At the most basic level, the services of Auxiliary Nurse-Midwives and anganwadis (pre-primary schools) provided the closest mandate to care for antenatal and postnatal women. With the implementation of the SSS project, these service providers were compelled to complete their job sincerely and be accountable to the community. Sure Start also ensured that women who qualified for the Janani Suraksha Yojana (JSY) scheme received proper benefits.
Both SHG’s and volunteers are supported by HMF staff which consists of facilitators and coordinators. The staff ensures that initial and refresher training is regularly provided to the volunteers to keep them updated on new information and innovative techniques. This democratization of health care aspires to counteract the existing one way process of health care delivery. HMF emphasizes that health should be as accessible to the illiterate woman as to the educated one, and therefore provides training that uses flash cards, visuals and is kept free of jargon. The Sure Start model paves the way for community ownership of health care provision.
The Halo Medical Foundation began almost 30 years ago when a group of medical students felt that medical care was significantly inadequate for the poor. Since then, HMF’s success has been based on creating a cadre of barefoot doctors to improve community health in the rural Marathwada region of Maharashtra, India. The program works towards creating sustainable health care by training local rural women to deliver basic health services in their own villages. HMF believes that 70 to 80% of diseases can be treated and prevented at the village level. HMF translated its successful policies to the slums of Solapur, using SHGs to facilitate improved health status for ante- and postnatal mothers. A key goal of this success is the use of volunteers to promote the sustainability of the project. Community volunteers from local SHGs, as well as student volunteers from local colleges, help to ensure the long-term sustainability of the project. College volunteers come from V.M Medical College, Vaishampayan Medical College, Samaj Karya Mahavidyalaya, Mahila Mahavidyalaya and Solapur Vidyapeeth. HMF believes that this project can provide sustainable and lasting impacts to the slums of Solapur.
Works Cited UNICEF, 2008. The state of the world’s children 2009. UNICEF, New York.
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