Raising Consciousness Creating Awareness

Enhancing access to NRHM entitlements: CHETNA’s efforts in five

districts of Rajasthan ( April 2010- July 2011)

Presented by Ms.Chitra Iyer, CHETNA and

CHANGE partners, Rajasthan

11 August, 2011

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• The National Rural Health Mission (NRHM) is GoI flagship programme launched in 2005 to enhance access to quality health services from the public health system, particularly rural poor women and children

• The NRHM covers the entire country, with special focus on 18 states. Rajasthan is one of the EAG states with high MMR (335 per 100,000 live births) and NMR (35 per 1000 live births) – DLHS 2008

• Building capacities of ASHAs to facilitate access to health services is one of the key strategies of NRHM

Rationale

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• Communication for Health Advocacy in National Rural Health Mission for Grass root Empowerment (CHANGE) project aims to complement the government’s NRHM efforts by strengthening community mobilization and focuses on increasing access to quality health and nutrition services

Communicating for CHANGE

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• To ensure community access to quality health and nutrition services

Goal of the Project

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• Development of a participatory communication strategy to advocate for health entitlements of rural communities.

• To enhance capacity of the service providers, civil society orgnizations, media and PRI on communicating and advocating for NRHM commitments.

• To promote community awareness on MCH entitlements.

• To promote exchange of experiences, innovations, learning and challenges.

• To document and disseminate key processes and learning.

Project Objectives

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Coverage and Partners

Churu

Alwar

Karauli

Udaipur

Banswara

Akhil Bharitya Gramin Utthan Samiti

Aravali Serva Sewa Farms

Shikshit Rojgar Kendra Prabandhak Samiti

Education Conscientisation, Awareness and Training Bodhgram

ALERT Sansthan

Total no of Villages: 794

Total population: 9,74,430

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Mobilizing communities to access Maternal and ChildHealth (MCH) entitlements by :• Participatory Needs Assessment (PNA)

• Development of participatory communication strategies

• Capacity building of local stakeholders in the intervention block

• Advocacy through creating spaces for dialogue and learning among different stakeholders

Project Strategy

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Needs identified through PNA conducted in May 2010 with 2269community members/ASHAs/VHSC/PRIs and Service ProvidersCommunity needs: 1800 pregnant and lactating women and

communitymembers expressed the need for:• Information on services/public health• Appropriate tools to access information• One point person at village level for information source on access

to services• Regularity of the visit of frontline workers ASHA’s needs• 227 ASHAs expressed the need for clarity on :• Their roles and responsibilities and that of ANM/AWW• Information on MCH entitlements/schemes/Government Resolutions• Communication material for education and counselling community

Needs identified

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Needs of VHSC/PRI148 VHSC/PRI members expressed the need for clarity

ontheir roles and responsibilities, untied funds and its

use

Needs of PHC staffFocus Group Discussion and Key Informant Interview

with 94PHC staff revealed the need for• Clarity on NRHM programme and MCH entitlements• Their role to facilitate access to MCH services

Needs identified

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Community mobilisation

Community Awareness

meetings with 22000

community members

(pregnant and lactating women,

adolescent girls and men)

Celebration of thematic days (International Women’s Day, Breast feeding week, World Health Day)

Through local fairs (kaila

Devi/Gangaur/Baba

Gaugandas fair)

Government initiatives (Swasthya

Chetna Yatra, Prasasan Gaun

ki aur)MCHN day at sub centre

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Motivating communities to access the services• Partners oriented 581 ASHAs on MCH entitlements

and their role as key communicator to inform and motivate the community members to access services

• Partners oriented 400 VHSC members oriented on MCH entitlements, untied fund and its use and their role in monitoring the health services

Capacity building

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Creating spaces for dialogue to ensure servicesObservation of MCHN days and joint meetings withASHA/ANM/AWW to establish linkages for health andnutrition servicesProvide mentoring support to ASHAs on monthly

meetings toenable her share her concernsParticipation in block/district/PHC meetings, one to

onesharing with Block Program Manager/Block ASHA

Advocacy

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Community level:• Enhanced awareness about MCH entitlements and started

accessing services• More no. of women have started accessing services such as

institutional delivery and referral transport• More no. of children coming to the AWC for getting immunized• More no. of women, adolescent girls and children participating

in MCHN days

Changes observed..

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• At ASHAs level• Enhanced confidence • Started sharing her issues/concerns in PHC sector meetings• Enhanced rapport with community/service providers• Increased motivation to mobilize and share information on

MCH entitlements to the community• Service providers level• Enhanced clarity about their roles and responsibilities• Initiated to invite project team in sector/PHC meetings to

share the field realities and support the partners accordingly• Regular follow-up by the partners and support by the Block

Officials has led to recruitment of ASHAs (34) at Karauli and Tijara block

• Regularisaton of services at Anganwari centre (10), sub-centre (10) and PHC level

CHANGES observed

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• Regular refresher training and mentoring support to ASHA

• Institutionalization of ASHA within the system• Attention to training quality and systems,

recruitment and timely payment to ASHAs would enable her to play a key role in motivating the community to access health and nutrition services

• Regular communication with community and with ASHAs

• Increased about entitlements among communities has brought a shift from access of private health services to public health services

Lessons learnt