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Communities’ Health
India’s Wealth
Annual Report
(2009-2010)
Centre for Health Education, Training and Nutrition Awareness
June 2010
Chairperson's
Address
I
am delighted to present I congratulate CHETNA for Trainers for ASHA module five
CHETNA’s annual report taking a lead in training elected which aims to strengthen its
to you for the year women leaders of village social activist role. This effort
2009-2010. I have observed panchayats and municipal of CHETNA will reach out to
CHETNA since several years. corporations of Gujarat state. about 7,95,000 ASHAs all over
Its contribution to With this intervention it is the country. In Rajasthan state
empowerment of women, expected that they will be CHETNA’s health
young people and children over motivated to take gender communication material is
30 years has been significant. sensitive decisions to enhance being replicated to strengthen
The organisation is unique in women’s empowerment. ASHA’s role as a health
its capacity to absorb new communicator.
challenges and go forward to CHETNA has also been able to
achieve them. CHETNA’s demonstrate community level This year CHETNA has
efforts to bring changes in the mechanisms to ensure access tirelessly advocated to make
social determinants of health to and continuum of maternal child rights a reality by its
particularly nutrition and health care services in the sustained efforts to get the State
gender equality are well states of Gujarat and Plan of Action for Children and
recognised not only in India, Rajasthan. In the state of the Early Childhood Care,
but all over the world. Gujarat CHETNA has been able Education and Development
2 to demonstrate significant Policy announced. Sustained
This year is especially important increase in participation of dialogue through interactive
for the organisation as it has community level stakeholders discussions and consultations
successfully brought back the to ensure continuum of has created an enabling
issue of nutrition into its maternal health services environment to take the process
priority agenda. CHETNA’s particularly to disadvantaged forward. The team envisages to
contribution to the document communities. continue making efforts, till the
“Essential Intervention for policy and plan are released.
Reducing Malnutrition for Girls CHETNA has been actively
and Women in India: A contributing its learnings and I wish CHETNA all the best for
leadership Agenda for Action” experiences into existing its future endeavours.
published by the Coalition for government programmes and
Sustainable Nutrition Security policies. This year its
which aims to improve nutrition significant contribution was in
security in India is significant in the implementation of National
this direction. I am confident Rural Health Mission (NRHM), A R Nanda
that their contribution has a Government of India’s Chairperson, Governing Council
brought to light field realities of flagship programme by CHETNA, Ahmedabad
marginalised communities. facilitating National Training of June 2010
From the
Director's Desk
Together with the In the state of Gujarat Since 2009, CHETNA
valuable support and CHETNA is demonstrating through interactive
insights of partners, strategies to strengthen the discussions and consultations
CHETNA has undertaken a services of Integrated Child is advocating for child rights
meaningful journey of thirty in Gujarat state and has been
Development Services
years. We have experienced working towards facilitating
(ICDS). CHETNA has also
successes and also faced the release of the State Plan of
demonstrated community
major challenges. In these Action (SPA) for Children and
level mechanisms in a tribal
thirty years the health the Early Childhood Care,
block to improve access to
Education and Development
scenario of women and
maternal health services. It (ECCED) policy.
children has changed,
has ensured continuum of
however still much more
In the coming year, CHETNA
maternal health care and
needs to be done to bring
envisages to demonstrate a
increase in institutional
about positive changes in the
model to make reproductive
deliveries.
lives of marginalised
and sexual health and
communities. It is a grim
In the State of Rajasthan nutrition services and
reality that there has not
during public hearings in information accessible to out
been much change in the three districts, women came of school girls. 3
nutritional status of women
forward to share their stories
and children, especially We would like to thank all
on denial of health care.
prevalence of under nutrition those who partnered with us
and anaemia. Keeping this As the Regional Resource in these efforts. We also look
reality in view CHETNA has Centre (RRC) and Mother forward to continue working
brought back its focus on together to improve the
NGO for the State of
working on issues of food and health and nutrition status
Gujarat, CHETNA has been
nutrition entitlements. of women, young people and
ensuring access to
children.
In the year 2009-10 we Reproductive and Child
undertook a study in the Health services from public
State of Rajasthan to health system since October,
understand the reason for 2004. Introduction of
low compliance of Iron Folic monitoring and evaluation Indu Capoor
Acid (IFA) tablets and system through the RRC Founder Director
community’s perception to proved useful for NGOs to CHETNA, Ahmedabad
prevent and treat anaemia. showcase their achievements. June 2010
Content
Building 36
Alliances
Community
Responding to Networking
Action for
the Challenges for Advocacy
Maternal
of Young People
Health
5 25 Acknowledging
Our Partners 38
17
41
15
Collective
Supporting
Strength
Government
Empowering
4 Health
Women
Programme 26
About
Initiatives CHETNA 42
24
43
CHETNA
Advocating for Promoting Facilitating:
Improvement in Rights and Sharing and
Nutrition Status Holistic Health Learning
of Women and
of Children
Children 21 29 44
Glossary
Community Action
for Maternal Health
ensuring women’s health?
While direct and indirect
medical causes are well
known, this is just the tip of
the ice-berg. A deeper probe
reveals social determinants,
particularly the age at
childbearing, fertility rates
and patterns, literacy rates,
access to food and nutrition
and other socio- cultural and
economic factors need to be
addressed urgently.
CHETNA believes that
maternal death is an
T avoidable tragedy, one that
he statistics of a just a number. As she draws
is undoubtedly a collective 5
maternal death every on her last laboured breathe,
responsibility. CHETNA
eight minutes places desperate eyes beg for life
contributes to the larger
Indian women at a risk 200 that is a right denied. But
efforts of the government by
times higher than that of a alas! In a community where
enabling the community to
woman in the developed such deaths are not
become aware and gain
world. According to the uncommon, there is the
access to their maternal
Registrar General of India usual failure to record
nutrition and health
(2006), Maternal Mortality details. Why did yet another
entitlements. Thus, it
Ratio (MMR) for India is mother die so young? In the
ensures that the government
estimated to be 301 per absence of a mechanism to
becomes more responsive to
100,000 live births. In other record relevant details, the
the needs of the community.
words, there are 77,000 stakeholders fail to develop
A narrative description of
maternal deaths in a year or appropriate action strategies
the efforts made by
211 maternal deaths per day. to stop mothers from dying.
CHETNA during 2009-2010
In marginalised Is it general neglect of
in the state of Gujarat and
communities across rural women’s health issues and
Rajasthan is given here.
India, a maternal death is poor commitment to
Empowering Communities for Better Access to Maternal Health Services
CHETNA initiated an effort Panchayati Raj Institution1 During 2009, the concluding
of improving access to members (PRIs) and Self year of the project, reviews,
analysis and compilation of
maternal healthcare services Help Group members
the lessons learnt were
in Vansada, a tribal block of (SHGs), it strengthened
disseminated among the
Navsari District of Gujarat in links in the community
government and civil society
2006. After CHETNA built based mechanism to representatives to
capacities of Traditional improve access to maternal mainstream the knowledge
Birth Attendants (TBAs), health services. gained from the project.
Key Mechanisms Introduced:
• Introduction of the birth preparedness and complication readiness tool at the village
6
level.
• Mapping of facilities providing safe delivery services and emergency obstetric care.
• Equipping the communities with contact phone numbers by introducing a handy
telephone diary and a sticker to be displayed at a prominent place in the house.
• Developing a list of voluntary blood donors to be forwarded to the blood bank.
• Motivating private vehicle owners to develop a transport system to transfer pregnant
women from their village to the health facility.
• Training communities to call the 108 emergency ambulance service.
• Using meetings of elected bodies at village level (Gram Sabhas) as a platform to share
the concerns related to access to maternal healthcare services and motivating the
community and the village level stakeholders to ensure access.
1 Elected body for village level Governance
Increase in
Results
Institutional Deliveries
There has been a significant increase in the access to Maternal health and Uptake of JSY
services in Vansada Block of Navsari District, Gujarat State, India.
As work progressed, it is
Indicators Baseline Endline
important to note that
2006 2009
secondary data from the
Number of deliveries (N) 113 191
government records for the
Women visited Primary Health Centre Negligible 50.3%
year 2005-06 to 2009-10
(PHC) during pregnancy
(data till October 2009)
Female Health Worker (FHW) advised 40.9% 80.4%
indicates an increase in
pregnant women about rest and diet
institutional deliveries from
FHW advised family about birth 13.6% 81.8%
57.7 per cent to 82.3 per
preparedness
cent in Vansada Block.
Traditional Birth Attendants (TBAs) 16% 54.5%
Complimenting these
advised family about birth preparedness
numbers, it is encouraging
TBA advised about Maternal None 20.9%
to find that JSY benefits also
benefit schemes (JSY)
7
show a significant increase
TBA advised about Antenatal Negligible 56%
in the number of
checkups
beneficiaries from 493 in
Institutional Deliveries 43.4% 64.4%
2005-06 to 2113 in 2009-
Post Natal Care (PNC) visit 16.5% 39.7%
2010 (data till October
within 72 hours of delivery
2009) Vansada Block.4
Dissemination Meeting
A dissemination meeting was organised in November 2009 at Ahmedabad. 63 stakeholders
representing Government Health Department and NGOs, TBAs, Panchayati Raj Institution
(PRI) members and Self Help Group (SHG) members from the project area participated.
Shared project experiences generated discussions with public health experts and
government representatives to make maternal health services more accessible to the
community. Some of the suggestions which came forward were....
2 “Mamta Divas” is observed to deliver Health & Nutrition services on a designated day under the same roof.
3 JSY is maternal benefit scheme to suffice nutritional requirement during 7-9 months of pregnancy.
4Reported by Block Health Officer, Vansada and Quality Assurance Medical Officer, District Panchayat Office, Navsari.
...Implementation and Awareness and Capacity Building
Monitoring of
Programmes and Schemes • The information given in developed and widely
Government Resolutions disseminated to make the
• A ‘convergence’ model and health schemes/ community aware about
needs to be adopted to programmes need to be the maternal health
ensure effective delivery transcribed in simple local entitlements.
of services between language and widely
Department of Women disseminated among the • TBA’s role as a link person
and Child Development, community and Panchayat needs to be strengthened.
They also need to be
Department of Health members.
equipped with necessary
and Family Welfare and
• Health Communication is scientific information and
Panchayati Raj
a crucial component of skills to conduct safe and
Institutions to improve
every health programme. hygienic deliveries and
Maternal health scenario
The health education cope up with emergency
at the community level.
material needs to be situations in remote areas.
8 • Review the
implementation of
various government
schemes every three
years to identify the
micro-problems at the
community level and take
necessary measures to
address them.
• Birth and death
registration in each
village needs to be
regularly maintained as it
is the indicator to
measure progress in the
health status of women
and the community.