Tuesday, November 1, 2016

Mobilising adolescent girls to improve healthcare

“Many girls in my class have dropped out this year, but I will complete my studies,” says 15-year old Vimal with a bright smile.  “I want to be a police officer when I grow up. I want to do something which will make everyone in the village proud of me” she says. Others in the group of about 15 girls slowly speak up as well, and each reveals a similar ambition. Some want to be teachers, others want to be nurses, but almost all of them express a desire to make a difference by serving the communities they live in.
When we tell them, about Akshada, the maternal and child health program that we run in Rajasthan, they are quick to respond with interesting questions and observations they have on the topic.
“Kya aap tika-karan karwaenge” (will you get children immunized); “garbhvasta mei hari sabzi khani chahiye (one should eat green vegetables during pregnancy); “kya aap unn bachon ka illaj karenge jinka vazan kam hai (will you treat those children who weigh less)?
They were not only keen to know what we were attempting through our program, but also remarkably insightful about the issues and challenges that we were most likely to face, saying, for example, that it would be difficult to explain changes in approaches to elders in the community.  When Vimal followed us till her school compound to ask us whether we will be back and as promised tell her more about our work, we knew we had to come back.
In the weeks to follow many such interactions led us to believe in the vast potential of adolescent girls in villages in Rajasthan to be change agents. Like Vimal, there are hundreds of girls who are aspiring to finish school, to be recognized, to be aware of the problems facing their communities, and to do something for their communities.
In some of the villages in Rajasthan that the Antara Foundation serves, we are starting to co-opt several of these change makers as part of our ambitious Akshada program aimed at bringing about dramatic improvements in health outcomes in the state.
Chief among our initiatives over the first year of the program has been an effort to focus the work of frontline healthcare staff on the neediest beneficiaries. Looking ahead, we believe that a large part of the success of our mission will come from generating community involvement to drive demand for healthcare services. This will help not only in holding the delivery mechanism accountable for the quality of healthcare service delivery but also in driving demand for services from beneficiaries, especially those who currently cannot—or will not—participate in consuming healthcare services. For example, by some estimates, as few as 25% of pregnant women receive all four antenatal check-ups that they are supposed to receive during the course of their pregnancy.
The barriers to receiving these check-ups are real—from a loss of income from daily wages, to real or perceived discrimination at service delivery points. However, improved healthcare outcomes require that we have more informed and empowered beneficiaries who demand and receive all the services needed to ensure safe deliveries. The lives of mothers and children depend on it, not to mention the integrity of families and future wage-earning capacities.
This is where we think Vimal and her fellow adolescent girls have a major role to play. These adolescent girls, some still in school, others having recently dropped out, were all very excited, when we spoke with them about it, at the thought of partnering with us to help support their local communities. Armed with training from us and from frontline healthcare workers on some of the basic concepts of maternal and child health, many of these girls have already become force-multipliers for our program.
They are helping ensure pregnant women in their mohallas (neighbourhoods) regularly take their iron and folic acid tablets. They are helping ensure that any young children showing signs of malnourishment are given appropriate care and treatment at the earliest. They are shadowing the frontline worker on her regular rounds in the community, helping potentially train a future cadre of such workers.  Above all else, they are becoming aware and empowered themselves as young women who will one-day start families of their own.
If you have thoughts or suggestions on other ways to empower communities, we would love to hear them. Please do drop us a message via this blog, or via our social media channels. We look forward to hearing from you.

Tuesday, January 12, 2016

WHY MUST THE KIDS DIE? A New Year question

Ashok Alexander

More than a million children under-five die every year in India from largely preventable illnesses. Of the ones who survive, some thirty per cent are malnourished. Many women don’t get good care when pregnant, when they deliver, or after they give birth.
There is improvement, and states like Tamil Nadu, Kerala and Himachal show the way. Others, like Rajasthan and Chhattisgarh, are tackling the problem. But the fact remains: India’s maternal and child record is one of the world’s worst.
Ironically, India’s public health system is well designed, and potentially, has great reach. Every last village and hamlet in India is covered by a health facility. There are three health/childcare workers for every such unit – higher than in most countries. There are visionary, grass roots health programs. Health spending is low, overall—but many states don’t spend all their funds.
Reach, design nor funding is the real problem. It is far more complex.  A woman just may not be in position to take care of herself and her baby. She needs to get back to work in the field right after birth. Her father-in-law won’t allow her to travel to the health facility. She doesn’t know of her health needs, or services she is entitled to. She has no voice. She is simply left out.
And yet there is hope. After all, how complicated could providing basic nutrition, breast feeding, or keeping a baby warm be? The pieces of the solutions are mostly known. The crux is this: delivering integrated solutions at scale. That’s when we run into the really complex barriers to scale: livelihoods, physical access, health worker skills, social norms, ignorance, and indifference.
Delivery at scale requires supply, demand and data backed policies working well, and together. That front line health worker needs data at her finger tips. Those women in the small village need to come together to recognise and exercise their collective power and voice. Media and influentials need to nudge the government machinery towards action and change. Solutions need to be sustainable. It has been done – in tackling Polio, DOTS in TB, and Avahan in HIV. There are lessons to be learnt from business.
The Antara Foundation is a non-profit start-up in public health, committed to changing the lives of mothers and children. We focus on scale, working with government. The task is difficult. It needs all kinds of support – from CSR, donors, managers, people with passion, willing to work at the grass roots.

Ashok Alexander is the Founder-Director, The Antara Foundation

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