Its not a drug Its not a vaccine

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It's not a drug. It's not a vaccine. It's not a device. It's women,

It's not a drug. It's not a vaccine. It's not a device. It's women, working together, solving problems, saving lives. Richard Horton, Editor - The Lancet, May 2013 THE EKJUT INITIATIVE A PARTICIPATORY LEARNING AND ACTION CYCLE WITH WOMEN’S GROUPS TO IMPROVE MATERNAL AND NEWBORN HEALTH OUTCOMES

THE CONTEXT – WHERE THE INITIATIVE AIMS • Infant Mortality Rate (IMR) has been

THE CONTEXT – WHERE THE INITIATIVE AIMS • Infant Mortality Rate (IMR) has been decreasing; but Neonatal Mortality Rate (NMR) remains high • Supply side has picked – Heath Centres • Research suggests that demand side has a lot of scope • Community participation • Health seeking behavior • ASHA workers • The first significant success towards mobilization • This initiative – As a structure to the work of ASHAs

THE TRIAL* • Among over 2 lakh women • 3 Districts of Jharkhand Odisha

THE TRIAL* • Among over 2 lakh women • 3 Districts of Jharkhand Odisha • Reducing newborn deaths by 45% over the last two years of cycle • Later extended to the 200 control villages to get similar results • This community mobilization was endorsed by the World Health Organization (WHO) in 2014’ * Tripathy PK et al. Effect of a participatory intervention with women’s groups on birth outcomes in Jharkhand Orissa, India: the Ekjut trial. Lancet 2010, 375: 1182 -1192.

THE PARTICIPATORY LEARNING & ACTION CYCLE [PLA] The module is designed as a Cycle

THE PARTICIPATORY LEARNING & ACTION CYCLE [PLA] The module is designed as a Cycle of 20 meetings of women’s groups EVALUATE TOGETHER ACT TOGETHER IDENTIFY CAUSES PLAN STRATEGIES

PARTICIPATORY LEARNING AND ACTION (PLA) CYCLE • The 20 meetings mostly consist of scientifically

PARTICIPATORY LEARNING AND ACTION (PLA) CYCLE • The 20 meetings mostly consist of scientifically designed stories, role-plays and games • Problem/Solution Identification is done by the group itself • Facilitated by an ASHA trained in PLA • Systematic community interaction, through plays

AN EXAMPLE GAME: UNDERSTANDING THE CAUSES Newborn death Immediate Causes Hypothermia Prematurity Cord cut

AN EXAMPLE GAME: UNDERSTANDING THE CAUSES Newborn death Immediate Causes Hypothermia Prematurity Cord cut with unsterile instrument Delayed cord Clamping/ Exposure to cold Underlying causes No Skilled BA No transport available Infection Faith healer Informal provider Poverty Home delivery Teenage mother

STRATEGY • Starting a Saving & Credit group • Arrangement for transport (Mamta vahan)

STRATEGY • Starting a Saving & Credit group • Arrangement for transport (Mamta vahan) • Institutional delivery • Not bathing the child for 3 days after birth • Encouraging pregnant mothers to visit health facility • Delaying age of marriage • Not bathing the child for 3 days after birth • Delaying age of marriage • Institutional delivery or use of SDK in home delivery • Knowledge of danger signs of infection • Each strategy has protocols for implementation including division of responsibilities, system for monitoring etc from within the group

WHAT DOES THE PLA CYCLE DO? • Increases problem solving skills of members •

WHAT DOES THE PLA CYCLE DO? • Increases problem solving skills of members • Helps them understand cause and effect relationships • Empowers women to make decisions about health of self and their children • Increases demand uptake of services

REPLICATION • Similar projects of PLA in Bolivia, Malawi and Nepal • This model

REPLICATION • Similar projects of PLA in Bolivia, Malawi and Nepal • This model developed by Ekjut has collaborations with • MP – As ‘Saanjhi Sehat’ with MPSRLM in 1000 villages • Odisha - As ‘Shakti Varta’ with Health Department; in 170 blocks • Bihar – As ‘Gram Warta’ with Jeevika in 15 districts • Jharkhand independently • Well on its way to being scaled-up On Sustainability - According to a recently published paper once a group goes through a PLA cycle, the outcomes continue to sustain for a long time.

THE WAY FORWARD • For SAGY villages • Locally acceptable content development through SRLMs

THE WAY FORWARD • For SAGY villages • Locally acceptable content development through SRLMs • Trainings of ASHAs as facilitators • Incorporation in national programmes • PLA as a convergence between NRLM and NHM

THANKS!!

THANKS!!