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
Raising Consciousness
Creating Awareness
11 August, 2011
Rationale
• 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
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Communicating for CHANGE
• 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
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Goal of the Project
• To ensure community access to
quality health and nutrition
services
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Project Objectives
• 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.
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Coverage and Partners
Total no of Villages: 794
Total population:
9,74,430
Akhil Bharitya
Gramin Utthan
Samiti
Churu
Alwar
Karauli
Aravali Serva Sewa
Farms
Shikshit Rojgar
Kendra
Prabandhak Samiti
Education
Conscientisation,
Awareness and
Training Bodhgram
Udaipur
Banswara
ALERT Sansthan
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Project Strategy
Mobilizing communities to access Maternal and Child
Health (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
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Needs identified
Needs identified through PNA conducted in May 2010 with 2269
community members/ASHAs/VHSC/PRIs and Service Providers
Community needs: 1800 pregnant and lactating women and community
members 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
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Needs identified
Needs of VHSC/PRI
148 VHSC/PRI members expressed the need for clarity on
their roles and responsibilities, untied funds and its use
Needs of PHC staff
Focus Group Discussion and Key Informant Interview with 94
PHC staff revealed the need for
• Clarity on NRHM programme and MCH entitlements
• Their role to facilitate access to MCH services
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Community mobilisation
Celebration of
thematic days
(International
Women’s Day,
Breast feeding
week, World
Health Day)
MCHN day at
sub centre
Community
Awareness
meetings with
22000 community
members (pregnant
and lactating
women, adolescent
girls and men)
Through local
fairs (kaila
Devi/Gangaur/Ba
ba Gaugandas
fair)
Government
initiatives
(Swasthya Chetna
Yatra, Prasasan
Gaun ki aur)
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Capacity building
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
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Advocacy
Creating spaces for dialogue to ensure services
Observation of MCHN days and joint meetings with
ASHA/ANM/AWW to establish linkages for health and
nutrition services
Provide mentoring support to ASHAs on monthly meetings to
enable her share her concerns
Participation in block/district/PHC meetings, one to one
sharing with Block Program Manager/Block ASHA
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Changes observed..
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
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CHANGES observed
•
•
•
•
•
•
•
•
•
•
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
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Lessons learnt
• 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
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