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Popfocus 2009 April June English |
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Volume XXII; No.2 April – June 2009
THE POPULATION FOUNDATION OF INDIA NEWSLETTER
PFI, USAID and MoHFW Successful Partnership
for the NRHM BCC Campaign
The Ministry of Health and Family
Welfare (MoHFW), Government
of India, initiated an integrated
Behavior Change Communication
(BCC) campaign using television, radio
and print media to improve knowledge
and practice of key maternal,
neonatal, child health and nutrition
related behaviors, and to promote
various National Rural Health Mission
(NRHM) schemes and programs
among key target audience. The main
themes of the campaign were age at
marriage, family planning and birth
spacing, antenatal care, immunization,
newborn care, Janani Suraksha
Yojana (JSY scheme) and the role of
ASHA and the NRHM. In all, the
campaign used 16 television, seven
radio and 11 print ads.
At the request of the Ministry,
USAID’s Maternal and Child Health
Sustainable Technical Assistance and
Research (MCH-STAR) Initiative
commissioned a study through the
Population Foundation of India (PFI)
to assess the reach and effectiveness
of the BCC Campaign. MCH-STAR
is a USAID initiative to improve
policies, program approaches and
resources in the areas of maternal,
neonatal, child health and nutrition
Dr. Lalitendu Jagatdeb, PFI and
Dr. Marta Levitt-Dayal, MCH-STAR
(MNCHN) in India.
The MCH-STAR
Initiative
aims
to strengthen the
capacities of premier
Indian institutions (PFI,
PHFI, IndiaCLEN,
CINI and SIFPSA) in
the areas of research
and evaluation, policy
analysis and advocacy
and in responsive
technical assistance
for MNCHN. MCH-
STAR’s goal is to Still shots from TV spots of the campaign
provide sustainable technical household level for quantitative data.
leadership of global standards.
Under the qualitative process of data
The objectives of the concurrent
evaluation were to: (a) evaluate the
extent of reach/visibility and exposure
of the target audience to the
campaign; (b) evaluate target audience
recall, comprehension and interest in
collection, in-depth interviews were
carried out with policy makers and
program managers including Health
Secretaries, NRHM Directors and
officials of the IEC/BCC cell from the
states. Semi-structured interviews with
the theme and aired TV and radio ads;
(c) assess the effects of the campaign
Inside
on the perceptions of policy makers
and program managers; (d) provide
Safe Motherhood Day
... 3
feedback to MoHFW for improving
Improving Health Status of Married
Adolescent Girls: SATHI
... 4
their communication strategy. This
Life Skill Education Module Piloted
was a national level study conducted
among NCC Cadets
... 4
across 18 districts spread over 11
states in India. The sample study states
were West Bengal, Karnataka,
Maharashtra, Tamil Nadu, Haryana,
Uttar Pradesh, Orissa, Chhattisgarh,
Madhya Pradesh, Mizoram and Bihar.
PFI contracted the ORG Centre for
Social Research, A Division of
ACNielsen ORG MARG Pvt Ltd, to
Adolescent Health Mela: OVHA
... 5
‘Yuvak Mahotsav’ in Maharashtra
... 6
Convergence of Reproductive Health and
Family Planning Programmes with
HIV/AIDS Control Programmmes
... 7
Role of Dais in Health Programmes
in Bihar
... 8
Workshop on Quality of Care in RCH ... 9
RCH Services in Urban Areas:
SWABHIMAN
... 10
execute the study.
‘Quality’ Family Planning Services in
Uttarakhand: Baseline Survey Findings ... 11
The methodology of the study
consisted of both quantitative and
Strategic Communication Training
for Advocacy
... 11
qualitative techniques. Structured
Children Education Awards Go to... ... 12
interviews were conducted at the
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From the Executive Director’s desk...
On July 11 this year, people around the
world observed the 20th World Population
Day in different ways. The theme of this year’s
World Population Day was “Fight Poverty:
Educate Girls”. Education of girls is adding a
crucial dimension to the world of development
as it is found to be an essential ingredient towards
long term sustainable development and for the
promotion of the society’s well-being. This year’s
theme is a chance to build awareness of the
importance of educating girls to a wide range of
development issues, including poverty, human
rights and gender equality. Letting girls go to
school, learn to read, and experience more of
the world beyond their homes makes them better
off immediately and enriches their families. Over
time, getting girls into school can transform
societies. In countries and communities where
women have access to reproductive health
services – such as family planning, skilled
attendance at birth and emergency obstetric and
neonatal care – survival rates are high and
maternal and newborn deaths are rare. Access
to reproductive health, in particular family
planning and maternal health services, helps
women and girls avoid unwanted or early
pregnancy, unsafe abortions, as well as
pregnancy related disabilities. This means that
women stay healthier, are more productive, and
have more opportunities for education, training
and employment, which, in turn, benefits entire
families, communities and nations. When girls
are educated, they have economic opportunities.
Their families have more of a stake in their
survival and their success. They marry later and
are able to take part in household decisions. They
choose to have fewer children and can invest
more in the health and development of each
child. Their daughters and sons have expanded
horizons, enabling them to escape poverty. Policy
responses that build on women’s role as
economic agents can do a lot to mitigate the
effects of the crisis on development, especially
because women, more than men, invest their
earnings in the health and education of their
children. Investments in public health, education,
child care and other social services help mitigate
the impact of the crisis on the entire family
and raise productivity for a healthier economy.
The Foundation remains committed towards
supporting women’s empowerment and gender
equality. On this World Population Day, let us all
reaffirm our determination to encourage women
and girls to speak or write about the impact of
education in their own life, and work with them
to build a better world for all.
A. R. Nanda
2
service providers and influential persons were also conducted.
Approximately 3,600 currently married women (15-29 years),
1,800 currently married men (husbands of women aged 15-29
years) and 360 influencers (mothers-in law/fathers-in-law) were
covered under the study.
PFI provided overall management and technical oversight to the
study and received technical and financial support from MCH-STAR
and USAID. The scope of work included finalization of study’s
terms of reference, selection of an agency to conduct the research,
technical support in study design, research tools and analysis, field
monitoring and ensuring high quality and timely results and report
and their dissemination.
The co-ordination with multiple stakeholders i.e., the research
agency, MCH-STAR, USAID and MoHFW, was a challenge to PFI.
This was very successfully addressed by a well managed consultative
process. A presentation on the key findings and recommendations
was first made to USAID and the study is being recognized as a
model for other partner organizations. Subsequently, a presentation
was made to the Ministry of Health and Family Welfare.
The following are the important key findings and recommendations.
Key Findings
• The majority of the target audience was exposed to media,
primarily TV. The most popular channel among women and
men was DD National.
• The reach of radio spots was low at 15%.
• The reach of television spots was high at 64%.
• The maximum proportion of target audience watching a
particular TV spot was 30%.
• The spots on family planning and antenatal care had maximum
reach among both men and women.
• Nearly a quarter of the target audience had watched four or
more TV spots.
• The majority could recall the messages conveyed and most of
them liked the spots.
• Among those who did not like the spots, language was the major
complaint.
• Between 40% and 60% of mothers-in-law who were exposed to
the spots discussed the contents with their daughters-in-law.
Conclusions and Recommendations
• The campaign had a wide reach among target audiences.
• “NRHM logo promotion” was a definite outcome of the ads.
• States expressed interest in getting involved in the campaign
and willingness to adapt mass media spots and interpersonal
communication (IPC) activities to local context/language.
• Village functionaries such as ASHAs had higher recall of the
messages, who can now interpret and promote messages through
complementary IPC.
• Respondents felt the campaign should focus on a few themes at
a time with higher frequency of broadcast for greater recall and
comprehension.
• States suggested that the spots be in local languages for better
understanding by the viewers/ listeners.
• It is important to monitor the frequency of ad airing by various
channels to ensure the MoHFW funds are well spent.
Contd. on page 3
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Safe Motherhood Day
In response to the campaign of
White Ribbon Alliance on Safe
Motherhood Day, 11th April 2009,
the Lalitha Foundation, a field NGO
working in the field of reproductive
and child health in Kurud Block of
Dhamtari district in Chhattisgarh,
organized a workshop on Quality
Maternal Health Care – Every
Woman’s Right with technical
support from PFI Regional Resource
Centre at Chhattisgarh. The
participants drawn in the workshop
were eligible women from six villages,
Mitanins, AWWs, ANMs, Mitanin
district resource persons, PFI-RRC
coordinator (as resource person), field
animators, workers and trainers of
Lalitha Foundation, women SHG
representatives, RCH-II programme
coordinator and the representatives
of community based organizations.
The objectives of the workshop were
to: (a) sensitize the stakeholders at
village level on ‘quality’ of maternal
care, (b) design strategies for ensuring
justice on reproductive rights
exercised by women, (c) involve the
community in seeking quality
maternal health care for safe
motherhood, (d) encourage for 100%
birth preparedness (birth planning),
complete ANC, PNC and institutional
delivery, and (e) ensure compulsory
visit by Mitanins /ANMs during and
after delivery.
The importance of tracking the
pregnant women and eligible couples
in the area was emphasized. There
was discussion on the three delays
that are contributing to maternal
mortality as well as birth
Contd. from page 2
The findings and recommendations of
the evaluation have been well received
by the MoHFW and are likely to be
useful in the development of the
upcoming communication strategy
by the Ministry.
The evaluation has been recognized
as a model project for outstanding
performance by USAID and MCH-
STAR. In this context, the Joint
Director (Monitoring & Evaluation) of
PFI, Dr. Lalitendu Jagatdeb, who was
preparedness. On the issue of
JSY, it was discussed that
merely ensuring benefits of
JSY is not enough but to
ensure the quality in care,
which is more essential.
The reproductive rights of
women with special focus on
informed choices was
discussed.
To ensure quality of care in
maternal health, it was
discussed that the following A session on ‘Quality of Care’ in progress
issues need to be taken
care of:
The last session included the group
• Ensure the supply of quality drugs
and 100% consumption of Iron
Folic Acid.
work by the participants, wherein
they identified the key issues and
designed strategies for addressing the
quality issue in maternal health. Some
• The right to claim treatments of the actions proposed were (i) birth
during ANC check-ups from the planning, (ii)100 per cent post-natal
sub-centres and written complaints care, (iii) full consumption of IFA,
to District Health Societies, if any (iv) ensuring transportation facility
lapses found in the treatment.
during emergency, (v) stakeholders’
• Ensure the correct usage of
financial benefits received under
JSY scheme exclusively for
nutrition of women.
involvement including CBOs
and SHGs, (vi) awareness about
reproductive rights,(vii) conducting
death audits, (viii) delaying age at
marriage, and (ix) promoting spacing
• Exercise the informed choices and between children.
reproductive rights.
• Ensuring 100% post-natal care
through a skilled person.
The workshop was significant in many
ways. Within one week of the
workshop, the animators and Mitanins
The IEC material prepared in line with circulated the “List of Reproductive
Know Your Entitlements of Rights and Entitlements” to each
White Ribbon Alliance was distributed household spread over 15 villages.
by PFI and a request was made to all Besides, the organization prepared a
Mitanins and AWWs to sensitize on format of birth planning and circulated
the entitlements of every woman. to all the pregnant women in 15
Discussions were also held on villages. The formats were also made
situations of maternal mortality and available at the sub-centres and
its various reasons in Chhattisgarh. anganwadi centres.
the Chief of the evaluation team,
received an award along with a
Certificate of Appreciation from
Dr. Marta Levitt-Dayal, Chief of Party,
MCH-STAR. The Certificate of
Appreciation says “The MCH-STAR
Initiative would like to
recognize Dr. Lalitendu
Jagatdeb for his commitment
to improving the quality and
responsiveness of Research
and Evaluation for MNCHN.
Dr. Lalitendu went above and
beyond to ensure that the
Evaluation of the NRHM BCC
Campaign was done in a timely
manner, that all partners were
involved in the entire process
and that the quality of the work
was of high standards.”
For more information,
please visit the MCH-STAR website:
www.mchstar.org
The contents of this document are
the sole responsibility of PFI and do
not necessarily reflect the views of
USAID or the United States
Government.
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Improving Health Status of Married Adolescent Girls: SATHI
Areview meeting of the SATHI
project in Maharashtra was
organized on 4th April, 2009 at
Apeksha Homeo Society, Amravati.
The project is a joint collaboration of
Population Foundation of India (PFI)
and Institute of Health Management
Pachod (IHMP) with 5 field NGOs and
is being implemented with support
from Sir Dorabji Tata Trust (SDTT).
The meeting was attended by
representatives of SDTT, PFI, IHMP
and five implementing partners, viz:
• Apeksha Homeo Society (AHS),
Gurukunj Mozari, Amravati
• Gramin Vikas Mandal (GVM),
Bansarola, Beed
• Late Sriram Ahirrao Memorial
Trust (SAMT), Betawat, Dhule
• Sanskruti Samvardhan Mandal
(SSM), Sagroli, Nanded, and
• Youth Welfare Association of India
(YWAI), Buldhana
RTI / STI clinic at the project area
SATHI initiative is a research project,
which aims to demonstrate specific
interventions to (i) improve
reproductive health/family planning
status of married young women, (ii)
build capacity of NGOs in programme
planning and management, and (iii)
undertake action research for policy
advocacy. Each NGO is covering a
rural population of 20,000 in each
district. The interventions will benefit
young married women (15 to 24
years of age) and their husbands.
During the project period, there have
been many positive changes in
community perception towards
reproductive health of married
adolescent girls (MAGs). More and
more married adolescent girls are
getting themselves registered with
the project in all the five NGO sites.
The resistance of the mothers-in-law,
which was faced initially, has been
overcome and they too are getting
involved in supporting the cause.
Meetings are regularly held with the
spouses of the adolescent girls on the
issues of adolescent reproductive
health and new born care. The
monthly surveillance of married
adolescent girls is being done regularly.
Specialized services of a gynecologists
are being provided to the MAGs in all
the five sites. The spouses of the
MAGs have also started coming for
MAGs reading IEC materials distributed
at the meeting
the treatment of RTIs/STIs. Hb testing
by trained ANMs is being done for all
the MAGs in the project areas and the
MAGs, who are found anaemic, are
being treated at the clinics. As most
of the MAGs in these areas go to their
mother’s place at the time of delivery,
inland letters have been developed
to record birth weight and delivery
details.
An innovative feature of the project
is the Couple Workshops, which are
being organized for all the MAGs and
their spouses and have received good
response. Couples are being
benefited by the SATHI Kendras’ set-
up in all the project villages. As an
important outcome of all these
interventions, the acceptance of
family planning methods has also
increased. About one-fourth of the
MAGs are now the users of various
methods of spacing.
Life Skill Education Module Piloted among NCC Cadets
Population Foundation of India in association with CINI
Jharkhand has piloted a module on Life Skill Education
among the cadets of NCC in the NCC 22 Jharkhand
Battalion camp held from 10th to 19th June, 2009. The
objectives of the pilot test were to (a) understand the
relevance of the module in fulfilling the needs of NCC
Cadets, (b) understand and identify the gaps in the design
of sessions, contents, methodology, language used and
the time required for executing the module, and (c)
understand the appropriateness of case studies, stories,
role plays and terms used in the modules in accordance to
the age group and culture.
Prior to the pilot test, a three day orientation programme
was organized with Associate NCC Officials (ANOs) to
gather feedback and make necessary changes in the
module. The orientation was held with two ANOs, who
were the part of entire pilot test. The knowledge and
learning on life skills among the Cadets was also measured
through pre and post tests. The life skill education module
was divided into 12 sessions and each session was
conducted by facilitators, who was co facilitated by another
one. The feedback/comments of each session were noted
down by an observer to justify the flow and the steps used
in the pilot test were appropriate and fulfill the objectives.
At the end of each day, the facilitators/observer shared
their feedback/ comments with the participants, ANOs
and other higher personnel of NCC, Jharkhand.
A Certificate of Participation was given to the NCC
Cadets and the ANOs for their participation in the pilot
test and finalizing the Life Skill Education modules.
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Adolescent Health Mela: OVHA
Adolescence, the transitional stage
of development between
childhood and adulthood, represents
the period of time during which a
person experiences a variety of
biological changes and encounters a
number of emotional issues. It is also
an age, when peer pressures are huge
and teen desires experimentation,
sexual explorations and tendency to
indulge in high risk behaviors
including venturing into drug abuse
is substantially high. A disturbing
trend observed among adolescents is
that of increase in teenage pregnancy
world over. Whereas all these are risk
behaviors, adolescence is an age,
which can foretell a person’s future
mental illnesses e.g. schizophrenia,
signs of which appear in late
adolescence. Because it is an age of
turbulence, upheavals and erratic
changes, this age-group needs to be
specially addressed in all the health
and family welfare programmes.
Orissa Voluntary Health Association
(OVHA) conducts this through
Adolescent Health Melas at regular
intervals. PFI has been supporting
OHVA through funding and technical
assistance for the maternal mortality
reduction in a remote tribal area in
Orissa.
One such Mela was organized at
Nalini Devi School (residential school
for tribal girls mostly Dongaria Kandh
Tribes), Bariguda, 8 Km from Bissam
Cuttack (the project intervention site),
where students from 5th to 10th
standards (10 years to 16 years)
attended. The broad objectives of the
Mela were:
• Awareness on adolescent issues
including physiological changes in
body, behavior changes, emotional
alterations and handling peer
pressures as well as addressing
various fears including the fear of
examinations.
• Awareness on menstruation and
ensuring hygiene.
• Awareness on clinical remedies
available for addressing adolescent
mental disorders such as
counseling, cognitive behavioral
therapy and
use of anti-
depressants
under medical
doctor’s advice,
if need be.
• Addressing any
queries which
an adolescent
may have.
The reason why
the adolescent
health mela was
conducted in A view of adolescent tribal girls attending the Mela
the tribal girls’
residential school was that the issues
faced by this cohort would be the
representative of adolescents in the
society. As the girls are educated and
have a keen aptitude for learning and
development, they have the potential
to act as peer educators and change
• About 16 million girls aged 15 to
19 years give birth every year –
roughly 11% of worldwide births.
• The risk of dying from pregnancy
related causes is much higher for
adolescents than for older women.
agents within the adolescent group,
even among the no school going
group and can address these issues
• Need advocacy for late marriage,
abstinence, safe sexual practices
including use of condoms and
amongst the larger masses especially
with adolescents.
family planning in case of early
marriage.
Ninety students participated in the
programme, where there was a mini
exhibition of books, pictorial posters
and leaflets on the messages of
adolescent health. Key messages on
the following topics were discussed
along with information on the same
as it stands today globally:
1. The state of adolescent health
2. HIV and young people
3. Early pregnancy and childbirth
4. Malnutrition
5. Mental health
6. Drug and substance abuse
including tobacco use, harmful
drinking of alcohol
7. Violence
8. Injuries and road safety
Some of the following interesting facts
also shared with them, were:
• One in every five people in the
world is an adolescent, and 85%
of them live in developing
countries.
• Young people aged 15-24 years
accounted for 45% of new HIV
infections world wide in 2007.
Need for counseling, ICTC/ VCTC
centers.
• Many boys and girls in developing
countries enter adolescence
undernourished, making them
more vulnerable to disease and
early death.
• Conversely, overweight and
obesity – another form of
malnutrition with serious health
consequences – is increasing
among young people in both low
and high income countries.
• Malnutrition is a vicious lifecycle
disorder. A malnourished anemic
mother gives birth to a low birth
weight malnourished baby, who
grows to be a malnourished and
anemic adolescent and carries the
risk of complicated pregnancy and
maternal mortality or may deliver
a low birth weight anemic baby.
Contd. on page 6
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‘Yuvak Mahotsav’ in Maharashtra
Population Foundation of India,
Maharashtra state unit and
Network of Maharashtra by People
Living with HIV (NMP+) had
organized ‘Yuvak Mahotsav’ during
June 9-11, 2009 to address issues of
HIV/AIDS and to provide a platform
to positive youth to share their views.
Lack of access to correct information,
illiteracy, tendency to experiment and
an ambience, which makes discussion
of sexuality as a taboo added to the
vulnerability of the youth towards
HIV/AIDS. In the ‘Yuvak Mahotsav’,
unmarried positive youth between
20 to 25 years of age participated
from 34 districts of Maharashtra.
From each district, two unmarried
positive youth participated along with
Treatment Outreach Workers from
the Access to Care and Treatment
(ACT) programme. The aim of the
Mahotstav was to sensitize youth
towards positive prevention.
The youth took part in posters,
slogans, poems and street plays
competitions. The programme was
inaugurated by Mr Nilesh Nikam,
Chairman, Standing Committee of
Pune Municipal Corporation. He was
impressed by posters, slogans and
poems prepared by members of the
District Level Networks of People
Mr. Nilesh Nikam, Chairman, Standing Committee of Pune Municipal Corporation
viewing the posters prepared by the Members of District Level Networks of People
Living with HIV/AIDS
Living with HIV/AIDS. The three best
District Level Networks of People
Living with HIV/AIDS were given
prizes. In this programme, the focus
was on positive prevention. Therefore,
the informative sessions on HIV and
ART, sexually transmitted infections
and sex and sexuality were organized.
The eminent persons in the field
of HIV, Dr Gangakhedkar, NARI
and Mr Bindumadhav Khire were
the resource persons. Also, the board
members of NMP+ were invited to
have dialogue with participants.
Participants gave inputs on advocacy
issues and NMP+ promised to
take them up. The district plan
was prepared for three months
involving participants, who will work
voluntarily.
Contd. from page 5
• At least 20% of young people will
experience some form of mental
illness such as depression, mood
disturbances, substance abuse,
suicidal behaviours or eating
disorders.
• The vast majority of tobacco
users worldwide begin during
adolescence. Today more than
150 million adolescents use
tobacco, which is increasing
globally.
• Alcoholism among young people
is an increasing concern in many
countries. It reduces self-control
and increases risky behaviours.
Harmful drinking is a primary
6
cause of injuries (including those
due to road traffic accidents),
violence (especially domestic
violence), and premature deaths
• Among 15-19 years of age, suicide
is the second leading cause of
death, followed by violence in the
community and family. Promoting
nurturing relations between
parents and children early in life,
training in life skills, and reducing
access to alcohol and lethal such
as firearms can help prevent
violence. More effective and
sensitive care for adolescent victims
of violence is needed.
• Unintentional injuries are a leading
cause of death and disability in
adolescents; and road traffic
injuries, drowning and burns are
the most common types. Injury
rates among adolescents are
highest in developing countries,
and within countries, these are
more likely to occur among
adolescents from poorer families.
The above issues were discussed
which kindled the student’s interest
and good response was received from
them especially in the question &
answer session organized during the
Mela. Queries of the students/
participants on personal health
related issues were answered in the
question & answer session and the
adolescents were counseled by the
senior staff of OVHA.
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Convergence of Reproductive Health and Family Planning
Programmes with HIV/AIDS Control Programmes
Sexual and reproductive health
problems share many of the same
root causes as HIV/AIDS, such as
poverty, gender inequality, stigma and
discrimination and marginalization of
vulnerable groups. HIV infections are
pre-dominantly transmitted sexually
and through child birth and breast
feeding which are elements of sexual
and reproductive health care.
Integration of reproductive health,
family planning and HIV/AIDS
provide an opportunity to reduce
unsafe sex, strengthen identification
and treatment of sexually transmitted
infections, reduce maternal and infant
morbidity and mortality and ensure
that the sexual and reproductive
health and rights of people as well as
people living with HIV are respected.
A stronger integration in services
contributes to achieving universal
access and coverage, which in turn
contributes to greater public health
benefits in a cost effective manner.
To address this issue of integration of
reproductive health, family planning
and HIV/AIDS, a seminar on
‘Convergence of Reproductive
Health and Family Planning
Programmes with HIV/AIDS
Control Programs in Rajasthan’
was jointly organized by Population
Foundation of India and Social
Policy Research Institute, Jaipur.
More than seventy policy makers,
consultants, Government officials,
NGO representatives, donor agency
representatives, service providers,
A view of participants
Ms Shubhra Singh, IAS (former Director, NRHM), addressing the participants. Also seen
(left to right): Dr S D Gupta, Director, Institute of Health Management and Research,
Jaipur and Dr Gauri Shankar Ghosh, Country Director, FXB Suraksha India
clients, academicians and PLHIV
participated in the seminar.
The experts, Dr Almas Ali (PFI),
Dr S D Gupta (Director, Institute of
Health Management and Research,
Jaipur) Ms Shubhra Singh, IAS
(for mer Director, NRHM),
Dr R N D Purohit (Director, Rajasthan
State AIDS Control Society), Shri
N C Saxena (former Bureaucrat and
Senior Development Consultant),
Dr Gauri Shankar Ghosh (Country
Director, FXB Suraksha India),
Professors, Dr Shiv Chandra Mathur
(Preventive and Social Medicine),
Dr Dinesh Mathur, (Dermatology),
both faculty at SMS Medical College,
Professors, Dr Veena Acharya
(Gynaecology and Obstetrics) and
Dr Kiran Nijhawan (Psychiatry), both
faculty at Mahatma Gandhi Medical
College), added value to the seminar
and laid the foundation for a clearer
understanding of the case for
convergence of Reproductive Health
and Family Planning Programs with
HIV/AIDS Control Programmes
in Rajasthan. In the seminar,
a discussion was held on the
possibilities of including mechanisms
of operationalizing the integration
of SRH/HIV programmes in
Rajasthan.
The objectives of the seminar were
to (i) prepare a ground for advocacy
to strengthen the availability and
accessibility of integrated SRH/HIV
services thereby increasing access of
these services by a larger user group,
and (ii) form an advocacy group for
information sharing, mutual learning
and collaborative advocacy activities
to strengthen implementation of
policy modifications.
Various recommendations emerged
from the ideas and experiences of a
vast spectrum of stakeholders. Finally
a consensus did emerge towards the
need and potential benefits of
convergence between SRH and HIV
programmes and policies. It was felt
that this convergence could lead to
the benefits of the clients, the
providers and the programmes.
It would also help in strengthening
the rights and gender perspectives for
people living with HIV/AIDS.
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1.8 Page 8 |
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Role of Dais in Health Programmes in Bihar
The Population Foundation of
India, as part of its advocacy role
on National Rural Health Mission
(NRHM), is in the process of engaging
with the government and civil society
organisations in understanding the
role of Dais in the current health
programmes particularly in NRHM.
PFI feels that although NRHM has
showed significant progress in
improving access to skill health
personnel and health facilities, it still
has a long way to go towards
achieving the desired maternal health
outcomes. One of the important gaps
in the programme is the unmet need
particularly in the EAG states. It is in
these unreached pockets with poor
health infrastructure that women
and families continue to access
community level health workers
particularly Dais in ensuring timely
and safe delivery of the child.
However, the emphasis of the flagship
incentive based maternity benefit
scheme of JSY has led to the
sidelining of the Dai, who has and
continues to provide valuable services
at the community level. In order to
bring back the important role of the
Dais, a national consultation was held
in Delhi in 2007 towards highlighting
the need for greater discussion,
respect and inclusion of Dais in the
health programmes.
Similar consultative processes were
adopted in many states by NGOs to
determine the state level role of Dais
in health programmes. PFI in
collaboration with SEWA undertook
the effort in Bihar. The process
adopted was participatory and
consultative, which included a profile
of Dais in Bihar, mapping of NGOs
working with Dais and undertaking
state level consultations with Dais,
NGOs and other stakeholders like
Gujarat Dai Sangathan.
The consultations revealed that health
service in Bihar was improving, yet
had a long way to go. ASHAs are
appointed by privileged families
rather than through gram sabhas.
Panchayat level committees are yet
to be formed. ASHAs still have yet
to be trained. The current focus is on
creating master trainers from NGOs,
at the district level, who in turn will
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train block trainers. Confusion
between committees on health, water
and sanitation still exists. ASHAs
work as assistant to ANMs.
It was highlighted that Dais have
played a very significant role in Bihar
in providing safe deliveries. People
still continue to go to Dais for delivery
and basic health care needs. There is
an implicit trust in Dais, particularly
in the large pockets of Bihar, where
institutional delivery is not possible.
Dais play a crucial role in informing
ASHAs on health and antenatal/
postnatal care. The role of Dais has
not been limited to delivery only.
Many continue to provide antenatal,
postnatal and primary health care
services as well.
Until 2006, most NGOs had been
closely involved with training of
Dais, both independently and in
collaboration with government under
RCH-I and II. At the onset of NRHM,
trainings were significantly decreased.
Participation of doctors or govern-
ment functionaries in trainings also
became negligible, even to the point
of negativity towards the concept of
Dai training. This has led to loss of
confidence and respect in Dais.
NGOs have continued to conduct
trainings on their own, with a range
of modules developed in 1990s.
In post NRHM, ASHA has taken only
the referral role. Dais do not get any
financial incentives and often are
pressured into sending women with
ASHAs. Because of the emphasis on
institutional delivery, advocacy for
Dais’ role became very difficult. In the
recent strike of health functionaries
in Bihar, Dais continue to provide
their services. MAMTA scheme,
launched in 2008 in Bihar, provides
Rs.75/- per delivery to Dais, who
have spent eight hours a day in the
PHC.
NGOs in Bihar continue to work with
Dais in many ways such as:
1. Two NGOs have successfully
placed Dais as ASHAs despite the
educational requirement and
formed SHGs of Dais to promote
livelihood and financial security.
2. Dais have been integrated
into other programmes, such
as disaster management in
Madhubani and Darbhanga
districts.
3. Dais are performing deliveries at
village level delivery centers
4. Cooperative of Dais has been
formed in Kishanganj district.
Following are the recommendations
which emerged from the consultation:
1. Provide greater recognition to
Dais and restore their respect and
confidence.
2. Ensure that Dais play a proactive
role in government schemes
including receipt of incentives.
3. Dai Sangathan should be
established in consultation with
Dais in the state. It should be at
the panchayat, block, district and
state levels.
4. Need to broaden/expand the role
of Dais beyond birth assistance
such as village counselor,
motivator and Janani Sevika.
5. Role of NGOs in mentorship and
orientation support should be
specified and should advocate
with government and other
stakeholders for greater
recognition, respect and security
for Dais.
6. Dais should have been placed in
panchayat committees.
7. There is a need for social security
for Dais and their families.
8. Dais could be integrated in artisans
insurance, RSBY and backward
regions grant funds.
9. Standard training module should
be certified by the government, as
has been the case in Gujarat.
Training should include issues like
safe delivery, ANC, PNC, birth
registration, nutrition awareness,
family planning, immunization,
breastfeeding, HIV/AIDS, age at
marriage, personal hygiene and
other general health issues,
knowledge of government
schemes including receipt of
incentives, surgical kit and disaster
preparedness.
10.Create livelihood opportunity
for Dais.
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Workshop on Quality of Care in RCH
Q“ uality of Care” has always been
a matter of priority for PFI due
to its commitment to ‘Rights Based’
approach. Ensuring Quality of Care
in delivery of reproductive and family
planning services is also a major
objective in one of the projects being
supported by PFI titled ‘A Model
Initiative to Ensure Quality Family
Planning Services in Uttarakhand’
being implemented by The
Himalayan Institute Hospital Trust
(HIHT), Uttarakhand. Besides HIHT
project, PFI is also supporting many
projects involving direct delivery of
reproductive and child health services
through mobile health van, where
ensuring quality of care is critical to
the success of the project.
Quality is a dynamic and complex
phenomenon. A sharp need is felt for
building capacities of the health
system in planning, implementing
and managing quality in health and
family planning services. With this
aim, a two day workshop was
organized by PFI on April 20-21,
2009. The goal of the workshop was
to improve quality of care in PFI
supported reproductive and child
health service delivery projects
through capacity building of key
players involved in ensuring quality at
service delivery like project managers,
field coordinators and key service
providers. The workshop was
attended by over 25 participants from
HIHT (Dehradun, Uttarakhand), Naya
Savera project of JK Laxmi Cement
(Sirohi), Parivartan Project of JK Tyre
(Rajsamand), SRKPS (Jhunjhunu),
SSS (Tonk) from Rajasthan,
TCSRD (Budaun, U.P.) and SMILE
Foundation from Delhi.
Themes of the Workshop
1. The concepts of quality of care in
reproductive health and family
planning programmes.
2. The deter minants of quality
improvement, assessment tools
for service quality, barriers to
quality of care and quality
improvement.
3. Rational use of drugs and QoC.
4. The monitoring and evaluation of
quality of care with assessment
tools and MIS for QoC, relevant
indicators and project results and
gender sensitive MIS.
5. Participatory approaches and
facilitative supervision as a vital link
in quality reproductive health
service delivery.
6. Gender perspectives and quality of
care.
Workshop in progress
Workshop Proceedings
The first day started with brief
introduction of the participants and
focused on building participants’
understanding on the concept of
Quality of Care in reproductive health
and family planning. The participants
shared their understanding on QoC
through presentations after group
work.The discussions highlighted that
the QoC is need based, client
centered and uses technology which
is affordable, acceptable, accessible
and appropriate.
This session was followed by a session
on the nine key elements of QoC
(UNFPA framework). The first five key
elements viz. service environments,
client provider interaction, informed
decision making, integration of
services and women’s participation in
management of services are common
to all health services and the
remaining four: access to services,
equipment and supplies, professional
standards and technical competence
and continuity of service are specific
to conditions of health.
It was explained that quality assurance
process in health care can be broken
down in to three mutually reinforcing
components: quality design, quality
control, and quality improvement.
• Quality design uses planning tools
first to define an organization’s
mission including identifying its
clients and services, and then to
allocate resources and set
standards for service delivery;
• Quality control applies monitoring,
supervision, and evaluation
methods to ensure that every
employee meets the established
standards and delivers high-quality
services; and
• Quality improvement involves
solving problems and improving
processes on a continuous basis.
The second day focused on
importance of mainstreaming gender
into service delivery and other
determinants of the QoC. The need
for gender analysis of the data for
planning, evaluating and improving
service delivery was emphasised.
Discussion on determinants of QoC
followed covering presence/absence
of policy statements, participatory
management, laws, regulations,
protocols and standards, MIS,
supplies and logistics, service
infrastructure and access. All these
determinants decide the therapeutic
outcome (successful/unsuccessful
treatment), occurrence/non occur-
rence of unintended outcomes,
changes/no change in level of client
knowledge regarding his/her health
conditions, client satisfaction/
dissatisfaction etc.
Rational use of drugs was discussed
in relation to the concept of quality
of care. Irrational use of drugs is a
violation of client’s rights, which is
cost effective, appropriate and timely.
It was a successful workshop that
ended with a video screening on
interpersonal communication and
environmental aspects of service
provision, which affect the quality of
services rendered. The participants
were also provided IEC materials on
the subject.
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1.10 Page 10 |
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RCH Services in Urban Areas: SWABHIMAN
Sitara, a young girl of Indira Camp,
a conglomerate of migrants and
urban poor, near Malviya Nagar in
Delhi, was married off at a tender
age of 13 years only to be deserted
by her husband. Dejected and
crushed, she visited the
SWABHIMAN centre seeking help.
She came to the centre as a frail
girl with no education and limited
understanding of her right to good
health and other human rights
and emerged with time and
SWABHIMAN’s association as a
fine enthusiastic girl with a better
self esteem. She now actively
participates in street plays and
other awareness activities for the
underprivileged urban poor
thronging hinterlands and fringes
of all growing cities, towns and
metros. She has now volunteered
as a SMILE Health Volunteer,
earning herself an honorarium and
living a life of dignity once again.
With the nation now focusing its
attention towards its urban
underprivileged, mega budget
programmes like the Jawaharlal
Nehru Urban Renewal Mission
(JNURM) have come into existence
and now National Urban Health
Mission (NUHM) is proposed for the
urban India. PFI and SMILE
Foundation have added a new
dimension to the outlook of urban
development by focusing on urban
and peri-urban poor women and
adolescents. The SWABHIMAN
project endeavors to weaken the
vicious cycle of deprivation, social
taboos, lack of education, dwindled
support from families and community
leading to empowered youth and
women.
SWABHIMAN – literally means “self
esteem”, and Sitara’s story is just one
of the many success stories of the
programme. The realization and
knowing that there being a woman
is a blessing and in no way a curse,
no matter what has been culturally
and socially ingrained for
generations. This very self esteem is
also a means to achieving our
goals of “realizing the need for
reproductive and sexual health
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care” as well as “demand for &
utilization of health care services’’
thereby taking the lead in ensuring
improved health of family and
community”.
The objectives of SWABHIMAN
programme are:
• To generate awareness on issues
of reproductive and sexual health
covering safe motherhood, child
health, family planning, RTI/STI/
HIV/AIDS among adolescents.
• To sensitize adolescent girls on
gender issues and imparting Life
Skill Education (LSE) including
communication and negotiation
skills.
• To provide reproductive and child
health services through mobile
health clinic for currently married
women, adolescents and children.
• To document processes, case
studies and success stories for
dissemination.
SWABHIMAN aims to cover about
78,000 underprivileged population
residing in slums and urban-rural
hinterland of Delhi ( 4 project partners
are: Nav Srishti – Neb Sarai, Malviya
Nagar; Adhaar Society – Shashi
Garden, New Ashok Nagar;
Sahyogita Samaj Vikas Sanstha in
Chattarpur, The Health & Care
Society in Begampur, Dhaula Kuan).
Adopting approaches like mobile
health clinic providing general health
and reproductive health services,
building community trainers
(10 Community Health Educators and
a cadre of 50 self motivated and
empowered volunteers) giving proper
information and education to the girl
child and empowering her towards
healthy behavior, the programme tries
to achieve its objective of building more
confident women for tomorrow, even
in the most vulnerable of settings.
Through mobile health van and
weekly clinic, where a doctor visits
the clinic (which houses in satellite
partner NGO offices), RCH and other
medical services are provided. 5,860
women and children have received
mobile health van services. 1,884
children (0-2 years) completed full
immunization and 237 women and
adolescent girls treated for
Reproductive Track Infections/
Sexually Transmitted Infections
Street plays are being used as an
effective media for communicating
key messages on social issues
pertaining to RCH, family planning,
ARSH and RTIs/ STIs/ HIV/AIDS.
The street plays drive the key
messages to the often resistant mass
comprising mothers-in-law, elderly
folk and men and help the CHEs and
the ever growing battalion of
SWABHIMAN volunteers in
communicating for behaviour change
among the society. Theatre groups
like Aradhya, Nav Umang Yuva
Sansthan and Mehak develop
innovative scripts for street plays,
which are very popular among
communities addressing local civic
issues also.
SMILE–SWABHIMAN also has
excellent media coverage of its
activities with strong support from
celebrities like Farooq Sheikh and
Kiran Bedi endorsing its causes. Print
media coverage like Washington
Post Coverage, The Statesman, The
Navbharat Times, The Asian Age,
Nai Duniya, The Global Times,
Femina Magazine and The Hindu, has
publicized SWABHIMAN’s many
initiatives, electronic media such as
Delhi Ajtak, Doordarshan, CNEB,
P7 News Channel, All India Radio,
has spread SWABHIMAN’s messages
with great fervor.
Through all its initiatives and behavior
change activities in community,
SWABHIMAN has been able to
successfully ensure male involvement
in empowering the urban poor
women and in improved access of
RCH services to women, children and
adolescents.
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2.1 Page 11 |
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‘Quality’ Family Planning Services in Uttarakhand:
Baseline Survey Findings
The Rural Development Institute (RDI) at the Himalayan Institute Hospital Trust (HIHT), Dehradun, Uttaranchal,
is implementing a project on Quality Family Planning Services with support from Population Foundation of India.
The project covers a population of 2,00,000 in Doiwala block of district Dehradun and the slum of Rishikesh (Chandreshwar
Nagar). The project aims to develop and implement an innovative model of ‘Quality’ family planning services in the
project areas.
A baseline survey was recently carried out in the project areas and some of the key findings, which emerged from the
survey, are:
• About 56 per cent of the eligible women surveyed got married between the age 18-21 years and 18 per cent after
21 years of age, while 26 per cent got married before 18 years.
• About 53 per cent of these women gave their first child birth by 21 years of age, 10 per cent before 18 and about
32 per cent after 21 years. About 45 per cent of the women had three or more children.
• The awareness about all modern methods of contraception is quite high at about 92 per cent. The Contraceptive
Prevalence Rate (CPR) by any method was found to be 51.5 per cent amongst the study population. It was also found
that among the current users of contraceptives, majority adopted spacing methods, i.e., condom (21.7%), followed
by OCP (7.2%) and Copper-T (1.7%). The unmet need of contraception came out to be 49.1 per cent.
• Only 10 per cent of the women were offered the basket of choice for family planning methods. About 76 per cent of
the women received check-ups before adopting modern contraceptives and about 45 per cent women received
follow-up services. Reasons were also sought for discontinuation of family planning methods amongst the women,
who ever used any methods and presently were non-users. The most common reasons cited for discontinuation were
desire to conceive (39%) and method failure (20%).
Thus, it is apparent from the findings that though awareness about modern methods of family planning is quite high in
the project area, the availability and quality of family planning services is a concern. Programmatic efforts need to be
directed towards counseling and information exchange in quality domain. The service provider’s skills and capacities
also need to be built for provision of family planning services with a focus on ‘quality of care’.
Strategic Communication Training for Advocacy
As part of the Spitfire Strategic
Communication Training for
Advocacy on Family Planning and
Reproductive Health issues, PFI
extended its support to the coalition
partners of Advocating for
Reproductive Choices (ARC) led
by FPAI. A two day Strategic
Communications Training for
Advocacy on Reproductive Health &
Family Planning focusing on family
planning methods was held at
Mumbai on April 16-17, 2009, has
helped the coalition partners in
preparing their advocacy plan on
NSV, IUD, emergency contraceptives
and injectables. The ARC partners
and members from Bihar, Jharkhand,
Maharashtra, Rajasthan, Uttar
Pradesh and Madhya Pradesh were
present at the training. Based on the
learning, a three day training is
proposed to be conducted for ARC
partners of Bihar and Jharkhand in
August 2009.
An orientation programme on smart
chart tool was organized with the staff
of International Planned Parenthood
Federation (IPPF), New Delhi on 4th
May 2009, which helped them to
plan their advocacy strategy. They
have shown interest to
take the support of
Smart Chart master
trainers in this regard
and requested PFI to
provide necessary
technical support in
designing their
strategic plan and
building the capacity
of their staff on smart
chart tool in future.
A view of participants at the Spitfire Strategic
Communication Training in Muzaffarpur, Bihar
Continuing the efforts
on the subject, the
coalition partner, Ghoghardiha
Prakhand Swarajya Vikas Sangh
(GPSVS), Madhubani has coordinated
a two day training programme on
Strategic Communication for the
representatives of North Bihar and
Nepal NGOs at Muzaffarpur, Bihar
on May 18-19, 2009. The overall aim
of the training was to improve
advocacy efforts in the regions of
North Bihar and Nepal on maternal
health during flood. The objective of
the training was to inculcate an
understanding of the smart chart
approach among the community
based organizations and the NGOs
in both the regions prone to flood of
river Kosi. Since advocacy is an
integral part of developmental
activities, it was felt that making
understand the organizational
representatives about the importance
of advocacy and its planning, usage
of smart chart planning tool and work
with the tool would help them to build
their confidence and strategic skills in
undertaking advocacy efforts on
health issues specifically maternal
health and care during the natural
disaster like flood.
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2.2 Page 12 |
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Children Education Awards Go to...
The Children Education Awards
were given away by Mr A R
Nanda, Executive Director, at a
function organised on June 26, 2009
at PFI for the academic year 2008-
09. These awards were constituted
by the Foundation to encourage
children of PFI staff to excel in their
academic performance and motivate
them to do better in the coming years.
The awards, every year, are presented
to children, who score a minimum of
eighty percent marks in their final
examinations. A three member
“Children Education Award
Committee” has been constituted,
which shortlists applications
according to the eligibility criteria and
nominates the winners.
In the current academic year, the
children who scored 90% and above,
for their performance in I to V
standard, were Mounika Nukella
(92.7%), daughter of Dr Phanindra
Babu Nukella, Shruti Paul (91.90%),
daughter of Mr P K Paul and Pratyush
Ramesh (90%), son of Ms Prema
Ramesh. They received cash award
of Rs 1000/- each, a meritorious
certificate, a trophy and a gift.
Award winners with Mr A R Nanda, Executive Director, PFI
Children, who scored 80% and above
for their performance in I to V
standard received certificates of merit,
trophies and gifts. The children in this
category were Rishi Raj (89.71%), son
of Mr Rakesh Kumar, Aakash Rawat
(88.4%), son of Mr Mohan Singh,
Harikrishnan P (87.5%), son of
Mr P Narayanan, Anushka Joyal
(83.6%), daughter of Mr Rakesh Joyal
and Nishtha Neogi (83.6%), daughter
of Dr Sharmila Ghosh Neogi.
Abhishek Sekharan, son of
Mr P J Sekharan received cash
award of Rs 2,000, a meritorious
certificate, a trophy and a gift for
his perfor-mance in IX standard
(89.4%). V. Satyanarayanan, son of
Mr K Venkatachalam, received cash
award of Rs 3,000, a meritorious
certificate, a trophy and a gift for
his outstanding performance in
X standard (93%).
We welcome...
Ms Mridu Pandey, who has joined the Foundation
as Programme Associate (Programme Development)
in May 2009. She has Masters Degree in Nutrition
and Post Graduate Diploma in Health Management.
She was earlier working with the Government of
Gujarat under the NRHM-RCH ambit as Project
Officer (Nutrition). She was extensively involved in
initiating and implementing nutrition strategies,
planning, budgeting and project management.
We bade farewell to...
Ms Sudipta Mukhopadhyay
worked with PFI for Packard
Project as Project Manager
in April 2009. She has joined
the Centre for Development and
Population Activities (CEDPA) as
Senior Advisor – Youth.
Editorial Guidance
Mr A.R. Nanda
Ms Sona Sharma
Editor
Ms Chandni Malik
Editorial Assistance
Ms Jolly Jose
Editorial Committee
Ms Usha Rai
Dr Almas Ali
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
Published by
Population Foundation of India
B-28, Qutab Institutional Area
New Delhi-110016, India
Tel: 91-11-42899770, 42899771
Fax: 91-11-42899795
e-mail: popfound@sify.com
website: www.popfound.org
Designed & Printed by Communication Consultants Tel: 91-11-24610176, 9811074665
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