Advancing maternal, newborn, and child health in tea plantation and tribal communities in India

In the tea plantations of Assam located in the northeastern part of India, pregnant women found it difficult to access the state-sanctioned cash benefit of INR 12,000 (~USD 140) under the Wage Compensation Scheme, meant to improve nutrition and care.

A core group of frontline workers (FLWs) identified this gap and, with support of the District Program Management Unit (DPMU) and a multistakeholder forum, carried out a collaborative campaign titled “MAAdol” to strengthen the implementation of the Wage Compensation Scheme. It helped expand the reach of the scheme to more than 5,000 beneficiaries, leading to the disbursement of INR 9,180,000 (~USD 110,000).

In Chhattisgarh, a state with a 30 percent tribal population, three FLW core groups were formed in Kanker district. Their primary task was to identify high-risk pregnancies and devise individual follow-up plans for better birth outcomes. This resulted in enhanced identification rates through coordination between different health worker groups within the primary health care system, such as the accredited social health activists (ASHAs), auxiliary nurses and midwives (ANMs), rural health officers (RHOs), and community health officers (CHOs).

These interventions were undertaken under PATH’s Project Saksham, which is a part of USAID’s Maternal, Newborn, and Child Health (MNCH) accelerator initiative. Saksham attempts to scale high-impact interventions in Indian states with a high burden of maternal, newborn, and child morbidity and mortality.

Project Saksham’s current priority lies in addressing the needs of marginalized areas in Assam, Chhattisgarh, and Odisha, where maternal and child health concerns are prevalent among vulnerable populations. These regions are predominantly occupied by tea plantation communities (Assam) and tribal communities (Chhattisgarh and Odisha). Learnings from implementing Project Saksham in these areas will serve as a viable and adaptable model that may be replicated and scaled to suit various settings across the country.

At present, India is witnessing positive trends in MNCH outcomes, reflecting the efficacy of various initiatives and interventions. Over the past decade, there has been a notable reduction in maternal and child mortality rates, indicating progress in addressing preventable health issues. As per the Sample Registration System (SRS), the country has witnessed a progressive reduction in maternal mortality rate (MMR) from 130 in 2014–2016 to 122 in 2015–17, 113 in 2016–18, 103 in 2017–19, and 97 in 2018–20.

Despite these developments, challenges persist in achieving optimal MNCH outcomes across the nation. Disparities in access to quality health care services persist, with rural and underserved communities often facing significant barriers in accessing essential maternal and child health services. Maternal mortality and morbidity and newborn deaths continue to be important public health issues, particularly in certain states and regions. Life-saving health technologies exist, but they are inaccessible because they are either too expensive or unsuitable for the specific context. At the same time, under-tapped public–private collaborations and ambiguous scale-up pathways often inhibit sustainable introduction and scale of innovations that have the potential to rapidly improve MNCH outcomes.

Project Saksham is a collaboration among USAID, PATH, Piramal Swasthya, Jhpiego, and Deloitte. It adopts a multi-level approach to drive change and better maternal and child health outcomes. At the national level, Saksham has facilitated the establishment of a National Technical Advisory Group (NTAG) for MNCH to identify, review, and recommend high-impact interventions. By ensuring the effective implementation of evidence-based practices, Saksham aims to strengthen the impact of interventions on MNCH outcomes nationwide.

At the state level, Saksham empowers health systems, catalyzes private sector partnerships and leverages technology to enable data-driven decision making. At the district level, Saksham aims to introduce point-of-care devices/solutions for FLWs and health care providers, and demonstrate process innovations for implementing existing programs.

To ensure quality, equitable, and accessible MNCH services, Project Saksham employs a comprehensive set of strategies. Utilizing human-centered design methodologies, the initiative involves end-users in designing systems that enhance learning and accountability for health care providers and FLWs. For example, one of the project interventions is the creation of a model Village Health Sanitation and Nutrition Committee (VHSNC), where members come together to identify issues in their catchment areas and design a solution at the local level. One of the model VHSNCs in Assam identified the unavailability of transportation to a health facility as a challenge for pregnant women. Therefore, the committee decided to onboard an additional vehicle that could be used to ferry pregnant women from the tea garden areas to the nearest health facility.

In Assam and Odisha, skill labs have been established in consultation with state health missions. These skill labs will be used to impart skills in ante-natal and intra-natal care to students in medical colleges and service providers in public and private facilities.

Integrated MNCH dashboards at the state and district levels provide evidence-based data for planning and monitoring, as well as facilitating timely adjustments when needed. Engaging the private sector is vital, as it will enable collaboration to expand the reach and quality of MNCH services. Project Saksham also focuses on strengthening innovations and policy advocacy through various centers of excellence, which promote evidence-driven scaling of innovations and widespread dissemination of best practices.

These strategies collectively drive Project Saksham’s mission to enhance MNCH outcomes and create lasting positive change in MNCH. Early successes in Assam, Chhattisgarh, and Odisha can pave the way for similar initiatives nationwide, propelling India towards achieving its ambitious goal of eliminating maternal and child morbidity and mortality.