By building community support, Sure Start helps save the lives of mothers and their babies

“I do this in order to pay my debt to the country. I understand that I can’t do big things, but I can at least bring about tangible change in my neighborhood.”—Sure Start community volunteer

Every year, thousands of women and babies in India die due to complications of pregnancy and delivery—most of them preventable. Sure Start works consistently toward creating awareness of maternal and newborn health in the wider community and focuses in particular on helping women and their families make individual decisions which will make motherhood safe and give babies the best possible start in life.

The essence of Sure Start's endeavor is to work in close partnership with families and community groups through collaborative and creative initiatives, encouraging them to become agents of lasting change in urban and rural societies.

The power of unity

In villages in Uttar Pradesh where Sure Start works, mothers-to-be and mothers-in-law are both part of “mothers’ groups” managed by Sure Start. The village women work with the local health caregiver to hold meetings that help increase maternal and newborn health awareness. These meetings tackle important and serious topics with entertaining methods—dolls, games, music, and dance. Since January 2008, Sure Start has organized 109,936 mothers’ group meetings involving approximately 322,937 expectant mothers and mothers-in-law.

As part of the program, fathers-to-be receive letters from their unborn children. The letters help men understand the importance of their role in ensuring a safe delivery for their wives and unborn children.

Communities take charge

While many districts in India have government-run Village Health and Sanitation Committees (VHSCs), these often fall short of realizing their full potential. Sure Start has been instrumental in activating the VHSCs and ensuring that members hold regular meetings. The committees have helped establish improved facilities at the primary health care level and have been instrumental in the dissemination of essential information, such as emergency phone numbers and names of doctors.

Through the committees, communities have been able to demand improved health care and other services from district authorities. For instance, payments under the Janani Suraksha Yojna, a government scheme that incentivizes delivery in hospitals, have increased.

The Sure Start project has also built the capacity of 7,540 government-recognized Accredited Social Health Activists who work in Uttar Pradesh’s villages. In fact, 67 percent of ASHAs are now facilitating mothers’ group meetings with support from supervisors. In 2010, nearly 3,000 specially trained ASHAs will make three postpartum home visits to mothers within the first week after delivery. During these visits they will provide counseling, reinforce key newborn care messages, identify complications in babies and mothers, and assist in referral to an appropriate facility.

Building bridges

In Pune, Sure Start has set up 51 Monitoring of Maternal and Newborn Health Services committees which are creating a bridge between health practitioners and their clients. Women reach out to new and expectant mothers to explain improved maternal health care, while men handle logistical responsibilities such as the provision of blood services and transportation. The committees are also helping to create a stronger sense of community identity.

The next stage of this project in Pune aims to integrate HIV counseling and testing services into the program agenda.

Similar Sure Start initiatives are being implemented across Maharashtra. In Navi Mumbai, the project is helping to create community support groups that will facilitate interaction between communities and health service providers. In Nanded, Sure Start has enabled 220 families to take charge of their health by establishing a community-based health insurance scheme with a special provision for maternal and newborn health. In Solapur, hundreds of volunteer college students and community members are participating in awareness-building campaigns.

Bharkherva village: making a tangible difference

Like thousands of Indian villages, Bharkherva village in Hardoi district, Uttar Pradesh, has to contend with many big issues—electricity shortages, delayed monsoons crippling crops, and the challenge of ensuring the right to education for all. But perhaps the biggest issue has to do with life itself—the lives of those yet to be born.

Until recently, expectant mothers in Bharkherva village often did not have transportation to reach medical facilities. Community members did not recognize basic danger signs in pregnancy, such as bleeding, and these symptoms were not taken seriously until it was too late. Education on safe delivery practices did not exist.

Despite endemic newborn and pregnancy-related deaths in Bharkherva, the issue was not considered as important as the other difficulties facing the community. That is, until Nirbhay Singh, the pradhan (elected village headman), was approached by Sure Start.

Singh estimates that since Sure Start’s innovative awareness-building program began in 2008 that between 70 and 75 percent of adults in the community have become aware of safe delivery practices and the vital importance of ensuring access to maternal and child health services. Facilities at the primary health care level have also improved. “No longer do we always need to travel all the way to the big district hospital,” Singh says proudly.

Pune: Real lives, real change

In Pune, Maharashtra, the Monitoring of Maternal and Newborn Health Services committees had a difficult time when they began work. “People used to think that the health of mothers and newborns wasn’t any of our business,” says Ms. Shamshad Sheikh, a committee member who also holds a day job as a social worker.

But the committees made it their business, on every level. They approached doctors and nurses at local hospitals and health care facilities, explaining the Sure Start mission. Initially, there was a disconnect between health care practitioners and the community. After repeated visits from committee members, however, a bridge between the two was created.

Community perceptions toward the project also slowly changed. Ms. Sheikh and her colleagues vividly remember the story of one pregnant woman. “We kept asking her to go for an antenatal checkup,” Ms. Sheikh says, “but she was averse to the idea.” Step by step, the committee members chipped away at the mother-to-be’s resistance. Finally, she went to a nearby health center. “The doctors found her to be in dire need of medical attention and blood transfusions, which they administered,” says Ms. Sheikh. “They narrowly saved her life and the life of her unborn child.”

A quick look at some of Sure Start’s achievements

Uttar Pradesh

• Facilitated 44,976 Village and Health Sanitation Committee meetings.
• 100 percent of committees have plans for providing transport for expectant mothers.
• 100 percent of committees have plans to improve the quality and reach of maternal and child health services.
• 97 percent of VHSCs are registering births, and 79 percent are also registering deaths in their villages.
• Built the capacity of 7,450 Accredited Social Health Activists.
• Government funding of US$1.5 million has been released to committees.
• Organized 109,936 mothers’ group meetings involving approximately 322,937 expectant mothers and their mothers-in-law.
  

Maharashtra

• Built the capacity of 35 community health workers in Nagpur.
• Set up 97 emergency health funds in Nagpur, with special provisions for maternal and newborn health care. So far, 512 families have benefited from using these funds, including 72 mothers and newborns.
• Established 20 community groups in Navi Mumbai.
  Institutional delivery in Navi Mumbai has increased from 79 percent in 2007 to 95 percent in 2009.
• Created a network of 1,797 volunteers in Solapur.
• Established 51 Monitoring of Maternal and Newborn Health Services committees in Pune.
• Founded a community-based health insurance scheme for 220 families in Nanded.
  

Photos (from top): Lakshman Anand, PATH, PATH.