An exemplary example of Community based health care RGMVP

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RGMVP works in an area of Uttar Pradesh that has some of the lowest Human Development Indices in the country. There is lack of health education, prevalence of chronic diseases like tuberculosis, diarrhoea, etc, and reproductive health problems such as high-risk pregnancies, RTI/STD, non-institutional deliveries, anaemia, maternal and infant mortality, and malnutrition. Women have limited or no access to basic healthcare facilities and are often compelled to depend on unscientific treatment.Almost every second girl is anaemic and every second child is malnourished in UP. More than 50 percent of institutional deliveries are low birth weight cases, and belong to the poorest of poor strata. More than 70 percent institutional deliveries are un-booked cases without follow up or ante natal care. Infants are born prematurely or with neonatal jaundice and respiratory diseases. The government infrastructure as compared to population is almost insignificant. The situation is exacerbated by the fact that many of these health issues are linked to traditional beliefs and practices and a hierarchical social structure.

The Community-based Health Care initiative is aimed at reducing the Infant Mortality Rate (IMR) and the Maternal Mortality Rate (MMR) by:

Enhancing awareness on ante-natal care, infant care and nutrition;

Generating public consciousness of health services as a fundamental right;

Creating public accountability; and

Creating a better understanding of health and healthcare.

RGMVP has built a systematic, institution based approach to addressing community heath and healthcare. At the centre of the solution is the Community Health Activist (Swasthya Sakhi), a volunteer from the community who is trained to provide basic knowledge on reproductive health and sanitation (personal and public hygiene) with special emphasis on prevention. She is responsible for generating demand for health services in the community and linking the community with the existing public health services. She also provides a measure of immediate relief for health problems, organises the community on healthcare issues, especially pregnancy and ante-natal care, and sensitises SHGs/VOs/BOs and builds capabilities. SHGs members are encouraged to internalise the seven best practices for healthcare based on basic hygienic and healthy behaviour so that they can lead a secure and responsible life.

Currently, RGMVP is scaling up its health intervention by ensuring that a Swasthya Sakhi is linked to every SHG in the Programme area. Systematic dissemination of knowledge and information-sharing is taking place since every SHG group meeting s agenda includes a discussion on health, especially on targeted issues such as pregnancy, nutrition, immunization, delivery and care of child, adolescence health, and hygiene and sanitation.

RGMVP s convergence strategy has been especially effective in consolidating the impact of the Community-based Health Care initiative and to promote health care among the poor as a right and an entitlement that they must demand. The Swathya Sakhi promotes convergence by acting as a link between public health workers such as the Auxiliary Nurse Midwife (ANM), the Anganwadi Worker (AWW) and the Accredited Social Health Activist (ASHA). These public health workers are able to use the CIP meetings as a platform to disseminate information on issues such as immunisation and to communicate with women on healthcare issues. The CIP meetings are thus a one-window convergence platform for various interventions such as the Integrated Child Development Scheme (ICDS) of the government, or for village functionaries such as the Gram Pradhan to promote schemes such as sanitation amongst the community.

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