This project, initiated in April 2007, has improved the health and nutrition of pregnant women, children and adolescents living in Khagramuri. Interventions were targeted the critical life stages - pregnancy, early childhood and adolescence.
Community members were encouraged to actively participate in health related awareness raising activities, supported by local governing bodies ( panchayats ). This aimed to build and strengthen existing community platforms for community mobilisation, awareness and ownership, thus improving the sustainability of the benefits of the project. Enhancing links with government and non-government stakeholders, and community based organisations formed another crucial component.
Objectives
- To build the capacity of the key stakeholders to undertake dialogue and action, by coordinating mechanisms on reproductive and child health issues, services, rights and entitlements
- To ensure safe motherhood
- To ensure child survival and growth
- To equip adolescents with knowledge enabling them to make informed choices about health and nutrition
Safe motherhood
- Health workers identified and tracked 380 pregnant women. Of these, 92% were identified within 16 weeks of pregnancy, and 85% were registered within 16 weeks of pregnancy
- Regular home visits generated greater awareness of pregnancy care and practices, and pregnant women were also encouraged to receive timely antenatal check ups at the local health clinic. Home visits continued after the birth of the newborn. Mothers were advised on feeding practices and the importance of immunization. Other family members, particularly key decision makers, such as the husband or the mother-in-law, were also involved. This will help ensure that a conducive environment is created for the pregnant women, so that they receive adequate care and support.
- 97% of pregnant women received blood tests, which revealed that most were anaemic. Except for one case of severe anaemia, the expecting mothers suffered from either mild or moderate anaemia. With regular intake of nutritious food, along with rest, and medical checkups, CINI was able to support them to address this problem.
- 97% of pregnant women received complete Tetanus Toxide inoculations, 81% received 100 or more IFA tablets and 91% received at least three or more ante natal checkups (the average for rural West Bengal is 56%*).
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*2005-2006 National Family Health Survey (NFHS-3) - Fact Sheet West Bengal
Child survival, growth and development
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- 380 women delivered and there were 382 live births (with two cases of twins).
- 87% of deliveries had a trained person present, either in hospital or at home. This is more than double the average for rural West Bengal which is 37%*.
- 91% of newborns were weighed within 48 hours. Of these, 85% weighed at least 2.5 kg or more. It is not possible to completely eradicate underweight babies as so many mothers are chronically malnourished.
- Through continued home visits and community events, mothers and family members were advised on the importance of exclusively breastfeeding for the first three to six months, followed by the introduction of complementary feeding. 87% of babies were exclusively breastfed for the initial three months, and 59% of babies were exclusively breastfed for the initial six month period.
- The importance of complete primary immunization and the role it plays in preventing deadly childhood diseases was emphasised. 92% of eligible children (age 1) received complete primary immunisation.
- Unfortunately, 6 babies died. In each case, representatives from the Women's Health Division and Division of Child Health and Development, along with doctors, visited the families to assess the causative factors. Their visit also provided the much-required psychosocial support to the family.
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*2005-2006 National Family Health Survey (NFHS-3) - Fact Sheet West Bengal
Adolescent health
- Approximately 40 adolescents were directly reached by this project. Adolescent health activities were conducted at an individual and community level. Activities were targeted at various sections of the community to improve awareness of adolescent health issues. A number of meetings were held. These provided a safe space for adolescents to freely express themselves, raise questions and gain further clarification on issues affecting them.
- Six meetings with peer educators focused on the project aims and objectives, the importance of the adolescent health programme, and the expected roles and responsibilities of peer educators.
- Fifty nine issue based meetings were conducted with adolescents to discuss adolescent health issues, thereby creating greater awareness. They explained the importance of nutrition in adolescence, various physical and psychological changes that occur, nutritional demands and the prevalence of anaemia.
- Four stakeholders meetings were conducted involving various decision-making heads, crucial for creating a stronger support network, as well as creating a more responsive environment for adolescents.
- Four newly wed ceremonies for married adolescents were held. These highlighted the importance of family planning, contraceptives and the benefits of delaying the first pregnancy.
Community mobilisation
- The rural legislative body or the Panchayati Raj system was integral to policy formulation. Decision-making bodies were involved to make the project outcomes more sustainable.
- Five meetings with panchayats were conducted. Government health schemes for pregnant women and the need to improve greater awareness of the availability of such schemes was also discussed. As CINI plans to phase out of the area , sustainability of the project was also discussed. Activities to be undertaken will mainly be community-based to bring about greater convergence of various systems and institutions and to generate greater awareness and collective ownership. Also, the details of Women and Child and Friendly Communities (WCFC) were discussed.
- 41 male involvement meetings (with 25 participants each) were conducted. Meetings focused on the role of male family members. Husbands were encouraged to share the domestic workload with their pregnant wives, and were encouraged to accompany their wives to the local health centre, particularly in later stages of pregnancy. With the arrival of a newborn, the responsibilities of the father to ensure that the child receives correct food and timely immunization were also highlighted.
- Seven meetings with service providers discussed the WCFC concept, the importance of the adolescent programme, and HIV and AIDS.
- 39 meetings with pregnant or lactating women discussed good mother and child health practices.
- Staff-sharing meetings were held monthly, allowing project staff to discuss problems that arose during the implementation process and explain how they were solved.
- Three capacity building activity sessions were conducted with project staff, updating them on how to implement the project and discuss difficulties that might be faced. In addition, capacity building activities with peer educators were undertaken regarding the structure and details of adolescent part of the project.
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Key challenges
- Despite being informed of the benefits of hospital delivery, many pregnant women choose a home delivery because it is common practice in the community, followed for generations. Delivering at home in India is a very different experience than in the UK, and can often be very unsafe as there is no blood supply on standby, no drugs and no ambulance if things go wrong.
- Exclusive breastfeeding for the initial six months of an infants' life remains difficult to attain, primarily because mothers and other family members lack awareness of the benefits.
- Some members of the community were not convinced of the benefits of adolescent involvement, thus the adolescent health programme requires a sensitive approach to engaging greater community participation.
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Key learning
- Continuous interaction at the individual level, as well as at the community level with the target group, as well as with key stakeholders, has proved to be an effective means of reaching out to greater numbers of people and encouraging them to participate.
- Use of behaviour change information not only strengthens the process of positive behaviour change, but also explains the various concepts of health and nutrition amongst community members. Since these materials are largely pictorial, they enable illiterate community members to understand the concepts.
- One-on-one interaction with key stakeholders proved to be effective in securing their support, particularly in cases where formal meetings could not be arranged.
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