In 2001, a team of UNFPA officials visited the Centre to deliberate on the possibility of initiating a project on Information, Education and Communication (IEC) of the community for appropriate usage of the BEOC services. Thus, a demand-driven and need-based project was formulated, after series of participatory discussion with the community and key medical officers. The project proposal was sanctioned by the District RCH Society (DRCHS), Chittorgarh, to be implemented in Hathiyana gram panchayat of Kapasan block of the district .
The project aimed to bridge the gap between government activities and community need, through NGO interventions. Broadly, the main objective was to initiate awareness generation, information dissemination and advocacy activities for safe motherhood practices, by encouraging participatory processes of education and mobilisation of the community. The specific objectives were to promote: “awareness generation”, to avoid delay in ‘decision-making at home’, to shift the pregnant women having obstetric complications to the health institution; “information dissemination” about the service delivery centre at the community level; and “advocacy” for developing co-ordination among ‘health institution, panchayats and communities for effective utilisation of funds available for referral transportation, under the RCH project, and efficient organisation of IEC activities of the health department.
IEC for Community Empowerment on RCH (2002)
This IEC project on RCH, supported by the UNFPA and the DRCHS, was implemented in the Bhilwara district. The project endeavoured to sensitise the project population, women in particular, to RCH. The target groups of the project were the couples in the reproductive age group and the adolescent girls.
Project Implementation Methodology
As per the directive/instruction of the DRCHS, the time frame of the proposed project was reduced from ‘one year’ to ‘seven months’. Multi-pronged strategies were adopted to integrate “innovative” aspects based on ‘the experiences of the centre’ and “participation, facilitation and co-operation” aspects of the ‘community, members of PRIs and the Health Department’. The focus was mainly on people of ‘disadvantaged and weaker sections’ amongst the ‘deprived areas’. There were “direct and indirect” as well “support” action groups. The direct-action groups included the ‘eligible couples, pregnant women and the heads of their families’. ‘Community leaders, including the members of the village-level Panchayati Raj Institutions (PRIs), dais (traditional birth attendants), gunis (traditional healers), Mahila Swasthya Sangathans (women groups), self-help groups (SHGs), jan mangal jodas, depot holders and government health personnel (specially ANM and AWW)’ were part of the ‘indirect-action’ groups. Non-traditional stakeholders (e.g., school teachers) were also involved in this initiative. These broadly constituted the large and united effort critical to bring in the desired changes.
As a whole, the methodology included four components, namely, awareness generation, information dissemination, community mobilisation and building alliances. “Awareness generation and information dissemination” was done among the “direct-action groups” on ‘social, cultural, religious and urgency’ issues to ensure safe pregnancy and childbirth. Further, “community mobilisation” involved ‘bringing specific as well as non-traditional stakeholders’ under a common platform, while “building alliances” was intended to incorporate effective and efficient co-ordination with the ‘formal health system’ and include the co-operation of the ‘informal health sector’ and aimed at the people at large to sustain the interventions.
As envisaged in the project, the Centre has organised: one ‘orientation programme’ of the project staff, as well as net workers; 12 focused chaupal baithaks, as well as 30 focused gram baithaks, in the four project villages (viz., Hathiyana, Rampuriya, Ramthali and Roodri) and two hamlets of Hathiyana village (Keer Khera and Lalaji ka Khera). One training programme, as well as one follow-up training programme of the ‘Social Action Committee (SAC)’; and seven monthly meetings of the SACs in the project villages/hamlets in the project period: May to November 2002. Besides, one workshop of sarpanchs and secretaries of the gram panchayats (GPs), which are covered under the referral transport scheme, was conducted, in addition to information dissemination activities by the members of SACs and community monitoring of usage of referral transport scheme by members of SHGs.
Project Orientation Programme
The one-day orientation programme was held at CHD campus on May 02, 2002 and divided into four sessions, namely, subject introduction; project briefing; social mobilisation; and plenary/open-house. The project staff, as well as the preraks (motivators) and sachetaks (animators) of the Centre participated in this interactive programme.
The specific issues discussed in session one, ‘Subject Introduction’, were: safe motherhood practices, maternal death/mortality, maternal morbidity, the five direct medical causes of maternal deaths, obstetric emergency, major signs of an obstetric emergency, emergency obstetric care (EOC) and safe abortion (including post-abortion care and incomplete abortion). In the project briefing session, the project proposal was also discussed. The social mobilisation session broadly included methodologies for building network alliances and acting as a catalyst for raising awareness on multi-sector initiative for planned and effective usage of emergency obstetric care services.
In the final session, open discussion was held. The discussion involved international, national and state scenarios of maternal mortality and morbidity; guiding principles of various approaches and roles for ensuring maternal and neo-natal health; and the need of social mobilisation for achieving safe motherhood and its processes, as well as planned impacts. The discussion on the desired impacts included building a sense of ownership in the community, capacity building and focused action.
Focused Chaupal Baithaks
Focused Chaupal Baithaks (FCBs) were organised in the four project villages and two hamlets. Awareness generation and sensitisation of the community were the key objectives of these meetings. These meetings, facilitated by the project staff, were organised to involve ‘direct as well as indirect action groups’, along with the ‘non-traditional stakeholders’, for sensitisation on the consequences of obstetric complications.
To ensure maximum participation of women, in particular, and efficient interaction with the community, in general, the meetings were mostly conducted during the evening hours. The women’s SHGs located in Ramthali, Keer Khera and Lalaji ka Khera hamlets of Hathiyana villages played key roles in the mobilisation of various stakeholders and organisations for the meetings in their respective villages
Issues related to maternal health, safe motherhood practices, the effect of delay in obstetric complications, women’s rights, reproductive rights, health care-seeking behaviour, health care delivery system and government schemes were discussed during the meeting. Indigenous communication methods, such as cultural programmes (folk songs/dramas) were used, along with video shows, for raising awareness on social issues.
Formation of Social Action Committees (SACs)
SACs were formed in the four project villages, as well as two adjoining hamlets (Keer Khera and Lalaji ka Khera of Hathiyana village), involving ‘sachetaks and preraks of the Centre, community leaders, PRI members, Auxiliary Nurse Mid-wife (ANM), Anganbadi Workers (AWWs), self-help group leaders, dais (traditional birth attendants), religious leaders and traditional folk artists. Regular monthly meetings of the SAC members were organised in the project villages, as well as at the Centre. Facilitated by the members, these committees were engaged in awareness generation, information dissemination and community interaction activities on issues related to ante-natal care, safe delivery, referral transport facility and post-natal care. Proceedings of the meetings were recorded by the members in registers issued by the Centre. The members of the committees also interacted with the AWWs and ANM for accessibility of nutrition, immunisation and health services.
Focused Gram Baithaks
FGBs, as follow-up of the FCBs, were aimed at informing the community, in general, and the ‘direct and indirect action groups’, as well as ‘non-traditional stakeholders’, in particular, regarding the “social malpractice, cultural taboos, religious myths and economic factors” in reproductive and health-seeking behaviour of the community, procrastination of which could lead to emergency, sometimes, even death of pregnant women. The SACs were co-ordinating the FGBs with the CHD staff, acting as facilitators.
To generate social awareness on issues related to small family, women’s health, safe delivery and social malpractice (e.g., child marriage), cultural programmes were organised in project villages and adjoining hamlets. Messages related to obstetric complication/emergency, safe/institutional delivery and ante/post-natal care were written on the walls of the houses located at key places of the project villages. This activity was aimed at people who might have missed any of the awareness generation and information dissemination activities organised by the centre, as well as to act as a ‘reminder’ for the people who might have participated in those activities.
Training of SACs
Many members of the SACs had participated in various training programmes organised by the Centre, under the health and empowerment projects. Follow-up trainings were held from time to time to enhance the capacity of the members for addressing problems. Issues discussed by the members during the meeting were delay in decision-making at household level to transport the pregnant woman with obstetric complications to health institution; delay in availability of vehicle for transportation; lack of awareness and information on referral transport facility among the project population; and inadequate direction to sarpanch on utilisation of referral transport money.
Additionally, following need and learning-based innovative activities were also undertaken by the Centre, for which there was significant initiation from and active partnership of gram panchayats and SACs. These integrated activities were in continuation of the above-mentioned ones and were aimed at broader community empowerment.
Workshop of Sarpanchs and Secretaries of Gram Panchayats
In Chittorgarh district, under the referral transport scheme, 69 GPs have received money for distribution among poor families. A detailed study has highlighted the fact that most of the money has not been utilised and, surprisingly, some of the money has also been spent for purposes other than it were meant for. As project innovation, a workshop of sarpanchs and secretaries of each GPs was organised in the premises of the Centre for wider coverage, awareness generation and multiplication of interventions.
Inaugurated by R.N. Arvind (District Collector, Chittorgarh), the workshop was attended, among others, by Swami Omanand Saraswati (eminent educationist, social activist and religious leader), Dr. Umesh Singhai (DRCHO) and Rup Singh Kabiya (District Public Relation Officer). Effective utilisation of referral transport money, community mobilisation for institutional delivery in cases of obstetric complications and the efficiency of sarpanchs and secretaries were discussed.
- Increased usage of ‘referral transport’ facility and timely availability of ‘money’ for transportation of pregnant women to health institutions, even from sources other than the ‘referral transport’ facility (e.g., SHG fund)
- Increased knowledge regarding ‘obstetric complications’
- Timely referral of cases involving ‘obstetric complications’
- Increased interaction with the ‘government health personnel’
- Increased importance to ‘own health’ by women.