India’s struggles with maternal, newborn and child health were highlighted in a 2008 WHO report, stating that “India, along with Bangladesh, Pakistan and Indonesia, contributes over 50 percent of all maternal and child deaths globally. What’s worse, India is not making sufficient...

Basic Health Care for Women and Children: A High-Impact Investment

India’s struggles with maternal, newborn and child health were highlighted in a 2008 WHO report, stating that “India, along with Bangladesh, Pakistan and Indonesia, contributes over 50 percent of all maternal and child deaths globally. What’s worse, India is not making sufficient progress. India’s population is massive and even if the ratio of maternal and child mortality may not be high, the numbers are staggering.” The lack of services for pregnant women and newborns is far worse in Bihar state, which has the poorest rate of antenatal coverage in India.

This Initiative, which commenced in late 2007, was designed to address Bihar’s maternal and infant health issue through a variety of programme components, as health is indirectly impacted by a number of other issues like education and economic status. Over US $1.38 million in grants were distributed to 14 local community-based organisations (CBOs), allowing them to initiate a number of programmes.


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Strategic Initiative

SECTOR

Health

TOTAL INVESTMENT

US$ 1,379,710

LOCATION

India

LIVES CHANGED

357,025

SOCIAL IMPACT INDEX

68.9 (out of 100)

AVERAGE COST PER LIFE

US$ 3.86

Expand All

SI Breakdown:

Key Achievements

  • Decreased mortality rates – Infant and maternal mortality rates were reduced by as much as 40 percent. There were also significant increases in safe deliveries, immunisation, and basic health care services.
  • Infant health care services provided – Over 120,000 infants and children received health care services, including vaccines. This resulted in an increase in infant immunisation rates by as much as 40 percent.
  • Maternal health care services provided – Over 20,000 pregnant and lactating mothers benefitted from antenatal and postnatal care and other services, a 45 percent increase from the start of this programme.
  • Health workers trained – More than 6,300 community health workers were trained, resulting in sustainable, improved services for both mothers and children.

The Problem

India’s struggles with maternal, newborn and child health were highlighted in a 2008 WHO report, stating that “India, along with Bangladesh, Pakistan and Indonesia, contributes over 50 percent of all maternal and child deaths globally. What’s worse, India is not making sufficient progress. India’s population is massive and even if the ratio of maternal and child mortality may not be high, the numbers are staggering.” The lack of services for pregnant women and newborns is far worse in Bihar state, which has the poorest rate of antenatal coverage in India. Quality essential services for women during pregnancy and childbirth are inadequate or non-existent. Infant mortality rates (IMR) exceed the national average and the maternal mortality rate (MMR) in Bihar is the fourth highest among all states in India. In addition, it has the sixth lowest rate of full immunisation for children age 12 to 23 months.

Solution

This Initiative, which commenced in late 2007, was designed to address Bihar’s maternal and infant health issue through a variety of programme components, as health is indirectly impacted by a number of other issues like education and economic status. Over US $1.38 million in grants were distributed to 14 local community-based organisations (CBOs), allowing them to initiate a number of programmes, including: training and equipping of traditional birth attendants and rural health care providers on safe delivery practices, immunisation delivery, and treatment for common diseases and ailments among infants and pregnant and new mothers. The primary goal of this Initiative was to improve maternal, infant and childhood health through improved health care services and better-equipped local health care providers. However, two secondary goals were to change attitudes and behaviours among communities through education and sensitisation and to provide economic empowerment so that community members could better afford to provide for themselves. In addition to working with direct beneficiaries, the Initiative aimed to advocate and partner with government agencies to improve access to vaccines and routine health care, as well as services for infants, pregnant women, and nursing mothers.

Critical Analysis

This Initiative was highly successful in improving health care for women and children. Through the 14 CBOs funded, more than 120,000 infants and young children were provided with various forms of care, including potentially life-saving immunisations. These organisations were able to assist more than 20,000 pregnant women, ensuring that they received vital care and information that reduced health risks during pregnancy. Both of these numbers far exceeded expectations at the beginning of the programme, improving health outcomes for 40 percent more women and children than expected. In addition to working directly with women and children, many of the CBO partners worked with local health care providers, such as traditional birth attendants and rural medical practitioners, equipping them to provide better care for women and children. In total, over 6,300 health workers were trained, increasing the opportunity for sustainable impact.

In India, the state guarantees many basic health care services for rural and poor communities, but in reality these services are often not provided. Initiative-funded CBOs worked with communities to revive these services. Programmes such as integrated child development centres and local health clinics, where pregnant women have access to antenatal and postnatal care, were reopened, and services were improved.

Due to the fact that health issues are so closely related to other life circumstances, the Initiative included a variety of components that, on face value, do not have an obvious health impact. For example, by delaying the age of marriage and childbirth, the risk of both infant and maternal mortality is reduced. Because girls attending school marry later than those who don’t attend school, CBOs sought to increase school attendance among girls. Likewise, by increasing income, families increase the number of meals they eat as well as the quality of the food, improving overall health. As a result, many CBOs’ programmes included women’s self-help groups with an economic empowerment component. In the same way, adult literacy programmes helped women to better access government services, as completing forms is often part of the process.

Through the many approaches taken, the Eastern India Health Initiative has had a profoundly positive impact on over 350,000 Biharis in over 650 villages. As so many of the outcomes are long-lasting, the benefits of this Initiative will continue well beyond its final year of funding.

Lessons Learned

Successes:

Significant reductions in both maternal and infant mortality rates – While figures vary among the districts covered through this Initiative, both MMR and IMR were reduced. The results were achieved through increases in antenatal and postnatal care, immunisations, training of rural health providers, and increases in institutional deliveries. These improvements are in contrast to state-wide statistics, which remain static or are only marginally improved.

Increased immunisation rates – Education on child vaccinations and child health had a large impact on immunisation coverage, reduced IMR, and improved overall health of children under the age of five.

Advocacy efforts improving health infrastructure – Grassroots, district and state level advocacy efforts are bearing fruit as health infrastructure is improving in the project areas of the implementers. Communities have begun to demand government health services that were not previously being provided.

Improved perception of women’s value – During the three years of the Initiative, we have seen the development of many rural Indian women from hesitant and shy to confident and determined to move to the next level in terms of health, social and economic status.

Challenges:

Health personnel shortage – There has been a shortage of skilled frontline health personnel (auxiliary nurse midwives, rural health care providers) to provide timely and quality antenatal and postnatal care services and to assist in home-based deliveries.

Inadequate public health facilities and medicines – The public health facilities providing obstetric and gynecological care at district and sub-district levels are inadequate. Likewise, vaccines and medicines remain in short supply.

Cultural barriers – Deeply rooted divides in terms of caste, religion, gender and economic status still exist in the rural areas. Transformation of the mindset and behaviour of the rural population influenced by long-held superstitions and traditions is very difficult, but not impossible.

Quality partner CBOs and CBO staff retention – A lack of law and order and an abundance of environmental disasters and economic hardship make rural Bihar an undesirable place to work. Identifying quality CBO partners in some areas is a challenge. For CBOs, identifying and retaining quality staff is a challenge.

Government corruption – Corruption at all levels of government remains a significant barrier to effecting lasting change.

Eastern India Health: Featured Projects

SII ScoreProject NameGrantLives ChangedCost Per LifeSector
88.00 Duncan Hospital$183,06652,690$3.47
88.00 Fakirana Sisters Society$110,64816,369$6.76
87.40 Adithi$158,05034,832$4.54
83.60 Center DIRECT$136,599115,073$1.19
76.00 Azad India Foundation$115,57618,832$6.14
72.20 Nav Bharat Mission$28,1003,017$9.31
68.40 Purnea Social and Educational Society$129,09524,999$5.16
68.40 Bal Mahila Kalyan$69,55113,439$5.18
68.40 Integrated Development Foundation$113,34314,013$8.09
57.80 Jan Nirman$49,10027,164$1.81
57.60 Magadh Vikas Lok$61,80413,654$4.53
57.60 Mahila Bal Jyoti Kendra$98,47711,532$8.54
51.00 Nari Nidhi$41,9829,542$4.40
40.80 Bihar Voluntary Health Assocation$63,6601,869$34.06
Note: The Social Impact Index Score reflects the relative social impact of a given development project. The lowest possible score is 20; the highest possible score is 100.

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