Social accountability and education revives auxiliary nurse-midwife sub-centers in India, reduces travel time and increases access to family planning services
Background: Uttar Pradesh (UP) is the most populous state in India. The maternal mortality ratio, infant mortality rate and fertility rates, are all higher than the national average. Sixty per cent of UP inhabitants live in rural communities. Reasons behind the poor state of health and services in many areas of UP is inadequate knowledge and availability in communities of healthy behaviors and information on available government health services.
Methods: World Vision Inc. implemented a three-and-half year mobilizing for maternal and neonatal health through birth spacing and advocacy project (MOMENT), partnering with local organizations in rural Hardoi and urban slums of Lucknow districts in UP. World Vision Inc. used print, audio and visual media, and house-to-house contacts to educate communities on timing and spacing of pregnancies, the benefits of seeking and using maternal and child health (MCH) including immunization, and family planning (FP) services. This paper focuses on World Vision’s Social Accountability strategy – Citizen Voice and Action (CVA) and interface meetings – used in Hardoi that helped, educate and empower Village Health Sanitation and Nutrition Committees (VHSNCs), and village leaders to access “Government Untied Funds” to improve community social and health services.
Results: 40 VHSNCs were revived in 24 months. Nine local leaders accessed government untied funds. In addition, increased knowledge of the benefits of timing and spacing of pregnancies, MCH, FP services, and access to community entitlements, led the community to embrace, work together to contribute their time to rebuild and reopen 17 non-functional Auxiliary Nurse Midwife (ANM) subcenters. 17 ANMs received refresher training to provide quality care. Sub-center data showed 1,121 and 3,156 women opted for intra-uterine contraceptive device and oral pills respectively and 29,316 condoms were distributed.
Conclusion: In Hardoi, UP, education, using CVA, and interface meetings are contributing to increasing the number of government sub-centers that integrate contraceptive services with others such as immunization and antenatal care, bringing care closer and more accessible to women and children, and reducing travel time and cost to families who would have otherwise sought these services from higher level facilities. Social accountability can help mobilize communities to contribute to improving services that affect them.
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