THE EKJUT INITIATIVE

A PARTICIPATORY LEARNING AND ACTION CYCLE WITH WOMEN’S GROUPS TO IMPROVE MATERNAL AND NEWBORN HEALTH OUTCOMES

It's not a drug. It's not a vaccine. It's not a device. It's women, working together, solving problems,

saving lives. Richard Horton, Editor - The Lancet, May

2013

THE CONTEXT – WHERE THE INITIATIVE AIMS

• Infant Mortality Rate (IMR) has been decreasing; but Neonatal Mortality Rate (NMR) remains high

• Supply side has picked – Heath Centres

• Research suggests that demand side has a lot of scope

• Community participation• Health seeking behavior

• ASHA workers

• The first significant success towards mobilization• This initiative – As a structure to the work of

ASHAs

THE TRIAL*

• Among over 2 lakh women

• 3 Districts of Jharkhand and Odisha

• Reducing newborn deaths by 45% over the last two years of cycle

• Later extended to the 200 control villages to get similar results

• This community mobilization was endorsed by the World Health Organization (WHO) in 2014’

* Tripathy PK et al. Effect of a participatory intervention with women’s groups on birth outcomes in Jharkhand and Orissa, India: the Ekjut trial. Lancet 2010, 375:1182-1192.

THE PARTICIPATORY LEARNING & ACTION CYCLE [PLA]

IDENTIFY CAUSES

PLAN STRATEGIES

ACT TOGETHER

EVALUATE TOGETHER

The module is designed as a Cycle of 20 meetings of women’s groups

PARTICIPATORY LEARNING AND ACTION (PLA) CYCLE

• The 20 meetings mostly consist of scientifically designed stories, role-plays and games

• Problem/Solution Identification is done by the group itself

• Facilitated by an ASHA trained in PLA

• Systematic community interaction, through plays

AN EXAMPLE GAME: UNDERSTANDING THE CAUSES

Hypothermia

Newborn death

InfectionImmediate Causes

No Skilled BA

Delayed cord Clamping/

Exposure to cold

Cord cut with unsterile

instrument

Teenage mother

Poverty

Informal provider

Home delivery

No transport available

Faith healerUnderlying causes

Prematurity

STRATEGY •Starting a Saving & Credit group•Arrangement for transport (Mamta vahan)•Institutional delivery•Not bathing the child for 3 days after birth

•Encouraging pregnant mothers to visit health facility •Delaying age of marriage•Not bathing the child for 3 days after birth

•Delaying age of marriage•Institutional delivery or use of SDK in home delivery•Knowledge of danger signs of infection

• Each strategy has protocols for implementation including division of responsibilities, system for monitoring etc from within the group

WHAT DOES THE PLA CYCLE DO?

• Increases problem solving skills of members

• Helps them understand cause and effect relationships

• Empowers women to make decisions about health of self and their children

• Increases demand and uptake of services

On Sustainability - According to a recently published paper once a group goes through a PLA cycle, the outcomes continue to sustain for a long time.

REPLICATION

• Similar projects of PLA in Bolivia, Malawi and Nepal

• This model developed by Ekjut has collaborations with

• MP – As ‘Saanjhi Sehat’ with MPSRLM in 1000 villages• Odisha - As ‘Shakti Varta’ with Health Department; in

170 blocks• Bihar – As ‘Gram Warta’ with Jeevika in 15 districts• Jharkhand independently

• Well on its way to being scaled-up

THE WAY FORWARD

• For SAGY villages

• Locally acceptable content development through SRLMs• Trainings of ASHAs as facilitators

• Incorporation in national programmes

• PLA as a convergence between NRLM and NHM

THANKS!!