Reaching the unreached

Women empowerment –targeting girls for empowerment and healthy development :

SWACH has assisted in education and vocational training on tailoring and embroidery to the economically weaker girls in the rural areas. Our endeavor was to make them economically self reliant and thus empower them for healthy development. An educational programme was also launched by SWACH by campaigning with and motivating the parents to send their girls to schools. In order to encourage the parents, SWACH provided school uniforms, books, shoes and footwear free of cost. An intensive educational programme for adolescents was initiated by sensitizing them towards better menstrual hygiene. A social marketing approach was adopted in making available sanitary napkins through local shop keepers at an affordable price. The sale of sanitary napkins increased from 45 packets per month to more than 500 per month. The introduction of sanitary napkins for adolescent girls has enhanced the communication and helped a large number of them to solve their minor menstrual problems through a better understanding that was provided by the school teachers, health workers and SWACH staff.

Promotion of contraceptives through depot holders- a social marketing approach through village based vendors :

 A network was established in more than 1800 villages in 4 districts in Haryana by 60 field workers. Through this network a system was established to make contraceptives available and accessible to the community in 1835 villages and urban slums with a population of 23 lacs (2.3 million). The village based vendors included RMPs (57.8%), grocers (27.3%), chemists (10.3%) and others (4.9%). Other depot holders included panwalas, dhaba owners, village barbers and others. The social marketing focused on educating the target groups about the maintenance of small family norms, safe sex and prevention of STD, HIV/AIDS through pre marital and extra marital sex. SWACH established 2860 depot holders who have marketed the products and spread the knowledge about the correct use of condoms and oral contraceptive pills. They have reinforced the need for adherence to correct practices. The sale through social marketing has peaked to about 300,000 condoms and 30,000 cycles of oral contraceptive pills per month. In this project, social marketing of sanitary napkins was also introduced to empower the women and adolescent girls.

Anaemia control through iron and folic acid :

The studies carried by SWACH showed that while 90% of the pregnant women were getting Iron and folic acid tablets only 10% adhered to the prescribed medicine. Therefore a social marketing approach was adopted for making the IFA available to pregnant and lactating women and adolescent girls in Chachrauli block in Yamunanagar district. A basket approach was used in which tablets, syrups and capsules were offered to 1228 pregnant women and 1016 adolescent girls. Majority of them opted for IFA tablets. Women with moderate anaemia had a significant rise in hemoglobin as a result of this approach. In this project adolescent girls in the family provided the treatment to women in their houses under direct observation. This improved the compliance and adherence to treatment. This approach lead to a greater increase in hemoglobin in the intervention group (directly observed) as compared to the controls. These observations demonstrate the importance of innovations in operational aspects of the programme.

Peer group educators- the change agents in adolescent health  :

Considerable proportion of adolescents is out of school. Any health interventions or efforts to improve communication with them exclude them since they are out of reach of the school system. In the adolescent programme, peer group educators (PGEs) were identified, trained and made functional. They acted as a link in bridging the communication and information gaps with the adolescents. Two types of tools were developed. These were the FAQs and hand outs. The peer group educators were trained through five sessions. To date more than 60 PGEs have completed their training. They have contributed to dissemination of information solving problems of adolescents and referring those they cannot help. The PGEs have worked on a one to one basis with adolescent boys and through group meetings with adolescent girls. Guidance and support to the PGEs was provided by SWACH staff on an ongoing basis and this has sustained their motivation to work on a voluntary basis.

Management of health information system :

Completeness, timeliness and quality of health information are important in programme management and are useful for assessing the progress of implementation of public health programme. Under mother NGO scheme of GOI under RCH II all the field NGOs were involved in providing information on key indicators relating to pregnancy, child birth and post natal period. Formats were prepared, discussed with the staff of NGOs and training was provided to emphasize the importance of health information and the value of complete and quality information. NGOs that delayed submission of report by more than one week were contacted on the telephone. Continued default was followed by a site visit from SWACH staff. NGOs established a network between village TBAs, Anganwadi workers, ANMs and others. The monthly data flow was maintained and the information was entered on a computer at SWACH. The feedback was provided after analysis of the report in which the targets were taken into account. This has helped to improve the quality of information. NGOs were called to SWACH for review meetings regularly to strengthen training, increase motivation and to discuss progress. The system has been functioning well for the last 19 months. The effort was supported by improving the regular supply of iron tablets, mother retained MCLC, DDKs, weighing balances, ORS and contraceptives. It has helped to increase the percentage of institutional deliveries by more than 50% as compared to the figures quoted in NFHS. It has strengthened the linkages and increased the utilization of services.
 


 


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