Presented by Ms.Chitra Iyer, CHETNA and CHANGE partners, Rajasthan

1. Enhancing access to NRHM entitlements: CHETNA’s efforts in five districts of Rajasthan ( April 2010- July 2011) Presented by Ms.Chitra Iyer, CHETNA and CHANGE partners, Rajasthan

2. Rationale • The National Rural Health Mission (NRHM) is GoI flagship programme launched in 2005 to enhance access to quality health services from the public health system, particularly rural poor women and children • The NRHM covers the entire country, with special focus on 18 states. Rajasthan is one of the EAG states with high MMR (335 per 100,000 live births) and NMR (35 per 1000 live births) – DLHS 2008 • Building capacities of ASHAs to facilitate access to health services is one of the key strategies of NRHM

3. Communicating for CHANGE • Communication for Health Advocacy in National Rural Health Mission for Grass root Empowerment (CHANGE) project aims to complement the government’s NRHM efforts by strengthening community mobilization and focuses on increasing access to quality health and nutrition services

4. Goal of the Project • To ensure community access to quality health and nutrition services

5. Project Objectives • Development of a participatory communication strategy to advocate for health entitlements of rural communities. • To enhance capacity of the service providers, civil society orgnizations, media and PRI on communicating and advocating for NRHM commitments. • To promote community awareness on MCH entitlements. • To promote exchange of experiences, innovations, learning and challenges. • To document and disseminate key processes and learning.

6. Coverage and Partners Total no of Villages: 794 Total population: 9,74,430 AkhilBharityaGraminUtthanSamiti AravaliServaSewa Farms ShikshitRojgar Kendra PrabandhakSamiti Education Conscientisation, Awareness and Training Bodhgram ALERT Sansthan Churu Alwar Karauli Udaipur Banswara

7. Project Strategy Mobilizing communities to access Maternal and Child Health (MCH) entitlements by : • Participatory Needs Assessment (PNA) • Development of participatory communication strategies • Capacity building of local stakeholders in the intervention block • Advocacy through creating spaces for dialogue and learning among different stakeholders

8. Needs identified Needs identified through PNA conducted in May 2010 with 2269 community members/ASHAs/VHSC/PRIs and Service Providers Community needs: 1800 pregnant and lactating women and community members expressed the need for: • Information on services/public health • Appropriate tools to access information • One point person at village level for information source on access to services • Regularity of the visit of frontline workers ASHA’s needs • 227 ASHAs expressed the need for clarity on : • Their roles and responsibilities and that of ANM/AWW • Information on MCH entitlements/schemes/Government Resolutions • Communication material for education and counselling community

9. Needs identified Needs of VHSC/PRI 148 VHSC/PRI members expressed the need for clarity on their roles and responsibilities, untied funds and its use Needs of PHC staff Focus Group Discussion and Key Informant Interview with 94 PHC staff revealed the need for • Clarity on NRHM programme and MCH entitlements • Their role to facilitate access to MCH services

10. Community mobilisation Through local fairs (kaila Devi/Gangaur/Baba Gaugandas fair) Celebration of thematic days (International Women’s Day, Breast feeding week, World Health Day) Community Awareness meetings with 22000 community members (pregnant and lactating women, adolescent girls and men) Government initiatives (Swasthya ChetnaYatra, PrasasanGaunkiaur) MCHN day at sub centre

11. Capacity building Motivating communities to access the services • Partners oriented 581 ASHAs on MCH entitlements and their role as key communicator to inform and motivate the community members to access services • Partners oriented 400 VHSC members oriented on MCH entitlements, untied fund and its use and their role in monitoring the health services

12. Advocacy Creating spaces for dialogue to ensure services Observation of MCHN days and joint meetings with ASHA/ANM/AWW to establish linkages for health and nutrition services Provide mentoring support to ASHAs on monthly meetings to enable her share her concerns Participation in block/district/PHC meetings, one to one sharing with Block Program Manager/Block ASHA

13. Changes observed.. Community level: • Enhanced awareness about MCH entitlements and started accessing services • More no. of women have started accessing services such as institutional delivery and referral transport • More no. of children coming to the AWC for getting immunized • More no. of women, adolescent girls and children participating in MCHN days

14. CHANGES observed • At ASHAs level • Enhanced confidence • Started sharing her issues/concerns in PHC sector meetings • Enhanced rapport with community/service providers • Increased motivation to mobilize and share information on MCH entitlements to the community • Service providers level • Enhanced clarity about their roles and responsibilities • Initiated to invite project team in sector/PHC meetings to share the field realities and support the partners accordingly • Regular follow-up by the partners and support by the Block Officials has led to recruitment of ASHAs (34) at Karauli and Tijara block • Regularisaton of services at Anganwari centre (10), sub-centre (10) and PHC level

15. Lessons learnt • Regular refresher training and mentoring support to ASHA • Institutionalization of ASHA within the system • Attention to training quality and systems, recruitment and timely payment to ASHAs would enable her to play a key role in motivating the community to access health and nutrition services • Regular communication with community and with ASHAs • Increased about entitlements among communities has brought a shift from access of private health services to public health services