Communicating for Change:  Enhancing community’s access to quality health and nutrition services

Communication is the key ingredient in empowering communities on their health and nutrition entitlements.  By fostering a dialogue between the community and other key stakeholders, communication processes can empower the vulnerable groups to provide information and knowledge as a basis for change, take decisions individually or collectively to improve their own health.

CHETNA along with partners from seven states of India (Orissa, Gujarat, Rajasthan, West Bengal, Jharkand, Tamilnadu and Karnataka) has undertaken a project (Participatory Communication Initiative for Improving Access to Public Healthcare Services for Rural Communities In India under the National Rural Health Mission, a Government of India flagship programme) since December 2008. In Gujarat and Rajasthan states, CHETNA is leading the process.

The overall goal of the project is to ensure communities in above selected above seven states to have improved access to quality public health services through the process of Community Mobilisation with the help of participatory communication techniques.  .

In partnership with ten district NGOs of Gujarat and Rajasthan (five in each state), CHETNA is striving to strengthen the NRHM activities in identified 10 districts of both these states of India.  The district partners in turn carry out communication interventions in the identified 10 blocks covering a total population of 16,83,495 in both the states.

The Participatory Needs Assessment (PNA) was an appropriate sequel that facilitated learning about community awareness on health entitlements under NRHM, Focus Group Discussions were facilitated with 3213 community members, 300 Accredited Social Health Activist  (ASHA), Panchayati Raj Institution (PRI)/Village Health and Sanitation Committee (VHSC) members and 199 service providers. In all 116 ASHAs and service providers were interviewed.    The findings revealed that the stakeholders, particularly the community are lacking complete information on health entitlements/ health services and its benefits.  A total of 457 block and district officials were appraised of the findings and Action plans and support required from them were discussed.

CHETNA facilitated State level training for the district partners to enhance their understanding on participatory communication for NRHM activities.  Through a series of trainings and follow-up support, 1026 ASHA/Auxilliary Nurse Midwives (ANM) /Anganwadi Workers (AWW), 728 Village Health Sanitation Committee(VHSC)/Panchayat Raj Institution(PRI) members and 500 community  members were engaged for a clearer understanding of their roles in supporting community to access health services.

The CHANGE project is in its fourth year and has reached out to approximately 1,50,000 community members (particularly pregnant women, nursing mothers and adolescent girls) of 1255 villages in both the states.   To maximise the outreach, a resource inventory was prepared for every block in both the states to identify the existing customs/practices /local traditions e.g. fairs and other platforms (both local and govt platforms). Based on this, a communication strategy was developed for each district. The aim was to present clear and consistent messages on health entitlements/services to the key stakeholders, both the service seekers and the service providers, make best use of available resources, simplify and present the core information on health entitlements/provisions of the schemes/Government resolutions and health services.

Regular sharing and consultations/dialogue with different stakeholders both service seekers (community) and the service providers, have been the key feature of this project.

Technical support and mentoring was provided to district partners to facilitate 20 round tables with 890 stakeholders to facilitate open dialogue, sharing of field realities and bridge the gap between the accessibility and availability of health services. The key processes and the interventions are regularly documented and widely disseminated with block/district and state officials for advocacy.

The future plans include training of district partners, project evaluation, documentation of the stories of change, consolidation of experiences and national workshops to disseminate the learnings.

Changes observed

Community level: More  numbers of women have started  accessing services such as institutional delivery and referral transport, mothers are bringing children to the Anganwadi Centre for immunisation and women, adolescent girls and children are participating in  the Maternal and Child Health Nutrition (MCHN) days

At  the frontline workers level: The rapport of ASHA with community/service providers has enhanced and their motivation ot mobilise and share information on MCH entitlements to the community. VHSC members are taking active role in monitoring and ensuring the services. Community Based Organisations(CBOs)/Self Help Groups(SHGs) have started taking health as an agenda

Service providers level: Started inviting district partner NGOs in sector/Public Health Committee(PHC)  meetings to share the field realities and support the partners accordingly. Regularisation of services at Anganwari centres, sub-centres and at PHC level.

Time Frame: December 2008- September 2012

Coordinating Agency: Christian Medical Association (CMAI), New Delhi