The following article appeared in India’s leading publication, The Economic Times, written by AIF CEO Nishant Pandey.
India accounts for approximately 25 % of the total number of newborn deaths in the world and 22% of the under-5 deaths in the world. Despite significant progress, we missed the Millennium Development Goal (MDG) 4 on reducing under-5 (U5) mortality as well as infant mortality. The global Sustainable Development Goal (SDG) for child mortality represents a renewed commitment to the world’s children: by 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 deaths per 1,000 live births and under-five mortality to at least as low as 25 deaths per 1,000 live births.
According to the Ministry of Health and Family Welfare (MoHFW), approximately 26 million babies are born in India annually, out of which 730,000 die within the first month of their lives. The first 28 days of life – the neonatal period – are the most vulnerable time for a child’s survival. What remains an urgent concern is that 80% of these newborn deaths are both preventable and treatable. So the question is what can be done to prevent these newborn deaths that occur, despite the fact that the knowledge and technologies for life-saving interventions are available.
India’s public health system suffers from a variety of challenges, including an acute shortage in of trained medical personnel, poor health infrastructure and service delivery particularly in rural areas and, a lack of community ownership and partnerships in addressing abysmal health outcomes. In order to address some of these challenges, the government appointed 8.9 lakh female community health workers called ‘Accredited Social Health Activists’ (ASHAs) in villages across the country under the National Rural Health Mission (NRHM). ASHAs are the cornerstone of maternal and newborn health, bridging the gap between the public healthcare delivery system and the communities. Now, a 5-year pilot project in Jharkhand has shown how ASHAs, when appropriately trained, supported, and supervised, can effectively contribute to improving maternal health and reducing newborn and child mortality.
Starting in 2009-10, Maternal and Newborn Survival Initiative (MANSI), a community-focused health intervention that addresses the problem of access to quality and affordable health care for mothers and newborns close to their place of residence was piloted through a Public Private Partnership (PPP) model in Seraikela, Jharkhand. MANSI is a simple but effective set of home based and community based interventions that are relevant and practical in a low resource setting. At its core lies the empowerment of local frontline health workers or ASHAs so that they can save lives of newborns in remote rural areas, often tribal areas, where there are no doctors or Primary Health Centers for miles. ASHAs received training and mentoring in simple life saving interventions for maternal and newborn health covering the antenatal period, the time around birth and the first month of life, as well as care for small, sick newborns and children.
Covering a rural and predominantly tribal population of 83000 across 167 villages in the Saraikela block of the Seraikela Kharswan district, the MANSI pilot achieved significant results. An external evaluation of independently conducted qualitative findings was reflective of the quantitative findings, both of which confirmed across the board reductions of child mortality. Neonatal mortality reduced by 46%, infant mortality reduced by 39% and under-5 mortality reduced by 44%. Although MANSI did not measure a comparable control population, it compared the improvements both over time as well as with overall statistics for Jharkhand. The differences in health outcomes was found to be statistically significant. These reductions were 5 times the reductions achieved in rural Jharkhand during the same period.
MANSI provided quality training, refreshers and mentoring support to ASHAs of the block along with hand-holding support to the district health team of the government for strengthening the supply chain and incentive systems. Along with building the capacity of ASHAs, significant behavior change activities were conducted at the community level. With these encouraging results, MANSI aims to scale up to the rest of Jharkhand as well as nationally.
The impact of MANSI is rewarding for all project partners. Each brought in its unique strength and, together, achieved what was beyond them individually. It is a successful example of how the public sector, the corporate sector, civil society and a technical organization can collaborate to address a key national health problem. Especially remarkable is how the government’s own program and workers benefitted from both the non-profit private sector and the for-profit sector. These lessons can be of enormous value to the state governments desirous of reducing child mortality and to corporates who wish to contribute socially.