The grassroots workers of every social intervention are the driving force of the organisation’s mission and vision. At Project MANCH, we are working to improve Maternal and Newborn Child Healthcare (MNCH) outcomes in three intervention blocks of Shahdol, Madhya Pradesh. The ASHA supervisor Mentors (ASMs) are the community field workers of the project. They provide need-based supportive supervision and mentoring to ASHA Supervisors and Accredited Social Health Activists (ASHAs).
In this article, I bring up three stories from Shahdol. These stories encapsulate our ASMs’ efforts to realize the project’s vision of improving maternal and newborn healthcare. By sharing these stories, I aim to highlight the creativity, determination, and persistence that grassroots workers employ in their everyday.
Improving coverage of institutional deliveries through a community-focused approach (Badwaha)
Villages Belia, Bela and Bhadwahi which come under the Badwahi sub-centre used to experience a high number of home-based births. The population is primarily composed of Jaiswal and a few families of the Baiga community. Between July 2022 and February 2023, 10 deliveries in the villages were conducted at home with the help of a Dai, a traditional midwife. The villages had two Dais who wielded significant influence in the community. The trust in the abilities of the Dai and convenience in access made home-based births a norm here. Though the area frequently experienced difficulties in the phone network, the villages were connected through roads to the nearby health facilities of Primary Health Care Centre, Lafda and Community Healthcare Centre, Gohparu.
Delivering at home with the support of an untrained Dai has several consequences – lack of adequate care and support for the newborn and mother, lack of access to emergency care including medical equipment, late initiation to breastfeeding, delay in registration of birth etc. In Belia, the case was more acute as all 6 deliveries (in the above mentioned timeline) had happened at home. The weak rapport between the frontline workers and the community worsened the situation. It was these conditions that lead IHAT’s ASHA Supervisor Mentor Preeti Pandey to make this area a high priority.
Preeti Pandey, the ASM planned a three-pronged approach to improve the rates of institutional delivery here:
- Raising community awareness of the consequences of home deliveries
- Targeted counselling and group counselling for pregnant women and their families
- Counselling the Dais and incorporating them as community influencers to increase institutional deliveries.
Along with the frontline workers and the District Community Coordinator, the ASM counselled the two Dais and their families. Emphasis was placed on making the two families understand the consequences they will have to bear in case any mishappens occur. They were persuaded to realize their influence in the community and to use it to promote safe institutional deliveries. Understanding this, the dais stopped conducting home deliveries and started encouraging whoever came to them to visit the institution for their delivery.
In the same month, the ASM and the Auxiliary Nurse Midwife (ANM) attended the Gram Sabhas and raised the issue of the high incidence of home deliveries in the village. Parallel to this, the frontline workers and ASM started working among pregnant woman and their families to encourage institutional deliveries. The ASHA and the ASM regularly conducted home visits to pregnant women to counsel them. Along with the frontline workers, the ASM led group counselling sessions during Village Health Sanitation and Nutrition Days on the benefits of institutional delivery as well.
The efforts soon started bearing fruit. Since February 2023, these villages have seen an improvement in the coverage of institutional delivery. All 17 deliveries from the subcentre – 7 in Belia, 5 each in Bhadwahi and Bela have happened at the public health institutions. The community is more aware and their relationship with the frontline workers is much stronger today due to the combined efforts of the frontline workers and Preeti Pandey.
Improving Home-Based Newborn Care Practices (Khannaudi)
When Rajni Baiga’s baby was born at the district hospital on 22nd December 2022, he only weighed 1.930 kg. Since the day the mother and baby returned from the facility, the ASHA paid regular visits to provide Home Based Newborn Care (HBNC) for Rajni and her newborn. On 31st December 2022, the weight of the baby had decreased to 1800 kg. As it was the winter season, the family and the ASHA were even more concerned about improving the baby’s health.
When the ASHA was unable to convince the family to weigh the baby as per protocol to provide services, she took the help of Roopa Singh, the village’s ASHA Supervisor Mentor. The ASHA and the ASM counselled the mother on exclusive breastfeeding and taught her to provide Kangaroo Mother Care(KMC). The continuous monitoring by the ASHA who conducted 19 home visits within 56 days, helped the baby gain weight. Watching her baby’s weight increase through proper breastfeeding and KMC instilled confidence in Rajni. By 14th February 2023, the baby weighed 3.200 kg and has been vaccinated.
The timely care and intervention by the ASHA along with the handholding support of the ASM to provide KMC and counselling helped the mother provide the necessary care to raise a healthy baby.
Saving lives through effective Counselling (Baruka)
Providing support in tracking and Managing High-Risk pregnancies (HRP) is a core objective of Project MANCH. As HRPs stand at a much higher risk of maternal morbidities, it is vital to ensure that they receive quality antenatal care and institutional delivery. One such effort was led by Seema Mishra, an ASHA Supervisor Mentor in Baruka from Sohagpur Block.
During one of Seema’s routine Village Health Sanitation and Nutrition Day observations in Baruka, the ASHA and ANM informed her of Lakshmi Baiga’s case. Though Lakshmi was in her third trimester, she had only received 1 antenatal check-up. She was identified as severely anaemic during this check-up. Though the ASHA conducted home visits to persuade Lakshmi to come for the VHSND, her mother-law and husband had restricted her from doing so.
The ASM Seema Mishra along with the ASHA conducted a home visit to counsel the husband and the mother-in-law on the importance of antenatal (ANC) checkups and Lakshmi’s health status. This counselling enabled the ASM and ASHA to address the family’s concerns and improve their understanding. During the subsequent ANC check-up, her haemoglobin count was found to be 3. Given the precarity of her condition, she was immediately referred to the district hospital, and from there to Medical College. Lakshmi and her family stayed back at the Medical College for 15 days where she underwent 7 HB dosages. Post this, the frontline workers and ASM constantly monitored her condition. By the time Laksmi’s delivery happened in the District Hospital on 14/12/2022, her HB count had increased to 8 grams.
Lakshmi’s baby weighed 2.7 kg at birth. The combined efforts of the frontline workers and ASM helped in ensuring appropriate care for the mother and newborn. This illustrates how providing health education and appropriate counselling can go a long way in influencing people’s behaviour and reinforcing positive actions.
Conclusion
These stories provide a glimpse into the everyday work of the grassroots workers of Maternal and Newborn Child Healthcare services. They outline the multiple levels of efforts taken by the ASM and frontline workers to respond to the challenges of their work. By focusing on educating the community and counselling them in a culturally sensitive manner to improve the uptake of services and reinforce positive health behaviours, their work is rewriting a healthier future for our populations.
