Community Health Project

 

1982 – 2000
 
1982
2000
Crude Birth Rate
35.6
20.48
Crude Death Rate
12.7
8.33
Infant Mortality Rate
172
41.27
Immunisation Coverage
<10%
98%
Couple Protection Rate
35
71.2
Severe Malunutrition
16%
2.4%
Maternal Care
<25%
91%
Vit. A Deficiency
Frequent
Rare
Measles Epidemics
Frequent
Rare
 

The ultimate goal of SEWA Rural was not limited to the four walls of the hospital. It was soon realized that due to a numbers of complex social & cultural factors, the hospital remains inaccessible to the vast majority, very often until it is too late.

 

A baseline survey of the surrounding villages in the year 1982 revealed the gross neglect of health services. Children often suffer from measles, diarrhoea, malnutrition, high incidence of anaemia, malaria and TB beside apathy towards women’s health. As a result there is a high mortality rate among women & children. Many of these deaths were related to diseases which were unfortunately preventable.

 

1982-2000

 

The above mentioned rural health scenario prompted SEWA Rural to formulate & commence project of health care at door steps initially in 10 villages in 1982. Later on it was expanded to cover 40 villages and Govt. entrusted Jhagadia PHC was managed for more than 10 years. Such innovative public-private partnership model was experimented for the first time in the country. The targets of Health for all by 2000 were achieved by SEWA Rural much before the target deadline due to new approaches and innovations. Please click here to read evaluation of this project carried out by IIM-Ahmedabad.

 
     
     
 

2003-2011: Family Centered Safe Motherhood and New Born Care Project

SEWA Rural since 2003 managed “Family Centred Safe Motherhood and New Born Care Project” in entire Jhagadia Block covering a pop. of about 175,000 and in partnership with district and block level govt. health dept. The main aim of the project was to develop an evidence based model to reduce maternal and neonatal mortality and morbidity in resource poor settings. Community level and family centered interventions were introduced for ensuring proper antenatal care (including aspects of birth preparedness and complication readiness) and intranatal and postpartum care. This were made possible by building up the cadre of front line volunteers which include village level ASHA alike women volunteers (Arogya Sakhis) and Trained Birth Attendants ( TBAs). There has been about 74% reduction (from 19 to 5 deaths/100,000 live births) among cases of maternal deaths and about 39% reduction (from 47 to 29 neonatal deaths/1000 live births) in Neonatal Mortality Rate as compared to baseline information. Over and above the increase in institutional delivery rate from 22% to 66%, there has been significant improvement and positive increase in coverage of various services and process indicators in aspects of prenatal care, intranatal care, immediate new born care and postnatal follow up both for mothers & babies at the field level. SEWA Rural received prestigious MacArthur Award for being a “creative and effective institution” in area of reproductive health for its efforts. Please click here to read complete report of this project.

 

2011 onwards:

1. Village Health and Sanitation Committees (VHSC) capacity building project: VHSCs are created in every village under central government’s National Rural Health Mission (NRHM) for community based monitoring, and decentralized planning and implementation. SEWA Rural has taken up responsibility of capacity building of all 87 VHSCs of Jhagadia block. After completing training in 2010, SEWA Rural’s facilitators are attending village based meetings of the committee to provide guidance.

2. ImTeCHO  (Innovative Mobile phone Technology for Community Health Operation)

ImTeCHO Project

 

Title : “Innovative Use of Mobile Phone Technology to Improve Maternal and Child Health by Empowering Front Line Health Volunteers (ASHAs) in Tribal areas of South Gujarat: SEWA Rural Experience”.

 

Background : “ImTeCHO” initiative is being successfully piloted by SEWA Rural in partnership with the Department of Health and Family Welfare, Govt. of Gujarat since May 2013. SEWA Rural, a voluntary service organization is providing medical, health and education related services to the rural, poor and tribal population of Bharuch, Narmada and surrounding districts in South Gujarat for past thirty five years.

 

“ImTeCHO” initiative is now being implemented in 22 PHCs (700 villages) in high focus tribal talukas of Bharuch, Valsad and Narmada dists. Thus in total about 600 ASHAs are now satisfactorily using the smart phones in delivering maternal, new born, infant and child care at the doorsteps more effectively.

 

Intervention : ImTeCHO stands for “Innovative Mobile-phone Technology for Community Health Operations”. “Techo” in Gujarati means “support”; hence, ImTeCHO means “I am support”. The mobile phone based software application for ImTeCHO was developed by Argusoft India Ltd, Gandhinagar in partership with SEWA Rural for content specific guidance. Every ASHA is given a low cost smart phone (costing approximately Rs. 4,500/-) which is General Packet Radio Service (GPRS) enabled and have multimedia feature available. ASHA logins the mobile-phone application everyday and smart making home-visits based on the schedule indicated through ImTeCHO application. Asha fills out forms on her mobile during home visits. Data is being instantly sent using GPRS network to a server where data will be stored.

 

ImTeCHO is used in 3 ways : (1) Mobile phone as a job aid to ASHAs to increase coverage of MNCH care (2) Mobile phone as a job aid to ASHAs to screen and adequately manage morbidities among mothers, newborns and children and facilitate timely referral (3) Web interface to provide timely information to PHC medical officers for monitoring and supporting programme, including accurate and timely reporting of births and deaths and incentive disbursement to ASHAs.

 

Results : More than 50,000 pregnant women, newborn babies and children under two years of age, predominantly from tribal communities, have already directly benefitted in about one and half years. The intervention and its delivery were found to be acceptable, feasible and useful within the ASHA program under existing government health system specifically for the rural, tribal regions. Thus there is a huge potential to scale up this innovation to cover about 15 lack mothers, infants and children residing in all 18,000 villages of Gujarat through about 37,000 ASHAs using ImTeCHO mobile phone application in coming years.

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3. Surveillance of maternal and newborn health-ouomes has been already started in 800 villages of Bharuch & Narmada district. SEWA Rural’s community-based link-workers use mobile phone to enter data which is uploaded on a central server using GPRS. Information about more than 25,000 pregnancies has been collected so far. Further modification is underway to add other features on the software platform. Extensive research is planned to evaluate effectiveness of introducing mHealth solutions.

Research and innovations in community health

Along with service delivery, SEWA Rural has a long tradition of experimenting with innovative ideas and documenting results in scientific manner. SEWA Rural pioneered in using of clean delivery pack, empowering community health workers, organizing monthly vaccination day (which now celebrated as monthly village health and nutrition day), using Kangaroo-jholi for low-birth-weight babies and other micro-level interventions. Click here to read SEWA Rural’s selected scientific publications. SEWA Rural is a member of Multi-institutional Ethics Committee, Mumbai. Please visit http://www.cser.in/iec.php to read standard operating procedures and other vital information regarding the ethics committee.

 

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