The Maternal and Newborn Survival Initiative (MANSI) will demonstrate that a combination of effective interventions applied together in one of India's poorest districts can achieve dramatic reductions in maternal and newborn mortality.
The project has four principal objectives:
1. Strengthen individual, family, and community knowledge and decision-making skills to promote positive health practices and care seeking behaviors.
2. Enhance community capacity to form groups and institutions that promote social cohesion in order to sustain health initiatives beyond the life of the project.
3. Improve access and utilization of services provided by public and private health care providers by using total quality management approaches.
4. Influence implementation of policies by civil society, private, and public sectors and share lessons learned and best practices
The two main components to the intervention are:
1. Increasing institutional delivery in public and private facilities through incentives to these facilities: MANSI is aligned with the national Janani Suraksha Yojana, which aims to increase institutional deliveries in families living below the poverty level. Based on the Chiranjeevi scheme that has proven successful in Gujarat, private health facilities will be given a fixed fee for each batch of 100 deliveries that they carry out. Since their payment is capped and guaranteed by the government, they also have incentive to reduce unnecessary interventionist approaches.
2. Implementing Community-based newborn care
Based on a successful model implemented in Gadchiroli Maharashtra by SEARCH, this intervention will include intensive training of community health professionals in implementing a package of simple practices for the routine postpartum care of newborns. Practices will include thermal control; recognition and resuscitation of asphyxiated newborns; identification of the signs and symptoms predictive of acute neonatal infection; development of an algorithm for use in identifying neonatal infection; training and testing the abilities of community health volunteers to use the algorithm to identify and appropriately manage/refer infected neonates; promotion of early and exclusive breast feeding; optimal skin and hygienic cord care; and provision of immunization.
The Project will employ the following strategies:
1. Community competence development. An initial analysis of project participants and communities will be carried out through asset-based diagnostic approaches (i.e. appreciative inquiry), resulting in subsequent development of action oriented community mobilization and behavior change strategies.
2. Improved access to services. The project will create regular service provision outlets,
a) 22 mobile clinics organized fortnightly in a cluster of 8-10 villages by TSRDS,
b) Organization of monthly nutrition and health days in all the villages.
3. Improved utilization of services. This will be accomplished through improvements in quality of care, and through health system strengthening with a special focus on streamlining the implementation of Janani Suraksha Yojna.
4. Developing sustainable structures and systems by developing linkages with government and other developmental schemes.
The project had been discussed in principle and had been approved by the State Government. The location of the project had been selected in consultation with the State Ministry of Health.
India ranks in the lowest quarter of countries in the world for mortality in children under the age of 5.1 in 70 women in India die during childbirth and less than half of births are conducted by a skilled attendant. These statistics translate into a large number of women and children dying during birth and at the neonatal stage.
Within India, Jharkhand state has one of the worst newborn and maternal mortality rates. The Maternal Mortality Ratio in the state is 371 per 100,000 live births and the Neonatal Mortality Rate is 49/1000 live births. These rates are the second highest in the country. Further, in rural areas, these rates are almost double those in urban areas.
However, there are instances of very effective low-cost community-based interventions which have radically improved maternal and newborn survival rates in other parts of India. These interventions consist of government incentives to seek the presence of skilled attendants during birth, effective ante-natal care, and community based post natal care. It is essential to build community awareness and ownership of maternal health initiatives since in this area the decision to seek care (when, where and from whom) continues to be dictated by other family members (including husbands and mother-in-laws) and community leaders.
It would be helpful to get more media attention about the effectiveness of the program. AIF feels that this is a powerful story, as well as an impactful model that can be scaled throughout India. Being featured in a prominent media outlet would help the organization in these efforts.