TRANSFORMING
LIVES
Š Mamta Health Institute for Mother and Child, 2019 B-5, Greater Kailash Enclave - II, Delhi-110048 Photography: Rahul Bareja Design & Print: Cherry Peach Plum
Implemented by
Supported by
Good Food, Good Life “Mother's milk is best for your baby”
FOREWORD Nestlé’s motto is “Enhancing quality of life and contributing to a healthier future.” Embracing the purpose and values of Nestlé, we have aligned our Nestlé in Society's projects to make a positive impact on the lives of the people. We are committed to making a positive impact on the development of communities through better nutrition, health, and wellness. We are very proud of Project JAGRITI in partnership with MAMTA Health Institute for Mother and Child with an outreach across 15 districts in India. The project has been instrumental in bringing the issues of maternal, child and adolescent health to the centre stage of the communities. The project of this magnitude brings both challenges and opportunities. In the three-year journey, the project faced challenges from the stakeholders at various levels such as hesitancy to turn up for community events, non-cooperation during baseline surveys and low compliance to education sessions, etc. However, the peer leaders - the women champions of the project - not only addressed those challenges, but also fueled transformation in the lives of their peers. I truly appreciate the project's strategic and innovative approaches to address the poor behavioral practices of the communities on health, nutrition and hygiene. I thank the project team for bringing out this coffee table book. The book highlights the key components of the project including beneficiaries, strategies and its impact. The book unfolds the journey of the project to the broader audience on a photo canvas. The intangible social benefits of our efforts have been ingrained in the book through visual stories. I appreciate the efforts of the team in summarizing the myriad of interventions and outcomes in a clear interpretation for different stakeholders. The project embarks on our mission to support, promote and protect the key issues of maternal and child health including breastfeeding, immunization, sanitation, hygiene, improved maternal and adolescent health. We will continue to support the cause and the innovative ways to address the gaps in improving maternal and child health. I once again thank the team for this wonderful document for larger dissemination. I wish great success to Project JAGRITI team and all the best for their efforts.
Mr. Sanjay Khajuria Senior Vice President (Corporate Affairs) Nestlé India
03
MESSAGE
from the Executive Director
MAMTA began its journey in 1990 with providing clinical services to women and children from marginalized and vulnerable population in a slum called Tigri in south Delhi. It has been both fascinating and an inspiring journey since then. Today, MAMTA is nationally and globally acclaimed for its pioneering role in adolescent, maternal and child health and is at the forefront of policy strengthening and implementation research. These add to the extremely robust project implementation structure which happens to be the core strength of our institution. In our journey for improving maternal and child health, we have been implementing Project JAGRITI with the support of NestlĂŠ India, for marginalized and vulnerable population across 15 high priority districts of the country which had poor development indicators. Project JAGRITI intervened with dedicated efforts to improve the health indicators by community participation and peer-led approach; focussing on continuum of care. In the past three years, the project touched 1.5 million lives through social and behaviour change communication and linked the communities with the public health facilities. The project has not only empowered communities but also brought about a change in the communities by addressing various myths and misconceptions, which are the key barriers of maternal and child health, hygiene and nutrition. I commend Project JAGRITI team for bringing out this coffee table book that showcases the intervention strategies and approaches along with various innovations adopted as part of the implementation of the project. I congratulate Project JAGRITI team for their journey of dedicated efforts so far and sincerely thank NestlĂŠ India for all the support extended for making this project a reality.
Dr. Sunil Mehra Executive Director MAMTA Health Institute for Mother and Child
05
CONTENTS 1. The Need
09
2. Project JAGRITI
13
3. The Beneficiaries
15-19
4. Situational Analysis
21
5. Mapping the Community
23
6. Understanding Gatekeepers
25
7. Intervention Strategies
27
8. Impact
49
9. About MAMTA
69
07
In India, an estimated 27 million pregnancies occur every year; 27% of the young married women (20-24 years) are married before the age of 18 years and 13% of all currently married women reproductive age have an unmet need for family planning. At present, only 51% women had four or more antenatal care visits, which are important to reduce the health risks for mothers and their babies. Infant mortality rate is 34 per 1000 live births, which is largely caused by poorly managed diarrheal and acute respiratory
THE NEED
infections, and widely prevalent malnutrition. Further, 54% and 39% of adolescent girls are anemic and stunted respectively in the country.
09
To realize the sustainable development goals, specifically those for health, gender equality and poverty, it is pivotal to enhance capacities across sectors and facilitate departmental convergence and partnerships between government and civil society on inclusive and equitable community outreach for prevention, care and management of health issues. It is extremely important to enhance capacities and the quality of care at the primary level. To overcome ignorance and socio-cultural barriers that results in exclusion and marginalization and to enhance the demand and access to healthcare services, one requires strong community engagements and sectoral convergence in healthcare.
00
11
Project JAGRITI is the mission to create awakening in the communities on issues related to health, nutrition and sanitation (HNS) in alignment with the national goals while working with pregnant and lactating women, young couples and adolescents. It is based on strategies that form the holistic package of interventions to cater to different life stages.
PROJECT JAGRITI 13
Safe motherhood is a means to ensure healthy pregnancy and childbirth. It aims to improve the wellbeing of mothers through a comprehensive approach of providing preventive, promotive, curative and rehabilitative health services. It ensures provision of services including family planning, antenatal, obstetric and postnatal care, etc. It is crucial to work with pregnant and lactating women for improved maternal and child health.
MOTHERS & CHILDREN 00 15
The transition from adolescence to adulthood varies across gender, class, region, culture and above all where are they now. These changes have enormous influence and any neglect of these changes has a huge impact on young people and the society as a whole. Adolescent health needs special attention and to be fully integrated into all the existing sustainable development goals (SDGs). Comprehensive integration with gender equality, sexual and reproductive health and rights, mental health, nutrition requires involvement of young boys and girls to attain the goals faster and sustain them in the long run .
ADOLESCENTS 17
Marriage is an institutionalized social structure that provides enduring framework for regulating sexual behaviour and childbearing. The young couple is prone to many such issues of early pregnancy, lack of awareness regarding nutrition and health schemes. Preconception health includes provision of behavioral and social health interventions to couples before conception. This aims to improve maternal and child health outcomes in both short and long terms.
YOUNG COUPLES 19
SITUATIONAL ANALYSIS 21
MAPPING THE COMMUNITY 23
UNDERSTANDING GATEKEEPERS
25
a.
Community Mobilization
b.
Peer-led Approach
c.
Community Engagement
d.
Safe Space (YIC)
e.
System Strengthening
f.
Reinforcing Messages
INTERVENTION STRATEGIES 27
Community Mobilization 29
The peer-led approach is the key strategy of the intervention. The peer leaders are identified from among the beneficiaries; equipped with self-confidence and leadership skills to drive the thematic areas. These peer leaders are trained in the key thematic areas of the interventions (Health, Nutrition and Sanitation). Peer leaders conduct Behavior Change Communication (BCC) sessions with their respective groups.
Peer-led Approach
31
33
Community Engagement 35
37
Safe spaces in the community have been developed as Youth Information Centers (YICs). The centres are owned and run by peer leaders in the communities. The YICs have several infotainment materials and games to engage the youth for improving their health seeking behavior and provides a platform to share the health-related information with their peers.
Safe Space
39
41
The health service providers such as frontline workers, nurses and medical officers are engaged and oriented to make the delivery of health services quality assured and inclusive. Frontline workers were oriented on issues such as infant and young child feeding, handwashing and malnutrition management, etc. We supported these workers to increase the outreach of public health services to the marginalized populations and hard to reach areas.
System Strengthening 43
Reinforcing Messages 45
States / Union Territory
Intervention Population*
Project Reach* THE INTERVENTION POPULATION IS
Bihar
4.5
1.23
4.6
Chandigarh
2.0
0.58
MILLION
Delhi
2.5
0.59
Karnataka
2.0
0.58
THE PROJECT REACH IS
Maharashtra
2.0
0.58
Odisha
9.0
3.1
1.5
Rajasthan
13.0
4.9
Uttar Pradesh
11.0
3.38
* in lakh
MILLION
PROJECT REACH
Chandigarh
Delhi Rajasthan
Uttar Pradesh Bihar
Odisha Maharashtra
• 15 Districts in 7 States and1 Union Territory Karnataka
• 1822 villages covered • 300 Project Staff
JAGRITI FOOTPRINTS
47
IMPACT 49
Breaking Myths 51
The stakeholders such as mother-in-laws and husbands who have a significant role in influencing maternal health are involved through inter-personal communication and community-based events. This 360-degree approach to social and behavior change ensures a holistic view of people's desires, needs and barriers and facilitators to change.
Enabling Environment 53
Komal was like any other timid and shy girl. Project JAGRITI transformed her to an empowered individual. She is now trained in Judo and is providing training in martial arts to other girls, which has resulted in development of self-confidence of all. She will soon be representing India in international tournaments.
Transformed 55
Educated 57
Empowered 59
Enabled 61
Healthy 63
Motivated Parents 65
Community Ownership 67
MAMTA’s JOURNEY
25 YEARS OF SERVICE TO THE NATION
ADAPTING INNOVATIONS AND M-HEALTH
NONCOMMUNICABLE CONDITIONS & DISEASES
1990
2 CENTERS OF EXCELLENCE FOR ADOLESCENT HEALTH & DEVELOPMENT
2013
2010
TUBERCULOSISCARE, TREATMENT & CONTROL
CLINIC FOR PREGNANT WOMEN AND CHILDREN
2015
2008
ADOLESCENT DEVELOPMENT CENTER
1993
2018
2001 CHRONIC DISEASES HIV CARE & SUPPORT
ABOUT MAMTA MAMTA Health Ins tute for Mother and Child
OUR VISION Working together towards building a world that is just, equitable and inclusive
OUR MISSION To empower the underserved and marginalized individuals and community through gender sensitive participatory processes for achieving optimal and sustainable health and development
THE THEMATIC AREAS • Maternal, New Born, Child Health & Nutrition • Young People’s Reproductive, Sexual Health and Rights • Communicable Disease • Non-communicable Disease
69
OUR GEOGRAPHICAL COVERAGE
National intervention sites (existing) National intervention sites (completed) International intervention sites MAMTA’s international technical interventions are in Indonesia, Cambodia and Burundi
71
73
The journey of
Project JAGRITI
to
transform lives continues... 75
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