Richard Horton, Editor - The Lancet, May 2013 It's not a drug. It's not a vaccine. It's not a device. It's women, working together, solving problems, saving lives. Richard Horton, Editor - The Lancet, May 2013 The Ekjut initiative A Participatory Learning and Action cycle with women’s groups to improve maternal and newborn health outcomes

The context – where the initiative aims Infant Mortality Rate (IMR) has been decreasing; but Neonatal Mortality Rate (NMR) remains high Supply side has picked – Heath Centres Research suggests that demand side has a lot of scope Community participation Health seeking behavior ASHA workers The first significant success towards mobilization This initiative – As a structure to the work of ASHAs

The Trial* Among over 2 lakh women 3 Districts of Jharkhand and Odisha Reducing newborn deaths by 45% over the last two years of cycle Later extended to the 200 control villages to get similar results This community mobilization was endorsed by the World Health Organization (WHO) in 2014’ * Tripathy PK et al. Effect of a participatory intervention with women’s groups on birth outcomes in Jharkhand and Orissa, India: the Ekjut trial. Lancet 2010, 375:1182-1192.

THE PARTICIPATORY LEARNING & ACTION CYCLE [PLA] The module is designed as a Cycle of 20 meetings of women’s groups EVALUATE TOGETHER IDENTIFY CAUSES ACT TOGETHER PLAN STRATEGIES

Participatory Learning and Action (PLA) cycle The 20 meetings mostly consist of scientifically designed stories, role-plays and games Problem/Solution Identification is done by the group itself Facilitated by an ASHA trained in PLA Systematic community interaction, through plays

An example game: UNDERSTANDING the CAUSES Newborn death Immediate Causes Hypothermia Prematurity Infection Delayed cord Clamping/ Exposure to cold Cord cut with unsterile instrument No Skilled BA Faith healer Home delivery Underlying causes No transport available Informal provider Teenage mother Poverty

STRATEGy Starting a Saving & Credit group Arrangement for transport (Mamta vahan) Institutional delivery Not bathing the child for 3 days after birth Encouraging pregnant mothers to visit health facility Delaying age of marriage Institutional delivery or use of SDK in home delivery Knowledge of danger signs of infection Each strategy has protocols for implementation including division of responsibilities, system for monitoring etc from within the group

What does the PLA cycle do? Increases problem solving skills of members Helps them understand cause and effect relationships Empowers women to make decisions about health of self and their children Increases demand and uptake of services

Replication Similar projects of PLA in Bolivia, Malawi and Nepal This model developed by Ekjut has collaborations with MP – As ‘Saanjhi Sehat’ with MPSRLM in 1000 villages Odisha - As ‘Shakti Varta’ with Health Department; in 170 blocks Bihar – As ‘Gram Warta’ with Jeevika in 15 districts Jharkhand independently Well on its way to being scaled-up On Sustainability - According to a recently published paper once a group goes through a PLA cycle, the outcomes continue to sustain for a long time.

The way Forward For SAGY villages Locally acceptable content development through SRLMs Trainings of ASHAs as facilitators Incorporation in national programmes PLA as a convergence between NRLM and NHM

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