1. 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

2. 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

3. 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:

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. Thanks!!