Rural Women Accessing Health Services for Maternal Health
Ways were found to make rural women aware of their need to take care of their bodies as against the prevalent negligence and faith in superstitious cure. Once they were convinced to seek health, they were led to access health services from the service providers employed by the government.
About You
Section 1: About You
First Name
Ila
Last Name
Pathak
Website
Organization
Country
India
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?
No
Section 2: About Your Organization
Organization Name
Ahmedabad Women’s Action Group - AWAG
Organization Website
Organization Phone
079-26441214 / 079-26442466
Organization Address
: AWAG, AWAGKunj, Bhudarpura, Ambawadi, Ahmedabad - 380 015
Organization Country
India
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Your idea
Name Your Project
Rural Women Accessing Health Services for Maternal Health
Country your work focuses on
India
Describe Your Idea
Ways were found to make rural women aware of their need to take care of their bodies as against the prevalent negligence and faith in superstitious cure. Once they were convinced to seek health, they were led to access health services from the service providers employed by the government.
Website URL
Innovation
What makes your idea unique?
While working on the issue of health of rural women, AWAG came to note that health seeking was not ingrained in them; at the time of childbirth a traditional birth attendant was called. On the other hand, the Primary Health Centers (PHC) were hardly opened, the medical service providers appointed by the State government were not seen around the villages. Naturally the MMR and IMR were high.
This required work at two ends, (i) bringing women to PHCs and (ii) making the medical staff attend to them. AWAG decided to raise the awareness of the women so that they ask for the services of the medical service providers and get them.
This necessitated raising the rural women’s awareness on various issues, providing leadership training, holding hands in monitoring the services, supporting in making complaints and finally empowering them so that they access services on their own asserting their constitutional right. As they access these services their maternal health improves.
The uniqueness lies in: (1) AWAG being able to withdraw. The poor stick to that which is useful to them and is inexpensive. In a block where a PHC is not working the women took to calling well-fitted ambulance. (2) Once a woman accesses healthcare from a government employee free of charge, she would certainly tell the next generation. (3) The method followed is replicable. AWAG could replicate the same in two other blocks freeing women’s health from ignorance and bringing it into the light of scientific knowledge through institutional deliveries.
Do you have a patent for this idea?
Impact
This Entry is about (Issues)
What impact have you had?
Responses by the state improved. Health services were organised but the service providers had played truant, Primary Health Centers (PHC) did not open regularly, the Female Health Workers (Trained as Auxiliary Nurse Midwife) did not attend to work assigned nor stayed at the sub-centers, medicines were not made available. Whenever they helped in deliveries the FHWs used to charge quite a deal of money. Women guided by us started asking for services, the PHCs opened and stayed opened regularly, the FHWs started reporting on work, and started staying at the villages wherein sub-centers were assigned to them. Those who had paid them in immediate past asked for refund insistently and received it. Medicines were provided free of charge; deliveries were done at the sub-centers. The following table shows the impact in the first block where this approach was tried.
PHC Functional Non-functional
Before intervention - 2003 01 02
After intervention - 2005 03 -
Sub-centres Status of FHW's Residence at quarters at villages
Total subcenters FHW Appointed Vacant in the quarters in the village but not in quarters away from sub-cetnres
Before Intervention-2003 26 24 02 nil 05 nil
After Intevention-2005 26 24 02 17 05 02
Problem
1 Raising the awareness of women to say ‘no’ to violence and to make them seek health by freeing themselves from the traditional practices and superstitious cures they have been subjected to, and training them as leaders and change agents.
2 The prejudice that ‘services provided free are useless’ to be countered.
3 Officers higher up ignore the complaints made by the illiterate rural women since these remain oral.
4 The officers and staff in the government’s set up keeps changing so importance of providing health care to the rural women has to be repeated often.
5 The change agents do not remain constant. A woman could be a very good change agent / leader but her family may need her more urgently so she may not be able to give time or the family may migrate etc.
Actions
1. Rigorous awareness training imparted to the women in general and to change agents / leaders in particular. Health seeking behavior inculcated by hand holding while impressing the need to access services provided free of charge for them by the State
2. The complaints of the illiterate women supported in writing and representations made to the highest authorities.
3. The importance of providing health care to the poor women is repeated when service providers get transferred.
4. Train new change agents when needed.
5. Support and monitor the activities of the change agents for a fairly good time because the poor 1) are not in the habit of continually asserting themselves and may discontinue seeking services if intimidated by a service provider or by a local person and 2) may feel unequal to act if the situation takes an unprecedented turn.
Results
The rural women are strengthened in accessing health care. When they ask for it as their right the government has to respond to their demands. The State has to improve its record in health care so its network is established. It had remained unutilized as the rural people were indifferent and the service providers were taking it easy. Once we wake up the women to get the services which were to their advantage and free of charge they would opt for it and when the realization of its being useful dawns on them they would continue seeking health. The health care providers are bound to respond to their demands. FHWs and other service providers are bound to attend the PHCs and the sub-centers. The pregnant women will be looked after better. Institutional deliveries will start taking place so mothers and newborns will survive. The MMR and IMR will improve.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
A project like this takes minimum three years to make women of a block active in accessing health care. AWAG 's policy is : (i) Not to provide services which are expected to be provided by the Government, (ii) The person who needs something has to ask for it, AWAG could teach what to ask for and how. Maternal health care is needed by the rural poor, illiterate-semi literate women, so they must ask for it and get it. To raise their awareness to ask for it could be done by AWAG and that is at the center of the project: Raise awareness and make them access what they certainly need.
Year - I: A team of committed and well-trained workers is the first requisite and through such a team only results can be achieved. To begin with, a survey of the health seeking habits of the women of the block with reference to their customs, traditions and superstitions that restrain them from seeking healthcare is made. Awareness of women of the villages is raised on the issues of domestic violence, their need to say ‘no violence’ to their body and to insist upon it, their right to health care and their need to seek health for their own self and their children and the need to reject supersttious cures..
Year - II : Rigorous training is given to change agents in demanding health care. Panchayati Raj office bearers and members are associated with the demands for health services.. Health-seeking behavior is inculcated by hand holding of the change agents and the women.
Year - III : Change agents are supported in demanding and monitoring services from Health Service Providers. Absenteeism of service providers is reported to immediate superiors and is pursued till positive response is received.
What would prevent your project from being a success?
1) The project is based on the presumption that Health Services are provided by the State through Health Service Providers in rural areas. In the event of the Department of Health not responding to the demands of rural women, their access would be meaningless, they would not have their demands met satisfactorily.
2) Another presumption is that the nutritive input to pregnant women and lactating mothers would continue through Anganwadis, which are now under the department of Women and Child Development.
3) In the event of the state abdicating its responsibilities, the project could not achieve success. Otherwise, the poor, once they become aware of their rights, would assert them.
How many people will your project serve annually?
More than 10,000
What is the average monthly household income in your target community, in US Dollars?
$50 - 100
Does your project seek to have an impact on public policy?
Yes
Sustainability
What stage is your project in?
Operating for more than 5 years
Is your organization a
Non‐profit/NGO/citizen sector organization
Is your initiative connected to an established organization?
Yes
If yes, provide organization name.
How long has this organization been operating?
More than 5 years
Does your organization have a Board of Directors or an Advisory Board?
Yes
Does your organization have a non-monetary partnerships with NGOs?
Yes
Does your organization have a non-monetary partnerships with businesses?
Does your organization have a non-monetary partnerships with government?
Please tell us more about how these partnerships are critical to the success of your innovation.
The non-monetary partnership with ngos is towards advocacy. AWAG has built a network, ‘Alliance of All Gujarat Women’ (AAG), the Fouder Secretary of AWAG is invited to be the President of another, ‘Gujarat Mahila Federation’ and is closely associated with another recent one focusing against Violence against Women, ‘Stree Hinsa Nivaran Manch’. Through all of these AWAG has asked the State authorities to make Gujarat State ‘violence free for women’. In this AWAG has focused more on proper implementation of pro-woman legislations and presenting critique of new legislations from women's points of view.
The monetary partnership with government is to run a mental health project for women and adolescents.
The partnerships are not relevant to the innovations except that a branch of the Department of Health and Family Welfare is approached in the program referred to here and another branch of the same department is approached for MH Project.
What are the three most important actions needed to grow your initiative or organization?
1. Raising awareness of women to their individuality, to their right over their body, their right to social justice and equality. A five-day workshop is used towards achieving this. The participants of the workshop realise that they need not accept violence, that they need to seek health through medical services offered by the State and not resort to superstitious beliefs and cures, that they need to seek support when needed and support other women in need.
2. Organising women’s groups to assert their voices as and when needed. They take up issues of primary sanitary services, health services and livelihood support. Leaders from these groups are trained as Change agents who lead women in their area to protest against domestic violence, organize protest groups in case of social violence, monitor movements of government servants of department of ‘Health’ and ‘women and Child Development’, access assistance from the officers and members of Panchayat Raj institutes as and when necessary. The Change agents thus trained are led to demand services the State is committed to provide, like services of health, of ‘anganwadi. (a child care cente). The Change agents with the Panchayat Raj members and office bearers do get for the people what they need and the State is committed to provide.
3. Well informed actions by the work force of AWAG trained to run awareness raising workshops, to train the leaders / change agents. Field visits, checking the details of the complaints made by the target group women through the change agent, lest these be overstated, putting the grievances of the women in writing, dispatching the same to the specific level of the bureaucratic hierarchy, pursuing the complaints to their logical end so that the grass-root person feels vindicated and is satisfied, thus pursuing the goals set by AWAG.
The Story
What was the defining moment that you led to this innovation?
AWAG was working on the issue of Violence against Women with rural women in Radhanpur block of Patan district, Gujarat State, India. AWAG began with holding Awareness Raising Workshops for women, of five days' duration, during which the women were also introduced to their body and the need for health care. They were asked where they sought health care. The response was that they turned to traditional and /or superstitious cures largely but in case of emergencies went to the referral hospital in block town. They were then asked if they ever went to the local Primary Health Center (PHC) to seek health. Some of them stated that it was open at times but was not useful. AWAG spoke to them of the need to have medical care and also tried to lead them to the PHC in the villages. To AWAG’s dismay those were found closed and the Service Providers appointed for the villagers, absenting from work.
The rural women were asked to try getting services from PHC as and when it was noticed as opened and to report if services were not provided. In a month's time women reported how they were not provided treatment but instead were asked to go to the block town. Their reports were turned into complaints and they were asked to present them at the block hospital to the Resident Medical Officer (RMO). The RMO took action and the PHC in their village soon started offering services. Then the attendance of the Female Health Worker, a trained nurse, appointed to care for women's health was followed up and she started attending to her rounds. The way the rural women enthusiastically took up the issue and spread the news around, gave me the impetus to try this further.
Tell us about the social innovator behind this idea.
I, Ila Pathak, was behind this idea, which occurred while working in Radhanpur block of Patan district.
I have been a teacher of English literature and language in a college teaching graduate and postgraduate students from 1956 to 1993.
I am one of the founder members of ‘Ahmedabad Women's Action Group – AWAG’, and have directed its activities from its inception (1981). Initially, we had wanted to address issues of women's development but as we initiated work with dalit and urban poor women in Ahmedabad, I realized that survival of women was a larger problem. Domestic violence was at the root of thousands of women dying unnatural deaths every year.
So, AWAG concentrated more on violence against women, its impact on health of women and its cause in subordinate status of women. Ignorance, superstitious and tradition bound society oppressing women took their lives too. So AWAG decided to address social issues through raising awareness of individuals. Women, thus addressed, started asking for their human rights, seeking health from health service providers appointed by the state and asserting their rights.
I was appointed a member of a commission with a Police Officer, by the Supreme Court of India in 1987, to look into the misdemeanor committed by a number of police officers in the matter of a gang rape committed by policemen on duty in a police station in a tribal area.
The High Court of Gujarat appointed me, in 1989, as the Chair of a committee appointed to report on the working conditions of women working in tobacco processing factories of Kheda district in Gujarat State.
I have held sensitization workshops on gender issues for the police force of Gujarat covering 80% of them in 1998 to 2000. Similar workshops have been held for advocates, medical officers, media persons etc.
How did you first hear about Changemakers?
Friend or family member
If through another, please provide the name of the organization or company
 | 114 weeks agoJake Miller said: I like the idea of teaching women about their rights. Could you please elaborate more on how exactly you are going to teach them. You ... about this Competition Entry. - read more > |
| 114 weeks agoIla Pathak submitted this idea. |
