There are some fundamental issues:
- There is no village map, so workers are often unfamiliar with the geographical area and location of households
- Frontline workers have different methods for identification and tracking of beneficiaries
- Households are approached in a prescribed linear sequence and not prioritised in terms of case urgency
- Workers are not equipped to handle community resistance
- There are few opportunities to share information and learn from each other
1. Establishing a common database:
AWWs organise people by families, ASHAs use households and ANMs work on a record of eligible couples (married couples in the age group 15-49).
AAA work together to create a village map, synchronising household and family coverage. On these maps, they number houses and affix coloured bindis to denote various categories of beneficiaries and dynamically track them, prioritising those at highest risk. Now, village health and nutrition information is available at a glance. AAA also involve the community in validating the maps. This raises community's interest in village health issues and the AAA's standing in society.
ASHA workers visit ten houses every day. Previously, they did it in a linear manner (House one to ten on day one, eleven to twenty on day two and so on). AAA enables them to plan visits based on beneficiary needs using a simple algorithm. This enables them to deliver care when and where it is most required.
One specific day every month (varies state-wise), a Village Health and Nutrition Day (VHND) is organised in every village. Through the AAA platform, the three workers have a formal meeting. Here, they review each other's work and data, plan for the next month and close with a peer learning session where they educate each other on technical and administrative matters.
Know more about village mapping in the video below
This is a good platform, where we can review our day to day work, and discuss and finalise the activities of upcoming month in the meeting. We review the status of ANC, PNC, High Risk Pregnant Women, Immunisation, New Born care and malnourished children in accordance with the Anganwadi Centre. This review helps us to identify the women who are not coming for their first and second ANC, children left out from immunization and also the status of women with high risk pregnancies
– Munni Devi
ANM - Kamkheda, Jhalawar
Akshita is the Antara Foundation’s new program being implemented in the state of Madhya Pradesh in Chhindwara and Betul districts. We have been working closely with the state government since 2019, tailoring the AAA platform process to the state’s needs. We are focusing on adapting our program design and interventions to Madhya Pradesh’s tribal context (over 20% of the state’s population is tribal).
In addition to this, we are also scoping a few other districts to scale up our interventions.
Aadhya is the Antara Foundation’s pilot program in Chhattisgarh, being conducted in Bagbahara block in Mahasamund district. We are currently working with the state to roll out a variant of our flagship AAA platform as the AAM platform (since Chhattisgarh has a Mitanin cadre instead of ASHAs).
The strategy in Chhattisgarh is to work primarily through the supervisory cadre of the departments of Health & Family Welfare and Women & Child Development to build ownership of the AAM intervention by the government, and to expedite training of frontline workers through a cascading model. This will also ensure sustainability. The program has been witnessing strong progress across intervention activities.
Note 1: According to Rajasthan government estimates, 10-15% of pregnancies are at high risk
Note 2: Outcomes based on monitoring done in 80 anganwadi centres in Jhalawar district, Rajasthan in 2018 over a period of one year
Watch the AAA Platform's impact along its theory of change: Enhance enumeration, enable prioritisation, improve knowledge and ensure joint-work
Ensuring inclusion of missed out beneficiaries
Ensuring service delivery to all critical groups
Enhancing quality of services through peer learning
Fighting social barriers through AAA collaboration
Increasing beneficiaries covered through ASHA workers
Mamta (High Risk Pregnancy) - Shyampura village, Rajasthan
When first time I became pregnant, ASHA and ANM advised me to look after myself. They also suggested that I conduct a sonography at Jhumki Community Health Centre. But my family and I did not give any attention towards their advice. They also suggested that I avoid much weight during pregnancy. Instead of this, I fetched water in a Matka from ground to the first floor of my house, as I was allotted upper portion of the house to live. As a result of not believing health workers’ advice and also due to ignorance on my part towards my health, I lost my first pregnancy in 6th month.
After six months of my first miscarriage, I become pregnant again. During my first ANC investigation ANM told my mother-in-law that it is a high risk pregnancy as I already had a miscarriage. ANM told her that this time ‘AAA’ will look after my pregnancy but she also needs to give special attention towards my health.
Now I am following all the advice given by the ‘AAA’ in this pregnancy. They have also done counselling of my mother-in-law and husband about my health. My husband and mother-in-law are taking care of me. My mother-in-law also has given me ground floor of the house to live. She also does not give me any heavy weight to carry during pregnancy.
Few days back, during my investigation at Sub Centre, I came to know that my haemoglobin is below 7. On this, ‘AAA’ suggested conducting an investigation at District Hospital Jhalawar. They were also ready to go along with me. My husband took me to Jhalawar where doctors prescribed me 2 unit of blood and also prescribed iron injection. According to their advice, my husband has provided me treatment. Doctors also told us that this is a twin pregnancy and I am going to give birth to twins, so I need more care and attention.
Now I am eight months pregnant and my haemoglobin is improved to 9. All this credit goes to ‘AAA’ as they are regularly taking care of my health. ASHA Sahyogni used to visit 4 to 5 times in a month to provide me advice and suggestions. I also frequently visit the Sub Centre for their advice.