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AAA Platform

The Solution

Bringing the three frontline workers on one common platform to synchronise data, review each other’s work, micro-plan activities, and share learnings

Three government women health-workers are responsible for delivering health and nutrition services in India’s villages. Each village has an Auxiliary Nurse Midwife (ANM), the ASHA (Accredited Social Health Activist) and Anganwadi worker (AWW). Each of these frontline health workers has distinct, but related roles, and they work in the same villages. All too often, they do not collaborate enough. The AAA (ANM-ASHA-AWW) Platform brings them together.

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

The AAA way

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.

2. Micro-planning:

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.

3. Meetings:

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

AAA Platform

Status

The AAA Platform is being scaled up across the state of Rajasthan, and in select districts of Chhattisgarh and Madhya Pradesh

* Scale-up announcement by Former Hon.CM of Rajasthan- Jaipur, 2017

Rajasthan

The AAA platform was a key intervention of our Akshada program in Rajasthan. The solution was initially piloted in 2700 villages (3 million population) across Jhalawar and Baran districts in Rajasthan, with just 13 of our staff providing support. The mapping of villages was done entirely by the AAA workers together with local communities. In December 2017, the then Hon. Chief Minister of Rajasthan Vasundhara Raje announced that the AAA platform would be introduced to every village in the state (over 45,000) under the name 'Rajsangam'. 140,000 frontline workers and supervisors were trained, reached through transmission to over 250 regional video-centres.

Rajsangam has been embedded within the state government's health system and is being managed by the government. The government also developed a system to monitor the scale-up of the program across the state, hence allowing us to withdraw our support smoothly.

Build, operate and transfer!

Aaa Platform Comic

As part of the intervention, we also created a comic book to visually explain the AAA platform. Access the comic book here

Madhya Pradesh

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.

Chhattisgarh

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.

AAA Platform

Impact

The AAA Platform has had significant impact on identification of high-risk cases in Rajasthan. Outcomes are based on internal monitoring.

Rajasthan

Our monitoring data from 80 anganwadi centres in Jhalawar district showed a strong increase in identification of various critical beneficiary groups, due to the AAA Platform. These high-risk beneficiaries are most vulnerable, and contribute the largest towards morbidity and mortality. Timely identification is crucial to ensure prioritisation and focussed service delivery, thereby improving health outcomes.

The AAA Platform enabled this through a combination of factors:

  • Data sharing and synchronisation of records increased enumeration quality, by inclusion of missed beneficiaries and higher data accuracy
  • Joint accountability with regular AAA review meetings ensured increased adherence to job responsibilities (e.g., weighing of children, screening for malnourished children)
  • Peer learning sessions on various topics improved AAA’s knowledge and skills (e.g., proper weighing of children, accurate detection of malnourishment)

Below are three metrics that recorded a significant rise:

  1. Identification of malnourished children below age-five went up by over three times.Rise in malnourishment screening from 20% to 76% was a key contributor.
  2. Identification of underweight children below age-five increased by 117%, contributed by an increase in number of children weighed from 70% to 97%.
  3. Identification of high-risk pregnancies increased by over 60%. Better knowledge among AAA about classifying pregnancies as high-risk was an important factor (AAA knowledge scores rose from 43% to 67%)

A key factor driving increased identification across categories was a sharp rise in overall data integration among the AAA, from 57% to 94%. Data integration measures the degree of synchronisation of AAA records for crucial information such as number of households, number of pregnant women registered, number of infants, etc. Higher data integration reduces chances of beneficiaries being left out, and increases accuracy of captured beneficiary details.

This increased identification has been ensuring provision of proper service delivery for each beneficiary type. For example – extra supplementary nutrition provided to severely underweight children, referral of severely malnourished children to nutritional rehabilitation centres, and special counselling to high-risk pregnant women including referral to a medical officer.

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

AAA Platform

Case Studies

Stories from the field: AAA in Action

Impact stories

Watch the AAA Platform's impact along its theory of change: enhancing enumeration, enabling prioritisation, improving knowledge and ensuring 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


Beneficiary speaks

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.