AAA Platform

AAA Platform / 1

The AAA story

Introductory film

Situation:

Three women frontline workers - Accredited Social Health Activist (ASHA), Anganwadi Worker (AWW) and Auxiliary Nurse Midwife (ANM) are jointly responsible for delivery of health and nutrition service delivery in India's villages. Each of them has a distinct role - The ASHA mobilises the community to participate in healthcare programs, the AWW is responsible for nutrition and health monitoring of young children and their mothers and the ANM provides basic health diagnosis, treatment or referral. Their roles seem complementary. Yet, cooperation between them has traditionally been minimal. AWWs and ANMs are employed by the Women and Child Development (WCD) and health ministries respectively. In Rajasthan, ASHAs are paid a fixed honorarium and incentives by the WCD and Health Ministries respectively.

Complication:

There are some fundamental issues:

  • There is no map so workers are often unaware of geographical area and population to be served by them
  • Frontline workers differ in identification and tracking of beneficiaries
  • Tasks are carried out in a linear manner and not as per need
  • Workers are ill-equipped to handle community resistance independently
  • There are little to no opportunities to 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 worked together to create a village map, synchronising household and family coverage. On these maps, they numbered houses and affixed 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 involved the community in validating the maps. This raised community's interest in village health issues and the AAA's standing in society.

2. Micro-planning:

ASHA workers visit ten houses everyday. 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 Thursday every month, a Village Health and Nutrition Day 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.

This is a good platform, where we can review our day to day work, we can discuss and finalise about the activities of upcoming month in the meeting, firstly 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 / 2

Status

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

Scale-Up

The AAA platform was initially piloted in 2700 villages across Jhalawar and Baran districts in Rajasthan. In December 2017, the Hon. Chief Minister announced that it would be scaled up to every village across the state under the name "Rajsangam". Frontline workers across the state are currently being trained via videoconferencing.

AAA Platform / 3

Case Study: AAA in Action

Benficiary speaks: Mamta (High Risk Pregnancy) - Shyampura village, Rajasthan

When first time I become pregnant, ASHA and ANM advised me to look after myself. They also suggested me to conduct a sonography at Jhumki Community Health Centre. But me and my family have not given any attention towards their advise. They also suggested me not to take much weight during pregnancy. Instead of this, I fetched water in Matka from ground to the first floor of my house, as I was allotted upper portion of the house to live. As aresult 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 need 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 not gives me any heavy weight to take 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 to conduct investigation at District Hospital Jhalawar. They were also ready to go along with me. My husband took me to Jhalawar where doctors prescribed me to give 2 unit of blood and also prescribed to give iron injection. According to their advice, my husband has given me treatment. Doctors also told us that this is a twin pregnancy and I going to give birth to twins, so I need more care and attention.

Now I am eight month 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.