Background

Improving maternal and child health in Rajasthan”

Akshada

Akshada / 1

Background

* Jhalawar, Rajasthan

In 10 seconds

Aim

To significantly improve Rajasthan’s status in maternal and child health and nutrition

Program Partners

Government of Rajasthan, Tata Trusts

Geography

Rajasthan

Beneficiaries

Pregnant women, Mothers, Children

A for 'Akshada'

Akshada, which means ‘God’s blessings’, is a unique public-private partnership between the Government of Rajasthan, Tata Trusts and The Antara Foundation. The program aims to significantly improve Rajasthan’s status in maternal and child health.

"1000 days"

Akshada program focusses on the critical ‘1000 days’ between conception and age two. It is designed to influence the most critical markers of maternal and child health such as maternal anaemia, neo-natal and infant mortality and immunization.

Akshada / 2

Interventions

Our interventions in the Akshada program are classified into three broad areas. The first set of interventions targets every aspect of healthcare service delivery. Second is a set of interventions targeted directly at the Community to help shape the demand for healthcare services. Finally, the program also has interventions that help build an enabling environment for the overall suite of interventions.

* Baran, Rajasthan

Interventions that target every aspect of healthcare service delivery

AAA Platform

Meet the three women responsible for health delivery in a village

Three women frontline workers are responsible for delivering health and nutrition services in India’s villages. They are the Auxiliary Nurse Midwife (ANM), the ASHA (Accredited Social Health Activist) and the Anganwadi worker (AWW). Each of them has distinct but related roles and serve the same area. Yet, there is little collaboration between them. The AAA (ANM-ASHA-AWW) platform brings them together.

Integrated AAA app

The app enables instant real-time data sharing between the AAA frontline workers. This one-of-its-kind solution was adopted by the Government of Rajasthan for scale-up in 2017.

Rationalised Registers

Frontline workers (AAA) maintain numerous, voluminous registers. For instance, the Anganwadi Worker alone has eleven. Several of them contain repetitive fields. Naturally, AAA saw registers as a burden. We saw it as a job-aid.

We worked with designers and government functionaries to make the Auxilary Nurse Midwife’s service delivery register easy to use. We eliminated repetitive columns, introduced a logical sequence and made it visually appealing. It helped to save time, improve data quality and morale of health workers.

In April 2017, the new register was adopted by the State Government for roll-out across the state. This effort also formed the basis for the integrated AAA app.

Nurse Mentoring

Each Community Health Centre (CHC) caters to approximately eighty thousand people. Our nurse mentors work to ensure that labour room facilities and personnel at high case-load delivery points are well-equipped to handle deliveries.

There are two sub-components:

Facility enhancement: Includes labour room organisation, ensuring availability of essential drugs and equipment and proper display of posters and educational material.

Skill building: Observation and training of nursing staff to enable them to enhance their skills.

Mobility

Auxiliary Nurse Midwives (ANMs) typically serve a population of five thousand across few villages. Some of them have to travel to inaccessible areas. To ease their burden and improve efficiency, six ANMs were provided with scooties in December 2015. The event was presided over by the Hon. Chief Minister, Smt. Vasundhara Raje.

2. Interventions targeted directly at the Community to help shape the demand for healthcare services

Jagori Kishori – Adolescent Girls Program

We work with adolescent girls to mobilize community demand for health services. Participants are trained on maternal and child health issues. Then, they visit beneficiaries’ houses and reiterate key messages.

This intervention is in its infancy and we’re working on developing a scalable model.

    3. Interventions that help build an enabling environment for the overall suite of interventions

    Stanford University Partnership

    Bringing knowledge from one of the world’s leading medical schools to people serving in the most difficult contexts

    In December 2016, Stanford University, the Govt. of Rajasthan and The Antara Foundation came together to ink a historic MoU. The MoU proposes collaboration between the three parties for enhanced quality and greater access to medical education in Rajasthan through high-quality digital content produced by Stanford University’s Digital MEdIC initiative.

    Stanford lessons and content have been integrated with the Jhalawar Medical College’s curriculum. Engaging audio-visual content has also been made available to frontline workers in Rajasthan to aid them in educating beneficiaries.

    Please watch this video to know more.

    Akshada / 3

    Impact

    * Aerial view - Jhalawar

    Akshada views impact with respect to the following objectives:

    • Increase collaboration, coordination and data synchronisation between the three front-line workers
    • Increase identification, follow-up and referral of critical beneficiaries
    • Enhance the quality of services provided by front-line workers to beneficiaries by improved record keeping, increasing efficiency & effectiveness of service delivery
    • Improve labour room management and enhance skills of nurses deployed in labour rooms
    • Improve the demand for nutrition and health services and to enable adolescent girls to act as change agents within their communities

    The program is deploying several innovative and path breaking interventions that are designed to be scaled up in partnership with the Government-run public health system. This ensures not only rapid scale-up during the period of the Akshada program but also the sustainability of the program in future. While there is a lot of room for improvement in outcome indicators for Rajasthan, the state is taking progressive steps to emerge as a beacon for maternal and child health. Under the program, over 2,700 villages have been mapped in Jhalawar and Baran districts. Frontline workers in every village across Rajasthan are being trained on the AAA platform currently via videoconferencing.

    Scale Up 2

    AAA training via video conferencing

    Akshada / 4

    Program Updates

    Along with quality and coverage, speed is all-important in our scale mantra. Follow this space to know the latest developments.

    * Jhalawar, Rajasthan

    • Raj Sangam

      State makes giant leap in mother and child healthcare

      The Hon. Chief Minister of Rajasthan, Smt. Vasundhara Raje, announced the launch of Rajsangam, a program that will result in scaling up of the AAA model across the state.

      Read full article →