Project implementation period :

2017-2019

Project area :

Chhattisgarh (6 districts) and Odisha (6 districts)

Project Reach :
Auxiliary Social Health Activists (ASHA) :

27, 527

Auxiliary Nurse Midwives (ANMs) :

1,791

Service Providers :

2,630

Rogi Kalyan Samiti Members :

1,230

Project supported by :

The Maternal and Child Survival Program (MCSP) is a global, USAID Cooperative Agreement

Community participation in delivery of family

Goal :

To demonstrate delivery of quality family planning services in the public health system through improved clinical governance and other innovative processes and systems in selected districts, and thereby advocate for delivery of quality FP services in the country

Need :

Cultural, reproductive and demographic barriers are significant factors that affect non-use or discontinued use of Family Planning (FP), more influential than physical and administrative barriers. Therefore, it is important to work with families and communities to understand and address barriers to FP adoption and use. In India, gendered and patriarchal family structures make the arranged marriage system work through family growth. The timing and number of children a couple bears is often a decision that goes beyond the couple and is influenced by the normative pattern of no contraceptive use to delay first birth and an expectation that women bear the burden of childbearing and contraception. The desired family size includes the need for at least one male heir, so uptake of FP methods, delay in first birth or spacing of births are sometimes based upon the gender of the previous child. Therefore, despite low prevalence and clear reasons for promoting contraception, there is limited effect of behavior change messaging on uptake of contraception for delaying or spacing, especially in rural India.

Our program

The Maternal and Child Survival Program (MCSP) is a USAID cooperative agreement to introduce and support high-impact health interventions with the ultimate goal of ending preventable child and maternal deaths. The MCSP project works to expand access to high-quality family planning services and contribute to India’s FP2020 commitments. C3 is tasked with leading the components of MCSP for improved informed choice, respectful care, gender-sensitivity, support community participation into the program and address social factors which inhibits FP uptake.C3 is working in Chhattisgarh and Odisha, to roll out measures to improve community participation in family planning services and capacity building of service providers on Respectful Care seeks to ensure that quality, respectful and gender-equitable family planning services are available and accessible within the public health system.

Under the initiative, C3 is building the capacity of service providers of various cadres like Chief Medical Officers, ASHA’s, Auxiliary Nurse Midwives, Staff Nurses etc. at the Community Health Centre level on Family Planning counselling, informed choice and respectful care and establish and/or strengthen existing health systems for better interactions.

A quality of care framework is used for training on Respectful care the health care providers:

  • Help providers define disrespect and abuse in interactions and in facility conditions and stress on national and human rights standards for good quality and respectful care
  • Ensure that all patients receive a careful explanation of proposed procedures in a language and at a level they can understand so they can knowingly consent to or refuse a procedure (informed consent), importance of couple participation
  • Support providers to build a culture of choice, consent and conformity to standard protocols and alerting violations by FP clients and Increased engagement and participation of communities in promoting access to and usage of family planning services
Key Highlights :
  • Sensitization of Providers on issues of gender, social exclusion, discrimination and its relationship to how FP services are provided and to improve this through provision of Respectful care framework and trainings
  • Activate the existing system of community involvement of the health care system, strengthening and creating an accountability mechanism – which is done through the Rogi Kalyan Samiti (RKS) activation
  • Worked on the utilization of the IVRS feedback as a communication of client needs and satisfaction with regards to the quality of services – especially focusing on elements of Respectful care
  • Support provided and systems activated to Increase service provider and the client interaction and including counselling on the whole range of clients rights around access, acceptability, quality and accountability for FP services in a most gender inclusive and respectful manner
#
Case story
Ms. Prafulla Sanibigraha

Ms. Prafulla Sanibigraha is one of the dedicated ASHA of Bairanda Mangarajpur village under Soro Community Health Centre of Balasore district. She has studied up to +2 science and working as ASHA since last 13 years.

She attended the training on gender, social inclusion and respectful care (GIRC) in family planning services under MCSP, USAID supported and facilitated by Centre for Catalysing Change (C3). Gender biases in our society creates more inequity and often various forms of discrimination against women, which can be altered by a progressive processes and actions at family and society levels which she has learnt and realised from training programs. Child bearing and breast feeding are the only things which God has given to women only; on all other things women are equal with men. In other words, me should share equal responsibility with women in matter relating to reproductive health and child rearing. She got training on gender for the first time and this training was an eye opener for her. On respectable care, she says all Frontline Health Worker-ASHA and ANMs should behave well with the clients and their family members, maintain privacy and confidentiality about their health and other information relating to health and choice of family planning etc. According to her, “warm and friendly behaviour of service providers will minimise pain of a client magically even before the onset clinical intervention”.

She says after attending GIRC training program, frontline workers were more serious and conscious of their behaviour with the clients. Now- a-days, curtains are used almost invariably for the antenatal check-up during VHND sessions. Also, client examination and counselling is provided maintaining privacy and confidentiality at Sub-Centres and VHND sessions. “GIRC training has given her more confidence for counselling the eligible couple, especially the men. This has been great benefit to her, she says