Sure Start works to educate women in India on maternal and neonatal health. Sure Start, an initiative by PATH, supported by the Bill & Melinda Gates Foundation works to promote safe childbirth practices in India. Visit Sure Start! Facebook: http://www.facebook.com/pages/Sure-Start-Project-by- Path/178629192101 Twitter: http://twitter.com/pathsurestart/

1. Hospital births: Saving lives to save a generation
Having a baby in
India can be a
dangerous
experience,
especially if you
are a woman living
below the poverty
line in a rural area.
Nine women die
each hour from
complications
related to
pregnancy or
childbirth, adding
up to 78,000 deaths
a year. A million
babies die annually. Of the mothers and infants who survive, many do so with long-term
health damage and poor physical or cognitive skills.
According to the latest National Family Health Survey (NFHS-III 2005-2006) data, there
is a direct correlation between the percentage of institutional deliveries and the infant
mortality rate; it is apparent that women who deliver their babies in hospitals not only
increase their own chances of survival, but also those of their children.
Infant mortality rate Percentage of women who
delivered in a health
facility
Lowest wealth quintile 70.4 12.7
Highest wealth quintile 29.2 83.7
Mother’s education < 5 66.0 36.3
years complete
Mother’s education 12 or 29.9 86.4
> years complete

2. Unfortunately, ensuring access to health care facilities for all women, regardless of their
wealth levels, remains a big problem. As is illustrated in the graph above, only 12.7
percent of women from the lowest wealth quintile deliver their babies in a health facility,
as compared to 83.7 percent of women from the highest wealth quintile.
To address this discrepancy, the Indian government has come up with schemes such as
the National Rural Health Mission (NRHM), whose goal is to improve the availability of
and access to quality health care for those at the lowest rung of the socio-economic
ladder. The soon-to-be-launched National Urban Health Mission (NUHM) has also given
high priority to the issue of maternal and newborn health for marginalized communities.
Additionally, a government program called the Janani Suraksha Yojana gives money to
mothers as an incentive
if they opt to have their
babies in a hospital,
instead of at home.
Yet, despite these
schemes, supply gaps
and challenges remain.
In a country of India’s
size, where a maternal
death occurs every
seven minutes, it
requires considerable
effort from various
quarters to ensure a
smooth and successful
institutional delivery
for an underprivileged woman.
This effort does not have to be a solo one. In order to ensure that everyone receives the
services they need, why not link up those who have the expertise, those who have the
funds, and those who have the infrastructure? Public-private partnerships are a way for
communities and governments to work together for the good health of their women, their
children, and future generations.
Just ask Dr. Vidya Kshirsagar, who has long worked to provide specialized health care to
the poor mothers and children of Navi Mumbai. In 2007, she was approached by a project
called Sure Start—a five-year initiative based at PATH, an international not-for-profit
organization supported by the Bill & Melinda Gates Foundation—that is working to help
mothers and their children to survive and stay healthy in the states of Uttar Pradesh and
Maharashtra.

3. With Dr. Kshirsagar’s help, the
project assisted with the
organization of a public-private
partnership between the Navi
Mumbai Municipal
Corporation (NMMC) and
local nongovernmental
organizations, community
groups, professional
associations, medical
institutions, and private
hospitals. Now, the women of
Dr. Kshirsagar’s city have
access to services such as
gynecological visits, pediatric care, nutrition consultations, and yoga classes—services
that address complications before pregnancy and in the postnatal period for mothers and
newborns. Thanks to the joint efforts of all these different groups and individuals, the
percentage of women delivering in hospitals has increased from 79 percent to 85 percent
in one year.
There are also other innovative ways to give people a hand up, instead of a hand out. For
instance, in the informal settlements of Nanded, Maharashtra, more than 200 families
have formed a partnership and each contribute a small amount of money (US$5) toward a
community-based health insurance fund. The fund is used to meet the specific health care
costs of the contributors, including maternity coverage. With the help of community-
based and national organizations, the government’s Janani Suraksha Yojana scheme has
also been integrated into this program. Should patients require a procedure included in
the government’s scheme, the money is mobilized for the contributors.
Initiatives such as these highlight the power of partnership: people working together to
change what seemed unchangeable. Indeed, in this age of high-flying health insurance
schemes and exorbitant medical bills, there is something wondrous about a group of
disparate people coming together to create small miracles with big results.
Sure Start works to educate women in India on maternal and neonatal health. Sure Start,
an initiative by PATH, supported by the Bill & Melinda Gates Foundation works to
promote safe childbirth practices in India.

4. Visit Sure Start!
Facebook: http://www.facebook.com/pages/Sure-Start-Project-by-Path/178629192101
Twitter: http://twitter.com/pathsurestart/