Sure Start Fact Sheet
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  • 1. FA C T S H E E T www.path.org Sure Start Helping Mothers and Newborns Thrive Each year, an estimated 78,000 In Maharashtra, Sure women in India die from Start works with pregnancy- and delivery- municipal corporations related complications, in several urban and a million babies die areas of seven cities during the neonatal period.1 and has been invited Sure Start—a five-year to contribute to initiative based at PATH the Government of and supported by the Bill & India’s forthcoming Melinda Gates Foundation— National Urban Health Mission. To support Maharashtra’s is working to reduce urban population, Sure Start is harnessing the value these numbers by helping of innovative health financing models, volunteerism, mothers and newborns convergence, and public-private partnerships. The project survive and stay healthy. has already achieved tangible results at the community level; examples include a documented increase in the Because no one set of interventions will work everywhere, number of women giving birth in hospitals and an Sure Start is based on the idea that maternal and neonatal increase in early registration of antenatal mothers. health should be prioritised within primary health care programmes and by communities themselves. The project is reducing barriers to accessing lifesaving maternal and newborn health (MNH) services by mobilising village-, Empowering communities block-, and district-level government, nongovernmental, Sure Start’s approach is based on extensive engagement and community-based organisations. Working with 95 with rural and urban communities. local partners—15 lead partners and their 80 consortia— Sure Start is focusing on the states of Uttar Pradesh and Maharashtra, working to improve MNH amongst Uttar Pradesh a combined population of 24.5 million residents. • Sure Start has built the capacity of In Uttar Pradesh, Sure Start works in seven districts, 7,540 government- collaborating with both the state government and the recognised National Rural Health Mission. Across these districts, Accredited Sure Start is activating Village Health and Sanitation Social Health Committees (VHSCs), establishing mothers’ groups, and Activists (ASHAs) working with community health workers. These efforts who work at have produced concrete community actions in at least the village level, enabling them to share MNH 12,000 of Uttar Pradesh’s villages, improved access to knowledge within their communities. needed funds for MNH, increased the number of health providers delivering services, and promoted healthy • The project also establishes mothers’ groups to facilitate practices that save the lives of mothers and their babies. meetings at the village level to help increase women’s 1 UNICEF. State of the World’s Children 2009: Maternal and Newborn Health. New York: UNICEF; 2008. Available online at: http://www.unicef.org/sowc09/.
  • 2. awareness of MNH issues. Since January 2008, 68,000 • In Malegaon, client-satisfaction norms are being group meetings have taken place with approximately developed by working with communities and 150,000 expectant mothers and their mothers-in-law. aiding their interaction with public-service • In addition, Sure Start establishes and strengthens providers. This work is based on establishing a VHSCs. These committees are democratic, community- shared platform for bringing about an overall level forums charged with implementing government improvement in the quality of care. health schemes and ensuring that better MNH services • In Nanded, Sure Start has allowed 200 families are provided. Since September 2007, Sure Start has to take charge of their health by establishing helped 30,000 committee meetings take place. a community-based health insurance scheme that has a special provision for MNH. Sure Start has worked with VHSCs in Uttar Pradesh to ensure that 100 percent of committees have functional plans for providing transport for expectant mothers Raising awareness and that 94 percent have plans to improve the quality Sure Start employs a range of innovative communication and reach of maternal and child health services. Sure techniques to ensure that the right messages about MNH Start has also assisted VHSCs in accessing government reach communities effectively. funding. As a result, some US$147,000 in discretionary funds has been released to these committees. Uttar Pradesh Maharashtra • An extensive mass media campaign • In Nagpur, Sure Start is working to build the entitled Pehla Ek capacity of 35 community health groups, enabling Ghanta (The First them to effectively address MNH issues. One Hour) has been • In Navi Mumbai, the project is helping create 20 rolled out in all community support groups that facilitate interaction districts where Sure between communities and health service providers. Start operates. The • In Solapur, effort includes setting up five hoardings (billboards) in 1,210 self-help each of the seven districts and outfitting 750 rickshaws group members, with messages, in addition to organising quizzes and 208 college screening films with embedded MNH messaging. volunteers, and • Messages on MNH have been disseminated in 216 community village melas (fairs) for maximum impact. members are • Innovative interpersonal communication tools— now participating including games, songs, and demonstrations—have been in a volunteer developed and rolled out in mothers’ group meetings. programme to work with the residents of informal settlements and help • Materials have been developed to facilitate home visits raise awareness of MNH amongst antenatal mothers, for behaviour change. ASHAs have been trained in their families, and other community members. their use and are now using them in their work. • In Pune, Sure Start has helped form 30 committees • Communication materials to engage husbands of of residents from informal settlements. These expectant or new mothers have been prepared and Monitoring of MNH Status (MOMS) committees distributed, reaching more than 40,000 fathers in all. are trained and charged with improving MNH in • A vast programme of wall writings has been undertaken their neighbourhoods. Work at the community in most villages where Sure Start is active. These level in Pune also aims at converging MNH with writings share information on different aspects of MNH. HIV voluntary counselling and testing services. • In greater Mumbai, the project is improving the Ensuring that expectant mothers are vaccinated against quality of care available to communities by forming tetanus toxoid and take iron and folic acid tablets is community action groups that facilitate the extension essential to maternal and newborn health. Sure Start’s of better MNH services. Community resource efforts have helped 94 percent of all women in Uttar centres have also been established to provide Pradesh receive the tetanus toxoid vaccine by their third information about relevant government plans. trimester and 75 percent receive iron and folic acid tablets.
  • 3. Maharashtra Maharashtra • As in Uttar Pradesh, Sure Start has developed • Collecting data. Sure Start also established an MIS materials to facilitate home visits for behaviour change. in Maharashtra by incorporating rigorous design, Community-level personnel have been trained in their pretesting, field testing, and partner feedback. The use and are using them during their visits. system tracks approximately 22,000 pregnant women • The project has received substantial coverage in the across seven cities, collecting data on MNH behaviours press, in part because of its regular engagement with the and access to services through indicators such as the media at the state and district levels. number of home visits conducted, the number of antenatal mothers contacted for behaviour change • Sure Start has produced information, education, and communication, percentage of antenatal mothers who communication (IEC) materials that are being broadly have received tetanus toxoid vaccine, and the percentage used. For example, all of the Navi Mumbai Municipal of deliveries taking place in institutions. The project Corporation’s (NMMC’s) health posts and maternal has trained field staff, community health workers, and and child health centres prominently display the supervisors to use the MIS, and the team monitors data project’s materials. quality across the seven cities in Maharashtra where • In Pune, street theatre, music performances, and Sure Start works. other folk media are being used to increase awareness • Partnerships and trainings. Sure Start is collaboratively of MNH. building the capacity of its partners across project areas. The team regularly trains partners in all seven cities in advocacy, financial management, and capacity-building. Managing change Sure Start has facilitated three-day trainings for Working in two states and collaborating with frontline government health workers in the seven cities, 95 partners requires Sure Start to use innovative effectively building their capacity to provide antenatal management approaches. care. The project is also developing partnerships with private practitioners for improved MNH services to the community. Uttar Pradesh • Collecting data. Sure Start established Improving financial models a management In Maharashtra, Sure Start employs innovative models information system of improved MNH financing for communities. (MIS) after rigorous design, pretesting, • Community-based health insurance. In Nanded, field testing, and 200 families have enrolled in a community-based partner feedback. The MIS allows Sure Start partners to health insurance plan by providing a premium of collect data on several indicators for MNH behaviours Rs. 250 (US$5). Sure Start was able to keep this and access to services. The project supports in-depth premium low by obtaining a subsidy from the training of Sure Start personnel in use of the MIS, site local State Legislative Assembly. Through the plan, visits to mothers’ groups and VHSCs to ensure data families receive maternal care (including antenatal accuracy, and monitoring of ASHAs’ records. The MIS checkups), newborn care, hospitalisation for general can be accessed by relevant government personnel and illness, and reimbursement of transportation is designed to continue well after the project concludes. expenses. Six hospitals have enrolled in the plan. • Partnerships and trainings. Sure Start works with • Emergency fund. In partners with specialised knowledge of the project Nagpur, Sure Start has areas. Throughout 2008, training, mentoring, and established 35 emergency supervision activities enhanced partners’ capacity. The health funds (with a special project has focused on strengthening institutional, provision for MNH care) financial, and technical capabilities and planning for that allow the urban poor increased sustainability of project activities. As a result, to access resources for there has been remarkable growth in the institutional health needs. To date, 176 and programmatic capacities of all six lead partners. users have been briefed on how and when to use System improvements and enhanced credibility allowed these funds. The project 42 of the 55 consortium partners in Uttar Pradesh to has also initiated a prepaid receive program funding from the government and card system that improves the urban poor’s access to private donors. essential health services.
  • 4. • Public-private in communities across the country. Sure Start has partnerships. In Navi been well integrated with this programme from the Mumbai, Sure Start beginning and works to support its objectives in facilitated a partnership many ways: by providing support to ASHAs, helping between the NMMC and establish and strengthen VHSCs, undertaking local nongovernmental extensive IEC activities, and establishing an effective organisations, community- MIS that ensures a two-way flow of information. based organisations, professional bodies, institutions, and private Working with the National Urban hospitals to provide Health Mission in Maharashtra improved MNH services. In June 2008, the Government of India announced that The NMMC collaborates it would launch the National Urban Health Mission to with professional improve health in India’s urban areas. Since Sure Start is associations of obstetricians, already working on this issue, the team has been invited gynaecologists, paediatricians, dieticians, and yoga to participate extensively in planning the mission for trainers. Decentralised antenatal care has since been Maharashtra. Like Sure Start, the mission will focus on provided on a monthly basis through specialised strengthening public health delivery systems, improving clinics at 20 urban health posts. The services address the capacities of local municipal bodies, and working to complications during pregnancy and the postnatal collect accurate data period for mothers and newborns. Since March and strengthen client- 2008, 213 newborns and 303 pregnant and postnatal provider linkages. women have received care through this system. Sure Start is also well integrated with Institutional deliveries make the process of giving birth the government’s much safer. In Navi Mumbai, the percentage of women Reproductive delivering in hospitals has increased from 79 percent in and Child Health 2007 to 85 percent in 2008. Programme, Phase II. Supporting government mechanisms For more information From the outset, Sure Start has aligned with national-level government activities to ensure that To learn more about the Sure Start project or its contributions to MNH will be sustainable. PATH’s MNH activities in India, please contact: PATH A-9 Qutab Institutional Area Working with the National Rural New Delhi, India 110067 Health Mission in Uttar Pradesh Tel: 91-11-26530080-88 In 2005, the government announced the launch of the www.path.org National Rural Health Mission, which aims to make substantial improvements to the lives of villagers PATH is an international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health. By collaborating with diverse public- and private-sector partners, PATH helps provide appropriate health technologies and vital strategies that change the way people think and act. PATH’s work improves global health and well-being. For more June 2009 information, please visit www.path.org.