Small miracles, big results
Meet Sooraj Anamai, a young man who grew up in Kamraj Nagar, one of the marginalized settlements in Mumbai where Sure Start operates. He joined Sure Start as a junior project officer and youth coordinator for the community resource center (CRC) in the neighborhood. Soon after, Sooraj (which means “sun” in Hindi) learned that the municipal health post in the area had been inactive for the past 17 years due to a broken water pump. Upon discussions with community residents and Sure Start field workers, Sooraj discovered that were this government health post to be active, it would be invaluable in enabling women to get antenatal and postnatal checkups with ease. This in turn would ensure access to health services for his community members, and also improve the quality of maternal and newborn health care available to them.
However, Sooraj found out that activating the health post wasn’t as easy a task as he’d assumed it would be. Despite many letters to and discussions with local government officials by Sure Start staff and community residents, the government was unable to fix the water pump due to certain technicalities. Instead of seeing this as a dead end, Sooraj and a friend of his, an innovative plumber from the community, came up with a creative solution for getting the water pump to work. And so, after 17 years of inactivity, the health post has finally become functional.
The story doesn’t end here. What is the point of an active health post if the health workers in the post are unable to properly dispense quality health care? This turned out to be the case not only in Kamraj Nagar, but also in a number of health posts in other project areas where Sure Start operates. After discussions with the government, Sure Start learned that most government training literature had been written from a rural perspective, leading to confusion among urban health workers about their roles and responsibilities. To help the government address this challenge, Sure Start designed training modules from an urban perspective, and conducted training sessions from May to December 2009, for 374 auxiliary nurse midwives (ANMs) in 37 groups to reinforce their skills for antenatal and postnatal care. These measures have resulted in greater efficiency at the health post level and have helped bring about weekly antenatal and postnatal clinics. What does all this mean for the pregnant women in Sooraj’s community? They now have better access to better health care services.
These changes have certainly made a difference to 25-year-old Neetu, a resident of Sooraj’s community in Kamraj Nagar, who is currently three-months pregnant with her second child. During her previous pregnancy, Neetu decided to go home to her village for the delivery. She suffered some complications and was unable to get to the hospital in time as her village was too far way. Unfortunately, the baby passed away. Now, for this pregnancy, Neetu says she is not going to repeat the same mistake. “I will stay here, where I know it is safe for my baby,” she says. Her decision is a result of the efforts made by Smriti, a health worker trained by Sure Start. Smriti makes home visits to pregnant women and new moms to educate them about life-saving maternal and newborn health behaviors and practices. Neetu says that when she next visits her village, she will tell her friends about the things Smriti didi (“sister” in Hindi) has taught her—the importance of organizing emergency transport, of ensuring proper nutrition for the mother and the baby during pregnancy, of getting antenatal and postnatal checkups, and of getting tetanus toxoid vaccines, to name a few. Says Neetu, “Even my mother doesn’t know as much as Smriti didi does, about how to have a safe pregnancy. I trust her completely.” In this way, Smriti’s home visits are helping the women in Neetu’s village too, albeit indirectly. The knowledge she imparts to the pregnant women in her community has dual benefits. Not only does it help pregnant women in urban areas have safe pregnancies, but these very same women are also seen as opinion leaders when they return to their native villages—the knowledge they disseminate can have a life-saving impact there too.
So, small miracles—like an innovative solution to a plumbing problem or the forging of a trust-based relationship between a pregnant mother and a health worker—can lead to big results. Sure Start builds the capacities of individuals placed within marginalized communities, who in turn effect sustainable change through the employment of innovative, locally relevant solutions. Initiatives such as these are effectively integrating with government efforts and leading to an overall improvement in maternal and newborn health in the project areas.