Knowledge is power

India has the unfortunate distinction of accounting for a quarter of the world’s neonatal deaths. Each year, 78,000 pregnant women and a million newborn babies in the country die from largely preventable causes. In the face of such dire statistics, it is easy to wonder how any one project can make a real difference. But it can, and it does—often in surprising ways.

An important aspect of the Sure Start project in Maharashtra, which caters to marginalized communities in urban areas, is ensuring a close link between the community-based health workers, the medical officers at the municipal-level health posts, and the doctors at the large hospitals. This helps improve access to and demand for antenatal and postnatal health services for community members, and to improve the quality of care being offered to these families.

Purnima Sudar, who is 28 years old, is a pivotal part of this link. She was trained by Sure Start three years ago as a community-based field supervisor in one of the urban settlements in Mumbai where the project operates. Her job entails answering queries and holding meetings in the community resource center (CRC), a safe, centrally located community space where pregnant women come to learn about life-saving maternal and newborn health behaviors and practices. Purnima also informs her fellow community members about the various government health schemes available, such as the Janani Suraksha Yojana (JSY), which offers financial incentives to women who deliver their babies in a hospital instead of at home. Most importantly, Purnima serves as a bridge between the residents and municipal health officials, working with Sure Start to generate demand within her community for government health services. She often encourages pregnant women and new moms from her district to visit the local health post for checkups during and after their pregnancies. Purnima is a quiet, timid-looking woman who doesn’t speak or smile much. Upon a casual meeting, one would never guess that within her is a courageous spirit and a dedication to ensuring the health of her fellow community members that is humbling.

Purnima says that when she first began working, she quickly discovered that knowledge truly is power. She learned that even though government health schemes could greatly benefit pregnant women and their families, yet many residents were unaware of them. She also realized there was much advocacy to be done in ensuring that government health officials were in touch with the grassroots problems faced by her community—problems like lack of quality in health services due to the heavy workloads faced by municipal health officials, or the inability of health centers to supply JSY benefits due to the immobilization of government funds.

Inspired by the work she was doing at the CRC and in her desire to serve her community better, Purnima enrolled in a six-month course for training as a legal assistant last year. It was while she was doing the course that she found out that all of the 22 staff members at the local municipal health post in her area had gone on strike. The health post is meant to offer important health services as well as basic vaccines to community members, especially pregnant women.

Purnima took it upon herself to quickly bring together eight women field workers from her community who, like her, were accredited health workers and had received training and support from Sure Start. The women took over the health post to administer basic health services for five days till the strike was over, thus ensuring that nobody from their community was deprived of health care.

For Purnima, the incident was an eye-opener. She realized that despite the government’s best efforts, in a country of India’s size, people need to step in and work with instead of against the government to ensure that pregnant women and their babies survive and stay healthy. This is one of the fundamental tenets of the Sure Start project—the idea that communities and organizations can strengthen existing government mechanisms to create tangible and sustainable change. An example of this is the enrollment by Sure Start of 138 community workers in Maharashtra for a one-year curriculum at the Yashwantrao Chavan Maharashtra Open University. Upon graduation, they will be certified as health workers.

In ways like this, the project is creating a sustainable workforce of certified health workers who can be absorbed into the government’s health structures. And it is everyday heroes like Purnima who will play an integral role in ensuring that the government fulfils its mission, even after the Sure Start project concludes.

“At first, I was scared of the government,” says Purnima. “I would think, ‘How can we go and talk to them about our problems?’ I didn’t even know where to go. But now all that has changed. We tell them the needs of our community, and it does make a difference; each one of us can make a difference.” Equipped with her Sure Start training as a health worker and the confidence it has given her to enroll in other professional courses, Purnima will certainly continue to make a difference not only in her community, but also in her country.