Phase 1: 2003-2005

The Department of Health (Government of Andhra Pradesh) in partnership with Naandi (as a part of an European commission grant on promoting safe motherhood) began a program to make more effective and efficient the delivery of existing government sponsored healthcare and monitoring services to reduce Mahabubnagar’s Maternal and Neonatal mortality.

The challenge was on one to hand reenergize the government healthcare services so their delivery would be more accessible and responsive to the community’s needs, and on the other to encourage the community to access more of these institutional services.

This program was implemented in the Narayanpet division of Mahabubnagar and what led it was an innovation called the ‘fixed day model’. This was an attempt to converge a range of ground level healthcare services and their providers such as auxiliary nursing midwives, community health workers, and anganwadi workers, and make their maternal and neonatal healthcare services available to every village on a specified day in a month. Motivating, mobilizing and training government service providers and encouraging them to converge their services at one place was much appreciated not only by the service providers themselves (they were able to meet their healthcare service delivery targets without the necessity of always having to move house to house) but also by the communities who were earlier plagued by empty Primary Healthcare Centres (PHCs) and non-available medical staff.

The availability of these services at their doorsteps saw growing numbers of pregnant women and new mothers come for the fixed day services. As more people begin attending the services, it has been noticed that the very same service providers who were once perceived to be extremely apathetic transform themselves into active performers.

To build in a sustainability factor to this exercise (to ensure the programme continued to deliver quality service after the ‘official’ project period was over after 2 years) was the creation of village groups or health samitis who were representatives from the villages entrusted with the responsibility of keeping the liaison between the healthcare service providers and the village members.

Another highlight of this program was the specially designed Health Monitoring Information System (HMIS) that the staff (and later the samitis) used to track the progress of every woman visiting the center – each record was updated; complete with case histories and checkup details. This proved to be a useful tool in the early detection of abnormalities during pregnancy.

This Safe Motherhood covered a population of 596,174 people in 360 villages. Naandi exited from the area in 2005 at the end of the official project period.

Detailed Phase I report

Phase II: The CHAMPION Trial

With the conclusion of Phase I in the Narayanpet Mandal it was felt that while two years was a relatively short time to impact mortality rates, that fact that there were more women and children accessing institutional healthcare, that there was a reduction in neonatal deaths that only indicated the need that such interventions needed to be replicated.

But to prove this, in terms of numbers and lives impacted there was a need to initiate an action research project which would not only implement the fixed day model but also study and record with bias the trend of health and mortality rate changes.

The phase II began in 2006 with a collaboration between by Effective Intervention (EI) and London School of Hygiene & Tropical Medicine (LSHTM) and Naandi.

The area chosen to deploy the action research was the Nagarkurnool division of Mahabubnagar district, Andhra Pradesh.

Detailed Phase II report