Empowering mothers as household health workers

Description of the problem: Physical inaccessibility along with lack of awareness has been one of the main constraints to health service delivery in Arunachal Pradesh. Lack of adequate trained health manpower aggravates the situation. With the road density in 2001 of only 17.3 km per 100 sq km of area as against the national average of 82 km and 26.5% population living with had no road connectivity at all, [1] health infrastructure development has been slow and service delivery highly constrained. This has been aggravated by only 700 doctors and 900 nurses [2] , who too are unwilling to serve in remote areas. Methods: The Government of Arunachal Pradesh started the Public-Private Partnership (PPP) project as a part of NRHM in 2006 and outsourced the management of one Primary Health Centers in each of the 16 districts to Non-Governmental Organizations. The one at Sille in East Siang district is being managed by Future Generations Arunachal (FGA). With the premise that empowering the mothers to take care of their own health has the potential to dramatically improve the health status of the communities in inaccessible parts of Arunachal Pradesh, a pilot project entitled Mothers’ Training was carried out from May 2009 to April, 2011. The idea was to train one woman from each household in the catchment areas of the PHC. Each month, one woman from each of the six main villages in the catchment area was selected and was trained on basic home-based health care for a month. The training method consisted of one-hour talk on health issue everyday and involving the trainees in the works in the PHC the rest of the day. The outcome was measured with various health indicators in the PHC. Main findings : Dramatic improvements in health care indicators, especially those related to health behavior, were noted. Outpatient attendance dropped from 10543 in 2008 to 6838 in 2011. Similarly, total antenatal registration dropped from 269 in 2008 to 149 in 2011. However, percentage of pregnant women registering themselves in the ante-natal clinics in the first trimester increased from 39.4% in 2008 to 69.1% in 2011. There was also an increase in institutional deliveries from 33.8% in 2008 to 44.9% in 2011. In 2008, 5742 slides were collected for tests for malarial parasite whereas it was only 2122 in 2011. No death due to malaria has been reported whereas the disease was a major cause of mortality in the area earlier. Since posting of qualified personnel in the remote areas has been a major hurdle to health service delivery in Arunachal Pradesh, it is recommended that the existing health facilities like PHCs, CHCs and District Hospitals be used as community training centers on health so that they can participate in the health care delivery works of the government. This will not only improve the health status of the communities but also imbibe a sense of ownership in the health care process. Since the existing infrastructure and manpower will be utilized, this can be accomplished with minimal additional resource inputs. Conflict of Interest Statement : None Funding Source : Public-Private Partnership project funded by NRHM, Government of India and government of Arunachal Pradesh with additional funding by Future Generations, USA for Mothers’ Training program. [1] Arunachal Pradesh Public Works Department, Government of Arunachal Pradesh,1997. [2] There are 64 specialists, 512 allopathic doctors, 124 AYUSH doctors, 386 staff nurses and 548 ANMs as per the records in the Department of Health & Family Welfare, Government of Arunachal Pradesh.


Introduction
Physical inaccessibility and the lack of awareness have remained major constraints to health service delivery in Arunachal Pradesh. Inadequate trained human resource for health aggravates the situation. Road density in Arunachal Pradesh in 2001 was only 17.3 kilometer per 100 square kilometer of area as against the national average of 82 kilometer. This results in nearly 26.5% of the population living with no road connectivity at all [1]. The health infrastructure development has been slow and service delivery remains highly constrained. This has been aggravated by presence of total of only 700 doctors and 900 nurses, who too are unwilling to serve in remote areas.
The Government of Arunachal Pradesh started the Public Private Partnership (PPP) project as a part of the National Rural Health Mission in 2006 that outsourced the management of one Primary Health Center (PHC) in each of the 16 districts to non-governmental organizations. The one such PHC situated at the Sille in the East Siang district is being managed by the Future Generations Arunachal. A pilot project entitled Mothers' Training was carried out from May 2009 to April, 2011 with the premise that empowering the mothers to take care of their own health has the potential to dramatically improve the health status of the communities in inaccessible parts of Arunachal Pradesh. The idea was to train one woman from each household in the catchment areas of the PHC. Each month, one woman from each of the six main villages in the PHC catchment area was selected and was trained on basic home-based health care for a month. The training method consisted of one-hour talk on health issue everyday and involving the trainees in the works in the PHC the rest of the day.

Methods
The outcome of the above-described project was measured with various health indicators captured at the PHC.

Results
Dramatic improvements in health care indicators, especially those related to health behavior, were noted. Outpatient attendance dropped from 10,543 in 2008 to 6,838 in 2011. Similarly, total antenatal registration dropped from 269 in 2008 to 149 in 2011. However, percentage of pregnant women registering themselves in the antenatal clinics in the first trimester increased from 39.4% in 2008 to 69.1% in 2011. There was also an increase in institutional deliveries from 33.8% in 2008 to 44.9% in 2011. In 2008, 5,742 slides were collected for tests for malarial parasite whereas it was only 2,122 in 2011. No death due to malaria has been reported whereas the disease was a major cause of mortality in the area earlier.
Since posting of qualified personnel in the remote areas has been a major hurdle to health service delivery in Arunachal Pradesh, it is recommended that the existing health facilities like PHCs, the community health centers, and the district hospitals be used as community training centers on health so that they can participate in the health care delivery of the government. This will not only improve the health status of the communities but also imbibe a sense of ownership in the health care process. Since the existing infrastructure and manpower will be utilized, this can be accomplished with minimal additional resource inputs.

Funding statement
This abstract draws on a Public Private Partnership project funded by the National Rural Health Mission through the Government of India and the Government of Arunachal Pradesh, with additional funding by the Future Generations, USA for Mothers' Training program.