SNEHA’s Maternal and Newborn Health programme is working towards achieving SDG targets for maternal and neonatal mortality
Published on February 22, 2021 at 12:20 pm
Updated on March 4, 2021 at 10:21 am
By Dr. Harvinder Palaha, Programme Director, MNH and Vanessa D’Souza, CEO, SNEHA, Mumbai
The Sustainable Development Goals (SDGs), by providing a blueprint to help achieve sustainability through identified goals, have helped streamline interventions across programmatic levels for non-profit organisations and Governments.
In India, nearly 41% of the population in Mumbai, the country’s financial capital, dwells in slums faced by multiple problems like increased risk of maternal morbidity and mortality, low birth weight babies, malnutrition, gender-based violence and poor access to health facilities. Society for Nutrition, Education and Health Action – SNEHA –works in the slums of Mumbai Metropolitan Region (MMR) with public health and nutrition systems to improve health indicators of vulnerable women and children.
SNEHA’s goal is to achieve a healthy urban world for healthy women and children. The Maternal and Newborn Health (MNH) programme, SNEHA’s flagship intervention was started in 1999 to respond to the high maternal and infant mortality in Dharavi. Its aim was to ensure mothers and their newborns living there, were able to access public health services, get appropriate information on caring for their own and their newborns’ health during pregnancy and post-delivery. Over the years the programme evolved and now centres around three main areas:
- Strengthening primary health services: SNEHA, in partnership with the public health system, helped establish weekly antenatal clinics in 119 public health posts (HPs) across seven Municipal Corporations and ensured that the antenatal clinics provided all nine core services mandated by World Health Organization (WHO). It also trained health post staff, supported the clinics and provided data-backed recommendations for improving services.
- Establishing and strengthening maternity referral linkages: Referral linkages enabled high-risk antenatal mothers to access better-equipped health facilities. Along with public health authorities, SNEHA established referral linkages across 61 public hospitals. Twelve intra-regional and seven inter-regional referral linkages have been established across seven municipal corporations, each using the documentation/referral slip designed by the MNH programme. These linkages allow women to get appropriate maternal care during labour, especially critical for high-risk cases.
- Working with communities: SNEHA assisted National Health Mission, Maharashtra information of Mahila Arogya Samitis (MAS), community women’s collectives, a vital link between the community and the public health systems. They provide timely information on health and allied services and support the community to access health and allied services. The MAS facilitates community participation in health, including planning, implementing and monitoring of health programmes and allied services. They receive an annual untied fund from the municipal corporation for community health needs.
The most vulnerable population of the society, newborns account for 30% of all causes of under-five mortality. Thus, the programme reaches out to married women in the reproductive age (MWRA) between the age of 15 to 49 years, covering women in the antenatal and postnatal stages, couples for family planning counselling and children in the 0-2 years age group. SNEHA’s frontline workers conduct home visits to counsel pregnant women and mothers with infants, on antenatal and postnatal care, caring for newborns and immunization for children. They also organise community awareness activities like street plays, exhibitions and mass campaigns on topics like breastfeeding, complementary feeds, immunization and importance of handwashing. They also support the public health system during immunization camps, surveys for COVID-19, training of volunteers and regular capacity building of public health workers
Establishing maternity referral linkages within the public health system
SNEHA, in partnership with the Municipal Corporation of Greater Mumbai (MCGM), piloted a maternity referral network that established referral linkages between different levels of multi-tier health facilities for timely referrals of high-risk pregnancies. This ensured timely referral of high-risk mothers to an appropriate health facility for a better maternal and neonatal outcome. This maternity referral system has now been expanded to seven adjoining cities. In order to strengthen service delivery in public health facilities, SNEHA conducts regular training sessions for all levels of health care providers, viz., maternity home staff, peripheral hospitals, Medical Officers (MOs), General Nurse Midwives (GNMs), Auxillary Nurse Midwife (ANMs), Public Health Nurses (PHNs) and Accredited Social Health Activists (ASHAs). In addition, regular review meetings are conducted to facilitate sharing of beneficiaries’ feedback and to arrive at collective solutions, thus working in a systemic manner, from the highest tier of the public health system to the women and children at the community level, to bring about a measurable change in their health indicators.
Community Intervention in Bhiwandi-Nizampur Municipal Corporation (BNMC)
SNEHA initiated work in BNMC in 2016 due to the high level of home deliveries and poor uptake of antenatal care and immunization. The programme identified pregnant women in the first trimester to support at least four antenatal check-ups and institutional delivery for better maternal and newborn health outcomes. The programme works with 7,819 households, 15 Public Health Posts (HP) and one public (peripheral) hospital to improve maternal and newborn health indicators.
- 34% increase in early registration of pregnancy
- 22% increase in 4 antenatal check-ups
- 11% increase in institutional deliveries
- 24% increase in exclusive breastfeeding rates
- 67% increase in contraceptive prevalence rate
A sustainability intervention was done in three out of the seven municipal corporations (MC) we cover on a pilot basis. The objective was to transition the maternity referral system to the public health authorities in these seven MC’s. The intervention began with vision building workshops, forming action groups and appointing Nodal Officers in each MC who would oversee the maternity referral network. At the community level, three MAS groups have been absorbed into the public health system to promote and improve health-seeking behaviour in the community.
The programme plans to establish its sustainability model in all seven MCs. Community interventions in BNMC supporting the health of women and children -‘Home Based Care of Low-Birth-Weight Babies’ are being updated with special emphasis on Kangaroo Mother Care.In addition, early identification of common, infectious diseases viz pneumonia, diarrhoea, malaria and typhoid is being rolled out to reduce morbidity and mortality in children from 0-6 years.
Programme Pivoting in the Pandemic
COVID-19 highlighted issues such as poor access to public health among vulnerable populations living in urban informal settlements. However, the team continued to support the community remotely, through tele-counselling and online training sessions. It also rallied support and distributed food rations among community members and PPE kits to Government frontline workers.
Thus, SNEHA’s Maternal and Newborn Health programme, through community interventions and public system’s strengthening efforts, combined with emergency relief during the pandemic is working towards achieving SDG targets for maternal and neonatal mortality.
SNEHA’s Maternal and Newborn Health programme looks at achieving the SDG 3 of Good health and well-being working actively in improving the health of pregnant women, and mothers and their newborns in urban informal settlements across the Mumbai Metropolitan Region (MMR)
The Kangaroo Mother Care intervention aims at providing support to mothers of Low Birth Weight Babies by giving counselling regarding Kangaroo Mother Care, Feeding of Low Birth Weight baby, identification of danger signs and regular follow-ups in health facility.