Policy and Stakeholders
Social marketing-increasing the access to the use of contraceptives :
For the promotion of good quality condoms and oral contraceptive pills, SWACH has adopted a social marketing approach in four districts in Haryana i.e. Panchkula, Ambala, Yamunanagar and Kurukshetra covering a population of 23 lacs (2.3 million) in the rural and urban slum areas of the districts. This project is supported by the GOI Ministry of Health and family Welfare. The main objective is to promote child spacing through contraception and reduce the risk of STI, HIV/AIDS. Good quality condoms and OCPs are being procured, made accessible at an affordable price through the establishment of a network of 2860 trained depot holders (vendors) which include RMPs, Chemists, Grocers and others including tea stall owners, panwalas and dhaba owners.The programme has been backed up by providing key information about the correct use of the condoms and OCPs, their advantage and correct use through awareness and training programmes. At its peak, 300,000 condoms and 30,000 cycles of OCPs have been sold through the social marketing approach per month. The project has also helped to identify the sexual behaviour and age at sexual debut.
Reproductive and child health (RCH)- ensuring care of the pregnant women and neonates :
The RCH programme of GOI is being implemented through MNGO scheme of the government. This scheme was introduced in 1999 through 11 NGOs in 6 districts in Haryana (Panchkula, Ambala, Kurukshetra, Yamunanagar, Kaithal and Hissar). The logistic support is augmented by the MNGO (SWACH) through distribution of MCLC, DDKs, Weighing balance, condoms and OCPs and IEC materials. SWACH is guiding, supervising and monitoring the technical and financial activities of the field NGOs. The critical components of networking of the NGOs comprise of well designed protocols and provision of regular exchange of information and feed back. Site visits are undertaken on a regular basis with provision of managerial and technical information and skills. Networking has been linked to health management information system (HMIS) for improved surveillance and timely referrals. This has helped to improve timeliness, quality and completeness of health information and reproductive and child health. Looking beyond the implementation of RCH programme, SWACH carried out research study on the cause of death in the neonates and amongst the reported still births by using the verbal autopsy technique. The study has shown that there is lower mortality due to low birth weight and sepsis but the proportion of deaths has increased due to perinatal asphyxia and congenital malformations. The community audit of deaths serves to highlight the importance of preventive care during pregnancy, childbirth and in the post natal periods.
Meeting the needs of the adolescents :
A study on the feasibility of specific interventions to improve adolescent health has been ongoing in the Panchkula district in Haryana. The key interventions were developed after a need assessment in the block. These included control of anaemia its prevention and treatment, identification and care of adolescent pregnancies, improving communication with adolescents and reducing the risk of STI and HIV/AIDS. The interventions were introduced in the schools and also for non school going adolescents. Under this project anaemia control was undertaken through weekly iron and folic acid supplemented by once in 6 months albendazole that were combined with education on water and sanitation , use of foot wear and increased consumption of iron and folic acid. The communication was improved through the letter box system and development and use of FAQs. Case studies were written on each of the 58 adolescent pregnancies and assessment of quality and standards of care for adolescent pregnancy delivery and post natal care in the government and private hospitals and nursing homes. Peer group educators have extended health care and communication opportunities for out of school adolescents. This project has provided the basis for adolescent friendly health services in the rural areas.
HIV/AIDS-Targeted interventions amongst high risk behaviour groups :
SWACH is implementing a targeted intervention project on HIV/AIDS in Yamunanagar district of Haryana. The programme includes behaviour change communication, STD treatment, and promotion of condom use and creation of an enabling environment for the beneficiaries. The project is envisaged to provide services to 24,973 beneficiaries which would include commercial sex workers, intravenous drug users (IVDU), men having sex with men, eunuchs, truckers, migrant labourers and street children. Linkages will be developed for making provisions of service delivery through RMPs who would function as the health service providers for sexual health to the affected groups.
IMCI-a holistic approach towards management of childhood illness :
IMCI uses an integrated approach for early identification and prompt treatment of common childhood illnesses to reduce the mortality in children under five years age. Nutrition counseling is an integral part of IMCI. A project to train AWWs in selected districts in Haryana was carried out by SWACH in collaboration with NIPPCDD. Under this project besides training of AWWs and their supervisors SWACH developed protocols for follow up after training. The value of follow up after training and its timing was demonstrated by a study which is under print in the India Jr Paediatrics. SWACH has started to organize training of AWWs and their supervisors in two districts in Haryana under funding from DWCD.
Indian system of medicine and health-an awareness generation programme in the rural areas
A promotional scheme for acceptance of ISM&H was introduced in 11 community development blocks in Haryana state in 2001-2002. The objective of this scheme related to awareness generation in the community about the curative role of herbs that are available in the home for use in the treatment of minor ailments and for first aid. SWACH has not only promoted the use of herbs as home remedies, it has helped the practitioners to identify danger signs for referral. At the same time they have been sensitized to promote immunizations, use of safe water and popularize contraception to strengthen public health. The programme has included the training of ISM&H practitioners, to discourage them from using modern medicines since they are not authorized to use them and train farmers to grow commonly used medicinal herbs and plants and their marketing. The scheme is currently operational in two blocks. This is a good model for integration between modern and Indian system of medicine.