Around 60,000 women die from childbirth and pregnancy-related complications in India every year (RGI 2011). Despite the declining trend in maternal mortality ratio, India fell short of achieving the MDG target of MMR below 200 by 2007. The National Rural Health Mission (NRHM) launched in 2005 has created spaces for community involvement and significant civil society participation in health development at various levels. In addition, National Guidelines have been issued mandating Maternal Death Reviews at a district level in order to bring about systemic changes to improve maternal health care,
It is within this context that SAHAJ and ANANDI have initiated a collaborative project ‘Enabling Community Action for increasing Accountability for Maternal Health’ since 2012 in four Primary Health Centers of two backward and inaccessible blocks of Devgarh Baria, in Dahod district and Gogambha block in Panchmahals district respectively, covering 25 villages each. A new partnership with Kaira Social Social Service Society (KSSS), has begun from January 2014 in Anand block (Rasnol PHC) and Umreth block (Pansora PHC) in 20 villages.
The project has two objectives: To enable communities to monitor accessibility and quality of maternal healthcare through use of ‘safe delivery’ indicators; and to equip communities with skills of identifying and reporting maternal deaths. The project also focuses on raising awareness about various schemes, demanding transparency and empowering communities to monitor the maternal service health guarantees.
The tools and processes followed for accountability mechanisms were:
a) Situational analysis regarding the availability, accessibility, quality and affordability of maternal health services in the four blocks.
b) Maternal health monitoring tool which was developed to monitor the quality of Ante-natal care and Post-natal care based in the NRHM standards was developed. The Tool is being filled for every pregnant woman in 8th month and up to 20 days after delivery.
c) Report Card -Findings from the tool have been formed into a report card. This report card is reviewed every 6 months to assess changes in the quality of care and shared with the community and the health officials at the block, district as well as the state level.
d) Village Health and Nutrition Day Observation Check list Community leaders along with partner teams are involved in the systematic monitoring of the Mamta Divas through a simple monitoring tool.
The report cards and VHND check list are used as a base for dialogue with different stakeholders such as the Sangathan members,health system representatives, local elected representatives and other leaders. The dialogues lead to formation of collective plans with specified responsibilities for improving maternal health services.