IHAT is supporting the Government of Uttar Pradesh (GoUP) in strengthening the quality, coverage and accessibility of outreach health services in Uttar Pradesh. One of the key initiatives has been the Cluster Meeting Capacity Building Intervention to build the skills and knowledge of the Accredited Social Health Activists (ASHAs) by leveraging the existing cluster meeting platform. ASHA Sanginis (ASHA facilitator), a new cadre created by GoUP, were selected from amongst ASHAs. They were responsible to provide time-to-time, need-based supportive supervision and mentoring to ASHAs. ASHA Sangini Mentors (ASMs) were deployed by UP TSU to provide supportive supervision to ASHA Sanginis and each ASM supported five ASHA Sanginis. One ASHA Sangini provided handholding support to 20 ASHAs, and one ASHA catered to about 1000-2500 population. With this structure in place, the capacity building intervention sought to have an amplifying effect on improving the reach of the population with the necessary health services. This intervention has been rolled out in 321 blocks of 28 High Priority Districts of Uttar Pradesh.
Under the intervention, a tailor-made cluster module ‘Trainer and Facilitator Guide for ASHA Sanginis’ was developed after identifying the capacity building areas of ASHAs, in consultation with ASHA Sanginis. It aimed to enhance training and mentoring skills of ASHA Sanginis to, in turn, enhance the skills and knowledge of ASHAs on Reproductive, Maternal, Newborn, Child Health and Nutrition (RMNCHN) outcomes. The ASMs and District Community Specialists provided the cluster meeting capacity building training to the ASHA Sanginis.
ASHA Sangini using the Trainer and Facilitator Guide during the Cluster Meeting
Trainer and Facilitator Guide for ASHA Sanginis
The cluster module comprises of 18 key components of RMNCHN, namely, early identification and registration of pregnant women, antenatal care, iron folic acid supplementation, high risk pregnancy identification and referral, home-based newborn care, maternal-newborn complication identification and referral, routine immunization, non-communicable diseases, among others.
The cluster module provides a step-by-step guidance to ASHA Sanginis on the facilitation process to build the capacity of ASHAs. To ensure thorough participation from the ASHA Sanginis, the sessions involve role-plays, case studies and other interactive tools. Further, the module encourages peer learning and experience sharing, which expedites the process of learning and problem solving. At the end of every session, a quiz is administered, which assesses the comprehension level of the participants and also acts as a recapitulation. Feedback is elicited from the participants which further paves way to strengthen the intervention.
Intervention continues during the COVID-19 pandemic
Due to COVID-19, trainings and meetings had been suspended in districts. In order to keep the learning process ongoing, self-learning videos were developed for ASHA Sanginis. This helped them to learn and facilitate sessions in cluster meetings, which in turn, ensured that the outreach work with the community by ASHAs continues. The District and Block Community Process Managers were also oriented to the self-learning videos, so that they could guide the ASHA Sangini in case of any further guidance required.
The cluster modules as well as the self-learning materials have garnered a positive response, not only from the ASHA Sanginis, but also from the District Community Process Managers (DCPMs), Block Community Process Managers (BCPMs) and ASHAs. The DCPMs and BCPMs have appreciated the constructive use of cluster meetings to mentor the ASHA Sanginis through cluster modules to enhance knowledge and skills of the ASHAs. The ASHAs have also repeatedly shared that the handholding from ASHA Sanginis helped them to gain the confidence of the beneficiaries and to reach out to them with the necessary health services.
Self-learning Material for ASHA Sanginis
The Self-learning Material for ASHA Sanginis included videos on RMNCHN topics such as causes of maternal death & maternal death surveillance and response, antenatal care, home-based newborn care, high risk pregnancy, routine immunization, pneumonia and diarrhoea in children, among other topics. The Self-learning videos can be watched here.
Dr Rajesh Jha
General Manager-Community Process, NHM, Uttar Pradesh
“ASHAs are important links between the community and health care; hence it becomes crucial to regularly build their capacities to have a positive impact on the community. Moreover, cluster meetings were found to be the best platforms to engage the ASHAs in capacity building activities so as to enhance their knowledge and strengthen their skills pertaining to RMNCHN indicators. Further, ASHA Sanginis could be trained as trainers on various process indicators to capacitate the ASHAs. And during field visits, ASHA Sanginis could guide the ASHAs and relate the training to actual practice. After brainstorming and discussion with UP TSU, the Cluster Meeting Capacity Building Intervention was conceptualized and implemented in 25 HPDs of Uttar Pradesh. This intervention has received appreciation and has brought considerable improvement in outreach skills of ASHA Sanginis as well as ASHAs. We hope to scale-up this intervention in all the 75 districts of Uttar Pradesh.”
DCPM, District Bahraich, Uttar Pradesh
“Now Cluster meetings are being held in a more systematic manner and have demonstrated quality interactions between ASHAs. Enhancing the facilitation skills of ASHA Sanginis has led to effective management of needs & issues of the ASHAs. The Common Review Mission team of Government of India has appreciated this initiative during their visit to Bahraich.
Mr. Man Singh
DCPM, District Siddharth Nagar, Uttar Pradesh
“Through the intervention, now the ASHA Sanginis facilitate structured scheduled sessions in cluster meetings. ASHA Sangini’s confidence level enhanced and they are able to mentor and provide quality supportive supervision to their ASHAs. Indeed, effectiveness of this intervention is reflected in during the ASHA’s mentoring visits.”
ASHA Sangini, District Barabanki, Uttar Pradesh
“Our confidence level of training session facilitation has improved and hesitation removed to speak in-front of MOIC & BCPMs. We facilitate sessions as per structured schedule and during field visits, I have observed that there is increase in the number of pregnant women line listing, and HRP identification. An increasing trend in institutional deliveries and quality home visits have also been observed in the villages which was motivated and facilitated by the ASHAs.”
ASHA, District Sitapur, Uttar Pradesh
“In earlier cluster meetings we were only submit vouchers and signed attendance but now cluster meetings are more effective and interactive where our ASHA Sangini didi provides us knowledge on different topics which has not only improved our knowledge but also useful in our home visits.“
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IHAT supports the government in building capacity of the service provides to provide quality family planning services to the community. Through this Hindi dubbed version of the WHO film adapted film “Why Did Mrs X Die, Retold”, the service providers are sensitized to medical as well as social factors that play a key role in affecting the health of women during pregnancy and child birth.
The 7th issue of PAHAL chronicles the concerted efforts of the GoUP and UP TSU to restore access and delivery of RMNCH+A & nutrition services in Uttar Pradesh, while managing the COVID crisis. It highlights UP TSU’s efforts to convert to online ecosystem – real-time UPHMIS data updation by ANMs, the LaQshya Resource Package to ensure NQA standards, among other strategy innovations.