Social accountability and education revives health sub-centers in India and increases access to family planning services

Abstract

Background: Uttar Pradesh (UP) is the most populous state in India. The maternal mortality ratio, infant mortality rate, and fertility rates are all higher than the national average. Sixty percent of UP inhabitants live in rural communities. The reasons behind the poor state of health and services in many areas of UP are inadequate knowledge and availability in communities of healthy behaviors, and information on available government health services. Methods: World Vision, Inc. implemented a three-and-half year mobilizing plan for maternal and neonatal health through a birth spacing and advocacy project (MOMENT), partnering with local organizations in rural Hardoi and urban slums of Lucknow districts in UP. World Vision used print, audio, visual media, and house-to-house contacts to educate communities on timing and spacing of pregnancies; and the benefits of seeking and using maternal and child health services (MCH) including immunization and family planning (FP).This paper focuses on World Vision’s social accountability strategy – Citizen Voice and Action (CVA) and interface meetings – used in Hardoi that helped educate and empower Village Health Sanitation and Nutrition Committees (VHSNCs) and village leaders to access government untied funds to improve community social and health services. Results: Forty VHSNCs were revived in 24 months. Nine local leaders accessed government untied funds. In addition, increased knowledge of the benefits of timing and spacing of pregnancies, maternal child health, family planning services, and access to community entitlements led the community to embrace and contribute their time to rebuild and re-open 17 non-functional Auxiliary Nurse Midwife (ANM) sub-centers. Seventeen ANMs received refresher training to provide quality care. Sub-center data showed that 1,121 and 3,156 women opted for intra-uterine contraceptive device and oral pills, respectively, and 29,316 condoms were distributed. Conclusion: In Hardoi, UP, education using CVA and interface meetings are contributing to an increase in the number of government sub-centers that integrate contraceptive services with other services such as immunization and antenatal care. This brings care closer and makes it more accessible to women and children, reducing travel time and cost to families who would have otherwise sought these services from higher level facilities. Social accountability can help mobilize communities to contribute to improving services that affect them.