Institute of Health Management Pachod AGRT
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Mission Statement
Institute of Health Management Pachod (IHMP) is committed to reducing gender inequities intrinsic in a paternalistic society. Our mandate is to educate, organize and mobilize adolescent girls to achieve sustainable, inter-generational change. Context: In Maharashtra, the second most populated state in India. NFHS 4 data collected in 2015-16 revealed that 31.5% of women, between the ages of 20 and 24 were married before the age of 18. Since there is wide inter-district variation, in the district where IHMP is working, these data revealed that over 50% of the girls were married off as child-brides; merely 29% received minimal antenatal care and only 13% reported home deliveries. Our Mission: Provide an integrated and collaborative project that empowers unmarried adolescent girls and protects married adolescent girls from the adverse consequences of early motherhood, It is designed to have a synergistic impact in delaying age at marriage and first conception, reducing maternal and reproductive morbidity, and helping to reduce violence perpetrated against them. IHMP works with three target populations: 1. Unmarried adolescent girls. 2. Married adolescent girls and young married women. 3. Boys and young men. Part 1: Empowerment of unmarried adolescent girls through life skills education Specific Objectives: 1. Delay age at marriage. 2. Increase the duration of formal school education. 3. Demonstrate a measurable adaptive change and improvement in the self-esteem and self-efficacy of these girls. 4. Address the blatant sexual harassment of these girls in public places. Methodology 1: A Life Skills Education (LSE) course will be conducted by community-based volunteers for girls between the ages of 11 and19. Well specified modules will be included in the LSE for improving self-esteem and self-efficacy. A culturally appropriate scale has been developed by IHMP for measuring self-esteem / self-efficacy levels pre and post intervention. There will be a special focus on girls who are identified with low self-esteem / self-efficacy and low educational levels. 2: At each site two girls will be selected as Peer Leaders. They will be trained in leadership and facilitation skills, and then asked to establish support groups in the form of girls’clubs. 3: Individual girls, with the support of their clubs, will be empowered to negotiate with their parents to continue their education. 4: Individual girls, with the support of their clubs will be empowered to negotiate with their parents to delay their marriage till they reach their 19th birthday. 5: Nutrition education, exhibitions, and recipe competitions will be organized by the girls and their clubs. 6: Sessions on how to combat sexual harassment will be woven into the Life Skills Education. Part 2: Protection of young married women from adverse consequences of early motherhood Specific Objectives 1. Reduce maternal morbidity and reproductive tract problems. 2. Increase the proportion of these girls/women receiving minimal standard maternal reproductive health care, including treatment of complications. 3. Increase the proportion of girls/women using contraceptives for spacing. 4. Reduce the incidence of low birth weight babies. Methodology • Early detection of health needs and morbidity through a digital App. • Need specific interpersonal communication and counseling. • Effective linkage of individuals with primary, secondary and tertiary levels of care. • Strengthen the referral system for addressing complications during pregnancy. • Community based monitoring through health committees. Part 3: Promoting gender equitable attitudes and behaviours among boys and young men Specific Objectives • Reduce the numbers of young men perpetrating sexual and domestic violence. • Reduce sexual harassment of girls by boys and young men. • Reduce the numbers of young men getting married to girls less than 18 years of age. • Use the Gender Equitable Men (GEM) scale, to demonstrate a measurable change in the attitude and behaviour of boys and young men. Methodology Life skills Education for boys and young men: • Group meetings will be conducted with young men through a social norms approach. • During group meetings, boys and young men will be invited for individual counseling. On the basis of the attitudinal profile of young married men (inequitable attitudes), couples will be identified where there is risk of domestic violence. Couples will be interviewed separately where there is reported occurrence of domestic violence. In all such cases, counseling will be offered to young married men and the in-laws of the girls.
About This Cause
The Trust Ashish Gram Rachna Trust (AGRT) is a Public Trust registered under the Bombay Public Trust Act, 1950. AGRT has established the Institute of Health Management, Pachod (IHMP) as its executive body. IHMP implements all the Trust programmes of health and development in rural areas and the urban slums of Maharashtra, IHMP strives to improve the health and development of communities through the implementation of grassroots programmes, training, research and policy advocacy. The Institute aims at the holistic development of the individual, family and community, and is deeply committed to uplifting marginalised groups. Within this broad mandate, it has a specific commitment to the health and development of women, adolescent girls and children, and to reducing gender inequities intrinsic in Indian society. This is reflected in all its programmes. As a policy, the Institute of Health Management, Pachod, undertakes programmes with the aim of innovating new concepts, strategies and methodologies. It implements its programmes through organising and mobilising communities toward self-reliance and sustainability. Health and development programmes for children and adolescents are implemented with and through them to achieve sustainable inter-generational change. IHMP has been working for the past 40 years in Marathwada, a socially and economically impoverished region in the state of Maharashtra. During this period, it has developed and implemented innovative programmes in the field of community health, behaviour change communication (BCC), water and sanitation, child development, empowerment of adolescent girls and women, and HIV prevention and care. IHMP’s innovations are disseminated to the NGO sector through its training programmes. Over the years, the Institute has trained personnel from several thousand NGOs and provided them with resource material. IHMP has also successfully collaborated with NGOs having expertise in non-formal education, drinking water supply, agricultural development, and vocational training. Since 1998, IHMP has been actively involved in advocacy at the community level, with NGOs across the nation, with the Government of Maharashtra, and the Government of India. Through policy analysis, research and advocacy, these innovations have had a significant impact on policy formulations at both the state and national governmental levels. Summary of the Organisational Policy Framework 1. Providing health and related services with a focus on the poorest and marginalized. 2. Organising and mobilizing communities toward self-reliance and sustainability. 3. Modeling and demonstrating innovative health and development programmes. 4. Disseminating innovations to the Government and the NGO sectors. 5. Process evaluation and applied research. 6. Developing replicable systems and strategies. 7. Training Government and NGO functionaries. 8. Policy analysis, research and advocacy. 9. NGO networking - training and resource centre History and Evolution Marathwada is the most under-developed region of Maharashtra. It has a history of malnutrition and of illnesses resulting in high maternal, neonatal, infant and child mortality. This region experienced the worst famine of the century for a period of three years, from 1972 to 1975. The region where IHMP works was one of the worst hit districts, and women and children were the worst victims. In 1976, a young medical graduate keen to start a community health programme, heard about the need for health services in this drought hit region. He began his work that year by providing curative health services from a 5-bed hospital at Pachod, a small village in Aurangabad district. In 1977 he, along with a small group of committed colleagues and friends, decided to form the Ashish Gram Rachna Trust (AGRT), dedicated to initiating health and development programmes in the area. AGRT was registered with the Charity Commissioner in 1978 as a public trust under the Bombay Public Trust Act, 1950. AGRT formed the Institute of Health Management, Pachod (IHMP) as its executive body. The same year, IHMP put together a team of professionals consisting of two doctors, a nutritionist and a demographer. This team initiated a Comprehensive Health and Development Project with its base at Pachod. In 1978, IHMP undertook an extensive study of the community using medical anthropology tools such as key informant interviews, focus group discussions, body mapping, free listing and ranking, etc. These processes, subsequently documented by the Ford Foundation, were later formalised as Participatory Rural Appraisal (PRA) techniques. Responding to the expressed needs of the community, the IHMP started a health project with the provision of maternal and child health services through Traditional Birth Attendants (TBAs), Community Health Workers, Auxiliary Nurse Midwives and doctors. IHMP pioneered the training of TBAs. Scores of TBAs were trained in basic birthing procedures and were given sterilized kits. The most impressive outcome of this project was a reduction in the mortality of pregnant women and newborn children through timely intervention, primary level service, and referrals provided by these trained TBAs. Hundreds of children in the project villages survived to see their first birthdays. The Pachod Dai became a symbol of empowerment of rural women, which was documented in 1986 by the Ford Foundation in the first set of “Anubhav” series, a publication on ten innovative non-government health projects in India. Another major intervention the TBAs were trained to initiate was reduction in the prevalence of severe malnutrition. They began to provide nutrition education, counseling, and nutrition demonstrations in the kitchens of individual homes, with locally available ingredients and food products. Growth and Expansion By 1986, the Ashish Gram Rachna Trust had substantial experience in providing health care in rural areas. The trustees and partners of the Trust decided that this experience should be shared with other NGOs through training. In 1986, a training institute was established. By 1990, IHMP had established itself as a reputed training institute for imparting practically oriented, hands-on training in community health. In 1998, IHMP evaluated its training programme and repeated training needs assessment in the NGO sector to revise or develop new and more relevant training curricula. To date, the Institute has trained over 8000 NGO and Government health functionaries from various states of the country, several neighbouring and African countries. Goals and Objectives From 1992 to 1998, IHMP adopted a life cycle approach for programme implementation. This approach considers the holistic development of the individual, household and the community. Behaviour Change Communication (BCC) and Community Organisation are at the heart of the programme. Through BCC the community is mobilised to improve health service utilization behaviours, demand better quality services and greater accountability from providers; modify harmful behaviours; and promote healthier lifestyles. IHMP has organised the following field programmes around BCC: primary health care with a focus on women’s health, neonatal care and care for children under six years, Bal Vikas - a child to child, child to adult, community development programme, for children 6 to 14 years, and health and development of adolescent girls 12 to 18 years of age. Consolidation and Convergence In 1998, it was decided to consolidate the work of the Institute. Over a period of one year, new programmes were planned with the community using PRA tools and village level workshops. Since then the Institute has acquired a reputation for participatory planning and management in the field of health and development. Transition to Urban Health Care About 40 to 50 percent of the urban population of India lives in slums. The health infra-structure in urban slum areas is weak. People in unrecognised slums suffer deprivation. IHMP started an urban health care initiative in Pune city in1996. Focus on Adolescent girls In 2003, when the focus on adolescent girls began, almost 40% of women between the ages of 20 and 24 years in Maharashtra were married before the legal minimum age of 18 (NFHS 3, 2006). There is, however, wide inter-district variation. In the region where IHMP is working, 65% girls were married off before 18 years. The median age at marriage of adolescent girls was 15 years, and they were becoming mothers at a median age of 16 years. Such adolescent mothers are five times more likely to experience maternal deaths than women 20 to 29 years of age. Among married adolescent girls, 40.2% of all deaths are due to maternal causes, the highest in any age group. Based on this situational analysis it was decided to implement an integrated programme for unmarried and married adolescent girls. To date, IHMP has provided sexual and reproductive health services to 50,000 married adolescent girls, life skills education to over 30,000 adolescent girls and maternal health services to over one million young married women. The Covid 19 pandemic has greatly increased the vulnerability of adolescent girls in our project areas. Married adolescent girls are the worst affected. Routine pregnancy care has got disrupted. They have no access to iron tablets or nutrition supplements, and no access to safe delivery services or to hospitals if the girl is suffering from complications during pregnancy. IHMP has initiated the following in an increased effort to reach out to these girls: We have distributed masks, gloves, hand sanitizers and face shields to our frontline workers so that girls continue to have access to basic primary level care and counseling. We are distributing dry food rations to adolescent girls and their families, and the girls are being given iron tablets to prevent anemia. We are providing sanitary pads and panties to adolescent girls so that they can maintain their menstrual hygiene.