Apna Swasthya, Apni Pehel: Reforming Local Health Governance in Rajasthan

Maternal and adolescent health are given attention through the launching of public awareness campaigns and training-capacity addition of marginalised

Our Focus

In India's largest state, Rajasthan, health has always been an issue of concern. Rajasthan’s overall performance in terms of health Indicators is far below the Indian average (its maternal mortality rate is 255 and infant mortality rate is 47). The problem becomes all the more serious in the state’s tribal areas. Due to lack of communication and distance of health institutions from the villages, medical aid is not availed of by the tribals except in serious cases. These communities primarily tend to rely on home remedies. There is an urgent need for innovative strategic action to influence the behaviour of tribal communities to seek institutionalised health services. Traditional community institutions are in a better position to bring about attitudinal and behavioural changes. Lcal governance system (constitutionally mandated panchayati raj institutions) are better placed to influence and improve the local health delivery system, and the actions of community institutions.

PRIA is undertaking this intervention based on its past experience in promoting citizen engagement and participatory decentralised planning involving local actors and institutions to improve delivery of health services and its use. The project aspires to make the community aware and involve them in the process of service delivery and locally influence the governance mechanism. The overall objective is to strengthen governance and development capacities of panchayats, promote citizen engagement in planning and implementation of development plans, and facilitate integration of support from line departments and other development actors by strengthening the leadership of panchayats to address the issue of maternal health care.

Objectives

• Panchayat representatives, officials and community sensitised and appropriately capacitated to prepare realistic development plans
• Preparation and implementation of decentralised development plans significantly reduce the incidences of maternal mortality
• Civil society, media and academia engage and provide support to strengthening local governance for effective service delivery
• At least 2-3 trained community volunteers in every gram panchayat to support the development processes of panchayats
• Sustained public campaign across the blocks to create awareness on maternal health issues
• Officials at state and district levels are aware and sensitised to provide timely support to participatory planning and implementation processes 

Specific target groups
Marginalised women belonging to Scheduled Castes and Tribes of Banswara Rural (~1,09,887) and Govindgarh (~28,335) blocks of Banswara and Jaipur districts respectively

Geographical spread
Banswara Rural Block (Banswara district) and Govindgarh Block (Jaipur district), Rajasthan

Methodology/key components

• Capacity building and training 
• Advocacy 
• Campaigns

While recruiting local community volunteers, female and male volunteers will be recruited in equal proportion. Knowing the social realities of the intervention areas, special effort will be made to recruit female volunteers. Tribal and other marginalised sections of society will be included in project strategising and implementation to ensure equal representation from all sections of society with significant women and SC/ST participation. Needs of senior citizens and the disabled will also be prioritised.

Key outputs

• Gram panchayat-wise reports on health and nutrition status of all selected panchayats
• Enhanced awareness of gram sabhas, capacitated VHNSC and PRI members
• Gram panchayats prepare draft health plans as per available resources as part of Gram Panchayat Development Plans
• Volunteers identified and enrolled for providing monitoring and handholding support 
• Public campaigns at block/gram panchayat/village level
• Online tracking of pregnant women, infants and children, and immunisation in 2 selected blocks
• Reports on participatory assessment activities and outputs of PRIs in improving health and nutrition in each gram panchayat
• Advocacy meetings with representatives of state government and district administrations for advocating, and showcasing results 
• Regular review meetings

Impacts

• Awareness of maternal health issues through public campaign 
• Improved gender disaggregated child and adolescent health indicators
• Leadership of elected women panchayat representatives supported to incentivise and encourage greater women’s participation in gram sabhas for planning

Year/Period
36 months

Client
Azim Premji Philanthropic Initiative (APPI) & Dasra

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