Collective Village-Level Voluntary Action and Community Health System Strengthening for Improving Maternal-Infant Health in Agra District, India

This research focuses on the knowledge and influencing capacity of elderly Indian women on positive behaviour practices among families in several villages of Agra, India, for raising well-nourished infants, despite economic poverty. Researchers implemented a strategy of motivating them for a voluntary group effort in partnership with community service providers and facilitating their ability to take collective action and responsibility to improve maternal-infant health (MIH) in their communities.


The study selected families whose infants scored well on a weight-for-age scale and fit the profile of economic poverty derived from a standard-of-living index. "In 21 of 25 ...families, grandmothers were key facilitators of positive practices and [were] stimulated to become behaviour promoters (BPs)... Village-level service providers including traditional birth attendants and 3 literate women partnered in, and together they formed one voluntary health group named Bal Gopal Seva Manda."


Capacity building from the outside researcher enhanced the group’s knowledge for the 14-month project (December 2004 - February 2006). It included: “scheduled home counselling visits (pre, intra, and postnatal) by BPs, local village advocacy, a monthly health and immunization day, and improved reach and quality of health services by linkage of BPs with health providers.” In monthly problem-solving meetings, the BP group devised local strategies to address barriers to infant health.


Researchers measured and evaluated infant health at 0 and 7 days of age and monthly up to 6 months of age in both villages with these BP intervention groups and those without. After 14 months of study, undernutrition was more prevalent in the villages without BP intervention groups than those with the groups.


Moreover, two of the three intervention groups wanted to go forward as established community-based organisations (CBOs) and were provided with bimonthly mentoring by the researcher in the next 16 months (March 2006 - June 2007). These groups elected their leaders, made group rules, and conducted their activities as a CBO. Adolescent girls and health workers also joined the CBO.


The following describes the work of the CBO: "The CBO-managed intervention included: mothers’ group meetings, assisting home delivery, managing nutrition and health day, problem solving meeting, health fund for EmOC, use of social marketing to address scarcity of health supply, and continued communication with block-level health to ensure quality of health services. Behaviour tracking of pregnancies until their infant received the DPT-booster and CBO record keeping was maintained by the group’s literate member (LM). LM also conducted home counselling visits." The LM also took on the role of management of the group clusters. As a result, the researchers felt that "[g]randmothers were effective BP, and a strengthened group-health provider linkage ensured adequate demand-supply of health services and a community movement to work towards collective community benefit."


The posting concludes: "This study highlights the need to focus on institutional building of village health groups for long-term gains in healthy behaviour maintenance. The processes used in this study in “communitization”, MIH demand generation, [and] community-health provider linkage have potential utility for the National Rural Health Mission and programs working with community heath volunteers/Mahila Mandals/Mother-to-mother support groups."