RGMVP works in an area of Uttar Pradesh that has some of the lowest Human Development Indices in the country. There is lack of health education, prevalence of chronic diseases like tuberculosis, diarrhoea, etc, and reproductive health problems such as high-risk pregnancies, RTI/STD, non-institutional deliveries, anaemia, maternal and infant mortality, and malnutrition. Women have limited or no access to basic healthcare facilities and are often compelled to depend on unscientific treatment. Almost every second girl is anaemic and every second child is malnourished in UP. More than 50 percent of institutional deliveries are low birth

Swasthya Sakhis being trained in the seven best practices of health care    Indira Gandhi Eye Hospital & Research Centre   Inside the Sanjay Gandhi Hospital   An operation in progress at the Sanjay Gandhi Hospital   A Rajiv Gandhi Arogya Yojna clinic   A Health Activist or Swasthya Sakhi creating awarness among SHG women

• Enhancing awareness on ante-natal care, infant care and nutrition;
• Generating public consciousness of health services as a fundamental right;
• Creating public accountability; and
• Creating a better understanding of health and healthcare.

RGMVP has built a systematic, institution based approach to addressing community heath and healthcare. At the centre of the solution is the Community Health Activist (Swasthya Sakhi), a volunteer from the community who is trained to provide basic knowledge on reproductive health and sanitation (personal and public hygiene) with special emphasis on prevention. She is responsible for generating demand for health services in the community and linking the community with the existing public health services. She also provides a measure of immediate relief for health problems, organises the community on healthcare issues, especially pregnancy and ante-natal care, and sensitises SHGs/VOs/BOs and builds capabilities. SHGs members are encouraged to internalise the seven best practices for healthcare based on basic hygienic and healthy behaviour so that they can lead a secure and responsible life.

Currently, RGMVP is scaling up its health intervention by ensuring that a Swasthya Sakhi is linked to every SHG in the Programme area. Systematic dissemination of knowledge and information-sharing is taking place since every SHG group meeting’s agenda includes a discussion on health, especially on targeted issues such as pregnancy, nutrition, immunization, delivery and care of child, adolescence health, and hygiene and sanitation.

RGMVP’s convergence strategy has been especially effective in consolidating the impact of the Community-based Health Care initiative and to promote health care among the poor as a right and an entitlement that they must demand. The Swathya Sakhi promotes convergence by acting as a link between public health workers such as the Auxiliary Nurse Midwife (ANM), the Anganwadi Worker (AWW) and the Accredited Social Health Activist (ASHA). These public health workers are able to use the CIP meetings as a platform to disseminate information on issues such as immunisation and to communicate with women on healthcare issues. The CIP meetings are thus a one-window convergence platform for various interventions such as the Integrated Child Development Scheme (ICDS) of the government, or for village functionaries such as the Gram Pradhan to promote schemes such as sanitation amongst the community.

Convergence also works at another level: collaborations with the Sanjay Gandhi Hospital and the Indira Gandhi Eye Hospital and Research Centre (IGEHRC) ensure that the poor can avail of medical facilities at these establishments. Over 120 Swathya Sakhis have been trained in basic eye care and prevention by IGEHRC so that they are able to identify eye disease and refer people for medical help. A tie-up with the Rajiv Gandhi Sachal Seva, a mobile healthcare programme with 22 vehicles, has resulted in regular health camps being organised for the community in the project area. RGMVP has also formed a partnership with Vatsalya, a Lucknow-based resource training centre for maternal and child health.