Dashboard Global Community Group Engagement – HIPs Strengthening Women’s Groups

India Toolkit: Demand Generation

Strengthening Women’s Groups (Mahila Arogya Samitis)

Facilitating Access to Family Planning Services among the Urban Poor

Purpose: To provide guidance on how to establish Mahila Arogya Samitis (MAS), build their capacity as health advocates and develop them into self-governing institutions that work towards addressing and meeting the health and Family Planning (FP) needs of the community.

Audience:

Chief Medical and Health Officers (CMHO/CDMO/CMO)
Nodal Officer – Urban Health
Nodal Officer – Family Planning
District Program Managers
Urban Health Coordinators
Community Process Managers
Medical Officer-In-Charge-UPHC
Urban Accredited Social Health Activist (ASHA) facilitators/Auxiliary Nurse Midwives (ANMs)
Non-Government Organizations (NGOs)
Health Partners

Background: Women groups can be effective in expanding the base of health promotion efforts at the community level and building sustainable community processes. For this reason, the National Urban Health Mission (NUHM) has made a long term commitment to community empowerment and leadership within the community by creating a role for women’s groups in the form of MAS.

The NUHM guidelines (Refer Guidelines for ASHA and Mahila Arogya Samiti in the Urban Context by National Urban Health Mission, Page No. 17 to 23) define MAS as a community group involved in community awareness, interpersonal communication, community-based monitoring and establishing linkages with services and referrals. This group focuses on preventive and promotive health care, facilitating access to identified facilities and management of untied fund. A key function of the MAS is to support community members to access health entitlements.

Evidence

Evidence from other countries has documented the impact of women’s groups on improving family planning and maternal and new born health (Refer Post A. et.al., Women Group practicing participatory learning and action to improve maternal and newborn health in low resource setting: a systematic review and meta-analysis, Lancet 2013, 381, page no. 1736 to 1746). Although data is not available to document the impact of women’s groups on maternal and newborn health in India, anecdotal evidence, suggests that they play an important role on improving health in both rural villages and urban slums.

UHI’s work with women groups

The Urban Health Initiative (UHI) worked with 420 women groups across 11 cities in Uttar Pradesh, comprising women groups, savings groups, Shakti groups, sanitation groups and Integrated Child Development Services (ICDS) Matri Samitis.

After receiving orientation from UHI, these groups integrated FP into their existing agenda.
Though diverse in their objectives and functioning, each group worked to become a resource agency that disseminated FP information to the community and supported women to access FP services and entitlements provided under the government schemes.
Many women groups also worked to attain entitlements for community members related to nutrition, routine immunization, neonatal care, water and sanitation, voter registration, income generation etc.

“In the beginning things looked difficult as that time we were just 4 to 5 ladies but now we are around 1,600 women together, so every issue looks small in front of our strength which we get from each other. There is immense power in togetherness.”

Member of Vishal Shehri Mahila Vikas Samiti, Agra

Guidance on Establishing and Strengthening MASs

The steps below provide guidance on establishing and strengthening MASs

Identify Women Who Can Form a MAS

As per guidelines, identify clusters of households where an MAS needs to be formed
After conducting meetings at the community level in order to understand the health needs of the community, the ASHA will sensitize the identified women on the role of the MAS
Women who consistently participate in these meetings will emerge as the MAS members
In slums where other women groups such as self-help groups, saving groups, ICDS Matri Samitis etc. exist, these groups should be oriented by the ASHA and the members of these groups should be encouraged to join or form an MAS. These other groups can be co-opted into MAS, provided they-
- obtain approval from the respective authorizing department e.g. NULM, DUDA, ICDS
- open their membership to include new members and representation from all socio-economic sections
- incorporate health as a priority in their agenda.
Selection of MAS members:
Key criterion for selection of MAS members should be their commitment and willingness to work as a collective for community health.
Inclusion of women from the poorest and most marginalized segments of the community in the MAS is critical as they have the least access to health information and services.

Build Capacity of MAS Members on Health Issues

Plan training on FP, MNCH for MAS members as budgeted for in NUHM
Provide relevant IEC materials and job-aids including frequently asked questions (Refer to FAQs, IEC materials and job aids)
Provide support to MAS members through joint home visits and continue building capacity of MAS members on FP. Reinforce key issues such as including the most marginalized population groups, raising and using resources, undertaking advocacy etc.
Provide opportunities for MAS members to present their issues before the District Health Society (DHS). Link MAS to the District Urban Development Agency (DUDA) or to the ICDS project officers.

Use platforms such as the World Population Day or Breastfeeding Week to create events that provide MAS visibility and recognition. Such recognition strengthens MAS’s group identity.

Support Key MAS Activities

Support ASHA in mapping and listing slum households and preparing resource maps in the communities
Monitor and facilitate access to essential public services related to health, water, sanitation, nutrition and education
Support the ASHA, Anganwadi Workers (AWWs) and Auxiliary Nurse Midwives (ANMs) in organizing Urban Health and Nutrition Days(UHNDs), and in mobilizing women and children for outreach sessions
Generate demand for health services including FP
Support ASHA in counseling family members on health issues when required
Ensure access to health entitlements for the community
Ensure access to health facilities including accompanying women when required
Lead collective action and self-help initiatives at the community level
Support ASHAs and AWWs in the distribution of health supplies including FP methods. They can also be depot holders for condoms, OCPs, ORS etc.
Use untied funds to address health needs of the community
Participate in health campaigns, special events and drives

Roles and Responsibilities towards strengthening Mahila Arogya Samitis

Role	Responsibility
CMHO/CDMO/CMO	Plan and budget for MAS Review formation and functioning of MAS Ensure that MAS trainings are conducted as per calendar Ensure opening of bank accounts and disbursement of untied funds for MAS Ensure participation of MAS representatives in the district health society meetings / city coordination meetings
Nodal Officer Urban Health	Provide IEC materials and health supplies (such as FP supplies) to MAS Ensure implementation of all directives by the CMHO/CDMO/CMO Link MAS members with income generation schemes of the government e.g. NULM, Skill Development Mission, Start-Up Mission Reward and recognize well-performing MASs
District Program Managers, Urban Health Coordinators, Community Process Managers	Facilitate implementation of MAS activities in coordination with the Nodal Officer – Urban Health Reward and recognize well-performing MASs
Medical Officer-in-Charge, UPHC	Ensure that ASHAs are performing the following activities to form and strengthen the MAS: Facilitating orientation of community women regarding the establishment of MAS Ensuring representation of marginalized segments in the MAS Facilitating participation of MAS members in training, UHNDs, outreach camps Encouraging MAS members to use IEC materials and health supplies
ASHA Facilitator/ ANM	Mentor ASHAs in conducting MAS meetings Conduct periodic progress reviews on MAS with ASHAs in their area Prepare and submit reports on MAS to Urban Primary Health Center (UPHC)

Monitoring MAS Activities in Family Planning

As per NUHM guidelines, the monitoring of MAS and related reporting by ASHAs / ASHA facilitators to the city CMHO/CDMO/CMO include the following indicators:

Number of MAS established
Number and percentage of MASs that received FP trainings
Number of MASs that received untied funds
Number of MASs utilizing untied funds as per guidelines
Number of UHNDs and outreach camps supported by MAS members compared to the number conducted

Qualitative analysis of the sample agenda/minutes could also be done to overview compliance.

Sustainability

Creating sustainability of MAS is a long-term process, which requires on-going training and supportive supervision by ASHAs and other health functionaries. It also requires linkages to various income generation schemes of the government as well as the annual budget provisioning through the PIP. Reward and recognition to well-performing MASs can provide motivation for their continued activities.

Cost Elements

The cost elements required for the formation and activation of MASs include the following:

Orientation of MAS members: One day & one-time orientation cost of Rupees 3,000 is proposed in the NUHM PIP in 2017.
Untied fund of Rupees 5,000 to each MAS (Refer to Guidelines for ASHA and Mahila Arogya Samiti in the Urban Context, 2014, page no. 21 for minimum members required to take decisions on future action plan activities and how to spend untied fund).

Cost Element	FMR Code	Source
Orientation of MAS members	P.6.2.1	ROP, 2016-17, NHM-UP
United Fund	P.3.2.7	ROP, 2016-17, NHM-UP

This table is indicative and illustrates the manner in which cost elements are provisioned in a government PIP, thus giving guidance to the audience on where to look for elements related to a particular task, such as the formation of ‘Mahila Arogya Samiti’.

Disclaimer: This document is based on the learnings collated from Urban Health Initiative, Health of the Urban Poor (supported by USAID) and Expanded Access and Quality (EAQ) to broaden method choice in Uttar Pradesh. This document is not prescriptive in nature but provides overall guidance of how this particular aspect was dealt with in these projects for possible adoption and adaptation.

The downloadable versions of this document are slightly modified to make it state representative for Uttar Pradesh, Madhya Pradesh and Odisha, respectively.