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.
- 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 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.”
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.
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
|Nodal Officer Urban Health||
|District Program Managers, Urban Health Coordinators, Community Process Managers||
|Medical Officer-in-Charge, UPHC||
Ensure that ASHAs are performing the following activities to form and strengthen the MAS:
|ASHA Facilitator/ ANM||
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.
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.
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.
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Demand Generation Approaches
Government of India Resources
- Guidelines for ASHA and Mahila Arogya Samiti in the Urban Context by National Urban Health Mission, Page No. 17 to 23
- Guidelines for ASHA and Mahila Arogya Samiti in the Urban Context 2014, Page No. 21
- Induction for Mahila Arogya Samiti_English
- Induction for Mahila Arogya Samiti_Hindi
- ROP, 2016-27, NHM-UP
- Contraceptives Display Kit
- Pregnancy screening checklist
- Method Specific Training PPTs
- Method Specific counseling cards
- Frequently Asked Questions and Answers