Maternal and Child Health (MCH) and Family Planning Project in Mewat area of Haryana: This project implemented from February 1987 till March 2000 in a very backward area of India, highly resistant to family planning, was carried out using innovative approaches.

In the first phase, two fully equipped mobile vans with trained doctors, nurses and counsellors regularly visited 42 villages following a fixed schedule to cover every village once a week. Sensitisation and awareness generation in the community was done by the local community volunteers,Mewat Sevikas, who though illiterate, were trained in community mobilization, communication and reproductive health issues. They also dispensed basic medicines during the week when there was no other medical help. This phase was supported by the Government of India and the USAID (PVOH II)grant.

1Innovative Colour Coded Medicine Box of Mewat Sevika 2Interior of the Mobile Van of Mewat Project

 

3Team Member Disbursing Medicine from the Van  4

Entrance to the Mewat Static Clinic

In the second phase of the project, a building was constructed on the land donated by a local community leader. This was equipped and manned. This static maternal health facility was set up and implemented with grants from the British High Commission and the Canadian High Commission.

The project was highly successful. Maternal health was greatly improved with safe deliveries. Immunization coverage was vastly enhanced. Polio was eradicated. Family planning methods became highly acceptable.In particular, Injectable contraceptives and sterilizations became very popular.

An IEC project for introducing reproductive health and planned parenthood to low income young women and adolescents through Anganwadi workers.This project implemented in six districts of Uttar Pradesh – Lucknow, Kanpur, Agra, Varanasi, Aligarh and Bareilly –was carried out during October 1990 to March 2000.

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The project started with a six-day orientation course on family planning and safe motherhood for over 1,200 Anganwadi Workers (AWWs),who are a part of the government scheme to provide free and nutritious food to children below five years, pregnant women and nursing mothers. Their supervisors were also covered. The emphasis was girl adolescents and young women. The topics covered included physiology, sexual health, contraception, pregnancy, safe delivery, immunisation as well as indirect determinants of family planning such as age of marriage, age at first birth etc. The orientation was followed by health education in the villages at the Anganwadi centres by Parivar Seva teams, which not only effectively conveyed messages to the community, but also helped the AWWs to gain experience in conducting such meetings in the future. The meetings were followed by health camps from where referrals for family planning clinical/operative services were made to Parivar Seva’s clinics and the government facilities. Periodically,reorientation programmes for AWWs were carried out and they were encouraged to refer clients for services.

In the second phase of the project, the number of districts were reduced to four, covering Lucknow, Kanpur, Agra and Varanasi. In this phase, the participation and involvement of men was an added focus of the project. Special linkages were established at the local level with the public sector health units for family planning and maternal services. The project was funded by MacArthur Foundation

Pilot demonstration project through Combined Service Delivery for Promoting Spacing Family Planning Methods Adopting Community Based Education and Distribution Approach. This project was carried out in Sitapur district of Uttar Pradesh during August 1994 to September 2000.The focus was on slums and difficult to reach rural areas adjoining the Sitapur district headquarter. Door-to-door promotional activities and regular and timely supplies of contraceptive methods at their door steps, using the Community Based Distribution (CBD) approach, resulted in high acceptance and continued use of birth spacing methods (condoms and oral pills)in the community. Community based mid media activities were also carried out.Innovative Management Information System (MIS), manually set up,was the nerve of the project and its high effectiveness. Moreover,a doctor was made available in the community at weekly intervals for health check-ups and handling of family planning clients. CBD workers also referred clients to the static clinic established under the project for clinical family planning methods such as IUDs and sterilizations. Additional reproductive health services were also offered in the static clinic, which resulted in developing trust and confidence amongst the community. This project was supported by SIFPSA, which in turn was funded by the USAID.

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Pilot Project on Social Marketing of Iron and Folic Acid (IFA) Tablets among adolescents and pregnant women in outer Delhi.This project was carried out during February 1996 to December 2001.

As part of the project, a good quality, affordable IFA product was developed and branded as Iron Plus. Using the social marketing approach, the project ensured widespread availability of quality iron tablets at an affordable price and easy accessibility, particularly amongst adolescents and pregnant women in three blocks of Delhi. It also involved community awareness on the benefits of iron supplementation and its compliance for a prescribed period of time for prevention and control of anaemia. Extensive work was carried out with schoolchildren in association with the Education Department and depots were set up in schools. Out of school children were covered through Anganwadi workers. ANMs and private practitioners in the area were given orientation training on the subject. Haemoglobin estimation camps were carried out pre and post usage of IFA. The outcome of the activity revealed good acceptance and utilisation of the tablet with substantial benefit.

The project was funded by UNICEF, with technical support from the Directorate of Health & Family Welfare, Delhi.

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An innovative Family Planning and Service Delivery Programme for Improving Maternal and Child Health Care, Using Social Marketing Approach. The first phase of the project was for a period of 52 months from December 1, 1997 to March 31, 2002.It was implemented primarily in the rural areas of three states– Himachal Pradesh, Rajasthan and West Bengal – by social marketing Parivar Seva Sanstha’s branded condoms (Sawan and Milan) and oral contraceptive pills (Ecroz).The project developed effective distribution system, using not only the traditional outlets, but also non-traditional outlets so that the contraceptives availability and accessibility was considerably enhanced. The distribution system was supported by localised promotion and mid-media activities. The project yielded an overall sales performance at 61.14 million condoms at 112% of the project target and 3.34 million OCPs at 146% of the project target.

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Social Marketing Phase II project was implemented for a period of 63 months from January 2003 to March 2008 and covered two states – Himachal Pradesh and West Bengal– with focus on family planning and HIV/AIDS and creating a social franchising network of allopathic service providers for making injectable contraceptives

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available in rural areas. Intensive information education and communication (IEC) activities were carried out in both the states to bring about a behavioural change (BCC) towards the use of condoms among high risk groups. Condoms and OCPs were widely made available in these two states. In the pilot project covering two districts in West Bengal, injectable contraceptives(DMPA)were made available to the franchised service providers.after training them in this new method. The project generated considerable demand for condoms and oral pills and their use in both the states.The project also established 49 Blue Star franchisees, where the franchised doctors set up Family Planning Centres in their practice, where in addition to injectables, other FP methods such as IUDs were also
provided. Acceptance of injectables was most encouraging.

Both phases of the project were funded by Kreditanstalt fur Wiederaufbau (KfW) under the bilateral German Financial Co-operation with the Government of India.

Comprehensive Urban Reproductive Health Project in Orissa: This project covering the entire state of Odisha, with focus on few districts for specific activities,was implemented during 1997-2003. The project had several multi-pronged strategies such as setting up of sustainable reproductive health clinics for women in two districts (Bhubaneswar and Balasore)as well as district wise promotion of contraceptive social marketing products, community-based distribution (CBD) programme, reproductive health communication and motivation (RHC&M) programme; state-wide promotional campaign and setting up of innovative Purush clinics for men at Cuttack in Orissa and Chennai in Tamil Nadu.The project targets for each component was exceeded. Purush clinic received 1535 clients within the first nine months. Condoms were promoted among highway truck drivers with free condoms outlets along the highway through a strong collaboration with the Family Planning Association of India and the State AIDS Cell. The CBD module transited from old to new area allowing access to further 1,00,000 people. Immunisation programmes in the CBD areas were organized with the help of government. In order to provide information on Family Planning, MTP, STIs/RTIs and HIV/AIDS promotional material including IEC leaflets in Oriya and English were distributed in the CBD areas. The strong advocacy module taken up during that period has highlighted the efforts of other modules providing a holistic approach to Reproductive Health awareness and care in Orissa. Parivar Seva regularly published a quarterly journal of OURHP called ‘Jigyasa’ which promotes an integrated holistic approach to reproductive health with contributions from the project staff and guest writers from the state government and other NGOs. Parivar Seva’s continued interventions, helped the market for condoms (estimated at 5 million in 1998) to grow to an estimated 15 million in the year 2000-2001. The number of retail and general outlets serviced increased from 1131 to 2613 during the year. A total of 6026880 condoms and 251140 cycle of OCPs were sold in Orissa in 2000-2001.

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The project received financial assistance from Overseas Development Assistance (ODA)/ Department for International Development (DFID),UK under a bilateral agreement with the Government of India.The project was actively supported by the Government of Odisha and The Ministry of Health & Family Welfare, Government of India. The monitoring of the project was carried out by the British Council Division of the British High Commission as well as Marie Stopes International, which also provided specific technical support on some aspects of the project.

Improved Access, Awareness, Utilisation and Sustainability of Reproductive Health Services in eight clinics in India.The project was implemented from June 1, 2000 to March 31, 2003 in three states: Bihar, Madhya Pradesh and Uttar Pradesh. The facilities in selected eight clinics of Parivar Seva were upgraded to enhance the quality of reproductive health care services in these clinics. Comprehensive Information Education and Communication (IEC) campaign, together with distribution of Iron-Folic acid tablets and contraceptives in the community followed.

This project was taken with co-financing support from the European Union/ European Commission

Project to Improve Reproductive Health in all 32 Districts of Rajasthan. This project to improve reproductive health in all districts in the state was implemented during 2000-2007. Under the project,seven additional hub clinics were set up, which were in addition to the existing clinics of the Sanstha in the state. The hub clinics were then supported by setting up 20 spoke centres, thereby serving both the urban and rural areas with clinical services. Each clinic in the state was supported by an innovative awareness, educational and training programme on reproductive health and related issues, which included inter-personal communication as well as mid media activities. In addition, the contraceptive social marketing programme of the Sanstha was strengthened with better distribution and contraceptive awareness in the entire state.Mass media campaign as well as van promotion activities throughout the state helped to create mass awareness regarding reproductive health and availability of services for the same.

The project wasfunded by an institutional donor in the USA.

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Youth Friendly Services for RTI/STI including HIV/AIDS Prevention & Management.As part of a three country project of the UNFPA, this pilot project was taken up in Jawahar Nagar, the largest slum in Rajasthan, covering a population of over 50,000. The pilot phase was for 18 months from June 2005 till December 2006. This project with an objective to prevent STIs/RTIs(including HIV/AIDS) and unwanted pregnancies amongst adolescents and youth in the age group of 10-24 years was innovatively designed to attract the target audience to the static Youth Friendly Clinic for sexual and reproductive health information, counselling and services. The project was named Aadhar and the services were packaged to include career counselling, skill development and income generation. The stakeholders, parents, teachers, school principals, Government health workers, local untrained doctors, community leaders and other NGOs were actively involved in the project. Community educational/awareness programmes covered not only sexual reproductive health, but wider issues such as sanitation, hygiene, nutrition. This was followed by the active participation of the stakeholders to improve these
services in the slums. This phase was supported by UNFPA.

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The project has since continued as an on-going activity of the Sanstha. The project design is being modified from time to time as per the local needs. One of the important interventions has been the introduction of peer educators from the community, who have been fully trained to carry the project forward.  Dissemination of information by the peer groups has resulted in greater participation of the adolescents and youth in the project and an increased acceptance of SRH services. The project has now moved to another phase wherein smaller Youth Friendly Services (YFS) are now covering additional sites in more slums.

Implementation of the Public-Private Partnership (PPP) Model for STI/ RTI Services.This project, covering several districts in three zones, was awarded by National AIDS Control Organisation (NACO) in April 2008 in Punjab, Delhi and Rajasthan. The objective of the project was to ensure widespread availability of quality STI/RTI service (both preventive and curative) at affordable price and easy accessibility to those individuals particularly the high risk groups for HIV infection. The project used franchised route in partnership with allopath and AYUSH health care providers for management of RTI/ STI and referrals for HIV/ AIDS. Parivar Seva also socially marketed branded treatment kits as well as its branded condoms under the project. Community awareness programmes were conducted on the availability of the services for prevention and cure as also need for partners’ treatment

Urban Health Initiative in Uttar Pradesh to Improve Urban Health especially urban Reproductive Health and Family Planning among the urban poor in five districts of Uttar Pradesh: Agra, Lucknow, Varanasi, Bareilly and Kanpur. This project carried out from May 2011 to May 2013 leveraged its existing five static Reproductive Health clinics in the five project districts by implementing cost effective strategies and approaches to expand demand, access and utilisation for family planning. Community-based mobilisation was carried out in all the allotted urban slum areas by a group of community educators, using door to door approach for giving information and providing counselling as well as community activities such as meetings, health camps. Mid-media communication through wall painting, posters, hoardings, street plays, dramas, magic and film shows helped to increase demand creation activities and access to the clinics. The project focus was on long acting and permanent methods of contraception (IUCD, DMPA and sterilisations, both for women and men).During a short span of 25 months, the project staff mobilized a sizeable number of Married Women of Reproductive Age (MWRA), who were provided quality family planning services of their choice. A sizeable number of women availed injectable contraception (DMPAs), which was
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provided at their doorstep in the slum itself by the technical team of the Sanstha. Using this mobile approach, not only acceptance of this method was enhanced,but their continued use increased and there were minimal drop outs. At the end of the project period, there was an overall 37% increase of clients accepting and continued some long term/permanent methods of contraception and were fully satisfied.

The project was taken up with support of FHI 360,who in turn received financial support from the Bill Melinda Gates Foundation (BMGF)

Organising Awareness Generation and Conducting Family Planning Camps in selected JJ colonies/slums in Delhi in collaboration with the project implemented from November 16, 2015 to March 17, 2016. It covered 146 JJ colonies/slums identified from the nine districts/regions in Delhi. In each JJ colony/slum, awareness generation and counselling on various Family Planning methods was jointly carried out by the Song & Drama Division, Government of India and Parivar Seva teams.

30Door to door visit by a field worker of  Parivar Seva 31Street plays on Family Planning in the community
32Artist performing magic show during Awareness Campaign Camp 33FP Service Camp, Gynaecologist consultation by clients

Parivar Seva team members carried out door-to-door visits to conduct inter-personal communication, which was backed by mid media communication. Songs & Drama division’s team communicated through street plays, magic shows, puppet shows etc. These were followed by Family Planning camps including other Reproductive Health care services the next day at the same site.The clients were thus able to avail on the spot counselling and delivery of various contraceptive methods/services. IUCDs were inserted at sites where minimum facilities could be arranged. Those who opted for permanent methods and required specialised reproductive health services were referred to either to a nearby Parivar Seva clinic or the nearest government facility. As a result of the project, 17,118 clients could be mobilised. A majority of them were women (95%) in the age group of 18 to 44 years. Among them, 6337 clients attended Family Planning camps the next day, 2753 (43.4%) accepted/availed some form of Family Planning methods and 3900 (61.5%) availed other Reproductive Health services.

This project was supported by Jansankhya Sthirata Kosh (JSK).

Training of AWW and ASHA workers in seven identified Area Development Programme (ADP) districts of Rajasthan to address the issue of malnutrition. The project trained and equipped frontline workers (AWWs& ASHAs) with knowledge and skills that would be practiced at the household/grassroots level, to bring behaviour change in health and nutrition practices. The project was implemented by Parivar Seva in seven identified districts of Rajasthan, namely Bundi, Barmer, Baran, Alwar, Dungarpur, Pratapgarh, Tonk and Udaipur. The training activities were started in April 2016 and completed in September 2016. The district authorities actively collaborated. The training module, developed by World Vision was used and their teams also attended most sessions.

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Ice-breaking exercises were organized to help the trainees to get to know each other and get into the purpose of the event.

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(Pre-Test of ASHAs during ToT) Activity through Role Play
39Chart Paper Activity by the Group

The training was totally interactive involving full participation of the trainees. Case studies, movie clips, chart papers activity, demonstrations, group discussion methodologies were utilised for imparting the training. The trainees were encouraged to express their views on the subject without any fear or prejudice. To make the training more interesting, role plays were also conducted by the trainees on specific issues to improve their counseling skills. They were trained on the use of Flip Book to equip them with skills on the components of timed and targeted counselling (TTC) approach on various issues of safe motherhood and childcare. In each batch of training a pre and post-test of the knowledge of the trainees was assessed. The pre and post knowledge assessment of the trainees (ASHAs/AWWs) revealed 50% increase in their knowledge and majority of them were equipped to interact with the community to create awareness regarding healthy food habits, use of locally grown nutritious food and take care of malnutrition amongst children, adolescents and pregnant/nursing women. Total 20 training’s were conducted by Parivar Seva Sanstha and total 619 ASHA/AWWs were trained in seven districts of Rajasthan as mentioned in the above paragraph.

This project was supported by World Vision India.