Third Worker Model in Rajasthan

Status of child health: Rajasthan

Of 1000 children born in Rajasthan, 115 died before age five

Of these 75 died in the first year And, 49 in first four weeks What was even more worrying was that NN

mortality rates seem to have stagnated or somewhat increased in the last decade!

ICDS- Objectives

The main objectives of ICDS are :-

Improving the nutritional and health status of children in the age group of 0 to 6 years,

Enhancing the capabilities of the family members to look after the health and nutritional needs of the pregnant women and children through relevant education and providing skills for child stimulation and development.

--Contd--

It was supposed that AWWs will achieve this objective by carrying-out all the ICDS related activities.

AWWs are mostly engaged in organizing supplementary nutrition activity, pre school education and other supportive activities.

These responsibilities do not allow her to act as a change agent in the Village.

Need felt for a change agent especially in the context of early child care practices

JANANI SCHEME (2004)Focusing pregnant mothers and under 3 children.

Sahayogini is paid Rs. 500 PM as honorarium

Providing counseling on health & nutrition issues at Providing counseling on health & nutrition issues at door stepdoor step

Ensuring immunization of under 3 children and Ensuring immunization of under 3 children and pregnant women.pregnant women.

Ensuring adoption of early child care practices like Ensuring adoption of early child care practices like early breast feeding, and timely complementary early breast feeding, and timely complementary feeding etc.feeding etc.

An additional worker (Sahayogini) at each AWC for: -

Key features of the scheme

“Sahyoginies” selected by the “Gram Sabha”

Minimum qualification - class 8th. Intensive 10 day initial residential training Seven days refresher training in the second

year Each "Sahyogini" has been equipped with a

Sahyogini guide book , a Sahyogini diary, a Flip book and other IEC material for counselling families

Job profile of Sahyogini

Family of New born – 1st, 3rd, 7th day and once every week in first month and two times in a month from second month to 3 years.

If new born is underweight :- 1st, 3rd, 7th, 14th, 21st and 28th day in the first month and every week till new born gains his/her normal weight from second month.

General Families – once in each month

Each “Sahyogini” visits about 10 households per day for counseling.

The Schedule of visit is as follows.

Contd.

Counsels the members of the family on health and nutrition issues

Ensures consumption of IFA tablets and proper utilization of supplementary food at home by pregnant women, lactating mothers and 7 months to 3 years children

Motivates them to attend the Health day at the AWC every month for immunization, health check up, NHED, growth monitoring of 0-3 years children

Maintains comprehensive records of all services

Convergence with NRHM

NRHM provides for a village level voluntary health activist called ASHA.

Significant overlap in roles and responsilibilities of "Asha" and "Sahyogini"

Responsibilities of "ASHA“ assigned to "Sahyogini" - "Asha-Sahyogini" .

Paid additional incentive under NRHM

10 day integrated training module has been developed for "Asha-Sahyogini"

Mother & Child Health & Nutrition DayContd.Contd. Related Initiatives Related Initiatives

Joint Plan of Action formulated & joint circulars issued by WCD & Department of Medical & Health for the purpose of :-

Organizing MCHN Day once a month on a fixed Thursday or Monday at AWCs.

Ensuring availability of ANM on MCHN Days along with vaccines at AWCs.

Joint monitoring visit of AWC by regional officers of WCD & Deptt. Of Medical & Health on MCHN Day.

Organization of MCHN Days increased from 40% in Sep., 04 to 75% in May, 06.

Complete Immunization

Impact

48% as per CES, 2006

ImpactContd.

Assistance by trained personnel during delivery

20.7

45.1

05

101520253035404550

%

ICDS Baselinesurvey(2000)

ICDS Endline survey(2005)

Colostrum FeedingContd. Impact

9.1

38.5

0

5

10

15

20

25

30

35

40

%

ICDS Baselinesurvey(2000)

ICDS Endlinesurvey(2005)

Early initiation of Breast FeedingContd. Impact

10.1

45.1

0

5

10

15

20

25

30

35

40

45

50

%

ICDS Baselinesurvey(2000)

ICDS Endlinesurvey (2005)

Exclusive Breast FeedingContd. Impact