Ali Hussein is the chief of the village council in the small village of Haidarpur Naubasta in Uttar Pradesh, one of India's most populous states. Ali Hussein's wife, Kheroon Hussein, assists him in his duties. Ten years ago, their pregnant daughter-in-law fell ill one night. The nearest hospital was nine kilometers away and the family was at the mercy of auto-rickshaws as they did not have a vehicle of their own.
When the Husseins arrived at the hospital, the medicine they required was not available. They could not find a doctor to help them. Finally, they convinced a nurse to accompany them to the village and provide medical assistance to their daughter-in-law. Fortunately, she survived the night and her baby was born healthy, but the memory of helplessness and fear has remained with the family until this day.
Neonatal and pregnancy-related deaths are a major problem not only in Uttar Pradesh, but in all of India. The country accounts for a quarter of the world's maternal and neonatal deaths. Every year, 78,000 pregnant women and a million babies in India die due to such complications. Poverty, lack of awareness, and lack of access to health care are common causes for often-preventable fatalities.
To address this problem, the Indian government runs the National Rural Health Mission and the Reproductive and Child Health Program. Their goal is to improve the availability of and access to quality health care for the socially and economically deprived.
Yet, despite these schemes, supply gaps and challenges remain. In a country of India's size, where a maternal death occurs every seven minutes, it requires considerable effort from various quarters to ensure a smooth and successful delivery in a health facility for an underprivileged woman.
So when Ali Hussein was approached by Sure Start —a five-year initiative based at PATH, an international not-for-profit organization, and funded by the Bill & Melinda Gates Foundation—he was only too happy to collaborate with the project in its mission of helping mothers and their babies survive and stay healthy. Sure Start is working with rural communities in Uttar Pradesh and amongst settlements of marginalized people in Maharashtra. The project strives to demystify health by promoting simple maternal and neonatal health practices through innovative awareness-building activities. It makes communities aware of available medical facilities and government schemes and empowers them to access these. It ensures accountability by serving as a bridge between communities and public health providers.
Sure Start started at exactly the right time to integrate closely with critical Government of India programs, like the National Rural Health Mission, which are designed to improve overall health outcomes for the rural and urban poor. Sure Start has played an integral part in the capacity building and activation of government-accredited community-based groups such as Village Health and Sanitation Committees (VHSCs) and Accredited Social Health Activists (ASHAs). ASHAs are volunteers (often housewives) from the community, and VHSCs consist of elected community members. Since these agents of change are also part of the National Rural Health Mission structure, they act as critical links between local people and the government. They empower communities through improving logistics and village infrastructure; developing the knowledge and skills of mothers; planning and monitoring MNH services at the village level and; ensuring that families know how to get care. Sure Start's efforts have been integral in activating the VHSCs and ensuring that members hold regular meetings. Through the committees, communities have been able to demand improved health care and other services from district authorities.
These efforts have certainly had an impact in Haidarpur Naubasta village. Ali Hussein believes 70 percent of the men and women in his village now know about the benefits of opting for an institutional delivery versus a home delivery. Men are encouraged to ensure their pregnant wives receive proper nutrition, iron-folic tablets, and tetanus toxoid vaccines during the pregnancy. Village community members have also put together an emergency health fund to assist pregnant women in receiving health care they might not otherwise be able to afford.
Perhaps most heartening for Ali Hussein is the old truck he bought for his village with discretionary funds made available to village councils by the government. This emergency transport system is always there, day and night, to take a pregnant woman from Haidarpur Naubasta village to the nearest hospital. All she has to do is dial a number (printed on the front of the truck) and a community volunteer will be at her doorstep.
Says Kheroon Hussein, "I feel proud of what we have managed to accomplish together. I can sleep in peace at night knowing that no pregnant woman has to worry about getting to a hospital."
Sure Start, a project funded by the Bill & Melinda Gates Foundation and implemented by PATH, works with about 25 million individuals to improve maternal and newborn health in the states of Uttar Pradesh and Maharashtra in India.
