Training of Accredited Social Health Activist (ASHA) on the “Postpartum Home Visits” in Sure Start U.P.
“Reaching 3000 ASHAs in 7 Districts of U.P.”
Introduction

Sure Start is an initiative intended to catalyze sustainable improvements in maternal and newborn Health (MNH) through effective community action in selected districts of Uttar Pradesh and urban sites of Uttar Pradesh. Sure Start is supported by the Bill and Melinda Gates Foundation as part of its “Community Health Solutions” program, in partnership with PATH.     Sure Start has been designed to compliment and support the Government of India’s commitment to improving maternal and newborn health and is synergistic with National Rural Health Program, state level policies and programs and district level plans and activities.

Sure Start promotes integrated attention to both maternal and newborn health, within a broader continuum of health services and programs. Sure Start supports the scaling up of promising approaches, leveraging the successes of pilot projects across large populations. Sure Start focuses on household and community action, complementing other initiatives that focus on clinical facilities and overall health systems. Sure Start in Uttar Pradesh reaches to more than 23 million population in seven intervention districts through five lead partner NGOs and district level consortia of 55 sub partners.

Sure Start has provision for building capacities of Accredited Social Health Activists (ASHA) for conducting three postpartum home visits in Level 3 intervention sites. These home visits will be monitored for any improved impact on maternal and new born survival.

Objectives of three postpartum home visits by ASHA in Level 3 villages:

Prevention, early detection of danger signs in mother and newborn
Timely and appropriate home based care/actions for management of danger signs of mother and newborn
Appropriate referral of mother and newborn with danger signs for specialist care when necessary
Counseling on the monitoring newborn care especially thermal care, cord care, and immediate and       exclusive breastfeeding.
Monitoring and supporting families in postpartum care of the mother
Support mother in breastfeeding and solve breastfeeding problems if any

ASHA is the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.

ASHA will be a health activist in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. She would be a promoter of good health practices. She will also provide a minimum package of curative care as appropriate and feasible for that level and make timely referrals.

In proposed project Sahbhagi Shikshan Kendra (SSK), a state level support Non-Government Organization (NGO) is being identified as Training Agency for capacity building of ASHA to facilitate effective postpartum home visits in Sure Start project districts of U.P.
The entire training program will be facilitated by the close collaboration of PATH and Sure Start lead partners and its consortia members.

SSK will be facilitating the project as a resource agency which includes the development of the training material, directly conducting field trainings of ASHAs and post-training mentoring and monitoring of selected ASHAs, hence, by the effective transfer of knowledge and facilitation of training programs at block level, could render their extreme support on participatory training methodology so that a pool of trainers could be developed.

The proposed capacity building program is very holistic in its approach as it not only focuses on organizing class room training sessions, but also provides scope for onsite field and mentoring support. This handholding support and experience sharing workshops will enable ASHAs to develop skills and confidence in counseling families for behavior change.

The project will have an inbuilt quality assurance mechanism which will be relevant in all the phases of the project implementation.

The project, “Training Agency for Training of Accredited Social Health Activists (ASHA) on the Post partum Home Visits” under Sure Start U.P. has duration of 10 months i.e. from September 2009 to June 2010.

It aims at covering 7 districts of U.P. reaching out to around 2590 ASHAs in all and giving them training on maternal and new born care through Post partum home visits.
The donor agency is PATH, with whose cooperation and joint venture SSK has forwarded hands in providing them training.

Objectives
The key objectives of the training program are:-

Making trained human resources available at village level for conducting effective post partum home visits.
Enhancing problem solving and counseling skills of ASHAs under Sure Start project for effective post partum home visits.

The key project deliverables are as follows-

Developing “ Postpartum Home Visit Checklist ”
Developing training module and facilitator’s guide
Developing participants hand book and home visit checklist
Developing a pool of Master Trainers and District Trainers
Organizing Block level trainings for ASHA
Documentation of training completion report
Organizing post training experience sharing workshops
Organizing at least one mentoring visit of all identified 20% ASHA in sequential manner after two months of their training.
Monthly progress
Final Process documentation

SSK proposes to conduct trainings of L3 ASHAs deploying adult learning principals and participatory approaches. Participatory philosophy builds on the premise that local knowledge exists and new interventions must be designed taking into account exiting knowledge. We will build on the existing knowledge base of ASHA and facilitate the generation of new knowledge.
The training will include participatory methodologies such as brainstorming and role plays to bring to fore existing knowledge of the ASHAs and will knowledge gaps in easy to understand and recall ways.

The training sessions will provide scope for experimental learning and enable ASHA to overcome their prejudices as well problems faced by them in applying their knowledge in the field.

Simultaneously all training material and methodologies will be scanned for gender sensitivity. SSK will assess socio cultural environment which a rural post partum woman faces. Counseling tips for ASHAs will include how ASHAs can address some of socio cultural issues in addition to technical issues related to post partum care of mother and newborn.

At the end of the capacity building program, ASHAs will be able to-

1. Counsel and demonstrate to the new mother and her family members how to keep the newborn warm (thermal care)
2. Explain the benefits of immediate and exclusive breastfeeding for the mother and the newborn to the new mother and her family members
3. Provide support to the mother for exclusive breast feeding
4. Identify breastfeeding related problems and offer solutions for the same
5. Counsel the woman and her family to keep the newborn’s cord clean
6. Identify maternal and newborn danger signs and facilitate referral to the appropriate health facility for each danger sign.
7. Use postpartum home visit checklist and systematically track newborn and postpartum care behaviors.

1. Development of Training Material
2. Training Curriculum for all levels will be finalized and acted differently.
3. Selection and recruitment of master trainer
4. Selection of District Training Team(DT)
5.  Induction of MTs and DTs
6.  MNH orientation for Master Trainers
7.  Training of trainers for MTs on Participatory Methodology
8.  MNH orientation for District Trainers
9.  Sharing of Draft Material with PATH and Sure Start Partners for Feedback and Inputs
10. Pilot Testing of Module/ Training Material
11. Involvement of Health officials in training program
12. Pre and Post Training Assessment
13. Introductory Meetings at District level
14. Training of Level 3 ASHAs on Postpartum Home Visits
15. Post Training Experience Sharing workshops

New mothers and babies, at their most vulnerable, need care, protection, and nurturing. That’s why ASHAs are trained to make sure new moms have a healthy environment in which to give birth and ways to avoid problems.
The main motto of training the ASHAs is that they could be able to counsel the new mother about the care of her newborn and the precautions to be taken. She would be able to explain the benefits of breastfeeding.
Lastly ASHA would be able to facilitate new mothers with appropriate health facilities.
Counseling and problem solving skill building would be a great feature seen in them.

Team