Rationale

Health indicators for rural areas are quite poor in comparison with urban areas. In the maternal and child health space, only 54% of mothers availed at least four antenatal care visits in rural areas as compared to 68% in urban areas; 40% women consumed iron folic acid for 100 days or more when they were pregnant in rural areas vs 54% in urban.  Similarly, infant mortality rate (IMR) is 28.6 in urban areas as compared to 38.4 in rural areas. (Source: NFHS 5)

For a healthy pregnancy and infancy, regular monitoring through visits with a health-care provider is essential for timely detection of high risk factors, ensuring prompt referral and appropriate treatment, prevention of life-threatening complications and reduction of child mortality. However, inadequate access to public health care services in rural areas becomes a barrier while private health-care is usually unreliable and unaffordable. There is thus an urgent unmet need for improved access to home-based diagnostic, monitoring and curative services during the antenatal period and during childhood, which will also ensure reduction in costs of health care.

Programme Design

Women from within the community are selected and trained to become Arogya Sakhis. They perform home-based preventive care, diagnostic and treatment interventions during the antenatal and infancy period

Salient Features

Equipped to perform basic diagnostic tests

Arogya Sakhis are equipped with medical kits and trained to perform basic diagnostic tests including haemoglobin, blood sugar, urine, blood pressure, foetal doppler and anthropometric measurements.

Leveraging technology through mobile application for better care and improved efficiency

Arogya Sakhis are supported by a mobile application that guides them through the care process, helps identify high-risk signs and symptoms and gives alerts regarding the need for referral.

Creating women health entrepreneurs

As the Arogya Sakhis are trained and charge a nominal sum for diagnostic tests, they are empowered financially and through skill-enhancement.

Impact

Arogya Sakhi was implemented as part of a Randomized Cluster Trial (RCT) in 250 villages with 166 sakhis across Solapur, Washim & Osmanabad in rural Maharashtra with the following results:

• 20.3% increase in women who made 4 or more ANC visits
• 22.0% increase in infants (< 1 yr of age) who have tripled their birth weight at the end of infancy
• 27% increase in women who were aware of the need for growth monitoring every month

The project is currently being implemented through 87 Arogya Sakhis in three rural/tribal blocks of Palghar district in Maharashtra. The Sakhis aim to reach over 9000 women and children in Jawhar, Mokhada and Vikramgad.