A maternal and child health programme in Agra’s slums is using games to change perceptions

Poonam, Madhu, Munni, and other community women of an urban slum in Agra sit around a multi-coloured map of their neighbourhood. Poonam explains what they are doing. “In this map, the big red bindis (dots) are for children, while the smaller ones denote pregnant women. We are putting white dots on each of the red bindis to indicate the number of women and children who have been immunised.”

Meet the members of Mahila Arogya Samiti (MAS), an all-women group responsible for implementing an innovative community monitoring programme that ensures maternal and child health in their Ramnagar slum. Like any other urban slum, Ramnagar is densely populated, with poor levels of hygiene and sanitation. The efforts of the MAS, however, are helping to slowly bringing about change.

MAS is part of the Health of the Urban Poor (HUP) programme, a consortium-based initiative of the Population Foundation of India (PFI) being run with the support of USAID and the Indian government. “The HUP programme is focused mainly on women. Our intervention is not about building physical infrastructure — like hand pumps or clinics — but bringing on a behavioural change so that existing facilities are made use of. Broadly, the idea is to ensure that the community is able to take care of itself,” shares Dr. Swati Mahajan, manager-city demonstration of HUP.

According to Dr. Mahajan, the HUP programme is testing out some principles and approaches of proposed National Urban Health Mission with the purpose of generating evidences. In the cities of Delhi, Agra, Jaipur, Pune and Bhubaneshwar, a total of 287 slums/shanty towns have been identified in which HUP programme works in association with local non-government organisations to mobilise the community to utilise existing infrastructure by developing their own tools.

Ramnagar’s bindi map is one such tool. Madhu, the feisty 50-year-old president of Ramnagar MAS, says, “We are a group of 12. Each one of us supervises 10-12 households. To make things clear, we have made a map with different coloured blocks that represents each member’s area of supervision.”

During their regular visits, whenever an MAS worker comes across a pregnant woman, she puts a small red bindi on the map. For an infant, it’s a big red dot. “As time progresses, we keep ensuring that the women and children get immunised, and keep putting white dots on the red bindis. We can also track deliveries through this method,” adds Madhu. Ever since they got together, around a year ago, she reveals that the number of institutional deliveries in their slum has gone up.

Besides devising the effective bindi map, the MAS also interacts with community women on issues related to maternal and child health. But to ensure that its discourse on good practices doesn’t remain mere rhetoric but is internalised, it has developed its own version of the popular board game, ‘Snakes and Ladders’. The game has been designed in such as way that every good practice leads a pregnant woman to climb up the ladder while a bad one pushes her towards the snake’s mouth. The MAS group reports to a link worker, who is akin to an Accredited Social Health Activist (ASHA) in National Rural Health Mission. Picked from within the local community, it’s this link worker who facilitates the group. While the link worker and the cluster coordinator are on the payroll of the NGO, the MAS members are volunteers. The idea, Dr. Mahajan explains, is that after the project ends, the group continues their work because it is motivated to make a difference in the community and not because of any economic incentive.

“Ramnagar’s MAS members are really motivated. They are all literate and work independently, although we do meet at regular intervals,” says Suman, the link worker for Ramnagar, who has to supervise 500-600 households.

For the MAS women, their journey to “do something worthwhile” has not been easy. Recalls Poonam, “The first time I told my husband that I was going to attend such a meeting, he beat me up.” A mother of five, she, however, refused to be cowed down and attended the meeting nevertheless. “I knew it will benefit all of us, my children too. Later, when the results of our work started showing, my husband’s stance softened. Today, he is on my side,” she says. Like Poonam, many other women of the group have had to face abuse from family members and others in the beginning.

According to Madhu, what helped change the community’s attitude was the corpus fund built through the contributions of members, “We collected Rs. 20 per member every week and once we had a sizeable amount, we started giving loans to anyone in the community, levying a small interest of Rs. 5 every month. Our only condition — it had to be for health reasons.” The group has lent more than Rs. 9,000 till date.

The good work being done as part of the HUP programme has motivated government health workers as well. According to Mahajan, ever since their intervention began, the local anganwadis have been observing an Urban Health and Nutrition Day every month. (Women's Feature Service)