Advocacy

Evidence based advocacy for maternal and neonatal health

ARTH is undertaking an evidence based advocacy for maternal-neonatal health (including safe abortion) across the seven divisions of Rajasthan state, using a gender, rights and health systems approach, in collaboration with the Department of Medical Health and Family Welfare Services, Government of Rajasthan.

The focus of ARTH's advocacy efforts has emerged from the various research studies that it has conducted. One of these was a qualitative study on neonatal care and childbirth practices at home and institutions, another was a quantitative survey of delivery practices, and there were 2 verbal autopsy studies for maternal deaths. These studies have thrown light on very crucial issues, including quality of delivery services, referral mechanisms, timing of discharge, costs of services and immediate neonatal & maternal care at home and in institutions.

As a part of this advocacy, various activities are being carried out:

Seminar for faculty of training institutions of Rajasthan: Expanded Role of Nurse-Midwives in Providing Reproductive Health Services
In collaboration with the Department of Medical, Health & FW Services, Government of Rajasthan, we organized a one day seminar to orient the faculty of nurses' training schools in the state, about the expanded role of nurse-midwives in providing safe abortion, delivery and newborn care services.

The main objectives of the seminar were:
- In the light of recent changes in policy and programmes, to review the expanded role of nurse midwives in providing key reproductive health services, viz. safe abortion, delivery and newborn care
- To orient the faculty of training schools of Rajasthan, about the implications of these expanded roles for training nurse-midwives
42 nursing tutors from different nursing colleges of the state participated in the seminar, that was held in the state capital, Jaipur in January 2010.
State level consultation of expert group on "evidence based delivery and newborn care" organized by ARTH in partnership with government of Rajasthan, UNFPA and UNICEF, in Jaipur on 11th&12th September 2009. The consultation brought together senior faculty members (gynecologists and paediatricians) of all the medical colleges of the State for review and adoption of evidence based practices. Principal Secretaries of MH&FW and Medical Education, Secretary (FW) & Mission Director NRHM, various officials from GoR and representatives of UNICEF and UNFPA were present in the consultation.
A booklet entitled "Recommendations for Key Delivery and Newborn Care Practices in Health Facilities of Rajasthan" is under printing.
In the month of August, GoR issued a notification directing all the public health institutions to follow evidence based obstetric practices.
Strong emphasis on evidence based care during training of trainers for skilled birth attendants: ARTH has so far trained more than 217 midwifery trainers across all districts of Rajasthan, whereby information on certain key practices during labor and delivery is collected, training on evidence based care in delivery and neonatal care is provided and at the end of the training, all participants make a plan for implementing these practices in their own institutions.

Influencing policy and programmes- advocacy initiatives

In the last decade, ARTH has made significant efforts to inform policies and programmes, at the district, state, national and international level.

Successful innovations from the field area, such as the introduction of Copper-T 380A (the “ten year Copper-T”) have impacted on national policy. In 2004, GOI switched to using Copper T 380A and the Department of Family Welfare Ministry informed that the publication of ARTH played a part in bringing about this change.
The innovation of first trimester abortion using MVA technology has also had an impact. ARTH had demonstrated that locally resident nurse-midwifes can be equipped and trained to play a larger service role in the management of community health. This was published in an international journal and helped in the effort to liberalise national law on rules of safe abortion in 2003.
Due to its direct involvement in rural health care, ARTH’s advocacy through various committees at local, national and international levels have had a significant degree of credibility.
ARTH has undertaken research involving government health systems – this featured 12 government PHCs of Udaipur district as part of a WHO-supported child health project (IMCI), an assessment of abortion services in government and private sectors, and a study of why auxiliary nurse-Midwives (ANMs) of Rajasthan commute rather than stay within their allotted work areas.
ARTH has prepared and published a range of training and educational materials and manuals, including one on skilled maternal-neonatal care for nurse-midwives, pictorial material for village health workers and life skills education for adolescent boys.

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	Advocacy Evidence based advocacy for maternal and neonatal health ARTH is undertaking an evidence based advocacy for maternal-neonatal health (including safe abortion) across the seven divisions of Rajasthan state, using a gender, rights and health systems approach, in collaboration with the Department of Medical Health and Family Welfare Services, Government of Rajasthan. The focus of ARTH's advocacy efforts has emerged from the various research studies that it has conducted. One of these was a qualitative study on neonatal care and childbirth practices at home and institutions, another was a quantitative survey of delivery practices, and there were 2 verbal autopsy studies for maternal deaths. These studies have thrown light on very crucial issues, including quality of delivery services, referral mechanisms, timing of discharge, costs of services and immediate neonatal & maternal care at home and in institutions. As a part of this advocacy, various activities are being carried out: Seminar for faculty of training institutions of Rajasthan: Expanded Role of Nurse-Midwives in Providing Reproductive Health Services In collaboration with the Department of Medical, Health & FW Services, Government of Rajasthan, we organized a one day seminar to orient the faculty of nurses' training schools in the state, about the expanded role of nurse-midwives in providing safe abortion, delivery and newborn care services. The main objectives of the seminar were: In the light of recent changes in policy and programmes, to review the expanded role of nurse midwives in providing key reproductive health services, viz. safe abortion, delivery and newborn care To orient the faculty of training schools of Rajasthan, about the implications of these expanded roles for training nurse-midwives 42 nursing tutors from different nursing colleges of the state participated in the seminar, that was held in the state capital, Jaipur in January 2010. State level consultation of expert group on "evidence based delivery and newborn care" organized by ARTH in partnership with government of Rajasthan, UNFPA and UNICEF, in Jaipur on 11th&12th September 2009. The consultation brought together senior faculty members (gynecologists and paediatricians) of all the medical colleges of the State for review and adoption of evidence based practices. Principal Secretaries of MH&FW and Medical Education, Secretary (FW) & Mission Director NRHM, various officials from GoR and representatives of UNICEF and UNFPA were present in the consultation. A booklet entitled "Recommendations for Key Delivery and Newborn Care Practices in Health Facilities of Rajasthan" is under printing. In the month of August, GoR issued a notification directing all the public health institutions to follow evidence based obstetric practices. Strong emphasis on evidence based care during training of trainers for skilled birth attendants: ARTH has so far trained more than 217 midwifery trainers across all districts of Rajasthan, whereby information on certain key practices during labor and delivery is collected, training on evidence based care in delivery and neonatal care is provided and at the end of the training, all participants make a plan for implementing these practices in their own institutions. Influencing policy and programmes- advocacy initiatives In the last decade, ARTH has made significant efforts to inform policies and programmes, at the district, state, national and international level. Successful innovations from the field area, such as the introduction of Copper-T 380A (the “ten year Copper-T”) have impacted on national policy. In 2004, GOI switched to using Copper T 380A and the Department of Family Welfare Ministry informed that the publication of ARTH played a part in bringing about this change. The innovation of first trimester abortion using MVA technology has also had an impact. ARTH had demonstrated that locally resident nurse-midwifes can be equipped and trained to play a larger service role in the management of community health. This was published in an international journal and helped in the effort to liberalise national law on rules of safe abortion in 2003. Due to its direct involvement in rural health care, ARTH’s advocacy through various committees at local, national and international levels have had a significant degree of credibility. ARTH has undertaken research involving government health systems – this featured 12 government PHCs of Udaipur district as part of a WHO-supported child health project (IMCI), an assessment of abortion services in government and private sectors, and a study of why auxiliary nurse-Midwives (ANMs) of Rajasthan commute rather than stay within their allotted work areas. ARTH has prepared and published a range of training and educational materials and manuals, including one on skilled maternal-neonatal care for nurse-midwives, pictorial material for village health workers and life skills education for adolescent boys. «Back to activities	Service innovation Technical assistance Research Advocacy Mainstreaming Gender in India’s RCH Programme This approach document for the RCH programme prepared in 2004 drew extensively from ARTH’s experience of work in Rajasthan in implementing reproductive health programme. The RCH II programme document drew extensively from this document to frame its gender mainstreaming strategy.