1. Participatory Learning and Action(PLA)
Rajkumar Gope

2. THIS PRESENTATION What is COMMUNITY MOBILISATION vis-à-vis PLA?
The Ekjut Trial & related studies
Addressing Inequities
Global recommendations
PLA in states and scaling up innovation
Summary

3. What is community mobilization?
A capacity building process through which community members, groups or organizations
plan, carry out, and evaluate activities in a participatory and sustained basis to improve their health and other conditions, either on their own initiative or stimulated by others.
Lisa Howard-Grabman et al, 2007

4. PLA meetings happened in 4 phases
1st Phase : Identifying and prioritizing problems
2nd Phase: Finding solutions and deciding strategies
3rd Phase: Implementing the chosen strategies
4th Phase: Evaluating their activities

5. PLA meeting

6. THIS PRESENTATION What is COMMUNITY MOBILISATION?
The Ekjut Trial & related studies
Addressing Inequities
Global recommendations
PLA in states
Summary

7. IMPACT ON NEWBORN MORTALITY FROM 4 STUDIES IN INDIA
2009
2010
2011
2012
…………
2015
1. THE EKJUT TRIAL (cRCT)
2. REPLICATION IN TRIAL CONTROL AREAS ( )
3. SCALING OUT IN 5 NEW DISTRICTS (evaluation)
4. PLA THROUGH ASHAs (cRCT) (JOHAR Trial)
Action Against Malnutrition
CARING
Trial

8. Improving maternal and newborn health among tribal communities in Eastern India THE EKJUT TRIAL [ ]
A collaboration between:
Centre for International Health and Development
PRADAN 8

9. THE EKJUT TRIAL (cRCT) (LANCET 2010)
3 DISTRICTS OF JHARKHAND AND ODISHA (2005-8)
Population covered by SURVEILLANCE
228,186
Mothers interviewed
19,030

10. THE EKJUT TRIAL Lancet publication Intervention with WOMEN’S GROUPS
244 GROUPS FOR EKJUT TRIAL
Intervention with WOMEN’S GROUPS
NO Intervention with WOMEN’S GROUPS
Cluster mean neonatal mortality rate per 1000 livebirths 60
45% REDUCTION IN NEONATAL MORTALITY
(OR: % CI: ) 40 20
Lancet publication
2004-5
2005-6
2006-7
2007-8
Tripathy et al. Lancet 2010

11. REPLICATION IN CONTROL AREAS
GROUPS IN EKJUT TRIAL INTERVENTION AREAS
GROUPS IN TRIAL CONTROL AREAS
Cluster mean neonatal mortality rate per 1000 livebirths
31% reduction in NMR
(OR: 0.69, 95%CI: ) 60 40 20
2004-5
2005-6
2006-7
2007-8
2008-9
Sarbani Roy et al. – Bull World Health Organ 2013; 91: B

12. POPULATION COVERED BY SURVEILLANCE
FIVE NEW DISTRICTS
POPULATION COVERED BY SURVEILLANCE
364,030
Non- Randomised, Controlled Evaluation in 30 Geographic Clusters Of ~ 7000 Population
20,010 BIRTHS
20% REDUCTION IN NMR

13. 5 districts of Jharkhand & Odisha
JOHAR Trial
Study Area
5 districts of Jharkhand & Odisha
[2010 to 2012]
Population 158,053 [approx.]

14. ASHAs conducted monthly PLA meetings with women’s groups
in addition to their routine work

15. 31% REDUCTION IN NEONATAL MORTALITY
RESULTS
31% REDUCTION IN NEONATAL MORTALITY
36% reduction in Maternal deaths
Tripathy et al. Lancet Global Health 2016

16. Reduction in neonatal deaths was amongst small, low birth weight and premature babies, infection prevention and prevention of hypothermia; and better birth preparedness and increased facility deliveries

17. ‘ADDRESSING INEQUITIES’

18. ADDRESSESING INEQUITIES
71%
33%
Houweling et al. Int J Epidemiology 2013

19. JOHAR TRIAL (2010-12) (Jharkhand Odisha Health Action Research)
Neonatal mortality rate (per 1000 livebirths
Tripathy et al. Lancet Global Health 2016
Marginalization defined as belonging to a tribe, low wealth quintile and unable to read

20. JOHAR: IMPACT AMONG POOREST
Tripathy et al. Lancet Global Health 2016

21. THIS PRESENTATION What is COMMUNITY MOBILISATION?
The Ekjut Trial & related studies
Addressing Inequities
Recommendations
PLA in states
Summary

22. GLOBAL
ENDORSEMENT
&
RECOMMENDATION

24. THIS PRESENTATION What is COMMUNITY MOBILISATION?
The Ekjut Trial & related studies
Addressing Inequities
Global recommendations
PLA in states
Summary

25. EKJUT SUPPORTS PLA
‘Shakti varta’, Odisha –providing technical assistance in 15 districts – improving nutrition and WASH
‘Gram Varta’, Bihar - providing technical assistance in 8 districts – improving nutrition and WASH
‘Sanjhi Sehat’ Madhya Pradesh - providing technical assistance in 8 districts – improving nutrition and WASH
West Bengal – Sunderbans – technical assistance for PLA on nutrition and WASH
FLAG: Facilitated Learning Action Group-Across Jharkhand in a phased manner

26. EKJUT SUPPORTS PLA Action Against Malnutrition(AAM) project
Community Action Research to Improve Nutrition and Growth among children under two (CARING project) cRCT
Jharkhand – PLA for PVTGs, in Santhal Parganas and across the state in next 5 years
‘Home for the homeless’ – Right to the city initiative

27. SHAKTI VARTA in ODISHA

28. Population-2011 (Census provisional) No. of most difficult Blocks
Coverage
District
Population-2011 (Census provisional)
C.D. Block
No. of most difficult Blocks
G.P.
No. of Villages
No. of SHGs
Male
Female
Total
Bolangir
8,31,349
8,17,225
16,48,574 14
285
1794
10642
Kandhamal
3,59,401
3,72,551
7,31,952 12 3
153
2515
6143
Rayagada
4,69,672
4,92,287
9,61,959 11 9
171
2667
7098
TOTAL
16,60,422
16,82,063
33,42,485 37
609
6976
23883
Anugul
6,54,898
6,16,805
12,71,703 8
209
1922
14872
Kalahandi
7,85,179
7,87,875
15,73,054 13 2
273
2205
11126
Keonjhar
9,07,135
8,95,642
18,02,777 4
286
2127
11881
Sundargarh
10,55,723
10,24,941
20,80,664 17 6
262
1744
17602
Bhadrak
7,60,591
7,45,931
15,06,522 7
193
1307
9512
Gajapati
2,82,041
2,93,839
5,75,880 5
129
1576
5209
Jharsuguda
2,97,014
2,82,485
5,79,499 78
356
4324
Koraput
6,77,864
6,99,070
13,76,934 10
226
1997
17370
Malkanagiri
3,03,913
3,08,814
6,12,727
108
928
7676
Nawarangpur
6,04,046
6,14,716
12,18,762
169
897
9204
Nuapada
3,00,307
3,06,183
6,06,490
109
659
6475
Sambalpur
5,29,424
5,14,986
10,44,410
148
1325
8841
71,58,135
70,91,287
1,42,49,422
115 38
2190
17043
115251
Grand Total
88,18,557
87,73,350
1,75,91,907
152 50
2799
24019
139134

29. District TA Coverage

30. MADHYA PRADESH

31. Gram varta in BIHAR

32. Innovation in Scaling up

33. ‘ODD AND EVEN’ ARRANGEMENT
SCALE-UP IN JHARKAHND
‘ODD AND EVEN’ ARRANGEMENT
The ASHA Facilitator facilitates PLA meeting in the 10 even numbered villages during the month
Neighbouring Sahiya from odd numbered villages attend the meetings & get ‘on the job training’
Then they conduct PLA meetings in their respective villages on their own
2nd month Sahiya Sathi will continue same process with Odd number villages and the cycle continues…

34. THE BENEFITS...
Training of ASHA facilitators Vs ASHAs in the state
Cost of residential training came down considerably
Enabling spurred scaling up

35. THIS PRESENTATION What is COMMUNITY MOBILISATION?
The Ekjut Trial & related studies
Addressing Inequities
Global recommendations
PLA in states
Summary

36. SUMMARY… Is based on evidence Saves lives Is nutrition sensitive
Is equitable : meetings attract the poorest
PLA impacts and interests of group members are sustained
Meetings can engage & energize frontline health workers
Different cadres can be trained to conduct meetings: Facilitators, ASHAs, AWWs … men!
Addresses various issues – newborn and maternal mortality, Under-nutrition, WASH, FP, adolescent health, violence against women, Linking agriculture with nutrition & natural resources(LANN), etc

37. SUMMARY Increases problem solving skills of members
Empowers women to make decisions about health of self and their children
Increases problem solving skills of members
Helps them understand cause and effect of the problems
Increases demand and uptake of services
The PLA approach can be scaled up in a very short time

38. @richardhorton: It's not a drug. It's not a vaccine. It's not a device.
It's women, working together, solving problems, saving lives.
(1st May 2013)

39. Thank you