Forming women’s groups in urban slums to improve Universal Health Coverage
On August 4, 2016 the National Health Mission, Maharashtra (NHMM) signed an MOU with SNEHA as "Mother NGO" to collaborate with local NGOs to form 9393 Mahila Arogya Samitis (MAS) with bank accounts across 95 Urban Local Bodies (ULBs) in the state. 27 Municipal Corporations, 64 Councils and 4 Cantonment Boards were covered through the initiative.
The program trained 1600 state, ULB and NGO trainers and 3600 ASHAs and NGO field staff. By the end of the programme on October 31, 2018, 8075 MAS were formed, as per GOI guidelines for MAS. Bank accounts were opened for 5733 MAS.
Mahila Arogya Samitis (MAS) are women’s groups of 8-12 locally resident women, formed for every 100 households in urban vulnerable settlements, for neighborhood health planning, action on social determinants of health and for monitoring all local services. The municipal Accredited Social Health Activists (ASHA), or health outreach worker is a member Secretary of the MAS and a member is elected as Chair. The MAS is expected to, increase uptake of government health services through creating awareness among the 100 families, on all health and allied issues, and referring community members on a timely basis to the appropriate service provider. A well-functioning MAS can support neighborhoods to take ownership of their health and allied concerns through empowerment of women and thereby bridge the gap between people’s needs and service delivery.
As the first step SNEHA decided to co-opt NGOs functioning in urban slums across Maharashtra to help form MAS in the 95 ULBs, with an incentive of Rs. 500/- per MAS formed with bank account. NHM, ULBs and SNEHA together conducted a rigorous exercise of selecting NGO partners. MOUs were signed by SNEHA with 32 local NGOs in January 2017 and 22 NGOs continued to partner till the end of the project in October 31, 2018. 40 volunteers were recruited as an additional support with approval from NHM to support the different stages of MAS formation. NHM and ULB officials, UPHC and NGO staff and volunteers were facilitated to work in close collaboration with local banks and their staff. Joint efforts were made to advocate with bank senior officials, zonal bank managers, district collectors, lead bank managers and the State Lead Bankers Committee. ICDS, NULM, MAVIM supported MAS formation through participation in the State Advisory Board and issuing circulars to their staff.
The process of collaboration with the state, all ULBs, NGOs and volunteers was a positive experience as each one contributed actively. This was a fine example of multiple stakeholders coming together for a common cause.
The Municipal Commissioner in Mira-Bhayander took a personal interest in the achievement of their MAS target. This motivated the Medical Officer of Health and UPHC staff to participate in the training on MAS formation and initiate the MAS formation process. Learning from our experience of opening MAS bank accounts, Mira-Bhayandar Municipal Corporation, UPHC staff and SNEHA worked together to innovate the process by first identifying women in the slums who have their KYC documents to enroll as MAS Chairs and then select the MAS members in their neighborhood of 100 families. Regular internal updates on progress made by each UPHC and personal visits by senior officials to every bank branch where MAS applications were submitted, greatly contributed to the success of the programme. The annual untied fund of Rs. 5000/- was also promptly released by the corporation in every MAS account.
The UPHC staff were highly motivated and the SNEHA team reciprocated by conducting training on the use of this fund though it was not part of our mandate. One MAS used its funds to buy mats for ICDS Aanganwadis, others conducted various awareness activities with the community. ASHAs continue to personally seek guidance from our team. There was a sea-change in the attitude of the MBMC from, “We have too much work and our field team will work with you” to, “How much MAS target is pending and what support do you need from us? Just tell us.” MBMC continues to remain grateful to SNEHA as they believe they could not have achieved their MAS target without SNEHA. They appreciate our quality of work and are keen to collaborate with SNEHA for sustaining MAS.
We are grateful to the state for providing SNEHA with resources such as office space in the NHM office at Arogya Bhavan, which enabled regular interaction with all stakeholders and timely support. for MAS formation with NHM innumerable letters to all relevant stakeholders, meetings to review and advocate with banks, We also thank all ULBs, NGOs, banks, local volunteers and staff form across SNEHA, without whose active support we would not have succeeded in forming 8075 MAS.
We believe that the future NHM work, while saturating slum population with MAS, requires focus on sustaining the formed MAS to achieve the NHM purpose of universal health care.
SNEHA has received an NOC from NHM and in- principle funding from a CSR Foundation to sustain 1000 MAS in 2 ULBs. Once we receive the letters of collaboration from the 2 ULBs, we will initiate a pilot to sustain MA. The purpose is to test the model before scaling it across the state through the NHM.