“Volunteers can be agents of change,” one survey respondent answered. Another mentioned “the environment has become less corrupt than what was prevalent before the project.” A recent evaluation of the End Maternal Mortality Now (EndMMNow.org) initiative illuminated dynamic changes in the maternal health landscape in Assam, India since the project started, but also highlighted the need to scale the initiative and continue trainings with current volunteers.

EndMMNow previously released an advocacy report illuminating gaps in service delivery of legally guaranteed maternal health care, the result of months of data collection by volunteers and coordinators in two districts in Assam. Following up with the coordinators and leaders in the project in a post-pilot assessment, respondents indicated:

Positives:

  • Many tea-garden workers had gained an awareness of their rights
  • 45 women Tea Garden workers empowered to use mobile tools to document health system gaps, 18 of whom have become community activists
  • Food rations for pregnant women now regularly provided at 527 health centers – affecting 27,000 women in six months following the report
  • Improvements were seen in healthcare delivery, including increased medicines, ambulances, cleanliness, HIV testing, and baby kits
  • Increased responsiveness of doctors and nurses
  • Lighter work is now being given to some pregnant tea garden workers
  • Some ration shops are giving correct rations and community members are better aware of their rights to rations
  • Some upper-level district officials expressed interest in the initiatives (but mid-level officials block progress)
  • Reporting via SMS overcomes uncomfortability with writing complaints and some literacy issues
  • Awareness has been raised of required infrastructure improvements, such as running water at health clinics, better roads for ambulatory access, more medical resources, etc.
  • Partner Nazdeek filed two legal complaints – one for bribery by health officials to treat pregnant women, and another to advocate for blood banks under the “right to survive pregnancy.”

Challenges:

  • Health professionals (doctors, nurses, and administrative staff) have a complaint prevention attitude and make it difficult to discuss concerns
  • Some district officials have expressed displeasure in the initiative, stating that it focuses too much on the negatives
  • Health professionals express fear that reports are being filed against them and were unaware of the project
  • Tea garden management has retaliated against workers for complaints in certain situations
  • Health professionals sometimes blame patients for their conditions, or blame the lack of resources that they are tasked with supplying
  • Reporting via SMS is limited and sometimes requires follow-up to capture important details

Through the assessment it also became clear that more needs to be done to keep participants motivated, that providing “know your rights” training courses lead to greater community empowerment, and that a variety of outreach options should be considered, both using SMS and trainings but also via local media-outlets to raise awareness in the community at large. Respondents also suggested scaling the initiative to include more communities in the region, and through the inclusion of faith institutions.

EndMMNow is a joint project between NazdeekPajhra, and ICAAD.

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