Celebrate Solutions: Converting Innovative Practices into Health System Change in Rajasthan, India

By: Rati Bishnoi, Special Projects Intern

More women die giving birth in India than in any other country in the world—an unfortunate distinction caused largely by the high number of deliveries in rural areas that occur without the support of trained health care providers. One Indian nonprofit, however, is saving the lives of women by using innovative practices to provide mothers around-the-clock delivery and newborn care and working to incorporate these interventions into the government-run rural health care services system.

For the last 13 years, Action Research and Training for Health (ARTH) has promoted sexual and reproductive health, neonatal and child health, and health system policy change in Rajasthan, one of India’s least developed states. Addressing maternal mortality in the largely rural state has meant addressing the issue of home births without a doctor, nurse, or midwife present. More than one-half of deliveries in India occur without any such support—a main contributing factor to the 63,000 maternal deaths in the country per year.

ARTH staff train women in villages to become midwives so they can assist with births by supplying antibiotics, intravenous drips, and other services to provide “routine care during pregnancy, delivery, and after and keep an alert eye for complications,” Pediatrician and Co-Founder Sharad Iyengar recently told the Wall Street Journal. In addition to training and checklists to help midwives recognize symptoms of complications and determine when to hospitalize a woman, ARTH has a small network of doctors committed to responding to midwives’ calls for more specialized medical support. A small fleet of vehicles is also available for physicians to quickly reach patients.

ARTH’s task-shifting approach has enabled a limited number of physicians to address serious complications more effectively and saved the lives of a greater number of rural women. ARTH’s trained midwives help provide approximately 1,000 deliveries per year across several districts in south Rajasthan. Recognizing this success, the Rajasthani government has decided to adopt ARTH’s practices and contracted with the organization to develop “master trainers,” who teach select village women to become skilled birth attendants. In 2007, the organization also opened a School of Midwifery Practice and Training Primary Heath Care.

ARTH was recently recognized by the John D. and Catherine T. MacArthur Foundation for saving the lives of women and girls through both its innovative approach and commitment to incorporating successful strategies into the government-run health system. ARTH is planning on using a $350,000 2010 MacArthur Award for Creative and Effective Institutions to expand field campuses to provide more safe births.

Photo via One_day_in_my_garden