Center for Health Market Innovations (CHMI)

ARTH’s work broadly focuses on three programme areas- Reproductive Health, Child Health, and Health Systems and Policy. Work in the area of reproductive health is directed towards developing women-centered approaches for lowering reproductive mortality, morbidity, and unwanted fertility. The programme objective of the work on child health is to strengthen primary health care approaches for lowering infant and child mortality. Health systems and policy initiatives strive to promote financial and human resource investments in primary health care and to advocate policy change for enhancing equity, rights and quality within health systems.

Several of AARTHs services are described below:

• Reproductive & Child Health Centres. ARTH has been providing RCH services in its field area through two health centres. At each centre two to three nurse-midwives provide outpatient services six days a week and emergency services round the clock. A gynaecologist visits each centre twice a week and a paediatrician visits once a week. ARTH’s health centres demonstrate that trained nurses are capable of providing a wide range of maternal-neonatal services and managing complications in the absence of a doctor. An active system of referral (counselling for decision making, arranging transport, providing subsidy for poor, accompanying the patient till referral hospital) allows majority of patients to receive referral care for complications.
• First trimester abortion services. Many women facing unwanted pregnancies went to the informal service providers, often with disastrous consequences. There were no certified abortion facilities in the block when ARTH started its work. A gynaecologist visits the centres on fixed days twice a week from 10 AM to 4 PM throughout the year. First trimester MTP services are provided during those fixed days using MVA (manual vacuum aspiration) technique or by giving medical abortion drugs. As of May 2010, ARTH's centres have provided MTPs to 2389 women using MVA technique and to 1043 women using medical abortion.
• Gaon Pas: Village pregnancy advisory services. ARTH introduced village level pregnancy advisory services in July 2007. This effort utilises the potential of non-medical persons (ASHAs) to increase awareness of and access to reproductive health services to enable women to better manage their own fertility.
• Continuum of maternal-neonatal-infant care. The project aims to develop a strategy for continuum of care from pregnancy to one year after delivery in order to help reduce maternal morbidity and mortality, and neonatal mortality. The essential components of the intervention are: (1) VHWs ensure that all the pregnancies are registered, (2) all pregnant women get at least one ANC at ARTH, during which morbidities are identified, managed and recorded, (3) VHWs and other key informants report all the deliveries, irrespective of place of delivery, preferably within three days of birth, (4) two post natal visits are made by nurse midwives and subsequently by VHWs/ ASHAs to provide PNC according to a prescribed format, (5) doctors and nurse midwives who attend to newborns/infants enquire about maternal morbidity and while attending to mother’s concerns, enquire about the infant’s health.