The Antara Foundation partners with government to improve maternal and child nutrition outcomes by increasing collaboration among existing community health worker cadres in India.
India’s maternal and under-five mortality rates are 113 per 100’000 live births and 30 per 1’000 live births respectively. While there has been progress over the past three decades, India still ranks in the bottom one-third of countries globally. Pregnancy and childbirth-related complications account for two-thirds of maternal deaths, whereas child and maternal malnutrition cause ~70% of under-five deaths. Most of these deaths could be prevented through timely interventions.
Although there are currently approximately 2 million community health workers (CHWs) active across the country, a lack of coordination limits their ability to provide quality care. There are three CHWs in each village in India (the ANM, ASHA and Anganwadi Worker – termed together as the AAAs*), addressing the various community health needs, from midwifery and nursing to health education to nutrition and childcare. Even though these AAAs operate within the same communities, because they are part of different government departments with varying reporting structures, processes and information systems, they are unable to collaborate and share data, serving their communities in silos instead. This lack of integrated healthcare delivery approach limits their effectiveness and prevents the sharing of knowledge and data. Furthermore, although AAAs are required to undergo role-specific pre-service trainings and subsequent refresher trainings, in reality a significant percentage of AAAs are inadequately trained and insufficiently supported by overburdened supervisors.
*1) ANM (Auxiliary Nurse Midwife – trained nurse-midwife working at the most basic health facility, known as Sub-Center). 2) ASHA (Accredited Social Health Activist – community mobilizer who goes door-to-door educating people on health). 3) AWW (Anganwadi Worker – runs the community-based nutrition center and creche, known as Anganwadi Center).
Ashok Alexander founded The Antara Foundation (TAF) in 2013 to address the problem of public health delivery and to improve maternal and child health and nutrition (MCHN) outcomes in India. While there are tested, known solutions to MCHN issues, Ashok knew that the challenge is to deliver a “combination of these solutions at scale, with appropriate quality and speed”. TAF’s model leverages India’s existing public health infrastructure and improves the system’s effectiveness by 1) improving coordination among CHWs, 2) building the capacity of CHWs to deliver quality care and 3) leveraging data to address targeted healthcare gaps.
At the core of TAF’s intervention is the AAA platform. The platform, which comprises processes, tools and training, aims to increase collaboration, coordination and knowledge exchange and to break down the silos among AAAs working in the same village, resulting in an improved, data-driven and patient-centric approach to primary healthcare. The platform includes:
Between the time of its founding in 2013 and 2021, TAF trained 134’000 CHWs, who have reached 3.6 million pregnant and lactating women and 7.8 million children under the age of five. To date, as a result of TAF’s intervention, CHWs’ knowledge of health and nutrition has increased by 56%, and CHWs have identified and managed 1.5 times as many high-risk pregnant women and three times as many malnourished children as before, as per a sample study by TAF. The organization expects to reach 13 million beneficiaries by 2023.
TAF has contributed to ensuring maternal and child health and to increasing the training and development of health workers (SDG target 3.1, 3.2 and 3.c). TAF has also contributed to the goal of achieving universal health coverage, including access to quality essential healthcare services (SDG target 3.8).
|Impact Reach (cumulative)||FY16||FY17||FY18||FY19||FY20||FY21|
|No. of districts reached||1*||2*||2*||12*||1* + 33**||6*|
|No. of CHWs trained||52*||6'500*||6'500*||133'000**||290* + 133'000**||500*|
|No. of beneficiaries reached||4'650*||179'825*||355'000*||3'248'000*||54'400*+ 10'600'000**||619'000*|
* Reach through TAF's direction intervention
** Reach through scaling driven by AAA platform adoption by government