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Ekjut, Jharkhand & Orissa

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Ekjut (meaning ‘coming together’) is a NGO founded by Dr Prasanta Tripathy and Dr. Nirmala Nair in 2005 to tackle poor maternal and child health services in the states of Jharkhand and Orissa. Jharkhand and Orissa are two of the poorest states in eastern India, with very poor performance in indicators such as female life expectancy, and female literacy. More than 20% of Jharkhand and Orissa’s population is affiliated with scheduled tribes, and 12% with scheduled castes.

Dr. Prasanta's and Dr. Nirmala's decision to enter maternal and child health was a result of the confluence of two factors; i) their experience running a clinic allowed them to observe that many babies died during the first month of life after home births, ii) the results of a community mobilization trial from Makwanpur, Nepal demonstrated the effectiveness of participatory interventions through women’s groups.

Ekjut’s Participatory Learning & Action (PLA) approach entails the active involvement of community members in all components of tackling maternal and newborn health problems; from identifying problems, to crafting solutions and strategies, to implementing those strategies, and finally to the evaluation phase. The approach requires Ekjut-trained facilitators to facilitate 20 meetings at the community level. Ekjut’s first trial (2005-2008) in 3 underserved districts in Jharkhand and Orissa proved the effectiveness of the participatory intervention approach with a 32% reduction in NMR during the 3 year trial, and a 57% reduction in moderate maternal depression in the final year of the trial. Having proved the effectiveness of PLA, Ekjut expanded its activities into the control clusters of the initial trial, and into 5 new underserved districts in Jharkhand and Orissa.

Ekjut is currently undertaking 2 additional trials. First, the JOHAR trial aims to evaluate the scalability of the PLA approach using trained ASHAs as facilitators. Second, the POSHAN evaluation site, aims to evaluate the effectiveness of adding a nutrition component to the PLA approach by having home visits to deal with mild to moderate cases of undernutrition, and referrals for severe cases.

Ekjut’s trials are underpinned by a rigorous surveillance system. Surveillance for the JOHAR trial covers a population of approximately 175 000, and includes collecting information on births and deaths to women of reproductive age, and on events during the antenatal, delivery and postnatal periods. The POSHAN evaluation is a before and after study, with a baseline done for a population of 130 000 in May & June 2012, and end line data collection planned in 1 and half years’ time.

Ekjut hopes that its models prove scalable, and eventually get adopted by government at various levels.

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