Mitanin Programme- an
introduction
The Integration of Training,
Deployment, Support and Monitoring
of Community Health Activists (
Mitanins) to yield measurable
outcomes .
Objectives of the
Mitanin Programme:
• Improve awareness of health and health
education.
• Improve utilisation of existing health care
services
• Provide a measure of immediate relief to health
problems.
• Organise community ,especially women and
weaker sections on health care issues
• Sensitise panchayats and build capabilites
Operational Objectives
• 1. Select a Mitanin in every hamlet of the
state- 60,000 in all. A mitanin is a woman and
-fully voluntary - selected by the community
and approved by the panchayat.
• 2. Train the Mitanin over 18 months- 20 days
of camp based training and 30 days of on the
job training at the village.
• 3.Provide support to her in her work and
closely coordinate with ANM and AWW for
maximal effectiveness.
What are the Compulsions for a
Community health volunteer?
• 4000 subcenters, 26,000 villages and 54,000
hamlets- If infant mortality must fall further
then in every hamlet every newborn, every
diarrhoea, every ARI, every case with fevermust be seen on Day One.
• Health education requires someone from within
the community who knows the local idiom and
perceptions,
How is increased utilisation of
health care services effected?
• By providing information on health care services
• By creating awareness on key health care
services- as an entitlement- the rights based
approach.
• By facilitating the delivery of healthcare
services- coordination with TBA,ANMs
,anganwadis and PHC
• By local advocacy- pressure for ensuring access
to these services:
• IN PARALLEL IMPROVEMENTS IN HEALTH
CARE DELIVERY
What are the special features of the
Mitanin Programme( as compared to
earlier such programes)
1.
2.
3.
•
The volunteer is a woman – and so are all her trainers(
59,000 women require approx. 2900 trainers)
The selection is hamlet/village based
The selection is through a 3 to 6 month process where
the community makes the choice but facilitated by a
trained prerak drawn (largely from but not necessarily)
from NGOs.
While selecting a Mitanin four guidelines to remember
1. Preferably be a married woman
2. Should be able to give time( supportive family
circumstance)
3. Preferably Should have been involved in some social work
4. Education not a must but preference to good literacy level
Special features of the
Mitanin/ASHA Programme
• Curative care is complementary and essential –
but not central part of the programme.
• Continued training and support for the entire
duration of the programme – not merely an
initial effort.
• Parallel strengthening of public health systemsnot a substitute to strengthening public health
systems – but forms a context in which it
becomes more accountable and functional.
• State- civil society partnership at all levels.
Selection ProblemsWho speaks for the community?
• Method 1: ANMs/AWWs made selectionsdeclared per Mitanin selection rate of
compensation: Too many got selected, the
selected were familiar/obedient to
ANMs/sarpanch. They had expectation of
wage; Little community acceptance or
motivation.
• Method 2: Collector gives deadlines to
panchayats. Entire selection completed within a
month. All sarpanches do the selection in
expectation of wage/influence. Little knowledge
of programme. Even ANMs do not own it –
leave alone community. Weaker section
representation poor.
Selection ProblemsWho speaks for the community?
• Method 3: The anganwadi worker and helper
selected as Mitanin. Programme took off very
well- as they did not want a competitive cadre
to emerge- but in 3 months programme started
flagging, and in 9 mnths they declared that if
imposed more work they could go to court!!!
Zero community ownership
• Method 4: Contracted out to NGOs- selected
persons familiar/associated to them. ANMs
refused to own selection. Sarapanches variable
on support. Weaker sections well represented
but negotiation poor.
Approach to selection:
• Faciliation has four aspects-
– Informing the community of the programme
– Ensuring that women and weaker sections are
consulted in the choice..
– Ensuring that the panchayat approves the choice of
the gram sabha.
– Ensuring that there is enough preceding community
mobilization to generate participation and number
of volunteers to choose from. Kalajathas were used
extensively to convey /explain three key messages:
• Hamar Swasthya Hamar Haath
• Swasthya hamar adhikar hawai
• Mitanin is a volunteer of the community
How to facilitate
selection:
1. Identify one person (prerak)per cluster of villages – about 10
to 15 persons for a block.Maybe ANM/AWW worker or from
NGO or from any other source.
2. Insist on consulation meeting between different stakeholder
groups( prereak)
3. Orient them on this programme- 3 to 5 day workshop
4. Help them( training and mentoring) to develop insights on
gender, caste and power equations.- same 3 days
5. Ensure/monitor no.of meetings, at least 3 in each hamlet.
6. Hold some public events(kalajatha, aam sabha) to explain the
programme.
7. The formal gramsabha selection .
8. Then written endorsment by panchayat.
9. Documents all of these, verify and then only confirm.
10.Block level coordination of selection by an active ICDS persons
and one Active ANM/MPW and two or three NGO members or
one lead NGO.
What actually happened
in Mitanin
• Only 30% selected in this way.
• But the first four wrong types of selection were
less than 20% .
• Even where ANM and AWW chose they chose
better then they would have done otherwise. So in
effect 80% effective Mitanins.
• Assembly questions and political protests easily
faced!!! With written endorsements.
• AND LESS THAN 5% DROPOUTS
The training programmefirst round• Approach, Objectives and
specific activites of
Mitanin programme,
• An understanding of the
health and related
services available/should
be available in their area.
• An understanding of how
to improve access to and
utilisation of health
services
 An understanding of child
health – why we are
focussing on it, what are
its causes and how to
tackle it.( nutrition
including breast feeding,
diarrhoea, ARI and
immunisation).
• A brief introduction to
issues involved in women’s
health
Following the first round
– action at the village
• Forming a data base of
families and children
under 5 in her area
• Assessing state of
current utilisation of
services
• Maintaining record of
some relevant health
events begins
• Organising womens
meeting
• Focus is on health
education work- both
in group meetings and
with home visits emphasis on child
nutrition and child
health
• Focus is on developing
Mitanin’s
understanding of
health
Mitanin training- the
second round
Training Content:
• Child health
understanding
strengthened
• Utilisation of health
services – the role of the
village health register
• Management of
diarrhoea, ARI;
worms,anemia, child
malnutrition,
Village Level Action:
• ANM visits facilitated by
negotiating/publicising her
visits
• Gaps in child health care
and pregnancy care
services addressed
• All TBAs identified and trg
scheduled.
• Health education & Home
visits gain momentum
• Village health register
introduced
Mitanin Training – Round
3
Training Content
•
•
•
•
Womens health
Adolescent health
Care in pregnancy
Maternal
entititlements
• Anemia in women
• Violence & women
• RTIs
After training:
• Strengthen womens group
meetings and collective
actions
• Radio programmes on
womens health
• Campaign against anemia
• Better utilisation of
pregnancy related services
and birth planning- Janini
suraksha yojana
Mitanin Training – Round
4
Training Content:
• Community role in
Malaria control – early
diagnosis and
treatment; vector
control
• Management of
Gastoenteritis
outbreaks
Village Level Action:
• Community initiates
local level planning for
vector control
• Back up in these
campaigns provided by
sensitised, trained
PHC staff
• Mitanins trained for
making blood slides
and giving chloroquine.
Mitanin Training –Round
5
Training Content:
• Introducing the
village medical kit
• Herbal and home
Remedies
• First Aid
• Basic symptomatic
care and care in
minor illness
Village Level Action:
• Mitanin provided
with drug kit.
• Provision of first
contact care
begins
Mitanin ProgrammeRound 6
• Strengthening training
on the the village
medical kit and Basic
symptomatic care and
care in minor illness
• Tuberculosis and
leprosy- early
detection, referral
and assistance in case
retention.
• Adequate first contact
care skills established.
• TB and leprosy referral
moves up to Village level
action
• Community initiated case
detection drive and control
measures in leprosy ( as
part of campaign on skin
diseases) and in
tuberculosis.
Mitanin Training- Round
7
Training Content
Intersectoral health
determinants
• Control of waterborne
disease --Water and
sanitation
• Food Security
• School retention
• Panchayat role
• Comprehensive microplanning for health
Village Level Action:
• Drawing up a
panchayat level health
plan
• Health and human
development index for
capability building and
ensuring adequacy of
local level processes –
What does the Mitanin do?
Which can be monitored?
1. Mitanin visits every single newborn family – on
the first day of child-birth and package of six
messages/practices to be ensured
2. Every pregnant woman’s family is met with in the
last month—and the birth is planned for – and
ANC is checked/on completed.
3. Every child with diarrhoea, ARI, Fever is met
with/receives appropriate home care on first day
and a fair% of them get referred
What does the Mitanin do?
Which can be monitored?
4. Mitanin attends the Immunisation Day- which
means that left out children/ women are brought
in.
5. Mitanin knows every malnourished child in her
area and has visited them more than thrice for
counseling on preventive, curative care and
feeding practices
6. Mitanins are functional DOTS providers
7. Mitanins hold a hamlet level health meeting – as
part of a SHG or as part of independent health
committee.
Programme Structure
• State level- SHRC – a state civil soceity
partnership institution guided by a State
Advisory Committee. Has a 30 persons training
cum monitoring team.
• District level- District RCH society and dt
coordination committee/task force.
• Also district team of 15 to 30 Dt training
team. Chosen as 3 per block- 2 of whom are
from NGO and one from govt and at least one
woman.
Programme Structure
• Block is the central unit of operation. Has
appox 400 Mitanins.( 120 ASHAs).
• Wide variety of block level programme
organisation- from govt led to NGO led
• Block coordination committee. Has one
lead NGO, the BMO and per plan the block
panchayat rep.as well as the three block
coordinators(DRPs)
Block level programme
management
• Block has 15 to20 trainers one for 20 Mitanins –
all women, all full time paid Rs 50 compensation
per day of work.
• Each trainer has to take 25 days of camp based
training and to be part of training team for four
mitann training camps.
• Also every trainer has to visit Mitanins for onthe-job training on at least two days between two
rounds of training. Approximately 20 days of work
every month for 12 to 18 months.
About trainers
• Trainer also conducts cluster level Mitanin
meetings along with ANM/AWW
• Trainers are ALL women and emerge from
after the selection phase.
• Trainers- preferably ,but not necessarily
they may be all drawn from one NGO.
Budgetary Outlay.
• Out Rs 4000 per Mitanin per year or about Rs 15
per block or about 18 crores for state: plus cost
of drugs( Rs 12 crores /year for a 12 drug/20
item drug kit): plus incentives/honoraria
•
•
•
•
•
Rs
Rs
Rs
Rs
Rs
2600 of which is on training and support
400 on training materials and supplies
200 is on selection and mobilisation
500 is on monitoring and support.
300 is state and district adminstrative overheads
• Rs 10 per capita of population plus Rs 6 per capita
on drugs plus on incentives …….
Thank you