2011 Grant Recipient
MHS Program, International Health, JHSPH
The RESPOND partners EngenderHealth and JHUCCP are providing technical assistance to the Government of Uttar Pradesh (GoUP) to expand awareness, acceptance and access to No-Scalpel Vasectomy (NSV) services. RESPOND’s technical assistance is closely aligned with the State’s National Rural Health Mission (NRHM) Action Plan for 2009—2010 and is supportive and synergistic of the State’s planned interventions and activities and sets the stage for expansion and scale up of NSV interventions in 2010-11 and beyond.
I was excited to return to my home country for summer internship with the RESPOND Project. This was more so, due to the opportunity of working with demand generation efforts for No Scalpel Vasectomy (NSV) in a state like Uttar Pradesh, where strong cultural factors can challenge such efforts, and the state having gone through a dark phase in the mid 70s involving forced vasectomies during the Emergency. But when I came to Kanpur for my field work, I was impressed by the dedication of the Program officers – they had joined just a few months ago; were living away from their home towns and working so hard from about early morning till late evening six days a week. They themselves were new to rural Uttar Pradesh and yet had reasoned and convincing answers for any concern that a client or his family would ask about NSV. I instantly connected with them and they were friendly and supportive enough. My work with this project involved interviewing female health workers who are the mainstay of demand generation for NSV, the accredited social health activists (ASHA), to report the challenges they face in counseling male clients for NSV. Later, I prepared a health communication tool for ASHAs to enable them to better counsel their clients. A lot of my field work and interaction with ASHAs, Medical officers and other facility personnel was made possible due to the support and excellent coordination between the Program officers.
In this process, I learned, by listening to the respondent and making rapport as qualitative field work always generates a lot of additional key information which need not fit into the format of the questionnaire or the field tool that you are using and; by probing through the questions. This strongly helped in the data analysis. One key aspect learned was the importance of interacting with all members of the “accountability chain” – to know the perspective of auxiliary nurse midwives (ANMs) who supervise the ASHAs and the medical officers who in turn supervise the ANMs. Knowing their views and challenges, would ultimately affect demand generation; particularly in case of the ones who were pessimistic about NSV demand generation through ASHAs. This group also challenged my effort, as it was important to break through their resistance and know why they think so.
While making the communication tool, I had to think of some unique job aids and some of the most culturally appropriate and contextually relevant ones for a sensitive topic like NSV came after a lot of brainstorming with colleagues. I presented my findings in the annual work plan meeting of EngenderHealth in New Delhi, got to interact with other Program officers outside Kanpur as well as senior program managers from New York. It was satisfying to see that some of the field work findings were considered (such as involving ASHAs’ husbands) in creating the future demand generation plan of the Project.
This experience has made me realize the comfort level I have with regular field work and interacting with health workers; and the fact that spending more time in the field strengthens your data and analysis, complements the theoretical principles learned in graduate school and greatly informs your report or final documentation for any project. This internship has greatly contributed to my future goals in reproductive and maternal health. Capacity building and training of health workers is something I want to focus on, when I would work with International NGOs. RESPOND also gave me the opportunity to prepare a communication tool, which is difficult, particularly in case of family planning programs. More so, I also thoroughly enjoyed my foray in qualitative data analysis due to this internship.
The internship was extremely well structured and the different activities were linked to each other – an orientation to the Project, preparation and repeated revisions of the questionnaire, ASHA interviews, interviews of other personnel, qualitative data analysis, inferences which would clarify the challenges ASHAs face in NSV counseling, presentation of findings and reporting the challenges, recommendations to Program officers and selection criteria for ASHAs and then preparation of the health communication tool, all of which I gave on the basis of these inferences. I would advise the future Center for Global Health awardees to choose their projects not just to gain a field experience but to assess what skills could get strengthened through the summer internship and what skills they feel they should be strengthening.
|ASHAs in a meeting in a primary health center, Uttar Pradesh|
|One of my field visits for taking interviews of ASHAs (view from ASHA’s house)|
|RESPOND Team in the Project work plan meeting in New Delhi, India|
|With a community health worker in Kanpur|
|Role play to demonstrate counseling skills for ASHAs performed by program officers (at the work plan meeting, New Delhi)|