Blog by Cathy Riley, Assistant Country Director, CARE Nepal
''On a recent fieldtrip to the Far West (July 2013), I was really impressed to meet a Mother’s Group and their Female Community Health Volunteer (FCHV) and to learn about the technique that has been developed, and which they are using, to keep track of important actions that can help prevent maternal and neonatal death.
The technique, known as SATH (an acronym for ‘Self Applied Technique for Health’ which also means “supportive togetherness” in Nepali), is based on the commonly used technique of participatory mapping at the community level, but the map is not about what resources there are in the community as it is so often the case. It is about the health seeking behaviour of mothers-to-be.
Using flexi-sheet provided by the project, the women in the Mother’s Group noted the geographic position of all the houses in their community, as well as a few key location markers such as roads and rivers, forests, temples, the FCHV’s house, Health Facility, VDC office etc. The group I met had also recorded the names of the families against each of the houses.
Now, here is the crux of this story: The map is a living document which gets updated on a monthly basis depending on the behaviour/practice of all the mothers in the group. In particular, an assessment is done on whether or not a woman is pregnant, and if she is it is noted whether or not she has visited the local health centre for each of the four recommended antenatal visits during her pregnancy. Each visit is recorded with a particular ‘tika’. So also whether or not a pregnant woman is taking her iron tablets (this is known to the FCHV as she is the stockist of the tablets, so knows who is taking them and who isn’t). Those not taking the tablets get an undesirable black mark against them. Finally, a woman who delivers her baby at a health institution, rather than at home, is rewarded with a double green tikka; whereas those not managing to do so for whatever reason only receive one.
The idea, and it seems to be working incredibly well, is to encourage and incentivize pregnant women to adopt behaviours that will improve both maternal and neonatal health. I believe that a key reason that this technique should work is that there is an element of peer pressure to the monitoring of behaviour, such that mothers want to be seen to be doing the thing that gets rewarded through appreciation by peers even if it is not the ‘traditional’ way or if it means overcoming many barriers (like travelling some distance to a health post when heavily pregnant for the fourth check-up).
I am very happy to report that, for the group I met, no maternal death has occurred in the past two years, since the concept was introduced. While we cannot necessarily attribute this only to the SATH technique (as there has also been work to train local health workers, and improve facilities), I do believe that by empowering mothers to track their own behaviour and support each other to take steps for their own protection and that of their babies, we are bringing change in the lives of these women.
What a fantastic testament to the creativity and ingenuity of all the women involved – from CARE Nepal to the FCHV and the mothers in her group! It goes to show that empowered women can, do and will, make a difference in this world.''
CARE was one of the first international aid agencies to work in Nepal. Today, CARE Nepal works to address the systemic and structural causes of poverty and social injustice, such as discrimination based on gender, caste, class and ethnicity; poor governance; and vulnerability from conflict and natural disasters.
Find out more, read CARE Nepal's Country Factsheet.