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Jan Mangal: Community-based contraceptives distribution intervention, Rajasthan
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Subject Area="Social marketing and franchising." Objective="Access to family planning."
Details for Reform Option "Jan Mangal: Community-based contraceptives distribution intervention, Rajasthan"
Summary

Background: From 1951-1991, a high rate of population growth was recorded in Rajasthan. The absolute growth in population was coupled with low acceptance of spacing methods, high infant mortality rates and lack of adequate knowledge of permanent and, particularly, reversible methods of contraception. Poor contact between the community and Auxiliary Nurse Midwives (ANMs) meant that the community did not perceive her as a source of reversible contraceptives (Oral Contraceptive Pill (OCP) and condoms). The Jan Mangal Project was therefore developed to generate awareness in community, create demand for family planning products and address socio-cultural barriers. Action: The programme was carried out by unpaid volunteer husband and wife (in most cases) teams known as Jan Mangal Couples (JMCs), recruited by the ANMs after consultation with community members using a pre-decided selection criteria. Their role included: (i) Supply of contraceptives (OCPs and condoms). (ii) Contraceptive counselling as well as referral for other contraceptive methods. (iii) Providing information on the needs and benefit of use of spacing methods. The JMCs have three days of training, mainly at the PHCs. Topics covered include: (i) Ill-effects of child and maternal health due to frequent pregnancies. (ii) Need and benefits of using spacing methods. (iii) Information on spacing methods and their side-effects, as well as management of side-effects. (iv) Record maintenance. (vi) Counselling skills. JMCs also attend bi-monthly meetings called Milan Baithak at the PHC. The JMCs bring with them the village register in which they record details of the users of OCPs and condoms. Their performance is assessed and discussed in these meetings. Quality issues such as discontinuation, incidence of side effects etc are discussed and the meetings used as continuing education sessions. Results: After seven years, TNS MODE Pvt. Ltd. (New Delhi) carried out an evaluation study in two districts of Udaipur and Sawai Madhopur into service coverage and quality; the profile and competence of the volunteers; the system support; and community perspectives on Jan Mangal intervention. [Findings can be found in the documents section.] Generally, the programme has ensured ready availability and accessibility of OCPs and condoms in remote villages and has facilitated the creation of a large community-based volunteer cadre. As of March 2003, there were 28,303 JMCs in 32 districts catering to a total of 2,41,817 uses of OCPs and condoms.

Cost From 1999 to 2002, the programme cost INR 2.45 Crore. Cost-effectiveness has been calculated by comparing the cost saving of providing contraception under the Jan Mangal initiative against the equivalent cost of sterilisation in the country under the family planning programme (which is funded by the state). The cost of sterilisation in Rajasthan under the programme was less than half the cost in the country and about a third of the cost in the state (where the programme was not being implemented). (See TNS MODE report in Documents section for more details).
Place Initially two districts of Alwar and Udaipur in Rajasthan. Later up-scaled to seven districts, then to the whole State. June 1993 – ongoing.
Time Frame Six months.
Advantages

Increased availability of contraceptives: in remote areas. Widens health coverage: Creates a sizeable workforce (of JMCs) in remote areas to assist in any other national health programme or allied activities, e.g. during epidemics etc. and can be used to piggyback other interventions, such as HIV/AIDS. Cost effective.

Challanges

Threat perception: The ANMs sometimes perceive the JMCs as competitors rather than facilitators and do not keep them supplied with contraceptives. Corruption: Strict adherence to the eligibility criteria during JMC selections has not always been followed due to political interference. Needs support: MOs holding the Milan Baithaks are sometimes unmotivated and do not provide the JMCs with the support they need. Needs good management: Delays in paying honoraria to/ lack of regular contact with JMCs does lead to a lack of motivation and use of contraceptives falls if the JMCs do not maintain regular contact. Training: JMCs need regular re-training.

Prerequisites

Training programme and available trainers for JMCs. Clearly articulated selection process. A sound programme management structure.

Who needs to be consulted

State government, ANMs, MOs.

Risks

Sustainability

Has been working in Rajasthan for more than 10 years. Because contraception awareness has been generated in the community and demand has been created, men and women are increasingly approaching ANMs for contraceptives. The existence of local depots with supplies is likely to improve accessibility of the supplies which is in turn likely to ensure the sustainability of the Jan Mangal intervention if donor agency stops funding. However, coordinating the functioning of the local depots will be important for achieving sustainability.

Chances of Replication

Good. The Jan Mangal intervention was piloted in two districts of Alwar and Udaipur in 1993 and later up-scaled/ replicated in all districts in the state. UNFPA supported the programme in 7 districts in the state (Alwar, Udaipur, Bhilwara, Bharatpur, Chittorgarh, Karauli and Sawai Madhopur).

Comments

The project was innovative and involved active participation by community volunteers. The findings of the TNS MODE evaluation suggest that the Jan Mangal intervention has potential to increase use of family planning methods, particularly spacing methods. The intervention has been found to be useful in increasing education and counselling of couples to use family planning methods and make services accessible in the villages.

Contact

Submitted By

Clare Kitchen, Research Consultant, ECTA, New Delhi. August 2004.

Status Active
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