SASHAKT LEARNINGS AND WAY FORWARD

STRUCTURE OF PRESENTATION
• Key project outcomes
• Findings and recommendations from MPR evaluation of the Sashakt project
• Recommendations/observations by different stakeholder during state level dissemination workshop with state government
• Pathfinder’s implementation learning and key recommendations
• Conceptualization of next phase of the project
• Question/answers and discussion
CONTEXT: GEOGRAPHICAL COVERAGE AND TARGET GROUP

o Total population 203406, Mahadalit population

Three districts
six blocks 97461 (Sashakt program data, Aug 2019) expected
adolescent @9.7%= 9453
o Total unmarried adolescents covered under the
67 panchayats project – 6931, married adolescent 2193 (total 9124)
o Average age of the adolescent cohort unmarried was

288 Mahadalit 16 years, married was 18 years .

hamlets o Caste profile – Musahar – 75%, Chamar 12%, Hari 6%
and Dhobi 2%.
o Total ASHA -192
 Sashakt Objectives and Outputs

Project objective Curriculum development Capacity Building PE led group meetings/SL sessions

PO 1: • Peer led education - SRH • 423 peer educators of which • PE’s conducted 2403 (80% of the
Improved knowledge and life skill curriculum 233 were girls and 190 were planned 3006) SL module sessions,
and attitudes on HTSP, based on 12different boys were trained at CHC’s 5606 out of 6931 adolescents (81%)
and demand for Unmarried modules • Provided on job supportive participated in group activities
contraceptive services Adolescents supervision to trained PE’s by • Average 58% of the girls and 55% of
among Mahadalit BPC the available boys were attending SL
adolescents sessions

• ASHA curriculum – social • 192 ASHA’s (100%) received • Total 1966 (90%) married Mahadalit
Community

PO2: inclusion, IPC and family training on IPC, Social Inclusion adolescent women reached by ASHA
Improved access to planning + job aids for and FP (listed couple-2193)
contraceptive and facilitation of home visit • 192 ASHAs received training on • Average 5 visits were conducted to
maternal health and community meetings how to use job aids, tools and one women, Total 11593 visits were
services for married Married + migration tool facilitate the community conducted by 192 ASHA’s
Adolescents
Mahadalit meetings. • Total community meetings
adolescent/couples conducted 383 out of 400 to reach
7098 men and women.

PO3: System strengthening/RKSK-

Strengthened
government capacity • 83 meetings were conducted • Letters were issued for PE • Joint review meetings district level –
to deliver and sustain with block level officials validation in RKSK and AHD 3
Government

quality adolescent including MOIC, BCM and observations in each district to

health programming BHM’s.
for Mahadalit • BCM’s the nodal officers for
adolescents RKSK visited eight locations,
Block Health Managers made
three field visits whereas one
visit with MOIC was
conducted
the block nodal officer RKSK.
• PE validation exercise was
completed in three Sashakt
intervention blocks,
• 44 Sashakt PE were integrated
in RKSK in Araria district.
• End of project State level
dissemination workshop conducted
in Feb 2020
Government Official from 38
districts
 Evaluation Findings and Recommendations (MPR End-Line Study)

Knowledge around Age of marriage and HTSP Contraceptive knowledge across all sub-groups Service Delivery and behavior of ASHA workers

• Awareness about the legal age of marriage for both men • knowledge of three or more methods rose • ASHA’s no longer refer to Mahadalits by
and women increased significantly among all subgroups in significantly for all groups except for married women derogatory terms, as they did at baseline and
range of 10.4 to 28.5 percentage points (PPTs) to 82 to 97 percent (from a baseline of 52 to 70 midline
Key Findings

• Significant gains in unmarried adolescents knowledge about
benefit of delaying first and spacing subsequent births
increased by 14 to 30 percentage points, to 70 percent for
men and 90 percent for women.
• Significant decrease of 20.3 to 24.9 PPTs in proportion
expressing belief that girls should have no role in decision
making regarding timing of marriage across all sub groups
percent).
• proportion of married women reporting that
contraceptive use should be a joint decision between
a husband and wife rose from 77 to 90 percent
• increase in demand - 40 percent of married men and
women said that they plan to use a method in the
next 12 months.
• pregnant or who had recently delivered—
interaction with ASHA increased from 2.0 at
baseline to 2.5 at endline
• Between 80 and 90 percent of married
adolescents thought the ASHA was very good at
running the meetings

Community Health system Environment

• To reach and influence Mahadalit adolescent men,
• Leverage financial incentives, and more closely tie • Intensify training for peer educators around
Key Recommendations

explore new strategies and platforms for awareness-

them to SRH service provision, to improve ASHA interactive activities, and if possible, hire older,
building and sensitization that are not reliant on
outreach to Mahadalit adolescents. more experienced peer educators in the future.
community-level outreach. -digital solutions are a
• Reinforce the key messages of the social inclusion • Incorporate activities into SL sessions and
promising means of achieving social and behavioral
training for ASHAs, whose views towards Mahadalits community meetings that promote not only
change regarding SRH and FP
may have softened, but still need improvement. knowledge acquisition, but also help build
• Continue conducting community meetings.
communication and negotiation skills and increase
• Explore ways of increasing participation in the SL sessions
agency and autonomy.

• Project beyond knowledge acquisition - negotiation skills, increase agency and autonomy (social and gender norms)
Take Away • Migration – innovative communication to address the issue
• Continuation of PE led education and FLW activities
• Continuation of social inclusion
 Key Outcomes from State level dissemination

Community (Peer Educators) Environment (Other NGO’s)

Health system

• The peer educators need an official recognition,
and authorized identity
• Peer Educators could actively participate in the
state/government organized program and become
authentic source of information in the village.
Also, this would help peer educators to establish
accountability of the system towards service
delivery for Mahadalit community.
• The peer educators should be linked to economic
and social opportunities as incentive for
motivation to continue working as peer educators.
• The RKSK program has immense potential and that • Develop new partnership with
needs to be realized. This program has not been on the organizations and communities that
priority the district nodal officers hereon would take this
would help to link PE’s with
program on priority (ED, SHS, Bihar).
development opportunities and build
• To make the RKSK successful the Sashakt project
learnings are useful and to be included. market base or community based
• The peer educators need more confidence and capacity sustainability mechanisms.
building.
• The Sashakt peer educators could be a potential
resource in building the capacity of the RKSK peer
educators and this opportunity needs to be explored .
• The project and done well in increasing age at marriage,
health system needs to learn Sashakt experience and
implement .

Take Away • Opportunity to scaleup the Sashakt learnings with the state health system
• Rethinking the role of PE’s beyond SRH
• New partnership for scalability and sustainability
 Key Learnings and Insights

Community Health system Environment

• Various determinants affect the behaviors and the
SRH outcomes apart from knowledge; primary are
social norms, economic
consideration/opportunities and social
opportunities such as inclusion and education
• Males aged 15 to 19 years migrate to other parts of
the country for labor. Therefore, the adolescent
male population is not available in the villages. This
affected engagement with married, adolescent
couples.
• Married couples need a special strategy to address
each person individually and engage their trusted
sources of information, such as relatives and peers,
to create awareness of HTSP.
• Caste-based prejudices and discrimination among the
service providers as social hinderance for Mahadalit
adolescents to access the services. Involvement of
government health workers, ASHAs, ASHA facilitators, and
block community mobilizers ensures the effective
mobilization of Mahadalit unmarried, adolescent boys and
girls (15-19 years) and married couples.
• State system is willing to partner and work on adolescent
SRHR; however dearth of human resource and capacity is
critical limitation of the health system
• Village level ASHAs interaction with the adolescent can be
increased with PE approach. PE has demonstrated
potential to become link between health care services and
adolescent population.
• Increase interaction has also brought focus to the specific
FP needs of married adolescent.
• Peer education has potential to address the
knowledge needs of Mahadalit adolescents;
notably majority of the Mahadalit adolescent do
not attend school and have no reliable sources of
information.
• Community meetings have potential to
disseminate knowledge and address the social
and gender norms.
• Trainings conducted by external trainers are
impactful in increasing knowledge.
• knowledge and attitudes related to marriage and
contraception did not always translate into
positive changes in autonomy and decision
making for SRH.
• For equitable services provisioning both provider
as well as client/beneficiaries bias needed to be
addressed – sensitization and constant
engagement works

• PE’s has potential to establish community based and health

care accountability mechanisms to address the issues such
as norms around marriages, systems accountability to
ensure service provisioning for marginalized.

Conclusion • The Sashakt project has low cost demonstrated strategies to reach adolescent among most marginalized and especially girls.
• The achievements of Sashakt project are replicable and for benefit of larger marginalized community needs to be scaled up.
• There is need to build in strong component addressing the issues of autonomy for adolescents leading to a positive behavior change
• Long term thinking and intervention for longer period is required.
 CONCEPTUAL FRAMEWORK FOR THE NEXT PHASE
Promote and ensure access to comprehensive SRH knowledge and services among Mahadalit/SC adolescents by addressing factors which
constrain/prevent effective SRHR choices, decisions and behavior.

Components
• Community and Individual level • Institutional level

Partnerships to sustain
Peer Education Home based Community Capacity building and system strengthening PE’s
counselling meetings

Technology enabled communication approaches to reach migrating males Institutional barriers, Social inclusion, quality RKSK services & new opportunities for PE’s

Primary outcome one (Po1), Primary outcome two (Po2),

• Change in factors and social norms associated with apathy towards the • Strengthened public health systems capacity towards social inclusion,
desired SRH behavior and create an intent to adopt desired behavior improved client provider interphase, confidential SRH service provisioning
through; Peer Educators as change agent, FLW’s to increased demand and and improved access to contraceptive and maternal health services for
uptake of SRH services among married and unmarried (ages 15-19), married Mahadalit/Dalit adolescent/couples (ages 15 -19)
• Favorable shift in underlying social and gender norms driving adolescent • Create potential for sustainability of Sashakt interventions through;
marriages and early pregnancies, increased male participation to improve Community volunteers, Public health care delivery system, Create
couple communication and decision making around use of contraceptive appropriate replicable market mechanism
services.
Implementation and governance

• Project management structure - state- and district-level presence with national and global support. A project director - overall project coordination management of implementation partners.
State project managers, Manager –Monitoring, Evaluation and Learning (MEL), and Senior Project Officer. One full time project advocacy manager.
• The project activities will be implemented by implementing partner a locally contracted organization, who will recruit district and block level coordinators for all project district.
• Pathfinder’s Country Director in India who will provide overall strategic guidance, technical guidance around public/private collaborations and advocacy/policy. In addition, the project will
receive punctual and strategic technical support from Pathfinder’s global technical advisors.
THANK YOU