Post Written By Annemijn Sondaal
“It’s not a drug, it’s not a vaccine, it’s not a device. It’s women, working together, solving problems, saving lives” -Richard Horton, editor-in-chief of the Lancet, May 2013
Participatory women’s groups all over the world have created spaces for women to engage in dialogue, exchange their ideas and experiences and spur them to take action to improve their community’s health. The Institute of Global Health, University College London and its’ partners including Women and Children First, have shown that participatory women’s groups can, with participation of at least a third of pregnant women, cut maternal deaths in half and newborn deaths by over a third.
Women’s groups are run and attended by local women (and sometimes men), mobilising local resources to address local problems. This type of capacity-building and community-mobilising intervention is perhaps the most likely to sustain after the supporting organisation leaves, but organisations rarely investigate the long-term effect of interventions or their sustainability. This means that little is known about optimal times and methods to withdraw support, the capacities needed, and support mechanisms necessary for sustainability.
Mother and Infant Activities (MIRA) has worked with participatory women’s groups in rural Makwanpur, Nepal in collaboration with the Institute of Global Health since 2001. A paid local woman, supported by a supervisor, ran each group. She was also given a meeting manual and training. In 2008, MIRA enacted a handover strategy when the project ran to the end of it’s funding. Twelve to eighteen months passed with no intervention, and we were interested to find out what had happened to the groups. Some essential questions asked were:
- Had they continued meeting and organising activities?
- How had they sustained their activities?
- If they had stopped meeting, why?
80% of the women’s groups were still ‘active’ (groups who formally conduct meetings, work on strategies and keep meeting minutes). Anecdotal evidence suggests that these groups are still active to this day.
Local importance: Women had experienced how the groups improved maternal and newborn survival. This motivated them to continue meeting and enable the next generation to learn about how to look after themselves and their babies.
Financial independence: Many groups had established maternal and child health funds. Being able to save, and have some financial independence attracted women to the group and motivated them to continue meeting. One woman told us: “When we save, we don’t have to depend on our husbands. We don’t have to beg for money.” Also, we found that many groups had increased their fund to support community activities unrelated to maternal and newborn health.
Leadership capacity: Active groups were led by a strong female community health volunteer or community leader. Or members themselves were confident in owning and leading the group. One group member told us: “MIRA showed us the way. They showed us the right track, and we are now confident to walk that track. Because of this, the group is still running.”
Those groups who were not meeting, or meeting infrequently felt that they had not been given enough time to reach the level of confidence and capacity necessary to continue activities and meetings. These groups told us they wanted more skill-based training: “If there would be [skill-based] training for the chairperson, treasurer, secretary on how to run the group, than we would have planned to do more.”
It is important to consider how interventions can continue after a project support stops. In Makwanpur, the participatory nature of the group and local embeddedness were not enough to sustain groups. They also needed leadership capacity, a unifying activity (such as the fund) and a strong belief in the value of their meeting to sustain.