Abstract
BackgroundThe trial addresses the general question of whether community resource centers run by a non-government organization improve the health of women and children in slums. The resource centers will be run by the Society for Nutrition, Education and Health Action, and the trial will evaluate their effects on a series of public health indicators. Each resource center will be located in a vulnerable Mumbai slum area and will serve as a base for salaried community workers, supervised by officers and coordinators, to organize the collection and dissemination of health information, provision of services, home visits to identify and counsel families at risk, referral of individuals and families to appropriate services and support for their access, meetings of community members and providers, and events and campaigns on health issues.Methods/designA cluster randomized controlled trial in which 20 urban slum areas with resource centers are compared with 20 control areas. Each cluster will contain approximately 600 households and randomized allocation will be in three blocked phases, of 12, 12 and 16 clusters. Any resident of an intervention cluster will be able to participate in the intervention, but the resource centers will target women and children, particularly women of reproductive age and children under 5.The outcomes will be assessed through a household census after 2 years of resource center operations. The primary outcomes are unmet need for family planning in women aged 15 to 49 years, proportion of children under 5 years of age not fully immunized for their ages, and proportion of children under 5 years of age with weight for height less than 2 standard deviations below the median for age and sex. Secondary outcomes describe adolescent pregnancies, home deliveries, receipt of conditional cash transfers for institutional delivery, other childhood anthropometric indices, use of public sector health and nutrition services, indices of infant and young child feeding, and consultation for violence against women and children.Trial registrationISRCTN Register: ISRCTN56183183Clinical Trials Registry of India: CTRI/2012/09/003004
Highlights
The trial addresses the general question of whether community resource centers run by a non-government organization improve the health of women and children in slums
We have addressed health care from two directions: on the demand side, by attempting to create informed users of health services who expect higher quality; and on the supply side, by working with public sector health providers to improve the quality of health services [8]
Some organizations, including Apnalaya, Stree Hitkarni, Committed Communities Development Trust, and Navjeevan, have focused on community health. Their resource centers occupy a range of locations: individual homes, leased spaces, or sites provided by community-based organizations
Summary
Rationale A recent review of developments in urban health over the last 30 years identified four perceptual shifts [1]. The Society for Nutrition, Education and Health Action (SNEHA), a Mumbai-based non-government organization (NGO), works to improve the health of women and children in disadvantaged communities. Some organizations, including Apnalaya, Stree Hitkarni, Committed Communities Development Trust (www.ccdtrust.org), and Navjeevan (www.navjeevan.org), have focused on community health Their resource centers occupy a range of locations: individual homes, leased spaces, or sites provided by community-based organizations. Our previous trial of community mobilization through women’s groups suggested that women were eminently able to articulate their experiences, identify problems and suggest local solutions, but that they hit a wall when they tried to move to community action [9] To some degree this is a feature of what we call the urban paradox: despite the density of informal settlement populations, contact with people outside one’s immediate area, cultural or kinship group is limited. Aims Our propositions are that: (i) on the basis of our experience in community mobilization for health, we would like to move to a decentralized community resource center model; (ii) for feasibility given our expertise, we will limit both the intervention and its evaluation to health issues; (iii) the model is a common one with many potential benefits, we have equipoise on its effect on population health; (iv) we would like to evaluate the model on the basis of outcomes designed to be unambiguous, commonly measured, externally comparable and representative of women’s and children’s health
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