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A report by UNICEF India in January 2009 found that about a million neonatal deaths occur in the country each year. Uttar Pradesh (U.P.) has the largest population of any state in India and continuing problems with neonatal mortality. In an effort to tackle this problem PATH India with funding from the Bill and Melinda Gates Foundation has initiated Sure Start, a five year project that works with a population of roughly 25 million in Uttar Pradesh and Maharashtra.

A major contributor to these death rates is the lack of literacy and awareness that exists in the rural areas of the country. For example, the benefits of immediate and exclusive breastfeeding are not well understood. For this purpose Sure Start in U.P. works with community health workers and facilitates the functioning of village health and sanitation committees.

Emphasis is laid on educating families especially pregnant women and their mothers’ in laws through home visits by village appointed health workers and the organising of mother group meetings for behaviour change. The latter is a particularly interesting endeavour where expectant mothers are given essential knowledge through interactive games and music to ensure a safe delivery and a healthy child. – is really interesting to see this remarkable mobilisation of communities around issues of maternal and neonatal health (MNH).

Has this made a difference? Ramvati in sabji village district of Raebarelli in UP has said that the regular visits of the village health workers to her house have made her aware of the ills of un- safe birth practices. This time around she will be more careful and will deliver in a clean safe environment.

While one part of this expansive project focuses on engaging with rural communities another works with urban populations in Maharashtra. Here, Sure Start is working to improve MNH by harnessing the value of innovative health financing models, quality of care, volunteerism, convergence, and public private partnerships.

Sure Start, a five-year initiative based at PATH and supported by the Bill & Melinda Gates Foundation is working to reduce maternal and newborn deaths during and after child birth in India.Sure Start uses mass media, interpersonal communication tools and community-level initiatives to educate people about safe child birth practices in Uttar Pradesh and Maharashtra.

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