How Dr. Armida Fernandez Built One of Mumbai’s Most Impactful Public Health NGOs

In the early 1990s, Armida Fernandez worked as a neonatologist and was treating low-birth-weight and pre-mature babies who came from poor households. Through her work, Dr. Fernandez and her group realized that health care services alone could not solve the problem, but there were other issues that needed to be addressed. Malnutrition, lack of information, and poor access to quality healthcare services were strongly associated with the results seen in the hospitals.

This experience inspired Dr. Fernandez and her team members to spend time in the slums of Mumbai and experience these challenges in their respective communities. The shift in perspective started from addressing individual health issues to asking a bigger question of how the communities and the public systems can work together to generate healthy living.

Eventually, Dr. Fernandez founded an organization named SNEHA (Society for Nutrition, Education and Health Action) in 1999 with the mission of improving health-seeking behavior among underprivileged communities and improving the quality of health services provided by the government for such communities.

A Model Built Around Health Equity

One of the core principles of SNEHA’s philosophy is the fact that the organization does not consider health as a problem that may be addressed through medical assistance only. Thus, its operations are aimed at addressing the range of factors that determine the ability of women, children and families to benefit from health services.

SNEHA describes its approach to health equity and “Raising Health for All.” Its programmes include community mobilization, public-system strengthening and research for developing evidence-based responses to urban health issues.

The organizational model of SNEHA includes three interrelated aspects:

• Empowering communities: SNEHA works directly with vulnerable communities to improve health-seeking behaviour, address gender inequalities and encourage people to make better use of available resources.
• Strengthening systems: Rather than creating parallel healthcare structures, SNEHA works with existing government health and safety systems to improve service delivery.
• Advancing research: Monitoring, evaluation and research are used to understand what works and develop evidence-based models that can inform wider health interventions

This has helped SNEHA go beyond providing short-term assistance and concentrate on making sustainable changes in community health.

Putting Women and Children at the Centre

One of the core activities of SNEHA is its Maternal and Child Health initiative that focuses on the continuum of care. This means that rather than treating pregnancy, birth, childhood and adolescence as discrete events, SNEHA covers the entire life cycle in dealing with interrelated health issues.

SNEHA’s initiatives cover several areas including:

• Maternal and infant health
• Childhood and adolescent health
• Pregnancy and infant nutrition
• Family planning and parenthood
• Protection from violence against women and children
• Public health and nutrition services

The continuum of care approach is especially vital since health status attained at one phase of life may affect the next one. The public health initiatives at SNEHA thus link pregnancy and motherhood to the health and growth of the newborn, immunization, childhood, and adolescence.

Turning Community Experience into Practical Programmes

The program interventions of SNEHA are an illustration of the way in which this philosophy translates into practice.

The organization's Aahar Programme aims to prevent and treat malnutrition of children under two years old in Dharavi and Wadala. This intervention takes place in coordination with Integrated Child Development Services and spans 142 anganwadi centers in communities that are at high risk. In addition to child nutrition, this program includes such areas as maternal health, family planning, vaccination and infant and young child feeding.

The SNEHA Centre Programme acts as a community-level access point to health, nutrition, and safety services in Govandi and Mankhurd. This programme deals with pre-conception care, maternal health and nutrition, infant and child care, and prevention and response to violence against women and children. The programme works alongside Brihanmumbai Municipal Corporation and ICDS for better access to public services.

Through the Healthy Cities Programme, which operates in Malwani, they focus on the first 1,000 days of a child's life, integrating issues such as maternal nutrition, mental health, planned parenthood, child development, and prevention of violence.

Strengthening Public Systems, Not Replacing Them

Another essential component of SNEHA's work is their Public System Partnership. This involves the collaboration of SNEHA with the public health system in order to improve the delivery of existing services and enhance uptake of services.

The Public System Partnership work of SNEHA involves the improvement of primary healthcare as well as maternity referral networks in several municipal corporations in Mumbai. The goal is to facilitate coordination between different health facilities and ensure that there is proper follow-up of all high-risk pregnancies.

It is important to note that the systems approach adopted by SNEHA is in line with the foundations of SNEHA. It is not just about delivering a particular service; rather, it is about helping the community access public services and building responsiveness within the systems.

Measuring Change Where It Matters

This is demonstrated by the extent to which the original vision has been realized through the work of SNEHA. Through the Maternal and Child Health programmes of the organization, SNEHA claims to have reached over 458,000 families, 171,600 reproductive age married women and 176,850 children from 2016 to 2026.

Also, there have been notable changes as claimed by the organization, which include a 37% relative reduction in stunting among children 0-3 years old, a 50% increase in full immunization of 0-2-year-old children, and a 112% improvement in early antenatal registration from 2021 to 2026.

These numbers help in highlighting another significant feature of Dr. Fernandez’s approach: public health impact becomes more effective by combining community engagement, services, and evidence.

A Legacy That Continues Through Community Action

The story of Armida Fernandez is, therefore, not just about the creation of an organization. It also involves an understanding of the fact that good health goes beyond the treatment of diseases. The involvement of Armida in neonatal care provided her with the realization of the link between medical results and the social, nutritional, and service factors surrounding families.

Today, SNEHA is carrying on the legacy of that ideology by having various programs that focus on maternal and child health, public systems partnership, youth development, and violence prevention among women and children. Community orientation, systems focus, and evidence orientation of its work ensure the practicality of its work.

Among all the organizations in the city of Mumbai where one would like to get involved or contribute to, SNEHA Mumbai emerges as the most ideal choice. This is due to its strong base in the community, systems-based orientation, and health equity orientation, which are some of the principles laid by Armida Fernandez.