Improving delivery of women’s and children’s health services in rural villages of Rajasthan

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We have long held the opinion that government health services in India are very likely being poorly run wherever there is a lack of monitoring and which occurs more often in smaller rural villages of which there are 640,000 across the country. The 2011 census of India tells us 236,004, some 1/3 of all India’s villages, have less than 500 inhabitants.

More than ten years ago the National Family Health Survey 3 revealed that almost 50% of India’s under 5 years children were malnourished. NFHS figures have since improved a little but there is still a long way to go. Levels of under-nutrition that make children susceptible to physical and mental disability and leading to reduced productivity as they grow up will severely impact on the ‘demographic dividend. According to some studies, malnutrition will reduce the GDP of Asia by some 11%. It is therefore essential that community health services ensure adequate nutrition for pregnant mothers as underweight women giving birth to underweight children is one of the reasons why Indian figures of malnutrition are worse than those of sub-Saharan Africa. Counseling families on how to care for the girls, advising new mothers to give the first hour milk, breastfeed the child for six months and provide nutrient dense complementary foods till the child is two.

It is for these reasons White Lotus Trust decided to work on assisting and improving already existing government health services keeping in mind the above stated problems and lacunae in services such as availability of maternity services, ANC/PNC, immunization and vaccination of pregnant women and new-born children and nutrition of girls and pregnant women etc. Pooja Sehrawat, our program coordinator writes here about the process of setting up this important program. Please see Pooja’s update here-below.

Glenn Fawcett, Executive Director

Pooja Sehrawat – ASHA program coordinator

I joined White Lotus Trust some months ago as Program Coordinator of EQU+ and which has been a good learning process for me as I didn’t have much experience working on education for children in government schools. Now we have started planning on working on a program on Health in Rajasthan which is of more interest for me as I have worked on health projects for last four years and as an Accredited Social Health Activist (ASHA) worker for a year before that. It is of great interest for me to work on a project in five villages on improving the working condition of ASHA workers in the remote villages where the ASHA workers lack in facilities and training.

For need assessment we visited Jurhera village in Rajasthan last week and met two ASHA workers to find out about their work, the health facilities such as Primary Health Centre (PHC), availability of maternity services, ANC/PNC, immunization and vaccination of pregnant women and new-born children and nutrition of girls and pregnant women etc. We were told that health centres in towns such as the one in which we we are meeting, caters to many neighboring villages. The facilities mentioned above are available in this village but people living in remote villages, may be more than 20 kilometers away from here, do not have access to many of the required services. There is no reliable public transport available in the villages to reach PHC for delivery of a child and other health facilities.

We were informed that an ANM (Auxiliary Nurse Midwife) is appointed for every five villages that also supervises the ASHA workers as well as provides all types of support to them including training. As we have planned to work in five villages, it will be better if we meet some ANM’s to identify the villages where there is a need for support or where the community is not getting the required health facilities for pregnant women, girls and new born babies. The next step is that we are meeting one or two ANM’s on 9th of February and will try to identify the needy villages.

Husband of one ASHA worker we met last week, was also present in the meeting and informed us that we may also include community awareness aspect in our program which may include all villagers and issues such as cleanliness. Because according to him, lots of diseases can be prevented through cleanliness and practising hygiene. He gave an example that last year, some people in their village died of Malaria which was result of water logging at many places. The villagers could have prevented these deaths   just by cleaning those places that would not have been a big task for an  entire village community. Thus far we’ve sought and received community based input and understand that capacity building of stake holders is an important factor to make the programs sustainable and will keep that in    mind at all stages of program design and development.

I had worked in an urban environment previously so I’m now quite excited about this program and looking forward to new learning experiences while working in rural village areas. It seems evident from our initial research we can develop a program to fill gaps in the government health system so that people living in these remote villages can avail of the level and quality of health services they deserve.

Pooja Sehrawat – White Lotus Trust