It is a
well recognised fact that the issue of maternal mortality is complex and the
socio-medical factors contributing to high maternal deaths cannot be
ignored. Beside improving the health infrastructure, training of all the
public health providers and making efforts to enhance accessibility of
Emergency Obstetric Care (EmOC) for reduction of maternal death, there
is a need to ensure community participation at all the levels of programme
implementation.
Keeping this in view,
the above mentioned project aims to improve women’s access to information
and quality maternal health care services in
the state of Gujarat. The project is being implemented in Navsari district
of the state. It has a component of building capacity of community level
stakeholders members of Panchayati Raj,Self Help Groups
(SHG),
Traditional Birth Attendants (TBA) and grassroots public health
providers Auxiliary Nurse Midwife (ANM) to develop mechanisms
for improved
access to maternal health services to women. It also has an inbuilt
component of advocacy, which aims to mainstream the community based
mechanisms evolved at Navsari district.
The effort
will contribute in overcoming delays in accessing health services which are major
contributing factors in high incidence of maternal deaths in the country. Skill and
sensitization training of TBAs, Panchayati Raj and SHG members will ensure
reduction at the initial delay, which is to recognize complications and take
timely decisions for accessing obstetric health care. The training of TBAs, ANMs,
Panchayat members and the SHG members will reduce the delay in reaching the appropriate health facilities. The efforts related to
advocacy will facilitate the process for initiation of treatment at the
health centre level.
The project is being implemented in close collaboration
with ANS Hyderabad, Government of Gujarat and local CBOs of Navasari
district.
At the end
of the
project a community based model will be evolved which can be mainstreamed in
the Navsari district. This project has the
potential to be replicated in all the other districts of the state.
Some
statistics
Geographically and socially Navsari district has block
wise variations which are
reflected in accessing maternal
health services from the public health system. Though 96% of pregnant women across
the five blocks of the district are registered with government health systems,
significant differences are noted in tribal and non tribal blocks in
accessing antenatal and natal health services.
Non-Institutional
deliveries constitute almost 50% of the total deliveries conducted in the
tribal blocks. Dais conduct about 90 % of these home deliveries. Of the
total institutional deliveries in the district, a majority (76%) is
conducted in private health facilities. Only 15% women across the blocks
received Postnatal care within 72 hours of delivery, which is considered to
be the most crucial phase as most of the maternal deaths occur during this
period.
Project Implementation
Till
June 2008, CHETNA has trained 287 TBAs from Vansada block (a tribal block). The pre and post training results
indicate significant increase in knowledge of the TBAs. Initially there
was less than one percent of TBAs under Grade A which increased to 48%. More
than 90% TBAs were under Grade C which decreased to 23%. The follow up visits
confirmed that TBAs have started maintaining the records of births
conducted by them and also initiated the referrals to avoid maternal deaths.
The follow up
visit and discussion with the TBAs reveals that
57% of the TBAs have started cleaning the
outer reproductive organs of women with antiseptic solution before delivery
55% TBAs have started providing information to
the mother about immediate breastfeeding,
58% TBAs use gloves while delivering the
child,
46% TBAs have taken initiative to discuss
about birth preparedness with the family members of the pregnant woman.
62% TBAs have stopped
putting
pressure on
the
abdomen of the woman to hasten the delivery.
Panchayat members and
Self Help Group members are important stakeholders
of our project The interviews with Panchayat members revealed that majority
of the women Panchayat members articulated the increased
nutritional need of the pregnant women. More than 50% mentioned Tetanus Toxide, Iron and Folic Acid tablets, blood test and Blood Pressure
measurement services
are
available from
the
Public Health System. However,
the knowledge about services available during “post delivery” phase was very
poor. Their perception about their own role in improving maternal health
scenario was limited. They had limited knowledge about the role of ANM. They
had also not made any significant efforts to coordinate with Anganwadi
workers or ANMs to improve maternal health scenario at the village level.
A two day training for the Panchayat members and Self
Help Group members provided them opportunity to take a fresh look at the
situation of maternal health in their village and district. Actual visit to
the PHC/Sub center was a first in a lifetime of experiences for many. It
provided them the opportunity to understand their role in accessing maternal
health services.
During the
last phase of the project, efforts will be concentrated in the geographical
area under the five selected Primary Health Centres
of the tribal area.
We will be
updating you on the progress periodically.
Further details please contact
Ms. Pallavi
Patel, CHETNA.
