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July 2006 - March 2007 |
Introduction
This 3-year project started in July 2006. This report highlights the progress from October 2006 to March 2007, in the Khorda gram panchayat situated in Diamond Harbour Block II in South 24 Parganas district, West Bengal, India. The area has a total population of around 16,000 spread over seventeen villages.
The project involves tracking a cohort of pregnant women and their children until they reach the age of two. The aim is to ensure that pregnant woman receive the necessary care including appropriate diet and rest, attending government medical check ups and getting support from other family members. Health workers are also ensuring that children's growth is being tracked and the requisite done in terms of feeding and caring practices.
Also adolescents are being sensitised on health and other social issues. They are being encouraged to play an active role in highlighting issues and working on them. Activities aimed at engaging the local communities, local self government (Panchayat Raj Institutions or PRIs), government health functionaries and other stakeholders are an integral part of the project, as they help to ensure community ownership and sustainability.
Section I: Safe motherhood and child survival
1) Interventions with mothers and children
96 pregnant women have so far been identified within the first 16 weeks of pregnancy and have been registered in the nearby government health centre. Each woman is being regularly visited by a health worker who gives maternal health advice, such as adequate intake of nutritious food, along with more rest and reduced workload. Other family members, especially the mother-in-law and the husband are involved in the process. The importance of timely registration, along with regular visits to the nearby sub-centre for checkups and intake of at least 100 IFA tablets, is also being explained. As the date of delivery comes closer, the value of institutional delivery is explained. In cases of strong resistance, they are advised to have their baby delivered by a trained traditional birth attendant. |
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Under the project, from January 2007 onwards there have been a total of 7 births. Out of the seven, four deliveries were in government hospitals while the rest of the three deliveries were conducted by a trained traditional birth attendant. All the deliveries were conducted by trained and skilled personnel.
Health workers have made regular home visits. Attempts are being made to improve the nutritional status of the children and bring them to the level of normalcy. The mothers have been advised to exclusively breastfeed their children for the initial six months. Related to this mothers and their families are being told about the importance of good maternal nutrition during the post pregnancy period. The value of timely immunisation is also being explained to families enrolled on the programme.
2) Community and stakeholder events
There has been an increased focus on intensifying the interaction with various stakeholders at community and other levels, to highlight safe motherhood and child survival issues.
- Block level orientation meeting with service providers: An orientation meeting with service providers was organised on 14 th October 2006. The issues discussed in the meeting included importance of registration of pregnant women at sub-centre, spacing and contraception, supply of contraceptives and supply of iron and folic acid (IFA) tablets for pregnant women. In addition, a one-day orientation of rural medical practitioners was held on 27 th of March 2007. Discussion focused on the need to continually update skills and knowledge through training, and understand the obstacles commonly faced by patients.
- Village-level sensitization meetings: Sensitization meetings have been organised at village-level in all of the 17 villages to generate awareness amongst the general population, especially targeting women, children and adolescents. Issues discussed in the meetings included causes and consequences of early marriage and early pregnancy, ante- and post-natal care coverage, reason behind the growth failure during the first year of the child, importance of contraceptive choice.
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- Orientation of self help groups: A one-day orientation was organised for self help groups (all women members) of all the 17 villages on 22 nd December 2006. The objective was to educate these women on importance of safe motherhood and child survival, so that they can share this information with the other members in their respective groups. Follow up training held on 28 th March 2007, aimed to improve their knowledge of ante- inta- and post-natal care, and also childcare. Further, it generated greater awareness of various sexually transmitted diseases and infections, and aimed to break down the popular myths related to HIV/AIDS.
- Formation of women's groups and facilitation of women group leaders at a community level: To date, 42 women's groups have been formed. Meetings with group leaders are being held monthly. During these meetings various issues related to health and nutrition are discussed, along with the various aspects of the intervention program requiring immediate attention. People are turning to these women for support on health related issues, and are adopting positive health practices.
- Male involvement meetings: Meetings with male members were held on a regular basis at the village-level. The main objective is to educate these men on major issues such as STI/STD, HIV/AIDS, workload sharing during pregnancy period, ante-natal care, post-natal care, immunization for children and child spacing.
- Meeting with parents of children aged under two: It is important to not only involve the mother in the process of ensuring child health, but also the father. Discussion focused on various components of child health, such as feeding practices (exclusive breastfeeding for the first six months followed by complementary feeding), importance of immunisation, hygiene to be maintained, common childhood diseases and how can they be prevented as well as the importance of love and care in the development of a baby.
Section II: Adolescent health
Community events to promote adolescent health have been planned and successfully conducted. Four adolescent groups have been formed in Ashurali, Bangla, Seorahati and Ausberia villages, with about 15 members in each group, each with a group leader and joint leader. To date, 12 monthly meetings have been held in their respective areas, where various adolescent issues are openly discussed. Issues discussed included the need for addressing adolescent reproductive and sexual health, the importance of nutrition in adolescence, effective parenting, and building effective leaders for future.
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There are regular monthly group leaders meetings for the four groups formed, where personnel from CINI-Diamond Harbour Unit and Gram Panchayat were present. The objective of this meeting was to critically understand issues relating to health and nutrition, various other needs, and enable them able to understand the importance of ownership, ensuring that activities are undertaken by themselves, with the support from their respective local government bodies.
One peer session has been successfully conducted. These sessions inform adolescents on the importance of health and nutrition, along with spreading awareness on various reproductive and sexual health issues, which are otherwise not openly discussed. |
Challenges faced
- It was difficult to organise meetings involving the male members, as most of them are daily wage earners (agriculture) and losing out on even one day of work would imply loss of income. The venues and timings of the meetings were therefore chosen with this in mind.
- Most of the adolescent boys and girls go to school; hence it was difficult to arrange adolescent meetings. These meetings were therefore arranged so that they did not clash with school hours.
- Bringing all the service providers together at the same time for orientation meetings was difficult because of their busy workload. Therefore, project activities were structured so that they could be properly integrated with the functions of the service providers, whilst utilising existing platforms/committees to serve the project's objectives.
Lessons learnt
- Parents need to be sensitized prior to the formation of the adolescent groups. Their co-operation and support is essential. Accordingly, one to one interactions and group meetings with parents are being held.
- Involving the local self government and integrating this project with their health, nutrition and self help group activities is essential for giving the project a strong base for both its current duration and also its future sustainability.
The plan ahead
- Continue identifying pregnant women
- Organise male involvement meetings
- Organise community linkage activities with multiple stakeholders
- Conduct sessions with pregnant and lactating mothers on pregnancy care and childcare
- Organise training of male peer educators
- Organise training of adolescent peer group leaders
- Organise a health fair
- Conduct meetings with parents of children under the age of two
- Organise exposure visits for male peer educators
- Continue monthly adolescent group leader meetings
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