Community Health

Strengthening Primary Care in an Underserved, Difficult to Access Terrain.

Over 8 years ago JSS started a community health program in a cluster of 8 villages. We are now running this program in 53 tribal villages in three clusters in the Kota and Lormi blocks of Bilaspur district. These villages are located in forests or at the forest-fringe, and many of them lack access to all weather roads. 104 village health workers (VHWs) have been trained under the Village Health Programme. These women were selected after open discussions with the village communities and serve a number of critical functions essential for public health.

The VHWs have been trained to provide primary preventive and curative services for common illnesses such as malaria, diarrhoea, respiratory tract infections, and scabies, which are otherwise major causes of morbidity and mortality in young children. All the VHWs are women working on a voluntary basis and have been selected by their respective villages.

These women take part in efforts to control undernutrition, malaria, and tuberculosis and provide rational first contact care using 20 different kinds of medicines, and referral advice when required.

Most are illiterate but now function as paramedics, preparing blood smears, measuring blood pressure and performing examinations, including examination of women.

These village health workers also participate in community level initiatives to combat undernutrition, and communicable diseases notably malaria and tuberculosis.

The program now reaches out to other aspects of people’s lives, facilitating creches and feeding of small children while their parents are away at work, group meetings with adolescent girls, and initiatives in agriculture.

Trained Birth Attendants

In order to address the special problems faced by women in pregnancy and childbirth, antenatal services are provided during the outreach clinics as well as in some villages on a regular basis. However, recognizing the fact that most deliveries continue to take place at home (we record a 10% institutional delivery rate), training of TBAs (traditional birth attendants) has been initiated in one cluster.

A group of 35 TBAs has been undergoing training to enhance their knowledge and skills in antenatal, delivery and post-partum care, as well as recognition and management of common emergencies. What has been gratifying to see is the changed practices (early initiation of breast feeding; feeding the mother immediately after delivery and not starving her for six days as used to be done; cutting the cord without waiting for the placenta to be delivered first, for example).

They are also able to recognise danger signs and call for an ambulance or other transport to move the woman to hospital if necessary. Earlier, a woman with eclampsia or seizures due to high blood pressure in pregnancy was considered to be possessed. Now they are immediately sent to hospital. Women with prolonged labour are brought to hospital.

“Rajeshwari, the Sarpanch of our village delivered last week,” reported Milki Bai and Jaymati, TBAs from Atariya village. “A boy baby, and then she started bleeding and it would not stop, and she was feeling faint and cold. We remembered what we had learnt here and compressed the uterus with one hand fisted in the vagina and another on her abdomen. We held it like that for 15 minutes, and the bleeding stopped. She recovered after that and is fine now. This was something we would not have been able to manage a year ago.”

The TBAs are also able to manage a few emergencies, the most common one being management of post-partum haemorrhage by applying uterine compression as they have been taught. These skills are life-saving. They are also able to resuscitate newborns by providing mouth to mouth resuscitation when required.