Specific lessons learnt in the community programme at JSS
The nutritional security of people is under serious threat and needs to be counteracted by multiple interventions. Data from our centre and the village programme suggests that the adults of today had better nutrition during their childhood as compared to the children of the present day.
A trained village health worker is an essential requirement for any primary health care initiative. It is possible to develop a cadre of village health workers even in marginalised rural communities with low literacy. These workers can not only be entrusted with the care of most common and important illnesses including those in women but can also perform many other functions, e.g. nutritional rehabilitation, participation in community-based disease control initiatives e.g. in tuberculosis and malaria, and provide advice for referral. Training can do wonders, and training is possible.
The nutrition of the under 3 child is specifically under stress, primarily due to poor complementary feeding that results from the lack of a caretaker at home and the lack of child specific food. There are specific requirements (especially nutritional) of the child below the age of 3 years which are not being met with by the current dispensation of the Anganwadi based ICDS. If we want to do something lasting and effective in child under-nutrition, nothing short of having a special mission for it will succeed. Crèches where children below 3 actually get to eat under supervision is the only way out.
There is no alternative than a universal public distribution system for food to address the present problem of massive chronic hunger. Given the fact that over half of us are undernourished and the problems inherent in targeting, it is only obvious that we should have a universal programme. A poor people’s programme becomes a poor programme.
Not only should the PDS be universal, it should also address the problem of variety of food, cereal security is necessary but not adequate for ensuring food security.
It is possible to evolve community-based initiatives that involve an integrated strategy for the control of communicable diseases like falciparum malaria, which is a major cause of morbidity and mortality in forest related villages. It is possible to develop a community-based programme which aims at early diagnosis and prompt treatment of malaria through the agency of the village health worker; environmental and biological control of vectors; use of personal protection measures; and protection of especially vulnerable groups like pregnant women.
It is possible to reduce mortality in adults as well as children with the help of a village health worker programme supported by a referral system.
There is a large unmet need for contraception including safe termination of pregnancy and spacing methods. Provided that these services are available in a non-threatening environment, acceptance is good.
There is a large unmet need for primary animal care in villages. Loss of animals to disease, which might be easily preventable and treatable, is a serious and often irreparable loss to the family. Along with primary health care initiatives in human health, similar initiatives in the care of animals are required. We are now exploring with the village health workers the possibility of preventive practices and first-contact care for animals through their medium.
Though essential, it is not easy to run an antenatal programme for rural women because pregnancy and its attendant problems are clearly seen as part of life. The benefits of a check-up during pregnancy are not easily recognised. We also felt that it is possible to introduce practices related to the safe conduct of delivery but not so easy to change practices related to postnatal care.
The problem of chronic diseases, many of which are called Non communicable diseases is a major one. These include problems like hypertension, cancers, diabetes and cardiac illnesses. The difference is that they happen in poor marginalised areas such as Bilaspur in people who have not gone through any nutrition transition.
We have been able to get the Infant mortality rates to below 30 per 1000 due to an integrated child care programme, and the under 5 child death rate to below 60 per 1000. Still there is a long way to go, that may require a specific newborn care programme.
