REDUCE INFANT & MATERNAL MORTALITY IN THE HIMALAYA: January - March 2014
1 COMMUNITY HEALTH
After conducting a baseline survey in 15 villages, we started collecting information from the 35 villages in which we will be working in the first year. The villages are Okhalkanda Malla, Okhalkanda Talla, Khansyu, Chyurigaad, Pokhari, Kulori, Putgaon, Reekhakote, Tanda, Surang, Sui, Jamraadi, Takura, Karayal, Rekuna, Tushraad, Paitana , Ramela, Putpudi, Bhadrakot, Herakhan, Dewli, Kalaagar, Kwerala, Gargadi Talli, Gargadi Malli, Galni, Teemar, Chamoli, Jhadgaon Malla, Jhadgaon Talla, Saal, Badoun, Thalaadi and Bagor.
Highlights of the past 3 months work with the community
1.1 Exposure visit
From 18-23rd January Aarohi health staff visited Jan Swasthya Sahyog (JSS), a voluntary, non-profit and registered society founded by a group of health professionals committed to developing a low-cost and effective health program that provides both preventive and curative services in the tribal and rural areas of Bilaspur district in Chhattisgarh. The objective of the visit was to gain exposure to JSS’ activities. Those of note that Aarohi would consider replicating or adapting to their own work environment, include:
-meetings in which creative learning materials are used to raise the awareness of adolescent girls of issues such as personal hygiene and menstruation
- forming self-help groups amongst local villagers to address health or social issues
- organising fairs at the local market to spread awareness of health and social issues
- providing supplementary food when giving medicine to patients to boost their immunity
- colored thermometers for illiterate health workers to identify if a person is running a fever and provide medicine with the help of diagrams.
1.2 Training Camp
Dr. Ramani Atkuri, a consultant, trained senior Aarohi staff and trainers on Ante natal care, Post natal care, Neonatal care, sepsisin neonatal, nutrition, malnutrition, diarrhoea and growth monitoring. The training took place from 26th-30th of January and occurs twice a year as a means of updating Aarohi’s staff’s knowledge.
1.3 Health Management information System (HMIS) training
Mr. Ganga Singh and Mr. Nain Singh trained the 13 Aarohi health supervisors on HMIS tools that they use in the field. Sessions focussed on how to use HMIS tools and their importance for the project – the recording of essential data in progress reports, daily activity schedules, and child growth monitoring charts. This provides a refresher for most supervisors and is a necessary introduction for new supervisors.
1.4 CommCare Programme
Since March 2013 Aarohi has been running a pilot project using an innovative job aid tool for mobile health workers. The tool is a free, open source mobile phone application that Aarohi developed in conjunction with Dimagi Inc, an American not-for-profit. Ten Accredited Social Health Activists (ASHAs) have tested the application in the Okhalkanda Block of Nainital district in their door-to-door ‘safe motherhood’ educational visits to families. The results have been a win-win-win, benefiting the women and families to whom the health awareness work is targeted, the ASHAs themselves as well as their managers. The novelty of a multimedia questionnaire using sounds and images on a mobile phone sustains the interest of the woman interviewed as well her whole family allowing the ASHA to provide health awareness more effectively to her target groups. The mobile-phone application questionnaire also ensures that the AHSA does not forget to transmit crucial information during her health education exchange with the women and their families. The application is a lighter and more efficient way for the ASHA to record and manage the information she collects (rather than recording it all into countless paper notebooks) from each visit. Given that the data is automatically uploaded onto a cloud server each time that the ASHA has internet access, real-time information becomes available to managers allowing evidence-based change to strategies in order to respond to needs. The availability to managers of the information on the interviews conducted by ASHA also makes remote supervision far easier. In light of the positive results of the pilot, Aarohi intends to expand its use of the application to all health workers in the area and make it available for use by other organisations.
1.5 ASHA selection
Aarohi’s proposal to train ASHAs in Okhalkanda Block was approved by the Uttarakhand Health and Family Welfare Society, the state government body. This training, which will start in April 2014, will supplement and provide key additional information and skill not covered by government training. Aarohi thus looks forward to receiving better-quality data from the ASHAs who have been trained; indeed they are the only people collecting such data at the grass-roots level.
During the reporting period, Aarohi identified ASHAs in Aarohi intervention villages who will each be paid Rs. 500 per month and who will benefit from Aarohi’s training and mentoring.
Mother and Child Data*:
Aarohi health supervisors are in the process of weighing all children aged 0-5 years in the project areas and have identified malnourished and severely malnourished children. Further advice on diet is being provided to mothers.
Health supervisors are also visiting all pregnant women in the project areas and encouraging them for undergo regular antenatal checkups.
TOTAL NO. OF VILLAGES: 35
TOTAL POPULATION: 17,379
ELIGIBLE COUPLES: 613
NO. OF PREGNANT WOMEN: 82
LACTATING MOTHERS: 54
CHILDREN (0-6 MONTHS): 97
CHILDREN (6 MONTHS- 1 YEAR) 27
CHILDREN (1-3 YEARS) 414
CHILDREN (3-6 YEARS) 341
* The data is incomplete due to the fact that we had a few supervisors who had quit their jobs and therefore no information was collected from the villages in their absence.
Mobile health care monitoring comes to a Himalayan village
Just 23 years old, Keshvi represents the typical mountain woman whose life is defined by relentless house work from morning till dusk, poor education and marginalized social status. Keshvi is all of this but a lot more as well. She has been working as an ASHA (Accredited Social Health Activist) in her village Galni, Okhalkanda Block for over two years now. When Aarohi started working in village Galni for the first time, not many women were open to work as health workers. They did not have the time to do anything but housework. Keshvi would have been one of those women as well if her father in law did not encourage her to take up the role. Since then, there has been no looking back for her. Not long after she joined as a health worker, the VHNSC (Village Health, Nutrition and Sanitation Committee) recruited her as an ASHA- Keshvi’s commitment to her work and potential to grow had not gone unnoticed.
During the second phase of the Aarohi Arogya Project when the Commcare application was introduced, Keshvi joined as one of the mobile users. In the beginning she found it challenging to work with a mobile phone as she had never used one before. While the other workers were literate enough to read the instructions and were aware of how to use a mobile phone, Keshvi, a school dropout in class 5, could not use one. Taking it as a challenge, she started learning how to operate a mobile phone first and then how to operate the Commcare application. In just three months, she was able to operate the application without any problems.
Today Keshvi is the best mobile user we have under the Commcare programme for maternal and childcare. She updates and collects information from the village on a regular basis. She even does her own basic troubleshooting regarding the application or the phone.
Keshvi has proven that all one needs to use the Commcare application is just the will to learn.
2 CURATIVE HEALTH
2.1 Routine clincial services based out of hospital in Satoli continued with a fair increase in surgicak wiork done through monthly mulit-specialty camps.
TOTAL PATIENTS TREATED 1158
VILLAGES COVERED 49
SPECIALIST CAMPS HELD 4
PATIENTS TREATED IN SPECIALIST CAMPS 460
SURGERIES PERFORMED 41
ULTRASOUNDS PERFORMED 63
DENTAL CAMPS HELD 2
DENTAL PATIENTS TREATED 67
2.2 Mobile Medical Unit (MMU)
Aarohi signed a contract in October 2013 with the Government of Uttarakhand to reactivate the first Medical Mobile Unit that ran in Uttarakhand until 2012. The reactivated MMU will improve the reach of Aarohi’s clinical services to remote areas in the districts of Nainital and Almora. It will be staffed by a General Physician, a Lab Technician, an X-Ray Technician, a Nurse and a Pharmacist. Specialists and a Radiologist will be made available for 25% of the camps. The MMU will be capable of conducting ultrasounds, X-Rays, ECG, distribution of drugs, blood tests, sputum exam for Tuberculosis and will provide immunisation and family planning services.
The MMU which was lying idle at the Birla Institute of Applied Sciences has been transferred to Aarohi. After inspection of the equipment, the vehicle was taken to Haldwani for repair. The unit will next be sent to Delhi for major repairs and servicing. It should be functional by 1st May.
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