Improved Maternal & Child Care in the Himalayas

 BACKGROUND

Aarohi, a not-for-profit organisation, was founded in the year 1992, with the aim of creating development opportunities for the rural Himalayan communities.  Keeping an integrated approach to development, Aarohi, for last 25 years, has been committed to creating sustainable livelihood opportunities, providing quality health care and education services to the rural mountain communities.

In August 1992, Aarohi was founded by Oona, a development professional and Sushil, a doctor, with the mission of “creating development opportunities for rural Himalayan communities through quality education, health care, promotion of livelihoods and other development interventions.

Working primarily in the Kumaon region of Uttarakhand, Aarohi reaches 141 villages in the remote mountain districts of Nainital, Almora and Bageshwar through its varied development initiatives, covering a population of 65,000. Considering the remoteness of the area, poor infrastructure and over all low development indicators, Aarohi’s interventions have bridged the gap in existing government structure and provided essential services to the people from the region.

SUMMARY 

Committed to providing quality healthcare services to the rural communities from the Himalayas, Aarohi’s community health programme, focussing on maternal and child care, caters to the health needs of 70 (currently working) villages, covering a population of 34,168.  This project is implemented in 70 villages in the Okhalkanda block in Nainital District of   Uttarakhand.

 We currently have a well-trained cadre of 24 village supervisors who are leading the project at the village level covering every pregnant woman in the area. A grassroots team constituting 76 village health workers and 89 Traditional Birth Attendants (TBA), trained by Aarohi on all aspects of maternal and child health, are reaching the remotest parts of these mountains. 

Reducing the maternal & child mortality and morbidity in the region is the primary aim of the project Arogya.  As of 31^st June 2017, there were 257 pregnant women in the project area, benefiting from various health interventions made under the project Arogya.  A total of 2,709 children between 0-5 years are being monitored for malnourishment, in the project area.

PROGRAMME OVERVIEW

 Maternal health

1. Early registration of pregnancy

Early registration has increased to 88% from 74% in last six months period. Total 250 pregnancies were registered in this six months period of which 220 pregnancies were registered within 16 weeks of gestation.

2.  Antenatal coverage and antenatal care services

Antenatal coverage has reached more than 90% which means 90% pregnant women received antenatal checkup by a skilled care provider at least once during pregnancy. High-risk pregnancies are referred to the higher health centre for the treatment of complication and advised for institutional delivery. It is noteworthy that almost 50% of the antenatal care for the villages is provided through a Gynaecologist during the MMU visits. Her checkups are supported by ultrasonography examinations also provided by the MMU.

 3. Postnatal coverage

The proportion of women who received first postnatal care within 48 hours of delivery was 76.6%.

 4. Early and exclusive breastfeeding

 Early breastfeeding rate has increased to 83% which means 83.3% newborns were given breast milk within one hour after delivery. Similarly, the rate of exclusive breastfeeding was 72%.

 5.  Community Mobilisation

82 Matruh Samuh (Mother’s groups) meetings were organised in the period reported, with a total participation of 4351 women. In 49 of these meetings, short films on various health issues were screened. Films on diarrhoea and safe drinking water, the importance of ANC check up, the importance of growth monitoring of 0-5 years children in Aaganwadi (government pre school) centres, the importance of immunisation, institutional delivery, immediate newborn care had a considerable impact on the audience.

14 Village Health Sanitation and Nutrition Committee (VHSNC) meetings were also organised in this period. Use of untied fund was discussed in the VHSNC meetings. This has been a major achievement considering the almost defunct state of these committees.

Eight health fairs were organised in different villages through which the community was made aware of the issues related to maternal and child health. The importance of institutional delivery, post partum complication such as post partum haemorrhage, the importance of taking iron folic acid during pregnancy, the importance of antenatal check-up and danger signs during pregnancy were discussed during these health fairs.

 6. Vital events

In these six months, one maternal death was reported which was due to postpartum haemorrhage (PPH).  Seven neonatal deaths and two infant deaths and one child death were also reported.

Clinical HEALTH

The Aarohi Arogya Kendra (AAK), continues providing state of art clinical facilities. A total of 6,853 patients benefited from the services provided through AAK, the specialist medical camps and the Mobile Medical Unit (MMU) during the period January to June 2017.

Taking the health services to remote mountain villages, the MMU  continues to ply on some the toughest mountain routes in the region. A total 39 medical camps were held during the period. A total of 2,970 patients were treated during these medical camps.

1. Introduction

          Committed to providing quality healthcare services to the rural communities from the Himalayas, Aarohi’s                   health programme caters to the health needs of 70 (currently working) villages, covering a population33,882 

         With the focus on improving infant and maternal health in the region,  Aarohi has further strengthened and                  consolidated its Aarogya project, in70 villages in the Okhalkanda block. The project currently has a well-                    trained cadre of 24 village supervisors who are leading the project at the village level covering every pregnant              woman in the area. A grassroots’ team constituting 76 village health workers (ASHA/ SK) and 89 traditional birth          attendants, trained by Aarohi on all aspects of maternal and child health, are reaching the remotest parts of                these mountains.

         The Aarohi Arogya Kendra (AAK), continues providing the state of art clinical facilities. A total of 5,715 patients           benefited from the services provided through AAK, the specialist medical camps and the mobile health unit                 during the period July to December, 2016.

         There is still a long way to go considering the six neonatal deaths and two maternal deaths which were reported          during the period. The challenge still is about providing timely interventions in these remote mountain villages,             with limited infrastructure and low human development index. 

2. Maternal Health

• Antenatal care services: Early registration of pregnancies has risen to 74.4% which was 59% in Jun 2016. Antenatal coverage was 87.4% and proportion of women receiving 4 antenatal checkups was 46.4%.
• Postnatal care coverage: Postnatal coverage has increased to 73%, which means 73% of women received postnatal care within 48 hours after delivery. (Postnatal coverage: proportion of women received postnatal care within 48 hours after delivery).
• Referral and management of complication: High-risk pregnancies are being identified by ASHAs in the villages and till Dec 82.9% of such women were referred to health facilities for treatment of complicated pregnancies.

3. Child Health 

• Percentage of early breastfeeding was 64.3%, which means 64.3% children, were breastfed within 30 min after delivery. Similarly proportion of children who were exclusively breastfed was 69.7%.

• Total 76 schools are covered in 105 villages under school health program and 7745 children were participated in school health session, which includes raising awareness on personal hygiene, environmental hygiene, domestic hygiene and prevention and domestic management of acute diarrheal diseases.

4.  Community Awareness and Mobilization

Community meetings like the Mothers’ group meeting and general awareness camps are more interesting now with projection of health videos. 405 mother’s group meetings were organized where total 4357 people participated.

We started organizing a village health fair in which large numbers of people are made aware on selected themes by role plays and games. Till December, we organized 7 health fairs and our themes were safe drinking water, waste disposal, and the importance of institutional delivery.

5.  Vital Events

Six neonatal deaths were reported during period July to December, 2016, of which five were early neonatal deaths and 1 was late neonatal death. Three infant deaths and three child deaths were also reported in this period. Two maternal deaths were reported for the priod which were due to postpartum haemorrhage.

 6. Case study

Women in the mountains are often subjected to frequent pregnancies – all towards fulfilling the family’s desire of having a male born. On a cold mid-November morning, Neema delivered a healthy baby girl and soon after, her placenta was also removed. However, this being her seventh pregnancy, her uterus was weak and hence did not contract well. This led to postpartum hemorrhage and continuous bleeding in the form of large blood clots.

 When Sangeeta, Aarohi’s health co-ordinator arrived on the scene, she noted that the gunnysack on which Neema had delivered her baby girl was soaked in lood. On recognizing the symptoms, Sangeeta advised Neema’s family to take her immediately to the hospital. Met with resistance at first, Sangeeta administered Neema with Oxytocin, uterotonic drug, and simultaneously gave her a uterine massage to help her uterus contract. As the next step, she called for the Gram Pradhan’s (village head) intervention to counsel the family into taking Neema to a hospital. After much coaxing, the family relented and called for the ambulance.

On knowing that the ambulance was a good distance away and seeing Neema’s condition deteriorating, it was decided that she be taken in Aarohi’s vehicle till it met the ambulance on the way. Eventually, she was rushed to the Sushila Tiwari hospital in Haldwani where she was promptly put under observation and medication. Today, Neema is well on her way to recovery!

Neema is one of the many mountain women who are at risk continually due to lack of adequate care and proper diagnosis, especially in an emergency. Aarohi’s community health intervention strives to reduce these risks and thereby saves lives in remote parts of the Kumaon region.