Health
 India
Project #10365

Reduce Infant & Maternal Mortality in the Himalaya

by Aarohi
Vetted

Final Report – June 2016

Project Title: Reduce Infant & Maternal Mortality in the Rural Himalayas

Project Duration 4 years: 2012-16

Reason for Closure: Full funding received

 

Summary: The Arogya Health Project brings together training, awareness and treatment to reduce the number of mother and infant deaths, and improve the general state of well being for 30 remote villages in the Central Himalayas of India.

 

Challenge: Over half of the women living in mountain villages of Uttarakhand are severely anemic and malnourished. This along with a lack of health care services in the area results in alarming rates of maternal and child mortality and morbidity. The problem is further compounded by social taboos that often resort in extreme diet restrictions of pregnant and nursing mothers, endangering the health of the infant. Aarohi aims to change this trend through comprehensive community-based training and awareness.

Solution: This project provides extensive training for traditional birth attendants and local health workers (accredited social health activist) in antenatal and post-natal care, safe delivery, and comprehensive growth monitoring of children in the age group 0-3 years. Through Aarohi's mother and child care program, these community members are provided with a dignified livelihood, and are equipped with the skills, guidance and support needed to tackle high morbidity and mortality rates in their village communities.

Long-Term Impact: Going beyond simply providing services to remote mountains villages, the Arogya Project empowers traditional birth attendants and health workers (ASHAs) to improve the quality of health care in their own communities. This ensures that mother and child health is achieved in a sustainable way that provides local people with the knowledge and determination to continue providing services long after the project has ended. The proven result is fewer mother and infant deaths and healthier communities.

Achievements these past 4 years

 

-       Our outreach grewfrom 70 to 105villages in theCentral Himalayas

-       We trained 36health supervisors, 114 ASHAs and other health workers and 111 Traditional Birth Attendants,who now help to support health programs in their villages.

-       With the help of these trained workers, we have increased our antenatal checkup coverage (which includes one pregnancy consultation by a skilled care provider) from 49% to 88% of pregnant women.

-       Institutional deliveries has increased from 20% to 35%, geography of the area is a main obstacle to institutional delivery

-       Of the total patients receiving ultrasounds during the Medical Mobile Unit (MMU) camps, 68.2% were pregnant women. However, only 48% of the women return for a follow-up consultation and our goal moving forward is to increase the percentage of women who receive follow-up care throughout pregnancy.

-       Through the MMU,the number of women receiving antenatal care doubled from the first to the second half of 2015 (461 from January-June to 877 from June-December, for a total of1338 women).

-       Infant mortality was 57 per 1000 live births has reduced to 38 per 1000 live births likewise neonatal mortality has fallen from 36 deaths per 1000 live births to 29 deaths per 1000 live births.

 

Conclusion

In light of these successes, we seek to continue our grassroots approach to healthcare in rural Uttarakhand. In the next phase of this project, we will consolidate our coverage of remote and underserved communities by working jointly with the Uttarakhand government and other regional NGOs—strengthening current collaborative efforts and exploring new cost-effective ways to reach our goals.

Ganga and her new born baby, both doing well!
Ganga and her new born baby, both doing well!

 

HEALTH CASE STUDY

Aam, a village located in the remote interiors of Okhalkanda block, has no access to road or mobile phone connectivity, as a result of which access to medical facilities is limited.  Most deliveries are conducted at home as getting medical help is a big challenge.  On 19 November 2015, Bhavana, a health supervisor at Aarohi received information that 23 year old Ganga had delivered a baby at home. Her blood pressure had fallen drastically and she was unconscious. Preliminary diagnosis revealed that her placenta had only been partially delivered, part of it visible outside the body.  This lead to a lot of blood loss. Ignorant of her medical condition, the family attributed it to the ‘’devil’’ and were administering traditional medicine (‘Jhad-phook’). On persistent counseling by the Aarohi health team, the family was finally convinced to take her to the hospital. After almost 24 hours of this ordeal, she was administered proper medical care. Today, both mother and child are    doing well. Timely intervention, helped save a life!

 

Clinical Hospital Data for the Period July-December 2015

  • Total patients seen - 5362
  • Number of patients treated in hospital - 836
  • Number of Female Patients Treated - 352
  • Number of Male Patents Treated - 453
  • Number of Children Treated < 5 years -  31
  • Indoor patients seen - 32
  • Home visits/Emergencies - 0
  • Laboratory Tests - 352
  • X-Rays - 52
  • ECG - 7
  • Total villages covered - 130
  • School children screened for Health problems- 0
  • Specialist camps held - 6
  • Total patients screened in camps - 314
  • Plastic Surgery- 19
  • Eye check-ups - 43
  • Gynae check-ups - 25
  • Physician visits - 203
  • Total  surgery done - 26
  • Dental camps held - 6
  • Total screenings in Dental OPD - 209
  • No. of dental extractions done - 64
  • Total dental filling done - 42
  • Total scaling - 13

   

Data for Medical Mobile Unit (MMU) Camps for the Period July-December 2015

  • Total camps held - 62 
  • Total pateints registered - 3465
  • Total antenatal check-ups - 877
  • Total Lab Investigation - 3710
  • X-ray - 79
  • ECG - 27
  • Total ultrasound - 738
  • Total ANC Ultrasound - 516

 Antenatal coverage has reached 98% and this can be attributed to the Medical Mobile Units (MMU).  The women from remote villages are getting antenatal check-ups and essential tests and investigations done in MMU.

In the last 6 months the number of villages covered has increased to 130, almost a 38% higher reach than the period from January to June, 2015.  The reasons for this could be attributed to the following:

  • The MMU route has been changed, and it now visits a village called Kodar instead of Jhadgaon, this provides access to more remote villages that are availing services at MMU.
  • Local doctors in the villages are also referring patients to the MMU for essential lab investigations.
Growth monitoring in the village
Growth monitoring in the village

Dear friends,

We are happy to give you an update on our community health work for the period May to July 2015. It has been a hectic 3 months while we have expanded our work to include all 105 villages covering a population of approximately 50,000 people in the Okhalkanda Block of Nainital District in Uttarakhand.

Do read on to learn more.

Should you have any questions or suggestions on the review please do write to me at sushil@aarohi.org 

On behlaf of all of us at Aarohi we thank you for your continued support in helping bring better health opportunities to the communities of rural Uttarakhand.

With gratitude and good wishes to all of you,

Sushil

 

 

 

 

                               REDUCE INFANT & MATERNAL MORTALITY IN THE HIMALAYA: May- July 2015

Community health

Our community health project has now expanded to a total of 105 villages in the Okhalkanda Block of Nainital District of Uttarakhand. A remote, mountainous zone in the Himalayas, its greatest issue is access to reliable, timely and ethical health care delivery systems. The community is mired in the cycle of poverty and ignorance and public health care delivery systems are indolent and their private counterparts exploitative.

Achievements & Highlights

  • Revival of VHSNCs: 68 Village Health Sanitation and Nutrition Committees (VHSNCs) were identified out the 70 project villages. We revived these VHSNCs by organizing meetings of their members. Prior to these meetings, members did not know that they were part of the VHSNC, and were unaware of their roles and responsibilities. Accredited Social Health Activists (ASHAs) and ASHA facilitators prepared the list of members and forwarded it to the concerned senior authority.
  • We started systematic training of VHSNC members on their roles and responsibilities. As a result, some of the VHSNCs have undertaken new initiatives. Some of these are as follows:
  • ANM appointment: An Auxilary Nurse Midwife (ANM) was appointed in the sub-centre of Kalaagar, where the post had been vacant for the last 6 months. This was achieved by bringing the issue to the notice of the VHSNC and guiding the members who formally pushed the matter with the CMO.
  • ASHA recruitment: In Matela and Goniyaro villages, the VHSNC recruited an ASHA in each village after the meeting. This post had been vacant for approximately 1 year.
  • We have now started conducting collective activities during the Village Health and Nutrition Day (VHND), such as Antenatal Care (ANC), growth monitoring; Matru Samuh meetings - counseling on hygiene, contraceptives, food etc. Earlier, in VHND, Anganwadiworkers distributed only THR (Take Home Ration).
  • Coordination with the block level government system: After formal discussion with the Block Coordinator of the National Health Mission (NHM) Okkhalkanda, we decided that we would share monthly data with each other on a regular basis. In doing so, we expect the quality and authenticity of data to improve over time. .
  • We started decentralised trainings for ASHAs and Dais (Traditional Birth Attendants). Through this, we are saving on travel time of participants and trainers are able to give more one-to -one attention to participants by working in smaller groups.
  • Two exposure visits were conducted for school children for their personality development. A total of 74 school children participated.
  • A women’s bathroom was constructed in Kalagar village. As a common cultural practice, menstruating women are subject to many restrictions within the household, including having to bathe and look after their sanitation needs outdoors and in the dark. The newly built bathroom will enable women of the village to bathe safely during menstruation. The local community was actively involved in the construction of the bathroom, and has taken responsibly for its maintenance.    
  • The supply of Iron Folic Acid (IFA) was not regular for the last year. With the help of a Zila Panchayat member, we raised the issue of intermittent supply to the CMO,Nainital. As a result, the government began supply of IFA to ANM centres immediately.
  • We started conducting meetings with local government ANMs (Auxilliary Nurse Midwives) to ensure improvement in services and greater collaboration.
  • A 5-year extension for use of the MMU (Medical Mobile Unit) has been obtained by the State Government. This MMU benefits approximately 600-700 patients every month and has brought ultrasound and good antenatal care to many pregnant women in our community heath project area.
  • Placing a senior volunteer Swiss midwife in PHC (the government Primary Health Centre) Okhalkanda for 4 months enabled local nurses to implement better birthing practices under the NHM.
  • We have achieved 100% coverage of the Smokeless Chullah programin Dewali village, which has a population of 25 households. Till date, 21 households have installed the chullah in their homes. On 17th September, a meeting was organized, in which the remaining 4 households agreed to install the smokeeless chullah in their houses. A total of 341 chullahs have been constructed over the past 2 years. 98% of these are in use and the users are extremely happy with this addition to their houses, bringing the comfort of a smoke free use and also reducing the consumption of wood by approximately 50%, thus significantly reducing the drudgery of women.
  • Water testing and purification at household level                                                                           We are procuring water testing kits from TARA Life Sustainability Solutions Pvt. Ltd, an ISO certified company known for manufacturing, distributing and supplying a wide range of the premium quality of water testing kits and check vials. We are currently using H2S test kits named TARA aquacheck vial, which can test the presence of pathogenic bacteria (colifrom bacteria) in water that causes common water borne diseases. Supervisors test water from the common source with the help of this kit.                                    Forty five out of 48 or 94% of water sources were found faecally contaminated.This brings out the enormity of the problem of the existence of water borne diseases in the region and the need for a sustained campaign to rectify this issue.                                                    
  • In Jhargaon Talla, chlorination of the village’s drinking water CWR (Clear Water Reservoir) was successfully carried out.

 

 

                                                                 Maternal and Child Health Statistics

ANTENATAL CARE

Currently pregnant women                                                                              853

Total pregnant women given care over three month period

     (currently pregnant+ live births+abortion+sb)                                            319

PREGNANCY OUTCOMES

Abortions                                                                                                         8 (0.9%)

Deliveries                                                                                                        151

Live births                                                                                                       150 (99.3%)

Still births                                                                                                        2 (1%)

Institutional deliveries                                                                                      52 (34%)

Home deliveries                                                                                               99 (66%)

Deliveries conducted by Aarohi trained TBA                                                   55 (55.5%)

Low birth weight                                                                                              11 (7.3%)

Maternal Deaths                                                                                              None

 

POSTNATAL CARE

Neonates breastfed within 30 minutes (indicator to hasten 3rd stage labour)   122 (82.6%)

Neonates breastfed within 24 hours (for baby)                                                 148 (98.6%)

 

FAMILY PLANNING

Eligible couples                                                                                                  10,638

Eligible couples using contraceptives                                                                1,753 (16.4%)

 

 CHILD CARE

Children 0-6 months                                                                                          703

Children 0-5 years                                                                                            10,219

Infants 0-6 months exlusively breastfed                                                            610 (87%)

Children 0-5 years                                                                                            10,219

Children 0-5 years monitored for growth                                                          5,950 (58%)

Children 0-5 years with normal weight                                                              5,508 (93%)

Severely malnourished children 0-5 yrs (red category)                                    129 (2%)

Mildly malnourished children 0-5 yrs (yellow category)                                     313 (5%)

 

 CHILD CARE

Infant Deaths                                                                                                      3

 

CURATIVE HEALTH

Patients treated                                                                                                  2,011

Villages covered                                                                                                 145

Specialist camps held                                                                                          2  

Patients treated in specialist camps                                                                    63

Surgeries performed                                                                                            16 

Mobile Medical Unit (MMU) camps                                                                      45

Ultrasounds performed                                                                                        260

Dental camps held                                                                                               1      

Dental patients treated                                                                                        107

 

Saved the mother, not the child

Kakkod, a village located in the remote interiors of Okhalkanda block has no access to a road or cell phone connectivity. The nearest accessible road is 15 kilometers away which makes it tough for the inhabitants to access a health facility or for the government health workers to visit the village. Majority of deliveries are conducted at home and if any complication arises during a delivery, getting medical help is next to impossible.

On 13May 2015, Munni, a health supervisor with Aarohi received information that 24-year-old Durga of Kakkod was in labor. Within 10 minutes of Munni’s arrival, Durga gave birth to a girl. After the delivery it was found that the umbilical cord was wrapped around the neck of the baby. Munni carefully removed the cord from the neck of the baby, cut it and placed the baby at the breast of the mother. The placenta was not expelled even after an hour of delivery and Durga was losing blood. Knowing well the consequences of a retained placenta, Munni advised the family members to immediately evacuate Durga to a hospital, but they were not convinced. The family was dejected as Durga had given birth to a third girl and they were hoping for a boy. Munni then took it upon herself to do whatever she could to save the mother. She massaged the fundus, simultaneously made the mother feed the baby every 10 minutes and after 6 hours, the placenta was expelled. Munni thereafter gave tips to the family for necessary care for both the baby and mother and left the house.

The next day, Munni learnt that Durga’s child had passed away in the early hours of the morning and the cause of death was uncertain. On enquiring, she was told that Durga was losing blood profusely. In the meantime, the local ASHA and ANM had reached their home and Durga was given Iron Folic Acid Tablets and medicines to bring down her fever. Later in the day Munni made another home visit and counselled the family on the importance of getting urgent medical help. Durga was then taken to Sushila Tiwari Hospital in Haldwani, where she underwent blood transfusions for a week. The doctors later said that had they waited for more time, they probably would have lost Durga. The family was grateful for the support they got and thanked Munni for all her help and guidance.

 

 

 

 

 



Links:

Dear All, 

We present to you the Annual Review for the year 2014-2015. You'll get a detailed account of not only the work we did in our curative and community health initiatives but in our education and livelihoods programs as well. The highlight of the community health project this year was that ALL pregnant women in our project area in the remote Okhalkanda Block are now able to access ante natal care. In addition our mobile medical unit reached out to patients in few of the remotest parts of Uttarakhand.  The coming year will see the completion of our pilot solar bathing house for the women for Kalagaar village, in an effort to bring better sanitation facilities for menstruatiing women. 

Should you have any questions or suggestions on the review please do write to either Sushil at sushil@aarohi.org or me at sheeba@aarohi.org. 

On behlaf of all of us at Aarohi we thank you for your continued support in helping bring better health opportunities to the communities of rural kumaon Himalayas. 

with gratitude, 

Sheeba


Attachments:
Medical Mobile Unit
Medical Mobile Unit

THE MEDICAL MOBILE UNIT

The Medical Mobile Unit (MMU) has 15 scheduled camps every month over 8 days, catering to the population of approximately 80 villages. The unit has the services of a lady doctor, a general physician, a lab technician, an X-Ray technician and a nurse cum pharmacist. Services provided are X-Rays, ECG, drug dispensation, laboratory tests for blood and sputum and family planning services. Over the past six months of its operation, the MMU has greatly added to the reach we have had to bring clinical services to some of the very remote villages in Okhalkanda Block of Naiintal District and support our community health program. It is also covering a large gap in the delivery of antenatal services that the government is unable to provide comprehensively.

To see hospital services data please see the attachment below titled CURATIVE HEALTH DATA

PINDARI CAMPS

The Pindari health camps of Aarohi started in September 2009, a result of the efforts of our dear friend Pankaj Wadhwa. The bi-annual camps aim to provide basic but essential health care services and spread general health awareness in government schools largely bereft of teachers. These villages lie scattered on the trek route to the Pindari, Sunderdhunga and Kafni glaciers. They lie between altitudes of 2000 to 3000 m above sea level, and a good ten hours of a tough trek through mountain terrain from the road head, which itself is eight hours of difficult driving from our village headquarters in Satoli. A total of 9 camps have been done over the past 6 years. The focus now is on growth monitoring of some 200 children in 5 schools. Six monthly records of height and weight are done along with a complete medical and dental check-up. The medical team deworms the children and gives Vit A and Calcium supplements. Volunteers help conduct awareness sessions on personal hygiene and cleaning campaigns are conducted in the villages. Village out-patient care is conducted for the ill seeking treatment.

ENERGY

Our research in the energy sector has been driven by the need to improve the crude stoves and methods used in the region to heat homes and cook food, using wood as fuel. On average women spend 2-3 hours every day collecting fuel wood and in the Okhalkanda Block of Nainital District - our target area – the stoves used are virtually the same as those used by cave men. These burn wood inefficiently and fill the house with hazardous smoke which, after a lifetime of inhalation, causes compromised respiratory function and early death. In 2010 we started the construction of 'Improved Chullahs' (smokeless stoves). The focus was on reducing the amount of inhaled smoke in the house, especially by women and children. Over the last three years we have constructed 401 smokeless chullahs and this has been a period of intense learning for the community, the masons and us. We struggled with different designs as well as getting women to understand maintenance of these chullah and the benefits of a smoke-free home. We teamed up with ARTI (Appropriate Rural Technology Institute) of Pune and also brought in a much more scientifically designed chullah that used a fixed mold, allowing little room for error in construction. However an end-of-phase evaluation found that only 116 or 29% of chullahs were working and used well. The rest were either not in use or had been broken. An analysis of the situation revealed that the main reason for non-compliance was the mouth of the chullah. It was too small to puff the standard-sized `roti’ (Indian flat bread). Many women chose not to adapt and reverted to their old smoky chullahs. Another key reason was not a very aggressive follow up by the masons’ team, resulting in clogging of flue pipes with soot and smoking the house.

To see the Energy Project data please see the attachment below titled CHULLAH REPORT. 

Manoj Ram of Wacham with unformed ear.
Manoj Ram of Wacham with unformed ear.
Pindari Group September 2014
Pindari Group September 2014

Attachments:
 

About Project Reports

Project Reports on GlobalGiving are posted directly to globalgiving.org by Project Leaders as they are completed, generally every 3-4 months. To protect the integrity of these documents, GlobalGiving does not alter them; therefore you may find some language or formatting issues.

If you donate to this project or have donated to this project, you will get an e-mail when this project posts a report. You can also subscribe for reports via e-mail without donating.

Get Reports via Email

We'll only email you new reports and updates about this project.

Organization Information

Aarohi

Location: District Nainital, Uttarakhand - India
Website: http:/​/​www.aarohi.org
Project Leader:
Neeraja Joshi
District Nainital, Uttarakhand India

Funded Project!

Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.
   

Still want to help?

Support another project run by Aarohi that needs your help, such as:

Find a Project

Learn more about GlobalGiving

Teenage Science Students
Vetting +
Due Diligence

Snorkeler
Our
Impact

Woman Holding a Gift Card
Give
Gift Cards

Young Girl with a Bicycle
GlobalGiving
Guarantee

Sign up for the GlobalGiving Newsletter

WARNING: Javascript is currently disabled or is not available in your browser. GlobalGiving makes extensive use of Javascript and will not function properly with Javascript disabled. Please enable Javascript and refresh this page.