It was late at night when the mukhiya (head) of Naal village in Gogunda block, Udaipur district in Rajasthan, called the medical emergency helpline ‘108’ for an ambulance to take a pregnant women to the nearest community health centre (CHC) for delivery.
The ambulance would only reach the next morning at 5 a.m., he was told curtly.
The reasons for the delay that could have proved costly were discussed at a meeting of the community with elected representatives, health workers and the staff of the local non-governmental organisation ALERT (Active for Literacy and Environmental Enovation Task) Sansthan that works in 151 villages in the block.
ALERT Sansthan helped the mukhiya to probe the reasons for the delay in ambulance services to the Bhil dominated tribal block of Gogunda. The Bhils work on daily wages at nearby construction sites. They regard alcohol as “holy spirit” and many are involved in brewing and consuming illicit liquor.
Discussions with the ambulance driver revealed that the residents of Naal had earlier stoned the ambulance on several occasions so the driver decided not to risk his life at night. Villagers, when questioned by the mukhiya , said the noise of the siren at night had frightened them and they thought it was a police raid on their illicit distilleries.
The NGO later held meetings with the Sarpanch, panchayat members as well as the community, teachers and local health workers to inform the communities that the ambulance service was an entitlement of the community and would enable them to access their health rights. Villagers realised that their resistance to the ambulance could have negative health consequences for the community. A collective decision was taken for the safe passage of the ambulance and the driver was also informed.
The Centre for Health Education, Training and Nutrition Awareness (CHETNA) based in Ahmadabad, has been working in partnership with 10 NGO partners like ALERT in Rajasthan and Gujarat on participatory communication strategies to create awareness as well as to ensure that the public health entitlements and services as guaranteed under the National Rural Health Mission reach people in remotest rural areas.
The activities of the ‘Participatory Communication Initiative for improving health care services for rural communities’ under NRHM using traditional and modern modes of awareness generation was implemented in five blocks of five districts each in Gujarat and Rajasthan between 2008 and 2012. During local fairs like Kaila Devi fair, Gangaur fair in Rajasthan and Bhadarvi Poonam Mela, Urs Mela in Gujarat and festivals like Janmashtami and Navratri, the communities were informed about their health entitlements. Information on health and nutrition services and community entitlements was shared with over 600,000 people in two States.
Simultaneously for improving services more than 600 service providers and 1,500 ASHAs were trained on their roles and responsibilities. A needs assessment at the start of the project had shown that only 25 per cent of the people were aware of government health schemes and their entitlements.
The utilisation of anganwadi services increased dramatically by almost 80 per cent and the Sarpanch and panchayat members realised the importance of meeting the health needs of the community. By the end of the project in 2012, there was a significant awareness about Maternal and Child Health (MCH) entitlements and the community began accessing services. More women are now opting for institutional deliveries and are availing of the referral transport and more woman and children are attending the anganwadi for immunisation and other facilities as well as the Maternal Child Health Nutrition Day.
CHETNA used posters, wall writings, street meetings and road shows in addition to distribution of audio visual material in local dialect to inform the population about their health entitlements.
