Moving forward on the contention that reproductive right is also a human right, the civil society organisations in this backward district are contributing in their own little way to improve the reproductive and child health care.
The Rogi Kalyan Samiti, as mandated under the National Rural Health Mission (NRHM), of the District Hospital here has taken up several initiatives to provide better facilities to the patients particularly for pregnant women. ``In addition to providing awareness among the masses, we organise capacity building exercises and have added to the infrastructure at the hospital in whichever small manner we could,’’ says Rabi Rajan, chairman of the National Peace Unison (India), part of the White Ribbon Alliance-India.
The untied funds provided to the Rogi Kalyan Samiti under the NRHM have been used to add to the bed strength in the hospital from 161 to 260 the approval for which would be taken subsequently. A 24X7 helpline and a subsidised canteen will be started next month that will benefit those coming from the remote areas. ``The helpline will help the patients to know about their entitlements under various schemes and provided any additional help,’’ Mr Rabi Ranjan explained.
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It was the initiative of the civil society organisations that mother and child health is taken up as an important part of the Zilla Parishad meetings. ``At every meeting I take up the issue of maternal mortality,’’ says Bhanumaty Raut, president of the Balangir Zilla Parishad though she was quick enough to add that the bureaucrat often dominated the meetings and that the elected representatives should have more powers as far as monitoring and accountability processes are concerned.
While maternal deaths can largely be prevented by adhering to some basic health interventions, the White Ribbon Alliance-India uses various tools for creating accountability at various levels to address the issue like public hearings, using checklist for elected representatives and civil society organisations to enable systematic tracking of the implementation of national policies and programmes at the district level. Checklists were developed for a social assessment of the progress of policies under the national Reproductive and Child health policies. It specifically references health facilities at all levels, provision for services of health workers and implementation of the national schemes.
Verbal maternal death audits is also one of the key tools for generating accountability by collecting evidences of the root cause of a maternal deaths. These audits are done by group of experts comprising WRA-India, media, doctors, government officials and elected members. The information is then shared and used with the government for advocating corrective measures.
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Of a series of public hearings organised by the WRA-India as part of the Maternal and Prenatal Death Inquiry and Response (MAPEDIR) between 2005 and 2009, the issues highlighted were the lack of adequate health providers, need for improvement in quality of care in service provision, and issues of accountability- including irregularities in Janani Suraksha Yojana benefits. Other issues like recommending Caesarean-section
in order to charge more money and the apathetic attitude of service providers across all levels in addition to high instances of referral.
The first report of the MAPEDIR had recommended developing a comprehensive maternal survival package of services for implementation under the NRHM and initiation of new intervention.
Importantly, he MAPEDIR results point at the interplay of `perception-role-action at different level. Maternal death is not for medical causes only and socio-cultural factors have determining impacts as seen from verbal autopsies. While education and economic standard of the family affects the health seeking behaviour, the availability and accessibility of services and facilities also play an important role. Maternal deaths continue to be a problem amongst the poor, illiterates and inaccessible -- inequity of service access and utilization.
The Birth Planning and Complication Readiness (BPCR) needs significant strengthening. Most important are universal accessibility to skilled birth attendance and, when needed, timely referral to accessible emergency obstetric care, the report had said.
Looking at the facilities the women visited, it was seen that most of the maternal deaths in the facilities occurred because of poor quality, and non-availability of services. So facilities should be strengthened with skilled manpower, specialists, equipments and blood transfusion facilities.
Transport availability continues to be a challenge and availability of money in advance at mothers’ level is a decisive factor leading to delay. In some places even transport facility is not available although the people do have money. More emphasis should be placed on ensuring timely transport facility for emergency cases.