Difficult terrain and lack of essential supplies including water, electricity, and communication have virtually derailed the National Rural Health Mission in most parts of Nagaland. Despite this, the infant and maternal mortality rates are low, thanks to the strong community bonding.
Though the State government has made serious efforts to create infrastructure under the Centrally-sponsored National Rural Health Mission (NRHM), access to these facilities is difficult owing to non-existent or bad roads, undependable communication system and acute shortage of water and power supply. At times taking a pregnant woman for delivery to the hospital can itself pose a threat to her life and that of her unborn child, given the condition of the roads.
Fewer infant deaths
A landlocked tribal-dominated State, Nagaland presents a conflicting picture of impressive infant and maternal mortality rates but extremely low percentage of institutional deliveries. The infant mortality rate is 20 per 1,000 live births as against the national average of 50 per 1,000 live births. The maternal mortality rate was 240 per one lakh live births (last surveyed in 2005-06) as against the then national average of 254.
A closer look at the scenario suggests that while access is a major issue, indigenous communities by tradition are averse to the idea of delivering at health facilities. A husband, father-in-law or any male member helping in deliveries is common among these tribes, says Bonnie Konyak, District Programme Manager, NRHM at Mon — one of the most backward districts of Nagaland.
Roping in communities
“We are trying to speak to the communities through accredited social health activists [ASHAs], and all those who can influence and encourage women to go in for institutional deliveries. It was a very difficult task initially but now more and more people are understanding its importance,” she said adding that people in these communities were unaware that every infant or child death had to be reported. It is now being done under the Mother and Child Tracking System.
Church's role
The local church has been instrumental in creating awareness on institutional deliveries. At least one session every week is dedicated to women and child health. “Student unions, tribal groups and civil society groups are our main source of feedback on service delivery. They come with complaints which are taken note of and funds are released only if the utilisation certificate is counter-signed by the pastor or the village head to ensure accountability,” Ms. Konyak said.
Assistance at home
“The community network has been strong even before we became a State and that is working to our advantage. Community participation can make any programme successful. Considering all these factors and the fact that there is an acute shortage of doctors in the rural areas, we have now adopted the concept of home-based skilled attendant who assists in deliveries at home,” Dr. Yangerlemla, Principal Director, Department of Health and Family Welfare, said.
Traditional attendants or dais , ASHAs and auxiliary nurse midwives were being trained to ensure hygienic and safe delivery, and even identify early signs of distress that could threaten the lives of the mother and child, she said.
No blood banks
The Janani Shishu Suraksha Karyakram has been implemented in the State recently, but this too, is facing difficultly because there are no blood banks and it is impossible to maintain the cold chain due to fluctuating power supply. Drugs do not reach in time as distances are unimaginable and women cannot be transported to hospitals for delivery because ambulances are few and often at the services of the doctors rather than patients, and hiring a private vehicle is far too expensive. The ambulance helpline does not function because mobile connectivity is bad.
