Maternal Health and Nutrition in Tribal Areas
Beside the governmental data on Declining Maternal death Rate and improved maternal health; there are massive gaps when it come to the reality . To find out the reality, a team comprising of Vasavi Kiro (ex member of the Jharkhand Women’s Commission), Dr. Abhijit Das (Member of Advisory Group on Community Action, NRHM) and Jashodhara Dasgupta from NAMHHR, along with other civil society members undertook a fact finding from 20th to 23rd of November 2013 in Sunder Pahari block, Godda District. The team also tried to explore issues of service provisioning and suggest alternate strategies to improve health and nutrition services in the area in the tribal areas of Jharkhand.
The FFM team visited three villages selected on the basis of different tribal communities, varying distance from the block CHC, as well as different accessibility to roads. The team also visited one Community Health Centre (CHC), one First Referral Unit (FRU) and the Godda District Hospital; where the health providers and managers were asked about their assessment of barriers and challenges.
The Fact-Finding Mission Report was launched in Godda on 1st September 2014 by the D-RCH (former Civil Surgeon) Dr. Pravin Chandra, WHO representative and the Medical Officers in Charge of the Sunderpahari CHC and Mahagama FRU. During the District Dialogue attended by tribal women, Sahiyas and civil society activists of Santhal Parganas, the doctors admitted some continuing challenges like vacancies and lack of skilled staff in the CHC, and the problem of live-saving blood transfusion, which could not be provided in the entire district. The Report was also shared with the different media in Ranchi and MLA Bandhu Tirkey also joined us and he also did a launch with the media people.
The profile of the visited area
Godda district is part of the Santhal Parganas division of Jharkhand which is dominated by tribal communities. Sundarpahari is a backward block in Godda. The block has an entirely rural population, with 79% belonging to the Scheduled Tribe category, and more than half the villages are inhabited by particularly vulnerable tribal groups (PVTGs). Nearly 50% of land in Sundarpahari block is forested and hilly and most habitations are not connected to the few roads that exist. The literacy rate in Sundarpahari is 27%, and AHS 2011-12 data indicates that childbirth at home is 75.2% for district Godda
- · Giving Birth at home
All the women had given birth at home even though some had complications and near-miss experiences. There was also a maternal death in one of the villages. Yet the women did not consider going to the local health facilities as an option, and had no information about JSY or JSSK.
- · No Access to Basic Health Facilities
These women did not have access to basic health services such as ANC, and even immunization services for children was unavailable in the case of PVTG communities.
- · The ANMs did not go to the villages
The ANMs did not go to the villages for either ante-natal care or for home births; the health sub-centres were not easily accessible for many hamlets in the village, and the VHND was not taking place in even half the villages of this block owing to shortages of human resources and transportation issues.
- · No functioning of blood storage and transfusion facility
In the entire district although a large number of the pregnant women present with high anemia and comprehensive emergency obstetric care had to be accessed (by those who could afford it) in Bhagalpur Medical College in Bihar. In other blocks where ante-natal care is provided, it is not identifying any danger signs such as anemia, malnutrition or pre-eclampsia.
- · Free supply of grains- traditional Practices were neglected
The PDS does not incorporate the local grains that are richer in nutrients and instead provides the standard cereals that are given all over the country. The traditional food patterns of the tribal communities which were linked to the forests and the robust practice of mixed organic farming has been disturbed by the introduction of PDS grains. Local practices and resources have been ignored and women have been asked to take iron-tablets during pregnancy instead of promoting consumption of local iron rich foodstuff.
- · No efforts to integrate the tribal health system
Given the geographical situation of Godda district, it is difficult for health services to reach communities located deep in the forests. The tribal communities are seen as ignorant and uneducated, and their practices are looked down upon. The health system has made no efforts to integrate the tribal health system (based on local herbs) and integrate some of the good practices so that the tribal feel less reluctant to use the health facilities.
- At health facilities in tribal areas
- Inter-departmental convergence
- Re-orientation of community and facility health providers
- Integration of healthcare with the nutrition services
- Community Monitoring and Accountability by strengthening the capacity of members of Village Health, Sanitation and Nutritional Committees