Integrated approach on Health Issues in India’s desert

Cairn India has pioneered education in health sectors in the far flung oasis of Rajasthan. Mobile ambulances with well qualified and experienced teams with a specific responsibility in spreading awareness to the community in the vast sand covered tract which stretches for miles and miles together and forms a part of the Thar Desert known for its dryness, extreme temperature and erratic rainfall. Awareness on prime issues such as child nutrition, maternal care, gender bias, reproductive health care and HIV/AIDS were addressed. Besides, upgradation of the infrastructure was also undertaken to provide quality care to the community. Barmer District at a glance Sl. Indicator Figures 1. Area ( In Sq. Km.) 28,387 2. Number of Gram Panchayats 380 3. Number of villages 1,941 4. Number of Towns 4 5. Total Population 1,963,758 Child and Maternal Health Background Only 4% of pregnant women believe and receive a full antenatal care (ANC) package, with majority of the deliveries are conducted at home, and with 90% of pregnant women suffering from anaemia. The couple protection rate is very low at 24.5% and unmet need for family planning services is high at 27%. With only 14% of children between 1-2 years of age fully immunized, and almost half of the under-six population severely malnourished, there is an urgent need to address the health of women and children in this area. The community at large is affected by diseases like malaria, TB, diseases associated with animal husbandry, dust-borne ear and eye problems, rabies, and snake bites. Cairn India CSR initiative Cairn India and International Finance Corporation (IFC) in partnership assisted The Centre for Development and Population Activities (CEDPA)in implementation of the child, maternal and reproductive health initiative in 32 Revenue Villages of 13 Gram Panchayats in three development blocks of Barmer, Rajasthan with a target population of approximately 18,000 benefiting approximately 3,060 children under the age of six, 3,600 women, 2,500 men, 1,200 adolescents, and 400 truckers and their cohorts. This programme pioneered a holistic, integrated approach to health issues including women’s and children’s health, HIV/AIDS, while strengthening the existing government health services. Additionally, the programme aimed to reduce Reproductive Tract Infections (RTIs), Sexually Transmitted Infections (STIs), and HIV/AIDS transmission among truckers and their communities. It was significant that the programme did not try to create parallel structures but complemented and collaborated with the government. Programme intervention Significant highlights of the programme intervention included linking of reproductive health and HIV/AIDS information and services, increasing awareness within the community and thus improving quality of life; and generating demand for basic reproductive health services, mainly maternal and child health services such as institutional deliveries and immunization. Male Community Health Volunteers (MCHVs) mobilized the community to seek health services during Maternal Child Health and Nutrition (MCHN) Days. The project also built the technical capacity of the Community Health Workers and ANMs and worked with them for better coverage of health services. To increase the involvement and ownership of Panchayat members in RCH activities, it built their capacity in leadership and managerial roles.  These Panchyat leaders were also encouraged to monitor the delivery of health programmes in their areas. Adolescent girls and boys in intervention areas were provided information related to life skills such as setting a goal, building a strategy to achieve it, importance of family values, importance of personal hygiene, their rights, knowledge on environment etc. Uniqueness Adding to the hindrances to development is low level of awareness and education not to mention the purda (veil) system that keeps the women under veil and restricted to the four walls of the house. Some of the unique constituents are: MCHV (Male Community Health Volunteer) which aimed to reach men at the community level with Reproductive Health information to promote men's support for increased use of Family Planning and enable them to make informed decisions regarding Reproductive Health; to encourage men to support their wives, children and other young persons in the family unit and advocate for increased utilization of FP/RH commodities and services. This is for the first time such an initiative was taken in a similar project. The initiatives taken under CMH programme have been quite helpful for the adolescents in the community. These initiatives have helped youths in self-realization and have changed their lives. They are now more curious on asking questions and rectifying their queries. (Youth Facilitator, village Sindhwasa Harniya) Better Life Options and Opportunities Model: The strategy aimed to provide adolescents information, skills and tools to make healthy decisions and practice healthy behaviours that reduce risks and incidence of early and unwanted pregnancies, anemia, STD/HIV/AIDS transmission, and RTIs. Under the programme a cadre of trained school teachers and Youth Facilitators were trained who acted act as change agents and provided counselling and information services to the school students and community at large. Some of the adolescents trained through the BLP was identified as Youth Facilitators (YF). They assisted in enrolling other adolescents, and act as change agents in the community. Children have become more vocal, expressive and confident … they understand the symptoms of common diseases and STDs/HIV/AIDS. They have started looking out changes in their own body/physique after going through session on adolescence. (Teacher, village Indra Colony) This contributed towards sustainability by facilitating adolescent participation and leadership in the community Impact The achievements and learning’s have been immense, although the intervention period was one year only. Notable has been the increase in awareness and improvement in health seeking behaviour of communities; empowerment of in-school and out-of-school adolescents with Life Skills education; development of a pioneering cadre of MCHVs; enhanced capacity of community level government health functionaries; partnership established with the government in organizing health camps and melas. In Maternal Health, the key indicators reflect significant improvements- such as 47.7% increase among women in knowledge regarding risks associated with early pregnancy, 29.1% increase in knowledge regarding risks associated during pregnancy and 15.7% increase in knowledge regarding risks associated in post pregnancy. In addition, programme results also show significant increase in infant care immediately after birth with 34.4% children being dried with a cloth, 18.2% increase in breastfeeding within one hour of birth and 24% increase in proportion of institutional deliveries. Programme evaluation shows an increase of 23% in use of condom among truckers and considerable increase of 89.3% in knowledge related to HIV/AIDS among adolescents. However, despite the successes, there were challenges that hindered progress – example, remote, inaccessible areas, limited time for the intervention, lack of incentives for Youth Facilitators which hindered continuity and limited financial sustainability for MCHV, etc. In villages, elder ladies are now more convinced and allow mothers to give first milk to their newborns. This is just because of ANM behenji who visits us and talks about safe delivery, immunization, etc. (Females, village Sindwasa Harniya)

Cairn India has pioneered education in health sectors in the far flung oasis of Rajasthan. Mobile ambulances with well qualified and experienced teams with a specific responsibility in spreading awareness to the community in the vast sand covered tract which stretches for miles and miles together and forms a part of the Thar Desert known for its dryness, extreme temperature and erratic rainfall. Read more