While mother and child health care rules the roost, other schemes fall flat

There is a discrepancy in various health schemes adopted in the state. While one has seen massive success, many others flounder

According to the United Nations Inter-agency group for Child Mortality Estimation(UN IGME) report 2017, six countries that account for half of the world’s under-six deaths are India, Pakistan, Nigeria, the Democratic Republic of Congo, Ethiopia and China. Of these, India and Nigeria alone account for almost 32% of world’s under-five deaths. Every year hundreds of children under five years of age die in India, mostly due to preventable and avoidable causes.

Where India has been so unaccommodating of proper health care, where so little is allocated for healthcare in every budget, Karnataka as a state has risen as an exception, making sure that mother and child care is taken proper care of, from the Taluk level to the ground level in the remotest of villages. Anganwadis are abundant and working adequately. Anganwadis are rural mother and child care centres in India, started by the government of India in 1975 as a part of Integrated Child development Scheme, aiming to fight malnutrition. They provide basic health care and food in the villages. They ensure antenatal and postnatal care for pregnant women and instant care for new born children and nursing mothers. They manage the vaccination of all children below the age of six, enrolled in the Anganwadi. Apart from vaccines and meals, they also have teachers who provide pre-school education to kids going to Anganwadis.

Recently ASHA ( Accredited Social Health Activist) workers have also joined the endeavour to work towards creating awareness on health planning, counselling women on birth preparedness, importance of safe delivery, breast-feeding and complementary feeding, immunization and contraception. They also spread awareness on the need for prevention of common infections that include Reproductive Tract Infections/Sexually Transmitted Infections (RTIs/STIs), and care of the young child as mentioned in the National Health Mission website, under which the initiative is taken care of.

The success of Anganwadis was partly due to a huge struggle led by the ASHA workers after they were asked to perform various non-departmental jobs due to lack of anganwadi centres. In 2015, anganwadi workers from all over the state gathered in front of Freedom Park in Bangalore to protest against the struggles they face in their job due to the ignorance of the government. Constant wake up calls given to the government brought anganwadis to a point where they run so systematically.

In October 2017, the Chief Minister launched another scheme that aims at mother and child care, named “Mathrupoorna”. The scheme ensures one meal a day for all pregnant and lactating women, in order to curb malnutrition.

“I registered myself at the anganwadi nearest to my house during the first three months of my pregnancy. I am in the 8^th month of pregnancy, and I come here every day for lunch and other food supplements” says Suma, 26, a resident of Gama village in Shikaripur Taluk.

Why is it that the mother and childcare healthcare programmes succeed at the taluk and village level of a progressive state like Karnataka, when other major initiatives like TB, Leprosy, Malaria, Mental health and diabetes control flounder?

Shikaripura is a taluk in Shimoga district of Karnataka, and till 2005, Shikaripura had no government hospital. “Earlier there was no hospital in the taluk, due to which we had to travel 80 kms to Shimoga for medical treatment. I needed a c-section during the birth of my son, and had to go to Shimoga for the operation,” says Bhagya, a resident of Kagenahalli village in Shikaripur taluk. Since the Government hospital was set up in 2005, there are more than 300 deliveries, both normal and c-section, that took place in the hospital. The hospital has three gynaecologists, and the doctors reach out to villagers by visiting Anganwadis every week.

Shikaripur’s health office reported 19 out of 1000 and 120 out of one lakh as the infant mortality rate last year. According to the Shikaripur taluk head office reports, the total number of infant deaths from April 2015 to May 2016 was 38 and from April 2016 to May 2017 was 48. The main reasons for the infant deaths were, reportedly, breast milk aspiration, pneumonia, asphyxia, severe bronco pneumonia and septicemia among others. Also, most of these deaths are reported at home than health centres or hospitals.

Senior health inspector of Shikaripur taluk health office, Pandu S., informed, “The infant mortality rate in the taluk is not high and have only been decreasing over the years.”

The main reason why deaths under the age of five occur are that people find it difficult to travel to the taluk all the way from their villages for medical care. In most cases, mothers go back to working in the farms within 6 months of delivery, which leads to lack of timely breast feeding.  In other cases people prefer delivery at home and there is a possibility that mid-wives that help lack proper knowledge. There are more 20 currently ongoing schemes in total at both central and state level for mother and infant care.

On one hand, such schemes for mother and child healthcare have seen massive success over the years. While on the other hand, various programmes for other major initiatives towards communicable and non-communicable diseases like Leprosy, Diabetes, Malaria and TB have failed to succeed in the same taluk. What is it that mother and child healthcare schemes adopt that the others don’t?

National Leprosy Control Programme
National Anti Malaria Programme
National Programme on Prevention and control of Diabetes
Revised National Tuberculosis control programme

Above are various schemes ongoing in the taluk that aim at controlling and spreading awareness about major diseases that are making India their home. India is one of the top three nations that account for maximum number of people with Diabetes and Tuberculosis, a disease spreading rapidly among people. Awareness for these diseases is a must. Then why is it that these schemes fail to reach to the ground level and remain limited to papers?

According to a WHO report, “In 2008, an estimated 347 million people in the world had diabetes and the prevalence is growing, particularly in low and middle income countries. India had 69.2 million people living with diabetes (8.7%) as per the 2015 data. Of these, it remained undiagnosed in more than 36 million people.”

“I have diabetes and had no idea about the prevention or symptoms, until one day, the doctor himself sent for a blood test when I complained of regular body pain since few months. That is when I got to know about the disease and all that things that I had to avoid eating,” says Mobina Bano, a resident of Begur village in Shikaripur taluk.

The hospital authorities, when questioned, began to blame the ignorance of the government or the people as one of the main reasons for poor access to available schemes or benefits.  “We make sure that the department leaves no loopholes in spreading awareness about how dangerous this disease is and that there is cure available. But patients stop the course of the medication as soon as they begin to feel better” says Veeresha, TB Department assistant at the taluk government hospital.

“We have various awareness programmes for every scheme, be it centre or state. We train people and these people not only go door to door but also to fields and schools to spread awareness. We have been able to educate people regarding the same to a large extent,” says Pandu S., Senior health officer, Shikaripur taluk.

But when asked, nobody except a few knew about the various schemes. The schemes are on paper, and the centre allocates funds for them, but the benefits fail to reach people who are actually supposed to get it. The wire of communication gets broken in between. Sometimes the people responsible for educating have other jobs to do, and they ignore this responsibility, thinking it to be less important. Many times there is nobody to watch over how the work is going on, so the work doesn’t happen as the salaries anyway reach without any efforts.

When the taluk has a government hospital that provides benefits that are supposed to reach the people with adequate equipments and branded medication, the main reason for the breakage of this link between the people and the schemes remains the referral. Who refers these people, and how aware are they of these benefits and schemes in existence?

In case of ICDS, every village has a minimum of two Anganwadis with trained workers and teachers who are aware of the benefits that the mother and child are supposed to receive, and they refer them to concerned authorities. For various other schemes, there aren’t enough people aware of the associated disease or its consequence, which leads to no referral and subsequently the schemes and benefits are not availed in the manner they are supposed to be.

“I think the main reason the ICDS work properly and are successful is the availability of Obstetricians and Gynaecologists and the instant care given to the new born. We work for 24 hours, the main reason being proper and timely referral. We carry out a lot of successful C-sections daily and about 300 children are given birth to in the hospital daily,” says Dr. Geetha, a gynaecologist in Shikaripur taluk hospital.

Many villages in the taluk do not even have a Primary Health Centre (PHC), which disrupts the due course of a process that leads to people availing benefits that the government provide. Begur is one such village. Zakir M. Saudagar, a private Ayurvedic practitioner, says, “I have been practicing medicine for the past 15 years in the village. We have complained about and demanded for a hospital in the village every time a new MLA gets appointed, with no response. I treat whatever I can but I can’t detect and treat diseases like TB, Leprosy or Diabetes. I ask people who come to me with serious conditions, to visit the taluk hospital. But most people ignore the suggestion due to various reasons, lack of transport facilities being one of them.”

Of all the schemes, only Tuberculosis Program has been successful, though partly. The taluk hospital authorities have managed to create some awareness regarding the symptoms of TB and the check-ups that are available free of cost, but that still hasn’t helped the Taluk rid itself of Tuberculosis completely. A few who knew about TB and its treatment told that advertisements and health campaigns were the primary sources of information.

When asked why the scheme hasn’t been completely successful despite the public being aware of the disease and its treatment, the Senior Health Officer said, “Once the disease is detected, the patient has to undergo a long term treatment. One major reason for the huge number of TB cases coming up each year is that, due to lack of awareness regarding re-occurrence of the disease, the patient stops regular medication once he/she starts to feel better.”

Table provided by the taluk hospital, Shikaripur

When questioned about the lack of awareness regarding various health schemes for communicable and non- communicable diseases, taluk Health Officer Dr. Manjunath N. said, “We are holding various awareness campaigns at all levels, be it Gram Panchayat level, village level, Asha level or even private health centre level.” But the result of these campaigns is not really visible as most of the people in the villages only complain about the help not reaching them and are completely unaware of various schemes that exist. The question that arises here is, while schemes for mother and child health care have seen massive success over the years, why do other programmes for controlling  communicable and non-communicable diseases like Leprosy, Diabetes, Malaria and TB fail in the very same taluk? What does the ICDS do that others don’t?

The main reason why mother and child health care have seen massive success is the immense trust that people have on Anganwadi workers, that has been  built over the years with the kind of service these workers have provided. For other programs, even if there are awareness campaigns, people ignore it, thinking them to be election gimmicks or one of the lies that government authorities usually keep telling. Each village in the taluk has a minimum of two and maximum of four Anganwadis that have worked efficiently over the years, providing the kind of help that pregnant women, infants and children below the age of six are supposed to get. For other programs however, there are no centres built to take care of them or spread awareness. They hold campaigns from time to time that fail to reach a wide range of people. Villages have a massive population of uneducated and illiterate people. Trust plays a major role, and people tend to not trust campaigns when they don’t see them working more often and frequently.

There should be centers that tend to people before the hospital  level just like Anganwadis, to make them aware about various diseases, educate them on the importance of the completion of course of medication and the consequences they may face due to ignorance. These centres should also be provided with basic equipment like glucometers that could help detect diabetes and save the people from having to travel all the way to the hospital for small check-ups.