Ensuring safe motherhood
Renuka Giri’s working day begins quite early in the morning. This young and motivated ANM (Auxiliary Nurse and Midwife) at Dhanora village health center in Latur, Maharashtra leaves for her daily round of home visits around 8 am but her time of return is never fixed. On specific days, when there are emergencies or deliveries to attend to, the time knows no bounds. As she lives in the village she can be called anytime of the the day or night.
Despite attending to such pressing tasks on a frequent basis, Renuka has no complaints about her work. Nor does she ever feel that she is over stretching herself. With a composed smile she says, "Mothers are not just the givers of life but also the nurturers. It is my duty to do whatever I can to protect them." For the women in Dhanora, her work means a lot. For them, Renuka represents functional and responsive health care, something which has been lacking in the village for years. According to them Renuka has managed to bring about some intrinsic changes to improve the quality of their lives.
Dhanora health sub-center caters to over 7,000 people across seven villages. Anyone visiting this presently well functioning center would hardly believe that till three years ago it existed only in name. Both the person in charge and health services were non-functional. The village planning process, initiated jointly by UNICEF and Sath (local NGO), in Latur in 2002, captured the people’s anguish over the defunct center. “The village planning process has empowered the community and made them voice their innermost thoughts and needs. The community is today confident of demanding the fulfillment of their basic rights including health.” said Ziya Syed, a SATH employee.
Describing the earlier state of health services Lalita Jadhav, Anganwadi Worker and enthusiastic volunteer in Dhanora, says, ‘Even for very basic health problems we relied solely on private doctors in Nilanga, 6 kilometers away from the village. Deliveries occurred at home with untrained attendants, which was unsafe or at private hospitals, which was costly. The pre and post natal care remained neglected. Women and children suffered most due to the unavailability of local health services.’ Therefore women quite vocally demanded change in the state of the village sub-center while village issues were being discussed in the village planning process. The village gave this top priority in their collective action plan
Through women’s meetings Renuka realized that they lacked even basic health information and therefore remained ignorant in taking their own care. "Earlier women never registered their pregnancies in time, responded poorly to immunization drives and also were reluctant to consume iron pills. They were not even aware that it is going to affect their health and also the baby’s well being", recalls Renuka.
She has also transformed the look and feel of the health center. The two-room center, with neatly stuck up informative posters and well painted educative slogans on its walls, is a holistic health centre and offers much more than just the basic services. Now the women with their young children not only come here for check-ups or health advice but also to seek information on health issues. The significance of early registration, regular immunization, proper diet and rest, periodic medical test and safe delivery has been properly understood by most women. The awareness is reflected in the improved number of deliveries by trained attendant. Twenty one out of a total of 29 deliveries in 2005 were done by the ANM at home and rest were referred to the hospitals.
In case of possible complications the ANM refers the concerned family to opt for hospital delivery. If required, she personally accompanies the pregnant woman. Now people trust their health worker so much so that they go in for any other service only when referred by her.
Women’s awareness and community support remained key factors, according to Renuka, in improving state of the local health services to its present level. She also maintains importance of training inputs and teaching material provided by UNICEF, which enabled her to upgrade her own skills. ‘UNICEF training programmes were especially useful to refresh knowledge and to engage in focused initiatives,’ says this self-motivated nurse.