Public-Private partnerships bring Kangaroo Mother Care to Karanjberi
By Patralekha Chatterjee
Valsad: No one had heard about “Kangaroo Mother Care” in Karanjberi till Paru Ben, the village anganwadi worker, showed rural mothers how this practice of holding a newborn, skin-to-skin (against the parent’s chest) could help pre-term, low birth-weight babies survive in this tribal village in Valsad district, southern Gujarat.
The practice that originated in Bogota, Colombia, in the late ‘70s and adopted worldwide eversince, is a key component of the training package of Integrated Management of Newborn and Childhood Illness (IMNCI) – a new, nation-wide child survival strategy being implemented by the government in around 25 districts across India, and supported by UNICEF.
Valsad was among the first 5 pilot districts selected to implement the initiative whose key component is home-based care for newborns and low birth-weight babies during the most vulnerable period of their lives – the first 28 days.
The first batch of health and nutrition workers in Valsad district were trained in the IMNCI approach in July 2004.
Two and half years on, Karanjberi is at the cusp of change.
Ashaben Jadav, a 19 year-old mother, speaks animatedly about how she used “kangaroo care” to save her son, born prematurely and just 1.3 kg, following the advice of Paru Ben. The anganwadi worker made half a dozen post-natal home -visits the first month. Each visit involved a systematic examination of the baby, as recommended under IMNCI protocol, counselling the mother on Kangaroo Mother Care and exclusive breastfeeding, jotting down the increase in weight, monitoring general progress and checking if the mother was following her directives. Within two weeks, the baby who was inactive and not suckling properly, had started responding. The weight had risen to 1.8 kg. Today, a smiling Ashaben cradles her 5 month old son, now almost 5 kg and thanks the community worker for helping her child survive and thrive. And Paru Ben’s confidence has surged witnessing the results of her newly acquired skills
As a pilot IMNCI district, Valsad had its share of teething problems. In the early days, one critical area was.firming up logistics for the training sessions. District authorities along with UNICEF staff forged strategic partnerships with the private sector to surmount the hurdle of arranging adequate number of cases of sick newborns for the traininees.
“The idea is to develop the skills of health and nutrition workers in newborn care. It is absolutely essential to make sure there are an adequate number of cases of sick newborns during the clinical sessions and community visits which are part of the IMNCI training. In Valsad, the district hospital could not provide enough of a case load. So, we tied up with Medicare, a private hospital, run by Dr Shirish Dave, a leading local paediatrician as well as with Kasturba Hospital run by a charitable trust,” says Dr Vijay Godbole, part of UNICEF’s field staff in Gujarat.
The out-of-the-box thinking is also evident in the state Health Department’s innovative approach of bringing in experts from medical colleges, and positioning them as key health administrators overseeing IMNCI training in the state. “We accepted that the level of understanding about what was killing children was poor within the administrative system. We also accepted that those who understood the key issues underlying neonatal and child survival in general were in the medical colleges. So the next step was to seek out those who have stature in medical colleges and get them into the system where they can have a greater impact. This was a new thing because teachers had not been made health administrators earlier,” says Dr Amarjit Singh, Commissioner of Health and Secretary Family Welfare, Government of Gujarat.
The dynamic approach to IMNCI and child survival has begun to impact tribal villages like Karanjberi where the terrain is hilly, the population dispersed, and outreach workers face enormous challenges. Tribal mothers often go without the services of a skilled birth attendant during delivery. Even those who have institutional deliveries do not get regular, post-natal visits by a trained community worker during the the critical first few weeks.
It is too early to gauge the impact of IMNCI on the Infant Mortality Rate in Valsad but there are significant outcome indicators : 69% of infants in the district now receive 3 post natal visits in the first 10 days after birth.
Anganwadi worker Paru Ben is buoyed by her newly acquired skills and her enhanced prestige in the village. Rural mothers, she says, were more easily persuaded to adopt recommended newborn care practices when she consulted a chart booklet as she examined the baby or spoke to the mother. “Weighing the baby each time we do a home visit has made a difference. Mothers now approach me and ask me to weight their child. The illustrated chart booklet given to us at the end of the training to help us with our work actually enhances out stature. If a mother is literate, we show her what is written in the book. That reassures her. If she cannot read, we show her the illustrations. Now after so many months, communities have realized the importance of regular post natal visits.”