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Safe deliveries and safety from mosquitoes: Assam pilots bundling of services to promote maternal health and malaria prevention

© UNICEF/ 2009
Fairda Begum with her son Suhail inside the bednet

Nipurnh Gupta

Morigaon District, Assam: When Farida Begum went to deliver, her first baby, at Lahorighat Primary Health Centre (PHC); she came back holding more than her little son, Suhail Alam.  

As a beneficiary of Janani Suraksha Yojna (JSY), the Central Government sponsored scheme to promote institutional deliveries, Farida also received a cash incentive – in the form of a cheque. And in the process of cashing the cheque, Farida gained a bank account – the first-ever bank account in her name.

But the `net gain’ that Farida banks on more than anything else, is the insecticide-treated bednet she received following her delivery.

Called Permanet it now hangs over her bed which takes up half of her one-room house, tucked away in a remote village of Morigaon district, some 85 km from the State capital, Dispur. 

There are plenty of mosquitoes in Morigaon, and the threat of malaria is very real. This holds true for most of Assam which reportedly accounts for more than five percent of malaria cases in the country. The State also has high infant and maternal mortality rates.

“We sleep soundly under the bednet – my three daughters, little Suhail and me. It is big enough for all of us and holds out against the jostling and pulling by my naughty kids,” explains Farida.

“But what matters most is that the net protects my children from nasty mosquito bites and the dreadful fever they cause. What more can a mother want?” she asks.     

There are plenty of mosquitoes in Morigaon, and the threat of malaria is very real. This holds true for most of Assam which reportedly accounts for more than five percent of malaria cases in the country. The State also has high infant and maternal mortality rates.
 
Improving maternal and child health in malaria endemic areas

With a view to improving maternal and child health in malaria endemic areas, UNICEF has supported the National Rural Health Mission (NRHM) and the Directorate of Health Services, Government of Assam, in piloting a bundling initiative in eight blocks of four districts -- Morigaon, Sibsagar, Golaghat and Goalpara. 

Under the pilot initiative, impregnated bednets are being provided to all women who opt for an institutional delivery as per the JSY norms. Detailed guidelines were issued for the distribution of the bednets which commenced in May 2008, after a thorough orientation of the district health officials. 

“The bundling of bednets with institutional deliveries has boosted the number of deliveries at our PHC,” said Sub Divisional Medical and Health Officer, Dr. Atul Pator from Lahorighat, showing the meticulously maintained bednet register and coupon-booklets. There were 223 deliveries in May which increased to 440 in September. A similar trend is visible in the other seven blocks.

© UNICEF/ 2009
Mobida, ASHA of Dhingarhati village, Assam, calls on mothers and newborns to check on their health and update them on available services.

Between May and November 2008, a total of 8,438 mothers who came in for institutional deliveries in the four districts went home safe and healthy, happily holding their bundles of joy – their babies and bednets. 

The chars have the lowest rates of institutional deliveries, on account of difficult access to health services. Cut off from the mainland during annual flooding, the chars in the mighty Brahmaputra River and its tributaries are home to some of the most marginalized populations in Assam. It’s reassuring that bundling of services is benefiting mothers and children in the hard-to-reach populations in chars too. 

The JSY cash incentive and motivation by ASHAs (Accredited Social Health Activist) has significantly increased institutional deliveries,” adds Block Program Manager, NRHM, Biplab Chakraborty from Lahorighat.

ASHAs also support in educating mothers about the use of bednets and monitoring their use by mothers and newborn to guard against malaria.     

Thanks to the motivation of ASHAs, Regia and Amiran, and the information about bednets, Dilwara and Nazima, came in boats, all the way from Tengagori and Kasem chars (riverine islands) for their delivery at the PHC, informs Chakraborty.

Bundling of services for hard-to-reach areas

The chars have the lowest rates of institutional deliveries, on account of difficult access to health services. Cut off from the mainland during annual flooding, the chars in the mighty Brahmaputra River and its tributaries are home to some of the most marginalized populations in Assam. It’s reassuring that bundling of services is benefiting mothers and children in the hard-to-reach populations in chars too.   

UNICEF’s advocacy, based on the pilot, has resulted in NRHM Assam planning to upscale the bundling initiative and extend bednet provision to fully immunized children and women who complete three antenatal checkups. 

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