Neighbourhood leaders help reduce maternal and child mortality in Kadapa, Andhra Pradesh
by Vikas Verma
Just three weeks ago, Ms. Lillipushpa, a community health worker and her team at DRDA (District Rural Development Agency), Kadappa, were not sure if Shanta Kumari, would live to give birth to a healthy baby, but today they all are happy that their efforts have saved two precious lives. The baby was born on the morning of 6 September.
What made this possible was the identification of twenty-year-old Shanta Kumari as a “red alert” case during a village level meeting being conducted by Kaddapa district DRDA team at a scheduled caste ward in the Modimala Gram Panchayat on 19th August, 2005. Just a day before this meeting the people from this ward had been trained by the UNICEF team at the district headquarters in electing neighbourhood leaders at the village level to report on critical cases.
While in the process of identifying a neighborhood leader, one of the women members immediately volunteered to be one - she had a red alert case next door. The entire group accompanied her to see the eight-month pregnant neighbour who had oedema all over her body. The team found that Shanta Kumari was severely anemic and took her to the PHC. Upon investigation, it was found that her HB level was 3 gms and she had to be admitted to the PHC as an emergency case, where she was then treated under the supervision of DMHO. DRDA released Rs.1000 to meet her immediate medical expenses.
It was evident that the service delivery channel had completely missed out on Shanta Kumari not just due to negligence but due to her social and economic status. Neighbourhood groups (NHGs) are meant to take care of these kinds of issues. Consisting of about 20-25 adults, the NHG is based on the geographic division of a village into units of 20-25 households. The members of households in each NHG elect a trusted person from amongst themselves to represent them. This person is called the neighbourhood leader or NHL. The NHL represents the neighbourhood group and promotes exchange of information between the household, village and the administration.
The NHL, as an intervention, has been successfully implemented earlier by UNICEF in about 600 villages of Raichur and Gulbarga Districts of Karnataka from 2001-2004 as part of the community monitoring project. The need for the same arose because of the inability of service delivery channels to reach out to the most needy, especially those who are socially excluded and live in the peripheries of the villages.
Looking at the success in Karnataka, DRDA had sought help of UNICEF to initiate the project in the district and took full responsibility of piloting the project in twelve villages across two mandals this year with the possibility of scaling up next year at their own expense. They also agreed to install Sisu Samarakshak (SSK) in all PHCs in the district. Upon their request, UNICEF provided technical inputs in coordinating district level teams as well as in training the ANMS, Anganwadi workers and health workers in SSK and in the modalities of the project.
Apart from DRDA Kadapa team, the success of community monitoring project in Karnataka has also attracted the state ILO office. They are adopting community monitoring project as part of their child labour interventions in the districts of Prakasam, Guntur and Rangareddy districts of Andhra Pradesh.
Ahead of the project being adopted in the convergent district Medak in Andhra Pradesh, this timely success story in Kadapa has further boosted the morale of the team. Not only has the system proven in being effective in saving precious lives but has also provided the much needed credibility to the red alert system among the villagers as well as among the district authorities. The fact that one could see the impact of an intervention at such human level makes it clear that community monitoring can help the community in various ways.