India Together: A revolution in infant survival – 01 October 2003

01 October 2003 –

It took Maya Umargundavar only minutes to get her gear organized – a thermometer, a simple weighing scale, a small baby-sized ‘warm bag’ to treat hypothermia, soap, a few strips of tablets, and the all-important booklet. She checked her wristwatch, which she would need later, and eyed the steady drizzle that turned the more distant village roofs into blurred hues of grey. Then, with a few hurried instructions to her husband, Bhaskar, she strode out into the muddy lane that serves as the main street of Mudjha, a village of around 1,850 residents.

Slim and wiry, Maya radiates the assured confidence of a professional in her element. Her element is a village at the edge of the dense forests of central India, a region that is as yet uncharted territory where official public health care is concerned. Mudjha is about 10 kilometers away from the administrative headquarters of Gadchiroli district, the nearest transport link to the rest of Maharashtra. The region is the easternmost part of the state and one of its most economically backward. The nearest urban center, Nagpur, is about 150 km away.

But Maya’s competence dispels any feeling of being cut off from health care. Her assurance derives from the training she underwent with a voluntary organization, Society for Education, Action and Research in Community Health (SEARCH), which has for the last 12 years successfully shown how ordinary villagers and illiterate ‘dais’ or midwives can be instructed to take care of newborns in the absence of doctors.

Like health workers in the 40-odd other villages of Gadchiroli district where SEARCH has been carrying out its intervention work, Maya has been trained in simple first-aid methods like prompt resuscitation of the newborn, preparing and monitoring feeding schedules, monitoring the infant by examining the soles of the feet for warmth and color. These methods, when applied and supported by the SEARCH center in the forests of Gadchiroli, have brought about a revolution in thinking and practice relating to neonatal survival.

The health non-governmental organization has been responsible for the dramatic plunge in the infant mortality rate, from 121 per 1,000 live births in 1998 to 30 in 2000.

India’s mortality rate for infants up to four years old is 68 deaths per 1,000 live births, according to the National Family Health Survey. The target of 30 per 1,000 is one set by the National Population Policy 2000 and to be achieved by 2010. That this target has already been reached in the villages of remote Gadchiroli – which is categorized as a tribal and economically backward district by planners – is all the more remarkable.

“This is my first visit of the day,” Maya told IPS as she strode off to her first call, a young mother and her 15-day-old infant, in a house at one end of the village. “Right now I have about 150 such cases on my register. Some babies I visit every third day as these are still in their first few weeks, others I see once a week or once a fortnight.”

The unique data collected by health workers like Maya represent what is among the very few such richly documented research studies in the world – one that proves that while the long-term economic measures of reducing malnutrition accrue to remote rural communities, infant and neonatal mortality can be reduced through health education and infection management.

Impressed enough with the work done by the NGO, and its impeccable research, the Govt of India wants to introduce a training programme for village health workers in 400 districts across the country.

The study results are the essential building blocks of a 10-year experiment initiated by Drs Rani and Abhay Bang, a gynecologist and physician respectively, who established SEARCH in 1986.
The immediate impact of such work demonstrates that village workers – whether illiterate or functionally literate – can produce dramatic results when they are supported by training and supervision.

Keeping local requirements in focus, the Gadchiroli saga has a potentially huge impact on a country which, as Dr Abhay Bang pointed out, every year sees more than a million newborn babies die in the huts of rural India. ”No doctor reaches them; often their deaths go unrecorded,” he said. “These newborn deaths constitute 75 per cent of the infant mortality rate in India. While current medical guidelines insists upon hospitalization to avert neonatal morbidity and mortality, India is in no position to bear the total burden of 13 million babies who need hospitalization every year.”

Hospitalization costs for them will amount to over rupees 20 billion a year (437 million U.S. dollars), a gigantic sum that is equivalent to the country’s entire maternal and child health budget. That, said Dr Abhay Bang, is apart from “the fact is that hospitals are simply not available and patients are unwilling to go to them”. It is the magnitude of logistics and economics – common to developing countries in South and South-East Asia – that demands an examination of alternative avenues of neonatal primary health care.

Despite the blunt criticism from SEARCH of the shortcomings of women’s reproductive health and child health in Maharashtra, the government of India has been impressed enough with the work done by the NGO, and its impeccable research, to want to introduce a training programme for village health workers in 400 districts across the country. This is planned as part of the second phase of the 2004-09 Reproductive and Child Health policy being discussed by the central government and the World Bank.

The impact of what has been achieved in Gadchiroli has much to do with community health workers like Maya. She sees her village not as a statistic of 1,850 people but as 500-odd households, most of which she is intimately familiar with. Packing her things away and patting the infant on her head, she reassured the mother, then stepped out again into the drizzle for her next house call. In the three years Maya has cared for infants, not a single one has been lost.