For the last mile delivery of public health

Carrying her six-month-old malnourished son in her arms, Saraswati Devi trudges along a narrow mud track to keep an appointment with her child’s dosage of Vitamin A at the Anganwadi centre in Hitjara hamlet in Ranchi district, Jharkhand.

She does not forget to carry the immunisation card. Like Saraswati, several women, some accompanied by their husbands, from nearby “tolas” (hamlets) walk under the blazing June sun to Anganwadis and health sub-centers for the administration of Vitamin A to their children, aged up to five years.  Some have babies in their arms.

These mothers are not the only ones who travel, sometimes over a mile or two, to reach the centres. In fact their vaccinators, the ANMs (Auxiliary Nurse Midwives), and other community health workers, mainly <g data-gr-id="54">saiyas</g> (trained Accredited Social Health Activists) and mobilizers, have to arrive at the centres ahead of them.

Madhuri Sinha, a dedicated ANM, gets dropped at the Lohahetu health sub-centre by her husband on a motorcycle during the days scheduled for routine <g data-gr-id="66">immunisation,</g> while others reach on foot. These foot soldiers are the ones who track, monitor and ensure that children are immunised routinely.

An <g data-gr-id="69">occasional</g> overcrowded auto rickshaw or a bus, the only modes of transport, rattle past as I travel to Hitjara, <g data-gr-id="68">Dhumar</g> and Chitrudih hamlets, set in a forested belt in Ranchi district. My aim is to get a first-hand account of the Vitamin A supplementation programme.

Organised on Thursdays and Saturdays—integrated with the routine immunisation and deworming schedules—the UNICEF-supported biannual programme has been revived after three years. It was discontinued on February 12, 2012, following procurement issues and sub-standard quality of Vitamin A.

On June 1, Jharkhand Chief Minister Raghubar Das rolled out the second biannual round of the Vitamin A supplementation programme--Jharkhand <g data-gr-id="74">Matru</g> Shishu Suraksha <g data-gr-id="75">Evam</g> <g data-gr-id="76">Poshan</g> <g data-gr-id="77">Maah</g> (Jharkhand Mother Child Health and Nutrition Month). To reach the last mile, UNICEF is supporting social mobilisation, information dissemination, planning and monitoring of the session in remote areas.

During the month-long drive, children, between 9 months and 5 years, are administered Vitamin A. Children aged one to five years given deworming tablets to prevent helminth (parasite worm) infections, and those between six months and 5 years are screened for malnutrition. Meanwhile, pregnant and lactating women, and children aged six months to five years are given IFA (iron and folic acid) to combat anaemia.

Undernourished children, measured by their Mid-Upper Arm Circumference, are referred to the nearest Malnutrition Treatment Centre (MTC). Spot testing of household salt for iodine content is also done at eight endemic districts in the State. All these tests are carried out in addition to the routine vaccination.

At the Anganwadi in Dhumar hamlet, about 80 km from Ranchi, where mothers and children have gathered from nearby hamlets, it looks like a fair--bustling with activity. A social mobilisation programme has been organised by UNICEF through its partner Animation Rural Outreach Service (AROUSE), a voluntary organisation. Tribals from nearby village clusters have assembled to participate.

Project coordinator Sushil <g data-gr-id="55">Minz</g> and his group of activists and volunteers enact a skit, highlighting the virtues of Vitamin A intake. Pointing to a display of vegetables, roughage, mango, papaya, guava, jackfruit, milk, egg and fish, he explains in their local tongue the value and benefits of consuming them.

Through dance, songs, music and drama, his group educates and counsels the kids, who also march through the open spaces carrying placards depicting the importance and qualities of the eatables and the vitamins needed to take care of one’s health. Meanwhile, one of the mobilizers Munni <g data-gr-id="70">Urain</g> plays the box radio, an important tool in attracting villagers, which blares out pre-recorded songs in local languages.

A team of 270 volunteers, Central and State government health officials and members --spearheaded and monitored by UNICEF--is making strenuous and coordinated efforts to ensure that young children  and pregnant women in far-flung regions of the state are given Vitamin A as supplement--crucial for maternal and child survival.

Lack of Vitamin A in children causes severe visual impairment and blindness and significantly increases the risk of severe illness, and even death, from such common childhood infections as diarrheal disease and measles. For pregnant women in high-risk areas, Vitamin A deficiency (VAD) occur especially during the last trimester when demand by both the unborn child and the mother is the highest. The mother’s deficiency is demonstrated by the high prevalence of night blindness during this period.

Pratima Singh, a micro-nutrient consultant with UNICEF, guides us through the dust-laden paths, as she explains and provides copious amounts of details, reeling out facts and figures, about the implementation of the government’s child development programmes in Jharkhand.

Expressing optimism, the medical officer-in-charge, Sonahatu block, Dr Babu Lal Murmu, says that despite the three-year-long gap the resumed programme is being carried out with renewed enthusiasm.