For every 100,000 live births, 677 women in Rajasthan
die during pregnancy. The reason for this shockingly high maternal
mortality rate is that few women have access to antenatal care or skilled
birth attendants. In fact, fewer than half of women in rural areas visit
antenatal centre to receive the crucial vaccinations against disease that
are given there. What's more, only one in three deliveries in Rajasthan
are attended by a health professional. Rajasthan also has one of the
highest fertility rates in the country - a sure sign that patriarchy still
persists in the state, where women do not have control over their own
bodies. Infant mortality in Rajasthan is similarly high - as many as 83
infants die per 1,000 live births. The majority of infant deaths occur in
the first month of life, and almost half in the first week itself. Most of
these infants' lives could have been saved with adequate nutrition, safe
drinking water and straight forward immunization.
Women and children in Rajasthan are also increasingly threatened by another killer -HIV/Aids. India has the second highest number of HIV-infected people after South Africa. Yet fewer than half of all women in Rajasthan have even heard of HIV/Aids. The fact is that, Rajasthan has several national highways passing through it and a large number of tourists visiting are clear danger signals that AIDS may spread further unless something is done to prevent the epidemic.
While Aids is a serious threat for the future, at present the largest cause of death in Rajasthan is respiratory illness. Tuberculosis and silicosis are rife in the state, where over two million people work in quarries and mines. Prevention is the only effective measure to fight against silicosis, as it is not curable. Yet most mine owners today offer no substantial safety measures to protect their workforce. As a result, the average life expectancy of a mineworker is pitifully low - between 40 to 50 years.
Most of these mineworkers are landless families who have been forced to migrate in search of work due to severe drought and poverty. Children as young as nine work with their parents for up to 14 hours a day for meager wages. The families live in remote areas in makeshift huts that have no toilet facilities or electricity. They have no access to safe drinking water, and the nearest health services and schools are many miles away. For all the workers, sick days are no wage days. In the past, long distances between the mining sites have made it difficult for workers to form collectives and campaign for better working conditions and wages.
|To put pressure on the government to ensure quality health services to the
community as their basic right.
|To promote community-centered preventive and curative health care, with
special focus on mother and child health.
|To empower women so that they have control over their fertility and can
make their own decisions about their healthcare.
|To campaign for basic health facilities for miners and brick kiln workers,
and to ensure the effective implementation of laws designed to safeguard
|To mobilize members of the community to create awareness about HIV/Aids
and how it can be prevented, and to provide support to HIV-infected people
facing social exclusion.
|To ensure better health of the villagers, particularly, children,
adolescent girls and boys, pregnant and lactating women and old people, by
popularizing home based remedies.
|To generate awareness of home remedies for prevention and cure of anemia.|
Prayatn’s approach on Health is primarily rights based. The organization believes in building capacity of the people so that they are able to demand and avail their corresponding entitlements. Be it the public services under the National Rural Health Mission, the Integrated Child Development Scheme, the Midday Meal Programme, the Public Distribution System and the Total Sanitation Campaign, but Prayatn tries to build awareness in the community and empower it through the process of institutional development. It simultaneously undertakes capacity building and advocacy measures for duty bearers like ANMs, ASHAs, Anganwadi Workers, concerned Government Officials and PRIs so that they deliver their role effectively and sensitively.
Prayatn also undertakes certain direct support measures as per need of the community and resource availability to provide immediate relief to those who are in immediate need. We also strongly believe that, no talks of rights are worthy if it is fulfilled after an irreparable loss.
Prayatn has worked on a variety of health
interventions broadly focusing community at large with special focus on
women and children. The mode of interventions has been project basis. The
details of the project and issues are as follows:
1. Reproductive and Child Health (RCH) Project
The organization was a part of both the phases of the RCH project implementation in Dholpur district of Rajasthan. This Project was implemented in collaboration with the Health and Family Welfare Department in 25 villages of Dholpur district, Rajasthan with the aim to promote safe motherhood in the remote villages with the help of health department and traditional measures.
|-||To bring reduction in the number of child and maternal mortality rates, ensuring safe deliveries and proper treatment of the pregnant and lactating mothers.|
The project had following achievements:
|-||In 25 villages it was ensured that delivery kits are distributed to every pregnant woman in the village.|
|-||100% immunization of all the pregnant women and new born children up to the age to 5 years.|
|-||In the duration of the project implementation no maternal and child deaths took place in all the 25 villages.|
|-||Increased approach of the community members to the government services and generated a demand from the community for services from the government.|
2. Routine Immunization Programme
Dholpur district is famous for red stones and its geographical features support the same throughout the district. On one side there are ravines and on the other side there is Chambal River which forms the border of two states Rajasthan and Madhya Pradesh. Dholpur is considered as one of the backward district in Rajasthan. The population in the region is scattered and the region experiences a lot of health related problems especially with regard to women and child health. Because of tough geographical conditions and fear of dacoits the villagers hardly get any service from the government department in remote villages. The immunization status in this district was the lowest in the state. Against this backdrop the organization in association with UNICEF initiated the routine immunization project in 150 villages in Dholpur district in Rajasthan.
|-||To formulate and strengthen the health committees in all the villages and increase awareness among the people about the importance of the routine immunization in the life of women and children for a better health and future.|
|-||To increase the capacities of the community based groups on the issues of routine immunization, working of the health committees and aspects related to the routine immunization.|
|-||To promote sense of responsibility and accountability among the health department people through advocacy and networking at various levels.|
|-||The district was ranked 3rd in the state out of last because of a collective efforts of all the stakeholders including district administration.|
|-||There was complete immunization in the 150 villages.|
|-||There was awareness about the immunization in the 150 villages as a result of which there were reduced superstition in the community.|
|-||There was a process of complete immunization for the pregnant and lactating mothers and the children in the age group of 0-5 years. With regard to this there system of community monitoring was developed in the villages to sustain the initiative.|
3. Management of Malnutrition Programme
Malnutrition is one of the biggest social problems in Rajasthan and the data says that almost 52% of the children suffer from different grades of malnutrition. This has a huge impact on the lives of children and many children die out of malnutrition. Dholpur district has the highest percentage of malnourished children in comparison to other districts majorly because people work in mines the whole day and take less care of their children. Prayatn with the financial support from UNICEF has worked in 2 blocks covering a total of 208 Aanganwadi centre on malnutrition management.
|-||To protect the children in the age group of 0-5 years from malnutrition.|
|-||To ensure complete immunization of pregnant ladies and the children in the age group of 0-5 years.|
|-||Improvement in the overall quality of performance of the Anganwadi centres including performing all activities efficiently as desired and conceptualized by the ICDS and women and child development department.|
|-||Regular monitoring helped to reduce the cases of malnutrition.|
|-||Could save lives of many children who were in the 3rd and 4th grade of malnutrition.|
|-||Alertness in the district health department for malnutrition management and immunization.|
|-||Ensured immunization of pregnant mothers and children in the age group of 0-5.|
|-||Referred serious cases of malnutrition to the district hospital, Dholpur and ensured that they receive free treatment.|
|-||Registered children at Aanganwadi centres and ensured that they get nutritious food from the Aanganwadi centres.|
|-||Significant improvement in the documentation process at the Anganwadi centres.|
|-||There was improvement in the capacity of the Anganwadi workers, co-workers, ANMs and team members of Prayatn.|
4. AIDS Public Awareness Campaign
Dholpur district is famous for its stone works and due to this there are lots of employments for the labours form the local region as well as from the other region. As a result of which there is a lot of transportation that takes place with regard to the supply of stones from one region to another and the people who are involved in this process very often makes sexual contacts with the sex workers and the women in the nearby villages. This therefore increases the risk of HIV/AIDS and Sexually Transmitted Infections (STI) among these people. Prayatn, Dholpur in collaboration with the Rajasthan State AIDS Control Society carried out a preventive programme on the issues related to HIV/AIDS, STI, its prevention and treatment.
|-||To spread awareness on the issues of HIV/AIDS, STI, its prevention and treatment inthe community.|
|-||There was awareness on the issue of HIV/AIDS and STI in the entire district.|
|-||Ensured treatment availability to HIV/AIDS and STI affected people at minimal rates.|
|-||Community people started using condoms.|
|-||For the very first time, there was knowledge on the identified cases of HIV/AIDS in the district.|
5. Mobile Health Unit
There are lots of mining activities that happens in the Dholpur district in Rajasthan as a result of which there is lot of labour intensive work that takes place in the region and which facilitates the process of migration. This set of population majorly experience life sustaining and life threatening diseases like AIDS, Hepatitis and other forms of sexually transmitted diseases and also trade generated diseases like tuberculosis, silicosis and other forms of respiratory tract infections. Since most mining activities are carried out in the geographically isolated areas and most people cannot afford for their treatment, these diseases get worsen with time which further leaves its impact on children too. Due to this their body functioning gets affected at most times and lack of proper medication prove to be fatal many times. There is less accessibility of the people to the Government and private health delivery systems. Keeping this in mind Prayatn commemorated a mobile health unit in collaboration with Save the Children, Finland.
|-||To provide preventive and curative health support to the workers and their families residing in and around mining areas in Dholpur.|
|-||Health services were enabled to the local community and different areas through the mobile health unit.|
|-||Awareness of the community people with regard to the protection of diseases.|
|-||There was improvement in the health of people as a result of better health service delivery system.|
|-||Increased number of safe deliveries and trained birth attendees.|
6. Smile on Wheel (SOW)
Prayatn in collaboration with the Smile Foundation was providing low price treatment for the poor and marginalized residing in slums areas of Banaras district in Uttar Pradesh through mobile health unit in the name of Smile on Wheels. This area had a paucity of good medical facilities. Over population is another problem that is encountered in the and hence there was very low sanitation facilities that were available. The place is occupied by the migrant’s from Bihar, Orissa and West Bengal who were mostly rag pickers and casual labourers. The economic condition of these people did not allow them to avail medical care for themselves and thus the problem of ill health continued.
|-||To provide easy and affordable access for medical facilities.|
|-||The SOW could come out with the revenue based self-sustaining model which could provide services to the needy people in long run.|
|-||The SOW could cover maximum population of the slums and able to make them participate in the SOW activities.|
|-||A good number of memberships has been developed which again reinforces the need of such facility.|
1. Shaksham - Leprosy Rehabilitation
Banaras is considered as a religious place or holy land of Uttar Pradesh, India. It is also popularly known as Kashi. The presence of numerous temple in the state attracts many devotees to come here for worship, therefore it can be noticed that this place is always crowded with people throughout the year. Many people believe that their sins are forgiven if they take bath in the holy river Ganga and so many leprosy patients come here with the faith of getting healed and reside in the slums that exist near the river Ganga.
Bhadoi, neighboring district of Banaras also has a number of slums where many leprosy affected people come and reside. In order to mainstream this particular set of community. Prayatn in collaboration with Back to Life, Germany is running a project called Saksham – Leprosy rehabilitation project which deals with the issues of health and livelihood for this people and provide them with the necessary medical services.
|-||The main objective of this project is to provide quality treatment and livelihood support to the leprosy affected people in Varanasi and Bhadoi districts in Uttar Pradesh.|
|-||A model of community managed livelihood generation in which people deposit their installments and the community decides for the new beneficiary.|
|-||Access to the government programmes and departments has increased including health services and livelihood.|
|-||All the children of the leprosy patients could be saved by getting infected from leprosy through regular health check up and are linked with the education system.|
2. Child Development Project - Healthy And Secured Infants
PRAYATN, in the very initial year of programme implementation is doing its best to raise the awareness level of the community and sensitivity of community people on various issues of health, hygiene and nutrition. The fundamental theory of working with children under 0-5 is that “A child cannot wait”. We work on the improvement of improper and insufficient service deliveries by the related institutions like Aaganwadi centers, schools, panchayats, etc. at local level and officials elected representatives, other civil society organization and media at larger level. Under this, special efforts have been made towards community organization and institution building. For instance, formation and strengthening of Child Protection Committees, Immunization camps, Referral of malnourished children to MTC centers have been focused during the year. Training of pregnant and nursing mothers on Nutrition management and Training of Aanganwadi workers on Nutrition Management have contributed a lot to achieve the set objective for the year. We also emphasized on meeting the immediate needs of small children of 0-5 years through providing Nutrition Supplement support to the children and quality support to ICDS centers.
3. Ensuring Food Security and Nutrition
Originally forest dwellers, the Saharia have been forced to move out of their original vocation and livelihood due to increasing depletion of forest resources. They are mostly landless and do not have any profitable skills or training. Illiteracy is rampant in the community and they are not in a position to access the government benefits and welfare schemes that are meant for them. As a result, they are mostly forced to work as daily wage earners. The only source of earning left for the Sahariyas is that of farm labour (Since most of them are landless unskilled).
Unavailability of Medical services was one of the most sought after concern of this area for over long time. Due to poverty, illiteracy and ignorance coupled with non-availability of PHC or Anganwadi Center, common treatable diseases become chronic even leading to untimely deaths. Children under five are highly vulnerable. People are unaware of hygienic and sanitary needs of infants. Nutritional requirement of children and newborn babies remain ignored. Due to lack of transport facility of any kind poor people find themselves helpless when the patients become critical. Pregnant women are often found to be unaware of their proper immunization, vaccination and nutritional requirement and become anemic. Childbirth is facilitated by untrained village Dai under unhygienic condition resulting in to increased MMR (Maternal Mortality Rate) and CMR (Child Mortality rate).
Due to ignorance and poverty, infants do not get proper nutritional feeds and are found to be suffering from Marasmus and Kwashiorkor. This further makes them susceptible to common diseases and people mostly depend on village ojha (Faith healer) for the treatment instead of Doctor, who charge fees unaffordable to them. Stone mine workers often faces injuries and bruises during the work, which often remain unattended due to poverty and lack of health services, and become septic.
|-||To develop in-depth understanding on various actors and factors affecting/influencing the state of nutrition of Saharia children.|
|-||To facilitate (evolution of) a community action on issues of Food Security and Nutrition of Saharia children.|
|-||To establish an enabling environment for Food Security and Nutrition in the state thereby influencing state’s programs and policies (related to nutritional security of children).|