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All up to fight child mortality

Oct 25, 2010

In the Kamaalganj block of the state of Uttar Pradesh, India, women like Saira Begum are working to improve the health of the infants through programmes run by UNICEF and the state government. The result is better immunisation levels and reduction in polio incidence.

Kamaalganj: Saira Begum likes to believe that she was born with a mission: To help build a cohesive and progressive society with healthy children. In her early thirties, Saira has studied up to high school. Today, she is part of UNICEF Social Mobilizing Network in Kamaalganj, one of the six blocks in Farukkabad district of Uttar Pradesh (UP), situated some 250 kilometres from the state capital of Lucknow. Out of the state's 72 districts, 15 have been identified as high-risk ones needing special attention. Farrukabad is one of them.

Saira knows that Kamaalganj needs people like her. With a Muslim population of nearly 50%, it is a poverty-stricken region in constant risk of being the site for infections and diseases of all kinds. Although Saira's work is primarily to sensitise the local community on polio, she also helps expedite the government-run Bal Swathya Poshan Mah (BSPM), a bi-annual, month-long health programme organised in June and December in all the 72 districts of UP. The focus of the programme is children in the vulnerable age group of 0-5. In fact, high mortality levels of children belonging to this age group in India have been a cause for global concern. 

The BSPM, besides providing children with the vital dose of Vitamin A, the lack of which can result in blindness, is also meant to ensure that children get their routine immunisation shots. Severely malnourished children are also identified in these two months and referred to hospitals while young mothers as well as pregnant and lactating women are provided with crucial information on nutrition, proper feeding practices and good hygiene. 

Saira explains, "This year, the BSPM session got over on August 14, but we are already looking forward to the next one in December. My work is to affirm and reaffirm the faith of families in these health programmes. My team works with the Accredited Social Heath Activists (ASHAs) and the Auxiliary Nurse and Midwife (ANMs) to ensure that all the children in the age group of 0 to 5 years, especially newborns, reach the centres during these two months in the year."  

Kamaalganj has 238 'anganwadis' (mother and child care centres) and over the years the health team here has devised its own special ways to ensure that the children of the area go to them and get the benefits of all government health schemes. Wednesdays and Saturdays are days earmarked for immunisation in Kamaalganj, as is the case in all the other districts in the state as well. The village hums with activity on these days, with women - their sari pallus invariably covering their heads - making a beeline for the centres with their babies in their arms. 

Another interesting feature is the mobilisation of children in this effort. Says Tausif Baig, district co-coordinator of Farukkahabad's Social Mobilizing Network, "There are these 'bullawa tolis', or groups of child volunteers, who go from house to house to get mothers to bring their children for health check-ups and immunisations. Special announcements are also made on loudspeakers to attract crowds." 

Since Kamaalganj has a sizeable number of Muslims, all the publicity material, including hand pamphlets and posters, are printed in Urdu. The team also ensures that its members are around in discreet corners during religious gatherings, like the 'Annu miya ki dargah' held every Friday. "We do not leave out even the weddings or village fairs. These are big gatherings and it becomes important to reach our health messages about BSPM and immunisations to the people gathered there," says Baig.

All these efforts appear to have paid off. Kamaalganj has made great progress in terms of child health, with the coverage of routine immunisations going up from just 58 per cent in 2007 to 80 per cent in 2009. Institutional deliveries have also gone up from 1,262 to 1,883 over the same period.

Today Dr C. Prakash Mishra, the medical officer in charge of Kamaalganj is a proud man. Says he, "We may have started with a disadvantage, since this was a high risk block. But we have worked very hard and turned the situation around. There has not been a P3 polio case here since 2008!"

While there is much to cheer, the BSPM programme in Kamaalganj had to contend with the non-availability of Vitamin A medication this time. While UNICEF had been supplying the vitamin free of cost for the past several years, this time the UP government took upon itself the task of doing so and failed to deliver this vital vitamin in time for the programme, not just in Kamaalganj but throughout the state. It can only be hoped that the issue will be sorted out before the next session in December. 

There are general lags as well. For instance, the supply of a nutritional food for children coming to the 'anganwadis', as well as for pregnant women and lactating mothers. Some of the stocks were found to be very substandard, and poor storage conditions have resulted in the powdered nutritional supplements getting spoilt. Confesses Sandhya Agarwal, who is in charge of the Amanabad 'anganwadi', "We are forced to keep these bags in the open and often they get infested by worms and eaten by rats." Apart from such horror stories, many of the 'anganwadis' here have no drinking water facility or electricity, and are not equipped with emergency medical kits.

There is much scope for improving delivery on the ground in Kamaalganj. If India is serious about addressing the high mortality levels of its children in the 0-5 age group, it should set its house in order, especially in places like these. As Saira puts it, "We work hard to deliver health care, but we also need to ensure that there is proper infrastructure and enough provisions. Otherwise all our efforts will go waste."

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