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Improving Maternal Health through Health Education in Jharkhand

Providing nutrition education and counselling during pregnancy is one way to improve maternal nutrition practices, although good practices need to continue through lactation. Why Maternal, Infant, and Children health is important? If you have this question our sample project on improving maternal and child health by promoting nutrition and health education is the perfect answer. This project has many objectives like to minimized cases of child and maternal death, reduced number of malnourished children, strengthening of children and Mother to organize and express themselves as active citizens and improved water and sanitation facilities for the community along with sub objectives and related activities. This sample proposal will focus on essential outcomes like to improve food and nutrient intake for pregnant and lactating mother, Full Immunization and vaccine of mother & children, Anti natal care and post-natal care with check-up and Institutional delivery.

Introduction

Jharkhand is the 28th state of the Indian Union. The state of Jharkhand was carved out from the state of Bihar on November 15, 2000 with Ranchi as its capital. The state Jharkhand has a population of 26.90 million, consisting of 13.86 million males and 13.04 million females. Like most of our states Jharkhand is also a melting pot where people from different parts of the country have come and settled down. The population consists of 28% tribes, 12% Scheduled Castes and 60% others. There are 32 different tribal communities, major one being Santhals, Oraons, Mundas and Hos. Other tribes include Asur, Baiga, Banjara, Bathudi, Bedia and Binjhia.

The literacy rate of women is only 34.1% as against 64.9% literacy rate of men. 73.5 percent families living in kaccha house whereas 78 percent population surviving with low standard of living (DLHS 3). Until recently, many families followed breastfeeding traditions that unwittingly threatened children’s lives. Old traditions and beliefs required new mothers to discard their colostrum, the first, nutrient-rich breast milk instead of giving it to their new-borns.

About 54.1 % -as per DLHS 3 and 45% as per HMIS Oct 10 data – children are fully immunized. There are challenges to be addressed for minimizing the dropout rates of DPT, measles and vitamin A.

Maternal mortality rate (MMR) in Jharkhand is 261 deaths per one lakh live births, which is much higher than the national average of 212 deaths, according to a report prepared by a central agency.

The percentage of institutional delivery in Jharkhand, according to National Family Health Survey (NHFS) III, was 19.2 compared to national average of 40.7. The rate of anaemia in women of Jharkhand is highest with 70.6% compared to all states in the country.

With 638 million people defecating in the open and 44 per cent mothers disposing their children’s faces in the open, there is a very high risk of microbial contamination (bacteria, viruses, amoeba) of water which causes diarrhoea in children.

Health & Nutrition status of women and children in the state is alarming. Malnutrition is the single most important risk factor for diseases. NFHS-3 indicates that in Jharkhand, prevalence of malnutrition is the 2nd highest among states in India, child mortality below 5 years age group is 93 per 1000 births, 70% of <5 years are anaemic, 70% of all women are anaemic. Jharkhand ranks the lowest in IFA consumption for 90+ days i.e. 14%.  Malnutrition rate are: 54% among children under three, 49% are stunted, and 25% are wasted (source: Report published by Micronutrient and nutrition cell, Jharkhand, 2011-2012). The proportion experiencing malnutrition is higher in rural areas and among disadvantaged groups, particularly the scheduled tribes. Based on the body mass index, 41%, of women are undernourished. Only 56% of households in Jharkhand use iodized salt at the recommended level. In Jharkhand, iron deficiency, vitamin A deficiency, iodine deficiency and Zinc deficiency disorder are of greatest public health significance. Micronutrients are lifesaving nutrients that are needed only in small quantities for effective functioning of brain, the immune system and energy metabolism. Micronutrients malnutrition makes a considerable negative impact on health, learning abilities and cognitive development and work capacity.

Project Background

Problem Statement

Health & Nutrition: Jharkhand has poor health and nutrition indicators for its children, adolescent and women, and these are worse off amongst the tribal population. Bundu being a tribal dominated block also have the low health indicators. The cases of malnutrition are also very high in these areas. Though there are well meaning schemes that have a potential to improve the health and nutritional status of the community, these schemes are not accessible to the tribal population.

Drinking water & Sanitation: Individual Health and hygiene is largely dependent on adequate availability of drinking water and proper sanitation. Prevailing High Infant Mortality Rate is also largely attributed to poor sanitation. In Jharkhand about 30% of habitations have partial facility with drinking water. All habitations do not have safe drinking water as source contains Fluoride, Arsenic & Iron. Poor WASH causes diarrhoea, which is the second biggest cause of death in children under five years. Diarrhoea is an immediate cause of under nutrition. 4 per cent reduction in risk of And if mothers washed their hands prior to handling their new-borns.

Activities

  • Mapping and situation analysis:
    • Resources Mapping
    • Beneficiary mapping
    • Baseline survey
    • End-line survey
  • Capacity building:
    • Project team
    • AWW/PGW
    • Mother Support to Mother Group
    • VHSC
    • PRI Members
    • SHG
  • Target Group
    • All children under 0-3 years will be covered under the project
    • All children in age 3-6 year will be ensure to provide proper nutrition diet
    • All identified pregnant woman will be covered under the approach.
    • All identified lactating woman will be covered under the approach.
    • Mother Support Group of all 20 villages will be covered
    • Village health and sanitation committee of all 20 villages will be covered.
    • PRI member of all Panchayat will be covered under the project.
    • SHG groups in all these 20 villages will be covered under the project.

Approach

It will play a role of mobilize and information giver to the community people to enhance their knowledge regarding the issues of health, nutrition, participation and sanitation which make the community people to demand the fulfilment of the services. It will work with the Gram Sabha, SHG and community people.

Udyogini social security wings will play a key role in implementing this project, which is a role of facilitator instead of service provider. It will be linkage with all the grassroots level institution and service providers. It will strengthen the capacity building of the services provider for proper effectively functioning. It will work with the services providers of various grassroots level member and institution like ANC/ Creche, VHNSC, SHG, PRI Member, SHAYA, Jal SHAYA, and other key stakeholders in health, nutrition, participation, and sanitation issues. The main motive is to enhance the capacity, quality, skill and knowledge of the services provider.

  • The implementation will flow the flowing way:
    • Sanitization and Orientation – Generating awareness among the community.
    • Participatory Situational Analysis – Different issues to be addressed at community level.
    • Prioritization – Prioritization the key concern or issues are identified
    • Gap Identification – Gap identification of the following issues.
    • Plan of Action – Action plans with specific target, responsibilities and timeframe is developed.
    • Implementation – Implementing the action plans.
    • Monitoring – Quarterly Community based monitoring mechanisms designed to assess the quality of implementation and improvement
    • Follow up – Follow up the Flowing implementation works.

Expected outcome

The organization will focus on following essential outcomes:

  • Improved food and nutrient intake for pregnant and lactating mother.
  • Full Immunization and vaccine of mother & children
  • Anti natal care and post-natal care with check up
  • Institutional delivery
  • Early initiation of breastfeeding and polio drop within one hour of birth
  • Full immunization and bi-annual vitamin A supplementation of children.
  • Exclusive breastfeeding during the first six months of life
  • Timely introduction of complementary foods at six months
  • Age-appropriate, energy and nutrient-dense complementary foods for children 6-24 months of age with continued breastfeeding.
  • Safe handling of complementary foods and hygienic complementary feeding practices
  • Frequent feeding and breastfeeding during and after illness, including oral rehydration therapy and zinc supplementation for children with diarrhoea.
  • Use proper mechanism to prevent from malaria and diarrhoea.
  • Timely and quality therapeutic feeding and care for children with severe acute malnutrition.
  • Increase the number of woman entrepreneur like Lac.