Wednesday, April 7, 2010

Malegaon’s beacons of change

CHEERS OF HOPE: The women at work

Malathy Iyer | TNN

Fatima is a tenth-pass divorcee who speaks in soft tones, recites shayari and covers herself from head to toe in a black flowing burkha. One would hardly view her as a messenger of change. But the 22-year-old along with 12 others — is changing the way mothers-to-be and newborns are treated in 36 slums in this communally sensitive town near Nashik.

As a part of Bill & Melinda Gates-sponsored project called Swasthya-Sure Start, she is part of a band of Muslim girls who knock on every door in 36 villages to conduct a menstrual surveillance, an innovative adaptation of the time-tested public health tool of door-to-door surveillance of infectious diseases. “When we find out a woman has missed her period and could be pregnant, we start educating both her and her mother-in-law on the care they need to take during each trimester,” says Fatima’s colleague Ayesha. In the next nine months, the girl-counsellors guide the mother-to-be about pills, clinic visits and the need to register in advance at a public hospital. The results are heartening. Registrations of pregnancies before 12 weeks rose from 38% in 2008 in these 36 villages to 61% in 2009. “While 48% women delivered in hospitals in 2008, the figure was 57.2% for 2009,” says Dr Kranti Ramayane of PATH, the international NGO implementing Swasthya-Sure Start along with the Malegaon Municipal Corporation. Dr H Shaikh, acting health officer of MMC, endorses this: “The project has given us the manpower to detect high-risk pregnancies.”

But this microscopic change in Golden Nagar, an area comprising a largely poor migrant population, has not been easy. The girls were initially shooed away. Says Kismet, a community health worker, “When we first started about three years back, elders in houses would shoo us away saying it was not becoming of young girls to talk about such stuff.” But persistent visits and results —healthier babies — paid off. “Now mothers-to-be go to civic hospitals demanding tetanus shots as well as checks on their blood pressure,” says project coordinator Arun G. It has found another unlikely role as a family planning advisor. Says Ayesha, “When we go for home visits, the women always ask for condoms as they want to space their children.

Incidentally, when the Centre launched the National Rural Health Mission three years back, there was criticism that the urban poor had been left out. “When PATH approached the Maharashtra government for the project, we were pleasantly surprised when told the government would prefer if we looked at the urban poor instead of the rural poor,” says Benazir Patil, state head of PATH. “The Malegaon project is the most special as the town has a tremendous gender bias,” Patil adds. The aim of the project is to provide a prototype for the National Urban Health Mission, which will be launched in 2012.

Says Dr Anant Phadke of NGO Cehat-Pune, “While the Janini Swasthya Yojana only give incentives to mothers (Rs 600 to women who deliver in hospitals), such community-centric schemes manage to change their mindset.” There is concern about what will happen when the project winds up in 18 months. Slum communities have already elected ‘leaders’ and ‘supporters’ to take the message ahead and are also toying with the idea of setting up a motherand-child fund.

The Times of India, April 7, 2010