Perched atop the Aravalli hill range, the fort of Bundi overlooks a large expanse of houses painted white and blue. Scattered among them are a few havelis that remind the visitor of the region's rich heritage. At a stone’s throw, there’s a lake. Its view from Kipling’s Palace—the house where the famous British poet and novelist once stayed—will put even the most restless minds at ease. But travel further into the hinterland and realisation dawns that Bundi suffers a curse.
Many children born in the district don't survive infancy. For every thousand babies born in Bundi, 72 die. In Rajasthan’s context, this is one of the highest infant mortality rates (IMRs)—Jalore, with an IMR of 81, tops the list. This is particularly surprising because neighbouring Kota has a relatively low rural IMR of 44.
Gaping holes in infrastructure
Bundi’s health infrastructure is much like its fort. It looks strong from far. But inspect it from closer quarters and one finds it crumbling from inside.
I visited three Community Health Centers (CHCs) in three different blocks—Nainwa, Hindoli and Talera. At Talera, an immunisination camp was underway; the wards were full and nurses flitted about, giving the impression that it is a functional institution. Things were not radically different in Hindoli or Nainwa.
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Despite the poor healthcare system, the Janani Shishu Shuraksha Karyakram (JSSK), launched by the Centre in September 2011, seems to be fairly functional in Bundi. Under this scheme, women get free transport for delivery, medicines and food. Sick new-borns are given free treatment up to 30 days after birth. Besides, the district has a proactive district magistrate, Aarti Dogra. Excerpts from a chat with her:
The district of Kota, which is right next to Bundi, has a low IMR of 44 (rural). Bundi has 72. What's wrong?
There’s a huge difference in terms of economic variables between the two districts. Industrialisation is a big factor. We have a greater rural population, and our economy is dependent on mining and agriculture, while they have a number of industries. Differences in terms of literacy also make an impact.
What have you done at your level to reduce Bundi’s IMR?
We’ve carried out campaigns in Dabi and Nainwa. We’ve seen an increase in institutional delivery and decrease in home delivery now that transport is being provided free to women. Now that all these facilities are being provided, we think we will improve our IMR. We have a programme called high-risk pregnancy tracker, under which the local nurse-cum-midwife keeps track of pregnant women. If we find any abnormalities, that woman becomes our priority. PHC doctors check her medical history and regularly check her for anaemia and high BP. We put a circle mark on the houses of women with high-risk pregnancy. This alerts everybody in the vicinity. So if there’s any problem, the woman can easily get help.
IMR data collection is a challenge. Do you have a system in place for improving this?
We have a software, which we built in association with non-profit ARTH (Action Research and Training for Health). This has been going on since 2010, and is specific to Bundi. As part of this, all nurse-cum-midwives have mobile phones. They send us details of delivery and vaccination through an SMS. This message goes into our server and from there I get an SMS. If there is an infant death or maternal death, she sends an SMS which is forwarded to me and the chief medical health officer. This data is also simultaneously sent to ARTH which audits the data.
This system has increased reporting. Within 24 hours, we can track a case of maternal or infant death and figure out what went wrong. National Service Scheme volunteers track maternal deaths and home delivery. They go door-to-door to find out why the woman could not be taken to the hospital.
Why can’t the women in labour go to the hospital? What do your findings say?
We found that the number of home deliveries increased during rainy season. This is something we’re going to look into and see that rains don’t become a problem for expectant women.
We are running another special programme called Sakhi. Sakhi consists of college volunteers, who on Monday and Friday perform local songs and and plays to spread awareness among women about hygiene and nutrition. The DM also attends such meetings.
Our short-term plan to make sure the delivery is safe and we’re also very particular about the first month after delivery. We make sure we provide women with the best post natal care in the first month. |
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Crippling illiteracy
ASHAs not empowered
Last word