Self Learning and Change - a Journey to Understand and Understand Community Health · Community Health

Self Learning and Change - a Journey to Understand and Understand Community Health

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Title: Self Learning and Change - a Journey to Understand and Understand Community Health
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CHFP-2009.2/FR117

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Self - Learning and Change

A Journey to Understand and Understand Community Health

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Two years community Fellowship Program

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From 02.11.2009 and 31.10.2022

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Guide

Presenter

Dr. Ajlay Kumar Khare
Madhya Pradesh Science
Assesmbly

Lalita Jain
Fellow

Guide
Sri Prasanna Saligram
CPHE Bhopal

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Lalita jain CPHE Bhopal

Page 1

Gain chartS.No Activities

__ Month
May
II
III IV

April

rn

1
2
3

4
5

6
7

8

Readings
writing______
To collect the
dist health plan
Reporting
To make an
NGO profile

Resource
mapping
(dobra jageer)
To check the
cold chain
Three villages
meeting
(adolescence
girls)________
To check the
proper
immunization

Lalita jain CPHE Bhopal

•

■

•

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14 Adolescent Reproductive Health in Asia By Bhakta B Gubhaya , 10-13 June 2002
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17 Adolescent Girls in India Choose a Better Future : An Impact Assessment (CEDPA-2001)

18 Awareness of Reproductive Health among Rural Adolescent Girls (A comparative Study of school going Girls and
'kdropout Girls of Jammu - Nidhi Kotwal, Neelima Gupta and Rashi Gupta
19 Awareness of Reproductive Health among Rural Adolescent Girls (A comparative Study of school going Girls and
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Scaling up Priority Health Intervention in Tanzania : The Human Resources Chanllenge

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22 Adolescent Girls in India Choose a Better Future : An Impact Assessment (CEDPA-2001)

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25 Identification of an Appropriate strategy to control Anemia in adolescent girls of poor commmunities
26 Identification of an Appropriate Strategy to control Anemia in Adolescent girls of Poor Communities - Anshu
Shrma , Kanti Prasad and K. Visweswara Rao )
27 Indian Journal of Community Medicine Vo 31, No. 4 , Oct-Dec,2006- Prevalence of Anemia in Adolescent Girls
Belonging to Different Economic Group
28 Kamla Raj 2005 Anthropologist, 7(4):265-267(2005)Prevalence of Anemia among Adolescent girls of Scheduled
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31 Start with a Girl -A New Agenda for Global Health -Miriam Temin , RuthLevine
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34Adolescent Girls in India Choose a Better Future : An Impact Assessment (CEDPA-2001)

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Lalita Jain Fellow,CPHE,Bhopal

Page 2

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Lalita jain Fellow,CPHE, Bhopal

Page 3

\ /

Brief report
On

JSY study conducted in Dist. Morena
Study conducted

By

Madhya Pradesh Vigyan Sabha

Supported by

National Health Systems Resource Systems

New Delhi

MRVS office - Technology Bhawan, Sagonikala, Kolua Khurd, Raisen Road, Bhopal, MP.

Phone- 0755-2852783

Lalita Jain Fellow, CPHE Bhopal

Mail- mpvs.bpl@gmail.com

Page 1

K I

Report of study on status of deliveries and status of institutional deliveries
conducted in Morena district, MP
IntroductionMadhya Pradesh is known as heart of incredible India. MP is having Morena district is
situated in northern part of MP. It is known for its ravines and dacoits. Its main river is Chambal
and ravines are mostly formed in bank of Chambal, Kwari rivers due to soil erosion which is
alluvial soil. Near Chambal ravines are deep while near kwari they are shallow.
Gwalior is situated nearest to it and it is closest district of MP to New Delhi Capital of
India. Agra is also very near from here.
Morena is mainly agriculture dependent. Its main production is mustard, Bajra,
tuar,wheat and gram. In Jaura block sugarcane produced while vegetables like chilies, potato
are grown in Morena, Ambah and Porsa blocks.
It is not industrialized district. It s main industry is mustard oil mills and sugar factory in
Kolaras.
It is very famous for Kakanmath ' Shiv Temple' which is 11th century monument and
famous Jain temple is also situated in Sehonia. On Shivratri and Anant Chaudas pilgrims are
coming to worship these deities.
Madhya Pradesh Vigyan Sabha has conducted study on JSY for NHSRC, New Delhi to
know field reality of its implementation. Some salient features of the study are discussed in this
report.
Demographic profile of Morena district
Morena district is constituted from 6 blocks. Its total population is 1592714; male
population is 874089 while female population is 718625 according to 2001 census. It is having
sex ratio 822 and child sex ratio is 837 which is second lowest in MP. Details are given below-

SNo
___ 1.
___ 2.
___ 3.
___ 4.
___ 5.
___ 6.
___ 7.
___ 8.
___ 9.
___ 10.
___ 11.
___ 12.
___ 13.
___ 14.
___ 15.
16.

Indicator _______
Population Total
Total H.H________
Rural____________
Urban___________
Population Male
Population female
SC______________
ST______________
Population Urban
Population Rural
Sex Ratio Adult
Sex Ratio Child
Literacy rate Male
Literacy rate Female
Total Workers_____
Non Worker______

Status_________
1592714_______
237808________
185437________
52366_________
874089________
718625________
21 %__________
0.92%_________
343305(21.55%)
1249409(78.44%)
822/1000
837/1000_______
35.69 %________
16.91%________
39.95%
60.05 %

Source census 2001
Lalita Jain Fellow, CPHE Bhopal

Page 2

V

/

Morena is having high population of SC population 21%. Schedule cast population is
very low 0.92%. It is having very high non workers population 60.05%. Literacy rate is poor
specially women literacy shown dismal picture and discrimination of girl child in providing
education.
Health of rural population is dismal in Morena due to inapproachability; women position
is society is weak and high SC population. Girl’s marriage before age of 18 years is 51.7% in
Morena and MP is 29.2%. 3 ANC coverage is only 30.8% in Morena and if we look at complete
ANC than it is only 4.1%. Institutional deliveries are having remarkable increase which is
92.43% in Morena district. Other details are given in table below.
Important health indicatorsSNo Indicator_____________
___ L IMR(SRS 2009)________
___ 2. MMR(SRS 2009)_______
3. Girls marrying before age
of 18 yrs_____________
4. 3 ANC_______________
5. ANC Complete_________
6. PNC within 2 weeks of
delivery______________
7. Institutional delivery
8. Breast feeding started
within 1 hrs of delivery
9. Children exclusive breast
feed up to 5 months
10 Children fully immunized

MP_______

Morena

70/1000
335/100000
29.2%

51.7%

34.8%
7.9%
37.7%

30.8%
4.1%

47.9%
43.1%

92.43%

51.5%

36.2%

32.2%

Source MP Data form DLHS3 and Morena DLHS2

Public Health system:
Morena is having one district hospital, one civil hospital, 8 Community health Centers
and 15 PHCs. It has 196 Sub Health Centers. Staff availability is varied

S.
N

1

2

Block

Morena

Ambah

Health Institution
PH, CH, CHC
Normal
Difficult
area

District
Hospital
Noorabad
(CHC)
Civil
Hospt.

Lalita Jain Fellow, CPHE Bhopal

Most
Difficu
It area

BEmON
C/CEmO
NC

PHC
Normal

CEmON

Banmor

Rampurkala
n

V

Deemni

Rithora

y

Joha

y

C_____

Difficult area

Most
Difficult
area

BEmO
NC

BEmON

C
Khadiaha
r(CHC)

CEmON
C

Page 3

3

Porsa

CHC

BEmON

Mahua

y

C_____
4

Joura

CHC

5

Kailaras

CHC

6

Sabalgra

CHC

Jundpura
(CHC)
Pahargra
h(CHC)

BEmON

Devgarh

Bagchini

Tetra

y

Parikshitpur
a_________
Magrol

N

C

CEmON

C_____
h

Sujarma

CEmON
C

Sumawali
Galaitha

Pachokha
ra

N

Janani Suraksha YojnaIn MP maternal mortality and IMR are very high. Both of these mortalities are happening in
first 3 days after delivery. To reduce complications after delivery JSY scheme is introduced with
cash incentive to women for deliveries and ASHA who will bring patient for delivery to
institutions. Under the scheme important provisions are as follows1. Women who are coming to deliver in recognized public health institution will receive Rs
1400 in rural area and Rs 1000 in urban area irrespective of their economic or cast
classification. She should stay in institution for minimum 48 hrs.
2. ASHA will receive incentive in rural area Rs 600 (250 for transport+ Rs 150 incentive +
200 for PNC check up and immunization of new born). In urban area she will receive Rs
200 only.
3. BPL women who are above 19 years age and giving birth up to 2 children will be eligible
to receive Rs 500 in home delivery. This amount should be provided to women 8 to 12
weeks before delivery. Certification of BPL should be done by VHSC and amount will be
given from untied fund which will be replenished by BMO..
4. If delivery is happening , in parental home than she will require to carry transfer
certificate and vaccination card with obstructive record to avail JSY facility.
5. Under Janani Sahyogi Yojna private institutions are recognized for deliveries. These
hospitals are known as Janani Sahyogi hospitals. If any women who is BPL or SC/ ST will
receive Rs 1000 as incentive. ASHA will not receive any incentive under Janani Sahyogi
Yojna.
6. Transport availability is very big problem in rural area and many women are dying due
to non availability of transport in time. Government has started facility of transport
form home to hospital for delivery which is known as Janani Express Yojna. If any
women is utilizing this facility than Rs 250 for transport will not be given to ASHA.
Study designIt was planned to take 300 samples in 30 villages. To finalize sample Population
Proportional Sample method is used. We have calculated rural population and divided it by 30.
All villages were listed in ascending order on the basis of population. Total population of Rural
Morena is 1249409. When it is divided by 30 we obtained 41647. Villages are selected when
Lalita Jain Fellow, CPHE Bhopal

y

Page 4

total of villages reaches to 41647. In this way we have selected 30 villages. These villages have
variable population. To decide number of sample in village, we took total population of the 30
villages and divide it by 300. Now when we considered population of villages it is divided by
that number so sample number is obtained in particular village.
Apart from this sample all complicated cases were also interviewed.
As it is study of JSY beneficiary only so we took only JSY beneficiary. In Mp JSY
beneficiary are all women delivering in government institutions, in accredited pvt hospitals who
are BPL and SC or St. Home deliveries of BPL families who are 19 years above and having only
two children are also beneficiary so they are also included. After making list of all these
deliveries randomly number of sample is decided and interviewed.
List of surveyed villages______

S No
1.

2?
3.

5?
6.

tT

8?
9.
10?
11.
12?
13?
14?
15?
“76?
17?

18?
““19?

20?
2L

22?
23?
24?
25?
26.
27?
28?
Lalita Jain Fellow, CPHE Bhopal

Block
Ambha
Ambha
Ambha
Joura
Joura
Joura
Joura
Joura
Joura
Joura
Joura
Joura
Kailaras
Kailaras
Kailaras
Kailaras
Morena
Morena
Morena
Morena
Morena
Porsa
Porsa
Porsa
Porsa
Sabalgarh
Sabalgarh
Sabalgarh

Village________
Purawas Khurd
Esah__________
Khadiyahar
Khadariyapura
Mahdewa______
Kolhudanda
Ghador________
Nandganoli_____
Khidora_______
Umedgarh Bansi
Mainabasai_____
Tiktoli Gujar
Pate Ka Pura
Dungrawali_____
Gastoli________
Chouki________
Parauli________
Jai Nagar______
Jatawar________
Kheda Mewda
Nawali Badagaon
Budhara_______
Dondari________
Pali___________
Rajaudha_______
Lakenjara______
Kheda Digwar

Jawrol

Population
2154
4283
9787
495
906
1434
1652
1753
1882
3152
3736
4984
661
1036
1146
1285
1552
2456
4541 __
5616
7616
2629
2785
2998
14799
816
1986
3420
Page 5

29.
30?

Sabalgarh_____ _
Sabalgarh_______
Total population

Mangrol
Bamsoli

5257
6399
103216

Methodology followedSecondary data is collected form census office. Villages are selected as per methodology

given above and sample number is determined. We have formed three teams of 3 interviewers
and one coordinator. Three days training workshop was organized at Morena in which
schedules were explained and one day field experience was also conducted in which team
members have house listed selected sample and interviewed. In the evening schedules were
checked and corrections explained.
Later team has visited all the villages and after house listing sample is selected and
interview conducted.
Data analysis
villages which were selected had different characteristic like Khadariys is smallest village
having population of only 495 while Rajauda is largest village with 14799 populations. Maximum
number villages came in sample from Joura block and minimum number villages are from Ambah block.
Population of these villages covered is 103216 which are divided in 22612 households. Family size of this
population comes to be 4.56 it is ower than MP average family size._____________________________
Institional
BPL
API
Total
Home
Block
Village
delivery
Complication (Govt.
(Govt.
S.N.
delivery
delivery
Name
name
Hosp)
Hosp)
Govt. Pvt.
Purawas
khurd

42

37

2

3

nil

6

31

Esah

118

83

17

18

1

10

73

3

Khadiyahar

186

167

5

14

nil

4

163

4

khadariya
Pura

28

24

Nil

4

2

8

16

£

Madewa

30

27

£

2

nil

2.

25

6

Kolhudanda

39

25

11

2

4-

21

1

ghador

47

45

1

2

£

40

Khidora

54

45

4

5

nil

4

41

9

Umedgarh
Bansi

73

69

2

2

nil

29

40

10

Mainabasai

68

55

2

10

nil

6

49

11

Nandganoli

37

33

4

nil

1

3

30

119

116

nil

3

1

32

84

26

17

nil

9

nil

nil

17

16

15

1

nil

nil

10

5

30

29

nil

1

1

11

18

1

2

8

Ambah

Joura

12
13
14
15

Kailaras

Tiktoli
Gujar
Pate ka
pura
Dungrawali

Gastoli

Lalita Jain Fellow, CPHE Bhopal

Page 6

16

Chouki

45

42

17

Parauli

50

18

Jai nagar

43

29
41

Jatawar

117

Kheda
Mewda

21

22

19
Morena

20

23
24

Porsa

2

1

7

35

2

3

26

2

8

33

7

4

13

93

16

1

nil

35

91

182

9

25

9

31

151

68

64

3

1

2

23

41

Pali

76

50

7

19

1

7

43

239

15

14

8

6

233

16

2

nil

106

4

143

126

Hawaii
Badagaon

216

Budhara
Rajaudha

268

25

Dondari

73

68

1

4

5

6

62

26

Lakenjara

23

21

2

nil

2

1

20

27

kheda
Digwar

24

24

nil

nil

nil

2

22

Jawrol

84

78

2

4

nil

23

55

29

Mangrol

109

109

nil

nil

2

13

96

30

Bamsoli

113

106

4

3

nil

29

77

Total

2365

2072

114

179

49

341

1731

28

Sabalgarh

Highest home deliveries are reported in Kalaras block. Ambah is second in % but Sabalgarh I
shaving minimum home delliveries which is 1.98 %. It is also reported that Janani Express Yojna
ias also running best in relation to other blocks;

Distribution o

R
I

eliveries

■ Public K Private n Home

!2.94

88.68

95.75

88.03

85.06

3

B

--

6.93 10

M»H

.b1

..

w 3.637.67
IB

'■11 ll *Fl I

. .10.25
5 7

BiL

5-3s7±

6328.61
g® wr
, „ W W IH
Morena

Sabalgarh

Surprisingly trend in institutional deliveries are showing decling trend in comparisan to
previous year. In 2009-2010 institution delivery in reported deliveiries is 97.78 %. It is
appreciable to have such high number of institutional delivery while it is surrounded by dacoit

Lalita Jain Fellow, CPHE Bhopal

Page 7

who are kidnapping various perosns very frequently. Home delivey in previous year is very low
which is 2.22%.

Proportion of deliveries
« Oct 2009- Sept 2010

92.43%

I! 2009-2010

97.78%

,-v 5’^

il’islliill

illilii!

s

7.57%

2.22%
■ WiTK

Janani Express Yojna is not working in Morena district. Patients are hiring private
vehicles from their villages and they have to pay Rs 500 to 800 for reaching to hospitals. In
nights they may need to pay even more if their emergency. Some times due to delay in
transport some times deliveries ar ehappening in vehicle also. Most of the times such cases are
considered under JSY benefit. One delivery has been reported which has happened in corridore
of district hospital.
Blood Bank is only working in District hospital so cesarean operation is performed only
in Morena hospital although Ambah is also CeMONC but due to non availability of Blood
operations are not performed.
Building of some hospitals are also found in bad condition specially Khadiyar where
quarters of ANMand LHV are in very bad condition. In Pahargarh approach is difficult specially
in rainy season due to one Nala. Some times patients has to be shifted on cot to the hospital.
Coverage of ANC is limited to giving TT and Tab Iron Folic Acid only. BP, Hb, Urine test or
health education etc is not provided. Rich and higher cast families are availing ANC facility form
private hospitals and if condition is normal they go for delivery in government health
insitutions. If we look at API and BPL saaperately regarding utilisation of government hospitals
than we found that it is API who are enjoying JSY benefits not BPL for whom it is meant. Food
during ANC is not enriched with green leafy vegetables. It is same as consumed by other

members. It is either Roti / dal or rolti / vegetables in morning and evening. Morena
isproducing milk in high quantity but most of the milk is sold to dairies and not consumed by
women or children. No concept of rest during pregnancy is prevent in Morena district. Same is
also with PNC. Low PNC coverage is also due to cultural barrier as family members do not allow
women and child to go out side for at least two months.
It is also reported that some ASHAs are having practice to wait at health facility rather
going workig in villages so as soon as delivry form village is coming they take advantage of being
in hospital and register that delivery in their name.
Lalita Jain Fellow, CPHE Bhopal

Page 8

I

Case Study1. In village nawali one women of SC community has gone for two ANC check up in
which she has received Inj. TT and 50 tabs of Iron Folic Acid only. She had
surprisingly mentrual bleeding during her whole ANC period. When delivery pains
started family members arranged pvt vehicle for which they have paid Rs 500 for
dropping hospital only. Up to half an Hour, she was not attended by any hospiatal
staff and she delivered in corridore of district hospital. Her mother in law assisted
her delivery. After delivery she was attended by hospital and given treatment.
Weight of her child is also not recorded. She has to spend Rs 800 for injection,
medicine and other expenses. She expressed dissatisfaction of the services. She has
received JSY incentive also after 20 days. ASHA has not accompanied her.
2. Women of Bada Gaon had complication in 7th month of pregnancy. She has anemia
and pain in abdomen. She went to district hospital and consulted doctor but hcould
not receive proper treatment so went to medical store and purchased medicine on
his suggestion. She has paid Rs 550 for those medicine. She has purchased such
medicine two times. She has done blood test also on his advice. Althogh pain in
abdomen was not releived till her delivery. They could not go to private hospital as it
was unaffordable. Later she has delivered in District hospital Morena. She is not
satisfied with the services.
Conclusion

JSY is most successful scheme of NRHM. Due to cash transfer it is very popular
and large numbers of poor families is now reaching to government hospitals for at least
deliveries and are getting facility of skilled birth attendance. They are also monitored for
minimum two days for any maternal or neo natal complications.
It is apprehended that in case of stopping cash transfer this may fall back to same
practice of home deliveries as people have to spend large amount of Rupees while staying in
hospitals.
It is flag ship program of NRHM and we need to rejoice its success.

Lalita Jain Fellow, CPHE Bhopal

Page 9

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Adolscent girls participated in the health meeting conducted in village Kolua Khurd- dated: 19/05/2010

Name

o

1.
2.
3.

4.
5.
6.

7.
8.
9.
10.

11.
12.

L

13.
14.
15.
16.

I
17.

I

18.

19.
20.

21.
22.

23.

Fathers name

Mothers Name

Age

Cast

Educational
qualification

Educational
HB
Situation

Blood
Group

Media: Lalita Jain CHFP-2009-2-FR-117.pdf

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