A MOBILE KEY TO MATERNAL HEALTH
Dr Anita, who just goes by her first name, has a flourishing practice in Bihar. She is the most sought-after consulting gynaecologist in a state with India’s highest fertility rate — the average number of children a woman has in her lifetime is 3.6 here. Her day is so packed that she cannot meet all her waiting patients. So she advises them on the phone, and they love her because the advice comes free.
Dr Anita is not a real person. She’s a recorded voice that, along with 40 illustrated cards on a kunji (Hindi for key ring), works as an audio-visual aid for community health workers advising families on mother and child health. The target is to bring the state’s maternal deaths down, by 2017, from 261 per 1,00,000 live births (Sample Registration System — SRS 2009) to 119, neonatal deaths from 31/1,000 (SRS 2010) to 20, infant deaths from 48 (SRS 2010) to 26, and total fertility from 3.6 to 2.9.
Work’s been going on in earnest since end of 2011. The ‘ mobile-kunji’ initiative is part of the Bill & Melinda Gates Foundation’s Ananya programme, which has partnered with Bihar government to help its more than 2,00,000 frontline workers use innovative tools to reach out to the state’s 27 million women in the reproductive age.
Sunita Kumari, 38, an accredited social health activist in Sonmai village in Patna’s Dhanarua Block, never leaves home without her mobile kunji, which has been developed by BBC Media Action. “Everyone has a lot of questions, you never know what they’ll ask. The kunji and Dr Anita ensure I don’t leave anything out,” she says.
On her schedule last weekend was a follow-up visit to Lakshmi Devi, 22, who has two sons: two-month-old Amit and two-years-old Amish. Kumari efficiently examines the children, cleans the barefooted toddler’s snotty nose and swats away the flies around the baby before turning to the young mom to ask her how she is. “We’re all okay,” says Lakshmi.
Next Kumari flips out her kunji and bombards her with questions about her children (“Are you exclusively breastfeeding the baby? Don’t give him anything top feed, not even water.” “Does he pee at least five to six times a day? If he doesn’t, it means he’s not getting enough milk”). Vaccination is next on the list followed advice on contraception (“Have you considered family planning?” she asks. Lakshmi says she’s mentioned it to her husband. “Ask me if you need help,” says Kumari).
Then comes the cellphone. Kumari dials a toll-free number and tells Lakshmi to listen to Dr Anita. The doctor echoes Kumari but still Lakshmi listens in awe till the doctor signs off and it’s time for the health-worker to leave.
Kumari loves Dr Anita. “Now everyone says I know as much as doctor madam,” she smiles. And that’s just what Dr Anita does: she validates what community health workers tell families, giving them credibility that may be denied some in caste- and class-ridden communities. There are problems, like occasional medicine and equipment shortages, but plucky healthworkers have found a way around it. “We just ask for more. If we need 100 iron and folic acid tablets for mothers, we get 50, so we ask for 100 when we need 50,” says Neetu Kumari, an auxiliary nurse midwife, who does a monthly review of the work done by accredited social and health activists and anganwadi workers in the village. The village has had no home deliveries in a month.
They’re also on top of when to push for contraception advice. “It’s best to discuss family-planning options when women are seven to nine months pregnant. That’s when the pregnancy-related discomfort is maximum and they are more likely to consider spacing their children or limiting births,” adds Neetu Kumari.
They’re all part of the the Mobile Academy, a phone-based dial-in training service that regularly upgrades skills. Calls to the Academy are 90% less than standard rates. “We’re not doctors but we’re as good. When people see that, they listen,” says Neetu Kumari.
Now that motivated health-workers have the key to success, less women and children are likely to die of avoidable causes.