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Health
For every 100,000 live births, 677 women in Rajasthan
die during pregnancy. The reason for this shockingly high maternal
mortality rate is that few women have access to antenatal care or skilled
birth attendants. In fact, fewer than half of women in rural areas visit
antenatal centre to receive the crucial vaccinations against disease that
are given there. What's more, only one in three deliveries in Rajasthan
are attended by a health professional. Rajasthan also has one of the
highest fertility rates in the country - a sure sign that patriarchy still
persists in the state, where women do not have control over their own
bodies. Infant mortality in Rajasthan is similarly high - as many as 83
infants die per 1,000 live births. The majority of infant deaths occur in
the first month of life, and almost half in the first week itself. Most of
these infants' lives could have been saved with adequate nutrition, safe
drinking water and straight forward immunization.
Women and children in Rajasthan are also increasingly threatened by
another killer -HIV/Aids. India has the second highest number of
HIV-infected people after South Africa. Yet fewer than half of all women
in Rajasthan have even heard of HIV/Aids. The fact is that, Rajasthan has
several national highways passing through it and a large number of
tourists visiting are clear danger signals that AIDS may spread further
unless something is done to prevent the epidemic.
While Aids is a serious threat for the future, at present the largest
cause of death in Rajasthan is respiratory illness. Tuberculosis and
silicosis are rife in the state, where over two million people work in
quarries and mines. Prevention is the only effective measure to fight
against silicosis, as it is not curable. Yet most mine owners today offer
no substantial safety measures to protect their workforce. As a result,
the average life expectancy of a mineworker is pitifully low - between 40
to 50 years.
Most of these mineworkers are landless families who have been forced to
migrate in search of work due to severe drought and poverty. Children as
young as nine work with their parents for up to 14 hours a day for meager
wages. The families live in remote areas in makeshift huts that have no
toilet facilities or electricity. They have no access to safe drinking
water, and the nearest health services and schools are many miles away.
For all the workers, sick days are no wage days. In the past, long
distances between the mining sites have made it difficult for workers to
form collectives and campaign for better working conditions and wages.
Objectives
To put pressure on the government to ensure quality health services to the
community as their basic right. |
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To promote community-centered preventive and curative health care, with
special focus on mother and child health. |
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To empower women so that they have control over their fertility and can
make their own decisions about their healthcare. |
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To campaign for basic health facilities for miners and brick kiln workers,
and to ensure the effective implementation of laws designed to safeguard
their rights. |
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To mobilize members of the community to create awareness about HIV/Aids
and how it can be prevented, and to provide support to HIV-infected people
facing social exclusion. |
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To ensure better health of the villagers, particularly, children,
adolescent girls and boys, pregnant and lactating women and old people, by
popularizing home based remedies. |
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To generate awareness of home remedies for prevention and cure of anemia. |
Our Approach
Prayatn’s approach on Health is primarily rights based. The organization
believes in building capacity of the people so that they are able to
demand and avail their corresponding entitlements. Be it the public
services under the National Rural Health Mission, the Integrated Child
Development Scheme, the Midday Meal Programme, the Public Distribution
System and the Total Sanitation Campaign, but Prayatn tries to build
awareness in the community and empower it through the process of
institutional development. It simultaneously undertakes capacity building
and advocacy measures for duty bearers like ANMs, ASHAs, Anganwadi
Workers, concerned Government Officials and PRIs so that they deliver
their role effectively and sensitively.
Prayatn also undertakes certain direct support measures as per need of the
community and resource availability to provide immediate relief to those
who are in immediate need. We also strongly believe that, no talks of
rights are worthy if it is fulfilled after an irreparable loss.
Prayatn has worked on a variety of health
interventions broadly focusing community at large with special focus on
women and children. The mode of interventions has been project basis. The
details of the project and issues are as follows:
1. Reproductive and Child Health (RCH)
Project
The organization was a part of both the phases of the RCH project
implementation in Dholpur district of Rajasthan. This Project was
implemented in collaboration with the Health and Family Welfare Department
in 25 villages of Dholpur district, Rajasthan with the aim to promote safe
motherhood in the remote villages with the help of health department and
traditional measures.
Project Objectives
- | To bring reduction in the number of child and maternal mortality rates, ensuring safe deliveries and proper treatment of the pregnant and lactating mothers. |
Major Achievements
The project had following achievements:
- | In 25 villages it was ensured that delivery kits are distributed to every pregnant woman in the village. | |
- | 100% immunization of all the pregnant women and new born children up to the age to 5 years. | |
- | In the duration of the project implementation no maternal and child deaths took place in all the 25 villages. | |
- | Increased approach of the community members to the government services and generated a demand from the community for services from the government. |
2. Routine Immunization Programme
Dholpur district is famous for red stones and its geographical features
support the same throughout the district. On one side there are ravines
and on the other side there is Chambal River which forms the border of two
states Rajasthan and Madhya Pradesh. Dholpur is considered as one of the
backward district in Rajasthan. The population in the region is scattered
and the region experiences a lot of health related problems especially
with regard to women and child health. Because of tough geographical
conditions and fear of dacoits the villagers hardly get any service from
the government department in remote villages. The immunization status in
this district was the lowest in the state. Against this backdrop the
organization in association with UNICEF initiated the routine immunization
project in 150 villages in Dholpur district in Rajasthan.
Project Objectives
- | To formulate and strengthen the health committees in all the villages and increase awareness among the people about the importance of the routine immunization in the life of women and children for a better health and future. | |
- | To increase the capacities of the community based groups on the issues of routine immunization, working of the health committees and aspects related to the routine immunization. | |
- | To promote sense of responsibility and accountability among the health department people through advocacy and networking at various levels. |
Major Achievements
- | The district was ranked 3rd in the state out of last because of a collective efforts of all the stakeholders including district administration. | |
- | There was complete immunization in the 150 villages. | |
- | There was awareness about the immunization in the 150 villages as a result of which there were reduced superstition in the community. | |
- | There was a process of complete immunization for the pregnant and lactating mothers and the children in the age group of 0-5 years. With regard to this there system of community monitoring was developed in the villages to sustain the initiative. |
3. Management of Malnutrition Programme
Malnutrition is one of the biggest social problems in Rajasthan and the
data says that almost 52% of the children suffer from different grades of
malnutrition. This has a huge impact on the lives of children and many
children die out of malnutrition. Dholpur district has the highest
percentage of malnourished children in comparison to other districts
majorly because people work in mines the whole day and take less care of
their children. Prayatn with the financial support from UNICEF has worked
in 2 blocks covering a total of 208 Aanganwadi centre on malnutrition
management.
Project Objectives
- | To protect the children in the age group of 0-5 years from malnutrition. | |
- | To ensure complete immunization of pregnant ladies and the children in the age group of 0-5 years. |
Major Achievements
- | Improvement in the overall quality of performance of the Anganwadi centres including performing all activities efficiently as desired and conceptualized by the ICDS and women and child development department. | |
- | Regular monitoring helped to reduce the cases of malnutrition. | |
- | Could save lives of many children who were in the 3rd and 4th grade of malnutrition. | |
- | Alertness in the district health department for malnutrition management and immunization. | |
- | Ensured immunization of pregnant mothers and children in the age group of 0-5. | |
- | Referred serious cases of malnutrition to the district hospital, Dholpur and ensured that they receive free treatment. | |
- | Registered children at Aanganwadi centres and ensured that they get nutritious food from the Aanganwadi centres. | |
- | Significant improvement in the documentation process at the Anganwadi centres. | |
- | There was improvement in the capacity of the Anganwadi workers, co-workers, ANMs and team members of Prayatn. |
4. AIDS Public Awareness Campaign
Dholpur district is famous for its stone works and due to this there are
lots of employments for the labours form the local region as well as from
the other region. As a result of which there is a lot of transportation
that takes place with regard to the supply of stones from one region to
another and the people who are involved in this process very often makes
sexual contacts with the sex workers and the women in the nearby villages.
This therefore increases the risk of HIV/AIDS and Sexually Transmitted
Infections (STI) among these people. Prayatn, Dholpur in collaboration
with the Rajasthan State AIDS Control Society carried out a preventive
programme on the issues related to HIV/AIDS, STI, its prevention and
treatment.
Project Objective
- | To spread awareness on the issues of HIV/AIDS, STI, its prevention and treatment inthe community. |
Major Achievements
- | There was awareness on the issue of HIV/AIDS and STI in the entire district. | |
- | Ensured treatment availability to HIV/AIDS and STI affected people at minimal rates. | |
- | Community people started using condoms. | |
- | For the very first time, there was knowledge on the identified cases of HIV/AIDS in the district. |
5. Mobile Health Unit
There are lots of mining activities that happens in the Dholpur district
in Rajasthan as a result of which there is lot of labour intensive work
that takes place in the region and which facilitates the process of
migration. This set of population majorly experience life sustaining and
life threatening diseases like AIDS, Hepatitis and other forms of sexually
transmitted diseases and also trade generated diseases like tuberculosis,
silicosis and other forms of respiratory tract infections. Since most
mining activities are carried out in the geographically isolated areas and
most people cannot afford for their treatment, these diseases get worsen
with time which further leaves its impact on children too. Due to this
their body functioning gets affected at most times and lack of proper
medication prove to be fatal many times. There is less accessibility of
the people to the Government and private health delivery systems. Keeping
this in mind Prayatn commemorated a mobile health unit in collaboration
with Save the Children, Finland.
Project Objective
- | To provide preventive and curative health support to the workers and their families residing in and around mining areas in Dholpur. |
Major Achievements
- | Health services were enabled to the local community and different areas through the mobile health unit. | |
- | Awareness of the community people with regard to the protection of diseases. | |
- | There was improvement in the health of people as a result of better health service delivery system. | |
- | Increased number of safe deliveries and trained birth attendees. |
6. Smile on Wheel (SOW)
Prayatn in collaboration with the Smile Foundation was providing low price
treatment for the poor and marginalized residing in slums areas of Banaras
district in Uttar Pradesh through mobile health unit in the name of Smile
on Wheels. This area had a paucity of good medical facilities. Over
population is another problem that is encountered in the and hence there
was very low sanitation facilities that were available. The place is
occupied by the migrant’s from Bihar, Orissa and West Bengal who were
mostly rag pickers and casual labourers. The economic condition of these
people did not allow them to avail medical care for themselves and thus
the problem of ill health continued.
Objectives
- | To provide easy and affordable access for medical facilities. |
Major Achievements
- | The SOW could come out with the revenue based self-sustaining model which could provide services to the needy people in long run. | |
- | The SOW could cover maximum population of the slums and able to make them participate in the SOW activities. | |
- | A good number of memberships has been developed which again reinforces the need of such facility. |
1. Shaksham - Leprosy Rehabilitation
Project
Banaras is considered as a religious place or holy land of Uttar Pradesh,
India. It is also popularly known as Kashi. The presence of numerous
temple in the state attracts many devotees to come here for worship,
therefore it can be noticed that this place is always crowded with people
throughout the year. Many people believe that their sins are forgiven if
they take bath in the holy river Ganga and so many leprosy patients come
here with the faith of getting healed and reside in the slums that exist
near the river Ganga.
Bhadoi, neighboring district of Banaras also has a number of slums where
many leprosy affected people come and reside. In order to mainstream this
particular set of community. Prayatn in collaboration with Back to Life,
Germany is running a project called Saksham – Leprosy rehabilitation
project which deals with the issues of health and livelihood for this
people and provide them with the necessary medical services.
Project Objectives
- | The main objective of this project is to provide quality treatment and livelihood support to the leprosy affected people in Varanasi and Bhadoi districts in Uttar Pradesh. |
Major Achievements
- | A model of community managed livelihood generation in which people deposit their installments and the community decides for the new beneficiary. | |
- | Access to the government programmes and departments has increased including health services and livelihood. | |
- | All the children of the leprosy patients could be saved by getting infected from leprosy through regular health check up and are linked with the education system. |
2. Child Development Project - Healthy And Secured Infants
PRAYATN, in the very initial year of programme implementation is doing its
best to raise the awareness level of the community and sensitivity of
community people on various issues of health, hygiene and nutrition. The
fundamental theory of working with children under 0-5 is that “A child
cannot wait”. We work on the improvement of improper and insufficient
service deliveries by the related institutions like Aaganwadi centers,
schools, panchayats, etc. at local level and officials elected
representatives, other civil society organization and media at larger
level. Under this, special efforts have been made towards community
organization and institution building. For instance, formation and
strengthening of Child Protection Committees, Immunization camps, Referral
of malnourished children to MTC centers have been focused during the year.
Training of pregnant and nursing mothers on Nutrition management and
Training of Aanganwadi workers on Nutrition Management have contributed a
lot to achieve the set objective for the year. We also emphasized on
meeting the immediate needs of small children of 0-5 years through
providing Nutrition Supplement support to the children and quality support
to ICDS centers.
3. Ensuring Food Security and Nutrition
Originally forest dwellers, the Saharia have been forced to move out of
their original vocation and livelihood due to increasing depletion of
forest resources. They are mostly landless and do not have any profitable
skills or training. Illiteracy is rampant in the community and they are
not in a position to access the government benefits and welfare schemes
that are meant for them. As a result, they are mostly forced to work as
daily wage earners. The only source of earning left for the Sahariyas is
that of farm labour (Since most of them are landless unskilled).
Unavailability of Medical services was one of the most sought after
concern of this area for over long time. Due to poverty, illiteracy and
ignorance coupled with non-availability of PHC or Anganwadi Center, common
treatable diseases become chronic even leading to untimely deaths.
Children under five are highly vulnerable. People are unaware of hygienic
and sanitary needs of infants. Nutritional requirement of children and
newborn babies remain ignored. Due to lack of transport facility of any
kind poor people find themselves helpless when the patients become
critical. Pregnant women are often found to be unaware of their proper
immunization, vaccination and nutritional requirement and become anemic.
Childbirth is facilitated by untrained village Dai under unhygienic
condition resulting in to increased MMR (Maternal Mortality Rate) and CMR
(Child Mortality rate).
Due to ignorance and poverty, infants do not get proper nutritional feeds
and are found to be suffering from Marasmus and Kwashiorkor. This further
makes them susceptible to common diseases and people mostly depend on
village ojha (Faith healer) for the treatment instead of Doctor, who
charge fees unaffordable to them. Stone mine workers often faces injuries
and bruises during the work, which often remain unattended due to poverty
and lack of health services, and become septic.
Objectives
- | To develop in-depth understanding on various actors and factors affecting/influencing the state of nutrition of Saharia children. | |
- | To facilitate (evolution of) a community action on issues of Food Security and Nutrition of Saharia children. | |
- | To establish an enabling environment for Food Security and Nutrition in the state thereby influencing state’s programs and policies (related to nutritional security of children). |