Importance of Pre School Education at Anganwadi Centre

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'kkykiwoZ f’k{kk ds egRoiw.kZ ?kVd gSa%

Ø     cPpksa ds lokZaxh.k fodkl dks izksUur djuk

Ø     vkSipkfjd fo|ky;hu f’k{kk ds fy;s cPps dks rS;kj djuk

Ø     ekrk ds jkstxkj esa lgk;rk ds fy;s cky ns[kHkky lg;ksx iznku djuk

Ø     ikfjokfjd@?kjsyq okrkoj.k esa cky ns[kHkky vH;kl o cPps o vfHkHkkodksa dh varZfdz;k dks csgrj cukuk

Ø     lh[kus dks izksRlkfgr djuk

Ø     lkoZHkkSfesd f’k{kk esa ;ksxnku nsuk

Ø     izkFkfed Ldwyksa esa cPps dk de le; yxukA

vkaxuokM+h dsUnzksa ij cPpksa dks izkd`frd lalk/kuksa tSls & ty] taxy] tkuoj] bR;kfn ds ckjs esa izkjafHkd Kku djk;k tkrk gSA cPpksa ds [ksyus gsrq f[kykSuksa dk dz; djus ds fy, izfr vkaxuokM+h izfro"kZ 1000 :i;s dh jkf'k dk izko/kku gSA ftlds ek/;e ls vkaxuokM+h dsUnzksa dks izfro"kZ ,d izh&Ldwy fdV miyC/k djk;k tkrk gSaA gkW¡ykfd ;g ,d vyx eqn~nk gS fd vkaxuokM+h dsUnzksa ij ;g 'kkykiwoZ f’k{kk fdV ;k rks miyC/k gh ugha gS ;k gS Hkh rks dkQh th.kZ 'kh.kZ voLFkk esaA blds vfrfjDr ;g fdV cPpksa dh la[;k ds eku ls vi;kZIr gksrs gSaA urhtru] izR;sd cPps dks buds iz;ksx dk ekSdk ugha fey ikus ls cPps vkaxuokM+h dsUnzksa dh vksj vkdf"kZr ugha gks ikrs o ekrk firk mUgsa futh Ldwyksa esa Mkyus ds fy;s etcwj gks tkrs gSaA tcfd vkaxuokM+h dk;ZdrkZ dh ftEesnkjh gS fd og 'kkykiwoZ f’k{kk dk;Zdze dh ;kstuk cuk;s] 3 ?k.Vksa rd 'kkykiwoZ f’k{kk dh xfrfof/k;ksa dk lapkyu djs] LFkkuh; miyC/k lkexzh ls 'kkykiwoZ f’k{kk ds lk/ku rS;kj djs] vfHkHkkodksa esa tkx:drk yk;s] izkFkfed Ldwyksa ds lkFk lglaca/k cuk;s] vkfnA

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izkFkfed f’k{kk dk vk/kkj cukus ds fy;s vkaxuokM+h dsUnzksa ij iznku dh tkus okyh 'kkyk iwoZ f’k{kk cgqr egRoiw.kZ gSA ;g f’k{kk dk vk/kkj gSA

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[1] ekfld izxfr izfrosnu] efgyk ,oa cky fodkl] e-iz- uoEcj 2009A

A case of maternal mortality in Mangabeli village of Bicchiya Block of Mandla District

In Mangabeli village of Kanranjia Panchayat of Bichhiya block of Mandla district a women “Babli” wife of Mr. Vinay died after delivery in Community Health Centre Bichhiya in January 2010.

ASHA, Ms. Kamla Jharia, reported that Babli (age 16-17 yrs.) was first taken to SHC, Rajo, (5 Km. from village) for delivery and after keeping for one day ANM, Ms. Reeta Shyam referred her to CHC (20 Km. from Mangabeli village) because of anaemia. From Rajo family members returned her back to village and then take her to CHC by bus. Mother-in-law Sivratia Bai, and Husband, Vinay reported that they tried to call Janani Express but it could not came because it went to bring another women and if they hire other private vehicle to take Babli to hospital it will take 600-700 Rs. and health institution will not provide money for transportation if transported by private vehicle or two wheeler and moved walking. The economic condition of the family was very poor and they were unable to arrange any other vehicle. ASHA also accompanied them to CHC. In CHC she had normal delivery and delivered a low birth weight (2 Kg.) male baby. After delivery placenta also came out and Babli drink tea with biscuits. ASHA returned back to her home. Babli’s mother went to clean clothes and mother-in-law take baby to give him sunlight, as doctor prescribed. From window of the room her mother-in-law started talking with Babli and after few moments Babli died without any complaint.

Baby of Babli they named him “Nishant”, as remembrance of Babli, was 5 months old and received all the vaccines. Vinay showed his Jachcha Bachcha card also. It was an UIP card and from this card it was noticed that Babli received 3 ANC, IFA tablets and 2 TT vaccines during her pregnancy. But Nishant could not be weighed by AWW as AWW not visited their house to weigh him. We contacted AWW also but she was out of station then we contact her son and she provide weighing machine and growth chart of AWC. We weighed Nishant and found that his weight was only 3 Kg. and falls in IV^th grade of malnutrition. We advised his father to take him to Nutrition Rehabilitation Centre Mandla and also make arrangement for his movement.

For further inquiry ANM of Rajo SHC Ms. Reeta Shyam was also contacted. She reported that Babli was atrisk due to many reasons:

1. Less than 18 yrs. of age.
2. Primy para
3. Short structured
4. Low BP with acclampsia
5. Anaemia

In CHC there was no gynecologist was posted and there was only one doctor Dr. Taksande, BMO was on duty. He has to serve 1,54,815 population and his absence there was no other technical person available.

India has committed “To achieve Goal-5 of MDG, i.e., India should reduce maternal mortality (MMR) from 437 deaths per 100,000 live births in 1991 to 109 by 2015.” How any one can expect to reduce maternal mortality in such circumstances?   

STATUS OF HEALTH INSTITUTIONS IN BICHHIYA BLOCK OF MANDLA DISTRICT IN MADHYA PRADESH

In Bichhiya CHC Sangeeta W/O Deepkumar was brought at 7.00 AM as she delivered a baby at home at 5-5.30 AM and placenta didn’t come out. Hospital staff tried to call Nurse but after waiting for about half an hour Nurse would not come then Dai accompanying Sangeeta tried to take out placenta and she succeeded. CHC is the place of 24X7 with 30 bed facility and it is also a FRU (First Referral Unit) but if this is the situation who wants to take services from the facility. In January 2010 a woman died after half an hour of normal delivery without any complaint. That time also there was no expert available to look her.

When we visited CHC of Bichhiya on 15^th May 2010 around 9.00 AM, a person examining OPD persons in chamber of Medical Officer. We want to talk him thinking that he is Doctor but we are reported that he is not the Doctor he was a retired Compounder Mr. Khan and the Doctor (Block medical Officer) Dr. Taksande was on leave due to death of his mother. Is it acceptable that we should leave villagers on mercy of god? Thus population of more than one and half lac (154815) of 196 villages is left without any authorized Doctor. In this block there are 7 PHC in 9 sectors and 44 SHC operational. The CHC is an old institute and has been working as Block PHC since 1935 and upgraded as CHC in 1980. Building of CHC is newly constructed and was inaugurated on 4^th July 2008. It is a 30 bedded hospital.

As per Govt. of India norms a CHC should have 15/16 doctors i.e., 2 specialists namely Anaesthetist and Public Health programme Manager will be provided on contractual basis in addition to the available specialists namely Surgery, Medicine, Obstetrics and Gynaecology and Paediatrics. The support manpower will include a Public health Nurse and ANM in addition to the existing staff. An Ophthalmic Assistant will also need to be provided in centres where currently there is none. One Ophthalmologist (MS-Ophthalmology) for every 5 CHCs is recommended in addition to existing provisions. One Dental Surgeon, 6 GDMOs, One AYUSH specialist and One AYUSH general doctor are also recommended in IPHS[1].

But MP Govt. sanctioned 5 posts of Doctors (1 BMO, 1 Specialist Gyanecologist, 1 Specialist Pediatrician, 1 PGMO Surgery and 1 PGMO Anaesthesia) for Bichhiya CHC[2]. But other than BMO all other 4 positions are vacant. Although one Dr. is transferred to CHC only one day prior this visit and he may join CHC in few days. But in absence of Gynecologist and Anesthetics, in case of emergency, a pregnant woman or case of obstructed labour will remain un operated and she has to go 40 km. to District Hospital Mandla. In such circumstances how can we think to reduce maternal and child mortality.

Although cleanliness in labour room of CHC was satisfactory but relatives accompanying pregnant women will have to maintain this cleanliness as they have to clean surface before and after delivery as well as to wash clothes and sheets used during delivery even when Sweeper and Aya are available at CHC.  

    

In CHC there were more than one ward but male and female, both patients are kept in the same ward. Although there is an OT but in absence of gynecologist and anesthetics no cesarean section can be performed and OT is only used for LTT camps. There is one OT table available but it was found that that it is not an advanced operational table but a simple iron table. Focus lamps are also not available. In absence of incubator a local made baby warmer was kept in a corner of OT. Bulb of baby warmer is loosely fitted and cause damage to baby any time.      

One PHC, Sijhoura, was also visited and the condition of that PHC was also not satisfactory. Position of doctor is vacant and there is only one ANM who has to conduct delivery. Although one LHV was also posted in the PHC but she was not providing services in PHC as she is a field duty LHV. According to other staff members of PHC she is always on tour and never works in PHC. LHV keep cheques of JSY at her own house and ask people to come her house to collect cheque of incentive of JSY, where people get cheques after several rounds.

Condition of delivery table in this PHC was also not satisfactory. Thus ANM conducts deliveries on floor. In this PHC position of Sweeper and Ward Boy was vacant and in their absence relatives of pregnant women have to clean labour room before delivery and other items used during delivery. In such conditions when community members contacted they reported that why we should opt institutional delivery when we have to maintain cleanliness in the institution and there is no expert. Thus they do not prefer institutional deliveries.

Sub Health Centre  Rajo has 2 ANMs. In past, ANMs take services of Dai when she was getting remuneration of Rs. 100/- per delivery. But after stopping this honorarium Dai are not a helping hand in conducting deliveries. Cleanliness could also be not maintained without their participation. However Village Health and Sanitation Committee arrange Rs. 500/- per month for a worker who clean labour room but now a days this arrangement is also not working.   

Above mentioned  status of health institutions clearly indicates that how much it is difficult to achieve Millennium Development Goal 4 and Goal 5 i.e.,


Reduce by two‐thirds, between 1990 and 2015, the under‐five mortality rate
Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio

Only 5 years are remaining to achieve these goals and in such circumstances it is quite impossible to attain these goals.  

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[1] http://mohfw.nic.in/NRHM/Documents/IPHS for CHC.pdf

[2] http://www.mp.gov.in/health/institution/sanctioned post-chc.htm