Home Birth
I am put this article, from NHS ( National Health Service) of United Kingdome to educate people on Home Birth,this is to bring a important point in understanding on Home Birth on scientific & on national policy ( at England).
This is a must read for the managers working with JSY( Janani suraksha Yogna)
Sunday, March 28, 2010
JSY
Community Observation
On Janani Suraksha Yojana (JSY)
at Kot Khalsa ( Amritsar)
a project by
Kiran- a society of creative women
kiran.scw@gmail.com
Cell: 9855181280
A n interacting exercise was conducted on random basis for 18 possible women , women ( L- 1 to L-18) , participating women in this survey had a baby child in last one year or so.
interaction was also made with other stake holders such as possible family members of woman & service providers ( Dr /nurses / pharmacist / AMN / Anganwadi)
.
The key issues was to find out
• Is community /pregnant women aware of risk involved in child birth.
• Why they don't opt for Govt hospital services for child birth / ANM care.
• Why they decided to give deliveries at home.
• On what factors , they select there service provider (Dai) for deliveries at home.
Whole exercise was conducted by keeping core, concerns of beneficiary ( the pregnant woman)
•
Description of area
(1) Total Population – 33,000
(2) No. of dispensary- 01
(3) No. of doctor(s) – 01
(4) No. of ANM – 03
(5) No of pharmacist – 01
(6) No of Anganwadi worker - 08
(7) No of trained Dai – 10
Figures for
Year | Reg. For ANC | Govt Institutional delivery | Pvt institutional delivery | Delivery at home |
2008- 2009 | 345 | 26 ( 7.53 % ) | 105 (30.43 %) | 214 ( 62%) |
2009-2010 | 515 | 56 ( 10.87 % ) | 195 ( 37.86 %) | 196 ( 38.% ) |
There is a increase of 66.99 % in registration for ANC.
Random survey of women ( L-1 to L-18) by Kiran society , survey provided following figures.
(1) No. of delivery at home : 11 ( 61 % )
(2) No. of delivery at pvt hospital : 03 ( 16.66 % )
(3) No. of delivery at Govt hospital : 02 ( 11 % )
(4) (L- 11 , L12 ) two women was pregnant at the time of survey , this is there 1st pregnancy.
(5) No. of women pregnant ( 2nd or 3rd time ) at the time of survey : 07
Out of the 18 women surveyed , 07 ( 38.88 % ) was pregnant again , a additional question was asked , where they plane for there present delivery.
– THE OUT COME WAS almost 100 % FOR OPTING DELIVERY AT HOME.
Additional interaction was made to understand , for this major trend.
The points are summarized on feed back as under
(1) No trust on services & care at government Hospital.
(2) High cost of private hospitals
(3) No clarity for JSY , if so.
To get further understanding on this key points , a in-depth series cross question was floated , that leads to a conclusion
(1) 1st impression on care from dispensary itself is not encouraging towards health sector , like absence of doctor
(2) Promotional massage of JSY , from ANM & doctors fail to generate trust.
(3) ANM not clear on guideline of JSY for assisting the pregnant women
(4) Behavior of doctors & nurses towards patients is primitive/ crude
– Personal communication of service provider (Dr & nurses ) shows “apathetic” ( Marked by a lack of interest), with patient & attendants
– Information on type on treatment, possible adverse / & side effect never taken (* this bring distrust towards the treatment , when medication show its 'natural' A/s effects ) .
– un/required clinical test are refereed to private sector,
– quarrel between service providers themselves.
The other point was understand as under
“Fear” – was a common word used in every women communication, when asked for opting delivery at Govt hospital.
The fear is associated towards - discriminated for being poor, ( no money for extra test , payment of fee ) , discriminated for being illiterate ( can't understand what is told by dr /nurses), this all brings a true evaluation towards , fear of loss of self respect for them.
As Kiran society was interacting , the women was very free to shear there experiences, on talking to L-15, it was important to understand why , she is opting to government hospital, beside she had her 1st baby at Pvt Hospital ?
– She cant affort the high cost of private hospital , that is a reason for opting towards govt hospital ( * there is no role of JSY for the change of institutional preference).
A new trend was also seen , as we name it as 'semi- JSY” , where the woman visit govt hospital & then she decide to pay 'private consultation fee ' to attending gynecologist, & finally delivering the baby under “JSY scheme”
The other woman L-16 , has yet opt for making delivery at home , beside loosing her twice child at the time of birth.
On talking with ANM , following things was understood
(1) lake of guideline/understanding on JSY
(2) No proper assurance on funding periods
(3) more emphasis on institutional deliveries
Issues with Dai :
(1) The dai (semi) financed there training programs for government
(2) the quality of training was of very poor level , so themselves they have put more resources to “skill' it.
(3) In the present practice of JSY, there non integration at the part of 'clinical delivery'
(4) They are not sure of there new / alternative role & incentives under JSY.
Summery of interaction with community woman & other stake holders
(1) Women largely know the risk of baby born dead or alive , but may not know the other complications associated with child birth.
(2) Absent of resource for transportation
(3) The awareness of JSY program is low ( what this program offer, who will provide ) !
(4) Most of promotion / registration for ANC is taken around dispensary, the distanced Gali/ streets are not covered in general.
(5) ANM not clear on guideline , transport money is available under the program
(6) Trust not built by local dispensary Drs & staff.
(7) Fear – a main factor
(8) Fail to define / integrate new role of existing grass root strength- Dai.
(9) Increase in number of registration for ANC , but not for the benefit to ANC
(10) At large women was not interested to have 'cash acceptance” - there key demand is to facilitate them with transportation at the need of hr, free treatment / hassle free environment from hospital
(11) Drs & nurses behavior is key problem.
Recommendations :
(1) Behavior of service providers to be monitored
(2)No false promises , communication should be clear on terms of services
(3)Organizing appropriate referral and provide referral transport to the
pregnant woman
(4) Pregnant woman should be accompanied with ANM at time for making hassle free paper work / or else.
(5)Making sure the presence of Dr & other staff is always at the working hrs , specially at dispensary level.
(6) assuring an accredited private Dr , (emergency referral in same area / or nearest ) associated in terms of JSY guidelines, clear terms of practices.
(7) Existing services from traditional Dia , is yet key factor at grass root, her new role should be places in JSY.
(8) At regular interval a check up camp should be conducted at the nearest possible area.
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Friday, March 12, 2010
Street Play To Promote Janani Suraksha Yojna (JSY)
Street play "Jaan Hai Ta Jahan Hai" was organised by Kiran- a society of creative women & Health department for the promotion Janani Suraksha Youjna (JSY) , the main objective of the JSY is to provide maternal & infant mortality by focusing on increased institutional deliveries & making available quality care during pregnancy, delivery & post delivery.
The challenge to meet NRHM 2012 goal for Maternal mortality ratio (MMR) <100/1,00000
The team for undertaking JSY program for Kot Khalsa , Amritsar .
Honorable D.C. Mr. K.S Pannu , was chief guest to the program. he said .....(watch video news) ...
The street play was held at Inderpuri ( Kot Khalsa ) slum which
is on the sides of , international
railway line between Amritsar to Lahor .On the behalf of everyone , members of Kiran society welcomed Chief guest
The them of JSY was very nicely delivered by SSAI Creations ( Mr. Makana & group) in pay
"Jaan Hai Ta Jahan Hai"
s<<<<<<<<<<<<<<<>>>>>>>>>>>>
I post this promotional video for NRHM ( National Rural Health Mission )...must see .
Thursday, March 11, 2010
Open Invitation For Street Play.
At
Guru Teg Bahadhur, Gurdwara Sahab (Near Railway Line) , Inderpuri - Kot Khalsa Amritsar.
Date & time : 12th March 2010 , 5 Pm
Honorable D.C. Mr. K.S Pannu , will be chief guest to the program.
Play
" Jaan Hai Ta Jahan Hai"
directed
by
Mr. Gurwinder Makana
(SSAI creations)
Tuesday, March 9, 2010
AMRITSAR VIRASAT MELA 2010
Kiran- society of creative women was invited to be part of JAAGO procession , Literally Jaago means wake up! When there is a marriage in the house, girls dance through the village streets carrying a pot (gaggar) decorated with lightened candles and sing Jaagu songs. The themes of the songs are social and usually a bit of teasing, often aimed at elders, goes with the song
One can see amazing pictures of jaago & gaggar at "Amritsar Virasat Mela 2010" at link
At Ghandi Ground a big stage was placed for open theater , with few display on heritage of punjab.
The later day there was a play - Bulleh (shah) , by Madeeha Gauhar ( theater director) ,she is associated to Ajoka Theater ,
The following day , was Sufi musical evening.
Thursday, March 4, 2010
What does this roads entailed ( Roads are not for masses )
Cycling is one of the issue, promoted to archive healthy lifestyle. this was one of the central massage from all the speakers, the point was made well relevant from speaker Vibhuti , she spotlit that today seminar would be relevant , if the outcome of the seminar provide few practical suggestion on, how cycling can be made as practical mode of transportation in city.
This is ignorance, if we think the goodness of cycling is not known to community
The need is to know , why cycling is not used as mode of transport
The answer is simple , 16% of deaths on roads are of cyclist & pedestrian.
The argument is given that 16% is not 'on higher' side , as we see 27 % deaths are from 2/3 wheelers category. this adds up to 33 % in total for all 2/3 wheelers ,pedestrians & cyclist.
The cause of high percentage for 2 wheelers on roads ( i.e 71 % ) is due to failure of government to provide adequate & efficient public transport system. The total buses are just 1% of the total registered vehicles.
I find this two official documents , for the support of my data
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An apex organisation under the Central Government , The Ministry of Road Transport & Highway, main vehemence is on road that are suitable for hight speed traffic, which count only care, jeeps & taxis ( 13 % ) & LMV ( 5%) . for whom the driving speed limit can be above 100 Km/ hr. where els 71% use is with two wheelers , with driving speed of 50-60 Km/hr.
What NGOs should target , for bringing a change in road system for integrating safe cycling:
(1) Advocating formation of separate wing in , The Ministry of Road Transport & Highway , for safety of cycle & other non motored vehicles along with pedestrian.
(2) Identity roads of city with heavy traffic & speed , mobilize local authority to mark cycling & non motored lane on it.
(3) Make educational institutes & government premises 'ONLY CYCLES & PEDESTRIAN' zone.
(4) Get free parking status for cycles at all the parking lots.
Monday, March 1, 2010
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