Documenti di Didattica
Documenti di Professioni
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Minal Jain
Indian Institute of Technology, Guwahati
Mannu Amrit
Indian Institute of Technology, Guwahati
keyur@iitg.ernet.in
minal@iitg.ernet.in
m.amrit@iitg.ernet.in
ABSTRACT
Assam, having highest maternal deaths in India demands attention to investigate the problems and provide appropriate solutions. We present a qualitative user study conducted with ASHAs (Accredited Social Health Activist) and ANMs (Auxiliary Nurse Midwife) in Amingaon, Kamrup District, Assam. The study aimed at investigating existing problems faced by ASHA members and ANMs', their work environment, their role in safe and healthy motherhood, relationship with pregnant women (PW) and family members, technology literacy and opportunities for Information Communication Technology (ICT) interventions to empower maternal health scenario. Two sub-centers (SC), one anganwadi center, one primary health center (PHC) and one community health center (CHC) were visited and observed. 6 one-to-one on-field interviews were conducted with ASHA members and ANMs. This paper presents research insights, findings and analysis of conducted on-field user research. It identifies problem & information gaps and proposes opportunities for technology and design interventions.
They are mostly ignorant of any government schemes or health care measures during pregnancy. We intend to identify the opportunities for design interventions in the entire system with an aim to improve maternal and child health and ensure a safe and healthy motherhood.
Keywords
Maternal Health, ASHA, ANM, Pregnant Women, Assam
1. INTRODUCTION
Tucked away in the northeastern region of India, the state of Assam presents various challenging problems in the field of health. The reason behind most of them is the lack of knowledge or awareness amongst the general public and lack of proper infrastructure and manpower. In the present context, Assam records one of the highest maternal mortality rates in India. Before the inception of the National Rural Health Mission in 2006, the mothers and infants health was in a grim state. With NRHMs inception and the Accredited Social Health Activists (ASHA) program, the efficacy of the intended health schemes has improved. ASHA members are shouldered with the responsibility of taking care of the pregnant women all through their pregnancy and childcare period. Despite the efforts, the maternal mortality rate is high and very less women are able to enjoy a happy and healthy motherhood.
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healthcare. She is responsible for maintaining records like the village record register, sub center OPD register, UIP master register, family planning register, eligible couple register, MCH master register, stock ledger (medicine/ kits/instruments/equipment/ furniture) register, death register, register for recording minutes of S/C Management Committee meeting and accounts register for keeping records of Untied and Maintenance fund. [4]
Figure1: Moriyapati Health Sub Center A, Amingaon, Kamrup, Assam They are established on the basis of one sub-center for every 5000 population. Sub-Centers provide services in relation to maternal and child health, family welfare, nutrition, immunization, diarrhea control and control of communicable diseases programs.
3. METHOD
We started the project with extensive literature research to understand the complete system of healthcare distribution at all the levels of the hierarchy. Roles, incentives, environment of all the people involved were studied. Categories of people who needed to be interviewed were identified and questionnaires were prepared. We then carried the research forward with visits to the Sub Center at Amingaon. In the initial visits, we carried out fly-on-the-wall observations of the sub centre operations. This was followed by detailed discussions and interviews with the ANM and the ASHA members. Their work dynamics and ecosystem were studied and understood. A few pregnant women visiting the sub-center were also interviewed. The interviews of ASHA and ANM focused on the following: General Demographics - their age, residence, working since how many years, family background. Motivation - motivation behind joining the job. Training - when the first training was given, for how long, what was taught, methods of teaching, reference material. Record Maintenance - what records need to be maintained, how are they maintained, how effectively are they maintained. Work Routine - what work has to be done in the entire day, what are the different things taken care of, what is the work environment, how exhausting it is. Monetary Benefits - how much money is given for the work, how is it disbursed, what procedure is followed. Mobile Phone usage - how much technological exposure is there, what features are used in a mobile phone, how efficiently it is used.
In the later stage the Community Health Centre where the ASHAs are imparted training was visited. The block program manager was interviewed to know more about the training sessions.
educated till 5th standard and had taken care of 40 pregnant women till date. She was an ASHA since 6 years and had a population of 1560 under her and 18 pregnant women currently. She was proficient in assamese, bengali and hindi and was given the best ASHA award by the state government. Each one of them was given a mobile phone by the government but its usage was limited to calling.
The Bishnuram Medhi Community Health Centre, Hajo is situated at a distance of 23.8 kms from the Moriyapati Health Sub Center A. It is where the ASHA members are given training. There is a small room for this purpose. The doctors train certain resource people who in turn impart the training.
Booster, ASHA in-charge. They are also required to submit a monthly report of the sub centre (printed 9 page form), report of the mamoni receivers and the immunization report to the PHC. And few weekly reports like those for Syndromic Surveillance about fever, jaundice, stool etc., Immunization report are also submitted. They maintain a hangar with month-wise sorted health cards. They also have a community self-monitoring tool that gives them a quick glance of the details of the pregnant women. Some ASHA members also maintain the record of all the pregnant women for their convenience. Others convey all the details verbally to the ANM.
Many pregnant women, at the time of delivery, go to their maternal homes and get delivered there. This is another cause for maternal deaths. The government has launched the JSY scheme specifically to encourage institutional deliveries. There is a need to motivate pregnant women to go for it.
4.7 Lack of information amongst pregnant women and hence high dependence on ASHA
Pregnant women, as gathered from the research, are highly dependent on the ASHA members for their day-to-day activities. They have no knowledge of proper diet, exercises, healthcare and pregnancy. They also follow the ASHA blindly with regard to the medical check-ups and tests. ASHA is their first port of contact for any information. This dependence can prove dangerous for the pregnant women. There is thus a need to impart education to the pregnant women and make them independent. Figure 3: Records maintained by ASHA Due to improper or no records with the ASHA, chances of missing out the check-ups of the pregnant women increases. Also, due to the same record being kept and maintained separately by ASHA, ANM and PHC, the redundancy increases. There is a need to have a record maintenance system that can be accessible at all levels.
6. REFERENCES
[1] Indranee Dutta and Shailly Bawari, Health and Health Care in Assam, a status report, Centre for inquiry into health and allied schemes 2007 [2] About ASHA [online]. Available from http://mohfw.nic.in/NRHM/asha.htm#abt [Accessed 12th August 2012] [3] Compensation to ASHA [online]. Available from http://www.mohfw.nic.in/NRHM/RCH/guidelines/ASHA_guidelin es.pdf [Accessed 12th August 2012] [4] Auxiliary Nurse Mid-wife [online]. Available from http://mohfw.nic.in/NRHM/stakeholders.htm#anm [Accessed 12th August 2012] [5] State Funds [online] Available from http://www.nrhmassam.in/state_pip/state_funds.pdf [Accessed 18th August 2012] [6] Janani Suraksha Yojana (JSY) [online]. Available from http://www.nrhmassam.in/jsy.php [Accessed 12th August 2012]
4.5 Need for motivation amongst the pregnant women for institutional delivery