An initiative called ‘Pukar Abhiyan’ started in April this year in Bikaner district of Rajasthan by District Collector Bhagawati Prasad Kalal is showing encouraging results. The objective is to save the lives of pregnant ladies and their newborn babies and provide proper nutrition to them. And, as far as results go, the decrease in maternal mortality rate is the biggest success of this campaign so far, impacting the lives of thousands of women.
Indian Masterminds interacted with the 2011-batch IAS officer officer behind the initiative, the District Collector of Bikaner, Bhagwati Prasad Kalal, to get more details.
PUKAR PATHSALAS
This scheme has created a much needed awareness toward nutrition in the district. The campaign has established itself as a better model for bilateral dialogue with pregnant and lactating women and adolescent girls. ‘Pukar Pathshalas’ are being organized at the houses of the local women, where government representatives and targeted women exchange ideas on the same platform. Due to this, decrease in maternal mortality rate, recovery in anemia, increases in institutional delivery are being seen.
On 12 July, we had done a story on the Pukar initiative after speaking to the Collector, who had told us confidently that in few months when the results start coming, we will get to see the positive changes. And, true to his word, the changes are visible now.
VISIBLE CHANGES
The Pukar initiative involves providing better nutrition to the mother, taking care of the health of the child, teaching the art of staying healthy in life to adolescent girls, and many other things that can provide a better life to women. Speaking to Indian Masterminds, Collector Kalal said, “Our main aim is have community involvement and partnership in the issues related to maternal health. That is why the Pukar initiative was started and now the results are very good. Pukar Pathshala, which started as small meetings with 20 to 50 people, has now become a public movement. Awareness about what the woman and child need from pregnancy till the child is 2 years old, is fixed in the memory of the community.”
DECREASE IN MATERNAL MORTALITY
The biggest success of the campaign is the decrease in maternal mortality rate. Last year during the period from April to August, 70 maternal death were recorded in the district. This time, due to the Mother-Child Health and Nutrition Pathshalas organized under the campaign, the number has come down to 32. Thus, through the campaign, lives of 38 mothers have been saved as compared to the last year figure.
Due to the continuous efforts made under the Pukar campaign, there has been a better improvement in the cases of anemia among women, too. Last year 0.39 percent women had hemoglobin of 7 grams or less. This time it remains only at 0.19 percent. Women with 7 to 8 grams of hemoglobin has also decreased from 9.17 percent last year to 5.04 percent this time. Women with 8-9 grams of hemoglobin were 39.75 last year, which has now come down to 24.27 percent. Similarly, last year 44.47 percent of women had hemoglobin between 9-10 grams. This percentage has also fallen to 32.97 now.
ENCOURAGING RESULTS
Talking about the many positives of the Pukar initiative, that is clearly visible in few months, Mr. Kalal said, “Increase in awareness about pre and postnatal vaccination is also noticed as the PNC checkup increased as a result of the campaign. Last year, PNC checkup was done by 50.64% pregnant women. This year 58.63 women got their check up done even after delivery. Similarly, 86.65 percent children were immunized this year as compared to 85.39 percent last year.”
The number of deliveries at home has also come down due to the campaign. Till August last year, 267 home deliveries were done, the number has come down to 146 this time. In percentage terms, 74.44 per cent institutional deliveries took place till August last year. At the same time, it has improved to 76.98 percent this time.
The village to village efforts of Pukar have increased the percentage of antenatal check-ups. Till August last year, 63.86 percent pregnant women got four prenatal tests done. This year, it has increased to 74.28 percent. Similarly, a significant increase has also been recorded in the registration percentage for institutional deliveries within 12 weeks of ANC. While 68.29 percent women got this registration done till August last year, this time, 82.70 percent pregnant women have got it done till August.
HOW IT WORKS
District Collector Kalal started this initiative from 6 April. Every gram panchayat and all the wards of the urban areas started organizing the Pukar Pathshalas every Wednesday. Here, people are being made aware about the precautions to be taken from conception till the child turns two years by the ANM, Anganwadi workers, Sahayika aur Sathin under the supervision of experts from the medical department. Beside this, information about institutional delivery, nutrition during pregnancy, necessary tests, vaccination is also given. So far, 10361 such Pathshalas have been organized under the campaign.
In these meetings, direct communication has taken place with 234756 women, and 70657 pregnant and 92368 adolescent girls were given necessary guidance. So far, 679724 iron tablets have been distributed in schools, while 71937 tablets were administered during the camps itself.
PUKAR MODEL
Pukar is a communication programme, where continuous interaction results in better care of the expecting mothers and new mothers with their babies. This mechanism helps to create awareness in the minds of the people that present and future mothers and their children need to be taken care of, from conception to two years old.
Bikaner is a desert district with large villages. So each village has been divided into three parts. One part is taken care of by an Asha worker, another will be looked after by an Anganwadi worker, and the third one by Sahyogini and Saathin. And all three will be supervised by the ANM. All of them are allotted the area where they themselves live as they have complete information about it. Their task is to maintain information about their respective area, from new marriages to pregnancy and delivery, in a register. The information is then recorded by the ANM for reaching out to the target beneficiaries.
Meetings are held in all the wards of cities and all the panchayats of villages with the women beneficiaries, such as pregnant women, adolescent girls, etc., and they are provided with information on a host of topics related to marriage, pregnancy and motherhood. “To help us in this, we have prepared a 7-page document. We spread information and listen to their problems,” Mr. Kalal said.
