Institutional Child Delivery: Kandhamal’s Journey from Abyss to Zenith

Phulbani: Not so long ago, the tribal-dominated Kandhamal district was in news for a wrong reason that nobody admired – having the highest number of home deliveries, when the rest of the country is moving towards total institutional deliveries. It was the only district in Odisha that had the dubious distinction of highest number of home deliveries. Besides adverse geographic conditions of Kandhamal district, the practice of traditional healing systems coupled with societal blind beliefs often stood as barriers resulting in poor turnout of women for institutional deliveries. In April 2017, the district recorded 282 home deliveries, which was one of the highest in the State. But with an active and timely intervention of the district administration through a systemic approach, the scenario is now completely reversed. There has been a complete reversal in the trend and positive improvement in institutional delivery.

Adverse Geography

Kandhamal district lies in the high altitude zone with inter spreading inaccessible terrain of hilly ranges and narrow valley tracts. Almost 66 percent of the land area of the District is covered with dense forests and towering mountains comprising of 12 rural tribal blocks. The scattered remote pockets have always been a barrier in providing the proper health services to the tribal people.

Although a number of schemes have been implemented by both the State and Central Governments, including special strategies for reduction of IMR and MMR in Odisha to improve the status of maternal and child health care services, due to the inaccessible terrain, and, deep forest areas, it has always been a challenge to reach out to the ground and provide health care services to needy.

Prevalence of Traditional Healing Systems

For ages, the tribals in remote areas have a strong belief in their traditional healing systems and used to avoid hospitals. In their community, pregnancy and childbirth were being treated as part of a natural process, not requiring much external intervention. The child births were usually conducted by the untrained dais in the villages and pregnant women hardly went to local hospitals for delivery purpose. Hence, several deaths went unnoticed.

How the Scenario Has Been Changed

The district administration under the guidance of Collector Dr Brundha D, has taken several initiatives to change the mindset of the tribals and overcome the geographical barriers, so that women would be encouraged to go for institutional deliveries.
Soon after joining as Collector, Dr. Brundha found that the exploration of traditional practices of women during pregnancy and delivery shows that in the community, pregnancy and childbirth are treated as part of a natural process, not requiring much external intervention.

“It was just a matter of mobilizing them (women) and enable them to reach hospitals for safe delivery. But due to the geographical barriers, it was difficult to reach the hospital for safe delivery”, she said.

To overcome the issue of High Home Delivery which basically represents the High Rate of IMR & MMR, the District Administration focused on increasing the number of Delivery Points from 23 to 40 by mobilizing funds from various sources.

Trained staff and necessary equipment, instrument and furniture were put in position in the Delivery Points. On the other hand, as the district is having the highest number of difficult villages (914) and there are less number of 102 Ambulance Vehicles, the District Administration took a number of innovative strategies to bridge the Community people with the Health facility.

Steps were taken and five numbers of Bike Ambulances were placed in strategic locations of the district where there is incidence of high home delivery. Besides, fourteen Autos branded as “JANANI AUTO” were also placed in strategic locations of the district where there were incidences of high home delivery.

Considering the non-availability of approach roads from the villages to the Road Points, Janani Stretchers are being provided to the difficult villages. To check delivery on roadsides and under the trees in some of the difficult areas of Phiringia block, the district administration made facilities such as special vans equipped with all the facilities for a safe delivery.

A van was innovated which is equipped with all necessary instrument and equipments required for normal delivery, water facility, delivery table etc. with two SAB trained Staff Nurses to manage the cases.

After the implementation of these strategies, the district now boasts being achieving the first position in the State so far as institutional delivery is concerned