Saving Lives - Reducing Newborn and Maternal Mortality in Jharkhand

Infant mortality is relatively high in the state of Jharkhand due to inadequate institutional or government-administered health services, widespread ignorance of healthcare practices, and limited access to a nutritious diet and basic medicines in several villages especially those in the remote, hilly terrain of Seraikela block of Seraikela-Kharsawan district. This is where Tata Steel’s Corporate Social Responsibility division, Tata Steel Rural Development Society, stepped in to enhance the competence of local communities in taking care of new born children and their mothers through training and capacity building as part of the Maternal and Newborn Survival Initiative (MANSI) in partnership with American India Foundation (AIF), Society for Education Action and Research in Community Health (SEARCH) and Department of Health and Family Welfare (Government of Jharkhand). AIF provided some of the funding for the project while SEARCH provided technical assistance. The project was later expanded to Odisha as well.

According to Sourav Roy, Tata Steel’s CSR Chief, “Corporate Citizenship is a key aspect of Tata Steel’s vision statement and underscores one of its four core strategic objectives. Therefore, addressing fundamental development challenges within our communities by bringing in the necessary resources, talent and expertise in the process is germane to our way of doing business. Project MANSI is a shining example of this larger intent wherein we have been making a concentrated attempt at reducing infant mortality and maternal morbidity in Jharkhand and Odisha.” In addition to handholding, the project involved provision of simple equipment and supplies to enable local Accredited Social Health Activists (ASHA) and Sahiyas to provide basic healthcare to infants and their mothers.

Tata Steel launched a pilot project in Seraikela block covering eighty-four thousand four hundred and seventy people across one hundred and sixty-seven villages at a budget of Rs 3.69 Crores as part of Phase I from December 2009 – May 2015. Phase II of the project was launched in June 2015 and the project was expanded to twelve blocks across the two Eastern states of Jharkhand and Odisha. This includes all eight blocks of Seraikela-Kharsawan district, Noamundi and Manoharpur blocks of West Singhbhum district in Jharkhand as well as Joda and Harichandanpur blocks of Keonjhar district in Odisha. The project is likely to be complete in 2020 at a total estimated cost of Rs 7.65 crores.

Skill training and handholding of Sahiyas, traditional birth attendants, midwives and Anganwadi workers was followed by practical application the knowledge gained on the field. Women were also encouraged to use institutional facilities for childbirth, in cases where they had access to such facilities, to reduce likelihood of infections and complications. Low body weight combined and infections are factors that contribute substantially to neonatal mortality of infants up to twenty-eight days old when infants are their most vulnerable. Home Based Newborn Care is imperative during this period since healthcare institutions typically discharge the mother and child within a few days of birth.


Sahiyaas during cross-learning visit

Sahiyas, who are government health workers and volunteers under the National Rural Health Mission, are typically semi-literate or illiterate women from the local community. Building their capacity involved training them in Home Based Newborn Care including weight and temperature measurement, breast feeding and dealing with potentially dangerous neonatal conditions using pictorial images as well as visual aids. This was essential to helping villages become self-sufficient in provision of basic health services in line with the Gandhian model of self-reliance.

A supply system was put in place for sourcing requisite medical supplies and other materials in advance and making them available at a central location to ensure quick and easy access to necessary items. A Management Information System was used to track the usage and re-stocking of supplies in locations where demand was high. Sahiyas, who also serve as the secretary of any Village Health Sanitation & Nutrition Committee (VHSNC), procure supplies using the VHSNC fund provided by the Government for public health purposes.

A comprehensive, data-driven system of monitoring and evaluation was put in place with central and field level health workers tracking performance of Sahiyas and providing detailed reports to Tata Steel management on the progress of project MANSI. There was a significant surge in the use of Information Technology based interventions. The field staff used tablets with relevant applications to replace manual reporting systems. The flow of data related to mother and child health was captured in real time and corrective actions were taken, where needed, without delay in line with the total quality management approach.

The success of the project was reflected in the significant decline of over sixty percent in the neonatal (children aged 0 to 28 days) and infant (children up to one year of age) mortality rates. Child mortality rate for kids aged one to five years fell by fifty five percent in line with the Sustainable Development Goal three (improving health and wellbeing) of the United Nations. Awareness of existing health services increased in Seraikela Block, in particular, resulting in higher demand for these services in this area due to effective dissemination of information regarding existing health facilities, Government schemes, and entitlements for intended beneficiaries. The proportion of institutional deliveries increased while the percentage of pregnant women, who received iron and folic acid tablets to reduce incidence of anaemia and boost maternal and child health, also rose. A critical medicine recommended for use among infants called Co-Trimoxazole, which was initially not part of the standard kit provided by the Government to Sahiyas, was added to their tool kit. Administration of this syrup to newborn babies helped in saving several lives.

Guria Khatoon, who was only twenty-five years old, found herself pregnant for the sixth time. Sahiya, Mustari Begum, came to know about Guria’s pregnancy in the sixth month and registered her at the health centre and encouraged her to go for regular check-ups. Mustari and MANSI project community mobilizer, Salhi Murmu, assisted Guria in giving birth to twins, kept them warm to stave off hypothermia and fed them with expressed breast milk. Today the twins are growing into healthy kids adding to Guria’s happiness.


Guria with her twins

As part of this project, public-private partnerships were successfully leveraged to address major public health challenges and make a positive social impact. The National Health Mission, led by Government of Jharkhand, provided the necessary administrative support and approvals for project implementation. Project MANSI serves as an example of an evidence-based public private partnership model for accelerated reduction of maternal and neonatal mortality in a limited time period. In fact, the Chief Secretary to Government of Jharkhand, congratulated Tata Steel on the success of its endeavor to provide community based maternal, infant and childcare in partnership with the state government. Local communities were provided training in essential health skills and services to empower them to become self-reliant in provision of basic health facilities with key stakeholders from like Sahiyas and ASHA workers playing a vital role in the overall success and sustainability of the project.

This initiative has recently won NGOBOX-Dalmia Bharat 5th CSR Impact Award in Healthcare category.

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Aditi Gupta

Aditi is a budding writer who has published a Book titled Sun Sand and Sea on her travels to remote places in North Africa and the South Pacific. She has worked as a Manager at Grant Thornton and PwC while also being a volunteer at Embracing the World, an NGO focused on uplifting undeserved communities worldwide.