Laxmipriya, an Anganwadi worker in Baunspal village in the state of Orissa, was on her regular home visits when she came across a very feverish one-month old Bishal, son of Gopabandhu and Mausumi Behera. Bishal was lethargic and obviously very sick. The worried parents had given him homeopathic treatment to reduce the fever. When the fever did not subside, they sought Laxmipriya’s help. “Looking at the sick child and the parents faces creased with worry unnerved me. It took me a moment before I took up the case facts”, recalls Laxmipriya.
Baunspal is a small village in Udala block of Mayurbhanj, a tribal district in the state of Orissa. As part of the Border District Cluster Strategy (BDCS) programme, Mayurbhunj was one of the 48 focus districts, with high infant mortality, where UNICEF has provided intensified support to strengthen basic minimum health care services. The success of BDCS programme in Mayurbhanj district created a good base for implementation of other proven child survival interventions. It was therefore one of the first districts in Orissa to initiate IMNCI (Integrated Management of Neonatal and Childhood Illnesses), which has been rolled out in 14 of its 26 blocks since October 2004.
Trained in IMNCI, Laxmipriya immediately deduced that fever in a one-month old child is a sign of danger and therefore immediately referred the child to the nearest hospital.
In these 14 blocks, training of Medical officers, health workers and Aanganwadi workers has been completed and essential supplies were made available at all levels of service delivery. At present training of Medical officers, health workers and Aanganwadi workers in another 6 blocks is being carried out and the implementation is expected to start in these blocks by June 2006. Subsequently, the final 6 blocks will be covered. As per the present plan, IMNCI would be in place in the entire district by December 2006.
Trained Anganwadi workers like Laxmipriya are probably the most vital link in the child survival strategy. Trained in IMNCI, Laxmipriya immediately deduced that fever in a one-month old child is a sign of danger and therefore immediately referred the child to the nearest hospital. But Bishal’s parents are poor and were hesitant to move the baby to the hospital immediately as Bishal’s father wanted some time to arrange funds. This was a matter of Bishal’s life and Laxmi acted promptly by offering them the sick child referral transportation money from ICDS programme and counselled them on the importance of hospital treatment. Also, she gave Bishal, the first dose of antibiotic and sent them with proper advice and a referral slip. At the hospital, the medical officer saw the referral and examined Bishal immediately. Once stable, Bishal was sent home with his parents with a note for Laxmi to facilitate home management of the child. Laxmipriya followed her IMNCI lessons and confidently managed Bishal. Under her constant supervision and medication as per the doctor’s advice, Bishal recovered within a week. A grateful mother Mousumi states “Laxmi didi was an angel sent by the gods to save my Bishal. My husband would not have taken Bishal to hospital on that day if didi had not counselled us and provided the money for transportation.”
“I was able to save Bishal because I could identify the imminent danger and successfully motivate Mausumi and Gopabandhu to take him to the hospital. I shall save more lives and thanks to my CDPO and UNICEF for providing me the opportunity to learn this skill and giving me confidence to treat children,” says Laxmipriya.
The district level data suggest that Mayurbhanj district now has significantly lower Infant (59.2) and Under-Five Mortality Rates compared to the state averages
The two distinct advantages that the project has brought in the implementation areas are: a) A significant expansion of home visits made by the skilled frontline functionaries to monitor newborns and b) A demonstrated confidence of the functionaries to communicate better with families and manage cases, including early referral for the high risk children. Reporting of deaths and frequent home visits have not only resulted in accurate reports on the status of infant and neonatal deaths but also led to improved case management practices. IMNCI implementation has enabled 240 grass root level workers to manage sick neonates and children and has consequently reduced child deaths in 140 communities of Mayurbhanj so far.
Orissa is one of the states in the country with the highest Infant Mortality Rate (IMR) of 83 per 1000 live births. The district level data (RCH-RHS I & II and UNICEF Monitoring & Validation) suggest that Mayurbhanj district now has significantly lower Infant (59.2) and Under-Five Mortality Rates compared to the state averages, as a result of BDCS and IMNCI strategies. Of the total births reported in the 14 IMNCI blocks, 95.5% were examined within two months of birth.
UNICEF office for Orissa supports the IMNCI programme implementation in Mayurbhanj and Koraput districts and also supports the Government in creation of state and district level pool of trainers in scaling up the project activities in a phased manner. The objectives of the IMNCI programme in Orissa are: capacity building of frontline functionaries; better counseling on infant feeding; improving neonatal survival at household and institutional level; and strengthening of home visits for quality neonatal and post-neonatal care.