Jai Wadia

In the backward tribal hamlets of Jharkhand, the Child In Need Institute is working to nurture a healthier, happier new generation

Salakho Murmu was 20 years old. She was poor, anaemic and underweight, lived in a tribal hamlet of Sarwaha village which has no health service, and was expecting her first child. The community has strong faith in traditional healers and people visit the primary health centre only in a crisis. Naturally, things did not look very bright for her unborn child.

But Salakho was fortunate in having a sahiyya (literally, a friend) — Suganidevi, a village community health worker from the Child In Need Institute (CINI) — who advised her on the importance of a proper diet, helped her gain weight and improve her haemoglobin level. When she suddenly started bleeding one night while in the ninth month of pregnancy, her husband realised the need to take her to a clinic and, with Suganidevi's assistance, she was admitted to a nursing home late that night.

Without Suganidevi's intervention, both Salakho and her unborn child could have been at risk; one more addition to the high maternal and infant mortality rates in the backward Churchu region of Hazaribag district, in neglected Jharkhand. But thanks to her sahiyya, Salakho gave birth to a healthy baby.

CINI was set up in 1974, when Dr Samir Chaudhuri — director of CINI — Sister Pauline Prince of the Institute of the Blessed Virgin Mary, and Rev Fr J. Henrichs S. J., decided jointly to take on the widespread problem of malnutrition and ill-health among children and women in the poverty-stricken rural belt of south Kolkata.

It was clear that mere medical intervention would be inadequate, as the real problem was a lack of awareness about basic health, poor hygiene practices and insufficient food available to growing children as well as pregnant and nursing mothers. Since then, CINI has helped empower mothers to take important decisions on behalf of their growing children. It tries to improve their economic conditions and helps them understand their environment.

Three decades on, CINI's work has spread far beyond its home state. It reaches out to a population of over eight lakh women and children in the rural and urban areas of seven states, including Uttar Pradesh, Jharkhand, Bihar, Orissa, Madhya Pradesh and Chattisgarh. It has been recognised as a national mother NGO by the ministry of health and family welfare, government of India. Since 1998, the National Institute of Health and Family Welfare, New Delhi, recognises CINI as a collaborative training institute.

In November 2005, CINI received the National Award for Child Welfare from the government of India's ministry of human resources, for the second time (the first was in 1985). Last year, Dr Chaudhuri was given an award by the Italian Parliament, in a special session in Rome, in recognition of his contribution towards promoting the rights of the child through CINI's initiatives.

To improve the health status of the communities it works in, CINI disseminates information about childbirth and related health issues, promotes community participation and networks with government officials and agencies. Early prevention is an important part of its campaign to curb the problems of underweight babies, malnutrition and high mortality rates.

West Bengal continues to be its main area of work. Here, CINI directly implements projects like an outpatient department that provides medicines and conducts minor surgeries on children below six years of age. It has reproductive health clinics for men and women suffering from reproductive ailments and sexually transmitted diseases, as well as counselling services. In the other states, CINI mainly provides training and technical assistance to established local NGOs that can reach a wide target group.

In Jharkhand, CINI is working with two projects. The Hazaribagh life cycle approach (LCA) project, begun in 2004, is with partner agency Nav Bharat Jagriti Kendra. It aims to cover a population of 88,000 in 13 health sub-centre areas of the Churchu Block. The Gumla LCA project was started in 2005, in collaboration with the Lohardaga Gram Swarajya Sansthan. It will benefit a population of 30,000 in six health sub-centre areas of Sadar Block. CINI's contribution to these projects is to build up the capacity of these partner agencies to improve the maternal and child health status in their areas through the life cycle approach.

"The life cycle-based approach," says CINI senior programme officer and unit in-charge of Jharkhand and Bihar, Debashis Sinha, "starts at pregnancy and moves through birth, infancy, early childhood and adolescence. It is beneficial not just for the target group but to successive generations as well, because the interventions have a cumulative impact, being prioritised at several critical points across life." The organisation also encourages male participation, and sharing of responsibilities in critical events like childbirth.

To build a movement in which the local community takes on the onus of people's health and demands the services due to them from a functional health system, CINI sets up village health committees (VHCs). These select the sahiyyas, who represent women from each tola or hamlet. The project staff train them to educate not only the women but also the men in the community on health issues. Says Sinha, "Initially, the men were reluctant to participate and asked us to speak directly to the women. But after the formation of the VHCs, they are venturing to take part. We still ensure, though, that at least 60 per cent of the VHCs constitutes women."

Funding for the Jharkhand projects has come from the Sir Dorabji Tata Trust (SDTT), Mumbai, and the Population Foundation of India (PFI), New Delhi. The Trust has granted CINI Rs 1 crore over a period of three years, beginning March 2005. Jasmine Pavri, senior programme officer at SDTT, says, "This region has a large tribal belt which is steeped in poverty, illiteracy and has high maternal and infant mortality rates. Jharkhand is a needy state and while deciding to fund projects we look at both the requirements of the area and the credibility of the NGO."

CINI being one of the four national NGOs with a mandate for conducting maternal and child health programmes across the country with the co-operation of government institutions, helped the Trust in making the decision. The organisation operates democratically, and its founder members and chief executives, like Dr K Pappu, are well known for the work they have done over the years.

Effective communication methods like nukkad nataks (street plays), wall writing and games, help CINI address issues like family planning, prevention of HIV/AIDS, tackling gender bias, etc. The sahiyyas hold regular meetings with the project staff, discuss problems faced in the field and share best practices. Health camps for pregnancy care and child immunisation are also held in some remote areas of Hazaribagh, but the project hopes to phase these out as the community begins to assert itself and ensure that the government health system is functioning smoothly.

As it continues its efforts in holistic healthcare among the underprivileged, one hopes that CINI will bring a smile to the faces of many more women like Salakho Murmu.

Uploaded on June 14, 2006