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Small beginnings in a tribal village

In one of the poorest villages of central India, villagers and the district collector have provided an innovative health service, with the barest of resources

The central Indian state of Madhya Pradesh has the largest area of any state in the country, much of it undeveloped. Scheduled castes and tribes make up more than 50 per cent of the state's population. Their living conditions are a reflection of the state's low levels of illiteracy, nutrition and basic health. Some 31.3 per cent of the population is classified as living below the poverty line. Many villages have no approach roads; existing health centres are often inaccessible because of sheer distances. Seventy-four per cent of the population of Dhar district for example, lives below the poverty line.

Community-based health care takes on a new meaning in this context…..At the community delivery room (CDR) in Kothobhirotha village, Dhar district, a middle-aged woman sits in a bare room whose furniture consists of a single hospital bed, a trolley, a medical kit and a chair. But she is grateful that it is now possible for her needs to be attended to at her own village.

The concept of a ‘community delivery room’ is an attempt by Dhar’s district collector (DC) Dr Rajesh Rajoura to tackle the district’s very high maternal and child mortality rates. The CDR scheme was set up in May 1999 following a demand from the village panchayats (elected councils) set up under India's legal directive, to divert power to villages for self-help. With Primary Health Centres (PHCs) few and far between, unhygienically-conducted home deliveries resulted in complications. With the CDR initiative came the first signs of change.

The panchayats offered space in panchayat buildings and anganwadi (child-welfare) centres to the DC in exchange for training local midwives. The DC, in turn, took the government's Integrated Tribal Development Programme (ITDP) funds for infrastructural equipment like furniture and utensils, setting aside an annual amount for medicines.

United Nations International Children's Fund (UNICEF) supports midwife training. The midwife then manages the CDR with the district-nurse (ANM), while the sarpanch (elected village headman) assumes responsibility for maintenance and recurring expenses.

With 54 CDRs begun experimentally, Rajesh Rajoura is encouraged by the first year's performance. "I think the CDRs can assume reproductive and child health (RCH) duties. This programme could be popularised in other districts in time."

The DC hopes to tackle problems such as the lack of trained midwives and the absence of transportation to CDRs for Dhar villagers who didn’t seem to have a solution to such problems till a year ago.

Contact: Rajesh Rajoura
District Collector, Dhar District,
Madhya Pradesh, India