Glimpses of health care from Immunization Days in Bhopal

After undergoing a 3 day training on Information Communication Technology(ICT) organised by the Community of Practitioners on Accountability and Social Action in Health (COPASAH) we (Rakesh and Dhirendra) are coordinating the use of ICT in  4 districts of Madhya Pradesh (Sehore, Chhindwara, Sidhi and Morena) and facilitating  the process in Bhopal district. Through ICT we are trying to find out the status of maternal health services. We have observed  Ante Natal Care (ANC), Post Natal Care (PNC) and referral services in  slums and public health institutions. So far we have conducted 7 meetings with the community amongst pregnant women and lactating mothers in 6 different slums. We conducted personal interviews with some mothers and also attended the immunization sessions.

We attended three immunization sessions in as many slums. We found that the communities are not getting all the services they are supposed to during immunization days and the situation is the same even at the Anganwadi centres(AWC). ANC and PNC services were incomplete and there was no proper counselling. As per our observation the space is not sufficient to conduct the immunization day.

Immunization days are held most of the time in the AWC. The AWC is approximately 10’x10’with no windows or ventilation, no toilets, no proper space to  sit, no mats to sit on, no proper place for storage of equipments, no observation table and no simple table.

We observed that the Auxiliary Nurse Midwife (ANM) is not providing proper ANC and PNC services to the pregnant women, lactating mothers and children. She was not measuring weight, height, or blood pressure. The blood sugar test & abdominal examination were not being done. An old method of Haemoglobin testing was being used. There was no separate place for abdominal examination and there were no curtains for privacy. Toilet facilities were lacking.

Community members gave feedback that the ANMs do not come on fixed days and come according to their convenience. Their behaviour is very poor-they do not talk properly nor give proper advice. Many a time people face discrimination from the ANM.

The ANM referred pregnant women to the district hospital for complete ante-natal check-ups and some of the tests were repeated there. They faced other problems at the district hospital such as long queues and waiting times, no proper guidance, unhelpful and rude behaviour of the hospital staff, corruption and having to visit repeatedly. Hence they were unwilling to visit the district hospital again and subsequently visited private clinics. As a result of this situation many home deliveries have also taken place.

We motivated the community to monitor the services. We are empowering the community with knowledge and skills regarding their health rights and entitlements. We informed them that for the better service delivery they have to use public services and avoid private services. They were told to have to raise their voice and fight for their health rights. We are also providing a medium for dialogue with the government officials for sharing of problems and looking for solutions.