Voices from the Field > Abha Jha

Abha Jha - Catholic Relief Services

Dr. Jha is a physician working with Catholic Relief Services (CRS). Her work has helped her realize that most poor women in India have no control over decisions with tremendous impact on their lives. Their mothers-in-law or their husbands decide for them. Because she is a doctor providing services directly to these women, they often confide in her rather than in their husbands or families. She relates an experience that was pivotal in her own career and that helped her to decide to dedicate her work to improving the lives of poor women. She also describes safe motherhood and child survival projects organized by CRS in Uttar Pradesh.

Dr. Jha's story
Dr. Jha was working in a village and she found out from one of the women that a woman in the village who had been pregnant was at home bleeding but that the woman's mother-in-law would not allow her to go to a clinic or call a doctor. Dr. Jha hid her own medical instruments in her clothing, went to the house, and asked to see the woman. The mother-in-law confronted Dr. Jha at the door and demanded to know why she had come and what she planned to do. Dr. Jha replied that she had only stopped by to see the pregnant woman. The mother-in-law allowed her to come in and Dr. Jha went into the room and closed the door. She could see that the young woman was bleeding badly. She took out the instruments that she had brought and tried to stop the bleeding as best as she could. The woman had just had a miscarriage. Dr. Jha realized that the woman needed to be taken to a hospital immediately. She asked to speak to the woman's husband and explained to him that his wife would die if she was not taken to a hospital. Once he realized the severity of the situation, he agreed - in spite of his mother's objections.

Safe Motherhood
Catholic Relief Services (CRS) is implementing safe motherhood and child survival activities in eight districts in Uttar Pradesh. Because they do a lot of work with grassroots NGOs, CRS has developed standards to identify implementing agencies. They look for organizations that already have some sustainability. CRS receives funding from USAID India and in this project, provides technical assistance for groups working with pregnant women, lactating mothers and infants. The NGOs provide take-home rations once each month through the U.S. Government's Title II Food Commodities program. In addition to providing monthly food rations, this project is designed to get women out of their homes and to the health center so that health related issues can be discussed with them. The NGOs also do growth monitoring of children, health education, and make home-visits for priority cases. CRS and the NGOs have also developed and implemented a health management information system. They do community mobilization and help in the formation of self-help groups. The project does not focus on curing existing health problems, but rather on prevention and awareness about healthy behaviors. Poor people in rural Indian villages are totally dependent on the government for services. CRS sees its challenge as establishing a productive relationship with the government. It also wants to continue to strengthen relationships between other implementing agencies and the government. Service delivery is also heavily dependent on the state government's health system and, as in many other states, the auxiliary nurse midwife system in these districts is not functioning properly.

Catholic Relief Services has diversifed and expanded its health interventions and a few results-oriented projects have been approved by PATH and Integrated National Health Program.

Community-Based Health Care

CRS has helped to develop a real community-based health care system in the areas in which it is working. It collaborates with local NGOs to identify potential community-based health care workers and train them. At first, these newly identified health care workers are not vocal about their community's needs. After training and capacity building initiatives, these community-based health care workers can also act as advocates for their villages.  This program has been very successful.  It has been tried out with different partners at different program locations and nearly fifty local resource persons have been trained to scale up the enhance village health clinic program.

CRS has also established a nodal health center to deliver services. Initially the plan is to have a doctor on site part-time who would train and support the community-based health care worker and provide clinic-based services. CRS's NGO partners agreed to provide intensive training for each new health care worker so that she can continue to provide services after the funding for the doctor is no longer available. CRS believes that sustainability for the health centers must eventually come from each community.

The community health worker provides services in the clinic for 3-4 days each week. These services currently include antenatal care, child health care, and postnatal care. In Phase II, services are expanded to include first aid for snakebites, insect bites, cardiac arrest, burns, and fractures. The health worker also does counseling, promotes healthy behavior, and generates awareness about HIV/AIDS prevention

After 3-4 years of operation the clinics run smoothly. And there has been tremendous community response. They have a good relationship with the community, and empower the people. Two local resource persons can now deliver services; one is working as a role model to the second.

CRS tries to work in districts where CARE is not already working, since they work in many of the same types of activities. This project is actually a good example of cooperation between CARE, CRS and the government of Uttar Pradesh.

TBA Program
CRS has also initiated a training program for traditional birth attendants (TBAs). The training of TBAs is an integral part of any mother, neonatal, and child health care program.  In an area where the percentage of institutional delieveries is less than 10%, trained traditional birth attendants are very important change agents.  Through this training program, we continue to build the capactiy of TBAs and equip them to conduct safe deliveries in locations where there are no facilities available.

Because the umbilical cord is traditionally cut by a "lower caste" person, many women and their babies have to wait hours in pools of blood until the woman who cuts the cord actually arrives and does it. This frequently leads to infections and death due to septicemia and shock. In order to eliminate this harmful traditional practice, CRS is training local TBAs and integrating them into the CRS program. CRS had developed a checklist to identify TBAs who are ready for change, who would benefit the most from training. For example, most of the TBAs are not literate. CRS therefore had to develop pictorial training materials and a pictorial MIS system for them to use.

Initially, some communities were hostile to the idea of changing this tradition, and even to the idea of providing training for the TBAs. CRS organized some community mobilization activities to raise awareness of the role of the TBA. Their skills have been enhanced and the TBAs who have been trained are being integrated into the safe motherhood/child survival program.

After evaluating their program, CRS has found that maternal and child health indicators are better in their districts than in some other areas. The two activities or projects that have had the most impact have been:

The integration of TBAs into the health care delivery system and

The development of the nodal health centers.

Other Activities

Recently, CRS has been working in community participation.  They have been trying to involve community members in assessing the existing health situation in their communities.  They have also been trying to listen to their thoughts on key maternal and child health issues and then involve them in the process of planning and monitoring key MCH programs.

More about Catholic Relief Services activities in India: http://www.catholicrelief.org/where_we_work/asia/india/index.cfm