Report 2011 - Deepalaya

treated for one or more year. In order to help breastfeeding and mother's health, she should be shown
how to eat better, with limited budget. Advices on exercising and psychological support are also part of
PNC.
2. Prevent complications of postpartial pediod. Most common include puerperal sepsis, thrombophlebitis,
secondary hemorrhages and urinary tract infections to which anemia might contribute.
3. Provide family planning services to space births and limit family size.
4. Provide health education to mother and family on hygiene, nutrition of mother and baby, pregnancy
spacing and importance of check-up. 59
All these elements are key parts of prevention and treatment of anemia.
INSTITUTIONAL VS HOME DELIVERIES
In rural areas, most of deliveries are still done by the only person who is readily available and, unfortunately,
not trained. To reduce maternal and infant mortality, caretakers need to have some knowledge on safe hygienic
conditions and techniques. Otherwise, the Rural Health Scheme of India has undertaken an extensive program
to improve the knowledge on obstetrics skills, elementary concepts of maternal and child and sterilization of
these traditional birth attendants, which are called local dais. After having successfully completed 30 working
days of training, every local dais get a certificate and a delivery kit. India's target is to train one local dai per
village who could play a vital role in spreading education on small-family standards 60 . This aim to improve
delivery safety, but home delivery conducted by these dais are not included in safe delivery definition by NFHS-
3 and DLHS-3. In India (2005-2006), 48,2 % of delivery were “safe” 61 , with most of them being institutional
deliveries and a few being home deliveries trained by skilled staff. Home deliveries, by untrained people lead to
increase blood losses and then, more postpartum hemorrhage have been seen. Lack of hygiene and sterilization
(e.g. utilization of dirty tools) increase infections in mother and baby.
SERVICES ACCESS
India has a national health policy (not a national health service). Financial resources are inadequate to assure
the costs of running health services for every one. Even if the problem is large in urban area, in rural areas
where 72 per cent of the population is living 62 , the problem is enormous. People cannot benefit from the
modern curative and preventive health services. A lot of villages depend on indigenous systems of medicine to
get help for health problem.
As long as money is a scarce resource for providing health services, it will affect all parts of the health delivery
system. In many developed countries, average government expenditure for health is approximately 18% of the
Gross Net Product (GNP). Today about 3 per cent of the GNP of India is spent for health and family welfare
development 63 and to make matters worse, in every country much of this money is given for services that reach
only a small part of the population. “To achieve Health for All, WHO has set as a goal the expenditure of 5 per
cent of each country's GNP on health care.” 64 . Due to lack of money, some organizations have to change their
procedures and fees for the patients because they cannot afford all the costs. For example, since October 1 st
2011, in Gusbethi's Deepalaya Hospital, the patients have to pay for many prescribed medicines. Furthermore,
non-pregnant women have to pay to get iron and calcium supplementation. It will probably limit the access to
the clinic's services for villagers with poor incomes. Hopefully, the clinic is still providing free calcium and iron
59 Reference 2- p.454
60 Reference 2- p. 803
61 Reference 2- p.482, table 17
62 Reference 2- p. 800
63 Reference 2- p 801
64 Reference 2- p. 801