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Similarly, it is observed that there is no fixed day, time, or place for delivery of services in habitations by ANMs. There is no co-ordination between the AWC, ANM, the village practitioners and other elected representatives, functionaries or groups in service delivery. Fixed day services in coordination and complemented by services of other functionaries and the ANM could significantly improve access, coverage and quality of service delivered. The practice of giving dry rations instead of cooked food to pregnant women and lactating mothers in AP and UP may not help the women, as this is likely to be used for the entire household, particularly in very poor households where overall food availability is low. The overall health situation of the community and in particular of the children is influenced by availability (or its lack) to basic healthcare facilities. Interestingly, most mothers report the use of allopathic medicines for all illnesses that affects their children and rarely herbal medicines and home remedies. For instance, simple home remedies for scabies seem to have been forgotten or are seen as being ineffective. In the tribal village of Andhra Pradesh, for instance, several children had mild to severe scabies. In one of the households the 3-year-old girl had severe scabies on her scalp. When we told the mother that she could apply Neem and turmeric paste and this would not only provide immediate relief but also cure the child, her reaction did not convince us that she might actually do something about it. However, on our final visit to the village 20 days later, she proudly produced both her children before us. Both the girl and her brother were free of scabies and the child was smiling. This seems to suggest the need for a concerted effort to retrieve, revive, and revalidate herbal medicines in the eyes of the people, an intervention that would place medicine back in the hands of the poor themselves. 10 10 Our research indicates, that traditional health practices of households and communities and alternative modes of indigenous medicines are fading away among the poor. Although our research mandate precluded the exploration of the ‘why’ underlying this emerging trend, one can put forth a host of reasons based on secondary research as well as our experiences in the field. Earlier studies have indicated that the destruction of forest cover has led to the extinction of certain herbs and hence traditional herbal remedies. Further, deforestation has further made the task of collecting herbs and making medicines a tedious process. Often this has meant adulterated traditional medicines leading to reduced faith in them. However, one of the major blows has come from the pervasiveness of allopathic medicines and its association with modernity, education, and also status – irrespective of its efficacy in treating certain local ailments. Some also say that traditional cures, often demand certain dietary restrictions etc. which allopathic medicines do not. Educational Resource Unit Page 84 April 2003
Table 27: Utilisation of health related services in 3 states Uttar Pradesh Pregnancy and Delivery Care Karnataka Andhra Pradesh Number of mothers observed/interviewed 18 18 18 Iron supplementation in 5.5% 27% 94% last pregnancy Tetanus immunisation- in last pregnancy Supplementary nutrition 11% 22% 94% Where available not used. None in urban areas Available in 75%not specific to these families Available in all habitations, no specific information for these mothers %Delivery at home 99% 93.2% 78.4% %Delivery assisted by un trained 99% 93% 88% Children observed Immunisation 22 18 27 BCG 0 50% 30% Polio 64% 94% 89% DPT 14% NA NA Measles Nutrition 0 0 19% Supplement Where available not used, none in urban areas Available in 75%not specific to these families Available in all habitations-No specific information for these mothers Vitamin A Curative services None None None Obtained from Govt 5.5% 22% 66% Access to modern medical care is no longer seen as a problem given the improved transportation system, at least in Karnataka and Andhra Pradesh. Here people approach private medical practitioners or go to the government doctor in his / her house (paying a fee). The charges include consultation and medicine. Discussions revealed that not all government PHCs / District Hospitals provide free medicines, and if people have to purchase the medicine themselves, they find it more convenient and cost effective to approach a private practitioner. The harsh reality is that since medical care is expensive people often decide to wait till the situation turns grave. No wonder, more often than not the burden of non-treatment is disproportionately borne by women and girls. Educational Resource Unit Page 85 April 2003
Page 1 and 2:
Publication released by World Bank
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Acknowledgements My first and heart
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LIST OF TABLES Table 1: ICD Concept
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GLOSSARY Ab iska kahan fayada hota
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Taluka Administrative unit - often
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concentric domains that span proxim
Page 13 and 14:
Taking its cue from the above frame
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The rising cost of healthcare can h
Page 17 and 18:
This emerging phenomenon of ‘hier
Page 19 and 20:
day workshop in Hyderabad in late A
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Profile of the study area: Key indi
Page 23 and 24:
stable, Uttar Pradesh continues to
Page 25 and 26:
Village Village 1 UP Village 2 UP V
Page 27 and 28:
SECTION TWO: THROUGH THE LIFE CYCLE
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implicated, wholly or partially, in
Page 31 and 32:
women. Since, most children began t
Page 33 and 34: families… The incidence of low bi
Page 35 and 36: Box 4: Devdasi woman of Karnataka K
Page 37 and 38: odies. Running noses, skin rashes a
Page 39 and 40: low, as is knowledge about the link
Page 41 and 42: Box 7: Glimpse of healthcare facili
Page 43 and 44: years, in our sample, suffer from e
Page 45 and 46: Measurements taken in the course of
Page 47 and 48: The problem of irregular food suppl
Page 49 and 50: Box 10: The Aanganwadi worker of th
Page 51 and 52: other services (looking after the c
Page 53 and 54: women who are pregnant and those wh
Page 55 and 56: completed primary education, 13 nev
Page 57 and 58: The same issue was reiterated as we
Page 59 and 60: instance, let us take the example o
Page 61 and 62: gradually becoming more common. Wha
Page 63 and 64: desired. In Uttar Pradesh free text
Page 65 and 66: fuzzy. Learning outcomes are integr
Page 67 and 68: discussed earlier, dry rations seem
Page 69 and 70: mixed village pointing to the need
Page 71 and 72: and further fragment the experience
Page 73 and 74: poverty line. The households survey
Page 75 and 76: databases in recent years on the is
Page 77 and 78: and are able to cross the initial b
Page 79 and 80: contrary to current received wisdom
Page 81 and 82: - Height and weight for age an impo
Page 83: eliable and regular immunisation, m
Page 87 and 88: Aanganwadi worker irregular +++ +++
Page 89 and 90: impedes retention in school is the
Page 91 and 92: for both. Enhancing access without
Page 93 and 94: SECTION FOUR: POLICY IMPLICATIONS A
Page 95 and 96: o While in-service teacher training
Page 97 and 98: Balwadis of Pratham (Mumbai, Delhi
Page 99 and 100: and monitoring, poor cold chain mai
Page 101 and 102: BIBLIOGRAPHY AND REFRENCES 1. Aggar
Page 103: 47. Sundaram, K. 2001. ‘Employmen
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