Case StudyThis is a case of 8 years old girl child named Rani (original named changed) who resideswith her family in a remote village of Neemrana Block. Her family comprises of parentsand three younger sisters. Her father works on a construction site on a daily wages whileher mother takes care of household chores. Rani is a student of second class in primaryschool around a kilometer away from her home. But, it was observed that most of thetime she was absent from school on pretext of looking after her younger sisters and beingsick. On regular basis, she complaints of weakness, tiredness, chest pain, shortness ofbreath etc. Due to lack of awareness and resources in the family, her parents ignored hercomplaints regarding her health.Suddenly one day when Ranis health deteriorated to the extent that she fainted, hermother panicked and took help of the Project Implementation Plan (PIP) worker withwhom she was sharing a good rapport and was taking assistance for her own prenatalcare. The PIP worker immediately contacted the NGO mobile van and took Rani alongwith her mother to the NGO hospital. The doctor attended Rani immediately and gave herbasic treatment and advised blood test as she was a suspected anemic.Ranis mother was little skeptic of getting the test done due to lack of money but on or’sinsistence and assurance that the test could be performed in the hospital’s lab without anyfee (nominal fee was waived off based on her critical condition). Her blood reportconfirmed that she has severe anemia and her HB count had come down to 3 gm. Theimmediate intervention required blood transfusion but due to limited resources, the casewas referred to doctors in Fortis hospital for alternative treatment through Telemedicareservices (Telemedicine centre bridges geographical distance and provides healthcareservices through teleconferencing with urban based specialists and super-specialists.)Rani was put on specific diet which consisted of sources of folic acid which includedmilk, eggs, green leafy vegetables, raw fruits, lima and kidney beans, and yeast.Additional to diet control, Folic acid tablets were prescribed by the doctor. NGO
supported her diet supplements for some time to help her to overcome the initial severity.Within a span of 3-4 months, her hemoglobin rose to 8gm . At the time of discharge herparents were advised to continue with the healthy eating habits especially leafyvegetables and milk (looking at the financial condition) and not to exhaust her by loadingher with household chores. Presently, Rani is an active child who is regularly attendingschool. Observations Rani is one of the exemplary cases highlighting the health related issue in rural India. NGO is focused on health related issues in Neemrana for over 7 years and made the following observations. Lack of knowledge /awareness, faith on the modern medical system which leads them to worsening their health. They have more beliefs on myth and would go to the doctor as a last result. Poor sanitation and hygiene condition which is the root cause of all the infectious diseases Lack of proper infrastructure and quality health care services. Severe problem of malnutrition leading to high rate of anemia. Problems related to reproductive health (maternal health and child birth related issues)Solution provided by the government so farNational Rural Health Mission (NRHM) was formed in April 2005. The mission aims atintegrating different vertical programmes, decentralizing health care service delivery atthe village, and improving intersectoral action. One of the main bottlenecks to theeffective delivery of comprehensive healthcare services at the community level has beenthe multiplicity of vertical national health programmes. While all these programmes havedepended upon the lowly multipurpose health worker (officially called the AuxiliaryNurse Midwife - ANM) for their implementation, the programmes different planning,monitoring and supervisory systems bring about very uneven pattern of service delivery.
The interminable rounds of the Pulse Polio campaign have a serious impact on routineimmunization programmes as well as delivery of other essential services like maternalhealth. Also the family planning programme often takes precedence over all otherinterventions in the absence of any integrated decentralized (bottom-up) planning. TheNRHM proposes to address these problems by a number of innovations at the communitylevel.Local ownership of health related planning, and the monitoring of health activities by thepanchayat bodies is another key area of activity proposed for the NHRM.What Civil Society Organizations can do?Non-government organizations with their advantage of non-rigid, locality specific, feltneed-based, beneficiary oriented and committed nature of service have establishedmultitude of roles which can affect rural health scenario. In this context, the need toanalyse how far the NGOs are effective in rural development, what their roles are,components of their development work, their consequences etc. At National, State and District levels, including Standing Mentoring Group for ASHA Member of Task Groups Provision of Training, BCC and Technical Support for ASHAs/DHM Health Resource Organizations Service delivery for identified population groups on select themes For monitoring, evaluation and social audit.Challenge: 1. Identify the major problems in the situation. 2. What can be the immediate response system to address these problems? 3. Develop a long term strategy to combat the health care problems of underprivileged people, with the given constraints in the case.