The context
Jharkhand is one of the Empowered Action Group states and continues to share many characteristics with other backward states of India: high infant mortality, low immunisation of children and expectant mothers, high mortality from infectious and contagious diseases, high maternal mortality and low institutional delivery. Coupled with poor access to health facilities and the high cost of treatment, these have made the achievements in the health sector insignificant.
Despite the National Rural Health Mission (NRHM) and the government’s commitment to improving the availability of and access to quality health care — especially for people in rural areas — public health care services in the state have not shown marked improvement in public health indicators. Many factors contribute to poor health, including poverty, poor infrastructure and high morbidity.
Poverty-associated communicable diseases such as tuberculosis and malaria, along with maternal mortality and morbidity, make up a major portion of the disease burden. Malaria is endemic, with frequent epidemic outbreaks of Plasmodium falciparum malaria (about 50%). Over 60,000 deaths occur every year due to tuberculosis. The prevalence of leprosy is 10 per 10,100. Sixty percent of infant deaths are neonatal deaths.
Only 52% of children are fully immunised (CES, 2007), and 35% according to NFHS-III. About 78% of children were anaemic (NFHS-III, 2005-06) and 59% of children below three years of age were underweight. In Jharkhand, 208 mothers die during delivery for every 100,000 live births, compared with the national rate of 178, while the under-five mortality rate is a high 51 per 1,000 live births, according to the state health department. Maternal mortality was high at 371 per 100,000 live births (SRS, 2003).
Around 45% of women have reproductive health problems and 30% complain of reproductive tract infections. About 70% of women in Jharkhand were anaemic, and about 30% of them moderately to severely so. According to state government figures, only 38–47% of pregnant women received antenatal care (NFHS-III shows 36%); IFA consumption was 15% (NFHS-III) and 50% received tetanus toxoid injections. Nearly 80% of deliveries take place at home. Only 31% of couples use any modern method of family planning (NFHS-III); permanent sterilisation, particularly female sterilisation, dominates (23%), and the total unmet need for family planning was as high as 24%.
The Jharkhand Economic Survey 2015-16 showed that more than 90% of expectant mothers in rural areas are unaware of health and nutrition issues. The state has one of the country’s worst maternal mortality rates.
SIGN’s approach
SIGN uses health education as one of its strategies for health promotion and disease prevention. Health education provides learning experiences on health topics, and its strategies are tailored to the target population. SIGN imparts health education on hygiene and cleanliness to schoolchildren and teachers, while adolescent girls receive health education on physical changes and how to handle them, along with information on sexual and reproductive health.
SIGN plays a vital role in strengthening the links between government health services (ANMs and Sahiyas) and the community. SIGN promotes visits to Malnutrition Treatment Centres (MTCs), regular immunisation and colostrum feeding among pregnant women and lactating mothers. Beyond this, SIGN is determined to promote good health — ensuring that health resources are evenly distributed and essential health care is accessible to everyone.
