Capacity building workshops for maternal health care workers to prevent maternal deaths due to postpartum hemorrhage in India - Dr Vidyadhar Bangal
Postpartum Haemorrhage continues to be the commonest cause of maternal mortality in India, which contributes to 20-25 percent of maternal deaths in the world. Delays at various levels have been identified during MDSR meetings, as the most important causative factor for deterioration of maternal health resulting in mortality. Sensitization programmes and capacity building workshops were conducted at ten government run primary health centre of Ahmednagar district in Maharashtra, India covering 5 lakh population. Health care workers including Auxillary Nurse midwives (ANM), Lady health visitors (LHV) ,Multipurpose workers (MPW), Accredited socialhealth activists ASHA), Medical officers, Gynecologists and postgraduate students were sensitized and trained to identify high risk pregnancies ,timely referral , use of Non Pneumatic Anti-Shock Garment (NASG) , Uterine Balloon Tamponade (UBT) and Active management of third stage of labour.(AMTSL) Ten primary health centres and one medical college hospital were assessed regarding their preparedness to prevent and manage postpartum hemorrhage.
Many shortcomings and bottlenecks were identified. The corrective measures were suggested, where ever necessary. Follow up visits to all eleven health facilities showed improvement in their preparedness for prevention and management of postpartum haemorrhage. There was active participation of health care workers in the campaign for prevention of maternal deaths. The sensitization programme helped in refreshing the knowledge of health care workers on various important topics related to maternal health and safety. Replication of similar actions all over the country will help India to achieve the SDG 3 target in stipulated time frame. Dr Vidyadhar Bangal, one of the active member of WHTF co- originated this activity
Collaborative Efforts of Women and Health Together for the Future, Vitamin Angels, USA, Janhit Manch, NGO Wardha and Social Work Students for Women and Child Health – Prof. Surekha Tayade
Women and Health Together for the Future are committed women and men from diverse professions: academics, community organizers and activists from over 22 countries who educate, advocate and implement programs to improve women’s health around the globe. WHTF began in 1991 as a task force of The Network: TUFH and continues its support. In 2003, GHETS began providing financial support to increase our impact. In 2018 they incorporated in the Republic of South Africa. WHTF member Prof. Surekha Tayade is a committed Gynecologist from Wardha district of Maharashtra who facilitated the collaboration of Janhit Manch, NGO of Wardha with Vitamin Angels, USA, a non- profit organisation with a mission to reach children with essential nutrients like vitamin A for children with deworming and multivitamins for pregnant women.
Vitamin Angels donates grants in kind like Vitamin A 100,000 IU - for infants 6- 11 months, Vitamin A 200,000 IU - for children 12- 59 months with Albendazole 400 mgs deworming chewable tablets and multivitamins for pregnant women. After the training of MSW students of Ambedkar College Wardha, the first activity of distribution of prenatal vitamins was carried out at Mhasala village of Wardha followed by Padpanagar slum area, Umri road Wardha and Padegaon Village, Wardha.
Prof. Surekha Tayade was the main resource person, who spoke about Nutrition, infections and their prevention, safe water and hygiene. She also educated the women about balanced diet, metrual disorders, cervical cancer screening and self- breast examination. She facilitated the distribution of prenatal vitamins among pregnant women of the localities and guided them on antennal care and safe delivery. She also facilitated the distribution of Vitamin A and Albendazole tablets for deworming to under five children through local NGO Janhit Manch.
The Padpanagar Slum area had landless residents living in make shift zuggi- zopdis (huts made of tin roof, mud and cloth ) and the women greatly appreciated the concern and collaborative efforts of the organizations involved. Residents from all three localities benefited immensely from the project. This work will continue in future to benefit pregnant women and under five kids.
The collaborative efforts of Prof. Surekha Tayade , founding member of WHTF continues to affect rural women and kids under the age of five years in providing much needed Multivitamins, Proteins and Calcium supplements along with health awareness for holistic healthcare
Authors- Prof. Surekha Tayade, Prof. Judy Lewis
The Department of Obstetrics and Gynecology, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, India organized a one-day training workshop for health care professionals working in the field of women’s health to increase awareness and examine the skills and strategies to address violence against women (VAW). The workshop on 6th March 2016 was attended by 40 participants, including consultants and residents from Obstetrics and Gynecology, residents from Community Medicine and Forensic Medicine Departments and nursing professionals.
The Convener for the workshop was Prof. Surekha Tayade,who conducted the workshop with Prof. Judy Lewis and Prof. S Chhabra—all three are active members of the Women and Health Task Force. Prof. Lewis is from the University of Connecticut, USA, and is a VAW expert with years of experience in women’s health projects, counseling and advocacy programs., Prof. S Chhabra and Prof.Surekha Tayade are both experienced clinicians with expertise in VAW.
The workshop was part of activities leading up to a community survey to assess the prevalence and community attitudes about VAW in order to develop effective community interventions to prevent and treat VAW. The workshop also coincided with International Women’s Day activities, and Prof. Tayade organized nursing and medical students to give short dramas about VAW. These were performed at the hospital on April 8th (International Women’s Day) and will be part of the community program.
Health workers have a crucial role to play in helping women and children who experience violence. Those working in the community, in health centers and clinics, may hear rumors that a woman is being beaten or a child abused, or notice evidence of violence when women seek treatment for other conditions. Those working in hospital emergency departments may be the first to examine women injured by rape or domestic violence. Health workers visiting institutions such as prisons, mental hospitals and retirement homes may be the only source of outside help for victims of abuse. The problem of violence against women is enormous and troubling. There are no easy answers. The health sector cannot solve it alone. Still, with sensitivity and commitment, it can begin to make a difference
Most health workers have neither the time nor the training to assume the full responsibility of meeting the needs of women who have been abused.
At a minimum, health workers can(WHO 2013) :
This workshop was conducted with the goal of improving awareness about the dynamics of violence against women and improve prevention, screening, identification and treatment. This was accomplished through various activities: to exchange best practice examples between the participants, and to build the capacity of the participants to recognize various forms and patterns of violence, sympathize with the plights of the victim/ survivor, discuss the impact of violence on women, institutes and the community and suggest solutions to the problem .
This was an interactive workshop beginning with introductions and expectations of participants about the workshop, followed by a basic VAW and domestic violence, in particular. Using a combination of presentations and exercises, the facilitators helped the participants to understand the dynamics of domestic violence, and to become aware of its intrinsic patterns. The gender biased nature of abuse was highlighted as well as the links between violence against women and patriarchal social structures.
The importance of using a gendered perspective and victim-centred approach in service provision was stressed as participants were asked to reflect and share about the plight of the survivor and how to be empathetic.A group activity was conducted to discuss the impact of violence on the women, her family, and the community and how policies can be created or adjusted to better assist victims of domestic violence. In particular, the connection between abuse of the mother and the abuse of children was discussed—even if children do not directly experience physical violence, as witnesses of violence against the mother, children are also victims.
Participants shared solutions in local context, taking into consideration the intricate social framework of the Indian rural community. The workshop ended with feedback and evaluation.
PHOTOS OF CAMP CONDUCTED IN MELGHAT, HILLY FOREST REGION
KIDS ADOPTED GLOBALLY UNDER AKANKSHA, WOMAN AND CHILD HEALTH CENTRE, KHS, SEWAGRAM, WARDHA, MAHARASHTRA
Pranjal Family (Italy) Sparsh Family (Spain)
AKSHARA FAMILY (Italy, Milan)
Dr Vidyadhar Bangal from India is Professor Obstetrics and Gynecology,Maternal health consultant Mother NGO project,Group Leader ICTC at the Rural Medical College,Loni in Maharashtra . He is a WHTF member and shares with us his work on Skill shift to ASHA (Accredited Social Health Activists) workers for reduction in disease burden among pregnant and women in general from Rural and Tribal India- Community level intervention
I am working in rural area for the cause women’s health since last twenty five years. I am obstetrician by profession. It is very painful to see on day to day basis, so many young women suffering from preventable medical diseases and presenting with serious life threatening complications at the peak reproductive life.
The women from rural and tribal area residing in villages and small huts or temporary shelters are most neglected for their health issues in India. Their health needs are attended ,only when they fall seriously ill or when their illness affects the routine life of other family members. Hypertension, Diabetes and Anemia are three common diseases noticed among pregnant and women in general from rural area.
The recent data shows that India is on the verge of becoming capital for Diabetes in the world. These three medical conditions remain un-diagnosed till serious complications arise. Non availability and accessibility of health facilities, scarce health manpower, gender bias, poverty, illiteracy add on to their vulnerability to these diseases and their complications.
Presently, fifty percent of villages do not have any full time doctor or nurse available in the village. It was necessary to create local health manpower, who would be available full time and can provide first aid and accompany the sick person to the nearest health facility. ASHA worker is a local resident of the village, educated above 8th class and is responsible for helping ICDS (Integrated Child development Scheme) workers in conducting immunization sessions and helping Auxiliary Nurse Midwife in catering antenatal care services in the village. In addition, these workers provide health education to the community and also carry out work related to national health programmes at village level. They are paid performance based honorarium by the government. Presently, the laboratory facilities for diagnosis of diabetes ,anaemia and hypertension are available at primary health centers. Unfortunately ,these centers are not easily accessible to many villges under the jurisdiction of the primary health center.
It was thought that these medical diseases can be diagnosed by creating screening facilities at village level by training the available health manpower ie ASHA workers.
What was done– An intervention programme was implemented in jurisdiction of five primary health centers with approximately 2.4 lakh population of Ahmednagar district in Maharashtra State in India over a period of one year. The selected five primary centers with approximately 200 ASHA (Accredited Social Health Activist) has workers appointed by the local government. Pilot testing of the equipment and methodology of blood tests to be used for the training,was carried out. Hands on training programme was organized at the primary health center for the selected ASHA workers for the individual skill. Training programmes were conducted by principal investigator and the faculty members from the department of Medicine, Clinical biochemistry and Clinical pathology from Pravara Institute of Medical Sciences,a health university. The user friendly equipments (sophisticated electronic digital instruments and equipments available for record of blood pressure ,blood sugar (Accu- Chek –performa) and hemoglobin level estimation (Hemo Cue Hb 201+)) were used for training. After the demonstration of the procedure/skill on the women at primary health centers, the trainees were given hands on experience and were asked to perform the procedures /skills under supervision. They were trained till they achieved perfection in the individual skill.
After the satisfactory training in performing these tests, they were asked to regularly screen the women at risk and refer them to appropriate level of care for further evaluation and management. They could also follow up the cases in the villages through regular home visits and simultaneously educate the women and other family members about the preventive and curative aspects of these three common diseases.
Lessons learnt– The programme helped in reducing the disease burden and thus improve the quality of life of women.It also helped in understanding the possibility of skill shift from doctors and nurses to less qualified, but trained health worker in developing countries and especially in rural and difficult to reach areas, Outcome– The strengthening of knowledge and skills of ASHA workers in performing the simple tests for diagnosis of Hypertension, Diabetes and Anemia at village level have resulted in reduction the morbidity and mortality associated with these medical conditions in women. The skill shift has helped in building up their confidence in using the digital diagnostic equipment, gave them better job satisfaction, has improved their image in the community and has also improved the clientele satisfaction about the services provided at the door steps.
You can reach Dr Bangal at email@example.com
About the association
Committed women and men from diverse
professions: academics, community
organizers and activists from over 22
countries who educate, advocate and
implement programs to improve women’s
health around the globe.
Address of association
Women and Health Together for the Future (WHTF)