Rough roads and rivers: getting institutional delivery services to women in rural West Bengal
published 14 September 2015
published 14 September 2015
“The greatest success of the Community Delivery Centres has been the decline in home births”
– quote from Community Delivery Centre doctor cum manager.
Apart from a sign in Bengali and English, the centre was not obvious. It was set in a half-finished, bare concrete and brick building surrounded by paddy fields on the edge of a village, within a kilometre or two of the Bangladesh border. Despite its modest exterior, the centre was equipped with four beds in a surprisingly cool, softly-lit maternity ward. It had a clean, well-stocked delivery room that delivers 25-30 babies a month. For each delivery the nongovernmental organisation receives a government subsidy of Rs 5,000 (around 70USD) to cover staff salaries, essential commodities and women’s meals for the 2-3 days during and after birth that they spend at the centre.
Overlooking the tranquil, agricultural landscape, with a gentle breeze punctuated by occasional birdsong and scattered, end-of-monsoon showers, we interviewed the doctor and practice coordinator on the clinic’s veranda. They took us through their meticulously detailed, hand-written record books that were submitted to and verified by the district hospital every month. All such centres must submit monthly data on deliveries to help the district health authority monitor institutional deliveries. We heard that the greatest success of these centres has been the decline in home births. Giving birth in the centre means a woman and her baby is more likely to receive the life-saving care they need.
Set within a complex river system prone to flooding in the monsoon, where many villages are accessed by boat, the remoteness of the setting can be a substantial problem if there is an emergency at night. The clinic is open 24 hours a day, seven days a week with one doctor and two nurses permanently resident, and is more than capable of safely delivering a baby in normal circumstances. However, the clinic is not equipped to deal with complications, such as performing emergency c-sections, and these cases have to be transported to the nearest district hospital (about a three hour road journey with two river crossings) which can only perform surgeries during the day. So for emergency care at night, a woman would need to travel all the way to Kolkata involving an uncomfortable rickshaw ride, a river crossing on a small, diesel-powered wooden boat, a drive of an hour and a half through villages and dense tropical forest, another river crossing by wooden boat, followed by a three to four hour drive to the city.
It was clear that while the state government’s programme was making important improvements in levels of institutional deliveries, more could be done: “Yes we do expect to continue, but we are also expecting to get a boat from the government because the boatman demands a lot. So, we want an emergency boat from the government’“, says Pradeep*, the resident doctor at the Community Delivery Centre who has worked in remote primary health centres for many years. Pradeep was trained in management of labour during his degree in Ayurvedic medicine (he is known in India as an AYUSH doctor) and also later, on the job, while working with another nongovernmental organisation. Two young nurses and seven field workers who raise awareness of institutional deliveries in the surrounding communities were supporting Pradeep in this Community Delivery Centre.
In the words of a local health department official we spoke to: “Many Community Delivery Centres do not have [biomedical] doctors – you cannot get MBBS doctors in those areas..delivery is conducted by a nurse, and an AYUSH doctor can also do that..if any complication is there they can come to the doctor [in the government facility]. If people are aware that institutional deliveries are better, that kind of awareness can be generated [by the private Community Delivery Centres]. So the Community Delivery Centres are doing very well.” Although our trip showed more is needed to get women to the government health facilities in the case of emergencies, it also showed that public private partnerships can be successful in getting women to give birth into both public and private health institutions where life-saving care can be provided.