Community Delivery Rooms
Dhar is a tribal dominant district situated in south-western corner of Madhya Pradesh. The district has a geographical area of 8198 sq.km. The population of the district is 13.67 lakhs (according to 1991 census) of which 53% is tribal. Main tribes residing in the district are Bhils, Bhilalas, Patlyas, Bareliyas etc. 74 % of the population lives below the poverty line. According to the last census, merely 27 % of the population was literate. Female literacy was 16 % and in several areas it was even below 5 %.
The district has I.C.D.S in all the 13 blocks. There are 8 CHC's, 52 PHC's, 303 subcentres and 2085 anganwadi centres. There are 4 post partum centres located in Dharampuri, Kukshi, Dhar and Sardarpur and 5 First Referral Units (FRU's) located in Manawar, Kukshi, Sardarpur, Dhamnod and Badnawar. There are 70 doctors, 87 staff nurses, 49 LHV's, 255 female MPW's (ANM's), 224 male MPW's, 42 lab technicians, 889 jan swasthya rakshaks, 2578 trained birth attendants(TBA)/trained dais and 2085 anganwadi workers.
Community Delivery Rooms - An Introduction To The Concept
District Planning Committee, Dhar unanimously decided in May'99 to start 54 Community Delivery Rooms (CDR's) in 54 villages on pilot basis.
The CDR is the centre where safe deliveries are conducted at the village/panchayat level. It is a general feeling amongst most of the villagers that deliveries commonly take place at homes under unhygienic conditions, often leading to many complications. There was a demand from most of gram panchayats and village health committees to support them in starting a CDR, which would be run by a trained village dai/trained TBAs. This demand was stressed during "Gram Sampark Abhiyan" conducted during 6-12 th April'99, when teams of officials visited all the villages of the district. The strategy of safe motherhood through CDR encompasses financial incentives and logistical support toall panchayats to take reproductive child health initiatives and to build ownership of and responsibility for the program. A comprehensive skill - imparting and motivation building campaign for the panchayat has been given importance in establishing CDR's.Safe-motherhood amongst women is stressed through imparting training to dais and distribution of kits of the essential items for deliveries. The community and the panchayat were assisted in maintaining a separate room with all the equipments needed for conducting safe deliveries, so that the expectant women can come here and have the trained dais to attend them. These Community Delivery Rooms (CDR) were locally termed as "Samudayik Prasuti Kaksh".
Objectives of CDR'S
- To reduce maternal morbidity and mortality caused by complicated births in the villages.
- To provide referral services to pregnant women for reproductive and child health care.
- To provide basic reproductive and child health care information and services through TBAs/trained dais.
- To provide other MCH care services like immunisation, ANC registration, promotion of family planning measures etc.
Infrastructure of the CDRs
The CDRs typically have 1-2 large rooms. In all the cases, there is a bathroom or a latrine (pit type) attached to the room along with an area for washing. The CDRs are provided with all essential items for conducting deliveries and providing medicine. Essential items like white bedsheet and pillow, one table, 2-3 chairs, one stool, one wall clock, footstep for women to sit on the bed, instrument for sterilizing equipments, scissiors, weighing machine, big and small buckets, tray for keeping baby, lantern, dustbin, almirah, labour table and items for social marketing (including condoms and dai kits) were provided in each CDR. The walls of the CDR display posters, showing nutritional requirement of pregnant women and immunization chart for children.
The CDRs are kept clean and hygienic, with the help of trained dais. The CDR also provide MCH services to the women. After the establishment of the health post, the ANC and PNC services are provided at the CDR itself with either the ANM or the TBA placed at the CDR providing required IFA tablets, analgesics, vitamin tablets, antibiotics and immunization to children, etc., A campaign was launched to identify one place (govt. building or community owned building) in every gram panchayat. All gram panchayats came foreward to earmark a room with attached latterine & bathroom, preferrably in the main locality of the village.
The CDRs are run by trained dais. One nodal trained dai has already been earmarked for each CDR. Other trained dais in the village assist the nodal dai in managing the CDR's. However, the MPW's and ANMs are closely associated with their functioning. In addition, the Mahila Mandal, village health committies and the panchayat, especially the sarpanch, are also closely associated with the functioning of the CDRs. The nodal trained dais are from the same villages and have been working as dais in the village for a long time. The keys of the CDRs are either kept with the nodal dai or with the sarpanch. Whenever there is a need, the CDRs are opened immediately as the dais stay nearby . The overall coordination of the CDRs is done by the ANMs / MPW's, who regularly visit the villages, meet the dais, provide dai kits to them under the social marketing approach, and provide all managerial and logistical support needed in managing the CDR's.
- The CDRs, as the name itself suggests, provide delivery services to the women, with the trained dais having the main role to perform. By virtue of staying in the same villages, the dais know all the pregnant women in the village. With due date for delivery approaching, the dais go and meet these women and encourage/motivate them to come to the CDRs for the deliveries.
- The second role which they play is to examine and assist the women when in labour. They may use stethoscope to examine the hearbeats of the foetus, as well as checking for the position of the foetus. The main role of dais is to assist the women during delivery and to clean the mother and baby after delivery.
- Provide referral services in case of complicated pregnancies. The dais entertain and identify any complications/difficult cases, referring them to the higher centres at the district level.
- Provision of other MCH services: Depending upon the needs, the CDR also serve as a venue where ante and post natal care to the mothers and children is also imparted. In addition, CDRs shall have stocks of other medicines for common ailments as well as dai kits provided under the social marketing approach.
Apart from this, the dais, jan swasthya rakshaks, link workers, anganwadi workers and ANM's/MPW's meet woman and motivate them for using FP methods, both temporary as well as permanent, besides, motivating dais from other villages to use only dai kits while performing deliveries.