Bringing Health Care to the Doorstep – Mobile Health-care Unit (MHU)
Saving the Lives of Children’s in the Slum Areas of East Delhi
The majority of people in India seek health-care only when the situation goes beyond control rendering the person more vulnerable to serious health disorders and risks. Women and, children in particular are denied of even basic health care facilities due to unavailability, for being unaffordable and or, the inability to access health related services. Women, especially in the reproductive age group are more at risk due to the process of pregnancy and also due to social and cultural conditions, having a direct impact on child mortality.
The solution was to make medical services available to the underprivileged at their doorstep to promote health-seeking behaviour, both preventive and curative services to ensure an impact and, initiated a process of sensitization of health/medical service professionals to extend a more understanding and considerate attitude towards the less privileged in society. The strategy was to also develop a model to be replicated by the government.
Most of the health care facilities provided by the government for antenatal and postnatal care are focused on the rural areas while the health care facilities in the urban centres have been mostly handed over to the private sector which is not accessible/reachable by the urban poor. The government considers the urban poor living in the slums as unauthorized encroachers – they are criminalised for one or, any innumerable reasons and, the government does not consider itself accountable.
Health Data of Delhi
- Neonatal mortality rate (first month) for the urban poor of Delhi is 35.6 per 1000 live births whereas the total neonatal mortality rate for Delhi is 29.3 per 1000 live births.
- The infant mortality (first year) is 54 per 1000 live births
- The under five mortality rate for the urban poor of Delhi is 73.6 per 1000 live births more or less double the rate in non-poor areas.
- The percentage of underweight and malnourished children in Delhi’s urban poor is almost double (at 45.9%) to that for rural and urban non-poor (23%).
- The indicators for maternal health are dismal. Only 4.2% of Delhi’s urban poor women are receiving adequate antenatal care, 51.4% are anaemic with only 16.6% delivering babies in institutions.
- Infant and young child feeding behaviour is sub-optimal
- Only 39.1% were exclusively breast-fed up to six months of age.
- Immunization against six common vaccine preventable disease is at alarming low levels.
- Complete immunization coverage with all antigens is at 39.5% in comparison to that for children in other parts of the city at 65%.
Main Objectives of the MHU Project
- To provide reproductive , maternal, new born, child health and nutrition (RMNCHN) care
- To raise the level of community awareness on issues of environmental sanitation, hygiene and other health and nutrition related behaviour.
- To develop an effective system of referrals and linkages with public as also private health facilities in and around the slum areas.
The Services under MHU are
- Health care services required for child survival to reduce child mortality
- Will also address primary health care needs of the community
- The services of the MHU van will not be limited to the curative aspect but will also cater to diagnostic services.
Major Issues for Capacity Building
- areas of safe motherhood,
- total immunization,
- life-cycle approach,
- management of common illnesses (diarrhoea, pneumonia, fever, malaria etc)
- RTI, STI and HIV/AIDS.
Nodal Point Persons were identified from the community itself – preference being given to women, women’s groups, youth and adolescent girls clubs with the objective of creating a system driven by the children and youth of the community adopting a child-to-child and a child-to-community approach. Cluster Programme Management Committees involving slum elders, men and women from the families of the children and youth involved in this programme was also developed to ensure :
- one-to-one interaction by community volunteers
- other community mobilization activity such as street theatre, monthly group meetings, celebration of specific days, health camps and related activity.
Coverage : Two Lakh Population of North East & East Delhi with special focus to women and children.