Health workers face a number of challenges in explaining the importance of birth control in Uttar Pradesh.
Ahmadpur village in Sitapur district, Uttar Pradesh, has no electricity and no piped drinking water. A majority of the 300 families here belong to the Scheduled Castes and earn their livelihood as labour.
Most of the residents have never been to school.
It is a tough challenge on the ground for the frontline health workers like Accredited Social Health Activist (ASHA) Santosh Kumari Shukla, and the anganwadi worker, Pushpa Devi.
Along with the ANM or Auxiliary Nurse and Midwife, the health workers play a crucial role in family planning services, in addressing issues of maternal and child deaths and ill health.
The maternal mortality rate and the fertility rate in the state are higher than the national average.
Now a newly set up technical support unit by the UP Government and the Bill and Melinda Gates Foundation is seeking to be the wind beneath their wings. Frontline health workers and nurses who have been neglected, now have mentors and community resource persons to handhold them and guide them with technical support. The technical support unit works within the government system and is running in 100 worst performing blocks in the state.
And change is visible in Ahmadpur village. Teenage mother Sawani has opted for an intrauterine device after her delivery to space childbirth and has the support of her mother-in-law, Sursati.
Sursati said, "The child will benefit, my daughter-in-law will benefit. If children are born one after the other, my daughter in law will get weak. How will we take care of their health?"
At a monthly meeting at Biswan block, groups of ASHAs are trained to communicate with the community and to enhance their capacity. For the first time, health workers too have an opportunity to discuss their challenges within the system, including that of corruption.
Puspha, an ASHA worker in Biswan block, said,"If we are paid Rs 600 for a delivery, we have to give Rs 100 as commission. Hansraj and Pradeep charge us money when we deposit our vouchers. If we don't give them money, they won't send the vouchers."
Payments to ASHAs are going to be streamlined soon by an online system.
At the Biswan community health centre or CHC, we meet one of the new cadre of nurse mentors in the state who are imparting skills and knowledge to staff nurses and ANMs.
Priyanka Singh, who is nurse mentor at the Biswan CHC, said, "When I came here initially, I found there were a lot of things that were not being utilised properly. Copper T was available but the nurses didn't know how to insert it."
There are complaints of nurses demanding money after delivery from patients, and essential medicines not being available free of cost. The CHC does not have a surgeon, an anesthetist or a blood bank. While there is a long road ahead, the technical support unit is a positive step. Their feedback will also help the government identify and address systemic challenges.