Banjaras, a semi-nomadic tribe in various parts of India, have a substantial presence in the Chandrapur District of Vidarbha. Known for beautifully bejeweled women and age-old traditions, they work as either agricultural labor or shepherds for their livelihoods.
Their society has a marked 'son-preference', which reflects in the large number of children each family has in the hope of having a male child.
Steeped in traditions and acutely conscious of their 'parampara' (traditional customs) the tribe members still reject efforts to impart health related information and some times even verbally abuse health care workers as they perceive a threat to their cultural integrity.
However, sustained effort by a good team at the nearest PHC and the Ambuja Cement Foundation workers in this area has today started to show results in the form of increased hospital deliveries, complete ante-natal checks and care, and considerably reduced cases of neonatal and maternal mortality.
The commonest occurrence in this area, in relation to mother & child health is deliveries happening on the way to the PHC. And this happens mostly in the lone auto available here (The driver calls himself a 'delivery expert').
The reason of course is clear as one attempts to reach the village on a motorcycle. The road (if one could call it that) could make even a woman who is not pregnant deliver a baby! The picture below is a snapshot of the road that goes on for about 30 kilometers to the nearest PHC.
The lesson seems to be clear. The level of the sub-center, which today seems to be totally dependent on how the 'Nurse' at a particular sub-center is, needs to be strengthened, with increased accountability and more 'systems interventions' so it becomes less individual dictated.
This needs to be also complemented by a better system of ensuring 'safe deliveries' with a flexible approach that combines the role of the trained birth attendant and institutionalization. This choice should in turn be made on a situation analysis of, and adaptation to, the ground realities of the population covered by that sub-center.
And above & beyond all policies, plans, and strategies, each and every employee of the health system, right from the sweeper and aaya to the Minister for Health, needs to deliver the service he or she is being paid to carry out, to make good healthcare delivery a reality.