With the strength of our network, we started a fundraiser – first to donate ourselves, then inspire our commune, and finally reaching out to everyone.
Pyari Bai and her grandchildren of Talgaon Village, Panna district, Madhya Pradesh
We opened the map of India, to choose a region where the penetration of civil society was really low, indicators of human development poor, and stark socio-economic and environmental challenges prevailed. There was a singular plan – spend considerable time looking closely at the scenario on ground, till the time it becomes dear what the course of future action should be. After an initial assessment, three locations were narrowed in for the proposed immersion. Kalahandi in Odisha, south Chhattisgarh and the Bundelkhand region.
With multiple droughts, a history of underdevelopment even after getting the attention of the government, significant forest cover and tribal population, low industry setup, unique political history and context, and lowest indicators of health and education, within Bundelkhand, the district of Panna in Madhya Pradesh was chosen.
Education and skilling
Strengthening local governance
Improving conditions around migration
Agency of women and leadership
Maternal and infant health
Months of a deep immersion process began to make the picture clearer. Five areas emerged as possible first interventions. Multiple rounds of deliberation later, we zeroed down to work on healthcare, specifically on maternal and infant health and mortality. At present, the district level Infant Mortality Rate (IMR is the number of children who die before their first birthday for very 1,000 live births) of Panna is 85, and the Maternal Mortality Rate (MM is the number of deaths of a woman from pregnancy-related causes during or within 42 days of pregnancy for every 100,000 live births) is 322. This is way higher than even India’s national aggregate figures of IMR 33 and MMR 113.
In conversations with the community, this stood out as an emergency. Mothers and babies who can be easily saved, were dying. We realized that the health of the children would be a sensitive yet strong inroad into the community, as everyone was concerned about it. Health of women would also include entitlements and services of the government pertaining to health. It would also focus on women and in some ways would look into the empowerment of the women in the community. And thus, Koshika was born on April 2019.
Vitamin A drive in Gahadra village, Panna Tiger Reserve, Madhya Pradesh along with AAA (ASHA, ANM and Aanganwadi worker)
The 10 villages selected for Koshika lie in close proximity to the Panna Tiger Reserve. This geographical positioning of the community itself brings about many challenges, because of the restrictions faced. There is no electricity supply in seven out of ten villages and no roads in five out of ten villages. Forest roads are both dangerous and tough to travel by some modes, and much of the community only goes out of the village for the weekly haat. The general state of government infrastructure is crumbling, as there is little monitoring in these interior regions.
Health, sanitation, education facilities are superficial. Especially when it comes to medical emergencies, and during instances like childbirth, ambulances can barely reach on time. There is very poor telephonic and internet connection. There are strong beliefs amidst the community with regard to pregnancy and motherhood. Limitations also arise due to the caste, class and gender dynamics, which make the women of this tribal community the most vulnerable.
A comprehensive baseline survey in 10 villages
Nurture a team of 9 health facilitators who act as a bridge to and representatives of the community
Close monitoring of all pregnant women and infants via health workers and our facilitators
Working closely with the health, women and child welfare departments of the administration
Establishing a referral system for health issues between the community and the health institutions
Regular community meetings and periodic health camps
Nutrition garden prototypes in 2 villages
In the long haul, the vision is to enable the community, especially build the agency of the women and health workers who will be able to look after their mothers’ and infants’ well being. Here are some reads as insights from the Koshika team based on the past four years:
Team photo, taken after a training of village health facilitators. From left to right (front row) – Kamla, Kali (and her son Surendra), Komal, Uma (with her son Pushpendra), Kamla, Sajan Bai (with daughter Shobini). (back row) – Dr. Mayank (consulting doctor), Har bai (with son Anil), Neeta, Nikita, Rajni, Rashmi and Saurav