It is a hot day in June, the mercury touching 40 degrees centigrade. Madhuri Sinha, an Auxiliary Nurse Midwife (ANM) from Lohahetu Health Centre is riding pillion on her husband’s motorcycle. He winds his way through a bumpy, dusty kuchha road to arrive at village Hitjara in Ranchi district. It is Thursday, a designated day for vaccinations for children.

With public transport scarce in the area, Madhuri relies on her husband to take her to these vaccination rounds every Thursday and Saturday, and sometimes even on other days if the village is ‘hard to reach’.

With four villages and seven hamlets to cater to, this has become her routine on at least eight days in a month. Today is an important day as she has the added responsibility of administering Vitamin A supplement to children aged nine months to five years, under the Jharkhand Mother Child Health and Nutrition Month. This is being done after a long gap of three years.

Besides the routine vaccination, the month-long bi-annual exercise includes de-worming children aged one to five through Albendazole tablets, screening children for malnutrition and referring them to the nearest Malnutrition Treatment Centre (MTC), spot testing household salt for iodine content, and IFA (iron and folic acid) supplementation for pregnant and lactating women and children aged six months to five years.

Nirmala Devi, an Accredited Social Health Activist (the ASHA worker is called Sahiya in Jharkhand), walks from one tola (hamlet) to another cajoling, coaxing and using all her wits to persuade parents to bring their children to the anganwadi at Chitrudeeh, a hamlet of Hitjara.

At the anganwadi, she displays on a table local vegetables, jackfruit, mango, milk and egg to educate women onthe natural sources of Vitamin A. ASHAs are a vital link between villagers and health authorities, but their remuneration is inadequate as they receive only incentive payments and no salary.

Before every session, members of AROUSE (Animation Rural Outreach Service), a voluntary organisation working with UNICEF, create awareness by playing recordings and performing skits.

As many as 270 volunteers from five organisations have been roped in to educate villages across Jharkhand on the need for Vitamin A supplement in the diet. UNICEF is supporting the State Government in planning, real-time monitoring and social mobilisation to take the programme to even remote areas.

It is the combined effort of all the stakeholders that has motivated tribal villagers like Naginder Munda. Though there is no road connecting his home to the anganwadi, he carries his son Badar on his shoulder and holds his daughter Barkha Rani by the hand as they trek long distances for their date with vaccination and Vitamin A supplement.

Dr Babu Lal Murmu, the medical officer in Sonahetu Block, admits that the three-year gap has caused a huge setback but is confident that resumption of the programme with new vigour will help.

Fifty-five per cent of the children below five years (nearly 22 lakh) in Jharkhand are malnourished, 12 per cent of them seriously. According to the Annual Health Survey of 2012-13, of the eight lakh children born in Jharkhand, a region where 92 per cent of the rural population defecates in the open, 18,400 die within the first month of birth and 28,800 before their first birthday. However, the newborn mortality rate has dropped from 46 children per thousand in 2000 to 23. Among adults, too, malnutrition is rampant.

Poornima, a young girl from Tapkara Dhoomer tola in Lapung says her parents are farmhands who can’t afford to buy pulses or milk or even flour. All they get to eat is rice from the ration shop and a small helping of local vegetable, whenever available. That is what most villagers, with a little or no land, get to eat in the region. Programmes like Jharkhand Mother Child Health and Nutrition are vital to reach the last mile.

The writer is a senior journalist based in New Delhi

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