Ambala/Kaithal, Sept 18
ASHA (Accrued Services Health Agent) worker from Ambala’s Nandiali village, Nirmala Devi, has only a couple of cases in the name of record of the village’s pregnant women. With no auxiliary nursing midwife (ANM) having visited the village for around two months, maintaining the register has become a headache for her.

She is often constrained to spend money from her own pocket and take the women to the local Civil Hospital for mandatory tests checks such as blood pressure and haemoglobin.

While the women themselves have lost interest in visiting a doctor regularly, Nirmala is also no longer keen on pursuing cases because she has to spend more than what she earns from every case. She essentially goes out supplying iron tablets to the patients registered with her.

ASHA worker Kulwinder Kaur’s record of Lotni village in Kurukshetra reflects no risky pregnancies in her area with blood pressure (BP) of all pregnant under complete control and the haemoglobin (Hb), too, in a “manageable” range. Almost all 17 women are in good health.

In Kaithal’s Kultaran village, ANM Parveen takes almost 15 minutes to locate the pulse to record blood pressure (BP). Despite being an ANM for a few years now, she still struggles to get it right. In the end, as registers of ASHA workers Anjula and Poonam show, the readings hardly vary.

Of the 15-odd names in the register, as many as 11 women have a BP of 110/70 or 120/80 and their Hb varies from 8.5 to 9.5 gm.

The “invariable” readings are now posing the biggest challenge to the Health Department struggling to bring down the maternal mortality rate (MMR) and the infant mortality rate (IMR) in Haryana.

With MMR at 160, Haryana is placed 12th in the country. In case of IMR, Haryana and Bihar stand at number 27 and 28 among the 35 states and union territories. Both states have IMR of 48 infant deaths for 1,000 live births.

By their own admission, officials of the Health Department believe the information pouring in from ANMs and ASHA workers could well be “fudged”. This could especially be true since 32 per cent of these workers do not have Hb meters with them as per a survey under the supportive supervision exercise carried out by the department at 250 sub-centres of the state. Of those who do have the meters, nearly 36 per cent do not know how to use them, leading to discrepancies in data.

“MMR and IMR are high in Haryana because we are unable to identify risky pregnancies, which usually go undetected. According to international data, 15 per cent pregnancies are risky while reports from the field, gathered through ANMs and ASHA workers, do not throw up any such findings,” explains Mission Director, National Rural Health Mission, Rakesh Gupta.

The Health Department has recently initiated an exhaustive exercise of supportive supervision by roping in the PGIMS, Rohtak, and the state Institute of Health and Family Welfare and to consistently monitor sub-centres so as to bring down MMR and IMR.