Seva Mandir addresses some of the most critical unmet healthcare needs in the rural villages around Udaipur. Our 422-strong cadre of community health workers has made major strides in improving maternal and child health across 152 villages, and we have helped nearly 20,000 people gain access to clean drinking water and sanitation. The Health Program also facilitates access to government services and undertakes rigorous research projects leading to solutions on the ground.
- HEALTHY MOTHERS
In remote villages, public health services for pregnant women are often unreliable or inadequate. Because home deliveries are the norm, and antenatal and prenatal care are almost nonexistent, there is an increased risk of both maternal and infant mortality.
Seva Mandir’s Response
323 Traditional Birth Attendants (TBAs) live and work in 152 villages where they perform deliveries and care for pregnant women both before and after delivery. TBAs delivered care to 5,500 women last year alone, organized more than 600 informational meetings, and remain the primary providers of maternal healthcare in many areas. While TBAs provide safe and hygienic home births (nearly 2,000 last year), they encourage women to deliver at hospitals when possible, accompany them throughout the arduous multi-hour journey, handle medical complications that arise en route, and are key advocates for mothers in overcrowded and bureaucratic public hospitals. In addition, Seva Mandir has piloted an obstetric insurance program that, for a Rs. 350 ($6) premium, has granted 229 women access to antenatal and delivery services at Seva Mandir-accredited hospitals, and increased antenatal care-seeking behavior from 54% to 74%.
- HEALTHY CHILDREN
A survey of rural Udaipur conducted by M.I.T.’s J-PAL found that just 19% of children were fully immunized, half had been sick during the last 30 days, and 75% were anemic.
Seva Mandir’s Response
Community Health Workers for Infants: Seva Mandir has trained 99 infant health workers, called Balsakhis, who provided care to 2,117 children in 2012-13. Balsakhis counsel new mothers on critical aspects of newborn care including breastfeeding, weaning and appropriate nutrition. Balsakhis also chart child growth, treat basic illnesses and refer serious cases to hospitals, all at a cost of just Rs. 2100 ($35) per month.
Immunization: Seva Mandir’s immunization program, called “the most impressive we have ever evaluated, and probably the one that has saved most lives” by M.I.T. Professors Abhijit Banerjee and Esther Duflo, has nearly doubled child immunization rates from 35% to 60% in many intervention villages. It does so by increasing both supply and demand: regular camps are held on well publicized dates, and parents receive incentives (lentils) for every shot of vaccine their child receives. Last year our camps immunized 1,324 children across 113 villages at a cost of Rs. 2,400 ($41) for a camp serving 100 families. The camps are also hubs for other medical services, and last year treated 2,429 children for common illnesses and provided antenatal checkups to 1,783 expectant mothers.
- WATER & SANITATION
54% of households in rural Udaipur drink from unhygienic open wells, and during summer many water sources dry up. At the same time, a staggering 92% of rural households lack toilets. The practice of open defecation poses health risks and safety concerns.
Seva Mandir’s Response
Seva Mandir has helped 3,200 families - some 16,000 people - gain access to clean drinking water over the past eight years. Building better water sources not only makes people healthier, it eliminates hours of daily drudgery for women who must carry water to the home. Seva Mandir builds bespoke water systems including tanks, restored wells and household biosand filters.
In parallel with our work on water, Seva Mandir has built sanitation facilities for over 650 families (about 3,250 people). This includes 242 pioneering Ecosan toilets - zero-water toilets uniquely suited to Udaipur’s desert climate - for which Seva Mandir is the Government’s official Implementing Agency throughout the district. To ensure toilets are used - not just constructed - we build toilets on a purely demand-driven basis, do months of preliminary demonstration and discussion, and ask for a monetary and labor contribution from beneficiaries.
Recent Resource Pilots
A 2013 internal study to address the 75% rate of anemia among young children provided double fortified salt in meals at Seva Mandir’s Balwadi preschools. Over 80% of children showed improved anemia levels, and the salt will now be introduced at scale across all 187 Balwadis.
Following a multiyear pilot across 80 villages, improved cookstoves are being distributed to a target of 18,500 families. By cutting wood consumption by more than 50%, the cookstoves improve health, slash greenhouse gas emissions, reduce deforestation, lessen the drudgery of wood collection, and generate employment for young people trained in stove maintenance. The project is funded by carbon credits sold through the United Nation’s FCCC and the Gold Standard, and is monitored by an online tool that collects realtime data on stove usage.
Acute malnutrition is one of the highest risk factors for under-five mortality where Seva Mandir works. In partnership with Action Against Hunger, 15 of our Balsakhis participated in a 2011-12 pilot of community-based treatment of malnutrition, including early referral of malnourished children alongside a preventative campaign of parental education.