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Ancient trees close in overhead on the long, undulating road from Khunti to Chakradharpur in Jharkhand, as the musty smell of red earth wafts up, waterfalls cascade down craggy rocks and forest-clad hills alternate with valleys in the distance. Yet, you are warned: it is part of the Naxalite ‘red corridor’.
There are many ways to understand danger here. One way is through the story of husband-and-wife doctor duo, Prasanta Tripathy and Nirmala Nair, who left global careers to settle down here, jettisoning all fears and expectations, for an opportunity to solve a crucial problem and avoid a greater danger. “I am from Chakradharpur,” says Tripathy. “I grew up here. It was repaying my debt of gratitude to my birthplace.”
The greatest danger was the unrelenting grip of malnutrition on the area, spawning stunted and underweight children. Tripathy and Nair found very little data on the health status of isolated communities—Ho, Santhal, Oraon, Juang, Munda and Bhuyian—tribal communities, as well as socially disadvantaged non-tribal people.
They set up Ekjut, as a non-government-academic consortium, in 2002, to provide a health and nutrition training programme based on community participation that would empower mothers and result in healthy babies. Woman volunteers trained by the duo went to remote villages, encouraging women and adolescent girls to think through gender issues, especially maternal-newborn health, and then come up with strategies to tackle those. “At the core of the Ekjut model is the idea of unleashing community spirit,” adds Nair.
Starting with 20 women in three villages around Chakradharpur, by 2010 Ekjut could muster 20,000 trained women across 1,000 villages in nine districts of Jharkhand and Odisha. From 2012, Jharkhand and Odisha governments started accepting the Ekjut model. At present, Ekjut conducts training in 40,000 villages across the country, empowering over a million women.
Naturally, this stunning success did not happen in a vacuum. Ekjut, along with the NGO PRADAN and the Centre for International Health and Development (University College, London), identified three districts. Between 2005-2008, they started work with 250 women’s groups in 400 villages, where the neonatal mortality rate (NMR) stood at around 60 per 1,000 births. They can now prove that NMR had dropped by 45 per cent in three years, while post-natal depression was down by 57 per cent. Positive change was recorded in hygiene, newborn care and child rearing.
The efficacy of ‘participatory learning action’, as the Ekjut model is being called, was validated in 2013, after The Lancet and the World Health Organization evaluated Ekjut’s work in 600 villages across eight districts of Jharkhand and Odisha, involving over 20,000 women. Data again proved its success: a 20 per cent reduction in maternal deaths and 30 per cent in neonatal deaths. Ekjut received the 2015 WHO Public Health Champion honour. By 2016, the Centre announced its decision to use the model to bring down maternal and neonatal deaths in eight states.
Tripathy and Nair are sharpening their model. From storytelling to visual cards, role playing to theatre and music—the power of community crosstalk finds new channels of expression. “It’s community partnership all along,” says Tripathy. “Our job is to explore what more can be done.”
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By Damayanti Datta in Chakradharpur