Jaipur, March 6, 2019
 
Almost half (49%) of women’s expectations were for service availability such as availability of clean, requisite infrastructure, trained and skilled service providers and regular supplies of medicines. This was revealed in a study conducted by CHETNA, a member of White Ribbon Alliance (WRA) India which anchors SuMa -Rajasthan Surakshit Matritva Gathbandhan.
 
SuMa undertook the responsibility of engaging with women and explore their demands to improve reproductive and maternal health services in Rajasthan.  The campaign known as “Hamari Awaz Suno”  (Listen to our Voices) was implemented in 23 districts of the state.
 
The study further stated that one-fifth (21%) had expectations related to their entitlements such as timely and free care and availability of transport, while one-fifth (21%)  asked  to be treated in a dignified and respectful manner with provision of adequate and relevant information and services responsive to their needs and without any discrimination and 9% of these women had other miscellaneous expectations such as basic civic amenities, good quality food at anganwari centres (AWCs), good quality medicines and special separate arrangements for women at health facilities.
 
A state level dialogue on ‘Quality of Maternal Health Services’ was organised by SuMa-Rajasthan White Ribbon Alliance for Safe Motherhood on Wednesday at Jaipur. A report on the study ‘Hamari Awaz Suno’ was released on this occasion. Chief Guest of the function was State Institute of Health and Family Welfare (SHIFW) director Dr Amita Kashyap and Guest of Honour was Consulting Editor, India America Today Dr Shipra Mathur.
 
SuMa Rajasthan state coordinator Vd. Smita Bajpai said SuMa took the responsibility of engaging with women to explore their demands to improve reproductive and maternal health services in Rajasthan.  
 
She said SuMa approached a total of 6972 women from 239 villages of 23 districts of Rajasthan to know their demand on ‘Quality of Maternal Health Services’ and expectations from the government health system in particular. These 23 districts in Rajasthan include Churu, Jhunjhunu, Alwar, Bharatpur, Sikar, Jaipur, Karauli, Nagaur, Jodhpur, Barmer, Jalore, Sirohi, Udaipur, Rajsamand, Dungarpur, Pratapgarh, Chittorgarh, Jhalawar, Kota, Bundi, Tonk, Sawai Madhopur and Ajmer.
 
Women spoke in regard to inadequate human resource, infrastructure and poor medical supplies. “There is health centre in the village but ANM comes occasionally. Sub centre was upgraded to Primary Health Centre level. Doctors are not available in the PHC and there is no facility of ambulance. Health centres should have electricity, water, toilets, accommodation arrangements, which are not there. Even though there is a health centre, treatment is not available,” said 34-year old Dhapu from Barmer.
 
Similarly, 23-year old Guddi from Ajmer said, “When there is no health center in the village, what can one talk about the health of women? They have made Anganwadi centers where one does not even get a pill for bringing down fever. ASHA does not have anything, she only discusses about our health. All these facilities should be there.”
 
Women also face a major problem in form of non-availability of female doctors and nurses. Tara (37) from Ajmer said, “There should be female doctor and nurse, to whom we can easily tell our problems. If there are female doctors, women and girls will be able to easily tell their problems and get proper treatment.”
 
Based on the demands and expectations by women, SuMa has submitted its recommendation and suggestions to the health department of Rajasthan. It suggested that Mahila Gram Sabhas or women’s assemblies must be held to ensure women’s participation and their say in health service planning and provisioning; availability of adequate and skilled human resource at government health facilities; service providers should be available round the clock, particularly female service providers should be available to address women’s health concerns. ASHAs and ANMs should be available regularly in the field; women should be treated with due respect and sensitivity while maintaining their privacy and confidentiality. Staff should be trained, mentored and sensitised for respectful, non-discriminatory behaviour; strengthening and upgrading of public health facilities; health facilities should be clean, well equipped with requisite supplies and equipment for providing quality maternal care; services and supplies should be free of cost and no medications should be prescribed from outside and informal payments by service providers should be stopped.
 
It is to be mentioned Rajasthan is one of the high focus states of the National Health Mission and has demonstrated significant progress in reduction of maternal and infant mortality. Over the time, access to and coverage of health services has improved. This is reflected in the Sample Registration System estimates of Maternal Mortality Ratio which showed a decline from 244 to 199 per 100,000 live births.  To sustain the momentum of this decline, there is a need to ensure quality and dignity along with access and coverage.
 
According to the World Health Organisation (WHO), to achieve desired health outcomes, health services have to be safe, effective, timely, efficient, equitable and people-centered.  To achieve this, availability of essential human and physical resources, evidence-based practices, respectful and effective communication and community engagement supported by requisite financial resources, is essential.
 
Most importantly, women’s perceptions of quality of services determine their seeking of these services. There is a need to bring women in the centre stage of quality dialogues and design health services based on their wants and suggestions.

Mohammad Ahsan Manager reproductive health and rights wrai said , The government has placed most of its efforts on preventing maternal deaths on policies that increase the number of deliveries that happen in facilities, so listening to what women’s expectation is, is of critical importance. WRA India’s campaign, Hamara Swasthya, Hamari Awaz (What Women Want) has reached to global levels reaching out to 1 million women across the world. By this campaign, WRA India has amplified the voices of women by shairing their their thoughts and demand for respectful, quality health care