Reaching the unreached: Access to reproductive health in disaster prone regions in rural India

Purpose: The river islands of Brahmaputra are geographically isolated with a serious dearth of reproductive health services. Annual floods pose a major challenge to the river dependent population aggravating their vulnerability. The public private partnership (PPP) between CNES, a non-profit, the National Rural Health Mission (NRHM) India, and UNICEF provides an umbrella of community pronged reproductive health strategies. This study evaluates the significance and learning's from targeted reproductive health campaigns in resource-limited disaster prone regions.

Methods: In 2008 flood season, data was collected from 72 households, comprising 512 individuals from 4 Brahmaputra river islands using systematic random sampling. Demographic and health and Knowledge, Attitude and Practice (KAP) Surveys, Semi structured Interviews, and Focus group discussions were used. Data analytics included descriptive statistics and qualitative analysis using SPSS 14.0 and Atlas.ti.

Results: PPP implemented a multi pronged intervention strategy involving medically equipped mobile boat outreach, community health workers (CHW) and home visits. Accredited Social Health activist (ASHA) and CHW's delivered customized reproductive health packages. 78% of the women in islands use Akha boat as sole source of healthcare during floods. 47% received institutional delivery through the program. Akha boat, ASHA home visits were positively correlated (p<0.005) with increase in iron folate consumption and healthy delivery practices during floods. Qualitative analyses also indicated positive change in sanitation and general hygiene, and maternal health.

Conclusion: The health care delivery model validates a multi pronged community based intervention for future programs targeting universal access to healthcare for disadvantaged populations burdened with disasters.