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Kashmir Times

'Butterfly' spreads pollen of rural family planning

MAHUA, Bihar, Nov 26 (UNI): A drowsy woman on a stretcher is brought by four rustic people to a tent, a makeshift post-surgery unit under a family planning drive to reach the country's remotest parts.

From the small operation theatre, Lalmuni Devi is being shifted along a grassy pathway under the afternoon sun. She is then helped to lie down on the carpeted floor of the 'pandal' already occupied by rows of more than 50 women, all of them being provided medical care after tubectomy.

Beneath the not-so-pleasing sight is a happy story of yet another rural woman getting her pregnancy prevention surgery done free of cost. All because of a non-governmental organisation engaged in family planning among the poor in the interior belts.

It is not that 'Janani' always does its services without charging anything. Founded in 1995, it believes in public-private networking of reproductive health care involving rural health practioners, doctors in small towns, owners of medical shops and a team of volunteers in various capacities, each of them monetarily benefiting out of the process.

"We are into social marketing and medical franchising. We leverage resources from the private sector. Our services and products are only subsidised and not free of cost," points out the NGO's President Gopi Gopalakrishnan. "When we find revenues satisfactory during the course of a financial year, we conduct such free camps."

"Gayatri Devi, Darwa Chatti Gaon (village)," comes an announcement through the loudspeaker, heard above the rumble of the diesel-run generator. And it is time for the next candidate to get ready for the surgery.
The hospital housing the camp at this tiny town in Vaishali district is franchised by Janani, currently working in the backward states of Bihar, Jharkhand and Madhya Pradesh, and given the brand name: Surya Clinic. Those undergoing surgery at the four-day camp have been referred by rural health practitioners (RHPs) and a team of volunteers functioning under Janani's grassroot-level unit called Titli Centre (TC).

"We gave the names 'surya' (sun) and 'titli' (butterfly) after a market research. We wanted them to be bring a bright and colourful image," informs Gopalakrishnan, a one-time journalist working with the NGO since its inception.

He attributes poverty and pathetic contraceptive prevalence rate as the main reasons for Janani's concentration of work in Bihar, where it has 32,000 shops condoms and pills marketed by the NGO. Figures show that Bihar has a per-capita income of only Rs 5,445 which is 30 per cent of the national average, while its contraceptive prevalence rate is among the worst (23.4 per cent couples protected versus 48 per cent nationally). Thus, together Bihar and the neighbouring Jharkhand, Janani has set up 32,000 TCs. It has a growing network in Madhya Pradesh, and is aiming to spread across North India and eventually to other parts of the country.

The TCs, managed on paying an annual membership fee of Rs 300 by the RHPs and a female colleague (mostly spouse) who have been certified by the NGO as its eligible workers for a year's time after giving lessons at a refresher course, are in the highly interior pockets of the state. So much so that a cluster of them are brought under an umbrella point called Super Titli Centres (STCs). These are located in the more accessible areas of the state.
"STCs, relatively nearer to main roads, help us ensure that the network of supplying medicines and giving prescriptions is not snapped in times of calamities like flood (a common feature in Bihar during monsoon months). Our target is to set up 57,000 TCs in Bihar and Jharkhand so that each village has a TC," says Gopalakrishnan, whose NGO is affilated to Washington-based charity organisation called DKT-International.
Janani's awareness campaigns have evidently enabled villagers to embrace family planning measures in a bigger way. Mainly because, each case of sale and reference fetches the Janani worker a commission.
Points out Arjun Thakur, an intermediate who runs an STC in nearby Abdulpur village comprising about 100 families, "On an average, we sell two jars of condoms (totalling 120 pieces) a month."

Chimes in his wife Rita Devi who has learnt to conduct pregnancy test: "I have referred over eight cases to the Surya Clinic for tubectomy. Even yesterday, a woman came."

At which Gopalakrishnan hastens to add, "We (Janani) don't accept everyone. Their haemoglobin level should be satisfactory."

Surgeons at Surya Clinics also endorse that their income has gone up after becoming a franchisee of Janani.
Dr M K Singh of the Surya Clinic here estimates that he performs an average of above 20 vasectomy operations a month. "However, the number would dip too low during summer time," adds the middle-aged MBBS degree holder, who set up Surya Clinic last year after paying the customary fee of Rs 6,000 to Janani.
In short, it is a win-win situation for all. For instance, the doctor at the Surya Clinic is referred for more number of tubectomy, the subsidised rate of which is Rs 499 vis-a-vis the market rate of Rs 900 to Rs 2000. Of this, Rs 45 goes to the TC as incentive, Rs 10 to the STC and Rs five to the clinic coordinator. Abortion of unwanted pregnancy is charged a fee of Rs 399 with Rs 35 going to the TC, Rs the TC and coordinator getting Rs 10 and Rs five respectively.

Sensing the degree of gender sensitivity in the case, Janani is planning to involve more number of women in its operations. Janani Assistant Manager (Training) Reetima Das says the NGO is to shortly organise a three-day workshop for female consultants."Again, there will be some fee charged," she adds.

Janani claims that its programme could last year protect 11 lakh couples and avert 6.4 lakh unwanted births. Sixty per cent of its sale of condoms and contraceptives were in rural areas.

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