In the small village of Aruapalli in Odisha, Jhili Rout cradles her newborn with relief and gratitude. As a mother of two, her journey through her recent pregnancy underscores the profound challenges faced by families in rural India, where access to essential healthcare can often seem like a distant dream.
For Jhili (25), whose family of eight struggles with an unstable income, healthcare costs could have been an insurmountable burden. Her husband’s modest earnings as an agricultural labourer often run dry meeting the family’s needs.
Recalling her first experience with antenatal care, she says, “Five years back, when I was pregnant with my first child, I received two ultrasound scans that cost me Rs 1,600. My husband requested sahukar (employer) to lend him this amount. For families like us, sparing so much amount is not easy,” she adds.
However, Jhili was able to monitor her second pregnancy closely without the financial strain. Thanks to the Ganjam District Administration’s initiative, she was offered up to three ultrasound scans for free of cost.
“When ASHA [Accredited Social Health Activist] didi told me that it is for free, I did not believe her at first. But when I went to the centre, no money was taken from me. It came as a relief. I underwent three scans in my third, seventh, and ninth months of pregnancy. I was very worried about my child but the doctor told me everything was fine; my baby was healthy and it was positioned normally,” adds Jhili.
“The only thing that I needed to ensure was that I keep on taking iron-rich food, such as jaggery and green leafy vegetables, and iron tablets. My haemoglobin was 10 [normal range is 12.0-15.5 g/dL]. I followed all the instructions and my baby was born a month back. Both of us are healthy,” she smiles.
In an effort to provide much-needed diagnostic services to underserved populations in rural areas, Dibyajyoti Parida IAS spearheaded the Nirikhyana initiative in Ganjam district.
Conceptualised in November 2022, the programme aims to address the glaring gap in access to essential diagnostic services, especially ultrasounds for pregnant women, in remote villages. Formally launched in 2023, this service has significantly improved maternal and child health, providing reassurance to 1.38 lakh pregnant women, including Jhili, during a vulnerable time.
Bridging the diagnostic gap
During extensive field visits and review meetings after his joining in July 2022, Dibyajyoti found a critical lack of ultrasound facilities in rural areas. “This gap left many pregnant women without access to the necessary ultrasounds during their nine-month gestation period,” says the District Collector.
“The diagnostic services were concentrated mostly in urban areas, making it difficult for remotely placed villages to access these services. This motivated us to bridge the gap and use technology for a real-time assessment of diagnostic needs,” he adds.
To address the first gap — availability of services — the Nirikhyana scheme invited private players to collaborate with government services. This Public Private Partnership (PPP) approach ensures that both government and private diagnostic centres provide services, expanding reach exponentially. “Many women, who had to travel up to 75 kilometres for an ultrasound, can now access facilities within their blocks,” he adds.
As a result of the partnership, about 42 government and private clinics are offering up to three free ultrasound scans to pregnant women.
The second gap, Dibyajyoti points out, was data transmission. To ensure seamless communication among pregnant mothers, doctors, and diagnostic personnel, the team developed the Nirikhyana mobile application. This app facilitates effective information flow and real-time monitoring, vital for timely interventions.
“The backbone of this scheme is the Nirikhyana app,” says Berhampur Sub-Collector Dheenah Dastageer IAS, stressing its role in overcoming socioeconomic barriers and the digital divide. She also assisted the team in designing the mobile app and its implementation at the grassroots.
The district follows a three-module approach that allows Auxiliary Nurse Midwives (ANMs) to register pregnant women on the Nirikhyana mobile app, facilitating consultations with doctors who can then refer cases to nearby ultrasound clinics.
Dibyajyoti says, “This structured three-tier system approach allows for the proactive identification of high-risk pregnancies at least 20 to 25 days before the due date. This allows us to enable timely interventions and treatment that significantly help us reduce maternal deaths, still-births, and child mortality rates,” he explains.
Ultrasounds are no longer a ‘rich person’s thing’!
Perhaps the most groundbreaking aspect of the initiative is making ultrasounds free. “In a patriarchal society, spending on women’s health is often considered a burden. Rural women felt that ultrasound scans were a luxury reserved for the rich. We made it free to address this policy gap,” emphasises Dheenah, adding that in Particularly Vulnerable Tribal Group (PVTG) areas, free transportation is provided to ensure women can access healthcare without financial strain.
Utilising existing resources from the National Health Mission, district mineral funds, and corporate social responsibility (CSR) budgets, the project effectively covers the costs. So far, the district has spent up to Rs 20 lakh to implement the project.
Before the launch of the scheme, less than 30 percent of registered pregnant women would undergo USG tests. This number has increased to 128.6 percent post the launch. As a result, high-risk pregnancy detection has also increased from 4 to 25 percent.
After the intervention, the maternal mortality rate (MMR) has reduced from 97 in 2021-22 to 69 in 2023-24. In the same period, the neonatal mortality rate has reduced from 18 to 9.
Looking at the success of the Nirikhyana initiative, Dibyajyoti says, “High-risk pregnancy detection has improved due to better access to ultrasounds and systematic follow-ups by healthcare workers. It’s incredibly rewarding to see an initiative making a tangible difference, especially for pregnant women who are bringing new life into the world.”
“Moreover, the initiative has encouraged entrepreneurs to establish diagnostic centres in rural areas. We are also putting in strong auditing systems to ensure the scheme’s efficacy,” he adds.
The next phase, the IAS officer mentions, involves integrating artificial intelligence to automatically identify risk cases and send alerts, elevating the system’s responsiveness.
Edited by Pranita Bhat; All photos courtesy IAS Dheenah Dastageer
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