News & Updates

As a nurse on a remote tea garden in the north-east Indian state of Assam, Mitali's days tend to be long. In a state with the highest maternal mortality in India, 229 deaths per 100,000 births, much of her time is spent with young mothers, who are invariably undernourished, often underage, and usually reluctant to seek care. So that they will seek the care they need - and return - Mitali must act as health worker, counselor, and friend.

The women who tend India’s famous tea gardens live and work on remote farms that accommodate between 100 and as many as 5,000 workers. The workers depend on their employers for their income, housing, food rations, fire wood, and other necessities. When sickness strikes, their only recourse is to turn to Mitali and her coworkers, a full-time doctor, a primary care nurse, and a team of community health volunteers, who staff the tea garden health center. Together they are responsible for ensuring that the 3,500 people in the tea garden stay well. However, limited resources at the health center and long distances between the tea garden and the towns where hospitals are located often turn serious complications, particularly during pregnancy and birth, into fatal ones.

When Mitali has to refer a pregnant woman to a hospital for a higher level of care, the woman has to travel three hours or more over bad roads to deliver her baby. If she is a temporary or seasonal worker, she will also have to bear the cost of the referral, amounting to a month's wage on average. “There were so many difficulties,” says Mitali, who has worked here for most of her 20 years as a nurse. “People who come [to us] may not be able or willing to do what we say; we may not be able to provide what they need. When our facility was less equipped, we had to turn people away regularly.”

But now, due to the efforts of the Sambhuya (which means 'together’ in Hindi) project, a partnership between the United States Agency for International Development (USAID) and SAATHII, Mitali's facility does not have to turn away worried, soon-to-be mothers. Mitali and her colleagues received focused, practical, and context-sensitive training on maternal and newborn care, family planning, and other pressing health issues in the tea gardens. After returning to her facility, Mitali received months of mentorship support from nursing instructors, who helped her to apply the medical techniques she learned as well as keep records, maintain the health center, and interact with patients and their families. The program staff also helped her team to identify the equipment and supplies they need, and persuaded the tea garden managers to provide them. The results are striking: In the last month alone, Mitali's team has successfully delivered three babies, one of them a delivery with complications. “I could not have handled any delivery a year ago”, she says. “Only now, after the training, do I have the confidence to do it.”

But many tea gardens are not as fortunate. One in three tea garden health centers do not have a permanent doctor or a functional labor room, with smaller gardens faring significantly worse. Many tea garden facilities are often equipped with only minimal supplies, infrastructure and staff strength, which leaves providers little time to update their skills. 

Following a successful pilot phase in 22 facilities, the Sambhuya project is now partnering with the state government of Assam to provide similar support to almost 400 tea gardens across the state, which serve a population of approximately three hundred thousand tea workers.

A partnership between USAID/India and Solidarity Against the HIV Infection in India (SAATHII), Sambhuya aims to expand and improve the decentralized availability of care in both public and private health sectors in India. In the Assam tea gardens, Sambhuya builds capacities of tea garden healthcare providers, increases community awareness and care-seeking, as well as advocates with the state government and other stakeholders to strengthen the overall health system.