www.swaniti.in    

       

‘The healthcare setup in Kalika is inadequate and there are a lot of gaps in the delivery of services. These issues need to be addressed in a comprehensive manner so as to cater to the health and personal development needs of the village.’ According   to   the   SAGY   guidelines   issued   by   the   Ministry   of  Rural  Development,  healthcare  is  one  of  the  core  components  of  an  Adarsh  Gram.  It  is  imperative  that  an  Adarsh  Gram  has  a  robust   healthcare   setup,   which   ensures   efficient   and   quality  delivery   of   services   in   order   to   address   the   health   and  nutrition  needs  of  the  community.  Understanding  the  need  for  the   same,   Mr.   R.K.   Jena,   the   Hon’ble   MP   from   Balasore  requested   the   Swaniti   team   to   assess   the   existing   healthcare  setup  comprising  of  the  Hatigarh  CHC,  Anganwadi  Centres  and  frontline   health   workers   in   Kalika   so   as   to   identify   the   gaps  and  subsequently,  draw  a  roadmap  for  addressing  the  same.      Accordingly,   the   team   identified   the   key   stakeholders   –  Chief  District   Medical   Officer   (CDMO),   Balasore,   Medical   Officer   In-­‐charge   (MO   I/C),   Hatigarh   CHC,   ANM,   ASHA   Workers,  Anganwadi   Workers   and   Helpers   (AWWs   and   AWHs)   and   the  community   –   in   the   entire   healthcare   set   up   and   interacted  with  them  over  a  course  of  a  month  to  get  a  clear  picture  of  the  existing  situation  pertaining  to  health  and  nutrition   in  Kalika.  

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Journey towards a ‘Swastha Gram’ – Ensuring Access to Quality Healthcare and Promoting Healthy Habits

   

Health Synopsis of Kal ika Kalika has a Community Health Centre (CHC) and 10 Anganwadi Centres (8 Main and 2 Mini AWCs). The 6-bedded CHC, Hatigarh has 4 doctors and is overburdened with patients. The facilities at CHC include AYUSH, 102 Ambulance Service and a RBSK (Rashtriya Bal Swasthya Karyakram) team. While the AWCs are fully equipped with workforce (Anganwadi Workers and Helpers), all Centers lack the required basic equipments and infrastructure. None of the AWCs have a functional toilet. The frontline health workers including 5 ASHA workers and the ANM are discharging their duties well. Major health issues prevailing in the GP include water-borne diseases and Maternal and Child Health.

 

Kalika, Balasore

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Existing Healthcare Infrastructure – the only missing jigsaw in the puzzle?

The   Health   Synopsis   section   above   highlighted   the   existing   healthcare   set   up   in   terms   of   physical  infrastructure  and  human  resources  in  Kalika.  Based  on  a  comprehensive  assessment  of  the  Hatigarh  CHC  and  the  10  Anganwadi  Centres,   the  team  identified  the   infrastructural  gaps,  which  result   in   inadequate  delivery  of  healthcare  services  in  the  GP.  For  instance,  Dr.  P.C.Nayak,  the  MO  I/C,  Hatigarh  CHC  and  Mr.  Dinda,   the   Block   Programme  Manager,   National   Health  Mission   told   the   team   that   since   the   CHC  was  previously  a  PHC,  the  facilities  have  not  been  upgraded  to  the  desired  levels  and  there  is  no  post-­‐mortem  centre,  no  duty  rooms  for  doctors  and  staff  nurses,  shortage  of  toilets  and  other  basic  infrastructure  such  as  drinking  water.  The  pressing  requirements  as  stated  by  the  doctors  included  the  need  for  posting  of  staff  nurse,  installation  of  X-­‐Ray  and  setting  up  of  a  Postmortem  Centre.  During  the  multiple  visits  to  the  CHC,  the  patients  and  attendants  also  stressed  on  the  fact  that  there  had  to  wait  in  the  open  area  and  it  was  a  major  issue  during  the  monsoon  season.    Similarly,  a  majority  of  the  Anganwadi  Centres  functioned  out  of  a  temporary  structure  and  did  not  have  the   desired   equipments,  medicines   and   facilities   such   as   toilet   and   electricity   connection.  While   the   5  ASHA  workers,  AWWs  and  AWHs  and  the  ANM  are  fully  committed  to  their  roles  and  responsibilities,  the  aforementioned  gaps  are  a  major  hinderance   in   ensuring  quality  delivery  of  healthcare   services   to   the  intended  beneficiaries   i.e.   the  pregnant  women,   lactating  mothers,   children   in   the   age  group  0-­‐6  years  and  adolescent  girls.      However,   the   in-­‐depth   analysis   done   by   the   team   and   interaction   with   community   members,   health  workers  and  experts  highlighted  that  infrastructural  gaps  are  only  the  tip  of  the  iceberg  and  there  needs  to  be  an   increased  focus  on  fostering  healthy  practices  and  improving  community  awareness  on  health  and   hygiene  matters.   As   Dr.   Chittaranjan   Sahu,   a   health   expert   approached   by   the   team,   pointed   out,  “Various  health  ailments  in  the  village  are  owing  to  poor  sanitation  practices,  lack  of  exercise  and  yoga,  lack  of  poor  menstrual  hygiene  as  well  as  general  disregard  for  personal  hygiene  among  certain  sections  of   the   population.   It   has   resulted   in   cases   of   urine   infection   among   women   and   multiple   cases   of  malnutrition  among  children.”    Therefore,  based  on  this  assessment,  feedback  from  various  stakeholders  and  inputs  from  health  experts,  the  team  prepared  a  detailed  roadmap  for  strengthening  the  healthcare  setup  in  Kalika  with  a  focus  on  addressing   infrastructural   gaps  as  well   as   taking  up  community  awareness   initiatives.  The   idea  was   to  create   an   ecosystem  where   good  and  affordable  health   services   are   accessible   and  available   to   all   and  there   is   increased   community   awareness   on   the   importance   of   personal   hygiene,   good   sanitation   and  exercise.      As   part   of   this   roadmap   and   to   further   strengthen   the   plan,   the   team   initially   placed   emphasis   on  celebrating  the  International  Day  of  Yoga  to  promote  yoga  among  school  children  and  conducting  a  mini  health  camp  for  immediate  detection  and  treatment  of  health  ailments.  

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Celebrating International Day of Yoga – Ama Gaon, Swastha Gaon  Under  the  Saansad  Adarsh  Gram  Yojana  (SAGY)  scheme  of  the  Government  of  India,  a  major  focus  is  on  fostering   healthy   habits   and   promoting   daily   exercise.   So  when   the  world   geared   up   to   celebrate   the  Second  International  Day  of  Yoga  on  21st  June,  the  team  in  consultation  with  Mr.  Jena  and  PRI  members  also  decided  to  promote  the  ancient  Indian  discipline  among  the  students,  teachers  and  health  workers  in  Kalika.  The  Sarpanch,  Ganga  Babu   suggested   that   the  Yoga  Day   could  be   celebrated  at   the  playground  inside  the  Hatigarh  School  compound  and  also  gave  the  tagline  of  ‘Ama  Gaon,  Swastha  Gaon’  for  the  event.  The  team  also  sought  permission  of  the  District  Education  Officer  (DEO)  and  the  Block  Education  Officer  (BEO)  for  conducting  the  Yoga  Camp,  to  which  they  readily  agreed  and  also  informed  the  teachers  about  the  same.      Now,   one   of   the   key   components   of   the   SAGY  Development   Programme   is   to   identify   implementation  partners  and  outstanding  models,  which  can  be  leveraged  in  the  GP.  Accordingly,  the  team  approached  Dr.  Chittaranjan  Sahu  from  Healthy  Life  Clinic,  a  prominent  institute  promoting  AYUSH  in  Balasore.  Dr.  Sahu   assured   full   cooperation   and   support   for   this   initiative   and   said   that   two   yoga   experts   from   his  institute  would  lead  the  yoga  day  celebrations  in  Kalika.      Subsequently,   the   team   and   Ganga   Babu   got   down   to   making   logistical   arrangements   such   as   mats,  loudspeaker  and  mike  for  the  event.  In  the  meantime,  the  MPs  office  designed  a  poster  for  the  event  and  got   it   printed.   Finally,   on   21st   morning   at   7   am,   the   yoga   day   celebrations   started   in   Kalika   and   the  trainers   from  Healthy  Life  Clinic   introduced  various  asanas   to   the  attendees,  which   included   students,  teachers,  frontline  health  workers,  curious  onlookers  and  PRI  members.  Mr.  Nag,  the  lead  trainer  talked  about  the  importance  of  Yoga  in  ensuring  a  healthy  life  and  also  emphasized  on  breathing  exercises  and  meditation  techniques,  so  that  the  attendees  could  practice  the  same  on  a  regular  basis.      

Attendees   Number  

School  Children   170  

School  Teachers   10  

Grass-­‐root  Health  Workers  (AWW,  ANM,  ASHA)   9  

PRI  Members     5  

Team  Members  and  Trainers   4  

Others   15-­‐20  

 The  response  of  the  participants,  including  students  and  teachers,  was  overwhelming.  Most  of  the  students  looked  eager  and   inquired   if   the  session  was   to  continue  over   the  week.  The   teachers  and  health  workers  also  approached  the  trainers  with  specific  health  issues  and  requested  for  more  such  sessions.    

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Organizing a Mini Health Camp at the Panchayat Bhawan – Understanding the health

problems in detail Post   the   Yoga   Day,   the   team   decided   to   leverage   Dr.   Sahu’s   expertise   and   knowledge   for   further  interventions  and  proposed  the  idea  of  a  long-­‐term  engagement  to  truly  make  Kalika  a  Swastha  Gram.  Dr.  Sahu  responded  positively  to  the  request  and  agreed  to  actively  participate  in  the  Model  Village  Program.  Hence,  the  team  invited  Dr.  Sahu  to  conduct  a  mini  health  camp  to  study  the  health  issues  in  the  GP  and  provide   free   treatment  and  medicines   to  some  needy  villagers.  The   idea  was   to   further  strengthen   the  roadmap  for  resolving  health  related  problems  in  the  village  with  inputs  from  Dr.  Sahu.      Accordingly,  the  team  organized  a  mini  health  camp  or  consultation  session  at  the  Rajiv  Gandhi  Jana  Seba  Kendra  on  the  28th  June  and  word  about  the  same  was  spread  on  a  small  scale  across  a  few  habitations  in  the   vicinity   of   the  Kendra.   The   team  also   especially   invited   the  ANM  and  ASHA  workers   to   attend   the  

Pictures from the International Day of Yoga Celebrations in Kalika

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 consultation  session  since  it  was  good  platform  for  them  to  learn  more  about  Naturopathy  and  Medicine.  Over   the  next   two  hours,  Dr.  Sahu  attended  a  sizeable  number  of  patients  and  also  provided  them  free  medicines.  The  beneficiaries  comprised  of  children,  women,  adults  and  old  aged  villagers.  Dr.  Sahu  made  it   a  point   to   impart  Yoga   lessons   for   specific   ailments   complained  by   the  patients.  The  health  workers  sitting  next  to  Dr.  Sahu  paid  great  attention  and  noted  all  the  relevant  points.      

 The  response  to  the  Mini  Health  Camp  was  extremely  positive.  The  participants  expressed  great  interest  for  more  such  health  camps,  which  according  to  them  was  a  quick  and  easy  solution  for  their  health  problems.  The  health  workers  also  took  a  lot  of  advice  from  Dr.  Sahu,  who  handed  the  remaining  medicines  to  the  ANM  and  ASHA  workers.  Dr.  Sahu  particularly  pointed  that  women  in  the  village  are  very  weak  and  there  are  a  lot  of  anaemia  and  urine  infection  cases.        

     

The above set-up gave Dr. Sahu a first-hand account of the health status of Kalika, directly from patients and the grass root health workers. Accordingly, he was now able to help us strategically design the future steps for health care delivery to Kalika residents. According to Dr. Sahu, most of the health ailments in the GP, particularly among women and children, are due to lack of proper hygiene and sanitation.

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Health Camps

   

• Introduce  discipline  in  the   lifestyle  of  villagers   through  Yoga   and   inculcate  healthy   habits   so   as   to   reduce  financial  burden  and  health  problems    •Plan   4   to   5   Day   Yoga   Camps   at  regular   intervals   and   at   different  locations   within   the   GP,   including  community  areas  and  markets  

 •Plan   construction   of   a   Community  Center   that   has   a   Yoga   room  dedicated   to   Yoga   Classes   and  Ayurvedic  treatment  

 •Post  the  organization  of  Yoga  Camps  –  permanently  place  Yoga  trainers   in  Kalika  and  levy  fees  from  villagers  for  future  sessions  

   

•Plan  Health  Camps  at  all  11  wards  on  a  Sunday  of  each  month   throughout  the   year.   Dr.   Sahu   has   agreed   to  provide   Ayurveda   and   Naturopathy  treatment   for   all   sessions.   Idea   is   to  provide  a  long  term  low  cost  solution  to  health  problems  of  the  GP    •Conduct   Free   Blood,   Urine,  Hemoglobin  and  Diabetes  Test    

 •Estimated   cost   of   INR   3-­‐4   lakhs   for  Medicine  to  be  paid  to  Dr.  Sahu  

 •Organize   awareness   sessions   for  women   of   Kalika   with   support   from  Dr.  Sahu’s  spouse  who  is  also  actively  involved   in   Yoga   and   Medicine.   She  has   agreed   to   travel   to   Kalika   with  Dr.  Sahu  on  Sundays  

 

Yoga Center

Cost Analysis of Year Long Medicine

Camp  v Number of Camps

(Wards) - 11 v Population per

ward (assumption) – 500 v Attendees per

session (assumption) – 150

v Cost of Medicine (Ayurveda) per person – INR 200

v Total  Cost  –  200  *  150*12  =  INR  3.6  Lakhs