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Transcript of Mewat Healthcare Project
DOCC PROJECT REPORT
Feasibility study of mobile
medical unit operations in
Mewat
Helpage India
By
Charan Puneet Singh (PGP-07-102)
2008
Centre for Development of Corporate Citizenship
SP Jain Institute of Management and Research
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Preface
The project began on 24th
March at HelpAge office in New Delhi. At a meeting with the staff
of Helpage, I was given the required reference material and was asked to explore possibilities
of starting Mobile medical units in Mewat.
At the outset, I didn’t even know where Mewat was! It being a new district most maps avail-
able don’t show where exactly the place is. Mewat is referred to as land of the Meo-Muslim
community spread over Haryana, UP and Rajasthan in the Aravalli region.
I started the project with field visit at Gehlap village ahead of Palwal on the Delhi-Alwar
Highway. It was an eye opener visit for me. From all the glorious talks about emerging India,
rise of Asian powers, world of malls and hyper malls, an easy life and then 40 km outside the
capital into an abyss of darkness. Gehlap did not have a doctor anywhere till 9km at PHC Ha-
thin. Talking to villagers there, understanding their problems showed me a face of my coun-
try I had not seen before. It made me aware of the acute medical, psychological and social
problems the aged in rural India have to face.
My subsequent visits were to the Primary Health Centres at Hathin, Nagina, Nuh and to the
Civil Hospital at Mandi kheda. I visited some NGOs in the region like Chandipur Health As-
sociation (Gehlap), MSEDS (Punhana) and Deepalaya (Tauru). I also visited the district col-
lector’s office to collect data about the socio economic profile of the district.
The project gave me an opportunity to look at rural India closely. I got to see effectiveness of
various government policies like the Prime Minister’s road project, the National old age
pension scheme, the girl child education scheme and their impact on the real benefactors.
I presented my findings and recommendations on the 6th
May to Helpage in New Delhi. It
was a great exchange of ideas and hopefully Helpage will be starting operations there in the
near future.
This project under DOCC has given me insights into rural India which have changed my per-
ceptions about development. There can be no development if the rural India is not taken
along. Also with a rapidly growing aged population, aged rights simply cannot be ignored.
Society has to give them their due. Someone once said that India lives in its villages. Now I
can truly comprehend the meaning of this small but great statement.
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Acknowledgement
I am grateful to Helpage India for giving me this opportunity to work with them.
I would like to thank Mr. Mathew Cherian, Ms. Anupama Dutta , Mr. Manjeet Singh and Mr.
Suresh for their constant support, guidance and resourcefulness through the project.
I would also like to thank Dr. H.S. Randhawa, chief medical officer, Mewat for taking time
out of his busy schedule to listen, guide and encourage us in this project.
I would like to acknowledge efforts of Mr. Shiv Kumar in Chandipur Health Association
(Gehlap), Dr. Shamim Ahmed (Nuh), Mr. Avinash Pandey (Deepalaya- Ghuspethi) and Dr.
Aziz (MSEDS-Punhana) for their hospitality and help extended during field visits. Without
their guidance in the field areas, I could not have managed to do this project.
Finally I feel indebted to Prof. Nirja Mattoo, Chairperson, Centre for Development of Corpo-
rate Citizenship, for identifying this opportunity to work with a great organization like Hel-
page.
I would like to thank my team mates in the DOCC Committee for their hard work and dedica-
tion.
Charan Puneet Singh
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Contents Contents .................................................................................................................................................. 4
List of Tables and Graphs ......................................................................................................................... 8
Executive Summary ................................................................................................................................. 9
1. Introduction .................................................................................................................................... 10
2. Project Details ................................................................................................................................. 11
2.1. Scope .......................................................................................................................................... 11
2.2. Methodology .............................................................................................................................. 11
2.3. Strategy for the Project ............................................................................................................... 12
3. About Helpage India .......................................................................................................................... 14
3.1. Mission ........................................................................................................................................ 14
3.2. Affiliations ................................................................................................................................... 15
3.3. History......................................................................................................................................... 15
3.4. Current Operations ...................................................................................................................... 15
3.5. Overview of Major Helpage Initiatives ......................................................................................... 16
3.5.1. Mobile Medical Units or MMU: ........................................................................................ 16
3.5.2. Sponsor A Grandparent Project ........................................................................................ 17
3.5.3. National Small Grants Program ........................................................................................ 17
3.5.4. Poorest Areas Civil Society (PACS) .................................................................................... 18
4. PROFILE OF MEWAT ........................................................................................................................... 20
4.1. Historical background .................................................................................................................. 21
4.2. Route Map .................................................................................................................................. 24
4.3. District at a Glance ...................................................................................................................... 26
4.4. WHY MEWAT IS NOT DEVELOPED? .............................................................................................. 32
4.4.1. Illiteracy ........................................................................................................................... 33
4.4.2. Poor Health ...................................................................................................................... 35
4.4.3. Crime ............................................................................................................................... 36
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4.4.4. Low Farm Yields ............................................................................................................... 37
4.4.5. Politics ............................................................................................................................. 37
4.4.6. No Sops to Investors ........................................................................................................ 37
4.5. Mewat Development Agency, Nuh .............................................................................................. 38
4.5.1. Introduction ..................................................................................................................... 38
4.5.2. Focus areas ...................................................................................................................... 38
4.5.3. Work done by MDA .......................................................................................................... 39
5. Health Survey in Punhana .................................................................................................................. 42
5.1. Why Punhana? ............................................................................................................................ 42
5.2. Partner NGO: MSEDS ................................................................................................................... 42
5.3. Villages surveyed: ........................................................................................................................ 43
5.4. Major Findings from the Survey:- ................................................................................................. 43
5.4.1. Health .............................................................................................................................. 43
5.4.2. Sanitation......................................................................................................................... 45
5.4.3 Drinking Water ................................................................................................................. 46
5.4.4. Transport Services ............................................................................................................ 46
5.4.5. Communication ................................................................................................................ 46
5.4.6. Law and Administration ................................................................................................... 46
5.5 Conclusions .................................................................................................................................. 47
6. Recommendations ............................................................................................................................ 48
6.1 For Long term Intervention .......................................................................................................... 48
6.2. Short Term Intervention .............................................................................................................. 51
6.3 Medium Term Intervention .......................................................................................................... 51
7. Feasibility ........................................................................................................................................ 53
7.1. SWOT Analyses ............................................................................................................................ 53
7.2. Functional Feasibility ................................................................................................................... 54
7.3. Operational feasibility ................................................................................................................. 57
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7.4. Financial Feasibility ...................................................................................................................... 59
8. Case Study: Deepalaya Gram ........................................................................................................... 61
8.1 Introduction ................................................................................................................................ 61
8.2. Why Mewat? ............................................................................................................................... 61
8.3. Other Projects involved: ............................................................................................................. 62
8.4. About the Project ........................................................................................................................ 62
8.5. Mobile Health Unit ...................................................................................................................... 62
8.5.1. About the Region ................................................................................................................. 62
8.5.2. Nature of Health Services Offered: ................................................................................... 63
8.6. VISION OF THE PROJECT ................................................................................................... 65
8.7. FUTURE PLANS ................................................................................................................. 65
9. Risk Factors ..................................................................................................................................... 66
Appendix: A More On MMUs ................................................................................................................. 67
A.1 MMU Collage ............................................................................................................................... 67
A.2 MMU India Coverage ................................................................................................................... 68
A.3 North India Operations MMU ...................................................................................................... 68
A.4 A.4. MMU Cost Break Down ........................................................................................................ 70
B. Sponsor a Gran Program- national coverage ...................................................................................... 71
C. National Age Care Small Grants Scheme- National coverage .............................................................. 72
D. PACS National Coverage .................................................................................................................... 73
E. District Statistics ................................................................................................................................ 73
F. More on MDA .................................................................................................................................... 75
F.1 Members of Mewat Development Board...................................................................................... 76
F.2. Members of Mewat Development Agency................................................................................... 77
E. Health Survey Punhana ...................................................................................................................... 79
E.1. Survey Form Template ................................................................................................................ 79
General Information .......................................................................................................................... 79
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Healthcare information ...................................................................................................................... 79
Education facilities ............................................................................................................................. 80
Water, Sanitation and Infrastructure Facilities ................................................................................... 80
F. Field Report – Gehlap Village.............................................................................................................. 84
F.2 FIELD VISITS- NUH, MANDI KHEDA, NAGINA ..................................................................................... 87
Plan of visit: ...................................................................................................................................... 87
Summary of field visit: ...................................................................................................................... 87
Meeting with Dr. Shamim Ahmed ...................................................................................................... 87
Action Points: .................................................................................................................................... 89
Talks with Help Age India ................................................................................................................. 89
Meeting with Dr. HS Randhawa, MCO .............................................................................................. 89
Action Point....................................................................................................................................... 90
G. Project Plan ....................................................................................................................................... 91
H. Abbreviation and References ............................................................................................................. 91
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List of Tables and Graphs
S.N. Type Title Page Num-
ber
1 chart Block wise Population& Villages 21
2 chart land use mewat-1 26
3 chart land use mewat-2 26
4 chart Population distribution 26
5 chart literacy level comparison 27
6 chart Sex Ratio Comparison 27
7 table block wise Population 28
8 chart Pie distribution-Population 28
9 table Worker distribution 28
10 chart Worker distribution 28
11 table Pensioner Population-block
wise 28
12 chart Pie distribution-Pensioners 29
13 table BPL stats block wise 31
14 chart Pie distribution-BPL Families 31
15 chart MDA Fund allocation 1980-2006 39
16 chart MDA Fund allocation 2007 40
17 table Cost Breakdown-Solution1 50
18 table Medical Team-Deepalaya 63
19 table MMU Operations-North India 69
20 table MMU Cost Breakdown 70
21 table School Enrolment Stats 74
22 Chart distribution of School Enrol-
ment 75
23 Table members of MDB 76
24 Table Members of MDA 77
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Executive Summary
India is a country of 81 million aged people, 33% of whom live below the poverty line, 90%
of whom belong to unorganized sector and do not have a social security to rely on and 73%
are illiterate. Helpage tries to reach out to these disadvanged elders through different pro-
grams focusing on health, finance and emotional aspects.
Primarily a fund generation and fund disbursing agency, Helpage supports several NGOs
working at grassroots level through technical, financial, legal and consultative intervention.
Mobile Healthcare is one program directly implemented by Helpage. A mobile van with a
social worker, doctor and a pharmacist on board dispense free medicines and healthcare to
disadvantaged old people in rural areas and urban slums where healthcare facilities are re-
mote and inaccessible. The rural healthcare infrastructure based on PHCs is inadequate to
meet demands of the aged because of their inaccessibility and limited functionality.
Mewat is predominantly a rural district in Haryana. Though adjacent to Gurgaon and Farida-
bad, it has remained poor and undeveloped because of various reasons explained further in
this report. High illiteracy, poor income levels, high crime rates, few economic or educational
opportunities mark this region.
The healthcare infrastructure is in bad shape. The 17 PHCs employing less than 90 doctors
are inadequate to meet demands of the 12 lakh population spread over 500 villages. Problems
become worse for the aged. With breakdown of the joint family system and the youth migrat-
ing to economically developed cities, the old Meo have to fend for themselves. Lack of pub-
lic transport services, cost of healthcare in cities compound their problems. Frustrated, their
only hope is the numerous private doctors of dubious qualification. Backwardness, illiteracy
and superstitions compound the problems.
The Mewat Development Agency, responsible for funding development projects in the region
is aware of the health situation, but its focus has been child care and strengthening the exist-
ing health delivery mechanism. It is aware of the usefulness of Mobile Healthcare in the re-
gion and started operations with partner NGOs in 2003. These were stopped in 2004 due to
administrative difficulties.
There is a huge need for Mobile healthcare in the region. Three plans have been recommend-
ed in this report difference being in cost and time period of intervention. Under first plan,
Helpage can use the existing MMU at Faridabad to visit selected villages in Hathin block
along the Delhi Alwar highway on few weekdays and on weekends. Referral patients can be
sent to Palwal.
Under the second plan, Helpage can acquire an MMU and start a medical only MMU service
based out of Gurgaon and into Nuh, Tauru and Nagina. Referral patients can be sent to PHCs,
private doctors in Gurgaon.
Under the third and long term plan, Helpage could coordinate with MDA, use MMU in Pun-
hana block for preventive and prescriptive cure. These will use the existing PHCs as base and
for referral patients. Helpage could set up training modules for RMPs and prepare multimedia
kits for geriatrics care. Coordinate operations with government agencies, PHCs, CHCs and
other NGOs in the region.
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1. Introduction
Helpage works for the rights of old people around the world. Helpage India works to improve
the lives of old people through various programs like supporting old age homes, running toll-
free counseling services, running free mobile medical units etc.
It works as a funding agency between NGOs who work directly with people and funding
sources which could be private individuals, corporate, agencies or government.
The Mobile Medical Unit program is a flagship program of Helpage, running since 1982. A
Mobile Medical Unit or an MMU as it is called is an OPD clinic and pharmacist, which tra-
vels from village to village in remote areas. Often there are no alternate systems for health-
care deliveries in these regions as these regions are poor, remote and backward. Currently
there are 52 such MMUs serving the country in places like Jammu and Kashmir, Sikkim and
Kerala.
Mewat is a region close to Delhi, populated by Meo community and spread over southern
parts of Haryana, over the borders with UP and Rajasthan. Though it is close to the bustling
new economy townships of Gurgaon and Faridabad, Mewat is a poor, remote and conserva-
tive area. It has a population of 12 lakh, with little in the name of infrastructure for schools
and hospitals.
This project concerns with the feasibility of starting Mobile Medical Units in Mewat. The
feasibility has been discussed with regards to operations, functions and finances.
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2. Project Details
2.1. Scope
The scope of this project is to suggest how Helpage can start MMU Operations in the region.
Three approaches have been given: short term, medium term and long term.
This report does not include a village by village survey of the region, which would be re-
quired before deciding the actual route of the Mobile Unit. Such a survey would require more
manpower and time and a similar survey has been done for the health commissioner in Chan-
digarh.
The report outlines strategic requirement of MMUs in the region through a socio economic
analyses, followed by a health survey of selected block and feasibility.
A case study has been included about Deeplaya which has been working with children in
Mewat for over 5 years and also running a Moble Medical Unit.
2.2. Methodology
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The methodology followed for this report was recursive and can be broadly divided in three
phases.
Phase 1: Secondary Research: Using the contacts given by Helpage of partner NGOs in the
region and telephonic conversations, basic data was collected about Mewat for major towns,
villages, approach, etc. This was backed by internet research about Mewat for different
NGOs already working in the region, their areas of concern, socio economic make up of the
place etc.
Phase 2: Field Visits: based on information collected during secondary research, made field
visits to NGOs, schools, hospitals, private and government doctors, police officials, eminent
social workers in the region. Also a health survey was conducted in a few villages of the
Punhana district. Here information was collected on disease pattern, effectiveness of the gov-
ernment apparatus and efforts of NGOs and private healthcare.
Phase 3: Analyses: Based on findings from field visits did further research, discussed the
findings with Helpage contacts and developed further action plan
2.3. Strategy for the Project
The aim of the project is to study the feasibility of Mobile Medical Units in the Mewat district of
Haryana. The feasibility aspect can be looked into three ways:-
1. Operational feasibility
2. Financial feasibility
3. Functional feasibility
Under Operational feasibility we address issues like “is it possible to run operations here?”
“Is there enough population of aged people here?”
“Is it possible to find doctors, paramedical staff here?”
“Is there a hospital where locals can be referred to in case need be ?”
“Is it possible to run operations within Mewat and not from Delhi or Gurgaon?”
Under Financial Feasibility, we addressed issues like
“ is it possible to make operations self funded ?”;
“ is it possible to get sponsors with interest in development of Mewat?”
“ is it possible to get MDA funding for the project?”
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“ Is it possible to use local resources to keep cost of healthcare low to the local populace?”
Under Functional feasibility, we address issues like
“ is intervention through mobile medical units likely to make a lasting impact?”
“ is helpage the right organisation to intervene in the region?”
“ can the operations be made self sustainable in the region?”
Besides this a SWOT analyses was included to identify strengths and weaknesses of Helpage for
running such an operation and the threats and opportunities identified in running Mobile
Healthcare units in Mewat.
Helpage criteria for Mobile Medical Units:-
1. Target population (60+ people)
2. Population strong enough to support more than 20,000 transactions in a calendar year.
3. There should not be access to similar service offering free or subsidised medical care
by government or NGOs.
4. Presence of funding agencies with dedicated budgets on healthcare.
Strategy adopted was:-
1. Get rough estimate of the target population in the region.
2. Understand economic health of the target population
3. Understand existing healthcare set up both from sides of consumer and provider
4. Identify whether Helpage criteria can be met in the region
5. Suggest a suitable entry strategy in the region
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3. About Helpage India
HelpAge India features among the leading non-profit organizations of the country. Its activities
are oriented toward improving the quality of life for aged persons who are financially inse-
cure and lack access to healthcare facilities.
HelpAge India is secular, not-for-profit organization registered under the Societies' Registration Act
of 1860. It was set up in 1978, and since then it has been raising resources to protect the rights of
India’s elderly and provide relief to them through various interventions.
It works to voice the needs of India‟s 81 million “grey” population, and directly impact the
lives of 15 lakh elders through our services every year. It advocates with national & local government to bring about policy that is bene-
ficial to the elderly.
It makes the society aware of the concerns of the aged and promotes better un-
derstanding of ageing issues.
It helps the elderly become aware of their own rights so that they get their due
and are able to play an active role in society.
It conducts research in issues related to ageing, and promotes the study of age-
care and its related problems.
Promotes Advocacy for:
Pensions and Social Security
Geriatrics and Home Care
Policies Beneficial to elderly
Barrier Free residential care
Transportation and Mobility
Involvement and Recreation
Safety and Security
3.1. Mission
HelpAge India's mission is to work for the cause and care of disadvantaged older
persons and to improve their quality of life.
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3.2. Affiliations
HelpAge India is one of the founding members of HelpAge International, a high profile
body having 51 member countries representing the cause of the elderly at the Unit-
ed Nations.
It has received a special testimonial from the United Nations for "Dedicated service
in support of the United Nations Programme on Ageing".
HelpAge India is also a full member of the International Federation on Ageing.
3.3. History
The origins of HelpAge India go back to the late 1960s when the then speaker of
the Lok Sabha visited his counterpart in the House of Commons(UK), who was
also honorary secretary of an organisation called Help The Aged. He came
back with a vision of setting up something similar in India.
But it took 7 years for this vision to take shape. In March 1974, when Mr. Jack-
son Cole, founder of HelpAge International visited India, an intrepid philanth-
ropist named Samson Daniel approached him for financial help to set up a
member organisation in Delhi. A far-sighted man, Mr. Cole instead offered to
train him to raise funds. After a three month training course in London, Mr.
Daniel and his wife returned to India and organised a sponsored walk with
schoolchildren in Delhi. It was so successful that in 1975 HelpAge Internation-
al recruited more staff to cover Bombay, Madras and Calcutta.
In April 1978, HelpAge India was registered in Delhi. Within three months it
became autonomous as financial support ceased from UK. Soon after, in July,
the Society was awarded Certificates of Exemption under Sections 12A and
80G of the Income Tax Act, 1961, thus indicating general confidence in the
Society’s affairs.
3.4. Current Operations
55 million older people in India do not have the luxury of relaxing in their autumn years. Hover-
ing at and below the poverty line, they struggle daily to muster basic meals, and so long as
they work, they survive. It is for them that HelpAge India exists. It implements a number of
programs and services in the areas of rights, social protection, and health care and enables
them to live with dignity and independence
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52 MMUs (Mobile Medicare Units) provided health care at the doorstep of the needy aged. New Units were launched in Raipur & Madurai.
The MMU at Nagpur worked in Vidarbha, providing relief to families affected by farmer suicides.
274 Old Age Homes, 72 Hospitals and 113 Day Care Centres have been sup-ported.
15,985 destitute older people were covered under the Sponsor-A-Grandparent Programme. 230 new senior citizens were included in the fold. 24,500 cataract operations were enabled, through 48 projects. Helplines for senior citizens began functioning at Chennai (1253) and Delhi (1291) with support from police.
3.5. Overview of Major Helpage Initiatives
3.5.1. Mobile Medical Units or MMU:
What is an MMU?
A Mobile Medicare Unit is a moving dispensary, manned with a qualified doctor, pharmacist,
social worker and driver. It is fully equipped with medicines. Treatment and medicines are
dispensed free of cost or at a nominal rate to needy older people. All MMUs have referral tie-
ups with local hospitals for complicated and advanced cases.
Promoting health consciousness amongst the elderly and their family members and encourag-
ing attitudinal transformation with respect to the well-being of the older persons are integral
parts of the programme.
Besides providing healthcare, MMUs take on individual initiatives within their areas of work
such as:
Disaster Relief:
During major disasters such as those in Tsunami in southern part of India, Earthquake in J&K
and Gujarat, Super Cyclone in Orissa, MMUs immediately got involved in rescue and relief
work in the affected areas.
Community Development:
The MMU staff in MMUs counsel people on hygiene and sanitation, and on the other health
related aspects. They also mobilize volunteers to look after older people in their localities.
Awareness Camps:
Awareness camps are held in rural areas to educate the people on various diseases and their
symptoms, and what precautions they should take to ward off illness.
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Specialized Camps:
Concentrating on one particular disease, hygiene, cleanliness and nutrition are held in villag-
es. Through these camps it is not only the elderly who are educated but also their careers,
guiding them to look out for symptoms etc. Elderly people suffering from the disease are
treated and given medication. Referrals are also made for specialized cases to local hospitals.
elderly who are educated but also their careers, guiding them to look out for symptoms etc.
Elderly people suffering from the disease are treated and given medication. Referrals are also
made for specialized cases to local hospitals.
For More on MMU refer Appendix A
3.5.2. Sponsor A Grandparent Project
This program started in 1978, is in partnership with more than 200 NGOs in 25 states of the
country and is presently servicing about 16,000 beneficiaries. The program is Community
based but also involves old age homes and day care centers across the country.
This program has been etched on a welfare mode, focusing on subsidizing the basic needs of
the older people, such as food, clothing, medicines, repair of houses etc who are economical-
ly deprived and socially alienated. It also aims to foster independence and dignity, thereby
restoring their rightful place in their families and society. Each beneficiary is provided with
cash and kind worth about Rs. 500 a month.
In 2005, the program underwent a shift from "welfare" to "development". The new approach
focuses on the poorest of the poor, and looks at community development rather then individ-
ual welfare.
For More on above refer Appendix B
3.5.3. National Small Grants Program
The National Age Care Grants program defines the spirit of HelpAge India mission of work-
ing for the cause and care of the elderly.
Its objectives are:-
1. To support & guide local non government organizations for taking up welfare & develop-
ment projects for disadvantaged older people
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2. To build the capacity of voluntary organizations on age care,
3. To sensitize the government, media, civil society & general public on ageing issues & con-
cerns of the older people.
Under the program, HelpAge India provides limited financial support (grants) to non government
organizations for executing time-bound projects aimed at securing an improved quality of life
for a given target of older person's population (beneficiaries). The old age specific problems
of social, economic, health and emotional security are addressed in this program. The grant
support is in the area of old age homes, day care, eye care, special health care, livelihood, re-
search and training, emergency relief, rights of the older people etc. The average grant per
project is of Rs. 30,000 and an average life span of one year.
Since its inception, HelpAge India has supported over 2300 projects with a value of more than
Rs. 880 million touching lives of over 1,000,000 older persons.
3.5.4. Poorest Areas Civil Society (PACS)
The primary objective of the PACS project (Oct 05 - Dec 07) is to strengthen the awareness
and capabilities of poor people to demand and use their rights - political, economic, social
and human - and services to improve their own lives. The program seeks to achieve this
through a network of Civil Society Organization working for the poor.
This HelpAge India project is designed to raise awareness amongst the older persons on the
relevant rights and social welfare schemes and facilitate access to the same in some of the
most backward districts of India. The project is being implemented in partnership with local
Civil Society Organizations.
A number of Central and State government schemes have been devised to mitigate problems
faced by the aged, ranging from pensions to medical aid, travel concessions, preferential in-
terest rates. Further, the destitute aged also qualifies as potential beneficiaries of a slew of
poverty reduction/ relief schemes. But there is very little mass awareness on the same. Bene-
fits of the scheme rarely ever reach the aged if they are poor and illiterate, if they live in re-
mote backward regions and if they belong to socially oppressed communities. As later men-
tioned the surveys conducted during the project, plans remain on paper and rarely make an
impact on ground.
The prevalent poor structures of communication, implementation and enforcement have ex-
acerbated the problem of accessibility to these schemes and services. In addition, older per-
HelpAge India| Fighting Isolation, poverty, neglect
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sons rarely receive support from Panchayat and other formal political institutions; and there
are virtually no associations/ institutions working for their interests at the local level.
Success of PACS has emboldened Helpage to work stronger in this area and Helpage
aims to model itself as a rights based organisation working for benefit of the elderly in
the next 10 years.
[For more on PACS please use the gallery at
http://www.helpageindiaprogramme.org/AgedRightsAdvocacy_imagegallery.html]
The focus of the PACS program is Awareness, Access and Advocacy. Recently there has
been an attempt to integrate the PACS program with the MMU program. The MMUs through
their long lasting and strong relationships with the rural populace enjoy their trust and have
been instrumental in increasing awareness about benefits offered by the government to them.
They have helped increase penetration of the National Rural Health Mission, Old Age
Pension Schemes, National Health Insurance Scheme etc. Though not formally integrated
with PACS, efforts have been made in this direction and the future endeavors will work to
make this integration stronger.
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4. PROFILE OF MEWAT
At the time of its formation on 1st November, 1966, Haryana State had seven districts. Thereafter
13 new districts were notified from time to time by changing the boundaries of the existing
districts. The Mewat district was carved out from erstwhile Gurgoan and Faridabad districts,
which came into existence on 4th
April 2005 as the 20th
district of the Haryana State. The
newly constituted district comprises of three sub-divisions namely Nuh, Firozpur Jhirka and
Hathin. The district headquarter is located at Nuh. The district comprises of six blocks name-
ly Nuh, Tauru, Nagina, Firozpur Zhirka, Punhana and Hathin. There are 532 villages in the
district out of which 27 villages are either uninhibited or are jurisdiction of Municipal Com-
mittees.
Geographically, Mewat District is situated between 26-degree and 30-degree North latitude and
76-degree and 78-degree East longitude. Gurgaon district bounds it on its North, while Rewa-
ri district lies to its West and Faridabad district to its East. On South, the district shares its
boundary with the State of Rajasthan. Mewat district is largely comprises of planes. Inconsis-
tency in Mewat topography is evident from its patches of land with hills and hillock of the
HelpAge India| Fighting Isolation, poverty, neglect
21
Aravali Mountain on the one hand and plains on the other. Thus, physio-graphically the area
is divided into two tracts- upland and low land.
4.1. Historical background
Mewat - Land of the Meos, has its
genesis in its tribal inhabitants, the
Meo tribals, who are agriculturalist.
The area is a distinct ethnic and socio-
cultural tract. The Meos, who trace
their roots to the early Aryan invasion
of Northern India, call themselves
Kshatriyas and have preserved their
social and cultural traits to a surprisingly large extent, unlike the other tribes of nearby areas.
During the regime of the Tughlak dynasty in the 14th century A.D., these people embraced Islam
but till today, they have maintained their age-old distinctive ethno-cultural identity.
Historically, the region has been extremely turbulent and has been subject to repeated invasions
and resultant plundering throughout the post-Vedic period, largely due to the situational pe-
culiarity of the area and the non-sub-jugative attitude of the people. The destruction and de-
vastation over the centuries resulted in backwardness and gross under-development of both
the area and its proud people.
According to the Census of India 2001, the total population of Mewat district was 9,93,617 of
which 46,122 (4.64%) lived in urban areas and the major chunk 9,47,495 (95.36%) of the
population lived in rural areas. Out of the total population of 9,93,617, the district has
5,24,872 males and 4,68,745 females. The SC population in the district is around 78,802. The
total numbers of households are 1,42,822 out of which 1,35,253 (95%) are in rural areas and
remaining 7569 (5%) are in urban areas. The total number of BPL households in the district
are 39667 and APL households are 1,03,155.
The main occupation of the people of Mewat district is agriculture and allied and agro-based
activities. The Meos (Muslims) are the predominant population group and are completely
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agriculturists. They perceive themselves as such, with a sense of pride. The agriculture in
Mewat is mostly rain fed except in small pockets where canal irrigation is available. Agricul-
ture production measured in terms of crop yield per hectare in Mewat is comparatively low to
the other districts of the State. Animal husbandry, particularly dairy is the secondary source
of income for people of Mewat and those who live closer to the hilly ranges of Aravali also
keep a few sheep and goats. Milk yields are not so low in the district, however, due to heavy
indebtedness most of the farmers are forced to sell the milk to the lenders at lower than nor-
mal price, which drastically reduces their income from the milk. The poultry population in
Mewat district is much less in comparison to other districts of Haryana State.
Mewat has remained a region of backwardness even after independence. The area lags
behind the rest of Haryana on almost every yardstick of development indices, even though
the farthest point of Mewat is no farther than 145 Km. from the National Capital of India.
SOIL
The soil of the district is light in texture, particularly sandy, sandy loam and clay loam. The
upper hills are mostly barren.
AGRICULTURE
The total population of district Mewat according to the 2001 Census was 993617 of which
46122 i.e. 4.64% was urban and 947495, i.e. 95.36% was rural. The average household size
in rural Mewat was 7. The Meos (Muslims) are the predominant population group and are
virtually completely agriculturist. They perceive themselves as such, with a sense of pride.
The agriculture in Mewat is mostly rain fed except in small pockets where canal irrigation is
available. Agriculture production measured in terms of crop yield per hectare in Mewat is
comparatively low.
ANIMAL HUSBANDRY
Animal husbandry is the secondary source of income. Those who live closer to the
hilly ranges of Aravali also keep sheep and goats. Milk yield is not so low, but due to heavy
indebtedness the income from the' milk is much reduced, as many farmers have to sell the
milk to the lender at lower than normal price. The poultry population in Mewat is much less
than in rest of Haryana.
CLIMATE
Mewat falls under the Sub-Tropical, Semi-arid climatic zone with extremely hot tem-
perature in summer. Dryness of air is standard feature in Mewat except during the monsoon
season. May & June are the hottest months of the year with the temperature ranging from 30
C to 48 C, January, on the other hand is the coldest month with temperature ranging between
4 C to 25 C. Strong dusty winds are conspicuous during summer.
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RAINFALL
The annual rainfall varies considerably from year to year. The maximum rainfall is
experienced during the monsoon season, which reaches its peak in the month of July. The
principal precipitation occurs during monsoon period from June to September when about
80% of the rainfall is received. The average rainfall varies from 336 mm to 440 mm in the
district.
HUMIDITY
Humidity is considerably low during the greater part of the year. The district expe-
riences high humidity only during the monsoon period. The period of minimum humidity
(less than 20%) is between April and May.
WIND
During the monsoon, the sky is heavily clouded, and winds are strong during this period.
Winds are generally light during the post-monsoon and winter months.
REGION SPECIFIC WEATHER PHENOMENA
Mewat experiences a high incidence of thunderstorms and dust storms, often accom-
panied by violent squalls (andhar) during the period April to June. Sometimes the thunders-
torms are accompanied by heavy rain and occasionally by hailstorms. In the winter months,
fog sometimes appears in the district.
LITERACY
The literacy rate in Mewat is appallingly low, particularly in case of females. For
Muslim women in Mewat, the literacy rate ranges 1.76 % to 2.13 %, the lowest in the coun-
try. The literacy rate for men also falls below the National average and ranges 27 % to 33 %.
SEX RATIO
The Male: Female sex ratio is also lower than the National average. In Mewat there
are only 894 females to each 1000 male as against the national average of 927 females per
l000 males. Infant mortality rate in Mewat indicate similar backwardness rising up to 85 per
1000 in Punhana block, which has 80% Muslim community, as against the national average
of 72 and 75 for the State of Haryana. Maternal mortality rates are not available, but consi-
dering the poor health facilities, large family size and the adverse sex ratio, it can be safely
assumed that maternal mortality is high.
Recent Investments:
a) Classic Golf Resort
Classic Golf Resort is a wholly owned subsidiary of ITC Limited, one of India’s leading
corporate organizations. The golf course comprises of 27 holes of 3 nines each (The Ridge,
The Valley and The Canyon), which bear witness to the Master’s virtuously and golfing
HelpAge India| Fighting Isolation, poverty, neglect
24
skills. It has been designed by Jack Nicklaus. It is located off the Delhi-Jaipur Highway and
only 35 kms away from the International Airport and about 75 miles drive from Central Delhi.
The investment is important because it shows the faith ITC has put in Mewat by investing in the
region. A good location, near the airport and on the tourist map can bring prosperity to the
region.
4.2. Route Map
The map shows way to Tauru, Nuh and Nagina from New Delhi.
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b) Country Club
The Best Western Resort Country Club is situated near Manesar on the Delhi Jaipur High-
way. The Resort is only 25 kilometers from Nuh District Headquarter (Mewat). Pink City
(Jaipur) and Taj Mahal (Agra) are only 200 kilometers away. Vrindavan and Mathura are 150
kilometers. Other nearby attractions are Tijara Jain Temple (60 kilometers) and Neemrana
Fort (70 kilometers). The Resort is only 25 kilometers from sprawling Gurgaon Shopping
Mall.
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4.3. District at a Glance [Source: 2008 Statistical Data, Additional DC Office, Nuh]
1. Graph1:
2. Graph2:
3. Graph 3:
Land use indicates that region is
predominantly rural, with most area being dedicated to agriculture.
Only 70% of cultivated land is irri-
gated area.
Even though Mewat borders Gur-
gaon and Faridabad, which have
faced rapid development over the
past decade, it represents a stark
contrast. More than 95% of the 10
lakh people live in villages.
Even though farming is a common
practice in the region, yields are
low and income from farming is
low.
Most farmers have secondary oc-
cupations as well.
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4. Graph 4:
5. Graph 5:
6. Family Size: 7.5 Average
7. Economy: Agriculture Based, Rainfed Agriculture and Animal Husbandry. People living in Aravalli
are used to rearing sheep and goats and cattle, selling milk and occasionally meat for subsistence
during the non-crop months.
Milk sellers do not command good rates as transport services are remote and products cannot
reach Gurgaon or Delhi.
Recently real estate prices in Tauru and Nuh have gone up, due to construction boom in the Gurgaon
region.
8. Number of Sub Divisions: 3
9. Number of Tehseels: 5
10. Number of Blocks: 6
Mewat has low literacy levels, lower than
neighbouring districts in Haryana, Ra-
jasthan or UP. There are many reasons
for this including conservative atti-
tudes, lack of access etc. This has
compounded other problems in the
region like health, female foeticide
etc.
The sex ratio for Haryana is skewed as against
the national average. The figure for Mewat is
better than for Haryana. Though a positive
sign, it is more because health facilities in Me-
wat are not advanced enough and people can-
not afford sex determination tests at labs more
than any other reasons.
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11. Number of Villages : 531
12. Number of Panchayats: 355
13. Number of Muncipal Committees: 3
14. Number of Police stations: 6
15. Number of Police Posts: 6
Number of Police Personel :100
[ Mewat has high crime rates. Many gangs frm the region operate in Delhi and on the Delhi-Alwar
and Delhi-Mathura Highway. The police force of 6 cars and 100 police is inequipped to control crime
in the region.]
16. Length of roads: 800km including Hathin
17. Blockwise population distribution
S.N. Block Population
1 Nuh 212855
2 Tauru 126169
3 FP Jhirka 243868
4 Punhana 206858
5 Hathin 203867
Graph 6:
18. Worker Distribution
Ferozepur Jhirka is most populated. The Mewat region actually spreads out be-tween Haryana, UP and Rajasthan and there is significant floating population of Meo who keep moving from place to place for trade or in search of livelihood. Since the conditions are even worse in neighbor-ing states Meo flock to Mewat for medical treatments etc.
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S.N. Employment Number
1 Cultivator 175794
2 Agriculture Laborer 61136
3 Household Industries 7629
4 Other Workers 151647
Graph 7
:
19. . Population of Pensioners in Mewat Region (Block wise)- 2008 list
SN Tehseel / Block Pensioners 1. BDO Nuh 7970
Sec Nuh 331
2. BDO Tauru 4385 Sec Tauru 490
3. BDO Punhana 8430
4. BDO Nagina 4340
5. BDO Ferozepur Jhirka 5290 Sec Ferozepur Jhirka 542
6. BDO Hathin 10470
Sec Hathin 523 42,771
Graph 8: Distribution reflecting above table
Among Other Workers, daily wage earners like drivers, construction
workers, etc. A lot of these workers work at construction sites in Gurgaon
and Faridabad. The place also has large number of truck drivers and taxi driv-
ers working in nearby states.
The difference between the BDO – block development officer and Secretary
Count is that the BDO list accounts for rural and the Secretary list accounts
for the towns. Sum of both is taken for the whole region
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20. Health Infrastructure Of Mewat District
The government estimates
number of pensioners in
rural villages to support
people above the age of
60 in rural areas. However
the exact population of
60+ in the region is esti-
mated to be in range of 1
to 1.2 lakh. It is because in
most villages half to a
third of all elders are reg-
istered to receive pensions
Above graphic illustrates the government run medical apparatus in the district designed
as under the National Rural health Mission. The Health commissioner at State ministry
of health is the administrative head of the apparatus and is represented by the MCO at
the district level.
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12. BPL Data [Source: Additional DC Office, Nuh. 2008]
BPL Survey Distt. Mewat( 2002 )
Blocks No. families
Tauru 3179
Nuh 6725
Nagina 5653
Punhana 10195
FP Jhirka 4452
Hathin 6025
total 33229
Graph 10: BPL families
As per the figures collected in 2002 there were 33,229 BPL families in the region. These
figures are higher if we account for the floating population of Meo from neighbouring states.
The people in this category are mostly aged, illitrate, unable to take of themselves and their
dependents. Punhana bordering UP on the Delhi-Mathura Highway has the highest number of
the BPL families as opportunities for income generation are limited here.
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4.4. WHY MEWAT IS NOT DEVELOPED?
Mewat is close to Delhi and shares border with Gurgaon, a district which has seen the
fastest growth in real estate prices in the world, and is seen as the hub of Indian IT revolution.
However, Mewat continues to face fundamental problems like any other remote rural district
in India where female feticide is rampant, deaths at child birth stand highest, electricity runs
for a couple of hours a day, villages have never received clean drinking water, crime rates are
high, opportunities for education and jobs are low and the future seems bleak.
At least this was the picture till a few years ago. The government then created a Mewat De-
velopment Agency, an independent body, headed by an IAS officer, to look into the needy
areas, allocate funds and foster development in association with local agencies and outside
NGOs. The MDA has done significant work in the area.
The report first looks at the factors because of which Mewat has remained an under devel-
oped district as compared to its peers in Haryana.
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4.4.1. Illiteracy
As per the government statistics the literacy rates for men in Mewat stood at 45% and for
women at 17.5% while the average for Haryana district stood at 77% and the national average
is 78%. There are various reasons for this.
Access to education is one of them. Earlier, most villages in the district did not have schools.
For a long time after independence, no new schools opened in the district and there were few
educated people who wanted to make their children study. Coupled with a low capacity to
pay, it became a dormant case of no demand and no supply. The people also did not have the
resources or the inclination to send the kids to school in neighboring villages. Most Meo kids
as such get married early and start earning as farmers or as semi-skilled laborers.
Graph 9 (Refer Appendix E) gives the latest enrolment stats declared by the MDA. The drop-
out rates and the number of primary schools also reflect a trend. The number of primary
schools is 600+, and enrollment is highest, and as the level increases, number of school stu-
dent decreases sharply, mentioned as drop-out rate, which is as high as 85% from primary to
middle level and 75% from middle to high school level. This means if more schools are
opened, situation can definitely become better.
Another problem is the conservative mindset. 85% of the Meo people are Muslims and do not
like Modern education, which they see as an attempt by government to undermine their belief
and society. For the Muslim women, literacy rates were as low as 2% in the 2002 census.
These mindsets are changing slowly due to the effort of government, MDA and NGOs like
Dr. Aziz’s MSEDS ( Mewat Social and Economical Development Society, Punhana). Mewat
has mosques and madrassas dotting the landscape and most kids do not attend school, prefer-
ring to attend the madrassas. There are 215 madrassas in the region with several having sepa-
rate class rooms for women. However the quality of instruction here is questionable as they
are meant primarily for religious instruction.
In recent years, there has been a spurt in number of schools including girl schools because of
favourable government policies. Starting with the mid day meals scheme and free books, bag
and uniform for kids in primary school kids, enrolment statistics are high. However, in the
field trips undertaken to villages across blocks for this project, no kids could be seen attend-
ing any kind of government school, nor were they in uniform. The quality of education re-
ceived in these schools is thus doubtful.
The school enrolments are at an all time high, especially after cash remunerations offered by
the government for the girl child under the scheme. In fact at a village Naseempuri in Punha-
na district, the sarpanch proudly told us that the local primary school has higher enrolment for
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34
girls than boys. Not a small feat considering the conservative Meo society where women
have had a status akin to a servant and a birth giving machine (Most households that were
visited had women with 15 to 23 kids).
In fact Dr. Aziz, a Meo educationist and social worker refers to the mindset change that has
come about with regard to education. There was a local saying here which said, “ thoda pada
to kam chhuta, bada pada to gaon chhuta”, can be translated to “some education, will make
you disinterested in field work and excess education will render you disinterested in village
life, so why study?” This was a reason why children dropped out of school early to work in
fields, become daily wage earners in Delhi or Faridabad etc.
Now private education institutes offering professional courses and distance education learn-
ing centres of famous universities have come up in Nuh , besides there is an ITI for vocation-
al training and a planned medical college at Mandi Kheda.
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4.4.2. Poor Health
As per discussion with Dr. H. S. Randhawa , the chief medical officer of the Mewat district, a
major cause of the diseases the Meo people suffer from is the lack of awareness, lack of edu-
cation, lack of balanced diet and the resulting low hemoglobin content.
The low hemoglobin content contributes to complications during pregnancies and weak
health of new born children, as well as several problems for the older people. The common
diseases prevalent in the region are skin problems like Scabies, heart problems like Hyperten-
sion, eye problems like myopia etc.
Mortality rate is 85 per 1000 births in Punhana district which also has the highest number of
BPL families.
The poor health means lesser life expectancy for people in the region. The life expectancy for
women is lesser than for males. This is because women have a more difficult life than men.
The average age of women getting married in the area is 13. They have their first child by 14
or 15. An average woman in Mewat will have around 18 pregnancies.
Abortion or use of contraceptives is not welcome by the Meo society. By the time a woman
reaches middle age, her health is in shambles because of unusually high number of pregnan-
cies and their impact on the body. When a woman is not heavily pregnant she is supposed to
do household work, farm work and take care of family. A pregnant woman is not given any
special diet. A common practice is to make a pregnant woman spread eagled on a stove of
boiling water, supposedly to help make the child develop better. Also after the delivery, child
and mother are fed only jaggery and kept in a dark room laced with cow dung, for a week.
Such practices seem to have been inspired from dark ages.
In old age, women often face problems moving about because of joint problems; complain
about eye problems, body pains, skin problems etc. Rarely do the women get enough health-
care in old age in lieu of the hard work they do all their life.
Healthcare is also not accessible to most villagers. Though there are 17 Primary Health Cen-
ters, which are supposed to have all facilities and cater to a captive population of over 50000,
we found that people often don’t trust doctors here. Medicines which are supposed to be giv-
en free of cost, are almost never available. Most villages do not have chemists.
There are several quacks practicing openly without restriction, and draw crowds of eager pa-
tients.
Men suffer from poor health because of bad diet and habits like smoking tobacco and coal
based Hookah have health problems starting from middle age (40 onwards). They complain
of incessant cough but cannot stop hookah, back pains because of tough life of a farmer and
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36
skin problems like Scabies because of exposure to infected animals. Poor health affects their
productivity and ability to earn.
4.4.3. Crime
Mewat is one of the most dangerous districts around Delhi and robberies along the Delhi-
Alwar highway and Delhi-Mathura Highway are not uncommon. The two are some of the
busiest highways which see thousands of vehicles pass everyday to world famous tourist
places like Taj Mahal and Neemrana Fort. However, due to high crime instances, private in-
vestors do not feel safe in investing in the region.
Also, the Mewat region has over the years become a breeding ground for such gangs that in-
dulge in a wide range of crimes in Delhi and the satellite townships of Gurgaon, Faridabad
and Noida. Right from cheating, robbery and burglary to motor vehicle thefts, these gangs
have proved to be a tough nut to crack for the police. According to senior police officers, a
large number of people from this region take to crime for sustenance.
There are certain gangs operating from Rajasthan that cheat people on the pretext of selling
them "gold". Mewat gangs have gained international attention because what police calls a
traditional game for gangs from the region.
During a meeting with Mr. Alhawat, an Inspector with the Punhana Police Station, he re-
vealed that Mewat is a difficult posting for police officers. It is because Meo are very con-
servative and prefer the good old ways of settling disputes. Gun culture is rampant. The dis-
trict has low prosecution rates because there are long running family disputes and each family
will pile up trivial cases against each other, to trouble the other. More recently, with real es-
tate boom in Gurgaon , property dealers often use uneducated Meo youth to settle scores and
do shady deals.
With 6 police stations and a staff of less than 100, the police in Mewat is unequipped to take
care of more than 500 villages spread over Mewat. It is stretched and is tested to limits by
soaring crime graphs.
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4.4.4. Low Farm Yields
The Mewat district has no natural source of water like lakes or river. It depends on rain water
and ground water to irrigate its crops and sustain farming. Average land holdings are small,
as divisions between successive generations has lead to division of farms.
The farmers thus have low income levels and often have a secondary source of income to sus-
tain their families through the year. Some rear animals, some open shops, some become truck
drivers or do labour at construction sites in Gurgaon. Unlike Punjab and neighboring Haryana
districts, these farmers are not rich.
4.4.5. Politics
An uneducated voting populace is a blessing for our elected leaders. Only this can explain
why this region was ignored for almost 3 decades, after independence. Even after MDA was
created in 1980, little has changed on the ground. There have been vested interests at work in
keeping this area the way it has been, so that those in power do not face any questions, any
consequences of their actions. An uneducated, conservative and backward community which
doesn’t think and question its own conditions is a coveted political base in a democratic set
up.
4.4.6. No Sops to Investors
Districts like Faridabad and Gurgaon in Haryana owe their economic boom to investors like
Hero motors, Suzuki motors, DLF group etc which were offered land at throwaway rates and
tax concessions and other sops which allowed industries to flourish. However, Mewat seems
to have missed the bus. Though surrounded by industrial complexes of Gurgaon, Faridabad in
Haryana and Mathura in UP, Mewat has not seen much industrialization so far.
Even transport within the district is not well developed. If there is a good incentive scheme
offered to investors, it could open up avenues for the people of Mewat.
There have been attempts to open an industrial estate in Nuh, but the uptake by industries has
been rather slow.
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4.5. Mewat Development Agency, Nuh
4.5.1. Introduction
The main idea behind creation of Mewat Development agency was to bring acceleration in
development, for which creation of basic infrastructure is most vital thing viz. education,
agriculture, irrigation, drinking water, livestock management, health; housing, industrial
training and community works attracted foremost consideration of the government.
MDA’s role is to plan, coordinate and administer Mewat.
The MDA has done good work by attracting several funding agencies like the IFAD, Rome
and Indian and multinational NGOs for the benefit of Mewat. The IFAD sponsored a decade
long program spanning all aspects of community development worth US $22.23 million.
4.5.2. Focus areas
The focus areas of these programs were:-
1. Child Care
2. Women Emancipation
3. Income Generation
The program now sustains through a smaller version focused exclusively on promotion of
Self Help groups in the region. MDA supports over 400 SHGs which are run mostly by
women in villages and support income generation, micro finance, child healthcare and educa-
tion.
The MDA also gives out contracts to NGOs to run target based projects in fields of health-
care, education etc. This has helped some local NGOs like MSEDS ( Mewat Social and Eco-
nomical Development Society) run by Dr. Aziz in Punhana do some good work in the region
on a sustainable bases.
Also NGOs like SPYM, Shahid Foundation, Brahmjyoti etc have worked on MDA contracts
in the region and contributed to development.
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4.5.3. Work done by MDA
The following graphic shows the budget spend of MDA in the region. The spend distribution
outlines the kind of project MDA has undertaken. Besides The IFAD, the MDA also gets fi-
nancial support for its projects from Haryana Government, Central Government, and other
international agencies from time to time. Though primary socio economic indicators have
shown progressive development, the area remains remote and ill developed.
For detailed information on the projects taken up by MDA, the programs sponsored and the
timelines can refer the MDA website at http://mda.nic.in/MADP.htm
Graph 11:
From the above graphic it is apparent that the focus areas for MDA have been :-
Socio Economic development of the region
Gender Self reliance on a sustainable basis
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40
Broad range economic opportunities
For details on the projects sponsored under the different schemes in the above period, informa-
tion can be obtained from http://mda.nic.in/MADP.htm and Appendix part F
For the year 2007-08 the MDA has following budget allocation:-
For the current year the MDA budget -spend is concentrated on the following sectors:-
1. Education:- through:-
Expansion of primary school education
Expansion of adult education program
Expansion of college education
Introduction of the Open school concept
2. Community works:-
Construction of Village roads
Construction of drains and storm water ponds
Village development programs
3. Health:-
Maintenance of Medical Infrastructure
Health Camps
Delivery Hut schemes
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41
Mobile medical Unit
Pulse Polio Mission
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5. Health Survey in Punhana
5.1. Why Punhana?
Punhana block is a remote block of the Mewat district, sharing borders with UP along the
Delhi Mathura national highway. The area is notorious for robberies and being a den of crim-
inal gangs operating in Noida, Delhi and Gurgaon.
Punhana was selected for the health survey because of the following reasons:-
1. Highest number of BPL families in the district
2. One of the most populated regions in the district
3. Distance from NCR areas like Gurgaon and Faridabad is higher than blocks like Tau-
ru, Nuh or Hathin.
4. Identified as a tough area to work in by the government medical surveys because of
various reasons like:-
a. High concentration of the Sunni Meo people, who view government attempts to pro-
vide healthcare or other development programs with suspicion
b. High crime rates like vehicle thefts
c. Problems like absenteeism by teachers in schools and doctors in hospitals
d. Problems faced during the Pulse Polio program where religious figures from Deoband
and Jamia-Hamdard University had to be brought in to this region to restore faith; Meo had
fears that Pulse Polio drops were attempts to make the people impotent and threaten their
race.
e. High illiteracy in the region compounding problems of health workers
f. One of the highest instances of female feticide. Also infant mortality rates are among
the highest in the region.
5.2. Partner NGO: MSEDS
The Mewat Social and educational development society MSEDS, is a registered voluntary
society which works in areas populated by the Meo community like Mewat in Haryana, Bha-
ratpur in UP and Alwar in Rajasthan. It has a clear goal of organizing rural communities with
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43
a focus on child development, women empowerment, education enhancement and poverty
alleviation programs.
The society has headquarters in Bisru village of Punhana and 90% of the staff belongs to the
operational area. This helps in understanding the problems of the region, establish good rela-
tionship with the local people and run community driven projects in the region.
Major activities of MSEDS are:-
1. Socio Economic Development
2. Health, Sanitation and Medical care
3. Education for girl child
4. Agriculture and Horticulture development
5. Animal Husbandry and dairy development
6. Organizing rural women for active and equal participation in projects for income gen-
eration, promotion of rural art, provision of drinking water etc.
5.3. Villages surveyed: Shahpur Chowkha
• Owtha
• Naseempur
• Pinangwa
• Sultanpur
• Teher
• Thet
5.4. Major Findings from the Survey:-
5.4.1. Health
1. Common diseases in the area include Scabies, Dry Cough, eye problems, heart problems,
Joint pains etc. There are seasonal diseases like malaria and flu which usually strike in mon-
soons or during summers.
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44
2. Most villages do not have a doctor; some large villages have a chemist shop. Almost every
village has one RMP (rural medical practitioner). These men are barely qualified and attend a
six month course run by government in basic healthcare. RMPs are meant to address common
problems like fevers, pains, cold, and cough and to help patients in villages till they can reach
out for a proper medical care.
3. A big problem is lack of para- medical workers in the region, there are no institutes for
training paramedical workers in the region, and outside workers have little incentive to work
in the region, it being poor and unapproachable and crime ridden.
4. People do not trust the government doctors in PHCs and CHCs. They prefer visiting more
expensive private doctors with dubious qualifications. They visit the PHCs (though they are
free) only if their private doctors fail to address their pains, or in case of accidents. This is
against the widely held notion that poor people will prefer free healthcare. A doctor’s fee is a
common criterion among locals to measure quality of his services. The more expensive the
better.
5. People often travel all the way to Faridabad, Palwal and even Delhi to get proper medical
care. But those who cannot afford the travel have little option. Cost of transport is a large
component of the cost of medical care.
6. The government doctors in Mewat also are not happy. The postings in Mewat district are
considered as punishment postings and doctors try everything to avoid being posted here.
There is little scope for private practice here, there is no quality of life, education opportuni-
ties for children are limited and the place is crime ridden. Government doctors are thus not
inspired to work here. In spite of this, there is always a rush at the PHCs which are usually
teeming with patients.
7. There is little understanding of geriatric care among society. It is considered quite normal for
an aged person to be ill, irrespective of whether the problem can be medically addressed or
not.
8. Investing in an aged person’s care is considered a burden on family. Even for kids, Meos
average family size is 9. So it is not possible for a family to look well after them. Usually if
the kid is a male, he is likely to have a better chance at healthcare.
9. Mewat lacks doctors. There is 1 civil surgeon, the Chief medical officer, Dr. Randhawa
himself, and no gynecologist, no eye surgeon, no cardiac surgeon in a district with population
of 12 lakh.
10. Besides the health infrastructure, Mewat being a backward place is quite remote in terms of
attitude to healthcare. Ancient practices like child marriage still prevail. Girls get pregnant
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after marriage at early age. They are not given a balanced diet till during pregnancy or after
child birth. Men sit at home and smoke hookah, which causes coal to deposit in lungs and
breathing tract.
11. The Sub centers are usually do not have any facilities and the PHCs are either short of staff or
short of medicines or both. There are few chemist shops and a problem of genuine medicines
is acute.
12. Government’s current health policy focuses on organizing health camps in the region. A
health camp had advantages that large number of patients are taken care of, doctors from
outside can be involved, people in other villages can be informed in time. However, problem
with health camp is that because they are organized with pomp and show, with ministers at-
tending and using them as a political tool, there is little effectiveness. Also there is no scope
for follow up checks. For heart ailments etc, only diagnoses can be done, and patients can be
referred to big hospitals outside.
13. MDA’s health focus has been on kids and women. This is because child deaths are common
during child birth. Efforts are on to make sure that child deliveries occur in safe and clean
surroundings and women can get counseling for pre and post natal care. The Sub center me-
chanism and Delivery Hut schemes are used for this purpose. The Sub centers are extensions
of medical services into remote villages employing trained Medical workers. These medical
workers get 6-month training in healthcare at the civil hospital in Mandi-Kheda.
The Delivery Hut scheme is meant to provide pick and drop services to pregnant women in time
of delivery. A toll free cell number is used and a back office in Nuh receives the call. The
nearest delivery Hut van which is a RTP, rural transport vehicle, is stationed at nearby PHCs
is sent to collect the patient from the village and bring her to the PHC for delivery.
5.4.2. Sanitation
1. Very few villages have drainage facilities, storm water ponds, paved roads or street lights.
2. Almost 95% of the villagers do not have access to toilets. They use open forests and farms to
relieve themselves. This becomes a problem for aged men and women who find it difficult to
travel 2 to 3 km outside the village during winters and in rainy season.
3. Meo people do not bathe regularly or follow hygiene practices like washing hands.
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5.4.3 Drinking Water
Few villages have access to clean drinking water. The pipes laid down for water supply have
rusted and are broke. Most villages depend on ground water for drinking, washing and cook-
ing needs. Usually it is water from the same source which is used for all three. No one boils
water for drinking. Water is stored in earthen containers.
Women often walk long distances outside the city to fetch water and also for washing and
bathing.
For photos refer Appendix E
5.4.4. Transport Services
As shown in the pictures in Appendix E, state of public transport in the region is bad. There
is almost no public transport. The autos and tempos run between major towns like Nuh and
Punhana,often overcrowded. However for travel between the villages, the roads are narrow,
often muddy and chief transport options are horse carts.
Recently private taxis like Tata Sumo are also running between major villages. The cost of
transport between villages is low, Rs 2 to neighboring villages. It is high for Palwal, Farida-
bad or Delhi.
During the field visits undertaken, patients were found who were in desperate need of medi-
cal attention, which refused to travel outside and see a doctor because the difficulties and
costs of travelling!
Roads between major villages are good and motor able, others between smaller villages were
muddy. Under the Prime Ministers Road Project, MDA has done good work in providing a
lifeline to these villages.
5.4.5. Communication
Penetration of Cell phones in the region is strong. Lying between important industrial clusters
like Faridabad and Gurgaon, this is an asset to Mewat. Cell Phones have helped connect the
place to outside community.
5.4.6. Law and Administration
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Child marriage is another social malice that is prevalent in the region. In almost all villages,
girls between 13 and 16 years of age are married off to grooms between 17 and 19 years.
Dowry is not a common practice in Muslims but Meo Muslims, probably because they are
surrounded by Hindu communities in the nearby areas of Mathura, Bharatpur and Alwar, ac-
cept and demand a huge dowry.
Like in other parts of Haryana, women are rated as second-grade citizens here. Women work
in the fields, at home, fetch water and do all the chores, while men just sit around the chaupal,
smoke and play cards.
This was witnessed in course of field visits while visiting to villages in the peak harvesting
season. Groups of young men were to be found loitering while no woman would be in sight
as they would toil away their day in fields.
The role of the community is strong, and decisions taken by the village, pal or Khaap Pan-
chayat are binding on all people. The police or civil administration has rarely interfered.
The police and the state government had decided to crack down on those indulging in trade of
women but in the wake of stiff opposition from the community leaders, the police did not
take punitive action against those who were involved in the buying and selling of minor girls.
5.5 Conclusions
1. There is a tremendous need for mobile healthcare services in the Mewat region.
2. Besides the prescriptive care, there is also a need for preventive care. Medicines alone cannot
help improve the health standards in the region.
3. For preventive care, winning the confidence of local community has to be the first step.
4. There is a need to make the community sustainable in terms of its own healthcare needs.
5. The existing health infrastructure is in state of disuse and disarray. However, MDA is inter-
ested in using Public-private partnership for maximum benefit of people.
6. There is a significant population of aged people, who cannot travel or afford private health-
care, to sustain the momentum of a new MMU launched in the region.
7. Organizations like Deepalaya have proven that Mobile Units can succeed in the region if
backed by a proper referral system.
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6. Recommendations
6.1 For Long term Intervention
• Strengthen existing healthcare delivery mechanism in Punhana-
– Train RMPs (rural doctors), village doctors, and ayahs. Even with MMUs it is possible to
cover villages once a week or once a fortnight. Training the RMP who live in these villages
and coordinating medical care with them will help serve communities better. Also creating an
alternative to the services of quack doctors in the region which draw hordes of people.
– Use Primary Health Centres, Community Health centres spread over Mewat as base stations
to run Mobile Medical Units. There are 17 PHCs in the region and there is no private hospital
with comparable facilities. It is not possible for the MMU to refer patients to hospitals outside
Mewat because of cost considerations. Using PHC and CHC as bases, we can use whatever
facilities have been provided by the MDA in the region.
This will reduce chaos at PHCs, increase density of cases coming with MMU referrals, in-
crease efficiency of the modern systems being acquired by MDA. It is suggested that this me-
chanism be used as bases for improving the PHC system through the public -private partner-
ship in future.
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– Make supply chain for genuine medicines effective by tying up directly with Pharma compa-
nies to deliver medicine for Mobile Units. The Mobile Medical Units can supply medicines in
bulk to be disbursed through RMPs in the villages. This will reduce the incentive for quacks
selling fake drugs in the region.
– Prepare modules on geriatrics (care of aged) in local language using interactive multimedia
tools like CDs, which can be used to train medical workers of Sub Centre Clinics. Multi me-
dia is being used heavily for promotion of Pulse Polio, Aids awareness and birth control.
However, used intelligently it can be used to create awareness of the sad state of elders in the
local language.
• Bring co-ordination in works of different agencies-MDA, MSEDS SHGs, NGOs like Venu’s
Eye Clinic, Fortis Healthcare, Deepalaya, CSR divisions like Escorts, Ford Foundation etc
because though on paper every agency has done great work, little has changed on ground in
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Mewat in last few years. Coordinating efforts of different agencies will bring synergies and
consolidation of efforts.
• Use Mobile Medical Units to reach out to tough areas and engage the elderly in community
development. This may involve using social workers from Jamia Hamdard, or Wakf board or
Deoband communities to encourage safer health practices like avoiding hookah, tobacco and
alcohol, using contraceptives, avoiding marriage at young age etc.
• Build health awareness through healthier habits, make local communities self sustainable in
their healthcare through better diet, better lifestyle and awareness of treatable diseases
• Create awareness of government run schemes for the aged like old age pension, senior citizen
rights, geriatric care initiatives
• Support income generation activities for the aged through MMUs, by disbursing medicines
locally in village or supporting MMU operations locally
• Create Help lines for the Meo to give information about MMU, Healthcare in Mewat region.
This helpline will also give information on basic healthcare, availability of specialist care in
and around Mewat and save time and money spent on travel.
EXPECTED TIME PERIOD FOR OPERATIONS: 5 TO 1O YEARS
EXPECTED COSTS: 30 lakh per annum
No Cost Head Amount
1 MMU Operations 13
2 Training RMP 2
3 Preparing Multimedia kits 1
4 Engaging Social Workers 4
5 Help Line Operations 2
6 Marketing costs 0.5
7 management costs 5
Sum 27.5
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6.2. Short Term Intervention
• Area: Hathin
• Intervention Plan:-
– For one day in a week, the existing Faridabad MMU can cover villages bordering Palwal in
the Hathin Block of Mewat.
– Doctors from Palwal-have supported Helpage Healthcampsand can be recruited for once a
week trip to the Hathin Area
– Referrals can be forwarded to PHC Hathin and Govt Hospital / Guru Nanak Hospital in
Palwal
– Coordinate with the CMO, SMO and the local supporting NGO for route plan, Health focus
areas, referral patients etc
• Benefits
– Close to Delhi-Easy monitoring and control
– Hathin more safe for operation than Punhana
– Easier to get paramedical staff for Hathin: staff can up-down from Palwal or Ballagarh on the
Delhi-Alwar highway.
– Separate MMU acquisition not required
– Facilitate coverage of Mewat on pilot bases before full time operation in neighboring areas
– Less start up time and Low start up costs
– Target 10 villages on a weekly or 20 on a fortnightly bases-Acquire 5000 to 10000 patients
accordingly-costs to go up by-50000 to 1 lakh per month accordingly
6.3 Medium Term Intervention
• Area: Hathin and Nuh
• Plan:
– I MMU running fortnightly operations based out of Gurgaon into Nuh and Tauru, and out of
Faridabad into Hathin and Nagina
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– A dedicated MMU running in Mewat every day in villages in Nuh, Hathinand Tauru.
– Training RMPs and Village doctors in old age care
– Penetration of old age schemes, sanitation practices in target villages
– Target 50 villages per week, with upto10 villages each day
– Coordinated field trips with PHCs and commercial hospitals in the area, share information on
disease pattern and kind of intervention required, referrals etc.
– Tap donors from Gurgaon and Faridabad
– Use facilities available in Gurgaon and Faridabad to train local doctors, RMPs and aayis
• Benefits
– Tap Captive population of over 5-6 lakh in Nuh, Hathin and Nagina
– Lesser risk to Operational staff and property-operate out of Gurgaon and Faridabad
– Can act as an eventual bridge for Helpage into the region; can look to target more remote
areas in near future.
– Cost : 15 lakh per annum
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7. Feasibility
7.1. SWOT Analyses
The purpose of this analyses is to identify the Strengths, weaknesses of Helpage as an organisation and
compare them to the opportunity and threat arising out of running the Mobile Medical Operations
in Mewat
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7.2. Functional Feasibility
MMUs cannot by themselves eliminate health problems of the aged in the target region. They
have to be a part of the overall health strategy in the region. As suggested, they can be best
used in coordination with the PHCs and the Sub centres and the RMPs acting as parts of a
value chain delivering healthcare services to the people of Mewat.
Can act as an instrument of social change, inspire them to a better and healthier life, primarily
because several diseases can be avoided with simple precautions, and these ways are much
more effective than providing cure through medicines. This will also be an opportunity to
bond with the local community elders and engage them in this task. It is difficult but achiev-
able and has been attempted in past for Pulse Polio mission.
Results will not be quick, long term intervention is required. Any organisation cannot look at
a timeframe of less than 5 years in the target region. Enabling self reliance will need some
measures and a plan to discontinue operations eventually when suitable success has been
achieved.
Need to meaningfully engage the target audience through a concerted campaign directed at
– Gender equality,
– Aged rights,
– Economic self reliance without angering local sentiments.
• Burn out rate of NGOs in the area is high, hence cooperation with other NGOs , MDA and
medical fraternity a must.
In 2003 when the MDA engaged different NGOs to run Mobile medical units in different blocks,
Helpage also started operations in Nuh. The operation was a success as it did 28000 transac-
tions that year. However, with change of management in MDA, policy changed and funding
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was discontinued in 2004. Helpage had to shut operations there and look at interventions in
shape of occasional health camps organised through the local partner NGO. However these
issues should be included when launching operations and a long term contract of 3 to 5 years
should be agreed on before launch of operations.
• Independent operations involving distributing free medicines without creating an awareness
of issues will lead to short-term success but long-term loss, because the local community will
become even more dependent on outside intervention for its self sustenance.
In the rural areas, quality of care is often measured with cost of care. While interacting with
the people in villages, a patient would often mention the amount he spent on his treatment,
and not mention about what treatment he underwent. Similarly for the doctors, their fee is a
used by patients as a measure of comparison of skills. Hence it makes sense to charge a
nominal amount to the villagers in this area. Even if people cannot afford it, and are in a bad
state, medicines can be given on credit and credit can be separately accounted for at the end
of year. This will give transparency in accounts and a project a “ not for charity” attitude to
the recipients.
• The presence of multitude of agencies presents a unique opportunity to work in the
area
Talking to Dr. Randhawa, the chielf medical officer in the region, it came out that there are
many stakeholders interested in the benefit of Mewat. The government has tried but has its
limitations. The doctors in PHCs are not a happy lot. The government doctors do not enjoy
confidence of local people as much as private doctors do. There is a severe dearth of doctors
in the region, there being less than 100 government doctors for a population of more than 12
lakh.
The Mobile Medical Unit can address this problem in a unique way which has not been at-
tempted before. It provides an opportunity to pool efforts of various organisations, govern-
ment and private to create a model which is best suited to Mewat.
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Essentially the model suggests;-
1. Use PHC as base of operations for mobile medical units
2. Use Sub Centres as local access points for remote villages for the MMUs
3. Use RMPs as agents of the MMU in the region
4. Shift the MMU base at each day / alternate day / bi weekly/ weekly to a different op-
erational base to cover the most needy areas and cover as many number of villages as de-
cided.
5. Refer patients to PHCs for further treatment, with referral from MMU.
6. Evolve a feedback mechanism to escalate issues if any in the value chain to the MCO,
who will be responsible for smooth operations
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7.3. Operational feasibility
To decide the operational feasibility, following parameters were identified:-
1. Sustainability of operations over a long period
2. Quality of infrastructure
3. Security of staff and property
Sustainability over a long period can be achieved if following points are kept in mind:-
a) Confidence of the local community lies with our organisation.
b) Confidence of the Mewat Development agency, and local doctors lies with our orga-
nisation
c) Doctor and para-medical staff from within the community, work with our MMU, or
the ability of MMU to engage local people in community development.
d) Operations are made self funded eventually, to make them replicable in other parts of
the region and inspire competition to emerge with similar models.
Quality of Infrastructure:
a) Quality of roads; there are no roads in many interior villages in Mewat. Also because
the neighbouring villages in Rajasthan face heavy mining activity, the dumper trucks running
in the region cause heavy wear and tear of the roads. These roads need to be repaired every
year. MDA has budget for it and does good work, but the need far outweighs the efforts.
b) Village development works: If villages have open drains and sewers, which continue
to breed disease causing insects, there is little which intervention through MMUs can
achieve. Villages need to have proper drainage and clean environment.
Security of Staff and Property:
The cases of Mewat based gangs engaging in crime are common. However one needs to note
that there are organisations in the region which have done good work for a number of years
without being harassed.
Example is Deepalaya gram in Gusbethi in Tauru block of Mewat which has done great work
infield of education, health and community development in this region. It has worked well in
the region considered tough even by standards of the local administration.
General precautions will have to be kept in place like limiting the visiting hours till 6pm in
summers and 5pm in winters and keeping the village sarpanch and the local police aware of
the MMU movement in the area.
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Also a case in point is presence of retail networks of multi national consumer good compa-
nies like coke, Pepsi and the Indian-oil run petrol pumps in the region.
There is a strong recommendation here that if approached correctly, the region can meet all
above requirements.
Besides the above points, the operational issues like finding out the optimum path can be
done once a complete survey is done of the target area and every village is thoroughly
surveyed. The health commissioner convened such a survey in the region and 100 villages
out of 500 villages in the district have been identified in the region as difficult. Most of
them lie in the Punhana block. It is not possible to meet requirements of 100 villages, so it
will be better if we start with a target of 25 villages in Punhana block.
These can be finalised in consultation with health commissioner or the medical chief officer.
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7.4. Financial Feasibility
The aspects under financial feasibility looked at are:-
1. Potential partners and sponsors
2. Self sustainability
3. Cost cutting measures
The cost structure of running an MMU is in Appendix A.4
The running cost of an MMU is 9 lakh per annum.The acquisition cost of an MMU is 4.5 lakhs.
Converted Rural Transport Vehicle or a 4* 4 Tata sumo depending on the type of geography we
are looking at. In the given case the roads in villages, in remote regions are very bad and a 4 *
4 vehicle is required.
Estimated running costs are likely to be around 10.5- 11 lakh per year. Since the area is popu-
lated and there is no service in Punhana, a captive population of 2.4 lakh is assumed. Even if
the MMU can capture 10% market in its first year of operation and charge a basic amount (
equal to that charged by most RMPs), Rs 30, the amount is Rs 7.2 lakh. This means most of
the running costs can be met even if helpage charges a basic amount currently paid to RMPs.
Benefits to Helpage through self funding are:-
1. Less dependence on sponsors for sustaining the operations
2. More respect for paid services than free services
3. Lower chances of misuse of medicines
4. Can be made target specific for staff; can be inspiring and competitive
5. Can refer patients with diagnoses to PHCs
Benefits to villagers are:
1. Get qualified doctors, pharmacist and genuine medicine at doorstep
2. Do not have to bear travel costs
3. Freedom from quacks
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4. Need not travel to PHCs and wait for OPD; can produce diagnoses from MMU.
The operations can be made completely self reliant by raising the fee, but we have to consider the
ability to pay of people as well. We suggest Helpage seek funding on per transaction bases
from MDA or donor agencies active in the region. This would mean even if the transaction
cost is 45 Rs per patient, 30 is borne by patient and 15 by the donor. Exact figures can be
identified only after staff has been appointed, route has been fixed and all cost heads are
known.
Among the sponsors identified are some agencies which have worked in the area and are aware
of its complexities. These are:
1. Aga Khan Foundation
2. Ford Foundation and its local concern Meo Foundation
3. Haryana Wakf Board
4. Escorts Motors
5. MDA
For medicines, Helpage can get subsidised medicines from Pharma companies like Ranbaxy, Dr.
Reddy’s Labs etc.
COST CUTTING MEASURES
1. Use local doctors and local paramedical staff. Retaining outside doctors will be difficult
because of higher costs involved
2. Use local base stations to run the operations, do not run operations from Delhi or Gurgaon.
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8. Case Study: Deepalaya Gram
8.1 Introduction
Deepalaya initiated the Chameli Dewan Rural Health Clinic and Mobile Unit under this backdrop
with support from the Dewan Foundation for providing health services to the rural poor of
Mewat region in Haryana.
8.2. Why Mewat?
The region is located 60 km from Delhi, nearly 35 km from Gurgaon, which is a developing
metropolitan city. It is, for the most part, rural with a population of 8, 00,000 with nearly 500
villages dominated by Meo-Muslims (Converted Hindus). Following findings were found
after surveying the area:
Immunization of children very low with large number of children affected by poli-
omyelitis.
Diarrhea amongst children very high and the villagers are ignorant about its means of
prevention.
Infant and childhood death common due to pneumonia.
Awareness of antenatal care very low and routine checkup negligible.
Access to public sector services is limited as well as there is lacking of female provid-
ers.
Adolescent young people at the threshold of marriage and adulthood have no life edu-
cation as any topic related to sex and sexuality is a taboo.
Poverty and superstitious beliefs also indirectly plays an underlying factor behind
other factors cause of diseases.
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Social and religious issues act as constraints for females to access reproductive health
services.
8.3. Other Projects involved:
Deepalaya is involved with the formation of Self-Help Groups comprising women
covering nearly 150 villages of the region to improve their financial status by setting
up micro enterprises through micro finance, using savings and loans from banks.
Training and awareness are also held for the womenfolk in leadership, community
development, vocational skills and literacy.
Deepalaya has established Deepalaya Gram with a School, Vocational Training Insti-
tute and a well furnished Transit Home (Hostels) for working and street children of
Delhi.
8.4. About the Project
The Chameli Dewan Rural Health Clinic and Mobile Unit was established in 2005 in collabo-
ration with St. Stephen’s Hospital, Delhi to bring about long-term changes in health which
would help in development and capacity building of the community. St. Stephen’s Hospital
provides the necessary technical/professional inputs in running the community outreach pro-
gram. Doctors, Training program as well as Participatory planning exercises are provided by
St. Stephen Hospital.
8.5. Mobile Health Unit
Deepalaya’s goal in initiating the project was to offer better accessibility in health care in Mewat
region. At present we are able to provide health services to 14 villages i.e. Pipaka, Tavru, Re-
hari, Shikarpur, Chahlaka, Soondh, Sabras, Bissar, Dhidhara, Bhango, Nizampur and Jaurasi
and a cluster of villages surrounding the out patient clinic viz. Gusbethi, Kirori, Patuka, and
Bhutlaka through our clinic and mobile unit.
8.5.1. About the Region
The area is pre-dominantly composed of Meo Muslims i.e. converted Muslims who depend
largely in farming for livelihood. As agriculture cannot sustain everybody some work in stone
quarries, some drive trucks, and other vehicles to transport goods and humans. Migration is
very limited as any outside influence is, eyed suspiciously. Thus it is a very common sight to
see young men unemployed and women trying to scrape together a living.
In most of the villages the would be mothers are primis i.e. teen mothers and the nearest hos-
pital to provide institutional delivery is at Tauru where in event of a caesarean the Surgeon
has to be called from elsewhere. Almost all deliveries are conducted at home by local old
woman.
After parturition the baby is not given the colostrums but the newborn is given „Desi ghuti’
(local medicine) believing that it would help in digestion. This practice is not advisable by
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medical terms. Postnatal women are given jaggery syrup for 2-3 days instead of any solid
food, assuming that she will not be able to tolerate food. This leads to the vicious cycle of
lack of mother’s milk, lack of hygiene, gastroenteritis and malnutrition. The average children
borne by mothers here are eight to ten. Women are keen to use methods of spacing, but have
to face considerable opposition for the same.
8.5.2. Nature of Health Services Offered:
8.5.2.1. Clinical Check-Up
The clinic and mobile unit operates from 9.30 - 17.30 hrs for 5days a week. Two lady doctors
are deputed for the clinical checkups. One lady doctor is available for all the days while the
other is available for 3 days a week. The mobile van follows a schedule to visit the villages.
The doctor, a pharmacist, Nurse goes with the mobile unit to the village that has been sche-
dule for the day.
Medical Team
Doctor
Full Time
– 1
Part Time - 1
Health Coordinator 1
Nurse/ANM 1
Community Health Workers 3
Pharmacist 1
Community Health Volunteers 15
Driver cum Health Worker 1, acts also as community
health worker when needed
Data Entry Personnel 1
Driver 2
Ayah 1
The Registration Process
The beneficiaries are charged nominal fee for health check -up. New patients are charged Rs.
5 at the time of registration and in the succeeding visits they are charged Rs.2. Medicines are
provided with 50 % discount of the exact cost. The clinic also provides few medicines, which
are necessary at the time of pre-natal and postnatal care free of cost.
Status of Patients Visiting the Clinic and Mobile Clinic
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Month Male Female Old New D.S. T.H. ANC
October 177 350 323 223 70 78 129
November 219 496 395 308 98 55 187
December 174 399 312 254 34 21 183
January 112 397 269 240 25 27 193
February 153 436 351 238 57 46 203
Total 835 2078 1650 1263 284 227 895
From October to February, the Clinic treated 2913 Patients with the majority of 2078 females, in
contrast to only 835 men as shown the table above. 284 Children from the Deepalaya School
at Deepalaya Gram and 227 Children from the Transit Home were treated as well. Many pa-
tients were referred to other medical institutions.
8.5.2.2. A dental health camp
Awareness Programmes by the health team
To create and raise health awareness in this area, health workers, doctors and volunteers hold
regular community meetings with the villagers. In the meetings the health team discusses
about the prevailing health problems. Other topics are like having nutritious food, hygiene
and vitamins. An important topic is always the precautions woman should take within a preg-
nancy to ensure the health of the baby.
In a poor area, where many of the children are malnourished, it is important that the clinic has
a Malnutrition program. The doctors took weight and height of several children of the villag-
es. The health team guided the parents which had undernourished children and demonstrated
some remedies. After the intervention of Deepalaya the children showed great improvement
in their appearance and in general health.
Deepalaya’s health staff is trained at regular intervals to enhance their knowledge and their
skills. In doing so, Deepalaya is ensuring a good health care and a well trained health team.
Besides the training, new A.N.M. and health worker joined the team to deal with the growing
number of patients caused by the higher acceptance within the villages.
Now more and more villagers are medicated by the mobile clinic, because these villagers saw
how good the treatment of the Chameli Dewan Rural Health Clinic and Mobile Unit was in
the past. Even former skeptical patients from Muslim villages adopted the methods of family
planning, the doctors offered.
8.5.2.3. A health camp
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The health team in regular intervals organizes health camps, awareness campaign in the villages.
Within these camps better nutrition, hygiene and illness and disease prevention is teached.
The Clinic is providing health service to the Deepalaya Gram in Gusbethi. The doctors regu-
larly examine the health of the children. The health team tests eyesight by using eye charts
and takes the weight and the nutritious status of the children.
8.5.2.4. Referral System
In creating an effective local referral system, Deepalaya is working close together with the
doctors at PHC-Tavru, GH-Sohna and Mandikhera and the medical institutions within this
area. The referral system includes patients for sputum tests, X-rays and treatment for Tuber-
culosis, Hansen’s disease and ophthalmic examination. Deepalaya is trying to get in touch
with more institutions in this area, to offer the best medical treatment as possible.
8.6. VISION OF THE PROJECT
Through the Chameli Dewan Mobile Health Clinic, Deepalaya aims to provide quality health
services to the unserved at affordable costs in Mewat region. The Clinic is also an important
part of the Deepalaya Gram as it offers good health care to the children.
8.7. FUTURE PLANS
1. Expansion of the Clinic to provide better health service
2. Campaign for Awareness Programmes and organize more health camps
3. Reaching out to larger population of Mewat Region
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9. Risk Factors
• Security of staff and property will be a risk. High crime rates in the region mean there will be
a pressure to provide adequate safety measures and precautions. This could mean avoiding
certain routes, informing local police about Mobile unit schedule and restricting operating
hours.
• Trust of local community is important especially at the start up stage. The community is
backward, attempts to promote healthier lifestyle and promotion of women welfare could
alienate the locals.
• Sustaining interest of MDA / Donor. As regards to MDA, policy changes happen with change
in management (the officer in charge) and changes in ruling political parties. Funding
through MDA is thus not reliable if it is on a year-to-year bases. Sponsor should be ready to
support on a long term bases.
• Employing Manpower for Mewat. There is a shortage of qualified manpower in Mewat, for
doctors and paramedical workers. Getting workers from outside a challenge because
Helpage cannot afford paying higher than market for such a program.
• Finding a reliable local partner. Most local agencies are focussed on local needs and are not
mature to scale up to a region level. This means Helpage may need to identify multiple local
partner NGOs for its operations in Mewat.
• Management of Public private partnership a challenge. Though not impossible, it has not
been achieved so far in field of healthcare delivery in Mewat, even though numerous NGOs
have worked with the MDA at different times.
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Appendix: A More On MMUs
A.1 MMU Collage
MMU Operations shown in above pictures from Helpage website. For more please log on to
http://www.helpageindiaprogramme.org/mmu_imagegallery.html
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A.2 MMU India Coverage
A.3 North India Operations MMU
North India Operations -MMU
Mentioned below are average number of treatments taken up by Helpage MMU. Each MMU covers a
group of Urban villages or rural villages where parallel healthcare facilities are not available.
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State District Treatment
Delhi Delhi Unit 1 22024
Delhi Unit 2 20782
Punjab Chandigarh 18238
Amritsar 21109
Jallandhar 16866
Moga 23568
Haryana Jagadhari 18095
Faridabad 18910
J & K Jammu 20344
Baramulla 3358
Rajasthan Jaipur 14632
Udaipur 20215
Bikaner 20081
Kota 16159
Uttar Pradesh Lucknow 20308
Kanpur 26540
Ghaziabad 18663
Mathura 27919
Varanasi 8186
TOTAL 355997
Note: Average 12 sites are covered by each MMU
[Reference : http://www.helpageindiaprogramme.org/mmu_nr_state&district.html]
Above statistic is useful because Helpage considers an average of 20000 annual treatments as
breakeven limit for each of its Mobile Medical Units. The operations which have reached a
maturity stage are well over this figure. Low treatment density can be described for opera-
tions yet to reach mature state.
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A.4 A.4. MMU Cost Break Down
ANNUAL BUDGET FOR AN MMU
Budget Heads Particulars Amount
(a) Human Resources 4,27,400
Doctor 1,17,900
APO/SW 1,38,000
Pharmacist 92,500
Driver 79,000
(b) Infrastructure and Equipment 68,000
Insurance 4,000
Road Tax 3,000
Fitnes 2,500
Fuel 42,000
Miscellaneous 2,000
Vehicle servicing/maintenance 13,400
Base Office Furniture and Civil Works 1,100
(c) Commodities and Products 3,28,600
Drugs purchase 3,20,000
Printing and Stationery 8,600
(e) Administration 76,000
Local conveyance 12,500
Advertisement (recruitment) 1,000
Bank charges 500
Depreciation 26,000
Electricity and Water Expenses 1,000
Insurance Expenses 800
Misc Camp Expenses 4,000
Misc Exes 5,000
Staff Welfare 7,200
Rent, Taxes, Rates 9,700
Office Stationery, Books & Periodicals 300
Mobile, Telephone, Communication 5,700
Postage & Telegram 1,600
Audit, legal & Professional charges 700
TOTAL
9,00,000
The heads for fuel and local conveyance are shaded to indicate that these costs could be higher
and depend on the distance covered and where the staff is sourced from. These calculations
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represent the average cost from the 52 MMUs running all over India.
B. Sponsor a Gran Program- national coverage
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C. National Age Care Small Grants Scheme- National coverage
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D. PACS National Coverage
E. District Statistics 1. Nagina- Govt. College, Industrial Training Institute
Nuh- Yasin Meo Degree College
Ferozepur Jhirka- Shanti Sagar Kanya Maha Vidyalaya, Industrial Training Institute
Tauru- Seth Hardwari Lal
Hathin- ITI, Govt Polytechnic
2. Primary Schools : 622
3. Middle School : 74
4. High School: 55
5. Senior School : 30
6. College: 3
7. Polytechnic :1
8. ITI / VEI: 7
For more pictures on PACS please use the gallery at
http://www.helpageindiaprogramme.org/AgedRightsAdvocacy_imagegallery.html
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9. Bal Bhavan: 3
10. Teacher Training Institute: 1
11. Enrollment Statistics at Gov. Schools in Mewat
Total students
Boys Girls Total Drop Out rate
1 Primary 87474 61414 148888
2 middle 14905 6261 21116 86%
3 High 3667 1264 4931 77%
4 Senior Sec 3113 936 4049 18%
The primary school infrastructure has been in a dilapidated state. Only recently the MDA has refocussed
on improving the facilities available in schools . Drop out rates remain high especially for girls as they
get married off early.Girls as young as 12-13 get married. Even opportunities for education after
Primary level are low, as few villages have middle schools and even fewer have high schools, forcing
some children to abandon education mid wat through. Illetracy compounds the problems of the
region.
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F. More on MDA
Mewat Development Agency DC Office, Nuh
Additional DC Office, Nuh
In the year 1980, Govt. of Haryana with a commitment to deliver social and economic justice
to the backward and under-privileged sections of society, constituted Mewat Development
Board (MDB) headed by His Excellency, the Governor Haryana, Ministers and Secretaries of
important sectors viz. Finance, Irrigation, Power, Industries, Agriculture, Animal Husbandry,
Cooperation & Development and all the M.Ps & MLAs of Mewat region and also few other
eminent persons of the region as official & non official members. Its executing agency at
field level, Mewat Development Agency (MDA) was also formed simultaneously and its Go-
verning Body comprises of Commissioner, Gurgaon Division, Gurgaon as Chairman, D.C
Mewat as Vice Chairman, CEO, MDA Member Secretary, Financial Commissioners, Reve-
nue & Finance or their Representatives, Additional Deputy Commissioner, Mewat and heads
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of concerned line departments as members. The role of MDA was one of planning, coordina-
tion and administration.
F.1 Members of Mewat Development Board
S.N. Name of Members/Special Invitees Members/Special
Invitee
1. His Excellency, the Governor Haryana Chairman
2. The Chief Minister, Haryana, Chandigarh Senior Vice Chair-
man
3. The Finance Minister, Haryana, Chandigarh Member
4. The Revenue Minister, Haryana, Chandigarh Member
5. The Agriculture Minister, Haryana, Chandigarh Member
6. The Industries Minister, Haryana, Chandigarh Member
7. The Development & Panchayats Minister, Haryana, Chandigarh Member
8. The Cooperation Minister, Haryana, Chandigarh Member
9. The Irrigation Minister, Haryana, Chandigarh Member
10. The Animal Husbandry Minister, Haryana, Chandigarh Member
11. The Power Minister, Haryana, Chandigarh Member
12. Sh. Avtar Singh Bhadana, Member of Parliament, Faridabad Member
13. Sh. Azad Mohammad, MLA, Ferozepur Jhirka Member
14. Sh. Habib-Ur-Rehman, MLA, Nuh Member
15. Sh. Harsh Kumar, MLA, Hathin. Member
16. Sh. Sahida Khan, MLA, Taoru Member
17. The Chief Secretary to Government, Haryana, Chandigarh Member
18. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Revenue Department, Chandigarh
Member
19. The Principal Secretary to Chief Minister, Haryana Member
20. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Irrigation and Power Department, Chandigarh
Member
21. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Animal Husbandry Department, Chandigarh
Member
22. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Finance Department, Chandigarh
Member
23. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Agriculture Department, Chandigarh
Member
24. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Industries Department, Chandigarh
Member
25. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Education Department, Chandigarh
Member
26. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Health Department, Chandigarh
Member
27. The Financial Commissioner & Principal Secretary to Govt., Haryana, Member
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Technical Education Department, Chandigarh
28. The Financial Commissioner & Principal Secretary to Govt., Haryana,
Women & Child Development Department, Chandigarh
Member
29. The Commissioner & Secretary to Govt., Haryana, Public Health
Department, Chandigarh
Member
30. The Deputy Commissioner, Mewat at Nuh Member
31. The Chairman-cum-Managing Director, Haryana Vidyut Prasaran Nigam
Limited, Panchkula
Member
32. Sh. Fazruddin Besar S/o Sh. Suleman R/o Village Sakras, Tehsil Fero-
zepur Jhirka
Member
33. Sh. Shakur Khan S/o Sh. Umed Khan R/o Village Kairaka, Tehsil Nuh,
District Mewat
Member
34. Er. Mohammad Israil, House No. 35, Sector-14, Gurgaon Member
35. Smt. Veena Eaglton, IAS (Retd.) J-5, South City, Phase-I, Gurgaon Member
36. Sh. Tayyub Hussain R/o Village Bhimseka, Tehsil Hathin (Mewat) Member
37. The Vice Chancellor, Maharshi Dayanand University, Rohtak Special Invitee
38. The Vice Chancellor, Haryana Agriculture University, Hisar Special Invitee
F.2. Members of Mewat Development Agency
S.N. Name/Designation of Officer Members
1. Commissioner, Gurgaon Division, Gurgaon Chairman
2. Deputy Commissioner, Mewat Vice Chairman
3. Chief Executive Officer, MDA Member Secretary
4. Additional Deputy Commissioner, Mewat, (Nuh) Member
5. The Special Secretary to Govt. Haryana, Revenue Department,
Chandigarh through his representative not below the rank of Joint
Secretary.
Member
6. The Special Secretary-II to Govt. Haryana, Finance Department, (F.D.-
Branch), Chandigarh through his representative not below the rank of
Joint Secretary.
Member
7. Peoples representatives—6 (one each from six Panchayat Samities in
the Mewat area)
(i) Chairman Block Samiti-Nuh
(ii) Chairman Block Samiti-Taoru
(iii) Chairman Block Samiti-Hathin
(iv) Chairman Block Samiti-Nagina
(v) Chairman Block Samiti-Punhana
(vi) Chairman Block Samiti-F.P. Jhirka
Members
Special Invitees
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8. The Sub Divisional Officer (Civil), Nuh. Special Invitee
9. The Sub Divisional Officer (Civil), F.P. Jhirka Special Invitee
10. The Sub Divisional Officer (Civil), Hathin Special Invitee
11. The Superintending Engineer, Public Health, Gurgaon Special Invitee
12. The Superintending Engineer, Irrigation, Faridabad Special Invitee
13. The Superintending Engineer, Ranney Well, Palwal. Special Invitee
14. The Superintending Engineer, DHVBN, Gurgaon. Special Invitee
15. The Civil Surgeon, Nuh (Mewat) Special Invitee
16. The Deputy Director Agriculture, Mewat. Special Invitee
17. The Deputy Director, Animal Husbandry, Mewat. Special Invitee
18 The District Horticulture Officer, Mewat. Special Invitee
19 The Divisional Soil Conservation Officer, Gurgaon/ASCOs, Mewat. Special Invitee
20 The Executive Engineer, Panchayati Raj, Nuh. Special Invitee
21 The District Forest Officer, Mewat. Special Invitee
22 The District Education Officer, Mewat Special Invitee
23 The District Elementary Education Officer, Mewat Special Invitee
24 The Project Officer, ICDS, Gurgaon. Special Invitee
25 Three Representatives of NGOs in rotation to be nominated by Chair-
man, MDA.
Special Invitee
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E. Health Survey Punhana
E.1. Survey Form Template
General Information
Q1. Village Name:
b) Village population:
c) BPL families’ population
d) Pensioners population
Q2. Name of Person
Q3. Age
Q4. Occupation
Q5. Income
Q6. How long have you lived in the village?
Q7. How many kids do you have?
Healthcare information
Q8. Do you have any healthcare facilities in your village?
Q9. If no, please mention in case of illness, where do you go? How far is it from your village?
Q10. How much do you usually spend on medicines / healthcare?
Q11. In case of emergencies like accidents what do you do?
Q12. What are the common diseases in the village?
Q13. Is there any healthcare program run by government / NGO / private organisation in your village /
neighbouring village?
Q14. Please mention if any awareness program has been run in this village, like about clean drinking
water, use of toilets, healthier food habits etc.
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Education facilities
Q15. Do you have a school in your village?
Q16. If yes, then what level:
a. Primary
b. Middle
c. Senior Secondary
Q17. Do you send girls in your family to school?
Q18. Are you aware of the government schemes like free education and cash incentives to girl students?
Water, Sanitation and Infrastructure Facilities
Q19. Do you have a toilet in your home?
Q20. Is there a community toilet in your home?
Q21. Where do you dispose of your household garbage?
Q22. Do you have a rainwater harvesting system (Called “ dhalao” in Hindi) in your village?
Q23. Do you have a community centre, a Panchayat ghar or a day care centre ( “Aanganwadi”) in your
village ?
Q24.What are the facilities for drinking water in your village?
Q25. What is the condition of drainage in your village?
Q26. Whom do you approach in case of drainage problems, flooding, disease outbreak etc ?
Q27. What are the transport facilities available to villagers here?
Q27. Any other suggestions?
Pictures from Survey:-
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Pic1. Men smoke Hooka in Punhana
Pic2: Few villages have access to clean drinking water. The pipes laid down for water supply have
rusted and are broke. Most villages depend on ground water for drinking, washing and cook-
ing needs.Women often walk long distances outside the city to fetch water and also for wash-
ing and bathing.Women in Teher, wash utensils as children watch. Women live like second
class citizens, rear children, work in fields, do household work and cook while men idle away
time.
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Pic 3: An Overloaded Auto in a Mewat Town: Nuh
Pic 4: The unofficial Mewat Transport: Horse cart
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Pic 5. Collage of Health Survey.
Deepalaya Mobile Health Unit at Ghusbethi, Tauru
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F. Field Report – Gehlap Village
Field Visit Report 1
The purpose of this report is to report findings from field visit of village Gehlap in Mewat district of Haryana
while studying the feasibility of starting mobile medical van service in the region. *All figures quoted in this
report are based on interviews and observations and have not been validated from any standard source.
Executive Summary
Village Gehlap is one of the 230 villages in Mewat district. It has a population of 8500 to 9000.The general
diseases found in the target group here are breathing problems, eye problems, joint problems, heart ailments
and seasonal problems like diarrhea, fever and flue. The villagers face problems due to lack of access to
medical facilities, the problem being more acute for elders who cannot support themselves or are immobile.
Target Group Strength
There are around 8500 people in Gehlap village. There are 550 registered pensioners, and applications
have been filed for another 1200 people. This indicates that approximate age of people above 60 years
of age is likely to be around 1000 or 10% of the population. Out of this there are 118 widows and 12
handicapped people. Widows generally refer to those who have lost their spouse due to old age. Talk-
ing to people in Gehlap, similar demographics exist in the neighboring villages.
Economic Profile
Gehlap is mainly an agriculture-dependent village. Nearly 10% people have more than 3 acres of land.
Most people have land holdings of size between 1 and 3 acres. Some 5% of the people are those with
no land of their own and work on others land to make a living. As per government data there are 647
people below the poverty line in the village (the yellow card holders). There are 150 people which are
even below this minimum standard and come under red card holders or known as poorest of the poor.
There are less employment opportunities for the youth because of small size of farm holdings and low
disposable income among villagers. As an indicator of economic state, number of TV sets per hundred
households was 40. Same figure for fridge was 15. There are 2 cars in the village. Socially, Gehlap is
one of the more developed villages In the area, with paved streets, good drainage and local adminis-
trative infrastructure. There is now a school till class 12th and a girl’s school in the village.
Disease Pattern
Based On Our Survey, main problems affecting elders in Gehlop area are:-
1. Eye Problems
2. Asthma or Breathing Problems
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3. Joint Pains / Back Pains
4. Heart Problems
5. Skin Related Problems
6. Seasonal Problems like Flu etc.
Based on medical records at Hateem Government hospital, the major treatments were given for following
diseases:-
1. Scabies- a skin disease caused by access to affected animals
2. URI- Upper Respiratoty tract Infection
3. Joint Problems
4. Anaemia
Health Infrastructure
The doctors also mentioned that the Haemoglobin content of the patients is very low and people are
generally weak. This is because of the diet habits in the region. Even though the diet is heavy in milk
such conditions exist. Habits like consumption of Hookah may accentuate the prevalence of dry cough
, liver and URI infections.
The medical infrastructure of the village consists of 5 RMPs and 1 nurse. There is a government run
Primary medical center in village. There are no registered chemists or pharmacists. There are some
stockists selling drugs illegally in the village. There is no check if the drugs sold are genuine or not.
RMPs also dispense drugs worth Rs 80000 annually to the village (Refer A1). RMPs see 30-35 pa-
tients in a day, of which 33% are elders.
In season, that is September and June, the figure is up to 100 patients a day. These are basic drugs like
pain killers, for fever, congestion etc. Main job is to give immediate relief and refer to doctors in the
CSU at Hathin (6 KM away). The CSU at Hathin serves a population of 240000 or 96 villages with
strength of 5 doctors including one on contract. The Hathin Hospital has limited beds and refer pa-
tients to bigger hospitals in Mandi Khera or Palval as required. It is also supposed to dispense drugs to
villagers but the large numbers means it is perennially short of essential drugs. In 2007 Hateem hos-
pital saw 18000 new patient registrations and served another 15000 patients. The purpose of the PMC
in village is to assist the village women during and after pregnancy and to help distribute drugs for
general purpose. However it doesn’t enjoy much faith in the village as it is usually out of stock and
there is little to offer in way of guidance beyond conventional wisdom. It has four nurses but the deli-
veries are handled at Hateem based hospital through use of an ambulance. For all emergencies and
serious ailments people in Gehlap visit the private hospitals in Palval (18 km away) or Mandi Khera
(35 KM away). This is because even the government hospitals in Hathin and Palval do not have spe-
cialists or required medical infrastructure. At Mandi Khera all medical facilities including X ray, den-
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tal etc are available.( as claimed by the SMO Hathin, Dr. PK Sharma. An Organization based out of
this village, Chandipur Health Association has done some good work in the village. They have from
time to time organized medical camps to diagnose diseases, refer patients and distribute medicine in
collaboration with organizations like the Red Cross, Fortis Hospital and Helpage.
The Panchayat at Gehlap has marked a 2 acre land for a medical assistance centre and has applied to
Help age and Fortis hospital to help establish and run the center.
CHCs in Mewat District:-
1. Nuh
2. Ferozepur Jarka
3. Punhana
4. Hateem
5. Tauru
Primary health centers under CSU Hateem
1. PHC Mindkola
2. PHC Nangal Jat
3. PHC Uttawal
Contacts: Dr PK Sharma (SMO) – Ph: 986856189 Dr HS Randhawa (CMO)- Ph 951268273010
Rajender (Pharmacist )- Ph 9896258914
Shiv Kumar- contact person- Chandipur Health Association - Ph 09813244916
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F.2 FIELD VISITS- NUH, MANDI KHEDA, NAGINA
Plan of visit: To visit Nuh tehsil, the DC office, the MCO office and the civil hospital at Mandi
Kheda and Dr. Shamim Ahmed at Nuh to collect secondary data about the Mewat district
with a view of selecting saml villages for survey.
Summary of field visit:
1) Met the chief medical officer of the district and discussed health situation at a macro level,
agreed to meet again for a detailed discussion with regards to current assignment
2) Collected substantial data about mewat district pertaining to the socio economic health of the
district from the DC office and the additional DC office
3) Collected information about different NGOs active in the Health area in the Meat region and
Nuh region, the problems faced and the likely areas for intervention by Helpage.
4) PHC Nagina Field Visit
Meeting with Dr. Shamim Ahmed
1. Mewat has 451 villages; population of 12 lakh; government stats put it at 10 lakh, but need to
include people of Mayo community in nearby states of Rajasthan who also depend on Mewat
for medical care etc. Problems in state include illiteracy, ignorance, lack of education facili-
ties, superstitions but above all apathy of government. Even today, Nuh tehsil with 44 villag-
es and a population of 50000 doesn’t have a government school till class 12 th.
2. Health among other infrastructure woefully inadequate as planned by the government; one
civil hospital at Mandi Kheda, inaccessible, hence a lot of dependence on the work done by
NGOs like Red cross and help age such as organizing medical camps, eye care camps etc.
3. Mewat development agency has been trying to do right things, it has right plans and the
funds, but due to some reasons the efforts have not borne fruits. In 2003, the MDA started the
Mobile Medical Unit scheme with a number of partner NGOs in different Mewat districts, by
disbursing money to these NGOs and providing Vans. This scheme lasted 1.5 years and in
Nuh region alone 27000 cataract surgeries were performed. However scheme was stopped
and vans not used later.
4. Government started with Delivery Hut scheme where they provide ambulance for pick and
drop of pregnant women for delivery in CHC or PHC. The scheme re-used the Vans lying
unused since the closure of the Mobile medical van scheme.
5. The government has a huge budget for health and the preferred mode of expense is through
medical camps which are organized every month by selecting a village at random. These are
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generally inaugurated by the Chief minister or governor and a lot of money goes in the band-
o-bast for organizing and publicity of these events. Also selecting a village at random reduces
the effectiveness as there are always other areas with a more urgent need of attention. The
theme of government organised camps is also random and not need based. Also there are 451
villages in the Mewat area, even if we take big villages say above 10000 population the num-
ber is close to 100, if a camp is organised in a village its turn will come again after 6 years,
which means no follow up or post surgical care.
6. The effectiveness of the Mobile Medical Unit lies in the fact that there is a doctor who comes
every week in the village leading to development of trust with the local people. Trust is a big
problem in the villages of Mewat region because of illiteracy and superstitions. The female
literacy rate is 1.5%, among lowest in the world, while that of Haryana is above 60%.This
illiteracy and a minority mindset is exploited by rumour mongers to further jeopardise the
efforts at development. Recently in the Pulse Polio Operation of the government, families
were hiding there infants fearing that the polio drops would make their kids impotent later in
life. Such a crises in confidence also exists about facilities in the PHCs, CHCs and even Mo-
bile Units. It is also a responsibility of the agency which offers medical care to win confi-
dence of people and make them understand their own need for better health care. The Mewat
Region has highest instance of deaths during child birth, infant mortality, besides high preva-
lence of diseases like TB, polio, scabies, respiratory tract infections.
7. Numerous NGOs are operating in the region. The major ones include;
1. Deepalika Foundation / Diwan foundation: - Mobile Medical Units in Tauru, Schools
throughout Mewat ; orphanage, computer training, vocational training center and a 100 bed
hospital in Tauru.
Based at 46, institutional area,
Janak Puri, D Block
2. Shahid Foundation: Mobile Medical Units and hospital in Punanah district.Based out of
surajkund in Delhi.
3. Red Cross has presence through DC ; DC is the district head of red cross; how is it working
in the area is not known;
4. Sehgal Foundation has started Mobile Medial Units in Hateen area in 2003; were discontin-
ued later; know big presence through work in SHGs and adult education.
8. There is an NGO Brahmjyoti foundation which is involved with running and maintenance of
the mobile delivery van infrastructure this year onwards.
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9. Helpage and Dr. Shamim have been talking about the Mobile Medical units in Nuh for some
4 years now, with main concern of helpage being that Nuh is far from delhi and it will be dif-
ficult to maintain the buses. But need to discuss tis
Action Points:
1. Talk to different NGOs present in the health / Mobile Medial unit operations and find out
about the scale and coverage of their schemes and their long term plans.
2. Talk to CMO about the problems mentioned above and find out how government plans to
counter these.
3. Talk to Brahmjyoti foundation
4. Need to talk to Helpage about what previous discussions or agreements have been made with
Dr. Shamim or in Mewat district.
Talks with Help Age India
Helpage plans to become a rights based organisation instead of a welfare organisation. It wants to
change its delivery model to a more wellness based model where elder citizens are made
aware of their rights as senior citizens, the facilities provided to them by the government, to
help them claim these benefits through legal, political and social lobbying if required.
The transition is based on premise that welfare model, based on making available free healthcare
is not sustainable in the long run, if the people of the rural populace are not made aware of
their rights . Pension is provided to all people above the age of 60 by the government of In-
dia. How many people in this age group in rural parts of India are even aware of their right to
claim tis income? Money is doled out all right but it hardly reaches the targeted beneficiaries
because of various reasons such as illiteracy, lack of awareness, backwardness of region,
Panchayat politics etc.
Helpage has been doing work in rural India for last 20 years. It has won the confidence of rural
populace in areas it has served. It has also tried to help by improving the health infrastructure
by creating awareness of these rights by campaigning for better health practices, pension
claims, training village RMPs and aashas. However the focus on MMUs has created short
sighted goals for the organisation and taken the organisation away from its main goals. This
has lead to a rethinking in terms of long term strategy and under its new program called the
Helpage vision 2013 it has set new targets for itself and its key stakeholders.
Meeting with Dr. HS Randhawa, MCO
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The meeting with the MCO, Dr. Randhawa was at the Civil Hospital at Mandi Kheda. The
hospital has a beautiful and expansive building with all facilities a modern hospital could ask
for. The building was built through funds donated by the Sultan of Oman. In 1994 the hospit-
al was closed for want of doctors and other qualified paramedical staff. However, the gov-
ernment acquired the building in 1998 with a view to further equip the hospital and offer bet-
ter medical services to Mewat people. Today the hospital also functions as the office of the
MCO who makes the plans and budgets outlays for health annually.
1. Dr. Randhawa expressed concern that inspite of so many stakeholders in Mewat’s develop-
ment, NGOs, Governor, MDA, State government, Central government there is no progress on
the ground for so many years. In short, he was apprehensive about what new could Help Age
do?
2. A new Medical Van service started in March covered 13 villages, plan to cover 26 next
month. This year there are plans to appoint a special doctor, a pharmacist and a nurse to tra-
vel to villages in the Nuh district and perform OPD and also small surgeries. The Bus do-
nated for the purpose is equipped with all modern facilities and has been lyng with the civil
hospital for last 6 months.
3. About what areas they can look at- need to think, about government plans and budget- not
discussed, about what NGOs present in the area- many but don’t know exactly what they are
doing and what they plan to do. He said Helpage needs to find out exactly what they can do
in this area and how can they contribute; say if it involves running of the current bus by the
government- as in since the government is incurring expense in medicines and it has already
outsourced maintenance of delivery hut and this bus to Brahmjyoti , how can Helpage contri-
bute here?
Action Point
1. Need to discuss with Helpage above situation before next meeting with Dr. Randhawa. I
essentially set out to do a needs analyses with the CMO, however, I am having to do market-
ing for Helpage which I am not equipped to handle with what background information I have;
Need cost structure of the medical division; any other direction I can lead the discussion to
for intervention by HelpAge; Does HelpAge have any other interests other than just serving
the people in Mewat---- attracting government funds meant for Health budget???
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G. Project Plan
ID Task Name Start Finish Duration
13 Jul 2008 27 Jul 2008
2016 2817 18 292623 302519 2724
1 02-06-20081w06-06-200802-06-2008Appointment of Project Manager
2 09-07-20082w22-07-200809-07-2008Liasoning with MDA,local NGOs and
CMO, local doctors
3 06-06-20084w03-07-200806-06-2008Seek Sponsors, Prepare Tentative
Project Plan
4 03-07-20082w16-07-200803-07-2008Organise Board Meeting
5 16-07-20081w22-07-200816-07-2008Finalise Project Plan, Route,
Responsibilities and Goals
6 25-07-20081w31-07-200825-07-2008Aqcuire MMU, Make appointments,
7 04-08-20084.4w02-09-200804-08-2008Start Operations
8 01-08-2008.2w01-08-200801-08-2008Review Meeting, Track Progress
20 Jul 2008
21 22 31 1 2
H. Abbreviation and References
Abbreviations
CHC Community Health Center
CMO Chief Medical Officer
DOCC Center for Development of Corporate Citizenship
PACS Poorest Area Civil Society
PHC Primary Health Center
MDA Mewat Development Agency
MMU Mobile Medical Unit
MSEDS Mewat Social and Economic Development Society
SMO Senior Medical Officer
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SWOT Strength Weakness Opportunity Threat
References
www.helpageindia.org
www.indiango.org
www.haryanaonline.nic.in
www.mda.nic.in
www.tribuneindia.com
www.deepalaya.org
www.helpageprogrammes.org
www.helpage.org
UN Report on Aged Rights
Planning Commission Report on Mewat
National Rural Medical Mission
National Policy on Aging- A report by Institute of Economic Growth
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