Bi­japur Model Trans­form­ing Ru­ral Health­care

The vast pop­u­la­tion and huge length and breadth of In­dia have been mak­ing pub­lic health­care ser­vice de­liv­ery a gi­gan­tic task for the gov­ern­ment, es­pe­cially in the ru­ral ar­eas. Sarita Barara, the se­nior jour­nal­ist high­lights the trans­for­ma­tion in the vill

Rural & Marketing - - CASE STUDY - Sarita Barara Sr. Jour­nal­ist

With her bun­dle of joy, a tiny baby girl in her lap, Sunita San­dra’s hap­pi­ness was writ large on her beam­ing face. The baby girl was born in Bi­japur district hos­pi­tal in Ch­hat­tis­garh just two days back. Sunita had ear­lier gone through the pain of two mis­car­riages.

Ear­lier preg­nancy cases with com­pli­ca­tions had to be re­ferred to Jag­dalpur hos­pi­tal, 170 kms away from Bi­japur as there were no fa­cil­i­ties for han­dling them due to lack of both medical ex­per­tise and equip­ment. Many a times, it would re­sult in the death of the un­born baby or the mother.

The district hos­pi­tal till 2015 worked with a skele­tal staff of just 3 to 4 doc­tors and half a dozen nurses and the OT too was ill equipped to han­dle ma­jor surg­eries.

Bud­hi­ram re­calls the or­deal he had to go through some years back when his Chacha (pa­ter­nal un­cle) had bro­ken his foot. “The only mode of trans­port avail­able to bring him to Bi­japur district hos­pi­tal from his vil­lage 30 kms away was a bul­lock cart. The hos­pi­tal could not han­dle this case and we had no op­tion but to hire a ve­hi­cle for Rs 3,500 to take him to the hos­pi­tal in Jag­dalpur. A mar­ginal farmer, Bud­hi­ram had to bor­row money

from his rel­a­tives to pay for the hir­ing of the ve­hi­cle.

This time when he came to the hos­pi­tal ear­lier this month to get treat­ment for his ail­ing mother, he could not be­lieve the trans­for­ma­tion the hos­pi­tal had un­der­gone. The hos­pi­tal to­day has the lat­est fa­cil­i­ties that many big cities may want to have and more im­por­tantly the in­fra­struc­ture is backed by near full strength of doc­tors and spe­cial­ists and other staff. The hos­pi­tal has a new 50 bed­ded Mother and child Care unit ‘Umang’ and a 12 bed­ded Spe­cial Care New-born Unit (SNCU) to han­dle crit­i­cal new born ba­bies in ad­di­tion to other medical fa­cil­i­ties.

This has been pos­si­ble thanks to some out of box think­ing, po­lit­i­cal will, sup­port from Na­tional Health mis­sion in terms of funds and poli­cies and UNICEF which fa­cil­i­tated im­ple­men­ta­tion of var­i­ous in­no­va­tive strate­gies to reach out to the vul­ner­a­ble and the marginalised in the district through its part­ner­ship with Pub­lic Health Foun­da­tion of In­dia and EKAM. Na­tional Min­eral Development funds in ad­di­tion to other resources were also utilised for im­prov­ing the health in­fra­struc­ture for con­struct­ing both the hos­pi­tal and res­i­den­tial fa­cil­i­ties for the doc­tors.

The Col­lec­tor of Bi­japur district Dr. Ayyaj Tam­boli, him­self an MBBS even used so­cial me­dia to at­tract doc­tors to this re­mote district and the re­sponse was over­whelm­ing.

Dr Kushal Mad­hukar Sakure from Bhan­dara district of Ma­ha­rash­tra, one of the first to re­spond to the call said once he came to see the place, it took him no time to de­cide that this was the place that would give him the

Bi­japur model has been repli­cated in Dan­te­wada and Sukma and there is need to do so in other parts of Ch­hat­tis­garh where over 80 per cent of the posts of ob­ste­tri­cians, gy­ne­col­o­gists, pe­di­a­tri­cians, sur­geons and anes­thet­ics are va­cant

kind of ex­po­sure he was look­ing for in terms of han­dling cases and the medical in­fra­struc­ture. He said that ad­min­is­tra­tion goes out of the way to meet their pro­fes­sional re­quire­ments with­out los­ing time. The added ad­van­tage, he said, is in­cen­tivised pay pack­age and the fully fur­nished ac­com­mo­da­tion with AC and other house­hold ap­pli­ances, Mess and other fa­cil­i­ties to make the stay of the doc­tors com­fort­able. To­day, there are over 20 doc­tors in­clud­ing nine spe­cial­ists and 50 nurs­ing staff.

A young doc­tor, Dr San­deep posted at the Com­mu­nity Health Cen­tre in Gan­ga­loor vil­lage in Bi­japur district has come all the way from Hy­der­abad to serve in this re­mote vil­lage. He says on an av­er­age he han­dles 50 to 60 cases every day. Dr San­deep says it gives him im­mense sat­is­fac­tion to work in a re­gion, where his ser­vices are re­quired the most.

In an­other ini­tia­tive, tem­po­rary health kiosks with im­mu­ni­sa­tion and vac­ci­na­tions kits, blood test and rou­tine health checkup of women and chil­dren are set up at weekly vil­lage haats, where vil­lagers in large num­bers come for trad­ing their goods. Also since many of the women and chil­dren visit the haat come from vil­lages where the health work­ers have no ac­cess, it is here that they can avail of the fa­cil­i­ties. Since the ini­tia­tive started, 70 health kiosks have been set up at the weekly haats and there has been good re­sponse.

The Bi­japur model has been repli­cated in Dan­te­wada and Sukma and there is need to do so in other parts of Ch­hat­tis­garh where over 80 per cent of the posts of ob­ste­tri­cians, gy­ne­col­o­gists, pe­di­a­tri­cians, sur­geons and anes­thet­ics are va­cant.

Although In­dia has made con­sid­er­able progress in the re­duc­tion of ma­ter­nal and in­fant mor­tal­ity, every year ap­prox­i­mately 44,000 women still die due to preg­nancy-re­lated causes and ap­prox­i­mately 6.6 lakh in­fants die within the first 28 days of life. Many of th­ese deaths are pre­ventable and many lives can be saved if qual­ity care is pro­vided

to preg­nant women dur­ing their an­te­na­tal pe­riod and high risk fac­tors such as se­vere anaemia, preg­nancy-in­duced hy­per­ten­sion etc. are de­tected on time and man­aged well.

It is to­wards this end that Prad­han Mantri Surakshit Matritva Ab­hiyan (PMSMA) was launched in June last year. The pro­gramme aims to pro­vide as­sured, com­pre­hen­sive and qual­ity an­te­na­tal care, free of cost, uni­ver­sally to all preg­nant women on the 9th of every month. PMSMA guar­an­tees a min­i­mum pack­age of an­te­na­tal care ser­vices to women in their 2nd / 3rd trimesters of preg­nancy at des­ig­nated gov­ern­ment health fa­cil­i­ties. Ob­stet­rics and gyne­col­ogy (OBGY) spe­cial­ists, ra­di­ol­o­gist and physi­cians from pri­vate sec­tor are be­ing mo­ti­vated and en­cour­aged to pro­vide vol­un­tary ser­vices at pub­lic health fa­cil­i­ties where gov­ern­ment sec­tor prac­ti­tion­ers are not avail­able or are in­ad­e­quate.

Un­der the pro­gramme free tests for preg­nant women in­clude blood pres­sure, sugar level, tests for HIV, Syphilis, weight, he­mo­glo­bin test among oth­ers. Medicines such as iron-folic-acid (IFA) and cal­cium sup­ple­ments are pro­vided to preg­nant women at gov­ern­ment health fa­cil­i­ties in both ur­ban and

The fo­cus of the Ac­tion Plan is on end­ing pre­ventable new­born deaths, im­prov­ing qual­ity of care and care beyond sur­vival, pri­ori­tises those ba­bies that are born too soon, too small, or sick as they ac­count for ma­jor­ity of all new­born deaths

ru­ral ar­eas.

Un­der the scheme, preg­nant women are given Mother and Child Pro­tec­tion Cards and safe moth­er­hood book­lets. One of the crit­i­cal com­po­nents of the cam­paign is iden­ti­fi­ca­tion and fol­low up of high risk preg­nan­cies. A sticker in­di­cat­ing the con­di­tion and risk fac­tor of the preg­nant women is added onto the Mother and Child Pro­tec­tion (MCP) card for each visit .For ex­am­ple, Green Sticker is for women with no risk fac­tor and Red Sticker is for women with high risk preg­nancy. This has been done so that doc­tors can eas­ily de­tect the prob­lem.

More than 3,750 pri­vate sec­tor doc­tors have reg­is­tered to vol­un­teer for the pro­gramme and pro­vide free ser­vices to preg­nant women across the coun­try. Giv­ing an up­date on the progress of the pro­gramme, Dr. Di­nesh Baswal, Deputy Commissioner, Ma­ter­nal Health, Min­istry of Health and Fam­ily Wel­fare said that more than 11,000 pub­lic health fa­cil­i­ties were pro­vid­ing PMSMA ser­vices and more than 45 lakh an­te­na­tal check­ups have been con­ducted so far across States and Union Ter­ri­to­ries. He said that more than 2.8 lakh high risk preg­nan­cies have been de­tected.

In­dia New­born Ac­tion Plan

The In­dia New­born Ac­tion Plan (INAP) pro­gramme launched in Septem­ber 2014 is aimed at at­tain­ing Sin­gle Digit Neona­tal Mor­tal­ity Rate by 2030, five years ahead of the global plan. The fo­cus of the Ac­tion Plan is on end­ing pre­ventable new­born deaths, im­prov­ing qual­ity of care and care beyond sur­vival, pri­ori­tises those ba­bies that are born too soon, too small, or sick as they ac­count for ma­jor­ity of all new­born deaths. The six pil­lars of in­ter­ven­tions that are de­fined un­der the plan are Pre-con­cep­tion and an­te­na­tal care, Care dur­ing labour and child birth, Im­me­di­ate new­born care, Care of healthy new­born, Care of small and sick new­born and Care beyond new­born sur­vival. INAP is to be im­ple­mented within the ex­ist­ing Re­pro­duc­tive, Ma­ter­nal, New­born, Child and Ado­les­cent health (RMNCH+A) frame­work of the Na­tional Health Mis­sion.

(The au­thor is a New Delhi based in­de­pen­dent Jour­nal­ist and writes in news­pa­pers on so­cial sec­tor is­sues. Views ex­pressed in the Ar­ti­cle are au­thor’s own)

Newspapers in English

Newspapers from India

© PressReader. All rights reserved.