Jan Swasth Sahyog

Project Theme

Health

Target Group

Others

Project Period

01 Apr 2015 - 31 Mar 2016

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Introduction

The State of Chhattisgarh was carved out of erstwhile Madhya Pradesh in the year 2000, essentially because of the poor treatment it had been meted out in terms of policies and works beneficial for the poor and underprivileged sections of society which constituted the majority in this part. The areas are essentially resource rich (esp. minerals and coal) and rain fed agriculture is the mainstay of economy of the people. This opportunity for closer interaction with the people and better development and implementation of schemes for the poor has been frittered away, as vested interests have forced exploitation of these natural resources and the labour of these people. Vast tracts of forest/farm land have been handed over for industry/mining, without consideration for the people who were living off this land. It is essentially the poor marginal farmers and landless who have had to suffer the most. In addition, forest dwellers have also been displaced to make way for biosphere reserves and wildlife parks where illegal tree felling and poaching are rampant. Social services especially health and education are neglected, especially at the village level. While on the one hand large, profit making, private hospitals are making forays into healthcare provisioning in the larger towns and cities, the state provision of health care services remains poor in both quality and quantity, especially in rural Chhattisgarh. A large number of quacks and faith healers take advantage of this miserable state of the people. State transport services have been wound up and people have to cough up large amounts to travel, thus worsening access to any health care for them. 

Even though Chhattisgarh has done better than some other states of the country in provision of food through the PDS, it is still grossly inadequate for three reasons – one, it is targeted at BPL families and many of the non-BPL families are equally poor or worse off. Secondly, the rations are usually sufficient for only 12-15 days of a month and for the remaining days they are forced to pay very high market prices or go hungry and thirdly, the rations  are qualitatively poor as only cereal (wheat or rice) are provided but no pulses, oil, sugar, etc. A large proportion of the poor are thus forced to go hungry on many occasions. Nutrition levels are poor in general as reflected by the median BMIs in the population we work with 18.5 among men and 17.5 among women. Malaria is rampant and falciparum malaria, especially in forest and forest fringe areas poses a challenge. Falciparum malaria in pregnancy is a potentially fatal combination and this is one area we would like to focus on. To improve food intake among women/mothers, it is essential that the quantity and quality of food available in the household be adequate. Our strategies would focus on this for the poorest. 

Improving access to quality health care in general and specifically quality obstetric care in particular would be our focus. This includes provisioning where feasible, training of relevant cadres in the field and in the health system, improving referral services, making them responsive and improving referral transport. Access to safer contraceptives with a choice for the woman, besides access to safe termination of pregnancy would be a priority. In addition, we would endeavour to spread the message of educating the girl child, empower her with life  skills and advise giving her in marriage only after attaining the age of maturity.

 

Lessons learnt from our work in the field would be taken up for advocacy at the State and National level in convergence with Oxfam India and its other partners in the project.    

The major aspects of health status in short, are: 1) High prevalence of Anemia, 2) low body mass index, 3) feminization of hunger, 4) Malnutrition, 5) Sickle Cell Anemia, 6) Majority of deliveries still being home deliveries, 7) High influence of Bhagats / Vaidus, 8) High prevalance of CMR and MMR

Under the Community based Monitoring programme of National Rural Health Mission, VHSCs are monitoring health care services provided. This includes ANC and PNC services which are most important in order to avoid maternal deaths. Rugn Kalyan Samitis linked with PHCs and RHs also can contribute for improving the health services. Institutions like VHSCs, RKSs, GPs can play important role in improving the health system and reducing maternal deaths. They need a proper orientation in this direction.

This demands efforts to make the women as well as the community people aware of women’s health issues, and initiate a process that supports their rights to health and health care.

 

About the Project: 

The project focuses on creating awareness and empowerment of women on women health issues, capacity building of women, people, VHSCs, RKSs about maternal health and advocacy with government health machinery for quality maternal health care and with PDS and ICDS departments for accessibility to food.

Awareness Campaigning: Issues related to maternal health services, maternal nutrition and health in general will be explained through media such as posters, pamphlets, films, street plays VHND/ WASH melas.

a)Campaigning for food justice, early child feeding and nutritional determinants

b)Capacity building: Capacity of VHSCs, RKSs, GPs, ASHAs and women will be built through trainings, workshops, meetings for monitoring and advocacy for quality health services, action against domestic violence, food accessibility

c)Organize Health Melas: VHND or WASH melas will be organized periodically to give information and bring forward various health issues.

d)Review and evaluation through periodic surveys: The surveys will record and keep track of whether the services are being improved. 

e)Community mobilization and advocacy for safe health facilities for deliveries and abortions

f)Community based monitoring on maternal health: VHSCs, RKSs will monitor and prepare report cards evaluating the services. On the basis of this evaluation, dialogue and follow up activity with health officials will be organized.

g)Advocacy with health machinery: for improvement in maternal health care.

h)Groups against domestic violence: village level groups will organize activities to stop or at least reduce the domestic violence.

 

Results to be Achieved / Impact: 

i)Improve Maternal Health

j)Promote gender equality and empower women

k)Eradicated extreme poverty and hunger

 

Quotes of Beneficiaries: 

Accessing medical certificates, healthcare and even complaining regarding non-performance of a hospital is just a call away and mundane for most of us. But think about someone who once had to walk 25 km to simply report a birth in the community and can now use the interactive voice recording (IVR) technique to inform and record her experiences in her home. 

 

Jan Swasthya Sahyog (JSS) has proved that innovation can have a life changing impact by introducing the audio based software named Mahatari Swara to capture and record telephonic messages using the IVR technique. Through this software, community members can not only provide information regarding births and maternal health issues, but also record their experiences of receiving health services in public health institutions. Mahatari Swara provides a voice forum and platform directly connected with people in remote areas which lack access to basic healthcare services. In Chhattisgarh which is known for its dense forests and a tribal population, accessing healthcare has been challenging so far. This innovation brings light to many people who walked many miles just to report a birth in the community. It is a simple technology.

Rekha Prasad from Devanpur, Bilaspur says, “I used this system for reporting a birth in my Community which helped a lot. Earlier it was difficult to report and even get help or counselling. With this system the experts are providing help in conducting. Pre-natal and neo-natal care. Also, this system saves time and expenses. It is easy to operate and doesn’t bring any barriers Related to literacy.”

 

Case Studies/Human stories: 

Place: Village Surhi, 

Tehsil: Lormi, 

District: Mungeli 

108, Sanjeevani express or emergency service was launched by Chhattisgarh government on 25th January 2011. This service was started as a public private partnership with GVK EMRI in 12 states and 3 UTs, Chhattisgarh being one of them. It was considered to be an important milestone in health sector to address the question related to health emergencies. This service was started with an objective to save life in a medical emergency, to report a crime in progress, and to report fire. Of the three purposes, the 108 services were used mostly for addressing the issue of medical emergencies and majorly for safe delivery. In 12 states about 4800 vehicles are placed of which 240 vehicles are in state of Chhattisgarh. 

108 is toll free telephone number for emergency services. The main feature of this service is a free round the clock service for providing integrated medical, police and fire emergency services. The Sanjeevani Express is well equipped with basic and state of art instruments to handle the emergency cases on its way to hospitals - oxygen, suction machine, medicines, BP operator and delivery kits besides other high end equipments make these ambulances efficient to handle emergency cases. 

108 ambulances were supposed to be serving remotely situated villagers as they are the one having poor access to health care facility and so, creating difference in their lives. 

After two years of starting service, the community has developed awareness towards the facility. They know that a free ambulance service can be made available by dialling 108 in emergency cases and it has helped some of the cases. But it is also seen that in remote villages especially forest fringe villages, this services is irregular or denied and because of this some life losses are noticed/recorded in the villages in Achanakmar forest area of Mungeli district of Chhattisgarh. The main reason for denial of services was given as unavailability / poor condition of roads in this forest area, which is not truly the case as other vehicles do reach the places. 

In emergency conditions when the 108 services were denied / not accessed, the villagers had to hire private vehicles or the condition reached to end stage of emergency such as death / delivery at home etc. 

To communicate this refusal/denial in accessing services with district and regional authorities of GVK, in presence of government officials; some of the local groups like Sangi 

Sahyogini mahila samuh, Diyabar Nasha Mukti Samuh, Jan Swasthya Sahyog, Ganiyari arranged a Jan Samwad (Public Talk) at Surhi village of Mungeli district on 6th June 2013. 

In Jan Samwad 12 members from various villages expressed their experiences and frustration in accessing the 108 services during the period of January – May 2013, of which 5 cases were related to intrapartum/child birth emergencies and remaining of other illness. The case mapping was done by Jan Swasthya Sahyog, Ganiyari. 

The program was attended by about 600 people, women majorly. Some of them travelled almost 18-20 kms. Among the government officials, BMO - Dr. C. S. Patley (Lormi block); BPM Mr. Shailendra (Lormi block); Dr. Sameer Garg, SHRC member & right to food campaign commissioner were present for the program. From 108 authorities District Manager Mr. Manish Singh attended meeting. Among other participants were the Janpratinidhi (People’s representative) Mr. Nandkumar Tripathi, Officials from forest department, Dr Yogesh Jain from Jan Swasthya Sahyog and Members from Akashwani Bilaspur were present for program. 

The program started at 1 pm with a formal introduction and explaining the objectives of the program. The 108 scheme was once again explained to the peoples. Then community members and representatives from the community shared their experiences. All the discussants were questioned and cross questioned for various details. 108 district authorities also shared the statistics and services provided in the area. 

The short narrations of the experiences shared in the discussion are attached at the end. The participants made posed some questions and gave few suggestions. 

The questions and suggestion were given by panel members – 

1. One 108 vehicle should be posted in village Surhi which can cater to 20 surrounding villages 

2. 108 service reports should be made available for all people on various places like block offices, at Panchayat level or though internet 

3. A social audit must be conducted on the utilisation of services. 

4. There should be some reporting authority to which complaint and denials of service can be reported. 

 

Along with suggestions for 108 services, people also suggested improvements in public health services. These were – 

1. An ANM can be posted at Nivaaskhar subcentre round the clock. 

2. Nivaaskhar subcentre must provide all possible services at least in rainy season when moving out of village become very difficult. 

 

In response to all these questions, suggestions and comments from the participants; 108 representative Mr Manish Singh firstly apologised for the deaths happened and assured the villagers for posting one vehicle in Surhi village within 2 weeks from the day of program. Looking at the difficult terrain of the area he also suggested that Mahtari Express (102) can be posted in these villages which will help in carrying pregnant women. But he still did not mention anything on grievance redressal mechanism. 

Currently transparency and accountability are two major issues that this service is affected with. There is no document available on the part of GVK and Government both, to show the financial aspect of service. None of the website or documents mentions the service charges publically. Also there is no accountability for refusal of services. The grievance redressal mechanism seems non-functional. 

The program became an opportunity for villagers to share their experiences and problems with respective authorities. There is need to follow up with the assurances made for improving the emergency care.