Jan Swasthya Sahyog (JSS)

Project Theme

Health

Target Group

Others

Project Period

01 Apr 2016 - 31 Mar 2017

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Introduction

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.

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.

 

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. Jan Swasthya Sahyog (JSS) is running this program in 54 program villages. In the present year also the program will aim at improving new-born and post-partum care in same villages which are predominantly tribal and remote area of Chhattisgarh.

The primary objective of all our activities has been to address the inequity in health especially for women and girls. The strategy that we have chosen is of providing health care. It is evident that women face more discrimination in terms of accessing health care. On the one hand due to cultural reasons they are subjected to various discriminations and on the other hand their health care needs are not given attention or priority. Our focus is primary health care in the broadest sense of the term. And in the context of running a service delivery programme, we have tried to understand the causes of poor health of people. 

 

Results to be Achieved / Impact: 

•To register 100% births, stillbirths and deaths by Maternal and child health worker (MCHW)

•To decrease mortality of early infant deaths by 50 % in 2 years as compared to year 2015-16.

•Increase involvement of husband and in-laws in post-partum care

•To decrease postpartum mortality and morbidity by 50% in 2 years as compared to 2015-16 figures.

•Strengthening of the Village Health and Sanitation Committees in villages.

•Advocacy with the government on policies related to availability of affordable medicines and provisioning of diagnostic facilities.

 

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. 

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.