Kalika, Balasore www.swaniti.in Journey towards a Swastha Gram Ensuring Access to Quality Healthcare and Promoting Healthy Habits Health Synopsis of Kalika Kalika has a Community Health Centre (CHC) and 10 Anganwadi Centres (8 Main and 2 Mini AWCs). The 6-bedded CHC, Hatigarh has 4 doctors and is overburdened with patients. The facilities at CHC include AYUSH, 102 Ambulance Service and a RBSK (Rashtriya Bal Swasthya Karyakram) team. While the AWCs are fully equipped with workforce (Anganwadi Workers and Helpers), all Centers lack the required basic equipments and infrastructure. None of the AWCs have a functional toilet. The frontline health workers including 5 ASHA workers and the ANM are discharging their duties well. Major health issues prevailing in the GP include water-borne diseases and Maternal and Child Health. The healthcare setup in Kalika is inadequate and there are a lot of gaps in the delivery of services. These issues need to be addressed in a comprehensive manner so as to cater to the health and personal development needs of the village. According to the SAGY guidelines issued by the Ministry of Rural Development, healthcare is one of the core components of an Adarsh Gram. It is imperative that an Adarsh Gram has a robust healthcare setup, which ensures efficient and quality delivery of services in order to address the health and nutrition needs of the community. Understanding the need for the same, Mr. R.K. Jena, the Hon ble MP from Balasore requested the Swaniti team to assess the existing healthcare setup comprising of the Hatigarh CHC, Anganwadi Centres and frontline health workers in Kalika so as to identify the gaps and subsequently, draw a roadmap for addressing the same. Accordingly, the team identified the key stakeholders Chief District Medical Officer (CDMO), Balasore, Medical Officer In- charge (MO I/C), Hatigarh CHC, ANM, ASHA Workers, Anganwadi Workers and Helpers (AWWs and AWHs) and the community in the entire healthcare set up and interacted with them over a course of a month to get a clear picture of the existing situation pertaining to health and nutrition in Kalika.
2 Existing Healthcare Infrastructure the only missing jigsaw in the puzzle? The Health Synopsis section above highlighted the existing healthcare set up in terms of physical infrastructure and human resources in Kalika. Based on a comprehensive assessment of the Hatigarh CHC and the 10 Anganwadi Centres, the team identified the infrastructural gaps, which result in inadequate delivery of healthcare services in the GP. For instance, Dr. P.C.Nayak, the MO I/C, Hatigarh CHC and Mr. Dinda, the Block Programme Manager, National Health Mission told the team that since the CHC was previously a PHC, the facilities have not been upgraded to the desired levels and there is no post- mortem centre, no duty rooms for doctors and staff nurses, shortage of toilets and other basic infrastructure such as drinking water. The pressing requirements as stated by the doctors included the need for posting of staff nurse, installation of X- Ray and setting up of a Postmortem Centre. During the multiple visits to the CHC, the patients and attendants also stressed on the fact that there had to wait in the open area and it was a major issue during the monsoon season. Similarly, a majority of the Anganwadi Centres functioned out of a temporary structure and did not have the desired equipments, medicines and facilities such as toilet and electricity connection. While the 5 ASHA workers, AWWs and AWHs and the ANM are fully committed to their roles and responsibilities, the aforementioned gaps are a major hinderance in ensuring quality delivery of healthcare services to the intended beneficiaries i.e. the pregnant women, lactating mothers, children in the age group 0-6 years and adolescent girls. However, the in- depth analysis done by the team and interaction with community members, health workers and experts highlighted that infrastructural gaps are only the tip of the iceberg and there needs to be an increased focus on fostering healthy practices and improving community awareness on health and hygiene matters. As Dr. Chittaranjan Sahu, a health expert approached by the team, pointed out, Various health ailments in the village are owing to poor sanitation practices, lack of exercise and yoga, lack of poor menstrual hygiene as well as general disregard for personal hygiene among certain sections of the population. It has resulted in cases of urine infection among women and multiple cases of malnutrition among children. Therefore, based on this assessment, feedback from various stakeholders and inputs from health experts, the team prepared a detailed roadmap for strengthening the healthcare setup in Kalika with a focus on addressing infrastructural gaps as well as taking up community awareness initiatives. The idea was to create an ecosystem where good and affordable health services are accessible and available to all and there is increased community awareness on the importance of personal hygiene, good sanitation and exercise. As part of this roadmap and to further strengthen the plan, the team initially placed emphasis on celebrating the International Day of Yoga to promote yoga among school children and conducting a mini health camp for immediate detection and treatment of health ailments.
3 Celebrating International Day of Yoga Ama Gaon, Swastha Gaon Under the Saansad Adarsh Gram Yojana (SAGY) scheme of the Government of India, a major focus is on fostering healthy habits and promoting daily exercise. So when the world geared up to celebrate the Second International Day of Yoga on 21 st June, the team in consultation with Mr. Jena and PRI members also decided to promote the ancient Indian discipline among the students, teachers and health workers in Kalika. The Sarpanch, Ganga Babu suggested that the Yoga Day could be celebrated at the playground inside the Hatigarh School compound and also gave the tagline of Ama Gaon, Swastha Gaon for the event. The team also sought permission of the District Education Officer (DEO) and the Block Education Officer (BEO) for conducting the Yoga Camp, to which they readily agreed and also informed the teachers about the same. Now, one of the key components of the SAGY Development Programme is to identify implementation partners and outstanding models, which can be leveraged in the GP. Accordingly, the team approached Dr. Chittaranjan Sahu from Healthy Life Clinic, a prominent institute promoting AYUSH in Balasore. Dr. Sahu assured full cooperation and support for this initiative and said that two yoga experts from his institute would lead the yoga day celebrations in Kalika. Subsequently, the team and Ganga Babu got down to making logistical arrangements such as mats, loudspeaker and mike for the event. In the meantime, the MPs office designed a poster for the event and got it printed. Finally, on 21 st morning at 7 am, the yoga day celebrations started in Kalika and the trainers from Healthy Life Clinic introduced various asanas to the attendees, which included students, teachers, frontline health workers, curious onlookers and PRI members. Mr. Nag, the lead trainer talked about the importance of Yoga in ensuring a healthy life and also emphasized on breathing exercises and meditation techniques, so that the attendees could practice the same on a regular basis. Attendees Number School Children 170 School Teachers 10 Grass- root Health Workers (AWW, ANM, ASHA) 9 PRI Members 5 Team Members and Trainers 4 Others 15-20 The response of the participants, including students and teachers, was overwhelming. Most of the students looked eager and inquired if the session was to continue over the week. The teachers and health workers also approached the trainers with specific health issues and requested for more such sessions.
4 Pictures from the International Day of Yoga Celebrations in Kalika Organizing a Mini Health Camp at the Panchayat Bhawan Understanding the health problems in detail Post the Yoga Day, the team decided to leverage Dr. Sahu s expertise and knowledge for further interventions and proposed the idea of a long- term engagement to truly make Kalika a Swastha Gram. Dr. Sahu responded positively to the request and agreed to actively participate in the Model Village Program. Hence, the team invited Dr. Sahu to conduct a mini health camp to study the health issues in the GP and provide free treatment and medicines to some needy villagers. The idea was to further strengthen the roadmap for resolving health related problems in the village with inputs from Dr. Sahu. Accordingly, the team organized a mini health camp or consultation session at the Rajiv Gandhi Jana Seba Kendra on the 28 th June and word about the same was spread on a small scale across a few habitations in the vicinity of the Kendra. The team also especially invited the ANM and ASHA workers to attend the
5 consultation session since it was good platform for them to learn more about Naturopathy and Medicine. Over the next two hours, Dr. Sahu attended a sizeable number of patients and also provided them free medicines. The beneficiaries comprised of children, women, adults and old aged villagers. Dr. Sahu made it a point to impart Yoga lessons for specific ailments complained by the patients. The health workers sitting next to Dr. Sahu paid great attention and noted all the relevant points. The response to the Mini Health Camp was extremely positive. The participants expressed great interest for more such health camps, which according to them was a quick and easy solution for their health problems. The health workers also took a lot of advice from Dr. Sahu, who handed the remaining medicines to the ANM and ASHA workers. Dr. Sahu particularly pointed that women in the village are very weak and there are a lot of anaemia and urine infection cases. The above set-up gave Dr. Sahu a first-hand account of the health status of Kalika, directly from patients and the grass root health workers. Accordingly, he was now able to help us strategically design the future steps for health care delivery to Kalika residents. According to Dr. Sahu, most of the health ailments in the GP, particularly among women and children, are due to lack of proper hygiene and sanitation.
6 Yoga Center Health Camps Introduce discipline in the lifestyle of villagers through Yoga and inculcate healthy habits so as to reduce financial burden and health problems Plan 4 to 5 Day Yoga Camps at regular intervals and at different locations within the GP, including community areas and markets Plan construction of a Community Center that has a Yoga room dedicated to Yoga Classes and Ayurvedic treatment Post the organization of Yoga Camps permanently place Yoga trainers in Kalika and levy fees from villagers for future sessions Plan Health Camps at all 11 wards on a Sunday of each month throughout the year. Dr. Sahu has agreed to provide Ayurveda and Naturopathy treatment for all sessions. Idea is to provide a long term low cost solution to health problems of the GP Conduct Free Blood, Urine, Hemoglobin and Diabetes Test Estimated cost of INR 3-4 lakhs for Medicine to be paid to Dr. Sahu Organize awareness sessions for women of Kalika with support from Dr. Sahu s spouse who is also actively involved in Yoga and Medicine. She has agreed to travel to Kalika with Dr. Sahu on Sundays Cost Analysis of Year Long Medicine Camp v Number of Camps (Wards) - 11 v Population per ward (assumption) 500 v Attendees per session (assumption) 150 v Cost of Medicine (Ayurveda) per person INR 200 v Total Cost 200 * 150*12 = INR 3.6 Lakhs