Sukhajeevanam: A Community Based Rural Health Project in Orvakal

Transcription

1 Sukhajeevanam: A Community Based Rural Health Project in Orvakal Health is not only absence of any disease but also incorporates social, economic, spiritual, physical and mental well being. For long, health has been linked with the a negative conceptualisation of a state. With this comprehensive understanding of health, it is important to understand that any health programme that is designed for the poorest of the poor has to focus on improving the socioeconomic well-being of the people as well as other aspects of health. Health does not exist in isolation, but it is greatly related to education, environment, sanitation, socio-economic status and agriculture. Therefore, improvement in these areas by the communities in turn improves the health of the people and the vice-versa. Health care includes promotive, preventive, curative and rehabilitative aspects. Integrating all these aspects together into any programme brings about effective health improvements. There is ample evidence that working at the grassroots level with village health workers and community groups leads to the process of empowerment of women and communities in general. This is an important aspect of community-based health care. Once people have knowledge and can make informed decisions, they have power they can use in constructive ways to transform their communities in all aspects, not just health or any other apect. The solutions to majority of health problems in rural areas are simple. But these problems can become worse and may even cause death if not identified and treated at the onset. To a large extent, the problems are preventable and amenable to health detection. The usual way of providing medical care mainly curative in an established hospital or clinic based on a western medical model is not always helpful in improving the health of poorer individuals or communities in our rural setting. This health pilot will look at the provision of health in a novel manner and with a holistic approach. 1

2 This approach is Community Based Primary Health Care in the rural area, linked to development. The major objective of the health and development work empowers people and communities to take care of their own health and take responsibility for the community s health. From the beginning, the different village communities will be involved and participated in a partnership relationship. Equity, Integration and Empowerment of people will be the principles of this pilot will be to improve the status of women and weaker sections of society. A similar approach in Jamkhed has brought about overall development of the people by introduction of holistic health practices in their lives. One of the main objectives of this pilot rural health programme will be to reach the poorest of the poor or the marginalised and improve their health. In reality, perhaps not everyone in the world will be able to have equal health care. However, it is possible to make sure that all people have access to necessary and relevant health care. This concept is known as equity, and it will be an important principle of this pilot. In fact the major principles of this pilot will be the following: 1. The first principle is equity. The programme must reach everyone, including the poorest of the poor. 2. The second principle is: integration. Not only must curative and preventive medicine be integrated but medical attention must be integrated with other factors that enhance life and health, such as agriculture, education, and a safe water supply. 3. The third principle is empowerment, with a specific focus on women. Poor people who receive knowledge, information, and models of organizing realize that they have the power to transform their own reality. The following health pilot has been developed keeping in mind the Kurnool situation. The Jamkhed Rural Health Programme initiated by Dr. Arole has been a great influence on the development of this pilot. It fulfills most conditions of making the health programme a success. At Jamkhed, an unique process in community action has been nurtured to result as one of the best primary health projects in the world. This project has 2

3 evidences of bringing down infant mortality and child mortality down drastically. Jamkhed Project has demonstrated that health could be an entering wedge into total socioeconomic development. It has proved that the very poor have a capacity for change and can effectively take positions of leadership if given a chance and some support. Illiterate and outcaste rural women can become leaders and address international conferences and advise the Prime Minister of India. Kurnool - Jamkhed Health Programme Base Hospital 1. Acute/emergency 2. care Continuous Health Education Education The pre-requisites to implement the model: 1. Mature SHGs, wherein some health activists will be identified by the communities to become Community Health Development Workers (s). 2. A base hospital (a charity hospital) to become the epicentre, to provide emergency care round the clock, of the health model. 3. The outreach activities are organised across this epicentre by the help of the s. 4. A training centre (SMLEC) to become a CHE Centre (Continuous Health Education Centre). 5. A group of master trainers to be identified and sent to Jamkhed to be trained initially for a period of four weeks. These women should be literate. Some very 3

4 motivated Nurse/ANM trained women can also be identified to become master trainers for this programme. 6. Then continuous medical and health training is provided to these women on a fortnightly basis. 7. This health programme will ensure that the s become the first contact persons for delivery of simple health services, for which, communities do not have to depend on the medical doctors. This will also give them some opportunity for health awareness and education and practice of healthy habits. 8. Health becomes part of daily routine, rather than something to attend to during an illness episode. This change in perspective will allow the community members to percieve health in a different way and also to reap the benefits of healthy lifestyle practices. The modifications in lifestyle will not happen overnight. It will take months and sometimes years to see benefits. But sowing seeds of this nature will ensure that the changes will takein the future. 9. A training currculum that has been developed based on our interaction with Dr. Arole and all the Health Workers there. 4

5 Detailed Action Plan Kurnool Rural Health Project Name of the Project: Sukha Jeevanam Project Area: Orvakal Mandal No.of villages: 27 Duration: Five years Partners/Implementing agencies: MMS Orvakal, Velugu and SMELC Target group: First SHG members and then the Entire community over a period of time Goal: Improved quality of life through empowered women Specific Objectives: 1. To promote community based health organization 2. To position community based health workers 3. To promote better nutrition for women and children 4. To deal with common childhood illnesses 5. To deal with common health issues of women 6. To build awareness for clean and hygienic environment 7. To reduce unnecessary health expenditure 8. To reduce the risk of catastrophic episodes of illnesses for the poor 9. To build awareness towards an accountable formal existing health system 10. To promote social action for better health of women and girl child 5

6 Nomenclature: The Community Health Worker will be called as Arogya Deepika under this project. Contact persons SERP Team: Ms. Lipika Nanda, Ms. Lakshmi Durga and Mr. Mukesh SMELC Team: Yet to be identified Mode of implementation / Strategies: Village Organisation (VO) will play a role of nodal organization under which a Sub- Committee will be formulated who will look after all the health related activities including social issues having direct impact on health. The committee will be comprised of the following members: 1. Sarpanch, if female/female ward member 2. Village Accountant 3. One representative from 4 SHGs to have geographic representation 4. One representative from Mothers Committee The committee will have 5-15 members depending upon the size of the village Tasks to be taken up by VO 1. Organise a general body meeting and present the project to them. Also, take their opinion whether the community needs such health programme or not. 2. Constitute Health sub-committee in the general body meeting 3. Selection of 1 or 2 Arogya Deepikas Criteria for selecting the Sub-committee members: a. The member should be able to spare time b. Should be vocal and have skills to convince others c. Should be practicing or willing to practice good health behaviours, like small family norm, etc. and become a role model for others. d. Should have shown some success in previous tasks assigned e. Should be healthy 6

7 Functions of the Health Sub-Committee: 1. Conduct a baseline survey along with Arogya Deepika in the village to assess the health needs and health status of the village ( Format will be prepared by SERP) 2. The committee will also access other services from the line departments, for example, collaborating with MDOs to get safe drinking water, health and nutrition activities from the DM&HO and ICDS, etc. 3. The committee will also deal with all the social issues within the community. 4. Take pledge in the VO and SHG meetings on promoting social change like, eating together as family, schooling of girl children etc., 5. Organise Village Health and Nutrition day, at least once per month. 6. Ensure implementation of DOT in the mandal. 7. Ensure one point in the agenda is on health and should be discussed in every VO meeting. 8. The sub-committee will also maintain a stock of some simple medicines and the drug list will be displayed in the form of billboard in the VO. The committee will also decide the rate of each medicine. The committee will review the drug stock every month and act accordingly. Guidelines for selecting Arogya Deepika: 1. The Arogya Deepika should be married/widow/separated, who has 2-3 children and has experiences in life.(social unjustice) 2. Should be the resident of the village but should not be wife of teacher, village sarpanch, etc. 3. Need not necessarily be educated, if educated, will be advantageous, if not, can be helped by her son or book keeper, for maintaining village health record. 4. Should be able to spend time for undergoing training and serving the community (2hours in the morning and 2 hours in the evening). 7

8 Role of Arogya Deepika: 1. The Arogya Deepika should attend all the SHG meetings in the village. 2. She should visit few families (outside the SHG members families) where there are sick people. 3. She should identify topics and get prepared to discuss in each SHG meetings. She can take up contemporary and issues based on current situation to discuss in the meetings. 4. Should demystify the medical technology and excess use of medication to the community. 5. Should provide support to ANM, AWW in carrying out activities like immunization, ANC check ups, conducting deliveries, etc. 6. Support during emergency cases & referrals. 7. Should submit report to VOs every month and follow the monthly programme given by the VO. 8. The Arogya Deepika will disseminate her learning to each of the SHG members. This can be done in groups or while she visits individual households. 9. In the longer run, she should be able to take care of the overall health of the community. In order to achieve this goal, she has to undertake a lot of health awareness activities at household and at the community level. Compensation for Arogya Deepika 1. To enhance her livelihood opportunity the Arogya Deepika will be given an amount (amount and modalities is yet to be decided) to start a small income generation activity. 2. She will be compensated for her travel and wage on days when she participates in meetings and training programmes outside the village. 3. She will also charge a minimal amount for the medicines she would provide to the community. 8

9 Curriculum for Community Health Development Workers (Adapted from the Jamkhed Curriculum) The major objectives of this CBHD course will be to: 1. Acquire a clear understanding of Primary Health Care and Community Development. 2. Learn practical skills to effectively manage projects for the urban and rural community. 3. Develop the skills necessary to make Community diagnosis, write a program proposal, generate resources, develop tools to monitor and evaluate projects. Duration: 4 Weeks Participants: Illiterate/High School/Passed Course Contents: Primary Health Care Health (Non Medical) Interventions 1. 5 elements which affect the health Water, Soil, Light, Air, Ether (Ordinary day-today-life is part of healthy life) 2. Nutrition: Basic Micro Nutrients Nutrition for pregnant women Nutrition for children Demonstration - Thali (Dal, rice/one chapati, boiled egg, palak) - Make Kanji 9

10 - (How much to fry, how much oil, salt, sugar, tamarind, chillies, wheat flour, boiled moong dal) - Spoon and bowl feeding - Bathing the baby with fruits 3. Water and sanitation Water quality testing Storage methods Different methods of water filtration Different types of soak-pits Smokeless chulla, vanjyoti 4. Practices (Good and Bad) Superstitions that are good for women s health Superstitions that cause harm to health 5. Natural Physiological process Pregnancy examination Delivery normal- demonstration through model Growth monitoring weighing the child, noting on road to health card 6. Existing Health Structure Who are partners How to work along with them 7. Illnesses and Immunization Pregnant Women Children 8. Treatment of diarrhoea, inhalation 9. Chronic Illnesses T.B. Malaria HIV/AIDS Leprosy 10. Family Planning 10

11 11. Women's issues and reproductive health Adolescent girl's nutrition Personal Development 1. Self esteem Strength and weaknesses Pick-up the item which will describe personality 2. Adult Learning 3. Vision, Mission 4. Values love, forgiveness, caring, sharing, selflessness, scripture and values Leadership Organizing communities Songs Dramas Games Income generation Savings Puppet show Magic 11

12 CURRICULUM : PREGNANCY AND DELIVERY 1. Reproductive organs: Male, Female, Anatomy, Physiology 2. Anatomy of female pelvis Anatomy of foetal skull 3. Menstruation, ovulation, Pregnancy 4. Foetal growth 5. Growth and special problems in 1st, 2nd, 3rd Trimester 6. Danger signs in pregnancy 7. High risk pregnancy Referral to hospital 8. Nutrition and care of pregnancy mother weight, breast care. 9. Safe delivery Vertex, Breech, Twins, Danger signs during delivery High-risk referral to hospitals 10. Obstructed labour, Bleeding, infection cervical tear, perineal tear 11. Care of cord delivery of placenta 12. Post partum care Bleeding Infection Swelling of leg Anemia 13. Observation of new born and congenital defects 14. General cleanliness: Room where delivery will occur Clean hands, clean blade, and clean thread to tie the cord 15. Delivery Pad: Two pieces of old clean sari Sterilized to cover the PV Gauze Cloth to support perineum Sterilized blade 12

13 16. Teaching material: Plenty of charts, models, specially model of pelvis and a doll Trainees examine pregnant women and conduct deliveries with help from midwives. Trainees watch Caesarian section, repairs of tears breach delivery. A female goat is dissected to show deferent parts of the body. Trainees practice delivery on a life-size doll. The work with experienced midwife in the village. Trainees learn to take blood pressure, measure HB and test urine for albumin. 13

14 Action Plan for the coming 3 months S.No Activity Time line Responsible 1 Organise workshop with MMS members for developing format in which baseline data to be collected. By end of May 03 2 Conduct general body meeting by VO to By end of 1. Constitute Health sub committee May Selection of 1 or 2 Arogya Deepikas 3 Exposure visit to Jamkhed to the president 1 st Week of & secretary of 27 Vos June 03 4 Preparation of Proposal to enter into MOU By 1 st week with CRHP, Jamkhed to be the resource of june03 organization for trainings 5 Selection of Master Trainers by giving 1 st week of advertisement by MMS June 03 6 Development of Training material 2 nd week of June 03 7 Training of Master Trainers at SMELC & 3 rd week of Jamkhed June 03 8 Exposure visit to Arogya Deepikas to 2 nd week of Jamkhed July st rd of training for Arogya Deepikas 3 rd week of July nd round training of Master Trainers along August 03 with Communication specialists & Artists SERP Health unit VOs & MMS SMELC SERP MMS SERP,CRHP& SMELC SERP SMELC Master Trainers SERP, CRHP & SMELC 14

15 Budget for the implementation of the Kurnool Rural Health Project Pilot in 1 mandal (25 villages) Overheads Time Unit Cost Units Total (Months/Weeks/days) Exposure visit of the SHG Members to Jamkhed Exposure visit of the Project Staff Jamkhed mobile team Trainer's Salary Training of trainers programme for 10 ToTs Training of the Arogya Deepikas Training Materials for training of Diagnostic equipment & Medicine bag for the Intial 15 day training for the Continuous Health Education Review visits by the Project Staff Base Hospital Costs Transportation Costs Loan to the Arogya Deepikas Total Costs Budget for year 2 5 Trainer's Salary Diagnostic equipment & Medicine bag for the Continuous Health Education Review visits by the Project Staff Base Hospital Costs Transportation Costs Total Costs Budget for year 3 5 Trainer's Salary Diagnostic equipment & Medicine bag for the Continuous Health Education

16 Review visits by the Project Staff Base Hospital Costs Transportation Costs Total Costs Budget for year 4 5 Trainer's Salary Diagnostic equipment & Medicine bag for the Continuous Health Education Review visits by the Project Staff Base Hospital Costs Transportation Costs Total Costs Budget for year 5 5 Trainer's Salary Diagnostic equipment & Medicine bag for the Continuous Health Education Review visits by the Project Staff Base Hospital Costs Transportation Costs Total Costs Budget for 5 Years Budget for year Budget for year Budget for year Budget for year Budget for year Total Budget % % Grand Total