Details for Reform Option "Local initiative programme for Reproductive & Child Health, Uttaranchal"
The Rural Development Institute (the rural outreach arm of the Himalayan Hospital Trust) set up a Local Initiative Program (LIP) as a pilot Reproductive & Child Health (RCH) project. The aim was to provide outreach services by enhancing community ownership.
It did this by:
(i) Recruiting Lady Medical Officers (LMOs), stationed at its headquarters, to hold satellite/mobile camps in the outreach areas to supplement the health care infrastructure. Initially, the satellite clinics were organised at rented premises, away from the sub-centres/ Primary Health Centres (PHC). However, over a period of time many of these clinics were held at sub-centres. These clinics were held as per pre-determined schedules drawn up on a monthly basis.
(ii) Training more than 400 community health volunteers (CHVs) in Eligible Couple (ECLO) mapping and basic RCH services. CHVs are women from the community who have been nominated by the villagers themselves. Each CHV monitors a population of 400 around her village.
(iii) Forming Swasthya Prachar Samitis (SPS) or “village health committees” in 400 villages, covering a population of more than 200,000. The SPS is an independent body which includes village elders, the local CHVs, field supervisors (each monitoring 12 CHVs) and the Gram Panchayat president. This committee meets twice a month to discuss health issues/problems and suggest possible solutions.
(iv) Identifying and training more than a 100 “peer educators”, through the SPS, who share information on reproductive health issues and family life education with approximately 10,000 adolescents in his/her area.
(v) Training more than 100 Traditional Birth Attendents (TBAs) in clean and safe delivery practices.
(vi) Introducing a Behavioural Change Communication (BCC) strategy where information on RCH has been used by the CHVs as part of their motivational campaign using posters, pamphlets and puppet shows. Wall writings in prominent places have also been found to be an effective medium and “swasthya melas” or health fairs are organised periodically where family check ups are offered free of cost. Specialist services are also available.
The costs during the project funding was a total of INR 1,42,75,000 of which INR 27,90,000 was that incurred on start up activities and a sustenance cost of INR 1,14,85,000 (for a period of 15 months).
Uttaranchal across the districts of Tehri, Pauri, Uttarkashi and Dehradun since 1998.
Six to 8 months.
Empowerment: Women are given decision-making information regarding their reproductive health behaviour.
Availability: Of doctor services (especially lady doctors) enables villagers to ensure their health and well being.
Education: Creates awareness and help to people in rural and hilly areas by utilising people from within their own community.
Gender-friendly: Women find it easier to share their problems and interact with the CHVs because they are mostly women well known to them.
Requires vision: Possible inability of existing bodies to see new ways of doing things.
Expense: Terrain makes services/referral facilities difficult and not cost effective.
Government acceptance of volunteers.
Willingness of people to volunteer.
Who needs to be consulted
Local government bodies, government health organisation, body imparting technical assistance (in this case Himalayan Institute Hospital Trust).
Currently LIP depends on external funding and so is not yet self sustaining. The initiative is being sustained by the HIHT and the village community.
Chances of Replication
This was a programme that was adapted from the Bangladesh model and was simultaneously tried in Calcutta and Chandigarh (other than Uttaranchal) in partnership with Management Sciences for Health (MSH) and Technical Assistance, Inc. (TAI) and funding from the Bill & Melinda Gates Foundation. (http://www.india-lip.org/)
J. P. Mishra, Programme Advisor, European Commission Technical Assistance, New Delhi. March 2003.