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Health Program 2013-14

Introduction:

The project for “Empowering Community and Strengthening Institution for Equitable Access to Healthcare” is in its 3rd phase and 4th year of implementation. In last four years project team has made all possible efforts to realize the stated objectives of the project. As a result of untiring effort by the project team, basic mental health services at least for people with acute mental illness could be made available, which earlier was completely absent. The community, who always remained passive recipients of health services, has started participating in governance and monitoring of village level health institutions. Besides, a ground for bringing positive change and constructive development at least in the intervened villages has been prepared by now. Hopefully, in the years to come, initiative undertaken so far will contribute towards countering exclusion and marginalization. This report narrates the progress made in last six months starting from October 2013 to beginning of March 2014 and also draws some highlights of earlier reporting period.

Project Team:

Currently total of 7 project staff are working under the project supported by Paul Hamlyn Foundation, UK, which is being led by an experienced Project Coordinator. In addition, a Mental Heath Coordinator has been attached who is being supported by NRTT.

Project Coverage:

2 Health Blocks (Gossaigaon and Balajan Block) of Kokrajhar district. Total of 88 villages, 78 Village Health and Sanitation Committees (VHSC) and approximately 30,000 population is covered directly, indirectly the project staff extends their operational areas whenever they are being invited by other villages and when need arises. The mental health services are accessed by people from entire district and partially by almost all the districts of Western Assam.

Highlights of the Activities Carried Out in Last Six-Months:

Village Health and Sanitation Committee Meetings:

Total of 32 community meetings have been organized through VHSC in both the intervened blocks. In these meetings different issues were taken up for discussion and review of progress such as entitlement under NRHM, functioning of ICDS, functioning of PDS, functioning of school management committee, MGNREGA and other rights and entitlement. These meetings have attempted to take stock of the services and entitlement of the villagers under different schemes and programs. These meetings have helped expose huge irregularities in service delivery mechanisms at grassroots thereby facilitate corrective action by the community especially of health, education and food related schemes. In many of such meetings, the villagers were shocked to know about the existence of range of schemes and programs which have hardly reached them. Hence, many of these meetings have been useful in motivating the beneficiaries to claim their entitlement. In a way, these meetings are first of its kind discussing about schemes and programmes implemented by Government for their citizen especially in the intervened villages.

Workshop for VHSC and SMC Members:

Total of 2 Block Level Workshops have been organized involving VHSC and SMC members. In these workshops, various schemes under NRHM and under Right to Education Act 2009 have been discussed and deliberated. The roles of VHSC and SMC for ensuring universal access to health care and education have been discussed thoroughly. In previous reporting period 1 workshop and in current reporting period 1 workshop has been conducted. In each of these workshops 45 to 50 VHSC and SMC representative have participated. These workshops reportedly have been very useful for the VHSC and SMC members for activating their respective committees as they had been non-starter since formation. The attending members having known their powers and functions have started exercising them in right earnest. Hopefully, such motivation will sustain in the long run and help community take control over these grassroots institutions.

Capacity Building Training for ASHAs and ICDS Workers:

Two Block Level Trainings have been organized so far for ASHA and ICDS workers. The first training was on Supplementary Nutrition and Screening Techniques of Malnourished Children. This training included sessions on menace of malnourishment in the country and importance of supplementary nutrition to deal with it. The trainees were also made aware about the existing schemes to deal with the problem of malnutrition. Then, the trainees were taught about the techniques of identifying malnourished children especially severely malnourished children. This training was imparted by Dr. Zunikar Ali, In-Charge, Nutrition Rehabilitation Center, Gossaigaon. The second training was on Primary Health Care. In this training basic skill of handling pregnancy and other common illness were taught. The technical know how to handle Blood Pressure Machine, Rapid Diagnosis Kits and other basic techniques were also taught to ASHAs to enable them to provide basic health care services in the village. The training was imparted by renowned public health expert Dr. Sunil Kaul. Total of 34 participants have attended the training.

Monthly Mental Health Camp:

The Monthly Mental Health Camp was started in the year 2009 in collaboration with ASHADEEP a Guwahati based mental health society. When ASHADEEP withdrew their brief period of services in Kokrajhar, it was taken up by NERSWN with generous support from Paul Hamlyn Foundation, UK from 2010 onwards. Since then it has made a good departure towards creating a permanent mental health services by the Government. From the beginning itself, the camp was organized in the District Civil Hospital, and active support by the government health department was sought. As a result, a team of Doctors led by Mr. R.C. Debnath has been regularly overseeing the camp. Now, an OPD also has been started by Civil Hospital under the supervision of these trained doctors. The Monthly Mental Health Camp is also being attended by a psychiatrist and Professor of Fakuruddin Ali Ahmed Medical College, Borpeta. This fiscal year, total of 12 camps have been organized and in these camps have been attended by total of 1000 (542 male and 458 female) people with mental illness (mostly acute) have attended. Out of these 174 cases are new cases.

Home Visits and Psycho-Social Intervention:

Total of 50 home visits have been made to ensure regular and effective treatment of clients. Through these home visits apart from monitoring the prognosis and continuity of treatment, counseling, referral for occupational and vocational rehabilitation etc. are being done. The psycho-Social Intervention part needs to be intensified but it has been started in a humble way.

Referral of Acute Cases of Mental Illness and Retardation:

In this year, total of 3 cases have been referred from the monthly mental health camp. Two cases have been referred to Guwahati Medical College and Hospital and one to Kokrajhar omega Clinic. They have been taken to Guwahati for better screening and referred back to Monthly Mental Health Camp.

BTC Level Consultation on Mental Health:

The NERSWN has been actively advocating for inclusion of Psychiatric Care with the General Health Care. It has been lobbying with the department of Health Services to implement National Mental Health Act 1987 and District Mental Health Program 1996. Despite continuous effort too, the response from the government has been very slow. Recently due to the active advocacy, the government of Bodoland Territorial Council (BTC) has agreed to organize Council level consultation involving all stakeholders to chart out a way forward for inclusion of mental health in its Public Health Services. Initially the consultation was planned on 20th of September 2013 but due to bandh same has been rescheduled on 30th of September 2013. The consultation was very fruitful as the government has accepted the fact that the mental health needs to be incorporated in their programmatic and financial plan. The Principal Secretary, BTC and Health Secretary, BTC have directed the Director Health Services to prepare a list of doctors who can be trained on Psychiatry and accordingly impart training so that they can start attending the psychiatric patients. Through consultation it was also decided to impart training to para-medical staff especially the grassroots level service providers such as ANM, MPW etc. Among many decision, one of the major decision was to keep reviewing the progress in every three months.

Hence, it was a good boost to the advocacy work carried out by NERSWN.

Capacity Building of Staff:

During this one year 3 capacity building training have been organized for 7 project staff. The first training was on Rights Based Approach in Community Health Action organized by Institute of Development Action (IDeA). Two trainings were on Basic Skill of Dealing with Mental Health and Brief Psychiatric Rating Scale. Besides, individual staff has been sent for different trainings and workshop organized by various organizations.

Awareness Building through Booklet and Poster Campaign:

The posters in both Bodo and Assamese have been put up in all important locations. The poster speaks about the right of the people with mental illness and also encouraging people to extend helping hand to the people with mental illness.

Strengthening ASHA Association:

The project team has regularly worked with Porbotjhora ASHA Association. During the riot, the ASHAs from estranged communities were facing difficulty in getting together for common cause. But after regular mobilization, the ASHA Association members from different communities have been brought together. In fact, the members have given commitment to remain together irrespective of the situation and ALSO worked for reconciliation to contribute towards peace building. The efforts have been made to form one more block level ASHA association and hopefully, it will take a final shape soon.

Lobbying and Advocacy for Basic Service Deliver:

In the intervention area, some villages were most excluded. One of such village is Harinaguri, in this particular village there was no ICDS centre. Hence, after the village mobilization drive, both villagers and NERSWN workers lobbied hard with the Social Welfare Department and now the process for setting up new ICDS centre has been started by the department.

Another such village is Gambaribil under Porbotjora, the Government Primary School was lying defunct for six months without classes, no mid day meal, no books, no uniform in one sense total violation of Fundamental Right to Education provisioned under RTE Act 2009. These were learned by the project team in the village mobilization meeting and a complaint was lodged with the higher up of education department. As a result, one teacher has been deputed to look after mid-day meal, books, uniform etc have been distributed but no regular classes are being held till today. The effort to push the department for deputing regular teacher is on. Many such village level issues have been taken up by the project team with support from the community. In many instances, the community themselves have proactively started advocating for improvement of services.

Challenges Faced:

  • The trust deficit in the aftermath of the terrible violence in 2012 at times appears as challenge

in implementing the project activities rapidly.

  • The frequent strike called by different organizations has been a big challenge in smoothly

implementing the project.

  • The high turn-over of project staff has also been a challenge.

Key Learning:

  • Dealing with the challenges handed over by the ethnic conflict and yet being able to stay afoot with the project activities has been enriching learning experience so far.
  • The multi-dimensional project activities ranging from education, food, nutrition, water, sanitation etc with core focus on health has really build up the capacities of the project staff.
  • Dealing with the problems of 1000 plus cases of mental illness day in day out has been a very good learning point for not only the project team but organization as a whole.

Conclusion: This particular project is one of the key to shape the organization to its present form. When the organization was at its nascent stage itself, this project was taken up, since both this project and the organization has travelled quite a distance. Hence, this project has contributed not only to the community it serves but the organization. And behind all these, the generous and continuous support by Paul Hamlyn Foundation, UK, has made enduring impact.

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