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Primary Health Care and RCH Services in urban slums, Uttar Pradesh.
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Subject Area="Access to service and coverage." Objective="Improved outreach services."
Details for Reform Option "Primary Health Care and RCH Services in urban slums, Uttar Pradesh."
Summary

Background: The state of Uttar Pradesh is the most populous in India. According to the 2001 census, Varanasi has a population of 3,138,671 (Rural- 1,878100 & Urban – 1,260,571). The Ramakrishna Mission Home of Service (RKMHS), Varanasi has been working in this area for 124 years. They have a 100-year-old, 230-bedded secondary and limited tertiary care hospital. A Public Private Partnership (PPP) between the State Government and RKMHS was developed to provide primary health care and Reproductive and Child Health (RCH) services in eight identified slums of Varanasi City. Action: Services are delivered through a mobile medical van and Community Health Workers (CHWs), trained by the RKMHS, thrice a week. The van contains the following: (i) Gynaecologist, General physician, Pharmacists (two), Nurse and support staff (two clerks and one driver). (ii) Patient examination facility where internal examinations, Intra-Uterine contraceptive Devices (IUD) insertion and minor operations can be conducted. (iii) Medicine dispensing counter (iv) Audio-visual display facility (v) Washing area The following services are provided on a weekly basis: (i) Curative primary health care including provision of essential medicines to residents, (ii) Vaccination of children for prevention of six major communicable diseases, (iii) Routine ante-natal care, (iv) Family planning services: oral contraceptive pills, condoms and IUD insertion, (v) Health education, (vi) Referral services to Ramakrishna Mission Home of Service hospital which provides free consultations, investigations, hospitalisation, operations, medicines and dietary services at a minimal cost. However, the hospital does not provide obstetrics services for which pregnant women are referred to district hospital and medical institute hospital (BHU Varanasi). There are two CHWs who visit the assigned slums regularly and provide antenatal care, family planning supplies and health education regarding primary health care and mother and child health services. They also maintain all the data regarding the various services. Results: (i) Evaluation survey has been undertaken in the identified slums covered under the project. The survey shows considerable increase in the reach of RCH services in the slums, covered by this project. ANC check-up coverage has touched 91% in Baulia slum, from 29.76% at the time of beginning of the project. Iron and Folic acid coverage stands at 89.8% from 31.15% in J.P. Nagar slum area. In Misirpur slum, tetanus toxoid coverage (two doses) is 100%. (ii) Outreach mobile primary health care services and RCH services are being provided to 34571 beneficiary patients in eight identified slums and neighbouring areas, from 30th March 2004 until May 2006. Patients coming from a distance of 50 to 100 km have also benefited. Apparent reason for the popularity of outreach services have been availability of assured quality of primary health services at the minimal/ no cost (for Below Poverty Line patients, the services are free of cost). (iii) Out-reach RCH services have begun in these slums and 6328 women have been treated for gynaecological problems from 8th June 2004 till May 2006. (iv) Transformational Health Education Workshop conducted over 9 days two sessions. (v) Health education group meetings have been conducted by the gynaecologist in the slums with good results in family planning coverage. (vi) In service training workshops held for Community Health Workers.

Cost Estimated Cost for slum out reach and Health education for five years is INR 20,000,000. The break-up of costs is approximately 46% for slum outreach and 54% for heath education.
Place Eight identified slums in Varanasi city of eastern Uttar Pradesh
Time Frame Six months. Approved in Principle: September, 2003; MOU formally signed with Government of UP: Jan. 2004 First cache of funds received: Feb. 2004. Work began in April 2004; it took two months to streamline the whole process. Work could begin very fast because outreach primary and mother and child health care required minimal infrastructure [the old mobile van was used until the new one was ready and doctors and paramedics sat in the open under the shade of a tree or veranda]. It took two months time to custom build a new mobile van and the same length of time to identify the slums and to train CHWs and other staff.
Advantages

Professional community based service coverage: RCH service delivery is done through CHWs. Improved access to professional services: Highly qualified individuals provide services to the underprivileged and poor persons especially women and children in urban areas. Economical: Infrastructure needs minimal and near zero administrative overheads and Popular among the target beneficiaries. Human Resource Development: This is inherent to the entire program.

Challanges

Highly qualified individuals required: Health Care depends on the availability of highly qualified individuals. Government involvement: Involvement of government machinery at various levels with its inherent problems of non-responsiveness [barring healthy exceptions] and instability in form of transfers. Potential conflicts with vested interests.

Prerequisites

MOU between government and implementing agency.

Who needs to be consulted

State / District Health Authorities. NGO management. Community leaders.

Risks

Sustainability

Sustainable and scalable provided mutual respect and trust continues along with flow of funds.

Chances of Replication

Very good chances of replication. However, resource constraint is a major hindrance; especially smooth and timely fund.

Comments

None

Contact

Submitted By

Dr Arti Bahl, Research Consultant, CBHI, New Delhi, September 2005. Last Updated: November 2006.

Status Active
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