Rajasthan has a difficult topography and a largely rural population which is scattered in desert and tribal districts. Therefore, access to public health care services is limited in these districts. Further, most of the Community Health Centres (CHCs) in Rajasthan, which are the first referral units, do not have all specialties and there are also a lot of vacant posts for specialists. To cater to the medical needs of the population, the government of Rajasthan proposed to introduce a novel scheme of providing specialist services periodically at block level, (an area covering a population of approximately 100,000). The scheme provides services to patients suffering from acute and chronic illnesses that need referral by a Medical Officer (MO) at the Primary Health Centre (PHC). The name of the scheme was coined from an epic Ramayana where Hanuman brought Sanjivani booti (herb) from Himalayas to Lanka to save Lakshman, brother of Lord Ram.
The Rajasthan State Government made their proposal to the European Commission-supported Sector Reform Investment Programme in August 2004.
The proposal was developed as per the demands from the districts. A number of meetings were held at state level to develop a scheme and finalise the details of operationalising the scheme.
Under the Secretary Medical and Health, a committee was constituted to work out operational details and management. The nodal department was Public Health and the nodal officer was Director Public Health.
In each district, the most backward blocks were selected. The Chief Medical Health Officers (CMHOs) and all the officers at the state level were given an orientation regarding the scheme. Each state officer (directors, additional directors, joint directors and deputy director, Officer on special duty, nodal officers of various programmes) was allotted a district. The funding agencies in the state (UNICEF, UNFPA, European Commission) were also allotted districts to monitor the activities pertaining the programme.
The first camp was organized as a pilot to test out the operational details, which had been developed. The principal health secretary, secretary health and director public health all participated in the first camp to understand the functioning of the camps. Thereafter, a review meeting was held under the chairmanship of the principal health secretary, Mrs. Rukmani Haldia.
Guidelines Finalized after pilot testing) were developed for the scheme and circulated to the districts.
•Nodal officer in each district is the district chief health and medical officer.
•Organize two camps with a gap of six months in every district.
•Duration of each camp to be for 3 days.
•Different colour referral cards were developed for the benefit of the patients as well as for those overseeing the delivery of care. The colour of the card denotes the different place for referral- referral from PHC to sanjivani camp was blue; referral from sanjivani camp to PHC/CHC/SubCentre was white; referral to district hospital from sanjivani camp was yellow; and referral to attached medical college was pink.
•Each of the above-mentioned cards has to be filled in duplicate, one of which was given to the patient and another was kept in the institution.
•Approximately a month before the camp, the CHMO develops a draft budget and plan of action including the responsibilities, publicity, printing, purchase of drugs, infrastructure provision at camp site, transport facility for people below povery line (BPL) and sterilized patients. Identifying local donors for organizing, tent provision, food, water, taking care of patients, drugs etc.
•Approximately a month before the camp, a meeting is to be organized under the chairmanship of district collector for finalizing the dates for scheduling the camp and all the above issues. The participant include official from all the sectors including Ayurveda, ICDS, district hospital, Treasury officer, social workers, NGOs, local donors, department of water, electricity, PRI, municipalities and health officials.
•A meeting is held at the campsite, CHC to finalise the responsibilities purchase of drugs, stationery, formats, printing of IEC materials and nitty gritty details including mapping out the places for service provision, exhibition, registration, waiting places for patients and their relatives, computer room, administration section etc. The participants include all the block level officers, local private practitioners, local donors, NGOs, CHC staff and PHC medical officers.
•Letters were sent by CMHO to all concerned people regarding what services they had to give at the camp.
1.Services to be provided
•The specialist services to be provided were medical skin diseases, tuberculosis, obstetrics/gynecological, pediatrics, surgical, ophthalmology, E & T, dental, family welfare, immunization, ayurvedic, unnani etc.
•The team of specialist was taken from district hospital, adjoining CHCs and local private doctors.
•The camp was to provide minor and major surgical procedures.
•The lab investigation for hemoglobin, TLC (total lucosyct count), ESR (Erythrocyt sedimentation rate), urine (albomin and microscopic examination and pregnancy), sputum examination, blood group, ECG X-ray, HIV, pap smear, malaria.
•Before the camps are organised wide publicity was to be carried out in all the villages by the Auxiliary Nurse Midwifes/ Male Multipurpose workers (ANMs/ MPW). The medical officer at the PHC would examine the people suffering from illness and refer only those patients who required specialised services.
•Organising an exhibition on all the health issues to create awareness among people.
3.Management of Information System was developed for monitor the flow of patients. Software was also developed to facilitate monitoring the progress of the scheme.
The camps were then organized in a phased manner to cover all the districts.
This is a statewide initiative started in 2004 and therefore documentation of its impact has not yet been carried out by the state. On average, two camps have been carried out in each district. A visit to one such camp in Churu district at Seth Chotu lal Sethia Hospital (CHC) Sardarshahr on the eve of 3rd camp revealed that each of the nine PHC MOs were supposed to refer 50 patients to the camp.
INR one lakhs rupee was donated by a local donor that was spent on a tent, food, water and even drugs. This was the second camp in the CHC. In the last camp held in March 2005, 2455 patients attended and forty-two referrals were made to district hospital; 248 surgeries were carried out including 243 major surgeries (female sterilization-113; cataract-122; Male sterilization-7; 142 patients were tested and ECG was carried out for 18 patients and X-ray for 44 patients.
In September, 2005 –53 X-rays; 120 laboratories; 200 BPL patients were given free medicines (Surgeries 262 patients had been referred from PHC to this camp. At the end of each camp all the voluntary workers including private doctors are given a token of appreciation.