Details for Reform Option "Mobile Health Care Service, Sundarbans, West Bengal"
The Sundarbans (which have a population of more than 3.5 million people living in 1,134 villages) are extremely remote and lack a satisfactory public transport network. Some villages are at least six to eight hours from secondary care hospitals. Even the nearest villages are two to four hours from subdivision or district hospitals. In addition, most of the region’s Primary Health Centres (PHCs) were built in the 1950s and 1960s and have since fallen into disrepair – none offer in-patient treatment and many are not staffed properly.
The Health and Family Welfare Department of the Government of West Bengal conducted a health system development project with funding from the World Bank between 1996 and 2004.
It set up links with five NGOs to improve access to primary health care in the Sundarbans and improve the health status of its people. The NGOs reach the islands by boat, carrying x-ray facilities and equipment, and take specialists from Kolkata to conduct regular health camps in different villages.
The NGOs were given the following terms of reference:
(i) to organise general, ante-natal, post-natal and well-baby clinics: at least four per village per month.
(ii) to provide maternal and child health services.
(iii) to boost immunisation programme with the help of sub-centre staff
(iv) to boost family welfare activities in the area.
(v) to organise specialist camps: at least two per month in the area of operation.
(vi) to provide common diagnostic services such as x-rays, routine blood, urine and stool exams.
(vii) to arrange regular awareness programmes addressing issues such as sanitation and personal hygiene.
(viii) to follow-up pregnancy-related complication cases.
The service was assessed by INSPIRATION (Institute for Planning, Innovative Research, Appropriate Training & Extension), in 2002 which highly commended the NGO’s services and recommended their continuation.
Under the Mobile Health Care Service (MHCS), 52% of remote villages in the Sundarbans are covered.
Total patient attendance at mobile clinics between March 1998 and March 2004 was 2.3 million.
The percentage of patients using government health centre facilities has increased from 11% to 21.25%, implying greater awareness and efficient referral.
A total of 14,3464 pregnant mothers were monitored in 7,386 clinics
From March 1998 to November 2002: INR 46 million.
From September 2002 to March 2004: INR 33 million.
The average cost of MHCS per year is INR 25 million.
Covering 351 villages in the Sundarban islands, Bay of Bengal, since 1998.
Eighteen months from the launch of the project to the beginning of services.
Extension of services: Provides specialist care to patients who otherwise would not travel to seek help.
Awareness raising: Improves health education and knowledge of facilities on the mainland.
Mobility constraints: Needs a better network of riverine and road ambulances to ensure timely medical intervention.
Cost Intensive: This is an expensive programme and is difficult for the government to sustain without external aid.
Limited effectiveness: Quality of health will only really improve in the Sundarbans with a parallel improvement in education and income generation.
Good network of reliable NGOs to carry out the services.
Availability of consultants willing to take part in the scheme.
Who needs to be consulted
Officials of the State Government.
State Government has sanctioned the budget to continue the service now that the World Bank programme has finished. It is applying for foreign funding to help finance it.
Chances of Replication
Good, although dependent on funding and available reliable NGOs.
Participating NGOs are:
Southern Health Improvement Samity (SHIS), Bhangar
Sri Ramkrishna Ashram (SRKA), Nimpith
Servik Vivekananda Gram Seva Sanstha (SVGSS), Belur
Bharat Sevasram Sangha (BSS), Kolkata.
The West Bengal Health & Family Welfare Department has brought out a policy document on ‘Health Sector Reform’ and developed a ‘draft strategic framework’ which has dealt at length on partnership with private sector and NGOs. It has developed a ‘Draft policy for Public Private Partnership in the Health Sector’ which is available on their website for public feedback. See entry on “Establishing a Public Private Partnership Policy, West Bengal”.
Clare Kitchen, Research Consultant, ECTA, New Delhi. November 2004.