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Health System strengthening

Health and Wellness Centres (HWCs):

The numbers of HWCs in the state have been increased from 900 to 1900 in 2019-20. Out of

which, 1500 are SHC-HWCs, 355 are PHC-HWCs and 45 UPHC-HWCs. SHRC continued to

provide technical support at state as well as district level for operationalisation of HWCs.

At state level, SHRC supported in preparing PIP, draft guidelines, reporting formats etc. SHRC

aided the necessary capacity building by designing training modules for RMAs and

ANM/MPWs and conducting the training and ToT in collaboration with AIIMS, Raipur.

Training of 650 RMAs has been completed at AIIMS, with 251 being covered in 2019-20.

Another 81 RMAs received ToT for training ANMs at district level.

SHRC helped in conducting examination for entrance into 6 month bridge course and

provided support during counseling. So far around 1000 CHOs have been admitted in the

course and around 500 have completed and got posted in HWCs.

SHRC provided field level facilitation and monitoring support in 10 districts, covering 860

HWCs. Field-visit reports of around 400 HWCs showed that the average number of patients

treated per SHC-HWC in a month was around 342. The average number of hypertension

patients under treatment per HWC was 55 and for diabetes it was 33. The overall availability

of drugs in HWCs, including for hypertension, diabetes and skin ailments has improved during

the last quarter.

SHRC produced monthly updates on HWCs, highlighting the issues that needed to be

addressed from state level. Some of the key issues were: availability of drugs in HWCs, HR

planning including second ANMs, system for line-listing of chronic disease cases in HWCs for

ensuring monthly follow-up etc. Inputs were provided to NHM for certain issues to be raised

at national level e.g. incentive Amount for ANMs working on HWCs, changes needed in the

NCD App etc.

SHRC carried out training of Mitanins on their role in HWCs. Mitanins continue to play a key

role in promoting HWCs and directing patients towards HWCs. Mitanins filled a large number

of CBAC (Community Based Assessment Checklist) forms but the usefulness of the form-filling

needs to be examined and alternative strategies may be needed.

Under NHM RoP 2020-21, 1200 new HWCs (1000 SHC-HWCs, 200 PHC-HWCs) have been

approved. SHRC plans to increase the number of consultants to facilitate and monitor HWCs

on the ground.

Community Engagement and Social Audit of HWCs- A new addition to the programme was

Community Engagement and Social Audit of HWCs. During 2019-20, two rounds of exercise

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were conducted by SHRC and report submitted to NHM. Major recommendations as per gaps

identified were-

To improve display of OPD timings

To improve regularity of RMA visits to SHC-HWCs,

To abolish user fees in HWCs

To increase quantity of availability of drugs and rapid tests for hypertension,

diabetes

Free Essential Drugs:

This is an aspect in which Chhattisgarh has made very significant progress in the

period starting from August 2019 onwards. The state was not performing well in

ensuring adequate availability of essential drugs in 2018-19. SHRC carried out periodic

assessments of drug availability in CGMSC and government health facilities. SHRC

helped the department in diagnosing the issues that led to frequent stock-outs. It

carried out studies from facility level stores, district stores and CGMSC godowns. It

worked with Directorate and CGMSC for resolving the following issues:

a) SHRC convinced the directorate and CGMSC to shift to a Buffer Stock based

system. SHRC helped directorate in developing buffer quantities for fast-moving

drugs.

b) SHRC helped the directorate in deciding a list of high-priority or fast-moving

drugs. It allowed CGMSC to focus on a manageable list of around 110 drugs,

which are most needed in facilities.

c) Another major gap that had led to shortages of drugs in the past was the poor

forecasting of annual quantity of drugs needed. SHRC helped the directorate in

working-out more realistic quantities required. The annual indent for 2020-21

was prepared in October 2019, thus giving CGMSC enough time for

procurement.

The above changes in the system have altered the scenario. CGMSC now has valid Rate

Contracts for most of the essential drugs. Availability has started to improve with

around 70% of the essential items being available and in adequate quantities. Purchase

orders for another 25% are in the pipeline and are likely to arrive soon.

SHRC carries out monthly assessments of drugs availability and raises alerts if any of

the important items are missing. A prescription audit study was carried out which

showed that 75% of drugs prescribed were generics though other prescription

practices had significant and persistent gaps.

Support for Free Essential Diagnostics:

NHM Chhattisgarh has started upgrading the diagnostics starting with District

Hospitals. It has decided that to strengthen the laboratories in public hospitals rather

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than looking for outsourcing based options. A new upgraded lab has been built by

NHM in Raipur District Hospital. Labs in four urban PHCs in Raipur city have also been

upgraded by NHM. NHM plans to soon upgrade one district hospital laboratory per

division. The laboratory in Narayanpur district hospital has made progress. SHRC

carried out a Baseline Assessment of diagnostic services available in District Hospitals

and CHCs. Alongside, the shortage of essential equipments for diagnostics have also

been identified and mapped. While gap analysis for District Hospitals has been

available with NHM through its earlier exercises, the Assessment by SHRC sheds more

light on situation in CHCs. Inputs were prepared for Directorate for improving tests

through increasing routine availability of reagents and equipments. Standard timings

for labs and taking samples and giving reports were recommended by SHRC which the

directorate has implemented.

The state is yet to decide on adopting an Essential Diagnostics Policy. SHRC has

prepared and submitted draft policy and guideline documents.

Human Resources in Health:

SHRC carried out Health Labour Market Analysis, a comprehensive exercise on HRH in

Chhattisgarh in collaboration with WHO. The exercise completed in September 2019,

has provided many recommendations on HRH, for which a consensus has been found.

In order to monitor progress and to update the HLMA, a Technical Working Group

(TWG) has been formed.

Some of the key recommendations on HRH, including from HLMA, have been put-

forward in form of a draft Cabinet Note. SHRC has helped in refining the note, though it

is yet to reach the cabinet level.

SHRC developed a proposal for Family Medicine PG Diploma. It was supported by NHM

and has got approved in the NHM PIP 2020-21. The admissions will take place in July

with a target of 150 Medical Officers. This is aimed at solving the shortage of speciskist

skills, especially at a CHC level.

A HRH plan was developed for Bijapur, Dantewada and Sukma. One of the

recommendations was to have district-wise quotas in CHO positions (for Health and

Wellness Centres) to ensure that tribal districts get enough CHOs. In last two batches,

NHM implemented Division-wise quotas resulting in more CHOs being selected from

tribal divisions. Yet, some districts continue to suffer shortage of CHOs. NHM has

agreed for district-level quotas for the July batch of 2020.

SHRC helped the directorate in developing a guideline for facility OPD timings and HR

availability in emergency duty etc. from Sub-centre level upto District hospital. It

revived the evening OPD that the state had discontinued a few years back.

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Health Insurance scheme through Trust Model - Dr Khubchand Baghel Swasthya

Sahayta Yojana (DKBSSY):

Chhattisgarh developed a Trust based model and started implementing it for PMJAY

and MSBY from September 2019. The state merged PMJAY and MSBY into a single

scheme - DKBSSY. It also merged Sanjeevani Kosh, Child Heart Protection Scheme (Bal

Hruday) and a few more smaller schemes into another scheme called MVSSY

(Mukhyamantri Vishesh Swasthya Shayata Yojana). SHRC provided insights based on

research on health insurance schenes in India and Chhattisgarh. It helped the State

Nodal Agency in designing guidelines for DKBSSY and MVSSY. One of the key inputs

was in deciding procedures/packages which could be reserved for public hospitals.

DKBSSY was launched in January 2020 and early results show a clear increase in share

of public hospitals in claims.

Capacity Building of HRH:

Training of Medical Officers: SHRC collaborated with AIIIMS Raipur to design and

implement a 3-month course on Pediatrics skills for MOs. 6 MOs were to be inducted

every quarter. In first three quarters, 13 MOs could be trained against target of 18.

Further strategies are needed to attract MOs for the course. With the support of AIIMS

Raipur, 22 MOs have been trained on emergency triage and treatment. 4 MOs were trained

on LSAS in collaboration with CMC, Vellore.

Training of around 300 doctors on clinical management for Dengue was facilitated in Durg,

Raipur Bilaspur, Surguja and Bastar with the support of Jan Swasthya Sahayog Ganiyari.

Standard Treatment Guidelines: Draft updated Standard Treatment Guidelines (STGs) for

MOs were submitted. STGs on Dermatology, Ophthalmology, Psychiatry, ENT,

Hypertension, Obstetrics & Gynecology and Pediatrics have been submitted to DHS for

approval after the approval from the STG working committee. Drafts of STGs on Diabetes,

General Medicine, Respiratory and Emergency Care have been prepared and are waiting for

approval of the expert committees.

Training of RMAs: SHRC continued to train RMAs in various courses covering skin

ailments, obstetrics and pediatric skills. In 2029-20, 190 RMAs were trained by SHRC in

collaboration with NGO hospitals and AIIMS (52 in Obstetrics, 8 in Pediatrics, 130 in Skin

diseases).

Urban Health

SHRC carried out an evaluation of Urban PHCs (UPHCs). 36 out of the 45 UPHCs were

visited. The analysis focused on what proportion of healthcare needs were met

through the UPHCs and the factors affecting performance.

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SHRC helped in drawing up a plan for upgradation of 4 UPHCs in Raipur. The

upgradation of infrastructure and services I close to completion. NHM plans to upgrade

more UPHCs across the state on similar lines.

Plan on Tribal Health through gap funding from Tribal Sub-Plan (TSP)

SHRC helped the directorate in oreparing a plan. Inputs were taken from JSS, Ganiyari

and NGOs. The main areas included in the plan were - malnutrition and health, TB,

Malaria, Sickle-cell disease, referral transport. Preparing plan

Sickle cell Disease Management:

SHRC helped the directorate in designing a campaign on sickle cell disease. The design

was focused on secondary prevention. Orientation training of of doctors and health

staff were carried out in three districts. The campaign could not start due to Covid

outbreak.

Environmental Health

SHRC carried out several studies on Air Pollution and Health in Raipur and Korba

districts. A significant relationship was found between pollution and respiratory

illnesses. Areas with power plants had several times higher prevalence of respiratory

illnesses.

Monitoring and Evaluation of PPP schemes:

SHRC analysed the 104 (Health Helpline) service and submitted a report to

Government, with suggestions for major changes in design of the service. SHRc helped

the directorate in redesigning the RfP.

SHRC provided monitoring reports on 102 (referral transport for Maternal and Infant

cases) services

SNCUs

An analysis of mortality in SNCUs was carried out for 2017 and 2018 and report was

submitted. A disproportionately large number of admissions and deaths are due to

Birth Asphyxia which indicates the need for training and supportive supervision for

ANMs, nurses and doctors on better labour practices and neonatal resuscitation.

Immunisation and Ante-natal care:

SHRC carried out monitoring of Routine Immunisation in tribal blocks in collaboration

with Unicef. It showed that immunisation rates were satisfactory but IPV vaccine

shortages were noticed.

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In Dantewada district, a pilot was started with ANMs to improve ANC services, using a

Participatory approach known as SALT (Support, Appreciate, Learn, Transfer) in

collaboration with Unicef.

Work on AYUSH:

On lines of Kayakalp, draft guidelines for quality assessment of AYUSH facilities including

evaluation and checklist (for self assessment, peer assessment and external assessment) have

been developed.

SHRC helped State Ayush Mission in recruitnents of consultants and other staff. Training of

school teachers and students on medicinal plants were carried out, covering 1667

participants.

Study on Sector Meetings:

A study was on sector-meetings was carried out for PHCs of Bilaspur district. It shows that the

sector meetings focus mainly on data reporting. Most of the discussion is centres around maternal

care and immunisation. Various campaigns of department occupy the centre-stage. Many

important aspects like family planning, prevention and control of diarrhea and malaria, follow-up

of TB and Leprosy are relatively neglected in sector meetings. Issues like Sickle-cell do not even

get mentioned in sector meetings.

Mortality Analysis:

SHRC provided analysis of community reported causes of deaths every year. It covered

around 1 lakh deaths for the year.

SHRC has also developed a system of carrying out Verbal Autopsies of Maternal Deaths

and under-5 Child deaths and provides the department annual analysis reports with

recommendations. Studies of maternal deaths have shown that multiple referrals,

shortage of c-section capacity in many districts and gaps in addressing the

complications identified during ANC are the aspects that need improvement. State

faced shortage of Iron Sucrose in 2019-20 which has now been resolved.

Special Plan for PVTG health – Baiga tribe in Kawardha district:

An inter-sectoral action plan was developed in collaboration with PHRN and submitted

to NHM in December 2017. After approval of funds in 2018-19, the project was

initiated. It covers 84 Baiga habitations in Pandaria block. The main components

implemented include community management of malnutrition, intensification of

community processes including Mitanin’s work, BCC interventions, inter-sectoral

action for safe drinking water and food security.

During 2019-20, 37 Nanpan Thiha (community managed health and nutrition centre

for children under 3 years of age) were operational, where 510 children, 96 pregnant

women and 101 lactating mothers are getting benefited. It was found that some Baiga

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hamlets still did not have Mitanins as a result those communities were deprived of

Mitanin’s services. So, such 14 Baiga hamlets were identified and new Mitanins from

Among the Baiga community have been selected. Constant supportive supervision is

being provided to strengthen existing 56 VHSNCs in the project area. A Progress report

has been submitted to NHM.

Some of the key improvements measured so far include:

For children under 3 years age Baseline July 2019

% of Children Washing hands with soap

before eating 12% 84%

% of Children sleeping under bednet 20% 77%

% of children consuming high protein foods

(e.g. eggs) more than 3 times a week 2% 86%

% of children with adequate calorie density in

diet (through addition of oil) 8% 88%

No. of children who were contacted by health

worker/CHW in last month 41% 92%

No. of children weighed during last month 30% 85%

No. of children whose nutrition grade

communicated to mother during last month 5% 75%

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Malaria test by Mitanin

Community Processes

Malaria Mukt Bastar – A Special Campaign on Malaria by NHM: This

campaign was implemented by NHM in 16 of the blocks worst affected by malaria in

the state. It was carried out in January-February 2020. Mitanins and MTs were

actively involved in mass screening and treatment of positive cases including drug

follow-up. Role of SHRC was in contributing to framing guidelines and field level

monitoring.

SHRC in collaboration with Unicef has carried out an evaluation of coverage. It was

found to be 91% for population covered in testing and 95% of the malaria cases

identified completed their three day anti-malarial treatment course.

Mitanins’ routine work on Malaria:

Role in Treatment: Mitanins trained and

equipped to diagnose and treat malaria at

community level. Mitanins tested around 18.47 lakh fever

cases and 1.29 lakh malaria cases were

detected in 2019-20. In comparison to

previous year, Mitanins have tested 2.14

lakh more whereas malaria positivity

rate has dropped down from 13% to 7%.

Mitanins treated 82091 PF cases with ACT and the rest with Chloroquine

Mitanins referred 12501 cases of malaria to health facilities, out of which 3028

were severe cases.

Children in Government tribal hostels were identified as a vulnerable category

requiring special attention. So, Mitanin Trainers covered children of almost all

government tribal hostels through fortnightly visits. During 2019-20, they tested

42379 hostel children having fever with RD tests and found 4024 Malaria positive

cases. They treated 2820 PF cases with ACT and referred 356 cases to health

facilities, out of which 60 were severe cases.

Social mobilization Campaign on Prevention was carried out in June through

involvement of Mitanins, PRIs and VHSNCs for prevention of malaria with

activities like, awareness through household visit of pregnant women, Wall

writings, Rallies, Street theatre, Larvae control by community volunteers adding

Outcome oriented and disease specific actions through Mitanin

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oil to stagnant water pits, filling pits, Neem smoke and talks in schools on

prevention of malaria.

Significant energy of Mitanin programme in tribal blocks has been concentrated on

malaria for last five years. Around 70% of the malaria in the state is now detected

and treated through Mitanins. The availability of drugs with Mitanins has improved

and large numbers of bed nets have been distributed. In 2019, a drop in malaria

incidence has been recorded.

The community reported mortality due to fever/malaria in tribal areas has also come

down substantially from 2016 onwards.

Year Fever-Malaria

related deaths

1-59 years Tribal 88

blocks Total deaths

% of fever/malaria related

deaths in 1-59 yrs deaths in

88 blocks

2013 1293 12679 10.20%

2014 1558 15087 10.33%

2015 1499 13695 10.95%

2016 1100 12754 8.62%

2017 554 13272 4.17%

2018 301 13130 2.29%

Source: Community Reported Mortality study report by SHRC

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Mitanins work on Malaria during last 3 years.

Mitanins' Work on Malaria Year-wise Comparison

2017 2018 2019

Total fever cases tested by Mitanins, on

which reports could be collected 1534490 1458472 1847436

Total malaria cases detected by Mitanins, on

which reports could be collected 271092 187208 129647

Total Pv Cases 95735 72283 42049

Total Pf Cases 175357 114925 87598

Positivity rate 18% 13% 7%

Above trend clearly shows drop in malaria incidence in Chhattisgarh..

Mitanins’ work on TB:

Identification of suspected TB cases and providing them regular follow-up

services are regular feature of Mitanin’s work. Under this, rural Mitanins referred

95726 presumptive cases and urban Mitanin referred 10804 Presumptive cases for

sputum test in 2019-20.

Source: RNTCP Chhattisgarh

Mitanins act as DOTS providers for around 85% of the TB cases.

Mitanins’ work on Leprosy:

Identification of suspected Leprosy cases and providing them regular follow-up

services are regular feature of Mitanin’s work. Under this, rural Mitanins referred

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31872 presumptive cases and urban Mitanin referred 5848 Presumptive cases for

confirmation in 2019-20.

Mitanin’s refresher training on Leprosy included Prevention on Disability with

components of self-care, prevention of ulcers etc.

Data source: NLEP National reports

Mitanins’ work on Water-borne diseases:

17.06 lakh diarrhea patients given ORS by rural Mitanins and 30051 severe cases

were referred to hospitals during 2019-20. Similarly, 1.26 lakh diarrhea patients

given ORS by urban Mitanins.

Raipur city faced an outbreak of Hepatitis E outbreak with around 500

documented cases and several deaths. Mitanins carried out testing of water and

door to door campaign for prevention. Urban authorities took up repair work on

water pipelines.

Water testing through use of H2S kit was done in Urban area by Mitanins and

Mahila Arogya Samiti’s members (8th round in May 2019). 3436 drinking-water

samples were tested from 19 cities. Mahila Arogya Samitis and Mitanins also

shared the status of the drinking water with the ward level elected representatives

(parshads) and Municipal Corporations to demand clean drinking water. This

model of community engagement around drinking water has been more

successful in getting the problems resolved and quality improved. Similar

approach can be extended to other environmental health issues like air pollution.

Water testing through using of H2S kits was done in Rural area by Mitanins and

Village Health Sanitation and Nutrition Committee’s members (5th round in May

2019). About 10% of 16567 samples taken for test were found contaminated. In

comparison to previous year result, the contamination rate has come down for 2

69998115 8519 8847

10440

12609

10474

2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

New Cases Detected

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point. List of contaminated sources were submitted in the respective departments

at Block, District and State level for ensuring safe drinking water.

During April 2019, Rural Mitanins and VHSNC members had identified 4309

hamlets with inadequate access to safe drinking water. Most of these habitations

were dependent on wells, shallow dug wells (dodhi), surface water sources like

streams. Many of them had bore wells but were non-functional for long periods.

List of such hamlets were given to concerned authorities at Block, District and

State level for corrective action.

Mitanin work on Maternal Health:

18.80 lakh home visits done by Rural

Mitanins and 1.59 lakh by Urban Mitanins for

counseling pregnant women on rest, diet and

ANC check-ups during 2019-20. Fixed day

services for ANC are functional in majority of

blocks and Mitanins escort a large number of

women there.

3.86 lakh deliveries of rural women and 30356

of urban women were accompanied by Mitanin for institutional delivery during

2019-20. Mitanins escort more than 85% of rural and 82% of urban institutional

deliveries.

According to NFHS-4, Chhattisgarh has been one of the better performing states

on basic indicators. It is the result of Mitanins, AWW and ANMs’ joint effort.

ANC

Mothers who had antenatal

check-up in the first trimester

(%)

Mothers who had at least

4 antenatal care visits (%)

Current

Status

% points

improvement

in one decade

Current

Status

% points

improvement

in one decade

Chhattisgarh 70.8 24.8 59.1 30.8

India 58.6 14.7 51.2 14.2

Source: NFHS-4 & NFHS-3

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Anemia in women

Pregnant women age 15-49 years who are anemic

(<11.0 g/dl) (%)

Current Status % points improvement in one

decade

Chhattisgarh % 41.5 21.6

India 50.3 7.6

Source: NFHS-4 & NFHS-3

Mitanin work on Family Planning:

46770 cases in rural area and 15662 cases in urban area were facilitated by Mitanin

for IUCD insertion during 2019-20.

Mitanin work on Newborn Care:

5.04 lakh rural newborns (around 92% of

total estimated newborns) and 46317

urban newborns (around 86% of total

estimated newborns) were visited by

Mitanins (designated 7 home visits for

HBNC) for counseling of families and

identification of illnesses during 2019-20.

60676 sick rural newborn identified (around 13% of all newborn), out of which

26058 (42%) cases were treated by Mitanin with Amoxicillin and 32416 severe

cases referred by Mitanins to health facilities for treatment. Out of those referred,

21693 (67%) cases were referred after giving 1st dose of Amoxicillin.

Similarly, in urban area 9751 sick newborn identified (around 15% of all

newborn), out of which 2301 (24%) cases were treated by Mitanin with

Amoxicillin and 6991 severe cases referred by Mitanins to health facilities for

treatment. Out of those referred 2432 (35%) cases were referred after giving 1st

dose of Amoxicillin.

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Immunisation:

Mobilising for immunisation continues to be a key activity for Mitanins. Mitanins

and ANMs have worked as a team to improve immunization status. According to

NFHS-4, the state has maintained its pace of improvement in immunisation.

Immunization

Children age 12-23 months fully immunized (%)

Current Status

(2016)

% points improvement in one

decade since 2006

Chhattisgarh % 76.4 27.7

India 62.0 18.5

Source: NFHS-4 and NFHS-3

Mitanin work on ARI in Children:

105996 Pneumonia cases (under-5 year age) identified by rural Mitanins. Out of

which, 78780 (74%) cases treated by Mitanin with Amoxicillin and 25121 cases

referred to health facilities for treatment during 2019-20.

Under urban Mitanin programme, 11062 Pneumonia cases (under-5 year age)

identified by Mitanins. Out of which, 4566 (41%) cases treated by Mitanin with

Amoxicillin and 5762 cases referred to health facilities for treatment during 2019-

20.

Counseling on Child Integrated Health, Nutrition and Care:

67.96 lakh home visits were made by Rural Mitanins

and 4.33 lakh by Urban Mitanins for children under 3

years age for counselling on nutrition, prevention,

identification and treatment/referral of infection,

psycho-social development in 2019-20. There has been

a substantial increase in home visits by Mitanins over

last 5 years.

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Mitanin Drug Kit Follow up and Monitoring:

SHRC monitored availability of drugs with Mitanins.

S.N. Name of Drug

Approved

quantity for

2019-20

Received

till March

2020

% of

drugs

received

1 Paracetamol Tab 500 mg 54596100 31802000 58%

2 Paracetamol Syrup 60ml 1679880 506738 30%

3 ORS Sachets (Large) 4199700 2661475 63%

4 Chloroquine Tab 2377075 3647100 153%

5 ACT (>15 Years) 614400 343560 56%

6 ACT (9-14 Years) 115090 79991 70%

7 ACT (5-8 Years) 99756 83055 83%

8 ACT (2-4 Years) 142643 80853 57%

9 ACT (0-1 Year) 72800 62630 86%

10 Bivalent R.D.Kits 684400 248412 36%

11 Metronidazole Tablet 41997000 18202100 43%

12 Antacid Tablet 25198200 88700 0%

13 Permethrin Lotion 839940 1115 0%

14 Povidon Iodine ointment 419970 95636 23%

15 Amoxycillin Tab (Dispersible)

125mg 6299550 11900800 189%

16 Zinc tablets 26231625 12157100 46%

17 Gentamycine 0.3% Eye Drop

IP 279980 813 0%

18 Bandage 3"x3"m 419970 0 0%

19 Cotton 25 g.m. 419970 0 0%

Source: CGMSC website online reports

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Rashtriya Kishor Swasthya Karyakram (Baal Swasthya Sahyogi)-

Adolescent health has been one of the relatively

neglected aspects of work in Chhattisgarh. A

new addition to the Mitanin programme during

2019-20 was through Rashtriya Kishor

Swasthya Karyakram. It was focused on peer

educators and adolescent leaders (Baal

Swasthya Sahyogi initiative). A total of 101431

students from 19846 schools have been

selected as Baal Swasthya Sahyogi. First round training of 83507 Baal Swasthya

Sahyogi has been completed. During first round of training, students were taught on

the importance of the Baal Swasthya Sahyogi programme, what is good health, how a

better society can be formed, adverse effect of tobacco and causes and prevention of

road accidents. During training they were encouraged to organize street theatre to

bring awareness on tobacco and road accidents. 2364 street theatre shows have been

organized by the Baal Swasthya Sahyogi till February.

Follow-up and screening for hypertension (BP

measurement by Mitanins):

978 Urban Mitanins have been trained on BP

measurement skill with the objective of early

identification of Hypertension cases at the community

level. An interim evaluation showed that per Mitanin,

18 cases of hypertension were being followed-up.

Mitanin looks at a population of around 600 in these areas. In addition, each Mitanin

screened around 180 persons (above age 30) over a year and identified and referred

around 35 suspected cases. Around 72% of the suspected cases went for a check-up to

a doctor and around half of them got confirmed as hypertension cases. This pilot has

shown that equipping Mitanins with digital BP instruments can be a useful and feasible

strategy for addressing hypertension in urban areas. There is plan of equipping all

urban Mitanins for BP measurement.

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Street Theatre:

Street theatre was promoted Amongst Mitanins,

Mitanin Trainers, VHSNCs and MAS. They have

been trained to organize street play at village and

Mohalla level on relevant issues. Street plays are

used in forums like Public-dialogue, including on

issues like rights of patients when they seek

treatment from public or private hospitals.

During 2019-20, VHSNC conducted street plays on following issues-

Anti-tobacco- 5088 VHSNCs organized street

play to make community aware on harmful

effect of tobacco consumption.

Malaria- 12779 VHSNCs organized street play

on prevention and treatment of malaria.

Diarrhea- 11927 VHSNCs organized street

play on prevention of diarrhea.

During 2019-20, MAS conducted street plays on following issues-

Private Hospital- 1440 MASs organized street

play to make people aware on various issues

such as RSBY card, unwanted tests and

treatment, extra charges.

Anti-tobacco/Dengue/ Diarrhea/ Violence

against women- 770 MASs organized street

play to sensitize community on gender issues

and to make community aware on harmful effect of tobacco consumption and

prevention measure of Dengue and Diarrhea.

Village Health Sanitation and Nutrition Committee:

About 17500 VHSNCs out of 19180 (94%) VHSNCs are regularly monitoring the

village level services. VHSNCs are being guided to take on the spot action on the

issues identified through monitoring register and discussions. Report shows, about

Strengthening Community Participation

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15366 VHSNCs had undertaken any on the spot action during 2019-20. Following

major campaigns/ activities were undertaken by VHSNCs during 2019-20.

Anti-tobacco community Campaign:

A campaign on sensitizing people on dangers of oral tobacco (Gutka, Gudakhu in

particular), including its link with stroke was carried out. The focus was on a)

schools b) women. The campaign used various platforms like VHSNC, cluster

meetings, street theatre to initiate a dialogue. During this campaign, 17618 VHSNCs

had discussion on harmful effect of tobacco, 14994 VHSNCs had done wall writing,

5088 VHSNCs organized street play and 9786 VHSNCs visited schools to discuss

with the teachers and school going children. 1319 rural-hamlrets have banned selling

of tobacco product in their area.

Wall writing for IEC-

Under an innovation activity, a kind of health wall was designed which have three

parts, left side part to write the names of VHSNC members, central part of the design

is like a black board where time to time

health messages and various important

information can be written time to time,

and in the right side part of the design role

and responsibilities of VHSNC have been

written. This kind of wall writing have

been done in 2249 Gram Panchayats.

There is very positive response from the

community as well as government

officials on this activity. Now VHSNCs of rest Villages have carried-out this activity

from untied fund.

Toilet facility for Girls in school- During August-September 2019, VHSNCs

carried-out a campaign on ensuring toilet facility for girl students in schools. Under

this campaign, 13290 VHSNCs visited schools to monitor toilet facility for students,

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1657 schools found with gaps. In consultation with School management and Gram

Panchayat, VHSNC resolved issues of 958 schools.

Swasth Panchayat Yojana:

Continuous supportive supervision being provided to strengthen village health

planning at Panchayat level. About 17200 Villages are active in making Village

health plan and its implementation.

Swasth Panchayat Sammelans and

Community Action on Health:

Swasth Panchayat Sammelans successfully

organized in 143 out of the 146 Blocks.

PRI members training on health:

About 9300 Panchayat members from 86 blocks have been trained on health,

sanitation and drinking water related topic. Around 50% of the training plan

remained incomplete as training got postponed because of Covid pandemic.

Swasthya plus Fulwari:

2850 Swasthya plus Fulwari centres have been approved for 23 Districts under TSP.

Nine out of the 23 districts received the funds till the process got disturbed due to

Covid outbreak. These centres are aimed at improving health outcomes of tribal

children in poorest villages through integrated action on health, nutrition and early

childhood development.

Mahila Arogaya Samiti (MAS) in urban slums:

Samuday adharit nigrani evum samajik ankeshan karyakram/ Sammelans- 15

sammelans were organized in 13 cities during 2019-20. Issues raised by communities

included drinking water quality in slums, gaps in ICDS and over-charging by private

hospitals under the insurance scheme.

21

Mitanin action on Sickle cell disease - A campaign on identification of sickle cell

cases among children was carried out by urban Mitanins in 19 cities. Identification of

suspected cases was done by asking about history of blood transfusions. Under this

campaign 8287 suspected cases were identified and referred to health facilities for

test. 4182 cases visited hospitals for electrophoresis test and 1566 cases were found

to be SS, who are presently under treatment.

Dengue - A campaign on prevention of dengue was carried-out during 2019-20.

Under this campaign Mitanins and MAS visited 5.98 lakh households to make people

sensitize on dengue. Identified 2.05 households with stagnant water out of which

15127 households found with Larvae. Mitanins and MAS organized rallies, wall

writing in 5151 spots and identified 57926 fever cases. During this year, a new

initiative under Dengue prevention campaign was of putting a check list in the wall

of households to remind them of doing certain activities like weekly emptying of

items that hold water such as buckets, tires, flowerpots, toys, etc. So, Mitanin and

MAS had put checklist in 1.89 lakh households in urban slums and about 1.65 lakh

households regularly filled-up for 8 weeks.

A study was carried out by inviting experts in urban planning. A report with detailed

recommendations was submitted to government. Some of the recommendations were

included in the Health department letter on Dengue prevention to district Collectors.

Mitanin Patient Help Desks in Hospitals:

210 existing help desks are functional in hospitals (CHC or above levels).

S.N. Type of Institution No. of Institution No. of Helpdesk

1 Medical College 6 15

2 District Hospital 24 50

3 Civil Hospital 6 7

4 CHC 137 137

5 PHC 1 1

Total 174 210

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Training of Rural Mitanins:

Annual training of 38791Mitanins (58%) against target of 66319 Mitanins has

been done by the mid of March 2019. Training has been postponed in several

blocks due to COVID-19 pandemic.

Induction training of 1739 Mitanins (37%) against target of 4736 Mitanins has

been done by mid of March 2019. Mitanin chosen for induction training are

either new Mitanins or Mitanins who are weak in technical knowledge. Training

has been postponed in several blocks due to COVID-19 issue.

Supportive supervision training has been done of District Coordinators, Block

Coordinators and Mitanin trainers.

Urban Mitanin Training:

Under this 9th round training, 3671 Mitanins have been trained during the year.

Major topics covered under this training are HBYC, SNCU, Birth defects,

Family planning, Dengue, Malaria, Road accident, Air pollution, etc.

Supportive supervision training has been done of City Coordinators, Area

Coordinators and Mitanin trainers.

HWC- NCD training of Mitanins:

9434 (69%) out of a target of 13677 Mitanins have been trained on NCD. The

remaining training suffered because of gaps in the way funds were allocated.

19.45 lakh CBAC forms have been filled-up by Mitanins.

Training of MAS (Mahila Arogya Samiti):

2948 MASs have been trained during this year. Under this 5th round of training,

MAS have been sensitized on Dengue, Private hospitals, anti-tobacco and gender

issues.

In-house video production:

With technical support of NGO called Digital Green,

SHRC has built in-house capacity to produce good

quality videos. Mitanin Trainers and Block

Coordinators have learnt video-photography and

SHRC staff have learnt editing.

22 films produced so-far on topics like Diarrhea,

Training and Capacity Building

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Malaria, Pneumonia, Family visits (care during pregnancy, care of newborn, care

of 6-9 month and 9 month to 3 year children) IFA for pregnant women,

Complementary feeding, Keeping babies warm, Family planning, BP

measurement, ill effect tobacco, abortion and Food security.

150 portable projectors were received from an NGO in 2018 but 24 of them have

become out of order after 1-2 years of use. Further strategies are needed to be

worked-put to ensure dissemination of films produced.

Mitanin Incentive payment:

As per State order, Mitanins are supposed to be paid 75% top-up from state

Government over incentive Amount earns from NHM. This share (around Rs.1100

per Mitanin per month) could not be paid for the period January to March 2020

because the state budget allocation was not released by the finance department.

Unless state budget allocations are increased and released, payments to Mitanins will

suffer.

Mitanin Career Development:

1487 Mitanins completed ANM training course out of which only 788 Mitanins

have got job. There is need of Govt. policy to absorb remaining 689 Mitanins in

Government jobs. A proposal have been submitted to government for

recruitment of above Mitanins against existing ANM posts under NHM

210 Mitanins were enrolled in GNM course. So-far 186 of them have completed

the course, out of which only 32 have managed to get a job.

Communication Activities:

New issues of Mitanin newsletter were brought out, including in Gondi. Three Issues

– 13th

edition (September 2019) for rural Mitanins, 6th

edition (November 2019) for

urban Mitanins and 5th

edition (January 2020) for Gondi speaking Mitanins were

published in 2019-20.

NIOS Certification:

SHRC has been accredited by NIOS as AVI for ASHA certification in Chhattisgarh.

20 state trainers and 361 ASHAs have been certified so far. Results of 154 ASHAs

are awaited and application forms of another 30 ASHAs have been submitted to

NIOS for certification.

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Mitanin Kalyan Kosh: Existing activities continued. The cumulative number of

Mitanins who have been supported for attaining educational qualifications has

reached around 26000.

Main Activities No. of Mitanins

benefited

Educational Incentive (for class class 8th Rs. 2000, for

10th Rs.5000, for 12th

, graduation, PG Rs. 10000) 1412

Higher Education (for Mitanin’s children who secured

75% and above in class 10th

Rs. 25000 and for class 12th

Rs. 50000)

2075

Maternity Support (Rs. 15000) 1277

Old Age Support (Rs. 20000 for Mitanins who completed

60 years of age and not enrolled in Swavalamban pension

fund)

82

Medical Support 730

Kanya vivah support 139

Support to Mitanin on Husband’s Death 417

Support to family on Mitanin’s Death 135

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