by iphindia | Jul 14, 2012 | Blog, Latest Updates, Research
It was another day in the field collecting data for Health Inc project. The team reached village near Nelamangala. After meeting staff in Gram Panchayat (GP) we were asked to talk to Anganawadi teacher and take her help to identify the houses for collecting data. But the teacher was not happy to accompany us. She said “why should I help you? it is GPs responsibility”, however we managed to convince her to accompany us.

Source*
Interesting discussion started after that, we gave her the list of household and explained where we got that list. She said…oh then I have that list with me and I also have many cards in the cup board and she took out box full of Rashtriya Swasthya Bima Yojana (RSBY) smart cards. When asked why cards were not distributed..she said…”why should I give, it is GPs responsibility”! It was clear there was no coordination between Anganawadi teacher and GP. But it was poor who were deprived of benefit. I asked teacher, do you know what this card is. She said yes it is health card!! Do you know anything more than that? No…that is the only information given on the day of camp!!
Then team got divided and along with Mr Omkar I followed teacher to one house. Teacher first entered the house and said there are some people who want to collect information and she started walking out. I heard female voice from inside asking what information? Teacher screamed from outside.. “about that PAN card you collected from me last week”!! I said …what!! PAN card…no no we are not here to collect information about PAN card…teacher smiled and said “madam these people don’t understand” and she started walking away….I questioned myself…who does not understand? Does the teacher understand? How does she know they do not understand? Anyways it was time for me to get inside the house and sit with Omkar.
When Omkar showed RSBY smart card asked do you know about this card….informant said yes it is AADHAAR card (AADHAAR is Unique Identification number issued by Govt India) and when asked who told you that…Anganawadi teacher came and called us to take photo for AADHAAR card and she gave this card later. Informant showed some paper which was given on the day photo was taken; those papers were related to AADHAAR.
I thought on the day of camp did they take photos for AADHAAR and RSBY? Why was no information given to people about RSBY? Why did Anganwadi teacher call people for AADHAAR card? Did not get answer but thought may be people responsible to issue cards felt poor people will not understand or they did not want to give information? Not sure but I moved to next house thinking does different types of card means the same for poor…NO BENEFITS & NO INFORMATION?
*http://www.rsby.gov.in/
by iphindia | May 4, 2012 | Blog
ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರದ ಕಿರಿಯ ಮಹಿಳಾ ಅರೋಗ್ಯ ಸಹಾಯಕಿಯರು ತಮ್ಮ ಕ್ಷೇತ್ರದಲ್ಲಿ ಎದಿರುಸುತ್ತಿರುವಾ ಸಮಸ್ಯೆಗಳು ಮೇಲೆ ನಮ್ಮ ಕ್ಷೇತ್ರ ಭೇಟಿಯ ಅನುಬವಗಳು
ಪ್ರಾಥಮಿಕ ಆರೋಗ್ಯ ಕೇಂದ್ರ ಮತ್ತು ಸಮುದಾಯಗಳ ನಡುವೆ ಅತ್ಯಂತ ಬಾಹ್ಯ ಮತ್ತು ಜನರ ಆರೋಗ್ಯಕ್ಕೆ ಸಂಬಧಿಸಿದ ಮೊದಲ ಆರೋಗ್ಯ ಸಂಪರ್ಕ ಕೇಂದ್ರವೆಂದರೆ ಅದು ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ. ಪ್ರತಿ ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರಕ್ಕೆ ಸಾಮಾನ್ಯ ಪ್ರದೇಶದಲ್ಲಿ ೫೦೦೦ ಜನಸಂಖ್ಯೆ ಇರಬೇಕಾಗಿದ್ದು ಹಾಗೂ ಗುಡ್ಡಗಾಡು ಪ್ರದೇಶದಲ್ಲಿ ೩೦೦೦ ಜನಸಂಖ್ಯೆ ಇರಬೇಕು ಎಂಬುದು ನಿಯಮವಿದೆ ಆದರೆ ಪ್ರಸ್ತುತವಾಗಿ ಸಾಮಾನ್ಯ ಪ್ರದೇಶದ ಕೆಲವು ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರಗಳಲ್ಲಿ ೭೦೦೦ ಕಿಂತ ಹೆಚ್ಚು ಹಾಗು ೨೦೦೦ ಕಡಿಮೆ ಜನಸಂಖ್ಯೆ ಕೂಡ ಹೊಂದಿವೆ, ಪ್ರಸ್ತುತವಾಗಿ ಭಾರತದಲ್ಲಿ ೧,೪೫,೨೭೨ ಆರೋಗ್ಯ ಉಪ-ಕೇಂದ್ರಗಳು ಕಾರ್ಯನಿರ್ವಹಣೆಯಲ್ಲಿವೆ. ಪ್ರತಿಯೊಂದು ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರದಲ್ಲಿ ಕಿರಿಯ ಮಹಿಳಾ ಆರೋಗ್ಯ ಸಹಾಯಕಿ (ಕಿ.ಮ.ಆ.ಸ) ಮತ್ತು ಕಿರಿಯ ಪುರುಷ ಆರೋಗ್ಯ ಸಹಾಯಕ (ಕಿ.ಪು.ಆ.ಸ) ಎಂಬ ಸಿಬ್ಬಂದಿಗಳ ಮೂಲಕ ಈ ಕೆಳಗಿನ ಸೇವೆಗಳನ್ನು ಒದಗಿಸಲಾಗುತ್ತಿದೆ. ಉಪಕೇಂದ್ರದಲ್ಲಿ ದೊರುಕುವ ಮುಖ್ಯ ಸೇವೆಗಳು ಎಂದರೆ; ತಾಯಿ ಮತ್ತು ಮಗುವಿನ ಆರೋಗ್ಯ ಕಾಳಜಿ ಅವರ ಪೌಷ್ಟಿಕತೆಯ ಬಗ್ಗೆ ಪೋಷಣೆ, ಮಕ್ಕಳಿಗೆ ಮಾರಕ ರೋಗ-ನಿರೋಧಕ ಲಸಿಕೆ ನೀಡಿಕೆ, ಅತಿಸಾರ ನಿಯಂತ್ರಣ, ಸಂಪರ್ಕ ರೋಗಗಳ ಬಗ್ಗೆ ಜನರಿಗೆ ಅರಿವು ಮೂಡಿಸುವುದು ಮತ್ತು ಅವಗಳ ನಿಯಂತ್ರಣ ಹಾಗೂ ಪರಸ್ಪರ ಸಂವಹನ ಮುಖಾಂತರ ವರ್ತನೆ ಬದಲಾವಣೆ. ಪುರುಷ, ಮಹಿಳೆ ಮತ್ತು ಮಕ್ಕಳಿಗೆ ಅವಶ್ಯಕ ಆರೋಗ್ಯ ಬೇಡಿಕೆಗಳಿಗೆ ಬೇಕಾದ ಚಿಕ್ಕವ್ಯಾದಿಗಳಿಗೆ ಮೂಲ ಹಾಗು ತುರ್ತು ಔಷಧಿಗಳು ಕೂಡ ಲಭ್ಯವಿರುತ್ತವೆ.
ಆರೋಗ್ಯ ಇಲಾಖೆಯ ಅಡಿಯಲ್ಲಿ ಯಾವುದೇ ಹೊಸ ಕಾರ್ಯಕ್ರಮಗಳನ್ನು ಪರಿಚಯ ಮಾಡಿ, ಆ ಕಾರ್ಯಕ್ರಮ ಯಶಸ್ವಿಯಾಗಿ ಅನುಷ್ಟಾನವಾಗಬೇಕಾದರೆ, ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಹಾಗೂ ಅದರ ಕಿ.ಮ.ಆ.ಸ ಪಾತ್ರ ಬಹಳ ಮುಖ್ಯ ಹಾಗೂ ಅವಶ್ಯಕ. ಈಗಾಗಲೆ ಆರೋಗ್ಯ ಇಲಾಖೆಯಿಂದ ಹಲವಾರು ಕಾರ್ಯಕ್ರಮಗಳು ಅನುಷ್ಟಾನವಾಗಿ ಕೆಲವು ಯಶಸ್ವಿ ಹಂತದಲ್ಲಿದ್ದರೆ ಇನ್ನು ಕೇಲವು ಕಾರ್ಯಕ್ರಮಗಳು ಗುಣಾತ್ಮಕವಾಗಿ ಯಶಸ್ವಿಹಂತದಲ್ಲಿಲದಿದ್ದರು ಕು೦ಟುತ್ತಾ ಸಾಗಿವೆ. ಇದಕ್ಕೆ ಕಾರಣ ಏನು ಎಂದು ನೋಡುತ್ತಾ ಹೋದರೆ ಆರೋಗ್ಯ ಕಾರ್ಯಕ್ಷೇತ್ರದ ಮೂಲಮಟ್ಟವಾದ ಆರೋಗ್ಯ ಉಪಕೇಂದ್ರ ಹಾಗೂ ಕಿ.ಮ.ಆ.ಸ ಎದಿರುಸುತ್ತಿರುವ ಹಲವಾರು ಸಮಸ್ಯೆಗಳು ಪರೋಕ್ಷವಾಗಿ ಈ ಕಾರ್ಯಕ್ರಮಗಳ ಅನುಷ್ಟಾನ ಗುಣಾತ್ಮಕತೆಯಲ್ಲಿ ಕಡಿಮೆ ಆಗಿರುವುದಕ್ಕೆ ಕಾರಣ ಕಂಡುಬರುತ್ತದೆ
ಹಾಗಾದರೆ, ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಮತ್ತು ಅದರ ಕಿ.ಮಾ.ಆ.ಸ ಎದಿರುಸುತ್ತಿರುವ ಸಮಸ್ಯೆಗಳಾದರು ಏನು? ನಮ್ಮ ಕಾರ್ಯಕೇತ್ರ ಭೇಟಿ ಸಂರ್ದಭದಲ್ಲಿ ಕೆಲವು ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರ ಕಿ.ಮಾ.ಆ.ಸ ನಮ್ಮೊಡನೆ ಹಂಚಿಕೊಂಡಿರುವ ಕೆಲವು ಸಮಸ್ಯೆಗಳುನ್ನು ಇಲ್ಲಿ ಪ್ರಸ್ತಾಪಿಸಾಲು ಇಚ್ಚಿಸುತ್ತೇನೆ; ವರದಿ ತಯ್ಯಾರಿ ಮತ್ತು ರೆಜಿಸ್ಟರ ಬರೆಯುವದು, ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ (ರಾಷ್ತ್ರೀಯ ಗ್ರಾಮೀಣ ಆರೋಗ್ಯ ಅಭಿಯಾನ) ಬರುವುದಕಿ೦ಥ ಮುಂಚೆ ೧೬ ರಷ್ಟು ರೆಜಿಸ್ಟರಗಳು ಪ್ರತಿ ಕಿ.ಪು.ಆ.ಸ ಬರೆಯುತ್ತಾ ಬಂದಿದ್ದು ಈಗ ಇವುಗಳ ಸಂಖ್ಯೆ ಹೆಚ್ಚಾಗಿದೆ. ದಿನಗಳ ಪೂರ್ತಿ ಹಳ್ಳಿಗಳ ಮತ್ತು ಮನೆ ಭೇಟಿ ಮಾಡಿ ಮರಳಿ ಮನೆಗೆ ಬಂದು ೧೬ ಕಿಂತ ಹೆಚ್ಚಿನ ರೆಜಿಸ್ಟರಗಳ ನಿರ್ವಹಣೆ ಮಾಡುವುದು ತುಂಬಾ ಕಷ್ಟ. ಅಲ್ಲದೆ ವಿವಿಧ ಕಾರ್ಯಕ್ರಮದ ಮೇಲಿನ ಅಧಿಕಾರಗಳು ಪ್ರತಿತಿಂಗಳು ಒಂದಲ್ಲಾ ಒಂದು ವರದಿ ಸ್ವರೂಪದಲ್ಲಿ ಹೊಸ ಬದಲಾವಣೆ ಮಾಡಿ, ತತಕ್ಷಣ ವರದಿ ಸಲ್ಲಿಸುವಂತೆ ಕೇಳುತ್ತಾರೆ, ತತಕ್ಷಣ ವರದಿ ಸಲ್ಲಿಸುವದು, ಅದರಲ್ಲಿ ಹೊಸ ಸ್ವರೂಪದ ವರದಿ ಸಲ್ಲಿಸುವುದು ತುಂಬಾ ಕಷ್ಟದಕೆಲಸ. 
ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ ಬಂದನಂತರ ಪ್ರತಿ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಗಳಿಗೆ ರೂ: ೧೦,೦೦೦ ಮುಕ್ತ ನಿಧಿ ನೀಡುತ್ತಿದ್ದು, ಆ ಹಣವನ್ನು ಉಪ ಕೇಂದ್ರಗಳ ಸಣ್ಣ-ಪುಟ್ಟ ದುರಸ್ತಿ. ಅನಿರೀಕ್ಷಿತ ಅವಶ್ಯಕ ಘಟನೆಗಳಿಗೆ ಮತ್ತು ತಕ್ಷಣದ/ತುರ್ತು ಔಷಧಿ ವೆಚ್ಚವನ್ನು ಪೂರೈಸಲು ಹಾಗೂ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಕ್ಕೆ ಬೇಕಾಗುವ ಸಣ್ಣ-ಪುಟ್ಟ ಸಲಕರಣೆಗಳ ಖರೀದಿಗೆ ಈ ಹಣದಿಂದ ವೆಚ್ಚಮಾಡಬಹುದು. ಏನ್.ಆರ್.ಏಚ್.ಎಮ್ ಅಡಿಯಲ್ಲಿ ಪ್ರತಿ ಉಪ ಕೇಂದ್ರಗಳಿಗೆ ರೂ ೧೦,೦೦೦ ನೀಡಿರುವದು ತು೦ಬಾ ಸಂತೋಷದ ವಿಷಯ ಆದರೆ ಈ ಹಣದಲ್ಲಿ ಯಾವುದೇ ಹಣ ವೆಚ್ಚ ಮಾಡಬೇಕಾದ್ದಲ್ಲಿ, ವೆಚ್ಚಮಾಡಬೇಕಾದ ಚೆಕ್ ಮೇಲೆ ಗ್ರಾಮ ಪಂಚಾಯತಿಯ ಅಧ್ಯಕ್ಷರ ಸಹಿ ಇರಲೇಬೇಕು, ಪ್ರತಿ ಕಿ.ಪು.ಆ.ಸ ತಮ್ಮ ವೃತ್ತಿಗೆ ಸಂಬ೦ದಿಸಿದ ಎಷ್ಟೋ ಮುಖ್ಯ ಕೆಲಸಗಳನ್ನು ಬದಿಗಿಟ್ಟು ಈ ಒಂದು ಸಹಿಗಾಗಿ ಮೂರ ರಿಂದ ನಾಲ್ಕು ಬಾರಿ ಗ್ರಾಮ ಪಂಚಾಯತಿಯ ಅಧ್ಯಕ್ಷರ ಮನೆಗೆ ಅಲೆದಾಡಬೇಕಾಗುತದೆ, ಈ ಒಂದು ಓಡಾಟದಲ್ಲಿ ತಮ್ಮ ಅಮುಲ್ಲ್ಯವಾದ ಸಮಯ ವ್ಯಯವಾಗುತ್ತಿದೆ ಎಂಬುದು ಕಿ.ಮ್. ಆ. ಸಹಾಯಕಿಯರ ಅಭಿಪ್ರಾಯ.
ಎಂ,ಸಿ,ಟಿ,ಎಸ್(ತಾಯಿ ಮತ್ತು ಮಗುವಿನ ಟ್ರ್ಯಾಕಿಂಗ್ ವ್ಯವಸ್ಥೆ) ಮತ್ತು ಎಚ್,ಎಮ,ಆಯ್,ಎಸ್ (ಆರೋಗ್ಯ ನಿರ್ವಹಣಾ ಮಾಹಿತಿ ವ್ಯವಸ್ಥೆ) ಗಳನ್ನೂ ಪರಿಚಯಿಸಿ ಸುಮಾರು ೩-೪ ವರ್ಷಗಳು ಕಳೆದರೂ ಕೂಡಾ ಇವಗಳು ಇನ್ನು ಮುಖ್ಯವಾಹಿನಿಗೆ ಬರುತ್ತಿಲ್ಲಾ ಏಕೆ ಎಂದು ಕಾರಣ ಹುಡುಕುತ್ತಾ ಹೋದರೆ; ಕೆಲವು ಕಿ.ಪು.ಆ.ಸಹಾಯಕಿಯರು ಇನ್ನು ಸಮುದಾಯ ಆಧಾರಿತ (Community based) ಅಥವಾ ಸೌಲಭ್ಯ ಆಧಾರಿತ (Facility based) ಕೇಂದ್ರಗಳ ವರದಿ ವ್ಯವಸ್ಥೆಯ ಅರಿತುಕೊಳ್ಳುವ ಗೊಂದಲದಲ್ಲಿ ಕೆಲವರು ಇದ್ದರೆ ಇನ್ನು ಕೆಲವರು ಎಂ,ಸಿ,ಟಿ,ಎಸ್ ಅಂತಹ ತಂತ್ರಜ್ಞಾನಕ್ಕೆ ಮೊಬೈಲ ಮೊಲಕ ವರದಿ ಸಲ್ಲಿಸವುದರಲ್ಲಿ ಪರದಾಡುತ್ತಿದ್ದಾರೆ, ಹಳೆ ತೆಲಮಾರಿನ ಕೆಲವು ಕಿ.ಮ.ಸಹಾಯಕಿಯರು ಕಾರ್ಯಕ್ಷೇತ್ರ ಭೇಟಿ ಮತ್ತು ಮನೆಯ ಬೇಟಿ, ಆಪ್ತಾಸಮಾಲೋಚನೆ ಹಾಗು ಹೆರಿಗೆ ಮಾಡುವದು, ಇತ್ಯಾದಿ. ಹೀಗೆ ಆರೋಗ್ಯಕ್ಕೆ ಸಂಬದಿಸಿದ ಇತರೆ ಚಟುವಟಿಕೆಗಳಲ್ಲಿ ನೈಪುಣ್ಯತೆ ಹೊಂದಿದ್ದು, ಆದರೆ ಎಂ.ಸಿ.ಟಿ.ಎಸ್ ಅಂತಾ ಹೊಸ ತಂತ್ರಜ್ಞಾನಕವನ್ನೂ ತಿಳಿದುಕೊಳ್ಳಲು ಹಾಗು ಅದಕ್ಕೆ ಸಂಬ೦ಧಿಸಿದ ಕೆಲಸ ನಿರ್ವಹಿಸಲು ಪದೆ-ಪದೆ ಇನ್ನೊಬ್ಬರಿಂದ ಸಹಾಯ ಕೇಳುವುದು ಪ್ರತಿ ಕಿ.ಮ.ಸಹಾಯಕಿಯರಿಗೆ ಮುಜುಗರದ ಸಂಗತಿಯಾಗಿದೆ.
ತಾಯಿ ಮತ್ತು ಶಿಶು ಮರಣ ಸಂಭವಿಸಿದಾಗ ಕಿ.ಮ.ಸ ಮನೆಗೆ ಹೋಗಿ ವಿವರವಾಗಿ ವಿಚಾರಣೆ ನಡೆಸಿ ಮೇಲಾಧಿಕಾರಿಗಳಿಗೆ ವರದಿ ಮಾಡಬೇಕಾಗಿರುವುದು ಕಿ.ಮ.ಸ ಕರ್ತವ್ಯ. ಆದರೆ ವಿಚಾರಣೆ ನಡಸಲು ಪದೆ-ಪದೆ ಅವರ ಮನೆಗೆ ಹೋದಾಗ, ಆ ಕುಟ೦ಬದ ಸದಸ್ಯರು ಹಾಗು ನೆರೆಯ ಜನರು ಕಿ.ಮ.ಸಹಾಯಕಿಯರನ್ನು ತಪ್ಪಾಗಿ ಭಾವಿಸುತ್ತಾರೆ. ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಗೆ ಸರಕಾರದಿಂದ ಹೆಚ್ಚಿನ ದುಡ್ಡು ಸಿಗಬಹುದು, ಆದರೆ ಆ ದುಡ್ಡುನ್ನು ಫಲಾನುಭವಿಗಳಿಗೆ ಕೊಡುತ್ತಿಲ್ಲಾ ಎಂದು ಸಂಶಯ ವ್ಯೆಕ್ತಪಡಿತ್ತಾರೆ. ಕಿ.ಮ.ಸಹಾಯಕಿಯು ಕ್ಷೇತ್ರದಲ್ಲಿ ತಮ್ಮ ಕರ್ತವ್ಯಗಳನ್ನು ಸರಿಯಾಗಿ ಮಾಡಿದ್ದರೂ ಸಹ ಯಾವುದೋ ಕಾರಣಾಂತರಗಳಿಂದ ಯಾವಾಗಲಾದರೂ ತಾಯಿ ಅಥವಾ ಶಿಶುಮಣರವಾದಾಗ, ಇಲಾಖೆಯ ಮೇಲಾಧಿಕಾರಿಗಳು ನಡೆಸುವ ತಾಯಿ ಹಾಗು ಶಿಶು ಮರಣದ ವಿಚಾರಣೆ (Maternal & Infant death Audit ) ಸಂದರ್ಭದಲ್ಲಿ ತಪ್ಪು ಎಲ್ಲಿ ನಡೆದಿದೆ? ಯಾರಿಂದ ನಡೆದಿದೆ? ಯಾತಗೋಸ್ಕರ ನಡೆದಿದೆ? ಎಂಬುದು ವಿಚಾರಿಸದೆ ಎಲ್ಲವು ಕಿ. ಮ. ಆ. ಸಹಾಯಾಕಿಯರದೆ ತಪ್ಪಿನಿಂದಲೆ ಯಾಗಿದೆ ಎಂದು ಅಪರಾಧಿ ಸ್ಥಾನದಲ್ಲಿ ನಿಲ್ಲಿಸಿ ಜನರ ಮುಂದೆ ನಿಂದಿಸುತ್ತಾರೆ. ಎಷ್ಟೋ ವರ್ಷಗಳಿಂದ ಕಿ.ಮ.ಆ.ಸ ಆರೋಗ್ಯ ಇಲಾಖೆಯಲ್ಲಿ ಸಾಕಷ್ಟು ಸೇವೆ ನೀಡುತ್ತಾ ಬಂದಿದ್ದರೂ ಆ ಸೇವೆಗೆ ಕೂಡ ಪರಿಗಣನೆ ಕೊಡದೆ, ಯಾರೋ ಮಾಡಿದ ತಪ್ಪಿನಿಂದಾಗಿ ಕಿ.ಮ.ಆ.ಸ. ನಿಂದನೆಗೆ ಒಳಗಾಗಭೇಕಾದ ಸಂದರ್ಭ ಉಂಟಾಗಿದೆ ಇದರಿಂದ ಬಹಳ ದುಃಖವಾಗುತ್ತದೆ ಎಂಬದು ಒಬ್ಬ ಹಿರಿಯ ಆರೋಗ್ಯ ಮಹಿಳಾ ಸಹಾಯಾಕಿಯ ದುಃಖದ ಮಾತುಗಳು.
ಈ ಎಲ್ಲಾ ಸಮಸ್ಯಗಳಿಗೆ ಪರಿಹಾರವಿಲ್ಲವೇ? ಯಾವ ರೀತಿಯಾಗಿ ಈ ಸಮಸ್ಯೆಗಳಿಗೆ ಪರಿಹರಿಸಿ ಪ್ರತಿ ಕಿ.ಮ.ಆ,ಸ ವೃತ್ತಿಯಲ್ಲಿ ಗುಣಾತ್ಮಕತೆ ಕಾಯ್ದುಕೊಳ್ಳಲು ಹಾಗು ಪ್ರೇರಣೆಯುತವಾಗಿ ಕೆಲಸ ನಿರ್ವಹಿಸಲು ಹೇಗೆ ಸಹಕಾರ ನೀಡಬಹುದು: ಎಲ್ಲಾ ಆರೋಗ್ಯ-ಉಪಕೇಂದ್ರಕ್ಕೆ ನಿಯಮದ ಪ್ರಕಾರ ಸಮಾನ ಜನಸಂಖ್ಯೆಯ ಹಂಚಿಕೆ ಅಥವಾ ಪುನಃಸ್ಸಂಘಟನೆ, ಪ್ರೇರಣೆ ಆಧಾರಿತವಾದ ಮೇಲ್ವಿಚಾರಣೆ, ವಿವಿದ ಕಾರ್ಯಕ್ರಮಗಳಿಗೆ ತಕ್ಕ೦ತೆ ನಿಯತ ಹಾಗು ಚೈತನ್ಯದಾಯಕ ಗುಣಮಟ್ಟದ ತರಬೇತಿ, ಪ್ರಸ್ತುತ ಸಲ್ಲಿಸುತ್ತಿರುವ ವರದಿ ಪದ್ದತಿಯಲ್ಲಿ ಬದಲಾವಣೆ, ಉತ್ತಮ ಕಾರ್ಯನಿರತ ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಯನ್ನು ಗುರ್ತಿಸಿ ವಾರ್ಷಿಕವಾಗಿ ತಾಲೂಕು ಮತ್ತು ಪ್ರಾಥಮಿಕ ಆರೋಗ್ಯ ಕೇ೦ದ್ರಮಟ್ಟದಲ್ಲಿ ಸನ್ಮಾನಿಸುವುದರ ಮುಖಾ೦ತರ, ಪ್ರಸ್ತುತವಾಗಿ ಕಿ.ಮ.ಆ.ಸಹಾಯಕಿಯರು ಎದುರಿಸುತ್ತಿರುವ ಸಮಸ್ಯೆಗಳು ಪರಿಹರಿಸಿ, ಅರೋಗ್ಯ ಕಾರ್ಯಕ್ರಮಗಳು ಯಶಸ್ವಿಗೆ ವಿಷೇಶವಾಗಿ ಗುಣಾತ್ಮಕ ಕಾರ್ಯಕ್ರಮಗಳ ಅನುಷ್ಟಾನಕ್ಕೆ ನಾ೦ದಿಹಾಡಬಹುದು.
by iphindia | Apr 16, 2012 | Blog

The Urban health project ofInstitute of public health has begun working in KG Halli since 2009. When we came to the area, our first action was mapping all the health facilities in ward no 30. As we did the mapping we found two government facilities in the area. One was the urban health center which comes under BBMP and mainly focuses on the RCH Preventive programs and the RNTCP. Another one was the Primary health center, which is under the Karnataka state and family welfare wing. Interestingly these two physical structures share a common wall but one had to jump it informally to get to the other side. Psychologically this wall could not be crossed, as the health centre staffs are answerable to different bodies- state and corporation.
As the days moved on we noticed that near the PHC, new big posh buildings were being built. Somewhere in 2009, we heard news that this PHC had been upgraded into a CHC- Community health center. Months later, one of the new buildings started being used. As patients had been lining up in long queues in the hot sun, particularly during the Chikangunya epidemic, and the existing PHC size was insufficient, an interim agreement had been reached. Without the official inauguration, one building would be used for examining outpatients.
Meanwhile the posting of doctors remained frequent and unpredictable. For a while there was a string of specialists and rumor was that it would be a functioning trauma centre. Happily this idea was thought through and discarded and for much of the two years -2010 and 2011, a senior administrator with four interns managed the outpatient care, in the newly inaugurated, well lit OP building.
However, an operation theater had been constructed and we waited with bated breath to see how it would be put to use. For some time we had been campaigning for a sorely needed maternity center for the area. It appears that our prayers were heard, because, finally they posted a senior lady doctor in charge. However a team was still necessary and they had only one staff nurse on board.
Once the gynecologist Dr. Mangalagowri had taken then charge, things moved faster. She also realized the need, but the final hold up was in hiring the ‘D’ group staff.
We also put in a word with local Councilor to push for hiring the necessary staff, but unfortunately our councilor also remained unsuccessful.

The fully provided-for labor room should lose this new and unused look soon!”
At last, on 15th march 2012 we had news that the labor ward action is in action. The Community health center has now become a 24×7 health service. Now the community can access the maternity facility without any time limit. Dr. Mangalagowri said within a month two deliveries have been conducted and requested the urban health team to spread this news across ward.
by iphindia | Feb 6, 2012 | Blog, Urban Health Action
A recent visit to the offices of the local government health offices and the tertiary level hospitals confirmed what I had suspected for ages, after working in the field of public health for over two decades. There are two key reasons why our public health system is in shambles on the ground, despite India being one of the first countries to sign the Alma Ata Declaration. Briefly, the first is the completely top down approach of the government hierarchy and mindset of medical education. The second is the colossal divide between the preventive and curative wings of our health system. This article explores the first fact, the second I leave for another day.
Permit me to outline how the first operates in translating great planning on paper to a non-functioning apparatus in the field. The experience of these visits will be used to illustrate why, even if we straighten out the “systems”; integrated, holistic, affordable care will never be available to our one billion people, while our “experts” in the field hold conferences on achieving Universal coverage in New Delhi and Geneva.
In every document that outlines how the public health systems in the rural and urban areas should function, the interface with the population of responsibility is seen as being important. Obviously, people should know who they should rely on for health care, but experience has shown that it is equally important that the health care services should be responsible to the population they serve. The balance of this translates as a spectrum of community participation- from the lowest level where people are passive recipients of care to the highest level where communities plan, monitor and evaluate the services.
We strive to the latter goal. Let me clarify who ‘we’ are. As a team of researchers, trying to bring both private and public providers onto a platform with local community leaders, we have been working for two years with the local doctors and community members in a single geographic ward of the city. Time and again we have been struck by the warm hearted welcome in the homes, particularly the poorest. The home of a patient in the community may consist of a single room, 6 feet by 10 feet, in which a family of 2 to 8 members might live. Even so, in this room, where walking is restricted by the tiny space, there is no awkwardness in rolling out a mat or putting out the single foldable chair to make one feel at home. And with this single human act of trying to make the visitor feel at home, a relationship is established which dictates the future partnership.
Contrast this with the reception our team met with in the various offices we visited last month. In an effort to meet the officers in charge of the health services in the city, we hired a taxi and went from office to office, hopeful that someone in the system might be interested in what we were attempting. And everywhere the response was the same. More often than not, a waiting of 15 -45 minutes outside the room, a cursory invitation to enter, not necessarily to sit…a brief look up from the files to hear what we had to say. And before we had launched two minutes into our story , an interruption with “ So tell me Madam, what is it you want me to do?” as we shuffled on our tired feet.
The interesting fact is, in both cases (the patient with us and then us with the officer) the only need was to be listened to. But in the first, the community member has taken the proactive step of setting the stage for listening to happen. (I remember a senior physician who taught us in Medical College saying that sometimes the most important input for an inpatient on rounds is the doctor sitting by the bedside in order to listen to him or her.) And in the latter, a power equation that invisibly translates from officialdom – top-down. The assumption on the part of these authorities is that they already know what needs to be done, so your presence in their office could only be for audience, permission or financial aid. And undoubtedly, the stroke of a pen on a file changes the response down the line. A three minute brief at the Commissioner’s office got us the desired result.
So we were honoured by the visit of the officer-in-charge to the ward, at the behest of the senior authority a day later. The visit and her interface with the community workers can be best described in their own words. “Madam, when they learn to be big doctors and officers like this, are they not taught manners?”
So I conclude that while community participation and corridors of power are identical, mutually exclusive acronyms, like all health system reforms, work must happen at both ends.
by iphindia | Jan 18, 2012 | Blog
No child got affected by wild polio virus last year in India; the last reported case of polio was a two year old girl child from West Bengal on 13 January 2011. India is now said to be out of the list of polio endemic countries in the world. In the year 1988, the World Health Organization launched polio eradication initiative to eradicate polio from the world. During the same period, 1000 children used to get affected by polio everyday- half of them were from India. India has begun mass vaccination campaign from 1995. In 2009, India reported 741cases, 42 in 2010 and 1 case in 2011. To achieve this status, 172 million children were immunized by 2.3 million vaccinators through massive campaigns at consistent intervals.
Consistent global advocacy from WHO, UNICEF and Rotary International were successful in bringing in the commitment of Government of India which has consistently announced the share in the yearly budget for polio eradication initiative., Two billion US dollar had been financed by the Indian Government. , In addition to the same amount spent by of USA, Rotary International and BMGF donated one billion each.
Though the initial efforts were aimed at reaching above status a decade earlier, mere implementation of strategies that proved successful elsewhere, did not work in a complex context like India. The complexity of context in India in areas of health delivery system, health governance, hurdles in community participation, supply chain management, poor sanitation, and interfering factors in vaccine uptake posed numerous challenges to the programme.
There was criticism from many in India saying that polio eradication initiative has been getting undue attention neglecting other health priorities. The criticism also voices the concern that India is in a situation of double burden of diseases. Many Communicable diseases like Tuberculosis Malaria and measles are still major concern while incidence of non communicable diseases which need chronic care are also on the rise and needs health system attention.
The vertical disease control programs do have inbuilt negative externalities of affecting the health system functioning. It may put pressure and affect regular health service delivery while at the same time; they also come with positive externalities. As part of this, the polio eradication program in India drew the health system’s attention to maintain the good cold chain system, equipments and training throughout the country that contributed to improving quality vaccine delivery for other antigens of the universal immunization program. Large scale polio campaigns also brought community awareness to other vaccines resulting in community demand for vaccination.
I got an opportunity to witness the measles catch up campaign last week in Rajasthan where the campaigns were planned from the lessons learnt from polio campaigns and community mobilization was being encashed from the set mode of community participation from polio campaigns. Measles injections being administered to children between the age groups of 9 months to 10 years, The micro plans are in place with the details vaccination sites, Vaccinators, mobilizers, beneficiaries and logistics etc. This catch up campaign for such wide age range of children (20% population) will be conducted only once in the lifetime of the district, one time strategy later will be followed up by routine vaccination and follow up campaigns after 3 to 5 years. Unlike polio vaccine which is administered orally we need, vaccinators who can give injections for the children in measles campaign, In Sawai Madhopur in addition to ANM’s from the health sector, general nurses from private, who are already involved in routine immunization on contract basis under NRHM been taken for the campaigns. Campaigns are school based first followed by the community or Anganwadi centers and span upto three weeks.

Parents bringing their children for measles campaign at Sawai madhopur
In the era of National Rural Health Mission and thrust on health system strengthening, future vertical programs need to have components of health system strengthening which will contribute to the general health systems functioning and strategic integration of the programs.
The role of a robust and strengthened health system, high quality routine immunization and a good surveillance system are crucial in sustaining the success of last year of polio and reach the goal of eradication soon.
by iphindia | Dec 28, 2011 | Blog
Just want to share some of my feelings/observations during my two weeks visits to these hospitals for my parent’s treatment:
Sl.No | Karnataka Institute of Diabetology | St.John’s Medical College Hospital |
1 | Well management of crowded patient | Very crowded but well managed |
2 | Minimum charges | |
3 | Very cooperative and well behavior | Cooperative & well behavior by staff |
4 | Good procedure for keeping patient record | Good procedure for keeping patient record |
5 | Good team work | |
6 | Integrated health care with minimum expenses | |
7 | Adequate number of attendants play very important role in managing crowded patients and in guiding them. | Adequate number of attendants/ security man play very important role in managing crowded patients and in guiding them. |
8 | Adequate patient waiting facility | Adequate patient waiting facility |
9 | Good toilet facility | Good toilet facility |
10 | Good cleanliness by non-clinical staff | Good cleanliness by non-clinical staff |
11 | Good drinking water facility | Good drinking water facility |
12 | Max limit of OPD registration is 108 only | Limited OPD registration (Registration is allowed till 12:00 noon) |
13 | Focusing more on providing quality care by limiting OPD | Focusing more on providing quality care by limiting OPD |

Now I have some questions:
- Poor village people also have the right to avail at least these basic health services in their villages. Why cannot they?
- It requires some additional manpower, orientation & finance? Does not govt. has this much resources?
- How universal health care is possible, with these vast differences in private & public hospital?
- Can’t private and public institution work together for to strengthen the health facilities in rural areas?