There is a need for technology to be taken to the people of lower strata of life in terms of healthcare initiatives, according to Jayati Singh, Assistant Collector, Barwani, Government of Madhya Pradesh, reports Mukul Kumar Mishra of Elets News Network (ENN).
During Elets Healthcare and Wellness Summit held in New Delhi recently, Jayati Singh, the Assistant Collector of Barwani, spoke at length on various aspects related to healthcare in her region.
Talking about the challenges of taking healthcare to the last-mile in the State, she said: “Topographically, our terrain is mix. We have flat terrain which is a very prosperous area of Barwani, a district of Madhya Pradesh, and we have undulated terrain which lacks on developmental parameters. This is the area where delivery of healthcare service or rather delivery of any services is a big challenge. As a civil servant, we try and make efforts to reach out to the last person in the area.”
Stating about the peculiarity of the delivery of healthcare being a challenge because of the terrain, she said: “We have a majority of tribal population in Barwani. These tribal people have unique settlement pattern. These people settle on hilltop, one house on one hilltop and another house on another hilltop. We have to cover a huge distance for delivery of any service.”
Health service seeking behaviour among people also seems very passive as people don’t actively demand services. As a result of which, delivery suffers.
Stating that in Barwani, human resource (HR) issue is also a major problem due to difficult terrain, she said: “In order to improve effectiveness as well as efficiency of a service, we did major change in logistics of the entire way in which the healthcare is delivered to the people especially to the last-mile people. ”
“We accumulated the resources, primarily the HR resources, across the district. We made a mobile team. In a mobile team, we have health workers known as ANM. Then we have ASHA workers (Accredited Social Health Activist) who deals with malnutrition and overall developmental parameters. We coupled them with local population who are a local subject market expert of the area.”
“We had this team which moved on feet on the particular day to cover all the areas, including all the houses and all the individuals. They provided health services; they provided immunisation to the expected mother as well as the child. Apart from this, ASHA workers worked on malnutrition which is a major challenge in the tribal area.”
Stating how an ASHA worker would bring the list of kids suffering from MAM (Moderate Acute Malnutrition) and SAMs (Severe Acute Malnutrition), she said: “After their identification, we would move them to the district headquarter or the block headquarter depending the state of the child.”
ASHA workers would carry common medicines for common ailments like fever and cough too. This area has the “propensity of tuberculosis as well”.
So, these separate services would take different set of people to deliver to different beneficiaries at different rate of efficiency. “We combined them in one team and delivered it to people. This was a very difficult experiment because of the terrain.”
Singh said: “In our experiment, we used boats; we used another means to reach out the people who have been left behind. As a result the immunisation percentage increased to 100 per cent from 40-50 per cent. We were able to identify 70 kids who were suffering from acute SAM and malnutrition.”
One of the most positive changes of this whole initiative is that “there has been an improvement in health seeking behaviour among people”.
This experiment was carried out in three rounds starting from November. So “when our team went in November, people generally were passive; not willing to engage. But when the next time we went around, people would pro-actively seek information about family planning or some counseling inputs. This has been a huge plus for us,” she added.
Revealing that immunisation has been a huge success in the area and the impact has been “positive”, the Assistant Collector said: “We have extended immunisation programme in other forest areas and other blocks. Overall the immunisation programme has benefitted people the most.”
On convergence of policy, she said, “In Pati area, convergence has brought about huge benefit. We had converged with Deen Dayal Upadhya Gram Jyoti Yojna which is a scheme that brings in electricity to left out hemlets and to the individual people who have been not given electricity till now.
“It has brought about positive change in health seeking behaviour of the people. With electricity came mobile. And, the mobile brought wider exposure. Exposure ushered in more engagement of people with the Government as a whole for their health and for other nutritional aspect of the family.”
While talking about innovation she said that there are three components of innovation. There is no barrier or no qualifier as to how normal an idea might be especially from grass-root innovation perspective.
“We think that if I am doing a particular process in a certain way, it gets better through creativity or ingenuity that for me, would be the innovative way of doing it.” “In this particular context we have desperate people providing services on everyday basis to certain set of people. We were pooling those people to provide them resources, to provide them motivation, and they managed to achieve a target. This is application component of innovation,” Singh added.
Second component is human resource. “We had a set of ANM who went outside their market. They had defined spheres of responsibilities. They engaged and supported us in every rounds of immunisation. They went out of the way and worked so hard for the benefit of the local people.”
Third component and most important is intended benefit. In this case, “We had a significant positive benefit not only for the individual but for the entire society as well; not for this generation, but for coming generation as well”.
Jayati Singh said that there are “particular areas and particular aspects” which I suggest to take up which would help in healthcare delivery of services to the last person.
“We need to change the way the consumers use health. There has to be ease of use. We are talking about daily wage worker who has to go to PHC (Primary Health Centre) on one particular day, from there they move to CHC (Community health centre) and may be to district hospital.”
“There need to be vertical and horizontal integration in this sphere so that he can be benefitted. There has to be a change in perception in which he perceives health. It has to be linked with behavior. He has to pro-actively come and seek health.” Talking about technology, Singh said, “It is a major game-changer in healthcare. We are linking various data. We have ASHA workers in villages who actually connect the health data of a child and an expected mother. Then we try to share this data with ANM who provides the delivery services. We are working on improving the institutional difficulties.”
The senior official said: “We are trying to have pro-active approach so that there is a particular alert when a lady is going in a labour room. Same information passes on to PHC which receives the lady and carry on the operation. He wants to get her profile, her indicator and then they should go to PHC and they should realise whether this lady is anemic; whether she should come to PHC or she should set out to CHC for better care. This is a major game-changer.”
For a policy making, Singh stated that it can’t be 100 per cent effective as well as 100 per cent efficient. “There has to be compromise between these two. There has to be a horizontal integration. We have different providers providing different facilities, but we would want to have a horizontal integration of different stakeholders combined so that efficiency gets improved. Similarly, for chronic diseases, we need to have vertical integration,” she said while talking about need for improvement of efficiency.