Asha Kiran Community Health Program:
Asha Kiran Society has been involved in health and development projects since 1991 in the Lamtaput and Khairput blocks of the state of Orissa with the aim of holistic transformation of communities.
Lamtaput block has a population of 59,309. From the years 2000 – 2009 an integrated approach was incorporated into the interventions of the Community Services Unit. 19 focus villages were chosen from among 220 villages of the 15 panchayats of Lamtaput block. Specific interventions for the different development components such as agriculture, health, education, literacy, community development were carried out based on ongoing community needs assessment coupled with the availability of staff. The assumption was that these focus villages would act as models of health and development from which a ripple effect would spread to surrounding villages. Work in the other villages comprised of primary health care delivered by community health workers (CHWs) trained by Asha Kiran and health awareness spread by Community development organizers (CDOs). Development issues were handled by forming Health and Development Committees and Self Help Groups.
In 2010, a major review of the work till date was held with an outside consultant. An extensive survey was held and the results evaluated. 7 panchayats of Lamtaput block were still in a critical condition according to the vital statistics validation survey report (Nov. 2008). It was decided that for more impact with our limited resources, a cluster approach needed to be taken. 3 clusters of the most backward villages (in terms of health statistics, government health system functioning as well as accessibility) were chosen. From 2010 we have been working intensively in 2 of these clusters. (The third cluster remains inaccessible due to inadequate staffing as well as the presence of anti govt agents in the area). Each area has a health outpost with a nurse run clinic. The vulnerable population of children and pregnant mothers are focused on with antenatal checks and monthly weight monitoring of under-5 children. 100 other villages are covered by our CDOs with health awareness, school health visits and SHG work. 80% of the remaining 100 villages are covered by our CHWs.
Present status of the community health program:
Presently, with the advent of the NRHM programmes and the government’s increased drive to improve health care facilities in rural areas, it is becoming clear to us in AKS that old models of parallel health care systems need to be discarded where possible while at the same time we work hand-in-hand with the government and the people to ensure that those most in need receive the health care required. Our extensive knowledge of the people and this area developed over the last 20 years on the one hand (the trust that AKS generates) along with the trained community health staff workers (experienced with coordinating with the government as well as disseminating training and information to the community) on the other hand, places AKS in a unique position just now. It is with pride that we note some of our CHWs are being chosen by the government as ASHA’s – a position they slip into with ease due to the training they have received. In the future, ensuring the setting up of Gram Kalyan Samitis in each village and enabling them to work on behalf of the villagers to take charge of their own health and to access health care is a priority in this program.
Structure of the health program:
Most of the villages are covered by community health workers who are women chosen by their village. They work as volunteers. They attend a training every month at Asha Kiran campus and also in the village on common health and development issues. They are given oral medications to treat common illnesses like malaria, viral fevers, scabies and diarrhoea. They also monitor the births and deaths in their areas and report to their respective CDOs (community development organisers). We have been motivating these workers to tame on government roles like becoming village ASHAs.
Gram Panchayat level:
Around 15 villages make a gram panchayat which is looked after by a Community Development Organizer or CDO. The CHWs report to the CDOs of their area. The CDO is also trained in managing health issues like epidemics and ongoing government programmes. Other than health, the CDO is involved in development issues including Self Help Groups(SHGs). They attend monthly local nodal meetings between the villagers and the panchayat officials and motivate action from both parties. The CDOs are the backbone of the community program and affect changes in the villages. Some of our previous CDOs have gone on to become sarpanches and ward members.
Nurse run Health Outposts:
At present we have two health outposts at Dasaput and Ranithota villages. The Dasaput outpost covers the 4 gram panchayats across the lake. People in this area find it difficult to access reliable health care due to the presence of the reservoir. There are no regular boat services and they have to travel a distance to the other side. The Ranithota village outpost serves the outer area of the block from where again people have difficulty reaching health services.
Base Hospital Level:
6 coordinators cover the block . They are trained in different areas of health and development and work through the CDOs. They report to the Program Manager.
Elderly and vision:
The elderly population being a vulnerable age group, the team looked for ways to improve their situation. In an agricultural society which involves a lot a manual labour, age brings on the belief of being useless and a burden. The tribals live in nuclear family set ups and old people who cannot contribute to the table are often neglected. Deteriorating eyesight in particular makes their lives difficult. And so it was that the eye program of Asha Kiran was born. Three CDO’s have been trained to organize screening camps and with the help of a coordinator they bring groups of the elderly to the hospital for an ophthalmological check. The vast majority having cataract means eye surgery camps have to be organized with distribution of free spectacles. It took a lot of patience and humour to propogate this program. Initially patients were reluctant to come as the rumour had gone around that eyes would be removed and goats eyes put in their place. However success stories spread and constant visiting and teaching by the CDOs has resulted in patients now voluntarily coming for surgeries. Good eyesight means even the elderly can contribute to the village by grazing cattle or looking after the grandchildren.| Read on Aita Kirsani's story.