Improving the delivery of services.
Department of Health, Guna(MP) India
India

The Problem

- It is very much imperative to understand and know the problems of the area . Guna , district of Madhya Pradesh of India, is the gateway of Malwa. Chambal is located on the north-eastern part of Malwa Plateau. The western boundary of the District is well defined by the river Parbati. The Parbati is the main river flowing along the western boundary touching Rajgarh District of M.P. and Jhalawarh and Kota District of Rajasthan. Shivpuri & Kota are located in north where as Vidisha, Bhopal, and Rajgarh lies to the South. The total area of District is 6307.66.63 sq.Km. with a population of 977827.

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HEALTH AND NUTRITION STATUS OF GUNA

The health and nutritional status of the population is an important indicator of the development of the society. Mortality rates, micronutrient deficiencies and malnutrition status are some of the important indicators that can be used to assess the health status of a specific area.
• Infant Mortality Rate- 96 per thousand.
• MMR- 700 per one lakh
• Malnutrition rate – about 50%
• Birth Rate-35.2 per thousand









SOCIAL AND ECONOMIC BARRIERS OF THE DISTRICT

• Increasing trend of nuclear families, implying lower opportunity for family support,
• low levels of literacy and lack of awareness about health and nutrition related issues among women and families, and saharia tribal people.
• Large number of women have to work outside the house, due to poor economic status,
• Poor housing condition and lack of access to safe drinking water.

Solution and Key Benefits

 What is the initiative about? (the solution)
Strategies adopted by the Department of Health, Guna under the able leadership of the District Collector Dr. G. K. Sarswat IAS have been multi-prolonged. As the district has had high MMR, IMR and high malnutrition rate among 0-5 yrs of children so the initiatives taken to improve existing delivery of services are numerous and are being attempted at all levels. Major areas of thrust are health, education, water and sanitation and women and child development issues.
1. MATERNAL MORTALITY REDUCTION STRATEGY BY STRENGTHENING DELIVERY INSTITUTIONS ACROSS DISTRICT-GUNA
1. Key Interventions
For improving and strengthening of institutional delivery system in the district which alone can make lots of differences, a number of initiatives have been taken.-
i. Initiation of Community Mobile Health Services in all five blocks of the district. That has been the glaring example of community participation in the process of development.. Five mobile vans were purchased with the local community support. CM of the state honorable Mr.Shivraaj Singh came to Guna to launch the programme on 27 th May,07 and handed over vans to local community. These vans are used to carry doctors and their teams along with medicines to far flung areas to provide emergency services. to people. So far, 65 thousand people have been benefited from its access since last one and half year.
ii. Strengthening of Institutional Delivery Centers- Reducing maternal mortality requires strengthening of the health care system. One strategic entry point is provision and improvement of EmOC. A crucial part of EmOC is the availability of skilled attendants at birth and this requires long term planning. The overall effectiveness of skilled attendants depends, however, on the immediate access to life saving EmOC. Thus, reducing maternal mortality needs a strong and functioning health system. District administration has been assisting and supporting department of health Guna for setting priorities that strengthen health systems, i.e., provision of 24-hour quality EmOC should be a top priority. So far, 26 delivery centers have been identified and giving services. Two years back, District reported only 35 percent of institutional births and now the figure has gone upto 95 percent.
iii. Opening of 24 hours call center-A call center with TOLL-FREE NUMBER -102 at the premise of District hospital was opened five months back. The call center has all informations about pregnant women. Everyone has the access of free mobile vans for the transport of pregnant mothers. The results have been very phenomenal. Institutional deliveries have improved.
iii. Mother and Child Protection camps: Every pregnant woman faces risk of developing obstetric complications during pregnancy, during and after childbirth.. Basic education and literacy are among the most important determinants of family planning. Because an educated girl is likely to get married later, she reduces her risk of developing infection and dying during childbirth. Her babies are also more likely to survive the first year of life. An educated mother tends to be healthier and raise her family accordingly. Considering the importance of this, department of health has been organizing regular MCP camps at sector levels.
v. Maternal mortality audit – providing evidence for action
The five methods promoted by District are: verbal autopsy, facility-based death reviews, confidential enquiries into maternal deaths, near- misses review, and clinical audit. The five steps are identification of deaths, confidential data collection, anonymous analysis, recommendations for action and guidelines, and evaluation and refinement.

Actors and Stakeholders

 Who proposed the solution, who implemented it and who were the stakeholders?
• Realizing the gravity of the problems especially in health areas and improving delivery of services demand a great deal of commitments. These get reflected when initiatives are being undertaken by enthusiastic team members of Department of Health, Guna and well supported by a supportive and strong leadership of a civil servant the District Collector, Dr. G. K. Sarswat IAS who has a clear vision for the service of humanity. In this whole process, Government Of MP, India and its community centric policies are helping hand. Besides this, Unicef MP and their support in the areas of health, women and child development issues, water and sanitation and education start bringing dividends. Last but not the least, Indian Institute of management, Indore has helped a lot in raising the capacity of officials of the district. And above all, the coordinating efforts have been taken by the DC Dr. Sarswat.

(a) Strategies

 Describe how and when the initiative was implemented by answering these questions
 a.      What were the strategies used to implement the initiative? In no more than 500 words, provide a summary of the main objectives and strategies of the initiative, how they were established and by whom.
Strategies that are being involved centre around identification of problems, assessing resources and plan the things accordingly.
Overall objective- To provide safe delivery services in clean, hygenic and women friendly locally environment. and to provide an evironment which could be very prompting and encouraging for the stakeholders.
The major initiative has been taken by the district leadership.District health society, Guna and the core group of the district headed by the district collector Dr. G.K.Sarswat IAS has formulated policies focusing on the identification of the problems encountered by general public. The main aim has been to streamline the process very effectively.

(b) Implementation

 b.      What were the key development and implementation steps and the chronology? No more than 500 words
Key developments-
• Community Mobile Health services launched in the district on 27.5.06
• Tribal health camps per month on regular basis since May,2006
• Strengthening of Institutional services by raising the number of delivery institutions to 26 from 10.
• Mother and child protection camps at sector levels- held quarterly since Feb,06
• Initiation of Home-based therapeutic care services to severely malnourished children known as MAMTA KI CHHAON ME.
• Declaration of Nirmal villages (Purely hygenic villages)- numbering three and awarded by Honorable President of India Dr. A.B.J. Kalaam Ajaad in the month of May,2007
• Opening of the call center - a 24 hours call center for providing free referral service s to pregnant women of the district.-Sept.07. Visited by Norwegian Ambassdor, Unicef country as well as regional Director Mr. Tool
• Opening of well equipped Health subcenter at Fatehgarh - 55 kms. away from district headquarter, providing health services of very high class.
• Operationalization of SNCU- a special neo natal ward for new born children at the district hospital. The second of its nature in the whole country after one at Mayurbhanj district, Orissa.
• Initiating steps to make Guna a Cataract free district of the state.
• 70 percent household report the use of Iodized salts. Mid day Meal report 100 percent use of Iodized salts. Two years back , it was showing a meagre 14 percent household reported this.
• Helpline for effective monitoring of the services in the fielsd of education, Aanganwari, PDS and Employment guarantee scheme- Toll free numbers are provided for the community to response.
• mobile phone facilities to Village-chowkidaars(Village-guards)

(c) Overcoming Obstacles

 c.      What were the main obstacles encountered? How were they overcome? No more than 500 words
Poor female literacy rate that is around 42 percent, social and economic conditions of the district which has been challenging because the economy is primarily agriculture based . Migration of laborers is also a severe problem. there has been problem on the part of service delivery as well as stakeholders initially. There was lack of enthusiasm on the part of service providers while a sense of disbelief was there on the part of stakeholders and beneficiaries. It was a big challenge for the district.
Major steps were taken to create a great sense of belief and faith among local community. It all began with providing good health services. Monitoring was made stringent by the district collector. Apart this, several capacity building measures for service providers were initiated. There was search for development partners. Unicef, MP supported the initiatives fully. Their technical inputs have been very helpful

(d) Use of Resources

 d.      What resources were used for the initiative and what were its key benefits? In no more than 500 words, specify what were the financial, technical and human resources’ costs associated with this initiative. Describe how resources were mobilized
All local available resources are mobilized in such a way to garner maximum outputs. Inter departmental coordination has been given maximum thrust. All government funds are pooled in such a way to give the desired results. First, there was no additional load on government exchequer. Capacity building measures like training of personnel have been put in rigorous way. Responsibilities have been entrusted. Service to humanity has been the guiding force and this to be treated as a working philosophy

Sustainability and Transferability

  Is the initiative sustainable and transferable?
As the government has no dearth of funds, what we need to have a clear cut strategy and pragmatic approach for sustainability of things.Initiative can be replicated at different levels once we set our priorities.

Lessons Learned

 What are the impact of your initiative and the lessons learned?
If ours vision has been clear, we can achieve positive results. What we always need to have a very pragmatic approach and understanding of things. Everyone has got to contribute something substantial for the sake of society and humanity.

Contact Information

Institution Name:   Department of Health, Guna(MP) India
Institution Type:   Government Department  
Contact Person:   Dr. Gopal krishna Sarswat
Title:   District collector, Guna  
Telephone/ Fax:   91 7542255626
Institution's / Project's Website:   91 7542255408
E-mail:   dmguna@mp.nic.in  
Address:   District Collector, Guna(MP)India
Postal Code:   473001
City:   Guna
State/Province:   Madhya Pradesh
Country:   India

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