| 4. In which ways is the initiative creative and innovative?
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The Ayush Mamta Clinic concept is seen as a vehicle to ensure that preventive and promotive interventions reach the vulnerable and marginalized sections of community through expanding outreach and linking with local influencers.
Below given are the key aspects which make this initiative one of its kind.
Maximum utilization of available health resources
No cost or minimal cost involved
By bringing in the AMCs and local leaders, tribal people connected to what they said and hence people started to avail the benefits of the services provided by the government health sector.
Outreach services provided empowers community through awareness generation, whereby they are able to demand services from the Health System.
Addresses health needs of under- served areas
Based on community level action for increasing preliminary treatment, mobilization and behavior change process required to enable women from poor access to quality health services.
Referral to higher health facility for chronic diseases and follow up of the same has been increased.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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Health and Family Welfare Department of Sabarkantha District under Chief District Health Officer guidance implemented the initiative.
The size of the population affected is 13.88 lacs as per the census of year 2011.
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| 6. How was the strategy implemented and what resources were mobilized?
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After “Call to Action”, district agreed to accelerate RMNCH+A strategy with all available interventions. The main objectives were to increase service coverage especially in Maternal, Child, Adolescent and Geriatric Health. All interventions are directed to achieve highest level of service delivery and so the service utilization.So in this approach, district utilized available AYUSH MOs for conducting health clinic at community level. Three days in a week were identified i.e. Tuesday, Thursday and Friday of every week for NHM AYUSH and Tuesday and Thursday two days in a week for RBSK AYUSH. In the start of the financial year all PHC AYUSH MO had prepared a micro plan of fixed day clinic in their respective catchment areas, where main focus was given to farther most villages or difficult to reach areas. Time to Care approach was also used to identify the villages to conduct AMC. The plan was then shared with the FHWs (Female Health Worker) and ASHAs (Accredited Social Health Activist) in order to make the community aware about the day, time and venue of the clinic as well as to mobilize the beneficiaries. Mainly pregnant women and infants are mobilized at the site with the help of ASHAs. Available facilities like Anganwadis and sub-centers are being used for the clinic. So it also serves as an example of convergence between ICDS (Integrated Child Development Services) and Health department. Other services provided on this day are screening of people more than 30 years of age for the diabetes, hypertension, arthritis, asthma, TB, skin diseases, RTI/STI etc. among community, registration of disabilities for the Ability Gujarat program and referral of the high risk ANC’s to higher health care center. AYUSH arrange a meeting with the local influencer’s atleast once in a month in a given village to make them aware about all the Government health schemes, available services at public health facilities and to solve their issues related to common ailments.Patients are screened for high blood pressure, hemoglobin levels and diabetes, Tb and asthma. All suspected cases are sent to the PHC for confirmation of diagnosis. The data about all the clinics held during the month, suspected cases for various NCD’s, cases referred etcetera is uploaded at the end of month on the google based online reporting form, which is further analyzed and monitored on monthly basis.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The Program advocacy, strategy planning, technical inputs, guideline development and implementation of the program was carried out by Department of Health and Family Welfare, Sabarkantha District. ASHA, FHW, AWW, (Multi Purpose Health Worker) MPHW, MPHS (Multi Purpose Health Supervisor),Laboratory Technician are others from the Health department.
Key Stakeholders from village functionaries are – Village Sarpanch, Panchayati Raj Institution (PRI) members, Local leader/ influential person of the village
Stakeholders at beneficiary level - Pregnant women and lactating mothers, children(0-5 years), Adolescents, Geriatric people, RTI/STI symptoms.
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| 8. What were the most successful outputs and why was the initiative effective?
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The Ayush Mamta Clinic was able to increase institutional OPD by 25 percent.
Through Ayush Mamta Clinic, in a monthly schedule of 30 days, Ayush & RBSK doctors cover 390 villages screening about 16000 people every month which in FY 2013-14, can be seen by looking at the OPD data of AYUSH that it was only 4639 per month.
With 780 clinics being held every month, a total 9360 AYUSH Mamta clinics are held in a year in Sabarkantha district.
So far since the initiation of this programme, Out of 112266 Total OPD
2220 suspected cases – for diabetes,
3721 suspected cases – for hypertension
710suspected cases - TB,
4412 suspected cases – asthma,
12457suspected cases - arthritis,
3592 suspected cases - RTI/STI,
Blood smear collection for 6243 suspected cases of malaria.
A total of 2860 suspected cases were referred to further higher health facilities.
5181 people were screened for Anaemia of which 791 had Hb levels less than 7gm and were referred for Iron Sucrose Therapy at PHCs.
Out of 9460 ANC’s screened, 1927 ANC’s were referred to higher facilities.
As can be seen in the above specified data, District’s new healthcare concept has performed remarkably well in specific areas that it has chosen to focus upon, principally in rise in the OPD of government health centers along with increased trust of communities on government health care system and ensuring that an overwhelming proportion of births are from institutional deliveries thereby contributing in bringing down maternal and infant mortality. Identification of cases of disability, malnutrition, anaemia, high risk pregnancy, TB, Malaria treatment of minor ailments of children using IMNCI protocols and high impact essential NCD interventions are delivered through a primary health-care approach by strengthening of early detection and timely treatment.
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| 9. What were the main obstacles encountered and how were they overcome?
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a) Improving Community participation
During the earlier weeks of the initiation of this programme, there was some resistance in the community about how to get patients to use PHCs and other primary treatment options optimally. In order to cover that it was decided by the Health and family welfare department of Sabarkantha District that ASHA being the focal point at community level would organize sensitization meetings of AYUSH/ RBSK MO with local authorities, community & religious leaders at Ayush Mamta Clinic. These meetings organized by ASHA helped Ayush to interact with the influential persons of community, unshackling them from age old mentalities, gradually shifting their own practices and inspiring others in the community.
b) Transportation issues for the Ayush & RBSK doctors –
The problem was resolved by provision of PHC Vehicle for the AMC sessions and also same vehicle was used for the referral of High Risk ANC’s with low Hb levels for Iron Sucrose Therapy.
c) Lack of availability of Traditional Ayurveda medicines –
The issue was put up at State level by the District Officer, and was later resolved by the state officials and Ayurveda and Homeopathy medicines were provided to the AYUSH doctors.
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