Van Sanjivani Project
District Administration Narmada

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Narmada district is an administrative district in the state of Gujarat in India. The district headquarter is located at Rajpipla. About 40 % of total land area is covered under forest and hilly regions. The district has 23 primary health care and 4 community health centres, with 2 government hospitals. Weak mobile phone connectivity and improper infrastructure are the chief problems in this location. Many tribal areas still exist in the same district where the mobile phone connectivity is zero. The tribal community prepared mobile phone connecting spots in specific geographical locations of the hill. Indeed, many mobile spots are accessible on top of the trees. People who successfully managed to call the 108 ambulance services they use cloth stretcher and bed to carry the patients from village to either the hospital or 108 emergency services through hilly forest. Entire process was taking around 4-5 hours. Time gap of transferring patients was much high in life threatening medical emergency and that cause higher mortality rate. In case of critical medical emergency tribal population has very limited resources for saving the life of their own community members. Apart from the above mentioned troubles another shortcoming was limitation of 108 emergency vehicles. The vehicles are not made to drive through the hilly forest areas. 108 emergency vehicle stops at specific point and wait for patients’ arrival. Again this entire process consumes lot of time and it results into exclude the aim of golden hour’s treatment by 108 emergency services. An additional dilemma in this region is monsoon season. Many small and big streams of water, land sliding and floods are the main challenges in front of tribal community. In case of critical medical emergency once again this seasonal natural attack put them in very challenging situation. However, in winter and summer they manage but in monsoon it was near to impossible for them to bring the patients at hospital or 108 emergency vehicles spot.

B. Strategic Approach

 2. What was the solution?
Considering the exceed situation Honourable Collector & District Magistrate Shri Sandip Sagale IAS, Narmada District formed brain storming committee for solving the problems in Dediapada taluka. This committee were included Shri Sandip Sagale (IAS, collector), Dr. Vipul Gamith (ADHO- Health department), R. Dhanpal (DCF- Narmda district), and Mr. Sumit Thesia (CSR-consultant). The committee concluded that with the help of Narmada district administration department, an initiative of implementing the new Project should be carried out. In January 2016 two sturdy vehicles was allotted to the forest department in two different clusters. These two clusters were responsible to cover 18 nearest villages of Dediapada taluka. These vehicles and their process were known as “Van Sanjivani” (means Forest plant which can reverse even death). The same started to carry the patients at either nearest Community health centres or emergency vehicle spot. The project was taken by collaborative approach from District Administrative Office, Health Department, 108 Ambulance Services and the Forest Department of Narmada District. It was intellectual experiments successfully executed by Shri Sandip Sagale (IAS, collector) by developing Inter Departmental Cooperative System Approach (IDCSA).

 3. How did the initiative solve the problem and improve people’s lives?
By putting an innovative effort important link was used for solving problems related to phone and road connectivity. Forest Department has extended its wireless connectivity system through linking Walkie-talkies of forest duty guard and 108 emergency services made it available for the village people. Now to avail emergency health services, villagers communicate with forest duty guards through wireless service and get connected with the 108 emergency services. Ambulance service 108; and simultaneously the sturdy vehicle took the patient from the village and started moving towards ambulance way. Thus, patient is transferred half way in Van Sanivani Vehicle and then in mid-way Ambulance 108 takes the patient. In 2013 and 2014 CHCs (means Community Health Centre) didn’t received any patient from 108 ambulance service providers. Gradually, changes has been observed in the year of 2015 and 2016 where 38% hike recorded because of on time delivery of patients by collective effort from 108 ambulance and Van Sanjivani vehicle. Majority of the respondents from the CHC responded that the in the year of 2016 they have observed unexpected patients rate for treatment. Majority of the respondents replied that the recorded information is only included the woman delivery cases not other cases.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The initiative is creative and innovative because if we focus on quarterly reports of ministry of health and family welfare, In the year of 2013 and 2014 ambulance service providers did not received any calls from the Dediapada taluka in case of emergency. In the year of 2015 the numbers of cases suddenly increased up to 74 because of the tribal awareness activity from district administration department. Next year the number phone calls have been increased up to 194. Compare to previous year the 38% hike has been observed because of implementation of Van Sanjivani project into remote location of Dediapada region with less barrier and managing the aim of golden hour’s treatment ratio. In the year of 2016 because of late delivery of patients, 0 death cases have been registered. Majority of the respondents replied that in spite of bad infrastructural conditions and poor mobile networks up to certain extent the 108 ambulance service providers successfully able to manage the golden hour’s treatment in project implemented region of Dediapada under the core guidance from district administration Narmada. In 2016 average time of patient delivery was 60 to 100 minutes. According to the respondents the district administration department played very effective role in minimizing the time gap from 240 minutes (4.16 hours) to 60-100 minutes (1 hour to 1.30 Minutes).

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
Originally, the initiative implemented by Shri Sandip Sagale (IAS, Collector & DM) with the help of other brainstorming committee members named Dr. Vipul Gamith (ADHO- Health department), R. Dhanpal (DCF- Narmda district), and Mr. Sumit Thesia (CSR-consultant). The project was taken by collaborative approach from District Administrative Office, Health Department, 108 Ambulance Services and the Forest Department of Narmada District. It was intellectual experiments successfully executed by Shri Sandip Sagale (IAS, Collector & DM) by developing Inter Departmental Cooperative System Approach (IDCSA). The size of population included 13371 inhabitants in 18 remote located villages of Dediapada Taluka by this initiative.
 6. How was the strategy implemented and what resources were mobilized?
Once the brain storming team concluded that the implementation strategies to be planned out through collaboration of key departments i.e. Health Department, Forest department and 108 Ambulance Service. It was started with stakeholder mapping which includes villagers, Forest Bit Guard, 108 Ambulance Driver and sturdy vehicle drivers, CHC Doctor and Nursing Staff. Next stage was conciseness building through training sessions by respective departments and focus group discussions about the project implementations with all stake holders. Mock runs/drills were conducted to provide the understanding of medical emergency communication plan to illiterate population tribal area. They have been informed about the simple do’s and don’ts during the medical emergency in their local language. This has made them aware about the utilisation of emergency medical services. The overall implementation and monitoring was handed over to DCF-Forest department for the execution of this project. As the project was implemented on collaboration approach most of the resources like man power, vehicles etc.. were in-house of respective department so in that way it was very much cost effective project. However, District Administration has sponsored two sturdy vehicles worth of Rs. 10 lacs (One million rupees) to support this project. The key human resource involved in this project was Forest Bit Guards about 18 nos. and Ambulance Drivers 2 nos. who are the main channel in implementation of this project. The Forest Bit Guards are on government pay roll as local forest supervisors and salary of two vehicle drivers (Rs. 20,000 per month for both drivers) were sponsored by forest department from their local finance grant.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
The stakeholders were included Collector & DM (Narmada – District, 2016 ), ADHO- Health department, DCF- Narmada district, and CSR-consultant.

 8. What were the most successful outputs and why was the initiative effective?
Most successful outputs as follows  Successfully managed the time gap (30 -60 minutes) and established communication linked between tribal patients and 108 emergency services.  Effectively delivered the patients at nearest community health centres and PHCs without compromising the golden hour’s treatment aim within 60 -90 minutes.  The strategic usage of wireless services of forest department and additional ambulance in remote area has successfully ensured 108 services in “Golden Hours” as per the mandate of emergency medical service.  As of now 194 tribal leaving in interior parts of Dediapada taluka has been attended for medical emergency. Majority of them are females. The same well attended during their pregnancy trauma. There are about 32 highly critical medical emergency condition cured and life saved.  Saved many medically critical cases because of on time delivery of patients at CHC, PHCs. The initiative was effective because number of patients for treatment compare to last four years the reference through 108 ambulance services at CHC/PHC has been increased and after introducing the project no death registered because of late patient delivery at hospital.

 9. What were the main obstacles encountered and how were they overcome?
Main Obstacles as follows.  Forest rights Act does permit to build roads and established mobile network in forest regions.  Developing the cooperative mechanism and linked them with the project was biggest challenge.  Poor road condition, lack of mobile network availability, monsoon season.  Response problem in night when the all the guards are on patrolling and limited human resource available in pick time at night.  Not able to manage the golden hour’s (60 minutes) treatment because of poor infrastructure, mobile network and unfavourable season like monsoon.  Carry patients on Char Pai (Bed) or Jholly (Cloth stretcher) and walk in through hilly forest area.  Served to the medically critical tribal patients after time causes into higher natural or accidental mortality rate.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Key benefits as follows.  On time treatment Served to 194 critical medical emergency cases of socio-economic poor background.  Saved the life of 32 patients whose existence was on higher risk.  Achieved the golden hour’s ratio in many regions up to certain extent.  Succeed in elimination of communication berries by the use of wireless of forest department.  The tribal population in project implemented region have good amount of educated boys and girls. Some of them have complete nursing courses. Impact evaluation of Van Sanjivani project in 18 inaccessible villages of Dediapada taluka is basically action research in nature. Area of study included 13371 inhabitant populations in 18 remote located villages. Focus group discussion and Interview schedules used to collect primary data from collector, Range forest Officers, forest guards, Van Sanjivani vehicle drivers, Manager of 108 ambulance service, Superintendents of Community health centers, PHC supervisors, Village beneficiaries and Village leaders. Various reports from all linked departments used as secondary source of information. Around 35 samples studied by researcher to assess the impact of Van Sanjivani project. Qualitative analysis of primary data and quantitative analysis of secondary data is used in this report. Mainly census sampling for established system and convenient sampling for tribal population is used for study.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Yes, Honourable Collector & DM has successfully generated Inter Departmental Cooperative System Approach (IDCSA). The project is connected to serve the help in cooperation with Forest department, Health Department, Tribal welfare department and District Administration department. Through this collective system approach all public service department are connected directly or indirectly which result into to accountable departments bond to serve for the public.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The Van Sanjivani project as special measure put in place where 2 sturdy vehicles with 2 drivers allotted in the 2 different clusters of Dediapada taluka. The project through the vehicle Saved life of total 194 medical critical cases out of which 32 were highly critical medical cases. In which 96% of the patients were pregnant woman, girls and old people beneficiaries only and all are belongs to socio economic poor background in remote location of Dediapda taluka.

Contact Information

Institution Name:   District Administration Narmada
Institution Type:   Local Government  
Contact Person:   Sandip Sagale
Title:   Collector and District Magistrate  
Telephone/ Fax:   +912642240600/2
Institution's / Project's Website:  
E-mail:   collector-bha@gujarat.gov.in  
Address:   : Nw Jilla Seva Sadan, Behind Railway Colony, Bharuch
Postal Code:   392001
City:   Bharuch
State/Province:   Gujarat
Country:  

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