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Strengthening Health Ecosystem through Ayushman Bharat Health & Wellness Centres

Bal Raksha Bharat, in collaboration with Mondelez India Foods Pvt Ltd, has implemented a project titled “Strengthening Health Ecosystem through Ayushman Bharat Health & Wellness Centres (AB-HWCs).” The objective of the project is to support 200 selected Health & Wellness Centres (HWCs) across four states—Madhya Pradesh, Maharashtra, Himachal Pradesh, and Andhra Pradesh. The aim is to enhance their facilities and outreach services, benefiting over 1.45 million people. The health system strengthening initiative operates in close coordination with Chief Medical Health Officers, Block Health Officers, Nodal Officers of AB-HWCs, Medical Officer In-charges, nursing staff, ANMs, and ASHAs at these centres located near Mondelez factory locations.

The specific objectives of the project include strengthening the HWCs to deliver quality Comprehensive Primary Health Care (CPHC) services through system improvements and technical assistance. A focus has been placed on prioritizing services for new-borns, children, and adolescents while establishing forward and backward referral linkages. Additionally, the project aims to scale up learning and replicable models for health system strengthening, with a focus on gender-inclusive health and wellness centres.

The implementation process involved several key steps. Initially, sufficient manpower was positioned to ensure effective execution. Partnerships were formed with the health departments of the states, and facilities in need of transformation were identified. The project provided continuous handholding support and conducted extensive documentation to record progress and challenges.

User-Friendly Health and Wellness Centres

The Ayushman Bharat Health & Wellness Centres are designed to provide comprehensive services, including preventive, promotive, curative, rehabilitative, and palliative care. These services ensure the clinical management of patients, care coordination, and continuity of care, particularly for chronic and critical cases. Public health functions such as health promotion, disease prevention, and outcome measurement for the population served are integral to these centres.

A key principle guiding the design of user-friendly health facilities is to ensure that services are delivered in a manner sensitive to gender, religious, and cultural needs. Discrimination on economic or social grounds is strictly prohibited. Care is collaborative, coordinated, and accessible, with an emphasis on physical comfort and emotional well-being. The viewpoints of patients and families are respected, and they are always included in decision-making processes.

Before finalizing the design of the HWCs, key cultural characteristics of the local community are identified and integrated into the design process. The aim is to ensure minimal environmental disturbance while considering local language, social and family structures, gender relations, spirituality, and social issues. These aspects are vital in creating a culturally appropriate health facility.

Transformational Process of HWCs

The government envisions the delivery of comprehensive healthcare services at the community level with high quality, supported by an efficient referral system. The Ayushman Bharat guidelines for health and wellness centres encapsulate this vision. The Bal Raksha Bharat (BRB) program took this vision and applied it to select blocks in the four states, working with the health departments to transform select Primary Health Centres (PHCs) and Sub Health Centres (SHCs) into HWCs.

The transformation process involved an eight-step approach. The first step was conducting a need assessment to understand the specific requirements of each facility. Following this, the team mapped out space for the construction of essential facilities like toilets, handwashing stations, and breastfeeding corners. After receiving approval, infrastructure construction began, followed by the supply of necessary equipment, including examination beds and medical kits. The health personnel received training on Ayushman Bharat requirements and how to use the equipment.

A significant focus was placed on creating gender-friendly HWCs by developing a Gender-Friendly and Social Inclusion Package. This included displaying IEC materials, orienting the staff, and organizing outreach sessions. Collaboration with Panchayati Raj Institutions (PRI) was essential, as local governance bodies could leverage untied funds for facility improvements.

The efforts resulted in remarkable improvements in the condition of the facilities. Waiting areas with proper seating, toilets for patients and caregivers, handwashing stations, and breastfeeding corners were introduced. The construction of boundary walls and pits for safe medical waste disposal further enhanced the facilities. These improvements have led to a significant increase in outpatient footfall across all four states. For instance, in Maharashtra, SHCs supported by BRB have seen a 30-40% increase in service seekers due to the improved facilities.

Functional Jan Arogya Samitis

The Jan Arogya Samiti (JAS) plays a crucial role in effective health planning and monitoring at the community level. Formed with representation from healthcare staff, elected representatives, frontline workers, and community members, the JAS is empowered to plan and monitor health services. However, in many areas, JAS has remained a paper activity without real engagement at the ground level. Many individuals were unaware of their selection as members, and as a result, the envisaged role of JAS as a monitoring body became diluted.

The BRB program aimed to reinvigorate JAS as an effective community monitoring mechanism. This was achieved by establishing rapport between the Medical Officers (MOs) or CHOs and the PRI heads. Following this, JAS members were identified, motivated, and trained. Stationery and meeting registers were provided, and monthly meetings were organized to set agendas and manage fund disbursements.

The Mondelez-supported BRB initiative facilitated the functioning of 116 Jan Arogya Samitis, many of which now have operational bank accounts. Before the intervention, none of these committees had active accounts. In Maharashtra, one JAS was able to mobilize INR 3 lakh to construct a new health centre. JAS members have also secured resources for purchasing medicine, installing water purifiers, repairing buildings, connecting electricity, and hiring helpers for sanitation.

The BRB program helped address apprehensions and power dynamics between JAS and healthcare workers. Initially, health staff feared that engaging with the community would attract unwanted attention and hinder their duties. However, the program’s success in improving facilities and fostering cooperation demonstrated that these fears were unfounded. The JAS has now become a vital community monitoring tool, helping to ensure the smooth functioning of HWCs and contributing to improved healthcare services at the grassroots level.

Impact and Learning

The project has had a considerable impact, with 200 Ayushman Arogya Mandirs strengthened through the provision of maternal, new-born, and child health equipment. The establishment of 24 user-friendly Ayushman Arogya Mandirs has led to a 58% increase in patient footfall, and 11 centres have received Kayakalp accreditation for hygiene standards. Moreover, 861 health staff members have been trained in gender and social inclusion services, and 5,096 high-risk pregnancies and 1,477 under-five children were identified and referred for additional care. The success of this project underscores the importance of infrastructure, training, and community engagement in transforming healthcare facilities into effective centres of care.

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India Flood Response 2023 in Himachal Pradesh

Key Initiatives or Changes:

Himachal Pradesh, India, faced a severe crisis as it grappled with continuous flash floods and cloudbursts during the month of July 2023 and August 2023. The regions of Mandi and Solan were particularly affected by these devastating natural disasters. The situation led to significant damage to life and property and necessitated an immediate response to aid the affected individuals.

The planning to launch a humanitarian response in the affected area was conceptualized in the month of July’23 with activities ranging from distribution of essential resource materials and providing Psychosocial First Aid services, but unfortunately, the revoking of the FCRA license during this period dealt a severe blow in launching a swift humanitarian response in the area. Unperturbed by the new challenge and focussing on the mission to reach out to the most vulnerable person in the area, BRB reached out to the local donors and corporate CSR funds to help/fund the response. The BRB team’s resilience and dedication paved the way in attracting 3 CSR donors to fund response.

Recognizing the need to address the requirements of the population, Bal Raksha Bharat (BRB) implemented a comprehensive strategy for restoring and upgrade the damaged healthcare facility in the Solan and Mandi Districts. Bal Raksha Bharat’s proposed strategy was at three level – Preparedness, Response and Recovery conceptualized in partnership with the CSR donors involved in strengthening Primary healthcare facilities for resilient recovery impacted due to these floods.

Innovative Approaches or Strategies:

One of the major innovative approaches that was implemented was the introduction of technology to reach out to the most remote part of this mountainous state with essential medical supplies. The Drone capable of carrying 15 kg of medical supplies would prove to be a ground breaking advancement in reaching out to the most remote villages in the area or areas where all possible road connection have been severed due to landslides, floods or other disaster. The Drone could deliver medications and supplies to patients being cared for in the home instead of a hospital-based setting, which might have been damaged due to any disaster like situation such as flood, landslides, etc. Thus, this is a big step in ensuring continuous medical care even in times of severe disaster

The response strategy implemented by Bal Raksha Bharat (BRB) in the flood-affected areas of Himachal Pradesh was comprehensive and proactive. As soon as the disaster struck, the BRB team initiated on-ground coordination and selected health facilities in collaboration with the respective Chief Medical Officers (CMO) and Block Medical Officers (BMO). A dedicated team of 6 to 7 members was deployed for needs assessment, and engaging with the community in the district. A key aspect of their efforts was gathering information about the affected areas and families. Working in close collaboration with community volunteers, the team collected detailed data on families impacted by the floods. This information was crucial for directing targeted relief initiatives and enhancing the decision-making process

The successful implementation of the disaster management project underscores the efficacy of coordinated initiatives in enhancing disaster resilience in rural communities. By repairing health facilities, raising awareness, forming a dedicated committee, and conducting training drills, the project has empowered villagers and fortified the community’s ability to mitigate risks and respond resiliently to disasters.
The methodical approach of the project was designed to maximize the use of resources and personnel. It ensured that each response team was fully prepared to meet the specific needs of each location. Bal Raksha Bharat tailored the deployment plan to the unique requirements of each area, aiming to enhance the impact of the response activities and provide timely support to the families affected by the disaster

Measures of Success:

The response was able to achieve the following major milestones during the entire reporting period:

Infrastructure revamping done (including restoration and repair work) in all the 10 Primary Health Facility, thereby achieving 100% of the desired target

Capacity Building Training (including practical sessions, where ever required) for the staff of all the selected 15 Primary Health Centers were conducted on the following topics, thus achieving 100% of the target:

Disaster Preparedness

Health Facility Risk/Vulnerability Assessment Exercise

Safe Health Facility and Safe Community Plan

Mock Drills

A 12 days’ awareness campaign was organized with the objective to improve behavior change of communities on health, nutrition & wash during emergency like situation in two identified districts of Solan and Mandi in Himachal Pradesh. During the awareness campaign we could reach to reached 88564 people

Procurement and handing over facilitating technology level support (Drone) to the state authorities for delivering essential medical supplies in coordination with district administration.

Distribution of 1085 Food Kits, 1295 Hygiene Kits, 1646 Shelter Kits and 390 Health Equipment (BP Machines) thereby reaching to close to 25K affected people

Bal Raksha Bharat (BRB) team implemented a post-distribution/post-response feedback mechanism, which has been vital in evaluating the impact and effectiveness of the response. After the distribution and other response activities (such as PFA, strengthening of Heath Facility), the team engaged with the beneficiaries to collect their feedback on the usefulness and suitability of the kits and the feedback received by enhancing the health facility. The feedback received indicated that the impact from the various response activities were immensely beneficial. This positive response highlights the success of the initiative in meeting the immediate needs of the affected families and children.

Additional Information

Case Story : Overcoming Adversity: Ms. Preeto Devi’s Journey of Resilience

Background

Ms. Preeto Devi, widow of the late Lt. Sh. Tara Chand, is a resilient individual currently residing with her daughters, Beena (20 years old), Sushma (13.5 years old), and Kamaljeet (11 years old). Following the untimely demise of her husband due to a heart attack in 2017, Preeto found herself confronted with immense challenges in raising her children in their village of Silh-Sunani. Tragedy struck once more in 2020 when Preeto’s 17-year-old son succumbed to a snake bite, leaving the family grief-stricken and struggling to cope.
The family’s plight worsened when heavy rainfall triggered a devastating landslide on August 15th, 2023, which obliterated their home and agricultural land. Forced to seek refuge with her parents, Preeto and her daughters relocated to her maternal home in the village of Jaman da Dora, where they became reliant on the support of relatives for their basic needs. The turmoil disrupted Beena’s education, compelling her to halt her studies after completing her 12th-grade examination.

Current Context

Amidst this adversity, a beacon of hope emerged in the form of the ‘India Flood Response – 2023’ project initiated by Bal Raksha Bharat in collaboration with Zee Entertainment. In January 2023, during a distribution event for hygiene kits at the Health Sub Center/Health and Wellness Center in Jaman Da Dora, Beena shared her family’s hardships with the field staff. Touched by their story, Bal Raksha Bharat, along with Zee Entertainment, distributed 30 hygiene kits to families in need within the Bawasini Panchayat, including Preeto Devi’s.
The partnership between Bal Raksha Bharat, the health facility, and the Panchayati Raj institution culminated in a community sensitization session on personal hygiene. Preeto and Beena were among the beneficiaries of this initiative, receiving hygiene kits and expressing their gratitude for the support provided by Bal Raksha Bharat and Zee Entertainment. Beena emphasized the significance of the hygiene kit in promoting good hygiene practices among girls and women in their community.

Furthermore, Preeto’s active involvement in the Disaster Management Committee reflects her newfound understanding of the importance of disaster preparedness, illustrating her resilience and commitment to safeguarding her family and community.

Conclusion

Ms. Preeto Devi’s journey through adversity underscores the power of resilience and the transformative impact of community support. Despite facing numerous setbacks, Preeto and her daughters have persevered with dignity, finding strength in the solidarity extended by organizations like Bal Raksha Bharat and Zee Entertainment. Through their intervention efforts and partnerships with local institutions, tangible strides have been made towards rebuilding lives and fostering resilience in the face of adversity.