|
 |
-
Chhattisgarh ranks “high”
on nutrition insecurity. The high child undernutrition rate
of about 59 percent, and an anaemia prevalence rate among women
of 53.8 percent, are two of the most important health indices
expected to be reduced by the Mitanin Programme. Towards this,
the most significant role of the Mitanin is behaviour change
communication to alter dietary practices and related knowledge
and attitudes in the community to achieve better nutritional
status. However, various additional factors related to the lack
of an enabling environment impede the translation of this knowledge
into practice. In this context, the current initiative proposes
to analyse the role of the Mitanins to alleviate nutritional
insecurity through interventions ranging from promoting kitchen
gardens, altering intra-household food distribution patterns,
dietary diversification, and raising awareness about and increasing
access to food security schemes of the state.
-
Besides
the primary role of the Mitanin to provide preventive promotive
health care, she also has important supplementary functions
of providing basic curative care and referral to the public
health system. For the provision of basic curative care, each
Mitanin is allotted a Drug Kit comprising of basic symptomatic
drugs. However, it is imperative that the Mitanin is provided
with appropriate diagnostic equipment to facilitate the prescription
of basic drugs and referrals. Towards this, the current initiative
proposes the introduction of low cost diagnostic equipment to
Mitanins, such as easy-to-read thermometers, neonatal weighing
machines, respirometers, and urinary tract infection tests.
The use of such equipment is expected to enhance the Mitanin’s
credibility and augment her effectiveness by facilitating diagnosis
and the required intervention – referral or prescribing
symptomatic drugs from the drug kit.
-
The state of Chhattisgarh
has a significant shortage of paramedical staff at the level
of primary health care facilities. 96 percent of PHCs in the
state do not have paramedics or laboratory technicians. This
results in a huge gap in addressing clinical needs of and conducting
diagnostic tests for the community. The Mitanin Programme has
created a large cadre of Mitanin trainers – Prashikshaks
who are oriented to issues in the area of health. The existence
of this cadre provides opportunities for continuing education,
multi-skilling and human resource development in health by imparting
paramedical training to capacitate these large cadres of health
personnel in the resource poor context of the state. The current
initiative proposes to train the Prashikshaks as laboratory
technicians who can independently perform basic diagnostic tests.
The specific activities include training of the eligible Prashikshaks
for paramedical roles; accreditation and certification of these
paramedics by credible institutions; negotiation with government
and NGO health care providers for the inclusion of this new
cadre into the system, developing a feasible line of supervision
by medical staff in order to ensure correct diagnosis, prevent
irrational or incorrect treatment and unauthorised prescription
of drugs; and dissemination of this innovation for contribution
towards charting the future of other CHW programmes.
.
-
The state of Chhattisgarh
has well established Panchayati Raj (local self government)
Institutions . There is 100 percent coverage of Janpad Panchayats
for the 146 blocks and almost 60 percent coverage of Gram Panchayats
in the 20,379 villages of the state. Panchayati Raj Institutions
are considered to be significant platforms for eliciting community
participation in health and development planning and in guiding
the village to adopt a comprehensive and empowering approach
towards community health. The translation of this objective
is indicated by the active involvement of Mitanins in Panchayats.
About 2000 Mitanins have been elected as Panchayat Panches and
Sarpanches. As these Mitanins continue their role as CHWs, they
present an opportunity to translate decentralised and participatory
health planning into practice. In this context, the current
initiative proposes to support the Swasthya Panchayat Yojana,
which entails selecting Panchayats across the state and supporting
them to draft Panchayat level health plans as well as to build
a model of indicator-based Panchayat-level planning support
that can be widely replicated across states. This innovation
is expected to contribute significantly towards the capacity
building of Panchayats to play the crucial role as the basic
unit of planning health sector reforms, as defined for them
by the NRHM.
|
|
As
CHW programmes develop and stabilise, they present further challenges
to ensure sustainability and generate new opportunities to diversify
and deepen impact. Although there have been numerous experiences
of CHW programmes in the country, future directions for these
programmes in terms of continuous capacity building of the CHWs
as human resources for health have not been systematically conceptualised.
The
Mitanin Programme in Chhattisgarh over the past 6 years has placed
about 60,000 trained women community health workers (Mitanins)
performing the role of health change agents by providing preventive-promotive
and basic curative care to the communities across the state. Internal
impact evaluation studies of the Mitanin Programme have shown
its success in more than 30 percent of the blocks across the state
in terms of both outcome and process indicators, with about 60
percent of the Mitanins ranked as ‘well performing’
on the basis of their impact on health knowledge and health seeking
behaviour. This programme provides a unique opportunity to explore
this interface between diversity and sustainability and develop
future trajectories for CHW programmes.
This
action-research initiative in the Mitanin Programme aims to explore
potential directions of growth of the programme, in particular,
building diversity into the roles performed by Mitanins and ensuring
the sustainability of the programme structures. It will introduce
pilots in select blocks of the state-wide programme to build lateral
linkages through strategies that would both build skills and sustainability
in the roles of CHWs and their trainers, as well as enhance health
and nutrition outcomes in the community. These would be taken
up in a total of 35 blocks across the state, selected on the basis
of their performance. Areas for innovative work include the following:
