Integrated women and child health programme: A community out reach model Overview of Proposal for POC and Pilot at Gajwel constituency Hyderabad, September 2014 For discussion purposes only
Integrated women and child healthprogramme: A community outreach modelOverview of Proposal for POC andPilot at Gajwel constituencyHyderabad, September 2014For discussion purposes only
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Agenda
2.0 The context and objectives: POC and pilot for Gajwel constituency
3.0 The concept
2.1 Healthcare performance in Gajwel constituency
2.2 Critical gaps and potential services
4.0 Operationalization of the model
5.0 Project implementation and monitoring
6.0 Key outcomes of the POC and Pilot project
2.3 Potential services, components and beneficiary segments
3.1 Field activity plan
3.2 Service areas and execution map
3.3 Resource requirement
4.1 Timelines, action plan
4.2 Project Monitoring committee
7.0 Support from the Government of Telangana
1.0 IntroductionContents of Detailedpresentation submittedas a concept note forapproval by the StateHealth Ministry - TS
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Opinion ofcommunity
experts
Discussionwith key
stakeholders
Piramal HMRIResearch
Field VisitsOpinion of
internalmedical experts
Aug 112014
3 Shortlistedthemes
We AreHere
6 Potentialthemes
Potential healthcare pilot at Gajwel
Assessment ofpotential
interventions
Today
The context: We have had iterative discussions with variedstakeholders to arrive at potential healthcare concept for Gajwel
1. Women health2. Infant and child health3. Maternal care4. Chronic condition screening5. School health programme –JBAR CHIP6. Drinking water
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In 66.67% of villages, Garbage is thrown in the vicinity of households: Sanitation issues
More than 95% of the people have to travel 5 KMs+ to reach a PublicHealth Facility
Out of the above 95%, only 50% of the people have access to Public Transport
Qualified doctors are available in only 11.11% villages
Absence of JSSK 102 service and helpline prompts for dependence on 108 for transport ofpregnant women and sick new born
The context: Field survey & key observations
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The concept:Integrated women and child healthprogramme through community outreachmodel
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Healthcare reach Limitations of care reach (Secondary research)
~ 97% of pregnant women received3 ANC check ups during pregnancy1
Institutional delivery is ~ 77%2
Functional 104, School Health CHIPprogrammes
Functional 9 PHCs, one CHC
Only ~ 25% of the population hasaccess to specialist care4
75% of the population need tocommute an average of 25 KMs toaccess specialty care5
Limited Specialist level screening toidentify high risk maternal cases
Source(s)
1,2 – NRHM MIS Standard reports – Maternal and child health Updated till 15 Sep 20144,5 – Field survey of Piramal HMRI
The healthcare performance on key indicators at Gajwel constituencymeets certain Indian health standards…..
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CurrentHealthcarePenetration
Populationreach
Conditionreach
• Socially excluded sections• Economic vulnerable sections• Demographic vulnerable• Physical vulnerability
S
I
R
E
F
Screening
Identification
Referral
Enable
Follow up
• Gender based• Age related• Community based• Endemic• Acute & Chronic
… but saturation of healthcare at the last mile is only possible througha three dimensional approach
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D
• SC,ST populations constitute ~19% of total population1 (18.58% SC; 1.36% ST)
• ~ 120 habitations of SC, ST communities2
• 95 is the number of households per habitation vis-a- vis the average of 472 for other communities3
• 535 population per habitat vis-à-vis 2112 population per habitat of other communities4
• High prevalence of school drop out (5-15 years range); as high as 50.43%5 among SC and79.41%6 among ST
Demographics: SC, ST sections in Gajwel constituency
Key implications for healthcare models
Dimension -1: Segmentation of population highlights gaps of currenthealthcare reach
• The SC, ST community population is highly fragmented and scattered
• Reach of traditional channels for healthcare delivery likely to have limitations
• The current design of Public health programmes (104, School CHIP under JBAR) experiencelimitations to address the needs of diverse segments
Source(s)1. Census 20112,3,4 http://indiawater.gov.in/IMISReports/Reports/BasicInformation/rpt_RWS_AbstractData_S.aspx?Rep=0&RP=Y&APP=IMIS5,6. Source: DiSE data 2012-13(As on Sept-2012)
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Screening Identification Referral Enable Follow Up Closure
Gender basedcare initiatives(15+ years age)
Child health(5-15 years)
Maternal care
Newborn care
Care Services Continuum
Pote
ntia
l Ar
ea o
f int
erve
ntio
nDimensions 2,3: Redefine the areas of intervention and care servicesto asses the gaps of healthcare execution
Areas of improvementAreas doing well Proposed areas of intervention from Piramal HMRI
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Beneficiary segment Segment scope Overview of theservices Potential number of beneficiaries
15 years+75
(Especially SC, STadolescent girls &women)
1. Healthawareness
2. Screening &identification
3. Referral4. Follow up
~ 26,000 women (SC,ST communities 15+years)1
Programme @ Gajwel constituency
5-15 years
(Essentially schooldrop pouts)
1. Screening &identification
2. Referral
• ~ 9,000 school drop outs (SC, STcommunities)4
Programme @ Gajwel constituency
Pregnant womenfor deliveries
Newborn check up(Sick infants 0-30days)
JSSK 102Programme
• 6,024 women expectedpregnancies3
• 5,422 expected neonates4
Programme @ Gajwel, Siddipet,Zaheerabad AH/CHNC jurisdiction(Estimates in a year under the areas covered byCHC/AHC @ Gajwel, Siddipet & Zaheerabad)
WomenCare
Children
The 3 dimensional analysis suggests the following beneficiarysegments and service areas of priority
1. Census 2011; 2. DISE data 2012-13(as on 30th Sept-2012); 3,4. CHFW, Govt of AP, 2013-14.
Pregnantwomen &newborn
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WomenCare
(15 years+)
• Pyoderma• Scabies• Ringworm• Leprosy• Eczema• Pediculosis
• Xerophthalmia• Bitot spots• Conjunctivitis• Refractive errors• Squint• Night blindness• Cataract
• Reproductive tractinfections - screening
• Sexually TransmittedInfections – screening
• Contraception• ANC & PNC• Pre Menopausal syndrome• Unwanted pregnancies• Senile vaginitis• Uterine prolapse
Eye
Reproductive& sexual health
Skin
Overview of service areas for women care segment at Gajwelconstituency
• Malnutrition, Anemia• Hypertension• Diabetes• Breast cancer,
malignancy screening• COPD• Osteoporosis &
rheumatoid arthritis• Hyper/hypo thyrodism
Primaryconditions
• Tonsillitis• Ear infections• Defective Hearing• Otitis media• Deafness
ENT
• Dental Caries• Oral Ulcers• Glossitis• Cheilitis• Angular Stomatitis• Pyorrhoea
Oral
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Children(5-15 years)
• Pyoderma• Scabies• Ringworm• Leprosy• Eczema• Pediculosis
• Xerophthalmia• Bitot spots• Conjunctivitis• Refractive errors• Squint• Congenital anomalies• Night blindness
• Dental Caries• Oral Ulcers• Glossitis• Chelitis• Angular Stomatitis• Cleft Lip & Palate• Pyorrhoea/Periodontitis
• Tonsillitis• Defective Hearing• Ear infections• Speech defects• Otitis media• Congenital Deafness
Oral ENT
EyeSkin
Overview of service areas for child care segment at Gajwelconstituency
• Anemia• Malnutrition
Other medicalconditions
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• Free referral pick up and drop for pregnant women• Safe transport for sick newborn (up to 30 days)• Referral transport to higher care institutions per case is basis
• Timely reach to hospital/home• Mitigate risk due to delayed transportation• Encouragement of institutional delivery• Referral transportation in hygienic environment
• Improved care access during pregnancy for deliveries• Increase in institutional deliveries• Assurance of neo natal care access (30 days from day of birth)
The concept
The benefit
Potential impact
Project area
• Siddipet Mandal (Area Hospital area only)• Zaheerabad Mandal (Area Hospital area only)• Gajwel Mandal (Under CHNC area only)
JSSK 102 concept to aid referral transport for the pregnant womendelivery and check ups for sick new born: An overview
Pregnantwomen
SickNew born(0-30 days)
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The plan proposes to implement the pilot programmes at 5 locationsacross Medak district
Medak district: Proposed areas of pilot implementation
Siddipet
Gajwel
Jagdevpur
• JSSK 102
Zaheerabad
• SC, ST Women care• Children care (5-15 years)• JSSK 102
• JSSK 102
• SC, ST Women care• Children care (5-15 years)Toopran
• SC, ST Women care• Children care (5-15 years)
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Community
Door todoor
Women
Children
Pregnantwomen
Monitoring andcoordination platforms
ICT Platforms Service tracking cell
Tertiary careFacility/TMC
CHC
Diagnosisfacility
The project to employ an outreach model with a centralizedmonitoring leveraging ICT platforms
JSSK 102
GNM
PHC
MedicalPractitioner
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Kondapak
Jagdevpur
Gajwel
Wargal
Mulugu
Toopran
Field operations & monitoring
• Gajwel block accounts for 23% of SC,STwomen
• ‘Complete and move to next’ model;programme to commence at Gajwel block
• Gajwel is divided in to 4 sub regions
• 7 teams to be deployed in total
• 4 GNM per each team and a doctor oncase is basis
• Gajwel to act as a local monitoring office
• Ahmedipur PHC to be connected toHyderabad for Telemedicine
SC,ST population concentration Community to PHC
PHC at Ahmedipur
Operationalization of Women and child care programme
Block map of Gajwel constituency
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A case in point: Project Shruthi to address preventable hearingdisabilityPOC in partnership with Medtronic at Hyderabad
Decreased cognition & learning
Decreased life & social skills
Social exclusion
Exclusion from livelihood
Economic dis-advantage
Social exclusion
Decreased family interaction
Increased dependency –low self-dignity
Social exclusion
Hearing Disability… An Unseen Burden
Create and manage a self-sustaining ecosystem forawareness, diagnosis,treatment and rehabilitationof ear diseases inunderserved patients indeveloping countries
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Awareness, Screening, Diagnosis, Counseling, Facilitation, Treatment , Follow-upIntervention:
Medtronic Shruti – HMRI Hyderabad Proof of conceptIntervention across care continuum leveraging pioneerMICT platforms*
*Medical Internet Communication Technologies
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Medtronic Shruti – HMRI Hyderabad Proof of conceptProject areas and impact
• Vulnerable population in Hyderabad(population at slums, below poverty line etc.)
• 70,000 population – Target coverage
• Universal door-to-door screening
• Beneficiaries - All age group and gender
Project area: 6 communities in GHMCProject reach
Project outcomes (As on date)
• 30,000 population screened
• 6,000 with ear problems identified
• 2,000 with critical ear issues identified
• 500 patients registered for treatment at ENT
• Developed extended care @ 3 Charityhospitals
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Piramal Swasthya is a registered non-profit organization based in Hyderabad, Telangana State. Piramal Swasthya is supported by PiramalFoundation and works towards making healthcare accessible, affordable and available to all segments of the population, especially those mostvulnerable. In order to achieve this goal, Swasthya leverages cutting edge information and communication technologies to cut costs withoutcompromising quality as well as public-private partnerships to scale its solutions throughout India and beyond.
Swasthya envisions a future in which all vulnerable groups have the necessary information to make informed decisions regarding their healthand affordable, available and accessible high quality health infrastructure to support the realization of those decisions.
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