Untitled - National Health Mission, Assam

Regular communication to the Health Care Workers andcitizens regarding the various steps taken byGovernment of Assam in improving public health hasbecome extremely critical, especially in the background

of ongoing COVID pandemic.Swasthya Dapoon, an integrated approach between a

purely scientific medical journal and a magazine related topublic health issues in an understandable manner, is an efforttowards this unmet goal.

Dr Himanta Biswa Sarma, Hon’ble Chief Minister of Assamhas been kind enough to bless the first edition of SwasthyaDapoon through his words of encouragement and continuousguidance.

Sri Keshab Mahanta, Hon’ble Health Minister has been thespirit and strength behind the department’s efforts in comingup with Swasthya Dapoon. I am sure that under the visionaryleadership of Hon’ble Health Minister, we will be moretransparent, communicative and scientific in our approachtowards attaining better public health.

The editorial team has put in the best efforts to assimilatea variety of topics related to public health ranging fromscientific papers published in International Medical sciencearena to morale boosting successes achieved in the difficultareas of our state.

I hope, each reader will enjoy, cherish and learn fromSwasthya Dapoon and contribute for a healthier Assam.

Sincerely yours,

(Anurag Goel, IAS)Principal Secretary

Health & Family Welfare Department

Editorial Board ofSwasthya Dapoon

Assam

From Editor’s Desk...

Managing Editor

• Commisioner &Secretary H & F W Dept.

Members• Mission Director,

National HealthMission, Assam

• Chief Executive Officer,Atal Amrit Abhiyan,Assam

• Director of MedicalEducation, Assam

• Director of HealthServices, Assam

• Director of HealthServices (FamilyWelfare), Assam

• Director of AYUSH,Assam

• Project DirectorAssam State AIDSControl Society

• State Program Manager,National HealthMission, Assam

Anurag Goel, IASPrincipal SecretaryHealth & Family

Welfare Department

CONTENTSPage No.

Message of (Hon’ble Chief Minister), Assam 3

Message of Hon’ble Health Minister, Assam 4

Doctor’s Day: A Tribute : Dr. Rathindra Bhuyan, 5DHS, Assam

Haemo Dialysis: Life Savior for : Dr. A K Barman, DME, Assam 6-7COVID-19 patients with Renal Failure Dr. Rahul Sarma, SPO- PMNDP

Improvement in Health Infrastructure : Dr. Manoj Kr. Choudhury, 8-9during COVID-19 Pandemic in Assam Addl. DME & ED, NHM, Assam

Dhrubojyoti Bora, ACS, Addl. DME

300 Bedded COVID Hospital at Sarusajai, : National Health Mission 10-11Guwahati: A Story of Will, Confidence andTechnological Success

First '1000 Days' of Life : Dr. Dipangkar Hazarika 12-13Consultant CH, NHM, Assam

Marching towards Universal Health Coverage : Dr. Biraj Kanti Shome, HSO-WHO, 14-15through Comprehensive Primary Dr. Rahul Sarmah, SPO-NCD,Health Care-Health & Wellness Dr. Siddharth Maurya, SPC-NCDCentres in Assam

Assam Community Surveillance : Dr. Dipjyoti Deka, SPM, NHM 16-18Plan (ACSP) Dr. Biraj Kanti Shome, HSO, WHO

Dr. Subhajit Bhattacharjee, SRTL, WHO

COVID Vaccination in India: The largest : Munindra Nath Ngatey, ACS, DHS (FW) 19-20Vaccination Campaign in the World Dr. Sukumal Bassumatari, UNDP

Frontline Health Workers- Central to : WHO Publication 21Create Resilient Health Systems

E-Sanjeevani OPD for Healthy Assam : 22-23

Poem : Dr. Rajiv Borbora, 24Addl. CM & HO, Barpeta

Healthy Fun 25

··

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¸¬ı«±—· ≈µ1 1+¬ÛÓ¬ õ∂fl¡±˙1 fl¡±˜Ú± fl¡ø1À “±º

Dr. Himanta Biswa SarmaChief Minister, Assam

Keshab Mahanta

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Tel : 0361-2237007 (Fax) / 2237063 (O) / +91 94350 60006, 99540 60006 (Mobile)

MINISTERHealth & Family Welfare,Science & Technology,Information Technology

Doctor’s Day : A Tribute

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Œ˚±·±Ú Òø1ÀÂ√º ¤ ◊ fl¡˘ ø‰¬øfl¡»¸fl¡1+¬Ûœ Œ˚±X±fl¡ ∆˘ ’±ø˜ Œ·Ã1ª fl¡À1± ’±1n∏ fl¡À1±

’ √√—fl¡±1º ø‰¬øfl¡»¸± ’±·¬ıϬ± ◊ Ô±Àfl¡±ÀÓ¬ ◊ ˙Ó¬Ê√ÀÚ õ∂±À̱ ø√¬ı˘·œ˚± ∆ √√ÀÂ√º Ó¬Ô±ø¬Û›

ø¬ÛÂÕ˘ ‚”ø1 Œ‰¬±ª± Ú± ◊º ø‰¬øfl¡»¸fl¡ ø√ª¸1 ø√Ú± ¤ ◊ fl¡˘ Œ˚±X±fl¡ Œ‰¬ ≈…Ȭ fl¡ø1ÀÂ√±º

Happy Doctors Day.

ά±– 1Ôœf ˆ”¬¤û“±

¸=±˘fl¡, ¶§±¶ö… ø¬ıˆ¬±·, ’¸˜

Swasthya Dapoon 5

Dr. A K Barman, DME, AssamDr. Rahul Sarma, SPO- PMNDP

Haemodialysis is the process ofpurifying the blood of a personwhose kidneys are not workingnormally. This type of dialysis

achieves the extracorporeal removal of wasteproducts such as creatinine and urea and freewater from the blood when the kidneys havefailed to do so. Haemodialysis is one ofthree renal replacement therapies (the othertwo being kidney transplant and peritonealdialysis). Haemodialysis can be done asinpatient or outpatient service depending upon the clinical status of the patient.

Routine hemodialysis is conducted in adialysis outpatient facility, either a purposebuilt room in a hospital or a dedicated, stand-alone clinic. Prior to implementation ofPradhan Mantri National Dialysis Programmein Assam, there were only 124 Haemodialysis

Haemo Dialysis:Life Savior for

COVID-19patients withRenal Failure

Machines across the state with Private Sectorcontributing to larger chunk of thosemachines. As per studies, approx 200 EndStage Renal Diseases (ESRD) patients areestimated per 10 lakh population and 70 % ofthem need Haemodialysis treatment.

Considering a population of 3.4 crores inAssam, a total estimated of 6800 ESRD patientsare in Assam. On an average, a patient onHaemodialysisrequires 8 Haemodialysis permonth and total projected Haemodialysis permonth is 54400. An average cost to patientsper session around Rs. 4000.00 and Rs.32,000.00 per month in a private setting.

Pradhan Mantri National DialysisProgramme was launched on 14th June 2019,whereby free of cost Haemodialysis servicesare being provided to patients at differentDistrict Hospitals and Medical Colleges ofAssam. M/s Apollo Hospitals EnterpriseLimited is the private partner responsible forproviding repair & renovations, manpower,dialysis consumables and National HealthMission, Assam provides space for dialysisunits, water for RO and drugs in the EDLincluding Inj. Erythropoetin to the patients.At present, 26 Dialysis Units are operationalin state (110 HD machines), supported by

6 Swasthya Dapoon

Fairfax India Charitable Foundation andBandhan Bank as a part of Corporate SocialResponsibility.

During COVID 19 pandemic, it wasobserved that the patients with ARF/CRF orpatients with COVID-19 progress into Renalfailure as a complication. Moreover, Dialysisof COVID-19 positive patients cannot be donein a normal dialysis unit and has to beconducted Bed-side in COVID-19 wardscomplying with all the precautionarymeasures. Therefore, state took a consciouscall and decided that dialysis services will beextended to COVID-19 patients, who are inneed of the dialysis. Total facility wise COVIDdialysis both 1st wave and 2nd Wave till 26th June2021 is detailed below;1. Tezpur Medical College and Hospital: 552. Jorhat Medical College and Hospital : 713. Assam Medical College and Hospital: 3374. Gauhati Medical College and Hospital: 9555.Silchar Medical College and Hospital: 1176. Fakhruddin Ali Ahmed Medical College andHospital, Barpeta: 4

Existing staff engaged by private partnerfor running normal dialysis services has beenmanaging the additional services of runningdialysis services for COVID-19 at 5 MedicalColleges. Thus, no extra manpower wasengaged.

Summary of lesson and challengesThe lesson learnt from this innovation is

very encouraging as many lives could be savedby timely decision of extending the dialysisservices at the COVID-19 patients’ ward itself.Understanding the need of the hour, ApolloHospitals Enterprise Limited respondedpositively and extended support by managingthe dialysis services at COVID-19 wards.

Responses from the patients who receivedsuch on spot Haemodialysis has beenextremely encouraging. A few excerpts arebeing shared:

1. Pran Krishna Pathak, a beneficiary ofdialysis service from Nalbari, Assam whileexpressing his gratefulness towardsGovernment of Assam shared “Previously Iused to travel 150 kms for each session, whichI used to find too difficult as kidney patient.

Now, the Dialysis Facility at Nalbari CivilHospital has made my life easier andcomfortable because, I need not travel too farto get the dialysis done frequently. I call myselffortunate that I have been enjoying thebenefits of Pradhan Mantri National DialysisProgramme, which has come as blessings forme and I get all services free of cost. The staffof Dialysis Clinic are very helpful, supportiveand caring. The quality of the treatment beingrendered is also very good. There is a homelyfeeling, thanks to the friendly nature of thestaff and doctors. I owe a lot to each one ofthem, I pray that God bless each one ofthem”.

2. Smti Bibi Bala Haloi, anotherbeneficiary of dialysis service from Nalbari,Assam while sharing her thanks towardsGovernment of Assam shared “with thestarting of dialysis services at Nalbari CivilHospital, I am saved, I need not travel 100Kms away at Guwahati to get my dialysisdone, which was a nightmare task for meas chronic kidney failure patient. Now, Iget the service at my door step, which hasnot only reduced my tension but also helpedmy family members to a large extent. Earlier,I used to spend around 35000 per month,which I get free of cost now. Thanks to theGovernment of Assam for this noble initiativeand saving lives of many like me. I do not havewords to express my feeling of gratitude forthe healthcare providers, engaged in thisnoble mission. The quality of services beingprovided, and the behavior of staff needappreciation. The cooperative attitude of thestaff helps us in feeling better during thedialysis cycle", she said.

Swasthya Dapoon 7

Prior to COVID, the ICU system under government sector in Assam was basicand very minimal in number. Duringthe first and second wave, Health

Department undertook massiveinfrastructure up gradation in the form of ICUbeds, Oxygen supported Beds, OxygenGeneration Plants, Liquid Medical OxygenTanks, etc with assistance from Governmentof India, so as to provide better service to thepatients. Some of the major improvementsare as follows:

1. As on 31st march, 2020, the number ofICU beds including all medical college anddistrict hospitals in govt sector were 741 only,including paediatric beds. This has been nowincreased to more than 1,500 with 1,000 ofthem dedicated for COVID. The details of ICUBeds exclusively for adults are as follows:

Dr. Manoj Kr. Choudhury, Addl. DME &Executive Director, NHM, Assam

Dhrubojyoti Bora, ACS, Addl. DME

2. As on 31st march 2020, the number ofbeds with medical oxygen supported bedswere limited to Medical colleges and some ofthe district hospitals with Oxygen Cylinders.But all efforts have been taken to increaseoxygen supported beds through dedicatedmedical gas pipe lines, Oxygen generationplants, Liquid Medical Oxygen Tanks andOxygen Concentrators procured by the stateas well as donated by Government of India.The details are as follows:

ICU Beds ason March,

2020400

ICU Bedsas on March

20211140

ICU Beds as on27th June,

20211540

OxygenSupportedBeds as on

March, 2020400

OxygenSupportedBeds as onMarch 2021

1700

OxygenSupportedBeds as on

27th June, 20213855

Out of these, almost 3,000 beds are keptdedicatedly for COVID patients requiringoxygen support.

3. Similarly, Medical Oxygen productionand storage capacity in the State was alsominimal. During the first and second wave,

8 Swasthya Dapoon

Improvement in HealthInfrastructure duringCOVID-19 Pandemic

in Assam

Improvement in HealthInfrastructure duringCOVID-19 Pandemic

in Assam

Oxygen Generation as well as storage capacityhas been increased as follows:

Cryogenic Oxygen Tanks installed within thehospital premises.

All these permanent infrastructure shallcome handy in coming days as well.

MedicalOxygenStorage

Capacity ason March,

2020200 MT

MedicalOxygenStorage

Capacity as onMarch 2021

400 MT

MedicalOxygenStorage

Capacity as on27th June, 2021

480 MT

MedicalOxygen

productionas on

March, 202045 MT

MedicalOxygen

production ason March

202168 MT

MedicalOxygen

production ason 27th June,

2021100 MT

Out of 100 MT Medical Oxygen production,15 MT is through Medical Oxygen generationplants installed in Medical College premisesitself. All medical colleges have now more thanone Oxygen Generation plant and now the

same is being implemented in all DistrictHospitals.

4. Further, Oxygen storage capacity inthe district has also been increased more thandouble from the situation in March 2020 tilldate.

Out of these, 220 MT capacity is in theMedical colleges itself, through dedicated

During the first and second wave,Health Department undertook

massive infrastructure upgradation in the form of ICU beds,Oxygen supported Beds, Oxygen

Generation Plants, Liquid MedicalOxygen Tanks, etc with assistance

from Government of India,so as to provide better service to

the patients.

Swasthya Dapoon 9

10 Swasthya Dapoon

300 Bedded COVID Hospital at Sarusajai,Guwahati: A Story of Will,

Confidence and Technological Success

In the month of May, 2021, the number ofCOVID cases in India was all time high,

with reported incidents of nonavailability of ICU beds, even at the nationalcapital, New Delhi. Considering theevolving pandemic situation in Assam,when the daily number of cases werehovering around 5,000 plus cases, one ofthe very first decisions of the newgovernment in Assam, under thevisionary leadership of Dr.Himanta Biswa Sarma, Hon’bleChief Minister of Assam, was toestablish sufficient number ofICU and oxygen supported bedsat strategic locations of the state.

In view of the ever increasingdemand for quality medical careand pressing time constraints,Government of Assam took up withDefence Research & Development

Compiled by : NationalHealth Mission

Organization (DRDO) under Ministry ofDefence, Government of India and thushappened the memorable establishment ofa 300 bedded COVID hospital.

On 13th May 2021, an MoU was signed withDRDO and within 28 days (4 weeks), the 300bedded hospital was fully established. AllGovernment departments like Public Works

Department (PWD), Public Health

Swasthya Dapoon 11

Engineering Department (PHE), APDCL,Sports Authority of Assam and DistrictAdministration of Kamrup Metro workedshoulder to shoulder with Healthdepartment to complement the efforts ofDRDO so that we could achieve such ahumongous target in record time. In fact,OIL and ICICI also came forward, observingthe enthusiasm and commitment of thestate government to establish qualityhealth care institutions and contributedfrom their CSR funds towards thisestablishment.

With a total sanctioned amount of Rs.21.47 Crore (Including 19.7 Cr to DRDO, 1.25Cr to APDCL, 59 lakhs to PWD, 16 lakhs toPHE), GMCH Annexe Hospital at Sarusajaihas 5,000 Sqm area with 100 ICU Bedswith Ventilators/ Monitors and 200 bedswith Oxygen Facility. With full fledgedLaboratory, Pharmacy, X-Ray - USG andECG facilities and own Liquid MedicalOxygen tank, the hospital is completelymanaged by the experienced seniordoctors and a dedicated team of healthprofessionals under direct patronage ofGauhati Medical College.

Th is magni f i cent fac i l i ty wasinaugurated by Hon’ble Chief Minister ofAssam in the august presence of SriKeshab Mahanta , Hon’b le Hea l thMinister of Assam and other dignitarieson 10th of June, 2021. Indeed, it is amatter of pr ide that Hon’ble Union

Defence Minister Sr i Ra jnath S ingh,himself visited the facility on 18th June,just before the patients started gettingadmission. Within this short time, GMCHAnnexe Hospital at Sarusajai has alreadyserved more than 100 numbers of sickand serious patients requiring medicaloxygen and ICU support.

The establishment of such a facility,w i t h a l l o u t c o o p e r a t i o n a n dc o o r d i n a t i o n b e t w e e n v a r i o u sd e p a r t m e n t s o f C e n t r a l a n d S t a t eGovernments, within an unprecedentedr e c o r d t i m e , t o f i g h t a g a i n s t t h ep a n d e m i c , s h a l l d e f i n i t e l y b e ah i s t o r i c a l e p i s o d e , r e f l e c t i n g t h econfidence and commitment of the StateGovernment to protect the valuablelives of its citizens.

The "First 1000 days of Life"- Ninemonths (270 days) in mother's womband first two years (730 days)of life-isthe most important part of human life,

as it is the period of development of a child'sbrain and the quality of brain development,which are the determining factors of thecognitive development of a child and his orher future too.

We all are born with 25% of adult brain atbirth, 75% of total brain development iscompleted by two and half years and by 5years 90% of brain gets developed. So,adverse events during pregnancy, at the timeof birth and during first 2 years of life havemajor impact on child's brain development.Brain is the organ, which controls everythingof humans. The development of brain startsduring the laterpart of third trimester ofpregnancy and mainly depends on the qualityof stimuli, the child gets from the surroundingsand partially depends on the genes, which thechild inherits from the parents. Child gets theneeded stimulus for brain development whenparents talk to them, touches and exposureto new experiences through vision. There areways to provide different stimuli in differentage group.

First '1000 Days' of LifeDr. Dipangkar Hazarika

Consultant Child Health, NHM, AssamAsso. Prof. Paediatrics DMCH

Research has proved that the period frombirth to 6 years is the most critical years for allchildren,especially true for children withdevelopmental delay. During postnatal years,the growth and development of child is at itspeak during first 2-3 years. Every child's brainhas unique capacity to revert the adverseeffects at early life. Brain is malleable in thefirst 2-3 years of life because of its uniquecapability to revert back to normal stage, ifearly identification of such problems arediagnosed and early interventions are donein the form of various stimulations. Suchapproaches helps to achieve normaldevelopment.

Few children are vulnerable fordevelopmental delay, particularly those whoare born preterm and low birth weightbecause of their immaturity. They maydevelop different types of developmentproblems later in life like delay in walking,problem with vision, hearing, speech,behavior and other cognitive problems.

We all know that a child with such type ofproblem may become differently able, iftimely diagnosis and interventions are nottaken. They may totally be dependent onothers, but this does not happen in one day.At first, the child will show a few signs of

From Survival to Healthy Survival

12 Swasthya Dapoon

developmental delay and if not identified andinterventions are not taken many furderdeteriorate. So, if we detect developmentaldelays at the onset and early interventionsare taken, we can certainly manage all theseproblems.

Every parent should take early initiativesto ensure that there is proper developmentof the brain of the child. Govt of Assam throughNational Health Mission (NHM) has taken twoimportant initiatives for providinginformation to the parents on how to take careof their child starting from the womb and howto identify developmental delays early in thechild.

First one is a Booklet on Journey of first1000 days of life: This book containsinformation starting from planning ofpregnancy by the couple to care of child up to2 years of age.

Second one is the Mother and ChildProtection Card (MCP card), which we usuallyconsider as a vaccine reminder or vaccinerecording Card. But it contains lots ofinformation on what care, how to give thestimuli to the child at different age groups,signs of normal development in child, earlysigns of developmental delays etc. Everyparent should utilize this card as resourcematerials and all parents need to read thecontents of the Card. Hence, explaining thesepoints to the parents is an inevitableresponsibity of ANM.

Available on https://nhm.assam.gov.in

Swasthya Dapoon 13

Introducing Ayushman Bharat and Health& Wellness Centre: The national flagship program -Ayushman

Bharat marks a translational shift in priori-tizing policies and programs towards achiev-ing Universal Health Coverage (UHC). TheComprehensive Primary Health Care is onearm of Ayushman Bharat. An Expanded rangeof 12 services by converting existing Sub Cen-tre (SC) as health & wellness centre (HWC) toaddress the basic primary health care needsof the entire population of the area and thusexpanding access, universality and equity closeto the community is the target. The focus isgiven on preventive and promotive aspects ofhealth care by community engagement to en-sure sustainable health care practices. This isplanned to ensure that less and less personsfall sick and thus to help them to lead a HeathyLife.

Assam's journey towards Universalizationof Health Care (UHC) through HWCs:

As per the mandate of Ayushman Bharat,Assam has to convert 3698 Sub Centres (SC),946 Primary Health Centres (PHC) and 55 Ur-ban Primary Health Centres (UPHC) into Health

Marching towards Universal Health Coverage (UHC)through Comprehensive Primary Health Care (CPHC)

-Health & Wellness Centres (HWCs) in Assam& Wellness Centres by December 2022. Ac-cordingly, Assam has been marching towardsachieving the target and till 30.06.2021, statehas made 2210 HWCs functional (1540 SCs, 617PHCs and 53 UPHCs). The appointment of mid-level care provider, namely Community HealthOfficer (CHO) at the SC is the non-negotiablerequirement of converting SC in to HWC. TheCHO is the Team Lead of the Sub Centre Com-prehensive Primary Health Care (SC-CPHC)team members. Under his/her leadership,other CPHC team members (MPW, ANM andASHAs under the SC-HWC) work on their as-signed job. Training is given to the SC-HWCCPHC team members to perform collectively.

The mid-level care provider (CHO), is a per-son with nursing background (B. Sc-Nursing,GNM) or Ayuerveda Graduate, who undergoes6 months Certificate in Community Health(CCH) course at Program Study Centres (PSC)under India Gandhi National Open University(IGNOU). There are 11 PSCs in Assam func-tioning in 11 District Hospitals. IGNOU ap-proves faculties from the respective PSC it-self, who act as course academic counselorsto take classes and they are paid by IGNOU as

Figure 1: CCH Counseling from NHM- State Hq, Assam Figure 2: Wellness Activity (Yoga) is being practiced at HWC

14 Swasthya Dapoon

per norms. Students must pass in both theoryand practical examination and must have 75%and 100% attendance in theory and practicalclasses respectively. IGNOU conducts 2 ses-sions per year - January and July batch.

So, to convert all SCs into HWCs by Decem-ber 2022, Assam has been working to get therequired numbers of CHOs. State has alreadyappointed CHOs at SC-HWCs from all the pre-vious batches and from the January 2021 batch,more than another 300 candidates will beposted. State is also planning to post students,who have passed B.Sc Nursing (integratedcourse) in 2021 as CHOs at SC-HWCs. As perMoHFW, GoI guideline, students, who havepassed B.Sc Nursing (integrated course) neednot undergo 6 months CCH course at IGNOUaccredited PSCs. With the state's robust plan-

ning of program roll out, Assam will be ableto achieve the HWC target by December2022.

The Development Partners (WHO,Jhpiego, TATA Trust and WISH Foundation)have been extending technical supports toState Non-Communicable Diseases (NCD)cell in implementation of ComprehensivePrimary Health Care throughfunctionalization of Health & Wellness Cen-tres in Assam.

All in all, it can be said that with the aug-mentation of manpower in the form ofCHOs and by necessary infrastructureupgradation and community engagement,Assam is moving towards universalizationof health care through CPHC roll out by mak-ing SC functional as HWC.

Figure 3 : WHD 2021 celebration at Borguli SC-HWC Figure 4: WHD 2021 celebration at Magurgaon SC-HWC

Compiledby: Dr.

Biraj KantiShome,

HSO-WHO,Dr. RahulSarmah,

SPO-NCD,Dr.

SiddharthMaurya,SPC-NCD

Swasthya Dapoon 15

In Assam, to boost up “TESTING”, “TRACING” and“TREATMENT”, of COVID state carried out AssamCommunity Surveillance Plan (ACSP) phase-I during the1st wave of pandemic in May 2020. Under ACSP, house

to house visits were carried out in all villages of Assam byrespective ASHA of the village to line list all the personswith COVID symtom, Severe Acuite Respiratory Infection(SARI)/Influenza Like Illness (ILI), fever or any other healthissues (Malaria, Diarrhea, Dengue, Japanese Encephalitisetc). Hence, ACSP approach more like “COVID PLUS”approach. Based on the list, prepared by ASHA, testing wasdone on the following day by the medical team, comprisingMedical Officer (as leader of the team), ANM, MPW andLab Tech. Those, who were found positive, wereimmediately isolated as per the SoP (either at COVIDHospitals or at home). Symptomatic persons, who testednegative in RAT were advised for strict home quarantinetill the RTPCR report is made available. Those, who hadany other issues, were given prescription based on thenature of complaints by the medical team lead. During the

Assam CommunitySurveillance Plan (ACSP)

Dr. Dipjyoti Deka, SPM, NHMDr. Biraj Kanti Shome, HSO, WHO

Dr. Subhajit Bhattacharjee, SRTL, WHO

A unique initiative to strengthen active surveillance at thecommunity level during COVID-19 pandemic

16 Swasthya Dapoon

medical team visit, other than screening thepatient, they also interacted with familymembers and informed them about DOs andDON’Ts of COVID, need for using mask, socialdistancing, hand washing, quarantine,isolation, different SoP issued by Governmenton COVID. Help from the Village Health andSanitation & Nutrition Committee (VHSNC)and community members is also sought inreaching to each and every household so thatno potential case is missed out from testing.

Based on the encouraging responses of theACSP Phase I, Assam carried out ACSP phaseII in the name of Assam Targeted SurveillancePlan (ATSP) with the tag name of“NISCHAYATA” during June 2020, where activetesting was done in hotspot points - bus andtruck terminal, petrol pumps, hotels, policestaff, Health staff, municipality staff etc. Theobjective of this surveillance was to enhancesurveillance of high-risk populations. Thetargeted approach helped in finding out manypositive cases and then immediately isolatingthem and to start appropriate treatment.Theinitiatives of ACSP and ATSP (NISCHAYATA)were well appreciated by MoHFW andinternational agencies like WHO in its website(https://www.who.int/india/news/photo-story/detail/community-surveillance-programme-launched-in-assam-to-contain-covid-19)and was considered as one amongthe good practices of COVID-19 management.

The 2nd wave of COVID-19 brought addedchallenges as compared to the 1st wave ofCOVID-19. In the 2nd wave, the spread ofinfection is much faster and many COVIDpatients had suddenly breathlessness withlow oxygen saturation (SpO2). They neededimmediate hospitalization and a few of themrequired ICU admission with ventilatory care.

During the 2nd wave, it is also seen that COVID-19 is no more a urban centric disease and ismaking inroads to villages, tea gardens &access compromised areas, which have limitedhealth facilities. The lack of awareness amongrural population is another major contributingfactor for fast spreading of virus in villages.Therfore, with the added challenges during 2nd

wave, state took up all necessary steps instrengthening early testing, followed by tracingto isolate all positive cases to reduce the rapidspread of virus. With this aim and based on thelast year’s encouraging responses of ACSPPhase I& II, Assam has been carrying out ACSPPhase III, from 1st of June, 2021. Like ACSP PhaseI, under ACSP Phase III, medical team(comprising MO, ANM, MPW, Lab Tech) hasbeen visiting villages and screening the listedpersons (as per ASHA list) to take necessarysteps, as felt necessary by the Medical Officer.

As a preparatory step of ACSP Phase III,Assam rolled out month long campaign onPublic Health & Social Measures (PHSM) in May2021. State decided to generate masscommunity awareness on CAB (COVIDAppropriate Behaviour) focusing 3 Ws – WearMask, Wash Hand and Watch distance of 2meters. Once community members adhere toCAB, then rapid spread of virus will reduce,resulting in less number of positive cases withless hospitalization and that will eventuallyimprove the treatment quality for those, whoare already admitted at different COVIDhealth facilities.

Under PHSM roll out in Assam, state trainedthe district and block staff, who in turn-orientedcommunity health workers (ASHA Supervisorsand ASHAs). Subsequently, they met

Swasthya Dapoon 17

community members, visited house to houseto generate mass awareness on DOs andDON’Ts of COVID-19, need for coming forwardfor early testing since the onset of symptoms,addressing myths around COVID vaccinationand awareness of different SoPs. The visitingteams also handed over medical kits to theCOVID positive patients availing HomeIsulation. The PHSM campaign also focusedon how the non COVID essential health careservices are being continued at Sub Centre,PHC and even at home by ANM, ASHA andhow to avail non COVID essential health careservices. The PHSM campaign certainly

Sl. No. Particulars Performances1. Total No. of Villages & Wards (in urban area) visited 21,000 villages visited in 25 Days2. Total population covered 2,55,75,9533. Total no. of persons screened 10,23,0564. No. of fever cases Identified 36,6405. No. of SARI &ILI cases identified 1215 SARI & 12823 ILI6. No. of cases showing COVID like Symptoms 14,2007. No. of samples collected for COVID 3,98,9818. No. of samples tested positive 12,588 (5.7% Positivity)9. No. of Children screened 91,82210. No. of Children screened where household

members are positive 5,02711. No. of children tested positive 1724 (16.8% of total Positive

cases)12 . No. of Persons Identified & tested for having

symptoms of Malaria/JE/other communicable diseases 17,798

yielded positive results, which is understoodfrom the fact the more and more people aresharing their health status with ASHA whenshe is making home visits under ACSP PhaseIII. The ACSP III program was launched withproper capacity building, regular review androbust data management with WHO field teamsupport. Field Monitoring is also being doneby WHO SMOs& DHC with a structuredchecklist to generate qualitative feedback.Thefigure below is the testimony of the fact thathow the ACSP Phase III is found to be aneffective strategy of COVID-19 managementat community in Assam.

18 Swasthya Dapoon

Swasthya Dapoon 19

The Covid-19 vaccination campaign rolledout by the Government of India on16.01.2021 is the largest of its kind in the

world. Starting with Healthcare Workers, theprogramme gradually expanded to coverother priority groups as the vaccineproduction in the country gradually expanded.

Starting with Healthcare workers on16.01.2021, followed by Frontline workers on17.02.2021, all Citizens 60 years above andthose between 45-59 years with specific co-morbidity on 01.03.2021, then all Citizensabove 45 years on 01.04.2021 and finally allcitizen above 18 years on 01.05.2021, COVID

COVID Vaccination inIndia: The largestVaccination Campaignin the World

vaccination has been implemented across thelength and breadth of Assam too.

The Vaccination programme is undertakenby Directorate of Health Service- FamilyWelfare along with NHM Assam through a wellestablished and experienced network ofHealth subcentres manned by ANMs and wellsupported by United Nations Development

Munindra Nath Ngatey, ACSDirector of Health Service (FW)

Dr. Sukumal Bassumatari, UNDP

20 Swasthya Dapoon

Programme (UNDP) and World HealthOrganization (WHO).

Since the commencement of thevaccination programme, 70 lakh vaccinationshave been done as on 29th June, 2021 withmore than 57,85,111 First Dose and 12,23,547Second Dose administration. Approximately,13,02,412 People aged > 60 years, 25,77,141People aged 45-59 years and 30,97, 062Persons between 18-44 years have beenvaccinated. It is heartening to observe that2,14, 524 Health Care Workers and 4,34,732Frontline Workers have also been vaccinated,who forms the first line of service against thepandemic.

Government of Assam took a decision toprovide COVID vaccination free of cost to allcitizens at the Government Covid VaccinationCentres (‘CVCs’) and made publicannouncement. Accordingly, AssamGovernment had procured 13.48 lakh dosesof vaccines worth Rs 45.17 Cr under the StateGovernment quota of 25% as per the policy ofthe Government of India and has successfullyadministered the same.

The State Vaccination Plan is based on thetwin-pillars of:

1. Vaccination Capacity: Assam hadoperationalized 7, 617 Centres suitable forvaccination and on an average 2,000 numbersCVCs are active daily. The state has providedsafe drinking water, toilet facilities and evenrefreshments to the beneficiaries andvaccinators so as to promote vaccination andmake it an enjoyable experience as much aspossible. In fact State could vaccinate about9.8 lakh plus beneficiaries during megavaccination drive launched from 21st to 23rd

June, 2021 is a successful show of strength ofour robust health system.

In addition to the aforesaid sites, the Govthas operationalized CVCs in workplaces andindustrial complexes, Special Centres fordifferently-abled persons, Centres for personswithout prescribed ID Cards and Walk-inCentres to increase access. The endeavour isto reach a target capacity for vaccinating around5 lakh beneficiaries per day.

2. Availability of Vaccine : Since theannouncement of the new Liberalized andAccelerated policy of the Government ofIndia for vaccination, the Government ofAssam has been making continuous anddedicated efforts towards securing supply ofthe vaccine for the state and accordinglydistributing to all districts as per theguidelines. State government has also comeup with an interest free financial assistanceplan to support the interested Private HealthInstitutions to promote COVID vaccinationconsidering the particular circumstances inthe state.

All in all, vaccination against COVID is onemajor step to attain a safe environment forour family members to lead a healthy andnormal life. Nevertheless, the COVIDappropriate behaviour of wearing masks andmaintaining social distancing shall be neededfor the near future until a vast majority hasbeen immunized.

Let’s all get vaccinated and savehumanity and Assam.

"Being a community health worker, I amso proud that I am able to support myfellow villagers during the COVID19pandemic. I am happy to share that I

facilitated home quarantine of 45 people who returnedto the village from other states when the lockdownrestrictions were relaxed. I also participated in the AssamCommunity Surveillance Programme (ACSP) andconducted house visits in my Khakragool village area as apart of active community surveillance where the healthworkers covered 30 000 villages across the state to trackpatients with severe acute respiratory infections (SARI)and Influenza-like Illness (ILI) to detect any communitytransmission of COVID19”, shared Suchitra.

Community health workers and the availability ofprimary health care facilities are key pillars of the nationalresponse to COVID19. The invincible spirit of millions ofhealth workers like Suchitra Goala has contributedsignificantly to strengthen primary health care and ensurehealth for all. Their unparalleled contribution during thepandemic has helped in enhancing the resilience of thehealth systems and the communities.

Link: https://www.who.int/india/news/feature-stories/detail/frontline-health-workers-central-to-creating-resilient-health-systems?s=08

Acknowledgement : World Health Organization,India.

Frontline Health Workers- Central toCreate Resilient Health Systems

Mrs. Sushitra Goala, ASHAfrom Khakragool village

under Ramkrishna Nagar,BPHC, Karimganj

Swasthya Dapoon 21

22 Swasthya Dapoon

Swasthya Dapoon 23

24 Swasthya Dapoon

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Healthy Fun............Healthy Fun............Healthy Fun............Healthy Fun............Healthy Fun............Crosswords!Crosswords!Crosswords!Crosswords!Crosswords!

Interesting facts

· There are more bacteria in your mouth than there are people in the world.· One single bacteria cell can multiply to become more than eight million cells in less than

24 hours.· When you sneeze your body is getting rid of infected cells and an average sneeze will

spread over 100,000 virus cells up to nine metres. Hence the importance of maintainingRespiratory Etiquette and social distancing.

· There are 2.5 trillion (give or take) of red blood cells in your body at any moment. Tomaintain this number, about two and a half million new ones need to be produced everysecond by your bone marrow.That’s like twice population of Guwahati City every second.

· No doubt, why pregnant mothers need Iron and Folic Acid Supplementation!

Across3. Regional Medical Research Centre ofICMR in Assam is at.....?5. Edward Jenner is known as the fatherof.....?8. Covid 19 infection is caused by.....?9. Largest gland in Human Body...?10. Which virus has the appearance of abullet.....?

Answers are available at https://nhm.assam.gov.in Please click or visit the page.

Down1. The first AIIMS in north eastern re-gion is established at.....?2. Science of treating mental disordersis known as.....?4. In India July 1st is celebrated as.....?6. Lokpriya Gopinath Bordoloi NationalInstitute of Mental Health is at....?7. World popultation Day is on.....?