Orissa Projects

  • Introduction
  • Activities
  • Acievements
  • Case Study

Introduction

MICHP

LEPRA Society started intervention in Mayurbhanj district in the year 1998 to support the Government of Orissa in leprosy elimination in Mayurbhanj district.
To involve the communities and with a planned approach to Community Health, the five year Project named Mayurbhanj Integrated Community Health Project was initiated in 2006 jointly supported by Big Lottery Fund, UK and LEPRA, UK.
The Project has covered all the 26 Blocks of the District in a phased manner.

The project is being implemented with the partnership of local partner NGOs to contribute better health for people in areas of malaria, and leprosy. The principles that the project promotes are inclusion, participation, collaboration of varied stakeholders at different stages of the project intervention starting from inception to follow up.
The Long term Change expected through this project is “Improved health status and quality of life of rural communities living in remote and inaccessible areas of Mayurbhanj district”. The expected outcomes of the projects are:

  1. Rural communities, community health workers and other key stakeholders are able to access information and resource materials on health issues relevant to their needs.

  2. Tribal communities are able to carry out preventive and curative actions for improving their health and/or reducing risks to their health.

  3. Tribal and other rural communities are able to effectively communicate and advocate for their rights to access quality services.

  4. Tribal and other rural communities have better access to quality care.

Details of the Project Areas and Target Groups covered:

Factors

Numbers or %

No of Blocks 26
No of GP 200
No of Revenue village 1580
Total population 2221782
Tribals 57.92%
Rural population 93:7 %:

Beneficiary group

M

F

Total

1. Communities living in remote inaccessible areas of Mayurbhanj district with very poor access to health services for the diseases which affect them most.

809017

794810


1603827

2. Tribal communities who are most disadvantaged because they live in areas with very poor health services and because their understanding of health and their health seeking behaviour limits their use of existing health services

604983

585213

1190196

3. Pregnant women and children under 5  years whose health status is most vulnerable

131128

236066

367194

4. Formal and informal health providers, community based organisations, local NGOs, influential key persons, LEPRA Society project staff and all other stake holders with an interest in and/or influence on health issues in the district

23382

26405

49787

4.1. PRI members

2230

1528

3758

4.2. ICDS Staffs

 

3364

3364

4.3. Gov. Health staff

471

1024

1495

4.4. DDC Holders

223

1061

1286

4.5. DOTS providers

312

779

1091

4.6. School Teachers

1257

127

1384

4.7. Private Medicine Practitioners

496

66

562

4.8. Community Based Organisation(VHC,SHG and youth clubs)

5681

8141

13822

4.9. Local NGO staff

119

53

172

4.10 Students

11119

9324

20443

4.11. NGO staffs

143

44

187

4.12. Leprosy affected persons

1237

888

2125

4.13. Lepra staffs

106

24

130

 
 
Achievements and Progress of MICHP

Formation of Village Health Committees and Resource Centres:

  • During 2009 the project formed and strengthened VHC/GKSs in all the 367 villages of selected 50 Gram Panchyats of 4 blocks intervened in 2009.
  • Formed and strengthened 50 Health Resource Centres at the Gram Panchayat level.
  • Formed and strengthened 4 Block Link Resource Centres at the Block level.
Equipments and assets supported to health resource centres: After the formation of GPHRCs, for their initial setup and functioning, project supported few need based assets/equipments and health resource materials to all the GPHRCs such as; Almirah, Chair, Mat, Black Board, Health Books, Disability kit, Posters on PHRC, Leaf let on Malaria, Poster on Leprosy and Sticker on leprosy etc.
 
PHRC formed by the project in 2009
 

Documentation, information promotion and dissemination:

During 2009, 3338 numbers IEC materials were prepared by the PHRCs. Along with the project supported IEC materials; those were displayed during Malaria Samadhan Sivir (MSS), Village exhibitions, local festivals and different community events during the year.
 
Innovative models describing about health information developed by the PHRCs
 

District Resource centre at District level:

District Resource Centre functioning at the district level at the Project head quarter. Through continuous support and communication, it strengthened the linkage between the Health Resource Centres and the Government Health Department. 

 
District Resource Centre

Community action on different health aspects during 2009.

 
Medication of bed nets in the community
Awareness meeting on Leprosy by PHRC
Sanitation by health committees
 

Advocacy & Networking Initiatives at the community level.

The project developed Panchayat level, block level and district level information network by establishing and strengthening 200 numbers of Gram Panchayat level networks, 26 block level networks and subsequently district level network, the DRC. As a result of which during 2009, 5650 IEC materials were mobilised by different PHRCs for health information dissemination in the community.

Apart from the health committees, network were also established with 127 numbers of community based organisations like Self Help Groups, Youth Groups, Forest protection committees, Farmers Groups and other area specific associations for a collective effort to place the issues before the appropriate authorities of Government Departments.  As a whole, during 2009, 446 numbers of collective efforts were made by the members for improvement of health services and quality of life in the community.

Lobby and Advocacy Initiatives by the Project:

During the year project has also made effort for sustainability of the PHRCs in the district. Through the lobby document developed this year, project tried to share the concept of PHRC before the state and national level higher authorities of the health department, health ministers and policy makers and tried to influence their decision for the inclusion of PHRC in the health system of National Rural Health Mission. As initial response to this, Project got invitation from the Health Director of the state to display the community made health IEC in a state level health exhibition at Bhubaneswar, Capital of Orissa State and at Dhenkanal District. This year project has also got an opportunity to participate in the state level meeting for strengthening Public Private Partnership for Malaria control in the state. Project has made best use of this platform to share the real challenges and success occurred by the voluntary effort of the PHRCs.
Diversity issues addressed by the Project during 2009.
Project laid emphasis and sensitized the stakeholders on equal participation from the deprived sections like women, scheduled tribes, scheduled castes, other backward castes and persons with disability.

Direct Health Service by MICHP in 2009:

Project has provided services to the people with leprosy disabilities, malaria through disability service activities, malaria samadhan sibir and health camps in remote and inaccessible pockets of the project area. The table below describes about the disability services provided by the project during the reporting period.
Disbility Services:In the year 2009, the project provided grade-II foot wears to 299 numbers of beneficiaries (194 male and 104 female) which reduced the risks of getting ulcers and worsening of existing ulcers among the said numbers of cases identified for this service. Besides, 113 numbers of cases healed from the severe ulcer condition out of the 158 numbers of cases with ulcer treated by the project. The project facilitated reconstructive surgeries for 20 cases fit for surgeries who had lost their cosmetic look and suffering from stigma. They got back their cosmetic look and status in the communities. 12 among them participated in GKSs and GPHRCs as active members. 96 numbers of cases with leprosy disabilities could receive disability prevention services in primary health care centres. This was a week area as service providers were lacking skills in this aspect and the project trained them in training event and also supported them in the process.

The Progress of the Project in terms of Outcomes:

Increase access to information:
The project has established community mechanism of information promotion in selected rural and remote areas and increased the availability of information in all the 26 blocks. The graph given below also describes an increasing trend of people accessing the information available at the health resource centres in different years of intervention (2006-2009) which is encouraging and expected to be increased.
 
 
The most important aspect is that the project has been able to develop community ownership in relation to information promotion though there are challenges to be addressed in the coming years. QUEST has been identified as a best practice that is developing gradually community’s interest to prepare and repackage the IEC materials by use of local materials based on the identified needs of respective communities and disseminate them appropriately.
Increased Community Actions for preventive and curative measures
Activities like meetings, sensitisation and trainings were conducted for the PHRC and VHC members on Malaria, TB and Leprosy with follow-up supports. This has increased the numbers of health actions in the communities and the case referrals from the communities as shown below graphs and expected to continue in future through the supports of local NGOs and service providers.
 
 

Increased advocacy efforts by the communities:

The efficiency of the tribal and rural communities has increased to identify their felt needs and advocate for their rights to quality services. With support in the form of capacity building and continuous follow up, now the members of health resource centres are able to identify specific issues to be advocated. All the PHRCs have developed their plan for advocacy to address the Health and related issues affecting to the rural life at most. The graph below describes about the issues identified and addressed by VHCs & PHRCs in last 3 years of project intervention (2007-2009):
 
 
This shows that the PHRCs and VHCs are taking up advocacy issues and it is expected that in the next year it will improve further.
With improvement in the provisions of health service delivery in the community, faith of rural and tribal communities has gradually increased. Apart from the curative aspects they have started adopting preventive practices like community sanitation, gambusia culture, indo-residual spray and have also started medication of the bed nets. The improvement brought changes in bridging the gap between the community and health service providers.
The direct service by the project through malaria samadhan sibir and health camps demonstrated participatory approach and considered as pest practice and replicable. The provision of Direct health services by the project has served the target population living in the remote and inaccessible pockets of the district. In the process it has sensitized them for availing health services from the Government health staff and institutions instead of the village quacks and traditional healers. Project with the active volunteer ship of the health committees and health resource centres has contributed to reduce the chances of diseases for being more complicated.
The project has contributed to the improvements of women participation in health committees and health resource centers as described in the graph below:
 

 
Again, the project has contributed to change the attitude of the communities as a result women were also accepted to take leadership roles in different community structures. The graph below describes about the percentage of women in the leadership positions of VHCs & PHRCs.
 
 
Besides, through the motivational efforts of the project by the end of 2009, 2119 people from ST and 625 from the SC communities were leading the health committees as president and secretary.

 

Case Study

  • Case Study 1
    Sukuri Ho is an inhabitant of village Gobardhan sahi of Neuanti GP in the Block of Raruan. The area is covered with forest with a majority of tribal population. Due to illiteracy people of this area prefer to go to the traditional healers for treatment of diseases and has a strong belief on the practice of sorcery. The same was observed in the case of “Sukuri Ho” when she was affected with malaria.
    A number of times Sukuri was invited by the members of health committee in that village and the PHRC members to visit PHRC to learn about the diseases affecting to the life in their community and its prevention strategies. She neglected the invitation and had given very less priority to the discussions on the health perspective. Due to illiteracy and lack of knowledge on common human diseases, she followed the advice of her family for the treatment of her fever and visited Makhan (a person doing sorcery in the village). With his advice she offered 6 black cocks to the deity and observed the customary practice to get cured from the disease. But her condition was worst after she offered cocks to the deity. Mrs. Indira Patra, a member of the Village Health Committee (Gaon Kalyan Samiti) in that village came to know about the issue. She visited sukuri’s house and observed the situation. Immediately she rushed to other members and shared about her situation. Perceiving the criticality of the case from the symptoms, they arranged a vehicle to take her to the Government Health Institution at Jashipur. As per the doctor she was suffering from complicated Malaria and further delay in treatment would have resulted with sever consequences. After a week she was recovered and relieved from the hospital.

    Name: Sukuri Ho
    Village: Gobardhan Sahi,
    GP: Neuanti,
    Block: Raruan,
    Dist: Mayurbhanj

    After returning from the hospital she realized the effect of the disease on her physique and source of livelihood. Recognizing the consequences due to lack of concern for health, now she is visiting to the Village Health Committee (Gaon Kalyan Samiti) in her village and consulting the members regarding different preventing practices to reduce the chances for further occurrence of such diseases in her family and neighborhood. With this her hope on sorcery for treatment of diseases has reduced and she understood the benefit of availing health services from the Government health system.
    Case Study 2

    Child to Child communication on Malaria prevention: The case story of Madhusmita.

    This is the story of Madhusmita, a ten year old girl who keeps up convincing her village friends to practice malaria prevention. The fact was traced by our Community Health Promoter Mr. Prahallad mangaraj as follows:

    Madhusmita Behera , aged 10 years is the daughter of Rimarani Behera(mother) and Surendra Behera (father) belongs to village Nuhamalia, Gram Panchayat – J. S. Jamudiha , block- Kaptipada of MAYURBHANJ district.

    Once during the rainy day of 2007 Madhusmita suffered from fever. As her mother is an active member of the Panchyat Health Resource Centre (PHRC) she suddenly called the Anganwadi worker of the village for the blood examination through the kit from PHRC. Madhusmita’s blood test was done and she was found positive (pf) for malaria. Within three days she was cured with the treatment from near by Govt health dispensary. After three days madhusmita’s mother RIMA suffered from fever. Madhusmita went with his father and other PHRC members to call the Anganwadi Worker for the blood testing of her mother. RIMA was found having PF with the ICT kit test available in the PHRC of Nuhamalia. Not waiting any more she started taking medicine from the AWW (Anganwadi Worker). Then she went to the near by health centre at Podadiha. She was cured within five days. RIMA runs a small shop in her village which was closed for all five days she suffered from Malaria. Loss of five consecutive earning days was painful for the family members. Madhusmita was little aware of crisis in the family due to her mother’s suffering from fever.
    Madhusmita, to her inquisitiveness, she asked her mother –how you suffered from Malaria? She again asked “you are telling people to prevent Malaria in all the awareness activities of PHRC but you are suffering from the same disease”. As Madhusmita was used to go with her mother to the newly organized PHRC, once her mother tried to explain Madhusmita about the causes, symptoms and preventive practices as well as the behaviuoral aspects of Malaria. RIMA the mother of Madhusmita showed her a flip book on Malaria to explain the basic facts of Malaria to her daughter. Madhusmita was quite happy with the information. Then she started showing the same flip book to educate her village friends on malaria prevention in leisure hour where she derives much pleasure out of this activity. Rima could see this type of interest within Madhusmita. She tried to orient her on two health songs. And, this strategy worked well when Madhusmita owned prizes by in school/ village level programmes by singing the health songs including the song on Malaria prevention. With this strength she also participated in the PHRC MELA (District level convention of Panchyat Health Resource Centers).
    Now madhusmita say “I will educate my village friends and make stage performance on Malaria prevention”. The continued encouragement of her parents, PHRC members, village ASHA and the staff of LEPRA Society (MICHP) and ANWESANA (the partner of MICHP) have provided motivation to Madhusmita to KEEP up the spirit. The intervention through MICHP has brought up Madhusmita to this extent says the PHRC members like- Anjana Mohanty, Dasarath Pal, village teacher and the BEE (block extension educator) - Mr. Surendra DAS. Madhusmita is instrumental in Child to Child communication as observed by the project-MICHP.
     

Case Studies

The support restored the Childhood

Kumari Jyotsna sethi, 14 years old, daughter of Banamali sethi belongs from Rajanpali village of Boudh district. She is the only child of her parents and that is why she gets all the affection from her parents. She grows up with much love in the family. She studies in class 8th at Butupalli, High school of Boudh district.

Her father is a small farmer with one acre of agriculture land. The annual income is not sufficient to manage the family economy. However, with the income from his own agriculture land as well as labour work sometimes, her father manages the family and the education of Jyotshna.
Time passes and one day her mother observes that Jotshna is not able to tracing the things and domestic appliances properly and father also observes the same. School teachers complains that Jyotshna is not keeping any interest on study. Her father also observes the same. The school teacher says that she is not able to look at the black board and reading properly. Subsequently, friends and neighbours starts to address her as the blind Girl in the community. Gradually Jyotshna becomes depressed and stops going to play with her friends and avoids the gathering in the community. She also expresses her unwillingness for study. One of the neighbors observes a white spot on the right eye pupils. Her father contacts the local traditional healer for treatment who fails to recover the same through his treatment. The parents make lots of expenses for the treatment of Jyotshna. Then they takes Jyotshna to Boudh District Head Quarter Hospital for treatment. The doctor diagnoses her with immature cataract and asked them for contacting the Mahanadi Netra Chikitsalaya of Birmaharajpur of Sonepur district.
She comes to MNC 5th August 2009 and was admitted for cataract surgery. Her Uncle and Parents are counseled by the Ophthalmic Assistant for the surgery. The cataract surgery is conducted on her right eye on the same day through phaco with the intra ocular lens (IOL) in free of cost. Free spectacles and medicines are provided to her as per the prescription of the Ophthalmologist of the Mahanadi Netra Chikitsalaya of LEPRA Society. After the successful surgery, her parents express their happiness and gratitude to LEPRA Society as well as the person or institution who provides support for this noble work. Jyotshna is now very happy she becomes able to see. Now she has got back her earlier life stile i.e. in relation to continuing her study, playing with friends and joining the community gathering.

The support could provide relief in old age by restoring the vision

Basanti Mahananda, 65/F, she is an old widow lady belongs to very poor family of the Menda village of Tarabha Blcok of Subarnapur District. Long back her husband dies due to heart stroke. She has 3 daughters only without a son who already have married. So, Basanti is living alone and manages her by wage works in different households. She is landless.

However, she gets the oldage pension which is Rs. 200/- (Rupees Two Hundred only) per month. Suddenly, she feels vision problem which increases gradually. She becomes unable to see and work properly. Cooking for herself and earning for herself becomes difficult. As her daughter are in their in-laws’ house, there is no scope of getting support from them. In the course of time, Basanti loses his complete vision. She could know about the community eye screening camp of Mahanadi Netra Chikitsalaya of LEPRA Society at Tarava. She requests her elder son-in-law to guide her to the screening camp. Basanti attends the screening camp and diagnosed with matured cataracts. She is brought to the Mahanadi Netra Chikitsalay by the project outreach bus on 13th August 2009 and was registered for cataract surgery. On 14th August 2009, her right eye is operated through the use of phaco and operating microscope and IOL is implanted. The surgery becomes successful and Basanti gets back her vision in the right eye. After seven days of her surgery, her vision is tested and found with very good vision. She also expresses her happiness as she is able to see the things and do her daily activities independently. She is waiting eagerly for the surgery in her left eye.

Restoration of Childhood

Sumanta Beriha,7/M of C/O Bhagban Beriha, hails from Jatasingh village of Boudh District. He is the youngest son of his parents with three brothers and only one sister. Being the youngest son of his parents Sumanta is being loved by everybody in the family. His elder brother was having eye diseases which led him to incurable blindness. Sumanta was all of sudden lost his vision at the age only 4 years. His father is a farmer and also works as a labourer. The mother is a house wife and sometimes works as labourer. When Sumanta is admitted into the school, the irony that he is found to have very low vision in both of his eyes for which he faces lot of problems in reading and writing. Gradually Sumanta was pushed into more and more darkness. Sumant is not able to carry out independently the daily activities, reading and playing. Gradually he stopped school going, playing with friends. He loses his childhood. The parents have no money for the treatment of their beloved son and because of the same reason and ignorance their elder son becomes blind. They have to only cry and blame their lucks. The parents go to the District Head Quarter Hospital, Sonepur but, the treatment could not be possible as the hospital is not having facilities for children surgery.

In course of time, his uncle who is staying nearby MNC informs his parents to come to MNC for treatment. The parents come with the son on 7th February 2009 and Sumanta is registered bearing the MR No 47526/09. He is detected with congenital cataract in both his eyes. Parents and the uncle are counselled for the surgery. Sumanta is admitted on the same day. His right eye is being operated with Small Incision Cataract Surgery (SICS) with IOL on 8th February 2009. His vision is improved to 6/18 in his right eye.

Now, he is able to play, read and write and he is happier that his vision has again restored. His parents are too happy as the childhood of their beloved son is getting restored and have expressed their gratitude to MNC for great support to their child and family. After few days, his left eye will be operated.

Resources

Infrastructure: The hospital is housed in its own two storied building having a covered area of 5000 sq. ft.. MNC has accommodation for 30 beds, suitable surgical and therapeutic equipment are available for providing eye care. The hospital has a minibus for outreach activities and transportation of patients identified with cataract to the base hospital for surgical intervention.
Physicians/Staff: There are 30 full time/part time workers at the MNC hospital. These include one full time doctor, nurses, paramedical staff and non-clinical personnel. The physicians are well supported by a multitude of staff members such as nurses, refractionists and technicians who actively participate in the health care team
Work Times: The hospital works six days (Mon-Sat). Patients usually come at 9 a.m. and the work day ends at 5 p.m.
Food: Breakfast, lunch and dinner are also provided free of cost to the patients and their attendants. On an average food is provided to 30 numbers of people per day at MNC.

 

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