During the field visit to the primary health care centers in Jwala Puri and Nangloi,
Delhi, an assessment was conducted to evaluate the ongoing facilities and government
programs implemented under the National Health Mission (NHM). The focus was on
programs such as Anaemia Mukt Bharat, Haemoglobin intake levels,Maternity Welfare, Pre and PostNatal Care,Immunization, and the challenges or setbacks faced by ASHA workers of that area.
Introduction into the PHCs:
The PHC located at Jwala Puri named Mother and child care center had a maternity ward wherein regular checkups were conducted for expecting mothers by female doctors and general precautions and medications are prescribed to them. They also run pregnancy tests and provide injectables as the prenatal care.They also had child nursing and care homes for children of age group 0-6 years. There are also basic laboratory tests available for BP, sugar and hemoglobin intake. They have birthing facilities only for women who had a normal delivery in their first pregnancy and have come to the PHC in their second or more pregnancies. Otherwise they are recommended to tertiary centers for delivery and birth like nearby government hospitals.
The DGD dispensary in Jwala Puri had a Dot center for Tuberculosis wherein patients Of different age groups come for their TB blood or skin tests. They had prenatal care facilities for women and provided them with necessary medications and vitamins. They provided anemia shots and injectables to the identified patients. Blood tests, sugar tests and other laboratory tests are conducted on a daily basis. They conduct surveys in local communities to reduce the spread of chronic infectious disease like leprosy. They also had a homeopathic center working independently for people of the community.
The primary urban health center located at Nihal vihar, Nangloi have a build in dispensary and provides pharmacy medicines,controlled drugs and antibiotics to the patients. They have a Maternity and child welfare center with pre and postnatal care facilities available. They conducted basic laboratory tests including sugar, blood pressure, urine tests, ultra sound, hemoglobin levels, etc. They provide consultancy and medications to anemia, TB patients and for other common active diseases as well.
Facilities and Programs:
- Identified surveys: One of the centers initiated a project wherein different groups of medical staff members, team of doctors and nurses visited nearby local communities in order to reduce the spread of chronic infectious diseases like leprosy, Chlamydia, etc. After notifying cases they provide them with effective antibiotics, injectables or other required medications so that the whole community doesn’t get infected with it.
- Maternity homes and child care wards: All the centers provided comprehensive maternity and child care services. These included antenatal and postnatal care, immunizations, and nutritional support. The staff actively promoted the importance of early registration and regular check-ups for expectant mothers. Staff encourages providing proper knowledge and education to these community women about different trimesters, hemorrhage,lactation and labor processes.
- Facility for Birth/Delivery: The centers being primary health centers lacked a proper infrastructure for delivery and birth facility, in case of which they provide a reference of a nearby tertiary center e.g. government hospitals to the expectant mother for them to get a skilled doctor to assist during their labor. One of the PHCs had a delivery/birth facility only for women who already had gone through a normal delivery in their first pregnancy and have come to the PHC for their second or more pregnancies.
- Anaemia Mukt Bharat: Two of the centers had an anemia lab, which facilitated testing for anemia and provision of anemia shots/injectables to the identified patients. Following the test results, necessary vitamins and antibiotic pills were provided to address anemia, contributing to the government’s Anaemia Mukt Bharat initiative. This facility was available for all age groups and gender.
- Dot center for Tuberculosis: One of the PHCs had a tuberculosis ward wherein the patients of different age groups can come for their TB blood or skin tests. The recognised cases are then provided with necessary antibodies, injectables and vitamins. They also addressed tuberculosis complaints within infants or toddlers and provided them with anti-TB medications.
- Awareness Posters: The primary health care centers had various posters displayed, highlighting government programs and general health-related information to increase awareness among the community. The posters were particularly focused on maternity and child care, emphasizing the importance of prenatal and postnatal care for expectant mothers. They also provided information on various infectious diseases and ways to prevent them.
Role of the ASHA workers:
Asha workers contributed devotedly towards their respective divisions amongst the nearby communities and played a vital role in raising awareness about available government schemes.. The Asha workers identify eligible beneficiaries and educate them about various health programs and maternal health. They initiate door to door surveys in households to educate them about prenatal,postnatal care,importance of regular checkups and the health infrastructure available by the government.
Asha workers educate the women of their communities about the frauds and malpractices happening in the healthcare sector. For example, an Asha worker said that a NGO had set up a polio vaccination program near their locality for infants and they were charging a certain amount of money for it. So the Asha workers prevented the people from buying medications from such unknown sources. They educated them that their medications are available to them free of cost or at very low price at the government dispensaries.
The ASHA workers also participate in camps and rallies organized by non government organizations in the community to disseminate information about government schemes, encourage participation, and address misconceptions or doubts. These initiatives have been successful in engaging the community and promoting the utilization of healthcare infrastructure.
ASHA workers played a pivotal role in implementing the Janani Suraksha Yojana. They surveyed contributed at large in creating awareness about government schemes and the benefits of institutional deliveries. Their efforts resulted in a significant increase in the number of people seeking healthcare services at the centers. For example, women who are affected with TB or anemia also visit the PHCs with Asha workers once gaining the knowledge about their condition come for regular checkups on their own through appointments.
The Asha workers were pleased with the response they got from the women of their communities and said that they have witnessed dedicated and heavy participation from women of their respective zones. People cooperate with them and follow their suggestions, they consult them before taking any step related to the medical health of their families. Then these Asha workers act as an intermediary in bridging the gap between these beneficiaries to the healthcare provider PHCs of their area. The people follow the prescribed medications timely and witness the positive changes in their health themselves building a sense of trust and interdependency.
Challenges:
- Eye checkups:The centers lacked proper equipped staff or infrastructure for eye checkups. The doctors were not eye specialists thus they could only guide based on traditional methods of analyzing health through eye color or pigmentation which is not enough. Well trained staff personnel should be hired for eye checkups as it is very essential for the worker communities to have a focused eye sight.
- Breach of unity: A camp was set as a political move by a NGO focussing HIV/Aids checkup. The Asha workers tried to discourage the women of their community not to go forward with these tests as the syringe they will use might not be sanitized or staff they have hired might not be skilled enough. Also the motive because of which the camp was setup was mortally unethical. According to them some women practiced prostitution in the community thus such a camp was set up to identify the potential spread of HIV/Aids. 8 out of 10 women followed the Asha workers and did not participate in the camp but the rest did this breaches certain unity amongst the women union and develop a sense of doubt for Asha workers in the minds of other women.
- Lack of Awareness: The centers faced the challenge of limited footfall due to the lack of awareness among the local population. Efforts should be made to enhance community engagement and promote the available services to increase utilization.
- Mistrust: After the COVID19, the centers had stopped conducting tests despite orders from the government for quite some time. At that point of time Asha workers faced backlash from the community people for failing to provide them with healthcare at that point of time. Later on the issue was resolved and laboratory tests plus regular checkups were back on schedule.
Conclusion:
In conclusion, the field visit to the primary health care centers in Jwala Puri and Nangloi, Delhi, provided valuable insights into the ongoing facilities and government programs
under the National Health Mission. While the centres displayed posters to increase
awareness, their focus on maternity and child care was commendable. The presence of an anemia lab was a positive aspect, enabling the centers to diagnose and treat anemia effectively. Similarly the efforts made in curing tuberculosis or leprosy by some Primary health centers were also very praiseworthy.
The ASHA workers played a crucial role in raising awareness about government schemes and Increasing community engagement. Their proactive approach, including house-to-house surveys and active participation in camps and rallies, has yielded positive results. However, challenges such as mistrust and breach of unity remain, necessitating further attention and efforts to build trust, establish credibility, and ensure effective communication about the benefits and intentions of government programs.
Additionally, it is recommended that efforts should be made to address the concerns of the community and strengthen the trust between healthcare providers and beneficiaries promoting utilization of healthcare services.
By addressing these challenges, the primary health care centers can enhance their impact and contribute to improving the overall health and well-being of the community they serve.
Photos from the field visit:
Author –
Rhea Bhatnagar
MA Development Studies, Dr. B.R. Ambedkar University, Delhi