HEALTHCARE SERVICES

The curative services had to give way to a paradigm shift to community health and development so that poverty can be alleviated. This was accomplished by establishing an infrastructure with a large component of health education. 

The health programmes interact at the following interfaces:

• RCH interventions (family welfare & SOMARC), community health (ASHA & voucher scheme) were the hallmarks of community health, Innovative community-based slum (18) programmes were funded by USAID, EHP and completed its tenure in three years. This programme validated the PPP concept and the vital role of Accredited Social Health Activist Services( ASHAS), which was the hall mark for the success of a viable People, Private, Partcipation( PPP) concept.
• The Jijani Suraksha  Scheme of the Government which is established at the Chatikata MCH Centre in 2007-8 has increased institutional deliveries by more than 129% thereby contributing to reduction in MMR and IMR.
•  Referral services for serious & complicated illnesses (including trauma) to the Swarn Jayanti Samudaik Hospital (SJSH) which fulfills Public Private Partnership (PPP) -(P=Private (NGO NIRPHAD); Public=IOCL; P=partnership. Community-based services and for 2010 a Community-based Rehabilitationb for the physically and mentally challenged is being planned with the collaboration of Laval University and CBM. In 2010, proposal for AusAid is being processed.
• NIRPHAD provides  FP, maternal, eye and HIV/AIDS services to the ten adopted villages of SJSH.
• The HIV/AIDS programme was started with the collaboration of the Methodist Public health Services of Mursan, District Hathras. PHS also provides training facilities to Laval Medicos.  

Millennium Development Goals and NRHM

• With the advent of the National Rural Health Mission (NRHM), the strategy has shifted to provide quality healthcare especially to the poorest. This concept is reinforced by former President Abdul Kalam who suggested a PURA scheme (Providing Urban Resources to rural areas).
• The collaboration between a Church Organization and the Government is unique. This opens a new horizon wherein all corporate institutions require fulfilling their social obligations.
•  The main objective is to provide quality affordable healthcare irrespective of caste, race, color and creed or the ability of the patient to pay for healthcare services. In 2008, Curamericas (by Programme Specialist Ira Stollak)   completed a proposal entitled:  Census-based Impact Oriented Methodology to provide Primary Health Care to every child, female and male in a target community. There is also a section on Oprations Research (OR). NIRPHAD is exploring for financial support.
• In 2006, the MCH program of SIFPSA was implemented in 3 blocks of rural Agra District. An assessment of the program was completed by SIFPSA of 4 NGOs in the Agra District and the impact is given below:

• Strategies for Innovations in Family Planning Agency ( SIFPSA- funded by USAID) completed its tenure of about 20 years in developing a viable infrastructure for health and family planning services in the Mathura District.and AligarDistricts.
• Primary and Secondary Eye Care Hospital at Chattikara & Bajna
• No Government Eye Program; some NGOs provide sporadic services
•  Statistics indicate those affected most belong to the weaver community thereby resulting in economic loss
•  It is estimated by WHO that a District has 200 new cases of cataract for every 100,000 of the population. Estimates show that 20,000 cataract operations have to be done every year to make the District cataract free.
•  In 1980 night blindness and other defects due to vitamin-A deficiency was rampant. Through NIRPHAD nutrition programmes - kitchen gardens were introduced and the community was encouraged to eat green leafy vegetables, carrots and yellow fruits. NIRPHAD has a large oral vitamin-A programme. This has reduced the incidence of eye diseases. Coverage to 14,00,000. The patients are examined in eye camps and brought to the two "fixed" Centers by the mobile units for surgery.
• 51728 children in schools were screened after providing awareness programmes. Since only 20% attend school, community services are essential.
• In 2007, CBM took a major policy decision of providing funds to build a new Surgical Block at Bajna village. The new facilities will provide: eye care services to about 400 villages around Tappal & Khair villages of Aligarh block.
• New vehicle, equipment and renovation of the old building will vastly improve quality and coverage.
• Future plans will include low cost vision and participating in the Vision 2020 programme of CBM.
• In 2009 the Additional Director of the Uttar Pradesh Government – Ministry of Health has suggested that NIRPHAD extend its eye services to Hathras. He has informed that besides the usual grants for cataract operations hed hopes to recommend a special grant for the expansion services. In 2010, it is estimated that 3000 contract operations will be performed.

Nutrition and Balanced Diet

Malnutrition produces a vicious cycle of low resistance to disease leading to morbidity and a high incidence of mortality.

• Food Insecurity Map by World Food Program and MSSRW indicated that Mathura was ranked in the 5-8 (severely insecure) zone. NIRPHAD aims at food security as the first step to over come malnutrition. Purchasing power of the poor can only be achieved if their incomes increase. (insert map here and delete from above).
• The world development report of UNDP shows that in India the gap between the rich and poor is increasing (UNDP Report 2000).
• Nutrition education linking with socio-economic interventions thereby increasing purchasing power and educating the target groups, are the need of the hour.
• Knowledge, attitude and practices (KAP), communication, education and information programmes are part of the health education component:
  This intervention is the gold standard in health education. To assess the impact of this intervention, the touch stone of knowledge-base of the target groups and how they are sharing with the rest of the community, is essential.
• The importance of clean potable water has reduced the incidence of typhoid, gastro-enteritis, diarrhea and hepatitis B.
• In 2010, Laval University will send a nutrition student to be involved in the nutrition programme.    

NIRPHAD's Health Achievements... so far

• Curative care provided to 2,66,222 patients
• Promotional care provided to 16 villages with an estimated cumulative population of 1,36,000
• Ante-Natal care to 23,054 women
• knowledge-base of the target groups and how they are sharing with the rest of the community is essential
• 13,465 safe deliveries 
• 32,664 household visits by ANMs to bring healthcare to households
• 39,324 health education sessions
• 3 mobile units operate for delivering healthcare to the remotest corners of the Mathura District.
• 55 villages covered in a month in a round of vaccination for common preventable diseases.

NIRPHAD's Milestones since Inception

• Contraceptive prevalence rate has increased from 20% to 40%. The target is 75% by the year 2013. 
• NIRPHAD was chosen to monitor pulse polio program by UNICEF.
• WHO, Canadian Public Health Association (CPHA) and Canadian Organization of Development Education (CODE) financially helped to translate relevant 5 texts in Hindi, since there was paucity of teaching and learning material.
• NIRPHAD chosen as Managers for the super specialty Swarn Jayanti Samudaik Hospital (SJSH) – 1999
•  Evaluation/ Upgradation as Trauma Center – In 2008, Ministry of Health sent a high powered team spearheaded by Dr. Prem Saga, Neuro Surgeon RML Hospital, Delhi to evaluate a trauma project which has been pending for there years. With 6000 emergencies on highway 2, this will be a boon to the community and highway traffic. Decision is still a controversy as SJSH  is on 40 KMs from Agra- even though SJSH treats 6000 emergencies per year and over 1200 need surgical treatment (see Annual Report- 2008-2009-Records Officer).
• 10 year Contract- NIRPHAD managed SJSH from 1999-2008. The Hon’ble Supreme Court of India has requested whether NIRPHAD is interested in continuing to manage SJSH. NIRPHAD has submitted an affidavit requesting an extension for another 10 years (2008-2017). An Agreement (between IOCL and NIRPHAD was signed for a further five years (effective 2013).
• Implementation of Succession Plan – Dr. Henry Perry of Gohns Hopkin University has initiated a succession plan for NIRPHAD as the Director has reached the age of 85. Dr. Nanda has been selected and is undergoing training to take over from 1st April 2008. Dr. Perry is supervising and assisting in this training programme. He has already completed a training programme with Indian Society for Hospital Administration (ISHA) through a distance training programme. Dr. Nanda attended the Global Health Council, Washington and other international Conferences, as part of his training.   
• The National Institute of Public Policy and Child Development (NIPPCD) chose NIRPHAD to train their national and international students.
• NIRPHAD has provided 56 international University students from Europe, Africa, USA & Canada for short exposure courses in low cost healthcare delivery and its effect of socio-economic programs.
• Three of the students from Copenhagen, Denmark who had exposure training were later admitted into the Copenhagen Medical College.
• Since 2007 an ongoing training programme with Laval University is in progress and is being expanded to include 2 nurses, a physiotherapy and nutrition student. Two vists by Dr. and Mrs. Vernon Blondue, Head of the Dept. of Family Medicine and Dr. Richard Poulin, in-charrge of International Prograrammes visited NIRPHAD and had also discussions with Dr. Neeraj Sethi, Health Consultant to the Planning Commmission, GOI. It is hoped that an exchange programme can be developed so that NIRPHAD and SJHS staff can visit Laval University.
• In March 2010, Laval Director of Nursing Mrs. Ginette Lazlu and her Social programmes specialist visited NIRPHAD.
• In May 2010, Ms. Sylvie Lapierre and Dr. Helene Moffet of the physiotherapy Department of Laval Universityy will visit NIRPHAD for an assessment regarding the Physiotherapy Department of NIRPHAD, before starting the training session of a physio Laval student. These experts hope to represent the NIRPHAD Physio programme to AusAid for supporting a proposal, related to Community-based Rehabilitation Project.