Developing a Roadmap for Health in Chhattisgarh 2025 Workshop 17-18 February 2016 Raipur Organised by NHM Chhattisgarh and State Health Resource Centre, Chhattisgarh 1 Workshop Report Table of Contents Topic Page Workshop Objectives 3 Schedule of workshop 4 Participants 5 Key Public Health Challenges in Chhattisgarh 6 Poverty alleviation at compounding speed 8 Free Diagnostics 12 Strategies for intra-department coordination 14 Vector control and future role of Mitanin 16 Improving Maternal healthcare 22 Improving TB detection 32 Leprosy Elimination 35 Telemedicine 36 2 Background: At the initiative of National Health Mission, Chhattisgarh, a workshop was organised to develop a roadmap for health in Chhattisgarh. External and local experts participated in the workshop. Objectives: The objectives of the workshop were explained by Secretary (Health) and Director (Health Services) Chhattisgarh. The state has made considerable progress over the last decade on many health indicators but there are still major public health issues requiring fresh strategies and new interventions. The purpose of the workshop was to create a list of action-points that the state can take to improve the situation. Further, it was aimed to list immediately do-able action points along with longer-term strategies. Some of the key challenges outlined were: Improving maternal healthcare Strategies for malaria prevention Making Chhattisgarh Leprosy-free Improving Detection Rates of TB Telemedicine Future roles of Mitanin Free diagnostics – how to move forward? 3 Schedule: Developing a Road map for Chhattisgarh 2025 Date- 17th& 18th February 2016 Venue: Hotel Shamrock, Cherikheri, NH 06 Raipur Day 1: 17th Feb 2016 Sr.N. Topic Resource Person Time 1. Inauguration of workshop Secretary Health & Family 10.30- 11am Welfare department, CG 2. Agenda Setting Director Health Services, CG 11- 11.10 am 3. Emerging need of comprehensive Commissioner Health & Family 11.10- 11.20 am State Health Policy Welfare department, CG 4. Priorities for the State and way SHRC 11.20 – 11.11.40 pm ahead Tea Break 11.40 – 12 noon 5. Expert group formation NHM Consultant/SHRC 12- 1.30 pm 6. Group wise discussion Chairperson 1.30 – 1.45 pm Lunch Break 1.45pm – 2.30 pm 7. Group wise discussion 2.30 pm – 3.30pm Tea Break 3.30pm – 3.45pm 8. Group wise discussion & Preparing NHM consultant to facilitate 3.45pm – 5 pm presentation 9. Brief overview of the day Expert Group Members 5 pm – 5.30 pm Day 2: 18th Feb 2016 Sr.N. Topic Resource Person Time 1. Free Drug Diagnostic Scheme Panel discussion 10.30am – 11.30am 2 Strategies for coordination between Panel discussion 11.30am – 12.30 pm programme divisions & ensure implementation of action points to achieve common goals Tea Break 12.30pm – 12.45pm 3. Group 1 presentation & discussion 12.45 -1.15 pm 4. Group 2 presentation & discussion 1.15- 1.45 pm Lunch Break 1.45pm – 2.30 pm 5. Group 3 presentation& discussion 2.30 pm – 3pm 6. Group 4 presentation & discussion 3pm – 3.30 pm Tea Break 3.30pm – 3.45pm 7. Presentation onFree diagnostic & 3.45 pm – 4.15 pm Strategies to bring coordination among programme divisions 8. Consensus Building and Drafting a Road Presentation by 4.15 – 5.30 pm Map for 2015 (In presence of Secretary Experts Health) 4 Group 1: Topic- Improving Maternal healthcare 1. Dr.Prabir Chatterjee- Chairperson 2. Dr.SurendraPambhoi 3. Dr.Alka Gupta 4. Dr. Ajay Trakru, (Unicef) 5. Dr.Soniya Daniel (Unicef) 6. Dr.RohitBaghel Group 2: Topic- Telemedicine for providing better access to health services:- 1. Dr.J.P.Mishra- Chairperson 2. Dr. Rajesh Sharma 3. Dr.Kamlesh Jain 4. Dr. B.K. Das 5. Dr. Manish Gawande, WHO 6. Dr.Abhyuday Tiwari 7. Dr.Ajitendra Kumar (Unicef) Group 3:Topic- a. Leprosy elimination and b. Improving TB case detection 1. Dr. Anil Kumar- Chairperson 2. Dr. C M Agrawal 3. Dr. M A Arif 4. Dr.Sourabh Jain 5. Dr. Sunil Gitte 6. Dr.Mahendra Singh 7. Mr. Samir Garg 8. Dr. Roshan Gupta Gropu 4: Topic – a. Future Direction of Mitanin Programme & b. Strategies for Vector Control 1. Dr. K.R. Antony- Chairperson 2. Dr. T. K. Agrawal 3. Dr. S.M.M. Murthy 4. Dr.KhemrajSonwani 5. Shri Somshekhar 6. Ms. RajulNahata 7. Ms. Shweta Adil 5 Key Public Health Challenges in Chhattisgarh Where do we stand today? Some health indicators:- Indicator Chhattisgarh India Period Source IMR 46 40 2013 SRS Under-5 Mortality Rate 53 49 2013 SRS MMR 220 167 2013 SRS Crude Death Rate 7.9 7 2013 SRS Stunting % (0-59 months) 43 38.7 2014 RSOC What are people dying of in Chhattisgarh ? (Source: CBM Report (SHRC 2014) Compilation of death registers kept by VHSNCs, in 2014) No. of Annual Deaths % of total recorded Recorded Suspected Cause recorded (rural) deaths (rural) Fever or Malaria 3962 5.3% TB 1795 2.4% Jaundice 1429 1.9% Diarrhea 949 1.3% Pneumonia 1199 1.6% Low Birth weight, Neonatal Illnesses 2516 3.4% Neonatal Asphyxia 1680 2.3% Maternal Deaths 456 0.6% Accidents 3722 5.0% 6 No. of Annual Deaths % of total recorded Recorded Suspected Cause recorded (rural) deaths (rural) Suicides 2728 3.7% Snake/animal bites 703 0.9% Key Public Health Challenges in Chhattisgarh:- Infectious Diseases • Malaria • TB • Leprosy • Water borne diseases e.g. Hepatitis E in urban areas • ARIs in Children Key Public Health Challenges in Chhattisgarh:- Reproductive and Child Health Issues: • Reducing Maternal and Newborn mortality and morbidity: Providing services with quality • Reproductive Health: Meeting unmet demand with quality services Key Public Health Challenges in Chhattisgarh:- Non-Communicable Diseases : • Sickle Cell Anemia • Providing services to patients with Diabetes, Hypertension Key Public Health Challenges in Chhattisgarh :- Other Important Issues: • Road Accidents • Suicides • Social Determinants: Gender, Poverty, Malnutrition, Social Exclusion 7 Poverty Alleviation @ Compounding Speed Brief Summary A.K.Somasekhar 94252 02643 Despite rapid economic growth in the last two decades, huge public spending on education, health etc, large number of good schemes to alleviate poverty, good intentions of many political leaders & bureaucrats, the social indicators of the country are still unacceptably low. It appears that every ingredient required for poverty alleviation is in place, but still the reaction is not taking place. This book is to suggest a catalyst which can trigger the reaction to alleviate poverty at compounding speed. The proposal is involve the same poor to help themselves and their neighbourhood to change towards constructive behaviour by incentivising them for promoting the right behaviour in a different model. Why poor are poor? If a family is poor it is because of the following reasons. We need to address all the below issues simultaneously. o Lack of employable skills due to lack of appropriate education. o Lack of health and healthy habits. o Lack of awareness and voice to fight for their rights. o Lack of access to proper counseling. o Lack of financial resources What is required to educate a child and to keep people healthy? Schools, teachers, hospitals and doctors, etc. are necessary for the people to be educated and to be healthy. But they are not sufficient to educate a child or to make people healthy. School education, preventive health etc. demand behavioural change. Hence, mere infrastructure and facilities may not suffice. Counseling, nudging and convincing the people is essential. Behavioural change cannot be influenced by a few publicity camps by super stars. It can be influenced by ‘peer pressure’, ‘continuous reminders’, ‘nudging’, ‘counselling’ etc. We need people from the same neighbourhood whose social distance with the poor is minimum, to counsel, to guide and to nudge them towards constructive behaviour. 8 The solution The proposal is to create a scheme of Social Network Marketing (SNM) where any private individual can join as a Social Welfare Entrepreneur and earn incentives in a Multi Level marketing model. The incentives can be paid for notified welfare activities like institutional delivery, family planning operation etc. and for the sale of products like mosquito nets, condoms, sanitary napkins etc. ‘Mitanin’ programme is a similar programme in health sector. But Mitanin gets incentives in a flat model. There is no Multi Level Marketing model in it. SNM operates in a multilevel marketing model where in a SWE can sponsor others as SWEs and can benefit from their business/welfare activity also. Why multi-level ? Multilevel marketing is a legitimate business model and has the following advantages over a flat model. MLM provides a reason and incentive to tell others about the business opportunity and triggers compounding growth. MLM provides a mentor to each SWE and ensures smooth information flow from top to bottom MLM provides an opportunity to be very rich & successful and hence elite, rich and intellectuals shall enter the business MLM provides an opportunity for a team of people with different talents to work towards a common goal The last, but most important advantage of MLM is that it gives an opportunity to the poor to be rich & successful and hence provides a scope for dreaming to be rich, within the limited education, skills and resources they have. Welfare activates that can be incentivised Welfare activities whose outcome can objectively be measured and less susceptible to fraud can be identified to incentivize SNM. They include o Institutional delivery, 9 o Family planning operation, o Skill development courses, o Winning sports competitions at different levels o Small saving, o Health, Crop and life insurance Need of Viral growth to solve problems of one billion people SNM is nothing but convergence of all existing referral incentive schemes in MLM model to take the advantage of ‘Power of Compounding’. Let us suppose 1000 SWEs start in the first month and they sponsor one more SWE per month. Each SWE, including newly joined SWEs can sponsor one more SWE per month. Can you guess how many months it takes to cover one billion people? It is just 20 months. Now, let us see linear growth. Suppose, the first 1000 people are trainers and can train another 1000 people per month, each. But the trained SWEs cannot train others further, restricting compounding growth. Thus, 1000 trainers create one million SWEs in a month.. To reach one billion, they have to work 1000 months i.e. more than 83 years. That is the difference between compounding and linear growth. SNM, taking the advantage of compounding, grows beyond our imagination. MLM model enables SNM grow at compounding rate. ‘Viral growth’ cannot be expected in liner models. Today, a good SMS or a video initiated in the morning, reaches millions of people by the evening, not because one person or agency is sending to millions of people very efficiently, but because every person is sending to five or ten of his friends. When messages or videos are forwarded by a few people to a few of their contacts, they are more targeted and they are more read or watched. Thus, information in MLM model travels at a compounding speed, in a targeted manner and will be received with trust and hence used. Problems of one billion people cannot be solved by linier growth models, involving a few million Government employees or NGOs. We should involve the same millions of poor people in MLM model. SNM can be started in the whole State of Chhattisgarh, with a budget of Rs 250 Crores per anum. The money will be spent only when the desired outcome is achieved. Out of Rs 250 10
Description: