Health and Wellness: Where there is no doctor

Community Health Officer (CHO) of Jambhali village in Maharashtra talks about the impact of the Jan Arogya Samiti (JAS) or People’s Health Committee. AID partner SATHI has worked with 45 Health and Wellness Clinics in Maharashtra to help initiate the JAS that have significantly improved rural people’s access to the Clinics.

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First the good news.  300 people in 5 villages where there is no doctor are now being diagnosed and treated for high blood pressure and diabetes.  All these years, not even 10-15 people in these villages were being diagnosed, as they didn’t have access to a medical practitioner.

Then more good news. This is happening in 45 sets of such 4-5 villages where AID partner SATHI (Support for Advocacy and Training to Health Initiatives) is intervening to ensure delivery of health care at the last mile in rural Maharashtra, India.

A game changer for rural health

In a move that can impact rural health care if implemented properly, the Indian government created the post of Community Health Officers (CHO) who would head the Health and Wellness clinics (previously called sub-Primary Health Centers) that roughly look after 4-5 villages each.

As Dr Abhay Shukla of SATHI says, for the first time, within reach of every village,  we have someone (the CHO) who can conduct OPDs (Out-Patient Care) and diagnose and treat conditions like tuberculosis, high blood pressure, and diabetes. The CHO is a graduate in the health field while not being an MBBS or an MD.

To ensure that the rural health system stays accountable to the people, the government blueprint called for Jan Arogya Samitis (JAS) or People’s Health Committees to oversee the health clinics.  However, this was not implemented in practice.

With support from AID, SATHI stepped in to actualize JAS committees

SATHI facilitated the formation of 45 JAS committees in 45 Health and Wellness Clinics in 3 blocks spanning two districts of Maharashtra. Pictured above is the CHO in Ambegaon Taluka with JAS members.

Each Jan Arogya Samiti is composed of the villages’ Sarpanch (village head) as president, the community health officer as secretary, and draws its members from the 5 villages served by the clinic.  The JAS  includes school teachers and even a couple of school children, 5 ASHA workers (community health liaisons in each village), and the village Anganwadi worker (responsible for countering malnutrition in children under 5 years).

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Pic: Jan Arogya Samiti of Jambhali village, Bhor Taluka with Sarpanch or village head (woman in yellow sari) and Community Health Officer (woman to right of sarpanch) along with 5 ASHA workers and teacher (women on right) and Anganwadi workers, community members, SATHI coordinators (the two men on the left) and visiting volunteers of AID (center) outside the Health and Wellness clinic.


— When medication strips supplied for BP were over this was brought up in the JAS meetings at several clinics and the sarpanch managed to get funds for more strips.

— In a clinic in Nandurbar district there was no water supply and the CHO brought this up in the JAS meeting which followed up on it. A few hundred thousand rupees were granted by the government and now there is water supply.

— School children members of JAS brought up the issue of dysfunctional toilets and these were repaired. Now they are bringing the issue of drinking water filters that need to be replaced.

— An Anganwadi worker reported how some severe cases of malnutrition that she brought up in the JAS were followed up on.

— The JASs are also applying to the government for grants to upgrade their Clinic’s building and supplies.

As the CHO of Jambhili village in Bhor Tehsil of Pune district says (see video clip here), the biggest achievement of the JAS is the removal of fear of the government’s clinic, and increased attendance at the Clinic. She now sees 40-50 patients a day.

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The picture shows several CHOs of different JASs that AID partner SATHI has helped initiate.


And saved the best news for last.  In Ambegaon Taluka, where one of the public health clinics was simply locked and abandoned, villagers agitated (see pic below), got their non-functioning Health Clinic up and running, and formed the JAS committee to keep it accountable.




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