7/30/2019 07_10_PHC Report9

1/16

Status ReportOf

Primary Health Center, Sille,East Siang District,

Arunachal Pradesh

September 2007

Co-managed under PPP Project by:

Department of Health & Family Welfare Future Generations Arunachal

Government of Arunachal Pradesh Vivek Vihar, H-Sector,

Itanagar Itanagar

7/30/2019 07_10_PHC Report9

2/16

2

Contents

1. Introduction 3

2. Transition to a Model PHC 4

3. Services provided 5

a. OPD and Emergency Services 5

b. Laboratory Services 6

c. Antenatal Care 6

d. Labor Room 6

e.

Immunization 7

f. Other National Programs 8

4. VWW Trainings 9

5. Rogi Kalyan Samiti 10

6. Outreach Programs 10

7. Prominent visitors 11

8. SWOT Analysis 11

9. Results 12

10.Annexure I: Some Comments by Visitors 13

11.Annexure II: Chronology of Main Events 15

7/30/2019 07_10_PHC Report9

3/16

3

Status Report

Of Primary Health Center, Sille,

East Siang District,

Arunachal Pradesh

Cleanliness, labour room attendance, DOTS case attendances are very encouraging

- Dr. P P Chaliha,Former DHS, Arunachal Pradesh

Introduction: The Department of Health and Family Welfare, Government ofArunachal Pradesh initiated the Public Private Partnership (PPP) pilot project under

National Rural Health Mission in 2005. As a part of this project the management of thePHC located at Sille in East Siang district was handed over to Future Generations

Arunachal, an organization registered under the Societies Registration Act in ArunachalPradesh. The Memorandum of Understanding to this effect was signed on December 8,

2005 and the PHC formally handed over on January 4, 2006.

Future Generations Arunachal (FGA) a Non Governmental Organization (NGO), hasbeen working in partnership with other local NGOs, the government and communities in

Arunachal Pradesh since 1997 to bring about a sustainable and equitable development byfollowing the SEED SCALE approach to community change. As of date, FGA has

established three Scale Squared Centers, popularly called Community Learning andDoing Centers; around 100 VillageMahila Mandals (Womens Groups)

and about 150 women volunteers who work as Village Welfare Workers; and FarmersClubs and Youth Groups comprising of men and school children. Three local

coordinating committees are collecting data, making work plans and taking coordinatedaction towards sustainable development.

FGA is participating in the PPP project of the government with its vision of

demonstrating a model health care delivery system in Arunachal Pradesh in which the

Handing-Taking Over of PHC, Sille

7/30/2019 07_10_PHC Report9

4/16

4

communities own the process, every mother becomes a health care provider and the focusof health care is shifted to every household.

Transition to a Model PHC:It is the endeavor of FGA to promote the Sille PHC as the model primary health carecenter. The recruitment for the staff was done in December 2005. All the staff as

recommended by the government was in place before the PHC was formally taken over

in January 2006. The PHC building, at that time, was in a dilapidated condition and other

infrastructure was almost non-existent. Only a few rooms in the front were used toprovide rudimentary OPD services. The wards and labor room were full of cobweb and

filled with few broken and rusted steel beds. There was no laboratory or regularimmunization service. Medicines and supplies were rarely available. Though there were

surplus Grade IV staffs in the PHC, a lone Medical Officer was struggling to provideskeletal curative service.

Female Ward in PHC, Sille: December

Male

PHC, Sille in December 2005

Present Female Ward in

December 2005

Dressing Room: December 2005

Male ward: December 2005

7/30/2019 07_10_PHC Report9

5/16

5

Immediately after take-over, the FGA staff along with community and staff of the CircleOfficer cleaned the building, making it more tolerable. In the next two months, the

building was completely renovated, giving it a new look. Services stipulated to beprovided in a PHC were started. By March 2006, the center was a fully functional PHC.

At the same time, the lone Sub-Center at Mangnang too was renovated and made fully

functional.

Next, outreach activities were started. As a part of this, the first batch of VWW trainingwas held in April 2006. Since then, three village women are being trained to become

Village Welfare Workers (VWWs) each month. Various awareness campaigns ondifferent health related issues have been conducted and school health has been started in

different schools. Simultaneously, steps have been taken to build the capacity of the staffon managerial as well as technical aspects of primary health care.

Services Provided:

The following services are being provided to the people of Sille Catchments area rightfrom the inception.

a. 24 hour emergency service.

b. OPD service from Monday to Saturday, from 8.00 AM to 4.00 PM.c. 24 hour labor room and essential obstetrics facilities.

d. Ambulance facility as per the vehicle condition.e. Essential medicines as per Schedule B are made available.

f. Routine laboratory services.g. Weekly routine immunization

OPD and Emergency services:

The number of OPD cases seen has steadily risen from a low of 536 (January 2006) to an

average of above 1100 per month in 2007. This indirectly reflects the growing confidenceof people in the PHC. A break up of the OPD, Emergency room registrations and

deliveries conducted till date is given in the table below. As can be seen more than half(58%) of the OPD cases comes from NonTribal background. This section is relatively

poorer and is more vulnerable compared to tribal population.

Staff cleaning the PHC

7/30/2019 07_10_PHC Report9

6/16

6

Break up of Patient Registrations from January 2006 to August 2007NonTribal Tribal Male Female Total

OPD Registration 12526 8917 9388 12055 21443

Emergency

Registration 274 526 436 364 800

Laboratory services:

The investigations being done in the laboratory are: Routine blood examination, ABOand Rh typing, MP and RMT for malaria, sputum for AFB, Urine routine examination,

Urine for sugar, Widal test, Pregnancy test

Antenatal Checkup Services:

Antenatal services are provided daily except Sundays and holidays. Till date, a total of

452 registrations have been made. The services include counseling and tetanus

immunizations.

Labor room services:

There has been no maternal death till date in the PHC .Two still births have been

recorded so far, one of which had a congenital defect. The number of deliveriesconducted in the PHC is shown below:

Break up of Institutional Deliveries from January 2006 to August 2007

Nos of deliveriesSl.No YearMale Female

Total

1 2006 25 35 60

2 2007 19 10 29

Total 44 46 89

In addition, 3 more cases were referred to the General Hospital, Pasighat. One had twin

pregnancy and severe maternal anemia was the indication for the other two.

First baby born in PHC, Sille after PPP

7/30/2019 07_10_PHC Report9

7/16

7

Immunization Services:

In addition to routine immunization, which is carried out weekly, the PHC has been

observing out all the National Immunization Weeks as per the programs of the Health and

Family Welfare department.

The following table shows the status of immunization

activities:

No of Doses of Vaccine delivered through National Immunization Week and Routine Immunizationat PHC Sille

Jan-

2006

Feb

2006

Mar

2006

Oct-

2006

Nov

2006

Dec

2006

Total NationalImmunization

Total RoutineImmunization

BCG 0 21 16 0 0 0 37 174

Measles 63 33 19 10 1 2 128 99

OPV 1 195 56 40 8 14 16 329 145

OPV 2 37 68 60 2 4 4 175 152

OPV 3 15 21 53 13 3 3 108 121

OPV B 287 102 65 42 32 33 561 36DPT 1 195 56 40 8 14 16 329 145

DPT 2 37 68 60 2 4 4 175 152

DPT3 15 21 53 13 3 3 108 121

DPT B 36 18 23 42 32 33 184 36

Total 880 464 429 140 107 114 2134 1181

Sri Omak Apang, Honble MLAparticipating in the National

Immunization Day

7/30/2019 07_10_PHC Report9

8/16

8

As can be seen from the above table, more doses were given in the months of January toMarch when the PHC was taken over. With routine immunization being given in the

PHC on a regular basis, the number of catch-up immunizations decreased sharply for themonths of October to November.

Other National Programs:

In addition to routine OPD, our PHC is actively participating underRevised National

Tuberculosis Control Program (RNTCP). The MOs are trained on RNTCP and allVWWs and volunteers have been trained as DOTS provider. We have a success rate of

72% (excluding those under treatment) as can be seen from the table below

No of Patients

under PHC

No of Patients

under VWW

Total

Cured 11 3 14

Died 1 0 1

Default 2 0 2Under Treatment 2 6 8

Total 16 9 25

Anti-malarial activities under the National Vector-borne Disease Control Program(NVBDCP) are another thrust area. Malaria is endemic in Sille-Oyan area. Between

March 2006 to April 2007, we have found a total of 948 positive cases. One death hascome to our notice till date which might be due to malaria. We are carrying out intensive

outreach activities like DDT spraying, awareness campaigns on malaria, mass blood

Dr. Yangling Perme,DTO with PHC doctors

7/30/2019 07_10_PHC Report9

9/16

9

sample collection, mosquito net impregnation among others (See outreach activitiesTable).

VWW Training:

The unique feature of SIlle PHC and FGA involvement in its management is the onemonth long Intensive training in Development and Home based Care being given towomen . This was inspired from the Comprehensive Rural Health Project (CRHP) at

Jamkhed, Maharashtra, the precursor to PHC movement before Alma Ata declaration.FGA is trying to follow in the footsteps of Jamkhed and train women on Development

and Home-based Health Care and transform a traditional government Primary HealthCentre into a more effective community-based centre where the focus of health care

delivery is being shifted from clinics to every home and health care giver is the mother,rather than a professional medical personnel. This, it may be mentioned, is the principle

of ASHA launched under NRHM.

Future Generations works with the underlying theory that to help promote a better and

healthier life for the rural mass, the local women can be trained as Village WelfareWorkers (VWWs) who can be leaders in the communities, collect data, deliver home-

based health services, and mobilize their communities. They can be role models for otherwomen and can help in empowering them. As a whole, the VWWs can teach other

women preventive healthcare and hygienic practices, preventing infection, boilingdrinking water, designing and building toilet facilities, and promoting family planning.

Village Welfare Workers Training

7/30/2019 07_10_PHC Report9

10/16

10

Apart from the one-month training at the PHC, the VWWs along with the MahilaMandals are also given training on income generation activities by micro-credit,

sustainable agriculture and various other vocational activities. They play a very importantroles in generating some income for their family. Together with the men, the VWWs and

Mahila Mandals work to improve the health, sanitation, economic condition and

environment of their villages.

Rogi Kalyan Samiti:

Rogi Kalian Samiti, formally constituted on September 13, 2006, is fully functional. Itoperates its own account and user-fees are being levied at nominal rates w.e.f. April 1,

2007.

Outreach Programs:

The following outreach activities were carried out as a part of national programs:

National Immunization Weeks;

Intensive Pulse Polio Immunization;

DDT Spray and mosquito net impregnation;

Laparoscopic tubal ligation camps.

The following outreach activities were carried out with initiatives by PHC staff:

Awareness program on Breast cancer;

Rogi Kalyan Samiti Meeting

7/30/2019 07_10_PHC Report9

11/16

11

Blood sample collection for malaria detection;

Participation in Health Mela at Ruksin;

DOT providers training for VWWs;

School health programs.

Prominent Visitors

March 1, 2006: Henry Perry, Professor of Equity and Empowerment (Health), Future Generations

Graduate School

June 18, 2006: Dr. T. Basar, Jt Director of Health Services & State Nodal Officer (PPP)

July 16, 2006: Daniel Taylor, President of Future Generations (USA) and Luke Taylor

July 20, 2006: William E. McKibben, noted environmental writer and Robert L. Fleming, noted

ornithologist

September 14, 2006: Dr. A. Khan, ICMR Scientist, Dibrugarh

September 23, 2006: Jim Hollowood, Director (Administration and Finance), Future Generations

(USA)

October 18, 2006: The Honble Flora MacDonald, Chairperson of Future Generations (USA) andformer Foreign Minister of Canada

December 13, 2006: Dr. P.P. Chaliha, DHS visited the PHC accompanied by the Addl. Deputy

Commissioner, East Siang District and DMO, Pasighat.

January 17, 2007: Ms. Sunit Mani Aiyar, wife of Mani Shankar Aiyar, Union Cabinet Minister

Awareness Campaign on Breast Cancer

7/30/2019 07_10_PHC Report9

12/16

12

SWOT Analysis

Strengths:

Three way partnership between the community (bottom-up), government

(top-down) and FGA (outside-in) in managing the PHC;

Good Community participation leading to increased ownership of theinstitute; Located at relatively accessible area on the National Highway;

Fully staffed including two MOs who are dedicated and residing in thePHC compound;

Regular essential services leading to patient satisfaction; Training center for Village Welfare Workers.

Weakness: Some of the recruited staff are leaving for more secure jobs in the

Government Sector. Till now 6 staff have resigned resulting in a loss of180 man days. The most affected post is the ANMs.

Opportunities:

RKS has the potential to play increasingly important roles in themanagement of the PHC.;

The PHC can be upgraded to Microscopy Center under RNTCP; Demonstrates the feasibility of turning a traditional health center into a

community learning center; Potential to become a model health care center in the state.

Threats:

Delayed release of funds from the government threatens to adverselyaffect the smooth functioning of the center.

Results:

Increased community participation; Emphasis on preventive aspects and health education including school health

programs; Cleanliness of the health center compound;

Full staff, residing in the health center complex; Regular essential services.

7/30/2019 07_10_PHC Report9

13/16

13

Annexure I

Comments by Selected Visitors

June 18, 2006

I found the Hospital very neat and clean and I was really impressed by the Doctors andother staff of the hospital. Though it was Sunday the staff were engaged on collection ofblood slide from V.K.V., Oyan on an emergency mission to check malaria which I found

to be very holistic and dedication of officers and staffs on their duties.

Nakek Moyong,

ZPM, Bilat

June 21, 2006

It is pleasant surprise to know the set up and staff of PHC is much more than I expected

i.e, neat and well organized. Its quite eye opening after seeing many PHC/CHC in otherpart of India. I congratulate for having devoted staffs and changing rural scenario of

primary health care. In the course of activation of PHC through outreach, if mental healtheducation is also included would be highly appreciated.

Atsuko Ibata

Deptt. of AntropologyUniversity of Delhi

New Delhi-7

November 2, 2006

On a pleasant day while coming back from Ruksin to Pasighat I happened to visit SillePHC run by FGA along with Sri Arik Apum an old staff of Sille who had served here for

13(thirteen) years. I was impressed to see that hospital cleanliness is maintained andrecords are up-to-date, Sri Apum was highly impressed to see old hospital complex in a

good shape and orderly way.

Dr. J. Darrang, MDSMO, G,H. Pasighat

December 13, 2006

I have visited Sille PHC, run by Future Generations a reputed NGO, of the state. It is

heartening to see that all the staff wishing needs NGO are happy. Cleanliness, labourroom attendance, DOTS cases attendance are very encouraging. The state of Arunachal

Pradesh has been in the forefront in the PPP model of functioning and has handed over 16PHC at the initial phase to NGO of repute. I had the change of discussing with Ngo

representative, DMO, ADC, MO of the Pasighat. And have suggested active involvementof Rogy Kalyan Samiti in the affairs of the PHC as is laid down in the general guide line.

7/30/2019 07_10_PHC Report9

14/16

14

I wish and look forward for brilliant functioning of the PHC in near future.

Dr. P. P. Chaliha,

DHS

August 9, 2007

I am very happy tovisit PHC, Sille run by FGA that the health delivery system is fullyimproved. I must also thanks all the staff for their cooperation in the work of RNTCP. I

hope that this PHC, Sille will be one of the best example of best health institution

Dr. Y. Perme

DTO, Pasighat

.

7/30/2019 07_10_PHC Report9

15/16

15

Annexure II

Chronology of main events

December 8, 2005: Memorandum of Understanding was signed between the Government of Arunachal

Pradesh and Future Generations Arunachal (FGA) regarding co-management of Primary Health Center,

Sille.

January 4, 2006: Primary Health Center, Sille was formally handed over to Future Generations Arunachal

for taking a lead in its management. Official documents and the infrastructure was handed over to Dr.

Obang Taggu, MO Incharge by Dr. LC Darung, SMO in the presence of Dr. T. Taloh, DMO, Pasighat and

Dr. Tage Kanno, Executive Director, FGA.

January 30, 2006: The First National Immunisation Week was launched by Shri Omak Apang, Honble

MLA. The launching function was attended by DDHS (T & R), Medical Superintendent (General Hospital,

Pasighat) and public leaders. A total of 1110 children and 20 pregnant women were immunized against

various diseases.

February 10, 2006: Dr. Talom Pertin, MO and Nabam Yaka, ANM attended a 15-days training program

on community health and development in the Comprehensive Rural Health Project (CRHP), Jamkhed,Maharashtra.

March 15, 2006: Two-days training on DOTS for staff and VWWs was conducted by Dr. Y. Perme,

District TB Officer, Pasighat.

March 16, 2006: Ampi Tage, Staff Nurse attended 7-days training on Emerging Infectious Diseases at

Pasighat.

May 1, 2006: First batch of Village Welfare Workers (VWWs) underwent one month training in the PHC.

May 2, 2006: Dr. Talom Pertin, MO attended a one-day training program on National Rural Health

Mission (NRHM) at Naharlagun.

May 8, 2006: An awareness meeting on Breast Cancer Awareness was conducted in the PHC by a team of

experts from Maharashtra and Gujarat.

May 9, 2006: VWWs from PHC area were trained in impregnation of medicines in mosquito nets and such

nets were handed to them for further distribution to the villagers.

June 14, 2006: A team of staff participated in the Awareness Campaign on Malaria in Sika Tode and Sika

Bamin villages.

July 11, 2006: Dr. O. Taggu, MO i/c participated in the NVBCD program at Community Health Center,

Ruksin.

July 27, 2006: School Health Program at Primary School, Sille.

August 17, 2006: Mudang Tapyo, ANM, Mangnang Sub-Center, attended a 5-days training on CuT

Insertation and Removal at Pasighat.

August 18, 2006: Julie Perme, ANM and Nabam Yaka, ANM attended 7-days training program on

Disaster Management at Naharlagun.

September 13, 2006: PHC Management Committee (Rogi Kalyan Samiti) was formed.

7/30/2019 07_10_PHC Report9

16/16

16

October 5, 2006: A team of 6 staff participated in the Health Mela at Koloriang, jointly conducted by

Khiren Rijuju, Honble Member of Parliament and FGA.

November 26 and 27, 2006: A team led by Dr. Talom Pertin conducted School Health Program in the

Government Primary School, Sika Tode and Government Middle School, Sika Bamin.

December 6, 2006: Dr. T. Pertin, MO and Sujanta Choupoo, Program Coordinator, attended a Workshop

on IPPI in Itanagar.

January 19 to 24, 2007: Dr. O. Taggu attended a training program on HIV/AIDS, Malaria and Leprosy in

Naharlagun

February 14 to 28, 2007: Ms. Nabam Yaka, ANM, attended a two-weeks training program on Skill births

and Safe delivery in the General Hospital, Pasighat.

February 17, 2007: First Meeting of the RKS in which the important decision of user fees were taken

March 1 to 15, 2007: Ms. Julie Perme, ANM, attended a two-weeks training program on Skill births andSafe delivery in the General Hospital, Pasighat.

March 10, 2007: Laparoscopic Tubal Ligation Camp conducted in the PHC, Sille benefiting 78 women

March 15 to 21, 2007: Ms. Bijanti Sharma, Laboratory Technician, attended a skill training conducted by

NVBDCP at General Hospital, Pasighat

April 1, 2007: User Fees on selected services started

April 9 to 15, 2007: Refresher Training for Village Welfare Workers organized

April 27 to 30, 2007: Dr. O. Taggu attended 5 days training program on RNTCP

May 23, 2007: One-day training program conducted on blood sample collection for detection of malarial

parasite for the VWWs and other volunteers

June 1, 2007: Dr. O. Taggu, MO attended the Malarial Awareness Campaign organized by DMO, Pasighat

at Rani village

August 23, 2007: Mid-term review meeting of PHC management with the community leaders of Sille-

Oyan circle.