Supported by

Providing

Health Care

to Rural

Communities

in Tamil Nadu Project Report, May 2014

Kalanjiyam Trust

Right Information Community Heath ProgramRight Information Community Heath ProgramRight Information Community Heath ProgramRight Information Community Heath Program

The Right Information Community Health Program (RICH) is being implemented in villages of

Lattur and Maduranthakam blocks of Kancheepuram district. The RICH mobile clinic serves

nearly 100+ villages with support from Share and Care Foundation, USA and other corporate and

local funding. RICH is implemented using community based approaches and provides free

primary care to the coverage villages, It brings focus on prevention and health promotion,

and providing links to referrals for health care services.

• Since RICH program was started in August 2012, a total of 206 health camps have been

conducted and 107 villages have been covered in Lattur and Maduranthakam Blocks.

• Totally 13,714 individuals (33% male and 67% female) have been provided primary health

care and medicines.

• About 1000 children in primary and upper primary schools were provided health education,

800 children were free health care through health camps or private practitioners

• The program has reached 250 adolescents, to increase awareness on reproductive health and

life-skills

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RICH BENEFICIARIES AUG.2012-MARCH 2014

The RICH clinic reaches out to remote villages that have poor access to health care, where no

public transportation is available and basic health care is scarce. The major beneficiaries of

RICH program are children and elderly. These are the groups most dependent on others to take

them to a Doctor / hospital. Till date the RICH clinic has provided services to 2415 children ages

0 to 10 years. The total number of elderly 50% served till date is 3918.

Increasing Community awareness on health

While the RICH doctor and nurse provide basic primary care, the outreach workers interact with

villagers, school children and adolescents to provide awareness on a range of health issues. The

topics that are covered include basic hygiene, maternal and child health issues, TB, immunization

and problems faced by elderly. Once the van reaches the village and individuals are provided

tokens for seeing the doctor, the outreach worked gathers a group of people who are waiting or

who come by the RICH van. Rapport is built and a discussion ensued on how families are faring

and any major health problems faced. Each time a specific topic is focused upon, sanitation,

diabetes, Blood pressure, use of beetle leaves/ chewing tobacco etc. These sessions help our

team to get a better understanding of the health problems and also on how best to impart

awareness programs.

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Beneficiaries by Age group and Gender

Awareness for Pregnant women:

Awareness for pregnant women is a very critical to ensure good outcomes of pregnancy. The

project conducted a special awareness for pregnant women in the last six months, in preparation

for starting the new program to work with

mothers and families to improve

breastfeeding and complementary feeding

practices (expected to start soon). We

reached out to pregnant women in 22

villages in Lattur block spoke to them

about their knowledge and conducted

special awareness program for them. We

spoke to them about routine check-ups, proper nutrition and other issues such as sexually

transmitted infections and HIV / AIDS.

All pregnant women in the 22 villages were identified and interviewed using an interview guide.

A total of 73 pregnant women were interviewed. About 13% of women were 18 to 20 years of

age, 66% were 21 to 24 years and 21% were 25 to 35 years of age. Most of the women had

married before the age of 20 (42%) and 58% of them reported that this was their first pregnancy.

The majority of the women reported going

for their first antenatal check-up at 3

months or earlier (78%). About 69% of

women had some awareness about basics

of pregnancy care. Overall 70% of the

women reported taking all the basic tests

include for HIV, during the current

pregnancy. During the interactions, and

discussions, the women were informed on appropriate Antenatal care practices, based on their

month of pregnancy and all were registered with the program, for further follow up. In the

upcoming months we will be following with all the pregnant women, to interact with them on

breastfeeding and child care practices.

Awareness for Adolescents

Our assessment of knowledge levels among adolescents show that the majority are poorly

informed about what happens to their bodies during adolescence, menstruation and about

pregnancy.

Arming adolescents about these issues is very critical, as most girls are

married off by the age of 20 and invariably they have the first child

before 21 years.

We therefore work with adolescents to increase awareness and to

strengthen them for their future. Monthly adolescent programs were

conducted at Kalanjiyam training center in Kalpat village. The

adolescent girls were collected from their villages using our field office

van and they spent 2 to 3 hours at Kalanjiyam. During these session,

the RICH nurse and other Kalanjiyam staff conducted awareness and

activity based sessions for them on a range of topics from life skills,

reproductive health and future planning. We use the tools that we

have developed in Tamil for increasing awareness.

50

50

57

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0 20 40 60 80 100

Changes during adolescence

Understand menstrusation

Aware about conception

Aware about risks of early pregnancy for child

Aware about risks of early pregnancy for mother

Know Iron, folic acid prevent birth defects

Percentage

Awareness Levels among Adolescent girls

No Yes

At the end of each session feedback

was collected from five percent of

adolescents as a way of monitoring

and improving the program further.

Ninety percent of the girls gave

feedback that the program was very

good, that they had not thought

about these issue before and that the

sessions were useful for them. On

the key issues that they learned, the

girls reported the following:

1. About anemia, why it is important for girls to reduce anemia and how it can be

prevented

2. About menstrual periods and how to manage during menstruation, how to use

sanitary napkins, how to dispose them etc.

3. Learnt about communicable diseases / and non-communicable diseases

4. Learnt basics of communication skills and to assert oneself, be confident etc

5. General health and nutrition, what foods to eat to have a balanced diet

6. Self-cleanliness

7. About HIV/ AIDS, basics of how it is transmitted and how to prevent it

8. How TB spreads and about its treatment

9. Cancer, types of cancer, and possible reasons for cancer and prevention

10. About drinking more water regularly and proper breathing

12. Environmental cleanliness

13. How to maintain good health

14. How girls need to be confident and have courage

15. Discipline in studies and importance of education

16. Cold and cough and how it spreads etc

Holistic Children’s Health Program:

Awareness: This is a very important

component of RICH; RICH nurse and outreach

worker conduct health awareness classes in 14

of the project covered village schools. These

include, primary to higher secondary classes.

The stress here for the young children is about

health awareness, personal hygiene, nutrition

and basic communicable diseases. Classes are

conducted separately for different class

students, after arranging in the school officials.

Till date, 45 health education classes have

been conducted in schools, reaching 1000+

children. The topics covered include: Basic first

aid, communicable diseases and how to

prevent them, cancer, non-communicable

diseases, nutrition, Anemia and Vitamin A

deficiency, and for girls in middle school, topics

related to reproductive health are also

covered. Teaching children on good mental

health is also focused and yoga is a common

feature taught by separate master or Kalajiyam

staff in all project schools.

Free health Care: all children in the project schools (over 800 children) are provided with Health

Card, which provides free health care/ treatment from a local Medical Practitioner. This program

has been very successful in ensuring that parents immediately attend to their children’s health

problems, by seeking timely medical treatment, and has also reduced them practice of using

locally procured ‘medicines’ from quacks. Monthly an average of 80 children visit the doctor to

avail treatment. The RCIH Van also visits the

schools once a year, for an annual preventive

check-up for all the children. IN the last quarter,

health camps were conducted in five schools and all

children were provided with de-worming tablets.

Nutrition: Another program funded separately, is

the provision of supplementary nutrition

(vegetables, fruits) etc., either through kitchen

gardens set up in schools, or cultivated in

Kalanjiyam field office premises. The amount of

vegetables provided / used in school noon meals

has considerably increased and these are also

reinforce to parents, so that their children are

getting good balanced diet. Children’s height and

weight are checked regularly and the staff talk to

parents of children who are underweight to ensure

their improvement.

Hygiene and Sanitation: One of the most common

causes of illness among children is lack of hygiene

and sanitation. This is a very important component

that is taught to the children, toileting, hand-

washing and keeping oneself clean, on use of

slippers, boiling water before drinking and keeping

one’s body clean. In addition to the teaching the

children, Kalanjiyam using other funding sources,

also helps to renovate school toilets, provide clean

drinking water. IN all schools, we also provide a

‘sanitation helper’ who cleans and maintains the toilet, and teach the children on proper use.

Feedback from Beneficiaries:

Since December 2013, we instituted regular method for getting feedback from community to

improve the program. In each village, feedback was taken from about 5 percent of the total

number who received services. The feedback format included information of the respondents’

profile, what services they received and their rating and perceptions of the quality of RICH

services. The graphs below show the profile of respondents:

Respondents were asked about their level of satisfaction with the services, by giving a rating

between 1 to 10, one being the least

satisfaction and 10 being highest.

The graph to the right shows the

percentage of persons who gave a 9 or

10, was 42% and those who rated the

service 7 or 8 was 33%; about 25

percent rated the service as average by

rating 5 to 6.

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5 to 6

7 to 8

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Level of Satisfaction

83

17

Gender of respondents

Women

Men

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<30 year 30 to 40 41 to 50

Age of Respondents

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NO Education 7 years or less 8 to 10 years

Education status of

respondents

5817

8

17

Occupation of respondents

Wage laborer

Home maker

Anganwadi

helperothers

Problems for which individuals came to get services from RICH clinic were :

Feedback from beneficiaries also indicate

that the RICH program is tremendously

benefiting the villagers.

• Getting health care at our door step is

a boon for us, thank you for this service

• The doctor first talks to us, and then

only gives us medicines, and I feel better.

• We asked the doctor why they are not

giving injection, and he explained to us that injections are not required for all illness and

other medicines can make us feel better

• The doctor has advised me to stop chewing pan / tobacco leaves; the nurse also explained

how it can damage our body and once can get cancer.

Besides this, the community also gave suggestions for improving the RICH services. Their

comments included:

• Visit the village frequently and on a monthly basis

• To do Blood Glucose checking and provide medicines for blood sugar

• To take them to hospital or referral center for more serious problems

In the coming year, we hope to implement these suggestions by the community and in addition

increase referral linkages and work intensively with pregnant and lactating mothers in our villages.

Most common problems reported

1. Stomach problems / aches

2. Cough / cold

3. Eye related problems

4. Tooth ache

5. Knee/ joint problems and pain

6. Fever/throat pain/ neck pain/ body pain

7. Skin problems /Itching

8. Injury / wounds

9. Headaches

10. Urinary infection