Introduction

Health research plays a vital role in ensuring that the right healthcare services reach the people in need. Having a scientific basis for developing Primary healthcare projects is critical. It sheds light on insights and needs of the rural population based on which a public health program can be drafted that addresses it. Field research helps in finding out, demographic challenges, social determinants of health equity, and economic factors that affect health. It has huge importance and provides observations on disease trends, risk factors, spots where public health interventions are required, functional abilities, patterns of care, healthcare costs, and use.

Our Collaboration with IIPHG for field research, utilization, and needs for Primary healthcare services for MMU to be deployed in Banaskantha district

 

As the operational partner for District Mineral Foundation, HOPS Healthcare took the initiative of conducting and facilitating community-based healthcare research & survey by collaborating with Indian Institute of Public Health, Gandhinagar. The team in charge of Mobile Medical unit had a detailed discussion with the IIPHG and District Mineral Foundation to identify the spots/villages for deploying  Mobile Medical Units providing a range of primary healthcare services and do the assessment on the community needs of mining-affected villages in Banaskantha District. The research was commissioned by DMF, researcher provided by IIPHG, HOPS Healthcare facilitated the research by communicating with the district authorities and arranging the logistics for conducting research. The research identified villages that were deprived of access to basic primary healthcare services including Communicable and Non-Communicable Diseases and other facilities.

Public health Research objectives to be achieved through the Mobile Medical Units

 

 The research covered the broad objectives with the below scope 

• To observe and understand the demography of the area 
• Identify the existing health problems amongst the community in the mining-affected areas & existing healthcare services (public & private), and the rural units 
• analyze the accessibility, affordability, and quality of existing healthcare provision from the community perspective 
• Identifying key stakeholders and interviewing them 
• To gain insights into the way community, people as individual, and groups go about conducting their daily tasks naturally, including activities related to health problems they may be facing
• Adding health needs that are not addressed and healthcare services that need to introduced to bridge the existing care gap.

Methodology

 

Engaging CDHO for getting local information, entities so that we can reach a conclusion towards achieving the goals of the Mobile Medical units and conducting research. Conducting field visits, meeting, and interviewing the stakeholders with the open-ended questionnaire and snowball technique. Explaining stakeholders’ healthcare service provision planning and the project in detail (through videos/ICT system etc.) The research covered 70 villages of Banaskantha, Aravalli, Mahisagar, Morbi and Gir Somnath. Interviews with key stakeholders of the district, taluka and the members of the community was planned.  

 

The stakeholders included 

• DMF Geophysicist 
• Taluka health officers
• Medical officers of various Public Health Centers and Community Health Centers 
• Sarpanchs of the identified mining-affected villages 
• Asha and Anganwadi workers 
• Local NGOs 
• Community of mining-affected villages of Banaskantha identified by DMF 

Meetings with Talukas Health officers, areas covered – Danta, Dantiwada, and Kamrej 

 

• PHCs/CHC & villages – Chitrasani, Rampura Vadla, Wakdari, Danta, Veerampur, Navavas, Kankrej, Deesa, Tenivada,
• Interview with Sarpanch of Godh, Sikariya, and Nandotra villages

To understand the prevalent health issues in the region, a detailed discussion was done with taluka health officers. The prevalent health issues included severe acute malnutrition, Iron Deficiency Anemia, Low-birth weight, Acute-chronic Respiratory Diseases especially TB, Sickle cell Anaemia, preterm deliveries, skin-related diseases, Herpes. Through a detailed interview with the District Fluorosis Officer, it was observed that both airborne and waterborne Fluorosis were present in mining-affected villages.  It was found that although 5 Mobile Medical Units are already functioning in and around Banaskantha as a part of CSR activities by GVK it is not able to provide adequate, quality healthcare services. The main health emergencies which patients are facing include snake bites, around 200 to 300 patients visit the PHC/CHC for treatment of the same.  Injuries while working in the fields and mines, and road traffic accidents are major health impediments. Mental health ailments were also rising among the tribes. Respiratory ailments are prevalent in patients who work in the mines. Patients with TB, Diabetes and respiratory issues were also found. High prevalence of skin diseases, renal stone, sickle cell, and iron-deficiency anemia, and malnutrition. 

Key Insights

 

For the population of Banaskantha, Aravalli, Mahisagar, Morbi, and Gir Somnath, health services covering acute-chronic respiratory diseases, TB, skin diseases, Preterm disease, Sickle cell, and iron deficiency anemia, and malnutrition need to be covered in the Primary healthcare services to be offered through Mobile Medical Units. For effective outcomes, involving NGO and local influencers to sensitize the people and to create awareness of government healthcare facilities should be done.

Women Health Issues Identified in the community

 

 In Godh, Sikariya, and Nandotra villages female members of the community were contacted with the help of ANM. It was observed women health was neglected. They suffered from early conception, low – Hb, iron deficiency and sickle cell Anemia, early age conceiving. Most women in the village were malnourished and underweight and due to it they suffer frequent miscarriages. Females don’t have any say in family planning. A woman, during the interview told she injured herself intentionally to terminate her pregnancy as she already had two children and didn’t want to keep the child. Many a time, for initial two-three months, women are not even aware that they are pregnant. They don’t get the care which is essential in first trimester. They also suffer from various gynecological problems due to unhygienic conditions and lack of personal hygiene. Women in Ambhagati village are underweight and malnourished. They also show have symptoms of Dental Fluorosis. The living condition of the village is bad and women don’t have proper clothes let alone clean cloth to use as a sanitary napkin.

Key Insights

 

There is a need to involve NGOs and CSR activities to counsel women on the importance of personal hygiene. This provides organizations to create a channel for distributing sanitary napkins, periodic check-up for Hb as well as counseling for women’s personal hygiene to enable them to live a better life.

General Attitude of the Community towards Public Health System /behavioral issues impacting Primary healthcare services 

 

 Through interviews with the sarpanch and community heads, it was found that the community lacked trust in the Public healthcare system. The community complained about the effectiveness of medicines, especially skin diseases. Most of the villagers only used government healthcare facilities only in case of emergency or preferred to wait till the patient’s condition deteriorated. Patients did not seek medical help for small ailments such as fever, cough, cold, and they seeped treatment from local quacks and untrained doctors and had more faith in them. One of the reasons found was quack provided services at the doorsteps of the people and only gave IV infusions. The challenges observed include patient mobilization and built trust amongst the community. Villagers are ready to incur out-of-pocket expenditure and borrow money to spend in private facilities or to the quacks but weren’t willing to avail government-free services. People fear using government facilities, due to pandemic. they fear that they will be in lockdown for 14 days because of COVID.  The patients lack general awareness towards preventive measures and don’t take supplements when provided. They either feed it to their cattle or it remains unused. Other barriers to accessing Public Healthcare as observed in Navavas, a mining-affected village is the villagers aren’t able to avail healthcare services when they need it as the timing to avail the health care service collide with their shift time. To avail the healthcare services, they have to take an off from work which would result in daily wages. There are 30 -35 quarry sites near the village but the sites that can be centralized include Bharti Quarry, Check Post, Lal Tekri, Paras Quarry, and Banas Quarry.

Key Insights

 

 There is a need to create awareness for public healthcare services and sensitize people for consuming medicines and complete the treatment. There is an opportunity to introduce advanced healthcare facilities and services at PHC and supporting the far-off villages by deploying Mobile Medical Units.

Watch here how Mobile Medical Units are proving to be an effective solution to the lack of primary healthcare services in remote areas. 

Suggestions/Inputs for Mobile Medical Units

 

 The major impediments in mining-affected villages include lack of awareness towards health-related issues, lack of priority for early access to health services. To overcome this, a centralized health clinic with Mobile Health Van to reach the underserved people in peripheral areas.

Early initiation of community awareness sessions with mobilizing activities must be planned. These sessions can be organized with the support of NGOs, local community leaders and the ANMs. As the villagers trust these people, organizing session in their presence and involvement will help to built trust for healthcare services. CSR activities should be planned ahead of the launch of Mobile Medical Unit to create awareness of government healthcare facilities and villagers should be educated on health check-up and proper counseling should be done for post-care and follow-up to ensure that patients complete the treatment.

The route plan and timing should be planned in a manner that it is suitable for the villagers and they shouldn’t have to choose between health and work. Health services should be provided at the work-site of the workers during lunch, and for villagers morning hours can be targeted.

 MMU should add screening and tests for Fluorosis and sickle cell Anemia whereas the focus should be laid on reproductive, ante-natal, and post-natal services. 

For treatment of fluorosis, Mobile medical units can include lonometer in medical devices to detect fluoride levels in urine. In the entire Palanpur district there is only one lonometer and critically ill patients are sent to Ahmedabad. Besides medications for fluorosis including Antioxidants and combination of Vitamin C+A+D3 should be added to the list.  One of the suggestions received was to counsel patients and doctors should ask patients to take the first dose in front of them. Similarly, with ORS, when a patient is provided with a pack, he/she needs to be taught how to make a solution and consume some of it right there. 

Conclusion

 

The field research conducted for the launch of MMU has helped the authorities to answer open-ended questions related to the community which was not previously explored. It provides insights related to behavioral issues towards Public Health and government services. It has played a vital role in drafting a focused program that answers the specific needs of the community and expands the scope of Primary healthcare services in Banaskantha district. Every district has different health issues and research has helped in identifying impediments in achieving healthcare objectives and addressing the issues prevailing.

Mobile Medical units along with Health and Wellness clinics in locations deprived of any healthcare facilities will help the government to address the healthcare issues of the community and reduce the patient walk-ins and load of tertiary centers by 30 to 40%. With Mobile Medical Units at the doorstep of these villages, villagers will have access to primary healthcare services at their doorstep. 

Check out how our Mobile Medical Units are making primary healthcare services available in inaccessible areas. 

Rural health outreach platforms will play a vital role in improving the health graph of Gujarat state. For more details on the project, write to us at Info@hops.healthcare