Major gains have been recorded over the past five decades in people’s health status, with visible improvements across various parameters. Despite a large resource of physical infrastructure in the form of Primary Health Centres and Sub-Centres, health status of the poor remains dismally poor with high infant / maternal mortality rates, communicable diseases like malaria and tuberculosis.

The Trust has supported an integrated approach to public health problems, locating health concerns within the overall ambit of development and poverty. It encourages incorporating observation and research in field interventions, focus on rational health care and linking service delivery with impacting policy and practice. It supports initiatives that evolve innovative delivery systems, focussing on rural areas. Rural clinics demonstrating the use of auxiliary nurse midwives and/or client centred care have been supported by the Trust. Close linkage with community outreach programmes, emphasising preventive care, has been supported and there is also a focus on rural health insurance and partial community financing of health services.

Key projects supported by the Trust within this sub-thematic area include:

1. Improving maternal and child health care through trained nurse midwives and savings and credit groups
This four year project is being implemented by Action Research & Training for Health (ARTH). The organisation was established in 1997, with the objective of helping communities access and manage health care according to their needs capacities, by using research and training initiatives. It operationalises this through: (a) field programmes covering 50,000 population in three tribal blocks of south Rajasthan; (b) technical assistance to district administration in its operational area and eight non government organisations; (c) operations research, where it has conducted some pioneering and well recognised research on immunisation status and contraception devices among others; and (d) policy advocacy through research, representation on governing boards of district health societies and on national committees.

In the current second phase of support from the Trust, ARTH has refined its model of care through trained nurse midwives besides developing a community based model for improving child health and outreach services for reproductive health care. The project focuses on: (a) Provision of health services through a rural clinic run by nurse midwives who are supported by weekly visits of specialists, equipment and emergency referral support. This component focuses on maternal health, through upgradation of equipment and facilities at the rural clinic, particularly by setting up a labour room, defining guidelines on enabling environment for skilled attendance, refining training material and developing manuals and strengthening outreach programme of the rural clinic. It also focuses on providing child health services through visiting specialists, besides training nurse-midwives in management of childhood illness using the Integrated Management of Childhood Illness (IMCI) approach and government Auxiliary Nurse Midwives to enhance their effectiveness in managing illness in their area. (b) Organising communities for health care through using the existing savings and credit groups in its operational area for health education; nutrition improvement through community kitchens, community based distribution of contraceptives, micro nutrients and Oral Re-hydration Salts (ORS); and negotiating quality of care.

2. Consolidating Primary Health Care Services and Addressing select Public Health Questions in Primary Health Care through Service Delivery and Action Based Research in Rural Chhattisgarh
This three year project is being implemented by Jan Swasthya Sahyog (JSS). With JSS’s areas of operations constituting tribal villages with predominantly adivasi population and poor access to quality health services, the current second phase of support, operationalised in November 2006, consolidates primary health care services and addresses select public health questions through service delivery and action based research in 45 villages in Bilaspur district, Chhattisgarh. The three components of the project are as follows. (1) Consolidation of Primary Health Care Services: (General) JSS is consolidating Primary Health Care Services in 45 villages through the Village Health Worker (VHW) based strategy. Briefly: (a) 156 doctor based outreach clinics per year would be conducted where 9,360 patients would be examined each year and receive quality treatment; and (b) 104 VHWs would receive training and each of them would visit 60 households per month. (Child Health and Nutrition) JSS is working towards improvement in child health through early diagnosis and treatment of common childhood illnesses, particularly acute respiratory infections, malaria, diarrhoea, measles, skin infections, worm infestation, and under nutrition. (Tuberculosis) JSS is continuing early case detection and ensuring complete therapy for those diagnosed with tuberculosis through counselling sessions, economic aid and studying patient compliance to treatment. (Malaria) JSS is working on the community control of malaria and during the course of the project would focus on: (a) strengthening the functioning of the village health samitis to ensure increased awareness and timely diagnosis; and (b) ensuring prompt and correct treatment. (2) Documentation, Dissemination and Networking: JSS is documenting its efforts and the learnings from the program and compiling suitable training materials, Information Education Communication (IEC) / Behaviour Change Communication (BCC) material and good / successful practices in primary health care on an ongoing basis. The organisation is also conducting various workshops. (3) Action Research: JSS is conducting research to address issues that come up in their line of treatment for tuberculosis, malaria and diabetes mellitus.

3. Community based health insurance programme for providing in-patient health care services to tribals at Gudalur Adivasi Hospital
This five year project is being implemented by the Association for Health & Welfare in the Nilgiris (ASHWINI). Set up in 1990, ASHWINI aims to establish a multi-tiered health system that is accessible, acceptable, effective and sustainable for indigenous people of the Gudalur valley, Tamil Nadu. The Trust’s support is towards renewal of a third five-year cycle of an innovative health insurance policy with the New India Assurance Company, which would provide access to health care for 13,000 tribals of the area. During the project period, through recruitment of human resources, focussed reviews and networking, ASHWINI is increasing the effectiveness of management of the health insurance programme, whilst also further enhancing relevance of the policy to needs of the tribals.