This govt doctor shows the way

In a state, where ward boys and sweepers are often found to be treating patients in government hospitals, one may find it difficult to fathom that there are some who have been trying to rid the state of the tag.

Ashok Kumar, a government doctor, could easily have gone about his work like many other from his ilk bothering very little about improving the shoddy health services in India’s biggest state. Kumar, however, wanted to make a difference. 

An additional chief medical officer, reproductive and child health, and deployed in Uttar Pradesh’s Allahabad district, Kumar literally sweated it out with his team to put the district among the top in the rank on the basis of health indicators. Barely a year ago, when all the 75 districts of Uttar Pradesh were ranked on health indicators and overall performance of the Health Department, Allahabad  was at the bottom of the table at 67. Things changed completely this year.

This year in March when the annual rankings were done again, the district had shot up to the sixth position! Its best results came from family planning which showed a jump of 7% between June 2015 and March 2016 from a meagre 3% to 10%.

Kumar and his team, however, were far from being satisfied by this tremendous improvement. “We have set our eyes on becoming number one,” says Kumar, who has been the moving force behind this “movement” of promoting family planning.

The ranks are based on the indicators of family planning, immunisation and performance of “Janani Suraksha Yojana” (mother protection scheme) which includes ante and postnatal check-ups and institutional deliveries. But for Kumar, family planning does not mean restricting the number of children, as is traditionally understood, but creating awareness, training providers and motivating the community.

Kumar said “We have trained our accredited social health activists (ASHAs) on module to create awareness and sensitise and mobilise the community not only on family planning but  health issues as well.” 

When Kumar joined in April 2015, reporting was not done properly which has now been strengthened and the supply chain improved so that services are available for the seekers which include ensuring availability of condoms and oral contraceptive pills.

Out-of-the-box thinking has made a huge difference. “Traditionally, the thinking is that a woman should bear the burden of pain so she is made to undergo sterilisation. We have identified husbands of ASHAs who have undergone vasectomy to talk to men about family planning as ASHAs found it difficult to talk to men. Families are now talking about it, though it takes time to change mindsets but we hope to perform better this year,” he explains.

The focus on counselling is more in the case of second or third pregnancy and the result has been very encouraging. “The postpartum PIUCD and postpartum sterilisation uptake has gone up substantially,” he said. Kumar, with the objective of making the programme a success, decided to rope in the services of those who were not employees in the health department.

The health department has also identified influential people like “pradhans” (village panchayat chief)  and teachers, who can play an important role in influencing the community on not only development but also health. But the gamechanger has been the health department’s innovative ways of organising family planning days.

The department has ensured that no individual, who seeks services, returns empty-handed on any day whether fixed or otherwise. “Earlier, fixed days for family planning were organised only when a specified number of people came for the obtaining services…this has been done away with now and even if one individual turns up, he/she is provided services because it has been seen, anyone who is turned back does not come again for the same service,” says Kumar.

If the number is small, then the number of individuals in other facilities is counted as one camp. Similarly, if the number of service seekers is more than 30, then additional staff and even surgeons are called in to ensure that every beneficiary is taken care of. If there is a shortage of beds and beddings, then they are hired from the local tent houses so that no person is made to lie down on the floor and the quality of care is the best. 

There have been times when on the Fixed Day Family Planning Services the number of sterilisation seekers crossed 30 which is the permissible number for one doctor or the surgeon could not make it to the facility for some reason that the then Deputy Chief Medical Officer personally performed the procedures so that people do not go back.

“Equally important has been the role of AAA forums where ASHAs, anganwadi workers (AWW) and auxiliary nurse midwives (ANMs)…they come together and tell the community women about the pros and cons of spacing between two births,’’ the doctor said. 

Family planning days are promoted during AAA forums where myths and misconceptions are also cleared. The people are told that sterilisation is not a seasonal procedure to be done only in winters and can be done anytime just like any surgery.

“Better reporting and recording has also helped improve the ranking in addition to identifying and filling the gaps in service delivery,’’ he adds..