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Utilization and issues related to effective delivery of Government’s Health

care Services, Schemes and Programs for the Marginalized Population in


Maharashtra.
Marginalized Population:
Includes people belonging to the SC, ST, PWDs (Persons with Disabilities), Women,
Children and Transgender (LGBT) Community.

The National Health Mission:1


The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission
(NRHM) and the National Urban Health Mission (NUHM). The main programmatic components include
Health Systems Strengthening in rural and urban areas, Reproductive-Maternal-Neonatal Child and
Adolescent Health (RMNCH+A) and Communicable and Non-Communicable Diseases.

National Rural Health Mission (NRHM):

NRHM seeks to provide accessible, affordable and quality health care to the rural population especially
the vulnerable groups

National Urban Health Mission (NUHM):

NUHM seeks to improve the health status of the urban population particularly urban poor and other
vulnerable sections by facilitating their access to quality primary health care.

Various Health programs and Schemes and Health Services are rolled under the National Health Mission.

Accredited Social Health Activists (ASHA)

More than 10 lakh ASHAs are in place across the country and serve as facilitators, mobilizers and providers
of community level care. ASHA is the first port of call in the community especially for marginalized sections
of the population, with a focus on women and children.

National Ambulance Services (NAS)

As on date, 32 States/ UTs have the facility where people can dial 108 or 102 telephone number for calling
an ambulance

National Mobile Medical Units (NMMUs)

Support has been provided in 408 out of 673 districts for 1360 MMUs under NHM in the country.

1
The Annual Report of Ministry Of Health and Family Welfare 2017-2018. Available at
https://mohfw.gov.in/sites/default/files/02Chapter.pdf
Rogi Kalyan Samiti (Patient Welfare Committee) / Hospital Management Society

This committee is a registered society whose members act as trustees to manage the affairs of the hospital
and is responsible for upkeep of the facilities and ensure provision of better facilities to the patients in
the hospital.

The Village Health Sanitation and Nutrition Committee (VHSNC)

VHSNC membership includes Panchayati Raj representatives, ASHA & other frontline workers and also
representatives of the marginalized communities.

KEY INITIATIVES UNDER NHM:

• National Quality Assurance Programme

Under the QA programme, the Health facilities undertake their assessment, find-out the gaps, followed
by prioritisation and action for their closure. It also envisages training the field staff for building their
capacities.

• Kayakalp - an initiative for recognizing good Public Health Facilities

Kayakalp initiative was launched to promote cleanliness, hygiene and infection control practices in public
health facilities whereunder public healthcare facilities are appraised and those facilities that show
exemplary performance meeting standards of protocols of cleanliness, hygiene and infection control
receive awards and commendation.

• Free Drugs Service Initiative

Under the NHM-Free Drug Service Initiative, substantial funding is being given to States for provision of
free drugs and setting up of systems for drug procurement, quality assurance, IT based supply chain
management system, training and grievance redressal etc.

• Drugs and Vaccines Distribution and Management System (DVDMS)

DVDMS is a web based supply chain management system that deals with the purchase, inventory
management & distribution of various drugs, sutures and surgical items at all government health facilities
and Drug Distribution Counters (DDCs) within the State/UT. DVDMS facilitates the implementation of Free
Drugs Service Initiative and improve supply chain of the drugs, sutures and surgical items.

• Free Diagnostics Service Initiative

Several States have started providing essential diagnostics free of cost in public facilities and have
implemented these models as per National Guidelines under this initiative.

• Pradhan Mantri National Dialysis Programme

Under this initiative, free dialysis services are provided to poor people. All the States have obtained
approval for Dialysis programme under NHM.
• Comprehensive Primary Health Care

As a part of expanding the service package from selective to Comprehensive Primary Health Care, support
is being provided to States to strengthen sub centres to a Health and Wellness Centre and make it the first
point of care.

• Biomedical Equipment Maintenance and Management Programme

Prime Minister had observed that many equipment in hospitals and health centers were either unused or
there was no maintenance resulting in wastage of resources. To address the issue of non-functional
equipment across public health facilities, Comprehensive guidelines were designed on Biomedical
Equipment Management and Maintenance Programme (BMMP).

• e-Rakt Kosh

e-Rakt Kosh is a centralized blood bank management system to assist revamping of the existing systems
and processes through process re-engineering and automating data entry, search and availability of blood
and related components. Mobile version of e-Rakt Kosh with citizen interface is also available on Google
store, IOS store and Windows store.

• Kilkari and Mobile Academy

Kilkari, which means “a baby’s gurgle”, delivers free, weekly, time-appropriate 72 audio messages about
pregnancy, child birth and child care directly to families’ mobile phones from the second trimester of
pregnancy until the child is one year old.

MATERNAL AND CHILD HEALTH AND ADOLESCENT HEALTH & IMMUNIZATION SERVICES.

This is considered as an important aspect of NHM.

Programs of MCH Services of MCH Schemes of MCH.


New Born Care Corners Janani Suraksha Yojana (JSY)
Pradhan Mantri Surakshit
Matritva Abhiyan.

Rashtriya kishor swasthya Nutritional Rehabilitation


karyakram (rksk) Centres (NRCs)
Rashtriya Bal Swasthya Family Planning Services
karyakram (RBSK)
Janani Shishu Swasthya
Karyakram (JSSK)
UNIVERSAL IMMUNIZATION
PROGRAMME (UIP)

DISEASE CONTROL PROGRAMS UNDER NHM. (Communicable Diseases.)

NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP)

In this project we will be studying Malaria Disease Beneficiaries under this Program.
 NATIONAL LEPROSY ERADICATION PROGRAMME (NLEP)
 REVISED NATIONAL TUBERCUOSIS CONTROL PROGRAMME (RNTCP)
 NATIONAL IODINE DEFICIENCY DISORDERS PROGRAMME (NIDDCP)

NON –COMMUNICABLE DISEASES PROGRAMS UNDER NHM.

 NATIONAL PROGRAMME FOR PREVENTION AND CONTROL OF CANCER, DIABETES, CARDIO


VASCULAR DISEASE AND STROKE (NPCDCS)
 NATIONAL TOBACCO CONTROL PROGRAMME (NTCP)
 NATIONAL MENTAL HEALTH PROGRAMME (NMHP)
 NATIONAL PROGRAMME FOR CONTROL OF BLINDNESS AND VISUAL IMPAIRMENT (NPCB&VI)
 NATIONAL PROGRAMME FOR PREVENTION & CONTROL OF DEAFNESS (NPPCD)
 NATIONAL PROGRAMME FOR PREVENTION & CONTROL OF FLUOROSIS (NPPCF)
 NATIONAL PROGRAMME FOR HEALTHCARE OF THE ELDERLY (NPHCE)
 NATIONAL PROGRAMME ON PREVENTION AND MANAGEMENT OF BURN INJURIES (NPPMBI)
 NATIONAL ORGAN TRANSPLANT PROGRAMME (NOTP)

 Sickle Cell Anemia Control Program:

Sickle Cell disease is more prevalent among the SC, ST population. Hence the beneficiaries of this
program will be studied in this project.

HEALTH INSURANCE SCHEMES:

Mahatma Phule Jan Aarogya Yojana (MPJAY)

Health Insurance Scheme Covering all the Non- Communicable Diseases and overlaps with all the
programs mentioned above. Hence the beneficiaries under this scheme are studied under this project.

CAPACITY BUILDING:

Lack of trained Human resource acts as a major barrier to the effective delivery of these schemes to the
marginalized population. Hence this aspect of study is also included in this project.

Hence in this project we will be studying these five aspects:


 Maternal and Child Health and Immunization Services.
 Sickle Cell Anemia Control Program.
 Mahatma Phule Jan Arogya Yojana.
 Malaria under the National Vector Borne Disease Control Program (Communicable
Diseases.)
 Capacity Building for providing benefits to the Marginalized Groups.
SAMPLING:
Stratified Sampling will be followed. (Tribal Districts will be considered as they have highest SC
ST Populations.)
In Maharashtra 16 Districts are declared TRIBAL DISTRICTS.
SIX DIVISIONS OF MAHARASHTRA: (SIX ZONES) (334 respondents from each zone.)
NAGPUR DIVISION:
District name Village Name Available Known Contact Number
Person Name
Gadchiroli Armori Dr. Chaya Uikey N/A
Gondia Deori N/A N/A
Chandrapur Ghugus Dr. Dileep 9823237437
Kumre.HOD
Opthalmology GMC
Chandrapur (Ref. of
Keshav Walke Sir)
Ramtek Mansar Dr.Uttam Chaudhary 9823612644
Dr. Vivek Anantawar 9823442739
Ramtek SDH Dr. Chetan Naikwar 7350008361
(Ref of Keshav Walke
Sir)`
Bhandara GMC Civil Sugeon Dr. 9423628955
Khandate Sir (Ref of
Keshav Walke Sir)

AMRAVATI DIVISION:
District name Village Name Available Known Contact Number
Person Name
Yavatmal Zhari Jamni Devidas Shambharkar 9421892282
(Ref of Keshav Walke
Sir)
Amravati Melghat N/A N/A
Buldhana N/A N/A
Akola Akot, Murtijapur N/A N/A

AURANGABAD DIVISION:
District name Village Name Available Known Contact Number
Person Name
Beed Ambejogai Dr. Nazir Shaikh Sir 7770015057
(Ref of Keshav Walke (Manavlok College of
Sir) Social Work)
Jalana N/A N/A
Usmanabad N/A N/A
Latur N/A N/A
Hingoli N/A N/A
Nanded N/A N/A

KONKAN DIVISION:
District name Village Name Available Known Contact Number
Person Name
Thane Shahapur Dr. Pramod Gawai Sir 8888863055
Ratnagiri N/A N/A
Palghar N/A N/A
Raigad N/A N/A
Sindhudurg N/A N/A

WESTERN MAHARASHTRA
District name Village Name Available Known Contact Number
Person Name
Satara N/A N/A
Sangli N/A N/A
Solapur N/A N/A
Pune Chacan, Alandi, N/A N/A
Bhosari.
Kolhapur N/A N/A

NASHIK DIVISION:
District name Village Name Available Known Contact Number
Person Name
Nashik N/A N/A
Nandurbar N/A N/A
Dhule N/A N/A
Jalgaon N/A N/A
Ahmednagar N/A N/A

(These districts are arranged as per the tribal districts and convenience. We need to find the
contacts in these districts for data collection.)
The names of the Programs, Schemes and Services mentioned here are rolled out on a national
level. The list of programs, Schemes and Services in Maharashtra is similar and is available with
Ravindra. I will ask him to share that list with you.