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A REVIEW AND CONSULTATION REPORT ON
A
PART 2 THE SUPPLEMENT REPORT
JULY -NOVEMBER 2001
COMMUNITY HEALTH CELL TEAM
BANGLORE
SUPPORTED BY DFID, NEW DELHI
Prof Mohammad
Amulya Nidhi
Dr Shyam Ashtekar
Dr Dhruv Mankad
Dr Shashikant Ahankari
Dr Abhay Shukla
&
Ravi Narayan
COMMUNITY HEALTH CELL
CONTENTS
1. Choice of models for JSR programme
2. Review of JSR programme: 1997
3. JSR programme: Review of follow up on earlier recommendations
4. Opinion poll on the JSR programme
5. JSR programme: A Bimaru Innovation
6. List of recommended skills for JSRs
7. List of drugs recommended for JSRs by PHC group
8. Potential Role for JSRs in National Health programmes
9. Consultation within the study team on JSR programme
10. Responses of JSRs (trainees and working JSRs) to questionnaires
11. Text of Questionnaires used in the study
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
POSSIBILITES WITH 'PRIMARY CARE' MODELS
- Dr Shyam Ashtekar
Selection
Gender: men
or women
Age
Education
(caste)
Attitudes of Work
candidates motivation
Learning
Communicati
on
Candidate
locality
Distribution
All, even hamlets,
depending upon
available funds and
pattern
Training
Initial course
Monitoring
Social
aspects
Technical
aspects
Medicine
supply
(A) PLANNER'S CONCERNS
Planners can manage2
Usual Possibilities1
with a combined model
with staff model
Mixed-alternate
Men or women
village/both man and
depending upon
women in each
policy. Women tend
village/couple
to take even small
pay jobs.__________
Post-twenty-five
late teens/early
twenty candidates
candidates, other
hunting for Govt, jobs health cadres
Age strata will decide
entries,___________
Any is possible..on
Any
criteria_____________
Depends upon
Declines with tenure,
ca nd idates/ retu rns/
upward mobility if
work satisfaction_____
any._____________
Combining self-interest
Generally
plus programme
programme-related.
interests.
Little motivation of
their own._________
Possible to ensure with
More with
both administration and
administration, less
users______________
with people/users
Generally from locality
From anywhere
Can begin small,
stepladder
Poor control
Theoretically possible
Govt PHC/CHC
What happens with
PMP model______
Men mostly
Generally post 25
Need twenty + for
respectable earning
Generally upper and
middle.__________
Monetary gains are
the deciding factors
for attitudes.
Only client-bound
Usually from outside
Not so evenly spread
small hamlets can be
attached though.
Sustainability is prime
concern. May not
survive less than 2000
without contract
payments.__________
Qualifying necessary,
CME can be done
Feasible-
Only big villages,
cluster-centers. Can
not survive on small
population-below
5000
Overcrowding can
pose serious
problems.________
Initial crash course,
little CME later
Poor control
Possible- programme
wise_______________
Govt for NHPs, from
market for other needs.
Poor control
Market, Medical Reps
1 Assumes appointment of one primary care worker I each village.
2 Assumes provision of facility on village showing some preparedness, proper candidates etc
1
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
NHPs on priority
Can increase choices
with better training and
public education_____
Programme-specific,
but expandable______
NHP on contract
'almost Regimented'
protocol-driven/
narrow
Semi-control_______
Possible with standard
lists and rates.
Yes and No
Can be stable
Attrition
Negligible
System
linkages
Costs
In built
Can be kept at
moderate,________
Need to be designed
and administered
Medium_________
Medium to both
Generally allopathic
Healing
systems
Preventives Overall
NHPs
Controls
Rational
therapeutic
_____ s____
Program
durability
To the Govt
to the
consumers
Programme-specific
High
Low or nil
Payment
modes
Salaries/honoraria/pe
nsions
Financial
Sources
Taxation/grants to
local bodies
Venue for
work
Formal center
necessary
Legal status
for
providers
'Couple'
Easy-with Govt
notification
Basic needs
Incentives
Income
Self
worth/publi
c image
Learning
Combined: user paid at
prescribed rates+
contract payment for
NHP/State programmes
User-fees or insurance
plus programme grants
Former center desired,
but interim
arrangements possible
Possible to work out
Generally allopathic
No interest (actually
sickness-interest)
Poor compliance for
NHPs___________
No control_______
Poor
Generally stable,
though with some
flux. Increasing
competition can
destabilize PRMPs
Negligible
Difficult & tenuous
always abhorred.
Low-nil_______ _
Highest
User fees
Fees or may be
insurance at later
stage.____________
Private room in
bazaar lanes
essential._________
'Do not care",
generally some cover
is available.________
Unlikely, except when
both husband and
wife are practicing.
Possible, as payment is
on contract for
tasks/services_______
(B) PROVIDER CONCERNS_________
High, ever increasing.
Some costs are less
Mandatorythanks
to
local
housing/food/transpo
residence._______
rt/security/ ______
Not valued.
Always
eager
Felt as 'always
meager' ________
'Rewarding'
Adjusted to services
Fixed-effort or no
and tasks__________
effort____________
Unduly high
Can live respectfully
Unduly low,
and socially useful
tormented
career.____________
Limited to sales
Can be woven into the
Limited to directives
promotion
programme.
Not possible
2
J
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
belonging
(sense of)
Professional
security/sta
bility
Upward
Mobility
Healing:
(Medical
needs)
Access
Economical
Friendly?
Lasting?
dependable
User control
To Govt system
Both
In between, banks
somewhat on Govt
policy_____________
Limited, (a neglected
Limited to locality, but
issue in India)_____
skills can be improved.
(C COMMUNITY CONCERNS
Only limited, may not Good healing +
satisfy, may or may
satisfaction mandatory
not heal___________ for survival__________
Time bound,
Ensuring good access is
programme-linked,
precondition
not dependable
may be free, if not
Can save access costs
doing private practice and needless
medication_________
Depends upon the
Professional
person____________ requirement._______
transfers, and visiting Can be
nature makes it look
less like lasting_____
Not really-because of
various factors_____
Poor, works through
Can be fairly controlled.
long politicoadministrative links.
fair, because of
unionization
To professional guild
and user community
Ever searching for
better position
More equipment,
facility upgrading.
satisfying it must be,
(but may or may not
heal)
_________
Time-elastic, but
often distant. So
access is limited
High costs, and also
hidden costs
Professional
requirement.
Generally
Generally dependable
and accountable
Poor control on
quality of care
3
I
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
JSR EVALUATION I (JULY-DECEMBER 1997) : A
FOLLOW UP
Dr Ravi Narayan, CH Cell
THE JSR Scheme : Context
“Another major step towards community-centring of primary health was through
initiating the Jan Swastya Rakshak scheme discussed earlier. The much needed gap
in rural health care in Madhya Pradesh could only be bridged by unconventional
methods like creating a paramedic or barefoot doctor in every village. The scheme has
resulted in creating over 20,000 such rural health practitioners who could become
effective outreach agents of the government health system. The scheme is premised
on community support to these Jan Swastya Rakshaks who will be paid for their
services.
A mid-course evaluation of the scheme revealed poor ownership of the
scheme by the Public Health system which has historically been suspicious of rural
health practitioners.
Efforts are currently underway to integrate it fully within the
system”.
“The real challenge in Madhya Pradesh today appears to be to move to a
horizontal management of health care delivery as against management of vertical
programmes based on national and state level prioritisation. The experience of the two
Missions on Health in Madhya Pradesh as well as of the Rogi Kalyan Samiti and Jan
Swastya Rakshak point to the need to involve civil society more effectively in the
management of health and utilise the opportunities created through decentralised
governance of panchayat raj. Issues of public helth being inter-sectoral and requiring
societal mobilisation for efficient delivery, the challenge today is for policy reorientation
to put the public health system on its head and start planning from below. Problem
mapping exercises that can engage community leadership can generate awareness on
an unprecedented scale. Networking with other sectoral departments that impinge on
health, like water supply, sanitation or rural development could lead to dramatic
improvements in health delivery”
Source : The Madhya Pradesh Human Development Report, 1998.
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SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
1.
JSR REVIEW I (1997
RECOMMENDTIONS
Further clarification of job
responsibilities, functions and
functional linkages.
FOLLOW UP ASSESSMENT
REVIEW II (2001)
1. Revised manual has more clarity
on job responsibility and functions
but not on functional linkages
1. Objectives
with the health and PRI system.
2.
JSR
be
should
person
under
a
resource
2.
Panchayat
This linkage post-training is still
ambiguous
supervision.
1.
For better coordination and
1.
Has now become part of a new
streamlining the programme
Rajiv Gandhi Mission - SJGYS
should be located in Health
with
department
Health department in training and
greater
of
involvement
district level
2. Administration
2.
There should
be a
Project
2. No JSR Scheme think-tank as
Committee to organise scheme
with
all
of
representations
yet
related sectors.
though
the
SJGYS
Governing
body
and
executive
committee
may
play that role.
1.
Every effort to select more
1.
female candidates.
female
inadequate.
2.
3. Selection
Widescale
and
effective 2. Some
publicity at community level.
efforts
but
still
very
inadequate and not innovative.
f
Must be in campaign mode.
3.
5. Logistic Support
select
candidates are ongoing but very
*
4. Linkages
to
Efforts
Reduce
education
limit
for
females
especially
in
tribal
3.
Some
reductions
done
and
Anganwadi workers also included.
regions to enhance selection.
But much more efforts required.
Develop linkages with all sectors
No formal linkages developed at
(intra and inter sectoral) at village
any level.
and other levels.
on linkages.
Adequate and timely availability of
Some delays experienced.
Needs further clarity
Need to
5
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
funds for smooth functioning of
be
scheme
programme.
Use appropriate,
6. Communication
effective
local
No
looked
in
into
ongoing
communication
strategy
media at all levels
evident
❖
Village
regular and detailed Government
❖
Panchayat
Orders.
Needs
❖
Taluk
creativity
to
❖
District
dimension
for
❖
Inter and intra departmental
programme.
1. Venues should be suitable for
identification
problem
1?
and
at
any
clarity
and
enhance
this
of
success
PHC & CHC comprise 3/4th of
venues.
solving, community experience
except
level
in
hospital
District
Bhopal and Government Nursing
College in Jabalpur also used
2. Training should
move from
2.
Training is mostly lectures or
content orientation to process
manual reading. Some field visits
orientation and use integrated
and
problem based approaches
postings.
lots
of
injection
room
Audio visual methods
or'problem solving7 hardly used.
3.
7. Training
Training
manual to
be
written
- various
lacunae
re-
3.
Many of the lacunae pointed out
been
have
pointed out
introduced
rewritten manual.
protocols
into
Needs more
cheap
(Many
alternatives with irrational options
available)
4.
Regular refresher courses and
4. No.
Process
of
continuing
continuing education through
education
or
even
district learning modules.
supervisory
contact
after
training.
5.
Supportive facilities for greater
female participation.
5.
Some
efforts
anganwadi
made
centres.
including
But
not
enough.
8. Criteria for
certification
Recertification on a periodic basis
No policy for recertification yet in
contingent
place. Needs urgent attention.
on
defined
criterias
should be made mandatory.
6
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
1.
supportive
Technical
No policy for SME yet in
supervision linked to health
place. Role or link to PHCs or
training
training centre inadequately
/
health
primary
centres must be built in even if
addressed.
JSR is under PRI.
9. Supervision /
Monitoring /
1.
2.
Evaluation (SME)
Quantitative
and
Qualitative
2. No plan to measure process
indicators to measure process
and impact in place.
and impact to be collected in
concept of 'free standing JSR'
collaboration with panchayats
has
and PHCs.
accountability of those who
confused
issue
The
of
train and position them.
1.
Examination
to be handed
1. Examination conducted by health
to
independent
department once a year and may
over
NGO
-
body
professional
happen any time.
trainer, medical college, etc.
2.
10. Examinations
3.
assess
2. Consists only of a written paper
process (practical skills) and
requiring 50% marks to pass. No
knowledge by judicious mix of
practical test or problems / case
short answers, case studies,
studies cyclostyled papers often
MCQs, etc.
unreadable.
should
Examination
Short courses for those who
fail exam - first time.
Core
Project
Team
thought off.
train
No core project team as yet.
trainers, monitor the JSRs in
No think tank - so none of the
Core
11.
3. No such process or provision
project
team
to
are
feedback
activities
from JSR, community and PHC
ongoing.
and continuously innovate and
Rajiv Gandhi Mission, it may
improve scheme.
be possible in future.
field,
the
Core
ascertain
group
network
of
suggested
Now as part of new
supported
by
No core project team - so no
group
<of
peer network operationalised
peer
12. Peer Support
trainers in northern Hindi belt.
even though there is great
potential for this.
Source : JSR Review I - 1997, JSR Review II, July-November 2001 (Draft).
7
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Comment:
A comparison with the recommendations of the last review show that only some of the
recommendations regarding training, selection, logistic support were accepted.
Most of the
others which had important policy implications and would have greatly improved, structure,
framework, operational success sustainability and quality were ignored (see highlighted in table
above). Hence the distortions, deviations seen in the present review are not accidental but by
default. However, even at this stage, with a new mission emphasis the process can be improved
and successfully operationalised.
8
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
JSR & MP : A BIMARU INNOVATION
Dr Ravi Narayan
BACKGROUND
"The 'Jan Swasthya Rakshak' scheme launched by the Government of Madhya Pradesh in 1995,
is a significant effort aimed at bridging the wide gaps and disparities in health and human
development in the state.
It is especially significant because since the development of the
concept of the disadvantaged BIMARU region in planning circles in India (comprising Bihar,
Madhya Pradesh, Rajasthan and Uttar Pradesh) there has been a growing concern, that these
states need some radical and innovative strategies to make health care a reality for the large
numbers of marginalised and socially disadvantaged sections of society, who are presently not
reached by the existing services.
Madhya Pradesh with the largest land mass amongst Indian states presents a fascinating hue of
cultural and geographical diversity.
A total of 71,256 villages with varying population are
scattered over this region and 76.82% of the State's population is rural-based.
The State is
divided into five regions, each with its own different characteristics. To provide "Health Care for
All by 2000 AD" in such a situation is a daunting task indeed. There continues to exist large
unmet felt need for health services. As in rest of India, rural health care is a perpetual problem.
Notwithstanding the vast network of Block and Sector PHCs and subcentres, a large percentage
of rural population is unable to obtain comprehensive health care. A comparison of rural and
urban birth rates (rural and urban) crude death rates (rural and urban) and Infant Mortality
rates reveals the extent of health problems and needs lying unfulfilled specially in rural areas.
The above figures mask the wide inter-district variation, which also exist.
Where most villages do not have an all season approach road, where many rural area posts still
go unfilled because of reluctance of trained manpower to settle down in rural areas and where
facilities are more or less non-existent, even an ordinary curable illness undertakes a sinister
complexion and often ends in a severe complication
or, even death.
Very often the cures
required are simple and one which a trained and competent health worker can provide in the
village itself. For those illnesses that are truly serious, early identification and timely referral by
such a village based worker can make all the difference between an early recovery or chronic
illness and / or death...." (JSR Review, 1997)
9
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
The Village Based Health Workers - A policy challenge
"The idea of village based health workers and
the involvement of the community in their
selection, support and supervision is not new.
There have been governmental and non
governmental initiatives in this area and to contextualise the JSR Review undertaken by us, we
include a short background overview of these efforts.
Policy initiatives
The Bhore Committee report (1946) which formed the blueprint of post independence - health
care service development, had suggested the formation of village health committees and
voluntary health workers who needed suitable training. In 1975, the Srivastava report, 30 years
later suggested the utilization of part time, semi professional workers from the community who
could be trained in the management of common ailments and in basic preventive and promotive
services.
The fourth Chapter of the report entitled "Health Services and Personnel in the
Community" is an excellent concept paper on the significance of community based semi
professional health workers.
A few years later the ICSSR/ICMR Health for All study group (1981) reiterated once again the
need for Community Health volunteers with 'special skills', ready availability, who see health work
not as a 'job' but as a social function.
Finally, the National Health Policy (1982) included a policy statement on 'Health volunteers
selected by communities and enjoying their confidence and to whom certain skills, knowledge
and use of technology could be transferred'.
CHW - THE INDIAN EXPERIENCE (GOI)
In 1977, the Janata Government launched the Community Health Worker (CHW) scheme, which
focussed on CHWs selected by the community, having 6th standard education, and trained
informally in the PHCs for 3 months. They were paid a stipend during training and an honoraria
10
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
of Rs. 50/- per month after the training, when they began work,
Further details and a
comparison with JSR scheme is provided elsewhere in the report.
The CHW scheme was a massive operation and was subject to some mid course reviews which
identified problems including the lack of adequate preparation; the lack of pilot or feasibility
studies;
the
reduced
support of
the community;
the
inability of the community to
takeover the scheme; the non-payment of honoraria and the non replenishment of kit boxes; the
lack of professional enthusiasm with the challenge of the scheme at all levels; the predominant
selection of males as CHW and their subsequent cooption by the system and finally the problem
of the whole scheme becoming a subjudice matter due to litigation by CHWs about enhancement
of their honorarium, thus becoming non functional!
CHW - the Indian NGO experience
Prior to 1977 and also after it, many Community Health projects in the voluntary / non
governmental sector in the country experimented with community based health workers. Some
examples are the CHWs of Jamkhed; the village health workers of the Indo Dutch Project; the lay
first aiders of VHS-Adyar; the link workers on the tea gardens in South India; the Family care
volunteers and Health Aides of RUHSA; the MCH workers of CINI-Calcutta; the Swasthya Mithras
of Banaras Hindu University-Varanasi; the Sanyojaks of Banwasi Seva Ashram, Uttar Pradesh;
CHW course of St. John's Medical College - Bangalore; the Rehbar-e-sehat scheme of Kashmir
government; the CHVs of Sewa Rural and the Community Health Guides of many other projects.
An overview of these CHWs in the voluntary sector show that they were predominantly women;
were mostly voluntary or link workers with minimum support; most of them were mature married
volunteers; care had been taken by the project to prevent the cooption by village leaders and
there was representation of all segments; the participation of the community in identifying the
CHWs and their supervision was a goal itself; the training programmes had innovative
components and methods and projects had well trained and highly mobile field and supervisory
staff;
and many projects had women on action/advisory committees or local womens groups
supportive of the process.
11
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
CHW - The Global experience
At a Global level also, since the late sixties and early seventies, the experiments of training
community health workers of various types took place all over the world. Significant initiatives
were taken in Mexico, Guatemala, Jamaica, Venezuela, Brazil, Ghana, Nigeria, Sudan, Ethiopia;
Kenya; Tanzania,
Iran, Afghanistan, China,
Philippines and Papua New Guinea.
framework was similar.
Bangladesh, Thailand,
Malaysia,
Indonesia,
The terminologies were vastly different but the basic
These included community / village health workers; the community
health aides; barefoot doctors; community health agents; rural health promoters; national health
guides; family health educators; aid posts or orderlies; secouristes; hygienist; health auxiliary
and health post volunteers.
A review of these experiments showed a remarkable diversity in
framework and approaches.
Nearly all the countries where these experiments took place were from the developing countries
(South). The projects ranged from pilot and local projects to regional and national initiatives.
The trainees selected ranged from illiterates, to upto 10 years of schooling.
The duration of training ranged from 5 days to 10 weeks to 6 months and even upto three years
for different cadres. The location of training varied from subcentres and local health centres to
county and rural hospitals and in some instances there were training centres and national project
headquarters.
Training methods included lectures, discussions, demonstrations, role playing,
field visits, practicals, learning by doing and story telling and dialogue.
Finally the evaluation
methods ranged from written tests, practicals, oral tests, quiz, field performance reviews, role
playing and trainer observations.
The JSR Scheme in context
The concept of the community based health worker has been in vogue, therefore, for
many
decades with a wide variety of experiments at governmental and nongovernmental level in a
wide variety of countries.
The Madhya Pradesh Government's initiative - the Jan Swasthya
Rakshak scheme - is a significant development against the background of a series of similar
initiatives all over the country and the world.
A critical overview of the scheme at this juncture will not only be an important mid course
assessment of the initiatives but will also be an opportunity to assess the experience against the
12
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
backdrop of a wealth of previous experience so that we do not reinvent the wheel but ensure
that the scheme evolves in a way most suited and relevant to the local realities and challenges.
THE CHALLENGE BEFORE US
....The over-emphasis on provision of health services through professional staff under state
control has been counter-productive.
On the one hand, it is devaluing and destroying the old
tradition ofpart-time semi-professional workers which the community used to train and throw up
and which, with certain modifications, will have to continue to provide the foundation for the
development of a national programme of health services in our country. On the other hand, the
new professional services provided under State control are inadequate in quantity (because of
the paucity of resources) and unsatisfactory in quality (because of defective training,
organizational weaknesses and failure of rapport between the people and their so-called
servants). What we need, therefore, is the creation of large bands ofpart-time semi-professional
workers from among the community itself who would be dose to the people, live with them, and
in addition to promotive and preventive health services including those related to family planning,
will also provide basic medical services needed in day-to-day common illnesses which account for
about eighty per cent of all illnesses. It is to supplement them, and not for supplanting them,
that we have to create a professional, highly competent, dedicated, readily accessible, and
almost ubiquitous referral service to deal with the minority of complicated cases that need
specialized treatment.
- Srivastava Report, GOI, 1975.
Taking cognizance of the above situation and to improve health care services in rural areas, 18
years and 47 days after the launch of the Community Health Worker Scheme, the Government of
Madhya Pradesh on 19 November, 1995 launched the Jan Swasthya Rakshak Scheme under the
Integrated Rural Development Programme (IRDP) for unemployed rural youth to provide round
the clock curative, preventive and promotive health services in every village of Madhya Pradesh.
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SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Objectives of the Jan Swasthya Rakshak Scheme
1. To improve the health in rural areas, by providing a trained worker who can give first aid
care and treat small illnesses scientifically, in the village itself.
Efforts are to be made to
have both males and females in this scheme.
2. To provide a trained worker in the village who can assist in the implementation of National
Health Programmes and health schemes of the Government.
The Scheme has outlined a list of 24 functions for the Jan Swasthya Rakshak (Appendix - 4).
These include provision of curative services and first aid care in the village itself, recognition of
serious illnesses and epidemics and their immediate notification to health centres so as to provide
optimum health care, providing assistance in the implementation of RCH services
and other
national programmes in the village, collecting health related information and maintaining
registers.
TABLE 1: Analysis of functions of JSR as mentioned in the JSR Manual
Number in Manual
Type of Function
Total
Percentage
1.
Preventive
1,2,16,18,20,21,22,24
8
33.33
2.
Promotive
3,7,8,9,10,11,16, 23
7
29.16
3.
Environment promotion
4
1
4.17
4.
Health Education
5,12,15.
3
12.50
5.
Health Statistics
6, 19
2
8.33
6.
Curative
13, 14, 17
3
12.50
TOTAL
24
100.00
Of the 24 functions envisaged for a JSR, 8 are preventive, 7 promotive and 3 health education
related. Only 3 of the 24 functions are curative in nature.
Besides the provision of health services to rural areas, by recommending that only unemployed,
educated youth who belonged to families below the poverty line be chosen for training, the
scheme hoped to provide an occupation to atleast some of them and thereby a means of
livelihood. All financial assistance for training, including stipend, contingency and loans for setting
14
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
up the clinic are to come from the IRDP and the health department has to impart the training
and provide all necessary technical assistance.
Community Health Worker / Guide / Volunteer
This scheme is very much in tune with what was recommended in 1974 by the Shrivastava
Committee - - "the creation of large groups of part-time semi-professional workers, selected from
amongst the community itself, who would be close to the people, live with them, provide
preventive and promotive health services including family planning in addition to looking after
common ailments". These were to be essentially self-employed people and therefore not a part
of Government bureaucracy.
The Rural Health Scheme announced by the MHFW, GOI to
strengthen health care services in rural areas was an extension of the above concept. Under the
scheme, every village or community with a population of 1000, had to select one representative
who was willing to serve the community and enjoyed its confidence. The tasks expected of the
community health workers were:
*
immunisation of the new born and young children;
*
distribution of nutritional supplements;
*
treatment of malaria and collection of blood samples; and
*
elementary curative needs of the community.
The overall philosophy of the scheme was that the health work which was till then looked after
largely by Government was for the first time to also rest in the hands of the people.
The
community health worker belonging to the same community would be accountable to them and
they in turn would supervise his / her work.
The community health worker was not envisaged to be a full time health worker and was
expected to perform community health work in his/her spare time for about 2-3 hours daily.
During the period of training, the trainees were given a stipend of Rs. 200-00 per month for 3
months and a simple medicine kit. Once they commenced work they were given an honorarium
of Rs. 50-00 per month and Rs. 600-00 worth of medicines per year.
The responsibility of the Government was limited to training and technical guidance,
The
philosophy of community involvement and participation in the provision of primary health
services, also implied that the community would supplement the resources required for the
continuation of this work and would completely takeover the programme at a subsequent period
of time.
15
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
The scheme which was introduced on 2nd October, 1977 evoked wide public interest. While no
one doubted the sincerity of the Government in providing health care to the rural masses, the
programme came in for adverse criticism right from the outset. The Government was blamed for
inadequate preparation, lack of pilot studies on feasibility especially in the light of heavy
investment of public funds required for its implementation and for promoting quackery.
In
addition, community support remained minimal to nil and the envisaged possibility of the
community taking over the programme was an impossible proposition under the circumstances.
Because of the above and various other reasons like non-replishnment of kits, non-payment of
honorarium, etc., community health workers scheme which from the beginning had a poor
chance to succeed never really took off. Unable to wind it up, due to various matters which are
at present subjudice, the Government is now burdened with the recurrent costs for a "non
functional" scheme - the penalty of ill planning, hasty implementation and blind faith.
The present JSR scheme has tried to obviate some of the problems which plagued the old CHW
Scheme.
The scheme has issued clearcut guidelines on the selection process, training,
examination, registration, functions of JSRs and code of conduct.
JSR Scheme versus CHW scheme
The objectives and activities of the JSR Scheme do have many commonalties with the
Community Health Worker Scheme of 1977.
But, there are some important differences.
Important amongst these are :
1.
increased duration of training - six months (it was three months in the CHW Scheme);
2.
increased stipend from Rs.200-00 to Rs.500-00 per month during the training period with
funds coming from TRYSEM (it was Rs.200/- in the CHW scheme and the funds were not
from TRYSEM);
3.
no monthly honorarium is to be paid to the JSRs. Instead, JSRs who successfully complete
the course are to be given a registration certificate which will allow them to 'practise' in the
village which nominated them for JSR training. Guidelines which state that they are to
provide curative care only for illnesses mentioned in their training manual and for which they
have been given training as well as the drugs they can use for treatment of these minor
illnesses have been established.
To assist in the establishment of their practise, JSRs who
16
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
successfully complete their course are eligible to obtain a loan with subsidy from IRDP under
TRYSEM;
4.
only those who have passed upto 10th standard are eligible for JSR training (CHW scheme
permitted those with formal education upto 6th standard and above);
5.
whenever qualifications and other criteria are similar, women are to be given preference over
men in the selection process.
TABLE 2 : Comparison between CHW and JSR Schemes
Criteria
CHW Scheme
JSR Scheme
Year
1977
1995
Training duration
3 months
6 months
Goal
one CHW/ 1000 population
one JSR / village
Eligibility
upto 6th Standard
upto 10th Standard
Stipend during training
Rs. 200 per month
Rs. 500 per month
Honoraria
Rs. 50 per month
Loan - subsidy
Practice
Informal
Certified
Content of manual (special)
Mental Health
Minor
•
Ailment
Working with community
Anatomy / Physiology
by
Ay u rveda/Yoga/ U na n i/
•
Dengue/Filariasis
Siddha/Homeopathy/
•
STD/Blindness
Naturopathy/
•
Patient examination
Medicinal
Plants (See Appendix 5)
Though on first impression, these changes appear to be minor, the scheme as now envisaged
differs in 2 radical ways from the old CHW scheme. Not providing a monthly honorarium and
allowing market forces to determine their income per se could push the priorities of JSRs to paid |
curative services over preventive and promotive services specially with the spectre of loan
repayment looming over their heads. Secondly, under the present format of certification, the
Government has no direct supervisory powers over the JSRs as they are not staff of the Health
and Family Welfare department and the JSRs theoretically have the liberty to pursue their
practise and curative care without having the compulsion of carrying out preventive and
promotive services or assisting Government in the implementation of National Health
Programmes as envisaged in the scheme.
17
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
______
LIST OF SOME SKILLS JSRS CAN LEARN : LISTING
BY ALPHABETICAL ORDER
Dr Shyam Ashtekar
1
_______________ Diagnostic skills
Basic ANC check up-and risk factors in pregnancy
2
Body Mapping
3
BP measurement
4
Breath counting
5
Checking and grading undernutrition with growth charts
6
Checking anemia/pallor
7
Checking creps by auscultation
8
Checking dehydration in adult and babies
9
Checking edema
10
Checking for patch in mouth
11
Checking for signs snake bite : a) drooping b) gum bleed
12
Checking groin Armpit Nodes
13
Checking groin Lymph nodes
14
Checking jaundice in eyes
15
Checking jaundice in urine by froth test
16
Checking liver tenderness
17
Checking neck glands
18
Checking Neck rigidity
19
Checking rhonchi by auscultation
20
Checking skin sensation for leprosy
21
Checking tender nerves at six spots
22
Checking tenderness of frontal/maxillary sinuses
23
Checking testicles for site/swelling/tenderness
24
Checking throat and jugular nodes
25
Checking undernutrition with arm band strip
26
Checking urine retention or no- urine
27
Counting pulse at six sites
3 List not exhaustive,
18
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
28
Detecting fracture
29
Detecting injury/FB/ulcer on cornea
30
Detecting mature/immature cataract
31
Ear care in ASOM
32
Fever diagnosis
33
Headache diagnosis by simple tests
34
Identify carious teeth
35
Identifying snake as poisonous or non- poisonous
36
Light reflex
37
Locating illnesses to matrix of system-cause
38
Mapping GT organs on female pelvic model
39
Measuring temperature
40
P/V bimanual checking
41
P/V inspection
42
Percussing lung fields for solidification/fluid in chest
43
Tying splint for fractured limb
44
Use of basic diagnostic chart/table for Abdominal pain
45
Use of basic diagnostic chart/table for cough
46
Use of basic diagnostic chart/table for LM
Healing skills
1
Acupressure 50 points
2
Ankle bandage for sprain
3
Basic wound management-cleaning, dressing
4
Clearing airway of newborn
5
Cutting and tying cord
6
Demonstration of condom use
7
Ear care in ASOM
8
First aid in snake bite- immobilization, pressure bandage
9
Hot sponging for urine retention
10
Inducing vomiting with salt water as first aid for poisoning
11
Massaging / primary physiotheray
12
Oil syringe for fecoliths
13
Preparing 10 herbal remedies from local resources
14
Preparing home fluid for rehydration
19
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
_________________
16
Puncturing and draining a boil with needle
17
Steam inhalation
18
Stopping bleeds by pressure/artery forceps
19
Tepid sponging of fevers
20
Treating minor phimosis with oil massage
21
Treating scorpion bite with burnt alum
22
Vaginal douche
23
Vaginal painting
24
Washing dog bite wounds with soap
1
Correct method of brushing teeth
2
Correct reading technique for IEC
3
Demonstration of soak pit construction
4
Disinfecting of water-at home or well
5
Disinfection of dressings, instruments
6
Explaining copper T on model
7
Explaining correct dosage scheduling
8
Handwash
9
Health education on five topics in school
10
Identify 25 medicinal herbs in the locality
11
Preparing drug labels in Hindi for kit
12
Preparing referral note to Primary Health Care
13
Preparing sanitary pads at home
14
Preparing supplementary feed for malnourished children
15
Record keeping
16
Taking blood film on slide
17
Taking sputum sample, fixing with heat
18
Use of slide show for IEC
Other skills
20
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
LIST OF GENERIC MEDICINES RECOMMENDED FOR
PRIMARY CARE WORKERS
List Category
F Anti
Inflammatory,
anti-fever,
s
pain killers
(Non steroid)
F
F
F
s
s
F
Generic Name of Medicine
Aspirin tablets ,3150 dispersible,
____ ________ Remarks________
Pain killer, fever-reducing, antiinflammatory and anti-clotting
Ibuprofen tab & syrup
Pain killer, anti inflammatory
Diclofenac
Do
Paracetamol
Relief of fever, pain
Anti-allergic
Chlorpheniramine tablets
Ffor itch, allergic skin rash etc
Anti
Helminthic
agents
Mebendazole/albendazole
,tab/syrup
Broad spectrum medicine for worms
Praziquantel tab/syrup
Tapeworms
Diethyl-carbamazine tab, syrup
Filariasis
Amoxicillin oral
Broad spectrum
Erythromycin
URT and LRT infections, pus
Anti bacterials
F
~S
Furazolidine oral
Bacterial gut infections
Phenoxy-methyl-penicillin (oral)
T
URT bacterial infections, pyodermas
Trimethoprim- Sulfa-Oral
s
Broad Spectrum anti bacterial, LRTI,UTI
Doxycycline tab/cap
Some STDs, URTI
Chloroquine ,oral
Primaquine tab
As in Malaria Control Programme
"Do
Metronidazole tab/pessaries
"Do
Tinidazole tab
’Do
F
F
T
T
Anti-protozoa I
s
Anti anginal
Isobarbide
s’
Anti-anginal
Skin
medicines(External)
Miconazole
Fungal dermatoses
Whitfield ointment
Do
Gentian violet susp.
s
anti-infective
Neomycin+Bacitracin
F
F
Do
Providone Iodine
Do
Gamma BHC, Benzyl benzoate
lotion
Scabies, louse
Gentamicin & antibacterial drops
Anti-bacterial
Tetracycline ointment
Do
F"
F-
S
F
Eye
applications
’
21
2
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
F
Digestive
System drugs
Magnesium/ Aluminium salts
Antacid
Famotidine
Stops acid secretion
s
Domepridone
F
F
Promethazine/meclizine oral
Anti emetic
"Do
Dicyclomine
For colicky pain
Loperamide
Anti-motility (adults only)
Magnesium Sulfate
Cathartic
Isphagol
Bulk cathartic
s
Anti-Hemorrohidal ointment
Piles
F
Oral rehydration salts
Rehydration
F
Salbutamol oral/ inhalation
do, also as uterine relaxant
S
S
Anti-tussives
Codeine tab/linctus
To suppress dry cough
s
F
Vitamins &
Minerals
Vit D
Rickets/Osteoma lacia
Vit A
Prevent/Treat def blindness
s
s
Vit B12
specific indications
VitC
Scurvy
S
Calcium oral
calcium supplement
F
Ferrous salt oral (with folic acid)
Anti-anemic
S
Uterine
stimulant
Methyl Ergometrine tab/inj
After third stage of labour, to minimize
bleeding.
S
Local
anaesthetic
Urinary
Analgesic
Skin
Disinfectants
Injection Xylocaine
Only for wound suturing & scorpion bite
Fenazo pyridine tab
In dysuric burning pain
Chlorhexidine sol
External application
N itrofu rantoi n ointment/fra mycetin
Do
Hydrogen Peroxide
Do
Adrenaline injection
To be used in shock
Steroid injection
Acute Allergic reactions
Anti-histamine inj
(Diphenhydramine)
Acute Allergic reactions
Isobarbide
For anginaal pain
Pentazocine in
Pain killer
Nifedipine oral
High Blood pressure
S
F
F
S
S
s
s
S
¥
Emergency
medicines
22
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
COOPERATION ON NATIONAL & STATE HEALTH
PROGRAMS4
- Dr Shyam Ashtekar
The JSR can implement the following components of NHPs
_______ Program
Malaria control program
__________ Potential Role of JSR
Depot holders: Cholorquin and primaquin
PBS
Control of mosquito breeding spots with help of GP
TB control program
DOT program -detection, therapy
FW program
Condom.
OP holders,
Health education
Diarrhea diseases control program
Depot holders for ORT, antibiotics
Filariasis control program
Night smear,
DEC treatment
Blindness Control Program
Detection of childhood vision defects,
cataracts,
Vit A depot holder
Primary eye care
Child Survival
Neonatal care, feeding advice
Promoting immunization,
IEC about child nutrition,
Treatment of ARI,
Care in diarrhea,
Malnutrition-prevention and care.
4 List can expand depending upon National and State Initiatives
23
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH'
September -December 2001
Reproductive health/ Safe
Motherhood
Risk detection in pregnancy and childbirth,
distribution of iron and calcium, urine tests,
Assisting in normal childbirth,
Gynac check up,
Control of STDs
National Leprosy control program
Detection/screening
National STD control program/
Condom distribution,
Detection and treatment according to syndromic
approach
National IDD control program
School health program
IEC about salt
Screening for important illnesses
Health education-messages
Vital Registration
Keeping track of births and deaths
24
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
SUMMARY OF JSR CONSULTATIVE PROCESS AFTER THE FIELD STUDY
A
Issues
JSR
Mohammad
Continue,
_________ Dhruv______
Continue,
Shashikant
Halt, review, redesign
_________ Shyam________
Put the scheme in a system
_________ Abhay_______
Scheme in present form is
Scheme
but with
work out IEC,
the scheme
framework,
generalising a failed model
overall
prepare the
Incorporate PHC in the
redesign
therefore -
impression
system for it
system
Integrate finely with the
Halt all new selection and
prepare Clinical protocols
health system
training for review period
Consultation with various
agencies working in
community health
Completely review and
redesign the scheme
A
System
Panchayat
Community regulated model
RGM itself should
Can think of a Nigam or
Collaborative model with
framework
framework
necessary
evolve an HMO
HMO
community ownership, NGO/
of the
is enough
Think of HMOs
Start controlling the quack
CBO involvement for local
scheme
like GSS
sector
supervision and community
anchoring processes, Govt,
health system to give
resources for training, work-
linked honorarium, basic
medicines and referral
support, control of quacks
25
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -Decernber 2001
A
JSR as
Work on contract with
On contract model, with NHP
See above for my suggestion
social-
several organization: GP/
work on contract (see note
of model; may be called
marketing
CBO - SHG, YG, TU, NGO,
in appendix)
'social partnership model'
model:
PHC etc.
Each model has its own set
of requirements, Strengths,
limits, weaknesses, BUT a
clear choice is necessary
A
Pace of the
Slow down, review,
programme
redesign,
slow down,
Slow down, look for quality
Pace should be decided by
& depth of programme,
community willingness to
evaluate, look at external
take up the scheme, not
factors too
political compulsions
In present scenario it means
stopping the program for
review and subsequently
proceeding at a slower pace
based on community
response
A
JSR cell
Make a think tank from
Concur
Concur
should include
within and outside the Govt
representatives of major
health system, a cell on JSR
voluntary health networks in
in the dept
the state
26
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
A
NGO Role
Training,
Community awareness
training and
HMO experiments (Try JSR
In the first phase there
capacity
Designing/experimenting- a
monitoring
Extended RKS)
should be mandatory
building in
HMO model run by GP, NGO,
NGO network on JSR
NGO/CBO involvement for
JSR
Pvt Hosp
scheme
local supervision and
Training participation:
Organizing/networking JRSs
community anchoring
curriculum building,
House journal-CME
processes. Also role in
designing training and as
community awareness
resource person
building, capacity building
for community monitoring
B
Selection of
Let
Develop some technical
Combined Gramsabha
Recommend candidates thru
-GS meeting with observer
JSRs
Gramsabha
criteria for selection
decision and health
GS
from health dept. /NGO;
do it
health dept officer should
staff decision, rather
Entry test
minimum quorum of
steer
than leave it to GS
Collector be involved
villagers required
-Certification by GSS and
health dept, to ensure non
quack or 'non-resident
27
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
B
Women
Either take
Purdah not deterrent
Lower educational
Select women in all villages,
Select women in all villages
selection
AWW OR
problem, start the process to
requirements, ensure
if there is extra post in the
Lower edn. To 8th / to
the jsrs, do
overcome it
learning laearning
same village, take a man on
functional literacy in tribal
not take
Involve DPAP or NGO (SHG
skills by ET
that
areas
both in the
scheme) in selection process
Would prefer an all
Lower ed condition to 8th, let
Design special exam material
same village
Bonus marks for women
women scheme
entry test decide the rest.
for less educated candidates
candidates
Prepare books for entry test.
Bonus mark for unemployed
NHP money is essential,
nurses
village women make poor
PMPs
B
JSR couple
Feasible, need to develop a
Who will piggyback-the wife
protocol on this vis a vis
or husband? Women should
entry test
lead, it will take care of the
No concrete examples seen
man-selection. Worth trying
at places.
B
Old CHV
Entry test with bonus
Entry test with bonus marks
for them
marks (?)
(?)
Can select
Encourage, put bonus marks
Will work nice
Involve the ICDS dept in the
May work well in some cases
AWW, but
for them
decision, do time-study of
but evaluate the existing
then do not
AWW and then decide
workload of AWWs and their
take others
Only 5-10% AWWs are 10th
willingness to do additional
ithe same
educated (ref Dhar figures)
work
village
May not work without hon.
selection
B
AWW as JSR
Not much scope
Encourage, put bonus marks
No scope
28
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
B
Age
25-35
for favoring women,
For new people to come, put
25 - 40 to favour married
marriageable age+10 -- 10
the lower limit at 20 yrs- to
women
years (28 to 38 years)
40 to include the older ones
35-40 is Ok
Put them to an ET
B
Caste angle
select
School leaving certificate as
SC/ST/OBC should
majority
SC ST documents
get preference in
caste if
Bonus points in ET
selection (they can
Gramsabha
Concur with Dhruv
SC/ST/OBC should get
preference in selection
do honest work)
wants it-no
insistence
for
underprivile
ged castes
B
Quack-entry
in selection
many
5-10% of trainees are
5-10% of trainees are
5-10% of trainees are
5-10% trainees are quacks,
current quacks,
current quacks
current quacks, no need to
debar them as they
eliminate, but rigorous after
sabotage the basic idea
control is necessary
29
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
C
Training
Should be
Take problem solving
Enhance clinical
Redesign the manual
Redesign manual using other
content
skill-based
approach
training
Split the course in two
existing material; more
Put skills and attitudes also
practical and clinical content;
Redesign manual
accordingly, simple problems
attitude forming by exposure
in first Module like fever,
to NGOs / model JSRs; three
cold, diarrhea, malaria,
level training (literate / 5-8
scabies etc.
St. pass /High school ed.)
Complex ones later e.g
malnutrition, pneumonia etc.
C
Training
CHC with 4
criteria
Special institute/staff
Special training units
Special trainers from distt.
venue
MOs
trainer-availability
at DH is preferred for
essential for concerted and
Trg. Centre should
Availability of clinical
intensive course
committed training, Select
coordinate trg.; location part
experience venue
/select CHC in the
model center (can be
in CHC and part in SC and
The two venues can be
district
CHC/NGO) in each district,
village setting; exposure to
different
For first course, CHC
concentrate resources
NGO also; involve local
DTU, CHCs, Nursing schools
with special trainer(s)
NGOs as Training Centers,
Do it block by block
for social. IEC internship
Involve some NGOs
health NGOs in trg.
Pvt, Public, Trust Hospitals
for Clinical Internship
30
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
C
Method of
least
Least didactic
Educational aids/AV
Participatory,
Much more practical and in
training
didactic
Lecture as concept
aids
AV aids,
village setting
introducing/ info sharing
hands on training
Participatory method for
decision making and doing
C
manual
OK
n0
Rework with changes in
Not seen thoroughly
See notes on manual
venues, trainees, curriculum,
lacking in attitudinal / social
content, methods in mind
issues; also many small
mistakes / gaps
GC £
C
QC i
(P
o
o
OK for technical content but
BMO's role
C
Time too
Variable; some good
Enroll help of women
Time constraint
They have no time or
little
Entrust organizating
trainers, DTT
Orientation problem
orientation for actual trg.; at
training rather than just
Vested interests
the most can helpin
training (as a principal and
Methods problem
organising
house journal,
Regular revision / refresher
periodic contact sessions
meetings + journal + village
as a tutor)
C
f $
--
'i
CME
IEC
specialty/advance training
I 'yit
-i
■ 1 Zg
; v
House Journal necessary
House journal
supervisory visits by health
staff
C
RFWTC role
in training
Only TOT
Involve RFWTC for
Need to involve RFWTCs
Should be more in contact
curriculum setting,
down to filed level-training
with actual JSR trainings
methodology and monitoring
and monitoring
31
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -Decernber 2001
C
Exam
Not seen
papers
Not seen
Too theoretical
Revamp
Very theoretical; need to
As afterthought, more
Increase MCQs
Include practical tests-
judge attitudes and test
problem based questions
internal may be
clinical skills
rather than information
Print papers clean
based
C
Exam
Pre training Test
Conduct at district/regional
Part at dist. And part at
process
Formative assessment
town
Subcentre in working setting
Evaluative assessment
Fixed dates twice a year
Preferably as points or as
Skills-test mandatory
grades
C
Other books
Let them
List recommended books
Improve the jsr manual
Make a JSR library at CHC
use any
(Can staff sell its own
Prepare skills book/CD
and stock additional books
book
books?)
Stop privatisation of JSR
Prepare Problem based
manuals
learning block-books
containing
Curriculum, objectives,
schedules, topics, basic
information, learning
material, reference material,
exercises
32
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
C
use of
CDs as a self-learning and
CDs-In training
Record maintenance and
Infotech
self assessing process
interactive diagnosis
analysis at CHC level
exercises
Records and MIS
C
D
Involve Open
Involve Open University
Involve health NGOs like MP
other
University (Bhoj?) in
(Bhoj?) in distance
VHA; PSM depts
institutions
distance
training/certification
training/certification
Involve innovative NGOs
make it EDL based
Appended 40
Lists for course I and course
Three level (as above) - 10 /
Prepare separate list for
medicines list
II. 20/40
20 / 40 drugs
Role of
Drugs used
Involve Open University
each module
Include other systems (see
Encourage home remedies in
book H&H)
the first module:
herbal+acupressure
Add Other systems in basic
or advanced or specialist
training (Ayurved,
Homeopathy, Acupuncture,
Yoga) as per the additional
time, skill and knowledge
required
33
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
D
D
Drug Supply
Inj /saline
JP should maintain a store
Concur with D
Publish approved list for
Basic drugs (sub centre kit)
Experiment with financial
JSRs to begin with
to be supplied by PHC to
systems incl. social
Develop LOCOST type stores
JSRs free;
marketing of E D s thru'
at JP
Other drugs may be supplied
community groups : co
through LOCOST at JP
operative, SHG, Y G s, W G s
depots
Feel
Revamp the protocols, allow
Helpless-
No-stop
Protocols
No injectables to be allowed
what Injectible are
Allow programme-required
as they are not warranted at
how to stop
absolutely necessary e.g Inj.
inj (gentamycin) & ADR
this level.
and how to
TT, or
treatment injections
Widespread awareness
make it
Inj Adrenaline for snake bite,
Publish rate list
generation through GSS
viable
Inj Cyclopam for colic
start IEC and
Take strict action against
without that
Rates to be negotiated with
start action on quacks
JSR quackery and debar
the GP, user group etc.
quietly now
those who persist.
Home remedies as basic I
Develop lists for jsrs..about
Similar three level list - focus
module leading to Ayurved
40-50 medicines
on home remedies or simple
in Basic II module and also
Training for preparing some
herbal remedies rather than
as a advanced training
remedies at home
marketed preparations
A campaign to be lead by
the JSRs to stop irrational
drugs incl inj. Like Inj
Lariago and Inj Taxim in
OPD/saline in OPD
D
Ayurveda
34
SUPPLEMENTTOTH^REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
: September -December 2001
E
Cost of care
Try innovative methods like
by JSR
FCC insurance
work out rates for drug
costs+services
Co-pay the JSR for
state/NHP linked services
Try FCC insurance at places
Combination of support from
Put price lists in the village
public health system +
Women JSRs can
Panchayat managed FCC
substantially bring down the
insurance; minimal fee at
rates , as they look for
point of service
supplementary income not a
full professional income, and
F
more honest in dealings.
Honorarium
let GP/JP
for jsrs1
decide the
NHP linked
NHP linked
level
NHP linked
-Lack of regular support to
JSR is a major reason for
dropout and lack of
accountability of JSRs
-There are concretely hardly
any marked funds in NHPs
for village level activities.
-JSR should be supported by
public health system through
Panchayat with proper
monitoring of work
(technical by PHC, social by
villagers)
1 All respondents were unanimous on this issue, except the RGM and Principal RFWTC Gwalior
35
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
F
G
1500 pm upwards,
1500 pm upwards, from
JSR work is a part time
from combined
combined sources-users and
activity so about 500 pm +
surviving
sources-users and
NHP honorarium
some user fees may be
JSRs
NHP honorarium
Minimum
1000-1500
income for
pm
1500 plus pm2
Concur D
adequate
Concur D
Orientation of Gram Sabha
Community
GSS
Directed to protect users
control
framework
create administrative tools
and vill. Health committee
for GP control
can enable them to do this
JSR honorarium should be
linked to positive report from
Gram Sabha
2 Here the calculation is
Min wage for skilled labourer @ Rs 100 per day
Time reqd = 2 hours for clinical tasks, no of patients seen - treated or referred = 12
Therefore cost = 100/8*2 = 25 Therefore the JSR can charge Rs 2 to 3 per person as service charge
36
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
G
Community
IEC needs to be specified:
Ongoing DANIDA
Ongoing DANIDA work
Special material and process
IEC
E.g. Train GSS to
work should help
should help,
for awareness generation is
Recommend a JSR thru' a
Also prepare messages for
essential
mock meeting OR
JSRs and for villagers.
to inform PHC with a copy to
CMHO about > 1 case of
malaria in a village
OR to carry out chlorination
of a drinking water source
OR to seek and keep
account financial resources
as a Gram RKS
G
Legal issues
legal protection is necessary
legal protection is
First issue a clear GR on use
Legal cover for self-village
based on area practice and
necessary- based on
of remedies
based work, use of specified
drug-use
area practice and
look for provisions for
drugs
drug-use
certificate courses for jsrs
Work for a new FCC act to
use all system remedies
G
Relicensing
Necessary
Necessary
Necessary every 3 years
Necessary and based on
both technical performance
and community feedback
37
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
H
Mainly NHP linked support,
Can give some NHP related
community to uptake NHP
Prepare a simple recording -
support but should not use
linked services of staff
& reporting system
JSR as errand boy; no
Linkages
As colleagues, to mobilize
with
ANM/MPW
NHP-linked support
vertical relationship
Create pathbreaking
reporting system later to
expand it to all pvt
practitioners
I
Clinic site
Let GP
Concur M, GP at least
GP space must be
Some public space is
provide
facilitate getting space for
available, but let
necessary to define the
space for jsr
the clinic
them work also from
practice and facilitate GP
home for odd hour
control
clinic
Concur Shashikant
services
I
Boards
Provide standard boards
'Gram Swasthya Kendra'
from dept
board specifying name of
JSR; may be prepared by GP
in standard format
I
Clinic
Work out simple userfriendly
Avoid paperwork
Simple, standard, scannable,
Very simple, analysable and
records
relevant record-formats
overkill
small, MIS-friendly formats
only relevant records
38
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
I
About
It has a good range of
clinical work
Not satisfactory
Increase both depth and
Not at all satisfactory;
illnesses covered with
range—thru training
resembles quack practice
jsrs are
treatment or referral incl.
/support
with just a few differences
doing now
asthma, High BP, skin
like use of ORS; lot of
infections, pneumonia in
overuse of drugs including
children, migraine, acute
antibiotics and parenterals
abdomen, difficult labor,
burning micturition, incising
an abcess under local
anesthesia
It is not systematic: no
evidence based diagnosis
but based on experience.
Treatment based on 'my
guru taught us' rather than
rationally essential
It is filling the gap between
the clinical needs and its
services
To be steered with
protocols, CE and
supervision
39
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
I
Clinic Model
Let HMO setup a clinic
Develop a standard set, let
model
RKS like bodies build the
centers if and when possible,
this will give some credence
to the JSR as system
I
System
Let HMO decide : apron with
identity
a a colored emblem3
Not necessary
Give them Logos/ part of
Personal emblems to be
uniform (T shirts/Kameez)
avoided; let the JSR remain
a part of the village and not
a special being; however kit
gives a work-related identity
J
Survival rate
10%
10%
10%
10%
<10%, varies somewhat
from area to area
Working
JSRs out of
trained
J
What do you
Dismal right now but
feel about it
opportunity hopeful
Dismal
Is an opportunity to redesign
Only a miraculous change of
the scheme
mindset among decision
Several potentials : young
makers or major social
JSRs;
movement can transform
Nascent but widespread
this scheme
model;
several players with strong
support from CM/RGM
3 Please see a dummy logo for GP JSRs as JSRLogol.gif
40
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
K
Funding
For experimenting &
For experimenting &
For experimenting &
Adequate funding is required
developing JSR
developing JSR
developing JSR
at all levels; present funds
for the scheme are grossly
inadequate
L
Area size (
2000, ideally
2000, ideally
2000, ideally
Making the scheme purely
to make the
let it be decided by GS/GP if
let it be decided by
let it be decided by GS/GP if
fee-based is neither
scheme fee-
it can support the jsr
GS/GP if it can
it can support the jsr
desirable nor very feasible
sustainable)
differently (like insurance)
support the jsr
differently (like insurance)
differently (like
insurance)
L
Village
Take villages as they ask &
Take villages as they
I Concur with S & D, make it
Concur with others; let
selection
prepare for the scheme, Not
ask & prepare for the
a ongoing scheme, not the
villages take the initiative
somehow roll all in the same
scheme, Not
fight to finish kind of scheme
batch
somehow roll all in
the same batch
41
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
L
Links with
Standardize internship roles
Dangerous area, but need
Present danger of quack-like
Other PMP
of J SR and the instts
for a pragmatic and
linkages is very high;
Standardize institutional
systematic approach
primary linkage should be to
criteria
Need to accredit/list
Govt, centres or charitable
List such facilities
clinics/hospitals where they
centres only
Decide a stipend to be paid
can officially intern,
by the instt for the labor
discourage quack influence
(The stipend offered as
(better to make DH facility
student may be contd.)
available)
GP. GenPhysician, &Co OR
trust hospitals, PHC, CHCs
and Civil Hosp, homeopathic,
ayurvedic, etc. can be
internship instt when these
skills are taught
L
Social
Need to study in greater
Possible only if a regular
Basic preventive services are
marketing of
depth, and in the light of
clinic space is available,
practically never sold by the
preventive
social marketing done by the
list articles/services that the
public health system and
services/goo
health dept itself
community can buy or the
should not be; they are a
JSR can sell (condoms,
part of basic social services
nailcutters, etc)
to be available to all
ds
42
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
L
Prevntive
NHP,
NHP/SHP
JSRs can do some general
programmes
Health Education incl.
Give them school health
and some village-specific
School Health Education
programmes on some
activities with Panchayat
Health Promotion activities
honorarium
honorarium
like games, yoga, exercise
L
Supervision
Service supervision/
Set up a special cell, under
Technical: public health
Monitoring &
monitoring:
JSR cell, give contracts to
system
Quality
HMO+GSS+NGO+RKS+RFW
NGOs for technical
Social: vill. Health committee
Control
TC
monitoring with help of SC
/ Gr. Sabha
Technical
staff.
Support: NGO / CBO
supervision/monitoring:
Prepare feedback system
HMO+PHC+NGO+RFWTC
Inform the villager/users
Legal
about the process, about
supervision/monitoring:
his/her role
PHC+NGO
M
Community
GSS/BIJSS/JJSS + PHC +
Involve NGOs thru JSR cell
concerns
NGO should review it
in studying these aspects,
Involve sensitive women
officers. Share with
providers & users regularly.
43
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH: September -December 2001
M
Complaint
Rep of NGO/CBO (women) +
Put a box in Grampanchayat
Cell
DHO + MPO (women) + CF
& Janpad, JSR cell should
Chaired by NGO/CBO and
keep files of press clippings.
DHO alternatively every
three years
Should look into matters not
controlled by supervisors/
monitoring persons
44
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
JSR-T RESPONSES TO QUESTIONNAIRES
Methods used
Category
Frequency
1
Mannual Reading
53 theory
2
Practical
30 practical
3
Not yet(training yet to start)
26 Unclassifiable
4
Oral / lectures
24 theory
5
NR
33 Unclassifiable
6
PBS (practical)
21 practical
7
Theory (lecture?)
20 theory
8
Showing Patients
16 practical
9
Hospital Practical
15 practical
10
Exam
13 theory
11
Pictures
12 visual
12
Lab Practical
11 practical
13
Chart
9 visual
14
Dressing
8 practical
15
Post Mortem
8 practical
16
OPD Work
7 practical
17
Illness /Treatment
7 Unclassifiable
18
Discussion
6 participatory
19
Sanitation
6 practical
20
Group
5 participatory
21
Injection
4 practical
22
Medicine room /medicine
4 practical
23
Nothing
4 Unclassifiable
24
Field Work
3 practical
25
Black Board use
3 visual
26
Medical Treatment
3 Unclassifiable
27
ANC
2 practical
28
Experiment (?)
2 practical
29
Leprosy Clinic
2 practical
30
NHPs
2 practical
31
Physical Exam.
2 practical
32
Techniques (?)
2 practical
33
Ward Work
2 practical
34
Anatomy
2 theory
35
JSR Role
2 theory
36
Role
2 theory
37
Diagrams
2 visual
38
Sputum test
1 lab
45
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
39
About Tablets
1 practical
40
Body Mapping
1 practical
41
Dispensing
1 practical
42
Environment (?)
1 practical
43
History taking
1 practical
44
Immunisation sessions
1 practical
45
Patient Observation
1 practical
46
Records
1 practical
47
Registration
1 practical
48
Chitthi nikalna
1 practical
49
Explanied about Role
1 theory
50
Physiology
1 theory
51
Written (?)
1 theory
52
Demonstration
1 visual
53
video
1 visual
54
FP (?)
1 Unclassifiable
55
Gastro (?)
1 Unclassifiable
56
Health Science (?)
1 Unclassifiable
57
Malaria
1 Unclassifiable
58
Malnutrition
1 Unclassifiable
59
Many methods
1 Unclassifiable
395
Grand total 59 items
Subjects covered in training
Freq
1
Immunisation
60
2
Malaria
57
3
Anatomy
45
4
ANC
27
5
JSR Role
24
6
MCH
24
7
Dressing
23
8
FW
23
9
GastroEnteritis
22
10
Leprosy
21
11
Not Yet
21
12
TB
21
13
PBS
20
14
Baby Care
18
15
AIDS
17
16
Sanitation
17
17
Illnesses
16
46
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
18
Mai Nutrition
19
Diarrhoea
13
20
WaterSafety
11
21
Child Birth
10
16
22
dignosis
10
23
Physiology
10
24
Registration
10
25
ARI
9
26
NR
9
27
Skin
9
28
Anatomy/Bones
8
29
Chitthi
8
30
ORS
8
31
Infections
7
32
Injection
7
33
Typhoid
7
34
NHP
6
35
Nutrition
6
36
OPD
6
37
Anatomy/Muscle
5
38
Heart
5
39
Polio
5
40
Anatomy/Head
4
41
Dental
4
42
Maleria
4
43
Medicines
4
44
Observing Patients
4
45
Pulse Polio
4
46
Tablets
4
47
Womens Health
4
48
Anatomy/Blood
3
49
Anemia
3
3
50
Blindness
51
ENT
3
52
Health
3
53
Help Staff
3
54
Obs/gyne
3
55
Prevention
3
56
STDS
3
57
Vomitting & Lm
3
58
Ayurvedic
2
47
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESHSeptember -December 2001
59
Coding(?)
60
Cold Cough
2
2
61
Eye
2
62
Gramswasthya samiti
2
63
Health/Edu
2
64
High Risk
2
65
IMR
66
Jaundice
2
2
67
Malnourished Women
2
68
Medical Checkup
2
69
Pharmacology
2
70
Primary treatment
2
71
Village Sanitation
2
72
Whooping Cough
2
73
Allopathic
1
74
Anatomy/Skeleton
1
75
Antibiotic
1
76
Breathing
1
77
Cataract
1
78
Checkup
1
79
Child Birth(risk)
1
80
Cholera
1
81
Code Of Conduct
1
82
DPT
1
83
Fever
1
84
Fever Inj/Tab
1
85
Field Work
1
86
First Aid
1
87
Health edu
1
88
Health Pramotion
1
89
Health/Edu.
1
90
Homeopathic
1
91
Illness causes
1
92
Illness Treatment
1
93
Leprosy & Naru
1
94
Lungs
1
95
Maleria PBS
1
96
Malnutrition
1
97
MCH FW
1
98
Measales
1
99
Pathology
1
48
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
100 Pharmacoloty
1
101 Practice of Medicine
1
102 Responsibilities
1
103 Safe motherhood
1
104 Serving People
1
105 Surgery
1
106 Symptoms
1
107 Tounge
1
108 Village Safety
1
109 Vital Registration
1
110 Vitamin A
2
111 Vitamines
1
112 Wound Treatment
1
774
Gr total 112 list items
Opinion about training
Frq
1 Good
49
2 Little use
4
3 NR
9
4 OK
17
5 Very good
122
6 Very little use
3
Gr total
204
Interim Exam
Frq
1 Not Yet
128
2 Oral
27
3 Monthly & Tri monthly
13
4 NR
12
5 yes
6
6 Oral & Written
6
7 Two tests
4
8 Monthly
4
9 About illnesses
2
10 Tri monthly
1
11 question Bank
1
204
Total responses
More medicines they want
Freq
1
1 Not Yet necesary
88
2
2 Injection
78
49
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
3
3 Saline
29
4
4 Antibiotic
21
5
5 NA
12
6
6 Pain killers
11
7
7 Vomitting remedy
9
8
8 Dihorrea medicines
9
9
9 GastroE medicine
8
10
10 Unreadable
6
11
11 other+ More Medicines
6
12
12 All Medicines
6
13
13 TB Drugs
5
14
14 Malaria medicine
4
15
Abd. Pain remedy
4
16
Tyiphoid medicine
3
17
Reaction medicine
3
18
X Ray /Plaster
2
19
Vitamin
2
20
Paracetomol
2
21
No Mannual (so don't know)
2
22
Like Doctors use
2
23
Life Saving Medicines
2
24
Jaundice Medicine
2
25
Immunisation
2
26
Cough medicine
2
27
Cotrimoxazole
2
28
Clomine Tab
2
29
Ayurvedic medicines
2
30
Top Antibiotic
1
31
Temperature medicine
1
32
Skin Illnesses medicine
1
33
Safe Antibiotic
1
34
PV Bleeding medicine
1
35
Pulse(?)
1
36
Plaster
1
37
NR
1
38
No Other
1
39
No More
1
40
Nimesulide
1
41
Nil
1
42
Mebendazole
1
43
Laxative
1
i
I
50
Septernbe^-December 20o?RT °f CHCELL STUD'' °F “ SCHEME °F
7
Metro Entro furran
1
8
Metro ORS
1
9
NA
10
Not yet trained
11
NR
12
ORS
13
ORS / Fluids
80
14
ORS furazolidine
1
15
ORS Home fluids
1
16
ORS Medicines
28
17
ORS Metro
1
18
ORS Referal
6
19
ORS SSS
20
ORS SSS Home fluids
21
ORS TAB
22
ORS Home fluids Lomofen
1
23
ORS Home fluids SSS
1
24
ORS Norflox Dygine
1
25
ORS Paracetamol B Plex
1
26
Pulse (checkig)
1
27
Referral
28
Reglan Home fluids ORS
1
29
Saline Metro
1
30
SSS
1
31
SSS Home fluids
1
32
SSS Metro
1
33
SSS ORS
1
34
SSS ORS Home fluids
2
35
Tab ORS
1
36
Tab SSS
1
1
3
32
12
3
7
1
2
Total responses
Fever diagnosis
PRADEK
204
Freq
1
By Symptoms
1
2
Check Hands
4
3
Chills
1
4
Chills Body Ache
1
5
Chills Fever
1
6
Chills headache
1
7
Chills headache PBS
1
8
Chills PBS
1
56
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
9
Chills Pulse
1
10
Chills Temperature
1
11
Fever
1
12
Fever Sweating
1
13
Fever BP
1
14
Fever Chills
1
15
Fever Chills Symptoms
2
16
Fever Chills etc
1
17
Fever chills History
1
18
Fever Chills PBS
1
19
Fever headache
1
20
Fever History
1
21
Fever History Pulse Temp.
2
22
Fever History symptoms
1
23
Fever PBS
1
24
Fever Pulse
1
25
Fever Pulse Symptoms
2
26
Hand Check up
1
27
headache Bodyache
1
28
HiistoryTemperature Pulse
2
29
History
1
30
History Symptoms
1
31
History pulse
1
32
NA
1
33
Not yet trained
2
34
NR
7
35
PBS
1
36
PBS Chills
1
37
PBS Pulse
1
38
PBS Temperature
1
39
PBS-Eyes lips skin
1
40
Pulse
2
41
Pulse Fever Symptoms
2
42
Pulse PBS
6
43
Pulse Temperature
8
44
Pulse Temperature Symptoms
5
45
Pulse Temperature Symptoms
3
46
PulseTounge eyes etc.
3
47
Symptoms
4
48
Symptoms PBS
4
49
Temperature
8
57
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
50
Temperature Checkup Saline
5
51
Temperature chills
5
52
Temperature History
6
53
Temperature PBS
7
54
Temperature Pulse
7
55
Temperature Pulse Breathing
9
56
Temperature Pulse Nails
12
57
Temperature Pulse PBS
21
58
Unreadable
34
204
Total
Malaria diagnosis
freq
1
Not yet taught
38
2
PBS
30
3
Fever Chills PBS
23
4
NR+ NA
19
5
Fever chills + chiils fever
22
6
Chills Fever PBS + chills PBS
15
7
Chills PBS
12
8
Chills
6
9
Chills headache
4
10
Chills Fever AD
3
11
Symptoms PBS
2
12
Fever chills symptoms
3
13
Chills Fever headache
2
14
Yellow Eyes
1
15
Temperature PBS
1
16
Temperature headache
1
17
Symptoms PBS Pulse
1
18
Pulse Fever AD
1
19
PBS Fever
1
20
Malaria Chills Fever AD
1
21
History chills PBS
1
22
Hand Checking
1
23
Fever Pulse PBS
1
24
Fever Pain PBS
1
25
Fever headache chills
2
26
Fever chills headache PBS
1
27
Fever Chills referal
1
28
Fever Chills Pulse
1
58
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
__
________________
29
Fever chills AD + Chills AD
1
30
Fever AD PBS
1
31
Fever AD headache
1
32
Chills Weakness PBS
1
33
Chills headache PBS
1
34
Chills headache fever AD
1
35
Chills Fever Vomitting
1
36
Chills Fever headache PBS
1
203
Total
Treatment of malaria
Freq
1
NR
134
2
Chloro T
37
3
Malaria T
7
4
Chloro T Para T
6
5
Referral
4
6
Chloro T Inj
3
7
Not yet trained
2
8
Tablets
1
9
PBS
1
10
Paracetamol T
1
11
History PBS
1
12
Cold Sponging
1
13
Clean Water
1
14
Choloro T
1
15
Chlorto T Para T
1
16
Chloro T Referal
1
17
Chloro T Prima T
1
18
Water disposal
1
204
Total
How will you develop the jsr work
Freq
1.
All Services
1
2.
As a duty
1
3.
As Good JSR
2
4.
AS JSR
3
5.
Clinic (run a clinic)
8
6.
Clinic Health education
1
59
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
7.
Comprehensive Health
1
8.
Contacting Families
1
9.
Field Treatment
1
10.
FW Health Education
1
11.
FW Health Promotion
1
12.
FW and Prevention
1
13.
Giving Medicines
1
14.
Good Doctor
1
15.
Good JSR
2
16.
Good Work
2
17.
Health Awareness Sanitation
1
18.
Health checkup
1
19.
Health Education
24
20.
Health Education and Records
1
21.
Health Education Treatment
3
22.
Health Education Water Purification
1
23.
Health Programs
1
24.
Health Services
3
25.
Ideal Village(making)
1
26.
JSR (by being one)
17
27.
Learn with a good doctor
10
28.
Learn with a good doctor & Low Cost
3
29.
Learn with PHC Doctor
1
30.
Loan and FW
1
31.
Low Cost Treatment
4
32.
MCH
4
33.
Medical Store (will run one)
2
34.
Medical Treatment
26
35.
Medical Treatment Health Education
1
36.
Medical treatment MCH
1
37.
Medical treatment referal
1
38.
NA
12
39.
NHP Information
1
40.
NR
14
41.
NY
1
42.
Public Awareness
1
43.
Sanitation
5
44.
Sanitation Health Education
1
45.
Sanitation Education
2
46.
Sanitation FW
1
Serve People
14
47.
60
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
48.
Through GSS
2
49.
Treatment Referal
1
50.
Unique (?)
1
51.
Unreadable
1
52.
Village care
1
53.
Water Safety
1
54.
Win Trust
9
55.
Womens' Health
1
204
Total
Want an image of
Freq
56.
JSR
63
57.
Doctor
56
58.
Good JSR
14
59.
NR
14
60.
JSR -doctor
8
61.
Compounder
6
62.
Lady Doctor
6
63.
Serving People
5
64.
Good Citizen
4
65.
NA
3
66.
Serve people
3
67.
Social worker
3
68.
Honour (want honour)
2
69.
Medical Treatement
2
70.
A Small Doctor
1
71.
As Good JSr
2
72.
As Healer
1
73.
Care for people
1
74.
Citizen
1
75.
Clinic
1
76.
Doctor & Volunteer
1
77.
Doctor-J SR
1
78.
Family Doctor
1
79.
First Contact Care
1
80.
Godess
1
81.
Healer
1
82.
Volunteer
1
83.
Well Wisher (of village)
1
Total
204
61
“SXeZ JOO?" " CHCELL SrUD¥ °F JSR SCHEME °F “““ ™DESH:
Dreams of the trainees
Freq
84.
JSR
85.
Health For All
27
86.
Medical Treatment of all
19
87.
Serve Village
13
88.
Doctor (to become one)
11
89.
NR
90.
As Good JSR
8
91.
Health Education
5
92.
Good JSR
5
93.
Better Health Services
5
94.
Start a clinic
4
95.
Prevention
4
96.
Village Development
3
97.
NA
98.
Healthy Village
99.
Govt. Help
3
100. Good Work
3
101. Good Treatment & Referal
3
102. Win trust
2
103. Serve People & family
2
104. Progress of self
2
"
36
10
3
3
105. Healthy People
2
106. Health Facility in village
2
107. Earn respect
2
108. Earn Money
2
109. Community Health
2
110. Village Sanitation
1
111. Study
1
112. Right Referal & Good Rx
1
113. More Knowledge & Honour
2
114. MCH
1
115. Low Cost Treatment
1
116. Lady Doctor (become one)
1
117. Injections to Poor
1
118. Improvement of Village
1
119. Hospital Term
1
120. Honour & Income
1
121. Help People
1
122. Good Citizen
1
123. FW & Healthy People
11
62
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
124. Free Medicines Supply
1
125. For revision (for previous practice)
1
126. Facility in Village
1
127. Earn as doctor
1
128. Doctor(become) & Healthy People
1
129. Do my duty
1
130. Development
1
131. Better Health
1
Total
204
63
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
JSR-W RESPONSES TO QUESTIONNAIRES
Genera! Info
Issue
Results
Total JSR-w
22
gender
all M
average age
29y
range of age of jsrW
21-46
education
10(1), 12th(14), Gr/PG(7)
working since
0-5 yrs, average 2.7 yrs
distance from work-village
0-lkm(16),,,
2k(2)
W)
W)
12+(2)
Selection
Selection by
GP/GP&merit(13),,
GS/janpad (2)
Gramsabha(3)
sarpanch(l),
other(l)
SCST
10 (non scst-12)
Ro/e&COC
6tasks listed
Medical Treatement
12
Water Purification/BI powder dist
11
PBS/chloro T
9
Help NHPs
8
Sanitation
7
Referal
7
FW+oral pills
7
Immunisation/help in
6
64
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Epidemic Info,
6
registration of VE
6
MCH
5
Help Health Staff
5
Health Education
4
Pulse Polio
3
Epedimic Control
2
5 Safesfor child birth
2
Tablet (giving tablets)
1
Serve People
1
ORS
1
103
Any Code of Conduct
Yes (11), no/do not know(ll)
Describe COC
i jnost listed the tasks, not COC)
Nutrition Edu.
1
NR
7
Medicines
1
Injection
1
Illnesses
1
Home visits-ANC
1
Help in Med. Camp
1
Help People
1
Health Services
1
Fever Dign.
1
Dressing
1
Child Birth
1
ANC-TT/ANC
2
Age of Marriage ( awareness)
1
Advice Patients
1
22
Time given everyday
Whole day
1
half day
10
Morning evening
1
NR
10
Training issues
First training venue
CMC
5
65
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
PHC
14
Distric Hosp
1
NR
2
Second training venue
Ay. Hosp.Bhopal
1
CHC Mazgawa
1
Morn. Even
1
SC Pindra
1
Sub Centre Raygaon
1
Victoriya Hosp.
1
DH Bhopal
1
training batch strength
range 7-75, average 22.5
Received book/manual
All except 2, all found it useful
Training techniques
Fr of mention
Lecture
10
Practical
7
Dressing
6
PBS
5
Pulse Polio
3
OPD+pt observation
3
Injection Room
3
Discussion
2
Syringe Wash
2
Immunisation
2
Registration
1
Compounder room
1
Saline
1
Sub Centre Work
1
Med.Training
1
experiment
1
Illneses(NR)
1
Subjects taught
Fr of mention
Water safety
5
Stitches
1
STDs
1
Sanitation
1
66
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Registration of VE
1
Referal
2
Prevention
1
Polio immunization
3
Physiology
1
PBS
5
pathya ayurveda
1
parcha nikalna
1
ORS
2
Oral pills
1
Observing Patients
1
NR
2
NHP
2
Medicines
6
Medical Treatment
4
malaria
1
Leprosy
1
Lab
3
Immunisation
2
Illnesses
1
Home Remedies
1
Health Education
1
Gastro
1
FW
1
First Aid
2
Dressing
6
Diagnosis
2
Chloro T.
1
Child Illnesses
1
Catract
2
ARI
1
ANC/Child Birth
1
Anatomy
3
5 safes
2
74
Interim tests
Interim tests
Yes(22)-
monthly/writtn/oral/practical
Final test
all respondants said yes-written
tests
67
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Results of final test
17 P, 4 await Result (but practicing)
Certificate
3 NR, 3 await, 14 have Cert
Cert obtained at
PHC/CHC/DH/Janpad/ZP/ etc
Other training
7 with a PMP, lofthem vaidya,
1 other had acupressure training
WorkofJSRs
Time of work
Fr of mention
8 hr
1
12 (8to8)
1
Morning
1
Morning Even.
10
Regular
1
Whenever necessary
2
NR
6
22
Place of work
At Home
9
At Home & Clinic
4
At Home & Clinic & Visits
1
At Home Special Room
1
clinic
4
Out doors
2
NR
1
22
pts seen last month
range 0 to 8-300.(3 NR),
averge 48 pts per month
women pts last mo
3 to 100, average 14.6, 4 NR
keeping pt register
13 not keeping, 7 keep, 3 NR
main illnesses mentioned
Fr of mention
Fever
18
Diarrhoea
16
Vomitting
16
Malaria
13
Boil
11
Cough Cold
11
Abdominal Pain
8
68
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
ARI
8
Cold
7
Eye illnesses
7
Injury
6
Itch
5
cough
4
Gastro
4
Measeals
3
Headache
2
Headache& Bodyache
2
Mai nutrition
2
Scodpion Bite
2
Tootache
2
Asthma
1
Burns
1
Chills
1
Constipition/worms
2
Ear Pain
1
Joint pains
1
Leprosy
1
Mahamari
1
Minor Aliments
1
Pain
1
Seet?
1
skin illness
1
STD
1
Typhoid
1
Weakness
1
Total entires
163
Medicines/skills
Listed drugs
Fr of mention
Para T
22
Chloro T
19
ORS
10
Cotrimoxazole
9
Avil
8
Dexa
5
Metro T
5
Analgin T.
4
CPM
4
69
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Diclofenac
4
FFA
4
Furadine
4
Peri norm
4
Septran
4
Antibiotic
3
Bleaching Powder
3
Chlorine T
3
Reglan
3
Savlon
3
B Plex
2
Betnesol
2
Gauze
2
Terra cap
2
Amoxicillin
1
Ampoxine
1
Antacid
1
Beta dine
1
Brufen
1
Cipro
1
Combiflam
1
Genta
1
I nj Dexa
1
Inj Diclof
1
Inj Genta
1
Inj Oxy Tetra
1
InjTT
1
Mebandazole T
1
MVT.
1
Ointment
1
Prima T.
1
Sinarest
1
Spasmolytic
1
Spirit
1
TC?
1
TinctureB
1
NR
1
Listed items 46
152
Ay med & home Remedies
Adrak
2
70
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Adrak+Tulsi
1
Ajvayan
2
Chavanprash
1
Chiryata
1
Cystone
1
Dal Water
3
Garlic
1
Gassex
1
Hadki
1
Hingushtak Churna
1
Kali Mirch
1
Kasamrut
1
Kharwadiya (khadirawati?)
3
LB Churna
1
Lime
1
Live 53
1
Loung
2
Lonug Oil
1
M2 Tone
1
Mustard Oil
1
Neem
1
ORS?Sponzing?
1
Panchasakar Churna
1
Rice Water
3
Shankhapushpi
1
Tapina Goli
1
Trifla
1
Tulsi
1
No/NR
7
listed items 23 incl ORS
45
Conditions& injections
Condition/complaint
Injection used
AB Pain
Ana Forten
Allergy
Avil
ARI
Ampi
ARI
Genta+ decadron
ARI
Taxim +dexona
Boil
Genta+Diclof
Boil
Oxy Tetra
Cold ,Asthama
Dexa
71
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Cold Fever -
Genta
Cold/Boil
Genta
Emergency
NR
Fever
Chloro
Fever
Dexa
Gastro
Reglan
Injury
TT
Itch
Evil
Maleria
Chloro
No.
No inj
NR
NR
On PMP Ad
unnamed
Pain
diclof
Scorpion Bite
CPM +Dexa
Vomitting
MET
SUMMARY
users 5in(2), 4inj(2)z 3inj(l), 2inj(l), I inj(3), 0 inj (7), 5 NR
2 JSRs use it only for Scorpion bite (CPM Dexa)
Two say they give it on PMP's advice
15 commonly used injections
Ampi
Ana Forten
Avil
Chloro
Chloro
CPM +Dexa
Dexa
Dexa
Diclof
Genta
Genta
Genta + dexa
Genta+Diclof
MET/perinorm/reglan
NR
Oxy Tetra
Taxim +dexona
unnammed
72
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Common situations for injections
Abdominal Pain
Allergy
ARI
Asthma
Cold
Boil
Emergency
Fever
Injury
Malaria
Pain
PMP advice
Scorpion Bite
Vomitting
15 injectable are listed, Bplex does not find a mention
Ampi
Ana Forten
Avil
Chloro
CPM
Dexa
diclofenac
Avil
Genta
Decadron
MET
Oxy Tetra
Regia n
Taxim
rr
condition for giving saline
Freq
By prescription of other PMP
1
can not drink
1
Dehydration
4
Emergency
1
Ex Dihhorea
1
Ex Vomm.
1
GastroEnteritis
3
Low BP
1
73
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Do not give saline
9
NR
4
Dirrhoea
1
Heat (ayurvedic concept)
1
High fever
1
10/22 jsrs give saline, listed conditions 13,
want to use medicine not mentioned in manual
Other medicnes
fre of mention
Amox
2
Ampi.
1
Ampoxin
1
Cipro
2
Combiflam
1
Dexona
1
From Store
1
Genta
1
Metro
1
Mikacin
1
Nimesulide
1
No Other
10
NR
5
Pudinhara
1
Soframycine
1
taxim
1
Tetramycin
1
32
want Info of these meds
Fr
Injection
6
saline
4
NR
7
No Other
2
Aciloc
1
AIDS Medicine
1
All
1
Ampoxi
1
Ampoxin& Other 7
1
Ayurvedic Compounds
1
Elderhit
1
For Abd. Pain
1
74
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Homeopathy
1
Many
1
Netobion
1
Ranitine
1
Spasmolytic
1
Tablets
1
Taxim
1
tricort
1
35
Skills emploed by jsrs
Fr
History taking
8
Pulse
8
BP
5
Stetho
5
Check up
4
Thermameter
4
PBS
3
Weight
3
Temperature
2
Toung Check up
2
Blood check
1
Eye & Nails
1
NR
2
Palpation
1
torch
1
vacc,currete
1
51
(the idea of skill is not very clear, so confusing answers)
want to learn more skills
Injection
3
Stiches
3
All Illnesses
2
Dignoses
2
High Treatment
2
More Training
2
Saline
2
Accupressure
1
ARI
1
Ayurvedic
1
Better training
1
75
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Doctor/Compounder skills
1
High Bp
1
Homeo
1
I & D abscess
1
Lab
1
Like Doctor
1
Medical Treatment
1
Medicines
1
NR
1
NR
1
Reki
1
Special Training
1
Sujog & Magnet
1
toothache (treatment)
1
Total
34
many options, so total (34) exceeds 22 w jsrs
Clinical practices
Treatment for Diarrhoea
Fr of mention
ORS
8
HF
3
ORS ,ParaT.Metro T
2
ORS HF
2
ORS HF Metro
2
ORS Metro
2
Anti D Tab.+ORS
1
ORS Furadine
1
SSS/ORS+Antibiotic
1
Total
22
Fever Dig
Fr
Fever chills
5
Chills Fever Symptoms PBS
1
Eye,toung,Pulse checkup
1
History Symptoms
1
History Temperature
1
Malaria?
1
NR
2
Pain Chills etc
1
PBS
1
Pulse PBS
1
76
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Pulse temperature
1
Symptoms
1
Temperature/thermometer
2
Temperture,Eye weight,PBS
1
Touch
1
blanket-wrapped & Thermameter
1
Total
22
malaria diagnosis
PBS
13
Fever chills PBS
3
Fever Chills Symptoms PBS
3
Fever Chills
1
Fever Sweating PBS
1
Fever chills
1
T
22
malaria action
Chloro T.
7
Chloro T. Para T
2
Antibiotic + Para T.
1
Chloro T.
1
Chloro T.
1
Chloro T
1
Chloro T.
1
Chloro T
1
NR/not taught yet
7
Total
22
2-30 range. Average 9.47, 5 NR
PNC is the major backup for referral
Govt centers for referral
PNC
11
NR
6
CMC
4
NR
1
22
Ref-causes last month
Fr
Fever/high fever
10
Diahrroea
7
Malaria
4
77
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Injury
4
Gastro
4
Vomitting
3
Fracture
3
Child Birth
3
ARI
3
Anemia
3
Snake Bite
2
Measeals
2
Cancer
2
ARI
2
Urine ret.
1
Unconscious
1
TB
1
Swollen Feet
1
skin illnesses
1
Poisioning
1
PBS ( no slides)
1
Malnutrition
1
Immunisation
1
High BP
1
Headache
1
For saline?
1
For injection
1
Family welfare
1
Eye Problems
1
Ex Vomitting
1
cough cold
1
Cold Fever
1
Chronic fever
1
Bone Illnesses
1
Blood Spit
1
Appendicitis
1
Acute abdomen
1
Abdominal pain
1
Ref causes 39
76
39 causes, 76 incidents of referral tp PHC/CHC
Income/financia!
Average fees earned
No fees/don't pay
8
78
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH'
September -December 2001
5 RS
5
NR
4
2 RS
1
7 Rs
1
10 Rs
1
15 Rs
1
NR
1
5 Rs
22
Range of fees earned
Freq
No fees
5
NR
3
5 to 10
3
5 to 20
2
2 to 5
2
2 to 10
2
5 to 5
1
10 to 40
1
10 to 15
1
Ito 5
1
Ito 2
1
22
monthly income
Fr
0
7
500
4
100
2
200
2
800
2
NR
2
300
1
1200
1
1500
1
22
Monthly income , including non earners is 360,
Av income excluding Non earners is 553Rs
Income-satisfaction
No
15
NR
3
Yes
3
Unhappy
1
79
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Total
22
Any Other work?
NR
6
No
5
farming
4
half day
3
NR
2
Yes
1
Farming & Bazar
1
22
TRYSEM loan
No loan
21
yes-got it
1
Lnkages/support
Links with health personnel
Fr
MPW/ANM
7
MPW
3
ANM/MPW7LHV
2
None
2
ANM
1
Govt. Doctor
1
MPW ANM Dai
1
MPW/ANM/AWW
1
MPW/AWW
1
NR
1
PNC
1
PNC staff & PMP
1
22
Contact with staff last month
NR
9
No
8
MPW
2
Immunisation
2
Helped Staff
1
22
Actual Support from Village Staff
Fr
NR
5
80
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
No
5
Sub Center Staff
2
PHC
2
MPW/ANM
2
MPW/ANM/ Dai
1
Compounder
1
ANM/MPW/LHV
1
ANM & CMC Staff
1
ANM
1
All
1
22
PHC/CHC Meeting attended by /called for JSR
Fr
No Meeting
5
NR
5
4 meetings
4
Yes
3
2 meetings
2
Monthly once
2
5 meetings so far
1
22
Subject in Meeting
Fr
No subject
7
NR
5
Malaria Pneumonia, bleeching powder
3
“
2
FW
Dihorrea/ARI/Blindness/Meseals
1
JS Abhiyan + Child Nutrition
1
Malaria & Gastro
1
Nutrition, DihorreazMCH
1
Seasonal illnesses
1
22
TA/DA for Meeting
NR
10
No
12
22
Material Supplied at Meeting
Fr of mention
NR
11
81
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
No
8
Poster
2
NHP forms
1
22
Suggestions for meetigs
NR
11
Other Doctors should also attend
3
Hon. Rs.2000/-pm.
1
None
1
OK
1
Solve Our Problems
1
TA DA & medical Supply
1
TA DA Hon.
1
Teachabout Medical Treatment
1
Want Meeting
1
22
Referral to PMP ?
Fr
No
12
NR
6
Yes
3
Nil
1
22
No ref to PMPs?
Fr
No ref
12
NR
6
Yes
3
Nil
1
22
PMP resp?
Fr
NR
17
Yes (good)
2
Help ful
2
PMP Feels I am a threat.
1
22
Monitoring?
There is no monitoring
7
NR
6
82
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH'
September -December 2001
NR
3
Good (?)
1
Desired but none
1
BY PHC Compounder
1
BY BMO &BEE
1
Yes, by PHC staff
1
SC Staff
1
Total
22
PHC-help?
NR
7
No Cooperation
3
NR
2
Yes-treatment Edu.
1
Yes-ORS,Op, Chloro T-supply
1
Yes-OP ORS, Bleeching Powder-supply
1
Yes Many ways
1
Medicines (they support)
1
In Emergency (they support)
1
In difficulties (they support)
1
Guidence (they give)
1
Govt. Doctor & Ward Boy helpful
1
Desired
1
22
Suggestions for PHC support
FR
NR
17
Contact will Help
2
Many ways for help
1
Patient treatment, Observation (training)
1
Want Help
1
22
Village/GSS
Any GSS? (members)
Fr
Yes (7)
6
NR
4
Yes(12)
3
Yes (8)
2
Yes (6)
1
Yes (15)
1
83
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Yes
1
No Co op.
1
No
1
No
1
Don't Know
1
22
GSS met & date
Fr
NR
10
No
4
twice
2
Last month
2
No Meetings
1
Last Yr. 5 times
1
Last Year
1
Yes-20 July
1
22
Opinion-about GSS
NR
8
We should Help & Inform GSS
2
Special Discussion?
2
GSS Checks reg./ has good opinion
1
GP is still developing GSS
1
GSS cooperates
1
GSS praises our work
1
Health Edu
1
Helpful
1
I am Health Secretary
1
I Learn from GSS
1
Like JSR
1
Not existing-Want GSS
1
22
GP/GS Discussion
Yes (some discussion)
7
No discussion
4
NR
3
responsibility of JSR
3
Discussed about My work
1
Good Work-Honour me
1
84
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Health for All
1
OK Work
1
worried about?
1
22
IssuesJSR raised in GP?
NR
5
About Health
3
Sanitation & Water Safety
3
Health
2
Demand SC in village
1
About Medicine Cost
1
Hon & Loan
1
Maleria + Gastro
1
Medical Treatment
1
No issue
1
Payment
1
Sanitation FW
1
Yes-FW & Age of Marriage
1
22
Your efforts for Communtiy health?
NR
7
GSS meeting
2
Health/Edu.
2
Sanitation
2
Demand SC in village
1
Give me a chance in Med. Camp
1
Hand Pump Improvement
1
Help MPW
1
No effort
1
I will work with regularity
1
Sanitation, Health Edu.
1
Water Purification
1
Water Safety & ORS
1
22
Do all strata use JSR services?
Yes
12
Yes but limited
3
85
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
NR
2
Few
1
No
1
No - No Medicines
1
No-Many PMPs in village
1
Only Poor
1
22
Suggestions
Is Current income enough?
Not enough
13
NR
3
No-Hon. is necessary
1
No . must be improved
1
No Benefit
1
No Income
1
OK
1
yes-enough
1
22
Suggestions for income
NR
7
Hon
5
Hon.1000
3
Better training & Equipment
1
Hon Or Loan
1
Hon.500/-
1
Monthly Payment
1
Salary
1
Salary & Medicine
1
Salary & Permission to practice
1
22
Problems (From 4 options)
No Money/capital
5
No Kit
4
Lack of Medicines
7
No problem
3
No Equipment
3
No Permission for Inj/Saline
2
No Stationery
2
NR
2
86
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Medicine shortage
2
Blind Faith of people
1
Can not buy Medicine
1
Can not Prevent
1
Dignostic Difficulties
1
Inadequate Training
1
No Fees
1
No Hon
1
No Income
1
No Injection
1
No Injection - No Patient
1
No Medicines from PHC
1
No Money-No Medicine
1
No releif from PHC Mediciens
1
Panchayat doesn't support
1
People don't inform
1
People don't Trust
1
People uncooperative
1
PHC Doesn't support
1
PMP threatens
1
Time
1
Udhari
1
51
Suggestions of jsrs(4 slots)
NR
6
More Training
6
Medicine Supply/tablet
5
Village Swasthya bhavan/clinic room
4
Hon 1000/-
3
Medical Kit
3
Equipment
2
Hon.
2
Permission for Inj./Saline
2
PHC Meeting
2
1 Yr. Training
1
500 Hon.
1
call me in Med. Camp
1
Clinic room & Equipments
1
Drainage
1
Hand Pump Improvement
1
87
SUPPLEMENT TO THE REPORT OF CHCELL STUDY OF JSR SCHEME OF MADHYA PRADESH:
September -December 2001
Hon 500/-
1
Hon.& Higher Training
1
inform sarpanch
1
Inform, people
1
Injection
1
Kit Box
1
Latrines
1
Link with DH
1
Loan
1
Medicine+equip
1
Officers should inform people
1
Panchayat Help
1
PHC Help
1
Public Notice
1
Some Payment
1
Stationery
1
Sulabh Shauchalaya
1
58
88
Position: 1757 (3 views)