14th World Congress of Public Health, Kolkata Establishment of village level health units for sustaining universal health coverage in Madhya Pradesh, India Rakesh Parashar, Aboli Gore, Faiz Ahmed Kidwai   14th World Congress of Public Health, Kolkata Dr Rakesh Parashar MPTAST - FHI360

Introduction: Gram Arogya Kendra (Village Health Center) A decentralized service delivery system which caters to the last mile population with basic health services and provides a platform for convergence of health and nutrition services. Gram Arogya Kendra (GAKs) are established at existing Anganwari Centers Functional in about 49000 villages in the state. The health services are delivered by ASHA (Accredited Social health Activist) on regular days and by ANM (Auxiliary nurse and midwife) on the village health and nutrition day (VHND).

Study Objectives This study tries to inform the health planners and manager about the Gram Arogya Kendra (Village Health Centers) running in Madhya Pradesh as a mechanism for Universal Health Coverage by : Assessment of utility of and acceptance of Gram Arogya Kendras in village residents and health workers Understanding operational challenges in service delivery at GAKs Assessment of functionality of Gram Arogya Kendras

Methodology Semi-structured Interviews (Purposive sampling) 50 Village residents from 20 villages 20 ASHAs 10 ANMs 5 Medical Officers Status check of functional items on a 57 item checklist 350 GAKs randomly selected from 5 districts Data collection during April-May 2014 in 5 randomly chosen districts of Madhya Pradesh

Results

Scores on 4 groups of parameters on the 57 item checklist

Results Key responses from the interviews of health workers and village residents

Results Summary: Acceptance An overall positive attitude and acceptance in village respondents observed, which is backed by good utilization of existing services as well as willingness of utilization in future. The ASHAs perceive their role better now with a responsibility of providing medication to villagers The ANMs find their workload to have reduced , however with added responsibility of monitoring ASHAs work The Sector Medial Officers appreciate the presence of GAKs and find it a good concept to reduce geographical limitation and out of pocket expenditure for basic health problems.

Results Summary: Challenges ASHA : to manage their work seek more support from ANMs fixed remuneration for this activity with provision of more dedicated space. Village residents : demand for more medicines and for more time spent by ASHA Medical officer’s visit at least once a month. ANMs : Rrecord updating by ASHA at GAK remains a problem. Medical officers find management of supplies and monitoring visits by themselves and ANMs a challenge.

Study Limitations Small Sample with purposive sampling for interviews Study doesn’t include view point of health planners and managers at higher levels The functionality assessment is limited to infrastructure, supplies and other input parameters, doesn’t cover service utilization and service quality statistics The researchers are not exclusive from the implementers of the GAK concept

Discussion and Conclusions WHO Health System framework- 2007, Six building blocks of health system Service Delivery - Village level health units, Gram Arogya Kendra Health workforce Information Medical products, vaccines and technology Financing Leadership and Governance Extended and decentralized service delivery can improve level of health equity and outcomes through improved access and coverage

Universal Health Coverage Elimination of geographical barrier Reduced travelling for minor health issues Avoiding local private practitioners Early symptom check Better early referrals Improving Access Reducing out of pocket expenditures Improved health outcomes Universal Health Coverage

Village level health units in Madhya Pradesh, India have shown good acceptance by and large from the beneficiaries and health workers. Continuity of availability of provisioned medicines and supplies with monitoring and measurement of service delivery, utilization and service quality needs to be continuously improved for effective service delivery at these village level units.

Thank You Possible research themes in future: Service delivery – Coverage , Utilization , Quality Outcome measurement Impact on overall village health and functioning of health system Change in social equations-dynamics related to health within the villages Models of effective monitoring and sustaining supply chains Thank You