1. Kutch Mahila Vikas Sangathan (KMVS) Proposal for Pachchham Women's Clinic

2. Background Pachcham is located in a region called Kutch situated in the northwest state of Gujarat, India. The population is predominantly Muslim followed by Harijan, Kolis, etc. Pachchham is one of the most remote areas of Kutch, where there is only one severely understaffed government healthcare facility for a population of more than 40,000 people. The patriarchal mindset prevalent in the community generally restricts women's mobility and freedom to access healthcare. Multiple children and malnutrition also take a toll on women’s bodies. As a result women often silently suffer from various forms of health problems particularly gynecological and reproductive health issues. However, over the past 10 years, the status has improved due to the sustained efforts and training by a team of urban and rural health workers with the local organization Kutch Mahila Vikas Sangathan. The community has now started demanding services that are accessible and high quality.

3. KMVS: Brief History 1989: Sushma bahen began organizing Mahila Mandals in villages across Kutch. –Small projects began in all areas depending on the need and interest expressed by women in the mandals 1990-2000: –Dais were trained in hygiene and risk assessment. –The Sangathans collaborated with Bhojay Sarvodaya Trust in setting up gynecological camps in Khavda. 1996: Pachcham Sangathan came together to build an office in Khavda, and elected a committee of women to lead major projects 2001: Massive Earthquake 2003: KMVS begins to revive health activities

4. Health Insurance Project Problem: –Because of working and living conditions, women tend to have extremely poor health. –While families spend an enormous amount of money on health problems (about ¼ of their monthly income), women are rarely prioritized –There are few services available locally in Pachcham. Women would have to travel far (at high costs) in order to access any reliable or appropriate service. –Private insurance in such an area is practically impossible

5. Health Insurance Project KMVS Solution: Cooperative health insurance program among KMVS women –Women would be guaranteed high-quality services when they are in need, regardless of the expense for a particular problem –The services would focus on gynecological and reproductive health, those services most needed for women –The program would emphasize preventative and prenatal care

6. Services Through the insurance scheme, a woman will receive services at 3 different locations. Services provided at Sangathan Khavda Clinic: –Deliveries (normal and complicated, not requiring an operation) –Antenatal and Postnatal Care –Gynaecological diagnosis and treatment –Paediatric diagnosis and treatment for children 0-3 –Blood testing –Provision of Dai Kits –Provision of Contraceptives Services provided in Bhuj (through collaboration with a private hospital and linkage with the government hospital) –Operations required for delivery (caesarean, etc.) –Sonography –Blood Bank –Family Planning operations Services provided by Bhojay Sarvodaya Trust Hospital –Operations for serious gynaecological issues –Operations for serious paediatric issues Transportation from Khavda will be provided when patients are referred.

7. Winning Combination Health Insurance Memberships Monetary help from the local citizens and other institutions Partnership with the government The doctors will provide scientific diagnosis and allopathic treatment The staff nurse will provide vaccinations and conduct antenatal and postnatal checkups The dais (local midwives) will provide traditional knowledge and counselling.

8. Membership and Payment Scheme Self-sufficiency at the end of a five-year period. 5000 women members, paying a Rs.375 yearly premium. This will cover the running costs for services at all 3 locations of Rs.18,72,000. For the first year the target is 500 women, which would result in the collection of Rs.1,87,200.

9. Running Costs (In Indian Rupees) Monthly Salary Yearly Salary MBBS Doctor20,0002,40,000 Visiting Gynec6,00072,000 Visiting Paediatrician6,00072,000 3 Dais6,00072,000 Nurse8,00096,000 Compounder/Doctor’s Assistant /Administration 3,00036,000 Pune/Clerk1,00012,000 Total50,0006,00,000 ServiceAnticipated Incidence Service Cost Total Cost Deliveries (normal and forceps) 30015045,000 Antenatal and Postnatal Checkups 6005030,000 Gynecological Treatment 30010030,000 Pediatric Treatment5402001,08,000 Blood and Urine Tests 60010015,000 Sonography30020060,000 Delivery Operations (Caesarean) 206,0001,20,000 Blood Transfusion6030036,000 Bhojay Operations (Gynec and Peds) 486,0002,88,000 Total7,32,000 SalariesServices MonthlyYearly Electricity, Telephone, and other costs 15,0001,80,000 Vehicle (Driver, Diesel, Maintenance) 30,0003,60,000 Total5,40,000 Administrative

10. Total Running Costs RupeesUSD SalariesRs.6,00,000$13,950 ServicesRs.7,32,000$17,000 AdministrationRs.5,40,000$12,550 TotalRs.18,72,000$43,500 YearNumber of women enrolled Premium collected (at rate of Rs. 375) % of Remaining costs to be covered during that year from outside fund Remaining costs to be covered during that year from outside fund 15001,87,50090%Rs.16,87,500 ($39,200) 212504,68,75075%Rs.14,06,250 ($32,700) 322508,43,75055%Rs.10,31,250 ($24,000) 4350013,12,50030%Rs.5,62,500 ($13,100) 5500018,75,0000%0 Road to Self-Sufficiency

11. Government Partnerships

12. Local Awareness

14. Recent Progress A referral clinic was inaugurated on February 11, 2005 Clinic building was donated by the government Tripartite partnership between the Government, community and the Non-Government Organization (NGO) KMVS The clinic will serve primarily women and their young children. The women's care will focus on gynecological and reproductive health issues and child care will cover basic ailments and vaccinations. The clinic has a check-up room, labour room, one ward (5 beds), a waiting room with reception and medicine counter, a counselling and patient-education room, living quarters for staff, and a training hall. 9 successful deliveries so far… Positive response from the community

15. Recent Progress Members from other blocks realize the need for such a clinic at accessible distances Several training programs are scheduled over the next few months (practical hands on training, class room trainings, awareness camps and meetings at the village level) PMVS have organized 6 trainings during the last quarter. These trainings have focused on the importance of safe and hygienic delivery, clean and healthy habits and other related issues. Other blocks (SJS, Nakhatrana) have also organized orientation and trainings during the last quarter.

16. Training Camps

17. The Future: KMVS Women’s Health Clinic Run by the women of KMVS Services provided by both local Dais and an in-resident doctor Specialized women’s services: reproductive and gynecological healthcare –not overlapping with services that the government can be held accountable for Partnership with government Partnership with the whole community: funded by the community health insurance program –sustainable Not just to provide health services but also to impart health knowledge Train village health workers Engage citizens in activism about the health of their communities

18. Contact Information ASHA Cleveland Chapter –Email: asha_cleveland@yahoo.comasha_cleveland@yahoo.com Vishal Haria (ASHA Volunteer) –Phone: (440) 212-0044 –Email: Vishal.Haria@gmail.comVishal.Haria@gmail.com Sheela Maru (KMVS Volunteer) –Phone: (410) 627-3143 –Email: Sheela.Maru@gmail.comSheela.Maru@gmail.com