August 13, 2018

By taking clinics to local haats, a district in Chhattisgarh is reinventing last-mile healthcare delivery

The weekly local markets or ‘haats’ are an intrinsic part of small town and rural India. They reflect local culture and offer fresh produce, groceries homeware and other daily essentials. In Chhattisgarh’s Sukma, these haats also showcase tribal culture from the region. But of late, the markets have become a hub for healthcare service delivery.

Why traditional healthcare failed

Located at the southern tip of Chhattisgarh, Sukma is home to the Gond tribal community. Nearly 65 percent of the district is forest area. The region also has one of the lowest literacy rates in India at 34 percent. The tricky geographical terrain coupled with poor socio-economic conditions had turned Sukma into a hotbed for Left Wing Extremism (LWE). This also affected the delivery of government welfare programmes.

Today while the violence and threat posed by LWE is on the wanee, the challenges related to the delivery of government programmes still prevail. Delivery of quality healthcare is among the top challenges, and the state has been actively working to find a solution. Due to the lack of adequate transportation facilities combined with low awareness levels and people not wanting to make an effort to travel to the district hospital or PHCs for treatment, villagers were not availing healthcare services. Also, the local populace believed in superstitions and orthodox healing practices which kept them from availing government-led mainstream healthcare facilities. Even though specialist consultant doctors were available in the District Hospital and PHCs, their services were largely unutilised.

A disruptive idea

In this scenario, the District Administration of Sukma came up with an ingenious idea – to capitalise on the haats to deliver healthcare services through the Haat Bazaar Clinics.

The reason was simple – since villagers from the remotest villages in the region come to the weekly haat bazaars, it would enable the government to reach more people who are unable to visit the District Hospitals or PHCs. In addition to ensuring healthcare facilities at the last-mile, the initiative also has been designed to reduce malnutrition, Maternal Mortality Rate (MMR) and Infant Mortality Rate(IMR).

The haat bazaar clinics of Chhatisgarh

Haat Bazaar Clinics see active involvement and collaboration between a number of government departments such as Health, Education, Women and Child Development, making them an excellent example of convergence.  The ground staff of these departments come together with the health department to ensure effective implementation of the initiative. The Haat Bazaar Clinics have been operational across 22 weekly markets in the district.

The Haat Clinic has specialist doctors, staff nurse and multi-purpose workers. The Mitanin, or Aanganwadi workers, bring in patients from villages and also facilitate consultation in native tribal languages. Every market location has dedicated closed spaces for the Haat Bazaar Clinics. The Haat Bazaar clinics are equipped with seating arrangements for consultation, basic infrastructure and racks for storing medicine and equipment. In addition to conducting routine health diagnostics and tests, these clinics also disburse medicines. Every patient is provided with a Haat Bazaar Health Card to make healthcare delivery and management simple. 

Started in August 2017, Haat Bazaar clinics have facilitated more than 10,000 OPD consultations within four months of the initiative’s launch. This includes more than 174 maternity cases, 370+ malaria cases and others. What makes this initiative laudable is that these numbers have been achieved in areas where the nearest healthcare facility was more than 10 km away, making it inaccessible for people in remote villages.

While the Haat Bazaar Clinics have been successful in increasing the reach of healthcare facilities, there are challenges impacting the initiative’s success. The infrastructure at the clinics needs upgradation. And, of the 686 posts sanctioned by the government, only 310 vacancies have been filled -- this includes those of doctors, nurses, and multi-purpose workers. Compounding these challenges is the threat posed by LWE.

That said, the Haat Bazaar Clinics are making low-cost, high quality healthcare a reality for those living in the hinterland.  The queues of people at these clinics are a testimony to their growing popularity.

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