Access to Health Care Services

Diagnostic camps

One-day camps are held independently by LSM or in partnership with the State Government’s public health system as per the needs of the community. At these camps the doctors diagnose illnesses and prescribe the required treatment. If referrals to hospitals are made, the health workers or Sevikas facilitate these, often accompanying the patient to the hospital.

Camps are held for:

  • Gynecology and Reproductive Health
  • Children’s health
  • Eye Problems
  • General health
  • Non –communicable diseases

Treatment for Primary Illnesses

Sevikas make regular home visits in the communities they serve. During these visits, they diagnose primary illnesses and provide medication where required.

Referrals to hospitals

Sevikas help persons needing hospitalization by referring them to appropriate hospitals and accompanying them to the hospital where required. SEWA has developed strong referral networks with various trust, government and private hospitals over the past thirty years.

Objectives of referral services

  • To bridge the gap between the medical services and the SEWA members.
  • To reduce medical expenses by referring members to hospitals that provide services at affordable prices.
  • To ease the referral process by providing proper guidance regarding the hospital procedures as well as emotional and mental support.
  • To create awareness about various existing maternal and child health government programmes and link the members as and when possible so that the benefits can reach the members.

Between 2001 and 2010 more than 63,000 members were referred and treated through the services of the cooperative. SEWA members have saved Rs 22 lakhs in out-of- pocket expenses as a result of these services.

DOTS centers for Tuberculosis

India has more new tuberculosis (TB) cases annually than any other country, ranking first among the 22 high-burden TB countries worldwide, according to the World Health Organization’s (WHO’s) Global TB Report 2009. Lok Swasthya Mandali, LSM and the WHO jointly initiated the Revised National Tuberculosis Control Programme (RNTCP) in Ahmedabad city in February 1999 wherein the WHO-approved DOTS method for effective management of TB was introduced. Ahmedabad Municipal Corporation had delegated the management of TB (DOTS programme) to the cooperative in three municipal wards covering a population of 500,000. The health cooperative ran one sputum microscopy centre and ten sputum collection centers in working class areas till March 2011. A team of 30 DOTS workers provided education on TB, ensured that each patient completed her/his course and reported regularly for sputum tests. LSM also serves as a centre for detecting and treating multi-drug resistant (MDR) TB.

In Ahmedabad district, SEWA health workers detect, refer and follow up with all TB patients and link them with free government services and drugs. Intensive health education is conducted door-to-door and in village-wide gram sabhas (meetings) as well.

Aim of the TB prevention and control programme:

  • Develop the capacity of health workers to diagnose and treat tuberculosis and implement DOTS strategy (emphasis on community level implementation through health workers and others, who are from the same communities as the TB patients).
  • Undertake preventive health education and create greater awareness of tuberculosis among the community.
  • Provide curative services (diagnosis and treatment) for TB control through DOTS strategy and ensure 85 % cure rate.
  • Develop a workable, viable, filed tested model for TB control, which can be replicated.

The impact of Lok Swasthya Mandali’s TB initiative is shown as below:

Tuberculosis (December 2010):

*Cure Rate: 92.16% (WHO standard: 85%)
* Sputum Conversion: 88.00% (WHO standard: 90%)
* Defaulter Rate: 0.00% (WHO standard: 4%)
* Death Rate: 4.00% (WHO standard: 3%)

Note: These outcomes have been consistently maintained since 2001.

After running the Treatment Unit for a decade, LSM handed it back to the Government. Today, LSST is running two DOTS centers in the population of 1, 00,000. To extend its service further Lok Swasthya SEWA entered into a new collaboration with the Eli Lilly Foundation in the year 2008, for TB prevention and control, through “Swasthya Jyot” programe. The main activities under this program included training SEWA’s health workers on TB program, identifying people with symptoms of TB and referring them to nearest Government health centers for prompt treatment, working as DOTS providers and, most importantly, creating awareness through either one to one or group education.

Linkages with government schemes and services

The health workers or sevikas provide information about the maternal and child health government schemes and services to the women members and facilitate access to these. This is done through home visits and public dialogue. Lok Swasthya Mandali has been instrumental in linking its members with Chiranjeevi and Janani Suraksha schemes of the Government, both of which promote institutional deliveries. Additionally, regular public hearings are being conducted in rural and urban areas to ensure that eligible families are aware of, and avail, the benefits of the National Health Insurance Scheme (RSBY). The LSM team is also providing feedback to the insurance company to help increase the outreach and utilization of RSBY.

Monitoring public health services

LSM also works towards creating demand for public health services and ensuring their supply by building the capacity of local communities to monitor the delivery of public health services. This is done through providing information to the communities and helping them build linkages with local public health officials. For example, LSM has been building the capacities and mentoring the Village Health and Sanitation Committees (VHSCs) in 172 villages in Ahmedabad district for monitoring the public health services at the village level.

Wellness center – Arogyadham:

With the vision of providing integrated therapies for complete well being, ‘Arogyadham’ was started in 2011. The activities at the Arogyadham include counseling, access to medical experts, referral linkages for secondary and tertiary health care, blood pressure check up, Body Mass Index or BMI calculation, awareness on overweight and obesity, and linkages to lab tests through network labs. Other interventions such as acupressure and yoga are also being planned.

LSM runs a counseling center for women which is open twice a week and charges a nominal fee for its services. LSM has tied up with a psychologist and a psychiatrist to refer patients where required.

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