Photo by Rohit Pansare / Shivtarai
The second tier of the community programme are the three subcentres, Semariya, Shivtarai and Bamhani. These sub centres act as nodal point for cluster and each one of them is manned by two trained senior health workers round the clock.
Each sub-centres functions as daily clinic providing health care, with once a week doctor based clinic, and a place for training as well as various meetings for health workers and workers working on animal health care, agriculture and Phulwari. They also serve as an important site for community level training of the nursing students of the ANM and General Nursing Midwifery course run by the organization. The sub-centres also run as animal bite care centres as well as level 1 newborn care centre for transitional care for low birth weight babies before they go their home after discharge from the hospital.
We have been running weekly mobile outreach clinics at Shivtarai, Semariya and Bamhani sub centres, each 50 to 75 km away to north and the northwest of Bilaspur town, since March 2000.
One doctor visits the mobile clinic with a nurse, laboratory technician, pharmacy assistant, village health coordinator, registration clerk and driver and attends to 30 to 75 patients, depending on the season. These clinics serve around 50 forest and forest-fringe villages each in a radius of up to 15-20 km.
A distinctive feature of the clinic is the availability of basic laboratory services including malaria and sputum microscopy, which makes treatment more rational and effective. These outreach clinics have been particularly beneficial for patients with restricted mobility, e.g. the elderly and women with young children.
The table below shows the number of consultations at each of these clinics
The outreach clinic at Shivtarai, a forest-fringe village 43 km to the northwest of Bilaspur town,
has been running since March 2000. The clinic at Shivtarai used to function at the local high school
on Saturday afternoons after the school closed for the day. In October 2003, the village Panchayat
contributed land for a new clinic but construction got delayed because of regulations on construction in
forest areas. The new clinic, a brick and mud structure with a tiled roof finally came up in 2005 and we
started using it from December 2005.
The clinic at Semariya village, 42 km to the north of Bilaspur town has been functioning from July 2001.
It is very heartening that in Semariya, the villagers spontaneously contributed cash and labour to repair an
old building donated by forest department to build a permanent site for the clinic.
The third clinic at Bamhani village, 70 km to the north of Bilaspur town, in the Achanakmaar Wildlife Sancturary, started functioning in May 2003. This is the most remote of our clinics and it is not possible to drive
on the road to Bamhni in the monsoons, even with a jeep with a four-wheel drive. Therefore, the clinic
team parks the jeep in the last village on the way to Bamhani, treks a kilometre over mud to reach the Maniyari
river, wades through waist deep water to cross the river, and then treks another two kilometres to reach the village.
Senior Health Workers
The dearth of doctors working and staying in rural areas is not going to vanish as long as the yawning gap in the development between rural and urban remains. And the problems in rural areas are far too complex to be managed solely by a village health worker, howsoever well trained she is. We need to think of someone else who can deliver this. A (para) medic who is not an appendage to a medic is a possible solution.
The focus need to shift from the doctors based strategy to “where there is no doctor” – supporting a middle level cadre of health worker. The village level health workers could continue to provide first contact care at the village level, counsel for proper and timely referral, be a link person and also prevent illness and organise people to raise demand from the health care services. The senior health worker would be providing much needed emergency care for common health problems, do basic investigation, manage chronic illnesses with guidance from the physician, investigate epidemic and follow up public health problems at the village level.
For many years now we are meeting the unmet need with help from such senior health workers.
As of 2015, we have 14 Senior health workers helping us in sub centres and hospital.
Read an in-depth case study about sub-centre and senior health worker
Bamhani case study : The vision of comprehensive primary health care