Hospital on Wheels : Lifeline of rural heartland

hills & plains Reaching out to people living in

Hospital on Wheels :

, GUWAHATI -21VT. LTD. PSTAN OFFSETAND PRINTED AT HINDUN, ASSAML RURAL HEALTH MISSIOMISSION DIRECTOR, NATIONAHED BY UBLISP

needs of rural populaceOn the way to meeting health care

Hospital on Wheels :

Tarun Gogoi

st October, 2007

31

Dispur

Assam, Guwahati

Chief Minister

)Tarun Gogoi(

I wish the launching of MMUs a resounding success.

to the very do

eps of the people.

orst

will bring about a sea change in the rural health scenario by taking health care

ulace as wheels of change are now set in motion. I have no doubt that MMUs

-cure, suffer as a result. But things would change for the better for the rural pop

otherwise have prevented the onset of a disease or had an opportunity for timely

luxury, especially in far-flung areas and in difficult terrain. People who could

Access to doctors in some parts of our country including our State is still a service in the State on 11th November 2007.

flagship programme of National Rural Health Mission are being pressed into

It’s indeed heartening to know that Mobile Medical Units (MMUs) under the

Message

MMU : At the doorsteps of needy people in difficult times

Minister for Health & Family Welfare

Dr. Anbumani Ramadoss Government of India

New DelhiMessage 20th October, 2007

I am glad to know that Shri Tarun Gogoi, Hon’ble Chief Minister of Assam will be inaugurating the mobile medical units under support of National Rural Health Mission (NRHM) on 11th November, 2007 at Guwahati and that the Assam NRHM Unit is publishing a Souvenir on the occasion. The National Rural Health Mission launched in April 2005 by the Hon’ble Prime Minister had a Mission objective to provide accessible, affordable and accountable quality health services to the poorest households in the remotest parts of the country. In order to facilitate accessibility, a number of innovations have been initiated in the last two years.Mobile Medical Units (MMUs) constitute one of the key innovations designed to provide health care services at the doorsteps of the rural people. These Units not only provide access to basic services of health care but also provide essential knowledge and information on the kind of services under the umbrella of NRHM. Under NRHM, the North East Region has always occupied a special position as far as provisions for services, infrastructure, manpower priorities and access to services is concerned. The inauguration of the Mobile Medical Unit by the Hon’ble Chief Minister of Assam shall enhance the out-reach of NRHM in the difficult terrain of Assam.I am confident that this initiative of the Government of Assam will go a long way in enhancing out-reach of medical services to the remotest areas in Assam. This initiative will

surely enhance the belief of the people in the Public Health System of NRHM.I wish the Assam State under the dynamic leadership of its Hon’ble Chief Minister – Shri Tarun Gogoi, all success in mainstreaming NRHM in the lives of the common people. (Dr. Anbumani Ramadoss)

MMU : At the doorsteps of needy people in difficult times

MMU : At the doorsteps of needy people in difficult times

Panabaaka Lakshmi

2007

22

nd October, New Delhi

Government of India

Health and Family Welfare

Minister of State for

)Panabaaka Lakshmi

(

people as envisaged.

facility provided under NRHM would go a long way in taking health care to the

I congratulate the Government of Assam on this occasion and hope that the

nership with credible NGO/ Institutions.

-operationalisation of the MMU or by outsourcing through public-private part

Society/ Rogi Kalyan Samitis/ NGOs in deciding the appropriate modality for

amination. These MMUs are to be run in cooperation with the District Health

-of MMU with specialized facilities for the patients requiring basic specialist ex

transport, long distances for reaching the health centres necessitate the need

Eastern States, due to their difficult hilly terrain, non-approachability by public

MMU) in each District is one of the strategies to improve access. For North (reach underserved areas. Under the NRHM, provision of Mobile Medical Unit

care to the doorsteps is the principle behind this initiative and is intended to

care infrastructure limiting access to health services at present. Taking health

dominantly tribal and hilly areas, in North Eastern States lack basic health -by the Government of India in April 2005. Many areas in the country, pre

the goals set under the National Rural Health Mission (NRHM) launched damental requirements for achieving the Millennium Development Goals and

-Access to health care and equitable distribution of health services are the fun

Message

Dr. Himanta Biswa Sarma

2007

st October, 31

Dispur

Government of Assam

and Science & Technology

Information Technology

Health and Family Welfare

Minister

Dr. Himanta Biswa Sarma

( )

under NRHM.I convey my best wishes for all round success of the programme as envisioned

computerized medical records.

health profile of the families and communities covered, while maintaining their

Another spin-off from this mobile unit project would be the development of a

munities.

-fitted with a big screen would increase awareness on health issues to local com

During the day the unit would serve as a hospital; at night the TV/DVD system

tor. -outs and erratic power supply, provision has been made for an on-board

genera

-Eventually, interested medical staff will be inducted to lend support. For black

scriptions, dispensing medicines and referral.

-people especially those living in remote and far-flung areas in the form of pre

provide preventive as well as curative health care at the doorsteps of the rural

sound, X-ray, ECG, etc will help the traveling doctors and paramedical staff to

-The hospital on wheels equipped with modern diagnostic facilities such as ultra

tribal areas where there is no medical facility is a great boon for the patients.

Starting MMUs to cover underserved and uncovered areas like remote villages,

sion by the Hon’ble Chief Minister of Assam, Shri Tarun Gogoi..

-Mobile Medical Units (MMUs) under the aegis of National Rural Health Misin particular and the medical fraternity in general with the formal launching of

November 11, 2007 will be an epoch-making event for the people of the State

Message

MMU : At the doorsteps of needy people in difficult times

Naresh Dayal

( )

I wish the State all success in their efforts to strengthen the NRHM initiatives.

NRHM better with the access to Mobile Medical Units.

Assam especially those residing in remote areas would understand the benefits of

takes into account to quality health care as a critical component. The people of

State will go a long way in building the identity of NRHM as a Mission which the National Rural Health Mission. I am confident that this initiatives of the Gogoi, will be inaugurating the Mobile Medical Units on 11th November under

I am pleased to know that the Hon’ble Chief Minister of Assam, Shri Tarun

Mobile Medical Units has been one of the key initiatives undertaken by States.

played a stellar role in designing state-specific interventions. The provision of

mechanism which facilitates access to services. In the last two years, States have

In this endeavor, flexibility has been provided to States to ensure a functional

ing a fully functional, Community-owned, decentralized health delivery system.

-The National Rural Health Mission since its inception has focused on establish

Message

Naresh Dayal

2007

th October, 25

New Delhi

Government of India

Health and Family Welfare

Secretary

Joint SecretaryHealth and Family Welfare

K. Raamamoorthy Government of India

New Delhi 26th October, 2007

MessageIt is heartening to note that the Assam Government is launching the first batch of Mobile Medical Units (MMUs) on 11th November, 2007. It will be another feather in the cap of the State, which has been showing appreciable progress in achieving some of the NRHM objectives.Providing access to medical services for the rural people living in remote, inaccessible and unserved areas through Mobile Medical Units (MMUs) has been identified as an effective strategy under NRHM. Special provisions have been made for the North East region while framing the guidelines for the MMUs keeping in mind the specific requirements of the region. Provision for adequate manpower, equipment and drugs have been included. In addition, the State has been given flexibility to introduce Boat Clinics to reach out to Char areas of the mighty Brahmaputra.The MMUs have to be made operational by ensuring regular schedules of outreach-clinics by giving adequate publicity so as to enable the needy to access the services and the facility being provided fully. I am hopeful that the medical, paramedical and other personnel engaged in operationalising the MMUs would render dedicated and compassionate service.I place on record this Ministry’s sincere appreciation of the political leadership and commitment being provided by the Hon’ble Chief Minister and the Health Minister in steering NRHM. There are many challenges that ought to be surmounted. I am sure that the bureaucrats and the technocrats in active partnership with the people and their representatives would realise the objectives of NRHM well ahead of the Mission period and serve as a model to the rest of the North East.

MMU : At the doorsteps of needy people in difficult times

I wish the State Government and the people of the State a grand success in their endeavour to make this intervention an outstanding contribution towards better healthcare delivery in the rural pockets of Assam.

(K. Raamamoorthy)

MMU : At the doorsteps of needy people in difficult times

Amarjeet Sinha

26

th October, 2007

New Delhi

Government of India

Health and Family Welfare

Joint Secretary

people in your State

in Assam under the NRHM will translate into better health indicators for the

the unreached in difficult areas. I am confident that all the efforts being made

good results in the years to come. The MMU will realy facilitate reaching out to

the able guidance of the Hon’ble Health Minister of Assam will bear very very

ber, 2007. I am sure all the untiring efforts made by you and your team under

-Rural Health Mission are being introduced in Assam from the 11th of Novem

I am very pleased to hear that Mobile Medical Units under the National

Message

MMU : At the doorsteps of needy people in difficult times

Mobile Medical UnitBringing health care at people’s doorsteps

Recognizing the paramount importance of Health in the process of economic and social transformation and improving the quality of life of its citizens, the Government of India launched the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health care delivery system.

The goal of the mission is to improve the availability of and access to quality health care by people, especially those residing in rural areas, the poor, women and children.

In many areas of Assam there is a lack of basic health care infrastructure, limiting access to health services. There are many unserved and uncovered areas throughout the State. Many tribal, char, forest and tea garden areas are devoid of

1

any health care facilities. Over the years, various initiatives have been taken up to overcome these difficulties with varied results. Now, the Ministry of Health and Family Welfare, Government of India under the NRHM conceptualized the idea of taking the health services to the remotest corners of the country through the Mobile Medical Units. And in Assam, under the able and dynamic leadership of the Hon’ble Chief Minister Shri Tarun Gogoi and Hon’ble Health Minister Dr. Himanta Biswa Sarma the first noble step of introducing these mobile medical units equipped with latest medical equipment and medicines - to be subsequently made operational in all the districts of Assam - has been embarked upon today. These mobile units are being pressed into service to provide medical services to people living in far-flung rural areas of Assam.

It was at the directive of the Chief Minister in the course of a review meeting of the National Rural Health Mission, Assam that new vistas have today opened up for the health sector in

2

Assam with the approval of the units from the Hon’ble Union Minister of Health and Family Welfare Dr. Anbumani Ramadoss.

For taking the health services to the doorsteps of the people, especially in the unserved and uncovered rural areas, MMU is the best answar. The mobile medical units equipped with ultra modern diagnostic facilities such as portable X-ray machines, Microscope, ECG, ultrasound, autoclaves, stretchers, a pharmacy, etc, will help medical teams to visit remote villages. These units comprise a vehicle (Mahindra Scorpio) for the staff and two 709 Tata Bus with inbuilt OPD, laboratory facility and other essential diagnostic accessories. A generator for power supply is also fitted in the MMU.

The specially designed mobile medical units are complete with two medical officers, two nurses, a lab technician, a radiographer and a pharmacist. There is also a provision for audio-visual publicity in the unit. A TV and a DVD are there wherein all NRHM visual campaigns will be displayed for creating general awareness.

These units may also be utilized during the health days or health melas for service delivery as well as publicity through its audio-visual unit. It may be also be utilized by all the other health programmes like AIDS, cancer, etc.

3

Similar initiatives are also being conceptualized for providing health services for people living in the char (riverine) areas. These services will be provided through boat clinic. These boat clinics will also be pressed into service within the current financial year.

It is envisioned that these mobile units will go a long way in further strengthening the capability of the health personnel to reach out to the communities living in remote and far-flung areas.

With the launching of this noble project today, we see the heralding of a new tomorrow for the people of Assam in the health firmament.

MMU consists of three units of vehicles with the NRHM logo viz., two 709 Tata Bus equipped with inbuilt OPD, laboratory facility and other essential diagnostic accessories fitted with power generators and one Mahindra Scorpio for the Medical team.

4

Vehicle No.1 is a Mobile Unit with essential accessories such as Microscope, Auto-analyzer and Generator costing Rs. 18.25 lakh. The space at the back will be utilized for placing a couch which will be used as examination table during camps and for shifting of patients at times of emergency.

Vehicle No. 2 is a Mobile Unit with diagnostic facilities such as Portable X-Ray, Portable Ultrasound Machine and Portable ECG Machine costing Rs. 23.75 lakh. It is also fitted with a Generator.

Vehicle No. 3 (Mahindra Scorpio) will transport the medical team comprising two Medical Officers, three Specialists, Radiologist, Nurse, Laboratory Technician, Pharmacist, Helper and three Drivers.

Wheelson

Hospital

Mobile Medical Units : At a Glance

5

MEDICAL UNITMOBILE

The MMU in-charge will submit •

the performance of the MMU.

conducted. The meeting will review

persons with the MMU should be gramme Manager and all concerned

-of District Hospital, District ProDirector, Medical Superintendent meeting of District Committee, Joint

Every month a district level •

as MMU in-charge.

appoint one of the Medical Officers

The District Health Society will •

smooth functioning.

MMU with the help of BPMU for and making the schedule plan of the

for providing all the support system

The DPMU will be responsible •

aspect.

be responsible for the operational Joint Director of the district; he will

The officer in charge will be the •

of District Health Society (DHS).

the scheme as he is the chairperson

be responsible for operationalizing

The Deputy Commissioner will •

Administrative Guidelines

6

the monthly report to the district.

• A compiled monthly report of the MMU should be send to the state as per the format given and also to the Deputy Commissioner of the district.

• The DPMU will be responsible for the monitoring and evaluation of the

MMU.

• It will be the responsibility of the BPM and the District Media Expert to intimate the villagers two days well in advance. For this they can take the help of any local and field NGO, if available in that area, ASHA, local head/

influential persons of the village.

• MMU will be sent for servicing/maintenance as when required.

• The staff involved with the MMU, including the drivers should be given an orientation of the MMU that should include the type of services to be provided.

• The drugs/instruments can be procured from the District Warehouse/ Medical Store.

• In case of non-functional of any equipment/instrument, MMU incharge will inform the Joint Director Technical, State Health

7

Transport Organization with a copy to the Joint Director, District Health Society.

• After receiving the request it should be addressed within two days. After two days if no action has been taken then the MMU in-charge can directly lodge complain to the Deputy Commissioner of the district and mark a copy to the Mission Director,

NRHM.

• The MMU will be stationed in the Civil Hospital.

• District will draw up an Action Plan for the proposed coverage through MMU and it will be based on the block action plan. The action plan should be approved by

SDMHO at block level and Joint Director, DHS at district level.

• In the block plan all the uncovered/unserved villages should be covered.

• A road map for the MMU to be developed by the blocks and a copy of it should also be handed over to the

MMU team.

• The village selected should be uncovered/ underserved area and it should be motorable. The nearby village from the site selected has to be covered.

.• The

underserved/uncovered areas selected should be those that are socio- economically backward

8

and which do not have access to health care from the existing government health infrastructure, such as urban slums, tribal and hilly area, forest and semi-arid areas including SC/ST habitation.

• In case where vehicle cannot

reach the villages, in that case a common site should be selected to cover those villages but the distance to the site from the villages should be walkable.

• The villages covered should be revisited by the team after covering all the planned villages in the action plan. The villages to be revisited should be included in the schedule plan (whether to be once in every month or 3 months).

• The team accompanying the MMU will consist of two Medical Officers, (one of them will be a lady MO), one Radiographer, two Nurses, one Laboratory Technician, one Pharmacist, two Helpers and three Drivers.

• Three Specialists viz., O &

G, Paediatrician and a Physician from District Hospital will accompany the team twice in every month and whenever required. The Medical Superintendent of District Hospital will be responsible for deputing specialists.

• The ANM/ ASHA and one member of the VHSC will assist the camp.

• The village selected should not be near to the PHC/Mini PHC.

• A place should be selected in the village for service delivery, it may be a community hall or any public building, and school building can be selected, if there is a holiday in the school.

9

• The villages within the range of 5 km will be catered on the same day depending on the population of the village. Hence, publicity should be done in those villages as well.

• The timings of the MMU will be from 10 am to 1 pm and 2 pm to 4 pm.

• Educational programmes on health or any other issues will be shown to the masses.

• The waste generated in the site should be collected in the bins provided and has to be brought back to the district hospital, where it will be disposed of as per the Bio Medical Waste guidelines.

• A fixed day and time should be intimated to all the concerned villages prior in advance.

• To intimate the villagers any type of media can be used such as PA system, banners, street play etc.

• In health day or in any camp, the villagers should be apprised about the MMU and the services it will provide so that they will be aware of it. Even if possible, the scheduled date, time and venue for the convenience of the villagers.

• The schedule plan for a month will be put up in the Sub-Centre and also given to the ASHA, AWW, VHSC or any concerned person/organization

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identified by the Block/District. The schedule plan should be send to the Sub-Centre well in advance, i.e. before the month starts.

• The schedule plan should also be available in the District Hospital; it should be put up in the public area where it will be visible to the patient or his relative. The schedule plan should be send to the District Hospital well in advance, i.e. before the month begins.

• In case patient needs to be referred then he will be referred to the health facility according to the need, i.e. if the treatment required is available in secondary level health facility then they will be referred there or they will be referred to the tertiary care hospital.

• In case of referral the patient can avail the ambulance from the nearest health facility.

Financial Guidelines

• Funds for MMU will be released to the districts as per approved PIP.

• The district will pay salary to the

MMU team.

• The maintenance cost of the

MMU will be borne by the district.

• At the district level, PoL record will be maintained by the District Accounts Manager.

• Funds for MMU will be released after the approval from the Joint Director of the District/Deputy Commissioner/Chairman District Health Society as per financial guidelines.

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• Along with other activities, Utilization Certificates and Statement of Expenditure of MMU should be send to the state by the district.

MOBILE MEDICAL UNIT

OBJECTIVES

• To operationalise Mobile Medical Units in every district for improved access to health care services.• To make health care services available in underserved areas.

TYPE OF SERVICES

Every Mobile Medical Unit will provide the following services:

Curative

• Referral of complicated cases;

• Early detection of TB, Malaria, Leprosy, Kala-Azar and other locally endemic communicable diseases and non-communicable diseases such as hypertension, diabetes, cataract cases etc.;

• Minor surgical procedures and suturing;

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• Specialist services such as O & G Specialist, Paediatrician and Physician.

Reproductive & Child Health

• Ante-natal check up and related services e.g. injection-tetanus toxoid, iron and folic acid tablets, basic laboratory tests such as haemoglobin, urine for sugar and albumin and referral for other tests as required;

• Referral for complicated pregnan-

cies; • Promotion of institutional

delivery;• Post-natal check up;• Immunization clinics (to be

coordinated with local Sub-Centres/ PHCs; • Treatment of common childhood illness such as diarrhea, ARI/Pneumonia, complication of Measles etc.; • Treatment of RTI/STI;

• Adolescents care such as lifestyle, education, counselling, treatment of

minor ailments and anemia etc. Family Planning

• Counseling for spacing and permanent method;

• Distribution of Nirodh, oral contraceptives, emergency contracep-

tives;• IUD insertion.

DIAGNOSTIC FACILITIES

• Investigation facilities like haemoglobin, urine examination for sugar and albumin;

• Smear for malaria and vaginal smear for trichomonas;

• Clinical detection of leprosy, tuberculosis and locally endemic diseases;

• Screening of breast cancer, cervical cancer etc.

SPECIALIZED FACILITIES AND SERVICES

• X-ray• ECG• Ultrasound test • Emergency services and

care in times of

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disaster/epidemic/public health emergency/accidents etc.

• IEC materials on health including personal hygiene, proper nutrition, use of tobacco, diseases, PNDT Act etc., RT/STI, HIV/AIDS.

TEAM COMPOSITION

• Medical Officer : Two• Radiologist• Nurse• Laboratory Technician• Pharmacist• Helper• Driver : Three• Specialist : Three viz., O &

G Specialist, Paediatrician and Physician

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NRHM, Assam :A Quantum Leap Forward In Health Services The launch of National Rural Health Mission (NRHM) in Assam in November 2005 has given the State a new opportunity to address the long-standing problems at the grassroots level. The initiatives which have enabled the State take a quantum leap forward are:• Under capacity building, professionals with requisite skills at both the district as well as State levels have been inducted. The State Programme Management Unit (SPMU) has been made fully functional. • The District Programme Management Unit (DPMU) is already in position with the Programme Manager, District Media Expert, Accounts Manager, Data Assistant and Computer Assistant engaged in all the districts. For the Block Programme Management Unit, Block Program Manager posted in 149

BPHCs and Block Accounts Manager in 199 BPHCs/CHCs/DHs. • Contractual health manpower engaged under NRHM are 48 MBBS Doctors, 216 Ayurvedic Doctors, 19 Consultants, 2,827 ANMs and 1,371 GNMs. A total number of 25,940 ASHAs have already been selected across the State out of which 25,779 have already received training.

12• A total of 3,28,823 JSY beneficiaries have reported and 4,76,110 institutional deliveries (up to 30th September 2007) have taken place. • 32 health centres have been upgraded to FRUs and 103 CHCs to

IPHS with an investment of Rs. 40 lakh each. Fund amounting to Rs. 1 crore each for upgradation of 18 district hospitals have been received from Government of India. Initiatives have also been undertaken for strengthening Gauhati Medical College, 15 GNM Schools and 18 ANM Schools. Eight new GNM Schools @ of Rs. 2 crore sanctioned per school will be constructed during the current year. 80 PHCs/ CHCs have been identified for construction of staff quarters for doctors and nurses. 276 PHCs have been made functional on 24 x 7 basis.• For services in the outreach areas, Mobile Medical Units have been sanctioned for 27 districts of which 10 have arrived. Hospital Management Society exists in Assam since 2002. There are 610 registered Rogi Kalyan Samitis till date in CH, SDCH, CHC, FRU, BPHC, SHC, SD, SC, etc.• Extensive publicity has been undertaken since 2006-07 through both electronic and print

media involving the Government as well as private media channels in the State to facilitate the flow of health information and create health awareness among the common people.