Achievement at a glance: Boat Clinic

Progress Report of the Boat Clinic Programme implemented by C-NES in partnership with NRHM, Assam
February – August 2008

The Centre for North East Studies and Policy Research (C-NES) signed a MOU with the National Rural Health Mission (NRHM), Assam in January 2008. The two parties formally agreed on taking health care to the river islands of the Brahmaputra in five districts of Assam namely (Tinsukia, Dibrugarh, Dhemaji, Morigaon and Dhubri). C-NES was given the responsibility to take health care – Curative, Reproductive and child care, Family planning and laboratory services in the river islands through its boats Akha, Shahnaz and three hired boats. The MOU agreed on coordination, microplanning, coordination committees, referral transport, manpower, reporting and documentation. UNICEF has been involved in the training and technical support. Unicef has also been supporting the Dibrugarh boat clinic programme.

Two boat clinics are running with full crew and medical staff (districts of Dibrugarh and Dhemaji) while two ships have been completed at Dhubri and Tinsukia; a fifth for Morigaon is also being built.

Human Resources of Boat Clinic

Both technical and non technical staff was recruited by C-NES and NRHM for the five districts. In each district there is a total strength of 14 team members. This includes one District Community Organiser, Two Medical Officers, One GNM, One Pharmacist, and One Laboratory Technician, two ANMs, two Community workers and four crew members. The Project Management Unit has five members at the Guwahati office.

Progress

The District Community Organisers (DCOs) are at the apex of boat clinic activities in the districts and are responsible for the smooth conduct of camps and coordination with the district administration and the line departments of the districts. The DCOs meet the district administration, health officials, district NRHM staff, and chalk out district plans for conducting health camps. The boats were ready to start the camps in all districts by the 2nd week of February 2008. Inaugural camps in all districts took off between 16 and 22 February 2008. Responses from all the districts have been overwhelming.

The camps in the new districts received good response from the communities. As of July 31st 2008, over 47,000 beneficiaries have been reached which includes 3,061 Routine Immunizations. The details of the Camps are given in the Annexure.

Strategy of district health camps

Camps in Tinsukia, Dhubri and Morigaon are one day long, while the Dhemaji and Dibrugarh teams go for 3-5 days trips since they have had proper boat clinics from some time. The Dhubri and Tinsukia programmes are also expected to be longer in the field from August with the new boat clinics becoming operational. During each day, at least one or two camps are held. Tinsukia has also held longer trips occasionally by using the Dhemaji boat. In one camp on an average 130-150 general health check ups are done (this figure can reach at least 300-to-400 at times) and 15 – 20 Routine Immunizations. Diarrhea, Dysentery, RTI, ARI, ear infection, skin infection, Anemia and fever are some of the common ailment. Between 15- 20 camps are planned in a month.

Services

The Boat clinics provide the following services – Routine Immunization of children 0-5 years and pregnant mothers, Vitamin A Supplementation, Pulse Polio Immunization, JE vaccination (Special Programme), General health Check ups of Patients, Family Planning activities IEC & BCC Activities etc. In addition, blood and other analysis is done for malaria parasite etc on the lab on board each of the boats.

Outreach

The district wise breakup of population proposed to be covered and number of river islands where boat clinics are functioning so far are as follows:

Source: Block, District Health Society and C-NES survey

Our goal is to reach one lakh persons this year and 2.5 lakh next year culminating with one million patients (ten lakh) in 2010, a major campaign at reahing the flood-affected and marginalized groups; the ten lakh figure represents one-third of vulnerable island populations in Assam and the basic number of those affected by flooding and high water every year – this is reaching the bottom million(s).

Strengths and Weaknesses of the Programme

The strength of the boat clinic programme lies in the dedication and commitment of the team members and the concept. The Project Management Unit at Guwahati and New Delhi has been very active and able to consolidate the activities of the programme implementation very smoothly. Good coordination and support of the district administration and the line departments as well as with NRHM at the district and state levels have been critical to the success of the program..
Limitations such as delays in allotment of technical staff, non-availability of vaccines and reagents in some districts, and short supply of medicines existed at the initial stages and are being resolved.

Orientation and workshops

Three orientation programmes/workshops have been organized since the inception of the project, two in Dibrugarh and one in Guwahati. The main objective of the orientations were to orient the new team members of boat clinics, districts health officials about the boat clinic initiative undertaken by C-NES and discuss the process part and coordination in the implementation of the programmes. Field visits to the river islands were also organized. Resource persons from NRHM, C-NES, and members from the District Health Society facilitated in the orientations. These orientations have immensely helped in the implementation of the boat clinic programmes. The District Community organizers, the key persons behind the programs, are members of their respective District Health Societies.

C-NES BOAT CLINICS (Partnership with NRHM)

Achievement at a glance: Boat Clinic, 15th February 2008 onwards (monthly)

TINSUKIA DISTRICT:

DHEMAJI DISTRICT:

DIBRUGARH DISTRICT:

MORIGAON DISTRICT:

DHUBRI DISTRICT:

Boat Clinic under NRHM 15 February - onwards (Total)