NRHM and Titabar.

My visit to Titabar Block:
A report on NRHM in Titabar
As part of my field visit in the Project, I went to Titabar Block from 15th to 25th of September, 2010. There, I visited nine institutions including eight Sub Centres and one PHC that Block. These eight SCs were Garajan Sub Centre, Dangdhra Sub Centre, Mahimabari, Basic Tini Ali SC, Karali bari SC, Bandarchalia SC, Samaguri SC and Bengenakhuwa Sub Centre. There I tried to meet the ASHA and ANM. These two are the two agents which has the prime responsibilities to spread the NRHM in village. They play a vital role in community participation of the mission. As we have structured questionnaires for them I interviewed them with those questionnaires. But as only structure questionnaire and interaction is not enough to portrait the role, responsibility and success-failure of NRHM, I also took help of observation. In some SCs I had the opportunity to meet a few villagers who had visited the institutions for the health related problems. Apart from these SCs I also went to Titabar and Nakachari PHC. There I interviewed the BPM and Clients/Health Care Seekers.

Manpower:
The mission NRHM gives a very significant role of ASHA. They are the persons who have the responsibility to bring the mission to the people. ASHAs monitor the healthcare system in their respective villages. The visit to Titabar Block has given me some ideas about the position of ASHA. In Titabar all most all the ASHAs, I met, have minimum required educational qualification. They have gone through several modules of training they required. ASHAs in Titabar have able to motivate the people for institutional delivery but they failed to elaborate the reason of importance of Institutional deliveries. They, since their date of joining, gone through several modules of training but their personalities failed to prove that they have benefited from those trainings. When I interact with them I feel that they are more interested in fund and incentives than the vision of the mission. I saw that they are ready to handle any number of cases in a month to tally up her incentives. Even I heard that there are few ASHAs who stepped in other ASHA's village and handled cases just for the sake of Rs 600.00; she gets for taking care of the pregnant woman. About the ASHA the BPM of Titabar said that behaviour of ASHAs are not satisfactory but he has a positive view that they have contributed a lot to health care system which has bring the villagers out from home to hospital for their health related problems. Even the Clients, beneficiaries also appreciated their role. But I feel that they have not yet reached the milestone yet. Especially they need to improve their social relation with all other quarters of NRHM and with the general people.

About the role of ANM also I found a mix picture where their knowledge on NRHM is not so good. The Permanent ANMs are not totally aware of NRHM. But in practice I can say that whatever they know, both permanent and contractual ANM are doing so. The ANM in NRHM and also the newly join permanent ANM has more knowledge about NRHM. Almost all the ANM are HS pass. Some of them are graduate, and they understand the vision of the mission more nicely than the others. The ANM believes that NRHM has able to make positive change to health sector and it has able to mobilize the villagers toward health care. The ANM believes that BPM of Titabar has a good knowledge about mission, vision and objectives of NRHM. They also feel that BPM is very cooperative in this matter.

When I interact with the BPM of Titabar I found that he has good knowledge about NRHM. He believes that the trainings provided by NRHM had made his job easier and comfortable. He with his positive attitude to the mission believes that in last few years NRHM has able to bring positive change to the mission and he hopes that it will continue till the end. The positive thing I found in him is his willingness to learn. He asked me about the Alma Alta conference and other reports of NRHM to increase his knowledge about NRHM. Apart from this he said that PRI members and officials from department are not so much cooperative. Another positive sign that is with him is communication skill. In my conversation I feel that he is good in making public relation which is a good sight for this chair.

Apart from this I also interviewed few Clients or the health care seeker. It was the most interesting part of my visit. I meet several categories of Patients like Mother of new born baby, Attendant of new born baby, pregnant women, General OPD patients etc. In this part several interesting sides came out. In general the client has some knowledge about the mission. They know the programmes and schemes like Majoni, Mamoni, Morom, Mamata, 108 etc. But only few respondents have idea about programmes like 24X7 OPD, operation smile etc. So in Titabar though not totally but to a large extent NRHM has entered among the people. From the answers of the respondent I can say that people are not fully satisfied to the hospital management system. They are happy with the services of doctors and nurses but to them infrastructures especially the toilets, beds, water, food etc. are not in satisfied level. Again they don't prefer to use bed sheet, mosquito net, blanket provided by the hospital. They also preferred to conduct several tests like X-ray, USG etc at private institution rather than public hospital. One of the negative points I found there is asking and taking money from mother of new born baby by the doctor. One respondent said that they paid Rs 3000/- to the doctor for their caesarean case. So, all these had drawn a mixed picture of NRHM in Titabar.

To sum up my practical observation to these manpower and beneficiaries says that in last five years ANM has learned a lot about NRHM and healthcare system in this block. They become more responsible to the people. They have been trying their best to develop health standard at their SC. Apart from ANMs ASHAs are also doing well but they have not able to deliver their best. In Titabar BPM have been doing well and he is getting support from other parts. To state about the client they have been availing the basis services from the manpower, but does not seems they are satisfied enough.

Institutions:
The standard achieved by manpower is not enough to draw the picture of the field visit. My observation at several SCs and BPHC has brought some important point to focus which is also very important. In my visit to SC I noticed that almost all SC are in easily locatable place. Apart from one SC I visited others are situated near at Pacca road. Only one SC was in rented house and the others are in government owned building. I saw that people used to visit these SC to avail medical facilities. People also listen and react to the advice given by the SCs' persons. But all the SCs have few common problems like problem of drinking water, electricity and quarters etc. The ANM are not satisfied with these facilities. It will be better if I write about each SC and PHC.
Garajan SC: Garajan SC is situated in the way between Garajan Tini Ali and Bekajan. It is in a rented house and has some infrastructural problem. The ANMs of this SC are very good in their behaviour towards their clients.
Dangdhara SC: Dangdhara SC is in link road between Dangdhara char ali and Garh ali. It is recently shifted to the newly constructed government building. It has one newly appointed contractual ANM and one permanent ANM. The negative thing is that the area it covers is huge area and the road is kaccha. Government had started construction of the road and very soon it will become a pucca road.
Basic Tini Ali SC: Basic tini ali SC is good in infrastructure but ANM is not satisfied to her quarters. This SC is in such a place that anybody can locate it easily.
Karalibari SC: Basic Tini ali and Karalibari SC are in the same road. The infrastructure of this SC is not so good but it seems to be neat and clean. Bengenakhuwa SC: It is like the other few also located at road side place and it has problems like water and electricity.
Mahimabari SC: Mahimabari Sc and Mahimabari MPHC are in same compound. Therefor it never faces problems like shortage of medicine and other thing. The ANMs of this SC are very good and they are happy to the infrastructural facilities available at that SC.
Bandarchalia SC: This SC is situated in a tea garden area and is also located in roadside area. The ANM of that SC was cooperative in nature. She said that they are facing the problem of water.
Samaguri SC: Samaguri SC also comes in the same road with Bandarchalia. A new MPHC construction is going on near at this SC. In this Sub Centres I interact with few villagers. It was my unstructured interaction where from I came to know that they are satisfied with the facilities and feels that the mission can make positive change.
To sum up my experience about my SC visit, I can say that apart from few infrastructural problems these has able to serve the people. The renovation and construction of new SC have been going on and all the medical and financial supports are provided to these every year.

PHC:
Titabar BPHC: I have also visited to Titabar Block PHC which is also a civil hospital. The overall infrastructure of the BPHC is good but it is not neat and clean. The BPHC has a toilet at its entrance which too dirty to use and it has not water facility. The BPHC situated at the side of popular Dhudar Ali. So it is not tough to find it out and is easily communicable. Apart from it huge hard wing and banner are hanged in its gate along with NRHM and its various programmes advertisement so that people can easily locate it and can also understand and know NRHM. In the BPHC I also notice number of health seeker and attendants waiting either standing or sitting at baranda or at lawn. I also saw mother of new born baby and pregnant IPD women in the BPHC.

From all these I can sum up that in Titabar I saw a mix picture of NRHM, where some sectors are going good and some are way behind. Both the government and public need so take few steps to change the present stratus of NRHM in Titabar.


The Nakachari PHC.

I have also visited to Nakachari block to meet the BPM. The BPM of that block is a local person who enjoys his job as public servant to serve the people of his locality. He seems to be responsible to his job and his personality is appreciable. He has a good communicable skill which is necessary for this kind of job. He has a good understanding about NRHM. I saw that ASHA and he has a good professional relation and hope it will help the mission. When I interact with him I came to know that the PRI officials, Doctors and officials from other departments are not that much cooperative and it affects the mission adversely. Again the BPM also pointed out one important thing that he had to work without an accountant which had overloaded him. In infrastructure the buildings are not so good and not neat and clean. Apart from that my one day visit can say that Nakachari PHC is contributing positively to NRHM.