Community Management Improves Rural Primary Health Center

In East Siang District of Arunachal Pradesh, India, near the mouth of the Brahmaputra River in the town of Sille, a primary health center serves six major rural villages and a growing migrant population of more than 10,000 people. The surrounding indigenous population is within a 12km walk over difficult terrain to the primary health center, which was seldom used and was in such a dilapidated condition that curative and preventative care was practically non-existent.

To better serve the people, in 2006 the state government of Arunachal Pradesh contracted with Future Generations Arunachal through a Public Private Partnership to co-manage the primary health care center with the active participation of a “patient welfare committee.” Known as the Rogi Kalyan Samiti, the patient welfare committee is a locally nominated group of volunteers who participate in the day-to-day management of the center, thus increasing community oversight, transparency, and accountability.

A 2011 performance review shows that health indicators have improved dramatically, including no malarial deaths in three years, and the Sille PHC now serves as a statewide model and training center for primary health. In July 2011, Future Generations was awarded two more Public Private Partnership contracts to extend its training and community-based management innovations to the Lower Subansiri and West Kameng districts.

Future Generations Arunachal has played a major role in strengthening both curative and preventative care through the primary health care center.

The first major achievement in 2006 was mobilizing community volunteers to refurbish the center and create clean and welcoming conditions for new staff and patients.

In terms of curative care, the center provides outpatient services, inpatient services and dressing rooms with facilities for minor surgeries, as well as referrals to the district's General Hospital. At present, the PHC provides inpatient care with 10 beds. The most important change in curative care, however, has been the way the patients are treated, starting from the greeting to the farewell. 

Major emphasis has been placed on preventative care and community extension through volunteer community health workers, mother's training workshops, and a school health education program. Women from across the state have been trained as "Village Welfare Workers." In 2008, the primary health center began a program to train one woman from each household in the entire catchment area on basic health care and hygiene. Every two weeks, a new group of six women from six villages participates in a "Mother's Training." This program has significantly increased the ability of mothers to prevent and treat minor ailments at home.

With the constitution of the Rogi Kalyan Samiti, "patient welfare committee," in 2006, the communities have been more formally participating in the planning and implementation of the health services in the area. Members participate in regular meetings and make decisions about the reinvestment of unrestricted funds.

A system for community monitoring also has been put in place. Bi-annual review meetings are held with village representatives, including the Panchayat leaders, Gaon Buras, and other village elders.

A systematic management of medical information system as well as other relevant data and mobilization of communities to participate in the management of the PHC are the special features noted. According Dr. Tage Kanno, manager of the project for Future Generations Arunachal, "the feeling of community ownership has contributed greatly to   the success of the management."

The Government of Arunachal Pradesh introduced the concept of Public Private Partnerships (PPP) in 2006 as part of the larger strategy of the India Rural Health Mission to improve primary health through more direct involvement of communities.

A full report of the 2011 performance review will be released in the coming month.