Health Ka Bharosa: Aarogya Kunji and MARUs in Chatra District

The majority of the villages located in the Chatra district cannot access or afford healthcare as 60 percent of the district is covered in forests. The forest portion covers 4 territorial Forest division (North, South Chatra, Koderma, Hazaribagh West). The problem of accessibility has worsened due to the serious
phase of extremists’ violence perpetrated by the Maoist Communist Centre (MCC). However, since the ‘health’ subsector forms the major subsector (weighing 30 percent) in progress on SDG, the Chatra administration have been focussing on this. The DC has taken assistance of The Aspirational District Fellows (ADFs). Together and under the guidance of the DC they are employing different techniques to make basic health care acilities available at the village level.

The district administration have started Swasth Chatra (Healthy Chatra), an umbrella program to address the accessibility, availability, and affordability of healthcare. This program further consists of Motorcycle Ambulance Response Unit (MARU) and ‘Arogya ki Kunji.’

There is a dearth of ambulance vehicles available in the Chatra district. At present, there are only 13 ambulances catering to a population of around 10 lakhs. Further, it is difficult to commute using four wheelers on the undulating, mud tracks within the forests. These factors lead to high casualty rates as patients are unable to reach the hospital on time. This led to ‘Project Sugam,’ which involved using MARUs to reach the remote villages.

MARU is constructed by attaching a side carriage to a motorcycle on the side of its frame, which is customized for the comfort of the patient. On an average, MARUs cost 2 lakhs per unit which is funded by MPLAD. This initiative has helped many pregnant mothers. Till date, 49 units of MARUs have been purchased. Project Sugam will be expanded to other districts after a rigorous project assessment is carried out by the ADFs and the district administration.

There are places in Chatra which cannot be accessed through two wheelers. Therefore, the district administration has proposed Arogya ki Kunji as a solution. Under this initiative, medical kits containing medicines and essential health utilities like contraceptive, sanitary pads etc. are given to the ASHA workers or Sahiyas of the district. Sahiyas get freedom of mobility with the portable medical kit. Similarly, patients can approach these workers for treatment rather than traveling to a healthcare center. The district administration trains the Sahiyas to provide appropriate treatment given the condition of the patient. If the patient needs more care then they recommend/persuade the patient to approach CHCs or the district hospital.

The effectiveness of Arogya Kunji is no surprise. It addresses connectivity issues which is the main bottleneck causing lack of healthcare among rural households. Therefore, till date the district administration has distributed upto 1609 medical kits to Sahiyas. Different stakeholders are involved to ensure its sustainability. This initiative is directly monitored by Civil Surgeon Office, District Hospital under the supervision of Civil Surgeon. At the block level, the MOIC (Medical Officer In-Charge) of Public Health Center(PHC) is supposed to manage the demand and supply of medicines in the Arogya Kunji. Similarly, this is managed by the ANM at the front line level who then informs the PHC for necessary replenishment.

Though there are multiple layers involved in implementation of Arogya kunji, the district administration perceives it as simple and cost effective. The medical kit costs only Rs. 1870 because of which this initiative has been implemented in 3 blocks through DMFT fund and MPLADs fund will be used to cover the remaining blocks.

Source : Public System Strengthing in Aspirational Districts