Jan Swasthya Sahyog

Jan Swasthya Sahyog was founded in 1996 by a group of health professionals who were doctors trained at the All India Institute of Medical Sciences and Read more other reputed medical colleges. As other health professionals and health workers joined over time, we could develop this organization to serve the people in central India by basing ourselves in rural Bilaspur in Chhattisgarh. Now with a staff of 345 full time people, and 400 part time health workers and a large peer support group in India and outside, we are able to reach the rural poor in central India directly and poor people at large through our initiatives in training, advocacy and research outputs. Jan Swasthya Sahyog has been working in rural Chhattisgarh for the last 20 years. Through a service based programme, we have helped people in the care of their illnesses with treatment, as well as in maintaining health through preventive measures and health education. During these 20 years we have been able to build up the spectrum of activities at JSS – enabling us to analyse and learn from the service work and share these lessons in fora that address the health concerns of the rural poor. The primary objective of all our activities has been to address inequity. The strategy that we have chosen is of providing health care. Our focus is primary health care in the broadest sense of the term. And thus the greatest support for our organization has been from the people in the area. Due to the impact of the work evident in the decline in premature morality and avoidable morbidity, decreased indebtedness, social changes such as the empowerment of women, JSS enjoys a high level of credibility all over this part of rural central India, especially among the poor and tribals. In this context of running a service delivery programme, we have tried to understand the causes of poor health and then offer through training, writing, and lobbying. JSS now has 345 full-time health personnel as well as another 400 community based workers associated with it, along with a large peer group that works voluntarily with us. We have thus been able to implement primary health care in its detail and spirit, and in this process draw lessons for the country’s marginalised populations. Clinical services: The community health programme has provided effective, low-cost care through more than 7,00,000 consultations to over 3,00,000 patients drawn from more than 2,500 villages from across Chhattisgarh as well as adjoining districts of Madhya Pradesh. This care spans across a comprehensive range of medical, surgical, and obstetric care unique in the region. The inpatient services with 100 beds and an operation theatre complex (including 3 major operation theatres and a labour room) has provided high-quality services to more than 23,000 patients admitted for serious illnesses and 35,000 often life-saving surgical cases. At the second tier of services are community centres that support clusters of up to 30 villages each which are staffed by a team of senior health workers, specially trained by JSS in clinical and community health skills. The ‘last mile’ is the village health worker, all of who are women, based among a closely monitored cohort of 40,000 people in 72 remote villages.     Training and technology: The JSS community health programme is looked upon as a national resource centre and training site. The national ASHA mentoring group held its annual meeting at JSS in 2015 and has picked up several learning points with the view to replicate them at the national level. We have run training courses for village as well as mid-level health workers for both our own and other organization. We now run a full-fledged School of Nursing for tribal and dalit girls that offer courses in both Auxiliary Nurse Midwife training as well as General Nurse Midwifery. We recently have become one of the few organizations nationally to run our own postgraduate medical training programme, offering the Diplomate of the National Board (DNB) in Family Medicine and General Surgery. As far as technology is concerned, from the outset we have been developing appropriate health related technology in response the health needs we encounter in our work. This has resulted in the development of 32 such technologies that are being used in several government and non-governmental health care organizations beyond our own use. Knowledge and advocacy: Identifying the gaps in primary health care, whether technical questions or operational issues, through careful observation and documentation has helped us develop into a resource group for others. This aspect of JSS work has been recognised at the district, state, and central levels. Over the past few years, we have been asked to be a Technical Resource Group for the Government of Chhattisgarh, the Planning Commission, the Mission Steering Group of the National Health Mission, the National Asha Mentoring Group, the High level Expert Group for Universal Health Coverage and several other agencies. JSS has also built several regional and global partnerships including the Lancet commission on global surgery, the Lancet commission on NCDs among the poorest billion, the HEAL Fellowship at the University of California, San Francisco, and the Family Medicine Residency at Contra Costa County Hospital in the United States. JSS has tried to advocate for better policies in important public health problems like falciparum malaria, hunger and health, tuberculosis and food, price control of essential drugs, and under-3 malnutrition, with some success thus far. Our experience at JSS has taught us that simple people do not have simple problems and we wish to solve these with the appropriate complexity which they deserve. Thus while village health workers play an important role, we recognize they do so in conjunction with the ability to refer and access advanced care rather than abandoning them and their patients to a limited set of options. JSS is one of few rural centres that offer this spectrum of care, from preventative and social work in the periphery, to a rural ICU that can provide tertiary level expert care without the bells and whistles that unnecessarily adorn the urban centres that we have come to expect. Public Health System Strengthening: While we provide service and learn from our work, we are certain that for healthcare to reach the most marginalized, and even the middle-class Indians across this vast nation, it is possible mainly through a strengthened public health system. It is towards this end that JSS started a quality improvement initiative with the governments of Madhya Pradesh and Chhattisgarh in 2016. Spanning eight districts, our focus has been to bring about improved maternal and newborn care through training, assuring supplies, getting the Quality Improvement process to be embedded in the functioning of hospitals (District hospitals and First Referral Units), mentoring and supportive supervision. Changes have been slow to come, but are now seen definitively and we are looking at ways to make them sustainable. Much of this work has been accepted by the state government to be essential and hence significant components are now budgeted in the State Program Implementation Plan. JSS has been a technical partner at these facilities and has been offering its technical expertise in the areas of quality improvement of maternal and newborn health care; overall quality improvement of public health centers in Anuppur District of Madhya Pradesh; running rural crèches; screening, prevention and management of sickle cell disease; and tailored trainings for ANMs & medical officers broadly. Overall, these 20 years of work have allowed us to improve the quality of life for people in the area, and yet there remains much more to be done before one could be contentment so we would like to describe this as a work in progress. If one measures the work in survival, quality assessments, or in indebtedness prevented, there are significant gains. Equally important has been the learning, many of these have had lessons for the larger discourse in public health for the disadvantaged.