About a year ago, Reshma Khan, a resident of Kalyan, travelled to a hospital in Mumbai, because she suspected she was pregnant. The 27-year-old had been married for 12 years, and though she had missed her period for a couple of months she reasoned that it was something that happened every year. “The doctor in Mumbai told me that it wasn’t a pregnancy and that it was a swelling in my stomach,” she says.
Back in Kalyan though, in the Ashok Nagar area where she lived, Ms. Khan decided she wanted another opinion. She remembered that she would often run into two field officers from an NGO called Society for Nutrition, Education and Health Action (SNEHA), a Mumbai-based non-profit. A few months earlier, in partnership with the multinational Siemens, they had set up Sanjeevan, a healthcare clinic in a large van which stopped in the neighbourhood once every week. Ms Khan had visited once when she was ill, to get some medicine, but thought that for bigger issues she had to go elsewhere.
“We had been seeing her for a few weeks and I told her that she should come and get tested for a pregnancy,” says Vimal Bhuvad, one of SNEHA’s field officers who works with the community to inform them about sanitation and healthcare. “Back then she couldn’t pay ₹50 to do a urine test in the lab that we have in the van, so I offered to pay for her, and we discovered that she actually was pregnant.”
Today, those services in the Sanjeevan mobile healthcare unit are free, and hundreds of people like Ms. Khan — who gave birth four months ago to a baby boy — finally have access to primary health care that they can trust.
A neglected pocket
Ashok Nagar is one of the many slum areas in the Kalyan region. There is a dusty main street lined with small shops and narrow roads which spread out into a huge maze that accommodates about 10,000 houses.
One of the biggest problems facing the area is a lack of sanitation facilities, with public toilet blocks lying either in disuse or disrepair. The other is a lack of access to reliable healthcare.
There are a couple of private clinics and dispensaries, but the doctors are not MBBS-qualified, and most times, these facilities remain closed. “The only option that we have here is to go to the municipal hospital in Kalyan,” says Prakash Jadhav, a long time resident, “and the doctors there, for any serious problem will tell patients that they have to go to Thane or to Mumbai, which many people cannot afford.”
Healthcare on wheels
Over 2014-15, SNEHA did a needs assessment study on health amongst the most vulnerable communities in the Kalyan-Dombivli region, and found that there were many facets to the problems these communities faced in terms of accessibility to reliable primary health care. This included public health facilities being too far away and people being forced to visit private medical facilities which they said they could not afford. Diagnostic facilities like X-ray (both public and private) were not available close to the community Perhaps most importantly, there was a lack of awareness on several health-related issues.
As part of the project with Siemens, SNEHA chose 10 areas in the region to serve. A large retrofitted van seemed to be the ideal way to provide a flexible, mobile service that could cover all ten.
The vehicle is divided into three sections: a small room for consultation with a doctor, for patients to be examined and prescribed medicine, and two more for diagnostic services. The van has facilities for blood- and urine-testing, as well as X-Ray and ECG machines. If the patient is found to have serious condition, he or she is referred to a larger public health centre and follow-ups are done by SNEHA staff.
Aside from these services, the van is also accompanied by a team of field workers and community organisers like Ms. Bhuvad, who fan out and inform people about the health services they can avail off. They also regularly hold meetings about sanitation, prevention of communicable diseases, nutrition and family planning. “These meetings are usually in people’s houses,” Ms. Bhuvad says. “Since we’ve been working in this area for over a year now, people who recognise us will ask us to come and hold a meeting in their house.” If time permits, SNEHA’s community organisers reach the neighbourhood a day before the van is due, to spread the word and hold meetings about health problems that can potentially be addressed.
The prevention of communicable diseases has been a major area of focus, in addition to SNEHA’s long-time core area, maternal and neonatal healthcare. Kanchan Jagdhane, programme coordinator for the Sanjeevan project, says that the van provides nine core services for pregnant women and newborns, including abdominal checks, prescription of supplements, and getting the mother registered for delivery in a public hospital. Field officers also provide information on post-natal care, nutrition, and family planning.
Better healthcare
As awareness has spread, patients have begun coming in for a range of treatments. Between 2015 and 2016, according to the SNEHA website, thanks to the Sanjeevan van, 6,470 patients have accessed primary health care services at the clinic for the treatment of upper respiratory tract infections, reproductive tract infection, skin diseases, blood pressure and diabetes. 105 pregnant women meanwhile, accessed Antenatal Care services, received supplements of iron and calcium and were monitored for other problems during pregnancy. The mobile health clinic, Ms. Jagdhane explains, now also uses a state-of-the-art patient management software to document and track cases.
The operation is a three-year pilot, and SNEHA hopes to eventually work in partnership with the Kalyan-Dombivli Municipal Corporation (KDMC) and hand over to the service to them to implement. “The eventual aim,” Ms, Jagdhane says, “is to see if it can be relocated in other vulnerable areas around Mumbai.”
