Implementation of Project Swaasthya in Hyderabad by Smile Foundation
Evaluation by Daily Wage Worker Platform
The Covid-19 crisis has had a devastating impact on the urban poor, comprising migrants, daily wagers and others in the informal economy that constitute 90% of India’s total employment sector as per ILO. The majority of these workers reside in slums and squatters defined by characteristics of inadequate safe drinking water, sanitation, poor structural quality of housing and overcrowding. As a result, they often suffer from diabetes, cardiovascular disease, hypertension, asthma, diarrhoea and viral fevers. With the loss of livelihood and food security resulting from the nation-wide lockdowns, the difficulties being faced by a large population of migrant and daily wage workers in accessing essential drugs and necessary medical care has increased exponentially. With formal health systems being overwhelmed and states directing all resources towards the management of Covid-19, the most vulnerable have even less access to health services, especially to treat non-Covid related diseases.
Daily Wage Worker Platform (DWWP) is an NGO formed in response to the devastating impact of Covid-19 on migrants and daily wage workers. After mobilizing USD 50,000 to provide food and ration kits to 30,000 families in Dharavi slums, we focussed on healthcare. Our team developed the idea of an emergency health package to provide basic health services to migrants and workers without any access to healthcare, impacted by lockdowns. DWWP partnered with Smile Foundation to implement project Swaasthya among 10,000 workers spread across slums in Hyderabad, supported by the Swiss Agency for Development Cooperation (SDC). Project Swaasthya provides workers with a basic package of health services at their door step including: counselling, screening, diagnosis, treatment and referrals. The project was implemented using Tele-medicine and social distancing to address seasonal and non-communicable diseases that are being neglected in the context of Covid.
Smile Foundation identified 10 slums in the heart of Hyderabad city, covering a total population of 100, 000. The occupations of people in these slums are primarily daily wage construction labourers, rickshaw pullers, house maids and street vendors. Due to the lockdown many construction sites were shut down. With the onset of a major economic recession, workers are struggling to feed their families and access basic healthcare.
In the periphery of these 10 slums there is only one Govt. Hospital and no other affordable healthcare facility within 6kms of reach.
Smile Foundation adopted a combination of Tele-medicine whereby a full time doctor provided diagnosis and treatment remotely over the phone. A mobile medical unit staffed by a qualified nurse and pharmacist conducted basic tests and dispensed over 80 types of drugs to patients in the slums.
Community mobilizers spread awareness about the OPD clinics, the importance of practicing social distancing, hand washing and wearing masks. The project focussed particular attention on the needs of women and children. Women are often relegated into positions where they are not only more vulnerable to suffering from health problems, but also less able to have access and control over healthcare resources than men. Hence over 70% of project beneficiaries comprised women and children.
Awareness activities were conducted to educate workers and their families about ways to prevent Covid-19 and manage NCDs. The project focused on NCD patients (Hypertension & Diabetes Type II) and 683 consultations were recorded and about 200 rapid tests taking blood and urines samples were conducted. There were 47 patients that were referred to nearby hospitals such as Basti Dhavakana and Gandhi Hospital for advance treatment. Of these, 35 patients were successfully treated and 11 patient’s remain under treatment. 3000 Hygiene kits were also distributed which includes sanitary napkins and soap. These kits also helped to reduce social taboos and raise awareness about menstrual hygiene.
In order to successfully implement the Swaasthya Project, DWWP provided regular technical assistance and guidance to Smile Foundation. This included advice on staffing needs, surveys, monthly reporting and jointly addressing operational challenges. DWW developed a format for monthly narrative and financial reports and held bi-monthly calls with Smile Foundation to review progress and offer advice. Also, we made sure that while distributing the hygiene kits, conducting surveys, distributing medicines, screening and counselling patients, all the staff members were wearing PPE kits. Smile Foundation secured the health and safety of all their staff and frontline workers to protect them against Covid-19.
Due to the persistent efforts and rigorous approach followed by Smile foundation, supported by the DWWP team, the Swaasthya project was successfully able to exceed its targets in a matter of three months. It is one of the pioneers to have successfully delivered primary healthcare to migrants and daily wage workers since the onset of Covid-19 and ongoing lockdowns.
Here are some of the highlights:
3847 Beneficiaries were treated through 60 OPDs.
1130 of the beneficiaries were Male 2044 beneficiaries were Females and the rest 673 beneficiaries were children.
224 Point of Care (POC) tests were conducted
3000 Hygiene Kits were distributed in the operating slums
34 Community Meetings were conducted to increase community participation in issues concerning health especially on COVID-19 and NCD.
47 cases were referred to various specialists in Government Hospitals
3120 survey forms completed in the operating slums.
Tele-medicine to beat lockdowns - Initially, the plan was to rent an office where patients would be attended by a nurse. But with the rapid rise in Covid cases and the lockdowns, a mobile van was proposed. In order to provide innovation in the delivery of healthcare services to the slum residents, the use of Telemedicine was suggested by DWWP. The Swaathya project intended to cover a population of 10,000 & in order to achieve that, the project was implemented in 10 slums in Hyderabad & to ensure that the health services are delivered within close proximity to the slum residents, the mobile van developed a roster to provide services at different locations on a regular basis.
Medical Staff & Coverage - In order to provide healthcare services to the population via telemedicine, there was a doctor employed who was available for 6-8 hours daily. The healthcare service was provided by using a mobile van (smile on wheels) having a nurse for aiding the screening, testing & consultation via telemedicine route with the doctor along with one helper for aiding in the distribution of medicines.
Staffing - Having adequate human resource to complete the designated task is an important step in achieving the targets set within the defined timelines. One challenge was the initial unavailability of a pharmacist for distribution of medicines to the patients at the start of the program. The private sector was paying higher salaries with the onset of Covid-19. However, this did not stop Smile Foundation from achieving their goals and they continued the distribution of medicines by involving the nurse & other team members via Smile on Wheels (SOW) platform.
Awareness among patients - When the project was implemented in the month of July 2020, there were less patients who came to avail services via SOW platform, the main reason being the lack of information among the slum residents with regards to the implementation of Project Swaasthya. In order to cater to this, DWWP created flyers which were written in Hindi as well as the local language of the slum residents to help in the IEC & BCC related activities. Also, while distributing the sanitary kits there was some opposition faced by the community male head of households due to socio-cultural and economic barriers. DWWP advised the team to overcome this through counselling and communicating directly with the women beneficiaries. As a result, Smile Foundation was able to increase the awareness and uptake of sanitary kits in the communities.
Survey Questionnaire designing - DWWP designed a detailed survey to collect data from migrants living in slums on their health seeking behaviour, disease profiles, access to health services during Covid-19 and social distancing. The survey was field tested in local slums in Hyderabad and subsequently adapted to local conditions by Smile Foundation. In the beginning, the surveys got off to a slow start (200-300), as the community members were not aware about this initiative and in order to do that the various steps taken by DWWP included the creation of IEC flyers. The staff members were increased by Smile Foundation where they included more volunteers, community health workers and a data collector to scale up the survey implementation to meet the targets & deadlines. At the end, due to perseverance and efforts by Smile Foundation, the targets were exceeded.
COVID & Flood Issues - While the project was implemented, the Project manager in Hyderabad was detected COVID positive. Keeping in mind the safety and welfare of the community members, the project services were suspended for about ten days. The project was also impacted by heavy rainfalls and floods. However, to meet the deadlines, Smile Foundation increased the number of volunteers & community health workers from other ongoing projects to cover up the gap. This clearly shows the level of commitment from the NGOs in achieving the work taken up by them.
By Ridhima Vohra, Vijayendra Shrivastava and Siddhartha Prakash.
The next section describes the challenges faced by the partners in implementing the project in Hyderabad and how these were successfully overcome. This provides a good basis for scaling up the success. Some of the key challenges faced by the project were: