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Social Audit Unit- Sikkim (Voluntary Health Association of Sikkim) was assigned for conducting Pilot Social Audit under the National Social Assistant Programme (NSAP) by Social Justice, Empowerment and Welfare Department, Government of Sikkim (GoS) vide. Office Order No. 118/SJEWP Dated: 26/03/2016. The social audit was conducted of the beneficiaries drawing pension / allowances under the following schemes in Central Pandam Gram Panchayat Unit and Rangpo Nagar Panchayat ward in accordance with the Guidelines of National Social assistance programme. The social audit was conducted under the following schemes of NSAP:-

• Indira Gandhi National Old Age Pension Scheme
• Indira Gandhi National Disability Pension Scheme
• Indira Gandhi National Widow Pension Scheme
• Subsistence Allowance (State Innovation Scheme)
• Unmarried Women Pension Scheme (State Innovative Scheme)

The pilot Social Audit of National Social Assistant Programme (NSAP) schemes were audited from 08/04/2016 to 18/04/2016. The Social Audit covered 1 Gram Panchayat Units (G.P.Us), and 1 Urban Local Bodies (ULBs).

Details of Social Audit conducted in Gram Panchayat are as follows:

STEPS IN SOCIAL AUDIT

Kick off Meeting                                           1 day

Documents and Beneficiaries verification and door to door interaction         4 days

Report compilation & preparation for Jansunwai                    1 day

Social audit gram sabha/Jansunwai                              1 day

Exit Conference                                         1 day

The Process Involved

• Social audit Unit- Sikkim (VHAS) finalized the Social Audit Calendar to conduct Social Audit of National Social Assistance Programme schemes.
• Eight days was spent in Gram Panchayat (GPs) and Urban Local Bodies (ULBs) for document and beneficiaries’ verification, door to door verification and Gram Sabha/Jan Sunwai.
• Lastly Social Audit Unit- Sikkim prepared final Social Audit Report and submitted to the Social Justice, Empowerment and Welfare Department, Government of Sikkim (GoS).

The list of facilitators for conducting Pilot Social Audit of NSAP schemes

Inclusive India Foundation with financial support from Glenmark Foundation has approached VHAS for initiating a project on Providing Quality Primary Health facilities and awareness among the communities through mobile health clinic in 6 villages in East Sikkim for 3 years. The objective is to provide Quality Primary Health facilities and awareness among the communities through mobile health clinic covering 6 villages namely:-

1. Rumtek-Samlik
2. Tumlabong
3. Radong
4. Namin
5. Namli
6. Chuba

These villages are suggested to be covered for interventions where the basic access to health services is lacking for 20 000 population and the project has been named as Health on Wheels (HoW). The main target population is 0-6 year children, Pregnant and lactating mothers and Community. The project has been implemented from the month of July 2016.

STRATEGY OF HoW: Provide quality primary health facilities and awareness among the community through mobile health clinic.

OBJECTIVES OF HoW:

• To reduce and control diseases through mobile clinics covering the target population/proposed beneficiaries
• To provide health care to the poor and needy at their door step
• To undertake awareness and IEC activities informing the target audience regarding the programme and its operation
• To provide health education to the target population, especially women and adolescent girls
• To provide reproductive health care including immunization to the expectant and lactating women
• To provide complete immunization service for the children below 6 years of age
• To educate the target population on health and sanitation and the use of safe drinking water and protection of the environment
• To transport serious pediatric patients and emergency cases to nearby PHCs, District Hospital, Singtam or STNM Hospital, Gangtok or private clinics by Ambulance
• To strengthen the Village Health & Nutrition Day scheme of the Government through its activities in each ICDS Centre (AWC)
• To strengthen the hands of the Government as a collaborative partner in healthcare service delivery in order to progress towards its objectives of a complete healthy state

WHAT DO WE DO?

1. Free OPD services for children.
2. Free OPD services for mothers and expecting mothers.
3. Free medicines for children under 6 years of age.
4. Free medicines for mothers.
5. Free consultation for needy individual.
6. Free ambulance service for children under 6 years and mothers.
7. Awareness camps for various health related issues.
8. Screening for school children.

WHO CAN AVAIL BENEFIT?

Anyone can receive the benefits but free medicines and ambulance services are provided only to children less than 6 years, expecting mothers and lactating mothers.

HoW TEAM:

1. Project coordinator: Anjana Rai
2. Accountant : Siraj Darjee
3. Medical Officer: Ashish Sharma
4. Health worker: Miss Anita Rai.
5. Nurse: Miss Rubina Sharma & Miss Deepika Chettri
6. Driver:             Karna Bahadur Rai

TASKS DONE BY HoW TEAM UPTO MARCH 2017

• Number of health camp conducted: 163
• Number of patients seen: 2165
• Number of target group examined: 1241
• Number of health talk delivered: 21
• Number of medicine distributed: 4867
• Number of patients transported by ambulance:         03

PICTURE GALLERY: Photos sent separately.

Reported by: Anjana Rai, Project Coordinator, HoW Project

Date: 15^th march 2017, VHAS.

Project Background

VHAS has implemented the IIMK-Belgium supported project named as PARAS THEZUM in the seven villages of West Pendam Gram Panchayat Unit from 2001-2009 and the overall impact of the project seems successful. After the successful implementation of the PARAS THEZUM project in these villages of West Pendam area, VHAS shifted the focus to other area having similar kind of geographical and socio-economic background.

The new area is Budang – Kameray Gram Panchayat Unit falls under Duga Block in East Sikkim, where around six villages are covered under community health and development project.  The project has been given the name as PAKA project. PA for Pachak and Ka for Kameray as initially started with these two villages.

Components of the project:

1. Reproductive & Child Health
2. Women Empowerment & Development
3. Household Sanitation
4. Income Generation Programme

1. Reproductive and Child Health (RCH):

Under the RCH, awareness trainings have been given to the members of different SHGs of Sajong village under Budang Kameray GPU in East Sikkim from time to time. basically covering major topics as follows.

Training on Immunization / Ante Natal Care & Post Natal Care:

Importance of ANC & PNC has been highlighted:

• Early registration of pregnancy with nearest Govt. health facility is a must to every pregnant woman.
• Consumption of Iron Folic Acid Tablets
• Specified doses of TT injection
• Monitor the growth of foetus
• Measurement of Height, Weight, abdomen and Blood Pressure
• Identification of the risk factor in time, if any
• Management of complications in time, if any
• Birth preparedness
• After delivery, PNC up to 42 days is important to see if there are any complications.

Regarding Immunization, they were informed about the Immunization of pregnant women and children under National Immunization Schedule (India) where a pregnant woman has to get 2 TT injection and children have to be given immunization against  6 vaccine preventable diseases viz. BCG for prevention of childhood tuberculosis, D.P.T. for prevention of Diphtheria, Pertussis and Tetanus, OPV for prevention of Polio and Measles vaccine for prevention of Measles.

1. Women Empowerment & Development

Training on sustainability of  Self Help Group (SHGs):  Training on sustainability of SHGs was organized for the members of different SHGs from Sajong at Community Hall. The objectives of the program were:

• Sustainability plan by different SHGs
• Conceptual clarity on sustainability
• And also to finalize the beneficiaries of Individual Household Sanitation program

Program Coordinator from VHAS, briefed the participants that their SHG should sustain in long run and all the SHGs have to plan their sustainability factor. Economic growth of all SHG leads to sustainability and all SHGs need to think what could contribute to economic growth. They should always make a plan for future and needs to think beyond the support from VHAS-IIMK or any other external agencies. The ultimate objective of sustainability should be self reliance.

III. Household Sanitation:

Support for construction of Sanitary Toilets: A total of 11 sanitary toilets have been supported to the members of 5 different SHGs at Sajong. The lists of toilet beneficiaries are as follows:

1. Income Generation Programme (IGP):

Support for Ginger: Samarpit SHG from Sajong have been supported for ginger farming as group economic activity. 10 members group have been supported with 10 mounds (400 Kg) of ginger and next year they have to give back 10 mounds of ginger to the project for rotation to other beneficiaries.

Support for Piggery: 5 members of Sheetal SHG were supported for Piggery

Voluntary Health Association of Sikkim (VHAS) has been making constant and concerted efforts to formulate and implement schemes to ensure adequate health care services to the people of the state, facilitated by the West Bengal Voluntary Health Association (WBVHA), Kolkata  in line with National Health Mission. Under this endeavour attention is also being paid to take special care of the needs of the people of the tribal areas and backward regions.

VHAS has implementing a dynamic program called the Basic Health Care and Support Program and ‘Block Health Consortium program’ with partners organisation at Sombarey block ,west Sikkim since 4 years. The program is aiming for better collaboration between very fragmented health’s providers. However, it is often stuck too much at the level of declaration of intention with little improvement of health services at field level. This program was integrated in the overall MEMISA-DGD-program from 2014. The purpose of the Consortium was to have a real impact on the services for the population in 21 villages directly or indirectly at 4 Gram Panchayat. Through regular workshop and perspective of the NGOs was widened and deepened and they started to collaborate among each other with the other health workers at the Panchayats, block and district levels. Tools such as the case-building exercise (concentrating on first line and second line services for specific cases identified as priorities basis such as maternal health) were very instrumental in moving forward. This first program resulted in improved services at community level with better coordination between the health factors at this level and a genuine dynamic for change.

Overall Objectives of the Program

• To improve the health care in 4 Gram Panchayat.
• To develop of a coherent and functional Panchayat and block health care system with the active involvement of all concerned stakeholders.

Specific Objectives of the Program

• To ensure effective implementation of NRHM and other health program in selected district, block and Panchayat/villages with active community involvement and participation.
• To identify the policy gaps in NRHM and other health programmes & to advocate for change in selected district, block and Panchayat/villages.

Our team has observed a series of cases relating to the conditions of Public Health Centre, Community Health Centre, and the facilities in public hospitals. Due to  legal interventions, the government ordered that blood donation facilities be made available and has given directions for a number of states to conduct inquiries into their public health system.

The following areas are covered by VHAS under Basic Health Care & support Program through Partners.

The Japan International Cooperation Agency (JICA) assisted Sikkim Bio-diversity Conservation & Forest Management Project (SBFP) is approved for implementation from 2010-11 and the implementing department of this project is the Department of  Forest Environment & Wild life Management, Government of Sikkim. The project was covered in the four districts of Sikkim since 2011-12 financial years in the community level.  In these four districts project covered total 135 JFMC/EDC and within these  3 year.

Project Objective

The project has the goal of improving the management of natural resources and alleviating the rural poverty. In order to achieve these goals, the project has the following objectives:

• To strengthen biodiversity conservation activities and forest management capacity,
• To improve livelihood for the local people who are dependent on forests by promoting sustainable biodiversity conservation, Afforestation and income generation activities including eco-tourism for the community development, thereby contributing environment conservation and harmonized socio-economic development of Sikkim.

To achieve this project objectives with the support of NGOs as a district level facilitating Organization. Three same NGOs were selected  for this year also and they are:-

• Voluntary Health Association of Sikkim (VHAS) for the East Sikkim,
• Kanchandzonga Conservation Committee (KCC) for the West & South Sikkim &
• Eco-Tourism & Conservation Society of Sikkim (ECOSS) for the North district.

The following activities have been proposed in the Project.

• Afforestation
• Protected Area Management & Biodiversity Conservation
• Income Generation Activities for poverty alleviation
• Supporting Activities for Forest Management (Research and Training, Monitoring and Evaluation and Enhancement of Geographic Information System (GIS) and Management Information System (MIS).

In the 5^th year of this project Voluntary Health Association of Sikkim (VHAS) indentified 6 JFMCs and 5 EDCs under SBFP with the coordination of Project Management Unit and selected villages and details of JFMCs/EDCs are given below.

At the end of the financial year 2015-16 Voluntary Health Association of Sikkim (VHAS) initiated meetings with selected 56 SHGs under JICA assisted Sikkim Bio-diversity Conservation & Forest Management Project (SBFP) for their performance grading to provide loan from SBFP and also representative of VHAS attended the trainings and programmes which was organized by Project Management Unit of SBFP.

Targeted Intervention Project on HIV/AIDS & STIs

The voluntary Health Association of Sikkim is implementing the Targeted Intervention (TI) Project with the support of Sikkim State AIDS Control Society (SSACS) on HIV-AIDS/STIs amongst the high risked behaviour groups i.e. Female Sex Workers (FSW).  We have two TI project running i.e. TI Project (I) & TI Project (II). Under TI Project- (I) we are covering Gangtok & Ranipool and the target population registered till now is 235. Under TI Project- (II) we are covering Singtam and Rangpo and the target population registered till now is 289.

The project was initiated with the following objectives to achieve.

• To create awareness about HIV-AIDS/STI among the vulnerable flying FSW.
• To detect and cure Sexually Transmitted Infection.
• To motivate for visiting ICTC.
• To stop the transmission of HIV-AIDS/STI among the high risk group population.
• To promote safer sex practice.
• To reduce multiple partners and to use regular condom with regular partner.

The most effective way of controlling HIV-AIDS/STI from further spread was to carry out direct intervention programme among this high risk behaviour groups, through multi- pronged strategy such as:-

• Advocacy & Community Meetings
• Field visit/Networking
• Group Discussion/Focus Group Discussion
• One to One interaction
• Counselling
• STI Management
• IEC materials distribution
• Training to Peer Educator
• Condom promotion and distribution.

PROJECT COMPONENTS

Following components were emphasized in the project programmes.

• Out Reaching: To motivate target group to access the facilities available at DIC. Field visit & networking to reach towards target group for one to one interaction, GD/FGD, motivate to make visit Drop-In-Centre for seeking the facilities & benefit.
• Behaviour Change & Communication: correct and consistent use of condom and to motivate them for safer sex practice, IEC Materials for behavioural change, motivate for condom use, improves health care seeking behaviours, counselling on HIV-AIDS/STI to minimize the risk of spread & reduces number of sexual partners.
• STI Management: Clinical services for the management of STIs and to meet other health care needs. Besides this we also do partner notification and follow up on STI patient.
• Condom Promotion: Condom programming to ensure the availability of easily accessible, good quality and affordable condoms and to use regular condom with regular partner also.
• Linkages and Referrals: Linkages with ICTC, STI, DOTs, ART Centre For referrals and support.
• Monitoring and evaluation: Monitoring and evaluation for providing regular feed back to the managers for the project at different levels.

SPECIFIC OBJECTIVES

• To make awareness of HIV-AIDS/STI infection to flying FSW as well as their clients.
• To give knowledge on HIV-AIDS/STI to flying FSW as well as their clients.
• To established a Drop-in Centre for Health check-up, condom demonstration & distribution, counselling and other relevant program.
• To provide STI treatment facilities at DIC.
• Condom promotion for minimizing the spread of HIV-AIDS/STI.
• To extend individual and group counselling for behaviour change.
• To create awareness amongst the target groups through IEC materials, Training, Quiz competition, Group Discussion/Focus Group Discussion.
• To inform about HIV testing facilities available in our state and implication of positive or negative test result.

Background: The organization (VHAS)  has been approached by CIPLA Sikkim to conduct health  related Need Assessment Survey at 10 selected villages each  under Pakyong and Rhenock Block in East District . The name of 20 villages has been provided by CIPLA Sikkim.  Accordingly, VHAS has decided to do the survey in two phases. At 1^st phase, the survey was conducted at identified villages under Pakyong Block from 5th to 8^th Oct. 2015 in following villages:

S.No.       Name of villages                                                Date of visit

1.         Taaza Titrebotey-                                                         5.10.2015
2.         Pacheykhani-                                                                5.10.2015
3.         Amba Taksang-                                                            6.10.2015
4.         Dikling-                                                                          6.10.2015
5.         Tareythang-                                                                   7.10.2015
6.         Padamchey-                                                                   7.10.2015
7.         Rorathang Dhanukay-                                                 8.10.2015
8.         Dugalakha-                                                                     8.10.2015

Tools used for Need Assessment Survey:

1. Focus Group Discussion (FGD)
2. Interview
3. Questionnaire

Respondents:

1. Mothers having 0-5 years children for Focus Group Discussion to get data on RCH issues
2. Students of class IX & X in Secondary and XI & XII in Sr. Secondary Schools for Focus Group Discussion to get data on adolescent issues
3. Interview with School heads to know about the status of Student’s health and hygiene
4. Interview with PHC and PHSC staff to get idea on common diseases in people and the facility they have for people
5. Interaction with ASHA and ICDS workers to know their viewpoint on health seeking behaviour of the village people
6. Interaction with Village Panchayats for getting information and access to village

Objective of the Survey: 

1. To find out different health problems of identified villages
2. To plan intervention for the health problems of identified villages
3. To develop project proposal and submit to CIPLA Sikkim

Conclusion

The survey was done by 2 teams comprising of 2 members in each team.  This way 2 villages were covered in a day, thus total of 8 villages were covered by 2 teams in 4 days. Both the group had 1 male and 1 female member. The idea behind keeping 1 female surveyor per group was to make conducive environment for village women to interact openly with the team.

Team I members: Anjana Rai & Sawan Rai and  Team II members: Kusum Tamang & Kamal Kumar Rai

During the need assessment survey of 8 different villages, rampant prevalence of Non Communicable Diseases was found. There are issues of social problems as well. In one of the villages, Amba-Taksang, people shared that the case of Suicide is high and have asked for immediate mental health program focussing on prevention of suicide.

There are accessibility problems due to conditions like difficult terrain, improper road connectivity, unavailability of public transport in frequent basis, low economic condition, and cut off due to landslide during monsoons in most of the villages.

There is a vast scope for implementation of awareness campaigns and health camps  in these villages as lifestyle related diseases like diabetes and hypertension are reported from most of the villages. The necessity of School Health Programs has also been felt as in almost all schools, Student-Toilet Ratio is not sufficient. Awareness on importance of health and hygiene at School is necessary.

To address the above issues, focus should be on the following major subjects:-

1. Non Communicable Diseases
2. Mental Health program
3. School Health program

Reproductive and Child health Programme

In December 1998, the Ministry of Health and Family Welfare (MOHFW), Government of India launched the MNGO scheme as an effort  towards forging partnership and collaboration with Non-Government Organizations. The Mother NGO scheme is decentralized to state and district level and provides ample of scope for MNGOs and FNGOs to work in un-served and underserved parts of all districts in the country.

VHAS has been entrusted with the responsibility of acting as a Mother NGO under the Reproductive and Child Health Programme in the state of Sikkim by the Ministry of Health and Family Welfare, Government of India during 2001.

The basic philosophy of the programme is client centered, demand driven, need based and to provide quality care services.  After the sensitization workshops on RCH in which 17 NGOs from all four districts of the state participated, 10 FNGOs were identified members of the field NGOs in financial management, office management in addition to actual RCH programme and the role of NGOs and programme Management.

The second phase of RHC program i.e. RHC-II has been commenced from 1^st April 2005. The main objective of the program is to bring about a change in mainly three critical reproductive health indicators i.e. reducing total fertility rate, infant mortality rate and maternal mortality rate with a view to realizing the outcomes envisioned in the Millennium Development Goals, the National Population Policy 2000 and the Tenth Plan Document, the National Health Policy 2002 and Vision 2020 India.

In RCH-II, VHAS has been authorized to take up two districts for the implementation of the RCH programme. VHAS has taken up the three FNGOs from East and three FNGOs from west districts NGOs.

Ambulance donate by State bank of India

VHAS is planning to establish good hospital in the state of Sikkim. The ambulance was donated on 18^th march 2012 to VHAS by Mr. A. Krishna Kumar, Managing Director, National Banking Group, SBI corporate Centre Mumbai contributed for this future plan of VHAS.  VHAS has been working with the people of grass root level on health and social issues and was highly appreciated on the work done by VHAS and also encourages VHAS to work more for the people on health issues.

Now the ambulance is working for the good cause. The ambulance was also used during  Nepal earthquake for disasters relief.

The Earthquake that hit Sikkim on 18^th September evening at 6.10 pm measuring 6.8 Richter scale left in its wake a trail of death and destruction, leaving a population of close to 100,000 homeless and almost 60 dead (as on 21st of september 2011) and 32 seriously injured. The quake lasted for about 30 seconds and shook the entire state of Sikkim as well as its tremor felt in other part of India like Lucknow, Patna, Kolkota, New Delthi. The epicenter of the quake was located 64 kilometers North-west of Gangtok. The total loss as per the Chief Minister’s  announcement on 21st September was 1 lakh crore.

The major area affected was mostly in North District Sikkim and also East, West and South were also heavily affected.  In the North Sikkim especially Mangan being the location of the epicenter made it impossible for rescue operation to distant villages and towns, to be conducted on time as the connecting highways were blocked due to post earthquake landslides.

VHAS initiative in relief and rehabilitation activities in affected area:-

Despite being shocked and shattered by the earthquake of 18^th evening, the energetic staff of voluntary Health association of Sikkim strongly felt their need towards the society. Though the government had announced the state holidays for some time, they started working towards the Relief and Rehabilitation of affected villages and people.

Following are the detail of the activities carried out by VHAS:-

• Tumin GPU, Rakdong Tintek Block (East District): : A team of VHAS comprised of Executive Director and other staff of VHAS reached to the highly affected/damaged villages of Tumin, East district on 19^th September 2011. As the connectivity to that villages were totally damaged out team had to  walk through jungles and hills for more than five hours to reach to the affected villages. A partner organization of VHAS, Nava Jyoti Sangh of that locality supported the mission and also took up the responsibility of collecting information and supplied it to VHAS.
• Singbel Kambal GPU, Rakdong Tintek GPU under Tintek Block and Ralap Rangpu GPU under Khamdong Block (East District): A team from VHAS reached on 20^th September 2011to the highly affected areas of Singbel Kambal GPU, Rakdong Tintek GPU under Tintek Block and Ralap Rangpu GPU under Khamdong Block. VHAS distributed tents to meet the immediate needs of the affected people. A partner organization of VHAS of  that locality supported the work with full responsibilities.
• Sakyong Pentong GPU, Passingdong Block (North district): Based on the rapid assessment report various relief activities were also carried out at Nandok, Kamaray and Ralay in east Sikkim Monew, Nasa, Taribhir, Middle, lower and upper Rumbuk Daramdin Sai Mandir Relief camp and Ribdi Bharagn in west Sikkim.
• Under Ribdi Rharang GPU of Daramdin Block team visited three villages called Bharang, Upper Ribdi and Lower Ribdi. Team assessed the situation interacted with the affected families and delivered the relief materials like tent, torch light, candle, match box, and poly pipe, rice, pulses, blanket and first aid box to 14 households.

 VHAS carried out relief activities individually as well as in collaboration with different institutions.