Eleventh Five Year Plan

74 Eleventh Five Year PlanBox 3.1.5Akha—Ship of HopeOn the saporis or river islands of Assam that are inundated with floods every time the mighty Brahmaputra unleashes itsfury, life is a constant struggle against disease and deprivation. Some 30 lakh people live in 2300 remote, floating villages onthe Brahmaputra in Upper Assam. Here, there are no functional anganwadis, no health centres, no schools, no power, noteven drinking water. Till recently, immunization, Antenatal Care (ANC), disease management, and treatment were all unheardof. Then in 2005 the Centre for North East Studies and Policy Research intervened. They partnered with NRHM,UNICEF, and the government of Assam, to start Akha (meaning hope in Assamese)—a 22-metre long, four-metre wide shipthat carries hope and health care to 10000 forgotten people in Tinsukhia, Dhemaji, and Dibrugarh districts of Upper Assam.The 120 hp powered Akha has an Out Patient Department (OPD) room, cabins for medical staff and ship crew, medicinestorage space, a kitchen, two toilet cum bathrooms, and a general store. A generator set and 200 litre water reservoir are alsoinstalled to ensure that the medical team that travels to the saporis has adequate power and water supply.The idea behind Akha is simple—use the river to tackle the problems and challenges created by it. Doctors and ANMswho are unwilling and unable to survive on these remote islands, live on this ship stocked with medicine and other suppliesand hold health camps on the saporis. They immunize, treat, provide medicines, and advise people on preventive measures.They even take critically ill patients to the nearest health centre in Dibrugarh.In less than two years, Akha has provided succour to many. If we can upscale this innovative intervention under NRHM,health care will no longer be a distant reality for the people living on this highly volatile river. It can be upscaled to include ahospital ship with diagnostic facilities, in patient ward and operation theatre. Then health care would become truly inclusive.Most of the centrally sponsored disease controlprogrammes have a focus on the tribal areas. In spiteof all this, tribal communities have poor access tohealth services and there is also underutilization ofhealth services owing to social, cultural, and economicfactors. Some of the problems include difficult terrain,locational disadvantage of health facilities, unsuitabletimings of health facilities, lack of Information,Education, and Communication (IEC) activities, lackof transport, etc.3.1.63 Challenges such as demand side constraints,human resource development issues, and the providers’attitude are particularly acute in tribal areas. Duringthe Eleventh Five Year Plan, therefore, renewedefforts will be made to provide need-based qualityintegrated health and family welfare services, improvementof service coverage, promotion of communityparticipation, encouragement of tribal system ofmedicine under AYUSH and replication of successfulefforts (See Box 3.1.6).3.1.64 The challenge of increasing urbanization withgrowth of slums and low-income families in cities hasmade access to health care for the urban poor a priorityof the Eleventh Five Year Plan. Therefore, the thrustduring the Eleventh Five Year Plan will be to locate theservices in or around urban slums, Minorities, andSC bastis and SC concentration areas having 20%or more SC/ST population. With a view to improvinghealth status of people in urban slums, the EleventhFive Year Plan will provide support to the ComprehensiveProject Implementation Plan (PIP) for vulnerablegroups, which covers population in urbanslums and other vulnerable groups in cities andtowns with a population up to one lakh. The Planwill develop mechanism to address this particularissue. This will be in addition to the NUHM describedabove.3.1.65 In order to meet the objectives of reducingvarious types of inequities and imbalances, interregionaland rural–urban, the Eleventh Five Year Planwill increase the sectoral outlay in the primary healthsector. While recognizing the role of primary heathsector, the National Health Policy (2002) sets out anincreased allocation of 55% of the total public healthoutlay for primary care; the secondary and tertiaryhealth sectors being targeted for 35% and 10% respectively.The Policy also states that the increased aggregateoutlays for primary health care should be utilizedfor strengthening existing facilities and openingadditional public health service outlets, consistent withthe norms.