Ashwini (Association for Health Welfare in the Nilgiris)

ASHWINI is a registered charitable society working for the health welfare of the Adivasis of the Gudalur and Pandalurtaluks since 1990. Together with Read moresister organizations, ACCORD and VBVT, it works with the Adivasi peoples’ organization, The Adivasi Munnetra Sangam (AMS). 20000 Adivasis, belonging to four different tribes, who are members of the AMS and live in around 320 hamlets spread out over the Gudalur and Pandalur Taluks of the Nilgiris District in Tamil Nadu, are the primary beneficiaries of the project. The majority of them live below the poverty line and literacy rates are still very low. Vision: The primary objective of ASHWINI has been to establish a health system that is “accessible, acceptable, effective, and sustainable”. It should be owned and managed by the people themselves, and it should be a system capable of responding to the growing health needs of the Adivasis, and their changing social conditions. Mission: We assure patients of quality healthcare through reliable healthcare services, available medicines, and maintainable equipment. We shall ensure the efficiency of operations and effectiveness of treatment through our talented human resources. We shall review this policy for continuing suitability, adequacy, and effectiveness. We shall achieve this through the quality objectives and targets set for various departments ASHWINI has a three-tier health system: • The first tier consists of trained Village Health Volunteers at the village level. • The second tier consists of eight Area Centers (AC) manned by two health Animators(HA) each. They provide preventive and primary curative care. • The third tier is the 50-bed GudalurAdivasi Hospital. It is equipped with all facilities for secondary-level care The community health program and its outreach services form the foundation of the entire work. Eight area centers have been set up to improve accessibility for the villagers. Each has its own building with minimal infrastructure facilities. Eight area centers are staffed by 16 HAs to provide this gamut of services with the support of a coordinator, doctors, and other professionals. The village health volunteer plays a pivotal role in maintaining the health status of the people. More than 70% of the staff of ASHWINI is from the tribal community, many having been trained on the job. There has been a dramatic improvement in health indicators over the years, with infant and maternal mortality rates less than the Indian average.

Vision:
The primary objective of ASHWINI has been to establish a health system that is “accessible, acceptable, effective and sustainable”. It should be owned and managed by the people themselves; and it should be a system capable of responding to the growing health needs of the adivasis, and their changing social conditions.
Mission:
We hereby assure quality healthcare to patients through reliable healthcare services, available medicines and maintainable equipment. We shall ensure efficiency of operations and effectiveness of treatment through our competent human resources. We shall review this policy for continuing suitability, adequacy and effectiveness. We shall achieve this through the quality objectives and targets set for various departments

A brief note on ASHWINI
(Association for Health Welfare of the Nilgiris)
Website http://ashwini.org/new/
Introduction:
ASHWINI is a registered charitable society working for the health welfare of the adivasis of the Gudalur and Pandalur taluks since 1990.

The primary objective of ASHWINI is to establish a health system that is accessible, acceptable, effective and sustainable. It should be owned and managed by the people themselves. The most important aspect of this health intervention is the strong emphasis on involving the adivasi community and in training adivasi youth to deliver the services.

The program addresses the needs of more than 20000 Adivasis spread over 320 hamlets in the Gudalur Valley of the Nilgiri hills in South India.This particularly vulnerable tribal community, having lost access to the forests and an entire way of life, were on the edge of being decimated by poverty, malnutrition and disease. The health program started with training health workers to address the critical health needs of the mothers and children. This has, over the years grown to a 50 bedded hospital, The Gudalur Adivasi Hospital, 8 Area-Centres and health volunteers in over 200 hamlets. The training programs also evolved and today we have a formal nursing school. Most importantly, most of the management of ASHWINI is in the hands of the tribal community.

We believe that communities can be empowered by a participatory development process of capacity building and decentralization that culminates in community owned and managed programs and institutions. Ownership of institutions that cater to the mainstream population is a powerful tool in bringing about a change in social equations.

Tribal who are the primary beneficiaries of the project. They belong to four main groups:

• The Paniyas were once enslaved and were released from slavery at the time of independence.
• The Kattunaickens who are a minority are hunter gatherers and eke out a living from collecting forest produce. Today their heath situation is the most precarious of the lot.
• The Mullakurumbas are relatively better off, as they own some land and have enough food to eat.
• The Bettakurumbas are expert elephant trainers and some of them work with the forest department.

The majority of the tribals live below the poverty line and literacy rates are still very low. Illnesses that are directly related to poverty like malnutrition, tuberculosis, anemia and water borne diseases continue to be a major problem for these communities.

The health work and its impact so far

In 1987, the health situation of the people was critical. The health intervention centered around the training of village health workers. Mobile clinics visited the villages regularly. The Gudalur Adivasi Hospital was set up to offer secondary level curative care. Youngsters from different tribes with some schooling were trained at the hospital as nurses and health animators.

As the health seeking behavior of the people improved, the mobile clinics were replaced with 8 area centers from which the trained Health Animators provided health care. Deaths from preventable illnesses came under control.

The number of tribal deliveries being conducted in the hospital has been steadily increasing. Other health Indicators like antenatal check up for pregnant women and nutrition status of children have also shown a steady upward trend. Today more than 95% of women deliver in hospitals. Diseases like eclampsia have become a rarity.

ASHWINI has a three-tier health system:
• The first tier consists of trained Village Health Volunteers at the village level.
• The second tier consists of eight Area Centers (AC) manned by two health Animators(HA) each. They provide preventive and primary curative care.
• The third tier is the 50 bedded GudalurAdivasi Hospital. It is equipped with all facilities for secondary level care

The community health program and its outreach services form the foundation of the entire work.

Eight area centres have been set up to improve accessibility for the villagers. Each has its own building with minimal infrastructure facilities. Eight area centers that are staffed by 17 HAs provide this gamut of services with the support of a coordinator, doctors and other professionals. The village health volunteer plays a pivotal role in maintaining the health status of the people.

• Each centre has one accountant and the most data is computerized at the area level.
-The centres in GudalurTaluk are Gudalur, Devala, Devarshola and Srimadurai
-In PandalurTaluk are Ponnani, Pattavayal, Erumad and Ayyankolly.

The Gudalur Adivasi Hospital

This was established in 1990 to complement the Community Program. It has grown steadily over the years. In June 2009, the hospital shifted to a new building and is now has capacity for 50 inpatients. Apart from the tribal population, the hospital also caters to the poor non-tribals in the area. Being the only secondary care hospital in the area, it serves a critical need.

75% of the staff are from the Adivasi community. Today more than 80% of decisions are made by them. For some of the others, they get inputs from professionals or experts. The hospital is much sought after and the tribal staff provides services with confidence and dignity.
The health program is staffed by full time doctors include a general surgeon, gynecologist/obstetrician, family physician, anesthesiologist, dentists and junior doctors. Specialist doctors visit at regular intervals.
The Visiting specialists include orthopedics, pediatric surgery, urology, gynecology, laparoscopic surgery, vascular surgery, ENT, cardiology, pediatric neurology, developmental pediatrics, speech therapy, audiology etc. The Radiology department of CMC, Vellore supports us online. The specialists help us to provide a wide range of services in this remote area to underprivileged patients.

Gudalur Adivasi hospital has been accredited under NABH at entry level and NABL accredited for Covid-19 testing. It is also empanelled under the Government Insurance schemes.
The key focus of the work is on maternal and child health. Other special programs include:
Sickle cell anemia program- With Government TNHSP support, screening of the population under thirty years of age was completed.—- People from the tribal community and — from the Chetty and Baduga communities was done. — Patients with the disease were detected and are on a treatment program using protocols. Approximately 12% of the population is carriers of the disease. Counseling to help patients with the disease and for people detected to have the carrier state are ongoing activities. Treatment is offered at the hospital and the area centres. Morbidity and mortality from the disease has been significantly reduced.

RNTCP program- GAH is a microscopy and treatment centre and is equipped to screen patients for TB. Volunteers were trained to be DOT providers and supervise treatment. TB continues to be a problem in the tribal community.

Mental health program- A community mental health program was started in 2005 in response to the increasing rates of suicides in the community. Training to detect patients with mental illness was given to the health volunteers and staff of ASHWINI including doctors. Patients that were picked up were given treatment close to home. The program has become a well-established one with the support of The Tata Trusts and the formation of the Mental Health Team of ASHWINI,further on supported by Azim Premji Philanthropic initiative.

Nutrition intervention program- Malnutrition is on the increase in spite of improvement in the economic conditions of the people. Growth of all children under five is monitored and nutrition supplements with high calorie are provided to them. They are actively encouraged to access the Government ICDS centres.

Speech and hearing Programme- New born screening, under five screening in the villages and providing free hearing aid alongside speech therapy is provided.

Screening programs- Chronic illness like diabetes, hypertension, TB are screened village wise regularly and provided medication.

Training
ASHWINI Institute of Health
BSS one year diploma course was started in 2010 and all our in-house trained tribal nurses were encouraged to persue this course. From 2012 all admissions for tribal youth was started in various available courses.
ASHWINI Adivasi School of Nursing and the Auxiliary Nurse Midwife (ANM) course In 2017 ASHWINI got recognition to start a ANM Nursing school which is now recognized by the State Board of Nursing. This has been a long-standing dream; a way to get tribal girls a vocation to pursue. The first batch entered the two year program in October 2017. The course is rigorous and includes classroom learning, field work with Government staff and hospital postings. They will be soon working in their own community towards uplifting the health status.