An exemplary community health centre

In a remote village in Sehore District, Madhya Pradesh, a Community Health Centre decides to change for the better. The result: improved cleanliness in public health facilities linked to positive health outcomes. A story in images.

In 2016, the Community Health Centre (CHC) in Sehore district of Madhya Pradesh was felicitated for being a change agent. It received the Kayakalp Award, the first health centre in the state as part of the clean hospital initiative by the Government of India.

The six-decade-old health centre met the objectives of the award scheme which were to promote cleanliness, hygiene and infection control practices in public Health Care Facilities (HCF), to incentivise and recognise such public HCFs that show exemplary performance in adhering to standard protocols of cleanliness and infection control, to inculcate a culture of ongoing assessment and peer review of performance, and to create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes.

However, the condition of the CHC in Ichawar, a remote village in Sehore district of MP, was not the same until a few years ago. Constructed in 1956, the CHC was the only health centre in the district, addressing health issues of over 1.5 lakh people. The six-decade-old hospital required huge improvements, in terms of infrastructure, facilities, technologies, and best practices for the welfare of its patients. The accessibility of clean water, decent toilets, and good hygiene was deteriorating, leading to an adverse effect on the patients.

Dr. Bharat Bhushan Sharma examining a patient at the Community Health Centre

Image: WaterAid India

“Even today, this is the only CHC in the district that the local communities have access to. With constant efforts, today the facilities are way better than before,” shared Dr. Bharat Bhushan Sharma, working at the CHC for the last 15 years.

With repeated discussions at the district health society, the doctors were able to push the message that the health centre required urgent attention. Lack of handwashing stations in each department, poor garbage disposal techniques, no concrete path for easy accessibility of the patients and the disabled, unhygienic drinking water stations, the absence of a systematic parking space, and a waiting area for the patients, were just some of the issues prevalent in the CHC.

Post discussions with the concerned authorities, the renovation of the CHC began in 2014-15. The contrasting improvements in terms of infrastructure and services are depicted below –

For biomedical waste transportation, a better vehicle has been hired, that is covered from all sides and is spacious

The Biomedical waste storage area has now been marked with separate colours, so as to segregate the waste in a proper manner

The general ward of the Community Health Centre is now refurbished

The toilets for men and women patients were renovated, along with the installation of a handwashing station

The handwashing station in the nursing area shows a drastic improvement and overhaul in terms of cleanliness and hygiene

An RO water purification system has been installed to make clean drinking water available to the patients at all times

Segregated garbage collection is in practice with colour coded dustbins in each department

The vehicle parking lot has been revamped to be better organised and structured

For the convenience and comfort of those visiting the CHC, a huge common waiting area was constructed at the entrance

What came as a concern was the absence of an approach to sustain the infrastructural improvements. Thus, WaterAid India along with its partner, Samarthan, prepared a plan to maintain the quality of facilities offered. Regular training for the sweepers and garbage collectors were scheduled in order to explain the type of waste, their proper collection in colour-coded dustbins and their disposal in an appropriate way. Also, technical support was provided to the hospital staff.

Additionally, the Rogi Kalyan Samiti (Patient Welfare Committee) also known as the Hospital Management Committee has been extremely instrumental in looking into the overall management and functioning of the CHC. This committee, which is a registered society acts as a group of trustees for the hospitals to manage the key concerns. Also, the local MLA (Member of the Legislative Assembly) conducts regular visits to ensure maintenance of the quality of work at the CHC.

An orientation on water, sanitation and hygiene issues was held for the infection control committee and hospital staff

Image: WaterAid India

However, there is still a long way to go. The six-decade-old drainage system has been improved but not entirely. The internal pipelines and drains hinder the regular functioning of the hospital. Another major issue is the lack of doctors. “The lack of staff is one of the major concerns. There are about 300-400 patients visiting the hospital on a daily basis. The close proximity to the highway also leads to a number of accident cases,” expressed a concerned Dr. Sharma. With just one doctor and a couple of nurses, it becomes difficult to manage. “During monsoons, there have been patients to as much as 600 a day,” adds Dr. Sharma.

The Community Health Centre aims to sustain good practices with the active contribution of the staff. Even though some of them have been transferred to other CHCs, the ones left are determined to maintain the standards. With such relevant advances, the Kayakalp Award winner, CHC Ichawar, is an inspiration for many health centres that are still in need of desperate improvement.