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Comprehensive Rural Health Services Project, Ballabgarh Centre for Community Medicine All India Institute of Medical Sciences, New Delhidelhi

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Comprehensive Rural Health Services Project, Ballabgarh Centre for Community Medicine All India Institute of Medical Sciences, New Delhidelhi Comprehensive Rural Health Services Project, Ballabgarh Centre for Community Medicine All India Institute of Medical Sciences, New DelhiDelhi.. INDIA Profile: The Ballabgarh Health and Demographic Surveillance System (CRHSP-AIIMS) In 1961, with the help of the Rockefeller Foundation, the All India Institute of Medical Sciences (AIIMS), in collaboration with the state government of Haryana, began the Comprehensive Rural Health Services Project (CRHSP) Ballabgarh, also known as the Ballabgarh Health and Demographic Surveillance System (HDSS). The objectives of this project were 1. To demonstrate a model health-care delivery system for rural India, including demographic surveillance 2. To orient and train medical students in primary health care 3. To identify and conduct priority operational research to help address the needs of all of India. The Comprehensive Rural Health Services Project (CRHSP) Ballabgarh works as a site for community-based research, and functions as a demographic and health surveillance system. This demographic surveillance system has now been in operation for more than 40 years. Ballabgarh is located in Faridabad district of State of Haryana in India and situated between 28 o 25' 16" North latitude and 77 o 18' 28" East longitude. It is bound by Union Territory of Delhi (National Capital) to the north, Gurgaon district of Haryana State on the west and State of Uttar Pradesh on eastern & southern sides (Figure 1). It is about 35 km from Delhi by road on Delhi-Mathura National Highway-2 and is also well connected through Delhi-Mathura double track broad-gauge line of the Northern Railway and North-Central Railways. Figure 1: Geographical map of Ballabgarh HDSS As per the 2001 national census the total population of Ballabgarh town is nearly 150,000. It comprises exclusively of rural population from 28 villages with overall population density of 1647 persons per square kilometer. The predominant castes (social hierarchical groupings characteristic of India) of the region are Jats, Rajputs, Pandits and Scheduled castes. Ballabgarh HDSS experiences four distinct seasons: winter, autumn, summer and rainy season, each on an average lasting for 4 months. The main economic activity of majority of the population is agriculture or agriculture dependent trades. Main crops grown are wheat, sugarcane, millets etc. Table 1: Population Characteristics of Ballabgarh • Level of education - 73.1 % of above 6 year population are literate • Religion - Mainly Hindu (96.2 %), while remaining 3.8% were either Muslims or Sikh • House characteristics - Almost all are pucca houses • Access to water - 80.6 % within or near to house. • Sanitation and electricity - 100 % electrification and 38% sanitary latrines • Population Density: 1647 persons per square per kilo meter • Seasonality: 4 seasons (winter, autumn, summer and rainy season) • Main economic activity: Agriculture The Intensive Field Practice (IFPA) area under CRHSP Ballabgarh caters to 28 villages through the networking of 12 sub-centers and two Primary Health Centers. The total population of IFPA is 90,240 residing in 9,584 households (as on 31st December 2011). A unique identification number is provided to all the residents of IFPA and a prospective demographic and health records are maintained at our Health and Management Information System. The hospital under CRHSP Ballabgarh (Civil Hospital) is a sub district, secondary level care hospital. Figure 2: Comprehensive Rural Health Services Project, Ballabgarh CRHSP Ballabgarh is managed by the department of Centre for Community Medicine, the All India Institute of Medical Sciences (AIIMS), New Delhi in active collaboration with the State government of Haryana. The All India Institute of Medical Sciences is a premier centre of excellence in the field of medical education and health care in India. Its mandate is for setting standard in teaching, training and health care at all three level of health care. CRHSP joined INDEPTH Network in 2003 and since then has been actively collaborating with the Network. Ballabgarh HDSS is lead by Dr. (Professor) Shashi Kant and being supported by Dr. Puneet Misra and Dr. Sanjay Rai. The total manpower working for CRHSP, Ballabgarh is more than 200. Dr. Shashi Kant (M.B.B.S., M.D., D.N.B., M.B.A.,M.A.E.) Professor, Centre for Community Medicine All India Institute of Medical Sciences, New Delhi – 110029. INDIA. Email: [email protected] Phone no: +91-129-2241362 Link: http://www.aiims.edu/aiims/departments/ccm/drskant.HTM The health and demographic data from the Ballabgarh HDSS for the year 2011 are summarized in Table 2. In comparison to 1991 and 2001, the width of the middle of the population pyramid increased in 2011. High levels of premature mortality can be seen among women in the pyramids for 1991 and 2001. Life expectancy for women had improved by 2011, and the population pyramid depicts the effort establish family-planning practices and improvements in health services in the HDSS area. Over the past two decades the birth rate in the HDSS area declined from 40 per 1000 population in 1991 to 23.2 per 1000 population in 2011. Figure 3: Age Pyramid of Ballabgarh HDSS population (2011) Table 2: Demographic characteristics of Ballabgarh HDSS (2011) Sno. Indicators Result 1 Total Population 90,240 2 Male : female ratio 113 3 Male : female ratio at birth 123 4 Population density 1680 /Km 2 5 Population growth/1000 8.5 6 Crude birth rate/1000 23.2 7 Crude death rate/1000 6.7 8 Crude out-migration rate/1000 16.5 10 Crude in-migration rate/1000 7.7 11 Total fertility rate 2.5 12 Neonatal mortality ratio/1000 live births 27.2 13 Infant mortality ratio/1000 live births 48.2 14 Under-5 mortality ratio/1000 live births 60.6 15 Life expectancy at birth 67 16 Life expectancy at birth (males) (years) 65 17 Life expectancy at birth (females) (years) 70 18 Immunization coverage 97.4% 19 Institutional Delivery 78.7% 20 Couple protection rate 59% 21 Antenatal care coverage 100% Donors & Collaborations: • Donor: Being a part of Govt. Organization, the donor to run the HDSS site is All India Institute of Medical Sciences under Ministry of Health & Family Welfare (MOHFW), Government of India. • INDEPTH Network • Indian Council of Medical Research • Department of Science and Technology, Government of India • National AIDS Control Organization (NACO) • Centre for Disease Control and Prevention, Atlanta • WHO • UNICEF • University of Colorado • INCLEN Publications More than 160 publications have been published from Ballabgarh HDSS in various reputed National and International Journals. List of all publications are available at http://ije.oxfordjournals.org/lookup/suppl/doi:10.1093/ije/dyt055/-/DC1 Table 3: Domains of Publications from CRHSP, Ballabgarh Sno. Domains of Publications Frequency Percent 1 Non Communicable Diseases 38 24.5 2 Child Health 36 23.2 3 Communicable Disease 17 11.0 4 Women’s Health 16 10.1 5 Health Systems/ Operational Research 16 10.1 6 Demographic Surveillance 8 5.0 7 Medical Education 6 3.5 8 Others 21 12.6 9 Total 158 100.0 Major Strengths of CRHSP, Ballabgarh • More than 50 years of existence • Self-reliant: being an autonomous body with government funding • Part of All India Institute of Medical Sciences, which is a premier centre of excellence in the field of medical education and research in India. • Providing curative, preventive and promotive services (Primary and secondary level) • Health and management Information System: Computerized database since 1991 which is updated every month • Has led to policy changes at National and international level Future Plans at CRHSP, Ballabgarh • Increasing the IFPA to more than 120 thousand population, with the establishment of a new community health center at Fatehpur Billoch • Formation of a cohort of hypertensive and diabetic patients • Infrastructure o A new Hospital building o Residential area Staff members of Ballabgarh Health and Demographic Surveillance System .
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