EVALUATION STUDY OF AYURVEDIC AND HOMOEOPATHIC DISPENSARIES AND HERBAL GARDENS IN ALL THE EIGHT KBK DISTRICTS OF ORISSA (PROGRAMME/SCHEMES UNDER RLTAP FOR THE KBK DISTRICTS) FINAL REPORT CONDUCTED BY ORISSA VOLUNTARY HEALTH ASSOCIATION BHUBANESWAR SPONSORED BY DEPARTMENT OF PLANNING AND COORDINATION GOVERNMENT OF ORISSA BHUBANESWAR 1 CONTENTS Page No. PREFACE LIST OF TABLES LIST OF CHARTS A WORD ABOUT EVALUATING ORGANIZATION Executive Summary 1 CHAPTER I INTRODUCTION 1 1.1 SOCIO ECONOMIC AND HEALTH INDICATORS OF KBK DISTRICTS 1 1.2 The overall objectives of the programme were 6 1.3 District wise Target for In situ conservation of medicinal plants 7 under RLTAP in KBK Districts 2006-07 ( In Hec) 2 CHAPTER II: OBJECTIVES AND METHODOLOGY 8 2.1 Objectives 8 2.2 Sub-objectives 8 2.3 Methodology 9 3 CHAPTER III: PROFILE OF THE STUDY AREA 16 3.1 Map of the Study Districts 16 3.2 Profile of Ayurvedic and Homoeopathic Dispensary 17 3.3 Study area and beneficiary profile 23 4 CHAPTER IV: FINDINGS 24 4.1 Observation of Case Management at the Dispensaries 25 4.3 Facility review 27 4.4 Key informants interview 33 4.6 Analysis of the constraints faced both by the Implementing Agency and 42 Beneficiaries 2 4.7 Respondents Survey Findings 44 4.8 Satisfaction and Benefit report by village per 62 4.9 Aromatic and medicinal plantation 70 4.10 Constraints in implementation 74 5 CHAPTER V: CONCLUSION, SUGGESTIONS & 75 RECOMMENDATIONS ANNEXURES I Details of plantation sites surveyed 79 II Health Institutions in KBK Districts 80 III Study Instruments 82 IV List of beneficiaries 100 3 PREFACE It’s indeed a great pleasure for Orissa Voluntary Health Association in undertaking the assignment titled “EVALUATION STUDY OF THE AYURVEDIC, HOMOEOPATHIC DISPENSARIES AND HERBAL GARDEN IN ALL THE EIGHT DISTRICTS OF KBK DISTRICT (POGRAMME/SCHEMES UNDER RLTAP FOR THE KBK DISTRICTS”) of Orissa on behalf of Department of Planning and Coordination, Government of Orissa, Bhubaneswar. The assignment was of extreme importance in further visualizing the impact/effect of the programme for which it was meant. KBK Districts are considered as the most vulnerable districts in terms of health and well being. In order to expedite the development process, Orissa Government adopted a special area development approach and launched revised long-term action plan. Under this programme apart from many other issues, the issue of improving quality life of the people was one of the areas where a specific strategy like restructuring and energizing social security system was of extreme importance. The activities initiated under these broad objectives were (i) building rural productive infrastructure (ii) developing programmes for income generation activities on a sustainable manner (iii) restructuring and energizing social security system (iv) mobilizing and energizing the rural poor. Similarly to augment the need of health care of the people of KBK region, in the year 2002-03 a new scheme was launched on Ayurvedic and Homoeopathic medicines and initiation of herbal gardens in the region. However due to dearth of interim evaluation it was not possible to assess the pace of the programme and judge the impact of the programme whether the benefits are in tune with the objectives. As such Orissa Voluntary Health Association, Bhubaneswar during the period July – December 2006 in all the KBK Districts, carried out the evaluation. On this auspicious moment of preparing this document, we sincerely convey our heart felt thanks to Department of Planning and Coordination, Government of Orissa for giving us the scope and opportunity to undertake the evaluation successfully. We are thankful to the entire key Officials of the department and Particularly to Dr R V Singh, Special Secretary for his timely guidance, cooperation and support in carrying out this important activity. The evaluation could not have been completed on time but for the untiring effort of the study team, we acknowledge the efforts made by the team in timely completion of the work. The evaluation was carried out under the over all guidance and supervision of Mr B. Panda. Basudev Panda Executive Director 4 LIST OF TABLES 1 Age group wise distribution of respondents (%) 2 Sex wise distribution of respondents (%) 3 Caste group wise distribution (%) 4 Religion wise distribution (%) 5 Distribution of respondents by Education (%) 6 Occupation wise distribution of respondents (%) 7 Distribution of Household by Illness (%) 8 Distribution of Household by Types of Illness experienced (%) 9 Distribution of respondents by Place of Consultation during Illness (%) 10 Non using of Homeopathic and Ayurvedic service by reason (%) 11 Distribution of dispensaries by availability (%) 12 Distribution of Health point by distance (%) 13 Distribution of respondents visiting Dispensary at the time of Illness (%) 14 Distribution of respondents visiting dispensary with reasons (%) 15 Reasons for not using dispensaries at the time of illness (%) 16 Frequency of visit to dispensary during illness (%) 17 Instruction for receiving medicine (%) 18 Quality of instructions (%) 19 Availability of medicine at dispensary 20 Opening of dispensaries ( %) 21 Availability of staff at the time of illness (%) 22 Staff availability by category (%) 23 Conduct of Staff (%) 24 Satisfaction over dispensaries services (%) 25 Dissatisfaction over dispensaries services by reasons (%) 26 Perception of benefit (%) 27 Perception of benefit with reasons (%) 28 Perception that dispensaries of no benefit (%) 29 Respondent’s suggestions (%) 30 Suggestion in improving the effectiveness of dispensary (%) 31 Sonepur: Satisfaction by Village 32 Benefit by district 33 Nawrangpur : Satisfaction by village 34 Benefit by village 35 Nuapara Satisfaction by village 36 Benefit by village 37 Kalahandi :Satisfaction by village 38 Benefit by village 39 Bolangir: Satisfaction by village 40 Benefit by Village 41 Koraput Satisfaction and Benefit report 42 Benefit by Village 43 Rayagada Satisfaction and Benefit report 44 Benefit by village 5 LIST OF CHARTS Chart 1. Number of Patients Attended Daily Chart 2 Observation of Case Management – Clinical portion Chart 3. Observation of Case Management - Dispensing Chart 4. Observation of Case Management – Counseling Chart 5. Staff in Place at time of visit Chart 6. Type of Structure Chart 7. Fence/Compound Wall Available Chart 8 Building Maintenance Chart 9 Facilities Available in the Dispensary Chart 10. General Cleanliness in Dispensary Chart 11. General Structure of Dispensary Chart 12. Record Keeping at Dispensary Chart 13. Stock Level Last 3 Months Chart 14. Medicine and Equipment Storage Chart 15. IEC Materials Available in Dispensaries Chart 16. Area of Coverage of A/H Medical Officers Chart 17. Staff Strength & Qualification Chart 18. Supervision & Frequency Chart 19. Feedback Mechanism Chart 20 Inventory & Frequency of Report Submission Chart 21. Sufficiency of Medicine Supply Chart 22. Initiated Solution to shortages Chart 23. Source of Medicine Supply Chart 24. Frequency of Medicines Collected from Inspector office Chart 25. Length of Time Supplies Reach Dispensaries Chart 26. Status of Current Building Infrastructure Chart 27. Existence of IEC Plan Chart 28. Perceived Acceptance Rate of Services Chart 29. Staff Strength Chart 30. Supervision, Feedback & Frequency Chart 31 Staff strengths and qualifications Chart 32 Supervision Chart 33 Feedback/ Reporting/Record Keeping Chart 34 Systems in Place Chart 35 Frequency of Procurement and Delivery duration 6 A WORD ABOUT EVALUATING ORGANIZATION ORISSA VOLUNTARY HEALTH ASSOCIATION is a secular, non-political and non-profit making oldest and largest health federation registered under Societies Registration Act of 1860 (Act XXI) in the state of Orissa. Being a federation, with its pre- defined goal and objectives OVHA is recognized as one of the apex organization on health in Orissa. It acts as a catalyst in the field of health and development. At one hand it establishes a congenial relation with the policy makers, planners, academicians etc. in order to strengthen the effort in improving the health status of the people of Orissa with Government, Regional, National, International level and on the other hand in close collaboration with bodies of similar types, it strengthens its activities though wide range of activities. It operates from its headquarters at Bhubaneswar and caters its services to every nook and corner in the state of Orissa with its member NGOs. Mission • Promotion of community health, social justice and human rights related to the provision and distribution of health care services to the under privileged and economically weaker section of the community. • People’s health movement and advocating congenial policies and plans aiming at improving the health status of the people of Orissa. Vision: Making health a reality for the people of Orissa. As far as study and research activities are concerned, OVHA is one of the leading institute in undertaking studies exclusively related to health and its determinants. During last years it has undertaken a good number of studies starting from Community Health to RCH, Mental Health, Sexual Health, Nutrition, etc. It also undertakes base line and end- line surveys and evaluation studies as part of its initiatives. The study and research findings are extensively used in further planning programmes and doing interventions. The external studies are mostly sponsored by Government, National and International NGOs apart from its own based on the existing projects and programmes. 7 EXECUTIVE SUMMARY Title: Evaluation study of Ayurvedic, Homoeopathic medicines and herbal gardens in all the eight KBK districts of Orissa Objectives: To assess the overall impact/effect of the programme/scheme in improving the health status of the people of KBK districts. Methodology The evaluation was carried in all the eight districts on a sample basis. Apart from household survey the other techniques like FGDs, in-depth interviews and facility survey were of importance to assess the effect and impact of the scheme. Findings 1. Household survey 1.1 Demography Most respondents were in the middle age groups with 17.6% over 51 years of age. Of these nearly three quarters were male.