it's ok, just blog it out (health plan edition)

having issues coming up with this program plan for a new ngo...hopefully writing some notes here (and eliciting comments?) will help me put my mind in order.


in case you don't know me or know exactly what i've been up to, after working for about two years in pune, india, studying quite a bit of public health stuff (mostly independently) and reading too much, i'm working with a friend/former colleague to create an ngo in pune, bombay, kamshet ('s near lonavala, in the mountains halway from bombay to pune) and possibly eventually up in gujarat to work with members of criminal tribes (mostly the waghris, though expanding from there) who, for a number of specific historical circumstances, are extremely well excluded from pretty much any government assistance. not necessarily the poorest of the poorest of the poor, but definitely up there, and since we see this as primarily a case of lack of access, hopefully this can be worked out mostly in one generation.

so, in broad strokes the organization will be concentrated on education, health and community organizing (not necessarily in that order). education will be a serious bolstering of the education of kids attending govt schools (4+ hours of trilingual tutoring each day, pre-school, etc.), health is working out really basic stuff (childhood diseases, diabetes, pre-natal care, etc.) with a special concentration on tb and mdrtb (something i saw a disturbing increase of over the spring of 2009)--seriously working with the govt rntcp, identifying possibly resistant cases in the surrounding slum community, testing and treating with as little delay as possible. might end up opening a lab (or three) for this in the future depending on cost/benefit analysis, and definitely doing a lot of the DO half of DOTS, which the govt basically ignores. community organizing, though probably not the best or definitive term for this, will be concerned with supporting self-help groups, microfinance and getting legal documentation/representation for members of the community (caste certificates, ration cards, possibly unionizing to protect their employment from the slum "development" plans, etc.).

while i recognize it's kinda a dumb thing to open up a new "development" shop, especially in this economic climate (uh, or just in general), all of us working directly on it (one american, one brit, two indians from pune) have significant ties to the community which we hope to serve, speak the three languages which are most necessary (english, hindi and marathi, and we're working on gujarati), have good relationships with similar orgs in the general area (actually working to set up a health centre/program for an allied organization, hence the thing in kamshet), and generally recognize that this is a community which has specific needs (as they've enunciated them to us) which aren't being met by anyone in the area. so...yeah, there's my little defensive paragraph.

me personally, i'm going to be bouncing back and forth from washington to london to pune/bombay the first year, attending grad school in london, fundraising like a madman in the us and developing plans with local staff/community members to be implemented in my absence (in the areas we know best, namely pune), and then work on expansion to bombay upon moving somewhat permanently to india july 2010.

so there's that, now what will this health program be?


first order of business in health is to deal with primary care, specifically for kids and pregnant women, in an organized and systematic way. best way to do that would be to work through community health workers (CHWs) who could help them access mostly the government services that would be needed--pre-natal care, reminding about vaccination schedules, going with them to different hospitals/ngo offices to get services, and advocating on their behalf to doctors (perhaps one of the biggest barriers to healthcare in the area, ugh). they would be caseworkers, service coordinators, instructors and very basic healthcare providers--giving first-aid, recognizing when more care is needed, and generally checking in on people as needed.

we'll have a part-time doctor at our centre(s) (in pune to start, expanding in 6 months-1 year to bombay, then 2-3 years up to gujarat, somewhat north of ahmedebad, but i cant remember the name of the town right now) who will provide somewhat specialized primary care (prescribing antibiotics only when needed, checking in with diabetics, etc) and medical guidance for CHWs and other staff (when something comes up that nobody recognizes, where to go for specialized care, etc.).

we'll start work on health education in the realm of nutrition--promoting good foods (drumstick, yeah), talking about equal food distribution within a family, talking about practices that should be minimized (tobacco use, lots of chai especially adolescents who are kinda nuts in this area, eating crappy food as opposed to eating cheaper, more nutritious food at home--this will also have a lot to do with women's groups/women's empowerment, and will work closely with the organizing program in this area), that kind of thing. to expand from there to substance use/abuse, sexual health (female AND male), community clean-up campaigns during the monsoon to combat malaria and diarrheal diseases, all that. a lot of that is going to be fairly indistinguishable from the community organizing programs, but that's kinda ok in my mind.

tb will be sorta a strange-looking outgrowth on all this community stuff, since it doesn't make sense fighting tb in one small (~400 people) community and ignoring the entire surrounding slum. so we'll be working with the local govt tb clinic, which blatantly doesnt do the DO part of DOTS at all, to do real proper follow-up of (all? just some? this is starting to sound too ambitious) tb patients in the area, hopefully preventing a lot of acquired resistance and fighting (on our own dime, unfortunately) primary resistance, since the govt blatantly denies its existence in the rntcp plan. that's going to mean a LOT of foot work, carried out primarily by specialized CHWs from around the slum, and lots of culture/sensitivity testing and sometimes providing a lot of expensive medicine.

the point of all the expansion is to work continuously with the waghri community across the main areas in which they live (they're semi-nomadic), so that treatment and education don't have to stop when they go to bombay or the village for two months. we'll have a lot of coordination between CHWs across all sites (who will most likely know each other anyways, since this is a very closely-related community), and managers at all centres, to ensure that nobody falls through the cracks like they have in the past.


alright, that's my super-short description of the program in my mind, hopefully now i can write that in a more detailed and even somewhat professional way in the actual plan. i havent included any specific targets or evaluation rubrics, which definitely needs to happen. what else am i missing? what is just plain dumb? thanks for your help in advance.