1. Three Tier Outreach Model
for Hard to Reach Areas
The Sundarbans
Dr. ADiL (PT)

2. Background of the Sundarbans
 Located on the extreme south of
west Bengal.
 54 islands
 Beautiful but inhospitable
 Home for about 4m people over 19
admin blocks.

3. Health services in Sunderbans
Formal
• Govt is the largest health
provider through CHC,
PHCs & SCs
• Limited by large scale
absenteeism of doctors
and paramedics.
• Tagore Society for Rural
Development is providing
health services to far
islands.
Informal
• Absolute dominance of
Rural Medical
Practitioner(RMP)
• 62% op are treated by RMPs
• Providing irrational
combinations including
steroids &,modern
medicines without any
formal medical training.

4. Maternal Heath Care in the
Sundarbans
Maternal heath care utilization at institution is low
According to Future health systems research
program report(2010) _ only 29% delivered their
last child at institute & 71% were at govt hospitals.

5. Tagore
Society for
Rural
Development
Has been serving for the last 3
decades
Started with individual effort of
Mr Tushar kanijilal _ later
transformed in to social
development movement
The Rangabelia Comprehensive
Rural Development Project
focused on agriculture

6. The Rangabelia
Comprehensive
Rural Development
Project (1978)
focused on agriculture
& free poor villagers
from the clutches of
moneylender.
Training literate village girls
about health hygiene and
these girls will work with
villagers to educate them.
In 2 blocks(Basanti &
Gosaba) out of 13 blocks
there are 18 health
assistants and 3 supervisor.
1985 a hospital building
with 25 beds & other
facilities came up.

7. Health
facilities
under
TSRD
1 . Rangabelia hospital
provides both preventive and
curative services
Activities undertaken by
hospital are
• training
• Awareness generation
• Health check-ups
• Mobile health clinics.

8. Health
facilities
under
TSRD
2. Community delivery centre
(2008)
started under PPP initiative
NRHM, west Bengal.
Objective : serving pregnant
women of BPL
functions 24*7
2 doctors
2 paramedics
2 staff nurses available round
the clock.

9. 3 TIER OUTREACH
MODEL
Field clinic Doctor clinics
Cluster/Boats
clinics

10. Field
clinics(point
clinics)
2 field clinics in each location
Total locations 72 = 144 field
clinics
• ANC & PNC including home visit
• Immunization for both mother and
child
• Family planning
• Growth monitoring
• Rx for simple illnesses
• Awareness generation.
Services offered :

11. Doctors
clinics:
Two doctor clinics in each location
*120 doctor clinics in a month
Run by the 2 doctors ,health assistants
and pharmacists
Diagnoses and treats patients referred
from the field clinics & free medicines
to pregnant
Further referral to the cluster clinics in
case of diagnostic services needed.

12. • Six locations (covering at least 10-
12vilages) every months.
• Run by Drs ,nurses, paramedical
staff ,lab-technicians ,health
assistance , pharmacists & other
supporting staff.
• Treat patients referred from
doctors’ clinic.
• Diagnostic facilities : X ray , blood
test , urine examination
,pathology.

13. Key characteristics of
the organisation
DEDICATED
MANPOWER
MULTI SECTORIAL
APPROACH

14. Dedicated
Man Power
DEDICATED &
SELF-MOTIVATED
MANPOWER OF
TSRD.
SERVING FOR
LAST 20 YEARS
OR MORE.
THROUGH THEIR
WORK THEY ARE
CONTRIBUTING
BACK TO THE
SOCIETY AND
THIS MOTIVATES
THEM TO WORK
FOR THE
ORGANIZATION.

15. Multi-
Sectorial
Approach
Not only
working on
health
Also on
agriculture,
education,
livelihood
activities &
more
People are
also
motivated
to join
hands with
them.

16. challenges
Electricity
Difficulty in referral
Financial crisis
Post storm Aila

17. References
Kanijilal, B., Mazumdar, G.P., Mukherjee,
S.,Barman, D.,Singh, S.and Mandal, A.2010.
Health Care in the Sundarbans(India):
Department for International Development.
TSRD.2010 available at
http://tsrd.org/archieve.html

18. Thank you