Access to health care and equitable distribution of health services are the fundamental requirements for achieving the Millennium Development Goals and the goals set under the National Rural Health Mission (NRHM) launched by the Government of India in April 2005. Many areas in the Country, predominantly tribal and hilly areas, even in well-developed States, lack basic health care infrastructure limiting access to health services at present. Over the years, various initiatives have been taken to overcome this difficulty with varied results. Many States/NGOs have successfully tried out operationalizing Mobile Medical Units. Taking health care to the doorsteps is the principle behind this initiative and is intended to reach underserved areas. Under the NRHM, provision of Mobile Medical Unit (MMU) in each District is one of the strategies to improve access. For North Eastern States, Himachal Pradesh and J&K, due to their difficult hilly terrain, non-approachability by public transport, long distances for reaching the health centres necessitate the need of MMU with specialised facilities for the patients requiring basic specialist examination. Otherwise, the basic purpose of taking the health care to the door step of the needy people in rural areas would be defeated due to non-possibility of diagnostic examination to be conducted. The States are expected to address the diversity and ensure the adoption of the most suitable and sustainable model for the MMU to suit their local requirements. States are also required to plan for long term sustainability of the intervention. Objectives • To operationalise Mobile Medical Units in every district across the country for improved access to health care services. • To make health cares services available in underserved areas. Type of services to be provided Every Mobile Medical Unit has to provide the following services:- Curative: • Referral of complicated cases; 2 2 • Early detection of TB, Malaria, Leprosy, Kala-Azar, and other locally endemic communicable diseases and non-communicable diseases such as hypertension, diabetes and cataract cases etc.; • Minor surgical procedures and suturing; • Specialist Services such as O&G Specialist, Paediatrician and Physician. Reproductive & Child Health Services: • Ante-natal check up and related services e.g. injection - tetanus toxoid, iron and folic acid tablets, basic laboratory tests such as haemoglobin, urine for sugar and albumin and referral for other tests as required; • Referral for complicated pregnancies; • Promotion of institutional delivery; • Post-natal check up; • Immunization clinics (to be coordinated with local Sub-centres/PHCs; • Treatment of common childhood illness such as diarrhea, ARI/Pneumonia, complication of measles etc.; • Treatment of RTI/STI; • Adolescents care such as lifestyle education, counseling, treatment of minor ailments and anemia etc.. Family Planning Services : • Counselling for spacing and permanent method; • Distribution of Nirodh, oral contraceptives, emergency contraceptives; • IUD insertion. Diagnostic: • Investigation facilities like haemoglobin, urine examination for sugar and albumin; • Smear for malaria and vaginal smear for trichomonas; • Clinical detection of leprosy, tuberculosis and locally endemic diseases; • Screening of breast cancer, cervical cancer etc. Specialised facilities and services: • X-ray • ECG • Ultrasound test 3 3 • Emergency services and care in times of disaster/epidemic/ public health emergency/ accidents etc. • IEC Material on health including personal hygiene, proper nutrition, use of tobacco, diseases, PNDT Act etc., RT/STI, HIV/AIDS. Suggested composition of the Team • Medical Officers: Two, one of whom will be a Lady Medical Officer • Radiologist • Nurse • Laboratory technician • Pharmacist • Helper • Drivers: three • Specialists: O&G Specialist, Paediatrician and Physicia Type of vehicle Three vehicles will be provided for the purpose with the NRHM logo. One will be a ten seater passenger carrier to transport medical and para-medical personnel. The other vehicle will be for carrying equipment/accessories along with basic laboratory facilities. The space at the back will be utilized for placing a couch. This couch will be used as the examination table during camps and for transfer of patients at times of emergency. The States will have the flexibility to decide the type and the number of vehicles to be procured within the given budget. In addition to the above two types of vehicles, a mobile van with diagnostic equipments such X-ray, ultrasound, portable ECG machine and generator will be provided.