“Ships of Hope in the valley of Floods” better known as Boat Clinics of Brahmaputra, equipped with laboratories on board as well as pharmacies is providing basic health care services to thirteen districts in Assam through a Public Private Partnership (PPP) with the National Health Mission (NHM, Government of Assam) since 2005. The emphasis is to take sustained health care to lakhs of persons on the islands, for the first time since independence, with a special focus on women and children, who are the most vulnerable in difficult conditions. The brain behind this concept is The Centre for North East Studies and Policy Research (C-NES), established in 2000 is reaching out to the people by delivering people their birth right in the sphere of health, education, and sanitation among others.
Over 2.5 million people, living on about 2500 river islands villages, suffer annual devastation by the Brahmaputra in Assam: displacement, crop loss, property and livestock destruction are regular phenomenon. Post-flood health problems are acute. Most island inhabitants are poor and suffer from social and geographical isolation. Health care, especially for women and children, is among the worst casualties, along with basic education infrastructure, drinking water and sanitation. Government developmental programs are ineffective due to the barrier of access. Boats were the only means of communication and a river-based intervention to bridge the gap of access, with a mix of traditional boat designs and new technology was developed which helped ensure sustained delivery of health care services to the communities, difficult to reach and isolated.
The Concept of Boat Clinics –“Ships of Hope in the valley of Floods” won the India Marketplace 2004 competition, organized by the World Bank to draw ideas for meeting rural gaps. With the award fund the first Boat Clinic “Akha” meaning hope was built at Maijan Ghat at Dibrugarh in upper Assam where it first started.
In the first phase of partnership with NRHM, Govt. of Assam, beginning February 2008, the Boat clinic programme was implemented in 5 districts of Assam; Today, boat clinics operate in 13 districts of Assam through 15 units with very dedicated staff taking sustained quality healthcare to approx. 3.4 lakh difficult to reach island populations. Barpeta and Dhubri districts has two Boat Clinic unit since the size of the char population in both these districts are large. In 2005 when the concept was put in practice in Dibrugarh district, UNICEF had supported and helped to streamline the service delivery intervention module of the “AKHA” concept and has been supporting the capacity building/training program. Population Foundation of India (PFI) has been collaborating with C-NES to strengthen the family planning activity of the Boat Clinic program in 5 districts.
The program has also been able to receive support from other organizations like Operation Smile for cleft lip children, Mobility India for training and survey on disability, ASACS on HIV/AIDS screening, Mahindra Mahindra Financial Service Limited (MMFSL) donation of 2 sets of mobile dental equipment’s for 2 boats, SELCO Foundation providing Solar power to 1 Boat Clinic which includes also a solar refrigerator to store vaccines and has proposed to power 3 more Boat Clinics, NRL donation of 2 Boats and OIL providing funds for building one Boat, Manipal University has also signed an MoU for 5 years to work on research, skill development etc. A philanthropist Ms. Almitra Patel, Member, Supreme Court Committee for SWM, National Expert, and Swachh Bharat Mission from Bangalore had donated Solar Street light each for all island villages under the Boat Clinic program.
A series of camps sites to deliver these services are planned by developing yearly micro plans by each district units in consultation and collaboration with District Health Society through survey of the targeted area conducted by C-NES’ team of District Programme Officer (DPO) and Community Workers. On the basis of the micro plan, monthly action plan is prepared. The teams make 5-6 trips per month to these selected islands and conduct camps for 18 to 22 days making efforts to maintain the immunization rounds braving the harsh weather conditions during different seasons of the year. During winter months when the water level reduces Boat Clinic team has to walk for long distance, while in the monsoon floods when the river is turbulent with surging current and flooded villages, effort to reach and provide service persists. Each Boat Clinic unit comprise of two Medical Officers and paramedical staff includes two ANMs, a GNM, a pharmacist and one laboratory technician, non-technical staff includes three community worker from the community and four boat crew including a cook. The District Program Officer is the core of the team and is responsible to coordinate and plan smooth implementation of the program.
Health camps are announced through ASHAs/AWW and village headman and local volunteers by the DPOs and CWs to ensure extensive participation and minimum drop out of beneficiary. Community participation in the program is emphasized through involvement of villagers in discussions and awareness meetings, sports and competitions for school children, capacity building training for health workers, support to referred cases to higher health centers, follow up and advise on the mobile phone etc. In addition, Boat Clinics in different district has been supporting the District Administration during emergencies in rescue and relief operation during floods and in disasters caused by storm.
So far till 31st March 2017, C-NES has conducted, 23016 – Health Camps, 1729511 – General Health Check up, 203118 – Routine Immunization, 110383 – Ante Natal Care, 17 – Delivery, Family Planning: NSV – 18, LS -990, IUCD – 782.
The hope of life with boat clinic as life force has given the remotest people of Assam a definition of life. More help and intervention is still required as C-NES is enhancing its activities in reaching out to the people in need.