HELPAGE INDIA-ONGC MMU PROJECT FIELD REPORT FROM ONGC OPERATIONAL AREAS IN ANDHRA PRADESH AND TAMIL NADU

 
HELPAGE INDIA-ONGC MMU
       PROJECT

FIELD REPORT FROM ONGC
  OPERATIONAL AREAS
          IN
 ANDHRA PRADESH AND
      TAMIL NADU

          89
Contents
Sections                              Details                       Page No.
Section-I     Project Backdrop in South India                         93
Section-II    Project Initiation                                      93
Section-III   The Gram Panchayat Identification Process               94
Section-IV    Consultation with Gram Panchayats for Mapping           99
              Basic Infrastructure, Collection of Demographic and
              Other Basic Information, Identification Of MMU
              Parking Locations and Relationship Building for
              Smooth Project Operation
Section-V     Conducting Baseline Survey for Mapping Elderly          104
              Population, their Health, Psycho-social, and Family
              Related Issues
Section-VI    Suggested Office Locations for MMU Units and            105
              Search For Prospective Candidates
Section-VII   Linkages Established with Government and Private        107
              Health Resources
              Details of Parking Locations                            109
              List Of ONGC Officials Met During Project & Field       113
              Visits
              Field Observations from Andhra Pradesh & Tamil          114
              Nadu

                                      91
Section I. Project Backdrop in South India

The HelpAge India-ONGC collaborative Mobile Medicare Unit (MMU) project is designed
to provide basic health care to services to the elderly at their doorsteps in selected Districts
of two states of South India (Andhra Pradesh and Tamil Nadu). The following ONGC
project locations were to be mapped as per the information provided by the ONGC and
HelpAge India (HI).

      1.   Rajahmundry Asset4
      2.   Kakinada Asset
      3.   Karaikal Asset
      4.   Chennai Asset

Section II.
        II. Project Initiation

The field team of FourX4 was further suggested by HAI to start the baseline and project
operational process at Rajamundry Asset. Accordingly, the General Manager, Human
Resources Department, Rajahmundry Asset, who is responsible for Corporate Social
Responsibility (CSR) activities, was contacted and the FourX4 field team called on the
official at Rajahmundry. It was learnt during the meeting with GM-HR at Rajahmundry that
Kakinada Asset is a separate administrative unit which has been allotted one MMU. A
meeting was organized with the Top Management of Kakinada Asset led by its Executive
Director (ED). It was very aptly articulated by the ED of Kakinada Asset the MMU project
must focus on villages in and around its soon-to-be-functional permanent Gas Collection
Station (GCS) at Odalarevu Village in the Allavaram Mandal of East Godavari District.
Accordingly, villages (village Panchayats) were identified in and around Odalarevu with
the help of ONGC field officials where ONGC is presently having Drilling Units, oil and
gas producing Wells, etc. Table-1 reflects the number of village panchayats selected for
the operation of MMU.

In the meeting with the GM-HR of Rajahmundry Asset, it was made clear by ONGC
officials that their established operations are mostly concentrated in Malkipuram,
Sakhineti Palli, Razole and Mamidi Kuduru Mandals of East Godavari district and there is
great potential for future operations in Penugonda, Poduru, Achanta and Elamanchili
Mandals of West Godavari district. Therefore, it was decided to map these Mandals for
identifying the specific focus villages (village Panchayats). Table-1 reflects number of
village panchayats selected for the operation of MMU for Rajahmundry Asset.

Similarly, in the meeting with the GM-HR of Karaikal (Cauvery Basin) Asset it was
suggested by ONGC officials that villages belonging to two separate districts may be
mapped for MMU operations. After a thorough discussion with the field team it was

4
    An operational unit is referred to as an Asset in the ONGC lexicon.

                                                  93
decided to limit the operations to one district only, i.e. Nagapattinam. The neighbouring
district of Thiruvarur was the other operational location which was suggested by ONGC to
be included in the same MMU operation. However, this was dropped later on because of
lack of feasibility which is discussed in Table-2. Table-1 reflects the number of village
panchayats selected for the operation of MMU for Karaikal (Cauvery Basin) Asset.

The field team also met the Deputy General Manager-Field Operations of the Karaikal
forward base of Chennai Asset and after a discussion with the field team a number of
villages were suggested by ONGC officials for inclusion in the MMU operations. Table-1
reflects the number of village panchayats selected for the operation of MMU for Chennai
(Karaikal Forward Base) Asset.

Table-
Table-1: Details of village panchayats selected for the operation of MMU for Chennai
          (Karaikal Forward Base) Asset
Sl.       State     ONGC      Field   MMU         Operation       Operation          No.        of
No.                 Unit              Units       District        Mandal/Block       Village
                                      Allocated                                      Panchayats
                                                                                     Selected
1.        Andhra    Kakinada Asset       01       East Godavari   Allavaram                08
2.        Pradesh   Rajahmundry          02       East Godavari   Razole                   01
                    Asset                                         Sakhinetti Palli         07
                                                                  Mamidi Kuduru            01
                                                                  Malkipuram               06
                                                  West            Poduru                   01
                                                  Godavari        Achanta                  01
                                                                  Elamanchili              02
3.        Tamil     Karaikal             01       Nagapattinam    Kilvelur                 04
          Nadu      (Cauvery Basin)                               Thirumarugal             04
                    Asset, Neravy
4.        Tamil     Karaikal             01       Cuddalore       Bhubanagiri             07
          Nadu      Forward Base,                                 Keerapalayam            02
                    Chennai Asset                                 Katumanarkovil          07

Together with the focus village identification, the focus was also to establish initial contacts
with key stakeholders of the MMU project, collect basic demographic information and
initiate survey process for establishment of baseline. The key stakeholders with whom
communications were established were:

      •    ONGC’s HR/Corporate Social Responsibility Lead Representatives at different
           Assets
      •    Elected Gram Panchayat Leaders & functionaries
      •    Government Health Centres – Primarily NRHM facilitated health bodies like PHCs
           & CHCs
      •    Local Government Administration (Block/Taluka/Mandal/District)
      •    Non-government Organisations

Section III: The gr
                 gram panchayat identification process

Since almost all the operational areas of ONGC in the two focus states of South India are
located in villages, village identification was one of the most crucial steps in the whole

                                                  94
exercise. Since ONGC has arguably the highest stake in this process to highlight its
corporate image and augment its visibility in its operational areas, the village
identification process had to initially begin with a consultation with the ONGC team at all
concerned Assets or Forward Bases. The HR/CSR departments of concerned operational
locations of ONGC were informed before-hand about the team’s visit and its purpose.
They were requested to prepare a list of the villages, which from the ONGC’s point of
view would best suit their CSR objectives and its corporate visibility. The ONGC team
usually shared a list of villages with the FourX4 team which did not have any other
associated details like demography, distance of villages from one another, the
corresponding administrative structure details like Gram Panchayat or Block or Taluka,
etc. the list was to be further decoded for developing finer operational details for the
project.

Therefore, on the basis of the list of the villages provided by the concerned HR/CSR
department of ONGC, a mapping of the Gram Panchayats was done. This helped in
identifying the GPs which contained the suggested names of the villages. The mapping
was important because of four reasons, which were:

   •   The MMU operation needs to align itself with the local governance bodies,
       especially Gram Panchayats as it would require the sustained availability its
       resources for successful operation. The basic information that will feed into the
       operation of MMU will come from Gram Panchayats. The locations for parking of
       the MMU vehicle can be best identified in consultation with GP functionaries. As
       per the mandate of the MMU project, the parking locations need to be public
       places (Schools, Community Halls, Anganwadi Centres, Health Sub-centres, etc.)
       thereby guaranteeing uninhibited access by the target group. These locations in a
       village are essentially under the jurisdiction of Gram Panchayat and therefore, it
       becomes important that its consent and participation are elicited at the beginning
       itself.
   •   The GP mapping helped in assessing the operational feasibility in terms of
       distance coverage for the MMU. Here factors like contiguousness of Gram
       Panchayats, travel distance between the GPs and location for MMU office were
       looked upon. The second important factor that was looked into was population
       strength of GP and the corresponding potential patient load that it will be borne by
       any one MMU. Based on the patient carrying capacity of the MMU and the
       suggested operational areas by ONGC, coverage of GPs in the project was
       assessed.
   •   For determining the exact patient load and generating the corresponding baseline
       a door-to-door survey was envisaged from the very beginning. The in-principle
       support of the Gram Panchayat leadership was considered crucial to conduct the
       survey smoothly and gather the relevant information.
   •   The ONGC team does not make any differentiation between natural
       villages/habitats and village Panchayats or Gram Panchayats (GP). If one or two
       villages appear on the list of villages given by ONGC the MMU operation cannot
       stop at just reaching out to only these one or two stand alone villages. The services
       have to be made available to the whole GP in order to make it relevant and

                                            95
participatory. Therefore, GP mapping was essential for making the entire process
        meaningful.

The mapping of the Gram Panchayat was done by locating a field contact, primarily a
Gram Panchayat leader. Supporting help from the field contact was then taken in
mapping the names of the Gram Panchayats corresponding to the names of the villages
suggested by ONGC. In all cases the information on matching the list of villages with
corresponding GPs and other associated conditions like contiguity, operational feasibility
keeping the distance factor in view, etc. were collected from more than one source in
order to ensure its correctness and reliability. ONGC personnel helped in locating some
of the field contacts.

Table-2 below depicts the names of the villages suggested by ONGC representatives and
its corresponding GP Mapping.

Table-
Table-2: List of villages suggested by ONGC representatives and its corresponding GP
         Mapping.
  Sl.    State    ONGC Asset       Villages Suggested by    Finally Mapped GPs and Excluded
 No.                                        ONGC                         GP Details
 1.     Andhra    Kakinada        Odalarevu                Odalarevu
        Pradesh                   Bendamurilanka           Bendamurilanka
                                  Komaragiripatnam         Komaragiripatnam
                                  Thumalapalli             Thumalapalli
                                  Mogalamuru               Mogalamuru
                                  Godi Lanka               Godi Lanka
                                  Godi                     Godi
                                  Godithipa                Godithipa
                                  S. Palli Pallam          These two GPs along with
                                  Samanthakuru             Rameswaram hamlet of
                                                           Komaragiripatnam GP were
                                                           dropped from the list because of
                                                           their distance beyond 25 kilometers
                                                           from the MMU central location -
                                                           Odalarevu. Rameshwaram is 33
                                                           kms away from its GP.
 2.     Andhra    Rajahmundry-I   Karvaka                  Karvaka
        Pradesh   (East           Tatipaka                 Tatipaka
                  Godavari)       Antarvedi Palli Pallem   Antarvedi Palli Pallem
                                  Gondi                    Gondi
                                  Kesavadasu Pallem        Kesavadasu Pallem
                                  V.V. Mereka              V.V. Mereka
                                  Mori                     Mori
                                  Gudapalli Pallipallem    Gudapalli Pallipallem
                                  (+Gudapalli)
                                  Chintala Mori            Chintala Mori
                                  Sankaraguptham           Sankaraguptham
                                  Kesanapalli              Kesanapalli
                                  These 5 GPs were         Antarvedi Devasthanam
                                  included to maintain     Pademati Pallem
                                  contiguity between the   Antarvedi Kara
                                  ONGC proposed GPs        Golla Pallem
                                                           Toorpu Pallem

                                             96
Sl.    State     ONGC Asset        Villages Suggested by    Finally Mapped GPs and Excluded
No.                                        ONGC                          GP Details
3.     Andhra    Rajahmundry-II   Vadali                    Vadali
       Pradesh   (West            Deva                      Deva
                 Godavari)        Soma Raju Cheruvu         Soma Raju Cheruvu
                                  Manimanchilipadu          Manimanchilipadu
                                  A. Vama Varam             A. Vema Varam
                                  Badava                    Badava
                                  Yenugovani Lanka          Yenugovani Lanka
                                  These 3 GPs were          Monamaru
                                  included to maintain      Kotala Parru
                                  contiguity between the    Tamarada
                                  ONGC proposed GPs
4.     Tamil     Karaikal         Narimanam                 Narimanam
       Nadu      (Neravy)         Kuthalam                  Kuthalam
                                  Gopu Raja Puram           Gopu Raja Puram
                                  Eravanchery               Eravanchery
                                  Okkur                     Okkur
                                  Kurumanangudi             Kurumanangudi
                                  Venkatangal               Venkatangal
                                  A single hamlet under     Anaimangalam
                                  this GP was proposed
                                  by ONGC and
                                  therefore, the GP was
                                  included in the list
                                  Additionally, some        It was placed before ONGC that
                                  operational areas of      one MMU unit can only cover a
                                  Thiruvarur district was   distance of 15-20 kms. Since the
                                  being proposed by         listed GPs are already covering this
                                  ONGC.                     distance and have good patient
                                                            load it would not be possible to
                                                            cater to other operational areas of
                                                            ONGC in the neighbouring district
                                                            with the same MMU.
5.     Tamil     Chennai          Adivarahanattam
       Nadu      (Karaikal        Alisikudi
                 Forward Base)    Vattrayntethu
                                  Miralur
                                  Manja Kollai
                                  Kilavadinattam
                                  Pinnalur
                                  Orathur
                                  Sathamangalam
                                  Kandamangalam
                                  Kurungudi
                                  Chettitangal
                                  Kil Kadambur
                                  Mel Kadambur
                                  Veerandapuram
                                  Nattar Mangalam           These two GPs were not included
                                  Kalladikuttal             because of these are situated 25
                                                            kms away from the proposed MMU
                                                            central location
                                  Additionally, ONGC        This area was more than 35 kms
                                  also proposed several     away from the proposed MMU
                                  villages in Andimatam     central location. Moreover, one

                                             97
Sl.    State    ONGC Asset      Villages Suggested by      Finally Mapped GPs and Excluded
 No.                                      ONGC                          GP Details
                                area in Cuddalore          MMU couldn’t have taken more
                                district.                  patient load than what has already
                                                           been included through the finalized
                                                           GPs.

The Rajahmundry Asset in Andhra Pradesh has three operational districts – East Godavari,
West Godavari and Krishna. Since Krishna was far away from the other two districts it was
excluded from the mapping exercise from the very beginning. However, as per ONGC’s
own assessment East Godavari has a higher stake for the organization’s CSR activities
and the Asset’s top management initially thought of the idea of running both the MMU
units allocated to this Asset in East Godavari’s operational areas. West Godavari, which
has future potential, was being considered for included in future scale-up projects.
However, the management later on decided to run one MMU in 10 GPs exclusively from
East Godavari district and the second MMU to be operational by including 06 GPs from
East Godavari and 04 GPs from West Godavari. But it was decided that both these units
would run from Malkipuram.

Consequent upon the finalized GPs and the facts presented above, the five MMUs are to
be deployed in the following GPs as the constituent units as depicted in the table below.

Table-
Table-3 Detailed MMU operational areas
 Sl.   State     MMU Unit       Constituent   Gram     Proposed MMU Central Location and its
 No.                            Panchayats             Details
                                                       Details
 1.    Andhra    Kakinada       Odalarevu              Odalarevu      Village   of   Allavaram
       Pradesh   Asset          Bendamurilanka         Mandal. This location is highly
                 MMU-1          Komaragiripatnam       suggested by the ONGC to make it the
                                Thumalapalli           central point of operation since its GCS
                                Mogalamuru             is located at this place. The farthest
                                Godi Lanka             MMU parking location would be 12
                                Godi                   kms from Odalarevu
                                Godithipa
 2.    Andhra    Rajahmundry    Karvaka                Malkipuram. This location has all
       Pradesh   Asset-I        Gudapalli              necessary infrastructure and all the GPs
                 MMU-2          (+Gudapalli            are within 15 kms from this location.
                                Pallipallem)           The farthest MMU parking location is
                                Chintala Mori          16 kms from Malkipuram.
                                Sankaraguptham
                                Kesanapalli
                                Golla Pallem
                                Pademati Pallem
                                Toorpu Pallem
                                Tatipaka
                                Kesavadasu Pallem
 3.    Andhra    Rajahmundry    Antarvedi      Palli   Malkipuram. This location has all
       Pradesh   Asset-II       Pallem                 necessary infrastructure and all the East
                 MMU-3          Antarvedi              Godavari GPs are within 15 kms from
                                Devasthanam            this location. However, the 04 West
                                Antarvedi Kara         Godavari GPs are 35-40 kms from this
                                Gondi                  location. The farthest MMU parking
                                V.V. Mereka            location is 40 kms from Malkipuram.

                                            98
Sl.   State     MMU Unit         Constituent   Gram   Proposed MMU Central Location and its
 No.                              Panchayats           Details
                                                       Details
                                  Mori
                                  Yenugovani Lanka
                                  Badava
                                  A Vama Varam
                                  Manimanchilipadu
 4.    Tamil     Karaikal Asset   Narimanam            Nagapattinam.      It’s the   district
       Nadu      (Neravy)         Kuthalam             headquarters and has all necessary
                                  Gopu Raja Puram      infrastructure. The farthest parking
                                  Eravanchery          location would be 20 kms from
                                  Okkur                Nagapattinam.
                                  Kurumanangudi
                                  Venkatangal
                                  Anaimangalam
 5.    Tamil     Chennai Asset    Adivarahanattam      Shetiatopu. It’s a small town which is
       Nadu      (Karaikal        Alisikudi            the central point to all 15 focus GPs. All
                 Forward Base)    Vattrayntethu        necessary infrastructures are available
                                  Miralur              in this town. The farthest MMU parking
                                  Manja Kollai         location would be 20 kms from
                                  Kilavadinattam       Shetiatopu.
                                  Pinnalur
                                  Orathur
                                  Sathamangalam
                                  Kandamangalam
                                  Kurungudi
                                  Chettitangal
                                  Kil Kadambur
                                  Mel Kadambur
                                  Veerandapuram

All the finalized GPs for programme intervention and the ones that were declined because
of combination of distance as well as patient load factors were visited by the team gain a
first-hand impression of the situation. The facts were shared with the ONGC officials at all
locations. The GP finalization process also involved simultaneous consultation with the GP
leadership.

Section IV:
        IV: Consultation with gram panchayats
                                   panchayats for mapping basic infrastructure,
            collection of demographic and other basic information, identification of
            mmu parking locations and relationship building for smooth project
            operation

Establishing contacts with the Panchayats was the second most crucial step in the project
initiation process. There were many objectives for establishing this contact. They are as
follows:
     • Appraising the Panchayat leadership on the MMU project and develop a
         consensual understanding among the local leadership and general population on
         the need of the project and the health as well as psycho-social benefits that it is
         going to accrue to the elderly population
     • Mapping of basic infrastructure was another requirement which would help the
         project run from those points. Resources like government school, Anganwadi

                                            99
Centre, Health Sub-centre, Self Help Group Building, Village Community Halls,
       Temple, Mosque, Church, Cyclone Shelter, etc. are counted as basic infrastructure
       available in the villages or habitats. Usually all people in the village have access to
       these resources and these would serve as the parking place for the MMU. The
       MMU would park at these locations at pre-determined time slots and would offer
       the health and counseling services to the elderly of the nearby villages/hamlets
       within a particular GP. Since Gram Panchayats have many such hamlets the MMU
       would need to park at more than one location within the GP.
   •   A basic understanding of the constitution of the Gram Panchayat, its geographical
       spread, number of hamlets/natural villages, population with necessary
       disaggregation (male/female, BPL/APL, no. of elderly persons, etc.), etc. is
       required to address the health needs through this programme
   •   Unless it is known as to how many elderly persons (for this project an elderly
       person is one who is 55 years old and/or above) live in a village, how many
       households have elderly people, their habits, their disease history, etc. it would be
       imprudent to start the project because the benefits that accrued to the elderly
       people because of this intervention cannot be measured or evaluated at a later
       point in time. Monitoring would also not be possible without a baseline. Moreover,
       individual cards would be issued to each elder for tracking his/her individual
       health status at the time of his/her visit to the MMU. The consent and cooperation
       of the GP leadership to conduct this baseline survey is considered essential.
   •   Since the project will run for a period of five years sustained support and
       assistance would be required from the GP leadership for its smooth operation and
       conflict resolution in case of any eventual need. Therefore, a relationship building
       exercise is also at the core of establishing contact with the GP leadership.

The first point of contact was usually the Gram Panchayat offices and meetings with
Panchayat President, Vice President, Secretary and other key people of the village was
held. In such meetings the participants were introduced to HelpAge India’s organizational
objectives and operation. Thereafter, they were appraised in-detail about the objectives
and operational aspects of the MMU project. Their views on the project were also elicited.
In all the cases the Panchayat leadership welcomed the initiative undertaken by HelpAge
India and appreciated the working model of project and assured their continued support
for smooth running of the project. Immediate support was also available in the following
ways:

   •   Provision of demographic and other basic information
   •   Information on possible MMU parking locations and guidance as well as help to
       inspect the locations to examine their suitability in terms of accessibility, physical
       condition of the building, distance from nearby hamlets, sitting arrangements for
       Doctor and paramedical staff, etc.
   •   Provision of names of suitable candidates from the village for the MMU project,
       i.e. for Doctor, Project Coordinator, Nurse and Driver candidates
   •   Assistance to locate field investigators to conduct the baseline survey in the GP

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Table-4 gives the information of GP leadership with regard to each MMU unit.

Table-
Table-4: Details of GP Leadership in the project operational areas
MMU         State      Block / Mandal      Name of GP            GP President     Mobile No.
 Unit
MMU-    Andhra         Allavaram        Odalarevu
1       Pradesh                         Bendamurilanka
                                        Komaragiripatnam
                                        Thumalapalli
                                        Mogalamuru            Suryanarayana       9989483724
                                        Godi Lanka
                                        Godi
                                        Godithipa
MMU-    Andhra         Mamidi Kuduru    Karvaka               K. Balakrishna      9908853797
2       Pradesh        Malkipuram       Gudapalli             S. Ramachandra      9866288363
                                                              Rao
                                        +Gudapalli            V.S.Prasad          9912576099
                                        Pallipallem
                                        Chintala Mori         K.V. Raju*          9866067964
                                        Sankaraguptham        O. Durga*           9951452607
                                        Kesanapalli           A. Narayan Swami    9849251199
                                        Pademati Pallem
                                        Golla Pallem          GP Secretary*       9849555376
                                        Toorpu Pallem         V. Satyanarayana*   9441563024
                       Razole           Tatipaka              T. Uma. R. Rao      9440413413
                       Sakhinetipalli   Kesavadasu            Srinivasa Rao*      9441563026
                                        Pallem
MMU-    Andhra         Sakhinetipalli   Antarvedi     Palli
3       Pradesh                         Pallem
                                        Antarvedi             Nalli Mariama       9963948041
                                        Devasthanam
                                        Antarvedi Kara
                                        Gondi
                                        V.V. Mereka           B. Laxman Rao       9490186249
                                        Mori                  J. Shankara Rao     9849566324
                       Elemanchali      Yenugovani Lanka      V. Rataiya          9848844555
                                        Badava                I. Narasimha Rao    9705557288
                       Achanta          A Vama Varam          R. Naga Raju        9989982458
                       Poduru           Manimanchilipadu      B.V.                9849287436
                                                              Satyanarayana
MMU-    Tamil Nadu     Thirumarugal     Narimanam             Mrs. Neelawati      9965185209
4                                       Kuthalam              R. Sekhar           9865326647
                                        Gopu Raja Puram       Mrs. Indira         9842091787
                                        Eravanchery           Shiva Kumar         9524584005
                       Kilvelur         Okkur                 Balasubramaniam     9443974390
                                        Kurumanangudi         Mrs. Revathi        9943289430
                                        Anaimangalam          A. Durai Raj        9942676820
                                        Venkatangal           Thyagaraj           9842965774
MMU-    Tamil Nadu     Bhubanagiri      Adivarahanattam       S. Usharani         9443212854
5                                       Alisikudi             S. Ramachandran     9976867021
                                        Vattrayantethu        V. Gunasekaran      9965328933
                                        Miralur               Balasubramaniam     9751026567
                                        Manja Kollai          Ramanujam           9786734605
                                        Kilavadinattam        Mr. Kumar           9710680768
                                        Pinnalur              K.G.                9842344845
                                                              Krishnamurthi

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MMU         State      Block / Mandal      Name of GP           GP President       Mobile No.
Unit
                       Keerappalayam    Orathur              R. Silvarajan        9842890153
                                        C.                   Mrs. Devi            9865672336
                                        Sathamangalam
                       Kattumannark-    Kandamangalam        Mr. Annadurai        9787436576
                       ovil             Kurungudi            K.Kannan             9865360182
                                        Chettitangal         Sri Arivalagan       9486457134
                                        Kil Kadambur         Mrs. Jyoti Bhanu     9443666088
                                        Mel Kadambur         G. Devadas           9842750898
                                        Veerandapuram        Radha Ravi           9942369636
Note: * = GP Secretary
Note:
After initial discussion with GP leadership basic information on demography and infrastructural
facilities were collected. The parameters on which information were collected were:

   •   Population – with necessary disaggregation
   •   No. of Households (HHs) in the GP
          No. of BPL HHs
          No of HHs with M-NREGA Job cards – Discussion was held on elderly
             people’s participation in M-NREGA work
          No. of HHs enrolled under any government Health Insurance scheme
   •   No. of old Age pensioners (& pending pension applications, if any)
   •   Administrative arrangement – District, Sub-division, Tehsil & Block
   •   Basic Infrastructure facilities in GP
          Bus Services, Auto & Taxi services
          PCO, Mobile Service and Internet
          Community hall
   •   Health & Sanitation
          No. of HHs with Toilet facilities
          Cooking facilities – LPG & wood based chulha
          Drinking water facilities
   •   Health Infrastructure
          NRHM facilities – Sub-center to District Hospital related information
          Private Clinics operation
          Access to Health facilities
   •   Any NGO operating on Health issues or on old age care in the GP

All the above information is being consolidated into a Gram Panchayat information
format for future references. After collection of aforementioned information, discussion
was held on identification of MMU parking locations in the GP. The GP functionaries were
advised to select minimum number of locations that would be required to cover all the
constituent hamlets/villages of the GP effectively, i.e. all the elderly people can access it
without many problems. While suggesting MMU parking locations, the GP functionaries
were also asked to keep two important factors in mind, which were:

   •   The locations should be public places thereby assuring access to all elderly
       persons irrespective of their caste, faith or class.

                                             102
•   All the location can be accessed by four wheel medium size vehicle (Tata Sumo,
       Tata Winger, Mahindra Bolero, etc. type models) throughout the year (irrespective
       of seasonal damages to the road conditions).

Based on the above criteria and the size (guessed or projected) of elderly population, each
GP suggested the minimum number of locations that they would require. Table-5
presented below depicts the detail of the GP population and the corresponding number of
locations identified.

Table-
Table-5: Details of the GP population and the corresponding number of MMU parking
         sites
   MMU        State      Gram Panchayat             Total       Approximate     No. of MMU
   Unit                                           Population   55+ Population     Parking
                                                                                 Locations
 MMU-1      Andhra     Odalarevu                       3,700            1,000              03
            Pradesh    Bendamurilanka                  5,000            1,000              03
                       Komaragiripatnam               13,800            3,000              03
                       Thumalapalli                    2,100              600              03
                       Mogalamuru                      2,700              600              02
                       Godilanka                       1,700              550              01
                       Godi                            2,400              850              03
                       Godithipa                       1,700              450              02
 MMU-2      Andhra     Karvaka                         2,500              400              02
            Pradesh    Gudapalli                       6,500              700              02
                       (+Gudapalli
                       Pallipallem)
                       Chintala Mori                   4,300              450             04
                       Sankaraguptham                  6,500              750             03
                       Kesanapalli                     5,500              500             04
                       Pademati Pallem                 1,500              200             01
                       Golla Pallem                    1,500              150             02
                       Toorpu Pallem                   5,200              900             01
                       Tatipaka                        9,000            1,500             04
                       Kesavadasu Pallem               6,000              800             02
 MMU-3      Andhra     Antarvedi Palli Pallem          2,700              300             02
            Pradesh    Antarvedi                       2,300              225             01
                       Devasthanam
                       Antarvedi Kara                  5,000              500             02
                       Gondi                           5,800              600             05
                       V.V. Mereka                     8,000              850             03
                       Mori                            5,000              600             02
                       Yenugovani Lanka                5,000            1,000             03
                       Badava                          2,600              300             02
                       A Vama Varam                   10,000            2,000             04
                       Manimanchilipadu                1,000              150             02
 MMU-4      Tamil      Narimanam                       2,000              250             02
            Nadu       Kuthalam                        1,500              100             02
                       Gopu Raja Puram                 1,200               75             01
                       Eravancherry                    3,500              300             04
                       Okkur                           2,200              200             03
                       Kurumanangudi                   1,300              150             02
                       Anaimangalam                    2,000              125             03
                       Venkantangal                    1,300              350             03
 MMU-5      Tamil      Adivarahanattam                 5,000            2,000             03

                                                103
MMU         State       Gram Panchayat         Total        Approximate      No. of MMU
   Unit                                         Population    55+ Population      Parking
                                                                                 Locations
             Nadu        Alisikudi                   2,700               170               02
                         Vattarayantethu             2,000               150               01
                         Miralur                     4,700             1,000               02
                         Manja Kollai                2,500               800               02
                         Kilavadinattam              1,500                80               01
                         Pinnalur                    2,500               250               02
                         Orathur                     1,500               150               01
                         C. Santhamangalam           2,700               135               02
                         Kandamangalam               4,500               500               01
                         Kurungudi                   5,300               450               03
                         Chettitangal                1,200               250               01
                         Kil Kadambur                3,500               300               01
                         Veerandapuram               5,500               900               03
                         Mel Kadambur                2,650               150               01
 MMUs-
 MMUs-5     States - 2   GPs-
                         GPs-51                    191,750            29,760             117

Section V: Conducting the baseline survey for mapping elderly population, their
           health, psycho-
                   psycho-social, and family related issues

As has been briefly discussed above conducting a baseline survey is considered very
important and elementary for the intervention to become effective, monitoring its core
elements and evaluation of the differences the project has brought about to the elderly
populace of the focus GPs.

In order to carry out the baseline survey exercise support of the GP leadership was sought
to help identify educated youth from their respective GPs. The identified educated youth
was motivated to conduct the survey within a given time period in order to facilitate timely
launch of the project. The GP leadership was requested to ensure conduct of the survey in
the interest of the health care of the elderly persons of their respective GPs. They were also
requested to ensure that the survey is conducted in all the constituent habitats/natural
villages of their GPs.

The identified candidates were given appropriate training for collecting accurate and
complete information as per a pre-determined survey schedule. They were provided with a
detailed instruction-cum-guidance sheet in order to ensure a flawless survey.

One of these candidates was later on identified to supervise the survey process and was
delegated required responsibility and was supported with required resources. Except the
MMU-4 unit, in rest 04 MMU units this model was put into use. In order to conduct survey
in the GPs falling under MMU-4 unit services of a local NGO was roped in to help in
conducting the survey through its field staff. But in this case too, a survey supervisor was
appointed to ensure timely and accurate completion of survey.

                                             104
Section VI:
        VI: Suggested office locations
                             locations for mmu units and search for prospective
            candidates

It is quite obvious that an MMU unit will need an office to locate itself and its staff. Each
MMU has approved staff strength of four – a doctor, a project coordinator, a nurse and a
driver. The MMU needs a space to park during non-working hours and on days when it
does not operate. The staff needs to sit down and plan for the finer operational details,
programme records need to be kept and continuously updated, medicines to be stored,
patient records are to be maintained, etc. This location obviously has to be a place which
has minimum infrastructure that enables the office to operate efficiently, allows staff to
find accommodation, etc. This office has to be at a place that is located not too far from
the areas of operation, i.e. maximum within 10-20 kms so that it can reach the focus
villages within 15-20 minutes. The less time the vehicle spends on road more time will be
available to take care of the patients which is the core objective of the MMU operation.

Keeping these factors in view the following locations are being suggested for location of
the offices of different MMU units. The information is presented in Table-6.

Table-
Table-6: Suggested MMU Offices
  MMU        State       Operational      Proposed Location
                                                   Location for      Maximum Distance of
  Unit                     District           MMU Office            Operational Areas from
                                                                       Office Location
 MMU-1    Andhra       East Godavari     Odalarevu                           12
          Pradesh
 MMU-2    Andhra       East Godavari     Malkipuram                           16
          Pradesh
 MMU-3    Andhra       East Godavari     Malkipuram                           16
          Pradesh
 MMU-4    Tamil        Nagapattinam      Nagapattinam                         20
          Nadu
 MMU-5    Tamil        Cuddalore         Shetiatope                           20
          Nadu

As regards identifying potential staff for the project, the approach was to find out local
candidates in order to avoid situations of higher staff turnover. During the consultation
with GP leadership, information related to the vacancy available with MMU units were
shared in all the GPs. Other stakeholders like Primary and Community Health Centers
(PHC and CHC), local administrative officials, professionals working in social sector were
also informed of the vacancies. As a result, discussion with interested candidates was held
at various locations related to all the positions. Finding driver candidates was the easiest
of all and locating doctor candidates was the toughest. Even after searching all the GPs
Allavaram Mandal did not have a single MBBS candidate available for the MMU-1. A
candidate was located in Amalapuram which is 25 kms away from the suggested office
location for MMU-1. The quantum of salary and the timing of the MMU operation (from
morning till late afternoon) were issues that need to be addressed properly in Allavaram
Mandal. Many doctor candidates were available for the Malkipuram office location which
is the location for two MMU units, i.e. MMU-2 & MMU-3. The quantum of salary was not
an issue at this location.

                                            105
Availability of doctor candidates has been very much a matter of concern at
Nagapattinam and Shetiatope, the suggested office locations for MMU-4 and MMU-5
respectively. The quantum of salary and the timing of the MMU operation (from morning
till late afternoon) were also issues that need to be properly addressed at this location as
well.

Salary for project coordinator, nurse and driver was considered satisfactory at all
locations. No issue was raised regarding the timing of MMU operation too.

Since Malkipuram has to locate two MMU units at one office, it is suggested that the staff
structure may be modified to function efficiently as well as effectively. A Senior Project
Coordinator/Officer may be appointed with two project officers (PO) to take care of the
field operations of one MMU each. The Senior Project Officer /Coordinator will have the
supervisory responsibilities for both the units. The proposed structure may be arranged as
follows:

                  Figure-1: Proposed Staffing Structure at Malkipuram Office

The Project Coordinator or Project Officer may also be asked to play the role a social
mobilizer and counselor in order to create demand for health services among the elderly
population by conducting door-to-door visits and also working along with the available
government health infrastructure and the GP system. All the elderly persons may be
motivated and counseled to seek timely health intervention which would play a very
significant role in making the project inclusive and more participative.

Last but not the least, enough care may be taken while purchasing the vehicle to operate
as MMU. In East Godavari district village roads are usually wider as well as in good
condition. Therefore, purchase of any vehicle would not create any problem for the first
three MMU units. However, village roads in Nagapattinam and Cuddalore districts of
Tamil Nadu are not wide enough and are not in good condition. Therefore, a sturdy
vehicle with good ground clearance may be deployed for smooth operation.

                                             106
Section VII:
        VII: Linkages established with government and private health resources

The proposed HI-ONGC collaborative MMU operation will primarily address primary
health issues of old age people. Therefore, it becomes important that effective referral
links are established with the mainstream health system. The mainstream health system
functions as under in both the states of Andhra Pradesh (AP) and Tamil Nadu (TN):

Therefore in all the MMU locations a mapping of the Health center starting from Sub-
center to District hospital was done. This helped in identifying the following:
   • No. of Sub-centers operating in a Gram Panchayat
   • Names and location of PHCs catering to the population of respective GPs
   • Names and location of CHC (in AP) or Block PHC (in TN) under whose area of
        operation the operational GPs of the MMU project falls
   • Names of Sub-division level Hospitals (if any) for the concerned project locations
   • District Civil Hospitals

Information on Private Nursing Homes and Clinics was also collected at each location.
Names of all the government health centers visited by the team along with their contact
details are given below in Table-7. When visits to the PHCs/CHCs operating in all the
project locations were made the team members met the Medical Officer’s In-charge
(MOIC) or the available Medical Officer (MO) and they were was appraised about the HI
MMU project. All the MOICs/MOs expressed happiness about the initiative in the area of
geriatric care and assured necessary help in this context. It was underlined by them that
once the project starts they should be intimated about it so that the necessary coordination
and collaboration for providing better health care to the elderly persons could be
facilitated.

Table-
Table-7: Name and contact details government healthcare institutions
 MMU         Concerned PHCs        Concerned CHC or       Sub-
                                                          Sub-divisional      Civil Hospital
  Unit                                 Block PHC             Hospital
 MMU-     PHC Godilanka           CHC Allavaram         Area      Hospital   Civil   Hospital
   1      Dr. V. Venkata Rao      Dr. Chenchayya        Amalapuram           Kakinada
          Medical Officer         MOIC
          Mobile:9885088895       Mob:9849474761
 MMU-     PHC Lakavaram           CHC Razole            Area    Hospital     Civil   Hospital
  2       Dr. M.R. Rao                                  Amalapuram           Kakinada
          Medical Officer
          9949049904
          PHC
          Tatipaka/Nagaram
          PHC Sakhinetipalli
          Dr. J. Swarup
          Medical Officer
          Mobile: 9989594892
 MMU-     PHC Mori                CHC Razole            Area    Hospital     Civil   Hospital
  3       Dr. S. Ram Babu                               Amalapuram           Kakinada
          Medical Officer
          Mobile: 9030161860
          PHC Sakhinetipalli
          Dr. J. Swarup

                                            107
MMU        Concerned PHCs           Concerned CHC or           Sub-
                                                                Sub-divisional        Civil Hospital
 Unit                                   Block PHC                 Hospital
         Medical Officer
         Mobile: 9989594892
         PHC-A. Vama Varam          CHC-Achanta               N.A.                  Civil Hospital
         Dr. Venkata Rao            Dr. Venkata Rao                                 Eluru
         Mobile: 09849294024        Mobile:
                                    09849294024
         PHC-Poduru                 CHC-Palakol
         Dr. Namagiri               Dr. Prabhakar Rao
         Mobile: 09247226833        9440866248
         PHC-Elimanchali
 MMU-    PHC Thitachery             Block           PHC,      N.A.                  Nagapattinam
  4      Dr. M. Hasan               Thirumarugal                                    Civil Hospital
         Medical Officer            Dr. Liaquat Ali                                 Dr. Kashiraman
         Mobile: 9941468064         MOIC                                            Civil Surgeon
         Govt. Hospital Kilvelur    Mobile:                                         Tel:      04365-
         Dr. S. Arutchelvan         9442986710                                      242459
         Medical Officer
         Mobile: 9790629486
 MMU-    PHC Bhubanagiri            Block           PHC       Taluka Hospital       Cuddalore     Civil
  5      Dr. Sashikumar             Krishnapuram              Chidambaram           Hospital
         Medical Officer            Dr. M. Shiva Kumar
         Mobile: 9944312450         MOIC
         PHC Orathur                Mobile:
         Dr. Arul Anand             9443586546
         Medical Officer
         Mobile: 9994682695
         Additional PHC
         Veerandapuram
         Dr. M. Shivanandan
         Medical Officer
         Mobile: 8012115747
         PHC Shetiatope
         Dr. Henry
         Medical Officer
         Mobile: 9443282791
         Tel.: 04144-244545

Information on the ailment profile of the aged was also collected from the PHCs/CHCs.
Table-8 below depicts the major aliments that are afflicting the old age people in the
respective PHC areas corresponding to the MMU operation locations as cited by the
MOICs/MOs.

Table-
Table-8: Major ailments of people in the project operational areas
 MMU      State     Old Age
                        Age Ailment Profile
 Unit
 MMU-1    Andhra    Ulcers, Joint pains, Sugar, BP, Skin allergies, Leuko derma, Filariasis, TB,
          Pradesh   Deafness, Arthritis /Osteoporosis, Respiratory problems
 MMU-2              Dental problems, gastritis, BP, sugar, skin allergies
 MMU-3              Diabetes, Hypertension, Joint-pains, low backache, elephintis, Dementia, UTI,
                    Prostrate, Ulcer Diseases, Gastritis, Gastroenteritis
 MMU-4    Tamil     Arthitis, Hypertension, Diabetes, Gastritis/ ulcer diseases, skin diseases / fungal
          Nadu      infections, bronchial asthma, Anemia, neurological problems
 MMU-5              Hypertension, body/ joint pain, diabetes, osteo arthritis, back pain, bronchial
                    asthma

                                                108
The field visit team also collected names and contact details of private nursing homes or
clinics operating in the operational areas of various MMU units. The team met many
private practitioners at these hospitals or clinics. The information so collected is produced
in Table-9 below:

Table-
Table-9: Details of private doctors in the vicinity
 MMU       State        Concerned Block/Mandal          Operational
                                                        Operational Private Nursing Homes or
 Unit                                                   Clinics
 MMU-1     Andhra       Allavaram                       Dr. Varahala Rao; Mangayamma
           Pradesh                                      Nursing Home; Tel.: 08856-259468
 MMU-2     Andhra       Mamidi Kuduru, Malkipuram,
           Pradesh      Razole and Sakhinetipalli
 MMU-3     Andhra       Sakhinetipalli
           Pradesh      Poduru,      Achanta      and   Vijayalaxmi Nursing Home, Achanta;
                        Elimanchali                     Surya Nursing Home, Sai Krishna
                                                        Hospital-Palakol
 MMU-4     Tamil        Thirumarugal & Kilvelur         Sivabalan Hospital, Kilvelur
           Nadu                                         Dr. Murugesan
                                                        Mobile: 0-9245963688
                                                        Tel.: 04366-275545
                                                        Periyar      Hospital,       Solinganalur,
                                                        Nagapattinam
                                                        Dr. Haja Abudul Nazeer’s Private Clinic
                                                        Thitachery
                                                        Mobile: 0-9865025989
 MMU-5     Tamil        Bhubanagiri, Keerapalayam       Shravana Poly Clinic, Bhubanagiri
           Nadu         & Kattumanarkovil               Dr. Venkatachalam
                                                        Mobile: 0-9486632923

MMU parking location
            location details

MMU-
MMU-1

Allavaram Mandal, East Godavari District, Andhra Pradesh (ONGC Kakinada Asset)
Sl. Village             Location                                Nearest Landmark
1. Odalarevu            i. At/In front of Ramalayam Temple      Ferry Point
                        ii. At Ambedkar Community Hall,         ONGC Gas Collection Point
                        Ambedkar Colony
                        iii. At Anganwadi Centre, Fishermen’s   Water Tank & Post Office
                        Colony (Manna Colony)
2. Bendamurulanka       iv. At Ambedkar Community Hall,         Ramalayam Temple &
                        Ambedkar Nagar                          Ambedkar Statue
                        v. Besides Jambaban Peta Primary        Sub-centre, Bendamurulenka
                        School
                        vi. In front of Church, Palagunta       Private Well (Opposite
                        Cheruvu Dalit Colony                    Church)
                        vii. At Kali Temple Centre,             Anganwadi
                        Argatalapallem
3. Komaragiripatnam viii. At Primary School, Daivalapallem-     Ayyappa Temple & Byraju
                        Raju Pallem Colony Intersection         Foundation Building
                        ix. In front of Kodappa Church,         Primary School
                        Mannanagar Colony

                                              109
Allavaram Mandal, East Godavari District, Andhra Pradesh (ONGC Kakinada Asset)
Sl. Village                Location                                Nearest Landmark
                           x. In front of Ramalayam Temple,        Primary School & Church
                           Military Colony
                           xi. At Open Space opposite Revenue      Ramalayam Temple
                           Office (Saturday Haat Venue)
4. Thumalapalli            xii. At Prahlad Swami Ashram, Twatalu   -
                           Pandari
                           xiii. At Primary School, Thumalapalli   -
                           Main Village
                           xiv. At Laxmaneswaram Temple            Primary School
5. Mogalamuru              xv. At Primary School, Sirgatalapalli   Ramalayam Temple & Big
                                                                   Pond
                           xvi. At Ambedkar Statue                 Canal in front of the location
                           Toorpucheruvugattu Crossing
6. Godilanka               xvii. At Ramalayam, Ambedkar Nagar      Ambedkar Statue
                           xviii. At Zilla Parishad School         Sri Lakshmi Venkata Rice Mill
7. Godi                    xix. At Anganwadi Centre, Godi Main     Big Water Tank & Primary
                           Village                                 School
                           xx. At Kattavari Pallem Primary School, Ramalayam Temple
                           Godi
                           xxi. At Indira Colony Primary School,   Indira Colony Anganwadi
                           Godipallem                              Centre
8. Godithipa               xxii. At Mandala Primary School, Opp.   Water Tank, Panchayat
                           Fishermen’s Colony                      Office
                           xxiii. At Mandala Parishad Primary      Gopailanka
                           School
Note: All the above villages belong to Allavaram Mandal. MMU office for the above listed villages
proposed to be based at Odalarevu.

MMU-
MMU-2
Mamidi Kuduru & Malkipuram Mandals, East Godavari District, Andhra Pradesh (ONGC
Rajahmundry Asset)
Sl.  Village              Location                               Nearest Landmark
1.   Karvaka              i. Besides Panchayat Office            High School
                          ii. Water Distribution Point, Indirama -
                          Colony
2.   Toorpu Pallem        iii. In front of Panchayat Office      Primary School
3.   Golla Pallem         iv. In front of High School            Primary School
                          v. In front of Panchayat Office        Shiva Temple
4.   Kesanapalli          vi. Near Prarthanamandir Church, Rajiv Ambedkar Statue (nearing
                          Nagar, West Pallem                     completion)
                          vii. Near Primary School, Yedla Tatya  Anganwadi Centre,
                          Group Colony                           Ambedkar Statue
                          viii. At Kanakaya Bus Stop, Rapakawari Ambedkar Statue
                          Group Colony
5.   Pademati Pallem      ix. Near Zilla Parishad High School,   Panchayat Office, Water
                          Pademati Pallem                        Tank
6.   Gudapalli    (+Palli x. Near Cyclone Shelter Building,      Primary School, Anganwadi
     Pallem)              Gollamandala Vari Colony               Centre
                          xi. In front of Panchayat Office,      Water Tank (200 meters
                          Godapalli Palli Pallem                 away)
7.   Chintala Mori        xii. Poduthota Crossing, Near          Goparaju Temple
                          Ambedkar Statue & Ambedkar
                          Community Hall
                          xiii. At Post Office                   Panchayat Office

                                              110
Mamidi Kuduru & Malkipuram Mandals, East Godavari District, Andhra Pradesh (ONGC
Rajahmundry Asset)
Sl.   Village                Location                                 Nearest Landmark
                             xiv. At GDM Church, Molla Pallem (on     -
                             way to Palli Pallem)
                             xv. At Beach Nagar Entrance Point (in    Ramalayam Temple
                             front of Water Tank)
8.    Sankaraguptham         xvi. IPC Church, Beach Road (on way to -
                             NABARD SC Colony)
                             xvii. Panchayati Crossing Bus Stop       Electric Transformer
                             xviii. In front of Bethel Church         Main Commercial Centre,
                                                                      Sankaraguptham
9.    Kesavadasu Pallem      xix. Primary School                      Panchayat Office
                             xx. Besides Sai Baba Temple              Ambedkar Bust
10. Tatipaka                 xxi. Opp. Anjaneyaswami Temple           Maria Montessori School
                             xxii. At Monday Market                   Gram Panchayat Office,
                                                                      Ramalayam Temple
Note: Karvaka is in Mamidi Kuduru Mandal. All other villages are in Malkipuram Mandal. Office
location for this MMU Unit is proposed at Malkipuram.

MMU-
MMU-3
Razole & Sakhinettipalli Mandals, East Godavari District, , Andhra Pradesh     (ONGC Rajahmundry
Asset)
Sl.    Village              Location                                           Nearest Landmark
1.     V.V. Mereka          i. Ambedkar Community Hall, KV Podu SC             Primary School
                            Colony
                            ii. In front of Weavers’ Colony Community          Lion’s Club
                            Hall                                               Community Hall

                              iii. Besides GDM Centenary Church, St. Paul      Primary School
                              Nagar
                              iv. GDM Church (in front of Canal; other         Ambedkar Statue
                              side of the canal is Antarvedi Pallem Village)
2.   Antarvedi Kara           v. Behind Primary School, B.V. Kodappa           Small Pond
                              Colony
                              vi. At Quota Peta Ramalayam                      Bus Stop
3.   Antarvedi        Palli   vii. In front of Cyclone Centre Building,        Big Pond
     Pallem                   Ishiko Tota Colony
                              viii. At Muchallama Mariamma Temple              Panchayat Office
4.   Antarvedi        Deva    ix. Near Panchayat Office                        Zilla Parishad High
     Sthanam                                                                   School
5.   Gondi                    x. Adiveerlamma Temple                           Elementary School
                              xii. At Anganwadi Centre, Near Panchayat         Kanak Muchallama
                              Office                                           Temple
                              xiii. Madhya Gunta Pamulawari Centre,            Ambedkar Statue
                              Ambedkar Nagar
                              xiv. GDM Church, Jai Bhim Nagar                  Big Pond
6.   Mori                     xv. In front of Panchayat Office                 Mahalaxmi Temple &
                                                                               Sai Temple
                              xvi. Primary School, Mori Pademati Pallem        Ambedkar Statue
7.   Yenugovanilanka          xvii. Panchayat Office                           Anjaneya Swami
                                                                               Temple
                              xviii. Elementary School, Quota Harijan Peta     Ambedkar Statue
                              xix. Pallavaram Elementary School                Anjaneya Swami
                                                                               Temple
8.   Badava                   xx. Ramalayam, Main Road, Badava                 Primary School

                                                111
Razole & Sakhinettipalli Mandals, East Godavari District, , Andhra Pradesh (ONGC Rajahmundry
Asset)
Sl.    Village                Location                                         Nearest Landmark
                              xxi. Hope Ministry Church                        Primary School
9.     A. Vama Varam          xxii. Ramalayam Temple                           Anjaneya Swami
                                                                               Temple
                              xxiii. Panchayat Office                          Kanakadurga Temple
                              xxiv. Elementary School, Ishuka Garudu           Kanaka Durga
                                                                               Temple
                              xv. RCM Church, Pasala Peta                      Elementary School
10. Manimanchilipadu          xvi. Primary School, Chhinna Harijan Peta        Anganwadi Centre
                              xvii. Primary School                             Panchayat Office
Note: Tatipaka is in Razole Mandal and all other villages are in Sakhinettipalli Mandal. Office
location for this MMU Unit is also proposed at Malkipuram.

MMU-
MMU-4
Thirumarugal, and Kilvelur Mandals, Nagapattinam District, Tamil Nadu (ONGC Karaikal Asset)
Sl. Village             Location                                      Nearest Landmark
1. Narimanam            i. In front of Farmers’ Society Office        Perumalkovil Temple,
                                                                      Panchayat Office
                        ii. In front of new Anganwadi Centre          Community Toilet, Water
                                                                      Tank
2. Kuthalam             iii. In front of Panchayat Office (Meletheru) Middle School, Mariama
                                                                      Temple
                        iv. Vinayaka Temple, Pullavar Nallur          Panchayat TV Room
3. Gopu Raja            v. Panchayat Office (Sanyasi Panamgudi        Elementary School
     Puram              Hamlet)
4. Eravanchery          vi. Opposite Old Elementary School,           Present Panchayat President’s
                        Devemgudi Main Road                           Residence
                        vii. In front of Library Building, Nattar     Primary School, Mariama
                        Mangalam                                      Temple
                        viii. At SHG Building, Madhya Gudi            Community Toilet
                        ix. In front of Panchayat Office              Elementary School
5. Okkur                x. At Community Hall, Okkur                   Village Administration Office
                        xi. In front of Perumal Temple,               Shivam Temple
                        Kadambangudi
                        xii. In front of Primary School,              Singha Mahakali Amman
                        Vilambakam (this location is not presently    Temple
                        easily approachable because of bad road)
6. Kurumanangudi xiii. In front of DMK Library Building               -
                        (Periyar Hall), Road Theru
                        xiv. At Middle School, Melatheru              Shri Ganesh Temple, Water
                                                                      Tank
7. Anaimangalam         xv. At Community Hall, Anaimangalam           Aiyanar Temple, Panchayat
                                                                      Office
                        xvi. At Aiyanar Temple, Orgudi                Water Tank, Pond
                        xvii. Elementary School, Kulangudi            Kaliamman Temple
8. Venkatangal          xviii. Near Panchayat Office, Venkatangal     Anganwadi Centre
                        xix. Primary School, Porkalakudi              -
                        xx. Panchayat TV Room, Senbia Nadi            Medium Size Plastic Water
                                                                      Tank
Note: Villages from 1-4 belong to Thirumarugal Block and those from 5-8 belong to Kilvelur Block.
The office for the MMU Unit should be located at Nagapattinam.

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MMU-
MMU-5
Bhubanagiri, Keerapalayam and Katumannarkovil Mandals, Cuddalore District, Tamil Nadu (Forward
Base at Karaikal, Chennai Asset)
Sl.   Village            Location                                 Nearest Landmark
1.    Adivarahanattam i. In the premises of Middle School for     -
                         Boys, Adivarahanattam
                         ii. At Vem Vadi Amman Temple,            Water Tank
                         Rattaikulam
                         iii. At Balakrishna Temple, Sutukuli     Anganwadi Centre, Tubewell
2.    Alisikudi          iv. Near Panchayat Office                Sub-centre
                         v. Sri Cheliamman Temple,                Water Tank
                         Vandarayanpethu
3.    Vatarayanthettu    vi. At Panchayat Office                  Common Water Distribution Point
4.    Miralur            vii. At Pillayar Temple                  Water Tank
                         viii. At Sub Centre                      Shivan Temple, Water Tank
5.    Manja Kollai       ix. At Panchayat Office                  Panchayat TV Room, Murugan
                                                                  Temple
                         x. In front of TV Room                   Water Tank, Pond
6.    Kilavadinattam     xi. At Old Primary School                Anganwadi Centre, Water Tank
7.    Pinnalur           xii. In front of Water Tank, Ambedkar    Mariamman Temple
                         Nagar Colony
                         xiii. At Sub-centre, Main Road, Pinnalur Veterinary Hospital (across the
                                                                  road)
8.    Orathur            xiv. At Panchayat Office                 BSNL Office (across the road)
9.    C.                 xv. At Primary School, Sakhti Vilaham    Anganwadi Centre
      Sathamangalam      xvi. Adi Dravida Welfare School          Panchayat Office, SHG Building
10. Kandamangalam xvi. At Panchayat Building                      Primary School, Water Tank
11. Kurungudi            xvii. At Panchayat Office                -
                         xviii. At Ration Shop                    Pilliyar Kovil Temple
                         xix. Kali Amman Temple, Puliyadi
12. Chettitangal         xx. Near Community Hall                  -
                         (Ranganathapuram)
13. Kil Kadambur         xxi. Adi Dravida Welfare Primary School -
14. Mel Kadambur         xxii. In front of Panchayat Office       -
15. Veerandapuram        xxiii. At SHG Building, Veerandapuram    -
                         xxiv. At Panchayat Office, Vivakulam     -
                         xxv. Kalyana Madapam , Peria Ponga       Aiyanar Kovil Temple
                         Nadi
Note: Villages from 1-7 belong to Bhubanagiri Block; 8 & 9 belong to Keerapalayam Block and
10-15 belong to Kattumanarkovil Block of Cuddalore district. The office location is proposed at
Shetiatope.

Details of ONGC officials
                officials met during field visit of Andhra Pradesh and Tamil Nadu

 MMU         State             ONGC Asset                 Concerned Official
 Unit
 MMU-1       Andhra            Kakinada                   Mr. Anjaneyalu
             Pradesh                                      Dr. P.R.K. Raju, DGM-HR
 MMU-2                         Rajahmundry                Mr. J. A. Kumar, GM-HR
 MMU-3                         Rajahmundry                Mr. J. A. Kumar, GM-HR
 MMU-4       Tamil Nadu        Karaikal                   Mr. Vasudevan, GM-HR
 MMU-4                         Chennai (Forward Base,     Mr. Prabakaran, DGM & Head
                               Karaikal)                  Chennai Forward Base

                                              113
Field
 ield observations from Andhra Pradesh and Tamil Nadu

FIELD OBSERVATIONS FROM ANDHRA PRADESH

The key observations are as follows:

      All the villages visited have substantial Below Poverty Line (BPL) population, the
       minimum being around 75%.
      Elderly people are not satisfied with the services provided by government health
       infrastructure (PHC & CHC) as well as mobile medical services provided by 104
       which is managed by Health Management and Research Institute (HMRI) and
       sponsored by the State Government for all people.
      Since elderly people have to travel distances ranging from 3 kilometers to 20
       kilometers to approach either a PHC or CHC to avail health services offered by the
       government they prefer not to visit these centres; 104 comes to one location in the
       village once in a month and some of the hamlets in big villages are 2-3 kms away
       from the location where 104 parks. Hence, it does not provide any solution to
       health needs of elderly people closer to their doorsteps which is their prime need
       keep in view their limited physical capacity for mobility.
      Disease profile of the elders in the visited areas are: joint pain, ulcer diseases,
       elephantitis (endemic in Achanta Mandal in W. Godavari), lower back pain, sugar,
       BP, hypertension, gastritis, gastro-enteritis, cataract, pneumonia, strokes, prostrate,
       arthritis, diabetes.
      The community expressed that there is a great need of health services for the
       elders and showed their keen interest to participate in this programme.
      Non-MBBS doctors (RMP) are available in the villages who are not capable to offer
       satisfactory health solutions.
      Hence, in a village 2, 3 or 4 locations are needed (depending on the size of the
       village) for the ambulance to park and offer services in order to be inclusive in its
       approach and achieve visibility as well as success.
      As per our preliminary estimates one MMU may have to offer services to 7000-
       8000 elderly people in the 55+ age group.
      Consistent village level mobilization efforts are needed in order to create optimal
       patient load or health seeking demand among the focus populace.
      The Project Officer can work as a social mobilizer and he/she can create good
       demand for the mobile medicare services with the help of ANMs and ASHA.
      Health and well-being groups of elderly people could be promoted to keep the
       health seeking demand growing in focus villages.
      Although each village does not have a sub-centre of its own ANMs regularly visit
       the villages. Their help could be taken to spread the message.
      One unit could offer services to maximum 7-8 villages keeping the dense
       population, area coverage and representative location plan in view.
      Since the 104 and 108 (emergency medical service) ambulances are usually
       bigger vehicles (like Tempo Traveller) it is felt that a bigger vehicle would be
       needed to provide mobile medicare services. ONGC prefers bigger size vehicles.

                                            114
   It would be useful to recruit local candidates for the MMUs to keep effective grip
       on management aspects as well as local dynamics. However, availability of
       English speaking candidates except MBBS Doctors is a practical problem.
      Availability of MBBS doctors is a challenge.
      Keeping the Panchayats informed will be very useful from operational point of
       view.
      Building a good network with PHCs and CHCs will be essential. Providing referral
       services will be very crucial to satisfactory service delivery and managing people’s
       perceptions of service provision effectiveness.
      In case availability of MBBS doctors becomes an issue a strategic business
       partnership with private hospitals will be needed.
      ANMs (almost all are Telugu speaking) are available aplenty but pharmacists are
       short in supply.
      Deciding the office locations where all staff will board the MMU is another key
       issue.
      Preparing a list of all retired (from govt. service) MBBS doctors living in the
       operational area will be very helpful for future needs.

FIELD OBSERVATIONS FROM TAMIL NADU

The key observations are as follows:

      All villages have sizeable BPL population (70% and above)
      All the villages are serviced by individual as well as community water supply
       points. Water tanks are available in all villages
      All villages are located around ONGC’s important currently operational
       installations or potential future operational locations
      Most villages are not adequately serviced by currently available health
       infrastructure
      Patient load will be enough for optimum utilization of MMU units
      Availability of MBBS Doctors at these locations is a challenge
      All Panchayats have expressed willingness to provide necessary assistance to the
       project
      Government health professionals at PHC/CHC levels have expressed interest to
       provide all possible help
      Some of the diseases that elderly people mostly suffer from are: Sugar/Diabetes,
       Osteo Arthritis, Blood Pressure/Hypertension, Body Pain (Joints and Lower Back),
       Ulcer Diseases, Gastritis, UTI & Prolapsed Uterus (women), Prostrate and
       Cataract. Other minor but prevalent diseases as reported are: Skin Allergis, TB,
       Malnutrition and Fileria
      All the villages (except those in Katumannarkovil Block of Cuddalore district) are
       within a radius of 10-15 kms from the suggested office location.
      Almost all the villages are adjacent/ contiguous to each other.
      All locations identified and listed villages and locations (except the identified
       location Vilambakam hamlet in Okkur Panchayat, Kilvelur Block, Nagapattinam

                                           115
District, Tamil Nadu; this is because of present bad condition of the approach
    road) are accessible to Ambulance
   Since almost all villages consist of hamlets locations have been identified in order
    to cater to most of the elderly population of the habitations
   Since there is a genuine need to provide ambulance facility at multiple locations in
    a village because of the scattered nature of the hamlets (which the present service
    provided by 104 of HMRI is not catering to) each location may be given maximum
    1 hour in order to cover all locations and optimize provision of services
   Availability    of    an    MBBS      Doctor      in   Allavaram     Mandal     and
    Bhubanagiri/Katumannarkovil Mandals (Sethiatopu Office Location) may come up
    as an issue which needs to be addressed.
   The team approached many serving as well as retired MBBS Doctors who
    expressed that the salary amount is a big factor that may influence availability of
    doctors.
   Almost all villages have RMPs and utilize their services. Government and
    appropriate private health infrastructure being away from most of the villages,
    people are heavily dependent on RMPs.
   The villages which do not have sub-centres and services by ANMs or VHNs
   There are a number of PHCs in the areas of intervention but the elderly people are
    not happy about the services offered by these health centres.

                                      *****

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