Comprehensive Community Outreach and Coordinated Care (CCOCC)

Under this program incepted in 2017 in both India and Nepal, nurses make regular household visits to provide basic healthcare and referral services to the doorstep of community members, particularly beneficial for the bedridden sick and the elders. The nurse visits have been able to identify communicable diseases, such as Tuberculosis (TB) and Hepatitis, as well as non-communicable diseases, like Diabetes and Hypertension. Through health counseling, the sick is referred to clinics, primary healthcare, or secondary/tertiary hospitals, depending on disease severity.

During the home visits, nurses also communicate messages about healthy lifestyle-behaviour change. Health-awareness activities and sports events related to diet, nutrition, and exercise are organised in the settlements on World Diabetes Day, World Cancer Day, and World Nutrition Day.

Reproductive, Maternal, Newborn, Child and Adolescence Health

Pre-natal, labor and delivery, maternal, and postnatal/newborn essential services are being offered to pregnant women and mothers in India and Nepal. In addition, various children and adolescent-developmental health activities raise awareness among parents and children on wellness strategies.

A new initiative called Every Mother and Child is devised to ensure mothers and children have access to all TSRR-supported health and non-health services. Additionally, the most economically vulnerable receive targeted assistance, especially, single working mothers and those with many children. Pregnant women and mothers with newborns from all the settlements in India receive baby bags, containing sensorial toys, essential health and hygiene items, and baby books.

Elder Care Services Strengthening

In India, the implementation of this new program is aimed at improving the quality of care for vulnerable Tibetan elders through the Departments of Health and Home which jointly organise geriatric and gerontological care workshops for nurses from elder homes and large health facilities.

Fighting Communicable diseases

In India, TB and Hepatitis B and C patients receive testing and support through DOH facilities near large Tibetan settlements. Support is also provided for culture and Drug Sensitivity Testing (DST) for new TB patients and Multi-Drug Resistant (MDR) TB patients in India. Such disease diagnosis, care, and management are important factors contributing to the reduction of severe cases.  Patients receive food, shelter, nutrition support, and counseling. TB surveillance data shows economically vulnerable patients have more drug-resistant cases and higher default and death rates, indicating a need for continued support.

TB active case screenings are also conducted in settlements for early detection; Suspected cases receive further medical examinations and treatment. Nurses and health workers from India and Nepal attend TB review meetings to review program implementation and address data collection and entry issues.

Healthy Activity Program

The Tibet Fund supports the DOH mental health team’s efforts to implement its various programs in the Tibetan community in India and Nepal. These programs include the establishment of the Healthy Activity Program (HAP) which is designed to specifically address the need for culturally appropriate, affordable, and feasible treatment for depression. HAP delivers services in primary care settings where health workers are trained as lay counsellors, telepsychiatry services and awareness programs and workshops in settlements, universities, schools, and parents

COMBATING SUBSTANCE ABUSE

The Tibet Fund also supports programs that raise awareness against substance abuse and HIV prevention in Tibetan settlements and schools in India.

In Nepal, the Snow Lion Foundation works with the Sober Recovery Treatment and Rehabilitation Centre (SRTRC) to organize awareness events on substance abuse in schools in Kathmandu and settlements in Pokhara. Students and settlement residents continue to be very active in this program.

Health Information System (HIS) and Tibetan Medicare System (TMS) Strengthening

The Tibet Fund supports the strengthening of the Health Information System and the Tibetan Medicare System of the Department of Health (DOH).  The HIS used by all DOH health facilities are gradually being extended to non-DOH premises. As more centres upload monthly health data to the central HIS server at the DOH, they receive support for system maintenance, connectivity, and troubleshooting.

The TMS managed by the DOH is a community insurance scheme that provides emergency healthcare coverage for hospitalised patients. They keep the policy current and implement recommended revisions to TMS health packages, premium rates, and benefit limits from time to time. TMS nurses are being trained on how to increase enrolment and process claims in order to ensure the best health coverage services.

Traditional and Western Medicine Collaboration

The support provided to the collaborative work between the DOH and the Tibetan Medical and Astrological Institute, with the goal of improving community health through better integration of traditional Tibetan and Western medicine is expected to improve outcomes for diseases for Tibetans seeking healthcare from both medical systems.

Health Workforce Capacity Strengthening

In India, new nurses constantly receive training at the DOH Health care facilities covering all major DOH programs. Both pre-service training and regional mentoring are expected to address the challenge of implementing TSRR health activities at the facility level, where high turnover rates and heavy workloads have hindered the implementation of non-clinical services in the past. Both peer mentoring and on-the-job training are being conducted to upgrade overall health workforce capacity.

Ensuring Safe Water, Sanitation and Hygiene

Water, Sanitation and Hygiene (WASH) is implemented through the DOH in collaboration with the Snow Lion Foundation (SLF) in Nepal in partnership with the Environment and Public Health Organization (ENPHO) provides technical support and capacity building for SLF. Together, these organizations assess ongoing WASH needs as key components of the initiative including constructing wells and pumps; erecting new and improved toilets; and upgrading drinking-water facilities in the various settlements.  In India, in collaboration with the Leh Nutrition Project (LNP) WASH program works with community leaders and residents at Ladakh to construct borewells and submersible pumps, convert hand pumps into submersibles, repair defunct pumps, construct solar sheds for pumps and new composting toilets and construct disposal chambers for sanitary pads and install portable toilets. Household toilets and overhead tanks are also constructed under this program.

WASH activities are also implemented in schools and settlements all over India in collaboration with school administrations, settlement offices and community-based project committees.