NYT India Ink - India’s Hidden Health Care Labor Force
As India grapples with the daunting challenge of providing health care to the millions who can’t afford or access it, a growing number of “affordable health care” entrepreneurs are focused on developing new solutions for the rural and remote parts of the country.
One such initiative is gaining steam in Thanjavur in Tamil Nadu, where IKP Center for Technologies in Public Health has partnered with a local nonprofit, Sughavazhvu Healthcare, to set up a network of well-equipped health centers that provide a broad range of health care services.
“In India, money is not the problem,” said Nachiket Mor, a public health expert who is an IKP Center director and chairman of Sughavazhvu Healthcare. ”Manpower is not the problem. We just need to create and demonstrate on the ground how a primary health care system can work,” he said.
Courtesy of Zeena Johar/SughavazhvuA physician examining a patient in Sughavazhvu’s rural clinic in Andipatti, Thanjavur, Tamil Nadu.
The pilot, not-for-profit project is currently running seven facilities, which, Mr. Mor said, “could act as model primary health subcenters.” Each center has protocols for the treatment of a wide range of ailments, including cardiovascular diseases, diabetes, anemia, oral health, women’s health and reproductive care, ophthalmic care and even mental health counseling and treatment.
Across India, access to health care remains a pressing problem, exacerbated by the country’s large population and shortage of doctors. Nowhere is this challenge more acute than in rural India, which is experiencing a severe shortage of qualified health care practitioners. According to Health Ministry statistics, the doctor-to-patient ratio for rural India is one to 30,000; the World Health Organization recommends a ratio of one to 1,000.
This leaves the health of rural populations largely in the hands of people who aren’t always fully qualified, including family elders, midwives and doulas, untrained community health workers and accredited social health activists (known as ASHA workers) who merely refer patients up the chain to specialists and bigger-city hospitals, Mr. Mor said.
The Indian government has tried to fill this gap by providing low-cost care through rural health centers, called “subcenters,” in villages, tasked with offering primary care. But often they are empty rooms, Mr. Mor said, with little or no qualified staff or facilities.
The Tamil Nadu pilot program is intended to show that it is possible to provide continuous, quality health care for rural communities by using village-based “health extension workers” to assist doctors.
What Mr. Mor calls his “game changer” is India’s large talent pool of what are known as “Ayush” doctors, practitioners of Ayurveda, Unani and Siddha medicine, who are trained in indigenous medical education. (Unani medicine originated in the Arab world, while Siddha is from Tamil Nadu.) There are 750,000 qualified and registered Ayush practitioners who are currently severely underutilized, he said.
“In our view this talent pool is already large,” he said. “Their services can much more easily be expanded and utilized than the pool of physicians trained in allopathic care,” that is, conventional modern medicine.
These doctors already have much of the training they need, Mr. Mor said, as there is an 80 percent overlap between the curricula they follow to become Ayush doctors and the international M.D. curriculum.
The project trains and certifies these indigenous doctors to serve as “independent care providers” in a rural setting. A Supreme Court judgment made it legal for Ayush doctors to practice conventional medicine, provided they follow certain regulations. The training program has been developed in partnership with the University of Pennsylvania’s School of Nursing.
Mr. Mor said he hopes to find private sector players or state governments to partner with to set up similar facilities across the country. He is in talks with private and state partners in Odisha and Uttaranchal, he said.
He brings to the project his experience as a part of the government committee on universal health coverage instituted by the Planning Commission, which has recommended the establishment of a National Healthcare Reform Commission. It has also recommended the introduction of a new three-year Bachelor of Rural Health Care (BRHC) university program to train rural health care practitioners, double the number of community health workers in rural areas and recruit adequate numbers of dentists, pharmacists, physiotherapists and technicians.
Other countries are also trying to create a cadre of rural health care professionals, and the nongovernment sector has often stepped in when the state has shown reluctance or complacence.
In Bangladesh, for instance, BRAC, the world’s largest development organization, is in the process of training 80,000 community health care providers who, like paramedics, will be taught essential services such as maternal and child health care. They will be able to go door to door to provide services in the poorest parts of the country, Asif Saleh, BRAC’s senior director, said from Dhaka.
Jyoti Pande Lavakare is an author and columnist who has covered entrepreneurs from India and Silicon Valley, including producing features for All India Radio in New Delhi, and writing columns for Mint and the Business Standard. She is currently working on her first novel, “The Memory of Pain.”