Better rural healthcare through primary health initiatives

For decades, the government’s approach to meeting the health needs of the rural population in India has been one of offering mainly primary healthcare. For example, during the past half a century, India has built up a vast infrastructure of public health services by establishing one primary health centre (PHC) for every 50,000 population on the average. Undoubtedly the focus on primary and public health is the right one, but poor management, absence of committed physicians, corruption, and inadequate infrastructure, medicine and financial resources have turned them into ineffective institutions. Further, international organizations that provide much of the external funding seem to believe that a targeted approach to addressing some of the top health concerns can be successful, without worrying much about the institutions that actually deliver primary healthcare.

According to the World Health Organization (WHO), the top 10 preventable health risks are childhood and maternal underweight; unsafe sex; high blood pressure; tobacco; alcohol; unsafe water; sanitation and hygiene; high cholesterol; indoor smoke from solid fuels; iron deficiency and obesity. Our foundation’s experience in rural Tamil Nadu tells us that many of the health problems can be addressed through a comprehensive approach that deals with a) housing and sanitation needs, b) malnutrition and deficiencies in iron/folic acid and calcium among pregnant women and young children, c) worm infestation and skins ailments, and d) common infectious diseases such as viral fever, malaria and typhoid.

The George Foundation runs a rural clinic that offers healthcare and community development services to 17 surrounding villages. One aspect of our program is out-patient primary healthcare at the clinic, health education including training of birth attendants on safe delivery of babies, and holding periodic health camps in specific areas such as eye, gynecology, and heart. The clinic has its own laboratory to test for diseases such as diabetics, typhoid, malaria and HIV/AIDS. A computerized database of every patient’s health history is maintained to allow timely interventions and proper treatment.

The second part of our program is field services wherein our medical staff visits the villages every week and meets with women and children, especially high-risk pregnancy cases. The goal is to intervene well before health conditions deteriorate. Cases of malnutrition are identified, and protein-rich supplements are provided. Practically the entire population in every village is given de-worming tablets every six months, and skin ailments are treated with appropriate medication.

The third component of our health program is sanitation and safe drinking water. For the past several years, our foundation has been undertaking efforts to clean-up the area by leveling ground where water stagnation and mosquito infestation have been a problem. Latrines have been dug and drainage has been improved. Starting 2008, we are planning to drill wells to provide sufficient drinking water for the increasing population in each of the villages. 200 houses are targeted for improvement – to add adjoining latrine and ventilated kitchen to every home. Needless to say, all these require additional financial resources, and our foundation is reaching out to supporters for their contribution.

As can be seen, the main focus of all these initiatives is prevention and early intervention. Further, we are attempting to offer quality medical care for common ailments. Cases that require major interventions – less than 10% of all cases – are referred to nearby urban hospitals.

The above approach to healthcare delivery is found to be cost-effective. These programs are not very expensive. For example, to add a kitchen and latrine to a house will cost around $750 (Rs. 30,000). De-worming and protein/nutrition supplements cost around $10 (Rs. 400) per individual per year. It is the sheer large numbers of people that make these programs expensive. But we believe there are enough government and private financial resources to tap to make these programs successful. Over time, as incomes rise, patients will be able pay for most of the associated costs.

When early health interventions are undertaken and living conditions improve, the cost of long term medical care declines dramatically. Further, people do not have to needlessly suffer from preventable ailments. These initiatives do not require special expertise or high technology. It requires commitment and minimal but sufficient financial resources.

Please visit us at www.tgfworld.org and www.indiauntouched.com