India’s Hidden Health Care Labor ForceBy JYOTI PANDE LAVAKARE Courtesy of ZeenaJohar/SughavazhvuA clinic in Kavarapattu, Thanjavur, Tamil Nadu, run by Sughavazhvu, an organization whichprovides health care in rural areas.STARTUP INKEntrepreneurs and new ideas, made in India.As India grapples with the daunting challenge of providing health care to the millions who can’tafford or access it, a growing number of “affordable health care” entrepreneurs are focused ondeveloping 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 forTechnologies in Public Health has partnered with a local nonprofit, Sughavazhvu Healthcare, toset up a network of well-equipped health centers that provide a broad range of health careservices.“In India, money is not the problem,” said Nachiket Mor, a public health expert who is an IKPCenter director and chairman of Sughavazhvu Healthcare. ”Manpower is not the problem. Wejust 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 inSughavazhvu’s rural clinic in Andipatti, Thanjavur, Tamil Nadu.The pilot, not-for-profit project is currently running seven facilities, which, Mr. Mor said, “couldact as model primary health subcenters.” Each center has protocols for the treatment of a widerange of ailments, including cardiovascular diseases, diabetes, anemia, oral health, women’shealth and reproductive care, ophthalmic care and even mental health counseling andtreatment.Across India, access to health care remains a pressing problem, exacerbated by the country’slarge population and shortage of doctors. Nowhere is this challenge more acute than in ruralIndia, which is experiencing a severe shortage of qualified health care practitioners. Accordingto Health Ministry statistics, the doctor-to-patient ratio for rural India is one to 30,000; theWorld 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 fullyqualified, including family elders, midwives and doulas, untrained community health workersand accredited social health activists (known as ASHA workers) who merely refer patients upthe 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 healthcenters, called “subcenters,” in villages, tasked with offering primary care. But often they areempty 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” toassist 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 indigenousmedical education. (Unani medicine originated in the Arab world, while Siddha is from TamilNadu.) There are 750,000 qualified and registered Ayush practitioners who are currentlyseverely underutilized, he said.“In our view this talent pool is already large,” he said. “Their services can much more easily beexpanded 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 80percent overlap between the curricula they follow to become Ayush doctors and theinternational M.D. curriculum.The project trains and certifies these indigenous doctors to serve as “independent careproviders” in a rural setting. A Supreme Court judgment made it legal for Ayush doctors topractice conventional medicine, provided they follow certain regulations. The training programhas 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 setup similar facilities across the country. He is in talks with private and state partners in Odishaand Uttaranchal, he said.He brings to the project his experience as a part of the government committee on universalhealth coverage instituted by the Planning Commission, which has recommended theestablishment of a National Healthcare Reform Commission. It has also recommended theintroduction of a new three-year Bachelor of Rural Health Care (BRHC) university program totrain rural health care practitioners, double the number of community health workers in ruralareas 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 thenongovernment sector has often stepped in when the state has shown reluctance orcomplacence.In Bangladesh, for instance, BRAC, the world’s largest development organization, is in theprocess of training 80,000 community health care providers who, like paramedics, will betaught 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.Read more about the affordable healthcare market, and what a fund founded by eBay’s PierreOmidyar’s is doing in the sector.Jyoti Pande Lavakare is an author and columnist who has covered entrepreneurs from Indiaand Silicon Valley, including producing features for All India Radio in New Delhi, and writingcolumns for Mint and the Business Standard. She is currently working on her first novel, “TheMemory of Pain.”