The SEARCH experience
An inspiring visit to Gadchiroli, Maharashtra
Recently, I got an opportunity to spend three days in an organization without which any mention on India’s achievement in public health would be incomplete. Tomes have been written about this organization; this blog adds another page or two to it. This post was inspired by meeting a couple who have sacrificed the luxuries of life. They opted to traverse rocky terrain to ensure that people around them have better lives.
More than a quarter of a century ago, a couple of physicians trained in public health from Johns Hopkins University, then took a career path less travelled. They decided to work for the underprivileged, not from a distance but by being a part of their marginalized community. The couple is Dr. Rani and Abhay Bang. They established the Society for Education, Action and Research in Community Health (SEARCH) in 1985.
They chose to work in Maharashtra’s Gadchiroli district, one of the poorest and one of the most difficult districts to work in the state, if not the country. Gadchiroli has been the heart of the radical naxal movement in India. SEARCH’s campus is located about 10 miles from the district headquarters, which makes it even more remote.
The district is predominantly inhabited by tribals (Gond tribe). Working in Gadchiroli has been difficult even for the government. Therefore the district and its people have been mostly neglected.
SEARCH approaches health services by doing research to find out what works with the people. While choosing a topic or area for research, they go by the following criteria: First of all, people should need an intervention, and should be able to do it themselves; secondly, people should understand the intervention and use it; and lastly, they should own it.
The Bangs aptly named their campus as ‘Shodhgram’, ‘shodh’ means research and ‘gram’ means village. They have been publishing their research in leading public health journals including The Lancet, British Journal for Obstetrics and Gynecology, International Journal for Obstetrics and Gynecology, Journal of Perinatology, and Bulletin of WHO.
The Bangs organize a people’s health assembly annually for the non-tribal population and tribal health assembly for the tribals. Both the assemblies bring out key health and other development issues that need attention in the coming year. The organization integrates the issues brought out by the health assemblies, in their regular annual plan. They do not apply for external funding to deal with issues raised during the assemblies. These activities are managed through their internal budget.
In 1981, even before SEARCH formally took shape, the Dr. Abhay Bang published a study challenging the minimum wages fixed for agriculture labor in Maharashtra, forcing the government to raise the minimum wages. This strengthened their belief in the power of collecting and publishing data.
This led to the many studies. SEARCH has published an epidemiological study of the sickle cell disease in Gadchiroli district, and a study of gynecological diseases in rural Indian women. They organized community participation in research and action against alcoholism, and invented an intervention to manage pneumonia via trained health workers to reduce child deaths.
SEARCH has published numerous home-based neonatal care studies showing how effective this approach can be to manage sepsis. They have published that government under-estimated infant mortality rate, publicizing an alternative estimate.
They have used findings from their research as an effective tool for advocacy and in most of the cases have managed to get the attention of people concerned and contributed to shaping policy.
SEARCH was one of the first organizations to put the issue of neonatal mortality on the discussion table with policy makers. Before they had demonstrated that home based neonatal (including sepsis management) is an effective way to deal with the issue of neonatal mortality and it significantly reduces neonatal deaths, only facility-based care was recommended to deal with any neonatal morbidity.
The key feature here was that they simplified the clinical criteria to diagnose sepsis, so that it became easily understood by their field health workers. In a revolutionary move, SEARCH trained health workers to give intra muscular gentamycin injection for sepsis.
Their health workers have given around 18,000 injections with no complications reported . They got together a group of leading neonataloligists and public health experts of the country to examine the skills of their health workers. The health workers passed with flying colors.
The home-based neonatal care model developed by SEARCH has been replicated in seven other sites within the state of Maharashtra, with similar results. Their study was carried out by The Lancet(Vol. 354, 1999) and forced the policy makers around the world to accept that home based neonatal care was an effective way of dealing with the issue of neonatal survival. Many neonates owe their lives to the efforts of Dr. Rani and Abhay Bang.