Health for the BOP: The way ahead…

This is Part 2 of a four part blog series where Shelly Batra, founder of Operation ASHA, reflects on some of the challenges associated with providing health care to the bottom-of-the-pyramid (BOP) and how we can overcome them moving forward. Did you miss Part 1? Read it here.

Welcome to India, the land of Gandhi and Mother Teresa. The country of 700 million mobile phones but not enough toilets. The country where starvation deaths do NOT make headlines, where slavery exists, where in spite of the economic boom and billions of $$ spent on health programs, the govt has not been able to fulfill its promise to its citizens, of affordable, equitable, and accessible health care.

What happened after Independence? Let's do a post mortem examination of India’s moribund health system. In the 1950s, the government started developing a huge health infrastructure and initiated well meaning and ambitious programs. We have the National TB Control, Malaria Control, RCH, NRHM, NACO, Universal Immunisation etc. Now, there are some very interesting things about all these.

Let me begin with what are the plus points of the existing public facilities. There is a huge health infrastructure, which includes equipment & manpower that has been built painstakingly by the government, and just waiting to be put to good use. Unfortunately, the machinery is rusted and doesn’t work. At the lowest level, which is the village, we have the government ASHA workers, one for each village of 1000 people. ASHA stands for Accredited Social Health Workers (not to be confused with Operation ASHA, which is a not-for profit working for Tb treatment in India and Cambodia). These government ASHA workers are young women from the village with basic primary school education, employed by and trained by the government to deliver health care. They are supposed to do everything under the sun, from safe delivery to antenatal care to immunisation to TB treatment. The government has trained 600,000 such workers. But tall claims by the government do not translate into reality. The reality is that, in spite of this widespread network of local community health workers, India’s maternal mortality and neonatal mortality figures, which reflect the health of a population , are alarming, to say the least.

Then for 50 villages, there is a PHC or Primary Health Centre. For 100 villages, there is District Hospital. Most of these are equipped with facilities for surgery, obstetrics, immunisation, etc and there are doctors and nurses posted there. In big cities there are huge secondary and tertiary care hospitals, some with medical colleges attached to them, and what seems an army of resident doctors and other staff. Each is as large as a small city and functions like one, with various departments coordinating with each other for smooth and efficient functioning.

But if we look beneath the surface we can see the cracks in the system…

Read Part 3 and the continuation of this blog series.