Sunday, September 16, 2007
Improving Healthcare in India
To reduce the incidence of common ailments and preventable diseases through the establishment of kiosk-based, self-sustainable clinics in rural Rajasthan to provide affordable healthcare to poor populations.
Rajasthan has some of the worst health indicators in India. Poverty prevents much of the population from accessing primary health care for common ailments or preventable diseases such as respiratory infection, reproductive tract infection, measles, malaria, pneumonia, minor injuries, and diarrhea. Though the government has instituted several health care programs, these programs have proven inadequate due to a chronic shortage trained medical staff and the lack of standardized treatment protocols for common ailments or preventable diseases.
Innovation / Expected Results
Arogya Ghar will deliver primary care for an average cost of $0.25 per visit – a price affordable for even the poorest. The cost saving is the result of an innovative method of delivering diagnostic information and training to health workers. A system of computerized protocols will shorten the training of time of health workers as well as overcome absenteeism to increase the pool of available healthcare workers and thereby make healthcare affordable. In addition, the innovative computer kiosk system will make available simplified best practices and computerized disease protocols, as well as capture clinical demographic data. Arogya Ghar will benefit the 40,000 villages with vulnerable population exceeding 27 million inhabitants.
Kumar Bahuleyan : paying back to life
All it takes is a dream. He had a dream- of turning around his godforsaken village and improving the lot of its people. Unlike other NRIs he came back to India and spent all of his money to achieve this goal.Village Chemmanakary Kerala India 1989 An apology for a village, it was a minuscule swampy hinterland. Unemployment was high, there was no sanitation, potable drinking water or healthcare. Majority of the underprivileged inhabitants were caught in a vortex of poverty, starvation and deprivation. Survival was tough and escape from the quagmire-an impossible dream. Chemanakary is an hour drive from Kochi or Cochin airport.Chemmanakary Kerala India 1999Paddy-fields and tiled houses dot the palm-fringed landscape. A tarred road links Chemmanakary to the rest of Vaikom taluk. Cold storages, provision stores, medical shops, healthcare centres and a super speciality hospital are now a part of the effervescent village, that is clearly on the move.Set amidst serene ambience of Vembanad Lake, Dr. Bahuleyan’s Kalathil Health Resorts at Chammanakary – an hour’s drive from Kochi (Cochin) International Airport – is a unique travel and tour destination of Kerala. The Resort has rural country house settings that unobtrusively blend with modern amenities.Chemmanakary’s transformation took shape in the hands of a neurosurgeon, Kumar Bahuleyan, who invested his enormous private fortune to better the lives of his country cousins.Born to a physician in the village, times were hard for the poor family. Young Bahuleyan was one of the two survivors in a family of five; three of his siblings died in their childhood. Fighting disease and hunger every step of the way, Bahuleyan struggled to get an education. The young boy’s grit and sheer brilliance carried him through, with the help of many benefactors and government scholarships he went on to acquire a medical degree. Life was no cake walk, but ” I am an eternal optimist”,he says.Bahuleyan’s career, goaded by his ability to circumvent, started going places- the Kerala Government sent him to the UK for neurosurgical training as the state did not have a neurosurgeon at that time. He returned home to the Chinese aggression; the army gobbled him up for the armed forces did not have a qualified neurosurgeon.Three years later he discovered ” the Kerala Government did not have a place for me; my post had been filled by a freshman”. He, a qualified neurosurgeon, had to sit at home twiddling his thumbs waiting for bureaucratic red tape to work around his case. His patience wore thin and a disgusted Bahuleyan fled to Ontario, Canada, seeking employment. He eventually ended up in Buffalo, USA, where for the first time in his life he achieved economic security.Even as he was scaling professional heights, Bahuleyan used to visit Chemmanakary regularly. Fifty years after Independence, the village still did not have potable drinking water, sanitation, electricity, roads and health centres. “Even marginally well-off people had no concept of sanitation”, saidBahuleyan. “Chemmanakary was a beautiful village contaminated by the people’s lack of awareness”.The emotionally aroused doctor was determined to “clean up the mess” and in 1989 established a not-for-profit-private organization to bring basic healthcare to Kerala villages. ” I put all my money of more than Rs 10 crore into the foundation. My attempt was to come back here and do some community work,” he says.The Bahuleyan Charitable Foundation began with a health survey to pick a target area. It chose an area comprising 17 sq. miles with a population of 66,356. The foundation plunged into a latrine construction program in this area where 5009 of the 18,362 houses did not have latrines. So far 619 latrines meeting WHO standards and costing Rs 4,000 each have been built. “The people initially had no clue what to do with a latrine and started using it as a store room,” says Bahuleyan.In 1993 the foundation built a small clinic in the village to treat pregnant women and children. Demand was so high in spite of poor accessibility (there were no roads leading to the clinic), that the center was soon upgraded and moved to Vaikom town. The foundation also spent Rs 50 lakh to construct a 6 km road to the main highway and subsidiary roads to link the clinic.The Vaikom wing of The Indo-American Hospital opened in 1995 with 30 beds. ” It was named to highlight the fact that it is built with the money I earned in the U.S. and to acknowledge the American tax payer’s contribution,” explained the doctor.But with most of the patients being poor the hospital was making little by way of revenue and its very existence was threatened. ” I started this whole project out of my sentiments, with no planning,” said Bahuleyan. “However I realized I had to do something revenue generating to make it viable.”A project consultant was roped in and he suggested the idea of building a super specialty hospital to attract paying patients. “We decided to have a neuro center in Chemmanakary and opened with the most modern equipment in November 1996.”A super specialty hospital in the hinterlands?”Why not?” asked the doctor.” Hospitals are all built in cities which are inaccessible to the villagers. I want to develop my village and its economy. Treatment here is at roughly one-third the cost of city hospitals and free on cost for the poor.”The hospital today is the hub of life in Chemmanakary. Indeed a far cry from the early days when the villagers viewed Bahuleyan and his motives with suspicion.Most of the work force in the hospital is locally drawn, except for the specialized slots. ” Thanks to the hospital, our youth have a channel of employment. Agriculture has received an impetus and the general quality of life here has improved.” Said Sivaramakrishnan, 62. “Our sick people do not die for want of medical attention any more,” said Zuhara Begum, 45. “What more do we need?”According to Bahuleyan if “all the NRIs adopted a village each in India and did something for its people, underdevelopment in this country would soon be a thing of the past. When I hear these so-called NRIs crib about the lack of facilities here I tell them that the problem is with them and not with the country, It’s they who have changed, not the land- after all, weren’t they living here at one point in time? They come back and build huge mansions, with that money I can build 100 or more latrines. Don’t we all owe a little something to our motherland?”Though he pleads guilty of having strayed from his original vision of bringing general healthcare assistance to Chemmanakary, Bahuleyan says that he is taking steps to rectify this. He plans to upgrade the Vaikom clinic into a center of excellence for women and children.A multilingual learning center is also under construction where the doctor plans to introduce computers and Internet facilities.” ” I am targeting the children here, ” he says. ” I want to take them off the streets so that in future even the specialized posts in the hospital can be filled by local hands.”The doctor claims to be a “in a state of nirvana” today. He says: ” I am a dreamer; a professor of ideas. Everything I have achieved in my life is because of my dreams.””I have also done some unpardonable things in my life,” he says with a laugh. “But for a village boy desperate to do something, the world didn’t offer very many choices.”However, it’s yesterday no more; the little boy has grown up and today the world is his oyster. And Chemmanakary has finally made it to the map and the millennium- electricity, drinking water, health care and all.
Story of an exceptional Indian doctor in America
About two weeks ago there was a small news item somewhere hidden among daily routine news that an Indian American who made millions as a neurosurgeon and lived a lavish life, once owning a Rolls-Royce, five Mercedes-Benzes and an airplane has donated $20 million to his native village in Kerala.What is the story of this man?There are very large number of Indian doctors in the United States who mainly came to the country in past 3 decades but a grand majority during 1980s. Most of these physicians get educated in India supported by a poor resourceless country and they migrate to the US for making money to enrich themselves and to enrich their families. Sooner or later they forget all their promises and determination to do something for their country and they become Americans. American health care system is one of the biggest in the world but the most corrupt, most evil, most foolishly run by greedy lawyers and large hungry corporations that engage in health practices that has destroyed health of majority of Americans, whereby almost 80% of Americans live a sick and disgusting life thanks to the great American medical system.Very few, may be one out of 5000 of these doctors ever go back to India, mostly for personal reasons more than professional or charity reasons. Some of them go to India just to show off or to get a feel good effect to make themselves comfortable in their eyes, when they go to do some charity work but that is nominal or merely a big nothing.Coming back to our story, Kumar Bahuleyan, 81, who was born to a Dalit family in India, decided to donate his personal fortune as a gratitude to his village, to establish a neuro-surgery hospital, a health clinic and a spa resort in Chemmanakary, in Kottayam district of Kerala.”I was born with nothing; I was educated by the people of that village, and this is what I owe to them,” Bahuleyan said in Buffalo where he has lived since 1973.”I’m in a state of nirvana, eternal nirvana,” he said. “I have nothing else to achieve in life. This was my goal, to help my people. I can die any time, as a happy man.”The urge to do something for his village arose some 20 to 25 years ago, when Bahuleyan returned to Chemmanakary and was struck by how little it had changed.”The village remained absolutely the same – not a road, no school, no water supply, no sanitary facilities,” he said. “I looked in the (people’s) faces and saw the same people living in the same miserable conditions I had grown up with.”Bahuleyan has come full circle: from dire poverty in India, to the lifestyles of the rich in America and back to his native village, where he’s traded his Mercedes for a bicycle, The Buffalo News reported.The Indian American doctor lost two younger brothers and a sister to water-borne disease in 1930s.”I was the oldest, feeling very helpless, listening to the screams of these dying children, one by one,” he told the paper. “Their cries stuck in my psyche. Even now it haunts me.”As a former ‘untouchable’, belonging to the lowest strata of Hindu society, Bahuleyan had to take a roundabout route to school because he wasn’t allowed to pass within a few hundred yards of the Hindu temple.A star student, he went to high school, then a premedical school run by Christian missionaries before attending medical college in Madras, now called Chennai.Later he went to the United Kingdom for neurosurgical training at a college in Edinburgh, Scotland, where he spent six years before returning home. But he couldn’t land a job in his specialty.”They (government) didn’t know what to do with me,” he said. “There was no position available for a neurosurgeon. Many people didn’t know what neuro-surgery was.”So Bahuleyan went to Kingston and then Albany Medical College, before coming to Buffalo in 1973 to work with neurosurgeon Dr. John Zoll.Bahuleyan never saw ice cream until he was in medical college in his early 20s. And he remembers buying his first pair of shoes as a young adult; he put the right shoe on his left foot and realized it didn’t fit.During his 26-year career, Bahuleyan served as a clinical associate professor in neuro-surgery at the University at Buffalo before retiring in 1999. And he made millions.”I didn’t ask for the money,” he told The Buffalo News. “The money came to me. My secretary said to me, ‘Dr. Bahuleyan, you’re making too much money.’ I had never had any money. So I went berserk with money.”In 1989, he set up the Bahuleyan Charitable Foundation, which built a small clinic in India for young children and pregnant women in 1993 in south India. Bahuleyan’s foundation built the Indo-American Hospital Brain and Spine Center in 1996, starting with 80 beds.None of the facilities carries his name.In 2004, the foundation opened the Kalathil Health Resorts, http://www.kalathilresorts.com offering luxury rooms, health spas and exercise rooms.Bahuleyan’s latest idea, East India Seven Seas Sailing company, plans to invite applications from Americans willing to spend a few weeks in India, to volunteer in Bahuleyan’s hospital and to teach sailing.Bahuleyan, who lives with his wife, pathologist Indira Kartha, spends half the year in the US, the other half in India where he oversees his foundation’s work, gets around on a bicycle and still does almost daily surgery.
NRI docs’ to help Bengal’s poor
Kolkata, Sep 14: Thanks to the initiative of around 20 NRI doctors, mostly from Britain and the US, a hospital is being set up here with the aim of providing quality healthcare at a low cost to the poor.
Sanjiban, which will be located on the outskirts of Howrah, 30 km from here, will offer specialized services in fields like pediatrics, cardiology and ENT and will be operational by April next year.
“Sanjiban was an idea that we had conceptualized during our college days in the early 1980s. Now it will turn into reality,” Subhashis Mitra, a Britain-based medical professional said.
Mitra, who got his MBBS degree in West Bengal and has been in Britain for nearly 13 years, is all set to give up his job as a senior surgeon in Glasgow and come back to India to head Sanjiban.
“We have always thought that healthcare is not a business, but a service. We honestly believe that the concept of private healthcare should be changed so that even poor people can get access to this facility in West Bengal,” he said.
Mitra is also president of the Chikitsa Broti Udyog, the trust behind the Sanjiban initiative. Social activist Prafulla Chakraborty is general secretary of the trust.
“Since we are targeting a particular section of society, we are trying to help them with medical insurance. Talks are on with the National Insurance Company Ltd for a medical insurance tie-up,” Mitra said.
He said the hospital had joined hands with a low-priced generic drug manufacturing company, Locost, and taken the help of a Vadodara-based consultancy firm, MSP Consultant, to bring down the cost of its services.
“Inflated medical bills are a nightmare for patients in India. If we can bring down the cost, it will be a great help to poor people,” Locost managing trustee S. Srinivasan told IANS.
The hospital will have a captive power plant and a green house energy reservoir.
Mitra said the hospital would be able to reduce the operational cost by about 40 percent by using renewable energy.
The hospital will initially have 130 beds, but the capacity will be increased to 300 beds in the near future.
“We are planning to develop this hospital as a premier healthcare center in the entire Southeast Asia.” Mitra said.
HealthCare Challenges of Poor–
The pressure for health care These National Human Rights Commission’s hearings on the Right to Healthcare are bringing out hundreds of poor citizens’ experiences of being refused public health care. Gone are the days when citizens endured this with a fatalism born out of years of hopelessness, writes Abhijit Das. November 2004 – On the 9th and 10th of October 2004, over 250 persons from 15 different states, gathered together in Delhi for the People’s Tribunal on population policies and the Two Child Norm. Among these were 75 men and women who shared their stories of pain, agony and humiliation in the gathering of experts, media persons and concerned citizens. There were stories from women who had
been ill-treated during the family planning operations; stories where there was no one to care or their complications.
Rogi Kalyan Samitis are revolutionising public healthcare in Madhya Pradesh
Government hospitals in Madhya Pradesh are undergoing a sea change. Gone are the pathetic services and repulsive, unkempt environs characteristic of public healthcare facilities.
Instead, accolades are pouring in from various quarters. Be it patients shifting from private hospitals to government ones. Or the recent Global Development Network Award for the pioneering project that’s been changing the face of public healthcare in Madhya Pradesh over last six years.
The story of change begins with the 1,000-bed Maharaja Yashwantrao (MY) Hospital of Indore. When the hospital was inaugurated way back in 1955, it was Asia’s largest government hospital. Decadence slowly crept in, creating an inefficient system with absolutely no finances for upkeep.
Under the Indore collector, S R Mohanty, in 1994 Operation Kayakalp was launched to rid MY of thousands of rodents, and nearly 150 truckloads of garbage and junk. That was also when public participation first came in. When the administration appealed to people for money for the clean-up operation, donations poured in. Within no time Rs 48 lakhs were collected.
The question now was how to keep up the tempo. “The hospital had only bare infrastructure in place. And no funds were forthcoming from the state government. Left to itself, the hospital would have reverted to the old ways,” recalls Mohanty.
That was when the concept of the Rogi Kalyan Samiti (RKS) took root. RKS is a people’s body consisting of elected representatives, municipal corporation members, donors, doctors and members of the public, who would manage the hospital. The RKS was empowered to fix reasonable user charges and raise funds through loans and grants. It started by introducing a Rs 2 ticket for the OPD (out patient department), which now costs Rs 5. Even specialised services such as a bed in Intensive Care are as low as Rs 150.
Some broad guidelines were laid down for the levy of user charges. Thus, all hospital facilities were to be charged. Persons below the poverty line are totally exempt from any payment. For the latter a mere declaration was enough, without the usual complicated paperwork.
Monthly collection from user charges came to around Rs 8 lakhs; earlier it was nil. Money thus collected is distributed to the different departments, for upgrading equipment and employing contractual labour for maintenance.
The success of MY Hospital has led to the adoption of the RKS as state policy by chief minister Digvijay Singh. Thus all over the state, Rogi Kalyan Samitis have been formed in over 2,000 allopathic hospitals and dispensaries, 197 Community Health Centres and in most of the 1,690 Primary Health Centres in the last year. In Mandsaur, a Rs 175 lakh project for modernisation of the district hospital has been launched. Total monthly collection in the state through user charges is now estimated at Rs 50 lakhs.
Mohanty says the strength of the Rogi Kalyan Samiti lies in the fact that the people can now decide their own priorities. But the greatest success of the RKS lies in bringing about an attitudinal change and boosting the morale of the medical personnel and staff. Even they have begun to donate something for the hospital; like Roop Singh Karode, an accountant with MY hospital, who donated the marble benches for the orthopaedic department.
Contact: Rogi Kalyan Samiti c/o S R Mohanty D 2 / 11, Char Imli Bhopal, Madhya Pradesh India Tel: 91-0755-552409 E-mail : email@example.com
Shimla Devi, from Adilipur village in Uttar Pradesh underwent sterilization on 12th of February 2004. After the operation, she vomited continuously and no health worker came to assist her. Later she developed more complications and also hernia. On the 26th of June 2004, she underwent another operation and ended up spending 5,000 rupees. Suran Pulamma, from Rangareddy district, in Andhra Pradesh was married as early as 13, gave birth at 14 was sterilized at 18 years and soon lost her husband. She has neither received the benefits that she was promised and has since then suffered from chronic ill-health.
There were many similar stories. S Singh of Kanpur, Uttar Pradesh broke down recounting the story of how his daughter Sudha died after the doctors pierced her intestines while doing her family planning operation. Stories and evidence from the east, and the west, from the north and the south all pointed to how hundreds of thousands of family planning operations were being conducted on women with little care for quality but under the pressure of meeting family planning targets, even though targets were not part of the National Population Policy.
Doctors often completed an operation in less than 5 minutes, throwing all norms to the wind. This meant that there were infection, complications, failures and even death, and there were no provisions within the programme guidelines to deal with these.
Government funded curative services in major hospitals largely favour the rich, with Rs 3 spent on the richest quintile for every Rs 1 spent on the poorest 20 percent.
• Healthcare : Eyes on the prize
The people’s tribunal was organised by Human Rights Law Network, Healthwatch UP & Bihar, SAMA, Jan Swasthya Abhiyan and Hunger Watch. The sittings included noted personalities like Poornima Advani, Chairperson, National Women’s Commission, Jashodhara Bagchi, Chairperson State Women’s Commission West Bengal, Vasanthi Devi, Chairperson, State Women’s Commission, Tamil Nadu, Shabana Azmi, actress, Sandeep Dixit, Member of Parliament, Sayeeda Hamid, Member Planning Commission, Imrana Qadeer Professor of Community Health, and Ruth Manorama, Chairperson National Alliance of Women’s Organisations.
Not surprisingly, the members of the tribunal were moved by the experiences of the women and men, and strongly condemned coercive population policies.
Mr P.K Hota, Secretary Department of Family Welfare, Government of India was also present at the tribunal. Professing ignorance, he mentioned that he was not aware that the programme supervised by his department resulted in such misery for the people. The members of the Tribunal urged the Government to take immediate steps to stop coercive measures, remove the two child norm and ensure quality services.
Following this, on the 11th of October hundreds of health activists from West Bengal, Orissa, Bihar and Jharkand gathered together in Ranchi for the fourth Public Hearing on Right to Health organized the National Human Rights Commission and the People’s Health Movement. At this public hearing citizens from these states presented their cases of denial of health services by the government health sector. Similar public hearings had been organised in July at Bhopal, in August at Chennai and in September at Lucknow.
A few more are planned. These NHRC hearings on the Right to Healthcare are bringing out hundreds of cases where people are being refused health care. They highlight instances where complications are not being attended, of tuberculosis patients who do not receive their medicines leading to drug resistance, where lack of anti-venin or other life saving drugs have led to death and devastation for hundreds of families and many similar situations.
Events like the public tribunal and the public hearings raise important questions about the way health care is being provided to our citizens. The health care system in India is undergoing rapid and fundamental changes. On the one hand there is a tremendous sense of pride both among the health care providers and the privileged citizens that the healthcare facilities are among the best in the world and people from the world over are coming to Bangalore, Chennai, Mumbai or Delhi to get treated. But at the same time the health care services available to the poor and underprivileged is far from adequate. In the name of sectoral reforms many services are no longer being provided free and there is a push for increasing the participation of private sector entities in providing health care services.
Several facts about the public provisioning of health care services in India are well known. The Indian healthcare system is among the most privatised in the world and less than a quarter of all health care related expenses are met by the government. It is not surprising therefore that health related expenses are among the most important causes of rural indebtedness and impoverishment.
Studies have shown that even the little money there is to spend on health gets disproportionately spent on bigger hospitals and providing free care to those who can afford it. Curative public services for example, largely favour the rich, with Rs 3 spent on the richest quintile for every Rs 1 spent on the poorest 20 percent. This is because government-run referral hospitals (tertiary class) in India offer free curative services that are utilised by rich citizens more than the poor because the poor face a large number of access hurdles. Public funding for such services, dispensaries, insurance schemes, and medical education and training account for 60 percent of allocations, leaving only 26 percent for public health and family welfare, and 14 percent for administration and miscellaneous services. To add to this state of affairs, government expenditures in family welfare programmes have been conclusively shown to make poor women’s lives quite miserable.
But the tribunal meeting and hearings are a sign that the times are going to change. The rural poor are now bold enough to come forward and share their stories with a larger audience. Gone are the days when these very people faced the worst calamities with a fatalism born out of years of hopelessness. Still, it is ironic and unfortunate that in a socialist democratic country like India, the underprivileged need to come forward and assert themselves in the faint hope that the government will wake up to its constitutional responsibility of promoting welfare of its citizens.
The Common Minimum Programme of the government is another indication of possible change, since it provides for increasing allocations for health and for pursuing a more just social policy. The government constituted National Advisory Council is a vehicle for the government policy to incorporate suggestions and feedback from our informed civil society. The contours of a new approach to rural health care is on the anvil and it is hoped that this plan will incorporate the experiences from people from all over the country and provide a new direction to the provisioning of health care services in India.
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