Maitreyee Sganapathy is an independent health writer based in Delhi
Providing decent living and working conditions and basic amenities of sanitation and clean water will go a long way in improving health outcomes. According to UNICEF, research and experience show that six million of the almost 11 million children who die each year could be saved by low-tech, evidence-based, cost-effective measures such as vaccines, antibiotics, micronutrient supplementation, insecticide-treated bed nets and improved family care and breastfeeding practices. Barefoot doctors in China, the Accredited Social Health Activists in Indian villages, the Special Public Health Service Foundation in Brazil or Oportunidades programme of Mexico, global history of healthcare is dotted with examples that have proven effective in many a developing nation.
The barefoot doctors of China, for instance, who served as health-care providers at grassroots level were farmers who received minimal basic medical and paramedical training and worked in rural villages, promoting basic hygiene, preventive healthcare and family planning and treated common illnesses. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle.
In India, the National Rural Health Mission (NRHM) works to provide effective, quality health care to rural populations throughout India. It recognises the multi-dimensional aspect of poor health outcomes and thus promotes inter-sectoral convergence in services such as provision of adequate food and nutrition, water, sanitation and hygiene. Among the major objectives of the programme are raising public spending on health with improvements in community financing and risk pooling, and providing access to primary healthcare services to rural poor with universal access for women and children.
As a key component of NHRM and a frontline health provider, the Accredited Social Health Activist (ASHA – the acronym means hope), a trained female community health activist is expected to be an essential link in India’s public health programmes. Most ASHAs belong to the villages they serve and are educated until Std. 8 and beyond. The ASHA receives performance-based incentives for promoting universal immunization, referral and escort services for Reproductive & Child Health (RCH) and other healthcare programmes, and construction of household toilets.
In Brazil, the main goal of the National Health Foundation is to control endemic diseases in the inner areas of the country. The roots of this Foundation lie in the Special Public Health Service Foundation – SPHSF (or Fundação Serviço Especial de Saúde Pública – FSESP), which began in 1942 to bring important primary health care practices, based on work provided by local people in their communities. The foundation promoted two kinds of community workers: one was responsible for individual or family health assistance and nursing care, and was called sanitary visitor. The other, the sanitary guard, attended to the environment. These professionals worked in pairs, each one focusing on their specific area of performance. They were expected to cover specifically defined geographic areas, working very close together and maintaining a good relationship with the entire community. Both professionals received training from six to eight months. Sanitary visitors were trained by nurses; sanitary guards were trained by engineers.
One of the preventive measures promoted by the UNICEF in its “child survival revolution” was the GOBI strategy (emphasizing growth monitoring, oral rehydration, breastfeeding and immunization) in its selective cost-effective healthcare interventions.
Mexico’s Oportunidades is an anti-poverty programme in which conditional cash transfers are used to persuade poor parents in rural areas to send their children to school, improve the use of preventive and other medical services and adopt better nutrition.
In 2008, the Ministry of Labour in India rolled out the Rashtriya Swasthya Bima Yojana (RSBY) which provides health insurance coverage for Below Poverty Line (BPL) families which the aim to protect them from financial liabilities arising out of health shocks that involve hospitalization. The scheme is being extended to street vendors, building and construction workers and workers employed under the National Rural Employment Guarantee Act.
Better health is not only about curative care but also about better prevention, clean drinking water, sanitation and better nutrition, child care. Inter-sectoral and multi-agency coordination and collaboration is a pre-requisite to all public health programmes and convergence of schemes across ministries is a must.