Despite India’s rapid economic growth, high rates of deaths from preventable diseases such as malaria, tuberculosis, and pneumonia, as well as maternal and infant mortality are a big concern for the country.
A joint report by Johns Hopkins, Bloomberg School of Public Health, and the International Vaccine Access Centre (IVAC) published in 2020 finds that India’s annual deaths under 5 years stands at 233,240 amongst the highest globally, ahead of Nigeria and Pakistan. The report indicates that poor quality care leads to more deaths than insufficient access to healthcare facilities. A solution to tackle this issue is community engagement and outreach, not just in urban cities, but in rural India as well.
The Urban-rural Healthcare Divide in India
Traditionally, the standard of living, medical care, and hygiene practices in rural India have been lower, when compared with urban cities. While the central and state governments have public health programs to ensure timely awareness, vaccinations, and care, for children, adolescents, and adults, there’s still a gap in implementation. Why so?
The existing healthcare system is supply-side driven with little or no participation from the demand side.
Low education status, lack of awareness about the healthcare system, poor functional literacy, and low priority for health in the rural population are reasons that lead to negligence in basic health and hygiene practices. Cultural barriers also play a pivotal role in hampering service utilization and the practice of healthy behaviours, thereby leading communities to resort to traditional methods.
Community Engagement & Awareness of Preventable Diseases is Paramount
Studies show how community engagement is an enabler for individuals and society to progressively work towards establishing developmental goals, especially health. Like science, it involves a strategic process of planning, designing, and implementing to achieve desired health goals. Face-to-face interactions in community settings positively impact overall health status and living conditions by encouraging collective behaviour change, making it the norm. Public health organizations and NGOs, who work on-ground with the communities often employ a rights-based approach to convey critical messages to the target audience, leading to better adoption of good practices.
Hence, efforts need to be made to bring behavioural and attitudinal change in different communities.
By involving communities in the planning, implementation, and evaluation of healthcare programs, we can ensure our efforts are tailored to their specific needs. When designing an intervention complete consideration of the healthcare system, social and environmental dynamics must be considered.
A case in point would be, in the year 2012, the World Bank supported three State Health Systems projects in Rajasthan, Karnataka, and Tamil Nadu where they adopted multiple innovative strategies to improve the health of indigenous groups. The creation of customized, relatable, and engaging health content, aptly catered to the unique needs of the communities. Through Public-Private-Partnerships the project helped build capacity and institutionalized systems, to sustainably continue the momentum in these geographies.
Active Participation of All Stakeholders is Important
Close to 700 million people live in 6,36,000 Indian villages. It is noteworthy that the majority of people die due to preventable and curable diseases. The UN Sustainable Development Goal 3 aims to ensure good health and well-being for all across age groups. India being one of the fastest-growing economies is actively working towards achieving this goal by 2030.
Basic interventions to influence behavioural practices of immunization, hand hygiene, improved nutrition, sanitation, and neo-natal care can help India achieve this vision. Globally too, countries are aiming to lower mortality to as low as 12 per 1000 live births and under-5 mortality to 25 per 1000 live births. The central Indian government also aims to address maternal, reproductive, neonatal, child, and adolescent health through its National Health Mission. To effectively do so, there is an immediate need to work with like-minded partners at the ground level to bridge awareness, education, and communication gaps.
Active participation of all relevant stakeholders, sharing learnings, and dialogue exchange at different structural levels are critical to establishing trust within communities. Mobilizing support and garnering ownership, further lend to the success of such interventions.
For populations residing in “hard-to-reach” or remote areas, there is an urgent need for government, private partners, and NGOs, to come together to bridge the gaps in service delivery. The involvement of local state machinery is critical, to creating localized targeted strategies around important hygiene and health behaviours.
One-on-one counseling, door-to-door mobilization, community meetings, and sometimes the use of religious institutions have proven to be instrumental contributors to changing community behaviours. It has also been seen that involving communities since inception helps showcase participatory values, which go a long way in, improving communication. It also helps create openness in utilizing healthcare services, thereby boosting outreach.
The Way Forward: Working on Strategic Objectives
Preventable diseases can be averted with timely care and intervention. Adoption and practice of a combination of good hygiene practices like regular handwashing with soap, complete immunization, and timely medical treatment, can reduce mortality rates considerably.
While we know that a lot of deaths are preventable, it is also an established fact that an unavoidable proportion of those is attributed to health inequities, which have roots in larger socio-economic conditions. In a country as vast and populous as ours, these inequities can possibly be addressed through greater community engagement.
Even the National Rural Health Mission framework clearly articulates that communities must be “empowered to take leadership in health matters,” and interestingly this thought led to the creation of the cadre of female community health workers – Accredited Social Health Activists (ASHA) in 2005, who till date continue to be the backbone of our healthcare system. Similarly, the Self Help Groups (SHGs), formed under the State Rural Livelihood Mission, are associations of 15-20 women at the village level, who come together to improve the quality of life by running micro-finance systems for local communities, are also noteworthy examples of the power of community involvement. These ASHAs and SHGs work with the local state machinery to create enabling and empowering environments for communities to thrive.
Winning the battle against health problems in a country as large as India is no easy task. A shift in approach, from health systems designed around disease control towards health systems designed for people, will help us achieve key community health and development goals. As witnessed during the Covid-19 pandemic, a community-based approach to prevention is a well-thought strategy, which comes with a promise of substantial health gains, alongside enabling change in behaviour, environment, and healthcare practices of people.
[Madhusudhan Rao is Executive Director and General Manager - South Asia (Beauty & Personal Care) at Hindustan Unilever. He is a firm advocate of equity and believes in the potential of brands to contribute towards addressing societal challenges.]
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