Shubha Khandekar

Jan Swasthya Sahyog is responding to the healthcare challenges in rural India. An innovative approach and sustained intervention is the key to its success

Healthcare in India has been the bane of policy makers for decades. Half-baked measures and lack of resources has meant that the majority of India’s tribal and rural population has been denied basic health and nutritional services. The Jan Swasthya Sahyog (JSS), an organisation run by a team of doctors and healthcare professionals, is trying to change that.

Set up in 1999, JSS has been working in the rural and tribal areas of Bilaspur district of Chhattisgarh. Through determination and unwavering focus, it has created effective and sustainable community health programmes and is contributing its insights and experiences to a national debate on rural health care systems.

Evidence of its growing impact was visible at a workshop held in February 2006 at Ganiyari, a remote tribal village in Chhattisgarh. Convened by the JSS, the workshop attracted economists, agricultural experts, public health
professionals and activists from across the country. Entitled Hunger and Health: An Interdisciplinary Dialogue, the workshop broke new ground in the understanding of the health and nutritional crises in India today.

Success for the JSS approach has not been easy, but it promises to last.

Seed funding from SDTT enabled JSS to set up the rural hospital in village Ganiyari as well as to develop the community health programme in Bilaspur district. The hospital caters to patients from over 1,000 villages.
Nearly 2 lakh consultations have taken place till date. The village health programme does intensive community health work in 50 villages.

Its small but dedicated team of eight full time and two part time doctors has played a major part. The team has performed close to 7,000 surgeries. Together with the outreach clinics, another 1,000 villages benefit from the low cost good quality care that JSS provides.

JSS’s 94 health workers, local women, are trained in multiple interventions like diagnosis, treatment, and offering appropriate advice on common yet serious ailments like falciparum malaria, pneumonia, diarrhoea and under-nutrition. They play a crucial role in the control of malaria and tuberculosis (TB).

One step at a time
Women and children have always been a focus area. JSS runs programmes on antenatal care and early diagnosis of cervical cancer. And children, particularly those below three years of age get low cost nutritious food and non-formal educational inputs for a nominal fee at crèches called Phulwaris in 35 villages.

JSS has also been involved in the control of TB, the single largest killer disease in India. More than 3,000 patients have been detected and treated till date. Under-nutrition, widely prevalent in rural India, is a major factor in the development of TB, and has grave implications for a TB patient. A study by JSS points out that the degree of under-nutrition associated with TB in rural Chattisgarh was much worse than even that among the predominantly HIV-infected patients with tuberculosis in sub-Saharan Africa. Some of the concerns that JSS has raised with donors and in forums, on the therapy of patients, have turned out to be valid as reflected in current documents by WHO.

Equally valuable have been the insights gained by JSS on leprosy, diabetes, malaria, hypertension, rheumatic heart disease, antibiotic resistance, sickle cell anaemia, HIV, neurological disorders and nutritional deprivation in a rural milieu. With SDTT’s support JSS is feeding these
insights in primary and secondary healthcare into policies and programs.

Cost control
JSS recognises that healthcare costs are a major cause of rural indebtedness. For even as low a cost as Rs28 per month of treatment, a significant number of people have to sell grain to raise the money. Expenditure on drugs constitutes 70 per cent of healthcare costs, and drug
prices have risen due to the progressive deregulation over two decades.

Quoting a 2004 World Medicines Situations report, JSS points out that India has a large indigenous pharmaceutical industry, together with the largest number of people in the world without access to essential medicines. JSS strongly advocates availability of essential medicines through the public health system.

The same concern has driven JSS to use low cost technologies. It has adopted an H₂S paper strip test, developed by DRDO, Gwalior, for use in the control of water-borne diseases. A UV-based device developed by JSS disinfects stored water, while an inexpensive mosquito repellent oil keeps malaria at bay. A modular safe delivery kit helps in maintaining hygienic conditions during childbirth and also includes equipment for postnatal care. An innovative slide transport system enables the diagnosis of dangerous forms of malaria on the same day, even of patients living in remote villages. A simple 9V battery-run breath counter is used to detect lower respiratory tract infections in children. An easy to read thermometer, costing Rs30, facilitates detection of abnormally high temperature by health workers, many of whom are illiterate. These have been bought by a number of organisations, such as the famous Gonoshasthaya Kendra from Bangladesh.

JSS has also developed, at a cost of Rs60,000, a large and effective CO₂ incubator system and has used it successfully for over four years. The set costs over Rs5 lakh in the commercial market.

Low cost diagnostic methods developed by JSS are being used successfully to diagnose anaemia, urinary tract infections, vaginal infections, sickle cell anaemia and pneumonia. For diagnosing sickle cell anaemia, the kit manufactured by JSS costs Rs3,000 in contrast to the commercial kits which cost more than Rs40,000. These kits have been purchased by the State Red Cross Society of Chhattisgarh.

These devices and equipments have cumulatively brought the cost of treatment at the health centre down to a mere Rs63. The result is that on an average, over 30,000 patients at the centre and more than 7,500 patients per year at the outreach clinics are able to access healthcare, including surgical care. Even Baigas, a primitive tribe at the bottom of the
socio-economic ladder in the region, has been successfully covered.

Public policy initiatives
JSS has developed its own perspective on the state of healthcare services which it has presented to such bodies as the planning commission and the government of Chhattisgarh. It advocates a comprehensive primary
health care approach for achieving a lasting change in the health status of our people, and sees the village health worker as an integral part of any primary health care initiative.

JSS believes that under-nutrition is responsible for the occurrence and severity of a host of diseases and advocates aggressive attempts at improving nutrition as the most critical health and healthcare intervention.

Building stronger primary health care systems, appropriate technology relevant to public health, training support to other organisations and the
government, and advocacy on issues of public health importance: these are the tools that JSS wields today. And it seems determined to take India into a more equitable and effective health care system.

Uploaded on July 4, 2007