"It is impossible for a mother to provide high-quality child care if she herself is poor and oppressed, illiterate and uninformed, anaemic and unhealthy, has five or six other children, lives in a slum or shanty, has neither clean water nor safe sanitation, and without health services."

The introduction line comes from the "Asian Enigma", a report by Vulimiri Ramalingaswami, published by UNICEF. This women's day, we look at an organisation for women's welfare, run by women, that provides comprehensive health care in the villages.

A typical lazy Sunday for Bangalore, but for Arudi, a village of about 4000 inhabitants (predominantly SC/ST) and approximately 50km from Bangalore, it is a big day; a free health camp has been organized at the Sri Aurobindo High School by the Mahila Dakshata Samiti, Bangalore.

Healthcare in India
The poor have higher incidences of health problems that typically result from their environment that include deficient water supply, insufficient sewage, malnutrition, irregular health checks etc., but this is exacerbated in the rural poor due to lack of access to proper healthcare services. For the residents of Arudi or the slums of Ashwathnagar or Geddalahalli in Bangalore, the only healthcare they have known is either the arrival of volunteer doctors or the appearance of health workers Padmashri and Vasantha of the Mahila Dakshata Samiti.

Mahila Dakshata Samiti
Mahila Dakshata Samiti (MDS) was started in Delhi in 1976 primarily to deal with the problem of women harassment and gender bias. Over the years, branches were established in different cities; Mrs. Saranya Hegde spearheaded its efforts in Bangalore in 1992 and is now the President of the Bangalore branch. MDS provides a number of services like family counseling, short stay home at Vidyaranyapura that provides temporary shelter for women in distress and accommodates about 30 women, adoption of Geddalahalli Government School, scholarships for some of the students and health services for urban and rural poor; And all this with just a staff of six.

MDS’s attempts to address health related problems resulted in community health visits that started in 2004 in the slums of Ashwathnagar and Geddalahalli; these mainly focus on preventive healthcare and include aspects like personal hygiene childcare, nutrition, family planning etc. The proximity to these slums allows MDS to conduct regular health checks and maintain detailed records on the households. Explains Padmashri, one of the two community health workers at MDS, “The government has introduced a number of programs such as incentives for family planning or for the girl child, but the public is not equipped to utilize them; that’s where we come in. We also conduct a number of awareness programs such as the recent de-addiction program for drug abuse”.

In 2007, MDS and M. S. Ramaiah (MSR) Memorial Hospital identified the village of Hadonahalli, about 8 km from Doddaballapur for conducting rural health camps every Sunday from 10 am to 2 pm. The health camps on the third Sunday of every month however are conducted in nearby villages identified by the Hadonahalli Panchayat. Arudi was one such village; with about 350 people attending the health camp and over 50 referrals (patients who would need to visit the hospital for surgery), much above the usual average of 15. These referral cases are followed up with transportation and highly subsidized treatment at MSR.

Arudi is one of the rare villages with a Primary Health Center (PHC) and even rarer private doctor; however, as Mr. Shiva Prasad, the headmaster at the high school explains “while the PHC lacks regular doctors and medicines, the private practitioner’s treatment is regarded with skepticism given the high fees charged without a proportionate alleviation in the ailment”. About 15 interns from MSR participated in the Arudi health camp; they covered different specialties like ophthalmology, pediatrics, dermatology, orthodontics, gynecology, and general medicine. Such health camps are mandatory as part of the curriculum, explains Prashant, the social worker from MSR who accompanies the interns. With an estimated Rs. 30,000 worth of medicines provided free by Micro Labs Ltd., a pharmaceutical company located in Bangalore, these health camps do seem to work well. The village typically pitches in with providing lunch for the visiting doctors and the MDS staff and making necessary arrangements at the location.

Need for change
Public health expenditure in India has remained static at around 0.99% of the GDP since 2005-06, compared to say 15.2% of GDP in the US. Even when compared to other developing countries, India does not fare any better in prioritizing health care. In 2008, India ranked 128th among 177 countries in the Human Development Index (HDI provides a composite measure of three dimensions, one of which is life expectancy) and in 2009 the rank fell further to 132; India lags behind the African countries of Republic of Congo and Botswana and also Bolivia, known as Latin America’s poorest nation. Ignoring worldwide comparisons, consider this – hospitalized patients in India end up spending, on an average, 58% of their total annual expenditure; over 40% of them borrow heavily or sell assets to cover expenses; and over 25% end up falling below poverty line because of hospital expenses!

This gap between the health needs of the poor and the affordability of health care is one that MDS seems to be addressing, much to the relief of the beneficiaries, but questions remain. Though commendable, do such efforts increase the overall effectiveness of our healthcare system or do they end up making it easier for the government to wash it’s hands off the issue? Why is it that MDS has to organize health camps in villages which have PHCs? What would it take to make the PHCs better and accountable? Why does the public exhibit more confidence in these health camps than the PHCs? And the overriding question is what is being done to address the fundamental poverty-related issues that cause ill health such as lack of access to clean water.

The National Rural Health Mission (NRHM) launched in 2005 and expected to conclude in 2012, promises to provide effective healthcare to rural population throughout India with special focus on some states which have weak public health indicators and/or weak infrastructure. Till such a time as this promise is fulfilled, MDS has its work cut out with not much respite.

Contacts:

Mahila Dakshata Samiti
No. 66/A AECS Layout,
Sanjaynagar Main Road,
RMV 2nd Stage, Bangalore – 560094
President: Mrs. Saranya Hegde
Phone: 080-23512543
URL: www.mahiladakshatasamiti.org
Email: mahiladakshatasamiti@yahoo.co.in