Access to healthcare has become the topic du jour thanks to the monumental legislation in progress in the United States. On this side of the world also, healthcare accessibility is also a pressing problem, but on a level that Americans would have a hard time fathoming. Most of the rural population in India are more than 3km from the nearest Public Health Center (PHC) which makes it extremely difficult for them to access health care. Even more concerning is that basic maternal healthcare is still unavailable in many rural villages. The UNDP estimated that 60% of births in India are still unattended by a medical professional.
A number of social enterprises have risen to the challenge and have low-cost models for providing the essential basic healthcare that each person deserves. The Villgro fellows visited with a few during the past month of training (both models are public private partnerships):
- Byrraju Foundation runs a healthcare clinic in each of its adopted villages, where patients can seek diagnosis and treatment for common conditions – e.g., hypertension, diabetes, etc. These patients pay a nominal fee of Rs. 20, which allows them to get a routine check-up from a nurse and a consultation with a retired doctor.
- Health Management and Research Institute (HMRI) runs a mobile clinic program, where once a month, a healthcare van with medical supplies, 2 qualified nurses and pharmacist operate a temporary clinic in the village.
HMRI Mobile Clinic Van
Patients are provided check-ups, medication, and if necessary, consultation referrals to the nearest PHC. The emphasis is to encourage villagers who normally wouldn’t seek treatment for ailments at the PHC due to the distance to come forth and get treated. Particular emphasis is placed on maternal health, where the local ASHAs are charged with the task to get pregnant women to come to the clinics for monthly check-ups.
Both of these models are providing great services to the rural villages, but it’s still not enough. While visiting HMRI, the district manager told us that these clinics faced a difficulty in getting pregnant mothers to come for check-ups – their husbands often prevented them from going to the clinics. This deeply disturbs me. By denying their wives access to pregnancy check-ups, these husbands are risking the lives of both the mother and child. There are a few reasons, both rational and irrational, for why this is so:
- 1. Opportunity Cost of Time – going to the clinic, even in the village will take half a day of the mother’s time, which is also equivalent to half a day of wages. Pregnancy check-up is not valued highly enough to justify the lost wages
- 2. Distrust of Nurses – distrust of examinations that may compromise her modesty is a perceived barrier that is reinforced by cultural tendencies to shelter women from the public arena
- 3. Undervaluing Women – although less frequently an explicit reason, there is still a systemic undervaluing of a woman’s life that leads a husband to bar his wife from receiving free clinical check-ups. There still persists the idea that a man can remarry easily, or to put it bluntly – she is replaceable
HMRI has counseling and intervention systems in place to deal with the first two reasons. The ASHAs as well as HMRI personnel who are trained will prevail upon the husband to help him understand the value of regular check-ups during pregnancy. Often, it’s merely a lack of awareness and education and the problem can be corrected.
However, the third reason is more insidious and is a cultural problem that many developing countries face. Women still need to be empowered all around the world to be able to exercise their right to seek healthcare, particularly maternal healthcare. The WHO estimated recently that for every 100,000 births, there are 540 maternal mortalities. That is an astoundingly high number, which organizations like HMRI are trying to improve. But unless women can actually access the care made available by HMRI, the high maternal mortality rate will persist. For all the women that HMRI is able help, there are many more who are unknown to HMRI who are prevented from receiving care. For those women, it’s not the access to healthcare that we need to worry about, but rather the right to access the existing healthcare that we need to fix.
