A couple of years ago, the world had been shocked to see Odisha’s Dana Majhi carry his daughter’s dead body 8 km on foot to reach the nearest primary healthcare centre. Today, in the face of COVID-19, as lakhs of migrant labourers working in various cities of India compromised their safety and took to the roads to return to their villages, the question remains – will the poor always have to choose between hunger and healthcare, are some lives cheaper than the others?
As the world faces one of the worst health & heathcare crises of recent times in the form of COVID-19, once again the paramount importance of health has become front and centre. And yet again, the socio-economically marginalized are the worst sufferers. Whereas well-heeled Indians seem to be basking in a long holiday under the lockdown, the poor are in a state of unemployment and hunger, having lost their dignity, and in utter despair.
In the Covidian world, it has become glaringly obvious – Health Cannot Wait!
Healthcare in India
If we Google the term, ‘healthcare in India’, we would get around 80,40,00,000 results in 0.69 seconds. But when a person with limited means and at the highest risk to succumb to disease goes out to seek medical attention, he/she would find abysmally low choices. Either the person would have to sacrifice a day’s wage for a visit to the doctor or continue to live with the sickness and rely on fate. This is the unfortunate truth of our country – the ones who are in need of healthcare services the most are the last to receive them.
The overall healthcare scenario of the general population of India is a sad one. According to The Lancet, a global health indicator index, India ranks at 154 in a list of 188 countries. A staggering 70% of the population still lives in rural areas and has limited or no access to healthcare services or even a primary healthcare centre. The doctor-population ratio in India is 1:1456 against the WHO recommendation of 1:1000 (The Economic Survey of India 2019-20). On average, a government doctor attends to 11,082 people (Directorate of State Health Services and NHP, 2018), more than 10 times than what the WHO recommends. The country has the third-highest child mortality rate among SAARC countries with an average life expectancy of 69.4, which gives India a World Life Expectancy ranking of 130 (UNDP 2018). Our public health spending, at just about 1.3 percent of the GDP is among the bottom 24 countries globally. The out-of-pocket expenditure continues to be about three-fourth of the total health expenditure, which disproportionately burdens the poor.
Way Forward: Public Health
Everyone everywhere is susceptible to infection and to illness. And the only way forward is together. The COVID-19 pandemic has forced us to learn the harder way, why what ails one – ails us all. An individual’s health security is interdependent on everyone else. And yet so many in our country are living in conditions that make them more vulnerable to ill health including over-crowded living spaces, poor sanitation as well as lack of awareness. As such, focus and investment on public health has become the need of the hour – viewing health as much more than simply not being ill at an individual level.
Public health comprises of routinely analyzing the diseases that plague us, the determinants that impact our health, and the social dysfunction that ails our communities. It promotes a collective understanding and effort to promote healthy social and physical environments to prevent people from falling sick in the first place. Working together, we have a better chance of shaping social conditions that help individuals and whole communities to be healthy.
Health Cannot Wait
Adopting this collective path towards a healthier society, Smile Foundation’s Health Cannot Wait! campaign aims to a) provide primary healthcare services to the most vulnerable in urban slums, and the hardest to reach families in remote rural areas, and b) promote health-seeking behavior and living conditions among underprivileged communities to prevent people from falling ill. Through the campaign, we aim to reach 2 million people with primary healthcare.
Smile Foundation has designed a comprehensive primary healthcare programme that aims at addressing the issues of accessibility, affordability, mobility, accountability and awareness in the delivery of primary healthcare services to the vulnerable underserved population of our country residing in remote rural areas and urban slums. Through four intensive initiatives, we are working every day to improve maternal, neonatal, and child health and nutritional status, reduce vulnerability to communicable diseases, combat non-communicable diseases and enhance the quality of life, complementing the government health system.
The four initiatives are:
Smile on Wheels – A mobile hospital programme which takes healthcare to the doorsteps of vulnerable communities in the hardest to reach places through fully-equipped health vans, facilitated by a team of doctor and paramedics.
Smile Health Camps – Complementing Smile on Wheels, Smile Health Camps provide healthcare services to larger communities and offer multi-disciplinary healthcare through a team of specialized doctors.
Baaton Baaton Mein Sehat – A unique tele-counseling initiative that provides emotional, physical and psychological support in the times of Covid-19.
Health Online – Telemedicine or e-clinics overcome the scarcity of doctors in remote rural locations. For every 10 on ground clinics with paramedics there is 1 digital clinic with a doctor covering many communities.
Look around us! One health crisis has changed our world. We are living in uncertainty every day. But for the poor, this has been their entire life. Poverty is a daunting enough burden in itself; add sickness to it and it has the power of crushing even the strongest as we are seeing around the world today. Let us not let them get crushed. Let us ensure a healthy society for all. Join the campaign – www.smilefoundationindia.org/health-cannot-wait