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Taking healthcare to the doorsteps of the rural poor

If we Google the term, 'healthcare in India', we would get around 8,87,00,000 results in about 0.34 seconds. But, when an average individual from a random locale is in search of a healthcare centre, is he able to find at least a minimum of the above number? In an urban locality, maybe yes, but in a rural area where the need is the highest, the scenario is not half as good.

A staggering 72% of the total population in India still lives in rural areas and has no or limited access to healthcare facilities. This huge population mostly relies on unconventional medicine and government programmes in rural health clinics. As per a report by the UN, this major section of the population has access to only 25% of the health infrastructure available in India which includes doctors, specialists and other health resources. 75% of the health infrastructure is concentrated in urban areas that are inhabited by only 27% of the population of the country. Also as per WHO's World Health Report, India's healthcare system ranks 112th out of 190 countries. People from backward sectors of society, who live in destitution, still have no availability or the opportunity to avail proper health care. Daily wagers prefer to work even in their poor health condition, just to not miss their pay for that particular day, as the travel to the 'nearby' health clinic would consume their entire day. At a time when India is said to be a growing economy, healthcare has majorly failed it.

As per studies, one in three of the world's malnourished children lives in India. 46% of all children below the age of three are too small for their age, 47% are underweight and at least 16% are wasted. Every year, thousands of women die due to pregnancy related causes. The child and maternal mortality rates in India are amongst the highest in the world. When basic healthcare faces a situation of crisis, the expectation that fatal diseases like HIV or cancer can be prevented or cured will remain only a dream. The 2012 World Bank Report shows that India had 0.7 doctors for every 1000 individual. And, as on December 31, 2014, the Medical Council of India (MCI), claimed to have 936,488 registered doctors. When seen as such an enormous number, it might seem humungous, but when compared to the population of India 1,267,401,849, as on July 1, 2014, it is evidently scarce. And even if enough doctors are available in the country's urban areas, the unavailability of doctors in rural areas and marginalised sections of the society deprives the people of their right to good health. The shortage of doctors in India has been to the extent where 'regressive actions' were taken by the government. In 2012, doctors, who went abroad for higher education, were asked to sign a bond stating their return and acceptance to work in their motherland.

It is always easy to complain, but we should notice the fact that doctors come into this profession to serve the public. Due to adverse and compelling situations, the doctors are unable to render their services. The value of a college degree in monetary terms, the pressure to pay off the loans and yet live a life of luxury have compelled most doctors to work for clinics.


As per a report by the UN, this major section of the population has access to only 25% of the health infrastructure available in India which includes doctors, specialists and other health resources. 75% of the health infrastructure is concentrated in urban areas that are inhabited by only 27% of the population of the country. Also as per WHO's World Health Report, India's healthcare system ranks 112th out of 190 countries. People from backward sectors of society, who live in destitution, still have no availability or the opportunity to avail proper health care. Daily wagers prefer to work even in their poor health condition, just to not miss their pay for that particular day, as the travel to the 'nearby' health clinic would consume their entire day. At a time when India is said to be a growing economy, healthcare has majorly failed it. As per studies, one in three of the world's malnourished children lives in India. 46% of all children below the age of three are too small for their age, 47% are underweight and at least 16% are wasted. Every year, thousands of women die due to pregnancy related causes. The child and maternal mortality rates in India are amongst the highest in the world. When basic healthcare faces a situation of crisis, the expectation that fatal diseases like HIV or cancer can be prevented or cured will remain only a dream.

The 2012 World Bank Report shows that India had 0.7 doctors for every 1000 individual. And, as on December 31, 2014, the Medical Council of India (MCI), claimed to have 936,488 registered doctors. When seen as such an enormous number, it might seem humungous, but when compared to the population of India 1,267,401,849, as on July 1, 2014, it is evidently scarce.

And even if enough doctors are available in the country's urban areas, the unavailability of doctors in rural areas and marginalised sections of the society deprives the people of their right to good health.

private medical corporations limiting them to serving the privileged in urban areas.

When we think and talk so much about these issues, the inevitable question in our mind should be what can be done to minimize these. How would it be if people could avail the healthcare services from their place of stay? How would it be if people no longer would have to travel so much so as to miss their day's pay, but instead get the proper treatment at their door steps?

The concept and functioning of mobile hospitals helps in achieving just this. This concept was first developed in the battlefields where the medical officials would be moving with a medical kit with them, treating patients and their injuries. As time progressed, people started using this during times of disaster, but only by making it much better. They started using a transport unit with all facilities to take care of any emergencies and later the patients could be taken to a hospital if further care was necessary.

This support by the mobile health units cannot get rid of the above mentioned issues, but they can surely help in parenting the effects, keeping it under control while the country's health infrastructure gets strengthened.

Smile Foundation's mobile hospital programme Smile on Wheels is one such initiative in India that works extensively towards helping the people in need. This unique mobile hospital programme seeks to address problems of mobility, affordability, accessibility, availability and awareness of primary health care with a special focus on children and women, in urban slums and remote rural areas. Well equipped mobile hospital units with medical expertise, services and medicines traverse across deserts, forest tracts, hilly terrain and urban bylanes to bring affordable and accountable healthcare where none previously existed.

 


At Rudraprayag, a district in Uttarakhand, with villages scattered amidst the mountains, people had mostly remained disconnected with many of the basic health necessities. The entire district was left to ruins by the heavy floods in 2013, leaving the health system of the region ineffective at a time when the inhabitants needed it the most. The remoteness and undulating terrains made the delivery of the available medical resources difficult.

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Even today, two years after the disaster, the health system in Rudraprayag remains a challenge.

Smile on Wheels mobile health project was initiated in 23 villages of Ukhimath block in Rudraprayag, immediately after the disaster and continues to provide primary healthcare services to the affected population in these villages. Including a mobile healthcare unit, medical staff, pathological labs, medicine depots, static clinics with healthcare infrastructure, strengthening and effective utilization of the existing health care facilities, promoting health seeking behaviour, the comprehensive project is currently benefitting a population of over 24,500 every year.

Rudraprayag is just one story. Village after village, town after town, district after district where the Smile on Wheels reaches, people who have lived with debilitating illnesses for many years are finding relief, children are starting life with a healthy outlook, and social taboos and gender biases in terms of accessing medical care are getting broken.

Smile on Wheels currently has 22 operational projects across 16 states of India and covers more than 265 villages and slums. Last year 317,053 people benefitted from the programme.

Along with providing healthcare Smile on Wheels provides something more fundamental, it replaces the domination of circumstances and chance over individuals by the domination of individuals over chance and circumstances. As 52 year old Kumbha Ram who received treatment from the Jaipur Smile on Wheels project said, “For a poor man, health is really the only wealth. With it I make my livelihood, with it I feed my children.”


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