By S. Manasi, Associate Professor, Institute for Social and Economic Change, firstname.lastname@example.org
For Citation: SITE4Society Brief No.9-2018
Country focus: India
Site Focus: Engagement, Governance
Based on: Manasi, S., & Raju, K. V. (2015). Holistic approach to improve community health- The AYUSH approach. Journal of Holistic Healthcare, 12(2) pages 33-38
Related to: # SDG3(Good Health and Wellbeing), National Health Mission, AYUSH and Public Health
Context: Healthcare is the right of every individual but the lack of infrastructure and qualified professionals, as well as poor access to basic medicines and facilities, thwarts its reach to about 60% of the Indian population. In rural India, where access to healthcare is particularly a challenge, traditional medicine practitioners serve to plug the gap. Traditional medicine is a synthesis of therapeutic experiences from generations of practicing physicians of indigenous medical systems. India has a rich heritage of traditional medicine with these modes of health care flourishing through many centuries. To build upon this strength and also address the healthcare challenge, the Indian government established the Ministry of AYUSH (i.e. Auyurveda, Yoga, Unani, Siddha and Homeopathy – which are the diverse approaches in traditional medicine to improving health). AYUSH promote the concept of AYUSH Gram wherein where villages are selected for AYUSH interventions of healthcare by setting up facilities including hospitals under the scheme of ‘AYUSH and Public Health’.
The AYUSH Gram project in Karnataka is an example of such a Government-sponsored programme under the public-private partnership (PPP) model. Soukya is a luxury Ayurvedic spa located in a suburb of Bengaluru which has an international clientele, including famous ones like Prince Charles of England. Alongside, Dr. Mathai, its founder, runs a number of charities, among which is ‘Dr. Mathai’s Rural Health Care Centre’ or DMRC. The Government of Karnataka, under the AYUSH gram central scheme, provided Rs.34.95 lakh (1 lakh=100 000 INR) and 3 acres of land in Jadigenhalli Gram Panchayat. To this, Soukya added its own funds to set up Soukya-DMRC providing quality treatment free of cost to the villagers (see figure 1). It is 25 km from Bangalore and has 7 villages under its purview. This centre, initiated in 2012, is the first of its kind in rural India with different systems of medicine like Ayurveda, Unani, Siddha and Homeopathy integrated under one roof and is one the ten organisations selected under the State Government’s AYUSH Programme. Presently, Soukya-DMRC is entirely run by Soukya Foundation.
Furthermore, to help in rural development, Soukya-DMRC gives training in AYUSH knowledge based routines of preventive care to ASHA and Anganwadi workers (government appointed nurses for mothers and infants; government crèche workers), Panchayats (village councils), self-help groups and government schools.
Research Question: Can access to healthcare be improving by providing quality traditional medicine based therapies in rural India? If so, can public-private partnerships be vehicles for the same?
Motivation for Research Questions: The challenge of providing effective health care in rural India, with high costs and infrastructure challenges makes the development of traditional medicine based healthcare a possible solution. However, how far can or should it be promoted under the public-private partnership model?
1. Analysis of data sets from AYUSH Grama DMRC project and SOUKYA-DMRC containing information on number of patients visiting Soukya-DMRC over time, frequency of visits, type of ailments for consultation and follow up visits
2. Focus group discussions villages under Jadigenahalli Gram Panchayat for getting an overview of the situation.
3. Design of structured questionnaire covering socio-economic aspects, AYUSH activities, preferences and perceptions of healthcare centres, access to healthcare, drivers of health such as: water resources, sanitation and hygiene, cropping patterns, food and life-style habits, user satisfaction, drivers of beliefs: religious beliefs, growing and using medicinal plants, ecology and cultural traditions/practices.
4. Survey implementation and analysis of responses from 102 households (10% of the sample) across 5 villages of the Jadigenahalli Gram Panchayat
1. Village level problems
– Ground water depletion resulting in water scarcity for agricultural purposes and changing cropping patterns.
– Water scarcity for drinking purposes, particularly during the summer months.
– Solid waste dumping into the village farm lands from the cities. The local plastic burning is a major menace.
– Majority of the households have toilets but the villagers also practice open defecation.
– Overall hygiene in the villages is poor.
2. Health problems of rural poor: There has been a change in life style of all – rich and poor in India. Thus, chronic diseases like diabetes (16.7%), hypertension (2.9%) and respiratory problems (1.96%) are common among rural poor also. Furthermore, a majority of the patients visiting Soukya-DMRC, complain of body pain (22.5%), followed by diabetes (16.7%) fever (11.8%) and gastric ailments (11.8%). The doctors observe that villagers are more prone to body pain because of physical work. Gastric problems and weakness problems are due to irregular food intake.
3. Solution approach offered by Soukya-DMRC: The approach to health care is very different from that of an allopathic health care system. The Health care services are based on traditional medicine systems such as Ayurveda, Yoga, Naturopathy and Homeopathy. Treatment is based on the patient’s response and stand-alone treatments or a combination of treatments involving the four schools are offered according to the problem. (a) Homeopathy; (b) Homeopathy and Ayurveda; (c) Homeopathy, Ayurveda and Yoga; (d) Homeopathy, Ayurveda, Naturopathy, Yoga. Within each, a variety of holistic healthcare services are offered as shown in Figure 1.
4. Impact on poor households: On the whole, the impact has been majorly positive. Patients believe in the efficacy of the treatment and hence are regular in their follow-up visits. Within a short period, the foundation has been able to draw attention through an integrated approach in healthcare. Clientele is increasing by word of mouth. Overall, 66.66% of the people have influenced others, 41.17% have influenced their family members, and 15.68% have influenced their relatives to avail of the services. The drivers of success can be summarized as follows:
- Individualized attention: In government hospitals the doctors do not have time to listen to patients, besides, it is not the allopathic approach. In contrast, doctors in DMRC strive to understand the drivers of health of a patient from the patient’s narrative of her/his problems in life.
- Geographical and financial accessibility to health care: Prior to this initiative, patients from low income groups had to travel 12kms for availing treatment at government health centres or pay at the private health clinics. It has also reduced monthly medical expenditure because of the free medication provided.
- Awareness of health problems: Several poor were not even aware that they were suffering from diabetes and hypertension. Since DMRC Soukya does free checkup, several patients were identified and it was found that diabetes and hypertension are the two most common ailments.
- Experience of good results from life style change: More women and children are practicing Yoga regularly and have become aware about the benefits of Yoga. Yoga is taught by Yoga experts from Soukya Foundation. The importance of healthy eating is also spreading.
Eating Healthy – Promoting Nutritious Food Habits among children by Ayush Grama Soukya Foundation.
5. Challenges of Soukya-DMRC
- Getting doctors to stay in villages.
- Providing free services and maintaining funds in the long run.
- Influencing implementation of lifestyle change and dietary habits among all, especially diabetic patients.
- Approaching people to enrol for de-addiction programmes.
- Follow up visits by patients continues due to busy schedules and negligence.
Policy insights and recommendations:
1. Quality traditional healthcare units are extremely useful. They would not only improve access to health care but due to teaching of better lifestyle can contribute to preventive care.
2. However, these health care units are not sufficient for improvement of health status of rural residents, unless other related problems in the villages are taken care of. In this context, problems of water scarcity, sanitation, hygiene, environmental pollution and solid waste management of village and other garbage dumping from cities have to be solved.
3. Public-private partnerships or PPP cannot survive in the long run without financial sustainability. To become self-financing there are two possibilities:
– Make the patients pay. Possible financial options could be the charges could be free / priced among varied economic groups – BPL (free medicines), MIG (small fee) and HIG (standard amount).
– Build a corpus of funds from donors like corporate houses under Corporate Social Responsibility (CSR) programs, religious institutions and philanthropists
4. The Soukya-DMRC initiative is a shining example of how luxury spas offering services based on traditional medicines can also run hospitals for the rural poor as a part of their corporate social responsibility program.
In sum, provision of quality traditional medicines based healthcare seems a very good option to improve access to health care in rural India and other developing countries. Public-private partnerships can be an effective vehicle to promote the same. However, their financial sustainability after the period of the partnership has to be reflected upon, and even decided, before implementation.