Health Equity

Genesis

Indian Healthcare is riddled with serious inequities. There are no standards of availability, affordability, quality and accessibility across regions, the urban-rural divide, and income levels. The progress in the South outpaces the rest of the country. The rich have access to world-class healthcare while for the poor, an illness could mean the utter loss of economic security. Metros and tier I cities enjoy far higher per capita availability of healthcare services. Rural areas languish and have to make do with quacks and uncertified practitioners.

There are many reasons for this: poor availability of healthcare providers relative to need, poor allocation of resources towards healthcare, privatisation of medical education, lack of accountability in the governmental healthcare system, and more.

Successive Governments have tried to improve healthcare delivery. The Ayushman Bharat programme and the redesign of the primary care services is a case in point. Governments have also made investments in infrastructure and in creating additional manpower, and made policy changes to bring private investment into play, including through public-private partnership. All these, however, have had little impact.

Primary and secondary care services should cater to 85-95% of medical cases. In their absence, however, a large number of cases end up at the tertiary care level. For patients and their families this means higher costs, and great inconvenience.

While there are many examples of NGOs and charitable organisations doing useful work at these levels, there are precious few examples of organisations working at both primary and secondary care levels, creating a system of vertically integrated, scalable healthcare.

Health Equity was born out of the conviction that the limitations of the existing system can be overcome with appropriate training, technology, protocols and processes to make modern and professional healthcare available to the last citizen, safely and affordably.

Mission & Vision

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Our Mission

Health Equity’s mission is to take modern and professional healthcare to the last citizen in our villages.

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Our Vision

Health Equity is committed to bringing healthcare to the Last Citizen in our villages in a manner that reduces cost, improves quality, and enhances patient safety. In doing so, it will:

  • a) promote greater utilisation of an integrated model of team-based primary care involving Arogya Mitras supported by experienced professionals.
  • b) Create full time livelihood for the Arogya Mitras; and
  • c) Promote health as a human right, involve communities in decision-making, and advance equity in provision of care.
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Values

Health Equity promotes the following values in its work culture and in its interactions with the community, patients and the society.

Respect for all

Humility

Concern for the underprivileged

Desire to serve the suffering

Health Equity System of Integrated Care

  • Train the Arogya Mitra - 10th or 12th pass with a background and interest in healthcare, selected from the village with help from community – with a skills-based curriculum delivered over 6-8 weeks to treat cases requiring first aid, primary care for emergencies, palliation, drawing blood for lab samples and dispensing medicines made available to them.
  • Position a team of more qualified medical professionals – AYUSH doctors or nurses trained as CHOs in the Government’s Health & Wellness Centres – to supervise and complement the work of Arogya Mitras.
  • Equip the Arogya Mitras with a mobile application that connects them to the hospital’s medical staff using video conferencing so that they are able to serve as a conduit for consultations.
  • Create infrastructure which functions as a hub for all patient care requirements of the project villages which need secondary care treatment. Additionally, develop referral arrangements with tertiary care hospitals so that treatment not possible at the secondary care hospital is available to patients from project villages. Put in place systems for discharge of referred patients at an appropriate time to continue treatment at the secondary care hospital.
  • As Arogya Mitras gain confidence and credibility, train them to diagnose most common and simple symptoms and follow up with basic treatment in strict adherence with clinically-approved protocols. For this, the mobile app will be upgraded appropriately.
  • Encourage the villagers to create a fund, to be managed by the community itself, which could help meet the cost of treatment for tests, medicines and, in case required, for hospitalisation.

Where We Work

For the pilot phase, we have selected Sojitra taluka of Anand district. Although part of one of the wealthiest districts of Gujarat, Sojitra taluka, which lies on the north-west border of Anand district, does not enjoy adequate availability and access to healthcare. Since it is located around 30 km from Anand with 24 villages and a population of around 100,000, the taluka presents an ideal choice to test the concept. Before starting out, we undertook a village-level Baseline Survey to understand the healthcare infrastructure in villages and community preferences for healthcare providers. This study underlined the need for intervention.

Meetings with leaders from each village of the Taluka have led to their nominating a person from their village – in most cases, one of the ASHA workers – who we could train to be Arogya Mitras. The training programme for the first batch of candidates is currently under way. Simultaneously, we have sent the contents of the training programme to experts for validation of its objectives. We are also hoping to have the course certified by a University.

On our request, a trust which owns a small, sparsely equipped and largely underutilised hospital with a capacity to accommodate 40 beds in Sojitra town (population; approximately 25,000), has handed over its management to us for a 25-year duration with effect from June 1, 2023. The hospital was in disuse for a number of years and operated merely two departments; Dental and Physiotherapy. The disuse of most facilities of the hospital meant that extensive renovation for modifying existing facilities and adding several others was required. The hospital also needed to be entirely re-equipped as there was hardly any equipment available. The renovation and equipment planning has been undertaken bearing in mind the local needs and deficiencies in the existing local infrastructure. The renovated hospital is now serving the community with all its facilities and services matching those of a secondary care hospital.

Next Steps

Once the villages of Sojitra taluka are fully covered, the concept would be extended to other talukas. Initially we have earmarked the neighbouring talukas of Matar and Tarapur, which together have around 100 villages with a population of 350,000 and share the same healthcare situation as in Sojitra. Eventually we will expand operations to any area that faces similar healthcare inadequacies

As for secondary care facilities, the initial services (OPDs, 35-40 in-patient beds, Diagnostics, Operation Theatres, Emergency, ICU and Pharmacy) would be upscaled and upgraded as required.

Viability of Health Equity

The viability of the project will be tested at two levels: First, at the village-level, to ensure Arogya Mitras earn adequate income to keep them interested in the work; and second, at the institutional level, to determine whether the revenues generated by the secondary care facility compensates for the cost of running the facility and leaves any surplus for meeting the cost of monitoring and administration of the village level component. We believe that the project should be cash neutral within 3-5 years.

The initial start-up costs and the funding required to build infrastructure, however, have to be met through support from external sources.

Board of Management

Savita Memorial Trust has established a Board of Management, consisting of 4 members of the Board and 4 external experts in the field of healthcare, especially Public Health, to guide and mentor the Health Equity project. The main functions of the Board of Management include:

  1. Monitoring the project periodically (at least twice a year) to assess its adherence to the operational plan and goals.
  2. Review and advise on the strategies to be adopted to make the project more effective.
  3. Advice course corrections in the implementation of the project, if felt necessary
  4. Review financial position of the project

The Board comprises:

Trustees

External Experts

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Ms. Sujatha Rao

Sujatha Rao, a 1974 batch IAS officer, is a former Union Secretary of the Ministry of Health and Family Welfare, Government of India. In her 36 years of service as a civil servant, she has spent 20 years in the health sector in different capacities at the state and federal levels. She holds an MA from Delhi University, an MPA from Harvard University, USA 1991-92 and was a Takemi Fellow at the Harvard School of Public Health 2001-2002 and Gro Harlem Brundtland Senior Leadership Fellow at HSPH in 2012. She is the author of the book entitled “Do We Care? India’s Health System” published by Oxford University Press in 2017.

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Dr. Sudarshan Iyengar

Dr Sudarshan Iyengar is a Gandhian economist and a former Vice Chancellor of Gujarat Vidyapith, in Ahmedabad, India, the university founded by Mahatma Gandhi in 1920. Sudarshan calls himself a social volunteer by disposition. He also headed the Gujarat Institute of Development Research, Ahmedabad, the Centre for Social Studies, Surat and served as a Distinguished Chair Professor of Gandhian Philosophy at the Indian Institute of Technology, Mumbai. He is a Director of the Gandhi Research Foundation Jalgaon, and a trustee at the Sabarmati Gandhi Ashram.

Dr.Iyengar researches in the areas of the commons and natural resource development and management, non-government institutions and Gandhian thought and practice. He has published around 70 papers and articles and eight books. His 2016 book In the Footsteps of Mahatma: Gandhi and Sanitation by the Publication Division, Government of India, has been translated into Gujarati and Tamil. He now works with Action Research in Community Health and Development (ARCH) in Western India.

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Dr. Pavitra Mohan

Dr Pavitra Mohan is a community health physician, pediatrician, and public health practitioner. He is a co-founder and Director at Basic HealthCare Services (BHS). BHS is a start-up not-for-profit organization, registered as a Trust and is driven by the vision of a responsive and effective healthcare ecosystem that is rooted in the community, where the most vulnerable communities can actively access high-quality, low-cost health services with dignity.

Dr Mohan also serves as Director, Health Services, Aajeevika Bureau, working to improve health of the families dependent on labour and migration. He was also a senior health specialist at UNICEF's India Country Office. He also taught in the RNT Medical College in Udaipur and worked at Action Research and Training for Health (ARTH), a leading public health NGO. Pavitra is a Fellow with the prestigious National Neonatology Forum of India and is also the recipient of the Ashoka Fellowship. He has an MBBS and an MD from Delhi University, and a master's in public health from University of North Carolina at Chapel Hill.

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Dr. Kaumudi Joshipura

Kaumudi Joshipura joined Ahmedabad University as the Dean of the Bagchi School of Public Health and the Susmita and Subroto Bagchi Professor in Public Health in 2023. Professor Joshipura is also an Adjunct Professor of Epidemiology at Harvard T. H. Chan School of Public Health (HSPH). She served as the National Institutes of Health (NIH) Endowed Chair and as Director of the Center for Clinical Research and Health Promotion (CCRHP) at the University of Puerto Rico Medical Sciences Campus.

Professor Joshipura has a Master's degree in Biostatistics and a Doctorate in Epidemiology from Harvard University (completed in a record time of two years). Her research (H-index 66) has focused on evaluating lifestyle factors, microbial and inflammatory markers, and other modifiable risk factors for cardiometabolic and other non-communicable diseases. Her recent work includes hurricane preparedness and COVID-19. She has mentored numerous students and faculty and led several NIH-funded projects, including cohort studies, a randomised controlled trial, and a mentoring grant.

She has served on several editorial boards and is currently the inaugural Chief Editor for an open-access Frontiers journal, now PubMed and Scopus indexed with over 1000 editors/reviewers. At HSPH, she developed and taught methodological and substantive courses, co-directed training grants. She is on the steering committee for the Master of Public Health programme in Epidemiology. She has served as an advisor to the Centers for Disease Control and Prevention (CDC), the American Association of Periodontology (AAP), and the World Health Organization (WHO). She is serving on the American Public Health Association advisory committee on Climate and Health Equity.

She focuses on identifying and promoting preventive measures that are free, low-cost, or cost-saving, and that can be adopted widely and globally. To this end, she founded a global public movement, "VMove" (read "We Move" https://www.vmovement.org/), to help individuals and organisations incorporate physical activity throughout the day. VMove, launched at a TEDx talk, aims to reduce the risk of several chronic diseases by promoting "CreActivity" (creative physical activity) in different settings to enable people to overcome barriers, change norms and move more throughout the day in a fun manner, and encouraging everyone to help spread and lead the movement. She has also written songs to translate research into action (to reduce sedentary time and single-use plastic). She is passionate about improving both human and planetary health and promoting wellness.

Financials

Unaudited financial statement of CC Patel Sarvajanik Hospital for the financial year 2023-24 can be seen here.
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Financial Year 2023-24