While the hospital is being established, efforts will be made to identify permanent resident women between ages 30 to 45 who are interested in doing voluntary health work amongst their own people. These women upon selection with the help of the community will undergo a 2 weeks training programme in basic health care work. They will be responsible for ensuring health care to a population of about 1000 people living around their houses. The outreach activities like health education, early ANC registration, Infant care, under five care and elderly care will be done through the Health Assistants (HA). The HAs will meet every Saturday at the hospital for a review of work and also further training. The HA will refer any one from her area requiring health care to the clinic and provide follow up care.
The community will be involved by participating in the planning, identification of personnel, ensuring proper implementation, supervision and monitoring of work and most importantly, utilization of facilities. A minimal fee will be realized for the services for of the clinic from all patients except those from the poorest of poor identified through the community.
Though healthcare technologies have improved tremendously over the last few years in India, they remain largely inaccessible to those in real need of them. On the other hand the misuse of technology for commercial purposes is high, leading to much distress to the public in terms of anxiety, loss of money and time. People need to be empowered with the right knowledge, attitude and behavior concerning their health. In addition to this, people also need access to honest and efficient health care facilities for their day to day needs and where appropriate advice on treatment or referral is given.
RSMLH, with the involvement of health professionals proposes an initiative to create such a micro health system in an urban community in Guntur district of India. The emphasis of the programme is on community based action aimed at empowerment and health security.
In a country like India, especially an urban slum, with the existing infrastructure and hygiene levels, all residents are victim to at least 8 to 10 episodes of infectious illnesses (Malaria, typhoid, gastro enteritis, viral fevers etc). If they avail treatment with private practitioners, they would spend a minimum of 500 rupees per episode, i.e. 5000 rupees per year. In a family of 5 this would work out to about 25,000 rupees in a year. This amount is only for the minor ailments and does not account for any chronic illness or unfortunate epidemics.
A population of 5000 would at this rate be spending about 25 lakhs a year on health care. If we include chronic illness sufferers like diabetics, hypertensives, asthmatics or people with obstructive pulmonary diseases, thyroid diseases etc, it will work out to at least 1 crore or more. This still does not include emergency illnesses needing surgical interventions like appendicectomies, caesarians, acute abdomens etc.
The actual cost if the health care is to be provided in an ethical manner, would work out to much lesser.
(Rs 150 per head per episode of illness (includes consultation, essential investigations, drugs and follow up) x 5000 people = 7, 50,000 Rupees. This would be about 3 $ per person per year)
The government is indeed already spending much more than this through various health centers and clinics, which is however just being wasted. On the other hand this is an amount which the individual and community can afford. It calls for an enhancement in the right knowledge, change in attitude and practices. RSMLH would have to support the programme till these changes are realized (3 years) after which the programme would be able to support itself. In these three years, the infrastructure, human technology, capacities and peoples’ utilization of the center would be established. It will also prepare a platform for launching a community based limited health insurance scheme.