21-state exhaustive report on the state of healthcare in rural India released

A recently published report titled The State of Healthcare in Rural India Report – 2024, Neighbourhoods of Care has provided a comprehensive overview of healthcare-seeking behaviours in rural India. Jointly conducted by Transform Rural India (TRI) and the Development Intelligence Unit (DIU), the survey covered 5,389 households across 21 states, highlighting the key challenges and emerging trends in rural healthcare.

Health systems around the world, including those in India, exhibit significant variations influenced by factors such as local policies, economic conditions, infrastructure, and cultural practices. This diversity is highlighted in the WHO’s study on health systems governance. Against this backdrop, understanding health-seeking behaviour from a public health perspective, particularly in rural India where nearly 68 per cent of the population resides, becomes crucial.

The report reveals that 73 per cent of rural households with elderly members require constant care. However, the practice of engaging external caregivers as a paid service is not widely adopted in rural India, with only 3 per cent of such households opting for it. The majority, 95.7 per cent, rely on family caregivers, predominantly female (72.1 per cent). This finding underscores the need for caregiver training focused on home-based care.

In response to these findings, the report introduces the concept of ‘Neighbourhoods of Care,’ a transformative model that moves away from the traditional health delivery approach. This model recognises that not all health issues can be addressed through medication or clinical interventions alone. It emphasises holistic, personalised care that considers social and ecological factors. The Neighbourhoods of Care model is more adaptable than traditional health models, integrating the preferences, interests, and goals of individuals, families, and communities. It promotes collaboration among health professionals, social service providers, caregivers, community organisations, and residents, recognising that healthier futures require co-creation, co-execution, and co-evaluation.

Dr Maj Gen (Prof) Atul Kotwal, Executive Director, National Health Systems Resource Centre (NHSRC) said, “This model, highlighted by the eco-socio-epidemiological approach, aims to address health comprehensively rather than relying solely on technocratic solutions. It underscores the need to integrate community and behavioural dynamics into health planning. However, the existing mechanisms demonstrate a framework for collaboration, but more effective and frequent interactions are necessary. Strengthening these connections and linking with local committees and self-help groups is essential for enhancing neighbourhood care and addressing community needs comprehensively.”

One of the major findings of the survey was related to mental health, revealing that anxiety levels have risen in rural India, making it no longer just an ‘urban’ phenomenon. Notably, 45 per cent of respondents from rural communities, across genders, reported being affected by anxiety and worry most of the time, impacting their state of mind.

Shyamal Santra, the Associate Director of Health and Nutrition at Transform Rural India  (TRI) added, “People typically talk mostly about curative healthcare. But this report looks at the need for maintaining good health as a standard. Many studies are about diseases, or about services and facilities, but in real life, it’s about individuals, their families, their social connections, and their caregivers. So this report is focused on those different dimensions of health that relate to making people healthy.”

The survey also uncovered other significant findings. Over 60 per cent of respondents reported having no life insurance coverage for themselves or any other household members. Limited access to diagnostic facilities and affordable medicines remains a major challenge, with only 12.2 per cent of respondents having access to subsidised medicines and 21 per cent lacking a nearby medical store.

Regarding physical fitness, around 50 per cent of respondents believe that working on their farmland and engaging in physical labour keeps them fit, thus negating the need for additional exercise. Only 10 per cent practice yoga or other fitness activities.

The report also highlights infrastructure issues in rural areas. One in five respondents reported the absence of a drainage system in their villages, and only 23 per cent have a covered drainage network. Additionally, 43 per cent of households lack a scientific waste disposal system, leading to waste being dumped indiscriminately.

Among the survey participants, 44 per cent earned their livelihood primarily through farming activities. The second largest occupation was daily wage labour, accounting for 21 per cent, while 14.2 per cent had full-time or part-time jobs. The remainder engaged in vocational trades such as tailoring, carpentry, masonry, electrician work, and plumbing.

The report concludes by emphasising the importance of training and enhancing the skills of local leaders, self-help groups, and service providers. This support should be practical, well-organised, and work in tandem with local healthcare facilities to ensure effective assistance to individuals and families in rural villages.