Alisha Moopen, Director, Aster DM Healthcare, as a young entrepreneur working for improving women’s health, feels that in India there is an immense need for continued innovation in this sphere. She talks about the need for the government, private sector and NGOs to integrate their efforts to strengthen the health system for women in India, in an interaction with Raelene Kambli
A majority of the health concerns in India revolve around women and children. What is your opinion on the same?
Women in India are depicted as goddesses and the country is called as Bharat Mata or Mother India. It constitutes this family of men and women of diverse cultures, religions and beliefs.
Despite this philosophical status for women there is unfortunately an inherent inequality towards women in India, from conception to death. Female foeticide, although actively combated by the PCPNDT Act, which aims to prohibit sex determination prenatally, still remains a problem in many regions in India. The deeply ingrained patriarchal societal norms here glorify the birth of sons, potential wage-earners of the future, while daughters are considered a burden for whom dowry will have to be arranged.
It is the combined effect of the denial of education to women and the corresponding attitude towards them that forms a vicious cycle which gets passed through the generations. As resources are stretched in poorer families even proper access to healthcare is not given along with education to the girls in the family, which are two building blocks to improving their status in society as well as improve their health profile.
Illiterate girls are married off as adolescents and bear multiple children without adequate spacing or awareness of how to provide for themselves or their offsprings when it comes to basics such as nutrition, immunisation and accessing primary healthcare. So in effect, the babies and children suffer, boys and girls, without discrimination as mothers are not really taught how to care for themselves and their children in a healthy manner under their existing circumstances.
I believe that although this is still a very prevalent problem, there are remedies campaigns and general awareness drives in society. If done effectively and in a focused manner, it can go a long way to alleviate these problems.
What is the most effective way to help these women access quality care, even in rural and low resource settings?
Education, information and creation of awareness are the best tools to combat these health concerns from a grassroot level. This would ensure a sustainable solution to the issue at hand as with increased literacy and awareness, there comes an active healthcare seeking behaviour.
Programmes such as the Integrated Child Development Services (ICDS) and the Midday Meal Scheme have been very effective in encouraging parents to send their children to school as it partially alleviates the burden of feeding them. Simultaneously, the pregnant women and new mothers are also educated regarding important aspects of pregnancy care and child care by accredited social health activists (ASHA), local women who are trained by the government to be health educators. ASHA has been a double-edged blessing in the promotion of women’s health, as it is their duty to create health awareness and promote health seeking behaviour, and also to hold the health services accountable. They promote institutional deliveries, family planning methods, vaccination of children and are even involved in improving basic sanitation and clean water availability in their own villages. There is a need for more community health workers (CHWs) who can be trained in as little as six weeks, as opposed to the 5.5 years of training required to produce a doctor, as they have been proven to be most effective in creating awareness and a shift of attitude from curative care to preventive care.
Do you agree that integration is important to strengthening health systems, especially while providing healthcare services to rural women and children?
Geographical inaccessibility is one major reason for the unmet healthcare needs of especially rural and remote areas, even more so than financial restrictions. The lack of manpower and physical infrastructure impedes the public sector from permeating their services to these communities, while the private sector does not emerge in these markets due to lack of resource availability such as doctors in rural areas. A feasible and effective policy innovation to combat this issue would be to allow greater private sector involvement in healthcare, as the private sector is ready to tap the potential of the opportunity that lies in this region as long as the public sector facilitates resource availability and infrastructure development.
Subsidies and healthcare stamps would allow for allocation of resources to these poorest and downtrodden of society. While Public Private Partnerships (PPP) is already prevalent in some areas in the form of credit or land allocation in return for subsidised or free care for the poor, other types of PPPs such as government financing and private provisions are still areas which can be explored and have tremendous potential.
Integration would not only help provide a platform to provide basic healthcare, but also fortify referral services, leading to better patient care.
Which are the government initiatives for women’s healthcare that you consider to be effective?
The National Rural Healthcare Mission(NRHM), which strives to provide accessible, effective, affordable and reliable primary health care has been quite successful in its endeavour since its inception. While they have not achieved their maximum potential due to lack of infrastructure, health manpower and lack of penetration of health insurance, certain components such as ASHA and Janani Suraksha Yojana (JSY) have managed to have a profound impact in improving provisions for the most vulnerable women in society. JSY has been effective in reducing MMR and IMR by promoting institutional deliveries by providing financial incentive, and also providing prenatal and postnatal care, while ASHA has tackled the issue from a different perspective by creating a shift in attitude.
Also, Mother and Child Health Wings (MCH Wings) with a focus to reduce maternal and child mortality, dedicated Mother and Child Health Wings with 100/50/30 bed capacity have been sanctioned in high case load district hospitals and CHCs which would create additional beds for mothers and children. This also allows for separation and protection from exposure of illness related diseases which is beneficial for the mother and child.
Is there an example that stands out and demonstrates the immense need for continued innovation in women’s health for development?
The burden of gynaecological and breast cancers in India is on the rise. Both are preventable and curable in the early stages of the disease. Besides having a powerful tool such as pap smear for early detection of cervical cancers, we even have preventive measures in the form of HPV vaccinations. Despite these available provisions, the mortality associated with cervical cancer in India is too high. Possible interventions to alleviate this burden could be scaling up of cheaper screening techniques such as visual inspection with acetic acid (VIA), and subsidising the cost of HPV vaccination.
Similarly, mortality associated with breast cancer is very high, when simple interventions such as teaching women the importance and technique of a breast self-exam could go a long way in early diagnosis, which would drastically reduce the mortality associated with this treatable condition, which is often detected too late.
Even with so many healthcare schemes for women and children in order to achieve the MDGs, yet there are many states in India that lag behind. Do you feel that these health programmes organised by the government are less effective in these regions and why?
Yes, there is definitely a disparity in the effectiveness of government organised programme in certain regions. Although there is an undeniable lack of financial resources at the state level, numbers show that the states which are least financially distressed are spending less on healthcare per capita than states with higher per capita budget deficits. States such as UP, Chattisgarh, MP, Jharkarkand and Bihar, with poor health indicators, can increase their current healthcare expenditure since their budget deficit is lower than states with better indicators such as Delhi, Kerala or Himachal. While this is largely a political-economical decision that has to be made, facets such as the rural health insurance should be further explored to try source funds from the private sector. Less than two per cent of India’s rural population which accounts for 70 per cent of the population is currently insured. Micro-health insurance schemes are being studied and implemented on small scales, and have been showing tremendous potential. With increasing rural income and geographical accessibility, the private sector is likely to heavily invest in rural healthcare infrastructure. The government needs to safeguard the sustainability of rural healthcare plans to ensure continued investment by the private sector in rural healthcare segments including tele-medicine services, remote diagnostics and operation of other rural health services.
What, according to you, are some of the simplest ways to see real health gains in the developing world?
I strongly believe that education is our best available instrument we have to see real health gains. Educating and empowering women has been shown to not only improve their own condition physically, mentally and financially, but of the family as a whole, and in turn of the entire community.
Do you agree that the public health landscape is crowded. Governments, philanthropists, NGOs, and the private sector scramble, sometimes haphazardly, to attain health goals. Is there a way that would make development assistance more effective?
Yes, while the intentions of all the factions involved in trying to attain health goals are similar, there is a dire need for better collaboration and organisation within the healthcare sector. Precious resources are often going to waste due to overlapping of allocation in certain areas due to lack of communication, whereas certain spheres are completely left unattended to.
The onus is upon the government to implement a system which ensures cooperation amongst everyone involved in trying to achieve these similar goals. PPP is an avenue that needs to be aggressively tapped, whereas NGOs should be supported and encouraged by the government for the work they are doing. Most importantly, rural healthcare needs to be declared as a priority growth area by both central and the state governments.
Women’s health has favourable social, economic and other far reaching consequences for the society at large. And I hope that we can, together as a nation, tap these resources that will lead to exponential growth and prosperity for the nation as a whole.
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