Rural Health Program

The Tej Kohli Foundation is of the firm view that public health, especially in the rural areas, is vitally important for the economic and social development of the country and for ensuring a good quality of life for the people of India.

Special attention needs to be paid to aspects such as nutrition, sanitation, hygiene and safe drinking water even as efforts are made to improve access of the rural poor, especially women and children, to quality healthcare facilities.

The Foundation will strive to provide effective healthcare to rural population in a selected area, which has weak public health indicators and weak infrastructure.

In addition to working with the village Panchayat and the village female health activist, the Foundation will pay special attention to women's health, childrens health, water, sanitation and hygiene, immunization and nutrition in the chosen area. It will work on prevention and control of communicable and non-communicable diseases and will also strive to promote healthy lifestyles and work towards reduction in consumption of tobacco and alcohol, among other things.

The health challenges in rural India are daunting. One of the major points to note is that the private sector is a major player in the Indian health sector and people have to pay for medical expenses out of their pockets, something the poor simply cannot afford to do. Added to this is the fact that qualified doctors in the private sector are few and far between in rural and tribal areas, forcing many poor people to turn to "quacks". When they do manage to get access to good health care in the private sector, it takes away a large chunk of their money. It is well known that one of the most common reasons for extreme poverty is unexpected healthcare costs.

"We want to enable the rural poor, especially women, to know that they can be healthy, learn valuable skills, earn an income and realize that they are human beings with worth and dignity," Mr Tej Kohli says.

"India, of course, has made great strides in healthcare since its Independence in 1947 and its healthcare indicators have continuously improved. But it is also a fact that the situation today does not quite match its enviable economic growth in the past two decades. In fact, it compares poorly with many other countries at similar levels of development. Fertility rates are high, as are maternal and infant mortality rates," Mr Kohli points out.

“To put it simply, a rather high proportion of the population continues to suffer and die from easily preventable diseases, lack of access to affordable and quality health care, and malnutrition. Women and children from low-income households, especially in rural areas, are the most vulnerable.”

Maternal and child health, childhood nutrition, communicable diseases, and the high cost of healthcare are just some of the areas that require attention.

For large sections of the population, it is a grim and often losing battle for survival, even more than six decades after the country's independence in 1947. The struggle begins even before birth, with malnourishment reducing the mother's life chances even while the fetus is still in the womb.

Add to this other factors such as unsafe and unhygienic birth practices, unclean drinking water, poor nutrition, unlivable habitats and unsanitary environments. Somehow, these children survive into adulthood, only to spawn a fresh cycle of birth and struggle.

The Government laid the foundations of comprehensive rural health services through the concept of primary health centers (PHCs) that began in 1952. Stress was laid on population control from the mid-1960s and the Integrated Child Development Scheme (ICDS) was launched in 1975.

While these measures led to a significant extension in health infrastructure and an improvement in many health indicators, significant problems in the area of rural healthcare remained.

On April 12, 2005, the Government launched the ambitious National Rural Health Mission (NRHM), which seeks to radically overhaul the architecture and manner of delivery of healthcare services in the country. One of the key components of the Mission is the creation of an Accredited Social Health Activist (ASHA) in each village, a woman who is trained and incentivized by the Government to be an agent of change.

The mission also aims to set Indian Public Health Standards that will give all rural citizens good, functioning round-the-clock public hospitals. The District Health Plan drawn up under the mission contains both health action and inter-sectorial action in sectors like safe water, sanitation and nutrition.

The Government has also committed itself to raising health spending from 0.9 per cent of GDP to 2-3 per cent.

To be sure, there has been progress on key indicators in the past 60 years. Life expectancy has doubled from around 30 years at the time of independence to over 63.5 years in 2002-06. The overall life expectancy increased by 14.1 years in rural areas during the period 1970-75 to 2002-06.

India's infant mortality rate has shown a steady decline, from 129 deaths per thousand live births in 1971 to 53 in 2008. Currently the urban IMR is 36 as compared to the rural IMR of 58. The Millennium Development Goal (MDG) for IMR of 27 per thousand live births by 2015 would appear to be a formidable challenge at this stage, though the Government is hopeful of achieving it.

Data suggests that India had a maternal mortality rate of 254 deaths per one hundred thousand live births in 2004-06, down from 460 in 1984.

Institutional births, a key focus area of the NRHM, have increased from 41 per cent in 2004 to 47 percent in 2008.

Some of the systemic constraints that still need to be tackled include low effectiveness of public health spending, unregulated private provision, lack of adequate health insurance (only about 20% of Indians have any form of health insurance) and little emphasis on communication to improve health and create demand for health services.