Health solutions for rural India
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How do you design a developmental solution or provide a digital tool for a poor and inaccessible area where visitors are tracked by Maoists? An area so remote that barely any telecom network works, where more than 90% of the population lives in villages.
I am talking about Gadchiroli, the newest district of Maharashtra, bordering Chhattisgarh and Andhra Pradesh and heavily infested by Maoists. The day I visited Gadchiroli, the Maoists had declared a bandh. On the same day, the sarpanch (head) of a village was shot dead in daylight by alleged Maoists who suspected him to be a police informer.
I visited two villages—Munjal Gondi and Bodhli, both completely tribal. In these and hundreds of other villages in Gadchiroli, nothing happens without the permission of the village head; people do not even go to the hospital without informing the village head. There is a separate shed or a hut (kurma in the local Gondi language) for menstruating women. If you see a stick lying across at the entry gate of a house, it means there is a newborn in the house, indicating that anybody coming inside must clean themselves thoroughly before meeting the baby. If you see an engraved wooden pillar in the courtyard of a house, it indicates that there has been a marriage or there is a married couple in that house—two pillars means two marriages. Every village has a gotul (a community area) where all major decisions are made and congregations happen, where boys and girls can meet each other to freely choose their life partners.
In the middle of all these cultural experiences of the Gondi tribes, I meet an amazing woman. Anjana Bai is in her 40s. She is a Gondi tribal and lives in a village called Bodhli, some 5km from Gadchiroli district headquarters. She speaks Gondi as well as Marathi fluently—when among the villagers, she converses mostly in Marathi.
There are about 600 households in the village. While the roads inside the village are pucca (concrete), almost all settlements have a mix of pucca and makeshift constructions with common water-fetching points. Most households have a mix of all kinds of cattle, poultry, goats, oxen, cows, buffaloes, pigs and so on. They all work in the fields—as farm labourers or minor landowners or both.
Anjana Bai could be a national example of how a frontline health worker should be trained and put to use on the ground. She has been working in the village as an accomplished health worker for more than 23 years. She is obviously not literate, or educated, but if one spends two hours with her, any university would give her a degree.
The purpose of my visit to Gadchiroli was to spend some time with SEARCH, the organization that works in just three blocks of Gadchiroli district across 148 villages, but whose action and research impact the nation. SEARCH stands for Society for Education, Action and Research in Community Health, which was started by doctors Abhay and Rani Bang. Gadchiroli is one of the best places to conduct an experiment for developmental work, particularly in health, if one has to look at a replicable model for the nation. Several SEARCH experiments have resulted in national policy changes, including the introduction of the Home Based Newborn Care (HBNC) scheme in every village under the National Rural Health Mission. (Read the latest HBNC guidelines at bit.ly/1KpwHuX.)
My visit to SEARCH and many of the villages it works in was for the purpose of finding out whether information and communication technology tools, digital interventions, mobile- and tablet-based solutions and broadband wireless networks could make the work of SEARCH more efficient. The idea was to create a model of digital intervention with health solutions in the remotest possible area. I wanted to learn from the people on the ground before I could propose or share any solution.
Anjana Bai alone takes care of every newborn child in her village. Her life for the 25 years has been very simple: she is a daily-wage earner and tills her own land, but she is known to all villagers and even neighbouring villages as the “Stree Arogya Doot” (female health worker). Her work with expectant mothers and newborns is so meticulous that even the government-assigned ASHA workers refer all the newborn cases to her. She works with SEARCH as a part-timer. In fact, all Stree Arogya Doot—or SAD—frontline health workers of SEARCH work as part-timers. SEARCH’s methodology is that it first takes a census of the village it works with—every member of every household. The selection criteria for a SAD candidate are that the woman must have land, be settled, married and with children so that there is little likelihood of her leaving the village.
They are trained by SEARCH for months and years. The SADs are trained to maintain more than 13 kinds of registers and entry folios. They start tracking women from the time of their marriage, expecting they will become mothers soon. They diagnose and manage not only the mothers but also the infants—their work includes measuring weight, heartbeat and blood pressure and using highly specialized HBNC kits developed by SEARCH.
Considering the advent of mobile telephony and mobility devices that have given a huge impetus to develop diverse applications for the health sector, my learning from Gadchiroli and SEARCH’s work is that digital designers and developers who want to find solutions to India’s health problems must spend months with groups such as SEARCH for a real idea about what kinds of solutions we should develop to tackle India’s terrible maternal and child mortality rates. As for us, we are already planning many more visits to try and understand the intricate culture of the Gondi tribals and their health issues and map them with several decades of SEARCH’s work to find out how we can design digital solutions that could not only be relevant to Gadchiroli and several such tribal villages but also to any village in India where health problems persist but where solutions are far from the reach of villagers.
Osama Manzar is founder-director of Digital Empowerment Foundation and chair of the Manthan and mBillionth awards. He is also a member of the screening committee of community radio at the ministry of information and broadcasting.
Tweet him @osamamanzar