Now, the corner stone of the new National Healthcare Policy is the role being played by rural primary healthcare centers and district hospitals. Most programs under the new policy, including new initiatives like Universal Screening, increasing beds per population of 1000, eradication of measles and increase in spend on healthcare would be dependent on the rural state healthcare set up.
It is also interesting to see that many of these centers are tying up with private not for profit foundations to ensure that healthcare services reach the last mile. I realize that NGOs are often in the news for the wrong reasons but at the same time there are so many others who are carrying out very critical work in parts of rural India.
Rajasthan continues to lag most other states on healthcare parameters with infant mortality at 41, maternal mortality at 255 and Under 5 mortality at 51. Now, the state is actively working towards ensuring that those at the grassroots of the healthcare infrastructure get all the support they need. It is not surprising that they have started working with independent organizations to maximize effectiveness at the ground-level.
Antara Foundation is one such not for profit organization working closely with the state government in the maternal, child health and nutrition space. Based in Delhi, Antara is currently present in 3 districts in Rajasthan, namely, Jhalawar, Baran and Sikar. Antara’s programs have received funding from Tata Trusts, Children’s Investment Fund Foundation (CIFF) and BAJAJ’s CSR arm, in the past. As a young start-up, Antara continues to seek funding to further enhance coverage and impact of programs.
Their flagship program, Akshada, has been on for the last 2 years. In that time, Antara has been working with the triple A’s- Anganwadi workers, ASHA Workers and Auxiliary Nurse Midwives (ANMs) to build capacity and skills. Antara also works on upgrading rural health facilities and skills of staff, especially related to the labor room.
An interesting challenge observed in Rajasthan is the traditional gender inequality when it comes to infant mortality with more deaths among female infants, as opposed to males. This points to broader, deep-rooted social issues in the state, which go hand in hand with primary and preventive care across the world.
The good news is that the State government and health machinery is now working hard to progress on these aspects, concentrating their efforts at the grassroot level.
“We have many state administrators in Rajasthan who are genuinely interested in solving healthcare-related problems in the state”, says Karthik Ram, a representative from Antara. ”They look to us as partners to bring in innovation, new ideas and strong implementation capabilities to the table”. That said, given the prevailing healthcare statistics in Rajasthan, we acknowledge that there is definite scope for improvement.
This improvement is being brought about by leveraging the state network, district hospitals, frontline health workers (AAA), nurse mentors, labour room productivity experts etc., But such an effort is not without its challenges. Recruiting talent is a challenge for Antara, as it is indeed difficult to find high-quality personnel with desired qualifications to work at the district / block level. This does limit speed of scaling.
Distribution of load between health centres also appears to be a systemic challenge due to the gap in referrals from Primary Health Centers (PHCs) to district hospitals. Often the patient is referred too late and without case history, necessitating duplication of effort. Of late we have seen cases of violence against doctors at district hospitals, especially in Maharashtra and some part of the blame may be attributed to this gap in communication between primary healthcare centres and district hospitals.
This is where the partnership with Stanford School of Medicine comes in. Stanford’s Digital Medic platform has offered its online medi-learning platform to train students at the Jhalawar medical college cum district hospital. Similar training is being given to auxiliary nurse midwives (ANMs) at the rural health sub-centres for maternity care, in addition to training offered by Antara Nurse mentors for improvements in labor room productivity.
Also, there are other cultural challenges while operating in rural India. “Certain tribes in the districts where we work were initially opposed to immunization”, says Karthik, “and there were certain cultural beliefs within those tribes, that made them suspicious of interventions but once front line workers started gaining the trust of the community through their enhanced effectiveness & care, they have become more receptive.”
So, a beginning has been made but looks like there is a long way to go.