Journey of designing OpenCHS with Samanvay

India does not have a National health insurance or universal health care system for all its citizens. This has propelled the private sector to its dominant position in the healthcare market. Private companies provide the lion’s share of healthcare services in the country.

Despite the structures in place to ensure equality and funding from government and non-government sources, we still observe a visible gap in access to healthcare in rural areas compared to cities. A staggering 68% of the population lives in rural areas and has no or limited access to hospitals and clinics. Consequently, the rural population mostly relies on alternative medicine and government programmes.

If one had to paint a picture of rural India, it would be people living in mud houses in small villages. These villages have next to no electricity supply. There are setups of solar power stations which people use to charge their cellphones. Travelling to these villages is not always easy. One would require to change at least three different modes of transport to reach many of these villages. The residents seek out healthcare in cases of pregnancy and severe illness like Tuberculosis, Dengue, etc. However, villagers often do not seek treatment for early symptoms which appear less dangerous. This is not always due to lack of awareness. It is often also the case that infrastructure to support the long tail of healthcare is simply not that accessible in rural India.

Healthcare in Rural India

The public healthcare in rural areas has been developed as a three-tier structure based on predetermined population norms.

1. CHC (Community Health Centres)

Community Health Centres form the uppermost tier and are established and maintained by the State Government. Community health centres are staffed by four medical professionals supported by twenty-one paramedical and other staff. Surgeons, physicians, gynaecologists and paediatricians provide comprehensive care in each CHC.

Each CHC has thirty indoor beds, an Operating Theatre, X-ray, Labour Room, and Laboratory facilities. The community health centre provides expert facilities in obstetric and other care for patients referred to them by the four primary health centres within their jurisdiction.

2. PHC (Primary Health Centres)

Primary Health Centres (PHCs) comprise the second tier in rural healthcare. PHCs provide integrated, curative and preventive healthcare to the rural population with emphasis on preventive and promotive aspects. Activities include promotion of better health and hygiene practices, tetanus inoculation of pregnant women, intake of IFA tablets and institutional deliveries. A medical officer is in charge of the PHC supported by fourteen paramedical and other staff. Each primary health centre has four to six beds. Patients are referred to the PHCs by six sub-centres.

3. Sub-centres

A sub-centre is the most peripheral institution and the first contact point between the primary healthcare system and the community. An Auxiliary Nurse Midwife (ANM) is in charge of six sub-centres each of which provides basic drugs for minor ailments. A sub-centre provides services in relation to maternal and child health, family welfare, nutrition, immunisation, diarrhoea control, and control of communicable diseases. ANMs also use Anmol Tablet, a product that aids in maintaining and collecting data, specific to primary health.

4. Non-government Infrastructures

Apart from the government bodies there are other players in the system, which are closest to the villagers (bottom most in this tier). There are private hospitals, which run to provide special services or even basic healthcare.

Accessing health support is not that easy for village residents. They have to travel long distances to visit public hospitals spending money, and time that could be spent doing their daily chores. That’s when community health services come to play.

There are non-profit NGO Hospitals which run Community Health Services (CHS). They hire and train health workers who work closely with villagers in providing health services and education.

Health Workers who work as a part of the Community Health Services are known as VHWs (Village Health Workers), as a part of CRHP (Comprehensive Rural Health Programme). Jamkhed is a programme run under CRHP.

Jamkhed is centered around mobilising and building the capacity of the community, empowering the people to bring about their own improvements in health and poverty-alleviation. This is one of the better known and appreciated community health systems.