August 2016 India Trip
Rural Primary Health Care: How One Organization is Striving to Decrease the Non-Communicable Disease Burden in India
Thanjavur, Tamil Nadu, India
By: Abbey Roepke
My name is Abbey Roepke and I am a dual degree Master of Public Health and Family Nurse Practitioner student. This summer I had the opportunity to travel to India, where I learned about many exemplary models of care delivery throughout the southern state of Tamil Nadu. I was able to experience systems which demonstrated exceptional continuity of care and comprehensive services that gracefully linked clinical care, community-based care, and community development programs. Additionally, witnessing care extending beyond only the patient to a focus on family and reintegration offered a holistic perspective often not seen in the United States. Here I will share my experience at Sugha Vazhvu, an organization striving to develop effective ways of delivering rural primary health care to create disease free villages.
August 10th, 2016
India’s population exceeds 1.2 billion people, with 70% of the population living in rural villages. Many villagers struggle for a reliable source of income and are unable to access healthcare through government centers. While many deaths are still attributed to communicable diseases, the leading cause of death is ischemic heart disease. This dual burden of disease is straining the Indian healthcare system, but has given rise to innovative ways of care delivery.
Sugha Vazhu is an organization focused on decreasing the non-communicable disease burden through providing rural primary health care focused on preventing and providing basic treatment for hypertension, hyperlipidemia, and diabetes. The models of care delivery are being tested to best promote patient compliance and promote behavior change. Through a combination of care delivery, human resources/capacity building, community engagement, technology, and operational research Sugha Vazhu has evolved to one stationary clinic and mobile clinic operations.
I was most impressed by the use of technology and the low cost prescription based care provided within the mobile clinic operations. Initially, Sugha Vazhu had six stationary clinics but though evaluation of services the mobile clinics evolved. Community members wanted services that were more easily accessible. It was also noted through the back end operations that many patients were only transiently seeking follow-up care and medication refills. Because villagers often have an unreliable source of income, funds may not be available every month for healthcare. Therefore, a low cost prescription plan was developed. Patients are able to enroll either three or six-month low cost plans that cover all follow-up care. These plans also allow the patient to appreciate the cost of their care. This payment plan is being tested to determine if patient compliance can be improved, subsequently leading to improved chronic disease management.
Additionally, an electronic health information system is used for all clinic operations as well as for research purposes. Mobile clinics are able to be conveniently located because of the use of GIS technology. Health extension workers (HEW) go door-to-door to enroll and “geo-tag” each household in the villages served. A typical village may exceed 5,000 people. I was amazed at the dedication of the four HEW’s and one physician to serve the basic healthcare needs of such a large population. Additionally, the staff’s commitment to provide services for the good of the patient instead of a monetary benefit was refreshing to witness.
Sugha Vazhu is an innovative, efficient model of care in a resource poor area of India that has offered an exceptional model that does not accept the status quo. It was valuable to learn about an approach that is focused on involvement of the community and evaluation to adapt care delivery to the needs of patients. I also appreciated to large scale community outreach incorporated with clinical care; all done with minimal staff and resources. Although there is not one perfect approach to providing primary health care, reflecting on this model has offered great perspective and comparison to services provided in the United States.