Saving the World, part I
So I work in an international aid agency in India, and we’re looking into projects that we can do for the next three years. The agency is radically redefining the way we work to build systems and provide aid to the Indian government, but I’m listening in on the meetings for the last traditional project design. I’m not an expert, but if a major aid agency was essentially propping up the Indian healthcare system, and had three years to help it stand on its own before yanking the scaffolding out, wouldn’t that team want to do things that would build upon the system and work to create sustainable change?
I was on YouTube a lot this weekend, and I came across the Uncultured Project (http://www.youtube.com/watch?v=-50dnGnoj6A&feature=g-all-s). I think there are probably better ways to save the world than one guy with a few hundred dollars, but this particular video features my favorite aspect of healthcare work in rural underdeveloped areas.
Where there are no doctors, but the diseases that cause the most deaths are largely preventable and easily curable, doctors and nurses train community health workers in basic medicine, diagnostics and treatment, and then those workers or volunteers go back to their villages, where they can save hundreds of infant and child deaths per year. Save the Children trained the Bangladeshi volunteers in the video, but in India, the government has Anganwadi workers who do the same thing, and they recieve a very small stipend (but in rural India, $20 a month goes a long way). Ashas, Accredited Social Health Activists and Auxiliary Nurse-Midwives (ANMs in acronym-happy India) save hundreds of mothers and pregnant women, and provide counseling, health education and basic services to poor women in rural areas, who might otherwise never see a doctor. These services are vital, but they are often unavailable because nurses in India are so overworked. by my calculations, combining all the people trained to do any kind of basic medical care from a nurse aids to surgeons, and comparing that to the general population in Andhra Pradesh, a state in eastern India, there is one medical care worker for every 2,443 patients. As India’s population continues to expand, especially in rural areas, the country desperately needs more nurses and medical staff to provide medical care services to rural villages.
These services focus mostly on helping women and their children, and also serve as a method of women’s empowerment. Anganwadi workers and Ashas are overwhelmingly female, ANMs are almost always women, and they work to improve the lives of women. As women are given more responsibility and respect in the village (and these are mostly village women), the status of women in rural India improves.
Having these ehalth workers is really important for global and national development, and in improving women’s status. With the millions of dollars allocated to the agency for these projects which focus on reproductive health and family planning, improving maternal health and ending child deaths, as well as addressing tuberculosis in rural India, wouldn’t funding (or hell, building) nursing hospitals in the states and districts with the lowest indicators be an effective solution? Build and fund the schools, have doctors and already trained nurses train rural women in detecting, diagnosing and treating preventable illnesses, and then send them on their way. Yes, schools are expensive, but the buildings need not be fancy. the equipment isn’t fancy. the diagnosis tools are not fancy. With the $50 million allocated to this project, it would be relatively simple to address all these issues in a sustainable way.
I think getting private interests involved would also be an effective method for implementing this strategy. Private companies have a vested interest in making a project like this work, and are often small enough that it wouldn’t get lost in the bureaucratic shuffle that impairs the Indian Government’s ability to function. A private company could also build the roads necessary to move medicine and technologies (like scales) to the rural areas. They could open clinics which would get them prestige, help them make back some of their money, and would create a more efficient delivery and monitoring system.
I’m not sure exactly how to end this section, so for now I’ll leave it unfinished, because the work is unfinished. I’ll probably be doing more stuff like this over the course of the summer.
**I’m being very cagey about the agency and the amount of money because I’m not allowed to speak in specifics until September. If you work in a group that’s trying to get money from an international aid agency, know that no one is listening to me, and this is not likely to be the way we go, although someone should.
