Champa’s young daughter was suffering from fever and care received from the local practitioner did not help. There was no option but to visit the nearest hospital in the block even if it meant foregoing the day’s work and wages. Champa incurred expenses for travel, consultation and medicines totalling to Rs 450 to seek necessary treatment for her daughter.
This experience led to Champa bringing up the lack of healthcare in her village for discussion in the women’s collective meeting. After a prolonged and heated debate on the matter, Leelawati, the leader of the collective admitted, “People in cities have family doctors. If we fall sick here in villages, what can we do? We should also have a doctor for ourselves.”
The women reached a consensus in the same meeting to start a Gaon Dawakhana (village clinic).
With “Our health is in our hands” as the motto, the clinic was started in Pratapgarh district of Uttar Pradesh in January 2017. Gaon Dawakhana has been designed as a subscription-based model, owned and managed by the community with the help of visiting doctors.
Need for a village clinic
Primary health care is the villagers’ first point of contact with the healthcare system.
The government has designed a three-tier public health system, the first one being health sub-centres (HSC). These centres, manned by a trained nurse, are meant to cater to a population of 5,000. However, in densely populated geographies such as Uttar Pradesh, HSCs often serve 8,000 to 10,000 people.
Consulting a doctor through a primary health centre (PHC), which exist for every 30,000 people, villagers have to travel to seek a consultation. Further, challenges related to infrastructure and competent paramedical personnel at facilities still exist.
In such a scenario rural people have no choice but to seek care from quacks who provide services at doorsteps. What if a qualified physician is made available to serve in every village? Will it be sustainable? Gaon Dawakhana is an attempt to answer these concerns.
Community-owned self-sustaining clinics
Each household pays Rs 50 per month to avail healthcare services at the clinic. The beneficiaries’ health cards are updated as soon as the monthly contribution is collected from them. Patients receive free consultation and medicines while visiting the clinic. The subscription amount was fixed at Rs 50, assuming average family size as five.
Though healthcare services are offered now at the same subscription even if the family size is more, an additional amount of Rs 10 per head may be collected in future.
So far, 1,665 families have registered and have paid a total subscription of Rs 1.94 lakh.
Those without subscriptions are also treated now but are encouraged to subscribe.
Clinics are held at the Lalganj block on Thursdays and Sundays. Village clinics are held in the panchayat office premises on two days fixed by the women’s collective leaders.
Expenses towards doctors’ fee and medicine are met from the subscription amount.
In addition to the clinics, quarterly health camps are organised. These were initiated to help non-subscribers seek consultation and also to encourage more households to subscribe to the dawakhana scheme.
Of the 227 patients above 40 years of age screened for risk factors for diabetes and hypertension, 41 were suspected to be facing the conditions. A trained health worker from the community and on the rolls of Gaon Dawakhana, will actively track these 41 patients.
At these health camps, government doctors and paramedical staff, offer free services. Medicines available with the public health system are issued free of cost.
Role of the women’s collective
Nari Sangh, the women’s collective was started in 2008 with the objective of empowering rural women, through the joint efforts of Lokpriya Janhit Sewa Sansthan (LJSS), a local community-based organisation (CBO), Tata Trusts and People’s Action for National Integration (PANI). The women learnt to access food security service entitlements under MGNREGA (Mahatma Gandhi National Rural Employment Guarantee Act) and food grains under the Public Distribution System (PDS).
With a Nari Sangh at every village and leaders identified at each level – from panchayat to state – the collective serves as a pressure group to mobilise and improve grassroots processes. Over a period of time, the women realised that food security did not necessarily translate to better health; mainly due to lack of healthcare services. Hence Gaon Dawakhana was a need.
“The women informed us that they spent up to 30% of their income on healthcare annually. So we applied our insight and encouraged them to start the clinic through collective contributions,” Shashi Bhooshan of PANI told VillageSquare.in.
Women leaders shared that the villagers’ faith in the Nari Sangh helped them start Gaon Dawakhana. They arranged for homoeopathy doctors, considering the feasibility and the awareness among villagers about alternative treatments. The very first clinic attracted more than 50 patients.
As a norm, the amount collected as the subscription is held by the Nari Sangh leaders in a joint account with the CBO representative to ensure transparency. According to Niranjan Tiwari of LJSS, the women follow guidelines set by PANI to ensure transparency in all their work.
Lessons and challenges
Gaon Dawakhana demystifies the common notion that rural poor are always in need of free services. Poor and vulnerable families are willing to pay for services especially when they perceive value in it.
Despite voluminous efforts, the entire healthcare system is facing several challenges to address key attributes like availability, accessibility, acceptability, appropriateness and affordability.
In densely populated villages, clinic days are crowded and it is a challenge for the doctors to see every patient. Conducting health camps with designated manpower and available budget also pose a challenge. To bring down cost, health camp services can be clubbed with routine village health and nutrition days. Hence, constant engagement with grassroots health system staff – nurse, anganwadi worker and ASHA (Accredited Social Health Activist) workers will be a good option.
The experiment is a work in progress and its future will largely depend on the success of the health camps and sustained the interest of the community in regularly contributing to it. Gaon Dawakhana certainly holds the promise of happier Champas who shall be spared from disproportionate expenses to seek basic health care services.
Sandeep Chavan is a homoeopathic doctor, trained in public health administration from Tata Institute of Social Sciences, Mumbai. He works in Tata Trusts as a program officer for health initiatives in eastern Uttar Pradesh. Views are personal.