We must acknowledge that the Government of India has done a remarkable job in bringing people back home from hundreds of students and other Indian citizens stranded in foreign lands...(Now) we cannot leave behind labourers and migrant workers on our highways to fend for themselves when all shops & establishments and services are closed. This will create a crisis that may be worse than the one we seek to fight as we try to fend off the COVID19 pandemic.
Dr. Pavitra Mohan is a paediatrician, a noted public health expert and co-founder of Basic Health Care Services. He writes extensively on issues of health systems and health policy. Basic Health Care Services is a start-up not-for-profit organisation, registered as a Trust in the year 2012. The organsiation has the vision of helping build a responsive and effective healthcare ecosystem that is rooted in the community, where the most vulnerable communities can actively access high-quality, low-cost health services with dignity.
Dr Mohan also serves as Director, Health Services at Aajeevika Bureau, where he leads the design and implementation of solutions to improve health of the families dependent on labour and migration. Earlier, as Senior Health Specialist, UNICEF India Country Office, he designed and led large-scale health programmes to improve maternal, newborn and child health in India. He earned his MBBS and an MD in Pediatrics from Delhi University and a Masters in Public Health from University of North Carolina at Chapel Hill.
BHS functions in the Indian context where poor people in rural, underserved areas face a huge and disproportionate burden of ill health. For example, in a baseline study of four underserved panchayats in South Rajasthan, BHS found that a whopping 68 per cent of all children reported falling ill at least once in the previous two weeks. In such areas, public health services either do not exist or are affected by absenteeism of physicians and nurses. Concurrent evaluation of the National Rural Health Mission reported that physicians were available in only two out of 10 PHCs surveyed in Rajasthan. The formal private sector also does not reach this area as people have very limited ability to pay. In such conditions, unqualified private practitioners and traditional healers are the default care providers—often of poor quality and exploitative, but available. Most such providers are men, further limiting the access of women to even this level of care.
High illness load and poor access to quality healthcare is reflected in high levels of mortality and in large disparities in mortality; for example, infant mortality in rural India, at 44/1000 live births, continues to be one and a half times that of urban India. Yet even these averages hide the further inequalities within the rural areas, especially those prevailing within the underserved areas. For example, 33 per cent of all women of reproductive age, in the survey referred to above, reported at least one child death in the past.
Families also end up incurring huge costs, despite receiving poor quality care. It is not surprising that expenditure on healthcare is one of the major reasons for families slipping into indebtedness in rural India.
Due to the absence of adult males from the household and the erratic availability of liquid cash, families of migrants are even more likely to defer treatment when ill, thereby incurring higher costs and becoming more likely to fall into indebtedness from healthcare expenditure. Migrants themselves have higher vulnerability to illness due to the unhealthy and unhygienic environment in which they work and live. Being less familiar with the city and its healthcare systems, and having limited liquid cash, they defer seeking care when ill, or they go back to the “pastures” they know better, their own village, prematurely breaking the migration tenure and further reducing their income.
It is in these communities that BHS under the leadership of Dr. Pavitra Mohan serves. His writings bring in experiences form the rural heartland and often argue for policies that can support the most vulnerable sections of our population.