Action Areas

Equity

Making health services accessible and affordable for all

Being poor in India means that proper health care is probably out of reach, too expensive, or too far away. The situation is worse for women, children, tribal communities, those from backwards castes, and minorities. Added to this, expenditure on health is woefully inadequate leading to millions of Indians having to live a life where proper health care, in a good institution with qualified doctors, is not an option. The poor are the worst off with health indicators - the mortality rate of children from Schedule Castes/Tribes is 30% higher than children born in other families. People living in far-off rural areas are cut off from infrastructure and suffer the most when they need medical attention.

In this context, DFID -supported technical assistance support teams, or TASTs, in Madhya Pradesh, Orissa, West Bengal, Bihar, and Andhra Pradesh work closely with state governments to bridge gaps between different poor communities, reduce maternal and infant mortality, and improve the health situation for those living in rural, inaccessible areas. The key focus is to ensure that any reform in the health care system addresses financial, geographical, and social barriers that people often face that deny them their right to quality health care. This means that the technical teams work with state governments to ensure that health reforms - in the National Rural Health Mission and other health and nutrition programmes - are sensitive to costs attached to health services and that they are, if not free, then affordable for poor communities; that health services are accessible to everyone regardless of gender, caste, or religion; and that no one from a background that is discriminated against be denied quality health care because of who they are.

Here are some examples of how the TASTs have worked with state governments to make health systems accessible and affordable for poor communities -

Andhra Pardesh

• Initiated Rajiv Aarogyasri scheme (a health insurance scheme) for those living below the poverty line (BPL) where the state government pays an annual premium on behalf of poor communities
• Adopted a public-private partnership model and set up 108 emergency response services in collaboration with the Emergency Management Research Institute

Madhya Pardesh

• Working with the state government to ensure resources are used more effectively and reaches poor and underserved areas
• Providing hospital services in rural areas

Orissa

• Scaled up investments in disadvantaged districts to improve service delivery
• Engaged with policy makers and planners to increase attention to gender and equity issues
• The Orissa Equity Strategy and Plan is expected to reduce infant mortality rates among disadvantaged communities from 70 per 1000 live births to 60 by 2012 in 3 years
• Under the Orissa Health Sector Plan 2009-10, workshops will be held for district and block health officials to include equity actions and indicators in their annual plans

West Bengal

• Worked with the state government to
  1. include issues related to access and demand to health services in the Health Sector Strategy
  2. create a profile of community members and categorize vulnerable groups within district health plans ande
  3. improve outreach of health services to those in hard-to-reach areas by analyzing constraints to access and demand
• Established NGO-run mobile health clinics for those living in far-off, inaccessible areas
• Initiated mobile boat dispensaries that conduct basic diagnostic tests
• Waived user-fees for all children and pregnant women
• Supported a transport scheme for women to give birth in a proper health institution