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The Pioneer Private tender loving care The government should support the private sector through subsidy. If it is serious about stabilising population, the Health Ministry has to think out of the box --------- Yoga Rangatia One has to take the arduous ride on Bihar's pot-holed roads to understand the paradox of galloping population in one of the most backward states of the country. Every 10th shop along the road, wherever there is any, claims to be a medical clinic. Several of these are run by private practitioners, better called quacks. Others are visited by a qualified doctor once a week. And yet, Bihar's record in healthcare is enough to embarrass the rest of India. Travelling further into the hinterland, one comes across a makeshift camp in Mahua (Vaishali district). On this particular day, at least a hundred women have queued-up for tubectomy. Most are accompanied by other female family members and toddlers. These women have waited several weeks for the local Surya Clinic to perform the operation without charge. It is then that the irony hits you. Are not the government-run health centres supposed to conduct the operation for free, through the year, as part of their family welfare programme? The message from Mahua is loud and clear: Even the poorest of the poor is aware about limiting population and bringing up a smaller family. Yet they have no access to modern means of contraception. The poor prefer this "private" clinic to the government-run, where they are neither sure of seeing a doctor nor of receiving quality healthcare. Mahua's Surya Clinic makes a case for moving beyond public healthcare to reach family welfare programmes to the poor. Janani, literally meaning the one who gives birth (mother), is a NGO which has stepped in to provide contraceptives and condoms to the rural hinterland of Bihar, Jharkhand and Madhya Pradesh. The NGO has experimented working with non-state actors to provide health services, especially family planning methods. It started with marketing condoms to 12 million shops dotting Bihar. After a few years, Janani roped in roughly a quarter of the 1.25 million rural practitioners and helped them upgrade their services and include condoms and contraceptive pills in their medicine box. They trained these practitioners on methods of family planning, and offered them incentives on sale of products supplied by Janani. Further offering "carrots", the practitioner and his partner, usually his wife, were trained in basic services like taking a pregnancy test and measuring blood pressure and sugar in urine. These services not only added to their income (by sell contraceptives), but also gave them some standing in their community. Janani branded their "clinic" Titli Centres and heavily promoted them in the rural areas. These practitioners and several other salesmen form the core of NGO foot-soldiers who reach health services to the poor where no doctor, public or private, is around. In marketing parlance, these are "franchisee" of Janani and pay an annual membership fee of Rs 300. The third link is the Surya Clinic, which has been upgraded from a private nursing home to offer complex procedures like tubectomy, vasectomy, termination of pregnancy, insertion of Copper-T and delivery. Besides family planning, these clinics conduct hernia, piles and gall bladder operations. Patients are charged for these services, but the costs are about one-third of what local private clinics ask for. One day of the month select services are provide free to the poor. Cases are referred to the Surya Clinic by Titli Centres, who in turn
earn a commission (roughly Rs 5 to 10) per case, closing the chain of
a system for healthcare. In essence, it runs parallel to, and competes
with, the public healthcare system for reaching services to the poor.
Unlike the public health system, with primary healthcare centre as its
base, the Janani network offers incentive to its franchisee for making
the most of the system, while keeping an eye on the quality of the service
About 15 percent couples using family planning methods in Bihar and Jharkhand use the Janani network. Janani accounts for two-third of condom sale in rural areas. And at costs significantly lower than that incurred by the government. "The government invests capital in building primary health centres, while we use the existing private centres to reach health services," says Gopi Gopalkrishnan, president of Janani. If leveraged on a mass scale, the system is self-sufficient and does not need subsidies. But to scale up the network to cover all villages of Bihar and Jharkhand and provide free service available to the poor every day, Janani needs support of the government and private donors. "Services will have to be increased three-fold if we are aiming at population stabilisation in Bihar and Jharkhand," Gopalkrishnan says. The scale will ensure costs coming down further, and closer to the poor person's reach. The Health Ministry, despite its lip service for encouraging public-private partnership, has not looked at funding novel approaches to healthcare. "Policymaking in Delhi is held hostage by NGOs who have no grassroot experience," rues the Janani chief. There is still so much to be done that the government alone cannot cope
with. It can at least begin by supporting the private sector through various
subsidies. If it is serious about stabilising population, the Health Ministry
has to think out of the box. |
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