IT HAPPENS ONLY IN INDIA,
GREAT JOB MR. PARMAR
it is good to eat as many as vegetables and fruits (totally vegetarian), but my aurvedic doctor asked me to stop eating every...
A RURAL health programme operating arolmd Sevagram in Maharashtra
has given new expression to
Mahatma Gandhi's dream of rural
development. The scheme, based on
self-help and risk-sharing through
insurance, is proof that quality health
care can be provided in rural areas at
an affordable cost.
The moving force behind the proJect, which covers 23 villages with a
combined population of about
19,500, is Ulhas N Jajoo, a doctor at
the Mahatma Gandhi Institute of
Medical Sciences, who has been
involved in welfare work in the
region from 1978. He explains, "Our
aim was to develop art egalitarian 8r'
system so that health services could
be accessible to the poorest members for
of the community."
A hospital at Sevagram. serves as the base for the village health service scheme. The hospital receives 75 per
cent of its funding from the government and the rest from
service charges and donations. Its outreach service, however, is supported entirely by funds generated from the
villages because, says Jajoo, "charity given from above
only fosters dependence. By making use of local
resources, the villagers develop a sense of confidence
Only those villages in which 75 per cent of the poor
enrol are included in the health insurance scheme. If the
membership falls below this figure, the scheme is withdrawn. Furthermore, to ensure the cooperation of the villagers, only if the panchayat is unanimously elected is
the village eligible for enrolment. This rule was introduced to prevent political rivalry from undermining the
Under the health insurance scheme, a fund is
established to set up a dispensary in each village to stock the medicines required for primary health care. Villagers contribute to the
fund based on their capacity to pay. Annual
payments can be made in the form of a fixed
amount of jowl crop at harvest time.
Landowners pay according to the number of
hectares they own, while landless labourers
make a nominal contribution, equivalent to
about Rs 16 per year.
A mobile health team, consisting of a village health worker, an auxiliary nurse-mid-
wife and a social worker, tours the villages
regularly. One health worker is selected from
each village and joins a nurse and a social
worker to form a team that i4 assigned to meet the health
care needs of 20 villaged.2The village fund pays the
team's travel costs and th4wages of the health worker,
who forms the link between the village community and
the base hospital.
Health workers are tr"d by doctors at Sevagram to
provide health education to the villagers, treat mild illnesses and diagnose serlo4s cases for reference to the
hospital. The Sevagrarn doctor also conducts annual village meetings at which the health worker's performances
is reviewed. Meanwhile, the social worker and nurse
visit villages regularly to provide maternal and child
health care and vaccination services.
insured villagers are treated free at the hospital for
unexpected illnesses and receive a 75 per cent subsidy
for.planned admissions, such as normal pregnancy and
cataract and hernia surgery. Villagers
insole who are not insured can avail of the
hospital facilities, but they must pay the
A measure of the success of the
schente, no cases Sevagrant health scheme is that more than
75 per cent of the villages in the region are
of vaccine-pre- enrolled in the scheme. During the decade
that the scheme has been in operation, there
ventable illness has been no case of vaccine-preventable illness among children or maternal death during delivery and there has been a sharp
decline in perinatal mortality.
These are encouraging achievements,
given the high degree of poverty prevailing
death during in the region and the low priority given by
the 'villagers to their health. As Jajoo says,
delivery has been "Within the existing social limitations, the
Sevagram scheme offers a replicable model
reported- for rural health care."