Notes from the field: A first-hand account of rural healthcare in India

Dateline: March 16, 2011
Location: Hyderabad, Andhra Pradesh
By: A team of MIT graduate students in ghdLAB

The MIT CRHM team arrived in safely Hyderabad on Sunday March 12, 2011 at 4AM and were swiftly greeted and whisked away to our hotel and spent the day recovering from jet-lag and the end of the semester.

On Monday, we met our hosts (Girish, Chief of CRHM and Prasanth, Head of Operations of CRHM) and were given a tour of the CARE corporate headquarters, followed by a tour of the Banjara Hills flagship CARE hospital. The Chairman and founder of the CARE Group, Dr. Soma Raju, graciously received us in his office for close to an hour and explained his vision of providing the highest quality care at low costs. We were impressed with how dedicated the organization is to its mission, evidenced by how even the chairman himself continues to practice. Following the tour of the hospital, we drove an hour out to Janwaoa village and met Prasoona, the Village Health Champion. She had an impressive grasp of basic medical care (passed all of Yechiel’s tests!) and seemed to keep good medical records.

Rural health worker Indira seeing a patient, March 2011

We spent Tuesday and Wednesday in the neighboring state of Maharashtra, beginning with a tour of CARE’s hospital in Nagpur. We met with the managing director of the hospital, Dr. Varun Bhargava and with the head of operations, Rajeev Chovrey. They spoke of the ethics by which CARE operates and emphasized how they are the only healthcare provider in India run by physicians and not by business people. They also explained CRHM’s plans to launch ahealthy eating educational campaign targeted at 5-8th graders in hopes that they would in turn educate their parents. CARE Nagpur plays an important supporting role in the CRHM hub and spoke model. CRHM currently has VHCs (Level I, basic primary care) in 44 villages in Maharashtra, all less than 1 hour by car from the CRHM clinic in Yavatmal (Level II, more sophisticated primary care), which is in turn supported by CARE Nagpur (Level III, secondary care), about 160 kilometers from Yavatmal. CRHM is currently piloting a handheld device which will allow VHCs to electronically input patient data and diagnoses and CARE Nagpur will host the backend servers.

We then traveled 165 kilometers to Yavatmal and met with the head of the CRHM projects in Maharashtra, Sanjay Telrandhe. Sanjay is in charge of three project coordinators who are each in charge of 15 villages and VHCs. Sanjay’s team is focusing the majority of their efforts on expanding the CARE micro-insurance network and have been working hard to convince villagers to enroll. The major roadblocks are trust and lack of cash. Later in the day, Sanjay brought us to Chondhi village and we had the opportunity to observe a community meeting where Sanjay and the project coordinator presented the insurance product to a group of 50+ villagers. Although the entire meeting was conducted in Marathi, we were able to get a sense for how CRHM is respected and trusted by the villagers.

The following day we went to two other villages close to Yavatmal. At Murzadi, we met Indira, the VHC and observed as she performed an examination of a patient. We were very impressed with how professionally she conducted herself and the examination. We also met the school teacher and had a translated dialogue with some of the villagers centered around the micro-insurance plan. At Ratchandana, we met Vandan Gedam, the VHC and the local school teacher. She kindly invited us to her home and we were able to experience some local hospitality, complete with sweet, unpasteurized milk, some raw peas, and the company of a mixed-breed cow!

Overall, we were impressed with the quality of care that CRHM is able to deliver at very low costs. The micro-insurance they are pushing is priced at $6/year for a family of four and should be able to cover all routine healthcare costs for the family.

We are still focusing our research on existing and future low-cost diagnostics at the request of our host. We might explore a side project or two as well if possible, but will be focusing the majority of our work on diagnostics.

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