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Future Health Systems is a research consortium working to improve access, affordability and quality of health services for the poor. We are a partnership of leading research institutes from across the globe working in a variety of contexts: in low-income countries (Bangladesh, Uganda), middle-income countries (China, India) and fragile states (Afghanistan) to build resilient health systems for the future. After a successful first five-year phase from 2006-2011 (see our success stories), we are entering a new six-year phase of research, funded mainly by UK aid.

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Improving Health Care Delivery for the Underserved: Issues & Prospects in West Bengal

Future Health Systems

On June 20, 2011 FHS India partner, IIHMR, organized a seminar on ‘Improving Healthcare Delivery for the Underserved: Issues and Prospects in West Bengal’ in Kolkata.

The purpose of this event was to facilitate key stakeholders in West Bengal’s health sector to debate and discuss a priority agenda on strengthen the state’s health programs with a special focus on under-served and specially challenged areas of the state. This meeting an initial step towards building a local knowledge platform to help both government and non-governmental organizations to commit their efforts and effectively allocate resources to upgrade health services in the underserved areas of the Sundarbans. This forms part of FHS India's goal in the second phase of the program to build stronger links between policies and research.

The speakers included representatives from various stakeholders, such as government, private, voluntary, researchers, and the UN agencies. Among key participants, notable were: the Additional Chief Secretary (Health) and the Health Secretary of the Government of West Bengal, representatives from the private hospitals and voluntary agencies, and a representative from UNICEF.  About 70 participants attended this seminar. 

Professor Barun Kanjilal, the country coordinator of FHS India, initiated the discussion. He suggested that the state has made remarkable progress in basic health indicators during the last decade. However, there still remain pockets where the health records are comparable to low income countries. If these areas are not taken care of, overall health indicators for the state could stagnate and soon decline. Such areas needing special care and attention include the Sundarbans, the tea gardens of North Bengal, the mining areas and areas of political conflict.

The keynote presentation was followed by a panel discussion. Dr Charulata Banerjee of Terre des Hommes Foundation gave an account of her organization’s successful interventions in medically underserved areas across the globe, including Bangladesh, Afghanistan, Nepal and Sri Lanka. From that vast range of experience, she highlighted the need for

  • Create an evidence base
  • Inform those whose health is being managed
  • Strengthen infrastructure in hard-to-reach areas- across all sectors
  • Focus on Provision of Primary Health care especially for children

Mr Dilip Ghosh, Secretary, Department of Health and Family Welfare, Government of West Bengal, and State Mission Director of NRHM offered the government’s take on the problem. He noted three vulnerabilities: 1) spatial; 2) Sectoral – the poorest person visiting a hospital is invariably served last and served worst; and 3) Institutional – overloaded medical institutions and overworked medical staff. Consequently, he recommended:

  • Skewed distribution of medical institutions should be addressed to make the system balanced.
  • Streamlining the entire equipment system of hospitals, including rationalization of staffing.

Dr Prabir Chatterjee of the UNICEF stressed on good practices in underserved areas, with special emphasis on ensuring equity. He showed that:

  • Economic inequity affected health care services.
  • Maternal mortality was strongly associated with mothers’ literacy levels.
  • Social factors affected immunization with data showing that it was lowest among the scheduled tribes.

Commenting on what is to be done, he emphasized 1) Community, 2) Outreach and 3) Clinical Facility. Improving health would require building up the health system in the next ten to twenty years. Five core concerns emerge when facing the challenge of improving health:

  • Promoting equity by reducing household expenditure on total health spending and experimenting with alternate models of health financing;
  • Restructuring the existing primary health care system to make it more accountable;
  • Reducing disease burden and the level of risk;
  • Establishing institutional frameworks for improved quality of governance of health;
  • Investing in technology and human resources for a more professional and skilled workforce and better monitoring.

Dr M.N. Roy, Additional Chief Secretary, Department of Health and Family Welfare, Government of West Bengal, highlighted the successes of the government in improving health care services in underserved areas and listed a few steps that the government was taking for further progress in the direction. These included:

  • Strengthening the sub-centers and improving access
  • A minimum number of required drugs need to be made available in the sub-centres and they must be encouraged to disburse according to need.
  • Mobile medical camps need to be organized for underserved areas.
  • Free transport for obstetric care for pregnant women needs to be organized and improved.
  • Sensitivity and preparedness of medical staff need to be improved.

The final speaker of the evening, Padmashree Tushar Kanjilal, an internationally acclaimed health activist, emphasized that a health movement had to be initiated if all these issues were to be addressed. He also said that changing lifestyles accounted for the emergence of newer diseases, especially in the villages, and spoke of the need to combat poverty in order to take healthcare to the underserved areas and populations.

Discussion during the interactive session revolved around measures to pull up these underserved areas to the level of better performing regions through innovative ways and new ideas.  The speakers and participants were unanimous that a special, executable plan is required. The plan would be based on scientific evidence and would inform the government as well as non-governmental organizations to commit their efforts and resources in those areas through a common knowledge platform. The FHS seminar is a step in that direction.