Rural and Tribal Health, Thane District, Maharashtra

The fifth day brought us respite from Mumbai’s urban jungle as our group headed out into Thane District and rural India. The experiences of this day provided an excellent counterpoint to many of the disheartening conditions observed in the cities.



Our host for the day, Ms. Neelam, Director of Special Projects for IMPACT India took us to visit some very successful public-private partnership enterprises between IMPACT India and the Indian Government (Central and State). We visited a tribal (Adivasi) children’s residential school, a local women’s clinic run by a trained nurse from the Adivasi community, a Government Primary Health Center, and IMPACT India Mobile Eye Clinic, located in various villages about a 100Km outside Mumbai.

Our first stop at the tribal children’s residential school showcased an adolescent girl’s health initiative geared towards providing health education about adolescent health, early marriage and iron/folic acid/multivitamin supplementation. Supplements donated or supplied at low cost by pharmaceutical partners such as CIPLA, are distributed free of charge to the young women who range in age from 10 to 17 years. The girls also undergo periodic check-ups with the government physicians from the local Primary Health Center. One of the most striking things about this experience was how extraordinarily welcoming and friendly the children were and how open the girls especially felt around us. Some of the young women expressed the hope of college studies including medical or nursing school as a means of giving back to their community, yet at the same time they were emotionally attached to their families and wanted to attend only nearby colleges of which only a few exist in rural areas.

Another striking point was how the Government Primary Health Center offered both Ayurvedic and Allopathic medical services as part of the Indian Government’s AYUSH Program. The AYUSH Program integrates traditional Indian medicine systems including Ayurveda, Yoga, Unani, Siddha, and Homeopathy which are primarily used for long-term, chronic treatments. The National Rural Health Initiative includes several sub-programs targeting malaria, leprosy, HIV screening for pregnant women, diarrheal disease, infant and maternal mortality.

A third striking point is the extra-ordinary use of a manual census type system to count and record information on the entire community and jurisdiction served by the Primary Health Center. This detailed, monthly data collection and verification represents updated information that is forwarded to district headquarters for further analysis and allows the Government Health System to modulate services in shorter time spans than the traditional 10-year National Census time block.

The two physicians we interviewed also demonstrated an unique commitment to staying and serving in the rural, tribal areas beyond the requisite 1-year program they signed up for initially after medical school.

All in all, it was very heartening to see tangible evidence of how public-private partnerships can work successfully in the Indian context. Ms. Neelam from IMPACT India further corroborated the importance of these partnership programs as means for the private sector to demonstrate best practices (such as through the LifeLine Train, Mobile Eye Clinic etc) to the Government system and to use the pre-established governmental infrastructure without re-creating systems thereby reducing parallelism and redundancy and possibly increasing confusion.

The long term goals in addition to eliminating and reducing preventable disabilities, is to build local capacity within these rural and tribal communities and to empower them to experience better health outcomes while supporting some (but not necessarily the quackier) of their traditional beliefs and practices.