Many of the slums are no longer in the vulnerable category but people are facing situations far worse than those who live in slums. They do not live in jhopdis but in properly constructed houses but they are densely populated. We need to redefine those localities and people. We need to focus and recognise this different vulnerable group. That is the need of the hour.

Shahid Akhter, editor, ETHealthworld, spoke to Mohan HL, CEO, KHPT , to find out more about the different models of public involvement that can be a game changer in bringing healthcare to remote regions.

Healthcare : Participation of the civil society

The last decade has seen a lot of new things happening. Many things have been initiated; there is greater political will and a high visionary approach that is bringing TB to the forefront. There are numerous campaigns, and the involvement of different sectors. Together, things are moving in a very positive direction.

Recently, perhaps a year back, a Jan Andolan has been conceptualized and launched by the Government of India. We are all part of it now. Civil society organizations are taking a keen interest in both, preventive and promotive care. But there are a few gaps and we need to think of what can be done to end TB as early as possible?

First, there should be people’s participation . The spaces are there even at the lowest rural and urban levels like the panchayat and urban local bodies. The involvement of these elected representatives will enhance effectiveness. Second, there must be participation by civil society organizations. It is required in such campaigns, because they (civil society organizations) have a connection with the people at the local level. I know the government has a complete infrastructure catering to the curative aspect, but the preventive and promotive aspect is always a challenge. The involvement of civil society organizations has a positive effect. Third is that, things are changing every day at the ground level. Take the example of metro urbanization. We need to redefine some of our vulnerable target groups as there is a lot of migration happening. slums are no longer in the vulnerable category but people are facing situations far worse than those who live in slums. They do not live in jhopdis but in properly constructed houses but they are densely populated. We need to redefine those localities and people. We need to focus and recognise this different vulnerable group. That is the need of the hour.

Healthcare: Need for PPP

Public and private partnership is a must. This has been happening for almost one and a half decades. We too are working closely with the private sector. For instance, in a project called Jeet, we involved all the private practitioners and private hospitals to increase case notification. That yielded very good results. There are a lot of things we need to do.

We need to understand the ground reality. Three sets of people are there. The people who go to private clinics, those who go to public clinics.They have some trust, and they find it accessible and affordable.

There are also people, who don’t go at all due to their negligence. There could be many reasons – it could be related to gender or the fear of losing a job. We need to understand all three categories of people if we want to have better partnerships. Then we’ll be able to identify where people are left out.

If you want to increase the participation of both, workings together with private sectors, the understanding of the reality and community and population level is something important. KHPT is trying to create solutions for these specific vulnerable groups in four states — Assam, Bihar, Telangana, and Karnataka. The whole idea behind that is to create behavioural change solutions on how these vulnerable groups can be addressed. We need to test this so the government can scale up; across the country and I think that is where KHPT is contributing.

KHPT: Redefining the vulnerable groups

If so, as I said, redefining these target groups, their vulnerability, especially for migrant workers (is needed). You take any metro city, there is a huge number of people travelling across this state for their livelihood, (they) need to be reached out — either at their workplace or residence. There is a gap here — earlier it was very defined. Slums are (areas) where labourers used to stay. Now, that is not the case. So, we need to remap it, which we had done extensively in all these states. And we are already moving on to the solution levels. That will contribute in a huge way to reach out to these populations.

KHPT: HIV and Sex workers

KHPT, initially began with working on HIV and for over a decade we worked on it. We have seen that the new infection rate is coming down and we transition the entire programme to the government. But interestingly, when we are transitioning to government, we are transitioning to the sex worker groups themselves. So, they continue to work. We have seen a big reduction in the infection rates.

When you are working with the sex workers, you get a good understanding.We also had a good understanding of the migrant sex workers. So we started working with the migrant population. Then the children of sex workers. (That is) how we entered into adolescent health.

We started many (health) verticals.. When it comes to maternal and child health, we reached (out to the) vulnerable women. We worked for almost more than six-seven years in Northern Hyderabad Karnataka region – a model of innovation that we reached out to, so that it is scaled.

We helped the Uttar Pradesh government to map the entire state. So, again few districts were selected and the entire model is now scaled up. We helped Uttar Pradesh government to map the entire state in Uttar Pradesh for maternal and child help. The (WHO) came out with a kangaroo mother care on mother care, as in a lab in the Northern Karnataka. Later, that also with the evidence, scaled up across Karnataka. So we worked on the different (models). If you ask me our ‘reach’, at present, we already work in the entire country except for five states. On the nutritional aspect, we very intrinsically work in four states.

KHPT: Future plans

KHPT has a clear mandate for the next five years. We are focusing on four thematic areas — TB, adolescent health, comprehensive primary healthcare, and maternal and child health.

Our vision is clear. What do we need to reach? How many of them do we need to reach? Which geography do we need? So, we are here to complement and contribute to the large public health domain. KHPT is doing that and we’ll continue to do so. So, we are happy to note that many of our innovative models are scaled up by the government across the country, and also in a few of the African and other countries as well.