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In keeping with changing patterns

Healthcare policies must account for the role of changing behavioural patterns to ensure efficiency in delivery systems and proper utilisation of facilities.

In keeping with changing patterns
Nothing so needs reforming as other people's habits." - Mark Twain
World Health Day is celebrated on April 7, which was the day in 1948 when the Constitution of the World Health Organisation (WHO) came into force under the flag of the United Nations. Over the years, the international body has been advancing pioneering work in facilitating communication and collaboration across the world on subject matters related to public health and well-being. This year's World Health Day was also the 70th anniversary of WHO. This was celebrated with the bold theme "Universal Health Coverage: Everyone, Everywhere".
While we talk about world health and universal coverage, it is perhaps more important to talk about health in the world's most populated countries. With over 130 crore people, India is home to 17.74 per cent of the world's population. While China's share to world population is 18.54 per cent, India happens to grow by more than 1 per cent every year against China's population which has a growth rate of less than 0.5 per cent. This means that within a decade from now, India will overtake China as the most populated country in the world.
A study conducted by RAND Corporation reveals some worrying outcomes from a comparison between the two countries. China's population is aging and the economy is witnessing a declining growth rate with a smaller share in the working-age population; as compared to India, which is expected to grow younger and economically faster for the next few years to come.
India has a higher children-per-mother ratio of 2.65, whereas China's stands at 1.54. But, when it comes to tapping the vast human resource, China is ahead on most important counts. China happens to have a higher literacy rate; has 67 per cent of its women are older than 15 years and a part of the workforce against India's 33 per cent; and, China has a higher economic efficiency and stronger infrastructure, including communication and energy. When it comes to the quality of health despite rising health costs and an aging population – China fares better than India, with a healthier population and a better healthcare system.
What ails India?
One can go at length and talk about the health and healthcare challenges faced by India, the country's diversity in terms of geography, culture, and demography, political system, unsafe boundaries, huge population burden, poor investment in health — almost any factor can be associated with the present health scenario. But something misses the eye, and most importantly, is not a part of the discourse as extensively as it should be. That something is the changing behaviour pattern of the Indian masses, including the patient population.
The realisation of how behavioural patterns, old traditions, beliefs and habits affect the success rate of healthcare efforts dawned upon us more strongly when we began our initiative of taking healthcare to the rural and underserved people of tier 3 and 4 regions in the country.
After setting up the first series of Gramin Health Care clinics at IFFCO bazaars, we were observing how these clinics would be received by the people. The clinics were strategically based at IFFCO bazaars so that they would be equally accessible to a cluster of nearby villages. Being situated near the highways also meant that we could ensure the continuous supply of goods to the clinics for running the operations efficiently. Our initial belief was that the people would begin accessing a modern healthcare clinic, which is operational across all days of a year. However, during the period, we would only receive few persons in a day, mostly farmers who came for some other purpose. After witnessing a low turnout across several days, we shifted our approach.
We began organising camps and reaching out to each village individually -- only then did people respond. With the experience of hosting camps in the villages and interacting with the villagers, we realised the conviction with which people abide by conventional beliefs and habits. The lack of trust on existing healthcare models was evident, and rightly so, because, over the years, thousands of villages in India have never been touched consistently by primary healthcare. Busting various myths, sharing continued education and awareness, and going door-to-door especially for women and child care — all these aspects have triggered a change in the behavioural patterns of the villagers, who have begun trusting a scientifically sound model, moving away from the long-entrenched practices of going to quacks and unqualified doctors.
In a short span of time, we began recording a daily footfall of 15 to 20 persons in our clinics. The signs have been encouraging as today we hold around 800 camps monthly, around 25 to 30 camps daily, and are able to take primary healthcare services to the villages of India. Most importantly, our schedules are fixed. We visit each village at least once every month and a camp is held routinely.
The first step towards a healthy India
Previously, healthcare was mostly a reactive system which would focus on treating illness. Increasingly, the focus has been shifting towards the prevention and management of chronic diseases. From considering individuals and masses as fully objective and scientific, we now recognise the humane aspects of them being affected by subjective understanding, cognition, socio-cultural norms, and habits.
The objective remains to prevent the onset of diseases, to make ecosystems supportive of positive health practices, promote health education and awareness, and most importantly, to make a robust healthcare delivery system which can show outcomes to the masses.
Roadmap for the future
Any public policy promoting health awareness and healthcare delivery will find it difficult to succeed unless efforts are made to modify individual behaviour. All policies related to health and healthcare should be drafted keeping in mind the transformation required of behavioural patterns for a healthy nation as one of the key objectives to be realised. Whether it is planning of the smart cities, urbanisation of rural areas, or opening of healthcare facilities – the focus needs to be towards the following:
• Effective people participation and engagement healthier practices. The more interactive health policies will be, the higher will be the chances of developing public understanding, appealing to a larger consciousness and modifying habits.
• New care delivery models should list behaviour change as a core component. The models need to be thought-out and viewed from public behavioural psychology during inception and while being drafted.
• Convince influencers first. From the head of the village panchayat to celebrities and other famous people, there needs to be a strategic approach to taking their help in bringing about behavioural change amongst followers.
• Using modern technology to bridge the gap. Technology has brought the world closer; we need to use it to drive the right message. Social media, digitisation, tele-assisted medicine, video and audio campaigns can play a significant role in reaching out to the remotest of the region in achieving the objective.
• Incentivise and penalise. Certain changes can be triggered by incentivising and supporting positive behaviour while making guidelines and laws discouraging unhealthy practices. Human interest needs to be prioritised over capitalistic gains while drafting such guidelines.
• Include more accountable stakeholders. Health remains everyone's business and it is influenced by a wide array of factors ranging from the environment to lifestyle. It is important that multiple stakeholders are recognised, assigned responsibilities and made accountable to implement processes which encourage healthier behaviour. For example, ensuring workplace hygiene should be initiated by employers and positive behaviour should be encouraged among employees. Regular health audits can penalise or incentivise the organisations.
This is not to say that the measures mentioned are not being implemented at all. But, more often, these are by-products of policies. A complete change in approaching healthcare policies from a human behavioural angle can ensure more impact, a better systemic efficiency, and large-scale transformation.
(The author is Founder of Gramin Health Care. Views expressed are strictly personal)
Ajoy Khandheria

Ajoy Khandheria

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