It’s a shame that despite decades of developing health infrastructure, Health for All has just remained a slogan. All over the world there are government health programmes, assembled at huge expense, meant for all and available to all. There are NGOs, international agencies and governments focused on health. Billions of dollars have been invested in health programmes by the World Bank, Global Fund and international aid agencies.
Health workers worldwide have managed to penetrate deep in war-torn and conflict-ridden zones, tirelessly serving the poor, often at great peril to their own lives. In spite of that, globally, health indicators are abysmal, and more so in marginalized communities, as shown by the three following facts:
1. 20 million infants worldwide are still missing out on basic vaccines. This is in spite of ubiquitous universal immunization programmes, through which free vaccines are available for all. Sadly in India alone, 40% of children are not immunized, even though free vaccines are available at 700,000 centres across the country, in villages, slums, mountains and deserts.
2. 1 billion women and children suffer from anemia and other nutritional deficiencies. Meanwhile, 800 million people in the world go to bed hungry every night. This is surprising indeed, considering that international food-banking networks say there is more food than we need on the planet.
3. 10 million people get tuberculosis (TB) every year. But the fact is that TB is curable. It is simply an infectious disease, and all medicines, diagnostics and specialist doctors services are available for free through government programmes. With this many new cases annually, a curable disease has become a worldwide pandemic.
It is the same story all over the world. Lack of access to healthcare is the biggest challenge faced by disadvantaged patients. On one hand, we have well-intended, excellent health programmes, all for free; on the other hand we have patients who live marginalized by society, living far away from existing health infrastructure, who often live with shame and fear. There is a total disconnect.
The huge gulf between government programmes and disadvantaged communities is the reason why we were not able to achieve the Millennium Development Goals of health for all and poverty alleviation. And this is the reason, once again, why attainment of Sustainable Development Goals might become a distant dream.
The TB treatment gap
Let me explain in depth by giving the example of TB. Patients must go every day to a designated centre for six months and swallow their medicine daily in the presence of a trained health provider. Medicines are not given for home consumption. If treatment centres are miles away and open at inconvenient hours, getting treatment becomes an insurmountable challenge. Patients naturally prefer to work and get wages to feed their families, rather than waste time and money in getting TB treatment, so they continue to suffer and infect others. And when there are no jobs, where is the bus fare coming from?
This is an example of a physical gap. But there are other gaps – psychological, emotional, and financial – that must be addressed. Fear, shame and hesitation are by far the biggest psychological barriers. In 2005 I established my NGO, Operation ASHA, for this very reason, to provide doorstep delivery of health to those at the bottom of the pyramid. What Operation ASHA has done is to build the elusive last mile of the cable, reaching deep into disadvantaged areas, far into distant lands and difficult geographies. We are even serving the poorest of the poor: the tribals. These are the communities where starvation deaths are known to occur, and incidence of disease is several times higher than the rest of the country.
Going the last mile
We hire and train disadvantaged people from local communities and empower them with technology. We work as partners with governments, which gives us free medicines, diagnostics and services of physicians. We utilize existing government infrastructure, which provides a leverage of 100% to the donor. We solve the problem of the last mile by establishing treatment centres within slums and shanty towns, which are open early morning and late at night, so no-one has to miss work or wages to get their medicines. Where patients are scattered, our health workers go on bicycles and motorcycles and even on boats right up to patients’ doorsteps. Health workers use eCompliance, the biometric fingerprinting device created by Microsoft Research that ensures every dose is taken and prevents incomplete treatment.
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We are serving close to 18 million people in India and Cambodia. We are active in war-torn Afghanistan, where we do 8% of the country’s TB work in collaboration with the country’s National TB programme and a local NGO. In Cambodia, we started work six years back and treat 18% of all patients. This has been replicated by third parties in Uganda, Kenya, Peru, Dominican Republic and even Tanzania.
The world has conquered diseases that have wiped out entire populations, such as smallpox and the plague. We must make a resolution now. We must identify and take the best models to scale. Effective models that are low-cost, high impact, scalable, replicable, which measure outcomes and impact. Let’s use them to ensure doorstep solutions for improving health access, and providing safe water, adequate food, and immunization. Our last miles must get deeper, stronger, bigger, better, more efficient and all-pervading. Only then shall we succeed in our mission: health for all. This is the only way forward.