India ranked 145th among 195 countries on quality and accessibility of healthcare in 2018, with many neighboring countries ranking higher. Moreover, there are wide differences in healthcare access within regions of India.
Although the government of India has been ramping up healthcare infrastructure across the country, public healthcare expenditure is still very low at about 1.3 percent of the Gross Domestic Product (GDP). Healthcare in the country is characterized by a high level of inequity. Most of the poor people are underserved, with no viable solution in sight.
With the novel concept of Arogya Swarāj described below, the people of India can take health into their own hands to improve the quality of their lives.
Swaraj – A historical movement calling for a self-reliant India
Maharshi Dayanand Saraswati, a social reformer, gave a call for Swarāj or ‘self-rule’ of India in 1876. Bal Gangadhar Tilak famously declared, “Swarāj is my birth right, and I shall have it.” Mahatma Gandhi strengthened the idea of Swarāj when he pledged to boycott foreign goods in Mumbai on July 31, 1921. Much of the focus of movements inspired by Swarāj had hitherto been on economic self-reliance.
Arogya Swaraj
When the doctor couple Abhay Bang and Rani Bang returned to India after completing their training at the prestigious Johns Hopkins School of Public Health, USA, they visited the Gandhi Peace Foundation in Delhi, where they met an older man, who asked them, “You have studied public health in America. Tell me, what is the Indian definition of health?” They repeated what they had learned during their medical education: “Health is a state of physical, mental and social well-being, not just the absence of disease or infirmity.” The older man dismissed it as a western fad and asked them for the Indian definition. They had never thought that the Indian definition would be different and did not have an answer. The older man revealed, “Jo swa mein stith hai woh Swasth hai” (The one centered in the Self is healthy). The older man was Prof. Ramchandra Gandhi, the grandson of Mahatma Gandhi.
This conversation led the Bangs to rethink health in the Indian context. They proposed a new vision for India – “Our vision is to realize Arogya Swarāj: People’s Health in People’s Hands: ‘Empowering individuals and communities to take charge of their own health, and thereby, help them achieve freedom from disease as well as dependence.’”
Inspired by Mahatma Gandhi’s ideals, the Bangs broadly spelled out three concepts of Arogya Swarāj:
Swarāj, in the context of health, means understanding of oneself, including one’s mind, body, conscience and conduct. An individual must control food choices and
avoid substance abuse
Health is freedom – An individual must be Atma Nirbhar (self-reliant) and not depend on others for her health. One must reduce dependency on doctors, drug manufacturers and the government
The health services unit must be located at the village level. Every village must have a Village Health Worker (VHW), drawn from the village, providing primary healthcare to the people
Translating the idea of Arogya Swaraj into reality
The Bangs went on to set up SEARCH (Society for Education, Action, Research and Community Health) in 1986. They were moved by the dire circumstances of the population in the impoverished tribal hinterland in Gadchiroli, Maharashtra. They gave up the prospects of financially rewarding medical careers and decided to live among the poor people and serve them. Their dream was to make healthcare affordable and locally accessible to everyone and ultimately to empower people to take care of their own health. They propagated the idea of Arogya Swarāj – People’s Health in People’s Hands.
They successfully applied the principles of Arogya Swarāj at SEARCH, transforming the lives of tribal people in Gadchiroli district. They lived amongst the locals and empathized with the healthcare issues that these people faced. Once the rapport with the locals was established, these people readily accepted the interventions proposed by the doctor couple.
During the early 1990s, women in Gadchiroli raised concerns about the high incidence of newborn deaths. SEARCH conducted a study, resulting in the development of a home-based neonatal care (HBNC) package, after recognizing that hospital-based care for sick newborns was impossible due to poor accessibility and extreme impoverishment. The Bangs decided to provide newborn care through VHWs. Semi-literate women from the villages were rigorously trained to become VHWs. They could resuscitate asphyxiated newborns, support breastfeeding, maintain the child’s body temperature, recognize and treat bacterial infections using basic antibiotics, and provide health education to the mothers.
Consequently, Infant Mortality Rate (IMR) reduced from seventy-six per one thousand live births during 1993-95 to thirty-one by 2001-03, which then became the national and international target. HBNC program became an effective solution to create a hyper-local, agile, and cost-effective healthcare delivery model, which was then widely emulated by other states across India and other poor countries.
Thus, Arogya Swarāj has the potential to empower citizens to set their own priorities for healthcare, thereby contributing to building a healthier nation. It can heal India and the world.
About the authors:
Srikrishna Mamidipudi is a manager at ISB-Centre for Business Markets. He has over 10 years of experience in the digital marketing industry and led business development at Deep
Red Ink Consulting, playing an integral part in the company’s growth. Selected as a Grassroutes Fellow, he traveled extensively across Kerala to document the rural culture and presented a plan to link local artisans with eco-stores across India. He has also founded a 500+ member community to promote empowering conversations around failure through live events and social media. His research interests include sustainability and equitable healthcare access.
Dr Shweta Jaiswal is a senior healthcare professional with over 18 years of experience as an Anaesthetist & Intensivist. She has worked across India in various tertiary care hospitals. Her field of expertise are Cardiac & Neuro Anaesthesia and Cardiac Critical Care & Transplant Critical Care. She has been instrumental in establishing E-ICU in two hospitals in Chhattisgarh. And has also worked with NABH & JCI Committees in several corporate hospitals. She did her MBA in Healthcare from ISB and is currently involved in Research in the field of Healthcare at ISB.
D.V.R. Seshadri is a professor of practice in the marketing area at the Indian School of Business. His areas of interest are healthcare, business-to-business marketing, and climate change. He is actively involved with several NGOs such as Aravind Eye Care Systems, Madurai and DHAN Foundation, Madurai in addition to engagement with several top corporates such as companies of the Tata Group and L&T. Over the years, he had been engaged in teaching/ consulting capacity with over 100 large corporates, both India-based and foreign MNCs. He is currently the director of ISB-CBM (ISB-Centre for Business Markets), a platform for the engagement of global top academics in B2B Marketing with the industry, particularly in India.
