Rising population and socio-economic transition in the country have led to rapid urbanization and unplanned expansion of cities, as more people are migrating from rural areas to urban centers in search of better livelihood opportunities. "This has placed increased demand on urban infrastructure, services and public places, leading to upsurge in disease burden through increased susceptibility to risks for NCDs". Following these changes in the socio-economic environment of individuals, risk factors for NCDs have become widespread. Market liberalization and agricultural subsidies have made unhealthy products easily available at reduced prices, which are causing negative health outcomes.
Some of the behavioral risk factors of NCDs are closely interlinked to poverty, low education, poor diet, inequitable access to health services, and gender disparity. Diabetes (particularly type 2) was previously seen as a disease of affluence, which now seem misleading, as approximately 70% of the world's diabetic people live in low and middle income countries, with high prevalence in world's poorest cities, where access to health care and social support is either not available, or is very limited. Low intake of fruits and vegetables and lower levels of physical activity coupled with unhealthy food consumption is now being witnessed among the urban poor in India. Tobacco, seen as the single largest preventable risk factor, disproportionately affects the poor and the less educated. The inequities in vulnerability and exposure to tobacco use (social, psychological, health status, exposure to tobacco through advertising, lack of cessation services) is clearly evident, and often leads to prolongation of tobacco use among the adolescents and adults from poor socio-economic backgrounds. In the case of mental disorders, the risk is determined by an interface of genetic, biological, social, psychological factors. Increased rates of depression are associated with NCDs, and socio-economically disadvantaged groups bear uneven burden of negative health outcomes, with poor access to mental health services. Evidence gathered so far indicates higher burden of alcohol-attributable disease among people of lower socio-economic sections, despite lesser overall consumptions levels, as health outcomes depend not only on the amount but also on the type and quality of alcohol consumed.
High NCD mortality in India, which is attributed among other reasons to a weak health system, leads to high and many a times catastrophic out-of-pocket expenditure on health. For a country like India, which is facing scarce resources, prevention of diseases, particularly NCDs that are expensive to treat, is the most cost-effective strategy. India spent nearly INR 846 billion out of pocket on health care expenses in the year 2004, amounting to 3.3% of India's Gross domestic product (GDP) for that year. This marked a substantial increase from INR 315 billion spent out of pocket on health care in the year 1995-96 (about 2.9% of India's GDP in the year 1995-96). Out of this, a total out of pocket health expenditure on NCDs including heart diseases, hypertension, respiratory diseases, orthopedic problems, kidney diseases, neurological disorders, cancer, accidents, and injuries was INR 99.61 billion in 1995-1996, which has increased to INR 400.31 billion in 2004. Access to basic health care in itself is a challenge in India and contributes to health inequalities as this is mainly influenced by wider social determinants of health and infrastructural support. Thus, combating NCDs requires effectively addressing these social determinants of health, through comprehensive action focusing on prevention and control of NCDs.
VHAI believes that health and development are closely linked and therefore, community action and participation play a key role in achieving its goals.
VHAI works actively at the grassroots in rural as well as tribal India, through a number of interventions, training as well as capacity building programmes. There are some projects that are directly implemented at the field level but most were executed through partner organizations like State VHAs or credible voluntary agencies.
“The Khoj Project was one of the long term initiatives of VHAI being implemented in 1993 to bring about a holistic change in the lives of its beneficiaries by uplifting the socio-economic and health status of vulnerable communities
Its primary objective was to develop an enduring partnership between VHAI and the implementing organizations thereby strengthening the latter to effectively implement innovation, self sustaining community health and development programmes.
Voluntary Health Association of India’s deep concern about making a breakthrough in the health status of the people, particularly those living in the remote and in-accessible areas and generally of extreme low economic status, led to the evolution of an innovative approach of tackling health and development issues Khoj.
Of the 21 projects initiated in 1993, 9 were phased out by August, 2006, after nine years duration. Currently 5 projects were implemented and continued for a further term of three years till 2010 in Orissa, Madhya Pradesh, West Bengal, Jammu & Kashmir and Sikkim.
The thrust areas of work undertaken under this programme are:
Health: Health interventions were mainly used as an entry point, and provision of curative services was the main emphasis. In addition, health and relief camps in epidemic situations were organized in project areas. A health centre was established in each project site to take care of emergency situations. Priority also had been accorded to improve women’s health status in the community and focus on health promotion by improved communication and developing need- based area specific strategies.
Community Development: To ensure community participation in the project implementation process, all projects had initiated steps to organize groups at different levels in the project villages. Involvement of the Community helped to increase literacy levels in the community.
Community Organization: Community development was an extremely important area of thrust. Major strategies adopted for community development are capacity building, income generation programmes and education.
Environment: Village and Town environment, sanitation and drinking water related activities, prevention of deforestation, preservation of natural resources; kitchen gardens were some of the areas covered by the project.
1. J&K State
The Khoj project was implemented in Chadoora and Khan Sahib blocks of Budgam district reaching the most vulnerable families. Under the project, curatives services were provided, various trainings on health promotion and awareness generation programmes were conducted. The orientation sessions were organized for the field staff for effective implemention of the programme. For economic development of women, income-generation activities were implemented, which will lead them to socio-economic empowerment.
2. Dzongu, Sikkim
Dzongu is one of the remote areas consisting of 30 small village hamlets located in North Sikkim. Geographically covered with hills, mountains and trenches. As per the Sikkim government notification, Dzongu area is a protected area, imposed due to the backwardness of the inhabitants so as to protect them from exploitation.
The Dzongu Khoj project was initiated with the goal to improve the health and economic status of the inhabitants of Dzongu block. The Khoj project in Dzongu focused on optimum utilization and strengthening of the government health infrastructure for long term sustainability through orientation of the PHC & PHSC Staff, MLAs and Board Members, conducting health awareness generation programmes, ensuring economic empowerment of the community through SHG strengthening, group formation and health promotion camps and fairs.
3. Urban Health Project, Khoj Katwa, West Bengal
Through an urban project launched in 19 wards in Katwa Municipality, West Bengal, VHAI has worked in locations of Baganipura, Katwapara, Khalpara, Mondaolpara, Faridpur colony and Mathpara for health promotion with the goal to improve health and socio economic status of the people of Katwa town, especially women and underprivileged sections of the project area. Under the project, activities like community health promotion, formation of SHGs, their support and training, school health promotion activities and community medical health check-up camps were organized in the Katwa Municipality.
4. Kujanga Block, Jagatsinghpur district, Orissa
It is one of the most underdeveloped regions where not much development has taken place in the last 50 years and the area is also prone to different kinds of disasters. The project was one of the model programmes where the issue of poverty were addressed with a right-based approach and the overall development of the community were structured by organizing community level health, livelihood and disaster management initiatives. Activities undertaken were orientation programmes for volunteers on health issues, health promotion activities in schools and community, health promotion programmes in the slums of Bhubaneswar, disaster preparedness initiatives, right-based activities for poor and marginalized community, linkages with other development activities for sustainability of the project and self-help group initiatives for economic empowerment and improvement of the social status of the women members in the community.
5. Maheshwar block, Madhya Pradesh
It attempts to improve the health and socio-economic status of the people, especially women and underprivileged sections of the project area. The project aims to strengthen the health-related structure of the community organizations to work as more effective change agents, implementers and confluence of backward and forward linkages to ensure the success of health along with development programmes in an integrated manner. The project primarily focused on Health, Community Development and Environmental issues. Thus improving health and socio economic status of the people of 25 villages especially women and underprivileged sections of the project area.
The journey of VHAI in managing the 5 PHCs in the state of Arunachal Pradesh has been both rewarding and a learning experience.
Since the state under discussion has a difficult geographical terrain, Arunachal Pradesh was given the state status in 1987.
It is situated in the North eastern part of India with 83743 sq. kms area and shares a long international border with Bhutan in the west (160 km), China in the north and north-east (1,080 km) and Myanmar in the east (440 km). Arunachal is the largest state, area-wise, in the north east region.
The Government of Arunachal Pradesh handed VHAI over the management of five almost dysfunctional Primary Health Centres in January 2006.
Keeping in context the pioneering efforts of VHAI in making the five almost dysfunctional PHCs not only functional but also improving the health seeking behaviour of the community, the State Government decided to hand over the management of the Community Health Centre (CHC) located in Deomali, Tirap district to VHAI with effect from 1 August 2009. Soon after the take over, VHAI deployed several qualified doctors, including specialists, and placed the nursing and paramedical staff as per the Memorandum of Understanding.
With all these efforts in place the healthcare delivery has improved significantly; almost four times after the takeover. Now the hospital is suitable to become a first referral unit (FRU), since the operation theater (OT) and related facilities are in place.
VHAI was handed over the management of the CHC in Deomali w.e.f August 2009