Pichamma, a middle-aged migrant laborer from Mallaram village in Telangana, faces a daily struggle to make her ends meet. She travels for over ten kilometers to nearby towns in search of work. This search often ends fruitless. Pichamma does not always find something substantial to sustain her livelihood.
Pichamma suffers from hypertension and diabetes. To add to her woes, she was recently diagnosed with breast cancer. A cancer diagnosis poses many questions and uncertainties to the patient. Questions like “How did it happen?”, “ Why did it happen to me?”, “How will I manage it?”, “Will I be able to live?”, “Where should I go for treatment?” beset the patient. Pichamma was overwhelmed by the burden of medical expenses and felt like the end was near.
Pichamma’s neighbors informed her about the availability of private medical facilities and urged her to seek treatment. The expenses led her down a path of financial catastrophe. She sold all her possessions, including her land, to pay for her medicine and care. The once resilient Pichamma was pushed into abject poverty and hardship. However, Pichamma’s misfortune changed when she chanced upon meeting a doctor at the private hospital. This doctor informed Pichamma about a government program called Aarogyasri, which offers high-quality health service, free of cost. Despite being faced with the most difficult time, there was still some hope left for her.
Burdened by her condition, venturing outside to acquire remedies was beyond Pichamma’s capacity. During this hour of need, the Accredited Social Health Activists (ASHA) made life-saving medicines and diagnostic services available to her at the nearby primary health centers. With the help of ASHAs, she could get the medical attention she needed, free of charge. The Aarogyasri scheme provided her with comprehensive care and palliative services, allowing her to manage her pain and symptoms. Despite her financial setbacks, she recovered and resumed her life.
Pichamma’s story ends well. But it also highlights the lack of awareness about government-led initiatives among its citizens, and how this leads to catastrophic health expenditures for millions of people. People seek high-quality healthcare regardless of their socioeconomic class and often choose higher-quality care even if it is more expensive. It is unfortunate that often individuals are forced to choose between quality and cost when it comes to their health and well-being.
One of the overarching goals of the 2030 Agenda for Sustainable Development is to achieve Universal Health Coverage (UHC), ensuring all people have equal access to high-quality health services without financial hardship. India introduced the Ayushman Bharat – National Health Protection Mission as a novel approach to achieving UHC. Telangana already has a state health insurance scheme known as ‘Aarogyasri,’ which has now merged with the Ayushman Bharat PM-JAY. According to Socio-Economic and Caste Census (SECC) 2011 data, 26 lakh beneficiary families will be eligible to receive services under this scheme in the state. In addition, the commencement of bastidawakhanas (community clinics) is improving the accessibility to physicians and treatments. Despite this, many hidden roadblocks to better care provision continue to persist. In Pichamma’s story, despite its efforts, the government could not prevent Pichamma from availing treatment from a private facility and face financial hardships subsequently.
India carries a disproportionate burden of the world’s sick. Our healthcare system is afflicted by myriad system-level flaws, most notably the paucity of referrals and the insufficient navigational aid for patients, exacerbated by a lack of health promotion and awareness. Despite the profusion of policies at the national and state levels, their efficacy is undermined because the populace remains ignorant of their existence.
Most often, referrals are initiated verbally by ASHA or Auxiliary Nurse Midwife (ANM) workers, with no formal record or systematic documentation. Most of the time, ASHA workers accompany the patient to the nearest PHC or the district hospital. However, patients are commonly referred to higher facilities, with referral slips and bare minimum information. This ineffectual approach to treatment leads to undue delays, causing many to seek refuge in private healthcare settings.
A patient navigator and a toll-free helpline number at the district hospital can serve as an enabler of robust and efficacious healthcare. With the simple act of making a phone call, patients can inquire about the numerous services available at the facilities, taking the first crucial step towards strengthening the referral systems and empowering the citizens with the knowledge necessary to make judicious choices for their health and well-being.
The introduction of Ayushman Bharat Health Account (ABHA) IDs will pave the way for digital health and improve the accessibility of health records, thus avoiding duplication and promoting integration and interoperability between different programs. The VillageHealth Sanitation & Nutrition Committee (VHSNC )and Village Health and Nutrition Day (VHND) meetings should be used as opportunities to create awareness about various programs, as lack of awareness is quoted as one of the most common devils in disguise.
Pichamma’s health journey is one with many highs and lows. From despair over the bleak news of her cancer and the excessive treatment expenses, she discovered the availability of affordable healthcare services. Her story is a testament to the importance of integrated care to achieve universal healthcare.
The story is also a reminder of the lack of awareness about the government’s health facilities and the devasting impact it can have on people’s lives despite the government’s multiple efforts. It clearly highlights how much more needs to be done to make its citizens aware of what is done around them. An effective Information, Education & Communication (IEC) strategy can create awareness and disseminate information regarding the benefits available under various schemes/programmes of the Government and to guide the citizens on how to access them.
Integrated healthcare ensures people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services at the different levels and sites of care within the health system, organizing health system more around health needs rather than diseases. People and/or community are in the centre of health service delivery so that a comprehensive range of services can be provided to varying health needs and preferences at all levels of care.
Others like Pichammas are falling into poverty because of a lack of an integrated health system. The need of the hour is an integrated system to ensure timely, affordable, and high quality care for all.
Dr. S. SreeMeena, Dr Chilshu Chandran and Dr Shweta Singh
Photo Credits: Plexusmd