Promoting Healthcare in India
All across the planet, countries and societies are increasingly facing social, economic and climatic challenges. Good health and a robust healthcare system are integral to the quality of life for all human beings. Hence, global healthcare and innovation in the field have become pressing needs of our times. This is why the German Embassy New Delhi hosted an Indo-German Health Roundtable in August 2016. Among the speakers at the event was Mirai Chatterjee, director of social security at the Self Employed Women's Association (SEWA), an Ahmedabad-based trade union that works for the rights of poor, self-employed women workers in India.
As a follow-up to her participation in the roundtable, she was invited to be part of the Third International German Forum that was held at the Federal Chancellery in Berlin on 21st/22nd February, under the heading “What matters to people – global health and innovation”. Experts from 25 countries met to find ways of enhancing health and the quality of life. They discussed various approaches and ideas about these issues, possible courses of action and exchanged experiences. Improving wellbeing worldwide was the overarching theme of the forum.
During one of the panel discussions, Chatterjee highlighted her observations and talked about the critical success factors in promoting health in India. Pooja Chaturvedi from the German Embassy New Delhi spoke with Mirai Chatterjee about her experience at the forum, her presentation and what she gathered from her by interactions with the many international experts present at the forum.
Mrs Chatterjee, how was the experience?
Prior to the forum, all the main panellists had an informal dinner discussion about the forthcoming forum. It was also an opportunity to get to know the participants from all over the world, including Africa, the US, Canada, United Arab Emirates and so on. The event was well organised and the discussions were very fruitful and enriching.
I was on the opening panel on the second day of the forum, wherein I spoke about how governments and organisations can actually provide public health services to the poorest of the country and how to make such operations successful, based on my experience in India, The main challenge is how to reach people and then how to organise them for better health. I was given ten minutes to speak, and I obviously spoke about my SEWA experience. My observations and points resonated with other participants from developing countries who were also on the panel.
Can you tell us more about your participation as a panellist, and what were your contributions?
I spoke about the critical success factors in promoting health in India. The key learning that I focussed on was that people must be at the centre of all efforts. Further, health promotion must be by, for and with the people, especially the poorest, like women workers in the informal economy. A decentralised, local and “doorstep” approach is most effective in promoting people’s health.
For that, it is very important to organise women workers into their own union and cooperatives, including a worker-run and -owned health cooperative. I also talked about how integrating health promotion into primary healthcare and ensuring that all efforts are led by local health promoters-cum-health workers—preferably women—results in effective, low cost and appropriate health education and promotion.
According to you, what is needed to achieve the objective of low-cost health education?
One of the important factors that I mentioned during the panel was to build partnerships between people, the public health system, private providers, medical associations and medical colleges, as it significantly strengthens and supports local health promotion and enhances local health promoters’ knowledge, skills and linkages for deepening health promotion at people’s doorsteps.
As we are in a technology-dominated age, my panel was also focussed on putting technology like mobile phones and hand-held tablets in the hands of local women health workers, as it helps to strengthen their work and credibility at the local level. With such technology, they can send health promotion messages, undertake diagnostic tests for diabetes and show short health education and awareness film clips. Tablets also help to send and store authentic health data collected at the local level.
What other factors did you mention?
The other major point was primary healthcare. How can we provide basic healthcare to people’s doorsteps so they don’t have to go to big hospitals and spend time and money? My points resonated with other colleagues from Asia and other developing countries. For example, a participating colleague from South Africa spoke about similar situations for rural and poor people in his country. Likewise, a professor from the University of Toronto said that the door-to-door approach is beneficial to a lot of rural people in remote areas, including the indigenous or First Nations’ people in Canada. It was also a learning experience for me to hear others’ experiences and to participate in the panel at the forum.
Can you tell us more about the panel discussions at the forum?
The Third International German Forum focussed on four main aspects. First was using the potential of information and communications technology (ICT) in the healthcare sector. How can it be harnessed to bring healthcare to remote regions through telemedicine or data or just instant communication? ICT is one of the greatest global drivers of innovation. Technological developments, significant potential cost savings and changing behaviour patterns in digitally connected societies are accelerating the development of eHealth.
The second aspect was improving the use of antibiotics. Often improper use of antibiotics around the world is causing more and more strains of bacteria to develop antimicrobial resistance. This means that antibiotics lose their effectiveness. I found this very interesting, as the issue of tuberculosis and antimicrobial resistance is a huge health challenge in India. And we need more research and solutions for this problem.
The third aspect was fighting neglected tropical diseases (NTDs) which primarily occur in tropical and subtropical regions, where medical care is often deficient and healthcare systems are weak. To fight NTDs, good preventive measures, effective diagnostic methods, treatment and research are essential.
The last—but immensely important—topic was the issue of mental health and overcoming the taboo related to it. Around the world, every fourth individual is affected by mental illness at least once during his or her lifetime In many societies, and in India as well, mental illness is a taboo and those affected by it are stigmatised. It is therefore necessary to examine how societies can arrive at a better understanding of mental illness so they know how to better deal with it. As a part of the mental health group, what really stuck me was how the situation of mental health, even in advanced countries like Germany, has a long way to go. That was surprising, knowing Germany’s strong and robust social security and healthcare system. Much needs to be done when it comes to mental health all across the globe.
Was there a presentation that you particularly liked?
One particular presentation that I enjoyed was on global ethical hacking. Young Kenyans were encouraged to come up with solutions, and one team was given the first prize. They also had presentations on the use of data when it comes to public health.
For me, it was enriching to know what kind of research is happening and what solutions are being developed across the world vis-à-vis public health. For example, I learnt how South Africa is approaching the issue of reaching remote rural areas. There was also a doctor from Abu Dhabi who spoke about how they are using telemedicine for people who are elderly or extremely sick. These are the solutions that I took back with me to India.
You also met Chancellor Dr Angela Merkel during the visit. How was the experience?
The highlight was of course the special discussion with Chancellor Merkel. This happened on the second day in the afternoon. One person from each of the four mentioned groups presented their points to Dr Merkel, and she asked subsequent questions. I got a chance to speak to her and tell her about the importance of primary healthcare systems and the challenges in promoting healthcare in countries like India. I also stressed on involving local women as front-line workers to tackle mental health issues and the taboos related to mental health. I think she appreciated that. After that I managed to meet her one-on-one and presented her with a silk stole made by my SEWA sisters. She asked me to convey her best regards to all the SEWA sisters. Later, I got a thank-you letter from her team.
Mrs Chatterjee, thank you very much for your time and insights!