1. India’s Hidden Health Care Labor Force
By JYOTI PANDE LAVAKARE
Courtesy of Zeena
Johar/SughavazhvuA clinic in Kavarapattu, Thanjavur, Tamil Nadu, run by Sughavazhvu, an organization which
provides health care in rural areas.
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Entrepreneurs and new ideas, made in India.
As India grapples with the daunting challenge of providing health care to the millions who can’t
afford or access it, a growing number of “affordable health care” entrepreneurs are focused on
developing new solutions for the rural and remote parts of the country.
One such initiative is gaining steam in Thanjavur in Tamil Nadu, where IKP Center for
Technologies in Public Health has partnered with a local nonprofit, Sughavazhvu Healthcare, to
set up a network of well-equipped health centers that provide a broad range of health care
services.
“In India, money is not the problem,” said Nachiket Mor, a public health expert who is an IKP
Center director and chairman of Sughavazhvu Healthcare. ”Manpower is not the problem. We
just need to create and demonstrate on the ground how a primary health care system can work,”
he said.

2. Courtesy of Zeena Johar/SughavazhvuA physician examining a patient in
Sughavazhvu’s rural clinic in Andipatti, Thanjavur, Tamil Nadu.
The pilot, not-for-profit project is currently running seven facilities, which, Mr. Mor said, “could
act as model primary health subcenters.” Each center has protocols for the treatment of a wide
range of ailments, including cardiovascular diseases, diabetes, anemia, oral health, women’s
health and reproductive care, ophthalmic care and even mental health counseling and
treatment.
Across India, access to health care remains a pressing problem, exacerbated by the country’s
large population and shortage of doctors. Nowhere is this challenge more acute than in rural
India, which is experiencing a severe shortage of qualified health care practitioners. According
to Health Ministry statistics, the doctor-to-patient ratio for rural India is one to 30,000; the
World Health Organization recommends a ratio of one to 1,000.
This leaves the health of rural populations largely in the hands of people who aren’t always fully
qualified, including family elders, midwives and doulas, untrained community health workers
and accredited social health activists (known as ASHA workers) who merely refer patients up
the chain to specialists and bigger-city hospitals, Mr. Mor said.
The Indian government has tried to fill this gap by providing low-cost care through rural health
centers, called “subcenters,” in villages, tasked with offering primary care. But often they are
empty rooms, Mr. Mor said, with little or no qualified staff or facilities.
The Tamil Nadu pilot program is intended to show that it is possible to provide continuous,
quality health care for rural communities by using village-based “health extension workers” to
assist doctors.

3. What Mr. Mor calls his “game changer” is India’s large talent pool of what are known as “Ayush”
doctors, practitioners of Ayurveda, Unani and Siddha medicine, who are trained in indigenous
medical education. (Unani medicine originated in the Arab world, while Siddha is from Tamil
Nadu.) There are 750,000 qualified and registered Ayush practitioners who are currently
severely underutilized, he said.
“In our view this talent pool is already large,” he said. “Their services can much more easily be
expanded and utilized than the pool of physicians trained in allopathic care,” that is,
conventional modern medicine.
These doctors already have much of the training they need, Mr. Mor said, as there is an 80
percent overlap between the curricula they follow to become Ayush doctors and the
international M.D. curriculum.
The project trains and certifies these indigenous doctors to serve as “independent care
providers” in a rural setting. A Supreme Court judgment made it legal for Ayush doctors to
practice conventional medicine, provided they follow certain regulations. The training program
has been developed in partnership with the University of Pennsylvania’s School of Nursing.
Mr. Mor said he hopes to find private sector players or state governments to partner with to set
up similar facilities across the country. He is in talks with private and state partners in Odisha
and Uttaranchal, he said.
He brings to the project his experience as a part of the government committee on universal
health coverage instituted by the Planning Commission, which has recommended the
establishment of a National Healthcare Reform Commission. It has also recommended the
introduction of a new three-year Bachelor of Rural Health Care (BRHC) university program to
train rural health care practitioners, double the number of community health workers in rural
areas and recruit adequate numbers of dentists, pharmacists, physiotherapists and technicians.
Other countries are also trying to create a cadre of rural health care professionals, and the
nongovernment sector has often stepped in when the state has shown reluctance or
complacence.
In Bangladesh, for instance, BRAC, the world’s largest development organization, is in the
process of training 80,000 community health care providers who, like paramedics, will be
taught essential services such as maternal and child health care. They will be able to go door to

4. door to provide services in the poorest parts of the country, Asif Saleh, BRAC’s senior director,
said from Dhaka.
Read more about the affordable healthcare market, and what a fund founded by eBay’s Pierre
Omidyar’s is doing in the sector.
Jyoti Pande Lavakare is an author and columnist who has covered entrepreneurs from India
and Silicon Valley, including producing features for All India Radio in New Delhi, and writing
columns for Mint and the Business Standard. She is currently working on her first novel, “The
Memory of Pain.”