Getting health care to vulnerable communities.

Abstract

On 26 July 2005, when Mumbai was flooded within hours, Savita Das, 35, faced a decision no woman should have to make. Savita's 10-month-old daughter had fallen into the dirty floodwaters and urgently needed to be taken to hospital. The child was already suffering from severe malnutrition and the floods made her diarrhoea and respiratory infection even worse. But as a widow living with her six children in a slum on the edge of the city, Savita had no choice but to watch her youngest child die. She recalled with sadness how she named that child "Lucky" in defiance of the family's already bad fate. "I knew my baby had to be taken to a hospital. But I have five other small children, Who would look after them if I am away for more than a day?" Savita said, referring to her daughters: Sujara, 9, Supriya, 6, and Kantari, 5; and sore: Amar, 4, and Chaman, 2, who were also malnourished and unwell before the floods. "If I take time off from work, how will I feed them?" said Savita, who earns around 50 rupees (about US$ 1) a day, after eight hours of back-breaking work at a scrap warehouse, separating plastic and other products that are used by the recycling industry. Savita's story illustrates one disconnect, among many, that sometimes exists between public health policy and practice. While the Indian government's health policy is aimed at helping women like Savita, in practice such people often fail to access available health-care services for a number of reasons. Addressing this disconnect is vital for making public health services more equitable in developing countries. This was a core issue at the annual meeting of the Global Forum for Health Research in Mumbai, 12-16 September, attended by 700 international researchers and public health experts whose theme was "poverty, equity and health research". The Geneva-based nongovernmental organization (NGO) campaigns for more research and development funding for the diseases of the poor and more funding for research into how to improve service delivery to vulnerable communities like Savita's. Just weeks before the flood hit Mumbai, a local NGO, the Society for Nutrition, Education and Health Action (SNEHA), demonstrated how, in practice, such research can indeed come to the aid of vulnerable and impoverished communities. They and others involved in similar work believe that research into health systems and how they function on the ground can save lives in such communities. In a study of six wards in Mumbai, the NGO identified Bhim Nagar as one of the most vulnerable communities because of its lack of access to basic shelter, hygiene and health care. In the absence of these basic services, the group knew that--even though the slum was not one of the worst flood-affected areas--its people were likely to suffer more than those living in better-served parts of the city. A team of doctors and social workers from SNEHA reached Bhim Nagar on the third day after the deluge. They brought food, medical aid and counselling, but it was too late to save Lucky, who died on 4 August. The group's research findings ring true for Savita. When Savita's mother died because the family could not afford medicines to treat her high blood pressure, Savita's children lost their support system while she and her husband were out working. Seven months later, Savita's husband Kewal, a construction worker, died of gastric-related problems. His daily pay of 60 rupees barely provided the family with a frugal diet of rice and lentils and certainly not enough to buy' the drugs prescribed for him by government hospital doctors. "Savita's inability to access timely health services for her child is a consequence of her circumstances," said Dr Armida Fernandez from SNEHA, calling for the provision of mobile health services to such communities. Savita's family are Bengali speakers who came to Mumbai from Assam. …