Can the training and employment of young women fix healthcare in rural India?
Roughly 7 of 10 Indian citizens live in villages of 500 to 3000 people and nearly 70% of the population lacks access to quality healthcare, relying often on dubious "quacks" who seek to solve ills via harmful steroid shots or the like. But one one organization saw the chance to harness the idleness of young women and "marry" them to technology in order to develop a model for fixing basic healthcare in India.
case of Piramal e-Swasthya is often held up in the global healthcare world as an example of how to use mobile technologies to expand access to basic healthcare. I learned about it when co-authoring
a case study about it a couple of years ago.
However, while reading Hima Batavia's post about mobile training in India and Sam Green's post about data and pattern recognition, it made me view Piramal e-Swasthya in a different light.
As the video above explains, the intervention begins with the insight that much basic healthcare diagnosis and treatment doesn't require a medical specialist. It involves being able to ask the right questions about the symptoms and antecedents, using that information to make (in the majority of cases) a correct and straightforward diagnosis, and then prescribing a known/low-cost treatment. Piramal e-Swasthya realized this could be done by training local young women to act as a
swasthya (health) sahayika (helper or 'friend in need'). These women attended to people in villages for a small fee and when in need of support connected with a call center in Mumbai where a first-line of people running diagnostic algorhytms supported them and a second line "doctor" on call verified diagnoses and treatments and consulted on more complex cases.
Coverage of this case usually focuses on the scalable healthcare access piece. However, Piramal e-Swasthya also learned that they made a difference with these young women because, since the women were based in Rajastan, they generally lacked socio-economic opportunity. (For example, girls have higher infant mortaility rates than women because of the shifting in resources toward the males when tough trade-offs are made.) Piramal e-Swasthya gave these young women skills, a job, income, and built their self-confidence - all while working to make the village healthier.
As one of the co-founders once shared with me. The greatest measure of the program's impact, for him, was speaking to one young woman who explained her experience as such (to paraphrase):
"When the program started I would talk to people looking at the ground, after six months I looked here (she raised her hand a little), and after a year I started looking people in the eyes."
There are complex cultural elements at play here in need of evaluation, but one cannot discard the young woman's increased sense of self-confidence which made her feel better about herself.