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Urban health is a catastrophe waiting to happen

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After the devastating earthquake in Latur, Maharashtra on September 30, 1993 the Americares Foundation airlifted vital medicines and medical supplies to ensure access to medicine for the survivors. Today, they are involved with Cyclone Fani but their work goes beyond disaster relief. Rachel Granger, Vice President- International Partnerships and Programs, Americares Foundation and Shripad Desai, MD and Country Director, Americares India Foundation review the journey over the past 25 years and explain to Viveka Roychowdhury why they decided to focus on local health centres and urban health in India

Could you tell us more about Americares and the work you do around the world Granger?
Americares is a health-focussed relief and development organisation that saves lives and improves health for people affected by poverty or disaster. Each year Americares reaches more than 90 countries, including the US, with life-changing health programmes, medicine and medical supplies. We envision a world in which all people have pathways to health and opportunity. We believe that for people affected by poverty or disaster, health is essential. With good health, people can attend school, be productive at work, care for their families and contribute to a strong community. Poor health puts all of that at risk. Health is fundamental to all aspects of development.

Therefore, Americares invests in local health centres. When local health centres thrive, so do people in their communities. Our programmes help communities prepare for, respond to and recover from disasters; increase access to critical medicine and medical supplies; improve and expand clinical services; and prevent disease and promote good health in vulnerable communities.

What are the focus areas of Americares India Foundation?
Desai: Americares India Foundation builds on the global as a health-focussed relief and development organisation with a particular emphasis on urban health. Our programmes align with our global interventions in emergency programmes, access to medicines, and clinical services together with community health. Since inception, Americares India’s work has been characterised by compassion, expertise, quick response and effective aid for the people who need it.

Over the last decade, the Americares India team has launched large scale response and recovery efforts following emergencies in India including the Rajasthan flooding in 2017 and more recently the Kerala flooding to provide immediate aid and help restore quality health services. We support and deliver quality healthcare services at public hospitals and in low income communities, preventing and treating illness and promoting good health for each patient. Through our mobile health centres and partner clinics, we provide patients with treatment, prevention, education and health management services. We also provide referral services to our network of partners to help patients navigate the healthcare system. Finally, we design and implement sustainable programmes in school and low-income communities in order to strengthen community health.

What is the source of funding, resources for the activities being conducted by the Americares India Foundation?
Desai: Being a non-profit, Americares India Foundation solicits funds from corporate donors and foundations for the programmatic work. We work closely with the corporate CSR teams/ Foundations, with aligned strategic vision to partner for programmes. Americares India Foundation a charitable organisation registered in India, raises majority of funds from donors within India and part from our global donors.

How does Americares choose to allot funds, resources for the projects it chooses?
Desai: Our mission is to save lives and improve health of people affected by urban poverty and disaster so they can achieve their full potential. We design and implement high quality programmes to address the needs of these population. Our core health themes include Mother and Child Health, Infectious Diseases, Mental Health, NCD (hypertension and diabetes) and Health System Strengthening. We channelise our resources to address the needs of these population through our programmes.

How does Americares monitor the outcomes and benefits of the projects and programmes? For how long etc?
Desai: Americares follows a structured project management process that involves monitoring and evaluation as a vital component. A dedicated team tracks the achievements for each programme versus the set outcomes.

What are the focus areas of these interventions globally and in India? What kind of partner network does it engage with?
Desai: Globally, Americares invests in local health centres. When local health centres thrive, so do people in their communities. Our programmes help communities prepare for, respond to and recover from disasters; increase access to critical medicine and medical supplies; improve and expand clinical services; and prevent disease and promote good health in vulnerable communities.

Americares India Foundation builds on the global as a health-focussed relief and development organisation with a particular emphasis on urban health. Our programmes align with our global interventions in emergency programmes, access to medicines, and clinical services together with community health. Since inception, Americares India’s work has been characterised by compassion, expertise, quick response and effective aid for the people who need it.

How is Americares engaging with government programmes like Ayushman Bharat, etc? 
Desai: Our focus is to collaborate with government to catalyse their health interventions and priorities. Our programmes therefore are rolled out in collaboration and partnership with the local government. Be it our mobile health centres, school health programme or health centre strengthening we work with the local government and public health facilities. During disasters, we work closely with the government to improve access of medicines, medical supplies and aid at the government health facilities. In Kerala, we are supporting the upgradation of 67 primary health centres (PHCs) to family health centres (FHCs) in line with Ayushman Bharat Family and Wellness centres.

What is the long term strategy for the Foundation in India?
Desai: Our India strategy focusses on building ‘Thriving Urban Health Centres’, through capacity building, infrastructure support, service delivery and connecting them to conscious communities. We aspire to maintain the synergy with our global vision while customising the strategy to address the local mission of being the urban health catalyst.

How is Americares involved with natural disasters like the ongoing Cyclone Fani and the floods that hit Kerala last August?
Desai: Americares is responding to Cyclone Fani survivors, conducting health camps and ensuring medical supplies. We are supporting more than 3,000 families in the affected districts ensuring access to safe drinking water, shelter and hygiene kits. Post the relief efforts Americares will assess the damage to the health centres and support the rehabilitation efforts.

To restore and improve health services for survivors of the devastating August 2018 floods in Kerala, Americares India is donating medical and diagnostic equipment to flood-affected health centres. With support from multiple donors, Americares is upgrading of 67 Family Health Centers across seven districts in Kerala. Upgrades of Family Health Centres are part of Americares India’s emergency response and recovery programmes following the historic floods in Kerala. A Family Health Centre provides universal (whether patient approaches an institution or not) and comprehensive (promotive, preventive, curative, rehabilitative and palliative) health services to strengthen the health care system. The upgrades will be part of the ‘Ayushman Bharat – Family and Wellness Centres’ under the ‘Ayushman Bharat’ national programme announced by Prime Minister Narendra Modi.

These floods and landslides in Kerala, during the monsoon of 2018, caused permanent damage to health equipment, assets and overall health facilities, leading to diminished services, reduced efficiency and placing a huge burden on the health system going forward. Kerala is known for its network of effective local health centres, engaging with the community to achieve better health outcomes.

In addition to health centre upgrades, Americares India is also focussing on two other key areas of intervention in conjunction with the state government:

The first is on Mother and Child Nutrition. A vulnerable population of lactating mothers and children are at risk of compromised nutrition that can have long-term impact on the growth of babies. Americares is working with the government to provide nutritional support to 11,000 mothers and children in the worst affected districts of the state. This is being done in a programme identifying the mothers at risk through the ASHA (health worker) network and reaching out to them through health education and product support.

The second is the Mental Health Programme. Post-traumatic stress disorder (PTSD), anxiety disorders and other mental health issues are common after such large-scale disasters. Kerala has a high burden of people facing mental health issues, including senior citizens and individuals suffering from alcoholism who need support post-disaster.

The state of Kerala, NIMHANS Bengaluru and Americares are undertaking a large-scale programme spanning over one year, collaborating among health centres, counsellors, ASHA and communities to identify individuals with mental health issues and connect them to health centres for treatment. Americares is supporting the training and capacity building of the counsellors and ASHA, in 275 panchayats as part of this field-based programme to strengthen the mental health management and capacity within the state.

Shripad Desai

Why has Americares chosen to focus on the urban poor?
Desai: Rapid urbanisation has outpaced the public healthcare infrastructure growth in India. By 2030, 50 per cent of India’s population will be living in urban areas and approximately 50 per cent of urban population living in slums. Life in overcrowded and unsanitary urban slums is dangerous for health, development and welfare. For millions of urban poor living in slums healthcare is not a priority due to lack of access, affordability, education and awareness. Urban slum dwellers are at risk of the double burden of both communicable and non-communicable diseases. Unless addressed now, urban health is a catastrophe waiting to happen.Over the past decade Americares has developed transformational programmes to address the urban health gaps of access, awareness and quality of care and aspired to catalyse the urban health challenge in the coming years.

Tell us more about your global strategy.
Granger: At the core of our global strategy is a focus on health centres – helping them thrive.
Local health centres are the health posts, clinics and hospitals that serve as hubs of primary care and health-focussed activity in their communities. More than simply facilities, health centres include the health workers – from medical professionals to health educators – who staff them, as well as the people and communities they serve.

We define thriving local health centres as those with strength in four areas:1. Professional capacity of the health centre itself;
2. Sense of care, respect, and dignity patients experience;
3. Community engagement to prevent disease and promote good health, while ensuring those served by a health centre have a voice in how it serves them; and
4. Connection with larger health systems for referral, support and resilience.

How do you see the relevance of the global vision and strategy to Indian context?
Desai: Our India strategy focusses on building ‘Thriving Urban Health Centres’, through capacity building, infrastructure support, service delivery and connecting them to conscious communities. We aspire to maintain the synergy with our global vision while customising the strategy to address the local mission of being the urban health catalyst.

How do you see Americares playing a role in driving urban health in India over next few years?
Granger: Americares will help to drive the discussion around urban health in India and continue to advocate for investment/support to urban health centres. This is particularly important because the urban population in India is growing at a more rapid rate than the rural so urban health centres will continue to see their service requirements increase. Addressing these needs will require the pursuit of creative public/private partnerships, which we are fortunate to have started developing, and raising the discussion level on the importance of good health as a core component to strong communities.

How do global healthcare players partner/contribute to your efforts?
Granger: Partnership with global healthcare organisations is a critical component to the success of Americares. We are the leading global non-profit provider of donated medicines and medical supplies, distributing over $900 million in medicine and supplies to more than 90 countries each year. We can match these donations with an expansive partner network of over 4,000 health centres in the US and around the world. These donations allow our partners to fill acute gaps and ensure that patients who otherwise would not be able to receive these medications now have the access they require.

What is the role of Indian healthcare players in your efforts in India
Desai: Healthcare players in India both local and global play an important role in driving health focus in India. Americares partners with leading healthcare players during disaster response, relief and recovery programmes. We seek sustained and scalable strategic partnerships with healthcare players as we strive to build thriving urban health centres in India. Our health themes of mother and child health, infectious diseases, hypertension-diabetes and mental health are the issues most leading healthcare players care for. We therefore see a huge potential for synergistic partnerships aligned to their CSR vision in India.

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