Articles Perspectives

Promoting Translational Public Health through public health proficient NGOs

Developing countries with weaker health systems find it challenging to provide equitable, affordable and optimal healthcare to its population due to conflicting developmental priorities. In India, low budgetary spending on healthcare, human resource constraints and paucity of hospitals to cater to the needs of the population have resulted in severe yet unaddressed gaps in the public health sector. This forces the majority of the population to seek healthcare in the expensive commercialised private sector, often resulting in catastrophic expenditure on households. This cycle continues to constrain India’s roadmap to improving population health and achieving desired health outcomes. Non-governmental organizations (NGOs) are paramount in bridging this gap by strengthening health systems, fostering community participation and promoting healthier societies. Some may also have the audacity to build health systems in scale and breadth while maintaining low-cost service.  

The ongoing COVID19 pandemic further emphasises the urgent need for the government to collaborate with NGOs that cater to the communities at the grass-root level. The lockdown strategy adopted by governments around the world has been criticised extensively by public health experts as it inflicts severe economic damage and disrupts social protection. India’s primary healthcare continues to be severely underfunded and understaffed relative to its massive burden, and COVID19 only highlights the apparent as it ravages the nation. A major shortcoming of the state and central governments during the national lockdown was the joint inability to serve  the daily wage-earning internal migrants who compose about 40% of the country’s population. On the other hand, NGOs sprung to action by providing food, emergency supplies and transportation to the stranded migrant workers across the country. Although the lowest of the economic strata bore the brunt of the lockdown, urban health was also affected in a different way. A recent survey by CHD Group, a Mangalore headquartered NGO, which explored the impact of lockdowns on urban population stated that 38% reported experiencing emotional and mental stress during the lockdown. Furthermore, over 70% of the respondents also believed that NGO-government collaboration could have resulted in an improved response to the COVID19 pandemic.  

Although NGOs are historically known for their contribution in providing relief during humanitarian crises, they have tirelessly supported India’s poorly structured health system in various other domains, especially mother and child health and mental health. For instance, nearly 60% of all healthcare workers operate in urban areas, where only 28% of the population resides. On the contrary, only 40% work in rural areas, where over 72% of the population resides. Moreover, India is short of half a million doctors, based on the World Health Organization’s recommendation of 1 doctor for every 1,000 population. This economic disparity further reinforces the need for the government to involve grass-root NGOs that have the ability to independently and extensively access even the most rural belts of the country, where the health needs are rarely met. While from an infectious disease perspective COVID-19 reigns supreme, the world needs to be ready for the next pandemic in mental health as well. Lockdowns, quarantine and social neglect has inched this closer to a potential catastrophe in the near future. 

A 2019 mental health report of the Karnataka state showed that the majority of  severe mental health disorders including schizophrenia and major depressive disorders, accumulate in the rural districts.  NGO-government collaborations are even more essential in conducting massive screening drives, such as that for malnutrition, primary care and others, increasing vaccination coverage and maternal education also. Moreover, NGOs – that operate at a low cost in a sustainable manner – also create low-cost replicable healthcare models. Thus, NGO collaboration with government programs is a potential strategy to improve healthcare equity. 

Local governments cater to a wide array of social and developmental requirements at the local level, but cascading risks do not get addressed in this process. Integration of a social health model created by CHD Group and other institutions must be linked to co-create risk informed planning and policies which brings inclusivity and sustainability at the very heart of development. Line ministries need to evolve a mechanism through which they can work together and streamline bottlenecks in the existing process of policy making.

About the author

Gautam Satheesh

Gautam Satheesh

Dr. Gautam Satheesh is a global health researcher who primarily focuses on access to essential healthcare for non-communicable diseases in developing countries. As a research assistant with the CHD Group, he has engaged in multiple projects such as distribution of mental healthcare utilization in Karnataka and assessment of lockdown among India’s urban population. Gautam has published his research in Tropical Medicine and International Health, Journal of Pharmaceutical Policy and Practice, Health and Quality of Life Outcomes, and Journal of Global Health.

About the author

Edmond Fernandes

Edmond Fernandes

Dr. Edmond Fernandes, MBBS, MD, PGD-PHSM, is the CEO of the CHD Group, India Country Office. He is a Community Health Physician with global health expertise who has written 2 books, has 19 research publications, 17 public policy advocacy impacting 2 million people and written over 160 articles in the print and electronic media. He is a Non Resident Senior Fellow at the Atlantic Council, Washington DC. He was the US State Department Legislative Fellow 2017 (Only doctor from India to be selected in 2017) & the Urban Health Collaborative Visiting Scholar at Drexel University Dornsife School of Public Health, Philadelphia, US and is Member – Health Task Force, DDMA, Government of Karnataka. He travels around the world delivering key-note addresses and as a resource person for different events in healthcare and is an external consultant to the United Nations Agencies from time to time. He writes articles for The Times of India, India Today Group and Forbes India currently.

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