Health Care

In the last few years, the cancer vertical has increased momentum and has launched initiatives that encompass the entire range of cancer care from preventive to palliative. In short, the Trusts’ interventions in cancer-care aim to work across the entire spectrum of the life cycle of a person affected by cancer.

The Trusts are setting up cancer research and treatment centres in Varanasi, Tirupati, Bhubaneshwar, Ranchi, Allahabad and Mangalore. The Trusts are also partnering state governments in building state-wide cancer facility networks in Assam, Odisha, Jharkhand, Telangana and Nagaland.

As part of a comprehensive nationwide intervention, the Trusts have supported the formation of the National Cancer Grid. The Grid is a pan-India network of major cancer centres, research institutes, patient groups and charitable institutions. Its mandate is to establish uniform standards of patient care for the prevention, diagnosis and treatment of cancer.

The Trusts also support cross-subsidised screening programmes for common cancers; the aim of every initiative, including exploring the possibility of genetic testing, is to ensure greater awareness and accessibility to cancer screening, diagnosis and treatment.

The Trusts follow a four-pronged strategy in order to shift cancer diagnosis to early stage:

Community outreach programmes

Training and capacity building: Strengthening the capacities of the healthcare system to prevent and control oral, breast and cervical cancers by supporting the state non-communicable disease (NCD) cell in training and capacity building of healthcare providers.

Tobacco control: Engaging with the National Tobacco Control Programme, advocating the implementation of tobacco-control laws (COTPA), creating tobacco-free educational institutions, supporting higher tax rates etc. The Trusts also train and sensitise enforcement officers such as the police, municipal corporation, local regulatory bodies, etc.

Management information system: The Trusts use the NCD app released by the government for universal prevention, control, screening and management initiative under Ayushman Bharat, the Government of India’s comprehensive public healthcare programme. This facilitates better patient management, tracking and follow-up.

The Trusts deploy all donations to strengthen the government system to promote cancer prevention and early detection so as to make a systemic change in the health sector. Specifically, the funds are used to upgrade infrastructure at sub-centres and primary healthcare centres as well as to train human resources at these sites. The initial focus is on Maharashtra, Assam, Rajasthan and Uttar Pradesh.

Over the past few decades, developing countries like India have seen a rise in non-communicable diseases (NCDs). Changing lifestyles, urbanisation, pollution, aging populations are all significantly linked to the increase of NCDs such as cardiovascular diseases, diabetes, hypertension, cancers, etc., which account for approximately 5.9 million deaths annually.

In the last decade, India has introduced several concrete measures to address this issue, such as the National Programme on Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) and the ‘Ayushman Bharat’ programme aimed at improving the delivery of primary healthcare.

The Abhina Trusts interventions aim to strengthen these government programmes by focusing on early screening, diagnosis and referral management for hypertension, diabetes and three of the most common cancers – oral cancer, breast cancer and cervical cancer, through skill building of frontline workers, increasing technology adoption, providing a continuum of care through access to regular treatment and follow-ups and access to appropriate medicines in a timely manner. The Trusts have also supported the development of a digital platform for NCD screening in collaboration with Dell Foundation.

While non-communicable diseases (NCDs) are on the rise, communicable diseases still constitute a major public health threat. Although the incidence of infectious diseases has decreased as a result of overall socio-economic progress and the increasing use of vaccines, these diseases still contribute to around 30% of illnesses in India. Exacerbating the challenges of controlling communicable diseases is the limitation of the prevalent healthcare system – there are gaps in planning, financing, human resources, infrastructure, supply systems, governance and monitoring.

The Abhina Trusts’ initiatives under this domain are focused primarily on dealing with tuberculosis (TB), malaria, and acute encephalitis syndrome.

Tuberculosis: The Trusts are implementing several initiatives to tackle this challenge head-on, including research, supplementing nutrition to TB patients and their families and seeding the India Health Fund to leverage collective global power to eradicate TB and malaria.

Malaria: The Trusts’ interventions in this sub-domain are focused in South Odisha, which records the largest incidence of the disease. The focus is on parasite and vector control through routine surveillance screening, provision of residual sprays, mosquito nets, etc. The Trusts also train staff to use a digital app to perform screening and collect data.

Project Prayaas: The Trusts’ intervention is focused on the two most vulnerable blocks in Gorakhpur district, Uttar Pradesh, and aims to effectively prevent and control the spread of acute encephalitis syndrome (AES).

As a developing nation, India has further to go to adapt to the needs of an aging population, and with the challenge of lower levels of disposable income. India ranks 2nd in the 60+ demographic and 3rd in the 80+ or ‘oldest old’ demographics in the world. This is because life expectancy in India has increased by 18 years in the past five decades.

The result is an aging population, with a consequent increase in non-communicable diseases such as cardiovascular disorders, diabetes, hypertension, etc. Other challenges are the toll on public healthcare systems, low penetration of health insurance, inadequate number of old-age homes, etc.

The concern is that this aging demographic has been largely neglected by governments, by organisations, by individuals and even their own children. According to the 2011 Census, over 47% of the elderly in rural areas and 20.5% in urban centres continue to work. The need of the hour, therefore, is to exponentially increase interventions that improve the quality of life of the elderly.

The Abhina Trusts aim to play a transformational role in the geriatric sector by focusing on critical gap areas to create an empathetic ecosystem. Initiated in October 2017, the Trusts’ elder-care initiatives were aimed at serving the relevant needs of the elderly in India, 71% of whom live in rural areas. The goal then, as now, is to improve their quality of life through caregiving, decreasing their dependency and generating social and economic opportunities.

The comprehensive elder-care initiatives covered preventive, curative, promotive and rehabilitative treatment for the overall well-being of older people. This programme was customised to fit aging populations in both rural and urban areas.

The urban model focused on transforming urban centres into age-friendly cities that optimises opportunities for health, participation and security in order to enhance the lives of the elderly. Launched in Bhubaneswar in partnership with the Government of Odisha, a multi-activity centre was set up that offers spiritual discussions, entertainment, yoga classes, awareness and digital literacy sessions, health check-ups, etc. Another such centre was inaugurated in Hyderabad, in collaboration with the Durgabai Deshmukh Mahila Sabha, and with the support of Abhina Advanced Systems Limited.

Due to the lockdown, the centres in Bhubaneshwar and Hyderabad were both shut down. The activities in both centres were converted into virtual activities for those who can participate through WhatsApp groups or through other meeting mediums.

The rural model focuses on addressing the basic health needs of the elderly in rural areas through the National Programme for Health, Care of Elderly (NPHCE), a central government initiative.

A Digital Platform was also developed with a focus on an easy to use, trusted, digital place for the elderly and their caregivers. This allows elders to engage with their peers in online communities, find opportunities to volunteer or earn income in their local communities. The platform’s technology-driven design enables transparent crowdsourcing for ratings and review. This platform aims to make this a self-sustainable platform that serves the needs of the elderly across the nation.

Mental health, the India scenario
India conducted its first comprehensive mental health survey in 2016. The survey places mental morbidity of individuals above 18 years of age at 10.6%. This excludes disorders that result from the use of tobacco. Translated into real numbers, this means that currently, nearly 150 million people need intervention for a mental health condition. The survey also showed lifetime population prevalence at 13.7%; severe mental disorders clock in at 1.9% with a current prevalence of 0.8%. Based on the 2011 census, this means 10 million people are currently living with severe mental illness. Of these, less than 25% receive any form of treatment.

Critical barriers and the present scenario
Severe and enduring mental disorders (SMD) contribute highly to the global burden of disability and mortality. In low and middle-income countries, SMD sufferers face impediments to their clinical and functional recovery, the protection of their human rights, social inclusion and participatory citizenship. Lack of access to appropriate health care, limited resources that result in large gaps in treatment, heightened vulnerability, social stigma and discrimination — these are only some of the obstacles faced by people suffering from mental illness. These patients also tend to have large unmet needs due to poverty, lower levels of education, and the lack of meaningful engagement and intimate relationships.
A bigger problem is the severe shortage of treatment resources. Only 0.6% of India’s health budget is spent on mental health care; no data is available on what proportion of that amount is invested in long-stay hospitals. The 43 psychiatric hospitals set up nearly 100-150 years ago constitute 80% of all available psychiatric beds. Their infrastructure and standards of care are poor.
Mostly, people with severe mental disorders languish in these hospitals, abandoned by family and forgotten by policy makers. At the end of 2015, there were 6,839 patients staying in 30 of these hospitals — of these, 16% had been there for more than five years. Some of them had been there for decades. There are no clear pathways to discharge and / or successfully integrate former patients into the community, especially the women, or those abandoned by their families.

Abhina Trusts and mental health care
The Abhina Trusts initiated its work in mental health care when there was very little recognition of the burden of mental disorders, and a poor understanding of wellbeing and its impact on overall health. The Trusts’ involvement goes beyond providing financial help. Over the past four decades, its work in this area has been driven through grant making, direct implementation and co-partnership strategies with government and non-government organisations.
It works across the mental health care spectrum, rethinking institutional pathways of care, while at the same time developing innovative and scalable community care models. The Trusts’ wide experience of community engagement and development means that its programmes not only include clinical care, but also look at important components such as employment, disability and psycho-social care.

Reproductive, Maternal, Neonatal, Child and Adolescent Healthcare Reproductive, maternal, neonatal, child and adolescent healthcare (RMNCHA+) is a key thematic area for Abhina Trusts. India is the world’s second-most populated country and observes over 30 million births annually. It also ranks among the top five countries in the world in terms of absolute numbers of maternal and child death rates. In 2010, India recorded around 19% (56,000 deaths) of all global maternal deaths. In absolute numbers, India also has the largest number of child deaths in the world – approximately 1.58 million children under the age of five die annually.

In 1990, when the average global under-five mortality rate was 88 per 1,000 live births, India’s child mortality rate was 115. Much progress has been made in the intervening years. In 2010, India’s child mortality rate of 59 per 1,000 live births almost equalled the global average of 57 per 1,000 live births.

Despite this improvement, multiple challenges remain around maternal and neonatal care. These include timely treatment during pregnancy to identify and treat causes of maternal deaths like post-partum haemorrhage, sepsis, hypertensive disorders, etc. The key challenges in addressing neonatal deaths remain the treatment of premature pregnancies, infections like pneumonia and septicaemia, and asphyxia. Many lives can be saved if these issues are identified early and treated appropriately.

The Trusts’ interventions in RMNCHA+ are focused on programmes in Madhya Pradesh and Rajasthan, covering 8 districts and over 80 facilities. The Trusts are involved in providing training to accredited social health activists (ASHAs) and auxiliary nurse midwives (ANMs) in identifying and treating high-risk pregnancies, as well as identifying and resolving infrastructural gaps in MNCH facilities. These interventions focus on using technology to do these tasks at scale, while also monitoring and evaluating the Trusts’ activities and outputs to improve programmatic performance.

The Trusts support sustainable change in the healthcare system by strengthening existing healthcare systems and facilitating evidence-based decision-making. In order to achieve this goal, the Trusts ensure that their strategy dovetails with that of the state governments.