About 200 kms from Nagpur in the Gadchiroli forests on the western border of Maharashtra, a small board on the Dhanora road directs you to a diversion on the left. Just 500 metres away, a cluster of huts welcomes you.Shodhgram is home to a couple that has just been honoured the state’s highest award, the Maharashtra Bhushan. It’s from Shodhgram that Abhay and Rani Bang have conducted their experiment in community health.Ironically, though the Maharashtra government is yet to formally adopt the Bangs’ people-friendly approach to health problems, neighbouring Bangladesh is already implementing it. The Centre has also taken it up as a pilot project in five states.Their success is a vindication of the couple’s belief in research-based action aimed at influencing government policies. But behind the now-famous SEARCH (Society for Education, Action and Research in Community Health) model, is 18 years of effort that began almost with the wedding of the two medical post-graduates from Nagpur. In 1983, the couple moved to John Hopkins University in the US to study public health. Back home in 1986, they moved to Gadchiroli and established SEARCH. Initially, they worked with the government’s health department but soon started working independently.The Bangs began their community-based healthcare through an army of health workers called Arogyadoots and Traditional Birth Assistants (TBA) or dais. They organised villagers’ rallies, acquainted themselves with their health problems and put in place a healthcare system that worked. Their illiterate barefoot doctors treated basic ailments. By 1990, child death rate in the area where they worked was down from 121 to 30.The medical journal The Lancet even published Rani’s study of women’s reproductive health and Abhay’s child death curtailment experiments. In 1991, the Maharashtra government was rattled when SEARCH, along with 13 other NGOs, published a study called Kowli Pangal (tender leaf-shedding), which claimed that 80 per cent of child deaths in the state go unreported. The government refuted the claims, but later did a complete 180 degree turn. On May 2, it honoured the couple with Maharashtra Bhushan. But the real honour would be if it implemented the Bangs’ model.‘We need arogya swarajya’ Was the Maharashtra Bhushan a surprise, considering you have been exposing the government’s record on health?It was unexpected, especially after the storm over child mortality. But it’s heartening to know that there are liberal minds in the government. How do you feel that the state is still not following your Gadchiroli healthcare model? Government mindsets don’t change overnight. But that the government hasn’t accepted our claims is a half-truth. Former chief minister Vilasrao Deshmukh had issued a GR within 20 days, ordering cent percent registration of child deaths and introduction of Gadchiroli model in 14 districts. Two months ago, State Minister Vimal Mundada told the Legislative Council that the government had accepted our report and was already following our healthcare model. When your Kowli Pangal report alleged that 80 per cent of child-deaths go unreported, it sounded exaggerated. But you were never in doubt. Why? Science believes that one accurate measurement is infinitely superior to a thousand intelligent opinions. Our findings were based on accurate measurements from a carefully selected sample of 2 lakh people from 13 districts. And then we have been measuring child mortality in Gadchiroli for 15 years now. When we pegged it at 80-90, the government showed only 13 deaths per thousand. Superstitions amongst the tribal are often a hurdle but you seem to have overcome them.The most important trick is to listen to the people with respect. We asked people what they wanted. It was surprising to note that even after five decades of malaria control programme, the tribals didn’t know it was caused by a mosquito. Our intervention reduced the incidence by 60 per cent. Go by their priorities, and their response is enormous. What’s your prescription for improving the health scenario? We need to usher in Arogya Swarajya (health self-rule). As government healthcare is ineffective and private healthcare costly, communities should be made sufficient to take care of their own health. For that, they should be suitably empowered.
