After earning masters in public health at Johns Hopkins University(USA), Drs. Abhay and Rani Bang are launching a program in India that promises significant changes both in the public delivery of services and in public health priorities and policy.
The New Idea
The Bangs are moving to one of the country's most undeveloped districts, Gadchiroli (the southeastern corner of Maharashtra), to develop a new system to deliver health care and essential services. The region is almost totally rural, has a large tribal population, only 22 percent literacy, meagre transportation, and no industry. Health care is almost non-existent, although new government services are trickling in. Their idea is to improve health care services in this and other regions considered "unservable" through research, service, and training which utilize and improve existing government programs and facilities.
Although average life expectancy has grown dramatically since independence, India's public health and medical care system remains deeply flawed. Most Indians suffer to some degree, but the poor suffer unecessarily. For example, pneumonia kills roughly 600,000 children under five each year in India. In theory, ill children go to the hospital for treatment, but, as the child mortality statistics demonstrate, hospital care is rarely received. The Bangs are developing methods for village level health workers, both modern and traditional, to diagnose and treat common illnesses in the village.
The Bangs founded SEARCH, the Society for Education, Action and Research in Community Health, in order to increase the effectiveness of India's health care system. The Bangs operate independently of the government and at the same time through and with it all levels. They did not create a parallel private system, the usual and much less risky approach taken by most health organizations. Instead, they seek to find practical ways, with the Gadchiroli government workers, to show how the country's only mass scale delivery system might do far better in reaching those it should. At the national level, the Bangs work to influence health policies through problem identification, field research, and demonstration of innovative problem solving approaches.
At the same time, the Bangs undertake applied policy reasearch with massive potential impact. They will try to train village workers to diagnose and handle cases of pneumonia, the second largest childhood killer. Gynecological disorders, which can cause village women pain, psychological hurt, and illness for decades, have long been left unstudied because male doctors and village women feel uncomfortable discussing them and because they are usually not fatal. The Bangs study all aspects of the problem, including the psychological, and evolve patterns of care appropriate for the village. They also advocate using the menstrual cycle as a practical diagnostic tool. Other planned work includes recognition and clinical testing of specific herbal medicines and a district wide survey of the instance of sickle cell disease. The Bangs intend to encourage use of their research results in government health care policy formulation at all levels.
Drs. Abhay and Rani Bang have been struggling for years to find a way to bring better health to everyone, especially the poor. Abhay Bang grew up in the Ghandian movement, including early work with Vinoba Bhave. Rani Bang comes from a family with strong commitment both to medical service and, in her grandparents' generation, to public service. Both have placed first in prestigious national medical competitions, and they helped organize and lead a national group of medical professionals concerned with health-care quality and delivery. Both spent years providing health services in the Wardhal area of Central India, helping rural people take charge of their lives by working on issues ranging from grain banks to minimum wage. After receiving their Masters Degrees in Public Health from Johns Hopkins University in 1984, the Bangs returned to India and organized SEARCH.