Accessing higher level health care; the rural person’s dilemma

Competition Finalist

This entry has been selected as a finalist in the
Patients | Choices | Empowerment competition.

A centre within the state capital’s central bus depot (72 platforms) offers rural patients help accessing ethical, appropriate and inexpensive health care in this city of 9 million people. The centre is linked to a team of patient counselors in government hospitals who guide, counsel and empower patients

About You

Organization: Institute for Rural Health Studies Visit websitemore ↓↑ hide↑ hide

Section 1: You

First Name


Last Name



Institute for Rural Health Studies



Section 2: Your Organization

Organization Name

Institute for Rural Health Studies

Organization Website

Organization Phone


Organization Address

P O Box 50, Banjara Hills, Hyderabad 500 034, India

Is your organization a

Non‐profit/NGO/citizen sector organization

Organization Country


Your idea

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Name Your Project

Accessing higher level health care; the rural person’s dilemma

Country and state your work focuses on


Describe Your Idea

A centre within the state capital’s central bus depot (72 platforms) offers rural patients help accessing ethical, appropriate and inexpensive health care in this city of 9 million people. The centre is linked to a team of patient counselors in government hospitals who guide, counsel and empower patients


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What makes your idea unique?

1. Patient Counselors at the District Hospital to direct poor, rural patients to Hyderabad. The majority of Indians live in rural villages of fewer than 2000 inhabitants. Even when a sick villager struggles to reach the nearest Primary Health Centre or District Hospital, he finds poorly trained and motivated physicians and little in the way of diagnostic equipment or medicines (India spends less than .9% of its GDP on health care). Most frequently, the patient and his family are told to go to the state capital for all but the simplest ailment. Uniformed counselors in the Mahbubnagar District Hospital help these anxious and frightened patients access the Institute’s office located in the world’s largest bus station.

2. A special centre in the state capital’s central bus terminal. One uniformed patient counselor is always on the arrival platform to welcome patients and guide them to the centre. From the centre, they are guided to the appropriate hospital. The office also counsels on reproductive health and HIV-AIDS prevention and provides first aid to all passengers.

3. Patient Counselors in the government hospitals. The trained counselors guide the patients to the appropriate doctors and counsels them about their illness or treatment needed. They help the patients understand how they can access the doctors for future care.

4. Access to private hospitals at no cost to the patient. If the villager’s illness requires more sophisticated treatment/surgery, counselors use several good private hospitals who extend free treatment to the Institute’s patients. The counselors show the patients how to access available state funding.

Do you have a patent for this idea?


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What impact have you had?

1. Saving lives. Every year IRHS sees nearly 14,000 patients in its programmes of which more than half come through the bus terminal centre. Many of these patients are children who need open heart surgery or other critical care. Patients are guided to the most appropriate facilities/doctors as well as helped to access available funds. Most rural parents tell us they never expected their children to live or to see their husbands or wives work in the fields again. Accident victims and those who face sudden illnesses (e.g., heart attacks) have been helped by trained staff inside the bus terminal.

2. Helping patients understand the necessity of medical treatment. Most rural people have little cognizance of how their bodies work and so avoid seeking help. Counselors in the bus station centre and in the hospitals help them understand their diseases/conditions to reduce the fear and anxiety that has kept them from seeking treatment.

3. Helping villagers follow through with post-operative care. For post-operative villagers on long-term treatment who live in far away districts where specialized medicine is rarely available, IRHS mails medicines monthly, often though innovative means.

4. Teaching villagers about HIV/AIDS. Away from their villages, many young men are open to learning about this disease and how to protect themselves from it. (We offer free condoms.)


1. Lack of resources at the district level. The majority of Indians live in villages with fewer than 2000 inhabitants and have little access to health care. There are few physicians at either primary health centres or district hospitals and even fewer medicines are available within those facilities.. Most people with more serious conditions are simply told to go to Hyderabad, the capital city of 9 million people. It is a bewildering place for poor, rural residents.

2. Lack of knowledge. The rural poor have little knowledge of how to access more sophisticated health care available only in urban areas. The vast majority of rural Indian villagers have never been beyond the nearest market town. Most village women have never even been out of their immediate area.

3. Fear and anxiety. Patients are frightened that big city doctors may take their organs or mistreat them in some way.


Partnering with various government agencies and hospitals.

1. In the Mahbubnagar District Hospital, we already run the State’s only programme for early detection and treatment of cervical cancer (the biggest cause of death in Indian women). The District Collector and Medical and Health Officer are paying for three of our Outpatient nurses who also work as Patient Counselors. The district is one of the largest in the state (more than 4 million) and one of the three most impoverished on all measures.

2. The bus station centre was purpose-built for us and paid for by the State’s Road Transport Authority (APSRTC).

3. All the Patient Counselors are protected through a government order (GO) issued by the State’s Secretary for Health and Family Welfare.

4. The government hospitals have provided the counselors with rooms and lockers.

5. Corporate hospitals have partnered with us to offer our poor, rural patients free services.


1. By partnering with state agencies and private hospitals, the programme is more sustainable. For example, we take blood pressure measurements of the APSRTC staff and counsel them on lifestyle management. We also offer them first aid.

2. Corporate hospitals seek our cases as they provide excellent teaching material. They say they enjoy treating these rural patients as they are quite different from their normal sophisticated patients. They sometimes ask them to come as subjects for examinations which makes rural people very happy.

3. As the counselors enjoy the protection of a government order (GO) and wear a distinctive uniform, they are readily visible to the doctors and other staff who treat them more as colleagues than outsiders. This means that patient counselors are allowed to enter intensive care units to see patients and thus reduce the anxiety of rural parents or spouses who must remain outside.

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

The success of the project depends upon several components:

1. The continued support of the government agencies who have invested in the concept helping poor, rural people access health care.

2. The continued supply of rural patients who need more specialized medical care.

3. The continued failure of the Government of India to invest more in rural health care.


- Improve the knowledge of the Patient Counselors through continuing medical education and discussion of individual cases. This includes teaching sessions each week for 1-2 hours with doctors who come to the office to help in training.
- Continual interaction with government officials to reinforce the importance of their decisions to support us.
- Begin an ‘each one, teach one’ programme to encourage saqtisfied patients to return to their villages and tell others about it.


- Using the local press, increase the awareness of villagers that seeking higher level care is possible.
- Expand the programme to the second city in the state (Vizag) by using existing counselors as trainers.
- Improve the patient records kept on all patients who receive sophisticated medical treatment or surgery.


- Write a manual for others to begin the same programme in their localities.
- Present our work to NGOs working in health care in the major cities in India

What would prevent your project from being a success?

1. If the A P State Road Transport were to withdraw our lease agreement.
2. If the Government Order for our counselors were to be withdrawn.
3. If we did not get enough rural patients to make it worthwhile running the programme.

How many people will your project serve annually?

More than 10,000

What is the average monthly household income in your target community, in US Dollars?

$50 - 100

Does your project seek to have an impact on public policy?



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What stage is your project in?

Operating for more than 5 years

In what country?

India, AP

Is your initiative connected to an established organization?


If yes, provide organization name.

Institute for Rural Health Studies

How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?


Does your organization have any non-monetary partnerships with NGOs?


Does your organization have any non-monetary partnerships with businesses?


Does your organization have any non-monetary partnerships with government?


Please tell us more about how these partnerships are critical to the success of your innovation.

Without most of them, the programme would simply not work. We need to be in the bus station. We need to be in government hospitals and be able to move about freely to see patients along with the doctors. (This enables us to know what the doctor said and how to review these points with the patients – most of whom are illiterate.) We need to be able to receive guidance from our Board of Directors and to use their wisdom, experience and contacts. Our partnerships with other NGOs involves referring abandoned children for appropriate care and placing destitute women from the bus terminal into care. Without the support of the corporate hospitals, some of the most complex surgeries and diagnoses would not be possible.

What are the three most important actions needed to grow your initiative or organization?

1. More monetary support to expand. Perhaps sponsorship by some local businesses.
2. A steady and good supply of poor, rural patients.
3. More help with the promotion of our work - perhaps through the addition of a marketing-orientated person who could travel to villages and speak before rural elected village officials and ‘panchayat’ leaders.

The Story

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What was the defining moment that led you to this innovation?

It was the plight of a young child who moved me to start this programme. I was in a remote village when a young boy of two (Nagaraju) was brought to me by his mother. She explained that the boy had been born without an anus and that her husband and his sister took child to the district hospital for help, but that they had told them to go to Hyderabad. They were frightened and came back to the village. Then they decided that he would die and went to Hyderabad very, very reluctantly.

In the bus terminal they met a ‘kindly’ person who told them they looked worried and asked if he could help. He said he knew a hospital where the doctor just ‘loved’ poor, rural people and that he would charge them only a little. He took them to a private nursing home where someone opened the anus in a crude manner. (The correct treatment is to leave the anus as it is and put a colostomy or tube connecting directly to the gut.) He then said that the hospital needed what was the equivalent of a year’s wages from the father. He returned to the village and borrowed money from everyone and even sold his little plot of land and his hut. When he realized that he could never pay off the debts, he never returned to the village. When I saw Nagaraju, now aged 2 years, his anus was a mass of scar tissue and fecal material was coming out of his penis and he was nearly dead. I took the boy and went back to Hyderabad with the abandoned mother and child. A pediatric surgeon had to operate three times to save the little boy’s life. I vowed to start our programme to combat the touts who were ruining the lives of innocent village people.

Recently, I was standing outside the Mahbubnagar District Hospital when I saw a woman run across the open area next to the hospital. She threw herself into my arms and said, ‘Remember me, I am Nagaraju’s mother. He is now 10 years old.’ What more inspiration can one ask for?

Tell us about the social innovator behind this idea.

Pat Bidinger studied international nutrition and health at Cornell University. She has spent virtually all her life working as a volunteer. She knew that she wanted to spend the rest of her life in a developing country and to date, she has done just that. She did leave for a year’s sabbatical at Cambridge University where she still retains her visiting faculty position. Pat is the co-founder with Bhavani Nag of the Institute for Rural Health Studies founded in 1981. Pat and her organization also carry out applied research and have received grants from numerous organizations. Pat is an Ashoka fellow.

How did you first hear about Changemakers?

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225 weeks ago Patricia Bidinger said: Deepak, thanks for your welcome comment. There are only 24 more hours left and we are hoping for the best. We haven't the resources of ... about this Competition Entry. - read more >
226 weeks ago said: Dear Pat, Have heard about the immense work you do from Louise and I did meet you while in Hyderbad. Wishing you good luck with the ... about this Competition Entry. - read more >
226 weeks ago sreenatha reddy dinapadu said: dear pat, IRH is doing excellent service for the poor, especially in the villages. your services are very much appreciable. many poor ... about this Competition Entry. - read more >
226 weeks ago Patricia Bidinger said: Well, we were pretty amazed that little guys like us managed to get to the final 10. We know that we are really on to something when we ... about this Competition Entry. - read more >
226 weeks ago Patricia Bidinger said: Coming from a former volunteer, that means a lot to us. Those of you who have volunteered with us are some of our biggest supporters and ... about this Competition Entry. - read more >
226 weeks ago Patricia Bidinger said: Thanks, Smitha. We certainly try and are a bit intimidated by those big American non-profits. Small is beautiful is our motto. We love ... about this Competition Entry. - read more >
226 weeks ago said: To all who work at the IRHS, Best of luck with the competition. You really deserve to win - the work you do is nothing short of ... about this Competition Entry. - read more >
226 weeks ago said: I have no hesitation in supporting IRHS. I know you are doing invaluable work, and I really hope you get the recognition you ... about this Competition Entry. - read more >
226 weeks ago Patricia Bidinger said: Thanks vey much. Please tell all your contacts to vote. Rural medicine is so pathetic in much of India that it forces the poor to travel ... about this Competition Entry. - read more >
226 weeks ago said: Dear Dr. Pat Congratulations on being selected as a finalist. May you be selected as the winner in this final round. All the very ... about this Competition Entry. - read more >