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

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

Organization type: 
nonprofit/ngo/citizen sector
$50,000 - $100,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

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 Project

Problem: What problem is this project trying to address?

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.

Solution: What is the proposed solution? Please be specific!

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.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

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.)
About You
Institute for Rural Health Studies
Section 1: You
First Name


Last Name



Institute for Rural Health Studies

Section 2: Your Organization
Organization Name

Institute for Rural Health Studies

Organization Phone


Organization Address

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

Organization Country
Your idea
Country and state your work focuses on
Do you have a patent for this idea?


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?


What stage is your project in?

Operating for more than 5 years

In what country?

, 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
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.

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