Effective delivery of health services in rural areas remains challenging in most low- and middle-income countries (1). This includes rural India, where acute shortages of medical health professionals persist across the health system (2). Overcoming such inequities in healthcare is fundamental to achieving health for all, and enabling communities to reach their development potential.
The Comprehensive Rural Health Project (CRHP), located in Maharashtra, India, has been working to provide services to the poorest of the poor since 1970. CRHP is a non-profit NGO that facilitates the empowerment of people to eliminate injustices through integrated efforts in health and development. It currently serves approximately 500 000 individuals living in rural Maharashtra. Through their work, founders Drs. Raj and Mabelle Arole pioneered a comprehensive approach to community-based primary healthcare, known as the Jamkhed Model.
In the Jamkhed Model, and in each of CRHP’s Project Villages, there is at least one Village Health Worker (VHW) who facilitates various community empowerment programs including programs for adolescents, women, and men. These programs cover economic empowerment strategies, health education, gender, caste, and religious equality, and environmental sustainability practices. The role of VHWs has changed over the past 45 years due to the evolving burden of disease as well as the increased availability of Government resources and programs. While VHWs began focusing on communicable diseases, immunizations, malnutrition, and maternal and child health in the 1970’s, now their focus also includes non-communicable diseases such as hypertension, mental health, and diabetes.
The Mobile Health Team (MHT) acts as the connecting agent between the grassroots needs in the villages and specialized services. The MHT provides support to the VHWs in the villages in the form of medical referrals, data collection and analysis, agricultural, economic, and medical training, and access to further opportunities offered by the Government and NGOs. In order to build trust and confidence, the original outreach team provided curative services via weekly clinics in the villages, and, as rapport was built, the original team developed into the current MHT. Today the MHT possesses a broad array of capabilities including health promotion, preventive health services, social work, development projects, and community organization. The MHT works with CRHP’s secondary care center and management team to provide relevant weekly trainings to the VHWs, with CRHP’s demonstration farm and other NGOs to provide trainings for farmers and other community groups, and with community members and researchers to monitor and evaluate CRHP’s programs and health progress.
The innovation of the Jamkhed Model lies in involving the communities themselves in determining their needs and defining the parameters of their development. One of the great lessons learned by the founding Doctors was that approximately 80% of all health problems can be prevented or managed by the people themselves, regardless of education or poverty. CRHP provides guidance and access to information, experts, and resources to communities. This, in combination with local knowledge and capabilities, enables villages to break the cycle of poverty. Thus, it is the communities themselves, through the VHWs in partnership with the community groups who are the primary actors in launching and establishing their health and development initiatives.
The Jamkhed Model has been recognized across major health and development institutions, and CRHP provides related training to staff working in health and development globally (3). Through this engagement, CRHP continues to support the development of comprehensive health and development services in other rural and low-resource settings globally.
1. ILO. Global evidence on inequities in rural health protection. Geneva: International Labour Organization; 2015.
2. Sharma DC. India still struggles with rural doctor shortages. Lancet. 2015;386(10011):2381-2.
3. Pincock S. Rajanikant Arole. Lancet. 2011;378(9785):24.