The rural health care in India has always been in a sorry state. The American Association of Physicians of Indian Origin (AAPI) did four studies in rural Alamarathupatti, Samiyarpatti and Pillayar Natham in the state of Tamil Nadu and another in the village of Karakhadi, in the state of Gujarat some years ago, and found that not only were the people living in rural areas ignorant about common lifestyle disorders like diabetes and hypertension, but they were also deprived of access to quality health care and knowledge of basic sanitation practices.
AAPI, essentially a body of Indian doctors settled in the US started the project ‘SEVAK’ in 2010 on a pilot basis in Karakhadi village, and over the years, it’s reported that it has covered all villages within the 26 districts of the state.
Dubbed as an extremely successful rural health care model, SEVAK is the brainchild of Dr. Thakor Patel, AAPI member and a specialist in nephrology and internal medicine. The concept of SEVAK is based on the Independent Duty Corpsman (IDC) in the US Navy. Dr. Thakor Patel was associated with the US Navy for 23 years and during this period he has also served as the director of IDC.
The IDCs are high school graduates who undergo a training of one year during which they are trained in providing primary health care to Marine Corps units or Navy Ships. In addition to this, they are also responsible for managing disasters, ensuring preventive care of sailors along with conducting environmental checks such as humidity, temperature and sanitation.
The sevaks are responsible for providing holistic healthcare to their respective villages.
“The design of this project was based on one person per village per district of Gujarat for a total of 26 individuals — that is sevaks. Upon selection, these individuals underwent health training in Vadodara,” Dr. Patel said. Following this, they were sent back to their villages to discharge their duties.
The project is looking at a possible expansion into 100 villages. The project was started in Gujarat with the support of the state government and Local partners like the Bharatiya Seva Samaj (which is overseeing the project), and the Maharaja Sayajirao University in Vadodara.
A person should have at least passed 12th standard in order to become a sevak. A Sevak should be a permanent resident of his/her village. Women who will remain in their villages for a long period are eligible to become a sevak.
A sevak is responsible for the complete basic health care of his/her village. This includes conducting basic health checkups and screening of diseases like diabetes and hypertension. They will also be responsible for monitoring high-risk population for various diseases and patients with chronic disease who are on treatment.
Not just this, but the task of educating the village people about healthy lifestyle and preventive care is also to be dispensed by the sevak.
Sevaks are an important link in the chain of healthcare. They connect the rural folk to the health care experts.
“Special cases are referred to city hospitals and in some cases sevaks accompany the patient. The cost is borne by the project,” explains Dr. Patel.
One of the benchmarks by which the performance of the sevaks is measured is the sanitation of the villages. One of the variables is the number of toilets in the villages and since the inception of the project, the number of toilets in the sevak villages have increased.
Monitoring the Sevak project
“The state of Gujarat was divided into four zones: North, south, central and west, with a coordinator for each. The base education requirement for the coordinator was a bachelor’s degree. As the coordinator their job is to go to each village once a month and go over the work done by the local sevak, collect the data in an excel file, and email it to me. The data is then sent to Dr. Ranjita Misra*, who compiles the information into statistics. In addition, Dr. Padmini Balagopal* creates the lifestyle modification education program for the sevak,” Dr. Patel explains.
After the success of the first leg of Sevak project in Gujarat, the AAPI in collaboration with Dr Rahul Jindal, a transplant surgeon in Washington, New York-based philanthropist, George Subraj have launched the programme in rural areas of Guyana also.
To develop in cohesion, as a nation, we need to cater to the rural population more. The rural-urban dichotomy is a serious issue and steps need to be undertaken to bring the rural India at par with its urban counterpart. Sevak project is an initiative which attempts to take steps towards this issue. More projects on similar lines need to be brought about to revolutionize Indian society.
(* both the doctors are members of the AAPI)