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India, the world’s 10th largest economy, has witnessed a decline in the incidence of poverty during the last few decades largely due to economic liberalization. But one-third of its population still remain below the poverty line subsisting on less than a dollar a day. With economic advancement has come new vulnerabilities, inequalities, and insecurities in all development areas, including health.

Research in the second half of the century established that poor are less entitled to public subsidies and more likely to financial shock owing to out of pocket expenditures on health.

The situation is understandably worse for regions like the Sundarbans in West Bengal, where poverty stricken islanders have to cope with adverse geo-climatic conditions. Against this backdrop the FHS India research initiative was launched with the guiding principle of “putting the poor first”.


FHS Phase 1

In the initial phase of FHS India, research was carried out to gain a systematic understanding of determinants and consequences of inequity in health, healthcare, healthcare utilization and healthcare financing. Towards the later part of the research period, FHS India focused on the Sundarbans, a chronically handicapped region of West Bengal.

For the first time, FHS India generated systematic evidence on burden of ill-health in the Sundarbans based on household surveys, chronic morbidities suffered by older adults, healthcare utilization, choice of providers, issues in access to healthcare amidst extreme geographical barriers and issues in maternal and child healthcare. Further, a preliminary understanding of the healthcare delivery mechanisms in the Sundarbans was also gathered through a systematic survey of public health facilities, semi/unskilled rural medical practitioners and charitable trusts.

One of the major focus areas of FHS I was to build up a partnership for research that will be successful in influencing health policy and service delivery mechanism in the state of West Bengal.

FHS Phase 2

Evidence-based research from the first phase identified a need for greater community exposure, learning and identification of key systemic gaps and mitigation strategies. Through audience friendly communication methods, technology use, health services provider training and a prompt, need-based support, in this phase FHS India will work to formulate a feasible and comprehensive strategy for tackling health service delivery in the Sundarbans.

For the next five years, FHS India will concentrate on research focusing on systematic understanding of the multidimensional nature of crisis in child healthcare access in delta region of the Sundarbans. However, given that child health care shares the common fundamental problems with overall primary health care system, the uptake of research is expected to significantly impact the overall system.

We are planning operational research that will be piloted to learn about and demonstrate the effectiveness of the proposed model.

A common knowledge platform will be established, which helps to establish a communication link not only between the FHS team and the stakeholders but also among the stakeholders themselves.

A Centre for Sundarban Studies will be established to operationalize the concept, which as an institutional body, will generate more resources to provide research and technical support to local stakeholders.

FHS Partners in India

News and announcements from FHS India

Recent FHS India publications


Vadrevu L, Kumar V and Kanjilal B (2016) Rising challenge multi morbidity in the Indian Sundarbans, Indian Journal of Medical Research 5(2): 343-350  doi: 10.5455/ijmsph.2016.25082015129

Multimorbidity or multiple chronic conditions increase with age and imply complicated clinical management and lower quality of life that is compounded by poverty. Yet, there is a serious dearth of evidence on this issue. This article aims to explore the burden and predictors of multiple morbidities in the Sundarbans of West Bengal.

Bhati, D. K. (2015) Reflections of Child Health Rights: Perspectives from Healthcare Stakeholders in North India, European Scientific Journal, Vol 11, No 18, pp 143-15

In health-care settings, stakeholder’s knowledge, attitudes and perspectives influence their perception towards children, including children’s rights and right to health. The knowledge and attitudes generally present a culture of how children’s right are perceived and treated. This study explored the knowledge, attitudes and perspectives of 35 Indian health care stakeholders regarding children’s rights and right to health and their perspectives on realization of the selected domains of rights in reality. 

Risks and adversities during early childhood majorly hamper this neurological development. They are also irreversible with long standing impact on the eventual productivity in life. Given the huge impact that deficits in the early years have in terms of human productivity and sustainable development, early childhood development needs serious attention. This research brief provides formative evidence on the gaps in the care practices needed for Early Childhood Development in the Sundarbans. It will begin by first gauging the status of child development, the gaps and challenges in key practices needed for it and it will conclude with key recommendations.

Among the several determinants of child malnutrition – ranging from individual factors to societal ones – recent evidence indicates open defecation as an important determinant responsible for child malnutrition. This research brief explores the association between underweight children (0-6 years) and open defecation in the context of Indian Sundarbans, where low body weight is considered as an indicator of childhood malnutrition.

Vadrevu L, Kumar V, Kanjilal B (2015) Gender Differentials in the Impact of Multi-Morbidity on Self Rated Health in Rural West Bengal in India. IOSR J Nurs Heal Sci 2015, 4:16–21. DOI: 10.9790/1959-04231621

Self Rated Health (SRH) has widely been used as an indicator of overall health in a population. Given the rising burden of chronic conditions even in the rural region of India, the present study explores the gender differentials in the impact of multi-morbidity on SRH in the Sundarbans of West Bengal.

In this paper ex ante inequality measure is used to estimate inequality in childhood chronic under-nutrition among different vulnerable subgroups. Results found that vulnerability to consumption poverty aggravated chronic under-nutrition among less vulnerable groups mainly among those who perceived that unqualified providers provided quality service and were very effective during crisis.The paper finally suggests several policy suggestions for different vulnerable segments.