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
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.
Working with several women’s groups in the Sundarbans, FHS provided a range of trainings – on how to use digital cameras, how to approach a picture subject, and getting people’s consent – to study participants. In turn, the participants used the cameras provided to them to capture images that explain how a changing climate affects their daily livelihoods, barriers that exist to accessing health services, and ways that locals are adapting to these challenges.
এফ.এইচ.এস.- ইন্ডিয়া ২০০৯ সাল থেকেই সুন্দরবনের মানুষের স্বাস্থ্যের ওপর গবেষণার কাজ চালাচ্ছে। বর্তমানে (২০১০ সাল থেকে) এফ.এইচ.এস. শিশু স্বাস্থ্যের ওপর বেশি গুরুত্ব দিয়ে কাজ করছে। সম্প্রতি সুন্দরবনের পাথরপ্রতিমা ব্লকে শিশু -স্বাস্থ্যের ওপর একটি সমীক্ষা করা হয়েছে। বর্তমান রিপোর্টটিতে এলাকার শিশু স্বাস্থ্যের বিভিন্ন দিক ও তার বর্তমান অবস্থা, স্বাস্থ্য পরিষেবার ক্ষেত্রে ফাঁকফোকর গুলি ও সম্ভাব্য সমাধানসূত্র তুলে ধরার চেষ্টা করা হয়েছে। এফ.এইচ.এস.- ইন্ডিয়ার এই গবেষণাটি আরও বেশি করে সুন্দরবনের মানুষের মাঝে পৌঁছে দেওয়ার জন্য এই বাংলা সংস্করণটি প্রকাশিত হল।
Based on a household survey in Indian Sundarbans hit by tropical cyclone Aila in May 2009, this study tests for evidence and argues that health and climatic shocks are essentially linked forming a continuum and with exposure to a marginal one, coping mechanisms and welfare outcomes triggered in the response is significantly affected.
Using data from a household survey in West Bengal, the purpose of this paper is to identify the relative risks of catastrophic healthcare expenditures for different types of health need, and the impact of such expenditure on household coping strategies. It concludes that Catastrophic health spending is an important problem for the population in West Bengal. More attention is needed on the poverty-inducing effects of long-term expenditures on chronic illness, given that existing schemes only address hospitalization.
Health policy and systems research (HPSR) is a transdisciplinary field of global importance, with its own emerging standards for creating, evaluating, and utilizing knowledge, and distinguished by a particular orientation towards influencing policy and wider action to strengthen health systems. In this commentary, we argue that the ability of the HPSR field to influence real world change hinges on its becoming more people-centred. We see people-centredness as recognizing the field of enquiry as one of social construction, requiring those conducting HPSR to locate their own position in the system, and conduct and publish research in a manner that foregrounds human agency attributes and values, and is acutely attentive to policy context.