Many people in India cannot access medical care because of poverty, social exclusion and an under-resourced healthcare system.
High-quality services are available for those with means, but a significant portion of the population cannot obtain even basic healthcare. Treatment for diseases such as HIV, tuberculosis (TB) and kala azar (visceral leishmaniasis) is not universal. Médecins Sans Frontières (MSF) aims to fill some of these gaps and build capacity so more people can get the medical care they need.
Child malnutrition is an underreported health emergency and MSF has been working with health authorities to increase access to treatment for malnourished children in Darbhanga district, Bihar state. Most children are from impoverished families and live in villages where health services are often inadequate. The MSF programme provides weekly outpatient treatment for severely malnourished children aged six months to five years, through 12 basic health centres. More than 3,500 patients were enrolled for outpatient treatment and over 300 children with minor complications were referred to MSF’s stabilisation centre for inpatient care in 2014.
The malnutrition intensive care unit, built inside Darbhanga Medical College Hospital and run by MSF, is the first of its kind in India. It opened in March to treat severely malnourished children up to five years of age with serious medical complications, and admitted more than 250 patients over the course of the year. MSF continues to work with the health authorities to integrate nutritional care within the public health system.
Kala azar is endemic in the Vaishali district of Bihar. Transmitted by the bite of an infected sandfly, this parasitic disease is almost always fatal if left untreated. Although MSF’s kala azar programme saw more than 1,000 patients in 2014, the number of recorded cases has decreased across India in the last four years.
In order to achieve the goal of eliminating kala azar in India by 2015, the government adopted single-dose liposomal amphotericin B as the first-line treatment in October. This policy change was made following sustained advocacy by MSF, which included a presentation of the data collected from a pilot project, aimed at demonstrating the safety and effectiveness of new treatment models. MSF also supported the authorities by training doctors and nurses in areas where kala azar is widespread.
Ongoing, low-intensity conflict between the government and Maoist groups makes it difficult for people in Chhattisgarh, Andhra Pradesh and Telangana to obtain medical care. MSF continued to offer healthcare through weekly mobile clinics in villages in southern Chhattisgarh, and to displaced people in Andhra Pradesh and Telangana.
In Chhattisgarh, the MSF health centre in Bijapur district focused on mother and child health, providing obstetric, neonatal and paediatric care. Teams also ran mobile clinics to bring basic and specialist medical services to the surrounding population. More than 63,200 consultations were carried out, and 14,657 patients were treated for malaria.
Extending care for HIV and TB
In Mumbai, MSF runs a clinic that provides psychosocial and medical care to patients with drug-resistant TB, HIV and hepatitis B or C, and those who are co-infected with any of these diseases. These patients require specialised diagnostics, care and treatment which are not available through the public health system. Teams actively share knowledge with local organisations and professionals to build capacity.
MSF continued to run clinics providing HIV and TB diagnosis and treatment in Churanchandpur and Chandel districts in the northeastern state of Manipur, which has some of the highest rates of HIV in the country. MSF started cooperating with a local NGO to offer inpatient care for HIV patients, and offered additional support for opioid substitution therapy for intravenous drug users. After screening patients for hepatitis C, MSF confirmed that more than 25 per cent of HIV patients were co-infected.
Mental healthcare in Kashmir
MSF has been running mental health programmes in Kashmir since 2001. There are currently programmes in Srinagar, Baramulla, Pattan and Sopore, and normally patients come to the projects to see counsellors and clinical psychologists after referrals from hospital psychiatrists. To increase local awareness and the visibility of mental health issues, MSF worked with a Kashmiri production company to produce a 13-episode TV soap opera, Aalav Baya Aalav. The first episode was broadcast on 18 December, and immediately triggered 80 phone calls to the MSF clinic information line with questions and reactions. People subsequently visited the MSF clinics for more information and for counselling.
Floods in the Kashmir valley in September forced MSF to close mental health clinics in Kashmir for more than a month, but counselling services were later extended with the opening of clinics in Pulwama, Kakapora and Bandipora. In the immediate aftermath of the flooding, teams distributed relief items including water, food, blankets and wash kits.
By mid-year, more than 50,000 cases of malaria had been recorded in a four-month period in different areas of Tripura state. MSF trained community health workers to detect and treat simple malaria and refer complicated cases for intensive care. More than 5,200 rapid diagnostic tests were carried out and MSF treated over 2,300 patients in some of the hardest-to-reach areas of the state.
Nagaland project handover
MSF played a key role in revitalising the Mon district hospital in the northeastern state of Nagaland with equipment upgrades and staff training. The four-year project was successfully handed back to the Ministry of Health by mid-year, once the hospital was fully functional.
No. staff in 2014: 657 | Expenditure: €10 million | Year MSF first worked in the country: 1999 | msf.org/india