21-state exhaustive report on the state of healthcare in rural India released

The fourth edition of the Indian Rural Soliloquy 2024 organised by Transform Rural India (TRI) in New Delhi on Thursday saw the release of the State of Health in Rural India Report - 2024, Neighbourhoods of Care.

The report provides a comprehensive outlook on how different rural communities decide to seek medical help, types of healthcare services they choose, and the order in which they take action to address their health concerns.

Jointly carried out by Transform Rural India (TRI) and its initiative, the Development Intelligence Unit (DIU), the State of Healthcare in Rural India survey covered a total of 5,389 households in 21 states.

Among the members that participated in the survey, 44% earned primarily through farming activities. The second largest occupation was daily wage labourers (21%), while just 14.2% had a full-time or part-time job. The remaining resort to vocational trades including tailoring, carpentry, masonry, electrician and plumbing.

The report examined the components of rural care at the family and community levels, focusing on neighbourhood composition, access to home amenities, household care, and practices for physical and mental fitness.

The report found 73% of rural households with elderly members needed constant care, with only 3% opting for an external caregiver. The majority (95.7%) preferred family caregivers, predominantly female (72.1%), highlighting the need for caregiver training on home-based care.

The survey also revealed that anxiety levels have risen in rural India, making it no longer just an ‘urban’ phenomenon. 45% of respondents from rural communities, across genders, reported being affected by anxiety and worry most of the time, impacting their state of mind.

Based on these and other findings, the report introduced the concept of 'Neighbourhoods of Care' - a transformative model that shifts from the traditional health delivery approach.

According to the report, The Neighbourhood of Care is more flexible than traditional health models, integrating the preferences, interests, and goals of individuals, families, and communities. This model encourages collaboration among health professionals, social service providers, caregivers, community organisations, and residents, recognising that healthier futures require co-creation, co-execution, and co-evaluation.

Other findings from the report revealed over 60% of the respondents did not have any life insurance coverage, neither for themselves nor for anyone else in their household. Meanwhile, limited diagnostic facilities and access to affordable medicines remained major challenges, with only 12.2% of respondents having access to subsidised medicines and 21% lacking a nearby medical store.

Around 50% of the respondents felt that because they work on their farmland and do physical labour, it keeps them fit. Hence, additional exercise is not required. Only 10% practiced yoga or other fitness activities.

According to the report, one in five respondents reported no drainage system in their villages, and only 23% had a covered drainage network. 43% of households lacked a scientific waste disposal system and end up dumping their waste everywhere.

Speaking about the proposed model, Dr Maj Gen (Prof) Atul Kotwal, Executive Director, National Health Systems Resource Centre (NHSRC) said, “The current health system includes various providers such as ASHAs and CHOs, working within an evolving ecosystem. This model, highlighted by the eco-socio-epidemiological approach, aims to address health comprehensively rather than relying solely on technocratic solutions.

"However, the existing mechanisms demonstrate a framework for collaboration, but more effective and frequent interactions are necessary. Strengthening these connections and linking with local committees and self-help groups is essential for enhancing neighbourhood care and addressing community needs comprehensively," he added.

Shyamal Santra, the Associate Director of Health and Nutrition at Transform Rural India (TRI) added, "This report looks at the need for maintaining good health as a standard. It is focused on those different dimensions of health that relate to making people healthy. If we look at the demographic transition, a larger number of people are senior citizens now, and with the changing of the societal structure, the family nucleus is changing - with many children migrating away, so those elders are left in need of care."

The report also highlighted the importance of training and enhancing the skills of local leaders, self-help groups, and service providers so they can better support individuals and families in their villages.