Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project

BMC International Health and Human Rights

Research Article

Slim Haddad¹  Delampady Narayana²  KS Mohindra³ 

[1] Centre de recherche du Centre Hospitalier de l’Université de Montreal (CHUM), Université de Montréal, 3850 rue Saint-Urbain, Montréal, Québec, Canada;Centre for Development Studies, Prasanth Nagar, Ulloor, 695 011, Thiruvananthapuram, Kerala, India;Institute of Population Health, University of Ottawa, Ottawa, Canada;

关键词: Ethical Code;    Junior Researcher;    Vulnerable Community;    Global Health Research;    Autonomous Body;   

DOI  :  10.1186/1472-698X-11-S2-S3

来源: Springer

【 摘 要 】

BackgroundInadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women’s lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups.The researchThe goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1) design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2) strengthen local governance in monitoring and evidence-based decision-making, and 3) develop an evidence base for appropriate health interventions.Results and outcomesHealth and social inequities have been masked by Kerala’s overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group), for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA), under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community—although inclusion of the Paniyas has been a challenge.The partnershipThe Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research.Challenges and successesAdapting to unanticipated external forces, maintaining a strong team in the rural village, retaining human resources capable of analyzing the data, and encouraging Paniya participation in the health insurance scheme were challenges. Successes were at least partially enabled by the length of the funding (this was a two-phase project over an eight year period).

【 授权许可】

CC BY   
© Haddad et al; licensee BioMed Central Ltd. 2011