Breaking access barriers and bringing quality healthcare closer to the people in Meghalaya

Bobby Ramakant *

Unless the full cascade of quality healthcare services reaches closer to the underserved communities, how will we deliver on the promise of #HealthForAll? One positive ray of light comes from an underserved block of Meghalaya, a north-eastern state of India.

State-of-the-art screening and diagnostic tools, medical nurses and doctors, medicines, counselling, government-run health insurance, and other support services were brought closer to the people when a free health camp was organised in Thadlaskein block in West Jaintia Hills district of Meghalaya.

“Thadlaskein block has poor access to health services for people living in hard-to-reach areas. This block also has the lowest vaccine or immunisation coverage, and maximum number of children aged 2-5 years that have not been immunised with measles Rubella vaccine 1 or 2. It is important to note that all the people who have been mobilised by the Block Development Office and self-help groups are able to get a wide range of healthcare services at one place on the same day,” said Dr Helen J Uriah, Maternal and Child Health Officer, West Jaintia Hills District.

Several government agencies and other partners united to organise this camp, where same day test and treat for a range of health conditions became a reality for almost a thousand people, along with health awareness, counselling, and continuum of care.

Adapt and replicate this comprehensive health camp model

This is the first of its kind health camp in Meghalaya where quick and state-of-the-art rapid molecular diagnosis became a reality in a field setting for various diseases using RT-PCR technology – as well as – linkage to treatment and care was facilitated under the relevant government-run programmes on the same day.

“It is for the first time in India that for a free comprehensive health camp, all the vertical healthcare programmes have converged together on a single point of access. Vaccination for children and adults, medical consultation, routine screening and highly-specific diagnostic tests for multiple diseases, linkage to treatment and care, medicines, counselling, and a wide range of other healthcare facilities are being provided together – and closer to the underserved communities,” added Shiva Sriram, Vice President of Molbio Diagnostics (makers of WHO recommended Truenat).

In addition to Truenat - a point-of-care, decentralised and multi-disease molecular testing platform, this health camp brought more diagnostic technologies closer to the people, such as, MobMon - a point-of-care, battery operated and handheld ECG machine of Kallows; an ultraportable, point-of-care and battery operated x-ray machine of Prognosys; Thermolytix – a point-of-care breast cancer screening tool of Niramai; among others.

People who came to this camp were triaged at the registration counter itself by a team of doctors and nurses, followed by a second round of triaging. Free medical consultation was provided by a range of doctors of different specialities (such as, obstetrics and gynaecology, paediatrics, medicine, ENT, among others), along with screening and diagnostics for a range of health conditions, such as, Tuberculosis (TB), Cervical cancer, Breast cancer, malaria and dengue, chikungunya, sexually transmitted diseases and HIV, influenza, other respiratory diseases, scrub typhus, among others.

To ensure continuum of care, all those diagnosed for a range of conditions listed above were linked to respective government programmes under the National Health Mission (NHM), such as those for TB, HIV, maternal and child health, among others. Medicines were provided on the site as well for some of the diseases listed above, along with counselling for nutrition, adolescent health, STDs, TB, HIV, malaria, cancers (breast and cervical), and other related issues.

Meghalaya government’s State AIDS Control Society had brought a special van to the camp, which is referred to as “Integrated Counselling and Testing Centre (ICTC) van”. This van is equipped with dual testing kits for screening of HIV and Syphilis, as well as provides information about HIV prevention, counsels people to undergo testing, and links the positive people with treatment, care, and support system.

Multi-sectoral healthcare response at the grassroots

“It is for the first time that multiple sectors are coming together to organise a free comprehensive healthcare camp. From government agencies, research institutions, university, private sector, non-governmental organisations, financial institutions, among others, have joined hands to make multi-stakeholder collaboration a reality. This is extremely essential and should be adapted and replicated across the country to reach as many people as possible, and take healthcare closer to the patients,” added Shiva Sriram.

This versatile health camp demonstrates the importance of grounds-up synergistic inter-agency collaboration in bringing integrated healthcare closer to the most in need communities in Meghalaya. The partners included: North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Department of Health and Family Welfare, District Medical and Health Office, West Jaintia Hills district administration through the Thadlaskein Block Officer and Meghalaya State Rural Livelihoods Society -MSRLS , Community groups, International NGOs ( Rotary Club of Jowai, Johns Hopkins Program for International Education in Gynaecology and Obstetrics- JHPIEGO, North East Slow Food and Agrobiodiversity Society - NESFAS), local NGOs (Grassroots - Shillong, Voluntary Health Association of Meghalaya - VHAM) and Molbio Diagnostics.

Public education and awareness talk on various health issues including Intensified Mission Indhradhanush (IMI 5.0) children’s immunization initiative, TB, HIV, and other issues were an ongoing feature all day long.

“The aim of this health camp was to promote early screening, detection and linkage to treatment and care for a range of diseases; and raise people’s health literacy thereby improving health of the community. It was also to develop long term health seeking behaviour of the population. Investing in free health camps helps accomplish an optimal level of healthcare with individuals, communities and all the institutions working together in coordination,” said Dr Darivianca E Laloo, General Manager of Molbio Diagnostics.

High HIV and TB rates in Meghalaya

According to Sankalp 2022 report of Indian Ministry of Health’s National AIDS Control Organisation, Meghalaya state has double the HIV incidence (0.42%) in general population than that of the country (0.21%). Compared to 2010 rates, 2021 data shows that the number of annual new HIV infections has declined overall in India and so has AIDS-related mortality, but in Meghalaya, both have increased. Meghalaya has the 3rdhighest HIV prevalence (0.58%) among pregnant women as well as the highest Syphilis seropositivity (0.77%) among pregnant women (national average is 0.10% syphilis seropositivity among pregnant women).

According to India TB Report 2023 of Ministry of Health’s National TB Elimination Programme, Meghalaya deploys WHO recommended molecular tests for TB upfront to a higher degree: 71% of presumptive TB cases in Meghalaya get diagnosed using one of these molecular tests (36,209 tests a year). 4989 new TB patients were notified in Meghalaya in 2022 out of which 5% were of drug-resistant TB, and 71.4% had TB of the lungs. Over 92% of those diagnosed with TB were initiated on anti-TB treatment. Meghalaya had 84.8% TB treatment success rate in 2021.

As per the India TB Report 2023, there are 55 Truenat molecular test machines deployed for TB testing in Meghalaya by 2022, which performed 29,086 tests in the same year. Of those who got tested for TB on Truenat, 1829 people were detected with TB disease, and 124 people had rifampicin-resistant TB. In 2022, 244 people were tested for extrapulmonary TB in Meghalaya on one of these Truenat molecular test machines, out of which 12 people were found to have active disease.