What are MSF’s main areas of focus in terms of population and geography in India?
MSF works with the most marginalised and vulnerable populations that are excluded, hard to reach or have challenges with access and affordability to healthcare. MSF offers models of care to fill the gaps in healthcare for the people, including victims of sexual violence and patients with infectious diseases. One of the key aspects of MSF’s approach is to encourage healthcare-seeking behavior among people and to do so MSF focuses on making healthcare services more accessible.
Can you cite some examples of MSF’s work?
In Mumbai, through our independent clinic and outpatient department (OPD) managed in collaboration with local health authority Municipal Corporation of Greater Mumbai (MCGM) and National Tuberculosis Elimination Programme (NTEP), we provide medical and psychosocial care to people living with Drug-Resistant Tuberculosis (DRTB). In a densely populated city of 22 million people, over 43,000 have TB, and around 10 per cent are infected with drug-resistant strains of the disease.
MSF also offers screening, diagnosis and specialised care for TB, HIV and Hepatitis-C in the northeastern state of Manipur. In addition, we provide care for people with advanced HIV in Bihar, which is one of the most populous states in India.
In Delhi, we provide medical and psychological care to survivors of domestic and sexual violence and raise awareness on the importance of seeking timely medical and psychological care. In Jammu and Kashmir, where years of conflict have taken a toll on people’s mental health, we have been offering counselling since 2001. Our work includes reducing the stigma associated with mental health and emphasising the importance of seeking medical assistance.
Our teams conduct mobile clinics in Chhattisgarh to take primary healthcare to remote villages and provide free treatment for malaria, respiratory infections, pneumonia and skin diseases among others. Another notable aspect of MSF’s work is its collaboration with government healthcare initiatives. In both Maharashtra and Bihar, we work along with the state healthcare setup and this alliance is important because it enables sustainability by strengthening existing systems of healthcare.
What is the volume of investments made in rural India? What are its sources?
The volume of investments in rural India varies depending on the specific projects and interventions that are being conducted by MSF at that point of time. MSF operates in India through a combination of donor contributions, grants, and partnerships with government agencies and other humanitarian organisations. The financial figures tend to vary based on the dynamic nature of our programs.
What illnesses/deficiencies are peculiar to India in your experience?
MSF's experience in India has highlighted several health challenges which are unique to the country. These include communicable diseases like tuberculosis and vector-borne diseases such as malaria and dengue. Malnutrition, especially among children, is another critical issue. Additionally, we have seen the impact of natural disasters, urban health disparities, and healthcare accessibility issues that are specific to India.
Since when have you been active in India? What were the major challenges?
MSF has been active in India since 1999 and there have been several challenges. MSF works on vertical diseases like DRTB (drug resistant TB) and ensuring that the continuity of treatment is accessible and affordable. This is a constant battle. Dismantling the societal stigma around HIV and especially among health workers requires consistent engagement and sensitisation. It is crucial to offer care with dignity. Ensuring access to healthcare in densely populated urban areas and addressing healthcare disparities has also been a significant issue.
Could you elaborate on 'inclusive global health future'?
An "inclusive global health future" envisions a world where all individuals, regardless of their socio-economic status or geographic location, have equitable access to essential healthcare services. It means ensuring that marginalised and vulnerable populations, including those affected by crises and conflict, are not left behind. Inclusivity in global health encompasses addressing health disparities, promoting universal healthcare coverage, and fostering collaboration among nations to tackle global health challenges collectively.
MSF advocates for more attention and efforts to improve Universal Health Coverage (UHC) for three groups that remain very vulnerable and are frequently forgotten or ignored in healthcare policies: people who can’t afford to pay for healthcare, excluded or marginalised groups, and people affected by emergencies.
In 2019, the UN committed to achieving UHC by 2030, as “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”. However, MSF field teams all over the world see how countries struggle to implement UHC and how people suffer because of it.
What are your biggest achievements in India?
One of the biggest achievements for MSF is continuing the fight for accessible and affordable medical care for diseases like DRTB, HIV Co-infections, Hepatitis-C etc. Recently, MSF along with TB survivors Nandita Venkatesan and Phumeza Tisile, played a crucial role in advocating for affordable access to the lifesaving TB drug-Bedaquiline by challenging Johnson & Johnson's secondary patent in India. The Indian patent office rejected the J&J’s patent allowing for cheaper generic versions and ensuring broader availability of the medication. This will benefit lower-income countries.
MSF has been working on offering “models of care” that can be replicated in multiple settings across the country and beyond. Through operational research and evidence-based science, our endeavor is to demonstrate quality, safe and effective medical care which in turn brings in opportunities to improve policies and protocols.
Some of our notable achievements in India include providing comprehensive medical care during emergencies, such as responding to the devastating floods in Assam and Bihar.
How are the challenges in India different from other countries in the global south?
India's healthcare system exhibits varying levels of quality. While some regions boast state-of-the-art medical care, others grapple with a concerning doctor-patient ratio. Despite the efforts of young entrepreneurs striving to enhance healthcare delivery, disparities in access persist. India serves as a microcosm of South Asia, reflecting diverse challenges in diseases, infrastructure, and care accessibility. Its vast population, intricate healthcare system, and diverse health concerns create unique challenges. Yet, India shares common issues with other nations, such as limited resources, healthcare disparities, and the imperative for effective responses to emergencies and disease outbreaks.
What about the use of technology in India and capacity building of health workers?
MSF, like many other health actors has optimised the use of technology to elevate healthcare delivery. We've effectively employed technology, such as Telemedicine, during the COVID crisis and adapted it for comprehensive Diabetes care across the country. Additionally, we've utilised Artificial Intelligence to bolster infectious disease diagnostics, notably for TB.
A critical lesson we've learned is the ethical and responsible utilisation of technology and data, given the fertile technological innovation ecosystem in this context, which holds immense potential to reshape the future of medicine.
In India, MSF recognises the importance of leveraging technology. We have integrated electronic medical records systems and telemedicine platforms to improve patient care and data management. Furthermore, we invest in health worker capacity building through training and resource provisions, such as the Global Health and Humanitarian Medicine (GHHM) program, enabling medical professionals to continue serving in their local settings while advancing their skills through blended learning. This includes support for healthcare staff in responding to emergencies and effectively managing complex medical conditions.