Laxmi holding her infant son, Nikhil.

Laxmi's care for her son Nikhil's health is supported by home health visits and an improved immunization system. Photo: Satvir Malhotra.

Comprehensive health system improvements mean new mother Laxmi can give her baby the care and protection he needs

In rural India, a young mother named Laxmi arrives at a small health clinic with her seven-month-old son. Laxmi, 21, has walked 15 minutes from her home to reach the clinic, where baby Nikhil will receive his third round of vaccinations. His mother keeps careful records of his care, prompted by the health workers who visit the modest house that Laxmi and her husband share with another family.

The health workers are mothers, too, and they know the importance of keeping their children healthy. Any time a baby is born in the village, these women simply walk to the house and offer a helping hand.

“The health worker is also a friend,” Laxmi says. “That makes me feel that I can take care of my family and that I can ask questions whenever I need to.”

It’s not always this easy for people in India’s rural villages to get the care they need. The cost of health services can be prohibitive to very poor families like Laxmi’s. And small village health posts often don’t have the resources to offer vaccines or treat babies that are severely ill—the chances of surviving preventable illnesses in rural areas are fairly low.

But Laxmi, Nikhil, and two million people just like them are benefiting from a historic partnership between PATH and the Indian government to strengthen health capacity all the way down to the country’s smallest villages.

Health care for people who can’t access services

From 2001 to 2006, PATH collaborated with the Government of Andhra Pradesh, one of India’s poorest states, to examine the health system from top to bottom and identify ways to eventually bring vaccinations and care to all of the state’s residents. How could the system reach families living more than a day’s walk from health services or those who simply can’t afford to see a doctor? How could health workers provide children with important vaccinations so that preventable diseases like diphtheria, measles, and tuberculosis could be avoided altogether?

Andhra Pradesh now boasts immunization coverage rates nearly equal to those in the United States.

The partnership tackled solutions both large and small, from training health workers to improving vaccine storage. Health staff upgraded their skills, learning to safely deliver vaccines and properly dispose of used needles—critical for reducing the spread of infections such as HIV. Hospitals and clinics took steps to ensure that medicines and vaccines are not exposed to heat and spoiled. In one district that serves 2.5 million people, health administrators hired a full-time refrigerator mechanic who can keep critical refrigerators running in clinics throughout the area—and ensure medicines remain safe and viable for the patients.

Health workers improved their capabilities and systems to boost their ability to serve patients in remote areas. One district purchased a handcart to move boxes of vaccines. Now it takes only one worker, rather than two, to load the heavy boxes into a truck and distribute them to outlying health posts. Health centers established a careful tracking system to organize and dispense medicines. Health workers load vaccines into special portable coolers and carry them on foot to visit families in their communities, and they chart their patients’ immunization schedules to be sure everyone is up-to-date.

Helping the youngest citizens

With PATH’s support, the system extended its outreach to visit patients in their homes and promote good health among families, right down to India’s tiniest citizens.

The careful analysis and reworking of Andhra Pradesh’s immunization system has improved the health of the region’s people by leaps and bounds. The state boasts excellent immunization coverage rates, and the improved practices across Andhra Pradesh are woven into the health system to sustain this success for years to come. Ten other states are adopting similar measures to improve their health systems. Andhra Pradesh hopes to eventually extend stronger services to all of its 80 million residents.

Important support for a mother and her baby

In Laxmi’s village, PATH’s partnership with the government has made a tangible impact. The young mother stays busy sweeping her dirt-floor hut, washing her clothes in the river, and cooking for her extended family, but village health workers come right to her doorstep to support the health of Laxmi and her child. Already, she has received tablets to treat baby Nikhil’s fevers, and the health workers’ encouragement has convinced Laxmi to bring Nikhil to the clinic for care.

Behind the scenes, the wheels of a stronger health system are turning, keeping vaccines potent, medicines available, and care ready when people need it—making an important difference in the lives of Laxmi and Nikhil. Here in this village and across Andhra Pradesh, two million other women and children are benefiting from real, lasting change that will ensure their good health far into the future.