Lee, Peter (2017). 'Challenging Inequalities from Below and On the Ground: Comprehensive Primary Health Care, Community-Based Development, and Sustained Social Change' Paper presented at the annual conference of the HDCA, Cape Town 2017.


Founded in the 1970s by two physicians, the Comprehensive Rural Health Project (CRHP) in rural Maharashtra, India employs a community-based, integrated approach that addresses underlying socioeconomic deterrents of health including poverty and gender inequality. CRHP's model (alternatively the Jamkhed model) emphasizes three principles: equity, integration and empowerment. One to two women from local project villages that have agreed to participate are trained as village health workers (VHWs) by CRHP. Working at a grassroots level within their village communities, VHWs share their knowledge and skills, provide primary health care services, demystify medicine, and disseminate information concerning practices of health and care. As a result, for the past forty years, CRHP and the VHWs have been able to drastically improve the health landscape within project villages. Malnutrition, infant mortality, maternal mortality, and endemic diseases such as malaria and scabies have rapidly declined since the program's implementaiton. In intimately recognition the fundamental link between social arrangments and health as not the absence of disease or infirmity but rather as the complete state of physical, mental, and social well-being, VHWs endeavor to prevent the negative, embodied experiences of caste, gender, and class through dismantling the power afforded to social constructions of hierachy. Gender based-violence, caste-based violence, and the incidence of dowry have also subsequently declined since the program's implementation.

In addition to their medical work, VHWs organize self-help groups for both women and men. Self-help groups receive support from banks, international organizations, and nongovernmental organizations in the form of financial loans which are utilized often for the production of agriculture, livestock, and bricks. In conjunction with health improvement, these microeconomic income generation projects contribute to sustainble social change for women, for their families, and for their village communities at-large. 

Although these communities in rural India are still in the process of overcoming poverty as strictly defined by economic indices of income, CRHP - the Jamkhed Model of health - nevertheless demonstrates the potentials of a community-based, comprehensive primary health care approach. Utilizing CRHP as a case study, this paper, based on ethnographic fieldwork, examines the mobilization of the capability approach in global health praxis and practice. How does a fundamental understanding of social, political, economic, and historical inequalities inform equity-based development? How can challenging structural inequalities enable, if not translate, into [individual and community] empowerment, freedom, and social justice? How will grassroots efforts of resistance and resilience allow for agency, mobility, and sustained social change? As ill-being is the inscription of lived local realites and is the embodiment of inequality and inequity, this paper concludes with an exploration of health as a framework for the capability approach to capture the diverse multidimensional nature of human lives; to further understand functionings; and to be better equipped in endeavors of development, policy making, and implementation.




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