The Jamkhed Model

The Jamked model of comprehensive PHC is community-based. It uses village health workers and sustainable development projects as a foundation to improve rural public health and work toward social justice.

Eight years before the conference at Alma-Ata and twenty-five years before Link and Phelan published their theory of fundamental causes of disease (read it here), the CRHP founders recognized social status (tied to gender and caste equalities) as a major determinant of health in rural Indian villages, and implemented a unique intervention that addresses these factors. The scope of CRHP’s work extends far beyond what is traditionally considered health-related—from watershed construction to self-defense for adolescent girls. As the Aroles wrote in their chapter of the WHO’s “Health By the People” in 1975, the project aimed to “use local resources, such as buildings, manpower and agriculture to solve local health problems.” It would provide the community with “total health care and not fragmented care” by blending promotive, preventive and curative care, unlike the existing rural practitioners and hospitals, which provided only curative care and thus could not address the root causes of disease.

One of the many strengths of the Jamkhed model is strong community support, some of which came through setting up Farmers’ Clubs. By joining the Farmers’ Club in their village, farmers gained knowledge about irrigation and more efficient and sustainable farming practices, built wells, and also had the opportunity to talk about other community wellbeing matters. Farmers’ Clubs brought together landowners and landless workers, men of different castes and economic means. The Clubs served as a point of entry for the CRHP, since the men in the villages were initially more interested in improving yields and animal health than improving the health of their community. Community health topics were integrated into Farmers’ Club meetings, and members participated in general health surveys, where health-related data was collected for each and every household in the village.

Water and sanitation projects were key both to community participation in the health program and to preventing common illnesses. In rural India, 80% of diseases are water-borne (source). Worldwide, 88% of diarrheal disease—which accounts for 1.8 million deaths, mostly to children under 5—is caused by unsafe water supplies (source). Projects carried out with the Farmers’ Clubs to prevent the spread of these diseases included installing tube wells with hand pumps to provide clean water and constructing soak pits to eliminate stagnant wastewater in the village. This fit into the goal of a comprehensive health system, involving every member of the community in improving health.

Further reading
–www.jamkhed.org
-Arole M, Arole R. Health by the People. Geneva: World Health Organization; 1975
-Arole M, Arole R. Jamkhed: A Comprehensive Rural Health Project: Macmillan; 1994
-Arole M. A comprehensive approach to community welfare: growth monitoring and the role of women in Jamkhed. Indian Journal of Pediatrics. Jan-Feb 1988;55(1 Suppl):S100-105.
-Crandall A, Job J, Singh P, Arole S, Arole R. Village Health Workers Improve Child Health: The Jamkhed, India Experience, International J. Global Health & Health Disparities, 5(1): 41-54.