National Geographic has an excellent article online called “Necessary Angels” about a program in India called Jahmked that is training community health workers.  The health workers live in villages where there is little or no other medical care available.  They focus on preventative treatment since the great portion of maladies that afflict the poor in these villages are preventable. Interestingly, the article explores the opinion of several people who say that doctors, because they earn their money off treating, rather than preventing, disease, are not the answer.

Furthermore, this indigenous program, which was started by Raj and Mabelle Arole, has taken on a radical social change experiment.  The village health workers that are trained are all members of the “untouchable” caste.   The caste system is officially banned in India, but continues to thrive in rural villages.  By placing “untouchables” in positions of authority, Jahmked has turned the social paradigm on its head.  The women from the “untouchable” caste gain confidence and the demonstration of their efficacy breaks down the superstitious and stupid social mores.

There’s an interesting point made about the growth of this program.  In 38 years of existence, they have trained health workers in 300 villages.  That figure shocked me because of how few villages they have reached in such a long time.  Contrast that with a program like BRAC, which is mentioned in the article and has been around for a similar amount of time.  BRAC has set up “essentially a substitute for a government health care system, with 70,000 village health workers in 70,000 villages.”  The response from Jahmked as to why it has not scaled up is that they have expanded to include other services beyond health.  That argument simply does not hold water in the face of BRAC’s success at providing health care, education, housing and financial services.  It sounds to me like Jahmked is lacking either the will from management or a sustainable model to allow them to scale.

Accompanying the article there is, as you would expect from National Geographic, a wonderful photo gallery as well as other supplementary material.