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首页> 外文期刊>BMC International Health and Human Rights >Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project
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Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project

机译：减少印度农村社区的健康不平等和获得保健的机会：印度-加拿大合作行动研究项目

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BackgroundInadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women’s lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups.The researchThe goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1) design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2) strengthen local governance in monitoring and evidence-based decision-making, and 3) develop an evidence base for appropriate health interventions.Results and outcomesHealth and social inequities have been masked by Kerala’s overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group), for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA), under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community—although inclusion of the Paniyas has been a challenge.The partnershipThe Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research.Challenges and successesAdapting to unanticipated external forces, maintaining a strong team in the rural village, retaining human resources capable of analyzing the data, and encouraging Paniya participation in the health insurance scheme were challenges. Successes were at least partially enabled by the length of the funding (this was a two-phase project over an eight year period).
机译：背景技术弱势社区的公共行动不足是中低收入国家（LMIC）贫困和边缘化群体健康的主要制约因素。以相对公平地提供公共资源而闻名的印度南部喀拉拉邦也不例外，弱势群体被边缘化。在喀拉拉邦，妇女的生活受到基于性别的不平等的制约，某些土著群体被边缘化，其健康和福祉落后于其他社会群体。农村社区的医疗保健。具体目标是：1）设计和实施基于社区的健康保险计划，以减少对医疗保健的财务障碍; 2）在监测和基于证据的决策中加强地方治理，以及3）为适当的健康干预措施建立证据基础结果和成果喀拉拉邦的整体进步掩盖了健康和社会不平等的状况。主要发现表明，不同社会群体之间存在巨大的不平等。低种姓妇女和Paniyas（边缘化的土著群体）尤其处于不利地位，他们在教育，就业状况，土地所有权和健康方面存在不平等现象。最脆弱的人群获得国家支持的可能性最小，这对整个国家都有更广泛的影响。在当地妇女的领导下，制定并实施了以社区为基础的健康团结计划（SNEHA），尽管对Paniyas的参与一直是一个挑战，但它为社区的健康平等带来了一些好处。经过十多年的合作。最初的重点是调查和数据分析，如今已侧重于社会参与的参与式行动研究。挑战与成功适应未曾预料到的外部力量，在乡村中维持一支强大的团队，保留能够分析数据的人力资源，并鼓励Paniya参加健康保险计划是挑战。资金的持续时间至少部分地使成功成为可能（这是一个为期八年的分两个阶段的项目）。

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