Putting the ‘Care’ Back in Healthcare

Walking into the Grameen Kalyan (GK) Health Center (HC), the first thing that hits you are the smiling faces of the Community Level Health Workers. While city hospitals and clinics are manned by personnel who are often discourteous and sometimes even downright rude, the community level health workers seem to have already put into practice what behavioral scientists thousands of miles away seem to have empirically verified only recently- that the quality of communication and interaction between a patient and his/her caregiver is one of the most significant explanatory variables for patient satisfaction which directly affects a patient’s responsiveness to the caregiver’s advice and treatment. (See ‘Communicating with Today’s Patient: Essentials to Save Time, Decrease Risk, and Increase Patient Compliance’ By Joanne Desmond, Lanny R. Copeland).

The GKHC we visited was a poorly ventilated one story building with six small rooms. Some rooms were missing ceiling fans and in the five hours we were there, there were three hour-long power outages. Considering that most urban health centers are air-conditioned and the customers are usually relatively well behaved, the conditions at the GKHC were almost inducive for misbehavior. And yet, even when customers were completely out of line, the staff showed a level of poise and decorum that could rival that of airhostesses on some of the world’s best airlines.

Each GKHC house 5 community level health workers, one lab technician, one Diploma Medical Faculty and one branch manager who also acts as the pharmacist. Each center is also supposed to have one doctor, but MBBS doctors refuse to inhabit remote rural areas despite considerably higher wage offerings than city doctors. As a next best solution, GK has arranged for doctors from peri-urban GKHCs to visit the remote HCs at least once a week. In addition, GK also arranges for monthly health camps where specialists (mostly eye specialists) come out to rural areas to diagnose and treat those in need.

What is interesting is that a government health center is present right around the corner from the GKHC, where a large number of the same services AND medicines are provided for FREE. One could then expect that for any ailment that could be diagnosed and treated at both the GKHC and the government health center, the obvious choice would be the government health center. And yet, we see that consistently, the GKHC is able to compete with a free provider and still retain a substantial share of paying customers.While I cannot be sure as to the reasons behind what is essentially an economic conundrum, I strongly suspect that the quality of communication and interaction with patients is one highly significant explanatory variable. At every point of contact in the GKHC, starting from the community level health workers, all the way up to the branch manager, patients are greeted and treated with an air of genuine care and kindness.

Posted by Ahmed Abu Bakr


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