NANDURBAR

Nandurbar’s healthcare landscape, like many other regions across India, is shaped by a mix of indigenous and Western medical practices. For centuries, indigenous knowledge and treatments provided by practitioners such as hakims and vaidyas have formed the foundation of healthcare in the region. This long-standing relationship between communities and their natural environment played a key role in shaping the district’s early medical traditions. Over time, its landscape has gradually evolved with the introduction and expansion of more specialized medical services.

Nandurbar’s healthcare infrastructure aligns with the broader Indian model, which is characterized by a multi-tiered system comprising both public and private sectors. The public healthcare system is structured into primary, secondary, and tertiary levels. Primary care is provided through Sub Centres and Primary Health Centres (PHCs), secondary care is managed by Community Health Centres (CHCs) and Sub-District hospitals. In contrast, tertiary care, the highest level, is delivered through Medical Colleges and District Hospitals.

Supporting this structure is a network of Accredited Social Health Activists (ASHAs) who, as described by the National Health Mission, serve as “an interface between the community and the public health system.” Over time, this multi-layered healthcare model has been continuously shaped and refined by national healthcare policies and reforms, with the aim of improving service delivery and health outcomes across regions.

Medical education and research form an integral part of Nandurbar’s healthcare landscape. As Mathew George (2023) highlights, medical institutions across India often serve a “dual purpose,” educating future healthcare professionals while providing medical services to local populations. Nandurbar reflects this pattern through a blend of systems, spanning allopathy, ayurveda, and Unani medicine, showcasing India’s pluralistic healthcare traditions.

One notable institution in the district is Jamia’s Ahmad Garib Unani Medical College. Established in 1997, it remains one of Maharashtra’s unique centres for Unani education. The college offers the Kamil-e-Tib-o-Jarahat (Bachelor of Unani Medicine and Surgery, B.U.M.S.) programme as prescribed by the Central Council of Indian Medicine (CCIM), New Delhi. The college is recognised by the Government of Maharashtra and affiliated with the Maharashtra University of Health Sciences (MUHS), Nashik.

In 2020, the Government Medical College and Hospital (GMC Nandurbar) was set up as part of a state initiative to convert district hospitals into teaching hospitals. This marked an important step towards addressing gaps in medical training and healthcare services in this region.

Before the rise of organised healthcare systems, communities in Nandurbar relied heavily on indigenous medicine. Local groups such as the Bhil, Pawra, and Gavit communities, especially in the Satpura Hill belt, have long preserved a deep understanding of traditional treatments passed down through generations. Local healers, often known as Bhagats, Vaidyas, or Vaidus, remain important figures for basic healthcare in remote villages.

Studies have documented various ethnomedicinal uses in the district. For example, locals prepare a paste from young saplings of Salai (Boswellia serrata) to treat eye infections such as conjunctivitis. Similarly, for epilepsy, root extracts from Mothi deni (Commelina benghalensis) are shaped into pills for medicinal use. These practices reflect a continued, though declining, reliance on traditional knowledge alongside allopathic systems.

The determinants of health and health outcomes, as the World Health Organization (WHO) elaborates, are not solely shaped by more than just medical factors and healthcare services. The organization uses the term “social determinants of health (SDH)” to refer to the “non-medical factors that influence health outcomes.”  These non-medical factors can be sanitation, nutrition, community well-being, or, as the WHO outlines, “income and social protection,” “food security,” access to quality healthcare, and more.

While there have been ongoing efforts to strengthen Nandurbar district’s healthcare infrastructure, certain areas still face challenges, particularly in addressing these broader health determinants. In response, non-governmental organizations have emerged as vital partners, working alongside public health systems to develop innovative, grassroots-level approaches that bridge these gaps.

Lakshya 84 Days is a maternal and child health programme launched in Nandurbar district in 2023 to reduce high rates of infant and maternal mortality. The initiative divides care into two phases: 42 days of focused antenatal care (ANC) for pregnant women, followed by 42 days of postnatal care (PNC) for mothers and newborns. The programme aims to address key risk factors such as low birth weight, birth asphyxia, sepsis, respiratory illness, and complications linked to sickle cell disease, which is prevalent in the region.

This issue has deep historical roots, underscored by numerous Public Interest Litigations since 2007. In September 2022, the Bombay High Court summoned the District Collector to address the alarming rates of maternal and child fatalities, often attributed to malnutrition and inadequate healthcare services.

The launch of the programme came in response to a significant local health crisis. In 2023, the district civil hospital recorded 179 child deaths within three months. Historical concerns about maternal and child health in Nandurbar have been raised repeatedly since 2007, including through Public Interest Litigations. In September 2022, the Bombay High Court called on the District Collector to explain persistent deaths often attributed to malnutrition and gaps in healthcare delivery.

Nandurbar’s remote terrain and limited infrastructure make access to emergency care challenging, particularly at night. To overcome this, health centres have arranged transport for expectant mothers near delivery, and villagers often assist by carrying women in makeshift carriers to reach health facilities in time.

In September 2020, Maharashtra was reported as the worst-affected state in India during the COVID-19 pandemic. The virus's spread in urban areas gradually reached the rural parts of the State, leading to widespread concern. The fear of COVID-19 resulted in the closure of many private healthcare facilities, including small hospitals and nursing homes in rural towns. Those that remained open were often hesitant to admit severely ill patients due to the prohibitive costs of treatment. Meanwhile, the public health system became overwhelmed, struggling to meet the needs of both COVID-19 and non-COVID patients.

Among the few facilities to remain open in Nandurbar during this time was the Chinchpada Christian Hospital, which implemented strict infection control measures and continued providing care. Its reputation for affordable, patient-friendly services drew patients not just from Nandurbar but also from neighbouring districts like Dhule and Tapi. Recognising its capacity, district authorities designated it as a Dedicated COVID Health Centre (DCHC), expanding its role in managing moderate COVID-19 cases.

By 2021, the Nandurbar Model for tackling COVID-19 gained attention for its effective strategies led by District Collector Rajendra Bharud. Despite widespread struggles for medical supplies, Nandurbar, a remote tribal district, managed to ensure accessibility for its underserved communities. Starting in September 2020, Bharud established oxygen plants in local hospitals, ensuring that when the second wave hit, Nandurbar had five operational plants, sufficient supplies, and ample hospital beds. The district transformed schools into quarantine centers for patients with mild symptoms, preventing delays in care.

As per BBC reports (2021), through this approach, Nandurbar increased its healthcare capacity to 148 critical care and 556 oxygen beds, and installed three oxygen plants capable of producing 4.8 million liters of oxygen daily. Additionally, the district acquired 30 oxygen concentrators for remote areas and trained "oxygen nurses" to optimize oxygen delivery. This proactive approach not only mitigated the pandemic's impact in Nandurbar but also served as a model for other districts in Maharashtra.