The Impact India Foundation, which set up the unique Lifeline Express, is working on an innovative project which aims to halve the incidence of disabilities in three areas of India, each with a population of one million, in just three years
By Rasika Dhavse
In 1981, the United Nation's Year of Disabled People, health statistics showed that 50% of all disabilities were preventable. The UN resolved to meet this challenge by bringing in the private sector as an equal partner. Consequently, the Impact India Foundation (IIF) was founded, on October 2, 1983, in Delhi to pioneer a worldwide initiative against disability. It was endorsed by the UN general assembly in New York, and supported, in its initial years, by the United Nations Development Programme (UNDP), Unicef and the World Health Organisation (WHO).
Launched as India's National Plan of Action Against Avoidable Disablement, the leading people behind the foundation were founder-chairman A H Tobaccowala and chief executive officer Zelma Lazarus, both well-known in the field of social development.
"We embarked on our mission with two aims in mind," says Zelma Lazarus. "Firstly, to initiate, augment and intensify action against those causes of massively prevalent disablement against which there exists a potential for prevention and control and which can be delivered through ongoing health and development programmes. The second aim was to treat an estimated 15 million people who are disabled by curable blindness, deafness and physical handicaps, by restoring sight, hearing and mobility. We also take every possible action to prevent and mitigate mental impairment."
Over the years, the IIF has developed a two-pronged strategy to achieve its objectives. It undertakes large-scale health-related projects in close partnership with the government, NGOs and other civil society organisations. Previous assignments in this line of work include 'Bombay Fights Disability' which undertook the immunisation of 300,000 children in Mumbai, the 'Malaria Control Project', also in Mumbai, that treated 150,000 patients and 'Polio-Free Madras' in which 216,000 children were immunised against the crippling disease.
The IIF also set up a unique hospital on wheels, the Lifeline Express, with the intention of taking healthcare services to distant and inaccessible towns and villages. Elaborating on the hospital, the concept of which has been replicated in China (two trains), Zimbabwe and Bangladesh (the 'Jibon Tari' or floating hospital) Lazarus says: "The Lifeline Express is the world's first hospital on rails and has so far medically treated 370,000 Indians free of cost. The idea came several years ago from Jawaharlal Nehru. He was of the opinion that the Indian railways is the best network to carry health services to the people." Impact's idea was supported by the railway ministry, which donated three coaches on a train. Medical professionals chipped in to prepare a list of required items and soon donations, in the form of financial contributions and the latest equipment. poured in. The hospital on rails was flagged off on July 16, 1991.
Along with providing basic healthcare, the staff of the Lifeline Express has surgically restored mobility, sight and hearing, and corrected clefts. The train halts for six weeks at each location, but the ground is prepared well in advance. Using Primary Health Centres (PHCs) and volunteers as the channel, messages about the train are spread to an average of 1 million people. The PHCs screen around 25,000 people and select those ready for surgery. Local volunteers play a huge role in running the entire project.
Currently, the train is equipped with three operation theatres, five to six doctors, three anaesthetists, five to six operation theatre assistants, eight medical assistants or pre/post-operative nursing staff and some support staff -- all non-paid. Till date, the Lifeline Express has completed 64 projects; over 60,000 medical personnel have volunteered their time and services.
Each project costs about Rs 15 lakh, and the train returns to a location if there are enough funds and number of patients.
Impact India is involved in another innovative project -- the Disability Reduction Project (DRP). The objective is to dramatically reduce, by one-half, the incidence of disabilities and to reverse, also by one-half, existing disabilities over a three-year period in three areas of India, each with a population of one million. The project has already commenced in the six blocks of Bargarh district in western Orissa and will now move into Maharashtra and Karnataka. Lazarus explains: "The IIF realises that the success of the Lifeline Express has largely been the result of the dramatic and clearly visible reversal of disability in identifiable individuals. At least 70 million people in India are disabled and a major portion of this disability could have been prevented. The need is for organised, managerially effective, financially low-cost and focused efforts. Hence the DRP."
While there are various types of disability, the IIF concentrates on a fairly wide range that can be prevented. Towards this end, efforts to improve sanitation, reduce waterborne diseases, encourage the production of appropriate food, etc, are being stressed. Infant mortality, maternal mortality, the probability of dying before the age of five, malnutrition and the stunting of children under the age of five, immunisation levels, iodine and vitamin A deficiency, acute respiratory infection, infant dehydration and low birth height and weight are among the disabilities that can be prevented. In its endeavour at reversing existing disabilities, the IIF's activities include surgery to correct vision and hearing deficiencies and the at least partial reversal of handicaps arising from polio, cleft lips and palates.
"The baseline data and target results will be quantitatively measurable, and there will be an independent monitoring agency," says Neelam Kshirsagar, special projects coordinator. The integrated software programmes developed specially for the Lifeline Express -- covering records of patients, doctors, treatment, control of materials, inventories, and also human resource management, financial planning and appraisal systems -- will be applied to this project too, she adds.
While it may seem like a colossal responsibility to take on, and an almost impossible one to achieve, Impact India is confident that disability can be reduced, especially if the government, the corporate world, determined professionals and the community at large come together and make a concerted effort to consider health a national priority. Awards conferred upon the IIF, such as the United Nations Grand Award for Excellence in Public Service Worldwide, prove that Impact India's thoughts and activities are headed in the right direction.
Contact: Impact India Foundation
65, Maharshi Karve Road
Mumbai 400 002
-- Rasika Dhavse is a freelance journalist based in Mumbai
(InfoChange News & Features, March 2004)