CHALLENGE

Decoding the dynamics of Hep-C in rural Punjab to understand the reasons behind the low adoption of its treatment.

OUTCOME

A system of awareness and easy adoption of treatment driven by the community along with the help of a pharmaceutical company.

PROJECT DURATION
SERVICES
AREA OF WORK

8 MONTHS

ETHNOGRAPHIC RESEARCH & ANALYSIS, BUSINESS STRATEGY, SERVICE DESIGN, DESIGN THINKING WORKSHOPS, PILOT DESIGN & EXECUTION

HEALTHCARE, DESIGN FOR SOCIAL IMPACT

Punjab, formerly the richest state in India has seen its glory days owing to its highly fertile soil. In the last few years however the health of the state has deteriorated owing to alcohol & drugs abuse. There is on the other side, the rise of a silent killer – Hepatitis C. During this project we’ve visited districts like Muktsar where ~60% of the people are at varying stages of the disease.

Pharmaceutical companies have been trying to grapple with the thought – if there’s indeed this great a prevalence of the disease, why is the treatment not being adopted at the same rate? One of the answers we received from the various pharmaceutical agents in the region is that the cost of the treatment is too high, rendering it unaffordable for a farmer.

Our project, a collaboration with one of India’s pharmaceutical companies was to decode dynamics of Hepatitis-C on the field & understand the reasons behind low adoption of treatment and the type of financing that might reduce the perceived cost of treatment.

Understanding the dynamics around Hep-C in rural Punjab.

  1. In an effort to make the locals adopt RO systems, the state & central government launched massive campaigns to detail how the water from bore-wells is harmful for the body. This perception of the water being unhealthy has been linked as the reason behind the expansion of Hep-C, along with it being the reason for the steady decline of the health of the state.
  2. Hep-C is a silent killer, it remains dormant in the body for upto 20 years and doesn’t visually surface on the body till the final stages of liver cirrhosis when the only treatment available is a liver transplant. Due to its dormancy, most patients died above the age of 50 which was considered death due to the old age and not attributed to Hep-C.
  3. Hep-C or Kaala Peeliya is phonetically similar to Peeliya in the local dialect which led most patients to misinterpret their diagnosis. Peeliya traditionally has been handled by local, herbal treatments which is the same medication that was adopted for Kaala Peeliya.
  4. In Punjab, a continuous lending system is adopted with the money-lender at its core. Against the crop as mortgage, loans are taken almost on a weekly basis for running of the house to building one. If money is needed, the money lender will be approached but Hep-C wasn’t considered to be a disease that needed to be treated.
  5. The surmounting debt from the money lender was cleared at the time of harvest. Due to the BT-cotton crisis, the crop was minimal such that it couldn’t recover the cost of loans. This led to increase in farmer suicide and mistrust towards the money lender.
An intervention on awareness by placing posters on the walls of R.O. stations promoting a healthy message around water - that it is safe to play with. It also talks about Hep-C not being water-borne but blood-borne.

Intervention

We realised at this point, that there was an urgent need to dispel misconceptions, to create awareness and to increase the vocabulary of the people in the districts to create new associations during common discourse around water and Hep-C. It was also sensed that such an awareness would be best communicated through word-of-mouth. A concept of a local hero was thus introduced, who would be given vernacular information on the disease and treatment. Local heroes were either people who’ve been cured or are undergoing treatment, or people who are active collaborators in the community. Local metaphors were provided to make communications by the local hero sticky during whispers from one to another. These local heroes were further point contacts for pharmaceutical companies and doctors wherein they helped organize health camps in return for benefits on their rehabilitation, tests & treatments.

“Yeh deemak ki tarah hota hai, jese ped ko andar se khaa jata hai aur jab bahar dikhe to samjho andar kuch nahin raha.”

Further more, tie-ups were created with micro-finance groups such that an alternate stream of funding could be reached at by the community. These micro-finance groups were aided by local counselors that were equipped to engage in discussions around loan amounts and authorise quick loan disbursals. In this way, the counselors, while maintaining one-on-one relationship with the people, were portrayed as the authority in financing matters – just like a money lender is to the community.