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Creating the Demand for Quality in Healthcare: Should we go the reverse way? By: Prof Vikram Datta

India is a vast and diverse country with a population of more than 1.4 billion people. It faces many challenges in providing equitable and quality healthcare to its citizens, especially those living in rural and remote areas. How do we create demand for quality in healthcare and move beyond the target-led and certification-led approaches to a culture of continuous quality improvement in our health systems? NQOCN India ( has been grappling with this question for over eight years, is this the time we shift our focus from the healthcare workers and start creating empowered communities who create an accountable health system with high quality and equity?

To date, one of the major barriers to improving health outcomes is the lack of awareness and demand for quality healthcare among the community. Many people do not know their rights and entitlements, do not seek timely and appropriate care, and do not hold the health system accountable for its performance.

How can we change this situation and create a culture of quality in healthcare? One possible way is to empower the community to become active participants and partners in their own health and well-being. Empowerment means giving people the knowledge, skills, confidence, and resources to make informed decisions, voice their needs and preferences, and demand better services from health providers and authorities. Empowerment also means enabling people to organize themselves into groups and networks that can advocate for their interests and influence policies and programs. One of the key factors that can influence the quality of healthcare is the demand for quality healthcare from the community. If the community is aware of their rights and entitlements, and if they have the capacity and confidence to voice their needs and expectations, they can play a vital role in ensuring that the healthcare providers are accountable and responsive to their demands. This is what we call active empowerment of the community.

Active Empowerment of the Society:

Active empowerment of the community means that the community members are not passive recipients of health services, but active participants in shaping and improving them. It means that they have access to information, education, and advocacy tools that enable them to make informed choices and decisions about their health. It also means that they have mechanisms and platforms to express their feedback, grievances, and suggestions to the healthcare providers and authorities, and to demand corrective actions when needed. Active empowerment of the community can create positive pressure on the healthcare system to improve its quality and performance.

One of the ways to promote active empowerment of the community is to create awareness campaigns that highlight the importance and benefits of quality healthcare, and that encourage the community members to demand it. The campaigns should also inform the community about their rights and entitlements under various health schemes and policies, and about the standards and norms of quality healthcare that they should expect from the providers. The campaigns should also provide guidance on accessing information, education, and advocacy resources that can help them in their empowerment journey. The key slogan for such campaigns could be: An empowered community demands quality.

An empowered community demands quality:

An empowered community demands quality is a slogan that captures the essence of active empowerment of the community. It implies that the community has the knowledge, skills, and confidence to demand quality healthcare from the providers. It also implies that the community has the power and influence to hold the providers accountable for their quality and performance. It also implies that the community values quality healthcare as a right and a necessity, not as a luxury or a favour.

There are many examples of successful community empowerment initiatives in India that have improved health outcomes and quality of care. One such example is the Kiran Clinics of MGIMS Sevagram, which are community-owned and managed health clinics that provide primary care services to rural populations in the Wardha district of Maharashtra. These clinics are run by trained local women who are members of self-help groups (SHGs) formed by the Department of Community Medicine of MGIMS Sevagram. The SHGs are also involved in health education, behaviour change communication, family life education, adolescent health, nutrition, sanitation and hygiene activities in their villages. The Kiran Clinics have increased the access and utilization of essential health services, reduced the out-of-pocket expenditure on health, improved the satisfaction and trust of the community, and empowered the women to take charge of their health.

Another example is the Kishori Panchayats (KP), which are adolescent girls' groups formed by the Department of Community Medicine of MGIMS Sevagram in collaboration with UNICEF. The KP aim to empower adolescent girls to improve their health, education, life skills and leadership potential. The KP members meet regularly to discuss various issues affecting their lives, such as menstrual hygiene, reproductive health, gender discrimination, child marriage, domestic violence, substance abuse, etc. They also conduct peer education sessions, awareness campaigns, street plays, rallies, and advocacy meetings with various stakeholders. The KP have improved the knowledge, attitude, and practices of adolescent girls on various aspects of health and well-being, increased their self-esteem and confidence, enhanced their participation in decision-making processes at the home and community level, and reduced the prevalence of child marriage.

These examples show that community empowerment is a powerful strategy to create demand for quality improvement in healthcare in India. By empowering the community, we can enable them to become aware of their health needs and rights, seek timely and appropriate care, monitor, and evaluate the quality of services, provide feedback and suggestions for improvement, and hold the health system accountable for its performance. An empowered community demands quality healthcare from the providers and authorities and contributes to improving it through its own actions and initiatives. These empowered adolescents have not only improved their own lives but also catalysed a significant shift in the way their communities seek quality from the primary and secondary levels of the healthcare delivery systems. Many of the members of KP’s have moved on to join the health workforce as ASHA and ANM workers and are contributing to the delivery of high-quality care for their very own communities.

Thus, the new magic mantra to create demand for quality in healthcare in India could be very aptly entitled “An empowered community demands quality”. This slogan can inspire and motivate both the community and the providers to work together towards improving the standards of quality in healthcare in India.

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