H. SUDARSHAN

India,

Hanumappa Sudarshan has been working with communities at the margin, demonstrating how they can transform their lives without losing their traditional and cultural practices. By using health as an entry-point, Sudarshan addresses questions of equity, governance and access within these communities.

This profile below was prepared when H. Sudarshan was elected to the Ashoka Fellowship in 1982.
 Fellow Sketch

Over the last 30 years, Dr. Sudarshan has been pushing the boundaries of health care systems, making them work effectively for the poorest and most marginalized communities. Combining strong grassroots interventions with effective advocacy, he is realizing access to health-care for all.

Sudarshan started out by addressing the curative health needs of the Soliga community in the remote BR Hills in Karnataka. Over the course of time, he realized that the curative approach alone was insufficient to respond to the mounting health issues of the tribe. With tribal communities increasingly unaware of their own practices, even as they fall behind in education, and livelihood, they could never fully address the low health indicators in the area. Sudarshan saw traditional tribal knowledge, and the community’s interdependence with the forest for nutrition and livelihoods as critical towards improving their health and well-being.

In response, Sudarshan pioneered an integrated system of preventive health care, addressing the health, education and livelihood needs of the community. Between the 1980s and 1990s, he set up a fully equipped health centre, a school, a junior college, and a vocational training centre so that the community is fully equipped towards solving their own health problems. Further, through grassroots advocacy, he won forest rights for the Soliga tribes, so that they can remain in control of the forest and its produce, and consequently their livelihood and nutrition sources. Today, the Soliga tribe has become self-sufficient, across health, education and livelihood indicators. Having seen success, he is now replicating this model in Tezu, Arunachal Pradesh for the Idu Mishimi tribe.

Sudarshan’s experiences with local health systems allowed him to see the importance of strong government health infrastructure, particularly the Primary Health Centre (PHC), to improve the quality of care for rural populations. Seeing the need to work with the government towards improving the status of PHCs in the country, he advocated for and secured the first public private partnership (PPP) to address primary health care across Karnataka. He set up Karuna Trust, to demonstrate that with better management it is possible to have better health outcomes on the same, if not lower budgets as allocated by the government. In this way, he successfully improved health outcomes in Karnataka, particularly in some of the most marginalized sections of the state. The success of this model elicited interest from Orissa, several states of the North-East and in some parts of Andhra Pradesh. Today PPPs have become a defacto method for NGOs to work with, and to demonstrate innovations to the government.

Sudarshan is now successfully managing close to 70 PHCs in the country, and is turning his attention towards the quality and range of services offered by them. He is particularly looking to include vision and eye care, mental health and the use of traditional and local medicines within their mandate.

By using health as an entry-point, Sudarshan is addressing questions of equity, governance and access within different communities across the country. He has been closely involved in building community monitoring systems to ensure quality and comprehensive health services for local and rural communities through the National Rural Health Mission. At the state level, he has been addressing the availability of health insurance for the poor and very poor through the Vajpayee Arogyasree scheme. At the same time, he has been directing his efforts at addressing the issue of corruption in health systems in India. He served a stint as the Vigilance officer in Karnataka, in which time he ensured that good governance became a part of the ethical framework of the Karnataka Health Services. Through his work with different health committees and task forces, Sudarshan continues to advance his vision for an equitable health environment in the country.

*Note: This profile was updated February 2014. Read on for the ELECTION Profile

INTRODUCTION

Hanumappa Sudarshan has been working with communities at the margin, demonstrating how they can transform their lives without losing their traditional and cultural practices. By using health as an entry-point, Sudarshan addresses questions of equity, governance and access within these communities.




THE NEW IDEA

In the Biligiri Rangana Hills in the state of Karntaka, India, Dr. H. Sudarshan works with the Soliga peoples to provide alternate food sources and income generating projects renewing hope for the Soliga people and their culture. In the last seven years his work has had a tremendous impact on the lives of these people, and his work has provided a model now being replicated throughout India.




THE PROBLEM

In India today there are 42 million tribal people who derive part or all of their livelihood from the forest. These people have traditionally survived using slash and burn agriculture. During parts of the year when the harvest is insufficient, they have traditionally lived on wild fruits, roots and tubers collected from the forests, and grazed their cattle in the forest.

In 1972, the Indian government, under pressure from environmental groups, enacted the Wildlife Protection Act which mandated that forest land could no longer be inhabited or used for food and fuel. The 15-20 thousand Soliga people became landless and unable to hunt or gather. They suffered malnutrition, acute poverty, and alienation from their traditional culture. The Soliga, like millions of other Indians, could not realistically have suddenly learned the income-producing skills which would have allowed them to enter the Indian job market.




THE STRATEGY

Dr. Sudarshan arrived in the Biligiri Rangana Hills fresh with enthusiasm from medical school. He began his work by identifying a previously-unrecognized but prevalent genetic disease. He also understood that the swollen stomachs, thin extremities, anemic-looking faces, sparse hair, jaundice, and dysentery so common among the Soliga people was not merely due to this genetic disease but to other health problems the Soliga suffered.

Through a rural development program, Dr. Sudarshan has established a multi-faceted approach to alleviating the inadequate food supply, and has implemented programs to insure on-going projects to maintain these improvements. The innovative quality of his work is that it is multi-dimensional-- agricultural, educational, and income generating. Examples of his projects he has initiated include:

- Planting 20,000 vitamin A-rich papaya seeds (previously missing from the Soliga diet). This provides economic support for 1000 families

- Establishing a dairy program providing nourishing dairy products and income for families

- Founding a school for health and nutrition education

- Establishing a readily-accessible hospital for the tribal groups

- Co-founding an association of independent rural developers across Karnataka state.




THE PERSON

Dr. Sudarshan has earned significant recognition for his work, receiving the government's Rajyotswaba Award and an award from the Indian Medical Association. Recently he won the international Right Livelihood Award ("The Alternate Nobel Award").