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Making heathcare affordable to poorest communities through acupuncture: India

Author(s) Walter Fischer1
Affiliation(s) 1Barefoot Acupuncturists, Barefoot Acupuncturists, Mumbai, India.
Country - ies of focus India
Relevant to the conference tracks Health Systems
Summary Barefoot Acupuncturists is a non-profit organisation registered in Belgium and founded by acupuncturist Walter Fischer in 2009. We run acupuncture clinics in slums of Mumbai and villages in Tamil Nadu (south of India), and also train local acupuncturists in order to encourage autonomy.Our services have been developed to give the poorest communities access to affordable and efficient healthcare, limited mainly to pathologies for which acupuncture has been recognised and proven (among others by the WHO) to be an effective treatment.
Our range of action covers chronic or acute pain, paralysis and stroke recovery, digestive disorders, fatigue, gynaecological issues and hypertension.
What challenges does your project address and why is it of importance? In India the healthcare sector, which is highly privatised, urged around 39 million people to fall into poverty in 2004-2005 because of out-of-pocket expenditures for their treatments.
India is the country with the largest number of poor people in the world and also has one of the most privatized healthcare systems.
It was estimated in 2010 that in India there was a shortfall of 100.000 doctors and 1000.000 nurses.High absenteeism and corruption amongst health workers discourage the poor to access public facilities. Surveys have pointed out that even when the poor try to seek medical assistance in the public sector, richer people have a greater share of public services.The challenge we are trying to address with Barefoot Acupuncturists is the great disparity between rich and poor, between public and private health systems, in which the poorest:
- choose to be treated in private sector at a high cost that puts them at even higher risk in terms of financial insecurity and social instability.
- often choose low quality publics services with the risk of not being taken care of properly and with the threat of developing more chronic diseases, which in the long term might negatively impact their future.

In both cases, the poor become poorer.

How have you addressed these challenges? Do you see a solution? We have been trying to address that great disparity between rich and poor in healthcare by providing efficient and affordable health services to the poorest through low-cost acupuncture clinics and offering acupuncture training to local communities.
Acupuncture is a unique tool not only for social health practitioners as it is cheap, effective and easy to teach. It treats pain and illness without harmful side effects. A healthcare system provided by local «barefoot doctors» who offer first-line services is a simple solution to ensure much-needed healthcare in slums or rural areas where there is little or sometimes no access to medical facilities.Why is acupuncture a unique tool against poverty:
Acupuncture from an economic perspective:
• Allows treatment at a low cost (acupuncture equipment is cheap).
• Is highly adaptable to different environments due to its simplicity and portability.
• Provides an alternative to expensive and sophisticated treatments.
Acupuncture from a healthcare perspective:
• Offers a proven and effective solution to health related issues.
• Can offer help in cases that have not been successful with conventional medicine.
• Can reduce the excessive use of chemical drugs and their potential side effects.85% of our patients consult for pain related to musculoskeletal disorders.
Coolies, farmers, workers, housewives, drivers, and maids are the majority of people at the lowest economic level who earn their living through physical works. Those are our patients.
Because their body is overused, often misused, and because of poor living conditions, this group will suffer more than others from physical pain. At the same time, they cannot afford to remain inactive without wages. Acupuncture (well known for and particularly effective against pain) allows them to recover faster and better.
The well-known efficiency of acupuncture against pain has not only been an observation through our practice in India, but globally in our acupuncture clinics around the world. In 2002 The World Health Organisation (WHO) issued a detailed report about acupuncture and a list of diseases for which through controlled clinical trails acupuncture has been proven to be an effective treatment.

- In 5 years, we have treated more than 3.500 patients, both in slums and villages.
- Today we offer 10.000 treatments every year.
- We are employing a team of 20 local people, including 7 acupuncturists.
- We are preparing to organise acupuncture trainings at a larger scale.

How do you know whether you have made a difference? We are presently making a difference at a very local level, in the slums and the villages where our clinics operate. Our clinics are busy due to our reputation spreading in the community by patients who have been encouraged to consult us by relatives or neighbours who were treated by our barefoot acupuncturists and found relief and solutions to their health problems.
A medical survey and various testimonies have shown and explained the impact and the level of satisfaction among slums dwellers and villagers.
Although our impact is clear upon surrounding poor communities, it is true that we lack scientific data to support our field experience and to quantify that impact.
We plan to hire specialised external skills to enable us to build our practises and communication.In order to expend our impact to other areas, others states in India and later in different countries, Barefoot Acupuncturists is developing an acupuncture training program. This program is aimed at the staff of local NGO’s that will fully manage their own acupuncture clinics, based on their own network and financial resources. This will allow an exponential growth of low-cost clinics, independently of Barefoot Acupuncturists’ human and financial resources. By bringing all the knowledge and tools into the hands of local communities, we hope to create more sustainable growth and functioning.
Have you or the project mobilized others and if so, who, why and how? - Founders: private founders in Europe and India have supported us financially and made it possible for our project to develop during these 6 years.
- Around 30 experienced acupuncturists and medical doctors from all over the world have joined us to work and teach in our Indian clinics.
- In 2012 we signed a collaboration with the "World Federation of Chinese Medicine Societies", an important group of Chinese doctors and professors in Beijing (China) to work on the elaboration of an acupuncture training manual.
- The Foundation Frédéric et Jean Maurice in Switzerland has offered us financial and technical support.
- The association "Humanitarian Acupuncture Project" was created in 2012 in the United-States by American acupuncturists to support our work in India with funding and volunteer acupuncturists.
- Two Indian organisations, UnLtd India and Toolbox, have been advising and coaching us for the year to help us strategise our goals and grow more efficiently.
- Professionals from various fields share their skills continuously with us: graphic designers, photographers, web designers, professional development coaches, accountants, lawyers, film makers…
When your donor funding runs out how will your idea continue to live? Today Barefoot Acupuncturists fully manages and finances all its activities. If funds run out, clinics close and all our patients lose the benefit of our services. This is the main reason (added to the need of a better cost-efficiency ratio) why in the following two years we are preparing to become an organisation offering acupuncture training to local NGO’s and communities, making possible not only an exponential growth but also sustainable structures that will function independently from Barefoot Acupuncturists resources.