Be The Pathfinder: Dr. Abhay Bang on Grassroots Healthcare
By Arunima Rajan
Imagine earning a degree from the prestigious Johns Hopkins University only to choose a calling in one of India’s most underdeveloped regions—Gadchiroli, Maharashtra. While this scenario might evoke a scene from the film Swades, it is precisely the journey that Dr. Abhay Bang and his wife, Dr. Rani Bang, embarked upon in the 1980s. The couple went on to establish a tribal-friendly hospital and launch a community-based healthcare programme across several villages. Their pioneering work in village healthcare has evolved into a model celebrated both nationally and internationally, influencing health policy in India and beyond on multiple occasions.
In this exclusive interview with Arunima Rajan, Dr. Bang discusses his inspiration to serve Gadchiroli—reflecting on his childhood, the broader challenges in healthcare outcomes, the obstacles he encountered bringing healthcare to an underserved community, and the methods he employed to bridge the gap between grassroots innovation and national policy.
Is there a specific person or event in your life that motivated you to go to Gadchiroli and pursue this line of work? Was there a particular moment in your childhood when you realised you wanted to be a doctor, or was it something that came to you later?
Dr Abhay Bang: That clarity came to me when I was 13 years old. There’s a bit of background to that. I was born and raised in Wardha, in Maharashtra in the 1950s and '60s, a period of post-Independence optimism. Wardha was the capital of the Indian freedom movement, and Gandhiji ran much of the movement from Sevagram Ashram.
I was fortunate to grow up in an atmosphere steeped in Gandhian ideals. My father was a freedom fighter inspired by Gandhi, and my mother was the principal of the school started by Gandhiji himself. Although I never saw Gandhiji, his influence was palpable everywhere.
In 1964, my elder brother Ashok and I were out cycling on a scorching summer day. We paused for a breather, and he said, "We’re grown up now. Let’s decide what we want to do in life." It seemed like a simple question at the time, almost like deciding what to eat for dinner.
We reflected on the state of the villages around us. India was grappling with severe starvation, poor agricultural output, and a lack of healthcare. Ashok decided he would work to improve agriculture. That left me with healthcare, so I said meekly, "I’ll improve health in rural India." That moment was one of commitment, almost a "tryst with destiny."
Ashok went on to study agriculture and worked with farmers for decades, while I pursued medicine. As a child, I wasn’t particularly interested in medicine as a subject, but I wanted to improve rural healthcare. My commitment drove me through medical college, further studies at Johns Hopkins, and eventually back to India.
When I returned, the story of my father’s life served as a guiding principle. In 1946, he had been offered a chance to study economics in the US but chose instead to live and learn from Indian villages because the Mahatma advised him, instead of the US, go to the villages of India. His decision to prioritise the grassroots over personal advancement deeply influenced me. When we returned from the US, the Mahatma’s words still echoed in our ears.
This is why I chose Gadchiroli—a district with high illiteracy, poor infrastructure, and a predominantly tribal population. It wasn’t an easy transition, but the commitment to serve rural communities kept us going.
That’s such a powerful story. So, when you first moved to Gadchiroli, what were your initial impressions? It must have been a cultural shock, especially after coming back from the US.
Dr Abhay Bang: Yes, it was a contrast. Rani and I got married in 1977 after completing our MDs at Nagpur Medical College. Gadchiroli wasn’t entirely new to us since we had grown up in Maharashtra, but it was challenging in many ways.
Gadchiroli had been carved out as a separate district due to its backwardness. Nearly half the population was tribal, 70% of the land was covered in dense forests, and the villages were incredibly remote. There were no roads, literacy levels were abysmal—female literacy was just 32%—and diseases like malaria, tuberculosis, and malnutrition were rampant.
We were also dealing with the problem of Naxalism, which was very active in the region. The area was considered "punishment posting" territory, and most professionals didn’t want to come here. But we were determined to make it work.
Initially, we faced a lot of hurdles. Healthcare facilities were almost non-existent, and the local population largely relied on traditional medicine and magic cures. On the second day of our stay, a young girl was brought to me with a letter from the local medical officer. She was eight years old; I suspected she had sickle cell disease—a condition that hadn’t been documented in the district at the time.
Out of intellectual curiosity, we conducted a district-wide survey and found that while less than 1% of the population had the disease, 15% were carriers of the sickle cell gene, which offered some protection against malaria.
We were thrilled when our findings were published and received attention from the health ministry. But when we shared the results with the tribal community, they were unimpressed. They told us, “We didn’t ask you to study this disease. It’s not our priority.”
That was our first big mistake—we didn’t ask the community what they needed. We imposed our priorities on them, driven by our own scientific curiosity. It was a humbling experience and a turning point for us. From then on, we resolved to focus only on work that directly benefited the local people.
That’s such an important lesson. Speaking of priorities, how did you decide to focus on neonatal healthcare and develop your home-based care model? It must have been difficult to gain the trust of local women.
Dr Abhay Bang: Absolutely. Trust was a significant factor. We realised that neonatal mortality was one of the biggest challenges. At the time, Gadchiroli’s infant mortality rate was 121 per 1,000 live births. In comparison, Kerala’s rate was around 12, and the US was at six or seven.
The primary causes of infant mortality were pneumonia and neonatal complications. While we developed a village-based approach to treat pneumonia effectively, the challenge of neonatal care remained.
One night during the monsoon season, two women arrived at my house carrying a very sick newborn. The baby was malnourished, dehydrated, and struggling to breathe. Despite my best efforts, the baby died on my own bed. That moment was devastating and left me questioning everything.
As I reflected on the situation, I realised that this baby had 18 contributing factors that led to its death—poverty, illiteracy, traditional beliefs, lack of infrastructure, and more. I felt powerless to address all these issues at once. But then it struck me: I didn’t need to solve every problem. I just needed to break the weakest link in the chain.
The weakest link was the lack of healthcare in the village. If babies couldn’t reach the hospital, then healthcare needed to reach them. That’s how the idea of home-based neonatal care was born.
We studied traditional practices, trained local women as community health workers, and equipped them to provide neonatal care in their villages. These women became the first community healthcare workers in the world, offering round-the-clock neonatal care at home and bridging the gap between modern medicine and traditional beliefs.
The results were astonishing. In a controlled trial, neonatal mortality reduced by 62%. The Lancet published it in 1999. The model was later replicated across India and became part of the national strategy to reduce infant mortality.
That’s incredible. How did you manage to bridge the gap between grassroots innovations and national policies?
Dr Abhay Bang: It was a combination of rigorous science and timing. Our work in Gadchiroli coincided with a national focus on reducing infant mortality. We ensured our interventions were low-cost, scalable, and backed by strong evidence.
We also involved top pediatricians and policymakers early on, which helped build credibility. When our model was replicated in five states through the Indian Council of Medical Research (ICMR), it demonstrated consistent success. This convinced policymakers to adopt it at a national level.
That’s so inspiring. But healthcare is interconnected with larger issues like poverty, education, and gender norms. How did you address these broader challenges while improving healthcare outcomes?
Dr Abhay Bang: That’s a crucial point. You can’t address healthcare in isolation—it’s deeply intertwined with social determinants. Our approach was incremental. While we couldn’t solve every problem at once, we started with what we could manage.
For instance, malnutrition and alcohol abuse were significant issues in the community. Initially, we were hesitant to tackle alcohol abuse, but the women in the community insisted. We were compelled by them to take the leadership. Over time, it became a district-wide movement, leading to the ban of commercial alcohol sales in Gadchiroli.
This taught us the power of combining grassroots efforts with broader systemic changes. By addressing smaller, manageable problems, we could create a ripple effect that impacted larger policies.
That’s such a thoughtful approach. You’ve emphasized the importance of empathy and compassion in healthcare. How did you ensure these values were embedded in your model, especially when training community health workers?
Dr Abhay Bang: As doctors, our interactions with patients are often limited to a few minutes, and we tend to focus on biological problems rather than the person as a whole.
The beauty of the community health worker model is that these women are part of the community. They live in the same villages and see their neighbors as their own kin. This inherent connection fosters a natural sense of care and accountability.
One story stands out. During our work in Uttar Pradesh, a community health worker told us, “You’ve given me a new life. Earlier, I was known only as someone’s daughter, someone’s wife, or someone’s mother. Now people in my village know me by my name.”
This transformation gave her a sense of identity and purpose, which, in turn, made her more committed and compassionate in her work.
Another important aspect was listening to the community. Early on, we learned the hard way that imposing solutions without understanding local needs doesn’t work. By engaging with the community, we built trust and co-designed solutions that were culturally appropriate and effective.
Moving on, your work isn’t just about delivering healthcare—it’s also about helping communities achieve self-sufficiency. What do you think are the essential elements for achieving real independence in healthcare?
Dr Abhay Bang: The concept of health in India inherently includes self-sufficiency. The Sanskrit word for health, “swasthya,” combines “swa” (self) and “sthya” (being), meaning self-sufficiency, autonomy or independence. This philosophy has guided our work.
We believe in minimising dependence on external systems like hospitals, doctors, or pharmaceutical companies. Instead, we focus on empowering individuals and communities to take care of their own health. This vision, which I call Arogya Swaraj (health self-rule), is the foundation of our approach.
Of course, complete independence isn’t always possible. People will still need hospitals and specialists for certain conditions. But our goal is to reduce this dependency as much as possible by building local capacity and solutions.
Today, traditional medicine often faces criticism. What’s your take on balancing traditional practices with modern healthcare?
Dr Abhay Bang: Traditional systems of medicine have existed for centuries and undoubtedly contain valuable knowledge. However, they must undergo scientific scrutiny to separate effective practices from outdated or ineffective ones.
Modern science is not infallible, but its strength lies in its willingness to challenge and revalidate its own beliefs. Traditional medicine must embrace this process. We shouldn’t ridicule traditional practices, but we also shouldn’t accept them blindly.
That makes sense. On a personal note, you’ve spent decades in this field, which must have been demanding. How did you maintain your energy and hope during difficult times?
Dr Abhay Bang: I think several factors kept me going.
First, having a larger dream—a purpose bigger than myself—was crucial. My commitment to improving rural health was the driving force.
Second, staying connected to the community provided me with energy and inspiration. Seeing the resilience and determination of tribal women and villagers often renewed my own strength.
Third, my wife, Rani, has been my greatest source of support. She’s not just my partner but also my collaborator and co-dreamer.
Finally, spirituality has been a cornerstone of my resilience. I draw strength from daily readings of spiritual texts and our community prayers. These practices remind me of the bigger picture and help me navigate moments of despair.
Did you face resistance from the community at any point?
Dr Abhay Bang: Resistance is natural, especially when introducing new ideas. For example, many traditional beliefs, such as not breastfeeding babies for the first three days, took time and effort to change.
We also encountered skepticism when promoting oral rehydration solutions for diarrhoea, as it went against the belief that giving fluids during diarrhoea worsens the condition.
However, these challenges were more about education and trust-building than outright resistance. By working closely with the community, addressing their concerns, and showing results, we were able to gain their acceptance.
As you reflect on your journey, what do you consider your biggest contribution to healthcare? And what advice would you give to the younger generation as they navigate the challenges of climate change, new diseases, and growing inequalities?
Dr Abhay Bang: If I had to distill my contribution into one sentence, it would be this: Arogya Swaraj, empowering the people for health.
My advice to young professionals is to go where the problems are, not where the facilities are.
Too often, professionals are drawn to urban centers or places with abundant resources. But it’s the underserved areas that need us most. By going where there were no facilities, we were forced to innovate and address challenges head-on.
My advice to the younger generation is to live a meaningful and purposeful life. Don’t chase money—it’s endless and ultimately unfulfiling. Instead, choose a path where you can make a genuine impact.
Vinoba Bhave once said, “If you are standing at the end of a queue, there’s little chance you’ll reach the front. Turn around, and you’ll be the first.” This means that if you go where no one else is willing to go, you’ll find purpose and fulfilment. You will be the pioneer. Be the pathfinder.