Abhay Bang

Abhay Bang and Rani Bang are Indian social activists and researchers working in the field of community health in the Gadchiroli district of Maharashtra, India. They have revolutionized healthcare for the poorest people in India and have overseen a programme that has substantially reduced infant mortality rates in one of the most poverty-stricken areas in the world. The World Health Organization (WHO) and UNICEF have endorsed their approach to treating newborn babies and the programme is currently being rolled out across India and in parts of Africa. The Bangs founded the 'Society For Education, Action and Research in Community Health' (SEARCH) – a non-profit organisation, which is involved in rural health service and research. The couple is the winner of the Maharashtra Bhushan Award. Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow has conferred honorary doctorates on Abhay and Rani Bang. SNDT Women's University, Mumbai has also awarded Honoris Causa to Rani Bang. The Lancet has honoured the couple as 'the pioneers of health care in rural India'. Abhay and Rani Bang are the first recipients of the Distinguished Alumni Award from the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. They were also inducted into the Johns Hopkins Society of Scholars. The Bangs are honoured for their leadership in community-based health care that is now helping to save the lives of millions of the most vulnerable newborns and children. During their careers, the Bangs have helped foster a renaissance in community-based primary health care. In 2016, Johns Hopkins University conferred the Distinguished Alumni Award upon them.

Abhay Bang was born at Wardha, Maharashtra, India in 1950 to Thakurdas Bang and Suman Bang who were followers of the Sarvodaya movement inspired by Gandhian thoughts. His father, Thakurdas Bang, a young economist, went to Mahatma Gandhi to seek his blessings while he was about to go to the United States to do his doctoral studies. Gandhiji looked at him for few seconds and said – "Young man, if you want to study economics, go to the villages of India" Thakurdas cancelled his plans to go to the US and remained in India to study Economics of Indian villages.

Abhay spent his childhood in Gandhi's Sevagram Ashram at Wardha with Mahatma Gandhi's foremost disciple Acharya Vinoba Bhave. Until ninth standard, he studied in a school which followed the tenets of Nai Taleem (a method of practical hands-on Education) as propagated by Gandhiji.

When Abhay was 13-years-old, he and his elder brother Ashok, who was 16 years old, would have discussions on what they should do with their lives. Ashok Bang decided to work for issues related to farming and Abhay decided to work for the health of villagers.

Rani Bang (formerly Rani Chari) was born in Chandrapur. She belonged to a family with strong commitment both to medical service and, in her grandparents' generation, to public service. Abhay and Rani completed their graduation and post graduation in medical studies from Nagpur University. When Abhay was studying for final year exam of MBBS at Nagpur, he read an incident about Gandhi where Gandhi was very careful regarding use of natural resources. After reading the incident Abhay decided to use resources carefully. He switched off the fan in his room. He thought that he should be able to live without fan. He did not use the fan for next five years during his education even in the heat of Nagpur. Abhay and Rani married in 1977. Both of them have secured MPH (Masters in Public Health) from Johns Hopkins University. Anand Bang is their elder son and Amrut Bang is their younger son.

Abhay and Rani Bang, along with their younger son Amrut

Abhay and Rani Bang completed their MBBS from Government Medical College, Nagpur, Maharashtra in 1972. Abhay Bang was first in the University in MBBS and had three gold medals. Abhay Bang did his MD in Medicine (with a first position in the University) while Rani Bang did her MD in Obstetrics and Gynaecology (with a first position in the University and gold medal). They helped organise and lead a national group of medical professionals concerned with health-care quality and delivery. After their medical studies, the couple moved to Wardha and co-founded Chetna Vikas – a non-profit organization. While working in villages of Wardha district, Abhay Bang published a study challenging the minimum wages fixed for agriculture labour in Maharashtra, forcing the government to raise the minimum wages. This strengthened their belief in the power of research as a way of solving social problems. They realized the need for further studies in public health to address larger health-care issues. Both of them completed Masters in Public Health from Johns Hopkins University, Baltimore, America in 1984. The couple had decided to follow Gandhian principles and to work with the poor and thus immediately returned to India after finishing their masters.

After returning to India they started working in Gadchiroli. They founded SEARCH in December 1985 and started working on community health problems in the tribal and rural areas of Gadchiroli. SEARCH established a partnership with communities in Gadchiroli for health and development and helped create "tribal-friendly" clinics and a hospital in the district.

Reduction in Infant Mortality Rate

When the couple started holding people health assemblies they found that addressing infant mortality was a pressing need. The death of a one-month-old child within minutes of being brought to them greatly impacted the couple. They found that there were 18 causes that may have been responsible for that infant's death, ranging from poverty, diarrhoea, infection or pneumonia to lack of a hospital. The challenge was how to save an infant who can die of 18 causes. The Bangs and their colleagues at SEARCH conducted world-class research on practical approaches to reduce mortality of young children in resource-constrained settings. Bang found out a simple but radical solution – training of the village women in neonatal care. He wrote a draft of the action research to be conducted and sought comments from his mentor, Carl Taylor, the founder of the Department of International Health at Johns Hopkins University. In a handwritten note on the draft, Taylor wrote 'Abhay, this will be the most important work that you will ever do in your life'. Subsequent work by Abhay Bang and his colleagues in two of the most notable of their studies demonstrated the feasibility and effectiveness of community-based management of childhood pneumonia and the provision of home-based neonatal care by community health workers.

Home Based Neonatal Care (HBNC) model developed by Bang has resulted in reduction in infant mortality in the study villages of Gadchiroli. The home-based neonatal care interventions developed at SEARCH ignited worldwide interest and research on preventing neonatal deaths in high-mortality, resource-constrained settings. Prior to that, such deaths were considered nearly impossible to avert. As a result of their work, home-based neonatal care and community-based management of childhood pneumonia are now being implemented throughout the world in these settings. Although initially the medical fraternity objected to Bang's unconventional methods, they gradually understood his wisdom to provide an alternative to a large village community. Later, Indian paediatricians, after studying the evidence from the field, wholeheartedly backed Bang's initiative to save newborns. Today, based on Bang's Gadchiroli model, 800,000 village women in India are now being trained by the government under the ASHA programme. A report from the Harvard University South Asia Institute states that "SEARCH is world renowned for its pioneering work in home-based neonatal care", "the landmark paper, published in The Lancet, changed the medical community's perception of community health workers and the power of home based care for neonates forever" and "the success of the HBNC program spawned the creation of over 800,000 "ASHA" workers through India's National Rural Health Mission."India has incorporated this model in 12th national five-year plan to reduce infant mortality. This field trial showed that newborn care can be brought out of the confines of big hospitals and high tech units and be so simplified that it can be provided in any village in any home. After this research the global newborn care has never been the same. This approach, which brought down the infant mortality rate in rural Gadchiroli from 121 per 1000 live births to 30, was honoured by The Lancet in 2005 as one of the Vintage Papers. The editor and the historian of the journal considered Bang's paper on newborn care to be one of the milestone ones published in 180 years. This approach has been incorporated in the national program by the Government of India and has been accepted by the WHO, UNICEF and USAID for reducing newborn mortality in developing countries.

Abhay Bang with the Breath Counter he designed

In May 2017, the High Court of Bombay invited Dr. Abhay Bang to provide suggestions about how to reduce child mortality and malnutrition in the state of Maharashtra. The High Court accepted the suggestions made by Dr. Bang and directed the state government to incorporate the recommendations in its policy decisions and take appropriate actions.

Liquor Ban in Gadchiroli District

Abhay and Rani Bang were driving force for the movement of liquor ban in Gadchiroli district. Gadchiroli is the first district in Maharashtra where liquor is banned due to demand by the public. Bang made people of Gadchiroli aware about ill effects of alcohol, which led to demand from people to ban alcohol in Gadchiroli. Maharashtra government has come up with ban on alcohol in Gadchiroli. In 1990, the couple raised a movement for liquor ban in Gadchiroli district. The movement resulted in liquor ban in the district in year 1992, being the first example in India of liquor ban due to public demand. In May 2012, Abhay Bang was member of panel to study ban of Liquor in chandrapur district. He advocates the need for an alcohol and tobacco free society since as per the Global Burden of Diseases 2015, alcohol and tobacco are two of the top ten causes of death and disease in India. Abhay Bang is developing a multi-pronged approach named "Muktipath" in the district of Gadchiroli to reduce the prevalence of alcohol and tobacco consumption there. He also welcomed Supreme Court of India's ban on liquor shops on state and national highways.

Abhay and Rani Bang

Women's Issues

Rani Bang has worked extensively on women's medical issues. The community based study of gynaecological problems in rural area that she conducted in 1988 is the first study in the world focusing on women's health beyond maternity care. Rani Bang first brought to the notice of the world that rural women had a large hidden burden of gynecological diseases. She subsequently trained the Dais in villages to make them village level health workers. With convincing evidence she advocated the need for a comprehensive reproductive health care package for rural women in India. This study initiated the programme of women's reproductive health all over the world specifically in developing countries. She has written a book – Putting Woman First, which throws light on women's issues in rural India. Their research showed that nearly 92 percent of women had some kind of gynaecological issues. Her research in this field has changed the understanding of this issue worldwide and global policy has changed accordingly. Rani Bang was one of the principal speakers in Tietze symposium in Rio de Janeiro, Brazil in 1990. She served as a consultant to INCLEN (International Clinical Epidemiology Network) for Reproductive health, IWHAM (International Women's Health Advocates on Microbicides), 10th Five Year Plan Maharashtra Health and Nutrition Committee Member. She was nominated for Nobel Peace Prize in 2003 as a member of 1000 women worldwide for peace prize. Rani Bang has worked on women's reproductive health issues, sexually transmitted diseases and AIDS control, adolescent sexual health, tribal health, alcohol and alcoholism. She conducts sessions on sex education called 'Tarunyabhaan' for adolescents and teenagers across Maharashtra. Rani Bang has been awarded with National Award for Women's Development through Application of Science & Technology in recognition of her outstanding and pioneering contribution for the past two and a half decades on improving women's health in rural India through an innovative and powerful approach of research with the people and for the people. The award was conferred upon her by the President of India at the National Conference on Showcasing Cutting Edge Science & Technology by Women in New Delhi.

Tribal Health

Abhay and Rani Bang have been working with the tribal communities in the forest area of Gadchiroli district in Maharashtra since 1986. They found malaria to pose the biggest health concern for this population. So, regular medical treatment apart, they also sought to make the local adivasis aware about the importance of using insecticide-treated mosquito nets. They also run a mobile medical unit in the forty eight tribal villages in the Dhanora block of Gadchiroli district and have a network of village volunteers trained in providing primary care in these villages. In July 2017, the Government of Maharashtra formed a task force to control the spread of malaria in the district of Gadchiroli. Dr. Abhay Bang has been appointed as the head of this task force which comprises the nonprofit SEARCH, Tata Trusts, National Institute of Research and Tribal Health (NIRTH) and the Government of Maharashtra. Dr. Abhay Bang is chairing a 13-member expert committee set up by Union Health Ministry and the Ministry of Tribal Affairs, tasked with coming out with a nationwide status report on tribal health issues along with suggesting possible policy formulations. While the "old" problems of malaria, malnutrition and mortality persist, Abhay Bang emphasises "new" health issues among tribals partly due to outside socio-cultural influences and steady inroads by market forces. Tribal women now list alcohol addiction among men as their biggest concern. The same goes with tobacco, with over 60 per cent of adults in Gadchiroli consuming it daily. These, alongside addition of salt in their foods and stress, are contributing to increased incidence of hypertension, feels Bang. The problems of language barrier and lack of motivation among healthcare staff, besides vacancies and absenteeism when it comes to working in tribal areas, has rendered the formal public healthcare system virtually dysfunctional.

NIRMAN

In 2006, they started an initiative, Nirman, for identifying and nurturing young social change-makers in Maharashtra. It is an educational process to train the youth to take up crucial issues and problems in the society. NIRMAN provides guidance, expertise and environment to inculcate self learning and encourages youth for social action. NIRMAN includes a series of 3 camps, each separated by 6 months. So a batch of NIRMAN goes through 3 camps in a period of 1 year. A camp generally runs for 7–10 days at SEARCH, Gadchiroli. NIRMAN is a learning process based on Nai Talim way of education introduced by Mahatma Gandhi. It believes in – problem based learning instead of – classroom based learning. NIRMAN initiative is providing a common platform for youth to engage, self-educate and decide on how they can make a difference to the society.

Started in 2006, NIRMAN brings together a group of youth aged between 18–28 years who are looking to give meaning to their lives. Amrut, Abhay and Rani Bang's younger son actively manage NIRMAN. Abhay thinks that it is important to make present generation of doctors think about social challenges. "All doctors can earn enough to make a decent living and they must think about the purpose of their lives. Change would happen the moment they start contemplating." He believes that medical students should regularly be given rural or tribal stints as part of their curriculum so that they are exposed to the real challenges. He thinks that it is equally important to reward doctors who shun the charm of corporate world to serve the real people in need.

Non-Communicable Diseases

Abhay and Rani Bang and their team at SEARCH has started working on the non-communicable diseases (NCDs) as that is emerging as a priority area. A study conducted by SEARCH in 86 villages of Gadchiroli district has shown that rural people are now falling prey to lifestyle diseases like stroke which emerged as the most frequent cause of death. One in seven (14%) deaths in these villages occurs due to stroke, showing that the places like Gadchiroli are now passing through an 'epidemiological transition'. 87.3% stroke deaths occurred at home, indicating that rural people don't approach hospitals for treatment. Taking the study ahead, the SEARCH team now plans to test village based solutions to minimize deaths caused due to stroke in Gadchiroli villages in collaboration with the Wellcome Trust of UK and the department of biotechnology of the government of India. Yogeshwar Kalkonde, Neurologist and Senior Research Officer at SEARCH is the main author of the study. The team also included three young MBBS doctors from Nirman. The study has been published in 'Stroke', an international journal published by American Stroke and Heart Association. The work has been presented at the 5th International Conference on Neurology and Epidemiology (18–20 November 2015) in Australia.

In a study published in Economic and Political Weekly, Bang and SEARCH team members showed that the rural and tribal district of Gadchiroli was spending approximately ₹73.4 Crore. annually on consuming tobacco and related products. More than 50% of the population was consuming tobacco. SEARCH has been conducting programs to spread awareness regarding the ill effects of tobacco use and providing de-addiction services. The Maharashtra state government has formed a 12-member task force under chief minister Devendra Fadnavis for creating awareness about ill effects of using tobacco products and Abhay Bang is an advisor in the force. It will concentrate on Gadchiroli district for the first three years. A committee has also been constituted under the Gadchiroli District Collector for implementing the plans devised by the task force. A representative of Bang's organization SEARCH will be a member of the committee. According to Bang, spread of information and awareness for prevention, initiation of village committees and urban ward committees, implementation of laws and regulations, treatment for deaddiction, counselling via NGOs and stimulation of an alcohol and tobacco free environment in government offices, schools, colleges, markets etc. will be the methods used by the task force.

Surgical Care

The couple, through their organisation SEARCH, built the Maa Danteshwari Hospital for the rural and tribal people of Gadchiroli. Along with OPD and IPD care, a variety of surgeries are also conducted in this setup. Doctors from throughout the state of Maharashtra come and operate in this setup. Spine surgeon from Mumbai, Shekhar Bhojraj and his team of 6 - 8 other spine surgeons have been associated with SEARCH for 10 years and have conducted more than 100 spine surgeries in Gadchiroli. In August 2016, when Rani Bang was to undergo spinal surgery herself, she too was operated in the SEARCH hospital by Shekhar Bhojraj and his wife Shilpa who is an anaesthetist in Mumbai.

Apart from being the founder directors of SEARCH, Abhay and Rani Bang have served on various national and state level committees. Some of them are as follows:

• Chairman, Expert Group to Plan Health Care for Tribal Populations in India, Ministry of Health and Family Welfare, Govt. of India
• Expert Member, Central Health Council, Apex Body of Ministry of Health and Family Welfare, Government of India
• Member, National Rural Health Mission Steering Group, Govt. of India
• Member, High Level Expert Group on Universal Health Care, Planning Commission, Govt. of India
• Member, National Commission on Macro-economics and Health, Govt. of India
• Member, Kelkar Committee on ‘Regional Imbalance and Balanced Regional Development', Govt. of Maharashtra
• Member, Audit Advisory Board, Comptroller and Auditor General, Govt. of India
• Chairman, Child Mortality Evaluation Committee, Govt. of Maharashtra
• Member, National ASHA Mentoring Group, Ministry of Health and Family Welfare, Govt. of India
• Member, High Level Committee on Status of Tribal Communities, Govt. of India
• Member, National Commission on Population, Govt. of India
• Member, Steering Committee, Tropical Disease Research, World Health Organization, Geneva
• Member, Advisory Board, Saving Newborn Lives Initiative, Save the Children, USA.
• Member, Committee on ‘Improving Birth Outcome in Developing Countries’ constituted by the Global Board on Health, National Academy of Science, USA
• Member, Scientist Advisory Board, Indian Council of Medical Research, New Delhi
• Member, National Expert Group on Health for planning the 10th National Five Year Plan, Govt. of India
• Member, Governing Board, National Population Stabilization Fund, India
• Member, Planning Commission's Task Force on Panchyat Raj in Health
• Member, WHO Review Committee on Anti-fertility Vaccines
• Member, WHO Review Committee on Measuring Reproductive Morbidity
• Member, Governing Body of IIHMR(Indian Institute of Health Management and Research)
• Member, Institute of Medicine U.S. Committee on Improving Pregnancy Outcome in Underdeveloped Countries (2000 - 2001)

Abhay and Rani Bang

Marathi Books

• माझा साक्षात्कारी हृदयरोग Majha Sakshtakari Hrudayrog – Abhay Bang

(In this book Abhay Bang has written about his experiences during his heart disease and the learning he has gained due to it. The book won the Kelkar Award for the Best Literary Book in Marathi, 2000.)

• गोईण (Goin) – Rani Bang

(This book won the Literary Award of the Government of Maharashtra. Goin means Friend in the Gondi language of tribal people. The book describes the relationship of tribal women with various trees in Gadchiroli district.)

• कानोसा (Kanosa) – Rani Bang

(This book is about the perceptions of rural women regarding various issues of reproductive health.)

English Book

• Putting Women First: Women and Health in a Rural Community – Rani Bang (Published in 2010.)

Abhay Bang has written an article "Meeting the Mahatma" which is published in English Kumarbharti Textbook of Class 9 of Maharashtra State Board of Secondary and Higher Secondary Education. Two of his articles "My Magical School" and "Sevagram to Shodhgram" have been translated in English by Arvind Gupta.He has written an open letter to the Chief Minister of Maharashtra, Devendra Fadnavis, urging him to act on balanced development of Vidarbha and Marathwada regions of Maharashtra and to take steps to reduce liquor consumption in the state.

Abhay and Rani Bang and their organization SEARCH have been felicitated with a number of awards, a few of them are as follows:

• Padma Shri,The fourth highest civilian award in the Republic of India, 2018
• Maharashtra Bhushan Award The highest state honour of the Government of Maharashtra, 2003
• Time Magazine The Global Health Heroes, 2005
• MacArthur Foundation International Award, 2006
• Society of Scholars, Johns Hopkins University, USA, 2013
• World Health Organization - Public Health Champions Award for Outstanding Contribution to Public Health in India, WHO India, 2016
• National Award for Women's Development through application of Science & Technology, Government of India, 2007
• Sheshadri Gold Medal of the Indian Council of Medical Research for outstanding research in community medicine, 1996
• Ashoka Fellows, 1984
• Times of India Social Impact Award, 2015
• Jamnalal Bajaj Award, 2006
• First Distinguished Alumni Award from the Department of International Health at the Johns Hopkins University Bloomberg School of Public Health, 2013
• Stree Shakti Puraskar from Ministry of Women & Child Development, Government of India, 2005
• Satpal Mittal Award for Population by the Indian Association of Parliamentarians, New Delhi, 2002
• Mahatma Gandhi Award for Humanitarian Service, 1994
• 'Bapu' Award from Gandhi National Memorial Society, Pune, 2009
• Vivekanand Manava Sewa Award, 2002
• The Kelkar Award for the best literary book in Marathi, 2000
• Ramshastri Prabhune Puraskar for Social Justice, 2002
• 'Navratna Puraskar' from Doordarshan Sahyadri Channel, Mumbai, 2005
• 'Dr Wankar Memorial Lifetime Achievement Award' Indian Medical Association, 2016
• 'Iconic Changemaker Award' The Hindu, Business Line, 2018