Swasti’s i4We Demonstrates How Community Ownership Of Primary Healthcare Is Possible

According to the “Tracking universal health coverage: 2017 global monitoring report” by the World Health Organization and International Bank for Reconstruction and Development, in India alone, about 50-60 million people in the last decade have been pushed to poverty because of health-related expenditure[1]. The poor lose up to 1-2 months of productive time in a year to illness of self and family. Almost 50-80% of them live with some form of undiagnosed illnesses and die earlier than those who are economically better off[2].  To address this issue and break the vicious cycle of ill health and poverty, Swasti’s Invest for Wellness (i4We) programme has brought primary care to the doorstep of 2 lakh+ of the poorest and most marginalised people. Their aim is to reach 100 million well-thy days[3]  by the year 2030.

The programme is currently being implemented across 4 States and 5 locations in urban and rural areas in India – Sehore District (2 blocks)  in Madhya Pradesh; Ramanagara District (1 taluka), , and Bengaluru urban district in Karnataka; Karur urban in Tamil Nadu; and Gurugram in Haryana. The model is designed to  have local community leadership through not just frontline health workers, but through health focused groups and a local community institution, equivalent of the Mahila Arogrya Samiti. Each family is a “member” and actively participate in their well-being journey, actively being navigated through health information, advice and services (screening, treatment and care services and referral) , social protection (awareness,eligibility and facilitation of government identity and schemes) as well as financial literacy and services (savings and credit)  

As a response to COVID-19, the community leaders  prevented the spread of the virus among their members  by conducting surveillance, providing local support and advice, reinforcing safety protocols and behaviours, offering telecare services for home isolation, chronic conditions  as well as facilitating vaccination drives.   Community leaders worked alongside staff from Swasti to follow-up with families  during COVID-19 and support access to rations, medications, govt services, hospitalization and oxygen support.

Best described as a system innovation in primary healthcare, i4We combines health and wealth interventions, and focuses on well-being for the most poor and marginalized communities. It was incubated by the Catalyst Group – a 26-year-old social impact platform, working in the spaces of social and economic development as well as humanitarian emergencies. Sister organizations of the Catalyst Group are CMS – social impact specialists, Swasti, The Health Catalyst – a Global South public health non-profit, Vrutti – Livelihood Impact Partners were instrumental in bringing i4We to life. It is being supported by various partners in different locations including flagship partner - Marks & Spencer and others like Migros, Levi Strauss & Co., Social Venture Partners, Morgan Stanley, Ashraya Hastha Trust, PCMH Restore-Health, PCI 360 etc.

Shiv Kumar, the co-founder of the Catalyst Group and Chief architect of i4We, said, “i4We uses a strong technology strategy which includes an app for the health facilitator, nurse, and the healthcare provider network, real-time analysis and dashboards for action, point of care diagnostics, and a range of innovative health products. It also uses the latest behavioral science theory and practices including survival analysis, nudge, and other tools.”

Describing their experience, Puja Devi, President of Sanjeevani Kalyan Samiti, Mohammadpur-Jharsa says,  “We save about Rs, 200 per month in our own accounts which earns interest. Every family gets a variety of benefits ranging from screening, treatment, care, health education and advice, low-cost credit and opportunities for training and livelihood.  We work to help families take charge of their health - from what they eat, their emotional health, solving problems or working through them. When we work together, we can move forward faster”

ealth outcomes cannot be guaranteed with a linear approach. For the vulnerable, unless crucial challenges such as financial security and protection are ensured, health for all will continue to remain a pipe dream. And therefore, it is imperative that public health solutions are designed to address challenges beyond just the obvious. The i4We model demonstrates one such holistic approach, that supports people navigate their health journey, towards well’thy days.  

About Swasti

Swasti is a Global South civil society organisation committed to adding 100 million ‘wealthy days’ for Vulnerable Communities. Swasti upgrades the discourse from health to wellbeing and brings the missing pieces in wellbeing together (social, behavioural, management and technology) around the technical/medical aspects, with a strong focus on Prevention and Promotion. Swasti is a registered not for profit organisation and part of the Catalyst Group of institutions, working across 25 countries South Asia, South East Asia and parts of East Africa.

In response to COVID-19, Swasti and the Catalyst Group co-incubated the #COVIDActionCollab - The COVIDActionCollab (CAC) is an all India collaborative, united to provide relief, recovery and build resilience among the most vulnerable communities. The collaborative consists of Organizations and Networks working together to support these communities during the period of crisis and enable them to secure their future. The 333 partners strong collaborative has delivered 17 lakh services with 2000 volunteers. The Collaborative envisions a world where vulnerable communities are empowered to survive and thrive during a humanitarian crisis. CAC aims to achieve synergy among its partners at multiple levels in order to accelerate impact, in keeping with the needs of these communities.