Swasti: Healthcare grounded in the community

For people in poor, marginalised communities, India’s health system is hard to access, inconvenient and expensive. Primary and preventative healthcare is under budgeted and in short supply. For many, receiving care from public health facilities means not only forgoing wages but also covering costs such as travel and hospital fees out of pocket. According to a report co-authored by the WHO, health-related expenditures had pushed about 50-60 million Indian citizens into poverty in the previous decade alone.

Low-income people in India generally prefer to invest their time and resources in immediate needs such as food and shelter rather than in healthcare. At least half of them live with some form of undiagnosed illnesses, and as a group they die earlier than the economically better off. When they do get treatment, they often choose to self-medicate or seek informal care from providers whom they trust but who may not provide quality care.

Led by nurses and with a focus on India’s poorest, most marginalised communities, Swasti’s flagship initiative, Invest for Wellness (i4We), offers patients health advice, screenings, diagnostics and treatment as well as referrals to more complex interventions (including hospitalisation) when needed. The nurses are supported by wellness facilitators – all local women selected, trained and engaged by i4We and mentored by clinicians. A Swasti-developed app guides nurses and wellness facilitators through predefined workflows in real time to facilitate efficient service delivery.

A family joins i4We by saving a minimum of USD 1 per week in a local self-health group. When a family member becomes ill, they receive free, prompt, convenient and empathetic care from a nurse either at home or in a local i4We clinic. Even when well, members are regularly screened for high-burden conditions. If ill health or risk factors are discovered, their root causes are identified and families supported in adopting healthier behaviours. People with chronic conditions like diabetes receive help in adhering to treatment and making necessary lifestyle changes.

In addition to providing healthcare, Swasti facilitates social protection services, links people to livelihood opportunities and provides access to financial products such as savings and credit. In this project supported by the Swiss Re Foundation, it offered its full programme of services in about 100 villages in Madhya Pradesh, Karnataka and Haryana.

During the two-year project period, Swasti enrolled 31 391 family members in i4We and enhanced the health resilience of 19 466 of them by providing care. It also facilitated social protection schemes for 4 901 community members/households out of 7 823.

Swasti learned that strengthening community institutions and fostering community leadership increased ownership among community members, enhancing the programme’s sustainability of. Active community institutions proved instrumental in enabling communities to recover more swiftly during challenging times like the COVID-19 pandemic.

While the programme facilitated the establishment of systems and tailored initiatives for sustainable primary health and well-being, these institutions are still on a journey towards independent management. Currently, some supported locations contribute 10-15% to the Swasti programme cost. It will likely take another three to four years for the intervention to achieve self-sustainability.

The copyright for all images displayed lies with Swasti.