As stated by a report in 2015, there is one NGO for every 400 people in India. These 30 Lakh NGOs are striving to change the socio-economic status of the vulnerable populations and facing tremendous challenges. One of the many challenges is the lack of larger and scaled up operations. This challenge, coupled with a vast-sized population, and a plethora of varying socio-economic issues further aggravates the situation. Now, let’s look at another aspect of this equation, government implementation. A World Bank report notes that governments in developing countries spend, on average, about a third of their budget on health and education. However, very little reaches the poor because of leakage (due to administrative costs as well as corruption). On top of this, there is rampant absenteeism and poor-quality service on the part of teachers and health workers.
The central and state functionaries comprehend the need to collaborate with leaders of non-governmental organizations and philanthropists to deliver more on human development. The last few decades have witnessed a major shift in the relationship between the state and the private sector for delivering goods and services all over the world. Needless to say, economic growth without human development is meaningless. To accelerate the improvement in key health and nutrition indicators and to ensure that no district in the country is left behind, the Government of India has launched the Aspirational Districts Transformation (ADT) Programme. Under the programme, 115 districts lagging in key health and nutrition parameters will be transformed by 2022.
Supported by Piramal Foundation, Piramal Swasthya is bridging the last mile gap in Primary Healthcare service delivery. With the help of technology and innovation, we work towards making healthcare accessible, affordable and available to all segments of the population, especially those most vulnerable. Our service delivery channels – Remote Health Advisory & Intervention Service, Community Outreach Program – Mobile Health Services and Tele-Health Services are all conceptualized around technology. In March last year, Piramal Foundation signed a Statement of Intent with NITI Aayog to partner with it in 25 Aspirational Districts to help improve the outcomes for healthcare and education.
A key transformational practice that the Piramal Swasthya initiated was to scale up involvement and ensure due diligence during the observance of Village Health Sanitation and Nutrition Day (VHSND). As per National Family Health Survey-4 data, India is facing challenges to reduce the rates of underweight, wasting, stunting, anemia among women of reproductive age and children below 5 years and low birth weight. All of these issues cannot be addressed solely by one intervention but require an integrated effort.
VHSNDs provide a basket of health and nutrition services and counseling to the community on a pre-designated day, time and place. It is an important platform which ensures the reach of the health and nutrition services along with the participation of the beneficiaries and their family members. It addresses 23 out of 31 indicators of the NITI ADT program. VHSND is a major intercession of POSHAN Abhiyaan addressing important indicators of health and nutrition, generating coverage with convergence, partnerships, participation and behavior change communication.
We have also initiated advocacy with community influencers and religious leaders. Various religious and cultural beliefs act as barriers to accessing healthcare services. This also results in a lack of immunization coverage, delayed initiation of breastfeeding, postponement in the registration of pregnancies, low rates of institutional deliveries, early marriage, and prevalent teenage pregnancy, amongst others. Religious leaders and faith-based organizations are crucial in promoting healthcare-seeking behavior of the community. They are not just uniquely placed as social influencers but can also play the role of champions tackling the prevalent myths and misconceptions attached to health services.
Quality implementation of health programs is the biggest challenge in India. As we are aware, there are wide disparities in the condition of districts, and the gap is only getting wider. I firmly believe in the merit of collaborating with the government because of the scale of impact. An innovation or strategy is of limited use if it cannot be scaled up. It is vital to understand that one of the key reasons why India is lagging behind on several health and nutrition indicators is an excessive focus on curative care as opposed to public and primary health interventions. Primary healthcare has been limited to a narrow package of interventions focused on pregnancy care, childcare and certain services related to national health programmes, which represent only 15% of all illnesses for which people seek care. Other challenges with the primary health system include unevenly distributed infrastructure, lack of essential supplies and a shortage of adequately motivated human resources.
We, at Piramal Swasthya, are known and appreciated for our innovation and implementation models with over four thousand healthcare delivery staff, across 16 states. The knowledge is in bulk, extremely valuable and demanded to be translated and replicated in the primary healthcare ecosystem. Piramal Swasthya recently established its advisory vertical with the vision of collaborating with the government and ensuring quality delivery of large-scale solutions.
Ashwin Deshmukh is the head of Advisory vertical of Piramal Swasthya. He currently leads NITI Aayog’s Aspirational District Transformation (ADT) Program, which is being implemented in 25 Districts situated in 7 states and SATH (Sustainable Action for Transforming Human Capital) Program for Assam; Remote Health Advisory and Intervention (RHAI), which runs call centres to provide awareness about healthy practices, government schemes and benefits. It also ensures coordination between healthcare functionaries and the beneficiaries and clinical advice to reduce the minor ailment load on the public health system, by offering medical information and advice, virtually.