Invest For Wellness — A New Age Primary Health Care Model

By Shiv Kumar, Founder, Catalyst Group of Institutions

Problem

Healthcare does not work for the poor in most parts of Asia. The system is unfriendly, or costly, or both. Health is not a priority for the poor, unless it affects their work, and generally only symptomatic relief is sought. This results in repeat episodes of preventable illness as well as drug resistance to treatment. According to the 2017 Global Health Monitoring Report, they lose one to two months of productive time a year due to illness in their family, and nearly 50%-60% live with some form of undiagnosed illness and die earlier than more economically secure counterparts. Research shows that in India alone, about 50–60 million people in the last decade have been pushed to the brink of poverty because of health-related expenditures.

Primary care delivers significant returns and is reasonably simple to implement. However, it has seen few successful models which deliver quality, scale, sustainability, and particularly, addresses the poorest, with emphasis on prevention and promotion of health. Unlike treatment, primary health is not easy to quantify in monetary terms. Governments have generally not succeeded in this area. Many social entrepreneurships have failed, and the private sector appears uninterested.

Solution

Swasti, a non-profit organisation based in India, has designed Invest for Wellness, or i4We, a self-funded, primary healthcare model which combines health and wealth interventions, and focuses on wellness for the poor in an affordable, quality assured and scalable way. The program ensures primary care of members (locally) and navigates them through a range of existing secondary and tertiary providers (where required). The model combines medical, behavioral, and social science with an appropriate mix of technology and health financing. This blended financing model, which starts with grant capital and breaks even in five to seven years, leads to self-sufficiency.

How Does It Work?

A household becomes a member by saving a minimum of ~ 0.8–1 USD per week in a local self-help group (SHG). The diagram below depicts the “wellness flow”. When a family member is ill, they get free, prompt, convenient, and empathetic care in the local clinic. When they are well, they are screened systematically for 10 high-burden conditions. In both cases, once the treatment is done, the root cause is analyzed and the family is helped with prevention of the next episode. In the case of chronic conditions, continued support to adhere to treatment and other changes are supported. The i4We model does not aim to replace any existing health practitioner, instead, it is guided by the philosophy of “work with what works” and complements the existing network of health providers by making them more effective and efficient.

For every 5,000 families, delivering preventive, promotive, and curative aspects of primary healthcare, is a team of 20 Health Facilitators, one nurse, one program manager, and a dial-in doctor. The cluster has about 500–600 SHGs and one Health Trust comprising of SHG leaders and local community leaders who govern the program. i4We further uses a strong technology strategy which includes an app, Al. Al enables real time analysis and dashboards for action, point of care diagnostics, and a range of innovative health products and services.

Scaling and Impact

The programme is being implemented in 40 locations within India and has a reach of about 200,000 people. Swasti aims to scale-up to 100 intervention sites, reaching 2.5 million people by 2020. We envision that this will reduce unhealthy days by 30%, reduce undiagnosed conditions by 30%, and deliver an independently certified Social Return on Investment (SROI) of 300% for investors.