Democratising India’s Public Healthcare Ecosystem

Solving access, availability and affordability challenges of primary healthcare for remote and unserved vulnerable populations

Even today, many of India’s remote locations and isolated tribal belts remain undiscovered, mainly due to geographical distance and tough weather conditions. Additionally, rising treatment costs and the shortage of skilled health professionals in public health centres, pose as a challenge in delivering basic healthcare to its people. As a result, native communities residing in these rural areas are most often marginalised and underserved.

Observing the need to democratise India’s public healthcare ecosystem by supplementing the Government’s efforts, Piramal Swasthya, the philanthropic arm of Piramal Foundation aims to transform India’s health ecosystem through high impact solutions, thought leadership and partnerships. Today, our 4000+ strong workforce comprising over 580 doctors and specialists, covering 16 different states of the country, makes Piramal Swasthya one of the largest public healthcare organisations in India. Our work in the primary healthcare space focuses on maternal, child and adolescent health, as well as non-communicable diseases (Diabetes Mellitus, Hypertension, Oral Cancers, Breast Cancers and Cervical Cancers).

We are a learning organisation with a strategy to drive sustainable impact at scale, with the help of knowledge, expertise and experience. This enables us to deliver evidence-based, beneficiary-focused solutions that help us to contribute towards changing health-seeking behaviour of communities. Our flexible partnership models and technology-enabled innovative solutions aim to improve health outcomes by serving one million beneficiaries every month, with services designed to reach the remote rural underserved communities. Our service delivery channels: Remote Health Advisory & Intervention Services (RHAI), and Community Outreach Program: Mobile Health Services are conceptualized around technology. To address current healthcare challenges, Piramal Swasthya has developed integrated community models comprising health advice, specialist consultation, patient education, awareness on healthy practices, nutrition hub etc., with the objective of reducing Mother and Infant Mortality rates in intervention areas. Project ASARA, our unique Tribal Healthcare Program, covering the tribal belt of Araku Valley in Andhra Pradesh is specifically designed to overcome the barriers of healthcare delivery in remote underserved areas.

 

Discovering on-ground realities

Our operations in Andhra Pradesh provided us in-depth insights and a complete understanding of the everyday realities of the nomadic tribals residing in the hard-to-reach locations of Araku Valley.

We discovered that the area’s pregnant tribal women do not have access to proper care, counselling and treatment, due to the tough terrains and difficult conditions. Secondly, a majority of the tribal children and adolescents in the Araku Valley suffer from anaemia and stunted growth because of poor awareness amongst the tribals on the importance of a nutritious diet. Although freshly grown millets, ragi, vegetables and fruits are readily available in the region, they are sold in the open markets and not consumed by them. In addition, decade old superstitious beliefs, which dictate that cow milk is meant for calves and not for humans, deprives the tribals of the much-needed nutrients and proteins.

These were a few factors that contributed to the high maternal and infant mortality rate in the region.

 

Ending preventable deaths

We realised that medical intervention alone will not have a sustainable impact and that our approach must include several factors to tackle the challenges faced by the communities in the area. Our strategy must incorporate community outreach, education, awareness, capacity building, access to specialists through telemedicine, identification of high-risk cases, referral and follow up. Taking all of this into account, Piramal Swasthya carefully designed Project ASARA to combat the region’s tribal health challenges and deliver overall primary healthcare to 1179 hard-to-reach habitations in Vishakhapatnam’s tribal belt area.

Our intervention included telemedicine services in Araku, Paderu, Chintapalle and Dombriguda mandals, as well as specialist care and quality healthcare service delivery to tackle the issue of inaccessibility. These centres are linked to our specialist obstetricians and gynaecologists in Hyderabad, and provide monthly antenatal and postnatal care for pregnant women and their infants, counselling and social interventions, training of traditional birth attendants, promotion of institutional deliveries and health and nutrition education to adolescents in these habitations.

Simultaneously, our trained Auxillary Nurse Midwives (ANMs) from these centres travel from habitation to habitation to register and create a database of pregnant women. This in turn, helps us keep a tab on the number of pregnant women in the area and provide them with necessary services. These ANMs also provide services at their doorstep and take them to the telemedicine centre and to the government hospital for their deliveries.

Additionally, to improve the nutrition level and awareness in the area, we set up a Nutrition Hub with the aim to increase local knowledge on diet during pregnancy and lactation; and ensure that children under five years receive proper nutrition through production, processing and preservation of locally available nutritious food.

Owing to the consistent and dedicated efforts by our staff and team over the past six years, we have served 49,000 pregnant women, reported zero maternal deaths in the last two years and improved the percentage of institutional deliveries from 18% to 68%. These achievements bolster our resolve and aim to complement and supplement the existing healthcare system. The Piramal Swasthya team is making great strides towards transforming the health ecosystem by moving towards a rights-based approach to achieve health promotion and behaviour change among the communities while providing quality services.

 

The way forward

India has made a commitment to achieve sustainable development goals (SDGs) by 2030. To usher in transformation in India by achieving the SDGs, we need quality implementation at scale, need-based innovative approaches and robust policies. Piramal Swasthya aims to bring in transformation through operational excellence, consistent research and innovation, focus on impact and advocacy.

With the success of our pilot in Araku Valley, our expansion plans aim to maximise reach in tribal areas and empower communities through community outreach, telemedicine services and nutrition hubs. We believe that the replication of this model across India’s tribal areas will have significant impact at scale on the country’s overall health indicators.

We, at Piramal Swasthya, strongly believe in collaborating closely with the government and plan to replicate the tribal health program across the country’s tribal areas, in turn, contributing towards achieving India’s Sustainable Development Goals (SDGs), ahead of time.

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