Swasth Foundation

In India, every year, 1 in 20 people (~60 million Indians) fall into a cycle of impoverishment because of a health shock. Health shocks, defined as unpredictable illnesses that diminish health status have a two-fold impact on one’s financial status through both the payments for medical treatment and the income loss from an inability to work. This forces many in India to adopt sub-optimal strategies of coping with this unprecedented financial burden, especially in the absence of a strong and well implemented public health insurance policy leading to a high proportion of out of pocket expenditure on health (65-80%). These include forgoing income, using savings, informal borrowing, using loans or mortgages, and selling assets and livestock. If a household head falls ill, family members previously not working may begin to do so to substitute for lost income and repay loans, sometimes dropping out of schools and higher educational institutes. This leads to a magnified negative impact of a health event as it feeds effectively into other forms of inequity.

Based on a pilot that we ran with the International Labour Organization in rural Maharashtra, we observed that high quality primary care can reduce the incidence of such health shocks by half. While availability of qualified physicians is a key barrier in rural India, lack of quality and measures of accountability of providers is a problem both in urban and rural India. This results in wrong incentives for providers, unnecessary referral and subsequently delayed care for basic primary health care diseases. This is why we have spent the last 10 years building a network of ‘one-stop-shop’ primary healthcare centres that provide patient-centric, high-quality and accountable care at half the market rates. These medical centers provide general, dental and lab facilities to low income communities residing in Mumbai’s slums.

In the last 10-years, we have been successful in creating the most innovative solutions based on a holistic set of values to support our communities in living a healthy life. Through (1) introduction of different types of warranties for dental procedures, general procedures, timeliness of reports, and for patients suffering from chronic conditions (2) a subscription model to raise affordability further and (3) a rigorous system of quality control through audits and collection of patient feedback, we have been able to reduce out-of-pocket expenditure and re-institutionalize trust and balance in the relationship between a medical service provider and a patient, challenging status quo.

To measure the quality and impact of this network, we have in place a robust and transparent system. A strong data driven foundation and an independent quality monitoring team are two key elements of this system. We focus highly on metrics essential to measure impact of any health intervention and they lie in the three fields of health status, reduction of financial risk and patient satisfaction, according to a globally designed health systems framework. In a healthcare industry focused on measuring volumes and utilization, we believe that measuring patient satisfaction and patient recovery holds us accountable to our core values – those of striving for excellence and serving with empathy.