Leveraging Technology and Partnerships to Drive Change in Rural Health Services During a Pandemic

“Voice of the Village” by Dharma Life, Siriti and the Wheeler Institute for Business and Development – event three.

“The most effective and responsive policies can only be made when we are constantly hearing from voices from the ground.” – Urvashi Prasad

The Voice of the Village is a series of conversations on issues that affect those living in rural communities in India – inviting a wide breadth of stakeholders to collaborate and build solutions together. For the third series, we were joined by both experts from around the world and on the ground.

  • Rajesh Chandy, Academic Director of the Wheeler Institute for Business and Development
  • Gaurav Mehta, CEO of Dharma Life, an organisation working to create rural entrepreneurs and alleviate poverty through inclusive progress in rural India
  • Vainateya Gavai, Co-Founder of Siriti, a design and communication agency coming together to leverage local relationships and connectedness with real time insights
  • Daniel Sinnathamby, Country Director of Pathfinder India, an organisation working with Thermo Life for the Yuvaa Project, which improves access to contraceptive choices and positively shifts gender and social norms by delivering customised family planning messages to young couples
  • Subhashini Chandran, EVP & MD of India. Xynteo
  • Urvashi Prasad, Senior Public Policy Specialist of NITI Aayog, Government of India
  • Five Dharma Life Entrepreneurs from Maharashtra and Bihar
  • Asiya Gavande, Dharma Life Entrepreneur
  • Suvarna and Mangesh Mane, Dharma Life Entrepreneurs and Yuvaa Corps, Maharashtra
  • Satendra and Anjali Diwakar, Dharma Life Entrepreneurs and Yuvaa Corps, Bihar

“While the more obvious health impacts of COVID itself are well-documented, there are many other things that have taken a backseat.” – Vainateya Gavai

This roundtable looked at how the pandemic has affected rural health, particularly on the dilemma of balancing health versus livelihood. On the one hand, we must ensure that lives are saved, yet, people’s livelihoods also need to be maintained so that they can have food on the table. As with any societal problem, solutions are most effective when created by the community and implemented and adapted as needed. For rural India, or any rural communities, how do we create solutions to stick and truly make a difference?

Deep Understanding of the Community Context

“When we brought all this information together, there were some very interesting conclusions. First, COVID-19 was not a priority for the communities. Traditionally also in rural India, health seeking behavior is not a priority.” – Daniel Sinnathamby

In rural India, many communities were not following the prescribed behaviors in order to suppress transmission and prevent infections of COVID-19. The cause for this is two-fold: dire need to focus on preserving livelihood and lack of discussions on the pandemic. In times of adversity, erosion of livelihoods is the main priority for a lot of communities because adversity can lead to distressed activities such as selling off of assets and livestocks, as well as corrosive activities such as sexual exploitation and child marriage. The inability to dedicate focus on the pandemic is further exacerbated by the lack of systematic discussions on COVID-19 matters. While accurate information was available, the gaping uncertainty caused many members of the community to adapt a wait-and-see approach. 

At the same time, the pandemic caused a deprioritisation of non-Covid-19 related health services, including important initiatives around tuberculosis, cancer screening, reproductive health, and family planning.

It Takes a Village to Create Community-tailored and Community-owned Solutions

“We provide a platform where we train them in various skills. There’s communication skills, digital literacy, among other things.” – Gaurav Mehta

“We want to actually look at reducing exposure to the virus, reducing vulnerability by making sure that there’s understanding and more certainty in the face of the pandemic. And lastly, to improve the options for coping mechanisms, specifically through economic opportunity.” – Daniel Sinnathamby

The best solution at the village level is not determined by any single entity, it is tailored and owned by the people on the ground, administering these solutions and living with the challenges, and supported by private businesses and the public sector. The role of business in building community and giving local people tools to support one another is critical.  One example of this is how Dharma Life, focused on sustaining and improving livelihood via social entrepreneurs, and Pathfinder, focused on the health dimensions, came together to form the Yuvaa Corps Project, which hires and trains entrepreneurs to provide counseling to new families who often knew nothing or little on the topic of family planning. Having established the linkage between the two organisations and the network of entrepreneurs, they were able to shift to a digital platform and continue providing these important services even when the pandemic hit.

Technology is another important enabler that organisations use to adapt to the new demands.

Subhashini Chandran shares how Xynteo’s mission to “bring and leverage technology [in healthcare] to enable early diagnosis, and more cost-effective interventions at the last mile” have translated to during the pandemic. Xynteo was working with technologies, innovation enablers, and innovators when the pandemic hit, and were able to transform their existing innovation network to spearhead solutions in response to COVID-related needs. They focused on prevention by leveraging digital platforms to get messages out to the mass public. They produced COVID-related early screening solutions that leveraged technology and local teams in order to reduce the dependency of constrained healthcare professionals. They created impact at scale by standardising these innovative solutions and deploying them across geographies.

Subhashini also emphasises the importance and power of partnerships. “Our lived experience is that partnerships have helped, and really been key. So both with government, but also broader private sector action… The strategy of combining technology and community as delivery agents can truly, I think, unlock resource pools and reduce demand pressures on healthcare professionals.” One particularly powerful example of leveraging technology and collaboration to solve healthcare challenges was that of Project Step 1, where 7,000 plus volunteer doctors used tele-consultations to reach around 23% of COVID-19 positive patients across the country.

“NITI Aayog has [brought] together civil society partners, the private sector, because I think these partnerships will be needed in the long run. This is not a short term problem, unfortunately. So we really need to continue to work on these partnerships if we are to scale up the delivery of these services in our time of very, very varied context.” – Urvashi Prasad

Urvashi Prasad shed light on how the government is handling the pandemic and the unique complexity that exists in India due to its socio-cultural and geographical diversity. India’s healthcare system is unevenly developed, where certain parts cope significantly better than others, which is why even with the central government providing overall protocols and guidelines in dealing with the pandemic, partnerships are necessary at the state and sub-state levels. Given its diversity, it would not make sense to make decisions for the entirety of India from Delhi.

Instead, with creative solutions popping up in different states, the government is playing its role to disseminate, scale up, and support these innovations. Yet, major concerns about the long-term disruptions of the pandemic remain where short-term neglects in health care, including essential services such as cancer screening and immunization, can have detrimental effects in the long term.

Heroes on the Ground

To know if a solution is truly working, it is critical to understand the ground context. Here, we have the extraordinary opportunity to hear from Dharma Life Entrepreneurs on how their community is currently responding to the situation.

Asiya Gavandi, long-time entrepreneur of Dharma Life and deputy Sarpanch (deputy village head) shared how precautions undertaken are working well in her village. Given her previous experience on the Internet Saathi Project, training village women to use smartphones, Asiya was able to leverage technology to get accurate and timely information regarding the pandemic. She was also able to increase the digital literacy of others in her village. “Before associating with Dharma Life and Internet Saathi project, I was not aware of anything related to internet or how to operate digital platforms. But after… I know all of it and I have been able to create awareness around various things along the way forward…. I use internet to understand what all things we can do, what all precautions we can do, and what awareness I need to create.”

Their pandemic prevention work included pre-entry screening, awareness campaigns, and delivery of essential goods. The community came together to take care of each other during this time of need. “There were a lot of people in the villages who did not have ration cards and could not get access to groceries and other essentials that governments were giving. So then we had a meeting and we tried to bring an arrangement where everybody contributed and we made checks of people who were in need who did not have access to ration cards and distributed ration, which was contributed from the village people along with the village head. And we distributed it to them.” Not surprisingly, the pandemic has disrupted people’s livelihoods as people were losing their jobs. To offset this, they issued job cards under MGNREGA.

Suvarna and Mangesh Mane are Dharma Life Entrepreneur couple in the Yuvaa Corps program working on family planning in Maharashta. They shared their family planning journey and motivation to join the Yuvaa Corps Project. “We as a couple have always planned everything in our lives. We have our first child after two years of marriage, and we have a gap of five years between both our children. So we are a successful couple, and we joined Project Yuvaa with the same vision, that we can guide young married couples to become successful couples by proper family planning.” Family planning is expansive and includes topics like contraceptive measures, women’s health, and safe pregnancy practices.

Before the pandemic, they provided guidance to over 200 beneficiaries, but everything changed when the pandemic arrived. To continue providing support, they became digitally trained on COVID-19 and telecounseling, and were able to continue providing guidance to another 60 beneficiaries on the phone during the pandemic. They shared a poignant story where they were able to convince a family to take the necessary gap of six to eight months between two pregnancies, instead of pushing forward after an unfortunate miscarriage, for the health of the mother. “We are very proud that we are part of the Yuvaa Project … we thank Dharma Life for giving us this platform so that we can make a difference to the society.”

Satendra and Anjali Diwakar are Dharma Life Entrepreneur couple in the Yuvaa Corps Program working in Bihar. “When we entered the field, we realized that the people in the village were very hesitant to talk about family planning, and were actually not aware about a lot of that as well.” People, especially women, were not forthcoming in discussing this topic, but that made the work they did even more valuable. Similar to the experience of Suvarna and Mangesh, Satendra and Anjali also learnt to conduct their work via a digital platform. They provided counselling over the phone and delivered products with safety measures in place.

The theme of collaboration continues, even more so on the ground, as Yuvaa Corps Entrepreneurs work with ASHA workers, who are government-related healthcare workers based out of the village. The entrepreneurs work closely and collaboratively with ASHA workers. “In my view, our goals are very similar. The only difference is that the ASHA worker takes them to the hospital for pregnancy, for deliveries, whereas we just provide the information and guidance on what sort of products to use.” As part of their work, Yuvaa entrepreneurs have established connections with beneficiaries in advance, which help the ASHA workers get in the house. At the same time, Asha workers are able to provide entrepreneurs with useful information. The collaboration is a win-win for everyone, including the beneficiaries.

“It is amazing how pre-COVID they’ve built up their respect. Their identity had that sense of agency … worked towards the benefit of community without anyone having to tell them what to do. They leveraged the information and the resources they got through all of the other stakeholders, understood the ground reality, and put it together.” – Vainateya Gavai

Communities are fighting their unique battles. Through technology and support by businesses and government entities, heroes on the ground continue to provide critical rural health services. The services they provide may not be directly linked to the pandemic, but it is not something that can or should be deprioritised and must continue, in tandem, to ensure people’s lives and livelihoods are protected.

“Rural health services during COVID-19: Priorities and possibilities” was the third in a series of round table events hosted as part of the Voice of the Village Events series. Further roundtables are planned for later this year.

Dharma Life Labs welcomes the support and ideas of individuals and organisations, as well as the opportunity to collaborate with others. Sharing insights and solutions and learning from one another can bring about real change at scale. The Voice of the Village roundtables are open to anyone interested and more information can be found at www.dharmalifelabs.com or by emailing dharmalifelabs@dharmalifefoundation.org   

Ina Liu (MBA 2021) is Co-President of the Women in Business Club and VP of Events for the Impact Consulting Club at London Business School. Prior to LBS, Ina studied business at Wharton, University of Pennsylvania and was a project leader with the Government of Canada. Ina completed her MBA summer internship with Bain in their Boston office. Ina is an intern for the Wheeler Institute, contributing to the creation of content that amplifies the role of business in improving lives.

The Wheeler Institute, individual faculty and PhD students at London Business School, have been working with Dharma Life for nearly 10 years, almost since the inception of the organisation. The Wheeler Institute collaboration with Dharma Life, thanks to Gaurav Mehta (MBA2010) the founder and many others at Dharma Life, covers all three pillars of the Wheeler Institute: conducting rigorous research, forging communities of practice and shaping business education.

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