by: Esha Chhabra, rethink social
Women don't have the autonomy to make decisions about their own health in rural India, explains Dr. Minal Singh, Assistant Vice President of Health at Drishtee who recently won an Ashoka Changemaker Maternal Health Competition for her innovative model of healthcare for women by women in Assam, India.
"Women don't have power in the home to make decisions, even if it means going to a local doctor for a checkup or giving birth in a nearby clinic, they have to consult their mother-in-law or husband to do so. And those cultural and social issues are the biggest hurdles in maternal health," Singh delineates.
Working at the acclaimed social enterprise in India, Drishtee, Singh and her team have crafted a franchise model to health that resonates with Drishtee's earlier work in setting up rural kiosks, or franchises, which provided a variety of services and goods. The new health franchise hires local women who are trained for maternal care as well non-invasive diagnostics (such as checking for BP, glucose levels, pregnancy, and temperatures). Moreover, these women, as a collective set of entrepreneurs in the Dristhtee Health Franchise, become owners of the Drishtee Health Kiosk, providing them a source of income.
Working in Assam, India, a region to the East, known for its teas as well as stark levels of poverty and poor health, Drishtee is experimenting with this new business model for health that doesn't believe in handouts. Rather, they're charging for their services- even if it's a nominal fee of 150 Rs. (equivalent to $4), a price that Satyan Mishra, founder and CEO of Drishtee, believes is not only appropriate but part of his larger vision to make the enterprise sustainable.
"The culture is against a woman when it comes to safe pregnancy. The carrier has no importance. But in terms of economics, if they have the funds and the awareness of a local doctor, they will come. If you get the family there and explain to them the importance of these precautions, they will listen. It's just a matter of time," Mishra affirmed.
Drishtee's Health Kiosks house not just a community of health workers but also trained midwives and gynecologists who make regular visits to the community, providing routine check ups to pregnant mothers. Couple that with discussions held by local women on maternal health, a documented record of all pregnancies in the area, and education for moms-to-be on what to expect during pregnancies and how to stay healthy and safe. It adds up to a comprehensive but low-cost and community-based health business.
For Singh who has been at the grassroots developing this model, she points out that it's not only a business model. Rather, the Drishtee Health Franchise is empowering women by giving these women a skilled profession.
"I was surprised when I learned that what made these women feel good about being part of the Drishtee wasn't the additional income, it was the respect they received in their community," she says.
In recent years, the Government of India has taken strides to improve maternal health conditions by having a legion of health workers, referred to as ASHA workers (accredited social health activist), who survey rural areas and encourage women to give birth in hospitals, not at home. In fact under the government's Janani Suraksha Yojana scheme, or simply the Motherhood Protection Scheme, families receive a monetary sum for having births at hospitals.
Singh explains that, though the sum varies from region to region with the country, in Assam, these women will receive 1200 Rs for going to the hospital to consult with doctors and give birth. Yet, getting there, paying for travel costs, arranging for family to travel with them, and the time spent away from work are all tall task for poor families who simply cannot afford it. Thus, by providing a rural option, and bringing doctors and skilled health workers to the women, Drishtee Health Franchises are making maternal health easier for rural families.
Mishra clarifies that the problem actually occurs before delivery. "It happens during pregnancy and even before that. So, if the right nutrition is provided and the proper pre and post natal care is available, we can correct some of the deliveries that go wrong at the end. In many ways, we are complimentary to what the government and ASHA workers are dong," he says.
The Drishtee Health Franchise program began in 2010 and has gathered steam along the way, garnering the support of global pharmaceutical company Merck and is collaborating with Accenture on a mobile health platform for their services. Surveys of 700 women in Assam have shown positive results with a majority of the women, coming forward and prescribing to the Drishtee Health Franchise during their prenancies.
Though health was not the primary focus for Mishra when he started Drishtee ten years ago, it's certainly taken center stage now.
"We've learned that health is one of the key reasons why a rural community becomes unsustainable -people have to migrate, they get ill. And within health, maternal health is a massive problem. But it doesn't take too much to make an impact. So, with our vast network that's already in rural areas, we can make a big impact and that's what we're trying to do with this new model," he reflected.