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. Dr. Singh is the Assistant Vice President of Health at Drishtee, an organization that is helping to build an ecosystem of micro-enterprises throughout rural 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,” said Singh.
At the award winning social enterprise (Singh herself was a recent winner in the Ashoka Changemaker’s “Healthy Mothers, Strong World” competition), Singh and her team have crafted a health care model that resonates with Drishtee’s earlier work. The organization originally worked setting up kiosks, or franchises, that provide a variety of services and goods in rural areas. The new health franchise hires local women trained in maternal care and non-invasive diagnostics (such as checking for BP, glucose levels, pregnancy, and temperatures). In turn, these women are part of a collective set of entrepreneurs in the Dristhtee Health Franchise, and therefore owners of the Drishtee Health Kiosk, providing the added benefit of an additional source of income.
Assam, India, in the far Northeast of the country, is known for its teas and stark levels of poverty. Now it’s also home to one of Drishtee’s experimental business models for health care. Rather than providing free services, they charge a 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,” said Mishra.
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. That’s in addition to discussions held by local women on maternal health, record-keeping of all pregnancies in the area, education for moms-to-be. It all adds up to a comprehensive but low-cost and community-based health business.
Singh, who has been at the forefront of the project, points out that it’s not only a business model. The Drishtee Health Franchise also empowers women by giving them 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 (accredited social health activist), who survey rural areas and encourage women to give birth in hospitals instead of at home. In fact under the government’s Janani Suraksha Yojana scheme, or simply the Motherhood Protection Scheme, families receive a payment from the government for giving birth at a hospital.
Singh explains that, though the sum varies from region to region, in Assam, these women will receive 1200 Rs for going to the hospital. However, getting there, paying for travel costs, arranging for additional family to travel and the time spent away from work adds up to an insurmountable sum. 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 doing,” 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 in addition to collaborating with Accenture on a mobile health platform. A survey of 700 women in Assam has shown positive results for Drishtee Health Franchise.
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.”