Invest for Wellness (i4We) is a system innovation in primary healthcare, which combines health and wealth interventions, and focuses on wellness for the poor in an affordable, quality assured and scalable way. The programme ensures the primary care of members, navigates them through a range of existing secondary and tertiary providers and uses a blended financing model. The model combines medical, behavioural and social science with an appropriate mix of technology and health financing. It is currently delivered in four settings – Urban, Rural, Factories and Sex Workers’ collectives.
Healthcare does not work for the poor.
Health system in India is inadequate, poorly designed, lacks customer focus and largely concentrates on diagnosis and treatment. The cycle of ill health and poverty is kept intact by system inefficiencies, episodic treatment seeking behaviour of the poor, and minimal focus on prevention and non-medical determinants of health. The poor lose up to 1-2 months of productive time in a year to an illness of self and family. Almost 50-80% of them live with some form of undiagnosed illnesses and die earlier than those who are economically better off. About 50-60 million people in India have been pushed to poverty, in the last decade, because of health related expenditure.
i4We is our innovation designed to specifically deliver primary health services to communities, who have the greatest need for primary healthcare but are least likely to receive it.
In any setting, a household becomes a member by saving a minimum of ~ 0.8-1 USD per week in a local health group. When a family member is ill, they get free, prompt, convenient and empathetic care in the local clinic by a nurse and a dial-in-doctor. When they are well, they are screened systematically for 10 high burden conditions. In both cases, once the treatment is done, the root cause is analysed and the family is helped to prevent the next episode. In the case of chronic conditions, continued support to adhere to treatment and other changes are supported. When the condition is not primary and requires hospitalisation or advanced treatment, they are referred to a quality assured network of providers and treatment adherence and completion followed through.
The i4We model is guided by the philosophy of “work with what works” and complements the existing network of health providers by making them more effective and efficient, with a customer focus.
Members get health advice, assured screening and treatment for 20 diseases and conditions, and priority access to health services.
Uniquely, i4We removes every excuse and impediment for not improving wellness – systematically and in a customer focused way. It continuously builds women self-help group members as first responders, analyses root cause, when an illness is treated successfully and helps families make changes. It promotes systematic immunisation and health products, and screens and treats for high burden conditions. Further, it supports groups to deal with chronic illnesses, violence, and addictions and improves key determinants of health at the community level.
Partnerships, community institutions, and technology augment impact.
i4We uses a strong technology strategy, which includes an App for the Health Facilitator, Nurse, and the Healthcare Provider network, AI enabled real time analysis and dashboards for action, Point of Care diagnostics and a range of innovative health products. It also uses the latest behavioural science theory and practices including survival analysis, nudges, and other tools. Members experience sustained changes in non-medical health determinants such as sanitation, air, water, and food as i4We partners with local institutions and stakeholders, including local government providers, to effect change in these areas.
Our vision is to reach 2.5 million urban and rural poor with primary health services by 2020.
i4We is modularised through technology tools and strong documentation, with inbuilt processes, tools, and methods that are led by a framework. Agile implementation at scale is enabled with a ‘plug-in’ and workflow approach for each component. A ‘primary healthcare landscape’ exercise that Swasti ran for 10 years, and continuing, provides an arsenal of tools, which have proven to work in many contexts, enabling us to build on what works.
Started in 2017, the model is operational in five locations in India, covering 36,000 people and growing rapidly. The programme which began in urban settings is already being adopted by partners into other settings – rural, factory, sex work collectives, schools – due to its ability to be an easy add-on to existing programmes and community aggregations/outreach. The programme is already expanding from India to Sri Lanka, Lesotho and potentially Botswana.
We are committed to impacting 100 million households and help ensure special communities to “Get Well, Stay Well”.
i4We aims to increase healthy days (by reducing unhealthy days by 30%), reduce undiagnosed conditions (by 30%) and deliver an independently certified Social Return on Investment (SROI) of 300% for the investor. The programme is co-created with a range of partners including Vrutti, Catalyst Management Services, Marks & Spencer, Levi Strauss & Co., Social Venture Partners, World Health Partners, Dtree among others.
Our goal is a self-propelled, viable primary healthcare model that can effectively break the cycle of ill-health and poverty. We invite private and public sector actors and donor community to join us to transform the delivery and experience of primary health services, and ensure that no one is left behind. Write to us at [email protected]
