Photo Credit: ADT District and Block Teams Piramal Swasthya
Story by Callie Wen
Keeping the Faith: How Piramal Swasthya Works to Advance Healthcare in India

"In addition to talking about breastfeeding and institutional deliveries, [religious leaders] also have to talk about COVID now."

The philosophy of Piramal Swasthya revolves around serving rural communities and working within hard-to-reach areas to ensure healthcare access. The non-profit healthcare organization, based in India, partners with national health providers and community leaders alike to fill gaps in the state-run services, raise awareness of healthy practices, and provide a platform of health services for non-communicable health concerns catered to each community’s specific needs. One way they engage with the community is by working with religious leaders and faith-based organizations, with significant influence to increase health awareness and demand for healthcare services among community members. These efforts made them one among the five winners of USAID’s 2019 Inclusive Health Access Prize, a prize that sought to recognize and incentivize work that demonstrates how integration and public-private partnership expands access to affordable, accountable, and reliable health services for poor and vulnerable groups. The prize also celebrated and spurred a broad range of approaches that are sustainable, scalable, and replicable — and in serving 112 million people, there’s no question that Piramal Swasthya has hit scale. Yet dealing with the COVID-19 pandemic has required new mindsets and strategies, not only for the religious leaders Piramal Swasthya works with, but among the organization itself as it expanded beyond focusing on non-communicable diseases, and maternal and child health, to also working on COVID prevention and control.

Piramal Swasthya worries about setbacks in their traditional set of health areas as a result of the pandemic. For example, 72% of Indians’ incomes have decreased, leading to ripple effects in multiple health sectors. As a result, food insecurity is rampant; Ashwin Deshmukh and Dr. Shailendra Hegde, representatives of Piramal Swasthya, predict a reduction in food intake and an increase in malnutrition and stunting levels. Mental health challenges will also rise with economic troubles, as will domestic violence. Overall, Piramal Swasthya is “exploring ways to expand its service offerings to reach a large population. .” Deshmukh and Hegde emphasize the difference between the increasing need and decreasing demand for healthcare services. Regular healthcare problems and issues such as diabetes, malnutrition, tuberculosis etc… have not disappeared in the shadow of the global pandemic-- in fact, they have been exacerbated. But, despite the greater need for healthcare services, demand has plummeted, as people are afraid to leave their homes to seek routine health services. Deshmukh predicts “an increase in non-communicable diseases and preventable deaths over the next six to nine months” as a result of this shifting relationship between community members and healthcare providers.

The pandemic has also raised new obstacles for Piramal Swasthya on the supply end of healthcare provision. Deshmukh and Hegde use the organization’s flagship mobile cancer screening program as an example. Screening for oral, cervical, and breast cancer has been a long-standing core service of Piramal Swasthya, but patients and providers come into close contact during screenings, leading to a risk of disease transmission. “One infection can completely destroy the entire cancer screening program we have set up over time,” they explain. “We do not want people believing that cancer screening leads to COVID,” as the potential stigma would reduce the demand for screening and increase the cases of undetected cancer in the long run. For certain service provisions, the communicable nature of this disease has disrupted Piramal’s strategy of working deeply within the community and on a very personalized basis, pushing the organization to shift their mindsets and approaches.

For other services, however, Piramal Swasthya has leveraged several existing healthcare platforms to join the fight against COVID-19, using the same tools but completely shifting their implementation strategies. “We have greatly leveraged our mobile medical units to work deeply within communities,” says Hegde. Typically used as a community outreach platform in hard-to-reach areas, “these units are now used to check swab samples of suspected cases, refer patients to treatment facilities, deliver healthcare services on the ground, and raise general community awareness around COVID.” Piramal Swasthya has also continued its work in 25 aspirational districts, which have been identified as lacking in a set of indicators including education, health, infrastructure, and financial inclusion. In these districts, the health systems are very poor and citizens face challenges around healthcare access and affordability. Beyond providing their normal services for non-communicable health concerns like diabetes and hypertension, Piramal Swasthya has extended their services to train frontline workers around setting up isolation wards and intensive care units, implementing community screenings, enforcing quarantine protocols, and controlling disease spread through contact tracing. According to Deshmukh, “we want to make sure that these districts have the basic infrastructure and capacity to curb the spread of disease.”

Similarly, Piramal Swasthya has relied more heavily in the past months on their existing health helplines, which work in eight different states and have now pivoted into COVID-related helplines. Unlike close-contact screenings, this particular platform allows the organization to provide essential services without fear of transmission, and to continue building their relationship with the community. Through these helplines, community members are able to access crucial information about COVID, including where testing centers are located, where to get treatment, and where to register if coming from high risk areas. Within the first six months, these helplines have received almost 1.2 million calls regarding COVID-- making up 43% of the total calls received, as the organization continues to address ongoing health concerns in their traditional areas of expertise.

Piramal Swasthya has also expanded the helpline to ensure the implementation of several social security programs by the Government, via the platform. In Assam, one such project is a cash transfer program for people stuck outside of the state; this program provides financial assistance to ensure healthcare needs are met. Piramal Swasthya register those who qualify for the program, validate their information, and follow up once the money is transferred-- all through the ‘helpline’. Another is a registration program for the large population returning to the region from bigger cities with high infection rates. These citizens register with the helpline, which screens them for symptoms and follows up with them for seven days to ensure they adhere to quarantine protocols. The helpline is also useful in addressing challenges with accessing medicine. “A patient can call up the helpline with their prescription for diabetic medicine, for example, and Piramal Swasthya will work with the state’s supply chain to ensure that medicines are available and accessible,” explains Deshmukh.

While the cancer screening program has been scaled down during the pandemic, the health helpline has seen a capacity increase of 35%, due to increased resources, technical support, and funding, both from the Piramal Foundation and the Government. All partners and stakeholders have been highly supportive of the organization going even deeper into communities to ensure healthcare service provision for some of the most vulnerable populations in the country. Piramal Swasthya has also recruited almost 200 new staff on temporary contracts in an effort to scale up some of the initiatives, covering their traditional services and expanding to provide resources and services relating to COVID-19.

With the onset of the pandemic, Piramal Swasthya has leveraged its existing initiatives but shifted its implementation strategy to adjust to the current context, proving that these platforms “have a significant role to play and contribute to building the resilience of the overall healthcare ecosystem,” say Deshmukh and Hegde. Piramal Swasthya has faced its fair share of difficulties in the face of COVID-19, with setbacks in their traditional healthcare areas and a shifting relationship with community members. Even so, with flexibility and resilience embedded in their platforms, and an unwavering philosophy, Piramal Swasthya is determined to successfully balance short-term and long-term healthcare needs to best serve the communities they have long dedicated themselves to serving.
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