Best Practice 2

‘AROGYA-SETU’
A bridge to Antyodaya (Unto the last – Ruskin)
Launched in the year 2005.

CONTEXT
DMIHER inhabits a small hamlet of Wardha, an abode of Rashtrapita Mahatma Gandhi, who pioneered the mantra of Antyoday. Upholding the very same ethos DMIHER, has vouched for catering to the marginalized Rural and Tribal population in Central India.  

This region is considered one of the poorest regions, with an average annual per-capita income below the state average. The tribal population in these districts is around 12% of the total population, especially in the villages around the forest buffer zones. Most people are predominantly landless and often work as unskilled daily wage laborers. Household incomes depend upon forests and farm produce, which is declining due to erratic monsoons and climatic change.

Availability and accessibility of health and social services for tribal people is a great challenge in the region, and the situation is further exacerbated during the monsoon.  Although the Indian economy has enjoyed substantial growth, inequality has been increasing. The challenges to poverty reduction in India are not just economic. In addition to economics, the inequity is also strongly influenced by social class based on caste, ethnicity, gender, age, and religion, adversely affecting healthcare utilization, and leading to poor health indicators. Women face specific gendered risks and vulnerabilities in these rural and tribal areas. Wages for women are considerably less than for men. Women are overburdened with multiple responsibilities, such as income generation, household work, child care, etc. This social and economic distress has adverse consequences on the population's health. The region is unfortunately known for the farmer’s suicide. 

DMIHER is committed to bridging the gaps between the community and health services, addressing inequity in access to health care, and improving health-seeking behavior. DMIHER launched the AROGYA-SETU program in 2005, aimed at providing holistic healthcare to the community, Community-based education, health insurance services & undertaking evidence-based scientific research.  AROGYA-SETU was recognized as a Center of Excellence in 2017.

The objectives of the ‘AROGYA-SETU’ program:

1. Holistic healthcare services to communities of reach by bridging the community and healthcare facilities, including access to tertiary healthcare. 
2. Community insurance programs to make health care financially accessible and improve utilization public insurance programs like Ayushman Bharat and MJPGY
3. Linking community services to academic programs at DMIHER and creating opportunities for students to practice what they learn, undertake rural/tribal research, and inculcate the core values of empathy and compassion. 

THE APPROACH
The Center adopted an integrated approach, which includes Promotive, preventive, and curative aspects, and improving access to healthcare by bridging the community and health center gaps.

Impact model of the AROGYA-SETU

Community academic partnership - - A Beyond Curriculum Program

To inculcate values of professionalism, empathy, and compassion among learners at all levels, the DMIHER links its outreach and community services with academic programs. Such a Community-Academic Partnerships - A Beyond Curriculum Program provides an opportunity to practice what they have learned in real-life settings and promotes a citizen research program envisaged in NEP 2020 by creating research opportunities and adopting families throughout their professional years.

EVIDENCE OF SUCCESS

Since its inception, the AROGYA-SETU program has reached nearly 10 million people and touched more than 1.5 million lives. Most of the population served is from the rural and tribal areas of central India.

Care of the aged people:
In the last five years, nearly 100,000 people over 60 years received various preventive, diagnostic, and curative services, with a total benefit of nearly 2.54 million rupees.  The details of the population served in the last five years are presented in the adjacent graph.  

Health insurance scheme:
in the last five years, 116060 families were enrolled in the health insurance schemes under AROGYA-SETU, covering around 450782 family members. The figure below presents year-wise household members enrolled in the scheme with the total members eligible under the scheme.

In the last five years, under the health insurance schemes, the total claim of INR 38,285,432 of eligible benefices was settled for OPD and IPD services at its centers.

Primary care services are provided through the peripheral centers of the AGROYA-SETU. In the last five years, around 100000 beneficiaries availed basic and primary care services through centers, including immunization, health promotion, antenatal care, screening, treatment and support services, and need-based referrals to higher centers. The graph below gives details of the beneficiaries and referrals.


Health camps: in the last five years, 89 health camps were organized. The services offered through these camps include health education, screening, diagnosis, treatment, and referral to a higher center. In the last five years, 448337 beneficiaries availed services through camps, and nearly 50000 (21%) of the total beneficiaries were referred to the higher centers for specialized treatment. The figure below gives the year-wise distribution of the beneficiaries at health camps.


Government/Public insurance schemes:
in addition to running their programs and schemes, the AGROYA-SETU staff links the potential beneficiaries to government schemes. The program has successfully linked 35489 beneficiaries' for financial claims in the last five years. 29000 patients were given benefits through Mahatma Jyotiba Phule Arogya Yojna (MJPJY), and claims of around INR 122 cr was settled through our Interventions; 6300 patients were given benefit of Rashtriya Swasthya Bal karyakram (RSBK); and 220 Patients were given benefit through Ayushman Bharat Yojna with around 1 cr financial claims.


Blindness control:
AGROYA-SETU program work with the community and NGOs, for cataract surgery, correction of refractive errors, distribution of free spectacles, and school services. A total of 6009 patients underwent cataract operations. The figure below presents the number of cataract patients referred by AGROYA-SETU and get operated.


Indicators of Wardha district:
The following figures indicate that the indicators of Wardha have improved compared to the rest of Maharashtra, despite the socioeconomic disparity in the region compared to the state. The improvement in the health indicators of the Wardha district over the last decade compared to the rest of the Maharashtra state may be attributed to the joint effort and collaboration between the Public Health Department, AROGYA-SETU program of DMIHER, and other stakeholders.


SUSTAINABILITY AND PATH-TO-SCALABILITY
The potential scale of AROGYA-SETU is very high because it creates a self-sustaining, self-replicating ecosystem that uses local resources. The AGROYASETU works on the principles of ‘community empowerment,’ drawing from community resources and wisdom and working with the communities from the start to maximize contributions and opportunities to improve and scale service delivery.   Our primary path to scale is partnering with stakeholders, including CSR support, government partnerships (Government programs/National Health Programs), and local NGOs/CBOs. At scale, program implementation will be adapted to local needs, without negotiating the quality and impact. AROGYA-SETU will develop a high-performing workgroup of capable and engaged people who work collaboratively to achieve shared goals, demand generation, and policy integration.

WAY AHEAD
The evidence-based, high-impact, sustainable, and scalable model of the AROGYA-SETU, co-created and implemented through community engagement and stakeholder participation, aims to reach nearly 10,00,000 households from the region by 2025. 

What will success look like?  Our AGROYA-SETU programs will improve health indicators and empower the community, strengthening ‘Unnat Bharat Abhiyan’. Therefore, our approach may emerge as a Complimentary State prescribed under Article 21 of The Constitution of India.

Snapshot of the events and activities