Partnerships that can power people and the economy
- The article has been authored by Shama Karkal, CEO, Swasti Health Catalyst and Chair, Asia Pacific Alliance for Sexual and Reproductive Health and Rights.
Rajeshwari works in a garment factory and produces 30-35 pieces in a day. She often complains of tiredness and feels weak, taking additional breaks during the day and at least two days per month of sick leave. Diagnosis of severe iron-deficiency anaemia and treatment for three months led to an improvement in all her symptoms and an increase in productivity.
Why is Rajeshwari’s story relevant? Identifying and treating anaemia is a very simple example of the care that is required by millions of Indians and yet remains elusive. The factory that Rajeshwari works in, is likely to “earn” $ 87,500 in a year simply by ensuring their one-thousand workers for iron-deficiency anaemia.
In a study of garment workers in Tirupur, Tamil Nadu, 77% workers reported musculoskeletal problems, 57% anaemia, 51.6% had uncorrected vision issues, 31% had respiratory conditions, 12% had hypertension and 6% had diabetes. It's important to remember that Rajeshwari and garment workers, along with many of us working in the formal sector, make up only 6% of the workforce; the majority of India’s workers are in the informal sector. Not much imagination is needed to understand the health issues that affect workers in the informal sector. What should intrigue us more is that only 51% of Indians who can work, are actually engaged in economic activity (labour force participation).
Two facts give us some clues to the quality of our workforce - there has been no decline in the incidence of low birth weight infants in the last 40 years (Gopalan, 2018) and wasting among children has not changed significantly in the last two decades (NFHS 2019). Low birth weight is not only a risk factor during infancy and childhood, it is known that low-birth weight children have a higher risk of developing a variety of adult onset conditions as well. Maximum brain development happens in the first two years of life and is nearly complete by age six - critical windows that determine now just the potential of these individuals but also how they engage in the economy. While we may have a large working-age population, the ability to contribute to the economy, while dependent on many factors, is also dependent on the health status - productivity, fewer health conditions, increased participation in the workforce and reduced deaths.
Evidence exists that investing in primary health care can boost Gross Domestic Product (GDP) by as much as 6% and four times the economic returns. So, it comes down to where we make the investments.
When we think of healthcare, we think of illness and, therefore, the need to see clinicians, take medicines and need for medical facilities. Whether services are provided by the private, public or informal sector, whether it's about treatment, diagnostics or financing, it is about how we’ve structured health care. These are of course all important, but can only be part of a larger effort to keep people healthy.
The biggest shift we need to make is our mental model of health, which should be about preventing illness and supporting positive behaviours related to health. This is where understanding and focusing on primary health care becomes important. The World Health Organization (WHO) defines primary healthcare as “a whole-of-society approach to health and well-being centred on the needs and preferences of individuals, families and communities, addressing the broader determinants of health and focusing on the comprehensive and interrelated aspects of physical, mental and social health and wellbeing.”
A study by Doherty et. al. shows that 90% of all healthcare conditions can be treated through primary health care. Mass evidence published by health expert Barbara Starfield further shows that primary health care delivers better population health outcomes at lower cost and can counteract the adverse impacts of poor economic conditions on health.
How different would this be from today? Individuals or families would receive support to take care of their own health - so not only as a service but as a partnership where they would play a role. People would be supported over their life-cycle, i.e from the time of birth through childhood and adulthood, having information and guidance, navigating through various services and professionals, as per their need. Workplaces, formal and informal, which support workers with health and safety would add to the overall quality of life of people.
Can the future that we want for our people and economy be achieved by any one entity? India has already begun its journey towards primary health care for all with the National Health Policy, 2017 setting an ambitious goal of the “highest possible level of health of well-being at all ages.” The health and wellness centres when fully operationalised could function as “anchor institutions” which provide health care, promote healthy behaviours and support families’ physical and social environments. We need “all hands on deck” to achieve this vision. Efforts at integration and providing comprehensive care through partnerships between private, public and community institutions are underway and greater alignment of different initiatives will help accelerate results. We will see greater results achieved if we are able to break silos - health is not just the business of those working on health, but is everyone’s business.
An apparel brand decided to use their CSR funds to improve the health of not just the workers like Rajeshwari in their factories, but in the communities they lived in. They’ve helped set up a local women’s federation (along the lines of the NUHM’s Mahila Arogya Samiti), supported them to set up a cooperative society (which provides financial services of savings and credit), health education and primary health care is taken up by local women. The cooperative and the federation work closely with the district and local authorities, and have gained recognition in recent times for standing with the community during the pandemic. The company has worked to set up a hangar recycling unit in the same community, providing additional livelihood and income as well as decreasing their own carbon footprint. This CSR effort over five years has resulted in social returns that are 3.32X the investment made. This is but one example of how long-term CSR commitments, working with multiple partners as well as with local governments and communities can lead to transformations.
We will take the liberty of re-interpreting Hilary Ziglar’s quote on building businesses “You don’t build an economy...you build people and then, people build the economy”. Along with the other structural and economic reforms, affordable, convenient and accessible primary health care, will lay the foundation for an inclusive, thriving economy.