Raj Kamal Prasad Verma, Chairman (non-executive) & Independent Director on Board of Makers Laboratories (An IPCA Group Co.), Mumbai opines that the third sector, comprising social entrepreneurs, voluntary organisations, NGOs, charitable trusts and foundations, can be a great enabler to amplify government and public healthcare agencies’ efforts in grappling with the current pandemic. He also suggests measures as to how policy makers and decision makers can integrate the third sector organisations in their healthcare delivery system
Government of India greenlighting the moon-shot ideas of Dr Devi Shetty, Chairman, Narayana Health (formerly known as Narayana Hrudayalaya) to deploy final year students of medical and nursing courses and PG aspirants in COVID-19 ICUs is the right step toward augmenting the exponentially growing requirement of doctors and paramedics in managing COVID-19 patients undergoing treatment in various hospitals across the country. This decision would resurrect the crumbling healthcare structure in terms of human resources and can save thousands of lives in the current pandemic
India recorded the highest number of (over 4000) deaths in 24 hours on Sunday, May 15, 2021 as per the dashboard of Ministry of Health & Family welfare. Tedros Adhanom Ghebreyesus, the WHO chief warned that the pandemic’s second year would be far more deadly than the first for the world. The devastating wave has overwhelmed India’s healthcare system and it is abundantly clear that government alone cannot handle the health calamity of such an enormous scale and complexities.
Third sector comprising of social entrepreneurs, voluntary organisations, NGOs, charitable trusts and foundations is a potential resource which can be unlocked to battle the current situation and ease out the severely overburdened health care system. The Schwab Foundation 2020 Impact Report “Two Decades of Impact” demonstrated how the network of 400 leading social entrepreneurs have impacted the lives of more than 622 million people in 190 countries, distributed $6.7 billion loans or value of products and services, driving movements for social inclusion and environmental sustainability, and providing improved access to health, sanitation, education and energy.
One of the social enterprises showcased in the report is Dimagi – a cloud-based data collection software to improve healthcare tracking on a global scale. Dimagi has digitalised health work forces across 2000 projects in 80 countries. Their CommCare platform enables to quickly build and deploy custom mobile application for every phase of an effective COVID-19 response- from screening and contact tracing to patient monitoring and post care support. The project in India has seen over half a million community health workers adopt Dimagi’s mobile applications to provide critical services to 300 million people.
A sterling example of a third sector organisation impacting a global health issue is Rotary International. As a founding partner of Global Polio eradication initiate (GEPI) launched in 1988 Rotary has been working to eradicate polio for 35 years. Collaborating with the government agencies, WHO, UNICEF, US Centre for Disease Control and Prevention, Bill & Melinda Gates Foundation and GAVI, Rotary has been instrumental in eradication (99.9 per cent) of poliomyelitis from the world. So far, 2.5 billion children have been immunised against polio all across the globe.
And now, as COVID-19 vaccines are being distributed in around the world, the experience and knowledge of Rotary in the Global Polio Eradication initiative are helping protect communities from the pandemic. Rotary members are getting involved in supporting the COVID-19 vaccine roll out, raising awareness in their communities, supporting frontline health workers, combating misinformation and vaccine hesitancy and providing essentials including medial oxygen to healthcare centres. Rotarians in Lithuania and Chicago, Illinois, US, are promoting use of “bubble helmets” and potentially lessen the need for mechanical ventilators for COVID-19 patients.
National Health Services (NHS -UK) is another model of delivering health care service while closely collaborating with the voluntary, community and social enterprises (VCSE). The third sector organisations play massive part alongside NHS, around a third of all community health services are delivered by social enterprises and they are essential partners to bring a greater shift towards prevention and self-care. The Healthcare and social care enterprises in UK have a turnover of 1.5 billion euro and employ over 100000 staff. Some aspects of their response during COVID pandemic have shown how well integrated health and social care can perform together. By collaborating to ensure that medically fit patients were transferred out of hospital to home or to step-down care meant that hospitals were able to generate surge capacity and not be overwhelmed. Technology enabled the rapid deployment of carers to achieve 10 000 home visits a day and helped relatives to maintain contact.
NGOs are key factors in developing countries, where they frequently collaborate with government to deliver basic services. Such partnership is even more critical during the current pandemic which has exposed our fragile healthcare system. The third sector organisations have been reaching out to the most vulnerable to deliver health care services and supply of essentials often to those who the market and government are unable to account for.
For example, Mann Deshi Foundation, a Maharashtra based NGO has been working providing relief by supplying PPE and masks to frontline health workers and nutritious food packets to quarantined COVID-19 patients. They refurbished an unused rural hospital and turned it into a 300 bed COVID-dedicated facility in partnership with HSBC and the district authorities. This facility has provided relief to thousands of COVID-19 patients.
Hemkunt Foundation, a Gurugram-based voluntary organisation has been working 24/7 arranging resources, supplying oxygen cylinders to the people in need, so far, they have helped 10000 people during the second wave of COVID-19. Their latest initiative is a drive-through where people who need oxygen can come in their cars and avail the services directly from their centre in Gurugram. RT-PCR drive thru test is also provided at the centre.
With the country’s health system grappling with COVID infections, over 30 per cent of essential health services are impacted, including immunisation, antenatal and nutrition. Society for Nutrition, Education and Health Action (SNEHA), a Mumbai based NGO partners to build effective solutions to malnutrition in children and empowering women. By incorporating COVID-19 prevention into their programme, they have ensured that even during the pandemic, pregnant women living in slums and low resource settings continue to use public health services and gain access to treatments for life-threatening diseases such as malaria, pneumonia, and typhoid and ensure immunisation of children especially from the poorest families who are at the greatest risk of contracting preventable infectious disease.
Pandemics are known to exacerbate mental health conditions because of bereavement, isolation, loss of income and fear of unknown. WHO, in its survey of 130 countries observed that over 60 per cent of critical mental health services are disrupted. Banyan, a Chennai based NGO addresses people with severe mental illness. They have assembled a rapid response team which works through digital platform and toll free helpline providing psychiatric care and psychological counselling to the emotionally distressed people
Acute shortage of medical oxygen has become the single most cause of people succumbing to COVID infection. “Access Oxygen” a social enterprise in Senegal has demonstrated as to how frugal innovation can meet the surge of demand of medical oxygen. It is an inclusive business that provides medical oxygen to healthcare centres, by creating “Oxygen Houses,” run by local micro-entrepreneurs and offer the product, maintenance, training and digital tools. This model of oxygen generation for medical use can be replicated at rural level where COVID-19 has started to spread fast.
With their ground level knowledge acquired through decades of societal R&D and their models of running inclusive organisations that serve undeserved populations, the organisations around the Third Sector are uniquely placed to support Government to tackle the pandemic and are vital to recovery planning and reducing health inequalities in the long run.
The way forward
All social enterprises, NGOs and voluntary organisations operating in the healthcare sector should be identified by the policy and decision makers at regional, district and country level and resources available with them should be matched with the resource scare areas.
The resources could be ambulances, doctors, paramedics, oxygen generators, data analytics, mental wellness counsellors, and in some cases even hospital beds. Schwab Foundation, Ashoka, UnLtd India, Villgro are some of the incubators for Social Ventures with such database.
Whereas the Public Health System should focus on the patients needing ICU or hospitalisation, those requiring step- down care can be served by the third sector organisations. They can provide home care, teleconsulting, tele counselling for mental wellbeing and other support services on the model of NHS -UK.
Health policy should be reset to integrate mission driven NGOs to health care pathways at each hierarchy of healthcare system while keeping the focus on undeserving populations.
To make lasting, significant change on a system-wide scale, not-for-profit organisations need sufficient resources. Fund crunch is the biggest challenge that most of them are struggling currently as many of the donors have diverted their resources towards COVID-19 related relief. To address this issue, an alliance of 40 leading global organisations known as COVID Response Alliance for Social Entrepreneurs has been formed to support 15000 social entrepreneurs globally. Also, a database (Covidcap.com) of emergency funds available to non-profit and for-profit entrepreneurs during COVID-19 and global capital relief offers worth over $1 trillion is created by the Centre for the Advancement of Social Entrepreneurship (CASE) at Duke University.
Another resource for the not-for-profit organisations to get an initial seed grant is Action COVID-19 Team (ACT) which has set-up an Rs 100 crore grant, created by India’s start-up community to give wings to impactful ideas that could combat spread COVID-19.
Social entrepreneurs are battling at the forefront of this pandemic to serve the most vulnerable populations with missionary zeal using their understanding of the social determinants and rapport they have built up with the communities.” These community-based models need to be scaled up” – opines Soumya Swaminathan, WHO Chief Scientist. The time for adoption, collaboration and collective action is now.