We are community-based. We stay. We are a permanent program serving a population of 220,000 residents. Our commitment to stay and deliver services is the basis of our bond with the communities. This deep trust is reflected in our programs: every year community members call us with thousands of referrals.
We take care to the patient’s doorstep. It is our poorest patients who can least afford the time, cost and energy of traveling to health facilities. In our TB program, we challenged the orthodoxy that a poor patient must travel 3 times a week to a health center to get her drugs. We decided to go to our patients’ homes instead. A decade later, our approach is now accepted as mainstream. When we receive word that a patient might be sick, we make a house visit. In our maternal and newborn health (MNH) program, we perform ante-natal checkups at home when pregnant women are unable to visit health facilities.
We invest in women. Our teams are local. We believe in female community health workers (CHWs), and have made significant investments to strengthen them in our catchment. A persistent, appealing myth is that more technical training for CHWs transforms health outcomes. In our experience one must start instead with addressing the deep disenfranchisement, misogyny and loss of agency that CHWs face in public health institutions and their communities. We have advocated for fair wages for CHWs, we offer round-the-clock field support, have created a career path, and given voice to their aspirations.
We strengthen public health institutions. We believe that public health institutions (PHIs) have a central role in the care of the rural poor. All our work is through PHIs. In both TB and MNH, we have significantly strengthened the PHI’s ability, and transformed the community’s view of public health. We are not ideologues. We seek private avenues for our patients when PHIs prove inadequate.
We never leave a patient behind. Our patients and families know that we will not leave their side, often literally, until they are well. Our dedicated local staff endure long hours of travel and hospital stays to ensure that patients get proper care. Newborns born in isolated hamlets are taken to neonatal ICUs. Those suffering from TB and HIV are taken to district-level referral facilities. Our resources may limit us, but our principles do not.