i4We - Invest For Wellness

Get Well, Stay Well

Primary health care is highly effective and has huge returns for the society. In many countries, primary health care does not work for the poor. About 50 million Indians become poor due to ill-health. The health system is expensive, unfriendly, complex and generally less accessible and with significant conflict of interests. Health seeking behaviour of poor lead to repeat episodes, undiagnosed conditions and resistance to treatment - all leading to significant Out of Pocket expenditure (70%), high morbidity and early death. Many conditions are preventable and easily treatable. Current models in primary care are not comprehensive, scalable or sustainable. Almost no model has cracked balance between prevention and treatment, sustainable funding vs. comprehensive package of services, and community participation vs. payment for services - elements key for long term success.

Invest for Wellness (i4We), incubated by the Catalyst Group, is a system innovation in primary healthcare, which combines health and wealth interventions, and focuses on wellness for the poor in an affordable, quality assured, and scalable way. i4We ensures primary care of members (locally), navigates them through a range of existing secondary and tertiary providers (where required), and uses a blended financing model. It is currently delivered in five settings: urban, rural, factories, schools schools and sex workers’ collectives. i4We has five revenue streams: interest spread on inter-lending among members, sale of health products, fees for citizenry services, sale of insurance, and direct sponsorship of ultra-poor families’ health. The program is self sufficient with a startup grant capital ramp of five to seven years.

The model marries medical+social+behavioural sciences, technology and health financing and is owned and operated by the community. It operates on principles, results and modular processes which allow rapid scaling in different settings.  Members get eight benefits -free primary treatment, free insurance, free medicines, free screening for 10 high-burden conditions, access to savings and credit, free health education, membership in support groups and improvement in community situation on Sanitation, Air, Water, and Food (SAWF), key health determinants, through community action.

i4We by itself is not unique, but is innovative in the way it brings lessons and innovations in healthcare sector together and in the way it works for the poor. i4we aims to reinvent the health system (primary health delivery + navigation of secondary/tertiary care + insurance). It’s neither free, nor does it have a fee. It is appropriately tech-enabled and provides pathway for technology innovations to reach the poor. It is sustainable (financially, systemically, environmentally), and it delivers results in variety of settings and is process driven and quality assured.

We aspire to affect millions of people, improve their healthy days by 30%, reduce undiagnosed conditions by 30%, and provide social return of 300% for investors. Our ambition is to create a market for primary health outcome bonds and in the long term a market for prevention. We will make the model easily adaptable, pluggable and copyable by a range of stakeholders who are interested in the welfare or development of the poor and marginalised.

i4We by itself is not unique, but is innovative in the way it brings lessons and innovations in healthcare sector together and in the way it works for the poor. As a system innovation, it’s not supply oriented but customer focused and community owned, reinventing the health system (primary health delivery+navigation of secondary/tertiary care+insurance). It’s neither free, nor does it have a fee. It’s appropriately tech-enabled, and provides pathway for technology innovations to reach the poor. It is sustainable (financially, systemically, environmentally), and it delivers results in variety of settings and is process driven and quality assured.

Our technology solution (designed and used by health workers) helps members navigate the healthcare journey. It tracks family members as a cohort, helps the health worker, nurse and doctor by providing them insights, with follow up action and sharing seamless information between them. It also holds the family health records and serves it on need basis. It helps understand trends, predict behaviours, dive deeper into repeat episodes (root cause analysis) and other protocol and AI driven solutions which expand over time. It has multi level dashboards which show results, funnel of attrition in care and ‘moving’ impact of the work.

We would like to expand our five variations of the model (urban, rural, factory, schools, sex workers) to reach a 350,000 people, largely poor and marginalised. At the community level, we would like to see 10 Swasth Samitis (local health corporations) and 40,000 local health club groups. We would like to complete the various phases of our technology solution (total 8 phases, of which we are in 4th phase currently). We would like the financial model to mature and reach 30% cost recoveries. We would also have an advisory body of 20 national and international experts fully functional.

For a million people, their healthy days would have improved by 30%, undiagnosed conditions down by 30%, and 25 Swasth Samitis (local health corporations) will govern the programme locally, of which 75% of them will be meeting all sustainability milestones. We will be prepared with our offering of health outcome bonds, to create a market for prevention. Other players reaching poor communities will be implementing 40% of our interventions in partnership model. With the Government we would have at least 3 places where the i4We model will be implemented.

Our value proposition is strong and better than any competitor. Customers continuously save, as it adds to their own asset and have an interest in improving their wealth and get health benefits too. To keep them motivated, the Self Help Groups (SHG) or health clubs, are formed, which meet every week and provides positive peer pressure. In addition, families maintain a healthy days card (includes health expenditure accounting), which provides them motivation to see how things are getting better. When members drop out, other members are motivated to sweep them back by visiting them, encouraging them and suggesting ways forward.

i4We currently serves about 1543 families and 6445 individuals, totaling to about 14000 individuals. The communities are a diverse population and they come from urban slums, rural villages, factory workers, and women in sex work. All i4We members are tracked on the i4We technology solution, and their information is continuously updated as and when the health workers and nurse interact with them.

Apart from working with the member families, regular health screening camps, sanitation programmes and school programmes are also conducted, and through such mediums we reach out to many more people in our areas.

In the next 12 months, we plan to expand to at least 350,000 people and a 1,000,000 in 3 years. At the community institutions level, we plan to have at least 10 Swasth Samitis in 1 year and  25 Swasth Samitis in 3 years.

We expect to see the following effects on the communities:

• More aware about their health and wellness

• Start demanding health services

• Feel more energetic and positive in their day-to-day lives

We expect them to see the following impact:

• Reduction in unhealthy days experienced in a year by 30%

• Reduction in undiagnosed conditions by 30%

The team is multi-disciplinary with technical people on social, behavioural and medical sciences.  We have a range of consultants and partnerships in technology and health financing. We also have a panel of national and international advisors in the above areas and also in the areas of monitoring and evaluation, marketing, communication, clinical and medical services, community institutions, etc. The implementation teams are focused around communities - urban, rural, schools, etc, and organised around geographies (which dictate language requirements). In total we have about 90 full time staff working on this initiative and a range of advisors, consultants and partners.

The programme uses a blended financing model, with five revenue streams: interest spread on inter-lending among members, sale of health products (like sanitary napkins, water filters), fees for citizenry services, sale of insurance, and non member user fees. These, along with a start-up grant capital ramp of three to five years, enables the program to break even and be self-sufficient.

Member family saves Rs. 50 (0.8-1 USD) per week in a Swasth Group. These savings accumulate over time, and can be used by members to borrow loans. The interest revenue that is received by the Swasth Group (local community group) is divided into two parts: 8% of the interest is set aside as interest that will be paid to the members on their savings. The rest of the interest income goes to a central pool of multiple Swasth Groups, and is used to pay for expenses.  By saving Rs 50, the members are not paying a user fee - rather they are saving for themselves, as this capital is returnable on demand at any time. Interest spread on inter-lending (along with other revenue streams) is used for the program costs, which are also governed by the SHG leaders.

Solve can help us raise the profile and attract talented human resources, researchers and others who can contribute. We believe our work can benefit millions of poor in different settings. Raised profile of the model can attract implementers looking for solutions and investors looking for opportunities. We will also be able to attract entrepreneurs, range of technology and other innovative health solutions, which can reach the poorest. Solve through its network can add value through mentoring, research and capacity building of the solution and help us go to scale while retaining quality and continuous improvements to the model.

We need mentoring support at the model development level and also for rapid scale up (more systematically and in different environments). We also need insurance and financing expertise to fine tune the economic model to make it break even faster and in a more assured way. Quality assurance and risk management is another area. Additionally, communication and marketing - to the local communities, to broader stakeholders, is also an area where we need expertise, and finally, we need advisors who can guide us on converting the Programme outcomes to a more investable outcome bonds.