Our Work

SATHI is one of the pioneering organizations in India, to adopt a rights-based approach to building the discourse around Right to Healthcare. From its inception, SATHI has focused on developing community-based accountability processes that lead to increased ownership of Public Health facilities by communities, and increased responsiveness of service providers.

Over the past two decades, SATHI has successfully collaborated with more than 50 civil society organisations in Maharashtra on health rights issues. Using a right based approach, it has facilitated action and policy advocacy at local, district, state and national level. SATHI has been working as the ‘State Nodal NGO’ for implementation of community-based monitoring and planning of health services, as part of national health mission, since 2008. Community- based Monitoring and Planning (CBMP) of health services in Maharashtra, India, represents an innovative participatory approach to improving accountability in health care delivery. The learnings from this can inform “communitisation” of health services in diverse contexts, as an alternative to privatization, and as a means to enhancing the “publicness” of health services. CBMP has deepened democracy, leading to increased accountability, and has created several forums and spaces for dialogue among stakeholders, and systematic data collection on health indicators. Drawing on these learnings, community-led processes like decentralised health planning and Social Audit of Public Services (Multi-sectoral)’ have emerged as innovative processes.

SATHI undertakes public health program related work in collaboration with national and international organisations such as World Health Organisation, Azim Premji Philanthropic Initiatives, American University-Accountability Research Centre, and International Budget Partnership. It has developed a wide range of resource material including training modules, booklets, leaflets, analytical documents, policy advocacy reports and flyers, for developing capacities of community for monitoring and strengthening public healthcare services.

Malnutrition is a multi-faceted issue with economic, social as well as political factors influencing it. Thus, placing the burden of finding a solution to this issue on the Integrated Child Development Scheme alone is quite unfair.  The solutions to this issue should be sought through the active cooperation of departments such as Public Distribution System, Employment Guarantee, and Rural Development apart from ICDS and Health. Along with the involvement of these departments, an active involvement of ‘Community’ at the grassroots level is essential, without which the issue of under nutrition would not be resolved.

SATHI seeks to address health and nutrition issues through active community participation and partnerships with civil society organizations. The organization facilitates dialogue and action at the local, district and state level, followed by dialogue at the national level. With a system’s strengthening and convergence approach, SATHI aims at promoting the view that instead of replacing public systems or substituting them, it is essential to improve the functionality and effectiveness of public systems using community-based interventions as well as primarily supporting household-level nutrition practices.

With this, SATHI in collaboration with 25 plus civil society organizations across the state, has implemented key processes as part of Nutrition Rights Coalition (NRC) Maharashtra –

1. 1. 1. Community-based monitoring and action (CBMA) related to ICDS services supported by Narotam Sekhsaria Foundation with the official mandate through Women and Child Development Department of Government of Maharashtra- This was implemented from mid-2013 to mid-2016, in selected nine districts across the state, covering 189 Anganwadis, with collaboration and mandate from the State WCD Department, and support from Narotam Sekhsaria Foundation.

    

2. Community Action for Nutrition (CAN) supported by the Tribal Development Department of Government of Maharashtra with an official mandate- CAN process is being implemented in 420 villages/habitations across 10 tribal blocks of seven districts of Maharashtra (Nandurbar, Gadchiroli, Palghar, Nashik, Raigad, Thane, and Pune)

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4. Building Community Action for Nutrition (B-CAN) supported by Bajaj CSR, Pune- This is being implemented in 120 villages/habitations across one tribal and two rural blocks of two districts (Amravati & Pune) of Maharashtra.

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Since its inception, along with systematic involvement in action at local, state and national level, SATHI’s strength lies in conducting action linked, Health Policy and Systems research initiatives, as relevant to the emerging issues from community action and advocacy activities. Going beyond academic research, we consciously ensure the use of research findings for action and advocacy initiatives for people’s rights to health care. The component of utilizing the research findings for advocacy purposes is envisaged right at the planning stage.

Research in SATHI is linked with field-level issues pertaining to functioning of the health system, that seeks to understand the health system’s performance, implementation of programs as well as assess health policies. It aims to provide inputs to refine community action, strengthen policy advocacy and ultimately contribute to improving the design and implementation of health programs and policies.  The SATHI research team keenly employs relevant and novel research methods in its work. For example, as part of research with King’s College, the team employed the technique of witness seminars which has been little used in LMICs until now.

SATHI conducts research across its three key work areas i.e. strengthening the public health system, community action for improving child nutrition and social accountability of the private healthcare sector.

Some of the recent studies conducted by SATHI include the following-

• Documenting the experiences of patients regarding healthcare services from public and private healthcare system during the COVID 19 pandemic.
• Practices, Regulation and Accountability in the Evolving Private Healthcare Sector: Lessons from Maharashtra State, India’
• Understanding challenges faced by nurses during the COVID 19 pandemic In Maharashtra
• Assessing and Explaining the Impact of Community Based Monitoring and Planning (CBMP) across Multiple Contexts in the State of Maharashtra

Our research-based knowledge products range from popular media articles, short booklets in vernacular language, research briefs, policy briefs, reports, to journal articles and papers for reaching out to a diverse audience.  SATHI has a number of research publications to its credit.

So far SATHI has partnered with following academic institutes and has conducted collaborative studies with them-

• King’s College London (https://unsettlinghealthcare.org/projects/corporatisation-and-regulation/),
• Accountability Research Center (ARC), American University (https://accountabilityresearch.org/)
• Tata Institute of Social Science, Mumbai (https://tiss.edu/ )

Although there is a dedicated research team, this team works in tandem with the Action Team, and the workflows seamlessly across the teams.

Some of our recently published, notable publications are- (links to be given for OXFAM, BMJ paper, Nurses study paper, witness seminar reports)

India has one of the largest private medical sectors in the world – yet this gigantic entity has remained largely unaccountable and unregulated until now. Serious problems in this sector include frequent financial exploitation of patients, often accompanied by sub-standard and irrational care in private hospitals and nursing homes. Costs of private medical services have spiralled. It is estimated that Health care expenditures account for more than half of all Indian households falling into poverty, with nearly 4 crore Indian people being pushed into poverty every year due to such costs. While ordinary patients are suffering tremendously due to this situation, it should be kept in mind that due to growing corporatization and commercialization of the entire health care sector, it is also becoming extremely difficult for the dwindling numbers of rationally practicing doctors and genuinely non-profit health facilities to practice ethically.

Located within the broader context of need for strengthening public health services and rolling back privatization, comprehensive social accountability of the private medical sector is an outstanding need today.

As a pioneering civil society organisation working since last two decades in the health sector in India, SATHI has been in the forefront of activities around ensuring social accountability of private healthcare, and it hosts the Global Thematic hub on Accountability of Private Healthcare Sector associated with COPASAH. SATHI’s work on this front in recent few years has been rapidly expanding within India in collaboration with various networks like Jan Swasthya Abhiyan (People’s Health Movement – India).

SATHI has initiated a National patients’ rights campaign in India, which is now finding enthusiastic and widespread responses from CSOs and citizens who are deeply affected and concerned about the wide range of issues related to commercialized and unregulated private healthcare providers.

Along with this, SATHI also works as the national secretariat of ‘Alliance of Doctors for Ethical Healthcare’ (ADEH-www.ethicaldoctors.org), which is a national network of medical professionals who support reforms in the health system to ensure de-commercialization of healthcare and more democratized regulation of the medical profession, while moving towards UHC. Complementary to this, SATHI has also been instrumental in developing ‘Patient- Doctor Forums’ in Mumbai and Pune.

We are also into generation of knowledge pertaining to practices of private healthcare sector and have also spearheaded innovative research related to it.