Improving health outcomes for under-served communities in rural Rajasthan


According to the India National Family Health Survey, 56 per cent of the district’s women of reproductive age are anaemic

This partnership aims to increase community awareness of health information and the availability of health options and reduce the financial barriers to accessing quality and affordable primary health care in Bhilwara district in Rajasthan state. Underscoring the partnership will be an intense community outreach programme including public awareness campaigns, grass root mobilisation, and screening drives for anaemia, malnutrition, non-communicable diseases, and vector borne diseases.

According to the India National Family Health Survey, 56 per cent of the district’s women of reproductive age are anaemic, 42.6 per cent of children under the age of five are underweight and 12.9 per cent suffer from acute malnutrition. While the district has both public and private health care facilities, there is a shortage of clinics with qualified doctors.

To provide quality primary healthcare, six clinics will be established in target communities comprising of five e-doctor clinics, and one “Super-Spoke” clinic offering a wider range of diagnostic services. Qualified female nurses, who will assist patients with a real-time consultation with a qualified doctor over an audio-video link, will operate the clinic. The e-doctor clinics will also have a mobile medical unit providing referrals from e-doctor clinics to the “Super Spoke” clinic. The clinics will provide services to all members of the community, with a specific focus on anaemia and malnutrition in women and their families. This partnership will deliver improved primary health care options to a catchment area of more than 225,000 people.

This partnership will leverage Karma Healthcare’s existing technology platform with the Smile Foundation’s experience in community engagement. Through its community education campaigns, the Smile Foundation will bring about a shift in health care seeking behavior and raise awareness of the services available at the new clinics. Karma Healthcare currently operates 22 e-doctor clinics as well as diagnostic services and referral services to over three million people in Rajasthan and Haryana states. In addition to providing critical co-investment, improving health and gender equality outcomes is a goal that aligns with Australian priorities under the Australia–India health Memorandum of Understanding. It also aligns with Australia’s India Economic Strategy, which identifies health as a priority sector.

Partnership aims:

  • Address an unmet need in preventive and curative health care in rural Rajasthan by utilising outreach services and nurse assisted e-doctor clinics that are remotely supported by qualified physicians.
  • Improve health outcomes by enhancing the number of people seeking access to formal primary health care.
  • Contribute to scaling a business model that provides preventive and curative services in remote areas that can be ultimately self-sustaining.

Mr Santanu Mishra, Co-founder and Executive Trustee, Smile Foundation shared, “We are happy to partner with DFAT on such a first-of-its-kind partnership in India, which is based on the principle of creating scalable shared value around development, partnership and social impact, to advance economic and social conditions among underserved communities. A critical part of it would be an intense community outreach programme through awareness campaigns, grassroots-level activities and screening drives for anaemia, malnutrition, non-communicable and vector borne diseases. This partnership leverages Smile Foundation’s experience in community mobilisation and engagement. We believe it will bring about a shift in healthcare seeking behavior and raise awareness of the services available at the new clinics.”
Shared value is defined as policies and practices that enhance the competitiveness of companies while improving social and environmental conditions in the regions where they operate. To qualify as shared value, there must be an identifiable economic benefit to the company as well as measurable impact on a social or environmental issue. The BPP is helping businesses partner with the Australian aid program in achieving shared value – advancing both social and economic objectives. These partnerships are primarily being created in one or more of the following ways:

Reconceiving products and markets
Redefining productivity in the value chain
Enabling local cluster development

By improving both their knowledge of and access to quality primary healthcare, communities in Bhilwara district will be better able to make informed decisions about their health and, with them, improved health outcomes. In demonstrating the commercial viability of Karma Healthcare’s e-Doctor “Super-Spoke” model in Bhilwara district, this could be adopted elsewhere. Further, the intense community outreach accompanying this partnership aims to increase the number of people attending the clinics, therefore increasing the commercial viability of the clinics.

Gender equality and women’s empowerment:

This initiative plays an important role in providing information and education about primary health care for women living in rural areas of Rajasthan, for whom lack of good information and access to quality service providers has long had a profound effect on health outcomes.

The intensive community mobilisation and social behavior change campaigns embedded in this partnership combined with the availability of nurse assisted e-doctor clinics will jointly address both the awareness gap and the service delivery gap, expanding access to formal care, enabling early detection of disease, enhancing quality of care, and improving nutrition status in women and their families. By making health education and health care more accessible to women, they are better able to make informed choices about the care of their families. The initiative also provides employment opportunities to female nurses and community health workers, all hired from the local community. The presence of female nurses and the availability of female e-doctors and specialists is also an important factor in creating an atmosphere where women feel free to talk about their health concerns.

While women and children are identified as the primary beneficiaries of this initiative, the e-doctor services and health outreach are available to all members of the community.