Swasth: Building a Consortium for COVID-19 Technology Solutions

Introduction

The COVID-19 pandemic brought about a need for collaboration between governments, nonprofit organizations, and private-sector organizations to drive equitable access to tests, treatments, and vaccines.^1,2 With only eight physicians per 10,000 people in India³, equitable access to health care was a challenge even before COVID-19. The pandemic only widened the gap as physical distancing further reduced access to in-person physician consultations.⁴ There emerged a need to bridge this gap by increasing the availability of digital health care solutions.

Technology and business leaders in India recognized this need and came together to offer solutions. Over 150 public and competing private-sector health care providers⁵—including hospitals, health technology services, pharmacies, and investment firms—formed a nonprofit consortium called Swasth during the first wave of the pandemic (April – November 2020).⁶ The objective of the consortium was to bring about equitable access to affordable and high-quality health care through digital solutions. While its initial offerings focused on telemedicine, online pharmacy access, home isolation management, and mental health support, the organization started working toward need-based initiatives such as providing oxygen concentrators, setting up an interactive voice response system for ASHA workers, technology-based monitoring by September 2020.

During the first two months of the pandemic, Swasth’s telemedicine platform enabled use of its services across 500 cities and towns in India.⁷ During the second wave of the pandemic (March – July 2021), the organization deployed over 51,000 oxygenation devices, ranging from oxygen concentrators to cylinders and bilevel positive airway pressure machines, across the country. Swasth’s work has served as a model for greater collaboration among volunteer groups, in line with the World Health Organization’s Health for All policy for reducing social and economic inequities in health care access.⁸

What are the lessons learned from this bright spot?

Given the nonprofit, volunteer-based nature of the consortium, scaling operations across states was challenging, especially as the number of calls for help increased across the country. Swasth also faced challenges in accurately estimating on-the-ground needs and deploying supplies, such as oxygen concentrators, to the last mile.⁹ Four factors helped Swasth overcome these challenges and enable equitable access to its services. These factors are highlighted below.

Collaborate with varied actors within the ecosystem

The consortium provided a wide variety of interventions due to its extensive public- and private-sector partnerships. These partners were engaged at various stages—from the formation of the consortium to the last-mile delivery of its services.¹⁰ Swasth worked with:

• Government stakeholders such as NITI Aayog, MyGov, and state government departments to establish the alliance and scale its solutions.
• The Embassy of India in Beijing to help locate suppliers for oxygen concentrators.
• The Indian Air Force and several private-sector logistics companies, such as Amazon, to deliver its services.
• Entrepreneurial organizations such as Tata 1mg, Practo, and Curefit that contributed their technical and financial resources.
• Nonprofits such as United Way Bengaluru and Social Alpha that helped manage the inflow of funds for Swasth.
• Volunteers with varied engineering backgrounds who provided support for building Swasth’s technology solutions;¹¹ for example, volunteers from organizations such as Amazon and Walmart Inc.’s Flipkart wrote the code for digital applications and engaged with regional governments for information exchanges.¹²
• Researchers from leading medical schools and hospitals who supported the consortium in building a toolkit for treating COVID-19.

Establish robust governance mechanisms to drive transparency

The consortium had the oversight of the governing council, which included members such as the leaders of Manipal Hospitals, Apollo Hospitals, and Practo, among others.¹³ The chairmanship of the alliance was for a fixed duration and on a rotational basis,⁵ which enabled unbiased governance. Additionally, the consortium had a nonbinding and open-membership model,⁵ which enabled Swasth to work with many stakeholders, in alignment with its key principle of collaboration.¹⁰ Swasth managed its many partners due to the governance mechanisms set up by the consortium’s partner ACT Grants.⁷

“The key principles guiding our COVID-19 response are equity, transparency, and impact. We are open to working with anyone, as long as the goal is the same.” —Dr. Ajay Nair, Chief Executive Officer, Swasth

Reduce development costs, engage volunteers, and offer free services

Swasth catalyzed funds from multiple channels including donor-based funding and national and international citizen contributions.¹⁰ The inflow and deployment of such funds were managed by Swasth’s nonprofit partners.⁵ Additionally, most of Swasth’s initiatives, such as distribution of oxygen concentrators, were largely volunteer driven,¹⁰ which considerably reduced its overhead costs. The donors funded initiatives that required immediate, on-the-ground response by grassroots nongovernmental organizations. Such mechanisms helped Swasth subsidize several technologies or offer them free of cost for use across many states. For example, Swasth offered its telemedicine services free of cost to the National Health Authority for its Unified Health Interface initiative, which aimed to build an open-source gateway for telemedicine.

Use resources effectively

The consortium effectively and promptly reallocated its resources to respond to the changing COVID-19 needs. For example, Swasth used an algorithm to manage distribution of oxygen concentrators based on the severity of the crisis, number of deaths, and other factors. This helped reduce human error and biases throughout the process. The consortium also redeployed oxygen concentrators that had been used in urban areas to rural areas that had weaker health care infrastructure.

“Swasth was 100 percent transparent about where the demand was, and we built all this into the website. The method of distribution was ratified with MyGov, which is the government’s citizen engagement platform, and other external experts.” —Dr. Ajay Nair, Chief Executive Officer, Swasth

Strengthen last-mile connectivity

The consortium leveraged support at the last mile to understand on-the-ground needs and implement suitable initiatives. For its initiative on oxygen concentrators, Swasth appointed state-level oxygen nodal officers, who circulated application forms for oxygen concentrators in public health centers. This helped the consortium understand the need for oxygen on the ground and respond accordingly. Swasth also worked with local nongovernmental organizations to design and implement information, education, and communication practices, such as creating a series of public information videos to enable the use of pulse oximeters in rural communities.

How was this promising practice implemented?

Focus on bridging gaps and meeting needs 

The consortium focused on ecosystem gaps and launched a telemedicine platform to enable access to health care services during the initial months of the COVID-19 lockdown. After September 2020, Swasth worked on need-based initiatives. These included providing oxygen concentrators in the second wave, setting up an interactive voice response system to support accredited social health activists with rural data collection, and other initiatives.

Collaborate with partners on shared principles of equity, transparency and impact

Swasth worked in close collaboration with various state governments¹⁰ to plan, implement, and scale its initiatives. It also worked with various private-sector organizations for product development and with nonprofits for last-mile delivery.

“The consortium has been successful because of the collaboration among stakeholders. We (Swasth) were willing to work with anybody—nonprofits, government, or private organizations. There was no limit to the partnerships we were willing to explore, as long as the goal was the same.” —Dr. Ajay Nair, Chief Executive Officer, Swasth

As of August 2021, the consortium continues to work on a wide range of awareness generation, technology-based monitoring and information exchange solutions, among others. The organization’s work extends beyond the pandemic in creating standards of information exchange between health insurance providers and consumers. Swasth is currently working toward scaling such initiatives in the long term.

Supplementary material

Swasth - Building a Consortium for COVID-19 Technology Solutions.pdf

Sources

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