In 2005, I took a strategic decision. Much as I loved surgery, I shifted my focus to Tuberculosis, (TB). While I faced criticism and jeers from my colleagues and other NGOs, I quickly realized my next challenge. In order to deliver crucial, life changing services – TB or otherwise – one has to work with the government.Government processes are tedious and tiresome. We were often turned away, given numerous steps to supposedly receive the proper approvals, only to eventually be denied any MOU between us and a government doctor. While I did not expect this process to be easy, what did shock me were the reasons many doctors and beaurocrats gave me. There are many organizations, small and modest, who do what they can. That means that many had simply detected TB, but left the government doctors to treat, track, and care for the patients – a lengthy, time consuming process – all by themselves. In other words, in their attempt to better the lives of those living in poverty, they were over burdening the government services. Government doctors saw them as creating more work (and in the eyes of the doctors, more harm) than good. What has come out of this, is an unfortunate conflict between the government and these organizations, each looking at the other as a hindrance, not a partner in the fight to provide services to our fellow citizens.
Fortunately for Operation ASHA, my Co-Founder and CEO, Sandeep Ahuja had previously been a very senior government official. Therefore, he was able to meet with officials in the Health Department and explain our model to reach the last mile. He explained, in detail, how our model, with the government on board, would be able to provide free medicines, diagnostics and services of TB Specialists all the while bringing down the financial costs, and the burden on government doctors. With these officials on board, the government machinery moved into action, slowly and ponderously no doubt, but it moved and we had a strong collaboration with the government to deliver life changing TB treatment to poor patients across India.
In hindsight – and after meeting other social enterprises who are providing malnutrition services, water, sanitation, and other services that just miss those living in the ‘last mile’ – having someone like Sandeep on our team put us at an advantage that most other enterprises do not have. It was as if we had a governmental stamp of approval from the beginning that allowed us to move forward, not necessarily swiftly and easily, but forward nonetheless.
The unfortunate conflict between the government and the social enterprises has placed a barrier between the two. But at the core, both are working to provide the best possible services to people who are without. After our initial encounter with the government, things got slightly easier, but not completely. There are issues with constant funding, availability of medicines, provider centers, all of which involve the government and take time away from our patients. If social enterprises and the government begin to work together, to see each other as partners rather than advisories, then, and only then, can we ensure a future without TB, without malnutrition, or scarce drinkable water, and toilets. Then can we reach the last mile.
Dr. Shelly Batra is the Founder and President of Operation ASHA, a health services delivery organization that aims to expand access to disadvantaged communities worldwide. She writes about the inspiration behind developing Operation ASHA and helping those most in need get access to crucial health services. This blog is a three part series about the challenges her social enterprise has faced in attempt to deliver services to the world's poorest populations.