India

How trust and collaboration are key in India’s last-mile response to the COVID-19 crisis

A healthcare worker gives a dose of COVISHIELD, a coronavirus disease (COVID-19) vaccine manufactured by Serum Institute of India, to a woman inside a classroom of a school, which has been converted into a temporary vaccination centre, in New Delhi, India, May 4, 2021. REUTERS/Adnan Abidi     TPX IMAGES OF THE DAY - RC2S8N9W7B1K

A healthcare worker delivers a vaccine against COVID-19 in a temporary vaccination centre in New Delhi, India. Image: REUTERS/Adnan Abidi

Diana Wells
President Emerita, Ashoka
Jeroo Billimoria
Founder, One Family Foundation
Carolien de Bruin
Head, COVID Response Alliance for Social Entrepreneurs, World Economic Forum
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  • Stories on the ground in India demonstrate how social entrepreneurs are stepping up to reach excluded and rural communities during India’s second wave.
  • Local trust in social entrepreneurs makes them uniquely placed to fill service gaps, especially in the last mile.
  • Their work is needed beyond the immediate crisis to build resilience and drive transformative change towards an inclusive economy.

In rural Maharashtra, India – seven hours from Mumbai – the queues for COVID-19 testing and hospital beds are getting longer every day. For social entrepreneurs like Chetna Sinha, founder-chairperson of Mann Deshi Bank and the Mann Deshi Foundation, the situation is beyond heartbreaking. “We don’t know when the vaccines will come ... We have a local saying that the sky has burst – we are trying to fix it with small pieces – it’s a bad situation.”

With around 2,000 people testing positive in that small district every day, Sinha says they are “very calmly” trying to focus on doing what they can as India is engulfed in its deadly second wave.

In normal times, Mann Deshi works to support and empower women in the district, helping them access finance, develop skills and identify markets for longer-term systems change. But during the pandemic – like so many other social purpose organisations – it has been working non-stop to provide COVID-19 relief, from supplying food packages and manufacturing masks to building a 300-bed COVID hospital in partnership with HSBC and the district government. They have also refurbished an unused rural hospital, turning it into a free COVID-dedicated facility. In the past six months, thousands have benefitted.

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It is a story that is playing out all over India – and indeed the rest of the world. At a time when governments and health systems have been overwhelmed, social entrepreneurs have stepped up in their thousands to fill the gaps. Most of these entrepreneurs are making a difference in the so-called last mile; the places where logistical and operational difficulties prevent services from reaching mostly poor or rural communities. Underserviced and overlooked at the best of times, these marginalised populations are exceedingly vulnerable during this second wave.

Social entrepreneurs are perhaps uniquely placed to play this role for several reasons, not least of which is that many of them were on the ground and in position long before the pandemic struck, making them trusted local resources. Founded in 1996, Mann Deshi, for example, is part of the fabric of the district, so much so that Sinha was asked to be one of the first to publicly receive the vaccine in order to encourage others to do the same.

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Social purpose organisations are also, by their nature, innovative and agile. They’ve often come into being to solve a specific challenge. Glocal Healthcare Systems, for instance, set out to address the fact that around 28% of the Indian population does not have access to a doctor, a problem that is particularly bad in rural and remote areas.

They did this by building a network of digitally-enabled clinics across the country that combine an examining room, test lab and a pharmacy and are staffed by a nurse using digital diagnostic tools with remote support from a doctor, if required. It's a simple and cost-effective solution that has helped deliver healthcare to thousands more citizens since 2010. “For the equivalent of about $4, you get a doctor, your tests, and your medications.” says Azim Sabahat, Glocal's Chief Executive Officer.

The system has been hugely effective but, Sabahat says, it has not yet scaled sufficiently to be able to deal with the speed and ferocity of India’s second wave. “We were bang on in terms of the solution, but too slow compared to the virus,” he says. Nevertheless, Glocal is doing what it can including rushing to set up two new hospitals - one in Delhi and one in Kolkata - in the next 30 to 45 days with 100 to 200 ICU/HDU beds in each.

Meanwhile, in all of its existing hospitals, teams are working to expand COVID beds and ICU facilities as well as trying to add oxygen plants, pipelines and oxygen concentrators. They have also launched a free telemedicine COVID consultation facility that can be accessed by phone, online and via apps, that they hope will help prevent panic and take some of the burden off the health system by ensuring correct screening, triage and treatment of patients.

The situation may be overwhelming says Sabahat, but that doesn’t mean that they are giving up hope or losing courage. “Most of our people are on the ground fighting a grim battle. We will still do whatever we can ... The battle is never lost until we give up.”

Such resilience in the face of crisis is a common character trait among social entrepreneurs. They are, in many respects, battle-trained and used to making do with little to achieve big things. This often means that they have become exceptionally well-networked and skilled at bringing people together when and where they are most needed.

For example, Creative Dignity, a collective started by India's leading artisan skill-based development organisations and master artisans in response to the first wave of the COVID-19 pandemic, is finding ways to protect - and even create - jobs in the informal sector.

In India, 93% of the economy is in the informal sector, where people have little to no income protection. This means that when the pandemic struck, most lost their livelihoods overnight. Creative Dignity responded by mobilising a 500-strong student network of volunteers to assist artisans to build e-commerce sites, allowing them to sell their wares online.

Neelam Chhiber, co-founder of the Industree Foundation and a founding member of Creative Dignity, explains that the group then used its collective voice to engage the private sector and government to build out a unique solution. This involved a leading global retailer waiving its no-work-from-home policy for suppliers, which was in place to guard against child labour, and committing to buying products from the collective during lockdowns.

This has secured the livelihoods of upward of 10,000 women over the past year. And now, in the grip of the second wave, Chhiber says they are making plans for the future, indentifying ways to scale this initiative and take advantage of what she believes will be a wave of sustainable consumption globally. Chhiber emphasises that the complexity of this solution means that it is not something a single player could have achieved in isolation.

“It is all about partnerships, not just among social entrepreneurs but among donors and governments.”

Indeed, the inspiring work of social entrepreneurs in India during the traumatic second wave is showing us that a radical new mindset and collaborative approach are needed to drive transformative change. And these smaller, local, innovative and, above all, more agile actors are demonstrating that they have a crucial role to play. What might the world look like if we chose to magnify the impact of these highly effective local players?

These social entrepreneurs need as much support as they can to sustain their operations and continue to provide critical services to vulnerable populations. And beyond the crisis, we need to find ways to better integrate them into economies and societies in order to build resilience and find more sustainable ways to live. As Chetna Sinha says, it is an imperative that goes beyond philanthropy, it is about our very survival: “It is about I am part of you – it is not doing something for them – it’s for all of us.”

This is part of a series of articles published by the World Economic Forum’s COVID Response Alliance for Social Entrepreneurs on the Indian response to the COVID-19 second wave. The Alliance is hosted by the Schwab Foundation for Social Entrepreneurship and includes 86 leaders in social entrepreneurship who collectively support an estimated 100,000 entrepreneurs, including Ashoka and Catalyst 2030.

Ashoka identifies and supports the world's leading social entrepreneurs and mobilizes a global community that embraces these new frameworks to build an "everyone a changemaker world." Ashoka Fellows are actively responding to COVID in India. Join Ashoka in supporting social entrepreneurs as first responders in India and beyond through Ashoka’s Changemakers United initiative here.

Catalyst 2030 is a global movement of social entrepreneurs and social innovators from all sectors who share the common goal of creating innovative, people-centric approaches to attain the Sustainable Development Goals by 2030. Its members in India are collaborating to respond to COVID through the National Association of Social Entrepreneurs here.

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