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Everyday wellbeing for the poor in India is likely to remain a pipe dream if we do not partner with communities to address critical challenges to their health and well-being. The marginalized bear the brunt of unsustainable environmental practices - contaminated water and soil, breathing unsafe air and struggling with structural issues in sanitation and hygiene. They are at the frontlines of natural catastrophes, pandemics like the ongoing COVID-19 that pushes them further into inter-generational poverty and marginalization. The health system is inadequate, poorly designed, lacks customer focus and largely concentrates on diagnosis and treatment. The cycle of ill health and poverty is kept intact by system inefficiencies, episodic treatment seeking behavior of the poor, and minimal focus on prevention and non-medical determinants of health. The poor lose up to 1-2 months of productive time in a year to an illness of self and family stemming from environmental and social determinants. 50-80% live with undiagnosed illnesses and die earlier and 50-60 million people in India have been pushed to poverty, in the last decade, because of health related expenditure. Primary care gives significant returns and is simple to implement. However, it has seen few successful models, which deliver quality, scale, sustainability and particularly, address the poorest, with emphasis on prevention and promotion of health. Primary health is not easily monetizable, unlike treatment.
i4We is a self-funded, primary healthcare model, which combines health and wealth interventions, and focuses on wellness for the poor in an affordable, quality assured and scalable way. The program ensures primary care of members (locally) and navigates them through a range of existing secondary and tertiary providers (where required) and uses a blended financing model, which starts with grant capital and breaks even in 5-7 years. It is currently delivered in four different settings - Urban, Rural, Factories and Sex Workers’ collectives. The model combines medical, behavioral and social science with an appropriate mix of technology and health financing. i4We has five revenue streams - interest spread on inter-lending among members, sale of health products, fees for citizenry services, sale of insurance and direct sponsorship of ultra-poor families health. These along with a start-up grant capital ramp of 3-5 years enables the program to break even and be self- sufficient.