Strengthening Stakeholder Relationships to Ensure Primary Care in Rajasthan's Tribal Communities

The Social Innovation

Magnitude of the Problem, and its Root Causes

Tribal communities in Rajasthan and similar regions face severe barriers to healthcare given the remoteness and systemic neglect which result in diseases like: high rates of malnutrition, Tubercolosis, silicosis, and chronic respiratory diseases.

During BHS’s participation in the Accelerating Healthcare Access Globalizer co-created by Ashoka and Philips Foundation in 2020, they highlighted the following key factors contributing to the magnitude of the problem:    

• Fragmented Stakeholder Relationships: NGOs, government, and local health teams often work in silos, limiting resource leverage and systemic influence.
• Hierarchical Work Culture: Public health systems are marked by rigid hierarchies, stifling innovation, team spirit, and action in silos.
• Resource and Knowledge Gaps: Lack of updated technology, insufficient research, and limited evidence-based advocacy hinder effective solutions.

Based on their systems change analysis, the BHS team made it a mission to work on improving the different types of relationships—between NGOs, government, academic and research institutions and Primary Healthcare Centre teams. 

Strategy to Catalyze a Network of Changemakers towards the Targeted Mission

The strategy involves nurturing a supportive environment that enables high-quality primary care for marginalized populations.

“We have found that there are value aligned organizations in every sector – non-profit, for profit and government.  

There are many people in the civil society space who say, ‘No, we won't work with investors.’  Similarly, there are organizations and people who say, ‘We won’t work with government,’ or sometimes, ‘We will work with government irrespective of whether that is important or not.’  

These partnerships can make a real difference. I think it’s important to be open and ask: What works for the communities? Where does influence and power lie, and how can we influence it, rather than being too ideology-driven.  

Accepting and respecting people for what they can bring to the table, and investing in them, is critical to forging and sustaining long-term partnerships needed to address the big problems.”

Some of the tactics they deployed towards the mission as a part of the strategy include:      

1) Co-creating Partnerships to Strengthen Public Systems by Influencing and Consulting on Policy 

BHS has proactively built partnerships across the health ecosystem to strengthen and make public health systems more responsive. They orchestrated a relationship with the district health system, Indian Institute of Management, Udaipur (IIM Udaipur), and UNICEF India supported primary care in one block of South Rajasthan, reaching 100,000 people.

Building on this success, BHS helped shape a national primary healthcare initiative with the Indian Council of Medical Research (ICMR), now operating across ten districts and reaching 10 million people. In partnership with IIMU, BHS is implementing the program locally, improving performance across 100 government-run Health & Wellness Centers.

These efforts have positioned BHS as a trusted advisor to government bodies on TB control and primary healthcare. The organization is regularly invited to contribute to state health budgets, advocate for digital TB diagnostics, and participate in policy dialogues at district and state levels. Drawing on field insights and research, BHS provides practical recommendations that have informed tangible policy shifts—from budget allocations for new diagnostic technologies to adoption of best practices in primary care.

“The value lies in connecting ground insights with the larger policy ecosystem—so people understand where evidence comes from and where change can happen.”

2) Collaborating with Partners Across Sectors to Gather and Produce Data & Evidence

“One thing that stayed with me from the Globalizer was the distinction between direct and indirect impact. I often share this with others on the team. We realized that much of our work would need to focus on indirect impact—working with other non-profit organizations, civil society, and government, as well as through research and knowledge generation. This led us to envision the Center for Primary Healthcare, with partnerships and research as its core components. The discussions and learning in the Globalizer program really helped us start thinking more deeply about these issues.”

Recognizing the importance of evidence-based practice, BHS has started a Centre for Primary Care, and built partnerships with academic institutions, donors, and technology companies to systematically gather and produce evidence on primary healthcare interventions.

By integrating research into its service delivery and advocacy, BHS not only improves its own programs but also generates knowledge products that inform policy and practice at a broader scale.

Some such evidence generation project include BHS partnerships with:

Society for Applied Studies and Bigtec Labs for studies on improving newborn health, assess effectiveness of daycare centers for malnourished children and the impact of portable diagnostic technologies for tuberculosis.

UNICEF India to synthesize evidence on four different aspects of primary healthcare and came out with a series of policy briefs.  

As of 2025, they have published more than ten research and policy papers with partners as varied as UNICEF India, Work Fair and Free Foundation, Indian Institute of Management and Indian School of Business.  

3) Collaborating with IIM Udaipur to Involve More Youth in the Space and Build Capacity

BHS’s partnership with the Indian Institute of Management (IIM) Udaipur has been instrumental in shaping the next generation of leaders in primary healthcare. Together, they established the Centre for Primary Healthcare at IIM Udaipur, with a focus on research, knowledge management, and capacity building. 

This collaboration has helped shape the the Center’s curriculum and research agenda, ensuring a strong emphasis on public health systems and primary care—areas often overlooked in traditional business school programs.

The stakeholders involved include IIM Udaipur faculty and research staff, BHS’s leadership and field teams, and external experts from the health sector. By engaging youth and emerging professionals through internships, research projects, and joint initiatives, the Centre has created pathways for young people to enter and contribute to the primary healthcare space. At the moment, more than 30 young public health professionals are engaged in one or other collaborative primary healthcare projects.  

4) Co-creating a Coalition with Partners to Inform & Involve Communities to address TB & Silicosis

To tackle the high burden of tuberculosis (TB) and silicosis in tribal regions, BHS has co-created a coalition of four strong community-based organizations- Aravali Majdoor Union, Kotda Adivasi Sansthan, Pathar Gadhai Majdoor Sansthan and Godvad Adivasi Sansthan

These partners, each with deep roots in their respective communities, work together to improve case detection, treatment adherence, and community awareness around TB and chronic respiratory diseases. BHS provides technical support, training, and coordination, while partner organizations leverage their local networks to reach affected populations.

The coalition engages stakeholders such as local NGOs, community health workers, patients and their families, and district health officials. By pooling resources and expertise, the coalition has been able to explore challenges that no single organization can tackle alone, such as the logistical barriers to diagnosis and the stigma associated with TB and silicosis.

5) Co-creating a Diagnostics System with Partners from Tech & Social Investment

BHS has partnered with Social Alpha and Molbio diagnostics to pilot and scale innovative diagnostic solutions for primary healthcare settings.  

It involves the use of portable X-ray and sputum testing machines for early detection of TB, which are rotated across clinics to maximize reach- approximately 20-40 per day.  

BHS also conducted a landscape study of diagnostic technologies, informing both its own practice and the broader innovation ecosystem.

By working closely with innovators and investors, BHS ensures that new technologies are adapted to the realities of rural healthcare—affordable, robust, and user-friendly.  

6) Collaborating with Other Organisations to Help Them Replicate the Amrit Clinic Model

BHS has actively partnered with other non-profit organizations to replicate and adapt the Amrit Clinic model in new geographies.  

By opening up its model and expertise, BHS is fostering a spirit of mutual learning and adaptation, ensuring that each partner could tailor the approach to local needs while maintaining core standards of care.  These collaborations involved not just operational support but also joint strategic planning and knowledge sharing, enabling partner organizations to strengthen primary healthcare delivery in their respective regions.

They have worked with three such partner organizations, which are now delivering primary healthcare to about 100,000 people/year.