With nearly 1/3rd of India’s urban population estimated to live in slums, the key challenges for healthcare in India are access to quality services at affordable rates.


60 million Indians go from above poverty line to below poverty line due to ‘health shocks’ in the family since between 65-80% of health expenditure in India is out of pocket.


High quality primary and preventive health services can reduce the incidence of ‘health shocks’ by half.


Urban poor in India experience higher health inequity and disease burden in comparison to rural India.

Impoverishment due to Healthcare

“Health shocks” are the single biggest cause of impoverishment in India. Every year, ~60 million Indians go from above poverty to below poverty line due to a health event in the family. Forgoing income, covering costs with savings, borrowing, using loans or mortgages, and selling assets and livestock to pay for healthcare costs are some of the key reasons.

Based on research, between 65-80% of health expenditure in India is out of pocket, while the average is 15% in developed nations, 35-40% in middle income countries (China, Mexico).

Based on a pilot that we ran with the International Labour Organization in rural Maharashtra, we observed that high quality primary care can reduce the incidence of health shocks by half.

Our focus on the urban poor is due to 4 key factors:

  • Slums increasing with urbanization
  • Higher Disease Burden
  • Health Inequity
  • Poor Supply Landscape

Urban slums are characterized by overcrowding, poor hygiene & sanitation and the absence of civic services. As per UN-HABITAT, slum population in India is expected to double to 200 million by 2026.

The urban poor in India currently have 3 alternatives for primary-preventive healthcare services. However, none meet their specific needs of affordable, convenient and quality care:

Existing options don’t meet consumer needs
LOW Medium High
  Public/ Govt Sponsored Charitable Clinics Private Clinics Swasth’s Aim
  • Concentrated on rural areas
  • Secondary/ tertiary care
  • Affordable, (out-of-pocket expenditure of USD 0.5 per visit), but inadequate, due to low network density
  • Run by local charitable institutions
  • Moderately affordable (out-of-pocket USD 1.5 per visit)
  • Lack scale and service quality guarantees
  • 2-10% of the market share based on their availability
  • Largely unregulated private sector
  • Expensive (average expenditure USD 4.3 per health episode)
  • Out-of-pocket expenditure constitutes 15% of household income
  • Rampant malpractices
  • Accounts for over 80% of healthcare spending
  • 40-50% direct savings on OOP expenditure (USD 1.7 per health episode)
  • Quality control: SOP’s encoded into IT, competent staff incentivized on patient health and satisfaction
  • One-stop-shop for all health needs

Our priority - health of the urban poor
Slums increasing with urbanization

India’s slum population to double to 200 milion by 2020

Higher disease burden

Average incidence in urban is 3.1% vs 2.3% in rural

Health Inequity

Anemia incidence among urban poor women is 59% vs 48% in the non-poor

Under-developed public health infrastructure

Dependence on high-cost exploitative private providers

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