SATHI Initiative Brings Life Changing Surgeries to India’s Urban Poor

By  
Sushiila Ttiwari  

 SATHI : Revolutionizing Surgical Care in Urban Slums

A Community-Driven Healthcare Model for the Underserved

Access to safe and affordable surgical care remains a pressing global challenge, with nearly five billion people lacking essential medical interventions. Addressing this gap, the Surgical Accredited & Trained Healthcare Initiative (SATHI) has emerged as a groundbreaking program to bridge healthcare inequities in Indian urban slums. Launched in 2018, SATHI is an innovative collaboration that empowers local communities, leveraging grassroots efforts and international expertise to transform healthcare accessibility.

The Genesis of SATHI

The initiative was pioneered by Professor Rahul M. Jindal, an Indian-American transplant surgeon, alongside Professor Dileep Mavalankar, Director of the Indian Institute of Public Health Gandhinagar (IIPH). Their vision was further strengthened by the contributions of Professor Kranti Vora, an expert in population health, and Mr. Rajendra Joshi, founder of SAATH, an NGO specializing in slum development. With support from the Fulbright-Nehru program and personal funding from Dr. Jindal, SATHI was born.

The foundation of the project was built on rigorous research. A study led by Dr. Vora in Ahmedabad slums revealed that 39% of surgical needs remained unmet, despite the presence of existing healthcare schemes. Key obstacles identified included financial barriers, lack of trust in medical systems, and low awareness. These findings laid the groundwork for a community-centered model that integrates trained Community Health Workers (CHWs) to bridge the gap between marginalized populations and surgical care.

The SATHI Model: Empowering Communities

At the heart of the SATHI project is its Community Health Workers (CHWs)—local women with basic education who receive specialized training to:

– Identify surgical needs in their communities.
– Provide first aid and post-operative care to patients.
– Guide patients through complex healthcare systems and ensure access to available health benefits.
– Address cultural and emotional barriers to surgical interventions.
– Monitor vital health indicators, including blood pressure and blood sugar levels.
– Counsel patients to build trust and alleviate fears about surgical procedures.

The program’s name, SATHI, derives from the Sanskrit word “साथी” (Sathi), meaning companion or friend—emphasizing the trusted role these workers play within their communities.

Global Collaboration for a Sustainable Model

SATHI’s curriculum was developed through international collaboration, involving experts from institutions such as Oxford University, Johns Hopkins University, and global healthcare professionals from Pakistan and Cameroon. This interdisciplinary approach ensures that CHWs are equipped with cultural competence, medical knowledge, and communication skills tailored to the specific challenges of urban slums.

The training modules address social determinants of health, including caste, gender norms, and religious sensitivities, ensuring that CHWs can effectively engage with their communities.

Impact: Transforming Lives Through Surgery

The pilot phase of SATHI, launched in Ahmedabad, made a significant impact:

– Reached 12,730 individuals across 3,000 households.
– Identified 167 patients with unmet surgical needs.
– Facilitated 99 life-changing surgeries, achieving a 59% success rate.

Some of the remarkable patient recoveries include:

– A 7-year-old girl who underwent a tumor removal, giving her a second chance at life.
– A 65-year-old woman who regained vision after cataract surgery.
– Early cancer detection that led to timely intervention for a 45-year-old woman.
– A teenager relieved of chronic pain through dental surgery.

Building on this success, SATHI expanded to serve 70,000 households, benefiting nearly 350,000 individuals. The initiative’s impressive 60% conversion rate of unmet surgical needs highlights its effectiveness in addressing critical healthcare gaps.

Breaking Barriers: Restoring Trust in Healthcare

One of the greatest challenges in slum healthcare is the trust deficit between residents and formal medical institutions. Many individuals hesitate to seek care due to:

– Past negative experiences in hospitals.
– Fear of discrimination and exploitation.
– Misinformation and myths surrounding surgeries.

CHWs play a pivotal role in rebuilding confidence in the healthcare system by offering consistent engagement, culturally sensitive counseling, and long-term support. Their efforts not only improve health outcomes but also restore dignity to those who have long been neglected by formal healthcare structures.

Challenges and Sustainability Efforts

While SATHI has demonstrated immense success, sustaining and scaling the program requires strategic support, including:

Increased Funding – Multi-stakeholder partnerships and corporate social responsibility (CSR) initiatives are crucial for financial sustainability.

Government Integration – Incorporating SATHI within national health programs, similar to the ASHA scheme, could ensure long-term impact.
Enhanced Data Collection – Tracking surgical outcomes, socioeconomic benefits, and patient feedback will help measure effectiveness and refine the model.

Public-Private Partnerships – Strengthening collaborations between governments, private hospitals, NGOs, and community organizations will enhance sustainability and resource-sharing.

A Scalable Model for Global Impact

SATHI’s success in India provides a replicable model for other low- and middle-income countries (LMICs). With urban slum populations expected to increase by 90% by 2030, according to United Nations projections, interventions like SATHI are critical for ensuring equitable healthcare access.

The initiative’s principles of community empowerment, cultural sensitivity, and global collaboration can be adapted to urban slums in cities like Dhaka, Nairobi, and Manila, creating a sustainable blueprint for addressing surgical inequities worldwide.

A Call to Action: Investing in Community-Driven Healthcare

To scale the impact of SATHI, governments, healthcare providers, and policymakers must prioritize:

– Increased financial investment to expand coverage and ensure sustainability.
– Community engagement strategies to strengthen trust and healthcare literacy.
– Policy advocacy to formally integrate CHWs into national health systems.

As Professor Mavalankar rightly emphasizes

“It’s time to move beyond primary care to specialized surgical care, ensuring comprehensive healthcare access for all.”

By addressing systemic healthcare barriers and leveraging local expertise, SATHI is not just providing medical treatment—it is restoring hope, dignity, and trust in the world’s most vulnerable communities