The major barriers to accessing health care include the emphasis on providing health care in medical settings, the lack of specialists and the high costs of medical care. Thus, in order to improve access to health care for children with developmental disabilities, adolescents and young people, or people with any form of mental disorder, our strategy has been to use relatively low-cost human resources or existing human resources, by empowering them with knowledge and providing them support from more specialised personnel. Examples of this work include:
• Training lay people to deliver psychosocial treatments for depression in adults attending primary health care centres (the Manas model) or for schizophrenia in community settings (the COPSI model)
• Training lay people or teachers to deliver a package of interventions for promoting the health of adolescents in schools (the SHAPE model)
• Integrating learning resource rooms and remedial education in mainstream schools with the aim of promoting inclusive education for children with learning disabilities (the LEL & Prayas model)
• Training community maternal and child workers (anganwadi workers) to promote early child development among pre-schoolers
• Training community out reach workers to promote the mental health of PLHIV and their caregivers (the ASHA model)
Our work has been driven by a few guiding principles:
• Multi-disciplinary interventions: We strongly believe that improving the health of our community requires a mix of social, psychological and medical interventions. The collaboration of diverse academic and health disciplines is likely to generate the most effective interventions.
• Linking services with research: All health programs must be based on the best evidence available and all work that we do must be thoroughly evaluated and disseminated.
• Participatory methods: We strive, as much as possible, to engage with beneficiaries and to involve them actively in our work.
• Inter-sectoral collaboration: Sangath believes that existing community resources, especially those in the public sector, provide the most sustainable setting for delivering interventions.
Our dream is to be able to develop a model of care that is scaled up through the existing health system. Our plans for the years ahead focus on generating evidence and partnerships which will allow us to achieve this goal.