You are always looked at as “different.” I have had the good fortune to straddle both my husband’s corporate sector, and my world of the development sector. I have always been looked at as the “social worker” and many times not been taken seriously.
As part of my series about “individuals and organizations making an important social impact,” I had the pleasure of interviewing Mukti Bosco, Founder & Secretary General, Healing Fields Foundation.
Mukti Bosco is an Ashoka Fellow, known for her efforts in health and women’s empowerment, leading a preventive health education program reaching over six million families in India. Since starting Healing Fields in 2000, Mukti has been continuously striving to find innovative solutions to India’s health challenges.
Her deep understanding of the communities and their needs led to the development of a highly innovative micro health insurance program at a time when the majority of Indians were not insured. The uniqueness of the health insurance product and model was recognized nationally and internationally.
She has a master’s degree in Healthcare Management from the Administrative staff college of India and John Hopkins University. Mukti has shared her experiences working with some of India’s most marginalized communities as a presenter at the Clinton Global Initiative, the World Economic Forum, and the Mayo Clinic’s Transform Conference.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Born to a family of medical professionals, Mukti’s early memories are of accompanying her parents to eye camps organized in remote parts of India. This sparked her interest in community health.
After working with several health-focused organizations, such as Christian Medical College & Hospital, Vellore, Spastics Society of India, and Medico Pastoral Association in Bangalore, she returned to Hyderabad, where a poignant encounter highlighted India’s broken healthcare system and its impact on those in poverty.
While conducting a Health Needs Assessment survey in the Charminar area, Mukti came across 7-year-old Tahir’s family. When his father fell ill, his parents were forced to trade his labor for INR 5,000. He was made to work about 15 to 18 hours with only one meal a day, and his wages were garnished. With a five-year-old son at home, Mukti could not come to terms with the severe consequences that an illness could bring to a little boy. This spurred her to start the Healing Fields Foundation in 2000 to research, innovate, and implement solutions that protect people in poverty from health shocks.
Can you share the most interesting story that happened to you since you began leading your company or organization?
When we started working with one of Bihar’s trust groups, Rama Devi, a member of a microfinance institution, joined the Community Health Facilitator Training program. During a monsoon one year, we went to visit and have a discussion with the women on how they were doing and what more needs to be done. Rama Devi was a quiet lady but extremely determined in her work. As a result of our conversations with this community of women, we had the Government Engineer talk to them about building toilets and secured a government subsidy to cover the cost.
Rama spoke up and volunteered to lead the project of mobilizing her community to build toilets. There were none at the time, and during monsoon season, the whole village would get submerged — there is no way to get in or get out of the village during flooding. We were not convinced that she could do it, as she was part of our first batch of trainees and quite shy.
She came up to me and said, “Madam, I want to build toilets, and there is no way you can stop me. Therefore, show me how to do it, what paperwork needs to be done, and I will build my own toilet and ensure a minimum of ten toilets is built.” Hearing her conviction and the quiet determination in her voice, we agreed to support and help her. She ended up building 200 toilets in her village!
This taught me two valuable lessons
Never underestimate the power of a woman’s determination
Keep your ears to the ground to know the need of the community and listen to them.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Again, Rama Devi comes to mind. We went for a field visit during the monsoon, where all the fields are flooded. And in the group meeting, Rama was describing how her village is surrounded by water. In fact, she had to wade through water to meet to discuss the importance of having toilets in every house. At that point in time, the Chairman asked whether we could see for ourselves what needs to be done. Rama turned around and asked us, “Do you think the water will recede just because you want to visit?” We all burst into laughter.
However much we think we know our communities, if we don’t live there, then we don’t know the real problems. Therefore, it is essential to listen, listen, listen more, and be open to learning from the women we claim to educate. It is more of an education for us than for them.
Can you describe how you or your organization is making a significant social impact?
Working across 5,000 villages in 50 districts of Bihar, Uttar Pradesh, Telangana, and Jharkhand, Healing Fields is building community culture and practices of preventive health care by integrating three critical themes:
Behavior-change health education programs
Gender empowerment
Entrepreneurship for women
Healing Fields Foundation partners with global nonprofit Opportunity International, whose microfinance institution members are trained as Women Community Health Entrepreneurs (CHEs), which was launched by Healing Fields with the support of Opportunity International and other donors. They are trained in basic healthcare management and equipped with a basket of affordable health products. Aided by technology, they offer a spectrum of health solutions in resource-poor communities.
Focusing on building the menstrual health, nutrition, sanitation, prevention of illnesses, and hygiene practices of their communities, CHEs ensure awareness, access, and affordability of health services in some of India’s most invisible and last-mile villages. They drive the adoption of good health practices, open up access to affordable health care products (such as sanitary napkins), serve as first responders by administering first-aid and basic care, and build the community by connecting with mainstream health care systems.
The School Health Education program, launched in 2018 in Shamirpet, expanded to Telangana, followed by Aurangabad, Bihar, and Hyderabad. Telangana brought the benefits of health leadership and education to the school level. Since February this year, Healing Fields has initiated a COVID-19 response in 1,200 villages with their network of Community Health Facilitators.
Since the year 2000, 5,000 health leaders have brought health awareness, affordable products, and critical health services to over six million people at the cost of less than $5 per family. By using health as an entry-point, Healing Field Foundation’s model is also impacting issues of livelihoods and gender.
Improving Health Outcomes
Communities served by CHEs have reported a 90% improvement in their hygiene and nutrition practices.
89% of families in these areas are immunizing their children.
Institutional deliveries have been 20% higher in Community Health Facilitator villages, of which 61% of referrals to hospitals for delivery have been by the faciliators.
98% of service users have reported improved health knowledge.
The use of sanitary napkins has increased by 30%.
Integrating Healthcare with Livelihoods and Women’s Entrepreneurship
66% of the once housebound women today report a 100–200% increase in incomes as a local health entrepreneur.
86% of Community Health Facilitators reported increased income.
The Healing Fields model is currently being replicated in Indonesia, reaching out to 120,000 people through the 120 women trained so far as Community Health Facilitators.
Can you tell us a story about a particular individual who was impacted or helped by your cause?
Since 2009, a woman named Saleha has engaged hundreds of girls and young women across Kajipur, a village in the Buxar district in Bihar, to break the taboo on menstrual health and encourage positive maternal health practices. Due to Saleha’s impact, the government also recruited her as an Accredited Social Health Activist worker.
After the coronavirus outbreak, Saleha got busy spreading COVID-19-related information, focusing on social distancing and hand washing. She maintained a steady supply of sanitary napkins for women from 250 families. The COVID-19 lockdown brought the government’s basic health and reproductive care services to a near-halt. Therefore, Saleha kept a close eye on the maternal health of women, especially those in their final trimester of pregnancy.
In the last week of April, a pregnant woman from Saleha’s village, Chandani, went into labor. Saleha rushed her to the primary healthcare center. She was shocked when the doctors refused to attend to Chandni. For four hours, Saleha tried to get the time and attention of the doctors to no avail. By then, Chandni’s pain had intensified, and she had begun bleeding. Saleha decided to rush Chandani to a private hospital, but there was no transport available. It took her two hours to convince an auto-driver to take them to the hospital.
Upon reaching the private hospital, the doctor on duty suspected that the baby had stopped moving. But after a complicated process, she delivered a healthy baby boy. Chandani’s low-income family had to pay a staggering fee of INR 12,000 for a service that should have been free. Saleha refused the leave the hospital until Chandi and her son had reached home safely.
Determined that no village family would have to ever endure Chandani’s ordeal, Saleha reported the matter to the District Magistrate. The case led to immediate action. Since this incident, no one has been refused treatment at the primary healthcare center. Saleha is providing routine neo-natal care advice to six other pregnant women.
“The virus does not look at religion, caste, or money. We need to work together as a community to fight this. I refuse to lose hope. I will continue my work to ensure healthcare is accessible to those who need it the most,” says Saleha.
Are there three things the community/society/politicians can do to help you address the root of the problem you are trying to solve?
I think there is a basic empowerment and economic self-agency story to tell, with our partnership with Opportunity International, an international NGO committed to ending poverty. Through Opportunity, Indian women are affording the chance to join a simple Trust Group to receive support and training for small businesses. This then awakens the women’s sense of leadership, agency, and ability to make changes in their communities, which leads to signing up to become Community Health Facilitators.
One of the major challenges we are trying to address is scarcity or lack of access to healthcare in the areas where we work. There is health infrastructure available in most places, however it is not fully functional. This, compounded with poor service provision, leads to a lack of trust in the government health system. This must change as the only solution to healthcare access in a country like India is to integrate and capacitate the existing government infrastructure to meet the demand.
Lack of awareness, the presence of superstitions and beliefs in relation to health, and patriarchy are other significant challenges that prevent progress in India.
The leaders of the community need to play a vital role, and so does the bureaucracy. The Community Health Facilitators are becoming leaders in their communities, and we have seen many of them breaking barriers by defying patriarchy to keep their daughters enrolled in school and colleges. After joining our Community Health Facilitator program, many women have gone back to complete their own studies as they felt confident that they could do something better.
How do you define “Leadership”? Can you explain what you mean or give an example?
Effective leadership is not just being innovative but also thoughtful, sensitive, and courageous. It is about building leaders within the organization and letting them lead while supporting them. This will foster a culture of mentoring, delegation, trust, and encouragement to make decisions and be responsible for those decisions.
I believe we are building leaders not just within the organization but in the community. Each woman we train becomes a leader of change in her village. That means we must be flexible, open, and willing to listen and learn from them, so that solutions to their problem will be theirs as well.
Ten years ago, when I visited Bihar and Uttar Pradesh, little did I think that we would work there given the poverty, scarce resources, and law and order issues. We were challenged to work in the most difficult parts in western Bihar and eastern Uttar Pradesh, and informed that we would be evaluated against another international organization given a more accessible geography. The program that had a greater impact would be taken to scale with their 500,000 microfinance institution clients. Now, ten years on, we are still there, and our program has grown. With minimal resources and against common advice, the decision taken that day challenged us to innovate, empower women, and become the solution in creating access to affordable and quality healthcare. We learned that for the program to be sustainable, the women must earn an income and continue being empowered health change agents in their communities.
What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.
There is no way out. It is a one-way ticket. You start something in health to help the women you serve, and there are so many problems to solve. If you have solved one, another comes up.
You must work with limited resources, and it is not easy to get resources in this field, including money, technology, or human capital.
You are always in a start-up phase. At no point can you sit back and relax, saying you have done enough.
You are always looked at as “different.” I have had the good fortune to straddle both my husband’s corporate sector, and my world of the development sector. I have always been looked at as the “social worker” and many times not been taken seriously.
The compromises both you and your family must make to succeed.
You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.
Health is in the woman’s hand, as she is the custodian of health in a family. Empower her and enrich her with information, knowledge, and skillsets, and she changes not just herself but her family and community. She puts herself out there to help and support others, sparking big changes in her community.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Never take anything for granted.” When I first started, I went into a remote rural area and started talking to the women about what their most critical healthcare needs, believing I was the expert. I anticipated that they would say they needed a network hospital, which was private and on the high-end of the spectrum in terms of fees.
Instead, the women told me they simply wanted a hospital and a doctor to treat them with dignity and respect. That was a huge lesson for me. We ensure that all the women we serve are treated with equality, respect, and dignity. Healing Fields will not compromise on this.
Is there a person in the world, or in the US with whom you would like to have a private breakfast or lunch with, and why? He or she might see this, especially if we tag them.
There are so many, but the first names that come to mind are Bill and Melinda Gates. The Gates are experts at working at scale, a topic that holds particular value for Healing Fields. I believe our model needs to be global. Also, they have championed effective and innovative health and women’s initiatives.
How can our readers follow you on social media?
On Facebook and Instagram, you can find us at @HealingFieldsFoundation. On Twitter, our handle is @healingfields.
This was very meaningful, thank you so much. We wish you only continued success on your great work!