Social enterprise models can show us the way in reimagining health systems

This article was first published in Pioneers Post and reproduced here in its entirety.

What do sewing machines, digital platforms and micro-savings groups have in common? They are all tools used by social enterprise to create community cohesion – and keep those communities healthier.  Julia Beart, Angela Chaudhuri, Nigel Crisp and Patricia Odero explore the role of agile, responsive social enterprises in creating social good, and their contribution to the Covid-19 response around the globe.

It is now well documented that socio-economically disadvantaged groups are at greater risk of contracting and dying from Covid-19. A previous Primary Care Perspectives piece, The Unpaid Debt of Underinvestment in Public Health, explores this in greater depth.

An important index-based vulnerability risk-mapping survey from our partner Swasti further highlights the ways that this has been playing out in India.

Not only has the rate of infection sped up, but it has spread to the rural areas with poor health infrastructure. This spread has been most intense in the more vulnerable parts of the country including Bihar, Assam, Odisha, Uttar Pradesh, Madhya Pradesh, and West Bengal. This corroborates with the predictions of the index-based vulnerability risk-mapping, which concluded that the most vulnerable areas of the country would be most affected by the pandemic. Health systems in India are under immense pressure, as they are in countless countries around the world.

How, then, are social entrepreneurs mobilising their teams and partnering with the government and with the private sector to protect those at risk and bolster their resilience? In the face of a pandemic not yet showing any signs of abating, what role can social enterprise play in meeting emerging needs?

What does social enterprise bring to the table?

Social enterprises are set up to deliver social ‘good’. Entrepreneurial in nature and often able to be highly responsive to emerging needs, social enterprises do not usually offer ‘hand-outs’ in the way that those operating a conventional charitable model may do. They must provide real and discernible value to their ‘customers’ whether these customers are other organisations, specific groups of people, or whole communities, if they are to thrive as organisations.

A new book by co-author Nigel Crisp, exploring the role of social enterprise in health creation, Health is Made at Home, considers two such examples and much more.

The Sewing Rooms is a social enterprise working particularly closely with groups and individuals who may be isolated, long-term unemployed, with refugee status, or at risk of developing mental health problems, creating opportunities for training, employment, and well-being. One project supported refugee women from Syria to join up with an existing group: ‘Silver Sewers’ (women 50+ who are lonely bereaved or isolated) – using sewing as a mechanism to connect with each other. The impacts of this were clear: there was an improvement in confidence seen from all the participants; some of them started to meet outside of the project and formed a support network; one woman was supported to set up her own counselling business; and one woman was employed in The Sewing Rooms own manufacturing department. In addition, all the women participated in the existing wellbeing Biophilia walks which improved their physical health.

The Tribe Project, meanwhile, creates a hub matching those needing help to those who can provide help, harnessing social action to address the challenges of an ageing population, loneliness and inequality across the UK. In both examples, improved community cohesion is key to improved health and well-being.

The role of social enterprise in the pandemic response

Community cohesion is also critical to Swasti’s Invest for Wellness (i4We) primary healthcare model, which brings effective healthcare to the poor in India (and beyond), substantially improving their ‘healthy days’. The model is anchored by community collectives through which healthcare is bundled with financial services ensuring affordability and viability. It operates on a blended financing model, through grants, pooling group resources, and user fees. Through community-based teams and referral networks, i4We services provide health education and advice – including support to deal with root causes such as chronic illnesses, violence, and addictions, access to primary care and referral to specialist care. Standard protocols, a technology platform, and partnerships augment delivery and quality. During the Covid-19 response, the primary care service has pivoted to ‘tele-care’; health, counselling and social protection schemes delivered via phone. This includes symptomatic Covid-19 surveillance, testing and follow-up care, but also extends to counselling and responding to gender-based violence. Within two months, i4We programmes clocked more than 30,000 calls from 9 sites alone.

Social enterprises can also be very adept at swift, agile re-purposing of existing products. Dimagi focuses on transforming frontline health services by improving data collection to enhance the quality of healthcare through CommCare, a mobile-based data collection platform. In response to the Covid-19 pandemic, Dimagi collaborated with partners across several countries to customise CommCare to support health systems meet new demands for immediate and accurate information. Working with the public sector and NGO partners in Nigeria, Sierra Leone, Kenya, Zambia and South Africa, some new use cases for CommCare included contact tracing, workplace testing and community health worker data collection. The platform is now customised to support triaging, contact tracing, provide decision support for frontline health workers and enable logistics management at community level.

Meanwhile Primary Care International’s (PCI) own Covid-19 open-access e-learning resources for clinicians were released at the end of March. This was some of the earliest content to be designed and disseminated specifically with primary care facilities in resource-poor settings in mind, at a time when other guidance and resources had not yet considered the feasibility of social distancing measures in crowded informal settlements or the logistics of handwashing where facilities are limited. This was achieved through the pro bono efforts of a small team standing in solidarity with healthcare workers around the world and reached people in more than 75 countries within a month of its release.

Why social innovation is needed now more than ever

Social enterprises are often well positioned to contribute to a rich tradition of social innovation. Social ventures have demonstrated their ability to rapidly pivot their service offerings, innovate new use cases for current service delivery models and even develop new technologies to support the Covid-19 response. With the uncertainty on when potential vaccine candidates will be ready for rollout, this entrepreneurial mindset and agility will continue to be needed as health systems seek to build the resilience needed to both manage Covid-19 and minimise disruptions in primary care.

While continuity of healthcare, particularly for those with underlying health conditions, is absolutely fundamental during a pandemic, as highlighted in an earlier op-ed for ‘Primary Care Perspectives’ Ensuring access to NCD services: spotlight on the key role of primary care, there is also now a compelling argument that things can and must be done differently in the future.

If a health system has been ‘broken’ for decades – that is, it is not able to ensure people have access to the care that they need for healthy lives – then why are we tinkering at the edges of this system, trying to fix it?

Let us reimagine health systems whose starting point is not fixing seriously ill people. Let us re-draw the boundaries and reimagine health systems which start at home. What if we were to design health systems where investment in prevention and promotion work in the community were funded in equal measure to investment in hospital-based infrastructure? Where cross-sector collaboration to ensure decent housing and access to social protection was rewarded? Where people felt enfranchised to take control of their own health? Social enterprise models can show us the way.

Note: Recognising the potential for social enterprise to contribute to stronger health systems, PCI is launching a Social Investment Campaign designed to catalyse funding for the growth of high impact models for primary healthcare strengthening. We invite you to find out more about our work and membership of the campaign


  • Julia Beart, CEO, Primary Care International. With a background in disability and community development in resource-poor settings, she has a particular interest in healthcare innovations with potential to reach vulnerable groups.
  • Angela Chaudhuri, Public Health Leader, Strategist and Journalist who has spent 19 years helping strengthen health systems across the globe to make wellbeing a reality for poor and vulnerable people. She currently serves as a Partner in Swasti, a global non-profit headquartered in India.
  • Nigel Crisp, author of ‘Health is made at home. hospitals are for repairs’, Co-chair of UK All-Party Parliamentary Group on Global Health, Co-chair of Nursing Now, the global campaign on nursing. Nigel also serves as an Ambassador for Primary Care International’s Social Investment Campaign.
  • Patricia Odero, Regional Director (Africa) for Duke Global Health Innovation Center (GHIC) and Innovations in Healthcare: organisations that are based out of Duke University ,that work with health systems and entrepreneurs to support the scaling and adaptation of innovations, and related policy reforms.


This article is part of Primary Care International’s new co-authored Op-Ed series exploring resilient systems and healthy populations in the context of COVID-19 and beyond, which will be published in multiple venues. The perspectives of the authors are not necessarily the views of any of their institutions or affiliations.