Mahila Arogya Samitis: a community interface for reducing out-of-pocket expenditure and strengthening public-sector uptake in non-communicable disease management

Background: Recurring out-of-pocket expenditure (OOPE) for managing non-communicable diseases (NCD) such as diabetes mellitus (DM) and hypertension (HT) is a reality for poorer households in India. The OOPE is primarily driven by reliance on the fee-for-service private healthcare sector in the absence of reliable public sector provisioning. SATHI’s community intervention project focuses on activating Mahila Arogya Samitis (MAS) as a community-level interface to support the management of NCDs through the public health system. Methods: This action-research data is generated through routine programmatic monitoring in which identified patients were tracked at baseline (November 2024) and across three monitoring cycles (July 2025, November 2025, and March 2026), recording the source of treatment (Private vs. ‘Government+’ (government+ trust+ other NGOs+ generic sources)). Results: The private sector's share of treatment fell by roughly 32-40 percentage points between baseline and Cycle 3 (DM 86.8% to 48.3%; HT 80.3% to 48.0%; both conditions 76.0% to 44.2%), with a corresponding rise in patients seeking treatment from the public health system. In total, the migration to the public health system led to savings of approximately ₹6,57,675 over nine months for the combined cohort. Conclusions: Empowered MAS triggered migration of NCD patients from the private to the public health system through three interrelated functions: information facilitation, trust transfer to the public health system, and reliable feedback between communities and the public system. Scaling participatory forums like MAS is a useful strategy to reduce OOPE and contribute to the elusive goal of household financial protection from health expenditures.