Sangath, founded in 1996 by Dr. Vikram Patel and six others, is a Goa-based nonprofit organisation that aims to address the holistic needs of children, including developmental, behavioural, and emotional aspects. Sangath's mission is to promote the overall health of children, adolescents, and families, particularly from underserved communities, while scaling up evidence-based mental health interventions. Its values include respect for community knowledge, building trust through transparency, collaboration with communities, empowering communities in research, and grounding interventions in scientific evaluation.
When it was founded, Sangath operated as a child guidance clinic that offered specialised services such as speech therapy and psychiatry, inspired by the care model commonly used in the UK at the time. However, challenges arose in delivering this mode of care, including resource intensiveness and a mismatch between families' expectations and the clinic's approach, which focused on unlocking children’s full potential rather than providing a quick fix to a single issue. To adapt, Sangath shifted towards a home-based and collaborative model, training local lay counsellors to deliver evidence-based interventions across the life course. As part of this shift, Sangath also transformed from a service-oriented organisation to one focused on conducting research to improve the delivery of services. This change enabled Sangath to reach a wider audience more effectively.
Sangath’s key objectives include building trust with communities, educating them about research, involving them in the research process, and ensuring community voices are heard in research findings. Over time, Sangath's objectives have evolved to address changing community needs, with a growing emphasis on power and equity in research.
Sangath works closely with marginalised and underserved communities, focusing on addressing mental health challenges within these populations. Their operational approach involves active engagement with the communities they serve, acknowledging their social position, unique experiences, needs, and perspectives. Reflecting on the necessity of working closely with the communities they serve, a Sangath staff member explained.
“If we were really seeking to extend sustainable models of mental healthcare into the community, we had to work with the community.”
They prioritise the inclusion of community members in their research teams, ensuring that those directly affected by the issues play a significant role in shaping interventions and research directions.
Sangath believes that the foundational work of building trust and rapport with the community is of the utmost importance when engaging with the community. After rapport is built, continuous engagement is required to build trust.
Stakeholders at Sangath suggested that creating more equitable relationships between communities and researchers requires a structured and science-based approach to community engagement. This approach acknowledges the diversity of pathways and approaches for community engagement while emphasising the importance of evaluation and assessment to ensure effectiveness. As one staff member explained,
“The first question we've always asked ourselves is, ‘What is the purpose of doing this? What is the ultimate objective of community engagement? Is it an end in itself, or is it a means to another end?’ And I think the latter has really prevailed in our thinking. That is to say, we have really positioned community engagement as a means towards ensuring the successful scale up of evidence-based health interventions.”
Across its work, the organisation follows a three-step framework for community engagement: acceptability, feasibility, and effectiveness.
While these three domains increase the odds of scalability, it's still not guaranteed. Continuous engagement with stakeholders is vital to navigate challenges and advocate for the adoption of new evidence-based approaches. The engagement process changes as objectives shift from understanding the problem and potential interventions to address it to incorporating a new approach to service provision within budgets and existing resources. Overall, scalability requires ongoing collaboration and implementation efforts beyond publishing research findings.
Overall, the stakeholders emphasise the need for a well-structured, science-informed, and community-inclusive approach to achieve more equitable relationships between communities and researchers. This involves ongoing evaluation, flexibility in engagement strategies, and a commitment to accountability and genuine participation at all levels of the research process.
Sangath believes that their success lies in designing innovations that can be scaled up and adapted across contexts and geographies through primary care and community delivery platforms so that they are able to reach underserved and marginalised communities. The concept of Universal Health Care is a strong underlying principle in all their research directions and interventions.
Their partnerships with policymakers have helped to ensure that their evidence-based interventions are taken up and implemented at scale. For instance, Sangath’s intervention programme for families affected by domestic violence has been incorporated by the Goa State Commission for Women.
Through programmes like EMPOWER, Sangath's interventions involving Non-Specialist Providers (NSPs) have gained traction even beyond Indian borders, finding adoption in the United States and Canada. They consider this a unique instance of an Indian non-governmental organisation effecting change in healthcare practices in North America. They believe that this accomplishment is primarily attributed to their unwavering commitment to evidence-based research as the foundation of their work.
Over the years, Sangath has come to recognise the importance of understanding diverse avenues and methodologies for community engagement, rooted in assessing the underlying principles and evidence guiding their approach. Stakeholders interviewed emphasised the need for genuine engagement with communities, driven by comprehensive understanding, lived experiences, and internal expertise, rather than tokenism. To foster genuine community involvement, they suggest, it is necessary to integrate participation, ownership, involvement, and equitable compensation into all of their research programmes.
Additionally, cultivating trust emerged as a vital lesson, requiring time, patience, and resources, leading Sangath to establish enduring relationships with communities beyond data collection, offering auxiliary support systems like resource centres, regular clinics, and training opportunities. They also acknowledge the need to enhance access to care through partnerships with government and NGOs to extend their reach to larger, underserved communities.
Some of Sangath's recent programmes such as iHEAR (Initiative for Health Equity Advocacy and Research), and Transcare incorporate some of these learnings and epitomises their commitment to fostering genuine collaboration among different research stakeholders and the community. iHEAR serves as a platform that brings together academics, researchers, activists, practitioners, and community representatives to conduct participatory research, advocacy, and educational initiatives, focusing on the intersection of marginalised identities, access to healthcare, and mental health.
Persistent challenges exist, however, in evaluating the impact of their public campaign on mental health awareness, underscoring the need for more rigorous studies to determine its benefits. Furthermore, the lack of emphasis on community engagement in grant allocations from government structures in India makes sustainable funding an ongoing challenge. Funding timelines also often fall short of what’s necessary to cultivate and sustain trusting relationships with communities. Being part of the civil society sector, Sangath is also influenced by various legislative changes at both regional and national levels.
Another key challenge is that Sangath’s interventions remain focused in peri-urban areas and they face challenges in reaching the rural poor with their interventions. The sustainability of their community-driven programmes also faces obstacles due to high turnover rates, especially among youth participants.
Key takeaways and implications emerge from the understanding that the effectiveness and integration of community engagement into research can be influenced by the diversity of perspectives within organisations as well as external factors such as local funding and political landscapes. The definition and involvement of communities are pivotal, highlighting their lived experiences as essential expertise for the development of effective biomedical models. Across their work, Sangath also emphasises the importance of developing strong and grounded scientific evidence rooted in effective community participation and accountability structures. Integrating community engagement with science is paramount, moving away from viewing them as separate domains of expertise.
However, communities' role in driving policy change remains nascent, necessitating their advocacy for mainstreaming Sangath's model. Grassroots mobilisation alone is insufficient; active engagement with political and bureaucratic leadership is essential to influence and sustain change. Thus, community engagement transcends research and delves into the realm of party politics, necessitating careful navigation of these complexities.