Data, Pragmatism, and Care: Why Sangath’s Model is Remarkable

I had been there probably an hour when I realise that Sangath’s work is quietly revolutionary. I’m writing this having just left their offices in Goa, India, and my head is buzzing. They’re an ambitious charity, and they’ve only grown more ambitious each year. Founded in 1996 as a clinic for children with developmental disabilities, they expanded outwards, pivoting their work towards the fundamental determinants of wellbeing. Frustrated by system-level causes, they transformed into something far bigger: a research-driven powerhouse, designing mental health solutions rooted in evidence-based practices.

The day began with a presentation walk-through of Sangath’s various programmes, with Interventions Lead Miriam Sequeira laying out the challenges for mental health care in India: stigma for receiving mental health care is a huge barrier; digital interventions are often thwarted by lack of viable platforms and stable connectivity; India is so vast, and many regions so remote, that travel times for in-person care mean that many simply cannot afford the time away from their day wages.

As far as I can tell, if you needed to design an organisation from the ground up, suited entirely to solving India’s mental health needs, you’d build Sangath (after all, that’s what they did). The presentation room is packed with wicked-smart Indian women articulating one data-driven programme after another: the CCAP programme for alcohol addiction support, the PRESENCE programme for youth mental health resilience, the MADAD programme for youth peer support, the MeWE Sports programme for children, the Men Against Violence programme, the IMPRESS programme for treating depression, the list goes on. A blistering two and a half hours of presentations, during which I pressed and poked – seeking flaws –  and coming away all the more admiring.

Whatever barriers to improving mental health outcomes in India exist, Sangath have reflected long and hard about how to conquer them. Sangath seem to me to be expert pragmatists: they know they can’t simply clap their hands and dissolve cultural taboos, so they don’t push where they’d face opposition, but focus their efforts first on finding unmet needs, and then packaging mental health support as part of a programme’s value proposition. For example, their MeWe Sports programme struck me with its efficacy and pragmatism: Sangath recognised that many schools lacked a sports curriculum, and so they created one. It’s a three-step structure, first with physical activities, then a sit-down reflection with the sports teacher, and then looping in the teachers back in the classroom.

The outcome? Young boys and girls engaging in a spirit of equality; kids reflecting on how to be a team player; lessons on a positive and proactive mindset, and Sangath have pulled off what seems like an effortless-seeming miracle, distributing high quality mental health education in a context where they would otherwise face stigma and taboos. But it’s no miracle. It is instead the result of Sangath’s process of experimentation and iterative design in their programme development. Their secret sauce is their commitment to the evidence; trialling programmes, evaluating the outcomes, and turning those findings into a feedback loop for further improving the results. 

Brinda Singh, lead researcher on the MADAD programme, talking me through the design of Sangath’s (ridiculously beautiful) materials for supporting youth mental health.

For us at Bloom, we seek to ground our grantmaking in a principled and data driven approach, evaluating the strength of the evidence, assessing theories of change, and calculating the wellbeing-per-dollar. Sometimes I’ll joke that we don’t decide where our funding goes, the data does – and I’m only half joking. For us, cost effectiveness is an essential consideration: we want to know how much the programmes cost, what they do, and what they achieve for each dollar spent. But for all of this spreadsheet nerdery, at the heart of what we care about is the real impact on real humans, and here it couldn’t be clearer just how deeply Sangath cares (indeed, just over half way through the presentations, Brinda has to rush off – she has a mentorship session with one of the youth mental health guides she’s training). They tell me about one of their participants, a young woman who used to tailor, but had become too depressed to function, losing touch with her love of sewing. Then the next slide shows me a beautiful finished piece of stitch-work: through Sangath’s efforts, her symptoms had abated, and so she had made it for them as a show of appreciation. Beside it is a picture of the young woman herself, and her smile is so genuine I can’t help but smile too.

I’m curious about how all this plays out in practice, and eager to see how their efforts on the front-lines actually work. We head out to the Aldona Primary Healthcare Centre (PHC), a 15-minute drive into the rural areas of northern Goa. The infrastructure isn’t great out here, with one daily bus from the nearest town centre through the hilly roads, and this can be a major problem. Many people would seek care, but simply don’t have the means to travel to the PHC, and rarely can they afford the loss of daily wages. Relentlessly pragmatic, Sangath employ someone part-time just to get people to their appointments. As we rumbled down the winding roads, past rolling fields and brightly painted hovels, I reflected on the very different setting from the data-heavy presentations earlier. This was where all of Sangath’s cerebral efforts actually benefited the people they serve. 

The IMPRESS programme is the first time a charity has garnered enough trust from local government to be able to integrate with PHCs and local health services to deliver frontline support. I ask the chief doctor there what she thinks of Sangath’s work, and her response is blunt: without their programme, those in need in India’s state of Goa would have no-one else to turn to. As we leave the clinic, I feel it, this quiet certainty that Sangath is onto something rare. They aren’t fighting the system. They’re redesigning it, patient by patient, programme by programme. And it’s working.