Wharton Around the Globe: Helping Improve Access to Vulnerable Populations in Rural India

Contributor: Karl Wang, WG’21 
To learn more about Karl, click here.


This past semester, a team of Wharton students from the Wharton Global Health Volunteers (WGHV) had the opportunity to work with Makunda Christian Leprosy and General Hospital, a 190-bed hospital strategically located at the junction of three Indian states: Assam, Tripura, and Mizoram. As a mission and not-for-profit hospital, Makunda believes in providing comprehensive health services to all, especially the vulnerable populations who make up a significant portion of the communities surrounding Makunda. 

For Makunda, a “vulnerable” patient is one who runs the risk of falling into acute poverty after paying for healthcare services. Thus, Makunda has developed and refined a process for identifying “socioeconomically vulnerable” patients for whom they provide fully or partially subsidized care. Despite having very little outside funding (e.g., donations) and limited resources, Makunda has been able to successfully deliver charity care to all of its identified vulnerable patients in a given year and still be profitable. Makunda’s unique operating model and mission-driven staff allows it to serve its community in ways that many other healthcare institutions have not been able to achieve. 

Screen_Shot_2020-07-21_at_12.00.31_PM.pngThe overall goal of the team’s project was to study Makunda’s charity operations and identify opportunities for improvement, as well as document its processes so that healthcare institutions across the world can benefit from learning about Makunda’s charity policy. 

The project had the following objectives: 

  • Document, analyze, and assess Makunda’s current charity process in its entirety, from the identification of vulnerable patients to the confirmation visits during which a determination is made as to whether or not a patient actually needed charity. 
  • Recommend improvements for Makunda’s charity process focusing on the prevention of false positives (patients who receive charity care but do not need it) and on how Makunda can create processes to help scale its charity operations efficiently and effectively as the hospital grows. 
  • Develop best practice documentation for Makunda to share with other comparable entities externally.

To tackle this project, the team conducted a literature review and interviewed stakeholders at Makunda’s peer hospitals to better understand appropriate approaches for identifying vulnerable patients and the charity policies and processes of the other hospitals. Additionally, the team also went to Assam, India and visited Makunda to observe the hospital’s operations, charity process, and interview stakeholders involved in the process. 


At Makunda, the team was amazed to find a mini-economy. Makunda was not only running a hospital but also a nursing school, primary school, and farm. At the hospital, patients waited in long lines to register, and the waiting room was completely packed daily. The team was awe-struck by how many patients were being serviced in such a low-resource environment and impressed by the dedication and quality of Makunda’s staff, who work tirelessly.

In addition to seeing the hospital operations, the team also had the opportunity to visit the patients who had received charity care to understand what it means to be a vulnerable patient. Some of the poorer communities could only be reached by foot, and the majority of houses were two rooms made from clay and wood. For these communities, Makunda is oftentimes the only functional hospital within hundreds of miles, and patients are willing to travel for hours to get care given Makunda’s reputation.

Makunda truly sets the standard for being a mission-driven organization. Staff at Makunda could easily earn a better livelihood in other areas of India but choose to serve one of the poorest regions to help the needy. The Wharton team was humbled by seeing how others live their lives and are inspired by how significant the impact Makunda has, even with minimal resources. 

image008.gifThe team hopes future Wharton students will continue to have opportunities to work with Makunda, as it is an experience that can be life-changing. Thank you to the alumni who made this opportunity possible with their generosity. The team is grateful for the chance to help mission-driven healthcare organizations improve healthcare access in the developing world. 

Contact Karl at: [email protected]