Reimagining inclusive public health delivery through experimental spaces

This study delves into the challenges of delivering primary healthcare to marginalized communities, emphasizing the complexity arising from economic and social inequities. It explores how SEWA Rural, an NGO in northwest India, has innovated in healthcare delivery for minority tribal communities since 1980. The research highlights the concept of experimental spaces—areas that foster innovation by existing at the intersections of institutional fields—and investigates how such spaces can promote inclusive healthcare practices.

The generative potential of place and space is examined through three perspectives: free spaces, interstitial spaces, and experimental spaces, each offering a different approach to overcoming institutional barriers and fostering social inclusion. The study underscores the importance of spatial and temporal boundaries that allow for cognitive and emotional relief from dominant norms, facilitating collaborative innovation.

The research identifies boundary work as a critical mechanism within these spaces, helping to negotiate definitions of reality, allocate resources, and enable cross-field collaboration. This boundary work includes communitizing, professionalizing, capitalizing, and entrusting efforts, each contributing to the development and maintenance of the experimental space.

The study presents a conceptual model illustrating how these forms of boundary work and their outcomes—knowledge generation, social impact, individual empowerment, and community engagement—interact within the experimental space to promote inclusive healthcare delivery.

In conclusion, the longitudinal ethnographic study of SEWA Rural illustrates the capacity of experimental spaces to foster inclusive healthcare practices that can evolve and sustain over time. This approach has broader implications for addressing global challenges by enabling coordination across multiple stakeholder groups and navigating complex institutional landscapes.