A recent media report highlighted remarkable reduction in the infant mortality rate (IMR) of India. India’s IMR improved from 47 in2010 to just 28 in 2022, bringing it closer to the global average of 27. (see here)
Much contrary to the popular perception, India achieved one of the best Covid vaccination rates in the world. As per the latest available data close to two billion doses of Covid vaccines have been administered, defying all the logistic challenges.
These are just two success stories from India’s public health sector. Recognizing these remarkable achievements, the World Health Organization (WHO) recently honored more than a million Asha Workers of India for their commendable public service, especially during the pandemic.
It is rather unfortunate that not much of the urban population is even aware of the existence of Asha (the frontline health workers). Many mistake Asha workers for Aanganwadi workers. Even though millions have “liked” the pictures of Asha workers administering Covid vaccines to people in remote places, sometimes walking for many kilometers, not many seem to have bothered to learn more about them.
ASHA stands for “Accredited Social Health Activists” – “community volunteers” engaged under the National Rural Health Mission (NRHM). The designated Asha worker is the first port of call for any health related demands of deprived sections of the rural population, especially women and children, who find it difficult to access health services. These workers create awareness on health and its social determinants; mobilize the community towards local health planning; promote good health practices; and provide a minimum package of curative care. (learn more)
‘Stories of Change”, a report published by the NITI Aayog, in collaboration with Center for Social Behaviour Change (Ashoka University), highlighted some of the brilliant stories of changes that are happening in the hinterlands, away from media headlines and social media gossips.
These are the real stories that reinforce faith in the bright future of India; much more than a startup with virtually no business model (or even any real revenue) raising a few million dollars at a billion dollar valuation to get “unicorn” status. These stories explain what a small but brilliant innovation could bring meaningful change to many lives.
In my numerous travels across the length and breadth of the country, I can certainly vouch that these true stories are not only inspirational, but also deeply insightful. These stories highlight an original Indian model of frugal innovation and entrepreneurship – the Gandhian model of Swaraj (self-reliance with dignity).
The following is a gist of three simple stories from hinterlands, reproduced from the cited report “Story of Change”, highlighting how small simple solutions can handle complex problems.
PARI – (A pilot program for Diarrhea management in Bihar
Pari (fairy), a plastic inflatable doll with two openings, one at the top and the other at the bottom, is used to educate villagers about diarrhea that kills many children every year. A frontline health worker (FLW) pours water into the top inlet to inflate the doll to show what a healthy baby looks like. Then she releases the water by opening the outlet at the bottom, which deflates the doll to demonstrate what diarrhea does to the body: causes dehydration. When the FLW plugs the second opening and pours ORS into the doll, the water does not leak out. She explains that in order to solve the problem, it needs to be ensured that the outlet at the bottom has been plugged. When the child is administered ORS and zinc supplements, it acts as a plug to the bottom outlet thereby retaining vital fluids that can be absorbed by the body.
Pari has been used in Bihar for over two years across eight districts. In 2018, the Government of Bihar committed funds to scale up Pari to all 38 districts of Bihar. Results showed that among women exposed to Pari, appropriate knowledge of diarrhea management was three times higher and the use of ORS and zinc was almost two times higher than women not exposed.
Mobile Kunji (Guide) – Aid for awareness on family planning, pregnancy and child care
Mobile Kunji is a multi-media job aid (Kunji means key or guide in Hindi) designed for use by FLWs when they counsel families. It has two components: a deck of colour-coded cards with illustrations and related key messages for each stage of pregnancy or post natal care, and an audio component accessed via mobile phone. Each card carries a unique, seven-digit number or mobile short code that the FLW dials from her mobile phone, playing a piece of pre-recorded audio content for the family she is visiting. The audio content is delivered in the voice of a fictional doctor character, Dr. Anita, who brings credibility along with her great and very localised bedside manner. Moblle Kunji helps standardise the FLWs' dellvery or the key messages, reducing inconsistency and significantly improving interpersonal communication.
Evidence shows that conversations between FLWs and families last twice as long when Mobile Kunji is used,and families trust FLWs who use Mobile Kunji more than those who do not.
Kilkari – Mobile health update for mother and the child
Kilkari (Hindi for a baby's gurgle) delivers weekly, time-sensitive audio information about reproductive, maternal, newborn and child health (RMNCH) directly to families’ mobile phones, from the fourth month of pregnancy until a child is a year old.It aims to improve families' knowledge and uptake of life-saving preventative health practices. Kilkari supplements the counselling visits that FLWs make, by providing a regular and more consistent source of timely, relevant information for families, reaching families that are otherwise left out, and addressing issues that FLWs hesitate to discuss. As of March 2019, Kilkari had reached almost 10 million users across 13 states in the country. Subscribers cited Kilkari as a private, comprehensive, credible source of information on family planning and the service contributed to building health equity by conveying information to women in marginalised communities, whom ASHAs may not visit.
