Community-based social entrepreneurs improve family planning practices and availability of products in rural India Tanya Liberhan, Palladium
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Health System Strengthening and Private Sector Engagement Recent projects DFID Maternal, Newborn and Child Health (MNCH2) /Nigeria: 2014-2019 DFID Ghana Adolescent Reproductive Health (GHARH): 2014-2017 DFAT/ AusAID HIV Cooperation Program for Indonesia (HCPI): 2008-2016 DFID Human Development Innovation Fund (HDIF)/Tanzania: 2014 2019 Reproductive Health Framework (DFID) Reducing Maternal & Child Mortality through Strengthening Primary Health Care / South Africa: 2012-2015 Delivering Increased Family Planning Across Rural Kenya: 2013-2018 Improved Family Planning and Reproductive Health Services India (Project Ujjwal): 2013-2016 USAID Innovations in Family Planning Services Technical Assistance Project (ITAP)/India: 2005-2012 USAID Communications for Behaviour Change: Expanding Access to Private Health Products and Services/Afghanistan (COMPRI-A): 2006 2012 3
Reaching the last mile populations- Enabling access to FP/RH products and services in rural Bihar and Odisha, India Problem Reaching BoP populations in remote villages; access limited to towns and bigger villages 89% Bihar and 83% Odisha populations reside in rural areas Due to high costs, existing distribution networks challenged to reach smaller villages Retailers do not stock contraceptives/rh products 20% unintended births in Bihar and Odisha annually (about 0.7 m). Higher in rural areas (89% of Bihar and 83% of Odisha is Rural) High fertility rates in Bihar and about 20% unmet need for FP - esp. high among women 15-24. Low reach to young, newly married under 18 women, who would benefit the most Opportunity Community based entrepreneurship programmes
1: Increased choice of sites providing quality clinical FP/ RH services with a focus on clinic-based services in rural and underserved areas 3: Build FP/ RH capacity of private sector providers, provide training and mentoring support; and Quality Assurance 2: Increased access to FP/ RH products with a focus on rural and underserved areas 4: Generate demand, overcome barriers to FP uptake, and address gender norms through communications and community outreach
Where the action really is? UJJWAL SAATHIS
Snapshot of the Ujjwal network 3-tier network with 280 private clinics- 86 Level 1 clinics and 212 Level 2 clinics Each Ujjwal clinic linked to 15-20 Ujjwal Saathis (Level 3) More than 5000 Ujjwal Saathis, more than 800 depot holders 3-tier distribution network: 30,000 social marketing outlets networked in Bihar and Odisha (traditional and non-traditional outlets) More than 15,000 outlets in C&D category villages (population less than 5000) SERVICES Level 1 CLINICS (80) Level 2 CLINICS (200) Family Planning Counselling Spacing Methods Injectable contraceptives IUCD (Interval IUCD & PP IUCD) Permanent Methods Male Sterilisation (NSV) Female Sterilisation (Minilap) Female (Laparoscopic) Abortion Services Sterilisation First Trimester Second Trimester Post Abortion Family Planning Services Comprehensive Abortion Care 7
How they fit in the network? Ujjwal Saathis Depot Holders Bihar 3500+ 700+ Odisha 2400+ 600+ Network Clinics Ujjwal Saathi State Franchising coordinator Area Franchising Managers Outreach Officers Ujjwal Saathi Depot Holder Market Wholesalers 8
Profile of social entrepreneurs (Ujjwal Saathis) Young, Highly Motivated, Female or Male Individual Native of the same village, Recognised and Preferably Literate Willingness to associate with the Project Experience in community mobilisation and possess good communication skills Exhibits entrepreneurial skills Self motivated to work for additional income Role in the programme Spread awareness and share information on family planning methods Encourage/motivate potential users to access the network for availing their choice of services and products Refer clients to Ujjwal clinics Facilitate community meetings; house to house visits for IPC Provide support for mid-media communication activities Act as a supply point/retailer in the assigned geography Maintain link with the nearest wholesalers for resupply
Training and orientation Social entrepreneurship/marketing skills IPC and community mobilisation Orientation on family planning and methods Product information use advantages and probable side effects cost/profit USP Record maintenance Forecasting Myth busting and counselling skills Use of AV materials on mobile phone/ memory chip for IPC 10
Depot holders: Supply chain/markets Product basket Condoms Oral contraceptive pills Sanitary napkins Emergency contraceptive pill Pregnancy testing kit ORS Depending upon interest and catchment area of the depot holder the product quantity is supplied Direct consumers/non traditional outlets/traditional outlets Products are sold on cash-on-delivery basis 11
The driving force: demand generation channels Narrow casting Counselling Facility Mass Media Demand generation for Ujjwal Network through innovative use of TV Radio Print media Mobile for IPC IPC Tools Ujjwal Helpline for tracking and follow up IPC Out Reach EE shows Live and Video Community meetings Market town activities
Uptake of FP services at Ujjwal clinics and percent referred by Ujjwal Saathis in Bihar Method Total clients (2013-15) Total clients counselled and referred by Ujjwal Saathis Injectable contraceptives 18473 12172 (65%) IUCD 11550 4911 (42%) Female Sterilisation 11910 2493 (20%) Project Ujjwal MIS (June 2013-March 2015) 13
Uptake of FP services at Ujjwal clinics and percent referred by Ujjwal Saathis in Odisha Method Total clients (2013-15) Clients counselled and referred by Ujjwal Saathis Injectable contraceptives 33521 14163 (42%) IUCD 29069 13548 (46%) Female Sterilisation 41598 17485 (42%) Project Ujjwal MIS (June 2013-March 2015) 14
Penetration tracking of FP/RH products at all outlets Percent changes in penetration of FP/RH products in all types of outlets of C/Dcategory villages at baseline (2013) and first year (2014) of intervention 35 30 Bihar 29.0 45 40 35 Odisha 33.5 38.7 25 30 20 15 10 5 11.8 16.6 8.3 11.6 7.2 16.1 12.9 7.3 5.3 25 20 15 10 5 21.5 22.5 14.915.2 17.0 13.9 12.5 10.4 0 Condom OCP ECP PTK S.Napkin 0 Condom OCP ECP PTK S.Napkin 2013 2014 2013 214 Project Ujjwal. Penetration tracking survey, 2013; 2014. 15
Penetration tracking of FP/RH products with community-based workers Percent changes in penetration of FP/RH products with community-based workers in C/D-category villages at baseline (2013) and first year (2014) of intervention Bihar Odisha 60.0 50.0 40.0 37.4 54.4 31.6 49.8 36.2 100.0 90.0 80.0 70.0 60.0 90.8 88.9 91.4 88.4 72.0 78.6 30.0 24.7 24.5 50.0 40.0 20.0 17.1 15.3 30.0 26.3 22.9 10.0 10.0 20.0 10.0 11.110.6 0.0 Condom OCP ECP* PTC S.Napkins 0.0 Condom OCP ECP* PTC* S.Napkins 2013 2014 2013 2014 Project Ujjwal. Penetration tracking survey, 2013; 2014. 16
Qualitative analysis Enhanced their knowledge on FP and skills to counsel clients The training materials enhanced their confidence to communicate with couples P-Test kit and OCPs found to have generated major revenue for the Ujjwal Saathis Use of mhealth during counselling creates an enormous positive impact on couples Look up to monetary reimbursement in time Challenges in communicating with couples largely related to myths and side effects Interest in continuing their role in expanded MCH and FP clinics and as depot holders A majority perceive their role as indispensable Community members (68% in Odisha and 20% in Bihar): Ujjwal saathi is an inspiration 17
Knowledge contribution Positives Lessons Franchisees attach maximum value to the Ujjwal Saathi Network Providers may continue to sustain referral payments beyond programme support Mobile technology is an effective tool to aid social entrepreneurs Facilitating partnerships with FMCGs to expand basket of products Garnering loyalty of this network will be critical in the long termthey influence the volume of services Consistent (equal) referral payments for both spacing and limiting FP methods, enhance choice of FP methods, improve method mix Counselling and myth busting form an important part of delivery of quality FP services Improve retention and performance of Ujjwal Saathis, as the costs to recruit and train sales agents are high 18
Sustainable livelihood opportunities Unique collaboration with GSK: expand basket of products for improved sales revenues (VLE programme) Add new products and services in due course to improve their margins Birthing kits- infection prevention collaboration with Ayzh Link the Depot Holders to the Wholesalers and Network Clinics Build their identity and recognition 19