The best part of my job is that I get to visit remote villages in many states. So often, I get a sense of déjà vu on these journeys, when I see frail pregnant women and new mothers, and malnourished children with listless eyes. But occasionally, there is a ray of hope. Inevitably it comes from groups of village women, working together to save and improve lives. These programmes, by both NGOs and government departments, should be sharing their best practices. That doesn’t happen.
Business knowledge for the most part is not shared, because it is the source of precious competitive advantage. When I left McKinsey and stepped into the public health world, I was dismayed because I saw something similar happening. NGOs were doing similar work, rarely exchanging knowledge. The only difference was that lives, instead of market share, were being lost. Couldn’t NGOs across India systematically capture and share grassroots knowledge?
Over the last two years, I led a small team that travelled across 53 districts in 18 states, to see if this knowledge network idea made sense. We visited 50 outstanding initiatives primarily in public health delivery. Indeed, many agencies were working on similar issues, and had many innovations they could share. There were five thematic areas — data use by front-line workers; community health workers; community mobilisation; data-based advocacy; and organisation building. Let’s consider each.
Health delivery programmes often fail to pinpoint the cases most at risk. It is not enough to know how many pregnant women and newborns there are in a village; programmes need to quickly find the few most at risk. In every village health services are provided by three women government staff — a nurse-midwife, community mobiliser and crèche worker. In Rajasthan, our Akshada programme developed a system of village mapping. These three regularly meet to share information, placing bindis of different colours on houses with the most urgent medical cases. This has been converted into an app. This data sharing and joint problem solving by front line workers is being implemented across the state, saving lives. We are eager to share our methods.
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But what happens when government front-line workers are missing? This was the case in remote tribal locations we visited in Chhattisgarh, Maharashtra and Andhra Pradesh. We found ingenious methods to create community health workers and fill the gap, in different places. These local wMomen are trained to identify high-risk cases, and connect to the nearest health care provider.
We found that NGO programmes often take the beneficiary for granted. However, barriers like a lack of awareness, and social and cultural norms get in the way.
Government partnership is becoming a buzz word in the social sector, but often lacks substance. In my experience, evidence generated at the grassroots, backed by community voice, is what makes for powerful policy change. Sex workers from the Ashodaya community based organisation in Mysore work with government departments. They come equipped with hard data, such as access denied to government entitlements, and incidents of violence against sex workers. Their voice, backed by media coverage, and legal support, has led to a reduction in HIV cases. This principle of data-to-voice advocacy can be applied in other health programmes.
Sometimes entire vital functions are missing in NGOs such as for knowledge capture. Culturally, staff are not encouraged to express dissent and to treat it as an obligation. There are plenty of best practices to learn, including from companies.
The two-year Bharat darshan across 18 states has reaffirmed our belief: That vibrant solutions to most public health problems already exist. We only need a pan-Indian real-time knowledge network, ever expanding driven by mutual interest. That’s another story!
Ashok Alexander is founder-director of the Antara Foundation. Hindustan Times