Développement communautaire

Selo, is known and popular in Central java about their vegetables and the beautiful view. Soil in there, is already fertile because it has been exposed to volcanic ash from Mount Merapi, so it does not need excessive chemical fertilizers. Supported with a beautiful view from the location itself is to be the main attraction to develop as an eco-friendly tourism potential agriculture. By this program, we could also invite women to cultivate organic vegetables into a nutritious food ingredient for consumption and resale in the form of vegetables flour as a food additive for the kids.

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To be able to grow and existence in serving the needs of farmers, it will be set up a business unit of the SL-PTT. These business will be providing farming inputs and services. The farming input such as fertilizers, seeds, farming equipment rental and harvest and post-harvest mechanization. In addition, SL-PTT will provide marketing services helping the sell of rice yields to the official government agencies and rice milling industry. The cooperation between SL-PTT school and farmers are mutually beneficial cooperation where farmers are served to get knowledge and services – input and market.

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This would allow GCC to greatly improve the quality of our consulting work. At the moment, we rely on pro bono remote experts. This added capacity will allow GCC to provide onsite assistance by covering visa fees, project transportation costs, and covering living expense. Additionally, the funding will allow GCC to provide seed funding to a number of youth projects as well as assist with 501(c)(3) registration to ensure future finical stability and our continued work in Burma.

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Deficiency of pharmaceutical care in pharmacies for populations looking for medicines and / or requiring a follow-up with guidance on how to follow the drug treatment safely after a medical diagnosis.
Allow the Brazilian population to have access to quality information and guidance from trained professionals at the time of access and adherence to medication in the pharmacy.

Through free education and distance learning, we train health professionals serving the population in pharmacies, so he/she is better prepared to provide the proper and safe pharmaceutical care to patients, monitoring and ensuring adherence to treatment. In the long-term, this is relieving the public health system in Brazil by involving new actors from different areas in the search for a systemic change of quality pharmaceutical service in Brazil.

Unite diverse areas of ​​operation within the Brazilian market to, jointly, provide training for health care professionals throughout Brazil, and thus, make the pharmacy a point of service and patient care. This allows the population to have another reliable and reference option, regarding treatment and guidance on health.

In the short term, to contribute to the empowerment and development of professionals working in pharmacies (graduates or those studying or working in the pharmacy window), improving their ability to find employment.

In the medium term, to encourage the development of the retail pharmacist and to establish a relationship of trust between the local population and community pharmacies, through the best care provided by their pharmacists and clerks. We believe that good entrepreneurial practices of a retail pharmacist will bring a whole chain movement, due to the highly competitive industry, which benefits the whole population with increasingly skilled and safe care.

In the long run, relieve the public health system through quality primary care in pharmacies.

Pharmacists and clerks who work in retail are directly impacted by the program, because the certification is geared directly toward this target group.
This program helps pharmacy students notice that the subject of Pharmaceutical Care will guide the future of their careers and their professional success in the long run.
Executives and senior leadership of the retail pharmacy, through our program, realize that the practice of pharmaceutical care in their companies can be a competitive advantage for short, medium and long-term satisfaction, and generate customer loyalty.
And finally, the society, because of proper care by qualified and trained professionals, brings security to their health treatments.

The communication of the program is conducted by the website of the Federal Council of Pharmacy, through a fixed banner on the main page. This site has daily access because the dispensation of some types of medications must be recorded in the CFF system. Another approach is the publishing of some modules of the classes in the pharmaceutical magazine Koiros. Boehringer Ingelheim team visits pharmacies and promotes the Program to 12,000 community pharmacies across the country. In all communication action, we highlight the changes that the program brings to individual participants - like career growth and social benefits for the Brazilian population. Moreover, we have seen that "word-of-mouth" among students is also very important.

Develop, implement and monitor updated and relevant content about the practices of pharmaceutical care for the health professional who operates within the retail pharmacy chain. This will contribute to the development of his/her career and improve the provided services within the community pharmacy, reflected in the quality attendance and confidence of the population.

Also, we offer certificates to the participants who attend the full course during the current year.
To bring more didactic content to the program, we develop practical case studies through 'Further Reading,' which reflect real situations of how patients should be treated in community pharmacy under the vision of Pharmaceutical Care.

The two components of the project are the Federal Council of Pharmacy, the Magazine Koiros, the University of São Paulo (USP) and the Ministry of Education and Culture (MEC). At the moment, the only situation that we see as a potential barrier to the project's future is unpredictable political dynamics between these actors, which could negatively impact some strategic changes on how the projects are managed. However, we consider this possibility very low due to the successes the project has achieved up until today and will keep achieving in the long run.
We have in the market today other sources of training for pharmacists and clerks (PEC Farma Zambom / IDVF, Torrent, Racine), but none of them is focused on pharmaceutical care. And they have lower academic relevance compared to PEC CFF.

Our biggest challenge has to do with the political sphere, involving partners of the program. Changes in the management of these institutions could reflect negatively on the operation of the project. In contrast, the constant alignment that we do with all the involved actors, clearly defining roles and responsibilities, allows us to minimize potential risks, especially when we see that PEC CFF has operation for 2 years and 4 months with positive engagement from all actors.

To grow the number of participants; promote presential classes throughout Brazil, in partnership with regional pharmacy councils; engage the retail industry in the pharmcaceutical care matters; create campaigns for the population to make them aware of the importance of pharmaceutical care before, during and after the treatments with medicines, in partnership with new health bodies such as the Ministry of Health.

In 2 years and 4 months, CFF PEC already has more than 28,000 active students in the program. Also, the high level relevance of the content combined with the certification of the program and the good online platform (which is able to support future growth), assure its success - short, medium and long term.

To change the image of the pharmacist in the health scenario in Brazil, increasing his/her relevance in serving the population, and this, alleviating the healthcare system and being one more reference for the well being of the patient, mainly focused on dispensing drugs to the population.
Also, to educate the population and change their level of exigency for these services.

In 2013, we intend to reach 35 thousand students until the end of the year. We also plan to engage the population in a campaign with the Ministry of Health
In parallel, we plan to increase, by 2014, the engagement of major pharmaceutical retailers, addressing the topic as a major potential differential provision of service to its customers, placing the program into their development plans for HR professionals who operate in the stores.

Given poor economic status and with lack of awareness, sanitary pad is last thing on mind of rural women and they use all kinds of things leading to a series of diseases to most common hysterectomy We connected it with another non issue i.e. clothing and turned an old piece of cloth into a powerful tool to raise awareness on the issue and use it as a viable, economic product also. What makes idea of cloth pads successful is familiarity to women. Mass scale replication is possible on a local level itself. We remove risk elements, do value addition in terms of cleanliness& awareness and this biodegradable pad becomes a good option and saves a lot of issue on disposal. NJPC turns material lying idle in urban homes to a very useful product and tool for rural people.

We work on a theory- Triple A i.e. Awareness, affordability and Access. The old waste cloth as raw material ensures regular supply of material helps reducing the pressures on land fill sites and makes it affordable. The engagement of urban masses for collection of old material opens up the taboo issue to larger audience and builds empathy among various groups. The open discussions in the villages and slum with ‘My Pad’ as a tool create massive awareness and as the initiative is based on the corrections on prevailing and traditional practices, a lot is not absolutely new to people and its easier to accept. In many cases it is solved at home by using the same piece of cloth but as a more aware and conscious woman !!

The base of model is old cloth, which people discard in plenty. As the process don’t involve heavy machines it can happen at smaller level at multiple places, It’s lucrative and viable to initiate for many. All stake holders contribute in some way.Urban people give cloth as raw material, user either pay in cash or labour by working under ‘Cloth for work’. In some cases women sponsor for women. Organisations, corporate working on health issues are buyers for us.

Vision is to make this an issue, something on discussions happen in public and not just in seminars and conferences. The idea is to build it up as a movement where citizens are involved in solution and not just government or some agencies as the scale of this not so opened issue so far is huge.

Rural women treat their needs as last priority thereby receiving less health care& education In scenario where they struggle for daily survival, NJPC brings awareness about fundamental issue, highlighting high-risk behavior that puts their health in jeopardy. Influencing health seeking behavior by giving empowerment to influence their own health. Exposure & interactions on taboo issue is key in highlighting possibilities available to them. Essence of NJPC is not just to provide clean pad or making women aware, but to address clothing holistically. Addressal of clothing help free meager resources for pressing needs like food and education. This reinforces Goonj’s mission of working on ‘ Micro looking – madro issues’ !!

Adolescent Girls: Nutrition Foundation of India says that average age of menarche is around 13 yrs yet 50%of both urban &rural girls aged 12 yrs have no understanding of this process.Adolescent girls face problems like low literacy level,sexual vulnerability contributing to dismal health.
Young married women in reproductive/child bearing age: In India 1 in 6 girls begin child bearing between 13-19yrs. Maternal mortality accounts for 15% of all deaths of women.
Older women:Most studies on reproductive health & menses say older women in family are primary source of information about menses practices.This segment plays key role as knowledge leader.
The larger target is certainly the rural and tribal population.

1.Sensitizing urban masses to bring attitudinal changes towards menses as taboo subject & show power of old clothing for women by initiating discussion through forums 2. Wide spread production of ‘MY Pad’ 3. Partners inform about community needs 4. meeting with partners highlighting need, solution& process. 5.Village meetings, organized with community women to talk about health risks & solution offered by My-Pad 6. Provide exhibition material with relevant information to partners to put up locally 7.Sends 1st dispatch to women & general clothing for cloth for work activity for village community 8. Providing pads with awareness meeting 9.Training to local women on how to make pads 10.other organizations buy pads for giving in their areas

1.sensiting urban masses -discussions through lectures, addressing forums etc. 2.collection of material- Generating material through awareness cum collection camps. Every camp leads to new contacts & volunteers. We organize monthly sponsorship campaigns, touch base with hospitals & hotels for large quantities of old cloth.3.Process- Collected material is sorted, packed at GOONJ’s processing center & sent to our partner groups according to requirements of their target communities. 4.Education- Partners provided them relevant information like illustrative posters 5.Replication on local level; Over a period of time share our learnings with them & help them replicate small scale.

So far there are sporadic and local solutions. There is still a gap in the segment to take it on a national or larger level. Also we don’t have experiments where people talk about product and education both on a large scale. Since this issue almost untouched and the scale of the problem is huge, we don’t see people as competitor and there is enough space for everybody. We need more people and experiments to tap the entire market.

The bad part is just some people and organizations who are taking it just as a fashionable subject without much ground work as this is still the initial phase and it needs solid pillars to create a mass awareness and understanding of the issue.

Goonj focuses more on idea spread with a practical viable and working product and process demo.

1.Communicating a new idea to urban & rural audiences is a slow process;unhealthy practices,huge taboo,mindsets of partner groups call for long term behavioral change communication.2.Planning Risk in generating material from masses;we are approaching different channels for committed supplies 3.tackling & changing the attitude of urban masses of acting as if they are doing greatest deed in giving away their discard. Sustained communication & awareness building on giving with dignity has helped 4.Risk is not using full potential of the idea; opening up idea and processes for wider audience for others to adopt and spread the work with our minimal expense.

Long term growth strategy– sustain organizational spread plus focusing on more partners & village women starting to make pads . We would like to put energy in idea spread,through knowledge sharing with partners, sharing replication kit & documenting, sharing impact with international academia to get rest of world excited about potential of idea.

Idea working for 8 years. Impact visible at many places,national & international agencies recognized work after rigorous due diligence, evaluation process. Demand much ahead of supply, ensuring long term sustenance. Overall volume growing, raw material ensured. Evolved multiple strategies for pad distribution. Right juncture of knowing what we want with understanding of strengths & weaknesses.

1. Work in backward areas directly, knowledge sharing in others
2. Cross subsidize costs by selling to organizations not directly working
3. Urban sponsorship for rural implementation
4. Speak at national and international forums
5. Open systems to enable replication
6. Work to motivate bulk suppliers for generating material, tie up with big brands for co-branded campaigns for idea spread.

Short-Term: next 1-3 years
1. Focus on some areas & key partners, who show interest & capacities to work to go deep 2. Strengthen systems 3. Document impact through case studies.4.Work on replication kit 5.Get involved at policy level to bring this as key women’s health issue 6. Communication plan to target more sponsorship 7.Increase production capacity
Mid Term
1. Replication of idea at various places 2. Involve village women to identify their challenges; work on issues & get pads in return. 3. bring out first major documentation report.4. Connect NJPC with village level health interventions. 5. Make My pad a part of many village haats (markets) as this is a non product for any haat so far despite a big need and scope

The continuously increasing costs of healthcare, drives the public healthcare systems in the developed countries in restructuring as funding is becoming harder. Given this situation the role of preventive medicine as well as primary care, seems as a valuable option. Both preventive medicine and primary care, are capable of sustaining the public health in reasonable levels, avoiding costs of hospitalization. But the primary care through the healthcare system of Greece it is offered through hospitals mainly, making the access very difficult to the patients. So, preventive health especially through traditional medicine, could be important solution to relieving the pressure to the public system.

The idea is based on the individual approach of the patient, including training on how to prevent the disease, by changing everyday’s habits. At the same time, it accepts the distinctiveness of everyone’s needs, taking care of aspects of life that cannot be changed, and at these cases, in intervenes with the use of natural medicines, according to the whole constitution of the patient, treating him and not only his disease.
The solution can work outside the public healthcare system, functioning complementary, at a time when pressure of healthcare services demand is intense. The whole approach refers to a cheap solution, bringing relief to the patient as well as the public system.

The vision is to help people in identifying the hazards of health through bad habits, learn how to handle them if it is not possible to avoid them and maintain a good level of health through prevention. So, when the first signs of the disease are aproaching, simple treatments can be efficient. This way the health level of the population can increase, permitting the health care system to handle more serious cases.

In the beginning about 30.000 people in the close region could be possible customers. In the case of expansion, then more people of the areas where the organization will operate, could be supported, as well as tourists, In that case, tourist agents could also be customers.

Possible accusations of unapproved medicines, which can be solved through clinical trials according to the recent EU regulations.

Modern medicine has not effectively solved the problems of Vascular blockages, stroke paralysis & DVT. Recurrences of symptoms are known after treatment or invasive procedures. Modern treatments include High cost infrastructure, skilled manpower, life long medication with its side effects. Modern treatments are not available everywhere. Majority population cannot afford costs for same.
Survey of 294 Patients seeking alternative to conventional treatment for reasons:
Preventive-84: Re-Symptomatic-52: Post MI-61; Post Angio/Bypass-31; NOT WILLING for Surgical treatment-54; Cases of Thrombosis/Stroke/DVT-12
More than 50% patients seek, need additional/alternate treatment. SHARP is scientifically proved, safe, economical, easily available, acceptable, accessible and simple treatment.

Sharp is developed by a patient for patients.
SHARP includes medicaments SUVED & REIMMUGEN and Global advice. SHARP is used as a standalone protocol especially in prevention of diseases arising out of vascular blockages.
Medicament is prescribed with dosage guidelines. Other medicines, if any, are reduced/discontinued as the symptoms change evaluated by the medical practitioner. Treatment spans 3 to 6 months and discontinued.
The products are successfully being used along with Modern medicine treatments for better recovery results (eg. Reduction in ICU Mortality, early recovery, reduced hospitalization days, early stabilization of patient, reduced rate of recurrence of symptoms during and after hospitalization etc) in many cases.
All patients need universal supportive treatment.

Technology is ready & commercially available. We consider up scaling this target of reaching out to 0.025 % of suffering population in India, at 100,000 patients in next two years; Budgeted over Rs.100 million (Manufacturing, Marketing and Further development) . The funds generated from sale will be reinvested for capacity building & marketing in first two years.

The technology is currently in use catering to approximately 300 patients per month; growth predicted at 300% over the first year. Network development and manufacturing cycle is geared to take 2 times the volume as of now.

As per WHO,WHF , UN data 33 % population globally, is suffering from this slowly killing / functionally disabling diseases arising out of vascular blockages. These form the basic customer / user group looking for additional /alternate treatments.

SHARP is used as a standalone protocol especially in prevention of diseases arising out of vascular blockages. The treatment is being actively adopted in Modern Hospital environment along with conventional treatments.
Direct marketing approach is being used for persons who choose to adopting alternate or preventive treatments.
The products are successfully being used along with Modern medicine treatments for better recovery results (eg. Reduction in ICU Mortality, early recovery, reduced hospitalization days, early stabilization of patient, reduced rate of recurrence of symptoms during and after hospitalization etc) in many cases.
All patients need universal supportive treatment. Numerous ‘awareness of treatment options’ lectures, workshops are conducted.

The Technology includes Ayurvedic and Natural medicaments that are manufactured by Health Solutions ( Proprietor Sujata Vaidya) and marketed by Sharp Health Care (Partnership company, equal partners Dr Vinod Marathe and Dr Sujata Vaidya).
Sharp is developed by a patient for patients.
Network development is thru Doctors and Direct Marketing.

Dr Vinod Marathe is an Alopathic MD doctor. Evolution of SHARP has been a personal venture to defeat a personal trauma. Self healing, other Patients, medical fraternity, Ayurvedachariya’s have been/are peers. Acute patients need High tech Hospitals with expensive ultra modern treatment options recommended by Specialist doctors dealing with vascular blockages. Integration of SHARP products with ongoing treatments gives better outputs. This technology needs to be taken to these doctors and their confidence built up.
Ayurvedic formulation with unproved claims on results and heavy misleading marketing are competitors.

Government policies changes with regards to Indigenous treatment systems and execution/implementation of Integrative NON INVASIVE treatment approach in orthodox conventional high tech modern treatment facilities becomes a challenge.
We are implementing SHARP in medium to small sized treatment facilities with reasonably good success where the common patient finds medical relief.
Availability of Raw material as it is Nature based is a challenge.

Increase in number of medical facilities using SHARP; awareness to the masses to SHARP as a viable, non-invasive, cost effective treatment option and building good network for direct marketing is the current endeavor.
Up-scaling the network of distribution is the main growth strategy.

Technology is ready & commercially available. We consider up scaling this target of reaching out to 0.025 % of suffering population in India, at 100,000 patients in next two years; Budgeted over Rs.100 million (Manufacturing, Marketing and Further development) . The funds generated from sale will be reinvested for capacity building & marketing in first two years.

Reaching out to at least 5% needy population in India alone, in next 2 years. International alliances and develop networks to make SHARP products available in other countries as well.

In next one year develop distribution channels to cater to 500 patients per month and in next two years be geared to upscale 5 times. Strong Marketing network is required to reach out to the millions who need this treatment option. India population is 1.3 billion. Even if we consider to reach & treat 1 % of the estimated adult 33% who are potential victims of Vascular disease, we have a target to reach more than 4,00,000 patients in one year at any given time; with active treatment for 3 to 6 months valid for each person.
This would need a proved reliable raw material supply chain & large scale manufacturing/ distribution/ marketing activity.

Operation ASHA’s mission is to eliminate TB among disadvantaged communities. TB is an infection caused by bacteria. Anyone can have the bacteria inside the body, but those with weak immune systems are most vulnerable. That is why the poor & the malnourished, pregnant women & AIDS patients are more prone. The challenge lies in the fact that treatment lasts for 6-8 months, and patients must visit a designated treatment center at least 60 times over 6 months. Therefore accessibility is a key issue. If the poor have to choose between feeding their families and taking treatment, they choose the former - with the result that treatment is often left incomplete, known as default. Default has severe consequences: it leads to MDR/ XDR-TB, which are near fatal and are the current emerging epidemics.

We work towards eradicating Tuberculosis by providing treatment, counselling, education, and supportive services to TB patients in the communities where we work. We follow DOTS (Directly Observed Therapy, Short Course), a treatment method approved by WHO and implemented by Governments across the world. We work in close collaboration with the National TB Program. We also implement awareness and preventive measures to prevent tuberculosis in these communities. Operation ASHA’s goal is to make TB treatment available to the most disadvantaged patients. We do this through focusing on patient convenience, community mobilization, and comprehensive counseling. Our management information systems include continuous monitoring and rigorous reporting.

Our Vision: A world free of tuberculosis.
Our Goal: Operation ASHA’s goal is to make TB treatment available to the most disadvantaged patients. We do this through focusing on patient convenience, community mobilization, and comprehensive counseling. Our management information systems include continuous monitoring and rigorous reporting.

Operation ASHA strives to continue providing free treatment and services at the doorsteps of the most disenfranchised communities worldwide. We seek new opportunities to ensure that we are reaching out to the most vulnerable and hard-to-reach areas. We place a lot of value in our mission and seek to achieve it at every opportunity. We empower communities through educating them about TB and training local people to become counselors. These being paramount to establish a ripple effect to adapt community’s behavior and attitudes towards TB. These benefits effect people on mass scales, even those who are not diagnosed with TB, as the preventative measures in place prohibits TB to manifest itself.

Beneficiaries: Operation ASHA serves the population at the very bottom of the pyramid. A large section of the population earn 20 cents a day per capita, and are worse off than even the absolute poor as defined by the World Bank (income less than a dollar a day). Some of them are rag-pickers; they are people who collect refuse and trash from various neighbourhoods and bring it to their huts. Their huts are made mostly of used paper boxes stitched together with twine. The whole structure is so flimsy that it collapses in no time in strong wind or mild showers. OpASHA is dedicated to bring TB treatment and health services to the heart of India’s urban slums & villages. We serve more than 6 million individuals in over 3,000 slums & villages in India & Cambodia.

Operation ASHA’s innovative model takes TB treatment to the doorsteps of the disadvantaged. It provides a dense network of treatment centers that are established within the community, e.g. in small shops, huts and in the premises of local health providers. They are open for long hours from early in the morning to late in the evening, allowing patients to procure the medicine conveniently without spending money on transport or losing wages. This accessibility is complemented by a robust TB-education and counseling methodology. Operation ASHA carries out intensive educational campaign and education camps. The counselors and program managers are recruited from the slum communities they serve; the highly trained counselors are responsible for tracking patients and eliminating default.

Operation ASHA works towards eradicating tuberculosis among disadvantaged communities, by providing treatment, counseling, education, and supportive services to tuberculosis patients in the communities where we work. We also implement awareness and preventive measures to prevent tuberculosis in these communities. In addition, we seek to build capacity among governments, public health organizations and other NGOs to adopt and implement our best practices. Operation ASHA makes TB treatment available to the most disadvantaged patients through focusing on patient convenience, community mobilization, and comprehensive counseling. Our management information systems include continuous monitoring and rigorous reporting.

We work closely with Government and other NGO’s at international and national levels. We work in collaboration to achieve maximum leverage worldwide. Our mission is to see TB eradicated from this world. To achieve this mission in the most effective and efficient way our partnerships are a fundamental aspect. It is always encouraging when a partner adopts our cost-effective model and incorporates our best practices in their own model. We do not consider others as competitors and therefore we do not foresee any threat posed to the success of OpASHA’s growth.

There are two major risks for this project which could hinder further scaling. First is if the technology fails or does not advance enough. Second would be if the relationship between the government ceases or changes in a negative manner. The technology has tried and tested replacing text with icons/pictures to have further impact for the illiterate. Our strong in-house technology team is capable and confident, as are we, to amend any weaknesses. Relations with the government and the scheme under which they provide support have never been problematic before. For the past six years we have relied on their collaboration and have not yet had any major problems and keeps us informed of policy changes.

We envisage the expansion of OpASHA and progress with innovations in Vietnam, Swaziland, and Uganda as well as further developments in India. 2012-2013 we successfully piloted our model in Uganda which brought phenomenal results, decreasing default and death rates from 16% to 0%. We also endeavor to maximize leverage by employing more counselors and ensuring that detection is most effective.

OpASHA’s model works to maximize leverage. With a team growing in dedication and passion it foresees the growth of OpASHA’s infrastructure. It also demonstrates that the results are an inspiration to the people we work with and those we impact. With the quantitative and qualitative data eCompliance provides, we see the results that puts our visions into action.

• Maximizing impacts to prevent MDR- TB through detection and treatment of TB patients.
• Building a rapport with communities through counseling, empowering and educating the truths behind TB as a curable disease. Encouraging the practice of preventative measures taught and compliancy to treatment.
• Providing opportunities of economic value for local residents in the communities we work in.

By 2016 we foresee the number of centers increasing to 329 covering a combined population of 11 million people.
We will initiate projects in Swaziland and Vietnam. Our projects in Cambodia will continue to expand and presently underway, ensuring maximum leverage.
Growth milestones include:
• Adaptation of eCompliance for the totally illiterate, opening employment opportunities to the most disenfranchised.
• eCompliance being totally transferable even to the most geographically hard-to-reach areas.

We want to make sure children do not die in pain; that their last days are kept comfortable with their pain & symptoms well-managed.
Most of our patients are from poor families. An illness in these families would push them to destitution. All their money and possessions would be used/sold to find cure, that when treatment fails, the child would invariably spend his/her last days in considerable suffering.
For the lucky few that find their way to the hospitals, their final days may not necessarily be pain free as pain & symptom management is not a priority. For those that are trapped at home (due to lack of information or funds), no medical care is available to them to ease their suffering.
Accessibility to good pain & symptom management is a challenge in Indonesia.

Need: Pain & symptom management to add quality to patient's lives, especially for those trapped at home due to poverty & without access to resources.
Solution: Palliative care (not taught in medical & nursing schools when we began).
We train nurses to provide palliative care in patients’ homes without charge.
One of the key components in the PC training we provide is impeccable assessment to ensure better diagnosis, treatment and pain & symptom management. This training is provided to medical professionals in hospitals to ensure better management of pain & symptoms for patients, and ultimately, for these hospitals to refer patients to us.
We train public health workers & volunteers to ensure better care can be provided to those in need.

Our vision is that no child should have to die in pain, alone & unloved.
Our objective is to make PC accessible to all children in need, providing effective pain & symptom management to add quality to their remaining days.
Our nurses are trained to have the best knowledge of cancer and HIV (the 2 areas we currently focus on), the disease trajectory and treatment to ensure the best care is provided to patients.
In bringing care to patients' homes, we make it possible for the patients to spend their remaining days in the comfort & security of their own homes.
We provide support to caregivers to allow them to give the best care to the children.
We share the PC knowledge widely to ensure PC can one day be accessible to all.

Pain and symptom management to relief the suffering of a dying child need not be a costly exercise.
With proper training, nurses can provide pain & symptom management to prevent costly (re)admissions to hospitals and emergency wards.
We have successfully proven through our team of well-trained nurses that excellent and effective PC can be provided to patients at home, making available affordable pain & symptom management to many.
Confidence in our nurses' ability has led to good flow of patient referrals from partner hospitals.
Our nurses are organised by locations and operate from satellite offices, reaching patients by motorcycles. They are supported by medical consultants to ensure the best care is provided, and where needed referrals are made for patients to be seen by doctors.

Our main customers are children (under 18) from the marginalised communities living with cancer and HIV, mainly referred by public health institutions and other NGOs; occasionally, by private hospitals (as we remain the only pediatric palliative home care service available).
The children's caregivers are also key customers, their wellbeing helps ensure the best care for children. Our nurses support the caregivers with information about the disease to allow them to confidently cope with the symptoms as they arise.
Training to ensure a widespread dissemination of PC knowledge is key to our work; hence, another key group of customers are the medical professionals from public/private health institutions, prisons etc., social workers, religious organisations & NGOs.

For patient referrals:
1. Train medical professionals at public health institutions to increase awareness of PC and our service;
2. Establish a clear patient referral process, which did not exist previously;
3. Active engagement with patients & families while they are in hospitals to explain the role of PC;
4. Regular training sessions in the community (involving health-related NGOs, public heath workers & volunteers) to increase awareness of PC & to introduce our service;
5. Public seminars on PC with international panel of experts to spread the knowledge widely;
6. Network widely with other health-related NGOs;
7. Collaborate with hospitals on patient care.

1. Provide palliative (home) care to children living with cancer and HIV;
2. Care & support for their caregivers to ensure the best care for patients;
3. Training & Advocacy of PC in the community (incl. public health workers & volunteers, NGOs);
4. Establish large network of partner hospitals for patient referrals, and forge collaboration for best patient care;
5. PC training for medical professionals to spread the knowledge widely, in line with our belief that PC should be accessible to all.

At the moment, we are the only pediatric palliative (home)care service available in Indonesia.
The only inpatient pediatric PC unit in Indonesia is at Dharmais Hospital, the largest public cancer hospital in Indonesia; the unit came about as a result of the training organised by us. We work closely with the Dharmais team to provide homecare to the patients discharged from the ward.
We hope, in time, more hospitals in Indonesia will establish their own PC unit, which will ensure better quality of life for patients & their families. We do not see this as a competition, but a positive impact of our work.
We intend to train more nurses to replicate the team we have trained at Rachel House - to increase the PC capacity, not just for us but for Indonesia.

• Medical professionals' reluctance to learn and incorporate/integrate PC in their work, resulting in poor symptom management for patients. Culturally in Indonesia, doctors do not communicate with patients nor are they opened to be questioned, leaving patients poorly educated. We try to overcome this by training both doctors & patients. We believe change will come when patients are empowered to demand better care.
• While nursing & medical schools are starting to provide PC in their curriculum, these are unfortunately taught by people who have never practiced PC, raising the question of the accuracy of the knowledge being taught.
• Hospice regulation is still unclear.
• We hope training & advocacy will improve the current situation.

1. Continue to provide PC training to spread knowledge widely.
2. Recruit & train a doctor to lead the team of nurses.
3. Provide training to health volunteers to allow them to better support those who are sick at home.
4. Collaborate with corporate to sponsor the training of nurses from rural areas to improve accessibility.

We have proven the need for PC and have seen the impact of the care given by our nurses.
Our nurses have also been actively providing training to nurses at hospitals, nursing schools and the community.
Going forward, to improve accessibility we need to increase the coverage by training others, not only the medical professionals but also the community members.

Provide better access to pain and symptom management for all in Indonesia, through:
1. Community Network in Palliative Care (CNPC) - train community members to provide basic PC and support to those who are sick at home;
2. Training of rural nurses - to ensure greater accessibility to PC;
3. Most important, to continue to upgrade and improve the quality of care given by our nurses.

CNPC Program:
2013: pilot (train 5 health volunteers in North Jakarta in early detection of cancer & HIV, public referral & welfare system, basic wound care, patient support information; monitor their work with patients supported by our nurses)
2014: proof of concept (train more groups in other areas of Jakarta), monitor the quality of patient care especially in wound care and patient support.
Training of rural nurses:
2013 - design a 4-month curriculum, get corporate sponsorship, pilot 1st training in Q4FY13
2014 - Monitor performance of 1st group of trainees in rural setting, launch 2 training groups
Training of medical professionals in Jakarta:
2013 & 2014 - 4 public PC training sessions, audit of our nurses' work by international experts (4 times/year)

In Mali, one in five children die before the age of 5, 90% due to 5 treatable, preventable conditions. For the poor, even low barriers to care become insurmountable as patients delay treatment, allowing illnesses to worsen and costs, morbidity, and mortality rates to rise. Simultaneously, Mali’s decentralized, fee-for-service health system remain incapable of appropriately meeting local needs, disproportionately so among poor communities where clinics lack the resources to function properly. This results in the continually exacerbated tragedy, then, of poor health outcomes, reduced livelihood capacity, and a skeletal health system without the means to achieve its purpose.

We will adapt 5 strategies of performance to address child mortality at the primary health level.
1. Reduce blockages in treatment, such as care-seeking, costs, and treatment adherence.
2. Help clinics manage systems such as labor use, wait times, inventory, and supply allocation.
3. Rigorous quality improvement, root-cause analysis, and feedback on outcomes.
4. Standardization and technology improvements to diagnose, treat, and refer patients.
5. Pricing strategy and financial mechanisms to reduce barriers to care-seeking and through cross subsidization.
We will operate in a peri-urban slum on the outskirts of Bamako, serving 50,000 of the city’s poorest and geographically isolated.

Aligned with our organizational mission to improve maternal and child health sustainably, the goal of our pilot program is to increase under-5 survival in a peri-urban community in Mali through improvements in clinical operation efficiencies, the reduction of barriers to care, more efficient treatment delivery, and a greater emphasis on quality improvement with continued evaluation by:

1. Instituting a “Goal for Zero” child mortality target objective and culture at identified clinic(s)
2. Improving patient/mother access to prompt and appropriate care and service delivery satisfaction
3. Strengthen a peri-urban health system’s efficiency, capacity and sustainability

With an emphasis on user-orientation, efficiency, and outcomes, we will increase access to basic care and preventative services through a model clinic that will utilize a number of methods to improve operations, increase volume, and manage costs. In addition, Mali Health will support the development of mobile health data collection and analysis tools, implement evidence-based algorithmic medicine, and implement a system of continual feedback, improvement, and learning.

The project will serve a peri-urban slum on the outskirts of Bamako, Mali’s capital and fastest growing city in Africa. The community is poor, most surviving on $1 - $2 per day. On average, women bear 5 - 6 children, 20% as teenagers. Saving money is rare, and the utilization of alternative forms of health care (market medicine, traditional healers) or deferment of treatment is common. Our customers include the clinic staff, women and mothers caring for children under 5 in this community, and, peripherally – given local decision making about care seeking and finances – male heads of households.

A cadre of 20 frontline community health workers regularly visit families, provide in-home health education, identify sick children, ensure access to the health system, serve as a patient advocate, and provide follow-up care throughout the community. In 2009 we constructed a clinic, now fully integrated into the national healthcare system, to better meet community needs. Customers are also identified often through word of mouth, given the organization’s longstanding development within the greater community.

Activities will take place in the clinic and the community. In the latter, we will implement an expanded in-home health worker program that delivers more services and products to patients, and activities like market days and health fairs. In the clinic, we will implement quality improvement systems and metrics, launch a clinic to health worker tele-communication program and implement new systems like patient exit surveys, feedback sessions, results reviews, and new incentive compensation schemes to reward achievements and improvements. Additionally, we will invest in mobile data collection and analysis tools and the implementation of algorithmic medicine for common childhood infirmities.

Traditional healers and clinics can be considered competitors to Mali Health, as they offer inexpensive services that draw patients away from the formal system. Private clinics exist, with quality and satisfaction rates similar to public institutions. The national healthcare system can be inconsistent and unreliable, promising plans to rollout a subsidization program for the poor, or distributing products inconsistently to local clinics. These actors could draw support and investment away from Mali Health’s efforts, though in anticipation, we hope to engage others as partners over competitors and prepare contingencies should policies or deliverables change.

Local politics, not uncommon in Mali’s healthcare systems managed by local committees, must be navigated. Mali Health employs a local MD with a track record of negotiation and experience, having run a rural Malian hospital himself, to mitigate these challenges. More, Mali itself presents a challenge, given the evolving nature of geopolitical challenges, particularly in the country’s northern half. Our approach in employing local capacity, operating in resource poor communities, and working with local government officials has and will continue to help the organization succeed despite the context.

As service delivery improves, we expect patient demand and clinic margins to increase. We will engage with the Ministry of Health and other NGO actors to expand services and best practices to additional facilities as the model clinic agrees to absorb programming costs and continue most effective practices.

We have the relationships and experience to pursue a sophisticated model of delivery and see opportunity in increasing our focus on health system improvements, for this community and the field of global health. More, the need for solutions exists in a growing slum where 1 in 5 children die unnecessarily.

1. To institute a “Goal for Zero” child mortality target objective and culture at identified clinic(s)
2. To improve patient/mother access to prompt and appropriate care and service delivery satisfaction
3. To strengthen a peri-urban health system’s efficiency, capacity and sustainability

Sept – Nov 2013:
• Develop initial methodologies and protocols
• Develop mobile health application and backend dashboard for data collection and analysis
• Observe processes, consider workflow to improve efficiencies and eliminate wasted efforts
Nov 2013 – June 2015
• Implement algorithmic protocols
• Analyze and adapt cost models
• Launch clinic-based community health worker system
• Hold quality improvement meetings, feedback sessions, and reporting on agreed-upon deliverables, adapting and adopting rapidly
• Develop best practices and program improvements
• Engage with Ministry of Health and NGOs to expand services
• June 2013: Hand over successful operations to clinic to continue employing most efficient and effective practices