Drishtee Maternal Health Care (Making it sustainable: Investing in developing skilled maternal health women entrepreneurs).

Competition Finalist

This entry has been selected as a finalist in the
Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health competition.

Project

This innovation also has a Project Page where you can read more about its latest progress.
Go to Project: Developing maternal health women entrepreneurs.

Making it sustainable: Investing in developing skilled maternal health women entrepreneurs.

Background

The idea is to deliver the maternal health care in an innovative and holistic manner which is sustainable. The Drishtee's Maternal Health care project in Guwahati started with the main aim of reducing the incidence of maternal mortality by educating community about the causes of maternal mortality and to meet the demand created by facilitating access to maternal health care services. The uniqueness of the model lies in the fact that the flagholders of project are the Drishtee trained women health entrepreneurs, unlike incentive based health workers in most of the community based health projects or interventions.

Why do we require a better maternal health intervention?

Efforts are being made globally for the improvement of maternal health as a part of the Millennium Development Goal 5. These ongoing efforts have surely made us informed about the state of maternal health all over the world and the challenges faced by various maternal health interventions. There is no doubt that the improved maternal and new born health can only be achieved by delivering the essential services at the critical times and in the key locations in such a manner that they can be easily accessed by the women.

We have clear goals, transparent data and defined requirements. And at this point of time, when we all stand only five years away from the expected achievement of the the millennium development goals, world calls for concerted actions that are truly effective, practical, equitable and sustainable. In simpler words, we all need a template for sustainable delivery of maternal health for the under privileged sections of the community.

The government led maternal health-care programs are based on performance based incentives for the health workers which require massive funds to sustain the program over a longer period. And, the major challenge is the high dependency of donor funding to sustain the program. Moreover, the required financial resources might not be affordable by every country. Secondly, the health workers are seen to loose motivation to maintain the quality of the services after sometime. The perceived reason is the lack of ownership towards the services and often start malpractices as their focus lies on the incentives.

Either the services are free or incentives are given to the pregnant women. For example a pregnant woman delivering at a healthcare institute will receive certain incentive for the institutional delivery. This can prove to be a negative reinforcement of the character as the pregnant females are delivering at the institute for the incentives. The proposed system should incorporate the necessary behavioral changes in the service user and the service provider establishing a programmatic dynamics between the both.

How the model works?

Drishtee is a social enterprise which works towards creating an impact on rural lives by building an eco-system of Drishtee trained women entrepreneurs. Drishtee's health model engages and trains women health entrepreneurs to work in a cluster of villages on defined routes based on predefined criteria. The selection is done carefully in the regions where the government facilities are absent or non-functional to avoid duplication.

In addition to basic maternal care, these women are also trained by Drishtee for non-invasive diagnostic and pathological tests (BP, Glucose estimation, pregnancy test and temperature). These Drishtee Health Franchisee (DHF) are owners of the Drishtee Health Kiosk (DHK) and owns all the maternal services.

The DHK is equipped with the digital thermometer, blood pressure monitor, digital blood glucose monitor, weighing scales, pregnancy test strips, etc. The amount to set-up a DHK is financed by Drishtee and is re- paid by the DHF in the form of easy monthly installments (EMI).

At the backend, this health franchisee is linked with a qualified Auxiliary Nurse Midwife (ANM), with an estimated ratio of 1:10 of ANM to DHF. Drishtee selects the ANM, partner and link them to the DHF. Similarly a gynecologist is also linked to the DHFs. Gynecologist holds a maternal health camp once in a month at the particular kiosk to screen the complicated pregnancy and refer them for timely management at the health care facility. A schedule is set for the visits of the ANM and gynecologist at various kiosk. For the rest of the month both ANM and gynecologist are available for the tele phonic consultations.

The pregnant women are charged a small and reasonable user fee for the registration. The ANM, gynecologist, Drishtee and the DHF share the revenue generated by the registration of the pregnant females. The higher involvement and the motivation of the DHF towards the maternal services positively impacts her revenue. As she experiences higher revenue from the services the motivation level and involvement are boosted. This ensure quality and regular services available to the pregnant women in the community.

Ironically, the pregnant women who were registered on the program by paying a reasonable amount of the user fee demonstrated higher level of ownership towards the maternal check-ups and services. A small amount paid by the females made them more responsible in attending the ANC clinics at the scheduled time.

DHF works as a community mobilizer and contact point for the pregnant females to avail maternal care. Her role and responsibilities can be summarized as follows:

1)Registration of the pregnant women in the region and maintain the maternal record of the women.
2)Hold community meetings and women discussions for educating the villagers about the need of maternal care and its role in preventing maternal deaths
3)Educate the pregnant females and their families about the maternal care, birth preparedness, complication readiness, institutional delivery, hygiene, nutrition and breast feeding. She also informs about the benefits under government schemes and methods to avail them.
4)Hold once weekly ANC clinic at DHK with the support of ANM. Ensure that pregnant women attends the check-up.
5)Track the drop out cases and counsel them and their families about the need for timely check-up.
6)Hold once monthly gynecologist check-up at DHK and to ensure all the pregnant women are screened for complication of pregnancy.
7)Interacting with pregnant women to ensure that the advise or treatment is followed for example Iron Folic Acid tablets etc.
8)Visit the pregnant woman, prior to the due date of delivery and ensure that she has all the information about place of delivery,time for travel, contact of ambulance, blood bank etc.
9)Visit the pregnant female for Post Natal Check-up (PNC)

While the project will preliminarily focus on a limited population, it is our objective to bring this program to a much wider scope, impacting the lives of not only the women in rural Indian villages but also their families whose livelihoods rest upon them.

This project looks at sustainability from two different perspective. The first sustainability is on project sustainability and the second one is on the institutional sustainability.

Project sustainability
The basic objective of this project is to create a team of health-care entrepreneurs, who will be skilled to mobilize the community on maternal health care and continue to provide these services on a long-term basis. The Drishtee Health Franchisee (DHF) are trained as business entrepreneurs. This approach enables them to generate the revenue for sustaining the health kiosk and related activities by charging a small user fee. The approach fosters a long-term presence in the villages and supports:

1. The sustained presence of a trusted, credible health-care provider who can meet several health-care requirements of the village long-term, in addition to the scoped intervention.

2. A small user fee for the registration of the pregnant women helps the DHF to understand the process of sustaining the business for a long-term. The revenue generated will keep DHF motivated to mobilize more females for the screening afterwards

Institutional sustainability
The most important aspect of any development project is to make the institution sustainable and motivated to carry-on facilitating the intervention. In this project, DHF shares a small margin of the profit with Drishtee to keep it engaged with the project and continue to provide the support in the form of health-care workforce and other facilities.

About You

Organization: Drishtee Development and Communication Limited Visit websitemore ↓↑ hide↑ hide

Section 1: About You

First Name

Dr Minal

Last Name

Singh

Organization

Drishtee Development and Communications Ltd

Country

India, UP

Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?

No

Section 2: About Your Organization

Organization Name

Drishtee Development and Communication Limited

Organization Website

Organization Phone

+91-012-4661000

Organization Address

Drishtee Development & Communication Ltd., Knowledge Boulevard, Tower B, 8 th Floor, Plot No. A-8a, Sector-62, Noida-201 301

Organization Country

India, UP

The information you provide here will be used to fill in any parts of your profile that have been left blank, such as interests, organization information, and website. No contact information will be made public. Please uncheck here if you do not want this to happen..

Your idea

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Name Your Project

Drishtee Maternal Health Care (Making it sustainable: Investing in developing skilled maternal health women entrepreneurs).

Country your work focuses on

India, AS

Describe Your Idea

Making it sustainable: Investing in developing skilled maternal health women entrepreneurs.
Background
The idea is to deliver the maternal health care in an innovative and holistic manner which is sustainable. The Drishtee's Maternal Health care project in Guwahati started with the main aim of reducing the incidence of maternal mortality by educating community about the causes of maternal mortality and to meet the demand created by facilitating access to maternal health care services. The uniqueness of the model lies in the fact that the flagholders of project are the Drishtee trained women health entrepreneurs, unlike incentive based health workers in most of the community based health projects or interventions.
Why do we require a better maternal health intervention?
Efforts are being made globally for the improvement of maternal health as a part of the Millennium Development Goal 5. These ongoing efforts have surely made us informed about the state of maternal health all over the world and the challenges faced by various maternal health interventions. There is no doubt that the improved maternal and new born health can only be achieved by delivering the essential services at the critical times and in the key locations in such a manner that they can be easily accessed by the women.
We have clear goals, transparent data and defined requirements. And at this point of time, when we all stand only five years away from the expected achievement of the the millennium development goals, world calls for concerted actions that are truly effective, practical, equitable and sustainable. In simpler words, we all need a template for sustainable delivery of maternal health for the under privileged sections of the community.
The government led maternal health-care programs are based on performance based incentives for the health workers which require massive funds to sustain the program over a longer period. And, the major challenge is the high dependency of donor funding to sustain the program. Moreover, the required financial resources might not be affordable by every country. Secondly, the health workers are seen to loose motivation to maintain the quality of the services after sometime. The perceived reason is the lack of ownership towards the services and often start malpractices as their focus lies on the incentives.
Either the services are free or incentives are given to the pregnant women. For example a pregnant woman delivering at a healthcare institute will receive certain incentive for the institutional delivery. This can prove to be a negative reinforcement of the character as the pregnant females are delivering at the institute for the incentives. The proposed system should incorporate the necessary behavioral changes in the service user and the service provider establishing a programmatic dynamics between the both.
How the model works?
Drishtee is a social enterprise which works towards creating an impact on rural lives by building an eco-system of Drishtee trained women entrepreneurs. Drishtee's health model engages and trains women health entrepreneurs to work in a cluster of villages on defined routes based on predefined criteria. The selection is done carefully in the regions where the government facilities are absent or non-functional to avoid duplication.
In addition to basic maternal care, these women are also trained by Drishtee for non-invasive diagnostic and pathological tests (BP, Glucose estimation, pregnancy test and temperature). These Drishtee Health Franchisee (DHF) are owners of the Drishtee Health Kiosk (DHK) and owns all the maternal services.
The DHK is equipped with the digital thermometer, blood pressure monitor, digital blood glucose monitor, weighing scales, pregnancy test strips, etc. The amount to set-up a DHK is financed by Drishtee and is re- paid by the DHF in the form of easy monthly installments (EMI).
At the backend, this health franchisee is linked with a qualified Auxiliary Nurse Midwife (ANM), with an estimated ratio of 1:10 of ANM to DHF. Drishtee selects the ANM, partner and link them to the DHF. Similarly a gynecologist is also linked to the DHFs. Gynecologist holds a maternal health camp once in a month at the particular kiosk to screen the complicated pregnancy and refer them for timely management at the health care facility. A schedule is set for the visits of the ANM and gynecologist at various kiosk. For the rest of the month both ANM and gynecologist are available for the tele phonic consultations.
The pregnant women are charged a small and reasonable user fee for the registration. The ANM, gynecologist, Drishtee and the DHF share the revenue generated by the registration of the pregnant females. The higher involvement and the motivation of the DHF towards the maternal services positively impacts her revenue. As she experiences higher revenue from the services the motivation level and involvement are boosted. This ensure quality and regular services available to the pregnant women in the community.
Ironically, the pregnant women who were registered on the program by paying a reasonable amount of the user fee demonstrated higher level of ownership towards the maternal check-ups and services. A small amount paid by the females made them more responsible in attending the ANC clinics at the scheduled time.
DHF works as a community mobilizer and contact point for the pregnant females to avail maternal care. Her role and responsibilities can be summarized as follows:
1)Registration of the pregnant women in the region and maintain the maternal record of the women.
2)Hold community meetings and women discussions for educating the villagers about the need of maternal care and its role in preventing maternal deaths
3)Educate the pregnant females and their families about the maternal care, birth preparedness, complication readiness, institutional delivery, hygiene, nutrition and breast feeding. She also informs about the benefits under government schemes and methods to avail them.
4)Hold once weekly ANC clinic at DHK with the support of ANM. Ensure that pregnant women attends the check-up.
5)Track the drop out cases and counsel them and their families about the need for timely check-up.
6)Hold once monthly gynecologist check-up at DHK and to ensure all the pregnant women are screened for complication of pregnancy.
7)Interacting with pregnant women to ensure that the advise or treatment is followed for example Iron Folic Acid tablets etc.
8)Visit the pregnant woman, prior to the due date of delivery and ensure that she has all the information about place of delivery,time for travel, contact of ambulance, blood bank etc.
9)Visit the pregnant female for Post Natal Check-up (PNC)
While the project will preliminarily focus on a limited population, it is our objective to bring this program to a much wider scope, impacting the lives of not only the women in rural Indian villages but also their families whose livelihoods rest upon them.
This project looks at sustainability from two different perspective. The first sustainability is on project sustainability and the second one is on the institutional sustainability.
Project sustainability
The basic objective of this project is to create a team of health-care entrepreneurs, who will be skilled to mobilize the community on maternal health care and continue to provide these services on a long-term basis. The Drishtee Health Franchisee (DHF) are trained as business entrepreneurs. This approach enables them to generate the revenue for sustaining the health kiosk and related activities by charging a small user fee. The approach fosters a long-term presence in the villages and supports:
1. The sustained presence of a trusted, credible health-care provider who can meet several health-care requirements of the village long-term, in addition to the scoped intervention.
2. A small user fee for the registration of the pregnant women helps the DHF to understand the process of sustaining the business for a long-term. The revenue generated will keep DHF motivated to mobilize more females for the screening afterwards
Institutional sustainability
The most important aspect of any development project is to make the institution sustainable and motivated to carry-on facilitating the intervention. In this project, DHF shares a small margin of the profit with Drishtee to keep it engaged with the project and continue to provide the support in the form of health-care workforce and other facilities.

Website URL

Innovation

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What makes your idea unique?

The idea is unique as it does not focus on a new medical protocol for the pregnant women, but it targets to develop a sustainable and cost effective framework for the delivery of conventional maternal care. Adoption of proposed framework can not only help in improving the maternal health in low resource settings but also a sustainable and replicable template which can be easily adopted for different geographies and set-ups with some changes.

Secondly, the behavioral change modification that the model promises to bring in the community, service users and the service providers towards the maternal care services through rigorous social mobilization and provision of quality maternal care services.

The model also promises strategic utilization of resources at each level. It utilizes the health care workforce in the best possible manner as the doctors and the ANMs are not stationed at one central place or a kiosk but travel on Drishtee defined routes to ensure maximum reach to maximum number of people.

Lastly, the idea is unique as the flagholders of the program are the owner of the services. The programmatic dynamics make their income directly proportional to their involvement and quality of services. This ensure the high motivation of the DHF through out.

Do you have a patent for this idea?

Impact

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What impact have you had?

Drishtee health model is working on the same business model for more than last 2 years. Drishtee has aimed general health and conducted more than 160 camps and 250 clinics of various speciality i.e. orthopedic, ENT, gynecology, etc. More than 9,500 people have benefited from these services in past 2 years.

Another impact of the Drishtee entrepreneur based health model is the financial support for the DHF. On an average each DHF earns around INR 1500 – INR 3500 on a monthly basis depending on her involvement and motivation.

This is an early stage to reflect any impact of the maternal health project in numbers. However, the impact will be measured at the end of two years by assessing the decrease in MMR (Maternal Mortality Rate), increase in number of females attending 3 ANC and PNC and increase in the rate of attended delivery in the catchment area.

Problem

1)Most of the maternal health programs are donor-driven and short-lived
2)Lack of motivation among the maternal health workforce on the poor health service delivery field. Often malpractices like over reporting are observed among the health workers for more incentives
3)Poor health seeking behaviour of the community

Actions

1)Sustainable health model with major part of investment focused on development of skilled maternal health entrepreneur
2)Shift of ownership to the health workers i.e. maternal health care delivery through the women health entrepreneurs
3)Community sensitisation for increasing the utilisation of the present facilities at the government centres for example Primary Health Centres (PHCs) for delivery

Results

1)Sustainable health model with major part of investment focused on development of skilled maternal health entrepreneur
2)Shift of ownership to the health workers i.e. maternal health care delivery through the women health entrepreneurs
3)Community sensitisation for increasing the utilisation of the present facilities at the government centres for example Primary Health Centres (PHCs) for delivery

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

1)First year:

a) Selection of the health workers and establishing the network - DHF and the location of the health centres have to be carefully chosen based on the pre-defined criteria such as distance of the centre from the other health facility, number of private practitioners in the region, etc.
b) Capacity building of the DHF - Training of the selected females as entrepreneurs and training in maternal health care. Women are also trained in effective communication skills such as holding a community meeting or interaction with the women
c) Partnering the ANM and Gynaecologist
d) Setting a schedule for the ANM and Gynaecologist
e) Community meetings – For the awareness generation related to the need of the proper maternal care, institutional delivery and post natal care
f) Setting a monitoring schedule
g) Starting the scheduled operations
h) Partnering hospital for referrals

2)Second Year:

a) Monitoring of the ongoing operations
b) Monitoring the sustainability indicators for each DHF
c) Tracking the pregnancies
d) Monitoring the impact indicators for the region
e) Ongoing community sensitization

3)Third Year:

a) Evaluation of predefined impact indicators based on the end line survey
b) Incorporating the changes based on the lesson learnt
c) Expansion to the next region

What would prevent your project from being a success?

In the proposed plan, DHF has to interests of involvement. The entrepreneur interest and the social interest. The balance between the two has to maintain for the success of the project.
Loss of either of the two will severely impact the idea of the project.

How many people will your project serve annually?

1001‐10,000

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Sustainability

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What stage is your project in?

Operating for less than a year

Is your organization a

For‐profit

Is your initiative connected to an established organization?

Yes

If yes, provide organization name.

Drishtee Foundation

How long has this organization been operating?

Please select

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have a non-monetary partnerships with NGOs?

Yes

Does your organization have a non-monetary partnerships with businesses?

Does your organization have a non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Approximately 150 words left (1200 characters).

What are the three most important actions needed to grow your initiative or organization?

1) Capacity Building of the set-up: The project should grow in future to address the emergency maternal situations. Although at this stage, we have partner hospitals and local government facilities where the emergency cases can be referred. But the network has to be strengthened to address these more effectively.Also,capacity building of the DHF as trained birth attendants should be done. This will make the DHF to attend to the deliveries taking place at home.
2) Ensuring sustainability of the DHF: Monitoring for the sustainability of the DHF is required. There are chances of the DHF to loose the motivation to participate if she can not sustain her health kiosk
3) Government Support: Government support is required to utilize the existing government infrastructure for provision of quality service to the pregnant females.

The Story

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What was the defining moment that you led to this innovation?

For last ten years, Drishtee is working for the development of the rural communities through ICT based services. Constant efforts in the field and learning indicated the need for a health model for the rural population. A model which can help the villagers to access the health services within the villages.
In 2006, health model involved as a pilot in areas of UP. The health model has under gone several changes to address the needs of the villagers.
During the health camps, Drishtee health team witnessed that the major part of the beneficiaries were females. Especially the pregnant females participated in the camps who were otherwise unable to travel to the distant locations.
In 2009, the project was launched in Assam based on Drishtee Health Model but focusing on the needs of the pregnant women.

Tell us about the social innovator behind this idea.

Satyan Mishra
Managing Director, of Drishtee, Satyan Mishra has a Masters in Business Administration from University of Delhi - Delhi School of Economics with International Business. Besides this he has extensive 11 years of enterprising experience. He has worked towards combining the passion with his managerial and technical expertise to create a viable organization. The concept has motivated like-minded people to come together and form an intellectual horsepower behind Drishtee. This team has also taken up limited equity in order to facilitate the growth of the organization along with few instituional investments.

How did you first hear about Changemakers?

Newsletter from Changemakers

If through another, please provide the name of the organization or company

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219 weeks ago Drishtee Maternal Health Care (Making it sustainable: Investing in developing skilled maternal health women entrepreneurs). has been chosen as a winner in Healthy Mothers, Strong World: The Next Generation of Ideas for Maternal Health.
221 weeks ago Dr Minal Singh said: Dear Reinhard, Thanks for your valuable feedback about the project. 1) I appreciate your recommendations about the non-users of ... about this Competition Entry. - read more >
224 weeks ago Reinhard Huss said: Dear Minal, this is an interesting and important project to improve maternity care in the community. I have got two comments and ... about this Competition Entry. - read more >
225 weeks ago Ashish gupta said: The project details are quiet informative. It is good to know about a successful social enterprise model. Best, Ashish about this Competition Entry. - read more >
225 weeks ago Radhika verma said: I appreciate the project idea and the way it promises wide social impact at multiple level. Drishtee keep the good work going! about this Competition Entry. - read more >
226 weeks ago Dr Minal Singh said: Thanks for your appreciation!! Following are the answers to your queries: 1)I think I have explained about the charges while ... about this Competition Entry. - read more >
226 weeks ago Dr Minal Singh said: Thanks for sending the judges feedback. We, at Drishtee, are glad that our efforts to service the marginalised population were ... about this Competition Entry. - read more >
226 weeks ago Dr Minal Singh said: Hi Vignesh, I replied to your queries very long back. For strange reasons, its not showing up in the website. However, I am ... about this Competition Entry. - read more >
226 weeks ago Amaka Okafor said: Congratulations. Your idea is great. But i have the same question as the first commenter Vignae: How much will be charged? How ... about this Competition Entry. - read more >
226 weeks ago Naveen Shakir said: On April 15, 2010 the judges reviewed the entries for the Changemakers "Healthy Mothers, Strong World" competition and would like to ... about this Competition Entry. - read more >