in good health-compendium on csr

7/25/2019 In Good Health-Compendium on CSR

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Achieving healthcare outcomes throughCSR innovations and partnerships

Dec 2015

IN GOODHEALTH


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Achieving healthcare outcomes through CSRinnovations and partnerships


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Tis healthcare CSR brie aims to inorm Corporate Social Responsibility (CSR)leaders who are looking to identiy opportunities in public healthcare that they wouldlike to address through CSR initiatives. Te brie highlights needs and areas in publichealth that can bring about sustained long-term impact or the CSR investment and hasrecommendations on the various courses o action that CSRs can take in building theirportolios. Te document is aligned to all the global and National missions on health:Sustainable Development Goals (SDGs), the National Health Mission (NHM), the 12thFive Year Plan and various State missions.

Tis publication was supported by BRICS-CCI.

Credits

Authorship


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Foreword

Healthcare and wellbeing is an essential pre-requisiteor the development o any community; it yieldshigh returns on investments both or human and oreconomic development o a country.

Good health has a direct link in enabling other keythematic areas such as education, skill development,and sustainable livelihoods, which eventually leads

to holistic social progress.

In light o the magnitude o Indias national healthand development challenges, healthcare wasenumerated within the Schedule VII o the CSR Actto play an important catalytic role in the governmentseffort. Tis was to ensure the holistic health ocitizens through the National Health Missionencompassing both Rural and Urban missions, theSustainable Development Goals (SDGs) outlinedby the United Nations and taken up by India, aswell as various Centre and State-supported schemesand programmes - ranging rom conditional cash

transers or maternal health to insurance throughthe Rashtriya Swasthya Bima Yojna (RSBY).

Tere is growing recognition among corporatesthat unless we address current health challenges,the demands or the uture growth o the nationwill make business difficult. Tese are exciting timeswhere we can look not only towards innovationsto address the complex development challengeswe ace in India, but also grapple with how to takeinnovations to scale or greatest impact.

On behal o the Indian Institute o CorporateAffairs, we are pleased to present the ollowing

report, which outlines our Institutes collaborativeefforts with our partner Sattva and BRICS-CCI(Brazil, Russia, India, China and South AricaChamber o Commerce and Industry) CSR Cell, toprovide recommendations or key stakeholders inthe Healthcare sector.

Tis report is an outcome document o aocused deliberation done with Industry leaders,Government officers, Civil Society organisationsand healthcare organisations through a round tablediscussion conducted with BRICS-CCI at NewDelhi in October 2015. Te document has beencomplemented with wide-ranging perspectives romacademicians, healthcare proessionals, CSR heads,policy-makers and practitioners.

Tis is the second o our Round ables planned

across the key development sectors o Education,Healthcare, Integrated Rural Development and Skill,which are essential to raise our countrys HumanDevelopment Index.

Tis outcome report will be ollowed by acomprehensive compendium reaching out toAcademic Institutions, Government agencies andCorporate India to inorm and help articulate theirCSR strategy, policy and implementation or visibleand meaningul Impact.

I would like to express my sincere appreciation andthanks to our partner Sattva, along with BRICS-

CCI CSR Cell and our in-house Learning &Development eam at the National Foundation orCSR (NFCSR), IICA, or their diligent efforts todocument and author the outcomes o the discussionso eloquently.

Dr. Bhaskar ChatterjeeDG & CEO, IICA

Dated: 15th December 2015, Bhopal

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Health is the oundation o our lie and without good health one cannot succeed in other areas o lie. Te majorcomponents o healthcare are daily diet and nutrition, liestyle, exercise, rest and sleep, and a balanced mind.

Te different panels in the round table conerence discussed all the related aspects o healthcare which include,experience o key stakeholders during one year afer CSR legislation, key priorities and ocus areas to enhanceimplementation, challenges aced and opportunities available in implementation o CSR programs in healthcareand sanitation.

We received an enthusiastic response rom all the stakeholders during RC and also in compilation o compendiumafer the round table conerence. I must express my gratitude to all the stakeholders or giving their sincere inputs orthe compendium which have made it truly comprehensive and worthy o consideration by policymakers and CSRpractitioners in planning the way orward.

I convey my best wishes to all stakeholders in the journey ahead.

Dr BBL MadhukarSecretary GeneralBRICS Chamber o Commerce & Industry

Dr BBL Madhukar, Secretary General, BRICS CCI

Message

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As Convener o Centre or CSR, BRICS CCI and CEO, Educomp Foundation, I am really proud to be associatedwith the release o the compendium. Te compendium is a proo o the act that while we have a long way to go, thenumber o corporates who have ventured into CSR and the number o corporates who have started integrating CSRinto their business strategy are indeed growing. I would like to express my heartelt gratitude to our MoS-FinanceMr. Jayant Sinha or taking out time to write a heartening message or our stakeholders. I also thank IICA and Sattvaor being our knowledge partner and Sattva Consulting or helping me put the threads together o the round tableconerence on CSR Feedback and Fast Forward.

I also thank the core team o Centre or CSR or helping me collate raw inormation. A final thanks to our socialmedia partner or uploading relevant inormation appropriately. I convey my greetings and good wishes to all thosewho have been associated with CSR activities as uture o CSR in India is truly promising.

I wish a speedy progress o the CSR cause in India. Let CSR move ast orward.

Dr Sushi Singh,Convener, Centre or CSR,BRICS Chamber o Commerce and Industry

Dr Sushi SinghConvener, Centre or CSRBRICS Chamber o Commerce and IndustryCEO- Educomp FoundationEx Director-International Exchange ProgrammeGDGWI | Lancaster

Preface

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BRICS CCI, CENTRE FOR CSR IICA

CSR COMPENDIUM

Executive Summary

BRICS-CCI CENRE FOR CSR with the support o Indian Institute o Corporate Affairs and Sattva, is putting togethera compendium on the theme o the round-table on CSR Feedback & Fast Forward with special emphasis on healthcare.

Te Knowledge product o the conerence will discuss issues and challenges aced by different stakeholders in the process oimplementation o Corporate Social Responsibility policies (Section 135 o Companies Act, 2013), various collaborativerameworks adopted by different corporate organizations and ocus on leveraging CSR unds in the health sector.

Interviews with experts and practitioners rom the healthcare sector, and case studies outlining innovative models o CSRinvestments in the healthcare space are among the highlights o the compendium.

Further this compendium supports the philosophy that good health is vital, at the very core o existence and it must start withpreventive health. Tereore, this insightul compendium would bring together the initiatives o responsible corporates aswell as NGOs engaged in providing quality health care to the underprivileged while promoting the belie that considerablepositive change can occur when like-minded stakeholders collaborate and nurture projects that are scalable, ensuring a longterm impact.

At present, when it seems that health has been in need o attention at all levels, public-private partnership can help us accelerateprogress and achieve the goal o affordable healthcare to every citizen o the country. It is in this context, the BRICS CCI,Center or CSR and IICA CSR Compendium is an effort to have a transormational impact on providing opportunities orall citizens to lead a healthy and happy lie.

As the reporting cycle o first year o this CSR revolution draws to a close, this compendium shall come out as an inormativeand insightul resource or CSR practitioners and all other National and International stakeholders.

Copyright @Convener, BRICS CCI-Center for CSR

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Sattva means essence or balance in Sanskrit.Sattva is an advisory, implementation and knowledge firm ocused on co-creating inclusive businesses that are sustainable,scalable and global.Sattva envisions the mainstream business ecosystem and the social impact ecosystem as a continuum and there is a growingtrend across both ends o the continuum to converge in the middle. Progressive corporations worldwide have started toview social impact as an integral part o their long-term sustainability strategy. Social organisations are working towardsachieving financial and long-term sustainability in order to scale their impact on the ground. We aim to serve as a bridgeacross varied stakeholders to co-create these inclusive business models that are scalable, sustainable, and globally relevantby design.Our work with BOP communities today spans across 16 states in India and we are engaged with leading multi-laterals,

social organisations and corporations across the globe.More at www.sattva.co.in

Te Indian Institute o Corporate Affairs (IICA) is the principal institution engaging with all aspects o the corporateworld in India, is established by and affiliated to the Ministry o Corporate Affairs, Government o India. It serves as athink-tank, action research, service delivery and capacity building institute or all corporate entities and proessionals.Te National Foundation or Corporate Social Responsibility (NFCSR) housed within the IICA, is the premier centreor enabling CSR in the country. In light o the enactment o Section 135, Companies Act 2013 on CSR, it has become anationwide mandate. Tis has led to a burgeoning demand or trained CSR proessionals rom companies that all withinthe purview o the Act as also or the Implementation Agencies that would be engaged. In order to address this need, theLearning & Development (L&D) Vertical at the NFCSR, IICA has developed a wide range o knowledge disseminationprogrammes that include capacity building, action research, and advisory services.Indian Institute o Corporate Affairs (IICA) - www.iica.in

Brazil, Russia, India, China and South Arica have emerged as the protagonists in the world economy significantly andrapidly. Te BRICS Chamber o Commerce and Industry is a parent organisation which promotes commerce and industryin the BRICS nations. Te objective o BRICS CCI is to create an enabling support system especially or MSME segmento business and young entrepreneurs rom across all geographies. While the BRICS nations will remain at the centre o allactivities, the chamber has taken in its credo to reach out to and enable young entrepreneurs rom other riendly nationstoo. It proposes to be the voice o young entrepreneurs and champion their business success.Visit http://www.bricscci.com/brics-cci/

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Contents

Public Healthcare in India:the ground reality

Te iron triangle o Access, Affordability and ualityHealthcare deliveryInrastructure

PeopleMedicinesechnology and ele-medicineAwareness and EducationOther Areas

Corporates and healthcare CSR:Approach and models to work together

Ravichandran Natarajan, Narayana HealthDr. R. Balasubramaniam, SVYM

Recommended areas of focus for healthcare CSR

Maternal HealthInant and Early Childhood Health CareB, HIV/AIDS, Malaria and Communicable DiseasesNon-communicable Diseases (NCD)AddictionWater and Sanitation (WASH)Adolescent and Reproductive Health

I.

II.

III.

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10

11

11

1214

16

17

16

1922

34

32

31

28

29

35

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Public healthcare in India:The ground realityI

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Ensuring the health and wellbeing o citizens is one oIndias oremost needs. Te United Nations has projectedthat Indias population will reach 1.45 billion by 2028,making it the worlds most populous nation surpassingChina. With the advantage o being the largest countryo young people (64% o Indias population will be in the

working age group by 2020) juxtaposed with the challengeo 168 million people in the geriatric age group by 2026, iIndia wishes to leverage its demographic dividend, then it isimperative that it nurtures a healthier population.

Te 12th Five Year plan on health says health should not beviewed as the absence o disease but as a state o completephysical, mental and social wellbeing. Yet, the healthcarestatistics o India presents a less than happy picture

1WHO Health Profile or India2National Health profile :20153WHO report, 2012

Te shortalls in the public healthcare system in India arewell documented: just 4% o the Gross Domestic Productbeing spent on healthcare which is low by all benchmarks,unaffordability o health access or a vast majority, highdisease burden rates among the poor, chronic lack o accessto clean water and sanitation that compounds the problem.

Tere is a lack o awareness o preventive measures, all owhich trap many in a cycle o debilitating malnutrition anddisease.

Rural Healthcare in particular operates through a unnel oawareness and promotion, prevention, diagnosis, treatmentand compliance. rained and incentivised human resourcesare required across this entire unnel to ensure effectivedelivery. Yet the ratio o practising doctors, healthcareproessionals and nurses to the population has allen to 1.4per 1,000 in India, ar below the World Health Organization(WHO) norm o 2.5.

Disease burden

Communtiy health workers

Doctors

Nurses

Beds

Lab technicians

20%

9%

8%

8%

6%

1%

Indias share in global disease burden vs. share of global healthcare infrastructure

India carries 20% o the worlds disease burden,including being the diabetes capital o the world1

About 75% o global deaths are due to communicable

diseases, o which India accounts or 17% 30% o Indians dont have access to primary healthcareacilities2

85% o healthcare expenses in India come out o thepocket

About 39 million Indians all below the poverty lineeach year because o health shocks

About 70% o Indians spend all their income onhealthcare and buying drugs3

Te healthcare needs o 47% o rural India and 31% ourban India are financed by loans or sale o assets4

Te country aces three key challenges in deliveringuniversal healthcare: ensuring affordability, accessibilityand quality o healthcare services.

A challenge and opportunity inUniversal healthcare

Much can be said o the progress in healthcare initiatives inthe last decade: the National Rural Health Mission set upby the Government in 2005 is one o the most noteworthyinitiatives in public health. Te 1983 drafing o the NationalHealthy Policy provided impetus to primary healthcareand has helped map the length and breadth o the countrywith PHCs (unctional or not). Te healthcare industryhas emerged as the second largest service sector employer,and private sector partnerships through PPPs in health aregradually gaining acceptance.

Source: Indian Healthcare Services, Asia Pacific Equity Research, J.P. Morgan, via Tomson research database, accessed July 2015.Inographic adapted rom KPMG FICCI R eport on Healthcare: Te Neglected GDP driver

ity

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Tere has been increased private sectorparticipation in health provision with a orecasto health being a $45 billion industry and medicaltourism poised to grow significantly. Te trendwith the most potential or transormationalimpact is the uptake o mobile phones India

currently has 900 million mobile subscribers, thehighest in the world, and internet penetration issteadily growing, providing a huge opportunityto reach out to populations to spread awareness,diagnosis and treatment through technology-based solutions5.

Te Universal healthcare goal laid down by theNational Health Mission and all State missions,presents a huge challenge and an equally hugeopportunity or partnerships and solutionsthrough innovation and entrepreneurship by bothpublic and private players.

Opportunities: Supporting the delivery of qualityhealthcare that is both affordable and accessibleTe value chain o healthcare delivery presents 6 points o possible intervention and partnershipsor corporates, in line with the key gaps and challenges aced by the public healthcare system today:

Health infrastructure (including transport) People Medicines Awareness and Education Health Financing Technolog y and Tele-medicines

5 IAMAI June 2015

While taking care o effective delivery to thelast mile, there is a need to take into accountthe iron triangle in healthcare: the case oinfinite need and finite resources. In the belowfigure, each o the vertices represents identicalpriorities. Increasing or decreasing one resultsin changes to one or both o the other two.Corporates, with their expertise, technologyand other resources at their disposal, can work

towards measures that can achieve a balance oall 3 access, affordability and quality.

Efficiency/ Cost Containment

High Quality Care Patient Access

The Iron Triangle of Health Care

Balancing Act among Intermediate Outcomes

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Health inrastructure can be broadly split into two parts:educational inrastructure and service inrastructure.Educational inrastructure covers medical and dentalcolleges, nursing colleges, AYUSH institutes, and

paramedical institutes and pharmaceutical colleges.Service inrastructure includes allopathic hospitals,Indian systems o medicine and homeopathic hospitals,sub-centres, public health centres (PHC), communityhealth centres (CHC), blood and eye banks, mentalinstitutions and cancer hospitals.

#1: Health infrastructure

6 Challenges in Indian Healthcare industry Pratap Reddy, Apollo Hospitals (http://www.dnaindia.com/money/column-government-spending-andprivate-investments-in-healthcare-is-need-o-the-hour-prathap-c-reddy-2005322

Beds

Hospitals

183602

492177

3490

16816

Urban

Rural

Provide gap funding and support to PHCs throughpartnering with competent NGOs: o target the BOP, wehave robust PHCs in the country but they are not workingeffectively, and this is an opportunity to partner. Karunarust works with PHCs in 6 different states, reaching1.5 million people. Government provides inrastructure

and we completely take charge o the PHC operation,including manpower, access to medicines, technologyor diagnosis and ollow-ups or tracking. Governmentpays 90% in some states, we add something to it and runthe PHC. Tese PHCs need gap filling and that is whereCSRs can contribute. Te bigger value o this contributionis being a ulcrum to get the government money to beutilised in a better way, says Dr. H. Sudarshan, oundero the Karuna rust.

Opportunities for CSR

On the service inrastructure ront, India needs to investheavily in beds and diagnostic equipment. Te lack oadequate beds in the urban areas is a rising concern. Indiahas 67557913 beds in government hospitals, at a ratio o

one bed or 61,011 people. o match bed availability tothe standards o more developed nations, India needs toadd 100,000 beds this decade, at an investment o $50billion6

Conduct activities in liaison with the Government:Corporates could carry out health or nutrition camps,but only the Government machinery can sustain it. Myrecommendation is to execute along with a Governmentliaison officer always or ollow-ups. Te officer isin complete touch with the Anganwadi, including

monitoring supplies, being in touch with the participantmothers etc. I there is shortage o supply, you can stepin to supplement the situation. Your costs may go up by15%, but impact will be 5x due to constant ollow up andworking with existing systems, says Sandeep Ahuja, CEO,Operation Asha.

In addition, unding and support or hard and sofinrastructure, including mobile health clinics, EmergencyResponse Systems, ambulances, are areas where CSR undscould be utilised to strengthen the existing inrastructure or

create a more affordable equivalent.

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Educational inrastructure has grown by leapsand bounds in the last 10 years, but it is still notenough. Te World Health Organization (WHO)

mandates a minimum o 2.5 doctors per 1,000people; India has 0.7 physicians per 1,000 people7.Te 12th Five Year Plan talks about setting upsix institutions like AIIMS (All India Institute oMedical Sciences) and upgradation o 13 medicalcolleges under the Pradhan Mantri SwasthyaSurakhsa Yojna. Additionally, 72 state medicalcolleges have been chosen or strengthening post-graduate programs.

o even come close to the global average, Indiahas to double its capacity o physicians andnursing proessionals. Te distribution o doctors

and nurses in the service ecosystem is extremelylopsided, primarily due to the lack o adequateeducational inrastructure in certain states. Tedoctor to population ratio in the rural areas is atleast six times lower than that in the urban areas.

#2: People

7,8 12th Five Year plan

Density of health workforce (per 10,000 population)

Global

Europe

America

South East Asia

India

0 10 20 30 40 50 60 70 80 90

4.5

21.5

28.6

13.9

6.880.2

32.1

7.244.9

3.815.3

5.9

517.1

7

Physicians

Nursing and midwife Personnel

Pharma Personnel

Data: 12th Five Year Plan

Based on the 12th Five Year Plan, the current nurse: doctor ratio is 1.68.Te ratio is expected to change to2.4 by 2017. Te desired ratio is 3.

India has added 90,000 ASHA workers under the National Rural Health Mission, but there is much to be done in building their capacity,providing support with technology and incentives. Pic: OpAsha

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Te table below illustrates the current availability o resources, the expected availability by 2017 and the gap in educationalinrastructure, which has to be bridged to attain the desirable density.

I the required number o colleges is sanctioned, then thetotal density will be up to 398 resources by 2017 but theheavy emphasis on physicians and nursing proessionals isthe need o the hour. On the basis o the 11th Five YearPlan, 40% o PHCs, 65% o CHCs and 69%9 o districthospitals have co-located AYUSH acilities. Tis is a goodstart and it helps provide manpower in the last mile.

India has a 3-tier cadre o trained Community HealthWorkers (CHWs), who orm the backbone o publichealthcare delivery, especially in rural areas and or manyo the critical health outcomes the country is gunning or:

Te Anganwadi Workers - Honorary emale rontlineworkers trained in health, nutrition and childdevelopment

Auxiliary Nurse Midwives (ANMs) Tey perormmultiarious activities including health education,treating minor ailments, maternal and child health andrecord keeping

Associated Social Health Activists (ASHAs) whoare voluntary workers and serve as the interacebetween 1000 community members and the statehealthcare machinery and provide a range o servicesrom promoting use o health acilities, providingknowledge on healthy behaviors and dispensing basichealth products to their community.

During the 11th Five Year Plan, there was a considerableimprovement in healthcare personnel: ANM was up 27%,doctors up 16%, specialists up 36%, pharmacists up 38%and nurses up 119%. But the gap between the staff in

position and the staff required at the end o the plan was52% or ANM10and nurses, 76% or doctors and 58% or

pharmacists. Tis is primarily attributed to recruitmentdelays and irrational distribution o human resources.

Opportunities for CSRProvide training and capacity building for last mile health

workers:rained para-proessionals are the need o the hour inthe healthcare space. Corporates can work on creatingor supporting training programmes, awareness sessions,education and livelihood support or para-proessionals inthe healthcare sector. We have programmes or skill building in duty

attendants. Tese workers, ofen rom rural areas, canthen take up jobs anywhere in the healthcare space,says Mohini Daljeet Singh, head o Max Foundation.

Karuna rust works closely with ASHA workers toprovide regular orientation and training towardsawareness and detection communicable and non-communicable diseases as a part o its PHC program.

Te Vocational raining program o NH aims toempower school drop-outs and people who belongto backward or economically deprived section othe society and bring them to the mainstream andincrease their chances o employment through the skilldevelopment route especially in Allied Health Caresector in the role o support and technical staff.

We have 5 lakh AYUSH doctors that are graduatingevery year. Te only ormal skill they lack isPharmacology. I would strongly recommend a bridgecourse or this and integrate them with the publichealthcare system, says Ravichandran Natarajan,Head, Corporate Relations and CSR, Narayana

Health.

9 National Health Profile 20151012th Five Year Plan

Category Available(2011-2012)

Density(Per lakh)

AnnualCapacity

ExpectedAvailability(2017)

Density (PerLakh)

DesirableDensity

Collegesrequired

Physicians 6,91,633 57 42,570 8,48,616 65 85 240

AYUSH 5,34,091 44 30,000 6,42,386 49 49

Dentists 88,370 7 24,410 1,93,797 15 15

Nurses/GNM(general nurseand midwife)

7,43,324 61 1,78,339 15,08,684 115 170 500

ANM (auxiliarynurse andmidwife)

3,61,879 30 38,290 5,16,090 39 85 970

Pharmacists 4,92,923 41 1,00,000 9,18, 276 70 70

Total 241 354 474

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#3: MedicinesAvailability o essential medicines is a must to lowerOOP expenses. Te 12th Five Year Plan recommendsa comprehensive set o measures including revisionand expansion o the Essential Drugs List, ensuring the

rational use o drugs, strengthening the drug regulatorysystem and setting up o national and state drug supplylogistics corporations. Expansion o the Jan Ausadhinetwork o drug stores is also crucial in lowering expenses.Recruitment o trained pharmaceutical proessionals isessential or public delivery o drugs.

Opportunities for CSRDrug registry, subsidisation:Corporates, both medical andnon-medical can support the nations efforts in affordabledrugs procurement. Most o the pregnant mothers areanaemic but there are no iron tablets/tonics that can be

provided to them or a lesser cost and these medicinesare expensive. According to a research, i the entirecountrys medicines are ree o cost, it will only come upto around 5000 crores (approximate). Patents are anotherissue we are fighting, as all medicines become expensive.Te solution is that everyone including private, publicinstitutions, not-or-profits, diagnostic institutions etc,comes together. What we need are about 600 essentialdrugs but we have more than 1 lakh medicines in themarket, says Dr. H. Sudarshan.Support traditional medicines: Each o Karuna rustsPHCs have a medicinal garden, used to prepare medicinesand also make it available to the community. Ayurvedicpreparations are integrated in the PHC as opposed toallopathic medicines in order to make it affordable tocommon citizens.Support generics: Narayana Health is working withPharma companies to produce a generic line o drugs thatcan be sold at very affordable prices in all its electronicallymanaged e-health Centres across the country.

#4: Health fnancingTere is no country in the world where healthcare isentirely unded by the Government; co-payment models,subsidized treatments and private unding are critical orsustaining healthcare. About 22 crore individuals were

covered under health insurance in 2013-1411

. Tis isapproximately 18% o the total population. About 67%o them are insured under public insurance companies.About 72% o people are covered under insurance undergovernment-sponsored schemes.

Te low coverage in insurance is directly proportionalto the high OOP spending in India. Te per capitaOOP spending was Rs 146 a month in urban India andRs 95 in rural India. Over 60% o OOP expenditurewas on medicines. As a share o the total expenditure byhouseholds, OOP expenditure on health was 6.7 % inrural India and 5.5% in urban India.

Te highest share, rom the charts below, is on procuremento medicines; 90% o OOP expenditure on medicines wasrom non-institutional organisations, highlighting a hugechasm in the availability o medicines in rural and urbanareas.

11National Health Profile 2015

Split of OOP Expenditure (2011-2012)

7%

12%

7%

6%

89%

8%

99%

7%

MedicineDoctor/ Surgeons fee

Other medical expensesX -Ray ECG Pathological test etc.Doctor/ Surgeons fee

Rural Urban

Data: 12th Five Year Plan

68% 61%

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Flagship schemes or social protection in health have been:

CGHS, a government health scheme or serving/retiredcentral government personnel and their amilies. Itcovers about 0.37 crore people; the expenditure on thesame was Rs 1,839 crore in 2013-14.

Te ESIS Scheme, a contributory scheme and theexisting wage limit on coverage is Rs 15,000 per month.Te number o beneficiaries covered under this schemeis 7.58 crore.

Rashtriya Swasthya Bima Yojna, a central governmentscheme launched in 2007 to provide insurancecoverage or BPL (below poverty line) amilies. RSBYis a cashless scheme and covers public and privatehospitals. Currently, 3.3 crore people are covered under

this scheme. Te annual expenditure on this schemewas Rs. 888 crore in 2013-14.12RSBY is one o thepriority items in the 12th Five Year Plan. Te intent isto increase the coverage o resources under MNREGA(Mahatma Gandhi National Rural EmploymentGuarantee Act).

Opportunities for CSRSupport state-sponsored schemes:Healthcare is largely a Stateprerogative in India, so or strategic reasons, I would ocuson supporting State-sponsored schemes and programmes.It would help as there is adequate political will around theissues, as well as the money travels urther. Education andhealthcare are two sectors where the marketis not going toully provide and neither is the Govt. So rom a sustainabilityperspective, anything that CSR supports should be workthat can be carried orward by the State, says Kaveri Gill,Chie Economist at the Oxord Policy Management, Indiaoffice.Secondary/tertiary care subsidisation: Te need o thehour is subsidising unaffordable secondary/tertiary care,

just as we invest in tackling primary care so that it doesntcome to secondary/tertiary stage. As a corporate, here iswhere we need to step in with our resources and expertiseto help the underprivileged. At MAX, a large portion oour CSR goes towards ree/subsidised cataract operations,pediatric cardiology, surgeries in MAX hospitals, especiallyor children, says Mohini Daljeet Singh, Head, MAXFoundation.Subsidise insurance: Tere is no country that has achieveduniversal healthcare coverage through insurance. Privateinsurance can make provisions or subsidised insurancealongside regular insurance, but this would require stringentregulations or CSR spend as opposed to market creation,says Kaveri Gill.

11National Health Profile 2015

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#5: Tech for Healthelemedicine is a ast-emerging sector in India. In 2012,the telemedicine market in India was valued at $7.5million, and it is expected to rise 20 percent annually, to$18.7 million by 2017. elemedicine can bridge the rural-

urban divide by extending low-cost consultation anddiagnostic acilities to the remotest areas via high-speedInternet and telecommunications. In addition, Indiassolid mobile technology inrastructure and the launcho 4G is expected to drive mobile health (mHealth)adoption. Currently, there are over 20 mhealth initiativesor spreading awareness o amily planning and otherailments the industry is expected to reach $0.6 billionby 2017.

A comprehensive HMIS would help in the smooth flowo data and analysis o data in a decentralised manner.Tis is one o the high priority agendas in the Five Year

Plan. Electronic medical records, even in private hospitals,are rudimentary to say the least. Inormation sharing isminimal and there are no central data standards. Te 12thFive Year Plan proposes to have a standardised rameworko data collection, system integration and scheme levelintegration. Human resources and financial managementsystems are to be integrated to ensure transparency andaccountability.

Opportunities for innovation in technology

echnology transcends over and above just a CSRprogramme it is a tremendous opportunity or corporatesto innovate and develop varied lines o new businesses,

products and solutions based on healthcare-technologyor the BOP. 3 immediate areas where corporates canstep in to support tech or health either through unding,resources o strengthening solutions are the ollowing:

Technology for healthcare workers:echnology cannot work with the exclusion o humanbeings. One is in complement to the other and this is howopAsha works our technology aids our health workersin delivering care effectively. We need to ensure that allstakeholders realise there is tangible impact and outcomesthrough using technology. Humans respond to humantouch and not SMSes. So, technology at the BOP has to

be accepted by the customer or the user.Out o OpAshas workers, 30% o the workers have onlystudied upto Class 4. Tey serve totally illiterate patientsand we are proud to deliver the best results in healthcare.Same technology is now being used to reduce dropoutrates in secondary schools and pharma companies todistribute medicines. For eg: Every small thing is recorded

Preventive healthcare is an important dimension o health

that needs significant attention and investment rom allsections o the society. It is a national health priority and anotified area under Schedule VII o the CSR Section 135 othe Companies Act.

Preventive healthcare directly improves health, wellbeingand productivity o the community, amilies and individuals,and promotes equity by benefiting most the disadvantagedand marginalised groups. It covers range o public healthactivities ocused on prevention o diseases, promotion ogood health and strengthening o health systems.

According to the welfh Plan, health services will be

delivered with seamless integration between Primary,Secondary and ertiary sectors. Te Primary Health Carewill be strengthened to deliver both preventive, publichealth and curative, clinical services. PHCs and Govt.programmes in awareness and preventive health are someo the nodal points in carrying out preventive healthcareactivities.

#6: Awareness andeducation

and reminded by tech. I the patient is due or an injection,an SMS alert goes out immediately and within 24 hours,the program manager has to rectiy the same there is aphenomenal eedback loop system. Our workers donthave to remember anything the entire set o WHO/Bcontrol program standards are being delivered by illiterate

community health workers with the aid o technology.Once technology scales up reasonably, it becomes veryeasy or CSRs to scale and start getting involved inhealthcare whether through unding, material supportor in replicating/scaling the reach o the tech says SandeepAhuja, CEO, OperationAsha.

Tele-medicine: Narayana Health has the largesttelemedicine network o 800 centres in India. Tenetwork perormed 3.4 lakh tele-consultations in 2012.Tis was easible due to the unique partnership withIndia Space Research Organisation, which provided high-speed satellite bandwidth. Tis allows delivery o superspecialised healthcare to rural districts without the need

to set up physical inrastructure.

Low-cost diagnostic tools:ouchHb is a Biosense product that enables anaemiadetection through a non-invasive battery operated device.Tis is extremely useul in rural areas as anaemia is one othe major reasons or maternal mortality here.

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Opportunities for CSR Immunisation, screening, detection camps:Te biggest

gap is in awareness and education, and by doing thiswe can significantly cut all healthcare costs. Weregularly screen health films, hold talks, stage nukkadnataks etc to help drive awareness and behavioural

change. Knowing that cancer in the subsequent stagescosts a lot more or treatment and cure than detectingearly, we ocus on changing mindsets and behaviourstowards getting regular screenings, says MohiniDaljeet Singh.

Awareness around water and sanitation: 60-70% othe diseases in rural area are water-borne: dengue,malaria, all communicable diseases are waterborne. Byocusing on clean drinking water and better sanitationpractices, we are hoping that the diseases come downdramatically, says Ravichandran Natarajan, NarayanaHealth, while Mohini Daljeet Singh says that waste,water and sanitation initiatives are precursors to anyhealthcare CSR programme.

Awareness and education presents an array oopportunities or CSRs in healthcare, rom healthand screening camps to immunisation, schoolprogrammes, community education, adolescenthealth and sex education, maternal health etc. Te coreo running awareness programmes, as pronouncedby all experts, is that there should be continuity andregular ollow-ups.

#7: Other Areas Goernance in health: Tere is an acute need or

regulatory rameworks in India. Non-standardisedhealthcare delivery is the norm in the country. Drugregulation is one o the talking points in the 12thFive Year Plan. Mandatory use o generic namesor essential drugs, strengthening o drug testinglaboratories, pharma vigilance, regulations on pharmamarketing, monitoring o irrational prescription ofixed dosage drugs and disclosure o ingredients arepriorities o the central government.

Funding shortfall in Govt. spending: My belie is thatNGOs should only do awareness and mobilisation

to. Corporates should find a way to und and workwith existing Govt. inrastructures through the right

NGO partners especially in areas where the Govt.has cut back unding. For eg: in the ICDS, PHCprogrammes, says Dr. Vanita Vishwanath, ormer-CEO o Udyogini

Support registration of medical establishments: A centralAct or the registration o all clinical establishmentshas been mandated. Some states do have registration,but huge data gaps mean that the central Act willtake precedence over the state registration Act.Networking o all clinical establishments is also amandate o the 12th Five Year Plan.

Sanitation financing discussions among SHG members. Pic:Wikimedia, ESAF-MF

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Corporates and healthcare CSR:Approach and models to work together

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Te healthcare outreach initiatives bycorporates and industry bodies in Indiaare happening in pockets. Tese multipleCSR (corporate social responsibility)activities have to converge in one placeand speak in one voice or better impact inthe community, advocates RavichandranNatarajan, Senior Vice-President andHead, Corporate Social Responsibility,Narayana Health, a pioneering healthcareinstitution established by Dr Devi Shetty.

A leading Global Health Organization hastermed healthcare initiatives in India as agraveyard o pilot projects. We have islandso excellence. Multiple parallel activitiescarried out by corporates, innovators,NGOs and multi lateral agencies butthese efforts have to consolidate. It wouldalso be great to see industry and tradebodies like FICCI (Federation O IndianChambers o Commerce and Industry),CII (Conederation o Indian Industry)and other aggregates o companies come

together, assess and identiy the top issueso the state/district/region supported bya credible baseline research, prioritize the

issues they will address and tackle themas a group rather than as individuals, saysRavichandran, who has been a part oseveral consultations and expert groupswith CII and FICCI to develop models orcorporates in healthcare delivery.

Ravichandran has spent over 26 yearsin profit centre management, productdevelopment, marketing, training, marketdevelopment, customer acquisition and

relationship management in investmentbanking and related sectors beore hetransitioned into the development sectorrole at Narayana Health (NH).

NH has made tremendous strides inreaching out to the weaker sections osociety through its CSR efforts in mobileand tele-medicine, promoting educationalacilities to create talent in the medicalfield and addressing the accessibility andaffordability challenges in public health.Ravichandran has been an integral part

o these efforts to evolve prototypes thatbenefit the community at large.

Mr. Ravichandran NatrajanHead, Corporate Relations & CSRNarayana Health

Ravichandran Natarajan, Narayana Health:Corporates must focus on primary healthcare for better living

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Mindset change need of the hour

Historically, Corporates have ocused on certain areas as part o CSR and they continue to invest in them. But not even20 per cent o corporates have a vision towards holistic healthcare. Tis is what I am striving to change.

Ravichandran cites a nationalised bank that is doing great work in healthcare, but doesnt have a programme beyondsponsoring ambulances. While it is hard to go back to the drawing board and re-think strategies, my recommendation tothem was, with their sizeable budget, they can start looking at a larger objective in overall healthcare.

NH recently conducted a roundtable with a large corporate that was doing community related activities around itsactories. A questionnaire NH administered among the industry workers revealed that there were little understandingo the major issues in the community around the actory. Understanding the community is the first step towards anyimpactul intervention. Afer three to our months o conversations with the company, NH managed to evolve a structuredcommunity involvement programme that encompassed healthcare, nutrition, sanitation education and livelihood.

Historically, corporates have focused on certain areas as part of CSR and they continueto invest in them. But not even 20 per cent of corporates have a vision towards holistic

healthcare. This is what I am striving to change.

Understand community needs

Ravichandran talks o a pilot project in North East, where a comprehensive pre-project qualitative survey is being doneacross a population o 90,000 through ocused group discussions (FGD) among all key stakeholders in partnership with aleading healthcare research organisation.

We are trying to understand the communitys priorities and what they care or. We did an initial analysis through publiclyavailable data (health and population surveys) and ormulated some hypotheses and then reconfirmed these throughFGDs. Tis means much lesser cost and time taken towards implementation o the programme. In six months, we willhave a structured ramework that can work as an off-the-shel model or need assessment within any community beoredeploying a CSR programme.

Ravichandran is a vocierous advocate o tackling healthcare through addressing it as a whole, including issues o waste,

water and sanitation.

A clean energy automobile company in India ran a commendable CSR program in 18 villages in the Karnataka-Keralaborder. Te ocus was on water; Reverse Osmosis (RO) community water treatment plants were set up. Over time, a co-payment model or the community turned out to be unsustainable and the plants were on the verge o being shut, saysRavichandran.In North East NH is anchoring a project towards setting up a water plant, as the water in the region is very toxic. About60-70 per cent o the diseases in rural areas are water-borne, be it dengue, malaria or other communicable diseases. Bycorrecting the water situation, the disease burden will come down dramatically as preventive measure.

We located a water program carrying out gravitational filtering mechanisms with reverse osmosis without power orfiltration. Electricity is one o the biggest issues in rural India. We are looking at this as a community-supported unit amodel that is sel-sustained with the capital payment by the corporate rom their CSR unds and the annual maintenance

will be by the community through a small pay-as-per-use model.Commenting on the prolieration o health camps in the country, Ravichandran says there is very little data on the outcomesrom these camps. How many people were detected with serious illnesses? Were there ollow-ups on treatment or trackingrom diagnosis to final cure? In the absence o this ollow-through, numbers like one lakh health camps do not indicatethe effectiveness o the healthcare delivered.

Technology is critical for large-scale delivery of quality healthcare

NH has been at the oreront o deploying technology in healthcare delivery. oday, it offers the biggest tele-medicineservice in the country. Started in 2002 as a partnership with Indian Space Research Organisation, NH offers a seamless eleECG service supported online by cardiologists.

Tere is a cultural acceptance issue when it comes to using technology. Patients are so used to seeing the doctor in person.We have observed that the doctors need to first come in person and visit the patients. Gradually, the technology must beintroduced, he says.

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o tackle this issue, NH has tied up with over 700 General Practitioners across the country to reer healthcare problems andensure that CSR efforts reach the underprivileged. NH is currently working along with Hewlett Packard on a technology-based primary care model through e-health centres. Clinic boxes are developed rom shipping containers measuring 20*6sq. eet. and put up in resource deprived rural locations. It is urnished with five stations: registration and vital capture,consultation, ECG, tele-consultation and diagnostics. Tis is linked to an electronic medical record (EMR). Te moment apatient steps in, the EMR captures and updates every data, right rom the photo to vitals such as temperature, pulse, BP etc.Tis technology is not person-dependent and is easy to reer to, through helpul drop-downs.

All diagnostics are done through dry-chemistry tests one drop o blood is sufficient. We just insert a strip with the bloodsample into the station and it automatically uploads readings into the patient EMR , says Ravichandran.

Another issue is o enabling easy access to drugs. Te same company delivers different brand names o drugs in differentstates. Prescriptions have to be uniorm and local in context. Te name o the drug must be clearly given. We have collaboratedwith local chemists to deploy medicines. We are talking to pharma companies to give a generic production line or our e-healthcentres, so that we can bring down the costs o the drugs even urther.

Primary Healthcare should be the biggest focus area

While Indias public healthcare structure is quite appropriate, with unctionality o the same being an issue, the country isprioritising on building big hospitals and tertiary care units, points out Ravichandran.

At Narayana Health, a good portion o the patients rom lower economic backgrounds come to tertiary care units witha primary care illness these could have been stemmed right at the Primary Care level itsel. Since Primary Care deliverysystems are non-unctional, with the perception & confidence level being low, people travel long distance to get to tertiarycare to get treated or primary care issues. Tis drives up healthcare costs.

In the new draf o the National Health Policy 2015, , primary care is being provided a much higher per cent weightage; thereis a ocus on allocations in the budget towards primary health care. Supporting primary healthcare means not just stemmingthe flow to tertiary care units, but also nipping the problem in the bud itsel, leading to affordable healthcare and better living.

Work with the government

Ravichandran is o the view that the government is a necessary partner in change. I healthcare initiatives take off suddenly,

where are the implementation agencies? We cant keep the government out o it they are the biggest providers, he says.

Help train and equip last-mile healthcare workers

Indias acute shortage o doctor and nurses is well known. According to Ravichandran, this shortage is also a result oinefficiency. Karnataka has made it mandatory or doctors to go to rural areas or one year or apprenticeship. Why dont wemake it completely mandatory or everyone? We have a large number o AYUSH (Ayurveda, Yoga and Naturopathy, Unani,Siddha and Homoeopathy) doctors graduating every year. Teir only inadequacy is pharmacology training to be eligible topractise allopathy in primary care why cant they be given as a bridge course? Tat way we are fixing the gap o doctors tothe primary care value chain.

NH is partnering with HSSC(Healthcare Sector Skills Council) under NSDC(National Skill Development Corporation)

to impart Vocational raining in Nursing and Paramedical Courses with very short durations. 24 job roles have been createdby the Council. NH in partnership with leading corporates, stage govt skill missions and implementation partners intendsto train large number o rural unemployed youth rom backward states and help provide employable skills in the healthcareindustry. Tis will effectively address the major gap in jobs in the Nursing and Paramedical disciplines in India.

Frontline health workers can be trained to transorm healthcare delivery, says Ravichandran. Tere are 2.7 lakh healthworkers but many o them have not attended a single training. o empower them requires advocacy, apart rom training. Tisarmy o rontline health workers can deliver wonders i they are motivated, trained and financially compensated.NH is partnering with a leading Corporate Foundation to upskill Nurses, paramedical staff and junior doctors rom a stategovernment in North East India.Tis training will help them recognise and locate symptoms o non communicable and communicable diseases and reer themto tertiary care or onward treatment.

Te approach and ocus to be towards a holistic approach in transorming Primary Healthcare in India that will serve well as

majority o our population lives in rural India.

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Corporate social responsibility inhealthcare gives maximum return oninvestments when it complements theability o the corporates to mobiliseresources with the competency othe on-ground partners, says Dr R.Balasubramaniam, the Founder andPresident o the Swami VivekanandaYouth Movement (SVYM,www.svym.org)in the state o Karnataka.Te CSR thinking should shif rommy responsibility to what can wecreate together or maximum impact.Tats where I believe the more excitingopportunities or innovation lie, says DrBalasubramaniam, who has been engagedin the areas o education, public healthand ood security or over three decades.

Under his vision, SVYM has workedtowards achieving health and happinesso displaced, dispossessed, and

disempowered people in the tribaland rural belts o South India. As aspecial investigator or the KarnatakaLok Ayukta, Dr Balasubramanaim hasinvestigated corruption in health andmedical education and institutionalcorruption and maladministration in thepublic distribution system.

Dr Balasubramaniam is a qualifiedphysician with interest in public healthissues. He has an MPhil in HospitalAdministration and Health SystemsManagement rom the Birla Institute oechnology and Sciences, Pilani and aMasters in public administration romthe Harvard Kennedy School, HarvardUniversity.

Edited excerpts rom an interview withDr Balasubramaniam on how corporatescan partner with non-profits to delivereffective healthcare on the ground:

Dr. R. Balasubramaniam,Co-ounder, SVYM

Te hospital in Saragur offers multi-specialty secondary care at an affordable cost to the rural and tribal populace.SVYM hospitals are recognised training centres or capacity building o entire gamut o health proessionals rom

specialists to grassroot workers. Pic courtesy: SVYM

Dr. Balasubramaniam, SVYM: Going beyondmedical care in healthcare CSR

The partnershipof corporates, non-profits and the localadministrative body canbring about huge impact.

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Healthcare CSR should go beyond curing diseases and look at the larger objective ofhelping people lead a healthier life.

What are the gaps in the public health care delivery system today?

Te government is constitutionally mandated to spend on citizens health and wellness. While the government proessesprimary healthcare, it has been spending a lot more on secondary and tertiary healthcare (78 per cent), when it is knownthat the returns on health are ar greater when invested in primary healthcare. oday, 85 per cent o healthcare costscome rom the pockets o common citizens; only 15 per cent is the contribution rom the government. Tis denotes ahuge shortall in our healthcare system.

Another big change is the transer o budget rom the Centre to the states, making states fiscally responsible or healthcare this has not translated to action on the ground. With devolving budget and responsibility to the states, the centralgovernment has cut back on its spending above 50 per cent, leading to a trap.

What are the various parameters in corporate social responsibility(CSR) in healthcare? How can corporates support public health?

Tere are three paradigms in healthcare CSR: Healthcare is more than medical care Healthcare is a collective responsibility (and there are various actors including the state, and corporates) Partnerships are critical in order to achieve the challenging goals posed by healthcare

Te pattern I see among corporates in supporting medical care includes hospital expenditure, medical equipment andree or subsidised surgeries. While this is much needed, I would urge corporates to examine healthcare beyond curingdiseases and look at the larger objective o helping people lead a healthier lie.

Tere are five areas where corporates can play a strong role in supporting healthcare delivery:

1. Affordability of healthcare: About 60 per cent o people routinely slip back into poverty because o a single healthshock in their amilies. Tis is where corporates can come in, either by being insurers, pooling in or insurance or micro-insurance schemes, providing a social security net or backing state-supported mechanisms to prevent people rom allingback into poverty.

2. Focus on integrated healthcare delivery:Corporates must look at the larger dimension o health and wellness thatgoes beyond treatment and hospital expenditure to exploring holistic ways o providing integrated healthcare throughinormed partners. Tese partners must be well-equipped to integrate the social determinants in health, includingsanitation, clean drinking water, nutrition, womens rights and other areas o healthcare delivery.

3. echnology: A country as big as India needs huge innovation in technology to deliver effective healthcare and this isan area o opportunity or corporates, both medical and non-medical, to create products and solutions.

4. Demand-supply match: Tere is a demand-supply mismatch in public health inrastructure 80 per cent o Indiaspublic health inrastructure is government-operated. However, only 34 per cent o the population is using the same. Weneed to investigate and understand these supply-demand issues and work towards creating an ecosystem where both areevenly matched. On one hand, there is a need or building awareness among communities about the government utilitiesand on the other we need to hold the government systems accountable to deliver quality healthcare.

5. Governance issues: Corporates can invest in unds that look at health systems. We have very little governance

systems in place. Given the existing shortall in public health spending, this is not at all a priority or the government.

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Will aligning to the United Nations SustainableDevelopment Goals help design CSR objectives?

While big companies with sizeable spends on CSR can look at the broader canvas o integrated healthcare delivery, smallerones can look at single ocus areas that they eel strongly connected to. For example tuberculosis, palliative care, mentalhealth, cancer care and so on. Any project that impacts health o communities, especially over a long period o time willsurely have a bearing on the SDGs.

What kind of partnerships should corporates look at?

Corporates need to partner with the government or scale.

I would quote the example o a corporate that started working in the Bidadi industrial area outside Bangalore onhealthcare. Due to the alarming pollution levels and industrial reuse being dumped in the area, the disease burden is veryhigh among the workers and population here. No single corporate can make a substantial difference in such an issue. Mystrong recommendation is to try and orm consortia, pool in CSR unds, have one strong community-based organisationas an implementation partner and necessarily partner with the government. Te local Panchayats and other local bodiesare constitutionally mandated to deliver on healthcare. Non-profits can play the role o a knowledge or technical partner.

Te partnership o corporates, non-profits and the local administrative body can bring about a huge impact.

Are health camps a model for effective healthcare CSR? We see many

corporates conducting independent health camps.

Health camps afford corporates a view o community healthcare that seems very tangible. You can mark the number opeople mobilised; the repeatability o the same lends itsel to showcases. Yet, ofen there is very little ollow-through oncethe event is over. My strong recommendation or corporates is to conduct health camps only i they are able to ollowthrough with action and support on the diagnosis that emerges rom these camps, which then translates to supportingpeople with medical interventions, surgical or otherwise. Health camps have relatively less impact i they are seen asstandalone events, though they do create a lot o PR and visibility opportunities or the Corporates. Tey need to be seenas a starting point or long term engagement with local communities and as part o a well thought through process.

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Maximising the return on investment in healthcare CSR means being able to develop partnerships that matchthe ability o the corporate to mobilise resources, the emotional connect the corporates have towards the causeand the implementation competency o the on-ground partners that corporates work with.

CSR must base metrics on health outcomes rather than the extent o donations. It is ar more effective, interms o social return on investment, to look at how many people were detected with health conditions likeuberculosis using an X-ray machine in a certain health camp and how many o those cases were then trackedand cured completely over a period o time than to measure an output like one lakh spent on medicines. Tereare many standard metrics that can be measured: community engagement in healthcare, medical audits andgovernance metrics, leading up to the larger goals around inant mortality rate, maternal mortality rate andmore. Te metrics to be measured must be standard and delivery systems must be relevant to the local context.

How do you determine the impact of healthcare CSR?

What kind of partnerships have you seen workingon the ground?

Tere are 6 Rs that are critical to ensuring effective partnership o corporates and non-profits/implementationagencies.

Resourcesbrought to the table by both corporates and non-profit partners. For instance, the corporates

may bring in the unds and NGOs may bring in intellectual expertise and implementation competency.

Risksto the partnership must be acknowledged and shared. For instance, will the corporate continue supportand will the non-profit deliver effectively on the ground?

Roles:Each partner must have a role clearly defined based on their competencies and skill sets. Te partnersmust be willing to hold each other accountable to play these roles meaningully. Role definitions should alsoensure that there is a sense o air play, equality in the partnership and that the partners treat each other withrespect and dignity.

Responsibilities must be clearly determined and shared. Corporates must participate in more ways thansigning a cheque. Non-profits must collaborate to create effective channels or partnership.

Rewardsin terms o better healthcare delivery that are equally shared.

Reviewmechanisms must be tuned to the processes o both partners.

As a health proessional, I would ocus on establishing long-term institutional partnerships, strengtheningexisting public inrastructure and mechanisms, demand creation and ensuring optimal utilisation o existingservices. Tese, I believe, would create programmes that have a long-lasting impact on the health o thecommunity.

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Corporates have valuable resources, technology and expertise that could support in making a substantialcontribution to the healthcare delivery system in India. Under Section VII o the CSR Act, as specified bythe Companies Act 2013, we believe there are 7 strategic areas within the ramework o healthcare servicedelivery that CSRs can ocus on.

Each o these areas aligns with the Sustainable Development Goals (SDGs) laid out by the UnitedNations, the National Health Mission and 12th Five Year Plan priorities as well as WHO models.Tis section outlines the priorities in each o these areas, the status in India and quotes examples oprogrammes in CSR that have scaled up and made substantial contributions to the issue.

Te 7 areas we recommend are:

Maternal Health

Infant and Early Childhood Care TB, HIV/AIDS, Malaria and Communicable Diseases

Non-Communicable Diseases (NCDs)

Addiction

Water and Sanitation (WASH)

Adolescent and Reproductive Health

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Maternal Health

Te current maternal mortality rate (MMR) in India is212/1000 live births, which is a decline rom the baselinerate o 254 (200406 to 200709) by 5.8% per year andcomparable to that in the preceding period (a all o 5.5%per year rom 301, over 200103 to 200406), but wellshort o the Eleventh Plan goal o 100.

According to National Human Rights Commission, only30% o the population receives services through the publichealth system. Household consumptions choices that areofen unavourable to women as well as environmentalsanitation conditions, play a role in undernutrition,low weight, anemia and pose a risk to womens healthwhich assumes risky proportions during pregnancy andchildbirth.

Unavailability o regular pre and postnatal care andobstetric care as well as delays in approaching institutionalcare, coupled with poor quality o service in governmenthospitals, have contributed to poor maternal health.

Goals we are targetting

SDG

Te Sustainable Development Goal or maternal health is o reduce global maternal mortality ratio (MMR) to

less than 70 per 100,000 live births Address the nutritional needs o pregnant and

lactating women

National Targets

National Health Mission: Reduce MMR to 100/1000live births

12th Plan: uality antenatal care, skilled birthattendants, institutional delivery, sae delivery, post-natal care or women and child, and emergencyservices.

Anaemia, an underlying determinant o maternalmortality and low birth weight, is preventable andtreatable by very simple interventions. Te prevalenceo anaemia needs to be steeply reduced to 28% by theend o the welfh Plan.

Public health programmes

Te public health system has taken the ollowing measuresto ensure better maternal health: Conditional cash transer schemes like Janani

Suraksha Yojana or promoting institutional deliveries

Skilled Birth Attendants (SBA) who are adequatelytrained and posted so as to reach the maximumpopulation with skilled attendance at birth

Area-specific interventions such as equippingraditional Birth Attendants (BAs)/dais or sae

deliveries, especially in remote and inaccessible areas Integrating detection and treatment or conditions

like B and HIV/AIDS, and conditions likehypertension and gestational diabetes, with theReproductive and Child Health centres.

Programmes to address maternal malnutrition in the200 high-burden districts

Anganwadis as convergence hubs or delivery o allnutrition, early child care and maternal health related

activities Better tracking with the aid o Mother and Child

Protection Card, linked to the NSS network and tothe NRHM Mother-Child Cohort racking System

Opportunities for intervention

Companies can work on the critical maternal healthchallenges o anaemia, obstructed labour, hypertensivedisorders, sepsis, and care through Supporting programmes or proper antenatal care,

reerral and timely treatment o complications opregnancy, promoting institutional delivery and

postnatal care. Running regular awareness camps and supportingState-sponsored/non-profit resource centres thatprovide nutrition, supplements, best practices oreeding, counselling or reproductive health etc.

Creating or supporting low-cost devices or diagnosiso anemia and tracking o mothers till delivery andbeyond

Case studies of corporates workingon maternal health

Community health programmes for better maternal health

Corporation: Dr. Reddys Laboratories

Initiative:Dr Reddys Laboratories (DRL) has partneredwith the NICE Foundation on the Community HealthIntervention Program (CHIP). Te Community HealthIntervention Program (CHIP) is primarily ocused atwomen and children living in 54 villages o RanasthalamMandal in Srikakulam District covering almost a 74,000population. Dr Reddys is contributing Rs 3.50 crores todrive this social initiative over next five years with an aimto provide quality health care services at the doorstepso rural communities. Tese services shall be deliveredthrough mobile medical vans with a team o qualified

1.

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2.medical personnel, creating health awareness, providinghealth care and dispensing basic drugs.Geography:Andhra Pradesh

Reach:54 villages in Srikakulam district

Maternity centres in remote areas

Corporation: Glaxo Smithkline

Initiative: Along with the Institute or Indian Mother &Child (IIMC) a non-governmental voluntary organisation,committed to promote child & maternal health andliteracy, Glaxo runs outdoor, indoor and maternity centersin remote and most backward areas o West Bengal wherepeople do not have access to basic healthcare and medicalacilities. Tis project was started with an objective oproviding primary health care services to the villagers and

to support prenatal, neonatal and postnatal care or motherand child. Deormities, premature babies, malnutritionlike Kwashiorkor and Marrusmas were the commonphenomena prior to the project. Te project helps toprovide supplementary nutrition mixed diet to all pregnant,lactating and weaning mothers along with their newbornsand awareness. It also tries to reduce maternal mortalityrate by training raditional Birth Attendant (BA) or saechild birth.

Geography:West Bengal

Reach: Trough this project IIMC has been able to cover950 villages while catering to 300 mothers and 26000

malnourished children.

eSwasthya mobile medical vans

Corporation:Piramal Foundation

Initiative:Mobile Health Services (MHS) tackles barriersrural people ace accessing primary healthcare. PiramalSwasthya deploys mobile medical units vans equippedwith technology, medical devices, and medicine andhealth workers to villages where public health systemis not accessible. MHS primarily ocuses on chronicdiseases, maternal and child health and minor ailments

by providing screening and reerrals, patient education,medication, monitoring and ollow up, and tracking, alldone through EMRs (Electronic Medical Records). Each othe beneficiaries has an Electronic Medical Record (EMR),immensely helping on the clinical management o diseases/conditions. Digitised data enables manage the operationsas well as keep the quality o service to high levels. PiramaleSwasthya also partners with other CSRs to deliver maternaland inant health on their behal.

Geography:8 States o Karnataka, Chattisgarh, Rajasthan,Assam, Maharashtra, Odisha and Jharkhand.

Reach:ogether these programs have provided services tomore than 26 million people across 26,500+ service points.

Infant and EarlyChildhood Health CareIndias inant mortality rate (IMR) is 44 deaths per 1,000

live births, placing it significantly behind other emergingeconomies such as China (IMR o 16), Brazil (IMR o 17)and Russia (IMR o 9). Te Inant Mortality Rate (IMR)ell by 5% over the 200611 period, but is short o thetarget o 28. While seven states have achieved the target,IMR is still high in MP, Odisha, UP, Assam, and Rajasthan.

More than 2 million children die every year due topreventable illnesses. As per World Health Statistics report2012, India ranks 2nd in the field o underweight childrenbelow the age o 5 years. Birth at home by unskilledattendants, poor inant care and eeding practices, lack odetection o sickness in newborns and unsanitary conditionsare all contributing actors to poor inant health.


SDG

Te Sustainable Development Goals or inant health (0-5)are End preventable deaths o newborns and children

under 5 years o age, with all countries aiming to reduceneo-natal mortality to at least as low as 12 per 1,000live births and under-5 mortality to at least as low as 25per 1,000 live births

End hunger and ensure access by all people, includinginants, to sae, nutritious and sufficient ood all yearround

End all orms o malnutrition, including achieving, by

2025, the internationally agreed targets on stuntingand wasting in children under 5 years o age

National Targets

Reduce IMR to 25/1000 Reduce under-5 mortality rate to 42/1000 by 2015


Te public health system has taken the ollowing measuresto ensure better inant and under-5 care: Conditional cash transer schemes like Janani Suraksha

Yojana or better neo-natal care Home Based Neonatal Care (HBNC) through ASHAs

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to improve newborn care practices in the communityand to enable early detection and reerral. ASHAsalso promote ORS, breasteeding and other positivepractices

ICDS and anganwadis as a convergence platorm ordelivery o all nutrition, early child care and maternalhealth related activities

Better tracking with the aid o Mother and ChildProtection Card, linked to the NSS network and tothe NRHM Mother-Child Cohort racking System

Opportunities for intervention

Companies can work on the inant care challenges o earlycare, nutrition, detection o disease and immunisationthrough Supporting and improving State-sponsored resource

centres like the anganwadis (ICDS) that providenutrition, supplements, best practices or eeding etc

Capacity building or ASHA workers and ANMs ornutrition practices, awareness training, good hygieneand sanitation practices etc

Running regular awareness and immunisation campsand mobile camps/support Government camps,especially in areas which have little access to healthcentres

Creating or supporting low-cost devices or trackingearly childhood care Adopt villages and work to improve healthcare

indicators through various measures

Case studies of corporates workingon infant health and nutrition

ICDS improvement for better child nutrition

Corporation:Essar group

Initiative: Essar Foundation unded a project in 10blocks o Kambaliya district, Gujarat, seeking to improvethe nutritional status o children in the age group o 0-5in some o the most malnourished villages. Te projectstrategy was to leverage the existing ICDS structureand exclusively ocus on improving the status o severelymalnourished children.

Te ollowing were carried out: A physical assessment and grading to identiy

nutritional status o children Health checkup o children in yellow zone by the

medical officers o the PHC and those in red zone bypediatricians

Medical causes were identified and basic treatment aswell as reerral was done

High protein nutrition supplement along withnutrition education was given

Individual tracking o weight gain was done througha separately designed health card

Parents and caretakers were educated and mobilisedor improving the nutrition status o their children

Essars mobile medical units (MMUs), completewith skilled doctors and paramedics, are deployed invillages around Essar acilities. Tese door-to-doorhealth and healing acilities ensure neighbouringrural communities have access to quality and timelyprimary healthcare

Geography: MMUs have been deployed by theFoundation at all the companys locations o work. Tenutrition project was in 10 districts o Kambaliya, Gujarat

Reach:> 100,000 people.

Umeed protecting childrens heart health

Corporation: Fortis Hospitals

Initiative: Working with Mission Smile, UMEEDs areaso ocus include children suffering rom CongenitalHeart Deects (CHD), Clef Lip and Clef Palate (CLP),including medical interventions or children sufferingrom CHD or Clef Lip and Clef Palate. UMEED ensuresthat through early and timely medical interventions andpost-operative care, the child can lead a unctional, healthy

and ulfilling lie.

Reach: Te UMEED Congenital Heart Deectsprogramme, in collaboration with partners, has supportedover 5559 surgeries in the last decade. Cases treated inOctober 2015: 115

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3. TB, HIV/AIDS, Malaria& CommunicableDiseases

B kills 1 person every 2 minutes in India. India carries2.8 million B patients, 21% o the worlds B burden, yetthere are inadequate resources or treatment and cure.Against a target to halt and reverse the HIV/ AIDSepidemic in India, there has been a reduction o new HIVinections in the country by 57%. Still, an estimated 2.09million people were living with HIV/AIDS (PLHA) in2011.Other communicable diseases like Leprosy, Malaria, Kala-azar and Encephalitis continue to strike poor and remotecommunities in India.

Goals we are targettingSDG

End the epidemics o AIDS, tuberculosis, malaria andneglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

National Priorities

Incidence and mortality through B by 1/2 Malaria to


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4.Geography:India and CambodiaReach: OpAsha serves a population o 5.48 million

Kavach for HIV/AIDS among truck drivers

Corporation:CI

Initiative:With the Gates Foundation support in 2003,CI-F started Kavach, which today reaches through5500 IPC (Interpersonal Communication) sessions permonth which contacts around 61,000 truckers1000 media activities like plays, kiosks per month coveringaround 65,000 truckersKhushi and its satellite clinics that treat around 21,000truckers per month including 4,800 monthly SItreatments300,000 audio cassettes containing scripted messagesinterspersed with popular Hindi musicCI-F was chosen as the SG (echnical Support Group)by the government o India, or the nationwide truckersprogramme initiated by NACO rom April 2009. As aSG, CIF on behal o NACO, based on the learningsand experiences o Kavach, is replicating and up-scalingaround 131 interventions all across the nation.Reach: Across India

HIV/AIDS awareness for key stakeholders in thecommercial vehicle community

Corporation: Apollo yres

Initiative: Te companys HIV-AIDS Awareness andPrevention Programme is targeted at 4 key stakeholders employees, customers, business partners andcommunity. Under this, Apollo undertakes awareness andprevention sessions and provides voluntary, confidentialtesting and support. Te Programme has the largestootprint in India and South Arica. At both locations,ormally trained Master rainers rom amongst theemployees conduct awareness modules or theircolleagues as well as or the companys business partners.In India, the company runs 21 Health Care Centres inprominent transhipment hubs or the commercial vehiclecommunity. Each o these centres is equipped withqualified doctors, paramedic staff and counsellors, and

also has its own network o peer educators who work withthe community to effect behaviour change.

Non-communicablediseases (NCDs)

NCDs accounted or 60% o the deaths in India in 2014,according to WHO. NCDs will cost India 126 trillionrupees (roughly 2.3 trillion U.S. dollars) rom nowthrough 2030an amount that is 1.5 times Indias annualaggregate income and almost 35 times Indias total annualhealth spending.

Goals we are targettingSDGReduce by one-third premature mortality rom non-communicable diseases through prevention and treatmentand promote mental health and wellbeing.

National priorities

10 key ocus areas including policy, health education,diabetes detection and early screening, screeningor cancers, physical activities in schools, restrictedmarketing o unhealthy oods etc.

Strengthen AYUSH Integrate mental health checks or amily in

community health centres

WHO Global monitoring ramework on NCDs tracksimplementation o the NCD global action plan throughmonitoring and reporting on the attainment o the 9global targets or NCDs by 2015, against a baseline in

2010.

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Te National Programme or the Prevention andControl o Cancer, Diabetes, Cardiovascular Diseasesand Stroke (NPCDCS) was initiated in 100 selecteddistricts in 21 States as part o the 11th Plan

Policy interventions include raising taxes on tobacco,enorcing bans on tobacco consumption in electronicmedia, counselling or quitting tobacco, early detectionand effective control o high blood pressure anddiabetes, screening or common and treatable cancers

Public awareness about healthy oods

Opportunities for CSR intervention

Encourage better liestyle practices healthy diet,exercise, yoga, stress-ree lie etc through a variety ocommunity and company interventions

Awareness and screening camps or early detection odiseases

Free treatment/Subsidisation o secondary and tertiarycare treatment or those who cannot afford the highcosts

Capacity building among staff and personnel in ruralareas to detect and counsel or NCDs

Case studies of corporates workingon NCDs

Affordable treatment for NCDs

Corporation:Max Foundation

Initiative:Cancer care: Max India Foundation has partnered withCanSupport to offer palliative care to advanced cancerpatients rom disadvantaged backgrounds. CanSupportoffers ree services such as Home Care, Day Care,counselling and therapy through centres across Delhi andNCR, by a team o dedicated nurses, doctors and volunteers.Free surgeries: Max India Foundation through MaxHealthcare set up a hospital or the underprivilegedo Madhya Pradesh on board the Lieline Express inpartnership with Shrimant Madhavrao Scindia SwasthyaSeva Mission in order to provide reconstructive surgeries

and cataract surgeries. Max also conducts regular reepediatric surgeries and other secondary tertiary caretreatments at the Max Hospitals. Patients come in througha process o screening and detection through regular healthawareness camps conducted by Max with its NGO partners.

Geography:Delhi and NCR

Reach:5600 patients till 2014 through Lieline Express inMadhya Pradesh. 1171 major surgeries perormed in 2013-2014 (rom the Business Responsibility Report).

A billion healthy hearts

Corporation: Apollo Hospitals

Initiative: Billion Hearts Beating (BHB) works with theobjective o increasing awareness and prevention o heart

disease and its contributing risk actors in India. BHB runscorporate awareness programs under BHB @ Work. As a parto School o Heart, BHB organises comprehensive healthchecks, awareness workshops, and healthcare amenitiesdistribution drives or the students rom economicallychallenged backgrounds. Te programme aims to addressthe problem o unhealthy eating habits and poor healthcare& hygiene. In addition, BHB runs workshops, awarenesscampaigns and emergency ambulance services.

Geography: Delhi and NCR

Reach: So ar over 1,75,000 individuals have received reehealth checks and over 3,54,000 people have taken thepledge to make meaningul changes in their lives to preventheart disease.

Arogya Raksha Yojana and tech for NCD preventionand cure

Corporation: Biocon Pharma

Initiative: Biocon Foundations cervical cancer preventionand control programme is structured around three keyservice delivery components - community inormation andeducation, accessible screening services and diagnostics, andtreatment services. Te program has been rolled out throughthe Arogya Raksha Yojana (ARY) clinics in Karnataka. Te Foundations health workers identiy women who

seem to be at risk and pre-register them or a screeningcamp

Te women undergo comprehensive screening byspecialists rom the tertiary cancer centres who visitthe ARY clinics once a month. Biocon Foundationprovides competent clinical care, generic medicines,and basic diagnostic tests. Each clinic serves apopulation o 50,000 people living within a range o10 kms

Regular general health check-up camps in remotevillages, with physicians and doctors rom network

hospitals A mobile diabetic oot van rom the Jain Institute oVascular Sciences, Bangalore, visits each clinic oncea month. On the pre-appointed day, patients withdiabetes get ree oot screening and advice on managingtheir illness and its treatment. Tese visits are hugelypopular, with more than 100 patients using the servicewherever it goes

Geography: Karnataka

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5. Addiction7 suicides occur in India everyday due to drug andaddiction related suicides. India has reportedly over 3.4million drug abusers and 11 million alcoholics, spanningacross ages rom youth till the elderly.


Across SDGs and national priorities, strengthen theimplementation o the World Health OrganizationFramework Convention on obacco Control. Strengthenthe prevention and treatment o substance abuse, includingnarcotic drug abuse and harmul use o alcohol


Behaviour change communication (BCC) campaignson alcohol, drugs and tobacco

Ministry o Social Welare policies to discontinuecommercial brewing o liquor in tribal areas

Integrated Rehabilitation Centre or Addicts(IRCAs) under the Scheme o Assistance or thePrevention o Alcoholism and Substance (Drugs)Abuse and or Social Deence Services run byvoluntary organisations

Policy interventions including raising taxes ontobacco, banning ads, banning o smoking in publicplaces

Opportunities for CSR intervention

Extensive behavior change communication campaignsto wean people away rom alcohol, tobacco and drugs,especially youth

Support construction, maintenance and running ode-addiction and rehabilitation centres by supportinglocal non-profits and State Governments

School, college and workplace campaigns in urbanand rural areas around the harmul effects osubstance abuse

Case studies of corporates workingon addiction

Pioneering de-addiction rehabilitation in Asia

Corporation:K Industries

Initiative: Te .. Ranganathan Clinical ResearchFoundation is a pioneering healthcare non-profit helpingrehabilitate people with alcohol addiction. Te KHospitals vision is to rehabilitate patients through in-house treatment and also ocus on helping patients amiliesin realising that addiction is a serious problem. Patientsreceive the help they need first through detoxification,and psychological therapy, which consists o bothindividual and group therapy. Te K Hospital also hasa unique part o the programme which requires amiliesto participate in therapy or 14 days. Afer completion o

the 25-day programme, patients can continue counsellingmultiple times a month or 2-3 years to help with living amore healthy lie.

Te Foundation also reaches awareness camps to villagersat their doorsteps, runs trainer programmes or para-proessionals, carries out research and brings out booklets.

Reach: K Foundation has helped over 20,000individuals with alcohol addiction and drug addiction andis the largest such acility in Asia.

Working with youth on de-addiction

Corporation: ata Steel

Initiative: ata Steel Rural Development Society(SRDS) was established to work with people in andaround its mines, collieries and plants. Te SRDS wascreated to sustainably provide what adivasis needed most:education, jobs, healthcare, power, water, inrastructureand environment protection. SRDS has partnered withinternational non-profit Initiatives o Change (IoC) tooffer a unique programme to inspire, equip and connectpeople with a ocus on economic justice, environmentaljustice and ethical leadership. Te programme enablesadivasi youth to return to classrooms, helps them with

their alcohol and drug de-addiction, trains them or jobs,connects them to their cultural heritage, creates a networkthey can reach out to and creates in them agents o changewho invest themselves in community development work.

Geography:Jharkhand and Odisha

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6. Water andSanitation (WASH)More Indians have mobile phones than access to toilets

is an of-quoted and worrying statistic. India has a severesanitation crisis: 600 million Indians practise opendeecation and 67% o rural households have no toilets which has se

in good health-compendium on csr

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