Ever since its independence in 1947, India has been on the path of all-round socio-economic progress. With more than 1 billion people, India accounts for nearly 20 percent of the world’s population. It is the world’s tenth largest economy by nominal GDP and the third largest by purchasing power parity (PPP), making it one of the top industrialized countries in the world.
However, despite India’s economic growth it continues to face the challenges of poverty, corruption, malnutrition and inadequate public healthcare. With its ever increasing population, India’s healthcare infrastructure is completely overburdened with continued and emerging diseases, as well as chronic degenerative diseases. This is largely due to lack of environmental sanitation and safe drinking water, under-nutrition, poor living conditions and limited access to preventive and curative health services.
PSI began its operations in India in 1988 and currently has more than 900 staff members across 20 states. Current areas of program focus are:
- HIV/AIDS and other sexually transmitted infections
- Malaria prevention
- Child survival
- Gender-Based violence
- Non-communicable diseases
- Maternal Health
- Family Planning
PSI/India estimates that in 2015, its products and services helped avert 460,389 DALYS, including, by health area:
- 228,078 HIV DALYs
- 206,828 FP DALYs
- 19,309 MNCH DALYs
- 6,173 Safe Abortion DALYs
PSI/India’s family planning programs also provided 1,497,037 couple-years of protection.
It’s estimated that India has 5.6 million people living with HIV – more than any other country. Success in controlling HIV in India can positively impact the overall world situation just because of the sheer numbers.
PSI/India is involved in several large-scale prevention projects aimed at curbing HIV incidence:
Sponsored by the Bill & Melinda Gates Foundation, this program promotes safer sexual practices in Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu states. PSI/India also makes condoms accessible along national highways. The core of PSI/India’s contribution to this program is intensive communication, franchising and distribution in 100 locations where HIV prevalence and risky behavior is highest. PSI/India has reached more than 7.6 million clients of sex workers in these areas.
HIV/AIDS Workplace Intervention Program
Under USAID’s Project Connect, PSI/India helps mobilize the private sector to support HIV/AIDS-related interventions. It also establishes prevention of parent-to-child transmission centers through public-private partnerships and advocacy with the insurance and pharmaceutical sectors.
Collieries Outreach Intervention for Limiting HIV/AIDS (COILA)
PSI/India implements this HIV prevention program for the coal mining community, in partnership with Jharkhand State AIDS Control Society. The project studies the norms of people in the coal mining districts of Jharkhand and then launches effective interventions with support from partners.
PSI/India targets high-risk behavior groups of commercial sex workers, their clients, and long-haul truck drivers in Mumbai with HIV-prevention activities. So far, the Mumbai project has touched 6,000 commercial sex workers in “red-light” areas of Mumbai, 600,000 men at risk and 2,500 injecting drug users with:
- Interpersonal and mid-media communication.
- Condom social marketing.
- Voluntary counseling and testing centers.
- Drop-in centers.
Additionally, PSI/Mumbai’s Saadhan Helpline provides counseling and information services to the general population.
PSI/India’s comprehensive family planning messaging and maternal health programs span 17 states. They create informed demand and provide reliable supplies of quality, affordable products, including:
- Oral and injectable contraceptives
- Intra-uterine devices
- Emergency contraceptives
- Vitamin supplements
- Drugs to prevent post-partum hemorrhage
In the state of Rajasthan, PSI/India manages a government-sponsored health center that provides antenatal and post-natal care, immunization, treatment of childhood illnesses and other services. With funding from KfW and David and Lucile Packard Foundation, PSI/India uses a variety of communication methods to reach thousands of women in Rajasthan, Madhya Pradesh, Chhatisgarh and Jharkhand with family planning messaging. PSI/India also markets the women’s anemia-prevention nutritional supplements, Vitalet and Vitalet PREG.
PSI/India’s five-year reproductive health initiative in 11 states is building the capacity of private-public health care providers, promoting underutilized products and creating demand for the services of trained, qualified health service providers.
More than 600,000 Indian children die of dehydration from diarrhea each year. Water disinfectants, rehydration salts and zinc supplementation are low-cost solutions that can yield priceless benefits. PSI/India currently works to lower incidence of diarrheal diseases and related child mortality in the states of Uttar Pradesh, Uttaranchal, West Bengal and Orissa.
PSI/India also markets Safewat, a water disinfectant, and various brands of oral rehydration salts and zinc tablets. A pilot program is under way to promote the use of ORS and zinc tablets to reduce morbidity and mortality due to diarrheal disease among children under age 5 in Rajasthan.
Water, Sanitation and Hygiene
Globally, there are 2.5 billion people around the world who live without access to improved sanitation facilities. Nearly one-third of these people live in India.
Supporting Sustainable Sanitation Improvements
In the state of Bihar, PSI is working with the Bill and Melinda Gates Foundation, the Monitor Group and Water for the People to implement an innovative sanitation project called Supporting Sustainable Sanitation Improvements (3Si). This project aims to increase access and use of improved sanitation facilities, as well as establish a sustainable market-based supply chain for sanitation products and services.
Currently, only 30 percent of households in Bihar have latrines, and diarrheal episodes make up 12.1 percent of the nation’s total. To address this, 3Si will contribute 59 percent of the total sanitation coverage in Bihar until 2017 (about 350,000 households) and will address the high rate of under-five deaths due to diarrhea.
India is a high burden tuberculosis country with more than one-fifth of the world’s TB cases. The goal of this project is to decrease mortality and improve access to quality TB care. PSI/India is implementing the program in six states: Bihar, Punjab, Haryana, Karnataka, Rajasthan and Maharashtra. The objectives of the project are to improve TB care and control, especially for marginalized and vulnerable populations, including TB-HIV patients. This project is sponsored by the Global Fund.
- U.S. Agency for International Development
- The Federal Republic of Germany through KfW Entwicklungsbank (the German development bank)
- U.S. Centers for Disease Control and Prevention
- Ministry of Health and Family Welfare
- National AIDS Control Programme
- Bill & Melinda Gates Foundation
- David and Lucille Packard Foundation
- William and Flora Hewlett Foundation
- British Department for International Development
- Central Indian Government
- Commissioners for Health and the State AIDS Control Societies (state and district levels)
- Community-based organizations
- Other NGOs
- Panchayat Raj Institutions (for rural promotion of birth spacing and good maternal/child health practices)
- Local medical providers and retailers that carry and promote PSI products
- Shaping the Family Planning Market by Strengthening the Public Sector
PSI considers total market approaches to be critical for achieving universal health coverage, especially when it comes to contraception. This program brief presents cases, supported by several different donors, which take into consideration the total family planning market.
- Translating Best Practices to Next Practices: A White Paper on Promising Practices in Management of Non-Communicable Diseases in India
The burden of diabetes in India is increasing and was 69.2 million in 2015 according to the International Diabetes Federation. Over the last three years, CII-Lilly Non-Communicable Disease Summit has established itself as a strong brand in trying to play the role of a catalyst in improving the management of noncommunicable diseases in India. The current summit is the fourth in the series with the objective of revisiting and reviewing takeaways from the earlier three summits.
- Business Model Development for Fecal Sludge Management: Insights from Bihar, India
In 2014 PSI began implementing Project Prasaadhan to address critical gaps in fecal sludge management in Bihar, India. Read about the project's key highlights on this poster presented at the 4th Global Symposium on Health Systems Research.
- Assessment of the Effectiveness of Dedicated Postpartum IUD Inserter in Achieving Fundal IUD Placement
Immediate Postpartum IUD (PPIUD) insertion offers a novel and convenient method to address unmet need for contraception. However, for this purpose a dedicated PPIUD inserter is not available and instead, forceps are used. Furthermore the string used in traditional IUD inserters is too short to be visible after PPIUD insertion.
We aimed to assess the safety, effective fundal IUD placement, acceptability (provider satisfaction, consumer comfort) and feasibility of a prototype dedicated PPIUD inserter and to determine client satisfaction and IUD retention at follow-up.
- Market-based Approaches to Sanitation: A Review of the Evidence
This review illustrates the components of market-based approaches to improved sanitation and how they can be used to sustainability and scale.
- A Dedicated Postpartum Intrauterine Device Inserter: Pilot Experience and Proof of Concept
Use of the inserter was found to be safe, with high fundal placement in 82% of cases. Complete expulsion occurred in 7.5% of cases and partial expulsion was detected in 10%, comparable with rates in other studies using standard IUD insertion techniques. Further study and use of the dedicated inserter may reveal increased convenience and reduced risk of infection among users and could improve acceptability of postpartum IUD provision among providers.
- Barrier and Triggers to Early Detection of Pregnancy Among Women of Reproductive Age (20-34 Years) in Three States of North India
In India, the Medical Termination of Pregnancy Act of 1971 permits medical abortion up to seven weeks (49 days) from the first day of the last menstrual period (LMP). Therefore, timely detection of pregnancy is essential for ensuring that a woman has enough time to make decisions regarding the pregnancy, such as registering for antenatal care or terminating the pregnancy through medical or surgical abortion. The Women’s Health Project (Pehel), aims to prevent unintended pregnancies by increasing women’s access to both voluntary contraceptive services and safe and legal termination of pregnancy through medical abortion. PSI/India designed an intervention to educate women about early detection of pregnancy (EDP). As part of that intervention, a qualitative study was conducted to understand women’s perspectives about EDP.
- Learning From Bihar, India: an Evolutionary Process and the Impact of a Market Development Program to Create a Functioning Sanitation Market
Market failures are not treated as final, but rather become the target of programs or policies to improve them.
- Effectiveness of a Personalized Interpersonal Behavior Change Model for High Adoption of Modern Family Planning Services in India
The Women’s Health Project (WHP) is the flagship program for family planning of PSI/India and is implemented in thirty high priority districts across three states, namely—Uttar Pradesh, Rajasthan and Delhi. Despite the fact that the IUCD is one of the most effective reversible contraceptive options, its use in India has remained low at approximately two percent of women of reproductive age (WRA) over the last couple of decades. Therefore, one of the one key objectives of WHP is to increase access to family planning methods, including the long-acting reversible IUCD.
- Role of Helpline Outbound Calling in Reduction of Dissatisfaction and Discontinuation Rate Among IUD Clients
Studies on family planning (F.P) methods have shown that user satisfaction is an important contributor to greater compliance and longer continuation. Studies have also shown that women’s perceptions of physical and psychological effects of each method strongly influence method selection. Making a follow up call after client service is important for a number of reasons, including improving organization’s/clinic’s credibility. The follow up adds value to the service or product the client received and gives an opportunity to build a stronger relationship with each client. This could result in referrals to more potential clients.