Established in 1988, PSI/India compliments the efforts of the Government of India in priority health areas of maternal and child health, sanitation, tuberculosis, family planning, and gender-based violence. Using PSI’s market development approach and targeted social behavior change, PSI/India works to address market failures in the public health space across the country.
PSI/India’s current areas of program focus are:
- Child survival.
- Family planning and reproductive health.
- Gender-based violence.
- Maternal health.
- Noncommunicable diseases.
- Water, sanitation and hygiene (WASH).
- Tuberculosis (TB).
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.
Poor sanitation, hygiene and lack of safe water contribute to more than 450,000 child deaths in India each year from diarrhea. PSI/India currently works to reduce the incidence of diarrhea through the following projects in Bihar and West Bengal, India.
Untreated tube well water is the root cause of diarrhea and other water-borne diseases in West Bengal. More than six million people are exposed to arsenic contaminated water (>50µg/l) extending to 79 blocks in eight districts of West Bengal. With support from Hindustan Unilever Limited (HUL), PSI/India is addressing this issue by creating access to arsenic-free drinking water for poor households in Nadia District of West Bengal. Project Arsenic is creating a corpus fund exclusively for facilitating financing of arsenic free water purifiers through self-help groups in selected regions.
School of Five
Hygiene promotion interventions are an effective way to prevent the transmission of diarrhea-causing pathogens. With this knowledge, PSI/India is assessing handwashing campaign models in government schools in Bihar with support from Unilever. The ‘School of Five’ project has shown to change behavior at the household level, leading to a decrease in incidences of diarrhea and pneumonia in children under five years old.
Family Planning and Reproductive Health
With the goal of providing quality family planning services and reducing maternal mortality and morbidity, PSI/India is working on expanding method choice in Uttar Pradesh, India’s most populous state. In addition, PSI/India is in the middle of two randomized control trials.
Better Birth: A randomized control trial of the World Health Organization Safe Childbirth Checklist
PSI/India is completing a five-year randomized control trial to test the efficacy of the World Health Organization’s (WHO) Safe Childbirth Checklist in reducing maternal and neonatal mortality and morbidity. With funding from the Bill & Melinda Gates Foundation, PSI/India, Harvard School of Public Health, and the Government of Uttar Pradesh, these partners are implementing this trial in 120 health facilities (60 intervention and 60 control health facilities) across 24 districts of Uttar Pradesh. PSI is using a peer-coaching model to introduce the checklist to 250 birth attendants. The project also aggregates direct observational data in real time, allowing for timely feedback towards improvement in services and systems.
Expand Access and quality to broaden method choice in Uttar Pradesh
It is estimated that Uttar Pradesh will contribute 26% of India’s FP2020 commitment to reaching 48 million new family planning users by 2020. Achieving this commitment will require engagement from both the public and private sector. With funding from the Bill & Melinda Gates Foundation, PSI/India is working across 32 districts of Uttar Pradesh under the Expanding Access and Quality (EAQ) to Broaden Method Choice in Uttar Pradesh grant. Under this project, PSI/India implemented PSI’s market development approach (MDA) to assess and understand the family planning market, specifically where the market was failing, in order to develop appropriate interventions to address the failures.
A newly designed, simple web portal was launched with clear processes for accreditation of private facilities, empanelment of private providers, and submission of claims and reimbursements. Named Hausala Sajheedari, or ‘Courageous Partnership’ in Hindi, this critical portal enables private providers to apply for accreditation into the scheme without having to physically visit government offices. It streamlines government inspection of facilities for accreditation and generates a memorandum of understanding for approved facilities. Private facilities can upload their client data directly into the portal and claim reimbursement for their eligible clients. Before payment, a random sample of their claims is selected for physical verification. After monthly claims are approved, the government makes payment directly into the private facility’s bank account.
The FPwatch project aims to address the lack of data available to inform evidence-based family planning policies and programs. Funded by the Bill & Melinda Gates Foundation, FPwatch is a multi-country research project to fill these evidence gaps in family planning. PSI/India implemented this study in the states of Uttar Pradesh and Bihar. PSI/India gathered data on contraceptive market, modern FP method availability, service readiness, across the private and public sectors.
Saving Lives at Birth
The Saving Lives at Birth (SLAB) project is a randomized control trial funded by the US Agency for International Development (USAID) for generating evidence on the safety, acceptability and feasibility of a dedicated inserter for postpartum intrauterine devices. The final results of this study are expected to be disseminated in 2017.
Although India has a constitutional commitment to gender equality, most women in violent relationships are unable to either stop the violence against them and their children, or leave their abusive partners.
The Wajood or ‘Identity’ project is one PSI’s first initiatives on gender-based violence (GBV). The project seeks to improve access to quality and comprehensive GBV services; strengthen institutional capacity; and build political will at national and state levels to address GBV. The project also works with communities through social behavior change interventions to overturn negative gender attitudes and beliefs.
The project geography includes Delhi, Haryana, Madhya Pradesh, and Rajasthan in addition to a low-touch approach in an additional 22 states across India. Project Wajood was launched in 2014 with the support of Indrani’s Light Foundation. In 2015, USAID/India expanded the Wajood project.
Tiko Sathi – Building a network of women entrepreneurs for maternal health in India
The Tiko Saathi project started in 2015. The project is funded by the Maverick Collective and is implemented in Rajasthan and Uttar Pradesh. The broad aim of this project is to test if technology can be used to help improve maternal and child health during the 1000 day period – from the first day of pregnancy to the day the child turns two.
Through female entrepreneurs, PSI is socially marketing Tiko Sathi cards to pregnant women, who can exchange them for subsidized antenatal check-up services from identified network clinics. Redeemable reward points are given to those who use Tiko Sathi cards through a software called ‘Movercado’. In addition to Tiko Sathi cards, the women entrepreneurs, or ‘pro-agents’, promote a basket of commodities which includes oral contraceptive pills as well as sanitary napkins. The pro-agents are also rewarded by receiving Tiko points for reaching clients. The whole process is mapped using the Movercado software.
About 20% of women suffering from cervical cancer globally are from India (Globocan, 2012). Early detection is the most efficient method to prevent this disease, however this is often unfeasible due to poor access to screening and treatment services. This is especially true for women living in a lower-middle income group in rural and urban areas. With funding from the Maverick Collective, PSI/India launched a program in 2014 addressing cervical cancer prevention via a ‘screen and treat’ approach, using World Health Organization guidelines.
Through this initiative, PSI built the capacity of private health care providers in 10 selected districts of Uttar Pradesh. They could screen women for pre-cancerous lesions in the cervix through visual inspection with acetic acid (VIA) and provide treatment through cryotherapy. After sharing its work with the Government of Uttar Pradesh, PSI provided them with technical assistance to incorporate this project into the public health system. This was done by establishing Sampoorna or ‘complete’ clinics which are noncommunicable disease clinics in 28 district women’s hospitals. This project is ending in 2017 but PSI/India will continue to engage with the Government of Uttar Pradesh, and potentially other state governments on how to replicate this work across India.
Uday or ‘Uprise’
In 2012, The Eli Lilly & Company began an initiative to raise awareness of risk factors associated with diabetes and high blood pressure in Sonepat and Vishakhapatnam. This project brings together a consortium of NGOs including Public Health Foundation of India and Hope Trust. The project is working to prevent, detect and reduce the risk of diabetes and hypertension, as well as improving the treatment and management of individuals with either condition. PS/India developed a mass media campaign based on qualitative research to encourage early diagnosis and adherence to treatment protocols.
Water, Sanitation and Hygiene
Supporting Sustainable Sanitation Improvement (3SI) and Domex Toilet Academy: Market facilitation to increase sanitation coverage and toilet use in Bihar
With support from the Bill & Melinda Gates Foundation and Unilever, PSI/India is building sustainable business models to improve the supply of sanitation products and services through the private sector. The project’s overarching goal is to catalyze the private sector to strengthen the supply chain of sanitation products and overcome supply side barriers to delivering desirable, high quality and affordable individual household toilets for the people of Bihar. Through 3SI, PSI continues to demonstrate the viability of market-based approaches to sanitation and the immense potential they hold to improve the livelihoods of the people of Bihar, and across the globe.
A key component of this program is sanitation financing. PSI/India has partnered with Friends of Women World Wide Banking to issue sanitation loans to purchase toilets through micro-finance institutions.
PSI/India is making efforts to improve access to quality Tuberculosis care and control services through enhanced civil society participation.
Complementing the efforts of the Revised National Tuberculosis (TB) Control Program, PSI/India is working to enhance the reach, visibility and effectiveness of this government initiative project, Axshya. A key element of this project is the engagement of community-based care providers and the private health sector in improving TB care and control. The purpose is to decrease morbidity and mortality due to TB in India and improve access to quality TB care and control services through enhanced civil society participation.
As a sub-recipient to The Union, with funding from The Global Fund, PSI/India is managing this project in 60 districts and nine urban cities across ten states of India – Bihar, Punjab, Haryana, Karnataka, Rajasthan, Maharashtra, Jharkhand, Uttarakh and and Chhattisgarh.
It is estimated that by 2050, over 70% of the world’s population will live in cities. According to the office of the National Sample Survey, there are over 52 million poor people living in the cities and towns of India.
The Challenge Initiative for Healthy Cities
Providing access to essential health services, especially in urban poor settlements, is key to building habitable and sustainable cities. The Challenge Initiative for Healthy Cities is an ambitious program to connect the urban poor with public and private resources, and implement proven health solutions.
Supported by USAID and the Bill & Melinda Gates Foundation, PSI/India is working to assist city governments’ capacity to manage, implement and monitor its response to health issues.
- Bill & Melinda Gates Foundation (BMGF)
- U.S. Agency for International Development (USAID)
- Maverick Collective
- United Nations Children’s Fund (UNICEF)
- Harvard School of Public Health
- Eli Lilly
- Hindustan Unilever
- International Union Against Tuberculosis and Lung Disease
- The Federation of Obstetric and Gynecological Societies of India
- Hindustan Latex Family Planning Promotion Trust
- Water for People
- Government of India
- Friends of Women World Wide Banking
- 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.