About the author

Ajoy Khandheria is the Founder of Gramin Health Care, the first ever start-up focused exclusively on primary healthcare. He has been an advisor to corporate giants like Harris Corporation, Telecom Ital, Tech Mahindra, Tellabs Maxis, UT Starcom, Hughes Software System and KPMG. Under his leadership, companies have seen exponential growth and geographical expansion in the global market. A strategic investor, Ajoy also has remarkable presence in telecommunication, geospatial and content businesses. He has invested in a number of companies across the world including Avenger (USA), Doc on call (Myanmar), Intersat (UAE), Emmanuel Healthcare (USA), Six Dee technologies and CERT Telematics (Abu Dhabi), among others.

SAM selects the target population on the following criteria:
Targeting vulnerability: SAM works with the poor and vulnerable communities who lack education, income, assets, status and access to healthcare.
Targeting pregnant, infants and children: SAM follows all pregnant women, infants and children under 5 years in the community.
Targeting reproductive age: For population stabilisation, SAM targets reproductive age group women and married couples between ages 18 and 49 years and adolescent girls from 10 to 19 years.
Targeting disease: SAM targets the families and contacts all TB patients, malnourished children and high-risk pregnant women.
SAM-ESP Innovation: SAM has developed a cost-effective platform for changing health behaviour ofa community. Health activists, in partnership with local public and private healthcare stakeholders, convert awareness to actionable knowledge. SAM has successfully used its Effective Social Persuasion Platform (SAM-ESP) in multiple locations. ESP relies on seven assumptions.
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Behaviour modification is the least expensive way to reduce disease burden.

Health is an individual and community responsibility; ownership of this responsibility empowers a community to demand healthcare rights. A campaign to push health information may improve awareness but is not sufficient by itself. Awareness is just one of many steps to change behaviour. Other essential steps include: a sustained, intensive, repetitive campaign without a predefined end time-point, encouraging peer to peer nudge and a methodical transfer of ownership to the community leaders.

Messages scripted by the community encourages their ownership. Trained volunteer activists can lead and sustain the ESP without external help.

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An established SAM-ESP platform can be used to address multiplehealth problems. SAM-ESP is not yetanother awareness building program. Awareness is often assumed to be equal to behaviour change. In practice, it is not true. Communication programs and prevalent awareness programs merely touch the surface without translating into significant behaviour change. SAM-ESP is a multi-step process, where awareness in just one of many steps for a sustainable behaviour change.

SAM promotes community ownership of both health and healthcare. SAM believes, that health is an individual and community responsibility and getting healthcare, as a right, has to be learned. SAM-ESP is a peoples’ program, which ensures that the health system is responsive and accountable.

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SAM trains volunteer health activists who lead the program and develops a cadre of social entrepreneurs, who sell contraceptives, sanitary pads and nutritional products. SAM field workers are from the community where they live and work. They are available 24/7 and take health to the doorstep of the recipients. The program sets no predetermined end date; repetitive training continues till SAM meets the objectives.

The following steps describe its execution:

Organize, create structure and build leadership capacity: SAM has well-trained field staff and managers;the voluntary directors of the organization are professionals from healthcare and management. Each district has a manager, trainers, and supervisors who are selected from the local population. They receive intensive training not only in health issues but also in motivational techniques, training methods and leadership.

Develop messages: SAM believes that a good message should be simple without technical jargon, short with less than five points, easy to understand without explanation and emotionally connected with a local need. For better retention, a message could be in the form of a story, song or a slogan. Some messages should be created by the community to feel ownership.

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Train health activists: Master trainers train volunteer health activists to be responsible for village health issues. Training is repetitive and intense.

Teach people: SAM organizes the village into a healthcare community. Field supervisors motivate and mobilize villagers and discuss each topic of healthcare with a specific training module. SAM uses local community resources to create training material and health leaders script their own songs and slogans. Activists meet villagers repeatedly to discuss best practices. Repetitive training of health activists and villagers is essential.

Cooperation with public and private health systems: SAM establishes linkage with the local private and public health system. Utilizing all available public health resources is an essential component of the program. Public health workers are invited to all meetings. This linkage creates awareness, which improves demand of healthcare and encourages accountability.

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Evaluation and improvement: Programs are monitored by community involvement and by participatory research action. Results lead tocourse correction.
Replicate: Solutions are validated and replicated in other locations.

Measuring impact: Each program starts with a baseline and finishes with an end-line evaluation. SAM defines objectives, activities, outputs and outcomes before the start of the program. They measure monthly progress against all these parameters.

Process of measuring impact is a four-step process:
Data Collection at community level: The field workers collect data during house visits and community meetings. They upload it on a smartphone.
Data review at block level: Field officers collate and review data every month at a block level. They validate it through client interaction.

Data validation at district level: SAM validates data through a monitor and evaluation protocol which includes field visits, focus groups and comparison with public health data. SAM compares outcomes and impact with similar programs run by the government and other private organisations.

External agency evaluation: Periodically, SAM engages external agencies to evaluate its work. The funding partners also send external evaluators to check the progress and impact.

Direct impact: Since inception, SAM has trained 37,000 volunteer health activists who live in the villages and are available to the community. SAM has directly impacted over 1,150,000 million people through maternal, child health, population stabilisation and TB control programs.

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Through maternal, child health and population stabilization programs, SAM has directly impacted: 530,000 women and over approximately 100,000 infants. SAM follows all (100%) pregnant women in the villages and has reduced maternal mortality by 90% and infant mortality by 60%. In some places, SAM has done even better. In the past 6 years, in 167 villages of Gadag, Karnataka; maternal mortality rate has decreased to 15.8 from 364 and the Infant mortality rate has decreased to 5 from 46.

Through population stabilizations program, the marriage of girls under 18 years of age has decreased to almost zero. Contraceptive use has increased from 28% to 62% and supplychain management has reduced the unmet need for contraception from 10.8 % to 2% been running in 700 villages. 287,042 people have participated in 14,552 community meetings. 13,973 people have had sputum tested. Sputum was positive for TB in 1329 people and 14 had multiple drug resistant TB. All received supervised treatment. SAM has directly helped with education and surveillance of 130,000 contacts of TB patients and helped another 317,000 community members with awareness program. TB detection rate has improved 3.7 times.

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Indirect impact: SAM estimates that approximately 0.9 to 1 million people, who did not actively participate in its programs, became aware of the benefits from those who attended our programs.

Women feel empowered, which has opened their minds to many choices in life. They express their opinions freely. Men and elderly women, who were suspicious and objected to their women attending public meetings, have mellowed their resistance and have even become enablers. Girls attend school more regularly and the number of girls attending college has increased. Adolescents participation has increased. Public health system and their workers are more responsive to public demand.Local elected politicians are responsive.

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Discussion: Multiple theories have attempted to explain the health behaviour of individuals. The most popular is the Health Belief Model (HBM), which was developed about 40 years back. It postulates that people make healthcare decisions based on perceived susceptibility to disease and consequences. The response is tempered by perceived benefits of action and with a belief that benefits outweigh risks. While this theory, like other theories, builds a plausible reference point to explain behaviour, it gives no guidance for modification of individual behaviour.

Theory of Planned Behaviour suggests that a person should be empowered with ability (self-efficacy) to change behaviour. The person should believe that the behaviour will improve his health and is socially approved. It has also been recommended that principles of marketing could be applied to a social cause, where the product to be sold is behaviour change.

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SAM model comes close to a hybrid variety of HBM, building self-efficacy and social marketing. SAM tries todevelop social efficacy through the agency of health activists by using techniques similar to social marketing. SAM Effective Social Persuasion is a people’s platform, which needs further elucidation and expansion. SAM is looking to use entertainment education or gamification for behaviour modification and use of technology in early detection of noncommunicable diseases. SAM seeks collaboration with others for mutual learning, sharing resources and scaling-up the program in vulnerable population.

About the author

Dr. Shiban Ganju is the Chairman of Atrimed Pharmaceuticals and Founder of Save A Mother Foundation, USA. He has dedicated his life to healthcare. Dr. Ganju graduated from AIIMS New Delhi and received advanced training in Internal Medicine and Gastroenterology both in India and USA. He is a consultant specializing in gastroenterology, liver disease and nutrition in hospitals in the greater Chicago area. His commitment to and understanding of how to drive improvements in health outcomes has benefitted big strata of society.

The forum highlighted the need of forward-looking policies and a proactive government to play a role in the development of smart cities & villages on the bedrock of JAM Trinity which has 1bn bank accounts (Jan Dhan) + 1bn Aadhaar + 1bn mobile broadband users, already organized for the technological revolution in this space, thus, Capitalizing the connected World with the help of modern & niche technologies like 5G, GIS, IoT, m2m and others. Likewise, the governments effort to connect 2.5 lakh Gram Panchayats with BharatNet project was discussed to leverage the smart villages concept in India.

5G vision for India was also one of the major highlights of the 2-day forum, as 5G technology has the potential for ushering a major societal transformation in India by enabling a rapid expansion of the role of information technology across manufacturing, education, healthcare, agriculture, finance and social sectors. The panelists voiced that India must embrace this opportunity by deploying 5G networks early, efficiently, and pervasively as well as emerge as a significant innovator and technology supplier at the global level. Emphasis should be placed on 5G touching the lives of rural and weaker economic segments so as to make it a truly inclusive technology.

Ms. Aruna Sundararajan, Honorable Secretary, Department of Telecommunications, Ministry of Communications, Government of India via her message highlighted, “A city is a complex system, involving many different domains, infrastructure, organizations and activity which need to be integrated for that city to emerge as a smart city. Standardisation forms a critical part of the work that needs to be done. Being smart cities, a new holistic and cross functional standardization approach is needed, breaking the old ‘vertical silos’ approach, through better cooperation and synergies.”

“While the cities of India are fast progressing towards digitalization, it is encouraging to note that digital solutions are being readily accepted amongst the rural population of India as well. To support this technology adoption, the Department of Telecommunications (DOT), Ministry of Communications, Government of India, has initiated projects to provide broadband connectivity for connecting various digital services and solutions across our Urban and Rural Landscapes”, added Ms. Sundarajan.

Elated about the forum Mr. Kunal Kumar, Joint Secretary (Mission Director – Smart Cities), Ministry of Housing and Urban Affairs stated, “The forum can make noteworthy contributions to the Smart City Program at large. By sharing and collaborating on topics such as technology, multi-country experiences and innovative approaches, I am sure that we can bring together the best minds, and the surest hands to co-create cities of the future.”

The attraction of the forum was, NOT TO BE MISSED ‘Technology Show – by FIWARE Foundation member companies namely – NEC Technology India, APInf, MobilePedia and Smart Cities Lab Ltd where they demonstrated the OPEN SOURCE PLATFORM designed and developed by the FIWARE FOUNDATION– a market- ready open source software, combining components that enable the connection to IoT with Context Information Management and Big Data services in the Cloud.

The forum also hosted a dedicated session on 'India-EU Dialogue on ICT for Smart Cities' which was organized by the prestigious project, namely, ‘India-EU ICT Collaboration Standardization’ of the Delegation of European Union to India, highlighting the absolute need for ‘Leveraging Standards for Smart Cities’, which brought together key stakeholders and smart city officials.

Participants from across the globe got the opportunity to meet Stellapps Technologies – an end-to-end dairy technology solutions company – the first of its kind in India, Sensorise – an IOT Services and Solutions company, Phoenix Robotix – a network-IoT and Big data company, Sensable – an IoT company offering end-to- end smart solutions using artificial intelligence and machine learning, C-DOT – an autonomous Telecom R&D Centre of Department of Telecommunications (DOT), Government of India – showcasing Common Service Platform for m2m communications on oneM2M Specifications.

“We appreciate the participation from our key partners, showing trust in the forum and the vision it stands for. The key speakers, thought leaders and industry leaders have made this forum a thought provoking one with dialogs on disruption these modern technologies can bring to make cities & villages smarter, and at the same time, mentoring the startups in this segment. We are proud to have EU partners to share their insight on business possibilities from across the globe. Thus, making the 6 th edition of this forum a success” concluded Ms. Shilpi Batra, Director, India m2m + iot Forum 2019

About India m2m+ iot Forum

India m2m + iot Forum is a cohesive and shared platform, which validates united and collective vision of the global m2m and iot ecosystem. It is the most awaited annual congregation of m2m + iot stakeholders representing the entire ecosystem comprising of academics, analysts and researchers, enterprises and industry, governments – policymakers and regulators, industry associations and organizations, media organizations, standards organizations, the student’s community and above all the end users from businesses, citizen services and government.

For more information, contact:
Pratik Baurai
E-mail: pratik@saintsart.in
Mobile: 9871006258

Sonali Shyam
E-mail: sonali.shyam@saintsart.in
Mobile: 9891820253

While World Health Organization (WHO) recommends 800 grams or 5-9 servings of fruit or vegetables per day, the new study has shown that it takes just half – that is, 375 grams to get the desired health benefits. This is important for people living in countries who cannot afford a lot of fruits and vegetables.

Potatoes and other tubers were not included and fruit juices were not considered as fruits while calculating the intake. Legumes included beans, black beans, lentils, peas, chickpeas, and black-eyed peas.

The researchers attribute beneficial effects of consuming fruits and vegetables to presence of antioxidants like vitamin C, vitamin E and carotenoids, and fiber in them, which reduces bad cholesterol, improves insulin response, lowers the blood pressure, prevents fat deposition in blood vessels, and improves cellular function in the body.

“Although there is a popular belief that fruits, and vegetables are healthy, there was no long-term study data to support this and hence our findings are new and significant,” said Dr.V Mohan of the Dr. Mohan’s Diabetes Specialties Centre in Chennai, who contributed to the study.

The decade-long research was done in 18 countries with 135,335 participants aged 35 to 70 years. Healthy individuals with no reported diseases and complications were enrolled for the study. They were given questionnaires to record daily diet, lifestyle habits like smoking, physical activity and alcohol intake, and their socioeconomic status like education, income, and employment.

At the end of the study, researchers recorded the number of deaths, cases of cardiovascular diseases, heart attack, and stroke. Then the data was analyzed to see if consuming higher amounts of fruits, vegetables, and dal is related to the number of deaths and adverse outcomes on health. “We found that regular consumption of vegetables, fruits and legumes protectedpeople from cardiovascular disease and death”, states Dr. Mohan.

“This study does not distinguish between cooked vegetables and raw ones, although it is common knowledge that cooking destroys some of the vitamins and minerals, hence as far as possible we should use raw vegetables like tomato, cucumber, carrot and green leafy vegetables which can be consumed raw”, pointed out Dr. Mohan.

According to Estefania Toledo, professor at the Department of Nutrition of the Harvard School of Public Health, Boston, USA, who is not connected to the study,“Increased consumption of fruits and vegetables should beat the expense of reducing other foods and drinks, such as sugar sweetened beverages, red and processed meat, saturated and trans fat, refined cereals, and sugar rich desserts”. She added that consuming more plant-based foods helps replace detrimental foods, which benefits the overall dietary pattern.

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When a pregnant woman drinks alcohol, it rapidly crosses the placenta to the fetus. Unlike the mother, the fetus cannot process alcohol at the same rate, and it remains in the baby’s body longer than in the mother’s. The result – the baby could be born with Fetal Alcohol Spectrum Disorder (FASD). FASD is the term used to describe the birth defects and brain damage that can be caused by prenatal exposure to alcohol.
Children with FASD do not grow out of their problems. In fact many will need a lifetime of extra health care, education and social services. When they get older, children with FASD often have difficulty paying attention and learning at school. They have trouble getting along with others. They may have difficulty remembering and thinking things through. They may struggle with depression or have drug and alcohol problems.

Want to write for InnoHEALTH? send us your article at  magazine@innovatiocuris.com

Read all the issues of InnoHEALTH magazine:
InnoHEALTH Volume 2 Issue 3 (July to September 2017) – https://goo.gl/MCVjd6
InnoHEALTH Volume 2 Issue 2 (April to June 2017) – https://goo.gl/Nv3eev
InnoHEALTH Volume 1 Issue 2 (October to December 2016) – https://goo.gl/4GGMJz
InnoHEALTH Volume 1 Issue 1 (July to September 2016) – https://goo.gl/iWAwN2

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Facebook: https://www.facebook.com/innohealth2017
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