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.

Dance is an art wherein you can express yourself and have a therapeutic experience. Dance movement therapy is an old concept but needs a grip in India. The author shares her experience on how dance therapeutically heals her mentally and physically.

What is DANCE?
It is not just a form of art wherein you move rhythmically to music for entertainment. But, it is also a type of therapy. Here is how?

The purpose of dance is to express one’s emotion freely and take pleasure in performing it. If one is angry, cheerful, melancholy, afraid or feel strongly about something, one may choose to show it through eyes, facial expression, and body movements in dance.

There is nothing new about dance. It is well known that dance benefits our body and mind. People have been dancing for centuries or you can say since childhood for entertainment. However, dance as a type of therapy was recognized back in modern dance movement of 19th century. During this movement, it was realized that dance could go beyond simple entertainment, and can be used as a form of expressions. By mid of 20th century, dance therapy developed in US and Europe which added observation, interpretation and manipulation of dance elements into the practice. In 1966, a professional organization, the American Dance Therapy Association (ADTA) was established. Dance movement therapy (DMT) in USA, Australia, and dance movement psychotherapy (DMP) in the UK is the psychotherapeutic use of movements and dance to support intellectual, emotional and motor functions of the body,as a form of expressive therapy.

DMT uses movement and expression with the skills of psychotherapy, counseling, and rehabilitation to help individuals to achieve both physical and mental health, stress reduction, disease prevention and mood management.

Following are the benefits of Dance Movement Therapy –
1. Improves cardiovascular endurance
2. Improves balance and coordination
3. Improves muscular strength and flexibility
4. Improves body posture and mobility
5. Reduces muscle tension
6. Reduces stress and anxiety
7. Mood elevator
8. Improves expression of feelings
9. Builds confidence and get over shyness

Following are some recent research which showcases that dance therapy can be effective in the treatment of mental health issues like eating disorder, depression, and anxiety.

A study from the Journal of Arts in Psychotherapy (2007) found that dance therapy had a positive effect on participants experiencing symptoms of depression.

A study from Alzheimer’s care (2009) suggests that DMP improves memory recall in people with dementia.

American Journal of Dance Therapy indicated that DMT may be a treatment option for children on the Autism spectrum.

Also, it can be considered as a treatment option for childhood obesity.

At my golden age with silver hair and a young heart, I must say, dancing helps me feel a lot better. I did all sorts of exercise, yoga, meditation, walking, jogging, etc. but I didn’t enjoy any of it and discontinued it sooner or later. Then, I realized that my body moves with emotions and expressions whenever I hear beats of music. I become thoughtless, feel happy and energetic. My mind connects with my body and soul, it’s like meditation to me. It therapeutically heals my aching joints and stiffness of body due to lifestyle diseases, much better than any physiotherapy ever could. This article is not some kind of scientific research, as lot of research on this topic has already been done all over the world. It’s only my insight and personal experience after joining a dance class. A group or couple dance class helps motivate you to do better each day and builds your confidence.

Some people might think, “A dance class? At this age? ”. Yes, I know it is uncommon but why not. One of the reasons that people of my age do not turn up at dance classes is because they are shy. Many North Indian families in earlier days did not appreciate dancing and did not allow girls to dance as it was looked down upon. I was never allowed to dance but allowed to do higher education in those days.

I will not tell you how to move your body or on which song you should dance or how you should dance…… No. I am only going to tell you to move your body and express your feelings as we all know that dancing makes us feel light, joyful, releases happy hormones such as Seratonin, Endrofin, Dopamin etc. Dance moves can predict our feelings like if we are anxious, or self-conscious while dancing, it will show through our moves. You can do any type of dance i.e. Ballroom, Ballet, Tango, Zumba or just wiggle slightly, do what you love or what you feel comfortable with.

Dance like no one is watching and just let go of yourself is the secret of good health. You do not have to be a dancer to get benefit from dance movement therapy. Do not let shyness, age or stamina come on the way. Let your heart dance with joy and happiness, your eyes will dance with emotions and your body movements will improve motor skills. The concept of DMT is new to India and needs more attention. India being the motherland of traditional and modern dance forms can be the new platform for DMT. A new concept like beer yoga is becoming a fad in our society wherein I feel DMT is much more scientific and effective in gaining holistic health. So be happy, enjoy and destress yourself, have a good diet and get better sleep. That is a secret of a happy and healthy golden age.

If you wish, sometime instead of sport shoes, put on your dancing shoes…Hey…..Come on…..Dance.

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