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Social Behavior Modification for Unmet Need of Prevention

InnoHEALTH Magazine — Fri, 01 Nov 2019 06:45:48 +0000

Resource poor communities are unable to afford expensive, supply side solutions for deficiencies in healthcare. Lack of finances, medical manpower, drugs and technology renders poor communities vulnerable to diseases, many of which are either preventable or curable. Unmet needs of preventive care often turn a completely preventable disease into a condition requiring expensive secondary or tertiary care, which further burdens the alreadymeagre resources.

The solution may lie in improving the demand side of the healthcare. Modifying social health behaviour may be the least expensive method to reduce disease burden in a community. Save a Mother (SAM), a healthcare NGO, works on the demand side by embedding in the communities to carry prevention to the doorstep. SAM has developed an Effective Social Persuasion platform (SAM-ESP), a model forsocial behaviour change, which reduces disease burden. In the past 11 years, SAM has successfully replicated the solution in different locations in India.

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Established in 2008, SAM has focussed on five themes: maternal and infant mortality reduction, population stabilization, TB control and malnutrition. SAM has worked with vulnerable communities of 3 million people living in 1800 villages and one urban slum, located in 10 districts of 4 states of India. SAM has shown considerable success in all the programs at all locations. SAM is currently active in five districts.

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 post Social Behavior Modification for Unmet Need of Prevention appeared first on InnoHEALTH magazine.

InnoBRIDGE Sweden 2019 : Report

InnoHEALTH Magazine — Fri, 31 May 2019 04:56:06 +0000

Executive summary

InnoBRIDGE is an initiative of InnovatioCuris (IC) along with Swedish partners, Swecare and Business Region Gothenburg, where the primary aim is to create a seamless access platform for the Indian healthcare stakeholders to the Swedish healthcare stakeholders, to strengthen healthcare collaboration between Indian healthcare organizations and the Swedish organizations and showcase the best of Swedish healthcare to the Indian delegates.

Innovation unit in Hospitals

The hospitals that we visited had an innovation unit running over ten years and have formalized the innovation process. From sourcing of unmet needs from stakeholders (patients, care providers etc) to running of an innovation marathon. Such an intervention can be beneficial for hospitals in India and a collaboration can be sought from interested Swedish hospitals to launch such trainings and innovation programs.

Developing healthcare AI

Through the intervention of innovation units in hospitals and county level regional initiatives, Swedish agencies are evolving the understanding of developing AI solutions. With possibilities to pay with data to develop AI tools, hands-on experiments about trying latest AI tools to build an informative position are some of the considerations already being made at the Swedish end. There is a natural synergy between India and Sweden on the topic of AI^[1]. India can offer data to build AI and can gain from the Swedish expertise of processes and considerations to be made for collecting and refining data. These synergies were discussed at the India Nordic Seminar by stakeholders in detail from both sides.

New Innovation Model of large private companies to incubate SMEs

A path breaking innovation model, which is experimented by AstraZeneca in form of AZ Bioventures at their Gothenborg site was a key showcase of the visit. Home to some 30 SMEs for last 5 years, the model has already resulted in 5 Initial Public Offers to some billion dollar successes. The model was discussed in last year’s Davos Summit^[2] and now actively being taken up by other corporates like ABB, Volvo in Sweden and AkzoNobel in Netherlands as an inspiration to unlock innovation in the ecosystem.

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Day 1

Figure 1 - Indian delegation with Swecare members at H2 Health Hub

The visit started with a visit to H2 Health Hub in Stockholm which is a coworking space where Nordic Health Tech startups can connect, collaborate and share their innovations. Currently, there are 45 startups representing 26 countries in this space. The Indian delegation met representatives from the Swedish Ministry of Health, Swecare, SMEs and startups comprising of medical technologies, wellness, Health IT, mental health, pharmaceutical, radiology solutions, etc. The Sweden Ministry of Health representative shared his views on how Sweden is facilitating cross-border collaboration with India by using innovation to increase social impact such as the 10-years MoU signed between Sweden and AIIMS Jodhpur aimed at learning and exchanging best practices. The discussion also pointed out the India-Sweden collaborative industrial research and development program between Vinnova (Swedish government agency) and GITA (executing organization under the Department of Science and Technology, India). The collaboration aims at innovation projects linked to addressing global challenges such as climate change and sustainable developments.

Figure 2 - Visit to EMPE diagnostics at Karolinska Institute Campus

The Indian delegates got an opportunity to go around the Karolinska Institute (KI), Sweden’s largest medical university, and academic research center. Since 1901, the Nobel Assembly at KI has selected the Nobel laureates in Physiology or Medicine. The prime institute has university hospital, science park and innovation center. EMPE diagnostics which has background from KI and in collaboration with KI researchers presented their rapid diagnostic solution for Tuberculosis (Tb). The test uses DNA sequencing which can correctly identify virus or bacteria and their antimicrobial resistance within 2 hrs. India has around 86,000 new cases of Tb per day and 1.7 billion people at risk. Considering these statistics, EMPE through InnovatioCuris (IC) are looking forward to venture into the Indian market.

Next was a visit to Karolinska Hospital and its Innovation Unit which has collaboration with 8 EU countries. The Region Stockholm has a policy for innovation i.e. every organization should have an innovation center. The Innovation Center is a great model which encourage and engage all stakeholders, such as health professionals, patients, medical researchers and industrial partners to address unmet needs in hospital services through innovation. The innovation activities happen in day-to-day work at all levels and across each department. The center helps identify needs, define areas for innovation and develop the best solution. There is also a certification course for innovation leaders and managers. The center showcased project I-AID (Integrated AI Diagnostics) which aims to accelerate the development and implementation of artificial intelligence (AI) in healthcare initially focusing on medical imaging and physiology. This is a learning for Indian healthcare sector wherein the hospitals foster innovation in their own setting by creating an environment where ideas can become reality.

Figure 3 - Indian delegation appreciating the serene and modern setting of Karolinska University Hospital

A part of the Indian delegation also visited the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU). Health Technology Assessment (HTA) involves systematic independent assessment of a method, including side-effects, cost-effectiveness, and ethical implications. SBU is one of the oldest organizations in the field of HTA and expressed interest in collaborating with India.

Figure 4 - Indian delegation members with SBU Staff, Sophie Werko

Day 2

The second day was in Uppsala, the fourth largest city in Sweden. Uppsala University is the oldest university in Sweden. The visit started with Region Uppsala where the delegation was welcomed by the chairman of the board, Vivianne Macdisi. Region Uppsala Innovation has a R&D department for 2 hospitals, primary care centers, and mobile units. The ideas from employees, patients, and relatives are collected by each hospital unit’s idea coordinator. The ideas are assessed and approved by idea counsel. The feedback on the idea is conveyed to the ideator. Region Uppsala innovation also organizes a workshop called innovation race where companies and innovators such as employees generate ideas and work together towards the idea.

The county also has Uppsala Innovation Center (UIC) which is the world’s fourth-best university-affiliated business incubator. UIC offers business development programs and supports innovative startups and growth companies to commercialize, scale-up and access the international market. UIC provides expert help, awareness and knowledge for companies, and a national platform to connect the best companies.

Figure 5 - Dr V K Singh from Indian delegation presented his healthcare innovation book to the chairman of Swecare board and Uppsala regional council, Ms Vivianne Macdisi

Day 3

The delegation had the opportunity to attend e-health matchmaking event, Vitalis which is the largest eHealth event in Scandinavian. Vitalis themes included Artificial Intelligence, IoT, Decision support, medical imaging, home care, elderly care, remote health care, and robotics.

The Business Region Gothenburg and Swecare organized a special seminar ‘AI and Collaborations in AI and Innovation’^[3]. The keynote speech was given by Linda Swirtun, program manager of Vinnova, Sweden’s government agency for innovation. Vinnova funds healthcare/life sciences innovation projects and research by collaborating internationally. Under the Swedish- Indian Innovation Partnership, the Swedish companies can collaborate with companies in India in joint research and innovation projects to address global challenges such as climate change and sustainable development. The corporate-driven collaborations can be in the area of smart cities and clean technologies, digitalization, and IoT.

Figure 6 - Linda Swirtun sharing the first keynote about India Sweden Collaboration

The panel discussions had representatives from the Nordic-Baltic region and India. The first panel focused on the transnational collaborations between the two regions and its challenges. Rohini Pimple, RICH, Dr V K Singh, InnovatioCuris, Dr Sandeep Bhalla, PHFI, Kingshuk Poddar, Medivalley Incubator represented the Indian side. Lars Lindskold, Swelife AI Institute, Iris Ohrn, Business Region Gothenburg, Jaanus Pikani, Scanbalt Forum and Magnus Bjorsne, AZ BioVenturehub represented the Nordic Baltic side. The session was moderated by Shampa Bari of Swecare. The Indian panelist discussed how the current government has been very supportive and driving innovation in all sectors. There have been changes in policies and regulations which has led to a smooth process for collaborations. India has huge data which can be used to develop AI tools by countries like Sweden. Also, knowledge sharing between the regions could be beneficial. The panelist further discussed the unmet needs, and public-private partnership models working in India. The research cluster of India shared the opportunities of life sciences. The government incubation center shared how it can be a soft-landing spot for Nordic-Baltic companies for medical devices. The representative from the Public Health Foundation of India discussed the challenges in public health in India and how capacity building can be done at scale. The Nordic-Baltic panelist emphasized on the various technologies which are relevant for India. In addition, the representative from Business Region Gothenburg stated that it is easier to do research collaboration – to test and validate one’s product in Sweden as compared to others. Furthermore, the Nordic/Baltic region has a strong IP protection regime. Therefore, the collaboration will be a win-win situation for both the regions.

Figure 7 - First panel had regions and clusters from both sides discussing collaboration

The second panel brought together hands-on experts on AI both from the developer and user side. Indian side was represented by Pradeep Mathapati, HCL, Deepali Jetley, Qwazent Healthcare. Swedish side was represented by Annie Chandy from LUDC, Devdatt Dhubhashi from Chalmers University of Technology and Peter Soderman from Karolinska University Hospital. The session was moderated by Sachin Gaur from InnovatioCuris. The panel discussed in depth the challenges of AI development and how processes are evolving at the end of the health system to collect and refine data. Interesting observations were made on the role of data in AI, future job roles for AI in health sector and business models that may emerge when the providers and IT players collaborate.

Figure 8 - Panel 2 keynote was shared by Pradeep Mathapati from HCL Germany office

Day 4

The last day gave a perspective about the second largest city of Sweden, Gothenburg. The delegation was welcomed by Business Region Gothenburg, West Swedish Chamber of Commerce, and Surgical Science. Surgical Science have virtual reality simulators for surgeries like evidence-based laparoscopic and endoscopic training. The representative of West Swedish Chamber of Commerce discussed why Sweden is interested in investing in India as it is an emerging market after China, and it is a volume market with rich data. India also has a large pool of highly skilled IT professionals. On the other hand, Sweden is one of the world’s largest 10 economies and has become one of the most innovative countries in the world. Sweden is home to companies like Volvo, Ericsson, SKF, Spotify, Skype, IKEA, etc. The Indian team visited the Sahlgrenska University hospital along with Gothia Forum, which has 54 clinics in West Sweden for clinical trials.

Figure 9 - Expert from Surgical Science ready to give us a handson training on various surgeries (ofcourse simulated)

Furthermore we visited Biobank West, a Swedish Biobank showed their infrastructure where they store the blood and tissue samples. Companies such as Surgical Science, Biobank West are actively looking out for collaboration with India.

Figure 10 - Site visit of Gothia Forum, Swedish Bio Bank

The last stop was at the famous Swedish pharmaceutical company Astra Zeneca (AZ) which has been ranked number one in IDEA Pharma’s Pharmaceutical Innovation Index (PII). An interesting model has been adopted by AZ called AZ BioVenture Hub. It is a collaborative innovation ecosystem for emerging biotech, medtech companies, and academic groups to strengthen competitiveness in the Nordic life science industry. AZ provides space to the SMEs and an opportunity to interact with highly-skilled AZ professionals. In addition, the SMEs can use the state-of-the-art lab facilities and infrastructure of AZ. Currently, there are thirty companies in the AZ BioVenture Hub.

Figure 11 - Indian delegation with Magnus, Pernila and Jesper from AZ BioVentures and GoCo City

AZ has also enabled a bigger initiative called as GoCo Health Innovation City. GoCo will be a collaborative innovation ecosystem with more than 30 companies working in biotech, medtech, and academia. This city will be completed in eight years and will have co-innovation programs and services such as networking events, experienced facilitators to mentor the innovator, connecting members with similar challenges, growth guides. It will be a place for focused work and healthy living.

Figure 12 - Field visit to the site of planned GoCo Health City

The way forward

Sweden being the global innovation leader and start-up hotbed can be a great example for India. The country has an innovation policy and each county is working towards it. It is focusing on the unmet needs of the population and fostering a culture of innovation. The Swedish innovations can be plugged into the Indian ecosystem and vice versa. Innovation is fostered by opening boundaries, by gathering insights and information from new connections, and by sharing knowledge. Keeping this in mind, InnoBRIDGE was envisioned and continuously working towards other collaborations.

We look forward to build on the initial interests among stakeholders from both sides in form of knowledge webinars, physical visits and signing of MoUs in cases of where the concrete plans emerge. The next milestone for us would be InnoHEALTH 2019, 4-5 October where interested Swedish stakeholders plan to visit us in India and hopefully by then we would have progressed on some of the existing discussions. Also, some of our Indian delegates look forward to participate in Vitalis next year!

Send your comments / feedback to sachin@innovatiocuris.com

References

To know more about the InnoBRIDGE Sweden 2019 program and details of Indian delegation, you may visit innovatiocuris.com/innobridge/innobridge-2019

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