Day 4: Impact India in the Thane District

I was definitely excited to hear our itinerary had changed and we would be visiting rural communities three hours north of Mumbai. I’ve always been very interested in the cultural differences of rural and urban communities. In college, I worked in an extremely rural Head Start in Ohio’s Appalachian community. Some of the kids traveled 2 hours on the bus to get to pre-school and were very isolated from any other way of life. I saw a lot of similarities between the tribal communities of the Thane District in India and the Appalachian families I worked with in Ohio. One of the main similarities between these two culturally different rural areas is the strong sense of pride as a community. There’s an automatic safety net built in that isn’t as present in urban areas. I think this allows for great opportunity in rural communities as far as health and prevention initiatives because having an established network of support is crucial in educating and promoting health throughout a community.

During our three-hour drive north, we were provided a thorough introduction to all that Impact India is involved in throughout the entire country. Of all the different organizations we’ve read about in class and visited throughout the trip, Impact India was definitely the most impressive. Their mission statement reads: To initiate, augment, and intensify action against those causes of massively prevalent disablement for which there exists a potential for prevention and control, which can be delivered through existing delivery systems and available infrastructure. To treat millions of people who are disabled by curable blindness, deafness and physical handicaps and facial deformities. Through a great example of public/private partnership, Impact India partnered with the Indian railways to make the “The Magic Train of India” or the Lifeline Express a reality.

The Lifeline Express is the world’s first hospital on a train that brings medical services to disabled people living in the impoverished rural communities throughout India. I think what made Impact so impressive to me was in conjunction with the surgical services provided on the train, they’ve established Community Health centers in these rural areas that focus on prevention. Impact is taking that next step necessary to allow these communities to one day provide their own health care with programs that work to prevent illness and disability. The end goal of Impact India is for the Lifeline Express to become obsolete and these community health centers will be the driving force behind reaching that goal.

Rural and Tribal Health, Thane District, Maharashtra

The fifth day brought us respite from Mumbai’s urban jungle as our group headed out into Thane District and rural India. The experiences of this day provided an excellent counterpoint to many of the disheartening conditions observed in the cities.



Our host for the day, Ms. Neelam, Director of Special Projects for IMPACT India took us to visit some very successful public-private partnership enterprises between IMPACT India and the Indian Government (Central and State). We visited a tribal (Adivasi) children’s residential school, a local women’s clinic run by a trained nurse from the Adivasi community, a Government Primary Health Center, and IMPACT India Mobile Eye Clinic, located in various villages about a 100Km outside Mumbai.

Our first stop at the tribal children’s residential school showcased an adolescent girl’s health initiative geared towards providing health education about adolescent health, early marriage and iron/folic acid/multivitamin supplementation. Supplements donated or supplied at low cost by pharmaceutical partners such as CIPLA, are distributed free of charge to the young women who range in age from 10 to 17 years. The girls also undergo periodic check-ups with the government physicians from the local Primary Health Center. One of the most striking things about this experience was how extraordinarily welcoming and friendly the children were and how open the girls especially felt around us. Some of the young women expressed the hope of college studies including medical or nursing school as a means of giving back to their community, yet at the same time they were emotionally attached to their families and wanted to attend only nearby colleges of which only a few exist in rural areas.

Another striking point was how the Government Primary Health Center offered both Ayurvedic and Allopathic medical services as part of the Indian Government’s AYUSH Program. The AYUSH Program integrates traditional Indian medicine systems including Ayurveda, Yoga, Unani, Siddha, and Homeopathy which are primarily used for long-term, chronic treatments. The National Rural Health Initiative includes several sub-programs targeting malaria, leprosy, HIV screening for pregnant women, diarrheal disease, infant and maternal mortality.

A third striking point is the extra-ordinary use of a manual census type system to count and record information on the entire community and jurisdiction served by the Primary Health Center. This detailed, monthly data collection and verification represents updated information that is forwarded to district headquarters for further analysis and allows the Government Health System to modulate services in shorter time spans than the traditional 10-year National Census time block.

The two physicians we interviewed also demonstrated an unique commitment to staying and serving in the rural, tribal areas beyond the requisite 1-year program they signed up for initially after medical school.

All in all, it was very heartening to see tangible evidence of how public-private partnerships can work successfully in the Indian context. Ms. Neelam from IMPACT India further corroborated the importance of these partnership programs as means for the private sector to demonstrate best practices (such as through the LifeLine Train, Mobile Eye Clinic etc) to the Government system and to use the pre-established governmental infrastructure without re-creating systems thereby reducing parallelism and redundancy and possibly increasing confusion.

The long term goals in addition to eliminating and reducing preventable disabilities, is to build local capacity within these rural and tribal communities and to empower them to experience better health outcomes while supporting some (but not necessarily the quackier) of their traditional beliefs and practices.

Is Social Entrepreneurship a Fad?

For today’s blog I was struggling to sift through the ideas and lessons presented from our visit to Dhavari. We were lead by Mr. Vinod Shetty from ACORN India to observe the waste management and engineering savvy implemented by the people of this slum. During the day Dr. Vyas posed the question, “is social entrepreneurship simply a fad?” The sights of the day and the discussion to wrap up our site visit lead to enticing food for thought.

To begin, Dhavari is the largest slum in Asia and home to 1.5 million people. Though this plot of land is a slum, the people have become extremely efficient when it comes to waste management. In fact, their waste management has become a sustainable industry. Over the past 75 years, the people of Dhavari have built a well-functioning society. They have mini factories that process and recycle every piece of cardboard that is found, they make beautifully embroidered clothing, and they even dabble in the dying industry. There are schools in Dhavari, music classes, and doctor and dentist’s offices.

What then is the problem? It took 75 years to get to this point, won’t they only continue upward with time?

No, and the problem is two-fold.

The first half of the problem: the recycling industry resides in the informal sector; the government does not recognize it on any level. These people are considered squatters on the government’s land. They are shunned by society and must struggle for electricity, water, and proper roads. The government could step in at any moment, flex their muscles, and level Dhavari homes to the ground. To prove residency in Dhavari, at least 15 years of dwelling must be provided. The majority of those in this community do not have documentation, in fact, the majority of the population in Dhavari is men who migrate for work and send money home to their families. Documentation is not a commonality. Other contributing factors include a highly Muslim population within Dhavari, creating cultural tension within a mostly Hindu nation and political corruption.

However, the people of Dhavari have created a system that works, for all intents and purposes this community is sustainable. For example, we met a man who owned his own business recycling cardboard. He "owns" the warehouse where he employs 4-6 men who find discarded cardboard in trash heaps and make it usable once again. These men eat, sleep, and work in the same warehouse. Simply put, sustainability is achieved because these men live in the factory. The owner has worked his way up through his industry and may live elsewhere. This hierarchy is replicated in several industries within Dhavari.

—Here in lies the second half of the problem, these slum dwellers have made a sustainable life, but they are not able to come to maximum scale.

--How do you create a better life and cause social change if you can only earn enough to provide for the next day and the next week?

There are two possible solutions; create a revolution demanding change or find an investor.

In our discussion Dr. Parrish framed the challenge well, “have you had enough? It is only when the answer to this question is yes, will things change.”

Let’s first tackle the idea of revolution. Consider the perspective of exploited members of a society where political corruption is prominent, as well as the Karmic belief that reincarnation could bring riches and intelligence in the next life if no harm is done in this life. These political and cultural barriers and infulences alone pose a major challenge.

Next, let’s tackle the idea of investment for this society. This involves understanding and dissecting the difference between social entrepreneurship and pure enterprise. If the idea was strictly profit an investor could come into the slums, see the workmanship involved in the embroidery industry, market and contract the product, produce profit and in return earn more than was initially invested by paying workers the bare minimum. The government does not regulate these people, and there are no unions—profit would be made. However, the goal is scaling up and making social change to better the lives of these slum dwellers. The progression can be viewed as:

Donor invests capitalà workers are trained in a skillà the equipment required to sustain production in this skill is donated to these workersà more workers become trained and achieve sustainabilityà these workers then re-invest capital into their communities in sectors of health and education.

These workers are (1) given the freedom to continue using the skills learned, independent from the initial investor and (2) they are given the choice as to what to do with their earnings. These two factors are key to successful social entrepreneurship.

*Idea for social change + well formulated business plan à sustainable social venture

**An important caveat remains; if people are going to re-invest they must first be invested in their community. This idea might be lost on a population comprised mostly of male, transient-migrant workers.

The sights of the day and conversations had throughout our site visit, debrief, and final evening meeting brought the challenges and promises of the idea of social entrepreneurship into a new light. I have a feeling the surface has only been scratched…