Reality Check

After meeting with Acumen on Monday and hearing about their projects, challenges and successes, it gave a great frame of reference for our following two meetings with international, American-based organizations. On Tuesday, we flew from Mumbai to Delhi and, during dinner that night, met with Nandita Chopra, a representative of the National Institutes of Health (NIH), living and working in Delhi on the NIH's India portfolio. It was really interesting to speak with her about her role and what the NIH is doing to promote health in India. She has an extensive history in HIV/AIDS research and it was amazing to hear about the work the NIH is doing, particularly for me, in the way of HIV/AIDS prevention in India.

The following day, we met with PSI – a HUGE international NGO with thousands of projects across the globe – I was definitely interested in PSI prior to the meeting, and was pleasantly surprised at the level of depth we were afforded to experience. I figured we would meet with them in a similar fashion as with Acumen or UnLtd - they would discuss their projects, provide some interesting examples and allow us to ask questions. They did that, and so much more. The PSI staff really engaged us. After a presentation of their current local women's health projects – working to increase access to low-cost intrauterine devices (IUDs) and medical abortion – they requested that each of us provide criticism of the project.

Obviously each of us would come away with thoughts about the program – the model, the implementation, the evaluation methods - but it was so refreshing to be asked, point-blank, about a real, functioning program (and then have the opportunity to go out and see it; to meet the people who take the theory and models about which we learn in class and turn them into something tangible). Amidst the craziness and uncertainty which India can breed within you, our time with PSI was the professional reality check I needed and really solidified much of my India experience thus far. Though our meetings and interactions with other organizations have been enlightening and engaging on a number of levels, I am still figuring out what social entrepreneurship means to me, and what role I can play within that sphere. Regardless of how India or social entrepreneurship strikes me, today reminded me that soon, I will be done with my degree, and will be doing work like this; work which will have the potential to make a real impact on people's lives.

Day 6: NIH dinner and PSI

Last night, after arriving in Delhi, we were given the amazing opportunity to have dinner with Nandita Chopra, the NIH Representative in India. Ms. Chopra shared her story of working for NIH for the past decade and how she eventually made her way to India. It was extremely interesting to hear her side of working for a government organization and how she paved her career path through NIH to do something more fulfilling. With all that we are experiencing within both the private and public sectors of public health in India, it was refreshing to hear the personal side of working for a government organization.

Today we visited the India branch of Population Services International (PSI) and were introduced to their Women’s Health Initiative to reduce maternal and infant mortality in India. The program discussed involved providing IUD education and services to impoverished women throughout Delhi as well as medical abortion kits. The two objectives of this specific program were to increase the percentage of women with IUDs by 1% as well as provide 300,000 medical abortion kits via PSI trained pharmacists. Personally, the PSI presentation was one of the more interesting presentations and was very relevant for what we are learning in the public health program at GW. I was able to approach the subject objectively and critique specific aspects of PSI’s program.

There are significant cultural differences between Indian and American women and their ability to choose their own forms of birth control and family planning mechanisms. Men are the dominating forces within the family, which lead Indian women to have less control over their bodies and how many children they want. IUDs allow for women to choose not to have children without daily contraceptive use or the permanence of sterilization. PSI takes a door-to-door approach and sends out IPCs to meet with women on an individual level. They explain the concepts of family planning, how IUDs work, as well as the side effects of IUDs. Women that are interested in the idea give their contact information in order for IPCs to follow up and provide assistance. We were able to see the actual spreadsheet of women visited and the extensive record keeping of the IPCs when the group set out in the field locations… it also showed the large amount of young women that already have multiple children.

We visited one of the community health clinics where women come to receive medical services ranging from standard check-ups to childbirth. The doctor sat down with us in her office (which acted as a patient room as well) and went over the issues women face in regard to family planning and women’s health. It was fascinating to see firsthand the medical facilities and services available. Visiting the clinic really provided insight into the barriers faced by women in India as well as the huge cultural differences in women’s health.

The other aspect of the program involves training pharmacists how to properly explain and distribute PSI branded medical abortion kits. The fact that these medical abortion kits can be taken up to 2 months into a pregnancy without the assistance of a doctor didn’t settle well with me. I absolutely believe they should be available and provided by trained pharmacists but the lack of follow up after the abortion kit is distributed concerned me. The potential for emotional and mental health issues is extremely present and not addressed in this program. I would add some form of tracking aspect for the women receiving medical abortion kits and follow up as they do with the IUDs.

PSI is doing fantastic work within their Women’s Health Initiative through education and providing access to affordable modes of contraception that are not otherwise available to this population of women. It was a great opportunity to experience a public health initiative in the works and feel comfortable providing feedback for the program.

contagious passion for change

For our last full day in Mumbai, we made a site visit to the Bombay Hub. The hub is a laboratory for change that provides start up social entrepreneurs with a physical space to come together and work while discussing their ideas. The Hub provides social entrepreneurs with the opportunity to engage with others in the field that are passionate about social change. The space was incredibly welcoming not only because we walked around bare foot, but because the atmosphere in the space was filled with a contagious passion for success of the organizations.

UnLtd India is a seed fund and incubator for social entrepreneurs. They work with entrepreneurs in the start up phase by providing support to accelerate their program, develop as leaders, and prepare their organization for scaling and further investment. Within the current social entrepreneurship landscape, an individual starts with an idea, experiments with it, consolidates a model, and if all goes well the idea is fully conceptualized. The next level of support widely available is given after an entrepreneur has implemented their idea for three years. In between these two levels there isn’t much support and several ideas “die” in this phase. That is where UnLtd India comes in. Their mission is to encourage individuals to take action and not wait for the government or other non-profits to intervene. They solely work with start-ups that have a clear vision for social change by providing them with several support mechanisms within the first 0-4 years. First they provide incubation support, which includes seed funding and a package of support services. Second, they utilize a boot camp that serves as an intensive accelerator to the social entrepreneur attempting to implement their idea. The Bombay Hub serves as a third program by providing individuals with the ability to co-inhabit the same space and work towards social change. The fourth program utilized by UnLtd is the social mashup; a conference for early stage entrepreneurs to come together and discuss their ideas.

When assessing applications for selection to receive UnLtd services, there are four criteria they are looking for in each person. First, they look at the individual’s social entrepreneur skills regarding their level of motivation, what initiated their motivation to pursue their idea, and how resourceful they are. Second, UnLtd assesses the potential for the idea to create an impact. If there is no need or demand for the idea, then it is not likely to succeed. Third, they try to match the idea, or determine how it will be put together. Finally, UnLtd seeks to determine the value that they are able to bring to the individual and vice versa. If they are not able to provide added value to the individuals efforts, it is not worth investing their time and effort. Conversely, selected individuals have to sign a contract stating if they are successful, they will give back time, money, and mentorship to UnlTd.

I really enjoyed the answer that Pooja, co-founder of UnLtd India, gave to our class when asked about her definition of a social entrepreneur. The political answer would be that it’s any individual with an idea to create change in the community and their successive ability to sustain that idea. Pooja encouraged us not to take the definition of a social entrepreneur so literally because as with most concepts in the social sector, terms lose their sex appeal as time goes on. What was once called a social worker or activist may now be categorized as a social entrepreneur. These terms and definitions are not what is important but rather the individual’s ability to create a lasting impact.

The entire conversation surrounding our discussion with the UnLtd India team was fun and inspiring. There have been times on this trip where pessimism has gotten the best of me, but I realized with each of the examples of programs UnLtd is working on that something as simple as developing a program that provides a bee box to a farm can have a significant economic and social impact on a community. I think sometimes I get hung up on my ability to think of unique and fresh ideas, but creativity does not necessarily have to be abstract if you have the passion for instituting change effectively and with persistence.

Three representatives from Acumen Fund also met with us at the Hub. Acumen was founded around the idea that there is a need for a different type of support from commercial and charity, specifically for social enterprise. Their India portfolio is primarily involved with water and sanitation, agriculture, and healthcare. When looking for potential beneficiaries, Acumen assesses the ability of the program to have a social impact, their financial stability, potential for expansion capital, and the dynamics of the management team. Of all the points we discussed with Acumen, I felt this was one of the more important ones that we have not really discussed in class. Too often I have either witnessed group failure because members are unable to work together as a team, or I have been a part of a team experiencing similar challenges. Acumen, and other potential funding sources, need to really assess this component. If a team does not have the ability to execute the plan, if they do not have the ability to follow through on the intended course of action, if they have not established appropriate partnerships- the plan may never succeed. It is crucial for organizations like Acumen and UnLtd to meet with social entrepreneurs face to face and assess the management team for the sake of the ability of the group to propel the idea forward.

PSI and Social Marketing

Blog 7- PSI – Day 7 (Wednesday August 10th)

Today our social entrepreneurship program met up with Population Service International (PSI) India. PSI is the third largest NGO in the world and it runs one of the world’s largest and oldest family planning programs in India. We had the wonderful opportunity to be presented about the Women Health Project. The goal of the Women’s Health Project is to increase the use of IUDs and to dispel myths and misconceptions about the contraceptive. India continues to haul high maternal mortality rates due to low usage of temporary methods such as IUDs, birth control pills and condoms. The goal of the Women Health Project is promote higher usage of temporary methods by an increase of 1% in the next two years.
To achieve the objective of higher usage, PSI India has really taken advantage on the opportunity of social marketing and the use of the media. What I noticed about PSI India’s marketing methods is that they take into consideration India’s conservative perspective about family planning, but provided a new twist in providing innovating solutions. For example, PSI India’s commercial about the Freedom 5 IUD contraceptive points out how providing a solution such as temporary sterilization can provide a couple the options not to have children until they are ready again. This provides the opportunity of birth spacing and another method to decrease the maternal mortality rate. The commercial has an empathetic, but a funny tone and it demonstrates that the right decision would be to use Freedom while empowering the woman on her decision, while receiving support from her husband.
Watching the commercial made me realized how the marketing methods that are used in business to sell dish washing soap for profit are now being used in public health for social impact. The commercial demonstrated the research that was put into studying the population, how to brand the Freedom 5 product, and how to sell it to the population. It illustrates that business models such as SWOT and other marketing tools can be transfer into public health to generate social impact and this is an important component of social entrepreneurship.

An International NGO Working In India

On our second day in New Delhi, we visited Population Services International (PSI), one of the world’s largest non-governmental organizations (NGOs) devoted to improving health outcomes. Over the years, PSI has sought to consolidate its efforts and focus on certain geographical areas of India (Rajasthan, Uttar Pradesh, and some North Eastern areas) to maximize their impact. We met with the PSI team at their offices and subsequently toured two of their sites in the city.

At headquarters we learned about PSI operations, goals surrounding the Women’s Health Program (WHA).

The WHA seeks to empower women and influence several key target audiences like providers, pharmacists, opinion leaders through the use of social marketing to promote services (not products). PSI provides information on contraceptives and medical abortions (for health reasons)to women in their target communities and has engaged with interested providers to promote the use of intra-uterine devices (IUDs) as a preferred method for the Indian population. In some ways, the IUD is regarded as an optimal long term contraceptive solution given its reversibility. However since numerous myths surround its use, PSI employs interpersonal communicators (IPCs) to disseminate information on a one-on-one basis to help dispel these myths. These IPCs are educated with Master’s degrees in Social Work, undergo periodic training and bring community experience to their job. Additionally, PSI employs an Integrated Communication Campaign to disseminate their message that IUDs are a form of empowering women to make reproductive choices.



One striking element was PSI, India’s recognition that Indian women in families live within a cultural milieu where many members of the family and even friends (husband, mother-in-law, sister-in-law, social circle) are jointly involved in reproductive decisions. PSI supports this situation by working with the women over a period of time through multiple visits, offers to explain information to family members, establishment of a telephonic helpline, physician referral and follow-up services. In a way, there is potentially both value and threat in peer pressure and husband support. PSI uses the helpline call centers as way to expand positive word-of-mouth stories surrounding IUD use.

The GWU Team also visited a physician service provider who partners with PSI and observed IPCs working in a community. PSI employs a multi-tier management information system and has collected field data over the past two and half years on their current initiatives. While some of this data is used to monitor programmatic progress and impact, much of it remains to be analyzed (potential opportunities for graduate public health students!).



A key challenge facing a large international NGO working in the Indian space is funding limitations since donors are inclined to work with governmental institutions or local Indian NGOs. Other areas of concern for an institution like PSI is ensuring their program and efforts are sustainable in the long run within the communities even after PSI pulls out.

An interesting feature of the PSI approach was some of culturally specific marketing efforts employed in the Integrated Communication Campaign. For example, (1) giving a freebie in the form of “stick-on bindis” (red dots worn on the forehead by most Indian women everyday) with contraceptive or provider information stamped on the back; (2) hosting mother-in-law and daughter-in-law meet-ups to provide an intergenerational forum where women’s health issues may be discussed; (3) hosting mothers meeting groups for mothers to share their concerns with other mothers; and (4) having physicians host small community get-togethers where women can ask questions in an informal set-up. PSI’s evidence indicates that women are more likely to attend the clinic of these physicians who initially met them in an informal get-together.

On the whole, the PSI site visit allowed a useful point of comparison to some of the smaller Indian NGOs observed earlier in the trip. PSI India is clearly able to take advantage of a rather solid and well established infrastructure from the parent organization. This was evident at all stages from the initial PowerPoint presentation at the office to the level of training afforded to the Interpersonal Communicators. This type of support ensures the organization is able to continue its work in multiple spheres simultaneously to interact with, influence multiple target audiences and influence public policy.

Day 5. UnLtd India

After all the sites we have visited in Mumbai to learn about the struggles people in the community are facing, it was nice to finally learn what role social entrepreneurs are playing here in India to address such struggles.

We visited the office of UnLtd India, a seed fund and incubator for social entrepreneurs, where we learned how ideas become realities when you have the proper business structure. UnLtd India offers different types of support for social entrepreneurs in the community. They offer financial support through grants, and low interest loans at different stages of the project. They also offer non-financial support through coaching, training, networking and even by providing physical space for meetings and other administrative tasks.

Thanks to our visit to UnLtd India, I feel I am finally able to understand the idea of a social entrepreneur. It all clicked when they talked about one of their examples, the “Honey Lady, ”and how she was able to increase the farmers’ productivity by 25% by using bees. This woman provided bee boxes and training for farmers on how to use them to increase pollination in their fields in order to increase productivity. Also she set up a system where she would buy the honey from the farmers as well, as a way for them to make additional profit, but what I found very interesting was that she allowed farmers to sell to other buyers if they could get a better price. She provided them with training plus tools, and also allowed for a source of income. I never thought bees could foment social change in a sustainable manner.

On this note, one of our classmates pointed out how whenever we think of ideas or projects to help communities we tend to complicate things and forget about the impact of the little things. We forget that bees, a soccer ball and even an electric fence can start something bigger than we can imagine. I will keep this in mind when thinking of ideas for our business plan.

Today was our last day in Mumbai.

Thank you Mumbai. Next stop, Delhi.