Day 8: IUDs and Indian Women

August 10th 2011

intrauterine device (abbr.: IUD)

· a contraceptive device fitted inside the uterus and physically preventing the implantation of fertilized ova.

Today we met with PSI India where we got to speak with them about their Women’s Health Project. The goal is to improve the health status and quality of women in three states of India: Delhi, Rajasthan, and Uttar. Their target audience is women in the reproductive age (WRA). The project aims to dispel the myths and misconceptions these women have towards the ideas of birth control and sexual health. One of the ways they market this message is by forming a group of Interpersonal Communicators (IPC). This group counsels WRAs, provides referral coupons for IUD insertions, and follows up with women post insertion. Furthermore they offer answers to questions like “what’s going to happen to my body” and provide support when the husband is against the idea of no more children. Their main two messages are that (1) IUD is as effective as sterilization and (2) side effects subside within 3 to 6 months.

I fell in love with the idea of the IPCs. Here is a group of women and men that go to impoverished areas to the homes of WRAs in to have an honest conversation with them about sex and the idea of IUDs. I’ve learned through my Communications major that interpersonal communication can be the most persuasive form. It is more personal and as a result the WRA is more likely to agree and accept the message.

Freedom 5 is the name of the IUD that PSI gives to selected to providers. The providers must assure quality of service and care. Providers then sell Freedom 5 for about $250 rupees.

PSI explained that many of the WRA do not want to continue to have children, they come in already having on average 3-5 children, but the husband is against the idea of an IUD insertion. As a result husbands are their biggest challenge. When the idea of no longer having children and the various available methods to be used, the women of India go to their husbands first. And if he shuts down the idea, that’s the end of the conversation. To try and decrease the pressure that these women feel IPCs go and talk to husbands as well and try to explain the benefits. In India the husband plays a vital role in family planning. It was hard to hear how controlling the husbands are, the final decision should really be up to the woman.

Still there are some women that go ahead with an IUD insertion, and sometimes there are husbands that agree with it. Post insertion, IPCS follow up with women. Another service that PSI provides is a helpline that includes inbound calling to answer questions and provide information along with outbound calling that provides referrals to providers and post insertion follow up.

PSI India is still working on ways to measure the effectiveness of their efforts. However they did point out lessons learned through the first phase of the Women’s Health Project. They found that it was costly to keep IPCs and that doctors are not giving enough time for IUD counseling.

Apart from the husbands another challenge the PSI faces is on the issue of funding. We learned that donors are giving to the local organizations or government initiatives instead of companies like PSI.

In addition to the IPCS, PSI also uses social media to get their message across. They showed us a commercial that is used for the Freedom 5 product. Using the symbol of a lock, the characters in the commercial are a couple having a conversation and then going to a doctor to talk about having an IUD insertion. It looked glamorous and simple. Two adjectives not usually used to describe anything to do with an IUD insertion but it worked!

After hearing about the Women’s Health Project we got to meet with a doctor that provides Freedom 5 and a “chemist” (the equivalent of a pharmacist) that provides abortion pills amongst other drugs. The doctor gave us great insight about who is coming in for IUDs and the skepticism towards them. She explained that women believe the myths and misconceptions and therefore worry about what it will do to her body. Moreover they are concerned about other women in the community finding out about the insertion.

When we met with the chemist you could immediately tell that it was a corrupt system. Even though abortion pills are only suppose to be given with a prescription, we found out that sometimes that does not happen, along with other drugs.

In conclusion, I found PSI to have one of the best marketing and communication strategies that I have seen thus far on my trip in India. I found it very unfortunate that they found the IPCs to be too costly, because having communicators that work at the ground level, promoting the Women’s Health Project, directly speaks to your target audience and can get their message across. Therefore my suggestion would be to keep the IPCs and focus on a way to train chemist and doctors on how they too should properly promote IUDs and PSI India’s Women’s Health Project.

Day 7: A New Day in Delhi

Aug 9th 2011

We arrived to New Delhi on Tuesday. After stepping off of SpiceJet I could already feel the difference; less noise and hotter weather. That night we went to a delicious and beautiful restaurant named: Olive Bar and Kitchen in Mehrauli, New Delhi. We had the chance to speak with Nandita Chopra, the NIH Representative to India; you could tell she was a woman of beauty and intelligence.

Day 6: Conversation with Change-makers

A Q&A Session in the Bombay Hub (8/8/2011)

On Monday it just seemed to all click and make sense. My worry of Social Entrepreneurship having a high failure rate and being just a fad was put to an end after meeting with Unlimited India and Acuman Fund. I was reassured that individuals have the power to make a social change and start a business from the ground up. It starts with a simple idea in a given community, a dash of entrepreneurial skills, along with a great deal of passion to follow through with the idea. In India, to be a social entrepreneur is no walk in the park, there is a lack of cultural support and available funding opportunities along with the fact that many do not come from a business background and therefore do not know how to write a business plan let alone run a business. That’s where investment companies like Unlimited India and Acuman Fund come into play.

“Our seed financing and incubation support is designed to help you develop as a leader and successfully launch your social venture. We meld the passion of the social sector with the rigour of the business sector” –Unlimited India

We met with leaders of Unlimited India that further explained to us their views on social entrepreneurship and how Unlimited helps with the process of becoming a social entrepreneur by providing funding and support. We met with Pooja Warier, the co-founder and director of UnLtd India, along with associates, Roshan and Karen D’Souza. When asked about the definition of social entreprenuership, Pooja explained by comparing a social entrepreneur with an activist. She gave the example of people going hungry. “An activist”, she said “only addresses the symptoms while a social entrepreneur on the other hand, gets to the root cause and asks ‘why are you hungry’”. However at the end of the day, the title means little to nothing. The support that Unltd provides goes far beyond rupees or dollar signs, their program offers a yearlong package. They provide seed funding, hands-coaching and training and high-value connections. Therefore not only are they paying for start-up costs but they also help with financial planning, governance and marketing. My favorite part though is that they stress the importance of mentorship. Unltd prides itself in coaching and connecting their investees with mentors, training clinics, peer learning, and experts in the field. They have a 3 level support system as follows…

Level 1: Develop Leaders (given up to 80,000 rupees)

· After the investee proves that he/she has done the due diligence proving that the idea is needed. Unltd provides a sustainable initiative plan along with “160 hours of hands-on support over the course of a year.”

Level 2: Prepare for scale (given up to 2,000,000 rupees)

· Boost the project “towards greater impact and sustainability”. At this level investees are given of “220 hours of hands-on support over a year.”

Level 3: Accelerate Support (given up to 20,000,000 rupees)

· Gives a social business fund of up to 20,000,000 of loan financing (“repayable over three years, along with a customized support package over the period of the loan”) allowing the business to be sustainable and continue to grow and provide an impact.

All of the funds given at each level are all low interest loans that are repayable over 3-5 yearsAfter hearing about this promising system of support, and with my eagerness to make a social change in the world, the question was “How can I be an investee?”

The selection process is just as organized as the support system. They begin by working with NGOs to find legitimate leaders that are passionate, have done the ground research, and have a structure for an idea. An investee cannot be illegitimately or politically motivated. In addition he/she must be at least 16 years of age and the business must be grounded in Mumbai so that the leaders and mentors of Unlimited can meet with the investee face to face. And lastly there is an executive panel, represented by people of the corporate and social sector that does the final selection by following a four part assessment criteria.

1. Entrepreneurial Capabilities

a. Will he/she connect to the community? Does he have a vision? Will the idea not only be able to generate money but more importantly attract funds?

2. Potential of the Idea

a. Is there a need for the idea?

b. How is it different from what is out there already?

3. Match

a. Do the person and the idea match?

4. Value

a. Will he give back to Unlimited India or another start-up in the future?

The organization sounded so flawless and systematized that we were curious as to know whether Unlimited India faces any challenges?

I remember Pooja smiling and nodding her head yes. She explained that investees of Unlimited face budget, business plan, and legal challenges but their main challenge comes from the home of the investee. She told us about family pressure and how the main reason for failure of an idea is when an investee buckles into family pressure. This could be a spouse disagreeing with the idea of a social entrepreneurship endeavor or the chance that there would be a lack of income. The other reason for failure is when the investee realizes that that a startup business will require a great deal of attention and as a result quits because he/she cannot be 100% devoted. Unlimited gave us examples of their successful social entrepreneurs

Moreover they explained the key elements of a business plan that aims to make a social change are:

· Problem

o What’s the problem?

· Approach

o How are you going to fix the problem? What method are you going to use?

· Impact

o How are you going to measure your results and what are your results?

Instead of waiting for NGOs or the government to come along and fix a problem affecting a community Unlimited encourages individuals to take action for themselves. It’s about changing that initial question of “what’s the government going to do” instead to “what can I do about this.” Pooja explained: that in every social entrepreneurship business plan, there needs to be a balance between thinking scale and thinking social change. Both Unlimited India and ACUMEN Fund India want to raise philanthropy, fund a sustainable business model, and measure the impact. However what we found was that ACUMEN Fund did not really have any hard evidence or research on the impact of their businesses. This missing piece, I believe, is crucial. Nonetheless, the energy that these leaders had was infectious. Unlimited and ACUMEN Fund both believe that it’s worth investing in individuals that are looking to leave a social impact on a given community. Change-makers is what they call them. The advice they gave to us in order to help businesses like the ones they fund is to volunteer long-term and to make donations to legitimate organizations. This conversation alone sparked ideas of my own for my upcoming business plan for the final project of this class.

Day 6. PSI

On our first full day in Delhi we had the pleasure to meet with Population Services International (PSI) to learn about their Women’s Health Project. The main goals of the project are:

1. to decrease maternal mortality

2. to increase the use of intrauterine devices (IUDs) from 3% to 4.1%, and

3. to increase access to medication abortion (MA).

With this project PSI hopes to empower women so they can make their own decision regarding their bodies and reproductive health.

I found this program to have a very sophisticated design; it targets all the important stakeholders in the community, including women of reproductive age, providers, pharmacies and the government. For instance, both providers and pharmacists are trained on how to disseminate information about both IUDs and medication abortion; and opinion leaders advocate for government support for IUD and MA use. PSI uses interpersonal communicators (IPCs) to educate women in the community about IUD use and the benefits of having a long term birth control plan. The main misconception and fear most women in the community have about IUDs is the idea of the IUD going up in their bodies and harm their health. IPCs clarify any other misconceptions women may have and answer any other concerns about the safety of the device.

Another interesting and impressive feature offered by this program is heir Helpline. PSI has made this toll free helpline available to women to call anytime with any questions and concerns, and it is also used to follow up women that have decided to get an IUD. About 600 calls are received each week. Impressive.

After we learned about all the features of their program we went out to the field to see it in action. We met with one of the providers and learned that when women go to her to get an IUD they never come with their husbands. In fact, in most instances their partners are not aware of her decision, and in 20% of the cases, when the partners find out they have the women remove the device. I was amazed. Men play a key role in a women’s decision making (at least here in India), and as such they should be equally educated and exposed to the benefits of the program.

Thank you PSI for a great learning experience!

Last Day in India

On the last day of the study abroad portion of our course, everyone met to share their experiences about the trip and exchange ideas about possible social enterprises. It was clear that all of us had internalized many of the experiences from our trip and were ruminating about potential roles we could play in helping to improve some of the conditions we witnessed. Several students were able to articulate ideas they were mulling over and in one particular spontaneous group-think effort were able to design a holistic business model that offered a concierge of mental health services.Needless to say, Prof. Vyas was ecstatic about how beautifully that idea was developed, so quickly and spontaneously by a group of students and I suspect we surprised ourselves with our ingenuity!

To extend the insights from the Salaam Baalak Trust visit on the previous day, our final group class session really reinforced the value of collective experience, immersion in an alternate culture, seeing traditional public health issues through different lenses and through the eyes of others in helping us articulate our own roles in the public health arena as we move forward with our lives and careers. For that opportunity alone, the India Study Abroad and Social Entrepreneurship Course was well worth the experience and one hopes GW-SPHHS will continue to offer such opportunities to more of its students!

With many thanks to the University, Dean Goldman and Dean Reum for permitting our study abroad adventure and to Professors Vyas and Parrish for their foresight in offering the course and for their tireless efforts to make it happen and so successfully at that!

Affirmation at PSI

Our first meeting in Delhi was with Population Services International (PSI). PSI is the third largest NGO in the world and is the undisputed leader (in my mind anyway!) in global health program marketing and communications, as well as program efficacy. Their interventions bring aid to millions of people around the world and their programmatic efforts span a variety of topics including malaria, reproductive health, safe water, and others.

Our meeting with PSI inspired me on many different levels. The most basic, yet perhaps the most important, is that it reaffirmed the lessons that we are learning in the classroom through the MPH program at GWU. This was truly an opportunity to see classroom knowledge being applied in the field, with success. As we listened to the very sophisticated reproductive health program presentation, it was so affirming to see simple things like health and behavior objectives incorporated into the presentation. I find myself sometimes actually being in awe of people who are successful in their careers, in areas where I would want to work and this was truly a moment where I thought “hey! I can definitely do that” and this feeling is directly attributed to my classroom experience at GWU. It’s funny, isn’t it, how sometimes you have to travel halfway around the world to have an affirming experience for what you are completing back home.

The PSI program for reproductive health is extremely well thought out, and has many components. My friend and classmate Kelly Healy has done simply an unbeatable job outlining the program in her blog today so I will spare another identical recap and will instead blog about what I found to be the best aspect of the program: the use of contraceptives through empowerment.

It was stressed numerous times during our discussion that empowerment was the major objective of the program, a sentiment that I truly appreciate. Giving women a contraceptive without information or skills is akin to giving them nothing at all. The PSI program uses a variety of techniques to truly empower women. Their outreach program identifies leaders in the community and trains them as Interpersonal Communicators (IPC). These IPC’s then go out into their own community, where they are already known, to educate and provide tools to empower women to talk to their husbands about contraception and understand where and how they can get it. PSI uses the Freedom5 intrauterine device (IUD) to do this. The IUD is a cost effective, long lasting (5 years), proven effective and reversible form of birth control that is sustainable for these communities.

From my perspective, there is so much that PSI is doing right in the area of reproductive health. Their programming combines grassroots community efforts on the ground with high-level social media campaigns that reach masses of people with just one television advertisement. They truly are a world-class organization and are worthy of every cent of funding.

The meeting with PSI also provided a type of full-circle experience for me as I reflect on this course as a whole. In addition to affirming classroom lessons from the MPH program as a whole, meeting with PSI provided great contrast and similarity to some of the smaller, more community-based NGO’s we met with in Mumbai and Delhi. Comparing a PSI program to an Acorn India (the NGO we met with in the Dharavi slum in Mumbai) provides a case study in its own right on the full spectrum of social entrepreneurship as well as NGO’s who are truly making a difference in communities, from the top to the bottom. PSI may have more money and resources to put together a power point, speak at a conference or provide marketing materials --- but is what they are doing so different from Acorn or Impact India? I don’t think so.

I appreciate so much about what PSI is doing in India, and around the world. Their funding allows for true market research to be conducted – resulting in more efficient, effective and targeted program. Now, if only every NGO could have such funding! It can be easy to become blinded by the celebrity and sophistication of programs from PSI; however, it is so important to remember that their mission is the same as any of the other smaller NGO’s we’ve seen in India. PSI wants to help people, they have identified target areas in which to do so, and they create programs for communities that provide education, resources and support.

A communications approach to improving women's health

PSI is the worlds third largest NGO. The organization began working in India in 1988 and has since extended their programs to 22 different states and union territories in India. With nearly 20% of the world’s population living in India, health disparities are abundant throughout the country. We met with representative from PSI at their India office to learn about their women’s health programs. The main goal of their program is to empower women of reproductive age (WRA) to make their own decisions. In their efforts to improve the health status of women, PSI seeks to increase the use of IUDs in WRA from 3% in 2010 to 4.1% in 2012. They also intend to increase access to medical abortion (MA) through sales of 300,000 MA kits by 2012.

By increasing the use of IUDs and MA, ultimately maternal morbidity and mortality will be reduced with a decline in the rates of unintended and unwanted pregnancies. There are several key stakeholders that PSI’s women’s health program is targeting to achieve their goals including WRA, providers, pharmacists, and opinion leaders. Their program is based on social marketing, improving access, advocacy, and managing information systems. Their approach seeks to motivate their target audience and to create an enabling environment for IUD and MA services available to WRA.

There are a variety of activities and strategies that PSI uses to target each stakeholder. It was really exciting to learn about the techniques that PSI is using to meet their objectives because many of their strategies are similar to the ones we learn about in our MPH program. One concept used by PSI is the interpersonal communicator (IPC). When we design community based programs in our classes, we often use the idea of community health educators and community mobilizers. IPCs work directly with women in the community by going into the home and discussing the use of IUD. They use a storybook depicting a happy family that has taken advantage of the benefits of IUD. Incentives are given to IPCs based on their performance. The main messages they are trying to dispel are that IUD insertion is as effective as sterilization and the side effects usually subside within 3 to 6 months. We later went out in the field to see how the IPCs work in the community. They pair off with their materials and go directly into the home. It is not uncommon for the IPC to have the discussion with both the woman and her partner as men usually have the final say in whether or not their wives get the IUD or not.

Another strategy that PSI used that I was really interested in was their use of media to promote the IUD product Freedom 5. They use media to expose both men and women. PSI showed us a YouTube video of a Freedom 5 commercial where a male and female are role playing a potential discussion a couple may have when discussing the possibility of using IUD as contraception. This link isn’t the one they showed us, but it is one example of a video used to promote Freedom 5: http://www.youtube.com/watch?v=KHXyj2Hj3NI. In the US, many health intervention programs are starting to use text messaging. Given that all over India it seems that everyone has a cell phone regardless of social class, I think it would useful for programs to begin experimenting with the utilization of telemedicine for intervention.

I also found it interesting to talk about the cultural barriers that prevent a woman from taking advantage of contraceptive methods. Mother in laws are a huge barrier for women because they want their sons wife to fulfill their duty of expanding the family and bearing a son. It is also essential that women gain endorsement from men because they need permission from their husband to leave the home. Kelly and Jenn had the opportunity to go directly into a home with two IPCs and when they reported back, they said the woman did not want to have any more kids, but that she couldn’t get an IUD because her husband wouldn’t let her. It is hard for us to imagine such pressures and barriers to individual freedom in the US, but these cultural norms are prevalent and need to be considered when designing any community based health program.

We made other site visits to a health clinic where a female OB/GYN works as one of the providers promoting PSI. We also visited a pharmacist/chemist that fills prescriptions for MA. PSI works with pharmacists because they dispense 80% of MA medications and they need to be properly educated on how to direct women to take the medication. Each group met with different chemists. The one we visited didn’t really give us any direct answers as to how many drugs he sells without a prescription so it was difficult to gauge the volume based on his response. I imagine this is because he was afraid we might report him, and he really had no reason to trust us either way.

This is just another example of many opportunities we have had on this trip to see what we learn in the classroom applied in the field and these experiences are invaluable. I really enjoyed meeting with the PSI staff. Given that PSI presence across the globe is so established, I can see why they are so successful. The models they have in place to improve health problems are creative and well thought out, and it was incredibly beneficial to see much of the theory we learn in action.

The Tortoise and The Hare -- UnLtd India

On Monday we met with both UnLtd India and the Acumen Global Fund. Each of these organizations operates with the goal of encouraging social change through the financial support of social entrepreneurs. UnLtd India financially incubates the ideas of social entrepreneurs in the first four years of the life of an idea. I love this model because, by reaching out with support in the first years UnLtd India that idea can grow from a solid base.

Both of the meetings took place at “The Hub”, which is an open air loft space that functions as rentable office space for social entrepreneurs. I love this idea because it promotes so much peer support, idea sharing and support and I truly feel that the greatest ideas arise from peer collaboration.

I was particularly inspired by our meeting with UnLtdIndia. We met with Pooja Warier, the vivacious and extremely intelligent co-founder and Director of the organization. Her vision and acute awareness of the social climate of entrepreneurs in India lends itself to creating a functional launch pad for those entrepreneurs’ ideas, through UnLtd India. We met at “The Hub”, which is a lofty area where entrepreneurs can meet, share ideas, work and be inspired.
Following the conversation with Pooja, we engaged in a very interactive session with two UnLtd India employees – Karen and Roshan. The interactive and informal nature of our meeting lent itself to a very open, question-driven session in which many members of our group were able to really connect with the organization, its’ people and its’ mission.

Karen led us through three examples of social entrepreneurs who had been funded and launched by UnLtd India. This was the most inspiring part of the meeting for me because these ideas, which have gone on to receive additional funding and success, are not grandiose. I think that so many people in our field of work, myself included, sometimes feel that the need “the one” great idea that will change the world. Even the title of our class textbook encourages this mindset. What UnLtd India showed us was that even the smallest or most basic idea can, in fact, change the world. It may not be changing the entire world as we think of it, per se; however, if an idea changes the way or scope in which an individual lives their life – isn’t that changing their world?

The greatest social change need not affect masses and masses. If our ideas can simply change one aspect of one community’s existence I truly believe that then, the goal has been met. Social entrepreneurship, social impact, social change – these buzz words tend to create a feeling of need to create an impact for the greatest amount of people possible. I certainly relate to this and understand those feelings. The meeting with UnLtd India was so valuable because it started me thinking about narrowing the scope of my interests and truly perfecting a program that will seamlessly and effectively create an impact for that group. Once tested, only then would it be appropriate to scale up the intervention, program or business to reach the masses.

This sentiment is analogous to the simple children’s story of the tortoise and the hare. We can hope and we can certainly dream about truly “changing the world” and there is no fault in that. What I will carry with me from meeting with UnLtd India is that it doesn’t take a “change the world” idea or mindset to truly affect the ways in which people live their lives. Focusing on a smaller population, with one simple idea can certainly carry out the tenets of social entrepreneurship and social change and provide a platform for that big, change the world idea.

Day 7 – Social Marketing in Action

After a lovely dinner in Delhi with Nandita Chopra, the NIH Representative to India, we headed off Wednesday a.m. for a busy day with Population Services International (PSI), looking specifically at its Women's Health Project. I knew going into this day that I was going to love it because a) I love women’s health and b) PSI is pretty much THE organization when it comes to health communication and social marketing. From the very beginning of the meeting when they flipped on the projector and started talking about objectives (SMART objectives like we learn about in class!), we could see the difference between a small, local NGO and a multi-national one like PSI. The team we met with walked us through the integrated program they have in place to reach women, healthcare providers, pharmacists, and opinion leaders. The scope of the project is too large to recap in one blog, so I’m going to focus on the interpersonal communicators (IPCs), which I was later able to watch in action.

The IPCs are primarily charged with increasing awareness about and use of intrauterine devices (IUDs), which are a safe and effective long-term (but not permanent) method of birth control. Most women choose an IUD after having several children, when they want to limit their family sizes, but have not completely ruled out more children. The IUD PSI promotes is called Freedom5, because it lasts for 5 years.

To raise awareness of IUDs, PSI has trained a team of IPCs to go into urban areas throughout several districts in northern India. The IPCs gather household information and, after determining that there is a women of reproductive age (WRA) who could benefit from an IUD, provides information and referrals. There are two good things I saw about this approach that no doubt reflect PSI’s experience and knowledge. First, the IPCs do not just provide information on IUDs, they educate the women about the “contraception basket,” including condoms, oral contraceptive pills, injections i.e. Depo-Provera, and IUDs. Secondly, the IPCs are not incentivized based on the number of IUDs inserted, which might lead to more forceful interactions with women. Instead, they are encouraged to meet certain targets for the number of women they speak with each day. If a woman is interested in IUDs, the IPC gives her a referral card and information for a nearby clinic. If the women goes to the clinic, the referral card serves as a tracking device to see how many women visit a doctor and how many actually get an IUD inserted.

When we went into the field, we met up with four of the IPCs and an IPC coordinator. Jenn M. and I had a chance to observe a one-on-one session with an IPC and a woman in her home. She invited us without reservations into her home where she shooed away two men, who looked to be maybe her son and father or father-in-law and had us sit on a bed in a small room. The IPC began speaking with her in Hindi and gathering the household data including her age and information about her children. We learned that she had four children and used condoms, but was hesitant about an IUD because she thought her husband would disapprove. Her reaction when we asked if she wanted more children was clear, she grasped her stomach and said no. It was clear that this family was struggling with the small means it had, so one could easily understand why the woman wanted to limit her family size. So the IPC gave her some additional information to keep in case she decided to pursue an IUD in the future. In public health classes we are always talking about community outreach workers and it was very neat to see one in action.

In addition to outreach via IPCs, PSI runs a call center that does follow up calls to women who have IUDs inserted (and give consent to follow up) to counsel them on any side effects or concerns one-month after the procedure. The outreach program is also integrated with a mass media campaign that promotes the idea of an IUD being a lock with a key. When we visited a clinic in the partner network we saw this advertisement posted on the wall. PSI said the campaign has already been very successful, with a 60% reach. Of the women reached, 50% reported that they talked with their husband about an IUD, 10% went to a provider, and 5% got an IUD. While these numbers may seem small, they are actually quite significant for a health promotion campaign. The mass media campaign augments the personal outreach because it can also help influence a woman’s husband and mother-in-law, who in this culture have a strong influence on decisions about contraception.

One of my favorite parts about the day with PSI was when PSI’s maternal and child health lead Sanjeev Dham flipped the conversation around and asked us for our criticism of the Women's Health Project. He really valued our insights, which included thoughts on expanding the program and strengthening evaluation.

Day 6 - Support for Social Enterprises

Our schedule in Delhi has been jam packed so I’m a bit behind but I have to share about our wonderful day on Monday with UnLtd India and Acumen Fund India. This was our first real view here in India into organizations that support social enterprises. I love UnLtd India’s incubator model for start-up social enterprises and NGOs and the stories they told about the unique and determined social entrepreneurs they have met and helped, and the women from Acumen Fund provided a very useful big-picture perspective about investing in social enterprises and the challenges in measuring results.

UnLtd supports non-profit, for-profit, and hybrid models in the 0-4 year phase during which these organizations prove their model and begin scale up. They also provide access to The Hub, a shared space for offices, events, and networking among social entrepreneurs. A quirky office space with little nooks for reading and chatting, The Hub reminded me so much of the Affinity Lab where my husband’s company got its start. The vibe of the office was inspiring, from the fact that you have to take your shoes off to come in to the open and airy loft and balcony where we met with UnLtd Director Pooja Warier (see pics below).

I was surprised but pleased with Pooja’s response to my question about how UnLtd defines social entrepreneurs. She said that terminology changes over the years and no matter what the development world calls them – activists, innovators, social entrepreneurs, or something else in 10 years – these people will be doing the same work. She also gave a great explanation of the difference between a social entrepreneur and a social worker. A social worker will say you are hungry, let me give you some food, but a social entrepreneur will say why are you hungry in the first place, and then look for a solution to the root problem.

I love the concept of Acumen Fund, which is an investment firm focused on social enterprises and willing to invest “patient capital,” in other words it does not expect the immediate and large returns that corporate investors do. What stood out the most for me during the conversation with Molly Alexander and her colleagues was how difficult it is to measure social impact, as well as attribute it to one specific organization or effort. This is certainly a challenge that has come up throughout my coursework and research at GW. We talked about how Acumen’s health portfolio evaluation is almost solely focused on outcomes like number of patients served, number of clean water jugs sold, etc., without getting at the long-term health impact. This discussion certainly revealed the need for more trained and talented researchers in the field – perhaps some from GW!

The measurement challenge flows naturally into contemplation of the potential impact of social entrepreneurship, which myself and others have struggled with throughout the last two weeks. For example, we have discussed that perhaps social entrepreneurship is not as sustainable as we initially thought. The meetings with UnLtd and Acumen made me think that while sustainability is important in the long-term, it is also important not to overlook the small-scale impact these types of organizations can and do have on individuals and communities. If support from UnLtd India can help a courier business get on its feet, hire 45 deaf workers, and change those 45 people’s lives in a profound way, while also raising awareness of this underserved population, I would call that a success. Or if Acumen invests in a company producing locally-filtered water that reaches 250,000 people and has catalyzed an industry that now reaches an additional 500,000, I would call that a success. And, many of the organizations UnLtd and Acumen support are on a path to sustainability. Like any enterprise, they may still need investor support, but they can start to move away from donor funds, which is key.

During our day at The Hub I had millions of thoughts racing through my head about what career path I should pursue after my MPH. While I’m still working through those, I was undoubtedly inspired by the ideas and energy coming from UnLtd India, The Hub, and Acumen Fund.