Country: India

Organization: Comprehensive Rural Health Project, Jamkhed

Focus of activity - Technology

Year the initiative began (yyyy) - 2006

Define the innovation - What is the main focus (product, services, etc) of your innovation? Who are the primary beneficiaries? How does it make health and/or health care more affordable, accessible, and simpler to achieve/use? How does it differ from what currently exists in the market? The Comprehensive Rural Health Project, Jamkhed has been working in partnership with village communities since 1970 to uplift India’s rural poor and marginalized population surviving in appalling conditions. CRHP aims to implement a wide range of interconnected community-based health and development programs that empower women, children and the poor and marginalized through a comprehensive, holistic and value-based approach emphasizing equity and justice. By strengthening families and building healthy communities CRHP has successfully brought about positive transformation and improved quality of life for hundreds of thousands of people living in its project villages. The Water For Life Program, administered under CRHP, will facilitate and enable poverty stricken communities to set up local Biosand filter production and distribution networks so as to ensure the availability of affordable safe drinking water in every household. Already relying upon such water purification methods as boiling, chlorination and moringa seeds, to varying extents, the village communities, working in partnership with CRHP, will be able to utilize these intermittent slow-sand filters as an appropriate and cost-effective technology that will be sustainable in the long term with little or no outside input. The local production and distribution of these filters will also boost the economy by serving as an effective income generating program. The high incidence of diseases such as diarrhea, dysentery, typhoid, and hepatitis A especially during the monsoon months are placing a heavy burden upon the poor. A concerted effort to tackle this problem and eliminate preventable suffering can be achieved using such elements as proposed in this program. Furthermore, education and training, emphasizing environmental awareness, hygiene and sanitation, will be key aspects of the program so as to eliminate gaps between community level service improvements and household-level water and food handling practices.

Context for Disruption: - Describe how your innovation is transforming traditional health or related systems in the short and long term. When considering the health of communities one cannot underestimate the importance and influence of the local water supply. Water is critical to life yet several factors besides its availability must be taken into consideration in order to fully understand and protect this vital resource, which is intrinsically linked to public health. These factors include water quality (source suitability), accessibility, use (resource allocation), and conservation. Furthermore, the 1978 Alma Ata Conference on Primary Health Care identified the provision of a safe and adequate water supply as being one of the eight fundamental components of primary health care.
A major goal of the Water For Life Program is to work with village communities to set up sustainable, locally-managed water and sanitation surveillance activities that will be used to assess and make any necessary improvements or changes in local infrastructure and behaviors in order to reduce morbidity from water-borne diseases. This will be conducted in conjunction with the Biosand filter promotion activities. The viability of using and promoting Biosand filtration technology at the household level becomes all the more promising when considering the diverse conditions under which these filters have been effectively used and tested by a number of governments, NGOs and academic institutions. Tens of thousands of filters in over 30 countries throughout Latin America, Africa, South and Southeast Asia have shown the ability of this technology to adapt to a variety of environmental as well as social conditions to improve the health of communities. Given the encouraging results of the filter under laboratory as well as field conditions in India and other countries as well as locally administered pilot studies, CRHP expects this program to be highly successful at impacting public health.

Delivery Model - How does your innovation reach its target populations? What mechanism(s) (e.g., communications, distribution channels, etc.) do you have in place? What is your current market penetration? How do you measure this? Health activities are arranged according to a three-tier health delivery system. The novel idea of using village health workers (VHWs) as local agents of change is at the core of the first tier – the village communities. Our mobile health teams consisting of a nurse, social worker, paramedical workers and doctor comprise the second tier. These teams serve as the liaison between village and health centre. Villages are visited periodically, more often in new project areas, to provide support and credibility for the VHWs and offer assistance and facilitation in development activities such as the Water For Life Program. The health centre makes up the third tier and consists of a formal training institute, administrative office and 50 bed low-cost secondary care hospital providing quality emergency, medical, surgical, and outpatient care for the 1.5 million people residing in the surrounding 8 block catchment area. The training centre promotes CRHP’s approach as a global model applicable to developing and developed nations among national and international trainees. The provision of quality curative services at our hospital has proven to be invaluable in establishing credibility for community-based primary health programs as well as earning the trust and confidence of the communities with which we work.
The current operational model of CRHP enables a highly efficient and open flow of information and resources from the health centre to the communities and from professionals to grassroots workers. This system, which has worked well for over 36 years, will enable the effective implementation and monitoring of the Biosand filter program. The program will be flexible, responding to the stated needs and wishes of the target population, and implementation will be conducted primarily by the people themselves so as to encourage local ownership of this program and to develop leadership.

Key Operational Partnerships - What key partnerships have you established to make your disruptive innovation model possible? Who are your partners (business, social, government, other) and what are their roles? How central are these partnerships for your initiative. Since its founding CRHP has engaged in key operational partnerships, which made it financially and technically possible to undertake a large number of vital activities such as the drilling of over 250 tubewells to provide the villages with an adequate quantity and quality of drinking water. These partnerships have included Oxfam, United Methodist Church, and Churches Auxiliary for Social Action in the past and currently Lutheran World Relief, Tearfund, American Leprosy Mission, and the Sisters of Notre Dame, Holland.
State and central government partnerships have made it possible to spread the community-based approach to health and development throughout India. This is achieved via residential and mobile training of grassroots workers, officials, administrators, and health professionals. Government partnerships have also provided a forum in which to advocate for the rights of the poor and marginalized. This is done through the current participation of Dr. Raj Arole on the National Rural Health Mission, chaired by the Prime Minister, as well as past involvement on various state and national health policy making bodies.
The Aroles have been recognized by the Schwab Foundation, part of the World Economic Forum, as social entrepreneurs. Membership in the Schwab Foundation provides access to strategic partnerships with leading business and government organizations that are interested in social investment. This also provides a valuable platform for exchanging ideas and resources.

Financial Model - Describe the financial model for your innovation. What percentage, if any, of the total operating costs does earned income (from products, services, or other fees) represent? CRHP aims to enable communities to achieve sustainable holistic development in which local resources are developed, maximized and used to their fullest potential. Financial reliance upon an outside organization is counterintuitive to achieving this goal. Experience has shown that when communities invest a substantial amount of their own time and resources into health and development activities a much greater sense of ownership and pride develops. The results of this approach have been very positive with communities showing significant interest and commitment to PHC activities long after CRHP reduces its presence.
In the Water For Life Program, households will be charged a fee for each filter based on a sliding scale. The very poor will receive the filters with heavy subsidization when necessary. In CRHP’s hospital, patients are also charged basic fees according to a sliding scale, made possible with input from VHWs who are intimately aware of the socioeconomic status of patients from their village. The ultimate goal, however, is not to turn a profit but rather to serve the poor by enabling them to improve their livelihoods and quality of life.

Effectiveness - What has been the measurable impact of your project to date? How many people have benefited from your program in total? What policies, communities, or institutions have been influenced to make fundamental changes because of your work? Approximately 2 million people have benefited from the many health, development and training activities of CRHP over the past 36 years. The impact of CRHP’s many health and development programs have been far-reaching into nearly every aspect of the lives of the poor – social, economic, political and environmental – as implied by the term “health”. This impact has been described quantitatively through a number of surveys and research conducted over time to identify changes in the health status within project villages. Equally important are the qualitative changes that have taken place with regard to quality of life and expectations for the future.
For instance people now willingly accept family planning since they no longer expect their children to die from communicable diseases, keeping the average number of births to 2-3. In addition 80% of health problems are effectively taken care of at the villages themselves by well-trained and confident VHWs.
The political structure of all our project villages have been drastically changed by the people themselves through social and cultural reforms. Caste and gender discrimination are no longer pervading aspects of daily life as they have been done away with in exchange for cooperation and peaceful coexistence. In some villages, previously untouchable women have even been elected as Mayor. CRHP has also been a strong and influential catalyst for various state governments throughout India and the central government to which the director is a public health consultant via the National Rural Health Mission, chaired by the Prime Minister. CRHP has also hosted a number of foreign dignitaries and ministers of health who come to learn about our unique approach to health care delivery and community development.

Scaling up Strategy - What is your priority for the next 3 years and please describe why. Over the next 3 years CRHP will focus on consolidating our activities with the SERP (Society for Elimination of Rural Poverty) project in the state of Andhra Pradesh through mobile and residential training of staff at all levels of health and development work. At the request of the state government CRHP will expand work in the tribal areas of Maharashtra through training of Ashram boarding school teachers and setting up community-based programs to empower tribals and develop villages. Advocating for health policy reform through the National Rural Health Mission will continue due to Dr. Raj Arole’s representation of India’s NGO sector.
Locally based expansion will include an increase in the number of project villages and the scope of current programs as well as initiating new ones in response to changing health and socioeconomic conditions in the villages. The Water For Life Program will be one of these new initiatives. A greater focus will be placed on the prevention and treatment of chronic diseases that are becoming more common. The hospital will expand in order to upgrade facilities, increase the number of beds and expand its services. Expansion of the training institute will also take place to accommodate a growing national and international interest in our programs.

Origin of the Initiative - Tell the personal story that will help people connect to your work. How did the initiative start? Was there a particular individual or event driving the idea? Tell the reader the story behind the innovation. CRHP was founded by Drs Raj and his late wife Mabelle Arole, who committed themselves to serving and uplifting India’s rural poor and marginalized population. The Aroles graduated from CMC Vellore and obtained their residency training in medicine and surgery and masters of public health in the U.S. While in the US they planned a project that would effectively meet the immediate and long term needs of the poor and marginalized, especially women, by working in partnership with the village communities. In 1970 Drs Raj and Mabelle Arole returned to India to implement this project. After visiting villages and holding open discussions with people to see where community cooperation and participatory development would be most welcome they decided to work in the areas surrounding Jamkhed in the Ahmednagar district of Maharashtra.
Among the many awards won by the Aroles was the Magsaysay in 1979.

What are your two main challenges to finance the growth of your initiative - What are the two (2) main challenges in financing the growth of your initiative with respect to operating costs and capital expenses? What amount of financing would your organization need in order to scale up operations? The effort to meet operating costs while attempting to expand and further develop community-based health programs is an ongoing challenge. Achieving full financial sustainability in an organization geared towards working with the poorest and most marginalized groups in society is impossible without alienating those same groups. Despite keeping the cost of patient fees and other health services to a bare minimum it is still necessary to subsidize these services for those who genuinely cannot afford to pay. Other activities undertaken through the joint partnership of CRHP with its project communities (e.g. drilling tubewells, watershed development) require a monetary investment often beyond the scope of the villages’ capacity. We therefore often attempt to access appropriate government schemes or set up partnerships with other NGOs involved in such areas of expertise in addition to contributing our own funds to finance a percentage of the larger projects.
The lack of professional PR representatives to publicize and promote CRHP makes fundraising difficult. We mostly try to target foundations and social investors. It would take about US$2 million to effectively scale up operations.

How did you hear about this contest and what is your main incentive to participate? - (This answer will not be published on the website.) A direct e-mail from Tyler Ahn of the Ashoka Changemakers Team to CRHP invited our participation in this contest. Through this competition we hope to promote and share a cost-effective and scalable approach to health and development through the use of innovative strategies.

Do you have an annual financial statement? - The Comprehensive Rural Health Project has an administrative office which records and stores the annual financial statements. These are audited statements of accounts officially conducted each year by chartered accountants and approved by the board of directors.

Do you currently have an annual financial statement that tracks profit/loss? - The financial statements of CRHP contain an itemized list of income and expenditures. As a charitable not-for-profit organization CRHP does not record its budget in a profit/loss format.