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Implementing the SDGs for Women’s Health using a Global Approach

Implementing the SDGs for Women’s Health using a Global Approach

“All countries should strive to make accessible, through the primary healthcare system, reproductive health to all individuals of appropriate ages as soon as possible and no later than the year 2015.”

In 1994, the International Conference on Population and Development (ICPD) collectively agreed upon achieving the goal of reproductive health for all by 2015. Although universal agendas set the tone for progress in the allied areas, there prevails a significant vacuum between the implementation stages and the practice of engaging with family planning needs. The United Nations has stressed the importance of reallocation and mobilisation of financial resources.

‘Among the 1.9 billion women of reproductive age (15-49 years) living in the world in 2019, 1.1 billion have a need for family planning, that is, they are either current users of contraceptives or have an unmet need for family planning. Of these 1.1 billion women, 842 million use modern methods of contraception and 80 million use traditional methods of contraception.’   Source: Family Planning and the 2030 Agenda for Sustainable Development: Data Booklet

Healthcare interventions need to recognize the local context, unique to certain cultures. the nature of health facilities, commercial outlets, and existing community-based systems. The WHO also promotes a reproductive health strategy that emphasises on strengthening the existing healthcare services to introduce new interventions in the allied areas.

Women’s participation in community organisations like SHGs and other microfinance programs generates non-financial benefits, improves social capital, reduces inequality, and improves health outcomes in terms of access to maternal services. It establishes a positive correlation in the improvement in availability of SHGs and an improvement in maternal health and wellbeing. In India, several studies have found an association between self-help groups (SHGs), the most prominent model of microfinance delivery and maternal health and well-being[1]. For instance, a project in Maharashtra trained women SHG members as health workers and provided funds for health emergencies with literacy training showed a reduction in infant mortality from 176 to 19 per 1000, 40 to 20 per 1000 birth rates, nearly universal access to antenatal care, safe delivery, and immunisation and decline in malnutrition from 40% to 5%  in two decades after 1970[2]. 

An integrative approach (both top down and bottom up approaches) towards Sexual and Reproductive Health is critical for the purpose of better health outcomes, education and gender equality. All the 17 goals under SDGs are interconnected and they intend to drive the allocation of the global financial and human resources along with guiding nations’ policy priorities until 2030.

The SDGs must address areas pertaining to SRHR and gender equality explicitly. Without doing so, the progress in such areas will be difficult to measure and to act upon the SDGs. In other words, there are two central challenges the SDGs face with regard to Sexual and Reproductive Health and Rights, i.e. lack of direct attention based on sexual health and lack of focus on context-specific problems in terms of meeting and improving sexual health needs. Specific targets pertaining to Sexual and Reproductive Health are as follows:

SDG 3. Ensure healthy lives and promote well-being for all at all ages  SDG 5. Achieve gender equality and empower all women and girls
Target 3.1:  By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live birthsTarget 5.1: End all forms of discrimination against all women and girls everywhere  
Target 3.7:  By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes.Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation  
 Target 5.3: Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation

In addition SDG #4, which seeks to Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all canprovide children and youth with unbiased, scientifically correct information on all aspects of sexuality. At the same time, it helps them develop the skills to act upon this information. Such education also incorporates concepts of human rights and gender equality. Research shows that programmes sharing certain key characteristics can help in promoting safer SRH practices: abstaining from or delaying the start of sexual relations, reducing the frequency of unprotected sexual activity, reducing the number of sexual partners, and increasing the use of contraceptive options against unintended pregnancy and STIs during sexual intercourse.

Working with men and boys to challenge gender inequalities can also have a positive impact on the health and well-being of women and girls. It is also important to recognize that men and boys also have health vulnerabilities. There is a growing recognition that an improvement in the SRH of boys, an area that has largely been neglected, is crucial for the improvement of that of girls.

SDG# 17 highlights the need for multi-stakeholder partnerships for the Goals to achieve impact at scale. Better access to family planning programs has been estimated to result in almost 40% increase in women’s monthly wages, increasing women’s control and agency over finances and property, and enabling greater long-term savings. This requires engagement with collaborative partnerships at local, national, and international levels. Governments and stakeholders, including corporates, can workwith family planning organisations at national and international levels, and with local NGOs and government health services to ensure long term capacity building to address reproductive and sexual health needs of the community. This is important to address issues of high maternal mortality, poor access to contraception and reproductive health services, and high cervical cancer death rates. For instance, the partnership between USAID and the Indian government, along with private and civil society organisations has strengthened health challenges including maternal and child mortality in the country. The partnership focused on improving the reach, impact, affordability, and quality of healthcare services[3].

In alignment with the WHO, SRH action plan and its three closely interlinked goals, corporates can align their health projects with the global goals and benchmarks by:

  1. Undertaking extensive and intensive awareness programmes for adolescents and youth, enabling informed decision making and preventing and responding to sexual violence by addressing gender inequality and cultural norms from a rights-based perspective.
  2. Build capacities of local health facilities by expanding and strengthening people-centred SRH care services for the vulnerable, disadvantaged, and hard-to-reach groups.
  3. Collaborate with governments at multiple levels to exchange learnings and promote people centred laws regarding SRH rights that are capable of addressing the needs of all.

Living up to the commitment to achieve universal access to reproductive health by 2030 requires the monitoring of key family planning indicators. Many SRH services, like contraception and abortion care, antenatal and post-natal care, can be provided through primary healthcare centres (PHCs). Thus, integrating SRH with PHCs for Universal Health Coverage (UHC) requires development of strategy and commitment from different stakeholders.

Information on sexual and reproductive health is important to support decision-making to advance initiatives and to develop effective programs addressing health needs. The two new tools – Handbook and Learning by Sharing Portal, released by WHO can be used by funding corporates, policymakers, programme managers, implementers, civil society and research organisations in developing coherent strategies to integrate best practices for making health systems more adaptive[4].

HandbookLearning by sharing portal
A guide for planning and implementing SRH services in health benefit packages, accountability processes and measures. It highlights best practices from different countries can serve as an information resource lesson that can be adapted in different contexts. For instance, a safe abortion service in Ireland, evidence-based solution in addressing mistreatment of women in institutional deliveries in Guinea, etc. are learning lessons for strengthening SRH service delivery.Launched in July,2022, is a SRH-UHC portal for peer learning. The portal is an online repository of qualitative case studies that documents experiences of different stakeholders in integrating SRH in Universal Health Coverage(UHC) reforms. It serves as guide in developing normative tools to address SRH needs of women, adolescents, and other vulnerable communities. It features implementation stories from across the world like changing laws in Kazakhstan, partnerships for progress between governments, NGOs and the private sector in Mexico, Nepal, and Pakistan etc.

Both the tools emphasise on the importance of meaningful participation of the people affected through health policies. However, to achieve universal access to SRH services integral efforts are required from the all the stakeholders including governments and corporates that will help align the FP2030 agenda with the SDGs to provide universal access to family planning and lead to healthy lives, informed decision making and participation of women as equals in the society. 

[1] https://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-12-36

[2] https://www.researchgate.net/publication/236956603_The_effect_of_Self-Help_Groups_on_access_to_maternal_health_services_Evidence_from_rural_India

[3] https://www.usaid.gov/india/health

[4] https://www.who.int/news/item/19-07-2022-universal-access-to-sexual-and-reproductive-health

Empowering Women through gender inclusive Sexual and Reproductive Health & Family Planning projects

Empowering Women through gender inclusive Sexual and Reproductive Health & Family Planning projects

Improving sexual and family health and well-being within communities starts with engaging both females and males. Traditionally, females have been the target beneficiaries for Sexual and Reproductive Health (SRH) & Family Planning (FP) initiatives. These initiatives complement each other towards population control, curbing the social problem of child marriage, and promoting children’s health and education. However, it is important to refocus SRH and FP initiatives on the health of family life; and that begins with the females and their male counterparts – the operative word being ‘and’.

In India, there has been an imbalance between male and female sterilizations dating back to the 1970’s. The forced sterilization of 6.2 million men at the time of the Emergency and mass protests, deepened stigmatization, and misinformation about vasectomies. The onus of SRH and FP fell on women in India[i], despite vasectomies being safer and less invasive in nature than most FP initiatives targeted at women. According to the National Family Health Survey (NFHS)-5 (2019-21), only 0.3 percent of family planning methods are male sterilizations, whereas 37.9 percent are female sterilizations[ii]. This stark disparity can be seen continuing since NFHS-1 (1992-93) and has only widened[iii], [iv].

Inspiration from global approaches to male engagement can be drawn, to increase the participation of Indian men in the FP ecosystem. Globally, the approach to include males in the dialogue around SRH and FP is by having SRH and FP programmes engage with males as clients, and/or agents of change towards SRH and FP. This means enabling men and boys to have healthy engagement regarding SRH and FP with their female partners, families, and communities, thereby, fostering equitable distribution of roles and responsibilities among males and females in making FP decisions. By doing so, unequal power dynamic and harmful gender norm practices, like delegating family planning as only the female’s/woman’s prerogative, are challenged and can be transformed[v].

International Commitments for Male Engagement in Sexual and Reproductive Health and Rights:

International commitment to involving men in reproductive health has been affirmed through various international conferences and statements, particularly the International Conference on Population and Development (ICPD) Programme of Action in 1994[vi] and the Beijing Platform of Action in 1995[vii]. The ICPD Programme of Action calls for the innovative and comprehensive inclusion of men and boys to help achieve gender equality and present men primarily as allies in this endeavour. The Beijing Platform of Action reaffirms this[viii].

Programmes around the world that are engaging with males[ix]

According to a report by ICRW titled “How are Men & Couples Engaged in Family Planning? – Learnings from a Review of Programs,” there have been initiatives around the world since 2001 that have been engaging men in their SRH and FP programmes. These include:

  • PRACHAR (Promoting Change in Reproductive Behaviour in Bihar) in India from 2001 to 2013
  • SASA! (Start, Awareness, Support & Action) in Uganda from 2007 to 2012
  • Male Malawi Motivators in Malawi in the year 2008
  • CHAMPION (Channelling Men’s Positive Involvement in the National HIV/AIDS Response) in Tanzania from 2008 to 2014
  • Smart Couple in Nepal for a duration of 1000 days in 2014
  • Promoting Health – Adjusting the Reproductive Environment (Transform/PHARE) in Benin, Burkina Faso, Côte d’Iviore, and Niger from 2014 to 2019
  • Project Ujjwal in India from 2013 to 2016
  • Cyber Rwanda in Rwanda in the year 2016
  • A360 (Adolescent 360) in Nigeria, Ethiopia, & Tanzania from 2016 to 2020

How these programmes have engaged with males[x]

These programmes have engaged with men in three potential areas: as clients, as partners to women in SRH & FP, and as influencers or agents of change.

The programmes provided the men space and support for one-on-one interpersonal communication or small group interaction in the form of:

  • Counselling in person/hotline,
  • Couples/family counselling – specifically with the female partners to encourage joint-decision making,
  • Peer education via community motivators/male community activist, and
  • Community theatre that showcased aspirational family communication around SRH and FP. 

Some programmes employed the use of social media and digital online and mobile phone tools that encouraged participants to:

  • Connect with age-appropriate services,
  • Think about fertility desires,
  • Talk and actively participate in discussions & openly raise concerns with SRH/FP provider or counsellor, and
  • To be confident in sharing about employing or changing family planning methods with family and friends.

A couple of key recommendations by ICRW to consider for including males in SRH and FP Programmes:

  • Develop peer support networks between the participants as well as with community motivators/activists. These networks should be intended to thrive post the end of intervention as participants could continue dialogue on these sensitive issues and have a constant support system to reflect and continue progress towards healthy sexual and reproductive & family planning behaviours such as HIV/STI prevention, contraceptive use, physical violence, domestic chores, and parenting.
  • Being mindful of the need of anonymity and requiring a safe environment free from backlash and negative implications to consume information about safe sex, sexual intimacy, other sensitive family planning topics.  

Other sensitive family planning topics could include sex education, sexuality education, pre-conception risk assessment, infertility, genetic code, anatomy/physiology, psycho-sexual problems, healthy emotional relations & responsibilities, assisted reproductive technologies[xi]. “…engaging men and boys in FP may improve FP outcomes for men, boys, women, and girls, as well as challenge harmful forms of masculinity that prevent men from fully participating in their own RH. Addressing gender dynamics has the potential to influence a host of factors that impact the health and well-being of men and women across the lifespan, including couple communication and decision- making about fertility desires and FP and shared responsibility for their family’s health and well-being.” – USAID[xii]

[i] Kaushik, Ashutosh. (2022, July 11). Man should be equal partners in family planning. Hindustan Times. https://www.hindustantimes.com/ht-insight/public-health/men-should-be-equal-partners-in-family-planning-101657511573064.html

[ii] International Institute for Population Sciences. (n.d.). The national family health survey 5: 2019-2021. Ministry of Health and Family Welfare, Government of India. http://rchiips.org/nfhs/NFHS-5_FCTS/India.pdf

[iii]  International Institute for Population Sciences. (n.d.). The national family health survey 4 (nfhs-4): 2015-2016. Ministry of Health and Family Welfare, Government of India. http://rchiips.org/nfhs/pdf/NFHS4/India.pdf

[iv] International Institute for Population Sciences. (n.d.). Key indicator for India from nfhs-3: 2005-2006. Ministry of Health and Family Welfare, Government of India. http://rchiips.org/nfhs/pdf/India.pdf

[v] (1995). Beijing declaration and platform for action. https://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf

[vi] United Nations Population Fund. (2014). Programme action of the international conference on population development. https://www.unfpa.org/sites/default/files/pub-pdf/programme_of_action_Web%20ENGLISH.pdf

[vii] (1995). Beijing declaration and platform for action. https://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf

[viii] United Nations Population Fund. (2014). Programme action of the international conference on population development. https://www.unfpa.org/sites/default/files/pub-pdf/programme_of_action_Web%20ENGLISH.pdf

[ix] Sahay, A., Joseph, J., Prashad, V.P., Yadav, K., Jha, S., Vachhar, K., Seth, K. (2021). How are men and couples engaged in family planning? Learnings from a review of programs. International Center for Research on Women. https://www.icrw.org/wp-content/uploads/2021/02/ICRW_How-Are-Men-Couples-Engaged-in-Family-Planning_LearningReview_Feb.2021.pdf

[x] -Ibid.

[xi] Wikipedia. (2022, November 19). Family planning. https://en.wikipedia.org/wiki/Family_planning#Assisted_reproductive_technology

[xii] Office of Population and Reproductive Health, Bureau for Global Health. (2018). Essential considerations for engaging men and boys for improved family planning outcomes. USAID. https://www.usaid.gov/sites/default/files/documents/1864/Engaging-men-boys-family-planning-508.pdf

Inclusive Health of Women: Building a case for corporate engagement with Sexual and Reproductive Health

Inclusive Health of Women: Building a case for corporate engagement with Sexual and Reproductive Health

The COVID-19 pandemic challenged the planning capacity, efficiency, effectiveness, and preparedness of the global public health systems. With increased socio-economic insecurities in low and middle-income countries, progress on the Sustainable Development Goals (SDGs), was stalled. The United Nations has forecasted a $2.5 trillion annual financial deficit to fulfil the SDGs, which has been compounded by the pandemic. Given that we are in an era of transnational governance, where companies, civil society, international organisations, and governments play interconnected roles in standard-setting, supervision, and enforcement of welfare policies and programs it is the responsibility of all the stakeholders in the health ecosystem, including the private sector, to collaborate and strategize how best we can do our part if we are to make progress on our shared goals and targets. This view is reflected in Goal 17 (Partnership for the Goals) of Sustainable Development Goals (SDGs), which aims “to mobilise, redirect and unlock the transformative power of trillions of dollars of private resources”.

In 2013, India became the first country in the world to make Corporate Social Responsibility (CSR) mandatory for eligible corporations in India. In doing so, it acknowledged industry as a key change agent and recognized the critical need for utilizing the skills and resources of the corporate sector. Through 2014-2021 CSR spending has been a crucial enabler of development services. Education and health were the highest recipients of support, these being the basic needs of most India’s underserved populations.

The COVID 19 pandemic however reshaped the CSR agendas in India. The pandemic set in motion an interesting trend – while there was a greater overall focus on health for all, women’s health was subordinated due to the immediacy and urgency of the COVID-19 crisis. 

Source: CRISIL CSR Yearbook 2021

One of the most severely affected areas of health, during the pandemic was and continues to be in the domain of Sexual and Reproductive Health, and Family Planning. For instance, access to contraception and reproductive healthcare has been greatly hampered while several countries were under a state of lockdown, due to very low mobility of people and services. The lockdown also had a disproportionately negative impact on women, due to its gendered manifestations. As per the UNFPA report, in 2020 the COVID-19 pandemic prevented 12 million women from accessing contraceptives, leading to 1.4 million unwanted pregnancies. In addition, COVID-19 related school closures and economic poverty have led to more sexual abuse, early child marriages and early pregnancies.

While India with its oldest family planning programme in the world has made progress, several gaps remain. Therefore womens’ health must be located in an intersectional analytical framework, which acknowledges women’s different experiences and identities. For instance, women, transgender and gender non-binary folks who are subjected to racism, ableism, and other forms of marginalization, discrimination, gender-based violence, sexual abuse and socio-economic exploitation have been exposed to such instances at a greater intensity, which has been further aggravated due to the COVID-19 pandemic.

In addition, globalisation has considerably influenced the nature of relationship and shared responsibilities present between business and society whilst the gender composition of such workplaces has witnessed a significant shift. Women currently make up a significant proportion, if not the majority, of the workforce in several industries. Therefore, there is a need to adopt standards and practices, in alignment with the changing gender composition in the workplace.  These changes necessitate inclusive Occupational Safety and Health (OSH) and other industry initiatives can help attain SDGs 3 (healthy lives and well-being for everyone) and 5 (gender equality and empowerment).

Sexual and reproductive health, and family planning is a cross-sectoral investment which impacts all the 17 goals of the SDGs, directly or indirectly. A collaborative and alliance-based approach can prove to be fruitful when the key stakeholders invest directly in fields such as education, reducing child marriages, sexual and reproductive health, and family planning, using an intersectional lens, as these sectors have a multiplier impact resulting in greater economic and social returns.

Sexual and Reproductive Health and Family Planning is an opportunity for India Inc. to ensure systems change and make a lasting difference at the grassroots. Some potential areas of engagement are offered below,

  • The National Family Health Survey 5 reported several gains for women’s health in India. However, some gaps remain. The need for family planning has declined among married women (15-49 years) across all states and Union territories except Meghalaya. This unmet need can be key to improving the maternal mortality record of India as well as to ensure child health. Further, according to the latest National Family Health Survey-5 (2019-2021) only 9.5% men used condoms but 37.9% of women underwent sterilisation. While the fertility rates have reduced in India, access to contraceptives and modern family planning methods remain patchy and were mostly virtual in the Covid 19 phase. It is key to a variety of development goals and is an opportunity for corporations to diversify their CSR agenda through comprehensive programmes on women’s health and engage with men as partners in change.
  • ESG provides a sustainable and long-term strategy to leverage opportunities and invest in behavioural change among the large number of youth employees across the supply chain. In addition, engagement with ESG ensures competitive advantage for both donors and recipients. The mandatory reporting format of Securities and Exchanges Board of India (SEBI)’s Business Responsibility and Sustainability Reporting (BRSR) requires corporates to report on 9 different sustainability parameters. The immediately relevant principles for the SRH and (Family Planning) FP sector include:
    • PRINCIPLE 3 Businesses should respect and promote the well-being of all employees, including those in their value chains
    • PRINCIPLE 5 Businesses should respect and promote human rights
    • PRINCIPLE 8 Businesses should promote inclusive growth and equitable development
  • Adopting an alliance model presents an opportunity to bring together resources and knowledge of different stakeholders.  India’s Condom Alliance established by SHOPS Plus in 2019 and Samhita’s REVIVE Women@Work coalition may be considered as an innovative model that is actively engaging with multiple stakeholders with a focused agenda and messaging that resonates with all stakeholders. The Condom Alliance, is a collaboration of market leaders such as DKT India, HLL Lifecare Limited, Janani, Population Health Services India (PHSI), PSI India Private Limited, Reckitt Benckiser, Raymond Group, TTK Healthcare Ltd, undertakes campaigns like ‘Break The Wall’, ‘The Birds & Bees Talk’ and ‘ConSenSuality’ aimed to remove the mindset barriers while delivering adequate and effective sexual education to Indian youth. The REVIVE Women@Work a $15 million blended finance platform, supported by United States Agency for International Development (USAID), Michael & Susan Dell Foundation (MSDF), Omidyar Network India, British High Commission New Delhi and United Nations Development Programme (UNDP) continues to support the revival, resilience and growth of India’s informal economy.

As a way forward, Samhita-Population Foundation of India proposes the Stakeholder Alliance Creation for Collaborative Impact (SACCI), a multi-stakeholder alliance of policy makers and practitioners, private sector, civil society organizations, and institutional funders in furthering the significance of autonomy, freedom and choice for women and young girls, whilst ensuring better, affordable, and quality healthcare services for the citizens through various milestone policies.

Entrepreneurs with Disabilities

Entrepreneurs with Disabilities

The COVID – 19 lockdown has adversely impacted the most vulnerable sections of society, such as informal workers, farmers, street vendors, gig economy workers, etc. Even among the sections of society hit the hardest, Persons with Disabilities (PwDs) have been among the worst affected due to an intersection of circumstances which include economic vulnerability, reduced mobility even in regular times and other hindrances which resulted from the lockdown.

Additionally, as entrepreneurs look to recover from these economic shocks, PwDs find it harder to obtain capital to start new enterprises or for working capital for existing enterprises. ATPAR is an organization that looks to create an enabling ecosystem for entrepreneurs with disabilities. ATPAR works with Entrepreneurs with Disabilities & their family members for their economic empowerment, social inclusion and rehabilitation by training them through NSIC Delhi on entrepreneurship development and mentoring them for 4 to 6 months to enable them to start, sustain and scale their entrepreneurial ventures. 

ATPAR’s NEDAR (Network of Entrepreneurs with Disabilities for Assistance and Rehabilitation) provides business mentorship, handholding support, financial and market linkages to the entrepreneurs over and above the entrepreneurship development training. Many of these entrepreneurs needed financial assistance to restart business and recover from the economic impact of the pandemic.

REVIVE has been working with 35 such entrepreneurs in Delhi – NCR, Jammu and Kashmir, Rajasthan, Uttar Pradesh, Bihar and Puducherry to provide financial assistance to fulfil their working capital needs, make asset purchases, etc. They have received zero – cost finance in the form of returnable grants (RGs) of INR 20,000 / 40,000 from REVIVE which would be repaid over the course of 1 year. The RG carries a moral obligation to repay as opposed to a legal obligation. During this period, all entrepreneurs will continue to receive ATPAR’s in-depth support through the NEDAR network as well.

Women Micro-Entrepreneurs

Women Micro-Entrepreneurs

COVID – 19 has disproportionately affected women, owing to the compounded effect of generally earning less, saving less and holding more insecure jobs. While women’s participation in the labour force has been in steady decline for more than a decade, the livelihood impact of the pandemic has put 4 out of 10 women out of the workforce. In addition, their situation is made much more complicated by additional factors. One of the major issues is that poorer women entrepreneurs face significant barriers to accessing livelihoods assistance and capital due to factors such as little or no credit history, lack of collateral, etc.

Despite women entrepreneurs’ excellent repayment records when running micro–businesses, they are not often graduated to larger individual or business loans beyond microfinance programs. Thus the share of women served declines as microfinance institutions diversify or transform into banks. Women are less conspicuous in programs with larger loan sizes that could support higher levels of business development. 

Financial institutions can proactively and profitably engage with women entrepreneurs as clients. Reports demonstrate successes where this has been achieved in ways that benefit both the creditors and their expanded female clientele. Understanding the depth of the problem, REVIVE was built to offer comprehensive solutions by partnering with three different organisations: Arthimpact Digital Loans, SEWA, and Chaitanya. 

One of the areas of its focus has been on providing returnable grants to 569 micro-entrepreneurs in the customer network of Arthimpact Digital Loans (Arth), an NBFC which provides collateral-free credit solutions to small enterprises, farmers and micro-entrepreneurs. 96% of the cohort supported by REVIVE are women entrepreneurs engaged in a wide range of occupations including agriculture, dairy, handicrafts, catering and small restaurants, tailoring, grocery stores, e – rickshaws among others. They are spread out over 7 districts in Uttar Pradesh, Haryana and Rajasthan.

Depending on their needs, the entrepreneurs were provided with either of:

  1. Zero-cost working capital support in the form of a returnable grant of INR 20,000 / 30,000 over a 1-year tenure or 
  2. For entrepreneurs requiring bridge financing during the devastating second wave of the COVID – 19 pandemic, zero-cost working capital support in the form of RG of INR 5,000 over 9 months but with a generous deferment period of 3 months

Another area of interest to REVIVE were initiatives of SEWA: RUDI – Rural Distribution Initiative, a production company owned and managed by small-scale women farmers, and Kamala, a food joint, providing nutritious dishes to its customers using millets and fresh produce procured directly from farmers. As the pandemic soared, the sales at both RUDI and Kamla sharply fell. The only way to revive the situation was by providing working capital to the entities to resume/accelerate the business operations. In view of the situation, Samhita/CGF supported SEWA in setting up the ‘Livelihood Recovery and Resilience Fund’:  a returnable grant of INR 25,42,373 lakhs (after TDS deduction) to support the end-to-end production process of RUDI and Kamala.

In addition, REVIVE is currently working with Chaitanya India, an organization at the forefront of the micro-credit movement for underserved women to provide affordable finance in the form of zero-cost returnable grants to 125 women in Vasai and Mankhurd areas of Mumbai. The women are engaged in a series of occupations from fruit/vegetable vending and selling fish (Vasai) to beauty services, tailoring, jewelry making, snack making, etc. (Mankhurd). The women have received access to finance amounting to INR 15,000 / 20,000 depending on their occupations and would have to repay on a monthly basis over one year. Chaitanya India’s model for financial support is actioned through a strong grassroots network of SHGs and clusters which are federated to provide financial services and training.

Women Artisans

Women Artisans

COVID-19 and the subsequent lockdown severely impacted artisans across the country. A KPMG study estimated that approximately 7.3 million people depend on handicraft and allied activities for livelihood. The handicraft and handloom sector in India is a Rs 24,300-crore industry and contributes nearly Rs 10,000 crore annually in export earnings. 

According to a survey by Dun and Bradstreet, 82 per cent of 250 MSMEs that were surveyed, said that Covid-19 had hit them hard. A Reserve Bank of India report states that MSMEs are one of the five worst affected sectors in India. Artisans and weavers form even a smaller number within the industry that is largely unorganised.

Since the lockdown, artisans witnessed production come to standstill. Huge unsold inventory piled up, while sales opportunities through exhibitions and through orders either came to a stop or dwindled quite low. Added to that, they had no working capital to reinvest. Some of the artisans reported their savings drying up and not having enough to meet the daily expenses. 

Most artisans have an important job of carrying forward and keeping alive the art. However, with so many additional problems during the pandemic, there were possibilities that many would look for alternative forms of livelihood. 

In order to revive these severely affected groups of artisans, Samhita-CGF with support from MSDF, S&P Global, and Vinati Organics, introduced Returnable Grants for women artisans. It is pertinent to mention that most of these women artisans are usually remotely located and spread across rural areas. Therefore, social enterprises take up the role of connecting these artisans, training them and skilling/upskilling them. It is also the enterprise’s role in such cases to source good quality raw materials and trains the artisans to produce high-quality products while simultaneously ensuring market linkages and sales. 

Identifying the role of an enterprise in bringing together artisans and the subsequent impact they can have on the lives and livelihoods of these artisans, Samhita-CGF collaborated with social enterprises like TISSER and SEWA Trade Facilitation Centre (STFC) as an effort to revive their livelihood within the REVIVE Alliance. 

The Returnable Grants have filled the gap of working capital for these enterprises. Once there was increased access to working capital, reinvestments in products and diversification into newer products like masks were undertaken by these enterprises. This also meant that slowly artisans could earn back their livelihood while upskilling themselves by making newer products. Products were specifically designed for festivals to increase the number of sales using the working capital given to these enterprises. Once the sales happen, the client money is revolved into the pool of returnable grants to impact more women artisans. 

Within the REVIVE Alliance, nearly 1200 women artisans including warli and pottery in Maharashtra, and textile artisans in Gujarat are being supported. Not only did these women artisans witness an economic revival as the orders increased, but they also underwent training and capacity building workshops to enhance their skills and diversify their products. Their average earnings have started showing an upward trend of slow and steady increase. 

Not only is the REVIVE Alliance supporting these social enterprises to enhance the lives of these women artisans, but are also safeguarding the traditional art of warli and pottery. 

In addition, the REVIVE Alliance aims to protect producer artisans directly linked to its ecosystem. Producer artisans are upskilled through distance learning to enable them to start producing the “Karuna ” range of products from their homes. Karuna products include face masks with designs, wrist bands, dining table mats with embroidered stories, embroidered bookmarks, embroidered handkerchief, tassel, keychains, hangings, natural fiber wristbands, coasters, and trivets among others. Market linkages (online and offline) are also provided to sell these products and thus ensure continued livelihood for the artisans during and post the lockdown. The project is implemented by Greenkraft Industree in Tirunelveli, Tamil Nadu. So far, 400 women artisans have undergone the training programs. The project envisages improving the avenues for the financial stability of women artisans and providing them access to market and financial linkages.

Street Vendors

Street Vendors

When a nationwide lockdown was announced, it immediately had a harsh effect on street vendors. An almost empty city without people stepping out of their homes meant that the city’s vendors immediately lost their source of income and were confronted with hunger and deprivation.

For women street vendors, the vulnerability doubled in such cases as they faced sharp repercussions after completely losing their livelihoods in the wake of the pandemic. A study shows that in the initial months of lockdown roughly 90% of vendors lost work, and even when the lockdown was lifted, recovery was slow, and it has not come back to pre-lockdown times. Women street vendors suffered most because they lacked access to assets and savings due to the lack of work and earnings. Most of these women street vendors used their savings to feed themselves and their families. Given this backdrop, restarting livelihood has become even more difficult but also the need of the hour. 

Across the country, many vendors have openly talked about issues in accessing loans since they are not recognised as ‘legal’ while also reporting a slowdown in the processing of loans. 

In the wake of these pressing problems, Samhita-CGF along with Brihati Foundation and S&P Global is supporting SEWA in reviving the livelihoods of 350 women street vendors. Spread across Gujarat, these women street vendors have received Returnable Grants within the REVIVE Alliance to be used as working capital to revive their livelihoods and tackle the cash crunch within their occupation. 

Although they are in the process of slowly recovering from this crisis, it is critical to take action to remove the barriers that are leading to their increased vulnerability. Returnable grants act as a 0% interest loan to these women which they have invested in buying raw materials for their vending business. However, there is an existing social stigma that these street vendors have to face as they are quite often seen as illegal occupants of public space. SEWA reported how these women are frequently targeted, harassed and evicted by officials of gated society, police, and sometimes government officials. 

For so many vendors, their businesses have fallen due to a perceived fear among people that the disease will spread more easily in markets. It is through continuous efforts by SEWA within the REVIVE Alliance that gradually the corporators/government officials have started to support these street vendors and their access to space for vending is not being denied anymore by the police. Challenges of entering gated communities/societies still persist, however, with enough vaccinated street vendors, this picture might change soon enough. 

Overwhelming demand from street vendors remains for support to resume working. Easier and faster access to capital and permission to work without harassment is essential to expedite recovery for vendors. Therefore, as a recovery model, Samhita-CGF along with Brihati Foundation and S&P Global is supporting SEWA in reviving the livelihood of 350 women street vendors by giving them returnable grants as a form of 0% interest loan.

Sanitation Workers

Sanitation Workers

There are more than five million full-time sanitation workers of which two million are directly engaged in high-risk tasks such as emptying septic tanks, maintaining sewer lines, and drains at the cost of their health, dignity, and safety. Irrespective of their contributions, they are not recognized as essential public service providers, instead are overlooked, made invisible, stigmatized, and ostracized by society at large. Moreover, the Covid-19 pandemic has exposed the vulnerability of sanitation workers and their families to many challenges. They face various challenges at the workplace, such as compromised health and safety, limited or no awareness about social security schemes, and limited skills and livelihood options. 

Therefore, the REVIVE Alliance aims to uplift sanitation workers by improving their overall quality of life while addressing critical socio-economic challenges faced by sanitation workers through focused interventions that cater to their immediate, medium- and long-term needs. In doing so, the project not only impacted the workers but also their family members resulting in 4x overall impact.

The project has 3 components: 

  1. Provision of PPE kits to sanitation workers, 
  2. Providing upskilling and entrepreneurship support
  3. Linking sanitation workers with relevant social security schemes. 

The program is implemented by Kam Foundation and Haqdarshak Empowerment Solutions Private Limited in Pune and Mumbai, Maharashtra. So far, PPE kits have been distributed to 1000 sanitation workers and have undergone covid-19 prevention training. 499 sanitation workers have received benefits from the social security schemes, and 792 sanitation workers have undergone upskilling and entrepreneurship training. The project envisages improving the health of sanitation workers by preventing them to catch the infection, increasing usage of PPE kits, access to government entitlements, and enhanced skills and technical know-how for increased income generation potential.

Pharmacists

Pharmacists

There are approximately 8,00,000 pharmacies in India with a compounded  annual growth rate of 10.08% in the organized sector. As per a study conducted on pharmacies by Samhita Social Ventures and the Cipla Foundation  41% pharmacists provide medical guidance to customers and 57% viewed themselves as a ‘supporter of people’s health needs’.  Moreover, 50%  saw an increase in customers seeking medical guidance post COVID-19.  During the COVID-19 crisis, pharmacies have defended the communities on the frontline and have supported them with hygiene essentials, information as well as guidance on maintaining overall wellness.

There is potential to transcend the one-dimensional approach of viewing pharmacies as a dispenser of drugs to an integral part of the healthcare system, providing primary healthcare services to the citizens. Tapping this potential is the driving force of the Pharmacy Alliance, which is aligned with WHO’s guiding principles, which suggests that “Contribution to improving the effectiveness of the healthcare system and public health” is an important function of pharmacies. WHO has suggested that pharmacies should engage in preventive care activities and services, provide point-of-care testing, where applicable, and other health screening activities. They should also engage in preventive care activities that promote public health and prevent disease.

What is the solution?

The Pharmacy Alliance aims to empower pharmacists with the knowledge, tools, resources, and incentives to become trusted healthcare providers (and not just sellers of medicines) to their local and underserved communities.

With the support of NIIF and Digihealth, Samhita-CGF  has piloted an intervention under the Pharmacy Alliance aimed at empowering pharmacies to become a hyperlocal tier for facilitating healthcare. Through this program, Pharmacists are supporting citizens with easy, quick, and free of cost access to BP and BMI screening that correlates to two of the most common lifestyle diseases  – Hypertension and Obesity. The pharmacists are provided pay for performance incentive for conducting screenings and booking teleconsultations. 

What has been the impact so far? 

A total of 237 Pharmacies have been onboarded as part of this pilot. These Pharmacies are situated across Mumbai, Pune, and surrounding areas of Palghar, Raigad, & Thane. So far, 2,100+ unique customers have been screened and made aware of their BP and BMI status through this pilot with a total of 2,400 BP and 2,250 BMI screenings. The pilot has been able to demonstrate that:

  • Pharmacies, if provided with the right set-up support and incentives, are willing to participate in such programs
  • Customers are open to considering Pharmacies as “points of care” as they are willing to get screened for non-invasive basic lifestyle diseases or concerns
  • The pilot has successfully been able to make these customers aware of their BP and BMI readings that might inform the customer of any potential risks/concerns at a touchpoint wherein the customer wasn’t expecting such care interventions in the first place.

Reach out

2nd Floor, Jagdamba House, Jay Prakash
Nagar, Goregaon East, Mumbai,
Maharashtra 400063, IN

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csr@samhita.org

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