Mobilising communities, empowering consumers

Good health often is good business. And no business principle can work without keeping the consumer at the centre.

Fourteen years ago, I received an offer I couldn’t refuse. The Bill & Melinda Gates Foundation asked me to launch a programme to help stem the growth of HIV in India. The epidemic most affects vulnerable sex workers living on the fringes of society. A few weeks from starting, I sat with twenty sex workers on the mud floor of a dark hut in the outskirts of Visakhapatnam. “HIV will kill you if you don’t use condoms. You will die within ten years,” I said earnestly. They looked at each other. One, Kollama, said quietly, “Why don’t you tell us something we don’t know? Ten years is a lifetime. Tell us how to find a life without violence from today.”

The consumer, instead of HIV prevention, wanted another ‘product’ — a life free from violence. We were baffled — we were in HIV prevention, not in tackling violence. But as we worked with the community we learnt how frequently violence was part of the unsafe sex transaction. Tackling violence would boost safe sex. It was only when we looked at the problem through the consumer’s eyes, were we able to develop solutions. How exactly we and the community went about doing that is another story!

Today, I work in a different field. My NGO Antara’s major focus is on the critical “1000 days” between conception and age two. In partnership with the state government, we work towards improving indicators such as maternal anaemia, neo-natal and infant mortality, and immunisation prevalence. We work with, and through the public health system to achieve scale and sustainability.

But is it really that different? Again, the consumer seems not to want the product that we offer. Underlying the numerous problems we are tackling, are needs far more important, which are likely related to our prime focus.

I recently visited a village Raatri Choupal (night gathering). Located in rocky terrain, the village lies alongside forests on one side, a half kilometre from a river flowing through gorges and inaccessible by foot. It was soon after sunset. With prayer bells ringing in the backdrop, we gathered in a dimly lit temple courtyard. Seated there were 200 to 250 villagers, men in front, women at the sides, sitting in the darkness. A large proportion of inhabitants were from the tribal community and comprised people below poverty line. We hoped to get insights into the village’s poor maternal and child health status.

Our questions on health services elicited an indifferent response. Health was certainly not at the top of their concerns. Ground water level in the region was substantially low, and borewells and handpumps were hard to install. A few spots identified for these were still vacant due to local politics. Women had to walk up to two kilometres, carrying heavy containers and often in scorching heat, to meet requirements. It struck us then, how maternal and child health were needs far less important than a need for basic survival, water.

So we are asking ourselves — how can we address the issue of water, and thereby the demand for health?

Our focus has been increasingly on empowering consumers and mobilising communities, while continuing supply enhancing efforts on health. Centring the process around the consumer naturally enables scaling-up, a key ingredient for change. We are listening closely to what the consumer is saying and developing initiatives such as the Local Self-Governance Programme, where local panchayats act as ombudsmen.

The great and exciting challenge for Antara is to create an active, aware and empowered consumer, who excitedly demands our product. And with it, a community that rises to solve its issues.