Project Area

Entrepreneurship       Unleashed

Janani has been able to play a significant advocacy role with policy makers on the basis of its experience in large-scale service delivery, specially in very poor and rural settings. Janani’s contributions have also included improving the contraceptive technology which leads to less side effects, more efficacy, and, in the long run, better adoption.

Janani was instrumental in upgrading the composition of oral contraceptives distributed by the Indian Ministry of Health and Family Welfare (MOHFW). The outdated formulation in use earlier, DL Norgestrel and Ethinylestradiol has been modified to Levonorgestrel and Ethinylestradiol, eliminating the part of progestin that was not bioactive, thereby reducing side effects.

Janani also was successful in integrating MVA technology for the provision of first trimester abortion procedures into MOHFW policy. Medical termination of pregnancy in the first 12 weeks of gestation account for 80% of induced abortions in India and the impact of this technology, therefore, is significant.

Janani was also involved in the discussions to upgrade Copper-T technology-- Cu-380A, which has a life of 10 years, has been added to the programme to supplement Cu-200 which has five years of use. This enables the Ministry and agencies such as Janani to use a paramedicalised spacing method for limiting births. A dialogue is currently under way to include Multiload IUDs which minimize infections at the time of insertion. Janani also had a strong role to play in the recent decision of the Ministry of Health and Family Welfare to declare oral emergency contraceptive an over-the-counter product which does not require a doctor's prescription. The method now has the potential to reach a vast number of people.

Current discussions include integrating ways to deliver good quality sterilization services without the need for general anaesthesia, and establishing a systemic way to forge private-public partnerships. The ongoing international debate on the latter subject is five years old and has been unable to reach a firm resolution. Besides MOHFW, Janani has held discussions at the World Bank, and with a number of national and international organizations.

Janani has also been taking a lead role in advocating franchising strategies to leverage the huge medical and paramedical resources available in the private and NGO sectors. This has resulted in a strong franchising component being added to the policy debates in the country.

Janani is lobbying for establishing output-based funding schemes that will free up resources for interventions outside the public sector. Though huge resources are available in the private and NGO sectors in India, their utilization has been sub-optimal because of the government’s inability to develop systems of support that are based on performance and impact.

Janani has also been working with the Ministry and with bilateral and multilateral agencies to strengthen management systems. Lack of such systems has become the prime reason for indifferent and inadequate delivery of services specially to the weak and vulnerable segments.

The Way to the Future
Complementing the current rural and clinical networks in providing quality products and services is the plan for franchising Surya labs, for providing quality diagnostic and pathological services, and Surya Pharmacies to make essential drugs available at affordable prices.

Janani is also exploring introducing a mobile morbidity screening component to the existing basic labs in its franchise Surya clinics to better utilize current resources and to strengthen the link between the rural and clinical networks. We envision the lab technician from a Surya clinic making regular visits to Titli centers in his clinic’s catchment area and collecting blood, stool, urine, and sputum samples from people in the villages who are feeling unwell. The samples will be tested for a range of morbidities, and clients will be referred from the Titli centers to their nodal Surya clinic for treatment.

The programme is keen on targeting various schemes available from the Indian government to cater to the needs of the poor. While it is difficult for individual doctors to access these schemes, Janani plans to become a conduit that can deal with the government machinery more effectively due to collective volumes. Participation of local bodies and panchayati raj (village council) institutions will provide the necessary basis for such provision. The Union Finance Ministry has suggested such safety nets to address comprehensive health needs of the poor.

Janani has also initiated dialogue with major companies about using the networks to distribute their products. With competition getting fierce, most companies are exploring rural markets and Janani gives them a unique opportunity, through its extensive distribution infrastructure in a tenth of this large country. This will offset some of Janani’s programme costs and perhaps will even open outlets which currently resist stocking contraceptives.

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