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Janani, a not-for-profit Indian Society, is among the largest public-private networks delivering family planning and reproductive health care in India. The programme covers Bihar, Jharkhand —two of India’s poorest states (annual per capita income Rs. 5,445 or $121) and home to 118 million people, and 10 districts of Madhya Pradesh in central India. Janani started as a conventional social marketing programme in 1996 where shops were used to sell subsidized products. The programme since then has been refining the strategies so that three major shortcomings of conventional social marketing are corrected. They are: • Inability to address needs beyond urban areas This means the channels of service delivery have to extend beyond shops. Identifying rural practitioners and private doctors as the avenues of opportunity, Janani has trained till January 2008 over 40,000 rural health providers, has established 620 franchisee medical clinics, and is delivering its products through 31,000 shops. (The programme also has an active presence in parts of Madhya Pradesh state.) Doctors deliver clinical services, and rural providers create access to products and services for village communities. Janani is an affiliate of DKT-International, a Washington D.C.-headquartered charity that is one of the largest and most cost efficient social marketing organizations in the world. Janani began its programme in Bihar in response to its rapid population growth (an average 4.6 children per couple), high unmet need for family planning (25% contraceptive use against national average of 48%), and overwhelmed public health services in desperate need of supplementation. In 1996, when Janani began operations, the programme partnered with the Indian government and focused only on delivery of condoms and oral contraceptives through shops. The integration of clinical services through a network of doctors began in 2000. The emphasis, since then, has been on enhancing the doctors’ surgical skills and paramedicalising routine procedures. The clinics are franchised as Sun (Surya) Clinics, and maintain quality under established standards, maintained by a Janani-appointed administrator at each Surya clinic. Janani’s clients are predominantly poor, and pay significantly less than commercial health service prices. A network of rural health practitioners, each working in partnership
with a woman family member, serves as the conduit between the clinics
and rural communities. After their training by Janani, the rural practitioners
are franchised as Butterfly (Titli) Centres, and they sell non-clinical
products and over-the-counter tests. Clients needing clinical services
are counseled and referred to the nearby Surya Clinic, which earns the
Titli Centres a commission. In sum, Janani’s operational strategy leverages service delivery
resources that are already in place. Creating such resources otherwise
is a time-consuming, frustrating, and a very expensive task. Working with
shops is relatively easy as they have become formally organized due to
long years of work by private companies. The other resources like rural
practitioners and private doctors are “non-formal”, and need
to be brought within an operational framework. The innovation in the Janani programme lies in turning the participants into stakeholders, both at the village-level, and at the urban-level. This has made providing products and services a viable economic activity. It has also resulted in an enhanced interest in sustaining family planning activities, as well as delivering quality of care. Such viability will make the programme inherently sustainable once critical mass is achieved. The programme in its twelve years of implementation has averted 11.35 million unwanted births. In 2007 alone, the programme protected 1.76 million couples in reproductive union, averting 1,005,714 births. And despite taking these products and services to the hinterland, the cost for protecting a couple last year was Rs. 120.73 ($ 2.94). (Internationally this cost is estimated to be around $20.) About 51% of the total cost is met by revenues; the cost of service delivery is often substantially lower than the government’s cost through the public sector. The reason why Janani could implement a programme in such a challenging environment is the operational style of DKT International. Decision-making is totally decentralized, and the US office has only five staff. The country programmes are given complete operational autonomy. Janani's administrative strategy is to keep a small core team with a high level of communication, and to outsource field work in a competitive framework, so as the gain of one is always at the loss of another. The long-term operational objectives of the organization focused on expanding service delivery from urban to rural, on integrating a strong clinical component, and on catering to the poorest segments. In the coming years,, the programme will cover Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Uttranchal, Rajasthan, Orissa, West Bengal and Assam. |
Janani & The Three Netwoks |
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