BUSINESS AND THE HEALTH MILLENNIUM DEVELOPMENT GOALS IN INDIA: CLOSING THE GAPS
RESULTS FROM A SURVEY OF LEADING COMPANIES ON HEALTH CSR IN INDIA We are grateful to Johnson & Johnson for funding support to develop this publication.
GBCHealth is a coalition of companies committed to investing their resources to make a healthier world for their employees, for the communities in which they work and for the world at large. Through convenings, partnership creation, alliance-building and advocacy activities, GBCHealth leverages the power and resources of the private sector to meet today’s most pressing global health challenges. For more information, contact Shuma Panse at [email protected].
MDG Health Alliance is a special initiative of the Office of the United Nations Special Envoy for Financing the Health MDGs and for Malaria. The Alliance works in partnership with governments, non-government organizations, academic institutions and corporations to develop innovative and accelerative efforts to drive progress towards achieving the Millennium Development Goals.
ii Health CSR in India Survey FOREWORD
The 2013 Companies Act is an unprecedented offices/operations. This bodes well for the social opportunity for India’s vibrant business sector to play development of those states, districts and cities with a heightened role in the country’s social development strong commercial activity, but it leaves other parts of through corporate social responsibility (CSR) the nation underserved and vulnerable. We hope the leadership. With an estimated 9,000-16,000 companies insights revealed, and the practical guidance provided, predicted to bring USD $2 billion in funding into the prompt companies to shape future investments in ways social sector as a result of this law, the potential to that boost health impact – both for the community and drive change is real, and exciting. also for the nation.
For over a decade, GBCHealth has mobilized business Importantly this report documents evidence of the action on health, recognizing that the private sector scope and depth of corporate action on health in can contribute valuable assets – both financial India, and can serve as a foundation for sector-specific and otherwise – to improve the well-being of men, reporting moving forward. We have also included a women and children around the world. The 200-plus number of resources for action to help companies companies in our diverse network have demonstrated identify issues, locations and learn from like-minded both ability and resolve to fight diseases like HIV, TB corporates as they develop their own CSR programs. and malaria and to promote maternal and child health. Our “health CSR activity mapping” presents survey Often working in partnership with the public sector respondent activity by topic and geography; this and civil society, these companies are increasingly mapping is intended to foster collaboration between aligning their efforts to help meet international and companies and with partners, based on mutual interest national targets and goals, to maximize impact. in a particular health area or state/district/city. I encourage you to take a look at these resources and With corporate investments expected to rise welcome your feedback. dramatically, this report seeks to inform our collective understanding of the Indian CSR ecosystem and its We are delighted to partner once again with the impact specifically on improving health outcomes. MDGHealth Alliance to research and produce this In conducting our research, we focused on one report. We would also like to acknowledge our robust important international target with a fast approaching Advisory Committee for providing insights, data and deadline: the Millennium Development Goals (MDGs). connections throughout this project. Together, we look By shedding light on the key characteristics (e.g. forward to partnering with India’s corporate sector to focus areas, target geographies and drivers) of existing realize the vision of a healthier India for all. health CSR programs, this report offers insights into how Indian businesses are currently supporting MDG Nancy Wildfeir-Field achievement and identifies gap areas that require President, GBCHealth urgent attention.
Maternal, newborn and child health, nutrition, and water and sanitation all feature highly as CSR priorities for the companies we surveyed. Investments are greatest in the areas surrounding a company’s
Health CSR in India Survey iii With less than 350 days to achieve the Millennium on the degree to which India’s thriving business Development Goals (MDGs), the world is focused community engages and focuses its investments where on India, the country where national progress will they will have the greatest impact. contribute significantly to the achievement of global development goals. We are delighted to present this report which documents the current health-investment activities of India has made significant strides across several MDGs, a number of leading Indian companies, shining a light halving the proportion of the population in poverty onto gaps in current strategy and opportunities for (MDG 1a), achieving universal primary education (MDG better alignment with the MDG goals. We hope that 2), coming very close to ensuring that girls have equal businesses in India takes note of the findings of the access to primary and secondary education (MDG report and reassesses their investment strategies—both 3), halving the proportion of the population without the type and location of investments—to increase access to safe drinking water (MDG 7c) and reversing MDG impact. the spread of HIV/AIDS, TB and malaria (MDG 6). The next 12 months is a period of great opportunity But in five critical areas of MDG performance, India’s for business to contribute to a rapid acceleration of progress has not been fast enough to achieve the progress in the health of women and children and in goals—reducing hunger (MDG 1b), reducing newborn sanitation in India. The critical factor is ensuring that and child deaths (MDG 4), reducing the deaths of new investments are targeted to fight the leading women in pregnancy and childbirth (MDG 5a), meeting causes of sickness and death in the regions where the unmet need for modern contraception (MDG 5b), and deaths and sanitation challenges are concentrated. increasing access to toilets (MDG 7c). If business rises to this challenge and works in partnership with all stakeholders, India can achieve all As a result, 60 million children under five are stunted of the health-related MDGs by December 2015. and 1.3 million die before they reach their fifth birthdays. More than half die in the first month of In generations to come, no other nation’s children will life and most from preventable infections including shape the world as will the children of India. Let’s work pneumonia and diarrhea. An estimated 50,000 together to make sure that all children in India can women lose their lives to pregnancy and childbirth. fulfill their true potentials at home and in the world. The unmet need for modern contraception is high, leaving 50 million women without access. Six hundred Leith Greenslade million Indians practice open defecation, severely Vice-Chair, MDG Health Alliance compromising the health and development of children.
Most of these health challenges are concentrated in specific northern States including Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan which together account for 60 percent of all child deaths. In addition, clusters of child deaths occur across specific districts in Chhattisgarh and Orissa and also in wealthier States including Andhra Pradesh and Maharashtra.
The Government of India is leading a national effort to close these MDG achievement gaps in partnership with the United Nations and the UN Secretary- General’s Every Woman Every Child movement. With new initiatives including the Reproductive, Maternal, Newborn and Child Health + Adolescent Strategy, the National Newborn Action Plan and the Ending Open Defecation Campaign, and with a special focus on the districts where mortality is concentrated, the Government of India is positioning the nation for success.
Business too must play its part in the national effort to accelerate the rate of progress to the levels required for MDG achievement. Indeed success will depend
iv Health CSR in India Survey 2014 India’s Health CSR Investments Survey v EXECUTIVE SUMMARY
Companies are increasing spending on corporate KEY FINDINGS social responsibility (CSR) programs in India spurred on by new government legislation (the Our results provide an informative snapshot of Companies Act, 2013) that requires them to how surveyed companies are currently investing invest two percent of profits in CSR activities; their CSR rupees, including priority health focus by a growing recognition of the benefits to areas, preferred partnership strategies, major communities, stakeholders and the bottom line; drivers of health CSR priorities, investment and in response to the Government of India’s models, geographic reach and location of development agenda. investments, number of beneficiaries and future investment priorities in the health area. We In the area of health, the Indian government found that: has outlined national priorities, such as the Reproductive, Maternal, Newborn, Child Health + • Surveyed companies are currently focusing Adolescent (RMNCH+A) strategy and the newly- investments on the health issues prioritized launched Every Newborn Action Plan (ENAP). by the Government of India and consistent It has also issued a call to action to achieve the with the MDGs. Their programs most Millennium Development Goals (MDGs) which frequently address child health (65 percent), include child mortality (MDG 4), maternal health maternal health (57 percent) and newborn (MDG 5), HIV/AIDS, TB and malaria (MDG 6) and health (48 percent), followed by water water and sanitation (MDG 7). (48 percent), nutrition (43 percent) and sanitation (39 percent). Companies expect to To identify health-specific CSR trends, increase spending in all of these areas in the GBCHealth and the MDG Health Alliance coming year. surveyed 23 leading companies to develop a “snapshot” of health-related corporate • Partnerships are key: 61 percent of investments, with a focus on business action respondents reported partnerships with on the MDGs. Our objective was to establish a national non-governmental organizations baseline understanding of the characteristics of (NGOs) to implement programs, followed health CSR programs. Importantly, we wanted by state governments (39 percent) and local to understand how and where companies are governments (35 percent). currently contributing to MDG achievement, and high-impact opportunities to accelerate progress • Population health needs were reported to in the coming year. be the number one driver of health CSR
vi Health CSR in India Survey priorities, with 91 percent of companies prioritized by the Government of India, which we detail indicating needs to be “very important” in this report. or “important.” Leadership commitment was the second most important driver at III. ACCELERATE MULTI-STAKEHOLDER 78 percent. PARTNERSHIPS FOR COLLECTIVE IMPACT, INCLUDING SHARED VALUE AND SOCIAL • Most companies invest CSR rupees BUSINESS MODELS to provide health services to a target population through an intermediary like an Surveyed companies all recognize the value of NGO (36 percent) or directly through an entity partnerships to achieve their health CSR goals. While like a company-run clinic (23 percent). there are many examples of corporate partnerships with local NGOs and state and local governments, • More than half of surveyed companies (52 more inter- and intra-industry partnerships are percent) invest CSR funds in the communities needed. Increasingly companies will need to move where they operate, resulting in underinvestment beyond traditional approaches to health CSR to in states and districts with a low business embrace new models including shared value and presence. social businesses that combine the very best of business acumen with achieving a public health goal. • The majority of companies (82 percent) agreed that new funding generated by IV. LEVERAGE CEO POWER TO ADVOCATE FOR the Companies Act should be invested in GREATER ACTION ON THE MDGS achieving the health MDGs by 2015. Surveyed companies reported that the personal RECOMMENDATIONS FOR ACTION commitment of company leadership is a major driver of health CSR priority areas, which underscores the Based on the findings, we have identified five critical powerful role CEOs in India play within their own areas where business can play a heightened role in companies. If CEOs also focused their advocacy ensuring India meets the MDGs by the December efforts externally, to encourage governments and 2015 deadline. other stakeholders to target the areas where the greatest MDG gains can be made, they could play a I. SHARPEN INVESTMENTS TO FOCUS ON major role in India’s achievement of these goals. THE HEALTH AREAS WHERE INDIA’S MDG PERFORMANCE LAGS V. MEASURE IMPACT AND SHARE DATA WITH ALL STAKEHOLDERS, INCLUDING THE GOVERNMENT Although corporate action in the health MDG areas AND PUBLIC is robust, there are still opportunities for companies to fine-tune investment strategies in order to fully Monitoring and evaluation systems are vital to guide maximize MDG impact. We uncovered three specific more effective investing. Companies should not areas for further action: newborn survival, sanitation only conduct rigorous evaluations of their health and reproductive health. CSR investments but should make this information widely available to all stakeholders. The reporting II. INVEST MORE IN THE STATES AND DISTRICTS requirements mandated by the Companies Act are a WHERE HEALTH CHALLENGES ARE MOST ACUTE critical first step in the public reporting process. Nearly all the companies surveyed are prioritizing health CSR investments based on their areas of operation. While this has been a boon for many communities, it has left many of the regions with the greatest health challenges without corporate investments. To improve the health and well-being of the nation as a whole, companies should target their health CSR investments to those states and districts
Health CSR in India Survey vii viii Health CSR in India Survey TABLE OF CONTENTS
INTRODUCTION...... 2 CSR CONTEXT AND BACKGROUND ...... 2 THE MDGS: CONTEXT AND ACHIEVEMENTS IN INDIA...... 4 SURVEY RESULTS ...... 9 CHARACTERISTICS OF HEALTH CSR PROGRAMS...... 9 PRIORITY HEALTH FOCUS AREAS...... 10 PARTNERSHIP STRATEGIES...... 10 MAJOR DRIVERS OF HEALTH CSR PRIORITIES...... 10 INVESTMENT MODELS...... 11 NUMBER AND TYPE OF BENFICIARIES ...... 11 GEOGRAPHICAL REACH AND LOCATION OF INVESTMENTS...... 12 FUTURE INVESTMENT PRIORITIES...... 13 MOVING FORWARD: RECOMMENDATIONS FOR CORPORATE ACTION ...... 15 I. SHARPEN INVESTMENTS TO FOCUS ON THE HEALTH AREAS WHERE INDIA’S MDG PERFORMANCE LAGS...... 15 II. INCREASE INVESTMENTS WHERE HEALTH CHALLENGES ARE MOST ACUTE. . . .15 III. ACCELERATE MULTI-STAKEHOLDER PARTNERSHIPS FOR COLLECTIVE IMPACT, INCLUDING SHARED VALUE AND SOCIAL BUSINESS MODELS...... 16 IV. LEVERAGE CEO POWER TO ADVOCATE FOR GREATER ACTION ON THE MDGS...... 16 V. MEASURE IMPACT AND MAKE DATA AVAILABLE TO ALL STAKEHOLDERS, INCLUDING THE GOVERNMENT AND PUBLIC...... 16 APPENDICES...... 19 ACKNOWLEDGEMENTS...... 44
Health CSR in India Survey 1 INTRODUCTION
India has made impressive gains since the coming year. More broadly, the results add committing to the Millennium Development to our understanding of the CSR landscape and Goals (MDGs) in 2000, and has already how corporate action is currently contributing achieved the goals relating to poverty towards improving the health of the nation. reduction, primary education, gender parity in This report is for CSR executives and managers education, water, and containing the spread as well as non-corporate entities partnering of AIDS, TB and malaria. But with the 2015 closely with business to design and implement deadline looming, the nation is at risk of falling health programs. It informs CSR decision- short in several critical areas relating specifically making and the national conversation on MDG to health of women and children. achievement, and shines a light onto how The Government of India has laid out clear business can increase their relative contribution national strategies and roadmaps to meet and impact by presenting: these remaining goals—and has called on all • a “snapshot” of corporate health CSR sectors to align and contribute. Business has a programs and partnerships particular role to play. New national legislation will increase spending on corporate social • examples of high MDG-impact health CSR responsibility (CSR) initiatives (see Box 1), investments by Indian companies and including health programs. Companies in India multinationals, and that act now have a huge opportunity to tip the • resources and ideas to help companies scales and help the country achieve the MDGs. create high-impact programs in high- As we approach the last mile of the MDGs, priority geographies. GBCHealth and the MDG Health Alliance surveyed 23 companies who are actively CSR CONTEXT & BACKGROUND engaged in health CSR in India, to assess India has a long history of corporate how well positioned business is to help close responsibility, with companies like the the MDG achievement gaps. Their responses Tata Group demonstrating leadership and provide insight into what business is currently commitment for over a century. Consumers and doing in health CSR and what is needed to stakeholders recognize and even expect such increase this sector’s collective impact on MDG commitment. According to a 2013 survey by achievement. The results illuminate the factors Cone Communications, 37 percent of Indians companies consider when deciding which believe companies have had a substantial health issues to focus on, which geographies to positive impact on social and environmental invest in, and considerations for investment for issues (compared to 22 percent globally), and
2 Health CSR in India Survey 88 percent say they will buy a product with a social or economic benefit (vs. 67 percent globally)1. Box 1: The Companies Act, Under the Companies Act 2013, CSR contributions are expected to rise considerably. Some estimates 2013, Section 135: suggest the new law could generate an additional “The 2% CSR Law” USD $2 - $4 billion annually2. Prior to the passage of the law, most companies—with a few notable exceptions—spent less than the now-required two The new “2% CSR Law” is an official percent (Figure 1)3. From 2012-2013, of the top 100 recognition of the private sector’s CSR spenders in India, only two-fifths spent two capacity to create positive social change. Supporters see the bill as percent or more of their net profit for that year on an opportunity to spur corporate CSR4. investment in social and economic With spending now poised to increase, it is all the more development, although others argue important for companies to be deliberate in developing their that CSR should be voluntary, and social investment strategies. The new law gives companies some worry the law will be ineffective autonomy to determine what social issues their programs without a strong enforcement address and where programs are located5. Companies must mechanism. The law takes a report annually on how much money they are spending on traditional philanthropic view of CSR, anticipating that investments will CSR activities. The government has recommended particular frequently be pure donations. Such areas of need that overlap with the MDGs, including: philanthropy is to be commended. eradicating hunger and poverty, maternal and child health, HIV, However, company investments will TB and malaria, promoting gender equality and environmental have the greatest impact for both sustainability; but companies can determine their own populations and business if they are investment priorities and approaches. CSR rupees, directed sustainable and strategic. Companies strategically, can help India achieve key development goals— should consider social investments and pave the way for a healthier India for generations to come. that link back to a company’s core business strategy and utilize core Figure 1: Top Indian Companies - Highlighting Current versus competencies such as research and Mandated Spending for 2013 development expertise, industry Actual Company Revenue AVG PAT CSR 2% of PAT relationships, media and advocacy Spending capacity, and information technology. Indian Oil Corporation Ltd. ₹ 470,651 ₹ 7,207 ₹ 80 ₹ 144 KEY FACTS Reliance Industries Ltd. ₹ 371,119 ₹ 17,386 ₹ 357 ₹ 348 Bharat Petroleum Corporation Ltd. ₹ 253,286 ₹ 1,465 ₹ 18 ₹ 29 • Thousands of companies will be Hindustan Petroleum Corporation Ltd. ₹ 215,675 ₹ 1,251 ₹ 22 ₹ 25 directly affected: estimates range State Bank of India ₹ 135,348 ₹ 9,379 ₹ 123 ₹ 188 from 9,000 to 16,000. The law Essar Oil Ltd. ₹ 97,068 -₹ 823 NA -₹ 16 applies to companies with an Oil And Natural Gas Corporation Ltd. ₹ 83,309 ₹ 20,272 ₹ 262 ₹ 405 average net profit of at least 50 Hindalco Industries Ltd. ₹ 80,193 ₹ 2,097 ₹ 30 ₹ 42 million rupees (~ USD $816,000) Bharti Airtel Ltd. ₹ 80,311 ₹ 64,276 ₹ 296 ₹ 1,286 over a period of three years. Mangalore Refinery & Petrochemicals Ltd. ₹ 68,838 ₹ 1,066 ₹ 5 ₹ 21 • Companies will be required to spend two percent of the average NTPC Ltd. ₹ 67,931 ₹ 9,018 ₹ 69 ₹ 180 of profits made in the past three Larsen & Toubro Ltd. ₹ 61,471 ₹ 4,264 ₹ 73 ₹ 85 years. Steel Authority of India (SAIL) Ltd. ₹ 49,350 ₹ 5,067 ₹ 33 ₹ 101 Tata Motors Ltd. ₹ 49,320 ₹ 1,765 ₹ 19 ₹ 35 • If a company does not develop its Coal India Ltd. ₹ 48,472 ₹ 11,759 ₹ 140 ₹ 235 own CSR strategy, it can give the required amount to a government Tata Consultancy Services Ltd. ₹ 48,426 ₹ 8,827 ₹ 71 ₹ 177 socio-economic welfare program. ICICI Bank Ltd. ₹ 48,421 ₹ 5,214 ₹ 117 ₹ 104 Bharat Heavy Electricals Ltd. ₹ 47,618 ₹ 5,787 ₹ 63 ₹ 116 • Activities must take place in India Mahindra & Mahindra Ltd. ₹ 43,413 ₹ 2,543 ₹ 34 ₹ 51 and companies are expected to Tata Steel Ltd. ₹ 42,317 ₹ 3,975 ₹ 171 ₹ 80 give preference to areas around their operations. ₹: rupees in crores ( 1 crore = 10 million); Revenue: Gross Operations Revenue from 2012-2013 fiscal year; AVG PAT: Average Profit After Tax from 2009-2012; Actual Spend: Amount spent on CSR activities in 2012-2013 fiscal year; 2% of PAT: The amount of CSR spending the new law will require based on the previous three years profit after tax. Source: Epstein, M., Yuthas, K., & Sanghavi, D. “CSR and the Companies Act, 2013: Be Bold, Take Action.” Dasra Source: Research by CSRidentity.org and GBCHealth using information published in each corporation’s 2012-2013 Annual Report Health CSR in India Survey 3 THE MDGS: CONTEXT AND Figure 3: Under-five Mortality Rate (deaths per 1000 live births) ACHIEVEMENTS IN INDIA 180180 160160 Adopted by the United Nations Member States 140140 126 with a target deadline of December 2015, the MDGs 120120 100 include three health-focused goals: reducing child 100 8080 mortality (MDG 4), improving maternal health (MDG 6060 53 5) and lessening the burden of HIV/AIDS, TB and 4040 42 malaria (MDG 6). A related goal—on water and 2020 MDG Target sanitation (MDG 7c)—has significant impacts on 00 1990 19951995 20002000 2005 20052010 20102014 2015 health and well-being. Source: “Under-five Mortality Ratio: Data by Country.” Global Health Observatory India made early progress in combatting HIV and Data Repository. World Health Organization, 1 Jan. 2014. Web. 8 June 2014 tuberculosis, and in improving water supplies, Figure 4: Maternal Mortality Ratio (deaths per 100,000 and officially achieved those MDGs in advance of live births) the deadline. Strong gains have been made in the 800800 areas of maternal and child health and sanitation— 700700 however, the pace of change must accelerate to fully 600600 560 achieve MDGs 4, 5, and 7 (Figure 2). 500500 India has made phenomenal progress in curbing 400400 child mortality, but still loses more than 1.3 million 300300 190 children under the age of five every year—more 200200 109 than any other country in the world. Globally, one in 100100 MDG Target every five deaths of children under age five occurs 00 1990 1995 2000 2005 2010 2014 2015 in India. Yet there is an encouraging side: India’s 1990 1995 2000 2005 2010 2015 under-five mortality rate declined dramatically Source: “Maternal Mortality Ratio: Data by Country.” Global Health Observatory Data Repository. World Health Organization, 1 Jan. 2014. Web. 8 Dec. 2014.
“India’s role in global development is the most important in the world. The MDGs can’t be reached globally if they’re not reached here.” - Lise Grande, UN Resident Coordinator
Figure 2. Highlights of India’s progress against the 8 Millennium Development Goals
On Track - Halve, between 1990 and 2015, the proportion Moderately On Track - Moderately On Track - of people whose income is Reduce by two-thirds the Integrate the principal of less than one dollar a day Under- Five Morality Rate, sustainable development between 1990 and 2015 Slow Progress - Halve, into country policies and between 1990 and 2015, the programmes and reverse proportion of people who the loss of environmental suffer from hunger resources
Slow Progress - Reduce Halve, by 2015, the proportion of people without sustainable On Track - Ensure that, by by three quarters, between access to safe drinking 2015, children everywhere, 1990 and 2015, the maternal water (On Track)and basic boys and girls alike, will be mortality ratio sanitation (Slow Progress) able to complete a full course of primary schooling
On Track - Have halted by Eliminate gender disparity 2015 and begun to reverse the in primary and secondary spread of HIV/AIDS On Track - In cooperation education, preferably by with the private sector, Moderately On Track - Have 2005, and in all levels of make available the benefits halted by 2015 and begun education no later than 2015 of new technologies, to reverse the incidence of especially information and On Track - Primary and malaria and other major communications secondary education diseases
Source: Ministry of Statistics and Programme Implementation. “Towards Achieving Millennium Development Goals – India 2013” Government of India. 29 Oct. 2013. Web. 10 Sept. 2014
4 Health CSR in India Survey over the past 25 years, dropping much faster than Figure 5: Countries with Highest Stunting Prevalence the global average. In 1990, over the under-five Stunting Number of stunted children mortality rate was 126 child deaths per 100,000 Country Year Prevalence (moderate or severe, in births: in 2013, it stood at 53 (Figure 3). (%) thousands) India 2005-2006 48 61,723
Similarly, India’s maternal mortality rate has declined Nigeria 2008 41 11,049 dramatically. But the number of women who lose Pakistan 2011 44 9,663 their lives during pregnancy and childbirth takes China 2010 10 8,059 an intolerable toll on families, communities, and Indonesia 2010 36 7,547 national development. Fifty-six thousand pregnant Bangladesh 2011 41 5,958 women still die annually, most during childbirth, Ethiopia 2011 44 5,291 and 17 percent of global maternal deaths are Democratic Republic of the 2010 43 5,228 concentrated in India. The country has improved Congo from 560 deaths per 100,000 live births in 1990 to Philippines 2008 32 3,602
190 in 2013 (Figure 4): impressive progress, but not United Republic of 2010 42 3,475 yet at the pace necessary to achieve MDG 5. An Tanzania estimated 50 million women have an unmet need Egypt 2008 29 2,628 for contraception6. Kenya 2008-2009 35 2,403 Uganda 2011 33 2,219 Millions of Indian children suffer from malnutrition, Sudan 2010 35 1,744 which often results in stunting (inadequate length/ Source: “Improving Child Nutrition: The Achievable imperative for Global Proress” height for age); the long-term consequences of UNICEF. April 2013 stunting are severe and include diminished cognitive development and lower economic productive and Figure 6: Improved Sanitation Coverage in India income. Stunting prevalence is higher in India than Percent of population by type of sanitation facility, 1990-2012 anywhere else in the world (with the exception of Improved facilities Unimproved facilities sub-Saharan Africa) (Figure 5). Shared facilities Open defecation 100%100% 100% 100% In the area of sanitation, recent progress has 12 90% 90% 28 90% resulted in improved access to toilet facilities 8 80%80% 80% 80% (Figure 6). However, nearly 600 million Indians 48 70% 70% 5 20 70% still lack toilet access and defecate outside: more 74 65 60%60% 60% 17 60% than the rest of the world combined (Figure 7). 90 50% 50% 50% 7 Improving sanitation underpins India’s other health 40% 40%40% 9 40% and development goals, as household toilet access 60 5 30% 3 30% 30% 50 5 – or lack thereof – has multiplying effects on disease 5 20%20% 36 20% 20% 2 25 10% 18 10% 10% 1 7 Box 2: Leadership for Health: 050% 0% 0% 19901990 2012 19901990 2012 19901990 2012 Toilets Before Temples TOTAL URBAN RURAL Source: “Progress on Drinking Water and Sanitation: 2014 Update” Geneva, Campaign Switzerland, 2014.
Soon after assuming office, Prime Minister Narendra Modi rallied the nation with a call to build Figure 7: Top Ten Countries with the Highest Numbers of “toilets before temples” and ensure toilet access to People (in millions) Practising Open Defecation
every Indian by 2019. Household access to some India, 597
form of a toilet, as low as five percent in 1990, is Indonesia, 54
now at 36 percent; a significant gap remains to Pakistan, 41 7 meet the MDG target of 53 percent . Investments Nigeria, 39 in sanitation are increasing as a result of Modi’s Ethiopia, 34 campaign. Within weeks of his Independence Day Sudan, 17
speech drawing attention to the issue, companies Niger, 13
and corporate trusts promised new funds, many Nepal, 11 8 targeted specifically towards girls . While these China, 10 new commitments are promising, coordination and Mozambique, 10 alignment will be important to ensuring that all Rest of the world, 182 geographies achieve sanitation coverage. Source: “Progress on Drinking Water and Sanitation: 2014 Update” Geneva, Switzerland, 2014.
Health CSR in India Survey 5 and malnutrition, and implications for the safety of Newborn Child and Adolescent Health” (RMNCH+A), women and girls. Recent action in this area, spurred a strategy that focuses resources on key locations by Prime Minister Narendra Modi, has been promising as well as vulnerable populations (newborns, girls, (see Box 2, prior page). and tribal groups). RMNCH+A also includes a call to Health indicators vary greatly between states and action and provides clear direction for companies to even from district to district within each state. For improve maternal and child health: Develop strategic example, 60 percent of child deaths occur in Uttar CSR, philanthropy, and core business initiatives Pradesh, Bihar, Madhya Pradesh and Rajasthan, with that focus on the government’s geographic and 10 clusters in specific districts. Chhattisgarh, Orissa, population priorities . Andhra Pradesh and Maharashtra also have pockets Along the same lines, in September 2014, the of high maternal and child mortality9. In response, government launched the India Newborn Action the Government of India has prioritized action in Plan (INAP)11. Designed to be implemented under 184 districts throughout the country where maternal the RMNCH+A framework, INAP aims to reduce and child deaths are highest. Figure 8 highlights newborn deaths, which account for over half of child these districts as well as the high-burden states, deaths in India. One of six key principles outlined all of which are critical to MDG achievement. A in the plan is partnerships, for which private sector complete list of these districts, by state is included in interventions are specifically noted as critical. For Appendix C.1 and a list of corporate activities in these more information on newborn deaths by location, see geographies in Appendix D. Appendix C.2. The government’s attention to high-priority locations Indian government policies, as well as global health is an important component of its strategy to save the frameworks such as the MDGs, provide invaluable lives of women and children. In 2013, the government, guidance on existing health challenges and what with leaders from the private sector, civil society, needs to be done to address them. Our survey and multilateral organizations, committed to the results, presented in the next section, reveal how “Strategic Approach to Reproductive Maternal current CSR efforts align with these priorities.
Figure 8: High-Priority States and Districts for Maternal and Child Health
Uttar Pradesh Rajasthan
Bihar
Madhya Pradesh
Source: “List of High Priority Districts Identified by the Department of Health and Family Welfare.” Open Government Data (OGD) Platform India. Government of India.
6 Health CSR in India Survey Health CSR in India Survey 7 8 Health CSR in India Survey SURVEY RESULTS
In July 2014, 23 companies completed an online number of beneficiaries and future investment multiple-choice and short-essay survey on their priorities in the health area. The survey was not health CSR activities in India. Respondents designed to provide a comprehensive mapping were drawn mainly from Indian companies (16 of the entire CSR landscape, but rather a of the 23 participating businesses), with the glimpse of the activities and insights of a set remainder Indian subsidiaries or operations of of active companies. multinationals headquartered in Europe or the United States of America. Most companies are Figure 9: Company Representation by Industry headquartered in Mumbai, with operations in Biotech & Pharma Biotechnology & Pharmaceuticals major cities (Delhi, Bangalore and Chennai) 4% Consumer Products 4% and/or in the states of Andhra Pradesh, Uttar Consumer Products 9% Metals & Mining Pradesh or Gujarat. Participating companies are 26% Metals & Mining from a broad range of industries (Figure 9), with FinancialFinancial Services Services 9% biotechnology and pharmaceutical companies EngineeringEngineering & & Construction Construction Retail forming one-quarter of survey respondents, 9% Retail 13% followed by consumer products and metals and TechnologyTechnology Services Services mining companies, financial services, engineering Industrial Conglomerate 13% Industrial Conglomerate 13% and construction, retail and technology Utilities Utilities industries. Nearly two-thirds of participating companies are of small to moderate size with # of employees fewer than 10,000 employees (Figure 10). Figure 10: Company Representation by Size
4% CHARACTERISTICS OF HEALTH CSR 16% 16% Less than 500 employees PROGRAMS Less than 500 people 500 - 5,000 employees 500-5000 people The results provide an informative snapshot 5,000 - 10,000 employees 5000-10,000 people 10,000 - 50,000 employees 10,000-50,000 people and baseline understanding of how leading 24% Do not know companies are currently investing their health 40% Don’t know CSR rupees, including priority health focus areas, preferred partnership strategies, major drivers of health CSR priorities, investment models, geographic reach, location of investments,
Health CSR in India Survey 9 Priority Health Focus Areas Partnership Strategies
Surveyed companies invest resources across a wide Nearly all surveyed companies implement their range of health issues ranging from child health, the CSR programs through strategic partnership area of greatest investment, through to neglected – underscoring the value of shared agendas. tropical diseases, the area of least investment A majority of companies (61 percent) partner (Figure 11). More than half of health CSR programs with Indian NGOs to implement their health CSR were in maternal and child health, followed by programs while a much smaller proportion (35- newborn health and water investments. These focus 40 percent) partnered with government agencies areas align closely with the Government of India’s (Figure 12). Even fewer (30 percent) worked with RMNCH+A strategy and are consistent with the MDGs. international NGOs, suggesting a strong preference Although corporate action in the health MDG areas for companies to partner with local organizations is relatively robust, there are still opportunities firmly rooted in local communities. Of interest, there for companies to fine-tune investment strategies were limited partnerships with international donors in order to maximize health impact. India’s (17 percent), central government (13 percent) or MDG performance to date suggests that there industry bodies (9 percent), suggesting there may may be a slight over investment in water and be missed opportunities for corporations in India underinvestment in newborn survival as India has to work with a new group of partners for greater met the water MDG (7c) but is lagging on the impact. Within this context industry bodies such newborn MDG (4). More than half of all under-five as the Confederation of Indian Industry (CII) and child deaths occur in the first month of life in India, the Federation of Indian Chambers of Commerce indicating that health CSR efforts in child health and Industry (FICCI) can help guide, develop, and should be disproportionately focused on newborn implement CSR programs and foster greater cross- survival. Surprisingly malnutrition, sanitation and company coordination and increased program hygiene were the focus of just over 40 percent efficiency, particularly as new companies commit of investments despite their potential impact on funds to health CSR. MDG 4 and 5 achievement. Of concern was that reproductive health attracted less than 20 percent Major Drivers of Health CSR Priorities of health CSR investment. Virtually all surveyed companies report that their CSR investments are driven by the health needs of
Figure 11: Health Focus Areas for CSR programs Maternal, newborn and child health are the areas most frequently Key CSR Program Partners addressed byHealth health CSR Focus programs, Areas followed for CSR by Programs nutrition and WASH. Figure 12: CSR Program Partners
70% 70%70% 70% 60% 60%60% 60% 50% 50%50% 50% 40%40% 40% 30%30% 30% 20%20% 20% 10%10% 10% 0%0% 0%
NCDs Water Other Other Hygiene Malaria HIV/AIDS Diarrhea Sanitation Pneumonia Child Health Malnutrition Tuberculosis I don’t know Mental Health Maternal Health Indian NGOs Newborn Health Industry Bodies Adolescent Health Does not partner International NGOs International Donors Programs for the Elderly Sexual/Reproductive Health Neglected Tropical Diseases State GovernmentLocal Government & Agencies & Agencies Central Government & Agencies
10 Health CSR in India Survey the target population (Figure 13). 91 percent identify Figure 13: Drivers of Health CSR Priority Areas health needs as “very important” or “important” Very Important Somewhat Important Do Not Know when selecting CSR activities and areas to invest Important Of Little Importance in. This highlights the importance of an accurate understanding of these needs. Health needs of population The personal commitment of company leadership has an enormous influence on prioritizing CSR Personal commitment of company leadership investment areas, according to 78 percent of respondents. This means that ensuring that Alignment with company leaders are well-briefed on health government priorities and policies challenges is critical. Other top factors are (e.g. RMNCH+A) alignment with business interests (69 percent), Alignment with government priorities (65 percent), and international international priorities and policies priorities and policies such as the MDGs (61 percent). (e.g. MDGs) Views of NGO partners were also of moderate Alignment with importance (48 percent) (not shown). business interests
0% 20% 40% 60% 80% 100% Investment Models
A large number of surveyed companies use their health CSR rupees to provide health services to Figure 14: Primary and Secondary Health CSR Investment Areas specific populations through an intermediary, 40% primary typically a local NGO (36 percent) (Figure 14). 35% secondary Many respondents provide direct health services 30% through a corporate entity, often a company-run 25% clinic (23 percent). After direct service provision, 20% companies support investments in mass media 15% and/or education campaigns, often with the goal 10% of influencing government policy, although no 5% 0% company identified these as their top priority. Unfortunately, there is little support for investing health CSR in infrastructure development—a critical area of need in achieving the MDG. Particularly In-kind donation target population target important is the need to improve quality maternal improvement policy (e.g. building hospitals) (e.g. and newborn hospitals facilities, transport to media/education/ Mass Direct provision of health provision Direct Fund/sponsor an NGO to an NGO to Fund/sponsor provide health services to to health services provide Public-private partnership Public-private Infrastructure development development Infrastructure Policy change/advocacy for for change/advocacy Policy awareness-raising campaign awareness-raising hospitals, energy and sanitation infrastructure. population target to services (e.g. via a company-run clinic) via a company-run (e.g.
Number and Type of Beneficiaries
Fifty-five percent of respondents reported that their Figure 15: CSR Program Impact by Beneficiaries health CSR investments reached more than 100,000 beneficiaries but nearly a quarter (23 percent) also 23% reported reaching very small groups of less than Less than 500 people 500 people. Women and girls were reported to 500 - 5,000 people be primary program beneficiaries by over half (63 55% 5,000 - 10,000 people 14% percent) of respondents. 10,000 - 100,000 people
More than 100,000 people 9%
0%
Health CSR in India Survey 11 Geographic Reach and Location of Figure 16: Reach of Health CSR Programs Investments 9% Community or district-specific (localized effort focusing on one or Over half of surveyed companies (52 percent) 9% a few specific towns/cities/districts) invest in health CSR programs in the communities State-wide (multi-district or where they operate, typically by investing in one 13% throughout the state) 52% or several districts within a State (Figure 16, next National (India-wide) page). A minority (17 percent) of respondents Multi-state or regional (one or more have state-wide efforts and only 13 percent are 17% Indian states) national in scope. This reveals that program impact Global (one or more countries is limited to the immediate areas surrounding outside of India) factories and other company operations. This is reflected in the concentration of activity in the cities where companies are headquartered including Delhi and Mumbai, and in the states where there is significant economic activity: Maharashtra, Andhra Pradesh, Karnataka and BOX 5: IN THEIR OWN Gujarat (Figure 17). In contrast, the states with the WORDS: CHOOSING most maternal and child deaths—Uttar Pradesh, PROGRAM SITES Bihar, Madhya Pradesh, and Rajasthan—were not high priority investment zones and attracted just 17 percent, 13 percent, 26 percent and 35 percent of health CSR investments, respectively. It is critical Every company must consider a unique set that health CSR investments are better aligned of strengths, risks, strategies, and stakeholder with the MDG achievement gaps if India is to needs when deciding where to develop health accelerate its performance and achieve its national programs. In their own words, CSR leaders health goals. told us how their companies choose the location of health CSR activities: Survey respondents shared the location (states/ districts/cities) and focus areas of their CSR “Health activities are taken in the programs; for a full list of this information districts where the company has its (presented anonymously), go to Appendix D. operations. However, the activities are chosen based on community need and Figure 17: Location of Health CSR Activities in India surveys undertaken.” Note: No reported activity in Himachal Pradesh, Jammu & Kashmir, Kerala, Manipur, Mizoram, Nagaland and Sikkim Location of Health CSR Activities “...In consultation with the key 60%60% stakeholders, central and state Priority States for government.” 50%50% MDG Achievement
40%40% “We want to reach the last mile population. Even our urban interventions 30%30% are in slums that are facing the most acute problems. Apart from need-based 20%20% approach, we also factor in locations where our partners and the government 10%10% State/City/Territorywant us to implement our activities.” 0%0%
Goa “...In and around the areas of operations Goa Bihar Other Bihar Assam Other Punjab Tripura Odisha Gujarat Assam Kolkata Punjab Odisha and on feedback from company- Mumbai Chennai Tripura Haryana Kolkata Gujarat Chennai Haryana Mumbai Rajasthan Bangalore Jharkhand Rajasthan Bangalore Jharkhand supported NGOs.” Chhattigarh Uttarakhand Delhi NCR & Uttarakhand Chhattisgarh Uttar Pradesh Andra Pradesh Andra Uttar Pradesh Uttar Madhya Pardesh Madhya Andhra Pradesh Andhra Madhya Pradesh Madhya Arunachal Pradesh Arunachal Pradesh Arunachal Maharastra (except Mumbai (except Maharastra Tamil Nadu (except Chennai) Nadu (except Tamil West Bengal (except Kolkata) Bengal (except West Karnataka (except Bangalore) (except Karnataka Tamil Nadu (except Chennai) (except Nadu Tamil West Bengal (except Kolkata) (except Bengal West Karnataka (except Bangalore) Karnataka Delhi & National Capital Region Delhi & National Maharashtra (except Mumbai) (except Maharashtra
12 Health CSR in India Survey Future Investment Priorities critical to closing India’s gap in reducing child mortality. A majority (58 percent) of responding companies When asked if any new health dollars generated reported plans to increase their health CSR by the 2% Company Law should be invested in investments through 2015 to comply with the “2% achieving the health-MDGs by 2015, 82 percent of CSR Law” and indicated a strong preference for surveyed companies agreed. This strong show of continuing to prioritize child health and maternal support for the increasing health CSR budgets to health, water and sanitation (Figure 18). However, close India’s MDG achievement gaps and, ultimately, newborn health and malnutrition did not surface as save lives. top priorities, indicating an urgent need to engage corporations in the challenge to reduce newborn deaths and malnutrition and save live as these are
Figure 18: Priority Areas for Additional Funding in the Coming Year BOX 6: NCDs IN INDIA: 60%60% AN EMERGING PRIORITY 50%50%
40%40% Non-communicable diseases (NCDs) cause 53 percent of deaths in India, and 30%30% treatment costs are frequently twice that of other conditions and illnesses12. 20%20% These numbers reflect global trends, as NCDs have become the leading cause 10% 10% of death worldwide. As mortality rates and costs rise, the next set of global 0%0% and national health goals will require NCDs Water increased focus on NCDs. Business is Malaria Hygiene Diarrhea HIV/AIDS Sanitation
Pneumonia starting to pay attention: 30 percent Malnutrition Child Health Tuberculosis Mental Health of companies in our survey expect CSR Maternal Health Maternal Newborn Health Newborn
Adolescent Health Adolescent spending on NCDs to increase in the coming year. Programs for the Elderly for Programs Sexual/Reproductive Health Sexual/Reproductive Neglected Tropical Diseases Tropical Neglected
Health CSR in India Survey 13 14 Health CSR in India Survey MOVING FORWARD
RECOMMENDATIONS FOR ACTION for more than half of all child deaths, and half of the population does not have access to a Companies are already reaching millions of toilet. Companies aspiring to help save the most Indians with health CSR programs, and the lives should focus investments in these three 2% CSR Law will spur business to new heights areas; for ideas on how business can improve of investment in coming years. With the 2015 reproductive health, newborn survival and MDG deadline approaching, now is the time sanitation, visit Resource for Action: to coordinate and focus corporate health Appendix B. programs where they will have the greatest impact; save the lives of thousands of mothers, II. Invest more in the states and districts newborns and children; and help India achieve where health challenges are most acute the remaining health MDGs, and pave the way for future priorities. Nearly all the companies surveyed are prioritizing health CSR investments based on The results of this survey suggest five their areas of operation, and while this has recommendations for action for companies, been a boon for many communities, it has left which are outlined in this section. many of the regions with the greatest health challenges without corporate investments. I. Sharpen investments to focus on Overlap between areas of operation and the health areas where India’s MDG health need will always a top priority for performance lags business—but it does not have to be the end of the opportunity. In order to do the most Although the companies surveyed are good, companies should consider expanding prioritizing investments in many of the lagging investments and replicating best practices in MDG areas—namely maternal and child health, the locations identified by the government nutrition and water—and expect to ramp up as high-need, including the 184 high-priority spending in the coming year, other areas such districts and key states highlighted in this as reproductive health, newborn survival and report. This is particularly relevant to companies sanitation are still not attracting the level of operating on a national scale, who can support support required to meet the MDG target the advancement of the country as a whole via goals. Fifty million women don’t have access to strategic CSR. When selecting new investment contraception in India; newborn deaths account sites, companies should consider if partnerships
Health CSR in India Survey 15 with state and local governments and nonprofits change programs that reach consumers; activating can be forged to accelerate program development distribution networks to reach underserved and enhance effectiveness. communities with new products; encouraging workers to volunteer; and utilizing corporate For more information on high-need geographies technology and social media platforms to spread and existing corporate activity in these locations, health messages. Companies should continue visit Resource for Action: Appendix C and D. to harness these opportunities and create new, innovative models for Indian CSR. III. Accelerate multi-stakeholder partnerships for collective impact, including V. Measure impact and share data with all shared value and social business models stakeholders, including the government and
Under the 2% CSR law, companies belonging to public the same group can set up a not-for-profit trust, or Monitoring and evaluation systems are vital can join together to undertake joint projects. The to identify what does and does not work and, Government of India is actively encouraging these ultimately, to guide more effective investing. Setting partnerships for collective impact. The companies goals and tracking progress is core to business surveyed all recognize the value of partnerships success and growth; the associated skills and to achieve their health CSR goals. While there are systems are one more example of critical business many examples of corporate partnerships with expertise that can be applied to health programs. local non-government organizations and state and In addition, monitoring and evaluation can be a local governments, more inter and intra-industry powerful tool for internal advocacy, providing partnerships are needed. Increasingly companies evidence of impact and results, and thereby will need to move beyond traditional approaches increasing support and buy-in within companies. to health CSR to embrace new models; shared However, there is much room for improvement value and social businesses combine the very best in both the quality of monitoring and evaluation of business acumen with achieving a public health of health CSR programs by companies and the goal. Industry, trade, and business associations availability of impact data. can play a pivotal role in developing these new partnerships by convening the parties, identifying In 2013, the Government of India announced a gaps and opportunities, coordinating investments, scorecard system to measure progress across and establishing and managing collective efforts. maternal and child health interventions, using India’s Health Management Information System (HMIS) and IV. Leverage CEO power to advocate for national survey data, along with a number of other greater action on the MDGs tools. Companies should explore how their own monitoring and evaluation of internal CSR programs Companies surveyed reported that the personal can align with these new tools, and how the data commitment of company leadership is a major they collect can be aggregated into national data driver of health CSR priority areas, which collection and dissemination platforms. Lastly, underscores the powerful role CEOs in India play companies should not only conduct rigorous within their own companies. If CEOs also focused evaluations of their health CSR investments, but their advocacy efforts externally to encourage should make this information widely available to all governments and other stakeholders to target the stakeholders. The reporting requirements mandated areas where the greatest health gains can be made, by the Companies Act are a critical first step in the they could play a major role in India’s achievement public reporting process. of the MDGs.
In addition to CEO advocacy, companies can leverage their many assets and apply business know-how beyond simple philanthropy. According to the survey, corporates are already bringing their corporate strengths, skills and technology to bear on health challenges: sharing marketing prowess to create health education, advocacy and behavior
16 Health CSR in India Survey RESOURCES FOR ACTION
Corporate Profiles: Selecting Program Sites Learning From Others Identify high-impact geographies for your Gain inspiration and ideas from these health programs by reviewing the following corporate case studies. Appendix A resources, and searching for strategic overlap with your company and stakeholder 1. Applying Business Expertise & priorities. Know-How Government of India’s High Priority • ZMQ Technologies Districts (HPDs) Appendix C.1 • Hindustan Unilever Limited Geographic Concentration of 2. Investing in High-Priority Geographies Newborn Mortality: 55 Districts with • Max India Group of Companies Highest Infant Deaths Appendix C.2 • Tata Steel
3. Partnering with State Governments • Primal Swasthya
Health CSR Activity Mapping, by Geography and Issue
7 High-Impact Opportunities To promote geographic- and issue-based For Companies knowledge-sharing between companies and partners, we asked our respondents to GBCHealth Investment Cases are designed tell us which state/city/district and health to support companies as they define, areas they are currently working in. Go to design, and ramp-up CSR giving. Each Appendix D for the mapping overview. Investment Case targets a specific health issue and presents a case for corporate action, while offering examples of existing private sector partnerships.
Go to Appendix B to learn more and start making a difference in: Coordinating Organizations & 1. Newborn Health Industry Associations 2. Pneumonia Go to Appendix E for a shortlist of 3. Diarrhea organizations and industry associations that 4. Nutrition can help guide your company to maximize 5. Women’s Empowerment, partnership opportunities with others. Reproductive and Maternal Health 6. Water, Sanitation and Hygiene 7. Frontline Health Workers
Health CSR in India Survey 17 18 Health CSR in India Survey RESOURCES FOR ACTION
A. CORPORATE PROFILES: LEARNING FROM OTHERS
1. APPLYING BUSINESS EXPERTISE AND KNOW-HOW...... 20
2. INVESTING IN HIGH-PRIORITY GEOGRAPHIES...... 21
3. PARTNERING WITH STATE GOVERNMENTS...... 22
B. 7 HIGH-IMPACT OPPORTUNITIES FOR COMPANIES
1. NEWBORN HEALTH...... 23
2. PNEUMONIA...... 25
3. DIARRHEA...... 27
4. IMPROVING NUTRITION...... 29
5. WOMEN’S EMPOWERMENT, REPRODUCTIVE AND MATERNAL HEALTH...... 31
6. WATER, SANITATION AND HYGIENE...... 33
7. FRONTLINE HEALTH WORKERS...... 35
C. SELECTING PROGRAM SITES
1. HIGH-PRIORITY DIRSTICTS IN INDIA...... 38
2. 55 DISTRICTS WITH HIGHEST INFANT MORTALITY RATE ...... 40
D. HEALTH CSR ACTIVITY MAPPING, BY GEOGRAPHY & ISSUE...... 41
E. COORDINATING ORGANIZATIONS & INDUSTRY ASSOCIATIONS...... 43
Health CSR in India Survey 19 ZMQ Technologies’ business expertise is in mobile entertainment – one of the most effective means possible to reach and engage consumers on health issues. ZMQ allocates 12 percent of profits to the development of tech tools that have positive social impacts, such as the Women Mobile Lifeline – or, “MIRA Channel.” MIRA is an integrated mobile platform design to engage rural women with ‘edutainment’: providing entertainment, developing knowledge and skills, and providing health resources and tools. Through games, soap operas, and story-telling designed for low- literacy Indian women, the channel provides valuable information and interactive tools such as health calculators, infection prevention reminders, family planning and pregnancy trackers, and immunization trackers.
LEARNING FROM OTHERS: APPLYING BUSINESS EXPERTISE & KNOW-HOW
Hindustan Unilever’s strategic CSR campaigns have made its brands extensively known around India while doing social good, reaching over 303 million people with programs that promote improved drinking water, sanitation and hygiene. Since 2010, Lifebuoy has substantially expanded its handwashing behavior-change campaigns, reaching 58 million Indians. Company representatives hold events in rural villages to promote good hygiene habits, as well as the brand, creating demand simultaneously with local retail supply. The Lifebuoy Swasthya Chetna program, a broader campaign to improve hygiene and reduce diarrhea-related deaths, has reached over 135 million Indians and saved countless lives in addition to helping Lifebuoy secure an 18.4 percent share of the soap market.
20 Health CSR in India Survey The Max India Group of Companies partners with government and nonprofits to provide health education and services in impoverished communities nationwide, including in the state of Madhya Pradesh – where the Government has identified the single highest concentration of priority districts.
The Max India Foundation’s Pan-Indian Immunization program has organized camps in over 142 locations nationwide in partnership with local NGOs, doctors and volunteers, and has immunized 35,000 children under 12 years old. Health Camps in rural and semi-urban communities provide free screening and medicine for patients of all ages, and facilitate treatment and surgery as needed. Over 66,000 patients have accessed health care through the camps.
LEARNING FROM OTHERS: INVESTING IN HIGH-PRIORITY GEOGRAPHIES
Tata Steel is committed to providing health care services in its area of operations, as well as the high-priority districts identified by the Government of India. In priority district Seraikella-Kharsawan, in Jharkhand State, the company is helping reduce the rates of maternal and newborn death in 167 villages. The Maternal and Neonatal Survival Initiative (MANSI) program trains local female community health workers to provide home- based neonatal and child care. The investment infants, and prenatal care and counseling to more has made huge impacts, including a one-third than 7,300 pregnant women. reduction in the newborn mortality rate, a doubling of the proportion of pregnant women In partnership with the American India receiving at least three antenatal checkups Foundation, the Society for Education, Action (from 40 percent to 90 percent), and a and Research in Community Health and the quadrupling of births in hospitals (from 20 Government of Jharkhand, Tata is committed to percent to 80 percent). Since 2009, MANSI has reaching more pregnant women and newborns in provided newborn care to more than 6,000 Jharkhand and a new geography - Odisha.
Health CSR in India Survey 21 LEARNING FROM OTHERS: PARTNERING WITH STATE GOVERNMENTS
Piramal Swasthya, a social of Telecommunications to reserve “104” as enterprise committed to India’s central resource for non-emergency improving water quality health services. Citizens across states can now in India, develops and easily access medical information and advice, implements health projects receive counseling services, request directory in close partnership with state and local information, or lodge a service complaint governments, non-governmental organizations, against any public health facility by calling and other companies. The company integrates “104”. Helplines provided services and referrals activities to address maternal and child to over 2.1 million callers last year. health, chronic diseases, and the lack of skilled healthcare personnel among vulnerable Notably, the company has successfully populations. transferred helpline operations in Andhra Pradesh to the state government – a victory for The company’s “Health Information Helplines” the ongoing sustainability and capacity-building program stands out as a particularly exemplary impact of the program, made possible by close partnership. Piramal Swasthya worked closely collaboration throughout program development with the Government of India and Department and implementation.
22 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #1 Corporate Support to Reduce Newborn Mortality
A staggering 780,000 Indian babies die in the Forum Partners first month of life; 300,000 on the first day. Newborn deaths now account for 55 percent of all under-five child deaths in India and progress to Millennium Development Goal 4 will not be achieved without a central focus on reducing newborn mortality. The leading causes of new- born death in India include prematurity and low birth weight (32 percent), birth asphyxia and trauma (27 percent), and infection (19 percent). Lack of access to quality, affordable prenatal care, skilled delivery and emergency obstet- 3. Postnatal Care: Eighty percent of ric and postnatal care are the major reasons newborn deaths in India occur in the first newborn mortality remains so high. Sixty-three week of life and newborns must have percent of Indian women do not get adequate access to attendants who are skilled at pre and postnatal care and half deliver without resuscitation, prevention and manage- a skilled attendant. ment of hypothermia, Kangaroo Mother Evidence suggests that newborn deaths could Care, infection management and breast- be reduced by up to 72 percent if all pregnant feeding support during this period. women and new mothers had access to the fol- 4. Home-Based Newborn Care: Ground- lowing products and services: breaking studies by Doctors Abhay 1. Prenatal Care: Pregnant women should visit and Rani Bang showed that newborn a qualified medical professional at least four mortality could be halved in communi- times during pregnancy to monitor weight gain ties where local women are trained and and receive nutritional supplements, to receive equipped in essential newborn care. For immunizations (particularly tetanus toxoid) and communities living far from health facili- to manage preeclampsia and infection. ties this is an essential component of reducing newborn mortality in India. 2. Skilled Delivery: Women should deliver their babies with an attendant skilled in delivery, hygienic birth practices, the use corticosteroids How Can a Corporation Help? in case of preterm labor and antibiotics, and the • Infrastructure, Product Develop- use of the partograph. Critically, women must ment & Service Delivery: provide have access to emergency obstetric care even quality, affordable products and Forum Sponsors if they deliver at home. Despite the success of services to strengthen facility- the Government of India’s Janani Surakhsha based prenatal care, skilled deliv- Yojana (JSY) and Home-based Newborn Care ery and postnatal care, including Schemes, their impact on reducing newborn home-based newborn care, and deaths has been limited underscoring the build and equip sick newborn care importance of emergency obstetric care and units in high-risk communities. specialized newborn care units at facilities.
Each year, over 300,000 50% of women in India Unsafe water and poor Indian babies die on the deliver their babies sanitation and hygiene very day they are born without a skilled at- practices cause high rates tendant of newborn infection
Health CSR in India Survey 23 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #1 Corporate Support to Reduce Newborn Mortality
How Can a Corporation Help? far below the price of existing prod- ucts. • Advocacy, Awareness, Educa- tion & Behavior Change: spon- “SAFE MOTHERHOOD AND CHILD sor high-impact campaigns that SURVIVAL PROJECT” stimulate greater action among One of the largest public-private governments, the private sector initiatives in India’s health sector, in and civil society for newborn 2005 Deepak Fertilizers and Petro- survival and outreach efforts to chemicals began supporting a cadre improve newborn care prac- of frontline women health workers tices. in 1,550 villages to improve access to government health facilities and • Innovation: provide funding dia’s Neonatal Resuscitation Program. increase community monitoring of and/or technical assistance to A recent evaluation of the program in service delivery among a population experiment with innovative ap- Tanzania showed a 50 percent reduc- of two million. Other partners include proaches (e.g. transport ser- tion in newborn deaths on the first the Government of Gujarat. vices that link women to emer- day of life. Other partners include the gency obstetric care, vouchers National Neonatology Forum, Indian “INSTITUTE FOR THE NEWBORN” to encourage care seeking for governments and the Helping Babies The NICE Foundation, an initiative sick newborns). Breathe partners. of Kallam Anji Reddy the founder of Dr. Reddy’s Laboratories, established “EMBRACE INNOVATIONS” Examples of Corporate a 120-bed, state of the art facility in In 2008, this social business venture Hyderabad to address the needs of Support launched its first product – an infant critically ill and premature newborns Corporations are already invest- warmer designed especially for pre- with a special focus on the needs of ing in newborn health, but much mature and low birth weight babies in tribal women. Other partners include greater support is needed because resource poor settings at a fraction of the Government of Andhra Pradesh, the burden is so high and this is one the cost of existing solutions. The Em- the Naandi Foundation and the Lon- of the most critical areas to achieve brace Infant Warmer is now manufac- don School of Hygiene and Tropical Millennium Development Goal 4. The tured and sold in India and has helped Medicine. following are several of the leading, 40,000 babies around the world. Em- best practice examples of corporate brace Innovation’s vision is to create a engagement in newborn survival: line of disruptive healthcare technolo- Next Steps gies for emerging markets focused on If your company is interested in “FIRST GOLDEN MINUTE” mother and child health. supporting an existing program, in es- In 2009, the Indian Academy of Pe- tablishing a new initiative or forming a “BRILLIANCE” diatrics with support from Johnson & new partnership with other stakehold- In 2010, Phoenix Medical Systems Johnson India launched a program to ers to reduce newborn deaths, please began manufacturing and selling train health workers, nurses, pediatri- contact Shuma Panse at spanse@ “Brilliance” a low cost phototherapy cians, and gynecologists in newborn gbchealth.org or Rahul Bhargava at device to treat severe jaundice in resuscitation practices, specifically [email protected]. how to use a bag and mask to prevent newborns. In an innovative partner- newborn deaths from asphyxia. This ship with US–based non-profit design “Golden Minute” training program was firm, D-Rev, Phoenix is able to sell the developed by the American Academy product to public and private health of Pediatrics in partnership with In- facilities throughout India for $400,
780,000 newborns died 50% of women in India de- Unsafe water and poor in 2012; one newborn dies liver their babies without sanitation and hygiene every 38 seconds a skilled practices cause high rates attendant of newborn infection
24 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #2 Corporate Support to Reduce Child Pneumonia Deaths
Pneumonia is the single leading cause of child Forum Partners death in India. In 2012, 45 million children con- tracted pneumonia and 300,000 children died from complications caused by pneumonia. Most of these deaths occurred in children under the age of two and 30 percent were among new- borns. Children in India are extremely vulnerable to pneumonia because they do not routinely receive the vaccines that can prevent the lead- ing causes of pneumonia or the antibiotics that can treat pneumonia. Further, as malnourished children are up to nine times more likely to die from pneumonia, Indian children are particularly 5. Education: Children of mothers who vulnerable. cannot read and who have had little or no education are at far greater risk of Interventions with greatest impact on reducing malnutrition. Educating the 40 percent childhood pneumonia deaths include: of women in India who are illiterate in proper nutrition is an urgent priority. 1. Vaccination: The pneumococcal, pentavalent and measles vaccines are highly effective at 6. Indoor Air Pollution: Halving house- preventing the leading causes of pneumonia. hold air pollution with proper ventilation Making these vaccines available to the children could reduce instances of severe pneu- most at risk of pneumonia could reduce deaths monia by 70 percent. by more than 30 percent.
2. Treatment: Identifying and treating children How Can a Corporation Help? with pneumonia with appropriate child-friendly antibiotics close to home could reduce deaths • Infrastructure, Product Develop- by 35 percent. Frontline health workers must ment & Service Delivery: ensure be trained and equipped to diagnose and treat that quality, affordable products to children with the WHO recommended amoxicil- prevent and treat pneumonia are lin dispersible tablets. manufactured and distributed to the most vulnerable communities, 3. Nutrition: Exclusive breastfeeding could especially vaccines (pneumococ- reduce pneumonia deaths by 23 percent, yet cal, pentavalent and measles), less than half of Indian babies are exclusively antibiotics (amoxicillin in child- Forum Sponsors breastfed for the first six months. friendly formulations), oxygen, diagnostic devices (e.g. respiratory 4. Hand Washing with Soap: Studies have rate timers, pulse oximeters), soap shown that hand washing with soap can reduce and clean cooking alternatives. the number of pneumonia-related infections among children under five by more than 50 percent.
Pneumonia is the single 30% of all pneumo- 60% of Indian families leading cause of child nia deaths are among use solid fuels for cook- death in India; a child dies newborns ing - a high risk factor for every two minutes pneumonia
Health CSR in India Survey 25 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #2 Corporate Support to Reduce Child Pneumonia Deaths
How Can a Corporation a bottom of the pyramid market for Help? Lifebuoy soap. • Advocacy, Awareness, Educa- “WORLD PNEUMONIA DAY” tion and Behavior Change: On November 12th every year India support communications cam- celebrates World Pneumonia Day paigns to increase awareness of with the Indian Academy of Pediat- the danger signs of pneumonia rics (IAP) sponsoring many advocacy and the importance of seeking events all over the country. In 2012, care quickly. the IAP launched a national campaign, “Say No to Pneumonia” to create • Innovation: provide funding awareness among parents, healthcare and/or technical assistance this vaccine has been introduced in professionals and policymakers on the to experiment with innovative nine States and national introduction importance of preventing pneumonia approaches (e.g. integrating is now recommended. Other partners and ensuring that it is diagnosed and the delivery of vaccines, with include GAVI and the Government of treated early. community management of India. pneumonia and good nutrition “SANKALP FORUM & GLOBAL ALLI- and hygiene and development “EROX AMOXICILLIN DISPERSIBLE ANCE FOR CLEAN COOKSTOVES” of rapid diagnostic tests for TABLETS” Indian business solutions company pneumonia). Manufactured by Indian pharma- Intellecap created the Sankalp Forum ceutical company, Micro Labs, this in 2009 to recognize and support Examples of Corporate antibiotic is the WHO recommended high impact social enterprises. In 2013 treatment for children with pneumo- the Sankalp Forum announced a US$ Support nia. Each tablet dissolves in breast 15,000 award for innovation in clean Corporations who have stepped up to milk or water making it easy for cooking solutions that would reduce fight pneumonia include India’s lead- small children to swallow. Making this household air pollution and the risk to ing vaccine manufacturers, consumer antibiotic available to children with family health from traditional chulhas goods companies, pharmaceutical pneumonia would dramatically reduce burning wood, coal and dung. companies, social entrepreneurs and child deaths. Other partners include professional associations. The fol- UNICEF and the governments of India. Next Steps lowing are several of the leading, If your company is interested in best practice examples of corporate “THE GONDAPPA CAMPAIGN” supporting an existing program, in engagement to prevent child deaths To increase rates of hand washing establishing a new initiative or form- from pneumonia: with soap in India, Hindustan Unilever launched the Gondappa campaign ing a new partnership with other “PENTAVAC VACCINE” with a video that has been viewed stakeholders to prevent child deaths One of the world’s leading vaccine more than 13 million times online. The from pneumonia, please contact makers, the Serum Institute of India, company has “adopted” the village of Shuma Panse at spanse@gbchealth. produces pentavalent vaccine which Thesgora in Madhya Pradesh, which org or Rahul Bhargava at rbhargava@ protects children against five diseases has one of the highest rates of child- mdghealthenvoy.org. including diphtheria, pertussis, teta- hood death with the goal of elimi- nus, Hepatitis B and one of the lead- nating child mortality. This is part of ing causes of pneumonia – haemophi- Unilever’s global campaign to change lus influenzae B or Hib. Since 2011, the hand-washing behaviors of one billion people by 2015 and to build
Pneumonia is the single 30% of all pneumonia 60% of Indian families leading cause of child deaths are among new- use solid fuels for cook- death in India; a child dies borns ing - a high risk factor for every two minutes pneumonia
26 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #3 Corporate Support to Reduce Child Diarrheal Deaths
Diarrhea is a leading cause of child death in Forum Partners India. The average child experiences three episodes of diarrhea each year and in 2012, 140,000 children in India died from complica- tions caused by diarrhea. Most of these deaths occurred in children under the age of two. Chil- dren in India are extremely vulnerable to diar- rhea because unsafe water, poor sanitation and hygiene combine with malnutrition to create a vicious cycle of infection and nutrient deple- tion leaving malnourished children up to 9.5 times more likely to die from diarrhea. Further, children in India do not routinely receive the ucts close to home at both public and vaccine that protects against one of the leading private sector health outlets. causes of severe diarrhea – rotavirus - and more 3. Water, Sanitation and Hygiene: than 70 percent do not receive the recommend- Improved water supply, sanitation and ed treatment for diarrhea – oral rehydration hand-washing with soap can reduce epi- salts (ORS) and zinc. sodes of diarrhea by 21, 37.5 and 35 per- Evidence shows the interventions with great- cent respectively. Additional improve- est impact on reducing child diarrhea deaths ment of drinking water quality, such as include: point-of-use water disinfection, could lead to a reduction of diarrhea episodes 1. Vaccination: The rotavirus vaccine is highly of 45 percent. effective at preventing one of the leading causes of diarrhea. A recent study revealed 4. Nutrition: Early and exclusive breast- an exceptionally high incidence of rotavirus feeding for the first six months and con- diarrhea among children in India and rotavirus tinued breastfeeding and good nutrition diarrhea is responsible for millions of outpatient during episodes of diarrhea are critical. visits and hundreds of thousands of hospitaliza- Vitamin A supplementation can reduce tions each year. Making the rotavirus vaccine diarrhea-related mortality by 28 percent routinely available to children could reduce an- in children six months to five years. nual diarrhea deaths by more than 30 percent. 2. Treatment: Treating diarrhea with oral How Can a Corporation Help? rehydration salts and zinc could reduce child Forum Sponsors diarrhea deaths by 90 percent and is one of • Infrastructure, Product Develop- the most cost-effective solutions available in ment & Service Delivery: ensure child health. Frontline health workers should that quality, affordable products be trained and equipped to treat children with to prevent and treat diarrhea are ORS and zinc, and families should be aware of manufactured and distributed to the importance of rehydration and zinc therapy at-risk communities, especially during bouts of diarrhea. Families should have rotavirus vaccines, ORS access to quality, affordable ORS and zinc prod-
Diarrhea kills 140,000 India’s 7.5 million low Unsafe water, poor sanita- children in India every birth weight babies are tion and hygiene contrib- year; one child every four extremely vulnerable ute to 88% of diarrheal minutes to diarrhea deaths
Health CSR in India Survey 27 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #3 Corporate Support to Reduce Child Diarrheal Deaths
• and zinc, soap and clean water ORS and its 1.5 millionth zinc treat- and that health workers are ment! Other partners include FHI-360 trained to use them. and the Bill and Melinda Gates Foun- dation. • Advocacy, Awareness, Educa- tion and Behavior Change: SANKALP: NO CHILD SHOULD DIE support campaigns to increase FROM DIARRHEA” awareness of the benefits of In 2012, Infosys, Teck Resources, IKEA vaccination, the dangers of Foundation and several other com- diarrhea and the importance panies joined forces with the United of rehydration and continued Nations, governments and non- feeding. it would sell the vaccine at a price of government organizations to reduce child diarrhea deaths in India. Major • Innovation: provide funding $US 1.00 per dose ($US 3.00 course), commitments made under the public- and/or technical assistance an extremely competitive price rela- private partnership include IKEA to experiment with innovative tive to other rotavirus vaccines. Foundation’s $US28 million* to the approaches (e.g. new product Clinton Health Access Initiative, Teck formulations, integrated deliv- “SHAKTI ORS” Resources’ $US5 million investment to ery of the rotavirus vaccine with In 2011, pharmaceutical company UNICEF as part of the “Zinc Alliance antibiotic treatment, nutrition Pharmasynth joined forces with Hin- for Child Health”, McCann Health’s and hygiene at the community dustan Unilever’s network of “Shakti” Zinc+ORS Campaign, and the Inter- level). entrepreneurs to sell ORS and zinc to 400 rural villages in three districts national Zinc Association’s $US0.5 of Uttar Pradesh. This partnership million commitment as part of the Examples of Corporate increased Pharmasynth’s access to “Mining Compact for Child Health”. All Support rural retail outlets and the incomes of of these investments are to increase the Shakti entrepreneurs. 8,500 litres access to ORS and zinc treatment for Corporations who have stepped up to of ORS were sold and generated posi- diarrhea in the states with the high- fight diarrhea include India’s lead- tive net returns of eight percent for est burdens of child diarrhea deaths ing vaccine manufacturers, consumer Pharmasynth and eight percent of the including Uttar Pradesh, Madhya goods companies, pharmaceutical total income of the 187 Shakti entre- Pradesh and Gujarat. companies, technology companies preneurs during the high diarrhea *Kenya is also included in this pro- and professional associations. The months. Further, the association with gram following are several of the leading, ORS enhanced the status of the Shakti best practice examples of corporate entrepreneurs in the villages. Next Steps engagement to prevent child deaths from diarrhea: “DAZT PROJECT” If your company is interested in sup- Pharmaceutical companies, Utopia, porting an existing program, in es- “ROTAVAC VACCINE” Prayas and Manstar partnered with tablishing a new initiative or forming Leading Indian vaccine maker, Bharat ten local non-government organiza- a new partnership with other stake- Biotech, has developed a rotavirus tions to increase sales of ORS and holders to prevent child deaths from vaccine called ROTAVAC® which has zinc in six districts of Gujarat and 12 diarrhea, please contact Shuma Panse shown a 56 percent reduction of districts of Uttar Pradesh, working at [email protected] or Rahul severe rotavirus diarrhea in children closely with Rural Medical Practitio- Bhargava at rbhargava@mdgheal- under one year of age and continued ners (RMPs) who are the main sources thenvoy.org. efficacy in the second year of life. The of treatment for the majority of sick efficacy of ROTAVAC® is comparable children in these areas. In 2013, the to currently licensed rotavirus vac- project sold its two millionth sachet of cines but Bharat Biotech announced
Diarrhea kills 140,000 chil- India’s 7.5 million low Unsafe water, poor dren in India every year; birth weight babies are sanitation and hygiene one child every 4 minutes extremely vulnerable to contribute to 88% of diarrhea diarrheal deaths
28 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #4 Corporate Support for Maternal and Child Nutrition
Malnutrition is the lead underlying cause of Forum Partners child death in India and a contributing factor in more than half of all 1.4 million deaths of children under five in 2012. Sixty-two million children or half of all children under five in India are “stunted”, the official measure of chronic malnutrition during the most critical periods of growth and development in early life. Twenty- five million are “wasted”, which is the official measure of acute malnutrition and carries with it a markedly increased risk of death. India also has the world’s largest concentration of low birth weight babies with 7.5 million babies receive the right amounts of nutrient born weighing below 2,500 grams - a reflection dense foods to complement breastfeed- of the low nutritional status of many pregnant ing ensures healthy growth and develop- women. ment.
Evidence suggests that malnourished chil- 3. Micronutrient Supplementation: dren are at far greater risk of death from other Children and pregnant women need causes, particularly pneumonia and diarrhea, adequate amounts of vitamins and and suffer long-term developmental deficits minerals, particularly vitamin A, zinc and that lead to lower levels of educational at- iron for children and folic acid, iron and tainment and labor market performance, and calcium for pregnant women. Fifty-seven a greater risk of developing chronic diseases percent of children in India are vitamin A in later life. By age two, most nutritional defi- deficient and a staggering 75 percent of ciencies have done irreversible damage, which expectant and new mothers are anemic. makes intervening in the first 1000 days after conception absolutely critical. 4. Promotion of Good Nutrition: Chil- dren of mothers who cannot read and Nutrition interventions with greatest impact on who have had little or no education are reducing deaths of pregnant women and chil- at far greater risk of malnutrition. Edu- dren include: cating the 40 percent of women in India 1. Early and Exclusive Breastfeeding: Breast- who are illiterate in proper nutrition is an feeding within one hour of birth and exclusively urgent priority. for the first six months is the single most ef- 5. Treatment of Moderate and Severe Forum Sponsors fective intervention for preventing child death, Acute Malnutrition: Increasing use with the potential to reduce newborn mortality of Ready-To-Use Therapeutic Foods by 20 percent and under five mortality by 12 (RUTFs) and community management of percent. Despite this, less than half of all babies acute malnutrition programs could avert in India are breastfed early and exclusively. hundreds of thousands of child deaths. 2. Appropriate Complementary Feeding: Ensur- ing that children six months to two years of age
Malnutrition is a factor in 75% of pregnant Poor sanitation and more than 700,000 child women are anemic hygiene expose children deaths in India every year and at greater risk of to repeat infections and preterm birth stunting
Health CSR in India Survey 29 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #4 Corporate Support for Maternal and Child Nutrition
How Can a Corporation “SCALING UP NUTRITION (SUN) Help? BUSINESS NETWORK” Launched in 2012, this platform pro- • Infrastructure, Product Devel- vides a forum for business to engage opment & Service Delivery: in the United Nations supported SUN manufacture and distribute movement. The State of Maharashtra quality, affordable micronutri- joined the SUN movement in 2013. ent-fortified complementary foods, supplements and thera- “SHISHU MANGALAM” peutic foods to meet the needs In 2012 Essar Energy set out to im- of children aged six months to prove the nutritional status of children two years and pregnant women. centrated in specific areas of Andhra living close to one of its plants in the Pradesh and Maharashtra. Examples Jamnagar district of Gujarat. More Advocacy, Awareness, Educa- • of nutrition initiatives engaging India’s than 1,000 children were enrolled tion and Behavior Change: corporate sector include: in the program and those with de- support campaigns to increase ficiencies were given a high protein access to best practice feeding “BRITANNIA’S FOOD FORTIFICA- nutrition supplement, education and practices for the most at-risk TION” individual monitoring with strong mothers. Since 2007, leading India food brand results. Partners included the District • Innovation: provide funding Britannia has been fortifying popular Panchayat and local Integrated Child and/or technical assistance children’s foods with iron and folic Development Scheme (ICDS) infra- to experiment with innovative acid and breads with ten vitamins structure. approaches (e.g. incentives and calcium. Britannia’s iron-fortified for breastfeeding, nutritional “Tiger Biscuit” is being distributed “VITAMIN ANGELS” vouchers for fortified foods). as part of school midday meals. A private-nonprofit partnership be- Britannia’s commitment to “Secur- tween nutrition company DSM and Examples of Corporate ing Children’s Right to Growth and nonprofit Vitamin Angels that distrib- Development through Good Food” is Support utes DSM’s Vitamin A capsules to 1.6 a business model that involves market million children who are not reached The economic losses associated with expansion, new product development, by existing efforts. Partners include malnutrition are estimated at three awareness – building partnerships 55 non-government organizations. percent of India’s GDP annually sug- and public grassroots engagement. Sixty-two percent of preschool aged gesting that investments in maternal Partners include the Naandi Founda- children are Vitamin A deficient, which and child nutrition can yield signifi- tion, Navjyoti Foundation and the is the leading cause of blindness in cant economic returns. Indeed India’s Global Alliance for Improved Nutrition children under five. long-term economic performance (GAIN). and international competiveness Next Steps may depend on improvements in the “KISSAN AMAZE” If your company is interested in sup- nutritional status of children as rates Hindustan Unilever launched Kissan porting an existing program, in estab- of malnutrition in India are five times Amaze drinks and snacks in 2007 to lishing a new initiative or forming a higher than China and twice those in meet the protein and micronutrient new partnership with other stakehold- Sub-Saharan Africa. needs of children. A study showed that after a year of consuming the ers to reduce malnutrition, please con- Six States – Uttar Pradesh, Bihar, Mad- Amaze protein-energy snacks fortified tact Jessica Johnston at jjohnston@ hya Pradesh, Rajasthan, Chhattisgarh with Vitamins A, B2, B12, C, folic acid, mdghealthenvoy.org or Jonathan and Jharkhand – account for over half calcium, iron, zinc, iodine, omega-3 Tench from the Scaling Up Nutrition of India’s malnutrition, while an addi- and six fatty acids, children had lower Business Network at jtench@gain- tional 10 percent of the burden is con- risk of illness. health.org.
Malnutrition is a factor in 75% of pregnant women Poor sanitation and more than 700,000 child are anemic and at greater hygiene expose children deaths in India every year risk of preterm birth to repeat infections and stunting
30 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #5 Corporate Support for Women’s Empowerment, Reproductive & Maternal Health
Women’s empowerment is one of the critical Forum Partners foundations for prosperous and peaceful societ- ies. When women suffer unequal opportuni- ties to reach their full potential, nations cannot sustain high rates of economic growth and social development. The relationship between a woman’s level of education and the health and welfare of her family, particularly her children, is profound. Societies where women cannot exer- cise control over their personal safety and their lives including who and when to marry, when to have a child and how many children to have, whether to complete an education or not, and immunizations (particularly tetanus whether or not to earn an income and to have toxoid), and manage preeclampsia and discretion over how that income is spent, will infection. experience higher rates of maternal death and poor health. 2. Skilled Delivery: Women should deliver their babies with an attendant In 2012, 56,000 women died of pregnancy skilled in delivery and must have ac- related complications in India. The leading cess to emergency obstetric care with direct causes of maternal death include hemor- staff trained and equipped to respond rhage (35 percent), hypertension (17 percent), to hemorrhage and complications from unsafe abortion (10 percent) and infection (7 preeclampsia, even if they deliver at percent). Lack of access to quality, affordable home. reproductive, prenatal care, skilled delivery and emergency obstetric care are critical factors. 45 3. Reproductive Health: Adolescent percent of adult women do not use contracep- girls and women should have access to tion, 63 percent do not get adequate prenatal information about family planning and a care and half deliver without a skilled attendant. choice of quality, affordable methods. The young age of many mothers increases the 4. Education: Increasing female literacy risk of maternal death and injury. One in every in the high population northern states two adolescent girls in India is married by 18; from the current 50 percent will have a one in every five by the age of 15. major impact across all areas of wom- Evidence suggests that maternal deaths could en’s health. be reduced and Millennium Development Goal Forum Sponsors 5 achieved if adolescent girls and women had How Can a Corporation Help? access to: • Infrastructure, Product 1. Prenatal Care: Pregnant women should visit Development & Service Delivery: a qualified medical professional at least four manufacture, market and times during pregnancy to monitor weight gain distribute products and services and receive nutritional supplements, receive that will reduce maternal mortality
If all Indian women had 56,000 women died Unhygienic birth practices finished high school the of pregnancy related are a leading cause of child mortality rate would causes in India in 2010 maternal infection and be 61% lower death
Health CSR in India Survey 31 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #5 Corporate Support for Women’s Empowerment, Reproductive & Maternal Health
in the communities where eight northern states. The campaign deaths are concentrated. urged people to Condom Bindaas Bol (Hindi for “Say Condoms Freely”) • Advocacy, Awareness, Educa- and increased use of condoms among tion and Behavior Change: married men from 38 to 60 percent. support campaigns that in- Other partners include the Govern- crease female literacy, enable ment of India and USAID. girls to stay in school and complete secondary educa- “BEL BAJAO” tion and provide information to In 2008, advertising agency Ogilvy at-risk mothers on how to have and Mather produced pro bono an a healthy pregnancy and safe award-winning campaign to encour- delivery. Pradesh, Rajasthan and Jharkhand the age men to stop domestic violence by initiative is one of the largest corpo- “Bel Bajao” (Hindi for “Ring the Bell”) • Innovation: provide funding rate contributions to reducing mater- - interrupting violence as it occurs. and/or technical assistance to nal mortality. Other partners include 130 million people have been exposed experiment with innovative ap- Hindustan Latex Family Planning Pro- to the campaign. Other partners proaches (e.g. nutrition vouch- motion Trust, Pathfinder International, include human rights organization ers for at-risk adolescent girls World Health Partners and the White Breakthrough, the Government of conditional on attending literacy Ribbon Alliance for Safe Motherhood. India and the United Nations. classes, funding for social busi- ness models that provide family “PROJECT UNNATI” “LIFESPRING HOSPITALS” planning to the poor). For the Bansidhar and Ila Panda Since 2005, this chain of no-frills, high Foundation, the CSR arm of the IMFA quality private maternity hospitals Examples of Corporate Group, women’s empowerment is in Andhra Pradesh has been offer- Support one of four priority investments. The ing care at 30 to 50 percent below foundation supports projects in five market prices. It cross-subsidizes to The economic losses associated For districts in the Indian state of Odisha offer tiered pricing so it is affordable companies with a large female cus- to strengthen women’s capacity to to families with very low incomes. To tomer base, who employ a largely manage their lives. Project Unnati is date it has delivered 23,000 healthy female workforce or who operate in an all-encompassing program that babies with plans for rapid expansion. areas where the status of women is addresses maternal and child health, Other partners include Acumen Fund the underlying cause of poor health health literacy and empowerment and HLL Lifecare. and maternal deaths, investments in through an integrated self help ap- women’s empowerment, reproduc- proach (i.e. finance and livelihood, Next Steps tive and maternal health can have a education, health, nutrition, sanitation significant impact. Below are some and hygiene). The goal is to provide If your company is interested in sup- of the leading examples of corporate a platform for social action where porting an existing program, in es- engagement in Millennium Develop- women become agents of change for tablishing a new initiative or forming ment Goal 5: the development of their own com- a new partnership with other stake- munities. holders to reduce maternal deaths, “MSD FOR MOTHERS” and empower women, please contact In 2013, pharmaceutical giant MSD “CONDOM BINDAAS BOL” Shuma Panse at spanse@gbchealtgh. India launched “MSD for Mothers” In 2006, Weber Shandwick and ICICI org or Rahul Bhargava at rbhargava@ with funding of $US 10 million over Bank supported a public awareness mdghealthenvoy.org. three years to improve the quality of campaign to encourage safe sex, care pregnant women receive through destigmatize discussion of contracep- the private sector. Aiming to reach tion and stimulate sales of condoms in 500,000 pregnant women in Uttar
If all Indian women had 56,000 women died of Unhygienic birth practices finished high school the pregnancy related causes are a leading cause of child mortality rate would in India in 2010 maternal infection and be 61% lower death
32 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #6 Corporate Support for Water, Sanitation and Hygiene
Unsafe water and poor sanitation and hygiene Forum Partners practices are at the root of many of India’s health challenges. Despite halving the propor- tion of the population without access to safe drinking water, only one in five Indians has ac- cess to water piped to their premises. Alarming- ly, one in two Indians has no access to a toilet and in rural areas open defecation is a necessity for 62 percent of the population. Rates of hand washing with soap are low, with only half of the population washing their hands with soap after the toilet and before preparing and eating food. In 2006, the World Bank estimated that the lack of access to clean water and functional bath- ticular price for lack of access to private rooms cost the Indian economy the equivalent toilets facilities with up to 30 percent of 6.4 percent of GDP. It is children who pay the exposed to violent attack in the process. heaviest price with unsafe water and poor sani- tation and hygiene triggering a vicious cycle of 3. Hand Washing with Soap: Studies repeat infections like diarrhea and malnutrition. show that hand washing with soap is one of the most cost-effective ways to Evidence suggests child mortality is seven times reduce the incidence of diarrhea (by 40 higher in countries with poor sanitation and percent) and pneumonia (by 30 per- that lack of access to safe water for drinking, cent). At-risk communities should be washing and cooking and to toilets contribute supplied with quality, affordable soap to 90 percent of diarrhea deaths: and should be educated in the commu- nity-wide benefits of regular hand wash- 1. Clean Water: Access to clean drinking and ing with soap. cooking water close to home improves family health, child survival and reduces the time girls 4. Menstrual Hygiene: 300 million girls and women spend collecting water. There is an and women in India do not have ac- urgent need for centralized, community level cess to menstrual hygiene products and and household water treatment solutions as many skip school for lack of access to 800 million Indians do not currently treat their toilets. When girls are not in school there water in spite of contamination. Point-of-use is a greater risk they will be married and disinfection can reduce diarrhea episodes by 45 begin childbearing so improving access percent. to sanitary products and toilets is an im- Forum Sponsors portant strategy for both girl’s education 2. Toilets: The majority of children under 5 in and child survival. India have no access to a toilet and 44 percent of mothers dispose of their children’s feces in the open. Forty percent of schools in India also lack toilets resulting in an estimated 100 million school days lost. Girls and women pay a par-
Poor water, sanitation and Poor hygiene practices Half of all Indians do not hygiene contribute to 90% contribute to maternal have access to a toilet; of child diarrhea deaths infection and death more than 600 million defecate in the open
Health CSR in India Survey 33 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #6 Corporate Support for Water, Sanitation and Hygiene
How Can a Corporation ties in Bhopal, Madhya Pradesh how Help? to disinfect water using Unilever’s Pureit sachets and purifiers. The Face- book users can then donate directly • Infrastructure, Product Devel- opment & Service Delivery: to these communities and monitor Provide funding and/or tech- their water progress. Other partners nical assistance to develop include Population Services Interna- quality, affordable household tional. and community water systems, ”WASH for INDIA” water purifiers, household and a collaboration by Indian social entre- community toilets and waste preneurs, WASH for India is launch- disposal systems, menstrual hy- ing a set of high impact projects that giene products and train people 2 million is being offered to support span infrastructure, service delivery, to deliver these services. Indian investigators to drive research, development and production of the behavior change and advocacy. across • Advocacy, Awareness, Educa- ‘next generation toilet”. The goal is rural and urban India and address four tion and Behavior Change: Sup- to produce toilets that capture and themes: toilets, hand washing with port WASH campaigns targeted process human waste without piped soap, menstrual hygiene and clean to high-risk communities and water, sewer or electrical connec- drinking water. specific campaigns to empower tions and transform waste into useful “ARGHYAM” girls and women as WASH ac- resources, such as energy and water, In 2005, Rohini Nilekani founded Ar- tivists. at an affordable price. ghyam Foundation to provide grants Innovation: Support new plat- • to local groundwater and sanitation forms for action (e.g. networks “TATA SWACH” projects across 22 states and to sup- of school-based WASH volun- Created by TATA Chemicals, TATA port the India Water Portal - an open teers) and models (e.g. school Consultancy Services and several and inclusive web-based platform that toilet franchises). other TATA companies, this low cost, user-friendly water purifier uses connects water sector practitioners Examples of Corporate patented TSRF and silver nanotech- with the public. nology to purify water at the rate of “KHARAH VISTAROTTHAN YOJANA” Support three to four liters every hour without Since 2002 the Ratan Tata Trust and the need for boiling, electricity or run- Corporations who are seeking impact GE Foundation have been turning ning water. across all of the health-related Mil- the salty coastal water of Gujarat into lennium Development Goals should “JAYAASHREE INDUSTRIES” drinkable water by investing in reverse consider investments in WASH. There Invented by entrepreneur Arunacha- osmosis plants that will benefit 5,000 are a growing number of corporate lam Muruganandam, the Sanitary Nap- households. investments in water, but more invest- kin Manufacturing Machine produces ments in toilets and hygiene practices sanitary pads at a fraction of the cost Next Steps are desperately needed: of existing products. Two hundred and If your company is interested in sup- twenty-five machines have been sold “REINVENT THE TOILET” porting an existing program, estab- across 14 states in India, several to In October 2013, the Bill and Melinda lishing a new initiative or forming a women-run self-help groups. Gates Foundation and the Indian new partnership with other stakehold- Department of Biotechnology and “WATERWORKS™” ers to improve WASH, please contact the Biotechnology Industry Research Launched in 2013, Facebook users Shuma Panse at spanse@gbchealtgh. Assistance Council (BIRAC) called around the world are connected with org or Rahul Bhargava at rbhargava@ for proposals as part of Grand Chal- “waterworkers” who teach communi- mdghealthenvoy.org. lenges India to reinvent the toilet. US$
Poor water, sanitation and Poor hygiene practices Half of all Indians do not hygiene contribute to 90% contribute to maternal have access to a toilet; of child diarrhea deaths infection and death more than 600 million defecate in the open
34 Health CSR in India Survey Reaching the Health Millennium Development Goals: The Critical Role of India’s Business Sector
Investment Case #7 Corporate Support for Frontline Health Workers
Lack of access to quality, affordable healthcare Forum Partners close to home is one of the major reasons 1.4 million children under five die of preventable causes and 56,000 pregnant women die of pregnancy related causes in India each year. Corporations can contribute significantly to re- ducing mortality by increasing access to front- line health workers. In so doing, corporations will not only save lives but will also gain deep knowledge and insights about these popula- tions and learn how to innovate with products, market-based approaches and new types of partnerships. programs, increase training on newborn Evidence suggests that a fully trained and danger signs, and provide more tools equipped frontline health worker can reduce for continuous learning and refresher child mortality by more than 25 percent. training.
The Government of India supports a large net- 2. Supply Chain: Strengthen supply work of frontline workers based in villages and chains so that frontline health workers urban slums to provide healthcare to women have a continuous stock of the right sup- and children. They help to bridge the criti- plies in their drug kits. cal gap between vulnerable populations and the lowest level health facilities by support- 3. Supervision and Payment: Increase ing 850,000 Accredited Social Health Activ- supervision of all frontline health work- ists (ASHAs), 2,000,000 Anganwadi Workers ers through Information and Commu- (AWWs) and 45,000 Auxiliary Nurse Midwives nication Technology (ICT) tools and (ANMs). In addition, the private sector plays performance management and ensure a critical role with Rural Medical Practitioners timely payment. (RMPs), Traditional Birth Attendants (TBAs), 4. Regulation and Certification: Expand doctors and pharmacists treating large popula- quality assurance of private sector front- tions of women and children. line health workers through certification While AWWs focus on nutrition, the ASHAs’ and incentive programs. main tasks are to encourage pregnant women to seek antenatal care and deliver their babies How Can a Corporation Help? Forum Sponsors in hospitals, to provide special care to babies born with low birth weight and to prevent and • Infrastructure, Product Develop- treat childhood diarrhea and pneumonia. While ment & Service Delivery: Build the Government of India’s rapid development of frontline delivery workforces to the ASHA program is a significant achievement, distribute health and related prod- challenges and gaps remain including: ucts and services to vulnerable communities and provide more 1. Training: Increase the number of frontline cost-effective tools for frontline health worker training institutions and outreach health workers (e.g. digital training
Frontline health workers 50% of women in India Frontline health workers can reduce child mortality deliver their babies can improve water, by more than 25% without a skilled sanitation and hygiene attendant practices
Health CSR in India Survey 35 Reaching the Health Millennium Development Goals The Critical Role of India’s Business Sector
Investment Case #7 Corporate Support for Frontline Health Workers
curricula, supervision and pay- gram focuses on the leading causes ment tools, diagnostic tools for of death and offers 80 pharmaceuti- pneumonia etc). cal, generic and over-the-counter • Advocacy, Awareness, Educa- products as well as vaccines. Arogya tion and Behavior Change: Parivar began returning a profit within Fund campaigns that increase 30 months and since 2007 sales have support for frontline health increased 25-fold. workers. “SMS FOR LIFE” • Innovation: Provide funding Using everyday technology to elimi- and/or technical assistance nate stockouts and improve access to experiment with innovative to essential medicines in sub-Saharan approaches (e.g. private sector Africa, SMS for Life helps health work- supply chain expertise for drug ers assess the stock levels of malaria kits and other improvements, medicines. The program sends weekly private sector supervisors and “MOBILE ACADEMY & MOBILE KUNJI” text messages to district health au- systems for government work- A private-private partnership that thorities who then respond by distrib- ers). uses mobile phones, Mobile Academy uting medicines to the health facilities and Mobile Kunji provide face-to-face that are running low. The program Examples of Corporate training and mass media to 200,000 dramatically reduced stockouts in the Support frontline health workers to reduce ma- pilot districts and eliminated them ternal and child mortality in the Indian in one. Corporate partners include Corporations are already investing State of Bihar. Health workers are of- IBM, Vodafone, Vodacom, Google and in frontline health workers employ- fered a training course on ten life-sav- Novartis. Other partners include Roll ing a variety of different models. The ing health behaviors on their phones Back Malaria Partnership, Medicines following are several of the leading, (Mobile Academy) and an on-demand for Malaria Venture, Swiss Agency for best practice examples of corporate advice service (Mobile Kunji). Televi- Development and Cooperation and engagement in this critical area: sion advertisements, radio programs, the Tanzanian Government. street theatre performances and “Maternal and Newborn Survival “listening clubs” reinforce the health Next Steps Intiative (MANSI)” messages. Corporate partners include A public-private partnership, MANSI the leading telecommunications pro- If your company is interested in that trains frontline health workers viders - Airtel, Vodafone, Idea, Reli- supporting an existing program, in – Sahiyas - to reduce maternal and ance, Tata and BSNL. Other partners establishing a new initiative or form- newborn mortality in 174 villages in include BBC Media Action and the Bill ing a new partnership with other the Indian State of Jharkhand. Based and Melinda Gates Foundation. stakeholders to increase the impact of on the home-based newborn care frontline health workers on preventing model pioneered by Drs Abhay and “AROGYA PARIVAR” maternal and child deaths, please con- Rani Bang, MANSI trains local women This corporate-led, for-profit social tact Rahul Bhargava at rbhargava@ to help new mothers deliver healthy initiative employs local women as mdghealthenvoy.org or Pooja Bhatt at newborns. Corporate partners include ‘health educators’ and a network of [email protected]. Tata Steel Rural Development Society. sales supervisors to provide essential Other partners include the American medicines and health services to 42 India Foundation, SEARCH and the million people in 33,000 rural villages local government. across ten states in India. The pro-
Frontline health workers 50% of women in India Frontline health workers can reduce child mortality deliver their babies can improve water, by more than 25% without a skilled attendant sanitation and hygiene practices
36 Health CSR in India Survey
Appendix C.1: Government of India’s High Priority Districts (HPDs)13
Identified by the Department of Health and Family Welfare, these 184 districts are the focus of the Government of India’s Reproductive, Maternal Newborn, Child Health plus Adolescents (RMNCH+A) Strategy.
STATE DISTRICT STATE DISTRICT
ANDHRA PRADESH ADILABAD HARYANA HISAR CUDDAPAH JIND KURNOOL MEWAT MAHBUBNAGAR PALWAL VISAKHAPATNAM PANIPAT VIZIANAGARAM HIMACHAL PRADESH CHAMBA ARUNACHAL PRADESH EAST KAMENG KINNAUR KURUNG KUMEY LAHUL SPITI LOWER DIBANG VALLEY MANDI LOWER SUBANSIRI JAMMU KASHMIR DODA TAWANG KISHTWAR UPPER SIANG LEH LADAKH UPPER SUBANSIRI PUNCH
ASSAM DHUBRI RAJAURI GOLAGHAT RAMBAN HAILAKANDI JHARKHAND DUMKA KARIMGANJ GODDA KOKRAJHAR GUMLA NAGAON LATEHAR BIHAR ARARIA LOHARDAGA GAYA PAKAUR JAMUI PALAMU KATIHAR PASCHIMI SINGHBHUM KISHANGANJ SAHIBGANJ PURBA CHAMPARAN SARAIKELA-KHARSAWAN PURNIA SIMDEGA SAHARSA KARNATAKA BAGALKOT SHEOHAR BELLARY SITAMARHI BIJAPUR CHHATTISGARH BIJAPUR GADAG BILASPUR GULBARGA DANTEWADA KOPPAL JASHPUR RAICHUR SURGUJA YADGIR DELHI NORTH EAST KERALA KASARAGOD NORTH WEST MALAPPURAM GUJARAT BANAS KANTHA PALAKKAD DOHAD MADHYA PRADESH DAMOH KACHCHH RAISEN NARMADA SAGAR PANCH MAHALS SATNA SABAR KANTHA SIDHI THE DANGS SINGRAULI VALSAD TIKAMGARH
38 Health CSR in India Survey STATE DISTRICT STATE DISTRICT
MADHYA PRADESH ALIRAJPUR RAJASTHAN BANSWARA ANUPPUR BARMER BARWANI BUNDI CHHATARPUR DHAULPUR DINDORI DUNGARPUR JHABUA JAISALMER MANDLA JALOR PANNA KARAULI SHAHDOL RAJSAMAND UMARIA UDAIPUR MAHARASHTRA AURANGABAD SIKKIM WEST BID TAMIL NADU KRISHNAGIRI DHULE MADURAI GADCHIROLI THIRUNELVELI HINGOLI TIRUVANNAMALAI JALGAON TRICHY JALNA VELLORE NANDED VIRUDHUNAGAR NANDURBAR TRIPURA DHALAI MANIPUR CHANDEL UTTAR PRADESH BAHRAICH CHURACHANDPUR BALRAMPUR SENAPATI BARABANKI TAMENGLONG BAREILLY UKHRUL BUDAUN MEGHALAYA JAINTIA HILLS ETAH SOUTH GARO HILLS FAIZABAD WEST GARO HILLS GONDA WEST KHASI HILLS HARDOI MIZORAM LAWNGTLAI KANSHIRAM NAGAR LUNGLEI KAUSHAMBI MAMIT KHERI SAIHA PILIBHIT NAGALAND KOHIMA SANT KABIR NAGAR MOKOKCHUNG SHAHJAHANPUR MON SHRAWASTI PHEREN SIDDHARTHA NAGAR ODISHA BAUDH SITAPUR GAJAPATI SONBHADRA KANDHAMAL UTTARAKHAND HARIDWAR KORAPUT PAURI GARHWAL MALKANGIRI TEHRI GARHWAL NABARANGAPUR WEST BENGAL KOCH BIHAR NUAPADA MALDAH RAYAGADA MURSHIDABAD PUDUCHHERRY YANAM SOUTH 24 PARGANAS PUNJAB MUKTSAR UTTAR DINAJPUR SANGRUR BARNALA GURDASPUR MANSA
Health CSR in India Survey 39 Appendix C.2: Geographic Concentration of Newborn Mortality: 55 Districts with Highest Number of Infant Deaths14
RAJASTHAN
NEWBORN DISTRICT DEATHS JAIPUR 5,975 JODHPUR 4,844 UDAIPUR 3,085 ALWAR 2,850 NAGPUR 2,791
BIHAR
NEWBORN NEWBORN DISTRICT DISTRICT DEATHS DEATHS PURAB 4,192 PATNA 2,980 CHAMPARAN GAYA 2,910 MADHUBANI 4,022 SARAN 2,906 PURNIA 3,849 KATIHAR 2,747 SAMASTIPUR 3,405 BHAGALPUR 2,589 DARBHANGA 3,248 SUPAUL 2,443 SITAMARHI 3,242 ROHTAS 2,424 PASCHIM 2,996 CHAMPARAN
UTTAR PRADESH
NEWBORN NEWBORN DISTRICT DISTRICT DEATHS DEATHS ALLHABAD 9,337 BALRAMPUR 3,592 SITAPUR 6,272 FAIZABAD 3,567 MORADABAD 6,135 GORAKHPUR 3,485 BAHREICH 5,923 GHAZIPUR 3,443 BUDAUN 5,469 KUSHINAGAR 3,435 HARDOL 5,358 LUCKNOW 3,336 GONDA 5,267 PRATAPGARH 3,266 KHERI 5,044 RAE BARELI 3,243 ALIGARH 4,969 JAUNPUR 3,085 GHAZIABAD 4,764 SULTANPUR 3,027 BAREILLY 4,522 AZAMGARH 3,016 MUZZAFFARNAGAR 4,412 KAUSHAMBI 2,901 VARANASI 4,081 MEERUT 2,817 BULANDSHAHAR 3,937 BASTI 2,835 SIDDHARTHNAGAR 3,883 KANPUR NAGAR 2,781 SHAHAJAHANPUR 3,817 BALLIA 2,751 UNNAO 3,672 ETAH 2,739 BARABANKI 3,658 FATEHPUR 2,703
40 Health CSR in India Survey Appendix D: Health CSR Activity Mapping, by Geography and Issue15 To promote geographic- and issue-based knowledge-sharing between companies and partners, respondents were asked to share which state/city/district and health areas their CSR program is currently focused on. While company names are not listed here, interested readers should contact GBCHealth for more information and facilitated connections with survey participants.
High Priority Districts (HPDs) are denoted by a
State/City Districts Health Issue Area of Focus Adilabad Nizamabad
Araku Secunderabad
Hyderabad Vijayawada Sexual/Reproductive Health, Maternal Health, Newborn Health, Child Andhra Pradesh Health, Adolescent Health, HIV, TB, Malnutrition, Water, Sanitation, Kamalapuram Vishakapatnam NCDs
Karimnagar Warangal
Medak Arunachal Maternal Health, Newborn Health, Child Health, Adolescent Health, Pradesh Malnutrition, Hygiene Assam State-wide Maternal Health, Newborn Health, Child Health, NCDs
Bangalore Bangalore Child Health, Malnutrition, Water, Hygiene, NCDs
Bihar Child Health, Pneumonia, Diarrhea, Hygiene Maternal Health, Newborn Health, Child health, Adolescent Health, HIV, Chhattisgarh Raighar NCDs Chennai Chennai Child Health, Diarrhea, TB, Water
Delhi Noida Sexual/Reproductive Health, Maternal Health, Newborn Health, Child Health, Adolescent Health, HIV, Malaria, TB, Malnutrition, Water, Delhi & NCR Sanitation, Hygiene, NCDs, Neglected Tropical Diseases, Mental Health, Lucknow Sawda Ghevra Elderly
Goa Panaji TB
Ahmedabad Surat Gujarat Child Health, Malnutrition, Water, Sanitation, Hygiene, NCDs, Elderly Panch Mahals Vadodara
Gurgaon Palwal Sexual/Reproductive health, Maternal Health, Newborn Health, Child Haryana Jhajjar Sonepat Health, Adolescent Health, HIV, Malaria, TB, Malnutrition, Water, Sanitation, Hygiene, NCDs, Mental Health, Elderly Mewat
East Singhbhum Sareikela Khaswan
Jamadoba West Bokaro Sexual/Reproductive health, Maternal Health, Newborn Health, Child Jharkhand Health, Adolescent Health, HIV, TB, Malnutrition, Water, Sanitation, Noamundi West Singhbhum Hygiene, NCDs, Mental Health Ranchi
Bhagalkot Kamagere Karnataka Hubli Mysore Maternal Health, Newborn Health, Child Health, Malaria, TB, Malnutrtion, (excluding Water, Sanitation, NCDs Bangalore) Kadivala Shimoga Kambipura
Maternal Health, Newborn Health, Child Health, Adolescent Health, TB, Kolkata Kolkata Malnutrition, Water, Sanitation, Hygiene, NCDs, Mental Health, Elderly
Chhindwara Thesgora Maternal Health, Newborn Health, Child Health, Pneumonia, Diarrhea, Madhya Pradesh Sheopur Malnutrition, Water, Sanitation, Hygiene
Health CSR in India Survey 41 Maharashtra Chandrapur Pune Maternal Health, Newborn Health, Child Health, Adolescent Health, (excluding Pneumonia, Diarrhea, HIV, Malnutrition, Water, Sanitation, Hygiene, Mumbai) Nagpur NCDs, Mental Health, Elderly Central Mumbai South Mumbai Maternal Health, Newborn Health, Child Health, Adolescent Health, Mumbai Mumbai Thane Pneumonia, Diarrhea, HIV, TB, Malnutrition, Water, Sanitation, Hygiene, NCDs, Mental Health, Elderly Navi Mumbai
Angul Kalahandi
Bamnipal Keonjhar
Cuttack Korapat Sexual/Reproductive Health, Maternal Health, Newborn Health, Child Odisha (Orissa) Gopalpur Nurapada Health, Adolescent Health, Pneumonia, Diarrhea, HIV, Malaria, TB, Malnutrition, Water, Sanitation, Hygiene, NCDs Jajpur Raygada
Jharsuguda Sukinda
Joda Sundergarh
Punjab Maternal Health, Newborn Health, Child Health, Water
Alear Dudu
Banswara Jaipur Maternal Health, Newborn Health, Child Health, Adolescent Health, Rajasthan HIV, Malaria, TB, Malnutrition, Water, Sanitation, Hygiene, NCDs, Mental Bundi Uadaipur Jhunjhunu Health Chittorgharh Johdpur Tamil Nadu (excluding Krishnagiri Orthanadu Diarrhea, Water Chennai)
Tripura State-wide Newborn Health, Child Health
Sexual/Reproductive Health, Maternal Health, Newborn Health, Child Uttar Pradesh Over 25 high risk districts targeted Health, Adolescent Health, HIV, Malaria, TB, Malnutrition, Water, Sanitation, Hygiene, NCDs, Mental Health
Sexual/Reproductive Health, Maternal Health, Newborn Health, Child Uttarakhand State-wide Health, Adolescent Health, Water, Sanitation, Elderly
Birbhum Murshidabad
West Bengal Burdwan Purulia Maternal Health, Newborn Health, Child Health, Adolescent Health, TB, (excluding Malnutrition, Water, Sanitation, Hygiene, NCDs, Mental Health Kolkata) Howrah Sunderbans Jalpaiguri
42 Health CSR in India Survey Appendix E: Coordinating Organizations and Industry Associations
The following is a list of organizations that can assist your company with CSR strategy and/or partnership development, who were involved in the development of this report. This is not intended to be an exhaustive list but, rather, a starting off point for companies looking for like-minded partner with a specific expertise in public health.
GBCHealth is a coalition of companies committed to investing their resources to make a healthier world for their employees, for the communities in which they work and for the world at large. Through convenings, partnership creation, alliance-building and advocacy activities, GBCHealth leverages the power and resources of the private sector to meet today’s most pressing global health challenges.
MDG Health Alliance is a special initiative of the Office of the United Nations Special Envoy for Financing the Health MDGs and for Malaria. The Alliance works in partnership with governments, non-government organizations, academic institutions and corporations to develop innovative and accelerative efforts to drive progress towards achieving the MDGs.
Partnership for Maternal and Child Health (PMNCH) is a platform for knowledge, advocacy and accountability to improve women and children’s health. In essence, the PMNCH enables partners to share strategies, align objectives and resources, and agree on interventions to achieve more together than they would have been able to achieve individually. The Partnership plays a central role in facilitating joint action on many fronts, mainly progress towards the United Nations Millennium Development Goals (MDGs) 4 and 5, to reduce child mortality and improve maternal health, as tracked by the Countdown to 2015 initiative, and through support for the Global Strategy for Women’s and Children’s Health and Every Woman Every Child.
UNICEF India is the largest UN organization in the country, and is fully committed to working with the Government of India to ensure that each child born in this vast and complex country gets the best start in life, thrives and develops to his or her full potential.
USAID India builds the capacity of national- and state-level institutions and demonstrates high-impact best practices in the areas of family planning/ reproductive health; maternal, newborn, and child health; and global disease threats including HIV/AIDS, polio, and tuberculosis. In line with this, USAID supports the Government of India’s flagship health programs, including the National Rural Health Mission, the National AIDS Control Program, the Revised National TB Control Program, and the Polio Eradication Program and Surveillance System.
Health CSR in India Survey 43
WORKS CITED
1. “2013 Cone Communications/ECHO Global CSR Study” 9. Lahariya, C. and Paul, V.K. “Burden, differentials, and causes Cone Communications/ECHO. 2013. 9 July 2014. of child deaths in India.” Indian Journal of Pediatrics. 2010
6. Dwivedi, Hemant. “India Steps Up to the MDG 5 14. Prof Usha Ram PhD,Prof Prabhat Jha DPhil,Prof Faujdar Ram Challenge.”United Nations Population Fund. 10 Sept. 2010. PhD,Kaushalendra Kumar MPS,Prof Shally Awasthi MD,Anita Web. 8 Dec. 2014.
Photo Credits: Cover – Woman with her child. India. Photo: © John Isaac / Page 18 - People bathing in river. India. Photo: © Curt World Bank Carnemark / World Bank Page 20 - Bangalore Woman on Cellphone. India. Photo: © vgrigas 2011 Page iii - Children in Hyderabad, India. Photo: © John Isaac / UN Photo Page 20 - Women at water pump. India. Photo: © Curt Carnemark/World Bank Page iv - Portrait of man and boy. India. © Curt Carnemark/ World Bank Page 21 - Medical check-up of infant. India. Photo: © Ray Witlin / World Bank Page 7 - Portrait woman and child with traditional jewels. India © Photo: Curt Carnemark / World Bank Page 21 - Mother & newborn in hospital. India. Photo: © Ray Witlin / World Bank Page 8 - Mission de vaccination. India. Photo: © Pyal Adhikary / UNDP Page 22 - Infant patients get check-up. India. Photo: © Curt Carnemark / World Bank Page 14 - Saving the youngest children. Mother and child. India. © Bill and Melinda Gates Foundation Page 43 - Migrant workers. India. Photo: © Curt Carnemark / World BankCarnemark
Health CSR in India Survey 45
ACKNOWLEDGEMENTS
We would like to acknowledge the efforts of the following individuals and partner organizations who generously contributed time, expertise and networks to this project:
Report Research, Analysis and Writing: Advisory Committee Members: Margaret Arbogast (GBCHealth) Sheena Chabra (USAID) Leith Greenslade (MDG Health Alliance) Mugdha Gangopadhyay (American India Foundation) Casey Levine-Beard (The Acuity Project) Ruchira Gujral (UNICEF) Zhelin Luo (GBCHealth) Vaibhav Gupta (PMNCH) Shuma Panse (GBCHealth) Roopa Unnikrishnan (Center10 Consulting)
Survey Design and Implementation: GLG Report Design: Nisa Patel (GBCHealth)
ADVISORY COMMITTEE MEMBERS
SELECT CORPORATE PARTNERS
Health CSR in India Survey 47 1 Rockefeller Plaza 28th Floor, Suite 2801 New York, NY 10020 Phone: (212) 218-4169 www.gbchealth.org