Anemia-management-prog

Anemia management as CSR: A stepping-stone to healthy communities

Healthcare is a popular intervention for CSR, with a diverse set of interventions and approaches available. Companies with a key focus on community development see healthcare as crucial to community well-being and undertake a range of interventions from health camps to strengthening healthcare infrastructure. The health of women is also a key area of support as their well-being has a bearing on the entire community and continues to remain neglected.

Within the wide spectrum of programs that companies fund, anemia management is a critical intervention. Anemia affects approximately 2 billion people worldwide. In India, over 56% of women are affected by the condition1. Failure to reduce anemia causes fatigue, weakness and pregnancy complications in women. Anemia also indirectly affects learning in children, lowers productivity and contributes to 2.5% of global DALYs (Disability Affected Life Years) lost – impacting the overall health of communities.

Iron deficiency – the leading cause of anemia – is the most common and widespread nutritional disorder in the world. The World Health Organization (WHO) has recently set a target to reduce anemia by 50% among women of reproductive age.2 Given the high prevalence of anemia in our country and the deep rooted and varied reasons behind this, achieving this goal requires a concerted effort from the government, NGOs and key stakeholders which include companies.

The Companies Act 2013 includes ‘eradicating malnutrition and promoting healthcare’ as one of the activities for the allocation of CSR funds, providing an opportunity to invest in a critical area that can impact the health of communities. This article presents our learnings and experiences from a recent anemia management program that we implemented in an effort to guide companies interested in conducting similar programs.

Our approach to managing anemia in a tribal community

Samhita recently concluded managing an anemia management program funded by a multinational diagnostics company as a part of its CSR. The program was a short-term project, implemented by an NGO partner over 4 months in 17 tribal hamlets, in the district of Palghar. It tested hemoglobin (Hb) levels in 292 women and provided medical and nutritional support to the 100 with the lowest levels. The program included awareness generation activities like street plays, wall paintings and recipe competitions to spread awareness about anemia and preventative measures.

Anemia mgmt

Community-based health volunteers played an integral part in the program, by providing medicines and nutritional supplements and monitoring intake continuously. Endline testing revealed increased Hb levels of 2.2 and 2.7 percentage points in the village clusters where women were targeted.

Key approaches to adopt for effective implementation

Based on our experiences and insights gained from the project, we have listed some key approaches to adopt during implementation to ensure that programs conducted are impactful and adequately address the needs of beneficiaries as well as the CSR requirements of companies.

1. Gather socio-demographic details of the target community

Before conceptualizing a location-specific anemia management program, a community-level needs assessment is highly recommended. This will bring out underlying eco-socio-cultural issues, which may have certain implications on the prevalence of anemia. A holistic understanding of the beneficiaries’ background will also help create contextualized solutions.

For example, while conducting the community needs assessment (CNA) we found that the tribal women did not have two wholesome meals a day. In tribal communities, this was further compounded by their low social status and greater economic dependence on male counterparts. Samhita worked with the NGO to define an approach based on the CNA and structured behavior change sessions that prioritized the health of women by positioning women at the center of the household and pointing out that caring for their health will lead to positive impact on the overall well-being of the family.

2. Define your approach – Targeted vs. comprehensive

There are varied methods of targeting anemia based on location, prevalence and causes of anemia, company’s priorities, funds, time and willingness of a community to cooperate. From a CSR perspective, it is important to define your approach based on the parameters of your program. Two main approaches can be considered here.

 

  • Targeted approach: A short-term intervention that targets a specific group of beneficiaries. For example, companies willing to target adolescent girls and women can use this approach. Support to beneficiaries can be provided through nutritional supplements and medicines. The program described above is an example of a targeted approach.
  • Comprehensive approach: It is a long-term approach which has a wider focus and a longer gestation period, requiring comparatively larger budgets. Here, overall health is usually a primary objective, a part of which is reducing the instances and severity of anemia.

3. Leverage existing community networks

Community workers often have personal relationships with beneficiaries and influence behavior on a regular basis – making their involvement a key factor for effective impact. Leveraging local networks are especially important for tribal communities, which are often close knit and difficult for outsiders to influence. For this program, Samhita co-ordinated with the implementation partners to involve the ASHA workers and community health volunteers (CHVs) based in the area as they had good relationships with the women and a better understanding of the health scenario in the region.

In a similar scenario, the Deepak Foundation leveraged their network of VHSCs (Village Health and Sanitation Committee), anganwadi workers and grassroots health functionaries to successfully target anemic women in remote rural and tribal villages as part of their broader initiative on safe motherhood and child survival.

 4. Conduct awareness sessions – a crucial part of an impactful program

For programs that require behaviour change, the importance of awareness sessions cannot be undermined. The Tamil Nadu State Health Society in association with DHAN Foundation used behaviour change communication as the main strategy in their anemia control program which resulted in the prevalence of anemia decreasing by 31 percentage points.

DHAN Foundation also recommends contextualized awareness activities that are aligned with the culture, attitudes, perceptions and beliefs of the target population.

In the recently concluded program, awareness about anemia and preventative measures were emphasized through interactions between the CHVs and beneficiaries, doctors/nutritionists and beneficiaries and other awareness programs. Sessions were customized to match the tribal socio-cultural tone. The impact of the awareness programs was realized in the form of higher adherence to the treatment provided and higher levels of hemoglobin at the end of the program.

5. Assess programs continuously with regular follow ups

In any healthcare-oriented CSR program, continuous assessment is critical. It allows program managers to undertake midcourse corrections in the overall program strategy if required. Continuous assessment is also a motivating factor for beneficiaries. During our program, we observed that women were motivated to focus on their food intake and adhere to the nutritional supplements when their Hb levels rose considerably (at least by 1.5 to 2 points) during midline testing.

Having said this, caution should be exercised while determining the intervals and frequency of the assessment with the help of doctors. Regular follow up with beneficiaries is another prerequisite for ensuring impact, which was achieved by utilizing Samhita’s online monitoring tool that gave companies access to information on the progress of the program in real-time.

Given the wide prevalence of anemia in India and the global attention it receives, it is critical that the condition is targeted through multiple approaches. Companies can target anemia through their CSR programs which can be tailored according to the company’s requirements. Interventions are easily scalable, modifiable, can be conducted over short or long-term periods and effectively monitored for impact. Anemia management can also form part of a company’s wider initiative within healthcare and presents a unique opportunity for companies investing CSR funds in the sector. Reducing the prevalence of anemia can result in intergenerational benefits for individual health and well-being, increase economic potential and develop the overall health of communities.

 – Tejashree Thatte,

Assistant Manager, Samhita Social Ventures

1 http://www.who.int/nutrition/topics/ida/en/; National Family Health Survey (NFHS-3), 2005-2006
2 http://www.who.int/nutrition/topics/globaltargets_anaemia_policybrief.pdf