Corporate Social Responsibility at Anupam Rasayan India Ltd.
The Company as a responsible corporate citizen has been undertaking CSR initiatives in letter and spirit. While Corporate Social Responsibility was already imbibed in the Company’s value system, with the advent of mandatory provisions of the Companies Act 2013, we have formalized policy structure setting out the areas and forming a guideline for the CSR initiatives, implementation and analysis.
Project 1. ‘Sickle Cell comprehensive care model project along with Reduction in Maternal, New-born and Child Mortality rate and Malnutrition Program’.
The Company had undertaken this project in the Tribal areas in the Gujarat state with SEWA Rural, Jhagadia, the implementing agency (“IA”). The program comprised of two projects, Project 1 was for reduction in Neonatal Mortality and Infant Mortality rate and malnutrition in children and Project 2 was the sickle cell disease comprehensive care model in the tribal communities of Gujarat. A brief about the Program is discussed below-
Project –To reduce Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR) and child malnutrition in six tribal blocks of Gujarat.
The objective of the program:
- to reduce Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR) and child malnutrition in six tribal blocks of Gujarat;
- provision of community based comprehensive care to approximately 30,000 pregnant women (maternal), new-born babies and children at community level;
- developing mobile phone application which as a job-aid to health workers at village and clinic level;
- training 250 health workers (population: 250,000 across 250 villages) for using this mobile phone application; and
- support to health workers for 3 years from April 2014.
About the project: The ImTeCHO a newly-built mobile-phone application intervention was evaluated in three ways: (1) Mobile-phone as a job-aid to ASHAs to increase coverage of maternal and new-born care services (2) Mobile-phone as a job-aid to ASHAs and Auxiliary Nurse Midwives (ANMs) to increase coverage of care among maternal and new-born cases with complications by facilitating referral, if indicated and home-based-care, and (3) Web-interface as job-aid for medical-officers to improve supervision and support to ASHA program. The intervention made it possible to improve the performance of ASHAs through better supervision, motivation and support.
Along with this, a state of art, comprehensive sickle cell program discussed in project 2 below, was established to reduce complications and deaths among individuals suffering from sickle cell disease. Both the projects had interdependence and were thus taken together to reach out a larger target population for greater benefit.
Impact Analysis: The project benefitted overall 25972 pregnant women, 20630 new-born babies and 17924 children under the age of 2 years from Bharuch & Narmada districts were benefitted in the project duration since April, 2013. Due to mobile phone technology aid in this program, 200 ASHAs and 70 PHC staff have been benefitted making their jobs easier and more effective. Total of more than 700 ASHAs received training during the project. The program has enhanced the capacity of village level health workers, making it possible for rural population to become self-reliant for taking care of most of their maternal and child health program, thus building sustainability of the program. Total of 4838 high risk child morbidities and 1014 maternal morbidities were diagnosed by the ASHAs and has been followed up by the helpline team at the head quarter. The help line from the IA were able to handle average 1429 high risk cases per month in the project period.
Indirect beneficiaries: The programs made an impact on the families of the beneficiaries and the villagers of approximately 200 villages of the implementation region.
Project – Sickle Cell Disease comprehensive care program
About the project: Sickle Cell Disease (“SCD”) is the most prevalent worldwide genetic blood cell disorder, characterized by sickling of red blood cells leading to complications due to vaso-occlusion and anemia. India, Nigeria and the Democratic Republic of Congo, cumulatively claim 50% of the world’s sickle cell disease burden and 15% of the world’s neonates with SCD are born in India every year. The prevalence of sickle cell trait is highest among tribal populations in India, varying from 5-34%, with an estimated 18 million Indians with sickle cell trait and 1.4 million with sickle cell disease. Several studies in India have found severe disease manifestations in 20-50% of Indian SCD populations, the majority presenting with severe anemia, acute febrile illnesses, and frequent vaso-occlusive crises. The Objective of the program was to develop comprehensive sickle cell care for approximately 300 patients every year at SEWA Rural.
The target population demonstrates that despite the Indian phenotype of SCD generally being milder than African phenotype, there exists a spectrum of SCD phenotypes with some patients experiencing severe complications, commonly including pain crisis, acute splenic sequestrations and febrile illnesses. Vaccinations provide 79% of the affected population with long lasting immunity, which is a marked improvement from the baseline vaccination rate of 0.5%.
The work under the program demonstrated that implementing an evidence-based continuity of care model for SCD in rural India can significantly improve coverage of evidence-based interventions for treating SCD. The comprehensive care model includes screening, standardized outpatient and inpatient protocols, population management, and health education components. This program can serve as model for program development in other resource-limited settings worldwide.
Impact Assessment: Total 1012 patients were enrolled and 70% patients followed up at the weekly sickle cell clinic. These patients were from 623 villages from 7 districts of Gujarat & Maharashtra. About 80% of the registered patients received required pneumococcal vaccination. Currently 93 children receive prophylaxis penicillin. Coverage of pneumococcal vaccination increased from 0.5% to 80%. 88% of the eligible patients are on life saving drug Hydroxyurea. Significant improvement in quality of life was observed in the patients and quite a few lives were saved during the project period. 1068 patients were hospitalized and received the standard care as per the international standards in the program period.
During baseline crisis rate for all patients was 249 crises/100-person year. During follow up, crisis rate decreased to 44 crisis/100 person years. There was significant decrease in hospitalization rate from 59 hospitalizations/100-person year at baseline to 51 hospitalizations/100-person year at follow up period. At baseline blood transfusion rate was 41 BT/100-person year and during follow up blood transfusion rate to 31.5 BT/year.
The average Hb level was 8.5 gm/dl at the baseline, while average at last follow up of each individual was 9.62gm/dl. Although after all our efforts, total 45 patients died since last 4 years.
The improving outcomes in the sickle cell disease patient is challenging, although above model suggest great acceptability and usability of the hospital based services among sickle cell disease patients.
The Sickle Cell program demonstrates that implementing an evidence-based continuity of care model for sickle cell disease in rural India can significantly improve coverage of evidence-based interventions for treating SCD. Several simple, cost-effective interventions have greatly improved outcomes in sickle cell disease, including early diagnosis by neonatal screening, educating patients and families about early recognition of complications, preventive care and regular follow-up and treatment with transfusion and hydroxyurea for severe cases.
Table1: Details of services provided
|Type and number of beneficiary (total Bharuch + Narmada districts)||Type and number of beneficiary under this grant (Sagbara+ Netrang + Jhagadia blocks)||Number of consultations per beneficiary from ASHA||Services provided|
|39231 pregnant women||20373||4 consultations||Counselling, physical examination, diagnosis and treatment for common illnesses, referral to hospitals for severe cases, follow up for complicated cases, guidance from head quarter to manage complicated cases.|
|32565 new-born babies||17501||6 consultations|
|30155 children under the age of 2 years||15977||10 consultations|
ASHA showing mobile based videos to family during consultation at home