Ms Pearl Tiwari is the Director and CEO of Ambuja Cement Foundation. In this interview with TheCSRUniverse, she talks on various aspects of its rural health programmes, community interventions, collaboration mechanism with government bodies and much more. She also talks on various on-ground challenges that ACF faces while implementing its project and the way the foundation is tackling those challenges towards solving the social problems.
Q: ACF recently conducted a Cancer Awareness and Education programme with ABS, UK and ABSI. What were the objectives of this programme?
A: Cancer is a serious health issue largely neglected in rural communities, with breast cancer having the highest incidence worldwide, including India. When Ambuja Foundation conducted an assessment of the issue in our locations, we found a high prevalence of negligence in identification and treatment in our region as well. Thus, taking a strategic decision, ACF decided to introduce cancer interventions under its Non-Communicable Diseases (NCDs) umbrella.
Our aim is to provide capacity building to Frontline Health Workers - ASHA, ANMs and Sakhis - to identify high risk signs and symptoms, teach self-breast examination techniques (including practical training on lump identification on breast prosthesis), early identification of cancer cases, and recommendations and referrals for treatment.
Therefore we invited health professionals from the UK and India to provide education and training on best practices and techniques to regional level doctors practicing oncology, newly appointed community health officers and government health officials.
Q: How do you train Frontline Health workers, ASHA, ANMs and Sakhis on identifying high risk signs and symptoms around Non-Communicable Diseases (NCDs)?
A: ACF has created a strong cadre of Sakhis in Chandrapur who have been at the frontline in improving health indicators in Maternal Child Health and NCDs and played a major role during COVID-19. By training them on Cancer Awareness and first level screening, behavior change communication is initiated in an attempt to improve indicators on cancer in ACF’s rural communities.
ACF collaborates with technical experts and partner organisations to provide training to the frontline workers. To launch the cancer initiative, ACF invited health experts from the UK , ABSI India chapter and Tata Trust Cancer Program set up to provide training; for the Chronic Obstructive Pulmonary Disease (COPD) program in NCD ACF invited health professionals from Chest Research Foundation; for malnutrition ACF invited a nutritional expert from a government health institution to provide training.
We feel this is the best way to inject knowledge from experts who are experienced, understand on the ground situations and have a wealth of knowledge on the issue and belief in primary care through frontline workers’ training.
Q: You have collaborated with oncologists, doctors and other health professionals of ABS, ABSI, AIIMS and Tata Trusts for this particular initiative? What unique capabilities do they bring into the implementation of this programme?
A: The health professionals who were part of this initiative are representatives from very well renowned organizations like ABS, UK, AIIMS, India and NHS, UK. They come with a depth of experience and knowledge having worked in detail on cancer, and have contributed to improving the indicators globally.
Some of these professionals have also worked in regions like Africa and Nepal and understand the nuances of working with under developed or remote communities. It was a huge opportunity for the regional healthcare workers and Sakhis to gain knowledge from such well-experienced oncologists and health professionals.
Q: Ambuja Cement Foundation has been on the forefront of taking community initiative, especially in rural areas. What are the key challenges that you face while working in the rural set up?
A: Rural communities get used to the fact that there are external sources who will come and fulfill needs of the region. They lack participation and lose confidence in themselves when modern thinking is put forth. However, we at Ambuja Foundation believe that community participation is a major part of a sustainable solution. We also marry traditional wisdom with modern techniques which helps them build their confidence and feel inclusive.
On the other hand because our geographies are so remote, we aren’t able to retain development professionals. So retention of our program staff and coordinators pose a great challenge in ensuring a seamless operation of our program in our geographies.
Q: Please tell us about a few health related initiatives of ACF over the last 3-4 years which has resulted in bringing change at ground level?
A: Our healthcare interventions are built on three core principles – providing community based health care through our frontline workers, an emphasis on preventative healthcare and the promotion of good health practices.
Apart from our regular work on Non-Communicable Diseases, Maternal & Child Health and WASH, we had initiated setting up of Community Clinics in our core regions. This is a unique model created as a centre housed in the communities to tend to the health needs of the community. This model is a complete community participation model with the village development committee overseeing to the operations, the Sakhis tending to the needs of the patients and an ACF assigned doctor visiting the clinic on a weekly basis. This clinic offers medicines at a nominal rate, health services etc. and has largely worked in treatment of NCD, COPD, Asthma and has ensured continuum of care.
Ambuja Foundation also saw a rise in Mental Health problems during the pandemic and thus started the Aatmiyata initiative in collaboration with the Centre for Mental Health Law & Policy creating a cadre of mitras and champions to promote mental health. The community mitras were responsible for identifying at-risk cases, providing basic counselling support and referrals, and acting as a liaison for serious mental health issues. The project is currently reaching out to 100 villages. However, ACF also consciously considered reaching out to its own team during the pandemic to tackle any mental health issues. This was instilled to build their resilience to continue working on the ground.
In spite of India being an emerging economy, the health indicators are still not very impressive. And from all the health related issues, Malnutrition is a problem everywhere which affects wellbeing and livelihoods. So in coordination with the Integrated Child Development Services Department we started our malnutrition program, taking a holistic approach by building the capacity of ASHAs and Anganwadi workers in identifying high risk SAM and MAM children and referring them to the Nutritional Rehabilitation Centre. Community members were also encouraged to start their own kitchen gardens and ACF also set up a nutritional knowledge platform for young mothers to refer to. About 25,000 children have benefited from this initiative.
Q: Who are your partner organisations in implementing your key initiatives in Education, Health and Livelihood areas?
A: For the past 30 years, we built a rapport with so many organizations working hand in hand with partners using our expertise and learning on the ground to achieve lasting change. This has led us to create meaningful impacts and seen transformation on the ground of over 54 districts of 12 states. But for all that, it is first our technical partners who come onboard to initiate a new project. We collaborate, plan models, pilot it and then expand it with our major partners.
Just like how we did with the cancer intervention, we collaborated with ABS UK, ABSI and Tata Trusts to training health professionals, build a model and now we are ready to implement and expand our cancer intervention in other locations.
We then have our major partners who then partner with us in various programs like Hafele India for menstrual hygiene management; Apollo Tyres Foundation in support our healthcare centre for truckers; and the Narotam Sekhsaria Foundation in supporting us with the tobacco cessation initiative.
And some partners like HDFC Bank Parivartan take a holistic rural development approach covering water, agriculture, women empowerment, education, health and skill training.
Under Livelihoods, NABARD plays a major partnership role in supporting us with over 35 projects across locations in agro-based livelihoods, women empowerment, skilling and education.
Our partnerships have fueled the expansion of our footprint, and synergy that comes from working with like-minded organizations and co-creating projects has been pivotal to our success on the ground in transforming rural communities. However, the need of rural India is vast and so much more work needs to be done! There needs to be a shift in thinking when it comes to CSR and collaboration, with organisations coming together to unite on these pressing issues. More companies should come to the fore in helping the country tackle its greatest issues.
Q: You also collaborate with district officials and government authorities for effective community intervention. What are the key advantages of such collaborations? What are the challenges you face in developing such collaborations?
A: The government is the largest development funder and also develops policies and schemes in the areas of water, skills, agriculture and women. However, most of these schemes don’t reach the remote masses.
The community majorly relies on the government and its various schemes and subsidies for support, and ACF helps with convergence of these government schemes with villagers helping them navigate and access these benefits. ACF has the capacity to manage large scale projects, working with multiple stakeholders - delivering tangible, on-ground impacts.
Q: Government has also been running various public health programmes. How does the ACF differentiate its initiatives from those run by the government?
A: Ambuja Foundation don’t duplicate government initiatives, but compliment it by taking a different approach to align with the government public health programs and fill in gaps. Thus, apart from creating the model, we offer training, capacity building, on-the-ground support by offering our Sakhis during screening camps, support in referrals and also end to end healthcare support.
Our trained Sakhis and CoviSainiks (Community Volunteers) played a major role during the government led vaccination camps in the villages, helping with registrations and also assisting senior citizens. Even today, our Sakhis and Community Volunteers provide support in the malnutrition program by identifying SAM and MAM children and providing them with referrals to the Nutrition Rehabilitation Centre.
Q: ACF has experience of working in social projects on different social problems. What government policy interventions can help organisations like you to make programme implementation more effective and create better impact?
A: The government has launched various policies which enable the development of rural areas, be it with farmers, women, youth or other community members. There is generally a problem in ‘accessing’ these schemes among rural villagers, with rural people being less computer literate and facing challenges in accessing information and submitting applications for these programs.
ACF tackles this and creates convergence between the community members and government, to avail such policies and schemes and reap the benefits as a result. Many schemes are embedded into our programs so that beneficiaries receive financial support from the government, ACF contributes a little, and they pay for the rest. Be it the installation of toilets, micro-irrigation or any other subsidies – these small incentives goes a long way in motivating rural people to also put their hand in their pocket and investing in solutions.
We also hope to see more Public Private Partnerships as we have had great success in this model and look forward to many more Projects and Schemes to benefit rural India in the future.
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