Objective="Availability of basic health products in rural areas."
Details for Reform Option "Outreach and referral services for slum populations contracted out to private organisations, Orissa"
Availability of basic health products limited in rural areas.
Population Services International (PSI) covered the State of Orissa by distributing basic health products such as contraceptives, oral rehydration salts (ORS), safe water systems and clean delivery kits to the rural population through existing commercial networks – in this case, mostly pan shops.
The initiative was supported by a state-wide mass media campaign, with the pan shopkeepers’ social contribution at the forefront.
PSI staff visit outlets once and then relies on traditional distributors/wholesalers to carry out the restocking. In the process, the project may lose up to 80-90% of the outlets visited but it is still considered that the approach is cost-effective and sustainable.
The link between the project and the retailers is kept through mailshots - which allows for some feedback from the field.
A single visit to rural vendors, counseling them on health product promotion and teaching them about the products (eg. how to take pills and use condoms correctly) is cost effective.
However referring them to wholesalers for restocking is problematic and sustainability fell to just 10-20% because most of their queries on clinical needs of products remained unaddressed.
A study on rural retailers of Orissa clearly indicates that 30-40% vendors would be interested in restocking if their key clinical products needs could be addressed.
Therefore repeat visits/counseling can no doubt increase the numbers of sustainable vendors.
Twenty-one districts of Orissa.(March 2004) (Puri, Cuttack, Kendrapara, Jajpur, Bhadrak, Balasore, Mayurbhanj, Jagatsinghpur, Khurda, Nayagargh, Ganjam, Rayagara, Koraput, Malkanagiri, Nawarangpur, Angul, Dhenkanal, Pulbani, Boudh, Balangir, Kalahandi). It was started in January 2001.
A blitz team of 10 members and a supervisor could cover the entire state (if budget is not a constraint) in around 500 days.
Extended coverage: Increased access to social marketing products in the rural areas.
Education: Improves knowledge, attitudes and beliefs concerning HIV/AIDS, family planning, clean delivery practice, diarrhoea etc. among the rural population.
Limited reach: Does not help the poorest of the poor as they cannot afford to use the shops.
Lack of support: Wholesalers are ill-equipped to deal with queries on clinical needs of products, leaving shop-keepers unsupported.
Communication constraints: In states with limited literacy/ multiple languages/ low ownership of televisions and radios (like Orissa) the reach of mass media is limited.
Cost: Low population density and a scattered rural population and make the project comparatively costly.
Area-specific baseline information.
Heavy support for IEC.
Who needs to be consulted
State government and local donors - in this case, UNFPA, State Aids Cell, UNICEF, PSI India.
Poor, given that only 10-20% of the rural outlets will survive. However, repeat visits/counselling rural vendors could increase numbers of sustainable vendors.
Chances of Replication
Easily replicable and more cost-effective in areas with higher population density and more developed network distribution.
The programme is still on-going but, due to lack of funds, is on a much smaller scale. However this has enabled the organisation to collate information on rural markets for social marketing through their survey reports.
A similar kind of project in 16 districts of Jharkhand has found that more than 55% of outlets will put in an order for more contraceptives after a repeat visit by trained field staff.
Dr Jean Patrick Duconge, Former Programme Director, PSI, New Delhi. November 2003.