Kum Kum's Story

Kum Kum Devi lives with seven family members — her husband, four children, and uncle — in a village in the northern state of Uttar Pradesh. The area was once known for its sugarcane plantations, but those have since closed, and there is little other economic activity. Nine years ago Kum Kum received her first microfinance loan from Opportunity’s program partner Cashpor. She used it to set up a small roadside shop, which continues to provide a steady stream of income for the family. She has taken subsequent loans to set up an additional business as a tailor, where she also trains and employs other local women to help her.

Kum Kum is passionate about three things: her children, education, and her family’s health. She never had the chance to complete her secondary education when she was young, and she wants all of her children to have that opportunity and go on to further education as well. The community she lives in commonly faces preventable illnesses like diarrhoea, dengue and typhoid. Her own family has suffered some of these diseases, and she has seen others in her community die from preventable health problems such as malaria.

Kum Kum sees health as a matter of dignity. When she grew up, her own mother wouldn’t speak to her about issues like reproductive health and menstruation. When her own daughter — now 15 years old — had her first period, Kum Kum took special care to look after her and let her daughter know she could confide in her.

Two years ago, Kum Kum became a health leader. At first, what she loved most was learning invaluable knowledge she could share with her family, friends and community members. She focuses on encouraging mothers to bring their daughters to her health education sessions, and shares her own experiences openly to challenge taboos. Now, when she goes to another village, women come to her first with their health problems. While she can’t treat their concerns, she can provide advice and encourage them to see a doctor when appropriate.

As Kum Kum completed her training, she realised that what she loved about the program was learning new things. Empowered with the new confidence that her role as a health leader brought her, she enrolled in a local secondary school, with the goal to complete her final years of education. As her children finished their own schooling, so did she alongside them — and her family couldn’t be prouder.

The changes in Kum Kum’s household are significant. Now they have a toilet, her children wash their hands, and they dispose of waste carefully. Most importantly for Kum Kum, she is giving her family opportunities to live better lives, free from the challenges she faced when she was growing up.

Gangotri's Story

Gangotri never had the chance to complete school when she was younger and always wished she’d had the opportunity. When she was given the chance to train with Healing Fields Foundation as a community health leader, she was determined to use her new knowledge to help others.

Once Gangotri started training, she realised how many health problems are caused by open defecation. Her research showed that children living in areas practising open defecation had a higher chance of getting preventable diseases, like diarrhoea.

Using her training, Gangotri has started changing her community one household at a time. She began by convincing two women to build toilets in their homes. Just ten months later, she has facilitated the construction of 400 more toilets. This is an incredible change driven by just one leader.

Your update in March 2016

By the Numbers

• 2,543 women trained as health leaders
• 635,750 families reached with health education — that’s 3,001,250 people reached with an average family size of five
• 150,240 health education sessions held
• 200,000 women using sanitary napkins
• 393,000 families accessing hospital care
• 4,230 community members accessing eye care (including glasses and cataract surgery)
• 14,000 toilets built
• 931 health leaders with access to increased income.

FIVE YEARS LATER

After five years of working with communities in Bihar and Uttar Pradesh, we recently completed a third-party evaluation to assess health in communities with and without health leaders.

Preliminary results show that the program is making a remarkable diference, helping families stay healthy and focus on breaking the poverty cycle.

• 70% of families reached by health leaders now filtering their drinking water
• 89% of women in communities reached by health leaders giving birth in hospitals
• 2.3% decrease in open defecation

As well as improving community health, health leaders benefit a lot as individuals. For example, results show an increase in income and reputation among women who participate.

• 82% of health leaders report increased community respect and reputation
• 93% of health leaders report increased earnings through health-related livelihood activities.

Your update in October 2016

BENEFITS FOR HEALTH LEADERS

An impact assessment completed in February this year confirmed that the health leaders are not only helping others, they’re also helping themselves!

Improved health knowledge

94% of health leaders report improved knowledge of hygiene, sanitation, nutrition, hand wash, pregnancy and child birth, adolescent health and menstrual hygiene.

Changes in health behaviour

96% of health leaders have been able to bring about changes in health practices in their families and their communities.

Improved access of health services by the community

After delivering health education, 63% of health leaders have observed an improvement in the likelihood of people in their villages accessing health services such as hospital care or health products such as sanitary napkins.

Increased income

66% of health leaders have reported an increase in income due to their work participating in health-related livelihoods.

BENEFITS FOR COMMUNITIES

The same impact assessment completed in February this year confirmed that the health leaders are truly helping their communities to be healthier.

Improved health knowledge

98% of community members have improved their knowledge of health by attending the sessions provided by the health leaders.

Increased hospital births

89% of deliveries in the intervention villages (where the health leaders are actively working) have been in hospitals referred by the health leaders.

Improved hygiene

75% of women and adolescent girls have learnt to use sanitary napkins from health training sessions.

Healthier mothers and babies

58% of pregnant women have received and used advice from health leaders on pregnancy care, nutrition, antenatal check-ups, institutional delivery and colostrum feeding.

Radhika's Story

Radhika carries herself with the quiet strength of an Indian matriarch. Radhika is a health leader, trained in basic hygiene and nutrition information by Opportunity's program partner Healing Fields Foundation.

The education Radhika has received through her training as a health leader has been life changing for her personally just as much as it has helped women in her community.

Meet Sitiamina

Like many mothers, Sitiamina is up early most mornings caring for her family. Probably unlike other mothers, though, she is usually making ice blocks. With fruit she’s purchased at the local market, each morning Sitiamina makes big batches of frozen treats to send on the daily boat to an island off the coast of Sulawesi. When the boat returns at night she collects her income for the day.

Sitiamina doesn’t mind doing things differently. In fact, after only completing elementary school herself she wants to do things differently to give her own children the best chance of a future free from poverty.

She recently became one of the first in her community to install a toilet in her home with the help of a water and sanitation loan from microfinance partner Komida.

With heavy rains causing frequent flooding, preventable health issues such as diarrhoea and giardia are commonplace for families in Sitiamina’s community. Simply using a toilet avoids these health issues, while making life much easier – especially for girls.

But funding a toilet isn’t so simple for families stuck in a cycle of poverty, where simply surviving is a daily challenge. More than an issue of money, many families just don’t know simple hygiene and health practices that can make a big difference. Health leaders will bridge these gaps, delivering both practical knowledge and access to services and products.

When they’re sick Sitiamina worries about her children and the schooling they’re missing out on. But after just three months she can already see a big difference in the health of herself, her husband and their three children.  

Meet Sashikala

Sashikala is a health leader and mother to three daughters. The family has a small farm, that they've grown over the years with small loans to invest in buffalo and seeds for vegetables. Most of their food comes from the farm, and they sell what remains at the markets, and live off the small income.

She's seen many children die from preventable illnesses including diarrhoea. She's also seen a number of adults in the village suffer from tuberculosis.

Sashikala's family is one of just five households with a toilet, in a community of around 2,500 people. She and her husband built it because they worried about their daughters going outside at night, and were also concerned about their young children being bitten by a snake during the rainy season.

When Sashikala heard about the training being offered through Opportunity's program partner Healing Fields Foundation, she put up her hand immediately to become a health leader. She has focused on encouraging families to build toilets and sells sanitary napkins to the community.

When Sashikala completed school, she wanted to become a nurse, but was unable to get the further education needed to qualify. Now, as a health leader, she is proud to help others improve their wellbeing. Her eldest daughter Schweta wants to be a midwife, inspired by her mum.

Your update in March 2017

A recent independent impact assessment conducted by Deloitte India looked at the current experience of health leaders and their communities up to four years after completing their training. 

BETTER HYGIENE

Nearly all of the health leaders and their community members surveyed report:

• Drinking purified water
• Washing their hands with soap 
• Having used sanitary napkins

BETTER HEALTH

In rural India, where it’s common for women to die during childbirth, and for infants to contract life-threatening diseases before they’ve even reached their fifth birthday, improved health means improved chances of survival.

By making relatively small changes in everyday practices, community members have reported significantly improved health. For example, health leaders reported a 50-60% reduction in household health expenses thanks to improved health practices.

EMPOWERED IN THEIR COMMUNITIES

All health leaders report feeling more confident. The impact of this is seen in their homes and in their communities: 

• Today 98% of these women have increased autonomy to leave their homes — before, 85% were not free to move around outside their homes.
• Now 68% are active in village-level discussions — in the past, just 1% of health leaders reported having any input.

Your update in October 2017

TECHNOLOGICAL INNOVATION IN INDIA

Technology is increasingly playing a greater role in the Health Leader program in India. With more efficient program implementation, health leaders can reach even more families. Better use of data and adopting innovative health tools means improved health outcomes for families.

Mobile applications for data collection

Most health leaders still use feature phones – this is the consequence of a few factors, including price, lower energy needs and lower literacy requirements. As a result Healing Fields Foundation has focused on developing a very basic survey app for health leaders to use when collecting their community’s baseline data. This information has always been an essential part of the program but digitising it means it can readily be analysed, providing useful insights into key health issues and needs.

Medical tools for health leaders

Recently an agreement was made with the Indian Institute of Sciences in Bengaluru to explore health leaders using a medical device they have pioneered based on nanotechnology. This provides a simple and cost-effective way of testing blood levels and identifying conditions such as diabetes and anaemia. The tool is also connected to an app to manage and analyse readings over time. 

Your giving means we can integrate these technologies while continuing to explore new possiblities – improving community knowledge, overcoming access issues and making quality care more affordable. 

FROM INDIA TO INDONESIA

Opportunity's microfinance partner KOMIDA is working with Healing Fields Foundation to pioneer the Health Leader initiative in Indonesia. This pilot program is innovative in two key ways – by adapting the program model for a new geography and by setting a precedent for the approach that Opportunity takes to scaling non-microfinance interventions.

Adapting the training curriculum

The health leader curriculum has recently been finalised, tailored to the needs of families living in poverty in Indonesia.

The curriculum was based on extensive community consultation and research, which found many similarities in the health challenges of families in Indonesia and northern India, including:

• anaemia
• diarrhoea
• mosquito-borne diseases
• tuberculosis; and
• water, sanitation and hygiene.

Meet Sunita

Sunita is from a small village in a rural area of Uttar Pradesh, India, where she lives with her husband of 18 years and their five children – as well as her brother-in-law, his wife and their three children. She earns an income through the family's buffalo and her small tailoring business, which she started several years ago with a loan from Opportunity's program partner Cashpor.

When Sunita heard about the health leader program she was eager to join. Attending classes meant battling her husband’s disapproval –until her new knowledge saved his life.

A seasonal labourer, Sunita’s husband Subash often works away for months at a time.

Luckily for Subash, Sunita had been attending classes under the guise of visiting friends.

When he returned from working away with a badly infected ulcer on his leg she knew he needed to get to a hospital immediately. After seven days in hospital, Sunita knew how to dress his wound and took care of Subash for the next three months. Without her training the family don’t know how they would have covered the cost of his care.

Now, Subash is Sunita's biggest supporter. He is proud of her role in their community

Sunita is grateful to have had the chance to learn about basic health, hygiene and nutrition, and to share this with her family and community. Without these skills, her husband might not be around today.

Your update in March 2018

UNDERSTANDING YOUR IMPACT

The highly-regarded Tata Institute of Social Sciences (TISS) has conducted another evaluation of the health leader program in India, canvassing 70 villages in six districts across Bihar and Uttar Pradesh. This confirmed previous results and provided new insights into program impact that will drive the program's adaptation going forward.

The study found the following impacts on health leaders and their communities:

Impact for health leaders

• Overcoming social and financial barriers to complete the training program
• Increased mobility and health knowledge
• Becoming confident
• Starting to play an active role in decision-making at the household and community level
• Their families follow better hygiene and healthcare practices leading to improved health
• Gaining recognition in professional and social space
• Increased financial status.

Impact for community members

• Awareness of basic health and hygiene practices
• Access to preliminary healthcare through the health leaders
• Improved changes in their hygiene practices such as hand-washing, paying attention to their diets and using sanitary napkins
• Increased use of toilets.

One of the biggest changes the health leaders observed was the shift in the way that they are viewed by their family and community members – they are now treated with respect and their opinions are sought on important matters.

INVESTIGATING HEALTH LIVELIHOODS

The program has begun investigating more ways of sustaining health leaders beyond their internships with two livelihood initiatives in India.

The first batch of Community Health Entrepreneurs – all graduated health leaders – started their training in December 2017. This initiative will provide 105 health leaders with additional training and access to health-related products such as sanitary napkins. By doing so, more women can earn an income from their work in promoting health. The lessons of this pilot will later be adapted so that all health leaders can become health entrepreneurs, if they choose.

53 health leaders are also being trained in additional first-response emergency care, using a curriculum devised in consultation with Stanford University. Each of these women has spent at least a year as a health leader in her community. After completing the training, the women are equipped to diagnose common acute diseases (pneumonia, infected wounds, malaria), to monitor chronic conditions (diabetes, tuberculosis) and to provide emergency triage and stabilisation. This training will equip these health leaders to be much more skilled at responding to primary care cases while also creating new avenues for generating income.

HEALTH LEADERS START THEIR TRAINING IN INDONESIA

Following extensive community consultation, the first cohort of 59 women have started their six months’ training on Java Island. Their internships will begin in the second half of 2018. This pilot is a valuable learning experience as we adapt and test the successful model from India for a whole new context. 

The launch of the Health Leader training in Indonesia

Health leaders enjoying their training

Meet Navihan

On first glance, Navihan Nisha seems like a quiet lady. Covered from head to toe in a pale blue salwar kameez and a white head cloth embroidered in dainty flowers, my first impression is that she's reserved, demure even. When we begin chatting, her son and daughter - both grown up now - sit nearby, as do a crowd of twenty other people from the village. Navihan Nisha speaks softly and carefully, pondering her answers before she gives them. She carries a small notebook in which she has prepared notes for the two of us to discuss, and after a few minutes I quickly realise my first impression is wrong: she is determined and defiant, respected by everyone in the village.

When Navihan Nisha lost her husband ten years ago, she struggled to raise her young children and keep her family afloat. She borrowed from a money-lender to make ends meet, but couldn't repay the exorbitant interest she was being charged. Finally, Opportunity's program partner Cashpor opened a branch in nearby Deoria, she took a loan to start a small roadside shop and has been running that ever since while also earning income from the family's small farm.

In her small village of about 200 households, health issues are commonly caused by high rates of open defecation and poor quality water - leading to illnesses like typhoid and diarrhoea. One day when her Loan Officer came to collect her repayment, she was invited to train as a health leader with Opportunity's program partner Healing Fields Foundation.

At first, Navihan Nisha went along to the classes out of curiosity, but she soon started to find the lessons useful for her own family. When she learned about the importance of washing hands as a tool for minimising illnesses like diarrhoea, it was a revelation. Her own family began washing their hands and she noticed that they were healthier overall.

Soon Navihan Nisha was ready to begin educating other community members with the important health knowledge she'd learned. But she noticed that many failed to adopt the seemingly simple practice of washing their hands. Undeterred, Navihan Nisha decided to turn her attention to a group of 60 children who participated in homework coaching after school. She would sometimes help the children, and as part of her lessons, she started encouraging them to wash their hands and to share the message with their own families, knowing just how much this easy solution could help reduce preventable illnesses.

As the children learned, Navihan Nisha saw another opportunity to change minds. Once a month, on a Thursday, she and the children would walk through the village singing, chanting and doing hand-washing demonstrations. At first, people laughed. But then, they started paying attention.

Now, Navihan Nisha is considered a true leader in her community, and people living there have become healthier. She is proud that her community is a clean place where families are healthy, and hopes to continue educating those around her with important messages about their health.

October 2018

To June 2018, 4,236 women have been trained as health leaders. These women are reaching families in their communities with simple but life-changing health, hygiene and nutrition information to build healthier communities.

INDIA: HEALTH LIVELIHOODS

215 health leaders are completing further training to become Community Health Entrepreneurs. The health entrepreneur pilot aims to equip health leaders with high-demand but hard to access health products – including sanitary napkins, hand wash, dishwashing liquid and toilet cleaner. Behind the scenes, this means bridging the last mile in supply chains to create local access to vital health products, in quantities families can afford. In time, health entrepreneurs will not only teach families about better health and hygiene, but make sure they can access the products they need to put this new knowledge in to practice.

Basic Care Providers are health leaders trained in first-response emergency care. Having completed the training – using a curriculum designed in collaboration with Stanford University – these 53 health leaders are actively assisting families in their community. So far 1,530 people have consulted a Basic Care Provider, who can use her tablet application to access remote medical care including prescriptions of basic medicines.

INDONESIA'S FIRST HEALTH LEADERS TO REACH FAMILIES

The first group of health leaders in Indonesia will soon complete their training. These 54 women are eager to begin reaching out to families in their communities to teach them better health, hygiene and nutrition.  

Meet Sunita

Sunita is a health leader with a passion for healthy eating. On her family visits she's become known as a persuasive advocate for the benefits of growing your own vegetables – she's affectionately called "Kitchen Garden Sister".

So far 25 families have started their own kitchen garden.

They're following her advice and growing a range of vegetables without harmful fertilizers or other chemicals. With their harvest of common vegies and herbs – including cauliflower spinach, coriander and chillis – families are regularly eating more fresh food.