Grassroots CSR Initiative for Public Health – MANSI

When businesses operate, they have an impact on their local community. Also, businesses themselves get impacted by the issues faced by the local community where they operate. One of the aspects that becomes important for corporate entities is to consider the state of local population health in the areas where they operate. Additionally, it is imperative that corporations act responsibly and are accountable for any public health issues arising from their business operations. Corporate social responsibility is constantly being redefined from what it used to be in terms of corporate responsibility to people and the planet. This redefinition is significantly also due to issues affecting public health. Hence, it is important for corporate entities to account for how their business operations affect public health.

There is an essential need to truly embrace corporate social responsibility (CSR) and ethical principles that would promote equal distribution of health care resources. One of the challenges for the healthcare sector, the government, the medical profession, and healthcare providers is to continually explore ways to ensure that the welfare of individual patients remains at the utmost primacy and promote healthcare equity via corporate socially responsible activities. Relevant CSR management systems can be instrumental in making progress in significant health problems in a given society the uppermost priority of health care.

Stakeholder Theory

This theory takes into account the interests and rights of the comprehensive range of individuals and organizations who cooperate with and are affected by business decision-making. It emphasizes the role of various stakeholders in the long term and the success of the organization. This theory is important to business ethics because it recognizes many values and moral agency on diverse levels. A stakeholder is any individual or group of people whose role is essential to the survival and well-being of the organizations or co-operations. Stakeholders are mostly affected by the cooperation or organization and its activities and guide it in defining objectives and mission. Management, employees, shareholders, customers, suppliers, society, and the community are examples of stakeholders.

This theory argues that the goal of any organization or company is to prosper the firm and all its stakeholders. It implies that profit maximization is not a problem in itself; it only becomes an issue if managers give profit-maximizing actions a preference over activities that promote the well-being of primary stakeholders, including society. The theory challenges the argument that a manager’s chief obligation is to maximize profits and encourages the firm to coordinate stakeholder interests. The father of stakeholder theory, R. Edward Freeman, believes that corporations and stakeholders have reciprocal relationships in the sense they can affect each other in terms of benefits and harms and in terms of duties and harms.

Health as Sustainable Development Goal

“Good Health and Well-being” is listed as the third Sustainable Development Goal (SDG) in the UN’s list of global SDGs. The focus of this goal is to “Ensure healthy lives and promote well-being for all at all ages”.

Ensuring healthy lives and promoting well-being for all ages is essential to sustainable development. Currently, the world is facing a global health crisis unlike any other – COVID-19 is spreading human suffering, destabilizing the global economy, and upending the lives of billions of people around the globe.

Before the pandemic, major progress was made in improving the health of millions of people. Significant strides were made in increasing life expectancy and reducing some of the common killers associated with child and maternal mortality. But more efforts are needed to fully eradicate a wide range of diseases and address many different persistent and emerging health issues. By focusing on providing more efficient funding of health systems, improved sanitation and hygiene, and increased access to physicians, significant progress can be made in helping to save the lives of millions.

Health emergencies such as COVID-19 pose a global risk and have shown the critical need for preparedness. The United Nations Development Program highlighted huge disparities in countries’ abilities to cope with and recover from the COVID-19 crisis. The pandemic provides a watershed moment for health emergency preparedness and for investment in critical 21st-century public services.

Improving the well-being of mothers, infants, and children is an important public health focus for this UN SDG. Their well-being determines the health of the next generation and can help predict future public health challenges for families, communities, and the health care system.

Child Health

• In 2018 an estimated 6.2 million children and adolescents under the age of 15 years died, mostly from preventable causes. Of these deaths, 5.3 million occurred in the first 5 years, with almost half of these in the first month of life.
• Despite determined global progress, an increasing proportion of child deaths are in Sub-Saharan Africa and Southern Asia. Four out of every five deaths of children under age five occur in these regions.
• Children in sub-Saharan Africa are more than 15 times more likely to die before the age of 5 than children in high-income countries.
• Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illnesses such as diarrhea, pneumonia, and malaria. Nutrition-related factors contribute to about 45 percent of deaths in children under 5 years of age.

Maternal Health

• Over 40 percent of all countries have fewer than 10 medical doctors per 10,000 people; over 55 percent of countries have fewer than 40 nursing and midwifery personnel per 10,000 people.
• In Eastern Asia, Northern Africa, and Southern Asia, maternal mortality has declined by around two-thirds.
• Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth.
• 94 percent of all maternal deaths occur in low and lower-middle-income countries.
• Young adolescents (ages 10-14) face a higher risk of complications and death as a result of pregnancy than other women.
• But maternal mortality ratio – the proportion of mothers that do not survive childbirth compared to those who do –   in developing regions is still 14 times higher than in the developed regions

Need for Caring for Child Health and Maternal Health in India

Since the beginning of the Safe Motherhood Initiative at the UN in 1987, India has accounted for at least a quarter of maternal deaths reported globally. India’s goal is to lower maternal mortality to less than 100 per 100,000 live births but that is still far away despite its programmatic efforts and rapid economic progress over the past two decades. The geographical vastness and sociocultural diversity mean that maternal mortality varies across the states, and uniform implementation of health-sector reforms is not possible. 

CSR Law in India

CSR in India has traditionally been seen as a philanthropic activity. However, India became one of the first countries for certain companies to have statutorily mandated CSR with the introduction of Section 135 in the Companies Act 2013. This Act requires companies with a net worth of Rs.5 billion or more, or turnover of Rs.10 billion or more, or a net profit of Rs.50 million or more during the immediately preceding financial year, to spend 2 percent of the average net profits of the immediately preceding three years on CSR activities. It also specifies the activities that can be undertaken and the manner in which the companies can undertake CSR projects/programs.

Under this law, it is stipulated that preference must be given by companies in their CSR activities to local areas and the areas where the company operates. Reducing child mortality and improving maternal health are also among the activities permitted under this law. This has resulted in many companies focusing on child and maternal health as part of their mandated CSR activities.

MANSI (Maternal and Newborn Survival Initiative)

MANSI (Maternal and Newborn Survival Initiative) is a grassroots-level CSR initiative in India, run and managed by Tata Steel, the American India Foundation (AIF) and SEARCH. In 2009 the three organizations came together for MANSI to strengthen the National Rural Health Mission (NRHM). The idea was to design and implement management systems and training methods for improving home-based maternal and neonatal healthcare. This program works on a public-private partnership model which focuses on building the capacity of existing government voluntary health workers.

TATA Group – A Stalwart for CSR Programs in India, including for MANSI

According to TATA Group, the largest multinational in India, their CSR programs aim to be relevant to local, national, and global contexts. They aim at keeping disadvantaged communities as the focus based on globally agreed sustainable development principles and strive for CSR initiatives to be implemented in partnership with governments, NGOs, and other relevant stakeholders. Tata companies are involved in a wide variety of community development and environmental preservation projects.

TATA Group lays down 10 core principles for their CSR philosophy:

1. Beyond Compliance
2. Impactful
3. Linked to Business
4. Relevant to National & Local Contexts
5. Sustainable Development Principles
6. Participative & Bottom-up
7. Focused on the Disadvantaged
8. Strategic & Built to Last
9. Partnerships
10. Opportunities for Volunteering

How MANSI Works

The core idea for MANSI is to design and implement management systems and training methods for improving home-based maternal and neonatal healthcare. It planned to do that by addressing fundamental development challenges within local communities by bringing in the necessary resources, talent, and expertise in the process. In addition to handholding, the project involved the provision of simple equipment and supplies to enable local Accredited Social Health Activists (ASHA) and Sahiyas to provide basic healthcare to infants and their mothers. Sahiyas were crucial to this initiative. By keeping track of women through their pregnancies, the Sahiya could get them to the hospital in time for deliveries. Most newborn deaths happen in the first 28 days. Taking care of the mother and child during this period is the key to having better public health indicators.

Since mothers living in remote areas cannot go to hospitals for checkups regularly the Sahiyas are bringing the hospital to them. Time is the key essence in many of these situations. It’s often about early detection and early treatment. The Sahiya prepares a woman and her family for delivery in the hospital. These days the Sahiya is allowed to go into the operation theatre for the delivery. It is a significant concession that raises the status of the Sahiya.

A Sahiya has been taught how to take care of premature babies whose weight is low. She can manage asphyxia and hypothermia. She knows to identify infections like sepsis. She provides treatment for diarrhea and moves an infant to a doctor quickly in cases of pneumonia.

An important innovation under MANSI has been to give a kit to the Sahiya. The kit consists of a thermometer, weighing scale, mucous extractor, watch, warm wrap, blanket, flipcharts for nutrition and health education, checklists to record the health status of the child, Tetracycline eye ointment, Gentian Violet paint, soap, and so on.

The government has also agreed to allow the Sahiya to administer cotrimoxazole syrup, which is used as the first line of treatment for sepsis and pneumonia.

MANSI program over time has also utilized modern digital technology and tools, such as a centralized website for case management and a mobile app for CSR management, providing field-based care and documentation of individuals. `Operation Sunshine’ is MANSI’s application software designed to run on the web, mobile phones, and tablets. The software application empowers the staff of the MANSI Project to detect and follow up on high-risk newborn babies and pregnant mothers, ease the training of women health volunteers and thus help in the mapping of high-priority areas deserving special focus on battling infant mortality and maternal morbidity.

The TechCSR application is aimed to reinvent the traditional manual information capturing with an on-field data capturing provision and a central repository of data, thus providing real-time monitoring. 

MANSI CSR Program – Results

MANSI aimed to reduce infant and maternal mortality rates through Home Based Newborn Care (HBNC). MANSI was initially launched in Seraikela block of Jharkhand, one of the most backward areas in India. MANSI drastically reduced the Neonatal Mortality Rate (NMR) by 61.2% and Infant Mortality Rate (IMR) by 63.1% in the block, over a period of five years.

According to Clinton Foundation, multiple stages of the MANSA program have reduced the neonatal mortality rate by 32.7 % and the child and infant mortality rate by 26.5%.