Since 2008 Save a Mother (“SAM”) Foundation has developed an Effective Social Persuasion (SAM-ESP) model for health care advocacy and behavior change for the poor in India. The SAM model has been proven in over 1,500 villages representing approximately 3 million people in the states of Uttar Pradesh, Telangana and Karnataka. For less than 25 cents or 15 Rupees per capita per year, SAM has dramatically improved health outcomes in underserved rural areas.
Following our SAM-ESP model, in 3 years our programs show effective results. Based on our work since 2008, maternal deaths were reduced by 90% and neonatal deaths were reduced by 57%.
The successful ESP method used to curb maternal mortality has been utilized for other healthcare issues such as tuberculosis detection and population stabilization. TB detection has gone up 10 times and treatment completion under supervision is close to 100 percent.
In SAM population stabilization program, contraceptive acceptance has increased by 20% and unmet need has decreased by 20%.
By partnering with local health organizations and governmental authorities, SAM ensures the sustainability of its solutions. SAM implements its programs at a low cost – approximately 15,000 Rupees (about $220) per village per year.
How We Work
Save a Mother has developed the Effective Social Persuasion Platform (SAM-ESP) to achieve its goals. SAM-ESP uses seven steps to develop social behavior change communication to significantly reduce disease burden.
SAM successfully used SAM-ESP to decrease maternal mortality by 90% and neonatal mortality by 57% in about 854 villages after about three years of the program. The annual cost is less than Rs. 15,000 per village with an average population of 2,000.
Step One: Organize the Structure and Build Capacity
Each district constitutes a unit for
How do we change behavior? Effective Social Persuasion (SAM-ESP)
Responsibility approach and not only rights
Simple messages: songs, slogans created by community
Repetition of messages without a preset end point
Step Two: Develop Messages for Health Literacy
SAM uses local community talent to create flip charts, slogans, songs and stories. A good message is simple and focuses on only one issue; it is short for easy recall; it has clarity for easy comprehension; it is structured as story, song or a slogan and evokes emotions about an unmet need. The community is encouraged to own the message by participating in developing the message.
Step Three: Train Health Activists
Master trainers impart health education to volunteer health activists over a three day period on one health topic. Each topic of health care has a separate training module. Examples are: child and maternal health, TB eradication, population stabilization. Repeat refresher training for half to one day is given once a month. Volunteer health activists are encouraged to own responsibility for the village health.
Step Four: Teach People
SAM organizes a village into an interactive healthcare community. Master trainers and health activists meet with the villagers every week to discuss health issues and best practices to promote health and prevent disease. Health behavior modification messages are delivered repeatedly at these meetings. Repetitive SAM-ESP, education campaigns and training of health volunteers are essential elements of the program. Between 2008 and 2011, SAM held multiple training sessions for the volunteers, who in turn held weekly SAM-ESP discussion groups at the village level. The following tables illustrate that the training sessions are repetitive and intense with no preset endpoint.
Step Five: Cooperate with Public Health Workers
Utilizing all available public health resources is the essential component of the program. Public health workers are invited to all meetings to establish linkages with the local public health system. The linkages create awareness, which leads to increased demand and encourages accountability of the health system.
Step Six: Evaluate and Improve
All programs are monitored and course correction applied based on the learning from the field. Modifications to training are done by participatory research action and community involvement.
Step Seven: Develop Solutions and Replicate
The field experience helps SAM to innovate modular solutions for the health care of the rural poor. SAM develops these solutions in an innovation zone of approximately 2 million people in about 800 villages in UP. The solutions are further validated and modified in over 300 villages in three districts in northern Karnataka. The solutions are kept simple, sustainable and scalable. SAM, in partnership with other institutions, replicates the solution in other districts.