Contribution
updated

ePustak

ePustak (ebook in Hindi) aims to improve access to already available Health and Nutrition social welfare programs established by the Government of India by introducing technology as an enabler and working with organizations such as the ASHA Women’s Organization as the vehicle.

Customers

The most important customers are slum-dwellers that find it challenging to gain access to social welfare programs in India. India is a country which is rich in natural resources, but approximately 6% of its population lives in slums. Slums in India are lacking at least one of the following: durable housing, sufficient living area, proper sanitation, clean drinking water and secure tenure. Although several subsidized food programs have been implanted by the government, it is still estimated that food insecurity in the slums in India is between 50% to 70%. The geographical relocation of families and individuals from rural areas to urban settings expose migrants to poor environmental conditions, such as overcrowding, poor quality drinking water and sanitation, and lack of waste removal, which as a result, leads to inadequate access to food, improper dietary habits, and poor overall health.
With the introduction of the Aadhaar ID system, individual IDs should be sufficient to apply for access but this population still find it challenging for several reasons. First access to the Aadhaar may be prohibited due to a lack of proof of residence due to their migratory trends and once an ID is accessed, social programs require additional documentation which may also be challenging to access or they are simply not aware. Thus, there are many for example that are going hungry in a country that does provide food programs due to access challenges and a lack of awareness and assistance.

Value Proposition

ePustak is a tablet with customized software that would allow the ASHAs to capture the current data they are gathering digitally rather than manually. Currently the ASHAs capture data in books which are eventually thrown away. This data is valuable and if anonymized could prove valuable to Governments and NGOs who need up-to-date information on the health and welfare of slum dwellers. The customized software will not only capture data more effectively, creating a data bank of information, but also offer training videos, health and nutrition information, and list eligibility criteria. A key aspect to the software is the ability to link the information directly to the eligibility criteria. As an example: once the ASHA has created the individual and family profiles and goes online the software automatically highlights which social welfare schemes they could be eligible for. The ASHAs can then focus their questions on what the barriers are currently and aid the slum dwellers where possible to overcome these barriers. Additionally, the the Aadhaar program already offers incentive remuneration for each Aadhaar ID introduced and completed. There is thus an opportunity in this program for the ASHAs to increase their incentive income with the introduction of this added task to their current tasks.

In summary: ePustak offers value to 1) the ASHA women's organization, 2) the Government of India, and 3) our most important customers i.e. the slum-dweller. ePustak also offers a solution by 1) creating a digital data bank of health & nutritional information of slum-dwellers that is currently not available, 2) aiding migrant families and individuals to access their national Aadhar ID through a trusted community partner who can also assist them in identifying which social welfare programs they are eligible for, and 3) further empowering and legitimize the work of the Asha Women's Organization who is already a trusted and valued partner within the slum communities and the Government.

The reason why value will be created now: Prior to 2010, access to services across India was fragmented with each social program requiring different identification documents to access government provided services and programs. Access to these cards is challenging for the slum dweller population due to the migratory nature of the population and the different policies governing each province. The introduction of the Aadhaar system in India not only aimed at meeting one of the UN Social Development Goals, “providing a legal identity for all”, but was also intended to give access to its impoverished and unidentified populace to the social services they are eligible for. Unfortunately, there are still challenges for slum-dwellers to get an Aadhaar ID and gain access to social schemes due to different eligibility criteria for each program.

Benefits to key stakeholders/customers:
1. ASHA Workers:
- Improve access to information and training for the ASHA workers to strengthen their work within the community;
- Assist in the data capturing process by moving from a manual to digital data capturing;
- Increase the ASHAs access, legitimacy and impact within the community, and;
- Increase their incentive income through the additional remuneration enabled by the added duties to their scope of work.

2. Slum Dweller Community
- Ensure that all families and each family member, visited by the ASHAs have an Aadhaar identity card;
- Improve access for slum-dwellers to Government Provided Social Welfare Programmes, and;
- Broaden reach within the slum community to include all families willing to participate and not only pregnant women.

3. The government, ASHA Partners, and NGO’s:
- Negotiate access to anonymized digitized data gathered by the ASHAs;
- Assist in actualizing the Governments Aadhaar initiative to provide an identification document to every citizen in India, and;
- Improve information on slum communities, their status, welfare, and access to Government and NGO provided programs.

Channel

The ASHA Organization has been identified as an effective channel to work with and engage with our ‘customer’ market i.e. slum dwellers. The Accredited Social Health Activists (ASHA) are community health workers instituted by the government of India's Ministry of Health and Family Welfare (MoHFW) as a part of the National Rural Health Mission (NRHM). ASHAs are local women trained to act as health educators and promoters in their communities. The Indian MoHFW describes them as: ...health activist(s) in the community who will create awareness on health and its social determinants and mobilize the community towards local health planning and increased utilization and accountability of the existing health services. ASHAs are also meant to serve as a key communication mechanism between the healthcare system and rural populations. The ASHAs are trusted by the community members and hence have access to their personal information like income, details of family members, occupation, health issues, etc. Our intervention would be administered through them because they are already working in the community and have the confidence of the people. They would, in addition to the information they are already collecting, be collecting Aadhaar and nutrition programs (TPDS) access related information, which would help the ASHAs assist the families with getting access to Aadhaar and TPDS cards. Through the stakeholder analysis, we identified the ASHAs and the UIDAI as the best parties to partner with for our intervention, since both parties would have the highest influence and the highest interest in the project. The ASHAs are already established in and belong to the communities that they work for, while the UIDAI is mandated with the task of providing an Aadhaar card to every Indian citizen. The ASHAs would also be meeting their unmet mandate by partnering with us, making their interest in our intervention high. Our intervention would also result in making their data collection process more effective and useful, while helping the slum dwellers get access to Aadhaar and TPDS cards, for accessing the various food and nutrition-related programs implemented by the government for their welfare.

Customer Relationships

Enabling the relationship of trust between the ASHAs and the slum-dwellers is essential. Even though they are already taking the personal information manually the transition to a digital method may create anxiousness or feelings of distrust of who may have access to the information or the purpose of gathering information electronically. I key focus would be to clearly communicate to all stakeholders and partners the security measures and ASHA ownership of the information.

By assessing the needs directly with the ASHAs as well as working and training the ASHAs directly we hope to establish a firm relationship with the drivers of our initiative. Ensuring our initiative does not impede the ASHAs relationship with the community is vital. The project should enhance and further enable their established legitimacy and not tarnish it.

Key Activities

Key activities - Organization
• Purchase of equipment and internet services
• Needs assessment to establish requirements for the ePustak software
• Software development
• Training on the software, tablets and Aadhaar system

Key Activities – ASHAs
• Visit slum families
• Digitally note down information as usual and include additional questions on Aadhaar and social
welfare programs
• As Aadhaar Introducers, assist with proof of residence certificate which can be printed at the ASHA
office.
• Advise on eligibility of social welfare programs such as the TPDS cards and what information is
required.

Financial Resources

The initial pilot cost is estimated at $34, 650.00. We are confident that the costs can be reduced with direct sourcing with suppliers in India.

Human Resources

Trainer, Software Developer

Physical Resources

Tablets (for 20 ASHAs) sourced through Datawind; Monthly internet for pilot year with unlimited data; Computer for the Office (one station); Printer/Photocopier/Scanner

Intellectual Resources

None at present. But secure data storage would be required.

Key Partners

Key Partners:
- ASHA Women's Organization
- Health Department of the Government of India
- UIDAI – the Aadhar Identification Department of India

Key Suppliers
- Selected Internet Provider
- Tablet suppliers
- Software Developers

Unanswered Questions

1. Other partners that could fund or sponsor this initiative?
2. Alternate uses of the data gather, which when anonymized by prove useful to gain access to more funds
and partners?
3. Possible social welfare schemes, driven by partners/NGO’s that would like to be included as options for
slum-dwellers?

Revenue

As the ASHA Organization is a non-profit, a fundraising campaign would need to be undertaken to raise the funds needed. We have completed a business canvas the ASHA Organization can use to reach out to their current partners, funders and government officials to raise the funds. It is important to note that the ASHA Organization has an established fund-raising initiative called the Friends of ASHA groups where global supporters that want to aid the organization and its efforts across India can donate funds and volunteer. Also, currently ASHA is supported not only by the Government of India, but also by global Friends of ASHA from the UK, Ireland, USA, and Australia. Thus, we believe these resources can be tapped into to raise funds.

Costs

The primary costs will go to the tables, software development and training which are key components of the initiative. As data security and retaining trust between the ASHAs and the community is vital, training and correct use and storage of the data is paramount.

The initial costs are based on a pilot intervention in a targeted slum where 20 ASHAs are actively engaging with the community.

Tablets (for 20 ASHAs).
Ubislate 7SC Tablets $1,600.00
Internet $360.00
Software development $7, 000.00
Computer for the Office $400.00
Printer, Photocopier, Scanner $70.00
Ink (2 pack x 2) $110.00
Printing Paper x 10 $70.00
Training program,
Instructor lead $25, 040.00

Total: CAD $34, 650.00

Profit/Breakeven

The ASHA organization is a non-profit and does not primarily make profit with its initiatives. The ASHA incentives are paid by Government and thus direct funding would be required. There is however a profit possibility should the ASHAs change their business model. For example: should the data be anonymized, and participants give their consent the data itself becomes an asset that could generate profit if sold to government and/or partners. This profit could be reinvested to into more equipment and training in future.

Mission

Our social mission is to improve access to social welfare schemes for the poorest of the poor living in slums across India. We believe that technology can be a great enabler in the hands of trusted local community activists and caregivers that are already active and making progress within these communities.

The fact that India has an abundance of food that goes to waste and has created food programs for the poor that are not fully accessible is frustrating but not insurmountable. We believe that ePustak could be a tool to aid in linking programs to the hands that need them.

Competition

There are organizations working on nutrition challenges in India. For example:

Double fortification of salt with iodine (DFS) and Iron was designed (by the University of Toronto and Micronutrient Initiative) to help the malnutrition problem in India. DFS was field tested in Uttar Pradesh state in India, where lunch for more than 3 million students was prepared using DFS, resulting in the cure of 34% of anemic students. Meanwhile, the Bill & Melinda Gates Foundation is funding a comprehensive evaluation of the effectiveness of the DFS in combating iodine and iron malnutrition.

Measurement

Evaluation:
After the initial pilot, the ASHAs will be encouraged to provide feedback to inform the user-ability, efficiency and effectiveness of ePustak alongside areas for improvement. As a new technological intervention, a formative evaluation will be conducted, as our interest is to identify the feasibility, appropriateness and acceptability of ePustak before it is fully implemented (
A mixed-methods approach will be adopted, incorporating interview and questionnaire data alongside quantitative metrics obtained directly from the software.
In addition, ASHAs will be encouraged to document their experiences with ePustak and their new Introducer role by recording notes in the device and asked to reflect on these during the interview.
Baseline data will be captured in ePustak during an ASHA worker’s data collection with slum residents, including the number of people with an Aadhaar ID and with TPDS access. Six-months post-implementation, the same metrics will be compared to baseline data to identify if ePustak had a measurable effect on improving access to Aadhaar and the TPDS.

Post-implementation user-acceptability will be assessed as a self-reported outcome via qualitative interviews and questionnaires administered to all 20 ASHA participants. The open-ended interview guide will ask ASHAs about aspects of the system with good or poor usability. More specifically, they will be asked to comment on sections of ePustak they thought were well designed, sections that were inadequately designed and suggestions for improvement.

In addition, they will be asked about their experiences as an Introducer, connecting clients to the TPDS and the overall usefulness of the software. We will also seek qualitative data on unintended adverse consequences of the intervention and process outcomes (e.g., reluctance of clients to consent to electronic data collection).

Strengths & Weaknesses

Strengths:
Our biggest strength is that we are a multi-disciplinary group with expertise in Business Management, Engineering, Health and Global Affairs.
Additionally, a group member had the opportunity to visit India well we were developing ideas for our intervention that gave us a better context of the landscape.
Our group also had members from India that strengthened our overall understanding of the country and its challenges.

Weaknesses
Overcoming our discipline differences has been a challenge but rewarding for our personal and professional development.
Minimal access to the targeted slum and country as well as the limited amount of data available.

Critical Assumptions

1. hat the technology will be desired and adopted by the ASHAs
2. That the technology will be used
3. That the slum-dwellers will participate and allow for the electronic capture of their data
4. That the ASHAs will own the data and be able to make use of it as a valuable asset
5. That the data will be of value to the ASHA organization

Most Significant Challenge

We believe technology adoption by the ASHAs and the slum dwellers allowing for the electronic capture of the data to be the greatest challenges.

The ASHA's have captured data manually since the onset, and thus a change of behavior and buy-in is required.
The slum-dweller may distrust the process and have concerns about their data being stored and distributed, even when anonymized.

Brief URL

https://youtu.be/lxRNbJaM8lY

Attachment(s)