The first thing you have to know is that you don't know anything - Dr. Armida Fernandez and Vanessa D'Souza

Sorry, the AC is off because of the noise. Would you like me to turn it back on? Okay. How well you recognize that I was looking for, sir. You know, is there AC on? You looked at my eyes and it's. See, this is why in-person meetings are far better than Zoom calls that we've had to do. Any numbers, Vanessa? I love Doc. This is our Doctor Fernandez always sets it up right, Vanessa. And then like 20 minutes from now, she'll have butter's command off numbers. She'll be like, "No, no, no, but that's like, I think that's inaccurate." Okay. I know how these wise elderly people work. My guest today is the founder of Stéah, Doctor Mirafor Nandes and their CEO, Vanessa D'Souza. Stéah has been working to improve health outcomes amongst communities across Mumbai and India since 1999. Great. So first of all, thank you for participating today in being a guest on No Cost Extension. We really, really appreciate it. And more importantly, thank you for all the phenomenal work you all have done for many, many years. Special. No, and we've been so lucky as D'Souza to be friends of Stéah for many years. And I think that friendship just continues to grow, whether it started with Doctor Fernandez or others, and Vanessa for the last decade, it really just shows a lot. And I know when I was speaking to Minakshi and Anshou from Goonsh, so I interviewed them two weeks ago. And we were just talking about the friends that we've made along the way. He has made it all worth it. That's true. That's absolutely it. And we're so lucky to meet such amazing people and again, just build these relationships with honestly, I don't think happens naturally in other sectors. Right. But to begin with Doctor Fernandez, and you were the first speaker, in fact, at our very first thus or philanthropy forum in 2009. And that was a goal of really to bring philanthropists to start talking about philanthropy, understanding what's happening. And we had individuals like yourself talk about what led you to do the phenomenal things you were doing in government hospitals in 1975, when I was born, in fact, and then how did that lead you to start Stéah? You know what they were, I think, I spent a large, almost three decades in a multiple medical college in hospital. It was a wonderful experience that I had in many ways that made me think differently. And the experience was that when I joined the hospital, I was a pediatrician. And I saw that among our deaths, the newborn babies, those less than four weeks, it was really high. Embarrassingly in those days, out of in a sick preterm unit, out of ten babies, one, you know, seven succumbed. And I went to the head of the department. So, this is why don't you do something about it? So, overnight, I became a neonatologist. There was no department of neonatology. I think that neonatologists didn't exist at that time. They, not in India at least. So, I moved from pediatrics to a newborn to find out why they died. And I found out that the most common cause was really infection. Looked at sources of infection. And it were the incubators that had, you know, all the bugs difficult to clean. It was a milk that we use formula and other milk with bottles. A whole lot of things. And we said, we need to change that if we had to reduce mortality. Unfortunately, in a multiple courtation in those days, things have changed today. The only thing you have is lots of patients. But, you know, you don't have staff. They didn't have money to buy new equipment. So, we had to think hard, you know, scratch your head. How can, within the existing circumstances, reduce mortality? And we did, you know, what I would call no cost technology. You don't have to need the best sciences to save babies. And simple things. We got rid of incubators, used warmers, used elected bottles to warm up babies. We got rid of the bottles and we got rid of formula milk, started the human milk bank. And you know, change the practice. A simple thing like changing the wash basin from outside the unit to inside the units of people will wash. So, these were some of them, but a whole lot of things that we changed. And the mortality decreased. And it was decreased deeply. And we were really happy. And the more the mortality decreased and thought, oh my god, we've done a great effort. And we found that when the babies went home and we struggled with them for weeks, saved their lives, many of them did come back. And when we found out that they didn't survive when they went back to the slums and some came back with problems of deafness, or vision, and all because of the complications. So, made me think that yes, we as doctors, as we do a great job within hospitals, we work very hard to save lives. But finally, when these babies go back to their communities, it's a different story altogether. And therefore, one needs to work within the system. There is need to work, but there was even more need to work outside the system in the communities where these babies are born, where their mother lives. So, then we changed these circumstances, actually to decrease the numbers of babies that come to hospital. Also, the second thing they were in, a municipal corporation like ours, we saw mothers, the way mothers were treated. This was the 70s. The way they were treated, if we had a female child, they wouldn't come and visit you. But the family didn't come off the baby, it was very sick. I have to go home. I'll take my baby and go home. Why? Because who's there to cook for my husband? Things like that that really upset you and then you had the burns ward where you had mothers, women, not mothers, but women who came to suicidal, homicidal burns. And of course, then there was a baby six weeks was raped. So, when you see these, you think, you know, the hospital is dumped, where you can sort out things. And one must move, work within the hospital, but move out to bring about this change. If the other thing I felt as I worked is that if you're doing work and you're doing good work and you don't really ask for financial support in my institution at least, people would allow you to bring about change. So, change was possible because we were allowed to change as long as to write down with no financial implications to the ones who got pushed at that time. Now things of course have changed. Once I saw that I could bring down mortality of babies in my hospital, in sign hospital, we had, you know, 10 to 15,000 deliveries. The fact that I could ensure that all babies in sign hospitals, so many babies could only get human milk. You know what I did is I said, we must spread the word to other municipal hospitals, you know, municipal hospitals, 13 hospitals, 26 maternity homes. So, when the DMC at that time and I said, can I go, can our team go and tell them how you can bring about the change and they allowed us. So, you know, I had, we used to train all the maternity homes and all the peripheral hospitals first in neonatal care, reduced maternal mortality in municipal hospitals. You can do it. That's one thing. The second is when it came to a breastfeeding and milk bank in breastfeeding, we then got unicef on board and we had the first infant feeding program for the whole city of Mumbai. So, I saw the changes that we made were within the hospital. When the babies went home like I said, they were, many of them succumbed in their homes or had complications. And I thought it would be more cost effective if they prevented babies from coming to hospital. If we got the mothers early enough, they went through antinatal care, they came regularly to the hospital. And we wouldn't have so many pre-term sick babies come to the hospital. It would have made the job of hospitals easier. But the fact that when I saw that baby rape, I know I couldn't do anything at that time, follow up what happened to that, that she'd criminal whatever rape that baby. But I swore to God that when I finished with the hospital, I'm going to do something about violence. And therefore, these two thoughts in my life, I think even before I left, I started in 1999, Sneha, and that's how the thought came to me. And Vanessa, if you can give us a little bit of a sense of where does Sneha do now? So today, they will, as you know, from the time Dr. Fernandes started it now, we had a much, much larger organization. And like she said, Sneha works at all the critical points of the life cycle. We work on preconception care, work during pregnancy, with children aged 0 to 6 years for prevention and treatment of malnutrition. We work with adolescents on physical, reproductive and mental health. And across all ages, we work with women and children on prevention and addressing gender-based violence. And our objective really is to break the intergeneration cycle of poor health, because we do know that they are not going to be able to do that. these are cycles. So an anemic adolescent will very likely give birth to a low birth weight baby and a low birth weight baby is likely to be a malnourished child and so the cycle goes on. Similarly, if you look at violence violence also is cyclical, a young boy or girl watching the mother being isolated or the father or the some relative perpetrating the perpetrator and therefore this kind of behavior becomes normative and then gets carried on to the next generation. I think one thing that Snéha believes very deeply and is working with the public system. So whichever system it is, whether it's health, nutrition, if it's safety, we work with the police, we work with the district legal aid, because we do believe that if you want to sustain change, then you have to work with the systems that actually serve these vulnerable communities. So our model is intrinsically one that works to strengthen public systems. On the other hand, like Dr. Fernandis was saying, "A note of the women and the children and the families, they don't have adequate knowledge on health, reproductive health, gender, and they're not aware of how to access services because remember, urban informal settlements have high migration rates. So you have 20 to 30 percent, this we've seen across all our communities." So there are new mothers coming in, the mothers you worked with leave and go to the village or they moved to another community and therefore this need to constantly work with them. Now there is a large number of them that will access services, but there are also a lot of reluctant mothers. So therefore you have to work with multiple stakeholders, it's not just the mothers, you'll work with other community influencers and that's where our work with the community has come in very strongly. Working with community action groups, volunteers, influencers, like religious leaders, sometimes even corporators, we have seen some good corporators by the way, who you can get good work done with this. So I think it's a combination of all that. And we talked about Dr. Fernandis' background and she's been a doctor, she's been there for 30 years at a government hospital, then went to start this. What was your journey Vanessa into the sector? So mine was very different, I've come from the corporate sector and I spent 21 years in the corporate sector and actually I started, I wanted to do something different, they were like, no I don't know what I wanted to do. And one day Dr. Fernandis called me and said, you know why don't you come and volunteer, snare and help us to fundraise. And you know you can't refuse Dr. Fernandis, right? So for two years I actually volunteer and I helped to fundraise and at that time Dr. Fernandis you know was saying why don't you come join us full time and I was like, you know, wondering what would I do in an NGO like snare? I'm not a doctor, I'm not a social worker, I'm not a public health person. And finally when one of the executives of the CEO at that time wanted to move on Dr. Fernandis said, you know why don't you come in and we agreed finally that we would do a three month trial period. And at the end of six weeks you know true to Dr. Fernandis she comes to me and says, I can give you three months, you have to decide this weekend because we have this don't know so that you know if you don't have a full time CEO, I'm going to withdraw funding. And guess what they were, this was the nutrition program, right? That was the largest program. And you know, and I'm thinking, you know, we have these 18,000 babies and you know if this money goes, you know, this whole thing will be my sponsor, I feel very responsible for it. But having said that I think by then I knew the organization well. And I also realized that I could add value in a different way, you know, while I wasn't a doctor or a public health specialist, I could certainly add value to building the capacity of the organization to take on more, you know, a work over the years and actually a scale impact over the years. And that's how I landed up. And it's now nine years there. So that I've been full time with Smeha. And on that note, what are some of the things that one has to unlearn to be successful in this space? Or is it just learning a brand new set of scales or both? I think you have to unlearn or rather the first thing you have to know is that you don't know anything. You have to come in there literally thinking that you're going to have a blank slate. And I think this is something a lot of people in the corporate sector think we can bring, of course you bring skills, you know, you learn certain things, you bring certain skills with you, bring certain ways of thinking. But there is so much of knowledge in this sector. And if you're willing to listen, I think that's the first thing. So I would say the first thing is coming with an open mind and a keen desire to learn because you know, it's nine years they were and I'm still learning so much from everybody. The second thing which I think is again very different, you know, the corporate sector you wake up on morning, you say, I want to change this. And you know, by 1 p.m everything is changed, right? In the social sector, it doesn't happen. Even if you have an idea, you have to sell your idea. It's very participatory decision making, which can be sometimes, you know, a little frustrating if you're trying to do things fast. But I think what I've learnt is that while it takes a lot of time, number one, there's so much of knowledge within that you can actually, whatever your ideas, it can become 10x the idea. If you're willing to take people with you, secondly in the sectors once there's buy-in, then they will adopt and run along with it. So you have to give it this time and then to take a life of its own, you know, you don't have to worry about it. But I think if you're, these are things I learnt. So, you know, it tries our patience at the beginning, but now I realise that, you know, it's the right way to go in the sector. I want to add to what Winner says, you have to deline, you know, I retired as professor of neonatology in Tien of an institution. And I come into the slums when you're in an administrative post or you're a professor, you lecture and you, you know, tell people what to do and within you know, people do exactly. So fortunately for me, when I moved, I had people from the social sector with me and the first thing they told me, you cannot lecture, you cannot sit on the chair, you have to sit on the ground with everybody around you. You have to speak the local language and you have to listen. It isn't easy and like, when I had this problem from the, you know, coming from the country to an agiosector, I think also as a coming from a teaching professor, you know, we have a different mindset and what Vanessa said is so true. You must be willing to learn. If you want to bring about change, you must be willing to learn and once you learn, and then you're learning all the time. And Vanessa, to your point, I mean, I think it's not just been the board, which like you said, was 50% corporate or Dr Fernandez, but there's been a large number of people who are part of this Sneha team. And I say this because I think we've seen again, and the same thing holds true in the for-profit sector, when there's a leader from the outside that comes, people feel like, oh, well, who is this person? Why is that happening? I should have taken that role. And so what are some of the things that you continue to do to sort of be a leader follower because from what I understand that has been really your style from day one? Absolutely. I think, first of all, they will have to say that we have an outstanding really outstanding. And there are of course program directors who beam with Sneha almost from inception, some from inception, but we've also built the next line. So now we have a large strong team. And what's I think what I value is that there is so much of diversity in that team. So we have, you know, from a medical doctor who's the executive director, we have research people, we have finance people who are specialists in nutrition, anthropologists, there's somebody who's in gender-based violence. And I think that diversity really is the biggest strength we have at Sneha. And I think as a leader, if you're willing to embrace that diversity and actually use it for the growth of the organization, I think that's very critical. Having said that, it wasn't all smooth. I mean, there have been of course challenges. But I think one of the things that we, in my early days, when I joined, I did find it a bit difficult because, you know, the senior team naturally was checking me out. And she's the founders. And, you know, everyone looks at her through roasted clasps. And I was this fish and a fish bowl. And, you know, what's she going to do? And every move was being watched. And one of our donors actually helped us to set up what we call an integrated coaching program. And I thought that was very useful because it created a safe space for us to talk and actually set up goals for each of us and then work with other members of the team to achieve the goals. And I think you need to find these programs where you create these safe spaces and then you begin to know people at a much more personal level. And then you accept that person, you know, as the person is with the strengths, with the areas that they need your support. And we've always had lots investment in leadership development. And we have a full-time person whose role is capability building and leadership development. And her role is to help all of us continuously build as leaders. I think the Dastra leadership program is very valuable. They were the one that Yodts had for seniors. So there have been different points and different stakeholders. Dastra is cosplaying a very critical role. I think most of my senior team have gone through your Dastra leadership program. And I think those are very critical for building the organization, building the leaders. How do you convince individuals that leadership development is important and critical and will add value to the impact you're trying to create and is not just another overhead expense? I would say it's leadership development and other organization capacity building together, they will, I wouldn't because I don't think you can leaders develop in isolation. And therefore when donors are looking at an organization and you want to scale impact and you want an organization to strengthen governance, you cannot do that without the building blocks of people technology. You know, your basic governance. I think those people, technology governance are three building blocks that donors must invest in because that eventually will help you to scale it back to later. We have been fortunate actually to have donors who have funded, given us unrestricted grants, who believe fortunately that it's important to develop leaders, it's important to invest in technology. And thanks to those donors, they were when the pandemic broke, we could shift overnight to an online platform. And continue literally the next morning, serving our communities. And you know, the donors who helped us now realize how valuable that is. To build out the organization, not just a program, but all the aspects of the organization's simultaneously. - And you talk about this safe space. Can you expand a little bit about that and how come that's so important in this sector where everyone is supposedly coming for a good cause, we're all good people, why is the safe space needed? You know, everyone's so busy, they will on a day-to-day basis that you don't have time to really connect. And you know, we're all even geographically located in different places. But these kind of programs and opportunities, so for example, in the pandemic, we had what we call the fun Friday. Then we later, we called it the learning Friday. It was an hour because we all realized that we needed to connect to the personal level. People were going through a hard time. So this was with my program directors, associate program directors, was a wider group. It's not necessarily a program, you know, for example, the fun Friday, learning Friday, was a Zoom call, the beaded, you know, scheduled Zoom call. But each time the topic would be different. It could be, you know, what does a difficult conversation mean to you, how do you know? Then you talk about difficult conversations. Everybody comes with so many of their own problems. And it makes such a big difference if you know where someone's coming from, you know, you can work with them very, very differently. - Dr. Fernandez, when you were at a hospital, everyone knew where the hospital was. People would come there. How did you start working with the community? How did they know where to come? How do they know what SNH was? How did they understand even the programs that you all offered? And for somebody then who, again, was in this profession for so long, who was teaching this, how did you start sort of taking two steps back and saying, I'm gonna listen to the community and have them first find value in themselves, which clearly is there, but they may not identify with. Then how do you get to a stage where you ask them what the issues are? And then even further from what I'm hearing you say, have them volunteer and actually look after their own community. I mean, that entire process for somebody who's a doctor who's been doing this for 30 years, where does the sort of the patients come from? And the value of doing that, versus just going in and saying, I know this is an issue. This is what I saw. This is the solution. It's quite true. They were writing the first thing as a teacher. I'll tell you, when you listen to your student, you learn so much from your students. If you listen to a patient talking a mother, talking about a baby, no one can tell you better the diagnosis of a baby than her mother has said. So if you're willing to listen and learn, then you know you can do much better job of diagnosing and treatment. And when we start with our communities, and the first thing you must say that, I'm not going to open my mouth for some time. And when you listen to them and we said, if they did the right thing, if for example, are Indian mothers, what all their babies next to their chest, hand feed them and hold them close. Now everybody is talking about this. You don't know, I touch, though keeping the mother, can't grow mother care. So things that you learn from what mothers are already doing. So when you find that they're doing something right, whatever practice they are following, we say, wow, you're doing a good job. So they say, okay, they understand what we're saying. And then slowly as the conversation goes on, then you find out what they do wrong. I'm putting oil. When they, if they say I'm massaging my baby, they're wonderful. It's so good that you yourself massage the baby. But then when they say I put oil in the nose and tap that we say, no, that can cause later on. Besides the mothers, we used to get their husbands along. And then we had these shows where the husbands answered questions and we gave them prizes. And you know, it made men feel so good. The men were getting involved in what the child cared and the baby had to be fair and things like that. So we had, you know, programs like this, when was not only the mothers, we used to get the mothers and laws also appreciate what they do and the men. - I just want to add over there, you know, where we really saw the impact was during the pandemic. Because, you know, we were overnight, you know, stuck in lockdown. And there are so many stories of, we actually call them COVID-owned thus. So we had these volunteers, we called them an I.D. card from the municipal corporation. So they could move. You remember, no one could move around. We were locked in. It was one very interesting story where there was a family that was that had COVID. So, you know, how everybody had to be rushed off to the quarantine centers. And that family then was ostracized by the community. And one of the volunteers actually went and got heard of community meeting to explain to them, you know, this could happen to any of us and how you need to make sure that you're sympathetic. And where the family came back, they had a joint meeting with the family and the rest of the community. So, you know, how do you work together, live together? So I think these volunteers have now taken it upon themselves to go way beyond just prevent a promoter of healthcare that we are teaching. We're actually taking responsibility for their communities. - No, no, and I think that's clearly an area that for whatever reason, new funders and sometimes even existing funders confuse that the amount of work it takes to, number one, listen to the community, have them lead, real empowerment. That takes time and effort, but then that's sustainable. - That's right. So many people, especially honestly nowadays, I think with the restrictions that are being put on, for example, on CSR, which is we want results right away, we want this, that in the other, your sort of that argument, I guess, of faster results is actually enabling sort of money to be wasted even more. - That's right. - Absolutely right. - These are protractive problems, David. I mean, if they were so simple, they would have been so long ago. So you have to, again, there are different ways of solving the problem. It doesn't happen overnight with one or two interventions. It's a multiplicity of interventions because these are intersectional problems. While I'm working on nutrition, I need to work on domestic violence. I can't not work with the mothers being beaten up. How is she going to look after her child? So I think it's important to understand the intersectionality of problems. We do collaborate with other field-based NGOs that work on other aspects. So that, you know, as a community, the community can be so. - And with that, I guess, I know one of the areas that you have started looking at is relative care. And if you can speak a little bit maybe about that and how is this also linked to pretty much healthy communities and one of the largest cities in the world. - We know that health brings on a lot of suffering. You know, and suffering of different types of suffering. And you could have a physical suffering as a pain or you could have mental suffering, way of depression or you could have anxiety, sometimes even suicidal. If social suffering, then where is the suffering the most in life-limiting disease? You know, a patient who has cancer, life is limited or a person with dementia, person with Parkinson's, a person with stroke or any chronic heart or lung disease. Actually, the motivation was in a way personal because I lost my daughter to cancer. And I know the suffering I went through, she went, my husband went through and I, I didn't know palliative care existed at that time. Well, it was existing, but being in the immunietal world and the social sector, I wasn't keeping in touch with what happened. So once I went through this, I said, is this something we can do about it? You know, something, and then I realized it's something like palliative care. That's when I said, let's do something about the suffering and palliative care. After we started working, I said, let's create a network of all those. So we reached out to people who are working in palliative care across the city. We formed a network of people so we could work together and therefore now we are doing training with the government people, having courses and all in palliative care. I think it's made a big shift in now because we are talking so much about palliative care working that are people who want to start hospices for palliative and non-cancer. So actually we've been appointed as the implementing partner to establish the model of patient palliative care department. So that has an OPD service as well as home-based because many of these patients are not mobile. So you need to provide home-based service to them. So there is a team of Dr. Nors Counselor that works with the palliative care patients and the doctor provides pain management, symptom management, the nursing tube feeding. It could be catheter, there is some nursing needs and the counselor provides counseling to the caregiver as well as to the patient, caregiver and family as well as the patient. And then we have other services like Nutritionist, we have a physiotherapist, an occupational therapist to provide other support services for the patient. Now this is done at the center as well as we have teams that go home across the city of two homes of these people with life-limiting illnesses. So in fact, recently in the pandemic when the vaccinations started, the COVID vaccination. The municipal corporation got a list of bedroom in patients and then you know we actually started contacting all these bedroom in patients around the OPD to let them know that these services existed and they're completely free of charge and that they should come in you know a way of the services. So I think it's a new fairly new venture they were but there is a lot of scope it's somehow people don't know about palliative care and I think there is a need for people to know that if you are facing any life-limiting illness then there are ways to get help for not just for the patient but even for the care kept us. And through these years I guess you all have a choice to scale pan-India in terms of outreach or to scale the number of incinerary or interconnected programs that you look at and it seems that Staya has been a group that's gone more depth and said look health is important all families needed if we built this strong network which over the years in the community how do we satisfy sort of all their health needs and again not directly but getting them sort of connected to the various government hospitals or institutions that needed but I guess how have Staya's programs affected communities outside of Mumbai? I remember Dr. Pala and this time discussing 2015-16 it said you know how do we scale Staya? And there were two ways to do it one is we could set up branches of Staya across the country wherever we needed to and the second we thought that you know if you think of Staya's biggest strength it's actually creating evidence-based models of urban health intervention. We have this unique combination of researchers and implementation people etc that work together and of course because the founding team of medical doctors researchers very much part of the DNA of the organization. So we said instead of us doing it why don't we find partners wherever we want to scale we find partners to scale. So for example they each took foundation a scale that we did scale up. So after foundation works on maternal and child health they don't work on gender-based violence but they did see a lot of violence in the community and they felt that this was impacting the health of the mothers so they actually had a partnership with us which lasted a year and a half where we took our technical knowledge on addressing gender-based violence. We contextualized it to rural charcund requirements and then helped build capacity of the team at H.J. to rule out this program. Now what this does really is that it uses our knowledge but it also uses the understanding of H.J. of their community. If I have to go and work in H.J. it'll take me forever to learn about the community. So you know similarly we've done you know our maternal and newborn health program has gone to Poon also we've done five such partnerships and I think as an organization we feel the better way for us to scale is to scale in partnership with other NGOs where we make our technical knowledge our trainings our expertise available and build their capacity and then let them then roll it out into their communities. So that's the way we scale outside of the greater Mumbai region but within the greater Mumbai region we believe in going deep and I think the pandemic actually really forced us to go even deeper where we started looking at social protection schemes and that's because in the first three months at the pandemic we didn't need assessment we knew things were changing in the community we didn't know what those changing needs were. So the need assessment actually brought out of course food insecurity to a great extent that we never seen in Mumbai the need for income because there was lots of wages and of course health information and that's when we partnered with the COVID action collaborator because we don't have knowledge on social protection schemes and they helped us to set up a social protection help desk which now is across all our communities we provide social protection schemes. So we've done about we've identified 12 to 14 schemes related to maternal child health and gender-based violence our target group continues to remain the same and therefore in many ways we'd call deeper in our implementation programs but we've gone wider through partnerships. And you talk a lot about evidence and a lot of people talk about evidence and data and impact. Can you give an example of how you've used evidence to either verify what you're doing as being on the right track or even using evidence to say actually we need to have a mid course correction in what we thought would happen? I can give you an example of what we found evidence that didn't work. Here we had a big program with University College London where we had these community groups where we worked with women and then the women took forward what they would do and with whatever they took forward they would reduce maternal and newborn mortality. So what happens in the city of Mumbai we couldn't have large community groups we were working with urban slums. So we had galley groups you know people because if it were two galley down the lane they wouldn't know the women at all. So we tried to get the women together and we spent I must say I don't know how many thousands of meetings they had with each one of these groups to look at the issues of maternal newborn health and how they could bring about changes to try and get the impact and it was around the mice control trial and at the end of the trial although we wanted to see that change and we could say oh it's possible even in Mumbai and in urban slums we found fairly that it didn't make there was a reduction in maternal newborn mortality but it was both in the groups with which we worked in the ones that we were you know that we didn't work at all. So then we realized know this in urban settings or at least in urban slums like Mumbai this methodology would not work. This is some data that we actually published to say that it didn't work. So I share with you what worked in the paternal and newborn health program. So again the group of doctors had seen that you know virus mothers were being shunted from one hospital to the other at the time of delivery. So we all keep hearing these stories on the newspaper and they started working with one very small link within Mumbai on the central line to set up what we call a maternity referral network. Now what this does is it makes sure that women are referred to the appropriate higher health facility women who are at risk in the shortest possible time. So they're not shunted from one facility to another. And while we worked in Mumbai we then found that this was working well doctors who were to send to the mother as well as the doctors who were receiving the mother both felt that you know that this was a formal referral system otherwise it was all informal. So we sent this up then from the central we set it up across Mumbai. Once Mumbai started you know found that the referrals were working effectively we collect data directly from the registers of 181 health facilities even today. The other municipal corporations around Mumbai also began to ask us to scale up this work. And again it was based on evidence and the evidence was how many women are being referred appropriately based on protocols between one health facility and the next. So we then rolled it, scaled it from Mumbai to three municipal corporations. So we went from one to four and then we went from four to seven because again the other three municipal corporations said you know we also want something like this to happen. And now they were we're going to the next three which is 10. We also then partnered with save the children in and to set the same system up in Pune because Pune on municipal corporation also felt that the referral network needed to be set up. So this is an example where we have used a model based on evidence and data and this was now the medical system. So you know doctors only take decisions based on data and they saw the value that this system was bringing to ensure bring down the mortality rate of mothers and newborn babies and that's how they asked us to scale up across. So this is an example where we've used data as well as a model to scale our work. And when you talk about 10 municipalities that you've scaled this to what's the approximate population? So the seven that we have set it up to the population would be 25 million I would imagine maybe more but the number of high risk women that actually have benefited high risk that means you're saving the lives of mothers and babies. In the last five years it's 48,000 high risk pregnant women in labor and that's you know the women who have a veiled of the system. So you're actually the system is helping you avert deaths of mothers or maybe you know not very good outcomes of mortality outcomes. No that's absolutely amazing and I say that just because I don't think people realize that again when we'd say Snéha is in Mumbai, your programs affect 25 million people if not more. What we directly impact so when I say directly I mean actually I have data of mother and child of my system is about 250,000 mothers and children and these are actual women that we are counseling, we're following up with we're collecting data on. The population coverage so when I say population now I mean the communities so we have over a million 1.1 million of these communities that we are directly working on. The maternity referral system works across seven cities so that's slightly different because that we don't consider ourselves working across all that population because we say there we count the actual high risk cases you know we're a bit conservative that way because we're very data driven and unless we have data for something we know we won't say we're working so but otherwise I would say the actual communities if you take it's about 1.1 billion that we're working on. Just taking this one example of the women there is a population coverage of approximately 25 million out of which 48,000 women use this referral service. So you know it's difficult to say a day but so for example we set up a program on gender-based violence. We have OPDs in Sin Hospital, KEM. We have run the one-stop center at KEM at Nair Hospital. Now, these women are coming from all over, not just Mumbai. They're coming from outside of Mumbai. Right now, you know, at the end of the day, when you say you're providing a service, there are so many people benefiting. And some of them will come in there, you know, and then they will actually avail of your services. But some of them might just come in, they may take information, they may take a counseling session and go away. But unless we have actually provided a service to them, we don't count it as a population, because we're not able to track them afterwards. For us to be able to track their impact is important. And so it's not touching, but it's actually being able to work with somebody and track impact. If you look at the nutrition program, you know, if you remember, 18,000 was the number of children we had said. Actually, over that four-year period, we screened 35,000 zero to three-year each year. Now, why did that happen? Because kids would come in and go out, come in and go out. But unless we had worked with them for at least six months and able to show some impact on their nutrition, we didn't count those kids. Because it's not a question just running and weighing a child once, the child doesn't become your beneficially. The child becomes your beneficially when you actually bring about impact on that child. No, and I think it just demonstrates again how to a certain extent as NGOs, we hold ourselves on a very different benchmark than our corporate peers in health do. And somewhat nonsensically as well, because it, I mean, you do so much, Stan, and all of the other NGOs. But sort of the funder or the sector, I don't know where it sort of originates from, but they want you to track every single child versus the four-profit sector says, "Anyone who comes into my doors." And I guess the standard that people hold the NGO sector too is unrealistic when you think of any other standard that whether it's the corporate sector or even government for that matter. Both I think they were as NGOs and as the whole sector, we have to stop just chasing numbers. We got to look at impact. You know, it is very easy for me to distribute flyers to 10 million people and say, "Hey, guess what? I provide messages on gender-based violence." That's not going to change people's attitude towards gender and gender-based violence. It's when I work with them, when I can work with their families, the communities, and actually bring about a change in the way they are thinking about violence, that's what I made an impact. So I think somewhere we also as a sector have to stop saying, you know, we're touching so many million people, touching another problem. How much change are we making? And I think it's somehow we have been very, very cognizant of the fact that for us, impact is what matters. Even when we're identifying partners to scale with, we will identify a partner that believes in impact the way we believe in. Now, I have to tell you the story. We had corporate, I won't mention the name, who well did a volunteering assignment with us. And they came in when we had our six monthly KRA meeting, which is, you know, in the organization. And they were surprised to see we have so many KRAs, including fundraising, communication, HR, finance, admin. And they were saying, you know, in the corporate sector, we don't have so many. Now, sometimes I think it's also a bit worrying to me because your frontline worker is obsessed about targets. And therefore for us as an organization, to make sure we maintain that balance between targets and quality. There's no compromise on quality. And therefore, we maintain that, you know, you have reasonable targets, you stop for those targets and make sure that quality is being done because we are dealing with lives. You're dealing with somebody's health. You cannot compromise on quality. And I think this is something that, you know, as boners, they need to understand that it's about actually making a qualitative and a change and a difference to that target beneficially. That's critical. Given that we've gone through such a horrible health tragedy as a world, what gives you hope sort of going forward with SNHA, the work you're doing, how do you keep motivated and inspired? I think because of the COVID, we are even more motivated. You know, it tells us that, you know, whatever you plan, there can be something true disaster in our global disaster that is affected. And it's affected health of people. It's affected not only the physical health that affected the mental, social, all aspects of health. And therefore, the need, the need to work even more than even closer to the communities to help them, you know, come out of this. You know, they were, I think the pandemic has really brought to light how important health is for everyone. Health has never been a priority, even for you and me, right? Until we fall sick, we don't think we're looking after health. So health, if you have health, you can reach full potential. So whether you're a child, you're an adult, it doesn't matter. And I think that belief that health is really important and therefore one must invest in health is something that gives me motivation. The second thing that I think gives me tremendous motivation is to see that we are igniting fire in those communities. We are providing sparks that actually help women, men, children get empowered to take charge of their own lives, not just their health, their entire lives and take charge of their communities. And I believe that if you really want to make change in this world, sustainable change, it cannot come by NGOs. It has to come because communities take charge as well as systems get strength, right? Ultimately, we're just catalysts. And I think seeing in this pandemic more than ever, we have seen how communities have stood up and really served themselves as well as serve the systems. I mean, the amount of support they provide in public systems. So I think to that kind of strong belief in really feeling that we are building over our igniting power in human beings, I think that's what gives me. Excellent. I think we're done. Sorry, the AC still offer. I hope you all are feeling good. And you know, we've not spoken about how much dust from health. I'll stop the point. No, no, the point is that dust from the onto. No, not too. No, but the point. I'll tell you honestly, they were, if it wasn't for you and me, both of you all, I think they were very nice to me and yes, you're doing a great job and all. But why don't you get a further do this too, that all I think made a huge huge difference. So we are totally, so you're really part of us. So you can take a credit for all that is happening. There's no credit at all. First of all, I think the journey at is so much more. And I think we learned so much from working with you all and ours, I mean, speak on stand, everywhere we go. Find us at dustera.org/nce for more details. Subscribe to No Cost Extension on your favorite podcast platform. [MUSIC]