New Delhi: Rajeev Asthana remembers the day in 2006, just before his wedding, when he walked into a drug store to buy a pack of condoms. The man behind the counter in Lucknow’s upmarket Gomti Nagar area had just one question: Are you married?
In response, 21-year-old Asthana’s face flushed and he beat a hasty retreat.
Today, the scene might unfold differently, thanks to Saathiya, a youth-friendly reproductive health initiative in Lucknow, the capital of India’s most populous state Uttar Pradesh, or UP.
A number of pharmacies in the city are participating in the programme aimed at taking the embarrassment out of shopping for condoms. They also dispense advice and information on family planning and reproductive health as part of the initiative launched in October by a group called Private Sector Partnerships For Better Health and USAID, the development funding arm of the US government.
Saathiya, which means “trusted partner” in Hindi, has quickly caught on in the capital of a largely conservative state (UP) of 167 million people, chosen to host the programme because it is a populous region where family planning and reproductive health indicators, based on government statistics, are low.
Total number of calls received 18,497 (from 27 Oct 2007 to 23 July’2008)
The average age of marriage in the state is 17 years for women and 18 for men.
Seeing the response it has generated in Lucknow, within the next two months, Saathiya plans to extend to Dehradun and Haridwar in Uttarakhand, and Agra, Allahabad and Varanasi in Uttar Pradesh.
Youth-friendly approach: The programme aims at taking the embarrassment out of shopping for condoms and will soon be extended to several other towns in Uttar Pradesh and Uttarakhand. (Photograph by Ramesh Pathania / MINT)
Its success is significant because it represents a joint effort by the private sector, civil society and state government—with each stakeholder having its own motive. The model, observers say, is an innovative initiative to reach out to the young and sexually active.
“Campaigns apart, year-long activities in and around cinema halls, paan shops and general stores should be targeted too and sales staff trained to speak in the local dialect, using images and themes they can relate to,” said Sanjay Goel, the Lucknow-based marketing manager for a technical support group set up by the government-run National AIDS Control Organization and managed by the Hindustan Latex Family Planning Promotion Trust. He spoke as an independent observer and is not involved in Saathiya.
Gap in knowledge
Saathiya’s strategy rests on working with the city’s pharmacies and the Indian System of Medical Practitioners (ISMPs) to create awareness amongst the target group and to bring about behaviour change.
Baseline surveys prior to entering the Lucknow market pointed to a gap in knowledge about contraception and reproductive health. Newly married couples were either turning to their spouse for information or to a friend for advice, and in both cases, not coming up with accurate information.
Though results from the field will be tabulated by the end of the year, indicators already show a 30-40% increase in sales of contraceptives with Lucknow areas such as Alambaug registering a 100% jump. There is a shift in the way chemists and sales staff deal with customers; they are told to initiate a dialogue with young people, to win their trust so that they can seek advice on safe sex, contraceptive choices and the best way of spacing apart their children.
The programme addresses both the demand and supply side. Demand was created by strengthening contraceptive knowledge and counselling skills among selected chemists, shop sales clerks, family physicians and gynaecologists by putting them through eight to 12 hours of training spread over two days, timed during lean business hours.
Out of the 1,800 registered chemists in the city, 200 have been trained in addition to 150 ISMPs. The number is expected to double by September. A helpline links consumers to other medical providers and sources of information, converting to higher contraceptive sales and availing of services.
“Our target audience was the 15-24 age group in the middle and lower income categories. We were not looking at slum dwellers or the upper middle class, since our programmatic idea would not be sustainable amongst them for they lack the capacity to purchase products,” said Sanjeev Vyas, programme director and communications adviser.
“With low literacy levels and weak Internet penetration, our safest bet was to combine a strong visual mass media campaign that for the first time looked at any sort of training programme, not for MBBS doctors, but for chemists, sales staff and ISMPs”, Vyas said
Lucknow’s medical community supported the programme, along with the Retail Chemists Association, National Integrated Medical Assocation, Lucknow Obstetrics and Gynaecology Society and medical practitioners in Lucknow who signed up for Saathiya.
The reliance of the lower and middle class on their friendly neighbourhood pharmacy for advice on over-the-counter drugs for minor ailments is huge, as is the dependence on alternative medical practitioners. The challenge was to make these providers transition from product to knowledge transaction.
Research worldwide has shown that the young prefer to obtain family planning information and products from the private sector and are more inclined towards temporary methods as opposed to permanent or surgical interventions.
According to Lena Kolyada, country coordinator of Washington-based PSP-One/Abt Associates, “The swiftness with which we could see results on the ground was because of the partnerships that were created between government agencies, the private sector and the NGO (non-government organization).”
Condoms (J.K. Ansell Ltd), emergency contraceptives (Win-Medicare Pvt. Ltd), low-dose oral contraceptive pills (GlaxoSmithKline Pharmaceuticals Ltd) and Standard Days Method (CycleBeads-IRH/Ross Life Cycle Products) were some of the companies that were partners on the programme. The Standard Days Method helps couples avoid unprotected sex during fertile periods of the female menstrual cycle and is yet to gain acceptance in India.
“We decided to tap this route and found chemists eager to participate. They were happy to see their status being elevated. Many have proudly framed their participation certificates and displayed them over their cash counters. It is like a “mini doctorate” for them,” adds Vyas.
To strengthen demand, a toll-free Saathiya telephone helpline was set up which Bharat Sanchar Nigam Ltd (BSNL) landline and mobiles users could call up to have questions on safe sex and reproductive health answered. Bharti Airtel Ltd and Reliance Communications Ltd as telecom partners pitched in by offering free services.
Results indicated that girls were more at ease talking to female counsellors, and vice versa. So all communication material had two toll-free numbers. From 20 calls in October 2007, the number has gone up to 18,497 total calls by July 2008.