INTRODUCTION Overview: Population Services International (PSI) is a nonprofit organization based in Washington, D.C. that harnesses the vitality of the private sector to address the health problems of low-income and vulnerable populations in more than 60 developing countries. With programs in malaria, reproductive health, child survival and HIV, PSI promotes products, services and healthy behavior that enable low-income and vulnerable people to lead healthier lives. Products and services are sold at subsidized prices rather than given away in order to motivate commercial sector involvement. Genesis PSI was founded in 1970 to improve reproductive health using commercial marketing strategies. For its first 15 years, PSI worked mostly in family planning (hence the name Population Services International). The main reason to work for population is as they did research and on the basis of secondary data and internal research data they found the ever increasing population one of the gravest issues. In 1985, it started promoting oral rehydration therapy. PSI‘s first HIV prevention project — which promoted abstinence, fidelity and condoms — began in 1988. PSI added malaria and safe water to its portfolio in the 1990s. ORGANIZATIONAL MISSION Mission ―PSI deploys commercial marketing strategies to promote health products, services and other types of healthy behavior that enable low-income and other vulnerable people to lead healthier lives.‖ this is their main mission This mission is their broad goal statement under this they have short listed eight main goals which are as follows. Goal 1 : Eradicate Poverty And Hunger PSI focuses on prevention of disease more than treatment because it is generally more efficient to prevent an illness than to cure it. Goal 2 : Achieve Universal Primary Education as literacy leads to awareness and awareness can prevent many diseases . Goal 3 : Promote Gender Equality And Empower women PSI's mission statement commits it to focusing on low-income and other vulnerable people; girls and women are a critical part of this mission given their relative powerlessness and disproportionate susceptibility to HIV/AIDS, high-risk pregnancy, malaria and iron-deficiency anemia. PSI contributes indirectly to this goal by providing a wide range of contraceptive and other health products that protect girls and women from unintended pregnancy & sexually- transmitted infection. Goal 4: Reduce Child Mortality is one of their main objectives and currently they have been able to prevent an estimated 105,000 child deaths from malaria and diarrhea. In malaria, PSI works both on prevention (through insecticide-treated mosquito nets) and treatment (through prepackaged malaria therapy). Goal 5: Improve Maternal Health is another goal of PSI and they have achieved this till date to a large extent. PSI‘s products and services averted an estimated 6.1 million unintended pregnancies and 12,000 maternal deaths. In malaria control, PSI has improved birth outcomes for thousands of pregnant women who are targeted to receive insecticide treated mosquito nets and continue to do so. Goal 6 :Combat HIV/AIDS, malaria and other diseases this is one of their main goals and they have been working towards this objective in full force with various programmes activities and campaigns. Goal 7: Ensure Environmental Sustainability PSI is contributing to increasing the proportion of people with sustainable access to safe drinking water through the social marketing of affordable home water treatment products in more than 20 developing countries. PSI home water treatment products prevented an estimated 8.8 million episodes of diarrhea and 26,000 child deaths. Goal 8: Develop a global partnership for development : PSI contributes to this global partnership by strengthening the private sector, expanding commercial distribution channels, creating good jobs and developing the capacity of a wide variety of private and public sector partners. PSI uses local manufacturers, taps into the local distribution network and employs local staff. By selling health products, even at highly subsidized prices, PSI supports wholesalers who earn a little profit on the sale, encouraging widespread distribution to rural and low-income areas. Hence they are working towards this goal rapidly . Hence these are the main 8 goals and objectives that PSI is working towards. PROGRAMMES AND ACTIVITIES OF PSI INDIA The programmes and activities are mainly decided on the basis of three parameters a) Need based programs b) research ( secondary and internal research data to identify the need ) c) Donor‘s requirement is also taken into consideration. The umbrella program of PSI India is Family Health Program (FHP) to achieve this target there are sub goals which are: 1. Reproductive health 2. Child survival 3. HIV/AIDS Reproductive health To achieve reproductive health at first PSI recognized that a couple's ability to determine the number and timing of their children is an integral part of maternal and child health so PSI/India works to increase the practice of birth spacing by creating informed demand and providing a reliable supply of quality, affordable contraceptive products in eight states in Northern India. PSI/India is addressing a key gap in India‘s population program – the adoption of birth spacing contraceptive methods by men and women in rural areas. Current initiatives raise awareness and confidence in the methods and benefits of birth spacing, and increase social support for the use of condoms and pills through mass media, wall art, folk shows, video shows, interactive games and women's group meetings in 3,268 villages in rural Rajasthan, Madhya Pradesh and Chhatisgarh. PSI/India's mobile nukkad-natak (street theatre) teams and video vans have crisscrossed 11 districts in rural Jharkhand, reaching over 4,000 villages with key messages on the why, when and how of birth spacing. In the state of Rajasthan, which has one of the highest maternal mortality rates in India, and where 350,000 induced abortions are recorded per year, PSI/India implements a social marketing project for emergency contraception (EC). The project raises awareness of EC through billboards, press advertisements and community outreach; it improves access to EC through regular detailing of doctors and chemists; and it promotes a supportive policy and social environment for EC in collaboration with other health organizations in India. The Family Health Program (to achieve reproductive health) markets several nutritional products designed to safeguard the health of women and children. These include Vitalet PREG, an iron- folic acid supplement to prevent anemia among pregnant women and are marketed in some of India's highest-need states: Rajasthan, Uttaranchal, Uttar Pradesh, Madhya Pradesh, Chhatisgarh, Jharkhand, West Bengal and Orissa Child Survival SafeWater Diarrhea disease is one of the leading causes of early childhood mortality in India, where many families lack access to clean drinking water. FHP(Child Survival Program) is working to lower the incidence of diarrheal diseases and related child mortality through a program that covers coastal districts in the state of Orissa and selected urban slums in the state of Uttaranchal. This initiative aims to increase local knowledge of proper drinking water practices and their impact on health, and to provide improved access to water disinfectant. A comprehensive behavior change campaign, consisting of radio and television ads, street theater, wall paintings and product use demonstrations is timed to coincide with the rainy season, when risk of water contamination is highest. PSI/India's brand of water disinfectant, Safewat, is sold in a 100-ml plastic bottle, sufficient to create 1000 liters of safe drinking water. ChildNutrition The Family Health Program markets several nutritional products designed to safeguard the health of women and children. These products include Neotral, oral rehydration salts for the treatment of diarrheal disease in children. HIV/AIDS PSI/India works in close cooperation with the respective State AIDS Control Societies to raise awareness of HIV/AIDS and increase the acceptability of condom use among high-risk groups, including truckers, commercial sex workers Migrant laborers and their families. The mix of communication activities include condom use demonstrations, folk shows, video shows and interactive games followed by question and answer sessions and billboards that normalize condom use and debunk misconceptions about condoms. One of the most famous and successful campaigns done for AIDS awareness is Balbir pasha campaign which was a great success in the target area they aimed at. All the programs of HIV AIDS ensures the availability of quality, affordable condoms in places that are frequented by the high-risk groups and also in rural areas which otherwise lack access to reliable condoms. In each state, PSI/India works with a network of stockists and a team of mobile field agents to distribute condoms through traditional condom outlets such as pharmacies, as well as non-traditional outlets such as dhabas (eating places that are popular with truckers and motorists along the highway) and paan shops. Operation Lighthouse (OPL)(Program For HIV Aids) (OPL) deploys a set of integrated communication, advocacy and service provision strategies to decrease the spread of the HIV/AIDS epidemic among vulnerable groups, focusing activities in 12 major port communities in India. In order to prevent HIV/AIDS, OPL focuses on desired behaviour change outcomes in the areas of increased condom usage, partner reduction, increased STI treatment and increased usage of voluntary counseling and testing (VCT) services. (pic2) The program includes targeted communication activities, mobile or conveniently- located VCT facilities for vulnerable populations, and a ground-breaking mass media campaign targeted to men in Mumbai. Distributing pamphlets to high risk men Voluntary counseling and testing (VCT) services Three principles guide the OPL Three principles guide the OPL approach: Targeting — activities that promise the highest impact among those likely to contract and transmit the virus. This concept is upheld in designing all of OPL's activities, from communications to counseling. Integration — In an integrated approach mass media, mid-media and inter-personal communications are designed to inform, motivate and create demand for services and products, which include phone help-lines, STI and VCT services and condoms. Information — changing behavior is an iterative process, demanding an ever-expanding base of knowledge across a wide range of topics, including beliefs and habits, socio-cultural characteristics affecting gender and empowerment, patterns of migration and sexual behavior. Other than the OPL project many other programs have been done for Aids Awareness like Bombay's red light district. The Bombay Project targets the largest conglomeration of commercial sex workers in the world (70,000 girls and women) and educates both sex workers and their clients while motivating them to use condoms. Underwriting from the Ford Foundation since the Project's inception in 1991 has enabled its continued success Social Marketing and Social Franchising as Part of the AVAHAN Program PSI/India implements a five year program to promote safer sexual practices and good STI treatment-seeking among male clients of sex workers in Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. In addition, PSI is making condoms easily available, affordable and well-promoted along national highways 1-9, a 12,500 km stretch of road. The core of PSI‘s contribution to this program is its intensive communication, franchising and distribution activities in 100 carefully selected locations where HIV prevalence and risk behavior is known to be highest. They estimate that their activities will reach over 5 million clients of sex workers in these areas. Rigorous monitoring and evaluation will measure regularly the effectiveness of the project in bringing about consistent condom use, correct STI treatment seeking and patronage of Key Clinics These are few of projects out of the many done by PSI. PSI /INDIA TARGET GROUP PSI India has a very broad target segment as their main aim is family planning (population control) and under that they have three main objectives as seen above each of the segment aims at different target audience: Family planning programs aim at families, women of reproductive age and their husbands HIV/AIDS programs aim at high risk groups such as informal and formal port workers, commercial sex workers and their clients, as well as truckers and their assistants Reproductive and child health programs aim at children, parents of young children, and women of reproductive age These are their main target group (all the programmes and activities are based on the needs of the above target segment) and beneficiaries covered are across 22 states and union territories in India. SOURCES OF FUNDING The source of funding of PSI India is mainly flows in from 4 areas: Government of India, Ministry of Health & Family Welfare, Private donors Sources of funding Sale of products Retained earnings Government of India, Ministry of Health & Family Welfare : From government of India and ministry of health and family welfare the kind of grants PSI gets are mainly in kind an example quoted by MR Wilson sales manger and communications head PSI is as follows : For example 1 Masti condom estimated budget by PSI is 30 paisa 1 Masti condom Manufacturing cost is Rs 1 Difference of 70 paisa will then be paid by the government of India. This kind of subsidies is received from government which helps PSI to achieve their target. Private donors: A large percentage of the funding comes from private donors international and Indian. Indian Private International donors A few of the donors are: 1. The Bill and Melinda Gates Foundation 2. The Hewlett Foundation 3. The Packard Foundation 4. State Innovations in Family Planning Services Agency 5. United States Agency for International Development (USAID) 6. U.S. Centers for Disease Control and Prevention 7. British Department for International Development (DFID) 8. The Federal Republic of Germany through KfW Entwicklungsbank (the German development bank) Sale of products PSI third resources of funding is sale of products , PSI doesn’t believe in giving anything free as it feels that anything given free is not valued so the most minimal charge is taken but a fee is definitely taken. Like for example the female condoms cost them Rs 38 they charge the beneficiaries Rs 2 though very minimal but they do charge! Their list of products are: Rishta female condom since 2005 ACT 1 STI kit since 2004 Preventol emergency contraception since 2004 Key Clinic Network of physicians providing improved STI services since 2004 Safewat safe water system since 2002 Vitalet-Preg iron-folic acid since 2002 New Born clean delivery kits since 2002 Saadhan voluntary counseling and HIV testing centers since 2002 Depo-Provera injectable contraceptives since 2001 KamaSutra condoms since 2000 Masti condoms since 1998 Mala-D oral contraceptives since 1997 Neotral oral rehydration solution since 1995 Pearl oral contraceptives since 1991 Deluxe Nirodh condoms since 1988 Neotral Orange oral rehydration solution since 1998 These are the main products sold by PSI and this is a major source of fund for PSI. Retained earnings The forth source of funding for PSI is retained earning (in other words ploughing back of funds) which is savings of other programs are re utilized for new programs or research and development. This kind of funding keeps the organization rolling at all points in time irrespective of continuous funds. ORGANIZATIONAL STRUCTURE The organizational hierarchy that is formulated at PSI is as follows: CEO Board of directors Country manager /representative Program heads Techinical department Field staff The organizational structure at PSI is a tall hierarchy at first it has one main head the CEO at Washington which is their main headquarters. Following which they have the board of directors which is a mix of all varied top most people of different nations as PSI has expanded to over 60 developing nations. The CEO along with the board of directors makes the most crucial decisions regarding expansion, collaborations & funding decisions of all PSI all over the world. Country manager: Each country that PSI has penetrated into they have a country manager. The main responsibilities of a country manager are to decide what the need of the nation is once the main focus is decided, then the implementations the funds required the expertise required all of it is finalized by the country manger before its implementation the country manger has to get the final approval from the CEO and board of directors. Program heads: Once the programs and activities are decided like for example in India PSI decided on reproductive health , child survival and HIV aids then each program head is decided who would be in charge of the success and impact of the campaign . Technical Experts Under each program head there are technical experts who decide on how the program will be headed, the strategies to be used, and the requirements is all decided by the technical department. Field Staff: The field staff is the one who actually implements the program at the ground level like for example PSI has condom use demonstrations at various places this is done by the field staff. The field staff is the one who actually deals with the beneficiaries a large part of the success of the programs depends on the field staff. PSI‗s people make the organization unique. PSI staff does their work in some of the most difficult places on the planet, yet they are known for their joie de vivre. Whether demonstrating the use of an insecticide treated mosquito net, traversing the bumpy back roads of a developing country, or creating a TV soap opera about HIV/AIDS, PSI staff bring a spirit to their work that comes from being part of an important, dynamic enterprise. EXTENT OF COMMUNITY PARTICIPATION AND INVOLVEMENT OF VOLUNTEERS In PSI the extent and level of community participation is restricted to mainly two sources of involvement which are as follows: Community involvement through community person Internships In case of volunteer involvement the involvement is not much as they consider it to be a sensitive issue as it is not everyone who can do demo at high risk prone areas and sensitive issues .Secondly they also avoid voluntary participation due to lack of commitment. Their voluntary participation is limited to internships which are given to various college students like students of TISS are allowed to do three months of internship. They are given hard core field jobs as PSI believes that is where the really learning occurs. Like for example students are placed at various ports of Mumbai for the OPL program as they would learn directly by interacting with beneficiary. The second type of involvement is in the form of training a community person and he in turn makes other people aware of the community like for example one of the commercial workers is made aware of HIV aids and trained to speak and she in turn makes other people aware in that community. They also use the method of opinion leaders like for example in brothels the Madame is a major influencer they explain to the Madame all the details and how to use female condoms who in turn would influence the girls under her . It is a difficult task but they involve the community person as it makes a lot of difference, the impact is much more than an outsider coming and talking about it. Hence the overall community involvement is minimal due to sensitive issues that are been dealt with but as and when required they do involve the community in every manner they can. NETWORKING WITH OTHER VSO PSI collaborates widely in the development and implementation of its social marketing programs. Ministry of PSI - central government Health and NACO Family Welfare PSI works closely with the central government, especially NACO and the Ministry of Health and Family Welfare to develop good policy for support of behavior change programming. At state and district level their leadership works closely with Commissioners for Health and the State AIDS Control Societies Community-based organizations and other NGOs are important partners in the deepening and increased reach of social marketing interventions and linkages to key services such as Care and Support for those affected by HIV/AIDS. In its rural programs for promotion of birth spacing and good maternal/child health practices, PSI forms partnerships with Panchayat Raj Institutions, with local medical providers and with retailers who carry and promote PSI products On the international level PSI has affiliations with several organizations to name a few: PSI international partners Behavior Works: CORE Group: Global Business Coalition on HIV/AIDS: Global Health Council: International Federation of Red Cross and Red Crescent Societies: Procter & Gamble: Roll Back Malaria: Africare American Foundation for AIDS Research (amfAR) Center for Global Safe Water Centre for Development and Population Activities DATA—Debt, AIDS, Trade in Africa HIV Medicine Association International AIDS Economic Network Johns Hopkins Center for Communication Programs KNOW HIV/AIDS AED's Linkages Repro Ado (en français) Reproductive Health Gateway UNICEF Water Advocates: These are the list of organizations that PSI networks with .PSI partners with NGO at various levels and for different needs which are as follows: PSI partners either because they don‘t have specialization in a particular thing then they take support from other Ngo‘s , they also partner to share resources and develop a better society . PSI partners with various organizations as and when desired by the program need or the situation need PROBLEMS AND DIFFICULTIES The main problems and difficulties faced by PSI are as follows: Ministry Subsidy Reduction Social Stigma Problems faced by PSI Timely Funding Lack of Volunteer Involvement Reduction In Ministry Subsidy Funding: : PSI though being a well established origination is currently undergoing difficulties in funding due to one major reason which is reduction in ministry subsidy. As most of the funding for the products manufacturing cost comes from ministry now their subsidies are reducing due to various political reasons which is a definite difficulty faced by PSI currently in India . Social Stigma: Second problem is that of Social Stigma: social stigma due to the sensitive issues they deal with like condoms, sex which are difficult to even talk about in an Indian society like ours this stigma reduces the social support thus making social awareness a slow process. Timely Funding The third difficulty faced by PSI is that of timely funding, the funds are not continuous which definitely hampers the growth of the organization. Lack of Involvement of volunteers: As PSI can hardly involve volunteers in their programs as most programs require field staff to give condom demonstrations or street plays which is difficult for any lay man to be apart of as he wouldn‘t like to deal with such sensitive issues and be even exposed to high risk areas like red light areas etc which In turn makes them completely depended on their own staff which definitely increases the cost. Hence these are the main problems faced by PSI/India. MAJOR ACHIEVEMENTS AND IMPACT PSI is an agent which believes in impact they have regular surveys, monthly tracking records which identify whether is the project leading to results desired. PSI has achieved its desired goals in every program headed by it to name a few achievements: Balbir pasha campaign: which was a mass media campaign done in a great manner by PSI. It drew great success a 2003 impact evaluation survey found a marked improvement in the respondents’ understanding of how HIV is transmitted and a consequent change in attitudes and behavior. Calls to an HIV/AIDS hotline featured in the campaign increased by 250 percent. More than half of the respondents had talked about a Balbir Pasha advertisement with someone else. Given its wide reach and frank, hard-hitting style, the Balbir Pasha campaign has, not surprisingly, also met with some criticism. But one thing is difficult to dispute. In Mumbai, Balbir Pasha has people talking—and that‘s a good thing Operation light house : OPL deploys a set of integrated communication, advocacy and service provision strategies to decrease the spread of the HIV/AIDS this has tremendous impact on the TG.The project has tracked notable behavior changes due to exposure to PSI messages. For example, between Feb. 2003 and Feb 2004, 'Last time condom use with non-commercial partner' increased from 25% to 48% among truckers that had been exposed to iBCC messages. Among sex workers, those that believed that 'STIs may lead to other health problems and increase the risk of HIV/AIDS' increased from 32% in 2002 to 87% in 2004. By systematically tracking behavioral and motivational change, the project has been able to identify the most successful messages for specific groups and continually redesign appropriate and targeted behavior change communications. Birth Spacing PSI/India works to increase the practice of birth spacing by creating informed demand and providing a reliable supply of quality, affordable contraceptive products in eight states in Northern India: Masti condoms and Pearl oral contraceptive pills are made available in over 1,600 towns and over 57,800 villages through the distribution network of 980 stockists and 275-strong sales force in the eight states this supply chain has been successful in reaching out to people. Safe Water Since its launch in 2002, Safewat has provided over 95,000 person-years of safe drinking water in the slums of Delhi and Uttaranchal and in cyclone- and flood-prone districts in Orissa. Residents of slums learn about Safewat and diarrhea prevention at tasting stalls and women‘s meetings; rural villagers are reached by video vans that provide infotainment on diarrhea and the benefits of Safewat. Bombay Project An impact study conducted three years after the launch of the Bombay Project indicated 80 percent awareness of HIV/AIDS, and that condoms—previously associated only with family planning—are now clearly associated with AIDS and STD prevention. "Key to the Project's success is a holistic approach, combining entertaining AIDS messages with clinical care, condom accessibility, and one-on-one counseling. The response to this has been overwhelming. The Bombay Project include marketing Nirodh and Masti brand condoms, a low- dose oral contraceptive pill called Pearl, and Neotral, an oral rehydration salt. In 1999, PSI/India sold over 87 million condoms at prices readily affordable to low-income Indians. PSI/India's two other AIDS prevention initiatives include the "Nexus" project, which works with journalists to write stories on AIDS and related health issues, and Project "Disha," which includes a radio call-in show that reaches young people with sexuality and reproductive health issues. This is a bird eye view of PSI achievements and impact. Due to their professional way of working they have been creating wonders. FUTURE PERCPECTIVE PSI is known as one of the best social marketing organizations they at first penetrated with social marketing in India and now have gradually moved to providing an integrated behavioral change communication programs like that of demonstration , street plays ,flipcharts , leaflets and this change has given them great impact on their programs. In the future they plan to expand and penetrate deeper into the cities and town and lead to complete awareness of child survival, HIV aids and reproductive health. In the future PSI plans to make India‘s population well aware of what they should be aware of for a good and healthy life. LEARNING POINTS FOR ME ! The learning point for me as a student has been as follows: PSI is run like a business.: Unlike many traditional public health programs, they use commercial marketing techniques. A visitor to a PSI project finds staff that are studying sales trends or meeting with advertising agencies to review proofs of the latest ads. These professionals use their private sector know-how to reach people in need at the lowest per capita cost. Which is what makes PSI a successful organization and this what all NGO should do. PSI involves private sector partners unlike many other organizations PSI uses the dynamism and resources of the private sector to achieve social goals. By giving wholesalers, retailers, and distributors reasonable profit margins, PSI enlists the support of hundreds of thousands of private merchants. In Pakistan, for example, PSI/SMP products are available at over 30,000 commercial outlets, while over 11,000 private sector health providers participate in PSI/SMP‘s Green Star Network of health clinics and pharmacies. This kind of private sector involvement makes the organization grow faster. PSI’s focus is highly practical which is the need of the hour : PSI does not invest its efforts solely in research or international conferences on public health—they do concrete programming on the ground, to help alleviate health problems directly. Over 90% of their annual budget is allocated to programs. PSI‘s focus on implementation means fewer children die from diarrhea or malaria, because they have access to ORS and ITNs; more couples can avoid unwanted pregnancies, because they learn about family planning and can afford the high-quality contraceptives that PSI‗s help make readily accessible; and fewer people get HIV/AIDS or other sexually transmitted diseases, because they can understand PSI‘s television and radio ads and also buy reliable, inexpensive condom. PSI’s management is results-oriented: Like any private sector company, PSI manages by results and holds staff accountable for results. Sales of each of PSI‘s products more than 220 brands are tracked monthly. Sales trends are an important indicator of potential health impact. Staff members are also responsible for the achievement of other important objectives, such as increasing sales to at-risk groups, product assessments in quality of care, and clients‘ increased knowledge about health PSI’s decision-making is decentralized which helps in making decision faster and avoids red Tapsim: PSI empowers its staff in the field to make program decisions, granting them an uncommon level of authority. PSI allows those closest to the action and local setting to make decisions that result in effective, adaptive in-country programs. PSI people have wide-ranging experience: Before joining PSI, they have marketed soft drinks, toothpaste, and cosmetics. They have sold pharmaceutical products, worked for advertising agencies, produced television shows, and worked as management consultants. But all their staff members have one thing in common: they bring high energy, creativity, and a bold entrepreneurial approach to their work. This makes PSI grow at a high level PSI doesn’t believe in isolation: PSI unlike other organization believes in partnering with government, other NGOS at every level for the benefit of the NGO‘s as well the society as a whole which is something every organization should. This is where PSI is different from other organizations and this is definitely a learning point for me as a student as it encompasses with ways to make an NGO run successfully. ACKNOWLEDGEMENT I take this opportunity to express my gratitude towards Dr (Mrs.) Asha Rane, Our professor for her guidance, her valuable insights, keen appreciation of new research ideas, and her open-mindedness has guided us into the realm of the research. Her enthusiasm. Knowledge and expertise were major stimulants for this project. My sincere thanks, to Mr Wilson Thomas Condom Communication and Sales Manager PSI, Mumbai for extending full co-operation, in giving me all the minute details for the project and most of all for administrating my questionnaire.