Public Health

On-time delivery: Ensuring reliable reproductive choice in India

Dr. Sudhir Maknikar

PATH has helped leverage the India Post—the world’s largest postal service—into a full-fledged distribution system delivering access to contraceptives for thousands of people in the state of Odisha.

In India, health systems face many obstacles when moving family planning commodities from state warehouses to towns and villages where health care providers and patients need them most. A lack of reliable transportation and other essentials triggers delays in delivery, severely impacting access to contraceptives. Lack of access—often triggered by failures in the supply chain—is a principal barrier to contraceptive use in the country.

PATH’s India office is working with state health systems, governments, and partners to address the gaps that prevent access to family planning commodities such as condoms, oral contraceptive pills, injectable contraceptives, and intrauterine devices (IUDs). With support from the Bill & Melinda Gates Foundation, the family planning supply chain strengthening project provides technical support to eight states in India to improve delivery of contraceptives.

Leveraging the India Post to meet supply chain challenges

A vehicle designated by India Post to transport contraceptives to towns and villages in Odisha, on India’s east coast. Photo: PATH

In Odisha, on India’s east coast, the state’s health system relied for many years on the services of a state-owned vehicle with a government driver to transport family planning commodities to district warehouses. With only one vehicle for a large state, it took at least three months to deliver shipments to all of Odisha. When a given district ran out of supplies—as was frequently the case—there was no chance for replenishment until the next quarter. Especially for women depending on the state-supplied contraceptives, this distribution system jeopardized their access to and choice in family planning.

In response, PATH analyzed several distribution systems that could supplement the existing one. The choice quickly become obvious: India Post, the world’s biggest postal network. With more than 155,000 offices across the country, it has been connecting the subcontinent for 242 years. In January, the state government used India Post to ship its first-ever consignment of family planning supplies from a warehouse in Odisha to depots in five districts.

An illustration of the flow of family planning commodities through India Post. Photo: PATH

The government of Odisha now uses India Post’s express parcel services to transport small quantities of commodities like IUDs, injectable contraceptives, and tubal rings. Larger shipments of condoms, emergency contraceptive pills, and pregnancy testing kits are still supplied through the state-owned transport.

This powerful intervention has strengthened the supply chain and distribution network for contraceptives throughout Odisha. Overall costs are lower, delivery times are faster, and there are no restrictions on the quantities that can be transported. Since the partnership between India Post and the state government began, the state’s health system has been more successful in meeting the urgent demand for contraceptives.

A boon during the COVID-19 crisis

In Odisha, the India Post and state government staff prepare a consignment of family planning commodities for delivery by India Post. Photo: PATH

Until the COVID-19 outbreak in India, the government of Odisha used both its own distribution system and India Post to supply contraceptives to the districts. But the nationwide lockdown closed borders and restricted the movement of vehicles. Soon, districts sounded the alarm: they were running out of contraceptives.

This is when the India Post proved invaluable. Classified as essential, postal services remained functional throughout the lockdown. Since March, the Odisha government has relied on India Post vehicles to dispatch more than 115 consignments of family planning commodities to about 28 districts, charting a 100 percent rate of on-time arrivals.

The project has also demonstrated the huge potential of India Post as a delivery method for other essential medical commodities. PATH is discussing with the governments of other Indian states how to leverage India Post for distribution of family planning commodities and expand it to strengthen the supply chain across the public health spectrum. The success of this intervention has proven, yet again, that innovative approaches can tackle critical health challenges and improve lives.

Dr. Sudhir Maknikar is Director, Family health at PATH’s India Country Program.

Healthcare Delivery

Management and care of Migraine

One of the common questions asked by people is the difference between headaches and migraine.

Headache, as the name suggests is a kind of pain which is experienced by a person in the head area. In medical terms, headaches is a pain located in head confined within certain boundaries which doctors describe from upper edges of eyes to backwards towards the ears to the nape of the neck. On the other hand, migraine is a neurological condition which can lead to several symptoms, one of which is a headache.

Headaches are of two types-primary headaches and secondary headaches. Primary headaches are common and take up to 90% of cases of headaches and migraine is one of them.  This kind of a headache starts from one side of the head and usually progresses to cause pain in the entire head. The patient may also complain of vomiting sensation and intolerance to light and sound in case of migraines.  One episode of migraine may last up to an interval of 4 hours but in severe cases, it may go on for 3 days.  Some other symptoms of migraine apart from pulsating headaches include nausea, fatigue, irritability, neck stiffness and numbness.

There are two types of migraines-one is the common type which is migraines without aura and the other is classic migraines or migraines with aura. An aura is basically a phase before onset of migraine wherein patient may experience improper vision, seeing flashes of light or bright spots and even difficulty in speaking. Some common triggers of migraine include fasting for long periods of time, sensitivity to sunlight or other lights, dehydration, loud sounds, changes in sleep pattern and stress.

Some red flags of migraines include sudden onset of headaches, high intensity headaches, headaches accompanied with other symptoms or signs such as double vision and headaches in elderly population. In such cases, the headaches must not be taken casually and neurological help must be taken. If headaches are increasing in intensity progressively, even in that case, consultation must be taken without any delay.

The treatment approach for migraines includes proper evaluation by a neurologist. The doctor may suggest a 3 point strategy.

First point is preventive. One must be able to analyse the triggers that may be causing them pulsating headaches or migraines and should avoid them to avoid chances of headaches altogether. Avoiding common triggers like high sunlight, certain foods and drinks and loud music etc is recommended.

The second point is to go for over the counter medicines prescribed by the doctor to control the episodes of migraines. The doctor may suggest medicines depending upon the intensity of the condition.

The third therapy is suggested for those who have frequent episodes of headaches or migraines and as many as 3 to 4 episodes per month. In this case, the doctor may give medicines especially suited for those who have high frequency and high intensity migraines.

Public Health

A healthy start for newborns in India

Every baby deserves access to lifesaving human milk and essential newborn care services.

By Isha Jain

A health worker pooling the donor human milk at Jay Prakash Hospital in Bhopal, India. Photo: Jay Prakash Hospital.

Nandini Kumari’s son arrived early. Because of his low birth weight, he was quickly shifted to the neonatal intensive care unit (NICU). The stay in the NICU and the feeding challenges that followed were hard on Nandini and her son. In an all too common story, what could have been a time of joy became a time of great distress.

India is home to roughly 18 percent of the world’s population, but about 33 percent of the world’s preterm births. The high prevalence of preterm births contributes to another alarming statistic—in India, newborns account for more than half all deaths of children under age five.

Though these statistics are grave, WHO estimates that nearly 71 percent of all prematurity-related deaths could be avoided with cost-effective interventions—breastfeeding and human milk banking, kangaroo care with skin to skin contact, and infection detection and treatment. With support from Philips India CSR, PATH is working with government partners in India to expand access to these critical interventions by scaling them across facilities and states.

Lifesaving human milk

With technical support from PATH, the states of Uttar Pradesh and Madhya Pradesh established their first comprehensive lactation management centers, and the states of Maharashtra and Rajasthan each upgraded their lactation centers into regional reference centers that now provide training and accreditation to others.

These achievements ultimately mean better access to lifesaving human milk for newborns in each state—especially preterm deliveries like Nandini’s son.

A mother expressing milk for her own baby at King George Medical University in Lucknow, India. Photo: King George Medical University.

To address the feeding challenges they faced, doctors prescribed donated, pasteurized human milk for Nandini’s son and provided counseling regarding its use. The donated milk helped him gain weight and prevented additional complications, while Nandini received lactation counselling and learned to express her own milk.

“Every hospital should offer this support for mothers and babies,” Nandini says. “I am really thankful to the mothers who have donated milk so other babies can benefit.”

Counselling support given to mothers by health workers at King George Medical University in Lucknow, India. Photo: King George Medical University

Pushing past the pandemic
The COVID-19 pandemic has disrupted the delivery of essential newborn nutrition and care services in India. Outpatient hospital services have been suspended. Hospital stays shortened. Staff headcounts reduced and more.

All these changes have made it difficult for mothers and families to get the feeding support they need. PATH is working with health facilities across India to help bridge these new gaps and provide lactation support to mothers and newborns. We’re supporting the government as they develop guidance for health workers, sharing best practices for newborn nutrition and care, and providing technical support as lactation management centers adapt to the new normal.

“From March to June of this year, PATH helped the health facilities to provide counselling and breastfeeding support to more than 10,000 mothers and their families,” says Ruchika Sachdeva, Deputy Director of PATH’s MNCHN portfolio in India. “Despite the pandemic’s challenges, we are working to ensure a healthy start for newborns.”

Isha Jain is Communications Officer with PATH’s India Country Program.

Healthcare Delivery

Causes and Management of Drug Resistant Epilepsy

Epilepsy is a disorder of the Central Nervous System which causes the brain to act differently or abnormally. In this disorder one may experience seizures, loss of awareness and certain sensations. It is one of the most common neurological disorders and can affect people of any age or race. In most cases, Epilepsy can be managed and controlled using anti-epileptic drugs but in some cases, patients fail to gain from these. This type of epilepsy is known as Drug Resistant Epilepsy or Refractory Epilepsy.

Drug Resistant Epilepsy (DRE), as the name suggests is that form of epilepsy in which the patient doesn’t respond to drug therapy as expected. Some other names by which this treatment is known are medically refractory epilepsy, intractable or pharmacoresistent epilepsy. It is rather surprising to know that as many as 20-40% cases of Epilepsy are refractory Epilepsy. However, it is recommended that a patient takes a few drug trials before DRE is established just to be sure so that the further treatment can be hence recommended by the doctors.

Treatment options for Drug Resistant Epilepsy patients:

–   Once DRE is established, doctors may refer the patient for a presurgical evaluation that is generally done at an Epilepsy center or healthcare facility. This is done in order to find out whether or not the patient is suitable for epilepsy operation.

–   If surgery is the way to go, then two options are available-resective procedure and disconnective procedure.

–   In case, the patient is not a suitable candidate for surgery or if the patient declines epilepsy surgery, the next step could be either a proper diet program or vagus nerve stimulation.

–   Vagus nerve stimulation is a procedure in which a pacemaker type of a device is implanted in the chest area to send electrical impulses to the vagus nerve. This inhibits the generation of seizures through the brain.

–   It has been a known fact that diet can help with Epilepsy and may reduce the occurrence of seizures. Those who do not benefit from medication or drugs thus rely on a high fat content low carbohydrate content diet. Some diets which epilepsy patients swear by include ketogenic diet, MCT-ketogenic diet, modified Atkins diet and others.

DRE or refractory epilepsy is not totally incurable but one has to undergo trials and different forms of treatments to be able to identify which fits best in their case. Deep brain stimulation as well as responsive neuro-stimulation is approved in certain countries and may prove beneficial for Drug resistant epilepsy patients.



As we continue to evolve into an interconnected world, the emphasis continues to be on how we can retain our health and vitality. While we might have achieved success over infectious diseases, the focus now shifts to Non-Communicalble Diseases (NCD). To add to it a lot of us spend more than 8-10 hours at the workplace, which determines the source of our health and vitality. Arogya World has been working in this space for a while.

Introducing Arogya World

Arogya World ( is a global health non-profit working to prevent non-communicable diseases (NCDs).   We strive to achieve our mission – to change the course of chronic disease – through a focus on partnerships and innovative technology, and by implementing scalable, sustainable programs with measurable impact. 

The Problem

Non-communicable diseases, NCDs, which include heart disease, diabetes, cancer and chronic lung diseases, are among the top health and development challenges of the century.  2 out of 3 deaths in the world are due to NCDs with 80% of them in developing countries. India has an alarming diabetes burden – 80 million people live with the disease and 1 million die from it each year.

Our Solution – Prevention is key

At the core of all our work is disease prevention through healthy living.  According to the World Health Organization, 80% of heart disease, 80% diabetes and 40% cancer can be prevented by avoiding tobacco, increasing physical activity and eating healthy foods.   These lifestyle changes are what we promote. 

With half of India’s 1 billion plus people less than 25 years of age, we have to find ways to reach young people and teach them prevention.  Mobile technology and leveraging schools and workplaces are smart solutions and these are the platforms our programs are built on.    

Our Work in India

We implement scalable diabetes prevention programs, educating and empowering housewives and farmers, working adults and school children to take definitive steps towards leading healthier lives.  With our India-based programs we are taking the first steps towards building a chronic disease prevention model for the developing world. To further advance this work, an affiliate Arogya World India Trust has been set up as a separate entity. 

Arogya World follows a doorstep health model, which takes prevention to people where they live, learn and work. Our focus is on scalable, science-based programs designed to reach a large population. These are deployed in schools, workplaces, and bringing information right up to people’s phones. Our programs are aligned with sustainable development goals and Government of India’s priorities (Ayushman Bharath, Fit India, Eat Right Campaign and Potion Abhiyan). We believe our work will help India meet SDG #3 which is Good Health and Wellbeing.

Healthy Workplace Initiative was developed with the intent of advancing the workplace health movement in India. We motivate companies in India to invest in workplace wellness through pioneering awards. This innovative approach leverages workplaces, where working Indians spend so much of their day, as a platform for chronic disease prevention. Public Health Foundation of India, IAOH Delhi, CII, iNFHRA, GACS and others have joined us as Commitment Partners.

Employees spend a significant part of their lives at the workplace. Many working professionals have become increasingly sedentary, contributing to inactive lifestyles and unhealthy living.  Employers have the opportunity and responsibility to improve the health and wellness of their staff, while simultaneously improving productivity.

As part of our program we urge employers and leaders to do more to help employees lead healthier lives, to shape their company’s culture to becoming health promoting, and to become data driven around health so that they can improve their employee health programs year on year. We also provide some tools to help individual employees make better and smarter lifestyle choices. 

Corporates have to seriously consider an employer approach to improve employee health, which will help them mitigate sick leave and absenteeism, reduced productivity and increased healthcare costs. Arogya World’s Healthy Workplace Program focuses on employee wellness, the investments companies are making in health and productivity strategies, and the effort towards increasing engagement in health and wellness programs internally.

Company sponsored wellness programs have to include activities such as company-sponsored exercise, weight-loss competitions, educational seminars, tobacco-cessation programs and health screenings that are designed to help employees eat better, lose weight and improve their overall physical health. A healthy workforce means a better bottom line, more productivity, greater competitive advantage.

What are the challenges at workplaces?

Challenges of a Corporate Employee often puts them at risk of NCDs

1. Unhealthy eating, smoking, and drinking,

2. Busy lifestyle and low awareness to health risks

3. Sedentary lifestyle and mental stress

4. Low compliance to annual health check-up

Arogya World’s Healthy Workplace Assessment is direct, robust and transparent.  The process of assessment for the Bronze, Silver and Gold level starts with initial awareness sessions where the organization is taken through the criteria ( ) and its implications- banning tobacco use, healthy eating, increasing physical activity, and improving work-life balance. Emphasis is also placed on changing the mind-set of management at all levels towards promoting employee wellness.

The company then submits an application highlighting its employee health initiatives by submitting a questionnaire that has been developed based on the set of criteria. Subsequently, a 3-person team (which includes a medical doctor, an industry expert, and an Arogya leader) visits the organization’s facilities, evaluates the initiatives taken, and has a meeting with the coordinating department (which is usually the HR department). This year, the assessments will be conducted virtually.

The findings are compiled and after a good discussion among the assessors, a decision is made as to whether the organisation is at Bronze, Silver or Gold category. To qualify, companies must meet 80% of the criteria in each level.

During the assessment, the strengths of the company are highlighted and areas of improvement are brought forward, as also the best practices adopted by peer companies. This gives the company a good opportunity to benchmark itself against industry standards, understanding of where they are and how they can advance to the higher level. We guide the companies  to improve employee well-being, including physical and mental health, along with tackling workplace and personal stress

More than 134 companies have been onboarded as Healthy Workplaces on our program from 2013-2020, out of which 33 companies have reached the Platinum level, leadership and data-driven initiative beyond the Gold level.

We felicitate our winning companies in front of their peers at our annual Healthy Workplace Conference which is usually held during first week in November- near World Diabetes Day. The event has a workplace wellness Best Practices workshop and an award event.  This year it will be organized virtually.

What are the benefits of our Healthy Workplace Program?

Employee Benefits

1.         Better equipped for and more aware of NCD prevention

2.         Better performance and reduced number of workdays lost

3.         Better quality of life

4.         Fewer health complications

Employer Benefits

1.         Better Corporate Health

2.         Improved productivity 

3.         Decreased reimbursements and healthcare costs

4.         Fewer sick leaves and reduced absenteeism

5.         Lower insurance premiums and lower hospital admissions

We believe a multi-sectoral approach is needed to advance the fight against NCDs and we believe it is our generation’s responsibility to fix NCDs.  Arogya World is determined to use public private partnerships and smart technology to make measurable and significant public health impact.

We aspire to develop a framework for the whole ecosystem of prevention of NCDs by integrating efforts being undertaken by various organizations and professionals in the domain. We would like to build Healthy Workplaces into a robust community and engage more deeply with them offering more programs and services.

By Usha Chander, Arogya World