Keywords: India, Children aged 0-6, community-based rehabilitation, early intervention, rural, app, Ashoka Fellow

Amar Seva Sagnam is an NGO working in the Indian state of Tamil Nadu. They have developed an app where community rehabilitation workers can access support and guidance from rehabilitation specialists. Amar Seva Sagnam has trained 1800 existing community rehabilitation workers in rural areas to provide early intervention therapy to children aged 0-6 at home. This addresses gaps in provision in rural areas and ensures children receive quality therapies. Their next step is scaling the project across the state with the support of local government in 2019-20.

About the practice at a glance
Name of OrganisationAmar Seva Sagnam
Type of organisationNGO
Country
of Implementation
India
Year started2014
Funding modelPublic funding ($900,000 USD from Grand Challenges Canada, Handi-care Intl. and  Azim Premji Philanthropic Initiative. Funding from Govt of Tamil Nadu is being secured to scale up the policy throughout the state. 

IMPACT

There are 54,000 children (age 0-6) with disabilities / delayed development in rural Tamil Nadu (state in India). There is a lack of access to early intervention (EI) therapy services for these children due to a lack of trained professionals and programs in rural areas and long transport time to urban areas where such programs exist. 

 40,733 children have been screened for delayed development.1102 children have received early intervention therapy.1858 health workers trained.39,423 people have improved awareness on child development and disability as a result of our awareness programs.  

75% of children in our program are enrolled in school by age 5 compared to 55% of disabled children in  the rest of Tamil Nadu, 1700 caregivers supported in the program with 74% showing decreased strain, 75% having increased empowerment and 62% having improved child interactions. 

Gross Motor Development of children with Cerebral Palsy matching and exceeding gold standard gross motor development curves established in the literature for children with 5 levels of severity. 

Amar Seva Sagnam is headed by people with disabilities including our president who has a spinal cord injury and our honorary secretary who has muscular dystrophy. The early intervention program has been guided by parents of children with disabilities through early intervention parent participation groups  who are a major stakeholder group in decision making and policy formation. 

THEORY OF CHANGE

We asked projects to outline their impact model (also called Theory of Change) – their main target groups, the key activities they offer these target groups, and what impact they want to achieve:

Target GroupActivityImpact
Children with Delayed Development / Disabilities
Therapy

Improved child development in the areas of cognition, self-care, mobility, speech, gross motor, social, emotional and academic using standardized scales: GMFM (gross motor) weeFIM (self-care, mobility, cognitive) FACP (social, emotional, academic) COM- DEALL (speech). Increased child enrollment in school
CaregiversTraining and Family-Centered CareReduction in caregiver Strain and Burden as measured by the MCSI (modified caregiver strain index). Increased Family Empowerment as measured by the FES (Family Empowerment Scale) and Increase engagement with child measured through the CI (child interaction scale) Parents able to set goals for their child’s therapy using the COPM (Canadian
Occupational Performance Measure).
Community StakeholdersAwareness and Education ProgramsImproved knowledge, awareness about child development, child disability and early intervention program and reduced stigma.

REPLICATION EXPERIENCE

We have already replicated our innovation. The policy started with 5 blocks (geographical areas) in 2014 (351 children). It was expanded to 8 blocks in 2017.  Funding from Govt. of Tamil Nadu and Grand Challenges Canada in 2019 -2020 will expand the program to 23 new blocks and enrol 2100 new children. The program will be scaled up with the Govt of Tamil Nadu funding other NGOs to run the same program to cover all rural areas of the state. By 2030 the goal is to cover all rural children with delayed development (54,000). 

ORGANISATIONAL CAPACITY AND STRATEGY

The replication model is supported by ASSA’s Board of Directors and we have good team with leadership to guide and execute the program’s next stage of scale up which involves covering 2 full districts of Tamil Nadu for Home Based Early Intervention Therapy. We already have a principal investigator, co- investigator, Project Co-rodinator, Assitant Project Coordinator, Technology Lead, Finance Lead, Govt. Liasion and Fundraising and Project Development Executive. This team’s expertise include professionals with backgrounds in medicine (MD), rehabilitation (PT, OT, SLP, special education), accounting (CA), technology, data analysis, management and finance. The financial resource for the next stage of scale up are in place with funding from Tamil Nadu Govt and Grand Challenges Canada.  

For further scale up beyond, funding needs to be secured and the team needs to be further strengthened with new leaders. We hope to the impact transfer being offered by the Zero project will lead to human resource recruitment and other funding opportunities. We have a project owner for this program, with the necessary skills and seniority: linkedin.com/in/sankar-sahayaraj-a24a84155  

MOTIVATION

As our team prepares for scaling up the program further with the Govt of Tamil Nadu funding other NGOs to implement out program in new districts of Tamil Nadu, the Zero Project Impact Transfer program will assist us in the process. Challenges will arise and advice and mentorship from people external to our funding partners will allow us to share our challenges freely and in unbiased way and get assistance and learn from others experiences. In addition, the networking opportunities provided by the Zero Project Impact Transfer program will provide us with potential replication partners both in Tamil Nadu state of India, and other states and countries. The networking, alumni community and follow up support provided by this program can allow us to not just explore replication opportunities, but provide us with a network of support and connections to allow a smooth transition to international scale up. Finally, the visibility factor at the Zero Project Conference in Vienna will allow our brand to gain visibility for future funding opportunities and also attract partners for replication and scale up.