Building on the Foundation - Biocon Foundation

Building on the Foundation - Biocon Foundation

Building on the Foundation ANNUAL REPORT 2017 Our Vision To promote social and economic inclusion by ensuring that marginalized communities have eq...

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Building on the Foundation

ANNUAL REPORT 2017

Our Vision To promote social and economic inclusion by ensuring that marginalized communities have equal access to healthcare services and educational opportunities

BIOCON FOUNDATION

A Message from Dr. Kiran Mazumdar Shaw

Dear Stakeholders, This year’s Annual Report theme, ‘Building on the Foundation’, is singularly apt as it gives you insights into the various initiatives undertaken by the Biocon Foundation during the year, building on the robust foundation of strategy and program design of yesteryears. Our programs are aimed at ensuring that marginalized communities living in underserved urban and rural areas of India can enjoy the ‘Right to Health’, the ‘Right to Education’ and the ‘Right to Sanitation’. Over the years, Biocon Foundation has built a strong reputation for the quality of its programs and their impact in addressing the social, humanitarian and environmental challenges of India. To widen and deepen the reach of our programs, we are using technology as a force multiplier. We have embraced technology for healthcare delivery at various levels – through mobile phones, handheld diagnostic devices, ICT-enabled smart clinics and digitized patient records. We have also entered into public private partnerships (PPPs) to scale up our various CSR programs. These initiatives have contributed to realizing our vision of empowering and integrating the underprivileged into the social and economic mainstream.

BIOCON FOUNDATION ANNUAL REPORT 2017

Our first eLAJ Smart Clinic at Huskur provided the ‘proof of concept’ to scale up the model elsewhere. Our eLAJ clinics are today facilitating effective preventive and primary healthcare interventions in several pockets of the country for the benefit of communities with poor healthcare access

HEALTHCARE Biocon Foundation is recognized widely for implementing innovative healthcare models to create a sustainable health ecosystem. Our work assumes significance in light of the fact that India has been ranked 154th among 195 countries on the latest Healthcare Access and Quality Index published in the Lancet. As early adopters of technology, we developed a unique e-healthcare model and introduced the first eLAJ Smart Clinic in 2015 to plug the gaps in public health delivery in Huskur in Bengaluru Rural district. The eLAJ Smart Clinics have state-of-the-art diagnostic equipment, clinic and patient management software along with trained doctors and technicians. The model has been designed to deliver data-based healthcare on the basis of socio-demographic and health indicators obtained from community-based screenings. The success of our first eLAJ Smart Clinic at Huskur provided the ‘proof of concept’ to scale up the model elsewhere. Our eLAJ clinics are today facilitating effective preventive and primary healthcare interventions in several pockets of the country for the benefit of communities with poor healthcare access. We have implemented the eLAJ program at eight eLAJ Smart Clinics run exclusively by Biocon Foundation in Karnataka. The model has also been applied at the five government PHCs we have adopted under a Public Private Partnership (PPP) with the Rajasthan government. We recently signed an MoU with the Karnataka government to set up eLAJ Smart Clinics in 15 government-run PHCs in the state. The first of these eLAJ-enabled PHCs was flagged off in Bengaluru in February 2017. Overall, the Foundation currently runs 14 eLAJ smart clinics covering over 30 Gram Panchayats across Karnataka and Rajasthan. Through the eLAJ Smart Clinics we are paving the way for evidence-based public health interventions in these locations by enabling multiple diagnostic tests and generation of Electronic Medical Records (EMRs) of patients. Over the past year, patient footfall at eLAJ clinics has gone up by 50% to more than 9,000 a month. The eLAJ model is facilitating on-time treatment, helping reduce out-of-pocket healthcare spending and cutting down the need for trips to tertiary hospitals, which is in line with our commitment to enable the ‘Right to Healthcare’ for every citizen. In addition to providing patients access to more effective diagnosis and treatment, eLAJ clinics also offer a wide range of preventive medical and early-detection programs run by the Foundation. We aspire to benefit many more villages across India through the eLAJ model in the coming years.

BIOCON FOUNDATION

Focusing on Women’s Health At Biocon Foundation, we believe the health of women determines the health and wellbeing of the nation. To reduce the threat to women’s health, we successfully organized several camps and diagnostic events for early detection of breast and cervical cancers during the year. The use of the latest, yet safe and easy-to-use diagnostic devices has helped us to increase coverage, both in terms of territory as well as the number of people screened. Taking forward our commitment to women’s health, we also undertook programs to improve antenatal care. India has one of the world’s highest rates of maternal mortality, with 174 of every 100,000 pregnancies resulting in the mother’s death in 2015. While India ranks first in the list of ten countries that account for 60% of all pre-term births, it has little more than 50% of antenatal care coverage. To tackle the issues of maternal mortality, premature births, low birth weight babies and stillbirths, India’s Ministry of Health and Family Welfare has launched a program titled Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). The aim of the program is to provide a comprehensive package of antenatal care services to pregnant women in their second and third trimester at government health institutions. Biocon Foundation is proud to be helping the Rajasthan government implement PMSMA efficiently at its eLAJ PHCs. During the year, nearly 2,500 pregnant women attended the PMSMA camp, of which over 350 were identified as high risk pregnancy cases and given medical attention.

Pathbreaking Oral Cancer Screening We have adopted a pathbreaking mobile phone-based health (mHealth) program for the detection and prevention of oral cancer, which accounts for about 7% of all new cancers diagnosed annually in India. The extensive reach of our oral cancer screening program has proved beneficial to communities which hitherto had minimal access to such facilities.

Tackling NCDs Non-communicable diseases (NCDs) account for 60% of all deaths in India. Biocon Foundation has developed a comprehensive program for the detection and management

During the year, nearly 2,500 pregnant women attended the PMSMA Camp, of which over 350 were identified as high risk pregnancy cases and given medical attention

BIOCON FOUNDATION ANNUAL REPORT 2017

of Type 2 diabetes and hypertension through its PHCs across Karnataka. The Foundation conducted monthly health camps and surveys for community risk profiling. The data so generated have helped us characterize the health status of communities, identify new cases and assess their vulnerability to associated risk factors. This year more than 8,000 individuals participated in screening at our NCD health camps. Over 2,300 diabetes and hypertension cases were managed through these camps during the year.

Fighting Malnutrition Malnutrition is a crucial element in the Foundation’s agenda. The 2015 Global Hunger Index (GHI) Report ranked India 20th amongst leading countries with a serious hunger situation. Some of the major causes for malnutrition in India are economic inequality, lack of nutritional knowledge and the low social status of some population groups. Women who have experienced malnutrition are less likely to have healthy babies, consequently, newborn infants are unable to get adequate amount of nutrition from their mothers. The Biocon Foundation established a Well Baby paediatric clinic in Austin Town, Bengaluru in collaboration with St John’s Community Health Department in 2016. The clinic provides general paediatric consultative services, follow-ups for ill children to support both the physical and emotional well-being of the children and their families. This year, we organized eight health camps on malnutrition. Balaspandana is the Biocon Foundation program for nutrition intervention for children under five years in Bagalkot district. A total of 190 health camps were organized under this program during the year and a total of 834 cases of malnutrition were managed.

EDUCATION Biocon Foundation is keenly aware of the fact that the quality of education children receive in school determines the quality of their future. Critical gaps in learning, such as language and numeracy skills, could affect their ability to attain sustainable livelihoods and lead productive and healthy lives. According to the 11th Annual Status of Education Report (ASER) 2016, which assesses government schools in the country, nearly 20% of the Standard 2 students surveyed didn’t recognise the numbers between one and nine, and only 25% of Standard 3 students could do subtraction. Since 2006, we are addressing this critical gap in mathematics learning through our Chinnara Ganitha workbooks. We have been distributing these workbooks, which approach mathematics through activities and games in the local language, to children in various government schools in Karnataka. Teachers have reported that the workbook has made it easier for students to understand mathematical concepts. During the year under review, over 100,000 students across 1,200 schools in Karnataka received the workbook. We also trained 1,200 teachers under this initiative.

COMMUNITY DEVELOPMENT Biocon Foundation is also working to address the acute shortage of water in Bengaluru through various initiatives. As part of ‘Project One’, our community safe drinking water initiative, we have established potable water kiosks equipped with water purification systems with reverse osmosis and ultraviolet technologies to provide safe drinking water with a capacity of purifying 500 litres in an hour. We also took the lead to rejuvenate the Hebbagodi Lake in Bengaluru Rural district. We have submitted a detailed project report and our teams have been working closely with the relevant administrative bodies to obtain necessary approvals for implementing the detailed lake revival plan. In the meanwhile, we have cleared the area in and around the lake. This had resulted in the growth in the water catchment area and a return of some birds to their habitat. We have also engaged with the local communities to sensitize them on the importance of water bodies and their role in preserving them with their best civic behaviour.

BIOCON FOUNDATION

BUILDING FOR THE FUTURE In the year gone by, Biocon Foundation was able to take forward and build substantially on the work done in the preceding years. We have been able to leverage technology to add scale to our operations. We have gained credibility for our program implementation, and this has resulted in queries from some of the other state governments for the expansion of coverage of our eLAJ program. I thank the governments of Karnataka and Rajasthan, our partners and collaborators and all our stakeholders for their unstinting and continuing support to the Biocon Foundation and its efforts during the year gone by. In the coming year and in the near future, we will solidify our efforts to deliver on our mission of working with the most underserved communities in India to help them improve their social and economic conditions and become equal beneficiaries of the India growth story. We remain committed to empowering communities for sustainable economic development.

With best wishes,

Dr. Kiran Mazumdar Shaw Founder, Biocon Foundation

BIOCON FOUNDATION ANNUAL REPORT 2017

Index A Message from Dr. Kiran Mazumdar Shaw Mission Overview ........................................................ 2 Our Reach...................................................................... 4 Empowering Communities ........................................ 5 Healthcare ..................................................................... 9 Education..................................................................... 27 Community Development ....................................... 31 Impactful Programs .................................................. 35 Grant in Aid ................................................................ 39 Biocon Foundation in News....................................... 41 Awards and Accolades ............................................. 42 Appendix ..................................................................... 43

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BIOCON FOUNDATION

Mission Overview 2016-2017

Biocon Foundation, the Corporate Social Responsibility arm of Biocon, has been working to empower marginalised communities since 2005. We believe, our corporate social responsibility lies in creating comprehensive programs that promote social and economic inclusion by ensuring that marginalized communities have equal access to essential healthcare services, educational opportunities, proper sanitation and other civic infrastructure.

Mission & Strategic Objectives

Working towards empowering marginalized communities since 2005

Raise awareness about the importance of preventive health and assist communities to implement preventive health measures •• Catalyse a movement for the adoption of good sanitation and public health measures by communities in rural India

•• Initiate education and screening for chronic diseases in order to prevent the disease or optimize management of a disease that has already manifested •• Expand the coverage of social protection schemes such as the Arogya Raksha Yojana Health Micro Insurance, to the poorest of the poor, to reduce their vulnerability to health-related catastrophes •• Assist in developing educational material that will facilitate learning of basic concepts in schools •• Provide opportunities for self and experiential learning to children from marginalized communities In addition to its core purpose, the Foundation further empowers the communities it engages with by providing basic infrastructure for self-sustained villages such as health and community centres, schools, sanitation, water and sources of light.

BIOCON FOUNDATION ANNUAL REPORT 2017

Our CSR Approach

The Biocon Foundation operates in three intervention modes: 1. Direct: The Foundation plans and executes programs by using its own resources and people. 2. Partnership Models: The Foundation has established longstanding collaborative partnerships with healthcare agencies, NGOs, other corporate entities and the

government, and works with these agencies to jointly participate and deliver programs of mutual interest. 3. Grants & Donations: Based on proposals received and subject to rigorous due diligence, the Foundation makes outright grants or donations to worthy causes in both core, as well as, other areas of social relevance.

Established long-standing collaborative partnerships with Healthcare Agencies, NGOs, Corporate Entities and the Government

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Administration The Biocon Foundation is managed by a Board of Trustees Dr Kiran Mazundar Shaw, Founder and Managing Trustee Dr John Shaw, Trustee

Our Reach

Mission Director Ms Pratima Rao (w.e.f June 01, 2017)

Biocon Foundation, which is the CSR arm of Biocon Limited and Syngene Limited, is also guided by the CSR Committees, constituted of members of the Boards of Director of these two companies. These CSR Committees provide strategic direction, oversight of CSR policy and monitor the execution of various activities of the Foundation.

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The members of the Biocon Limited CSR Committee are: •• Ms Mary Harney, Chairperson •• Dr Vijay Kumar Kuchroo •• Professor Ravi Mazumdar

The Syngene International Limited CSR Committee comprises: 1

•• Dr Bala S. Manian, Chairman •• Dr Vijay Kumar Kuchroo •• Mr Suresh Talwar •• Professor Catherine Rosenberg

Biocon Foundation is a registered trust under the Indian Trusts Act of 1882. Registration number IV410/06-07 dated August 09, 2006. The trust is recognised under Section 80G of the Income Tax Act 1961. Registration under Foreign Contribution (Regulation) Act, 1976 on application dated January 18, 2011.

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Karnataka 9 Districts 76 Gram Panchayats 1,382 Villages

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Rajasthan 3 Districts 15 Gram Panchayats 64 Villages

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Nagaland 1 District 1 Village

BIOCON FOUNDATION ANNUAL REPORT 2017

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Empowering Communities

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An Integrated Approach for Sustainable Development

The World Health Organisation’s (WHO) Sustainable Development Goals (SDG) were announced in 20151. These goals address the interplay between health and social, economic and environmental factors. Potable water, sanitation, optimal nutrition and primary education are direct as well as indirect determinants of health indicators. These coupled with preventive and primary healthcare are the foundation of a healthy community.

Ensures equitable access to basic amenities, quality education and affordable primary healthcare for social and economic inclusion of communities

The 2030 Agenda for Sustainable Development also stresses the importance of the use of information and communication technology solutions, allowing organisations and government agencies to share data and create an environment for ‘open data’ thus strengthening the national and global health information systems.2, 3 Biocon Foundation’s endeavours to improve opportunities for social and economic inclusion of communities by ensuring equitable access to basic amenities, quality primary education and affordable primary healthcare are in line with the underlying principle of the 2030 Sustainable Development

http://www.who.int/sdg http://www/who/int/gho/publications/world_health_statistics/2016 4 http://www/who/int/features/2016/health-inequalities 1

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Agenda- ‘Leaving no one behind’.4 We also believe in the use of technology to bridge resource gaps in remote areas as well as to study data trends and risk profiles of the community, thereby allowing introduction of need based program interventions. SDG 1- No Poverty Biocon Foundation recognized that the biggest gap in healthcare services was in delivering preventive and primary healthcare where the need is most critical. A robust, effective and affordable primary care program, supported by strong preventive health education, sanitation, clean drinking water, and early screening and diagnosis, can mitigate the burden on the healthcare system, and more importantly, reduce health related economic shocks to the individual and the community. SDG 2- Zero Hunger Biocon Foundation through its community development and maternal and child nutrition programs addresses nutrition sensitive as well as nutrition specific causes of malnutrition.

BUILDING THE FOUNDATION FOUNDATION BIOCON ANNUAL REPORT 2017

SDG 3 – Good Health and Well Being Biocon Foundation’s eLAJ Smart Clinic is an integration of primary outpatient care, state-of-the -art diagnostics, in-house Electronic Medical Record (EMR) system and disease focused camps. It is complemented by health promotion, prevention, and comprehensive health environment monitoring and risk assessment in the communities, which, in turn, has created a smart Corporate Social Responsibility (CSR) model that is viable and scalable. 3.1; 3.2 - Decrease maternal mortality ratio (MMR) and end preventable deaths of neonates and children under 5 years of age. Biocon Foundation has developed a workflow in a few primary health centres in Rajasthan to ensure quality antenatal care to pregnant women. The infrastructure of the labour rooms has been improved and skilled human resources have been made available to conduct safe deliveries. The Foundation works with the Karnataka government to improve the nutritional status of under-5 children in the district of Bagalkot. 3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. Biocon Foundation’s eLAJ Smart Clinic model in primary health centres (PHCs) delivers evidence based healthcare and collates the incidence of diseases. 3.4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. Biocon Foundation is on a campaign for action on NCDs and associated risk factors in its intervention areas. Periodic disease surveillance and health education in the communities are well supported by comprehensive management and care for NCDs through PHCs with linkages to specialist consultations and followups at the primary level. The program provides medication and health access

for select chronic illness on a ‘round the year’ basis. The psychosocial counselling provided at the clinics also helps to promote mental health and well-being. The primary objective of the oral, breast and cervical cancer screening programs run by the Foundation is to create a responsible health seeking behaviour at the primary level thus preventing progression of the disease which require high cost secondary or tertiary level interventions. 3.7 By 2030, ensure universal access to sexual and reproductive healthcare services, including for family planning, information and education, and the integration of reproductive health into national strategies and programs. Biocon Foundation through its maternal health and early detection and prevention of cervical and breast cancer programs at the community level addresses common reproductive health problems. Women also receive counselling about family planning and nutrition. 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. Our primary healthcare model is based on the principle of a sustainable health ecosystem. This includes preventive health outreach which leads to informed health seeking behaviour and is supported by access to affordable primary healthcare. This intervention should decrease the hospital admissions thereby creating a manageable risk for insurance. Biocon Foundation also has a micro health insurance scheme in some areas and encourages as well as helps the communities use government health insurance schemes wherever possible. 3.9 Substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination. We have been working towards the decontamination and rejuvenation of water bodies in some of our areas of care.

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SDG 4 – Quality Education

SDG 7 – Affordable and Clean Energy

Biocon Foundation’s Chinnara Ganitha program aims at improving the quality of primary education in government schools. The Foundation realises the importance of good infrastructure support in schools and builds classrooms, boundary walls and toilet blocks creating an environment for better learning.

Over 400 houses were built by the Foundation in North Karnataka and each house has solar lamps.

SDG 5 – Gender Equality Gender sensitisation and domestic violence awareness sessions are important parts of the capacity building training given to our healthcare providers. SDG 6 – Clean Water and Sanitation This is an important component of our CSR mandate and we set up RO (reverse osmosis) plants in communities, build school and community toilet blocks and household toilets. Decontamination and rejuvenation of water bodies also aligns with this principle.

SDG 10 – Reduced Inequalities Biocon Foundation’s vision is to promote social and economic inclusion and all our endeavours align with this goal. SDG- 17 Partnership for Goals We realise that to increase reach and scale, it is imperative that we work with local authorities and the government. Our Public Private Partnerships (PPPs) with governments are testimony to this. We also share our process innovations with partners in the development sector and foster collaborations with organisations who have the expertise in our areas of work.

BIOCON FOUNDATION ANNUAL REPORT 2017

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Healthcare

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Biocon Foundation is constantly engaged in improving the quality of life of several thousand communities in India. Our public health initiatives have been successful in providing sustainable solutions in the area of basic health and addressing the burden of chronic diseases like cancer, diabetes, hypertension and malnutrition

The highest attainable standard of health is a fundamental right of every human being. Through its integrated healthcare initiatives, Biocon Foundation is constantly engaged in improving the quality of life of several thousand communities in India. Our public health initiatives have been successful in providing sustainable solutions in the area of basic health and addressing the burden of chronic diseases like cancer, diabetes and hypertension as well as malnutrition. We have been among the earliest adopters of information & communication technology in our healthcare programs. Through our unique e-healthcare model, we are attempting to transform the system of healthcare delivery in India and bring medical services to the doorsteps of those who need them the most.

eLAJ Smart Clinics We designed eLAJ Smart Clinics to facilitate effective, preventive and primary healthcare interventions in the rural areas of India for the benefit of communities with poor access to healthcare. These eLAJ clinics are technology-enabled, smart clinics equipped with multiparameter monitoring device, which enables multiple diagnostic tests and generation of Electronic Medical Records (EMRs) of patients. The eLAJ model has been designed to deliver data-based healthcare on the basis of socio-demographic and health indicators obtained from communitybased screenings. Through the eLAJ model, we are converting Primary Health Clinics (PHCs) into a comprehensive single point treatment centre with systematic

Objectives of eLAJ

Continuum of care

Quality of healthcare

Monitor disease profile and trigger alerts in case of disease outbreaks

Protocols for care delivery are followed

Examine prevalence of risk factors to initiate preventive health education

Generation of reports for stakeholders at different levels

BIOCON FOUNDATION ANNUAL REPORT 2017

documentation of patient data. This innovative health delivery model is facilitating effective preventive and primary healthcare intervention in the rural areas of Karnataka and Rajasthan for the benefit of communities with poor access to quality healthcare. These clinics are staffed with doctors, technicians and pharmacists who are trained to handle state-of-theart diagnostic equipment and clinic management software, all connected to a secure server. The introduction of the eLAJ model in PHCs can provide access to affordable healthcare services in remote rural areas. The diagnostic centre in an eLAJ Smart Clinic can perform up to 50 tests and results are available under an hour. Patient records are digitized and stored on a central secure server. The eLAJ EMR system is mapped to a unique ID to ensure continuum of care. By providing clinical consultation and essential diagnostic services at

fair prices to all patients, eLAJ clinics reduce out-of-pocket expenses. Improved diagnostics at the eLAJ clinic also reduce the burden on the tertiary hospitals for treatment and insurance schemes. The organic workflow pattern starts with baseline indicators and preventive health and culminates in treatment. This enables surveillance, monitoring and evaluation of the health status of the population. Data from individual clinics or from groups of clinics are available to health administrators through live dashboards, which capture patient footfall, vital parameters, disease profiles of communities and disease trends. The dashboard sends disease notifications and alerts to the administrator. This enables forward planning for the implementation of need-based healthcare programs. Moreover, notifications help healthcare providers plan for seasonal disease outbreaks.

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Biocon Foundation’s eLAJ Model Addressing Gaps in Public Health Delivery in India Infrastructure • Improving and upgrading infrastructure of PHCs. • Renovating toilets & labor rooms. • Installing diagnostic centres in each PHC. • Providing laptops to each PHC for proper documentation.

Training and Capacity Building • Training lab technicians to use semi-automatic lab devices. • Training data entry operators to collect health information efficiently. • Training ANMs and health workers in data collection, immunization and antenatal check-ups.

Staffing • Recruiting doctors, auxiliary nurse midwives (ANMs), general nurse midwives (GNMS), data entry operators, pharmacists, lab technicians & other support staff. • Ensuring that PHCs are running as per Indian Public Health Standards (IPHS) norms on staffing.

Electronic Medical Records • Patient records digitized and mapped to a unique ID to ensure continuum of care. • Secure server stores data and patient privacy is maintained. • Multi-parameter monitors installed to record vitals. • Three interconnected modules: Registration, Clinical Consultation & Diagnostics. • Dashboard to capture data on disease profile of a community.

• Notifications to help tackle seasonal disease outbreaks. • Dashboards ensure follow-up and disease surveillance of the patients. Quality of Care • Ensured that the IPHS norms related to infrastructure, manpower and facilities are followed. • Upgraded labor rooms to ensure institutional deliveries. • Ensured proper power back-up and water supply. • Provided laptops for Pregnancy, Child Tracking and Health Services Management System (PCTS) data entry. • Ensured Water, Sanitation & Hygiene (WASH) practices are followed. • Working with the government to set up biomedical waste disposal protocols.

BIOCON FOUNDATION ANNUAL REPORT 2017

Smart Clinic

Patient - Doctor Interface at eLAJ Smart Clinics

Patient

Registration (EMR) + Vitals (MPM620)

Doctor

Pharmacy

Diagnostics

Test Report

Referral to Secondary/Tertiary Care

Smart Clinic Footprint

Kaladgi

Jawahar Nagar Shyampur Mangalguda

Haliyal Chikkaballapur

Soorwal

Malathalli Hennagara

Mathaniya

Kalkunte

Huskur Austin Town

KARNATAKA

Sangariya

RAJASTHAN

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Disease Profile of Patients Visiting eLAJ Smart Clinics in FY17

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7

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35

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29 Infectious diseases

Fever / Pain

Trauma & Orthopedics

ENT

Non Communicable Diseases

Others

Over the past year, patient footfall at the eLAJ Smart Clinics has gone up by 50% to more than 9,000 a month. Patient footfall spiked between July and October because of seasonal illnesses, hitting a peak of 13,330 in September 2016. Overall data shows that the majority of patient visits to the eLAJ clinics were prompted by infectious diseases (35%) and fever / pain (29%). Rajasthan, where we run five eLAJ Smart Clinics, also saw a jump in patient footfall in the July-October period. The patients diagnosed at these clinics were mostly suffering from pyrexia (31%) and diarrhoea (27%). We are also seeing good traction in the laboratory tests conducted at the eLAJ clinics in Rajasthan, with numbers soaring 13 times between April 2016 and February 2017.

eLAJ SMART CLINICS – SCALING UP Biocon Foundation set up its first eLAJ Smart Clinic in Huskur in Bengaluru in 2015. The pilot at Huskur provided the proof of concept to scale up the model elsewhere. By the end of 2016, the eLAJ Smart Clinic model was installed at eight clinics in Karnataka, run exclusively by Biocon Foundation and completed the adoption of five government PHCs in Rajasthan under a Public Private Partnership (PPP) with the Government of Rajasthan. In January 2017, Biocon Foundation and the Government of Karnataka signed an MoU to install the eLAJ Smart Clinic model in 15 government run PHCs in Karnataka. The first of these have been flagged off in February 2017.

Through this PPP, Biocon Foundation aims at strengthening the present public healthcare system in Karnataka by providing solutions around primary & secondary healthcare with effective use of technology. Biocon Foundation is recognized widely for implementing innovative healthcare models to create a sustainable health ecosystem. By joining hands with the government, we aspire to benefit many more villages in Karnataka through the eLAJ model that combines good infrastructure, latest technology and the best available medical expertise. The Foundation currently runs 14 eLAJ clinics covering over 30 Gram Panchayats across Karnataka and Rajasthan.

BIOCON FOUNDATION ANNUAL REPORT 2017

Pradhan Mantri Surakshit Matritva Abhiyan-ANC Camps

India ranks first in the list of 10 countries that account for 60% of all pre-term births. Yet, India has little more than 50% of antenatal care coverage. In order to tackle the issue of premature births, low birth weight babies and stillbirths, it is essential to increase the coverage of antenatal care in the country. To enable this, the Ministry of Health and Family Welfare, Government of India, has launched a program called Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA). The aim of the program is to provide a comprehensive package of antenatal care services to pregnant women in their second and third trimester at government health institutions. How Biocon Foundation is ensuring smooth implementation of PMSMA: •• All eLAJ PHCs use a unique prescription form, designed as per government requirements, to collect data. •• eLAJ PHCs collaborate with private doctors to be a part of PMSMA.

Biocon Foundation is helping the Rajasthan Government implement PMSMA efficiently at the eLAJ PHCs

•• All PHCs are provided with Fetal Doppler by the Foundation to check fetal heart rate. •• Glucometers with strips are provided to PHCs to track blood sugar levels of pregnant women. •• Creating monthly action plans for all health centres for smooth management of high-risk pregnancy (HRP) cases.

•• As recommended for HRPs in PMSMA guidelines, all eLAJ health centres use red stickers on the high-risk individual’s MAMTA card. •• eLAJ PHCs provide vehicles to pick up and drop off pregnant women for antenatal check-ups. •• Access to eLAJ dashboards are given to medical officers and senior officers from health department to monitor HRPs. •• The dashboards help them monitor HRP cases and ensure that proper preparations are done in case of referral. In case of high-risk pregnancy cases, eLAJ PHCs follow an action plan: •• Referral to higher institution for delivery: All HRPs, whose deliveries are due in the next two months, are referred to higher institutions. •• Birth and emergency preparedness plan: All pregnant women expected to deliver in the next two months, with a special focus on high risk cases. •• Referral to higher institutions for Iron Sucrose: All severe anaemia cases are referred as either inpatient to the PHC, if the facility is available, or to the higher institution. •• Referral to higher institution for other treatments: All pregnant women identified with some clinical condition for which, treatment can’t be provided at PHC. In FY17, nearly 2,490 pregnant women attended the PMSMA camp of which, over 353 were found to be high risk pregnancy cases. Over 34,116 Iron/ Folic Acid tablets were distributed to anaemic women. 156 women received iron sucrose infusions. Biocon Foundation also identified about 450 women for family planning counselling.

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Non Communicable Diseases

Biocon Foundation believes in an integrated community based risk factor management program, a cost-effective and efficient approach to tackle NCDs

Non-communicable diseases (NCDs), also known as chronic diseases, are not passed from person to person. They are of long duration and generally progress slowly. India is transiting speedily to lifestyle diseases. NCDs contribute to around 5.87 million deaths that account for 60% of all deaths in India. There is an urgent need to put NCDs at the centre of the country’s health policy plans and programs. At Biocon Foundation, we believe an integrated community based risk factor management program is a cost-effective and efficient approach to tackle NCDs. We have been conducting population-based screenings for oral, cervical and breast cancers.

•• Garner evidence for action through disease surveillance, monitoring and research •• Psychosocial counselling to meet the emotional, social and mental needs of patients •• Human Resources and their capacity building for prevention and treatment of NCDs •• Early diagnosis through periodic/ opportunistic screening of population •• Treatment and care of NCD patients in special health camps •• Handholding and referrals as and when required

The multipronged approach to NCD management at eLAJ Smart Clinics includes: •• Health promotion and prevention strategies for healthy lifestyles that prevent NCDs and associated risk factors

ORAL CANCER Oral cancer, which includes cancers of the lip, mouth, palate, inner cheek, and most of the tongue, accounts for about 7% of all new cancers diagnosed annually in India. India has a higher incidence of cancers of the oral cavity compared to the globe due to widespread use of different forms of tobacco in combination with areca nut and alcohol.

Total Number of Individuals Screened

6900 Oral Potentially Malignant Lesions Detected

2739

Early detection and prevention of oral cancer can drastically reduce mortality and the economic burden on the communities. We have adopted a pathbreaking mobile phone-based health (mHealth) program, designed for low resource and skill settings, for the detection and prevention of oral cancer. The mHealth program is a population-based screening service that facilitates the early detection of pre-cancerous lesions at one’s doorstep.

In FY17, we integrated our mHealth program for early detection of oral cancer into the existing government healthcare delivery system in association with the Karnataka government. The project “Screen & Treat”-Early Detection and Surveillance of Oral Cancer was implemented in Telagi & Yediyur PHCs. In addition, we continued our workplace screening programs and have fostered partnerships to enable screening at remote locations such as in Nagaland. Oral health awareness camps: During the year under review, 17,598 people benefitted from our oral health awareness camps which were held at various locations. Of these, 1,894 received basic dental treatment at these camps. As a service to the geriatric population, 34 complete dentures were distributed.

BIOCON FOUNDATION ANNUAL REPORT 2017

Oral Cancer Screening Process and Referrals

Identified high risk patients (HRP) by health workers are referred to PHC

House to house screening survey for individuals over 18 years by health workers

Dedicated NCD desk at PHC– Trained Dr/Nurse screens HRP give education and Aquasol-A (Chemoprevention) if required

Screened patients with advanced lesions are referred to tertiary centers

Data Collection & Follow Up Management

1. Health workers capture individual’s screening survey data through digital sheet & pen

3. Surveillance by Specialist: Both data sets are uploaded on a server, are reviewed and followup is managed

CERVICAL CANCER

Number of Women Screened

987 Women with Cytological Evidence Of Infections

184 Women with Abnormal Pap Smears

21 Cancer Detected and Treated

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According to the National Cancer Registry Data, 92,731 cases of cervical cancer were reported in India in 2013, a figure that is projected to go up to 100,479 in 2020. The latest estimates by Indian Council of Medical Research (ICMR) states that over 62,000 women died of cervical cancer in 2015, accounting for 24% of the total cancer-related deaths of women in India. Biocon Foundation’s program for early detection and prevention of cervical cancer works on a unique model of conducting its services through three stages of prevention. Primary prevention measures are aimed at individuals in the susceptibility stage. Secondary prevention measures focus on the sub-clinical stage and the early clinical stage and Tertiary prevention measures are directed primarily at the treatment and rehabilitation stage.

2. Trained Dr/Nurse captures HRP’s diagnostic data and images in mobiles inbuilt with clinical decision algorithm

Since its initiation, the program has benefitted around 3,000 women from underserved communities. Some of these women had significant lesions and some had ignored common reproductive tract infections due to lack of knowledge, privacy and their inability to access tertiary cancer centres on time. To take the benefits to a larger a population, we are implementing the program through eLAJ smart clinics as well as by partnering with different organizations/ workplaces. In 2016-17, 13,617 women received reproductive health education and 79 camps were held at various locations.

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Cervical Cancer Prevention

Primary Prevention

• Early detection of cervical cancer through community information and education • Door-to-door awareness by our Community Health Workers (CHWs) who use specially designed awareness aids like flipcharts, pamphlets and standees

Secondary Prevention

• Conduct monthly Pap Smear screening services that includes pelvic, breast and bimanual examinations • Target: 20 women per camp • Service Providers: 2 eLAJ clinic trained doctors, gynaecologists from tertiary centres, doctors from government taluka hospital.

Tertiary Prevention

• Follow-up and referral • Health services provided at tertiary centre: Colposcopy, Cone Biopsy, LEEP, Cryotherapy • Service Providers: Narayana Health, St John’s Medical College, S Nijalingappa Medical College and Karnataka Cancer Therapy Research Institute

BIOCON FOUNDATION ANNUAL REPORT 2017

Case study

Health for Every Woman Everywhere We started the Cervical Cancer screening program in Haliyal Taluk in July 2016. Our community health workers (CHWs) met Geetha (name changed), a resident of one of the villages in Haliyal, during their routine field work. She is 42 years old and a mother of two children. Discussions with the CHWs revealed that she had symptoms that indicated a high probability of cervical cancer. The CHWs encouraged her to come for cervical cancer screening. Geetha’s Pap smear test detected squamous cell carcinoma, a form of cervical cancer. Immediate follow up was planned for her and the CHWs were able to convince Geetha and her family about the urgency of visiting a tertiary healthcare centre. As advised by the doctors, Geetha under went hysterectomy and has recovered well. She now believes that no woman should ever ignore reproductive health related problems and timely intervention can prevent prolonged illness and possible death.

BREAST CANCER As per the Indian Council of Medical Research (ICMR), the total number of new breast cancer cases were around 14.5 lakh in 2016 with the figure expected to reach nearly 17.3 lakh new cases in 2020.

Biocon Foundation runs the breast cancer screening with a handheld device, the Intelligent Breast Examination (iBE), a novel US FDA approved medical instrument for pre-screening of breast lesions

Biocon Foundation runs the breast cancer screening program in association with UE Life Sciences. The screening includes clinical breast examination with a handheld device, the Intelligent Breast Examination (iBE), a novel US FDA approved

medical instrument for pre-screening of breast lesions. Those who are found to have lesions are then referred for ultrasound/mammography. This handheld device is able to identify high priority patients who require ultrasound or mammography at the first level, therefore reducing their risk of developing breast cancer. Of the 1,755 persons screened for breast cancer this year, 185 were found to have lesions in the breast. Among them, over 90 underwent mammography.

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NCD-Integrated Risk Factor Management for Type 2 Diabetes and Hypertension

retinopathy, cataract and other eye problems.

DISEASE SURVEILLANCE The Foundation routinely conducts surveys for community risk profiling. The data so generated helps characterize the health status of communities, identify new NCD cases and assess vulnerability to associated risk factors. In FY17, more than 1,200 individuals were screened in a peri-urban village in Bangalore. 12% of the people surveyed had high blood sugars and 4% were unaware of their glycaemic status. 30% of the surveyed population had high blood pressure and 23% were unaware of their elevated pressures. 49% of the participants were obese and 16.5% were overweight.

•• Neuropathy camp: Total 161 diabetes patients have gone through foot screening in special neuropathy camps. •• Psychosocial counselling: This part of the program provides the patient with factual information about NCDs and associated risk factors. Our aim has been to enable these patients to avoid behaviour that might damage their own health. 2,730 counselling sessions were recorded by the counsellors. 20.8% of the counselled individuals admitted to using some form of tobacco and agreed to quit with help from the counsellor. 17.2 % individuals agreed that their stress levels were high and required further sessions of counselling.

NCD HEALTH CAMPS Biocon Foundation conducts monthly health camps for NCDs through its clinics at different geographical locations in Karnataka. Early diagnosis is carried out along with the health screening in these camps. The health check-ups are free while medicines and lab investigations are very much subsidized.

•• Follow-up & awareness creation: Biocon Foundation rigorously conducts community awareness programs to avoid and reduce common risk factors of NCDs. Our CHWs from the NCD clinics regularly conduct follow-up medical checks on patients to monitor blood sugar and blood pressure and motivate members of the community to adopt a healthy life style, food habits and behaviour. Over 4,000 follow-ups were conducted by the CHWs in the community.

In 2016-17, we witnessed a footfall of over 8,000 at our NCD Health Camps, which was a growth of 36% of the preceding year. •• Retinopathy camp: Total 171 patients with diabetes mellitus underwent retinal screening and 62 have been diagnosed and treated for diabetic

Biocon Foundation has developed a comprehensive program for the detection and management of Type 2 Diabetes and Hypertension through its PHCs

NCD Cases Managed Diabetes + Hypertension

758

+

Only Diabetes

1,205

+

Only Hypertension

357

=

Total

2,320

BIOCON FOUNDATION ANNUAL REPORT 2017

Management of Child Undernutrition

Nutritional well-being is the key to human development and must be at the heart of all national development policies and programs. It must gain utmost importance in India’s health environment where annually 1.2 million children die before their first birthday. Nearly half of all deaths in children under five years of age is attributed to under-nutrition, which is a major public health problem.

In collaboration with Regional Government Departments, Biocon Foundation has demonstrated a coherent and effective action plan at the local level to improve the nutritional status of children

BALASPANDANA PROGRAM Biocon Foundation started nutrition intervention for under-5 children in Bagalkot district in 2012-13. Our role is supplementary to the government’s Integrated Child Development Services (ICDS) program. We seek to plug the gaps in the ICDS program and have established convergence with the government in supporting it in nutrition response initiatives. Our comprehensive strategy is anchored in the facilitation of cluster-wise health check-ups for malnourished children through government PHCs and CHCs. Biannual monitoring of Haemoglobin level is done to address the problem of micronutrient deficiency (hidden

hunger). Well baby files are given to caregivers with all health and nutrition records of children with Severe Acute Malnutrition (SAM) to ensure continuum of care. Nutritional supplements are given for free as prescribed by the government doctors in the camps. Our health workers visit homes of SAM children to reiterate the importance of good health follow-ups and care. Nutrition counselling strengthens the capacities of mothers or caregivers. To increase knowledge, attitude and skills of our health workers, we identify their training needs and impart it accordingly. We hand hold a child and his/her family in case of referral to secondary or tertiary centres for chronic or congenital problems. After successfully demonstrating viability of the Balaspandana Program, we have scaled up our intervention. Over the last one-and-a-half years, our program coverage in Bagalkot district has increased to four taluks, 1,275 Anganwadi Centers (AWCs), 31 PHCs and 8 CHCs from previous 389 AWCs, 8 PHCs and 3 CHCs respectively.

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Outcome of the Balaspandana Program: 2016-17 Indicators

Figures

Total Health Camps Organised

190

Camp Footfall

SAM-1,951 MAM-196

Average Footfall Per Camp

11

Number of Malnutrition Cases Managed

Total-834 SAM-713 MAM-121

SAM Improved (According to Weight-for-age)

216

Stunting (Height-for-age) Reduction in Malnourished Children

Children Improved From: •• Severe to Moderate Stunting-10.5% •• Severe Stunting to Normal-2.1% •• Moderate Stunting to Normal-8.6%

Wasting (Weight-for-height) Reduction in Malnourished Children

Children Improved From: •• Severe to Moderate Wasting-34% •• Severe Wasting to Normal-21.7% •• Moderate Wasting to Normal-43.7%

Upward Growth Trend in SAM (a/c WHO Growth Chart - Weight-for-age)

91.7%

Number of Children Monitored for Hb

407

Percentage of SAM Children with Anaemia

73%

Number of Children Dewormed

223

Number of Children Received Vitamin-A Supplement

231

Improvement in Anaemia (By Hb Level)

14%

Average Period Taken in SAM improvement (Age-group wise)

•• 06-24 Months Age Group-5 Months •• 25-36 Months Age Group-13 Months •• 37-60 Months Age Group-16 Months

Home Visits & Counselling Done

Total: 1,091 •• For Absentees: 824 •• For Anaemic Children: 267

Conversion Rate (Adherence to Subsequent Health Camps of the Total Home Visits Done for Camp Absentees)

63%

BIOCON FOUNDATION ANNUAL REPORT 2017

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WELL BABY CLINIC

Biocon Foundation provides general paediatric consultative services, follow-ups for ill children and supports both the physical & emotional well-being of children and their families

In August 2016, Biocon Foundation established a paediatric clinic in Austin Town, Bengaluru, in collaboration with St John’s Community Health Department. The clinic serves the surrounding community, mainly comprising migrant labourers living in slums and temporary dwellings. Malnourished children receive special care and attention at the clinic. While consultation and lab tests are free, medicines are dispensed at very subsidized rates. Our CHWs educate

caregivers about best child rearing practices. We have adopted a CommunityBased Management of Acute Malnutrition (CMAM) approach and provide Ready-to-use Therapeutic Food (RUTF) under the supervision of the clinic’s doctor, which enables us to identify and initiate treatment for SAM children before they become seriously ill. As and when required, children with medical complications are referred for in-patient medical treatment.

Outcome of the Well Baby Clinic: 2016-17 (Aug-March) Indicators Total Health Camps Organised in the Clinic Camp Footfall Average Footfall per Camp Number of Cases Managed

Figures 08 263 33 Total - 155 SAM - 05 Others-150

BIOCON FOUNDATION ANNUAL REPORT 2017

Case Study

Health Behaviour Change Pragathi (name changed) is a two-and-a-half-year-old child who is living a healthy life in Chikkshelikeri village, Kaladgi, Bagalkot. But life was not the same for this young child who is being raised in a family of generational farmers with a small household income. In the joint family of 12 members, the child’s primary caregiver is the mother, who has not even completed school education. On Jan 10, 2016, Pragathi was diagnosed with severe acute malnutrition; she was 1 year 7 months old and weighed just 6.9 kg. The detailed anthropometric assessment at our health camp confirmed her SAM status and systemic examination also indicated a loss of appetite, low cognitive skills and recurrent episodes of illness. Biocon Foundation ensured regular health check-ups while monitoring the growth of the child. It also provided free nutrition supplements to the child as prescribed by the doctor at the health camp. The rigorous counselling by our health workers led her mother to supplement breastfeeding with a healthy diet plan. She also adopted healthy dietary behaviour and child rearing practices. Counselling also resulted in diversification of diet and more reliance on locally available and cheap but nutritious foods. The child gained 2.3 kg in 7 months and has improved from SAM grade. Biocon Foundation is still following up with the child’s family to prevent any illness or repeated episode of nutritional aberration.

Impact Evaluation

Key Performance Indicators: 2016-17 Preventive Health Metrics Personal Hygiene

16215

Environmental Hygiene

14040

Safe and Clean Drinking Water

13991

Diabetes Mellitus and Hypertension

17208

Cervical Cancer

13617

Dengue and Chikungunya

11159

Key Motivators Counselled

86230

Primary Health Metrics Footfall in eLAJ Clinics

108799

Percentage of Infectious Diseases

35%

Percentage of Fever and Pain

29%

Percentage of Non Communicable Diseases

16%

Percentage of Trauma and Orthopaedics

9%

Percentage of ENT

4%

Others

7%

Pradhan Mantri Surakshit Matritva Abhiyan Total Footfall of ANCs Number of High Risk Pregnancies Identified

2490 353

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Breast Cancer Screening Total Women Screened

1755

Number of iBE Positive Cases

185

Cervical Cancer Screening Number of Camps Conducted

79

Number of Women Screened

987

Number of Women Counselled

13617

Positive Cytology Rate

2%

Rate of Reproductive Tract Infections

13.5%

Follow up (completed) for Positive Cytology

23%

Follow up (in process) for Positive Cytology

64%

Follow up Refused by Patient

13%

Oral Cancer Screening Number of People Screened

6900

Number of Oral Potentially Malignant Lesions Detected

2739

Individuals Reached through Oral Health Awareness and Treatment Camps

17598

Number of Patients Treated in Dental Camps

1894

Diabetes Mellitus and Hypertension Total Patient Footfall at Specialist Camps

8198

Psychosocial Counselling Done

2730

Control Rate-Diabetes Mellitus

35%

Control Rate – Hypertension

55%

Malnutrition Number of Health Camps Organized Total Camp Footfall

Total Number of Malnutrition Cases Managed Upward Growth Trend in SAM (a/c WHO Growth Chart - Weight-for-Age) SAM Improved (Weight-for-Age)

190 SAM-1,951 MAM-196 Total-834 SAM-713 MAM-121 91.7% 216

Home Visits & Counselling Done

1,091

Conversion Rate (Adherence for Subsequent Health Camps of the Total Home Visits Done for Camp Absentees)

63%

BIOCON FOUNDATION ANNUAL REPORT 2017

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Education

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In the area of Primary Education Biocon Foundation provides schoolchildren with the basic knowledge and skills needed to lead productive healthy lives and attain sustainable livelihoods

Primary and middle school education form the firm foundation of a child’s future, and provide the framework on which the quality of higher levels of learning and careers depend. Language skills and mathematical ability form the core of the learning process. While language is a key enabler, mathematics teaches logical and critical thinking, life skills and supports continuing education and better career prospects. Biocon Foundation's efforts in the area of primary education are geared towards providing schoolchildren with the basic knowledge and skills they need to lead productive healthy lives and for attaining sustainable livelihood.

CHINNARA GANITHA A robust mathematics program must incorporate techniques that comprehensively reinforce to the student, the importance of the subject in daily life and in the immediate environment. It should be closely mapped to other subjects in the curriculum. The program should make the journey of learning mathematics exciting and fun, and not a subject that seems too abstract and confusing. The aim of the program should be to endear the learner to the subject; rather than arouse fear. With these objectives in mind, the Biocon Foundation introduced the Chinnara Ganitha program via a series

BUILDING THE FOUNDATION FOUNDATION BIOCON ANNUAL REPORT 2017

of mental mathematics workbooks in Kannada for classes 1 through 7. These workbooks assist concept building through attractive illustrations and diagrams. There is minimal use of text and the vocabulary is kept simple. Each new topic carries a concept-building illustration, a worked example, a handy tip or short-cut, a link to real life situations, and plenty of practice. The Chinnara Ganitha program was launched in 2006 and has a wide reach across more than 1,100 government schools in eight districts in Karnataka. Teacher training and student assessment have resulted in encouraging results and feedback from both teachers as well as students.

As per the ASER 2016 report, for the first year since 2010 there is an upward trend in basic arithmetic skills for Class 3 in government schools. The ability to perform two-digit subtraction increased from 17.2% in 2014 to 20.2% in 2016. The ability to do simple division problems in Class 5 has remained almost unchanged. The ability to correctly do a 3-digit by 1-digit division problem in Class 8 has increased by about 5 percentage points. Over 100,000 workbooks were distributed in the academic year 2016-17.

Biocon Foundation distributed over 1,00,000 books to Primary School students across Karnataka

Books Distributed Class-wise Grade 1

Grade 2

Grade 3

Grade 4

Grade 5

Grade 6

Grade 7

Bengaluru (Anekal, Kalkunte & IISC)

2200

2000

3100

2800

3000

2500

2300

Chikkaballapur

1300

1700

1300

1600

1900

400

1200

Coorg

1200

1350

1300

1400

1350

1350

1350

Bagalkot

8000

8250

8000

8250

8200

7800

7400

750

1750

3000

3000

3000

3000

3000

Karwar (Dandeli, Joida & Haliyal)

A Total Number of 1,10,000 Books were Distributed Across Karnataka

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Additionally, we have been able to address speech defects, attention deficiency and emotional problems through a part-time trained volunteer. Students who attended the program in 2011-12 have returned to inform us that they have scored good marks in the SSLC examination and are able to attend the PUC classes with ease and confidence because of their firm foundation in English.

Children aged between nine and eleven are provided with a nourishing snack and are taught English, Digital Skills, Life Skills and Art & Craft

AATA PAATA WADI As a deliberate and conscious effort at achieving the goals of quality education for children in government schools, the Biocon Foundation runs the Aata Paata Wadi after-school resource center at Thithimathi in Kodagu district. Children aged between nine and eleven are provided with a nourishing snack and are taught English, digital skills, life skills and art & craft. Of the 35 students enrolled, only six knew English at the beginning of the program. At the end of the academic year, they were all able to read, speak and write English without any inhibitions. Some of our Aata Paata Wadi students attend a day school equipped with

computers, but without a computer teacher. Based on the computer lessons learnt at the Aata Paata Wadi, these children were able to teach other students to work with computers. As part of the Aata Paata Wadi life skills program, the students are taught to practice personal hygiene and involve themselves in environment protection. This has had a cascading effect, as evidenced by their parents at home and their teachers at their regular schools. The Aata Paata Wadi Swachh School Campaign that started in 2014 has gained momentum and has been greatly appreciated by their school authorities. Twenty of our students were awarded special prizes at the local Republic Day celebrations for their contribution in keeping their school toilets clean.

“A Class 10 teacher in the Government High School wondered how 22 of her students were so good in English. When she enquired, she found out that they had all learnt English at the Aata Paata Wadi.” -Ms Sajini Monappa Center Head Aata Paata Wadi

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Community Development

3151

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COMMUNITY DEVELOPMENT PROGRAMS

Biocon Foundation is committed to a child’s right to have a healthy and clean environment

Sanitation is at the core of human dignity and progress with every child having the right to a safe and healthy learning environment. Diseases related to inadequate water, sanitation and hygiene are a huge burden in developing countries. Being a responsible corporate citizen, Biocon, through its Biocon Foundation wing, is committed to a child’s right to have a healthy and clean environment. This is effective in reducing diseases and worm infestation. SCHOOL TOILETS Schools, particularly those in rural areas, often completely lack sanitation and handwashing facilities; alternatively, where such facilities do exist they are often inadequate in both quality and quantity. Keeping in line with the Swachh Bharat Mission and Swachh Vidyalaya program, Biocon Foundation constructed toilet blocks in four government primary schools, with two in Anekal Taluk (Attibelle and Marasuru) near Bengaluru and the rest in Bagalkote district (Gulledagudda and Nagarala). HENNAGARA SCHOOL BUILDING Pushing forward its commitment to the spread of education in rural India, Biocon Foundation completed the construction of four classrooms from grade 1 to grade 4 of the government school building in Hennagara. With the completion of the classrooms, 86 more students will be able to receive education. The school has a strength

of 153 students with grades spanning from class 1 to class 7. GIRLS’ HOSTEL Biocon Foundation, in collaboration with Shri V.R. Deshpande Memorial Trust has established a ladies’ hostel for the economically weaker sections of the society in Haliyal, North Karnataka. The hostel has dormitories with provision for 65 women. This hostel will further facilitate young girls from the surrounding and distant villages who come to Haliyal for learning vocational skills. PROJECT ONE Biocon Foundation has always encouraged the use of clean drinking water through its public health education sessions in the community. Understanding the growing health concern in the geography and lack of potable water, Biocon Foundation initiated ‘Project One’. It is a community drinking water initiative through which, water purification systems equipped with Reverse Osmosis (RO) and UV technology have been installed to provide clean drinking water to the community. Through this project, 500 litres of water could be purified within a span of an hour and can provide clean drinking water to a population of more than 5000 villagers every day. In FY17, we have installed water points in Mangalagudda (Bagalkote) and Maruti Nagar (Bengaluru).

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BIOCON NAGAR

Biocon has taken up the initiative to contribute to the lake revival mission of Bengaluru

Biocon Foundation has developed an integrated community development initiative in Mangalgudda in Bagalkote district. The township, which was built for the community displaced by the floods of 2009, consists of 411 houses that are equipped with solar lights and independent toilets. In FY17, the foundation has built a clinic for the community that provides, apart from medical consultation, medicines and diagnostic tests. Between October 2016 and March 2017, 1543 patients have visited the clinic with fever and respiratory illness being the most common ailments. Additionally, a boundary wall for the Anganwadi has been built this year. LAKE REJUVENATION Biocon has taken the initiative to contribute to the lake revival mission of Bengaluru. Biocon Foundation took the lead to sign an Expression of

Interest (EOI) for the rejuvenation of Hebbagodi Lake at the ‘Bring Back the Lakes’ workshop organized by Karnataka Lake Conservation and Development Authority (KLCDA). Biocon has cleaned up the area, removed debris and weeds in and around the lake including dense vegetation, which had resulted in the shrinking of the waterbody. Additionally, water inlets have been cleaned, covered and screens included to prevent debris from being washed into the lake. Land has been cleared to make place for children’s playground, fencing of the cleared stretch has been undertaken and information boards and streetlights have been installed. We have also engaged with the local communities to sensitize them about the importance of water bodies and their role in preserving them with their best civic behaviour. It is critical for the local community to play an active role in lake conservation and revival.

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NAMMA BIOCOMMUNITY Biocon accords high importance to the health and safety of its stakeholders including its neighboring communities. In FY17, Biocon employees came together under the aegis of Namma BioCommunity, a community connect initiative of Biocon to make a difference to people’s lives in urban and rural areas with a focus on ensuring a clean, green, and safe environment. A 40 member strong team of Biocon

Biocon employees came together under the aegis of Namma BioCommunity, to make a difference to people’s lives with a focus on ensuring a clean, green, and safe environment

volunteers, both men and women, spearheaded several drives during the year to clean up and renovate a number of underpasses around Hosur Road, Hebbagodi, Huskur, Hennagara, Bommasandra etc. which were in a very poor state thus making it impossible for use by public. Namma BioCommunity encouraged pedestrians in the area to use the underpass to avert road accidents.

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Impactful Programs

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Program Progress and Achievements Program

Secondary Data

Program Intervention

Program Outcome

Primary Healthcare

As per IPHS guidelines, ideal population per PHC is 20,000 (tribal/hilly areas) and 30,000 (plain areas). Currently, population per PHC is 23,385 (tribal/hilly areas) and 32,884 (plain areas) as per Rural Health Statistics-2016.

eLAJ clinics set up Karnataka: 9 Rajasthan: 5

1, 08,799 beneficiaries received comprehensive preventive and primary healthcare services.

Early Detection and Prevention of Cervical Cancer

As per ICMR report, over 62,000 women died of cervical cancer in 2015, accounting for 24% of the total cancer-related deaths of women in India.

Conducted population based screening and awareness programs covering 987 women in the 21-60 age group in rural and urban communities.

In 2% cases, positive atypical cells were detected. 13.5% of the screened women were diagnosed and treated for vaginal infections.

Early Detection and Prevention of Breast Cancer

As per ICMR report, the total number of new breast cancer cases in India were around 14.5 lakhs in 2016 and the figure is likely to reach nearly 17.3 lakh cases in 2020.

Screening of 1,755 women through a novel US FDA cleared medical instrument, Intelligent Breast Examination (iBE), for pre-screening of breast lesions through a non- invasive and painless method.

10.5 % of the women screened were found to have lesions in the breast; 50% of these positive cases underwent mammogram or ultra-sonography after referral.

Mobile Early Detection and Prevention of Oral Cancer

As per ICMR report, cancers associated with the use of tobacco account for about 30% of all cancers in males and females. According to National Family Health Survey (NFHS) -4 2015-16, 6.8% women and 44.5% men use tobacco in some form or the other.

6,900 persons screened using mHealth (mobile health) technology for early detection and treatment of oral precancerous lesions in community and workplace settings.

2,739 positive cases of Oral Potentially Malignant Disorders (OPMDs) detected.

Management of Diabetes and Hypertension

As per Global Status Report on NCDs published by WHO in 2014, NCDs contribute to around 5.87 million deaths that account for 60% of all deaths in India. India shares more than two-third of the total deaths due to NCDs in the South-East Asia Region (SEAR).

Disease surveillance, health camps, diagnostics, subsidized medicines and psychosocial counselling initiatives implemented to manage NCDs and associated risk factors. Community awareness and patient follow-ups conducted to improve compliance.

2,320 beneficiaries in the program. Camp footfall was 8,198 during the year. 2,730 counselling sessions were organized for NCD patients. 4,097 home visits made by health workers for patient follow-up.

Balaspandana Management of Child undernutrition

As per the Rapid Survey on Children (RSOC) 2013-14 report, stunting in under-5 children is 38.7%, wasting is 15.1% while 29.7% of the under-5 children are underweight in India. According to UNICEF, nearly half of all deaths in children under-5 years of age are attributable to undernutrition.

Conducted health camps and growth monitoring and provided free nutrition supplements for malnourished children. Home counselling was provided to caregivers to get them to adopt healthy behaviour and best child rearing practices.

A total of 834 malnutrition cases were managed, out of which 713 were severe acute malnourishment (SAM) cases. A total of 216 children improved from SAM grade. A 14% reduction in anaemia (by Hb level) has also been observed during this period in the malnourished cases.

BUILDING THE FOUNDATION FOUNDATION BIOCON ANNUAL REPORT 2017

Program

Secondary Data

Program Intervention

Program Outcome

Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

As per NFHS-4 2015-16, only 58.6% mothers had antenatal check-up in the first trimester and only 51.2% had mandatory 4 antenatal care visits.

Systematic care and supervision of women during pregnancy were conducted to monitor the progress of fetal growth and to ascertain the wellbeing of mother and fetus.

A total of 2,490 women received antenatal care. 353 high risk pregnancy cases were identified and managed. 34,116 IFA tablets were distributed. 156 women were given iron sucrose infusions. 449 women were counselled for family planning.

Chinnara Ganitha

Nationally, only 27.7% of Std III children could do a 2-digit subtraction, 26% Std V children could do simple division problems and 43.3% Std VIII students could correctly do a 3-digit by 1-digit division problem, according to 11th Annual Status of Education Report (ASER 2016).

Over 100,000 Chinnara Ganitha mathematics workbooks were distributed across 1200 schools. A total of 1200 teachers were trained.

Teachers reported that the use of the Chinnara Ganitha workbook has enabled students to understand mathematical concepts easily.

Swachh Vidyalaya

As per NUEPA & GoI report on elementary education in India, 2014-15, 8% of the schools in our country do not have functional boy’s toilets and 7.5% do not have functional girl’s toilets. 56% of the schools don’t have hand wash facilities near the toilets.

Constructed toilets in government schools with functioning water, sanitation and hygiene facilities to establish a healthy school environment and enable hygiene practices.

In line with the Swachh Vidyalaya program, we have constructed toilet blocks in 4 government primary schools 2 in Anekal Taluk (Attibelle and Marasuru) near Bengaluru and 2 in Bagalkot District (Gulledagudda and Nagarala).

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Program

Secondary Data

Program Intervention

Program Outcome

Civic Infrastructure Development

The annual average of land area affected due to floods is about 45.64 million hectares according to the Working Group on Flood Management set up by the Planning Commission for the 11th Five-Year Plan.

Developed essential civic infrastructure. We also promoted environmental education, rural development, better access to water and sanitation facilities, conservation of natural resources as well as support in disaster relief operations, in line with Companies Act-2013.

411 houses were built for the Mangalgudda community that was displaced by the floods of 2009.

Installed water purification systems with reverse osmosis (RO) and ultraviolet (UV) technologies to provide potable drinking water with a capacity of purifying 500 litres in an hour.

Set up community water points in Mangalagudda (Bagalkot) and Maruti Nagar (Bengaluru). Provided drinking water to communities of 5,000 members.

According to the Ministry of Environment, Forest and Climate Change, GoI, the dissolved oxygen content of the water of most of the lakes in and around Bengaluru has gone below the desired level of 4 mg/l including depletion of dissolved oxygen due to organic pollution. Project OneCommunity Safe Drinking Water Initiative

As per NFHS-4 2015-16, 89.9% households in India have an improved drinking-water source. Sustainable Development Goals target to achieve universal and equitable access to safe and affordable drinking water for all.

Ladies’ hostel for the economically weaker sections of the society in Haliyal, North Karnataka; has a provision for 65 women. The rejuvenation of the Huskur Kalyani (temple tank).

BUILDING THE FOUNDATION FOUNDATION BIOCON ANNUAL REPORT 2017

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Grant in Aid

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BIOCON FOUNDATION FOUNDATION

Biocon Foundation introduced the ‘Grant in Aid’ program in FY16 with a vision to increase its footprint in wider geographies across India and meaningfully engage in the domains of healthcare, education, rural development, water, sanitation, women's safety & empowerment and art & culture. In 2016-17, the program focussed on funding and collaborating with organisations in the domains of education and art & culture.

Biocon Foundation through its ‘Grant in Aid’ program aims to expand its scope of engagement across various domains such as womens safety & empowerment, rural development & sanitation and art & culture

EDUCATION This year, Biocon Foundation has supported four educational endeavours: Indian School of Business (ISB) The Indian School of Business is an internationally top-ranked, researchdriven, independent management institution that grooms future leaders of India and the world. The grant is towards The Biocon Cell for Innovation Management, which fosters innovation and links it to operational excellence. The Cell has been launched in partnership with Biocon Limited and works under the aegis of the Centre for Leadership, Innovation, and Change (CLIC). The Institute of Bioinformatics and Applied Biotechnology (IBAB) IBAB has been established by the Government of Karnataka and is chartered to become a globally recognized institution of higher learning in the bioinformatics and biotechnology domains. The Biocon Foundation grant to IBAB is an endowment to support a faculty chair at IBAB.

for Science Gallery Bengaluru(SGB). ‘Entanglement’ illustrated ones interaction and understanding of the natural and physical world. Through form, experience, and interaction, a collective of international and Indian artists, scientists, coders, and hackers engaged the public through projects on Environment, Gaming, Artificial Intelligence and Interactivity, and Physical Computing and Data Quantification. Biocon Foundation through its grant to Ujwal Trust that manages the Mallya Aditi International School and the Srishti Institute of Art, Design and Technology in Bangalore, enabled this exhibition. The Science Gallery Bengaluru is an extension of Science Gallery International, being set up in partnership with the Department of IT, BT & Science and Technology, Govt. of Karnataka, Srishti School of Art & Design, the Indian Institute of Sciences (IISc), National Centre for Biological Sciences (NCBS), and the Visvesvaraya Industrial and Technological Museum (VITM) in Bengaluru. The Science Gallery Bengaluru is a not for profit company, governed by an independent board, Chaired by Kiran Mazumdar Shaw, Founder & Managing Trustee, Biocon Foundation. Tushita Foundation Tushita Foundation offers after-school tutoring in the sphere of humanities and fine arts to serve the people of Amber, Rajasthan, who have asked for support with their children’s education. The grant funds infrastructure and healthcare camps for the students.

The Science Gallery Bengaluru

FINE ARTS

Biocon’s belief in promoting science and celebrating excellence, led Biocon Foundation to meaningfully engage with the world of Arts & Science. In December 2016, the Foundation enabled a special exhibition ‘Entanglement: A Dance between Art & Science’ at the Serendipity Arts Festival in Goa, as a prelaunch event

India Foundation for the Arts (IFA) IFA is a national, not-for-profit organisation that supports practice, research and education in the field of arts in India. The Foundation’s grant supports innovative projects, commissioning research and creating public platforms for the arts in India.

BIOCON FOUNDATION ANNUAL REPORT 2017

Biocon Foundation

In News Biocon’s Corporate Social Responsibility initiatives through the Foundation have been recognized as being responsible and inclusive. Various media stories during FY 17 talked about programs like eLAJ Smart Clinics, Cervical & breast cancer screening, Chinnara Ganitha, Management of Malnutrition in Bagalkot, Sanitation facilities, Community development work, Project One, Hebbagodi lake rejuvenation etc. Indepth stories on key projects in prime publications like The Times of India, Economic Times, Bangalore Mirror, Prajavani, Vijaya Karnataka, Vijayavani etc… during the financial year captured significant mindshare. We hope our inspirational CSR project stories will encourage others to join hands with us in these initiatives to make a larger societal impact.

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Awards And Accolades Letter of Appreciation Chief Medical and Health Officer, Sawai Madhopur District

•• Winner at the ‘3rd CSR Impact Awards’ by NGO Box for eLAJ Smart Clinics •• Plaque of Recognition at the FICCI Corporate Social Responsibility Award •• Winnerof ‘CSR Excellence Awards 2017’ for eLAJ Primary Healthcare under the category ‘CSR Health Project of the Year’ at CSR Conclave 2017. •• Winner of ‘Health CSR Project of the Year’ for eLAJ-Strengthening Primary Healthcare at ‘CSR Health Impact Awards 2017’. •• Letter of Appreciation by Chief Medical and Health Officer, Sawai Madhopur for Achievement in reaching Family Planning Targets at Soorwal and Shyampura PHCs, adopted by Biocon Foundation under the PPP model

BIOCON FOUNDATION ANNUAL REPORT 2017

Appendix

AIDS

Acquired Immuno Deficiency Syndrome

IEC

Information Education Communication

ANC

Antenatal Care

PMSMA

Pradhan Mantri Matritva Surakshit Abhiyan

ANM

Auxiliary Nurse Midwife

JMP

Joint Monitoring Program

ASER

Annual Status of Education Report

LEEP

Loop Electrosurgical Excision Procedure

ASHA

Accredited Social Health Activist

LMIC

Low and Middle-Income Countries

BMI

Body Mass Index

MAM

Moderate Accute Malnutrition

BP

Blood Pressure

MDG

Millenium Development Goals

BPL

Below Poverty Line

mHEALTH Mobile Health

CCS

Cervical Cancer Screening

MPM

Multi Parameter Machine

CEO

Chief Executive Officer

NCD

Non Communicable Diseases

CHC

Community Health Centre

NFHS

National Family Health Survey

CIN

Cervical Intraepithelial Neoplasia

OCS

Oral Cancer Screening

CSR

Corporate Social Responsibility

PHC

Primary Health Centre

CVD

Cardiovascular Disease

PNC

Prenatal Care

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DM

Diabetes Mellitus

PPBS

Postprandial Blood Sugar

DNA

Deoxyribo Nucleic Acid

PPP

Public Private Partnership

EMR

Electronic Medical Record

RBS

Random Blood Sugar

GDP

Gross Domestic Product

RTI

Research Triangle Institute

GOI

Government of India

SAM

Severe Acute Malnutrition

HIV

Human Immunodeficiency Virus

SDG

Sustainable Development Goals

HPV

Human Papilloma Virus

SPO2

Saturation of Peripheral Oxygen

HT

Hypertension

UNDP

United Nations Development Program

IARC

International Agency for Research on Cancer

UNICEF

United Nations Children’s Emergency Fund

IBE

Intelligent Breast Examination

USFDA

United States Food and Drug Administration

ICDS

Integrated Child Development Services

WHO

World Health Organisation

BIOCON FOUNDATION 20th KM Hosur Road, Electronic City Bangalore 560 100. INDIA. T: +91 80 2808 2808 E: [email protected] W: www.bioconfoundation.org