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How to change the world

The role of the social entreprenuer

By Nikhil Mustaffa

If ideas are to take root and spread, therefore, they need champions – obsessive people who have the skill, motivation, energy, and bullheadedness to do whatever is necessary to move them forwards to persuade, inspire, seduce, cajole, enlighten, touch hearts, alleviate fears, shift perceptions, articulate meanings and artfully maneuver them through systems. (From a book by David Bornstein).

The origin of the modern postal system is a classic example.

The system was introduced in England in 1840 by Rowland Hill, a then-unknown British school-master and inventor whose ideas initially met with hostile opposition and ridicule. Hill had noticed that postal revenues in England failed to increase between 1815 and 1835 although the country’s economy had grown considerably.

At the time, the average price to mail a letter in England was 12 cents, which put the service out of reach for most of the population. The price was a function of handling costs. Because postal clerks priced letters according to their weight, enclosures, origin and destination, each letter had to be studied individually: Clerks would hold letters up to lamplight to count the number of enclosures before consulting price tables and recording each transaction in a log. Additionally, letters were paid for at the time of receipt; if the intended recipients rejected them, no money was collected.

Through his analysis, Hill demonstrated that the costs for conveyance of mail were actually minor in comparison with handling and administrative costs. He began thinking about ways to simplify the system and came up with the idea of charging a uniform price for all mail in Great Britain (initially a penny for a half ounce) and a prepayment system: an adhesive postage stamp.

Hill’s proposal met with virulent opposition from the postal bureaucracy. Senior postal officials condemned it as “prep0sterous” and a “wild and visionary scheme”. But his call for a “Penny Post” struck a populist chord and eventually won the endorsement of leading newspapers, which stood to benefit from reduced postal fees. After a protracted political battle, the government authorized Hill to implement his system.

Hill then embarked on a two-decade battle within the postal authority to reorganize the collection and delivery of mail so that the service could handle a dramatic increase in volume and justify the trust that prepayment implies. It took several years for the system’s merits to be demonstrated. However, by 1843 the idea had already spread to Switzerland and Brazil. From 1838 to 1863 annual mail delivery to England rose from 76 million to 642 million letters. To cite one example of the impact of the Penny Post on commerce, in 1839 the annual amount transmitted via money orders in England was Stg L.313,000. By 1863 the amount was StgL 16.5 million , more than a 5,000 percent increase. Among those for whom Hill’s system was a godsend was Florence Nightingale, author of 12,000 letters.

Another behind-the-scenes innovator was John Woolman, an eighteenth-century American Quaker whose impact on American society remains largely unrecognized. Among those most active in the campaign to end the slave trade in the United States were the American Society of Friends, or Quakers, who voluntarily emancipated all their slaves between 1758 and 1800. Although individual Quakers had been preaching against the evils of slavery since 1680, Quakers did not actually abandon the practice of slaveholding in large numbers until Woolman, a tailor and part-time preacher living in Mount Holly, New Jersey, took it upon himself to travel the country talking them out of it.

Consider another, more hidden, healthcare innovation in the United States: improvements in the administration of anesthesia. Between the 1960s and 1980s, a death due to anesthesia error occurred once or twice in every 10,000 operations. With anesthesia administered 35 million times a year in the United States, that translated to 3,500 to 7,000 avoidable deaths each year – many of them during minor procedures. In a New Yorker article entitled “When Doctors Make Mistakes”, medical reporter Atul Gawande chronicled how Ellison C. Pierse, an anesthesiologist, changed the standards in his field.

Pierce grew up in North Carolina and attended Duke Medical School in the early 1950s. He began documenting deadly anesthetic mishaps in the 1960s, but his focus on patient safety intensified after friends took their eighteen-year-old daughter to the hospital to have her wisdom teeth pulled and the young woman died while under general anesthesia because the anesthesiologist mistakenly inserted the breathing tube into her esophagus instead of her trachea, a common error that is usually quickly corrected.

In 1973 Massachusetts General Hospital hired a man named Jeffrey Cooper to develop machines for anesthesiologist researchers. Cooper spent hours observing anesthesiologists and noticed a lack of standardization in the machines: in half of them, a clockwise rotation of a dial decreased the concentration of anesthetics; in the other half, it increased the concentration. He interviewed anesthesiologists to search for patterns in how mistakes were made and, using a technique developed by aviation experts called critical incident analysis, studied 359 errors. He published his findings in a 1978 paper entitled “Preventing Anesthesia Mishaps: A Study of Human Factors”.

As Gawande reported: “The study provoked widespread debate among anesthesiologists, but there was no concerted effort to solve the problem” In 1983 Ellison Pierce was elected vice-president of the American Society of Anesthesiologists. After ABC Television’s 20/20 aired a segment on the dangers of general anesthesia, Pierce seized the opportunity to move his field in a new direction. He established a committee on patient safety and pulled in respected colleagues. Then he teamed up with Cooper and persuaded the Food and Drug Administration to produce a preanesthesia machine checklist and a series of patient safety videos for anesthesiologists and persuaded pharmaceutical companies to pay to distribute the videos to every anesthetic department in the United States. Then he and Cooper brought fifty anesthesiologists from around the world to Boston for the first international symposium to focus exclusively on anesthetic patient safety, a meeting now held biannually.

Pierce then established the Anesthesia Patient Safety Foundation (APSF), raising money and embarking on an extended tour of meetings with surgeons, nurse anesthetists, anesthesia equipment manufacturers, insurance companies, pharmaceutical companies, government officials and senior figures in the American Medical Association – every group that had a role to play in the solution. “Through APSF, we were able to work without restricts and hierarchy,” Pierce told me. “It was much better than trying to work changes through existing organizations, which were so staid and rigid.” APSF launched a newsletter, which today has 60,000 sub-scribers, and began channeling grants to researchers focusing on patient safety.

Childline would operate like a franchise, with decentralized management, but with a uniform brand, operating procedures, and standards. It would remain a free, national twenty-four-hour service. The word “Childline” would always be written both in English and translated phonetically into regional languages. (India has eighteen officially recognized languages). The logo and the phone number would remain the same everywhere.

Each city would select organizations based on local needs but conform to a uniform structure: A “nodal” organization, a noted academic institution like TISS, would facilitate operations, training, documentation, and advocacy. “Collaborating” organizations, like YUVA, the shelter where I met Ravi, Samir and Rupesh, would respond directly to calls. “Support” organizations would handle follow ;up, and “resource” organizations would assist with long-term needs.

Each city would have one Childline coordinator. The government would make grants to Childline partners to pay salaries for Childline social workers and team members placed in them. Each organization also would have to raise its own funds for Chidline. Franchisees would receive training and promotional materials, a call-tracking database (in development), and, initially , one year’s funding for out-of-hospital medical assistance to children.

After the structure was defined, the phones were activated and the DOT communicated with pay phone operators across the city. Then, after locals had had two weeks’ experience handling calls, a staffer from the national office came to conduct a ten-day training. Two or three months later, if all went well, the local franchise called a press conference and launched an awareness campaign. The national office monitored franchises closely for several months and, thereafter, through spot checks.

There were always problems. One of the most common was when a local organization claimed full credit for Childline. “In the NGO sector, a lot of people, especially senior people, don’t like partnering,” explains Jeroo. “My biggest task is making everyone feel that they own Childline”>

By the spring of 1999, Childline had launched 1098 in Calcutta and Madras and was preparing to start up in Patna. Groundwork had begun in Bhopal, Bhubaneshwar, Calicut, Combatatore, Guwahati, Gwalior, Jaipur, Lucknow, Panjim, Pune, Trivandrum and Varanasi. (In one year Jeroo and her colleagues visited nineteen cities).

The ChildNet database system was an unusual computer program: It had been designed for users who were easily distracted and often semiliterate. It guided team members with picture and voice commands in English, Hindi, and regional languages. “Street kids really don’t like to document things,” Meghana Sawant explained. “And even when they do document them, there are often important elements missing.”

The new system, which addressed the problems, proved extraordinarily useful for analyzing call patterns. For example, it enabled Childline to track specific hot points within cities. If a high number of health-related calls were coming from a particular railway station, Childline could advocate for a medical booth to be installed in that station.

As Childline expanded to new cities, the call-tracking system also emerged as an important source of child protection information. National data showed that the biggest killer of street children was tuberculosis, but regional call patterns revealed a variety of local problems. In Jaipur, for example, childline received reports of abuse in the garment and jewelry industries. In Varanasi, there were reports of children being abducted to work in the sari industry. In Delhi, many calls came from middle-class children. In Nagpur, a transit hub, there were frequent reports of children abandoned in train stations. In Goa, a beach resort, a major problem was the sexual abuse of children by foreign tourists.

Despite many high-level pledges of cooperation, Childline found that police, health, and railway officials across India remained largely ignorant about and indifferent to 1098. So Childline designed a series of training workshops, and, in June 2000, in conjunction with the government’s National institute of Social Defense and seventy-eight partner organizations, launched a National Initiative for Child Protection.

The goal was to make police stations, hospitals, schools, and train stations more “child friendly” by educating officials about the law, introducing them to street children, and teaching them about Childline. One of the features of the campaign was the presentation of awards by children to child-friendly police stations and hospitals.

Because empathy begins with understanding, the training began with children explaining to officials what their lives were like. They role-played encounters with police and hospital employees. The interactions were followed by discussions about children’s rights and Indian law.

Despite much fanfare, the government came through with little funding for the National Initiative for Child Protection. As they had done before, Childine’s partners drew on their own resources, conducting more than 700 training programs with officials across the country.

The majority of participants in these programs reported to Childline that, in the future, when they encountered children in distress they would call 1098. Many of them regularly had experiences like that of a policeman in Calcutta who one day came across a young girl wandering naked alone in the streets. The policeman admitted to Childine that, if he hadn’t completed the training course, he might have ignored the problem – not knowing how to help the child and not wanting to take an action that might create significant paperwork for himself. Instead, he simply dialed 1098 and was immediately referred to a shelter with social workers and an educational program. He took the girl there. He even bought her crayons and a coloring book.

By the fall of 2002, Childine had spread to forty-two cities, with preparatory work under way in another twelve. Mature franchises were now directly paired with start-ups to speed training. In addition, preparatory activities had become more sophisticated. “We do much more training with the police, health departments, Department of Telecommunications, and the chair of the Childline Advisory Board,” Jeroo said. “And we don’t launch formally until the service has been in operation for at least six months.”

The network had more than 120 organizations directly implementing the Childline service and over 2,000 providing assistance. By October 2002, Childline had fielded 2.7 million calls. The Ministry of Justice and Social Empowerment had consulted with Childline during the drafting of its most recent Five Year Plan. The government also had incorporated several Childline recommendations in revisions of India’s Juvenile Justice Act and mandated Childline as a lead child protection agency.

In 2001, Jeroo received international recognition for her work from the Schwab Foundation for Social Entrepreneurship. Later that year she made the decision to step down as Childline’s executive director. She remained on board until May 2002, easing back from her 100-hour workweek and watching how things progressed without her. Some of Childline’s board members felt her decision was premature. But she believed that Childline’s expansion had become a technical challenge and felt her energy could be better applied elsewhere.


The capacity to cause change grows in an individual over time as small-scale efforts lead gradually to larger ones. But the process needs a beginnings – a story, an example, an early taste of success – something along the way that helps a person form the belief that it is possible to make the world a better place. Those who act on that belief spread it to others. They are highly contagious. These stories must be told.

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