RTI, HEALTH FOR LIFE

FINAL REPORT FOR

This document compiles introduction of the project, information on the program implementation, program design, main achievements made and constraint faced during the implementation period and lessons learnt.

[ A n t e n n a F o u n d a t i o n Ne p a l ]

[ K u s u n t i M a r g , E k a n t a k u n a ,

L a k i t p u r ]

[ 5 0 0 0 0 8 4 , 5 0 0 0 0 8 0 ]

[5 5 4 5 8 5 7 ]

[ 3 F e b r u a r y 2 0 1 5 ] FINAL REPORT FOR RTI, HEALTH FOR LIFE

SUB-CONTRACT INFORMATION Subcontract Number 5-330-0213728-field under USAID Contract Number AID-367-C-13- 00001 entitled “Communication program initiative under the funding support of Health for Life”

Name of Sub-Contractor: Antenna Foundation Nepal

Date of Submission: 4 February 2015

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LIST OF ABBREVIATION

AFN Antenna Foundation Nepal

AHW Auxiliary Health Worker

ANM Auxiliary Nurse Midwife

CAG Content Advisory Group

DPHO District Public Health Office

DHO District Health Office

FCHVs Female Community Health Volunteers

FM Frequency Modulation

H4L Health for Life

HIV/AIDS and STD Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome and Sexually Transmitted Disease

HFOMC Health Facility Operation and Management Committee

JKLS Jeewan Ka Lagi Swasthya

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EXECUTIVE SUMMARY The main achievements made during the implementation period are - x Enhanced capacity of radio program producers in areas of quality radio content by including field reports, investigative reporting, stories of success and failures; production of radio PSAs; skills for conducting public hearing

x Promoted health as a “main news” by radio stations like Radio Buddha Awaaj, Kapilvastu FM, Dhurbatara FM, Deurali FM, Radio Bheri, Bulbule FM, Nepali Awaaj, Radio Krishnasar, Radio Tulsipur, Naya Yug FM, Sworgadwari FM, Radio Kapurkot, Radio Rapti, Radio Sisne, Radio Rolpa and Radio Mandavi. “Health” getting a space in main news has been successful in advocating health stakeholders towards a positive action in health sector.

x Improved services of health facilities including appointment of AHW and health assistants; filling up of important vacant posts; improving sanitation of health posts; procuring medicines, stretcher, ambulance and other necessary equipments at birthing center

x Advocacy for better infrastructure and accountability of health workers: people are now aware of different facilities and services available from health facilities, different posts, and provision of action against absentee workers. People have been pro-active in demanding of birthing centers, medicines, facilities and services from health institutions and questioning health post for services and other pressing issues along with support from radios. This has made duty bearers and stakeholders more responsive towards their duty.

x Fulfilled gaps between service seekers and service providers: radio and public hearing has served as platform for connecting service seekers and service providers. Service seekers directly interact with service providers in sharing their problems and challenges for quality health service. On the other hand, service providers share about different health facilities and services; clarify myths around health facilities; take action against the wrongdoer and commit for a better health service.

The main constraints that have affected in program implementation are as follows- Weak capacity Radio stations like Argakhachi FM, Ramgyanu FM, Khalanga FM and Nari Awaaj FM have weak production and technical capacity thus effecting timely and quality production of radio programs. During load shedding hours, radio broadcasting is halted due to absence of back up in some radio stations.

Coordination with District Health Officers Some radio stations like Radio Rolpa and Radio Argakhachi faced difficulty in coordination with public health office for content approval and interviewing and while coordinating for public hearing.

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Difficulty in individual mentoring It is difficult for one producer at Antenna to minutely observe 28 scripts and mentor producers for quality content every week.

Producer’s multiple responsibilities Majority of the producers are engaged in multi-tasking apart from H4L project activities including both responsibility for producing radio programs to conducting public hearing; they are also responsible for other works in the radio station. Thus, they are overburdened. Moreover, in absence of responsible person not receiving payment for their set task their motivation level is low.

Change in management/producers Project activities – CAG meeting, radio program production and public hearing were hampered due to change in management of radio stations like Lisne Awaaj and Mandavi for almost 2-3 months. While in some radio stations change in producer effect project activities.

Issue planning/changing It has been challenging for radio stations to follow up the issue suggested by DPHO and DHO for producing radio program as sometimes it is more focused on the emergent local issue rather than complimenting to H4L objective. Thus producers had to revisit scripts in such cases to include matters related to family planning, maternal and new born child health issues as suggested by AFN.

Weather threats and festivals Monsoon, floods and festivals like Dashain resulted in postponement of public hearing and problems in field works for collecting reports for radio program.

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1. BACKGROUND / PROGRAMME DESCRIPTION Antenna Foundation Nepal is an independent, non-governmental and non-profit organization, dedicated to the development of public broadcasting in Nepal. Antenna has excelled in production of high quality radio programs including political affairs, health, democratic, gender, peace and justice, and child issues; TV and Radio PSAs along with online and social media messaging. It has in house training service and has experience of training of over 500 journalists.

Antenna Foundation Nepal (AFN) has successfully implemented a 15 month communication program initiatives since 13 October 2013. At the inception phase, 28 radio program producers and program managers from 14 project districts in the mid western and western region were oriented on the objectives, designing and developing radio program and process of conducting radio programs and public hearing. The 14 project districts included Arghakhachi, Banke, Bardiya, Dailekh, Dang, Jajarkot, Jumla, Kalikot, Kapilvastu, Pyuthan, Rolpa, Rukum, Salyan and Surkhet. The scripts prepared by the producers are sent at Antenna for editing and further refining. Scripts are thus edited and producers mentored on key components like language, format, communication approach, program packaging for improved quality content. The suggestions are thus incorporated by producers and presented at Content Advisory Group (CAG) meeting. CAG meeting thus approves the script after overseeing content accuracy and possible technical errors. CAG also suggest health experts for interviews along with VDCs for public hearings decided. Another major activity is public hearing that brought together locals and health representative in a common platform whereby health services and facilities provided by health post is informed to the public; and problems and challenges of service providers and service seekers in health facilities are freely discussed and commitment made for solution through a joint effort of health stakeholders and public. Output from both events provided sound information for devising radio programs. The project worked with wide range of stakeholders, including District Public Health Office, District Health Office, Female Community Health Volunteers, Auxiliary Nurse Midwife, Doctors, Health Supervisors and In-charges, Academics (Teachers/Professors) and civil society organizations, Representatives from family planning association. Major beneficiaries are poor, adolescent, women and marginalized groups and disadvantaged adolescent girls. The radio contents focus on reproductive and sexual health, new born care and child health, family planning particularly on birth spacing and contraception, HIV/AIDS and STDs, antenatal and post natal care/safe motherhood based on behavioral and attitudinal change both in terms of service seekers and service providers to improve quality of health service delivery and governance system of health institutions.

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2. PROGRAMMATIC ACHIEVEMENTS

1.1. OBJECTIVE WISE The major objective of 13 months project was to provide technical assistance for building capacity of radio program producers in producing quality radio health programs by focusing on behavior change communication approach for improving behaviors to adopt healthy practices for quality life; designing the programs that would encourage them for service seeking behavior and influencing institutional practices for delivering necessary health services/facilities. In the duration of program period, with the focus of capacity building of program producers the following achievements were made:

2.1.1 Planning a script Program producers have gained knowledge on well planning the script by including key messages and general focus, data to substantiate the information, voices/experiences of people of target communities, views of health experts, successful case stories, features based on research of the target communities and interactive platform for audiences like quiz, tools for promotion of program.

2.1.2 Writing up stories of success for creating trust Producers have been encouraged to include examples of success/real life stories which people believe in, to support behavior change and service seeking behavior as well as to make the content more appealing and interesting to the listeners. For example, the content on maternal health is suggested to exemplify role of dedicated health workers to present real picture of their services and how their role has been influential in the society. This fulfills two purposes – it makes people learn about important role of health worker as well as build up trust of people towards health post/facilities. As the problem of retention and recruitment of health workers is persistent in rural areas, highlighting such cases can contribute in retention of qualified health workers at demand of locals.

2.1.3 Capable in commanding attention Radio stations categorized as weak/medium like Naya Karnali, Nepali Awaaj, Radio Bheri, Kohalpur, Mandavi and Lisne are now capable of producing a program by incorporating Vox Pop, features, narrative stories with local details, names, places; interviewing with analysis, that draw attention of listeners; rather than practice of these radio stations in providing general information mostly contained in the handbook. The producers have also developed practice of incorporating facts and figures to exemplify the information and presenting comparative data for making the program more appealing and trustworthy.

2.1.4 Improved confidence to produce radio programs Some of the radio stations like Lisne Awaaj and Mandavi were unable to produce radio programs for 2-3 months due to the change in management. A situation of lack of confidence among new management to cover up missed episodes was observed. However, with consistent mentoring and support of program producer at Antenna, they gained skill and confidence in developing feature stories/ profile stories from field in a creative way,

Date Page 6 FINAL REPORT FOR RTI, HEALTH FOR LIFE illustrative real life examples to influence people rather than a simple narrative content. They covered up the missed radio programs in 2 months by hiring additional human resource.

2.1.5 Sharing of action oriented exemplary stories Producers were able to learn techniques of presenting practical examples by referring and including content of “Ideal mother: practice and importance of breastfeeding” Sindhupalchowk - Eastern region, “tracking change in adolescent sexual and reproductive health” Dang, “HIV infected women” shared by program producer at Antenna covered during visit in the project districts. Practice of such sharing culture had encouraged locals to learn from their experience and replicate the success.

2.1.6 Promoting positive message by communicating benefits Producers have gained skill in presenting positive side and alternative solution of health while addressing problems of health service in radio program so that the contents encourage audience to learn the existing problems as well as make effort to find its solution. During mentoring, when major part of script highlighted problems like if the content only tells about problem related to health post, lack of health workers and doctors; the producers are suggested to include positive message like FCHV’s role in promoting maternal health in case of absence of doctor, home remedies or provision of informing VDC secretary chairperson of health post or questioning sub health post about the services unavailable. Producers have also groomed themselves to alternative solution by including Vox Pop on questions like whether they know about Village Council budget for health. Such questions let public know about the budget for health as well as demand for it if it has not been utilized.

2.1.7 Field based reports/features Producers are now more confident to go to the field and collect necessary information by interacting face to face with health stakeholders and target local communities. Some of the stations categorized in weak stations are also mentored on interviewing techniques to get the required information. Producers have now understood the value of incorporating voices and opinions of real stakeholders who provides the service and people for whom the service is targeted. The feature with real life surroundings and experience inspires and motivates audiences towards a service seeking behavior rather than practice of incorporating telephone interviews. This has also supported in building good relationship with health stakeholders.

1.2. ACTIVITY WISE: BASED UPON THE WORKPLAN SUBMITTED 2.2.1 Team Building and Planning Set up a team of five comprising Program Manager, Radio Health Project Coordinator, Regional Coordinator, Finance and Admin Coordinator and Trainer cum facilitator for better management and implementation of the project. Discussed detail plan on approaches to achieve set objectives and proposed deliverables/activities as outlined in proposed technical proposal for increasing overall performance of team and productivity of project.

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2.2.2 Conduct a Planning Meeting and Contract with Radio Stations 23 station managers/representatives (2 females) of partner radio stations of 14 H4L program districts gained knowledge on objective of project, program plan, radio program production focus and approaches through a one day planning meeting convened in Nepaljung. The meeting was followed by signing of contract paper by radio stations.

2.2.3 Organize local language production training 26 producers (7 females) got trained on radio reporting skills as interviewing, radio magazine, testimonies, drama, script writing and packaging and producing quality radio programs. Participants gained knowledge on purpose and process of conducting CAG meeting and Public Hearing. The training participants also gained knowledge on media’s role in providing health information and gender communication and equality for health for improving knowledge and health facilities consumption on Family Planning, Maternal and Newborn Child Health along with improving governance of health services/institutions. Improved understanding among participants on need to produce radio health program that raise awareness, encourages seeking information, influence to change behavior and research based information for setting new healthy behavior. AFN consulted with stations managers and producers during the training design process to identify the needs, capacities and their learning interests in health issues.AFN also closely evaluate the institutional and technical capacities of the partner radio stations.

2.2.4 Prepare guideline for radio journalists A guideline for radio journalists have been prepared through series of discussion with concerned H4L representatives and health experts that serve as a reference manual for developing behavioral change radio programs on health.

2.2.5 Start scripting production Developed scripts through a series of process involving script writing based on the themes selected for scripts by following guidelines of script writing shared during training and the reference manual of World Health Organization and Ministry of Health and Population. Drafted scripts are sent to Antenna for editing and fine tuning; where the overall scripts are reviewed from the point of view of quality content, strength to draw listeners attention, action oriented messaging, communicating benefit and trust as well as clarity of the message. The edited scripts are approved through CAG meeting after it assures quality and technical errors are checked. Finally the approved scripts get recorded. This process has been followed every month.

2.2.6 Convene Content Advisory Group Meeting A total of 168 CAG meetings were held each in District Health Office of project districts during the program period for final approval of the scripts that ensured x health content accuracy x incorporation of good questions, ideas, useful perspective for effective radio programming x incorporation of emergent health issue x venue for public hearing x gauging gaps of health information x institutional/personal relationship with representatives of DPHO and DHO

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x suggest beyond script content e.g. recommend specific health experts to be interviewed x sharing of names and numbers for potential guests thereby increasing the number of contacts at the producers disposal Some questions/comments received during CAG meetings are as follows x “Include topics for e.g. like rabies, Japanese Encephalitis, Tuberculosis as these are local health problems in the VDCs” x “Who are you inviting for the program on Family Planning? Please make sure to invite Mr. XYZ who knows much about status and intervention about the issue” x “You should interact with a female gynae doctor for the topic on female contraceptive methods. I can recommend a good person if you need it” x “You should be sure to include talks FCHVs on misoprostol and maternal health interventions”

2.2.7 Promotional Activities 28 radio jingles and 15 radio PSAs on major issues of Maternal Health and New Born Care, and Adolescent Health produced and broadcasted by 28 radio stations during the project period. The jingles also promoted radio program and airing time. Distributed sound systems/speakers to 28 radio stations that supported in conducting public hearing. Distributed 30 Radio Sets each with sticker of USAID and Antenna Foundation Nepal to 28 radio stations and enhanced engagement of radio listenership with provision of gift to winners of quiz in the radio program.

2.2.8 Production of minority language program Naya Yug FM from Dang and Kapilvastu FM from Kapilvastu produced radio programs in Awadi language; and Gurubaba FM in Tharu language that catered needs of local communities who do not understand Nepali language. Rest of the 25 radio stations produced program in Nepali language.

a local woman from Dang is happy to be a regular listener of JKLS as it is easy to understand as the program is aired in Awadhi. Learning about good aspects of health facilities like counseling provided by health assistants and workers in matters concerning child health and maternal health, life saving services including immunizations and living a healthy life, I visit health post if I face any health problems. If I see any rashes in my children I rush to the health post. I regularly come for diagnosis of skin and its cleanliness.

2.2.9 Carry out Public Hearing 310 public hearings held in Health Post and Sub health post of respective VDCs. Problems/Issues voiced during public hearing: x Lack of physical infrastructure of birthing center affecting maternal service; x Delay in construction of birthing center and lack of equipments in the center; x Lack of warming facilities at birthing center; x Irregularity, absence and non-appointment of Doctors, health assistants, workers and Auxiliary Nurse Midwife (ANM) affecting regular and effective maternal and other services; x Women unaware of four Antenatal Care visits and its balanced time interval; x Non-distribution of delivery incentive at health institution;

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x Power supply affecting service at birthing centre, operation of X-ray and storage of vaccinations; x Scarcity and low supply of medicines; x Lack of drinking water at health posts; x Unavailability of Ambulance service; x Inactive Health Facility Operational Management Committee (HFOMC); x Some doctors not attending health institution and doing private practice; x Low awareness on contraceptive methods and vaccination to children; x Service seekers uninformed about distribution of free medicines; x Transparency of budget allocated by VDC; x Limited opening hour of health institutions instead of full hour; x Unfilled sanctioned posts x Lack of polite behavior by health workers; x Lack of accommodation for patients and their attendants in health posts; x Embezzlement of funds at health institution. x Difficulty in operation of Gaunghar clinic and vaccination clinic x Lack of space for check-up of pregnant women

Public hearing resulted in A. Improved health services/facilities in terms of- A.1. Physical Infrastructure and Basic Facilities A.1.1. As a result of public hearing organized in Gotihawa Sub Health Post by Kapilvastu FM, Kapilvastu as response to issue about lack of separate confidential space for checking up of pregnant women, a separate confidential room for the purpose has been established as committed during the public hearing. A.1.2. Before public hearing in Kotgaun Health Post, Rolpa its building was in dilapidated condition. When public complained about it in public hearing organized by Radio Jaljala, VDC secretary and political party representatives jointly committed for its renovation. The budget was released and now the maintenance work is ongoing. A.1.3. While in a public hearing organized at Sub-Health Post Magma, Rukum organized by Radio Sani Bheri, people raised the issue of lack of basic facilities like stretcher to reach health post during time of delivery. Soon after the public hearing, at the initiative of locals and political party representatives now a stretcher has been managed at the health post.

A.2.Human Resource A.2.1. Public hearing organized at Katmaula Health Post by Radio Rapti, Salyan raised the issue of lack of Skilled Birth Attendant (SBA) due to which pregnant women are facing problems during delivery, so most preferred delivery at home. As per the commitment made during the public hearing, Auxiliary Nurse Midwife at birthing center was sent for SBA training in District Health Office. A.2.2. In a situation where most of the health posts are without health workers, at a public hearing organized in Rachuli Health Post by Naya Karnali FM, Kalikot; people acknowledged their preference for a health worker for her dedicated services, who was decided to be terminated upon political interference. Then after the health worker was reinstated.

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A.2.3. As a result of public hearing organized at Deukhuri Health Post by Radio Naya Yug, Koilibas VDC has now observing regularity of health workers who were otherwise not available at the health post. DHO took action against the absentee health workers after the issue was raised by local service seekers during public hearing. Now people are getting timely services. A.2.4. Ruku Sub Health Post had unfulfilled post of health worker due to political conflict which hampered in timely availability of health services. Upon public hearing organized by Radio Nepali Awaaj, Kalikot, the issue was raised and discussed in presence of political party representatives, HFOMC, health in- charge. The stakeholders agreed in appointing one health worker who was immediately appointed to the post.

B. Improved information on health and services provided by health facilities B.1. Upon learning about need for antenatal visits provided and the service available at the post during public hearing organized at Dhanwang Sub health post by Radio Kapurkot, Salyan, the post saw increased interest of local pregnant women visiting the health post as per the record informs in- charge Devendra Sen.

B.2. As a result of information District Health representative informing about health facilities shared about health during public hearing at Latikhoili VDC in Surkhet by Bulbule facilities provided by FM. Photo: health post by qualified health workers at public hearing organized at Kabra Health Post in 24 June 2014, locals have gained trust in the health post and have been visiting health post for treatment and counseling informs health in charge Dhan Bahadur Budha.

C. Increased service seeking behavior One of the major achievements of the program is it has inculcated feeling of importance of service seeking behavior among listeners and participants of public hearing by highlighting health services/facilities provided, positive role of health workers and Health Facility Operation Management Committee and Locals gathered during public hearing at Shreegaun Primary Health Center organized by Radio Tulsipur in Dang. Photo: Date Page 11

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citizen’s role in making the health facilities accountable.

C.1. In Nepaljung, after public hearing at Mataihiya Sub health post, participants have increased awareness on health issues particularly service seekers on family planning has increased. Compared to none of the locals using contraceptive method, after public hearing, Mataihiya sub health post has documented 39 women have visited mobile camp and used Implant and Copper T. In the recent times, there has been increase in institutional delivery rather than maternity service at home.

C.2. At Dhanabang VDC, local citizens have developed ownership of health post in immunization of children and as a result of radio health program, local villagers have demanded for vaccination of their under five aged children and very soon the VDC would be declared as vaccination free VDC as informed by Dhanabang health post in-charge A group of enthusiastic women at public hearing at Kapilvastu Photo: D. Practice of encouragement/motivation to health workers In a public hearing conducted at Kabhra health post, Female Community health Volunteers who have contributed in enhancing effective service from health post have been provided incentive for food. Likewise, village council allocated necessary budget for increasing salary of Auxiliary Health Worker. Likewise, Female Community Health Volunteers of through a public hearing organized at Damachaur VDC, Rapti interacting during public Dubring Sub Health Post, Rolpa FCHVs hearing. Photo: have now been receiving encouragement incentive from VDC.

E. Improved accountability E.1. In response to irregular service in health post compounded with passive role of HFOMC raised during public hearing conducted in sub-health post Raralihi organized by Radio Karnali Jumla, representatives of HFOMC who are from local community committed for reviving HFOMC and playing active role in ensuring local needs are adequately met by health posts. Soon after public hearing the HFOMC was reformed and meeting is convened regularly and monitoring of health post is also done on a regular basis.

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E.2. Gaun ghar clinic and vaccination clinic was not operated since a period of 20 months in different wards of Ghode Mahadev VDC. This issue was raised at public hearing organized at Ghode Mahadeve Health Post by Radio Karnali, Jumla. Realizing the need to conduct such clinics, health in-charge of health post in consultation with FCHVs and health workers has fixed a date and made arrangements for Gaun ghar clinic in ward no. 1 and 2 of Sudi, ward no. 3 Ripi, ward no. 7 and 8 Tuui and Ward No. 9 Ghodesim. District health representative clarifying queries during public at in Dhanchaur VDC, Arghakhachi. Photo:

E.3. During public hearing organized at Dhanchaur Health Post, locals were found to lack knowledge and confused about different facilities provided by health post. HFOMC representative and health post representatives present during the event committed on displaying “Citizen’s Charter” at the health post mentioning all necessary details including facilities available, health service provided in community basis and responsible person.

2.2.10 Broadcasting of Radio Program A total of 1404 episodes were broadcasted during program period from 28 radio stations of 14 districts. From the inception phase till the end of the program, information on different emergent health issues particularly on Family Planning, Maternal and Newborn child health, Nutrition, Adolescent Reproductive and Sexual Health, HIV/AIDS and STDs, Role of HFOMC in management of health facilities, Role of FCHVs and VDC centric emerging health problems (like Rabies, Tuberculosis, Sanitation etc) were aired through “Jeewan Ka Lagi Swasthya (JKLS)”. Radio program provided phase wise information; starting from basic introductory to details supported by opinion of health experts, to real life situation and experience of health facilities and service seekers; to facilities provided by health institution and information on demanding for health services. Engaged audience through Quiz section where questions related to the aired issue like “Name a permanent contraceptive method for man”, “Which age group is prone to pneumonia?” is asked and section like “your question, experts answer” where questions like “Do users of implants require follow up?”, “Can a woman work soon after having implants inserted?”, “What is the best way for parents to know if their baby is developing on time?”, “What are the side effects of using IUD?” are asked. These sections were successful in drawing listenership of the radio program. People like from Kalikot got encouraged to listen to radio program after he got rewarded radio set from Radio Kapurkot for correct answer to the quiz question.

The figure below shows different topics covered during the program period.

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Health Topics covered during Program Period

Family Planning

Maternal and Newborn Health

Child Health

Communicable and Non-Communicabe Disease

Adolescent and Reproductive Health

Nutrition

Health Facilities/HFOMC

Public Hearing

HIV/AIDS and STDs

FCHVs

GBV

Impact of Radio Program

0 50 100 150 200 250 300

Topics covered on Communicable and Non-Communicable Disease included Health and Sanitation issues, Malaria, Typhoid, and Rabies etc. Issues like Health and Sanitation dealt with Child Health and Maternal Health like “How sanitation leads to improved child health and save them from diarrhea, other water borne and hygiene related diseases”; and promoted hand washing, safe drinking water, toilet habits and hygienic environment in the community. So sanitation is highlighted in the radio program as contributing factor to reduce unhealthy household environment and to reduce exposure to disease in child and mother. Likewise, Japanese encephalitis is another major topic covered as it is the most common problem concerned with mosquito borne viral infections in project districts. This issue is covered during the peak months like April, May and mid – August and late September which directly risk health of child and maternal health.

During the last episodes some of the radio stations covered radio program on wrap up of JKLS from the radio program review to impact created by the radio program.

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JKLS listeners’ response I have studied till class five. My family is very poor due to which we are unable to buy even a radio. Once I was informed by a neighbor about Radio Bahas to be organized in Rajpur sub health post. While participating in Bahas I came to learn that Jeewan Ka Lagi Swasthya is aired every Friday at 6:30 pm. From that day onwards I listened to the program at my neighbor’s home. I have a daughter and my husband insists on having more children. But as I know from the radio program about complications and consequences of having more children, I keep on discussing and clarifying about family planning. – Rajpur VDC, Kapilvastu

When I was pregnant, I came to learn about antenatal visit during pregnancy and need delivery at health institution through Jeewan Ka Lagi Swasthya, thenafter I went for ANC visit at Pipra hospital along with my husband. Recently I did a second visit. I am talking with my husband to give delivery at hospital. – Bhalwad VDC, Kapilvastu

I came to learn about health risk to both mother and child when delivery is done at home through JKLS. I realized the need for institutional delivery. – Kotwada VDC, Kalikot

As the program and health messages are in Awadhi language, locals have gained more knowledge on pregnant woman; and quality care and nutrition of children. – Baidauli VDC, Kapilvastu

Our sub health post was without of Iron Pills for pregnant woman. As the program discussed about the problem with health in-charge, now the pills are available in the health post has pills. – Saudiyar VDC, Dang

I am happy to learn about free treatment of government on Urinary Tract Infection to women through JKLS. – , Rim VDC, Salyan

I liked the issue covered on “infertility” by the radio program JKLS because in our village it was considered women’s fault for not having baby but now everybody who listened to the program must have got the right answer. – Thipu VDC, Kalikot

I learnt about many aspects of reproductive health through radio drama. – Garpa VDC, Salyan

2.2.11 Oversight and quality support Received quality support in terms of feature writing, story-telling approach, field research and field based reports/stories, Vox Pops and incorporation of data to substantiate information about the issue where appropriate. Improved level of script writing realized among medium and weak radio stations like Nepali Awaaj (Kalikot), Lisne Awaaj (Pyuthan), Radio Mandavi (Pyuthan), Kohalpur FM (Banke). Suggestions provided on identifying and changing issue if the issue is diverted like in case of Radio Kapurkot, Salyan wrote about “Ebola” reasoned as demand and curiosity of locals. However, upon receiving the script at Antenna, it was suggested to provide introductory information about Ebola and to add issue

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FINAL REPORT FOR RTI, HEALTH FOR LIFE about maternal and child health. Suggestions were also given on tips of interviewing. Other positive actions achieved through overseeing and quality support included sharing of action oriented exemplary stories and communicating Benefits by promoting positive message. Producers were encouraged to use colloquial language and local examples to make it more appealing to local listeners.

Program Producer’s Response I have enhanced my knowledge on health issues. It developed practice of researching on issue before producing any program. A good relation has been established with major health stakeholders. Producer, Tulsipur FM

Developed capacity of producing quality programs, promoted practice of visiting field for reporting and interviewing which instilled the habit of hard working. I came to learn different aspects about health. I also came to learn about health status of rural people who had no access to health facilities and presented it via program. I also discussed problems faced by people in accessing health facilities with concerned health stakeholders which I hope contributed in solving their problems. – Producer, Kohalpur FM

I learnt to produce radio program in a magazine format. Moreover, now I am capable of teaching about magazine format to others in the radio. I learnt a lot from training. I learnt a lot through field works which was the major demand of the radio program. – , Producer, Gurubaba FM

2.2.12 Monitoring A total of four monitoring visits were done in different cluster of project districts during a program period by project manager, project coordinator and regional coordinator in different time intervals. The monitoring visit was instrumental in identifying challenges faced by radio stations in conducting project activities and opportunities during the implementation. Monitoring visit also served as a platform for providing support to in improving coordination with District Health Office and health stakeholders as well as in providing programmatic/mentoring support to program producers.

2.2.13 Progress Report (narrative and financial) Four quarterly reports (Oct-Dec 2013, Jan-March 2014, April-June 2014 and July- Sept 2014) and one semi-annual report (July-Dec 2014) both narrative and financial were submitted.

2.2.14 Independent Project Evaluation Listenership survey was conducted by AFN in 23 radio stations covering 13 project districts at the last quarter (October-November) of project period mobilizing radio stations who are not professional enumerators. The survey was conducted to map listenership of the radio program “Jeewan Ka Lagi Swasthya” and its effectiveness in bringing positive changes in knowledge, attitude and practice on key health issues related to FP/MNCH. The study draws from a representative sample of 578 respondents, 297 male and 281 female both married and unmarried of reproductive age 14 to 69. Radio Khalanga from Jajarkot; Argakhachi FM and Radio Deurali from Argakhachi; Ramgyanu FM from Bardiya and Radio

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Lisne from Pyuthan were not able to conduct the research. Each radio station was assigned to conduct survey with 30 respondents. The major findings are as follows: ƒ Listenership of JKLS is 84.6% ƒ JKLS is popular most among adolescent (95%), followed by youth (86.9%) and Adult (75.4%) ƒ 51% of listener respondent of JKLS said they regularly listen to the radio program while 37% reported listening once/twice a month. ƒ 69.9% of the listener respondent feels that JKLS is relevant. This implies JKLS adequately addresses health information needs of locals on family planning, maternal and new born child health and related issues. ƒ Radio promotional spot is the most effective medium to promote about the radio program among the listeners. ƒ Drama (26.9%) and Interview with health expert (25.1%) is the most liked format in the radio health program. ƒ Among the three most preferred topics aired on JKLS, listeners preferred most Family Planning, Maternal Health, Safe Motherhood (22.7%), followed by Adolescent Reproductive Health (16%); Nutrition and Child health was preferred almost in the same proportion by 15.8% and 15.7% respectively. ƒ 21.9% of those who are not aware about radio program JKLS and its non-listeners believe that street drama is the most effective source of health messages; followed by TV (21.4%). ƒ 89.9% of listeners disagree that newborns should be bathed immediately after birth compared to only 60.7% of non-listeners. ƒ A whopping 99% of listeners of JKLS believe that if a child has diarrhea, fluid intake should be increased as compared to 87.6% of non-listeners. ƒ 95% of listeners of JKLS are aware that if a child has diarrhea, feeding should not be stopped as compared to 80.9% of non-listeners. ƒ 97.3% of the listeners of JKLS are aware that delivery should not be done at home compared to 82% of non-listeners. ƒ A significant number 99.2% of listener are aware of the fact that transportation incentive is provided if delivered at health facility compared to 88.5% of non- listeners. ƒ 86% of unmarried listeners are aware about marriage age compared to 75% unmarried non-listeners.

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1.3. UNEXPECTED ACHIEVEMENTS 2.3.1 Pro-active citizens for better health services Radio program provided health information phase wise, from basic introduction to detail on health issue with opinions and suggestions of health experts, detail on health services and facilities, responsibilities of health service providers and its function. Locals have become more aware of services the health institution must provide and incase of gaps in services, locals report radio station for absence of health workers or any other gaps as is practiced by listeners of Radio Buddha Awaaj Kapilvastu.

2.3.2 Important relationship developed with Government Health Stakeholders Radio stations have built cordial relationship with District Public Health Office, District Health Office and Health experts in the process of CAG meeting, public hearing and radio program. For example: “he project also contributed in developing good relation with District Public Health Office. Now DPHO has prioritized participation of radio in their regular meetings and different programs. Since there is no blood bank in Salyan district, in case any patient is in need of blood, DPHO informs radio about requirement of particular blood group which is then aired through radio. The patients in need of blood are thus being benefited” ReReshamsham GGautamautam - Station Manager, Rapti FM Salyan

“Established good relationship with employees of public health office and health posts; some even asked for coordinated effort for disseminating information to the local community. This way it has opened doors for easy working environment for future works” – MaMausamusam RRokkaokka - Station Manager, Radio Jaljala, Rolpa

2.3.3 Cross promotion reaching wider audience and making stakeholders accountable Coverage of public hearing in local print media/newspaper has promoted health activities of health institution/facilities to wider audience and at the same time highlighting problem of health institution in local paper has increased accountability and ownership of stakeholders to Photo: Radio Buddha Awaaj become more responsible towards their duty. Photo: Radio Krishnasar Likewise Radio Buddha Awaaj broadcasted all the activities of public hearing through Television Buddha Awaaj that contributed in disseminating experiences of health institution wide across the district resulting in increased interest and concern about the program.

2.3.4 “Health” as a main news Out of 28 radio stations, 16 radio stations –Radio Buddha Awaaj, Kapilvastu FM, Dhurbatara FM, Deurali FM, Radio Bheri, Bulbule FM, Nepali Awaaj, Radio Krishnasar,

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Radio Tulsipur, Naya Yug FM, Sworgadwari FM, Radio Kapurkot, Radio Rapti, Radio Sisne, Radio Rolpa and Radio Mandavi have been covering health issues in main news like distribution of free medicines and free health services, malnutrition issues, local health problems, ineffectiveness of vaccines provided by health post, challenges of recruiting and retaining qualified health experts, Antenatal visits, problems and positive stories from public hearing, post-partum care, need of additional health facilities, health policy.

2.3.5 First hand information about health institution Convening of public hearing at health post/facilities gave firsthand information on the condition of health post to the District Level health stakeholders for their role in improving its standard.

Acting Office Chief observing condition of Baluhawa Health Post, Kapilvastu Photo: Sona Khatik

3 CONTRIBUTION TO GENDER EQUALITY, WOMEN’S EMPOWERMENT AND SOCIAL INCLUSION Radio programs and public hearing both promoted and addressed cross-cutting issues like gender equality, women’s empowerment and social inclusion.

Radio programs particularly on family planning and maternal health promoted need for communication between husband and wife for deciding upon contraceptive method, number of children and unintended pregnancies particularly through radio drama, features and experts advice that addresses limited decision making power of women.

Maternal and child health also promoted role of family members and husband in care of pregnant women by helping them in household chores and maternity and new born child care irrespective of whether the child is boy or a girl. The need of nutrition and rest to newly delivered mother is also disseminated through radio programs.

Similarly, causes of infertility is also discussed with health experts through radio programs that clear myths prevailed in the communities for accusing woman in the case of infertility.

Jeewan Ka Lagi Swasthya also conveys message against Gender Based Violence (GBV) by highlighting effects of GBV on reproductive health along with voices of women whose health condition deteriorated due to violence they faced at home.

Early marriage and reproductive health issues in the radio program also convey adolescent health risk as a result of child marriage. Real voices of people and difficulties they faced both

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FINAL REPORT FOR RTI, HEALTH FOR LIFE in terms of health and finance was highlighted through radio programs that promoted appropriate age for marriage and discourage acts of child marriage.

Public hearing organized at different VDCs ensured equal participation of women and men for example by Radio Kapilvastu with majority of Madhesi communities has spread the message about maternal health services where a social practice of home delivery was highly prevalent in Madhesi communities. It helped them learn about Antenatal visits, maternal and new born services and institution delivery and put them into practice like in Maharajgunj, Kushahawa and Ajigara health post. It also promoted about Radio program which made them listen to the program. Same is the case Muslim women sharing their experiences at with Dalit community who believed that services public hearing organized by Kapilvastu FM Photo: were deprived for them. Public hearing clarified that health facilities provide equal facility to all irrespective of their caste which has encouraged them to visit health post. For example, through a public hearing conducted at Triveni sub health post, two roomed Gaunghar clinic has been established targeting Dalit communities. Marginalized communities like Kahar, Yadav and Muslim have been sensitized on need for family planning who were socially and culturally not open to such information and practice through public hearing. They also learnt about the radio program JKLS through public hearing meaning they can learn more about issues like family planning through radio.

4 PROGRAMME MONITORING AND SUPERVISION A total of four monitoring visits were done in different cluster of the project districts during a program period by project manager, project coordinator and regional coordinator. The first monitoring visit was done at end of January in Surkhet, Dailekh and Nepaljung; second was at end of February in Dang, Salyan and Rukum; third was done at end of April in Rolpa, Pyuthan, Arghakhachi and Kapilvastu and fourth monitoring visit was done at mid November in Kalikot and Jumla. Thus, it covered all the four cluster identified in the beginning of project for monitoring visits and support in varied time intervals. The field visits varied served to addressing challenges faced by program producers in executing H4L project activities; to learn about opportunities and monitoring public hearing. The monitoring visit was instrumental in identifying and addressing following major problems/issues during field visits- x Difficulty in coordination with public health office for content approval. x High transportation cost for conducting public hearing in distant location from district headquarters/cost allocation for public hearing is low x Requirement of effective sound system for conducting Public Hearing x Confused on format of conducting public hearing x Difficulty in gathering public for conducting public hearing x Difficulty in coordination with District Health Office

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x Lack of human resource in some radio stations like Nari Awaaj to execute project activities including radio program x DHO recommended annual planning and their engagement in message identification x Media support invincible in making health workers accountable towards DHO

During the visit, the team met with different health stakeholders like District Public Health Officers, District Health Officers, Health Post In-charge, Senior Health Assistants, HFOMC members and chairperson, Station Managers, Radio Program Producers and H4L district coordinators. Meeting and discussion with different stakeholders from Health Institution, Station Managers, Program Producers and H4L District Coordinators ensured good support and improved coordination among them and on the field mentoring to support quality radio content and convening public hearing. The producers are suggested to make personal initiation to coordinate with DHO and other stakeholder and suggested to clarify them objectives of conducting radio program and communicate with them in a harmonious manner. Producers are suggested to collect more local views, stories, cases and interviews to enhance quality content of radio program.

5 ISSUES AND CHALLENGES The major challenges faced during project implementation are as follows:

5.3 Weak capacity Out of 28 radio stations, radio stations like Argakhachi FM, Ramgyanu FM, Khalanga FM and Nari Awaaj FM have weak production and technical capacity thus effecting timely and quality production of radio programs. During load shedding hours, radio broadcasting is halted due to absence of back up in radio stations. Despite regular follow-up and mentoring, their level of performance is low. Producer at Antenna shared content to encourage them to replicate the format and learn the techniques of feature writing and packaging.

5.4 Coordination with District Health Officers Some radio stations like Radio Rolpa and Radio Arghakhachi faced difficulty in coordination with public health office for content approval, interviewing for radio programs and while conducting public hearing. During field visit AFN team has been holding meeting with DHO representatives explaining about the objective of radio program and paving an environment for cordial relation with radio station. Likewise, producers are suggested to build up a favorable environment.

5.5 Difficulty in individual mentoring It is difficult for one producer at Antenna to minutely observe 28 scripts and mentor producers for quality content every week. Thus Antenna has categorized radio stations as high, medium and low performers based upon which focus is placed on improving stations with low and medium performance.

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5.6 Producer’s multiple responsibilities Majority of the producers are engaged in multi-tasking apart from H4L project activities including both responsibility for producing radio programs to conducting public hearing; they are also responsible for other works in the radio station. Thus, they are overburdened. Moreover, in absence of responsible person not receiving direct payment for the task they are involved their motivation level is low. It is challenging for Antenna to address this issue as this is a sensitive issue for AFN and H4L to intervene.

5.7 Change in management/producers Project activities – CAG meeting, radio program production and public hearing were hampered due to change in management of radio stations like Lisne Awaaj and Mandavi for almost 2-3 months. While in some radio stations change in producer effect project activities. AFN kept in regular contact with new management and producer for orienting them towards the objective of project and mentor them in timely completion of activities.

5.8 Issue planning/changing It has been challenging for radio stations to follow up the issue suggested by DPHO and DHO for producing radio program as sometimes it is more focused on the emergent local issue rather than complimenting to H4L objective. Thus producers had to revisit scripts in such cases to include matters related to family planning, maternal and new born child health issues as suggested by AFN.

5.9 Weather threats and festivals Monsoon, floods and festivals like Dashain resulted in postponement of public hearing and problems in field works for collecting reports for radio program.

5.10 Financial constraint for conducting public hearing Radio stations have been expressing their dissatisfaction over having responsibility to convening public hearing at remote VDCs where the need is emergent but difficulty due to limited budget for conducting it. Sometimes radio stations have to organize public hearing at their own cost.

6 LESSONS LEARNT The following lessons were learnt during the implementation of the project- 6.3 Drama as an effective means of Behavioral Change Communication Drama has been identified as an influential communication format for educating, entertaining and motivating people for a change by showcasing real life stories and addressing socio- cultural practice of society in subtle way.

6.4 Promotional tools for engaging and increasing listenership A well planned promotional activity is a necessity both for promotion of radio program among new listeners as well as engaging regular listeners; and promoting and encouraging

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FINAL REPORT FOR RTI, HEALTH FOR LIFE people for their feedback and queries through toll free number and SMS. Quiz section accompanied by gift has proved to be working best for attracting regular listening habit.

6.5 Human resource AFN has realized need for additional producer at central level for minutely mentoring of project activities of radio stations and quality monitoring. AFN has also realized the need for increased field visit both for supporting radio producers and sound monitoring for tracking impacts from radio programs and public hearing.

6.6 Cross promotion effective means of increasing accountability Cross promotion of health stakeholder’s commitment along with highlight of challenges and problems of health institution and those faced by service seekers in different media like print (local newspaper), news coverage in main news and in some cases television has been effective means to make the District (Public) Health Office more accountable towards taking ownership of their responsibilities.

6.7 Public Hearing: an effective model Public hearing has proved to be very successful as a platform for two way communication - informing public about health information and services provided by health facilities/posts, and acknowledging about challenges and problems faced at health posts. Moreover, public hearing has been instrumental in making the authorized government health stakeholder commit towards solving the existing problem.

7 REPLICABLE GOOD PRACTICES / STORIES OF ACHIEVEMENT / IMPACT The synergistic effort of radio program “Jeewan Ka Lagi Swasthya” and Public Hearing has resulted in following achievements during the program period:

Success Story 1: Improved knowledge and practice of positive health behavior Radio program and public hearing has resulted in increased faith of public in health institution and its services. People responding to radio program have revealed their improved knowledge on family planning, quality health care of children and nutrition, birth spacing, antenatal and post natal visits.

– a local from Dang and a regular listner of Naya Yug with health worker during a regular check-up of her 15 month child Date Page 23

FINAL REPORT FOR RTI, HEALTH FOR LIFE responses that “before listening to radio program I did not feel the need to visit health post even when I was pregnant; now my child is 15 month. But after listening to JKLS I regularly visit health post. It is easy as there are female health workers. Moreover the program is in Awadi language which has made it easy for women like me to understand the program. If I observe any health disorders in my child’s health, I quickly visit health post. I also take suggestions from health workers to feed my child and learn a lot from radio program. These days we also discuss about health during meeting of Mothers Group”.

a local elderly woman from Dang analyses changes in health behavior during her time and her daughter in law. She recalls during her pregnancy there were no doctors in the village. They had to go to Ghorahi or Nepaljung for any treatment. Now there is health post in our village. Initially I thought I had to spend lots of money for treatment at the post, however after listening to JKLS, I came to learn it is wrong. I also came to learn about distribution of free medicines for treatment of common health problems like headache, fever and rashes. The health workers are friendly and give nice service. My daughter in law also visits health post for regular antenatal visits. As the program is in Awadhi language it is easy for me to understand.

Success Story 2: Stakeholders are more accountable Local level stakeholders other than health stakeholders like political party leaders are now actively engage in reforming health services like political leaders who participated in public hearing had been advocating for allocation of budget from Village Council prioritizing health sector in case of Kapurkot FM.

CPN (UML) Salyan, Chairperson, Ever since Radio Kapurkot organized public hearing in health post of Jhimpe VDC, it has made many progress. It made locals and political representatives realize health post has been backward due to lack of birthing center and health workers. VDC secretary and political party representatives committed on establishing birthing center. I was also present there as a representative of hospital development chairperson where I also committed for its establishment. Village Council of VDC allocated Rs. five hundred thousand for birthing center at sub health post of Kurbang Jhimpe likewise Bishnu KC coordinator of Poverty Alleviation Fund has committed at VDC for their full support for establishing birthing center. Upon realizing need of health worker, I talked with doctor at DHO for Health worker at the post who responded positively. Now a vacancy has been announced for health worker and exams set has been sent. Very soon the health post will have health workers.

Success Story 3: Sarpani Health Post gets Auxiliary Health Worker at Birthing Center In Sarpani VDC, public hearing has resulted in impacts. After public hearing news about lack of health workers in Birthing Center at Sarpani health post published as news in different papers and aired through radio, it has pressurized DHO to appointment a health worker. Sarpani Health Post in-charge, says “media has important role in raising public awareness about health, Radio Kapurkot has played an important role. Public hearing

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FINAL REPORT FOR RTI, HEALTH FOR LIFE has resulted in positive impact and disseminated a positive message. Birthing center was in operation a year ago but DHO has not provided health worker. Now after public hearing we have auxiliary health worker on contractual basis since mid January. Two applications were received however we selected a local Dhan Kumari Rana as health worker and recommended her in DHO.”

Success Story 4: Absentee Health workers resume their duty Sinbang Sub-Health Post also has observed significant change in the previously stalled birthing center. The absentee employees at health post have been made accountable towards their duty. HFOMC chairperson and VDC Secretary “public hearing has made health stakeholders responsible and accountable towards their duty and has contributed in making health services efficient by making it transparent and management of good governance. It has played important role in making respective stakeholders accountable and general public making empowered and active which has resulted in quality service of sub health post. As committed during public hearing we have managed for one health worker; and for active functioning of FCHVs, we have started giving additional hundred rupees to FCHVs as a motivational incentive. As committed during public hearing, political representatives and HFOMC is working for proper management of birthing center, we have managed gas for giving warm drinking water to women coming for delivery. We have also managed solar for providing maternal services at night. We have also demanded certain materials from district health office for making maternal service easy and accessible. As a response to this, District Health Office has provided warm clothes and additional medicines.

Demystify misconception towards positive change Majority of the listeners and participants of public hearing had responded that after listening to radio program and taking part in public hearing they had developed trust in health facilities resulting in a need for institutional delivery, use of contraceptive method, quality care of child health and nutrition for better health. Moreover, traditional belief that use of contraceptive method will deteriorate health condition has been removed by health program.

Success Story 5: Dal Singh from unprivileged VDC resorts to family planning lives in Sipkhana VDC, 33 kms away from headquarter Manma of remote district Kalikot. Sipkhana VDC is a Dalit community with about 95 households. is now 24 years old and has two children – a son and a daughter. It is normal to find a young parent aged 25 and above with 6-7 children in his village. He got married early not forcefully but at his own will. He was just 15 and studying at class 9 when he fell in love with a girl from his class Hajuri and married her. After a year of their marriage, they gave birth to a son. He recalls that he was not aware about adolescent and reproductive health. Though he read about family planning in his school, it was not practical for him to walk all the way of 6-7

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FINAL REPORT FOR RTI, HEALTH FOR LIFE hours to the health post to buy a Condom. Moreover, general belief was that use of contraceptive method would weaken their health and make them unfit for any work. It was this lack of knowledge and lack of easy access to health facility that resulted in birth of a daughter after two years. Sex and reproductive health is still a subject of shame and taboo in his village.

He continued his study after marriage and holds a Bachelor degree. However, his wife could not continue her study and had to take over responsibility of looking after their children. He now works in a forestry project of government and has to travel a lot in different fields. During his travels, he carries a radio to keep himself updated. He is also a regular listener of Jeewan Ka Lagi Swasthya. He heard about “Vasectomy” in one of the episodes. Drama on “Vasectomy” is what motivated him towards taking a major decision. He learnt about “Vasectomy” through drama which clarified myth that use of vasectomy would cause harm to health. For the first time he was convinced that use of vasectomy would not deteriorate health rather it would help in controlling fertility and maintain harmony of the family.

Breaking the strong traditional practice where even women are unaware and reluctant on use of contraceptive method, decided upon using “Vasectomy” instantly after listening to radio drama. He took appointment with doctor while he was in field and even inspired a local villager whom he met during his field visit. He shared he has opted for its use despite being only 24 years of age and having only two children and convinced the village man on using vasectomy upon finding his large family with 6-7 children. Both of them went to the health post on 7th September 2014 for vasectomy. This is an inspiring example of a man’s role in family planning decision by self in a marginalized society where people do not openly talk and discuss about family planning issues and are reluctant to practice it though they are aware of it.

Success Story 6: Son influences parents for adopting contraceptive method Born to a Dalit family in Ruku VDC of Kalikot, studies at Grade 9. He lives with his parents, four younger brothers and three younger sisters. His parents do not know how to read and write. He tunes into radio whenever he is back home from school. Once while he was listening to radio, he heard Jeewan Ka Lagi Swasthya, he found the program interesting and heard it till the end. At the end when a question was asked in quiz section, he hurried to answer it. He personally dropped answer in suggestion box outside the radio station. Next week, he was announced the winner. This motivated him to listen to radio regularly. He also took part in quiz section regularly. He came to learn about many things including family planning. As it was normal in his village to have 6-7 children and he himself had four brothers and three sisters, he thought it would be good if his parents would listen to the program. During airing time of JKLS, he turned on radio and asked his parents to listen to program. Learning about advantages of family planning, he talked with his father aabout family planning and radio program. He informed about how family planning would benefit family as a whole. Realizing truth in son’s information, he visited nearest health post and started using “Dhal” a temporary contraceptive method. Upon conversation

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FINAL REPORT FOR RTI, HEALTH FOR LIFE with , he admits, “my son inspired me to use the contraceptive method and now I have determined that I will have no more child”

Radio program producers also confirm about his regular listenership in radio program. Pradip has won radio set as a winner of quiz of the program.

Success Story 7: Increase in maternal and family planning women service seekers as a result of recruitment of female health worker and a separate consultancy room “How shall I share such confidential matters with male doctor that I do not even share with my husband?” this is what a female service seeker from Ramtolha -Gotihawa VDC had to say about health post. She had reached Gotihawa health post in 9 November for Depo provera Injection and some consultancy. When she reached there, she unwillingly took injection from male health worker and returned back without any consultancy. Another pregnant woman who went with her for antenatal check-up had to return back without service. These Women being attended by male health worker in common room Photo: women are only example and represented females from their community. Like these women, it had become a daily practice for other service seeking women to visit the health post and return back without any treatment or counseling. Although there was one Auxiliary Health Worker in health post, the rotational based duty of employees affected service seekers, most importantly those seeking check up of sensitive issue like pregnancy. It was revealed during public hearing at Gotihawa Health Post organized by Radio Kapilvastu in 10 November 2014 that women coming for pregnancy check-up were low due to the practice of check-up in open space. The sanitation and hygiene of health post was so poor it gave a sense that health post itself was sick.

Knowing about the status of health post the participants of public hearing were surprised. Soon after public hearing as a solution to this problem, chairperson of HFOMC and VDC secretary – partitioned one separate room for pregnancy check-up at budget of VDC; whereas Health for Life office arranged a bed while District Health Office appointed one female AHW on 17 December and took action against irregular health A separate partitioned room at initiation of assistant Now the sanitation of HFOMC and VDC secretary, and a bed health post has also improved. Pregnant women are provided by H4L Photo: now able to get checked up by female health worker in a confidential room.

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Success Story 8: Recruitment of doctor and lab assistant resulting in increasing service seekers from health post Since few years health service in Tharmare Primary health post was affected due to absence of doctor (though there was a post) and lab assistant. Senior assistant was providing service in absence of doctor. Due to their absence only service seekers hesitated to visit the health post. During public hearing organized at Tharmare Primary Health by Radio Rapti, Salyan in 24/01/2014 the issue of lack of Doctor and Lab Assistant was strongly raised by the locals. Program producer’s recalls, “While we were informing the objective of our program is to cater service to those whose reach is far from health facilities, locals responded how the health post without a doctor provide service? Would a building provide service?” Addressing the concern of the locals, Chairperson of District Health Office – committed for managing a doctor and a lab assistant. One month after public hearing, the primary health post was attended by a doctor – and lab assistant on a contract.

Now the environment of health post has changed, the premise and ground of the health post is busy with patients/service seekers and attendants; while the doctor is busy attending the patients and lab assistant busy in some test. Explaining the impact of presence of doctor and lab assistant among service seekers, program producers exclaims, “after few months when we went to the health post to observe impacts we saw many indicators of increase in service seekers. We were informed by doctor Sunny that number of service seekers has reached 900 in past three months. Villagers who participated in public hearing also expressed their happiness over getting doctor after many years. We also met and talked with representatives of HFOMC, political party and employees of the health post. They expressed their happiness on getting a doctor and a lab assistant as a result of public hearing. We have also compiled a 30 minutes radio program as an impact based upon conversation with them”.

Success Story 9: A post delivery room gets a roof at Bafukhola sub-health post These days in-charge of Bafukhola sub-health post - does not have to hear complaints from women coming for delivery at health post. The post delivery room at was in sorry state with water leaking from the roof during rainy days. So women coming for birth got annoyed at in-charge of health post. In-charge says,s “The post delivery room filled with water due to leaking roof during rainy season. Not only women yelled at me for such sorry state room but most of the women hesitated to come at health post for delivery; as post delivery period is a very critical time for women. If they are provided care, they can be prevented from many health problems; which our room was not able to provide”.

But now even during rainy days, women do not have to face such problems. The problem was solved after District Development Committee Office arranged for Tin roof and the room has now a new roof. This is a result of public hearing organized by Radio Rapti at Bafukhola health post where the issue was raised and Local Development Officer – - one of the stakeholders, present during the event promised to replace the roof. Health in-charge – Oli happily shares – “now the room has new roof. Women can come here for delivery any time around the year as it is not affected by sun or rain. I assume that women coming for

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FINAL REPORT FOR RTI, HEALTH FOR LIFE delivery at institution would increase. Bafukhola is one of the health posts in Salyan district with maximum delivery cases. As Bafukhola Health post is at the border of Salyan, Rolpa and Rukum, women from different VDCs of these districts come for delivery cases”.

Success Story 10: Improved services of health facilities including appointment of AHW and health assistants; filling up of important vacant posts and vital information dissemination There are many exemplary cases of auxiliary health workers, health assistants and ANM recruited and their regular attendance at many Health Posts after convening of public hearing, which were otherwise without the service providers that deprived locals from availing service at health post. Short cases of positive changes in regularity and fulfilling of vacant post of different districts are presented below:

Arghakhachi FM, Arghakhachi x A junior assistant had been looking after the patients at Argha sub health post prior to organization of pubic hearing by Arghakhachi FM. Soon after public hearing, health assistant and AHW started checking up patients informs Bhoj Bahadur Gandharba a local from Argha. x Health posts and sub health post in Dhanchaur, Wangla, Nuwakot, Thulapokhari has now a condom box. x Citizen’s charter has been displayed after locals raised unawareness about facilities provided by Dhanchaur health center during public hearing.

Radio Naya Karnali, Kalikot x Soon after public hearing was conducted at Chapre health post by Radio Naya Karnali, who was appointed through National Planning Commission has been appointed as a health worker, now a permanent AHW has been appointed to the post whereas earlier the health post had only one health assistant. x In public hearing organized at Gela health post, informing about end of contract period of trained AHW locals demanded for a new AHW. Soon after termination of her contract a new AHW was appointed at initiation of DHO whose representative was present at public hearing.

x Odankuma health post was known as the most problematic health post. Though DHO has insisted not to conduct the public hearing at the place but we conducted public hearing. Local communities were very eager to learn about health facilities and services during the event. A serious discussion with DHO was done right after public hearing. In response, one AHW was sent to the post in end of September whereas earlier the health post had only one health assistant appointed by VDC. Later in end of October, a permanent health assistant was also sent. All of this was possible through joint effort of locals and radio after public hearing. A memorandum was placed at DHO.

x Health worker at Chilkhaya Sub Health post did not attend health post regularly. Health assistant who was not present in the health post for

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almost a year has now been regular in the post after the issue was raised during public hearing. Service seekers call in radio to inform about problems they face at health post. x Bharta health post had unfulfilled post of AHW which was raised during public hearing. Now in a response of commitment made by health stakeholders a trained AHW has been sent along with one permanent and one contractual AHW been sent to Bharta health post.

Radio Naya Yug, Dang x Gaun ghar clinic is regularly held in Sonpur health post after the public hearing. x Health workers were not regular at Koilabas Health Post before convening of public hearing at the place. Soon after public hearing, DHO took action against health workers who are now regular and locals are getting timely service.

Radio Tulsipur, Dang x Halwar sub health post has now one additional AHW and a sweeper considering the issue raised in public hearing on how the services and sanitation of the health post was affected in their absence.

Radio Kapurkot, Salyan x As response to insufficiency of only one AHW at birthing center of Rim health post, additional AHW has been managed by DHO. x Maternity service at Sarpani Health Post was affected due to lack of AHW at the birthing center as only one AHW was appointed by VDC at the time of its establishment. However, when the issue of scarcity was raised both by service seekers and Health post in-charge Humraj Yogi at public hearing, DHO committed for sending one AHW. Now an AHW has been sent making it easier for women seeking maternal service at the health post.

Radio Jaljala, Rolpa x Dubring health post has now one AHW as a result of public hearing which has resulted in safe maternity service. x Health in-charge of Masina Health Post was in one month leave without informing anyone which was revealed during public hearing. Now health in charge is regular after action by DHO. x Hwama Health Post got two AHW after public hearing was convened, otherwise health service was severely affected.

Rapti FM, Salyan x After public hearing at Tharmare primary health center, a doctor and lab assistant has been appointed due to which service seekers seeking health services has increased to 900 in duration of three months. x As per commitment made in public hearing at Kotmaula health post an AHW has now become a competent nurse through SBA training from District Health. x Within two days of public hearing, AHW was managed at Devsthal Health post.

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8 RECOMMENDATION

The following recommendations are made based on the learning from project implementation- 8.1 Considering performance of weak radio stations, AFN recommends to review production partner in weak districts. With a view to cover wider coverage in terms of population and diversity, AFN recommends to add more production partners.

8.2 Recognizing the need for concerted and focused theme/issue of radio program and unmatched issues identified through CAG meeting, AFN recommends visiting each project districts for conducting 1-2 day joint initial planning meeting with the representative from District Public Health Office (DPHO)/District Health Office (DHO) and Radio Program Producers to identify program themes and issues.

8.3 AFN recommends production of 5-7 minutes drama in the radio program as it is realized that people would desire for change if they can realize it. The drama has power to address social and cultural myths surrounding health behaviors and to influence for change. AFN will focus on Behavioral Change Communication (BCC) so that listeners can relate the events and message to their daily life.

8.4 Considering the constraint faced in one to one mentoring of program producers and the time limit for minutely observing contents for quality enhancement by a single producer, AFN recommends two producers for mentoring and coaching of radio programs for more effective and quality content of radio program.

8.5 AFN recommends convening two public hearing every month in the districts in collaboration with partner radio stations recognizing its huge success on bringing positive changes in health services and health behavior among service providers and service seekers.

8.6 AFN has realized need for intensive promotion of radio program to reach the target audiences. AFN has also realized the value of promotional gift package for increasing engagement and dialogue with audience. AFN thus recommends wide distribution of promotional materials including stickers with toll-free-number and SMS number for increasing interaction of people and listenership of the program.

8.7 Need for increasing field visit has been realized for focused mentoring of program producer, documenting outcomes of public hearing and follow up on positive stories/cases/issues and for tracking changes in public concerns and health service seeking behavior.

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