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Generating Demand
Behavior Change Communication Activities and Achievements Sustainability Equity
Scale-up Access Quality
US Agency for International Development MARCH 2012 Behavior Change Communication The Power of American Embassy Activities and Achievements Innovations and Chanakyapuri Partnership New Delhi – 110 021 Lessons Learned, Best Practices and Promising Approaches INDIA Tel: (91-11) 2419 8000 MARCH 2012 Fax: (91-11) 2419 8612 This publication was prepared for review by the United States Agency for International Development. www.usaid.gov It was prepared by Futures Group International. Photo credits: Jignesh Patel, Gaurang Anand and Satvir Malhotra
Suggested citation: IFPS Technical Assistance Project (ITAP). 2012. Behavior Change Communication Activities and Achievements – Lessons Learned, Best Practices and Promising Approaches. Gurgaon, Haryana: Futures Group, ITAP. Editing, Design and Printing The IFPS Technical Assistance Project is funded by the United States Agency for International Development (USAID) under Contract No. GPO-I-0I-04-000I500, beginning April 1, 2005. The project is implemented by Futures Group in India, in partnership with Bearing Point, New Concept Information Systems Pvt. Ltd. Sibley International, Johns Hopkins University and QED. Email: [email protected]
For further information, contact: Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202, www.jhuccp.org; Futures Group International, DLF Building No. 10 B, 5th Floor, DLF Cyber City, Phase II, Gurgaon- 122 002 www.futuresgroup.com Behavior Change Communication Activities and Achievements
Lessons Learned, Best Practices and Promising Approaches
END OF PROJECT SYMPOSIUM
The Power of Innovations and Partnership
MARCH 2012 The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.
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FOREWORD
In the year 2000, India was home to more than one billion people, one-sixth of the word's population. The country's population is projected to increase by 60 percent, to 1.6 billion by the year 2050 (United Nations World Population Prospects, 2008). This large population and projected rate of growth present major challenges to health and resources for the world's largest democracy.
India has made significant strides in improving the health of its people. A reduction in fertility by 48 percent (from 5.2, 1972 to 2.7, 2005-06), and increase in contraceptive use of 38 percent (from 40.7, 1992-03 to 56.3, 2005-06) are indicators of progress. However, variances in health across sectors of the population, and prevailing rates of high fertility in northern states, such as Uttar Pradesh (UP), where fertility is 4.1 in rural areas (2005-06), highlight the need for continued efforts on family planning (FP) and reproductive health (RH) programs to improve health.
From 2004-10 the United States Agency for International Development (USAID) and the Government of India delivered innovative initiatives to expand access to FP/RH products and services among underserved populations through the Innovations in Family Planning Services-II (IFPS-II) project, a follow-up from the successful bilateral IFPS-I project (1992-04).
Under IFPS-II, behavior change communication (BCC) strategies were employed to generate demand for the uptake of FP/RH products and services to improve health among populations with low access to such services in UP, Uttarakhand and Jharkhand. BCC initiatives were developed and delivered in collaboration with key stakeholders – the National Rural Health Mission (NRHM); State Innovations in Family Planning Services Agency (SIFPSA); Government of India; Government of UP, Uttarakhand and Jharkhand; and district and block health program workers. BCC strategies have now become integral to India's Program Implementation Plans under the NRHM, and have positively influenced health programs from state level development through program managers, to community level delivery through frontline health workers across the country.
This document presents lessons learned, best practices and promising approaches of the BCC initiatives developed and delivered under IFPS-II. It seeks to provide a reference, along with insights and guidance, to policymakers, program planners, and implementers to contribute to achieving the goals of the country through improved health of women, children, families and communities.
Sincerely,
Kerry Pelzman Director Office of Population, Health and Nutrition U.S. Agency for International Development American Embassy Tel: 91-11-24198000 Chanakyapuri Fax: 91-11-24198612 New Delhi – 110021 www.usaid.gov/in
CONTENTS
Acknowledgments viii Abbreviations ix Introduction xiii
SECTION 1: BEHAVIOR CHANGE COMMUNICATION - NATIONAL LEVEL 1 NRHM BCC Campaign – Phase I 4 NRHM BCC Campaign – Phase II 7 New Family Planning Mass Media Campaign 10 Promotion of the JSK Helpline 13 Menstrual Hygiene Campaign 14 Campaign to Promote Socially Marketed Contraceptives by ASHA 16 Multimedia IUCD Campaign 17 Atmajaa TV Serial Drama 18 Capacity Building 20 NRHM Advocacy Film 22 Lessons Learned and Promising Approaches 23
SECTION 2: BEHAVIOR CHANGE COMMUNICATION - UTTAR PRADESH 25 NRHM Behavior Change Communication Strategy 27 NRHM’s BCC Implementation Guide for UP 29 Capacity Building 30 Distance Learning Program 31 Radio Drama Series 32 Multimedia Female Sterilization Campaign 33 Multimedia IUCD Campaign 34 Advocacy and Skill Building 35 Mid-Media 37 Community Mobilization 38 NGO Projects 39 Interpersonal Communication 40 Saloni Swastha Kishori Yojana 41 Public-Private Partnerships 43 Janani Shishu Suraksha Karyakram (Mother and Child Safety Program) 48 Lessons Learned and Promising Approaches 49
Contents v SECTION 3: BEHAVIOR CHANGE COMMUNICATION - JHARKHAND 51 State Behavior Change Communication Strategy 53 Addressing Needs of Special Populations 55 Intra Communication 57 IPC Capacity Building of Sahiyyas 58 Demand Generation for FP Services 60 Mid-media Street Play Campaign 62 Lessons Learned and Promising Approaches 64
SECTION 4: BEHAVIOR CHANGE COMMUNICATION - UTTARAKHAND 67 Mass Media 69 Childhood Immunization Campaign 71 Multimedia Campaign 72 Adolescent Health Campaign 75 Capacity Building 77 Mobile Health Vans 79 Lessons Learned And Promising Approaches 81
REFERENCES AND LIST OF RESOURCES 83
vi Behavior Change Communication Activities and Achievements LIST OF TABLES
Table 1: NFHS-3 Data Findings (India and States) xiii Table 2: BCC – Intended Outcomes xv Table 3: TV Spots Developed during NRHM BCC Campaign (Phase I) 5 Table 4: Key results of NRHM BCC Campaign (Phase II) Campaign Evaluation 8 Table 5: Key Message and Audience for FP Mass Media Campaign 11 Table 6: TV Spots/ Radio Spots developed and aired during FP Mass Media Campaign (Phase II) 11 Table 7: TV Spots/ Radio Spots developed and aired during FP Mass Media Campaign (Phase III) 12 Table 8: Production Milestones for Atmajaa TV Serial Drama 19 Table 9: National IEC Workshop Agenda 20 Table 10: Health Innovations shared at the National IEC Workshop 21 Table 11: Objectives of the MGHN Communication Campaign 44 Table 12: NFHS-3 Data on Birth Delivery (India and Uttarakhand) 69 Table 13: NFHS-3 Data on Immunization (India and Uttarakhand) 71 Table 14: FP/RCH services accessed (December 2007 – April 2008) 80
LIST OF FIGURES
Figure 1: Strategic BCC Approach 16 Figure 2: Impact of the Distance Learning Program on ANMs 31 Figure 3: Baseline and End line findings under Saloni program on Nutrition 41 Figure 4: Baseline and End line findings under Saloni program on Hygiene 42 Figure 5: IPC Training Feedback (Participant Rating) 58
Contents vii ACKNOWLEDGMENTS
his report documents the behavior This report is a second edition of the Constant encouragement and Tchange communication (BCC) “Behavior Change Communication guidance, and review of this BCC activities in India, specifically in the states Activities and Achievements: Lessons report were provided throughout the of Uttarakhand, Uttar Pradesh, and Learned, Best Practices and Promising development of this document from Jharkhand carried out by United States Approaches”, dated June 2010. It USAID India Mission, especially Agency for International Development now includes the additional activities Dr. Loveleen Johri, Shweta Verma, (USAID) funded Innovations in Family carried out between June 2010 to and Vijay Paulraj. Planning Services (IFPS) project, a joint March 2012. US-India initiative that has worked to This BCC end of project report was promote improved family planning (FP) The project acknowledges the developed by the Johns Hopkins and reproductive health (RH) for India’s support received from Government Bloomberg School of Public Health poor communities. Technical assistance of India and Governments of Uttar Center for Communication Programs has been provided by a consortium Pradesh, Uttarakhand, and Jharkhand (CCP) under the ITAP program. of technical agencies under the IFPS and the respective health societies It was authored by Heer Chokshi, Technical Assistance Project (ITAP) in implementation and design of Meenakshi Dikshit, Michael Kelly, led by Futures Group International, in BCC campaigns and materials. Kimberly Rook and Heidi Boncana. partnership with the Johns Hopkins Further, the project wishes to Additional contributions were made University Center for Communication acknowledge all efforts put in by local by Geetali Trivedi and Basil Safi. Programs (JHU/CCP), Bearing Point, NGOs, collaborating agencies, and Several individuals contributed to QED Group and the Urban Institute to community health workers for their the drafting and review of this end of develop, demonstrate, document and support in carrying out all of the project report, including Dr. Suneeta leverage the expansion of public-private communication initiatives discussed Sharma, Dr. Gadde Narayana, Shuvi partnerships (PPPs) for the provision in this document. Sharma, and Tanya Liberhan. of high quality FP and RH, services.
viii Behavior Change Communication Activities and Achievements ABBREVIATIONS
ANC Antenatal Care ANM Auxiliary Nurse Midwife ARSH Adolescent Reproductive and Sexual Health ASHA Accredited Social Health Activist AVC Assistant Voucher Coordinator AWW Anganwadi Worker BCC Behavior Change Communication BCIS Behavior Change Impact Survey BHC Block Health Center BISR Birla Institute of Scientific Research BPL Below Poverty Line BPM Block Program Manager CBHI Central Bureau of Health Intelligence CH Child Health CHC Community Health Center CHV Community Health Volunteer CINI Child in Need Institute CMO Chief Medical Officer CPR Contraceptive Prevalence Rate DAVP Directorate of Advertising and Visual Publicity DCM District Community Mobilizer DHEO District Health Education Officer DLHS District Level Household and Facility Survey EAG Empowered Action Group (states) EE Entertainment-Education FP Family Planning FWC Family Welfare Counselor GoI Government of India HEO Health Education Officer HIHT Himalayan Institute of Health Training HIV Human Immunodeficiency Virus
Abbreviations ix ICDS Integrated Child Development Services Scheme IEC Information, Education and Communication IFA Iron and Folic Acid IFPS Innovations in Family Planning Services IPC/C Interpersonal Communication/Counseling IPHS Indian Public Health Standards IRH Institute for Reproductive Health ITAP IFPS Technical Assistance Project IUCD Intrauterine Contraceptive Device IUD Intrauterine Device JHS Jharkhand Health Society JHUCCP Johns Hopkins University Center for Communication Programs JSK Jansankhya Sthirata Kosh JSSK Janani Shishu Suraksha Karyakram JSY Janani Suraksha Yojana MCH-STAR Maternal and Child Health-Sustainable Technical Assistance and Research Project MGHN Merry Gold Health Network MH Maternal Health MHV Mobile Health Van MIS Management Information System MoHFW Ministry of Health and Family Welfare NFHS National Family Health Survey NGO Non Governmental Organization NHSRC National Health Systems Resource Center NIC National Informatics Center NRHM National Rural Health Mission NRS National Readership Survey NSV No-scalpel Vasectomy OCP Oral Contraceptive Pill ORS Oral Rehydration Solution OTS Opportunity to See PFI Population Foundation of India PHC Primary Health Center PIP Program Implementation Plan PMU Program Management Unit PNC Postnatal Care
x Behavior Change Communication Activities and Achievements PPFP Post Partum Family Planning PPP Public-Private Partnership PPS Population Proportion to Size PRI Panchayati Raj Institute PSU Primary Sampling Unit PTG Primitive Tribal Group RCH Reproductive and Child Health RH Reproductive Health RKS Rogi Kalyan Samiti RMP Registered Medical Practitioner RTI Reproductive Tract Infection SDM Standard Days Method SIFPSA State Innovations in Family Planning Services Agency SIHFW State Institute of Health and Family Welfare SSK Yojana Saloni Swasth Kishori Yojana STI Sexually Transmitted Infection SWOT Strengths, Weaknesses, Opportunities and Threats TBA Traditional Birth Attendant TFR Total Fertility Rate TOT Training of Trainers TRP Television Rating Points UDAAN Understanding and Delivering to Address Adolescent Needs UKHFWS Uttarakhand Health and Family Welfare Society UP Uttar Pradesh USAID United States Agency for International Development VHSC Village Health and Sanitation Committee VMA Voucher Management Agency WHO World Health Organization
Abbreviations xi
INTRODUCTION
INNOVATIONS IN FAMILY Urban Institute. The program aims Background PLANNING SERVICES to develop, demonstrate, document Family planning and reproductive Launched in 1992, Innovations in and leverage the expansion of public- health have been the priority health Family Planning Services (IFPS) was private partnerships (PPPs) for the areas in India for more than three an ambitious 12-year bilateral project provision of high quality FP, RH and decades. Many programs have been funded by the United States Agency child health services to improve health implemented to increase access to, for International Development outcomes in the region. The project awareness and use of RH/FP products (USAID) that expanded and improved developed and demonstrated models and services. The programs have family planning (FP) and reproductive of PPPs including: development of made progress in this direction with and child health (RCH) services in conditional cash transfers like the the overall population growth rate Uttar Pradesh (UP), India’s most Voucher Scheme, social franchising declining from 2.2 percent in 1990 to populous state. IFPS achieved many of the Merrygold Health Network 1.5 percent in 2006. Similarly, total milestones and made significant (MGHN), expansion of a basket of fertility decreased from four children contributions to the health of contraceptive products, promotion per woman in 1990 to 2.6 children women, children and families in UP. of mobile health services, and per woman in 2006.1 Major achievements include the collaboration with traditional medical development of an autonomous providers in tribal communities. The IFPS project focused on UP, agency to oversee management of Through these activities, the Jharkhand and Uttarakhand, though activities: the State Innovations in project developed, demonstrated, special attention has been paid to UP Family Planning Services Agency documented, disseminated and due to the severity of indicators. (SIFPSA); a strengthened public leveraged expansion of effective healthcare system for the provision partnership models. In Uttar Pradesh, Reducing Fertility and Improving of FP and RCH services through Jharkhand and Uttarakhand, the Health technical assistance, training and IFPS project implements BCC and Since its inception in 1992, the IFPS capacity building; engagement of the marketing strategies to increase project aimed to reduce fertility private sector to bring FP and RCH demand for FP and RH services and and improve health in targeted services to rural and hard-to-reach products. areas of India by increasing the populations; and increased access to products and services through social marketing and behavior change TABLE 1: NFHS-3 DATA FINDINGS (INDIA AND STATES) communication (BCC).Technical NFHS-3 All India UP Uttarakhand Jharkhand assistance has been provided by a (2005-06) consortium of agencies under the CPR (any method) (%) 56.3 43.6 59.3 35.7 IFPS Technical Assistance Project TFR 2.68 3.82 2.55 3.31 (ITAP), led by the Futures Group ANC (3+ visits) (%) 52.0 26.6 44.9 35.9 International, in partnership with the Johns Hopkins University Center for Institutional delivery (%) 38.7 20.6 32.6 18.3 Communication Programs (JHUCCP), Full immunization 43.5 60.0 34.2 46.6 Bearing Point, QED Group and the (12-23 months) (%)
1 World Health Organization, WHO Statistical Information Systems, 2010
Introduction xiii demand for and uptake of FP and bring these models to scale with and community level BCC activities, RH services, and by increasing the resources from other sources. with support from (2) mass media use of behavioral interventions for Facilitate collaboration between and (3) community mobilization. The Human Immunodeficiency Virus public and private sectors in IFPS project and NRHM worked (HIV) prevention, maternal health, efforts to address FP and RH together with other stakeholders child survival and infectious disease. needs. to select five core health areas The main goal was to reduce total Ensure high standards of care. for intended behavior change. All fertility rate (TFR) and increase the Build capacity of local interventions and activities delivered contraceptive prevalence rate (CPR) organizations to meet the needs through IPC and community events, in married women of reproductive of their communities. community mobilization, and mass age by 50 percent (USAID/India, Increase the use of research media are coordinated and focused 1992). By addressing total fertility and to refine and improve program accordingly to achieve the overarching contraceptive use with the integration approaches. objectives. By following this schedule of the underlying factors of maternal annually, community-based activities health (MH), child health (CH) and Strategic approaches to BCC were coordinated with state level nutritional health, IFPS project has The BCC strategy for the National mass media efforts, and IPC efforts made many great strides that are Rural Health Mission (NRHM) began through local health workers, thereby presented in this report. with the prioritization of behaviors reinforcing messages and supporting for change based on individual behavior change at both community BEHAVIOR CHANGE health needs in each of the three and household levels. COMMUNICATION target states. With this information, Goals of BCC for IFPS Project a roadmap of interventions was National level Overall, the primary objective of the assimilated, designed and implemented At the national level, the IFPS project project was to achieve the following to address those needs through has provided technical assistance with the close support and integration state, district and block level program to the NRHM and the Ministry of of BCC: managers. Health and Family Welfare (MoHFW) Incorporate best practices in for designing of mass media RCH when models of PPP are Key elements of the BCC campaigns on RCH and FP issues developed, demonstrated and strategy: using the behavior change approach, documented. Address priority behaviors and and as a key technical resource and Form linkages with Indian targeted interventions for the advisor on BCC, FP and adolescent technical organizations to deepen most critical health needs. health for upcoming projects and the already strong national Deliver activities and schemes that the MoHFW plans to capacity for international quality interventions through converging launch. technical assistance. channels of communication. Assist in the establishment and Coordinate and deliver Uttar Pradesh nurturing of the National Health implementation plan for BCC activities in UP culminated in Systems Resource Center interventions in districts and the development of a BCC strategy (NHSRC) (see further details blocks across the three states for the NRHM and a companion below). through health program managers implementation guide for district Develop the capacity of the state and workers at all levels. and block level health program and national public sector to managers addressing priority enter into partnerships with the This strategy recognized the health behaviors. Numerous BCC private sector. importance of using a mix of media activities were developed to increase Incorporate sustainability to reinforce messages and ensure knowledge and awareness of, and considerations and replication sustainable behavior change. The core demand for FP/RH products and strategies into models and of the strategy revolved around: (1) services. Additional activities were systems from the outset and to interpersonal communication (IPC) conducted to advocate for improved
xiv Behavior Change Communication Activities and Achievements TABLE 2: BCC – INTENDED OUTCOMES Strategy BCC Campaigns/Material Development BCC Capacity BCC in Social Development Building Marketing/ Franchising Mass media Mid-media IPC/ Community Level National Campaign 2004–09 ‘ASHA se National IEC/ Campaign 2009–10 maango’ BCC Workshop (3 phases) campaign NRHM advocacy film Atmajaa Tele Series Promotion of JSK Call Center Menstrual Hygiene campaign IUCD campaign Uttar NRHM BCC Multimedia Sterilization Comprehensive Saloni Diary Distance Pradesh Strategy 2008 campaign 2004 Poster on Family Learning Planning Program Radio Series – Sunehere ASHA Newsletter NRHM Flipbook Sapne-Sanwarti Rahein for ASHA Immunization Saloni Teachers’ Communication – jachcha-bachcha Training Manual Plan for MGHN raksha card Folk Media–Street Family Welfare Brand Equity and plays, puppet and Counselors Barrier Analysis magic shows Training Module Study Regional BCC Voucher Scheme capacity building Uttarakhand BCC strategies for Institutional Delivery UDAAN- ASHA Plus specific programs: campaign Adolescent Program Mobile Health Health Program Vans Immunization campaign Voucher Voucher Scheme Demand Scheme Generation Adolescent Sambhav Voucher Mobile Health Health Scheme Promotional Van Demand Campaign generation Jharkhand Health Spacing campaign Voucher IPC toolkit Intra- Communication Scheme Demand for Sahiyyas communication Strategy Generation (ASHAs) Health Issues and Institutional Delivery Street Play Health Seeking campaign campaign Behaviors of Tribal Populations BCC Strategy for Voucher Scheme
Introduction xv service access and utilization, and Utilizing this approach, the IFPS project in 2004. To improve the health to build capacity among mid-level in collaboration with the Government of populations, the IFPS project health program managers within the of Uttarakhand, developed BCC to assisted in the development of a state, districts, blocks and frontline support various PPP initiatives including statewide BCC strategy for priority healthcare workers such as accredited Mobile Health Vans (MHVs), FP and health areas, with special emphasis social health activists (ASHAs) and RCH Voucher Schemes, and pilot on the needs of tribal populations auxiliary nurse midwives (ANMs). programs like adolescent health and unique to the region. Attention Activities delivered in UP engaged the the ASHA Plus program. All of these was given to improving capacity private sector and employed mass programs began as pilot projects, for intra-communication across media, entertainment-education (EE), and most models were subsequently stakeholders, and IPC of sahiyyas community mobilization and capacity adopted by the Uttarakhand Health and community health workers. building strategies. Society, and scaled up to reach more Additionally, generating demand families and communities. The need for FP and RCH services available Uttarakhand still exists in Uttarakhand for an through government schemes was BCC activities undertaken by the overarching BCC strategy to improve important. To generate this demand IFPS project began in Uttarakhand in health in this remote and mountainous for FP products and services, the IFPS 2004. To improve the effectiveness region of India. project implemented the Sambhav of existing BCC programs for FP Voucher Scheme through its technical and RCH services, the IFPS project Jharkhand assistance project ITAP as a PPP provided technical assistance through BCC activities undertaken by the initiative for which a range of BCC ITAP on an activity-by-activity basis. IFPS project began in Jharkhand materials were developed.
xvi Behavior Change Communication Activities and Achievements SECTION 1
Behavior Change Communication The Power of Innovations and National Level Partnership
Section 1 National Level BEHAVIOR CHANGE COMMUNICATION
CC activities undertaken by material development. The IFPS Bthe IFPS project at the national project assisted the NRHM in level focused on FP and RCH, with creating a range of TV and radio emphasis in UP, Uttarakhand and spots on priority health themes Jharkhand following evidence-based including FP, age at marriage, the strategic approaches to health role of the NRHM in promoting communication. BCC program health and preventing disease, HIV/ components at the national level AIDS, antenatal care (ANC) and consisted of information, education immunization. The IFPS project also and communication (IEC)/BCC, developed over 20 TV and radio mass media, assessment, sustainable spots for the NRHM which aired on BCC development, capacity building, cable and satellite channels EE and advocacy with the goal of in India over two phases between increasing awareness and knowledge, May 2010. Other activities conducted 2005 and 2009. The TV and radio improving attitudes, generating at the national level include a study spots largely relied on promoting demand and positively changing on assessing visibility, comprehension benefits and addressing barriers behaviors related to FP and RCH. and recall of TV campaigns aired under to behavior change and employing the NRHM; capacity building through role models based on social and With the launch of the NRHM in a national IEC workshop; Atmajaa, behavioral theories to trigger 2005, the IFPS project, through ITAP, a TV serial drama; and an NRHM positive change. provided all pre-2005 BCC materials advocacy film. In 2010–11, the IFPS to the NRHM and the MoHFW for project designed two mass media broad dissemination throughout the campaigns, one for the promotion of states and districts. Between 2005 the Population Stabilization Fund (JSK) and 2009, the IFPS project managed call center services and a campaign on the development of various BCC Menstrual Hygiene for the promotion campaigns that focused on FP and RCH of socially marketed sanitary napkin through IEC and BCC for distribution brand for the MoHFW. through mass media outlets (TV, radio and print). Starting in June 2009, a MASS MEDIA roadmap for a three-phase national Since the launch of the NRHM in mass media campaign to reinforce 2005, the IFPS project has been initial IEC and BCC messages was laid recognized as the technical leader out for creation and dissemination in in the area of BCC campaign and
Behavior Change Communication: National Level 3 NRHM BCC CAMPAIGN – PHASE I
In this first phase, the IFPS project created TV and radio spots for the NRHM from May through October 2006. Some TV spots were exclusively designed for and aired by MoHFW, while others were developed and aired under other programs.
Strategic Approach and Objectives: Empowerment through the use of role models, promotion of behaviors and benefits, and addressing barriers, audiences are motivated to improve attitudes towards and adopt positive behaviors for age at marriage, ANC, WHO-ORS, immunization, FP and HIV/AIDS. channel, along with a range of satellite Design: The study followed a two- channels. stage stratified systematic random Audience: Couples 20–45 years of sampling design. At the first stage, age and adolescents 15–19 years old, Survey Objectives: The main 213 primary sampling units (PSUs), largely in rural areas. objective of this study was to assess i.e., villages/urban wards were the reach and effect of the TV spots selected through the Population Creative Approach: A range on the target audience. Findings from Proportion to Size (PPS) technique of approaches were employed in this survey helped inform the future in eight Empowered Action Group the NRHM BCC campaign. Some directions of the NRHM BCC efforts. (EAG) states. At the second spots used celebrities from Indian The specific objectives of the study stage, interviews were conducted cinema and television to share how were to obtain information on the with 3,500 households that were the adoption of positive health following: selected in villages and urban wards behaviors impacted their lives, thereby by means of a systematic random encouraging audiences to also adopt Visibility sampling procedure. The number healthy behaviors for better health and Reach and exposure of the of participants interviewed in the quality of life. Other spots employed specified NRHM spots selected households is as follows: emotional approaches, pulling from Sources of seeing or hearing 1,496 married men aged 20–45 cultural and social traditions such as (channel, time of program) years festivals and customs that are rooted 1,588 married women aged 20–45 in Indian history. Comprehension and Relevance years Awareness regarding NRHM logo 779 adolescent boys aged 15–19 Results: A study on the Visibility, Recall – the contents of NRHM years Comprehension and Recall of TV spots 791 adolescent girls aged 15–19 spots aired under NRHM was carried Recall – main messages years out in 2007 by an independent communicated through NRHM research agency to gauge the impact spots Findings: The selection of health of the spots that were aired nationally Relevance and acceptability of the themes for the campaign was largely on Doordarshan, Indian’s largest TV messages in line with the three broad goals of
4 Behavior Change Communication Activities and Achievements TABLE 3: TV SPOTS DEVELOPED DURING NRHM BCC CAMPAIGN (PHASE I)
Theme/Objective TV Spot Study Findings Age at marriage Encourage completing Emotional black-and- Among the three TV spots on age at marriage, the black and white ad had school and delay marriage white ad maximum recall compared with the Raveena Tandon or Amitabh Bachchan until 18 years of age Celebrity ads: ads in color. This is true in the case of both rural and urban areas and also Amitabh Bachchan among the four segments of the target populations (currently married Raveena Tandon women & men; adolescents girls & boys). This clearly shows that the innovative treatment of the message very effectively broke through the clutter.
ANC Benefits and the role of ‘Afternoon gossip' with Under the NRHM TV campaign, there were five spots on ANC that ASHAs and ANMs pregnant woman USAID supported. Spontaneous recall of these ads was very low both in Celebrity ads: rural and urban areas. Recall increased marginally after probing and with Juhi Chawla aiding, an increase is noticed. Overall, among currently married women, Pallavi Joshi the ad by Pallavi Joshi has the maximum overall recall 33 percent in rural Supriya areas and 46 percent in urban area — with “Afternoon Gossip” coming Amitabh Bachchan second (25% in rural and 41% in urban areas). Among currently married men, however, the Amitabh Bachchan ad topped the list in rural areas (24%) and “Afternoon Gossip” topped the list in urban areas (30%) with the Amitabh Bachchan ad coming in a close second. As with currently married women, among adolescent girls as well as adolescent boys, the Pallavi Joshi ad, followed by “Afternoon Gossip” had best overall recall. WHO ORS Benefits and preparation 'School teacher' diarrhea The WHO-ORS spot has a better reach among women and adolescent ad girls in the community than the immunization ads. Almost 56 percent of Prevent recurring the currently married women in rural areas have reportedly seen the diarrhea – ORS and zinc WHO-ORS ad, and the proportion increases to 66 percent in case of urban areas. The proportion of adolescent girls who reportedly saw this Celebrity ads: ad was 48 percent in rural and 70 percent in urban areas. A similar pattern Sakshi Tanwar was documented in currently married men and adolescent boys. Chef Sanjeev Kapoor
Full Immunization Celebrity ads: The Amitabh Bachchan ad on immunization had a better spontaneous Amitabh Bachchan recall than the one by Pallavi Joshi. Around 7-8 percent of the women Pallavi Joshi and adolescent girls, and 11–18 percent of men and adolescent boys, respectively, reported having seen the spot. However, with probing and aided questioning, a higher proportion of women and adolescent girls reported having seen Pallavi Joshi’s ad on immunization as compared to Amitabh’s. HIV/AIDS prevention Celebrity ad: These spots were not evaluated. Amitabh Bachchan
NRHM programs Role and services of These spots were not evaluated. ASHAs JSY (Safe Motherhood scheme)
Behavior Change Communication: National Level 5 the GoI’s RCH-II program of reducing their family members or comprehension of the TV fertility, infant mortality and maternal children. spots vary by health theme and mortality. creative approach. This highlights Ownership of a functional TV The impact of the FP ad is seen by the importance of audience varied from 23 percent in rural actions taken by married respondents segmentation for message design households to 57 percent in where 58 percent of married men as well as media placement. The urban households and 46 percent of married women third round of the National Family TV viewership was high among reported that they started using a FP Health Survey (NFHS-3) and the men both in rural and urban areas method after seeing the ads. National Readership Survey (NRS) Overall, nearly three-fifths of can be excellent data sources for respondents in each of the Visibility/Recall of TV Spots: this purpose. target audiences who were An assessment of the recall of the Another aspect related to exposed to the ads found them TV spots was done at three levels: audience segmentation is the to be effective in conveying the a) spontaneously; b) after some choice of media channels. Though intended message prompting; and c) after aiding the TV is an important and effective In general, a higher proportion respondent by narrating the key medium, reach among rural of married men and adolescent aspects of the TV spot. audiences in EAG states is limited, boys than married women and albeit growing. For behavior adolescent girls attempted to Recommendations for Future Mass change to occur, TV should be take some type of action after Media Campaigns supplemented with other BCC seeing the TV spots. This is not As RCH-II service delivery is channels including community surprising, as numerous studies strengthened, the thematic outreach and IPC. have shown that women often are areas for BCC will need to be The celebrity spots had varying not empowered to make decisions expanded. However, this should impact with different audiences about their own health and the be done within an overarching and health themes. The evaluation health of their children. evidence-based BCC strategic also demonstrated that non- framework. The BCC strategy celebrity spots can work equally Specific actions included: should be implemented in phases well, if not better than celebrity gathering more information on an so that efforts are focused and spots. issue after seeing a spot on it; and lead to desired behavior change. Sustained airing of TV spots is encouraging friends, relatives or Too many messages aired less important. Several spots that others to follow the behaviors, frequently can lead to message had higher recall had also been or following the behaviors dilution. aired through multiple programs, communicated through the ad Findings from the evaluation increasing their exposure and for themselves, their spouse, indicate that recall and subsequently their recall.
6 Behavior Change Communication Activities and Achievements NRHM BCC CAMPAIGN – PHASE II
The second phase of the NRHM’s BCC campaign was implemented nationwide by the MoHFW, Government of India from 27 December, 2008 to 26 January, 2009. The focus of this campaign was to promote existing programs and schemes, improve attitudes towards and increase knowledge on key maternal, newborn, child health and nutrition interventions and behaviors. The campaign aired 16 television spots and seven radio spots in Hindi and released print ads in major newspapers nationwide. The IFPS project provided BCC content for the campaign, and development partners including USAID, UNICEF emotionally inspiring lyrics and visuals. Results: An independent study of and UNFPA participated in its This campaign called for promoting the reach, recall, comprehension, implementation. health services and schemes of the appeal and intention-to-act was NRHM and positioning the ASHA commissioned by USAID and carried Strategic Approach and as an important link between health out by Population Foundation Objectives: Through empowerment, services and families. To achieve of India (PFI) and MCH STAR2. role modeling and promotion of FP this, some spots showcased the The evaluation determined the choices and benefits: high quality of health services and extent of the campaign’s reach, motivate audiences to adopt presented them as within the reach of visibility and exposure among the positive FP and RCH behaviors by families through the ASHA. In a few target audiences as also the recall, addressing key factors that act as spots, celebrities from Indian cinema comprehension and appeal of specific enablers and barriers to adoption; and television shared how their lives spots of the campaign. Further, the and were improved by adopting positive evaluation aimed to provide relevant improve attitudes towards FP and health behaviors and appealed to recommendations to MoHFW to RCH among intended audiences audiences to also adopt healthy enhance the effectiveness of future, across focused health themes. behaviors for better health and large scale behavior change campaigns. quality of life. The evaluation represented urban and Audience: General population, 15–45 rural areas of 11 high focused states years of age. Interventions and Activities: and other states across the country Sixteen television spots, seven and surveyed 3,575 currently married Creative Approach: A range of radio spots and numerous print ads women (15–29 years of age), 1,784 creative approaches were used, across all major national newspapers husbands of women (15–29 years of including the use of cultural symbols, were developed, focusing on age age) and 350 fathers and mothers- festivals and customs that are rooted of marriage, FP adoption and the in-law. In-depth discussions were in traditions of everyday life, as well as NRHM. held with state level policymakers
2 A Concurrent Evaluation of Phase II of the NRHM BCC Campaign (2009)- MCH STAR, PFI
Behavior Change Communication: National Level 7 and program managers, and with 30 state, 54 district and 120 block level officials and health service providers at grassroots level to elicit their perceptions of and recommendations for improving the campaign.
Key Findings: The key findings of this concurrent evaluation included: Television has a much greater reach than radio in all locations. The TV spots used in the campaign appealed to most of the respondents (70-95%) who were exposed to them.
TABLE 4: KEY RESULTS OF NRHM BCC CAMPAIGN (PHASE II) CAMPAIGN EVALUATION
Key Message and Study findings (in percentages) Creative Approach
Message Recall Compre- hension Likeability Gained new knowledge Intend to take action Age at Emotional appeal to girls to delay marriage until Women 81.6 92.1 87.5 65.3 48.7 marriage 18 years Men 83.5 91.4 89.5 61.6 60 Family Celebrity couple Sachin and Supriya encourage Women 41.2 94.4 89.8 68.6 48.3 Planning couples to adopt FP by sharing personal experiences Men 41.4 94.9 88.8 67.4 59.4 Celebrity Juhi Chawla encourages couples to Women 40.3 89.1 87.4 70.1 41.2 adopt FP for child spacing and limiting to have a small but healthy family Men 57 88.5 82.6 67.1 40.6 Women discuss contraception choices while Women 50 88.0 87.2 64.7 41 applying mehendi or henna, in a cultural setting Men 40 89 87.2 66.4 58 Married couples discuss IUD as a FP method Women 41 92.6 87.8 67.1 42.5 at the Holi festival, a festival of colors that Men 25 85.8 70 79.7 41.1 symbolizes the joys of life NRHM Medical tour of services and schemes, and ASHA Women 36.5 91.3 88 63.4 43.7 as the link to the health system through the eyes Men 41.9 95.7 84.5 54 38.5 of a medical student A New Day, A New Sky: third-person view of the Women 29.2 84.7 83.6 73.6 43.1 reach and impact of NRHM on families Men 30 93.4 95.2 81.1 66.2 Celebrity couple promotes ANC, involvement Women 26.6 88.5 86.7 63.6 44.1 of men in decisionmaking, and communication Men 40.5 78.1 88.2 72.4 55.1 between husbands and wives Celebrity Juhi Chawla promotes ANC and shares Women 33.1 88.2 86.3 68.4 53.9 her personal experiences Men 35.3 87.2 88.9 75.5 47.8 N = 3,575 married women 1,784 husbands 350 fathers and mothers-in-law
8 Behavior Change Communication Activities and Achievements The radio spots used in the Hindi is not the major language Other major sources of campaign appealed to most of the spoken. information on the themes of the respondents (73-90%) who were A significant proportion of campaign among both men and exposed to them. respondents exposed to the TV women were ANMs, ASHAs, Creative and entertaining TV spots — 32 to 72 percent of men anganwadi workers (AWWs) and spots, without celebrities, and 40 to 55 percent of women relatives. can have as much recall, — intended to take action as a Policy makers and program comprehension and appeal result of the campaign including managers recommended that as spots featuring famous discussing the topic with their messages in print media should celebrities. spouse, family members and avoid ‘information overload’, Overall, language was not a major friends. This included seeking difficult words, jargon, and barrier to comprehension and services promoted in the spots photographs of politicians; it appeal of the spots, though the and following specific practices should have a regional flavor campaign was done only in Hindi. based on messages in the spots. for maximum effectiveness; and The few who reported difficulties Mothers-in-law discussed the include complementary IPC with the language in the spots contents of the spots with efforts. were from other states, where daughters-in-law.
Behavior Change Communication: National Level 9 NEW FAMILY PLANNING MASS MEDIA CAMPAIGN
In 2009, the MoHFW requested renewed campaigns on FP, CH and MH, with emphasis on birth spacing. A three-phase mass media campaign for 2009–10 to be rolled out on a quarterly schedule was designed to build on previous mass media messages, while outlining specific milestones for media creation. Based on data from the NFHS-3 and the District Level Household and Facility Survey (DLHS, 2005-06), gaps in FP knowledge and behavior persist, including knowledge and use of modern contraceptive methods, birth intervals and men’s attitudes toward contraception. This mass media Creative Approach: The FP Some of the central creative campaign aimed to reinforce IEC/ campaign for 2009–10 placed approaches included: BCC messages from 2005 through particular focus on birth spacing Interesting and memorable spots 2009, reach a broader audience with and postpartum FP, and on that normalized FP use through new messages, and address the most repositioning BCC in the context everyday slice-of-life situations pertinent gaps in a systematic and of adopting modern methods for with emotional appeal. consecutive way. healthier mothers and children. This Key roles for influencers campaign called for the promotion The husband and mother-in- Strategic Approach and of FP, especially spacing methods, law in larger roles Objectives: To improve health of among newlyweds and women with Presenting mothers-in- families by increasing knowledge and one child. There was also a need law, who have significant positively impacting attitudes and to promote FP methods other than influence over FP behaviors related to FP and RCH female sterilization, which has been decision-making, as role through mass media and involvement the most popular method adopted models. of men in decision-making, in particular, by women. ASHAs, as the link between to re-position modern FP methods as families and the health service health preserving and health promoting Participation of men in FP decision- system, in a mentoring capacity. for mothers and children. making was a key objective of this Promote FP, with specific focus campaign, which shifted the focus to Interventions and Activities, and on birth spacing and postpartum men by highlighting their important Duration: contraception. role. All TV and radio spots had Campaign tag line Improve communication between visuals and dialogues that encouraged A tag line was developed, pre-tested husbands and wives, and involve men’s participation in FP decision- and finalized for use as a common men in decision-making. making. thread in all spots.
10 Behavior Change Communication Activities and Achievements Phase I (July – December 2009) TABLE 5: KEY MESSAGE AND AUDIENCE FOR FP MASS MEDIA CAMPAIGN Re-launching of all previously Message Audience developed FP spots including 12 TV and 3 radio spots from Audience USAID and UNICEF focusing on Primary: Intended audiences varied with the particular communication birth spacing, ANC, breastfeeding theme: and newborn care. Delaying the first birth Newly married couples Three years’ spacing between children Couples with at least one child The Tag Line Postpartum use of IUDs Couples who just delivered, or are about ‘Pati patni karen vichar, swasth naari, to deliver their child swasth parivar’ Postpartum use – any contraceptive Couples who have completed their ‘When a husband and wife families interact, it results in the better health of woman and the family.’ Postpartum male sterilization Couples who have completed their families, particularly men Implied Meaning: When a couple has open communication, they Postabortion contraception Couples where the woman has can use their knowledge to plan undergone an abortion their family. Secondary: Family elders
Phase II (January – March 2009)
TABLE 6: TV SPOTS/ RADIO SPOTS DEVELOPED AND AIRED DURING FP MASS MEDIA CAMPAIGN (PHASE II)
PHASE II Mass Media Creative Approach Message/Topic Spots Delay age of marriage 1 TV spot Mard ki daad (The Mark of a Man) – A group of men discuss their 1 radio spot ‘manly’ deeds when one says he stood against his relatives who were forcing his under-age daughter to marry early. Basket of 1 TV spot Animated video with a catchy song and modern visuals shares a contraceptives 1 radio spot range of contraceptives and their benefits.
Delay first child 1 TV spot Aisi bhi kya jaldi hai (“What’s the Big Hurry!”) – A newly married 1 radio pot couple asks relatives who are pressuring them to have a baby, “What’s the big hurry?” Use of contraception 1 TV spot Nayi subah (“A New Dawn”) – A couple who recently had an after abortion abortion realizes they should have adopted a FP method to avoid the abortion, and ultimately chose to use an IUD to space their children.
Behavior Change Communication: National Level 11 Phase III (June – September 2010)
TABLE 7: TV SPOTS/ RADIO SPOTS DEVELOPED AND AIRED DURING FP MASS MEDIA CAMPAIGN (PHASE III)
PHASE III Mass Media Creative Approach Message/Topic Spots Three years’ spacing 1 TV spot Sahi Waqt Pe (“At the right time”) – Two men discuss everyday between children 1 radio spot things that happen at the right time, such as the planting of seeds, and realize that the right time to have a child is three years from the last born. Postpartum 1 TV spot Taiyaari Hamesh Pehle (“Be prepared”) – A husband tells his friend contraception 1 radio spot that it is better to plan and be prepared for things in life, and he and his wife have adopted PP contraception to plan their family.
Postpartum IUD 1 TV spot Fix It – An enthusiastic husband who fixes all his family’s problems finds answers to spacing from an ASHA.
Increased male 1 TV spot Mujh Pe Chhod Do (“I will handle it”) – A husband who likes to sterilization handle his family’s affairs decides to go for sterilization for the sake of their well-being.
Results: This mass media campaign has been aired by the MoHFW twice between 2010 and 2011.
12 Behavior Change Communication Activities and Achievements PROMOTION OF THE JSK HELPLINE
The "Jansankhya Sthirata Maulana Azad Medical College. The were used in a fun, empathetic and Kosh" (JSK) (National Population call center receives an average of 300 endearing manner to motivate young Stabilization Fund) has been calls per day. Based on June 2008 to couples to ask questions relating to FP established to promote and June 2010 data, trends indicate that and sexual health, clichés related to undertake activities aimed at the percent of male callers are higher love, marriage and sex. In the first film, achieving population stabilization than the female callers; approximately it was shown that Indian lovers are at a level consistent with the needs 70 percent of the callers were inspired by movies and go to lengths of sustainable economic growth, married, and a majority of the callers to woo one another, taking cues from social development and environment were from the age group of 21–30. film. However, as Hindi films do not protection, by 2045. JSK is a unique inform the audience of what happens organization. Its goal is to promote JSK sought assistance from the USAID after love, they are advised to call the initiatives that leverage the strength of funded IFPS project to develop helpline for credible information. In different economic and social sectors two TV and radio commercials to the second film, actors in the ‘REEL’ and reach out to needy population promote the helpline as a credible world ask difficult questions to make groups through innovative strategies. source of information on FP and an example that in REAL life there are It is a combination of government and sexual health. difficult questions related to FP and civil society working hand-in-hand to sexual health from which we shy away. promote innovations by drawing on Strategic Approach and Thus, the helpline provides credible the strength of joint partnerships. Objectives: The objective of this information. campaign was to increase knowledge JSK has established a helpline about the Helpline and the services Interventions and Activities, and service to give information on RH, it provided as well as to motivate Duration FP and CH issues in English and audiences to call the helpline for Campaign tag line Hindi using an automated computer information on relevant health topics, “Poocho to Jano” (“Ask and Know”), based software that has multiple where to seek additional information was the campaign tagline that questions and answers to respond (from local sources), and other issues. addressed both the mothers and to the callers’ queries based on daughters, and under which two taxonomy for common questions. Audience: It was strategically commercials were developed. The It is intended to fill the information important to target soon-to-be two TV and radio spots were aired gap on contraception, safe abortion, married couples and newly married nationwide by JSK February 2012 pregnancy, sexually transmitted couples to shape positive attitudes onwards on all public broadcast and diseases, infant and child health issues and support the adoption of CNS channels and even displayed among teenage mothers or unmarried recommended behaviors that would at events and fairs that are regularly and newly married couples. Technical persist. As this age group was also organized by JSK, and invested around support has been provided by technology and mobile phone friendly, 1.75 crore on television alone. National Informatics Center (NIC), the creative approach took advantage NASSCOM and the Central Bureau of alternative media channels. Results: Since this campaign is being of Health Intelligence (CBHI). The implemented as this document is software was prepared by the Creative Approach: Popular Hindi being developed, no impact study has Department of Community Health of cinema and topics from popular culture been conducted.
Behavior Change Communication: National Level 13 MENSTRUAL HYGIENE CAMPAIGN
In India, menstruation and menstrual importance of influencing the health to improve attitudes towards and to practices are clouded by taboos seeking behavior of adolescents. adopt positive behaviors related to and sociocultural restrictions menstrual hygiene by use of sanitary for women and adolescent girls. Social Marketing of Freedays napkins. Limited access to products for Sanitary Napkins: sanitary technology and lack of safe In 2010, the MoHFW launched their Audience: Adolescent girls aged sanitary facilities could be barriers own brand of sanitary napkins named 10–14 and 15–19 years, and mothers to increased mobility and the Freedays, priced at Rs. 6/- for six of adolescent girls. likelihood of resorting to unhygienic napkins. In the first phase, the napkins practices to manage menstruation. were to be marketed by the ASHA Creative Approach: The creative Traditionally in India, it appears that and the scheme was to be rolled out approach to this campaign was to use there are three primary strategies in 150 districts across the country. positive role models and normalize for sanitation during menstruation: the key behaviors. The mother– use of old clothes as pads by The IFPS project was requested to daughter relationship was used to recycling them, no protection, or develop two TVCs and two radio show positive mothers who prepare making disposable pads with material spots to help adolescents understand their daughters for menarche, talk to available at home. that menstruation is normal, hygiene them about menstruation, provide is very critical, and that sanitary sanitary napkins and are good role Anecdotal evidence suggests that napkins are a hygienic way to managing models. The approach was based on the lack of access to menstrual periods. The first commercial was for the findings from secondary research hygiene (which includes availability of 10–14 year olds and the second was provided by MoHFW that: sanitary napkins, toilets in schools, for older girls. Formative research The onset of menarche among availability of water, privacy and safe helped address the key barriers to 10–14 year old rural girls is disposal) could constrain school positive behaviors and triggers for traumatic, psychologically attendance and possibly contribute communication. The commercials disturbing, socially embarrassing to local infections during this period. were pre-tested and findings were and alienating. This is intensified Therefore, creating awareness and incorporated in the final campaign. given that mothers do not prepare increasing access to the requisite their daughters for menarche or sanitary infrastructure related to Strategic Approach and suggest using sanitary napkins. menstrual hygiene is important. The Objectives: Through empowerment Confusion, taboos and unexplained GoI’s commitment to adolescent from using role models, promoting restrictions surround young girls. reproductive and sexual health behaviors and benefits, and addressing There is little information or (ARSH) in RCH II recognizes the barriers, audiences are motivated knowledge among both mothers
14 Behavior Change Communication Activities and Achievements and daughters since discussing created a barrier that has led to Interventions and Activities, and menstruation is stigmatized. rampant school absenteeism. Duration Lack of information and Campaign tag line knowledge perpetuates ill- Thus, the campaign developed two “Taiyaar Raho, Taiyaar Karo” (Prepare informed superstitions and beliefs. core messages: and Be Prepared) was the campaign Unhygenic practices including use Empowerment through tagline addressed to both the mothers of sanitary napkins made from knowledge: Develop confidence and daughters. old clothes which are washed and to understand and accept menarche frequently reused or the lack of as natural and to view it positively The two TV and radio spots were sanitary products, left young girls as a “change that happens to every aired nationwide by MoHFW from vulnerable to infections and disease. girl” and that “she is not alone”. November 2011 onwards on all Lack of availability and Empowerment through public broadcast and CNS channels. affordability of sanitary napkins protection: Increase comfort leads to perpetuation of these and hygiene through greater Results: Since this campaign is being unhealthy practices. access to sanitary napkins, which implemented as this document is Restrictions on freedom of are now available at BPL/APL being developed, no impact study has movement and activity have prices for these girls. yet been conducted.
Behavior Change Communication: National Level 15 CAMPAIGN TO PROMOTE SOCIALLY MARKETED CONTRACEPTIVES BY ASHA
Until now, the MoHFW, GoI had FIGURE 1: STRATEGIC BCC APPROACH been providing free distribution of oral contraceptive pills, condoms Community level and emergency contraceptive Household level Posters at key locations Health Facility level pills to all beneficiaries under the IPC by ASHA using leaflets and flipbook Wall paintings at key Posters NRHM. However, access to these locations Sale of contraceptives Leaflets in dispensers contraceptives is reported to be low Tin plates on rickshaws because of delays in making supplies Follow up by ASHA to solve issues with the Flex banners for use that are available at the sub-district method or clarify use during VHND, group meetings, melas, etc. level and downwards, among other causes. As such, use of contraceptives in the country has been largely static. Further, unmet need for spacing Strategic Approach and Audience: Men and women of methods continues to be substantial. Objectives: The objectives of the reproductive age. campaign were: To improve access to contraceptives for to inform clients that The IFPS project designed a eligible couples, a pilot project has been contraceptives delivered by the communication strategy that developed to utilize the services of the ASHA will be charged nominally included a mix of activities that ASHA to deliver contraceptives at the and that the facility based ones reached beneficiaries at the family/ doorstep of households and incentivize will be free of cost; and household level, community level her for this effort. The initiative is being to help audiences identify the and health facility level. A set of implemented on a pilot basis in 233 differences in the packaging of the posters and banners were designed districts in 17 states. In the districts contraceptives between those that focused on branding of these where the distribution of contraceptives that will be charged and those for products, wherein clear differentiation through the ASHA is being introduced, free distribution. between free and ASHA marketed the free supply of contraceptives at contraceptives was made. A primary health center (PHC) and sub- mnemonic was designed for the center levels stands withdrawn in the audience to recognize the ASHA light of the new provision of home and the contraceptives she provided delivery of contraceptives by the ASHA. under the socially marketed route. However, free supply of contraceptives at community health centers (CHCs), Interventions and Activities, and sub-divisional and district level hospitals Duration: The campaign was launched shall continue as before. In the districts in January 2012 in the EAG states. and states that are not covered under the pilot, the existing system of the free Campaign tag line: ASHA se mango supply of contraceptives at all centers (“Ask/Demand from the ASHA”) shall similarly continue. The IFPS project was requested by the FP division of the Results: This campaign was launched MoHFW to design a community level by the MoHFW in January 2012, thus campaign for the same. no assessment has yet been conducted.
16 Behavior Change Communication Activities and Achievements MULTIMEDIA IUCD CAMPAIGN
The MoHFW decided to increase uptake of intrauterine contraceptive device (IUCD) by introducing IUCD 375 as an alternate short-term option and requested the IFPS project to design a mass media campaign with some promotional collaterals that could be used in the EAG states. The IFPS project suggested the use of the existing Suvidha IUCD campaign that it had developed in the past for UP, but was never aired due to branding issues. The Suvidha campaign was still applicable. Thus, the MoHFW agreed to use the same campaign with minor addressing the prevalent Radio commercials revisions. myths and misconceptions. Local and mid-media: Posters, banners and tin Strategic Approach and Audience plates Objectives Primary Audience: Wall paintings and Generate demand for IUCD by: Women 25–45 years with hoardings positioning IUCD as a one or more children wanting Health Facility level media: trouble free, reliable, to either space or limit family Posters on myths clinic-based method of size contraception providing Key Influencers: Creative Approach: The creative protection from unwanted Husbands approach was to promote IUCD as pregnancy, spacing between Mothers-in-Law trouble free and reliable FP method. pregnancies and long acting Service Providers It showcased key influencers that temporary methods for highlighted benefits and endorsed this limiting pregnancies; Interventions and Activities product as a viable FP method. introducing IUCD 375 as an Communication Activities: alternate short-term option; Mass Media Duration: The government will and Television commercials launch this campaign in April 2012.
Behavior Change Communication: National Level 17 ATMAJAA TV SERIAL DRAMA
The Atmajaa — Born from the Soul serial drama was developed and aired nationally on Doordarshan (the public broadcaster). It addressed female feticide and the dignity of girl children, and explored stigma associated with gender discrimination. Many activities to increase awareness on these issues were carried out between 2001 and 2003. One of the activities includes airing of a short film, titled Atmajaa, on national and regional television and in schools.
The impact of these activities and the short film was used to develop a pilot TV series, Atmajaa. This was produced and aired in 2004. The MoHFW considered this initiative as effective in introducing health and gender issues to audiences in Audience: Youth, married couples Interventions and Activities an entertaining and informative way and in-laws. Phase I (pilot): 13 episodes and recommended that additional Presented issues of female episodes be produced and aired Duration: feticide, gender inequality, and to reinforce and expand upon the 13-episode series in 2004 health and social well being topics from the pilot series. 52-episode series in 2005–06 of girls.
Strategic Approach and Objectives: Using the EE approach that allows audiences to have an ongoing relationship with compelling characters and storylines, introduce the issue of female feticide and other gender issues, and positively influence related knowledge, attitudes and behaviors.
The Creative Approach Create characters that audience members can easily identify with and view as role models, and introduce themes and messages through the characters as they tell their stories in scenes from everyday life.
18 Behavior Change Communication Activities and Achievements TABLE 8: PRODUCTION MILESTONES FOR ATMAJAA TV SERIAL DRAMA Phase III: Episodes 17–52 of 52- 2004 Production of the Produced by Plan International, and aired by episode series 13-episode pilot MoHFW nationally, regionally, and internationally. Part I (13 episodes) presented contemporary issues delving into Atmajaa Reports on female feticide gained global attention. mainstream health and family 2004–05 Pilot series The pilot had high television rating points among welfare problems at family and evaluation audiences, and insights for production of a new societal levels. series were gained. Focused on medical ethics, 2004–05 Plan developed for MoHFW approved the plan and production began. youth and adolescence, caring a 52-episode series for elders, sexual harassment in the workplace, domestic 2005–06 Production of first Aired nationally on Doordarshan and regional violence, gender inequality, 26 episodes channels. mother-in-law and daughter- Print and electronic media report on the series, in-law relationships, child increasing awareness of the drama and the issues. sexual abuse and sexual abuse 2006 Production of final MoHFW approved production and airing of the laws, female feticide, property 26 episodes additional episodes. rights, women’s rights, sex selective abortion, and forced polyandry or bride selling. Phase II: Episodes 1–26 of 52- Themes included gender Part II (closing 13 episodes) episode series inequality, dowry, rape, Targeted youth and focused Connected viewers with female infanticide, women’s on adolescent health, early characters as role models, rights, reproductive rights, marriage/age at marriage, introduced during the pilot property rights, domestic maternal health, institutional series. abuse, trafficking of women, delivery, FP including birth Elaborated on issues presented sex selection and sex spacing, government health during the pilot and explored selective abortion, sexual schemes, and career and underlying factors in depth. harassment and the law. development opportunities.
Behavior Change Communication: National Level 19 CAPACITY BUILDING
NATIONAL IEC WORKSHOP TABLE 9: NATIONAL IEC WORKSHOP AGENDA The mid-term review of RCH- TOPIC SPEAKER II in 2009 completed by GoI and Developing BCC strategies using the Ms. Geetali Trivedi-BCC Advisor, development partners identified a UP strategy and as e.g. new strategies, JHUCCP, ITAP Project, India need to sensitize and build capacity new media and new approaches. for health communication among Challenges in implementation of BCC Mr. Ram Mohan Rao, Former Principal IEC officials to strengthen programs programs Information Officer, GoI and interventions. Recommendations Developing the right message for the Prof. Devki Nandan, Director, NIHFW from the review included regular right audience meetings to share best practices Priority behaviors for health under: among states, and capacity building Family planning Dr. SK Sikdar, Assistant Commissioner, for key principles of BCC. To help Family Planning Division, GoI the NRHM meet its long-term goals Child health and Dr. Manisha Malhotra, Maternal Health and objectives, the IFPS project Program, RCH II/NRHM, MoHFW organized a national IEC workshop Maternal health B. Kishore, Assistant Commissioner, CH, for MoHFW on RCH to enable MoHFW better coordination and exchange H1N1-The emergency response Dr. AC. Dhariwal: Additional Director, of ideas between officials across Public Health and National Project Officer, National Center for Disease Control government sectors. Media Planning Ms. Mattu JP Singh, Director, DAVP, GoI Anti Tobacco and Mental Health Dr. Jagdish Kaur, Chief Medical Officer, Strategic Approach and Directorate General of Health Services, Objectives: To build capacities of MoHFW IEC staff at the state level in designing Field Publicity-Using mid media Ranjana Dev Sarmah: Director, strategic BCC programs through: effectively Directorate of Field Publicity, Ministry of Renewed dialogue between Information & Broadcasting states and the national IEC BCC for Adolescent Health Geetanjali Agrawal, Consultant, ARSH department to share and learn State presentations: efforts in BCC and 1B State IEC Officers from experiences of innovations innovative communication strategies and successful BCC campaigns Group work: Developing Annual Media Facilitator: Sheena Chhabra, Chief of the Development of a more focused Plans Health Systems Division of the Office of BCC activity plan for the Population, Health and Nutrition (PHN) at USAID following year’s state Program Participants: Andhra Pradesh, Arunachal Implementation Plans (PIPs) Pradesh, Bihar, Gujarat, Haryana, Madhya Understanding issues and Pradesh, West Bengal challenges faced by state IEC Group work: Importance of Facilitator: Supriya Mukherjee, Program officials in planning, implementing interpersonal Communication Communication Specialist, UNICEF and monitoring BCC activities. Participants: J&K, Kerala, Punjab, Rajasthan, Nagaland, Chhattishgarh, Audience: State level IEC officers Chandigarh from across India, communication Group work: Innovative Media Options Facilitator: Rajat Ray, Senior Advocacy and specialists from development partners, Communication Officer, UNFPA and IEC officials from MOFW. Participants: Tamil Nadu, Tripura, Uttar Pradesh, Maharastra, Delhi, Himachal Pradesh
20 Behavior Change Communication Activities and Achievements Interventions and Activities Results Workshop agenda developed to Representatives from 22 states address BCC for priority RCH attended, with 18 states sharing areas. innovative IEC/BCC approaches and Special sessions facilitated by methods. program heads of MH, CH and Recommendation for more FP, and various government platforms similar to the workshop media departments including the for discussion and mutual learning: Directorate of Visual Publicity. Development by states of their Participatory sessions on Annual PIPs with inclusion of BCC Media Planning, IPC interventions activities and Innovative Media Options. Uttar Pradesh adopted this model for the 2010–11 PIP. Duration: August 20–21, 2009.
TABLE 10: HEALTH INNOVATIONS SHARED AT THE NATIONAL IEC WORKSHOP
Andhra Pradesh Assam Bihar Chandigarh
Printing IEC messages on Counseling and advocacy A Health Action Plan Traffic roundabouts were NRHM and family welfare programs in schools on on IEC for each district used as a “Health Chowk” on school notebooks and ARSH and sanitation addressing diversity, e.g. to display different IEC savings booklets used by drought/flood prone messages, concepts and the postal department Radio jingles in 11 districts along with designs different dialects differential funds based on 108 Ambulance Services developed and broadcast cultural and geographical New health messages, challenges each month on displayed Fixed Health Day Services Video shows for people Bus shelters in the rural areas with 104 Health Information Milk collecting units no access to low-cost from different villages Using a tourist vehicle Helpline entertainment (COMPFED) reach – Chandigarh’s Hop On Running scrolls on Hop Off bus with health Tableau through the city messages to inaccessible television screens for 100 areas of the state. messaging interspersed carrying health messages creatively within days on key messages of under IEC activities all interventions of NRHM Using festive occasions promotional literature on and special family welfare to create low-cost, tourism activities on occasions high-impact messaging. Simple messaging on utility such as Diwali, X-Mas, E.g. messaging on Rakhi vehicles like milk vans New Year’s eve envelopes. Active school health scheme that has regularly updated capsules on diet and nutrition, tuberculosis, tobacco awareness, etc.
Behavior Change Communication: National Level 21 NRHM ADVOCACY FILM
Based on the request from boat clinics of Assam that deliver MoHFW, a 10–12 minute health services to families along multimedia advocacy film was India’s northern rivers, IPC/C developed in 2007 to showcase interventions of Orissa and the the initiatives, activities and intercommunication initiative of achievements of the NRHM and Jharkhand. outline their tasks heading up Capture comments and to 2012. The film was produced testimonials from functionaries in English and Hindi for use at of the MoHFW, GoI through international forums and for key state and field level interviews, stakeholders. especially with ASHAs, and share the branding of health programs, the participatory approach of Strategic Approach and specific interventions such as beneficiaries. Objectives: Increase awareness and the ASHA, Janani Suraksha recognition, and generate demand for Yojana (JSY), Rogi Kalyan Audience: Key stakeholders at the NRHM’s services: Samities (RKS), and Indian Public healthcare facilities and community Present the concept of the Health Standards (IPHS). level NGOs. NRHM, its vision and objectives, Share innovations and best the framework for the mission, practices across states such as the Duration: Produced in 2007
22 Behavior Change Communication Activities and Achievements LESSONS LEARNED AND PROMISING APPROACHES
Through the mass media campaigns and assessments, and TV serial drama employing an EE approach, the following key lessons were learned: The use of celebrities to promote BCC related to FP and RCH may not necessarily be more effective than employing other more traditional approaches such as the use of cultural symbols or traditions. Language and phrasing of messages, if not simplified for intended audience, may lead to low levels of recall and comprehension. Messages must be culturally and socially appropriate for the intended audience, and improved through pre-testing.
The mass media campaigns and TV Reinforcement and expansion of The importance of IPC serial drama highlighted best practices messages over time and through was demonstrated through for effective message recall and various channels such as mass improved recall and comprehension, and positive changes media and IPC improves recall comprehension of messages in knowledge, attitudes and behaviors. and comprehension. when aided or prompted. Creative and entertaining approaches to BCC, including What Works the use of EE, effectively Creative, memorable and entertaining BCC. capture audiences’ interest Simple, culturally appropriate messages that use clichés from daily life. and attention, encourage social FP messages that address the men and provide benefits , especially economic dialogue, and lead to positive benefits, both short and long-term. changes in knowledge, attitudes Demonstrating vital role of men in health and family planning while designing and behaviors. FP messages. A collaborative approach to FP 30 and 60 second TVCs that have one catch phrase repeated in different developing capacity building and situations instead of storylines. advocacy strategies with key Reinforcement and expansion of messages over time stakeholders across multiple levels Capacity building and advocacy strategies developed collaboratively with key of the health system can lead to stakeholders. the integration of more effective BCC into existing programs.
Behavior Change Communication: National Level 23
SECTION 2
Behavior Change Communication The Power of Innovations and Uttar Pradesh Partnership
Section 2 Uttar Pradesh BEHAVIOR CHANGE COMMUNICATION
NRHM BEHAVIOR CHANGE COMMUNICATION STRATEGY
evelopment of the NRHM’s Propose activities to close gaps DBCC Strategy for UP in coordinated BCC efforts Uttar Pradesh is one of the first states across and within national and in India to initiate a state level BCC regional programs. strategy for the NRHM. The BCC Build capacity of healthcare strategy was developed to provide a program managers and blueprint for focused interventions to frontline workers for achieve the NRHM goals. The strategy integration with state is evidence-based, and utilizes a major mass media activities, and ancient Indian theory of communication decentralization of BCC known as Sadharanikaran, in addition to activity planning at the district, the Pathways model™ from JHUCCP. block and village levels. The model focuses on 14 priority behaviors for BCC through a multi- Audience: All stakeholders at all pronged communication approach levels working in UP under various including IPC and community events/ health programs. activities, community mobilization and mass media. Interventions and Activities Selection of priority behaviors Develop and deliver a BCC and barriers analysis Strategic Approach and strategy for the NRHM in UP that Overarching BCC strategy for Objectives: Improve health service identifies priorities for improving interventions and innovations delivery and outcomes through the health across populations through Plans for short-term BCC development, orientation and delivery integration and coordination interventions of a plan for strategic BCC, addressing of activities, and adaptability at Plans for long-term BCC priority behaviors across 14 key health district, block and village levels. interventions issues within all districts and across all The document is divided into key State level roles and levels of program delivery in UP. sections: responsibilities Address gaps in BCC strategy and Situation analysis of health in District level roles and capacity in the state: UP responsibilities
Behavior Change Communication: Uttar Pradesh 27 BCC guidelines for Inclusion of a cascade training A model for capacity building TOT implementation component for master and subsequent cascade trainings Building BCC capacity among trainers to build capacity for was developed and delivered to the health program managers BCC activity integration with Government of UP, and has been Supportive supervision, PIP in all districts of UP. deployed at the district and block monitoring and evaluation Delivery of a training-of-trainers levels. Recommendations and (TOT) capacity building workshop The capacity building TOT program conclusions for key district and block level was delivered and included two Develop and deliver a guide for functionaries to train master participants from each district: District implementing BCC activities trainers for cascade trainings Community Mobilizers (DCMs) outlined in the state strategy at throughout UP. and District Health Education and the district, block and village levels Information Officers (DHEIOs/Deputy through program health managers Duration: November 2008 DHEIOs) for a total of 33 districts and frontline workers. onwards. and 69 participants (in Allahabad Design a model for orientation, regional workshop) and 38 districts training and capacity building of Results: and 73 participants (in Agra regional district, block and village level The BCC Strategy for NRHM in workshop). Overall, 71 districts in UP functionaries to integrate BCC Uttar Pradesh was delivered to the were covered and 142 participants activities from the state strategy Government of UP, and oriented through the “Soch se Amal with annual PIP. has been adopted at the state level. tak!” workshops.
28 Behavior Change Communication Activities and Achievements NRHM’S BCC IMPLEMENTATION GUIDE FOR UP
FROM AWARENESS TO provide clear guidance and ACTION – A GUIDE FOR direction on how to mobilize, DISTRICT AND BLOCK implement and monitor activities LEVEL FUNCTIONARIES in the field; and TO IMPLEMENT BEHAVIOR provide supporting and CHANGE COMMUNICATION monitoring tools for PROGRAMS implementation in the field. A guide was developed for district and block level health program managers Audience: BCC functionaries at to simplify implementation of the district and block levels: DCM, BCC activities outlined in the DHEOs, HEOs and BPMs. state’s strategy. Duration: January 2010 onwards. Strategic Approach and Objectives: Provide a hands- Results: The guide was distributed to on guide to district and block district and block level functionaries level managers responsible for at capacity building workshops in implementing BCC activities in their Allahabad and Agra, and will be communities through an abridged distributed to other districts through version of the strategy document capacity building workshops to ensure that would: widespread coverage and use.
Behavior Change Communication: Uttar Pradesh 29 CAPACITY BUILDING
DEVELOPMENT OF THE ASHA NEWSLETTER Under the NRHM, ASHAs have been selected from their village to create awareness on priority health issues, to promote and mobilize better healthcare planning and healthcare seeking practices, and increase utilization and accountability of existing healthcare services. Capacity building for ASHAs is seen as a continuous process going beyond initial training in order to ensure they are equipped with accurate and timely information, and well-honed skills. quality and timely healthcare groups for comprehension, Communication for, about, and information within the retention, appeal, likeability, overall between ASHAs was deemed community, and recognize impact and intention to respond. important to continue the capacity ASHAs as an identity. Production and printing of the building process, and to further Provide solutions to issues faced Ashayein newsletter. enhance ASHAs’ knowledge and by ASHAs to enhance their Development of a distribution skills to deliver BCC. Over 130,000 counseling skills. system for the newsletter through ASHAs work in UP and present a Serve as a motivational tool Chief Medical Officers (CMOs) in significant opportunity to disseminate by recognizing evidence-based each district who then distribute effective messages for priority health work of ASHAs, encouraging it to ASHAs. behaviors if they are continually them to share their stories and trained, informed, motivated and experiences, and act as a source Duration: Quarterly, beginning with empowered. A 12-page newsletter, of inspiration to others. the July–September 2008 issue. known as Ashayein, was created to take advantage of this important Audience: ASHAs working in UP. Results communication channel. A qualitative assessment of Interventions and Activities ASHAs carried out in Sitapur Strategic Approach and Completion of an informal needs and Barabanki revealed that Objectives assessment through field visits Ashayein had high likeability, Build capacity of ASHAs with ASHAs. comprehension and usefulness continually by increasing the Formation of a core group of among ASHAs and they relied on use and dissemination of subject matter specialists from the Ashayein for sharing information regular, accurate and up-to-date Government of UP, SIFPSA, and with their communities. information to improve health IFPS project. Issues of the Ashayein Newsletter service delivery and outcomes in Development of a conceptual were developed up to June 2011 UP. framework for a newsletter and 150,000 copies of each issue Create a forum for bringing through a participatory process, were printed for more than together ASHAs, position the pre-tested with ASHAs through 137,000 ASHAs working in the role as a skilled deliverer of individual interviews and focus state.
30 Behavior Change Communication Activities and Achievements DISTANCE LEARNING PROGRAM
While frontline health workers in Audience: ASHAs and ANMs. UP are trained in technical skills, they displayed low self-image, and Interventions and Activities perceived lack of appreciation for Development and airing of a their role in the communities they 26-episode radio educational work in. The need was thus to create program addressing health issues, a campaign that highlighted their role myths, misconceptions and good as a link between the community and healthcare seeking behaviors. the health services, as a credible and Episodes talk of FP and trained health promoter and provider contraception issues, maternal of consumables like oral rehydration and child health, and effective solution (ORS), oral contraceptive IEC and IPC skills. pills (OCPs), condoms, etc. Radio presented an opportunity to increase enhanced client–provider Results: Through a qualitative knowledge and improve skills critical interactions through assessment of ANMs in five blocks to the effective dissemination of BCC representative characters and of Jhansi district, the radio distance messages by local healthcare providers. radio role plays. learning program was found to Motivate and empower frontline have high levels of listenership, Strategic Approach and health providers by instilling in comprehension and appeal, and Objectives: Through the reach of them a sense of pride and self- increased knowledge specifically in radio, improve knowledge and skills of respect. IPC and RCH. frontline healthcare providers such as ASHAs and ANMs: FIGURE 2: IMPACT OF THE DISTANCE LEARNING PROGRAM Increase knowledge about health ON ANMS issues including FP, reproductive Percent ANMs Reporting tract infection (RTI), sexually 99 100 94 96 96 95 transmitted infection (STI), HIV/ 88 90 AIDS, MH, CH, and age at marriage. 80 80 Build IPC skills by demonstrating 70 70 60 Key Messages 50
40 34 ASHAs and ANMs are 30 valuable to the community, 20 and contribute to the health 10 and well-being of families. 0 They should be proud of their Aware Listened Recalled Liked the Talked to Wished Reported Improved Improved of the to key program others for future increased knowledge knowledge work. Continual learning will program at least messages about broadcast self- of IPC of RCH instill pride and confidence. 1 episode the esteem program n=100
Behavior Change Communication: Uttar Pradesh 31 RADIO DRAMA SERIES
RADIO DRAMA SERIES Duration: 2004–07; 2008. Radio is an important component Key Messages of mass media with a wide reach Results Women and men alike have across rural UP, thus offering a unique Demand for the first radio media edge most importantly among the right to good health. drama series was high, and led rural audiences, the largest and most A happy family is a small, to the development and airing critical audience for the IFPS project healthy and planned family. of a second 26-episode radio communication effort. In fact, more A planned family improves drama — Sunehere Sapne Sanwarti women and men in UP are exposed to health, education and quality Rahein (2008) – expanding upon radio than in India overall (NFHS-3). of life. messages of the original series. Couples should plan their Issues addressed included UP has high maternal mortality, lack of family size and health together the role and contribution institutional delivery, and high rates of with the help of a healthcare of ASHAs and ANMs to RTIs and STIs. There is also a large gap provider when needed. the health and well-being between awareness (95 percent) and of communities, nutrition, use (27 percent) of modern methods hygiene, immunization, of contraception (NFHS-3). One of the Motivate and empower gender issues and population major reasons for low and inconsistent responsibility and action for stabilization. use of contraception is misconception healthcare. Aimed to create awareness about contraceptive methods and and generate demand for JSY. cultural taboos on the subject. Thus, Audience: A mid-term evaluation revealed a radio drama series was used to Rural men and women of high popularity and positive disseminate BCC messages to the reproductive age and their feedback on the series, a desire general population addressing these families. of listeners for a TV series based myths through factual information and Local community leaders. on the topics covered in the radio perspectives of users. drama, and message dissemination Interventions and Activities: through multiple channels including Strategic Approach and Development and airing of a print and electronic media. Objectives: Using an EE approach, 26-episode radio drama series through representative and compelling addressing health issues, myths and characters and storylines: misconceptions, and good healthcare Increase knowledge and dispel seeking behaviors. myths and misconceptions about Episodes address the well-planned health issues including FP, RTI, family, value of a girl child, STI, HIV/AIDS, MH, CH, and age importance of delayed marriage, at marriage. male involvement in decision- Present role model couples making, and male involvement in discussing FP. caring for women and children.
32 Behavior Change Communication Activities and Achievements MULTIMEDIA FEMALE STERILIZATION CAMPAIGN
The XXXVIII PAC held in January Audience Key Messages 2004 recommended the promotion Couples 25 years and older with of female sterilization through an unmet need for sterilization a multi-media communication and their families. Promote usefulness and ease of female sterilization. campaign to increase uptake. The Influential community leaders. Address post-operative project envisioned development and Healthcare service providers. implementation of a BCC campaign complication. Promote sources of services. aimed at positively impacting attitudes Interventions and Activities towards female sterilization and Develop and pre-test a package increasing the number of women of BCC campaigns through a adopting sterilization. Accordingly, a wide range of channels including ‘Woman with Pot’ visual BCC package was developed for UP. radio, TV, folk performances, theme wall paintings, hoardings/ Hoardings: Strategic Approach and billboards, posters and Doctor visual theme Objectives: Through a coordinated cinema slides. Cinema slides multi-channel communication approach: Deliver the mass media campaign Increase knowledge of female across the state, and local media Duration: First Round – May to sterilization. campaign in 33 focus districts. August 2006; Second Round – June to Improve attitudes and motivate Creative package includes: September 2007. behaviors for female sterilization. TV Films – Two films in Hindi: Camp film Results (60 sec and 30 sec) In the first round of the campaign, Teej film 25 TV spots and 2,304 radio (40 sec and 30 sec) spots were aired; 43,150 posters Radio Spots – Five separate were printed and distributed; 411 spots in Hindi: hoardings and 66 glow signs were Camp spot (60 sec) installed across 33 IFPS project- Teej spot (40 Sec) focal districts; and 1,126 folk ANM Behanji spot performances were organized in (60 sec) 33 IFPS project-focal districts. Saas Bahu spot (60 Sec) During the second round (mass RCH Camps spot media focused), 647 TV spots (60 Sec) and 2,146 radio spots were aired, Poster – Bilingual Poster in addition to the release of 260 Wall paintings: newspaper ads in a number of Doctor visual theme leading regional dailies.
Behavior Change Communication: Uttar Pradesh 33 MULTIMEDIA IUCD CAMPAIGN
SUVIDHA IUCD CAMPAIGN Radio drama series for general public Strategic Approach and Distance Learning program Objectives: for service providers. Generate demand for intrauterine IPC: IUCD by: Counseling and follow-up card addressing the prevalent for beneficiaries myths and misconceptions; Counseling tools for service creating brand positioning providers and a visual identity for the Job aids for ANMs. newly launched Copper-T Local and mid-media: (CuT 380 A); and Interventions and Activities Posters, banners and tin plates positioning CuT 380A as Branding: Wall paintings and hoardings a trouble free, reliable, Brand name ‘Suvidha’ means Folk performances. clinic-based method of convenience. contraception providing Preferred logo design of the two Duration: The campaign was to protection from unwanted flowers and two leaves was found be launched between January and pregnancy for up to 10 years. to be very appealing and connoted April 2007, but was never launched Upgrade the counseling and IPC ‘Khushali’ or a feeling of well-being because the UP government could skills of service providers. to the target groups. not register the brand name Two flowers represented two ‘Suvidha’ for the IUD, given that a Audience: children and the leaves were the contraceptive pill existed in that Primary Audience: caring parents. name. This campaign however was Women 25–45 years having one Promote preferred benefits of revived under a new name, IUD or more children wanting to convenience and protection from 375, and used by the MOFHW. As either space or limit family size. unwanted pregnancy. of 2012, the GoI in 2012 plans to Key Influencers: revitalize an IUD campaign. Husbands Communication Activities: Mothers-in-law Mass Media Service providers. Television
34 Behavior Change Communication Activities and Achievements ADVOCACY AND SKILL BUILDING
NRHM FLIPBOOK FOR ASHAS SIFPSA recognized the need to improve With the establishment of the NRHM community involvement in program in 2005, an emphasis was given to implementation and set forth a strategy health among rural populations. to sensitize political leaders and A need was felt to communicate communities on MCH and the NRHM. the NRHM’s mission and goals, health focus areas, and schemes Strategic Approach and of the government broadly to the Objectives populations it served. Through IPC Improve knowledge and build and group meetings, ASHAs have capacity on FP and RH BCC a wide reach among populations Adolescent health through local, district and targeted by the NRHM, and NRHM programs such as vaccines state level political, social and presented an opportunity to broadly and disease prevention, and community leaders. and effectively communicate the vitamin A and iron supplements. Improve knowledge and build NRHM’s messages to members of the capacity for availing and managing community. Produced: 2007 need-based health services. Involve the community in sharing Strategic Approach and Results responsibility for their own health. Objectives: Provide ASHAs with a 129,450 flipbooks produced and visual tool to facilitate group meetings distributed to ASHAs in Audience that: 71 districts. Policymakers, political leaders, promote the NRHM mission ASHAs found the tool very useful, social representatives, influential and goals, address health issues and indicated that additional community members, and officials highlighted by the NRHM and information in this same format of health and development government services available. on mental illness, including facilitate talks on topics learned in depression, psychosis and the ASHA training; and schizophrenia was desired. Needs Identified deliver effective IPC on FP, MH, CH and RH. Sensitization of PRI Leaders Information gap between: Women and children in rural areas Service providers and Audience: Community members have traditionally depended upon clients receiving services from ASHAs. inadequate health infrastructure and Policymakers and under-supported service providers. A communities. Interventions and Activities: lack of inclusion by local stakeholders, Need for a participatory and Development of a flipbook for ASHAs low awareness of development and inter-sectoral approach to to use during group meetings covering health indicators, low awareness of healthcare. key issues of the NRHM. The flipbook rapid population growth and its effect Need to employ the NRHM’s included six sections: on overall development and provider- goal of assisting society to Overall health and sanitation driven services all contribute to the articulate its health needs, MCH including ANC poor status of health services in and provide a role in its HIV/AIDS the state. management. FP
Behavior Change Communication: Uttar Pradesh 35 departments at district and block involve stakeholders in Implement a “follow-up card” levels across 33 districts. developing action and system for local contributions to implementation plans to health services, administrative and Duration: July–September 2007. improve availability and managerial processes. management of appropriate Interventions and Activities health services based on Results Key district and block level healthcare situational analysis. District level workshops functionaries and stakeholders across Distribute a brochure with successfully held in 32 of the 33 33 districts were invited to one-day messages from the Chief Minister, focus districts, and sensitized workshops where they were sensitized Minister of Family Welfare, and 4,814 stakeholders. on the current health situation in UP, SIFPSA Chairman and Executive After district level sensitization and the NRHM’s vision, government Director. workshops, block level policies and programs relating to MCH. messages provide support for workshops were organized Program management units administrative and managerial within 32 districts; 396 out of (PMUs) organized and facilitated responsibilities of health 404 blocks held workshops FP and RH sensitization services at the community level. (97 percent coverage). workshops for influential Distribute a booklet developed Messages providing support to members of the community with specially for the panchayati raj community level health services support from local government institution (PRI) representative: management were distributed and NGO leaders to: “Jan Chetana Abhiyan – ek Swastha to all stakeholders at this time. share health indicators of Pradesh ki ore” (Community For each district/block level districts across UP, and UP Awareness Movement – towards workshop, authorities provided overall; and a healthy state). certification.
36 Behavior Change Communication Activities and Achievements MID-MEDIA
COMPREHENSIVE POSTER ON health services available to them and health facilities FAMILY PLANNING at clinics and from community Panchayat Ghar health workers. Anganwadi centers. Aao Batein Karein Expanding on the health information Audience: Single men and women Produced: 2006–2007. from a previous poster following a of reproductive age, and couples with previously successful FP program, Aao unmet need for family planning. Results: Batein Karein, a comprehensive poster 162,767 posters were placed in was created. Interventions and Activities targeted locations: healthcare Develop a comprehensive poster facilities at sub-centers, CHCs and Strategic Approach and on FP products and services, PHCs across 70 districts of UP. Objectives: Inform and educate men and maternal, newborn and child and women about: health services. Contraception options available Place posters in visible locations: Key Messages to them at clinics and from Public and private health clinics community health workers. Women’s hospitals Theme: Healthy and Happy Maternal, newborn and child Urban family planning centers Families Law supports delaying marriage until 18 years Educate girls ANC for pregnant women Institutional deliveries Immunization for children Postnatal care Health of women and babies improves economic opportunities for family Copper-T 380A For desired family size Small family has benefits Small, healthy family leads to more prosperity. Men should be responsible for FP decision-making.
Behavior Change Communication: Uttar Pradesh 37 COMMUNITY MOBILIZATION
KUMBH MELA 1998 in Haridwar, and again in Interventions and Activities Kumbh Mela is a significant religious 2001 in Allahabad, and drew very Kumbh Mela exhibition event held every four years that large audiences. The 2007 event SIFPSA pandal with a stage and attracts millions of people from all presented another opportunity for scene hosted folk performances over India from different religions SIFPSA to utilize a proven method delivering BCC messages. to partake in ceremonial holy to disseminate health messages to IEC panels communicated bathing. The crowd that gathers intended audiences. BCC messages. at the mela site is a mix of people Doctors counseled from all segments of society and Strategic Approach and community members on from all age groups, including people Objectives client-centered FP issues and with unmet need for FP, decision- Through audience analysis and opportunities. makers in families, and influencers in community mobilization, disseminate IEC/IPC materials were communities who can be instrumental messages about FP and RH to a developed and disseminated in bringing about necessary change captive audience through Kumbh to community members by in attitudes and behaviors of people Mela, and generate demand for FP and counselors and doctors. towards FP. The mela provides an RH products and services. Flipbooks were utilized by immense opportunity for SIFPSA to Using a mix of media including counselors and doctors reach out with a cross-section of community level (folk media), to convey information and health messages at one place. The mass media (video), and IPC educate community members. exhibition also offers the potential to (counselors), reach those who Free contraceptives were use a mix of different media, including may not otherwise be reached provided to interested local media to convey messages with health messages. community members. effectively to a captive audience. Audience: Literate/Non-literate, Duration: 45 days between January This platform had successfully been urban/rural, men and women of and February 2007. used by SIFPSA in 1995 in Allahabad, reproductive ages across UP and India. Results SIFPSA estimates around 2,000 people visited the SIFPSA pandal every day for each of the 45 days. Thus, the messages spread to an estimated 90,000 to 100,000 people. The activities increased awareness and educated individuals on FP and healthy families, and generated demand for FP and RH products and services.
38 Behavior Change Communication Activities and Achievements NGO PROJECTS
Folk performances are a popular form experienced folk troupes are trained families. This activity has been a of entertainment in rural areas across to deliver effective FP/BCC to captive major success with demands for India. Popular folk styles can be an audiences. more performances. effective platform, and folk troupes Orient troupes on the objectives Folk performances also proved with experience in these styles can of the SIFPSA project. useful in promoting the local help convey messages to audiences Sensitize them to the nature of community health worker and the with high impact. Five popular folk the messages. services she can offer. styles that provide a platform for the Host interactive sessions to Effectively carried FP messages to integration of FP messages include: finalize scripts that integrate FP rural populations. Nautanki (folk theatre) messages. Qawwali (traditional songs in Urdu) Duration: 1999–2007. Puppetry Alha and Birha (traditional ballad Results singers) SIFPSA conducted six training Magic workshops since 1999. In January 2007, 76 professional Strategic Approach and folk troupes were trained in all Objectives: To develop and five forms of folk media. deliver workshops to uniformly and The performances have been rigorously train selected troupes in rewarding for NGOs and developing scripts that integrate FP cooperative agencies involved as BCC messages. platforms to disseminate their project objectives. Following Audience: Rural communities. performances, inquiries from audience members poured in, Interventions and Activities: helping achieve objectives of Through popular folk styles, taking FP to the doorsteps of
Behavior Change Communication: Uttar Pradesh 39 INTERPERSONAL COMMUNICATION
FAMILY WELFARE Duration: September–December that makes it easy for them to COUNSELORS TRAINING 2009. disseminate BCC messages. MODULE AND FLIPBOOK Family welfare counselors (FWCs) Interventions and Activities Results: The training module was are placed at government health Strengthened counseling skills of reviewed and piloted by FWCs, and facilities under the NRHM to provide FWCs through the use of training will be used by the State Institute of counseling to families on social and manual on effective BCC. Health and Family Welfare (SIHFW) health issues, and provide a unique Provided FWCs with a flipbook for regular trainings of FWCs. opportunity to expand FP and RCH messages through community workers.
Strategic Approach and Objectives: To strengthen health messages delivered to families by frontline workers during in-house visits through enhanced counseling skills and job aids of FWCs in the areas of FP and postpartum FP, ANC, PNC, immunization and nutrition.
Audience: Trainers of the FWCs - Training Manual FWCs and their clients - Flipbook
40 Behavior Change Communication Activities and Achievements SALONI SWASTHA KISHORI YOJANA
Saloni Swastha Kishori Yojana (SSK a unique opportunity to leverage an Developed a Saloni Diary, which Scheme) is a government scheme for existing platform for the integration of is an interactive tool to record adolescent girls designed to decrease BCC, and bring about sustainable health and monitor health behaviors anemia levels through the provision behavior change in adolescent girls. pertaining to the nutrition and of iron and folic acid (IFA) tablets and RH among adolescent girls, de-worming. The scheme provides Strategic Approach and corresponding to the Saloni Objectives: To introduce specific sessions. nutrition and RH themes to motivate Created flipcharts to instruct girls to adopt healthier behaviors adolescent girls on nutrition and through IPC between teachers and reproductive health. adolescent girls, IPC tools, and Trained master trainers to structured group meetings. facilitate teacher training on delivering Saloni sessions on Audience: Teacher’s Training Manual/ nutrition and RH. Teacher’s Flipbook – School teachers Trained teachers to deliver Saloni of Saloni Schools (where scheme is sessions, and conduct Saloni being implemented); Saloni Diary – for Sabhas or group meetings in school going adolescent girls schools. Delivered Saloni sessions in Duration: 2009–2012 schools, to interactive and open discussion on nutrition and Intervention and Activities RH so as to change behaviors Created a teacher’s training affecting nutritional status of the manual with 10 curricula on RH adolescent girls. and nutrition.
FIGURE 3: BASELINE AND END LINE FINDINGS UNDER SALONI PROGRAM ON NUTRITION
100
90 88 79 80 77.5 72.9 72.3
70 66.2 61.7 62.3 59.8 56.2
60 55.1 50 42.8 42.2 40 32.6 29.5 25.8
30 25.8 22.8 24.3 18.2
20 15.6 13.3 13.5 12.2 10 0 Eating more IFA tablets Food variety in a Consumption of Consumption Consumption of that 4 meals day (>=8) vitamin C rich of sprouted protein foods per day foods legumes
Intervention Baseline (n=595) Comparison Baseline (n=600) Intervention Endline (n=600) Comparison Endline (n=600)
Behavior Change Communication: Uttar Pradesh 41 FIGURE 4: BASELINE AND END LINE FINDINGS UNDER SALONI PROGRAM ON HYGIENE
100 93.8 90.8
90 86.3 83.5
80 75.1
70 65.5 60 52.7 49.6
50 46.7 40 30.7 30 21.6 14.6
20 13.2 13.3 10 2.8 1.4 0 Daily handwashing Daily handwashing Daily handwashing Using soap daily while with soap after with soap before a with soap before bathing defecation meal cooking
Intervention Baseline Comparison Baseline Intervention Endline Comparison Endline
Provided girls with a Saloni Diary A cluster randomized trial was In terms of hygiene, all handwashing for them to keep track of their conducted through 2009–11 in select with soap behaviors (handwashing nutrition and eating habits. Government junior high schools for with soap after defecation, before girls in three blocks of Hardoi district eating, and before cooking) Results: The State Government to assess the impact of the one-year registered a significant increase. accepted and appreciated both the communication program using Saloni Reproductive behaviors that Saloni Teacher’s manual and Saloni Teacher’s Manual and Saloni Diaries. also improved include genital Diary. They proposed printing 20,000 hygiene and changing cloth during Teacher’s Manual and 125,000 Saloni The results indicate that there has menstruation three times daily. Diaries in NRHM PIP for the year been a signification impact in behaviors Importantly, the ideal number 2010–11, which was approved by in the areas of nutrition, hygiene and of children that girls wanted the Government of India. Following RH. These include eating four times lowered and knowledge about the this, an additional printing of 410,000 a day, adding food variety to the diet, marriage law, including the penalty, Saloni Diaries was also approved by and consuming weekly IFA tablets. increased. the Government of India.
42 Behavior Change Communication Activities and Achievements PUBLIC-PRIVATE PARTNERSHIPS
SOCIAL FRANCHISING This network comprises seventy SCHEME 20-bed Merry Gold Hospitals, A significant proportion of people in 700 Merry Silver clinics and about India that need healthcare seek the 10,000 Merry Tarang members. This services of the private sector, which integrated network of providers is served by individual doctors, provides varied packages of services companies and philanthropic at affordable prices and works on organizations. In Uttar Pradesh, referrals to ensure that health asset HLFPPT launched the MGHN as a utilization is optimized and utmost social franchising initiative through value is delivered to the healthcare SIFPSA in partnership with USAID, seeker. Government of India and the Government of UP. The trust is Brand building: Brand building committed to establish 70 Level 1 was one of the major thrusts of the franchisees (Merry Gold) at district program and the strategy involved level as a hub to connect to the creation of a brand: next two levels: Level 2 (L2) and to create and sustain a franchisee Level 3 (L3). While L2 comprises network of health facility fractional franchisees (Merry Silver) providing RCH services for the established at sub-division and block poor; levels, L3 (Merry Tarang) comprises to improve access to quality, providers like ANMs, ASHA and affordable RCH services; suggest simplicity, purity, accessibility, AYUSH and acts as first point of to increase demand for RCH affordability and auspiciousness. The contact with the community as services; and brand includes a tag line — “Acchi well as referral support to Merry to support to sustain program Sehat Sacchi Khushiyan” (Good Silver and Merry Gold hospitals. impact. services, Real Happiness) — to signify The Merry Gold network provides the quality of services for the entire high quality maternal and child The brand Merry Gold was developed family. health services at affordable prices. based on the marigold flower to On the basis of that creative angle, the same branding was prepared and finalized following pre-testing in three different districts of UP with perspective clients, network members, motivators etc. The majority of respondents accepted and liked the concept as it gave the impression of peace, security for loved ones, good health and trust.
The following communication products and branding were used among the general public as well as for the respective franchisees.
Behavior Change Communication: Uttar Pradesh 43 project was succeeding well and on its way to develop the targeted network by the end of 2010.
Project strengths: 63 L1 and 271 L2 facilities were operating. Across the network, approximately 5,500 deliveries were being performed per month along with about 22,000 ANC visits. By 2009, 62 percent of franchises reported that they had increased TABLE 11: OBJECTIVES OF THE MGHN COMMUNICATION client loads by being in the system. CAMPAIGN Franchisees were particularly Brand Equity Client Load Expansion of pleased with the introduction of Franchised Network the 13 protocols and the quality OBJECTIVE I OBJECTIVE II OBJECTIVE III of care training. I. Brand promotion I. Community-based I. Facility level activity Consumer satisfaction was Mass Media activity Special Days monitored and the results were Television Door-to-Door Celebra�on encouraging: over 90 percent of Local radio channel contacts Children’s Day users reported they were very Advt. in daily Referral slips Mothers’ Day satisfied or satisfied with the newspaper Hand bills for Breas�eeding Week quality of service. II. Advocacy informa�on of health Nutri�on Week Pricing had generally been Media Advocacy camps II. Rapport Building maintained at new "affordability" Advocacy with II. Health Camps 4 monthly meet for levels ranging from 30 percent to policy-makers Free ANC checkups L1 Local Media (hand FP counseling Biannual meet at L2 50 percent below average private bills, cable TV, wall Free distribu�on of Quarterly L1/L2/L3 sector charges. pain�ng, and �n FP methods mee�ng plates on rickshaw) III. Intersectoral Meeting Newsle�er/Mailer The study also highlighted that III. POS/Print ASHA, AWW, SHGs, III. Promotional schemes consumers were satisfied with the Pamphlets GP and NGOs Annual best awards services supplied, but did not yet
COMMUNICATION INTERVENTIONS Banners IV. Business Model/ for L1/L2/L3 stress any specifically unique brand Referral slips Mo�va�onal IV. New Franchisee identity or selling proposition to the Posters ac�vi�es for L3/L1 Development network as compared to competitors. Name plates (L3) Redemp�on of State /District In other words, the concept of quality Signage for L1 and L2 referral slips level mee�ng of care linked to low cost had yet to Incen�ve schemes with FOGSI and become a clearly distinguishing factor Merrygold Health other prospec�ve Policy franchisees for the franchise. Based on these findings, the second round of the campaign was revised and launched. Communication Strategy: At the interventions, which were planned and preliminary stage of the project, all the implemented under MGHN: As part of a review for the communication activities were focused performance of MGHN and fully on attracting new franchisees to Results franchised hospitals, a strengths, enlarge the MGHN. The network was In 2009, a mid-term evaluation was weaknesses, opportunities and threats based on the following activities and conducted. It concluded that the (SWOT) analysis was completed by
44 Behavior Change Communication Activities and Achievements Ernst and Young in January 2011. Its many programs have been launched the Government of India in 1968. The aim was to revise the design of the in numerous countries to promote program gradually expanded with the network and financial projections for contraception. In 2006, there were launch of Nirodh Deluxe, Mala-N and sustainability. The review indicated 86 contraceptive social marketing Mala-D. Of these Nirodh and Mala- that there was an urgent need to programs (with annual sales of over N are intended for free distribution revisit the brand, communication and 10,000 CYPs) running in 68 countries through the public health sector, marketing strategy for the MGHN in across the world, accounting for 39.9 while Nirodh Deluxe and Mala-D are the light of the changed health service million CYPs . By the year 2010, there socially marketed through a range sector, specifically the introduction are 93 contraceptive social marketing of contraceptive social marketing of conditional cash transfer and programs (with annual sales of over organizations. Additionally under insurance schemes by the government 10,000 CYPs) running in 69 countries the Contraceptive Social Marketing through the public sector. A barrier across the world in 2010, accounting Program, organizations are supported analysis and brand equity study was for 53.4 million CYPs. in marketing subsidized condoms and then conducted to critically evaluate oral contraceptive pills under their brand value and strength. Findings The contraceptive market is own private brand names. Various were used to design a creative most countries consists of two organizations such as DKT India, brief for the implementing creative components: public (represented HLFPPT, PSI India, PHSI and Janani agency who would then revise the by the government) and private among others are currently marketing brand, communication and marketing (represented by social marketing products under the CSMP. strategy in the future to ensure organizations, NGOs, commercial increased recognition, demand and marketing organizations), which Objectives: To increase the Total loyalty to MGHN and to make the generally work in isolation from each Annual Sales of all Condoms, Total franchise economically viable. other and often end up competing Annual Sales of all Oral Contraceptive for the same markets. A total market Pills, Village Penetration in rural UP. SOCIAL MARKETING approach represents an approach The term social marketing was first wherein the two sectors coordinate Audience: Men and Women in coined by Kotler and Zaltman in as one total market to target various reproductive ages in Rural UP. 1971 to refer to the application of population market segments. marketing to the solution of social Duration: under the IFPS Technical and health problems. Social marketing The Indian social marketing program Assistance Project, social marketing applies marketing principles and started with the launch of Nirodh by component started on April 01, 2007 techniques to create, communicate and deliver value in order to influence target audience behaviors that benefit society as well as the target audience. The behavioral changes targeted can include getting the audience to accept a new desirable behavior or reject a potential undesirable behavior. Other behavioral changes can include modifying a current behavior or abandoning an old undesirable behavior.
The earliest social marketing program for contraceptives was the program launched by the Government of India for the promotion of Nirodh condoms in 1968. Subsequently,
Behavior Change Communication: Uttar Pradesh 45 and continued up to March 30, 2008. using visual aids and poster on contraceptive methods and family The one year duration of the project exhibitions along with condom planning. The intent was to create reflects the fact that the IFPS project demonstrations to explain correct a discussion among the participants itself was due to end on March 31, and consistent use of condoms and regarding the messages exhibited. This 2008. The Social Marketing project oral contraceptives. was skillfully guided and moderated by was extended thrice for the periods the project staff present. Spot sale of July 02, 2008 to March 31, 2009; Healthy Baby and Mother Events- oral contraceptive pills and condoms November 01, 2009 to March 31, These events were conducted in was also conducted during this activity 2010 and December 10, 2010 to association with the Village Health in an attempt to induce trial. December 31, 2011. Nutrition Days. The Healthy Baby and Mother Events involved women Results: Between 2008 and 2009 Interventions and Activities who have infants and young babies The project used a two-pronged who then serve as a captive audience Activities Conducted strategy relying on demand for promoting the concept of family More than 13,000 Market Town generation (both generic and branded planning. The link between family Activities conducted reaching promotions) and product availability planning (in the form of spacing 945,000 men and nearly 315,000 to achieve its goal of increased usage between children) and maternal women of condoms and oral contraceptive health leading to healthy babies will be 430 Village representatives pills. explained. These events have also been meetings conducted used as a forum to educate mothers 21,300 community meetings Market town activities-Weekly regarding child nutrition, immunization conducted markets or haats are a routine affair and other selected issues. 780 retailer meetings conducted, in rural India during which the people attended by 17,000 retailers of surrounding villages gather to Van activities / Poster exhibitions- 145 community based distributor sell their produce and to purchase Van activities were especially focused (CBD) meetings conducted, their weekly necessities. The activity towards a woman audience. This attended by more than 4000 consists of use of locally acceptable helped counter the male dominated CBDs folk media (nautankis – street plays, audience present at the Market puppet shows, magic shows, etc.) to Town Activities. Vans decorated with Findings disseminate information on family promotional materials were used Retail outlets in rural villages are planning and RCH. to reach the targeted villages. The willing to stock condoms and pills staff traveling with the van carried if product is made available to Community Meetings-Outreach exhibition sets based on family them Workers interact and coordinate planning and promoted the message Total sales in 2008-09 in rural UP with the Aanganwadi Workers directly to end-users through the Condoms: 159 million pieces and ASHA workers to sensitize exhibition of promotional materials OCP: 2.99 million cycles relevant target groups towards and distribution of literature. The Number of retail outlets stocking various issues including anatomy activity also resulted in spot sales. condoms is higher than those and physiology of the human stocking OCPs reproductive system, pubertal Umbrella activities-Umbrella activities Innovative approach to mid level changes, family planning and various were organized at various places IPC such as market town activities contraceptive methods (including where people are expected to gather, strengthen both supply and condoms, oral contraceptives, such as melas, bus and railway stations demand injectable contraceptives and and special days under NRHM. The IPC is essential for consistent and intrauterine devices). The meetings activity consisted of a stall along with correct messages on usage of used interpersonal communication a garden umbrella at the venue with a products and management of side techniques such as group discussions poster exhibition providing messages effects, especially for pills
46 Behavior Change Communication Activities and Achievements VOUCHER SCHEME The voucher scheme encourages Development of street play script beneficiaries to use these services by for community mobilization. The voucher scheme is a demand-side providing vouchers that allow women Developing training package financing model that enables families to obtain services from private sector and impart training to Voucher in urban slums to access critical RH providers free-of-charge. Due to this, Distribution Agency Staff: services, while empowering them to increased uptake of services provided voucher coordinator, assistant choose the provider they want. To in the scheme to the target BPL voucher coordinators (AVCs) achieve this, affordable, accessible families has been very encouraging. and community health volunteers and quality RCH and FP services are (CHVs). provided to below poverty line (BPL) Based on lessons learned and the Training of voucher distribution families in the city through accredited performance of a pilot project staff. private facilities using a voucher conducted in Kanpur Nagar, the Home visits and group meetings scheme model. voucher scheme was scaled up to by CHVs and distribution of urban slums in Agra, Kanpur, Varanasi, vouchers. Uttar Pradesh has learned from its Allahabad and Lucknow. own experience of implementing the Results voucher scheme. A voucher system Audience: Urban slum populations. Voucher distribution staff trained was piloted in Agra and Kanpur in KAVAL towns on voucher Nagar covering seven rural blocks Duration: 2009–2011. distribution system, basic RCH of Agra and 368 urban slums of issues and IPC. Kanpur Nagar. The focus population Interventions and Activities AVCs in KAVAL Towns are was women of reproductive age and Development of voucher trained on FP counseling so as to children up to two years old from communication strategy in the State. increase uptake of FP vouchers. vulnerable families. The services Development of communication Voucher uptake and utilization of provided included ANC, delivery in a material as elaborated in services. health facility, PNC, FP and RTI/STI. Communication Strategy.
Behavior Change Communication: Uttar Pradesh 47 Janani Shishu Suraksha Karyakram (Mother and Child Safety Program)
JSSK is a government scheme scheme among the general rural by a committee comprising launched in the State of UP in 2010. population through radio, which has experts from SPMU IFPS project. The scheme aims to provide cashless the highest reach to the farthest areas Spots and Jingles were produced delivery services to the women of the State. after the script was approved delivering at a government health and then heard and reviewed by facility. The chartering of services has Audience: a committee comprising been developed for this program. To Charter – Pregnant women and experts from SPMU, SIFPSA, establish the program, SPMU–NRHM their families. FW Directorate, IFPS project was supported to develop the radio Radio Spots and Jingles – General and AIR. spots and jingles. rural population. The Listening Committee’s suggestions were incorporated. Strategic Approach and Interventions and Activities Objectives: Make pregnant A Service Charter was designed Duration: September 2011–onwards. women and their families aware of on the basis of GoI guidelines entitlements under the scheme by and services offered by the State Results putting up a charter at the reception, Government to place within 1000 charters were placed in waiting area, female ward and labor the facilities. facilities identified for JSSK. room of the facilities where the Scripts for the Radio Spot and The final spots and jingles were scheme is operational. Establish the Jingle were developed and vetted handed over by the SPMU to AIR.
48 Behavior Change Communication Activities and Achievements LESSONS LEARNED AND PROMISING APPROACHES
The comprehensive approaches disseminating health messages to employed in UP to increase community members. Additionally, What Works awareness and generate demand UP’s close-knit communities and its for improved health required a high key stakeholders were committed to Overarching strategy. level of coordination and support improving health, and were effectively Capacity building across from stakeholders at all levels. While mobilized to improve health status all levels of strategy the comprehensive strategy and under an overarching and broad-based implementation. implementation plan was effective at strategy and implementation plan. The Inclusion, collaboration improving the availability and delivery following were key to the project’s and participation across all of healthcare services across the success in UP: functions. Reinforcement and expansion state, decentralization was also found Develop an overarching to be helpful. BCC strategy for all levels of messages. Disseminating messages Health functionaries in far of administration within the reaching corners of the state are healthcare sector through across multiple mediums to reliable, credible, and sometimes collaboration and participation. captive audiences through institutionalized events: the only source impacting the Build capacity for synergistic health of their communities. BCC, program design and Mass media Community folk media ASHAs may deliver the only implementation across all levels healthcare men and women will of service delivery — national, IPC and counseling. receive in the most remote parts state and local; and among families, of UP, and must be well-trained communities and facilities through and provided with adequate events such as workshops and resources to make an impact. tools such as informative flipbooks. PRI Leaders may be the most Scale up programs and increase effective influencers of health reach through expanded capacity policy in their communities if they building efforts, and participatory are sensitized and trained in the BCC tool design and deployment. status of health in their districts, Brand and promote products and and the resources available to services from healthcare resources them through national or state to communities, ASHAs and Merry level schemes. Gold Network franchisees. The Kumbh Mela event was The development of BCC visual aids again effective in reaching large such as toolkits and flipbooks and audiences in cost-effective distance learning radio programs ways through proven BCC was found to be very useful for platforms such as folk media educating healthcare workers, and and IPC.
Behavior Change Communication: Uttar Pradesh 49
SECTION 3
Behavior Change Communication The Power of Innovations and Jharkhand Partnership
Section 3 Jharkhand BEHAVIOR CHANGE COMMUNICATION
STATE BEHAVIOR CHANGE COMMUNICATION STRATEGY
EVELOPMENT OF THE DJHARKHAND BCC BCC Strategies for Jharkhand STRATEGY The role of strategic communication Integrate mass media with is critical for the NRHM to achieve community level media and its objectives in Jharkhand, and IPC activities to increase the they recognized the need to move Opportunity to See (OTS) of from an event-oriented and isolated the health campaign. approach for addressing health issues, Use of radio for specific to a collaborative and comprehensive health messages to ensure approach. A comprehensive strategy that maximum reach in a cost- addressed priority health areas through effective way. an integrated and multi-channel BCC Extensive use of IPC and mid- approach was needed to improve health media in rural and hard-to- and impact infant mortality, maternal reach areas. mortality and fertility rates in the state. Leverage existing social networks, festivals Strategic Approach and and cultural practices linkages between the private and Objectives: Develop a comprehensive to disseminate health public sectors to ensure quality of BCC strategy for priority health areas information more widely. services; and Identify existing supply points to: create an enabling and such as chemist outlets, PHC enhance awareness, generate supportive environment through demand and facilitate behavior and cinema halls to reach community-based dialogue, change in specific target large numbers of people with advocacy and social populations for health services reminder health messages. mobilization. related to FP, MH, CH, HIV/AIDS and ARSH, to improve indicators Audience: of IMR, MMR and TFR; by increasing the IPC skills of Primary audience: build trust in and improve the providers through training and Men and women of reproductive image of the health system, capacity building, and by creating age
Behavior Change Communication: Jharkhand 53 53 Secondary audiences: prioritize health areas to The BCC strategy recommends the Parents, community leaders, be addressed; and following nine activities: faith leaders, health service identify barriers to 1. Conduct a Behavior Change Impact providers, traditional healers, local the adoption of health Survey (BCIS) for developing governance bodies, private-sector behaviors and promising baseline indicators and formative practitioners. interventions. research across a broad range An implementation planning of health issues for developing Interventions and Activities: The workshop was held in May communication concepts. Parivartan (“Change”) BCC strategy 2007. 2. Conduct an assessment of was developed by the IFPS project, A strategy framework was different media outlets available in USAID and leadership from the proposed to work as a blueprint the state, including mass media, in Jharkhand Department of Health, with to guide IEC/BCC campaigns order to understand the reach of inputs from all stakeholders working and efforts for the state and its different channels. with the state under various health partners. Strategies for focused 3. Finalize the development and programs. and targeted interventions under implementation of two integrated A situational analysis identified FP, MH, CH, HIV/AIDS and ARSH multimedia campaigns on birth the current health scenario, IEC were identified. spacing and MH. efforts and gaps to gain insights on A monitoring and evaluation 4. Initiate PPP models for introduction the issues faced in the state; implementation plan was drafted. of new contraceptives, e.g., SDM Participants and stakeholders Various levels within the and DMPA in the state. worked in groups through two Government of Jharkhand, IFPS 5. Develop and implement IPC workshops to develop a BCC project and USAID provided training protocols, manuals and matrix and identify primary and inputs for and revised the materials for health providers to secondary audiences, underlying communication strategy for support IPC and group sessions social barriers, and the tools the development of a final on prioritized health issues. and channels recommended to document. 6. Identify and ensure visibility at achieve desired outcomes: both public and private health A development workshop Print Date: October 2008. facilities about the availability of initiated by the Health and immunization services. Family Welfare department Results and Key Recommendations 7. Initiate PPP models on prioritized and supported by IFPS project of the BCC strategy adolescent health issues. using the results-oriented The Health Communication Strategy 8. Develop capacity of health framework was held in Ranchi for Jharkhand, Parivartan was formally providers to provide information in March 2007 to: launched on November 18, 2008 by and counseling to adolescents. explore the role the then Health Minister Shri. Bhanu 9. Introduce a telephone helpline and importance of Pratap Sahi. Ms. Monique Mosolf, Chief, to disseminate information on evidence-based strategic Reproductive Health Division, USAID HIV/AIDS and other priority communication; was also present. health issues.
54 Behavior Change Communication Activities and Achievements ADDRESSING NEEDS OF SPECIAL POPULATIONS
HEALTH ISSUES AND wanted to understand behaviors, among the traditional service HEALTH SEEKING BEHAVIOR rituals, beliefs and remedies related providers and providers from the OF TRIBAL POPULATIONS to RCH followed by the Santhal, mainstream health system. DOCUMENT Munda, Oraon and Ho tribal groups Jharkhand is home to over 30 tribes in the Santhal Pargana and South Audience: All stakeholders at all that make up 26.3 percent of the Chotanagpur regions, and better levels working in Jharkhand under total state population (Census of understand the interplay between the various health programs. India, 2001). There is a strong need physical and political environment to identify information gaps in health within these select tribal groups. Interventions and Activities: A practices and service utilization of qualitative assessment was conducted Jharkhand’s tribal population as there Strategic Approach and and a final report produced that have been constraints in addressing Objectives: Identify, understand identified underlying barriers their requirements through effective and analyze existing health seeking of geographic access, economic policy measures and service delivery behavior of couples in major tribal constraints and cultural issues to be programs (Health Issues and Health groups with a focus on the traditional addressed in order to improve health Seeking Behavior of Tribal Populations, system of healing, through a service utilization. January 2009). To improve health comprehensive qualitative assessment. Samples were drawn from Santhal, service utilization among these Munda, Oraon and Ho tribes, and populations, it was important to Objectives of the assessment: a minority tribe, Pahariya, and identify barriers to access that were Identify the key behaviors, unique tribal characteristics and unique to these tribes, and understand traditional rituals, beliefs, practices differences were documented. cultural and social factors that could and remedies followed during Social mapping was carried out aid in reducing barriers and increasing critical stages related to health to list resources and utilization of access. The Government of Jharkhand, and disease. services. in collaboration with the IFPS project, Assess the knowledge level, Force field analysis, listing and pile utilization and traditional practices sorting for perception of health related to contraception. system and treatment seeking Identify treatment-seeking behavior was completed. behavior during pregnancy, Key informant interviews were delivery and post delivery period. conducted with: Examine the rituals and practices ANM, AWW, and traditional related to newborn care and birth attendant (TBA) breastfeeding. Local registered medical Identify the beliefs and perception practitioners (RMPs), who about RTI/STI issues. practice in the villages Identify existing healing rituals, Village-based traditional perception about the existing healers health system, the role of In-depth interviews were indigenous medicine among the conducted with: tribal population and integration At least one woman/couple of traditional medicine with with experience of an the prevailing RCH program neonatal death
Behavior Change Communication: Jharkhand 55 At least one respondent with experience of maternal disease Recommendations for Tribal Populations or death in the household. There is an immediate need to ensure availability and accessibility of Focus group discussions were held with eligible couples. services to tribal and rural populations, and institute tribal-friendly health services in remote areas. For each tribe, key informant interviews were conducted There is a large unmet need for FP, and opportunity to promote with: tubiligation and IUDs. There is also a need to reconsider the Primitive Tribal Groups (PTG) Social activists policy that bans the promotion of FP among endangered tribes. Herbal practitioners (specialists) Integrated Child Development Services (ICDS) scheme must be universalized and quality output should be monitored in child Modern doctors and health workers at Mission hospitals healthcare facilities. ICDS data must be disaggregated to understand and government hospitals. and inform policy and action. Empower local populations to plan for and monitor health at the Print Date: October 2008. hamlet level through Village Health Committees and Sahiyyas. Ensure functional health and nutrition facilities in every village: Report Findings and Anganwadi center in each village Recommendations Adequate and efficient health sub-centers CHCs and PHCs for tribal areas in all scheduled districts. Situational analysis Ensure healthcare facilities are tribal-friendly with workers from tribal Tribal populations have led impoverished lives and the state villages fluent in local dialects. is ranked at the bottom of most Encourage local tribes to manage public relations. development rankings. Institutionalize traditional healing practices through universities and research institutes, promote vaid raj in each village, and document and Less than 10 percent of villages have electricity, and they lack provide platforms for sharing and dialogue. roads and institutions in health, education and services for women and children. utilization; however, there is ANMs are less available in remote Healthcare problems stem from willingness among stakeholders to areas. illiteracy, poor infrastructure, engage traditional and government AWWs are present but do not poor sanitation, and some systems if opportunities are made deliver healthcare services. customs and traditions unique to available. Traditional doctors (vaid rajs) tribes. and untrained birth attendants Programs by the GoI to improve Accessibility of health services (dais) are accessible, however, not welfare among tribal populations Most modern health services are integrated with the government have not impacted health service provided by local RMPs. healthcare system.
56 Behavior Change Communication Activities and Achievements INTRA COMMUNICATION
INTRA-COMMUNICATION Audience: ANMs and doctors. WORKSHOP FOR THE JHARKHAND HEALTH Duration: December 2007 – SOCIETY (JHS) March 2008. The MoHFW, GoI has initiated a move for intra-communication Interventions and Activities: amongst the stakeholders of the Workshops were held in two public health delivery system. This districts, Deoghar and Lohardaga. initiative under the NRHM aims at Workshop sessions employed optimizing organizational synergies interactive and participatory through intra-communication. The approaches such as question-and- IFPS project is engaged in working answer sessions, anecdotes, games, with the Government of Jharkhand to team exercises and practice sessions. improve the capabilities and deliveries Topics covered included: of the public health system in the Elements of communication state through communication. As part processes of this effort, the IFPS project has Basics of effective communication undertaken a pilot initiative to deliver Identification of communication developing wall newspapers and and evaluate the effectiveness of tools (IPC, mid-media, mass media). newsletters. intra-communication capacity building Development of simple reporting ANMs expressed a willingness activities. and monitoring formats. to write event reports following Development of templates for visits with clients, and to use Strategic Approach and community wall newspapers. IPC tools taught through the Objectives: Through a participatory workshop to improve their process, build capacity for intra- Results communication skills. communication between Jharkhand Thirty-two ANMs and 16 doctors A core team of ANMs and doctors health program managers and participated and gained skills in in each district was equipped workers to build skills in employing effective IPC, report writing, use and motivated to lead the intra- basic concepts of communication, and of IPC tools such as flipcharts communication initiative in their add value to the process of developing and posters, and designing and communities following the pilot. district IEC plans.
Behavior Change Communication: Jharkhand 57 IPC CAPACITY BUILDING OF SAHIYYAS
Effective IPC between healthcare providers and clients is one of the most important elements for improving client satisfaction, prevention, treatment adherence and health outcomes. Effective IPC also benefits the health system by making it more efficient and cost- effective. Thus, clients, providers, administrators and policymakers all have a stake in improved provider – client interactions. The Government of Jharkhand recognized the need for more effective IPC among sahiyyas.
Strategic Approach and Objectives: Through a TOT and subsequent cascade training model, Mock training sessions with Results: build capacity for IPC and counseling feedback from facilitators Through pre-testing, 10 master skills among Sahiyyas and ANMs. were held with master trainers and 20 sahiyyas identified trainers. changes for the development Audience: Sahiyyas and ANMs from An assessment of the training was of the final training module and the Bokaro and Gumla districts. conducted. materials. 122 master trainers were trained Interventions and Activities Duration: August 2009 over five sessions. A model TOT plan on IPC focusing on client–provider FIGURE 5: IPC TRAINING FEEDBACK (PARTICIPANT RATING) interaction was developed. Training material prototypes, IPC Training Feedback by Master Trainer: curricula, and job aids were Average rating of participants developed, pre-tested and finalized. A TOT Toolkit was developed 80 with materials for master trainers 70 67 and sahiyyas. 60 A follow-up and supervision plan was developed. 50 40 TOT training sessions were 30 delivered: 22 Three-day trainings 20 10 trained master trainers on 6 4 the GATHER approach, 0 strengthening their training Very good Good Average Needs improvement skills.
58 Behavior Change Communication Activities and Achievements 67 percent of participants rated the training as very good: G Greet client (establish rapport) Most liked sessions were A Ask client (gather information) those with role plays of T Tell (provide information) counseling situations (78 percent of participants), mock H Help client with problem-solving and decision-making training sessions (67 percent), E Explain to the client key information for the decision and steps of counseling (56 R Return/Refer/Reality check percent).
Toolkit Materials for Toolkit Materials for Sahiyyas Master Trainers
Sahiyya Box Facilitator’s Guide An easy-to-carry box with It includes detailed training contraceptive samples and curriculum and agenda to train takeaways for use as a facilitation and supervise Sahiyyas in IPC. and demonstration tool. Instructional Video on Counseling Steps for FP Reference Book It includes case studies that A book for Sahiyyas on FP with case can be analyzed to understand studies from the field. This booklet steps of counseling and skills of fits into the toolkit. a good counselor. Takeaways 40 takeaways for men and Sahiyya Materials All the materials that the 40 takeaways for women that Sahiyyas have in their toolkit. Sahiyyas leave behind after counseling, with information about contraceptive choices for men and women separately.
Behavior Change Communication: Jharkhand 59 DEMAND GENERATION FOR FP SERVICES
BCC strategy and campaign for provides low-income families with a critical importance to improve service Sambhav Voucher Scheme set of coupons, given by ASHAs or utilization throughout the private Many FP and RCH services are Sahiyyas, to obtain free FP and RCH sector. not available or are inaccessible services from designated providers. to vulnerable populations through The government reimburses private There was a need to increase the public healthcare system, and healthcare providers for services awareness, access to, and use of FP often, poor families are forced to performed under the scheme on a and RCH voucher services through seek services from a costly and previously agreed fee schedule, and private providers through demand unregulated private sector, causing monitors services to ensure generation BCC and more effective severe economic distress. This is a high quality. client–provider IPC. major barrier to accessing services for the most vulnerable populations. Effective IPC between healthcare Strategic Approach and The rate of healthcare service seeking providers and clients further impacts Objectives: Develop and deliver through private health providers healthcare seeking and service demand generation activities for BPL in Jharkhand, as in all of India, is utilization, and is recognized as one populations to increase healthcare high, with over two-thirds of the of the most important elements seeking and service utilization through population seeking private services. for improving client satisfaction, private healthcare providers using the adherence and health outcomes. voucher scheme. The voucher scheme allows the Effective IPC also benefits the Generate demand for use of government to reduce the financial healthcare system as a whole by the FP voucher scheme through burden of the poor when they making it more efficient and cost- increased awareness and access services in the private sector effective. Thus, clients, providers, knowledge. by linking vulnerable groups to administrators and policymakers Generate demand among BPL critical FP and RH services free of all have a stake in improved client– populations for the use of the FP cost at accredited private health provider interactions. Effective IPC voucher scheme through private centers. The voucher scheme was therefore determined to be of healthcare facilities by increasing knowledge and awareness, and increase use of services for: No-scalpel vasectomy (NSV) Female sterilization IUD Injectables Condoms OCPs Standard Days Method. Improve effectiveness of IPC and build counseling skills of Sahiyyas, ANMs and AWWs.
Audience Couples with one or more children Couples who have reached their desired family size and wish to have no more children
60 Behavior Change Communication Activities and Achievements Mothers-in-law and other key decision-makers within the household Service providers in the public and private sector.
Duration: 2008–2010.
Interventions and Activities Completion of a communication needs assessment to analyze: access to information on FP (methods, importance, use, benefits and barriers); knowledge about availability of FP services; preferred source of services and products, and reasons for preferences; retention of visuals and identifying intended beneficiaries; motivating factors and messages; Training healthcare staff at barriers to FP service access cultural relevance of visuals accredited private hospitals and adoption; and messages; and on quality standards; identifying myths and appropriateness of type of establishing a financial misconceptions related to FP materials: visibility, ease of disbursement system methods; and handling, portability and ease for advancing funds and preferred and available of material dissemination and reimbursing private hospitals channels of communication. storing. for voucher services; Testing of existing voucher Capacity building training on IPC managing project management scheme, demand generation for Sahiyyas, ANMs and AWWs information system (MIS), materials from Uttarakhand with semi-annual meetings for conducting periodic quality including flipbooks, leaflets and problem-solving and sharing audits, and seeking beneficiary posters to determine if materials of best practices and lessons feedback; and were relevant or adaptable to learned. disbursing and managing Jharkhand based on: Develop a Voucher Management incentives given to Sahiyyas, comprehension and appeal Agency (VMA) to manage and the reimbursement of messages, flow of content, the scheme with responsibilities of transportation costs to and visuals; of: beneficiaries.
Behavior Change Communication: Jharkhand 61 MID-MEDIA STREET PLAY CAMPAIGN
Under the IFPS project supported children. In doing so, it addressed trigger an emotional response in activities in Jharkhand, special efforts several FP/RH topics, including the the audience, make them realize, to increase the awareness and demand ideal age of marriage for girls, delaying contemplate and move towards for FP and RH in the state have been the first child, the benefits of spacing change. This was accentuated initiated. Under this initiative, the state children three years apart and limiting with the use of local folk tunes, empaneled troupes were trained in family size to two children. The play themes, songs and background performing a street play on FP and examined the health, economic, effects. RH, that was based on BCC and EE quality of life and relationship The play discussed the ideal age approaches. The program involved consequences that resulted from the of marriage for girls, delaying the eminent Darpana Academy of FP decisions made by each family. first child, benefits of spacing for Performing Arts, headed by Dr. Mallika three years and limiting family size Sarabhai (Indian Classical Dancer Audience: Men and women of after two children (be it girls or and social activist from Ahmedabad, reproductive ages in tribal districts boys) by comparing two families Gujarat) to train the troupes and and community influencers. — one with lots of children and perform over 150 shows in the three other with just one child. In doing districts, namely Simdega, Giridh and Interventions and Activities so, they see the impact of too Chaibasa, which were identified by the Six troupes were trained, many children, closely spaced state to implement the interventions of which four troupes were on economic condition, quality and conduct the folk plays. The trained selected to conduct shows at of life, inter-spousal relationship state folk troupes performed similar the village level. The play used and the health of the woman and plays in other districts through the EE approach which states child. The audience was shocked NRHM funds. that communication can bring when the woman with her sixth about a change in attitudes and child screams with labor pains Strategic Approach and perceptions if it caters to the head and is taken through the audience Objectives: The street play and the heart. Thus, more than by the other characters, and compared two families: one with only informing or creating awareness, even more when they hear the one child and the other with many the messages or events or stories baby dies during delivery. The audiences contemplate their own lives, when the father of the dead child realizes he should have listened to his wife and adopted a contraceptive method long time ago. Post-performance discussions and exit interviews aided in checking if the audiences understood the key messages.
Duration: The street plays were performed in the months of April and May 2011 each, drawing about 250 spectators including men and women of reproductive age, family elders, adolescents and children. Being the summer season and agriculture having
62 Behavior Change Communication Activities and Achievements taken a back seat, more men turned than 40 percent of informants entertaining and 100 percent up to watch the shows. It was very heard announcements on educational. well appreciated by the state. microphones on the troupes’ The play was seen as different due vehicle. to use of puppets (58.3 percent) Results: Over 87 percent recalled theme and songs before and within the An impact assessment was conducted of the play as FP and over 60 story (34.4 percent). in November 2011, seven months percent recalled them as benefits The play was acceptable, relevant after the intervention, using a quasi of a small family. and believable (over 96 percent) experimental design, where the Over 60 percent recognized the and 67.4 percent found close to respondents were men and women of impact of large family size on life. different parity (experimental villages health of the mother and child 92.1 percent discussed with were the ones that were exposed to and family finances. Characters their spouses and 78.4 percent the play (452 interviews and control recalled included woman with encouraged their friends and villages=284 interviews). The findings one child (69 percent), doctor neighbors to adopt FP methods were: (55 percent), narrators indicating that the message Of the total, 57.7 percent were (50 percent), puppets as children of male participation and aware of the play and 46.5 (40 percent) indicating high recall. inter-spousal discussion were percent attended the plays. More 92.6 percent found the play internalized.
Behavior Change Communication: Jharkhand 63 LESSONS LEARNED AND PROMISING APPROACHES
Lessons were learned through the and complimentary delivery Strategic BCC planning that development of the Jharkhand BCC approaches — such as state follows proven models of Strategy, and findings from the level mass media promoting health communication and evaluation of healthcare seeking services through ASHAs, includes a situation analysis, practices of special populations and a community level folk communication objectives, indigenous to Jharkhand, as well as performance demonstrating priority areas for focus, and from the formative assessment of ASHAs’ skills — can effectively training and capacity building voucher scheme materials. reinforce messages to intended of key healthcare providers in A collaborative, inclusive and audiences. facilities and communities; and participatory approach is critical This was demonstrated consideration and strengthening to the adoption of programs and through the state strategies of operational capacities can be services for specific populations developed and implemented a very effective approach for where social and cultural factors in both Jharkhand and UP. comprehensive and coordinated heavily influence behavior at all BCC. levels. BCC activities implemented in BCC development through Individual campaigns or isolated Jharkhand highlight the unique a collaborative, integrated approaches are less effective than needs and opportunities for health and coordinated process activities stemming from a broad, behavior change. Through strategy that includes multiple levels evidence-based, data-informed development, intervention delivery of stakeholders in the public strategy. and evaluation, several promising and private sectors, and BCC programs that integrate approaches for effective BCC were representatives from special health topics, BCC messages demonstrated in Jharkhand. populations can successfully empower communities and healthcare providers to develop and deliver the most culturally and socially relevant programs. Audience segmentation and tailored intervention delivery mechanisms to segmented audiences is necessary to reach communities that are diverse and may pose additional challenges, such as tribal populations in Jharkhand. Capacity building of ANMs and ASHAs who are the only health service providers accessible to some tribal communities, and training and inclusion of traditional healers in
64 Behavior Change Communication Activities and Achievements service delivery plans WHAT WORKS effectively demonstrated this approach. Collaborative, coordinated approaches to BCC strategy development. Empowerment of frontline Inclusion of special or at-risk populations in BCC development. healthcare providers such as Consideration of unique cultural and social factors in barriers and private doctors, ASHAs, ANMs behavior change interventions for healthcare service usage. and master trainers through Tribal populations may have needs and opportunities not capacity building, and the previously explored. provision of culturally appropriate Demand generation for healthcare services in tribal communities tools can effectively increase relies upon well-informed solutions. knowledge, generate community Empowerment of frontline healthcare providers is key to effective demand, and improve healthcare BCC. service utilization. Well-trained and well-equipped frontline workers in the private EE approaches work very well in and public sectors can increase demand for FP healthcare products designing impactful messages and and services. content that provide information EE approaches to story telling. and also touch people emotionally and psychologically.
Behavior Change Communication: Jharkhand 65
SECTION 4
Behavior Change Communication The Power of Innovations and Uttarakhand Partnership
Section 4 Uttarakhand BEHAVIOR CHANGE COMMUNICATION
MASS MEDIA
nstitutional Delivery Campaign Increased knowledge of birth I Based on a formative research danger signs and complications. study conducted in 2006, it was found Increased knowledge of birth that populations in Uttarakhand preparedness and birth planning. prefer home deliveries. Rates of Increased awareness of and women delivering in an institution confidence in ASHAs in delivering and delivering with a trained health BCC for FP and RCH services; and professional are lower in Uttarakhand BCC materials that utilize than in India overall. appropriate language, cultural and social representations. TABLE 12: NFHS-3 DATA ON BIRTH DELIVERY (INDIA AND Audience: UTTARAKHAND) Primary: Couples of reproductive age NFHS–3 Uttarakhand All (2005-06) India and newly married couples. Secondary: Births delivered in 32.6 38.7 a health facility percent percent Mothers-in-law or elder women, and women heads of Births delivered 38.5 46.6 practice is that institutional deliveries households. by a trained health percent percent are chosen in case of emergencies professional Healthcare providers, or when a dai refers the family to a specifically ASHAs, ANMs and hospital or health center due to birth hospital staff. In mid-hill and upper-hill regions, complications. accessibility to service delivery points and faith in TBAs (dais) are Strategic Approach and TV Airings key determinants for home delivery Objectives: Through mass media, preference over institutional promote the benefits of institutional Doordarshan 12 times daily delivery. In the lower plains, low births, focusing on increasing delivery cost of delivery at home, coupled in the private sector through: TV-100 4 times daily with a home-focused environment Increased awareness and Sahara Samay 4 times daily and faith in dais are key factors utilization of the JSY which for preferring home delivery to provides incentives for ETV Uttarakhand 4 times daily institutional delivery. The general institutional delivery.
Behavior Change Communication: Uttarakhand 69 69 Duration: Aired in September 2007, Develop IPC materials for and was repeated between January– community healthcare workers. March 2009. Develop folk media scripts and mass media TV or radio spots: Interventions and Activities: A media plan was developed Identify a campaign promise and to ensure high reach and benefit: “Enroll yourself today frequency for key audiences. in the JSY program and ensure Provide the spots to the a safe, secure and affordable3 Uttarakhand Health Society environment for delivery of for airing on TV and radio, and your baby”. printed materials for distribution. Develop samples of creative ideas for printed materials including Results: brochures, calendars, posters, The materials and media plan were stickers and “Q” cards illustrating provided to the Uttarakhand Health the JSY program and how to Society. TV spots were aired 24 times access the program and its daily on national and regional channels benefits. during the promotion period.
3 Affordable: The JSY program is meant for BPL families, but the program does not exclude non-BPL families in delivering a baby at public health facilities.
70 Behavior Change Communication Activities and Achievements CHILDHOOD IMMUNIZATION CAMPAIGN
Rates of childhood immunization TABLE 13: NFHS-3 DATA ON IMMUNIZATION for any illness in Uttarakhand are (INDIA AND UTTARAKHAND) generally better than rates for all NFHS-3 (2005-06) Uttarakhand All India of India. On the other hand, there are almost twice as many children BCG vaccine for TB 83.5 percent 78.1 percent in Uttarakhand that do not receive Polio 0 (at birth) 51.8 percent 48.4 percent vaccinations compared to India Measles 71.6 percent 58.8 percent overall. However, the higher rates of Full vaccination 60.0 percent 43.5 percent full and disease-specific vaccinations No vaccination 9.1 percent 5.1 percent for Uttarakhand children highlight the importance of initiating the immunization cycle and increasing Secondary: A media plan was developed the potential for disease-specific and Elders in the family, and village to ensure high reach and full vaccinations for healthier children influencers including religious frequency for key audiences. across the state. leaders, ANMs, ASHAs and Provide the spots to the AWWs. Uttarakhand Health Society Strategic Approach and for airing on TV and radio, and Objectives: Develop a communication Duration: Launched in September printed materials for distribution. strategy that focuses on reducing high 2007 and repeated between January– vaccination dropout rates and achieving March 2009. Results: The materials and media plan 100 percent routine immunization in were given to the Uttarakhand Health Uttarakhand by: Interventions and Activities: Society. TV spots were aired 24 times Promoting “full immunization” Identify a campaign promise and daily, nationally and regionally during for children before their first benefit: “If you have fully immunized the promotion period. birthday. children, you will join the family of Encouraging every parent to proud and responsible parents whose finish a series of vaccine visits children are protected against six at health centers or a place killer diseases”. where immunization services are Develop samples of creative ideas provided before the first birthday for printed materials including of the child; and brochures, calendars, posters, Improving image of the health stickers and “Q” cards to increase workers who administer vaccines access to the program and its among parents and communities. benefits. Develop IPC materials for Audience: community and facility healthcare Primary: workers. Caregivers (fathers and Develop plans for outreach mothers) of children under activities to increase attendance 12 months, 18–30 years, living at public health facilities on in rural and urban areas who immunization days. have not fully immunized their Develop folk media scripts and children. mass media TV or radio spots.
Behavior Change Communication: Uttarakhand 71 MULTIMEDIA CAMPAIGN
SAMBHAV VOUCHER SCHEME– BCC STRATEGY AND MULTIMEDIA CAMPAIGN In Uttarakhand, existing health services are underutilized, facilities are understaffed and under-equipped and accessibility to healthcare products and services is a major challenge. This environment, compounded by a geographically challenging landscape, present problems to improving health in the region. The Sambhav Voucher Scheme was developed to reach vulnerable populations with free of cost health interventions. The voucher offer a choice of service providers percent of the state’s rural population scheme links vulnerable groups to to members of the community; and have a large presence of private critical FP and RH services by providing and providers, which are nearly absent in quality products and services to BPL expand services across additional the upper Himalayan regions of the families free of cost at accredited health areas, and in geography. state. Scale-up, as discussed below, private health centers. ASHAs provide has been carried out in two phases: vouchers for services including The voucher scheme in Uttarakhand October 2009 to March 2011 and sterilization for men and women, OCPs, was originally piloted in Imlikheda April 2011 to March 2012. condoms, IUCDs, institutional delivery, and Bahadrabadd blocks of Haridwar ANC, PNC, and newborn care. district between May 2007 and March Strategic Approach and Families then take vouchers to nursing 2009, where rates of institutional Objectives: homes/private hospitals for quality deliveries and childhood immunization This integrated campaign included services at no cost. Involving both are among the lowest in the state. conducting a formative study, public and private healthcare providers Less than one-third of women deliver developing the BCC strategy, in the implementation of the voucher babies in a health facility, less than designing a 360-degree campaign, and scheme encourages competition, while 10 percent of women receive full providing technical assistance to the maximizing healthcare quality and access ANC, and less than one-quarter state to implement this effectively. to beneficiaries. of children are fully vaccinated, so it was important to expand access Audience: Couples with one or The voucher scheme aims to: to healthcare to communities in more children enhance RCH services and Haridwar.4 Building on the pilot coverage among BPL populations. voucher scheme in two blocks of Couples wishing to have no more provide access to quality Haridwar district, the Government of children healthcare services for mothers Uttarakhand decided to expand the and children of BPL families. approach to 38 blocks in five districts: Mothers-in-law and other influencing establish a system for accrediting Almora, Dehradun, Haridwar, Nainital family and community members healthcare facilities and ensuring and Udham Singh Nagar. These quality of care. districts encompass more than 50 Service providers in the private sector
4 Haridwar Baseline Survey 2006: Imlikheda and Bahadrabadd Blocks (Constella Futures, June 2007)
72 Behavior Change Communication Activities and Achievements Key implementing partners and The strategy focused on segmenting decision-making level stakeholders. audiences and reaching them through multiple activities to reduce Duration: Pilot: May 2007 – barriers, focusing on enabling factors, March 2009. and using positive deviants to create a ‘chain reaction’ of behavior change. Scale up in two phases: October 2009 Through proper harmonization to March 2011 and April 2011 to of interpersonal counseling, March 2012. community-based health facility level and mass media campaigns Key Interventions and Activities: and activities, individuals (at A. Formative Assessment: A different life stages) were exposed formative assessment was done to multi-layered opportunities to in 2010 to gain an appreciation understand, observe and practice on issues of concern. The the recommended FP/RH behaviors communication needs and seek services under the scheme. assessment was conducted to map knowledge, attitude and behaviors C. Multimedia Campaign: Based of BPL families with regard to their on this BCC strategy, a multimedia utilizing of services for FP and campaign was developed to institutional delivery, both of which address the following: are offered in the Sambhav voucher increase adoption of positive scheme. The assessment mapped health behaviors related to FP/ potential barriers among BPL families RCH and increase in positive to accept and utilize these services attitudes towards these offered in the scheme, along with increase awareness and their media consumption patterns. knowledge about the Sambhav A qualitative research study, utilizing voucher scheme, including focus group discussions and in- processes involved, services depth interviews with respondents available, facilities offering from BPL families and health service these services and the brand providers was conducted. among BPL families increase the utilization of the B. BCC Strategy: Based on Sambhav voucher scheme by the needs assessment, a BPL families for FP, as per life comprehensive BCC strategy stage needs was developed and handed over change in attitudes of family to the state. The strategy used a elders and other influential range of communication theories leaders regarding spacing and and models, namely the Pathways limiting childbirth; and Health Competency Model for strengthen the capacity of social and behavior change, the service providers in client– Trans-Theoretical Model of provider interaction. behavior change, the Orbit of Influence to understand social The BCC campaign used multiple, influencing factors and McGuire’s reinforcing media channels to Hierarchy of Effects to design the disseminate messages to intended media-mix for the program. audiences including IPC by ASHAs,
Behavior Change Communication: Uttarakhand 73 ANMs, other healthcare providers developed on the Voucher Scheme and influencers within the family and to be displayed as a mid-media level community; community media at the activity such as in mobile vans or in village level to ensure localization of the waiting areas of the health facility. activities and messages; facility level This film contained the details about media to improve service related the scheme, how to avail vouchers, transaction and mass media to inform processes involved, details about and shape social norms. This media the vouchers, how it can benefit the mix is based on media consumption clients, etc. This film incorporated patterns in each state, key points a television shopping program of contact, and the strengths and treatment that reinforces the key shortcomings of mediums. motivating propositions of the scheme in different ways. Campaign Tag Line: Coupon Lao, Sehat Pao (“Get the Coupon, Get Scrolls for local cable TV: a Healthy Life”) was a rhythmic, Animated scrolls at the bottom of motivational slogan subliminally aimed the television screen were developed to convey the message that changing to be displayed through local cable times call for changing attitudes to network channels. These ads were healthcare, and that the quality of life district specific, providing contact branding materials. Thus, tin plates is very important for the happiness details of the hospitals accredited and posters were developed and and health of the entire family. under the Voucher scheme. placed at different locations in the hospitals. Campaign Materials: Branding materials for Mass media: One TV and radio accredited nursing homes and Outdoor mid-media: Hoardings commercial that tracked a young hospitals: A range of branding and wall paintings were displayed couple using the multiple vouchers materials was developed to highlight at strategic locations in the town according to life stage in a catchy folk the Sambhav brand and the scheme. and cities where the scheme was jingle was developed. It aired on state This was after the findings from a implemented. level TV and radio channels. These TV rapid assessment in Uttarakhand in and radio commercials were also used 2010 that indicated that the brand IPC level materials: Community as display content during health fairs was not recognized. In addition, level workers and health promoters and other events. it was necessary that the clients used materials to provide more detail become familiar with the entire about the scheme. They included a Film on the Sambhav Voucher range of coupons available for the flipbook, leaflets and a directory of Scheme: A 10-minute film was services offered by the program from accredited nursing homes and clinics.
74 Behavior Change Communication Activities and Achievements ADOLESCENT HEALTH CAMPAIGN
The Government of Uttarakhand, build skills and capacity, and services for adolescents based on through the Himalayan Institute of empower parents to tackle their needs. Health Training (HIHT), developed barriers that make it difficult for and delivered a life skills education youth to access services; Audience: program for youth. This presented increase service usage at Youth 14–19 years the IFPS project with a unique adolescent-friendly clinics by Rural, school going and out-of- opportunity to enhance the existing setting standards and expectations school adolescent boys and girls HIHT youth program by adding for quality; Married adolescents. messages addressing issues of health, build capacity of healthcare hygiene, choices about marriage providers to improve service Duration: Pilot August 2009–May and childbirth, and education. delivery in adolescent-friendly 2010. Scale up: June 2010–March Utilizing HIHT’s training module clinics; and 2012. format, youth could be reached with establish a convergence of BCC messages on these important stakeholders in providing a Interventions and Activities: topics. To accomplish this, the comprehensive package of Formative Study: A formative study Understanding and Delivering to was undertaken to understand the Address Adolescent Needs (UDAAN) The UDAAN Campaign communication needs, aspirations and program was developed. The pilot role models of the adolescents. was implemented in five blocks ‘Taiyaar Ho’ (Get Ready) of each of the five districts. In the BCC Strategy: An integrated scale up, the state included all the This inspirational campaign campaign and related materials to blocks within the five districts of motivates adults to help advocate for adolescent needs and Uttarakhand. adolescents get ready for a rights, inform adolescents about healthy, successful and bright healthcare, inform caregivers about Strategic Approach and future. Materials display youthful their role, increase demand for Objectives: To make healthcare animation, and use bright colors adolescent services, and change services more accessible and depicting energy and vigor. attitudes of adolescents, caregivers acceptable to youth by building skills and service providers towards and capacity, and empowering adolescent health. youth to: increase utilization of services Peer Group Educator’s Toolkit: A in adolescent-friendly clinics and comprehensive toolkit was developed counseling centers; for peer group educators to conduct improve health by positively over 150 hours of interactive impacting behaviors such as workshops/sessions with out-of- consumption of weekly iron school adolescents. The kit contains foliate supplements, and improved materials, games, reference materials menstrual hygiene for girls; etc. on the following key areas: reduce unhealthy high-risk Marriage and FP behaviors through empowerment Awareness of disease and for abstinence from smoking, vaccination drinking and sexual activity; Hygiene practices delay age at marriage for boys Utilization of health services and girls; School going habits reduce school dropout rates; Personality issues.
Behavior Change Communication: Uttarakhand 75 BCC Multimedia Campaign: An Twenty-five different types of Results: The BCC strategy and integrated campaign was developed materials were developed, including campaign materials were handed over that reached adolescents, caregivers interactive board games, storybooks, to the Uttarakhand Health Society in and service providers at multiple healthy lifestyle booklets, leaflets, May 2010. Stakeholders were trained contact points under the program. dispensers for socially marketed in using these materials effectively. Mass media was not part of this products, posters, banners, letter The state invested money from the campaign, given that the program was boxes, referral cards, and birth NRHM PIP to print and distribute implemented in only five districts. preparedness kits. these materials to the five districts.
76 Behavior Change Communication Activities and Achievements CAPACITY BUILDING
Training and Tools for the ASHA-Plus Scheme The NRHM aims to employ one ASHA for every 1,000 people, however, given Uttarakhand’s hilly terrain, houses are distant and sparsely situated, and health services are difficult to access. Because of these unique challenges, under the ASHA-Plus program in the state, each ASHA serves only 500 people. Additionally, in Uttarakhand, there is very low media access, and a highly trained and well-equipped ASHA may be the only skilled healthcare provider available to many households. It is critical that ASHAs in these regions capacity among ASHAs, the primary Audience: ASHAs in Uttarakhand. receive enhanced training on FP and and at times only trained healthcare RCH products and services, and be provider accessible by communities, Duration: well-equipped with tools for effective and equip ASHAs with tools to Pilot phase: 2007–2009. IPC, health needs assessments, and improve health of women and referrals to hospitals or clinics. To children by promoting: Scale up: Began in 2009. deliver services through ASHAs with improved healthcare seeking enhanced training and tools, the behaviors among pregnant women; Interventions and Activities: Government of India called for the institutional delivery through the The ASHA-Plus program was piloted scale up of the ASHA-Plus scheme in JSY; in two blocks of Uttarkashi (Bhatwari Uttarakhand. improved home-based newborn and Purola), Chamoli (Karnaprayag care; and and Joshimath), and Pithoragarh Strategic Approach and routine immunization for children. (Munsyari and Munakot) districts. Objectives: To build increased Build increased capacity One of the major components of this among ASHAs to deliver program was the in-depth training effective BCC through IPC of the ASHA-Plus workers on IPC, on hygiene, sanitation and health interventions and community nutrition. mobilization. Build increased capacity A baseline survey was among ASHAs to effectively conducted in the six pilot facilitate group meetings on blocks and three non-ASHA- priority health issues, and Plus blocks to generate develop effective linkages with estimates of healthcare health program managers and knowledge, awareness, access PRIs. and identify gaps for training. Revitalize the Village Health Based on these findings, an and Sanitation Committee ASHA-Plus training model and (VHSC) with support of curriculum was developed: ‘Now we are recognized in the village. People have ASHAs, supervisors, ANMs The training followed a faith in us and depend on us for their health services’. and AWWs. participatory approach with
Behavior Change Communication: Uttarakhand 77 interactive discussions, Given the limited access to healthcare Monthly reporting formats group activities and group resources in Uttarakhand, and the and Supervisor and Block work, demonstrations and great need for services by ASHAs, Coordinator monitoring role plays, and audio-visual the ASHA-Plus scheme provides the formats were developed; presentations. flexibility, enhanced training, and job Household survey formats Implementing communication aids needed to support an enhanced were developed and were activities, and developing level of health services. Unlike the conducted by ASHAs in their communication materials ASHA, the ASHA-Plus worker uses areas. were part of the training to simplified and more illustrative Software was developed for encourage ASHAs to be self- training materials and job aids such MIS; with social mapping reliant. as flipcharts on FP and RH choices, and ELCO mapping done by The training materials and to help perform their work. Further, ASHAs for their coverage curriculum leveraged existing the ASHA-Plus worker is supported area. health training materials by a robust MIS that streamlines the On an ongoing basis, the ASHA and curricula from the workflow. recruitment process, training Government of India. Content process and operating systems included training the ASHA Results: Through the pilot program, are documented to enhance the in the life cycle approach and 571 ASHAs were trained. The program. life skills education to identify Uttarakhand Health and Family needs of families and provide Welfare Society recognized the Analysis of quarterly performance prioritized, need-based, client- higher quality of healthcare provided reports continually finds centered services. by ASHA-Plus workers and began improvements in healthcare A cascade training model was replicating the model across all 13 knowledge, awareness, access and developed where master trainers, districts. outcomes of the ASHA-Plus delivery supported by representatives A robust MIS was developed that process. MIS data show a steep from the state and district health included establishing a Technical increase in indicators related to departments, and NGOs were Advisory Group to review early registration of pregnancies, trained by an independent agency, program implementation. institutional deliveries, immunization who then trained select ASHAs ASHAs were provided and improvements in other as master trainers in intervention registers for recording community issues like water, hygiene blocks. activities and sanitation.
78 Behavior Change Communication Activities and Achievements MOBILE HEALTH VANS
To increase access to health services Health Society desired to scale up the increase utilization of mobile in Uttarakhand, mobile vans were mobile health van program. van services by focusing on the deployed providing diagnostics, health benefits of the program. consultations, and FP products and Strategic Approach and Create a brand for the mobile services to communities with limited Objectives: To develop a van program that positions access to healthcare facilities. A communication strategy that focuses the van’s health services as communication strategy was needed on benefits of the mobile van program efficient, economical and of to scale up the program and service through a communication needs high quality. usage. Through community led assessment to: Strengthen capacity of service mobilization, usage of services from increase awareness of health providers and improve client– mobile health vans improved during services available through the provider interactions. the pilot program launched in the Ram mobile van program, including Strengthen skills of service Nagar block of Nainital district. Based information on schedules, costs, providers in IPC, community on this improvement, the Uttarakhand registration and medicines; and mobilization and advocacy. �������
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Behavior Change Communication: Uttarakhand 79 Audience: Mobile SMS alerts, Results: The mobile van initiative Primary: Married couples, loudspeaker messages, and was fully functional from December adolescents. one-page van handouts 2007 until April 2008, during which Community groups, street 273 camps were held, 15,558 clients Other: Family elders, community plays and puppet shows attended and received services in the opinion leaders and ASHAs. Counseling takeaways and camps, of which 67.4 percent were portable counseling materials women and 34.5 percent were from Duration: Branding: BPL families. Pilot phase: 2007–2009. Brand name and logo Van paintings Linkages with stationary public health Scale up: 2010. Merchandising facilities and regular follow-up visits Capacity strengthening materials have maintained the credibility of Interventions and Activities for van staff and ASHAs: services provided. In addition to Commission a communication Orientation programs medical services, the van staff has needs assessment to identify Training programs and trained village health volunteers in communication needs, and most refreshers. mobilizing members of the community effective channels to increase to seek RCH services, and to TABLE 14: FP/RCH SERVICES mobile van brand recognition, and provide BCC. ACCESSED (DECEMBER 2007 message recall and comprehension. – APRIL 2008) Based on the communication needs The Uttarakhand Health Society assessment, develop a branding and Service Clients replicated this model to scale up communication strategy and materials ANC 1,454 the program in 13 districts across to promote the program and increase OCP cycles 1,908 the state. service uptake. IUCD 237 Advocacy and awareness communication materials Condoms (10-pack) 5,406 developed: Sanitary napkins 1,473 Posters, wall writings and Total RCH Clients 5,566 (36 percent paintings of total turnout)
80 Behavior Change Communication Activities and Achievements LESSONS LEARNED AND PROMISING APPROACHES
Social customs adhered to by families and community gatekeepers present WHAT WORKS unique barriers to programs that seek to increase uptake of services. Communication needs Barriers must be understood through assessments for unique formative assessments, and can be audiences and populations. addressed with participatory and Normalizing and positive role collaborative approaches. models motivate audiences to adopt a positive behavior. Challenges remain in efforts to increase access to healthcare Audiences understand products and services in key economic benefits, both populations. short and long term, thus, campaigns need to explore Services are inadequate to address the perceptions, these routes. barriers and needs of youth. Fixed dates and service delivery points establish Providers are ill-equipped to address the needs of youth. credibility of services, and can be effective BCC. Before scaling up programs, pilot Scaling up pilot programs is programs can provide useful most effective if assessment, monitoring and evaluation are information with fewer resources. communication needs where components throughout the This was demonstrated in the traditional channels did not exist. design, development, training successful scale up of the mobile van Communication needs and implementation process. program, and re-design of voucher assessments are critical to the scheme communication materials development of communication that were needed as a result of strategies for specific audiences loudspeaker announcements and implementation before the pilot that may be difficult to reach, such van paintings. assessment was completed. as healthcare providers in remote The rapid assessment of the areas, or adolescents. Existing and accepted structures can voucher scheme demonstrated be utilized to expand or enhance the need to reduce text, increase Through capacity building, providers healthcare capacity among critical visuals, and portray local of healthcare services themselves can participants or audiences, effectively representations of people in be very effective media channels for leverage resources, and increase communication materials. communicating programs and services stakeholder participation. when other communication channels Develop training modules for Through the development of strategic are poor or non-existent. youth that expand on youth BCC campaigns for key health issues IPC modules delivered by HIHT. in this unique region of India, new Positive client–provider interactions Enhance skills of ASHAs through the insights were gained in addressing Mass and mid-media, such as expansion of the ASHA-Plus scheme.
Behavior Change Communication: Uttarakhand 81
REFERENCES AND LIST OF RESOURCES
Section 1: National Level Proposed BCC Plan of Action for FP for the NRHM for July 2009–March 2010 BCC Plan of Action for FP for the NRHM for July 2009–March 2010: Phase Matrix National IEC Workshop Report NRHM Advocacy Film Proposal by Relative Media MCH-STAR Evaluation Top Line Findings Presentation MCH-STAR Evaluation Atmajaa Proposal Study on Assessing the Visibility, Comprehension and Recall of TV campaigns aired under the NRHM
Section 2: Uttar Pradesh (many of these resources can be found at: www.sifpsa.org) BCC Strategy for the NRHM in Uttar Pradesh Interview with Rita Banerjee Interview with Geetali Trivedi Background document on the ASHA Newsletter ASHA Newsletter Presentation Rapid Qualitative Assessment Key Findings Mid-Term Evaluation Report: Radio Drama Series Project Management Unit Guidelines for Sterilization Interviews with SIFPSA staff PAC Presentation (PowerPoint) Kumbh Mela PAC Project Summary Report SIFPSA Information Sheet
Section 3: Jharkhand Objectives of the Jharkhand BCC Strategy Development Workshop Presentation Health Communication Strategy Jharkhand Health Issues and Health Seeking Behavior of Tribal Populations Intra-Communication Workshop Report and Summary Proposal for BCC Vouchers, District Dhanbad; September 1, 2009 Proposal for BCC Vouchers, District Gumla-GN; August 6, 2009 Proposal for Jharkhand Needs Assessment
References and List of Resources 83 Section 4: Uttarakhand Proposal for BCC-Institutional Deliveries, Uttarakhand ASHA Training Program Implementation Framework Presentation ASHA-Plus Project: IFPS project Presentation November 26, 2007 Mobile Van BCC Plan-Uttarakhand ITAP Report September 3, 2009 Motivating Rural Communities Presentation by the Technical Advisory Group Vikalp Formative Research Pilot Report Communication Plan Mobile Van Formative Report BCC Strategy for Voucher Scheme in Uttarakhand Haridwar Voucher Scheme Rapid Assessment UDAAN BCC Plan-September 9, 2009 BCC Plan – Adolescent Health Presentation-August 8, 2009
84 Behavior Change Communication Activities and Achievements Photo credits: Jignesh Patel, Gaurang Anand and Satvir Malhotra
Suggested citation: IFPS Technical Assistance Project (ITAP). 2012. Behavior Change Communication Activities and Achievements – Lessons Learned, Best Practices and Promising Approaches. Gurgaon, Haryana: Futures Group, ITAP. Editing, Design and Printing The IFPS Technical Assistance Project is funded by the United States Agency for International Development (USAID) under Contract No. GPO-I-0I-04-000I500, beginning April 1, 2005. The project is implemented by Futures Group in India, in partnership with Bearing Point, New Concept Information Systems Pvt. Ltd. Sibley International, Johns Hopkins University and QED. Email: [email protected]
For further information, contact: Johns Hopkins Bloomberg School of Public Health, Center for Communication Programs, 111 Market Place, Suite 310, Baltimore, MD 21202, www.jhuccp.org; Futures Group International, DLF Building No. 10 B, 5th Floor, DLF Cyber City, Phase II, Gurgaon- 122 002 www.futuresgroup.com TATES S AG ED E T N I C N Y U USAID
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US Agency for International Development MARCH 2012 Behavior Change Communication The Power of American Embassy Activities and Achievements Innovations and Chanakyapuri Partnership New Delhi – 110 021 Lessons Learned, Best Practices and Promising Approaches INDIA Tel: (91-11) 2419 8000 MARCH 2012 Fax: (91-11) 2419 8612 This publication was prepared for review by the United States Agency for International Development. www.usaid.gov It was prepared by Futures Group International.