Integrated and Collaborative Approach Key for Impact on Health Behaviors

Digital Green has been working with Jharkhand State Nutrition Mission (JSNM) and the Department of Women and Child Development & Social Security, Government of Jharkhand to implement its USAID-funded project Samvad since 2016. The partnership aims to use Information and Communication Technologies (ICTs) to promote good practices in Maternal Child Health (MCH), nutrition and family planning among the rural community in a more accessible and scalable manner.

We worked with the Anganwadi Workers (AWWs) or frontline staff tasked with combating child hunger and malnutrition, building their capacities in video production and dissemination to create a set of locally relevant videos for the communities they work with. This exercise also helped us in mapping the key nutrition behaviours in consultation with JSNM and the implementation team at the block level including the Child Development Project Officer (CDPO) and AWWs. Each behaviour was further mapped on to the practices based on which technical content was developed by Digital Green.

Eight AWWs were trained on video production. We worked closely with them to develop storyboards based on their on-ground, first encounter experiences and relevant local contexts and beliefs to influence positive variance in the communities. They produced 15 videos.

This strategy of involving the staff at every level of the planning process helped integrate the project and approach into their systems.

We further planned the dissemination of these videos in a sequential manner among women of 1000 days cohort. 85 Picos were deployed on a sharing basis among 167 AWWs who were trained in dissemination (screening videos and moderating discussions). Each video is disseminated to a group of 20-25 beneficiaries every fortnight.

Over time, it was reported by the AWWs and lady supervisors that sequential video disseminations generated a lot of discussions, the turnout at the video screening started increasing and influencers such as the in-laws started attending the screening. Further, the AWWs reported that videos aided in explaining to the beneficiaries and their families important issues related to the health, nutrition and especially family planning in an easy, engaging and consistent manner.

At the initial screening of the family planning video the beneficiaries at my centre would smile and look down to avoid answering my questions, but after 2-3 video screenings they started asking questions and taking condoms, and contraceptive tablets from Sahiya Didi, shared one Anganwadi Worker.

The District Social Welfare Officer (DSWO) shared that, “Digital Green’s video-enabled approach has helped increase the attendance at the VHNDs in Patratu and helped in empowering Anganwadi workers.”

The DSWO witnessed the impact of videos on the direct beneficiaries and the subsequent rise in demand and was keen to support. She planned the distribution of 5,000 pregnancy kits aligned with the screening of the videos on ANC and Family Planning.

IVR-based Messaging Complements Impact of Video-based Health Extension

Deepa was pregnant for the first time and unsure about what’s the ideal diet and weight during pregnancy. I gave her the number of Samvad Mobile Vaani and told her to listen to the messages frequently. I also showed her the video on maternal diet on the pico projector,” shared Prabha Devi, Aanganwadi Sevika in Patratu block, Jharkhand, who disseminates community videos on health, nutrition and family planning topics and also advocates the use of Samvad Mobile Vaani.

Samvad (dialogue in Hindi) Mobile Vaani is an Integrated Voice Response (IVR)-based platform that allows communities to listen to relevant health, nutrition and family planning messages broadcast by the Samvad Project by just giving a missed call and receiving a call back from the system.

Digital Green’s USAID funded project Samvad aims to improve Family Planning, Maternal Child Health and Nutrition Outcomes across 6 states namely; Bihar, Chhattisgarh, Jharkhand, Odisha, Uttarakhand and Assam through the flagship human-mediated video-based approach.

Increased mobile penetration in rural India and available ICT solutions provide opportunities to adopt an integrated and comprehensive approach to increase awareness, achieve higher uptake of recommended actions by beneficiaries, create life-stage specific targeted messaging and increase overall reach. With this aim, Digital Green partnered with GramVaani in Jharkhand to employ their IVR-based social platform to complement our video-based outreach.

The messages on Samvad Mobile Vaani are a combination of drama, testimonials, infotainment directed to behaviour change and action. A unique element of the solution is that the platform allows two-way communication wherein the audience can hear the pre-recorded thematic messages and also record their own messages in response to what they are listening to and can also listen to messages recorded by others like them. These include their feedback, experiences, queries, additional and alternative best practices. The IVR messages reach men and women irrespective of the type of phone they own at zero cost.

In May 2018, we oriented 110 Aanganwadi workers (AWWs) in Patratu block to the use of the Samvad Mobile Vaani. These AWWs, in turn, oriented the community on the benefits and method of accessing this IVR platform and encouraged them to record their messages as well.

Since June 2018, over 10,600 unique callers have accessed Samvad Mobile Vaani about 156,626 times. We also conducted an IVR based survey with about 200 callers to analyze their profile. About 56% of the callers were women and 69% of them were younger than 28 years old. We also found that 69% of the callers were within the 1000-days period. This survey establishes that with Samvad Mobile Vaani we are able to reach audiences in a targeted manner through the help of Anganwadi workers (AWWs) who help deliver the solution to the target beneficiaries.

Callers have recorded over 2,500 messages which include queries, testimonials around various themes such as complementary feeding, IFA supplementation, care during pregnancy etc.

Family planning messages were accessed by over 4,600 callers about 41,000 times and they heard messages on the importance of family planning, spacing methods, spousal communication, and taking a combined decision of Family planning.

We are now evaluating the effectiveness of this solution and based on the results we will scale this across other states we’re working in. Preliminary findings demonstrate that this complementarity of ICT solutions is impactful.

Sharya Bano, Anganwadi Sevika from Jai Nagar, Patratu block narrates the experience of Salma Khatun, mother of an 8-month old child. She says, “Salma was not aware of the importance of a balanced diet for her child’s growth, as a result, her child was very weak. I showed her the video on complementary feeding and also shared with her the number of Samvad Mobile Vaani. She became a frequent listener and started following the practices suggested. As a result, her child’s growth has been very good and has gained weight too.”