Category: Reflections
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Short film on Digital Green (2014)
Kalavati Devi: Using Videos to Trigger Behavior Change
Contributed by Pallavi Lal
On a sultry summer afternoon, Kalavati Devi scurries around her house trying to finish all her chores in time to conduct a mothers group meeting at the Anganwadi center in Jeegon village, Rae Bareilly district of Uttar Pradesh, India. She has been working as an Accredited Social Health Activist (ASHA) under Government of Indias flagship National Rural Health Mission (NRHM) since 2008. ASHAs are frontline workers who serve as an integral link between the community and the health system, promoting key health behaviors and mobilizing the community to access available health services.
At half past noon, Kalavati reaches the center, where pregnant and lactating women, their mothers-in-law, sisters-in-law and a few kids are settling down for the meeting. Following the registration of new members and checking attendance, a video on exclusive breastfeeding is screened by Kalavati in the darkened room using a battery-operated Pico projector. She occasionally pauses the video, allowing for discussions within the group. There is constant murmuring in the room as the women recognize an actor (usually a local community member) in the video, which increases in volume when Kalavati herself appears on screen.
The screening is punctuated with questions from the women: Why do we need to feed the newborn within an hour of delivery?Why cant we feed the newborn with goat milk or jaggery? Kalavati handles these and other doubts with finesse. Towards the end of the screening, she encourages all the members, especially the silent ones, to share their experiences. The key messages from the video are summarized and reinforced to the audience. Though a few older women still cling to their cultural beliefs, which their families have practiced for generations, the video does succeed in triggering questions and generating a discussion. The session draws to an end with Kalavati leading everyone in a song that touches upon key health messages and reiterates the importance of maternal and neonatal health.
Parwati, a young mother, endorses the effectiveness of the approach: “We are now able to understand breastfeeding positions easily as these are conveyed explicitly through the videos. We are also able retain messages better through videos, as we are able to see and hear.
Kalavati is part of the Digital Public Health (DPH) pilot project, initiated in 2012 through a partnership between Digital Green, PATH and Grameen Vikas Sansthan (GVS). Leveraging Digital Greens model of video-enabled learning and mediated dissemination, the pilot promotes key maternal and neonatal health behaviors through ASHAs in 27 villages of Rae Bareilly.
DPH-led video screenings are mediated by ASHAs during monthly screenings at mothers group meetings and Village Health and Nutrition Days (VHNDs). Pawan Kumari, an ASHA from Churwa village, says Initially, I was very scared of using the Pico projector for the screening. I thought I would never be able to learn how to operate this technology, but with continuous mentoring and support, I am now able to use it with ease and confidence. The videos offer a medium through which ASHAs can promote health behaviors with ease and increased clarity.
Before this, ASHAs relied on verbal communication, games and print job aids such as posters, flip charts and flash cards to convey key health messages during mothers group meetings and on VHNDs. It was often difficult for them to remember everything that had to be communicated. They would often need to refer to prompters written behind the job aids, which would obstruct the smooth flow of the session. Now, conducting meetings using Pico projectors has become easier, and attendance has also improved. We have to speak less as the video does most of the talking but we facilitate the discussions around the video to address concerns and reiterate the messages, Indira Mishra, an ASHA from Sarura village recounts.
A Community Advisory Board (CAB), comprising members from diverse backgrounds and institutions, including the Department of Health, Women and Child Development and Panchayati Raj institutions is responsible for vetting the content and videos, as well as monitoring the pilots progress, challenges and lessons learnt at quarterly meetings. ASHAs too are included in the CAB, thus including voices from the grassroots, ensuring an inclusive approach to the delivery of health messaging. Playing dual roles of community member and representative of ASHAs in the CAB, Kalavati says I feel important when I am given the opportunity to share the same platform with high ranking officers, and my experience is respected and valued by the CAB. For approving the content and videos, she pays close attention to the language of the messaging in the video to ensure that it does not offend or hurt community sentiments.
Kalavati, Pawan Kumari, Indira Mishra and others like them have come a long way from the day they got appointed as ASHAs. They entered the frontline heath workforce with skeletal knowledge and skills and are now respected, confident, knowledgeable and experienced members of the community. With the introduction of DPH, the ASHAs have taken a leap in skill enhancement and consequently in effective delivery of health messaging. They are no longer seen solely as vehicles for the delivery of content, but are also being increasingly acknowledged for their contribution to the development of that content.
Sushila’s Story
By Nidhi Chakrabarty, Digital Green
During my field visit to a remote village in Bihar, I happened to meet a seemingly ordinary lady of extraordinary perseverance. Here’s her story.
Meet Sushila Devi, aged 30, mother of three, resident of Itaha village, Muzaffarpur district of Bihar, India.
Her husband, Ramanand Rai, works in a garage in Mumbai and earns around INR 5,000 per month. Sushila has two sons, aged 15 years and 14 years, and a daughter, who is 12. All three children study in Itaha Middle School; after school all of them help their mother out on their farm. Ramanand sends around INR 1,000 every month, which does not go a long way to support the family. Sushila dreams of her children growing out of poverty, and hence, her insistence on them attending school regularly.
Not having any land of her own, Sushila had taken 1 kattha (750-2000 square feet) of land on lease and grew seasonal vegetables, sharing half of the yield with the land owner and using the rest to feed her family, their only source of subsistence. In 2010, Sushila came in contact with the Bihar Rural Livelihoods Promotion Society (also known as JEEViKA), an organization that works toward social and economic empowerment of the rural poor. She bought a cow using a loan she took from the organization. With the money that she earned by selling the milk to a local co-operative, Sushila repaid the loan and took some more land (5 katthas) on lease. She began cultivating okra (bhindi), corn, and rice and sold the produce in the local market. Though she shares half of the yield with the owner, she still manages to earn INR 2,000 to INR 2,500 per month by selling the vegetables.
As a member of the Saraswati Self-Help Group (one of the many women’s self-help groups engaged with JEEViKA), Sushila has been regularly attending Digital Green-enabled video screenings on local best practices, videos that members of her community have produced and also helped disseminate. She regularly practices the farming techniques featured in the videos, for instance, making and using neemastra (natural pesticide made from neem) and ghanjeevamrit (liquid manure fertilizer). Sushila feels that although these techniques require more effort than traditional farming methods, she saves a lot of money she used to spend on seeds and pesticides. She has saved enough to pay for her fields to be watered regularly.
Today, Sushila is the proud owner of a one-room pakka house, built using her own savings, without any financial assistance from her husband or in-laws. Her aspirations haven’t ended with her own house nor has her determination to realize her dreams waned. She wants her three kids to grow up to be salaried professionals and help take their family out of the clutches of poverty. Sushila dreams of the day when she can confidently tell her husband to return from Mumbai for good and they can all stay together as a family forever.
Video screening in Sirbaa village, Rift Valley, Ethiopia
From the desk of Vinay Kumar, Chief Operating Officer, Digital Green
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We will adopt this practice tomorrow shout all 23 farmers, with a show of hands. They just finished watching a video that demonstrated how urea should be applied to improve the yield of teff. Their enthusiasm to adopt the practice as soon as the screening ended was a fitting end to a fascinating day with the community in Sirbaa.
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Sirbaa is a small village of Udee kabele in the beautiful Rift Valley area of Ada woreda, nearly 53 kms south-east of Addis Ababa, the capital of Ethiopia. The travel from Addis to Sirbaa presents a breathtaking panoramic view of green meadows along the road, though marred by thick fumes of carbon dioxide bellowing from heavy vehicular traffic. Along the way, we came across the familiar sight of 3-wheelers as in India. My colleague, Wondwossen, confirms that the 3- wheelers are from India and actually called Bajaj, eponymously named after the owner of the manufacturing company.
It was raining incessantly and I was wondering if we would be able to get any farmers to come for the dissemination. Finally, when we reached the village, there was no road to the venue. We thought wed trek to the venue but it was far and the ground too muddy and watery. Thanks to our driver Shobhit, who used his skills to navigate us through the dangerously muddy way, when we often felt that we could move no further.
Much to my surprise, the makeshift venue for the video screening was packed with farmers, despite the rain. A thatched hut was neatly converted into a studio. Farmers had brought wooden benches from their homes that were used for them to sit; they also used their shawls to cover the window and the doors to stop light from entering the hut. The Pico projector, a battery-operated device used to screen the video, was placed at just the right distance from the wall, where a white sheet was pasted to serve as a screen.
Degefa Mecha, a development agent and facilitator of the video, was trained a month earlier by Digital Green trainers in video dissemination skills and techniques. He started off, much like a professional, taking the attendance of the farmers present and talking to them about the videos they had seen earlier. He created a great environment conducive to discussion and learning. He screened the video stopping at several places using the remote, summarizing the key points and prompting a discussion.
The farmers seemed fully immersed in the session and asked several questions about the way urea should be applied. He not only answered all the questions but also encouraged farmers to respond and clarify doubts from one another. By the time the video was about the end, it was clear that the farmers had not only enjoyed viewing the practice but also learned it and were enthusiastically discussing it. Degefa was at ease with handling of the pico projector; he was also familiar with the practice and was able to ably respond to the questions that farmers asked.
I kept wondering what it was that made this dissemination so successful that all farmers were willing to adopt the practice. Was it a great facilitation by Degefa? Was it seasonal relevance of the practice? Was it the quality of the content in the video? Or was it that the video was screened to the right audience?
An interaction with the farmers shed light on all these questions. There were five model farmers in the group, and one of them was trained in video dissemination by Digital Green.
The facilitation was of good quality, but the farmers also felt that the practice shown was very timely. They could adopt it the very next day. I asked the group how they would get the urea and they said they had already procured it from the cooperative union and had it in their homes. What they learned today was its proper application. With regard to the content of the video, the farmers felt it was easy to understand.
How can we make this video better for you? They said it would be more effective if one of them featured in the film. I personally also felt that the video was more of a monologue and it would have been much better if the practice was presented as a dialogue between two persons.
A key factor that contributed to the willingness of all the farmers present to adopt the featured practice was that the practice was relevant and mattered to all the farmers – they were just the right audience for the screening.
Incidentally, all the farmers attending the screening were males.I asked them if it would make more sense to include their wives for these dissemination and all of them agreed it would really be great as their wives help them out in their farms. One of them also said their wives are the ones who do most of the work. Would they feel reluctant to ask questions and participate in the discussions in the presence of their husbands? No, that was true in the past. Times have changed now.
What I personally felt made the dissemination so effective was the detailed and timely feedback our staff (Wondwossen and Gudissa) gave Degefa in improving the dissemination session.
I would like to acknowledge the contribution of Gudissa who supports this woreda and thank Oxfam America for the good work.