Category: Reflections,Samvad

Communicating Best Practices

If there is anything that we have learned during this ongoing global crisis, it is the reorientation of our societal values. Now, more than ever, we link our own health, safety, and wellbeing with that of the larger community. It is times like this, where it is imperative to acknowledge the availability and access to proper health and nutrition services especially in rural and remote communities that are often risk-averse. Utmost importance must be given to strengthening these systems in place. 

Digital Green is an international development organization that harnesses the power of technology and grassroots-level partnerships to empower rural communities through the promotion of best practices in agriculture, health, and nutrition. Our community video-based solution has been a powerful digital tool in the hands of ground-level agents themselves to influence the adoption of these practices within these rural communities. 

In 2012, through a series of pilot projects in India and Sub-saharan Africa, we drew lessons from the global success of the community video-based solution in agricultural extension to also be adopted in health and nutrition projects. Samvad, which means ‘dialogue’ in Hindi, was a program started in 2015 to leverage the power of ICT enabled approaches to increase the adoption of an optimal maternal, infant, and child health, nutrition, and family planning practices among women in the reproductive age groups, particularly in the critical 1000 day period (from the time of conception to when a child is 2 years old). Project Samvad is funded by USAID and implemented by partners such as National Health Missions, and State Rural Livelihood Promotion Societies. This work is spanned across 6 states – Bihar, Chhattisgarh, Jharkhand, Odisha, Uttarakhand, and most recently, Assam. 

Unlike the adoption of agricultural practices which are evident when adopted, health and nutrition practices are not always physically verifiable. Digital communications tools and content, in this case, would have to be more nuanced with effective messaging. Best practices related to specific behaviors are dramatized so that the larger community can relate to it, and are disseminated in local languages and dialects. There is extensive research and contextual analysis carried out in order to understand local taboos, myths, and traditional community practices that are contrary to scientifically proven practices or alternatively that can be used in key messaging for better comprehension. The most impactful practices to share are identified in collaboration with researchers, and practitioners and by spending time in the field to understand challenges faced and the resources that the community can or cannot access. Some examples of the thematic areas shared through videos include – community feeding, mother’s diet, WASH, family planning. 

The dissemination of these videos happens in a systematic manner – they are logged in a content calendar and are shared in stages so as to acquaint community members and frontline workers and guide them through the adoption of practices.

These communications tools and approaches are the fulcrum of change in the community through the dialogues that they create to enable social behavioral change. Over the years, we have consciously worked with agricultural and health extension systems to ensure the ownership of our approach, and expand their reach and capacity of their interventions to impact behavior change at a human level.

A Hybrid Digital Approach

With increased digital penetration and the use of mobile phones in rural India, a comprehensive, hybrid digital approach that combines varied ICT-enabled solutions provides an opportunity to increase awareness, widen reach, and achieve higher adoption by the targeted beneficiaries. This model would also be more cost-effective, offering an advantage over the traditional system of mobilizing people.

The COVID-19 pandemic has greatly affected the availability and access to health and nutrition services and has brought out innate inequalities in the reach and quality of these services to remote communities. As a result, the hybrid digital model of communication was employed to mitigate these effects and strengthen health and nutrition services at the click of a button.

Community videos, widely used and known now, have been shortened and disseminated via Whatsapp, and other ICT solutions such as IVR (Interactive Voice Response) for audio messages, and Chatbots have complemented the video-based outreach to reach ground level agents of change at any point of time. The ‘Samvad Mobile Vaani’, for example, is the free-of-cost IVR-based platform that allows communities to listen to health, nutrition, and family planning messages just by giving a missed call and receiving a call back from the system. The two-way communication that this platform provides is unique wherein the audience can hear the pre-recorded message and also record their own in response to what they are listening to. This can include feedback, queries, and even sharing experiences.

One successful example of this has been with Salma Kathun, a mother of an 8-month-old child in Jai Nagar, who was not aware of the importance of a balanced diet for her child’s growth, as a result of which her child was very weak. When Sharya Bano, an Anganwadi worker showed her a video on complementary feeding and shared the Samvad Mobile Vaani number with her, she became a frequent listener and started following the practices suggested. Since then, her child’s health has improved, and has gained weight as well. 

Phone Survey to Assess the Effectiveness of a Hybrid Approach

After one and a half years since the pandemic, Digital Green conducted a phone-based survey to gain insights into the utility and the merits of a combined hybrid approach with varied communications channels. This was also conducted to get a better understanding of the implications of COVID-19 on the health and nutrition in these communities, and the training and knowledge of frontline workers about their roles and responsibilities. 

The survey found that the reach of the various mediums of communication was higher for women, standing at 88% compared to men which were at 62%. All digital tools used to disseminate messages to the community are targeted towards both men and women as in most cases, men of the household have had singular access to mobile phone devices.

Given the vitality and influence of frontline workers, the survey found that community exposure through non-digital mediums was much higher – over 77% of community members have been made aware of these digital tools through frontline workers. Since exposure through frontline workers is higher, we have focused on their capacity building to enable them in using digital tools for sharing videos and relevant information through Whatsapp. 

Almost all community members who have received IVR phone calls, or watched these videos, have found them useful because they have provided relevant information on health and nutrition, and have been easy to understand. As IVR offers a unique advantage of being accessed through any mobile device at any time, awareness around this still needs to be increased over time.

INTRODUCTION

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.

“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.”

In the Odiya language, Anna means rice and Prasana means to eat, and Annaprasana is a ceremony that is performed when a child attains 6 months of age with much fanfare in most parts of Odisha as well many other parts of India.

It is understood in these communities that as the child grows, the mother’s milk alone cannot meet the energy needs of the child. The diet needs to be supplemented with additional energy-dense food. Thus, the child is introduced to complementary foods like rice porridge, chhatua, pulses and vegetables in small quantities, which is increased gradually as the child grows and weaned away from breastfeeding.

Digital Green’s project Samvad has partnered with a strong grassroots organization, Centre for Youth and Social Development (CYSD), in Odisha to engage with the community through its range of digital engagement platforms that enable beneficiaries and influencers to interact and learn about best practices related to maternal child health nutrition (MCHN) and family planning.

We found that community members of most of the tribal villages of Thakurmunda block, Mayurbhanj District in Odisha were unaware of the various stages of infant and young child feeding practices and its importance for the child’s growth. The concept of Annaprasana was also absent.

Several videos were made and disseminated in these villages in self-help groups (SHGs) and on Village Health and Nutrition Days (VHNDs) to generate awareness and ensure the community embrace the healthy behaviors under MCHN and family planning themes.

The Samvad project is particularly concerned about addressing social taboos and embracing social practices that can enable and maximize social behavior change through its videos. We observed that as a result of videos that showcased the importance of introducing complementary feeding through a social ceremony such as Annaprasana, the community quickly embraced the ceremony.

The community now understands the importance of initiating complementary feeding at 6 months and in over 27 villages of Thakurmunda block, Annaprasana ceremonies are now a regular occurrence celebrated with great joy. When the child is given the semi-solid food for the first time, mantras are recited and prayers are offered to various deities to mark it as an auspicious occasion to be celebrated. The practice has become so popular that the community members are even celebrating it on the VHND day as a festival.