Category: Reflections,Samvad

Starting Dialogues: Including Hybrid Approaches One Step at a Time

Posted on by admindigitalgreen

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.

Communicating Best Practices in Maternal Child Health, Nutrition & Family Planning Through ICTs

Posted on by Susan Thomas

INTRODUCTION

Digital Green is an international development organization that empowers rural communities by harnessing the collective power of technology and grassroots-level partnerships to promote good practices in agriculture, nutrition and health. We have been working with government agriculture extension systems for over a decade using the community video-based approach that has been a powerful tool in the hands of agriculture extension agents in over 22 countries across Asia and Africa.

Since 2012, through a series of pilot projects across sub-Saharan Africa and India, we drew lessons that helped adapt the community video-based solution to health and nutrition messaging among rural communities who often receive scattered information regarding health and nutrition, and are often unaware of the government welfare programs that are in place or the importance of availing them.

The pilots also helped us adapt and revise the video production and dissemination training modules for effective implementation of health and nutrition projects, which required more nuanced content and treatment than in agriculture. Analysis of the data and anecdotal evidence from those pilots suggested that communities saw value and relevance in the videos. 

Our teams worked on improving the Data Management Information System to capture data and analyse trends related to the health projects. Additionally, with more experience, evidence, and observations from the eld, the health pilots were further streamlined by identifying best practices from the various pilot sites. Lessons such as the inclusion of men – to highlight their role in ensuring better health for the family, creating aspiration among the family to play a more supportive role. We captured successes, lessons, and challenges to define how this approach can be best utilized to trigger positive behavior change in the health domain.

In 2015, through a USAID supported five-year project, Samvad (meaning dialogue/conversation), we started to promote good nutrition practices among primary caregivers. With initial success in Bihar and Jharkhand, we expanded the scope of the project to include maternal and child health and family planning practices in 2017. We started promoting this basket of messages among women in the reproductive age group, specifically in the critical first 1000 days through locally relevant content created by the communities, for the communities.

This project is currently being implemented in 6 states in India, namely Jharkhand, Bihar, Chhattisgarh, Odisha, Uttarakhand and Assam, where we partnered with state-level counterparts of the National Health Mission, the National Nutrition Mission, Ministry of Women and Child Development, and National Rural Livelihood Mission, leveraging the existing cadre of frontline workers such as Accredited Social Health Activists (ASHAs), Aanganwadi workers (AWWs), Lady supervisors and extension agents.

We are also collaborating with various partners to introduce innovative and locally relevant ICT-enabled platforms including radio and interactive voice response systems (IVRS) to complement the video-based approach and enable a participatory learning environment and magnify the reach and impact.

While we started out with an aim of reaching 300,000 women directly and 1 million indirectly, we have, in fact, been able to reach over 500,000 women directly and 1.9 million indirectly as of July 2019.

Through project Samvad we have had a unique opportunity to work with a wide array of partners, witness inter-departmental collaboration and the dedication of the frontline workers working tirelessly with minimal resources ensuring they are able to spread awareness among their communities. This photo book documents our experience thus far as well as gratitude for the collaborations that helped achieve the impact.

EMPOWERING FRONTLINE WORKERS

“Digital Green’s video-enabled approach has helped increase the attendance at the Village Health and Nutrition Days (in Patratu block) and helped in empowering the Anganwadi workers.”

– District Social Welfare Officer in Jharkhand

We have consciously worked with the existing health extension systems to ensure greater synergy with the community needs and to ensure the approach is owned and assimilated into the government systems. Even our trainings of the field level workers (FLWs) involve an SBCC approach for scripting, producing videos, facilitation skills, community mobilization as well as group discussion to address deep-rooted social norms and cultural beliefs which is a major barrier to changing health behaviour among women.

Our approach builds the capacity of frontline workers so they can build the capacity of others

VIDEO AS A TOOL FOR BEHAVIOR CHANGE

“I shied away from taking the IFA tablets (iron supplements) fearing the side effects would hamper my abilities to take care of my household chores. At a video dissemination, the Mitanin Trainer (MT) noticed I had swollen feet and enquired if I had been taking the IFA tablets. She showed us a video about the importance of taking these tablets and how to tackle the side effects. This convinced me and I started taking the tablets and also shared my example with other pregnant women in my village.”

– Beneficiary, Chhattisgarh

The Samvad project aims for social behaviour change through its community-based videos. These are short videos in the local language, they dramatize the best practices related to specific behaviours, which are more relatable for the communities. These videos are created bearing in mind local taboos, myths and traditional practices that are contrary to scientifically proven best practices. The community videos are a blend of standardized messaging coupled with examples of positive deviance from the community resulting in social behaviour change.

BREAKING MYTHS & CHALLENGING TABOOS

“The side-effects of the iron supplement (IFA tablets) and the stigma related to having any medicine during pregnancy has been a big barrier to my work.”

– Mitanin Trainer in Chhattisgarh

The Samvad project is particularly concerned about addressing social taboos and alternatively embracing social practices that can guarantee social behavior change through its videos.

The video on the importance of IFA tablets for pregnant women shown by the FLW illustrates in great detail a woman’s hesitation in eating the supplementary iron tablets due to the side effects and how to tackle them in a relatable manner.

Frontline workers report that they carry the pico-projector loaded with Samvad videos even for house visits. They find it useful to have it on-hand if they find the families and neighbours willing to learn more about the best practices.

EMBRACE ENABLING SOCIAL CULTURES

While there are social taboos and myths that hinder the adoption of best practices, we have also discovered social practices that encourage faster comprehension and adoption of best practices.

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 (a ceremony commonly performed when a child attains 6 months of age with much fanfare in most parts of India) was also absent. 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. It is now a regular occurrence celebrated with great joy.

Engaging men, especially on the importance of using contraceptive methods and spacing of pregnancies, has not been easy for frontline workers. The Samvad videos are, though short, very comprehensive and engaging; easing the viewers and the mediator into discussions.

 

EXPLORING AG-NUTRITION LINK

“We used to grow a single crop in our kitchen garden and leave it fallow in the summers. Now we’re growing a variety of crops and watering it with the wastewater as explained in the video and don’t have to buy them from the market or store it in the refrigerator. We’re also not falling ill as much as before as we’re consuming fresh vegetables grown organically.”

– Beneficiary in Jharkhand

Undernutrition in rural communities can be traced to a dearth of information about nutrition, as well as the unaffordability of nutritious food.

Leveraging our experience in agriculture extension, a valuable collaboration with the Livelihood Mission in Jharkhand helped us layer in the agriculture-nutrition link through videos on the concept of ‘Agri-Nutri Garden’. The concept ensures, sustainability by using organic compost, wastewater and low-cost solutions for protecting the crops from livestock.

Once the community understands the importance of dietary diversity for healthy development through the videos, the frontline workers guide them towards options for bridging the gap with the Agri-Nutrition Garden model.

A team of Mitanins and Mitanin Trainers in Chhattisgarh. ‘Mitanin’ in Chhattisgarhi language means a female friend, traditionally a female friend who helps out in times of need or illness. This organic concept was adopted by the government in a state-wide attempt to create a cadre of health extension workers or ‘Swasthya Mitanin’ (a friend for health care needs). Frontline Health Workers play a pivotal role in ensuring impact at scale.

 

COMPLEMENTARY AND PARTICIPATORY ICT SOLUTIONS

“Salma (mother of an 8-month-old) 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.”

– Anganwadi Worker in Jharkhand.

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 change behaviors and prompt 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.

 

CAPTURING DATA, MONITORING & EVALUATION

To monitor progress and impact, periodic lean monitoring and evaluation surveys have been designed to evaluate core coverage, exposure, and outcome indicators. Digital Green is working with the London School of Health and Tropical Medicine (LSHTM) and Centre for Media Studies (CMS) to gather data and assess the project’s reach via different platforms and partnerships and evaluate its impact.

Note: All quotations are drawn from the blogs contributed by staff of Digital Green. Photographs by Aniruddh Kaushal.

Integrated and Collaborative Approach Key for Impact on Health Behaviors

Posted on by Susan Thomas

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

Posted on by Susan Thomas

“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.”

Embracing local cultures to promote nutrition messages

Posted on by Susan Thomas

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.

Triggering Synergies Between Demand & Supply in Government Health Systems in Uttarakhand

Posted on by Susan Thomas

The burden of iron deficiency linked anaemia among women in India is well recognized, as is the importance of combating this, particularly among pregnant women. Prevalence of anaemia in pregnant women in India while on the decline, is still at an alarming 50.3% according to National Family Health Survey (NFHS-4). NFHS-4 data observes that nationally about 26% pregnant women consumed 100+ IFA tablets during their pregnancy, while in Uttarakhand 24% pregnant women consumed 100+ IFA tablets. Despite initiatives such as the National Iron Plus Initiative (NIPI) by the Government of India, uptake of IFA supplementation has not increased significantly.

Digital Green’s community-based video approach has been trying to ensure social behaviour change in the health and nutrition domain. A short video in the local language that dramatizes the best practices related to specific behaviours are more accessible to communities and These videos are created bearing in mind local taboos, myths and traditional practices that are contrary to scientifically proven best practices. The community videos are a blend of correct messaging coupled with examples of positive deviance from the community resulting in social behaviour change.

However, to ensure adoption we need to address gaps in both the demand as well as supply. There are several factors that need to come together in perfect synchronization for this. On the demand side, it is well documented that social taboos related to consumption of IFA tablets, augmented by the side-effects of consuming it (including nausea and vomiting) are most prominent. On the supply side, various studies have revealed bottlenecks including procurement, storage, and lack of personnel are a few.

Digital Green’s Project Samvad, funded by USAID, aims to improve family planning, maternal child health and nutritional outcomes in 6 states of India, namely, Bihar, Chhattisgarh, Jharkhand, Odisha, Assam and Uttarakhand.

In June 2018, Digital Green initiated a partnership with the National Health Mission Uttarakhand (NHMUK) to implement this project in the aspirational districts, Haridwar and Uddham Singh Nagar.

Project Samvad targets beneficiaries by exploring platforms that have a high proportion of women in the reproductive age group and 1000-days period. We found one such platform that is effective in reaching the target audience in Uttarakhand to be the Village Health Sanitation and Nutrition Day (VHSND) that is conducted at the local Anganwadi centre. It is an initiative by the Government of India – focusing on improving maternal and child health and nutrition outcomes. VHSNDs are observed once a month and attended by an Auxiliary Nurse Midwife (ANM) who administers a health check-up and appropriate vaccination to the children and pregnant women. The beneficiaries are also provided information and counselling about family planning and the commodities are also distributed here.

At one such VHSND on September 8th 2018, Devi, 26, pregnant for the first time was advised by the ANM to consume IFA supplements. However, the stocks with the ANM had expired and she had not received the new batch yet.

At the next video dissemination when the ASHA worker showed the beneficiaries a video on the importance of IFA tablets, Devi described her situation. We took note of this gap in supply and the importance of addressing it urgently to achieve impact through this project. To understand the bottlenecks on the supply side, we conducted a mapping exercise with the National Health Mission (NHM) officials. This exercise gave us a clearer picture of the supply of commodities such as IFA and calcium supplements, ORS and family planning methods in the area. Through this mapping, we discovered that the supply of IFA tablets in the area was truly dismal. This supply-side mapping also became a criterion for identifying the villages where we would implement the program.

We interacted with Government officials at the state, district and block level at every possible platform to discover a quick and sustainable solution. Based on our findings from the mapping exercise, we had a discussion with Mission Director, NHM who shared that they were already aware of the issue and were working on improving the supply. He shared that they had also already allocated funds for the block administration to buy some of the required stock from the market until the government supply was restored. We then discussed this with the Chief Medical Officers (CMOs) of Haridwar and Uddham Singh Nagar.

Our first breakthrough in this situation was when after multiple discussions with our team the Medical Officer of the Bahadarabad block in Haridwar, used their available budgets to get the supply of IFA tablets from the market, ensuring that appropriate stocks were maintained at the areas where our videos were shown. This ensured that we were able to build demand through our videos and our partners were supporting it by ensuring regular supply, thus ensuring sustainable behaviour change.

In addition to the dialogue with the Government partners, we continued working with the ASHAs to continue the dissemination of videos that emphasise the importance of consuming the IFA tablets and convincing the beneficiaries to buy the required stock of IFA tablet from local pharmacies as well. ASHAs also discussed alternative sources of iron supplementation through dietary intervention that are highlighted in the Samvad videos.

Manjeet Kour, an ASHA in Sitarganj block, of Udham Singh Nagar district shared, “A beneficiary shared with me how she bought the IFA tablets from the market following a video dissemination. She said that she had understood the importance and urgency of consuming IFA tablets.” Manjeet Kour disseminated the video and initiated discussions to make sure the women are convinced about consuming it.

“Many women had misconceptions and reservations about having the IFA tablets and even when they wanted to consume it they would not unless they were given the tablets by the ANMs or ASHAs. So I convinced them (beneficiaries) to buy it, when possible, from the market for the sake of their own and their babies’ health,” added Manjeet.

When we see such dedication to the overall objective of improving health outcomes we’re convinced that the impact is achievable. We see communities come together and discuss these issues in a group and they want to adopt these improved practices. This in itself is impact. The government partners too, are making an effort to bridge the obvious gaps in supply by collaborating with development partners to identify specific needs.

These may be only initial steps towards bridging the demand and supply gaps. But we feel that such efforts will go a long way to bring together the beneficiaries, the government and social organizations to make a lasting social behaviour change.

How Samvad Project’s Video-based Intervention in Jharkhand is Addressing Supply Side Gaps

Posted on by Susan Thomas

30th October 2018 remains a memorable day for the men and women of a small village barely 100 kms from the capital of Jharkhand, Ranchi. On that day, armed with new knowledge they sat across the table with the Block Medical Officer to demand healthcare services particularly for 4 pregnant women, 10 lactating mothers and 10 children below 3 years of age.

“We gained knowledge about the health services provided by the government health system from videos shown by Parvati Devi (Community Mobilizer) in the anganwadi centre,” shared Dulari Devi, who has just delivered a child. She was able to get 2 Antenatal Check-ups (ANC) since the Anganwadi Nurse Midwife (ANM) resumed the services in Shijhua village, Tatijharia block of Hazaribagh district in Jharkhand.

The village now has regular Village Health & Nutrition Days (VHNDs) with an ANM in attendance, 2 beneficiaries have registered, services like scheduled check-ups during pregnancy, TT vaccine and distribution of IFA is now regular. The village has had 2 cases of Institutional delivery and 10 children have received immunization during the last quarter.

Digital Green’s Project Samvad, funded by USAID seeks to improve knowledge and awareness about health and nutrition among pregnant and lactating women and children under 2 years of age as well as the full range of family planning methods among the rural agrarian communities of 6 states in India, including Jharkhand.

Digital Green is working with MKSP PIA-Srijan , a local NGO in the Hazaribagh district of Jharkhand, that has been supporting the implementation of the Samvad project on the ground since July 2018.

The project blends health and nutrition messages with agriculture messages through community videos. For example, the nutri-garden intervention which is promoted to ensure the community is growing their own fruits and vegetables in their backyard using the wastewater and other materials to irrigate and create compost. This ensures they get the necessary nutrition through a diverse diet.

The community is also shown videos about services that the government health systems provide and the importance of availing those services, thus motivating them to further demand those services.

This project is being implemented in 35 villages of Ichak and Tatijharia Block of Hazaribagh district in Jharkhand.

In the neighbouring Shayalkala village of Ichak block, a hamlet, named Mammarak had never been visited by an ANM or received any government health services. The community lacked awareness on health issues. When videos of Project Samvad were disseminated in the hamlet community members started paying closer attention to the information shared.

“Very recently a family in our village had lost a mother and child immediately after delivery. After watching the videos, we understood that this had happened due to lack of proper care during pregnancy,” shared Baby Devi, who has watched all videos shown in the hamlet since the project intervention began.

The Community Mobilizer (CM), Chanda Devi, who mediates the video dissemination encourages a diverse and healthy discussion at the end of the video to gauge the grasp of the video among the community members and motivates them to identify any gaps in the supply of service and demand for it.

“After watching the videos under project Samvad, the community members understood the importance of the best practices promoted including Diet Diversity During Pregnancy, Importance of ANC checkups, Danger Signs During Pregnancy, IFA tablet etc. and met with the Mukhiya (village head) to discuss the gaps they had identified,” shared Chanda Devi. The Mukhiya further wrote to the Block Medical Officer requesting that the Village Health and Nutrition Days (VHNDs) be started and held regularly in their hamlet too. “The Mukhiya too started attending every video dissemination along with the Ward Member (local elected representative) and motivates the community to avail the facility being rendered during the VHNDs,” adds Chanda Devi.