A Hope for a Healthier Tomorrow in India

Each Story Brings Change

Munnawar is a 42 year old ASHA (Accredited Social Health Activist)  worker hailing from a Muslim family in Banera which is one of the Muslim dominant villages of Naarsan block, in Uttarakhand state in North India. She has four daughters and four sons, and her husband works as an agricultural laborer – they both work hard to ensure that their children obtain formal education which they were not able to as they did not have the means. Despite this, Munnawar has gone on to become one of the most well-known ASHA workers in her community, catering to more than 1400 families, because of how well she connects with mothers and their families. 

Prior to becoming an ASHA worker, she worked under a private doctor as a birth attendant, and assisted an ASHA worker in her village in carrying out scheduled health activities. By virtue of this engagement, she learned more about the role that an ASHA worker plays.

Noticing her work, in 2012, the village head Mr. Salim recommended Munawwar for the position of an ASHA worker in the village despite not being literate. Her limited exposure to formal education posed a barrier to being able to maintain records and reporting work, but her coworkers were supportive. In return, Munawwar assisted her coworkers by accompanying them for home visits especially for counseling families who were adamant on their traditional beliefs about mother and child care.

Over the years, Munawwar has gained the confidence to be able to support families within their communities and change their beliefs about ill-informed maternal and child health practices. She has worked diligently with families and has counseled mothers so that they can go for safer health and nutrition practices. By using digital methods that she learned about through Digital Green’s capacity building workshops on video production, training and dissemination, she has been able to share knowledge about institutional delivery, immunization, and modern family planning methods.

Even after all this time, she still ensures that she goes for daily home visits and that all necessary support is given to families at any point of time. Her level of care towards mothers has extended to the point where once a mother had a delivery complication, she even donated her blood to save her life. Her dedication has cemented her position as an influencer within her community. During the pandemic, she kept at it by sharing videos via Whatsapp, and continuing to support families for anything that they needed.

Frontline workers like Munnawar are the agents of change, and serve as the interface between health systems and structures, and community members to ensure their health and wellbeing. They have been integral to the overall success of Project Samvad. Similar to Munnawar’s story of perseverance and dedication, Project Samvad has been able to work with over 5,000 ASHA and Anganwadi workers across six states in India, to build their capacities on using digital approaches to share knowledge and connect with their respective communities. Resilient frontline workers at the grassroots level reflect all the more on the effectiveness of health system structures in being able to reach and impact communities in rural and remote areas. Project Samvad has significantly contributed to our learnings on gender and resilience.

What made Project Samvad so unique?

 Health is never just physical, it is also about growing up in a healthy household that allows a child to feel loved, secure, and physically healthy. In our society, more than anyone else, mothers are responsible for caring for the wellbeing of their children, and raising them in a healthy household, and so they must be educated and made aware of optimal health and nutrition practices. To build a truly equitable society, women must be allowed to have agency on how they plan out their families and futures.

When we say that information is power today, what we mean is not the bulk or abundance of information, but how the needed information reaches a person in the remotest area of a poor, developing, and yet a hopeful country that enables him or her to make an informed choice which has the power to transform lives.

Similarly, Project Samvad has not just been about sharing information through digital approaches, but how this method of sharing information, and the knowledge in itself can transform the communities that we have worked in for the past six years, and give them the hope for a better and healthier tomorrow. For example, by simply sharing an instructional video with targeted women in the community via Whatsapp, it is not just the availability of the content but the fact that at any given moment, it will only take a click of a button to access information that can change the quality of life of these women and children.

“We never let go of the hope, the heart, and the pulse of the community” is what Dr Sangita Patel, Health Director of USAID shared in the last dissemination workshop that was held by the Project Samvad team on 9th February. Community-centered approaches with the value-addition of digital technologies have always rung true for Digital Green across interventions in Health, Nutrition, Gender, and Agriculture. Collective learnings from Samvad continue to inform our approach towards community engagement, social-behavioral change communication, and hybrid digital approaches that have transformative potential.

Impact in Numbers

Project Samvad had a massive impact across six states in India, namely Uttarakhand, Bihar, Jharkhand, Odisha, Chhattisgarh, and Assam. Looking back, the Project has reached over 700,000 women directly, and 360,000 women have been using digital channels.

During the project implementation period, the exposure of women to digital dissemination channels gradually increased from 32% in July 2018 to 96% by December 2018. From the first survey conducted in September 2018 to the latest one in January 2020, the percentage of women and men who knew at least three different modern family planning methods grew from 39.1% to 76.3%.

A Phone Survey that was conducted during Project Samvad found that 9 out of 10 respondents would watch videos that they received via Whatsapp during the pandemic.

What have we learned?

Project Samvad has generated a lot of interest and insights in its duration. Our key takeaways are that the proven community video approach complemented by other digital channels such as Whatsapp and IVRS has rapidly scaled up impact amongst local communities and can be applied to any context, sector, and geography. We have found that using technology builds an intrinsic strength at horizontal as well as vertical levels – not only do they facilitate dialogues and joint learning within the community, they also serve as an interface between health system structures and the women beneficiaries.

From the standpoint of influencing behavior change within people, local and contextualized information that they are familiar with, plus the delivery of information in a human-mediated, participatory approach establishes and strengthens the link between service providers and the community. This is of paramount importance to improve the uptake of any best practices shared whether it be in the health domain or even agriculture.

The data that we have gathered and the lessons that we have learned are important and will continue to enormously contribute to future opportunities in strengthening national and subnational policy actions on health, nutrition, and family planning.

Here are relevant links to Project Samvad Learnings:

For more resources on Project Samvad, please visit www.digitalgreen.org/resources-samvad

Watch the Samvad Playlist that dramatizes the human impact of Project Samvad here: https://www.youtube.com/playlist?list=PL-WsPllTgj_6kJRhe1ER-PfnZGZb81Fcu 

Effective Monitoring & Evaluation of Health & Nutrition Program Performance

Digital Green collects information related to program performance from the community level, to monitor the performance of its agriculture and livelihood programs, which is uploaded on its web-based monitoring system called Connect Online Connect Offline (COCO). Major indicators regarding the effectiveness of program implementation are publicly accessible with the help of a web-based analytics dashboard. However, learning from initial pilots of health and nutrition projects (since 2012) highlighted that although there is an increase in knowledge and adoption of behaviors these are not physically verifiable nor as tangible as they are in agriculture and livelihood programs.

Thus, when we started the implementation of project Samvad in 2015, we knew it would be difficult to collect and monitor the information through COCO. Hence, in order to regularly track the increase in knowledge, practices, and behavior change outcomes of Samvad we developed an innovative design of periodic lean surveys in partnership with the London School of Hygiene and Tropical Medicine (LSHTM). LSHTM provided technical support to our Monitoring, Learning & Evaluation (MLE) team to execute the lean survey.

The lean survey monitors and evaluates the implementation of the Samvad project and seeks to understand and improve the outcomes and impact and are carried out in five states where the project is active, namely Bihar, Jharkhand, Odisha, Chhattisgarh, and Uttarakhand.

In Bihar and Jharkhand where the program implementation started earlier and is in a more advanced stage of implementation, the surveys are carried out every quarter and in others, biannually.

Statistical Process Control

To monitor the outcomes and processes of the Samvad project, we used an innovative method of lean survey which uses Statistical Process Control (SPC) method. SPC ensures regular monitoring of improvement in the implementation system, processes, and outcomes, and has its basis in the theory of variation. This helps us understand common and special causes of occurrence of an incidence (outcome or process) and its consistency and variability longitudinally throughout the period of program implementation.

With SPC, the outcomes of the intervention can be depicted chronologically through graphical representation. These graphs, called ‘control charts’ show program outcomes with upper and lower control limits based on the variability. These charts have a central line depicting the average of an outcome and two dotted lines representing upper and lower control limits. The control limits usually depict plus/minus 3 standard deviations from the mean. The control charts indicate a change in outcome when it exceeds the control limits. With the help of these control charts, one can easily identify consistency or variation within an outcome throughout the implementation process.

Since this method clearly shows the changes that occur on a continuous basis, it is useful for the purpose of monitoring and course correction, where needed. Moreover, SPC harnesses the power of classical significance tests and it is equally useful to understand the impact of a program and its exposure among the targeted populations. Surveys conducted using SPC help inform the program strategies and course correct. Information on SPC in further detail may be accessed here.


The control charts above show that the proportion of women who have been exposed to Samavd intervention. It showed that:

  • The exposure of married women (aged 15-34 or women with a child under two years) to Samvad intervention has increased in all states except in Bihar from the initial round (Sep 2018 in Jharkhand and December 2018 in Odisha, Chhattisgarh, and Uttarakhand to December 2019).
  • In Bihar, the exposure level has been within the control limits except in round 3 and 5.
  • In Jharkhand, in the first round, the exposure was below the control lines and in round 2 to 6, it has been within the control limits.
  • In the other three states, the exposure level has exceeded the control limits indicating a definite increase in the exposure level.

One of the major reasons for different levels of exposure to Samvad intervention in different states is the way the implementation partners in different states disseminate the videos. In Bihar, the videos are disseminated by frontline workers of the livelihood mission to the members of self-help groups. These self-help groups include members of all age groups but women of the target age group are relatively lower in number. This may be one of the reasons that the percentage of women exposed to Samvad videos is relatively lower than those of the other states. In Odisha, the videos are disseminated by an NGO which has greater control over their video disseminators and this along with their rigorous capacity building may have resulted in a higher level of women’s exposure. In Uttarakhand, the video disseminations started late and thus the exposure of women to the Samvad intervention is low.

These surveys have helped us in tracking the Samvad intervention exposure, knowledge and behaviors of communities, and also the availability of supplies. Tracking of program performance over the period has helped timely course correction of the strategies for improved health and nutrition outcomes.

Tracking the availability of commodities

Through the lean survey, we also track the availability of maternal, child nutrition, and family planning commodities at the village level with health and nutrition functionaries. For example, in the 6th round of the survey, in December 2019, we found that iron and folic acid (IFA) tablets which are important for preventing anemia among pregnant women, were not available in 25% of the villages surveyed in Bihar, 19% in Jharkhand, 33% in Chhattisgarh, 3% in Odisha and Uttarakhand each. Such a gap in the supply hampers the demand and adoption of practices promoted by the program.


Lean surveys have the unique strength of serving the purpose of program surveillance to understand the current performance and also to assess the impact of any intervention. The statistical process control method used in these surveys brings the rigor of classical statistical methods with time-sensitivity to programmatic improvement and makes them more useful than the traditional survey methods. The lean survey method can be used for other similar programs where tracking of outcomes is not feasible through ongoing program reporting.

If you’d like to like to learn more about this check out this webinar recording.