Wednesday, December 23, 2009
Tuesday, December 22, 2009
Converging on Child BCC
NGOS has been working in Shivpuri and Guna District with UNICEF support now for almost 5 years. The intervention was initiated with the Behaviour Development Intervention aimed at addressing the “aspiration” generated among the people to change their current status by improving their existing knowledge, attitudes and practices and their demand for availability of services which are their basic rights. Village women identified and trained by NGO became change agents as animators, going house to house to converse and convince their own community members to strengthen and adapt good practices, which are beneficial for their children and women and to give up harmful practices. Significant positive change came in exclusive breastfeeding rates including colostrums feeding and improved personal hygiene. Animators formed a crucial link between the people and service delivery centers - anganwadi, school or health sub-centre. However, it was realized that the services, in spite of the best efforts of NGO and his team, were not reaching the villages and more importantly the hamlets. The ANM would come to the main village but not to the hamlet, as people from the hamlet did not exert collective pressure nor had proper means to do so apart from the lone animator. At numerous villages the ANM would not come for months together or the Anganwadi worker will have no dalia to distribute. Again there was no effective means to inform the people about the prevailing state of services managed by the line-departments at the block and district levels or was there any way in which these departments can be held accountable. This led to designing of the Integrated Village Planning Intervention- Village Planning enables the community to use the constitutionally recognized forum of Gram Sabha to articulate their aspirations for change as well as to analyze and take action on issues that can be responded to at the village level. The need now is to support this with a structure, which is capable of responding to the demands articulated in the village plans that needs outside community interventions for realization. There is a further need to create a system whereby pressure can be exerted on this formal structure to respond in time.
Project Background and JUSTIFICATION
In the tribal district of Shivpuri alone, more than 4,500 children suffer from acute malnourishment. Unicef officials say close to 1,000 have been classified into Grade 4 - which means they are critical The tribals in Shivpuri district of Madhya Pradesh earn their livelihood by working in illegal mining. However, the working conditions are so appalling that most of the workers suffer from advanced tuberculosis with no hope of survival. And with medical facilities being practically non-existent, their suffering is often compounded. According to official figures, 860 people in Shivpuri district have respiratory disorders while 38 serious TB patients were admitted to hospitals. But of them, only one man has stayed while the others left without recovering because of the unhealthy conditions. "There is an acute shortage of staff in the hospital. There is only one nurse instead of the requirement of four. There are only two ward boys, one of whom is working in the chief medical officer's house," said Dr R K Jain, Nodal officer, District TB Hospital, Shivpuri.A UNDP India report lists fourteen districts in Madhya Pradesh that have the worst gender ratio, fertility rate and female infant mortality rate at age 2.
Ø Poor immunization coverage
Ø Uneven and scattered distances of villages from sub-centers.
Ø Dacoit effected area, decreasing the visits and outreach of health workers to villages.
Ø Migration population, often leaving villages and going to nearby areas in search of work.
Ø Very low coverage of health services among tribal communities.
Ø Illiteracy
Ø Outreach to roads in rainy seasons cuts off the villages from any service.
Ø Very low percentage of visits by ANM or any health worker
Ø Low prevelance of using family planning methods
Ø Significant amount of STI cases reported among females
Ø Very low cases where complete ANC has taken place, or complete doses of IFA tablets has been taken.
Ø High prevalence of child marriage among girls
Ø High rates of illiterates, very few people surveyed have received formal education to satisfactory levels.
Ø People not keen on using methods for delaying pregnancy
In Madhya Pradesh, the number of mothers who had at least 3 antenatal care visits prior to their delivery has increased from 27.1 percent in 1998-99 to 40.2 percent in 2005-06, according to the preliminary findings of latest National Family Health Survey.
For pregnant women in the villages of this vast, sprawling, picturesque state in central India, however, there is a reality beyond numbers. At 379 per 100,000 live births, the maternal mortality ratio in the state remains among the highest in the country.
Shivpuri and Guna are the two districts in Madhya Pradesh piloting MAPEDIR (Maternal and Perinatal Death Inquiry & Response). In Shivpuri, a recent collective brainstorming session of MAPEDIR interviewers helped dispelled many myths and provided important insights into how best to detect the ‘high-risk’ mother in time.
54 maternal deaths were investigated till February 2007 from various blocks in Shivpuri as part of the ongoing MAPEDIR. The preliminary analysis of the data is throwing up new, interesting findings that can be used as local evidence to spur district-level action.
A common misconception: only those women who had multiple pregnancies were “high risk”. But while sharing their experiences, public health nurses, ANMs, lady health visitors and NGO field staff who are tracking maternal deaths in the district discovered that even those who had had just one child or were expecting their first child could be potentially at high risk of maternal death due to sudden complications. (Source:UNICEF)
Objective of the intervention:
· Initiating efforts to identification of 4 key behaviors as a felt need.
· Ensuring 4 key behaviors are being practiced, sustained and promoted.
· Working in convergence with community based groups and other stakeholders to ensure a convergence approach to development.
· Amplify village planning as a mode to promote participatory development.
Key strategies
· Strengthen IPC and community dialogue sessions to promote four key behaviours
· Strengthening local groups, PRIs and SHgs and ensure their involvement in promotion of key behaviours and linkages with services
· Strengthening system of service delivery by improve linkages of community with available services.
· building leadership among excluded groups to ensure their full participation of service delivery system.
· work closely with key service institutions ( health, ICDS, education, Rural Development, PHED ) and will further linkage with NREGA and BRGF
· Documentation of success stories related to behaviors, service delivery or community empowerment that would impacting women and children.
Expected Outcomes-
a) 4-Key Behaviours
i) Colostrums/ Exclusive breastfeeding
· 100 % mother initiate colostrums feeding in an hour
· 80 % mothers continue exclusive breastfeeding – no water, only milk until 6 months
ii) No girl, below 14 is out of School
· 100% out of school girls (aged between 5-14 yrs) identified.
· Identifying 100% girls who are admitted in schools but not attending schools.
· 100% families of out of schools girls and the school girls not attending schools counselled and ready to send school from new sessions.
· 90 % girls completing class VIII.
iii) Hand washing with soap
· 90 % schools practicing hand wash with soap before MDM.
· 80 % families practicing hand wash with soap before eating and after defecation.
iv) HIV/AIDS
· 90% of youths (15-24 yrs) list at least three ways of HIV prevention.
· 80% of youths (15-24 yrs) observe safe sex practices (use of condom, sex with single partners, etc.).
b) Strengthening community Groups
As the social mobilization is also an important component of the Behaviour change communication program. The strengthening of the community groups needs to be focused following minimum deliverables needs to be insured in the HR villages-
Activating VHSC-
l All the members of VHSCs have orientation of their role and responsibilities.
l All the members understand the Health and sanitation issues and activities they can carried out in their villages.
l Members aware of the various Health related facilities available and know about various referral centre (like Call Centre, SNCU, NRC, PHC, CHC, ICTC, TB, Dist Hospitals etc)
l Members should know the various health and sanitation related schemes.
l Monthly structured meeting of the committee regularized.
l Village action plan developed and started implementing it.
Activating PTA
l All the members of PTA have orientation of their role and responsibilities.
l All members understand the Education status of the villages. (Like teachers, Attendance in the schools, School facilities, School basic problems, SSHE, MDM etc.)
l Members are actively participating in planning for improvement in school education status and environment and sanitation.
l Members actively participate in monthly meetings.
l Members motivate the parents of non school going children’s/ and drop out children’s sending them to school.
l Regularly monitor the quality of education provided in the school, MDM and Hygiene education.
Forming and Strengthening the Youth Groups-
l The youth group formed with participation from all type of community. (Every member should knows that he is the member of the group).
l The members of the youth group have been given a training on STD/RTI and HIV/AIDS with different tools (Kissa Goi, Flip book) and games etc.
l All the members are aware of Major STI problems, safe sex practices and HIV transmission routes.
l The misconception related to Stigma and Discrimination in HIV should be clear to youths.
l The member should know about the various facilities ICTC, PPTCT, ARTs and CCCs.
l The members have started discussing on HIV and STI issues.
l The members started spreading information in peer groups.
Forming and Strengthening Women’s Groups-
l The active women’s group formed with participation from all type of community. (Every member should knows that he is the member of the group).
l All the members understand the importance of Early Initiation of the Breast Feeding, Colostrums feeding, Ex. Breast feeding till age of 6 months, Hand washing before handling food and after defecation, and immunication.
l Members aware of the various Health related facilities available and know about various referral centre (like Call Centre, SNCU, NRC, PHC, CHC, ICTC, TB, Dist Hospitals etc)
l The members of group started home visit to Pregnant women’s and Lactating women’s for discussing about Breast feeding, Hand washing and Immunization.
l The group covering all pregnant women in their village by home visits.
Hand washing in the school before MDM
l All the school Children knows the benefits of Hand washing with soap before Eating and after defecation. All should know the correct steps of Hand Washing.
l A place of Hand washing is fixed and all knows about it.
l The regular supply of Soap and availability of water is insured by school teachers, PTA or villagers.
l The school based monitoring system is established for monitoring the regular hand washing of every child before MDM.
C)Strengthening Capacities of village Volunteers-
- VV must have knowledge about 4-Key Behaviours with various FAQs asked by community.
- VV must have knowledge of various services and referral points.
- VV must be supporting all health services.
- VV provide IPC to target audiences.
- VV regularly update the monitoring chart in their village.
- VV participate and facilitate the meetings of various community groups, thematic meetings and special event.
- VV regularly update the village health status report and information about target groups.
Behavior Change Communication
Behavior change communication (BCC) is the strategic use of communication to promote positive health outcomes, based on proven theories and models of behavior change. BCC employs a systematic process beginning with formative research and behavior analysis, followed by communication planning, implementation, and monitoring and evaluation. Audiences are carefully segmented, messages and materials are pre-tested, and both mass media and interpersonal channels are used to achieve defined behavioral objectives.
Behavior change communication (BCC) is part of an integrated, multilevel, interactive process with communities aimed at developing tailored messages and approaches using a variety of communication channels.
BCC aims to foster positive behavior; promote and sustain individual, community, and societal behavior change; and maintain appropriate behavior.
Before individuals and communities can reduce their level of risk or change their behavior, they must understand basic facts about reproductive health and HIV/AIDS, adopt key attitudes, learn a set of skills, and be given access to appropriate commodities and services.
People must also perceive that their environment supports behavior change, maintaining safe behavior (including abstinence), and seeking appropriate treatment for prevention, care, and support.
BCC aims to foster positive behavior; promote and sustain individual, community, and societal behavior change; and maintain appropriate behavior.
Before individuals and communities can reduce their level of risk or change their behavior, they must understand basic facts about reproductive health and HIV/AIDS, adopt key attitudes, learn a set of skills, and be given access to appropriate commodities and services.
People must also perceive that their environment supports behavior change, maintaining safe behavior (including abstinence), and seeking appropriate treatment for prevention, care, and support.
The terms BCC and IEC are commonly used. What exactly do they mean and what is the difference between BCC and IEC?
Information, Education and Communication:
IEC is a process of working with individuals, communities and societies to:
- develop communication strategies to promote positive behaviors which are appropriate to their settings.
Behavior Change Communication”
BCC is a process of working with individuals, communities and societies to:
- develop communication strategies to promote positive behaviors which are appropriate to their settings; AND
- provide a supportive environment which will enable people to initiate and sustain positive behaviors.
What is the difference between BCC and IEC?
Experience has shown that providing people with information and telling them how they should behave (“teaching” them) is not enough to bring about behavior change. While providing information to help people to make a personal decision is a necessary part of behavior change, BCC recognizes that behavior is not only a matter of having information and making a personal choice. Behavior change also requires a supportive environment. Recalling the interventions model, we learned that ”behavior change communication” is influenced by “development” and “ health services provision” and that the individual is influenced by community and society. Community and society provide the supportive environment necessary for behavior change. IEC is thus part of BCC while BCC builds on IEC.
An introduction to BCC programs
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