Social and Behaviour Change Communications
Making Change Possible, making communities aware and communicating in a manner that leads from knowledge to practice.
With increased awareness generation for all components of the 7 point plan, our studies and researches have shown that rarely are people unaware that poor sanitation leads to disease. In respect of usage of ORS and Zinc as a treatment aspect for diarrhoea, there were some gaps in terms of knowledge and prescription of zinc from the health providers and facilities, but largely knowledge on ORS exists among mothers and caregivers. Similarly for the prevention aspects, FGD’s and IDI’s and other quantitative studies led us to the understanding that knowledge prevails, given the recent impetus through various mediums of mass communications that the Government of India has resorted to. And also largely due to the sanitation, immunization and health programmes aimed at improving maternal and child health and nutrition areas. But then if this had been enough, statistics on child health and survival would have shown a better picture. The conclusion drawn therefore is that knowledge is not translating into practice. Specific barriers- local, regional, cultural, religious and others are hindering practice.
In line the Save the Children’s theory of change, the Stop Diarrhoea programme aims to:
- test the effectiveness and efficacy of the WHO/UNICEF 7 point plan;
- collate evidence to demonstrate proof of concept and value for money; and
- advocate to the Government, and its partners to replicate and scale up the approach nationally.
A large component part of the part of the SBCC strategy focuses on beneficiaries (Children) and their caregivers, in understanding their views on health, sanitation and accessibility of these services and devising strategies to bridge the gap between knowledge and practice and improving supply chain management. The SBCC plan also aims at participation of communities through organised structures such as Community Sanitation Committees, the VHSNCs, Mothers groups and the Children’s health and hygiene committees (CHHCs).
Stop Diarrhoea Initiative supports activities to raise awareness, reinforce knowledge and improve practices among community members on diarrhoea prevention and control, by encouraging two-way dialogue with communities to create an enabling environment, improving knowledge and skills and addressing unhealthy social norms for improved family and community practices. Replicating and scale up of good practices in community mobilisation and BCC is also being encouraged.
A comprehensive approach using a variety of delivery mechanisms is being implemented to create demand for services. We are building on the existing community structures, enhancing their capacity and ensuring we reach the most vulnerable and marginalised communities. The Community Health Volunteers (CHVs), Anganwadi Workers and ASHAs play an essential role in raising community awareness about the prevention and control of diarrhoea and in influencing improved individual, family and community practices across the 7 point plan through a raft of interventions. These include: interpersonal communication (house to house visits and facilitation of community groups); two-way dialogue for collective action using the participatory learning and action cycle and Mother’s Groups, User Groups and Youth’s Groups, and Children’s Health and Hygiene Clubs (CHHCs) and VHNDs as a platform which will help local group members to mobilise wider community members in solidarity and confidence to take action in the prevention and control of diarrhoea.
In order to implement the community mobilisation activities, Save the Children is identifying local partners to support development, pre-testing and introduction of IEC and training materials, and facilitating training and technical expertise on participatory approaches to use with Mother’s Groups (MahilaArogyaSamity MAS), User and Youth Groups and CHHCs, and overseing this process to ensure quality throughout implementation. The project supports trainings for NGO partners on participatory community mobilisation (learning, reflection and action cycle) and child-friendly mobilisation approaches, such as the Child-to-Child approach. We are providing capacity building to Integrated Child Development Scheme (ICDS) supervisors on participatory approaches used in group activities and supporting monthly meetings of Mothers’ Groups led by Anganwandi Workers and User and Youth’s Groups and CHHCs led by CHVs to address the 7 point Save the Children through local partners will also build the capacity to:
- MahilaArogyaSamiti (MAS) as the name suggest are local women’s collective. They are expected to take collective action on issues related to Health, nutrition, Water Sanitation and its social determinants at slum/ward level.
- Supporting public health service providers organising VHNDs to incorporate the 7 point plan for diarrhoea management and control (e.g. hand washing, breastfeeding, treatment with ORS and Zinc, Vitamin A supplementation, uptake of rotavirus);
- Supporting and supervising WASH cadre to facilitate understanding and provide counselling to the community on safe water handling practices, water quality issues, sanitation related issues and hygiene behaviour such as promoting hand washing;
- Conducting refresher training to orient User Groups and Youth’s Clubs on participatory learning and action approaches to identify, prioritise, implement and evaluate actions in diarrhoea prevention and control;
- Supporting exchange of experiences meeting between Women’s Groups, User Groups, Youth’s Clubs, and CHHCs on VHNDs to review successes, challenges and lessons and ways forward in community efforts for diarrhoea prevention and control;
- Developing community-based networks to help support appropriate infant and young child feeding at the community level.
We have designed a range of SBCC activities in consultation with community members (informed by the formative research carried out by Athena Infonomics and desk reviews of other relevant researches) to raise awareness on diarrhoea related issues across the 7 point plan that will promote healthier choices for caregivers, families and communities in diarrhoea prevention and control. The formative research results are being used to target specific behaviours and to develop content for the SBCC interventions across the 7 point plan, including interactive TV and radio programmes, and mobile and other mass media (mobile technology). This innovation is based on the London School of Hygiene and Tropical Medicine’s (LSHTM’s) experience and evidence generated in India, Nepal, Ghana and Zambia, where especially behaviour targeted mass media campaigns have seen increases in hand washing at critical times rise from 6% to 29% in India over a period of six months. The process followed has been modelled on LSHTM’s ABCDE process:
Assess: Formative research on social norms, disgust, shame, and behavioural trigger points for adults and children across the target States;
Build: From formative research results, identify key behaviours and messages to target towards adults and children;
Engage a creative agency (local media house and WASH United) to create a series of interventions across the 7 point plan (including IEC materials (print and AV), games, activities and mass media animations);
Deliver: Pre-testing of materials, mass delivery of messages at the community level through a selection of media channels and mass and social media campaigns (TV / radio / mobile phone messages, / animation films /quizzes / wall paintings, hoardings, posters, mobile cinema, folk-media, road shows, celebrity champions, during Intensified Diarrhoea Control Fortnight and key health days) around hand washing, breastfeeding, treatment with ORS and Zinc;
Evaluate: Carry out an evaluation on key behaviour change interventions to evaluate impact.
Save the Children will document success stories and lessons for dissemination. It is also hoped that the results from the evaluation will merit publication in peer review journal article(s) in collaboration with reputed organisation/ institution.
The specially designed BCC interventions are being implemented during key social mobilisation events, such as Intensified Diarrhoea Control Fortnight, Hand Washing Day, World Toilet Day, and World Water Day in collaboration with district government and agencies, such as WASH United. Celebrating these events is essential as they help to continuously create awareness on different aspects of the programme throughout the year. For each of these special days, Stop Diarrhoea Initiative organises a series of small events which culminate into a larger event at the district level. These events help us to further strengthen community mobilisation processes and to bring the diarrhoea prevention and control at the forefront of the district government’s development agenda. The district level events also help us to engage with political leadership and to get their commitments in implementing the programme.