Innovative Communication Strategies for Family Welfare Programme in Eight EAG States

Innovative Communication Strategies for Family Welfare Programme in Eight EAG States



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Innovative Communication Strategies for
Family Welfare Programme in
Eight EAG States
2005
Population Foundation of India
New Delhi

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CONTENTS
S No. Contents
Page No.
Abbreviation ....................................................................................................2
Acknowledgements .........................................................................................4
Executive Summary ........................................................................................6
1.
Introduction ...................................................................................................17
2.
Research Methodology .................................................................................20
3.
Findings National
3.1 Overview .................................................................................................22
3.2 Interviews ................................................................................................34
3.3 IEC Material Review ...............................................................................45
4.
Findings State
4.1 Bihar ...................................................................................................67
4.2 Jharkhand ..........................................................................................78
4.3 Uttar Pradesh .....................................................................................90
4.4 Madhya Pradesh ............................................................................. 112
4.5 Chattisgarh ...................................................................................... 139
4.6 Rajasthan ........................................................................................ 155
4.7 Uttaranchal ...................................................................................... 174
4.8 Orissa .............................................................................................. 190
5.
BCC Strategy and Recommendations ...................................................... 214
6.
State Specific BCC Strategic Recommendations ..................................... 215
7.
Annex 1 : Design and implementation at State/District/Block level ........... 234
8.
Annex 2 : Barriers ...................................................................................... 236
9.
Annex 3 : Key communication indicator types ........................................... 237
10. Annex 4 : Key behaviours to be addressed-Adolescents .......................... 238
11. Annex 5 : Suggestive list of communication activities ............................... 239
12. Annex 6 : Discussion guide/questions ....................................................... 240
13. Annex 7 : Roundtable Meeting Report ...................................................... 241
14. Annex 8 : National Workshop Report ........................................................ 244
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Abbreviations
AIDS
ANM
AWW
BCC
BEE
CG
CHC
CHV
CINI
CMO
DGHS
DHIEO
FNGO
FP
FPAI
FW
HIV
ICDS
IEC
IFA
IPC
M&E
MNGO
MOHFW
MO I/C
MP
MPW
MSS
NACO
NFHS
Acquired Immuno Deficiency Syndrome
Auxiliary Nurse and Midwife
Aagan Wadi Worker
Behaviour Change Communication
Block Extension Educator
Chattisgarh
Community Health Center
Community Health Volunteer
Child In Need Institute
Chief Medical Officer
Directorate General of Health Services
District Health Information and Education Officer
Field NGO
Family Planning
Family Planning Association of India
Family Welfare
Human Immuno Deficiency Virus
Integrated Child Development Scheme
Information Education and Communication
Iron & Folic Acid Tablets
Inter Personal Communication
Monitoring and Evaluation
Mother NGO
Ministry of Health and Family Welfare
Medical Officer Incharge
Madhya Pradesh
Multi Purpose Worker
Mahila Swasthya Sangh
National AIDS Control Organisation
National Family Health Survey
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NGO
NIHFW
NIPPCD
NRHM
PFI
PHC
PNDT
RCH
RMP
SC
SCOVA
SHRC
SIFPSA
SIHFW
TT
UA
UNFPA
UNICEF
UP
WB
WCD
Non Governmental Organization
National Institute of Health and Family Welfare
National Institute of Public Cooperation and Child Development
National Rural Health Mission
Population Foundation of India
Primary Health Center
Pre Natal Sex Determination Test
Reproductive and Child Health
Registered Medical Practitioner
Sub Center
State Committee on Voluntary Action
State Health Resource Center
State Innovation in Family Planning Services Agency
State Institute of Health and Family Welfare
Tetanus Toxide
Uttaranchal
United National Fund for Population Activities
United National Children Fund
Uttar Pradesh
World Bank
Women and Child Development
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Acknowledgement
The study on Innovative Communication Strategies for Family Planning and RCH in
EAG states has been a mammoth task and has involved many people at different
levels. It has been a challenging task given the time span and the resources available.
At the same time it has been learning and enriching experience.The exposure at national,
state and district levels has been tremendous. The participation by various stakeholders
has been very encouraging.The issue of population stabilization and the communication
initiatives in the emerging priorities and paradigms is still very much alive but growing.
The task was entrusted to lead consultant, Mr. Samaresh Senguta who was supported
by Dr. R B Gupta and Dr. Sanjeev Kumar. The consultant team brought together a
comprehensive perspective into the study from an management, demographic and
communication perspective. The study was guided by Mr. A R Nanda, Executive Director,
Population Foundation of India. The team of Dr. Almas Ali, Dr. Lalitendu Jagtab always
was available for discussion and review.
The consultants had several rounds of interaction, meeting and interviews with key
stakeholders in the Ministry of health and family welfare (Mr. P K Hota, Chaitanya
Prasad, UNFPA, Unicef, World bank, Bilateral agencies (USAID, DFID, EC), International
agencies (Population Council, IPPF, Bill and Milinda Gates Foundation, CARE) and
NGOs (FPAI, PSS, CMS, Janani) and Communication consultants (Supriya Mukherjee,
Avik Ghosh). We would like to acknowledge their giving us time and valuable insights
into the programmes and project they support and conduct directly or indirectly. The
sharing of information and documents contributed the richness of the document. We
would like to acknowledge all the persons who took time out for the interviews which
sometimes lasted much more time than was stipulated because of the deep commitment
and involvement of the persons concerned.
At the state level, the consultant team would like to acknowledge the state departments
of health and family welfare, medical education and social welfare. The concerned
principle secretaries, secretary, health and family welfare and other officers were more
than willing to talk to us and express their opinion and concerns. Similarly the State
Institute of health and Family Welfare and State IEC bureaus, wherever exist in the
EAG state also contributed to the understanding of the training and communication
aspects of the study. The directors and in charge of the institutes deserve to the thanked
for sharing us with the plans and activities they were conducting in the states. The RCH
officers and DHIEOs at state and regional also helped us in understanding the complex
dynamics of working in the states. The large NGOs, state units of UN and Bilaterals
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and other state level organisations and projects also allowed us to glace into some of
the innovation and plans they were working on. Infact, the state level visits and
interactions with academy of administration and Population resource centers along
with the Mass media units of I & B also helped us understand the collaboration or lack
of it in the programme. The changed scenarios with new programmes priorities and the
response and adoption to the new paradigms were a learning experience.
The visit to the district levels authorities and functionaries gave us a sense of the
implementation as well as the planning insights at that levels. We wish to acknowledge
our gratitude to the CMOs, Dy CMOs and the DHEIO, BEE and the other functionaries
who manage the show. Similarly at the field level we visted the functionaries at the
PHC and MOIC or ANM and MPW also gave us issues and concerns and the peep into
the functioning at the delivery level. We wish to thank them all for their invaluable
contribution.
All in all, this study has been a study in contribution by all concerned and involved. The
consultant team would once again like to acknowledge the help and support of all
concerned at PFI and MOHFW for their support and encouragement.
We would also like to acknowledge the participants at the roundtable meeting with
stakeholders and the national workshop that deliberated upon the findings and future
course of action in the field of IEC/BCC in the forthcoming RCH-II and the NRHM. The
Board members of PFI and the Executive Committee members of the PFI always took
a keen interest in the progress of the study and guided the study with their rich and
varied experiences. We wish to acknowledge their reviews and comments on the drafts
and discussions.
Once again, we would like to place on record the support of Mr. A R Nanda and his PFI
team of Dr. Almas Ali and Dr Lalitendu Jagatdeb who saw that we follow rigorous
protocol and facilitated our interactions with the national and state level interactions.
We look forward to the action oriented follow up of the study and its findings in RCH
and NRHM.
Samaresh Sengupta
R B Gupta
Sanjeev Kumar
June 2005
New Delhi
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Executive Summary
1. Introduction and Background
The Family Welfare programme in
India is one of the oldest and has
gone through several radical and
critical changes in recent years. India has
made considerable progress in social and
economic development in recent decades,
as is reflected by the improvements in
important indicators such as life
expectancy, infant mortality and literacy.
However, India’s population continues to
grow and stands at 102.7 million on March
2001(Census 2001). Even though some
of the states have been able to
demonstrate a substantial progress
towards population stabilisation, some
other states continue to have high fertility
and consequently high population growth
rate. Many surveys and studies including
the quinquennial National Family Health
Surveys (NFHS-I, 1992-93 and NFHS-II
1998-98), the 2001 Census of India,
Reports of National Sample Survey
Organization, the district surveys (RCH-
I), the facility surveys (RCH-I), and several
other studies have clearly shown that
there have been substantial differences
between states in the achievement of
basic demographic indicators.
There are several sets of factors that
contribute to the differential in the
performance of set of EAG states. One
major reason for variations in performance
are based in the deep rooted socio-
cultural and geographical features that are
peculiar in the Indian context. Poor
infrastructure, low and varying political will,
leadership, resources, lack of community
involvement, weak service delivery
mechanism
and
unfocused
communication programme all may lead
to low levels of performance. To take in to
account the existing variations, NPP 2000
states that ‘one size fit all’ strategy would
not suffice and hence a differential
approach for group of states at
homogenous levels of achievements has
to be taken into consideration.
2. Information, Education and
Communication in Family
Welfare
Right from the launch of family planning
program in India, value of information was
well recognized. However, it took quite a
while to realize that mechanical display
and dissemination of generalized
information fails to create a motivation
strong enough to result in attitudinal
change which is necessary for adoption
of suitable reproductive health and
contraceptive practices on a long term
basis. Over the years there has been
better appreciation of the role of IEC and
a variety of strategies have been devised
and put into use from time to time. There
has been considerable increase in the
knowledge and awareness levels about
the Family welfare programme and
methods of contraception and RTIs/STIs.
The results, however, have been far from
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satisfactory insofar as the resultant impact
in terms of contraceptive practice and
family size norm and ultimately in terms
of population stabilisation is concerned.
3. Shifts since ICPD and RCH
In the wake of the country’s acceptance
of Global Agenda of ICPD, the
Government of India launched the
Reproductive and Child Health (RCH)
program in 1997. This represented a
radical shift in the Government’s policy as
it moved away from obsession with
sterilization targets, to a bottom up
decentralized participatory planning
process based on community needs
assessments. The program covers an
extended range of services for unwanted
fer tility, maternal health, RTI/STI
infections, child health, and adolescent
health.
4. Issues and Gaps in the FW
communication
Studies conducted in the late eighties had
also brought to light the fact that in spite
of almost universal awareness of family
planning through the red triangle
symbolizing the program, the pace of
acceptance had lagged considerably
behind awareness levels. Gaps were
observed between a positive attitude
towards family planning and its
acceptance. Misconceptions and
inhibition regarding various family
planning methods, poor access to media
channels and even more critically the poor
outreach of the program functionaries in
making contacts with the community to be
served along with their very limited
capacity to pass on right messages,
emerged as serious lacunae in the
community efforts. The main purpose of
a well orchestrated IEC strategy is to
create intelligent demand with assured
availability of synchronous services as
well targeted inter personal
communications to build trust in the
diffused knowledge and to intimately
relate generalized information to specific
needs of the individual and family, within
the realm of socio-cultural choices.
The review clearly shows that the IEC
component of the FW programme is an
important and critical component of the
strategy. There are several gaps and
problems related to the IEC programme
and changing it from the missing link to
the driving force the need is to understand
the state’s perspective, the people’s
perspective, the provider’s perspective,
the community perspective and the
individuals perspective and needs and
respond to the situation in a focused,
systematic, sustained and strategic way
to generate expected results in the
population stabilization goals. The indepth
study and analysis of the respective EAG
states and case studies of other states
that have succeeded in their efforts should
provide a clue and plan for the EAG states
to follow.
5. Formative Research on IEC/BCC
As part of the research regarding the
Communication strategy and scenario for
the EAG states the research consultants
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gathered IEC materials from the states.
The family welfare programme in India has
been there for over fifty years. There have
been many efforts at education,
awareness generation, increasing
knowledge and information spread to the
people. These efforts have been varied in
content, design and effect. The fact that
EAG states have not fared as desired in
the family welfare has some of its
explanation in the design, effort, quality
and reach of the IEC materials and
activities. The research tried to gather as
much IEC materials as possible to see
whether that hypothesis holds some truth.
It goes without saying that any such effort
at getting and analysing IEC materials will
never be exhaustive.
6. Methodology
The IEC materials for Family Welfare in
the EAG states have been collected
during the visits to the states and also from
the IEC division of the MOHFW. These
materials have been collected from
various agencies such as IEC division, of
DOFW, Health System Development
Projects, SIHFW, UN agencies like Unicef,
UNFPA, international agencies like CARE,
PSI and JHU/PCS, and NGOs such as
FPAI, VHAI, Janani, SIFPSA etc.
The materials have been in print, audio
and video format. For obvious reasons the
outdoor materials and folk media
materials could not be collected as these
are live performances or the sizes are very
big.
7. Listing of the materials
The IEC materials were listed in three
basic categories: one statewise, second
agency wise and third, by type of
materials. The materials were collected
from the center and states of Uttar
Pardesh, Uttaranchal, Rajasthan, Madhya
Pradesh, Jharkhand, Bihar, Orissa, and
Chattisgarh.
Three broad parameters for the analysis
were used viz.
(a) Quantity and quality
In the quantity parameter we looked at the
adequacy of materials produced as per
the numeric needs of the state, second in
the quality parameter, was included
content and form of the material.
(b) Process of production, distribution
and utilisation
In this parameter we looked at three sub
variables namely, production (who briefs,
who designs and whether in-house or
outsourced, secondly what is procedure
and tracking of distribution, and thirdly how
are they actually used and by whom.
(c) Reception, Monitoring, evaluation
and impact
This parameter looks at the reception side
i.e. the reception by the audience, which
is captured through some of the
monitoring and evaluation of the IEC
materials and activities conducted. If there
were any specific impact studies were
conducted clearly (not acedotically)
demonstrates the correlation to the IEC
material or activity and also not
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necessarily linked to uptake of services.
8. Stakeholders interviews
An in-depth questionnaire (open ended)
was prepared for interviews with the key
stakeholders. 24 key national level
stakeholders/experts from academics,
NGOs, policymaking, corporate sector
and other walks of life were identified
based on their expertise in family planning
and communication.
The study highlighted that Family Planning
is a felt need of the people and there is a
definite need of behaviour change
communication. There is need to shift the
focus of the programme from IEC and to
BCC. It has been further pointed that
despite high awareness levels of the
family planning programme, health-
seeking behaviour did not improve.
Access, practices, affordability and quality
are serous concerns reflecting the urgent
need of behaviour change communication
Study shows that there is a need for
evolving Service Backed Specific IEC
Interventions. The specific audience in
EAG States have not be understood well
and no segmentation has been done
among newly weds; late adolescents are
left out completely.
It is also highlighted that influencers like
MIL, Husband, FIL, SIL and other relatives
were not well addressed in the BCC/IEC
campaign. A number of issues have been
identified by the experts for making the
policies comprehensive, broad based and
effective. The policy gaps, incorporation
of various stakeholders in the policy
making and formulation of appropriate
strategies for implementing the policies
have been emphasized by the experts.
The capacity building of the service
providers for new methods, techniques,
skills, approaches and development of
curriculum and teaching practices needs
to be carried out. The study has identified
various gaps at the policy and
implementation level. The issues
pertaining to brand building, positioning
of the programme with respect to RCH
programme and other related issues have
also been highlighted in the study. Finally
the study has shown a need for evolving
a comprehensive communication strategy
consisting of an appropriate mix of media
and messages. Various issues pertaining
to use of media and making the messages
more effective have also been identified
by the study.
9. BCC Strategy for Family
Welfare in EAG States
Based on the study finding it emerges that
one need to answer two questions in
evolving a communication strategy for
family welfare in the EAG states.
What are the programme inputs to reach
the behavioural results?
What contribution will communication
make to help the programme achieve
these results?
This strategic communication approach
clearly tells us the distinctive role that the
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communication initiatives will play and will
have to play in order to achieve the
ultimate programme objectives. This
approach to the BCC strategy also
focuses the issue on results rather than
on activities. And that is the key to the
proposed strategy. What should be the
guiding factor is the end point, the result,
the outcome. The communication strategy
has the result as a starting point and then
works backwards to locate what factors,
what action one needs to do in order to
achieve the desired result.
9.1 FROM RESULTS/OUTCOMES TO
INPUTS: BACKWARDS ACTION
The BCC strategy works in a backward
mode of coordinated actions. This
approach is in many ways challenges the
linear approach starting from objectives.
The normal approach or planning for
action planning was based on the funds
allocation as has been brought out by the
EAG states chapters mentioned earlier.
Nowhere are the outcomes defined. What
is usually defined is the production of
materials and activities. The IEC bureau/
staff at the state level is also oriented
towards the production of material,
performances, broadcast and
transmission, and “publicity” as their job.
There is an assumption that all this will
lead to the more acceptance of family
planning methods. The conception of the
linkage of the materials –more materials-
(there is no mention of research or
audience specificity), to change in
behaviour is very deep rooted.The second
part of the situation is the non defined
outcome indicators or the behavioral
actions that have different levels and types
other than service utilization. The concept
of behavioural steps and its steps/shifts
towards action are not seen as changes.
Change is only measures in terms of
adaptors of FP methods.
Communication materials and activities
only become a mean to facilitate and
achieve them. Defining the outcome also
tells us to look for the barriers that the
audience faces and asks us to look for
benefits, positions that will becomes
messages to help them overcome those
barriers. Simply projecting a generic
benefit that fits all audience categories
does not work. Working in this strategic
mode also calls for looking at the audience
specificities much more closely. It calls for
looking at audience segments that defines
the messages strategies that will help us
to reach out to clear the block that a
particular audience faces.
9.2 THE BCC STRATEGIC DESIGN
COMPONENTS
The BCC strategy can be seen an
interlocked scheme of things tying the four
components of the strategy together.
These four components need to be
worked at simultaneously and in
synergistic action to be able to make a
dent in the outcome of the programme.
There is need to get out of the mindset of
doing activities, developing IEC materials
and believing that awareness generation
and information dissemination done better
or more will lead to the behaviour change
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we are looking for. The simple approach
works only to a small extent but for a larger
part one has to understand the factors and
forces that guide and decide the action a
person is going to take.
9.3 STRATEGIC AND EVIDENCE BASED
PLANNING
The strategic planning aspect of the
framework says that all of the works need
to have an evidence base – formative
research, problem analysis, situation
analysis- to guide the priorities of action.
Almost none of the EAG states have ever
done a formative research to understand
the perceptions, factors and reasons or
the “why” of the non action of a behaviour.
One has over a period of time formed an
opinion that the factors such as poverty,
illiteracy, low socio economic conditions,
socio cultural or religious factors are
responsible for the non acceptance of the
family planning behaviours. Rarely has
there been an analysis of the positive
deviance cases of what people in difficult
circumstance have accepted the
behaviours which otherwise has not found
wider acceptance. The specific situational
problems of access to the services and
its relation to the quality of services has
also been referred as a bottle neck. The
attitude of the service provider has not
been seen as problem but several other
studies have pointed out this issue as one
of the major problems. Doing a situational
problem analysis in a scientific and
systematic manner will help build further
action much more action oriented and
focused.
9.4 AUDIENCE SEGMENTATION AND
BEHAVIOURAL ACTIONS
The clear need for audience segmentation
for figuring out specificity of the message
and channel fit is a critical component.
Generic audience is no audience as has
been the case in the past, it has to be
specifically addressing the audience in the
local context. The audience focus has
generally been the married women and
men in the reproductive age. Again it has
been looked at from a point of view of the
terminal methods and not from the
spacing methods as this required
concerted and continuous action on the
part of the worker as well as the system.
The audience segmentation has to be
looked in relation to the behaviour being
promoted. This will also help determine
the core of the message content and form.
Other than the audience segmentation
what is also of core importance is
understanding the issue from the point of
view and perspective of the audience. It
has been realized because of the long
history of the programme the providers
and the communication functionary has
come to hold the beliefs and perceptions
of the audience as given and not as
something to be explored or rediscovered
time and again.
9.5 BARRIERS AND BENEFITS
It is clear that what guides peoples action
is a combination of overcoming barriers
and perceiving benefits. The basic of
communication is reducing barriers and
increasing benefits. One of the most often
neglected component of the BCC strategy
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is the clear definition of the barrier the
audience is facing and again the
positioning of the message in the new way
of offering benefits. Generally this is not
even seen as part of the issue. The
problem is the people because they are
finicky, irrational and do not follow advise.
The reason for this behaviour is not
analysed or rationalized. Seeing thing
from the other’s perspective is a trait that
has not yet been internalized by the
communication fraternity. Barriers as the
people see, benefits as the people see,
is the key to the message design and IPC
actions. There are several layers and
levels of barriers one has to unearth.
Similarly there are several angles to the
positioning of the benefit. As it emerged
in the discussions in the field the benefit
slogans in the family planning programme
has been there for a long time and the
correlation to the personal benefit in the
context of the person is not realized. The
benefits have been defined in a singular
manner over the years and need to be
broadened and repositioned.
9.6 MONITORING AND MEASURING
BEHAVIOURAL OUTCOMES
Last and most significant is the need for
defined behavioural action and the
measurement of the behavioural
outcomes. Infact this should become the
guiding mantra of the whole process of
the strategic planning and implementation.
As is clear in the state reports detailed in
the previous chapters, no state action plan
has a clear, elaborate monitoring
mechanism defined. Some UN, Bilateral
and NGO projects have defined outcomes
and monitoring and evaluation
mechanism and some also have
attempted to show change process and
measurement demonstrated. But in
general, Monitoring is not be seen a
mechanism that is out there to find faults
or catch you on the wrong foot, it is actually
a planning and results tool that helps you
to perform better. The monitoring is linked
to the backward action approach and it
actually guides you to the corrective and
remedial action.
There is another aspect to the monitoring
and measuring behavioural outcomes.
Because there are several players and
projects in the same states and district it
becomes difficult to work out the
contribution, if any, towards the change
in the effort. If one starts with monitoring/
outcome indicators it is possible to ask
for the various players in the field to
commit the contribution in term of the
outcome (no necessarily in terms of the
funds). This in away holds all the partners
accountable and work together. As has
been shown in the state reports that there
has been accountable coordination
mechanism in terms of the outputs. This
forces the partners to think beyond
“physical or meeting” classified as
partnership would have to become
realistic and transparent. A strong and
clearly defined monitoring and evaluation
plan linked to the objectives would ago a
long way in moving towards tangible
results.
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9.7 PUTTING IT ALL TOGETHER
It would be imperative to have these four
elements working in tandem along with
an advocacy approach which resets the
agenda for family planning in a focused
manner. The four elements of the strategy
have to be understood in the major and
sub elements and also in the elements
that create and environment for it happen.
Again these have to be localized and
customized the specific state and district
situation. This variation and differentiation
will also be moderated for the urban, rural
and tribal sections of the population. As
these elements of the BCC strategy are
interlinked and also partially dependent
on the participation of all the players, it
will need to be operationalised in a
participatory manner.
10. Recommendations
For a state or even at national level it would
require steps to operaionalise the
backward action approach. This approach
asks for specific outcome and behavioral
actions to be defined for the audience
segment as well as the provider. See
annex for the specific actions to be
performed to overcome specific barriers.
Based on the backward planning action
approach the recommendations in the
strategy can be broadly categorized in four
focus issues. These are
(i) Locating behavioural actions at
different levels of indicators
Behaviours
Indicators
(ii) Defining specific audience to work
with
Adolescents
Couples (newly married, with one
child, with two children, with more)
Men
Influencers (MIL, religious)
Health service providers
(iii) Understanding barriers at different
levels and positioning benefits/payoffs
Different types and levels
(iv) Levels of planning and implementa-
tion structures/processes for IEC/
BCC
State
District
Block
Villages
Any plan at the state, district or block level
will have to keep the four elements clearly
defined and articulated. According to the
backward planning approach one will have
to define the behaviours and indicators
for the different audience segments and
define the barriers they face and therefore
define and design messages with specific
benefits from the perspective of the those
specific audiences.
11. Benefit/Payoff for the FW
programme
As has been brought out by the state visit
report and the stakeholders interview in
the previous chapters, the payoff or the
benefits that has been projected over the
years for the FP programme has run out
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of steam. The benefit is usually the driver
of the programme. It is clear that the chota
parivar, sukhi parivar and its may
variations have stopped being effective.
There is need to overall work at the
benefits offered by the family welfare
programme. The benefit statement of the
programme has run into a fatigue mode
and does not seem relevant to the different
set of situation and conditions of the
audience segments. Besides it has no
longer even projected with other elements
like the sex ratio, the PNDT act and of
course the HIV taking its toll on the FP
issue. The benefit has to stand out and
should have the possibilities of getting into
various moulds according to the needs of
the audience and the situations. It needs
to get:
Personal
Seen and believable advantage
Beyond happy and healthy
Beyond economic and national
Branding/identity
Rights perspective
Felt need instead of unmet need
Quality Assurance
There are several takes on this but none
that has found great and sustaining
appeal and lasting value. There has to an
agreement among stakeholders as well
on the basic benefit one wants to projects.
12. Coordinated chain of
action(s)
Another set of programatic set is the
coordination and synergy in the set of
actions and activities that the programme
may need to take up. As of now the set of
activities are uncoordinated or there is a
heavy skew in favour of the materials
being produced as they are visible and
also help spend the funds. The
uncoordinated action do not produce the
resonance and the results are defocused.
The actions have to be coordinated with
a media plan. The types of actions that
need to be coordinated are as follows:
- Strategy action
- Social mobilisation action
- Individual behavioural action
- Community action
- IPC action
- Capacity building action
- Intersectoral action
- Advocacy action
- Resource action
- Follow up action
- Monitoring action
These actions have to be reflected in the
choice of media selection and the mix of
media that is employed to reach out to
the audiences. What usually happens is
that a limited set of action takes place and
that too in a spurted way. There is hardly
any correlation to the other activity. The
media plan, capacity building, partnership
does not take into consideration that
possibility of the synergised action to build
the crescendo that will ultimately lead to
the behavioral action.
13. Beyond activities and
materials-Advocacy
It has been pointed out in the interviews
with the stakeholders and also in the state
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field visits, that the issue or the agenda of
population and family welfare has not
been in an aggressive public domain or
priority of the policy makers. It has, so to
say, lost being visible and important. This
suggests factors one has to keep in mind
is the other environmental factors that
needs to be worked at. These are
influencers that have a big impact on the
decision making and outcome. A
concerted action a community advocacy
and political advocacy needs to be worked
at.
14. Goals and principles
The BCC strategy for family welfare for
the EAG states presented in the previous
pages outlines the key strategic thrust and
components that needs to be worked at.
In these recommendations are presented
two key management and policy issues
that relate to the fundamentals of the
issues related to the communication
functions.
One, is the goals and guiding principles
of the programme that redefines the jobs
of the IEC divisions and persons. This
shifts the focus of the operations and
thereby the construction of the IEC efforts.
Goal 1. Fifty percent of all the method
acceptors must be of spacing
methods.
Goal 2. Fifty percent of all terminal
methods acceptors must be of
parity 2.
Goal 3. Fifty percent of all IEC budget
must be earmarked for IPC
activities.
Goal 4. Fifty percent of all the IEC efforts
should be directed to the
adolescents.
Goal 5. Fifty percent of all FP acceptors
should be men
This set of goals needs to get translated
in to corresponding action plans and
activities. This will require a change in
mindset of policy, managers and field
functionaries.
Second set of recommendations is largely
related to the management of the IEC/
BCC functions at the national and state
level.
Principle 1. Delink the IEC division as a
PR/Publicity division; it is a
professional programme
communication division
Principle 2. Coordinate IEC action at
regional/district level through
a coordinating corporartised
agency and manpower
Principle 3. Corporate/professional sector
need to be engaged for the
IEC/BCC management which
in turn builds capacity of the
government and NGO
sectors.
Principle 4. IEC needs to become
accountable beyond Utilisation
certificates (U/C). Instead of
utilization certificates one
should produce change
certifications. This could take
the form of an independent
impact assessment.
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Principle 5. IEC budgets should be
increased for specific outputs
like formative research and
monitoring and evaluations.
Principle 6. All the players in an area/
district need to work together
and be accountable on a
quarterly basis.
Principle 7. IEC work needs regular
single charge professional
heading it and wit well paid
professional trained staff.
15. Conclusion
The BCC strategy for family welfare in the
eight EAG states presented above calls
for some fundamental changes in
mindset, approach, manpower,
accountability, results orientation and
budgets. A further action plan to
operationalise and contextualise these
findings and proposed strategies would
be needed. Along with strategy,
components and principles we need to
keep in mind the following:
BCC/IEC needs to get its due importance
and be recognised for what change it can
trigger provide stimuli for action.
BCC/IEC need to evolve evidence based
strategic, audience segment specific, time
bound, result oriented plans that have
clear outputs, clear monitoring
mechanisms
Specific BCC/IEC capacity building,
training with learning and use of learning
defined in terms of outputs and
measurable indicators.
Finally we need to be proactive beyond
World Population Day, events like ICPD,
developing Population polices, answering
parliamentary questions on population
and development, and installing
population clocks.
The time to reposition and reactivate the
population agenda is urgently needed.
The role and strategy for communication
needs to be taken up seriously and
urgently in the wake of RCH-II getting to
take off in the current year.
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CHAPTER 1
Introduction / Background
India was the first country in the world
to have a state sponsored population
control programme and started the
programme of family planning as far back
as with the first five-year plan in 1951.
There has been a very steep rise in the
out lay on family planning in successive
five year plans from Rs. 1.0 million in the
first plan to Rs. 22 million in the second,
Rs. 249 million in the third. Subsequent
to the third plan, need for separate IEC
component of the family planning
activities were realized and accordingly,
allocation for this was provisioned (the
value of allocation of IEC component is
given in the parenthesis from the fourth
plan onwards). Rs. 3,844 million in the
fourth (Rs. 321.1 million), Rs. 4,974
million in the fifth (Rs. 131.3 million), Rs.
10,100 million in the sixth (Rs. 320.0
million), Rs. 32,562.60 million in the
seventh (Rs. 1,050.0 million), Rs. 65,000
million in the eighth (Rs. 1,270.0 million)
and Rs. 1,51,202 million in the ninth plan,
in which it was stated that the budgets of
the individual departments and
programmes would be prepared as per
the requirement.
The importance of education and
motivation was brought into the limelight
when the traditional clinic approach was
found to be most inadequate. ‘Extension’
wings were added to the clinics in 1963
in a bid to make them more effective.
Expertise from the field of mass
communication was brought into the
family planning programme on a very
massive scale a few years after the
adoption of the extension approach. In
fact, this aspect of family planning has
been gaining increasing importance over
the years. The strategy was to flash
continuously and repeatedly a few
meaningful, positive and understandable
messages to the public through all
modern communication media, and more
impor tantly, through the traditional
cultural media to which people are
accustomed to and in which they
participate. A great deal of mass
communication programmes were
mobilized by the mass media units of the
Ministry of information and Broadcasting,
viz. the AIR, Field Publicity Organisation,
Song and Drama Division, the
Directorate of Advertising and Visual
Publicity (DAVP) and Films Division etc.
The momentum of mass communication
was extensive and it was thought to have
a substantial impact on the birth rate. Just
as there was a ‘clinic’ phase, and
‘extension’ phase, and ‘IUD’ phase, and
a ‘time bound target phase’, one could
speak of the late sixties as a ‘mass
communication’ phase of the family
planning programme.
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1.1 NEED FOR INNOVATIVE
COMMUNICATION STRATEGY
Review of literature & evaluations show
that in India IEC activities have failed to
produce the desired results in terms of
increase in CPR, decrease in TFR and
necessary change in the behaviour of the
users. The following reasons have been
identified for the poor performance of IEC
activities in family planning programmes:
q Non involvement of stakeholders at
planning & implementation stages.
q Programme focused only on creating
awareness and not on empowering the
stakeholders.
q Aim was to promote small family size
only.
q Messages did not have variety,
continuity and were not very effective
in behavior change.
q IEC efforts were not adequately
supported by required services and
efforts to fulfill unmet needs.
q Management has been a missing or
weak link in the past efforts for
promoting IEC services.
It has been strongly highlighted in the
studies that the mechanical displays and
dissemination of generalized information
fails to create a motivation strong enough
to result in attitudinal & behavioural
change. Studies conducted in the late
eighties had also brought to light the fact
that in spite of almost universal awareness
of family planning programme, the pace
of acceptance had lagged considerably
behind awareness levels. Gaps are
observed between a positive attitude
towards family planning and its
acceptance. Misconceptions and
inhibition regarding various methods of
contraception, poor access to media
channels and even more critically, the poor
outreach of the programme functionaries
in making contacts with the community to
be served, emerged as serious lacunae
in the programme effort.
The need and main purpose of the
innovative well-orchestrated IEC Strategy
is to create intelligent demand with
assured availability of synchronous
services and well-targeted interpersonal
communication to build trust in the
diffused knowledge and to intimately
related information to specific needs of the
individual and family within the realm of
socio cultural choices. Family planning
communication programme cannot stand-
alone unless conditions are created for
child survival, introduction of reproductive
health education for boys and girls from
adolescents.
1.2 WHY FOCUS ON EAG STATES
The impact of IEC activities has been
observed to be least in the EAG states.
The socio demographic indicators in EAG
states present a very poor picture
compared to national level indicators. This
reflects a dismal performance of family
planning programme and communication
campaign. A summary (which is self
explanatory) of indicators in EAG states
reflecting the poor performance of family
planning programme & IEC campaigns is
given below:
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Particulars
EAG States
% of growth of population 1991-2001 (Census 2001)
25.0
Crude Birth Rate, SRS 2000
30.8
Total Fertility Rate, 1999
4.2
UP
Bihar
Current use of contraception, NFHS -II, 1998-1999
32.7
UP
Female literacy rate, (7+) (Census 2001)
Bihar
43.5
Median Age at Marriage (NFHS -II, 1998-99)
15.1
Exposure to mass media (NFHS-II, 1998-99)
41.7
Bihar
Rajasthan
India
21.3
25.8
3.2
4.6
4.3
48.2
24.5
28.1
54.2
16.4
59.7
27.3
36.9
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CHAPTER 2
Research Methodology
Objectives of the study
U nder the backdrop of urgent
need of an innovative
communication strategy for
family planning programme, a study has
been commissioned by the Population
Foundation of India. The study aims to:
1. Understand the reasons/factors for
poor performance of EAG states in
Family planning programme from
communication perspective.
2. Generate qualitative data base for
designing an innovative communication
strategy for family planning programme
in EAG states through:
y Literature review
y IEC material review
y Formative research (interviews
and case studies)
y Roundtable meeting and national
conference
3. Study to serve as an input for the
Department of Family Welfare’s IEC/
BCC vision strategy under RCH-II in
EAG states
Other than the Review of IEC/BCC
literature & review of IEC/BCC material -
print, audio, videos which were being
taken separately, for the research
purposes, a formative research through
interviews with the key stakeholders/
experts at national and state levels has
been carried out.
Methodology
This was a formative research study,
which was based on the in-depth interview
of the key stakeholders/experts at national
level and state level. An in-depth
questionnaire (open ended) was prepared
for interviews with the key stakeholders.
24 key national level stakeholders/experts
from academics, NGOs, policymaking,
industry and other walks of life were
identified based on their expertise in family
planning and communication. List of the
24 experts is given in the annexure -1. In-
depth interviews were conducted with
these experts based on the questionnaire.
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Chapter 3
FINDINGS/NATIONAL
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CHAPTER 3.1
Review of the IEC component of the
National Family Welfare
program in the EAG States
Background:
India has made considerable progress
in social and economic development
in recent decades, as improvements
in important indicators such as life
expectancy, infant mortality and literacy
demonstrates1 . However, the India’s
population continues to grow and stands
at 102.7 million on March 2001(Census
2001)2 . Even though some of the states
have been able to demonstrate a
substantial curtailment in their fertility,
some other states continued to have high
fertility and consequently high population
growth rate. Many survey studies including
the quinquennial National Family Health
Surveys (NFHS-I, 1992-93 3 and NFHS-
II 1998-98 4 ), the 2001 Census of India,
Reports of National Sample Survey
Organization5 , the district surveys (RCH-
I)6 , the facility surveys (RCH-I)7 and
several other studies have demonstrated
that there have been substantial
differences between states in the
achievement of basic demographic
indicators. There are wide inter-states,
male-female and rural-urban disparities in
the outcome indicators. The policy
planners had opined that the centralized
approach at the state level would work,
but long experiences have shown that with
the existing diversities in the country,
some times the planning has to be
undertaken beyond state, and at district
level. The differential performances at the
state level, clearly demonstrated that there
is a strong need for decentralized planning
process. Each state needs to be looked
at as an individual state, its requirements
up to district level, diversity, such as
addressing tribal population, need to be
addressed8 .
The performance levels of different states
show wide variations, ranging from very
high levels, to low levels of achievements.
The reasons for variations in performance
are based in the deep-rooted socio-
cultural and geographical features that are
peculiar in the Indian context. To take into
account the existing variations, it is
realized that ‘one size fit all’ strategy would
not suffice; hence a differential approach
for group of states at homogenous levels
of achievements has to be taken into
consideration9 .
National Scenario and EAG
states
As a signatory of Program of Action at
International Conference on Population
and Development at Cairo (ICPD, 1994)10 ,
India committed to wider program of
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improving holistic health services
(provision of accessible good quality
holistic health services for women and
children, with reproductive health care as
one of its component), especially at the
primary and first referral levels. With the
observations made through various
studies, the vision set by the Government
of India is to minimizing the regional
variations in the areas of Reproductive
and Child Health, through an integrated,
focused, participatory program, meeting
the unmet demands of the target
population, and provision of assured,
equitable, responsive quality services, by
adopting Mission Mode, as envisioned in
the Millennium Development Goals of
National Population Policy 2000, The
Tenth Plan Document11 , The National
Health Policy 200212 and the Vision 2020
India13 . Some of the states, however,
identified as heavily deficient in providing
required access, coverage and outreach
of basic primary and reproductive health
care, were included for focused attention
by the Empowered Action Group (EAG)14 ,
as notified in March 2001. The National
Population Policy 2000 and the
Empowered Action Group are focusing on
the identified eight states (viz. Bihar,
Jharkhand, Uttar Pradesh, Uttaranchal,
Rajasthan, Orissa, Madhya Pradesh and
Chhattisgarh), now, also known as EAG
states, as to why the improvement did not
take place across the land.
A comparison of some of the key
parameters within the EAG states and
also with national average is given in
Table 1.
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Table 1: Comparison of Some Key Indicators, India and EAG States
Indicators
India
Bihar
A. Census of India, 2001 estimates15
Jhar
-khand
Population (in million) 1028.6 83.00 26.95
EAG States
MP Chhattis Orissa Raja-
-garh
sthan
60.35 20.83 36.80 56.51
UP Uttar-
anchal
166.20 8.49
Population share (%)
100 8.07 2.62 5.88 2.02
Decadal growth rate
(1991-2001 (%)
21.34 28.43 23.19 24.34 18.06
Change in decadal
growth rate (% points)
-2.52 5.05 -0.84 -2.90 -7.67
Female literacy (%)
54.28 33.57 39.38 50.28 52.40
Rise in female literacy
(% points, since 1991)
15.00 11.58 13.86 20.93 24.88
B. Estimates from Sample Registration System (SRS-2002)16
Crude Birth Rate (CBR) 25.0 30.9 26.4 30.3 25.0
3.57 5.50
15.94 28.33
-4.12 -0.11
50.97 44.34
16.29 23.90
23.1 30.6
16.17 0.82
25.80 19.20
0.25 -0.03
33.57 60.60
9.20 18.97
31.6 17.0
Crude Death Rate (CDR)
8.1
7.9
7.9
9.7
8.7
Infant Mortality Rate (IMR)
64
61
58
85
73
C. Estimates from Rapid Household Survey (NFHS-II, 1998-99)17
9.8
7.7
87
78
9.7 6.4
80
44
Total Fertility Rate (15-49) 2.85 3.49 NA
Safe delivery (% of
total deliveries)
41.9 18.8 19.9
Contraception
prevalence Rate (%)
48.1 23.4 27.8
Children fully
immunized (%)
53.3 20.1 30.8
Sources: As quoted above (under sub headings A,B, C).
3.31
29.5
47.1
47.3
NA
22.4
40.1
59.1
2.46 3.78
32.9 33.5
49.4 40.5
57.4 36.9
3.99 NA
21.9 22.3
29.1 39.9
44.5 62.8
Table 1 clearly depicts that the EAG states
have some of the poorest socio-
demographic indicators in India with
significantly high level of fertility. In view
of this, the Department of Family Welfare
has moved a proposal for augmenting
existing management and monitoring
capacities in the health and family welfare
system, to enable these states to upscale
their performance in order to meet the
NPP goals. The notification of EAG by the
Ministry of Health and Family Welfare
coincides with the conclusion of the Ninth
Five Year Plan (1997-2002)18 . This
provides the EAG with a unique
opportunity to make a difference at the
national level and by extension, at the
state and district levels as well, within
these eight states.
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approach and developing about 400
prototype material to disseminate
appropriate knowledge, allay fears,
provide information on accessibility of
information and services and also
stimulating inter personal contacts.
However, 1975-76 saw a set back to the
program due to negative impact of
sterilization program and the program
could be revived only in late eighties and
early nineties under the new name of
‘family welfare program’23 . During next
three Plan Periods, redefined
communication strategies, essentially
brought in issues such as, ‘beyond family
planning’, by including issues like child
survivorship and improving status of
women in the program24 .
Shifts since ICPD and thereafter
In the wake of the country’s acceptance
of Global Agenda of ICPD25 , the
Government of India launched the
reproductive and child health program in
1997. This represented a radical shift in
the Government’s policy as it moved away
from obsession with sterilization targets,
to a bottom up decentralized participatory
planning process based on community
needs assessments. The program covers
an extended range of services for
unwanted fertility, maternal health, RTI/
STI infections, child health and adolescent
health.
RCH and communication
framework
The new paradigm embodied in the RCH
program generated a strong demand for
new initiatives in the IEC campaign. Under
the MoH&FW, a media committee
comprising experts in the field of
communication, representatives of donor
agencies, NGOs, Media Units of Ministry
of Information and Broadcasting etc, was
formed to oversee the media policy. Some
of the recent efforts made by the Ministry
of Health and Family Welfare in this
direction include26 ;
q Decentralization of communication
efforts (mainly through 228 district
level ‘Zilla Saksharata Samities’, ZSS)
q Training and capacity building, by
involving National Institute of Design
and National Institute of Health and
Family Welfare.
q IEC campaign for social mobilization
for Pulse Polio Immunization.
q NGOs involvement in grassroots level
communication.
q Outreach activities through ‘melas’ and
camps.
q Emphasis on behavioral change
communi-cation (BCC)27 using multi
media and multi level communication
campaign, including inter-personal
communication techniques.
Soon after the RCH paradigm shift
towards, client centered, demand driven
services, they needed strategic
communication to work as a tool, to create
demand for quality services. The
communication challenge for RCH is one
of demand creation and this required
understanding of media opportunities,
professional procedures and use of
marketing approaches. To encourage
individuals, families and communities to
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make informed decisions concerning
reproductive and child health, a program
of health communication, which facilitates
behavioral change, National
Communication Strategy28 was
formulated for RCH program.
Communication must be viewed
essentially as the process of empowering
people to build their knowledge, skills and
ability to act on their own health and family
planning needs. The inadequacy of IEC
activities and their congruity of
perceptions between service providers
and the recipients have resulted in low
level of knowledge about contraception,
their utility, safety etc.
Focus on adolescents
An important component of RCH program
is special interventions for adolescents,
which constitute a large segment of the
population. Even though its importance as
a segment, ready to join reproductive age
group, is well recognized, only sporadic
attempts have been made to address this
group. While UNFPA29 , along with its
partner agencies such as, UNICEF, UNDP,
UNESCO, ILO, with collaboration with
NCERT and other government institutes,
address the issue through Universalisation
of Adolescent Education (UAE), NGOs like
‘Parivar Sewa Sansthan’, Family Planning
Association of India and ‘Mamta’ have been
active by conducting Family Life Education
(FLE), under their broad based family
program efforts.
Manpower for IEC efforts
A further review of information, education
and communication (IEC), as a strategy
in the past shows, that there was a well
trained District Extension Educator, at the
district level and one Block Extension
Educator (BEE) at block level, who were
well trained personnel, mostly with post
graduate degrees in social works30 . These
people were supposed to train
supervisory staff, as well as the grass root
level workers (ANM and male workers) on
a regular basis in undertaking inter-
personal communication at the community
level and oversee their functioning, along
with the medical officer posted at the PHC
level. Some how the arrangement did not
work as desired and BEE preferred
sharing more of the administrative
responsibility with PHC medical officer
and the IEC and training, the major
responsibility of his, took a back seat. As
a result, the IEC efforts at the grass roots
were without any direction and the grass
roots worker, with their very limited
knowledge and skills in IEC, continued to
disseminate the program specific
messages, as and when they were asked
to do. In fact, even though the ANMs, the
main family planning motivator staff at the
grass roots, were provided training on
various occasions, including that under
IPP program and RCH in their skill
development, the IEC component was just
touch and go, during these skill
development courses. As a result, ANMs
is continuing using their over a period
acquired skills in motivating their target
groups, which remained much lower
efforts than required. Even though the
BEE cadre does not exist any longer, the
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health education and information officers
(HEIO) having taken their place, most of
them have been promoted from
supervisory cadre with hardly any skills
to play the assigned role as envisaged for
BEE. This has been a major bottleneck in
the program at the grass root level.
Issues and Gaps in the FW
communication
Studies conducted in the late eighties31
had also brought to light the fact that,
in spite of almost universal awareness
of family planning through the red
triangle, symbolizing the program, the
pace of acceptance had lagged
considerably behind awareness levels.
Gaps were observed between a
positive attitude towards family planning
and its acceptance. Misconceptions and
inhibition regarding various family
planning methods, poor access to media
channels and even more critically, the
poor outreach of the program
functionaries in making contacts with the
community to be served along with their
very limited capacity to pass on right
messages, emerged as serious lacunae
in the community efforts. The main
purpose of a well orchestrated IEC
strategy is to create intelligent demand
with assured availability of synchronous
services, a well targeted inter personal
communications to build trust in the
diffused knowledge and to intimately
relate generalized information to
specific needs of the individual and
family, within the realm of socio-cultural
choices.
Efforts at addressing
communication issues
In order to achieve the goals of family
welfare adopted by GOI to be
accomplished by 2000 AD, an action-
oriented agenda was set down that
comprised of expanding access to
services, improving quality of services and
increasing demand for services. In this
connection MOHFW felt it necessary to
develop a long-term IEC strategy for the
National Family Welfare Program.32
Operations Research Group33 was
contracted to research and develop a
strategy with the technical assistance of
Johns Hopkins University/Population
Communication Services (JHU/PCH). A
fairly comprehensive report was
submitted in September 1992, but this
comprehensive review report was never
utilized for any purpose. Another review
of a recently World Bank funded (2001-
02) intensive IEC program for RCH
communication in ten states of India
suggested that there are many state
specific and common problems being
faced by most IEC officers/divisions in
these states, in relationship to
infrastructure and delivery mechanism34 .
Observations on the
communication programme
components
Avik Ghosh35 in his comprehensive review
felt that interpersonal communication
skills of service providers, their sensitivity
towards clients’ needs and their
performance, have to improve, for
improving family planning program.
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Besides IEC strategy has to be based on
community needs assessments, audience
segmentation and field-testing of
materials. Emphasizing on BCC, which is
a complex strategy, he felt a need for
greater attention from program managers,
service providers, donor agencies and
policy makers. A similar feeling was also
expressed by JRD Tata36 in one of his
observations on India’s failure of its
population program in 1992, “A major
cause of our failure to achieve fuller and
quicker results in our family planning and
health programs has lain in a failure of
communication”.
Suggested framework for
communication efforts
The recent strategy framework suggested
by MoH&FW envisaged some of the
following37 :
q Where health seeking is already high
and there is a demand for services,
the strategy would be to strengthen the
quality of service delivery.
q Where knowledge and health seeking
itself is not up to the desired levels,
the priority would be placed on placed
on enhancing knowledge including
skills and provision of easily implement
able approaches in order to
demonstrate the utility and necessity
for seeking and using services.
q Emphasize on the well-designed
communication strategies, covering a
set of focused issues at different
stages of the progress of the program,
depending on the outcomes realized
through the communication. For the
purpose emphasis is placed on the
following:
y Planning should be based on
analysis of state level requirements
as assessed from district level
requirements.
y Differential approaches based on
states’ scenario.
y Encourage and gather evidences
for decentralized planning at state
level.
y Plans to be prepared by states,
based on the overall guidelines
provided by the national
framework, and
y Special attention for EAG states.
Study by CMS on IEC operations
In another study commissioned by the
Ministry of Health and Family Welfare,
GOI, on IEC operations of RCH program,
carried out in five states of India (UP,
Punjab, MP, Karnataka and Tamil Nadu),
CMS38 felt a need for ending of a long
prevailed suspense and suspicious as to
cost benefit aspects of IEC in behavior
change context, called for a unit cost
analysis approach as benchmarks,
especially in the context of family welfare
and RCH programs. A four member Core
Group39 was formulated with an objective
to prepare work plan on how service,
training and research could be simplified
if the core group approves the production
of an illustrated district profile identifying
the multi-factorial issues that need to be
taken into consideration for preparing the
district plan on behavioral change
strategies.
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Understanding the “BCC” paradigm in the
FW Program
This clearly indicated a need for
developing specific Behavioral Change
Communication (BCC) strategies. The
issues, which need to be addressed for
the purpose, include40 :
q BCC is currently very generic
q Thematic and segmented approach is
not there
q Objectives of IEC are not clear, and
q It is being carried out as just another
activity without considering its
potential.
In the Indian family planning program,
BCC has so far been mainly based on
generic published material and has not
focused on client needs. Very few efforts
have been made to emphasize on media
planning, even though its importance was
well realized. Similarly importance of
advocacy and social mobilization has
been recognized, but not orchestrated.
Further, inadequate understanding
among program planners, about the
difference between IEC and BCC has led
to unproductive training, without taking
into consideration the over all
communication need strategy. Insufficient
capacity to develop required material and
implement strategies, along with
inadequate budget, added to non-
coverage of the last mile.
Some success stories in BCC
initiatives
Some of the strategies adopted in isolated
projects however, produced good results.
These include, ‘Goli ki Hamjoli’ for Oral
Pills41 , PSIs ‘Balbir Pasha’ for HIV/AIDS42 ,
SIFPSA’s ‘TT Campaign’43 , GOI /
UNICEF’s ‘Polio Eradiation Campaign’44 ,
and ‘Janani Program’ in Jharkhand and
Bihar45 , which have successfully been
able to achieve behavior change through
communication in the target audiences.
Planning for IEC/BCC in RCH-II
To address the above issues, the RCH
second phase46 , set the following strategic
milestones for under taking the IEC
activities:
q Emphasis should be placed on
development of BCC strategy.
q Overall national priorities and desired
behavior change should be used to
arrive at strategy.
q Based on national BCC strategy –
states should adapt/adopt it to develop
state specific objectives and
strategies.
q Emphasizing on viewing BCC as a
change driver an adopt this to impact
the drivers impacting on the outcomes.
q Trained human resources and
partnership with NGOs/CBOs should
be reckoned.
q Linkages of present IEC structure
would be reckoned
q IEC input and output linkages should
track for optimal utilization of the IEC
resources.
q Emphasis should be placed on
increasing the health /life skill issues
in elementary and secondary
educational syllabus.
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q Accessing religious and traditional
channels for dissemination of ‘Health
Values’, Hygiene, HIV/AIDS, no to
early marriages, no to gender violence
and no to female foeticide.
EAG core group on BCC
In a meeting discussing the core group
on BCC, the Joint Secretary, Family
Welfare47 (November 2001) stressed the
need to strengthen the systems within
EAG states so as to enable them to
pursue the national agenda for family
welfare.The secretary further emphasized
on need for developing state specific
operational strategies for behavioral
change communication. A caution,
however, was also expressed that with the
striking diversities in demographic and
epidemiological within the EAG, only
strengthening of the BCC would not be
enough to serve the objective of bringing
about changes in health seeking behavior
of people on ground, unless these efforts
are accompanied and supported by
service delivery which is visible,
identifiable, available, and affordable.
Establishing Technical Support
Agencies for EAG states
Recognizing the importance of IEC in the
Indian Family Welfare program, more so
for the EAG states, the Department of
Family Welfare has decided to hire
services of Expert Technical Support
Agencies48 (TSAs) to assist 8 EAG states
in development and implementation of
behavioral change communication
strategies besides providing support for
building of state and district level
capacities within the public health system
or through partnerships of NGOs. The
major tasks to be performed in close
partnership with the respective state
government and the officials, institutions
and partners, as identified by the Health/
FW Secretary of respective state
governments are as given below.
q Develop a comprehensive advocacy
campaign, targeting opinion leaders
and policy makers
q Make a thorough assessment of
resources of functionaries, infra-
structure, equipments etc within a
department and also with private and
NGO sector.
q TSA to undertake a review of available
studies, reports and documents to
make an assessment of the behavioral
change needs of the people, using
formative research.
q Basing on the results, develop
behavior change strategies for clients,
service providers, and inter-sectoral
partnerships including private and
NGO sectors.
q Development of implementation plans
for behavior change campaigns.
q Implementation of advocacy
campaign.
q Management structures and system
development.
q Capacity building of functionaries
and other stakeholders including
NGOs.
q Implementation of BCC campaign.
q Monitoring and reporting.
IEC “vision” of the MOHFW
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The formation of TSAs brings out that the
Government of India is quite serious about
bringing in the behavior change among
people on RCH issues, especially in the
EAG states. IEC has been always a
significant component of the GOIs Family
Welfare Program. The IEC Vision for 2004-
0549 attempts to put emphasis on
designing the strategies for creating
awareness, enhancing visibility for policy
initiatives and create opportunities for
advocacy through multi media tools for
new initiatives. The targeted areas for the
vision are:
q IEC strategies would be synergized
with the overall objective of
strengthening the health and family
welfare services in the 150 high fertility
districts and demographically weak
EAG states, under the common
minimum program.
q IEC activities to be focused in
demographically weak states with
special focus on EAG states, which
hold the key for population stabilization
program.
q The North Eastern regions constitute
another key segment of IEC
interventions. A total of 10 percent
budget outlay is earmarked for the
region.
q The state IEC bureau to coordinate the
IEC interventions according to vision
document and
q Specifically IEC would target the un-
served population groups, the girl
child, mothers and children etc.
Some of the issues that would be
addressed have been identified for each
category of the target group. To position
the themes, the IEC division would utilize
multi-media tools in print and electronic
streams. The focus would be to generate
awareness, create content for information
dissemination and publicize initiatives
through inter personal, community based
and mass media communication.
In a recently held meeting of EAG states
under the Chairmanship of Deputy
Chairman, Planning Commission50 in
April, 2004, one of the major decision
taken includes, “Family planning for
limiting family size and promoting the
small family norm among eligible couples
would be emphasized as the core
activities under the family welfare program
along with the concerns for improving the
mother and child health”.
Looking forward
The strategic decisions taken clearly show
that GOI is seriously considering stressing
upon continued and more serious
emphasis on IEC, with BCC as the front
line approach in Indian family planning
program, more so in EAG states,
particularly. The strengthening of service
delivery has, however, to be taken up to
provide effective back up to the efforts
made.
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References:
1. The World Bank, Improving Women’s Health in India, Development in Practice, the World Bank, Washington, D.C, 1996.
2. Registrar General of India, Primary Census Abstract; Census of India, 2001, Office of RGI, New Delhi, 2002.
3. IIPS, National Family Health Survey-1992-93 (NFHS-I), Ministry of Health and Family Welfare, New Delhi and IIPS, Mumbai,
1994.
4. IIPS, National Family Health Survey-1998-99 (NFHS-II), Ministry of Health and Family Welfare, New Delhi and IIPS,
Mumbai, 2000.
5. Central Statistical Organization, Selected Socio-economic Statistics, India, 1998, National Sample Survey Organization,
1999.
6. IIPS, Reproductive and Child Health Survey (RCH-I), District Level Household Surveyl, Ministry of Health a nd Family
Welfare, New Delhi and IIPS, 2002-03.
7. IIPS, Reproductive and Child Health Survey (RCH-I), District Level Facility Survey, Ministry of Health and Family
Welfare, New Delhi and IIPS, 2002-03.
8. Government of India, Family Welfare Program in India, Year Book, 1999-2000, Ministry of Health and Family Welfare,
New Delhi, 2000.
9. Ministry of Health and Family Welfare, National Population Policy, 2000, Department of Family Welfare, MOHFW, New
Delhi, 2000.
10. ICPD, International Conference on Population and Development, Cairo, September 1994.
11. Planning Commission of India, Tenth Five Year Plan Document, 2002-07, Ministry of Planning, Yojana Bhawan, New Delhi,
2002.
12. Ministry of Health and Family Welfare, National Health Policy, 2002, Department of Family Welfare, MOHFW, New Delhi,
2002.
13. Ministry of Health and Family Welfare, RCH Vision for the Year 2020, Department of Family Welfare, Government of India,
New Delhi, 2004.
14. Ministry of Health and Family Welfare, Empowered Action Group (EAG)- First Business Session, Vigyan Bhawan, New
Delhi, June 2001.
15. Census of India, 2001, Primary Census Abstract, Final Population Totals - 2001, Registrar General, India, New Delhi,
2001.
16. Census of India, Estimates of Vital Events, Sample Registration System (SRS), 2002, Registrar General, India, New
Delhi, 2003.
17. IIPS, National Family Health Survey-1998-99 (NFHS-II), Ministry of Health and Family Welfare, New Delhi and IIPS,
Mumbai, 2000.
18. Planning Commission, Ninth Five Year Plan (1997-2002), Ministry of Planning, Government of India, 1997.
19. Ministry of Health and Family Welfare, Information, Education and Communication in the Department of Family Welfare,
Department of family Welfare, New Delhi, June 2000.
20. Ministry of Health and Family Welfare, Mass Education Media (MEM) Strategy, 1966-69, Department of family Welfare,
New Delhi, June 2000.
21. Planning Commission, Fourth Five-Year Plan (1969-1974), Ministry of Planning, Government of India, 1969.
22. Planning Commission, Fifth Five-Year Plan (1975-1980), Ministry of Planning, Government of India, 1975.
23. Banerjee, Sumanta, Family Planning Communication- A Critique of the Indian Program, A Family Planning Foundation
/Crendit Book, Radient Publishers, New Delhi, 1979.
24. Ministry of Health and Family Welfare, Integration of Mother and Child Health Program with Family Planning, Family
Welfare Program Approach, Department of Family Welfare, GOI, New Delhi, 1980.
25. ICPD, International Conference on Population and Development, Cairo, September 1994.
26. Ghosh, Avik, A Review of the IEC Component in the RCH Program, unpublished paper, February, 2004.
27. Ministry of Health and Family Welfare, RCH II and Family Planning – Program Implementation Plan, Department of
Family Welfare, GOI, New Delhi, April 2003.
28. Ministry of Health and Family Welfare, National Communication Strategy for Reproductive and Child Health Program,
Department of Family Welfare, Government of India, New Delhi, 1998.
29. UNFPA, Country Paper for South Asia Conference on Adolescents, Department of Family Welfare, New Delhi, July
1998.
30. Banerjee, Sumanta, Family Planning Communication- A Critique of the Indian Program, A Family Planning Foundation
/Crendit Book, Radient Publishers, New Delhi, 1979.
31. Ghosh, Avik, IEC for Promoting Behavior Change in the Population, Health and Nutrition Sector-A Review, Report
Submitted to the World Bank, 1998.
32. Ministry of Health and Family Welfare, Intensive IEC Program for RCH Communication, A World Bank Funded Project,
2001-02, New Delhi, 2003.
33. Operations Research Group, Review of Research and Development of Strategies for IEC in Family Welfare Program,
Study submitted to the Department of Family Welfare, GOI, In collaboration with JHU/PCS, New Delhi, September, 1992.
34. Ministry of Health and Family Welfare, A Report on Intensive IEC program for RCH Communication, Department of
Health and Family Welfare, government of India, 2003.
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35. Ghosh, Avik, IEC for Promoting Behavior Change in the Population, Health and Nutrition Sector-A Review, Report
Submitted to the World Bank, 1998.
36. J R D Tata, Encounter with Population Crises - Population, Poverty and Environment, Family Planning Foundation,
New Delhi, 1998.
37. Ministry of Health and Family Welfare, A Report on Intensive IEC program for RCH Communication, Department of
Health and Family Welfare, government of India, 2003.
38. CMS, IEC Operations of RCH Program in Five States of India, Report submuitted to Ministry of Health and Family Welfare,
Government of India, New Delhi, 2001.
39. Anand D, Cunha GD, Dyal Chand A and Almas Ali, Behavioral Change Strategies, Document prepared by the Core Group,
National Institute of Health and Family Welfare, GOI, New Delhi, November, 2001.
40. Kakkar, Pradeep and Hazel Slavin, Behavioral Change Communication in the Reproductive and Child Health Program
II, DFID Health System Resource Centre, London, February 2004.
41. Hinustan Latex Limited, Behavior Change & Communication Change in Eight States of Northern India through Goli ki
Humjoli Campaign, Ministry of Health & Family Welfare, GOI, New Delhi, 2003.
42. PSI, Balbir Pasha HIV/AIDS Campaign in Red Light Districts of Mumbai, MC SACS, Mumbai, 2003.
43. SIFPSA, Innovations-A quarterly Newsletter of State Innovations in Family Planning Project Agency, Lucknow, March
2004.
44. UNICEF, A Critical Leap in Polio Eradication in India, UNICEF Working Paper, India, 2003.
45. Janani, The Janani Social Franchising Program in Bihar and Jharkhand, Titli Network/Surya Clinic, Patna/Ranchi, 2003.
46. Kakkar, Pradeep and Hazel Slavin, Behavioral Change Communication in the Reproductive and Child Health Program
II, DFID Hea.
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CHAPTER 3.2
Interviews with stakeholders
Methodology
This was a formative research study,
which was based on the in-depth interview
of the key stakeholders/experts at national
level and state level. An in-depth
questionnaire (open ended) was prepared
for interviews with the key stakeholders.
24 key national level stakeholders/experts
from academics, NGOs, policymaking,
industry and other walks of life were
identified based on their expertise in family
planning and communication. List of the
24 experts is given in the annexure -1. In-
depth interviews were conducted with
these experts based on the questionnaire.
4. Findings
The findings of the study (based the
analysis of qualitative data generated
through in-depth interviews) have been
classified in the different sections. The
findings are primarily qualitative and
exploratory in nature. The different views
of the experts have been incorporated in
the form, most pronounced finding as well
as counter views expressed by some
experts.
4.1 IS THERE ANY NEED FOR BEHAVIOUR
CHANGE
Stakeholder analysis highlighted that
Family Planning is a felt need of the
people. Though the magnitude of the felt
need has varied across states and
sections of the society. The analysis also
reflects that there is a definite need of
behaviour change communication.
Various factors were identified by the
experts responsible for poor performance
of communication campaign & thus reflect
the need for an effective behavior change
communicating campaign.
It was pointed that strategically still the
focus of family planning programme in
India has been on IEC and not on BCC.
The programme went through a
paradigm shift after Cairo Conference
but corresponding paradigm shift in
the behaviour change did not take
place. Unlike other services, the
communication package did not
experience growth and innovation.
It was further pointed that despite high
awareness levels of the family planning
programme, health-seeking behaviour did
not improve. Further, access, practices,
affordability and quality are serious
concerns reflecting the urgent need of
behaviour change communication. The
need for BCC is both for the community
and the service providers (primarily for
advocacy).
Further research on finding out specific
felt need of the people has been
advocated. Still there is lack of clarity on
community needs. So far, the
communication strategy has been adhoc
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and sporadic.
The prime unmet need for beneficiaries
is related to service delivery & quality of
service. There is felt need of
contraceptive use by women, which is
still unmet. Need to address the issue
pertaining to men and their involvement
still needs to be addressed.
Prioritization of needs based on a matrix
need to be carried out.
It was equally emphasized by the
experts that for BCC it is very crucial
to identify whose behaviour needs to be
changed, what are the current
behaviour practices and perceptions.
Son preference and age at marriage are
the issues, which have not been
addressed by the IEC. More studies on
cultural norms and impediments need to
be carried out. Other crucial issues like
age of the marriage and utility and
availability of the spacing methods are
to be emphasized.
Currently, sterilization is identified as a felt
need, however, injectables and
emergency contraceptives need to be
promoted and introduced in the
programme. Also there is strong
misconception about IUD and safe
abortion that needs to be eliminated.
birth of child. LAM is not a full proof FP
method for preventing pregnancy.
In the Indian situation, two strangers get
married and get into sexual activities even
before knowing each other. This leads to
unwanted pregnancies. The women need
to be sensitized in this regard to have safe
sex until attaining 21 years of age by using
pills etc. In the mean time efforts should
be made to encourage the male counter
part to use condoms and other spacing
methods and mutually decide upon the
family size.
People have not understood the spacing
needs. Currently the felt need is for the
terminal methods, that too heavily leaning
towards the female sterilization. So, a
paradigm shift is required to create the
awareness of spacing of the childbirth,
especially among the men folks.
There is a need for evolving Service
Backed Specific IEC Intervention that
would clearly mention the place and
kinds of services available,
improvement in the quality of the
services and how to access the
services.
It was also pointed out that still not
much work has been done to define the
needs of the poor.
Delay and the spacing of birth of the first
two children are very crucial. This is
because women can’t articulate their need
and there are significantly high numbers
of cases of abortions following the first
Needs of the providers are the most
crucial in BCC as their mind set still
focused on contraceptive based
approach. Because of the issues related
to delay in age of marriage, delay in first
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pregnancy and delay in inter pregnancy
interval there is need for BCC.
It was also highlighted that to understand
the unmet needs related to family planning
and factors influencing the needs require
more ethnographic and demographic
studies.
social norms of old age support and dowry
related issues have not changed and
status of women and employment status
have not improved even. Son preference
particularly for the poor is major reason
for having more children, which a poor
person cannot afford. It needs to be
addressed.
So far, people feel the need of FP only
when their family size is completed and
the messages evolved and conveyed by
the government has been responsible for
that. However, there has been a change
in the perception of the people
regarding FP and now it has been
based on the value of small family. At the
same time the issues of availability of
quality health services has also been
crucial.
A particular respondent strongly argues
that tubal legation is the present felt need
of the people, which is eventually not
available readily. However, this is not going
to help in the issues of the liberation of
the women, better economic status etc.
Contrary to the earlier statements,
respondents also feels that there has been
felt need for having less children and of
FP in the EAG states and the methods
having least maintenance cost are
preferred.
4.2 SON PREFERENCE
The experts acknowledged existence of
strong son preference, for example, a
survey conducted in Assam 90 per cent
of the respondents preferred a son. The
However, some of the respondents are of
the opinion that the educated people have
started thinking differently and give equal
value to both son and the daughter.
Some experts opined that son preference
needs more BCC than dreaded disease
like AIDS.
4.3 POVERTY & BEHAVIOUR CHANGE
It was emphasized that poverty plays a
very important role in communication
effectiveness. The suggestion was to
address the needs of the poverty. However
the programmatic interventions with BCC
can also bring the desired change. We
should not wait for poverty to go before
starting a BCC campaign in EAG states.
Also, issues like education, nutrition and
good governance to be incorporated in the
BCC campaign.
Adoption of FP itself is a move towards
poverty alleviation. If the same is done in
EAG states, it will definitely have an
impact. Further consolidation can be
achieved through better programme
intervention and good governance.
4.4 INCENTIVES AND BENEFITS
The benefits of limiting family size, either
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as its outcome or as a part of the
programme needs to be studied. Access
to food and improvement in education due
to small family size can certainly be real
benefits achieved by limiting the family
size. The experts opine that the single
tangible benefit achieved so far is the
reduction in the incidence of IMR.
Certain experts discouraged external
benefits, however, poorest of the poor
could be given incentives. The tangible
benefits, if any, should be related to better
livelihood and the safety of the procedure.
It was also pointed that the community is
aware of all the tangible benefits like less
diversion of the resources, logistical
support and other economic factors.
4.5. AUDIENCE: ANALYSIS AND
SEGMENTATION
It was highlighted that the specific
audience in EAG States have not been
understood well. No segmentation has
been done among newly weds; late
adolescents are left out completely. It has
been suggested to carry out the
segmentation in close coordination with
programme planners and the district
authorities.
Audience segmentation is a critical issue
and should be a starting point for a
communication strategy. The program
should target the newly married.
Segmentation of adolescents and
addressing the needs of the adolescents
is very crucial in achieving the success of
the FPP. So far, there has been scarcity
of data on adolescents. Their needs are
very different and should be addressed
differently. Creation of favorable
environment and job opportunity can be
very instrumental in addressing their
needs.
There has not been significant effort from
both NGO and public health providers to
understand the needs of the adolescents.
Further more there was a handicap due
to the lack of experience in the field. And
segmented target groups like late
adolescents (16 - 18 years) and newly
weds are to be given more emphasis.
There has been an effort from CINI to
develop BCC materials for the targeted
groups with the help of communication
experts.
Male involvement in the FP programmes
has so far been negligible, both at ground
level and policy levels. FP programmes
are still not gender sensitive.
4.6. INFLUENCERS
It was highlighted by the experts that
influencers like MIL, Husband, FIL, SIL
and other relatives were not well
addressed in the BCC/IEC campaign. It
was not a part of the programme design
though their influences were recognized
in the programme. More research on
influencers, their identification & roles
needs to be carried out primarily at local
level.
Influencers like village leaders, school
teachers, role models and religious
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leaders are instrumental in influencing and
need to be incorporated in the BCC
campaign. However, some of studies are
also pointing out that AWWs, RMPs etc.
have been more influential than those
mentioned earlier. At the same time, it
should also be learned from the earlier
programmes that the campaign should not
be just limited to the awareness creation
of the influencers, but their active
participation should be structured in the
campaign.
The influencers need to be educated
about the concepts of X and Y-
chromosomes to influence and convey the
message to the masses in more effective
ways.
The husbands are still considered to be
the principal decision makers.
4.7 PERCEPTIONS & BELIEFS OF FAMILY
PLANNING
It was clearly pointed out by some of the
experts that the magnitude & direction
of change among the perceptions and
beliefs of the people about family
planning has been negligible. The major
reasons identified for this operated at
three levels:
q Family level: the family members did
not internalize the benefits of small
family.
q Community level: strong social norm
of son preference continues due to
economic & old age security.
q At Health System level: the providers
and services were consistent in quality.
4.8 POLICY
Various issues were identified by the
experts for making the policies
comprehensive, broadbased and
effective. The policy gaps, incorporation
of various stakeholders in the policy
making and the formulation of appropriate
strategies were emphasized by the
experts. A summary of the policy level
issues identified and measures that are
being adopted by the government are as
follows:
q There is no specific policy for men and
they need to proactively involved in the
family planning programmes to bring
desired changes
q Ministry is looking into the issue of
covering the private doctors by
indemnity insurance to make them feel
comfortable to participate in the FP
programme
q More utilization of the trained dais with
motivating incentives of Rs. 100 for
each case of sterilization and
immunization coverage, Rs 200 for
helping to conduct delivery at clinic
and Rs. 50 when delivery takes place
at home. Budget allocation for each
Dai would be Rs. 7000 - 8000 per year.
q Steps for more market oriented
approach than simple IEC/BCC
needs to be generated.
q Population should be treated as one
of the lead issues at every level.
q Govt. policy decision is needed for new
contraceptive methods.
q The EAG states are to be compared
amongst themselves to evaluate their
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performances and to evolve new
strategies about their BCC needs.
q There should be a regulatory
mechanism wherein the physicians
should be sent for the compulsory field
training before they are posted at the
PHCs.
4.9 MEDIA TYPES AND MESSAGES
The focus of media and the messages
should be on creating proper environment
for service providers and families. Govt.
should increase the budget for both media
and message effectiveness. It was also
pointed out that govt. should have long
term vision, at least for ten years, along
with annual action plans for use of media
and messages of FP. The NGOs need to
be involved more proactively in media and
message delivery. Still not much has been
studied about the effectiveness of different
kinds of media and messages in the
country in specific areas of FP. Following
specific issues were raised by the experts
on Types of Media and Structure of
Messages to be used in the family
planning programme:
A. MEDIA TYPES
q Counseling and interpersonal
relationships to be used to reach out
to the families.
q The potential of cinema halls, film
posters and local melas has not been
utilized as effective media for message
delivery.
q In remote areas, IPC is the most
critical and important media for BCC
and FP messages. It has been given
least priority and needs to be
structurally incorporated in the design
of the communication programme with
appropriate financial support. A
separate cadre for IPC can be
developed to engage in FP
programme. Govt. should become the
force multiplier and identify outside
support and coordinate activities.
q Proper and balanced mix of TV and
news papers can be effective in
conveying the messages of FP. Data
shows that the TV is the leading media
to convey the messages and would be
very helpful in projecting the image
and the quality of services as well.
However, before adopting the medias
of campaign, extensive media analysis
needs to be carried out.
q Folk media can be yet another
effective medium of communication
of FP messages particularly to the
far flung rural and tribal areas
through the performances of
Nautanki, Jatra, Folk Songs, Baul
songs etc.
B. MESSAGES:
q The slogan‘Chota Parivar, Sukhi Parivar’
has been strongly rejected by the
experts. It was opined that the issue
of “Child Survival Needs” should be
the focus of slogans and media
campaigns. More research should be
carried out on what slogans can work
and what will not work. Appropriate
mix of messages based on strong
research should be undertaken to
address the different needs of
different categories of audience.
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q Existing IEC has been looked as an
anti-poor advertisement.
q There should be a basket of culture
specific messages customized to
media type.
q There is no continuity among the
messages, hence, the message
contents need to be revised thoroughly
& which should have appropriate mix
of continuity and change.
q There should be lot of innovation and
frequent changes in the messages to
sustain the interest of the audience in
the key theme of the message.
q One-liners are very effective reminders
and should be largely incorporated in
the programmes.
q E-chaupals to convey the messages
of FP can be formed.
q It was also suggested the new slogan
“Bharat Barhao - Abadi Ghatao” may
be the key message of the
communication campaign.
q There is a need to address the women
activists groups.
q Alternative communication channel
like community radio, comic strips,
community news papers should be
tried out.
4.10TRAINING AND CAPACITY BUILDING
The capacity building of the service
providers for new communication
methods, techniques, skills, approaches
and development of curriculum and
teaching practices needs to be carried out.
Generally, methods have been clinical and
non-clinical. For clinical methods nothing
needs to be done for capacity building
except the knowledge enhancement and
IPC skills improvement of the service
providers. There is huge scope of capacity
building for non-clinical methods of
communication. Refresher trainings
should be carried out more vigorously in
EAG states. Appropriate technology
application is needed for capacity building.
Training in new methods like safe abortion,
use of MVA and injectables has to be
integrated in the technical section of the
curriculum. NIHFW needs restructuring
and revamping.
Training institutes need to be revitalized.
The infrastructure and training facilities are
in pathetic state and IEC training is also
out dated. Trainers’ skills are to be
upgraded and right kinds of trainees to
be sent for the programme.
A number of NGOs are contributing in the
area of FP but the approach has been
very individualistic and there is a lack of
sharing of the curriculum amongst
themselves. This has been a gray area
and needs to be given a re-look.
Finally, a shift is suggested from IEC to
BCC into the entire communication-
training package.
4.11 THEMATIC IN FP COMMUNICATION
CAMPAIGN
The focus of communication campaign
has been limiting the family size rather
than spacing of the children. The
preference of audience in the EAG states
has not been properly understood.
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Concretization of the slogans of the
benefits of small family has not been tried.
Hence, no benefit could be extracted from
it. Also more emphasis should be given
to the issue of TFR.
Finally, the felt needs of the people,
particularly in the EAG states could not
be met due to the shortage of supplies,
as pointed out be the NFHS data.
4.12 IMAGE BUILDING
Image of the FPP has improved over a
period of time, though the improvement
has not been uniform across the states
and communities. An image building
exercise is needed both for the service
providers as well as service centres. The
quality of the service has not improved to
infuse the trust and build the image of FPP
among audience.
the light of HIV/AIDS programme. To
understand the exact dynamics of it, the
different opinion makers emphasized
some field level research.
Yet another programme of pulse polio has
taken the centre stage and diminished the
importance the FPP.
4.14 ATTITUDE OF THE SERVICE PROVIDERS
Need of capacity building of the service
providers was identified as the one of key
areas of intervention. Public service
providers are still equipped with age-old
technologies and often possess
inadequate knowledge on the modern
methods of FP like EC, DMP etc.
Physicians on the other hand feel that
counseling on FP is not their domain. So,
there should be a change in the mindset
at all levels.
Quality has to corroborate with FP
messages in different media. Field level
services should be backed up through
proper quality referral services.
At the same time the political will and
commitment of the bureaucrats has to the
strengthened which will in turn infuse the
trust amongst the community.
4.13 RCH VS. FP
HIV/AIDS programmes have over
shadowed the FPP. FP communication
needs to be repositioned in this context.
Incorporation of FP messages in HIV/
AIDS messages should have been
exercised. However, there were also the
opinions that FP has lost its visibility in
Further, the general behaviour of the grass
root level service providers has been
unfriendly & discouraging. This has
repelled/ deterred the clients to seek
services of FPP.
415 GAPS IN FAMILY PLANNING
PROGRAMME
Following gaps have been identified by the
experts/stakeholder in family planning
programme
q At advocacy level equal focus should
be given on quality of services, service
providers, and factors influencing
family planning, like age at marriage,
son preference etc.
q Male involvement has been totally
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neglected in the family planning
programme & strong measures should
be taken to involve them at various
levels.
q Data generated & figures are not
reliable and there is no way to
revalidate the data.
q For better management of the
programme short term and focused
interventions are required.
q Translation of policies into
programmes and actions are very
limited and needs strong focus.
q Inter-sectoral coordination needs to be
strengthened.
q There is lot of confusion among the
people about the programme focus.
q Availability of contraceptive choices is
still limited and its expansion is
urgently required.
q The range and quality of services
provided at the PHCs have been very
poor and inadequate.
q The side effects of the contraceptives
need to be given attention in the
programme.
q The morale of health workers has to
be improved
q The FPP has reached a state of
communication fatigue. Govt. has not
invested enough to make FP more
attractive and peoples’ programme.
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References:
Banerjee, D. (1971): Family Planning in India: A Critique and a Perspective, New Delhi, People’s Publishing House.
Banerjee, D. (1985): Health and Family Planning Services in India, New Delhi, Lok Paksh.
Bergstrom, S. (1980): Family Welfare as a Health Need in Indian Population Policy, Tropical Doctor, Pt. 1, October.
Desai, Morarji (1977): Population control on Voluntary basis, Centre Calling, Vol. XII, No. 4-5, April-May.
Government of India (1976): National Population Policy, New Delhi, Ministry of Health and Family Planning.
Government of India (1981): Sixth Five-Year Plan, New Delhi, Planning Commission.
Government of India (1982): Health Statistics of India 1981, New Delhi, Ministry of Health and Family Welfare.
Government of India (1985): Seventh Five-Year Plan, New Delhi, Planning Commission.
Government of India (1992): Eighth Five-Year Plan, New Delhi, Planning Commission.
Government of India (1997): Ninth Five-Year Plan, New Delhi, Planning Commission.
Government of India, (1957): Review of First Five Year Plan, New Delhi, Planning Commission.
Government of India, (1965): Evaluation of the Family Planning Programme in India, New Delhi, Programme Evaluation Organisation.
Government of India, (1974): Fifth Five-Year Plan, New Delhi, Planning Commission.
Government of India, Health Survey and Development Committee (Bhore Committee), (1946): Report, Vol. I to IV, Delhi, Manager
of Publications.
SRS (2000): data: http://www.censusindia.net/results/
Census(2001):http://www.censusindia.net/vs/srs/bulletins/bulletin_2002_Vol36_No1.pdf.
NFHS (1998-1999): http://www.nfhsindia.org/anfhs2.html.
Kakar, V.N. (1979): Population Communication in India, New Delhi, Ministry of Health and Family Welfare.
Seal, K.C. (1974): The Family Planning Programme in India in Bose, A. et al. (ed.): Population in India’s Development 1947-2000,
Delhi, Vikas Publishing House.
Singh, K. (1975): Population, Poverty and the Future of India, New Delhi, National Institute of Family Planning.
United Nations Advisory Mission (1966): Report on Family Planning in India, New York, United Nations.
Wattal, P.K. (1916): The Population Problem in India, Bombey, Bennet Coleman.
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Annexure -1
Names of the Experts interviewed
1.
PK Hota
MoHFW
2.
Raman Prasad
MoHFW
3.
Rakesh Bhatia
MoHFW
4.
G Manoj
HLFPPT
5.
Geeta Bamzei
NIHFW
6.
Ena Singh
UNFPA
7.
JP Mishra
EC
8.
Vichitra Sharma
EC
9.
Ranjana Kumar
DFID
10.
Deepak Gupta
UNFPA
11.
GVN Rammna
World Bank
12.
Kate Dickson
UNICEF
13.
Gopala Kirshnan
Janani
14.
Preety Anand
Janani
15.
Rekha Masilamani
Pathfinder
16.
Bhavna Mukhopadhaya
VHAI
17.
PN Vasanthi
CMS
18.
Avik Ghosh
Freelance Consultant
19.
Sudha Tewari
Parivar Seva
20.
D Anand
SAKSHI
21.
Sushant Banerjee/Anusa Sarkar
PSI
22.
K Pappu
CINI
23.
Avabai Wadia
FPAI
24.
Supriya Mukherjee
Freelance BCC Consultant
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CHAPTER 3.3
Review of IEC materials for
Family Welfare program in the EAG states
1. Background
As part of the research regarding
the Communication strategy and
scenario for the EAG states the
research consultants gathered IEC
materials from the states. The family
welfare program in India has been there
for over fifty years. There have been many
efforts at education, awareness
generation, increasing knowledge and
information spread to the people. These
efforts have been varied in content, design
and effect. The fact that EAG states have
not fared as desired in the family welfare
has some of its explanation in the design,
effort, quality and reach of the IEC
materials and activities. The research tried
to gather as much IEC materials as
possible to see whether that hypothesis
holds some truth. It goes without saying
that any such effort at getting and
analyzing IEC materials will never be
exhaustive.
2. Methodology
The IEC materials for Family Welfare in
the EAG states have been collected
during the visits to the states and also from
the IEC division of the MOHFW. These
materials have been collected from
various agencies such as IEC division, of
DOFW, Health System Development
Projects, SIHFW, UN agencies like Unicef,
UNFPA, international agencies like CARE,
PSI and JHU/PCS, and NGOs such as
FPAI, VHAI, Janani, SIFPSA etc.
The materials have been in print, audio
and video format. For obvious reasons,
the outdoor materials and folk media
materials could not be collected as these
are live performances or the sizes are very
big.
3. Listing of the materials
The IEC materials were listed in three
basic categories: one state wise, second
agency wise and third, by type of
materials. The materials were collected
from the center and states of Uttar
Pardesh, Uttaranchal, Rajasthan, Madhya
Pradesh, Jharkhand, Bihar, Orissa, and
Chattisgarh.
The Materials were collected from the
following agencies in the states.
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S.No.
1
2
3
4
5
6
7
8
9
State
Uttar Pradesh
Uttaranchal
Rajasthan
Madhya Pradesh
Chattishgarh
Bihar
Jharkhand
Orissa
National
Govt Agency
DFW, SIHFW, IEC bureau
DFW, UAHSDP, DG
DFW, IEC bureau
DFW, IEC bureau
DFW,
DFW, SIHFW
DFW,
DFW, SIHFW/IEC unit
DFW, IEC division, NIHFW,
HLFPPT,
Other (UN, International, NGO)
Unicef, SIFPSA, CARE
HIHT, MOST
UNFPA, Unicef, CARE
Unicef, Janani, CARE, FPAI
CARE, Danida
Unicef, Janani,
Unicef, CARE, MOST
UNFPA, Unicef, CARE, VHAI, FPAI
UNFPA, Unicef, SIFPSA, PSS CARE,
FPAI, VHAI, CINI, PFI
The type of materials collected is as
follows:
Print
Flip chart
Flip book
Poster
Scrolls
Brochure
Booklet
Sticker
Calendar
Newsletter
Handbills
Danglers
Manuals
Reports
Audio
Cassettes
Audio CD
Video
VHS cassettes
VCDs
Other type of materials
For obvious reasons, it was not possible
to collect outdoor materials such as
hoarding, wall writings, banners etc.
Similarly the folk media performances are
live and therefore no such collection was
possible. We did collect a small number
of audio and video that documented the
folk performances. Other type of collateral
materials such as balloons, key chains or
backlit signboards, scooter seat covers
etc. were also mentioned but it was not
possible to collect them. Materials for
exhibition panels, tableau for Republic day
was also mentioned but again it was not
possible to collect them. We do have some
pictorial materials that capture some of
these materials.
In the same perspective IPC that is a
major IEC tools has been captured in the
printed materials or evaluations, but
obviously could not be “collected”.
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4. IEC materials analysis framework
It is clear that we could not have collected
all the materials from the states. Similarly,
the distinction between materials
produced and used by the central, state
government department and the ones
produced by UN/Bilaterals, NGO is
significantly different. Therefore, one can
easily see the difference between a
product that is supported by an external
agency for funds or design and layout in
comparison to the ones produced in
house or with funds from the department.
Every state has an IEC action plan1 and
also U/Cs2 for the previous years. Some
states do have an IEC strategy (UP/
SIFPSA3 , Revised BCC strategy for IFPS
20034 , UAHSDP5 , OHSDP6 , MP/BHSP-
III7 ,). Some NGOs like CARE8 or Janani9
operate with an IEC strategy within their
projects.
Based on the above-mentioned variability,
we have tried to use a minimum set of
criteria for the analysis of the IEC
materials. It is not in the scope and domain
of this study to have done a detailed
content analysis of the materials but we
have attempted to do a basic analysis of
the materials. We have used three broad
parameters for the analysis viz.
(A) QUANTITY AND QUALITY
In the quantity parameter we looked at the
adequacy of materials produced as per the
numeric needs of the state, second in the
quality parameter, was included content
and form of the material.
(B) PROCESS OF PRODUCTION,
DISTRIBUTION AND UTILISATION
In this parameter, we looked at three sub
variables, namely, production (who briefs,
who designs and whether in-house or
outsourced, secondly, what is the
procedure and tracking of distribution, and
thirdly, how are they actually used and by
whom.
(C) RECEPTION, MONITORING,
EVALUATION AND IMPACT
This parameter looks at the reception side
i.e. the reception by the audience, which
is captured through some of the
monitoring and evaluation of the IEC
materials and activities conducted. If there
were any specific impact studies
conducted, clearly (not acedotically)
demonstrates the correlation to the IEC
material or activity and also not
necessarily linked to uptake of services.
5. Findings
The states under EAG are under different
settings. It is important to make two basic
distinctions in the matter of IEC
assessment. One, there are three newly
created states viz. Uttaranchal,
Chattisgarh and Jharkhand, and second,
some states have an external support for
IEC/BCC in the form of an UN/Bilateral
agency and that makes a difference to the
IEC initiatives in the state.
Given these two distinctions we have
attempted to look at the scenarios and
made assessment on the basic
parameters mentioned above. It is also to
be noted that the assessment is made
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only on the material collected or observed complete picture.
and this not necessarily presents the
S. No.
1.
2.
State
Rajasthan
Uttar Pradesh
3.
Madhya Pradesh
4.
Bihar
5.
Orissa
6.
Jharkhand
7.
Chattisgarh
8.
Uttaranchal
Support agency for IEC
EC, UNFPA
SIFPSA (USAID/JHU HCP),
UPHSDP (World Bank)
Danida, UNFPA, Unicef, EC
Unicef
UNFPA, Unicef, OHSDP, CARE
CARE, IFPS (USAID), MOST
Danida, CARE, SHRC (EU/ Action Aid)
UAHSDP (World Bank), MOST
The major findings of the IEC material
assessment are as follows.
(A) THIS PARAMETER LOOKS AT THE
ISSUE OF QUANTITY AND QUALITY
OF THE IEC MATERIALS.
On the parameter of Quantity of IEC
materials, the states going by the IEC
action plan figures and sometimes the
print order, seen to be adequate, but this
may be misnomer. The calculations are
done generally by allocating one poster
per SC or one flip book by the number of
ANMs. The audio and video materials are
not calculated according to those
numbers. Similarly, the hoardings are
generally calculated according to the
number of districts. In the matter of IPC
performances, these numbers are still
very small and are generally not
calculated according to the number of
blocks. This IPC item may be the most
inadequate as this actually means one
performance in one year in some village
at an odd hour and that too usually
unannounced and without the knowledge
of the health system. The exhibitions are
generally restricted to the events such as
National day, state day or World
Population Day.
On the issue of quality, there are several
issues in terms of content and form.There
are some materials in some states and
other agencies production which will qualify
for a good quality design, layout and look.
Some of the materials produced by e.g.
SIFPSA and IEC bureau Rajasthan,
generally had the copy matter cluttered and
the visuals and graphics of poor quality. The
comprehensibility of the message is a
problem in terms of confusion of cultural
context and sensitivity. There is
inconsistency in terms of the identification
and the subject matter. There are too many
messages in one product. The choice of
color is sometimes garish and is not
suitable for the subject matter at hand. The
size of poster or the booklet is also
inappropriate for small size center or a
small size bag of the health functionary.
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There are issues with the matter of appeal
and attractiveness. Some of the materials
e.g. Meena series or the Tota maina series
from SIFPSA or Janani material have an
appeal and recall value but these are
primarily for literate audience. There is
hardly anything significant for illiterate or
neo literate.
(B) THIS PARAMETER OF ASSESSMENT
LOOKS AT THE ISSUE OF
PRODUCTION, DISTRIBUTION AND
USE OF MATERIALS.
There are issues related to production in
every state. Here we are talking about the
production process. Some of the states
have printing presses but they are old and
can only do a single color or two color jobs.
Others have press, but the control of the
press is in some department’s hand.
Another aspect is the outsourcing. The
tendering process, evaluation and the
lowest cost bid procedure is also
problematic. Some projects make it a
difficult process when the bid is of a large
value.
The second part of the issue is the
distribution. Usually there is a print order,
but the records are rarely available.
Usually this falls in the financial
department /section domain. The
distribution is usually delayed and is just
done and forgotten and this is also done
in an adhoc manner. At the district level
the receipt of the materials is with the
CMO office. A Dy. CMO generally is in
charge of the IEC and he is responsible
for the storing and distribution of materials.
There are no proper storing spaces or
procedures available. The district
supposedly sends the material to the
blocks and health centers. There is no
tracking of the materials distributed, these
are generally taken by officers when they
are visiting the state. The only record is
the dispatch register.
The third part of the issue is the use of
the material by the functionary. This is
seen by interaction with the field
functionary as well as during the visit to
the PHC/SC. This is one aspect that is
really weak. Use of flip books, audio and
video material and the posters is a skill
that one has to learn. There are two
aspects to the use. One the availability,
second the use in a session or during an
IPC interaction or during a performance.
It was clear that IEC functionary including
HEIO, BEE or the ANM, all lack this critical
skill, or they miss the importance of the
whole effort and rely on guess and
intuition.
(C) THIS PARAMETER LOOKS AT THE ISSUE
OF MONITORING, EVALUATION AND
IMPACT OF THE IEC MATERIALS.
There is no system of monitoring the IEC
material or activities. The only system is of
‘Utilisation Certificates’.The parallel system
of authentication by the ZSS or the PRI is
not really useful. The frequency, quantity,
quality and correctness as well local
adaptation timing are all amiss in this
process.
There have hardly been any formal or
rigorous evaluation studies of the IEC
materials and activities ever done. One
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or two studies, one by Danida10 MP and
a formal evaluation (not shared) by
SIFPSA11 are a case in point. The second
aspect of the monitoring and evaluation
of the IEC/BCC efforts is also besieged
by the problem of defining indicators that
are not just numbers and recalls, but the
change variables again not linked to the
uptake of the services. This is a gray area
across the states IEC efforts.
6. Issues
The IEC/BCC bureaus and units in the
states for the family planning and RCH
project, spend the budgets in almost all
the states, barring Bihar and UP, because
of different kinds of reasons. The purpose
of the material development is lost, if it is
not utilised. Looking at the situation and
the scenarios presented above, there are
a host of issues that emerge as to the
whole rationale of the IEC function.
I. MAJOR EFFORT IS PRINT
The majority of the IEC effort is print
materials. This is in contrast to the fact
that a large part of the population may be
illiterate/neo literate.
II. MATERIAL FOR NON LITERATE AND
LOW LITERATE
There are hardly any specific materials for
the less literate or neo literates. Non- text
pictorial material has not been
conceptualised.
III. VIDEO AND AUDIO PRODUCTS
There is a lot of mention of audio and
video products and the popularity of
electronic media. But the production
quality and use of these is difficult besides
being expensive.
IV. AUDIENCE SEGMENTATION
The materials are developed with much
thought to the segment of audience it will
cater to. The appeal to the segments of
audience has to be specifically addressed.
There has been some effort to address
adolescents recently but otherwise the
categories are still very broad.
V. SYNC BETWEEN MATERIAL AND
ACTIVITY
The IEC material and activity are still seen
as two separate parts of the effort. They
maybe used together but they are not
designed in a synchronised manner.
VI. PRE-TESTING
There is hardly any tradition or practice of
pre-testing. If at all done, this is done in a
non-scientific manner, by showing among
colleagues.
VII.DISTRIBUTION, USE AND
MONITORING
The system of distribution and use of
the material is a major miss.The record
keeping of requirements and the
tracking of utilisation, along with any
feedback, is not established. The
periphery centers never really get what
is there in the district head quarters.
VIII. TRAINING ON USE
The health functionary seldom gets
training on effective use of the materials
and methods of counseling. One has to
see an actual session, if it is happening
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unsupervised, to believe the unskilled use
of the material, which sometimes took so
much time and effort to develop.
6. Recommendations
The analysis and assessment of IEC
material from the EAG states suggests
that a lot needs to be done in several
factors, to make the best of the efforts
being undertaken. There are good
materials, good approaches and
innovative designs and one has only to
learn to make the material and activity
more effective and give value for money.
Some of the suggestions for improving the
situation are as follows.
Message thematic/thrust/focus/
drive
The overall message thematic for long and
continues to be “ chota parivar Sukhi
parivar”. The tag line has run out of steam.
The message does not have any catch
value anymore. The manifestations of the
benefits, if there were any, have also run
out of appeal. The imagery of small family
and its associated payoffs have different
meaning for the different audience
segments. The service provider also
needs to present the key message in a
new way. It is time that the IEC materials
are invigorated with a new message line
that is contemporary and does not carry
the baggage of an era bygone. The clients
as well as the provider do not understand
the concreteness and the message’s
benefits. The IEC material themes suffer
from this syndrome. It is evident on the
IEC materials produced. Some variations
on the theme were attempted, more on a
whim and fancy of the incumbent, but
largely it is the key line that needs to be
changed.
A. ROLE OF FUNCTIONARIES IN THE IEC
MATERIAL DEVELOPMENT
The functionary has been dealing with the
clients regularly and, therefore, it is
imperative that their experiences and
perspective be taken into account. This
will improve the effort on two counts. One,
there will be more ownership of the
product and, second, it will make a better,
more practical and relevant material.
B. IEC BUREAU AND THE MATERIAL
One has to look at the role IEC bureau
should play in the material and activity
development. This calls for an overall
assessment of the structure and role of
the IEC bureau. There are several
specialized functions that are required for
materials and activities to be developed.
This also requires newer techniques and
updating of creative ideas. Should the IEC
bureau be a coordinating unit as far as
the material is concerned, or it should
become a full-fledged advertising unit,
with all specialized needs. Ideally, the role
of the bureau should be giving a brief and
concentrating on quality and use of the
material rather than working as a
specialized production unit. Small local
jobs can be handled in house. Too much
concentration on production takes
valuable time away from the key jobs that
the bureau should undertake.
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C. IN-HOUSE
There is need for an in-house technical
capacity that knows the jobs and has more
programmatic capacity, rather than
technical capacity to do it in-house. Small
jobs can be handled in house but
campaigns and AV should be outsourced.
D. OUTSOURCING
Outsourcing is necessary as it will bring
in more creative ideas and competition will
enhance the quality of the product. There
has to be an easier yet transparent system
for outsourcing the jobs.
E. COORDINATION
Coordination is required at different
levels.
First, Coordination is required between
different agencies that produce or support
IEC material production, be it the
government agency/department or the
NGOs that are supported by the
government project or independently
produced materials. Different departments
produce and use systems and structures
of the health section with different inputs
and are not known to each other. (e.g.
SRC and the pop project). The FW
department, RD, WCD and other related
departments produce materials related to
FW but work in isolation.
Second, Coordination between central
and state IEC production units. This entails
a mechanism that ensures that there is
timely information sharing and material
production needs exchanged. The type of
materials and the resources available
need to be coordinated, and normally, no
reprints allowed, not at least with
localisations. A proper record keeping of
the number and type of materials
maintained and followed up.
Third, coordination between state, district
and block and Sub-center levels,
maintained. The state’s responsibility does
not end by just designing and dispatching
the materials. What happens to the
material at the end user point is also their
responsibility. The district as a nodal point,
for the use of materials in the area, has
also to take up the task of who is
responsible and how the materials is used
with tracking and utilisation follow ups.
F. CREATIVE BRIEF
No material should be allowed to go into
production without a proper creative brief.
This process needs to be followed up at
all levels. Note sheets and financial
requisition letters are not creative briefs.
G. MEDIA PLANNING
Media planning has to be made a
mandatory exercise, the synergy and
synchronisation made visible and the
scheduling, followed. The listing of
unrelated material and activity is not
media planning.
H. TYPE OF MATERIALS
A proper mix of materials has to be
maintained, with at least 50% of the
budget to be directed to IPC activities. A
diverse range of materials for different
audience has to be designed. The
materials and activities have to be
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updated regularly. There has to be less
emphasis on the print materials. Similarly
the Video and radio materials have to be
judiciously budgeted for.
I. CHECKLIST OF MATERIAL AND
ACTIVITY AT THE SUB CENTER
A check list has to be developed as to
what all should be available at the district
level, block level, facility level and a
catalogue needs to be prepared for what
has been acquired, procured and
produced in the current year.
J. MEDIA AND MATERIAL RESOURCE
CENTER
Of a program that has a history of over 52
years, a storehouse, a repertoire of efforts
in terms of material and activity is lacking.
Several attempts at national level and
state level have been made but nothing
of continuous or concrete value. It is time
that we make this professional and use
worthy.
K. CAPACITY BUILDING ON USE
The production of good quality material
does not ensure its good quality use. It is
necessary that all functionaries and
volunteers be given orientation to properly
and effectively use the material, this is not
there. The worker does not know the
participatory techniques or feel
comfortable with the tools.
L. MONITORING AND EVALUATION
This is one of the weakest links of the IEC
program. The U/Cs and production details
are no longer useful in any way for the
learning and accountability of the
program. New indicators that capture
broader parameters, in qualitative terms,
capture the process of change and
impact, need to be developed for a better
sense of the progress of the program.
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APPENDIX
IEC Material – Posters and Charts
Sr.
Title
Language
Publisher
Year
1. Stanpan sath sahi aahar agar chova
dhare sahi dagar
Hindi Care, Govt. of Jharkhand
2. Aapke swasthya par sare parivar ka
swasthya nirbhar hai
Hindi Care, govt. of Delhi
3. Maa avam shishu ke swasthya surkha
ke liye mukhya bindu
Hindi Care, Govt. of Jharkhand
4. Stanpan shishu ke liye sarvottam aahar Hindi
IEC bureau, Health and
Family Welfare, Rajasthan, Jaipur
5. Bal vivah kaisi nandani jivan bhar
aankho main me pani
Hindi
IEC bureau, Health and
Family Welfare, Rajasthan, Jaipur
6. Dast ke karn hoti hain wishv main
partivarsh 10 lakh bachcho ke mot
Hindi
IEC bureau, Health and
Family Welfare, Rajasthan, Jaipur
7. Hamajk payar aur bachchoki apeksha
janleva bemariyon se poorn surkasha
Hindi
IEC bureau, Health and Family
Welfare, Rajasthan, Jaipur
8. Purush nasbandi bina chira – bina tanka Hindi
IEC bureau, Health and
Family Welfare, Rajasthan, Jaipur
9. Garbhwati mahila ka panjikaran avam
tikakaran Hum aapki aur aapke
bachche ki sukarsha chahte hain
Hindi
IEC bureau, Health and Family
Welfare, Rajasthan, Jaipur
10. Garbhavastha me tatha parshav ke
samay khatron ke lakhan pahchane
aur garbhawati ki jan bachayen
Hindi
IEC bureau, Health and Family
Welfare, Rajasthan, Jaipur
11. Garbh samapan aur kanuni pravadhan
Hindi
IEC bureau, Health and Family
Welfare, Rajasthan, Jaipur
12. Navjat Shishu ke dekhbhal
Hindi
IEC bureau, Health and Family
Welfare, Rajasthan, Jaipur
13. Jaan leva bimariyon se bachcho ko
bachane ks liye aaiye ! sabhi tike
samay par lagwane ka sankalp len
Hindi
IEC bureau, Health and Family
Welfare, Rajasthan, Jaipur
14. Panch safai ka rakhen dhyan
15. Responsible Behavior
16. Youth have a responsibility
Hindi Care, govt. of U. P.
English Nagaland SACS
English Nagaland SACS
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17. Let’s use the weapon we have
English Nagaland SACS
18. Knowledge is power
English Nagaland SACS
19. Life is pracious
English Nagaland SACS
20. Do bachcho ke beech main rakhen teen Hindi
saal ke doori
Parivar kalyan vibhag, Bharat
Sarkar
21. Garbh ka jaise hi pata chale garbhwati
ko sawasthya kendra le jaaye
Hindi
Parivar kalyan vibhag, Bharat
Sarkar
22. Jachcha bachcha ko tetnus ki bhayankar Hindi
mot se bachao
Parivar kalyan vibhag, Bharat
Sarkar
23. Yaad rakho bade aspatal ka pata aur
ho le jaane ki sawari
Hindi
Parivar kalyan vibhag, Bharat
Sarkar
24. Dast se nikle sharir ka pani shishu ki
jaan par sankat aaye
Hindi
Parivar kalyan vibhag, Bharat
Sarkar
25. Sabke liye hain ek upay chune vahi jo
man ko bhaye
Hindi
Parivar kalyan vibhag, Bharat
Sarkar
26. Jansankhya avam parjanan swasthya
sector
Hindi
27. Aapka bachcha surakshit hain
Hindi Care, Rajasthan
28. Khoon ke kami ke karan avam ilaz
Hindi
World food programme and Care,
Rajasthan
29. Ghrelu ilaz turant aasptala le jaaye
Hindi
Government of MP, Orissa,
Rajasthan, West Bengal of Care
30. Computerized Management information
System (CMIS) for National AIDS
Control Programme in India
English National AIDS Control Organization
31. AIDS ke roktham ginti ke saman ashan Hindi Uttaranchal SACS
32. Kya aap jaante hain AIDS kaise nahi
failta
Hindi Uttaranchal SACS
33. Panchyat ka sahi faisala sahi jaankari
ke bad
Hindi Chattisgarh SACS 2003
34. Ye dosti hum nahi chodenge
35. Mere liye sabhi barabar
36. Choone se sirf pyar failta hai AIDS
nahi
37. Raktdan punya ka kaam
Hindi
Hindi
Hindi
Chattisgarh SACS 2003
Chattisgarh SACS 2003
Chattisgarh SACS 2003
Hindi Chattisgarh SACS 2003
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38. Jiye of jeene do
39. Mera parivar meri duniya ka kendra
40. Tikakaran
41. Kya aapne apne bachcho ko en tikon
ke chatri de
42. Swasth ma swasth shishu
43. Parivar niyojan ke kuch saral upay
44. Sahi umar main shadi aur kam umar
main shadi
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Chattisgarh SACS
Chattisgarh SACS
IPP –VIII, India population
project – Delhi
IPP –VIII, India population
project – Delhi
IPP –VIII, India population
project – Delhi
IPP –VIII, India population
project – Delhi
IPP –VIII, India population
project – Delhi
2003
2003
2002
2002
2002
2002
2002
45. Agar meri shadi choti umar main na
hoti to mai bhi school jaati
Hindi IPP –VIII, India population
project – Delhi
2002
46. Kahan tak khichoge badhte bachcho Hindi IPP –VIII, India population
ka boch
project – Delhi
2002
47. Hai ye kaisa chakavayu
48. Ye bharat ke bhavishya hain
49. Garbhawati ke dekhbhal parivar
swasth
khushall
50. Bachcho ko ho jab sardi jukam karo
ye panch upay aasan
51. Sore Throat in Children can damage
Heart
52. Surakshit Garbhpat
53. Gulshan me bas do hi phool eske
aage karo no bhool
54. Aghyan ke badal hatao abadi par
kaboo pao
55. Ratiz rogo ka ilaz sambhav hain
56. Your sputum may spread disease
57. Parivar Niyojan ke Vidhiyan
58. Garbh ke doran rakhen Dhyan
59. We have a role in bringing about
change. It is your responsibility, too
Hindi
Hindi
Hindi
IPP –VIII, India population
project – Delhi
IPP –VIII, India population
project – Delhi
IPP –VIII, India population
project – Delhi
2002
2002
2001
Hindi Parivar Kalyan Vibhag, Bharat
Sarka
English
Hindi
Hindi
Health ministry, Delhi Government
Health ministry, Delhi Government
Hindi Health ministry, Delhi Government
Hindi Health ministry, Delhi Government
English
Hindi Care India, Govt. of Delhi
Hindi Care India, Govt. of Delhi
English Family Health International
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60. Beti anmol hain
61. Maa ka doodh amrit saman
62. Hamari beti Saniya Mirza
63. Yeh umar mere padhne aur khelne
ki hai shadi ki nahin
64. Hum aapki aur aapke bachchen ki
surakha chahte hain
Hindi
Hindi
Hindi
Hindi
Parivar Kalyan Vibhag, Bharat
Sarka
Parivar Kalyan Vibhag, Bharat
Sarka
Hindi Parivar Kalyan Vibhag, Bharat
Sarka
65. Aayodin Namak
Hindi
66. Pati Patni ki vafadari rakhen door
AIDS ki bimari
67. Bachchon main anter rakhne ke upay
Hindi
Hindi
68. Ling janch karan kanooni apradh hai Hindi
aur naitik jurm bhi
IDD and Nutrition Cell, Health
and Family Welfare, Govt. of India
NACO
Parivar Kalyan Vibhag, Bharat
Sarka
Parivar Kalyan Vibhag, Bharat
Sarka
69. Doctor kya aap jaante hain
Hindi
70. Medical Termination of Pregnancy
Act 1971
71. Asali mard wo hain jo maa bahno aur
batiyon ki duvayen paye aur kisi bhi
mahila ka aapman na karen
72. The prenatal Diagnostic Technique
1994 Regulation and Prevention of
misuse) act
73. Mahila par koi bhi sharirik sambandh
ya garbh uski ichcha ke viprit nahi
thopana nahi chahiyen
74. Maa bahan ki gaali dekar aapni soch
aur apne sanskar ka samajik
pardarshan na karen
75. Sharerik sambandh aur garbh dharan
mahil aur purush dono ki ichacha
anushar hona chahoye keval purush
ki hi nahi
76. Parivar Niyojan ke liye bar bar
garbhpaat karana mahila sawasthya
ke liye hanikarak hain
77. Goon aur sootra ling nirdharan
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
Parivar Kalyan Vibhag, Bharat
Sarka
Voluntary Health Association of
India
Voluntary Health Association of
India
Voluntary Health Association of
India
Voluntary Health Association of
India
Voluntary Health Association of
India
Voluntary Health Association of
India
Voluntary Health Association of
India
Voluntary Health Association of
India
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78. Panchyat ka sahi faisala sahi
jaankari ke baad
Hindi NACO
79. Ye dosti hum nahi chodenge
Hindi NACO
80. Mere liye sabhi karigar barabad hain Hindi & NACO
English
81. Sahi aur poori jaankari rakhen door
AIDS ki bimari
Hindi & NACO
English
82. All my patients are special
English NACO
83. Friends we are Friends we will
always be
English NACO
84. Aapka kiya thodha sa raktdaan
layega kisi ke jeevanain muskan
Hindi UP SACS
85. Ye hain hamara Surksha chakra
Hindi UP SACS
86. Parivar Swasthya jaagrukta abhiyan Hindi UP SACS
87. Yaon rogo se chutkara swasth rahe
parivar hamara
Hindi UP SACS
88. Jeevan Anmol hain
Hindi UP SACS
89. AIDS ka gyaan bachyen jaan
Hindi UP SACS
90. Aapka rakta kisi bhi groupka ho sakta
hain aavashyakta hain pratyek
group ki
Hindi
Rajasthan SACS
91. Door rahen AIDS se na ke HIV
positive kisi rogi se
Hindi Rajasthan SACS
92. Chala desh main yeh abhiyan janam
praman ptra se hain nagrik ki
pahchan
Hindi
UNICEF
93. Hum aapki aur aapke bachchen ki
surakha chahte hain
Hindi IEC Bureau, Rajasthan
94. Stanpaan shishu ke liye sarvottam
aahar hain
Hindi IEC Bureau, Rajasthan
95. Kya aap jaante hain jeevan main
janam aur mrityu ka panjikaran
anivarya hain
Hindi IEC Bureau, Rajasthan
96. Gharbhavastha main tatha prasava ke
samay khtroan ds lakshan pahchane
aur garbhvati ki jaan bachaye
Hindi
IEC Bureau, Rajasthan
97. Aaiye hum poorush bhi parivar ko chota Hindi IEC Bureau, Rajasthan
rakhne main aapna dayitav nibhaye
98. Chote parivar kie avdharna ko aap
aur hum milkar janandolan banye
Hindi IEC Bureau, Rajasthan
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99. Garbh samapan aur kanooni pravdhan
100. Bachche ko ho jab sardi aur jukam
karo panch upay asan
101. Maa bachche ke swasthya ke liye
jaruri hain garbhvati mahila ki
samuchit dekhbhal aaiye hum aapna
kartviya nibhaye
102. Polio ka khatra abhi tala nahi isliye
apne bachche ko polio ki khurak jarur
pilvayen
103. Visheh saghan polio abhiyan
104.
Hindi
Hindi
Hindi
Hindi
Hindi
IEC Bureau, Rajasthan
IEC Bureau, Rajasthan
IEC Bureau, Rajasthan
Uttaranchal SACS
IEC Material – Flip books
Sr. Title
Language Publisher
1. Stanpan aur purak aahar
Hindi Breast Feeding Promotion
Network of India
2. Vitamin – A Baccho ke liye vitamin
– A jarury hai
Hindi USAIDS
3. Champa aur Mohan ki Kahani
Hindi Care India
4. Towards Better Child Health and
Development Integrated Management English Child and Adolescent Health
of Childhood Illness (IMCI)
Word Health Organisation
5. Badhti bachchi ke liye poshan
Hindi UNICEF
6. Matra and shishu jivita pariyojna
– chitra pustika
Hindi Care India
7. Selected Data on Child Indicators in
the Southern Sub Region of India
English UNICEF, Chennai
8. Shishu doodh anukalp (I. M. S.)
adhiniyam ke mukhya upbandh
Hindi Breast feeding promotion
Network of India
9. Garbhvati Mahila aur dooth pilati maa
ka poshtik bhojan
Hindi
10. Shishuka poshtik bhojan
Hindi
11. Aapatkalin parsav
Hindi
12. Tarang Network
Hindi HLFPPT
13. Key provisions of the act Statement
of objects and reasons
English Breast feeding Promotion
Network of India
14. ICDS Towards informed action
English World food Programme
15. ICDS Jankari karyavahi hetu
Hindi World Food Programme
Year
2002
1996
2001
1996
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16. Simplified STI and RTI treatment
Guidelines
17. Ayran ki kami se hone vale nukshan
aur unse bchav
18. Hand book for peer educators
19. Post Natal Care
20. Swasth Gram pariyojna
21. AIDS/HIV ke kahani hune kahi aur
tumne jaani
22. For the Commercial Sex workers
23. Apni khushyan apne hath
(parivar niyojan ke upay)
24. Early Childhood Care for Survival
growth and Development in India
25. Towards healthy Adolescence
26. Infertility
27. Prevent Unsafe Abortion
28. Sex Determination & Female
Foeticide
29. Bal Swasthya Salah Pustika
30. Jeevan Ke liye Shiksha
31. Nirdeshika
English NACO
Hindi USAIDS, Jharkhand
Hindi,
English
& Tamil
State AIDS Cell Dept. of
Health & Family Welfare
Govt. of Orissa
Hindi Voluntary Health Association of
& English India
Hindi HLFPPT Govt. of India
Hindi Voluntary Health Association of
India
Hindi
& English
Hindi Parivar kalyan vibhag
English Child Development & Nutrition, 2000
UNICEF, India September
Hindi Voluntary Health Association
& English of India
Hindi VHAI
& English
Hindi
&
English
VHAI
Hindi VHAI
& English
Hindi CHETNA and WFP
Hindi MP SACS
Hindi
UNICEF, Lucknow IEC Material
–Training Manuals and News
letters
Sr. Title
Language Publisher
Year
1. Niramya (Swasthya & parivar kalyan
patrika)
2. Niramya (Swasthya & parivar kalyan
patrika) polio viseshank
3. Niramya (Swasthya & parivar kalyan
patrika) Bal swasthaya viseshank
Hindi
Hindi
Hindi
IEC Bureau , Rajastyhan
IEC swasthya Bhawan, Health
& Family Welfare, Jaipur
IEC swasthya Bhawan, Health
& Family Welfare, Jaipur
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4. Niramya (Swasthya & parivar kalyan
patrika) Aakal main swasthya rakhsa
Hindi IEC Bureau , Rajastyhan
5. Vitamin A se bharpur sabjiyon aur
falon ka utpadan aur uplabdhata
badhana
Hindi Institute of Home Economics,
Delhi University and UNICEF
6. Parichaya kit
Hindi Rajya Swasthya Suchna Shiksha
Sanchar Bureau, Bhopal
7. Clinical Protocols Primary Health
care PHCs and CHCs
English Indian Institute of Health
Management Research, Jaipur
8. Building and Strengthening of Mahila
Mandals (Manuals for Mid level
Supervisors)
English
Department of Women and
Child Development Government
of Rajasthan, Jaipur
9. Mahila Swasthya karyakarta
Hindi Voluntary health association of
India
10. Champa ki Kahani
Hindi Voluntary health association of
India
11. Hamara Ghar
Hindi Parivar Kalyan Vibhag, Bharat 2004
Sarkar
12. Hamara Ghar
Hindi Parivar kalyan Vibhag, Bharat
Sarkar July – Sept. 2003
13. Hamara Ghar
Hindi Parivar Kalyan Vibhag, Bharat
Sarkar Jan. - March 2003
14. Hamara Ghar
Hindi Parivar kalyan Vibhag, Bharat
Sarkar Oct. 2003 –Mar. 2004
15. Hamara Ghar
Hindi Parivar kalyan Vibhag, Bharat
Sarkar April-June 2003
16. Swasthya Sanchar
Hindi
Rajya Swasthya Suchna
Shiksha Sanchar Bureau,
Bhopal April – June 04
17. Gramin Swachata karyakaram
Hindi UNICEF
18. Intensified Pulse Polio Immunization
19. Sukhad Bhavishya ki aur
English UNICEF
Hindi IEC Bureau
1999-
2000
20. State policy for women
Hindi Women & Child Development
& English Deptt., Govt. of Rajasthan
21. Janmangal jodon ke liye parshikshan
module
Hindi Health and Family welfare,
Govt. of Rajasthan, Jaipur
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IEC Material – Video (CD)
Sr. Title
Language Publisher
1. Making a Difference (Best Practices English
leading to Impacts
SIFPSA
2. PSI Products
PSI
3. Birth Spacing Communication
PSI
4. Audio spots (Nutrition/Malaria/
Immunization ARI/Diarrhosea/
Institutional delivery N.MBS/NSV)
5. Spacing of Birth ANC Registration
Spacing Methods PNDT Institutional
Delivery NMBS NSV
S.I.H.S, FW, Bhubaneshwar
6. AIU Presentation
7. Uttaranchal Directorate (Print Material)
Uttaranchal SACS
8. IEC Strategy UAHSDP
9. All IEC jobs till 25/09/03
Year
IEC Material – Video
Sr. Title
1. Ahsaas
2. Dhatri Panna
3. Aaj ki Pukaar
4 Aadhe Adhure
5. Ghonghat ki aad se
6. Radha
7. Nirankush
8. TV Spots
9. Kyon Nahin
10.
11.
12.
Language
Hindi &
English
Hindi
Hindi
Hindi
Hindi
Hindi
Hindi
English
Hindi
Publisher/Poducer
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
IEC unit, MOHFW
Year
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IEC Material – CINI
Sr. Title
1. HIV/ AIDS Hyp. book
2. HIV/AIDS leaflet
3. Puzzle card
4 ANC kit
5. Nutrition flag
6. Conception Hand Game
7. Conception game
8. Menstruation window kit
9. Exclusive breast feeding CP
10 Worm intestion CP
11 All about worms –leaflet
12 Food below 2 years
13 Peter Asukh
14 Peter Asukh Protirodhen upay
Language Publisher
Hindi
Hindi
Hindi
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
CINI
Sr. Title
1. Conception game (Old
2. Menstruation cut –out (old)
3. Contraception Board Game (Old)
4 FLE Book
IEC Material – PSI
Sr. Title
1. Prasav se sambandhit khatron
ke chinah
2. Maine sadhan network ke tahat
pramarsh koshal ka prashikshan
prapt kiya hai ab mai apne client
ko gaider vidhi dwara pramarsh
pradan karoonga
3. New Born
4. Kahani har ghar ki
5. Bachchon ke swasthya prabandh
se swasth parivar
6 Hath saf rakho dast se bacho
7 Condom
8 Shishu ke sahi vikas ke liye
poshtik bhojan tatha tikakaran
9 Naya nuetrol santre ke swad me
10 Safewat
11 Umar ke hisab ka chart
12 Janiye ke aapke liye konsa
tarika uchit hai
13 Dast se kaise bachen
Language Publisher
Hindi
Hindi
Hindi
English
CINI
CINI
CINI
CINI
Language Publisher
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Hindi
PSI
Year
Year
Year
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IEC Material – HIH Trust, Dehradun
Sr. Title
1. Himalayan Institute hospital Trust
(Directory of Reference)
2. Young adults moving towards a
healthly future
3. Light the future
4. Adolescent Initiatives
5. Calendar
6. Aao pahal karen
Language Publisher
English
English
Institutes on Adolescent
health and Development
HIH, uttranchal, India
English
English
English
Hindi
HIH Trust
HIH Trust
HIH Trust
HIH Trust
Year
2004
IEC Material – NIPCD
Sr. Title
1. Sanchalan margdarshika
2. Murgee Paalan
3. Bhed Paalan
4. Sawam sahayata samooho dwara
udhyog dhandhey
5. Swayan Sahayata samooh main
matbhed niptara
6. Swayan sahayata samooh ke
baare main pooche jaane vaale
aam sawal
7. Swayan sahayata samooh evam
panchayati raaj
8. Swasthya aur poshan main
samajik ling ke muddey
9. Swayan sahayata samooh main
loan prabandh lekhankan tatha
bank pravadhan
10. Swayan sahayata samooh main
loan evam bachat
11. Paani, Swachta evam mahilaon
ka swasthya
12. Sabjiyo aur unki katai ke baad
sangarhan
13. Suwar paalan
Language Publisher
Year
Hindi
Krishi Mantralaya, Bharat Sarkar
Hindi
Uttar Pradesh Bhoomi Sudhar
Nigam
Hindi
Uttar Pradesh Bhoomi Sudhar
Nigam
Hindi
Uttar Pradesh Bhoomi Sudhar
Nigam
Hindi
NIPCD
Hind
NIPCD
Hindi
Hindi
Hindi
NIPCD
NIPCD
NIPCD
Hindi
Hindi
Hindi
Hindi
NIPCD
NIPCD
SWA – Shakti
Uttar Pradesh Bhoomi Sudhar
Nigam
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References:
1. IEC action plan for Orissa, 2003-04, Bhubneshwar.
2. Utilisation Certificate for the IEC action plan for 2002-03, Orissa.
3. IEC strategy for SIFPSA, 1997, SIFPSA, Lucknow.
4. BCC strategy for 2003-04, SIFPSA, Lucknow.
5. IEC strategy for UAHSDP, 2003, Dehradun.
6. IEC strategy for OHSDO, 2003, Bhubneshwar.
7. IEC strategy for BHSP-III, Danida, 2002, Bhopal.
8. IEC/BCC strategy for INHP-II, CARE, MP, Orissa, Chhattisgarh.
9. IEC strategy for Janani, Bihar.
10. Internal evaluation of IEC materials supported by Danida, Danida, Madhya Pradesh.
11. Monitoring and Tracking of IEC campaigns, SIFPSA, Baseline and midterm evaluation.
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Chapter 4
FINDINGS/EAG STATES
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CHAPTER 4.1
BIHAR
State Profile and IEC Status with
Respect to Family Planning Program
1.0 Background:
Bihar was India’s first cradle of
civilization after the Indus Valley,
around 6th century BC, when a
dynamic combination of geographical and
political factors ensured its hegemony
lowest in the country1 . The state has
mostly rural base with almost 90 percent
of its population living in rural areas. The
female literacy is very low with only 23.4
percent literate women as per NFHS-II2 .
The state has equally poor demographic
over the entire sub continent. Bihar
borders with other states such as; West
Bengal in north-east, Orissa in south and
Uttar Pradesh in west. The total
geographical area of state is 94,164
square kilometer. According to the 2001
Census the State’s population was 82.90
million with a sex ratio of 919, one of the
scenario with high birth rate (31.9), high
death rate (8.8), and high infant mortality
rate (62). The natural growth of the state
population is very high (23.1%), mainly
because existence of very high fertility
rate. The total fertility as observed during
1998-99 (NFHS-II) was very high at 3.493.
The contraception prevalence rate for any
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modern method of family planning was
one of the lowest in the country (22.4%)4.
The unmet need for family planning was
one of the highest in the country with
about one fourth of women (24.5%)
expressing the same. The need was
expressed almost equally for both spacing
and terminal methods of family planning.
The mass media exposure of almost three
fourth of women in reproductive ages
(73.4%) was very low. With the prevailing
social, economic and demographic status,
the state requires special attention. The
state, therefore, was included among EAG
states5 so that it can draw attention for
improvement on priority basis.
The present chapter provides some of the
observations made by team of
Consultants on the IEC status in the family
welfare sector (particularly on family
planning and RCH components) in the
state and its impact on the program
implementation. The Population
Foundation of India on behest of the
MOH&FW, Government of India, has
sponsored this study. A range of RCH
indicators6 as observed through
household Survey is given in Annexure.
2.0 Methodology
A team of three consultants visited each
of the eight EAG states, all together, two
members or a single member team,
depending on the need of the state. In the
case of Bihar, a one-member consultant
team visited the state during 4-6 October
2004. The Consultants prepared and
followed a set of checklists and talking
points relevant to the study and to be
canvassed at different levels, after having
prolonged deliberations with PFI officials.
Some of the checklists were also prepared
for and used during interactions with
senior government officials and other
stakeholders in Delhi. These checklists
were modified suitably after each state
visit to cover more and more issues.
During each state visit, the Consultants’
tasks were broadly divided to cover three
major areas. The first was to meet with
state officials and setups responsible for
the health and family welfare program
delivery, with maximum coverage of those
directly responsible for IEC activities in the
state. For such interaction, in Bihar the
consultant met with the Secretary (H &
FW), Deputy Secretary (Family Welfare),
Director (FW), Director (SIHFW), Deputy
Director IEC, and other officials. Second,
the consultant met the partners and other
players in the field such as UN and
Bilateral agencies, international and
national NGOs, such as representatives
of ADITI, Janani, and BVHA. Third, the
consultant visited Kati PHC (Muzaffarpur
district), and met with the frontline officials
(In-charges/MOs/Bloch HEIO) and
workers (3-4 ANMs) who actually carry out
the tasks. A list of the officials/persons
contacted during our visit has been given
in Annexure Table.
3.0 Current Status of the Family
Welfare Program with a Focus
on IEC:
The increased decadal growth of
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population during 1991-2001 in the state
has become matter of concern for both
the Government of Bihar and GOI. It was
reported that while the growth rate was
below the all India average in the previous
decade, during this decade it has
registered a growth of 7 percent points
higher than the national average. As
observed, most of the demographic
indicators show the existence of poor
health and family welfare status of state.
The Government of Bihar realizing the
urgency of dealing with the problem has
prepared a draft Population Policy7 on the
pattern of National Population Policy-
20008 , with the objective of controlling the
population growth of State.
3.1 STATE POPULATION POLICY:
The mission of the state Population Policy
is to control the population growth and to
plan the strategy to achieve the
replacement level by 2015 and population
stabilization by the year 2045. In order to
overcome the possible hurdles in the
planned implementation, goal appraisals
would be undertaken on the basis of
achieving short (2008), mid (2015) and
long (2045) term targets. It is planned that
the TFR of the state would be brought
down to 3.4 (with CPR level of 36%) by
2008, 2.1 (CPR level of 60%) by 2015 and
to 1.6 (CPR level of 80%) by 2045.
Keeping in view that the increase in the
efficiency of family welfare program is of
prime importance; the program is being
implemented through SCOVA at state
level, and by creating DHDA on the pattern
of DRDA at district level9. The state’s
intentions on the population control issue
have been clearly expressed on many
occasions, and latest in the Project
Implementation Plan (PIP) for RCH-II10 ,
which has already been submitted to the
GOI. To augment the efforts, the state is
trying to create state level management
structure as per the provision of RCH-I,
and also recruit 6 Consultants for Bihar
as per provisions under the provision
made for eight EAG states. Even though
till the visit of the study team, none of
these officials were appointed, the efforts
are being made for their early deployment.
While the state has so far received about
Rs.280 million for SCOVA, only about
Rs.80 million could be spent on various
activities taken up till 2003-04. The State
Institute of Health and Family Welfare
(SIHFW) has been made as the nodal
agency for implementation of program
under SCOVA. It is encouraging to note
that for IEC activities, the total fund
release of about Rs.27.6 million, Rs. 27.5
million has been spent. It may however
be noted that the entire released fund has
been given to Mahila Swasthya Sanghs
(MSS), for undertaking different activities.
3.2 IEC DIVISION: STATE FAMILY WELFARE
BUREAU:
The state even though has an IEC division
in the Department of H&FW, no IEC
bureau exists, as that exists in some other
states. Although efforts are on to establish
an independent IEC bureau, because of
various reasons, so far the Bureau could
not be established in the state. The state
IEC division is presently headed by the
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state IEC officer and assisted by one
Deputy Director (Press/media), and
Communication Officer. The positions of
Health Education Officer and Electronic
Media Officer are vacant. The division also
has three other junior officers, and four
support staff. Even though a printing press
was established in 1970, it has now
become more or less defunct. The division
was publishing a monthly bulletin, Kalyani,
which is not published for quite some time.
At district level, out of 55 districts, in 39
districts district media officer exists, and
at block level about half of the 587 blocks
are functioning without Block Extension
Educator. The Division has been getting
funds from the state Directorate of the
tune of 80-90 lakh per year for its activities,
which are being spent on the regular mass
media activities. The state also received
additional budget allocation of Rs.45.00
lakh for undertaking IEC activities to
implement RCH specific communication
strategy11 .
3.3 EXPOSURE TO MASS MEDIA
In a state like Bihar, where a large majority
of women are illiterate or have little formal
education, informal channels such as the
mass media can play an important role in
bringing about modernization. In NFHS-212 ,
women were asked questions about
whether they read a newspaper or
magazine, watch television, or listen to the
radio at least once a week, and whether
they visit the cinema or theatre at least
once a month. Table 1 gives information
on women’s exposure to these forms of
mass media by selected background
characteristics.
In Bihar, nearly three-fourths of women
(73 percent) are not regularly exposed to
any of these media. While media exposure
was found similar in case of different age
groups, exposure varied widely by
women’s education and households’ living
standard. As expected, regular expose to
mass media increased with education,
ranging from 14 percent among illiterates
to between 57 and 86 percent among
women attended higher category of
education standards. Regular exposure to
media also increased with households’
standard of living to a high of 87 percent
for women living in the households with a
high standard of living.
Seventy seven percent of rural women are
not regularly exposed to any media,
compared with only 33 percent of urban
women. Relatively more Muslim women
were found not regularly exposed to any
media (79%) as compared to those of
Hindu women (72%). Similarly as high as
88 percent of scheduled tribe women, 82
percent of scheduled caste women and
about 75 percent women from other
backward classes were found not
regularly getting exposed to any media,
compared to only 50 percent women who
belonged to high caste groups.
Among the different types of mass media,
radio was found to have greatest reach
across all categories of women, including
illiterates and poor women. Overall, 20
percent of women are regularly listening
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to the radio at least once a week, and 17
percent watch television at least once a
week, compared to less than 10 percent
who were regularly exposed to print media
or cinema/theatre. The proportion of
women who listen to radio at least once a
week has declined since the time of NFHS-
I, when it was 26 percent. By contrast,
regular exposure to television has risen
over the same period- from 13 percent
during NFHS-I to 17 percent during NFHS-
II. Cinema and theater were found to be
least used medium. Exposure to each type
of media, however, was found increasing
sharply with women’s education and
households’ standard of living.
Only 9 percent of women read a
newspaper or magazine at least once a
week and only 4 percent of women visit
the cinema or theater at least once a
month. Therefore, although mass media
can be an important means of spreading
health and family welfare messages, as
well as exposing women to modern views
in general, innovative programs will be
necessary to reach the majority of women
who are not regularly exposed to any form
of mass media.
For exposure to family planning messages
through mass media, NFHS-II revealed
that radio remained the most common
source of exposure for family planning
(26%), followed by wall paintings/hoardings
(22%) and television (21%). Only 8 percent
were exposed to a message through a
Newspaper or magazine, 7 percent
through films and 3 percent to folk/drama
media. It may be noted that some of the
women do not even see TV or listen to radio
regularly, had received the message by
occasional listening.
3.4 ROLE OF UN AND BILATERAL AGENCIES
The state has presence of large number
of UN and bilateral funding agencies
working in many different sectors. In the
area of family planning and in general RCH,
such presence has not been very
significant so far. However, there are
agencies like Packard Foundation, Path
Finder, UNICEF, European Commission,
Indo-German Society, Action Aid, WHO,
Hunger Project and many more, which are
already present in the state, are also eager
to help and work in the area of family
planning. Till date, however, not many
efforts have been made to involve these
agencies in the program. Some efforts
have been made to involve UNICEF and
European Union to create IEC bureau in
the state, the implementation is still eluding.
Bihar IEC Unit had discussions with EU
and GOI for creation of IEC bureau in 2001
with a request for budget provision of about
Rs. One crore, that is yet to be
materialized13. Similarly, another review
meeting between the state officials and
GOI, UNICEF, EC and WHO was held
recently at Patna to review the status and
enhance the states’ capacity in family
welfare sector14 . It has been planned that
under SKOVA, all the organization would
be putting efforts in this direction.
3.5 ROLE OF NGO AGENCIES:
Bihar has equally high presence of
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different well-experienced NGOs, also
working in the health and related sector
and have good network all over the state.
Some of them include, Aditi, BVHA,
Janani, HLL and PFI. With the funding
from PFI, Bihar Voluntary Association has
been experimenting Community Radio
Program in five districts of Bihar to provide
information and messages on Family
planning related issues mainly to rural
masses. For the purpose Radio Listeners
Clubs have been formed and a program
on these issues is broadcast every
Sunday from AIR, Patna, at 6.30 PM and
12.00 in the noon15 . Similarly Aditi,
another NGO is working through village
volunteers with the help of Plan
International to under take IEC activities.
Janani is present in all the districts of Bihar
and offering quality reproductive health
services with their vast network of Surya
Clinics. This gives an impression that if
collaborative efforts are made between
NGOs, funding organizations and the
Bihar Government; opportunities exist to
improve the current scenario.
3.6 IEC STATUS AT DISTRICT AND LOWER
LEVELS IN THE STATE:
Besides Patna district, the Consultants
also visited Muzaffarpur district, where in
they visited Kati PHC. A discussion with
the district and PHC level officials revealed
some of the problems being faced by them
at respective levels. In the following
sections, some of the issues raised have
been discussed.
District Level:
y There is no dedicated staff
y ACS holds the additional charge of
District IEC officer
y Has never received any training in
either IEC or BCC
y Interested in Polio activity as it
entails monitory incentive.
y IEC materials are totally absent.
y Few materials available are from
either GOI or Unicef.
y Has no clue about what should be
done to improve the present status
of IEC in the state.
y No budget received for FP related
IEC activity. IEC given very low
priority.
PHC Level:
y Situation is no better.
y BEE post lying vacant for many
months.
y No FP related IEC materials found.
y Low priority to IEC.
y The MO does not know what is
BCC.
y No training for any of the staff in
the last two years.
y Not a single staff trained in IEC/
BCC.
4.0 Issues of Concern:
The population scenario is quite grim in
the state. The IEC activities are more or
less non-existent. With no IEC bureau, and
very few staff to undertake various IEC
related activities, the IEC situation is
equally poor. Some of the general
observations made on these aspects, as
also reflected in time-to-time letters written
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by the state IEC officer to different
authorities and negotiations initiated with
different bilateral organizations, are as
follows:
q Lack of manpower and equipment and
other infrastructure.
q No training for any category of staff.
q Current IEC officer has no financial
powers.
q No IEC materials at the state level. All
materials displayed are either supplied
by the GOI or UNICEF.
q The Secretary expressed his
helplessness at the lack of staff.
q IEC budget is not utilized- Availability
of unspent budget.
q Several bottlenecks at different levels.
Every file has to be sent to the Cabinet
and the CM’s office, if it involves
financial matters, irrespective of small
amount involved.
q Lack of coordination between different
departments, which is hampering the
program. Even intra departmental
coordination lacking.
q The Director FW does not know any
thing about IEC
q Several officers are not aware of BCC.
q No coordination between different UN,
Bilateral and NGO agencies, even
though strongly present in the state.
q The SIHFW, PRC and other
organizations although are involved
through SKOVA, so far not much dent
in the existing attitude of no work
culture, have been made.
5.0 Recommendations:
Some of the recommendations for
improving the present status of family
planning program in general and IEC in
particular, could be as follows:
q With the existing scenario, all out
efforts are required to address the
issues. Both the government and
organizations/NGOs/Agencies
present in the state have to work in
hand in hand, under SCOVA, the
presence of which should be utilized
as an opportunity.
q SCOVA could be given mandate to
bring more coordination among
different agencies and even
possibilities of involving private sector
should be explored.
q Under RCH program, and with
available unspent money, dedicated
and trained IEC personnel with
adequate power should be appointed.
q A functional IEC bureau, with vacant
positions filled up at all levels would
help create an atmosphere and
generate interest of stakeholders.
q Training has been almost missing from
the scene, which should be revived,
and efforts should be made to influx
BCC in to system, with repeated
reorientations at all levels.
q There have been suggestions from
different functionaries to involve local
political leaders, influencers, PRIs,
inter departmental personnel on one
hand, and local level available
resources such as, youths,
chowkidars, teachers, barbers etc. to
generate awareness among the target
groups.
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References:
1. Registrar General, India, Final Population Totals, Census of India, Paper No.2, Government of India, New Delhi, 2002.
2. IIPS, National Family Health Survey-II: Uttar Pradesh, International Institute for population Sciences, Mumbai, 2001.
3. IIPS, ibid,2, 2001.
4. Ali, Almas and B P Thiagrajan, District Profile of Bihar, Population Foundation of India, New Delhi, December, 2002.
5. Government of India, First Business Session of the Empowered Action Group (EAG) on Population Stabilization,
Ministry of Health & Family Welfare, Vigyan Bhawan, New Delhi, June 2001.
6. IIPS, RCH Indicators through Rapid Household Survey in the State of Bihar, Ministry of H& FW, GOI, New Delhi, 2000.
7. Government of Bihar, Draft Population Policy, Department of Health & Family Welfare, GOB, Patna, July, 2000.
8. Government of India, National Population Policy-2000, Ministry of Health and Family Welfare, GOI, New Delhi, 2000.
9. Government of Bihar, op. cit.,7, 2000.
10. Government of Bihar, Project Implementation Plan for RCH-II, Department of H&FW, Patna, 2004.
11. Government Of Bihar, RCH Specific Communication Strategy & Implementation Plan for the State of Bihar, IEC Division,
State Family Welfare Department, Bihar, Patna, 2004.
12. IIPS, ibid,2, 2001.
13. State IEC Office, Meeting with EC Team and GOI Officials, held at Patna, April,2001.
14. Dept of M& FW, Review Meeting of GOI, UNICEF, EC, and WHO with Bihar Government to Discuss enhancing State
capacity in FW Sector, Patna, Aug. 2004.
15. BVHA, Radio Listeners Club, Created for Awareness Generation On FP related Issues, BVHA and PFI, Patna, 2002.
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Annexure 1: Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to the
radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly exposed to any
of these media by selected background characteristics, Bihar, 1998-99
Background characteristic
Reads a
newspaper
or magazine
at least
once a week
Exposure to mass media
Watches
television
at least
once a
week
Listens to the
radio at least
once a week
Visits the
cinema/
theatre at
least once
a month
Not
regularly
exposed to
any media
Number of
women
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
9.5
13.9
19.5
4.9
72.7
825
10.3
15.9
22.4
5.1
71.5
1419
9.5
17.7
21.5
4.7
72.4
1419
10.7
17.6
20.2
4.9
71.5
1088
8.8
16.6
18.2
4.2
75.2
921
7.6
17.5
19.1
3.8
73.6
759
6.3
18.1
18.8
1.3
73.7
593
Residence
Urban
Rural
31.4
59.1
39.6
18.3
6.8
11.9
18.1
2.8
32.7
77.3
718
6306
Region
North Bihar Plane
South Bihar Plain
Jharkhand
9.2
14.6
22.0
4.3
73.8
3133
9.6
17.3
19.8
5.3
72.3
2199
9.0
20.0
17.8
3.4
71.2
1692
Education
Illiterate
Literate, <middle school complete
Middle school complete
High school complete and above
0.0
21.9
40.7
62.7
7.0
34.7
46.9
68.1
10.6
41.6
50.2
66.9
1.4
7.5
13.4
23.4
85.9
42.6
26.3
14.0
5383
779
267
595
Religion
Hindu
Muslim
Christian
Others
10.0
4.2
24.8
7.7
17.4
13.2
23.2
13.5
21.3
14.1
40.7
9.8
4.4
4.0
12.2
1.8
71.7
5872
78.9
1038
57.5
59
82.5
55
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
4.2
9.6
13.1
2.7
82.1
1452
2.7
4.2
10.4
1.1
88.3
582
7.1
14.9
18.4
3.7
74.9
3642
23.4
34.9
37.5
9.4
50.0
1348
Standard of living index
Low
Medium
High
Total
1.3
10.2
47.6
9.3
2.5
20.3
77.8
16.8
6.2
27.6
67.2
20.3
1.2
5.3
17.7
4.4
91.8
62.0
12.6
72.7
3709
2595
712
7024
Note: Total includes 8 women with missing information on the standard of living index, who are not shown separately.
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Range of RCH indicators in BIHAR
Indicators
Minimum
Maximum
Eligible women below age
Girls married at age below 18 years
Non-literate eligible women
Total fertility rate (TFR) (per women)
Birth order 3 and above
Infant mortality rate (IMR) (per 1000
live births)
Knowledge of any modern FP methods
Knowledge of NSV among husbands
Current use of any FP methods
Current use of modern FP methods
Unmet need for FP methods
Three of more ante-natal check-ups
Received full antenatal check-up (ANC)
Safe delivery
Exclusive breastfeeding
Full immunization
Eligible women aware of RTI/STI
Husbands aware of RTI/STI
Eligible women aware of HIV/AIDS
Husbands aware of HIV/AIDS
Pregnancy complications
Delivery complications
Post-delivery complications
Utilization of Govt. Health facilities
for antenatal care
Utilization of Govt. Health facilities
for postnatal care
30 years 51.6 (Muzzafarpur)
39.5 (Siwan)
48.8 (Patna)
2.6 (Pashchim Champaran)
41.7 (Muzzafarpur)
41.7 (Siwan)
65.5 (Samastipur)
67.7 (Samastipur)
78.2 (Pashchim
Champaran)
4.69 (Samastipur)
63.1 (Kishanganj)
82.4 (Madhubani)
99.7 (Muzzafarpur)
100.0 (Khagaria)
3.2 (Pashchim Champaran) 61.6 (Katihar)
22.9 (Samastipur)
36.8 (Patna)
18.9 (Pashchim Champaran) 33.9 (Patna)
20.1 (Madhepura)
36.2 (Siwan)
8.9 (Samastipur)
31.0 (Patna)
0.7 (Pashchim Champaran) 12.8 (Patna)
15.4 (Madhubani)
49.2 (Patna)
0.5 (Katihar)
32.5 (Muzzafarpur)
9.5 (Kishanganj)
41.3 (Patna)
51.6 (Pashchim Champaran) 96.0 (Patna)
37.8 (Jehanabad)
69.3 (Vaishali)
7.7 (Pashchim Champaran) 47.5 (Patna)
43.0 (Pashchim Champaran) 74.2 (Patna)
26.7 (Pashchim Champaran) 54.5 (Araria)
60.5 (Jehanabad)
96.4 (Madhepura)
32.2 (Siwan)
72.5 (Araria)
1.3 (Madhepura)
17.3 (Pashchim
Champaran)
4.9 (Madhepura)
56.4 (Pashchim
Champaran)
Note : All figures are in percentage except TFR and IMR
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List of the Officials Met During Consultants’ visit to Bihar during
4-6 October 2004
Mr. S.S. Verma, Secretary, Health and FW.
Mr. S.K. Singh, Deputy Secretary, FW.
Mr. Shahnawaz Khan, AO.
Mr. UK Verma, State demographer.
Dr. Geeta Prasad, (Dir) FW.
Dr. Manoranjan Jha, Medical Officer, Regional office of GOI.
Dr. Jayant Kaushal, RD/ R Office.
Dr. Shivanand Sinha, Deputy Dir Training.
Dr. R.K. Chowdhary, State Immunization Officer.
Mr. Ashok Moti, Dy Dir IEC.
Dr. SN Singh, Dir I/C.
Dr. Shanti rai , retd HOD, PMC.Mr. Swapan Majumdar, BVHA.
Dr. Ram S Ram, CS, Muzaffarpur.
Mr. Ganesh Prasad Singh, ADITI.
Mr. Upadhaya, Project Dir ADITI, Muzaffarpur.
Dr. M Nazir, MO I PHC Kati, District Muzaffarpur.
Dr. BB Rai, MO IV,PHC Kati, District Muzaffarpur.
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CHAPTER 4.2
JHARKHAND
State Profile and IEC status with respect to
Family Planning Program
1.0 Background:
The state of Jharkhand has been
newly created by bifurcating the
erstwhile Bihar state into two, and
is dominated by the tribal population. The
state is a land-locked territory bound by
the districts of Rohtas, Aurangabad, Gaya,
Nawada, Jamui, Banka, Bhagalpur, and
Katihar of Bihar on the north, the districts
of Malda, Murshidabad, Birbhum,
Barddhaman, Puruliya, and Medinipur of
West Bengal on the east, the districts of
Mayurbhanj, Kendujhargarh, and
Sundergarh of Orissa on the south, the
districts of Raigarh and Surguja of
Madhya Pradesh, and the district of
Mirzapur of Uttar Pradesh on west.
Jharkhand contains 18 districts divided
into 4 divisions, distributed over an area
of 79,714 sq. kms. The state has 152
towns and 32,615 villages.
Jharkhand has some of the richest
deposits of iron and coal in the world and
also is in one of the most industrialized
regions in the country. Additionally, the
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state is endowed with a rich forest cover.
It has a vast potential for generating
hydroelectric power, as is exemplified by
the location of the famous Damodar Valley
Corporation in the state (Director of
Census Operations, Jharkhand, 20011).
According to the provisional population
totals of India, Jharkhand had a population
of 26.9 million in March 2001. The
population growth rate was 23.2 percent
in 1991-2001, which is much lower than
the growth rate for Bihar (28.4 percent)
but was higher than the growth rate for
the country as a whole (21.3 percent).The
population density of Jharkhand was quite
low with 338 people living in one sq. km.
Area, and was less than half the
population density of Bihar (880 people
per sq. kms.). As compared with the
previous decade, the state registered a
slightly lower decadal growth rate (24.0
percent in 1981-91 and 23.2 percent in
1991-2001), but a higher population
density (274 in 1991 and 338 in 2001).
The sex ratio of 934 is close to the all-
India average (933), but is higher than that
for Bihar (921). The literacy rate for
Jharkhand is 67.9 percent for males, 39.4
percent for females, and 54.1 percent for
the total population.
More than one-fifth of the state population
(22.3 percent) lives in urban areas,
indicating that Jharkhand has a higher
degree of urbanization than Bihar (10.5
percent) but a lower level of urbanization
than the all-India average of 27.8 percent.
As per the provisional population totals of
the 2001 Census, the state has five cities
with a population of 100,000 and above
(Director of Census Operations,
Jharkhand, 20012).
The fertility scenario of the state
remained poor with estimated total
fertility rate at more than 3 children as
per other study sources, even though
NFHS-II estimate was lower at 2.8
children. As per the NFHS-II report, "At
current fertility levels, NFHS-2 estimated
that women in Jharkhand will have an
average of 2.8 children each throughout
their childbearing years. However, it is
clear that the survey substantially
underestimated the level of fertility in the
state, largely due to errors in the
recorded timing of births in the birth
history as well as omission of recent
births. The percentage of higher-order
(3+) births is about the same in
Jharkhand and Bihar (54-55 percent), so
the average number of children born
should also be almost at the same level.
The survey also shows that about one-
quarter of births in both Jharkhand and
Bihar take place within 24 months of the
previous birth" (NFHS-II3).
Knowledge of contraception is nearly
universal: 99 percent of currently married
women knew at least one modern family
planning method. Women are most
familiar with female sterilization (98
percent), followed by male sterilization
(96 percent), the pill (68 percent), the
condom (56 percent), and the IUD (48
percent). More than one-third of women
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(38 percent) have knowledge of at least
one traditional method. However, current
user ship of family planning methods
remained quite low in the state with only
28 percent of married women in
Jharkhand currently using some method
of contraception, compared with 48
percent at the national level and 24
percent in Bihar (NFHS-II4). The current
scenario, thus, underscores the need for
strategies that provide spacing as well
as terminal methods in order to meet the
changing needs of women over their
lifecycle.
Jharkhand has been identified as one
of the EAG states5. The state with its
socio-economic backwardness and
sizeable tribal population requires
special attention. Even though the state
with mining riches has potential to look
forward, the population scenario and low
literacy are adversely impacting upon its
socio-economic indicators. After the
bifurcation of the state from Bihar, the
state has, even though, made progress
on many fronts, the state is still to come
over the shortage of required resources.
The present chapter provides some of
the observations made by a team of
Consultants on the IEC status in the
family welfare sector (particularly related
to family planning and RCH
components) in the state and its impact
on the program implementation. The
Population Foundation of India on behest
of the MOH&FW, Government of India,
has sponsored this study.
2.0 Methodology:
A team of three consultants visited each
state of the eight EAG states, all together,
two members or a single member,
depending on the need of state. In the
case of Jharkhand, a one-member
consultant team visited the state during
28-30 September 2004. The Consultants
prepared and followed a set of checklists
and talking points relevant to the study
and to be canvassed at different levels,
after having prolonged deliberations with
PFI officials. Some of the checklists were
also prepared and used during
interactions with senior government
officials and other stakeholders in Delhi
and were modified suitably after each
state visit to cover more and more issues
that emerged during discussions.
During the state visit, the Consultants'
tasks were broadly divided to cover three
major areas. The first was to meet the
state officials and setups responsible for
the health and family welfare program
delivery, with maximum coverage of those
directly responsible for IEC activities in the
state. For such interactions, in Jharkhand
the Consultant met with Mr PP Sharma,
IAS, the Commissioner and Secretary
Health & Family Welfare (also additional
charge of DG H & FW), Dr (Mrs.) Pushpa
Beck, RCH Officer (additional charge of
IEC in-charge), Dr. Sumanta Mishra, Ex-
RCH Officer and Currently WHO
representative, Mrs. Jyotsana Verma Ray,
IAS, Secreary Social Welfare and Director
ICDS, representatives of bilateral
agencies such as PSI, Policy Group,
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CARE-India, and UNICEF, NGO agencies
like PFI representatives, CINI, GKVK, SAI
and others. A visit to Lohardiga district and
lohardiga Block PHC was also made to
meet district officials, PHC Medical officers,
ANMs and Anganwadi Center Workers. A
list of the persons met during visit and
places visited is given in Annexure.
3.0 Current Status of Family
Welfare Program with a Focus
on IEC:
The health and family welfare program is
facing a daunting task in the state with a
resource crunch, especially in the
absence of required manpower. The
status of lack of manpower is well reflected
in the remark made by the Commissioner
(H&FW) that," I am the only person in the
department, holding positions of
Secretary, DG, Director or the IEC Chief)".
And, as per the team observations, it was
true and only one RCH officer assisted
Mr. Sharma. However it was encouraging
to note that Mr. Sharma could manage to
receive support from all the bilateral
agencies present in the state and major
NGOs to initiate and get some work done
in the state. The feeling of most officials,
both government and others was that
once he is out, it would be difficult to run
the department. It may also be noted that
despite of all the bottlenecks and crunch
of officials and funds, Jharkhand was able
to formulate its own population and RCH
Policy6, Jharkhand State Health Policy7,
and Jharkhand State Drug Policy8 with
assistance from The Policy Group and
was able to hold number of Conferences/
Workshops to discuss FP and RCH
issues including one supported by The
Population Foundation of India9 on
Population Stabilization, Health and
Social Development. Besides The
Commissioner has been issuing office
orders from time to time reflecting his
focus on various issues related to health
and RCH10. The RCH Directorate, again
headed by the Commissioner has also
brought out a set of leaflets, "Healthy and
Happy Jharkhand" covering many related
aspects11. Obviously with least manpower
availability, no IEC bureau exists in the
state. The state does not have any
equipment also to produce its own IEC
material. It is mainly dependent on either
material directly received from GOI,
material produced by different
organizations in the state or some times
it is out sources to private vendors, if
necessary. The state Population Policy
and IEC issues addressed through have
been briefly discussed below:
3.1 STATE POPULATION AND RCH POLICY:
As stated, the Population and RCH
policies have been formulated very
recently, i.e. in June 2004, when the state
government decided to formulate an
integrated state specific population and
RCH policy. Accordingly, the main
objectives in the joint policy document
include, achievement of replacement level
of fertility by 2020, improve knowledge of
modern spacing methods from current
levels to above 90 percent by 2005 and
increase use of modern methods from 25
percent to 60 percent by 2015. Similar
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objectives have been fixed for achieving
RCH goals. The major strategies
suggested to achieve these goals include,
addressing adolescent health, age at
marriage, promotion of spacing methods
and terminal methods, immunization for
mother & child, empowering women,
involving men, community and NGOs in
the program. In the policy document the
government has made a special mention
to use behavior change communication to
increase demand for RCH and FP services.
Under this creation of IEC Bureau, creation
of structure with trained professionals and
arranging training in BCC for health care
providers in inter personal communication
and counseling skills.
Even though the state has yet to develop
Project Implementation Plan for RCH-II,
the state has set some indicators to be
achieved under RCH program. Similarly,
the state has developed some indicators
to be achieved in the areas of blindness
control, HIV/AIDS, TB, Leprosy and
malaria eradication programs. The over all
approach has been planned under the
program, "Healthy Jharkhand Happy
Jharkhand", brought out by the H & FW
Directorate12. The Commissioner H & FW,
is trying to involve all the agencies present
in the state including UNICEF, MOST,
Policy Group, WHO and NGO such as
PFI, KGVK etc to boost the efforts.
3.2 VILLAGE HEALTH COMMITTEES:
The department has formulated Village
Health Committees in each village,
consisting of 5 prominent persons in the
village to address health needs of the
people. The ANM, AWW and
schoolteacher are the member of the
committee besides the opinion leaders.
They would identify one village woman
volunteer to work with ANM and AWW and
address the health and FP related issues.
She will be called Sahayya, the friend. The
decision on payment/remuneration to this
volunteer is left upon the village
committee, whether or not to pay, and the
amount to be paid to this volunteer. If the
volunteer is to be paid, the Committee
would raise funds from Community itself.
Also the Committee is empowered to
oversee her work and decide about the
increment in her payment over time. From
June 2004 the scheme has already come
in force and in about 50 percent of villages
such committees have been formed. The
ANM training centers will be used to train
these workers and XLRI has agreed to
take up the responsibility to train them.
For running the training the department
would reimburse the amount on
performance based distribution system.
3.3 EXPOSURE TO MASS MEDIA:
For many years, the Government of India
has been using electronic and other mass
media to promote family planning.
Exposure to mass media is quite low in
Jharkhand, where only 32 percent of rural
residents live in villages that are electrified
and only 3 percent live in villages that have
a cable connection. Overall, only 18
percent of ever-married women listen to
the radio at least once a week and only
20 percent watch television at least once
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a week. As in Bihar, almost three-quarters
of women in Jharkhand are not regularly
exposed to radio, television, or other types
of media. Exposure to each type of media
is much higher among urban women,
more-educated women, women not
belonging to a scheduled caste,
scheduled tribe, or other backward class,
and women from high standard of living
households. Thirty-seven percent of
women saw or heard a family planning
message in the media during the few
months preceding the survey. In addition
to radio and television, wall paintings and
hoardings are important sources of
exposure to family planning messages in
Jharkhand. As with the exposure to mass
media itself, exposure to family planning
messages is much lower among rural
women, illiterate women, women
belonging to scheduled tribes, and women
from households with a low standard of
living. Only 13 percent of currently married
women in Jharkhand have discussed
family planning with their husbands and
very few women have discussed family
planning with other relatives, friends, or
neighbors.
More than four-fifths (78 percent) of
women who use modern contraception
obtained their method from a government
hospital or other source in the public
sector. Only 18 percent obtained their
method from the private medical sector.
The private medical sector, along with
shops, is the major source of pills and
condoms, however. The private medical
sector plays a larger role in urban areas
(where it is the source of modern methods
for 30 percent of users) than in rural areas
(where it is the source of modern methods
for 13 percent of users).
An important indication of the quality of
family planning services is the information
that women receive when they obtain
contraception and the extent to which they
receive follow-up services after accepting
contraception. In Jharkhand, only 13
percent of users of modern contraceptives
who were motivated by someone to use
their method were told about any other
method. A health or family planning worker
told only 18 percent of women about
possible side effects of the method they
adopted at the time of adopting the method.
Eighty-one percent of contraceptive users,
however, received follow-up services after
adopting the method.
From the information provided in NFHS-
II, a picture emerges of women marrying
early, having their first child soon after
marriage, and having about two more
children by the time they reach their mid-
20s. At that point, about one-fifth of
women get sterilized. The median age for
female sterilization is now 27.3 years.Very
few women use modern spacing methods
that could help them delay their first births
or increase the interval between
pregnancies (NFHS-II13).
3.3 SUPPORTS FROM INTERNATIONAL
NGOS/LOCAL ORGANIZATIONS:
The Secretary, H & FW has formed a
consortium of all bilateral, UN and NGOs
present in the state and getting their help
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in addressing different health and family
welfare related issues. Similarly, CARE-
India has formulated neighborhood
concept and working presently in eight
districts with life cycle approach in
reproductive health along with ICDS
workers (AWWs), and in 17 districts by
involving males. They have adopted BCC
approach to address village girls and
adolescent boys, and have been working
closely with the government for last two
years. The presence of CARE -India in the
state however has been for long time,
since 1996, almost for 8 years. CARE-
India has also introduced Chayan14
program in 11 districts to help implement
National Population and National AIDS
policies. Chayan promotes spacing
methods of family planning and prevention
and control of STIs including HIV.
Population Foundation of India is also
working in Jharkhand in close
collaboration with the government
program. The main thrust of PFI is to
promote adolescent reproductive health
care. The project is concentrating its
efforts in the districts of Ranchi and
Hazaribagh, chosen on the basis of
presence of high tribal population. The
project is based on identifying the
problems of adolescent in each of 22
blocks of these two districts through
formative research and than addressing
the concerned issues mainly related to
migration and early marriage in
partnership with other NGOs and Block
Development Officials. The major focus is
providing information to adolescents
through IPC. So far 14 blocks have been
covered under the scheme.
PSI is also present in the state and
working to promote condom and its other
products. The organization has prepared
a road map and undertaking IEC activities
through mobile approach. PSI has
adopted different approaches for different
size of villages and getting funds from
Gates Foundation and USAID. The PSI
target is to promote birth spacing through
these road shows. They have developed
a few documentary films one of them
called "Jharkhand Ke Shole" besides
holding Nukkad Nataks and street shows.
The problem with these shows is that, the
road show hits the village only twice during
whole campaign and only once in six
months. The long-term impact of such
campaign needs to be assessed.
The Policy Project of the Futures Group
has been working with the government
hand in hand and helping the state in
developing different policies for the state.
Similarly, UNICEF and Department of
Social Welfare are also working with their
limited resources hand in hand with the
health department.
Many Corporate sector organizations
have also come forward and trying to help
the government in its efforts.TATA through
Bharat Sewa Ashram, Usha Martin
through GGVK, Coal India Limited, Steel
Authorities of India and many more
organizations are already helping the
government in its efforts. KGVK has
established a chain of hospitals in the
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state and involved in training to grass root
workers in IEC and other activities15. More
of the corporate sector could be brought
in with innovative schemes. The
willingness seems to be existing which
need to be shown direction.
3.4 SITUATION AT DISTRICT AND LOWER
LEVEL:
A visit to one of the block PHCs in another
district Lohardiga (block PHC also existed
at the district headquarters) gave the
impression that while most of the positions
at the PHCs and sub centers were filled
in, no training whatsoever has been
conducted for more than five years period.
The BEE position also existed in the PHC,
but he was working as store In-charge for
many years and hardly knowing what he
was supposed to do as BEE. The medical
Officer In-charge, who called 6-7 doctors
posted in the PHC, mentioned that their
IEC efforts are restricted to distribution of
material received from GOI. He also
mentioned that except some posters
related to Polio eradication program; he
has not received any material for long
time. The BCC concept was beyond their
understanding. The ANMs positions were
filled up in most cases but they have not
received any training for long time, the
PHC In-Charge mentioned.
Because the newly created state has still
to have established directorate and other
functioning units at state level, no proper
monitoring of activities is taking place. The
presence of NGOs or bilateral agencies,
however, at some places is helping district/
block in undertaking some activities.
4.0 Issues of Concern:
Some of the issues of concerns, which need
immediate attention of the government, are
as follows:
q State lacks proper administrative
structure. Most positions from top (e.g.,
Director General to Bottom (IEC
Officer) at the state level are vacant.
Difficult to coordinate efforts by single
authority.
q Although it is claimed that coordination
among different partner agencies
exists, no such co-ordination is visibly
seen.
q The decisions of implementing
programs are some times taken
arbitrarily and lots of funding by donor
agencies on some ambitious programs
is being wasted. The impact
assessment of big programs should be
first taken up on pilot basis (e.g., One
time touch and go approach during
village drives, introduction of
Sahayyas at large scale etc.).
q Different policies are formulated
without taking the state specific needs
in to consideration. Addressing issues,
which are more relevant for the state
or area, should get priority.
q The corporate sector is willing to invest
in social sector. They need to be
tapped properly. There is a large no.
of corporate sector players which
could be brought in for implementation
of program. Usha Martin's KGVK
program is a good example.
q No IEC strategy exists. A large number
of the districts in the state are tribal
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dominated. They require special
attention and strategy.
q No monitoring & evaluation cell exists.
5.0 Recommendations:
q A proper administrative structure
should be created as soon as possible.
q IEC Bureau should be established to
coordinate the efforts.
q Training at grass roots in IEC/BCC
should be taken up.
q State has about 27 percent tribal
population, which has different needs.
Their requirements should be kept in
mind while formulating the IEC
strategy, which is urgently required.
q While formulating IEC strategy, some
related programs could be addressed
simultaneously.
q There is a need to develop coordination
between different players working in the
state to avoid duplication of efforts.
Corporate sector could be brought in
to picture in a big way to help the
government, as willingness among
them is evidently present.
q Strong monitoring and impact
assessment system should be
developed and placed.
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Table 1: Names of the Officials met in Jharkhand:
A. Government Officials:
1. Mr. P P Sharma, IAS, Commissioner and Secretary, Ministry of H& FW, Government
of Jharkhand.
2. Mrs. Jyotsana Verma Ray, IAS, Secretary Social Welfare and Director, ICDS,
Government of Jharkhand.
3. Dr. (Mrs.) Pushpa Beck, RCH Officer, Government of Jharkhand.
4. Dr. Chandra Bhushan, M O I/C, Lohardiga Block PHC, Lohardiga.
5. 4-5 Other Medical Officers.
6. BEE, Lohardiga PHC.
7. 3 ANMs from Lohardiga PHC.
8. Augumati Devi, AWW, Kemo village, Lohardiga.
B. Other Organizations:
1. Dr. Sumanta Mishra, WHO Representative and Ex RCH Officer, Jharkhand.
2. Dr. Sanjay Pandey, CARE-India, Jharkhand.
3. Dr. Nirbhay Mishra, CARE-India, Jharkhand.
4. Mr. Madhu Sudan, CARE-India Field Office, Lohardiga.
5. Mr. Dipankar Dutta, Policy Project, The Futures' Group, Jharkhand.
6. Dr. Suranjeev Prasad, Population Foundation of India, Jharkhand.
7. Ms. Indumati Dwedi, Population Foundation of India, Jharkhand.
8. Mr Prem Prakash, Population Foundation of India.
9. Dr. Ashok Kumar, Professor, Institute of Management, Steel Authorities of India,
Ranchi.
10. Mr. Debashish Sinha, CINI, Ranchi.
11. Mr. Subrato Mandal, CINI, Ranchi.
12. Mr. Mathew, PSI, Ranchi.
13. Dr. (Mrs.) Madhulika Jordenthen, UNICEF, Jharkhand.
14. Mr. Sumitra Roy, HLL, Ranchi.
15. Colonel Rath, Krishi Gram Vikas Kendra, Usha Martin, Ranchi.
16. Hospital Staff of KGVK, Ranchi.
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References:
1. Census of India 2001, Jharkhand Provisional Population Totals, Paper-2 of 2001: Rural-Urban Distribution of Population,
Series 21, Director of Census Operations, Jharkhand, Ranchi.
2. Census of India 2001, Jharkhand Provisional Population Totals, op.cit. 1.
3. IIPS, National Family Health Survey for Jharkhand, 1998-99, International Institute for Population Sciences, Mumbai, 2000.
4. IIPS, ibid, 2000, 3.
5. Government of India, First Business Session of the Empowered Action Group (EAG) on Population Stabilization, Ministry of
Health and Family Welfare, Vigyan Bhawan, New Delhi, June 2001.
6. Ministry of Health and Family Welfare, Population and RCH Policy of Jharkhand, Government of Jharkhand, Ranchi, June,
2004.
7. Ministry of Health and Family Welfare, Jharkhand State Health Policy, Government of Jharkhand, Ranchi, June, 2004.
8. Ministry of Health and Family Welfare, Jharkhand State Drug Policy, Government of Jharkhand, Ranchi, June, 2004.
9. Population Foundation of India, State Level Conference on Population Stabilization, Health and Social Development Issues
in Jharkhand, November 2003, Ranchi.
10. Letters issued by the Secretary, H& FW from time to time during Feb-June 2004 for implementing various programs and
involving various agencies.
11. Directorate of RCH, Healthy Jharkhand Happy Jharkhand, Ministry of H & FW, Government of Jharkhand, Feb. 2004.
12. Department of RCH, ibid, 11.
13. IIPS, op cit, 2000, 3.
14. CARE-India, Chayan-Promoting Birth Spacing and STIs, CARE-India, July 2002, New Delhi.
15. KGVK, Making A Difference, Krishi Gram Vikas Kenra, Ranchi, 2002-03.
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JHARKHAND
Range of RCH indicators in JHARKHAND
Indicators
Minimum
Maximum
Eligible women below age 30 years
Girls married at age below 18 years
Non-literate eligible women
Total fertility rate (TFR) (per women)
Birth order 3 and above
Infant mortality rate (IMR) (per 1000
live births)
Knowledge of any modern FP methods
Knowledge of NSV among husbands
Singhbhum)
Current use of any FP methods
Singhbhum)
Current use of modern FP methods
Singhbhum)
Unmet need for FP methods
Three of more ante-natal check-ups
Singhbhum)
Received full antenatal check-up (ANC)
Singhbhum)
Safe delivery
Singhbhum)
Exclusive breastfeeding Singhbhum)
Full immunization
Eligible women aware of RTI/STI
Husbands aware of RTI/STI
Eligible women aware of HIV/AIDS
(PurbiSinghbhum)
Husbands aware of HIV/AIDS
Singhbhum)
Pregnancy complications
50.8 (PurbiSinghbhum)
17.7 (Gumla)
41.3 (Purbi Singhbhum)
1.6 (Purbi Singhbhum)
38.1 (Purbi Singhbhum)
34.7 (Gumla)
58.7 (Godda)
66.4 (Godda)
73.2 (Godda)
3.3 (Godda)
56.8 (Lohardaga)
97.4 (Sahibganj)
94.1 (Godda)
22.7 (Dumka)
100.0 (Deoghar &
Ranchi)
38.4 (Purbi
22.7 (Gumla)
50.7 (Purbi
19.3 (Gumla)
45.8 (Purbi
22.0 (Sahibganj)
21.4 (Godda)
41.9 (Gumla)
58.9 (Purbi
3.6 (Dumka)
27.4 (Purbi
21.0 (Godda)
55.6 (Purbi
1.6 (Sahibganj)
18.0 (Pashchim
7.7 (Godda)
51.0 (Lohardaga)
34.4 (Pashchim Singhbhum) 93.2 (Sahibganj)
20.1 (Gumla)
60.9 (Godda)
11.6 (Godda)
50.9
31.6 (Gumla)
65.7 (Purbi
32.7 (Deoghar)
49.8 (Sahibganj)
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Chapter 4.2
UTTAR PRADESH
Review of the IEC component of the
Family Welfare Programme
1. Background:
Uttar Pradesh, with 1660.5 million
population in March 2001, is the
most populous state of India, in
spite of one of its part, Uttaranchal, been
made a separate state1. While India has
around one sixth of the world's population,
the state has one sixth of India's
population, living in the second largest
geographical area of around 241
thousand kilometers in the country. The
state is divided into 17 divisions and 72
districts. Geographically the state could
be divided in to four regions, namely
Western, Central, Eastern and
Bundelkhand. Every region has distinct
social, economic and cultural
characteristics, besides different local
dialects in Hindi.
Uttar Pradesh predominantly is an
agriculture-based state with its 80 percent
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population still living in rural areas. The
economic development indicators put the
state in rather awkward position with 40
percent of its population falling in below
poverty line. The contribution of the
agriculture sector to the state domestic
product declined from 50 percent to 42
percent during last 25 years, leading to a
marginal increase of less than 10 percent
in the manufacturing sector.
The present chapter presents some of the
observations made by a team of
Consultants on the IEC status in the family
welfare sector (particularly in family
planning and RCH components) in the
state and its impact on the program
implementation. The Population
Foundation of India on behest of the
MOH&FW, Government of India, has
sponsored this study.
The fertility scenario of the state remained
poor with total fertility rate at around 4.8
children (against 3.2 of Indian average)
in 1998-99 (NFHS II)2. The other
demographic indicators in the state depict
that while about 45 percent children are
fully immunized, trained personnel are
assisting only about 22 percent deliveries.
The couple protection rate as depicted by
the service statistics is around 29 percent,
similar to the estimated contraception
prevalence rate of around 28 percent
during 1998-99 (NFHS II).
Uttar Pradesh has been identified as one
of the major EAG states3. The state
because of shear population size and low
socio-economic profile, impacts adversely
upon all the socio-economic indicators of
the country. Many efforts have been made
in the state, especially during the last
decade, by the Government of India and
also with the assistance from bilateral
agencies, mainly with the assistance from
USAID, to improve its population scenario.
Even though some improvements are
evidently taking place, many more efforts
are required to be made.
2. Methodology
A team of three consultants visited each
of the eight EAG states, all together, two
members or a single member team,
depending on the need of the state. In the
case of Uttar Pradesh, a one member
Consultant team visited the state during
9-12 September 2004. The Consultants
prepared and followed a set of checklists
and talking points relevant to the study
and to be canvassed at different levels,
after having prolonged deliberations with
PFI officials. Some of the checklists were
also prepared and used during
interactions with senior government
officials and other stakeholders in Delhi
and were modified suitably after each
state visit to cover more and more issues.
During each state visit, the Consultants'
tasks were broadly divided to cover three
major areas. The first was to meet with
state officials and setups, responsible for
the health and family welfare program
delivery, with maximum coverage of those
directly responsible for IEC activities in the
state. For such interaction, in Uttar
Pradesh the consultant met with the
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Principle Secretary (H & FW), Director
General (FW), Executive Director
(SIFPSA), Executive Director (UPHSDP),
Project Director (UPSACS), Director
(SIHFW), Additional Director IEC Bureau,
and other officials. Second, the Consultant
met the partners and other players in the
field such as UN and Bilateral agencies,
international and national NGOs. Third,
the Consultant visited one CHC (Lucknow
District), one PHC (Barabanki District) and
another in Meerut district, and met with
the frontline officials (Incharges/MOs/
Bloch HEIO) and workers (3-4 ANMs) who
actually carry out the tasks. A list of the
officials/persons contacted during our visit
has been given in Annexure Table.
3. Current Status of the Family
Welfare programme with a
focus on IEC
The state has been able to attract several
innovative schemes to amicably address
the issue during last one and a half decade
and able to make some dent to deal with
the population related issues. SIFPSA, a
USAID funded innovations in family
planning services project has initiated
many innovative ways to generate
awareness and knowledge among
targeted population through IEC strategy
and other approaches, and its presence is
well felt on the state sponsored
programmes. The state has also been able
to develop its own Population Policy4 and
Project Implementation Plan (PIP) for the
RCH-II phase5, with the help of SIFPSA
and the Policy Group. During the last
decade there has been major
improvements in the infrastructure
development as well as training status of
the functionaries, mainly due to the efforts
of SIFPSA and UPHSD projects.
3.1 STATE POPULATION POLICY
The mission of the Population Policy is to
improve the quality of life of the people of
Uttar Pradesh with unequivocal and
explicit emphasis on sustainable
development measures and actions.
Population stabilization and improvement
of health status of people, particularly
women and children are essential
prerequisites to sustainable development.
Under this, the main objective of
population policy is to reach replacement
level of fertility of 2.1 by 2016. For this
purpose, the contraceptive prevalence
rate by modern methods must increase
from 22 percent in 1998-99 to 52 percent
in 2016. Fertility and contraceptive
behavior are inextricably inter-linked to
infant and child mortality. To achieve
population stabilization, there is an urgent
need to reduce the infant mortality and
also the maternal mortality ratio. For the
purpose the population policy aimed at,
increase in age at marriage, reduction in
fertility, reduction in maternal mortality,
reduction in infant and under five mortality,
and prevention from and reduction in the
incidences of RTI/STDs/AIDS. The
suggested major strategies for the
purpose include, community involvement,
addressing age at marriage, family life
education, empowerment of women, and
role of PRIs; involvement of private sector
by involving NGOs, cooperative sectors,
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organized sectors, ISM practitioners,
private health sectors, and through
contraceptive marketing; improving
access through and quality of RCH
services by strengthening maternal health
services, deliveries by trained personnel,
child health services, sterilization
services, and involving males in the
program; and by improving the service
delivery systems by meeting contraceptive
service requirements at different levels,
betterment in organizational structure,
decentralization, improving linkages with
other departments, improving logistic
systems, quality of care improvement and
introducing new technology an finally
improving the IEC component. A large
emphasis on improvement in IEC through
BCC approach has been placed in the
policy document. The policy states6,
"Information, education and
communication have a key role to play in
creating demand for services, in
promoting informed choice and in
increasing awareness about service
delivery points. Decision to adopt family
planning methods and also to seek health
care services is based on variety of
factors. Communication has a major role
to play in facilitating the informed choice
at both familial and community level." The
policy further emphasized on regional
based IEC and BCC strategies.
3.2 EXPOSURE TO MASS MEDIA
In a state like Uttar Pradesh, where a large
majority of women are illiterate or have
little formal education, informal channels
such as the mass media can play an
important role in bringing about
modernization. In NFHS-2, women were
asked questions about whether they read
a newspaper or magazine, watch
television, or listen to the radio at least
once a week, and whether they visit the
cinema or theatre at least once a month.
Table 1 gives information on women's
exposure to these forms of mass media
by selected background characteristics7.
Table 1 reveals that, majority of women
(55 percent) are not regularly exposed t
o any of these media. As expected, the
percentage of 'not regularly exposed' to
the media is much higher among rural,
illiterate, and the women with a low
standard of living than that among other
women. Sixty-nine percent of illiterate
women are not exposed to any media,
compared with only 6 percent of women
who have completed at least a high school
education. The percentage of not regularly
exposed to any media is 82 percent
among women with a low standard of
living and only 13 percent among those
with a high standard of living. Sixty-three
percent of rural women are not regularly
exposed to any media, compared with
only 20 percent of urban women. The
regional differentials are not much
significant, but women in the Hill Region
are more likely to be exposed to any media
than women in other parts of the state
(The hill region however is no longer a part
of UP and is now a separate state called
Uttaranchal).The proportion of women not
regularly exposed to any media is the
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same for Hindu and Muslim women (55
percent), but much lower for Sikh women
(33 percent). Almost two-thirds of women
from scheduled castes, scheduled tribes,
and other backward classes are not
regularly exposed to any media, compared
with 45 percent of other women.
Among different types of mass media, 32
percent of women are regularly exposed
to television, up sharply from 19 percent
in NFHS-18. Thirty percent of women
mentioned that they usually listen to the
radio at least once a week, the same
percentage as in NFHS-1. Television has
the greatest reach in urban areas, but
exposure to radio is slightly more common
than exposure to television in rural areas.
Only 13 percent of women read a
newspaper or magazine at least once a
week and only 4 percent of women visit
the cinema or theater at least once a
month. Therefore, although mass media
can be an important means of spreading
health and family welfare messages in the
state, many more innovative ways have
to be explored to reach the majority of
women who are not exposed to any form
of mass media.
The Human Development Index of UP is
0.07%, one of the most vulnerable and
populous state in India. While the statistical
data such as CBR (33.5), CDR (10.3), IMR
(80/1000 per year) are high, the life
expectancy at birth (61.2 years for males
and 61.1 years for females) is low in case
of Uttar Pradesh as compared to the
national figures.
The state has a good infra-structural
network of medical and health services
both in the government and private
sectors. There are around 20,153 sub-
centers, 3889 PHCs, 335 CHCs and 68
District Hospitals staffed by more than
10,000 doctors and 1.5 paramedics under
the Medical, Health and Family Welfare
Department9. In addition, the state has an
extended public health infrastructure.
Despite all this, the state is engulfed with
challenges on maternity and child health
parameters, spread of non-communicable
diseases etc.
3.3 STATE IEC BUREAU:
The state government following the
direction from the GOI, to strengthen the
family planning program activities in 1999,
formed the State IEC Bureau. A team of
State IEC officials visited Rajasthan to
observe the successful model of IEC
Bureau immediately after formation of the
bureau. For the purpose the state received
a grant of Rs. 50.52 lacks as against a
proposed budget of Rs.1.25 crores. The
bureau also received additional funds for
its activities and other aliened activities
such as pulse polio, sterilization and TT
campaigns from GOI, SIFPSA and
UNICEF10.
The State IEC Bureau has 15 full time
employees, headed by the Director, who
is usually Special Secretary, Family
Welfare or the Director General (FW), with
dual charge. This is one of the important
reasons that IEC bureau, even though
started with lot of fanfare, could not do
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well. In fact, the Additional Director, who
is mainly responsible for all the IEC
activities, is a medical background person
with very little experience in IEC.The other
officials with the bureau include, one
communication officer, one song and
drama officer, one artist, one storekeeper,
six workers running the press, one clerk,
one driver and one peon. The positions of
audio-visual officer, and state education
officer remained vacant all through the
project 11.
The districts usually have one Dy. CMO
designated to look after IEC activities of
State and supported by DHEIO. Most
districts have this position filled up.
Similarly, at CHC/PHC level, the new
cadre of HEIO exists, most of them are
promoted supervisors and had never
under gone any training in IEC12.
The major activities taken up by the district
IEC cell at present are related to pulse
polio program publicity and publicity for
motivating people for sterilization, that too
during sterilization campaign usually held
during months of December and March
every year (narrated by one of the DHEIO
during our field Visits). The DHEIO added
that during TT campaign also, publicity of
the campaign was done on mass scale. In
SIFPSA districts, the CHC/PHC level
publicity is also taken up before holding
RCH camps, on large scale.
The bureau has some electronic
equipment, which are now almost non
functional as these are not being in use
for number of years. The equipment
includes one color TV, one VCR, one VHS
camera, one still camera and one tape
recorder13. Since its inception, however
during initial years many activities were
under taken by the bureau, major ones
are as below:
q Material preparation and distribution.
q Cinema shows at district level
(prepared five serials on FP and RCH
related topics)
q Use of folk and other media.
q Use of media like, TV, Radio, Cable
TV.
q Out door publicity (Wall painting,
hoardings, bus panels etc.)
q Exhibitions on special occasions.
q Seminar/workshop conductions.
q Population education for youths.
q Mahila Swasthya Sangh formation.
q IPC.
q Formation of district level committees.
As mentioned, while in the beginning it
started well, most activities at present
have come to a stand still.
3.4 MEDIA MATERIAL RESOURCE CENTER
(MMRC):
To strengthen the IEC activities for family
planning programme, SIFPSA had
created MMRC with the state directorate
in April 1997. The MMRC was
strengthened with number of electronic
gadgets and connections with Internets,
managed by a media expert. After
formation of IEC bureau, however, the
center became non functional and finally
in January 2000 was merged with the
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State IEC bureau. The MMRC was finally
closed down in the year 2002 and the left
out literature and material was shifted to
SIFPSA, where MMRC is confined to one
room in SIFPSA office only, with SIFPSA
Librarian looking after the available
material.
3.5 STATE INNOVATIONS IN FAMILY
PLANNING SERVICES AGENCY (IFPS)
PROJECT:
In Uttar Pradesh the State Innovations in
Family Planning Services Project Agency
(SIFPSA), is responsible for managing
and implementing the USAID funded
Innovations in Family Planning Project.
The strategic objective of the project is to
significantly reduce the total fertility rate
and improve women's reproductive health
in the state. The IFPS project specially
aims at reducing fertility from 4.8 in 1993
to 3.9 in 2004. To achieve this, the CPR
has to be increased from 18.5% in 1993
to 35% in 2004. One of the strategies
adopted by IFPS project is to develop a
communication strategy to pass on the
relevant messages through the following
media14;
q Participatory communication (raising a
force of CBD workers in partnership
of local NGOs)
q Multi-media communication (using TV,
radio, wall paintings, posters, folk
media, bus panels, IPC material etc
to address the masses)
q Training (training at appropriate level
to deliver the promise of open
discussion, promote informed choice
by covering campaign theme and logo
etc and use of IPC material)
q Information dissemination using
different media.
q Decentralization, localization and
convergence.
The SIFPSA project in Uttar Pradesh
mainly addressed improving the access
and quality of health and family planning
services. SIFPSA had initially selected 29
districts to work and has so for worked
with about 150 NGOs, it is expanding its
scope to all the districts of UP now. A
communication strategy for the project
was developed in mid-1995 after a
detailed program analysis and literature
review, deliberations of a strategy task
group and an intensive workshop with
participation of experts from different
communication fields and program
stakeholders15.
Towards implementation of the strategy,
an over-arching campaign theme was
developed with the aim of bringing the
hitherto taboo subject of planning families
out into the open & to trigger dialogue
across groups. Articulation of the theme
was in form of a call to action 'Aao Batein
Karen' (Come, Let's Talk). In continuity
with the theme, a statewide campaign was
launched to promote spacing methods
with the identified strategic focus of
reinforcing the health benefit of family
planning. Campaign components include
mass media, local media, community
media & inter-personal communication.
Simultaneous to the campaign,
communication was implemented for
interventions such as RCH camps,
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Tetanus Toxoid Campaign, Prominent
Fairs, Dai Training, ISMP training etc. In
synergy with the Population Policy of Uttar
Pradesh, a campaign was launched
towards increasing awareness of legal
age at marriage16.
The stocktaking meeting of the IFPS
project, convened in October 2002 had
deliberations on program communication
needs. There was consensus that
communication needed to be intensified
with a focus on behavior change.
Additionally, with expansion of project
activities and inclusion of new areas of
concerns, it was considered appropriate
to re-visit the existing communication
strategy, extend the strategic approach &
develop a BCC Strategy Plan for the next
2 years. The Assessment Team appointed
by USAID during their visit to assess the
impact of the IFPS Project in November
2002, also indicated the need for
comprehensive,
coordinated
communication strategy 17. For all SIFPSA
projects internal monitoring and external
evaluation are being carried out as a part
of benchmark achievements18.
Accordingly, the IEC division at SIFPSA
& JHU/PCS, developed a draft BCC
Strategy jointly with inputs from JHU/PCS,
Baltimore. This was shared within SIFPSA
& with all the Cooperating Agencies as
well as USAID. Suggestions received after
deliberations there in incorporated and a
final strategy has now been developed19.
With emphasis on folk media and also
print/mass media, SIFPSA has been
collaborating efforts with department of
family welfare, UNICEF, UP Health
System Development Project and others
in its IEC efforts, which lately shifted to
BCC strategy. The folk media has been
mentioned as the most successful media
by one and all at the time of teams' visit.
This was also evident by looking at the
document produced by SIFPSA on Folk
Media alone20. To maximize behavior
change impact from communication, the
strategy root recommended is to build on
prior program communication in terms of
thematic and topic continuity and to focus
where the stage has been set for
behavioral change. The proposed focus of
BCC interventions, therefore, is within the
'Come Let's Talk' concept, on topic derived
from strategic roots including maximizing
the use of IPC.
3.6 RCH PROGRAMME IN UTTAR
PRADESH:
Government of India had launched RCH
Phase-I21 program during 1998-99 for five
years, as a result of ICPD+5 deliberations
in all the states of India. The program
interventions included major and minor
civil works, referral, transport for FP
accepters, appointment of additional staff
at grass roots, dai training, RCH camps,
outreach services, training for all staff up
to PHC level and IEC activities. With the
GOI plan to extend RCH Phase-I to
Phase-II for the period 2005-10, a new
Project Implementation Plan has been
prepared by SIFPSA as nodal agency and
DGFW, GoUP, and submitted to the
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Government of India in August 2004. The
PIP has proposed much greater emphasis
on IEC and a full chapter under
"Interventions for Creation of Demand for
RCH Services" has been devoted to this
aspect. Some of the proposed
interventions include, 'Support to PRIs',
'Community empowerment schemes',
'BCC', 'Involvement of religious leaders',
'Saas Bahu sammelans', 'Involvement of
PAC/barbers', and other such activities.
While different media have been
suggested for use, concentration would
be on BCC through IPC, use of PRIs, local
resources and folk media, those well
tested under IFPS project. For the
purpose of demand generation an
estimated budget of about Rs. 2500 million
has been proposed for the next five years
(2005-10)22.
3.7 UP HEALTH SYSTEM DEVELOPMENT
PROJECT (UPHSDP):
UP Health System Development project
assisted by the World Bank was initiated
in the state to address health as general
theme and reproductive health and family
welfare program also getting some
attention. The project was established in
December 2000 for ten years. Besides
addressing communicable and general
diseases, the project presently is putting
main thrust on safe drinking water, good
sanitary practices, and smoke related
diseases. The project at present is
working in 28 identified socio-
economically backward districts and
presently working with 74 NGOs on
different intervention programs. The
project is also addressing issues related
youths. Two projects, one by KGMC in
Ibrahimabad (Barabanki District) and
another in Lucknow slums with Mahila
Samiksha were mentioned, where lots of
IEC activities, using BCC as tool are being
tried by UPHSDP to address daily living
habits, health care and health promotion
among youths23. The project had carried
out a SWOT analysis of IEC activities in
MH&FW department of the state in 2001,
followed by a report on an overview of IEC
activities in the state. The project is also
publishing a quarterly newsletter,
'Chiranjeev', providing information on
various tasks undertaken by the project
and also some articles on safe practices
and obstacles24. While various IEC
activities have been taken up to address
water and sanitation issues and water
born diseases, not many activities have
been taken up to address family welfare
issues. Out of a total budget of Rs.4500
million, Rs. 60 million is allocated for the
IEC activities25.
3.8 UP STATE AIDS CONTROL SOCIETY
(UPSACS):
While UPSACS has been formed to
address the HIV/AIDS epidemic in the
state, the society is trying to converge the
efforts with total health system,
particularly with RCH and family planning
efforts. The NGOs who are involved in
targeted interventions and folk media are
also being involved to address RCH and
family planning issues, especially when
targeting the youths. The UPSACS has
joined hands with SIFPSA for such efforts.
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Since joining of new PD, who was earlier
heading SIFPSA, More coordinated
efforts are made between SIFPSA and
UPSACS. The well-tested NGOs are
being involved now in Targeted
Intervention projects run by UPSACS.
3.9 STATE INSTITUTE OF HEALTH AND
FAMILY WELFARE:
The SIHFW, even though is one of the
oldest institute established in 1972 to
address family planning and related
issues, the Institute has confined itself to
conduction of training programmes for
medical officers and other staff. The
Institute in its early phases was totally
involved in implementing India Population
Projects, sponsored by the World Bank,
is now confined to undertaking
government sponsored training programs.
3.10 ROLE OF NGOS:
All the three ace organizations SIFPSA,
UP SACS and UPHSDP have involved
number of NGOs in their projects,
especially to encourage information and
services provisions at the doorsteps of the
people. While SIFPSA alone has worked
with more than 150 NGOs, dairy
cooperatives, and corporate sector
partners, the number of NGOs involved
with UPHSDP was over 75 and UPSACS
over 20. These NGOs with the help of
Community based Organization are
involved in undertaking IEC/BCC
activities. The big names in corporate
sector like HLL and PSI are also involved
in social marketing of condom and pills
and their sizeable budget is spent on IEC
activities.
3.11 ROLE OF BILATERAL AGENCIES:
Number of bilateral agencies have been
working in UP, mostly with USAID
sponsored SIFPSA project, World Bank
(UPHSDP) project and also independently
like UNICEF and CARE. While main focus
of CARE project has been in the area of
RCH and family planning, UNICEF, while
putting more focus on women and
children, indirectly supports the program.
The JHU/PCS on the other hand is fully
involved in developing material and also
strategies for SIFPSA and also now for
RCH-II project.
3.12 SITUATION AT DISTRICT LEVEL:
Even though the departmental efforts at
the district and lower levels have been of
concern, the presence of SIFPSA has
increased the IEC activities at that level.
In SIFPSA districts (earlier 29 but now 33
districts), the present District Action Plan
(DAP) has made a big difference. Under
DAP, SIFPSA has opened its branch as
well established DIFPSA, which
coordinates the efforts put by SIFPSA
through its NGO partners and private and
corporate sector where ever exists, and
with the government district CMO office.
The RCH camp organization, training of
dais and ANMs has added its efforts. The
DAP office also coordinates the media
officer of CMO office to carry out different
IEC activities, whether arranged through
SIFPSA or Pulse polio program of
UNICEF/GOI. The training of NGO
partners and their workers in carrying out
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IEC activities, especially motivating
people for both sterilization and spacing
methods have added to the efforts.
Now SIFPSA is expanding its activities in
all the districts of state and hopefully
similar coordination would be established
over there. Similarly, UPHSD project has
identified 28 economically most backward
districts in the state and have
concentrated three of the districts to start
with, again by involving their NGO
partners.
3.13 SITUATION AT PHC AND LOWER
LEVEL:
The IEC activities at PHC and lower level
are carried by the HEIO at block level and
ANMs at sub center and village level.
Unfortunately the situation is quite difficult
with none of them ever receiving any
training in IEC. While most ANMs had
received some training in IEC at the time
of their inductions, and their after a few
hours were spent during various training
imparted to them, mainly under RCH and
SIFPSA programs, most of the HEIOs had
never received any sort of training in IEC
activity. The Block Extension Educator
(BEE), was a cadre, which was trained in
IEC, but does not exist any more and later
on the BEEs were replaced by untrained
HEIOs, promoted from supervisory level.
While ANMs themselves have developed
the ways to promote sterilization through
their own IPC techniques, and efforts are
being put to motivate people for
sterilization acceptance through their long
time experience, they are unable to
convince people for spacing methods
because they are not very keen to do so.
The major reason being, "their work is still
evaluated on the basis of sterilization
performances". The IEC material received
occasionally from district/state/GOI is
some times hanged on the walls of
subcenters, but hardly is being used to
motivate people.
4.0 Issues of Concern:
Despite of efforts made by the
Government of India, State Government
and bilateral agencies, particularly the
World Bank and the USAID, the health
scenario as well family planning status of
the state remained quite poor and of
utmost concern. As pointed out, the efforts
have been enormous, especially during
the last decade, the demographic
scenario has hardly shown any
improvement.
The socio-demographic scenario of the
state also does not provide a bright picture
with only 34 percent of female literacy,
lowest in the country, with Bihar, another
state placed in the similar critical groups
of states. The decadal growth rate of the
state increased from around 20 percent
during 1961-701 to 1971-81 and remained
around 26 percent during next two
decades and now stands at around 25.8
percent (1991-2001), registering a
marginal increase of around 0.25 percent
from the last decade, only one of the two
states (another being Bihar), to register
an increase in the population growth rate
during the previous decade.
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Some of the health indicators in the state
also do not show an encouraging picture,
with maternal mortality ratio remaining one
of the highest, at 707 per hundred
thousand deliveries, high infant mortality
rate, of around 80 per thousand live birth,
even though lower than the previous
decades, remained highest among the
Indian states. The sex ratio, even though
has registered some improvement,
remained low at 898 in 2001.
As pointed out earlier the fertility scenario
of the state remained low with total fertility
rate at around 4.8 children (against 3.2 of
Indian average) in 1998-99 (NFHS II)26.The
other demographic indicators in the state
depict that while about 45 percent children
are fully immunized, trained personnel are
assisting only about 22 percent deliveries.
The couple protection rate as depicted by
the service statistics is around 29.1
percent, similar to the estimated
contraception prevalence rate of around
28.1 percent during 1998-99 (NFHS II). In
SIFPSA districts, however, some
improvement in these indicators is evident,
but remained lower than expected27.
education. The percentage of not regularly
exposed to any media is 82 percent
among women with a low standard of
living and only 13 percent among those
with a high standard of living. Sixty-three
percent of rural women are not regularly
exposed to any media, compared with
only 20 percent of urban women. The
differential among different categories has
made the access to any electronic media
including radio non-accessible and, this
is the most vulnerable group, who needs
information, understanding and
motivation. As pointed out, while local
media like folk media tried out by SIFPSA
or inter personal communication could
bear the fruits of success, the other
communication material/media could
hardly reach to the people.
4.2 IEC EFFORTS AT STATE LEVEL:
As mentioned earlier that even though the
Depar tment of H& FW, GOUP had
established the IEC bureau in 1999, it is
no more a functional identity. The major
reason for this, as mentioned by the
Additional Director, who is also officiating
In-charge, is that,
4.1 IMPACT OF LOW SOCIO-ECONOMIC
STATUS ON MEDIA EXPOSURE:
With only 34 percent of female literacy rate
and high proportion of families falling in
low socio-economic category, the
exposure to mass media was quite low in
the state. Sixty-nine percent of illiterate
women are not exposed to any media,
compared with only 6 percent of women
who have completed at least a high school
"No independent Director was posted for
this position and mostly DG (FW) was
given additional charge to head this
position. DG being so busy with his own
assignments was hardly able to put any
time to look after this activity. Even though
the staff is still posted, they continue doing
their routine jobs, as not much is at stake
for them".
He further added that,
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"While earlier we wanted to develop
material and also make efforts to reach
that material at the grass roots level, we
had no funds then, and now we have
funds which we are unable to use as we
do not have technical expertise to use
those. Most of our technical people have
become disinterested to work. At present
whatever we do is for pulse polio
programme organization and nothing
else", he asserted.
The over all feeling of DG (FW) and other
senior officials was that, the efforts put up
on IEC and other activities for pulse polio
programme have virtually sidelined the
other activities from the district to the lower
level and everybody seems busy in
addressing that program. In fact, because
of pulse polio programme, an innovative
scheme launched by the Directorate with
SIFPSA to boost TT campaign for all
pregnant women had to be abandoned
under instructions from GOI. The feeling
of pulse polio programme adversely
impacting on other programmes was felt
and mentioned by most functionaries' right
from State to Subcenters.
Another example of non-response/ non-
interest shown in the toplevel officialswas
reflected clearly when looking into the
process of establishing of MMRC and its
slow death. SIFPSA project had tried to
coordinate with two government agencies
- the department by establishing MMRC
and with SIH&FW by establishing an
evaluation cell. Unfortunately none worked
because of lack of interest and
coordination. As of today, no direct
coordination or even contacts exist
between either SIFPSA or UPHSDP with
State IEC Bureau, according to the
Additional Director (IEC Bureau). It may
also be noted that no external or internal
evaluation was carried out either of IEC
Bureau or of MMRC functioning.
4.3 LACK OF COORDINATION BETWEEN
DIFFERENT AGENCIES:
As stated, a number of bilateral and
governmental agencies are working in the
state to address family planning and related
issues. Unfortunately, no coordination
exists between them. While SIFPSA has
been working in the state for more than 10
years now, it has established its own
functioning style and working, more like a
parallel body to the government
department. The DAPs established at
district level, though currently working in
coordination with district CMO, not much
thinking has gone into the sustainability of
the efforts once the DAPs are withdrawn
from the districts. Even though the
Executive Director, UP HSDP claimed that
they were working hand in hand with
SIFPSA project and the districts selected
for UPHSDP are different than those from
the SIFPSA concentrated districts, there
were many common districts where both
the agencies are working. Similar situation
exists in case of CARE India projects and
also UNICEF concentrated areas.
Lately, some synergy of working together
has been observed, when in some of the
programs,, SIFPSA and UP SACS have
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come forward to work together on many
programs. According to PD SACS:
"We are trying to explore the possibility of
working together, especially in the areas
of condom promotion, social marketing,
use of transport and use of folk media, as
the target group and promotion strategies
are similar".
She also felt that more of the local media
should be made use of, especially the
"Folk Media", as it captures the attention
of people immediately.
4.4 DISTRICT AND LOWER LEVEL ISSUES:
A discussion with various level
officials and workers at district, CHC
and PHC level clearly reflects that the
IEC efforts at that level were minimal.
Except for SIFPSA sponsored IEC
activities through NGOs or otherwise,
no efforts were made by the State IEC
bureau or State department to make
any significant impact. According to
one of MO In-charges:
"The preference for female sterilization in
the programme continues, and targets are
assigned, whether from PHC to State or
otherwise. The concentration of ANMs
remains on achieving these targets. While
no training in IEC has been imparted to
these ANMs for more than 10 years on
IEC, they hardly use any systematic way
of motivating people. By sheer experience
they are able to convince people for
sterilization which they have learned over
years".
On knowledge about BCC, one of the
Medical Officers commented:
"Even we have not heard of BCC, how do
you expect the ANMs to learn or hear
about it".
On IEC materials, one of the HEIO
commented that:
"We get material from district which doctor
sahib brings during his monthly meetings,
whether it comes from GOI or State
department, this material we pass on to
all the ANMs in equal numbers. They take
that material from us. There after,
depending upon their liking while some
hang those on the walls of subcenters,
others just keep those. Nowadays we get
material on pulse polio only. You can go
and observe in all the subcenters, you
would find those displayed".
On his own training in IEC, he further
mentioned,
"I was a malaria supervisor and I had
received training regarding malaria work
about 20 years ago. Now, after long years
of waiting, I have been promoted as HEIO.
I have never received any IEC related
training. By experience we read the
material received and tell the ANMs about
that. We instruct her to hang or paste the
material on subcenter walls and other
prominent places in village. Only a few
ANMs follow our instructions".
"The spacing methods remained non
thrust area at the lower level. As we are
evaluated on the basis of number of
women motivated for sterilization, we
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generally advise them to accept
sterilization. We also recommend use of
condom and oral pills, but they take the
method only one time and never come
back. Some times we follow such cases
and provide them supplies", mentioned
one of the ANMs. She further added,
"We were already over burdened with
work. The pulse polio programme has
further added lots of work for us. In fact it
has spoiled all our efforts for motivating
cases for family planning. We all are busy
doing pulse polio only".
While ANMs mentioned receiving
cooperation from AWWs, they did not
receive any cooperation from
Panchayats or any political/religious
groups in their FP related works. They
however felt that such help, if provided,
would be helpful in motivating people
for family planning acceptance. The
poverty, illiteracy and son preference
are the three basic problems, because
of which people don't accept family
planning. 'While it is easy to motivate
females, it becomes difficult to convince
their husbands, asserted one of the
ANMs.
'The other major problems mentioned
were, Muslims don't accept family
planning, not even polio drops and, people
still want at least two sons and one
daughter', mentioned one of the Medical
Officers.
The ANMs also mentioned a strong
need for reorientation in IEC/BCC and
changing their subcenter building, one
rented room with no window and
space, to some better accommodation
to help organize their work.
Conclusions:
Some of the major findings of the Uttar
Pradesh IEC review and state visits are
as follows:
q The IEC Bureau in the state
department although exists, has
become more or less non functional.
Similarly, MMRC, which was opened
with lots of fanfare, has been closed
down because of non-ownership.
q The IEC efforts put up by SIFPSA are
quite laudable; no coordination exists
between different departments and
agencies such as with UPHSDP, UP
SACS, CARE-INDIA and even with the
state directorate. While it was claimed
that UPHSDP works in different
districts than where SIFPSA has been
putting efforts, the efforts are
duplicated.
q Because of mass scale illiteracy, low
accessibility and diverse culture
between different regions, the mass
media and electronic media had very
low impact. Local media such as Folk
Media has been quite successfully
tried by SIFPSA and should be used
more frequently.
q Orientation training in IEC/BCC has not
been done formally for grass roots
workers for years. They therefore,
greatly lack motivational skills.
q Except ICDS/AWWs no other local
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level organizations are cooperating
with ANMs in their motivational efforts.
PRIs, school teachers, local religious
and opinion leaders could be useful.
q Not enough IEC material/literature is
produced and available at grass root
level for use and demonstrations.
q Wall paintings, hoardings and bus
panels have been found useful in
disseminating messages.
q At grass root level, no trained IEC
person exists. A skilled and welltrained
person is required as HEIO, who can
regularly orient and trained ANMs in
developing their IEC skills.
q The program is quite oriented towards
sterilization; innovative ways are
required to motivate couples for
spacing methods.
q Not many efforts have been made to
involve males in the program and
address youths.
q Regional and socio-economic need
based variations existin the state, need
addressing.
q ANMs are feeling over burdened with
work. Pulse polio program seems to
have adversely affected their other
jobs.
Recommendations:
On the basis of observations made some
of the recommendations, which can help
improve IEC inputs to the program, are
as follow:
q The state IEC bureau, which at
present is almost defunct, should be
revitalized with a full time Director with
independent charge, and assisted by
trained technical staff. The printing
press which has been placed
somewhere in the department should
also be moved to the same campus
with full control of IEC bureau.
q All the organizations, including State
Directorate, SIFPSA, UPHSDP and
UPSACS should plan their activities
with coordination from IEC bureau, so
that efforts are not duplicated and also
more than one issue can be addressed
in one go. The condom promotion
efforts through Government
machinery, Social marketing program,
SIFPSA and UPSACS could be the
best example, where the expenditure
on access, availability, issues to be
addressed, and target groups could be
saved.
q Advocacy efforts at all level, from state
to district to grass roots level are
required to influence political leaders,
religious leaders, opinion leaders and
other influential to promote family
planning cause and small family size
norm.
q Regional approach, more of grass root
level should be adopted in formulating
IEC strategy, addressing people locally
in the language they understand and
with simplicity. As also suggested in
new PIP for RCH program, Folk media
and IPCs should be given at most
preference. Other electronic and wall
writing, bus panels etc should continue
to be used.
q At grass root level, reorientation of
ANMs in BCC and there after
refreshers training should be taken
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with utmost urgency. At block level,
revival of BEE cadre with good skill
training should be considered.
q For preparation of IEC material, local
needs and language should be kept
in mind.
q Different strategies could be
developed for addressing different
sections of people and by involving the
influential, if possible.
q Addressing youths, and involving
males in family program efforts, should
be given importance.
q As far possible, other departments,
private sector, corporate sector and
NGOs, should be involved to address
the family planning issues.
q ISM practitioners and local health
practitioners should be involved to
become messengers and also depot
holders.
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Reference:
1. Registrar General, India, Final Population Totals, Census of India, Paper No.2, Government of India, New Delhi, 2002.
2. IIPS, National Family Health Survey-II-Uttar Pradesh, International Institute for population Sciences, Mumbai, 2001.
3. Government of India, First Business Session of the Empowered Action Group (EAG) on Population Stabilization, Ministry of
Health & Family Welfare, Vigyan Bhawan, New Delhi, June 2001.
4. Government of Uttar Pradesh, Uttar Pradesh: Population Policy, Department of Health and Family Welfare, GOUP, Lucknow,
July 2000.
5. SIFPSA, Uttar Pradesh Project Implementation Plan (PIP) for RCH-II Program, 2005-10, RCH Team, GOUP, Lucknow,
August,2004.
6. SIFPSA, op cit., 5.
7. IIPS, op cit., 2.
8. IIPS, National Family Health Survey-I-Uttar Pradesh, International Institute for population Sciences, Mumbai, 1993.
9. SIFPSA, op cit., 5.
10. UNICEF and GOUP, Uttar Pradesh State Plan of Action for Children, Lucknow, 2000.
11. Based on the personal discussion and list provided by the Additional Director, IEC Bureau, Lucknow, During our visit.
12. Ibid, 11.
13. Ibid, 11.
14. SIFPSA, IFPS Dissemination Seminar, presented at New Delhi, December 2003.
15. SIFPSA and John Hopkins University, Communication Strategy for Family Welfare in Uttar Pradesh, SIFPSA and Johns
Hopkins University, Lucknow, 1996.
16. Government of Uttar Pradesh, op cit., 4.
17. SIFPSA, Making a Difference: Best Practices Leading to Impacts, SIFPSA, December 2003.
18. SIFPSA, op cit., 17.
19. SIFPSA, Behavior Change Communication Strategy for IFPS 2003-04, SIFPSA, Lucknow, 2004.
20. SIFPSA, Folk Media: The SIFPSA Experience, SIFPSA, January 2004.
21. IIPS, Reproductive and Child Health Project- Rapid Household Survey, 1998-99, sponsored by Ministry of Health & Family
Welfare, New Delhi, 2001.
22. SIFPSA, op cit., 5.
23. Based on personal discussion with KGMC Team and Mahila Samiksha Officials during our team visit at Lucknow, 2004.
24. UPHSDP, Chiranjeev-A quarterly Journal by UPHSDP, Lucknow.
25. SIFPSA, op cit., 5.
26. IIPS, National Family Health Survey-II-Uttar Pradesh, International Institute for population Sciences, Mumbai, 2001
27. SIFPSA, op cit., 17.
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Annexure Table 1: Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to the
radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly exposed to any
of these media by selected background characteristics, Uttar Pradesh, 1998-99.
Background
Age
15-19
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Exposure to mass media
Reads a Watches
newspaper television
or magazine at least
at least
once a
once a week week
Listens to the
radio at least
once a week
Visits the
cinema/
theatre at
least once
a month
Not
regularly
exposed to
any media
Total
9.5
13.9
19.5
9.6
26.9
29.7
14.3
34.0
32.5
14.8
32.4
30.5
12.5
30.8
26.5
12.4
32.2
28.3
11.3
33.5
27.4
10.6
34.7
30.1
4.9
72.7
825
2.6
56.0
1,117
5.6
51.6
1,825
4.3
54.0
1,769
3.0
57.3
1,509
2.7
55.5
1,291
2.0
55.5
1,025
2.9
55.0
756
Residence
Urban
Rural
33.9
74.7
43.8
7.3
21.4
25.9
11.7
20.2
1,860
1.5
63.4
7,432
Region
Hill
Western
Central
Eastern
Bundelkhand
23.2
41.9
34.5
13.8
36.4
29.1
13.7
33.1
30.9
10.2
27.0
28.6
8.8
25.9
28.6
4.6
46.6
420
4.4
53.3
3,320
3.8
54.3
1,620
2.2
56.7
3,505
5.9
59.4
427
Education
Illiterate
Literate,<middle school complete
Middle school complete
High school complete and above
0.0
23.1
35.9
67.0
19.1
45.8
57.0
84.2
19.7
43.2
49.4
64.5
0.9
3.8
6.9
18.1
69.4
33.0
20.0
6.4
6,523
1,101
635
1,032
Religion
Hindu
Muslim
Sikh
12.9
31.4
30.2
10.5
34.5
24.7
20.6
50.5
46.5
3.5
55.0
7,715
3.5
54.6
1,483
6.8
33.1
55
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
5.5
11.6
7.1
19.8
21.7
20.9
24.2
42.8
24.4
25.7
25.1
35.6
1.9
64.0
1,805
1.1
65.5
191
2.0
62.2
2,591
5.5
44.6
4,276
Standard of living index
Low
Medium
High
1.9
8.7
11.2
8.4
29.1
29.3
42.3
79.7
59.3
0.6
82.4
2,598
1.9
53.8
4,887
13.3
12.6
1,612
Total
Source: NFHS-II, Uttar Pradesh, 1998-99.
12.6
32.1
29.5
3.5
54.7
9,292
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12.1 Page 111

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Annexure: Table 2
Interventions planned for demand generation (IEC/BCC strategy)
In Uttar Pradesh under RCH Phase-II project, 2005-2010
Major activities planned with
regards to IEC/BCC efforts under
IFPS project
1. Use of mass media and local media
2. Folk media
3. IEC support to training at district level
4. IEC support for quality service provisions
5. IEC support to DAP
6. IEC support for FLE
7. IEC support for TT campaign
8. IUCD campaign
9. Training of VHC members & CBDs
10. Environment building for RCH
11. Training for adolescents
12. Posters/hoardings etc.
13. District specific interventions
Total
Total physical activities Total financial outlays
planned
(in million Rupees)
440,316
57,000
79,666
824
70
1,465,419
2,600
129,777
1,592,061
843
78,659
420
1,050
3,848,705
374.410
114.000
3.533
0.330
2.730
66.252
18.200
39.211
476.004
8.380
1121.338
22.820
140.000
2,387.208
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UTTAR PRADESH
Range of RCH indicators in UTTAR PRADESH
Indicators
Minimum
Eligible women below age 30 years
Girls married at age below 18 years
Non-literate eligible women
Total fertility rate (TFR) (per women)
Birth order 3 and above
Infant mortality rate (IMR) (per 1000 live
births)
Knowledge of any modern FP methods
Knowledge of NSV among husbands
44.7 (Bijnor)
33.1 (Bijnor)
34.4 (Kanpur Nagar)
2.49 (Kanpur Nagar)
6.0 (Kannuj)
47.2 (Gautam B. Nagar)
90.0 (Saharanpur)
25.8 Raebareli
Current use of any FP methods
Current use of modern FP methods
Unmet need for FP methods
Three of more ante-natal check-ups
Received full antenatal check-up (ANC)
21.3 (Hardoi)
14.3 (Azamgarh)
16.3 (Jhansi)
11.6 (Budan)
0.4 (Eath)
Safe delivery
Exclusive breastfeeding
Full immunization
Eligible women aware of RTI/STI
Husbands aware of RTI/STI
Eligible women aware of HIV/AIDS
Husbands aware of HIV/AIDS
Pregnancy complications
Delivery complications
Post-delivery complications
Utilization of Govt. Health facilities for
antenatal care
Utilization of Govt. Health facilities for
postnatal care
Note: All figures are in percentage except TFR and IMR
9.8 (Hardoi)
9.9 (Kanpur Nagar)
14.3 (Sitapur)
2.8 (Saharanpur)
8.6 (Firazabad)
11.0 (Hardoi)
37.3 (Hardoi)
17.6 (Pilibhat)
4.3 (Pilibhat)
8.0 (Firazabad)
11.6 (Firazabad)
1.9 (Kanpur Nagar)
Maximum
63.7 (Maharajganj)
81.9 (Lalitpur)
78.5 (Bareilly)
4.78 (Bareilly)
66.9 (Hardoi)
133.5 (Eath)
100.0 (Jhansi)
96.4 (Gautam B.
Nagar)
55.1 (Jhansi)
51.1 (Jhansi)
38.4 (Azamgarh)
46.5 (Lucknow)
12.3 (Gautam B.
Nagar)
50.7 (Lucknow)
92.4 (Saharanpur)
51.6 (Lucknow)
58.3 (Kanpur Nagar)
57.7 (Kanpur Nagar)
63.0 (Kanpur Nagar)
83.3 (Kanpur Nagar)
44.4 (Sitapur)
32.9 (Barabanki)
47.0 (Barabanki)
57.2 Ghazipur
41.1 (Saharanpur)
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List of the Officials /Agencies Contacted during Consultants'
Visit to Uttar Pradesh
State Level:
1. Mr. Pritam Singh, IAS, Principal Secretary, Medical and Health, Government of Uttar
Pradesh, Lucknow.
2. Ms. Aradhana Johri, IAS, OSD to the Chief Secretary & PD, UPSACS, Lucknow.
3. Ms. Kalpana Awasthi, IAS, Executive Director, SIFPSA, Lucknow.
4. Ms. Shalini Prashad, Executive Director, UP HSD Project, Lucknow.
5. Dr. L B Prashad, Director General, Family Welfare & Director, State IEC Bureau,
Lucknow.
6. Dr. J L Chittoria, Additional Director, State IEC Bureau, Lucknow.
7. Dr. S K Verma, Communication Officer, State IEC Bureau, Lucknow.
8. Dr. Bijendra Singh, GM (Public Sector & Addl. Charge for IEC), SIFPSA, Lucknow.
9. Dr. B S Singh, DGM (M&E), SIFPSA, Lucknow.
10. Ms. Meena Shukla, Dy. Director, UPHSDP, Lucknow.
11. Mr. S. Ranjan, Dy. Director (IEC), UPHSDP, Lucknow.
12. Ms. Gupta, Mahila Samiksha, Gomati Nagar, Lucknow.
13. Dr. S C Tewari, Prof. & Head, Dept. of Psychiatrics, KGMC, Lucknow.
District & Lower Level:
1. Dr. C M Shukla, Superintendent, CHC, Chinhet, Dist. Lucknow.
2. Dr. T K Agarwal, Physician, CHC, Chinhet, Dist. Lucknow.
3. Mr. R N Yadav, HEIO, CHC, Chinhet, Dist. Lucknow.
4. Three ANMs of CHC, Chinhet, Lucknow.
5. Dr. S N Pandey, Superintendent, PHC, Deva Sharief, Dist. Barabanki.
6. Dr. I P Gupta, Physician, PHC, Deva Sharief, Barabanki.
7. Mr. S K Verma, Supervisor, Deva Sharief, Barabanki.
8. Two ANMs of PHC, Deva Sharief, Barabanki.
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CHAPTER 4.4
MADHYA PRADESH
Review of IEC component of
Family Welfare Program
1. Background
Madhya Pradesh is a state with a
considerable degree of regional
diversity in terrain, culture,
socio-economic conditions and status of
women. The state is divided into seven
regions based on geographical terrain
and agro-climatic conditions that also
with its land area of 308,144 square
kilometers.
According to 2001 Census1 the state had
60.35 million populations with a sex ratio
of 919, lower than the all India average.
With high natural growth rate of its
population at 21.1 percent, and poor
help classify the regions in terms of
cultural diversity, socio economic
conditions and status of women.
Madhya Pradesh, land locked in the
central part of the country, it is bounded
by the states of Rajasthan to the
northwest, Uttar Pradesh to the north,
Chhattsgarh to the east, Maharashtra to
the south and Gujarat to the west, is
geographically the largest in the country,
demographic indicators like high birth rate
(31.4), high death rate (10.3), and high
IMR (87), and equally poor socio-
economic indicators like low female
literacy (31 %) and very low per capita
income (Rs. 4725), the state has been
taken as one of the EAG states which
need highest concentration for overall
development. Besides high TFR (3.31)
according to NFHS-II2 , there exists a high
unmet need for family planning, almost
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equally distributed for spacing and
terminal methods. The current
contraception rate is also low at 45 percent
in the state3 . The state has a low exposure
to mass media, as well. With such low
indicators, the state requires special
attention for it’s over all improvement.
2. Methodology
The team of three consultants has visited
the EAG states sometimes together and
sometimes as a duo team and sometimes
as a single member team. In the case of
Madhya Pradesh, a single member
consultant team visited the state from 26th
to 31st July 2004. The consultant had
prepared a set of talking points and
questions that were relevant to the study.
These set of points were shared with PFI
and were also tried out in interactions with
stakeholders in Delhi and in other states
visited prior to visiting MP.
The consultant’s task was three fold. One,
meeting with the state machinery (people
and setup) that delivers the health and
family welfare programme with special
focus on the IEC system. The consultant
met the Principle Secretary, Public Health
and Family Welfare, Director, FW, Director
Health and Family Welfare services and
Director IEC Bureau, consultants for RCH
and other officials. Second, the consultant
met the partners, stakeholders and other
players in the field such as UN and
Bilateral agencies (Unicef, UNFPA, EC,
Danida), international (CARE) and
national NGOs (MPVHAI, FPAI). Third, the
consultant also visited the field and met
with the frontline officials and workers who
actually carry out the tasks in the district
of Vidisha. One could not visit the SIHMC
which is located in Gwalior.
3. Current Status of the Family
Welfare programme with
focus on IEC
The new philosophy of IEC activities
adopted by Madhya Pradesh Health IEC
Bureau focusing on promoting community
mobilization and community participation
in health and family welfare is said to have
brought encouraging results by way of
approaching directly the community and
promoting community participation. “It was
for the first time that the potential of
information, education and communication
activities in influencing the health seeking
behaviour and in promoting community
participation in health and family welfare
activities could be demonstrated.”. The
Bureau adopted the concept of working
directly with the community and its
representatives bypassing the traditional
administrative structure that was
introduced as an essential feature of the
IEC activities and programmes.
However, it seems that the enthusiastic
efforts could not sustain itself for long.The
ground situation today is rather different.
The IEC is not yielding the desired result.
3.1 STATE POPULATION POLICY
The State Population Policy of Madhya
Pradesh was adopted in January 2000.
In the message by Ex Chief Minister Sh.
Digvijay Singh in the Population Policy
document, says:
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“I am of the clear view that for stabilizing
the population, we will have to resort to
certain other practical measures along
with reduction in Infant mortality rate,
Maternal Mortality rate and Total fertility
rate. Key to the success of nay policy lies
in people’s participation. This is also a
precondition for the success of population
policy. Village level democratic institutions
have already emerged in our state, and
these institutions are capable of ensuring
overall people’s participation in various
programmes. Along with this we will have
to bring about gender equality and equity
in society, make population stabilization
programme a people’s movement, create
interest for longevity of life and small family
norm, improve and expand our health
services making them low-cost and
accessible. Further the planned family has
to be made a thing of pride and for this
people have to be involved in the
programme, to provide new insight, new
direction and modern thinking to the
society”.
The Mission
The mission of the population policy is to
improve the quality of life of the people in
the state by achieving a balance between
population, resources, and environment.
Rapid reductions in fertility and mortality
are essential to achieve population
stabilization and improvement in the
quality of life.
The Objective
The main objective of the population policy
is to reach a TFR of 2.1 by 2011.
Contraceptive prevalence must increase
from the present rate of 42 percent to
around 65 percent in 2011.
Specific Objectives
The population policy lists out four specific
sub objectives:
1. reduction in fertility
2. reduction in MMR
3. reduction in infant and child mortality
4. provision of other services
The policy also realizes that the success
of any programme of population
stabilization and reproductive health in the
state will depend on a series of policy
initiatives identified, spelled out and
implemented. Specific policy initiatives
that guide and direct the population
stabilization efforts are:
q Creating an environment conducive to
planned family and creating demand
for family planning and reproductive
health services.
q Increasing collaboration with the
Panchyati Raj Institutions, the private
sector and the non government sector
in community mobilization and
programme implementation
q Improving the management of the
family welfare programme to achieve
excellence in meeting the needs of the
clients
q Developing appropriate implementation
structures
In order to streamline the efforts to achieve
population stabilization within a stipulated
time period, the apex body called the State
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Population and Development Council
(SPDC) chaired by the Chief Minister will
be formed.The proposed State Population
Resource Center will act as a technical
secretariat for the SPDC, and an
additional chief secretary will act as the
member secretary. To coordinate and
monitor implementation of various
components of the population policy, a
committee under the chairmanship of the
chief secretary will be constituted. To
achieve convergence at district and below
levels, it is proposed to set up district
population and development coordination
committee.
The population policy also talks of the
Information, education and communication
activities. It talks of developing an
appropriate Communication Strategy.
In creating a conducive environment by
dispelling the myths as well as
psychological barriers especially among
the couples inclined towards the use of
family planning services, communication
will play a vital role.
q A communication strategy will be
developed to cater to different
segments of clients. Clients will be
reached with an appropriate mix of
interpersonal communication and
mass media campaigns. Electronic
media will be put to optimum use in a
systematic way to convey messages
on family planning and reproductive
and child health services.
q The communication strategy will aim
at creating a sense of pride among
couples about the small family norm,
promoting/encouraging male
par ticipation in a major way,
adherence to legal age at marriage ,
increasing age at first child and
increasing awareness of existing
government programmes from which
couples can drive benefits, etc.
q Social mobilization by community
leaders is essential to the success of
the programme that emphasizes
behavioural changes, the family
welfare programme does not have the
continuous support of community
leaders to create a conducive
environment for the programme. The
support of religious leaders and village
heads (pradhans) is crucial. The
District Family Welfare bureau will
arrange a series of meetings, training
programmes for these leaders to
garner their support and involve them
in family planning programme
implementation.
Building competencies of human
resources
Human resources development will be
given the highest priority and the training
programmes intended to improve skills of
health personnel and others will be
reviewed and redesigned with the help of
the State Institute of Health management
and communication.
An implementation plan was only recently
developed in 2004 by the academy of
administration.
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3.2 STATE IEC BUREAU
In case of Madhya Pradesh where the
State Health IEC Bureau was established
in the year 1995 at the initiative of the
Government of India, Ministry of Health
and Family Welfare. The mandate of the
Madhya Pradesh Health IEC Bureau was
to strengthen public health and family
welfare related IEC activities and to give
these activities a professional orientation.
It is stated in the document of the Bureau
(1998) that “the Bureau has been able to
shift the focus of IEC activities from just
creating public awareness about the
availability of public health and family
welfare services to motivating and
encouraging people to initiate and sustain
community health action and to modify the
health seeking behaviour. Creation of the
Bureau, of course, gave a boost to
promoting community participation in public
health and family welfare activities and
demonstrating the potential of IEC activities
in influencing the health seeking behaviour
of people.” (Anonymous 1998:5).
The report says that the previous efforts
because of the very limited scope of IEC
activities at that time could not result in
any significant increase in the use of family
planning methods and the interest toward
IEC activities gradually waned. Thus, the
new charter of the Bureau has been to
make the IEC activities essentially broad
based and to involve the community in an
effective manner in order to address the
felt public health and family welfare needs
of the people.
The Bureau report indicates that the
experience of an independent structure
and an independent identity for IEC
activities is necessary if the issue of
modifying the health seeking behaviour
of the community is to be addressed in
an effective and sustainable manner. Just
appending the IEC activities with the
public health and family welfare services
delivery system, as has been the case so
far, may not be the right approach. The
reason is that the scope of IEC activities
is much wider than the scope of health
and family welfare services.
IEC/BCC training for Family planning
and RCH
Strengthening the Training Systems and
Institutions
The state of Madhya Pradesh has
adequate training facilities both within the
Health Department and with other
departments of the state government.The
Regional Health and Family Welfare
Training Centres exist in Indore, Gwalior
and Jabalpur. Unfortunately in spite of the
basic infrastructure, facilities at these
Centres are not well maintained. Besides,
Mahatma Institute for Rural Development
at Jabalpur and State Institute of Health
Management and Communication at
Gwalior can more effectively be used in
organizing training of district IEC
personnel. Similarly, Madhya Pradesh
Voluntary Health Association can be
another better place for training.
A team of resource persons should be
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identified and invited for the training of
district level IEC officials. This training can
be organised at regional levels. Similarly,
the BEEs along with one or two very active
NGO representative/s should be trained
at the district level. The district level IEC
officials trained at the regional level,
should act as resource persons for block
level trainings.
At the district level, all the districts have
District Training Centres. District level
trainings and workshops should be
organized in collaboration with the District
Training Officer and their infrastructure
can be used. However, The District
Extension and Media Officer or the Dy.
District Extension and Media Officer be
the course coordinator and the course
should have a tilt towards IEC and not for
the general health scenario of the society.
Only those IEC persons who have better
understanding of education,
communication and information elements
of IEC should deal with the topics on IEC.
A non-IEC person should not be involved
in teaching IEC topics.
This will reduce duplication efforts. The
training should also emphasise on the
production of local IEC materials. It is
important that those who are from the field
of IEC and know the IEC well should only
teach the IEC topics.
IEC/BCC materials and activities for
Family planning and RCH
As there are many agencies and projects
that work towards family planning and
RCH there is a lot of materials and
activities developed by them for the
purpose. A large number of print
materials, AV materials (radio, TV), folk
media and outdoors have been used.
Interestingly the IEC for the neo literate/
low literate has also been tried but to a
lesser extent. Danida did an internal
review on the effectivity of these materials
and came up with low scores.
Existence of rich Folk Media
There is rich folk media tradition in the
State and they perform folk drama and
street plays etc. in different regions of the
State. The folk troupes and talents should
prepare IEC materials according to the
local needs and perform at the village
level. These performances should also be
organized on the occasions of Swasthya
Mela. Such cultural programmes should
be encouraged. The village panchayats
and block panchayats should be
requested to sponsor these
performances.
Staffing position in the State IEC
bureau and district level
IEC bureau in Madhya Pradesh was
established in 1995.
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The staffing position in the IEC bureau is as follows:
Post
Director
Deputy Director
Exhibition Officer
EDI/Publicity officer
Health Education Officer
DEMO
Deputy DEMO
BEE
Sanctioned
1
1
1
1
1
58
78
313
Working
1
1
1
0
1
15
22
221
Vacant
0
0
0
1
0
43
56
92
It may be pointed out that the post of the
director had been vacant for over a year
and even the current incumbent has
several other charges over and above the
post of the director. Second issue here is
that several of the position are
compensatory filled positions. The
position of BEE at the district level is
grossly vacant. It may also be noted that
almost all the BEE at the field level are at
the retirement age and most of them will
be not there in the next two years time.
It is also interesting to note the Job
Description of the persons in the IEC
bureau (see annex). It is clear that the jobs
executed by the IEC bureau are of the
routine nature and are generally carrying
forward what is there already such as
newsletter, exhibition, reports, MSS,
advertisement etc.
IEC training by the IEC bureau
Technically speaking the IEC bureau is not
involved in any IEC training directly, it is
facilitated by the danida project. Although
it is done in association with the
department and sometimes with the
participation of the bureau, it is not integral
to their work.
Budget for IEC
The IEC budget for the year 2003-04 is
Rs. 240.57 lacs. The state had Rs. 26.03
lacs as unspent money from the previous
year and thus they had Rs. 266.60 lacs
as the budget available for the year 2003-
04. Out of this Rs. 248.40 lacs is allocated
to the states, there by leaving Rs.18.20
lacs for the state head quarters. It is quite
obvious that this is a grossly insufficient
fund for any meaningful IEC activity.
Action plan for IEC
If one looks at the allocation of funds to
various activities it becomes clear as to
what is being done and probably why an
impact is not being achieved.
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S.No. State level activity
1. Publicity through DD
2. Publicity through AIR
3. Press ads- 5 leading
newspapers
Rozgar nirman
4. World Population day
5. Outdoor publicity
6. Upgradation of IEC
bureau
7. Untied funds
8. Production of AV
and print materials
Calendar
Newsletter
“Swasthaya Sanchar”
9. Exhibition and
exhibition materials
10. Population education
activities
11. Evaluation of IEC
activity
12. Workshop of opinion
leaders
13. Misc. (rail, bus)
14. SATCOM
15. MSS
16. Dist Opinion leaders
workshops
17. Wall writing
18. Cultural programmes
19. Local specific activity
20. 26 Jan tableau
21. Untied funds
22. Banners etc.
23. Counseling camps
No. of dist
No. of
Unit cost
to be covered programmes
all
250
16,000
all
250
8000
all
12
20,000
Total cost
(in lacs)
40.00
20.00
12.00
all
all
state
12
20,000
02.40
12.50
20.88
10.00
state
all
02.50
15.69
06.00
11.00
all
21.00
state
2
02.00
5.00
all
2.50
all
15.70
all
2.00
all
21.54
all
66.32
all
36.00
31.30
5.40
5.50
4.50
all
4.50
all
6.26
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Newsletter “Swasthaya Sanchar”
One of the better-produced newsletters
“Swasthya Sanchar” was initiated with
support from Danida. It has been coming
out regularly and has been in good
circulation. The newsletter covers
important topics as well as important
decisions and order taken up by the
directorate. As an act of decentralized
participation the bureau had asked the
districts to produce their own individual
newsletter and surprisingly that happed-
but for while. Each district produced their
version of the newsletter “Swasthay
Sanchar”. Unfortunately because of
delays in funds as well as follow up by the
state the efforts seems to be dying out.
Besides the use and value of such an
effort needed to be nurtured.
SIHMC, Gwalior
Madhya Pradsh has the dubious
distinction of having its state Institute
named as State Institute of Health
Management and Communication. The
SIHMC is located in Gwalior. The institute
has very good infrastructure and facilities.
Unfortunately it suffers from
underutlisation. There are several reasons
for the same – its location in Gwalior
makes it difficult to reach from other parts
of the state, the director and faculty has
been not there regularly and thirdly its
relationship with Bhopal has been
problematic.
3.3 RCH PROGRAMME IN MADHYA
PRADESH
RCH-I assessment4 internally done by the
directorate does not paint a rosy picture
of the programme, and its performance in
the state. Infact it highlights several issues
and concerns with budgeting, planning,
monitoring and evaluations and reporting.
The note is quite terse on the point on the
responsibilities or the lack of it on the
functionaries and the lack of any progress
report mechanism. It points out several
vacant positions of the consultants. It also
points out that the positions filled were
also non operational or helpful to the state
as several positions were sanctioned by
the center and they did not see
themselves as accountable to the state.
Madhya Pradesh Health and Family
Welfare Reform Project
The EC supported programme has
initiated several moves on infrastructure
and supplies. Discussion with the
consultant5 reveal that the communication
efforts proposed by the programme has
been taken up in the planning process for
RCH-II from the district and block levels
and inputs from there will inform the
communication efforts in the RCH –II.
Danida supported Basic Health
Services Project
In order to strengthen the health sector
activities in the State, the Government of
India sanctioned a project to strengthen
Basic Health Service in Madhya Pradesh
assisted by DANIDA. The project - Madhya
Pradesh Basic Health Service Project
(MPBHSP) was launched with main
objective to bring qualitative improvement
in the health status of people of Madhya
Pradesh, especially of women and
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children. The project had five major
components – Training; Information,
Education, and Communication; Drug
Distribution; Development of Management
Capacity; and Local Body Support. IEC
component of the project emphasized on
training of IEC personnel, streamlining the
annual IEC planning of the State and the
Districts, equipping the IEC units at the
State and the Districts with required
technology, providing basic skill for the
production of IEC material, and
strengthening mass media campaign.
MPBHSP carried out two phases of its
operation in Madhya Pradesh. Not much
has been achieved in case of IEC
implementation because of structural
problems. It is said that the IEC personnel
is not spending more than 20 per cent of
their time in IEC related activities. There
is a strong impression that IEC personnel
lack clarity and creativity. Now MPBHSP
entered into third phase of its operation.
It is at this juncture that the officials of the
Department of Public Health and Family
Welfare, Government of Madhya Pradesh
felt a need to get a clear picture of the
situation on IEC front. Though the
programme officials were aware that the
existing IEC systems are weak, they
wanted to have an independent scientific
assessment conducted by an outside
organisation.
DANIDA Assisted Madhya Pradesh Basic
Health Services Programme – III, under
its Terms of Reference (TOR) invited a
proposal for conducting IEC Needs
Assessment and Management study.
TALEEM Research Foundation with its
experience in conducting such studies in
the past proposed a study in selected
districts of Madhya Pradesh. It covered six
identified districts for getting
comprehensive data on the functioning of
IEC at the district and sub-district level. A
large-scale survey in 24 villages in six
districts was carried out for understanding
of the communication needs at the
grassroots level.
The study was carried out at different
levels in light of above stated needs under
three major heads as follows:
Systems Study
This part of the study comprised of
situation analysis at State, Region, and
District levels. It included understanding
of IEC management of MP Health IEC
Bureau at Bhopal and a few other
international and national NGOs who are
working in the field of health care using
IEC to reach to the people under their
coverage zone.
At the regional level the coordination and
organisation of IEC training were studied.
At the district level the study focused on
the information dissemination and
organization of IEC at district and sub-
district level. The functioning of Block
Extension Educators (BEE) in executing
IEC and role of the Multi-Purpose Health
Workers (MPWs) – male and female (the
female MPWs are popularly known as
ANMs - Auxiliary Nurse Midwives) were
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studied in light of their role responsibility.
A holistic view was kept in mind and IEC
was seen in totality with the health care
scenario at various levels. Attempts were
made to examine the extent and the
effectiveness of IEC training given to the
District Extension and Media Officers, the
BEEs and the health workers.
This part of the study was more in a
conversational qualitative form by
discussing the issues with all involved with
IEC program at State, Region, District,
and Village level.
IEC Needs
IEC needs were studied at the level of the
management of the IEC at the state,
district, and the villages. The top officials
of MPBHSP, including the Director of
Madhya Pradesh Health IEC Bureau,
other senior officials of the Bureau, the
Regional Directors of the Regional Health
and Family Welfare Training Centre and
the Chief Medical and Health Officers
(CM&HO) of selected districts expressed
their opinion on needs and how the IEC
component can be strengthened in their
area of operation.
At the district and block level, the DEMO
or Deputy DEMO or the BEE looking after
the IEC activities in the district were
approached to identify communication
needs, the operational problems, and for
suggestions to rectify them. A sample
survey was conducted in 24 villages of
six districts, namely; Badwani, Mandla,
Neemuch, Sheopur, Sidhi, and
Tikamgarh, representing six geo-cultural
regions of Madhya Pradesh. Analysis of
village data provided the clients’
perspective of IEC functioning and the
communication needs in villages of
Madhya Pradesh. Thus, the needs
expressed by the management,
executives, implementers, and target
groups themselves completed the line of
investigation from the top to bottom. This
part of the study could collect perceived
needs of the development agents and the
felt need of the people. Combination of
these two provided a glimpse of real
needs. It is interesting that the executives
and the implementers had their own felt
needs too to tell.
IEC in Public Health and Family Welfare
in Madhya Pradesh
Detailed discussions were held with all
levels of the officials and functionaries on
how to revitalise the IEC activities in the
state. Secondary information were
analysed to understand the facilities and
strength of the system to meet the
challenges of informing, educating and
motivating the target group for better
uptake of the government health care
facilities provided. Different aspects of IEC
management such as creativity,
technology, access, outreach, mobility,
inter-sectoral linkages, financial
arrangement, and organisational set up
required were looked into.
On the basis of the communication need
assessment study6 danida designed their
IEC programme support for the state. It
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has carried out training for all BEEs and
health functionaries. It supported the
newsletter, developed several IEC
materials and carried out an internal
evaluation of the effectiveness of the IEC
materials7 . Danida also carried out several
training workshops for the artists and
scriptwriters for developing folk media
based programmes.
HLLFPPT: Swastha Gram Pariyojana
HLLFPPT launched the Contraceptive
Social Marketing Programme (CSMP)
with a view to increase reach and facilitate
behaviour change.
It was realized that any successes
marketing of social product in village
would have to focus on the necessary
behavior change among the intended
target group in the village support by
making the social product accessible to
ensure continuity of the changed behavior.
Hence, the programme was designed in
view of expanding the use of spacing
methods by the rural population up to last
village through maximizing the
accessibility and improving the quality of
the offering and there by reducing thereby
reducing the opportunity cost to the rural
consumer.
The development objective of the project:
To bring about and sustain the positive
behaviour of using contraceptive and
health care products through
strengthened Community Based
Distribution Network (CBD) at the village
level supported by comprehensive local
media based IEC programme and a fully
developed vendor network.
This Project aims to address the three
major barriers – lack of access,
affordability and lack of motivation.
The Social Marketing of Contraceptives
Project in MP was implemented in
December 1998 and is operational in 5
districts including the new districts of Datia
and Shivpuri. The Project is attaining sales
of contraceptives through the network of
community service providers as per
targets. Currently the Project is covering
85 % of the villages in the districts of
Bhind, Morena and Gwalior and 60 % of
the villages in the newly scaled up districts
of Datia and Shivpuri.
The Strategies of the programme:
The strategies envisaged towards project
implementation are in line with the
Strategies successfully adopted by
HLFPPT in the Community Based Social
Marketing Project in 3 districts of Madhya
Pradesh. The core strategies of the project
are as follows:
q Demand Generation at Village Level
q Establishing A Community Based
Distribution Network
q Networking with ICDS Programme
q Collaboration with Health Dept
q To increase the basket of products in
Social Marketing Project
q To undertake client segmentation
towards enhancing the efficacy of the
Distribution mechanism
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The project aims at enhancing the
accessibility and knowledge of CSM
brand of contraceptives and other health
are products among the targeted
population in the last village level in the
select district of the three states. This
programme builds distribution
mechanism in the rural areas within the
Project area by utilizing the services of
unemployed youth in these areas. The
project affects its distribution and
counseling and IEC initiatives through a
network of community workers (Called
Block ‘Field Workers BFW). He engagers
the services of ICDS Workers, retailers,
pan shop owners, RMPs etc. as stocking
point for contraceptives, Sanitary
Napkins, IFA Tablets and ORS being
marked in the project.
The project encourage the Aaanganwadi
Workers of the ICDS scheme to become
vendors to the project. This is done as
the ICDS workers can effect community
mobilization and the acceptance of the
workers is significant in the village. The
workers co-ordinate Mahila Mandal
meeting, which is a medium of
addressing the women folk of the village
on a range of issue which include family
planning. The incentive in the vendor in
the Project is the incremental income that
accrues of the sales that is affected. The
project also solicits other channels like
retail outsets, RMPs, grocers, pan shops
etc as vendors but it is ensured that the
number of vendors in a village is
optimized so that the increment in come
to individual vendors remain lucrative
enough to sustain the interest of the
person in stocking contraceptive items in
the village.
The stock of various contraceptive items,
Sanitary Napkins & ORS are supplied to
the to the ICDS vendors on a weekly basis
by the block field workers and its there by
ensured that the vendors do not face a
stock out position. The vendors also
actively participate in local media
initiatives, which are undertaken in the
village by the project. The project provides
training to the vendors towards effective
implementation of the programme as well
as the feedback of the vendors is taken
prior to implementing any local media
activities in the villages.
The mid term evaluation of the above
project by the International Institute for
Population Sciences has highlighted that
the use of condoms has gone up by 34 %
and that of oral contraceptive pills by 18%
in the Project area.
HLFPPT and BCS effort for Madhya
Pradesh
HLFPPT was entrusted with developing
Behaviour Change Strategies for the state
of Madhya Pradesh by Government of
India. In the year 2002 they hired Center
for Media Studies (CMS) and conducted
a workshop with all the state holders with
a view to evolve a communication strategy
for the state. A rapid appraisal8 was done
in two districts of Shivpuri and Dhar
districts. CMS also submitted a report9 on
the possibilities of developing a
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communication strategy or the state. But
there has been no progress in the matter
after that effort
gauge of what work they actually do in
the district and how much of this is IEC
and what is its impact.
NGOs in RCH in Madhya Pradesh
Department of Family Welfare, MOHFW,
GOI, in the ninth Five year plan (1997-
2002) introduced the Mother NGO
scheme under the RCH programme.
Under this scheme the department has
identified and sanctioned grants to
selected NGOs called mother NGOs
(MNGOs) in allocated districts. MNGOs,
in turn, sanction grants to Field NGOs
(FNGOs) in the allocated districts. The
grants were to be used for promoting the
goals and objectives as outlined in the
RCH programme of GOI. These included-
addressing the gaps in information on
RCH services in the project area, building
strong institutional capacity at the state,
district and field level, and advocacy,
awareness generation. NGOs were also
exacted to move from exclusive
awareness generation to actual service
delivery of RCH services.
There are 10 MNGOs under RCH –I who
look after two district each in the state.
These include FPAI, MPVHA, Sanskar
Shiksha samiti, Sarvajanik Parivar Kalyan
and Sewa Samiti, Sambhav Social
services, Medical Counseling center,
Utthan center for sustainable development
and poverty alleviation, Tarun Sanskar,
Parsvnath Bal mandir Samiti, Mahila
Utkarsh sanstha (also see appendix).
Each of these MNGOs works with FNGOs
in their respective districts. It is difficult to
UNFPA
The IPD project in Madhya Pradesh has
envisaged the following interventions
under CP-VI: Integrate Training, Safe
Motherhood, Family Planning and RTI/
STD and HIV/AIDS. The state office was
operating form the district that then got
shifted to Bhopal. After shifting the state
office to Bhopal, the state office has
provided necessary technical
backstopping and also has facilitated the
successful monitoring and implementation
of the project.
Under CP6 the state programme includes
support to interventions that strengthen
district initiatives and support planning,
policy formulation and monitoring and
evaluation related interventions that will
impact programmes in UNFPA supported
as well as other districts.
The identified focus areas together with
their sub components are planned in three
different areas of interventions at state
level as follows:
- Population and development strategy
- Advocacy
- Reproductive health
Unicef
Unicef operationlises its Border District
Cluster Strategy (BDCS) in five districts
(Guna, Shivpuri, Morena, Tikamgarh and
Sheopur) in the state. The BDCS strategy
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aims atincreasing availbility, access,
utilisation and ensuring adequate and
effective coverage of all services in the
minimum intervention package(MIP) of
the RCH programme. While the BDCS
strategy has been adopted with a high
degree of success in the five BDCS
districts, gaps still exits between
availability and access, access and
utilisation, utilisation and adequate
coverage and adequate coverage and
effective coverage. According to Unicef10
the challenge, now, is to narrow the gaps
between the factors mentioned and
utilisation and adequate coverage. This is
indeed the communication challenge.
Building Community Health and Nutrition
team of the frontline workers such as
ANM, AWW and JSR is central to the
concept of BDCS, which envisages
revitilisation of health Subcenter. The team
building process also included enhancing
the communication and other people
related skills of the frontline workers.
Secondly to improve the access to health
and nutrition services for the remote tribal
areas Community care Center have been
established. Each of these CCC is
manned by a Community care provider-
a woman from the same hamlet- who is
paid by the government and supported by
the community. They are key change
agents in the process of communication
for behavioural change focussed on the
family.
Unicef has also done a kind of situation
analysis for the key behavioural change
issues. Given the current situation, the
communication intervention in the short
run would focus on the most critical
components of the Minimum intervention
package. Focus would be primarily on
increasing the utilisation and adequate
coverage targeting families with
programme communication interventions.
It would also target service providers for
quality enhancements (effective
coverage) as primary targets and for
counseling and providing critical
information to families as secondary
targets. The concept note suggest that the
proposed communication intervention
would initially deal with the problem of lack
of awareness by providing information on
the need and availability of services. The
concurrent evaluations and monitoring
which would be conducted throughout the
project cycle would reveal if there were
any attitudinal and behavioural barriers,
which then would be addressed.
Unicef follows their three pronged
approach of programme communication,
Community dialouge and advocacy and
social mobilisation.
CARE
CARE Madhya Pradesh under Integrated
Nutrition and Health Project-II (INHP-II)
covers nine blocks across three districts
in the state, i.e Chidwara, Seoni and
Balagaht districts. In these districts the
project covers 4640 aanganwadi centers
benefiting a mix of tribal and non tribal
populations. An extensive formative
research11 for assessment of INHP-II
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behaviours was conducted in the three
districts was conducted in 30 villages
covering seven communities.
The BCC strategy12 developed on the
basis of the formative research has
evolved around the life cycle contacts
approach adopted under INHP-II. The
BCC strategy is designed to
a) fit comfortably within the ongoing
activities of INHP-II;
b) be feasible to implement within the
existing staffing pattern and
c) not involve a lot of additional practices,
systems development, capacity
building of service providers etc.
To be effective, communication will need
to build strong social norms in support of
safe delivery, maternal nutrition, exclusive
breastfeeding and initiation of
complementary foods at 6 months. Many
of the behaviours being promoted require
action to be taken not only by the mothers
but other household members as well.
FPAI
Family Planning Association of India has
several offices and project in Madhya
Pradesh. In MP FPAI13 has been
operational since 1959 and covers 20
districts. It has four branches in the state
at Bhopal, Gwalior, Indore and Jabalpur.
FPAI also works as a Mother NGO in
Madhya Pradesh and has been
supporting as many as 27 field NGOs in
12 districts.
The Small Family by Choice project covers
four districts viz. Bhopal, Vidisha, Sagar
and Raisen. Initially it was a five year
project which had another five years of
extension till 2004 funded by Gates
foundation. The project adopted three
strategies –stimulate people’s
participation for promotion of reproductive
Health and Family Planning; improve
access and geographical coverage of
reproductive health and family planning
service, and focus on key areas of
community participation, women’s
empowerment, adolescent and youth,
sexual and reproductive health care and
family planning. The project reportedly
created a network of 4240 community
groups and 6206 continuing Community
Based Distributors, who shared the
responsibility of increasing people’s
access to improving the information and
services
The IEC component of the project has
taken up considerable efforts. Aiming at
bringing about behavioral changes in the
rural community, the project created a vast
chain of trained communicators, such as
community members, members of Local
Voluntary Groups (LVGs), panchyat
representatives and service providers.
The project also provided them with
required IEC materials to carry out
advocacy effectively. The newsletter “
Pargati Samachar”, published by the
project became a strong link between the
organisation and the community as a
means of sharing news and views, and
contributed to learning individually and
collectively. The project developed 37
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different types of pamphlets, small
booklets and posters. A diagnosis chart
developed on STDs, explaining syndromic
diagnosis, treatment and follow up, and
also the support to be given to clients
suffering from STDs, was distributed
among private medical practitioners and
other clinicians. The project developed
training materials and methods facilitating
learning. The project has won several
awards. A final evaluation of the project is
under progress.
MPVHA
MPVHA14 came into being in the year in
the year 1973 as an organisation originally
at Indore and now they have opened an
office in Bhopal in 2003. MPVHA is a
mother NGO for the RCH project in the
state. It manages two districts namely
Dhar and Jhabua. It collaborates with Field
NGO in these two districts in
operationalising the RCH programmes. It
provides IEC/BCC training to the
functionaries of the two Field NGOs.
MPVHA also has project on Indian System
of medicine sponsored by the department
of ISM & H, Ministry of Health and Family
Welfare, is under implementation in Nalcha
block of Dhar district since April 2003.
MPVHA produces large number of IEC
materials and activities. It includes
booklets on PNDT, sexual harassment,
care for the pregnant mother, audio
cassettes and video cassettes.
Monitoring and Evaluation
Monitoring should be incorporated as
inbuilt system at various levels. The
reporting format has been suggested in
such a way that the information from the
villages will reach the block, district, and
State. Monthly meetings at block, district,
and State level would facilitate two-way
flow of communication at all levels.
Periodical evaluation of the activities is
must and it should not be taken as a routine
matter. Outside agencies should be
involved in evaluating the programme
performance. The evaluation should take
into account the field situation as well as
the practical difficulties in operationalising
the IEC activities in the field. The findings
should be discussed in State and district IEC
forums and should be used as inputs to
the action plan for the district and the State.
- Family Welfare programme evaluation
sur vey15 2003 by GOMP, RCVP
Noronha Academy of Administration
and mamagement and population
resource Center,
- Appraisal of Material developed under
Danida16 -a report (March 2003) by Dr.
Namrata Sharma, Danida
- Studies in Population of Madhya
Pradesh17 , Alok Ranjan, Chaurasia,
PFI, 1999
District Level
The districts are large and spread over
different geographical and cultural
regions. The communication and other
connectivity are difficult. The far off district
do not receive the materials or instructions
on time. Besides the operational issue and
the leadership at the district in terms of
IEC variable.
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The districts which have some UN or
bilateral support seem to o a little better
but otherwise the district have no real
involvement in the IEC programme other
than meeting the targets.
PHC/SC Level
The BEE is a finishing cadre. The ANM,
AWW JSR are there but the lack of
material, capacity and continuity is a
problem. Utilistaion of the IEC materials
is an issue. The IPC part of the IEC
program is essentially talk on the method.
Behavioural issues are hardly addressed.
Influencers are not addressed. The
interest level and the old methods and
mindsets still prevails.
4. Issues and concerns
This brings us to look back and reflect on
the situation as far IEC for Family welfare
in the state is concerned. The consultant
had meetings with Director SIHFW, Dy.
Directror IEC, RCH (IEC) consultant.
Principal Secretary Health and Family
welfare, State resource Coordinator
UNFPA, programme Officer UNFPA,
Programme Communication Officer
UNICEF, State Director, SIP, Regional
Manager, CARE MP, State Director FPAI,
State Director MPVHA, RCH NGO
consultant, State resource center,
Population Resource center, Academy of
administrationstate IEC advisor, DBHSP,
CDMO, MOIC, ANM of Vidisha among
others during the state visit.
4.1 IMPLEMENTATION FOCUS ON FAMILY
WELFARE IN THE POLICY IS MISSING
The implementation of the IEC
programmes is missing as the only
mechanism the state has to know the
happening of the initiatives and activities
is the UC which obviously is not sufficient.
The structures that implement the
program i.e MSS, DFP, Song and drama
division, NGOs are not coordinated or
qualitatively inputted. The tracking or
support mechanism at the district and at
state are weak.
4.2 FAMILY PLANNING PROGRAMME
PERFORMANCE
The performance of the programme over
the years and especially during the RCH
days may seem to show a little quantitative
improvement but it is technically a natural
growth not really spurred by the
interventions. The FP survey conducted
by the Department show need for grater
improvement to be able to achieve the
population policy goals.
4.3 LOW EXPOSURE TO MASS MEDIA
In a state like Madhya Pradesh, where a
large majority of women are illiterate or
have little formal education, informal
channels such as the mass media can
play an important role in bringing about
modernization. In NFHS-2, women were
asked questions about whether they read
a newspaper or magazine, watch
television, or listen to the radio at least
once a week, and whether they visit the
cinema or theatre at least once a month.
Table 1 gives information on women’s
exposure to these forms of mass media
by selected background characteristics.
In Madhya Pradesh, nearly half of the
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women (45 percent) are not regularly
exposed to any of these media, more than
at all India level (40 %). As expected, the
regular exposure to any media was found
to be much more wide spread among
urban women (84 %) than among rural
women (45 %). The media exposure
varied even more widely by education and
standard of living categories. A negligible
proportion (2 %) of women who had
completed high school were not regularly
exposed to any media as compared to a
high of 60 percent of illiterate women
falling in this category. Regular exposure
to media also increased with standard of
living. While percentage of women not
regularly exposed to any media was 69
among women from households with a
low standard of living, and 44 percent
among women from households with a
medium standard of living, it was only 8
percent among women from households
with a high standard of living. The
proportion of Muslim women not regularly
exposed to any media (25 %) is about half
that of Hindu women (47 %). Almost all
the Jain women (97 %), were regularly
exposed to a media. Scheduled tribe
women are much less likely to be regularly
exposed to any media (36 %) than
scheduled caste women (49 %) or women
belonging to any other backward classes
(57 %). More than three fourths (76 %) of
women from other than the caste
mentioned above, were regularly exposed
to some form of mass media. By region,
regular exposure to mass media was
lowest among women in Vindhya Region
where almost two thirds of women were
not regularly exposed to any media, and
highest in the Central Region. Exposure
to media, however varied little by age of
respondent.
Among the different types of mass media,
television had the greatest reach across
all categories of women including illiterate
and poor. Overall, 45 percent of
respondents were exposed to television
at lest once in a week, as compared with
28 percent or less of respondents were
regularly exposed to any of the individual
media. The proportion of women who
watched television at least once a week
has risen sharply since the time of NFHS-
I, when it was 27 percent. There has
however been a decline in exposure to
radio and cinema/theatre in the last six
and a half years between the two surveys.
The proportion of women listening to the
radio at least once a week declined from
33 percent in NFHS-I to 28 percent in
NFHS-II and the proportion who had
visited cinema or theater at least once a
month declined from 10 percent to 7
percent over the same period. Exposure
to cinema or theatre decreased
moderately with age, but exposure to other
media varied little by age of respondents.
Exposure to each of different forms of
media increased sharply with education
and with standard of living and was much
higher among women living in urban than
in rural areas. Urban women were much
more likely to watch television (80 %) than
to listen to the radio (37 %) at least once
a week; where as rural women were only
some what more likely to watch TV than
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listen to radio. Muslim women (72 %) were
more likely than Hindu women (42 %), but
less likely than Jain women (96 %) to
watch TV at least once a week. Notably
women who have completed at least
middle school were more likely to be
regularly exposed to print media than
radio or cinema/theatre.
departments of the government do not
have any coordinated mechanism of effort
in the components that concern with
Population and development. This non
sharing and leaning leaves much to be
desired. Besides there is no accountability
on the outcomes proposed by these
partners.
Results indicate that family planning
message disseminated through the mass
media have reached only about half (49
%) of ever married women in Madhya
Pradesh. The most common source of
recent exposure to family planning
message has been television. About forty
percent of ever married women reported
having seen a family planning message
on television, 25 percent reported
exposure through radio, 20 percent
through wall paintings and hoardings, 14
percent through newspapers or
magazines, and 9 percent through
cinema/theater, folk media, etc and street
plays provided exposure to only 7 percent
of respondent women. Therefore,
although mass media is an important
means of spreading health and family
welfare messages, as well as exposing
women to modern views, innovative
programs will be necessary to reach
majority of women who are not regularly
exposed to any form of mass media.
4.4 LACK OF COORDINATION AMONG
DEVELOPMENT PLAYERS
The programme partners-directorate, IEC
bureau, UN partners, Bilaterals,
International NGOs, and other
4.5 IMPORTANCE ACCORDED TO IEC
It is clear from discussions from the
government officials that because there
is an IEC bureau it is sufficient and there
work is done. The Director IEC bureau,
also holds the dual position of Director
Medical Education and training, it is
apparent that he may not be able to spend
enough time to SIHFW. Similarly because
there is a Deputy Director IEC, the job is
done. Existence of a structure is seen as
job done. There has been quick and
frequent shift in the leadership as well.
4.6 PROBLEMS OF IEC COORDINATION
Unicef, UNFPA, CARE, EC and other do
have common programmetic goal and
audiences but there is no cross sharing
learning or contribution to each other.
Similarly various units, bureau also do not
share or learn from each others strengths
or mistakes.
4.7 IEC IN PIP PREPARATION FOR RCH –II
Although the preparation seems to be
particpative but and there is a group on
BCC but the inputs for BCC are not
understood or are still in the regular
domain.
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4.8 PROBLEM OF NGOS COORDINATION
AND CAPACITY
There is a large network of NGOs. But
lack of sharing learning and coordination
even among the NGOs is a big issue.
4.9 ISSUES RELATED TO MEDIA
Media seem to play a less than required
part in the process.There is a strong need
for Media involvement in the programme
and the issue.
4.10 ISSUES RELATED TO MSS
There is a huge number of community
structure existing but to little use.
Considering the budget spent on them it
would worthwhile to reap benefit from
them.
4.11TECHNICAL CAPACITY OF THE IEC
BUREAU IS WEAK
The bureau does not position itself as a
technical body in communication and
maybe does not have the technical
capacity to do so.
4.12 NO STRATEGIC DESIGN
The communication activities and
materials do not have any strategic
design. They follow what was done last
year with a little modification.
4.13 INFLUENCERS NOT ADDRESSED
Specific audience segments like
influencers are not addressed. This was
expressed by several stakeholders.
4.14 LEGAL CASES ISSUE
This does not seem to be a big issue in
the state although there have been some
cases here and there.
4.15 MONITORING AND EVALUATION IS
VERY WEAK
Although there has been an evaluation of
the Family welfare programme, the IEC
component does not figure in a significant
manner.
District and Field level
The infrastructure, support for capacity
and follow up has been sporadic and the
implementation is varying according to the
leadership in the district and the support
of an agency there.
5. Conclusion
It is clear from discussions from the
government officials that because there
is an IEC bureau available in directorate
it is sufficient and there work is done. The
Director IEC bureau also holds the dual
position of Director Medical Education and
training, it is apparent that he may not be
able to spend enough time to the bureau.
Existence of a structure is seen an job
done. The secretary, health and family
welfare also echoed similar views as IEC
is an important component. The director
Family welfare is very good medical
surgeon. The fact is that IEC bureau was
not even a part of the group that was
formulating the PIP for RCH-II. Obviously
there is a positive environment,
participatory methodology but again the
uncoordinated efforts, several players, and
a complex geographical and people state
make it difficult for the IEC programme.
6. Recommendations
The state needs to gear up to the new
paradigm and build on the strengths it
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already has in the matter of IEC.
1. Need to strengthen IEC bureau
- have single charge full fledged
director for the IEC bureau
- engage professional staff
- involve the in planning
- involve them in IEC training
- have M & E unit at IEC bureau
- develop an IEC strategy
- develop a year plan based on
research
2. Utilize the MSS structures for better
involvement and results
3. Coordinate the plans and process of
different players
4. Utilize the technical inputs for IEC from
the academy
5. Train IEC and field staff for effective
use of IEC materials and activities
6. Use a different media mix instead of
posters and other print materials.
7. Develop clear indicators for IEC/BCC
& place a mechanism for its rigorous
follow up
8. Use the panchayats and ICDS more
effectively for IEC and social
mobilization
9. Allocate more IEC funds and create
space for innovative activities
10. Have audience specific programmes
for involving med and adolescents in
the family welfare programme
11. Have specific advocacy efforts for
involving influencers and religious
leaders, women’s groups, elected
representatives etc.
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Madhya Pradesh at a glance
Setup
Area (in lac sq. km)
Number of divisions
No. of blocks
No. of Tribal blocks
No. of blocks with Scheduled Caste majority
No. of Villages
Population
Total Population
Male Population
Female Population
Sex Ratio
Major Health indicators
CBR
CDR
IMR
MMR
TFR (births per woman)
Literacy status
Literacy rate
Female Literacy rate
Male literacy rate
Rural literacy rate
Urban literacy rate
Health Department Infrastructure
State Institute of Health Management & Communication
RHFWTC
LHVTC
ANMTC
District Training Centre
District Hospital
Civil hospital
Community Health Centre
Primary Health Centre
Sub Health Centres
Civil dispensary
Poly clinic
Urban family welfare centre
Village family welfare centre
Leprosy home and hospital
T.B. Hospital
T.B. Sanatorium
Blood bank
** Source : Annual report 2001-2002 Department of Public Health and Family Welfare
3.08
8
313
92
91
51,906
60,385,000
31,457,000
28,928,000
920/1000
31.10
10.40
90.00
540.00
4.50
64.11
50.28
76.80
35.87
70.81
1
3
2
29
36
36
57
229
1,192
8,874
97
6
97
313
5
7
2
33
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Reference:
1. Census of India, 2001, RGI, Ministry of Home Affairs, Government of India.
2. National Family Health Survey-II, International Institute of Population Studies, 1999, Mumbai.
3. Reproductive and Child Health Survey- Madhya Pradesh, 2000, Government of India.
4. Review note on RCH-I by the directorate, GOMP, 2004.
5. Personal communication with G S sachdev, Bhopal 21 September 2004.
6. Communication Needs Assessment, Danida, 2000.
7. Appraisal of materials developed under danida, a report (march 2003), Dr. Namrata Sharma, Danida.
8. Rapid appraisal of IEC materials and activities in districts Shivpuri and Dhar, Center for Media Studies, 2002.
9. Report of the workshop for developing a BCS for MP, CMS for HLFPPT, 2002.
10. Concept note on Programme Communication strategy for stepping up RCH programme implementation in Madhya Pradesh,
2004.
11. Formative research on Behavioural change communication for INHP-II, CARE MP, 2004.
12. Behaviour Change Communication Strategy for INHP-II for MP, CARE MP.
13. Small Family by Choice report 1995-2000, FPAI, Bhopal 2000.
14. Annual report, 2002-03, MPVHA, Bhopal, 2003.
15. Family Planning evaluation survey 2003, Academy of Administration, GOMP.
16. Appraisal of IEC material developed under Danida project, 2003.
17. Studies in Population of Madhya Pradesh, Alok Ranjan, PFI, 1999, New Delhi.
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Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to the
radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly exposed to any
of these media by selected background characteristics, Madhya Pradesh, 1998-99
Background characteristic
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Reads a
newspaper
or magazine
at least
once a week
Exposure to mass media
Watches Listens to the
television radio at least
at least once a week
once a
week
Visits the
cinema/
theatre at
least once
a month
Not
regularly
exposed to
any media
Number of
women
13.4
42.8
27.8
17.4
44.1
29.6
18.8
45.2
28.2
16.8
44.2
28.5
14.6
46.0
28.5
15.3
44.1
26.1
16.1
44.8
26.6
7.7
45.3
894
10.2
43.4
1297
9.4
44.8
1377
6.9
46.0
1167
5.2
44.9
960
4.4
47.2
707
3.5
46.1
539
Residence
Urban
Rural
37.8
79.8
37.1
9.1
32.5
25.2
15.6
15.8
1756
4.6
55.1
5186
Region
Chattisgarh
Vindhyachal
Central
Malwa Plateau
15.9
10.1
24.6
21.3
Education
Illiterate
Literate, <middle school complete
Middle school complete
High school complete and above
0.0
21.9
40.7
62.7
40.4
26.3
58.8
58.8
7.0
34.7
46.9
68.1
40.4
17.0
33.0
28.3
10.6
41.6
50.2
66.9
13.0
2.6
8.8
5.4
1.4
7.5
13.4
23.4
41.6
65.4
33.8
35.3
85.9
42.6
26.3
14.0
1779
1030
667
1155
5383
779
267
595
Religion
Hindu
Muslim
Christian
Others
10.0
4.2
24.8
7.7
17.4
13.2
23.2
13.5
21.3
14.1
40.7
9.8
4.4
4.0
12.2
1.8
71.7
78.9
57.5
82.5
5872
1038
59
55
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
4.2
2.7
7.1
23.4
9.6
4.2
14.9
34.9
13.1
10.4
18.4
37.5
2.7
82.1
1452
1.1
88.3
582
3.7
74.9
3642
9.4
50.0
1348
Standard of living index
Low
Medium
High
Total
1.3
10.2
47.6
9.3
2.5
20.3
77.8
16.8
6.2
27.6
67.2
20.3
1.2
91.8
3709
5.3
62.0
2595
17.7
12.6
712
4.4
72.7
7024
Note: Total includes 1, 4, and 18 women with missing information on education, caste/tribe, and the standard of living index, who are not shown separately.
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MADHYA PRADESH
Range of RCH indicators in MADHYA PRADESH
Indicators
Minimum
Maximum
Eligible women below age 30 years
45.0 (Betul)
59.5 (Dhar)
Girls married at age below 18 years
8.6 (Balaghat)
71.1 (Sidhi)
Non-literate eligible women
36.0 (Bhopal)
72.8 (Guna)
Total fertility rate (TFR) (per women)
1.99 (Bhopal)
4.17 (Vidisha)
Birth order 3 and above
38.8 (Chindwara) 63.6 (Sidhi)
Infant mortality rate (IMR) (per 1000 live births)
18.6 (Indore)
97.7 (Balaghat)
Knowledge of any modern FP methods
83.8 (Sidhi)
99.9 (Dhar, Ujjain)
Knowledge of NSV among husbands
17.6 (Seoni)
72.7 (Devas)
Current use of any FP methods
27.3 (Seoni)
67.2 (Indore)
Current use of modern FP methods
27.2 (Seoni)
65.9 (Indore)
Unmet need for FP methods
10.3 (Indore)
33.4 (Chatarpur)
Three of more ante-natal check-ups
11.4 (Sidhi)
60.0 (Indore)
Received full antenatal check-up (ANC)
0.5 (Chatarpur) 19.7 (Bhopal)
Safe delivery
13.9 (Sidhi)
88.9 (Indore)
Exclusive breastfeeding
4.5 (Jhabua)
90.6 (Chatarpur)
Full immunization
10.5 (Guna)
60.5 (Seoni)
Eligible women aware of RTI/STI
0.9 (Sidhi)
36.4 (Indore)
Husbands aware of RTI/STI
5.5 (Seoni)
81.0 (Bhopal)
Eligible women aware of HIV/AIDS
8.5 (Sidhi)
73.5 (Indore)
Husbands aware of HIV/AIDS
35.6 (Sidhi)
88.1 (Indore)
Pregnancy complications
18.8 (Sagar)
51.5 (Sehore)
Delivery complications
5.3 (Sidhi)
68.9 (Sehore)
Post-delivery complications
14.5 (Gwalior)
58.7 (Sehore)
Utilization of Govt. Health facilities for antenatal care 13.6 (Sidhi)
49.2 (Bhopal)
Utilization of Govt. Health facilities for postnatal care 20.4 (East Nimhar) 59.2 (Datia)
Note: All figures are in percentage except TFR and IMR
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Persons met
Mr. Iqbal Ahmed, Principal Secretary, Public Health and Family Welfare.
Mr. Ashok Barnwal, Director, Public Heath and Family Welfare.
Dr. Ashok Sharma, Director, Public Heath & Family Welfare, Director state IEC bureau.
Dr. Thassu, Departmnt of Public Health and Family Welfare, GOMP.
Ms. Ceelina Singh, Project Director, MPSACS.
Mr. Pradeep Sarkar, IEC Officer, MPSACS.
Ms. Shradha Bose, IEC Officer, MPSACS.
Dr. Alok Ranjan Chaurasia, Director Population Resource Center, Academy of
Administration.
Mr. Guru, Dy Director, State IEC bureau.
Ms. Malti Bajpayee, Exhibition and media officer, State IEC Bureau.
Mrs. Rita Aggarwal, State IEC bureau.
State resource center (Abhivyakti), Bhopal.
Dr. Vandana Joshi, CARE Madhya Pradesh.
Ms. Pragnya Raipurkar, CARE Madhya Pradesh.
Dr. Namrata Sharma, Advisor, Danida Support Unit.
Dr. Narendra Dundu, UNFPA.
Dr. G S Sachdev, DFID/SIP/EC.
Mr. Pawan Mehta, FPAI, Bhopal.
(Ref: Situation Analysis- The Health Sector in MP, June 2002, HLSP Consulting Ltd., MSG).
Ref. Gopalakrishnan & Agnani, Rajiv Gandhi Mission: Occasional Papers, Document: 8, March 2001.
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CHAPTER 4.5
CHHATTISGARH
Review of IEC component of
Family Planning Program
1. Background:
On November 1, 2000 India gave
birth to a new state –
Chhattisgarh, carved out of
India’s geographically largest state of
Madhya Pradesh with an area of about
443,000 square kilometers. Though
Chhattisgarh with an area of 135,191
square kilometers accounts for only 30
percent of the total area of Madhya
Pradesh, it is still a considerable size and
is almost sixteen times the size of Kerala.
According to 2001 Census, the population
of Chhattisgarh was 20.8 million. The state
contributes to 2.03 percent of country’s
population. The decadal growth rate of
state was 18.1 percent during 1991-2001,
much lower than the previous decade
growth rate of 25.7 percent. The
population sex ratio was 990, much higher
than the all- India sex ratio of 933. The
demographical indicators put the state in
not much happy situation, with CBR of
26.7, CDR of 9.6 and IMR of around 80.
The state has about 81 percent of rural
population and a total fertility of 2 8. The
family planning user-ship in the state
remained almost at the country’s average
at 45 percent. The state registered a high
unmet need for family planning (13.5 %),
relatively higher for spacing methods
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(8 %). The state is nominated as one of
the EAG states, as much more efforts are
required to achieve the socio economic
and demographic goals in the state.
2. Methodology
The team of three consultants has visited
the EAG states sometimes together and
sometimes as a duo team and sometimes
as a single member team. In the case of
Chattisgarh, a single member consultant
team visited the state from 4th to 6th
October 2004. The consultant had
prepared a set of talking points and
questions that were relevant to the study.
These set of points were shared with PFI
and were also tried out in interactions with
stakeholders in Delhi and in other states
visited prior to visiting Chattisgarh.
The consultant’s task was three fold. One,
meeting with the state machinery (people
and setup) that delivers the health and
family welfare programme with special
focus on the IEC system. The consultant
met the Principle Secretary, Public Health
and Family Welfare, Director, FW, Director
Health and Family Welfare services and
Director IEC Bureau, consultants for RCH
and other officials. Second, the consultant
met the partners, stakeholders and other
players in the field such as UN and
Bilateral agencies (EC, Danida),
international (CARE) and national NGOs
(CGVHAI, FPAI). Third, the consultant also
visited the field and met with the frontline
officials and workers who actually carry
out the tasks in the district of Raipur.
3. Current Status of the Family
Welfare programme with
focus on IEC
As with the newly formed states there are
issues related to the setting up of an
proper administrative structures and
manpower, Chattisgarh also suffers from
the similar situation but probably much
more than the other two new states. Being
the farthest part of the parent state the
area did not get adequate attention as far
as Family welfare and within that the IEC
part of the efforts. The human resources
for the family welfare programme has
been restricted and the top key positions
have been filled by upgrading or
promoting the personnel available. In such
circumstances assumes or gets lesser
importance because the setting up of
services takes precedence. As per the
current setup the state has a secretary,
FW who looks after the family welfare and
public health departments. There is a
director of health services.
The state has attempted to merge all
health programmes to make state health
society to cater to the programes in a
coordinated and efficient manner but that
itself has apparently become a block in
the process.
3.1 NO STATE POPULATION POLICY
The state does not have a state specific
population policy. It was also learned that
the state as of now does not intend to have
one and has adopted the national
population policy for the purpose.
Interestingly the population policy of the
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parent state Madhya Pradesh was crafted
when Chattisgarh was a part of Madhya
Pradesh but apparently the MP population
policy does not seem to find favour with
the current state administration. It is also
to be noted that the state has recently
undergone a change of leadership from
a congress led government to a BJP lead
government and that too has had many
implications for the initiatives and the tone
of the work and strategy.
3.2 JAN RAPATS (PEOPLE’S HUMAN
DEVELOPMENT REPORT OF
CHATTISGARH)
The state does have two initiatives which
give some insight into the thinking of the
state for the family welfare programme
One of the documents is the background
note to the Peoples report (Jan rapat) of
Chattisgarh1 . This initiative was started
at the completion of one year after the
formation of the state. People’s report
were to document the human
development status of each village but
also use the inventory of resident natural,
physical and human resources leading to
community action in development.
3.3 STATE HDR
The idea behind state HDR is based on
the need for information for planning and
participation. It has basic four objectives.
It is seen as bottom-up participatory
exercise needed to view human
development through the eyes of human
beings rather than those of experts and
statistics. It emphasizes need to juxtapose
objective physical reality with subjective
people’s perceptions. The need of such
an exercise emanates form absence of
data for (i) new districts, (ii) district
incomes, (iii) district level IMR & life
expectancy and the need to cover (i)
society, (ii) institutions and (iii) natural
resources for a holistic view.
The data was collected ina partcipatory
manner and listed under six thematic
heads.
These were Health, Education – as well
as Information & Knowledge (including
traditional knowledge), Livelihood,
Society, Institutions, Natural Resources.
3.4 THE STATE HEALTH SOCIETY
The creation of state health society by
merging all parallel health societies for
tubeculosis, malaria, RCH, AIDS and the
Basic Health services programme was
q Hoped to improve functionality and
coordination
q Expected to provide space for
expertise from the funding agencies,
from civil society and professional
associations
q Help in interdepartmental coordination
It has been difficult to meet these
expectations. For one, since the chief
secretary is not on the Committee, the
interdepartmental co-ordination becomes
difficult. In the period of about 18 months
of its creation, the executive committee
has met twice-co terminus with its
governing body- and the decisions of even
these two meetings have had little
influence on subsequent actions. It is seen
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only as a channel for funds from the
central government from external donors,
bypassing the treasury.
3.5 STATE IEC UNIT
There is no state IEC bureau. As per
report of the IEC unit2 in the directorate
there are extension officer and deputy
extension and resources officer who look
after the work. There is no sanction for
the IEC bureau which is proposed. The
state has asked the center for the set up
of the IEC bureau with a structure and
manpower but apparently this is still in the
process.
IEC/BCC training for Family planning
and RCH
The state has 5 ANM training centers and
3 MPW training centers. The later are not
functional. The state also has 4 General
nursing training centers at Durg, Raigarh,
Bilaspur and Jashpur that give diplomas
in Nursing. It has currently no institution
for training LHVs and HAs. The annual
intake of these institutions is 60, thirty per
term. Some of the training is supported
by the Danida BHSP and other done by
the DTC and Mitanin project. The RCH
training are also supported by the NIHFW
directly but there has been less of the IEC
component in those training.
IEC/BCC materials and activities for
Family planning and RCH
The state being new has used and
adopted some of the materials developed
by the parent state (MP). Also some of
the material developed by the center has
been reprinted with the local adoption. The
materials provided by the support of
CARE and other international NGOs has
also bee used in the project. But since
there is a lack of a unit that will coordinate
and support the material development and
distribution there has been a focus on the
pulse polio material development. The
NGOs have also developed some of the
materials under the RCH scheme but
there is serious dearth of materials in the
state. Supported by Danida the districts
had developed action plans for IEC with
different thematics. Seven out of the all
districts were sanctioned with their action
plans. Only three of them had a focus on
the family welfare, MCH and child
surrvival.
There is an obvious shortage of the
capacity to manage the production to
conceptualistaion of the material and
activity. Even the Mitanin project has gone
through this problem and are coming up
with local solutions.
Existence of rich Folk Media
A large part of the state is primarily tribal
with primitive as well as tribal cultures. The
local tradition is strong. The state has tried
to involve the local troupes to use the
forms and develop the material and
activity on the local idiom. Since this
requires strong support from the state and
the local ownership by the district
authorities, this effort will require some
institution building for a sustained effort.
There is rich folk media tradition in the
State and they perform folk drama and
street plays etc. in different regions of the
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State. The folk troupes and talents should
prepare IEC materials according to the
local needs and perform at the village
level. These performances should also be
organized on the occasions of Swasthya
Mela. Such cultural programmes should
be encouraged. The village panchayats
and block panchayats should be
requested to sponsor these
performances.
Staffing position in the State IEC
bureau and district level
At present out of the sanctioned 7
positions of the DHIO there are only three
under posting. The required posts are 16
as there were new district created from
the existing but the new post were not
created. Similarly there are 6 district HEIO
in the sanctioned 14 positions which
actually requires 16 positions. The post
of artist and cinema operators are
classified as dying cadre but there are 8
persons in the positions still. There are 146
block in the state requiring same number
of posts but there are 127 people in the
position.
Budget and Action plan for the IEC
activities
The state receives funds from two heads
i.e. RCH and family welfare. For the last
three years the state has received funds
from the RCH head and none from the
FW head. These allocations are as follows.
In the year 2001-02 the state received Rs.
35, 21,000 out of which only Rs. 15,10,398
was utilized, in the year 2002-03 the state
received Rs. 45, 00,00 but only Rs.
15,71,988 was utilized and in the year the
state IEC unit received Rs. 3,00,00,000
but only Rs. 2,90,42,294 was utilised.
3.3 RCH PROGRAMME IN CHATTISGARH
The RCH programme in the was initiated
separately after the state was separated
from the parent state in 2001. As the state
was new and the infrastructure and
manpower was being restructured the
RCH programme was slowly coming into
force. It is obvious that the RCH -I has not
been a success in the state due to
management and clarity in terms of fund
flow as well the peculiar problem of the
new formation.
The RCH-II has been under preparation
in the state currently. The SHRC along
with department and other partners has
developed the plan for the RCH -II.
Chattisgarh State Health Resource
Center
State Health Resource Center (SHRC) is
an autonomous institution funded by the
state government as part of the sector
investment programme. It is functioning
as additional technical capacity to the
department of health and family welfare,
Government of Chattisgarh. The SHRC is
a joint initiative of the state government
of Chattisgarh and Action Aid India. Other
than Mitanin programme, the SHRC is
initiating a wide range of activities as part
of the Health sector Reforms Programme
and as part of its contribution to
strengthening public health systems for
achieving comprehensive universal
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primary health care.
SHRC working paper 3 Strengthening
Public Health Systems in Chattisgarh3
SHRC has undertaken a mammoth task
of looking at the workforce and
management issue for the health sector
in the state. The government of
Chattisgarh is engaged in the process of
re assessing the public health care system
to arrive at policy options for developing
and harnessing the available human
resources to make greater impact on the
health status of the people. As part of this
effort the study attempts to address the
issues of adequacy of human and material
resources at various levels of care, look
at the factors that contribute or hinder the
performance of the personnel in position,
and at the structural features of the health
system as it has evolved affect its
utilisation and its effectiveness.
Interestingly the task of the IEC and
communication activities has been kept
out of the purview of the study as danida
was exploring the IEC situation. Danida
has apparently come up with district action
plans which have been presented to the
director and has not found too much
favour with the directorate.
Danida supported Basic Health
Services Project
In order to strengthen the health sector
activities in the State, the Government of
India sanctioned a project to strengthen
Basic Health Service in Madhya Pradesh
assisted by DANIDA. This was extended
to provide the to Chattisgarh. The project
- Chattisgarh Basic Health Service Project
(CGBHSP) was launched with main
objective to bring qualitative improvement
in the health status of people of Madhya
Pradesh, especially of women and
children. The project had five major
components – Training; Information,
Education, and Communication; Drug
Distribution; Development of Management
Capacity; and Local Body Support. IEC
component of the project emphasized on
training of IEC personnel, streamlining the
annual IEC planning of the State and the
Districts, equipping the IEC units at the
State and the Districts with required
technology, providing basic skill for the
production of IEC material, and
strengthening mass media campaign.
CGBHSP carried out two phases of its
operation in Chattisgarh. Not much has
been achieved in case of IEC
implementation because of structural
problems. It is said that the IEC personnel
is not spending more than 20 per cent of
their time in IEC related activities. There
is a strong impression that IEC personnel
lack clarity and creativity. It is at this
juncture that the officials of the
Department of Public Health and Family
Welfare, Government of Chattisgarh felt
a need to get a clear picture of the
situation on IEC front. Though the
programme officials were aware that the
existing IEC systems are weak, they
wanted to have an independent scientific
assessment conducted by an outside
organisation.
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NGOs in RCH in Chattisgarh
Like in other states there are MNGOs
under RCH –I who implement the project
in different district. The MNGOs have yet
to come to terms with the realities of the
programme and the reach. FPAI and
CGVHAI are two of the prominent NGOs
who have stated to operate from the state.
CINI has also been assigned the task of
IEC resource center for the state also with
other neighboring states. This
arrangement does not seem to work in
favour of the state as the resource center
is in Kolkatta.
CARE
CARE is working on Integrated Nutrition
and Health Programme with the
government of Chattisgarh and in 2002
started working with NGO partners.
CARE4 has developed some best
practices and innovations and community
involvement programmes. These
innovations are aimed to strengthen the
existing system by help of government
counterparts and the change the
behavioural practices of the community
with the help of NGO partners. The
innovation are categorized under four
broad heads. These are (1) Strengthening
Just and Equitable Governance and
specially the local governance, (2)
Behaviour change, (3) Community care,
participation and monitoring, and (4)
gender equity.
Under the behaviour change innovation
there are several different types of
initiatives that cater to the behaviours
related to ICDS and RCH themes. These
are use of a tradition like Annaprassna
(Kheer Khilai), Thali, Making a chart of
locally available food, Serelc shishu aahar,
Bal Bhoj Swasthaya evam Poshan Saap
Seedhi, Suposhan Sangeet and Tiranga
for nutrition. CARE has tried to innovated
with the involvement of the community as
well develop some local specific IEC
materials with local content, language and
the simple formats.
The success of these efforts is closely
tracked and monitored through district
reports. Second these are operationalised
through Change agents trained by the
CARE staff as well the NGO partners.
These Change agents are similar to the
Mitanin and volunteers who are train and
are local persons.
Monitoring and Evaluation
There is MIS5 which tracks the
performance of the programme through
performance (target ) indicators.
Monitoring should be incorporated as
inbuilt system at various levels. The
reporting format has been suggested in
such a way that the information from the
villages will reach the block, district, and
State. Monthly meetings at block, district,
and State level would facilitate two-way
flow of communication at all levels.
Periodical evaluation of the activities is
must and it should not be taken as a
routine matter. Outside agencies should
be involved in evaluating the programme
performance. The evaluation should take
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into account the field situation as well as
the practical difficulties in operationalising
the IEC activities in the field. The findings
should be discussed in State and district
IEC forums and should be used as inputs
to the action plan for the district and the
State.
- MIS of the FW department does not
capture any of the IEC components
- Appraisal of Material developed under
Danida6 -a report (March 2003) by Dr.
Namrata Sharma, Danida
- Studies in Population of Madhya
Pradesh7 , Alok Ranjan, Chaurasia,
PFI, 1999
District Level
At district level in the outskirts of the state
capital it becomes apparent that the state
resources do not reach the even nearby
areas. The districts have a difficult reach
by rail of road. In the interior where there
is a major tribal population it is much ore
difficult. Some of the district are also naxal
infected.
PHC/SC Level
The PHC/SC have a serious lack of IEC
material of training in IEC. The stste lacks
infrastructure for IEC/BCC training.
Danida has tried to pitch in for the gap
but unfortunately has not made much
headway because of bureaucratic hurdles.
The functionaries have undergone a basic
training in IE C/BCC but need to be
supported by refresher training and
orientations.
4. Issues and concerns
The state is still grappling with the new
composition of the state. Secondly with a
change in the government the state is
again dealing with renewed priorities and
focuses. Though it may be said upfront
that IEC still clearly not a priority. Asking
for IEC bureau may not result in the focus
on production of materials.
4.1 IMPLEMENTATION FOCUS ON FAMILY
WELFARE IN THE POLICY IS MISSING
As the state follows the national policy to
a large extent there is less ownership as
well as awaresnesss of the local issues.
Also the large Mitanin project has been in
the initial stages of implementation. It is
an ambitious project whose
implementation and monitoring has yet to
be seen.
4.2 FAMILY PLANNING PROGRAMME
PERFORMANCE
Overall the FW programme has not yet
shown any marked improvement in
perfromance. This is understandable as
the state has evolved many plans and
schemes but the impact of them obvious
has to be seen. It is hoped that the inbuilt
mechanism in the progrmme will be
effective,
4.3 LOW EXPOSURE TO MASS MEDIA
In a state like Chhattisgarh, where a large
majority of women are illiterate or have
little formal education, informal channels
such as the mass media can play an
important role in bringing about
modernization. In NFHS-2, women were
asked questions about whether they read
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a newspaper or magazine, watch
television, or listen to the radio at least
once a week, and whether they visit the
cinema or theatre at least once a month.
Table 1 gives information on women’s
exposure to these forms of mass media
by selected background characteristics.
For many years, the Government of India
has been using electronic and other mass
media to promote family planning. In
chhatisgarh, 85 percent of rural residents
live in villages that are electrified and 20
percent live in villages that have a cable
connection. Two out of five ever married
women listen to radio at least once a week
and same proportion watch television at
least once a week. More than two out of
five women (42 %), however are not
regularly exposed to radio, television, or
any other type of media. Exposure to each
of media is relatively high among more
educated, women from households with
a high standard of living, women who
belonged to high caste group and urban
women.
More than half of urban women in
Chhattisgarh (56 %) had seen or heard a
family planning message in the media
during the few months preceding the
survey. In addition to radio and television
, wall paintings and hoardings and
newspapers and magazines are also
important sources of exposure to family
planning messages. As with exposure to
mass media itself, exposure to family
planning messages was much lower
among women from households with a
low standard of living, women belonging
to scheduled tribes/castes, illiterate
women, and rural women. Only 20 percent
of currently married women in
Chhatisgarh have discussed family
planning with their husbands in the past.
Therefore, although mass media can be
an important means of spreading health
and family welfare messages, as well as
exposing women to modern views in
general, innovative programmes will be
necessary to reach the majority of women
who are not regularly exposed to any form
of mass media.
4.4 LACK OF COORDINATION AMONG
DEVELOPMENT PLAYERS
The programme partners-directorate, IEC
unit, Bilaterals, International NGOs, and
other departments of the government do
not have any coordinated mechanism of
effort in the components that concern with
Population and development. This non
sharing and leaning leaves much to be
desired. Besides there is no accountability
on the outcomes proposed by these
partners.
4.5 IMPORTANCE ACCORDED TO IEC
It is clear from discussions from the
government officials that because there
is an IEC bureau it is sufficient and there
work is done. The IEC officer looks after
the jobs which is coordinated by the state
RCH society and get entailed in delays.
Existence of a structure is seen as job
done. There has been quick and frequent
shift in the leadership as well.
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4.6 PROBLEMS OF IEC COORDINATION
CARE, EC and other do have common
programmetic goal and audiences but
there is no cross sharing learning or
contribution to each other. Similarly
various units including IEC also do not
share or learn from each others strengths
or mistakes.
4.7 IEC IN PIP PREPARATION FOR RCH –II
Although the preparation seems to be
particpative but and SHRC along with
other partners has developed a draft plan
for IEC but it needs detailing and sharing.
4.8 PROBLEM OF NGOS COORDINATION
AND CAPACITY
There is a small network of NGOs. But
lack of sharing learning and coordination
even among the MGOs is a big issue.
4.9 ISSUES RELATED TO MEDIA
Media seem to play a less than required
part in the process.There is a strong need
for Media involvement in the programme
and the issue.
4.10 ISSUES RELATED TO MSS
There is a huge number of community
structure existing but to little use.
Considering the budget spent on them it
would worthwhile to reap benefit from
them.
4.11 TECHNICAL CAPACITY OF THE IEC
UNIT IS WEAK
The bureau does not position itself as a
technical body in communication and
maybe does not have the technical
capacity to do so.
4.12 NO STRATEGIC DESIGN
The communication activities and
materials do not have any strategic
design. They follow what was done last
year with a little modification. The Mitanin
project has a strteguic design but it
remains to be seen as to what it delivers
4.13 INFLUENCERS ESPECIALLY TRIBALS
NOT ADDRESSED
Specific audience segments like
influencers are not addressed. This was
expressed by several stakeholders.
4.14 LEGAL CASES ISSUE
This does not seem to be a big issue in
the state although there have been some
cases here and there.
4.15 MONITORING AND EVALUATION IS
VERY WEAK
Although there has been an MIS of the
Family welfare programme, the IEC
component does not figure in a significant
manner.
District and Field level
The infrastructure, support for capacity
and follow up has been sporadic and the
implementation is varying according to the
leadership in the district and the support
of an agency there. The tribal belt and
the Naxal issue has to be addressed.
5. Conclusion
Over all, the scenario in Chattisgarh as
far as IEC for Family welfare and RCH is
concerned at present seen pretty dismal
with political interference, bureaucratic
apathy, no strategic design based on
research and evidence, negative media,
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lack of mission and zeal, lack of leadership
and initiative, lack of conceptual clarity,
technical capacity, uncoordinated
manner, and lack of accountability in the
entire setup. It is only hoped that all the
players will pool their energy and
resources and work together for the
cause.
One has keep in mind the state is new
and has initiated new programmes with a
zeal and mission. A lot of ambitious
programme have been conceptulised. It
is hoped it will work for the state and a
lesson, if succeeded, for the others to
follow. It only has to be supplemented by
the human resources and the bureaucratic
will power to take it forward.
6. Recommendations
Being a new state has its own problems,
but there are several other issues that
need to be looked into for the better
performance of the FW programme.
1. Complete the IEC strategy with and
action plan with danida and SHRC
2. Utilize the technical inputs for IEC from
the partners
3. Train IEC and field staff for effective
use of IEC materials and activities
4. Use a different media mix instead of
large amount of posters and other print
materials.
5. Develop clear indicators for IEC/BCC
and place a mechanism for its rigorous
follow up
6. Use the panchayats and ICDS more
effectively for IEC and social
mobilization
9. Allocate more IEC funds and create
space for innovative activities
10. Have audience specific programmes
for involving media and adolescents
in the family welfare programme
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References:
1. Background note on People’s report of Chattisgarh, Government of Chattisgarh, 2003.
2. Presentation by the IEC unit at the IEC officers meeting in Delhi 31 July 2004.
3. SHRC working paper 3, Strengthening Public health Systems: Report of a study of workforce management, rationalisation
of services and human resource development in the public health systems of Chattisgarh state, December 2003.
4. Naye pradesh ke naye prayas, CARE, Chattisgarh, 2004.
5. MIS of the FW programme, CG. Nic.in
6. Appraisal of IEC material developed under Danida project, 2003.
7. Studies in Population of Madhya Pradesh, PFI, 1999, New Delhi.
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Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to the
radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly exposed to any
of these media by selected background characteristics, Chhattisgarh, 1998-99
Background characteristic
Age
15-19
20-24
25-29
30-34
Exposure to mass media
Reads a
newspaper
or magazine
at least
once a week
Watches Listens to the
television radio at least
at least once a week
once a
week
Visits the
cinema/
theatre at
least once
a month
19.3
4.3
42.8
16.3
41.6
45.6
20.7
42.0
40.0
13.9
42.9
40.5
17.6
17.5
14.9
13.2
Not
Number of
regularly women
exposed to
any media
34.6
34.2
44.0
40.0
119
182
192
158
35-39
40-44
45-49
12.9
38.6
38.7
13.9
34.7
32.9
8.4
30.4
35.3
6.8
46.2
132
7.0
50.2
100
6.7
51.1
59
Residence
Urban
Rural
36.6
80.0
51.4
11.3
31.6
37.8
29.7
13.1
172
9.3
48.0
770
Education
Illiterate
Literate, <middle school complete
Middle school complete
High school complete and above
0.0
35.1
57.4
77.2
27.9
52.4
77.9
91.1
31.8
55.6
54.3
68.4
9.1
17.5
21.9
29.1
55.7
645
18.2
160
3.4
59
2.6
78
Religion
Hindu
Other
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
Standard of living index
Low
Medium
High
14.8
31.4
14.8
7.2
15.7
56.2
4.9
11.7
60.1
39.7
49.2
41.0
23.9
46.1
81.2
24.0
37.7
90.7
39.6
49.3
43.2
29.9
43.9
61.3
26.7
43.2
61.9
13.0
13.3
13.3
7.2
14.9
27.4
10.0
11.5
25.7
42.7
875
28.4
67
43.4
133
57.9
337
33.8
392
8.8
80
60.4
308
38.6
504
8.5
127
Total
15.9
40.4
40.3
13.0
Note: Total includes 3 women with missing information on the standard of living index, who are not shown separately.
41.6
942
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CHHATISGARH
Range of RCH indicators in CHHATISGARH
Indicators
Minimum
Maximum
Eligible women below age 30 years
48.7 (Rajnandgaon, 54.0 (Bastar)
Raigarh)
Girls married at age below 18 years
13.1 (Raigarh)
55.3 (Koriya)
Non-literate eligible women
40.8 (Damtari)
69.2 (Bastar)
Total fertility rate (TFR) (per women)
1.86 (Raigarh)
3.26 (Bilaspur)
Birth order 3 and above
38.2 (Raigarh)
51.0 (Raipur)
Infant mortality rate (IMR) (per 1000 live births)
35.7 (Raipur)
75.1 (Damtari)
Knowledge of any modern FP methods
91.7 (Bastar)
99.8 (Raigarh)
Knowledge of NSV among husbands
16.9 (Damtari)
32.7 (Janjgir
Champa)
Current use of any FP methods
34.9 (Raipur)
57.3 (Damtari)
Current use of modern FP methods
31.4 (Koriya)
56.9 (Damtari)
Unmet need for FP methods
11.3 (Damtari)
21.0 (Raipur,
Bastar)
Three of more ante-natal check-ups
20.4 (Koriya)
62.6 (Damtari)
Received full antenatal check-up (ANC)
5.1 (Janjgir
Champa)
27.1 (Rajnandgaon)
Safe delivery
25.9 (Janjgir
Champa)
74.6 (Rajnandgaon)
Exclusive breastfeeding
76.2 (Raipur)
95.6 (Janjgir
Champa)
Full immunization
47.5 (Rajnandgaon) 68.0 (Damtari)
Eligible women aware of RTI/STI
7.5 (Rajnandgaon) 26.4 (Raigarh)
Husbands aware of RTI/STI
8.8 (Koriya)
36.2 (Rajnandgaon)
Eligible women aware of HIV/AIDS
19.8 (Rajnandgaon) 39.1 (Raigarh)
Husbands aware of HIV/AIDS
36.4 (Bastar)
57.4 (Janjgir
Champa)
Pregnancy complications
15.8 (Rajnandgaon) 21.6 (Damtari)
Delivery complications
6.3 (Janjgir
Champa)
33.8 (Damtari)
Post-delivery complications
8.0 (Janjgir
Champa)
16.5 (Raigarh)
Utilization of Govt. Health facilities for antenatal care 21.5 (Rajnandgaon) 46.6 (Raigarh)
Utilization of Govt. Health facilities for postnatal care 12.5 (Bilaspur) 67.6 (Raipur)
Note: All figures are in percentage except TFR and IMR
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Chattisgarh at a glance
Setup
Area (in lac sq. km)
Number of divisions
No. of blocks
No. of Tribal blocks
No. of blocks with Scheduled Caste majority
No. of Villages
Population
Total Population
Male Population
Female Population
Sex Ratio
Major health indicators
CBR
CDR
IMR
MMR
TFR (births per woman)
Literacy status
Literacy rate
Female Literacy rate
Male literacy rate
Rural literacy rate
Urban literacy rate
Health Department Infrastructure
State Institute of Health Management & Communication
RHFWTC
LHVTC
ANMTC
District Training Centre
District Hospital
Civil hospital
Community Health Centre
Primary Health Centre
Sub Health Centres
Civil dispensary
Poly clinic
Urban family welfare centre
Village family welfare centre
Leprosy home and hospital
T.B. Hospital
T.B. Sanatorium
Blood bank
** Source : Annual report 2001-2002 Department of Public Health and Family Welfare
3.08
8
313
92
91
51,906
60,385,000
31,457,000
28,928,000
920/1000
31.10
10.40
90.00
540.00
4.50
64.11
50.28
76.80
35.87
70.81
1
3
2
29
36
36
57
229
1,192
8,874
97
6
97
313
5
7
2
33
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Persons met
Mr. Basanta Kar, CARE.
Mr. B L Aggarwal, Secretary Health and Family Welfare.
Mr. Sanjib Cahkravorty, Danida.
Ms. Ira Saraswat, Danida.
Dr. Rajamani, Danida.
Dr. Madan Gopal, Danida.
Dr. D K Sen, Director FW.
Mr. Bhardwaj, RCH Officer.
D. Sunderraman, SHRC.
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CHAPTER 4.6
RAJASTHAN
State Profile and IEC status with respect to
Family Planning Program
1.0 Background:
R ajasthan is one of the most
preferred tourist states in the
country, especially famous for
its ancient and medieval architecture. The
state is located in northwestern part of
subcontinent. It borders on the west and
northwest with Pakistan, on the north and
north east with the states of Punjab,
Haryana and Uttar Pradesh, on the east
and southeast with the states of Uttar
Pradesh and Madhya Pradesh, and on the
southern with the state of Gujarat. The
state has an area of 342,239 square
kilometers. The capital city is Jaipur.
According to the 2001 Census the states’
population was 66.47 million with one of
the lowest sex ratio of 9221. The urban
population in the state is low at around
23.4 percent and female literacy
remaining one of the lowest in the country
according to NFHS-II2 at around 24.5
percent only.
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As observed in case of socio economic
status of the state, the demographic
scenario in the state is also not very bright.
The state has high birth rate (31.4), high
death rate (8.5) and one of the highest
infant mortality rates (79). The state has
registered the highest natural growth
(23%), mainly because its fertility
remained very high. The total fertility as
per NFHS-II was around 3.78, one of the
highest in the country. The contraception
prevalence rate for modern methods of
family planning remained low at 38.1
percent, with existence of high unmet
need for family planning at 17.6 percent.
The unmet need is equally high for both
spacing and terminal methods of family
planning. With media exposure remaining
very low at only 37 percent, innovative
ways have to be worked out to reach the
state population. The existing poor social,
economic and demographic scenario has
placed the state among one of the EAG
states3, which requires special attention.
The present Chapter brings out some of
the observations made by a team of
Consultants on the IEC status in the family
welfare sector (particularly on family
planning and RCH components) in the
state and its impact on program
implementation. The Population
Foundation of India on behest of the
MOH&FW, Government of India, has
sponsored this study.
2.0 Methodology:
A team of three Consultants visited each
of the eight states, all together, two
member team, or a single member team,
depending upon the need of the state. In
the case of Rajasthan, a three members
Consultants team visited the state during
25-28 August 2004. The Consultants
prepared and followed a set of checklists
and talking points relevant to the study
and to be canvassed at different levels,
after having prolonged deliberations with
PFI officials. Some of the checklists were
also prepared for and used during
interactions with senior government
officials and other stakeholders in Delhi.
These checklists were modified suitably
after each state visit to cover more and
more issues.
During each state visit, the consultants'
tasks were divided to cover three major
areas. The first was to meet the state
officials and observe the setups,
responsible for the health and family
welfare program delivery, with maximum
coverage of those directly responsible for
IEC activities in the state. In Rajasthan
the Consultants had interactions with top-
level government officials including the
Principal Secretary H&FW, Secretary,
Family Welfare, Director, IEC, who also
had dual charge as Director General
Family Welfare, Officer on Special Duty,
and others. Second, during the state visit,
the consultants also met the
representatives of bilateral/ donor
agencies involved in the state in helping
the cause of health and family welfare/
reproductive and child health in broader
perspective. Those mainly covered
include, the representatives of UNICEF,
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European Union, UNFPA, etc. Third, the
team also visited two districts, Jaipur and
Alwar, to observe the ground level
situation and get the views of officials/
grass root functionaries. A list of the
contacted officials with whom using
standardized checklists held the
discussions is given in Annexure I.
3.0 Current Status of the Family
Welfare Program with a
focus on IEC:
The Government of India mainly sponsors
family planning program, even though
health has been categorized as the state
subject. Many attempts have been made
to revamp the program from time to time
to address the ever-increasing population
problem. Even though Rajasthan has
been one of the backward states, which
could not address the issue successfully,
in terms of IEC implementation the state
has been pioneer in implementing many
innovative schemes from time to time to
address population problem. The
Government of Rajasthan should be
accorded credit for establishing IEC
Bureau among a few states, in 1990 by
pursuing the recommendations of Central
Council of Health with assistance from
UNFPA. This was a path breaking
initiative, which accorded importance to
communication in health and family
welfare program4. The Bureau was
establishing by reorganizing various
communication unit under the department
and making one single unit with a Director
heading the unit. The Bureau's functioning
style could be well understood by the first
evaluation report (Ashoke Chatterjee,
1992), which described the bureau's
relationships with other departments and
linkages up to the grass roots.
q The Bureau Director was supported by
a strong team of senior mangers in
charge of training, research and
operations wings, expected to help in
forward planning, overall coordination
and key task of advocacy.
q It was expected that the team would
be given at least tenure of five years
to plan and implement its strategies
with functional autonomy.
q It was also proposed to establish
district cells, and reorganizing the
district and block IEC cells, so that all
personnel directly report to the
Bureau.
q Besides the Center for Communication
and Material Production (CCMP) was
established as a unit to provide more
flexibility in production of creative
material.
3.1 FAMILY PLANNING KNOWLEDGE
AND USE OF DIFFERENT METHODS:
According to the National Family Health
Survey-1998-995, the extent of knowledge
of contraceptive methods among currently
married women for different methods was
almost universal, with 99 percent of
women in Rajasthan recognizing at least
one method of contraception. As expected
female sterilization was the most widely
known method (98%), followed by male
sterilization (9%), Oral Pills (79%),
Condom (74%) and IDU (69%).
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Following the pattern of other states, in
Rajasthan also, while knowledge of
modern contraceptives was high, only
about 40 percent of currently married
couples were found using a method of
family planning. Current user-ship, as
expected was higher in urban areas than
in rural places. It was interesting to note
that almost all current users were using a
modern method, and 86 percent of
currently married couples that had ever
used contraception, were current users.
This was mainly because most had sought
for terminal methods, and partly because
those accepted had high motivation for
continued use of the method.
3.2 RCH SURVEY FOR HOUSEHOLDS AND
AVAILABLE FACILITIES AT DISTRICT
LEVEL:
Besides NFHS II, Rapid household survey
was also conducted on behalf of Ministry
of Health and Family Welfare, Government
of India to understand the family welfare
situation after implementation of RCH I
with the help of various indicators. No
major changes, then those observed in
NFHS II were reflected through this survey
with Contraception prevalence rate
remaining at around 39 percent by any
modern methods of family planning, and
awareness of all modern methods
remaining at around 61 percent, however,
lowest for condoms and highest for
sterilization. The observed unmet need
was 18 percent, about 10 percent for
terminal and 28 percent for spacing
methods, indicating that child spacing is
becoming more and more important, but
there is some hitch in adoption of
methods, could be method specific,
program related or/and from the service
users perspective (RCH-1998-99)6.
3.3 EXPOSURE TO MASS MEDIA
In a state like Rajasthan, where a large
majority of women are illiterate or have
little formal education, informal channels
such as the mass media can play an
important role in bringing about
modernization. In NFHS-7, women were
asked questions about whether they read
a newspaper or magazine, watch
television, or listen to the radio at least
once a week, and whether they visit the
cinema or theatre at least once a month.
Annexure-I gives information on women's
exposure to these forms of mass media
by selected background characteristics.
Table1 reveals that, in Rajasthan majority
of women (63 percent) are not regularly
exposed to any of these media. The
regular exposure to media ranges from
32 percent among age 40-49 to 42
percent among younger women aged 20-
24 years. The exposure to media varied
more widely by education, standard of
living and residence. As expected, the
percentage not regularly exposed to
media is much higher among illiterate
women (78%) than among the various
categories of literate women (5-28
percent). Regular exposure to media
increased with the increase in the
standard of living for the household. While
the percentage not regularly exposed to
any media is 92 among women with a low
standard of living and 70 among those
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with medium standard of living, only 22
percent of women belonging to high
standard of living category, were found to
be not having a regular exposure to any
media. Similarly three-quarters of rural
women were not regularly exposed to any
media compared with only 27 percent of
urban women. The exposure to media also
varied by region.The proportion of women
not regularly exposed to any mass media
was higher in Western and Southern
regions (69% and 74%) than in other
regions (55-58 percent). Different religious
groups mostly exposed Jain women
exposed to any media (88%), followed by
Muslim women (43 %) and Hindu women
(35%). The exposure was quite low among
lower caste Hindus, with 83 percent of
scheduled tribe and 66 percent from other
backward classes remained unexposed to
any media as compared to 53 percent of
other caste women.
Among the different types of mass media,
television had the highest reach across
almost all categories of women including
illiterates and women belonging to
medium level of living standards. Only 4
percent of women belonging to
households with low standard of living
watched television at least once a week.
Overall, 30 percent of respondents were
exposed to TV viewing at least once a
week, whereas no more than 17 percent
were exposed to any other single media.
The proportion of women who watched
TV at least once a week has risen sharply
since the time of NFHS-I, when it was only
18 percent. By contrast, regular exposure
to radio has declined over the same period
from 27 percent to 17 percent in NFHS-II.
The cinema (3 5) was found to be among
the least preferred media. Notably,
women those had completed at least high
school were likely to visit the cinema or
theater (17%) more frequently. The
exposure to other media also increased
sharply with education, as well standard
of living. There was a little variation in
exposure to television by age, even though
exposure to other media decreased
moderately with increase in age.
The NFHS-II further revealed that family
planning messages disseminated through
mass media have reached only to 36
percent of ever-married women in
Rajasthan. The most preferred source of
exposure to family planning messages
however was television.Thirty one percent
of ever married women reported having
seen a family planning message on
television, followed by radio (19%),
newspapers or magazines (10%), wall
paintings or hoardings (10%) and cinema/
film shows (5%). Only one percent
respondents were exposed to a message
through dramas, folk media or street plays.
Therefore, although mass media can be
an important means of spreading health
and family welfare messages, as well as
exposing women to modern views in
general, especially the television,
innovative programs will be necessary to
reach the majority of women who are not
regularly exposed to any form of mass
media.
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3.4 DEPARTMENT OF FAMILY WELFARE
AND ADMINISTRATIVE STRUCTURE
OF IEC BUREAU:
The Department of Health and Family
Welfare follows the standard
administrative structure8 with Principal
Secretary, H & FW heading, and assisted
by Secretary Health and Secretary Family
Welfare. Director FW, who happens to
have dual charge of Director IEC Bureau
also, at present, further assists Secretary
FW. These officials are assisted by
number of Additional Director, Joint
Directors, IPD Director and RCH Advisor.
These officials are assisted by number of
Dy. Directors heading each unit, such as
FP, RCH, Immunization, School Health etc
at State level, CMOs and Dy. CMOs at
district level and Medical Officer In-
charges at CHC and PHC levels and ANM
at Sub Center level. This is a standard
structure of the department, which is
followed by most states in India9.
Even though most states have an IEC cell
in the department of H & FW, Rajasthan
is among only a few states that created
IEC Bureau independently in the
Department of H & FW to give boost to
IEC activities in the State10. The Bureau
was created in 1990, and was headed by
a Director, who is a senior IAS officer. One
Additional Director who usually is a
technical person in IEC activities assists
the IEC Director. While at state level, two
Dy Directors (Field Operations and
Material Production) assisted by Assistant
Directors, press manager, exhibition
manager and publicity officer help in
planning and carrying out activities, at
district level, one publicity officer and two
assistant publicity officers manage the
activities under the direction of CMO. The
Block level activities are carried out by
Block Health Supervisor (BHS).
3.5 FAMILY WELFARE ACTIVITIES AT
STATE LEVEL:
With the population scenario remaining
grim, the state family welfare department
has been making efforts trying out many
innovative approaches in the state through
its IEC Bureau. Some of the innovative
schemes are as follows11:
q Introduction of Integrated Population
Development (IPD),
q Jan Mangal Couple Scheme,
q Village Contact Drive,
q Raj Laxmi Scheme to encourage girl
child, and
q Parivartan ki Dhara
These schemes have been quite
innovative and well thought schemes to
address the population problem. Along
with RCH, the GoR, also introduced
setting Targets based on the Community
Need Assessment (CNA) carried out in
the whole of the state. On the direction
from the GOI, the state has also initiated
National Maternal Benefit Scheme
(NMBS), Social Security scheme and
RCH program. While under Jan Mangal
Program, out of 40,000-targeted couples,
27475 couples have already been
identified and trained; the identification of
rest is in progress. The trained couples
have already been activated and they are
moving in their assigned area to provide
messages on the benefits of small family
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size, and information on different FP
methods and also distributing spacing
methods of family planning (oral pills and
condoms). The other important programs
introduced include:
q Formation of Mahila Swasthya Sanghs
in each village (6783),
q Static Centers (214) and FRUs (138),
q Training of 1178 Medical Officers in
MTP,
q Formation of Rajiv Gandhi Population
Mission, and
q Special attention to three far flung
districts with the help of UNICEF.
In the process the Bureau initiated many
a popular development oriented programs
including Parivartan ki DHara and an
imaginative program like, Parivar Mangal,
involving around 10,000 Jan Mangal
Couples12. This activity was an interactive
exercise to strengthen the knowledge of
couples on health and family welfare and
pledging them to share the information
with those around them. Similarly, other
popular programs like Rajya Laxmi
Scheme, providing insurance to the girl
child, if couple undergoes sterilization
after one or two children and Village
Contact Drives for Safe Motherhood, were
first time initiated in the state of Rajasthan.
3.6 MAJOR ACTIVITIES TAKEN UP BY THE
IEC BUREAU:
Under the IEC Bureau number of issues
related to health and family welfare
program were addressed, those include;
information provision on family planning
methods, both terminal and spacing with
special attention to NSV, child marriage,
pulse polio program, Immunization, ANC
services, Male involvement in FP,
introduction of sex and family life
education in school and college
education, Village Contact Drives for Safe
Motherhood13, Celebration of population
day, use of mass media like TV, Radio and
Newspapers to provide these messages,
bringing out Niramaya, a quarterly
magazine, for service providers and
opinion leaders, use of audio/video van
to reach for flung areas to provide
information and messages etc.
3.7 SITUATION AT DISTRICT AND LOWER
LEVELS:
The visits to the districts (Jaipur and
Alwar) and some of the PHCs revealed
that the service providers are continuing
to follow putting emphasis upon the
sterilization as they are evaluated on the
basis of sterilization achievements. Almost
none has ever heard of BCC, and they
have not received any training for years,
and mostly, were unable to state when
they had received the last training,
especially related to IEC. Non existence
of any trained senior person at block or
level in IEC (BEE does not exist any more}
has added to their apathy further. Female
sterilization remained the most favored
method for one and all. The incentives
introduced were advocated and also
rejected by different audiences. While
higher authorities' opinion was not
favorable, at district level officials and
grass root level workers still felt that it
helps promotion of sterilization among
some strata of population. The fact that it
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has been reintroduced in the name of
compensation money, speaks that the
higher authorities have similar views. The
IEC material coming to sub center is
hardly used by grass root level workers.
According to them, they hardly get any
time to motivate people for spacing
methods. Most time is spent either in
promoting cases for sterilization and rest
in pulse polio program implementation.
3.8 ROLE OF BILATERAL AGENCIES:
As mentioned several bilateral
organizations are existing in the state,
including UNFPA, UNICEF, European
Union, The World Bank and ICHAP and
helping the government implementing
family welfare and RCH program,
unfortunately most of them have been
working in isolation. Even though lately it
has been claimed that a committee has
been formed and they share each other's
efforts, in practice it was not visible. The
role of UNFPA whose presence in the
state has been now for more than 15
years, was well reflected as it had helped
the state to establish the IEC bureau. The
divided efforts by bilateral agencies seem
to have led to non-responsiveness from
service providers as well as the targeted
population.
3.9 POPULATION POLICY:
A new population policy was formulated
by the Department of Family Welfare,
GOR for Rajasthan with the help of the
Futures Group International in 199914.The
mission of the population policy is to
improve the quality of life for the people
of the state with unequivocal and explicit
emphasis on sustainable development
measures and actions. Population
stabilization and improvement of health
status of people, particularly of women
and children, are essential prerequisites
to sustainable development. Therefore,
the goal has been set to achieve
replacement level fertility by 2016 in the
state. Though it is difficult, it is essential
to attain the objective. With this in view
the rate of contraception use has to be
increased to 6 percent by the year 2016.
Among the other efforts, the goals set
under IEC strategy are to change the mind
set of the program personnel from target
oriented approach and educating the
people about the present client oriented
approach and the concept of RCH.
Further, program aspects, such as
increasing age at marriage, delaying the
first pregnancy, spacing between two
pregnancies, adoption of terminal
methods after two or more children,
women's education and awareness,
responsibility of males in reproductive
behaviour and determination to have a
small and happy family are the main points
that will be propagated through IEC.
To achieve the above, some of the
strategies suggested include; increase
and make use of radio, TV and other
electronic news media, effective use of
cinema, ensure participation of religious
ad political leaders, include subjects on
population and RCH in formal and
informal educational programs, promote
local specific IEC, improve IPC and IEC
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skills of health workers and doctors,
formulate separate plans for remote
areas, use IEC resources from other
departments, and develop decentralized
district level plans. The family and
individuals will be the main focal points
for addressing.
3.10 PIP FOR RCH-II PROGRAM:
A new Project Implementation Plan for the
RCH II is being developed by the state
family Welfare department with the help
of IIHMR, Jaipur and also involving several
bilateral agencies present in the state
including, UNFPA, European Union,
UNICEF, and ICHAP. The PIP has already
undergone various rounds of changes and
was almost ready for submission to the
government of India at the time of our state
visit. It was mentioned by the stakeholders
that BCC approach has been given
importance in the planned document15.
4.0 Issues of Concern:
After five years of functioning, however,
the FW Bureau could not keep the pace
of its kick-start, in spite of undertaking high
level of field initiatives, and producing a
stream of communication material. This
even though brought both high visibility
and priority to communication process
and sparked considerable enthusiasm in
IEC of the field level functionaries, in the
process number of shortcomings surfaced
in program implementation.
4.1 IEC BUREAU:
The IEC bureau was evaluated on four
occasions by reputed persons/
organizations16,17. The evaluations
highlighted the need for continuity of
leadership, the importance of following
scientific communication approaches,
continuing capacity building efforts, and
not to resort to material production without
sufficient research and pre-testing.
Certain recommendations on improving
scientific processes could not be
translated into practice, mainly due to
technical backup essential for that was not
available with the Bureau. With the lack
of the establishment of institutional
mechanisms such as the advisory
committee, the recommendations of these
evaluations seem not be taken seriously
by the Bureau in ensuring that they meet
the objectives set in the beginning. As
monitoring officials know that the
government systems are adjudged for
their achievements by quantity of work,
than the quality, the Bureau has been able
to do well as far as production of material
is concerned. But developing institutional
strengths and external linkages to pursue
scientific rigor, experimentations,
institutional capacity building and
improving monitoring have taken a back
seat in the functioning of the Bureau. The
equipments possessed by Bureau also
mostly became defunct which is evidently
reflected in the Annexure-III. The staff was
also not adequate, both in terms of
quantity and training, either at Bureau
level or at lower levels (Distrct/CHC/PHC/
SC) This was added by the frequent
transfer of the Bureau Director (more than
7 times during last six years) which did
not allow the Bureau to take any firm
initiatives, and implementation of
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innovative approaches. This happened
despite the fact that the Bureau had
stability of experience and funds at its
disposal from external agencies those
supported its functioning.
4.2 BILATERAL AGENCIES:
While UNFPA helped establishing the
Bureau in its initial stages and is still
supporting eight districts of Rajasthan,
The European Union is supporting the
overall Family Welfare program (RCH in
broader sense) in ten districts. The
UNICEF is another donor agency
supporting the RCH program in 3 districts.
It was mentioned by the European Union
In-charge Rajasthan that out of Rs. 20
million allocated towards IEC efforts in the
state, the state has already printed the
posters of Rs. 10 million worth and are
being distributed. Budget as such is not a
problem for the state. Besides the bilateral
agencies which have sufficient budget for
undertaking various activities, it is the
unspent budget creating problem for the
Government of Rajasthan and the
Bureau, leading to no budget allocation
for IEC activities to the state by GOI for
the year 2004-05, as it already has
unspent budget18.
4.3 BOTTLENECKS IN THE PROGRAM
IMPLEMENTATION:
Despite the efforts made by the State
Government, IEC Bureau with the
assistance from Government and in the
independent capacity, and presence of
number of active bilateral agencies, the
knowledge about family planning
methods, importance of and need for
small family size, and efforts towards
behavioral change communication
remained low, which is evident from the
existing demographic scenario of the
state. In fact, the insensitivity of the service
providers, followed by the inaccessibility
of services due to various reasons, added
to prevailing low contraception prevalence
rate in the state. As discussed earlier, the
prevalence of rigid norms and customs,
including son preference, child marriages,
high infant mortality, further added to non-
acceptance of family planning. The
Government through its initiation of many
programs like Jan mangal19, Raj Laxmi
Schemes seem to have taken many
initiatives, the sustainability of these
efforts lacked greatly because of many
factors. The Behavioral Change
Communication (BCC), has not gone
beyond the corridors of the state
Directorate and even one of the CHC In-
charge, a MS degree holder commented,
"I am hearing BCC word for the first time
in my life", where is the question of
perculating it further down.
4.4 METHOD SPECIFIC:
The available methods were not sufficient
and do not provide enough choice for the
beneficiaries, was felt by many of the
respondents, including the IEC Bureau
Chief and State FW Director. While
rejecting that male sterilization could
become one of the choice methods, some
of the respondents strongly felt that it would
not become popular because various
socio-cultural factors are associated with
it. Male involvement in the program, without
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male sterilization, however, was strongly
advocated by many, from the Director to
the DY. CMO of one of the districts.
The problem of side effects of oral pills
and IUDs were mentioned at all levels,
mainly in the absence of availability of
quality services. It was mentioned at all
level that use of condom and oral pills do
not pose any problem in terms of its use,
such as privacy for use of condom and
regular taking of pills, but non availability
of regular supply and reach of the
methods when required continued to be
the major problem. As mentioned by one
of the senior officers, "if I want to use
condom, I am not aware where from I can
get a supply, if medical store is not in the
vicinity". "The publicity of methods without
provision of adequate and quality services
at accessible points has no meaning", he
added.
While some of the respondents felt that the
available FP methods in the kitty are
adequate and one does not need to add to
new methods, most of them opined that
there was a need for increasing the number
of methods in the present government
programs. They advocated strongly for
adding Injectables, female condoms and
Norplant.
It was mentioned that more information
on each method should be made
available, regular availability of methods
should be ensured and follow-up services
should be mandatory for making the
program a success.
4.5 POLICY ISSUES AND ROLE OF
BILATERAL AGENCIES:
The officials felt that both the Center and
bilateral agencies have their own agenda
and the funds allocated clearly reflect that.
The program, especially IEC and BCC
strategies need to address the state
specific issues. The state even though get
large funds from different sources in the
absence of its own required funds, unable
to use the GOI's sanctioned funds as well
and every year a sizeable amount is
returned back, as state fails to contribute
its portion. This mainly happens because
of lack of clear strategy as well as proper
planning. The money received from
bilateral funds is mainly utilized for printing
material. The material printing does not
mean that these material /messages
through the material, have reached to the
target group. For example, half of the EU
budget for IEC activities (Rs. one crore)
has been spent on printing posters. These
posters some how reach up to grass roots,
but hardly any service provider
understands or tries to understand what
messages have been given through these
posters. All stresses the area specific
needs. As a result, bilateral agencies are
concentrating on specific districts. Even
though the agencies claimed that they
follow common programs, hardly any
coordination exists between them. Each
of them works to target their own agenda
and therefore, common interest is lost.
Similarly, the state does not seem to have
inter-sectoral coordination. As some of the
donor agencies work with different
departments, like UNICEF, working with
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women and child department along with
health and family welfare department,
some kind of coordination could be
observed. However, no specific efforts are
visible in this direction.
4.6 TRAINING NEEDS FOR THE
FUNCTIONARIES AT VARIOUS LEVELS:
After ICPD (1994)20, the GOI has started
putting more emphasis on RCH program.
The district and below level functionaries
are hardly able to differentiate between
RCH and FP program. No proper training
has been given to the functionaries on IEC
or BCC after their inception training about
20 or more years ago. In some of the
training sessions for RCH or any other
program a mention of IEC is made, but
that hardly carries any meaning. The IEC
cadre at district, block and lower levels has
become defunct, because most position
of DHIEOs, BEE and other cadre are lying
vacant for years, and therefore, the grass
root level workers are not exposed to any
new techniques by which they can
effectively inform or convince people, and
continuing to follow the age old techniques
they were taught (Annexure IV). BCC is a
new name for them and they hardly
understand its meaning. In the absence
of proper cadre they have no one to guide
them.
5.0 Recommendations:
Most of the officials including the Principal
Secretary were of the opinion that IEC
Bureau was a good concept, and should
be revived with full vigor with certain
recommendations. Some of the
recommendations include:
q The Bureau should be revamped by
providing support of Technical Experts.
The senior officials felt that it has lost
the direction and professionalism,
which should be revived.
q The frequent transfer of the Director
and staff does not allow developing
any policy, which made the Bureau
direction less.
q Lack of training to its professional staff
and planning for training at lower levels
has created a gap in understanding
between material produced and its
actual use.
q The IEC bureau should put more focus
on BCC rather than IEC activities.
q The Bureau should be given all
autonomy to plan its strategies and
functions. The activities of the Bureau,
however, should be properly and
regularly evaluated so that the
required correction could be brought
about immediately
Some of the other recommendations
include:
q Instead of producing more and more
printed material, a mix of mass media
like radio and TV, and folk media along
with print media should be used, which
still have the best reach. It was also
suggested that enough research
should go before the material is
produced. The material before sending
at different levels should be properly
explained to the service providers.
q Concentration should be on inter-
personal communication (IPC), by
arranging appropriate training at grass
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root and higher levels. Training has
been the weakest input of the program.
q Lack of proper monitoring and
evaluation system does not allow
taking of any corrective measures in
the program.
q The population policy as well new
strategy for RCH should give more
emphasis on IEC/BCC, and should not
make only a reference of it, as the IEC/
BCC would be the key for
implementation of both RCH-II
programs, direction to FP program
strategy. Even though there is a
mention of IEC in the New Population
Policy for the State (1999)21, not many
solutions have been offered as to how
the suggestions would be
implemented.
q Innovative initiatives started in
Rajasthan should be revived and taken
up strongly.
q For BCC and mass communication
other resources such as privatization
of efforts, use of civil societies (NGOs/
CBOs /PRIs etc) should be explored.
q The IEC strategy for FP should be
planned jointly by addressing other
issues such as reproductive health
and HIV/AIDS. It should not be in
isolation. Otherwise there are chances
that we may come across slogans like,
"If you have one partner, you don't
have to use Nirodh", written in bold
letters at the gate of one of the CHC,
the team visited.
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References:
1. Census of India, Provisional Population Tables, 2001, Rajasthan State, Registrar General of India, Jaipur.
2. IIPS, National Family Health Survey-II,1998-99, sponsored by Ministry of Health & Family Welfare, New Delhi, 2001.
3. Government of India, First Business Session of the Empowered Action Group (EAG) on Population Stabilization,
Ministry of H&FW, Vigyan Bhawan, New Delhi, June 2001.
4. Chatterjee, Ashoke, IEC Bureau: A Report, National Institute of Design, Ahmedabad,1993.
5. IIPS, ibid, 2001, 2.
6. IIPS, Reproductive and Child Health Project- Rapid Household Survey,1998-99, sponsored by Ministry of Health &
Family Welfare, New Delhi, 2001.
7. IIPS, ibid, 2001, 2.
8. Directorate of Medical & Health Services, Parivar Kalyan Vibhag, Pragati Prativedan, 2003-04, Government of Rajasthan,
Jaipur, 2004.
9. Mukerji, Mohan, eds., Administrative Innovations in Rajasthan, IIPA,Jaipur,1984.
10. Department of Health & Family Welfare, Programs Initiated by The Department of Health & Family Welfare, Government
of Rajasthan, Jaipur 2003.
11. Srinivasan, venkatesh, Health and Family Welfare Programs in Developing Countries, Aalekh Publishers, Jaipur, 2001.
12. Department of Medical & Health Services, Jan Mangal Margdarshan Pustika, GoR,1992.
13. Directorate of Medical and Health Services, Longitudinal Assessment of Village Contact Drive on Safe Motherhood in
Rajasthan-A Report, Indian Institute of Rural Management, Jaipur, 1991.
14. Department of Family Welfare, Population Policy of Rajasthan,1999, Government of Rajasthan, Jaipur,1999.
15. Indian Institute of Health Management Research (IIHMR), Based on personal discussions with several professionals
involved in preparing the document.
16. Government of Rajasthan, Report on Mid-Term Evaluation of the UNFPA Assisted Area Project, Jaipur, 1993.
17. Government of Rajasthan, Report of End of Project Evaluation-Area Project Phase II, Directorate of H& FW, Jaipur,
1996.
18. Government of India, Budget Allocation for IEC Activities During 2004-05, Ministry of Health and Family Welfare, New
Delhi, July,2004.
19. Department of Medical and Health Services, Evaluation of Jan Mangal Project, Marketing and Research Group, Jaipur,1996.
20. ICPD, International Conference for Population and Development, held at Cairo,1994.
21. Department of Family Welfare, ibid, 14, 1999.
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Annexure-I: Exposure to Mass Media, National Family Health Survey, 1998-98
Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to the
radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly exposed to any
of these media by selected background characteristics, Rajasthan, 1998-99
Background characteristic
Exposure to mass media
Reads a
newspaper
or magazine
at least
once a week
Watches Listens to the
television radio at least
at least once a week
once a
week
Visits the
cinema/
theatre at
least once
a month
Not
Number of
regularly women
exposed to
any media
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
10.0
30.0
19.2
14.0
32.6
18.9
13.9
31.0
17.9
12.7
28.6
15.8
13.0
31.8
16.1
9.4
26.8
13.9
9.6
27.7
13.2
4.0
62.1
609
4.1
58.4
1355
3.6
62.0
1355
3.0
64.7
1159
1.8
63.7
1013
1.4
67.8
696
0.9
67.8
628
Residence
Urban
Rural
35.2
68.3
26.4
5.1
18.0
13.7
8.0
26.9
1650
1.3
74.7
5163
Region
Western
North-Eastern
Southern
South-Eastern
Education
Illiterate
Literate, <middle school complete
Middle school complete
High school complete and above
10.8
13.6
12.5
11.8
0.0
30.2
54.4
79.3
22.9
36.3
18.5
39.1
16.5
59.5
78.3
87.5
15.2
18.2
14.6
17.4
9.8
28.7
36.1
54.0
2.2
3.2
3.8
2.7
0.7
4.6
10.0
17.4
69.3
2094
58.0
3000
73.7
890
54.5
828
78.2
5144
27.8
774
10.6
402
4.5
493
Religion
Hindu
Muslim
Jains
Others
12.3
28.7
16.6
7.5
38.2
15.1
62.3
79.2
43.9
18.4
36.3
14.7
2.8
64.5
6023
2.7
56.6
656
13.0
11.8
70
3.0
60.4
63
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
3.5
20.7
12.4
2.6
8.3
10.4
7.3
29.0
13.0
20.7
40.1
21.8
0.9
73.9
1193
1.1
83.3
844
1.8
65.9
1557
4.6
52.5
3213
Standard of living index
Low
Medium
High
Total
1.5
3.8
4.9
5.5
22.2
13.6
38.1
72.0
34.7
12.4
30.2
16.7
0.5
91.7
1492
1.5
69.7
3662
8.1
22.3
1603
2.9
63.1
6813
Note: Total includes 6 and 56 women with missing information on caste/tribe, and the standard of living index, respectively, who are not shown separately.
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Annexure II : Contacted Officials from Government and
Bilateral and Other Agencies
Government Officials:
1. Ms Rukmani Haldia, Principal Secretary, H& FW, Government of Rajasthan.
2. Mr. O P Meena, Secretary, FW, GoR.
3. Dr. R S Gathala, Director Health & Director FW Bureau, GoR.
4. Dr. D K Mangal, Officer on Special Duty, Department of H & FW, GoR.
5. Mr. Sudhir Verma, Former Principal Secretary, H & FW, GoR.
6. Dr. Kamal Pareek, In-charge, CHC, Bassi, Jaipur District.
7. Dr. O P Meena, Medical Officer, CHC, Bassi, Jaipur District.
8. Dr. B P Agarwal, Dy. CMO/ RCH Officer, Alwar District.
9. Six to Eight ANMs in Jaipur (Bassi) and Alwar (Tijara) districts.
10. Other Officials related to IEC activities in the State.
Bilateral Agencies Representatives, included:
1. Dr. Satish Kumar, Office In-charge, UNICEF, Rajasthan.
2. Dr. Girija, IEC Officer, UNICEF, Rajsthan.
3. Ms. Laxmi Bhawani, PO, Child Development & Nutrition, UNICEF, Rajasthan.
4. Mr. Hemant Dwivedi, Office In-charge, UNFPA, Rajasthan.
5. Ms. Kumkum Srivastava, Office In-charge, European Commission, Rajasthan.
6. Mr. Sanjay Awasthy, CARE-India, Rajasthan.
Institutions:
1. Dr. R S Goyal, Professor, IIHMR, Jaipur.
2. Dr. Ravi Chandran, Assistant Professor, IIHMR, Jaipur.
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Annexure III : Position of AV Equipments in the State of Rajasthan, 2002-03
Equipment
Photo Camera
Video Camera
VCR/VCP
TV Sets
Over Head Projectors
Exhibition Panel Stands
Display Boards
AV Vans
16 mm Film Projectors
Generators
Super 6mm Projectors
Slide Projectors
Tape Recorders
Complete PAE System
Source: MOH&FW, Government of India, New Delhi, 1994.
Total
8
1
64
85
10
142
54
1
64
33
12
27
67
77
Out of order
5
1
34
19
8
115
48
1
43
26
9
23
41
40
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Annexure IV
Designation
A. IEC Bureau (ALL)
B. IEC (Communication Unit- All)
Sanctioned
positions
22
7
On position
19
3
C. District Level
q Educ. & Commu. Officer
40
4
q Dy. Edu. & Comm. Officer
54
0
q Health Educator
27
14
q Projectionist
27
10
D. Block Level
q BHS (Male)
232
52
Source: Director, Rajasthan IEC Bureau, Jaipur, 2004.
Vacant positions
3 (1DD & 2 Ads)
4 (Comm. Officer, Health
Edu. Officer, Health
Educator & Tech. Officer)
36
54
13
17
180
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RAJASTHAN
Range of RCH indicators in RAJASTHAN
Indicators
Minimum
Maximum
Eligible women below age 30 years
51.1 (Ajmer)
60.6 (Churu)
Girls married at age below 18 years
29.5 (Dungarpur) 62.9 (Bundi)
Non-literate eligible women
56.6 (Ajmer)
83.3 (Jaisalmer)
Total fertility rate (TFR) (per women)
2.5 (Jhunjhunu) 4.5 (Jaisalmer)
Birth order 3 and above
39.2 (Jhunjhunu) 55.5 (Jaisalmer)
Infant mortality rate (IMR) (per 1000 live births)
43.0 (Jhunjhunu) 84.2 (Chitturgarh)
Knowledge of any modern FP methods
98.0 (Jaisalmer) 100.0 (Sikar)
Knowledge of NSV among husbands
9.4 (Barmer)
53.8 (Jhunjhunu)
Current use of any FP methods
24.5 (Barmer)
57.4 (Jhunjhunu)
Current use of modern FP methods
23.4 (Barmer)
54.1 (Jhunjhunu)
Unmet need for FP methods
15.1 (Jhunjhunu) 27.2 (Barmer)
Three of more ante-natal check-ups
16.2 (Barmer)
46.4 (Bhilwara)
Received full antenatal check-up (ANC)
0.6 (Barmer)
9.8 (Sirohi)
Safe delivery
28.6 (Jaisalmer) 57.4 (Baran)
Exclusive breastfeeding
14.8 (Baran)
40.9 (Bikaner)
Full immunization
12.3 (Jaisalmer) 36.6 (Ajmer)
Eligible women aware of RTI/STI
11.9 (Jhalawar) 84.7 (Baran)
Husbands aware of RTI/STI
24.8 (Jhalawar) 82.4 (Bharatpur)
Eligible women aware of HIV/AIDS
10.0 (Jaisalmer) 42.0 (Jhunjhunu)
Husbands aware of HIV/AIDS
45.4 (Jhalawar) 85.3 (Sikar)
Pregnancy complications
22.9 (Jhunjhunu) 42.3 (Bharatpur)
Delivery complications
10.6 (Jhunjhunu) 27.7 (Baran)
Post-delivery complications
13.7 (Jhunjhunu) 40.3 (Bharatpur)
Utilization of Govt. Health facilities for antenatal care 20.0 (Jaisalmer) 61.4 (Ajmer)
Utilization of Govt. Health facilities for postnatal care 15.9 (Jhunjhunu) 69.4 (Jaisalmer)
Note: All figures are in percentage except TFR and IMR
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CHAPTER 4.7
UTTARANCHAL
State Profile and IEC status with respect to
Family Planning Program
1.0 Background
The new state of Uttaranchal was
created on 9 November 2000, by
combining the hill districts of
Uttarkashi, Chamoli, Rudraprayag, Tehri
Garhwal, Dehradun, Garhwal, Pithorgarh,
Bageshwar, Almora, Champawat, and
Nainital along with Udham Singh Nagar
district in the Tarai region and Hardwar
district in the foothills of erstwhile Uttar
Pradesh. After 1991 Census, administrative
boundaries of six districts and seven
tehsils were affected due to the creation
of four new districts and seven new tehsils
in this part of erstwhile Uttar Pradesh.
Himachal Pradesh surrounds the new
State in the west, Uttar Pradesh in the
south, Nepal in the east, and across the
international borders, the China in the
north.The state has 13 districts, 49 tehsils,
95 blocks, and 16,414 villages. According
to the 2001 Census, the provisional
population of Uttaranchal was 8.5 million
(Census 20011). The state contributes
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0.82 percent to the total population of the
country and has the 20th rank among the
states and union territories in terms of
population size. With a total area of 53,483
square kms, the state ranks 18th in terms
of area, and its share in the total area of
India is 1.69 percent.
The population growth rate was 19.2
percent during the decade1991-2001,
which is much lower than the decadal
growth rate recorded for the state of Uttar
Pradesh (25.8 percent), as well as the
growth rate for the country as a whole
(21.3 percent) (Census 20012). The
population density of the state however,
increased from 133 in 1991 to 159 in 2001.
The population sex ratio of 964 females
per 1,000 males is notably higher than
both all-India sex ratio (933) and the Uttar
Pradesh sex ratio (898), and also
recorded much higher than the state sex
ratio in 1991 (936). The literacy rate for
the population age 7 and above in
Uttaranchal is 84 percent for males, 60
percent for females, and 72 percent for
the total population (Census of
Uttaranchal, 20013).
According to the NFHS-2 survey, 78
percent of the population of Uttaranchal
lives in rural areas. The age distribution is
typical of high fertility populations that
have recently experienced some fertility
decline, with a slightly lower proportion of
the population in the 0-4 age group (11.2)
than in the 5-9 age group (12.8) and
declining proportions thereafter.Thirty-six
percent of the population is below age 15,
and only 5 percent is age 65 and above.
The sex ratio is 1,049 females for every
1,000 males in rural areas and 1,016
females for every 1,000 males in urban
areas. This shows variation from the
observations made from Census data,
where even though relatively a high sex
ratio was recorded in population, still
males were recorded to be high in number
than females (NFHS-II, 19994).
Uttaranchal has been identified as one of
the major EAG states5. The state, even
though is far better than the other
identified EAG states, because of its
terrain it faces a daunting task in making
services accessible to its people. Also, as
the state has been bifurcated only recently
from Uttar Pradesh, most populous state
of India, it inherits some of the socio-
cultural characteristics of the parent state.
Many efforts have been made in the state,
especially during the last decade, by the
Government of India and also with the
assistance from bilateral agencies, mainly
with the assistance from the World Bank
and lately by USAID aided agencies and
European Union, to improve upon its
population scenario. Even though some
improvements are evidently taking place,
many more efforts are required to be
made.
The present chapter presents some of the
observations made by a team of
Consultants on the IEC status in the family
welfare sector (particularly on family
planning and RCH components) in the state
and its impact on the program
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implementation. The Population Foundation
of India at the behest of The MOH& FW,
Government of India, sponsored the study.
2.0 Methodology:
A team of three consultants visited each
of the eight EAG states, all together, two
members or a single member team,
depending on the needs of the state. In
the case of Uttaranchal, a three member
consultants' team visited the state during
15-17 July 2004. The consultants
prepared and followed a set of checklists
and talking points relevant to the study
and to be canvassed at different levels,
after having prolonged deliberations with
PFI officials. Some of the checklists were
also prepared for and used during
interactions with senior government
officials and other stakeholders in Delhi.
These checklists were modified suitably
after each state visit to cover more and
more issues.
During each state visit, the consultants'
tasks were broadly divided to cover three
major areas. The first was to meet with
state officials and setups, responsible for
the health and family welfare program
delivery, with maximum coverage of those
directly responsible for IEC activities in the
state. For such interaction, in Uttaranchal,
the consultants met with the Principle
Secretary (H & FW), Secretary (FW),
Director General (FW), Executive Director
(UAHSDP), Additional Director IEC, Ex-
Principal Secretary (H & FW) and other
state officials. Second, the consultants
met the partners and other players in the
field such as UN and Bilateral agencies,
international and national NGOs. Third,
the consultant visited one CHC (Dehradun
District) and one PHC (Tehri District), and
met with the frontline officials (Incharges/
MOs/Bloch HEIO) and workers (8-10
ANMs) who actually carry out the tasks.
A list of the officials/persons contacted
during our visit has been given in
Annexure Table.
3.0 Current Status of Family welfare
Program with a Focus on IEC:
According to NFHS-II, knowledge of
contraception is nearly universal: 98
percent of currently married women in
Uttaranchal, know at least one modern
family planning method. Women are
mostly familiar with female sterilization (97
percent), followed by male sterilization (92
percent), the condom (78 percent), the pill
(77 percent), and the IUD (68 percent).
More than half of women (56 percent)
have knowledge of at least one traditional
method. Yet, only 43 percent of married
women in Uttaranchal are currently using
some method of contraception (CPR),
compared with 48 percent at the national
level and 27 percent in Uttar Pradesh.
Given the near-exclusive emphasis on
sterilization, women tend to adopt family
planning only after they have achieved
their desired family size. As a result,
contraceptive use can be expected to rise
steadily with age and with thenumber of
living children. In Uttaranchal,
contraceptive use does indeed go up with
age, peaking at 65 percent for women age
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35-39 and then declining. Use also goes
up with the number of children, peaking
at 58 percent for women with three living
children. It is the highest (81 percent)
among women having three children all
of whom are sons. Son preference has a
considerable impact on contraceptive use.
Women who have one or more sons are
more likely to use contraception than are
those who have the same number of
children but have only daughters. Among
women with two living children, for
example, contraceptive use is only 22
percent if both children are daughters, 41
percent if there is one daughter and one
son, and 58 percent if both children are
sons.
3.1 REPRODUCTIVE HEALTH:
Promotion of maternal and child health
has been one of the most important
components of the Family Welfare
Programme of the Government of India.
Reproductive and Child Health surveys
conducted at district level both to
understand level of services received and
facilities existing in government health
centers, also show encouraging results.
As expected, the accessibility of services
remained as the major bottleneck in the
state, partly due to difficult terrain, and
partly because of de-motivational factors
existing in the state and through out the
country among the service providers
(RCH Households and Facility Surveys,
20026) (Refer Annexure II)
3.2 MASS MEDIA EXPOSURE:
For many years, the Government of India
has been using electronic and other mass
media to promote family planning.
Exposure to mass media is fairly good in
Uttaranchal, where 70 percent of rural
residents live in villages that are electrified
and 19 percent live in villages that have a
cable connection. Overall, 38 percent of
ever-married women listen to the radio at
least once a week and 46 percent watch
television at least once a week. Two
among every five women in Uttaranchal,
however, are not regularly exposed to
radio, television, or other types of media.
Exposure to each type of media is very
high among urban women, more-
educated women, and women from
households with a high standard of living.
Half of the ever-married women in
Uttaranchal saw or heard a family
planning message in the media during the
few months preceding the survey. In
addition to radio and television,
newspapers and magazines and wall
paintings and hoardings are important
sources of exposure to family planning
messages. As with exposure to mass
media itself, exposure to family planning
messages is much lower among rural
women, illiterate women, and women from
households with a low standard of living.
Only 13 percent of currently married
women in Uttaranchal have discussed
family planning with their husbands in the
past few months.
More than four-fifths (77 percent) of
women who use modern contraception
obtained their method/supply from a
government hospital or other source in the
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public sector. Only 10 percent obtained
their method from the private medical
sector. The private medical sector, along
with shops, is the major source of pills and
condoms, however. The private medical
sector plays a larger role in urban areas
(where it is the source of modern methods
for 21 percent of users) than in rural areas
(where it is the source of modern methods
for 6 percent of users). An important
indication of the quality of family planning
services is the information that women
receive when they obtain contraception
and the extent to which they receive
follow-up services after accepting
contraception. In Uttaranchal only 15
percent of users of modern contraceptives
who were motivated by someone to use
their method were told about any other
method. Only 25 percent of women in
Uttaranchal (as against 13 percent in Uttar
Pradesh) were told by a health or family
planning worker about possible side
effects of the method they adopted at
thetime of adopting the method. Sixty-
one percent of contraceptive users in
Uttaranchal, however, received follow-up
services after adopting their method, as
against 49 percent in Uttar Pradesh (Refer
Annexure-I).
From the information provided in NFHS-
2, a picture emerges of women marrying
around the legal age at marriage or
somewhat later, having their first child
about two years after marriage, having
one or two more children, and then
getting sterilized. The median age for
female sterilization is now 27.2 years.Very
few women use modern spacing methods
that could help them delay their first birth
or increase the interval between
pregnancies.
3.3 STAFF POSITION AND BUDGET
ALLOCATION FOR IEC ACTIVITIES:
While staff position and equipments
available with IEC division was not
available with the department, except that
of individual projects as mentioned (e.g.
UPHSD and with the Directorate headed
by one Deputy Director level Officer),
probably because the details for the
separate states (viz. UP and Uttaranchal)
have to be still curl out, the budget
allocated to the state under IEC activities
was Rs. 50 lakhs for the year 2004-057. A
Sector Reform Cell was formed in the
state in January 2004, to address the staff
and other needs on the basis of different
sectors created in the state. This attempt
has been made under the SIP program8.
3.4 HEALTH AND POPULATION POLICIES
OF UTTARANCHAL:
The Uttaranchal Health and Population
Policy was formulated during 2002 in a
participatory process and was approved
in December 20029. The Health and
Population Policy has a well defined
mission, broad policy directions and
specific policy interventions to improve
health status of the people of Uttaranchal
and to achieve population stabilization.
These are to be achieved in a time bound
frame and phased manner involving all
partners from all sectors. As the Secretary,
Medical & Health, Government of
Uttaranchal has aptly said in a message
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in the policy document - "The ultimate
purpose of the policy is to make people
understand their health needs and rights so
that they follow risk free behavior and seek
quality health care whenever required".
The policy has set targeted objectives in
terms of health and population
stabilization issues. These are:
Health Objectives
- Eradicate polio by 2005
- Reduce leprosy to below 1 per 10,000
population by 2004- Reduce mortality on
account of TB, malaria, and other vector
and water borne diseases by 50 % by
2010
- Reduce the prevalence of blindness from
around 1 to 0.3 by 2010
- Reduce Iodine Deficiency Disorder (IDD)
by 50 % by 2010
- Reduce RTIs to below 10 % among men
and women by 2007
- Increase awareness of HIV/AIDS to over
70 % by 2005
- Achieve zero level of HIV infection by
2007 and launch curative services
Population Stabilisation Objectives
- Reduce TFR from current estimated level
of 3.3 to 2.6 by 2006 and further to 2.1
by 2010
- Reduce the CBR from 26.0 in 2001 to
22.6 by 2006 and further to 19. 9 by 2010
- Increase modern contraceptive prevalence
from the present level of 40% to 49% by
2006 and to 55% by 2010
- Reduce the IMR to 28 by 2010
- Reduce the CMR to 15 by 2010
- Reduce MMR from the present level to
250 per 100000 live births by 2006 and
further to below 100 by 2010
- Increase life expectancy at birth from 63
years in 2001 to 67 years by 2006 and to
70 years by 2010
The TOR and objectives of the IEC
strategy for Uttranchal for UAHSDP
support and further the health and
population objectives of the policy of the
Uttaranchal government by promoting
desirable health practices, improving
provision and utilization of services.
3.5 IEC STRATEGY:
UPHSD along with the Directorate of
Health and Family Welfare and an agency
MCN, New Delhi has developed a
communication strategy for the state10.
Understanding well that IEC is going to a
play major role in creating demand for
family planning and other health services,
by repositioning the accessibility and
availability of services and the service
providers' image in such a way that
matches peoples' perspective and needs,
the IEC strategy planned by UAHSDP
tried to present a clear, holistic, and
(creative, cultural, gender) sensitive
perspective. It aims to include evidence
based, meticulously packaged,
information component, and a simple
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mode of communication so that the target
group can understand and use the
information easily, resulting in desired
healthy behavior practices. The strategy
necessarily focuses on four essential
elements:
q The population to be targeted for their
problems of public health and family
health.
q The health information, awareness
and behavior message content,
structure and form.
q The creation and dissemination of
culturally appropriate products and
activities.
q The facilitation of behavior change
through creation of a supportive
environment.
Each of these components needs to be
fully and accurately understood. To
achieve this goal, it would require clearly
defined project objectives, strong
organizational structure, a sound training
program and a positive attitude of those
involved in policy formulation and
implementation of the programs. With
these aims, an attempt was made to
formulate an IEC strategy by the UAHSDP
with the following objectives11:
3.6 GOALS OF IEC STRATEGY:
Based on the TOR objectives, the specific
communication goals of the IEC strategy
are as follows:
q To appropriately inform the target
population about various aspects of
concerned health programmes and
issues, facilitate them for the proper
utilization of health information and
services and to reach to all segments
of target population by using
appropriate medium of information in
different geo-cultural zones of
Uttaranchal.
q To propose evidence-based appropriate
messages, products and activities that
are culturally appropriate, gender
sensitive, creatively innovative and cost
effective.
q To provide guidelines for effective
communication media utilization for
UAHSDP in the state. This is expected
to help the target group be better
informed and helps them in
understanding the problems and
prospects of healthcare, overcome the
barriers at personal and environmental
level that in turn would help improve
the image of the system and increase
in utilisation of government health
services in the state of Uttaranchal.
q To strengthen the IEC operations in
the project area of Uttaranchal and
make it more effective. It would also
help understanding the learning
process of use of health information,
by creating a network of
communication specialists, institutions
and health functionaries for
penetrating the information and
capacities to the grassroots level.
3.7 BEHAVIOR CHANGE
COMMUNICATION FRAMEWORK:
Behavior Change Communication (BCC)
is a multi-level tool for promoting and
sustaining risk-reducing behavior change
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in individuals and communities by
distributing tailored health messages in a
variety of communication channels. Before
they can reduce their risk and vulnerability
to health problems, individuals and
communities must understand the
urgency of the epidemic. They must be
given basic facts about the health
problems, taught a set of protective skills
and offered access to appropriate
services and products. They must also
perceive their environment to be
supportive of changing or maintaining safe
behaviors.
3.7.1 THE STRATEGIC ROLE OF BEHAVIOR
CHANGE COMMUNICATION:
Effective BCC has many different, but
related roles to play in health programming:
q Increase Knowledge. BCC should
ensure that people have the basic
facts in a language, visual medium or
other media that they can understand
and relate to.
q Effective BCC should motivate
audiences to change their behavior in
a positive way.
q Stimulate Community Dialogue.
Effective BCC should encourage
community discussions on the
underlying factors. BCC should create
a demand for information and
services, and should spur action.
q Promote Advocacy. Through
advocacy, BCC can ensure that policy
makers and opinion leaders approach
the issue seriously. Advocacy takes
place at all levels.
q Reduce apathy and lethargy.
Communication on health issues
should address habits and attitudes
and attempt to influence social
responses to them.
q Promote Services. BCC can promote
service image and utilization. BCC can
also improve the quality of these
services by supporting providers
counseling skills.
BCC strategies must be based on overall
program goals and objectives. They must
move beyond individual communication
products to a careful use of many different
interventions, products and channels for
a broad community approach. The
strategy developed by UPHSDP basically
emphasizes on introduction of BCC in a
big way which was clearly reflected in their
presentation to the visiting team in the
presence of DG, H&FW, Director
UAHSDP and other officials from both DG
and UAHSDP. UAHSDP along with DG
H&FW, have divided the implementation
of strategy in two phases, Initiative-Phase-
I and Initiatives Phase-II. Under the first
phase while the baseline data has been
collected on certain indicators, six monthly
implementation plans have also been
developed and initiated. It is proposed that
after doing the content analysis, during
phase I itself, the strategy for
implementation, mainly based on BCC
strategy, will be developed and
implemented.
3.8 REGION BASED APPROACH OF UA HSDP
AND THE DIRECTORATE OF H & FW:
The Principal Secretary while agreeing
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that the present status of IEC/BCC is quite
weak, was happy to mention that under
UAHSDP many steps have already been
taken to strengthen this part of the
programme. The Secretary mentioned
that the state has been divided into three
broader areas, for both the programme
implementation and development of IEC
strategy. These were a) Snow Laden
areas, b) Hilly Areas and c) Plains. He
added that because of difficult
accessibility and different needs of people,
(including unmet need for family planning)
it is essential that throughout the state the
needs of people should be tackled
differently.
The team visited UAHSD Project office.
The Project Director and his team made
an impressive presentation of IEC
activities taken up in the state and the
progress made so far. The DG Health and
Family Welfare was also present in the
presentation. The major feature of their
presentation was as below:
q Formation of IEC Strategy based on
stakeholders analysis, field surveys,
FGDs at various levels and holding of
state and district workshops.
q Strategy to address snow-laden areas,
Hilly areas and plains in rural
Uttaranchal and Hilly areas and plains
in urban Uttaranchal.
q IEC strategy formulated to achieve
both communication at internal and
external levels and also to address the
needs of high mountains.
q For
addressing
internal
communication, the state is planning
to launch a six months campaign for
client friendly BCC through IPC, for the
service providers.
q To address external communication,
the state has planned to launch a six
months campaign to address use of
drinking water and promote use of
emergency oral pills, with main targets
not only women and children, but
community at large.
q For the purposes the required IEC
tools have already been developed.
Similarly, Video/Audio pots have been
developed and are being aired by
taking help of external advertising
agencies.
q Process of developing MIS was also
started and expected to be in place
shortly.
q With help of World Bank they have also
identified 22 most difficult and
inaccessible blocks, and different
strategies are being tried out to
address their needs by involving
NGOs at different levels.
Under the UA HSDP project, a full-fledged
section with authority to involve outside
agencies for strategy planning, material
development, printing, and using mass
media and other available media, has
been established12. It was encouraging to
note that both the Directorate and the
Project were working hand in hand in this
venture.13
3.8 ROLE OF BILATERAL AGENCIES:
State being newly formed, has both
advantages and disadvantages. Many of
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the bilateral agencies have become
interested in helping the state in resolving
its health and population related problems.
While the World Bank has extended its
assistance by formation of Uttaranchal
Health System Development (UAHSD),
right from the day the state was bifurcated
from Uttar Pradesh, other agencies such
as European Commission, PSI, and some
Coordinating Agencies of USAID such as,
The Futures Group, CEDPA, are helping
the state, both in terms of technical and
financial assistance. The local NGOs such
as PFI, New Delhi, is also helping the state
in addressing important issues such as
adolescents' health.
Population Services International has
recently started working in the state with
social marketing of its products mainly,
condom, oral pills, and water purifier pills
and receiving good response. Similarly,
the European Commission is planning to
implement SIP project in a big way and
already has established its office with
state representative and UA government
appointing OSD for the project.
especially in the difficult terrain of the
state14.
Mr. J C Pant, Ex Secretary, GOI, is running
an NGO also felt a strong need for
implementing BCC strategy using IPC as
the mindset of people towards family
planning needs to be changed. While
talking about existing bureaucratic
constraints, he too felt that focus should
be regional needs of people. On existence
of son preference, he opined that even
though as in other parts of the country
and world over, it does exist but to a lesser
extent in Uttaranchal, as women are
equally important and participating in the
economic activities. In his book,
"Uttaranchal: A Perspective", Pant has
suggested a few innovative ways,
including implementation of regional
approach by which improvement in family
planning could be achieved, especially in
a state like Uttarnchal15. Mr Pant is also
associated with Uttaranchal State Council
for Child Welfare16, which undertakes
many activities related to women and child
welfare including family planning.
3.9 ROLE OF NGOS:
There are many NGOs, which are involved
in Health System Development Project to
help project implementation, especially to
carryout various interventions, IEC and
improvement in accessibility being their
major thrust. In fact, during discussion it
was mentioned by the UAHSDP Project
Director that many existing NGOs are
being involved to undertake IEC activities
and improvement of service accessibility,
The team visited RDI at HIHT, and met
the project Director and her colleagues.
The organization is currently working on
an intervention-based project,
implementing adolescents' reproductive
health program in Dehradun district,
supported by PFI, New Delhi17. They have
formulated a communication strategy for
this project and have developed IEC
material to address the related issues.
Project has also developed a website to
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address adolescent issues. Besides the
Institute carries out number of projects for
Uttaranchal government and also works
with bilateral agencies.
3.10 SITUATION AT DISTRICT AND
LOWER LEVELS:
Meetings with the district officials and staff
of PHCs clearly indicated that the most
staff including ANMs are performing
routine jobs as and when they come and
accessibility has been a big problem for
them. The local leaders play crucial role
in influencing peoples' opinion and,
therefore, should be involved much more.
The village girls, with adequate training
as ANMs, could solve the problem of
accessibility, as one can find many
adequately literate girls, literacy being
very high in the state. It was mentioned
by most ANMs, that no training (especially,
related to IEC/BCC) has been given to
them since they have been posted on the
present position. They were mainly
emphasizing on female sterilization, as
government also measures their work by
the standard of how many women they
have motivated for the operation. They
have evolved their own ways of
convincing people for sterilization, call it
IPC or BCC, one of the ANM mentioned.
The son preference does exist, but does
not really come in the way. They mentioned
that people do come forward for NSV (male
sterilization) if motivated properly, and this
could also become equally popular method
in the state. The workers, however, need
adequate training in motivation techniques,
especially in BCC.
4.0 Issues of Concern:
4.1 IEC EVALUATION AND BOTTLENECKS:
The monitoring and evaluation cell of
Uttaranchal has not been that functional.
In the new IEC strategy this component,
as mentioned above, has however, been
added as an important component. As
suggested in the strategy, monitoring and
evaluation indicators have been drawn
mainly from programme objectives/
activities and are classified in three main
categories viz., process indicators, impact
indicators and outcome indicators. As
suggested in the strategy plan, while a
monitoring and evaluation plan for the IEC
strategy has been developed by using
data as baseline, they would carryout a
midterm and the final evaluation at the end
of the project. The IEC cell as such in the
department exists only with one officer of
Assistant Director with a few staff
reporting directly to the Director General,
Health Services. As mentioned, under UA
HSDP, however, an IEC cell has been
established, which also assists the state
Directorate in developing and
disseminating IEC related material.
4.2 STAFF SHORTAGE:
The staff shortage has been posing a
major hurdle in the program
implementation. The positions of medical
officers and ANMs are lying vacant for
years, especially, in the remote blocks. The
accessibility in the hilly areas is difficult
and no ANM is making many efforts to
cover peripheries. The steps taken by
UAHSDP probably would provide the
solution for this problem.
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4.3 NEED FOR TRAINING:
As pointed out there has been no training
for the staff for years on IEC related
issues, and the staff is unaware of BCC
altogether, refreshers' training is very
much essential for the grass root level
staff. No BEE or supervisory positions
exist in the state, which makes it further
difficult for the ANMs to learn required
skills. Even though, as pointed out,
motivating people for sterilization is not a
big issue, as over period they have
developed their own ways and skills,
motivating couples for spacing methods
has not been adopted in their day to day
functioning. This requires a strong training
component to be added into the program.
5.0 Major Observations and
Recommendations:
The secondary data review and visit to
Uttaranchal state revealed the following:
q The state, even though, has been
newly created, has much better
progressive attitude than its parent
state. With UAHSDP and support of
other bilateral agencies, the state is
trying to address its two basic issues
in terms of IEC. One, development of
new IEC/BCC strategy based on
regional needs and by fixing
measurable indicators with utilization
of available resources. Both IEC
component and the MIS were almost
missing in the state. Secondly, the
state is also trying to reach and
address the inaccessible areas, both
to improve access to health and family
welfare services and reaching the
appropriate messages to them.
q It was heartening to note that all the
agencies present, different projects
and departments are trying to
coordinate each other's efforts in the
state.
q There is a strong need for training at
all levels on communication needs and
techniques, right from Directorate to
ANM level.
q Involvement of local NGOs and
Institute has been a good step and
should be further promoted.
q ANM Training to local girls and posting
in their villages could solve the
problem of inaccessibility to large
extent. Picking up educated girls
should not be a problem with very high
literacy rate and girls being so
forthcoming.
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References:
1. Census of India, 2001, Provisional Population Totals for Uttaranchal, Registrar General, India, Government of India, New
Delhi, 2002.
2. ibid, census of India, 2001.
3. Director General of Census Operations, Population Totals of Uttaranchal State, Census of India 2001, Dehradun, 2002.
4. IIPS, National Family Health Survey-II, 1998-99, Ministry of Health and Family Welfare, Government of India, 1999.
5. Government of India, First Business Session of the Empowered Action Group (EAG) on Population Stabilization, Ministry of
Health & Family Welfare, Vigyan Bhawan, New Delhi, June 2001.
6. Ministry of H & FW, District Level RCH Households and Facility Surveys, Government of India, New Delhi, 2002.
7. Ministry of Health & Family Welfare, Budget Allocation for IEC Activities during 2004-05for the states/ UTs of India, Department
of Family Welfare, GOI, New Delhi, 2004.
8. State Program Officer (SIP), Sector Reform Cell: Uttaranchal, presented at the Workshop held during 17-18 January 2004 at
Dehradun, 2004.
9. Department of M,H&FW, Health and Population Policy of Uttaranchal, Government of Uttaranchal, Deharadun, December
2002.
10. Medical Communication Network, New Delhi, IEC Strategy: Uttaranchal Health System Development Project, UAHSDP,
Government of Uttaranchal, Dehradun, 2003.
11. Medical Communication Network, New Delhi, ibid, 9. 2003.
12. ibid, MCN, New Delhi.
13. Based on the personal discussions with the Director General and Project Director, UAHSDP and observation made.
14. UAHSDP, A personal Discussion with Project Director, UAHSDP, Dehradun, 2004.
15. Pant, J C, Uttaranchal - A perspective: Bureaucratic Constraints vs Health, Population and Development, India Literacy
Board, Literacy House, Lucknow, 2001.
16. UASCCW, Uttaranchal State Council for Child Welfare, 2003-04, State Project Office, Dehradun, 2004.
17. RDI, Training Instruments adopted from Various Sources for the Training of Adolescents in Reproductive Health, A RDI and
PFI Joint Project, RDI, Dehradun, 2002.
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Annexure-I: Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to the
radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly exposed to any
of these media by selected background characteristics, Madhya Pradesh, 1998-99
Background characteristic
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Exposure to mass media
Reads a
newspaper
or magazine
at least
once a week
Watches
television
at least
once a
week
Listens to the
radio at least
once a week
Visits the
cinema/
theatre at
least once
a month
13.4
42.8
27.8
7.7
17.4
44.1
29.6
10.2
18.8
45.2
28.2
9.4
16.8
44.2
28.5
6.9
14.6
46.0
28.5
5.2
15.3
44.1
26.1
4.4
16.1
44.8
26.6
3.5
Not
regularly
exposed to
any media
Number of
women
45.3
894
43.4
1297
44.8
1377
46.0
1167
44.9
960
47.2
707
46.1
539
Residence
Urban
Rural
37.8
79.8
37.1
9.1
32.5
25.2
15.6
15.8
1756
4.6
55.1
5186
Region
Chattisgarh
Vindhyachal
Central
Malwa Plateau
15.9
10.1
24.6
21.3
40.4
26.3
58.8
58.8
40.4
17.0
33.0
28.3
13.0
2.6
8.8
5.4
41.6
65.4
33.8
35.3
1779
1030
667
1155
Education
Illiterate
Literate, <middle school complete
Middle school complete
High school complete and above
0.0
21.9
40.7
62.7
7.0
34.7
46.9
68.1
10.6
41.6
50.2
66.9
1.4
7.5
13.4
23.4
85.9
42.6
26.3
14.0
5383
779
267
595
Religion
Hindu
Muslim
Christian
Others
10.0
4.2
24.8
7.7
17.4
13.2
23.2
13.5
21.3
14.1
40.7
9.8
4.4
4.0
12.2
1.8
71.7
78.9
57.5
82.5
5872
1038
59
55
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
4.2
2.7
7.1
23.4
9.6
4.2
14.9
34.9
13.1
10.4
18.4
37.5
2.7
82.1
1452
1.1
88.3
582
3.7
74.9
3642
9.4
50.0
1348
Standard of living index
Low
Medium
High
Total
1.3
10.2
47.6
9.3
2.5
20.3
77.8
16.8
6.2
27.6
67.2
20.3
1.2
91.8
3709
5.3
62.0
2595
17.7
12.6
712
4.4
72.7
7024
Note: Total includes 1,4, and 18 women with missing information on education, caste/tribe, and the standard of living index, who are
not shown separately.
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Annexure II: RCH Indicators:
UTTARANCHAL
Range of RCH indicators in UTTARANCHAL
Indicators
Minimum
Maximum
Eligible women below age 30 years
45.4 (Deharadun) 74.0 (Almora)
Girls married at age below 18 years
24.1 (Almora)
48.0 (Pithorgarh)
Non-literate eligible women
31.2 (Nainital)
65.5 (Uttarkashi)
Total fertility rate (TFR) (per women)
2.3 (Pithorgarh) 3.8 (Hardwar)
Birth order 3 and above
37.4 (Nainital)
66.9 (Hardwar)
Infant mortality rate (IMR) (per 1000 live births)
22.0 (Almora)
63.7 (Rudraprayag)
Knowledge of any modern FP methods
39.9 (Hardwar) 100.0 (Uttarkashi)
Knowledge of NSV among husbands
40.4 (Hardwar) 62.7 (Nainital)
Current use of any FP methods
39.9 (Hardwar) 56.1 (Pithorgarh)
Current use of modern FP methods
36.1 (Hardwar) 51.3 (Pithorgarh)
Unmet need for FP methods
13.6 (Uttarkashi) 26.4 (Hardwar)
Three of more ante-natal check-ups
15.9 (Rudraprayag) 37.6 (Nainital)
Received full antenatal check-up (ANC)
6.6 (Almora)
15.4 (Nainital)
Safe delivery
12.5 (Uttarkashi) 56.1 (Nainital)
Exclusive breastfeeding
77.8 (Pithorgarh) 84.4 (Rudraprayag)
Full immunization
22.6 (Hardwar) 70.8 (Rudraprayag)
Eligible women aware of RTI/STI
9.9 (Uttarkashi) 51.6 (Rudraprayag)
Husbands aware of RTI/STI
15.0 (Uttarkashi) 52.1 (Nainital)
Eligible women aware of HIV/AIDS
24.9 (Uttarkashi) 56.9 (Nainital)
Husbands aware of HIV/AIDS
68.5 (Uttarkashi) 86.7 (Nainital)
Pregnancy complications
15.8 (Almora)
36.4 (Deharadun)
Delivery complications
8.6 (Rudraprayag) 29.8 (Deharadun)
Post-delivery complications
14.4 (Rudraprayag) 38.3 (Deharadun)
Utilization of Govt. Health facilities for antenatal care 18.7 (Hardwar) 49.4 (Nainital)
Utilization of Govt. Health facilities for postnatal care 21.4 (Nainital)
65.4 (Rudraprayag)
Note: All figures are in percentage except TFR and IMR
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Annexure III: List of the Main Personnel Met and had Discussions with:
1. Mr. J C Pant, Ex- Secretary, Ministry of Health & Family Welfare, Government of India.
2. Mr. A K Das, Principal Secretary, Health & Family Welfare, Government of Uttaranchal.
3. Dr. U S Panwar, Additional Secretary, H& FW, GOUA.
4. Dr. Rakesh Kumar, Director, UAHSDP, GOUA.
5. Dr. Pal, Directore General Of Health Services, GOUA.
6. Dr. R P Bhatt, Joint Directoe UAHSDP.
7. Assistant Directors IEC of both DGHS and UAHSDP.
8. Dr. Anil Bhatnagar, OSD, SIP Project.
9. Dr. Devendra Verma, European Union Representive.
10. Dr. V C Ramola, CMO, Tehri Garhwal.
11. Dr. M N Dhaundhiyal, Dy. CMO, Dehradun.
12. Medical Officers and Staff ( including 6 ANMs) of Sahaspur PHC, Dehradun.
13. Medical Officers and staff (Including 8 ANMs) of Chamba PHC, Tehri Garhwal.
14. Ms. Maithali, Director Rural Development Institute and staff.
15. Staff of PSI.
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CHAPTER 4.8
ORISSA
Review of the IEC component of the
Family Welfare Programme
1. Background
Orissa is one of the poorest states
in India with per capita income
of only Rs. 3963, with about
46% of its population officially below
poverty line. The health status of the
people of Orissa according to NFHS-II and
RHS1 is also poor. The obvious
manifestation of this scenario is the poor
West Bengal in the northeast, Bihar in the
north, Madhya Pradesh in the West, and
Andhra Pradesh in the south. The capital
of Orissa is Bhubaneswar. According to
2001 Census, population of Orissa was
36.71 million with a sex ratio of 972, much
higher than the Indian average.
Urbanization in the state has been very
slow, with only 15 percent of the state’s
health indices for the state, especially in
IMR and MMR. Orissa is also prone to
natural disasters. According to NFHS-II2
the female literacy was quite low at around
40 percent.
The state of Orissa is bounded by the Bay
of Bengal in the east and by the states of
population residing in the urban areas.
Administratively Orissa has 3 revenue
divisions, 30 districts, 58 Subdivisions,
171 Tehsils, and 314 Community
Development Blocks. There are 105 Local
Bodies, 31 towns, 6235 Gram Panchayts,
and 51,124 villages. Broadly, there are
four distinct geophysical zones of Orissa.
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They are: the Northern Plateau, the
Central Tableland, the Eastern Ghat
region and the Coastal region. These
zones have to be looked at differentially
for variations in health indicators as well
as for strategic planning.
and other players in the field such as UN
and Bilateral agencies, international and
national NGOs. Third, the consultant also
visited the field and met with the frontline
officials and workers who actually carry
out the tasks.
The Census results3 of 2001 reveals that
the rank (ordered from highest value to
lowest value) of Orissa among the 35
states and Union Territories in India is 11th
in population size, 29th in decadal growth
rate, 8th in sex ratio, 22nd in population
density, 26th in literacy and 16th in percent
of urban population.
2. Methodology
A team of three consultants has visited
the EAG states sometimes together and
sometimes as a duo team and sometimes
as a single member team. In the case of
Orissa, a single member consultant team
visited the state from 26th to 31st July
2004. The consultant had prepared a set
of talking points and questions that were
relevant to the study. These set of points
were shared with PFI and were also tried
out in interactions with stakeholders in
Delhi and in other states visited prior to
visiting Orissa.
The consultant task was three fold. One,
meeting with the state machinery (people
and setup) that delivers the health and
family welfare programme, with special
focus on the IEC system. The consultant
met the Principle Secretary, Director, FW,
Director, SIHFW, Dy. Director IEC,
consultants for RCH and other officials.
Second, the consultant met the partners
3. Current Status of the Family
Welfare programme with a
focus on IEC
The state has several strengths in the
health and population field and has in
some ways successfully placed basic
system and infrastructure for Family
Welfare programme. There exists a policy
for health and population. A large number
of international and NGO partners are
also there. Apparently the funds are not a
crunch.
3.1 STATE HEALTH AND POPULATION
POLICY
The Policy and Strategic Planning Unit
(PSPU) has initiated work on policy areas
including health financing. These
involvements have led to the State health
and Family Welfare department to develop
a Vision for 20104 and to an integrated
health policy. The Orissa State integrated
Health Policy developed by the Health and
Family Welfare Department, Government
of Orissa, indicated directions for health
improvement in a state specific context as
health is a state subject under the
constitutional framework of India. It is
supposed to help articulate the vision
statement for 2010 by providing a
framework within which strategies and
operational plans are developed and
reviewed.
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The mission statement of the policy read
as follows:
The mission of the health and family
welfare department, government of
Orissa, is to facilitate improvement in the
health status of the people of Orissa with
their participation, and to make available
health care in a socially equitable,
accessible and affordable manner within
a reasonable timeframe, creating
partnerships between the public,
voluntary and private health sector and
across other development sectors.
The policy states that the SIHFW will be
developed into a high quality center for
induction and in-service training, and
integrated continuing education for
various grades of health personnel. It will
be organisationally linked to the district
centers and other health worker training
institutions. The necessary infrastructure
and staffing will be made available. Faculty
development will be encouraged through
attending conferences, seminars and
short courses and through writing
professional papers. Good performance
will be mandatory with annual reviews.
With regard to the population stabilization
efforts the policy notes the general
acceptance of the small family norm, lower
TFR, lower decadenal growth,
comparatively higher age at marriage but
also realises that the momentum of
population growth will continue due to the
young age distribution of the population.The
focus of the policy will be on providing good
quality contraceptive care and increased
access to spacing methods. Reduced
maternal and infant mortality, improved
reproductive health care for women and
men, and life skills education will receive
support. Public campaigns and professional
education against son preference and sex
education will be undertaken. Gender equity
with reproductive rights will be one of the
core thrust areas of the policy. Appropriate
steps such as training, application of
community needs assessment, treatment
of RTIs and STDs, women's health
empowerment training, male involvement,
and attention to the population growth of
primitive tribes will be taken. The state is
expected to reach replacement level of TFR
of 2.1 during 2011-2016.
Regarding health promotion, the Policy
notes that IEC activities are fragmented,
being linked to different programmes.
Health promotion will be developed in an
integrated and more professional way with
feedback loops from the community and
youth. It will shift focus from merely
communicating information towards
participatory change and empowerment.
Different groups such as school children,
youth, women, workers and farmers will
be addressed appropriately, and use of
local folk media will be encouraged. The
SIHFW will lead this function.
3.2 SIHFW/IEC BUREAU
The State Institute of Health and Family
Welfare5, Orissa is a premier institute in
the sphere of IEC, Training and Health
System research and it is situated in the
capital city of Bhubneswar. It is the only
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SIHFW in India integrating all the above
three components together. It enjoys the
status of a Directorate and Head of
Department. The Institute is a
collaborating center with Government and
has been identified as an "Institute of
Excellence" by NIHFW, New Delhi. The
institute conducts short-term courses for
planners, Programme Managers,
Researchers and health educators in
health, Hospitals and Population
Management areas. The Institute has its
own printing press with Bicolor Offset
machine. The institute has a library,
training rooms, computer center, hostel
and research staff. The Institute also
brings out a quarterly newsletter entitled
"Health and Family Welfare Bulletin" in
Oriya.
IEC PERSONNEL IN THE STATE AND DISTRICT
Existing infrastructure of IEC/BCC bureau in the state, Orissa
S. No. State Level
Sanctioned In position Vacant
1. State IEC Officer
1
1
-
2. Production Officer
1
-
1
3. Health Education Officer
2
1
1
4. Health Educator
2
2
-
5. Extension Educator
1
1
-
6. Assistant Editor
1
1
-
7. Superintendent, Offset printing press
1
1
-
8. C. A. C.P
1
-
1
9. Artist cum photographer
2
2
-
10. Projectionist cum Mechanic
1
-
1
11. Cinema Operator
1
1
-
12. A V van Driver
1
-
1
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Existing infrastructure of IEC/BCC bureau at District and Bock Level, Orissa6
S. No. District and Block level Officer Sanctioned
1 District MEM Officers
13
2 District Deputy MEM Officers
26
3 Projectionists
19
4 Artist cum Photographer
17
5 Driver
13
6 Block Extension Educators (BEE)
314
In Position Vacant
1
12
25
1
11
8
11
6
13
-
286
28
Budget for BCC for the year 2003-4 is Rs.
1.91 crores.
3.3 FAMILY WELFARE SPECIAL SCHEME IN
ORISSA
Under the family welfare programme7 the
strategy has been to motivate eligible
couples to limit family size by adopting
various family planning methods. The
programme seeks to promote responsible
parenthood with focus on small family
norm. The number of green card holders
(persons who have undergone
sterilization after two children) in the state
as on March 31 2001 was 3.54 lakh
including 0.20 lakh during 2000-01.
3.4 RCH PROGRAMME IN ORISSA
GOI-RCH phase -I programme was
launched since 1998-99 with extension
upto March 2004. The project cost was
Rs. 119.57 crores including Rs. 15 Crores
for Kalahandi Subproject. The programme
interventions included major and minor
civil works, referral transport, appointment
of additional ANMs/PHNs/SN/LT, dai
training, outreach services, RCH camps,
moped advance for ANMs, training for
medical officers and paramedical staff,
IEC activities etc.
3.5 ORISSA HEALTH AND FAMILY
WELFARE REFORM PROJECT
The phase-III of the project8 is under
implementation in the state with financial
support from Department of International
Development (DFID), UK, since 1997 with
estimated project cost of Rs. 14.55 Cr.
Under the project, medical institutions are
to be strengthened by providing medical
equipment and machines and
construction of new buildings. The project
was extended with a revised cost of Rs.
23.30 cr.
3.6 ORISSA HEALTH SYSTEM
DEVELOPMENT PROJECT (OHSDP)
The OHSDP9 had the objectives to
improve the health care delivery in
selected primary and secondary hospitals
in the state and to increase the efficiency
in the allocation and use of health
resources. The project has utilized
resources for execution of civil works,
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procurement of vehicles, supplies of
drugs, conducting health camps and
salaries of additional staff. The OHSDP
has developed a comprehensive IEC
strategy for health with the help of a
consulting firm. The principle aim of the
comprehensive strategy was to facilitate
all concerned stakeholders for behavioural
change, which promotes increased
utilization of health facilities and services.
The IEC strategy10 notes that the existing
IEC interventions are particularly
programme focused; the SWOT analysis
(see annex) clearly demonstrates the
current state of affairs.
3.7 REDUCTION IN INFANT MORTALITY
RATE (IMR MISSION)
Infant Mortality Rate is a key indicator of
the general health status of a population.
Orissa's infant mortality rate - estimated
to be 98 per thousand live births in 1998 -
is the highest among the States in the
country. The most important cause of
infant deaths is maternal malnutrition and
lack of antenatal care of mothers. For
reducing infant mortality, interventions for
improving maternal health and nutrition
are essentially required. To reduce infant
deaths, care of the newborn is also an
essential intervention.
A comprehensive Action plan is being
drawn up by the Health and Family
Welfare Department to address these
problems in order to reduce the IMR of
the State. A mechanism/strategy is
supposed to be evolved for inter-sectoral
co-ordination between the Health Workers
and the Anganwadi Workers at the field
level for effective implementation of the
programmes of health care and the special
nutrition programme. A massive
information Education and Communication
(IEC) programme for health education of
the people, particularly for women, will be
launched emphasizing the need for care
of the new-born, the importance of
immunization and the prevention and
control of infections of the infant.
3.8 KBK PROJECT
In the year 1988, a special programme,
Area Development Approach for Poverty
Termination (ADAPT), was formulated and
implemented in 15 blocks in two districts
of the State: 8 blocks in Kalahandi and 7
blocks in Koraput district. This was
undertaken in order to provide
employment round the year to the rural
poor and to change agricultural strategies.
In due course, it was felt that short-term
strategies were not appropriate to address
the multi-faceted backwardness of the
region. Therefore, a Long Term Action
Plan (LTAP) for the three undivided
districts of KBK (Koraput, Bolangir and
Kalahandi) was prepared in 1993 in
consultation with Govt. ofIndia. The LTAP
was conceptualised for a period of seven
years from 1995-96 to 2001-02 with two
objectives in view: (a) drought and distress
proofing, and (b) poverty alleviation and
development saturation. LTAP envisaged
an outlay of Rs. 4557.03 crores. However,
LTAP did not take off for want of availability
of sufficient funds.
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3.9 NGOS IN RCH IN ORISSA
Department of Family Welfare, MOHFW,
GOI, in the ninth Five year plan (1997-
2002) introduced the Mother NGO scheme
under the RCH programme. Under this
scheme11 the department has identified
and sanctioned grants to selected NGOs
called mother NGOs (MNGOs) in allocated
districts. MNGOs, in turn, sanction grants
to Field NGOs (FNGOs) in the allocated
districts. The grants were to be used for
promoting the goals and objectives as
outlined in the RCH programme of GOI.
These included- addressing the gaps in
information on RCH services in the project
area, building strong institutional capacity
at the state, district and field level, and
advocacy, awareness generation. NGOs
were also exacted to move from exclusive
awareness to actual service delivery of
RCH services.
In Orissa there are ten Mother NGOs (see
annex) each of which have been allotted
some districts for implementation of RCH
programme through the Field NGOs.
Some of these NGOs/Agencies have a
good understanding of BCC and the
capacity to undertake quality IEC/BCC
training programmes.
3.10 EXISTENCE OF RICH FOLK MEDIA
Of all the states of India, Orissa has the
largest number of tribes, as many as 62.
Altogether they constitute an impressive
23 per cent of the total population of
Orissa. These tribes mainly inhabit the
Eastern Ghat hill range which runs in the
north south direction. More than half their
population is concentrated in three
districts - Koraput, Sundergarh and
Mayurbhanj. The state has a rich tradition
of folk media, which has sometimes been
used, but not to the optimal levels.
3.11 IEC/BCC MATERIALS AND ACTIVITIES
FOR FAMILY PLANNING AND RCH
There are several agencies including
government, UN and Bilateral and NGOs
that produce IEC materials and activities.
Obviously, all government department IEC
work is handled by the IEC wing of the
SIHFW. These include posters, flip books,
pamphlets, brouchures, banners,
handbills, folders, stickers and other print
materials. They also produce audio jingles
and songs to be used in broadcast and
miking or for training purposes during
camps and other event occasions. Quality,
quantity and utilization of these materials
may be questionable but still the IEC wing
is there for the purpose. One is also not
sure whether these materials are pre-
tested for content, comprehensibility and
form. These are designed in-house and
mostly printed also in the Institute's
printing press. It is also suspect that these
material are produced as a strategic
response based on the research or
communication Needs Assessments. The
other part of IEC materials is what they
get from the IEC division from MOHFW.
These include AV spots, films, radio
prgrammes and Kalyani Health magazine
programme supported by MOHFW. The
activities include folk performance through
the Directorate of Field Publicity and Song
and Drama Division.
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The other part of the IEC materials
production is through the UN and Bilateral
agencies and projects. These include
UNFPA, UNICEF, SIP, DFID, WHO, UNDP,
and others. These agencies have also
produced large number of print as well as
AV materials. UNFPA has supported a flip
book for the NSV and other materials for
the IPD projects. Unicef has produced
large number of posters, flip book,
booklets, stickers and AV materials. Unicef
has also conducted a formative research
and formulated an IEC strategy. Similarly,
SIP has budgeted for production of spots
and films on RCH. DFID has supported a
large number of print, outdoor and AV
materials through OSACS. The OHSDP
has also produced several IEC materials
and plans to have outdoor and signages.
CARE has developed an IEC strategy
based on a formative research and has
produced several print and AV materials
including wall writing and paintings.
Similarly, several NGOs who are involved
in the RCH and FP programmes such as
FPAI, OVHA, CYSD, OSCARD, BIJAYA,
MY HEART, NIHARD have also produced
print materials and AV materials.
Apparently few other outside the
respective agency know what is produced
and used in the other agency or
department. There is no cross learning, a
lot of duplication and coordination,
standardization of messages or strategic
synergy in the IEC efforts.
3.12 IEC/BCC TRAINING FOR FAMILY
PLANNING AND RCH
The SIHFW also has a major role to play
in the training component in the Family
Welfare and RCH activities. Apparently
there has been a full scale BCC training
for all the BEEs in 2002-3 supported by
NIHFW through NIHARD12. The IEC wing
of the SIHFW does not seem to have an
institutional memory of that exercise.
Neither there seem to a learning or growth
in the concept of BCC and its different
from the IEC approach. Currently four
NGOs have been entrusted with the BCC
training13 for the Health worker (F). These
agencies are FPAI, OVHA, BIJAYA and
NIHARD. A three day curriculum and a
course agenda has been designed by
SIHFW and is being made operationalby
the NGOs. Going through the agenda and
meeting the implementing agencies
leaves one wondering as to the purpose,
and outcome of these efforts.
3.13 BUDGET AND ACTION PLAN FOR
THE IEC ACTIVITIES THROUGH
SIHFW
The IEC wing of the SIHFW had proposed
the formation of BCC bureau in the
proposed Action plan and Budget14 for the
year 2003-4 but the MOHFW did not agree
with it and asked them to revise their
Budget and Action plan accordingly. It is
obvious that the IEC wing of the SIHFW
realises that in order to do a good and
effective job they need additional human
and financial resources. The task at hand
is enormous and it cannot be done without
any powerful, professional knowledge
center.
The action plan and budget for last two
years shows the inconsistency in fund
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allocation and utlisation. The IEC outlay
for 2002-3 was Rupees 1,06,31,000/- and
the allocation for year 2003-4 was Rupees
1,91,53,000/-
Division of IEC expenditure for 2002-3
State Level activities Rs. 19,51,478/-
District and Block Level Rs. 86,79, 522/-
Grand Total
Rs.1,06, 31,000/-
The major activities or expenditure heads of the IEC outlays are as follows:
District and Block level Activity Amount (Rs.)
State Level
Amount
1. Maintenance of MSS
60,33,600.00 Release of press ads
92,727.00
2. Orientation of PRI
4,71,000.00 Printing of IEC materials
3,82, 604.00
3. Observance of World Pop Day
15,000.00 Observance of World Pop Day
10,000.00
4. Exhibition and Video shows
1,88,400.00 Publicity through AIR
96,348.00
5. Preparation and exhibition mat
1,41,000.00 Orientation workshop, seminar
3,19,063.00
6. Maintenance of AV equipment and
PAE Set
1,98,000.00 TV spot and radio jingle
1,06,000.00
7. Folk Media performance
2,82,600.00 Preparation of display board on
immunisation
2,14,656.00
8. Campaign Activity
1,85,000.00 Telecast fee through DD, OTV, ETV 2,35,934.00
9. Orientation of HW/ANM on IPC
3,14,000.00 Evaluation study on MSS and
Institutional Delivery
2,98, 599.00
10. Misc. activities and mobility expenses 8,50,922.00 Misc. and Mobility Expenses
1,95, 987.00
86,79, 522.00
19,51,478.00
As can be seen almost half of the budget
is spent on maintenance of the 5028 MSS
who are supported through the IEC
budget. How is this activity funded through
the IEC budget and what benefit or impact
one is getting out of this is very much
suspect. Looking at the budget one can
easily see that the budget is completely
out of tune with the need and the size of
the operations. It is not even token
amount.
Apparently the fund allocation and its
utilisation is guided by and designed
according to the norms, line items in the
MOHFW guidelines and one has to follow
them. There is little thought or scope for
doing any meaningful activity based on
evidence and creating nay impact. No
wonder there has been no impact studies
or even a monitoring mechanism other
than the U/C that the district sends to the
state and the state to the center. The MSS
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was the only study which had an
evaluation, because it was mandatory for
them.
causing operational constraints to the IEC
division. There is an urgent and immediate
need to look at the issue.
3.14 EVALUATION OF MSS FOR SIX
DISTRICTS
An Evaluation of MSS in six districts
Orissa15 was conducted in 2004. These
districts are Gajapati, Phulbani, Sonepur,
Balasore, Cuttack and Sambalpur. It is
relevant to remember that there are 5028
MSS in the state spread over 30 districts.
Also that over Rs. Sixty lakh is spent on
the MSS yearly, which comes out of the
IEC budget.
The study reveals the poor organization
and performance of the MSS. The
objectives with which these were set are
not realized. The focus then shifts to the
paultry money which an individual MSS
receives. The composition of the MSS and
the purpose of using this as a tool for
awareness generation and using IPC for
facilitating behaviour change is a dram
unfulfilled. Neither the awareness part nor
the change part is realised. The issue of
poor mobility and need to transportation
is highlighted. Another issue of the training
and orientation of the focus group of MSS
and their capacity to address the
members of the group is also raised. The
novelty factor and the interest factor has
been mentioned. The population is being
reached through many other means with
regard to the health issues. The MSS asa
structure and as a process does not seem
to have delivered what was expected of
it. Spending more than half of the IEC
budget on the MSS is a binding that is
3.15 DISTRICT LEVEL
The strength at district level is also in
principle there. Majority of CDMOs are in
position. Almost all BEEs in BCC were
trained in BCC by NIHARD through
NIHFW. The districts hold health camps
and exhibition regularly. At district level
there is a health committee. Some of the
districts have been exclusively served by
respective donor or UN agencies. Unicef,
UNFPA and CARE serve through BDCS,
IPD and INHP projects. Wherever there
is a donor presence (e.g. CARE or
UNICEF) the coordination is
comparatively better. Districts have
immense potential to use folk media of
the district or the region. The districts also
have a rich range of vernacular
newspapers. One big advantage the
district has is that all district covered by
ICDS thereby giving them a great
workforce and reach mechanism. The
districts also have the advantage of
MNGOs functioning in districts.
3.16 PHC/SC LEVEL
The strengths at the PHC/SC levels are
that BEEs in position (almost all positions
filled), the MSS exist (currently there are
5028 MSS in the state/one for each
village), a large number of AWW is
functional under the ICDS scheme. The
BCC training initiated for health workers
through four NGOs. The Health
department and the ICDS scheme
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coordinated to hold NHD regularly every
week/fortnight.
4. Issues and concerns
Though there are several apparent plus
points in the state as far as family wefare
programme is concerned
4.1 SPECIFIC FOCUS ON FAMILY WELFARE
IN THE POLICY IS MISSING
An Integrated health and population
policy exists but a specific focus on family
welfare issues is missing. The vision
document 2020 also does have a chapter
on reproductive health and programmes
but again it is not articulated by the state
bureaucracy but by UNFPA. Though there
is provision for having a specific
population policy in furtherance to state
Health policy the Family welfare policy is
not articulated.
This is also reflected in the weak political
commitment. The involvement of the polity
and bureaucracy in the planning, design
and monitoring of the programme is hardly
there. Bureaucracy does not accord high
priority (one secretary for three departments)
4.2 FAMILY PLANNING PROGRAMME
PERFORMANCE
The demographic profile of the state is not
very encouraging with relatively high birth
rate (24.1), high death rate (10.5) and
highest infant mortality rate (95) in the
country.With existing high death rate even
though the natural growth of population
is low, the state has high total fertility of
around 2.5. The current contraceptive use
in the state is also low with Contraception
Prevalence Rate of 40.3 percent of any
modern method. The unmet need for
family planning was high in the state with
demand for spacing methods being high
(around 8.7 percent). With media reach
being poor, lot of effort has to be made to
generate knowledge among people
through folk and inter personal contacts.
With over all low socio economic and
demographical scenarios, the state has
been included among EAG states, so that
special attention could be given for
improving the status of the state.
4.3 LOW EXPOSURE TO MASS MEDIA
In the state of Orissa, where a large
majority of women are illiterate or have
little formal education, informal channels
such as the mass media16 can play an
important role in bringing about
modernization. Table 1(annex) gives
information on women's exposure to these
forms of mass media by selected
background characteristics.
In Orissa more than half of women (56
percent) are not regularly exposed to any
of the media. Surprisingly, regular
exposure to mass media is lower among
women aged 15-19 (36%) than among
women of all other age groups (42 to
46%). Exposure varied most widely by
education and standard of living. As
expected, regular exposure to media
increased sharply with increase in
education level. The percentage of those
not regularly exposed to the media is more
than twice than the illiterate women (76%)
as compared to those in any other literacy
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category and was the lowest (5%) among
women who at least had completed their
high school. Regular exposure to media
also increased markedly with standard of
living. The percentage not regularly
exposed to any mass media was 79
percent among women belonging to low
standard of living houses, 37 percent
among women with medium standard of
living, and 3 percent among women with
a high standard of living.
About Sixty percent of rural women are
not regularly exposed to any media,
compared with only 23 percent of urban
women. The proportion of Muslim women
not regularly exposed to any media (45%)
was lower than that of Hindu women
(56%) or Christian women (65%), perhaps
because Muslim women live
disproportionately in urban areas, where
media exposure is quite high. The
percentage by caste/tribe varied quite a
bit. As high as 84 percent of scheduled
tribe women were regularly not exposed
to any media, as compared to 65 percent
of scheduled caste women, 53 percent of
women belonging to other backward
classes and only 32 percent women
belonging to other caste groups.
Among the different types of mass media,
radio and television have the greatest
reach, with exposure to radio more
common among illiterates and poor
women. Overall, one-thirds of
respondents listened to radio and 28
percent watched television at least once
in a week, compared with less than 11
percent regularly exposed to any other
single medium. The proportion of women
who watched television at least once a
week has risen sharply since the time of
NFHS-I, when it was only 16 percent. By
contrast, regular exposure to radio
declined marginally over the same period,
from 35 percent in NFHS-I to 33 percent
in NFHS-II. The cinema is not an
important source of media exposure, as
revealed by NFHS-II. Women who were
literate were much more likely to get
exposed regularly to printed media than
to cinema. Exposure to each individual
medium increased sharply with increase
in education and standard of living levels,
but varied only little by age.
Results of exposure to family planning
messages indicate that that messages
disseminated through the mass media
have reached 59 percent of ever married
women in Orissa. The most common
source of exposure to family planning
message is radio. Forty four percent of
ever married women reported having
heard a family planning message on radio,
followed by 35 percent on television, 33
percent on wall paintings or hoardings, 12
percent in Newspapers or magazines, and
7 percent each at cinema/film shows and
at drama shows and through folk media
or street shows. Therefore, although mass
media can be an important means of
spreading health and family welfare
messages, as well as exposing women
to modern views in general, innovative
programmes will be necessary to reach
the majority of women who are not regularly
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exposed to any form of mass media.
4.4 LACK OF COORDINATION AMONG
DEVELOPMENT PLAYERS
This brings us to look back and reflect on
the situation as far IEC for Family welfare
in the state is concerned. The consultant
had meetings with Director SIHFW, Dy.
Directror IEC, RCH (IEC) consultant.
Principal Secretary Health and Family
welfare and ISM, Director, Family Welfare,
Project Director OSACS, Project Director,
OHSDP, State resource Coordinator
UNFPA, programme Officer UNFPA,
Programme Communication Officer
UNICEF, State Director, SIP, Regional
Manager, CARE Orissa, State Director
FPAI, State Director OVHA, State director
OSCARD, Director, NIHARD, RCH NGO
consultant, state IEC advisor, DANTB,
CDMO, MOIC, ANM of Behrampur among
others during the state visit.
4.5 IMPORTANCE ACCORDED TO IEC
It is clear from discussions with the
government officials that because there is
an IEC wing available in SIHFW it is
sufficient and there work is done. The
Director SIHFW also holds the dual
position of Director Medical Education and
training, it is apparent that he may not be
able to spend enough time to SIHFW.
Similarly, because there is a Deputy
Director IEC, the job is done. Existence of
a structure is seen as job done.
The principle secretary also echoed
similar views as IEC is a small component
and there is a SIHFW and IEC wing that
looks after it. He holds three charges of
health, Family Welfare and ISM. He does
not have time to need to look at
components that too small ones as there
are structures and officers to look after it.
Technically he is right, but if there is a
problem with the small component he is
the boss of the system and needs to look
at it. The Director Family Welfare is very
good medical surgeon. He is bothered
about the medical aspect of the issue and
does not have the time or the need to look
into a problem, which by training or
orientation is not his domain. He can only
know or suggest what he is told. The fact
that IEC wing at SIHFW was not even part
of the group that was formulating the PIP
for RCH-II, was not known to him. Luckily
when informed he was more than willing
to take interest and get them to be an
integral part of the PIP process. The SIP
person seems to be bold and
knowledgeable person but he does not
see any purpose or for that matter any
respect for the people at IEC wing. He has
many bright ideas and would galvanise
the things but there is no coordination
mechanism or forum-a competent one that
can take the lead and provide direction.
4.6 PROBLEMS OF IEC COORDINATION
Representatives at UNFPA provide
technical support to their project of IPD17
in the old Koraput District, which is a small
geographical area in the tribal belt. There
have been attempts at bringing the people
together but the effort seemed to be too
difficult to handle with many pulls and
pressures and disinterest in the partners.
The efforts at BCC training were initiated
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but it could not go to the final end. The
channel of SIHFW and IEC wing is not
taken seriously and rightly so as they have
had not so good experiences with them.
Unicef18 has a formidable presence in the
state. They have influence, technical
expertise and resources to facilitate the
process. But they have a different focus
on Polio as well as nutrition, IMR and
MMR and also Water and sanitation. But
there operational style is very solo and
they are very much guided by the mandates
which come from headquarters. They had
a mandate to introduce the concept of MBB
in the RCH-II PIP and they were very
determined to do so. Other players and
partners have almost no idea of the concept
or the tool. They were assigned (or they took
the role) of facilitating to design the IEC for
the PIP of RCH-II. This was not in the
knowledge of any other partner. This
process as well as the scale scope and
strategy were not discussed and the revised
formats for PIP were finally made to spit
between MBB and LFA. The IEC materials
produced by Unicef are independent of the
IEC wing.
SIP19 has a plan and will be there till 2005
after which everything supposedly merges
into SCOVA and sector wide planning
process. They have plans for IEC and
budgets but it is not yet operational and
neither is it known to any other partner.
CARE has been in the state for a very
long time. They have worked with the
WCD department through their INHP
programme. They have recently
conducted a formative research and
designed several IEC materials and
activities20. But surprisingly they have not
been a part of the process, neither have
they widely shared their insight with other
than maybe unicef. They have IEC
materials which is of good quality and
pre-tested but is not shared or routed
through the IEC wing of SIHFW.
OSCAS and OHSDP project have
considerable IEC budgets, which have
quite an overlap with the RCH and Family
planning domains but there has been no
real attempts in sharing of resources, ideas
and experiences. Token IEC committees
are there and the minutes of the meetings
are also there on record to demonstrate
participation but there is no real sense of
involvement. Incidentally, OSACS who
implements the HIV/AIDS programme has
more IEC budget than the complete IEC
budget of the IEC wing of the SIHFW.
4.6 IEC IN PIP PREPARATION FOR RCH-II
The phase-II of the RCH21 is under
preparation. It would be though that this
was the right moment and opportunity for
making amends to the shortcomings of the
phase-I and draw from learning of the
phase-I and make a plan that would
provide opportunity and pace for the IEC
activities in RCH Phase-II. But that is not
the case. It is quite clear that this is a cut
and paste exercise without much thought.
Hopefully, the review and revision would
add value to it and make it meaningful.
Interestingly, the inputs for the IEC
component have not been with IEC wing
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of SIHFW but with other big players like
UNICEF, UNFPA and SIP. This process is
happening in isolation and without any
participation or consultative process.
presentation but have forgotten the real
purpose. Not all of them. There are good
and still working with a mission NGOs as
well, but few and far between.
Here is the proposed action plan for the
RCH-II as submitted by IEC wing of the
SIHFW. Obviously this will be revised and
improved upon, but it very much illustrates
the state of affairs and the importance
given to IEC.
4.8 PROBLEM OF NGOS COORDINATION
AND CAPACITY
The large scale NGO, who also work as
MNGOs22 for the RCH, have also been
working in the state for a long time, have
kind of come in a project mode and are
working for survival. NGOs like FPAI23,
OVHA24, NIAHRD, OSCARD, CYSD,
BIJAYA have a bigger role to play. But their
current capacity and orientation is getting
limited and they also lack the punch, as
they are dependent on the government
for projects. The second issue being that
none sees the common platform or
strategy of working together. Incidentally
the 10 MNGOs who support the RCH -I
have never sat together to share
experience and work together. There is
almost a blasphemous attitude of the
NGOs towards each other. The mistrust
and accusation of corruption, malpractices
and game playing is all there. It seems
that the political affiliation and bureaucratic
relationship play a bigger role. Meeting
with the NGO advisor clearly showed that
the name of the game is getting the
project. They have learnt the design and
4.9 ISSUES RELATED TO MEDIA
There is a distinct lack of Media saneness.
Apparently people are wary of media.
Media is not seen as an ally. In fact, there
have been several incidences and
instances where the media participated
in the events supported by some of the
government agencies and programmes
but the reporting has been very negative.
The general tendency is that if there is any
extrovertness in the programme the media
tends to project is as a waste of money
and charges that the CBI should
investigate it. Therefore, the programme
managers have rather started playing safe
by not touching media. Besides the
programme persons do not seem to have
training on how to handle and manage
media for their advantage. Apparently, rival
political parties own the media and they
see it as a score settling game where
nobody benefits from the power and
potential of media.
4.10 ISSUES RELATED TO MSS
The state has a large set up of the MSS.
In fact almost half of the IEC budget is
spent on maintaining the MSS. It is seen
as a burden as there is no apparent gain
from this activity. This is also borne by the
MSS evaluation. MSS is suboptimal (cost
+ evaluation report). But this could be
turned around if there is a strategy.
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4.11 TECHNICAL CAPACITY OF THE IEC
WING IS WEAK
It is a unique and good feature that the IEC
wing is associated with the SIHFW, but it is
understaffed and the technical capacity of
the wing is weak. The conceptual, technical
and monitoring capacity in the staff that
would impart the training, design material
and carry out research, is weak.This implies
relying on external agencies including
NGOs which again is problematic because
is also uneven. There is another issue of
the respect and seriousness accorded to
the IEC wing staff, as the head of the IEC
wing has risen from the ranks and is not
considered technically qualified to hold the
rank. This creates an undercurrent of either
incorporating the IEC wing in the
programme by default because one has to
take the "system" into consideration.
Otherwise the possibility of IEC being able
to give leadership is surely problematic. This
is reflected in the poor quality of IEC
material.
4.12 NO STRATEGIC DESIGN
The state suffers from a typical syndrome-
that of an activity and material production
as an end. This is because there is no
strategic design in the process. Some of the
typical problems are reflected in the way
there is no flexibility in utilization of funds
and that the inter sectoral coordination is
weak. IPC Considered important but no
Specific training on counseling and also how
to synergies the mass/folk media with IPC,
no differentiation in rural/urban and tribal
strategies, No formative or KAP research,
Monitoring and evaluation systems are not
in place, ICT being used just for experiment,
Audience segments especially tribal and
adolescents not addressed. The
implementation mechanism and human
resources is target focused from a point of
view of material produced and activities
conducted. There is no coordination
between media unit of the state, which are
utilized by the state machinery for some of
their programme outlets.
Overall, this show there has been no
strategic design in the IEC programme. It
has been a reactive and repetitive
programme that needs refurbishing.
4.13 INFLUENCERS NOT ADDRESSED
Another element in the progrmme that is
missing is that religious influence and
superstition is a barrier. There has been
no or little attempt at advocacy with
opinion leader and influencers. As the
state has an overarching religious
influence this channel may prove to be a
big boost for the programme.
4.14 LEGAL CASES ISSUE
Another issue that surfaced during the
interaction with the health personnel in the
state was that the Legal case against
doctors for failure of sterilizations under
CPA is a barrier that deters them from
performing their duties. This needs to be
looked at from two perspectives-from the
doctors' perspective as well as from the
client perspective.
4.15 MONITORING AND EVALUATION IS
VERY WEAK
Overall, there is no set mechanism for nay
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MIS in the state. There is provision for the
data analysis (computer center) but since
there is no technical capacity as well as
the data flow is missing. The need and
utility of using evidence in design, in
knowing the progress and being
accountable is missing.
4.16 DISTRICT AND FIELD LEVEL
The field scenario is also not very
promising. The CDMO and the staff25 are
busy with managing the show of providing
services. Where is the time to look at IEC.
At the PHC the health worker does not
have any new material supplied. They
have not gone through any training on IPC
or BCC. Family planning does not seem
to be high on the agenda of the field level
functionary. Though the BEEs are largely
in position, but their role is not clear and
their reach is limited.
All activities are obviously under the CDMO
and collector. It depends upon the kind of
collector a particular district has. In the
health system several key positions vacant
(refer table of staff). Another issue at the
district level is the mobility for supervisory
staff at district and PHC level, which acts
like a barrier. Availability of specific FP IEC
material is an issue. Song CD and radio
programme are not received at the district
level. NGOs under MNGOs have not met
together or shared experiences. At the
district and block and subcenter the
importance of IEC is hardly there.
5. Conclusion
Over all, the scenario in Orissa, as far as
IEC for Family welfare and RCH is
concerned, at present, seems pretty
dismal, with political interference,
bureaucratic apathy, no strategic design
based on research and evidence,
negative media, lack of mission and zeal,
lack of leadership and initiative, lack of
conceptual clarity, technical capacity, legal
cases, too many players doing their own
thing in an uncoordinated manner, and
lack of accountability in the entire setup.
It is only hoped that all the players will
pool their energy and resources and work
together for the cause.
6. Recommendations
One needs o look at providing short term
and long term possible solutions for
revamping the IEC system in the state. Some
of the actions that can be done are as follows:
(i) All vacant position at the district level
to be filled.
(ii) Institutionalize performance
assessment and accountability
mechanism linked to rewards.
(iii) Greater involvement, will and
commitment of senior officials in
reviewing IEC work.
(iv) Establish coordination and
collaboration with other departments.
(v) Establish positive media relationship.
(vi) Utilization of services for spacing
methods to be improved.
(vii) Tap the local rich folk media for IEC.
(viii) Develop specific strategy for reaching
the tribal populations.
(ix) Improve the quality of IEC products or
outsource.
(x) Greater involvement of NGOs and
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PRI in the IEC programme.
(xi) See MSS as a strength and build their
capacity and effective use.
(xii) Provide for flexibility in utlisation of
IEC funds.
(xiii) Strengthen the BCC training for
service providers.
(xiv) A coordination committee for the
development partners should be
established.
(xv) Develop an IEC strategy for family
welfare based on formative research.
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Annex: SWOT analysis conducted by OHSDP
Strength
State has large number
of government sponsored
health programmes
Diversity in approaches
in implementation and
IEC approaches
Weakness
Fragmented; linked
to different
programmes
No feedback loops
from community
Presence of NGO
interventions in health
Wide spread
government health
infrastructure
catering to large
population
Presence of Non
Governmental health
infrastructure catering
to considerable number
of population
Experiences of
successful health
promotion approaches
Availability of large
number of skilled
personnel (besides
Government ) for IEC
implementation
Minimal community
participation in IEC
planning and
implementation
Almost no coordination
between government
and non government
efforts in health
promotion
Recognition of SIHFW
as nodal agency is not
well established
Inadequate strength of
SIHFW to address IEC
activities throughout the
state
Lack of Intersectoral
approach in
implementation of IEC
of IEC synchronization
of IEC efforts
- Use of Folk media is
very limited
- Lack of uniform
standards in IEC
- Inadequate
communication skills
of health providers
Opportunity
Use of diversified
media forms
Strengthening existing
IEC strategy with
successfully field tested
approaches
Scope of intersectoral
integration
Threat
Slow/non
implementation of
sector reforms
Non acceptance of
proposed health
strategy by political
administration
Donors’ disinterest
to policy reform
Use of community based
programmes e.g. Mission
Shakti, Watershed, SHG
etc. as means for health
promotion
Involvement of NGOs/
CBOs in health
promotion
Lack of resources
to complete the
implementation of
sector reforms
process
Non-cooperation
from service
providers
Availability of increased
resources (Government
and Non Government)
for health promotion
More PRI involvement
Failure in
convergence
Lack of appropriate
monitoring mechanisms
to measure process,
output, outcome and
impact of IEC initiatives
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Annex: Proposed Action plan for RCH-II for Orissa
Particulars of IEC/BCC Activity
1. IEC activities through
Doordarshan and Cable TV
and AIR-production, telecast
and broadcast cost
2. Press advertisements
3. Observance and Days/Weeks
relating to RCH issues
4. Outdoor publicity-Hoarding and
Display boards
5. Creation and Maintenance
of BCC bureau
6. Culture shows including
local specific activities
7. AV and Print materials and
exhibition including
provision for purchase of
multimedia van
8. Population education activities
like seminars and workshops
9. Evaluation of IEC/BCC
activities
10. Lessons programme through
AIR
11. BCC activities in urban slums
12. Maintenance of existing 5028
MSS
13. Misc. activities spendings
TOTAL
Ist year
35 lakhs
Funds requirement (in Lakhs)
2nd year 3rd year 4th year 5th year
36 lakhs 36 lakhs 36 lakhs 36 lakhs
5 lakhs
2.67 lakhs
5 lakhs
3 lakhs
5 lakhs
3 lakhs
5 lakhs
3 lakhs
5 lakhs
3 lakhs
9.42 lakhs 10 lakhs 10 lakhs 10 lakhs 10 lakhs
34.92 lakhs 35 lakhs 35 lakhs 35 lakhs 35 lakhs
61.70 lakhs 62 lakhs 62 lakhs 62 lakhs 62 lakhs
52.55 lakhs 60 lakhs 60 lakhs 60 lakhs 60 lakhs
37.90 lakhs 40 lakhs 40 lakhs 40 lakhs 40 lakhs
8.70 lakhs 10 lakhs 10 lakhs 10 lakhs 10 lakhs
3 lakhs
5 lakhs
5 lakhs
5 lakhs 5 lakhs
3.10 lakhs 5 lakhs
60.34 lakhs 70 lakhs
5 lakhs
70 lakhs
5 lakhs
70 lakhs
5 lakhs
75 lakhs
85.71 lakhs 90 lakhs 90 lakhs 90 lakhs 90 lakhs
400 lakhs 430 lakhs 430 lakhs 430 lakhs 435 lakhs
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References:
1. RHS Orissa, IIPS, Mumbai 2000.
2. NFHS-II, Orissa, IIPS, Mumbai.
3. Census of India 2001, RGI, New Delhi.
4. Government of Orissa, Health and Family Welfare Department, Orissa vision- A health strategy: Orissa State Integrated
Health policy, strategies and action points, February 2003, Bhubneshwar.
5. SIHFW folder, 2003.
6. Action plan for 2003-04 for IEC division of SIHFW, Government of Orissa.
7. Government of Orissa, Health and Family Welfare Department, Orissa vision- A health strategy: Orissa State Integrated
Health policy, strategies and action points, February 2003, Bhubnehwar.
8. Government of Orissa, Health and Family Welfare Department State Action Plan-II, Sector Reform Programme 2003-2004,
Bhubneshwar.
9. OHSDP, PIP, 2000.
10. OHSDP, and Xcellence Communications, 2003.
11. Government of Orissa, NGO cell for RCH, Bhubneshwar.
12 National Institute of Applied Human Research and Development, Annual Report 2002-2003, Bhubneshwar.
13. BCC training curriculum for Health Worher, SIHFW, Bhubneshwar.
14. Action plan and budget for 2003-04 for IEC, SIHFW, Bhubneswar.
15. Evaluation of MSS in Six districts, SIHFW, 2004.
16. NFHS-II, IIPS, Mumbai and RCH DHS, IIPS, Government of Orissa.
17. IPD project for Orissa, UNFPA.
18. UNICEF, Bhubneshwar, 2004.
19. Government of Orissa, Health and Family Welfare Department State Action Plan-II, Sector Reform Programme 2003-2004,
Bhubneshwar.
20. IEC/BCC strategy for INHP in Orissa, CARE Orissa, Bhubneshwar 2004.
21. RCH-II PIP for Orissa, 2004.
22. State of Health in Orissa, OVHA, 2004.
23. FPAI, annual report, 2003, and personal interaction with the Director.
24. OVHA, state of health in Orissa, and annual report, 2003.
25. Field visit observations, Orissa, July 2004.
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Exposure to mass media
Percentage of ever-married women age 15-49 who usually read a newspaper or magazine, watch television, or listen to
the radio at least once a week, who usually visit a cinema/theatre at least once a month, or who are not regularly
exposed to any of these media by selected background characteristics, Orissa, 1998-99
Background characteristic
Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Exposure to mass media
Reads a
newspaper
or magazine
at least
once a week
Watches
television
at least
once a
week
Listens to the
radio at least
once a week
Visits the
cinema/
theatre at
least once
a month
7.5
19.6
28.6
5.6
10.7
23.3
32.8
4.8
12.3
28.4
34.4
5.1
11.1
28.3
30.5
5.7
11.1
33.8
32.6
5.4
10.0
29.2
35.4
2.8
9.4
29.2
36.7
1.8
Not Number of
regularly women
exposed to
any media
64.1
300
56.2
811
53.5
931
57.6
820
54.6
601
54.1
554
53.8
407
Residence
Urban
Rural
29.4
67.1
41.7
8.4
22.9
32.0
17.3
23.2
488
3.0
59.8
3937
Education
Illiterate
Literate, <middle school complete
Middle school complete
High school complete and above
0.0
14.2
31.1
64.7
11.6
41.7
53.8
82.8
18.9
49.8
61.1
61.6
1.2
5.3
11.3
22.9
75.8
34.0
20.2
5.3
2633
1153
305
334
Religion
Hindu
Muslim
Christians
10.6
12.5
15.4
27.6
38.6
13.0
33.0
44.0
26.0
4.5
55.8
4279
12.0
44.8
75
6.4
65.1
68
Caste/tribe
Scheduled caste
Scheduled tribe
Other backward class
Other
4.1
1.4
9.9
23.1
15.6
8.2
29.0
49.0
27.4
10.9
34.1
51.5
2.1
65.4
938
0.4
84.1
868
4.3
52.8
1371
9.8
32.0
1246
Standard of living index
Low
Medium
High
2.1
11.8
50.7
8.4
37.4
92.5
17.5
47.4
63.6
1.4
78.6
2376
4.6
37.0
1559
20.3
3.3
474
Total
10.7
27.7
33.1
4.6
55.7
4425
Note: Total includes 3 women belonging to other religion and 1 and 15 women with missing information on caste/tribe, and the standard of living index,
respectively, who are not shown separately.
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Annex:
Range of RCH indicators in ORISSA
ORISSA
Indicators
Minimum
Maximum
Eligible women below age 30 years
42.3 (Sambalpur) 58.4 (Malkangiri)
Girls married at age below 18 years
8.6 (Khordha)
49.3 (Malkangiri)
Non-literate eligible women
28.7 (Khordha) 86.4 (Malkangiri)
Total fertility rate (TFR) (per women)
2.02 (Sambalpur) 3.14 (Malkangiri)
Birth order 3 and above
34.3 (Anugul)
53.7 (Malkangiri)
Infant mortality rate (IMR) (per 1000 live births)
51.5 (Bhadrak) 103.8 (Malkangiri)
Knowledge of any modern FP methods
98.1 (Mayurbhanj) 100.0 (Ganjam)
Knowledge of NSV among husbands
15.5 (Rayagada) 39.4 (Khordha)
Current use of any FP methods
43.6 (Rayagada) 61.9 (Sambalpur)
Current use of modern FP methods
34.9 (Kandhamal) 47.4 (Sambalpur)
Unmet need for FP methods
10.4 (Malkangiri) 22.9 (Mayurbhanj)
Three of more ante-natal check-ups
25.4 (Malkangiri) 66.1 (Sambalpur)
Received full antenatal check-up (ANC)
3.8 (Jujapur)
22.6 (Sambalpur)
Safe delivery
18.1 (Malkangiri) 61.7 (Khordha)
Exclusive breastfeeding
25.7 (Baragarh) 55.9 (Anugul)
Full immunization
36.7 (Kendujhar) 74.0 (Baragarh)
Eligible women aware of RTI/STI
27.5 (Malkangiri) 75.6 (Khordha)
Husbands aware of RTI/STI
32.9 (Malkangiri) 81.5 (Khordha)
Eligible women aware of HIV/AIDS
14.2 (Malkangiri) 84.1 (Khordha)
Husbands aware of HIV/AIDS
26.3 (Malkangiri) 95.3 (Khordha)
Pregnancy complications
12.5 (Malkangiri) 50.7 (Bhadrak)
Delivery complications
27.0 (Nuapada) 61.6 (Bhadrak)
Post-delivery complications
26.1 (Khordha) 58.1 (Jajapur)
Utilization of Govt. Health facilities for antenatal care 24.9 (Malkangiri) 61.5 (Sonapur)
Utilization of Govt. Health facilities for postnatal care 38.0 (Malkangiri) 77.9 (Kendujhar)
Note: All figures are in percentage except TFR and IMR
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Annex : Persons met with during visit to Orissa from 27 July -31 July 2004
Dr. Sanjeev Kumar
Government of Orissa
Dr. P N Senapati, Principal Secretary, H & FW
Dr. Das, Director, FW
Mr. Manoranjan Misra, NGO consultant
SIHFW
Sh. BC Das SIHFW Director
Smt. Banalata Devi, IEC, SIHFW
Sh. Shishir Parida, IEC consultant, RCH
UN and Bilaterals
Dr. H D Patnaik, SIP
Ms. Biraj Sarangi –CARE
Mr. S Ramanathan, UNFPA
Ms. Rachna, UNFPA
Ms. Rachna Sharma, Unicef
NGOs
Dr. Saraswati Swain-NIAHRD
FPAI
Dr. Basudeb Panda -VHAI
Dr. Mohapatra, OSCARD
Field
Behrampur CDMO
PHC
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CHAPTER 5
BCC Strategy and Recommendations for
Family Welfare Program in the
Eight EAG States
1. Introduction and background
T he study on innovative
communication strategy for
family planning in EAG states
has validated some of the known facts
about the reasons for these states in
lagging behind in the performance of the
family welfare programme and the role
of communication in these efforts, it has
also revealed some of the new and
strategic issues that have contributed to
the suboptimal outcome. Several factors
both at design, planning and
implementation levels as well as the at
the level of understanding the audience
we work with have major gaps that need
to be addressed. The family welfare
programme is an old programme with a
lot of history and baggage. It has seen
several changes in thrust, form and
nomenclature and direction. The study
also figured that this aspect also had a
bearing on the people and the policies
that are currently at work in the
programme.
2. Methodology and Process of
the Formative Research
The research team accomplished the
tasks assigned to them for doing a
literature review, IEC material review,
interviews with key stakeholders at the
national level and state field visits and
conducted interactions with key
governmental and non governmental
stakeholders in trying to locate the
strengths and gaps in the communication
efforts for family planning. These interim
results with PFI and with other core
committee members of PFI and also held
a round table meeting with key
stakeholders. Some of the ideas and
strategic points were discussed in the
meeting. Based on these inputs and the
interaction with the PFI team, the study
has come up with strategic
recommendation for IEC/BCC for Family
Planning for the 8 EAG states.
3. Issues and Gaps: National
and EAG States
Undoubtedly there is an urgent need to
revamp the whole IEC/BCC programme
in the EAG states. As it emerged in the
discussions at the national level
interactions, the very issue of family
planning as an agenda need to be
brought back as a key and priority
agenda and communication has a big
role to play in that. Looking at the
communication for family planning from
a state perspective, on gets the feeling
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that doing “more and better” seems to be
the solution in the minds of people at all
levels in the states. The need to think and
do things “differently” does not seem to
strike. This tends to bring the issue back
to the issue of funds and manpower, which
is not completely untrue, but the core
issue of strategic communication for
behaviour change is lost.
There are several components of the BCC
strategy and they need to be understood
in the links they hold over the
comprehensive approach being proposed.
Although there are several commonalities
in these 8 EAG states there are several
distinct characteristics that call for a
specific variation in the theme for catering
more specifically to that state. It is also to
be noted that the three newly carved out
states Uttaranchal, Chattisgarh and
Jharkhand need additional inputs.
4. BCC Strategy for Family
Welfare in EAG States
Based on the study finding it emerges that
one need to answer two questions in
evolving a communication strategy for
family welfare in the EAG states.
q What are the programme inputs to
reach the behavioural results?
q What
contribution
will
communication make to help the
programme achieve these results?
This strategic communication approach
clearly tells us the distinctive role that the
communication initiatives will play and will
have to play in order to achieve the
ultimate programme objectives. This
approach to the BCC strategy also
focuses the issue on results rather than
on activities. And that is the key to the
proposed strategy. What should be the
guiding factor is the end point, the result,
the outcome. The communication strategy
has the result as a starting point and then
works backwards to locate what factors,
what action one needs to do in order to
achieve the desired result.
4.1 FROM RESULTS/OUTCOMES TO
INPUTS: BACKWARDS ACTION
The BCC strategy works in a backward
mode of coordinated actions. This
approach is in many ways challenges the
linear approach starting from objectives.
The normal approach or planning for
action planning was based on the funds
allocation as has been brought out by the
EAG states chapters mentioned earlier.
Nowhere are the outcomes defined. What
is usually defined is the production of
materials and activities. The IEC bureau/
staff at the state level is also oriented
towards the production of material,
performances, broadcast and
transmission, and “publicity” as their job.
There is an assumption that all this will
lead to the more acceptance of family
planning methods. The conception of the
linkage of the materials –more materials-
(there is no mention of research or
audience specificity), to change in
behaviour is very deep rooted.The second
part of the situation is the non defined
outcome indicators or the behavioral
actions that have different levels and types
other than service utilization. The concept
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of behavioural steps and its steps/shifts
towards action are not seen as changes.
Change is only measures in terms of
adaptors of FP methods.
Communication materials and activities
only become a mean to facilitate and
achieve them. Defining the outcome also
tells us to look for the barriers that the
audience faces and asks us to look for
benefits, positions that will becomes
messages to help them overcome those
barriers. Simply projecting a generic
benefit that fits all audience categories
does not work. Working in this strategic
mode also calls for looking at the audience
specificities much more closely. It calls for
looking at audience segments that defines
the messages strategies that will help us
to reach out to clear the block that a
particular audience faces.
This backwards planning BCC strategy
becomes evidence based. Each set of
action is guided by what and why of the
action. The specific rationale of choosing
a path is defined and one is not doing
things for general public or for awareness
generation.
The “backward planning to forward action”
strategic approach needs to seen as
results guiding the process and inputs. But
this should not been construed as a
predefined, fixed and inflexible and
topdown approach. This BCC strategic
approach basically facilitates the clarity in
communication design and also helps the
implementers at different level to focus
and have a clear idea of what he/she has
to do and how does that fit into the big
picture.
4.2 THE DIFFERENCE BETWEEN RESULTS
AND TARGETS
Let us be clear that this approach actually
Outcome
Result
- Coordinated
action
- Monitored
progress
- Measure
behavioural
change
- Build
capacity
- Link to
services
- Evidence
based strategy
- Audience
specific
messages
- Media mix
- Adequate
Funds
Objectives
Goals
also has another advantage- it clearly
defines out route and options. Because
one starts from the end points and works
backwards one know the actions as well
as the links they have to each other and
thus also becomes measurable. Another
feature in this BCC strategic approach to
Family Welfare communication is that it
does away with the concept of targets and
is absolutely different from that. Targets
actually looked at the programme goals
and thus worked on the numbers of the
outcomes. Targets forced the worker to
think in terms of numbers and not in terms
of people. Whereas results are thought in
terms of people and behaviours working
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on understanding and facilitating in
removing the barriers people face in
achieving the desired results. In fact
thinking in results terms helps the worker
to overcome the target mindset. It also
helps to get over the activities trap that
they tend to get into.
5. The BCC strategic design
components
The BCC strategy can be seen an
interlocked scheme of things tying the four
components of the strategy together.
These four components need to be
worked at simultaneously and in
synergistic action to be able to make a
dent in the outcome of the programme.
There is need to get out of the mindset of
doing activities, developing IEC materials
and believing that awareness generation
and information dissemination done better
or more will lead to the behaviour change
we are looking for. The simple approach
works only to a small extent but for a larger
part one has to understand the factors and
Strategic planning and
implementation
Audience
segmentation
Message for defined
barriers and benefits
Defined behavioural
outcomes & measure
forces that guide and decide the action a
person is going to take. The strategic
components can be represented as
follows.
It may be said that for each of the EAG
states the various components will have
different set of these components but
basically the components will remain the
same. The states will go through the
process of understanding the problems
and the situation, defining the audience
segments with specific behavioural
actions define for each of the segment and
the messages for the each segment
positioned for it to be measured at the end
of the process.
Let us look at the components a little more
closely.
5.1 STRATEGIC AND EVIDENCE BASED
PLANNING
The strategic planning aspect of the
framework says that all of the works need
to have an evidence base – formative
research, problem analysis, situation
analysis- to guide the priorities of action.
Almost none of the EAG states have ever
done a formative research to understand
the perceptions, factors and reasons or
the “why” of the non action of a behaviour.
One has over a period of time formed an
opinion that the factors such as poverty,
illiteracy, low socio economic conditions,
socio cultural or religious factors are
responsible for the non acceptance of the
family planning behaviours. Rarely has
there been an analysis of the positive
deviance cases of what people in difficult
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circumstance have accepted the
behaviours which otherwise has not found
wider acceptance. The specific situational
problems of access to the services and
its relation to the quality of services has
also been referred as a bottle neck. The
attitude of the service provider has not
been seen as problem but several other
studies have pointed out this issue as one
of the major problems. Doing a situational
problem analysis in a scientific and
systematic manner will help build further
action much more action oriented and
focused.
5.2 AUDIENCE SEGMENTATION AND
BEHAVIOURAL ACTIONS
The clear need for audience segmentation
for figuring out specificity of the message
and channel fit is a critical component.
Generic audience is no audience as has
been the case in the past, it has to be
specifically addressing the audience in the
local context. The audience focus has
generally been the married women and
men in the reproductive age. Again it has
been looked at from a point of view of the
terminal methods and not from the
spacing methods as this required
concerted and continuous action on the
part of the worker as well as the system.
The audience segmentation has to be
looked in relation to the behaviour being
promoted. This will also help determine
the core of the message content and form.
Other than the audience segmentation
what is also of core importance is
understanding the issue from the point of
view and perspective of the audience. It
has been realized because of the long
history of the programme the providers
and the communication functionary has
come to hold the beliefs and perceptions
of the audience as given and not as
something to be explored or rediscovered
time and again.
5.3 BARRIERS AND BENEFITS
It is clear that what guides peoples action
is a combination of overcoming barriers
and perceiving benefits. The basic of
communication is reducing barriers and
increasing benefits. One of the most often
neglected component of the BCC strategy
is the clear definition of the barrier the
audience is facing and again the
positioning of the message in the new way
of offering benefits. Generally this is not
even seen as part of the issue. The
problem is the people because they are
finicky, irrational and do not follow advise.
The reason for this behaviour is not
analysed or rationalized. Seeing thing
from the other’s perspective is a trait that
has not yet been internalized by the
communication fraternity. Barriers as the
people see, benefits as the people see,
is the key to the message design and IPC
actions. There are several layers and
levels of barriers one has to unearth.
Similarly there are several angles to the
positioning of the benefit. As it emerged
in the discussions in the field the benefit
slogans in the family planning programme
has been there for a long time and the
correlation to the personal benefit in the
context of the person is not realized. The
benefits have been defined in a singular
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manner over the years and need to be
broadened and repositioned.
5.4 MONITORING AND MEASURING
BEHAVIOURAL OUTCOMES
Last and most significant is the need for
defined behavioural action and the
measurement of the behavioural
outcomes. Infact this should become the
guiding mantra of the whole process of
the strategic planning and implementation.
As is clear in the state reports detailed in
the previous chapters, no state action plan
has a clear, elaborate monitoring
mechanism defined. Some UN, Bilateral
and NGO projects have defined outcomes
and monitoring and evaluation
mechanism and some also have
attempted to show change process and
measurement demonstrated. But in
general, Monitoring is not be seen a
mechanism that is out there to find faults
or catch you on the wrong foot, it is actually
a planning and results tool that helps you
to perform better. The monitoring is linked
to the backward action approach and it
actually guides you to the corrective and
remedial action.
There is another aspect to the monitoring
and measuring behavioural outcomes.
Because there are several players and
projects in the same states and district it
becomes difficult to work out the
contribution, if any, towards the change
in the effort. If one starts with monitoring/
outcome indicators it is possible to ask
for the various players in the field to
commit the contribution in term of the
outcome (no necessarily in terms of the
funds). This in away holds all the partners
accountable and work together. As has
been shown in the state reports that there
has been accountable coordination
mechanism in terms of the outputs. This
forces the partners to think beyond
“physical or meeting” classified as
partnership would have to become
realistic and transparent. A strong and
clearly defined monitoring and evaluation
plan linked to the objectives would ago a
long way in moving towards tangible
results.
5.5 PUTTING IT ALL TOGETHER
It would be imperative to have these four
elements working in tandem along with
an advocacy approach which resets the
agenda for family planning in a focused
manner. The four elements of the strategy
have to be understood in the major and
sub elements and also in the elements
that create and environment for it happen.
Again these have to be localized and
customized the specific state and district
situation. This variation and differentiation
will also be moderated for the urban, rural
and tribal sections of the population. As
these elements of the BCC strategy are
interlinked and also partially dependent
on the participation of all the players, it
will need to be operationalised ina
participatory manner.
6. Recommendations for steps
For a state or even at national level it would
require steps to operaionalise the
backward action approach. This approach
asks for specific outcome and behavioral
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actions to be defined for the audience
segment as well as the provider. See
annex for the specific actions to be
performed to overcome specific barriers.
Based on the backward planning action
approach the recommendations in the
strategy can be broadly categorized in four
focus issues. These are
1. Locating behavioural actions at
different levels of indicators
Behaviours
Indicators
2. Defining specific audience to work with
Adolescents
Couples (newly married, with one
child, with two children, with more)
Men
Influencers (MIL, religious)
Health service providers
3. Understanding barriers at different
levels and positioning benefits/payoffs
Different types and levels
4. Levels of planning and implementation
structures/processes for IEC/BCC
State
District
Block
Villages
Any plan at the state, district or block level
will have to keep the four elements clearly
defined and articulated. According to the
backward planning approach one will have
to define the behaviours and indicators
for the different audience segments and
define the barriers they face and therefore
define and design messages with specific
benefits from the perspective of the those
specific audiences.
7. Benefit/Payoff for the FW
programme
As has been brought out by the state visit
report and the stakeholders interview in
the previous chapters, the payoff or the
benefits that has been projected over the
years for the FP programme has run out
of steam. The benefit is usually the driver
of the programme. It is clear that the chota
parivar, sukhi parivar and its may
variations have stopped being effective.
There is need to overall work at the
benefits offered by the family welfare
programme. The benefit statement of the
programme has run into a fatigue mode
and does not seem relevant to the different
set of situation and conditions of the
audience segments. Besides it has no
longer even projected with other elements
like the sex ratio, the PNDT act and of
course the HIV taking its toll on the FP
issue. The benefit has to stand out and
should have the possibilities of getting into
various moulds according to the needs of
the audience and the situations. It needs
to get:
q Personal
q Seen and believable advantage
q Beyond happy and healthy
q Beyond economic and national
q Branding/identity
q Rights perspective
q Felt need instead of unmet need
q Quality Assurance
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There are several takes o this but none
that has found great and sustaining
appeal and lasting value. There has to an
agreement among stakeholders as well
on the basic benefit one wants to projects.
media plan, capacity building, partnership
does not take into consideration that
possibility of the synergised action to build
the crescendo that will ultimately lead to
the behavioral action.
8. Coordinated chain of action(s)
Another set of programatic set is the
coordination and synergy in the set of
actions and activities that the programme
may need to take up. As of now the set of
activities are uncoordinated or there is a
heavy skew in favour of the materials
being produced as they are visible and
also help spend the funds. The
uncoordinated action do not produce the
resonance and the results are defocused.
The actions have to be coordinated with
a media plan. The types of actions that
need to be coordinated are as follows:
q Strategy action
q Social mobilisation action
q Individual behavioural action
q Community action
q IPC action
q Capacity building action
q Intersectoral action
q Advocacy action
q Resource action
q Follow up action
q Monitoring action
These actions have to be reflected in the
choice of media selection and the mix of
media that is employed to reach out to
the audiences. What usually happens is
that a limited set of action takes place and
that too in a spurted way. There is hardly
any correlation to the other activity. The
9. Beyond activities and
materials-Advocacy
It has been pointed out in the interviews
with the stakeholders and also in the state
field visits, that the issue or the agenda of
population and family welfare has not
been in an aggressive public domain or
priority of the policy makers. It has, so to
say, lost being visible and important. This
suggests factors one has to keep in mind
is the other environmental factors that
needs to be worked at. These are
influencers that have a big impact on the
decision making and outcome. A
concerted action a community advocacy
and political advocacy needs to be worked
at. These sets of audience and institutions
will be useful.
q Parents
q Religious leaders
q Teachers
q Service providers
q Elected representatives
q Media
q Private health sector
q Corporate sector
Media advocacy seeks to influence the
selection of topics by the mass media
and shape the debate about these topics.
Media advocacy’s purpose is to
contribute to the development and
implementation of social and policy
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initiatives that promote health and well-
being and are based on principles of
social justice. Media advocacy is about
strategic and innovative use of mass
media to promote public health through
the family welfare programme. Media
advocacy can provide the basis for
enhanced community participation in the
process. One of the key goals of media
advocacy is to advance the population
policy that was formulated almost four
years ago but no longer is in the news.
The digressing or even conflicting issues
such as two child norm have taken media
space. Getting the media attention or
being visible is sometimes the easy part
of the job. The difficult part occurs when
you have to frame your issue and solution
in the media for the people you want to
reach. The red triangle is no longer
memorable, the population policy as a
vibrant document is lost. Similarly the
commitment of the polity and
bureaucracy on the population
development agenda is lost.
A large part of the success of the family
welfare programme rests on the
advocacy with influencers, opinion
makers and stakeholders. Involvement of
elected representatives has been token,
involvement of the religious leaders has
been neglected, involvement of private
health sector has been isolated and
involvement of the community and family
influencers has been at best sporadic.
This calls for a sustained and systematic
advocacy plan for getting the family
welfare agenda its due space and
importance. Any reporting of event and
activity is not advocacy. Any meeting with
a higher up is not advocacy. Any media
input is not to be considered advocacy.
Advocacy has to be redefined and looked
into much more carefully and closely.
10. Recommendations
The BCC strategy for family welfare for
the EAG states presented in the previous
pages outlines the key strategic thrust and
components that needs to be worked at.
In these recommendations are presented
two key management and policy issues
that relate to the fundamentals of the
issues related to the communication
functions.
q One, is the goals and guiding
principles of the programme that
redefines the jobs of the IEC
divisions and persons. This shifts
the focus of the operations and
thereby the construction of the IEC
efforts.
Goal 1. Fifty percent of all the method
acceptors must be of spacing
methods.
Goal 2. Fifty percent of all terminal
methods acceptors must be of
parity 2.
Goal 3. Fifty percent of all IEC budget
must be earmarked for IPC
activities.
Goal 4. Fifty percent of all the IEC efforts
should be directed to the
adolescents.
Goal 5. Fifty percent of all FP acceptors
should be men
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This set of goals needs to get translated
in to corresponding action plans and
activities. This will require a change in
mindset of policy, managers and field
functionaries.
q Second set of recommendations is
largely related to the management
of the IEC/BCC functions at the
national and state level.
Principle 1. Delink the IEC division as a
PR/Publicity division; it is a
professional programme
communication division
Principle 2. Coordinate IEC action at
regional/district level through a
coordinating corporartised
agency and manpower
Principle 3. Corporate/professional sector
need to be engaged for the
IEC/BCC management which
in turn builds capacity of the
government and NGO sectors.
Principle 4. IEC needs to become
accountable beyond Utilisation
certificates (U/C). Instead of
utilization certificates one
should produce change
certifications. This could take
the form of an independent
impact assessment.
Principle 5. IEC budgets should be
increased for specific outputs
like formative research and
monitoring and evaluations.
Principle 6. All the players in an area/
district need to work together
and be accountable on a
quarterly basis.
Principle 7. IEC work needs regular single
charge professional heading it
and wit well paid professional
trained staff.
11. Conclusion
The BCC strategy for family welfare in the
eight EAG states presented above calls
for some fundamental change sin
mindset, approach, manpower,
accountability, results orientation and
budgets. The research (literature review,
interviews with national and state levels
stakeholders and the state field visits) has
highlighted current state of affairs,
strengths and the gaps and opportunities.
The research team along with the PFI
team has worked on the BCC strategy.
The strategy proposes a backward
planning and action model. It also
suggests key components of the strategy.
Finally the strategy has suggested some
key recommendations and principles that
can accelerate the nature, pace and
outcome of communication initiatives for
the family welfare programme in the EAG
states and of course at the national level.
A further action plan to operationalise and
contextualise these findings and proposed
strategies would be needed. Along with
strategy, components and principles we
need to keep in mind the following:
q BCC/IEC needs to get its due
importance and be recognised for
what change it can trigger provide
stimuli for action.
q BCC/IEC need to evolve evidence
based strategic, audience segment
specific, time bound, result oriented
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plans that have clear outputs, clear
monitoring mechanisms
q Specific BCC/IEC capacity building,
training with learning and use of
learning defined in terms of outputs
and measurable indicators.
q Finally we need to be proactive beyond
World Population Day, events like
ICPD, developing Population polices,
answering parliamentary questions on
population and development, and
installing population clocks.
The time to reposition and reactivate the
population agenda is urgently needed.
The role and strategy for communication
needs to be taken up seriously and
urgently in the wake of RCH-II getting to
take off in the current year.
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CHAPTER 6
BIHAR
State Specific BCC Strategic Recommendations
The population scenario is quite grim in
the state. With no IEC bureau, and very
few staff to undertake various IEC related
activities, the IEC situation is equally poor.
Some of the general observations made
on these aspects, suggest the following
for improving the present status of family
planning program in general and IEC in
particular, in the state;
q With the existing scenario, all out
efforts are required to address the
issues. Both the government and other
organizations including NGOs/
Agencies present in the state have to
work in hand in hand under SCOVA,
the presence of which should be
utilized as an opportunity.
q SCOVA could be given mandate to
bring more coordination among
different agencies and even
possibilities of involving private sector
should be explored.
q Under RCH program and with
available unspent money, dedicated
and trained IEC personnel with
adequate power, who can take
initiatives, should be appointed.
q A functional IEC bureau, with vacant
positions filled up at all levels would
help create an atmosphere and
generate interest of stakeholders.
q Training has been almost missing from
the scene, which should be revived,
and efforts should be made to influx
BCC in to system, with repeated
reorientations at all levels, especially
at grass roots. Refreshers training for
both supervisory staff and grass root
level workers should become part of
the system
q There have been suggestions from
different functionaries to involve local
political leaders, influencers, PRIs,
inter departmental personnel on one
hand, and local level available
resources such as, youths, chokidars,
teachers, barbers etc to generate
awareness among the target groups.
Their repetitive orientation should
become an essential part of the
bureaus functioning
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RAJASTHAN
State Specific BCC Strategic Recommendations
Most of the officials including the Principal
Secretary were of the opinion that IEC
Bureau was a good concept, and should
be revived with full vigor with certain
recommendations. Some of the
recommendations include:
q The Bureau should be revamped by
providing support of Technical Experts.
The senior officials felt that it has lost
the direction and professionalism,
which should be revived.
q The frequent transfer of the Director
and staff does not allow developing
any policy, which made the Bureau
direction lees.
q Lack of training to its professional staff
and planning for training at lower levels
has created a gap in understanding
between material produced and its
actual use.
q The IEC bureau should put more focus
on BCC rather than IEC activities.
q The Bureau should be given all
autonomy to plan its strategies and
functions. The activities of the Bureau
however should be properly and
regularly evaluated so that the
required correction could be brought
about immediately
q Instead of producing more and more
printed material, a mix of mass media
like radio and TV, and folk media along
with print media should be used, which
still have the best reach. It was also
suggested that enough research
should go before the material is
produced. The material before sending
at different levels should be properly
explained to the service providers.
q Concentration should be on inter-
personal communication (IPC), by
arranging appropriate training at grass
root and higher levels. Training has
been the weakest input of the program.
q Lack of proper monitoring and
evaluation system does not allow
taking any corrective measures in the
program.
q The population policy as well new
strategy for RCH should give more
emphasis on IEC/BCC, and should not
make only a reference of it, as the IEC/
BCC would be the key for
implementation of both RCH-II
programs, direction to FP program
strategy. Even though there is a
mention of IEC in the New Population
Policy for the State (1999), not much
solutions have been offered as how the
suggestions would be implemented.
q Innovative initiatives started in
Rajasthan should be revived and taken
up strongly.
q For BCC and mass communication
other resources such as privatization
of efforts, use of civil societies (NGOs/
CBOs /PRIs etc) should be explored.
q The IEC strategy for FP should be
planned jointly by addressing other
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issues such as reproductive health
and HIV/AIDS. It should not be in
isolation. Other wise there are chances
that we may come across slogans like,
“If you are having one partner, you
don’t have to use Nirodh”, written in
bold letters at the gate of one of the
CHC, the team visited.
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JHARKHAND
State Specific BCC Strategic Recommendations
Some of the issues of concerns, which
need immediate attention of government,
and recommendations, are as follows:
q State lacks proper administrative
structure. Most positions from top (E.G.
Director General to Bottom (IEC
Officer) at the state level are vacant. It
is very difficult to coordinate efforts by
single authority, which is presently
being done. Therefore, a proper
administrative structure should be
created as soon as possible.
q Although it is claimed that coordination
among different partner agencies
exists, no such co-ordination is visibly
seen. Therefore, IEC Bureau should
be established to coordinate the efforts
between different agencies.
q The decisions of implementing
programs are some times taken
arbitrarily and lots of funding by donor
agencies on some ambitious programs
is being wasted. The impact
assessment of big programs should be
first taken up on pilot basis, and then
only state level program should be
planned (e.g., One time touch and go
approach during village drives,
introduction of Sahayas at large scale
etc.).
q Different policies are formulated
without taking the state specific needs
in to consideration. Addressing issues,
which are more relevant for the state
or area, should get priority.
q The corporate sector is willing to invest
in social sector. They need to be taped
properly. There is large number of
corporate sector players which could
be brought in for implementation of
program.
q No monitoring & evaluation cell exists.
Attempts should be made to establish
a proper and strong M&E cell, probably
under IEC Bureau.
q Training at grass roots in IEC/BCC
should be taken up.
q State has about 27 percent tribal
population, which has different needs.
Their requirements should be kept in
mind while formulating the IEC
strategy, which is urgently required. No
formal IEC strategy exists at present.
q While formulating IEC strategy, some
related programs could be addressed
simultaneously.
q There is a need to develop
coordination between different players
working in the state to avoid
duplication of efforts. As suggested,
corporate sector could be brought in
to picture in a big way to help the
government, as willingness among
them is evidently present.
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UTTAR PRADESH
State Specific BCC Strategic Recommendations
Some of the major findings and
recommendations on the basis of the
observations made during Uttar Pradesh
IEC review and state visits are as follows:
q The state IEC bureau, which at
present is almost defunct, should be
revitalized with a full time Director with
independent charge, and assisted by
trained technical staff. The printing
press which has been placed some
where in the department should also
be moved to the same campus with
full control of IEC bureau. Similarly,
MMRC, which was opened with lots
of fun fare should be re-looked and
merged with IEC bureau to use its
positive aspects.
q All the organizations, including State
Directorate, SIFPSA, UPHSDP and
UPSACS should plan their activities
with coordination from IEC bureau, so
that efforts are not duplicated and also
more than one issue can be addressed
in one go. The condom promotion
efforts through Government machinery,
Social marketing program, SIFPSA and
UPSACS could be the best example,
where the expenditure on access,
availability, issues to be addressed, and
target groups could be saved.
q Advocacy efforts at all level, from state
to district to grass roots level are
required to influence political leaders,
religious leaders, opinion leaders and
other influential to promote family
planning cause and small family size
norm.
q Regional approach, more of grass root
level should be adopted in formulating
IEC strategy, addressing people locally
in the language they understand and
with simplicity. As also suggested in
new PIP for RCH program, Folk media
and IPCs should be given at most
preference. Other electronic and wall
writing, bus panels etc should continue
to be used.
q At grass root level reorientation of
ANMs in BCC and there after
refreshers training should be taken
with utmost urgency. At block level
revival of BEE cadre with good skill
training should be considered.
q For preparation of IEC material local
needs and language should be kept
in mind.
q Different strategies could be
developed for addressing different
sections of people and by involving the
possible influential.
q Addressing youths, and involving
males in family program efforts should
be given importance.
q As far possible other departments,
private sector, corporate sector and
NGOs should be involved to address
the family planning issue.
q ISM and local health practitioners
should be involved to become
messengers and also depot holders.
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UTTARANCHAL
State Specific BCC Strategic Recommendations
The secondary data review and visit to
Uttaranchal state revealed the following:
q The state, even though has been
newly created has much better
progressive attitude than its parent
state. With UAHSDP and support of
other bilateral agencies the state is
trying to address its two basic issues
in terms of IEC. One development of
new IEC/BCC strategy based on
regional needs, by fixing measurable
indicators with utilization of available
resources. Both IEC component and
the MIS were almost missing in the
state. Secondly, the state is also trying
to reach and address the inaccessible
areas, both to improve access to
health and family welfare services and
reaching the appropriate messages to
them.
q State had learned some of the
strategies by sending its teams to
other states like visiting IEC Bureau
of Rajasthan.
q It was heartening to note that all the
bilateral agencies present in the state,
different projects and departments are
trying to coordinate each other’s efforts
in the state.
q There is a strong need for training at
all levels on communication needs and
techniques right from Directorate to
ANM level. The knowledge of BCC and
IPC techniques need to be developed
among functionaries at all levels.
Besides time-to-time refreshers
training should be given importance in
the new strategy planned.
q Involvement of local NGOs and
Institutes has been a good step and
should be further promoted.
q ANM Training to local girls and posting
them in their villages could solve the
problem of inaccessibility to large
extent. Picking up educated girls
should not be a problem with very high
literacy rate and girls being so
forthcoming.
q Innovative schemes, as being tried out
by UAHSD by involving NGOs at
various level could be a guideline for
inaccessible state like Uttaranchal in
future.
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ORISSA
State Specific BCC Strategic Recommendations
The scenario in Orissa as far as IEC for
Family welfare and RCH is concerned at
present seen pretty dismal with political
interference, bureaucratic apathy, no
strategic design based on research and
evidence, negative media, lack of mission
and zeal, lack of leadership and initiative,
lack of conceptual clarity, technical
capacity, legal cases, too many players
doing their own thing in an uncoordinated
manner, and lack of accountability in the
entire setup. It is only hoped that all the
players will pool their energy and
resources and work together for the
cause.
Recommendations
One needs o look at providing short term
and long term possible solutions for
revamping the IEC system in the state.
Some of the actions that can be done are
as follows:
(i) All vacant position at the district level
to be filled
(ii) Institutionalize perform assessment
and accountability mechanism
linked to rewards
(iii) Greater involvement, will and
commitment of senior officials in
reviewing IEC work
(iv) Establish coordination and
collaboration with other departments
(v) Establish positive media relationship
(vi) Utilization of services for spacing
methods to be improved
(vii) Tap the local rich folk media for IEC
(viii) Develop specific strategy for
reaching the tribal populations
(ix) Improve the quality of IEC products
or outsource
(x) Greater involvement of NGOs and
PRI in the IEC programme
(xi) See MSS as a strengthen and build
their capacity and effective use
(xii) Provide for flexibility in utlisation of
IEC funds
(xiii) Strengthen the BCC training for
service providers
(xiv) A coordination committee for the
development partners should be
established
(xv) Develop an IEC strategy for family
welfare based on formative research
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CHATTISGARH
State Specific BCC Strategic Recommendations
The scenario in Chattisgarh as far as IEC
for Family welfare and RCH is concerned
at present seen pretty dismal with political
interference, bureaucratic apathy, no
strategic design based on research and
evidence, negative media, lack of mission
and zeal, lack of leadership and initiative,
lack of conceptual clarity, technical
capacity, uncoordinated manner, and lack
of accountability in the entire setup. It is
only hoped that all the players will pool
their energy and resources and work
together for the cause.
One has keep in mind the state is new
and has initiated new programmes with a
zeal and mission. A lot of ambitious
programme have been conceptulised. It
is hoped it will work for the state and a
lesson, if succeeded, for the others to
follow. It only has to be supplemented by
the human resources and the bureaucratic
will power to take it forward.
Recommendations
Being a new state has its own problems,
but there are several other issues that
need to be looked into for the better
performance of the FW programme.
1. Complete the IEC strategy with and
action plan with danida and SHRC
2. Utilize the technical inputs for IEC from
the partners
3. Train IEC and field staff for effective
use of IEC materials and activities
4. Use a different media mix instead of
large amount of posters and other print
materials.
5. Develop clear indicators for IEC/BCC
and place a mechanism for its rigorous
follow up
6. Use the panchayats and ICDS more
effectively for IEC and social
mobilization
7. Allocate more IEC funds and create
space for innovative activities
8. Have audience specific programmes
for involving media and adolescents
in the family welfare programme
9. Have specific advocacy efforts for
involving influencers and religious
leaders, women’s groups, elected
representatives etc.
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MADHYA PRADESH
State Specific BCC Strategic Recommendations
It is clear from discussions from the
government officials that because there
is an IEC bureau available in directorate
it is sufficient and there work is done. The
Director IEC bureau also holds the dual
position of Director Medical Education and
training, it is apparent that he may not be
able to spend enough time to the bureau.
Existence of a structure is seen an job
done. The secretary, health and family
welfare also echoed similar views as IEC
is an important component. The director
Family welfare is very good medical
surgeon. The fact is that IEC bureau was
not even a part of the group that was
formulating the PIP for RCH-II. Obviously
there is a positive environment,
participatory methodology but again the
uncoordinated efforts, several players, and
a complex geographical and people state
make it difficult for the IEC programme.
Recommendations
The state need to gear up to the new
paradigm and build on the strengths it
already has in the matter of IEC.
1. Need to strengthen IEC bureau
- have single charge full fledged
director for the IEC bureau
- engage professional staff
- involve the in planning
- involve them in IEC training
- have M & E unit at IEC bureau
- develop an IEC strategy
- develop a year plan based on
research
2. Utilize the MSS structures for better
involvement and results
3. Coordinate the plans and process of
different players
4. Utilize the technical inputs for IEC from
the academy
5. Train IEC and field staff for effective
use of IEC materials and activities
6. Use a different media mix instead of
posters and other print materials.
7. Develop clear indicators for IEC/BCC
& place a mechanism for its rigorous
follow up
8. Use the panchayats and ICDS more
effectively for IEC and social
mobilization
9. Allocate more IEC funds and create
space for innovative activities
10. Have audience specific programmes
for involving med and adolescents in
the family welfare programme
11. Have specific advocacy efforts for
involving influencers and religious
leaders, women’s groups, elected
representatives etc.
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Annex 1
Design and implementation at State/District/Block level
EAG IEC/BCC framework- State level
q State Government
q Health and Population Policy
q RCH programme at state (PIP)
q Inter-Depar tments, Intersectoral (WCD, RD,
Education, MSJE)
q Total fund flow from all sources
q Development partners (role/area of operation)
q IEC bureau/unit/division to be manned by IEC/BCC
specialists
q SIHFW
q DGHS
q PRC
q Private health sector
q NGOs
q Media/agencies
Strengthening design and management of IEC/
BCC at State level
q Who design the IEC plan at state level?
q Is there a IEC/BCC strategy? Who develops the
strategy?-Bureau, SIHFW
q Are the objectives, outcomes, results and indicators
clearly defined?
q Is there a specific focus on adolescent and young
people?
q How is it developed?
q Are districts, departments, partners involved?
q What is the basis of the design of the plan, based
on what-empirical data, previous performance,
etc.?
q Is it flexible to the needs of the districts, emerging
issues, priorities of the policy
q Does the plan take care of the developmental
partners/NGO projects
q Is there ownership of the plan
q Are these stand alone plans, are they linked to
previous plan? Continuity ?
q What are central government directives and
guidelines for this ?
q What is the content/emphasis/focus of the plan?
q How is the budget worked out?
q When is the plan developed-Time of development
and submission?
q Process of approval by the center, time taken,
release of funds, participation
q How is it implemented?
q How is it monitored and evaluated?
Strengthening implementation of IEC/BCC at
State level
q Approval of the plan, timely release of funds for
the state level activities and to the district
q Who implements the plan?
q Department
q Bureau
q District
q Agency/partners
q NGOs
q What are the major components of the plan? E.g.
training, printing, IPC, outdoor, broadcast fee, MSS,
vehicle, stationery, etc.
q What are the channels/mediums used?
q Does the implementation take into consideration
geographical, cultural and seasonal variation?
q How are the different partners coordinated?-
mechanism
q Does the implementation accounts for
interdepartmental and intersectoral activities?
q Is there a cross selling and cross fertilisation of
ideas amongst different streams/departments/
partners/agencies/stakeholders?
q Is there a regular periodic monitoring and
evaluation of the implementation?
q Is there state level review of the IEC plan
implementation in terms of funds, performance,
outcome?
Strengthening implementation of IEC/BCC at
District level
DESIGN
q Are the districts involved in the development of the
state plan?
q Are partners and sectors involved and how are they
coordinated?
q Do they have a district IEC plan?
q Basis, emphasis, data, targets, directives from the
state?
q Who develops the district plan?
q DM, CMO, DHEIO, DMO
q Is there a district IEC strategy?
q Defined objectives, outcomes, results, indicators
q Major components/heads
q Rural, urban, tribal
q Adolescent and youth
q Budget- timely received,
q Monitoring and evaluation-adequate, process
IMPLEMENTATION
q Who is the implementer?
q CMO, DHEIO
q Role of RHFWTC?
q Monthly meeting review
q Are District level flexibility needs addressed?
q How are partner activity coordinated?
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q How are MSS involved?
q How is Material from state, center received and
used?
q What are the channels, mechanism-Camps, Days,
IPC, Events
q How is the plan monitored and evaluated?
Strengthening implementation of IEC/BCC at
Block level
DESIGN
q Is there a block IEC/BCC plan
q How are the fund allocated/budgeted?
q What/How are activities planned?
q How and how often are field functionaries trained?
q How is BCC issues addressed?
q Do they have defined strategies for different
segment of population?
q Are there any specific strategy for adolescents and
young people?
IMPLEMENTATION
q Are BEEs in place?
q Who receives and distributes the materials?
q How are the materials used?
q What forms of different media being used?
q How is IPC being operationalised?
q What are the common practiced methods of
interaction-meeting, individual, camps, events?
q How are the efforts monitored and evaluated?
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Annex 2
Barriers
KEY BARRIERS –1
q Lack of knowledge
q Lack of correct knowledge
q Lack of complete knowledge
q Lack of access to information
q Lack of access to services
q Financial cost
q Personal cost
q No cost of not doing action
q No apparent/visible gain of doing the action
q Big social cost of doing the action
KEY BARRIERS –2
q No perceived threat
q No severity of threat
q No “others” following/doing it
q Hearsay of bad consequences
q Distance
q Timing of service availability
q Perception of reduction of pressure
q Against religion
q Against tradition
KEY BARRIERS –3
q Misinformation, myth, misconception
q Weak push for action
q Decision mandatory
q Decision optional
q Attitude of the service provider
q No personal gain/benefit
q Sensitivity of the subject
q Taboo subject
KEY BARRIERS – 4
q Disruption in Supplies
q Lack of communication skills on part of the provider
q Disagreement between partners
q Lack of couple communication
q Lack of gender sensitivity
q Lack of supportive environment
q Lack of counter on conflicting messages
q No immediate or tangible benefit
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Annex 3
Key communication indicator types
q IEC indicators
q Behavioural action indicators
q Community /social change indicators
q Service utilisation indicators
q Proxy indicators
KEY INDICATOR TYPES
q Input indicators
q Process indicators
q Output indicators
q Outcome indicators
q Impact indicators
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Annex 4
Key behaviours to be addressed-Adolescents
q Adolescents have knowledge about Reproduction,
STDs, RTIs, X-Y chromosomes/how sex is
determined, contraceptive methods, condoms, RH
services, HIV/AIDS,
q Adolescents have skills to understand and
overcome peer pressure and media influence, risk
perception, negotiation skills to say “No”,
consequences of unprotected sex,
q Adolescents have a supportive/enabling
environment that the information on sexual and
reproductive matters and skills needed are
essential and are provided by family, community
and service providers
q Adolescents have access to youth friendly SRH
services
IEC INDICATORS
q Production of materials
q Exposure
q Recall
BEHAVIORAL ACTION INDICATORS
q Delay marriage
q Delay onset of sexual activity
q Delay child bearing
COMMUNITY/SOCIAL CHANGE INDICATORS
q Dialouge/acceptance of ARSH
SERVICE UTILIZATION INDICATORS
q Increase in condom use
q Use of STI services
PROXY INDICATORS
q Telecounseling
q Adolescent Peer educators
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Annex 5
Suggestive list of communication activities
q Mass media
q Mahila Mandal
q IEC session with a flip book/chart
q Street play
q Social Mobilisation
q Community radio
q Puppet show
q Traditional folk media
q Film show
q Song and drama
q Competition
q IPC
q Saas bahu sammelan
q Male group talk
q Exhibition
q Community paper
q Camps
q Melas
q Festivals
q Children games
q Saap seedhi
q Baby show
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Annex 6
Discussion guide/questions
1. Have we understood the needs of the people in
terms of the Family Planning? How is need defined
for the poor? Daily wager? What is the “felt need”
of the people in the EAG states? Is family planning
a “felt need”?
2. Have we understood the factors/forces that are not
able to articulate the so called “unmet need” for
limiting or spacing family?
3. Have we clearly and really understood the specific
audience in the EAG states? Is there enough and
good segmentation according to their situation and
needs?
4. What is the real/tangible benefit we have offered
for limiting family size for a specific audience like a
farmer or labour or small business owner?
5. Have we addressed the influencers of family
decisions such as MIL, Husband, FIL, SIL, relatives
among others at the household level with regard
to the Family planning issues?
6. Why has the perception and belief of the people
not changed in a desirable direction and quantity
with regard to the family planning issue?
7. Have the addressing of adolescents (boys and girls
both) been from their perspective, adequate,
sustained, of quality? Is there a mechanism of
follow up?
8. What about the capacity building of the service
providers for new methods, techniques,
approaches for promoting family planning in terms
of communication skills- does this reflect in
curriculums and teaching practices?
9. What are the new skills introduced to the service
provider- negotiation, problem solving, analysis,
Trials, prompts, story telling, positioning, decision
making etc.?
10. What has been the thematic in the Family planning
communication campaigns and activities? Is there
a thrust in the family planning effort?
11. Has the quality of service really improved so as to
infuse the trust and image that will attract
audiences towards the family planning
programmes?
12. Has the RCH and HIV/AIDS issue diverted the
focus on the Family planning issues? Has the
multiplicity/overlap of the issues made the FP issue
diffused? Has there been enough steam in the
family planning programmes in the recent times?
13. Have there been more specific approached to
involve men as partners in the family planning
programme other than NSV? Is the programme
gender sensitive?
14. What are gaps in the FP programme and what are
shifts that will improve it- in policy, implementation,
monitoring and evaluation, training, advocacy?
EAG
Questionnaire notes in meeting with Samresh- 29
May 2004
Lacking/Gaps in IEC
What do you think should go into it?
Has IEC framework outlives its concept life/shist to BCC
What should be the shift that is required ?
How to involve men
Is the issue still hot?
Have we failed because we have focused too many
things
Which method has been over exposed
What need to be balanced
RCH/HIV AIDS
Training institutions and IEC same old things
No new blood in the faculty
Focus in the FP campaign
Fear psychosis for condom use in the campaign-justified
Polio/immunization-fear/risk
Effect on family/children/malnourishment
Two child norm/policy
Son preference ?
Domestic violence
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Annex 7
Round Table Meeting on Innovative Communication Strategy for
Promotion of Family Planning in EAG States
POPULATION FOUNDATION OF INDIA, NEW DELHI
OCTOBER 18, 2004
INTRODUCTION:
Mr. A. R. Nanda, Executive Director, Population
Foundation of India, in his introductory remarks stressed
upon the need and importance of Promotion of Family
Planning in India, especially in 8 Empowered Action
Group (EAG) States. He pointed out that even though,
many strategies, packages and forms of Communication
Strategies have evolved during the last 52 years of the
Family Planning Programme in India, the need of the
hour is to think of something innovative that can help
address this cause effectively.
The strategy planning focused on the eight EAG states
namely Bihar, Chattisgarh, Orissa, Madhya Pradesh,
Jharkhand, Uttar Pradesh, Uttaranchal and Rajasthan,
mainly due to some of their characteristics, such as,
q High infant mortality
q Low CPR
q Low other RCH indicators
q Family Planning to be repositioned in a broad
holistic manner
q Gender issues, quality of care, widening the
magnitude, reproductive health product & services
q Converting unmet need to demand— a need for
further communication strategy
q Make available interpersonal infrastructure
A study was therefore commissioned by Population
Foundation of India for MOH & FW, GOI to understand
the reasons/factors for EAG states’ who are lagging
behind in Family Planning programme performance
from a communication perspective and to generate
qualitative data base for designing an innovative
communication strategy for Family Planning programme
in EAG states to a team of researchers.
The Communication Strategy for Promotion of Family
Planning aims to:
q Consolidate strategies, packages developed over
the years into an innovative strategy which would
impact the implementation plan of the IEC/BCC
strategy for improving FP status in the EAG states
In this environment, capacities need to be built so that
the right people and institutions have the right
capabilities at the right time in order to play their role
effectively in making the programme more effective.
However, in this effort we are challenged with a wide
diversity of roles, people, contexts, backgrounds and
geographical location across the EAG states. Due to
this diversity the IEC/BCC materials-print, audio, video,
IPC no longer seem to make the impact that would be
required and is probably being not that effective in
helping people to learn.
This round table meeting endeavoured to bring together
people who have the responsibility to find solutions to
these barriers of learning and people who could possibly
respond fully or partially. In doing so a team of
consultants comprising of Mr. Samaresh Sengupta, Dr.
R. B. Gupta and Dr. Sanjeev Kumar has attempted to
bring together findings of the research conducted in
the EAG states, on behest of the PFI and GOI. The
Experts and stakeholders, both at the central level, and
in all the eight EAG states were interviewed and their
valuable inputs were put together and shared with an
aim to probe and share mutually amongst themselves
their experiences and try to find out or explore ideas
where one can look afresh or come up with innovative
ideas.
Mr. Chaitnya Prasad from MOHFW, acknowledged that
a change in the existing Communication Strategy is
essential. Changes focus and shift in the existing
communication strategy, specifically in the EAG and
North Eastern states has been agreed upon.
OBJECTIVE OF THE MEETING:
To share the findings of the study commissioned by
PFI for Ministry of Health and Family Welfare,
Government of India that would help formulate a more
Effective and Innovative Communication Strategy for
promotion of Family Planning in the EAG states. The
outcome of this study is to serve as an input for the
Department of Family Welfare’s IEC/BCC vision and
strategy under RCH-II in the EAG states through
literature review, IEC Material review, Formative
research (interviews and case studies), Roundtable
meeting followed by National workshop.
MEETING PROCEEDINGS:
Mr. Samaresh Sengupta, Consultant, who was
entrusted with the responsibility by PFI to conduct the
study, thanked all participants and key stakeholders for
their contributions and positive response during their
respective interviews. Special note of thanks was
conveyed to Mr. A. R. Nanda, Dr. Almas Ali and Dr.
Lalitendu Jagatdev for their continuous guidance and
inputs.
Dr. R. B. Gupta, one of the key consultants explained
the 3 approaches that were followed for formative
research.
q Formative research (interviews and case studies)
25 stakeholders were interviewed at the state and
national levels. The questionnaire was updated
continuously as and when feedback was received from
PFI & interviewers. The team of 3 key consultants met
with senior govt officials / secretary/ bilateral / UN
agencies/ NGOs and other stakeholders at the State,
selected Districts & PHC’s of all the eight states.
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q Literature review
q IEC material review
q Visits to all the eight EAG states By Consultants
and holding discussions with government
functionaries right from Secretary to the Bureau
officials to district administration and to CHC/PHC
Medical officers and ANMs. Also covered all the
other stakeholders at state level, UN agencies,
bilateral agencies, main NGOs and other working
in the area of RCH and family planning in particular
with the help of pre prepared guidelines.
THE PRESENTATION:
Presentation: By Dr. Sanjeev Kumar
Focus: Innovative Communication Strategy for
Promotion of Family Planning in the Eight EAG
States, A study commissioned by PFI for MOHFW, GOI
Dr. Kumar reiterated that the purpose of this roundtable
is for exchange of ideas; get views from the crucial
stakeholders and players in the area of family planning
in India and to know “are we on the right track”.
Dr. Kumar in his presentation brought out the need to
build capacity of the personnel implementing the
programme to enhance their skills, increase knowledge,
improving processes as well as sustaining the
motivation of the concerned personnel (For details
please see the attached presentation).
Questions/ points raised and discussed:
q What kind of media messages is used?
q Focus should be on target segmentation.
q The issue of spacing between 1st and 2nd child is
not addresses: Hence people are lost on the
planning process
q Need for a brand for family planning
q Concern on the disappearance of the red triangle
from the field.
q Common logo for family planning: it was felt that
due to bad quality of services the red triangle
disappeared: Need for an evaluation of the red
triangle
q Involvement of private sector recommended
q Development of training curriculum for the officials
implementing the programme
q Constant learning from our mistakes
q Accountability- who is accountable for IEC on the
fields
q RCH II planning- IEC planning & implementation?
q Mix of mass media and print media
q Brand ambassador for IEC
q Too many missions
q Too many health messages
q Fixing priority is a problem
q Replacement of red triangle
q IEC is required-implementation is important-
leadership at state level- strategy has to address
a broader framework
q Leadership at state level
q Strategy has to address a broader framework
q Media mix- Mix of radio, television & puppet show
q Structure in IEC/BCC strategy
q Lack of co-ordination between various departments
issue has not been handled
q The shift from IEC to BCC is at present being
implemented by a Pune based NGO called
Parivartan.
Despite of the programme not being effective to the
desired level, it was agreed that success is not
completely lacking. The difficulty of implementing a
programme of this kind on a scale keeping in mind the
diversity in India was acknowledged. Recognition of the
whole gamut of problems and corrective suggestions
were appreciated. The group felt that development of
solutions after proper analysis should be the priority.
Carefully designed and developed strategy can ensure
relevance and usefulness to the programme. IEC/BCC
materials should be constantly evaluated and
monitored. Another important point to be taken into
account is that materials produced in one place may
not be sensitive to the context, circumstance and culture
of the other. Therefore a separate communication
strategy to be in place especially for the states having
large number of tribal population. Also, some materials
can be versioned to suit the local context.
Leverage the ability of the capable, responsible
individual to act quickly and effectively. This can be done
by creation and acquisition of proper knowledge, storing
them correctly with the aim of transferring them for
proper and effective utilisation
q Training should be
focused on financial and material management. Change
in government officials holding key positions can harm
the smooth running/ implementation of the programme.
Research on literature review is limited. IEC needs more
backups in areas of monitoring and evaluation.
Generate idea to empower people in terms in terms of
information needs. Women should be given more
reading materials and information on family planning
and physiology. De-linking the concept of IEC from
service was another significant finding? These were
some of the suggestions given and issues were raised
during the discussions held.
The concept of “Chota Parivar, Sukhi Parivar”: is now
an old slogan and there was a strong need for bringing
in of new slogans, which should be able to strike hard
in the minds of people. Also the concept of BCC should
be brought in the program but first a good training on
this concept should be given to the program promoters
and service providers after identification of the program
promoters at grass root level, the study further
emphasised.
The meeting ended with a note that the team should
also look some more successful programs like
Parivartan Program in Pune, before coming out of
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recommendations and presentation in a Proposed
National Level Workshop. This recommendation was
strongly made by Mr. Chaitanya Prasad, IEC Director
of MOHFW, GOI. The Expert however felt satisfied with
the work done by the Consultants and lauded the efforts
made.
Participant List
NAME
DESIGNATION
ORGANISATION
PHONE NUMBER
Mr. A R Nanda
Dr. Alman Ali
Dr. L Jagatdeb
Mrs. Geeta Malhotra
Ms. P N Vasanti
Ms. Paramita Dasgupta
Ms. Supriya Mukherjee
A Banerji
S Narendra
Mrs. Sudha Tewari
Mr. Chaitanya Prasad
Ms. Sumana
Bhoothalingam
Ms. Priyanka Sarkar
Ms. Preeti Anand
Ms. Poushali Majumdar
Ms. Gita Bamezai
Ms. S. Bhavna
Dr. Sanjeev Kumar
Dr. R B Gupta
Mr. Samaresh Sengupta
Executive Director
Population Foundation of India
Population Foundation of India
Population Foundation of India
Director
Project Director
Consultant
Admin./Programme
Co-ordinator
Exe. Director
MD
ASCI, EC, DOFW, GOI
Health PR Communication
consultant
Programme Officer
Manager, Co-ordination
Programme Officer
Associate professor
VHAI
Consultant
Consultant
Consultant
CMS
CMS
Independant
Delhi Soc. For Promotion of
Rationing Use of Drugs
Pariuar SGA
GUI
Freelance
VHAI
Janam
CINI, Delhi Office
Dept. of Communication,
NIHFW, N.D. - 62
986821356
26864020
9111154
26717
98101091
24330004
23017333
9811065
26518071
5162888
5168130/98114280
26107/26189
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Annex 8
Report of the National Workshop on IEC/BCC Strategy for
Family Planning and RCH in EAG States
22nd February, 2005
Mr. A. R. Nanda, Executive Director, Population
Foundation of India, in his introductory remarks greeted
and thanked all the participants for taking time off from
their busy schedule on a working day particularly on a
day when the parliament is in session.
This National Workshop is a one-day deliberation on
Effective and Innovative Communication Strategy for
promotion of Family Planning in the EAG states.
The objective of assisting Ministry of Health and Family
Welfare to prepare a communication strategy meant
for family welfare & RCH was a matter of great honour.
Mr. Nanda highlighted an imperative distinction between
strategic communication for change and strategic
communication for effective change. He emphasized
that changes do take place but not all changes are
necessarily effective.
Concept of Reproductive Health encompasses family
planning, maternity health, and child health and
reproductive tract infection, sexually transmitted
infection as well as HIV/AIDS. Hence, care becomes
an integral part of the life cycle approach that positions
family planning in the context of welfare and well being
of the family to bring about effective changes for better
empowerment. Mr. Nanda reiterated that the
convergence of many pathways leads to effective
strategic communication.
From the demand side IEC has always taken a backseat
thereby information has often been much used,
sometimes misused and also abused & overused.
Communication has to be strategic and empowering
as against the previous authoritarian approach. Effective
two-way communication packages for rural population
to be the key initiative for the empowerment of the action
groups.
MEETING PROCEEDINGS:
Presentations and discussions:
Session- 1
Chair person: Dr. N. Bhaskar Rao
Presentation: Study on Innovative Communication
Strategies for Family Planning and RCH in the EAG
States: Study Genesis and Background, by Dr. Almas
Ali, Senior Advisor, PFI
Dr. Ali explained in details the evolution and the goal of
family planning and Family Welfare Programme In India.
Family planning programme in India is one of the oldest,
about 52 years old. The programme has gone through
several changes as well as got integrated with various
programmes like MCH, CSSM as well as minimum need
programmes. The present focus of the programme is
sustained development where the need for a
comprehensive reproductive health care and rights are
to be addressed through the life cycle approach. This
paradigm shift is not essentially to reduce the birth rate
and rate of population growth in the country. ICPD that
was watershed in the history of thinking of population
issues was mentioned. It has brought about changes
in framework, strategies, approaches relating to public
policies in general and population policies in particular.
Holistic agenda addressing the life cycle approach has
to come into immediate effect.
Population Foundation of India has been involved in
population and RCH issues for over 35 years. Their
interest and strength have been in the areas of service
delivery, capacity building, communication and
advocacy. PFI has strong presence and works very
closely in EAG states.
Need for the study emerged due to poor performance
of the EAG states, non-generation of demand for services
thereby no significant change in CPR or TFR was noted.
Communication, programme design, implementation
and effectiveness seen as a crucial factor.
Objectives of the study was to understand the
reasons/factors for EAG states’ lagging behind in Family
Planning programme performance from a
communication perspective both in terms of approach
as well as thrust. Generating qualitative database for
designing an innovative communication strategy for
Family Planning programme in EAG states was vital.
This study served as an input for the Department of
Family Welfare’s IEC/BCC vision and strategy under
RCH-II in the EAG states. Substantial differences are
visible between states in achievements of basic socio
demographic indices. There are wide inter state
disparities in outcomes as well as impacts.
Way forward
• The Study has provide a National perspective on
Family Welfare Communication initiatives
• Presented EAG State specific findings and
recommendations
• Input for RCH-II and NRHM communication design
and plan for EAG states
• Serve as a base-planning document for the IEC
division, Department of Family Welfare (For details
please see the attached presentation).
Presentation: Study findings and IEC/BCC Strategy
Presentation by Dr. Sanjeev Kumar
Based on the findings of the research study and building
on the strengths of PFI a “change and empowerment”
communication action proposal is presented for next
three years. Dr. Sanjeev Kumar expressed his view
that the proposal is in consonance with CMP, the
MOHFW’s new initiatives such as National Rural Health
Mission (NRHM), RCH-II.
PFI will submit the change and empowerment proposal
to MOHFW and also raise funds from other development
partners including corporate sector for this initiative.
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PFI will also facilitate each of the 8 EAG states to
develop IEC/BCC action plan for effective change and
empowerment.
Issues raised and observations made:
• Ability to utilize the results of the research findings
are vital for the programme
• Existing systems to be energized to deliver required
outputs
• Monitoring of proper utilization of funds and
accountability on the part of the officials essential
• Field realities to be brought into the programme
• Image of IEC to be redone/ undone
• Media to be a partner in the programme
• Social mobilization at various levels- at policy,
corporate, media will bring about effective
change
• Inputs to be given to non-performers
• Processes to be followed
• Internalization of prospective and attitude is
missing
• IEC/BCC materials to be pre tested
• States should have an IEC training plan
• Perspective should be whole some and backward
planning
• Corporate sector need to be hired for the IEC
management
• Coordinate IEC action at regional/district level
through an coordinating corporartised agency and
manpower
• IEC resource center
• Alternative media- video by adolescents
Session –2
State Specific Presentation
Chairperson: Mr. K.L. Chugh, Chairman Emeritus, ITC
Ltd and Member, Governing Board of PFI
The states of Bihar, Rajasthan, Uttar Pradesh, Madhya
Pradesh, Orissa, Jharkhand and Chattisgarh were
identified where socio-economic indicators are sub
optimal.
Issues raised and observations made:
• Social sector communication as well as research
has time and again pointed towards various
lacunae in the programmes. What corrective steps
have been taken are not clear
• This is an opportunity to over haul the
communication strategy and give it a new paradigm
shift to the programme.
• Communication policy to be interpreted in the right
perspective. Stressing too much on programme
dilutes the importance of communication inputs and
design
• Quality of life to be stressed
• Radical view of budget
• Unfilled positions in the IEC departments
• Holistic and synergistic approach to be followed
• Inter department co-ordination to be more
cohesive
• Level of competence in training is lacking
Session –3
Presentation: Taking IEC/BCC Forward in the Context
of National Rural Health Mission and RC-II-
Presentation by Dr. Sanjeev Kumar
Chairperson: Mr. Chaitanya Prasad, Dy. Director (IEC),
Ministry of Health and Family Welfare
Where do we go from here and how?
Journey so far included literature review of the IEC
material, interview with key stakeholders, state specific
visits and roundtable meeting and observations. The
study findings brings the issue if family planning to a
cross road where this is a non issue with low on priority
agenda either with the government or with people who
carry a lot of historical baggage. IEC for family planning
is seen as publicity with no particular needs, benefits
and threats.
Therefore the team suggested a generic IEC/BCC
strategy and a seven step metro strategy. The generic
model suggested:
• Allocation of adequate funds
• Provision of continuous professional support
• Intensive capacity building at every level
• Branding and positioning
• Increase visibility
• Synergise mass media and ground activities
• Focus on adolescent and young people
• Develop a system and mechanism of coordination
• Develop a systematic monitoring mechanism
The “metro” strategy recommended IEC image should
be changed at all levels- starting to be made from the
village and town levels. The seven steps recommended
changes in image, manpower, strategy, action,
monitoring, resources, and co-ordination.
The team strongly felt that there should be no mass
media, only IPC. Studies on cost-benefit of family
planning communication should be taken up and
analysed.
• Projection of FP communication outcome
• Intensive involvement of influencers
• Improve communication about Quality of services
Comments/ Observations:
Building public awareness on family planning through
Information, Education and Communication (IEC) by
conducting awareness programs and involving
community, local political leaders in the process are
important criteria for fulfillment of the objectives.
• Public awareness and community participation
process should be initiated from early stage of the
planning process and should continue till a desired
result is achieved. The importance of appropriate
mechanisms should be kept in mind.
• Seek the highest-level political and administrative
commitment from the local governments.
Fundamental change in government could make
a difference. Therefore, they should orient
themselves prior to orient the NGOs to the new
action plan.
• Develop collaborative strategy with the respective
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state take this process forward on emergency footing.
• Gaps in the rural and urban areas of the EAG states
to be addressed by preparing state specific action
plan for implementation.
• Seek commitment from the Centre to get financial
resources for effective influencing power on the
agenda.
• Guidelines on what behavioural aspect to focus
and target to be developed
• Opportunity, motivational level to be pushed to
higher level without losing direction
• Real behaviour outcome that will be communicated
• Present capacity of the states should be taken into
consideration
• Clarity on “what is it that we are trying to brand?
“Sukhi/ chota”. National Rural Commission,
demographic transition welfare/ well being not only
health/ more than wealth
• Thematic framework is evitable
• Sustainability mechanism for the CBOs to be in
place for proper movement in the programme
• Government machinery and NGOs to work towards
mind change- groping in the dark about not being
able to communicate properly
• Focused accountability, community participation to
be enhanced
• Master plan policies- learnt from our mistakes,
improve our systems, feeling of achievement &
accountability
• To get an outcome of the programme evidence
based research-scaling up of result possible,
supervision can be one
• Networking & intersectoral communication with
support from civil society is missing hence the feel
of a stand alone programme exists.
• Health-key to development- therefore should be
part of holistic design programme
• Good practice can be replicated: Jharkhand
Government takes along all the stakeholders for
decision-making. Doing studies in the community
and holding discussions regularly in all RCH
programmes. Political commitment is very high.
• Information, Education and Communication should
be key components of the family planning
strategies
• Look for innovative methods of sharing information
• Population policy should be there in each state.
State to improve upon the draft
• System of how to put the information in the net
• Education should be for the people and not for the
officers
• Communication to be the focus and communication
should be focused
• Should the start be by decluttering hence
refocusing
• Accountability between national and state policies.
Hence good co-ordination between the two to be
developed
• Gaps in the programme to be plugged
• Implementation plan for the population policy to
be drawn up and shared
• Coordination between state level bodies and
organizations to be stronger
• Structure of the communication policy is missing
• Prioritization of 12 strategic themes
• State governments were asked to prioritize based
on the IEC policy
• Prioritize strategy
• National Rural Health Mission is very vital-
communication strategy to be geld into and all can
play a role
• RCH- PIP (5yrs) all states are presently formulating
the IEC policy, therefore this is the right time to
provide inputs
• Central Government is providing the guidelines.
Most of the states have either completed or have
started working on the IEC strategy.
• The component of IEC is one of the least
understood
• The normal practice is to evaluate the budget in
the action plan of the current year multiplied by
five to come out with a five year budget
• The role of an advisor of advising and the
importance of strategizing in order to make the plan
better that could lead to strategise the three
successes
• Facility survey and beneficiary surveys done.
Allocating districts to different organizations,
localization of needs based approach. The various
reasons for this are the cultural differences, access
to surveys and success stories. Studies should be
made for the analysis of the community,
accountability on the part of all the players in
respective areas.
• Uttaranchal should be divided into blocks, different
strategies for different people.
• Diagnosis of the present state scenario is essential.
People working at the grass root level should know
opportunities within the state.
• Motivated people when committed to the
programme can take the programme to new heights
• Example was taken from Sitapur in Uttar Pradesh
where 54 agencies were working at the same time.
Lack of any strategy is very much evident.
• Communication to be the umbrella under which
information education should work in tandem.
• The ASHA programme can be a model
• Absence of a leader and money has always been
a deterrent factor. Felt that the system needs
strengthening.
• Can state level officers communicate to the
community? The provider has to know what has to
be communicated. Communication at the village
is crucial and different at different levels- it is many
fold. The best communication goes out of society
• Uttar Pradesh to create demand for health services
• Repositioning the whole gamut of IEC/BCC as a
wholesome entity.
Mr. Chaitnaya Prasad submitted that Ministry is in a
mission mode therefore there is a sea of opportunity.
Within the health system, reframing communication is
the key here therefore should begin at the top, put time
frame should be there but no input on research.
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Mr. Chaitnaya Prasad responded to the concerns and
observations of the participants. He admitted that it is
easiest to criticise the government. He acknowledged
that the government must be lacking in monitoring,
accountability, inputs as to how much can be absorbed
in the system and utilization issues.
Certain points highlighted are:
• Constraints under which the system operates
• Growing consciousness among the communication
fraternity
• NHCR – uniform design (formative research is
going on) – linked to performance indicators
• Jharkhand can be the model in the whole
government
• Position communication concepts
• Reference to ASHA
• Communication skills, capacity building skills
• Some of the states have money parked against
IEC/BCC that are not being utilized for many
years.
• MoHFW helps identify consultants in state as well
as district levels to —-
• One of the states with no systems – Bihar
• Good people available
• Utilization training – reorientation of the financial
systems in the concerned departments
• Within the government there are learners-other
agencies working in this area do not make use of
the government’s effective reach and capacity
• Institutions do not contact government departments
• No opportunity for training exploration
• Address the issue- a core committee that should
include experts and representatives from
successful states like Maharashtra, Tamil Nadu,
Sikkim, Punjab.
• National IEC meet for scaling up the profile of IEC/
BCC
• Proper monitoring systems to be in place.
Way forward and specific issues:
• Integration of IEC and Family planning
• Utilize the media world: leverage the capability of
the media
• MMR/IMR issues to be addressed
• Make use of the governments capacity and position
• Help the government with new and innovative ideas
• Government has decided to move in a great way
in terms of branding
• Feel free to criticize the government and encourage
them
• Lessons to be learnt from “model states”: TN,
Kerala, Maharashtra, Orissa
• Self sufficient-no red tapism, sustainable,
hardworking officials, infrastructure
VALEDICTORY:
Mr. Lalitendu Jagatdev, Consultant (Advocacy &
Communication), PFI, summarised the days
proceedings by emphasising that it has been a
rewarding workshop both in terms of positive
recommendations, agreement and disagreement He
agreed that similar to the family welfare programme,
communication has to be integrated with other
programmes, it has to be intersectoral, and area specific
as per the requirement of the EAG states. Different
stratum of strategy should be in place in accordance
with the requirement of the states. Mr. Jagatdev thanked
the Ministry of Health and Family Welfare for identifying
PFI as an important partner in terms of IEC
programmes. Mr. Chaitanya Prasad’s (Dy. Secretary
I.E.C) contribution towards technical & administrative
support was acknowledged.
Representative from different organizations and the
variety of suggestions were encouraging.
It was agreed that the important suggestions and
recommendations received would be incorporated in the
draft strategy report in a prioritised and focused form before
presenting it to the Ministry of Health and Family Welfare.
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