With poor knowledge and existing

practices of inappropriate infant and young

child feeding, nutrition and care during

pregnancy and adolescence, an important

focus of the POSHAN Abhiyaan has been

Behaviour Change Communication (BCC).

This learning note highlights the approach

adopted and experience of implementing a

BCC and community mobilisation strategy

for improving nutrition outcomes.

Creating a Communications Strategy

Jan Andolan (or People’s Movement)

The POSHAN Abhiyaan places immense focus on convergent actions for nutrition and in line with this, a new strategy termed Jan Andolan was developed. The strategy focusses on developing and operationalising media campaigns to create awareness on 12 key themes (Figure 1), using communication materials disseminated through multiple platforms (Figure 2) involving multiple stakeholders such as the ministries of health and family welfare, drinking water and sanitation, school education, rural development, panchayati raj institutions/ village organisations/ self help groups (SHGs) ensuring wide public participation.

In its operationalisation it adopts the following principles:

AspirationsCreating a sense of aspiration, tapping into people’s inherent goals and ensuring motivation, thus closing the “say-do” gap.

Collective identityCreating a perception of shared status for nutrition and a sense of collective identity.

NudgesCreating simple, doable actions and nudges for people to convert intent to action, thus making it easy for people to join in and participate. For example, asking them to make a pledge or a commitment.

RewardsCreating appropriate rewards-recognition among peers, appreciation letters from government - for spurring frontline workers, peer leaders and local champions to get involved with highest level of engagement.

I N D I A’ S P O S H A N A B H I YA A N

Background

POSHAN Abhiyaan aims to reduce malnutrition, through a life-cycle concept, adopting a synergised and result-oriented approach. Implemented by the Ministry of Women and Child Development (MWCD), Government of India, the target of the mission is to bring down stunting in children 0-6 years of age from 38.4% to 25% by 2022. It also aims to reduce anaemia among women and adolescent girls in the age group of 15-49 years and reduce low birth weight.

Behaviour Change Communication and Community Mobilisation for Improved Nutrition Outcomes4LEARNING NOTE

Development of Communication Content

The MWCD focused on developing communication products supporting key messages on maternal, infant and young child nutrition, with the objective of improving

window for healthy growth and development. The primary target audiences for these messages were pregnant women and mothers/ caregivers of children 0 to 24 months while the secondary target were service-providers including Anganwadi workers (AWWs), ICDS supervisors and Child Development Project

Mass Media

nutrition messages were developed by a media agency. This includes: (i) importance of consumption of at least 100 Iron and Folic Acid (IFA) tablets during pregnancy; (ii) a diverse and nutritious diet during pregnancy; (iii) early breastfeeding within one hour of birth; (iv) exclusive breastfeeding for six months; and (v) age-appropriate complementary feeding for infants over six months of age.

(Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan, Maharashtra, Andhra Pradesh and Uttar Pradesh). The pre-test revealed that the TV spots scored more than 80% for spontaneous recall, good comprehension, likeability and intention to act. The radio spots demonstrated a greater than 90% understanding and likeability. The full length and

pre-test and were translated into 12 regional languages.

characters, a second set was developed using cartoon characters, which elicited even greater appreciation and attention from communities. These were also translated into 12 regional languages.

Mid Media

The mid media component of the communication plan was

content for posters (Figure 4), bus back panels, posters

use by AWWs (Figure 5); and (v) a street play script. These outreach materials were developed in nine languages. While

01

03

05

07

09

11

02

04

06

08

10

12

Figure 1: Twelve Themes Under Jan Andolan

Overall Nutrition (Malnutrition, low-birth weight, good nutrition/healthy foods - WHAT and WHY)

Antenatal checkup, diet of pregnant women, calcium supplementation, institutional delivery and early initiation of breastfeeding

Optimal breastfeedingComplementary food & feeding

Full immunisation and Vitamin - A supplementation

Growth monitoring and promotion

Anemia prevention in children, adolescent girls and women – diet, IFA, deworming

Food forti cation and micronutrients

Diarrhoea managementGirl’s education, diet and right age at marriage

Hygiene, sanitation and safe drinking water

Early Childhood Care and Education (ECCE)

Twitter, Facebook,WhatsApp, YouTube

SOCIAL MEDIA

COMMUNITYMEDIA

Local Leaders, Faith Leaders,Social-cultural Leaders,

Panchayat Leader

INFLUENCERS

Lady Supervisor, AWWANM, ASHA, Teacher

FRONTLINEWORKERS

Television, Radio,Mobile, Print

MASS MEDIA

Wallpaintings, Hoardings, Bus Panels, Led Scrolls

OUTDOOR MEDIA

Entertainment Industry,Sports, Politics

CELEBRITY

PLATFORMS

CBE, VHSN Day, DAY-NRLM, Gram Sabha, School Management

Committee, Children’s School Cabinet, NSS, NYKS, Scouts &

Guides, Cooperatives

*Too

ls/M

ater

ials

* *G

ames

, Son

gs, P

raye

rs, P

ledg

e, P

oste

rs, F

lipbo

oks,

Dialogue C

ards/Interpersonal Communication Videos, Interactive Radio Programmes*

Tweets, Videos, Messages

Prototype Designs of Wall Painting,

Hoarding, Bus Panels, LED ScrollsTV Programmes, Radio Programmes, TV Commercials

Radio, Sports, SMS, Ringtone, Mobile Games

Scrip

ts, F

olk

Song

Lyr

ics,

Sto

ries

Comm

unity

Rad

io P

rogr

amm

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CCCCBE, VHSabh

ComCabi

SOC

TwTT ee

WWTeacher

*ToTT

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Nukkad Nataks + Local FolkSongs, Drama, Dance,

Story-telling

Indi

vidu

als /

Influ

encers

Media

CommunityGroups

Figure 2: Platforms for Dissemination

skill and understanding of service providers, the print, text, voice messages and the street play were designed to elicit

accordingly. Deployment guidelines for the mid media content were also developed.

Community Based Events (CBEs) and Home Visits

A key component of changing nutrition practices is holding CBEs to celebrate critical milestones in the life of pregnant women and children below two years of age. The gatherings serve as a platform for disseminating essential messages and to counsel pregnant and lactating women, and their

nutrition and health behaviours. The events are organised at least once every month at every Anganwadi centre (AWC) and primarily focus on promotion of maternal nutrition (Godhbharai) and/ or initiation of appropriate complementary feeding (Annaprasan). Checklists have been developed to facilitate organisation and supervision of these events.

There is also an explicit focus on home visits during the critical period from pregnancy till a baby turns two years of age, to enable counselling, problem solving and create a demand for services. Both the incremental learning approach

Figure 5: Flipbook for AWWs

and the ICDS-CAS software described in the other notes, support this extensive focus on home visits.

“Anganwadi didi comes more often now, as compared to before. Even though I meet her many times in the village, she still comes home, sits with me, my mother-in-law, and sometimes with my husband also…. She provides good information, for example about my child’s food, immunisation, and hand-washing.” – Mother of 9-month-old child

Implementation of the Strategy

Mass and Mid Media

The MWCD, through the government media agency, Directorate of Advertising & Visual Publicity (DAVP), broadcasted three TV and radio spots on nutrition in 12 regional languages from February to April 2018.These included spots on: (i) importance of iron and folic acid consumption during pregnancy (ii) early breastfeeding, and (iii) exclusive breastfeeding. Subsequently, TV spots on dietary diversity for pregnant mothers, and appropriate complementary feeding was broadcast from September 1 to 30, 2018. The radio and TV spots were available in public domain on the MWCD website. The ICDS-CAS videos,

for use by the AWWs.

Community Based Events

Monthly CBEs are being organised across 31 states/ UTs currently. When the CBEs were initially rolled out under the earlier ICDS Systems Strengthening and Nutrition Improvement project phase in late 2015/ early 2016, key messages from AWWs on maternal nutrition, institutional deliveries, and complementary feeding often got lost in the din of gatherings. Under POSHAN Abhiyaan, additional

and help get the message across better. The AWW checklist was also developed to help improve the organisation and counselling during CBEs.

Home Visits

Greater emphasis has been placed on home visits to promote maternal, infant and young child nutrition practices, which is now being systematically tracked through the ICDS-CAS. According to the Polling Booth surveys conducted in the programme areas, 46% of the pregnant and lactating women reported being visited once or twice in the past three months in May-June 2018 as compared to 39% in August-September 2017. The percentage of no home visits reported by the pregnant and lactating women also reduced from 14% to 9%.

Figure 4: Poster On Appropriate Complementary Feeding

Figure 3: TV Spot

Lessons Learnt

was rolled out, some lessons were learnt in the process:

1. Strategy development• Pre-testing of outreach materials adds value in terms

of adapting messages to the community’s perspective

essential to work with creative agencies experienced in public health/ nutrition, as educating an agency, which lacks nutrition experience, takes time.

• As interventions are addressed across programmes it is important to ensure common and consistent messaging.

• MWCD led the effort of collating all materials on the

partners. A Google drive was used to provide all states with access to these materials. New materials, such as

were also developed.

2. Mass media campaigns• Broadcasting TV and radio spots for a period of three

months, followed by a brief period in the month of September, helped sensitise communities to the key messages. However, these spots should be repeated at planned, regular intervals to reinforce messages. This needs to be factored into the larger annual media plan.

3. CBEs and home visits • In a recent third party survey carried out across 27

districts by MWCD, it was found that home visits and community events are the most effective platforms for message dissemination.

• while the focus on messaging during CBEs has improved, messages on complementary feeding, and importance of engaging the child while feeding require greater emphasis in all counselling and communication efforts.

•

Poshan Maah (Nutrition Month)

To provide an impetus to the communication strategy under the POSHAN Abhiyaan, the month of September 2018 was declared the Poshan Maah (nutrition month) with states encouraged to systematically roll out a month-long campaign on nutrition, engaging multiple departments, such as the health and family welfare, human resource development, rural development, panchayati raj, water and sanitation and youth affairs. About 23 lakh activities on nutrition including community-based events, nukkad nataks (street plays),

rallies, feeding demonstrations were organised across the country reaching over 270 million people during the month. Field observations reveal that the Poshan Maah sensitised communities on the importance of good nutrition and achieved convergence across various schemes.

“With the help of my team I was able to organise different community programmes during the Poshan Maah. The main part was involving children and their family members innovatively so that they feel a part of the programme and not consider themselves as ust targets’ or bene ciaries of the programme.” - istrict evelopment of cer, Surendranagar, Gujarat

to communicate and re-enforce key messages. Simple

support home visits and CBEs. •

can undertake regular CBEs.• The counselling videos embedded as part of the AWW

mobile application of ICDS-CAS has been a great enabler for interpersonal messaging during home visits.

• Drawing upon lessons learnt in the implementation of CBEs, the MWCD improved and issued revised guidelines under the POSHAN Abhiyaan. These include enhancing messaging with a focus on male participation

to support the AWWs. • It is essential to monitor BCC interventions like home

visits. Home visits require strengthening in terms of communicating appropriate content and problem solving. Indicators to monitor home visits through the ICDS-CAS and AWW incentives linked to home visits have recently been introduced under the Abhiyaan.

4. Jan Andolan strategy • The Jan Andolan strategy focuses on several nutrition

themes. However, it is imperative to focus and deepen the work on maternal and child nutrition, and key

Abhiyaan is operationalised.

“I saw Meena (name changed) sitting against the wall of the AWC. eatly dressed in a owered saree, hair tied in a bun. She was

silently and con dently breastfeeding her infant. The baby was one and half months; I asked her, “Where was the child born?” “In the district hospital” - she replied. “What are you feeding the baby?” “My milk” - she replied. “Anything else? Water or any other milk?”. “No, why would I? Only breast milk is what she needs to grow well”. She said this is what the AWW didi had told her when she visited her house when she was pregnant and after she came home from the hospital. This is also what they were taught in community gatherings particularly during the Godhbarai event. “Has she been immunized?” - I asked further. “Yes she has. The card is at home” she said as she effortlessly put her baby back to breastfeed”. - Village Loharsi, Block Dhamtari Gramin, District Dhamtari, Chattisgarh