Update on Tele-Counselling in Udaipur district

Submitted To

Directorate of Integrated Child Development Services, Department of Women and Child Development

Government of Rajasthan, Jaipur

May 2020

Prepared By

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Preface

This report provides an update on the efforts being undertaken by the POSHAN champions to continue

connecting with the Pregnant and Lactating women and their families in the times of COVID-19. IPE

Global through the support of Children’s Investment Fund Foundation is working with the Department

of Women and Child Development in Rajasthan to support the Indira Gandhi Matritva Poshan Yojana

(IGMPY). The scheme announced on 13th March 2020, will provided Rs 6000 as direct cash transfer

benefit to women for their second child. In addition to empowering the women to invest in her

nutrition and that of her young child, the scheme also promotes an intensive social behaviour change

communication strategy that will help influence the attitude of all stakeholders involved in the first

1000 days of the child – from conception till 2 years of age.

The RajPusht program implemented under the support has been piloting these initiatives in the district

of Udaipur and in the past one year, through inter-personal counselling, community meetings and by

strengthening the capacities of ANMs and AWWs, the program has been able to reach out to more

than 30,000 unique women and their households.

COVID-19 has presented a challenging situation where the need for communication and staying in

connect is of utmost importance. And in these times, a specific cadre of Nutrition workers deployed

under the RajPusht project, the POSHAN champions, are ensuring that they stay connected with the

women and support the front-line workers in delivering services with utmost efficiency.

We sincerely thank Dr. Pratibha Singh, Director, ICDS and her team who supported this initiative and

provided necessary guidance to carry out the initiative. This is the first step and together with the ICDS

team a plan will be drafted to engage advanced channels of digital communication and engagement

for reaching out to every women in the district.

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Background According to NFHS-4 2015-16, one out of three (36%) babies are born with Low Birth Weight (< 2500 grams) in Rajasthan and with age majority of them fall into the trap of wasting. Poor maternal nutrition is the key reason for Low Birth Weight babies. To address Low Birth Weight and Wasting, Government of Rajasthan (GoR) in Partnership with Children’s Investment Fund Foundation (CIFF) is implementing project RajPusht and IPE Global is the implementing partner. COVID-19 outbreak in Udaipur has affected lives of millions of people due to loss of livelihoods, lack of food, poor access to health and education facilities and other basic needs. Communities living in rural areas, are struggling to obtain health, nutrition and education services. Prior to COVID-19 lockdown, POSHAN Champions deployed under RajPusht were counselling beneficiaries via home visits. With restricted field movements due to COVID-19, a tele counselling initiative was started by team RajPusht to ensure that the connection with the end beneficiaries is continued even during the lockdown. The intervention aims at creating awareness about preventive measures of COVID-19 and to continue provide counselling on maternal and child nutrition to pregnant and lactating women in Udaipur district.

Beneficiaries covered Tele counselling started from 14th May 2020 by POSHAN Champions. A phase wise call script (specific to pregnant women, lactating women and mothers of young children aged 6-18 months) was developed and provided to the POSHAN champions followed by a detailed orientation. Each POSHAN Champions covered 20 beneficiaries per day. With a success ratio of nearly 50%, nearly 40 beneficiaries were called daily. There are still pockets where cellular connectivity is a challenge, leading to either poor call quality or failure to connect the call altogether causing such low success rate. Till 23rd May 2020, 11,109 beneficiaries of different categories were contacted as shared in the table below.

Category of beneficiary Count of

beneficiaries %

Pregnant Woman (0 to 3 months) 75 0.68

Pregnant Woman (4 months to 6 months) 428 3.85

Pregnant Woman (7 months to delivery) 1,468 13.21

Lactating Mother (0 to 6 months) 3,604 32.44

Lactating Mother (7 to 18 months) 5,534 49.82

TOTAL 11,109 100

It was ensured that husband’s and other family members were also included in the interaction. Wherever necessary, confidence of a male family member, was obtained before initiating conversation with the female. Useful Insights and Findings

Take Home Ration Of the 11,109 beneficiaries contacted, 76% (6,866) have received THR

PMMVY payment Of the 11,109 beneficiaries contacted 9,652 are registered for PMMVY scheme, 36% (3,471) have received payment, 35% (3,417) did not know about payment status, while 29% (2,764) have not received instalment.

Health check-up of pregnant women

Out of 1,971 pregnant women contacted, 86% (1,692) have got health check-up done by ANM or doctor in last one month of which 75% (1,469) got their weight monitored.

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IFA and Calcium tabs consumption by pregnant women

Of the 1,896 pregnant women of 2nd and 3rd trimester, 81% (1,302) are consuming IFA tabs and 80% (1,286) Calcium tabs.

Birth preparedness Nearly 1,500 pregnant women contacted were in the 3rd trimester contacted and almost all knew about the nearest hospital where they would like to go for delivery with some preparedness on how to reach.

Exclusive breastfeeding Of the 3,604 lactating women contacted, 77% (2,763) follow exclusive breastfeeding, whereas 19% reported giving milk from other sources as well as water.

IFA and Calcium tabs consumption by lactating women

Amongst lactating women, 45% were consuming IFA and calcium tablets.

Continued breastfeeding and complementary feeding

Of the 5,534 mothers of young child aged 6-18 months, 96% (5,307) are continuing breastfeeding, and 98% have initiated complementary feeding to their children.

An important insight that came out was availability of mobile phones with the female members. In nearly 80% of the calls, the beneficiary received the call herself. Acceptability of women receiving counselling on phone by the respective husband was also high allowing the calls to go uninterrupted and with information shared and received without much hesitation. Some husbands also showed interests to know about important messages being delivered to their wife. Process adopted for activity

POSHAN Champions prepare AWC wise list of beneficiaries along with their pregnancy, lactation and child age status and mobile number, a day before initiating the calls.

On the day of the call, beneficiaries are counselled as per script given to them (Annexure). After each call, key information is recorded on a predesigned Google worksheet. On an average 20 beneficiaries are called per day.

Every evening, feedback is shared to respective supervisors. Update is also shard on total number of calls, success rate, and calls with male members etc.

Minimum 10% calls are cross-checked by the supervisors via random calling. Quality assurance

7686

81 77

45

96

0

20

40

60

80

100

120

beneficiaryreceived takehome ration

pregnant womenreceived health

checkup

pregnant womenconsumed IFA

tabs

lactating womenfollowed EBF

lactating womenconsumed IFA

tabs

mothers of youngchild continuedbreastfeeding

% responses from beneficiaires

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Since the mobile phone medium is being used for the very first time as a counselling tool, it becomes imperative to ascertain aspects like medium effectiveness, quality of counselling and scope for improvement. With this objective in mind, team RajPusht initiated a quality monitoring exercise. The supervisors were requested to cascade this down to POSHAN Champions to ensure seamless execution of this quality assessment initiative. The following steps were involved:

• POSHAN Champions were briefed to dial in RajPusht state team members in conference call mode before dialling in the beneficiary.

• State team members were instructed to remain incognito and only listen in to the mobile counselling call.

• POSHAN Champions delivered their counselling script as usual.

• Observations were noted and feedback points with respect to scope for improving call quality.

• Feedback was compiled into a succinct orientation guideline.

• A follow-up training of the POSHAN Champions using the updated guideline is being done, thus resulting in better call output.

Going forward The activity will be continued for left-out AWCs which beneficiaries are not contacted due to any reasons. List of beneficiaries not received THR/Dry ration/IFA tabs and Calcium tabs has been prepared and will be discussed with respective AWWs for providing services to them. The same beneficiaries will also be followed again to know if they have received the services. Block level team of RajPusht simultaneously is in coordination with Lady supervisors and CDPOs, if AWWs reports unavailability at their end, this will also be taken up with CDPO or Lady Supervisors. Next update would also capture the no. of beneficiaries who have received the services after follow-up with service providers.

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Annexure 1 - Call script for the mobile counselling intervention

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