The views expressed in this report should not be construed as those of the BBC itself or of donors supporting the charity's work. Between 2011 and 2015, BBC Media Action and its partners carried out an ambitious project to improve family health in Bihar, one of India's poorest and most densely populated states. The initiative, called Shaping Demand and Practices (SDP), was part of the larger Ananya program, a collaboration between the Bill & Melinda Gates Foundation, the government of Bihar and other partners.
While the project originally targeted eight districts, with a mandate to scale successful communications solutions to the rest of the state, there was also a clear intent to view the project as a "laboratory" to test approaches that could be extensively across India's vast and diverse geography. Commitment to partnerships with state and national government, rooted in the collaborative design of project outputs, to ensure results are maintained beyond the life of the project. Bihar was one of India's most populous states and one of the least developed.1 Severe poverty, illiteracy, poor infrastructure, caste-based politics and poor governance for more than four decades had the potential benefits of its rich history, natural resources and fertile soil.
Access to information in the country was limited, and the data show that in rural areas the penetration of television and radio amounted to 26% and 33% of the adult population, respectively. 2. Data from 2011 showed that Bihar has one of the worst maternal, newborn and infant mortality rates in India and the world. Consortium partner BBC Media Action Pathfinder International delivered training in eight innovation districts and supported the roll-out of capacity building training for government in expanding districts.19.
From the early days of the project, emphasis was placed on transferring SDP communication outputs and activities to the Government of Bihar and other partners to promote sustainability.
The impact of Shaping Demand and Practices
Lessons in health communication
In Bihar, these were the State Health Society Bihar (SHSB) and the Information and Public Relations Department (IPRD) respectively. This experience had three main implications for the SDP project, each of which suggests lessons for future health communication work in Bihar:. i). As a result, the SDP project team was innovative in exploiting opportunities to distribute the project's mass media outputs through non-traditional broadcast channels.
The SDP project originally envisioned home visits as the primary window for contact between FLWs and their clients. To support this approach, the SDP project developed "disruptive" communication aids to be used by FLWs. The idea of rethinking platforms for communication also applies to the way in which the SDP project approached rural activism to engage different communities in Bihar.
Using this set of clearly defined insights, the SDP team began developing communication solution ideas. The human-centered design process used in the SDP project was iterative in nature, often requiring multiple returns to the ideation phase. This whole process involved the commitment of the SDP team, as one employee put it.
The SDP team also emphasizes that design and functionality are central to uptake and audience engagement. The SDP project found that going “beyond health” to focus on professional pride, credibility and empowerment was critical to engaging and motivating FLWs in Bihar. As one member of the SDP team put it, “across the project, FLWs were presented differently.
Through the SDP project, BBC Media Action and its partner Pathfinder International developed specific processes for use in two-way interpersonal communication that may be useful in other contexts. At the beginning of the SDP project, the aim was to ensure sustainability for as many communication outputs as possible. As one member of the BBC Media Action team put it, "government ownership transformed implementation".
Within the SDP project, a structured process was used to co-develop outputs with government counterparts from the outset. Within the SDP project, BBC Media Action also pursued partnerships with commercial mobile operators as a way to support mHealth services after donor funding ended.
CONCLUSION
ENDNOTES
19 BBC Media Action Monitoring Information System data, based on call logs shared by mobile operators. 28 Mathematica Center for International Policy Research and Evaluation (2014) Midline findings from the evaluation of the Ananya program in Bihar [online]. This design assumes that Bihar's 'non-intervention' districts are comparable to the eight focus/intervention districts, both in terms of outcomes measured at baseline and demographic/socio-economic measures.
The associations mentioned exist even when accounting for (or controlling for) characteristics such as parity (number of children), religion, literacy and education, and socioeconomic category. To understand this data, be aware that the specific Mobile Kunji topics covered during the last home visit were not captured. Therefore, the Mathematica analysis examines associations between broad exposure to Mobile Kunji (any use in the previous six months, regardless of topics covered) and health practices.
31 These results are based on research data collected by CARE India in 2012 and 2013 in eight districts of Bihar using the Lot Quality Assurance Sampling (LQAS) method. In 2017, BBC Media Action performed a "logical regression analysis" on this data, taking religion, father's and mother's education, value of family wealth and number of living children as control variables to provide the stated results. The analysis does not control for confounders such as age, parity, socio-economic status, etc.
35 These findings are based on regression results, controlling for important confounders such as age, parity and socioeconomic status, but not for education. 37 Of the participants in the CARE India LQAS survey, approximately 5% reported being exposed to TV advertising, radio programs, street theater performances and outreach by audiovisual vans. These are the women with the lowest degree of mobility and choice in rural Bihar.
Therefore, it is unlikely that they were exposed to any communication outcomes outside of interpersonal communication conducted through FLW at the household level. 38 These results are based on survey data collected by CARE India in eight districts of Bihar in 2012 and 2013 using the LQAS methodology. 42 Center for International Policy Research and Evaluation Mathematica, Medium Findings from the Ananya Program Evaluation in Bihar.
