ippi in india 2000- 2001 research based communication model for unreached children by dr k suresh...
TRANSCRIPT
IPPI in India 2000- 2001
RESEARCH BASED COMMUNICATION
MODEL
for
UNREACHED CHILDREN
By
Dr K SURESH
Project Officer, UNICEF India Country Office
Reaching the Unreached Communication Model
Process Evaluation involves Assessing
– Knowledge
– Attitudes/ Beliefs
Designing & implementation of appropriate intervention
Outcome Evaluation Recording behavior Change
MONITORS
S/NID’s & H-HOUSE
GOVERNMENT--DIST/STATE
WHO/NPSP / UNICEF
ON THE SPOT GUIDANCE
END DAY CONSULTATIONS
CORRECTIVE ACTIONS
Methods of Data Collection for the IndicatorsProcess Evaluation
Independent observers - NGO, Medical Colleges, IAP
members, Students …
Filled-in questionnaire within 10 days of S/NIDs were
included for the analysis
Five part questionnaire was developed
5000-9000 booths/areas observed On booth day and
third day for HtH activities
Process Evaluation Indicators
For Immediate intervention Quality of vaccine in Phase-III Communities with 2+ Unimmunised children
Subsequent round Cold chain gap Awareness regarding date/place Micro-planning
Next year strategy Training of service provider Reasons for not-immunizing children despite
HtH for planning IEC/SM
Inclen India (USAID Support)
AIMS, NEW-DELHINodal UNIT
PLANS, ORGANIZES ,ANALYZES DATAFEEDBACK TO ICC
24 MEDICALCOLLEGESALL OVER COUNTRY
COLLECTQUALITATIVE DATAFGD'S, DI'sINTERVIEWING DISTMANAGERS
Methods of Data Collection for the Indicators End Evaluation
Multi pronged approach - – carried in all 35 states/UTs – 1041 clusters (975 normal and 66 high-risk)-– In 218 clusters qualitative research carried out
Quantitative - 41640 children – Structured surveys- Individual one to one interviews to
assess Knowledge, its extent, behavioral indicators Qualitative - 202 FGDs & 467 DIs
– FGDs with beneficiaries, family influencers– DIs with service providers, community influencers– Village observation, Transects
Analysis– A holistic approach– Weaving the data from all sources
Indicators for the Communication Model- Knowledge
About the disease Action Required About the program About NID
• Use of Mass media
• Use of Interpersonal
• Training and Orientation Workshops
Awareness - 80% (1995) 99.4%(1997), 99.5%(2001)
I Prevention ‘Medicines required only when ill’ Concept of Prevention Vs. Cure - Health Vs. Absence
of Disease
Underlying Issue:
• Distrust of Medicines per se and excessive medication
• Particularly if free by Govt. & thrust without explanation
• Identity of Service Provider
Many rounds & Given at home New challenge
II Empathy
‘Not for me’- Amongst Affluent because ‘it happens only to the poor’ Hygiene factors at booth, ‘Look Good’, ‘Feel Good’- New problem Family doctor advice
Underlying Issue:
• Lack of exposure, Used to better services, demanding
•IAP/IMA/Pvt. Practitioners to immunize at their clinics
•Private hospitals to open booths
•Medical / Affluent college students to volunteer
•Celebrity endorsements
Refusal declined on
Doctors advice - 6.1% (1995) Nil (00)
III Trust
Government Service
Expertise of Service providers ??
Participation of Volunteers 30%(1995) 60%(01)
Training Outsourced last year
Readiness to believe negative stories
Sensitization of Journalists and other forums
Less negative reporting,
% of untrained staff - 26%(99) 5%(01),
91% SP satisfied with the training
Free service– ‘No free lunches’– Issue of dumping medicines
??
III Trust
Difference in reach across religions not significant now
Coverage in (0-6m)- 75.7%(1996) 91%(2000)
In 2000 - <1m - 60%, <3m - 86% were reached
Child too young IPC and Use of SMCs
Religious lines Appeals from religious leaders/
influencers-Verbal Print Vedios of Mollavi’s appeal
played in UP & WB Use of celebrities like Shahrukh
Khan
Empowerment
Fatalistic Attitude– “Whatever is to happen will happen”
How does it matter if we miss?– a few children– a few doses
• Repositioning of program as People’s program through Mass media and SM
“Every Child, Every Time” theme tune of Audio/ Video spots
‘Not aware of need for additional doses’ - 10.4 (1996) 4.5 (2000) (among those refused - 6.7(1996) 1.4% (2000)
COMMUNITIES WITH UNIMMUNIZED CHILDREN DESPITE HOUSE TO HOUSE IMMUNIZATION
17.7
10.49
0.81.9
3.5
0
2
4
6
8
10
12
14
16
18
20
Oct.99 Nov.99 Dec.99 Jan.00 Dec.00 Jan.01
Among the communities with unimmunized children, % with 2+/100HH such children - 70% (Oct. 99) 18% (Jan. 01)
Among the communities with unimmunized children, % with 2+/100HH such children - 70% (Oct. 99) 18% (Jan. 01)
Issues to Tackle in 2001
Concept of Health as different from absence of diseases as it becoming rare
Look good, Feel good and match demands (affluent families)
Building knowledge workers amongst service providers
Free Service- ?? Readiness to believe negative stories-
– Anti-fertility
– HIV/AIDS
Challenges...
Playing safe’ mentality- double edged sword Traditionally restricted access to the young
child (0-3m)– Social restriction– Exclusive breast feeding
Needs to be tackled as genuine concern Cultural and religious diversity compound the problem
Fatalistic Attitude - Hardships and uncertainties of life per se
Mental state - Historical suppression within the community
Increase in zero dose children - 0.7(2000) 2.4%(2001)
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