IPPI in India RESEARCH BASED COMMUNICATION MODEL for UNREACHED CHILDREN By Dr K SURESH Project Officer, UNICEF India Country Office

Reaching the Unreached Communication Model l Process Evaluation involves n Assessing –Knowledge –Attitudes/ Beliefs n Designing & implementation of appropriate intervention l Outcome Evaluation n Recording behavior Change

MONITORS S/NIDs & H-HOUSE GOVERNMENT--DIST/STATE WHO/NPSP / UNICEF ON THE SPOT GUIDANCE END DAY CONSULTATIONS CORRECTIVE ACTIONS

Methods of Data Collection for the Indicators Process Evaluation l Independent observers - NGO, Medical Colleges, IAP members, Students … l Filled-in questionnaire within 10 days of S/NIDs were included for the analysis l Five part questionnaire was developed l booths/areas observed On booth day and third day for HtH activities

Process Evaluation Indicators l For Immediate intervention n Quality of vaccine in Phase-III n Communities with 2+ Unimmunised children l Subsequent round n Cold chain gap n Awareness regarding date/place n Micro-planning l Next year strategy n Training of service provider n Reasons for not-immunizing children despite HtH for planning IEC/SM

Inclen India (USAID Support)

Methods of Data Collection for the Indicators End Evaluation l Multi pronged approach - –carried in all 35 states/UTs –1041 clusters (975 normal and 66 high-risk)- –In 218 clusters qualitative research carried out l Quantitative children –Structured surveys- Individual one to one interviews to assess Knowledge, its extent, behavioral indicators l Qualitative FGDs & 467 DIs –FGDs with beneficiaries, family influencers –DIs with service providers, community influencers –Village observation, Transects l Analysis –A holistic approach –Weaving the data from all sources

Indicators for the Communication Model- Knowledge l About the disease l Action Required l About the program l About NID Use of Mass media Use of Interpersonal Training and Orientation Workshops Awareness - 80% (1995) 99.4%(1997), 99.5%(2001)

IPrevention l Medicines required only when ill l 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

IIEmpathy l Not for me- Amongst Affluent n because it happens only to the poor n Hygiene factors at booth, Look Good, Feel Good- New problem n 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)

IIITrust l Government Service l Expertise of Service providers ?? n Participation of Volunteers 30%(1995) 60%(01) n Training Outsourced last year l Readiness to believe negative stories n Sensitization of Journalists and other forums Less negative reporting, % of untrained staff - 26%(99) 5%(01), 91% SP satisfied with the training l Free service – No free lunches – Issue of dumping medicines n ??

IIITrust Difference in reach across religions not significant now Coverage in (0-6m)- 75.7%(1996) 91%(2000) In <1m - 60%, <3m - 86% were reached l Child too young n IPC and Use of SMCs l Religious lines n Appeals from religious leaders/ influencers-Verbal Print n Vedios of Mollavis appeal played in UP & WB n Use of celebrities like Shahrukh Khan

Empowerment l Fatalistic Attitude –Whatever is to happen will happen l How does it matter if we miss? –a few children –a few doses Repositioning of program as Peoples program through Mass media and SM Every Child, Every Time theme tune of Audio/ Video spots Not aware of need for additional doses (1996) 4.5 (2000) (among those refused - 6.7(1996) 1.4% (2000)

COMMUNITIES WITH UNIMMUNIZED CHILDREN DESPITE HOUSE TO HOUSE IMMUNIZATION Among the communities with unimmunized children, % with 2+/100HH such children - 70% (Oct. 99) 18% (Jan. 01)

Issues to Tackle in 2001 l Concept of Health as different from absence of diseases as it becoming rare l Look good, Feel good and match demands (affluent families) l Building knowledge workers amongst service providers l Free Service- ?? l Readiness to believe negative stories- –Anti-fertility –HIV/AIDS

Challenges... l Playing safe mentality- double edged sword l Traditionally restricted access to the young child (0-3m) –Social restriction –Exclusive breast feeding n Needs to be tackled as genuine concern n Cultural and religious diversity compound the problem l Fatalistic Attitude - Hardships and uncertainties of life per se l Mental state - Historical suppression within the community l Increase in zero dose children - 0.7(2000) 2.4%(2001)

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