1. SBC  in Nutrition- using community platform( Jeevika) Bihar, Evidence and learnings
Biraj Laxmi Sarangi
Technical Specialist – Nutrition,
Project Concern International ( PCI)
Jeevika Technical Support Program, Bihar

2. OUR VISION
The most vulnerable people in the world will have the power to lift themselves out of poverty and to create vital, healthy lives for their families and communities now and for the future.

3. Geographical Coverage and MNCHN Interventions (JTSP)
District 11
Blocks
101
SHG
124529
SHG women
Village
6909
Maternal and Child Health (1000 Days Window Period)
Maternal Nutrition and IYCF
Access, choice, and quality in Family Planning
Enteric Diarrheal Diseases

4. Key Strategies Community Action Group (PRI, VHSNC)
Behaviour Change Communication
Capacity building of the community institutions for demand generation and quality of services
Develop Community Resource Persons to steer H&NS agenda through the community institutions
Convergence with ICDS and Health for service provision, availability and accessibility of adequate supplies, and timely referrals
Touch Points to integrate Health, Nutrition & Sanitation
HHs
SHGs
VOs
CLFs
&
Community Action Group (PRI, VHSNC)

5. Pre pregnancy, During pregnancy, Lactation, Inter pregnancy
Core Areas – Nutrition
Core areas
Maternal Nutrition
Pre pregnancy, During pregnancy, Lactation, Inter pregnancy
Diet Diversity
IFA consumption
IYCF
Early and Exclusive Breast Feeding
Complimentary Feeding (adequacy, frequency and diversity)
Hygiene
Hand Washing
© Bill & Melinda Gates Foundation

6. Campaign on Exclusive breastfeeding
Bihar
11th July – 18th July’2016

7. Why campaign on Exclusive Breastfeeding
Universalization of breastfeeding may help avert deaths of 823,000 children and 20,000 mothers globally each year (Lancet series on Breastfeeding, 2016)
Despite 63% institutional deliveries in Bihar, rates of EIBF are low (NFHS-4)
Only 35% of children are breastfed within an hour of birth
Only 54% of children were exclusively breastfed during the first 6 months of their lives
All figures in %

8. Evidence Formative research ( Alive & Thrive 2015)

9. Initiation
Despite 63% (NFHS4) institutional deliveries in Bihar, rates of EIBF are low, primarily because
Belief amongst family members and mothers alike that there is no milk in the first 2-3 days combined with lack of knowledge of how much milk a child needs during this time
Lack of knowledge and skills on part of FLWs to enable mothers to initiate BF early, lack of complete understanding of when and how breastmilk is produced
Common practice of giving pre lacteals due to cultural reasons
Delayed initiation in Muslim communities due to practice of reciting the Aazaan before the child is breastfed

10. Exclusive Breast Feeding
Most of the respondents do not practice EBF in spite being knowledgeable because
Consider exclusive breastfeeding to be inclusive of water
Feed other forms of milk/ milk products & pre lacteals as believe them to be nutritive, digestive & cleansing aids
Initiate feeding biscuits, daal ka paani from 4-5 months because of perceived insufficiency of breast milk to suffice child’s hunger
Confused about the ideal span of exclusive breastfeeding – before completion of 180 days or before
No variations across districts regarding exclusive breastfeeding was found

11. Continuation
Disparity in the period of breastfeeding for boys and girls was noticed among the Muslim communities across Gopalganj, Gaya and Patna as a form of adherence to traditions
Health workers do not emerge as the key advisors on problems related to breastfeeding as respondents prefer home remedies to their counsel
AWWs are concerned about contradictory advise given by private practitioners

12. Campaign Coverage District Patna, Begusarai & Nawada Blocks 20 VOs 477y P t n J m u i R o h s r K B k A S w p l M d b N W e j x z f g V D C E L
Units
Number/Details
District
Patna, Begusarai & Nawada
Blocks 20
VOs
477
Villages
240
Schools
252
Time
July
Goal: To increase knowledge around the usefulness/benefits of exclusive breast feeding and address the myths and misconceptions
Target Audience
Primary: Pregnant Women & Lactating Mothers
Secondary: Mothers- in-law, Husbands, School Teachers & Children, Adolescent girls &
Frontline workers

13. CAMPAIGN CHRONOLOGY DAY 1 (11th July) Target group: ASHA and JEEViKA
Community Mobilizers
BCC event: Slogan writing competition, Signature campaign and Oath taking ceremony.
DAY 2 (12th July)
Target group: Pregnant and lactating women
BCC event: Video films, interactive game on latching & positioning of baby and Padyatra (rally)
DAY 3 (13th July)
Target group: School Teachers and students
BCC event: Video films, slogan writing on EBF and demonstrations on hand washing.
DAY 4 (14th July)
Target group: Mothers-in-law
BCC event: Video films, quiz and interactive games on latching & positioning of baby
DAY 5 (15th July)
Target group: Male family members
BCC event: Video films, quiz and interactive games on latching & positioning of baby.
DAY 6 (16th July)
Target group: Adolescent girls
BCC event: Bicycle rallies with slogans.
DAY 7 (18th July)
District workshop led by the District Magistrate and attended by the DDC, Civil Surgeon, officials from Health, ICDS and Education departments.

14. Campaign Coverage District Blocks Village VO School Planned Covered
Pregnant & Lactating Women
Mothers-in-law
Fathers & Fathers-in-law
Adolescent Girls
Patna 3 38 37 82
 81
Nawada 9
126
115
118
107
192
 192
133
132
Begusarai 8 76 73 75 70
203
 202 81
Total 20
240
226
230
225
218
477
475 
252
243
More than 57,000 pregnant and lactating women, mothers-in-law, fathers, fathers-in-law, school children, teachers and adolescent girls took part in the campaign

15. Campaign Measurement
Two rounds of cross sectional quantitative sample surveys among mothers having 0-6 months old children were conducted using structured interview schedules.
A multi-stage systematic random sampling was used to select respondents using a random start.
Sample size:
Round
District
Block
Village VO
Women
Baseline 3 8 67 89
608
End-line

16. CAMPAIGN EFFECT Improvement in Knowledge on breastfeeding
Improvement in exclusive breastfeeding practices
All figures in %
Significant rise not only in knowledge but also in actual practice observed after the campaign!
Note: * shows 10% level of significance ,** shows significant at 5% level of significance and *** shows 1% level of significance

17. Lessons Learnt and Way Forward
Quality Execution
Meticulous planning, optimal involvement of JEEViKA ground force, convergence with other depts.
Efficient Delivery
No gap between planned and actual activities – universal campaign coverage as planned
Effective outcome
Spike in desired results among intended audiences
The campaign’s protocols, guidelines and resources can serve as a blueprint to drive smooth scale-up for organizing such community-based events - 1,16,856 members from 2,367 VOs participated in the village level awareness rally on EBF organized by ICDS during the World Breastfeeding Week (1-7 Aug, 2016)
Jeevika platform can be used in launching similar other campaigns aimed at reinforcing critical HNS outcomes besides other regular touch points.