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Rapid Assessment of Swasth Nagrik Abhiyan
(SNA) erstwhile IEC Programme
Submitted To
Advisor (Health)
Submitted By
Dr. Pawan K. Taneja & Dr. Roma Debnath
2020
ii
Final Report
Rapid Assessment of Swasth Nagrik
Abhiyan (SNA) erstwhile IEC Programme
Submitted To
Advisor (Health)
Submitted By
Dr. Pawan K. Taneja & Dr. Roma Mitra Debnath
i
Study Team
Dr. Pawan K. Taneja & Dr. Roma Mitra Debnath
Project Leader
Dr. Sanjeev Kumar & Dr. Shalini Manocha
Consultants
Disclaimer
The Indian Institute of Public Administration, New Delhi (IIPA) has received financial
assistance under the Research Scheme of NITI Aayog (RSNA) to prepare this report. While
due care has been exercised to prepare the report using the data from various sources, NITI
Aayog does not confirm the authenticity of data and accuracy of the methodology to prepare
the report. NITI Aayog shall not be held responsible for findings or opinions expressed in the
document. This responsibility completely rests with the IIPA, New Delhi
For Comments and Suggestions Contact
Dr. Pawan K. Taneja
Indian Institute of Public Administration
Indraprastha Estate, Ring Road, New Delhi-110002
Ph. No. +91-11-23468327, 9818210463
E-mail: dr.p.k.taneja@gmail.com
ii
Table of Content
Disclaimer .................................................................................................................................. i
Acknowledgments ................................................................................................................... ix
Abbreviations ........................................................................................................................... x
Executive Summary ............................................................................................................... xii
Background .......................................................................................................................... xii
Objectives of the Study ...................................................................................................... xiii
Research Process & Methodology ..................................................................................... xiii
IEC Activities of Central IEC DivisIon of MOHFW .......................................................... xiv
Manpower at IEC Division ................................................................................................. xiv
Findings - Exposure to Health Promotion Messages ........................................................... xv
Program Wise Exposure Level ......................................................................................... xv
NVBDCP Promotion Messages .................................................................................... xv
Exposure to NPCDCS Promotion Messages ................................................................ xv
Exposure to IMI Promotion Messages ......................................................................... xvi
Findings- Recall of Messages ............................................................................................. xvi
First Recalled Health Promotion Message ...................................................................... xvi
Findings- Intention to Behaviour Change ........................................................................... xvi
Disseminate Information/Motivate/Inform Others .......................................................... xvi
Perception about Impact of Health Promotion Messages on Suggested Actions ............ xvi
Implications of the Exposure, Recall and InteNd to Change Findings .............................. xvii
Media Usage and Behaviour Findings ............................................................................... xvii
Desk Review ................................................................................................................... xvii
Community Survey Findings .......................................................................................... xvii
Qualitative Findings from Community......................................................................... xviii
Findings from Interviews with Functionaries ............................................................... xviii
Media Preference Findings............................................................................................... xviii
Qualitative Findings from the Community ................................................................... xviii
Findings from the Interactions with Functionaries .......................................................... xix
Recommended Way Forward .............................................................................................. xix
Rework Communication Strategy and Media Plan as per SBCC .................................... xix
Findings- Execution of IEC Strategy .................................................................................. xix iii
Desk Review .................................................................................................................... xix
Findings from the Interactions with Functionaries ........................................................... xx
Study Team OBSERVATIONS ....................................................................................... xx
Suggestions During the National Consultation Workshop ............................................... xx
Way Forward ....................................................................................................................... xxi
Synergising Operational and Implementation Plan ..................................................... xxi
Findings: Content of Advertisement ................................................................................... xxi
Desk Review .................................................................................................................... xxi
Community Survey Findings ........................................................................................... xxi
Findings from the Interactions with Functionaries ......................................................... xxii
Suggestions during the National Consolation Workshop ............................................... xxii
Way Forward .................................................................................................................... xxiii
Findings - Management of Financial Resources .............................................................. xxiii
Desk Review ................................................................................................................. xxiii
Findings from the Interactions with Functionaries ........................................................ xxiv
Way Forward - Effective Utilization of Financial Resources ........................................... xxiv
Findings: Monitoring, Evaluation of IEC Activities ......................................................... xxiv
Desk Review .................................................................................................................. xxiv
Findings From the Interactions with Functionaries ........................................................ xxv
Way Forward Research, Monitoring & Evaluation ........................................................... xxv
Finding - Human Resources & Capacity Building............................................................ xxvi
Desk Review .................................................................................................................. xxvi
Observations during the Field Visit ............................................................................... xxvi
Way Forward Human Resources & Capacity Building .................................................... xxvi
Chapter 1: Introduction .......................................................................................................... 1
Background ............................................................................................................................ 1
Objectives of the Study .......................................................................................................... 3
Research Process & Methodology ......................................................................................... 3
Sampling Framework ......................................................................................................... 4
Focused Group Discussions................................................................................................ 5
In-depth Interviews ............................................................................................................. 6
Quality Control in IDIs and FGDs ..................................................................................... 7
Desk Review ....................................................................................................................... 7 iv
Literature Review ................................................................................................................... 8
Data Collection and AnalysEs.............................................................................................. 10
Limitation of the Study ........................................................................................................ 11
Chapter 2: IEC Activities of MOHFW ................................................................................ 12
Objectives of IEC Activities of MOHFW ............................................................................ 12
Key Achievements ............................................................................................................... 13
Strategic IEC/ Communication Plan ...................................................................................... 13
Mass Media....................................................................................................................... 14
Mid –media ....................................................................................................................... 14
Digital Media .................................................................................................................... 14
Events ............................................................................................................................... 15
Other activities .................................................................................................................. 15
MEDIA Plan in action .......................................................................................................... 15
Print Media ....................................................................................................................... 15
Television ......................................................................................................................... 16
Radio ................................................................................................................................. 17
Bureau of Outreach and Communication (BOC) ............................................................. 17
Social Media ..................................................................................................................... 17
Health Pavilion at Fairs .................................................................................................... 18
Structure and Organogram of IEC Division ......................................................................... 18
Management of Financial Resources ................................................................................... 19
Financial Resources at State Level for IEC under NHM Funds....................................... 20
National Programme-wise Expenditure on IEC Activities ............................................... 21
Media Wise Usage of Funds ............................................................................................. 21
Issues and Challenges Faced by National/ State/ District Level Health Functionaries ....... 22
Localization ...................................................................................................................... 22
Logistics Challenges ......................................................................................................... 23
Human Resources and Capacity Building ........................................................................ 24
Need Identification Studies, Monitoring & Evaluation .................................................... 24
Financial Resources Planning and Utilization .................................................................. 25
Media Plan and Strategy ................................................................................................... 25
Chapter 3: Respondents’ Profile & Media Habits .............................................................. 26
Demographic Profile of the Respondents ............................................................................ 26 v
Access to Media ................................................................................................................... 27
Region-wise Analyses of Access to Various Media ......................................................... 30
Access to TV in Different Regions ............................................................................... 30
Frequency of TV viewing ............................................................................................. 31
Access to Radio in Different Regions ........................................................................... 33
Frequency of Radio Listening ....................................................................................... 34
Access to Mobile in Different Regions ......................................................................... 34
Frequency of Mobile users............................................................................................ 36
Access to Newspaper in different regions .................................................................... 36
Frequency of Newspaper reading ................................................................................. 39
Chapter 4: Beneficiaries’ Exposure, Recall, and Intent to Change Behaviour ................ 40
Exposure Level to Health Promotion Messages .................................................................. 40
First Recalled Health promotion message ............................................................................ 42
Exposure Level for specific MOHFW Campaigns .............................................................. 45
National Vector Borne Disease Control Programme ........................................................... 45
Exposure to Health Promotion Messages ......................................................................... 45
Source of Exposure ....................................................................................................... 46
Frequency of Exposure ................................................................................................. 50
Recall of Messages ........................................................................................................... 50
Intention to Behavior Change ........................................................................................... 53
Disseminate Information/Motivate/Inform Others ....................................................... 53
Reasons for not Disseminating/Share Health Promotion Message............................... 53
Perception about Impact of Health Promotion Messages on Suggested Actions ......... 56
Willingness to Change to Desired Behaviour expected in NVBDCP Messages (Bed
Nets) .............................................................................................................................. 57
Preferred Medium to Receive Information in Future ....................................................... 58
National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases and Stroke (NPCDCS) .......................................................................................... 59
Exposure to Health Promotion Messages ......................................................................... 59
Source of the Exposure ................................................................................................. 61
Frequency of Exposure ................................................................................................. 62
Recall of NPCDCS Messages........................................................................................... 63
Intention to Behaviour Change ......................................................................................... 65
Disseminate Information/Motivate/Inform Others ....................................................... 65 vi
Reasons for not Disseminating/Sharing Health Promotion Message ........................... 66
Perception about Impact of Health Promotion Messages on Suggested Actions ......... 70
Willingness to Change to Desired Behaviour expected in NPCDCS Messages .......... 71
Preferred Medium to Receive Information in Future ....................................................... 72
Mission Indradhanush .......................................................................................................... 73
Exposure to Health Promotion Messages ......................................................................... 73
Source of the Exposure ................................................................................................. 75
Frequency of Exposure ................................................................................................. 77
Recall of message ............................................................................................................. 78
Intention to Behaviour Change – Mission Indradhanush ................................................. 81
Disseminate Information/Motivate/Inform Others ....................................................... 81
Reasons for not Disseminating/Sharing Health Promotion Message ........................... 81
Perception about Impact of Health Promotion Messages on Suggested Actions ......... 85
Willingness to Change to Desired Behaviour expected in NPCDCS Messages .......... 87
Preferred Medium to Receive Information in Future ....................................................... 87
Chapter 5 Grass-root Level Functionaries: Access, Exposure, Recall and Health Seeking
Behaviour ................................................................................................................................ 88
Introduction .......................................................................................................................... 88
Access to MEDIA AMONG grass root level functionaries ................................................. 89
Exposure to Health Promotion Messages among Grass-root Level Functionaries .............. 90
First Recalled Health Promotion Message ....................................................................... 90
Exposure, Recall, and Perception about Immunization Mission Indradhanush Messages .. 91
Exposure to Health Promotion Messages ......................................................................... 91
Source of the Exposure ................................................................................................. 92
Recall of IMI Messages among Grass-root Level Functionaries ..................................... 92
Perception about Content of the IMI Advertisements ...................................................... 93
Exposure, Recall, and Perception about NPCDCS Messages .............................................. 94
Exposure to NPCDCS Health Promotion Messages ........................................................ 94
Source of the Exposure ................................................................................................. 94
Recall of NPCDCS Messages among Grass-root Level Functionaries ............................ 95
Grass-root level Functionaries’ Perception about Content of the NPCDCS
Advertisements ................................................................................................................. 96
Exposure, Recall, and Perception about NVBDCP Messages ............................................. 96
Exposure to NVBDCP Health Promotion Messages ........................................................ 96 vii
Source of Exposure among Health Workers/School Teachers ..................................... 97
Recall of NVBDCP Messages .......................................................................................... 98
Perception of NVBDCP Advertisement Messages .......................................................... 98
Supply of IEC Material from State and its usage ................................................................. 99
Record Keeping for IEC Material Received ................................................................... 100
Training and Capacity Building of Grass-root Level Functionaries about IEC Material .. 100
USEFULNESS OF National IEC in Grass-root Level workers Functioning .................... 101
Suggestion By Grass root Functionaries ............................................................................ 103
Chapter 6 Recommendations and Way Forward ............................................................. 104
Rework Communication Strategy and Media Plan ............................................................ 104
Going beyond Special Days and Events ......................................................................... 105
Separate Plans for Urban and Rural Areas ..................................................................... 105
Develop Regional Plans to Address Regional Priorities and Challenges ....................... 106
Develop a Strategic Robust Dynamic Media Plan ......................................................... 106
Reworking Radio in the Media Mix ............................................................................... 107
Appropriate Use of Digital and Social Media Tools and Platforms ............................... 107
Leveraging and Forging Effective Partnerships for IEC as a Part of Communication
Strategy ........................................................................................................................... 108
Synergising Operational and implementation plan ............................................................ 108
Synergising Operational & Implementation Plan at Centre, State, and District Levels . 109
Institutionalization of Partnership mechanism for implementation ............................... 109
Coordination plan of IEC activities with ASHA/ANM work plan ................................ 110
Monitoring the Performance of Implementation Partners .............................................. 110
Leveraging and integrating Communication outreach with schemes and databases ......... 111
Streamline IEC Budgeting and Fund flows and Empowering State and District .............. 112
Robust Research, Monitoring, Evaluation, and Documentation Unit for IEC/SNA.......... 112
Human Resources and Capacity Building .......................................................................... 113
Content development.......................................................................................................... 114
Immediate Action Points .................................................................................................... 115
References ............................................................................................................................. 117
Annexure 1 ......................................................................................................................... 118
Research Tool 1 .............................................................................................................. 118
Research Tool 2 ............................................................................................................. 126
Research Tool 3 .............................................................................................................. 134 viii
Research Tool 4 .............................................................................................................. 138
Annexure 2: MoU with AIR............................................................................................... 140
Annexure 3: List of Participants for National Consultation Workshop on December 19,
2019 .................................................................................................................................... 142
National Consultation Workshop on Rapid Assessment of Swasth Nagrik Abhiyan
(SNA) erstwhile IEC Programme ................................................................................... 142 ix
Acknowledgments
This report on Rapid Assessment of Swasth Nagrik Abhiyan (SNA) erstwhile IEC
Programme of MoHFW is carried out by the Indian Institute of Public Administration (IIPA),
New Delhi with support of the NITI Aayog and MOHFW.
IIPA places its sincere thanks to Dr. Rajiv Kumar, Vice Chairman, and Dr. V K Paul,
Member, NITI Aayog for reposing his confidence in IIPA by entrusting the job of carrying
out this independent and impartial evaluation.
Among the officials of NITI Aayog, we are grateful particularly to Sh. Alok Kumar, Advisor,
and Mrs. Nina Badgaiyan, Sr. Consultant Health for their kind support and cooperation
during the conduct of the study. We are also grateful to the whole team of the IEC division of
MOHFW lead by Mrs. Padmaja Singh, Joint Secretary (IEC) division, and other program
divisions.
We express our sincere thanks to the entire state, district, and block-level officials of 7 states
taken into our study for providing all relevant material and their kind cooperation and
support. We are also thankful to state representatives and National Experts who participated
in the workshop and share their opinions.
We deeply acknowledge the efforts of our senior consultant Dr. Sanjeev Kumar who has
worked in this project and helped us throughout the project and our junior consultant Dr.
Shalini Manocha who provided useful inputs in the monitoring and supervision of data
collection, data cleaning, analysis, interpretation and writing of the report.
Our sincere thanks are also due to our data collection agency who helped us not only data
collection and but also in designing software for the same.
Finally, we are also thankful to Director IIPA and IIPA administration for providing required
administrative support to conduct this study.
Pawan Kumar Taneja Roma Mitra Debnath
x
Abbreviations
AIDS : Acquired Immune Deficiency Syndrome
AIR : All India Radio
ANM : Auxiliary Nurse Midwifery
ATR : Action Taken Report
AWW : Anganwadi Worker
BARC : Broadcast Audience Research Council
BCC : Behavior Change Communication
BPM : Block Programme Manager
CHC : Community Health Centre
CMO : Chief Medical Officer
CRM : Common Review Mission
CVD : Cardio-vascular Disease
DD : Doordarshan
DFP : Directorate of Field Publicity
DM : District Magistrate
DPM : District Programme Manager
FB : Facebook
FGD : Focus Group Discussions
HIV : Human Immunodeficiency Virus
HPDs : High Priority Districts
IDCF : Integrated Diarrhoea Control Fortnight
IDI : In-depth interviews
IEC : Information, Education, and Communication
IIPA : Indian Institute of Public Administration
IITF : India International Trade Fair
IMI : Immunization Mission Indradhanush
IMR : Infant Mortality Rate
IPV : Inactivated polio vaccine
IRS : Indian Readership Survey
JSY : Janani Suraksha Yojana
MCTS : Mother and Child Tracking System
MMR : Maternal Mortality Ratio
MO : Medical Officer
MoHFW : Ministry of Health And Family Welfare
MoU : Memorandum of Understanding
NFHS : National Family Health Survey
NGO : Non-Governmental Organisation
NHM : National Health Mission
NIHFW : National Institute of Health and Family Welfare
NITI AYOG : National Institution for Transforming India xi
NPCDCS :
National Programme for Prevention & Control of Cancer, Diabetes,
Cardiovascular Diseases
NRHM : National Rural Health Mission
NVBDCP : National Vector Borne Disease Control Programme
OBC : Other Backward Classes
ORS : Oral rehydration Salts
PHC : Primary Health Centre
PMSMA : Pradhan Mantri Surakshit Matritva Abhiyan
PPS : Probability Proportional to Size
PRIs : Panchayati Raj Institutions
RCH : Reproductive and Child Health
RHTC : Rural Health Training Centre
SC : Scheduled Castes
SPSS : Statistical Package for the Social Sciences
ST : Scheduled Tribes
TRP : Target Rating Point
TV : Television
UNICEF : The United Nations Children's Fund
USAID : United States Agency for International Development
WHO : World Health Organisation
xii
Executive Summary
BACKGROUND
The importance of IEC for achieving better health outcomes in public health interventions
has become more significant in developing countries where health outcomes indicators are
very poor (Elmendorf et al., 2005; Waisbord and Larson, 2005). Over the last four decades,
IEC strategies have evolved to Behaviour Change Communication (BCC) strategies and
further to a more comprehensive level i.e. Social and Behavior Change Communication
(SBCC) strategies in many countries. While designing an SBCC strategy the policymakers
formulate an evidence-based, participatory, and well-targeted researched communication
intervention to address community knowledge, attitudes, and practices with an appropriate
mix of interpersonal, group, and mass media channels (McKee et al., 2014).
Like other Sustainable Development Goals (SDGs) signatories, the Indian government has
shown its commitment towards SDGs by adopting New Health Policy in 2017 focussing on
ensuring healthy lives and promoting the wellbeing of all at all ages. At the IEC front, the
policy articulates the need for the development of communication strategies and institutional
mechanisms by initiating Swasth Nagrik Abhiyan – a social movement for health.
Considering all the above developments, it became imperative to review and take stock of the
existing IEC strategy, plan, and activities of the Ministry of Health and Family Welfare
(MoHFW)
1
. NITI Aayog, the premier policy 'Think Tank' of the Government of India (GOI),
responsible for providing both directional and policy inputs to GOI assigned this task to the
Indian Institute of Public Administration (IIPA), the premier policy training and research
institute of the Government of India.
IIPA carried out this independent rapid assessment of the Central IEC strategy and activities
of the MoHFW for the Finance Commission Cycle (2017-20). The scope of this study is
restricted only to the IEC activities financed under the Central Government Scheme. It does
not include only IEC activities carried out by State Governments. The period for the field
study was August 5 to December 5, 2019. Considering resources and time constraints the
focus of the study was restricted to NITI Aayog aspirational districts.
1
Nodal Ministry for policy, planning and implementation of national health policy and programmes. xiii
OBJECTIVES OF THE STUDY
The central objective of this assessment study is to document the learning from the
experiences and bring out suggestions to improve the planning, designing, and
implementation of Swasth Nagrik Abhiyaan (IEC program) keeping in view the targets of
National Health Policy 2017.
RESEARCH PROCESS & METHODOLOGY
To meet the above assessment study objectives, a study using a cross-sectional research
design with a mixed-method research approach was planned. Both primary and secondary
data sources were used in the study. Secondary data sources include annual reports of
MoHFW, Common Review Mission (CRM) Reports, action taken report of IEC divisions,
expenditure records for IEC division, research studies by development partners and states
NHM divisions, Feedback, comments, and shares received for social media content analytics
and data on TRP published by Broadcast Audience Research Council (BARC), etc. Primary
data sources included
• Survey with the community for exposure, recall rate, and understanding for
communicated messages,
• Focus Group Discussions (FGDs) with the community for comprehension, appeal of the
theme/ specific spots and ascertaining individual health-seeking behavior change, and
• In-depth interviews (IDIs) and Face to Face Discussions with the key stakeholders at
national, state, district, and functionaries at the village level, etc. for policy planning and
implementation challenges.
The major three campaigns of MOHFW for National Vector Borne Disease Control
Programme (NVBDCP), National Programme for Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), and Immunization Mission
Indradhanush (IMI) have been selected based on the budget spent, the timing of campaigns
and relevance. To get geographical representation, the NITI Aayog’s aspirational districts are
divided into 6 geographical regions i.e. North, East, West, South, Central, and North-East.
One aspirational district was selected from each region from a separate state. Since the
Northern Region has more states and aspirational districts, therefore, instead of one state, two
states (one district each) were selected from the same. The survey was carried out with 2214
beneficiaries from the community selected across 7 sample districts. In each state, 4 FGDs
were carried, out of which, one FGD was conducted only for women (especially of the rural
area) to gain female perspectives. In addition to female FGDs, two focus group discussions xiv
(one urban and one rural) were carried out in each aspirational District. Similarly, a special
focus group discussion was organized with the school children about the messages on
NVBDCP. Further, in-depth interviews and semi-structured discussions were also conducted
with various stakeholders at the national, state, district levels including grass-root level
functionaries like ASHAs, AWWs, ANMs, and school teachers. Collected quantitative data
were analyzed by using statistical software SPSS and qualitative data were analyzed with the
help of ATLAS-ti8 software.
IEC ACTIVITIES OF CENTRAL IEC DIVISION OF MOHFW
The Ministry has designed a strategic framework for targeted IEC activities encompassing
mass media, along with mid-media and inter-personal activities to disseminate information
about the various health schemes in the masses. MOHFW has a year-long
IEC/Communication Plan with a month-wise focus on health days and health themes. While
some activities are taken up to coincide with ‘Health Days’, others are week and month-
long plans for focused multi-media campaigns on schemes of the Ministry. These center
on topics such as Integrated Diarrhoea Control Fortnight (IDCF), Breastfeeding Week, and
Tobacco Control, etc. Seasonal ailments such as Dengue, Malaria, H1N1, etc. need campaigns
for a longer time. All the IEC activities have a print media component coupled with TV, Radio
Plans, Social Media, and Outdoor Media activities.
MANPOWER AT IEC DIVISION
Ministry of Health and Family Welfare has an exclusive IEC Section headed by Joint
Secretary to the GoI followed by a Director, Under Secretary, and Section Officer as an
additional charge. Other officers also look after IEC activities i.e. Chief Media, PO (AV),
Editor (Hindi), Editor (English), and DO (MMU). Some technical officers and
consultants are working for designing advertisements, issuing of media plans, Social
Media, exhibitions, etc. IEC Division has technical officers like Chief Media,
Programme Officer (AV), Editors (Hindi and English), and Consultants for traditional
and social media. They provide technical support to the Division. Further, almost all
campaigns are carried out through the Department of Audio Visual Publicity (DAVP) for
print media and private satellite and FM radio Channels or through Doordarshan (DD),
All India Radio (AIR), LokSabha TV, etc. xv
FINDINGS - EXPOSURE TO HEALTH PROMOTION MESSAGES
In general, 66 percent of rural and 72 percent of the urban sample respondents, out of 2214
respondents have seen advertisements/posters/messages educating about health and family
welfare programs without any assisted recall. After assistance, every respondent was able to
recall some health promotion messages. Respondents from the Chitrakut district of the
Northern region, have maximum exposure i.e. 86 percent followed by 75% of respondents
from the Eastern region whereas the least exposure has been observed in respondents of the
North Eastern Region i.e. 58.5%. Sixty-two percent (62%) of respondents from the Southern
and the Central region respectively have seen advertisements/posters/messages educating
about health and family welfare programs without any assisted recall.
Program Wise Exposure Level
NVBDCP Promotion Messages
Overall, 68 percent of the respondents from the rural locations across states have seen
advertisements/posters/messages related to the national vector-borne disease control program
and 72 percent of respondents, from the urban area, have seen advertisements/messages
related to a vector-borne disease control program. For the NVBDCP, in the northern region,
Chitrakut district from UP has the highest exposure level i.e. almost 85% followed by Baran
District in the western region i.e. almost 73%. The eastern region’s district Begusarai has the
least exposure level for NVBDCP i.e. almost 60%.
Exposure to NPCDCS Promotion Messages
Across the regions in the study, out of 2214 respondents, 64 percent of respondents from a
rural location across states have seen advertisements/posters/messages related to NPCDCS
and 73 percent of respondents, from an urban area, have seen
advertisements/messages/posters related to this program. There is a significant difference
within the Northern region districts i.e. Haridwar (77%) and Chitrakoot (65%) on viewership
related to NPCDCS advertisement. The western region has the lowest level of exposure to
NPCDCS health promotion messages i.e. 50.77%. Similar to NVBDCP exposure, a major
source of exposure for NPCDCS advertisements/message are TV, in health facilities and
through health workers and in posters. xvi
Exposure to IMI Promotion Messages
Compare to other programs, IMI has the highest exposure rate i.e. overall, 71 percent of
people from a rural location and 74% of urban population across regions have seen
advertisements/posters/messages related to the Mission Indradhanush (IMI) program. There
is a significant difference across the regions again and within the region on the account of the
level of exposure for Mission Indradhanush. Chitrakoot District, in the northern region, has
the highest level of exposure for IMI i.e. around 87%, followed whereas Haridwar district in
the northern region has the lowest exposure level for IMI i.e. around 60%.
FINDINGS- RECALL OF MESSAGES
First Recalled Health Promotion Message
In general, with the use of the Pareto Principle (also known as the 80/20 rule) it was observed
that, out of 2214 respondents, 80 percent of respondents could recall dengue, cancer, and
malaria-related health advertisements across regions. Very few (around 20%) could recall
other health-related advertisements.
FINDINGS- INTENTION TO BEHAVIOUR CHANGE
Disseminate Information/Motivate/Inform Others
Across programs in the study, most of the respondents or their families disseminate the
benefits of the advertisements to others. It was interesting to found that respondents in the
Northern region do not like to share information with others as compared to respondents in
other regions. For example, it was found in NVBDCP, in Ramanathapuram district of the
Southern region, almost every person i.e. 99% share and disseminate information received
with other family, friends, and known. But information-sharing habits are very less in the
northern region as in both Chitrakoot and Haridwar just 57% and 53% person
share/disseminate information with others.
Perception about Impact of Health Promotion Messages on Suggested
Actions
Overall, the majority of the respondent's regions believe that these advertisements have been
able to change their mind and action. In Chitrakut district of the Northern part of the nation,
only 5 percent of respondents reported that these advertisements have not been able to change
their mind and action, out of this 5 percent, 17 percent of respondents reported the reason for
this is no TV at their home and 11 percent of them feel that so much of information xvii
overloaded and no regional flavor in these advertisements whereas almost all respondents
were taken into our study from the Southern region felt that these advertisements have been
able to change their mind and action. Ninety-eight percent of respondents from the Central
and Haridwar district of North India respectively felt that these advertisements have a great
role in changing their minds and people’s action.
In the North-Eastern region, 85 percent of respondents believed that these advertisements
have been able to change their minds and action whereas 15 percent of respondents don’t
believe the same. Out of this 15 percent, 24 percent of respondents believe that too much
information is overloaded in these advertisements. Some respondents (18 percent) claimed
that because of the non-availability of the TV at their home and 20 percent of respondents
claimed no regional flavor in these advertisements as one of the reasons for not changing their
mind and action after watching these advertisements.
IMPLICATIONS OF THE EXPOSURE, RECALL AND INTEND TO
CHANGE FINDINGS
The rapid assessment study of the central IEC Division, MOHFW, clearly brings out that,
despite challenges and constraints, they are doing a good job and must continue to be
supported and further strengthened. It can do much better and achieve greater impact
provided some SMART, strategic, organizational, creative, operational, human, and financial
resources management is undertaken for SBCC as outlined in the following detailed analysis
of reasons for such behaviour, challenges, and way forward.
MEDIA USAGE AND BEHAVIOUR FINDINGS
Desk Review
From the desk review, it has been found that most of the IEC Strategy /Plan is based on days
and events spread across the year and there is no baseline or formative study as evidence
available to form the IEC strategy/plan. A somewhat reactive approach was adopted where
messaging only is not based on primary generated evidence but as required and needed.
Community Survey Findings
From the community survey, it has been analyzed that just 6% of the overall sample
population is having access to the radio, in a rural area it 5% whereas in urban areas it 9%.
Further, in the Southern Region, access to radio is 29% mainly due to the use of xviii
Smartphones, whereas in the Eastern and the North-Eastern region it is almost 0%. FM
Channels are mainly used while driving mainly in urban areas.
The penetration of mobile phones is just overall at 44%. In the central region, it is just 33%,
whereas in the Southern region it 52%. A significant variation across regions (UP 86%,
Uttrakhand 66%, Assam 58.5%) and within regions (across districts) have been observed
concerning exposure of health promotion messages.
Qualitative Findings from Community
During the in-depth interaction with the community members, it has been observed that most
of the community members especially in the rural areas don’t watch Paid TV Channels. Also,
religious and crime-related shows are preferred by the community on free private channels
over DD and the best time for viewing TV is 6:00 pm to 8:00 PM in the rural areas whereas
prime time in the urban areas is 8.00 PM -10.00 PM. Also, it has been observed that
viewership and preference for watching TV channels vary across regions. These findings are
supported by recent BRAC TV audience viewership reports which started segregating urban
and rural viewership data.
Findings from Interviews with Functionaries
In one of the interactions with the functionaries, it was suggested by the district
administration that the success of community radio is doubtful in the rural areas because of
the absence of radio sets and smartphones.
MEDIA PREFERENCE FINDINGS
Qualitative Findings from the Community
During the in-depth interaction with the community members, it has been noted that Inter-
Personal Communication (IPC) by ASHA and ANM is the better mode in rural settings.
Also, the respondents from the Northern, Southern and Central region suggested television as
the best medium among all other media whereas most of the respondents from Eastern,
Western, and North Eastern regions suggested that awareness workshops and seminars are
the best way to educate people of their communities. Also, the participation of the Local
Community/Faith Leaders, members of the PRIs will also be useful. These TV
advertisements/other forms of IEC help the community to better interact and understand
ASHA workers. xix
Findings from the Interactions with Functionaries
During the interaction with the functionaries, it has come out that the Miking/Munadi and the
announcements made by religious leaders has been taken up seriously by the community.
According to them, the combination of short audios and visual messages on the mobile
vans/boat is a better IEC method as done by political parties during the elections.
RECOMMENDED WAY FORWARD
Rework Communication Strategy and Media Plan as per SBCC
MOHFW needs to go beyond special days and events. It should plan a communication
strategy based on community needs (epidemiological and behavior data) and targets fixed in
NHP. Urban and rural areas are required to have separate specific strategies and media plans
to address regional priorities and challenges. In this strategy, a dynamic robust media plan is
required to be developed by considering regional and urban timing and channel preferences
mentioned above. In the media plans, rethinking, re-planning radio is required as it has lost its
relevance in rural areas. In urban areas, the penetration of digital and social media platforms
should be increased aggressively. For the rural areas, social media can be used through IPC
by grassroots level functionaries as there is very low penetration of smartphones and the
internet. The Bureau of Outreach and Communication (BOC) constituents Directorate of
Field Publicity (DFP) and Song & Drama Division (S&DD), the partner institute of MOHFW
for communication, should leverage effective partnerships for IEC strategy with Local NGOs
and community leaders as they are better heard by the community.
FINDINGS- EXECUTION OF IEC STRATEGY
Desk Review
During the desk review, it has been noted that there is no formal unified document as
“National IEC guidelines”. Some Letters/ circulars contain some operational instructions for
the NHM whereas some of the states like Madhya Pradesh and Tamil Nadu have prepared
IEC guidelines. Also, there is no formal linkage between Central IEC (SNA) Division, IEC
activities of other national programs, State IEC divisions, and the NHM funding for the IEC.
Every activity/scheme functions as a standalone activity. xx
Findings from the Interactions with Functionaries
During the in-depth interaction with the functionaries, it has come out that the District
officers do not plan and propose IEC activities as per the local needs in the district PIP.
Templates are filled as per past data or a model document shared by the state government.
Hence, neither local community needs are identified nor media planning for the same has
been done at the district level with few exceptions. Also, 25 percent of the grass-root level
functionaries didn’t receive any IEC material (Posters, Hoarding, and Booklets). Across all
the districts in the study, the district level officials and the grassroots level functionaries had
shown concerns about the delays in receiving material, and even some times, it reaches after
the scheduled campaign. No specifications about where to display and how to use a particular
IEC material are given. Further, materials to fix hoardings/banners/flex material are not sent.
According to them, the display of different IEC material in LED/LCD screens found
interesting to the community. Also, the use of PICO Projector by ASHA Supervisor/ANMs
as a pilot found useful to conduct IPC in the Uttrakhand and Tamil Nadu region. Moreover,
these TV advertisements/other forms of IEC by the state governments help ASHA/ANM
workers to better interact and make the community understand, change behavior, and sustain
it.
Study Team OBSERVATIONS
During the visits, the study team observed misplacements and out of context usage of IEC
material at several places. Also, many IEC materials received and pasted in health facilities
lead to disinterest in the community. Moreover, most of the IEC/BCC officers do not know
about his role and responsibilities beyond the routine jobs of sending and receiving IEC
materials.
Suggestions During the National Consultation Workshop
During the National Consultation Workshop, it has been suggested that the SNA division
should develop detailed National Guidelines for states so that not a single penny should get
wasted. Also, Quarterly Coordination meetings of National SNA, Programme, and State IEC
divisions should be in place, and further, the states should carry similar meetings with the
districts to improve the results. Also, it has been suggested that IEC Best Practices Summit
on IEC should be organized annually to share, learn, document, and reward IEC experiences
across the nations. xxi
WAY FORWARD
Synergising Operational and Implementation Plan
To synergize IEC operational and implementation plan at Center, State, districts, and IPC at
the village level, the SNA division should issue National Guidelines containing various
aspects of IEC planning, implementation, and evaluation. These guidelines should be
followed up with a national strategy with the regional and local level approach as mentioned
earlier. For effective partnerships to implement a national strategy, a coordination mechanism
needs to be institutionalized between the SNA division and other National Health
Programmes, States, and Districts. This mechanism may be established in the form of half-
yearly strategic planning and review meetings followed by a quarterly meeting to monitor the
progress. Further, the SNA division should organize national level IEC Summit annually to
share, learn, and reward IEC experiences across nations. In addition to the above, IEC efforts
should be integrated with other outreach schemes and databases of Centre and State
governments. For example,
a) Mobile Van used for Rashtriya Bal Swasthya Karyakram (RBSK) can be fitted with
an Audio Video screen for spreading IEC messages in the village when the RBSK
team works in the school
b) Registration data collected at OPD (mobile number with diagnosing) should be used
for sending specific IEC material or SMS.
FINDINGS: CONTENT OF ADVERTISEMENT
Desk Review
A Concurrent Evaluation of Phase II of the NRHM BCC Campaign by ORG Centre for
Social Research funded by USAID and PFI concluded that the need for producing content
that can be localized and the contents are majorly developed by the development partners.
MOHFW is not having the capacity to produce such content at its due shortage of skilled
manpower, financial resources, and research base.
Community Survey Findings
Across all the regions, 73 percent of respondents could recall in the NVBDCP advertisements
that diseases spread by mosquitos, 72 percent of respondents could recall the breeding places xxii
of mosquito whereas just 15 percent of respondents could recall that free blood examination
facility is available in all government centers.
Respondents have been asked to recall the messages communicated in the NPCDCS
advertisements. Across all regions, 56 percent of respondents could recall the risk factors
cardio-vascular diseases whereas only 7 percent of respondents could recall symptoms of
Cancer and 6 percent of respondents could recall symptoms of diabetes respectively.
Across all the regions in the study, 66 percent of respondents could recall in the IMI
advertisements that vaccination age birth to 5 years, 54 percent of respondents could recall
that seven times visit for vaccinations in 5 years is a must whereas only 17 percent of
respondents could recall that all vaccines are free of cost at Government health facility.
On analyzing the reasons for not sharing information with others, common reasons that come
up are “I am not able to understand the message properly” or “Message was not very
Interesting” across regions.
Findings from the Interactions with Functionaries
During the interaction with the functionaries, two major findings came out in this regard.
Firstly, Posters/Booklets are not very useful with too much information. They need to be
more pictorial material in a local culturally appropriate and sensitive manner. For example,
local folk dance can replace western dance on NCD posters. Secondly, Localization of IEC
material is not done. For example, for the deworming campaigns hoarding translated
deworming in the Hindi as Krimi Mukht Abhiyaan, community members did not understand
the same. It should have used simple local language like Bachoo ke Paet ke Kide
Merne/Mukti Abhiyaan.
Suggestions during the National Consolation Workshop
During the National Consultation workshop, it was suggested that standard messages should
be prepared at the centre, and the state government should involve the state medical college
PSM/community medicine departments and other local experts for localization of the
materials sent by the centre rather than just simple translation. xxiii
WAY FORWARD
1. Improve the internal capacity to generate quality content by getting consultants and
empaneling creative agencies those who will design, develop, and pre-test content based
on available Behavioural and epidemiological data
2. Content developed by donor and development agencies should be developed in
participation with SNA and just taken as given on face value.
3. Both at the National and State level engage communication specialists, Mass
communication experts, and experts in various research institutes/public health institutes
like NHIFW, IIPA, PHFI, IIMC, and PSM/community medicine department in medical
colleges to vet the content as per local needs, pre-test and validate.
4. Be innovative about content and campaign instead of just being ‘informative” and
technically and medically right considering the SBCC strategy.
5. A diverse range of content should be developed to suit and appeal to the different
regional audiences as well as the urban-rural audience.
FINDINGS - MANAGEMENT OF FINANCIAL RESOUR CES
Desk Review
The trend analysis of budgeted revised estimates (RE) for expenditure on the Swastha Nagrik
Abhiyaan (erstwhile IEC scheme) shows that overall there is a decreasing trend over the last
5 years. Similarly, in none of the years, the SNA division could spend annual budgeted funds.
The gap between budgeted and actual expenditure was the highest in the year 2017-18.
Similar to National IEC expenditure the huge gap has been observed in allocated and actual
expenditure under NHM for IEC to Sample State Governments.
The program-wise utilization of IEC funds in the last three years shows that the expenditure
on Reproductive and Child Health (RCH) is the highest among all other programs, followed
by NVBDP. Though RCH is a historical focus area of MOHFW but is expenditure does not
match with national disease profile and epidemiological data. MOHFW has to increase IEC
expenditure on NCDs and Mental Health issues, which account for almost 50% of the
discease burden. xxiv
Findings from the Interactions with Functionaries
During the detailed discussion with the MOHFW officials it was found that other than few
planned campaigns, the division spends conservatively so that they can preserve funds for the
possible contingent epidemics. Delay in receiving funds under NHM is a major cause of
unspent budget reported by state/district officials. District officials informed that either no
earmark funds or a meager amount are allocated for local level IEC which is spent for
printing stationery. There is no flexibility on national program-specific IEC Budget as even
type of media usage is fixed.
WAY FORWARD - EFFECTIVE UTILIZATION OF FINANCIAL
RESOURCES
• Increase the National budget of the SNA Division to at least double from the current
levels to fulfill the unmet demand for important public health issues like mental
health, NCDs, Geriatric care, etc. Further, additional budget allocation is needed for
PROMOTIVE care like improving immunity, exercises, healthy lifestyles, etc. to
bring a sustainable change in health-seeking behavior and improved health outcomes.
• Since epidemics/pandemics are creating inefficiencies and causing poor financial
management and unspent budget, it is recommended to create a separate replenish-
able pool of funds to finance unplanned epidemics like Ebola, ZIKA, Swine flu,
COVID 19, etc. This will help to stop diverting funds for emergencies and ignoring
daily needs.
• Streamline IEC Budgeting and fund flows & empowering State and District under
NHM is another area for action. Timely approval and disbursal of the budget at all
levels is a must for better utilization of the funds. Further, for local disease,
misconceptions, and epidemics separate IEC budget should be given to the districts.
On various National Programs, the budget on IEC should give the flexibility to choose
media as per local needs. State governments should hold quarterly discussions with
districts for the finalization of annual action plans and monitoring of the same inline
of national plans.
FINDINGS: MONITORING, EVALUATION OF IEC ACTIVITIES
Desk Review
Following are the few observations which have been made during the desk review- xxv
1. Progress of IEC activities is not monitored based on campaigns based output
indicators like exposure, recall, and behavior change indicators rather it has done
based on process indicators i.e.
• Progress on Annual Action Planned activities
• Proxy Indicator like TV viewership data of BARC India
2. No baseline or formative study as evidence to form the basis of the IEC strategy/plan
of MOHFW.
3. No impact assessment or detailed evaluation of the impact of IEC activities
• Brief studies carried to review Organizational Needs Assessment (2012),
issues and challenges faced by IEC Division of MOHFW (IIPA, 2017), or
concurrent evaluation of a campaign (2009)
• No documentation to showcase the success stories of the scheme
4. Swachh Bharat Abhiyan’s IEC monitoring and evaluation system has shown a way
forward to SNA to learn and set monitoring and impact indicators for each campaign.
Findings From the Interactions with Functionaries
During the in-depth interaction with the functionaries, it has been noted that none of the
districts covered in the study has conducted any formative/ need assessment study, which can
be used for media planning, targeted intervention, addressing misconceptions, etc. Also, in
absence of an effective monitoring system on the usage of IEC material at the district/block
level, it creates a hindrance in media planning. Besides, none of the districts or states covered
in the study has conducted any impact assessment of its IEC activities. It’s important to note
that only 29 percent of health workers maintain records of the stock of IEC materials received
and used.
WAY FORWARD RESEARCH, MONITORING & EVALUATION
There is a dire need to develop robust research, monitoring, evaluation, & documentation
system for SNA. For this purpose, a formative study for each health issue can be crowd
funded. In each district, health administration can assign the live project to final year students
from the community medicine department of medical college or Masters of social works to
carry out formative studies for different public health issues. These studies will help to xxvi
initiate localized SBCC campaigns. Based on these studies, for each campaign to monitor its
progress and success, output and outcome indicators need to be developed for each campaign.
SNA division should conduct a quarterly concurrent evaluation of IEC campaigns for
effective monitoring of progress. The outcome report of such concurrent evaluation should be
published online and reviewed during the suggested half-yearly progress meetings of central
and states IEC coordination committees. For impact assessment, as the recall rate of each
campaign is low, therefore, SNA should carry out bi-annual third party external evaluation at
the National Level to revisit the strategy.
FINDING - HUMAN RESOURCES & CAPACITY BUILDING
Desk Review
During the desk review, it has been noted that the IEC division officers are neither
professionally qualified nor equipped (in terms of resources)
or trained to chalk out M&E plan for their campaigns. There is a need to set a PMU for the
same (IIPA, 2017).
Observations during the Field Visit
During the field visits, the study team observed that out of 7 districts visited, 4 districts have
vacant district IEC official positions and with more than 50% vacant block communication
coordinator positions in each district. Also, due to lack of capacity in terms of technical
know-how, shortage of human resources, and paucity of time, state governments just carry
facial changes and do not localize IEC material open files sent by the Centre. No induction
training to newly joined District/Block/State IEC officers has been undertaken, which
resulted in the non-performance of strategic jobs (media planning, localizing the content,
planning for campaigns for local issues, contributing to DPIPs) and they are just carrying the
routine activities. No person has been given any specific or specialized training related to
IEC/SBCC at any level in recent times in any state and this has been observed even in the
central government. Only sixty-three (63) percent of the grass-root level functionaries have
received guidelines on how to use specific IEC material during monthly meetings.
WAY FORWARD HUMAN RESOURCES & CAPACITY BUILDING
1. Fill vacant sanctioned positions by upgrading job descriptions and qualifications as per
the present-day IEC requirement. xxvii
2. Set up PMU as recommended in an earlier study report by IIPA.
3. The orientation manual needs to develop for newly joined staff.
4. Three to five days Capacity Building Workshop to be organized for the district and
block Officials on SBCC.
5. Exposure visits should be organized for the central staff to state for learning and
experiencing grass-root level issues. 1
Chapter 1: Introduction
BACKGROUND
Recipients of the public health services must be well-informed about various services and
benefits available to them. The recipient of public health services are not simply users of the
services but are strategic partners in generating demand for the same. To meet these ends, the
Information, Education, and Communication (IEC) strategy of healthcare service providers
take an important function. Effectiveness of the IEC strategy is critical for the success of any
public health intervention as IEC plays a crucial role in every stage of the Programme
intervention - from awareness generation to demand generation to behavior change and
finally to social change.
IEC has evolved as a key concept in preventive care, primary health care, community health,
and health promotion (Valente 1994; Cofie, et al. 2013). The importance of IEC for achieving
better health outcomes in public health interventions has become more significant in
developing countries where health outcomes indicators are very poor (Elmendorf et al., 2005;
Waisbord and Larson, 2005). The effectiveness of the IEC strategy depends upon (1) frequent
and consistent IEC messages (2) use of right media mix i.e. use multiple media channels
(mass and interpersonal channels) (3) active participation of community workers and heads
(4) rigorous monitoring and evaluation of campaigns (5) redesign and redevelopment of
campaigns and strategy (Cofie, et al. 2013; UN IATF-Religion, 2018).
Over the last four decades, health communication programs of the governments have evolved
substantially from largely ad-hoc, isolated prescriptive medical doctor prescriptive message
to a strategic approach that treats communities and individuals as participants and as
consumers (Figueroa et al. 2002). IEC strategies have evolved to Behaviour Change
Communication (BCC) strategies and further to a more comprehensive level i.e. Social and
Behavior Change Communication (SBCC) strategies in many countries. While designing an
SBCC strategy the policymakers formulate an evidence-based, participatory, and well-
targeted researched communication intervention to address community knowledge, attitudes,
and practices with an appropriate mix of interpersonal, group, and mass media channels
(Neill McKee, 2008). Campaigns are targeted not just to educate people, rather it also
includes social change messages to dispel prevailing misconceptions, associated stigma, and
discriminations in the society (Bekele and Ali, 2008). 2
The adoption of the Sustainable Development Agenda by all United Nations Member States
in 2015, has further changed the game for communicators in development institutions,
especially in the health sector. Sustainable Development Goal (SDG) 3: ‘Ensure Healthy
Lives and Promote Wellbeing for All at all Ages’ not just provides health communicators
with a formal mandate and specific targets to raise awareness, build knowledge, and inspire
people. Rather it asked for a complete transformation of the public health system by
collaborating with new partners to reach all audiences of all ages (OECD Dev Com, 2017).
Like other SDG signatories, the Indian government has shown its commitment towards SDGs
by adopting the New Health Policy in 2017 focussing on ensuring healthy lives and
promoting the wellbeing of all at all ages. The policy recognizes the pivotal importance of
SDGs by including time-bound quantitative goals aligned to ongoing national efforts as well
as the global strategic directions, The policy envisages to attain SDG 3 through a preventive,
promotive health care orientation and ensuring universal access to good quality health care
services without anyone having to face financial hardship as a consequence (NHP, 2017). At
the IEC front, the policy articulates the need for the development of communication strategies
and institutional mechanisms by initiating Swasth Nagrik Abhiyan – a social movement for
health.
Considering all the above developments, it became imperative to review and take stock of the
IEC strategy, plan, and activities of the Ministry of Health and Family Welfare (MoHFW)
2
.
NITI Aayog, the premier policy 'Think Tank' of the Government of India (GOI), responsible
for providing both directional and policy inputs to GOI assigned this task to the Indian
Institute of Public Administration (IIPA), the premier policy training and research institute of
the Government of India. IIPA carried out an independent rapid assessment of the Central
IEC strategy and activities of the MoHFW for the Finance Commission Cycle (2017-20).
The scope of this study is restricted only to the IEC activities financed under the Central
Government Scheme. It does not include only IEC activities carried out by State
Governments. The period for the field study was August 5 to December 5, 2019. Considering
resources and time constraints the focus of the study was restricted to NITI Aayog
aspirational districts.
2
Nodal Ministry for policy, planning and implementation of national health policy and programmes. 3
OBJECTIVES OF THE STUDY
The main objective of this assessment study is to document the learning from the experiences
and bring out suggestions to improve the planning, designing, and implementation of Swasth
Nagrik Abhiyaan (IEC program) keeping in view the targets of National Health Policy 2017.
Specific objectives of this assessment study are to
• Assess the impact of IEC awareness in select aspirational districts for various
activities outlined in the scheme;
• Review the monitoring and evaluation activities undertaken in the program;
• Review the budgetary allocation and financial viability of the IEC plan in terms of
adequacy, utilization, and relevance;
• Assess the strengths and challenges in existing communication plan and strategy
because of the changing health environment; and
• Review the role of social media, electronic and print media, and mid-media activities.
RESEARCH PROCESS & METHODOLOGY
To meet the above assessment study objectives, a cross-sectional study design was used. The
study has used mixed method research i.e both qualitative and quantitative research
approaches. Both primary and secondary data sources were used in the study. Secondary data
sources include annual reports of MoHFW, Common Review Mission (CRM) Reports, action
taken report of IEC divisions, expenditure records for IEC division, research studies by
development partners and states NHM divisions, Feedback, comments, and shares received
for social media content analytics and data on TRP published by Broadcast Audience
Research Council (BARC), etc. Primary data sources included
• Survey with the community for exposure, recall rate, and understanding for
communicated messages
• Focus Group Discussions (FGDs) with the community for comprehension, appeal of the
theme/ specific spots and ascertaining individual health-seeking behavior change
• In-depth interviews (IDIs) and Discussions with the key stakeholders at national, state,
district, and functionaries at the village level, etc. for policy planning and implementation
challenges.
4
Sampling Framework
The basic design and operational plan for the communication campaigns of the IEC division
of the MOHFW are designed on basis of specific days, spread over the year. Every year, the
number of these campaigns ranges from 50-60. Considering the earnestness and paucity of
time and resources, the major three campaigns based on budget spent, the timing of
campaigns, and relevance have been selected for the study (See Table1.1). The study has
included IEC campaigns of the IEC division of MoHFW. State government IEC campaigns
under NHM funding were not included in the study.
Table 1.1: Targeted Audience and Sample Campaigns
Sample Campaigns Targeted Sample from
Community
State, District, and Block
Level
Immunization Mission
Indradhanush
• Married women from 15-
29 or Women with Child
up to 5 years
• Currently Married men:
husbands of women of 15–
29 years or a Father of
Child up to 5 years
• Mothers-in-law and
fathers-in-law of women
of 15-35 years
• Policymakers
• State Programme
Managers
• District and State IEC
Nodal Officer (BCC
Officer)
• District Immunization
Officer
• ASHA
• AWW
• ANM
• PRIs
National Vector Borne
Disease Control Programme
(NVBDCP)
• School Children
• Adults Male
• Adult Female
• Policymakers
• Program Managers
• District and State IEC
Nodal Officer
• District Malaria Officer
• School Teachers
• ANM
• ASHA
• PRIs
National Programme for
Prevention and Control of
Cancer, Diabetes,
Cardiovascular Diseases
and
Stroke (NPCDCS)
• Adults Male
• Adult Female
• Policymakers
• Program Managers
• ANM
• CMO
• MO PHC, CHC
To get geographical representation, the aspirational districts are divided into 6 geographical
regions i.e. (i) North, (ii) East, (iii) West, (iv) South, (v) Central, and (vi) North-East. One
aspirational district was selected from each region. Since the Northern Region has more states 5
and aspirational districts, therefore, instead of one state, two states (one district each) were
selected from the same (See Table 1.2).
Table 1.2 Sample Size
Region States Aspirational
District
Final
Sample Size
No. of
FGDs
IDIs
North
UP Chitrakoot 314 4 28
Uttrakhand Haridwar 315 4 28
East Bihar Begusarai 307 4 28
West Rajasthan Baran 261 4 28
South Tamilnadu Ramanathapuram 374 4 28
Central MP Vidisha 318 4 28
North East Assam Dhubri 325 4 28
Total 2214 28 196
For the survey with the community, the sample size of target beneficiaries has been
calculated statistically. The average sample size calculated for each district was 304. A total
of 2214 beneficiaries were selected for the exposure, recall rate, and understanding of
communicated messages. Field visits in all the districts were for 2-4 days. In each district,
1/3rd of the sample was collected from the urban area and the remaining 2/3rd of the sample
was taken from the two rural blocks (1/3rd each). Three teams were recruited from the fields
for 3-4 days. Since beneficiaries for two out of three targeted campaigns are the same almost
the same. Therefore, all beneficiaries except school children were part of the process. School
children's feedback was taken in Focused Group Discussions. The study team had tried to
ensure both genders should represent equally in the total sample.
Focused Group Discussions
For the school children instead of the survey, a special focus group discussion was organized
to gain insights from the school children about the message on National Vector Borne
Disease Control Programme (NVBDCP). Other than School children FGDs, since the
targeted audience in the study were diversified and heterogeneous, therefore, different
heterogeneous groups were covered to capture experiences (for measuring impact) and
viewpoint (to gain way forward). In each state, 4 FGDs were carried, out of which, one FGD
was with all women (especially of the rural area) to gain female perspectives. In addition to
female FGDs, two focus group discussions (one urban and one rural) were carried out in each
Aspirational District. Each FGD had 10-15 targeted respondents from diversified age groups.
6
In-depth Interviews
In-depth Interviews and semi-structured discussions were conducted with various
stakeholders at the national, state, and district levels.
• National Level – Joint Secretary of IEC division, Joint Secretary of NVBDCP,
Director IEC division, Under Secretary, Section Officer (IEC), Consultant IEC.
• State Level- State Program Manager and State Communication/Nodal Officer.
• District Level- Block and district officials like DM, CMO, DPM, BPM, BCMO,
DCM/DCC.
• Key Grassroots Level Functionaries: Semi-Structured In-depth interviews were
conducted with ANM, ASHA, and AWW health workers. 7
Quality Control in IDIs and FGDs
Further to ensure the high quality and proper understanding of field situation FGDs and key
Informant in-depth interviews were conducted by core team members themselves along with
a note-taker. To ensure proper transcription of qualitative data audio version of i.e. FGDs and
IDIs were digitally recorded after getting informed consent from the respondents. To avoid
loss of data, a double back up of audio files was taken daily. The audio recorded IDIs and
FGDs were transcribed and translated then these files were complemented by field notes.
Desk Review
Desk review of the existing documentation includes:
• National Family Health Survey – 4 (2015 -16)
• Situation Analyses: Backdrop to National Health Policy 2017
• National Health Policy 2017
• UN Sustainable Development Goals
• Annual Report of Ministry of Health and Family from 2012-13 to 2016-17.
• IEC material uploaded on social media platforms like Twitter, YouTube Channel,
Facebook Page
• Media Plans of MoHFW
• Annual Communication Plan and Action Taken Report (ATR) of IEC Divisions
• Detailed Expenditure summary of IEC division 8
• Media Research Users Council’s Indian Readership Survey (IRS) 2015
• Data on TV viewership published by Broadcast Audience Research Council (BARC)
• All India Listener Data of Audience Research Unit of Prasar Bharti
• Regular program reports, such as from JRM and CRM, which include BCC as one of the
key functions for achieving health outcomes
• Discrete BCC studies, such as that by NIHFW on Impact Assessment of IEC Campaign
on National Programme for Prevention and Control of Deafness; USAID-FHI Behavior
Change Communication Activities and Achievements: Lessons Learned, Best Practices
and Promising Approaches; USAID-IHBP Rapid Organizational Needs Assessment of
IEC Division of Government of India: Ministry of Health and Family Welfare; UNICEF-
ORG Centre for Social Research Assessment of Effectiveness of IEC Materials at
Integrated Counseling and Testing Centres; PFI-MCHSTAR-USAID-ORG Centre for
Social Research A Concurrent Evaluation of Phase II of the NRHM BCC Campaign
LITERATURE REVIEW
There are many BCC studies conducted in the recent past. Some of the previous studies
referred to in the conduct of this study are: Study by NIHFW on Impact Assessment of IEC
Campaign on National Programme for Prevention and Control Of Deafness; USAID-FGI
Behavior Change Communication Activities and Achievements: Lessons Learned, Best
Practices and Promising Approaches; USAID-IHBP Rapid Organizational Needs Assessment
of IEC Division of Government of India: Ministry of Health and Family Welfare; Evaluation
of IEC activities under NLEP, UNICEF-ORG Centre for Social Research Assessment of
Effectiveness of IEC Materials at Integrated Counseling and Testing Centres; PFI-
MCHSTAR-USAID-ORG Centre for Social Research A Concurrent Evaluation of Phase II
of the NRHM BCC Campaign, 2009. The key findings and recommendations which are
common to some of the studies on IEC activities are mentioned in Figure 1.1 & 1.2. 9
Figure 1.1: Challenges in Planning and Implementation of IEC activities at MOHFW
Figure 1.2: Key Recommendations from Past Studies
One of the studies was conducted in the rural area of Delhi i.e. in RHTC Bijwasan comparing
it with the urban area. The cross-sectional study design was used whereby patients coming to
Base hospital OPD of Delhi cantonment were included. The objective of the study was to
Overwhelming Focus
on Material
Development
Fire Fighting
Approach:
Messaging is not
based on Evidence
Low Budgeting &
Under Utilization of
Funds
Structural, Staffing
and Lack of Capacity
Challenges
No mechanism for
monitoring &
evaluation
Poor Planning and
Buying of Media
for mass media
campaigns
Key Recomendations of Past Studies
• National level mass media campaigns should link with state level complementary BCC approaches led by
local change agents such as ASHAs, ANMs and AWWs.
• To avoid message dilution, it may be beneficial to broadcast fewer themes with more intensity rather than
having so many different messages.
• The Ministry should consider tracking the frequency and timing of spots aired on TV and radio through a
trackin agency.
• Spots should be creative and entertaining.
• Improve budgetary planning and management.
• Strengthen Implementation and tracking.
• The Ministry should continue to conduct periodic concurrent evaluations to improve the impact of subsequent
campaigns 10
assess the malaria knowledge just before the commonwealth games in both the setups, where
intensive IEC activities were undertaken by various public health agencies. It was found that
vector control activities like IEC, fogging, source reduction, and most importantly
community participation has helped in raising the awareness levels in both the setups (rural as
well as urban). The study concluded that these activities esp. IEC activities that were
undertaken during the commonwealth games should be regularly carried out routinely in
malaria-endemic regions.
Similarly, one study was undertaken to assess the impact of Information, Education, and
Communication (IEC) on Knowledge, Attitude, and Practice on HIV/AIDS among the slum
dwellers of Dhubri town of Assam. A total of 492 slum dwellers aged 15-60 years were
selected from all the slums of Dhubri by probability proportional to size (PPS) sampling
method. The study was conducted in three stages. First, a baseline KAP survey on HIV/AIDS
was done followed by IEC intervention. Then, just after the intervention, another survey was
conducted, and after six months period, the final survey was conducted. It was found that
Eighty-seven percent of the study subjects heard about HIV/AIDS. Baseline knowledge
regarding prevention of transmission of HIV/AIDS by having one faithful sex partner was
there among 65% of the respondents, which increased amongst 82.2% of the respondents just
after the intervention and amongst 68.5% of the respondents after six months period;
similarly, knowledge of prevention by using condom increased from 70.7% to 80.3% and
76.3% of the respondents; using safe blood increased from 57.7% to 75.4% and 62.9% of the
respondents. The study concluded that these intervention programs i.e. IEC activities were
useful in enhancing the awareness regarding HIV/AIDS among the underprivileged
population.
DATA COLLECTION AND ANALYSES
The study team consisted of 4 professionals who visited all the 7 districts from August 25,
2020, to December 15, 2020. The study team spent 2 to 4 days in each district to collect and
carried out detailed discussions with all defined stakeholders. Primary data was collected by
using several research tools such as in-depth round table discussions, interviews with key
stakeholders, semi-structured questionnaires, etc. The study tools are attached in Annexure 1.
From each campaign output and outcomes were selected and these indicators were related to
viewership, reach, recall, awareness level, and individual health-seeking behavior change.
Some of the selected indicators are mentioned below: 11
• Percentage of the population exposed to the healthcare advertisement
• Percentage distribution of the population by their media exposure – TV, Radio,
Newspaper, booklets/leaflets/posters
• Percentage of the population found difficulty in understanding the advertisement
• Percentage of the population who can recall the advertisement among the rural and urban
population
• Percentage of the population who intends to take action after watching advertisements
Collected quantitative data were analyzed by using statistical software SPSS and qualitative
data were analyzed with the help of ATLAS-ti software. Obtained qualitative and quantitative
data were triangulated by using a triangulation design mixed method convergence model
(Creswell and Clark 2007) (Figure 1.3). Further, qualitative data obtained through In-depth
Interviews with National, State, and district level functionaries were analyzed by comparing
their views with plan documents and field notes with the help of strategic analysis techniques.
Figure1.3: Triangulation Design: Convergence Model (Creswell and Clark 2007, pp. 63)
LIMITATION OF THE STUDY
Considering earnestness and paucity of time and resources, just major three campaigns based
on budget spent, timing and relevance were selected for the study. The study included IEC
campaigns of the IEC division of MoHFW and allied campaigns of program divisions of
MOHFW. State government IEC campaigns under NHM funding were not being included in
the study. From each campaign, 2-3 individual level health-seeking behavior outcomes were
selected. These indicators were related to viewership, recall, awareness level, and individual
health-seeking behavior change. The study has not included service-related behavior change
indicators. The study included only aspirational districts which are not very high performing.
12
Chapter 2: IEC Activities of MOHFW
OBJECTIVES OF IEC ACTIVITIES OF MOHFW
The Information, Education & Communication (IEC) of MOHFW aims to create awareness
and disseminate information regarding the benefits available under its various
schemes/programs and to guide the citizens on accessing them. The other broad aim of the
IEC activities of MOHFW is to encourage the build-up of health-seeking behavior among
the masses in keeping with the focus on promotive and preventive health. The IEC strategy
caters to the different needs of the rural and urban masses through various communication
tools. Specifically, the main objectives of the IEC activities of MOHFW are to:
• inform people about the healthcare facilities and services available to them
• increase acceptance and uptake of government services, schemes, initiatives, and
programs
• to raise levels of public knowledge on important health issues; promote positive
attitudes and norms to facilitate health promotion and disease prevention
• reach out to various and diverse regions and communities through targeted programs
that leverage mass, mid and interpersonal media choices while harnessing the
advances in technology via the use of social media
• build capacity of the state governments to design, implement and monitor effective
communication strategies
The Ministry has taken up several, targeted campaigns focusing on Pradhan Mantri Surakshit
Matritva Abhiyan (PMSMA), Mission Indradhanush, Mother's Absolute Affection (MAA) (for
promoting breastfeeding), family planning services, new vaccines such as IPV, MR, rotavirus,
etc., TB-free India, Tobacco Control, Oral and Mental health, Blood Donation, Healthy
practices such as hand washing, for prevention and control of vector-borne diseases such as
dengue, malaria, H1N1, etc. Campaigns to counter myths and apprehensions and to inform
masses of emergency response mechanisms during outbreaks such as Ebola and Zika have used
various media platforms of traditional and new media.
13
KEY ACHIEVEMENTS
IEC has been a key component in the notable achievements of the Health Ministry, and some
illustrative ones are listed as under:
• The country rate of decline in IMR and MMR has been more than the global rate of
decline.
• Women age 20-24 years married before age 18 years (%) has come down from
47.4% to 26.8% (NFHS 4)
• The percentage of institutional deliveries has increased from 38.7% in 2005-06 to
78.9% in 2015-16 (NFHS 4)
• Institutional births in a public facility (%) have been improved from 18% to 52.1%
(NFHS 4)
• The total fertility rate (children per woman) declined from 2.7 to 2.2 (NFHS 4)
• Early initiation of breastfeeding (Children under age 3 years breastfed within one
hour of birth) has improved from 23.4% in 2005-06 to 41.6% in 2015-16 (NFHS 4).
• The percentage of children with diarrhea in the last two weeks who received oral
rehydration salts (ORS) has improved from 26% in 2005-06 to 50.6% in 2015-16.
(NFHS 4)
• As per the NFHS 4, 90.7% of the children age 12-23 months received most of the
vaccinations in public health facilities, which was 82% in 2005-06.
• The number of JSY beneficiaries has risen from 7.39 lakhs in 2005-06 more than
104.38 lakhs in 2015-16.
• The incidence of TB has reduced from 300/lakh (1990) to 217/lakh (2015), and
mortality has reduced from 76/lakh (1990) to 32/lakh (2015).
• There has been a 60.12% reduction in mortality rate and a 35.63% reduction in the
incidence of Malaria in 2015 since 2005.
• HIV/AIDS has registered a 67% decline in new infections since 2000 against the
global average of 35%. AIDS-related deaths have dipped by 54% since 2006-07
against the global average of 41%.
STRATEGIC IEC/ COMMUNICATION PLAN
The Ministry has designed a strategic framework for targeted IEC activities encompassing
mass media, along with mid-media and inter-personal activities to disseminate information 14
about the various health schemes in the masses. The year-long IEC/Communication Plan has
a month-wise focus on health days and health themes. While some activities are taken up to
coincide with ‘Health Days’, others are week and month-long plans for focused multi-
media campaigns on schemes of the Ministry. These center on topics such as Integrated
Diarrhoea Control Fortnight (IDCF), Breastfeeding Week, and Tobacco Control, etc.
Seasonal ailments such as Dengue, H1N1, etc. need campaigns for a longer time.
All the IEC activities have a print media component coupled with TV, Radio Plans, Social
Media, and Outdoor Media activities. The following sub-activities have been taken up as part
of the IEC activity. There is a mix of these depending on the need for outreach, visibility, and
the diverse audience:
Mass Media
1. Radio jingles on national and private radio, and Community Radio
2. TV spots on national and private channels
3. Out of Home (OOH) advertising including posters, banners, hoardings, public
utilities, metro rail, and airport spaces, TV screens on railway stations, bus queue
shelters, train wrap, etc.
Mid –media
The IEC Division has partnered with the Directorate of Field Publicity (DFP) for activities
such as street theatre, songs, and on-ground activities like video on wheels, projections on
screens, Melas, etc. It has also participated in annual events such as the India International
Trade Fair (IITF) at Pragati Maidan which draws lakhs of visitors, and some fairs/exhibitions
organized by State governments.
Digital Media
a. E-advertisement on select platforms and internet sites
b. Tweets and infographics to highlight various health issues
c. Videos on campaigns uploaded on YouTube; links provided on You-tube
d. SMSs like Kilkari using MCTS
e. Using mobile technology for messaging through mobile apps
15
Events
a. Media sensitization workshops at the Centre and States
b. Training and workshops for strengthening capacity at the state level
c. Press conferences and launch events
d. Visits of media persons for reporting from the field
e. Health Melas
Other activities
a. Printing of books, pamphlets, leaflets, policy documents, etc.
b. Research to provide an evidence base to IEC interventions
c. Monitoring and evaluation of the campaigns
d. Project monitoring Unit within the IEC unit at MoHFW to strengthen its
capacity
MEDIA PLAN IN ACTION
The Media Plan is monitored to ensure due implementation and mid-course correction, and
possible change in the focus to suit the need. Ministry of Health and Family Welfare has
laid renewed emphasis on promotive and preventive health which is being advocated
through expansive and targeted IEC Campaigns by using traditional as well as New
Media.
Print Media
The IEC Division regularly publishes advertisements in all the leading newspapers of
India, including regional languages. The aim of such advertisements is not only to
encourage people to adopt positive behavior but also to raise awareness and disseminate
information regarding availability and access to quality healthcare provided by the
Government. Significant health messages are delivered across the country through print
media on International Days like World Population Day, World Health Day, No
Tobacco Day, etc. For example in 2016-17, regular advertisements were published on
spreading awareness on preventing Ebola. Similar advertisements were released to create
awareness about Malaria, Dengue, Kala-Azar, etc.
The Division publishes advertisements to mark the launch of various health campaigns
like H1N1, Pulse Polio campaign, Conference on Population and Development of 16
Partners (PPD), India International Trade Fair (IITF), the launch of MAA Campaign on
breastfeeding, PMSMA (Pradhan Mantri Surakshit Matritva Abhiyan), COP 7 – Tobacco
Control Convention, India-Africa Health Summit, Mental Health Pulse Polio and Gandhi
Jayanti, to name a few.
Apart from newspaper advertisements, the IEC Division also publishes
pamphlets/booklets to disseminate information and raising awareness on crucial health
issues. These documents have been distributed to various stakeholders in advocacy
meetings, workshops, and other platforms.
MoHFW also brings out a wall calendar on various themes like ‘Newborn and Maternal
Health’. The calendar covered several issues highlighting mother and newborn care. It is
distributed to different departments of the central government, state governments, NGOs,
donor partners, etc.
Television
The IEC Division uses this medium extensively to spread positive health messages
amongst its target audience. The MoHFW has signed an MoU of Rs. 50 crores for 300%
bonus airtime with Doordarshan (Prasar Bharati) for the telecast of the
spots/advertisements on policies, programs, and schemes of this Ministry (See Annexure
3 for MoU between MoHFW and Doordarshan (Prasar Bharati)). The signed MOU is
utilized at the National Network and 300% bonus airtime is utilized through all Regional
DD Kendras in the States. The objective is to highlight policies, programs, and schemes
of the Health Ministry at the grassroots level. The DD has also telecast spots on
Reproductive Child Health (RCH) and Non-RCH themes on different occasions on the
national network as well as through regional channels. TV and radio spots are aired
during the launch of Intensified Diarrhoea Control Fortnight, National Nutrition Week
and National Breast Feeding Week, etc. Educative and informative TV spots have been
telecast on Doordarshan and satellite channels to spread awareness on Swine Flu,
Dengue, ZIKA, and other crucial health issues. This highlights the symptoms, ways to
protect oneself against it, and the need for timely medical help. The Ministry has also
coordinated the production and telecast of programs on the Lok Sabha Channel. 17
The Ministry also uses media like Satellite Channels, Digital Cinemas as well as FM
Channels through DAVP from time to time to air/broadcast spots on critical issues on
Maternal Health, Child Health, Family Planning, Adolescent Health, and Immunization.
Radio
The Ministry has approved an amount of around Rs. 25 crores for the broadcast of the
spots on all health issues of this Ministry particularly Swine Flu, Dengue, Zika, and other
health issues. The programs are broadcast through Primary channel/ Local Radio
Stations, Vivid Bharati, Regional News, News Bulletin on FM Gold, Mann ki Baat and
National network in the national news broadcast from Delhi in the morning and evening.
Radio jingles are played on private radio stations and FM channels of AIR to create
awareness regarding Dengue & Chikungunya. This provides information on its
symptoms, ways to protect oneself, and encourages timely medical intervention.
Bureau of Outreach and Communication (BOC)
The Ministry of Health & Family Welfare has also utilized the services of the Bureau of
Outreach and Communication (BOC) previously known as Directorate of Advertising and
Visual Publicity (DAVP) through channels empaneled with DAVP within guidelines
approved by the MoIB. The MoHFW avails of the services of all national and regional
satellite channels, all FM radios, Community Radios as well as Digital Schemes for
highlighting the issues related with RCH/Non-RCH.
Social Media
Social Media is being used by the Ministry for coverage of events as well as for the
dissemination of health messages to people. Currently, MoHFW uses the two most
popular social media services: YouTube and Twitter. Videos related to health are
uploaded regularly on YouTube with their links tweeted through its twitter handle. The
YouTube channel of the Ministry has a wide array of videos including short films, video
updates, and speeches and has had nearly 2 million views and counting.
There are more than 8 lakh followers of the Twitter handle of the Ministry. The handle
has been effectively used for various campaigns including PC&PNDT, Child Health
(MAA), PMSMA, Mission Indradhanush, Dengue & Chikungunya, etc. All the new 18
launches of Ministry have campaigned on the twitter handle viz. MAA program, NDD,
PMSMA, the new vaccine, etc. to name a few.
MoHFW has been working with the My Gov team for utilizing their ‘Creative Corner’
for designing posters for the MAA program of MoHFW besides regularly sharing info-
graphics of new schemes and programs on My Gov.
Health Pavilion at Fairs
The Ministry of Health & Family Welfare participates in fairs also to disseminate
information and awareness on health issues. MoHFW is regularly participating in the
India International Trade Fair (IITF) at Pragati Maidan, New Delhi every year. During
the trade fair, visitors are offered free health check-ups, counseling for population
stabilization, HIV/AIDS, family planning methods, yoga demonstration for lifestyle
diseases, etc. Additionally, the fair includes performances by the Song and Drama
Division of the Ministry of Information and Broadcasting, health quiz, interactive
lectures by health experts, “Swasthya Chetna” stalls for screening for Non-communicable
diseases viz. diabetes, cancer, and oral checkups.
STRUCTURE AND ORGANOGRAM OF IEC DIVISION
Ministry of Health and Family Welfare has an exclusive IEC Section headed by
Additional Secretary, Joint Secretary to the GoI followed by a Director, Under Secretary,
and Section Officer as an additional charge. Other officers also look after IEC activities
i.e. Chief Media, PO (AV), Editor (Hindi), Editor (English), and DO (MMU). Some
technical officers and consultants are working for designing advertisements, issuing of
media plans, Social Media, exhibitions, etc.
IEC Division has technical officers like Chief Media, Programme Officer (AV), Editors
(Hindi and English), and Consultants for traditional and social media. They provide
technical support to the Division. Further, almost all campaigns are carried out through
the Department of Audio Visual Publicity (DAVP) for print media and private satellite
and FM radio Channels or through Doordarshan (DD), All India Radio (AIR), LokSabha
TV, etc. 19
Figure 2.1: Organogram of IEC Division
MANAGEMENT OF FINANCIAL RESOURCES
Figure 2.2: Total Revised estimate and actual expenditure for SNA scheme (in crores)
The trend analysis of budgeted revised estimates (RE) for the Swastha Nagrik Abhiyaan
(erstwhile IEC scheme) in Figure 2.2 shows that overall there is a decreasing trend over the
last 5 years. Similarly, in none of the year SNA division could spend annually budgeted
SECRETARY (HFW)
JOINT SECRETARY
(RCH/IEC)
TECHNICAL
Chief
(Media)
Editor (H)/
DO(MMU)
Editor
(English)
Programme
Officer (AV)
Photo Officer
ADMINISTRATION
Director (IEC)
Under Secretary
(IEC)
Section
Officer (IEC)
DIRECTOR (SMC)
SOCIAL MEDIA
CELL
(CONSULTANTS)
290.71
273.16 269.5
241.3 242
266.99
229.19
251.08
188.47
226.57
0
50
100
150
200
250
300
350
2014-15 2015-16 2016-17 2017-18 2018-19
Expenditure (in Rs. Crore)
Year
RE AE 20
funds. The gap between budgeted and actual expenditure was the highest in the year 2017-18.
During the detailed discussion with the MOHFW officials it was found that other than few
planned campaigns, the division spends conservatively so that they can preserve funds for the
possible contingent epidemics.
Financial Resources at State Level for IEC under NHM Funds
In each state for the targeted IEC/BCC interventions as per the State Programme
Implementation Plan (SPIP), there is a provision of budgeting Rs.5 per capita for the target
vulnerable population. This will also include funds for community mobilization,
identification of recently settled urban poor families and support through NGO/CSO, etc. The
details of the mobilization strategy are given each district PIP. Further, states can use Flexi
pool funds for IEC/BCC intervention. Figure 2.2 represents an analysis of budgeted (revised)
estimates Vs actual expenditure on IEC activities for the states covered in the study. Among
these states, Uttar Pradesh has the highest budget approval i.e. Rs. 14352.05 whereas another
state of the same northern region i.e. Uttrakhand have the least budget approval i.e. 671.86.
Figure 2.3 highlights also a major cause of concern similar to national IEC expenditure i.e.
the huge gap between allocated and actual expenditure on IEC activities except in the state of
Rajasthan
3
.
Figure 2.3: SPIP approvals and Expenditure on IEC activities in 2018-19
3
It is important to note that year 2018 was year of election for the state legislation.
0
2000
4000
6000
8000
10000
12000
14000
16000
UP UttrakhandBiharRajasthanTamil NaduMP Assam
14352.05
671.86
5609.48
4445.24
2180.63
4612.093390.15
9291.69
401.11
2144.86
6340.04
1907.17
2055.36
1939.02
SPIP APPROVALS(in lakhs)EXPENDITURE 21
National Programme-wise Expenditure on IEC Activities
Figure 2.4 represents the program-wise utilization of IEC funds in the last three years.
Expenditure on Reproductive and Child Health (RCH) is the highest among all other
programs, followed by NVBDP. In the year 2016-17, other programs include MOU with DD
and Prasar Bharti for the telecast of the TV spots on the national channel. In this MOU IEC
has given advertisements for the various national health programs including RCH, NCD, and
NVBDP, etc. and got 300% airtime as a bonus. Through this 300% bonus airtime, they
reached out through 25 regional Kendras to various states/UTs. Expenditure Non-
communicable diseases that account for almost 50 % of disease burden are not just minimal
but are continuously decreasing in the last three years. The expenditure on RCH and family
planning activities has increased mainly because of the launch of Mission Indradhanush over
the last three years.
Figure2.4 National Programme wise IEC Expenditure of SNA Division
Media Wise Usage of Funds
Expenditure on electronic Media including Audio & Visual i.e. TV and Radio is the highest
spend among various media options over the last three years (See Figure 2.5). It accounts for
more than 90% of total expenditure. SNA division expenditure is an Umbrella cover over
other IEC/BCC activities done through NHM. The use of Mid-media is very limited. Further
share of electronic media is increasing every year through overall expenditure is reducing.
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
Vector borne NCD RCH &family
planning
Communicable
diseases
Others
IEC Expenditure in Billion)
2016-20172017-20182018-2019 22
Figure2.5 Media wise IEC Expenditure over last 3 Years
ISSUES AND CHALLENGES FACED BY NATIONAL/ STATE/
DISTRICT LEVEL HEALTH FUNCTIONARIES
Based on in-depth interviews with the various government functionaries at national, state, and
district levels following major challenges were identified at various levels.
Localization
For various national programs to standardize the messages advertisement and other IEC
material like hoarding, wall hanging, etc. designed at the Centre are sent in open files to the
state governments. However, due to lack of capacity in terms of technical know-how, lack of
human resources, and paucity of time, the state governments either change the photograph of
the Primeminister or write the name of the state government or just simply translate/dub the
message into regional language. Further, the state governments sent IEC material to the
district level some time printed or some time in open files. But similar to the state
government due to the above-stated reasons no localization of material is done.
The study team observed in the district Haridwar, for the deworming campaigns hoarding
translated deworming into the Hindi Language as Krimi Mukht Abhiyaan but community
members were not able to relate the message with same the essence. The community
suggested it should have used simple local language like Bachoo ke Paet ke Kida Mere/Mukti
Abhiyaan as an easily understood message. Similarly, In the district Baran, after explanation
by the study team on the importance of physical exercise in the form of any dance team the
0
500000
1000000
1500000
2000000
2500000
3000000
2016-20172017-20182018-2019
Thousands
Electronic MediaPrint MediaOutdoor MediaMisc. 23
community suggested that instead of using a female doing aerobics in the IEC material, a
local lady performing local/traditional dance could have better connection and
understanding/impact of the message.
Further, it was found after in-depth interviews with district-level officials that though
theoretically said, they plan and propose IEC activities as per local needs in district PIP
which finally complied as State PIPs. But practically due to lake of human resources,
understanding, and capacity state government just send them the template and which they fill
as per past data or a model document shared by the state government. Hence, neither local
community needs are identified nor the media planning for the same are done at the district
level with few exceptions.
Logistics Challenges
Another important challenge identified at the various level is the delays in supplying IEC
Material from the State to the district and finally to the block and the sub-center level. Across
all districts, in the study, the district level officials and grassroots level functionaries
interviewed complained about the delays in receiving material. Even some time IEC material
reaches after the program day or week or so. Further, it does not have any mention of
specifications about where to display and how to use a particular IEC. This lead to a lot of
wastage of IEC material. The study team observed several misplacements and out of context
usage of IEC material. Further, materials to fix hoardings/banners/flex material are not sent.
Community members during FGDs informed the study team to material written on flex leas
to disinterest.
“My mother was hospitalized due to illness, in the female wards in district hospitals I read about
a poster on male sterilization. Throughout five days, I could not only read about full details as it
was a female ward, …. I was also feeling shy…..better could have been if it would have been in
the general waiting area….”
Male - FGD, Rural, Ramanathapuram, Southern Region
“Our state government has organized a special drive for MR (Missile and Rubella), for this, we
have been given with special focussed training for a day, and it was told to us IEC material will be
sent to you in due course, it shall be displayed at prominent places of the village. ……when I went
to PHC for other work, after the drive, I got this material related to MR vaccination. ……..what
do with this now…..”
ANM, District Baran, Western Region 24
Human Resources and Capacity Building
In most of the districts/states visited by the study team, it has found there is an acute shortage
of specialized IEC officials at the state, district, and block level. In most of the places, some
other officials have been given an additional charge of IEC activities. In places where a
person IEC/BCC officer is available, does not know about his role and responsibilities as they
are just doing routine jobs of sending and receiving IEC materials. They have not been
imparted with any orientation training. Further, no person has been given any specific or
specialized Training related to IEC /SBCC at any level in recent times. IEC related issues are
just discussed during Monthly meetings sometimes. This leads to the above-stated problems
of underspending, poor planning, monitoring, and implementation of IEC activities.
“Am I supposed to give what should be budget and what should be activities in my
district…..…………….. I know there are many misconceptions are there in some of the
tribes/communities in my area, they don’t even come forward for immunization, at the
same time they are using locally made powder as Lal Manjan, which is full of
intoxicant, leading to mouth cancer…..but what can I do for them, I am not having
any authority for this……. And we don’t have any budget for this”
District Communication Manager
Need Identification Studies, Monitoring & Evaluation
None of the districts covered in the study has conducted any formative/ need assessment
study, which can be used for media planning, targeted intervention, addressing
misconceptions, etc. In most of the places, media selection, and targeted intervention are
done based on plans written in District PIPs, Whims, and experiences of CMO/DPM.
Further, there is no effective monitoring system that exists on the usage of IEC material at the
district/block level. Some of the district communication officers have innovated and started
using ICT. They ask the official-in-charge at block and grass level to click and send the whats
app the photo after placing the IEC material. However, the same has been criticized by their
senior officers as it, not a full-proof system.
Further, no state government has conducted any impact assessment of their IEC activities, all
IEC activities are based on experiences and whims, without getting a real community
perspective. 25
Financial Resources Planning and Utilization
During the study visit, District communication Officers and District Magistrate complained
that there are no earmark funds or a very small amount in budgets for local level IEC. Most
of the time this money is spent on printing letterheads or some pamphlets. Further, there is
no flexibility on national program-specific IEC Budget as IEC activity is fixed even type of
media usage is fixed.
“In the national malaria program, we have got Rs. 45000 for IEC activities, it has not
just fixed the amount……… it also is written we have to spend this money on giving
advertisements on cable TV scrolls. Now, in our district, most of the time in the
evenings the electricity is a major problem when people are at home, most of the rural
population is illiterate in the community where malaria and dengue cases are
happening, people prefer to listen to announcements by miking which is much
cheaper and effective……….what should we do, …………….just doing tick mark
work”
Chief Medical Officer, Northern Region
Further, delays in the release of budgets on national program heads lead to most of the time
unspent IEC budget.
Media Plan and Strategy
The study team felt that in most of the districts, state, and at the national level are following
the tick-box approach. No officer has a clear cut vision, plan, sense of urgency, and strategy
towards the community for which they are responsible. Most of the people lack motivation
and capacity in the absence of a strategic roadmap and shared vision.
Since health is the state subject as per the constitution, each state government has its priority
areas of working within the health sector. Therefore, it becomes necessary money spent by
the IEC division for the national programs should be coordinated not only at the national
level among program divisions but also with the state government efforts. At present other
than the PIP approval process of the states under NHM funding, no coordination mechanism
exists. This leads to a lot of duplication of efforts and reinvention of wheels. Best practices
and learning processes from other states are missed. 26
Chapter 3: Respondents’ Profile &
Media Habits
In this chapter, an analysis of the demographic profile of the respondents have been carried to
describe their various demographic features like age, sex, location, etc. with access to various
media options like TV, radio, print, and mobile phones, time spends on various media
options.
DEMOGRAPHIC PROFILE OF THE RESPONDENTS
The study conducted semi-structured conversations with two thousand two hundred fourteen
(2214) beneficiaries which include nine hundred seventeen (917) males and one thousand
thirty-six (1036) females across all the states. More respondents were in the 25-34 years age
group followed by 15-24 years of age group as shown in Figure 3.1.
Figure3.1: Distribution of the gender across the age of respondents
27
Respondents for this particular study were from both urban and rural locations. Thirty-four
percent of respondents were interviewed from urban and 66 percent from a rural location to
assess their understanding of communicated messages. Table 3.1 exhibits the distribution of
the sample across the Blocks in six regions, under the study.
Table 3.1: Distribution of the States and the Block with Urban/Rural division
Block Name
Urban
/Rural North East
North
East South Central West
All
India
UP Haridwar Bihar Assam
Tamil
Nadu MP Rajasthan Total
Attru Rural
31 31
Antra Rural
13 12
Baran Urban
108 108
Bahadarabad Urban
105 105
Bakhri Rural
107 107
Basoda Urban
105 105
Bhagwanpur Rural
106 106
Bolagur Rural
121 121
Begusarai Urban
98 98
Dandari Rural
102 102
Debitola Rural
111 111
Gauripur Urban
104 104
Golakganj Rural
110 110
Karvi Urban 106 106
Karvi
(Ramnagar)
Rural
104 104
Krishanganj Rural
43 43
Nateran Rural
106 106
Pahari Rural 104 104
Ramanathapu
ram
Urban
154 154
Roorkee Rural
104 104
Shahbad Rural
30 30
Thiruppullani Rural
99 99
Vidisha Rural
107 107
Others Rural
36 36
Total 314 315 307 325 374 318 261 2214
ACCESS TO MEDIA
The analyses of the collected data from the six regions, it has been found that a majority of
respondents have access to TV followed by mobile and newspaper, whereas; access to radio
is least across the country. The Southern region of India, having a massive 94 percent of 28
people access TV followed by the Northern region with 86 percent of people having access to
TV. However, the least access to TV is seen in the Eastern region of India where only 60
percent of people have access to TV as shown in Table 3.2.
To drive large-scale socio-economic change, the Government of India prefers to use mobile
technology over other media through programs like Digital India, but the study finds that
mobile usage is limited to only 44 percent across the country. In the Central region of India,
mobile access is only 33 percent whereas, the highest in southern India is 52 percent.
Similarly, access to newspapers across the country is less as compared to TV and Mobile.
However, despite having an 80 percent literacy rate in Tamil Nadu, access to the newspaper
is just 25 percent.
Table 3.2: Percentage of Sample Population having Access to Different Media
Access to
Media North East North East South Central West
All
India
UP Uttrakhand Bihar Assam
Tamil
Nadu MP Rajasthan
Total
TV 86% 82% 60% 73% 94% 85% 82% 80%
Radio 4% 6% 0% 0% 29% 2.50% 2% 6%
Mobile 41% 47% 38% 46.50% 52% 33% 50% 44%
Newspaper 44% 33% 25% 11% 25% 32% 54% 32%
Figure3.2 Access to Media among the Rural and Urban Population in India
As depicted in Figure 3.2, access to mobile is almost the same in both the locations, whereas,
access to TV is 86 percent in the urban location and 78.5 percent in rural locations among the
urban and rural populations. Similarly, access to the newspaper is more in the urban area as
79%
5%
44%
31%
86%
9%
46%
38%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TV Radio Mobile Newspaper
Rural
Urban 29
compared to the rural area. Access to radio is just 5 percent in the rural locations and 9
percent in the urban areas. Similar findings are found in qualitative discussions/interviews.
“…..I don’t have a radio. Further, I don’t think anyone in our village would be
having the radio set……. Radio is an old fashion thing in today’s modern area of TV
and mobiles………”
(FGD Participant; Rural block, North Eastern Region)
“…….Why should we listen to the radio, we have a TV at our home, in the evening
everyone watches a TV at his/her home, Radio is there in my father smartphone, but it
does not get any radio signal at our home, I tried so many time, I play a game on my
father’s phone, when so ever get time…….I watch TV after going back home from
here (school)……..”
(Class X student, School FGD Participant, Rural block; Southern region)
“Radio was a good medium of entertainment, we used to enjoy cricket commentary
and Binaca Geetmala program in our young days but with the coming of cable and
Dish TV, it becomes redundant, nobody listens to radio or transistors, and in today's’
world radio is unavailable in market……. Those who won't listen to songs they get
his/her favorite 1000 songs downloaded in their phone for just Rs. 10 from the corner
shop…… sir tell me why one needs radio…. Time has changed sir…..”
(FGD Participant, Rural block; Northern region)
“I love listening to the radio while driving back home from the office on my mobile
phone as you can enjoy a mix of old and new songs on the FM channel…….. Radio
set, haa haa (laughing) that I have never seen, my grandfather might have used
that….……...”
(FGD Participant Urban block; MP; Central region)
“In our district, I have got a proposal to set up community radio in some of the
backward blocks…….. I found it very useful in our university days on our campus, we
use to get many updates on happenings on the campus and show our talent on
community radio………… I am not sure of the success of the same in villages as
people do not have radio instruments and most of the people don’t have a 30
smartphone…… people love to watch a movie on TV and other serials….Frankly, I
am not very sure……..”
(District Magistrate, X Region)
“We are illiterate, how would we read newspapers, this is man’s work, one person
read and tell the news to other on the Choopal……..did not get much time whole day
busy, we go to the field, take care of cows, kids, cook food, we watch some time TV
while cooking food……”
(FGD Participant, Rural Women Focus Group Discussion, Western Region)
Region-wise Analyses of Access to Various Media
Access to TV in Different Regions
Across the country, 78.5 percent of people from rural areas have access to TV whereas in the
urban area, 86 percent of people have TV access.
In the rural area, the majority of respondents i.e. 90 percent from the Southern region have
access to TV followed by respondents from the Northern region. In the same area, the least
TV access has been seen among respondents from the Eastern region as shown in Table 3.3.
In the urban area, 99.4 percent of respondents from the Southern region have TV access,
followed by 95 percent of respondents from the Central region and the least TV access has
been observed in 77 percent of respondents from the North-east region.
Table 3.3: Region-wise Access to TV as per Location
Region State Rural Urban
Northern UP 87.5% 84%
Uttrakhand 81% 84%
Southern Tamil Nadu 90% 99.4%
North-East Assam 71.5% 77%
Central MP 80% 95%
Western Rajasthan 80% 82%
Eastern Bihar 60% 84%
All India Total 78.5% 86%
A cross-tabulation is done between the age of the participants and Rural/Urban having access
to TV and has been presented in Table 3.4. Across the country, TV access is more among 15- 31
24 years age group followed by the 25-34 years age group and the least TV access has been
observed in 45 years and above group in both the locations.
A common trend has been observed in the Northern, Southern, and North-eastern regions in
terms of access to TV for the age group of 15-24 in both rural and urban locations. This age
group has more access to TV as compared to any other age group in the study. In the Central
region, respondents residing in rural locations having the highest access to television belong
to 35-44 years of age group whereas, in the eastern region, the highest TV access has been
seen in 45 years and above group people residing in the urban location.
Table 3.4: Cross-tabulation between Access to TV and Age of respondents
Rural/Urban Age of Respondents
15 – 24 years 25 – 34 years 35 – 44 years > 45 years
UP Rural
91.5% 84.2% 83.9% 89.5%
Urban
90.0% 86.3% 77.3% 76.9%
Uttrakhand Rural
85% 88% 68% 74%
Urban
94% 93% 60% 81%
Tamil
Nadu
Rural
96% 90.5% 90% 85%
Urban
100% 97.5% 100% 100%
Assam Rural
82% 72% 72% 46%
Urban
92% 79% 62% 64%
MP Rural
80% 81% 87% 64%
Urban
95% 100% 90% 91%
Bihar Rural
68% 56% 54% 32%
Urban
79% 83% 86% 87.5%
All India Rural
84% 79% 76% 65%
Urban
92% 89% 79% 83%
Frequency of TV viewing
Respondents were interviewed about the frequency of different media which they access. It is
been observed that almost half of the sample (~ 50 percent) watches TV daily across the
country. Figure 3.3 depicts the frequency of TV viewing among rural and urban areas region
wise.
Here also, a common trend has been observed, where almost in all regions, most people
watch TV daily in both urban and rural areas. But in the urban areas of the North-eastern
region, the situation is strikingly different as a majority of people here view TV weekly.
32
Northern Region
Southern Region North East Region
Central Region Western Region
Eastern Region
Figure3.3 Region-wise Frequency of TV viewing
54%
6%
13%
27%
49%
8%
20%
24%
0%
10%
20%
30%
40%
50%
60%
DailyFortnightNeverWeekly
Rural
Urban
46%
5%
19%
30%
43%
5%
16%
36%
0%
10%
20%
30%
40%
50%
DailyFortnightNeverWeekly
Rural
Urban
57%
2%
12%
29%
73%
0%
3%
24%
0%
10%
20%
30%
40%
50%
60%
70%
80%
DailyFortnightNeverWeekly
Rural
Urban
43%
2%
29%
26%26%
4%
23%
47%
0%
10%
20%
30%
40%
50%
DailyFortnightNeverWeekly
Rural
Urban
46%
5%
20%
29%
66%
8%
6%
21%
0%
10%
20%
30%
40%
50%
60%
70%
DailyFortnightNeverWeekly
Rural
Urban
43%
7.00%
16%
33%
39%
5%
20%
35%
0%
10%
20%
30%
40%
50%
DailyFortnightNeverWeekly
Urban
Rural
24%
6%
40%
30%
71%
1%
13%14%
0%
20%
40%
60%
80%
DailyFortnightNeverWeekly
Rural
Urban 33
Access to Radio in Different Regions
As mentioned above, access to radio is less across the country. Only 5 percent of respondents
from the rural area have access to radio and in the urban area, 9 percent of respondents have
radio access as shown in Table 3.5. Among the rural population, 16 percent of respondents
from the Southern region and only 3 percent of respondents from the Western region have
access to radio whereas respondents from the Eastern and North-eastern regions residing in
the rural area only have no access to radio.
In the urban area of the Southern region, 49 percent of respondents have access to the radio
(Mostly on Smart Phones), 4 percent of respondents from both the Central and Eastern
regions respectively have radio access whereas none of the respondents from the Western and
North-eastern regions have access to radio.
Strangely, none of the respondents taken into our study from the North-eastern region has
access to radio. In both, the location i.e. urban and rural access to radio is zero.
Table 3.5: Region-wise Access to Radio as per Location
Region State Rural Urban
Northern UP 6% 1%
Uttrakhand 7% 5%
Southern Tamil Nadu 16% 49%
North-East Assam 0% 0%
Central MP 2% 4%
Western Rajasthan 3% 0%
Eastern Bihar 0% 4%
All India Total 5% 9%
India, as a country, includes persons with different backgrounds to understand the media
preference in different backgrounds each respondent has been asked about their social
category.
Across the country, radio access has been observed more in respondents of the ST category
residing in both rural and urban locations. In the Southern region, respondents who access
radio and residing in a rural area, 50 percent of them belong to the ST category and 24
percent of them belong to the OBC category. Also, respondents from the urban area having
more access radio belong to the ST category as shown in Table 3.6. 34
In the Central region, only 2 percent of respondents from the rural population having access
to radio belong to OBC and SC category. None of the respondents from the ST and General
category have radio access. Among the urban population of this region only, 11 percent of
respondents having access to radio belongs to the SC category and only 3 percent of
respondents belonging to the general and OBC category respectively have radio access
Table 3.6: Cross-tabulation between Access to Radio and Social Category
Rural/Urban Social Category
General OBC SC ST
UP Rural 6.7% 4.9% 7.5% 0%
Urban 0% 0% 6.3% 0%
Uttrakhand Rural 15% 8% 3% 0%
Urban 14% 6% 0% 0%
Tamil
Nadu
Rural 18% 24% 5% 50%
Urban 49% 44% 41% 92%
Assam Rural - - - -
Urban - - - -
MP Rural 0% 2% 2% 0%
Urban 3% 3% 11% 0%
Bihar Rural - - - -
Urban 0% 4% 6% -
All India Rural 6.6% 6.5% 3% 8%
Urban 11% 9.5% 10.6% 15%
Frequency of Radio Listening
Thus, it can be concluded that radio listening among people is very less in both rural and
urban regions across the country. Just 6 percent of people listen to radio daily across regions.
Access to Mobile in Different Regions
Across the country, 44 percent of respondents from the rural areas have access to mobile
whereas, in the urban areas, 46 percent of respondents have mobile access.
Strangely, in the northern and North-eastern regions, access to mobile has been observed
more in respondents from rural regions whereas in the rest of the regions mobile access has
been observed in respondents residing in urban locations as shown in Table 3.7.
Among the rural areas, the highest mobile access has been observed in the North-eastern
region i.e. 51 percent followed by the Southern region, whereas the least-mobile access has
been seen in respondents from the Central region. 35
In urban areas, mobile access has been observed more in the Western region i.e. 55 percent
followed by the Southern region whereas the least-mobile access has been seen in
respondents from the North-eastern region.
Table 3.7: Region-wise Access to Mobile as per Location
Region State Rural Urban
Northern UP 44% 36%
Uttrakhand 51% 39%
Southern Tamil Nadu 50.5% 54.5%
North-East Assam 51% 35.5%
Central MP 26% 48%
Western Rajasthan 45% 55%
Eastern Bihar 38% 53%
All India Total 44% 46%
A cross-tabulation is done between the age of the participants and Rural/Urban having access
to mobile and has been presented in Table 3.8. Across the country, mobile access is more
among respondents of 15-24 years age group and the least access to mobile has been
observed in 45 years and above group in both the locations.
Table 3.8: Cross-tabulation between Access to Mobile and Age of respondents
State/ Area Age of Respondents
15 – 24 Years 25 – 34 years 35 – 44 years > 45 years
UP Rural 56% 47% 29% 5%
Urban 50% 37% 18% 38.5%
Uttrakhand Rural 72% 61% 32% 23%
Urban 56% 46% 35% 19%
Tamil Nadu Rural 80% 66% 38% 29%
Urban 46% 57.5% 55% 53%
Assam Rural 81% 52% 39% 3%
Urban 67% 29% 17% 18%
MP Rural 43% 28% 17% 4%
Urban 59% 51% 35% 18%
Bihar Rural 49.5% 33% 23% 10.5%
Urban 29% 47% 64% 54%
All India Rural 64% 48% 30% 13%
Urban 51% 45% 63% 34%
36
A common trend has been observed in the Northern, North-eastern, and Central regions in
terms of access to mobile for the age group of 15-24 in both rural and urban locations. This
age group has more access to the mobile as compared to any other age group in the study.
In the Southern and Eastern regions, respondents residing in a rural location have the highest
access to mobile belong to the 15-24 years group only whereas respondents from the same
region but from the urban area having the highest access to mobile belong to the 25-34 years
age group and 35-44 years group respectively.
Frequency of Mobile users
Across the country, 33 percent of respondents use mobile daily and 8 percent of them use
mobiles weekly. Figure 3.4 depicts the frequency of mobile users among rural and urban
areas of all regions. It has been observed that almost in all regions, most people never use
mobile phones followed by respondents who use mobile daily in both urban and rural areas.
Access to Newspaper in different regions
Access to the newspaper is comparatively less in comparison to TV and mobile across the
country. Overall, only 31 percent of respondents from the rural areas have access to
newspapers whereas, in the urban areas, 38 percent of respondents have newspaper access as
shown in Table 3.9.
Table 3.9: Region-wise Access to Newspaper as per Location
Region State Rural Urban
Northern UP 49% 34%
Uttrakhand 34% 31%
Southern Tamil Nadu 12% 43%
North-East Assam 9.5% 13.5%
Central MP 30% 36%
Western Rajasthan 57% 49.5%
Eastern Bihar 25% 56%
All India Total 31% 38%
In all-regions, newspaper access has been observed more in respondents from the urban area
except for the Northern and Western regions where newspaper access is seen more in
respondents of rural areas.
37
Uttar Pradesh Northern Region Uttrakhand
Southern Region North East Region
Central Region Western Region
Eastern Region
Figure3.4 Region-wise Frequency of mobile viewing
45%
48%
6%
1%
55%
42%
2% 2%
0%
10%
20%
30%
40%
50%
60%
NeverDailyWeeklyFortnight
Urban
Rural
44%
6%
1%
49%
35%
3%
1%
61%
0%
10%
20%
30%
40%
50%
60%
70%
DailyWeeklyFortnightNever
Rural
Urban
23%
18%
8%
51%
45%
8%
2%
46%
0%
10%
20%
30%
40%
50%
60%
DailyWeeklyFortnightNever
Rural
Urban
34%
14%
2%
50%
24%
12%
2%
63%
0%
10%
20%
30%
40%
50%
60%
70%
DailyWeeklyFortnightNever
Rural
Urban
23%
3%
1%
74%
46%
0% 1%
53%
0%
20%
40%
60%
80%
DailyWeeklyFortnightNever
Rural
Urban
45%
48%
6%
1%
55%
42%
2% 2%
0%
10%
20%
30%
40%
50%
60%
NeverDailyWeeklyFortnight
Urban
Rural
24%
12%
2%
62%
44%
3%
0%
53%
0%
10%
20%
30%
40%
50%
60%
70%
DailyWeeklyFortnightNever
Rural
Urban 38
In the rural areas, 57 percent of respondents from the western region have access to
newspapers followed by respondents from the Northern region whereas the least newspaper
access has been observed in respondents of the Southern region. It is very strange to observe
that newspaper preference is least amongst the respondents of the Southern region from both
locations. It could be due to the shifting of the preferences to shift to mobile phones and
television.
The study tried to find out newspaper reading is common amongst the respondents of which
educational background. To understand this, a cross-tabulation is done between the
respondents residing in Rural/Urban having access to newspaper and their educational
background has been presented in Table 3.10.
It has been observed that newspaper access is more in graduates followed by respondents
who have done their education up to high secondary level whereas the least access to the
newspapers is seen in illiterates across the country.
Table 3.10: Cross-tabulation between Access to Newspaper and Education of
respondents
Rural/Urban Education of Respondents
Graduate
& above
High
Secon
dary
Illiter
ate
Literate
without
schooling
Middle Primary Secondary
UP Rural
77.5% 63% 6% 33% 37% 21% 61%
Urban
77% 50% 12% 12.5% 35% 24% 50%
Uttrakhand Rural
77% 51% 5% 0% 33% 6% 29%
Urban
77% 25% 0% 41% 14% 42%
Tamil
Nadu
Rural
4% 9% 25% 11% 23.5% 17% 11%
Urban
35% 38% 45.5% 50% 57% 44% 41%
Assam Rural
36% 17% 0% 0% 5% 6% 22%
Urban
67% 18% 0% 0% 18% 10.5% 20%
MP Rural
74% 29% 0% 0% 31% 12% 63%
Urban
52% 65% 0% 19% 11% 46%
Bihar Rural
100% 65% 2% 17% 24% 8% 39%
Urban
40% 59% 65% 67% 56% 65% 40%
All India Rural
61% 39% 6% 10% 25% 11% 37%
Urban
58% 43% 21% 21% 38% 28% 40%
39
Frequency of Newspaper reading
Table 3.11: Frequency of newspaper reading across regions
Region District Area Never Daily Weekly Fortnight
Northern
UP
Urban 67% 19% 8.50% 6%
Rural 52% 16% 17% 14%
Uttrakhand
Urban 69% 16% 9.50% 6%
Rural 66% 21% 6% 7%
Southern
Tamil Nadu
Urban 58% 40% 1% 0%
Rural 89% 9% 3% 0%
North East Assam
Urban 85% 2% 7% 7%
Rural 90% 2% 4.50% 4%
Central MP
Urban 65% 15% 14% 6%
Rural 71% 12% 11% 6%
Western Rajasthan
Urban 50% 20% 20% 10%
Rural 43% 28% 20% 7%
Eastern Bihar
Urban 44% 42% 11% 3%
Rural 75% 5% 15% 5%
Newspaper reading among the rural and urban populations across the country is less. Overall,
15 percent of respondents read the newspaper daily across the country.
40
Chapter 4: Beneficiaries’ Exposure,
Recall, and Intent to Change
Behaviour
This chapter analyses the exposure level, recall rate, and intent to behavior change of the
beneficiaries who have been exposed to health care message through different media.
Opinions of the respondents have also been analyzed about the content of the various health
promotion material used in different programs, the clarity of information supplied, the nature
of appeal used, etc. These opinions taken from the respondents include both self-recall and
assisted recall.
EXPOSURE LEVEL TO HEALTH PROMOTION MESSAGES
To evaluate the general awareness of the respondents about health-related programs, the
respondents were asked about whether they have seen/heard an advertisement/poster/
message educating about health and family welfare programs in the last one year. If yes, they
were have been asked to recall five health advertisements/ messages they can recall (Refer to
Annexure 1 – Research Tool 1; question 1.2).
Sixty-six percent of respond ents among rural location s have seen
advertisements/posters/messages educating about health and family welfare programs,
whereas; 72 percent of the urban sample have seen health-related advertisements as depicted
in Figure 4.1.
“We had seen advertisements on TV related to health, it gives not many interests, but
when ASHA DIDI and Nurse Madam explain us we understand that better, we ask
some time then, what was that advertisement...... or some time she brings with her a
booklet which carries good information with photographs......”
FGD Participant, Rural, Northern Region
“Yes, I have seen advertisement.......... when so ever we visit PHC; there are many
posters and hoarding related to mother-child health, immunization, TB, smoking,
etc...... I read some of them while waiting for the doctor.....”
FGD Participant, Rural, North-Eastern Region 41
“In our CHC, we have seen on the TV screen some of these advertisements and health
promotion messages, while waiting for our turn to meet the doctor for a checkup of
my baby, we get information about many other things...... this is a good initiative by
the doctor Sahib........ For example, I get to know about the use of contraceptives for
child distancing from the advertisement......”
FGD Participant, Rural, Western Region
“We have seen a lot of pamphlets,
which ASHA Didi bring with her,
she explains us very well .............
we don’t see much advertisement
on TV, all health-related things
are shared by ASHA and ANM,
they also explain with the help of
charts which are hanged there in
Sub-Centre.......”
FGD Participant, Rural, Eastern
Region
Figure 4.1 Percentage of people seen health-related advertisements/posters/messages
among the rural &urban population
66%
72%
0%
10%
20%
30%
40%
50%
60%
70%
80%
RuralUrban 42
Table 4.1 Seen Advertisement /Posters/Message educating about Health and Family
Welfare Programme
Region State
District Has Seen an
advertisement/poster
Northern
UP Chitrakut 86.0%
Uttrakhand Haridwar 66.0%
Southern Tamil Nadu Ramanathapuram 62.0%
North East Assam Dhubri 58.5%
Central MP Vidisha 62.0%
Western Rajasthan Baran 63.0%
Eastern Bihar Begusarai 75.0%
All India 69.0%
Table 4.1 depicts the percentage of respondents who have seen an advertisement/poster/
message education about health and family welfare programs in the last one year (2018-19).
It has been observed that most respondents (86 percent) from Chitrakut district in the
northern region have seen advertisements related to health programs followed by Haridwar
district where 66 percent of respondents have seen it. In the Southern and Central region, 62
percent of respondents have seen health-related advertisements or messages and in the north-
eastern region, 58.5 % of respondents have seen the same.
However, after assistance, every respondent was able to recall some health promotion
messages.
FIRST RECALLED HEALTH PROMOTION MESSAGE
With the use of the Pareto Principle (also known as the 80/20 rule), it was observed that, out
of 2214 respondents, 80 percent of respondents could recall dengue, cancer, and malaria-
related health advertisements across regions and the same can be seen in Figure 4.2. In the
northern region, 80 percent of respondents could recall dengue, malaria, cancer, and
immunization related advertisements/ posters/ messages. Similarly, in the North-eastern
region, cancer and dengue-related health messages have been recalled by 80 percent of
respondents. In the southern region, 80 percent of respondents can recall dengue-related
advertisements or messages. In the central region also, most people can recall dengue, cancer,
malaria-related health advertisements, or messages. In the eastern region, 80 percent of
people have seen cancer, TB, and dengue-related advertisements as seen in Figure 4.3. 43
Figure4.2 Overall First Recalled Health-Related Advertisement/Messages
“I watch TV in the bit and pieces in the afternoon when my kids come from the school,
most of the time they watch cartoon channels, in the evening, we (me, my mother in
law and other members) watch serials like family dramas or some religious serials
while cooking……..and you know as break comes in between I rush to the kitchen, I
have overheard some of the advertisement like Dengue Mosquitoes ad, family
planning, etc……, but did not give much notice to the issues…..but next time I’ll do
watch carefully….sorry…”
GD Participant, Urban Block, Eastern Region 44
Figure 4.3 First Recalled Health-Related Advertisement/Messages District wise
“…….on TV you know as advertisement come, we switch to other channels, but in a cinema
hall, you know, you have no chance to escape, I have seen the advertisement of Mukesh dying
due to mouth cancer after tobacco chewing, Akshay Kumar advertisement on use of sanitary
napkins in the movie theatre…..”
FGD Participant, Urban Block, Northern Region
“.........I have seen a big hoarding placed outside my daughter's school about Kirmi Mukt
Saptha when I went to drop him...... my child was given the medicine as well..... her teacher
explained to me about the same..... ”
FGD Participant, Rural, Northern Region 45
“I saw advertisement related to Dengue, ORS, Malaria, and family planning
advertisement on TV....it gives us good information and useful.....but it does not come
very often.......”
FGD Participant, Rural, Central Region
EXPOSURE LEVEL FOR SPECIFIC MOHFW CAMPAIGNS
As mentioned in the previous chapter, the study has focused on three specific programs
namely-
1. National Vector Borne Disease Control Programme (NVBDCP)
2. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular
Diseases and Stroke (NPCDCS)
3. Immunization Mission Indradhanush
For each Programme, the respondents were interviewed (i) about the advertisement seen, (ii)
in which media advertisement has been seen, (iii) number of times the advertisement seen,
(iv) recall of messages, and (v) intend to change related questions. (See Annexure –Research
Tool 1; Section 2)
NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME
Exposure to Health Promotion Messages
Figure 4.4 NVBDCP – Percentage of Respondent has seen Advertisement in rural &
urban areas
68%
72%
0%
10%
20%
30%
40%
50%
60%
70%
80%
RuralUrban 46
Overall, 68 percent of the respondents from the rural locations across states have seen
advertisements/posters/messages related to the national vector-borne disease control program
and 72 percent of respondents, from the urban area, have seen advertisements/messages
related to vector-borne disease control program as depicted in Figure 4.4. This response has
been received from a sample of 2214 respondents across all the regions in the study.
Figure 4.5 depicts the percentage of people who have seen the advertisements in all the
districts taken into the study. For the NVBDCP, in the northern region, Chitrakut district
from UP has the highest exposure level i.e. almost 85% followed by Baran District in the
western region i.e. almost 73%. The eastern region’s district Begusarai has the least exposure
level for NVBDCP i.e. almost 60%.
Source of Exposure
Overall, advertisements/messages related to NVBDCP have been seen on TV, in the health
facilities and posters, and through health workers by 80 percent of the respondents, out of
2214 respondents, across regions as depicted in Figure 4.7.
In Chitrakut district of the Northern region, 80 percent of respondents have seen the
advertisements/messages related to NVBDCP in posters, TV, hospital, and the newspapers.
In another state of the northern region i.e. Uttrakhand in Haridwar district, the majority of
respondents have seen this advertisement on TV, informed by a health worker, and in posters.
In the southern region, 80 percent of respondents have seen these advertisements on TV, in
health facilities, newspapers and listened over the radio. In the Central region, the majority of
these messages/advertisements have been seen on TV followed by informed by the health
workers and posters. However, in the North-Eastern part of the nation, the majority of people
have seen these advertisements on TV, followed by intimated by a health worker as shown
below in Figure 4.6.
47
Figure4.5 NVBDCP- Advertisement seen across districts
48
Figure 4.6 Source of Advertisement NVBDCP
49
Figure 4.7 Overall NVBDCP advertisement seen on which media
Figure4.8 Overall number of times NVBDCP related advertisements seen across regions
Figure4.9 Number of times NVBDCP related advertisement seen in all districts
12%
52%
36%
0%
10%
20%
30%
40%
50%
60%
Everyday Less than two times a
week
More than two times a
week
14%
11%
8%
0.30%
3%
13%
18%
52%
31%
36%
62%
25%
21%
46%
0%
10%
20%
30%
40%
50%
60%
70%
ChitakootHaridwarRamanathapu
ram
Dhubri VidishaBaran Begusarai
Everyday
Less than two
times in a week
More than two
times a week 50
Frequency of Exposure
Overall, the majority (around 52%) of respondents, out of 1687 respondents, across regions
have seen advertisements in less than two times a week followed by people who have seen
the advertisements more than two times a week i.e. 36 percent and only 12 percent of
respondents have watched these advertisements daily across regions as depicted in Figure 4.8
& 4.9.
Recall of Messages
Across all the regions, 73 percent of respondents could recall in the NVBDCP advertisements
that diseases spread by mosquitos, 72 percent of respondents could recall the breeding places
of mosquito whereas just 15 percent of respondents could recall that free blood examination
facility is available in all government centers as shown in Table 4.2.
Table 4.2 Overall Recall of messages of NVBDCP
Message Overall
Diseases spread by mosquito 73.0%
Breeding places of mosquito 72%
Sign and symptoms of the disease 39%
Free blood examinations in Government health centers 15%
Free treatment at all level 19%
Acceptance of Indoor residual spray 4%
Methods to prevent mosquito bites 20%
No. of Respondents (N) 1498
Table 4.3 represents the region-wise recall of the messages communicated in the NVBDCP
advertisements. The majority of respondents from the Central region i.e. 96 percent could
recall diseases spread by mosquito followed by respondents of the Southern region whereas
the least recall of this message has been observed in respondents of the North-eastern region.
The message like breading places of mosquito has been recalled by the majority of
respondents from the Northern region followed by respondents of the Central region. Only
22 percent of respondents from the north-eastern region could recall signs and symptoms of
the dengue/malaria. The messages like free blood examinations in Government health
centers, free treatment at all levels, and acceptance of indoor residual spray have been
recalled by very few respondents across the regions. None of the respondents from the North-
eastern region can recall that free blood examinations are being done in the government
health centers and free treatment at all levels is available. Similarly, only 3 percent of 51
respondents from the Southern region could recall-free treatment at all levels are available in
the health facilities.
Table 4.3 Region wise recall of messages of NVBDCP advertisements
Northern Southern Northeast Central Eastern
NVBDCP Messages UP Uttrakhand Tamil
Nadu
Assam MP Bihar
Diseases spread by
mosquito
84% 71% 86% 40% 96% 58%
Breeding places of
mosquito
93% 95% 53% 46% 78% 67%
Sign and symptoms of the
disease
34% 68% 16% 22% 45% 54%
Free blood examinations in
Government health centers
38% 11% 9% 0% 8% 20%
Free treatment at all level 47% 25% 3% 0% 15% 22%
Acceptance of Indoor
residual spray
4% 6% 5% 0% 6% 6%
Methods to prevent
mosquito bites
48% 24% 18% 0% 21% 3%
Table 4.4 depicts the cross-tabulation between the recall messages and the sources of
receiving the message. Diseases spread by mosquito messages have been on TV by 50
percent of respondents followed by messages seen in the health facilities by 22 percent of
respondents and 20 percent of respondents have seen this in posters. This message is least
seen in pamphlets, booklets and listened over the radio.
Similarly, breeding places of mosquito messages have been on TV by 49 percent of
respondents followed by messages seen in the health facilities and posters by 22 percent of
respondents and this message has been least in pamphlets, booklet, and listened over the
radio. Sign and symptoms of diseases and free blood examination in government health
centers messages have been seen on TV by 27 and 10 percent of respondents respectively
followed by posters which are seen by 11 percent and 7 percent of respondents. Both the
messages have been least seen over social media, in booklets, and listened over the radio. The
same trend has been seen in a recall of messages of free treatment at all levels and methods to
prevent mosquito bites where 13 percent of respondents have seen on TV followed by posters
and in health facilities. These messages have been least seen on the radio even compare to
social media, and booklets. It can be concluded that though the government is spending much
over the radio but radio preference among people is very least.
“....We have a dish at home but we cannot afford to buy cable connection (like TATA
Sky, Airtel TV, Videocon D2H, etc...) to watch free to air channels like Dangal, Big
Magic, Sony Pal, or some movie channels like Set Max TV, Manoranjan TV, etc....... 52
We watch TV normally after coming back from the field in the evening and while
cooking food and eating food, we go to sleep around 8:30 pm”
FGD Participant, Rural, Central Region
“We don’t like Hindi serials and movies we prefer to watch in Tamil channels like
Jaya TV, Vijya TV, Tamilan TV, etc....It has a variety of shows, movie programs,......
DD Chennai does not give very good programs but we watch the movie over it most of
the times............DD national channel is watched when a cricket match is on or like
Parade of 26
th
January etc....................”
“We watch Dangal TV, Sony Pal TV ........ on that we watch Jai Jai Shani Dev, Maha
Bharat, CID and Crime Patrol serial, etc....”
FGD Participant, Rural, Northern Region
“We prefer time to watch TV is evening 8 pm to 10:30 pm and sometimes we watch
TV at our shop in the afternoon when customers are not there, in the morning and
evening we prefer to watch News channels, etc....”
FGD Participant, Urban, Western Region
Table 4.4 Cross-tabulation between the Recall messages and the Sources of Receiving
the Message
Sources of
information
Diseases
spread
by
mosquito
Breeding
places of
mosquito
Sign and
symptoms
of the
disease
Free blood
examinations
in
Government
facilities
Free
treatment
at all
level
Acceptance
of Indoor
residual
spray
Methods
to
prevent
mosquito
bites
TV 50% 49% 27% 10% 13% 3% 13%
Radio 4% 3% 1% 1% 1% 0.30% 0.30%
Newspaper 12% 13% 7% 4% 4% 0.70% 4%
Pamphlet 4% 4% 2% 2.50% 2.50% 0.20% 2%
Booklet 4% 5% 3% 2% 2% 0.30% 1%
Poster 20% 22% 11% 7% 10% 1% 8%
Healthworker 15% 18% 10% 5% 6.50% 1% 6%
Hospital 22% 22% 10% 7% 8% 1.00% 9%
Social Media 7% 7% 3% 2% 2% 0.60% 2%
Facebook 3% 3% 2% 1% 1% 0.20% 1%
Whatsapp 2% 2% 1% 1% 0.40% 0.20% 0.60%
Twitter 0.20% 0.10% 0.10% 0.10% 0.10% 0.10% 0%
Other 0.50% 0.50% 0.50% 0.10% 0.10% 3% 0.20% 53
Intention to Behavior Change
Disseminate Information/Motivate/Inform Others
Across the regions in the study, out of 1672 respondents, 75 percent of respondents or their
families disseminate the benefits of the advertisements to others whereas 25 percent of
respondents do not facilitate to disseminate the benefits of advertisements to others. Figure
4.10 depicts the districts' wise percentage of respondents or their families who disseminate
the benefits of advertisements to others.
Figure4.10 Percentage of respondents who disseminate the benefits of advertisements or not
In Ramanathapuram district of the Southern region, almost every person i.e. 99% share and
disseminate information received with other family, friends, and known. But information-
sharing habits are very less in the northern region as in both Chitrakoot and Haridwar just
57% and 53% person share/disseminate information with others.
Reasons for not Disseminating/Share Health Promotion Message
The respondents who don’t share information with others were further probed by the
researchers to inquire about the reasons for not sharing information with others, in Chitrakoot
district, almost half of these respondents i.e. 52 percent say that they don’t have time and 36
percent believe that other people already know about this. Whereas, 24 percent of
respondents feel that they are themselves not aware much about these advertisements. 10
percent of respondents don’t feel the need to educate others and 10 percent believe that why
other people will listen to them as shown in Figure 4.11.
57%
53%
99%
83%
64%
81%
90%
0%
20%
40%
60%
80%
100%
120%
Chitakut HaridwarRamanathapuramDhubri Vidisha Begusarai Baran 54
Similarly, another region of North India i.e. in Haridwar, out of 230 respondents, 53 percent
of respondents or their families disseminate the benefits of the advertisements to others
whereas 47 percent of people do not facilitate to disseminate the benefits of advertisements to
others. Out of this 47 percent, more than half of these people i.e. 57 percent respondents say
that don’t have time and 32 percent of people don’t find it interesting whereas 27 percent of
people believe that other people already know about it. 15 percent of people feel that why
other people will listen to them as shown in Figure 4.11.
Chitrakut District
Haridwar District
Even I am not aware of
it properly
Did not find it
interesting
Did not feel the need to
educate others
They already know
Why they listen to me
I don’t have time
Can’t Explain
Figure4.11 Reasons for not disseminating the benefits of information of Northern region
In the Southern region, out of 257 respondents, only 1 percent of respondents don’t
disseminate the benefits of the advertisements to others. Out of this 1 percent, almost all
respondents believe that they are not much aware of these advertisements.
In the North-Eastern region, out of 226 respondents, 83 percent of respondents or their
families disseminate the benefits of the advertisements to others whereas 17 percent of
respondents do not facilitate to disseminate the benefits of the advertisements to others. Out
of this, half of the respondents (51 percent) feel that why others will listen to them. 21
percent of respondents don’t find it interesting and the other 21 percent believe that other
people already know about the benefits of these advertisements as shown in Figure 4.12.
Figure4.12 Reasons for not disseminating the benefits of information of North Eastern
region
24%
16%
10%
36%
10%
52%
1%
7%
32%
5%
27%
15%
57%
0%
8%
21%
8%
21%
51%
0%0%
Even I am not aware
of
We don’t find it
interesting
I don’t feel the need
to educate others
They already know
Why they will listen to
us
I don’t have time 55
In the eastern region out of 250 respondents, 82 percent of respondents or their families
disseminate the benefits of the advertisements to others whereas 18 percent of respondents
don’t disseminate the benefits of advertisements to others. Out of this 18 percent, 28 percent
of respondents believe that other people already know about it 23 percent of respondents
don’t have time and 21 percent of respondents don’t feel the need to educate others as shown
in Figure 4.13.
Figure4.13 Reasons for not disseminating the benefits of information of Eastern region
In the Central region, out of 227 respondents, 64 percent of respondents or their families
disseminate the benefits of the advertisements to others whereas 36 percent of respondents do
not facilitate to disseminate the benefits of advertisements to others.
Out of this 36 percent, more than half of these people i.e. 52 percent respondents say that
don’t have time and 32 percent of people don’t find it interesting whereas 16 percent of
respondents feel that why other people will listen to them as shown in Figure 4.14.
19%
17%
21%
28%
15%
23%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time 56
Figure4.14 Reasons for not disseminating the benefits of information of Central region
Perception about Impact of Health Promotion Messages on Suggested Actions
Overall, the majority of the respondents i.e. 95 percent across regions believe that these
advertisements have been able to change their minds and action. Only 5 percent of
respondents felt that these advertisements are not been able to change their minds and action.
This response has been received from a group of 1664 respondents.
Figure 4.15 depicts the percentage of respondents who think these advertisements have been
able to change their minds and action or not. In Chitrakut district of the Northern part of the
nation, only 5 percent of respondents reported that these advertisements have not been able to
change their mind and action, out of this 5 percent, 17 percent of respondents reported the
reason for this is no TV at their home and 11 percent of them feel that so much of
information overloaded and no regional flavor in these advertisements.
In another district of the Northern region i.e. Haridwar, only 2 percent of respondents
believed that these advertisements have not been able to change their minds and action. Out
of this 2 percent, more than half of the percent i.e. 60 percent of respondents believes that so
much of information is overloaded in these advertisements because of which they got
confused in understanding these advertisements fully and 20 percent of respondents claimed
that because of no TV and no regional flavor in these advertisements that’s why these
advertisements have not been able to change their mind and action.
In the North-Eastern region, 85 percent of respondents believed that these advertisements
have been able to change their minds and action whereas 15 percent of respondents don’t
believe the same. Out of this 15 percent, 24 percent of respondents believe that so much
6%
32%
2%7%
16%
52%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time
Any other, Specify 57
information is overloaded in these advertisements. Some respondents (18 percent) claimed
that because of no TV at their home and 20 percent of respondents claimed no regional flavor
in these advertisements as one of the reasons for not changing their mind and action after
watching these advertisements.
Figure4.15 Percentage of respondents who believes these advertisements change their mind an action
Willingness to Change to Desired Behaviour expected in NVBDCP Messages (Bed
Nets)
For any program to be successful the content, benefits, and advantages of the program have
to be understood by people and behavioral changes are needed to be understood, to accept
and internalize the concept and for taking the advantages of the program. In light of this
concept, the study approached various stakeholders and tried to understand they are intended
for behavior change. Respondents have been interviewed to know about their willingness to
use bed nets if given a choice. Overall, 85 percent of respondents across regions show their
willingness to use bed nets. Figure 4.16 shows the percentage of people who are willing to
use bed nets district wise. Across regions, respondents of the Northern region show their least
willingness to use bed nets followed by respondents from the Western region.
95%
98%
100%
85%
98%
96% 97%
0%
20%
40%
60%
80%
100%
120%
Chitakut Haridwar Ramanathapuram Dhubri Vidisha Begusarai Baran 58
Figure4.16 Willingness to use bed nets.
In Chitrakut district, out of 43 percent who were not willing to use bed nets, 50 percent of
them do not use the same because they feel claustrophobic. 40 percent of respondents do not
use bed nets because they have to share a bed with others and some felt that these bed nets
are ineffective. In Haridwar, more than 50 percent of respondents feel that bed nets are
ineffective. 29 percent of respondents reported that they cannot use bed nets because they
have to share a bed with others. Similarly, in the Southern and Eastern regions, most of the
respondents are not using bed nets because of their usage habits.
In the North-Eastern region, only 1 percent of respondents are not willing to use beds nets,
out of this 1 percent, most of them not using nets because they have to share beds and very
few felt that small bed nets become un-tucked at night.
Preferred Medium to Receive Information in Future
The study team tried to seek the respondent’s suggestion on what would be the best modality
to connect with them to propagate health-related messages. In Northern and Southern and
Central region people suggested television as the best medium among all other media
whereas the majority of people in Eastern, Western, and North Eastern regions suggested that
awareness workshops and seminars are the best way to educate people of their communities
as depicted in Figure 4.17.
57%
74%
99% 99%
90%
95%
78%
0%
20%
40%
60%
80%
100%
120%
Chitakut HaridwarRamanathapuram Dhubri Vidisha Begusarai Baran 59
Figure 4.17 Best medium to generate awareness
NATIONAL PROGRAMME FOR PREVENTION AND CONTROL
OF CANCER, DIABETES, CARDIOVASCULAR DISEASES AND
STROKE (NPCDCS)
Exposure to Health Promotion Messages
Figure4.18 NPCDCS – Exposure Level among rural & urban groups
Across the regions in the study, out of 2214 respondents, 64 percent of respondents from a
rural location across states have seen advertisement/posters/messages related to NPCDCS and
73 percent of respondents, from an urban area, have seen advertisements/messages/posters
related to this program as depicted below in Figure 4.18.
73%
84% 84%
88%
97%
68%
60%
0%
20%
40%
60%
80%
100%
120%
Chitakut HaridwarRamanathapuram Dhubri Vidisha Begusarai Baran
TelevisionPostersNewspaper Booklet/leafletsAwareness workshop
64%
73%
0%
10%
20%
30%
40%
50%
60%
70%
80%
RuralUrban 60
Figure4.19 NPCDCS Advertisement Exposure Level seen across districts
Figure 4.19 depicts the percentage of the respondents who have seen the advertisements
related to NPCDCS across districts in the study. There is a significant difference within the
Northern region districts i.e. Haridwar and Chitrakoot on viewership related to NPCDCS 61
advertisement. The Southern region district Ramanathapuram has the second-largest exposure
level. Similarly, the Western region has the lowest level of exposure to NPCDCS health
promotion messages i.e. 50.77%.
Source of the Exposure
Overall, advertisements/messages related to NPCDCS have been seen on TV, in health
facilities, and through health workers and in posters by 80 percent of the respondents, out of
2214 respondents, across regions as depicted in Figure 4.20.
Figure4.20 Source of exposure for NPCDCS related advertisements
In the Northern region, 80 percent of respondents have seen advertisements/messages related
to NPCDCS on TV, in posters, health facilities and through health worker whereas, in the
Southern region, 80 percent of respondents have seen these advertisements on TV, in health
facilities & newspaper and listened over the radio as shown in Figure 4.21. In the Central
region, the majority of these advertisements have been seen on TV followed by posters and in
health facilities, and the North East region majority i.e. 80 percent of respondents have seen
these advertisements on TV followed by social media. In the Eastern region, 80 percent of
respondents have seen these advertisements on TV, in health facilities, through health
workers, and in posters. In the Western region, 80 percent of respondents have seen these
advertisements on TV and in health facilities (Figure 4.21).
62
Figure4.21 Region Wise Source of NPCDCS advertisements Exposure
Frequency of Exposure
The majority of respondents i.e. 55 percent have seen advertisements less than two times a
week followed by 31 percent of respondents who have seen the advertisements more than two
times a week. Only 14 percent of respondents watch these advertisements daily out of 1595
respondents across regions as depicted in Figure 4.22. 63
Figure 4.23 depicts several times people have watched advertisements in all districts. In one
of the districts of the Northern region i.e. in Chitrakut, Southern, Eastern, and North Eastern
region majority of respondents have seen this advertisement less than two times a week
whereas in Central, Western, and in another part of North India, i.e. Haridwar majority of
respondents watch these advertisements more than two times a week.
Figure4.22 Overall number of times NPCDCS related advertisements seen across regions
Figure4.23 Number of times advertisement seen in all districts.
Recall of NPCDCS Messages
Across all the regions, 64 percent of respondents could recall the NPCDCS advertisements
about the risk factors of cancer, 56 percent of respondents could recall the risk factors cardio-
vascular diseases whereas only 7 percent of respondents could recall symptoms of Cancer as
shown in Table 4.5.
14%
55%
31%
0%
10%
20%
30%
40%
50%
60%
Everyday Less than two times a
week
More than two times a
week
16%
14%
12%
0.00%
6%
17%
13%
51%
27%
42%
63%
26%
34%
47%
0%
10%
20%
30%
40%
50%
60%
70%
Chitakoot Haridwar Ramanathapuram Dhubri Vidisha Baran Begusarai
Everyday Less than two times in a weekMore than two times a week 64
Table 4.5 Overall Recall messages of NPCDCS
Message Overall
Frequently getting screening for these diseases 33%
Awareness about the risk factor for cardiovascular disease 56%
Awareness about the risk factor for Cancer 64%
Cancer Symptoms 7%
Cancer is curable with early diagnosis. 9%
Awareness about the risk factor for diabetes mellitus 9%
A Healthy Lifestyle can prevent diabetes 11%
Awareness about the – sign and symptoms of diabetes 6%
No. of Respondents (N) 1463
Table 4.6 represents the region-wise recall of the messages communicated in the NPCDCS
advertisements. The majority of respondents from the Southern region i.e. 71 percent could
recall diseases spread by mosquito followed by 36 percent of respondents from the Central
region whereas the least recall i.e. 7 percent has been seen in respondents from the North-
eastern region. The majority of respondents from the Northern region could recall awareness
about the risk factor for Cancer followed by respondents of the Central region. Three and 1
percent of respondents from the Northeastern region and the Central region respectively
could recall cancer symptoms. Sadly, none of the respondents from the Northeastern region
has been able to recall message related to the sign and symptoms of diabetes mellitus, cancer
is curable with early diagnosis and a healthy lifestyle prevents diabetes.
Table 4.6 Region wise Recall messages of NPCDCS advertisements
Regions Northern Southern North
Eastern
Central Eastern
Messages/State UP Uttrakhand Tamil
Nadu
Assam MP Bihar
Frequently getting screening for these
diseases
28% 22% 71% 7% 36% 29%
Awareness about the risk factor for
cardiovascular disease (CVD)
53% 78% 37% 47% 55% 59%
Awareness about the risk factor for Cancer 90% 96% 15% 42% 91% 47%
Cancer Symptoms 6% 8% 6% 3% 1% 15%
Cancer is curable with early diagnosis. 22% 4% 8% 0% 4% 10%
Awareness about the risk factor for diabetes
mellitus
8% 19% 5% 1% 16% 3%
Healthy Lifestyle can prevent diabetes 22% 19% 5% 0% 16% 2%
Awareness about the – sign and symptoms
of diabetes
18% 1% 10% 0% 0% 1% 65
Table 4.7 depicts the cross-tabulation between the recall messages and the sources of
receiving the message. Frequently getting screening for these diseases message have been on TV
by 22 percent of respondents followed by message seen in health facilities by 10 percent of
respondents and 8 percent of respondents have seen this in posters. This message is least seen
over social media, in pamphlets, booklets, and listened over the radio.
Table 4.7 Cross-tabulation between the Recall messages and the sources of receiving the
message
Frequently
getting
screening
for these
diseases
Awareness
about the risk
factor for
cardiovascular
disease
Awareness
about the
risk factor
for Cancer
Cancer
Symptoms
Cancer is
curable
with
early
diagnose
Awareness
about the
risk factor
for diabetes
mellitus
A
Healthy
Lifestyle
can
prevent
diabetes
Awareness
about the –
sign and
symptoms
of diabetes
TV 22% 36% 42% 5% 6% 6% 8% 3%
Radio 3% 3% 2% 1% 0% 1.00% 0.00% 1%
Newspaper 5% 9% 10% 2% 2% 2.00% 2% 2%
Pamphlet 2% 3% 4% 0.60% 2.00% 0.00% 1% 1%
Booklet 2% 4% 5% 0.60% 1% 0.00% 1% 1%
Poster 8% 16% 21% 2% 4% 2% 4% 3%
Health worker 6% 14% 17% 1% 2.00% 1.00% 2% 1%
Hospital 10% 17% 22% 2% 4% 3% 4% 3%
Social Media 2% 6% 7% 1% 1% 1.00% 1% 0%
Facebook 1% 3% 3% 0% 0% 1.00% 1% 0%
Whatsapp 1% 2% 2% 0% 0.00% 1.00% 0.00% 0%
Twitter 0.30% 0.30% 2.00% 0.00% 0.00% 0.00% 0% 0%
Other 0.30% 0.60% 1.00% 1.00% 0.00% 1% 1.00% 0%
Similarly, recall messages like awareness about the risk factors for CVD and Cancer have
been seen on TV by 36 and 42 percent of respondents respectively followed by health
facilities which are seen by 17 percent and 22 percent of respondents. Both the messages
have been least seen in pamphlets and listened over the radio. The same trend has been seen
in a recall of other messages of where most of the respondents have seen these messages on
TV followed by posters and in health facilities. These messages have been least seen over the
radio, social media, booklets, etc.
Intention to Behaviour Change
Disseminate Information/Motivate/Inform Others
Across the regions in the study, out of 1593 respondents, 66 percent of respondents or their
families disseminate the benefits of the advertisements to others whereas 34 percent of
respondents do not facilitate to disseminate the benefits of advertisements to others. Figure
4.24 depicts the percentage of respondents or their families who disseminate the benefits of 66
advertisements to others across districts. Similar to the NVBDCP, in the NPCDCS, it was
found that respondents in the Northern region do not like to share information with others as
compared to respondents in other regions. For example, in one of the districts of the Northern
region i.e. Chitrakut district, out of 293 respondents, 51 percent of respondents or their
families disseminate the benefits of the advertisements to others whereas 49 percent of
respondents do not facilitate to disseminate benefits of advertisements to others.
Figure4.24 Percentage of respondents who disseminate the benefits of advertisements or not
Reasons for not Disseminating/Sharing Health Promotion Message
In the Chitrakut district of Northern Region, out of 49 percent of respondents who don’t
share/disseminate health messages with others, more than 52 percent of respondents say that
they don’t have time. The remaining 24 percent believe that other people already know about
this and 25 percent of respondents feel that they are themselves not aware much about these
advertisements properly. 20 percent of respondents don’t find these advertisements
interesting and 10 percent believe that why other people will listen to them as shown in
Figure 4.25.
Similarly, in Haridwar, out of 256 respondents, 59 percent of respondents or their families
disseminate the benefits of the advertisements to others whereas 41 percent of respondents do
not disseminate information gained to others. On asking the reasons for not disseminating the
information to others, the majority of respondents i.e. 70 percent reported that they don’t
have time and 32 percent of people don’t find it interesting whereas 34 percent of people
believe that other people already know about it. 17 percent of people feel that why other
people will listen to them as depicted in Figure 4.25.
51%
59%
62%
75%
64%
76%
93%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Chitakut Haridwar Ramanathapuram Dhubri Vidisha Begusarai Baran 67
(Chitrakut District)
(Haridwar District)
Figure4.25 Reasons for not disseminating the information in the Northern region
In the Southern region, out of 256 respondents, 62 percent of respondents or their families
disseminate the benefits of the advertisements to others whereas 38 percent of respondents do
not facilitate to disseminate the benefits of the advertisements to others. Out of this 38
percent, 88 percent believe that they are not much aware that these advertisements properly
and 31 percent of respondents don’t find it interesting and 2 percent of respondents reported
that they don’t have time as depicted in Figure 4.26.
25%
20%
5%
24%
10%
52%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to
us
I don’t have time
5%
32%
4%
34%
17%
70%
0%Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to
us
I don’t have time 68
Figure4.26 Reasons for not disseminating the information in the Southern region
Figure4.27 Reasons for not disseminating the information in the North-Eastern region
In the North-Eastern region, out of 224 respondents, 75 percent of respondents disseminate
the benefits of advertisements whereas 25 percent of respondents do not disseminate the
benefits of the advertisements to others. Out of this 25 percent, 42 percent of respondents
don’t find it interesting and 26 percent of the respondents feel that why others will listen to
their viewpoint and 12 percent of respondents believe that other people already know about
the benefits of these advertisements as shown in Figure 4.27.
In the Eastern region, out of 242 respondents, 76 percent of respondents or their families
disseminate the benefits of the advertisements to others whereas 24 percent of respondents do
not facilitate to disseminate the benefits of advertisements to others. Out of this, 24 percent of
respondents, 56 percent of respondents believe that they are not much aware of these
advertisements properly and 24 percent of respondents don’t feel the need to educate others
88%
31%
2%
8%
3%2%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time
18%
42%
4%
12%
26%
2%0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time 69
whereas 14 percent of respondents don’t find these advertisements interesting (See Figure
4.28).
Figure4.28 Reasons for not disseminating the benefits of information of Eastern region
Figure 4.29 Reasons for not disseminating the benefits of information of Central region
In the Central region, out of 219 respondents, 64 percent of respondents or their families
disseminate gained information in the advertisements to others. Out of this 36 percent, who
don’t share information with others, more than half of these people i.e. 51 percent
respondents say that don’t have time and 33 percent of people don’t find it interesting. The
remaining 15 percent of respondents feel that why other people will listen to them as shown
in Figure 4.29.
56%
14%
24%
12%
12%
10%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time
4%
33%
1%
4%
15%
51%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time 70
Perception about Impact of Health Promotion Messages on Suggested Actions
Across the regions under study, out of 1595 respondents, 87 percent of people believe that
these advertisements have been able to change their minds and action. Figure 4.30 depicts the
percentage of respondents who think these advertisements have been able to change their
minds and action.
Figure4.30 Percentage of respondents who believes these advertisements change their mind or action
In the Chitrakut district of the Northern part of the nation, only 6 percent of respondents
reported that these advertisements have not been able to change their minds and action. Out
of this 6 percent who thinks that these advertisements have not been able to change their
mind and action, half of them i.e. 53 percent of respondents reported that too much
information is overloaded which makes them confused in understanding these
advertisements, and 29 percent of respondents claimed of no TV at their home and 18 percent
found no regional flavor in these advertisements.
Similarly, in another district of the Northern region i.e. Haridwar, 2 percent of respondents
think that these advertisements have not been able to change their minds and action. Out of
this 2 percent, all respondents believe that so much of information is overloaded in these
advertisements because of which they got confused in understanding these advertisements
fully.
In the Northeastern region, 71 percent of respondents believe that these advertisements have
been able to change mind and action but 29 percent don’t believe the same. Out of this 29
percent, 72 percent of respondents believe that so much information is overloaded in these
94%
98%
77%
71%
100%
91%
96%
0%
20%
40%
60%
80%
100%
120%
Chitakut Haridwar Ramanathapuram Dhubri Vidisha Begusarai Baran 71
advertisements and 38 percent of them did not find any regional flavor in these
advertisements. That’s why these advertisements have not been able to change their mind and
action.
In the Eastern region, 91 percent of respondents believe that these advertisements have been
able to change mind and action but 9 percent don’t believe the same. Out of this 9 percent, 48
percent of respondents believe that so much information is overloaded in these
advertisements and no regional flavor in advertisements respectively. Whereas, 33 percent of
respondents, who think that these advertisements have not been able to change their minds
and action, reported that they don’t have a TV at home.
Willingness to Change to Desired Behaviour expected in NPCDCS Messages
To understand the impact of these advertisements on the behavior of the people, respondents
have been asked if they have seen anyone consuming less fried food, sugar, or quitting
smoking and tobacco after understanding these advertisements. It has been observed that
people are a bit concerned about their diet but a long way to go. Respondents from Western,
Eastern, and Central regions are in a better position than Northern, Southern, and North-
Eastern regions in terms of having less fried food in their diet as depicted below in Figure
4.31.
Figure4.31 Percentage of people who have seen others consuming less fried food and less sugar
As observed an earlier good number of people have seen cancer-related advertisements,
despite knowing the harmful effects of these diseases, people are not ready to quit smoking or
tobacco as 89 percent of respondents from North Eastern region have not seen anyone
quitting these harmful products even after understanding these advertisements. Sixty-six
57% 58%
46%
53%
66% 66%
71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Chitakut Haridwar Ramanathapuram Dhubri Vidisha Begusarai Baran 72
percent of respondents from Ramanathapuram district have also not seen people quitting
tobacco after watching these advertisements as depicted below in Figure 4.32.
Figure4.32 Percentage of people seen others quitting smoking or tobacco
In the Northern region, 95-98 percent of respondents from both rural and urban locations
have shown intend to change their behavior after watching advertisements related to the
NCPCDS program. In the Southern region, 15 percent of respondents residing in rural
location does not show any intention to bring any change in their behavior even after
watching advertisements related to this program.
Preferred Medium to Receive Information in Future
In Northern, Southern, and Central region respondents suggested television as the best
medium among all other media whereas most of the respondents from Eastern, Western, and
North Eastern regions suggested that awareness workshops and seminars are the best way to
educate people of their communities as shown in Figure 4.33. Apart from this, social media
has also been suggested by respondents of the Eastern region as the best way to generate
awareness.
48%
54%
34%
11%
38%
41%
60%
0%
10%
20%
30%
40%
50%
60%
70%
Chitakut HaridwarRamanathapuram Dhubri Vidisha Begusarai Baran 73
Figure4.33: Preferred medium to receive information in Future
MISSION INDRADHANUSH
Exposure to Health Promotion Messages
Overall, 71 percent of people from a rural location across regions have seen
advertisements/posters/messages related to the Mission Indradhanush (IMI) program and 74
percent of people, from an urban area, have seen advertisements/messages related to this
program as depicted in Figure 4.34. This response has been received from a sample of 2214
respondents across all the regions under study.
Figure4.34 Mission Indradhanush – Advertisement Exposure level among rural & urban population
0%
20%
40%
60%
80%
100%
120%
Chitakut HaridwarRamanathapuram Dhubri Vidisha Begusarai Baran
TelevisionPostersNewspaper Booklet/leafletsAwareness workshop
71%
74%
0%
10%
20%
30%
40%
50%
60%
70%
80%
RuralUrban 74
Figure 4.35 IMI- Advertisement Exposure Level across districts 75
Figure 4.35 depicts the percentage of respondents who have seen the advertisements across
the sample districts taken in the study. There is a significant difference across the regions and
within the region on the account of the level of exposure for Mission Indradhanush.
Chitrakoot District, in the northern region, has the highest level of exposure for IMI i.e.
around 87%, followed by District Begusarai in the Eastern Region. District Baran in the
Western Region and Haridwar district in the northern region are the laggards in exposure
level for IMI i.e. around 60%.
Source of the Exposure
Overall, advertisements/messages related to the IMI program have been seen on TV, in
hospital posters, and through health workers by 80 percent of the respondents, out of 2214
respondents, across regions, as depicted in Figure 4.36
Figure4.36 Overall IMI Source of Exposure
In one part of North India i.e. in Chitrakut district, 80 percent of respondents have seen
advertisements/messages related to IMI in posters, on TV, in health facilities, and through
health workers. In another region of the Northern region i.e. in Haridwar, 80 percent of
respondents have seen this advertisement on TV, by a health worker, and in posters.
In the Southern region, 80 percent of respondents have seen these advertisements on TV, in
health facilities, newspapers, and listened over the radio. In the Central and North East
region, these advertisements have been seen on TV followed by the health workers and in 76
posters by 80 percent of respondents. In the Eastern region, 80 percent of respondents have
seen these advertisements through health workers, TV, posters. In the Western region, 80
percent of people have seen this advertisement on TV and in the health facilities as shown
below in Figure 4.37.
Figure4.37 Sources of Exposure for IMI Promotion Messages 77
Frequency of Exposure
Overall, the majority of respondents (65 percent), out of 1434 respondents, across states have
55 percent of respondents have seen advertisements in less than two times a week followed
by people who have seen the advertisements more than two times a week i.e. 29 percent and
only 16 percent of respondents have watched these advertisements daily across regions as
depicted in Figure 4.38.
Figure 4.39 depicts the number of times people have watched advertisements in all districts.
In all the regions taken into the study except the Western region majority of respondents have
seen this advertisement less than two times a week. In the Western region, most people watch
these advertisements more than two times a week.
Figure 4.38 Overall number of times IMI related advertisements seen across regions
Figure 4.39 Number of times advertisement seen in all districts
16%
55%
29%
0%
10%
20%
30%
40%
50%
60%
Everyday Less than two times a
week
More than two times a
week
47%
29%
43%
73%
26%
34%
57%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Chitakoot Haridwar Ramanathapuram Dhubri Vidisha Baran Begusarai
Everyday Less than two times in a weekMore than two times a week 78
Recall of message
Across all the regions in the study, 66 percent of respondents could recall in the IMI
advertisements that vaccination age birth to 5 years, 54 percent of respondents could recall
that seven times visit for vaccinations in 5 Years is a must whereas only 17 percent of
respondents could recall that all vaccines are free of cost at Government health facility as
shown in Table 4.8.
Table4.8 Overall Recall Message of Immunization Mission Indradhanush
Message Overall
No. of times you need to take your child for vaccination 41%
Vaccinations age birth to 5 years 66%
Seven times visit for vaccinations in 5 Years 54%
Mark each Vaccination on Calendar 18%
Don’t Skip or forget any vaccination 15%
Responsibility of all of us 18%
Most important Task for the health of the child 16%
Vaccination protects/immunized child from dangerous diseases 15%
All information is written on the immunization card 16%
Go for immunization even child is sick 6%
Take care with you in case you are traveling 4%
After a Vaccination child may get fever or swelling don’t get frightened. 2%
All vaccines are free of cost at a govt health facility 17%
Name of the Celebrity depicted in the advertisement 15%
No. of Respondents (N) 1596
Table 4.9 represents region-wise recall of the messages communicated in the IMI
advertisements. Messages like vaccinations age birth to 5 years and seven times visit for
vaccinations in 5 Years have been recalled by a good number of respondents of all regions
except the Southern region. Only 1%, 2%, and 5% of respondents from the Southern,
Northeastern, and Eastern regions respectively could recall vaccination protect/immunized
children from dangerous diseases. None of the respondents from the Northeastern region can
recall all the information written on the card, the child needs vaccination even if they are sick,
all vaccines are available at the health facilities free of cost-related messages. The majority of
respondents from the Northern region could recall the name of the celebrity depicted in the
advertisements followed by 10 percent of respondents of the Southern region. None of the
respondents from the North-eastern and eastern region has been able to recall the name of the
celebrity depicted in the advertisements.
79
Table 4.9 Region wise Recall of messages of IMI Advertisements
Northern Southern North
Eastern
Central Eastern
UP Uttrakhan
d
Tamil
Nadu
Assam MP Bihar
No. of times you need to take your child for
vaccination
50% 19% 67% 39% 21% 43%
Vaccinations age birth to 5 years 90% 98% 25% 40% 90% 63%
Seven times visit for vaccinations in 5 Years 80% 77% 7% 38% 77% 51%
Mark each Vaccination on Calendar 31% 7% 10% 17% 17% 23%
Don’t Skip or forget any vaccination 16% 24% 6% 3% 29% 19%
Responsibility of all of us 36% 39% 3% 0% 22% 13%
Most important Task for the health of the
child
23% 36% 5% 1% 29% 5%
Vaccination protect/immunized child from
dangerous diseases
23% 34% 1% 2% 29% 5%
All information is written on the
immunization card
61% 18% 0% 2% 6% 4%
Go for immunization even child is sick 11% 19% 1% 0% 5% 2%
Take card with you in case you are
travelling
4% 17% 1% 0% 3% 2%
After a Vaccination child may get fever or
swelling don’t get frightened.
3% 4% 1% 0% 0% 1%
All vaccines are free of cost at govt health
facility
49% 27% 2% 1% 21% 4%
Name of the Celebrity depicted in the
advertisement
49% 17% 10% 0% 8% 0%
Table 4.10 depicts the cross-tabulation between the recall messages and the sources of
receiving the message. No. of times you need to take your child for vaccination messages
have been on TV by 29 percent of respondents followed by message seen in hospital and over
social by 15 percent of respondents and 12 percent of respondents have come to know about
these from a health worker. This message is least seen in pamphlets, booklets, and listened
over the radio.
Similarly, vaccination age from birth to 5-year message has been on TV by 45 percent of
respondents followed by message intimated by health workers i.e. 35 percent, and 28 percent
of respondents have come to know about these from posters. This message has least listened
to the radio and social media.
Recall messages like Seven times visit for vaccinations in 5 Years and mark each vaccination
on Calendar has been seen on TV by 36 and 12 percent of respondents respectively followed
by intimated from health worker which is to 31 percent and 9 percent. Both the messages
have been least seen in pamphlets and listened over the radio. The same trend has been seen
in the recall of other messages of where most of the respondents have seen these messages on
TV followed by posters and in hospitals. These messages have been least listened over the
radio and read through pamphlets. 80
Table 4.10 Cross-tabulation between the recall messages and the sources of receiving the message
Message/Media TV Radio Newspaper Pamphlet Booklet Poster
Health
worker
Hospital
Social
Media
Face
book
Whats
app
Twitter Other
No. of times you need to take your
child for vaccination
29% 3% 7% 4% 4% 4% 12% 15% 15% 3% 1% 1.00% 0.20%
Vaccinations age birth to 5 years 45% 2% 10% 6% 7% 28% 35% 25% 6% 3% 1% 0.20% 0.60%
Seven times visit for vaccinations in 5
Years
36% 1% 9% 5% 6% 24% 31% 23% 6% 2% 1% 0.20% 0.40%
Mark each Vaccination on Calendar 12% 0% 4% 2% 3% 9% 9% 8% 2% 1% 0% 0.10% 0%
Don’t Skip or forget any vaccination 10% 0% 3% 2% 1% 7% 9% 7% 1% 1% 0.30% 0.00% 0.40%
Responsibility of all of us 13% 0% 4% 3% 3% 9% 12% 9% 1% 1% 0.10% 0.00% 0%
Most important Task for the health of
the child
12% 0% 2% 2% 1% 8% 8% 6% 2% 1% 0.40% 0% 0.40%
Vaccination protect/immunized child
from dangerous diseases
11% 0% 2% 1% 1% 8% 8% 6% 2% 1% 0% 0% 0.40%
All information is written on the
immunization card
11% 0% 3% 3% 3% 11% 11% 10% 2% 1% 0.30% 0% 0%
Go for immunization even the child is
sick.
4% 0% 1% 1% 1% 4% 4% 3% 1% 0.30% 0.20% 0% 0%
Take card with you in case you are
travelling
3% 0% 1% 1% 1% 2% 2% 2% 1% 0.30% 0.30% 0.10% 0%
After Vaccination child may get fever
or swelling don’t get frightened
1% 0% 1% 0% 1% 1% 1% 1% 0.30% 0% 0% 0% 0%
All vaccines are free of cost at Govt.
health facility
12% 0% 4% 3% 2% 10% 11% 9% 2% 1% 0.40% 0% 0.40%
Name of the Celebrity depicted in the
advertisement
11% 0% 3% 3% 3% 9% 8% 1% 1% 1% 0.30% 0% 0.30% 81
Intention to Behaviour Change – Mission Indradhanush
Disseminate Information/Motivate/Inform Others
Across the regions under study, out of 1698 respondents, 73 percent of respondents
disseminate the benefits of the advertisements to others whereas 27 percent of respondents do
not facilitate to disseminate the benefits of advertisements to others. Figure 4.40 depicts the
percentage of respondents who disseminate the benefits of advertisements to others across
districts in the study. Contrary to NVBDCP and NPCDCS programs, more respondents in
Chitrakut district share and disseminate information gained about immunization programs
share with others. Similarly in District Ramanathapuram of the Southern region %age of
respondents sharing information with others is less. But, it is important to note that the full
immunization rate in Ramanathapuram is just 59%.
Figure4.40 Percentage of Respondents disseminate the benefits of advertisements
Reasons for not Disseminating/Sharing Health Promotion Message
In Chitrakut district of Northern Region, out of 309 respondents, 72 percent of respondents
disseminate the benefits of advertisements to others whereas 28 percent of respondents do not
facilitate to disseminate benefits of advertisements to others. On asking the reasons for not
disseminating the benefits of advertisements to others, more than half of the people i.e. 67
percent people believe that other people already know about these advertisements, and 36
percent of people reported that they don’t have time. Nine percent of respondents feel that
72%
58%
46%
65%
61%
80%
93%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Chitakut HaridwarRamanathapuram Dhubri Vidisha Begusarai Baran 82
they are themselves not aware much about these advertisements and 16 percent of
respondents don’t find these advertisements interesting as depicted in Figure 4.41.
Similarly, another region of North India i.e. in Haridwar, out of 222 respondents, 58 percent
of respondents disseminate the benefits of advertisements to others whereas 42 percent of
people do not facilitate to disseminate the benefits of advertisements to others. The majority
of people i.e. 61 percent respondents believe that other people already know about these
advertisements and 54 percent of respondents say that don’t have time and 11 percent of
respondents don’t find it interesting whereas 19 percent of respondents feel that why other
people will listen to them.
(Chitrakut District)
(Haridwar District)
9.30%
16.28%
10.47%
67.44%
5.81%
36.05%
0.00%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time
4%
11%
4%
61%
19%
54%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time 83
Figure 4.41 Reasons for not disseminating the information in the Northern region
In the Southern region, out of 290 respondents, 46 percent of respondents disseminate the
benefits of advertisements to others whereas 54 percent of respondents do not facilitate to
disseminate the benefits of the advertisements to others. Out of this 54 percent half of the
respondents i.e. 50 percent feel that they are not much aware of these advertisements.
Whereas 24 percent of respondents don’t find it interesting and 14 percent of respondents
believe that other people already know about these advertisements as shown in Figure 4.42.
Figure 4.42 Reasons for not disseminating the information in the Sothern region
In the North-Eastern region, out of 257 respondents, 65 percent of respondents disseminate
the benefits of advertisements to others whereas 35 percent of people do not facilitate to
disseminate the benefits of the advertisements to others. Out of this 35 percent, 53 percent of
respondents believe that other respondents already know about the benefits of these
advertisements. Whereas 28 percent of respondents don’t find it interesting and 13 percent of
the respondents feel that why others will listen to them as shown in Figure 4.43.
50%
24%
6%
14%
3%
3%0%Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to
us
I don’t have time 84
Figure 4.43 Reasons for not disseminating the information in the North-Eastern region
In the Eastern region, out of 294 respondents, 80 percent of respondents disseminate the
benefits of advertisements to others whereas 20 percent of people do not facilitate to
disseminate the benefits of the advertisements to others. Out of this 20 percent, 58 percent of
respondents believe that other people already know about the benefits of these advertisements
and 23 percent of respondents don’t feel the need to educate others. 15 percent of respondents
don’t find these advertisements interesting as shown in Figure 4.44. Therefore, they don’t
disseminate the benefits of advertisements to others.
Figure4.44 Reasons for not disseminating the information in the Eastern region
8%
28%
6%53%
13%
0%0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to
us
I don’t have time
15%
15%
23%58%
5%
7%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time 85
Figure4.45 Reasons for not disseminating the information in the Central region
In the Central region, out of 223 respondents, 61 percent of respondents or their families
disseminate the benefits of the advertisements to others whereas 39 percent of respondents do
not facilitate to disseminate the benefits of advertisements to others. When inquired about the
reasons for not sharing the benefits of the advertisements with others. Out of this 39 percent,
47 percent of respondents claimed that they don’t have time and 34 percent of respondents
don’t find it interesting and 16 percent of respondents feels that why other people will listen
to them as shown in Figure 4.45.
Perception about Impact of Health Promotion Messages on Suggested Actions
Across all regions in the study, out of 1693 respondents, 92 percent of people believe that
these advertisements have been able to change their minds and action and 8 percent of
respondents felt that these advertisements have not been able to change their minds and
action. Figure 4.46 depicts the percentage of respondents who think these advertisements
have been able to change their minds and action or not. In the Chitrakut district of the
Northern part of the nation, only 5 percent of respondents reported that these advertisements
have not been able to change their minds and action. Out of this 5 percent, 43 percent of
respondents reported that there has been no regional flavor in the advertisements and 36
percent of respondents felt that too much information is overloaded which makes them
confused in understanding these advertisements. Also, 21 percent of respondents reported
that because of no TV at their home these advertisements have not been able to change their
minds and action.
2%
34%
2%
34%16%
47%
0%
Even I am not aware of
We don’t find it
interesting
I don’t feel the need to
educate others
They already know
Why they will listen to us
I don’t have time 86
In another district of the Northern region i.e. Haridwar, only 1 percent of people think that
these advertisements have not been able to change their minds and action. Out of this 1
percent, 67 percent of respondents reported that there is no regional flavor in the
advertisements and 33 percent of respondents felt that too much information has been
overloaded which makes them confused in understanding these advertisements and 33
percent of respondents don’t have a TV.
In the Southern region, 80 percent of people think that these advertisements have been able to
change their minds and action whereas 20 percent of respondents feel the same. Out of this
20 percent, 16 percent of people feel that so much of information is overloaded in these
advertisements because of which they got confused in understanding these advertisements
fully and 12 percent of respondents do not find any regional flavor in these advertisements.
In the North-Eastern region, 74 percent of people think that these advertisements have been
able to change their minds and action whereas 26 percent of respondents feel the same. Out
of this 26 percent, 67 percent of respondents believe that so much information is overloaded
in these advertisements. 20 percent of respondents claimed of no regional flavor in these
advertisements and the other 12 percent of respondents feel the absence of TV at their home
as one of the reasons for not changing their mind and action after watching these
advertisements.
Figure 4.46 Percentage of respondents who believes these advertisements impact their mind and action
Across regions, 93 percent of people have seen immunization cards and 7 percent have not
seen immunization cards. This response has been received from a group of 1663 respondents.
Figure 4.47 shows the percentage of people who have seen immunization cards across
districts. It has been observed that a good number of people have seen the immunization card.
95%
99%
80%
74%
99%
94%
96%
0%
20%
40%
60%
80%
100%
120%
Chitakut Haridwar Ramanathapuram Dhubri Vidisha Begusarai Baran 87
Figure 4.47 Percentage of respondents who have seen immunization card
Willingness to Change to Desired Behaviour expected in NPCDCS Messages
In the Northern and Central region, 99-100 percent of respondents from both rural and urban
locations have shown intend to change their behavior after watching advertisements related to
the IMI programme. In the North-Eastern region, 8 percent of people residing in rural
location does not show any intention to bring any change in their behavior.
Preferred Medium to Receive Information in Future
Figure4.48 Preferred Medium to Receive Information in Future
In Northern, Southern, and Central regions, respondents suggested television as the best
medium among all other mediums whereas the majority of respondents of Eastern, Western,
and North Eastern region suggested that awareness workshop and seminars are the best way
to educate people of their communities as shown in Figure 4.48.
89%
95%
99%
78% 78%
99%
92%
0%
20%
40%
60%
80%
100%
120%
Chitakut Haridwar Ramanathapuram Dhubri Vidisha Begusarai Baran
80%
77%78%
74%
97%
70%
63%
0%
20%
40%
60%
80%
100%
120%
Chitakut HaridwarRamanathapuram Dhubri Vidisha Begusarai Baran
TelevisionPostersNewspaper Booklet/leafletsAwareness workshop 88
Chapter 5 Grass-root Level
Functionaries: Access, Exposure,
Recall and Health Seeking
Behaviour
INTRODUCTION
The chapter aims to gain insight into access to media and knowledge on health-related IEC
material among the grass-root level health workers like ASHA, ANM, AWW, and school
teachers. These functionaries are responsible for communicating and providing awareness to
the community and educating children. Besides, this chapter also gives insight into the
exposure, recall of the advertisements by the health workers, and also the change in behavior
or action in the community that has been observed as an impact of their training and
information being provided through different IEC materials.
Figure5.1 Distribution of various health workers/School teachers across the age of respondents 89
During the study, out of total 152 grass root functionaries interviewed, 34 percent ASHAs, 23
percent ANMs and AWWs, and 20 percent school teachers of different age groups. The
majority of ASHA workers i.e. 43 percent and school teachers (52 percent) belong to 35-44
years age group, whereas, majority of ANM i.e. 54 percent and AWW (49 percent) belong to
45 years and above age group as shown in Figure 5.1.
ACCESS TO M EDIA AMONG GRASS ROOT LEVEL
FUNCTIONARIES
Overall, the majority of health workers and school teachers have access to TV i.e. 96 percent,
followed by the newspaper which is 72 percent and mobile (69 percent), whereas, access to
radio is least i.e. 5 percent across the samples shown in Figure 5.2.
Figure5.2 Overall access to media among health workers/school teachers
In the region-wise analysis, across the sample in the study, 90-100 percent of the health
workers have access to TV, whereas, none of the regions has access to radio except the
Southern and Northern regions. Only 25 percent of health workers/ school teachers in the
Southern region have access to radio, followed by the Northern region where only 8 percent
have access to radio. Health workers and school teachers belonging to the Northern and
Eastern region have the least access to mobiles and health workers/school teachers belonging
to the North-Eastern region have the least access to newspapers as shown in Table 5.1.
96%
72% 69%
5%
0%
20%
40%
60%
80%
100%
120%
TV Newspaper Mobile Radio 90
Table 5.1 Access to Media among Gross-root Level Functionaries
Access to
Media North East
North
East South Central West
UP UK Bihar Assam
Tamil
Nadu MP Rajasthan
TV 95% 100% 90% 90% 95% 100% 100%
Radio 0% 8% 0% 0% 25% 0% 0%
Mobile 45% 58% 55% 80% 65% 80% 93%
Newspaper 90% 75% 80% 45% 65% 65% 82%
EXPOSURE TO HEALTH PROMOTION MESSAGES AMONG
GRASS-ROOT LEVEL FUNCTIONARIES
To check the general awareness of health workers/school teachers about health-related
programmes, the respondents have been asked, whether they have seen an
advertisement/poster/ message educating about health and family welfare programme in the
last one year (2018-19). Overall, 97 percent of health workers/school teachers have seen a
health-related advertisement in the last one year has been found. Table 5.2 depicts the
percentage of health workers/school teachers who have seen an advertisement/poster/message
education about health and family welfare programs in the last year across regions.
Table 5.2 Exposure to Health Promotion Message among Grass-root Level Functionaries
Northern Southern North
Eastern
Central Eastern Western
Chitrakut Haridwar Ramanathapuram Dhubri Vidisha Bihar Baran
100% 100% 90% 95% 100% 95% 100%
First Recalled Health Promotion Message
Across the seven regions under study, around 80 percent of health workers/school teachers
can recall few health-related advertisements like dengue, TB, cancer, malaria, and polio as
depicted in Figure 5.3.
Health workers/school teachers were also interviewed about the three programmes under the
study on various indicators such as (i) exposure to Progamme Specific Message, (ii) Recall of
key messages, and (iii) action taken. Besides these, some questions were asked about their
day to day functioning specifically related to IEC and training related questions were asked.
Further, they were asked about whether they ever have seen any change of behavior or action
in the community members as a result of the information by them or given in the IEC
material (See Annexure-Research Tool 2 for Semi-structured Questionnaire). 91
Figure5.3 First Recalled health advertisements
EXPOSURE, RECALL , AND PERCEPTION ABOUT
IMMUNIZATION MISSION INDRADHANUSH MESSAGES
Exposure to Health Promotion Messages
Figure5.4 IMI-Exposure level among health workers/school teachers
92%
100%
91%
81%
0%
20%
40%
60%
80%
100%
120%
ASHA ANM AWW School Teacher 92
Across the study sample, all the ANMs have seen immunization related advertisements to
IMI with 91 and 92 percent of AWWs and ASHAs. Though school teachers are not directly
involved with the immunization program still 81 percent of school teachers have seen
advertisements related to this programme as depicted in Figure 5.4.
Source of the Exposure
Across the sample, advertisements/messages related to IMI has been seen on TV and mid
media by 80 percent of these health workers. as depicted in Figure5.5. Around 66 percent of
health workers who have watched advertisements on TV, out of which 55 percent of them
have watched in private channels followed by DD i.e. 22 percent and 11 percent of these
people, have watched in regional channels. Among social media, 15 percent of these people
have watched in Whatsapp and 8 percent have watched on Facebook. Among mid media,
more than half of the health workers have seen these advertisements in banners and only 11
percent of them have seen it on wall painting.
Figure5.5 Sources of Exposure
Recall of IMI Messages among Grass-root Level Functionaries
The recall of IMI advertisements messages has been analyzed by using the Word Cloud
Method (Figure 5.6). The analysis shows that most of them recalled that vaccination is
important so every child should get it done. No child remains away from vaccination.
Vaccination prevents children from infectious diseases. Many of them even recalled that
seven visits are a must in 5 years. 93
Figure 5.6 Recall of IMI Message
Perception about Content of the IMI Advertisements
Figure5.7 What of Message and Why Grass root Functionary like Advertisement
Ninety-nine percent of sample health worker/school teacher respondents believed that these
advertisements are suitable for the community and they have liked them. Most of them liked
the way the message has been conveyed. Many of them liked the advertisements overall.
Some of them liked these advertisements because of the celebrity depicted in them and felt
that it is a good way to communicate the message as shown in word cloud Figure 5.7. Most of
them liked these advertisements because these advertisements help them to create awareness
as the community gets to know about the importance of vaccination and its benefits like it
prevents children from various diseases. 94
EXPOSURE, RECALL, AND PERCEPTION ABOUT NPCDCS
MESSAGES
Exposure to NPCDCS Health Promotion Messages
All sample ANMs across regions have seen NPCDCS related advertisements followed by 89
and 92 percent of AWW and ASHAs respectively. Further, 97 percent of school teachers
have seen advertisements related to this programme as depicted in Figure 5.8.
Figure5.8 NPCDCS- Exposure level among health workers/school teachers
Source of the Exposure
Across the sample of 152 respondents, percent advertisements/messages related to NPCDCS
have been seen on TV, and through mid-media by 80 percent of these grass root level
functionaries as depicted in Figure 5.9. 71 percent of health workers who have watched
advertisements on TV, out of which 64 percent of them have watched these advertisements
on private channels followed by DD i.e. 25 percent and 13 percent of these people have
watched in regional channel. Among social media, 9 percent of these people have watched in
WhatsApp and 5 percent have watched on Facebook. Among mid media, 41 percent of health
workers have seen these advertisements in banners and only 5 percent of them have seen it on
wall painting. Only 3 percent of the health workers have seen these advertisements in
cinemas.
92%
100%
89%
97%
82%
84%
86%
88%
90%
92%
94%
96%
98%
100%
102%
ASHA ANM AWW School Teacher 95
Figure5.9 Sources of Exposure
Recall of NPCDCS Messages among Grass-root Level Functionaries
When asked to remember the advertising messages, it has been analyzed from the word cloud
Figure 5.10 that most of them recalled the risk factors of cancer and how to prevent the
spread of disease. Some of them even recalled that smoking or tobacco is injurious to health.
Few of them could remember the risk factors of diabetes and also about the mandatory
screening of the diseases.
Figure5.10 Recalled Messages NPCDCS 96
Grass-root level Functionaries’ Perception about Content of the
NPCDCS Advertisements
Ninety-eight percent of health workers/school teachers believed that these advertisements are
suitable for the community as depicted and almost everyone (i.e. 97 percent) liked the
advertisements. Most of them liked the storyline and overall. Many of them liked the
advertisements as it creates awareness and the way the message has been conveyed. Some of
them liked best about these advertisements that methods of prevention are also explained as
shown in word cloud Figure 5.11.
Figure 5.11 What of Message and Why Grass root Functionary like Advertisement
Most of the functionaries liked these advertisements because these advertisements help them
to create awareness and they received knowledge about the diseases and their way of
prevention. Messages like smoking and tobacco cause cancer have been depicted in these
advertisements and these messages are thus beneficial for all. Therefore people liked these
advertisements.
EXPOSURE, RECALL, AND PERCEPTION ABOUT NVBDCP
MESSAGES
Exposure to NVBDCP Health Promotion Messages
Across the regions under study, out of 152 respondents, all ANMs and ASHAs are taken into
the study, have seen NVBDCP related advertisements. 97 percent of both AWWs and school
teachers respectively have seen these advertisements related to this programme as depicted
below in Figure 5.12. 97
Figure5.12 NVBDCP- Exposure Level among health workers/school teachers
Source of Exposure among Health Workers/School Teachers
Figure5.13: Sources of Exposure
Across the states under study, 80 percent of people have seen advertisements/messages
related to NVBDCP on TV, and through mid-media as depicted below in Figure 5.13. 80
percent of health workers have watched advertisements on TV, out of which 66 percent of
people have watched these advertisements in private channels followed by DD i.e. 30 percent
and 20 percent of these people have watched in the regional channel. Among social media, 13
percent of these people have seen in WhatsApp and a mere 7 percent on Facebook. Among
mid media majority of health workers i.e. 49 percent have seen these advertisements in
100% 100%
97% 97%
0%
20%
40%
60%
80%
100%
120%
ASHA ANM AWW School Teacher 98
banners and only 5 percent of them have seen it in wall painting. Only 3 percent of the health
workers have seen these advertisements in cinemas.
Recall of NVBDCP Messages
The majority of the health workers/school teachers recalled about the (i) breeding places of
mosquito, (ii) causation of dengue, and (iii) malaria and symptoms of the disease. Some of
them even recalled that water should not be accumulated around the locality. Few of them
recalled the message in which, it is advised to keep the surroundings clean and to use bed
nets, mosquito coils as a preventive measure against mosquito-related diseases as presented
in the word cloud (Figure 5.14).
Figure5.14 Recall of NVBDCP Advertisement Messages
Perception of NVBDCP Advertisement Messages
All the health workers/school teachers believed that these advertisements are suitable for the
community and almost everyone (i.e. 97 percent) of them liked these advertisements. Most of
them liked the storyline as children are depicted in the advertisement. They liked these
advertisements as these help them to create awareness. They like the overall content of these
messages. Some of them liked these advertisements because methods of prevention are also
explained, thus the respondent received new information about the health-related program
(See Figure 5.15). They like these advertisements because it educates the community about
the diseases, it's spread and the modes of prevention. 99
Figure5.15 What of Message and Why Grass root Functionary like Advertisement
SUPPLY OF IEC MATERIAL FROM STATE AND ITS USAGE
Overall, 75 percent of health workers received IEC material from the department whereas 25
percent of them didn’t receive it. Figure 5.16 shows the region-wise percentage of grass-root
functionaries who have received IEC material in the form of flex material, pamphlets,
posters, etc. Almost all the health workers of the western region have received IEC material
from the department followed by the Northern and Eastern region whereas in the Southern
region only 20 percent of health workers received IEC material and 53 percent of health
workers of the North-Eastern region didn’t receive IEC material.
Figure5.16 Percentage of functionaries who received IEC material across region
IEC material, which has been received by the health workers and school teachers, 80 percent
of them, used them for distribution among the community members and for display in various
47%
89%
85%
20%
85% 87%
100%
0%
20%
40%
60%
80%
100%
120%
North EastEast CentralSouth North North West 100
places. The other 20 percent of the respondents use IEC material for showcase and in
meetings.
Record Keeping for IEC Material Received
Out of 113 respondents, only 29 percent of health workers maintain records of the stock of
IEC material whereas 71 percent of them have no records of the materials, which were
received by them as depicted below in Figure 5.17. Those who maintain records, they
manually note down in the registers and diaries at their respective sub-centers/ Anganwadi.
Some of the records are maintained at their residence too.
`
Figure 5.17 Percentage of health workers who maintain records of IEC material
TRAINING AND CAPACITY BUILDING OF GRASS-ROOT LEVEL
FUNCTIONARIES ABOUT IEC MATERIAL
Figure 5.18 shows that an overall 63 percent of the respondents received training or
guidelines whereas, 37 percent of them haven’t got any instructions regarding the same. This
response has been received from a group of 110 respondents. Most of them received
instructions one month before the start of the programme or when programme starts in a
meeting mostly at CHC. Guidelines or instructions are all about how to demonstrate
particular IEC material to generate awareness in the people of the community. The majority
of these training has been conducted by the Doctors or the CMOs of that hospital followed by
block or district programme manager. Few of the ASHAs and AWWs training have been
conducted by ANMs as well.
29%
71%
0%
10%
20%
30%
40%
50%
60%
70%
80%
YesNo 101
Figure 5.18 Percentage of health workers who received training
USEFULNESS OF NATIONAL IEC IN GRASS-ROOT LEVEL
WORKERS FUNCTIONING
Sixty-one percent of health workers/school teachers believed that the impression/feelings/
created by the IEC activities helped them in mobilization and communication with the
community members in the village whereas, 39 percent don’t believe the same as exhibited in
Figure 5.19.
Figure5.19 Percentage of health worker believed that IEC material helped them in mobilization with the
community member
63%
37%
0%
10%
20%
30%
40%
50%
60%
70%
YesNo
61%
39%
0%
10%
20%
30%
40%
50%
60%
70%
YesNo 102
Further, Sixty-three percent of health workers/school teachers across states claimed that
community members have asked/inquired/talked for further information or clarification about
the messages given in the IEC material.
Overall, 71 percent of health workers have seen a change of behavior or action in the
community members as a result of the information given in the IEC materials as depicted in
Figure 5.20. However, it has been negated by 29% of the respondents,.
Figure5.20 Percentage of health workers who observed behavior change in community people
To understand the precise change in the behavior of community has occurred after being
perceptive towards the advertisements, health workers/school teachers are also probed further
towards the behavior change that has been observed in the people of the community. Both the
General and programme specific changes have given emphasis. However, few health workers
have responded to this question. Increased awareness is one of the major behavior changes
that have been observed by the respondents. As claimed by the health workers, there has been
an increase in the number of children getting immunized and people have started taking
treatment on time.
For example for the Immunisation Mission Indradhanush programme, health workers have
observed that the community members inquire them about immunization date and time and
availing full immunization services for their children. For NPCDCS, health workers have also
observed the community members are proceeding for testing and preventive activities. For
NVBDCP, health workers have observed that the community is using bed nets and are
involved in preventive activities.
71%
29%
0%
10%
20%
30%
40%
50%
60%
70%
80%
YesNo 103
SUGGESTION BY GRASS ROOT FUNCTIONARIES
The following suggestions have been received from the health workers and school teachers to
improve the outcome of IEC activities:
• The advertisements should be in the local language and this awareness should be
given community meetings as well.
• Miking (announcements using the microphones) should be made before at least one
day before the programme starts.
• The usage of big screen audio video for displaying of IEC material and attracting
audiences.
• Meetings of the health workers with the community people every month would also
be helpful.
• According to the health workers, meetings of community people with them, rally,
street plays, roadshows, and involvement of Panchayati members are the best ways to
connect with community people to propagate health-related messages.
104
Chapter 6 Recommendations and
Way Forward
The IEC Division of MOHFW provides an umbrella cover to the IEC/BCC plan of various
National Programs. It has over the years, undertaken communication campaigns, information
dissemination activities, and events across the years and the country. The division and its
communication activities have played a significant role in terms of visibility and information
dissemination. It also provides a communication environment that could prompt or trigger
behavior change among different populations segments. The rapid evaluation research study
has dwelled into the various aspects of the IEC activities, campaigns, and events and explored
the effectiveness and impact of these efforts and initiatives. The key findings and analysis
based on the primary and secondary data have been presented in the previous chapters. Based
on the key findings and analysis this chapter presents some suggestions and recommendations
and the way forward for the IEC Division and Swasth Nagrik Abhiyan (SNA).
REWORK COMMUNICATION STRATEGY AND MEDIA PLAN
The current communication strategy is designed based on campaigns based on disease-
specific days and running a campaign before or sometimes a little after that. These are short
term campaigns with heavy reliance on mass media (largely TV and print) and now
increasingly on social media. Second, it is also evident from data that the campaign time,
frequency, and intensity are rather limited thereby not able to achieve exposure and recall for
facilitating behavior change. Third, it is not a coordinated resonating effort in sync with the
states’ effort on the ground so again as a communication strategy it loses the desired impact.
These factors based on the study findings point to the urgent need to rework the
communication strategy and the media plan in the light changing burden of diseases and
media preferences of the community. The following seven sub-strategies are proposed under
this recommendation as action points to make communication strategy and media plan
produce better outcomes and results.
1. Going beyond special days and events
2. Separate specific strategy and media plans for urban and rural areas
3. A separate specific strategy for addressing regional priorities and challenges
4. Develop a strategic dynamic robust media plan 105
5. Rethinking, Re-planning radio in the media mix
6. Appropriate use of digital and social media platforms
7. Leveraging effective partnerships for IEC strategy
Going beyond Special Days and Events
The current communication strategy and action plan of the IEC division are based on special
disease or observational days and events. These days are supposedly used as pegs or entry
points for the short-term campaign around it. The community does not remember designated
special days by UN bodies, international agencies, or even set by the government. The FGDs
with community showed that there is no specific connection for the people for those days
especially in rural areas. These may be a good idea for observation of the days as part of our
international compliance and advocacy efforts and may even have a small potential to make it
visible and event giving chance to government officials and machinery to make it an event
that gets carried in the news media. The communication strategy needs to be localized i.e.
with broad aims and objectives at the centre by reworked with people, their perspective,
needs, and the local situation in mind. The barriers and benefits guide people’s behavior
change intents and change in practices.
Separate Plans for Urban and Rural Areas
One of the important insights that have emerged from the study findings is that there is a need
to have a distinctive approach to address urban and rural audiences separately. Though both
rural and urban audience prefers to get to use audio-visual mode. But the rural population
wants a follow-up explanation of the message by the health functionary. Further, most of
them don’t own TV and Radio. Further, those who own it in rural areas, the timing (6:00 pm
to 8:00 pm) and the nature of channels watched by them (Free on-air Channels) and programs
(religious and crime based repeat program) don’t match. Further, there are regional disparities
as people in the Southern and North-eastern regions prefer to watch programs in regional
languages than on national channels. Therefore, overall the medium for getting with different
appropriate messages, media plans as their situation, needs, issues, challenges, and response
mechanisms and capabilities are different. It requires a separate strategic communication
efforts to make a difference. This should be undertaken very clearly and urgently based on
evidence and creatively as well as strategically different designs and plans should be
developed. Use of mobile audiovisual screen as used in Rashtriya Bal Swasthya 106
Karyakram or used by political parties in election campaigns or giving Pocket Projectors to
ANMs/ASHA supervisors could be tried in rural areas.
Develop Regional Plans to Address Regional Priorities and Challenges
India is a large country with huge diversity in terms of language, culture, geography, health
system readiness among other things. The study has found enormous diversity in media
preferences, timing, resources, and knowledge sharing habits. Therefore, communication
strategy and media plan should incorporate these regional variations and requirements,
priorities, and challenges to be sharper in response to better value for money and efforts.
These regional plans should be jointly developed by region, state consultation, and the
synergy of the state and district in that region.
Develop a Strategic Robust Dynamic Media Plan
At present, the media plan is heavily tilted towards mass media in particular TV, print, and
radio as is evidenced by the budget and media allocation in the last five years. Technically,
the media plan is developed by the Bureau of Outreach (BOUP) (erstwhile DAVP). This
media plan is guided by the not exceeding 8% to any particular media channel/publication
rule which limits the intensity, frequency of a particular release to a minimum. These many
impressions are not enough to be visible and create exposure and recall. Further, the time and
frequency of a particular advertisement as well as the choice of the media vehicle chosen are
guided by cost consideration and equal distribution logic over the required impression. For
this purpose, the capacity of central IEC division officers needs to be built to understand and
guide media plans based on TRPs (BARC data) within the ministry.
Additionally, the media plan should have a measurability process and indicators inbuilt into
the efforts. Each campaign should be concurrently measured immediately after the campaign
to ensure success as well as learning from the effort.
Another action point in the media plan should be a coordinated effort with the states IEC
efforts. The IEC units state and district should be informed and readied in advance about the
media efforts so that they can use this synergy effectively multiplying the efforts and impact.
107
Reworking Radio in the Media Mix
The study has also brought about some very important facts about the reach, exposure, and
access to radio in the current times. It is true that during the 60s to late 90s, the radio played a
very important part in the rural outreach but that has dramatically changed in recent decades.
There is a very small number of radios and transistors available anywhere in the country.
Most of the radio is now “FM” that is a small number and that too largely urban outreach
which is inbuilt in mobile phones or car stereos. Although community radio is a powerful
medium in terms of reach and quality to make a difference it is successful only in a few urban
communities like universities and institutions. The unavailability of instrument / non-
preference for radio among rural users’ is important to be considered before planning a
community radio. Therefore, it calls for a rethink in terms of how much weight-age should be
given to the radio in the media plan. The use of radio should be looked into for better
reception and exposure. It should be considered that alternative media and written
communication like wall painting, posters, and pamphlets should be used for visibility and
pictorial content in rural areas. Radio listenership and listeners' profile needs to be reassessed
to make these choices. The need to relook at the content developed for radio is discussed in a
different section below.
Appropriate Use of Digital and Social Media Tools and Platforms
As per in-depth discussion with the IEC division of MOHFW officials, in recent times there
has been a lot of use of social media platforms in the communication strategy. It is a welcome
sign that new media has been utilized to extend the reach of SNA to the audience across the
spectrum. But one of the challenges is to gauge the success of social media communication
and the difference it has made to the achievement of the goals and objectives of the health
communication strategy of the IEC division. Social media can reach wherever the internet
access is there but to make it useful and impact requires much more local and strategic efforts
in coordination with the states and districts. For example, Whats App groups should be made
of Village Functionaries for sharing short communications. Community workers need to be
oriented for the same.
Also monitoring the social media and debunking the fake media content should be looked
into to make the investment yield much greater results and outcomes. More emphasis should
be made to develop User Generated Content (UGC). New platforms should be utilized like
Tik Tok can be used to develop localized content for local issues but it should be properly 108
made and supervised by the district administration. Further, the capacity of the district
officials needs to be developed. Facebook page of MOHFW should be more regular in
postings and make engaging content and events. The content design and execution are
discussed in a different section.
Leveraging and Forging Effective Partnerships for IEC as a Part of
Communication Strategy
Partnership for SNA is very explicitly developed and used extensively albeit as a tokenism.
IEC division almost works in relative isolation. For example, their partnership with
development partners is restricted to sometimes developing content for their program division
which is given to the IEC division for transmission. The partnership with the media and
private sector, CSR partners is much to be spoken about. Faith-based organizations, NGOs,
CBOs, and other potential partnerships with other ministries and units need to be strategically
spelled out.
SYNERGISING OPERATIONAL AND IMPLEMENTATION PLAN
The second important and critical aspect of the communication efforts is the operation and
implementation strategy and plan. There are several challenges to this aspect as well which
makes the efficiency and effectiveness of the SNA rather weak. IEC division is a central unit
in the MOHFW and there are no subunits in the states to support the operations and
implementation other than the State Health Society (SHS) which is not in any line of control
of the IEC division. The on-ground implementation of the IEC division campaigns requires
much more strategy and planning to ensure visibility and engagement with the real audience
instead of the advocacy audience if the aim is behavior change.
The following four actions are suggested for the same:
1. Synergizing IEC Operational and Implementation Plan at Center, state, and districts
2. Institutionalizing Mechanism for Partnership for Implementation
3. Coordination of Implementation Plan with Frontline Health Functionaries like ASHAs
and ANMs and AWWs
4. Monitoring the Performance of Implementing Partners 109
Synergising Operational & Implementation Plan at Centre, State, and
District Levels
The need of the hour is to build synergy and resonance in Center- State- District mechanism
for IEC activities. The implementation plan needs to think beyond just releasing the ads on
TV or print or outdoor. The IEC action of the Center has to resonate with the state and district
efforts to benefit, complement, and supplement each other to get the multiplier effect.
Ensuring that the plan and execution are in sync requires some kind of coordination and
tracking mechanism with all states. This needs urgent attention as the states together also
supposedly use the material and content shared with them but there is no way right now to
know how they have (if at all) utilized the materials shared and sent to them.
Further, it requires coordination on the following issues: what is the feedback of the state on
to the useful (if at all) of the material and have they some budgetary provision made in the
states’ IEC budget to use the material, adopt the material replicates the materials and of
course share back with the center that this is what they have done with the materials given to
them by the center.
It is suggested to set up a coordination cell at the center which not just collects data from the
states but also empowers, guides, informs, builds capacities, and monitors the action by the
states this would also build relationship and trust as well as inform the customization and
tailoring of the content for the states and provide insights into what works and why. The
second action that is required is to hold an annual review meeting of all IEC officers from
states with the central IEC division team along with the program divisions.
Institutionalization of Partnership mechanism for implementation
The crucial role of partnership and networking has been stated and observed in the critical
findings of the study. There should be a strategic partnership and not an event-based or
Adhoc partnership for the IEC/SNA efforts. This includes all partners whether it is
BOUP/DAVP or DD or AIR or private channels and publications or NGOs or Development
partners. The implementation mechanism is as important, if not more important, than the
creation of content. Since there is no direct line of delivery between States, DAVP, CSR
Partners, Development Partners, Research and Academic Institutions, media, and field level
functionaries. Therefore, it becomes important to cultivate these partnerships and employ
them actively in planning as well as execution of the campaigns with active feedback and
course correction dynamic mechanism. This will help the executing agencies like states, IEC 110
divisions, and DAVP, DFP plan and integrate actions in their action plan. These actions can
be done through the use of social media platforms like the What's app groups or the
web/internet to keep the partner informed and updated well in time.
Coordination plan of IEC activities with ASHA/ANM work plan
One of the strong on-ground implementation mechanisms is the frontline field functionaries
like ANMs and ASHAs along with AWWs across the country. These are the real champions
and frontrunners of action with the community. Though they are working under the control of
the state governments at the district level, they (ASHAs) can be also guided and facilitated by
the Center through NHSRC. There is a requirement of an interface of the Triple As (ANMs,
ASHAs, and AWWs) with the IEC/SNA action as they need to and should utilize and spread
the message that has been transmitted through the mass media on the various health issue and
events by the central IEC divisions efforts.
To gain a multiplier effect, a direct and more engaging field functionary plan should be
prepared. This plan should incorporate and utilize the “Umberala cover” support made
available by the Central IEC/SNA along with the State level and district level efforts. The last
mile efforts in social mobilization and IPC, as well as Home Visits, can greatly benefit from
the material and content provided by the Central IEC division. This requires some tweaking
of the planning efforts with states and NHSRC as well as ARCs and ANTCs and with
NIPPCD for AWWs. The field level functionaries have to be an integral part of the IEC/SNA
efforts and not just assumed and implied involvement in the strategic efforts. This will imply
a monitoring mechanism whether the integration of the IEC/SNA has happened at the field
level. Some specific IEC indicators will have to be incorporated in the MIS at the state and
district levels to demonstrate that. This will also require some nudging at the training and
capacity building institutes like NIHFW, SIHFW, ANTCs, AAWTCs, etc. to facilitate this
integration to happen.
Monitoring the Performance of Implementation Partners
To improve the effectiveness and efficiency of implementing partners like DAVP, DFP, DD,
AIR, and private media partners, Central IEC Division should develop a mechanism of
performance measurement and monitoring. It is important to have clear indicators – process,
output, outcome, and impact indicators. The results of the same should be submitted by the 111
implementing partners periodically validated by the central IEC team. The repots of output
indicators will also feed-forward for the planning of the next campaigns.
LEVERAGING AND INTEGRATING COMMUNICATION
OUTREACH WITH SCHEMES AND DATABASES
Several programs and schemes of both the State and Centre governments are simultaneously
targeting and focusing on the same population with different messages. These messages have
direct and indirect benefits for health actions and health-seeking behaviors by the target
population segments. These include, in particular, the ICDS/POSHAN, WASH/SBM Rural
and urban, the health programs under Ayushman Bharat, and other ministries like the
railways, Rural Development, Panchayati raj, etc. These efforts should be integrated and
made part of the coordinated and leveraged strategy to gain better traction and outcomes.
These can not continue in isolation either on paper or on an Adhoc basis.
Four specific instances and entry points are described below for the purpose.
1. Mobile Van used for the Rashtriya Bal Swasthya Karyakram (RBSK) may be fitted
with an Audio Video screen and equipment to screen shorts films at important locations
like Gram Sabha, Common Well for Water, etc. when the RBSK team is functioning at
schools.
2. Registration data collected at OPD (mobile number with diagnosing) should be used
for sending specific IEC material or SMS. These databases and insights could help
develop better engagement and follow up processes increasing the exposure and
impressions on social media as well on the ground.
3. Private sector medical and health sectors should be more holistically included in the
IEC/SNA plans. They spend a huge amount and effort on communication and reaching
out. One should not shy away from them or leave them out but engage with them and
bring them in for public health communication efforts.
4. WASH/SBM has been a major flagship program effort in the last five years. Although
a dotted relationship exists between the ministries, there are no direct or stronger links or
strategies that utilize or feed into each other’s efforts. 112
STREAMLINE IEC BUDGETING AND FUND FLOWS AND
EMPOWERING STATE AND DISTRICT
One of the issues that came up strongly during the study is the issue of release of the IEC
budget amount in time and some delays in getting access to the budget allocated. Although
the budget allocation is not directly in the purview of the Central IEC division, however, they
get into the picture for the PIP and budgetary planning processes. IEC division can oversee
and support the IEC efforts and build the capacity of the states to incorporate the critical
elements of media planning, coordinated actions, capacity Building, M& E, documentation,
and dissemination. The format of the IEC Budget should be redesigned to ensure that the
elements/fields are easy and simple and not just quantitative numbers and ensuring that they
are not just more of the same from last year. The annual review meeting of the IEC officers
should be utilized by extending it for one more day to build capacity to empower them to be
strategic and bold to take innovative efforts in IEC/BCC.
Five of the specific suggestions for the same are presented below:
1. Timely availability of budget at the earliest for better utilization of the funds.
2. Specialized IEC Fund should be given for the planning as per local needs as well as for
local disease, misconceptions, and epidemics.
3. Program Budget on IEC should give the flexibility to spend as per local needs
4. UCs of IEC plan and spends should be made public online
5. Proper discussion and deliberation should be undertaken before finalization of IEC
in District AAP or PIP
ROBUST RESEARCH, MONITORING, EVALUATION , AND
DOCUMENTATION UNIT FOR IEC/SNA
Communication strategies are supposed to be based on strong evidence, primary data
generated through quantitative and qualitative research from the field. This is an element that
is quite missing from the strategy and efforts of the central IEC division efforts. It is
presumed that some of these researches are conducted by development partners and are used
to generate content that is shared with the IEC division and the IEC division just becomes the
postman for the same. This should change. They need to take better control of the process as
well as the evidence to make informed decisions not only for the messages and content but 113
also for the other components such as capacity building funding and monitoring and
evaluation of IEC efforts. Six of the specific suggestions under this area are listed below:
1. A formative study should be done for each district to document and avoid whims and
wasteful expenditure. These studies could be “crowd-funded” meaning these could be
done by inviting students studying in courses like MSW, Mass Communication, MPH,
Community medicine for internships, summer placements and conduct the formative
research and formulate the communication strategy for the district/state which could feed
into the national IEC strategy. It will serve as an evaluation of the previous year as well as
provide scientific evidence for the forward communication strategy.
2. Periodic Monitoring of IEC activities need to be done rigorously (a standard Monthly
Progress Report (MPR) should be developed for IEC for reporting from each district)
3. It should be made mandatory to put Quarterly progress reports on IEC Online.
4. A third party external evaluation for IEC should be at the end of each year
5. The photograph of politicians should be avoided on IEC materials as these go wastes
during the Election Model Code of Conduct.
6. Case studies, success stories lessons learned, positive deviance stories should actively
be documented
HUMAN RESOURCES AND CAPACITY BUILDING
Effective communication requires skilled and competent human resources. Trained and
professional staff, dedicated staff, passionate staff, creative staff is a prerequisite for the
impactful communication efforts. The IEC division staffs do not especially have a
background or orientation in the professional communication function but have worked into
the domain – learning by doing. It should be noted that this lack of domain training and
specialization also gives scope for others especially donors and development partners to come
in as experts. The IEC division should beef up their technical capability as well media
acumen not just in the domain but in Capacity Building Efforts (for states and other program
divisions), Monitoring and Evaluation as well research, and people skills. A well thought out
and budgeted capacity-building strategy, in the house as well for states and partners should be
developed. Five of the specific suggestions in this recommendation are listed below:
1. Vacant Sanctioned Positions should be filled without any delays. 114
2. Proper Orientation needs to be done for newly joined staff. A manual of SOPs may be
prepared for the orientation, to avoid loss of any significant steps.
3. Three to five days Capacity Building Workshop should be organized for the district
and block Officials on SBCC to innovate at the local level.
4. M & E, Finance, and Medical Officers should also be trained in effective
communication.
5. Exposure visits should be organized for the central staff so that they can learn and
document good IEC practices from the states.
CONTENT DEVELOPMENT
Content is the key as well as the king. At the end of the day, all communication is developing
an effective, powerful as well as impactful content. Content creation is not easy. As has been
pointed out by the respondents in the research study the content has been a major challenge in
the communication efforts of the IEC division. Be it print, TV, radio, or even outdoors as
well as social media. It has not connected well, resonated enough, or been easy to recall and
make a mark for facilitating behavior change. A large part of AV content is not directly
produced by the IEC division. Social media content is done in-house. There has been no or
little pretesting of the content and campaign done for ensuring it is found useful and
compelling. Some of the suggestions for developing compelling, engaging, and impactful
content are listed below:
1. Brush up internal capacity to generate quality content by getting consultants as well as
internal full-time staff to learn specialized creative content development offline/online
courses.
2. Hire a creative agency that not only develops compelling content but also develops
capability in-house for the IEC division.
3. Do not accept content developed by donor and development agencies just on face value
and taken for granted that coming from them it will be good and appropriate.
4. Engage community medicine, Mass communication, MSW, and research agencies to wet
the content and pretest them thoroughly. 115
5. Be innovative about content and campaign instead of just being ‘informative” and
technically and medically right. Information is good by connecting it to the head and heart is
critical for behavior change.
6. A diverse range of content should be developed to suit and appeal to the different regional
audiences as well differently for the urban and rural audiences.
IMMEDIATE ACTION POINTS
From the above recommendations, the recommendations which require immediate action of
the policymakers are listed below to start with. However, this does not mean other
recommendations are not at all important.
1. Develop evidence-based national IEC/BCC strategy and action plan taking rural/urban and
regional diversity in mind.
2. Develop and share national IEC guidelines for states and districts to guide the States and
districts to develop state-specific IEC strategy and action plans and align them with national
IEC/BCC efforts to optimally get results.
3. Develop a performance measuring mechanism (concurrent monitoring and external
evaluation) for the national and state IEC/BCC efforts on a campaign basis as well as on a
quarterly and annual basis.
4. Re-strategize the national media plan for informed better-customized media mix to make
optimal value for many spend calculating the Social Return on Investment.
5. Increase the national IEC budget to double the current levels to make a real and long-
lasting change in health-seeking behavior and improved health outcomes.
6. Build the capacity of IEC staff and officers and add professionally qualified and competent
people to manage and deliver the IEC strategic outcomes.
7. Develop IEC/BCC capacity building plan and e modules to ensure all IEC staff from top to
field has undergone at least one IEC course and utilization plan
8. Build effective strategic partnerships with other ministries, development partners, donors,
research agencies, CSR to leverage the multiplier effect in consolidated outcomes. 116
9. Develop compelling quality content to engage, excite, and energies individuals and
communities to information seeking and behavior change by working on localized strategy.
10. Include campaigns on non-conventional areas like Mental Health, Geriatric Care, and
enhance the scale of NCD campaigns.
117
References
• Elmendorf, A.E., Cabanero-Verzosa, C. Lioy, M. and LaRusso, K. (2005) Behavior
change communication for better health outcomes in Africa: experience and lessons
learned from World Bank-financed health, nutrition and population projects (English).
Africa Region Human Development working paper series no. 92. The World Bank,
Washington, DC.
• Figueroa, M., Kincaid, D., Rani, M. and Lewis, G. (2002) Communication for social
change: an integrated model for measuring the process and its outcomes. The
communication for social change working paper series no. 1. The Rockefeller
Foundation and Johns Hopkins University Center for Communication Programs, New
York, NY:
• Mckee, N., Becker‐Benton, A. and Bockh, E. (2014) Social and behavior change
communication. In Wilkins, K. G., Tufte, T. and Obregon, R. (eds), The handbook of
development communication and social change, 1st edition, Chapter 17. John Wiley
& Sons, New Jersey, NJ, pp. 278-297.
• Cofie, P., De Allegri, M., Kouyate, B. and Sauerborn, R. (2013) Effects of
information, education, and communication campaign on a community-based health
insurance scheme in Burkina Faso. Global health action, 6 (1).
https://doi.org/10.3402/gha.v6i0.20791 (last accessed 13 April 2020).
• Bekele, A. and Ali, A. (2008) Effectiveness of IEC interventions in reducing
HIV/AIDS-related stigma among high school adolescents in Hawassa, Southern
Ethiopia. The Ethiopian Journal of Health Development, 22(3), 232-242.
• OECD DevCom (2017) 10 learning areas for SDG communications. Discussion Note
for the OECD DevCom Peer Learning Hub. Presented at Global Festival for Ideas on
Sustainable Development, Bonn, 1-3 March 2017.
• Government of India (2017) National Health Policy 2017. Ministry of Health and
Family Welfare, Government of India, India.
https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf (last accessed 25
January 2020).
118
ANNEXURE 1
Research Tool 1
Indian Institute of Public Administration
Questionnaire for Beneficiary (Male/female) (Urban/Rural)
CONSENT FORM
Project Title: “Rapid Assessment of Swasth Nagrik Abhiyan (SNA) erstwhile IEC Programme of Ministry of Health and Family Welfare”
Principal Researchers: Dr. Pawan Kumar Taneja, and Dr. Roma Mitra Debnath Indian Institute of Public Administration, India
Sponsored By: NITI Aayog, Government of India
The Information, Education & Communication (IEC) strategy of the Ministry of Health and Family Welfare (MoHFW) aims to create awareness and
disseminate information regarding the benefits available under various schemes/programs of the Ministry and to guide the citizens on how to access them.
The main of objective this study is to review the existing IEC activities concerning health and family welfare activities and suggest a framework to improve
upon the Swasth Nagrik Abhiyaan (IEC programme) in the future. Participation in this research study is voluntary. You are not exposed to any risk by
participating in this research. The interview will take approximately 20-25 minutes to complete. The results reported will be strictly anonymous; that is, no
one involved in this study can identify you personally. Please note that you may withdraw your consent to participate in the study at any time. You do not
have to assign any reason to withdraw from this research at any stage. If you have any complaints about any aspect of the study, then you may contact Dr.
Pawan K. Taneja/Dr. Roma Mitra Debnath, Indian Institute of Public Administration, IP Estate, Ring Road New Delhi-110002. Email:
pawanktaneja.iipa@gov.in, romadebnath.iipa@gov.in Telephone: +91-11-23468327/50.
I, _____________________________, freely agree to participate in this study according to the conditions in the consent form.
Signature ……………………………………………………… Date …………………………
119
SECTION: PROFILE
State
District
Location Rural Urban
Block
Name of Village/City
Date
Name (Optional) : ______________________________________________________________
Age : 15 – 24 years 25 – 34 years 35 – 44 years 45 years above
Gender : Male Female Other
Educational Status :
Mobile/Contact number: ___
Marital Status :
Occupation :
Social category :
Illiterate Literate without
schooling
Primary Middle
Secondary High secondary Graduate and above Other
Married Unmarried Divorced/ Separated/widowed
Self-employed Agriculture Service Housewife Retired Student Unemployed
SC ST OBC General 120
INVESTIGATOR/Name/Date/Time/Place
SECTION 1: Media access and general exposure of IEC Campaign/Activities of MOHFW
Now I am going to ask you some questions about your media access and use.
1.1 Do you have access to media and how often you use?
Never Daily Weekly Fortnight Monthly
TV
Radio
Mobile (Social Media)
Newspaper
1.2 Have you ever seen any advertisements/posters educating health and family welfare programme in the last 1 year?
1.2.1 If yes, please tell us the following about those advertisement/education material
Disease/Programme Advertisement/Material Media (TV, Radio, Social Media,
Print Media, Cinema, Mid Media)
Channel (If TV: DD/ Private
Channel/Regional; Social Media:
FB/WhatsApp, Print (Newspaper/
Magazine); Mid Media (Street Play/ Wall
Painting/ Movie/ Road show/ Banner)
SECTION 2: Exposure to specific MOHFW Campaigns (Now I am going to ask you some questions about health and
family welfare programme communication) 121
Name of Programme 1.1 National Vector Borne
Disease Control Programme
(NVBDCP) M ALARIA,
DENGUE
1.2 National Programme for
Prevention and Control of
Cancer, Diabetes, Cardiovascular
Diseases and Stroke (NPCDCS)
1.3 Immunization Mission
Indradhanush
A. Exposure
Have you ever seen any
advertisements/posters related to this
programme?
1.Yes
2.No (Proceed to section 3 Page No6)
1 Yes
2 No
1 Yes
2 No
Where all have you seen this
advertisement?
1. Television
2. Radio
3. Newspaper
4. Pamphlets
5. Booklets/Leaflets
6. Posters
7. Health Worker
8. Hospital
9. Any other, Specify
1. Television
2. Radio
3. Newspaper
4. Pamphlets
5. Booklets/Leaflets
6. Posters
7. Health Worker
8. Hospital
9. Any other, Specify
1. Television
2. Radio
3. Newspaper
4. Pamphlets
5. Booklets/Leaflets
6. Posters
7. Health Worker
8. Hospital
9. Any other, Specify
How many times you have seen this
advertisement?
1. Everyday
2. Less than two times/week
3. More than two times/week
1. Everyday
2. Less than two times/week
3. More than two times/week
1. Everyday
2. Less than two times/week
3. More than two times/week
B. Recall of messages 1. Diseases spread by mosquito
2. Breeding places of mosquito
i. Drainage
ii. Dirty Stagnant water
iii. Clean Stagnant water
iv. Garbage
1. Do you and your family are
frequently getting screening for
these diseases?
2. Awareness about the risk factor for
cardiovascular disease
i. Alcohol
ii. High BP
iii. Physical inactivity
iv. Obesity
v. Stress
vi. Don’t know
1. How many times do you need
to take your child for
vaccination?
i. Vaccinations age birth to 5 years
ii. . Seven times visit for
vaccinations in 5 Years
iii. Mark each Vaccination on
Calendar
iv. Don’t Skip or forget any
vaccination 122
3. Sign and symptoms of the
disease(dengue, malaria)
i. Fever
ii. Headache, body ache,
Fever
iii. Nausea and Vomiting
iv. Don’t know
4. Free blood examinations in govt
health centers
5. Free treatment at all level
6. Acceptance of Indoor residual
spray
7. Methods to prevent mosquito
bites
3. a) Awareness about the risk factor
for Cancer
i. Smoking
ii. Chewing tobacco
iii. Alcohol
iv. Don’t know
b) Cancer Symptoms:
i. Lumps
ii. Not Healing of wound/sore
skill,
iii. Prolong problems indigestion,
iv. Excessive flow of white fluid,
v. Blood spots even after
mensuration cycle
c) Cancer is curable with early diagnosis.
4. a) Awareness about the risk factor
for diabetes mellitus
i. Increasing age
ii. A diet containing fat/ Fried
Food
iii. Physical inactivity
iv. Obesity
v. Stressful lifestyle
vi. Don’t know
b) A healthy lifestyle can prevent diabetes
i. Exercise/Yoga
ii. Healthy Food Eating
iii. Physical activities like
games/walking etc.
c) Awareness about the – sign and
symptoms of diabetes
v. Responsibility of all of us
vi. Most important Task for the
health of the child
vii. Vaccination
protects/immunized child from
dangerous diseases
viii. All information is written on
the immunization card
ix. Go for immunization even the
child is sick.
x. Take the card with you in case
you are traveling
xi. After a Vaccination child may
get fever or swelling don’t get
frightened.
2. All vaccines are free of cost at
the govt health facility
3. Name of the Celebrity
depicted in the advertisement
123
i. Frequent urination
ii. Excessive thirst
iii. Frequent hunger
iv. Don’t know
C. Intend to change
Do you or your family members
disseminate the benefits of these
advertisements to others?
1. Yes
2. No, why
1. Yes
2. No, why
1. Yes
2. No, why
Do you think these advertisements
have been able to change your mind
and action?
1. Yes
2. No, why
1. Yes
2. No, why
1. Yes
2. No
Willingness to use bed nets if given a
choice
1 Yes
2 No, why
Have you seen anyone consuming less
sugar and fried food after getting exposed
to these advertisements?
1. Yes
2. No
Have you seen anyone quitting
smoking/tobacco after understanding this
advertisement?
1 Yes
2 No
Do you have/still have your child
immunization card
1 Yes
2 No, why
Section3: Effectiveness of the advertisements (Show the advertisement) Now I am going to show you some
advertisements about health and family welfare programme communication.
3.1 National Vector Borne Disease
Control Programme (NVBDCP)
MALARIA, DENGUE
3.2 National Programme for
Prevention and Control of Cancer,
Diabetes, Cardiovascular Diseases and
3.3 Immunization Mission
Indradhanush
124
Stroke (NPCDCS)
A. Comprehensiveness
Are these advertisements enough to explain
the details of the programme?
1. Yes
2. No, why
1. Yes
2. No, why
1. Yes
2. No, why
B. Clarity
Is the message clear? 1. Yes
2. No, why
1. Yes
1 No, why
1. Yes
2. No
C. Appealing
Are these advertisements appealing enough to
catch/grab your attention?
1. Yes
2. No, why
1. Yes
2. No, why
1. Yes
2. No, why
What did you like the most in these
advertisements?
1. The way the message was
conveyed
2. Celebrity/Characters
3. Storyline
4. Music
5. Overall
1. The way the message was
conveyed
2. Celebrity/Characters
3. Storyline
4. Music
5. Overall
1. The way the
message was
conveyed
2. Celebrity/Characters
3. Storyline
4. Music
5. Overall
Difficulty in understanding these
advertisements?
1. Language
2. Message too fast
3. Too many messages
4. Any other, specify
1. Language
2. Message too fast
3. Too many messages
4. Any other, specify
1. Language
2. Message too fast
3. Too many messages
4. Any other, specify
D. Recall to action
Have these advertisements able to explain
what to do when you need assistance?
1. Yes
2. No, why
1. Yes
2. No, why
1. Yes
2. No, why
E. Sensitivity
Is the advertisement acceptable and liked by
all sections of society?
1. Yes
2. No, why
1. Yes
2. No, why
1. Yes
2. No, why 125
Section 4: Suggestions
4.1 MALARIA, DENGUE 4.2 Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases, and Stroke
4.3 Immunization Mission
Indradhanush
According to you, what should
be the best medium to generate
awareness amongst the
community about this program?
1 Television
2 Posters
3 Newspaper
4Booklet/Pamphlets/leaflets
5 Awareness workshop/seminar
6 Any other specify
1 Television
2 Posters
3 Newspaper
4Booklet/Pamphlets/ leaflets
5 Awareness workshop/seminar
6 Any other specify
1 Television
2 Posters
3 Newspaper
4Booklet/Pamphlets/ leaflets
5 Awareness workshop /seminar
6 Any other specify
Thank you for your time and participation.
126
Research Tool 2
Indian Institute of Public Administration
Questionnaire for ASHA/ANM/Anganwadi worker/School Teachers
CONSENT FORM
Project Title: “Rapid Assessment of Swasth Nagrik Abhiyan (SNA) erstwhile IEC Programme of Ministry of Health and Family Welfare”
Principal Researchers: Dr. Pawan Kumar Taneja, and Dr. Roma Mitra Debnath Indian Institute of Public Administration, India
Sponsored By: NITI Aayog, Government of India
The Information, Education & Communication (IEC) strategy of the Ministry of Health and Family Welfare (MoHFW) aims to create awareness and
disseminate information regarding the benefits available under various schemes/programmes of the Ministry and to guide the citizens on how to access them.
The main of objective this study is to review the existing IEC activities to health and family welfare activities and suggest a framework to improve upon the
Swasth Nagrik Abhiyaan (IEC programme) in the future. Participation in this research study is voluntary. You are not exposed to any risk by participating in
this research. The interview will take approximately 20-25 minutes to complete. The interview will be recorded and transcribed for analysis. The results
reported will be strictly anonymous; that is, no one involved in this study can identify you personally. Please note that you may withdraw your consent to
participate in the study at any time. You do not have to assign any reason to withdraw from this research at any stage. If you have any complaints about any
aspect of the study, then you may contact Dr. Pawan K. Taneja/Dr. Roma Mitra Debnath, Indian Institute of Public Administration, IP Estate, Ring Road New
Delhi-110002. Email: pawanktaneja.iipa@gov.in, romadebnath.iipa@gov.in Telephone: +91-11-23468327/50.
I, _____________________________, freely agree to participate in this study according to the conditions in the consent form.
Signature ……………………………………………………… Date …………………… ……
127
SECTION: PROFILE
State
District
Location Rural Urban
Block
Name of Village
ASHA ANM AWW School Teacher
Age : 15 – 24 years 25 – 34 years 35 – 44 years 45 years above
Gender :
Educational Status:
Marital Status :
Working Experience in the position:
Social category :
Mob/Contact No. : ________________________________________
SECTION 1: media access
1.3 Do you have access and how often you use
Male Female
Primary Middle Secondary High secondary
Graduate and above Diploma Other – Specify
Married Unmarried Divorced/ Separated/Widowed
Year Month
Scheduled Caste Scheduled Tribe Other Backward Class General 128
Never Daily Weekly Fortnight Monthly
TV
Radio
Social Media
Newspaper
Mid Media
SECTION 2: Exposure/Reach/Recall to MOHFW Messages/campaign
2.1 Have you ever seen any advertisement /posters educating health and family welfare programme in last 1
year?
2.1.1 If yes, please tell us following about those advertisement/education material
Disease Advertisement/Material Media (TV, Radio, Social
Media, Print Media, Cinema,
Mid Media)
Channel (If TV: DD/ Private
Channel/Regional; Social Media:
FB/WhatsApp, Print (Newspaper/
Magazine); Mid Media (Street Play/ Wall
Painting/ Movie/ Road show/ Banner)
SECTION 3-5: SPECIFIC MOHFW IEC REACH/EXPOSURE –
3. Immunisation
3.1 Have you seen any Advertisement/Education Material Related to Mission Indradhanush?
3.2 If yes, please tell us following about those advertisement/education material
Advertisement/Material Media (TV, Radio, Social
Media, Print Media, Cinema,
Mid Media)
Channel (If TV: DD/ Private
Channel/Regional; Social Media:
FB/WhatsApp, Print (Newspaper/
Magazine); Mid Media (Street Play/
Wall Painting/ Movie/ Road show/
Yes No
Yes No 129
Banner)
3.3 Key Message do you remember
(If not Seen the advertisement show one advertisement)
3.4 Express your Opinion on-
1 Is it suitable for the community? Yes No
2 Do you like this add? Yes No
2.1 What do like in the advertisement?
2.2 Why do you like this advertisement?
3 Have you understood this advertisement? Yes No
3.1 What you understand?
4. Non- Communicable Disease
4.1 Have you seen any Advertisement/Education Material Related to Cancer/Diabetes/BP/Heart Disease?
4.2 If yes, please tell us following about those advertisement/education material
Advertisement/Material Media (TV, Radio, Social Channel (If TV: DD/ Private
Yes No 130
Media, Print Media, Cinema,
Mid Media)
Channel/Regional; Social Media:
FB/WhatsApp, Print (Newspaper/
Magazine); Mid Media (Street Play/
Wall Painting/ Movie/ Road show/
Banner)
4.3 Key Message do you remember
(If not Seen the advertisement show one advertisement)
4.4 Express your Opinion on-
1 Is it suitable for the community? Yes No
2 Do you like this add? Yes No
2.1 What do like in the advertisement?
2.2 Why do you like this advertisement?
3 Have you understood this advertisement? Yes No
3.1 What you understand?
5. NVBDP - Dengue/Malaria 131
5.1 Have you seen any Advertisement/Education Material Related to Dengue/Malaria/ Other Vector Born Disease?
5.2 If yes, please tell us following about those advertisement/education material
Advertisement/Material Media (TV, Radio, Social
Media, Print Media, Cinema,
Mid Media)
Channel (If TV: DD/ Private
Channel/Regional; Social Media:
FB/WhatsApp, Print (Newspaper/
Magazine); Mid Media (Street Play/
Wall Painting/ Movie/ Road show/
Banner)
5.3 Key Message do you remember
(If not Seen the advertisement show one advertisement)
5.4 Express your Opinion on-
1 Is it suitable for the community? Yes No
2 Do you like this add? Yes No
2.1 What do like in the advertisement?
2.2 Why do you like this advertisement?
3 Have you understood this advertisement? Yes No
3.1 What you understand?
SECTION 6: DEPARTMENT/CENTRAL IEC/OPERATIONS/TRAINING
6.1 Have you received any IEC materials from the
department?
Yes No
Yes No 132
6.1.1 Which material?
6.1.4 How it is used? Distribute Use in meeting Showcase Display/Demonstrate Other ways
6.2 Do you maintain record of stock? Yes No
6.2.1 If yes, how do you maintain
6.2.2 Where do you maintain?
6.3 Have you received Guidelines/ instruction or
training to use these specific materials?
Yes No
6.3.1 If yes, What
6.3.2 When
6.3.3 Where
6.3.4 By whom
SECTION 7: CHANGE/IMPACT/STRATEGY/INCLUSION
7.1 Have the “buzz” created by the IEC activities
helped you in your mobilization or
communication with the community members
in the village?
Yes No How
7.2 Have community members asked/ inquired/
talked for further information or clarification
about the messages given in the IEC materials?
Yes No
7.3 Have you seen any change of behaviour or
action in the community members as a result of
the information given in the IEC materials?
What change in behaviour
7.3.1 General
7.3.2 Immunisation People ask about
Immunization date
and time
Full
immunization?
Are they asking for
referral?
Preventive
activities
7.3.3 NCD Are they going for
screening/Testing?
Are they going
for screening?
Asking for referral Preventive
activities
7.3.4 Dengue/Malaria Are they using bed
nets?
Are they going
for fogging or
Seeking
information about
Preventive
activities 133
not? blood test in case of
fever continuation
SECTION 8: Suggestions –
8.1 Would you like to recommend any modifications in these advertisements to make it more consumers friendly?
8.2 Do you recommend any other means to reach to the masses, especially most vulnerable segments?
Thank you for your time and participation.
Name of the investigator _____________________
Contact details ______________________
134
CONSENT FORM
Research Tool 3
Indian Institute of Public Administration
FGD Guide (Male/Female) (Urban/Rural)
Project Title: “Rapid Assessment of Swasth Nagrik Abhiyan (SNA) erstwhile IEC Programme of Ministry of Health and Family Welfare”
Principal Researchers: Dr. Pawan Kumar Taneja, and Dr. Roma Mitra Debnath Indian Institute of Public Administration, India
Sponsored By: NITI Aayog, Government of India
The Information, Education & Communication (IEC) strategy of Ministry of Health and Family Welfare (MoHFW) aims to create awareness and
disseminate information regarding the benefits available under various schemes/programmes of the Ministry and to guide the citizens on how to
access them. The main of objective this study is to review the existing IEC activities with respect to health and family welfare activities and
suggest a framework to improve upon the Swasth Nagrik Abhiyaan (IEC programme) in the future. Participation in this research study is
voluntary. You are not exposed to any risk by participating in this research. The discussion will take approximately 20-25 minutes to complete.
Discussion will be audio recorded. The results reported will be strictly anonymous; that is, no one involved in this study can identify you
personally. Please note that you may withdraw your consent to participate in the study at any time. You do not have to assign any reason to
withdraw from this research at any stage. If you have any complaints about any aspect of the study, then you may contact Dr. Pawan K.
Taneja/Dr. Roma Mitra Debntah , Indian Institute of Public Administration, IP Estate, Ring Road New Delhi-110002. Email:
pawanktaneja.iipa@gov.in, romadebnath.iipa@gov.in Telephone: +91-11-23468327/50.
I, , freely agree to participate in this study according to the conditions in the consent form.
Signature ……………………………………………………… Date ………………………… 135
SECTION 1: PROFILE
State
District
Location Rural Urban
Block
Name of Village/City
Date
Name (Optional) :
Age :
Gender
Educational Status :
Mobile/Contact number: Marital Status
Occupation
Social category : SC/ST/OBC/ Gen
15 – 24 years 25 – 34 years 35 – 44 years
45 years above
Male Female Other
Illiterate Literate without
schooling
Primary Middle
Secondary High secondary Graduate and
above
Other
Married Unmarried Divorced/ Separated/widowed
Self
employed
Agriculture Service Housewife Retired Student Unemployed
136
Introduce yourself and the members of team. Share the purpose/objective of the
meeting. If the deliberation is being voice recorded, inform and take consent.
Explain that this is for research purpose only and will be kept confidential and will
not be used for any other purpose. Inform that this a group activity and all are
encouraged to participate actively and freely. There is nothing right or wrong in
what they feel or react to the question or opinion and we are neutrally listening to
the and there is no judgement about what they say, tell or share with us. This
meeting would take about 30-45 minutes. So, once again, thank you very much for
coming and being a part of this exercise.
Background
Health is important component of our lives. But right information and correct
information and awareness is very important for prevention as well as treatment
and cure. As they say prevention is better than cure. So the Government through the
Ministry of Health and Family Welfare makes these programmes and material and
activities to inform people about various diseases, illness, conditions, schemes,
services, signs and symptoms, dangerous, prevention methods and when to and
where to go for information and services. In the village there are health sub centers,
PHCs, CHC and district hospitals and of course one can also go to the private sector
providers.
1. So are you aware of the Health Sub Center in your village? There is the
Nurse Behanji, ASHA Didi and the doctor in the local hospital. Also you
have access to newspapers, TV, Radio and now a days’ mobile phone
which connect you with others and the world.
2. Do you sometime listen to radio, See TV or even go to the cinema hall
to see films? What health messages do you remember having seen on
TV or Radio? PROBE/PROMPT
3. Mobile phone is much more that talking to someone or receiving a
phone call from someone? What would you say? What else can be or
are the uses of the mobile phone? SMS? Taking pictures, seeing
videos, Internet? Have you received some SMS on your mobile
informing you about, e.g. about immunization day and your child
requiring the injection? PROBE/PROMPT
4. It is also possible that you would have seen some posters, leaflets,
banners, wall writing, nukkad natak, exhibition, miking in your village?
Ask who and what they have seen. PROBE/PROMPT
5. So now I am going to ask you about some specific messages about some
health programmes and ask you if you have seen them recently of in last
one year.
• Immunization, Tikakaran, What have you seen, where have seen,
what key message do you recall? Has that been useful to you?
Effective? 137
• Dengue/Malaria What have you seen, where have seen, what key
message do you recall? Has that been useful to you? Effective?
• Diabetes, Obesity, Heart attack, Cancer What have you seen,
where have seen, what key message do you recall? Has that been
useful to you? Effective?
Show some samples of the three specific campaigns and ask recall and opinion,
effectiveness, PROBE/PROMPT. ANY SUGGESTIONS, THANK YOU
138
Research Tool 4
IDI-SPM/DPM/BCM Interview Guide
1. What is the organisational structure and how much manpower is working for IEC
activities in the District/ State/Block?
2. What your annual budget for IEC activities?
3. Is budget sufficient for the implementation of the IEC activities under these
programmes as per the need?
4. How IEC activities are planned for different national level, NHM and State
Programmes?
5. How media plans are made for different IEC activities?
6. What were the activities planned in the last year and what is plan for the current year
for IEC programmes?
7. Do you have any special plan for the following:
a) Immunization Mission Indradhanush
b) National Vector Borne Disease Control Programme (NVBDCP)
c) National Programme for Prevention and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke (NPCDCS)
8. What all different media channels/mediums are being used?
9. What all different IEC materials you are being used and how you ensure that these
materials reach to the target audience?
10. How do you coordinate your activities (field activities) with NHM and Central IEC
activities?
11. How do you plan to serve different segments of population especially underserved
areas?
12. IEC materials which you receive, are they in local language? If not, then how standard
IEC material is converted into local language?
13. Do you have the sufficient manpower to smooth functioning of your activities?
14. Have you given with any training or have you attended any capacity building workshop
for the same?
15. How do you build capacity of different staff at District/Block/Village level?
16. Have you done any formative study, baseline and need assessment study for IEC
activities in your State/District/Block 139
17. How monitoring of the IEC activities under these programmes are done?
18. How frequently this monitoring and supervision is done?
19. Have you conducted any Impact Assessment study for IEC under any programme?
20. What is your reporting mechanism?
21. What are the issues and challenges faced during the implementation of the IEC
activities in your state/district/Block?
140
ANNEXURE 2: MOU WITH AIR
141
142
ANNEXURE 3: LIST OF PARTICIPANTS FOR NATIONAL
CONSULTATION WORKSHOP ON DECEMBER 19, 2019
National Consultation Workshop on Rapid Assessment of Swasth
Nagrik Abhiyan (SNA) erstwhile IEC Programme
S.No. Name of Participant Designation/Address Mobile No./Email
1.
Padmaja Singh
Joint Secretary
MoHFW
011-23061656
Padmaja.singh@nic.in
2.
Shri Suresh.k.Vatta
MOHFW 011-23231666
skvatta@yahoo.com
3. Raman Prasad MOHFW 011-23061960
Ramanprp.d@gmail.com
4.
Dr. Niraj Kulshreshtha MOHFW 9810162485
n.kulshrestha@nic.in
5.
Dr.Niranjan Saggurti India country Director
Population Council
9871211195
nsaggurti@popcouncil.org
6.
Dr.Devashish
Bhattacharyya
Director, CHEB 9868201236
dir.cheb@nic.in
7.
RK Sarkar MoHFW 9810653499
rajusarkar@gmail.com
8. Ziley Singh Vical Deputy Secretary
MoHFW
9871773328
Ziley.vical@nic.in
9.
Dilip Kumar Sahu
Under Secretary
MoHFW
9868936830
Dilip.sahu@gov.in
10. Dr. Ajay Trakroo Health Specialist
UNICEF
9424201597
atrakroo@unicef.org
11. Dr. Mayank Shersiya Senior Consultant, MoHFW 9654007166
Drmayankshersiya.mohfw@gmail.com
12. Dr. Padam Khanna Senior Consultant, NHSRC padamkhanna@rediffmail.com
13. Dr. Pooja MoHFW 9811833118
Drpooja.mohfw@yahoo.in
14. Prof. Poonam Khattar Head, Department of
communications
9910211552
poonamkhattar@gmail.com
15. Dr. M.A.Elangoran Deputy Director
Tamil Nadu
9443556775
dfwtlr@gmail.com
16. Raj Kamal Sharma Consultant, NHM-I
MoHFW
9062576910
rajkamal.mohfw@gmail.com
17. Dr. Pawan Taneja Faculty IIPA 9818210463
dr.p.k.taneja@gmail.com
18. Dr. Roma Mitra Debnath Faculty IIPA 9310338939
Roma.mitra@gmail.com
19. Dr. Sanjeev Kumar Consultant IIPA 9810162474
sanjeevbcc@yahoo.co.in
20. Dr. Shalini Manocha Consultant IIPA 9654548016
shalinimanocha152@gmail.com
21. Nina Badgaiyan Consultant, NITI Aayog nina.badgaiyan@nic.in 143
भारतीय लोक प्रशासन संस्थान
Indian Institute of Public Administration
Indraprastha Estate, Ring Road, Mahatma Gandhi Marg,
New Delhi, Delhi 110002
Rapid Assessment of Swasth Nagrik Abhiyan
(SNA) erstwhile IEC Programme of MoHFW
Dr. Pawan K. Taneja & Dr. Roma Mitra Debnath
Indian Institute of Public Administration
New Delhi IEC Activities of MoHFW
•Mass Media (TV, Radio, Print, OOH, TV Screens at Public Places)
•Mid – Media (Street theatre, songs, on-ground activities like video on
wheels, projections on screens, melas etc., Stall at IITF, Press conferences
and launch events, workshops and conferences)
•Digital Media including Social India E-advertisement, Face book page,
Tweets and info graphics, Videos on campaigns YouTube; SMSs
•Printing of books, reports, pamphlets, leaflets, policy documents etc.
•Planning, Monitoring and coordination activities of IEC division with
other programme , state government , media and development partners
2
© Indian Institute of Public Administration (IIPA), New Delhi Objectives of the Study
•Assess the impact of IEC awareness in select Aspirational Districts for
various activities outlined in the scheme;
•Review the monitoring and evaluation activities undertaken in the
programme;
•Review the budgetary allocation and financial viability of the IEC plan
in terms of adequacy, utilization, and relevance;
•Assess the strengths and challenges in existing communication plan
and strategy in view of the changing health environment; and
•Review the role of the social media, electronic and print media and
mid-media activities
© Indian Institute of Public Administration (IIPA), New Delhi
3 Research Approach & Strategy
•Cross Sectional Study design
•Mixed Method Research i.e. Both Qualitative and Quantitative research approach
•Both primary and secondary data sources
•Beneficiary Survey Community for Exposure, Recall Rate and Understanding for
Communicated Messages
•Focus Group Discussions (FGDs) with Community for comprehension, appeal of the theme/
specific spots and ascertaining individual health seeking behaviour change
•In-depth Interviews with Block and District officials like DM, CMO, DPM, BPM, BCMO,
DCM/DCC
•Semi-Structure interviews with Key Grassroots Level Functionaries Like ANM, ASHA and
AWW
•National Consultation Workshop at NITI Aayog
•Quantitative data was analyzed by using statistical software SPSS
•Qualitative data was analyzed with the help of ATLAS-ti software.
© Indian Institute of Public Administration (IIPA), New Delhi
4 Sample Size
© Indian Institute of Public Administration (IIPA), New Delhi
5
Region States Aspirational DistrictsSurvey SizeNo. of
FGDs
IDIs
North
UP Chitrakoot314 4 28
Uttrakhand Haridwar315 4 28
East Bihar Begusarai307 4 28
West Rajasthan Baran261 4 28
South Tamilnadu Ramanathapuram 374 4 28
Central MP Vidisha318 4 28
North East Assam Dhubri325 4 28
Total2214 28 196 Sample Distribution and Sample Campaigns
3 CAMPAIGNS CHOSEN FOR
ASSESSMENT
1.Immunization Mission Indradhanush
(IMI)
2. National Vector Borne Disease
Control Programme (NVBDCP):
Malaria, Dengue & Chikungunya
3. National Programme for Prevention
and Control of Cancer, Diabetes,
Cardiovascular Diseases and Stroke
(NPCDCS)
© Indian Institute of Public Administration (IIPA), New Delhi
6
#)*)+$!,
*)+
*)+"#-.
/#'#0#
$
."))$)12.3
.#)
.#)
.,45'#06
Two Rural Blocks and One Urban
Block
Each Block Two Sub Centres/ 1 AWW
4 Focus Group Discussions in each
district
1 School Children from Class 6-10
1 Rural Women
1 Rural Men
1 Urban (Mix Group) Exposure Level to Health Promotion Messages
© Indian Institute of Public Administration (IIPA), New Delhi
7
N=2214
RuralUrban
0%
10%
20%
30%
40%
50%
60%
70%
80%
66%
72%
However, afer assistance, every
respondent was able to recall some
health promoton message.
RegionState
District
Has Seen an
advertisement/
Message
Northern
UPChitrakut 86.0%
Uttrakhand Haridwar 66.0%
SouthernTamil Nadu Ramanathapuram 62.0%
North EastAssamDhubri 58.5%
CentralMPVidisha 62.0%
WesternRajasthan Baran 63.0%
EasternBihar Begusarai 75.0%
All India69.0% Program Wise Exposure Level
© Indian Insttute of Public Administraton IIPA), New Delhi
8
RuralUrban
0%
10%
20%
30%
40%
50%
60%
70%
80%
68%
72%
NVBDCP
RuralUrban
0%
10%
20%
30%
40%
50%
60%
70%
80%
64%
73%
NPCDCS
RuralUrban
0%
10%
20%
30%
40%
50%
60%
70%
80%
71%
74%
Immunisatin Missiin Indradhanush First Recalled Message
© Indian Insttute of Public Administraton IIPA), New Delhi
9
© Indian Insttute of Public Administraton IIPA), New Delhi Intend to Change 10
ChitakutHaridwarRamanathapuramDhubri Vidisha Begusarai Baran
0%
20%
40%
60%
80%
100%
120%
0.57
0.53
0.99
0.83
0.64
0.81
0.9
N-1672
ChitakutHaridwarRamanathapuramDhubri VidishaBegusaraiBaran
0%
20%
40%
60%
80%
100%
120%
95%
98%
100%
85%
98%
96% 97%
Pisitve Perceptin abiut Impact if Health Primitin
Messages in Suggested Actins
Share Infirmatin Gained in the NVBDCP Advertsement Implication of Findings
•The rapid assessment study of central IEC Division, MOHFW, clearly
brings out that, despite challenges and constraints, they are doing a
good job and must contnue to be supported and further
strengthened.
•It can do much beter and achieve greater impact provided some
SMART, strategic, organizatonal, creatve, operatonal, human and
fnancial resources management is undertaken for SBCC as outlined
in the next secton of “way forward”.
© Indian Insttute of Public Administraton IIPA), New Delhi
11 Media Usage and Behaviour Findings
Desk Review
•IEC Strategy /Plan is based on days and event spread across the year.
•There is no baseline or formatve study as evidence available to form the IEC strategy/plan.
•Fire Fightng Approach: Messaging is not based on Evidence
Cimmunity Survey Findings
•Just 6% overall sample populaton is having assess ti radii, in rural area it 5% whereas in urban areas it 9%.
•Further, in Southern Region access to radio is 29% mainly due to use of Smart phones, whereas in eastern and north-
eastern region it is almost 0%. FM Channels are mainly used while driving.
•Penetratin if mibile phone is just overall 44%. In central region it is just 33%, whereas in Southern region it 52%
•Signifcant variaton across regions UP 86% , Utrakhand 66%, Assam 58.5%) and within regions across districts) for
exposure to health promoton messages
© Indian Insttute of Public Administraton IIPA), New Delhi
12
Qualitatve Findings frim Cimmunity
Most of the Community Members especially in rural areas don’t watch Paid TV Channels.
Religious and Crime Related shows are preferred by the community on free private channels over DD
Best tme for TV is 6:00 pm to 8:00 pm in Rural Areas and Prime tme 8.00-10.00 in Urban areas.
Viewership and preference for watching TV channels vary across regions
Findings are suppirted by recent BRAC TV audience viewership repirts which started
segregatng urban and rural viewership data
Findings frim Interviews with Functinaries
•District Administraton suggested that success of community radio is doubtul in rural areas the absence of
Radio Sets and Smart Phones
© Indian Insttute of Public Administraton IIPA), New Delhi
13 Media Usage Behaviour Findings Media Preferences Findings
Qualitatve Findings frim the Cimmunity
•Inter-Personal Communicaton IPC) by ASHA and ANM is a beter method in Rural setngs
•In Urban Areas of Northern, Southern and Central regions people suggested television as the best medium in
Eastern, Western and North Eastern regions suggested that awareness workshops and seminars
•TV advertsements/Other form of IEC help community to beter interact and understand ASHA workers
•Partcipaton of Local Community/Faith Leaders, members of PRIs will be useful.
Findings Frim the Interactins with Functinaries
•Miking/Munadi and Announcements by religious leader taken seriously by community
•Targetng Middle and Senior School Children for SBCC found useful
•Combinaton of Short Audio and Visual message on mobile vans/boat is beter IEC method as done by politcal
partes during electons
© Indian Insttute of Public Administraton IIPA), New Delhi
14 Suggestions During National Consultation
Workshop
•Upgrade frim Infirmatin Educatin Cimmunicatin (IEC) ti Sicial Behaviir Change Cimmunicatin
(SBCC) Strategy
© Indian Insttute of Public Administraton IIPA), New Delhi
15 Recommended Way Forward
Rewirk Cimmunicatin Strategy and Media Plan as per SBCC
1.Go beyond special days and events. Plan communicaton strategy on the basis of community needs
epidemiological and behaviour data) and targets fxed in NHP.
2.Separate specifc strategy and media plans for urban and rural areas
3.Separate specifc strategy for addressing regional priorites and challenges
4.Develop a strategic dynamic robust media plan considering regional and urban tming and channels preference
5.Rethinking, Re-planning radio in the media mix as it has lost relevance in rural areas
6.Use of digital and social media platorms in urban areas but for rural areas Social media can be used through
IPC by grass roots level functonaries
7.Leveraging efectve partnerships for IEC strategy with Local NGOs and community leaders as they are beter
listened by the community
© Indian Insttute of Public Administraton IIPA), New Delhi
16 Findings- Execution of IEC Strategy
Desk Review
•No formal unifed document as “Natonal IEC guidelines”. Some Leters/ circulars contain some
operatonal instructons for NHM.
•Some of the State like Madhya Pradesh and Tamilnadu has prepared IEC guidelines
•No formal linkage between Central IEC SNA) Division, IEC actvites of other natonal programmes,
State IEC divisions and NHM funding for IEC. Every actvity/scheme functon as a standalone actvity.
Findings Frim the Interactins with Functinaries
•District ofcers do not plan and propose IEC actvites as per local needs in the district PIP. Template
are flled as per past data or a model document shared by the state government. Hence, neither
local community needs are identfed nor media planning for the same is done at the district level
with few exceptons.
© Indian Insttute of Public Administraton IIPA), New Delhi
17 Findings - Execution of IEC Strategy
Findings Frim the Interactins with Functinaries
•25 per cent of grass root level functonaries didn’t receive any IEC material Posters, Hoarding, Booklets).
•Across all districts in the study, the district level ofcials and grassroots level functonaries had shown
concerns about the delays in receiving material even some tme it reaches afer the scheduled campaign.
•No specifcatons about where to display and how to use a partcular IEC material are given. Further,
materials to fx hoardings/banners/fex material are not sent.
•Display of diferent IEC material in LED/LCD screen found interestng to community.
•Use of PICO Projector by ASHA Supervisor/ANMs as pilot found useful to conduct IPC in Utrakhand and
Tamilnadu
•TV advertsements/Other form of IEC by state governments help ASHA/ANM workers to beter interact and
make community understand, change behavior and sustain it.
© Indian Insttute of Public Administraton IIPA), New Delhi
18 Findings- Execution of IEC Strategy
Study Team OBSERVATIONS
•Misplacements and out of context usage of IEC material at several places.
•So many IEC material received and pasted in health facilites leads to disinterest among community .
•Most of IEC/BCC ofcers do not know about his role and responsibilites as they are just doing routne jobs of
sending and receiving IEC materials
SUGGESTIONS during Natinal Cinsultatin irkship
•SNA division should develop detailed Natonal Guidelines for SNA for states so that not a single penny
should get wasted
•Quarterly Coordinaton meetng of Natonal SNA, Programme and State IEC divisions and further states carry
similar meetng with districts to improve the results
•Organize IEC Best Practces Summit on IEC annually to share, learn, document and reward IEC experiences
across natons© Indian Insttute of Public Administraton IIPA), New Delhi
19 Way Forward
Synergising Operatinal and Implementatin Plan
1.SNA division should issue Natonal Guidelines containing various aspects of planning, implementaton and evaluaton as
given in the LEADERS framework mentoned at end .
2.Synergizing IEC Operatonal and Implementaton Plan at Center, State, districts and IPC at village level by devising a
natonal strategy with regional and local level approach as mentoned earlier.
3.Insttutonalizing Mechanism for Partnership between Centre IEC and Programme, State and District for Implementaton
in form of half yearly strategic planning and review meetngs followed by quarterly meetng to monitor the progress
4.Organize natonal level IEC Summit annually to share, learn and reward IEC experiences across natons
5.Leveraging and Integratng Communicaton Outreach with Schemes and Databases For example
a)Mobile Van used for Rashtriya Bal Swasthya Karyakram RBSK) can be fted with Audio Video screen for spreading
IEC messages in village when RBSK team work in the school
b)Registraton data collected at OPD mobile number with diagnosing) should be used for sending specifc IEC
material or SMS
© Indian Insttute of Public Administraton IIPA), New Delhi
20 Findings: Content of Advertisement
Desk Review
•A Concurrent Evaluaton of Phase II of the NRHM BCC Campaign by ORG Centre for Social Research funded by USAID and PFI concluded
the need for producing content which can be localized.
•Contents are majorly developed by Development partners. MOHFW does not have any such capacity to do so.
Cimmunity Survey Findings
•73 % of respondents recall cause of diseases spread i.e. Mosquitos and 72 % of respondents recall the breeding places of mosquito
•Just 15% of respondents could recall that free blood examinaton facility is available in all government centers
•56 percent of respondents could recall the risk factors cardio-vascular diseases whereas
•only 7 percent of respondents could recall symptoms of Cancer
•54 percent of respondents could recall that seven tmes visit for vaccinatons in 5 Years is must
•Only 17 percent of respondents could recall that all vaccines are free of cost at Government health facility
•Common reasons for those who not share informaton with others are “I am not able to understand the message properly” or “Message
was not very Interestng” across regions
© Indian Insttute of Public Administraton IIPA), New Delhi
21 Findings: Content of Advertisement
FINDINGS Frim the Interactins with Functinaries
•Posters/Booklets are not very useful with too much informaton. They need to be more pictorial material in
local culturally appropriate and sensitve manner for example local folk dance can replace western dance on
NCD posters.
•Localizaton of IEC material is not done. For example for the deworming campaigns hoarding translated
deworming in the Hindi as Krimi Mukht Abhiyaan, community members did not understand same. It should
have used simple local language like Bachoo ke Paet ke Kidai Merne/Mukt Abhiyaan.
SUGGESTIONS during the Natinal Cinsilatin irkship
•Standard Message should be prepared at Centre, State government should involve State Medical college
PSM/community medicine Departments and other local experts for localizaton of material sent by Centre
than just simple translaton.
© Indian Insttute of Public Administraton IIPA), New Delhi
22 1.Improve the internal capacity to generate quality content by getng consultants and empanelling
creatve agencies those who will design, develop and pre-test content on the basis of available
Behavioural and epidemiological data
2.Content developed by donor and development agencies should be developed in partcipaton with SNA
and just taken as given on face value.
3.Both at Natonal and State level engage communicaton specialist, Mass communicaton experts and
experts in various research insttute/public health insttutes like NHIFW, IIPA, PHFI, IIMC and
PSM/community medicine department in medical colleges to vet the content as per local needs, pre-
test and validate.
4.Be innovatve about content and campaign instead of just being ‘informatve” and technically and
medically right considering SBCC strategy.
5.A diverse range of content should be developed to suit and appeal to the diferent regional audiences as
well as urban rural audience.
© Indian Insttute of Public Administraton IIPA), New Delhi
23!$% Content Development Way Forward Findings - Management of Financial Resources
© Indian Insttute of Public Administraton IIPA), New Delhi
24
•Declining budgeted expenditure on the IEC scheme over the last 5 years.
•In none of the years in last fve years SNA division could spend annually budgeted funds.
•The MOHFW ofcials informed that frstly budget is very less and secondly other than few planned campaigns, the division
spends conservatvely to preserve funds for the possible contngent epidemics.
•Similar to Natonal IEC expenditure the huge gap has been observed in allocated and actual expenditure under NHM for IEC to
Sample State Governments.
•Delay in receiving funds under NHM is major cause of unspent budget reported by state/district ofcials.
•Historically MOHFW is spending maximum budget on RCH, similar trend has been observed on IEC expenditure of SNA division
on diferent natonal progarmme. This expenditure does not match with natonal disease profle and epidemiological data.
•District ofcials informed that generally there are no earmark funds or a meager amount is allocated for local level IEC which is
spent for prinitng statonary.
•There is no fexibility on natonal program-specifc IEC Budget as even type of media usage is fxed. Way Forward - Effective Utilization of Financial
Resources
1.Increase Natinal budget if SNA Divisiin ti at least diuble frim the current levels ti
A.Fulfl the unmet demand of important public health issues like metal health, NCDs, Geriatric care etc.
B.Add budget for not just for PREVENTIVE care but also for PROMOTIVE care like improving immunity, exercises,
healthy life styles etc.
C.Bring a sustainable change in health seeking behaviour and improved health outcomes
2.Create a separate replenish-able piil if funds ti fnance unplanned epidemics like Ebila, ZIKA, Swine fu
etc.
3.Streamline IEC Budgetng and Fund fiws & Empiwering State and District under NHM
a)Timely availability of budget at the earliest for beter utlizaton of the funds.
b)Separate IEC budget should be given for local disease, misconceptons, and epidemics.
c)Other Natonal Program Budget on IEC should give the fexibility to choose media as per local needs
d)State government should hold quarterly discussions with districts for fnalizaton of annual acton plan and
monitoring of the same in line of natonal plans.
© Indian Insttute of Public Administraton IIPA), New Delhi
25 Findings: Monitoring, Evaluation of IEC
Activities
Desk Review
•Progress of IEC actvites is not monitored on the basis of campaigns based output indicators like exposure, recall and
behaviour change indicators rather it done on the basis of process indicators i.e.
•Progress on Annual Acton Planned actvites
•Proxy Indicator like TV viewership data of BARC India
•No baseline or formatve study as evidence to form the basis of IEC strategy/plan of MOHFW.
•No impact assessment or detailed evaluaton of impact of IEC actvites
•Brief studies carried to review Organizatonal Needs Assessment 2012), issues and challenges faced by IEC Division of MOHFW
IIPA, 2017) or concurrent evaluaton of a campaign 2009)
•No documentaton to showcase the success stories of the scheme
•Swachh Bharat Abhiyan’s IEC monitoring and evaluaton system has shown a way forward to SNA learn and set
monitoring and impact indicators for each campaign.
© Indian Insttute of Public Administraton IIPA), New Delhi
26 Findings Frim the Interactins with Functinaries
•None of the districts covered in the study has conducted any formatve/ need
assessment study, which can be used for media planning, targeted interventon,
addressing misconceptons, etc.
•No efectve monitoring system that exists on the usage of IEC material at the
district/block level
•None of district or state covered in the study has conducted any impact assessment of
its IEC actvites
•Only 29 per cent of health workers maintain records of the stock of IEC materials
received and used
© Indian Insttute of Public Administraton IIPA), New Delhi
27Findings - Monitoring & Evaluation Way Forward Research, Monitoring & Evaluation
Develip a Ribust Research, Minitiring, Evaluatin, & Dicumentatin System fir SNA
a)“Criwd-Funded” Firmatve Study: District administraton can assign live project to fnal year students
from community medicine department of medical college or Masters of social works to carry out
formatve studies for diferent public health issues. These studies will help to initate localized SBCC
campaigns.
b)Design output and outcome indicators for each campaign to monitor its progress and success
c)Conduct quarterly concurrent evaluaton of IEC campaigns for efectve monitoring of progress
d)Publish Online Quarterly progress reports and review the same in suggested meetngs of central and
states IEC coordinaton commitees
e)Bi-Annual third party external evaluaton at Natonal Level to measure Impact and revisit Strategy as
recall rate of each campaign is low
© Indian Insttute of Public Administraton IIPA), New Delhi
28 Finding - Human Resources & Capacity Building
Desk Review
•IEC division ofcers are neither professionally qualifed, equipped in terms of resources) or trained to chalk out M&E plan for their
campaigns. Need to set a PMU for the same IIPA, 2017).
Observatins during the feld Visit
•Out of 7 district visited 4 district has vacant District IEC ofcial positon and with more than 50% vacant Block communicaton
coordinator positons in each district,
•Due to lack of capacity in terms of technical know-how, Shortage of human resources and paucity of tme, state governments just carry
facial changes and do not localize IEC material open fles sent by the Centre
•No inducton training to newly joined District/Block/State IEC ofcers resulted into non-performance of strategic jobs media planning,
localizing the content, planning for Campaigns for local issues, contributng to DPIPs) and just carrying the routne actvites.
•No person has been given any specifc or specialized Training related to IEC /SBCC at any level in recent tmes in any state even centre
government
•63 percent of the grass root level functonaries has received guidelines on how to use specifc IEC material during monthly meetngs
© Indian Insttute of Public Administraton IIPA), New Delhi
29 © Indian Insttute of Public Administraton IIPA), New Delhi
30$%+* $ Way Forward Human Resources & Capacity Building
1.Fill Vacant Sanctoned Positons by upgrading Job Descriptons and qualifcatons as per
present day IEC requirement
2.Set up PMU as recommended in earlier study report by IIPA
3.Orientaton manual needs to developed for newly joined staf.
4.Three to fve days Capacity Building Workshop to be organized for the district and block
Ofcials on SBCC
5.Exposure visits should be organized for the central staf to state for learning and
experiencing grass root level issues. LEADERS Framework for Planning and
Implementation of SBCC Strategy
L- Learning
E- Enabling
A- Adaptng
D- Develiping
R- Revising
S- SBCC L- Learning
E- Enabling
A- Adaptng
D- Develiping
R- Revising
S- SBCC
© Indian Insttute of Public Administraton IIPA), New Delhi Coordination
Mechanism
between Centre
& States
Target Group
identification &
Segmentation
Establish
Segment-specific
Goals &
Objectives
SBCC Delivery
Strategy
Financials
Plan for
Monitoring &
Evaluation
Creation of Communication Material ,
Media Campaign & Media Plan
Training
Health Workers, Community Groups,
NGOs, Community Leaders , Faith
Leaders & other Influencers
Advocacy & Collaboration
• Commitment of Political &
Social Leadership
• Resource Mobilization
• Collaboration with International
Agencies
Community & Social Mobilization
• Mobilization of Community
Groups, NGOs, Community Leaders
Faith Leaders & other Influencers
• Mobilization of Family, Peers, etc.
Training of Target Groups
Persuasion & Counseling
of Target Groups
Media Engagement of Target
Groups
• Choose Media Mix
• Dissemination of
Communication Material
• Execute Media Campaign
• Interpersonal Communication
Monitoring
Impact Assessment
by Third Party
Revsing
LearningEnabling
Adapting & Developing ExecutingRevising
Organization &
Staffing
Epidemiological and
Behavioral Data
Health Support Structure
Health Information
Management System
National Health Policy
LEADERS Framework for Planning and Implementaton of SBCC Strategy
L- Learning
E- Enabling
A- Adaptng
D- Develiping
R- Revising
S- SBCC
© Indian Insttute of Public
Administraton IIPA), New
Delhi Study Team
•Dr Pawan K Taneja, IIPA
•Dr Roma Mitra Debnath, IIPA
•Dr Sanjeev Kumar, IEC Specialist Consultant)
•Dr Shalini Manocha, Jr. Consultant Thank You