lalmani Diggal (22), a mother of twins is busy in finishing her household chores since morning. She has to be free by noon. Today Asha (Accredited Social Health Activist) Didi of her village will come to her house on her routine home visit to counsel her and answer her queries related to breast feeding and complementary food which she has to start soon. When Asha Didi litima Pradhan reaches their home, she enquires about lalmani and her family and gradually asks about the children. It's here that lalmani hesitatingly expresses her concern about children's low weight. Also present is lalmani's mother-in-law who also voices her anxiety. litima assures both of them of her support and asks them to sit comfortably. She soon takes out a colourful and compact deck of cards called Mobile Kunji as lalmani and her mother-in-law look on curiously. She selects a card on complementary food and elaborates how it will help her children to grow healthy. lalmani and her mother-in-law's worries are put to rest when litima dials a number and makes them listen to the voice of Dr Anita who corroborates what she had advised. "The counseling by Asha Didi and listeniang to Dr Anita helped us to know more about complementary feeding and other aspects to cleanliness. Now I feel confident that if I practice what she had advised, my children will definitely stay healthy and not fall sick," said lalmani, adding the Asha Didi also explained in Kui language that helps them understand well."
Mobile Kunji, is an ICT-based job-aid for frontline health workers (FlWs) to enhance their interpersonal communication (IPC). IPC with communities continues to remain a major challenge for the health workers like ASHAs in the field while they are counseling them on key health behaviors .Introduced by the Odisha Government in five High Priority Districts in 2014, the toolkit developed by BBC Media Action focuses on preventable and life-saving messages on key maternal and child health behaviours. Odisha's Kandhamal has high maternal and infant mortality rates. lalmani who stays in Badimunda village has nearly 500 households and Asha litima covers pregnant and nursing mothers, adolescent, mother of young children and counsels them on various health and nutrition issues on ante-natal and post-natal care, new born care, family planning, feeding and care till the child is two-years-old through her Mobile Kunji. As per Annual Health Survey (AHS) 2012-13, 82 infants (0-1yr) out of 1,000 die in remote Kandhamal district, which is second in the State after Balangir. Prior to using Mobile Kunji in the field for counseling women and their families, Ashas were trained on IPC skill building.
"Earlier when we used to counsel people they were not really interested. But now they find the colourful deck of cards quite attractive and are curious to hear our advice. The job-aid has also made us more confident and we try to counsel and convince beneficiaries in a proper way," said litima. Every month she meets 8-10 women including mothers of her village and counsels them through Mobile Kunji. On Village Health and Nutrition Days (VHNDs), she also tries to counsel a small group of women on various maternal and child health issues.
To enhance their IPC skill, Ashas are also pursuing a 190-minute training course on maternal and child health from Mobile Academy. Both the Mobile Kunji and Mobile Academy services have been free-of-cost by the Odisha Government. In the first phase, Mobile Kunji has started in five high priority districts like Kandhamal, Koraput, Balangir, Rayagada and Boudh and it is being soon launched in other five HPDs of Gajapati, Kalahandi, Nabarangpur, Malkangiri and Nuapada. Till now, in Kandhamal district around 1,135 Ashas have been trained to use Mobile Kunji. Talking about Mobile Kunji, Director of National Health Mission Roopa Mishra said, "In Odisha interpersonal communication was always a major challenge with frontline health workers and various efforts have been taken to tackle the issue so far.
Mobile Kunji helps to improve their IPC and enhance the health worker's knowledge on maternal and child healthcare. This also helps them to convince mothers and families towards the benefits of adapting health behaviours. More than 7,000 FlWs have been trained so far in the five districts and using the IPC toolkit who have so far used nearly". There have also been other initiatives undertaken for behaviour change in Odisha. Breaking the stereotype training and counseling to mothers and other community members, Oxfam India has produced short films starring local frontline health workers and community members under its maternal health project. "The idea of producing short films starring local people is to give them a personal touch with local flavour, where they can relate themselves. Also we thought recreation and messaging both needed for the community, through short films we can reach out to the larger audience.
The films which were screened during winter evenings in total 70 villages of Sundargarh andKandhamal districts were very popular among the community. These films are used for awareness that deal with maternal health including institutional delivery, nutrition and care during pregnancy, equal responsibility for family planning," said Oxfam India Regional Manager Akshaya Ku Biswal. Adding to this he said, the films were in Odia language so it was easy for them to understand. Besides, they were touching the local sentiments. The best part of the programme was before and after the screening of the short films our volunteers and frontline workers were interacting with the community, providing them knowledge and helping them in changing behaviour.
On the other hand, "Swasthya Kantha" campaign initiated by the State Government is designed to help and create health seeking behaviour of the poor and tribal communities in rural hinterland, where there is no access to other form of communication. Talking about the campaign, NHM Director Roopa Mishra said, "In Swasthya Kantha campaign a black board is used as village health wall to provide information regarding four thematic health issues like maternal health, child health, malaria and tuberculosis.
This 52 week integrated multimedia communication campaign aims to mainstream all GKS (Goan Kalyan Samiti) in 47,000 villages all over the State. We take a theme and through various forms of communication we try to aware people all over the State, but the major target group is always the community in rural pockets. Our 7,000 frontline health workers or Ashas who are being trained in interpersonal communication skill work as warriors to mobilise community towards health related issues and changing behaviour".
lalmani Diggal is among those thousand mothers who are now aware of child care, nutritional food and sanitation, thanks to various tools of communications.
(The article is a part of Child Survival Media Award-2014 fellowship by NFI in collaboration with Save the Children)