IPPI in India 2000- 2001

IPPI in India 2000- 2001

RESEARCH BASED COMMUNICATION

MODEL

for

UNREACHED CHILDREN

By

Dr K SURESH

Project Officer, UNICEF India Country Office

Reaching the Unreached Communication Model

Process Evaluation involves Assessing

– Knowledge

– Attitudes/ Beliefs

Designing & implementation of appropriate intervention

Outcome Evaluation Recording behavior Change

MONITORS

S/NID’s & H-HOUSE

GOVERNMENT--DIST/STATE

WHO/NPSP / UNICEF

ON THE SPOT GUIDANCE

END DAY CONSULTATIONS

CORRECTIVE ACTIONS

Methods of Data Collection for the IndicatorsProcess Evaluation

Independent observers - NGO, Medical Colleges, IAP

members, Students …

Filled-in questionnaire within 10 days of S/NIDs were

included for the analysis

Five part questionnaire was developed

5000-9000 booths/areas observed On booth day and

third day for HtH activities

Process Evaluation Indicators

For Immediate intervention Quality of vaccine in Phase-III Communities with 2+ Unimmunised children

Subsequent round Cold chain gap Awareness regarding date/place Micro-planning

Next year strategy Training of service provider Reasons for not-immunizing children despite

HtH for planning IEC/SM

Inclen India (USAID Support)

AIMS, NEW-DELHINodal UNIT

PLANS, ORGANIZES ,ANALYZES DATAFEEDBACK TO ICC

24 MEDICALCOLLEGESALL OVER COUNTRY

COLLECTQUALITATIVE DATAFGD'S, DI'sINTERVIEWING DISTMANAGERS

Methods of Data Collection for the Indicators End Evaluation

Multi pronged approach - – carried in all 35 states/UTs – 1041 clusters (975 normal and 66 high-risk)-– In 218 clusters qualitative research carried out

Quantitative - 41640 children – Structured surveys- Individual one to one interviews to

assess Knowledge, its extent, behavioral indicators Qualitative - 202 FGDs & 467 DIs

– FGDs with beneficiaries, family influencers– DIs with service providers, community influencers– Village observation, Transects

Analysis– A holistic approach– Weaving the data from all sources

Indicators for the Communication Model- Knowledge

About the disease Action Required About the program About NID

• Use of Mass media

• Use of Interpersonal

• Training and Orientation Workshops

Awareness - 80% (1995) 99.4%(1997), 99.5%(2001)

I Prevention ‘Medicines required only when ill’ Concept of Prevention Vs. Cure - Health Vs. Absence

of Disease

Underlying Issue:

• Distrust of Medicines per se and excessive medication

• Particularly if free by Govt. & thrust without explanation

• Identity of Service Provider

Many rounds & Given at home New challenge

II Empathy

‘Not for me’- Amongst Affluent because ‘it happens only to the poor’ Hygiene factors at booth, ‘Look Good’, ‘Feel Good’- New problem Family doctor advice

Underlying Issue:

• Lack of exposure, Used to better services, demanding

•IAP/IMA/Pvt. Practitioners to immunize at their clinics

•Private hospitals to open booths

•Medical / Affluent college students to volunteer

•Celebrity endorsements

Refusal declined on

Doctors advice - 6.1% (1995) Nil (00)

III Trust

Government Service

Expertise of Service providers ??

Participation of Volunteers 30%(1995) 60%(01)

Training Outsourced last year

Readiness to believe negative stories

Sensitization of Journalists and other forums

Less negative reporting,

% of untrained staff - 26%(99) 5%(01),

91% SP satisfied with the training

Free service– ‘No free lunches’– Issue of dumping medicines

??

III Trust

Difference in reach across religions not significant now

Coverage in (0-6m)- 75.7%(1996) 91%(2000)

In 2000 - <1m - 60%, <3m - 86% were reached

Child too young IPC and Use of SMCs

Religious lines Appeals from religious leaders/

influencers-Verbal Print Vedios of Mollavi’s appeal

played in UP & WB Use of celebrities like Shahrukh

Khan

Empowerment

Fatalistic Attitude– “Whatever is to happen will happen”

How does it matter if we miss?– a few children– a few doses

• Repositioning of program as People’s program through Mass media and SM

“Every Child, Every Time” theme tune of Audio/ Video spots

‘Not aware of need for additional doses’ - 10.4 (1996) 4.5 (2000) (among those refused - 6.7(1996) 1.4% (2000)

COMMUNITIES WITH UNIMMUNIZED CHILDREN DESPITE HOUSE TO HOUSE IMMUNIZATION

17.7

10.49

0.81.9

3.5

0

2

4

6

8

10

12

14

16

18

20

Oct.99 Nov.99 Dec.99 Jan.00 Dec.00 Jan.01

Among the communities with unimmunized children, % with 2+/100HH such children - 70% (Oct. 99) 18% (Jan. 01)

Among the communities with unimmunized children, % with 2+/100HH such children - 70% (Oct. 99) 18% (Jan. 01)

Issues to Tackle in 2001

Concept of Health as different from absence of diseases as it becoming rare

Look good, Feel good and match demands (affluent families)

Building knowledge workers amongst service providers

Free Service- ?? Readiness to believe negative stories-

– Anti-fertility

– HIV/AIDS

Challenges...

Playing safe’ mentality- double edged sword Traditionally restricted access to the young

child (0-3m)– Social restriction– Exclusive breast feeding

Needs to be tackled as genuine concern Cultural and religious diversity compound the problem

Fatalistic Attitude - Hardships and uncertainties of life per se

Mental state - Historical suppression within the community

Increase in zero dose children - 0.7(2000) 2.4%(2001)

Thanks for Thanks for caringcaring