Draw up a balance sheet of Bihar.
At first glance the negatives far outweigh the positives: it is one of the most populous states in India and one of the least developed. Abject poverty, illiteracy, poor infrastructure, caste-based politics and practically no governance for over four decades have cancelled out its rich history, natural reserves, fertile soil and future potential.
Bihar has some of the worst maternal, neonatal and infant mortality rates in India. (The statistics are daunting: the maternal mortality ratio is 305 per 100,000 births, while the neonatal mortality rate is 35 per 1,000 live births and infant mortality rate 55 per 1,000 live births.) Bihar’s total fertility rate is the highest in the country.
But Bihar is changing. For the first time development has overtaken caste as an election issue. Better roads, improved law and order, education for girls, a rise in private-sector investment and the focus on governance make Bihar an example for the rest of India. New aspirations and a new resolve create an enabling environment for tackling old problems.
Against this backdrop, the Ananya programme, funded by the Bill & Melinda Gates Foundation (BMGF), aims to reduce maternal and infant mortality in Bihar by up to 40%.
As an Ananya partner, BBC Media Action is committed to improving the demand and uptake of life saving health behaviours amongst a population of 104 million people, including 25.9 million women of child bearing age.
For BBC Media Action in India, the changing face of Bihar shows two sides: challenges and opportunities, problems and solutions. The guiding principles of the Shaping Demand And Practices project are evidence-based and result-oriented. It is embodied by what we call a 360-degree communication mix that allows us to deliver at scale.
Sustainability is a central principle. The work integrates with existing health systems and community structures to help develop capacity at all levels. And this is being implemented by working in close partnership with the government of Bihar and other stakeholders at all levels and all stages.
And this is where the two i’s of this project come in – insight and innovation. If we can shape knowledge, attitudes and social norms to enable a young mother to say “Yes, I can” more than once, it can mark the beginnings of sustained behaviour change.
The process starts with an insight – for new ideas to take hold, individuals need to see the benefit of change and, ideally, feel ownership of the idea. So how can we get a husband interested in birth spacing, when his wife alone does not have the agency to take decisions on such matters and needs his support?
A scene from TV ad ‘Ek Teen Do’
Perhaps, if he sees a benefit in it that overrides his desire for a male child, that could spur his interest. Could a benefit related to more savings and better resources in the near future, because the family is healthier and less is spent on health care, be the answer? And there you have an insight!
We also needed to tap into appropriate technology to help share information. How would we create an interface to help the community health workers of Bihar become better professionals? In a state which has more mobile phones than toilets, we realised this could be a powerful way of sharing information.
But it would need to be kept simple, and how do you use low-end technology for high-end gains? How do you create an interface that can be used by the most marginalized audiences? How do you then sustainably scale these solutions across millions of people?
Answer these questions, building creatively on insights (and working hard with mobile phone operators to provide hugely discounted tariffs), and you have the seeds of an innovation.
For more on the details of our work with insight and innovation, and to find out more of what’s happening in India on the Bihar project, watch this space.
* Re-posted from BBC Media Action blog