Transforming family health in India: lessons learned

, 23 June 2014

Over the past three and a half years, a large team of over 250 people has been hard at work on an ambitious project that aims to improve family health in Bihar, one of the poorest and most populous states in India. This month about 60 of us came together to take stock of all that’s happened, learn lessons and forge the way ahead for the next year and a half. These are the inspiring things we found out.

First let me tell you a little about the project itself. Called ‘Shaping Demands and Practices‘, it is part of the Ananya programme, a collaboration between the Bill & Melinda Gates Foundation, the Government of Bihar and other partners.

Our project takes what we call a “360-degree approach” to tackle the appallingly high maternal and newborn mortality rates in Bihar.

This means we’ve worked on a multitude of platforms to reach our audience in eight of Bihar’s 38 districts – and are now scaling up statewide – in the most effective ways possible. We’ve launched revolutionary mobile phone services for health workers and families, produced a radio programme that’s been taken to listeners’ hearts, conceived and rolled out mass media advertising campaigns and inspired communities through face-to-face activities such as listener clubs and street theatre performances.. (For lots more detail, click here.)

Who we’ve reached

To kick off the ‘retreat’, our Bihar team wowed us with a quiz that showed quite how impressive some of our project statistics have been.

Here’s a sample question: which mobile health service has seen an average of 20,277 minutes of its content accessed per day in March 2014?

The answer: Mobile Kunji, our audio-visual aid used by community health workers when they visit families (Click here for more up-to-date info).

Or: how many health workers have been trained to use Mobile Kunji or by its sister service Mobile Academy a whole training course accessible to those using the most basic of mobile phones? 

The answer: over 38,500, making it the largest ever training of community health workers outside the government system in India. (Click here for more up-to-date info)

2These statistics show how the project has used data-driven management that has helped us to be flexible and nimble so we could change course and take decisions as and when required.

Many more impressive numbers were rattled out – evidence of three and a half years of hard toil and unwavering passion from everyone in the room.

How we’ve worked

At the retreat we heard how the project calls for consummate choreography. Our teams have to dance in perfect unison and at the same time work in partnership with many levels of government. It hasn’t been perfect, of course, but passion and commitment to quality has driven us through the most difficult moments.

We have seen our admin staff spending days and nights monitoring the printing and compilation of Mobile Kunji cards; our information and communications technology (ICT) team, negotiating unbelievable deals with giant telecom companies; our creative and production staff creating films, rural activation and mobile services within impossible deadlines.

And how have we achieved this? Through a multitude of methods: by handling each activity like a project; having a multi-disciplinary team for each intervention; creating a sense of ownership amongst every member of this vast team; learning from different sectors outside of development; frequent brainstorms and using out-of-the-box thinking to solve problems.

The challenges we’ve faced

During our retreat, we also heard about the practical issues on the ground in the predominantly rural state of Bihar: three-day power cuts, awful weather, bad roads and no internet connectivity to mention only a few.

Xavier Kumar, one of our community mobilisation officers, remembers wading through the flood waters of East Champaran and Samastipur to set up listener groups for our radio show Khirki Mehendiwali (Mehendi Opens A Window).

3It has been back-breaking work, but when he talks about the 4438 “self-help groups” who now listen to the show and discusses how they can put the advice into action, you can’t wipe the smile off his face.

The lessons we’ve learned

One of the hallmarks of the project has been our “rethinking” approach – to learn from user tests and research, to redefine problems, to reboot strategy, to redo outputs, to redesign implementation.

You have to be honest to correct your course. You have to be unafraid to try out new ideas.

For example, our innovative mobile phone services, Mobile Academy and Mobile Kunji, came about because we needed to cut the costs of face-to-face training and design a service without using expensive hardware.

Our mobile service Kilkari is another example. Families who subscribe receive a phone call every week which gives them health advice relevant to the woman’s stage of pregnancy and later to the age of her child. Both the service and its promotional strategy went through several rounds of user-testing till we got it right.

Our rural activation template was also fine-tuned after its first round and our radio show Khirki Mehendiwali, reversioned for the Listeners’ Groups to make it more discussion-friendly.

On the whole, we have always tried to think innovatively – mining insights and disrupting audience expectations with entertaining TV adverts, for example. Watch a selection of them here!

What’s next?

So what was the mood in the room at the end of the retreat? It was happy but self-critical – confident and proud but also introspective and never-say-die. There was no place for complacency there – no chance to take your eye off the ball!

We left knowing and believing that we have to continue to change the paradigm. We have to innovate and create new ideas and platforms. We have to prove the efficacy of our work. And above all we have to transform lives.



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