In Odisha, which has a sizeable population of tribes, a concerted effort is being made to improve health-seeking behaviour and demand-generation. Ritesh Kumar Sisu has more on the successes and challenges of the initiative
According to the 2011 Census, Odisha has a tribal population of 22.8 per cent. Eight of its 30 districts have more than 50 per cent Scheduled Tribes (STs); in six others, STs account for between 25 and 50 per cent of the total population. Providing basic needs to the tribes and strengthening the education and health infrastructure in tribe-dominated areas is a challenge for the government.
The state has chosen a holistic communication approach to create platforms for behaviour change communication (BCC) in order to improve the tribes’ health-seeking behaviour and demand-generation. As a part of the initiative, the State Institute of Health & Family Welfare (SIH & FW) was declared a Centre of Excellence for Communication in 2011 and the programme is being supported both technically and financially by the National Health Mission, Odisha.
SIH & FW has taken major steps for need assessment, strategy formulation, capacity building, implementation and monitoring and evaluation of BCC interventions across Odisha. There has been integrated BCC planning and implementation of various programmes.
These include Reproductive Maternal Neonatal Child & Adolescent Health Plus, Communicable Disease & Non-communicable Disease programmes such as National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke, National Vector Borne Disease Control Programme, Revised National Tuberculosis Control Programme and Intensified Diarrhoea Control Fortnight. The Departments for Women & Child Development, Rural Development, Panchayati Raj, Scheduled Caste & Scheduled Tribe, and Education contribute to the effort. SIH & FW espouses a 360-degree mixed media approach, a blend of mass media, mid media and inter-personal communication (IPC) activities to reach out to the maximum number of people in the target group.
Despite various odds, timely interventions have resulted in encouraging success in some areas, including a fall in morbidity and mortality due to dengue, malaria and diarrhoea in Odisha over a period of time, because of the impact of the Diarrhoea, Malaria and Dengue (MDD) Campaign started in 2011. The impact of the campaign, which uses a popular mascot named Nidhi Uncle to popularise healthy habits and lifestyle, is evident from the State Integrated Disease Surveillance data which shows that deaths due to diarrhoea came down drastically to just 11 in 2015 from the 186 in 2010, while deaths due to malaria declined to 88 in 2015 as compared to 247 in 2010.
There were only two deaths due to dengue in 2015 while 33 persons lost their lives to the disease in 2011. Focused-evidence based BCC interventions on Maternal & Child Health have also shown encouraging results. The data generated by a comparative study in 2015-16 shows a 25 point decline in Infant Mortality Rate, a 42 point decline in under-five child mortality, 49.8 point increase in institutional delivery, 26.8 point increase in full immunisation coverage, 25.1 point increase in mothers who have had at least four antenatal checkups and a 20.5 point decline in anaemia in pregnant women.
Ultimately, focused BCC interventions have been contributing a lot along with other interventions in bringing about such a positive change in health-seeking behaviour of the targeted population. However, it has to be said that a lot remains to be achieved in the matter of improving overall health-seeking behaviour uniformly across the state. It has been observed that despite strategic, evidence-based and focused BCC interventions in tribe-dominated areas, there is slow progress in terms of change towards positive health-seeking behaviour and uptake of services through increased demand generation.
The underlying issue is communication. Illiteracy, poor exposure to modernisation, poverty, language, Maoism, lack of infrastructure, poor educational facilities, strong traditional cultural beliefs, myths and misconceptions, dogmas, superstitions and scattered inhabitation of tribal communities in hard-to-reach and difficult terrain are some of the factors that make it difficult to establish effective communication with the tribal population. The reach of conventional media is almost nil in tribe-dominated areas.
SIH & FW has adopted various strategies to breach these barriers. They include use of local folk media, video shows and IPC tools such as mobile kunji, flip books, etc. These strategies are designed to overcome the illiteracy barrier but are not able to overcome the language barrier. There are over 40 tribal languages spoken by the 61 different tribes found in Odisha and almost all are oral languages, without a script. Most of the population are unable to read and understand even Odiya.
It is hard to create an effective health communication environment using conventional media. In terms of media penetration in tribal areas, as per the statistical profile of Scheduled Tribes in India 2013, Odisha has the lowest number of ST households with TV sets (7.6 per cent) and the second lowest number of households possessing mobile phones (16.1 per cent).
A recent study conducted by the Indian Institute of Public Health, Bhubaneswar on behalf of SIH & FW shows that in tribal areas the preferred media are IPC, folk media, Swasthya Kantha (The Health Wall) and Village Health Nutrition Day (VHND) platforms, whereas in non-tribal areas the preferred media are TV, newspaper and Swasthya Kantha. Surprisingly, radio has limited scope as a source of information, the study points out. It also shows that a large chunk of the population (80 per cent) is dependent on ASHAs (accredited social health activists) and ANMs (auxiliary nurse midwives) to get health-related information through IPC. In such a scenario, the availability of quality health communication providers is vital.
It is evident that health communication alone cannot bring in a rapid change in lifestyle and behaviour in the tribal population. Rather, a collaborative effort to uplift the overall social, economic, infrastructural and education status of these areas can bring about a supportive environment for effective health communication interventions. In such a scenario, more resources are called for, to build capacity and strengthen frontline workers, particularly in respect to health communication. Though it could prove expensive, IPC should be the preferred channel of communication.
(The writer works as State Communication manager at the Centre of Excellence, Directorate of State Institute of Health & Family Welfare, Odisha, and has been associated with development communication for more than a decade.)
April – June 2017