Final RBSK National Communication Framework for UNICEF ...nhm.gov.in/images/pdf/programmes/RBSK/RBSK_IEC/RBSK_National... · CWSN Child With Special Needs DC District Commissioner

National Communication Framework for RBSK ‘From Survival to Healthy Survival’

July 2016

National Communication Framework on RBSK Deloitte

Contents

Introduction 6

Situation Analysis 9

Implications for Communication Framework 16

Conceptual Model 22

Barrier Analysis 24

National Communication Framework for RBSK 30

Key Audiences 32

Communication Approaches 34

How to Implement the National Communication Framework for RBSK 37

Capacity Development 50

Annex 1: Suggested Implementation Framework 54

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2Ds Birth Defects and Developmental Delays

4Ds Birth Defects, Developmental Delays, Deficiencies and Diseases

ANC Ante-Natal Care

ASHA Accredited Social Health Activist

AV Audio-Visual

AWC Anganwadi Centre

AWW Anganwadi Worker

AYUSH Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy

BCC Behaviour Change Communication

BPL Below Poverty Line

C4D Communication For Development

CD Compact Disc

CHC Community Health Centre

CHD Congenital Heart Disease

CMO Chief Medical Officer

CRC Convention of the Rights of the Child

CS Chief Surgeon

CSO Civil Society Organizations

CWSN Child With Special Needs

DC District Commissioner

DDRC District Disability Rehabilitation Centres

DEIC District Early Intervention Centres

DEO District Education Officer

DH District Hospital

DHO District Health Officer

DM District Magistrate

FLW Front Line Worker

FMR Financial Management Report


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GP Gram Panchayat

ICDS Integrated Child Development Services

ICT Information and Communication Technology

IE Inclusive Education

IEC Information, Education and Communication

IFA Iron and Folic Acid

IP Informal healthcare Providers

IPC Inter-Personal Communication

IVR Interactive Voice Response

LMO Lady Medical Officer

MDG Millennium Development Goal

MHRD Ministry of Human Resource Development

MHT Mobile Health Team

MLA Member of Legislative Assembly

MO Medical Officer

MOD March of Dimes

MoHFW Ministry of Health and Family Welfare

MoU Memorandum of Understanding

MP Member of Parliament

MSJE Ministry of Social Justice and Empowerment

MWCD Ministry of Women and Child Development

NGO Non-Governmental Organization

NHM National Health Mission

PHC Primary Health Centre

PIP Programme Implementation Plans

PNC Post-Natal Care

PRI Panchayati Raj Institutions

PSA Public Service Announcements

RBSK Rashtriya Bal Swasthya Karyakram

RCH Reproductive and Child Health


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RMNCHA Reproductive, Maternal, Newborn, Child and Adolescent Health

SBCC Social and Behaviour Change Communication

SDMC School Development and Management Committees

SHG Self Help Group

SMS Short Message Service

SNCU Special Newborn Care Units

SSA Sarva Shiksha Abhiyan

TV Television

UNICEF United Nations Children's Fund

VHND Village Health & Nutrition Day

WHO World Health Organization

ZP Zila Parishad


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Acknowledgements

The National Communication Framework on RBSK was developed by Deloitte team in coordination with Ministry of Health and Family Welfare, Government of India, and with funding support and technical guidance from UNICEF. This has been a collaborative engagement and a participatory process has been followed for the study. The team members from different organizations who were engaged throughout are listed below.

We are grateful to the team members from MoHFW – Dr. Ajay Khera (Deputy Commissioner, Child Health), Dr. Arun Singh (National Advisor to RBSK) and Mr. Premjith (National IEC Consultant, RBSK) who enriched this study with their active participation in meetings and field visits.

We thank the team members from UNICEF Delhi Office who provided valuable inputs and assisted Deloitte team in managing this study. This unique formative study covering 878 caregivers of children with 2Ds, and 170 community members and 80 Department Officials was led by Principal Investigators – Ms. Geeta Sharma and Dr. Pravin Khobragade from UNICEF. They were constantly engaged through the study and joined Deloitte team for field visits to Maharashtra, UP, Meghalaya, and Tripura.

We are immensely grateful to the technical advice provided by our Communications Expert, Dr. Nilesh Chatterjee. We also wish to acknowledge the efforts of our research agency, Dexter Consultancy Pvt Ltd. Last but not the least, the credit goes to over 1100 respondents who provided their valuable time and shared their experiences, insights, and stories to make this report feasible.

MoHFW Team UNICEF Team Deloitte Team

Dr. Ajay Khera Ms. Geeta Sharma Ms. Anupama Joshi

Dr. Arun Singh Dr. Pravin Khobragade Ms. Lakshmi Gopalakrishnan

Mr. Premjith Mr. Deepak Seharawat and Ms. Avani Venkateswaran


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About the Report

UNICEF engaged Deloitte India to conduct a Formative Research on Knowledge, Attitudes, Practices (KAP) of caregivers of children with birth defects, and developmental delays. The findings from the formative research were used to design a National Communication Framework for RBSK.

Deloitte developed this Report into two parts: This is Part 2 of the Report entitled ‘National Communication Framework for RBSK’ and is informed by the analysis and findings from Part 1: Formative Research Report. It is presented as a first part to this Report. This report covers situation analysis of 2Ds, implications for communication framework, barriers faced by caregivers of children with 2Ds, communication goals, and objectives, key audiences, communication approaches, and implementation framework, and capacity development of supply-side functionaries.

The ‘Formative Research Report’ covers the analysis from the primary study covering caregivers of children with developmental delays and birth defects (2Ds), community-level members including mothers-in-law, head teachers, informal service providers, and members of formal/informal groups, and frontline workers. The analysis has been presented by each type of stakeholder – covering their knowledge, attitudes, beliefs, practices towards children with birth defects and developmental delays. It also covers the systemic and operational gaps in implementing RBSK, capacity development needs of the supply-side functionaries.


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Child Health

With a child population (up to 18 years of age) of over 400 million, India has the largest number of children in the world. Child health indicators in India, however, continue to be a cause of concern. An estimated 26 million births take place in India every year. However, under-five child mortality is 1.27 million children per year, of which 81%1 takes place within one year of age. India’s contribution to global child deaths is a significant 20%.2 A substantial number of children die every year due to preventable diseases and infections, with four diseases (respiratory infections, diarrheal diseases, other infectious and parasitic diseases, and malaria) contributing to half of under-five deaths in the country.3

The Government of India has introduced several initiatives and programmes over the years to address the country’s poor child health and survival status over the years including Universal Immunisation Programme, RCH I, RCH II under National Health Mission, RMNCH+A approach under NHM. All these programmes were introduced to address the major causes of child mortality and delays in accessing and utilising health services. The National Health Mission’s Child Health interventions addresses child health and survival using a Continuum of Care approach, providing health interventions across a child’s lifecycle.

Rashtriya Bal Swasthya Karyakram (RBSK)

Along with efforts to reduce child mortality, the focus on improving survival outcomes became equally important. With a view to comprehensively address all child health conditions, including birth defects, and developmental delays, the Ministry of Health and Family Welfare launched the Child Health Screening and Early Intervention Services initiative (‘Rashtriya Bal Swasthya Karyakram’) in 2013 to provide targeted, comprehensive care to children aged 0–18 years. Screening of all children was meant to give opportunity of early intervention in conditions like congenital cardiac diseases, congenital cataract, among others. Under RBSK, children aged 0-18 years are screened for 4Ds - defects at birth, diseases, deficiencies and developmental delays including disabilities.

As per the guidelines of this programme, screening of children up to 6 weeks of age is conducted initially at delivery points by medical officers, staff nurses, and ANMs, and subsequently at home by ASHAs as part of Home Based New-born Care (HBNC). Screening of children aged 6 weeks to 6 years takes place at Anganwadi centres (AWCs) at least twice a year, and of children aged 6 to 18 years at school. A dedicated workforce, Mobile Health Teams (MHTs) comprised of two AYUSH doctors, one ANM/staff nurse, and one pharmacist, conduct screening for children at schools and AWCs.

Children screened and diagnosed with a health condition (within 4Ds of RBSK) are referred to early intervention centres that have been set up at district hospitals (District Early Intervention Centres- DEICs) or to other secondary/tertiary facilities if DEICs are yet to be set up. These DEICs are the first referral point for further evaluation, treatment and management and provide referral linkages to designated secondary/ tertiary health facilities.

1 Child Health Background, National Health Mission 2 The Situation of Children in India – A Profile, UNICEF 3 The Situation of Children in India – A Profile, UNICEF

Introduction


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Need for the Study

While the programme exists to screen, evaluate and treat children with 2Ds, India does not have a surveillance system to examine the magnitude of birth defects and developmental delays. In addition to limited surveillance/ epidemiological data, social research studies on this topic with the different types of birth defects and developmental delays is very scarce. Consequently, very little is known about the perceptions, knowledge, attitudes and practices of caregivers of children with 2Ds and that of the larger community including health system functionaries and institutional stakeholders.

While there are other health programmes in place to address the diseases and deficiencies, interventions to address birth defects and development delays including disabilities (2Ds) are covered only under RBSK. As a result, a formative research focusing on birth defects and development delays was essential to address this gap and build evidence on the social norms, knowledge, attitudes, practices and health-seeking behaviours, and barriers of caregivers of children with 2Ds and community members.

As the lead technical partner in India for Newborn and Child Health, UNICEF in India has been involved in RBSK among other Government of India’s Child Health programmes, especially for development for branding materials. The C4D team of UNICEF has developed a short film on ‘RBSK’ to highlight the importance of the programme in minimising disability through early intervention. The C4D team also provided support in development of branding materials for RBSK vehicles, RBSK brochures, posters and display boards for DEICs. However, before launching the full-fledged SBCC Framework, it was important to have experiences and learning from the field of caregivers of children with 2Ds. An effective communication framework requires evidence and data to guide it. Methodology

UNICEF engaged Deloitte India to conduct a formative study on caregivers of children with 2Ds. This study was meant to bridge the gap on the social norms, knowledge, attitudes, practices and health-seeking behaviours, and barriers faced by caregivers of children with 2Ds and community members. This study sought inputs from a wider range of stakeholders including individual caregivers having children with 2Ds to networks, communities and service providers. This builds on the insights and perspectives gained from the field including 878 in-depth interviews with caregivers of children with 2Ds, and focus group discussions with over 170 community members, frontline workers, and formal/informal groups. In addition, the Capacity Development Framework draws from discussions held with institutional stakeholders including 80 National, State, District, and Block level Health Department Officials. Other Department Officials including WCD, Social Justice, and School Education were also covered at National, State, District, and Block level. In particular, meetings with the IEC Officials in different States were useful to understand their perception of ‘IEC/SBCC’ as well the existing structures within which this Framework can be integrated and implemented. The process of developing the National Communication Framework was based on a sound understanding of the community-based needs of caregivers of children with 2Ds, community members, and health system and institutional stakeholders rather than a top-down information dissemination approach. This evidence-based, National Communication Framework for RBSK, engrained in a right-based programming framework, is aimed at targeting and overcoming awareness, attitudinal, and barriers related to accessing RBSK services. This Framework uses a Socio-Ecological Model, reflecting a shift from a focus on the parents (usually the mother) alone to recognising that a range of family, community members and social, political networks (policy makers, community and service providers) influence behavioural outcomes. Recognising the fact that this Communication Framework feeds into an on-going Child Health Programme under National Health Mission, the Framework uses the four key principles of the Convention of the Rights of the Child (CRC) including (i) non-discrimination, (ii) the best interests of


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the child, (iii) the right to survival and development, and (iv) participation, with all rights applying to all children at all times.4 Purpose of this Report

This framework is not prescriptive in nature. The purpose of this National Communication Framework is to serve as a guidance to support advocacy and communication interventions at the National and State level to achieve RBSK goals. The formative study covered 5 States across the country and reflects the ground realities across the country. However, the cultural nuances across and within States in India necessitate customisation of the National Communication Framework to suit the needs of each State. Structure of this Report

The National Communication Framework on RBSK includes: • Situation Analysis • Implications for Communication Framework • Conceptual Model • Barrier Analysis • National Communication Framework for RBSK • Key Audiences • Communication Approaches • How to Implement the National Communication Framework for RBSK • Capacity Development • Suggested Implementation Framework

4 http://www.unicef.org/crc/index_30177.html (Rights under the Convention on the Rights of the Child), UNICEF Accessed 22 June 2016


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Magnitude of 2Ds among children in India

Over the past decade, there has been a decline in the under-five mortality rate in India from 126 per 1000 live births in 1990 to 49 per 1000 live births in 2013. Although, India missed its Millennium Development Goal (MDG) 4 of reducing child mortality rate by two-thirds, the progress in child health has been commendable. Further reduction and prevention of child mortality demands due attention be given to birth defects prevention. Current situation and burden of birth defects Birth defects, or congenital anomalies, are structural or functional defects that arise before birth. Per the March of Dimes (MOD) Global report on birth defects (2006), it is estimated that nearly 8 million children worldwide are born with a serious birth defect of genetic or partially genetic origin. According to the joint World Health Organization (WHO) and MOD report, birth defects account for 7% of all neonatal mortality and 3.3 million under five deaths. This is owing to poor status of women’s health and nutrition, inadequate care during pregnancy, and childbirth and social determinants including poverty, high fertility, and greater frequency of consanguineous marriages.5 Major birth defects include congenital heart defects, Neural Tube Defects (NTDs), Down syndrome, hemoglobinophathies and glucose-6-phosphate dehydrogenase deficiency, cause 20% of infant mortality and are responsible for a substantial number of childhood hospitalizations. It has been estimated that 70% of the birth defects are preventable.6 The actual burden of birth defects is not known in India due to inadequate epidemiological information. In India birth defects prevalence varies from 61 to 69.9 per 1000 live births. 7 With a large birth cohort of almost 26 million per year, India would account for the largest share of birth defects in the world, which translates into 1.7 million birth defects annually accounting for 9.6 per cent of all newborn deaths.8 India’s focus on prevention of infants being born with birth defects have focused on strategies including iodization, double fortification of salt, flour fortification with multivitamins, folic acid supplementation, peri-conceptional care, carrier screening and prenatal screening.9 Babies with serious birth defects, are now able to survive with advancements in medical technology and health services, increasing the number of infants and children with lifelong disabling conditions. Such children require long-term medical and supportive interventions, putting an additional burden on stretched health systems.10

6 World health organization. Management of birth defects and haemoglobin disorders: Report of a Joint WHO-March of Dimes meeting. Geneva, Switzerland, Geneva: WHO; 2006 7 Estimates of the birth defects are conservative numbers due to constrains in diagnostic capability, poor health-related statistics, lack of birth defects surveillance and registries, reliance on hospital-based rather than population-based studies and systematic underestimation of the toll of birth defects 8 March of Dimes Report 2006 9 Sharma, R. Birth defects in India: Hidden truth, need for urgent attention, Indian Journal of Human Genetics, 2013 10 Regional communication strategy for the prevention and control of birth defects, World Health Organisation, 2015

Situation Analysis


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Current Situation of Developmental Delays

Functional birth defects, often related to a problem in working of a body part or system, lead to developmental delays including disabilities. An estimated 3.2 million children born globally who may survive, may have a lifelong mental, physical, auditory or visual disability.11 Few risk factors for these include genetic defects (such as Down Syndrome), fetal alcohol syndrome, perinatal factors and severe medical conditions soon after birth including birth asphyxia, and others associated with prematurity. Several social determinants are associated with developmental delays and disabilities such as poverty, poor maternal health and nutrition; poor care during pregnancy and childbirth, and lack of early stimulation. 12 In India, developmental delays including disabilities are also a substantial cause of morbidity in early childhood, affecting around 10% of children. About 20% of babies discharged from Special New-born Care Units (SNCUs) were found to be suffering from developmental delays or disabilities at a later age. 13 Developmental delays including disabilities in the first five years significantly hinder the growth potential of the child. It may reflect the child’s need for a special interdisciplinary care, treatment or other services that are lifelong or extended duration, usually planned on a case-to-case basis. With a strong grounding in population health and well-being, RBSK shifts away from viewing birth defects and developmental delays including disabilities only as a medical problem with a primary focus on screening, and early intervention for children with 2Ds. This view changes the focus from rehabilitation approach to a public health approach framed in terms of reduction of risk factors and early identification of children with 4Ds to prevent the onset of disability. Knowledge, Attitudes, Practices of Caregivers of Ch ildren identified with 2Ds

With limited epidemiological and social research data on children with birth defects, and developmental delays, the formative study explored the knowledge, attitudes, beliefs, and practices of community members and caregivers of children with 2Ds. The detailed findings can be accessed under a separate report on ‘Formative Research Report on RBSK’. The major highlights are summarised below:

The formative study included a total of 878 of caregivers of children who have been screened to have a birth defect or development delay, unscreened children suspected to have 2D, normal children, and newborns. The study had a diverse representation of rural population in terms of income, education, religion, and caste. Of all the caregivers interviewed, nearly 60% of the caregivers had children with 2Ds, 33% of them had children identified with developmental delays, and 22% of them had children with birth defects. Congenital Heart Disease (CHDs) was the most common birth defect (25%), followed by club foot (22%), and cleft lip/palate (13%). Among delays, the top three found in the study was language delays (27%), followed by visual impairment (22%), and hearing impairment (12%).

Knowledge of health conditions of children with 2Ds and RBSK

Caregivers’ knowledge is crucial from a communications perspective and to target awareness generation activities. Caregivers were unaware of any technical or medical details of their child’s condition. For children with visible birth defects, caregivers gave a vague explanation such as ‘the child’s legs are not okay and he can’t walk properly’ or ‘a hole in the heart’. For developmental delays, caregivers are only able to describe it in terms like ‘brain is not developed’ or ‘body is weak’, indicating limited understanding

11 Neonatal – perinatal database and birth defects surveillance, Report of the regional review meeting, New Delhi, World Health Organisation, SEARO (2014) 12 Gulati S and Wasir, V. Prevention of Developmental Disabilities, Symposium on Developmental and Behavioural Disorders, All India Institute of Medical Sciences, India Journal of Pediatrics (2005) 13 Operational Guidelines on RBSK, Ministry of Health and Family Welfare (2013)


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of the condition. This could be owing to the poor educational attainment of 75% of caregivers (38% of respondents were non-literate, another 37% of caregivers had completed primary level of schooling).

Further, 40% of caregivers of children with easily observable birth defects are able to know of the condition at birth. Whereas for children who develop developmental delays that take time to manifest, only 15% caregivers knew of the child being different at birth. This distinction is evident from the exhibits below.

Exhibit 1: Percentage distribution of caregivers’ a wareness about the child’s condition, having birth defects

Exhibit 2: Percentage distribution of caregivers’ a wareness about the child’s condition, having developmental delays

With respect to awareness of RBSK, 55% of the caregivers indicated knowing about the programme measured through their awareness a team of doctors coming to the schools and Anganwadi centres to conduct check-up children. The awareness was higher in States such as Maharashtra (38%) and Karnataka (24%). The source of this information was frontline workers including AWWs (55%), ASHAs (32%), and school teachers.

However, most caregivers had very limited knowledge of RBSK’s rationale and continuum of care. Probing on in-depth responses revealed that they were not clear about what the check-up (or screening) meant, and did not understand the potential benefits of screening and early intervention.

Attitudes and Beliefs of Caregivers towards Childre n with 2Ds

Attitude measures general attitudes of children with special needs (CWSN), responses of caregivers when they know of their child’s condition, response of community members, and front line workers towards families having children with 2Ds.

Largely positive stance towards children with 2Ds, or children with special needs

With absence of a scale to measure attitude towards 2Ds, caregivers’ attitudes were measured through a vignette of a fictional caregiver, ‘Kamla’ and her daughter ‘Radha’ with a speech and hearing impairment. 87% respondents did not feel that the community members in the village would socially exclude


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caregivers like ‘Kamla’. 69% of the respondents felt that children with special needs such as Radha could be mocked at by other children, attributing it to the mischievousness and immaturity of children. The vignette measured general taunts by mothers-in-law, 56% of the caregivers felt that the mothers-in-law could blame their daughters-in-law for bearing a child with special needs (or disability). However, they also added that this would only happen in a fit of a rage if the mothers-in-law tended to be angry with their daughters-in-law. Moreover, interviews with mothers-in-law revealed that they tended to be supportive and partake in caring for the child with special needs, often accompanying their daughters-in-law to the health facility, if required.

62% of the respondents felt that it would be easier for caregivers like ‘Kamla’ to deal with a male child with special needs than to raise a female child with special needs. While gender continues to colour even the perception of children with special needs, most respondents qualified this statement by adding that their main worry was regarding the long-term safety and security of female children with disabilities. They echoed social norms in India around daughters being a ‘paraya dhan’, and the fact they had to eventually be married off, and live with their husband’s family. The caregivers also worried that the disability status of girl children could even impede their chances of getting married or that the parents would have to struggle to find an appropriate match for such girls.

Worry looms caregivers about children’s future, com munities and frontline workers lend support

Over 50% of caregivers’ were beset with worry or depression when they found out about their child’s condition, majority of the caregivers’ worry originated from thinking about the future of their child, especially when the parents would no longer be around to take care of their children. Responding to a question on the response they received from community members and frontline workers, nearly 32% of them reported receiving encouragement to seek medical care for the affected child.

With respect to response of community members and frontline workers, nearly 32% of the caregivers received encouragement from their community members to seek medical care. Additionally, 24% of the parents/caregivers of children with 2Ds also felt that community members were sympathetic towards them. More than 40% of respondents felt that ASHAs and AWWs were only playing a role in provision of information, and often offer verbal solace.

Caregivers unable to discern between the cure vis-à -vis care approach for 2Ds

Most parents interviewed for the study perceived that RBSK screening was not offering medical care since no medicines were dispensed to address immediate health conditions such as fever, cough, diarrhea, among children. Caregivers are not be able to distinguish between medical conditions associated with birth defects and development delays, and are unable to distinguish between different interdisciplinary approaches of care or cure that may be possible for a variety of conditions covered under RBSK.

Caregivers pin their hopes on medical care and poss ess right set of beliefs

The study revealed that caregivers had belief in medical care and 80% of them were hopeful that their child could be cured. While there were a few caregivers who were fatalistic, a large proportion of caregivers were willing to access care, despite facing financial, transport and other barriers. Nearly 25% of caregivers met did not know the cause of their child’s condition.

55% of the caregivers attributed the cause of the condition of their child to poor health seeking behaviors during pregnancy and childbirth. Only 10% of the caregivers attributed their child’s condition to God’s wish, black magic, past deeds, or other inauspicious events that are outside their control.


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Practices

Preference towards private sector

It was observed that most caregivers had a higher preference to go to the private sector for the initial screening and diagnosis, especially in the case of visible birth defects. 35% of parents sought treatment at private sector and had incurred an average out-of-pocket expenditure of 45,000 INR. Nearly 16% of parents sought treatment at government health facilities. Only 7% of parents tried alternative forms of therapy such as traditional healing, Ayurveda, etc.

Joint decision-making was common

Further, 25% of the respondents expressed that mother was the primary decision-maker for choosing treatment for the child. About 30% of them felt that decision-making was done by the parents together

Barriers

Finance and Transportation, two most commonly faced barriers by caregivers of children with 2Ds

More than 50% caregivers identified finance as their barrier. Financial considerations were a barrier both in routine care of the child at home, and to avail treatment for the child at a health facility. Additionally, 21% of caregivers expressed that transport was a key barrier they faced, in reaching a health facility. Cognitive barrier was also observed, 13% of caregivers identified lack of information regarding child’s condition as an impediment to treatment. Further, psychological distress as a function of constant caregiving for children having 2Ds is also another barrier faced mostly by mothers.

Enablers

Several enablers or facilitating factors to motivate caregivers to avail RBSK services and improve utilization of the programme were identified. They include:

• Building awareness of RBSK and the importance of early intervention • Complementary health insurance schemes that also cover RBSK conditions to address financial

barriers of caregivers • Introducing a mechanism wherein transport to health facilities is covered or provided, either

through RBSK itself or other health programmes • Creating a positive experience with the programme for patients and families

Findings from Health Department Officials and other Department Officials

Detailed interviews with the various officials at State/ District levels across five study states revealed that the degree of knowledge about basic programme details varies among the different stakeholders.

Limited importance given to RBSK among senior burea ucrats in States

With the multitude of programmes under National Health Mission, perceived importance of RBSK among senior bureaucrats and focus on the RBSK was found to be weak. Interactions with NHM Mission Directors in the study states demonstrated that their own knowledge of the programme was limited, and they did not advocate strongly for the programme with other officials.

Further, limited focus on the programme is further demonstrated by the slow progress made in RBSK training. This poor focus on the programme has led to slow programme implementation. For example, screening by ASHAs at home and MOs in delivery points yet to pick up. Further, there has been slow progress on operationalization of DEICs. This, in turn, affects successful delivery of the programme, and creates reluctance among beneficiaries to use its services, especially the follow-up and tertiary care services.


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Weak referral system impeding evaluation and manage ment of children screened to have 2Ds, limited knowledge of RBSK among service providers a t PHCs/CHCs/DHs

Several states have a weak referral system to evaluate and manage children screened to have 2Ds. In the absence of DEICs, children are often referred to PHCs/CHCs/District Hospitals. It was observed that the medical officers concerned in these facilities do not possess the complete understanding of RBSK and its associated health conditions. This could be due to the lack of training or orientation of the health system functionaries at the regular health facilities. They often do not communicate clearly with the parents on the course of action appropriate for the child, duration and necessary procedures, etc. Parents often have to spend long waiting times at the facility, face overcrowded facilities and do not get the dedicated attention and knowledge on future course of action/treatment.

Delays in setting-up and operationalizing DEICs is a barrier to uptake of RBSK, especially for follow-up and care

Interactions with supply-side officials highlighted that the respective state governments are not very serious about expediting the set-up of DEICs. Despite three years of launch of the RBSK, the operationalizing of DEICs has been quite slow.

Public health facilities not sufficiently geared up to receive parents for follow-up and care

Public health facilities lack the necessary diagnostic infrastructure/equipment to perform the evaluation and treatment, often requiring parents to go to private sector diagnostics resulting in huge out-of-pocket expenditure for parents. Instead of experiencing the necessary care and free treatment, parents are often subjected to physical and financial stress both due to repeated visits, lack of clarity on the visits required and future course of action, further reinforcing their mistrust in the public health system.

Lack of mapping of tertiary/secondary care services impeding programme success

Many Health Department officials felt constrained by inability to act due to absence of Memorandum of Understanding (MoUs) with private sector/ government sector (medical colleges). Officials did not have a clear guidelines/mapping of secondary/tertiary care institutions for evaluation/management of 2Ds available in the State. Without this mapping, the programme was unable to deliver outcomes beyond screening phase. Even within screening phase, instead of a focus on quality screening, a target-driven approach to screening is being followed. Additionally, a few District officials were noted to have limited understanding of the meaning of “early intervention” under RBSK in minimizing disabilities.

Involvement of other Department Officials, and cons equently convergence is weak

Limited sensitization of officials in other departments at State/ District/ Block levels on RBSK. As a result of poor convergence mechanisms, especially at State and District levels, the awareness of RBSK is low among officials of other departments.

Poor focus on IEC/BCC

There is overall a poor focus on IEC/ BCC for the programme. This is exacerbated by a weak understanding among health officials of the importance of IEC/ BCC and its potential for impact in improving programme understanding and uptake among beneficiaries. The IEC/ BCC activities are being limited to printing registers and referral cards.

Several trainings needs emerged for different offic ials and service providers

Overall financial utilisation for RBSK training is poor with the exception of Maharashtra (50% of training budgets have been utilised in 2015-15). MHTs in UP are yet to receive the 5-day RBSK training to screen


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children. Further trainings for MHTs have largely been technically focused, with no attention being given to soft skills including IPC and counselling skills.

Service providers in these public health facilities including DHs/CHCs/PHCs do not possess the complete understanding of RBSK and its associated health conditions. A detailed capacity development measures have been proposed in the chapter on Capacity Development.

Findings from MHTs and FLWs

Mobile Health Teams play a crucial link between the community and health system

MHTs are playing a crucial role and are often the link between the community and RBSK system of care. However, most MHTs are themselves not clear on their role in the programme. Interactions with AYUSH doctors revealed that they felt ‘inadequate’ since they do not ‘treat’ children, and do not provide medicines beyond IFA tablets or flu, diarrhoea medicines’. In the absence of mapping of services available in the State/District, many of the MHTs are not aware on where to send children with developmental delays. This was seen as a major service delivery challenge in the absence of DEICs.

While there is no formal mechanism for follow-up with caregivers, follow-up is being done by MHTs on their own discretion, motivation, and level of engagement with the programme. Follow-up tends to be weaker for developmental delays and health conditions that do not have a designated treatment protocol.

Frontline workers role play a limited role in the p rogramme

FLWs are trusted source of information for families about health programmes. In particular, Anganwadi Workers (AWWs) play a crucial role in provision on screening dates and arrival of MHTs. In some cases, caregivers have gained a lot of emotional support from frontline workers. However, frontline workers were found having limited knowledge of RBSK, and rationale for the programme. Many of the frontline workers including AWWs who are involved in the community mobilization have not received any formal trainings. ASHAs have a limited role in RBSK delivery, especially since home-based screening for newborns has not yet been rolled-out.14

The next section expands on the findings to delineate key implications for the Communication Framework.

14 As of July 27, 2016


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Communication specific profile of caregivers of chi ldren with 2Ds

Mass-media campaigns have long been used as a tool delivering preventive and behaviour change health messages. Hence, the caregivers study tool had a component on communication channels to understand media consumption habits. As depicted below, television has the highest preference on a daily basis, with over 40% of the respondents watching television on a daily basis. In comparison, the newspaper and radio are not preferred sources within mass-media. While only 24% of the caregivers reported reading the newspaper on a daily basis, majority of the semi-literate caregivers stated that they used newspapers to find about ‘free medical camps’ and other health-related information.

In response to a range of current sources of health information, 36% of caregivers said they got their health information from doctors and another 33% respondents from their frontline workers. A similar response was obtained for future sources of health information as well. Given that the rural mobile subscriber base is nearly 42%15, it is not surprising that 22% of the caregivers in this study also expressed their desire in receiving health information messages or alerts through a cellular phone.

15 TRAI, New Delhi, September 2015, Accessed 22nd June, 2016

Implications for Communication Framework

Exhibit 3: Frequency distribution of media consumption habit s


Page | 17

Exhibit 4: Current v/s Preferred Sources of Health Information

Based on the situation analysis and the detailed formative research findings, a list of implications for communication framework have been developed and presented below:

Implications for Communication Framework

Using information as a means to improve RBSK outrea ch

In order to change behaviors around screening, it is important to address the knowledge of the parents / primary caregivers. As was observed in the study, many parents do not possess correct / complete information about screening. They do not understand screening and consequently early intervention as a way of detecting and minimizing disabilities for children with 2Ds.

A large majority of respondents were emotionally disturbed after becoming aware of their child’s condition. Majority of them neither knew the details of the condition nor could explain it in technical and medical terms. They had a limited understanding of the problem – such as brain being weak, or body being weak (depending on the nature of defect or delay).

Furthermore, our study indicated that even teachers and Anganwadi Workers (AWWs) were not aware of the objective of RBSK, even though they are directly involved in the programme.

Communication Standpoint

• Communities need to be given information on screening date/venue through Public Service Announcements, or newspaper ads so that they are aware of when the RBSK teams come for screening. Counseling parents of children screened with 2Ds about the importance of early intervention and evaluation can enable them to avail treatment for children and benefit from RBSK. Use of pictorial booklets and IPC by ASHA could help

• Orientation workshops should be conducted for all teachers and Anganwadi workers and they could be given a small booklet to refer to later. Further, schools and Anganwadi Centers could have posters / wall-paintings depicting screening and its importance


Page | 18

Create a sense of community ownership of children w ith defects and developmental delays

Interactions with formal and informal groups at the village level across study districts revealed their interest in the programme and willingness to help in improving programme uptake. Members of Gram Panchayat (GP), SDMC members, SHG members expressed a need for the programme to be strengthened by involving community members to raise awareness of RBSK and its benefits, especially among families with children with 2Ds.

It was also observed that while families and communities were offering comfort and verbal solace to caregivers, they were not forthcoming with offering ‘tangible’ support. Families need education on the importance of RBSK so that they can encourage all parents for getting their children screened. This may help communities to extend tangible support to parents such as taking care of children, etc. while parents are away for intervention and management. Communities’ ownership of such children can be improved by reinforcing messages such as ‘disabled children are also children of the same God and require more care and support’. Formation of community-level support groups that offers a forum for sharing experiences can go a long way in alleviating their emotional burden.


• Community norms regarding support can be targeted through mass-media efforts such as TV ads and radio jingles. There could be an effort to form community groups to help parents of children screened to have 2Ds

• Members of formal and informal community groups can be leveraged for community mobilization activities, to spread awareness of the programme and help change the mindset of the community towards improved health seeking behaviour. As key influencers in the society, these groups are in an ideal position to play this role in supporting the programme and motivating the community. These groups could also play a role in providing tangible support to families, for example, by organizing small community loans or bringing people together to form support groups

• Communication needs to empathize with the emotional burden on the mother – especially the psycho-social aspect. This could be addressed by leveraging an existing toll-free helpline or through IPC/counseling from AYUSH doctors. Support networks such as mothers groups’ with children with 2Ds could be formed to provide emotional support and persuade mothers for early intervention, physiotherapy, follow up treatment, etc.

Capitalize on the ‘hope’ factor

The study revealed that parents had belief in medical care and were ‘hopeful’ that their child could be cured. While there were a few parents who were fatalistic, a large proportion of parents were willing to access care, despite facing financial, transport and other barriers. RBSK could improve programme utilization by providing them with services at their first-point-of-referral. When parents reach PHC/CHC/DH/DEIC, they should be received well by public health providers.


• There should be weekly evaluation and management sessions at PHC/CHC/DH where health providers are readily available to receive parents of children and offer services with utmost care and quality. This can help caregivers in regaining the trust in the public health system

• Additionally, a kiosk / helpdesk to guide parents and help them navigate the hospital, may also facilitate


Page | 19

caregivers to return for follow-up visits

Changing attitudes of caregivers from ‘cure to care ’

Most parents interviewed for the study perceived that RBSK screening was not offering medical care since no medicines were dispensed to address immediate health conditions such as fever, cough, diarrhea, among children. Caregivers may not be able to distinguish between medical conditions associated with birth defects and development delays, as well as the nature of treatment or caring practices for the 2Ds. For instance, as was observed in the findings, parents both Down syndrome and neuro-motor impairment as ‘brain is weak (‘dimaag kamzor hai’). They are unable to distinguish between approaches of care or cure that may be possible for a variety of conditions covered under RBSK.


• Proper training of all medical officers at PHC/CHC/DH needs to be carried out in the short-term to ensure that parents get a warm reception at the facility. During the evaluation sessions, MOs can provide counseling to the parents on the type of condition and what treatment / management options exist for the child.

• Counseling and educating of parents should emphasize on the fact that ‘screening’ is the first step towards providing long-term care and cure for children. The idea of ‘care’ vis-à-vis ‘cure’ needs to be repeatedly communicated to parents and families. It is imperative to use this touch point with parents to highlight the importance of early intervention for children identified with 2Ds. Here, the providers need to be given training on the level of difficulty / waiting expected in accessing services for each defect or developmental delay. In the case of developmental delays that may require long-term care rather than cure, caregiver education and emotional support is required. Cost burden of long-term care that may not be covered by the programme is a major barrier for most families

Addressing mistrust in the public health system

Most of the caregivers took their children to private health facilities. This was due to their negative experience in the government health facilities or difficulty in accessing treatment services after referral. In many cases, parents had directly approached the private health system for their children with visible birth defects as they believed it offered quicker response time and better quality of care. Further, since RBSK MHTs go to the community to conduct screening, parents’ expectations of the programme is heightened. When the system is unable to cater to the demands, parents further lose faith in the system affecting the utilization of RBSK. Caregivers are not being persuaded from the public health system to come for repeated follow-ups and they lose motivation to come back to public facilities.


• Ensure that all MHTs/MOs dealing with the RBSK beneficiaries empathize with caregivers’ emotional burden, financial stress and long-term care that tends to be associated with children with 2Ds. Public health system could have kiosks at facilities to receive RBSK parents and toll-free helplines to address the parents’ queries. Having functional DEICs with quality services available could go a long way in serving needs of the caregivers with 2Ds


Page | 20

Utilize the communities trust in frontline health wo rkers

FLWs are trusted and inform families about health programmes. They are the main source of information about screening camps and arrival of MHTs. In some cases, caregivers have gained a lot of emotional support from frontline workers. This communication channel can be strengthened to act as a facilitating factor in generating demand for RBSK. However, FLWs themselves lacked knowledge of RBSK, especially screening and early intervention.


• Ensure all FLWs are trained and motivated to deliver the program on the field. FLWs can be used to provide information and emotional guidance and support. AWWs / School teachers can also reinforce messages to the parents and mothers-in-law through persuasive counseling

Leveraging the wide network of informal service pro viders to provide information on RBSK especially in areas with difficult terrains

Our study observed that it is common practice for rural households in developing countries, including India, to rely heavily on informal healthcare providers (IPs) as their first-point-of-care for most ailments. Most parents had gone to their village doctors/IPs to consult them on their child’s health because they are easily available, and accessible, allowing patients to save on time and cost of travel. In addition, IPs tend to charge nominal amounts and even dispense medicines so parents are able to avoid the cost of both travel and buying medicines. They don’t incur wage loss as IPs tend to have flexible working hours that are suited to the needs of the communities. The parents also tend to trust IPs as they belong to the same community (this was particularly observed in Tripura and Meghalaya). Our study found that most IPs had children with birth defects and developmental delays come to them; however, they were unaware of government programmes such as RBSK that cater to the needs of such children. IPs also had a positive attitude towards medicine, and often, directed these parents of children who required surgical interventions to seek care under the formal medical system.


• As traditional healers are often a trusted point of contact for the community, including caregivers of children with 2Ds, there is huge scope to leverage them to improve uptake of the programme. IPs can be trained by the Government to screen for the conditions covered under RBSK, and appropriately refer their patients to health facilities. As trusted members of the community who do not have formal medical training, they can be used to provide families with information on the importance of screening, and early intervention to minimize disability and for RBSK

Integrate awareness on preventing birth defects and developmental delays into other programmes

Our study observed that it is common practice for many communities in southern India to marry within the families (consanguineous marriages). Similarly, the study also found that many pregnant women were involved in heavy labor intensive field work, and did get complete antenatal check-ups done. Many studies including reports from WHO have established the importance of ANC care including micronutrient deficiency management to prevent children from being born with birth defects.



Page | 21

• Adolescent health programmes (Rashtriya Kishore Swasthya Karyakram) could incorporate messages around discouraging consanguineous marriages and pregnancy at advanced maternal age. Further, programmes on maternal health should reinforce messaging on immunization, supplementation of folic acid and B vitamins, prevention of exposure to tobacco and alcohol, discouraging self-medication during pregnancy, etc.


Page | 22

Social-Ecological Model

Various theoretical frameworks are used in the field of health promotion in order to better understand certain health behaviors or problems and to facilitate the selection and design of appropriate communication and behavior change strategies. A social-ecological model is important in providing a framework to understand the multiple levels of a social system and interactions between individuals and environment within this system. Mothers and children are embedded within networks, communities and systems. The barriers to healthy behaviors often lie beyond the individual in the family, within the interpersonal network, community, and societal culture or even within the health system.

Therefore, an RBSK communication framework that uses a social-ecological model recognizes the multiple determinants underlying any health condition or barriers at different levels that impede desired health behaviors, especially for something as complex as birth defects and developmental delays in child health. A communication strategy that is informed using such a framework will be more relevant and effective in bringing about change. And, although it is necessary that we educate individual mothers about RBSK issues and behavior change, that alone will not be sufficient to improve overall outcomes.

What may be necessary and sufficient is to address the multiple barriers to behaviors that lie at different levels of the social-ecological system in which the mother and child live. Effective RBSK communication framework will therefore use this social ecological model to identify key audiences at different levels – at interpersonal level it could be the mother-in-law, at organizational level it could be the district hospital staff and so on.

Using the social ecological model as a conceptual model, this RBSK communication framework helps identify behavioral and organizational leverage points and intermediaries for health promotion within organizations. There are five nested, hierarchical levels of the social-ecological model: Individual, interpersonal (household), community, organizational, and policy/enabling environment (see exhibit below). The most effective approach to public health prevention and control uses a combination of interventions at all levels of the model.

Conceptual Model


Page | 23

Exhibit 5: A depiction of different levels of the S ocio-Ecological Model

The socio-ecological model recognizes that caregivers are nested within families, communities, organizations, societies; and that these varied loci of existence shape health behaviors. This approach allows us to recognize factors at each of the levels within an individual’s environment and encourages us to integrate system‐wide interventions with person‐focused efforts to modify behaviour and/or environments.

This model guided the analysis of from the formative study on defects and delays among children in RBSK. The framework helped to identify the barriers for behavior change and classify them at their level of existence within the primary caregivers (audience) environment. These barriers have been adapted to the four broad levels: individual, family / household, community, and organizational. These have been described in detail below in greater detail, thus allowing for a better understanding of the caregivers and how to move them towards behaviour change using a strategic communication approach.


Page | 24

A key focus of this study was to understand the barriers faced by the caregivers of children with 2Ds. Based on the 878 in-depth interviews, an attempt has been made to analyze and categorize these barriers across the continuum of care experienced by a child with a 2D screened under RBSK. The key steps of this continuum, as well as the junctures at which children drop-out of the system, are depicted in the exhibit below:

Exhibit 6: Continuum of care under RBSK

The barriers have been categorized using the steps of the continuum as shown above. Additionally, the barriers have also been categorized based on the systemic level at which they exist as a barrier for caregivers, based on the social-ecological framework introduced above. A sample graphic of how the two frameworks have been superimposed is shown below:

Barrier Analysis


Page | 25

Exhibit 7: Illustrative Barrier Analysis

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

D

eloi

tte

P

age

| 26

Usi

ng th

e tw

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tem

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a tw

o-by

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atrix

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bee

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ana

lyze

key

bar

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y ca

regi

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in

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w:

Tab

le 1

: Bar

riers

rel

ated

to a

cces

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RB

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ana

lyse

d us

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Soc

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TE

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RG

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�

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�

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rs

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rs

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Nat

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Fra

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P

age

| 27

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(P

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plet

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men

t no

t av

aila

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as

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in p

lace

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and

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plet

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aine

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ams

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ot h

ave

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l ch

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n co

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r sc

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and

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ited

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ed jo

b ro

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thi

s st

age

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r R

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ited

info

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on a

vaila

ble

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t/man

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ited

info

rmat

ion

on

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sche

mes

or

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rust

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sour

ces

of h

elp

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defin

ed

role

at

th

is

stag

e un

der

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for

FLW

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s sk

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o pr

ovid

e em

otio

nal

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ort /

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MM

UN

ITY

(G

EN

ER

AL)

�

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of

info

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ion

on s

cree

ning

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te a

nd ti

me

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not

perc

eive

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m

edic

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be

caus

e no

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ent

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iven

exc

ept

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s,

or a

nalg

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s

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tain

com

mun

ities

do

not

trus

t

�

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| 29

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Page | 30

Communication Goals and Objectives

Based on the evidence from the formative study, the communication framework developed is results-oriented, intrinsically linked to other programme components, responsive to the current context in which the programme operates, and favours a variety of communication approaches, to stimulate positive behaviour and social change. Findings underlie the importance of demand generation through proper education, awareness, and counseling. However, the advocacy for the programme including capacity building of health systems functionaries needs emphasis.

The overall Communication Framework is pictorially depicted below:

National Communication Framework forRBSK


Page | 31

The overarching objective is to ensure that all families adopt desired behaviours, access and use continuum of RBSK services. Based on the broad objectives, States are required to develop their specific advocacy and communication objectives for the state-specific communication framework. For any Communication Framework to be effective it is important to identify key stakeholder groups or audiences so that the strategy can be customized to their needs.


Page | 32

Identification of Key Audiences

The purpose of the audience analysis is to identify relevant audience groups, their characteristics, and what resources each group can access to bring about and maintain the practice of desired behaviours. It describes the people to be involved in RBSK activities in order to achieve the RBSK objectives. They are also the audience in and targets of the communication framework.

The objectives of RBSK and study findings formed the basis for determining who the audience for communication should be. Different communication approaches, messages and content are needed for each of the audience groups. Identification of key audience groups allows for better designed, more focused and clear messages. For this purpose the audiences have been segmented into primary, secondary and tertiary groups as indicated below:

Exhibit 8: Audience Segmentation

Primary Audience: are those who are being directly addressed to change their behaviour. Their behaviour is an indicator of success of RBSK. In this case, caregivers of all children in the age group (0-18 years).

Key Audiences


Page | 33

This also includes, caregivers of children screened and confirmed to have 2Ds. However, this also includes all caregivers with children in the age group (0-18 years) to get their children screened. Caregivers should possess the correct knowledge on screening, and be motivated to visit the higher referral centres (if the child is screened to have any of the 2Ds). Even though in this case, the child is the beneficiary for RBSK, it is important to target the caregiver’s attitude and behaviour that is critical to improve uptake of RBSK. Hence, caregivers of children (0-18 years) is the primary audience.

Secondary Audience: are those whose behaviour or actions strongly influence the behaviour of the primary audience. They are usually present in immediate social and cultural environment of the primary audience. Based on the evidence and situation analysis, this includes immediate family and community members, and frontline workers such as ASHAs, AWWs, and MHTs. For example, the Mobile Health Teams that come each year for screening could explain the condition that the child is suffering from and also the rationale for early intervention to motivate caregivers of children with 2Ds. Similarly, Gram Panchayat Members could organize a community fund to motivate parents of children with neuromotor impairment to go for repeat visits including physiotherapy/speech therapy.

Tertiary Audience: Tertiary audience are those whose actions directly or indirectly help or deter the behaviours of other audience. Their actions reflect the broader social, cultural and policy factors that create an enabling environment to sustain desired behaviour change. For example, elected representatives incl. MPs/MLAs, Mission Director of National Health Mission, Officials of Health Department and service providers in District Hospitals/ CHCs/PHCs, civil society organizations (CSOs), non-profits (such as Shirdi Trust, Reliance Foundation, etc.), private sector players (including ILS Hospital in Tripura, or other hospitals who have a tie-up with the Government providing tertiary care services)

Building the Supportive Environment

Sustained change in the behaviour of the primary audience is more likely to happen in an enabling environment. An enabling environment consists of family and community, social and cultural norms, national policy, etc. Based on the Socio-Ecological Model, the Communication Framework will address behaviour change among primary audience. However, to create an enabling environment necessary for effective behaviour and social change, specific interventions on advocacy have been included in the Communication Framework.


Page | 34

Given that the audiences in RBSK have been analysed and key barriers to overcome have been identified, the Framework aims to consider the communication approaches to reach audiences at all levels of communication. The main communication approaches for key audience include interpersonal communication, and community mobilization, use of ICT/mobile, supported and reinforced by traditional mass-media and mid-media. There are number of ways to use approaches such as combining different media, which also promote behaviour change. For instance, mid-media (poster, flyer, and video) can be combined with IPC to make it more effective. After showing the materials, the facilitator can lead an interactive session with the audience to reinforce the messages. Hence, these components of the Communication Framework should be linked with ongoing RBSK activities such as trainings.

Interpersonal Communication (IPC)

An interactive medium, it helps in providing detailed information to the audience. It also allows for instant feedback on ideas, messages and practices. Interpersonal communication will make effective use of existing social networks or interpersonal relationships (family, FLWs, neighbours, teachers, formal/Informal groups) that bind people together to enhance the communication process. IPC is a key tool in the drive to not only increase awareness about 2Ds but also driving caregivers’ to avail treatment whose children have been confirmed to have a defect or a developmental delay. It can be used extensively for follow-up, especially after caregivers realize that their child is screened to have any of the 2Ds. Frontline workers, community leaders, volunteers and social networks, including religious groups, GP members, mothers groups’ and community gatherings can promote the key message of RBSK i.e. “to intervene early in the life of children born with birth defects and developmental delays to minimize future disabilities”.

Since IPC is a very powerful medium to influence and motivate caregivers to get their child screened under RBSK and avail further treatment, following can be done to strengthen the IPC skills of FLWs/other community members/teachers:

FLWs

• IPC tools for use by ASHAs and ANMs to understand visible birth defects, and to explain RBSK, importance of screening, etc. Screening kits for ASHAs to conduct home-based newborns screening

• Pictorial toolkits and job aids for each Mobile Health Team to ensure they can explain different conditions

• Contact information of key personnel of RBSK at Block and District level (MHTs, RBSK coordinator, etc.)

• Information on various government health insurance schemes available in the state, especially for the poor and marginalized communities

Communication Approaches


Page | 35

Other Community members

• Capacity building of GP, SDMC, and SHG members and other community leaders to facilitate dialogues in their communities about RBSK and importance of early intervention for children with 2Ds

Teachers

• Timely information on the RBSK screening schedule • Aids on RBSK like pictorial leaflets, guides, etc. to assist her during IPC and counselling of

caregivers • Contact information of key personnel of RBSK at Block and District level (MHTs, RBSK

coordinator, etc.) • Information on various government health insurance schemes available in the state, especially for

the poor and marginalized communities

Mid-media and folk-media

According to the context, the stakeholders and the resources available, a mix of different media can be used to sensitize on the key aspects of the RBSK and promote key behaviours especially among the caregivers of the children. The communication medium can range from the more common ones, such as hoardings and wall paintings, as well as traditional ones, including folk arts and theatre and can be used as reinforcement to IPC and mass media activities. Combining different media to disseminate same messages related to key behaviour also promotes effective behaviour change. These mediums can be used to reinforce the key messages among the caregivers of the children in the age group 0-18 years. An attempt can be made to make these as pictorial as possible so that even uneducated/ semi-literate parents in rural areas can understand. An integrated approach can be used to ensure that all the messages related to health seeking behaviour are consistent and reinforce each other. Some of the initiatives that can be taken under this category are listed below:

Poster/Hoardings/Wall paintings:

• Posters on development milestones displayed in all public health facilities • Posters on continuum of care of RBSK from screening, to referral to evaluation and management

displayed in the waiting area at health facility • Display RBSK posters/wall paintings with information on various 2Ds, screening to treatment

process and messages on ‘cure vis-a-vis care’ at Panchayat office, AWCs, School Building complex, etc.

• Flex boards/ poster with time and date of screening is displayed outside the Anganwadi Center or School where the screening is planned

RBSK-specific display area/corner can be created in each PHC/CHC/DH/DEIC where information like government health insurance schemes, RBSK success stories, contact information for higher centres for evaluation and management of 2Ds, list of key hospitals and services offered in the district and nearby districts, contact information of District/Block level RBSK staff, etc. can be displayed

Child Health Screening Card could potentially have a page of pictorial information on developmental milestones and RBSK continuum of care citing the importance of RBSK


Page | 36

Public Service Announcements (PSAs) to popularize screening date/venue at all popular spots including weekly bazaars, markets, etc.

Mass-media

Mass media can reach large audiences cost-effectively through the formats of radio, television and newspapers. Mass media campaigns that follow the principles of effective campaign design and are well-executed can have small to moderate effect size not only on health knowledge, beliefs, and attitudes, but on behaviours as well. Mass media can have a major public health impact given its wide reach.

Since findings from the study indicated that nearly 45% of the respondents watch TV and it’s a popular communication medium in rural areas, following can be done to increase awareness about the 2Ds and RBSK among the caregivers and the other community members:

• TV campaign with messages on normalizing disability and importance of early intervention for developmental delays and concept of ‘rehabilitative care’ into existing popular TV serials

• Creating TV spots on RBSK on local cable and satellite and provide RBSK related important information like screening schedules, evaluation camps, etc.

• Positive role model short film (3-4 minutes) and hosting talk shows with role models such as Paralympic winners/participants to create a positive attitude towards disability among communities

• CDs with AV running at District hospitals/SNCUs/CHCs/PHCs on developmental milestones to be showcased when pregnant women come for ANC/PNC check-up

Information and Communication Technology (ICT) / Mo bile Technology

ICT is the fastest growing and evolving approach, with an increasing ownership and usage16 of mobile phones in rural India. ICT can be used effectively to disseminate highly tailored messages to the intended audience while also receiving feedback from them and encouraging real-time conversations, combining mass communication and interpersonal interaction.

Some of the initiatives that should be taken under this category are listed below:

• Leverage existing toll-free helpline such as women’s helpline (1091) or set-up new toll-free helpline where mothers/caregivers can receive emotional support and strength, and information on coping with caregiver stress and information on different conditions, answer evaluation and treatment related queries of the caregivers of the children confirmed to have 2Ds

• Sending updates/reminders for the next steps of the treatment/evaluation of the child through text messages/SMS and/or Interactive Voice Response (IVR)

Specific information on communication approaches to be used are described in greater detail in the communication plan in the next Chapter.

16 81% of respondents in the formative study reported using a mobile phone


Page | 37

This Framework is a guidance document to support the advocacy and communication interventions at national and state level in achieving RBSK goals. It envisages achieving the advocacy and communication objectives in a phased manner:

Phase 1: Raising awareness for promoting SBCC among caregivers, their families and communities including IPC

Phase 2: Advocacy for creating an Enabling Environment

The two phases to achieve the supply and demand-side objectives are not sequential and there will be a degree of overlap in activities carried out during implementation. While the national level maybe coordinating advocacy for creating an enabling environment, the states can focus on developing contextualised communication materials for promoting SBCC among caregivers, their families and their communities.

Setting Priorities for Communication Framework

The Communication Framework is comprehensive and focuses on a variety of SBCC approaches, and advocacy, each State should customise communication needs, and materials based on their local context. Based on findings with respect to communication needs of caregivers, following have been prioritized:

• Interpersonal Communication (IPC) for Caregivers • Advocacy with National and State Officials for creating impetus for RBSK

Phase 1: Raising awareness for promoting SBCC among caregivers, their families and communities

This approach would focus on using various means of communication to reach caregivers, their families and communities both directly through interpersonal/social contact and indirectly through mass and mid-media in order to help change knowledge, attitudes, beliefs, mind sets, perceptions and practices. Some of the key interventions in this approach would be:

1. IPC17*: Since FLWs are a trusted source of health related information in the community, IPC pictorial toolkits would be helpful for them to understand visible birth defects and to explain RBSK, and importance of early screening to caregivers. In addition, pictorial toolkits and job aids for MHTs will help them to explain different conditions to the caregivers of children screened to have 2Ds.

17 * Indicates Prioritized Communication Activity

How to Implement the National Communication Framework for RBSK


Page | 38

2. Role models : Role models add credibility as well as visibility to any programme. Engagement of role models (Paralympics athletes) to promote key behaviours would help normalize disability as well as raise the visibility and popularity of RBSK.

3. RBSK kiosks in government health facilities: It was observed during the study that, many caregivers felt lost at the health facility in the absence of any single contact point. Hence, creating small kiosks at these facilities would be helpful to facilitate such caregivers in navigating through the system and get the necessary evaluation/treatment done for the child.

4. Helpline : Since caregivers (especially mothers) of the children having 2Ds has to be under constant stress of raising such child, a helpline is useful to answer their queries related to evaluation and treatment of the child.

5. Mid Media: These will support inter-personal communication and give credibility to community level communicators as well create an enabling environment.

6. Mass Media : Television spots will be helpful to address knowledge gaps, enhance self-efficacy, promote positive behaviours and increase awareness about RBSK among caregivers. Further, Publishing RBSK success stories in the local newspapers and popular magazines will help in spreading positive word about RBSK.

7. Community Mobilization: Existing platforms such as VHNDs and other SHGs like mother support groups can be used to sensitize community on the importance of early screening of children to prevent possible future disabilities.

8. ICT/Mobile : SMSs/Voice SMSs and outdoor activities in partnership with cellular companies would be an effective means of reaching out to caregivers at scale.

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iona

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e no

t av

aila

ble

F

amily

m

embe

rs

man

age

othe

r ho

useh

old

activ

ities

, w

hile

th

e ca

regi

vers

ac

com

pany

th

eir

child

fo

r sc

reen

ing

Com

mun

ity

mem

bers

sh

are

posi

tive

expe

rienc

es

abou

t th

e he

alth

sys

tem

/ P

rovi

ders

es

peci

ally

pa

rent

s w

ho

may

ha

ve

bene

fitte

d fr

om

RB

SK

ear

lier

Sup

port

gr

oups

fo

r m

othe

rs/

care

give

rs

to

alle

viat

e ca

regi

ver

stre

ss

Info

rmal

hea

lth

prov

ider

s (I

Ps)

gu

ide

pare

nts/

ca

regi

vers

to

se

ek

med

ical

he

lp

whe

n th

ey

iden

tify

child

ren

with

2D

s

FLW

s an

d te

ache

rs

com

mun

icat

e tim

ely

info

rmat

ion

rega

rdin

g th

e sc

reen

ing

date

an

d ve

nue

to t

he

pare

nts

A

WW

s/A

SH

As

faci

litat

e pa

rent

s in

br

ingi

ng

thei

r ch

ild

to

the

scre

enin

g si

te

MH

Ts

cond

uct

qual

ity

scre

enin

gs

with

ca

re a

nd d

igni

ty

MH

Ts

fill

up t

he

Chi

ld

Hea

lth

Scr

eeni

ng

Car

d fo

r al

l ch

ildre

n an

d le

ave

a co

py

with

par

ents

and

sc

hool

for

fut

ure

reco

rd-k

eepi

ng

IPC

* IP

C

pict

oria

l bo

okle

ts

for

use

by

AS

HA

s to

un

ders

tand

vi

sibl

e bi

rth

defe

cts,

an

d to

ex

plai

n R

BS

K,

impo

rtan

ce

of

scre

enin

g, e

tc.

Scr

eeni

ng k

its f

or A

SH

As

to

cond

uct

hom

e-ba

sed

new

born

scr

eeni

ng

Pic

toria

l to

olki

ts

and

job

aids

fo

r ea

ch

Mob

ile

Hea

lth

Tea

m

to

ensu

re

they

can

exp

lain

diff

eren

t co

nditi

ons

Cap

acity

B

uild

ing

of

AS

HA

s an

d M

HT

s to

co

unse

l m

othe

rs

of

child

ren

with

2D

s to

gui

de

them

tow

ards

whe

re,

how

to

ge

t ev

alua

tion

and

trea

tmen

t C

apac

ity

build

ing

of

Info

rmal

Pro

vide

rs (

IPs)

to

coun

sel

care

give

rs

of

child

ren

with

2D

s to

see

k m

edic

al h

elp

C

apac

ity b

uild

ing

of P

RIs

, S

DM

Cs,

an

d S

HG

# of

pa

rent

s

awar

e of

R

BS

K

deta

ils

# of

sch

ools

/ A

WC

s w

ith

post

er

on

RB

SK

co

ntin

uum

of

ca

re

# of

pa

rent

s aw

are

of

deve

lopm

enta

l m

ilest

ones

of

ch

ildre

n 0-

2 ye

ars

#

shor

t fil

ms

aire

d on

P

aral

ympi

c ro

le

mod

el

# T

V s

how

s ai

red

for

mot

ivat

ing

pare

nts

to

com

e fo

rwar

d fo

r sc

reen

ing

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 40

B

arrie

rs

Des

ired

Beh

avio

ur

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

pr

esen

t at

the

tim

e of

scr

eeni

ng t

o be

ab

le

to

unde

rsta

nd

thei

r ch

ild’s

co

nditi

on

and

inte

rven

tion

requ

ired

Car

egiv

ers

mai

ntai

n th

e C

hild

H

ealth

S

cree

ning

C

ard

give

n by

the

M

HT

fo

r fu

ture

fo

llow

-up

visi

ts

Car

egiv

ers

know

w

here

an

d w

hen

to g

o fo

r fo

llow

-up

afte

r sc

reen

ing

is

com

plet

e M

othe

r an

d fa

ther

of

th

e ch

ild

conc

erne

d de

cide

ab

out

taki

ng

thei

r ch

ild

for

furt

her

refe

rral

an

d ev

alua

tion

S

cree

ning

at

ho

me

P

aren

ts

are

avai

labl

e at

hom

e

If

the

child

is

sc

reen

ed

to

have

any

of

the

4Ds,

M

HT

s ex

plai

n th

e co

nditi

on

of

the

child

to

th

e pa

rent

s us

ing

a pi

ctor

ial t

oolk

it

Edu

cate

/cou

nsel

ca

regi

vers

on

th

e ne

xt s

teps

to

be

take

n fo

r fu

rthe

r ev

alua

tion

and

man

agem

ent

of

the

cond

ition

H

ome-

base

d sc

reen

ing

AS

HA

s co

nduc

t ne

w

born

sc

reen

ing

for

all

child

ren

in

age

grou

p 0-

6 w

eeks

by

vi

sitin

g th

eir

hom

es

AS

HA

s re

fer

child

ren

scre

ened

to

mem

bers

an

d ot

her

com

mun

ity

lead

ers

to

faci

litat

e di

alog

ues

in t

heir

com

mun

ities

abo

ut R

BS

K

and

impo

rtan

ce

of

early

in

terv

entio

n fo

r ch

ildre

n w

ith 2

Ds.

To

also

cre

ate

supp

ort

grou

ps t

o he

lp t

he

fam

ily in

ava

iling

car

e

Mid

Med

ia

Pos

ters

on

ke

y de

velo

pmen

t mile

ston

es in

al

l pu

blic

hea

lth f

acili

ties

/ de

liver

y po

ints

/ SN

CU

s

Pos

ters

on

the

cont

inuu

m

of

care

of

R

BS

K

from

sc

reen

ing,

to

re

ferr

al

to

eval

uatio

n

disp

laye

d in

th

e w

aitin

g ar

ea a

t al

l he

alth

fac

ilitie

s (in

cl.

SN

CU

s),

scho

ols,

an

d A

WC

s C

hild

H

ealth

S

cree

ning

C

ard

to

have

pi

ctor

ial

info

rmat

ion

on

deve

lopm

enta

l m

ilest

ones

an

d ab

out

RB

SK

co

ntin

uum

of c

are

W

all-p

aint

ing

Boa

rd/

post

er w

ith s

cree

ning

tim

e

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 41

B

arrie

rs

Des

ired

Beh

avio

ur

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

whe

n A

SH

As

com

e to

th

eir

hous

e fo

r ne

wbo

rn

scre

enin

g

Par

ents

un

ders

tand

th

e im

port

ance

of

ne

wbo

rn

scre

enin

g

Scr

eeni

ng

at

Del

iver

y P

oint

s P

aren

ts

spen

d at

le

ast

48

hour

s at

th

e D

eliv

ery

Poi

nt

so

that

th

e ch

ild

can

be

exam

ined

fo

r an

y vi

sibl

e bi

rth

defe

cts

P

aren

ts

unde

rsta

nd

the

impo

rtan

ce

of

new

born

sc

reen

ing

P

aren

ts

of

child

ren

who

wer

e tr

eate

d in

SN

CU

s

cond

uct

follo

w-u

p vi

sits

to

the

heal

th

faci

lity

at

leas

t on

ce a

mon

th u

ntil

the

child

is

abou

t

have

any

of

the

2Ds

to

the

near

est

PH

C/C

HC

or

A

NM

A

NM

s sh

ould

fu

rthe

r ch

eck

the

child

’s

cond

ition

an

d re

fer

the

child

to

a hi

gher

ce

nter

fo

r ev

alua

tion

and

trea

tmen

t S

cree

ning

at

D

eliv

ery

Poi

nts

For

scr

eeni

ng a

t de

liver

y po

ints

, pr

ovid

ers

at

PH

Cs/

CH

Cs/

D

Hs

scre

en

all

child

ren

born

for

al

l R

BS

K

cond

ition

s ac

ross

al

l th

e de

liver

y po

ints

be

fore

di

scha

rgin

g th

e fa

mily

an

d re

fer

child

ren

with

any

co

nditi

on

for

and

date

dis

play

ed o

utsi

de

the

AW

Cs

and

Sch

ools

, an

d po

pula

r ar

eas

(kira

na

shop

s/

GP

of

fices

)

Pub

lic

Ser

vice

A

nnou

ncem

ents

(P

SA

s)

for

popu

lariz

ing

scre

en

day

C

onta

ct

info

rmat

ion

of

RB

SK

C

oord

inat

or

at

Dis

tric

t /

Blo

ck /

MH

Ts

to

be d

ispl

ayed

at

GP

offi

ces

/ Sch

ools

/ AW

Cs

W

all p

aint

ings

/ P

oste

rs o

n go

vern

men

t he

alth

in

sura

nce

prog

ram

mes

at

all p

ublic

hea

lth fa

cilit

ies

M

ass

Med

ia:

TV

ca

mpa

ign

with

m

essa

ges

on

norm

aliz

ing

disa

bilit

y an

d im

port

ance

of

ea

rly

inte

rven

tion

for

deve

lopm

enta

l de

lays

and

co

ncep

t of

‘re

habi

litat

ive

care

’ in

to e

xist

ing

popu

lar

TV

ser

ials

H

ostin

g ta

lk

show

s w

ith

role

m

odel

s su

ch

as

Par

alym

pic

win

ners

/

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 42

B

arrie

rs

Des

ired

Beh

avio

ur

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

one

year

old

furt

her

eval

uatio

n an

d ch

eck-

up

For

al

l ch

ildre

n ad

mitt

ed

in

SN

CU

s,

prov

ider

s sc

reen

th

e ch

ildre

n fo

r an

y po

tent

ial

birt

h de

fect

s or

de

velo

pmen

tal

dela

ys,

and

follo

w-u

p on

ce a

m

onth

part

icip

ants

C

Ds

with

A

V

runn

ing

at

Dis

tric

t ho

spita

l/PH

C/C

HC

on

de

velo

pmen

tal

mile

ston

es

to

be

show

case

d w

hen

wom

en

com

e fo

r A

NC

/PN

C c

heck

-up

P

ositi

ve

role

mod

el

shor

t fil

m (

3-4

min

utes

) sh

owin

g a

Par

alym

pic18

ath

lete

with

th

eir

spor

t to

edu

cate

and

gi

ve

hope

to

pa

rent

s of

ch

ildre

n w

ith 2

Ds

Use

lo

cal

new

spap

ers

to

have

st

orie

s on

im

port

ance

of

ea

rly

inte

rven

tion

for

child

ren

born

with

birt

h de

fect

s an

d de

velo

pmen

tal d

elay

s

Pub

lish

succ

ess

stor

ies

of

child

ren

who

obt

aine

d fr

ee

trea

tmen

t in

th

e lo

cal

new

spap

ers

/ mag

azin

es

Com

mun

ity M

obili

zatio

n U

se

exis

ting

plat

form

s

18 A

thle

te G

irish

a H

N, w

ho h

as a

clu

b fo

ot, w

on a

silv

er m

edal

in h

igh

jum

p at

the

Lond

on P

aral

ymp

ics

in 2

012

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 43

B

arrie

rs

Des

ired

Beh

avio

ur

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

such

as

V

HN

Ds

to

educ

ate

and

sens

itize

co

mm

unity

on

disa

bilit

ies,

ca

uses

, an

d w

ays

to

prev

ent 2

Ds

Cre

ate

mot

hers

su

ppor

t gr

oups

in

each

GP

(le

d by

co

mm

unity

vol

unte

ers)

IC

T/M

obile

Le

vera

ge e

xist

ing

toll-

free

he

lplin

e on

lin

es

of

Van

itha

Sah

ayva

ni (

1091

) w

here

m

othe

rs/c

areg

iver

s ca

n se

ek

emot

iona

l su

ppor

t an

d st

reng

th,

and

info

rmat

ion

on c

opin

g w

ith

care

give

r st

ress

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 44

C

omm

unic

atio

n P

lan

for

Eva

luat

ion

and

Man

agem

ent

19

Bar

riers

D

esire

d B

ehav

iour

s fo

r P

rimar

y C

areg

iver

s D

esire

d B

ehav

iour

s fo

r S

econ

dary

Aud

ienc

e

Com

mun

icat

ion

Cha

nnel

s

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

Out

-of-

pock

et

expe

nses

fo

r di

agno

stic

s,

food

, ac

com

mod

atio

n,

etc.

in

curr

ed

by

the

care

give

rs

whi

le

acce

ssin

g ca

re f

or th

eir

child

w

ith

2Ds

in

the

gove

rnm

ent

heal

th

faci

lity

Rec

urrin

g ex

pens

es f

or

drug

s fo

r ce

rtai

n co

nditi

ons

(e.g

., ne

uro-

mot

or im

pairm

ent)

W

age

loss

ex

perie

nced

by

ca

regi

vers

du

e to

re

petit

ive

trip

s m

ade

by

them

to

th

e he

alth

fa

cilit

y fo

r ev

alua

tion/

tr

eatm

ent/

man

agem

ent

of

thei

r ch

ild

Tra

nspo

rtat

ion

cost

fa

ced

by c

areg

iver

s in

Car

egiv

ers

unde

rsta

nd

the

prog

nosi

s m

ade

by

MH

Ts

Car

egiv

ers

mai

ntai

n th

e re

ferr

al

rela

ted

docu

men

ts(C

hild

H

ealth

S

cree

ning

Car

d) a

nd s

eek

info

rmat

ion

from

MH

Ts

Car

egiv

ers

visi

t th

e P

HC

/CH

C/D

H/D

EIC

/cam

p fo

r fu

rthe

r ev

alua

tion

of

the

child

, as

dire

cted

by

MH

Ts

with

in th

e st

ipul

ated

tim

e pe

riod

Car

egiv

ers

cons

ult

the

spec

ialis

t at

th

e re

ferr

al

faci

lity

for

the

eval

uatio

n of

the

chi

ld t

o co

nfirm

the

pr

ogno

sis

mad

e by

MH

Ts

Car

egiv

ers

get

nece

ssar

y di

agno

stic

te

sts

for

the

child

as

sugg

este

d by

the

sp

ecia

list

For

ca

regi

vers

of

ch

ildre

n co

nfirm

ed

to

Fam

ily

mem

bers

en

cour

age

care

give

rs

of

child

sc

reen

ed

with

the

2D

s to

go

fo

r fu

rthe

r ev

alua

tion

of

the

child

as

re

ferr

ed

by

MH

Ts

F

amily

m

embe

rs

supp

ort

care

give

rs

of

the

ch

ild

(by

offe

ring

tran

spor

tatio

n,

etc.

,)

to

the

refe

rral

he

alth

fa

cilit

y fo

r ev

alua

tion/

m

anag

emen

t of

the

child

F

amily

m

embe

rs

man

age

othe

r ho

useh

old

Com

mun

ity

mem

bers

w

ith

posi

tive

expe

rienc

es

with

pu

blic

he

alth

sy

stem

sh

are

thei

r su

cces

s st

orie

s an

d th

ose

rela

ted

to R

BS

K

Com

mun

ity

mem

bers

or

gani

ze

com

mun

ity

loan

s w

ith

supp

ort

from

G

P

mem

bers

to

he

lp

care

give

rs w

ith

basi

c ex

pens

es s

uch

as

tran

spor

tatio

n,

food

, ac

com

mod

atio

n, e

tc.

Fro

ntlin

e W

orke

rs

AS

HA

s to

pr

ovid

e ne

cess

ary

info

rmat

ion

to

the

care

give

rs

of

the

child

ren

in

the

age

grou

p 0-

6w

for

furt

her

eval

uatio

n of

th

e co

nditi

ons

as

iden

tifie

d by

th

em

durin

g th

e ho

me

base

d sc

reen

ing

AS

HA

s/A

WW

s co

unse

l and

mot

ivat

e th

e ca

regi

vers

to

ta

ke n

eces

sary

ste

ps

requ

ired

for

furt

her

eval

uatio

n an

d m

anag

emen

t of

the

ir ch

ild

AS

HA

s/A

WW

s pr

ovid

e in

form

atio

n to

the

car

egiv

ers

on

vario

us

gove

rnm

ent

heal

th

insu

ranc

e sc

hem

es,

whi

ch c

an

help

them

to fu

nd th

e

IPC

* A

SH

As

and

othe

r F

LWs

to

use

pict

oria

l boo

klet

s on

R

BS

K f

or

IPC

an

d co

unse

lling

to

ca

regi

vers

of

th

e ch

ildre

n af

fect

ed

with

2D

s H

avin

g a

spec

ific

RB

SK

K

iosk

/Hel

pdes

k at

th

e fa

cilit

y (P

HC

/CH

C/D

H/D

EI

C)

on t

he d

ay o

f th

e ev

alua

tion

to

rece

ive

all

care

give

rs

DE

IC s

taff

/ M

Os

to

use

pict

oria

l bo

okle

ts

to

expl

ain

the

diff

eren

t R

BS

K

cond

ition

s an

d ty

pe

of

care

an

d tr

eatm

ent

optio

ns t

o th

e ca

regi

vers

# of

sc

reen

ed

child

ren

eval

uate

d a

t pu

blic

hea

lth

faci

lity

#o

f ch

ildre

n ev

alua

ted

to

have

a

2D

avai

ling

su

cces

sful

tr

eatm

ent

at

publ

ic h

ealth

fa

cilit

y

# of

fac

ilitie

s w

ith

spec

ific

RB

SK

ki

osks

/ H

elpd

esks

to

help

ca

regi

vers

#

of

RB

SK

ad

s ai

red

on

TV

#

FLW

s

19 M

any

of th

e co

mm

unic

atio

n ch

anne

ls m

entio

ned

unde

r sc

reen

ing

will

als

o be

rel

evan

t und

er e

valu

atio

n an

d m

ange

men

t. D

uplic

atio

n m

ay b

e av

oide

d w

here

fea

sibl

e

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 45

B

arrie

rs

Des

ired

Beh

avio

urs

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

carr

ying

ch

ild

to

the

refe

rred

hea

lth fa

cilit

y

Long

w

aitin

g tim

e fo

r ev

alua

tion/

tr

eatm

ent/

man

agem

ent o

f chi

ld in

th

e he

alth

fa

cilit

y ex

perie

nced

by

ca

regi

vers

C

ost

burd

en

of

long

-te

rm c

are

that

may

not

be

cov

ered

by

RB

SK

is

a m

ajor

ba

rrie

r fo

r m

ost f

amili

es

Lim

ited

atte

ntio

n fr

om

heal

th p

rovi

ders

whe

n fa

mili

es

reac

h he

alth

fa

cilit

y as

pro

vide

rs a

re

not

orie

nted

on

RB

SK

an

d co

nditi

ons

cove

red

unde

r it

and

due

to

heav

y ca

selo

ad

at

publ

ic h

ealth

faci

litie

s

Car

egiv

ers

ofte

n do

no

t po

sses

s in

form

atio

n ab

out

othe

r he

alth

pr

ogra

mm

es

(insu

ranc

e pr

ogra

mm

es)

that

can

pr

ovid

e fin

anci

al

supp

ort

have

2D

s:

Car

egiv

ers

take

the

chi

ld

to

the

refe

rred

hi

gher

ce

nter

fo

r th

e fu

rthe

r tr

eatm

ent/c

are

of th

e ch

ild

Car

egiv

ers

visi

t th

e hi

gher

ce

nter

fo

r fo

llow

-up

care

an

d th

erap

y of

the

chi

ld,

if re

peat

fo

llow

-ups

ar

e re

quire

d C

areg

iver

s en

sure

ch

ild

rece

ives

al

l th

erap

y/ca

re/

med

icin

es

at

hom

e an

d fo

llow

in

stru

ctio

ns

rece

ived

at

D

EIC

/DH

(e

spec

ially

fo

r ch

ildre

n w

ith

spee

ch

impa

irmen

t, he

arin

g im

pairm

ent,

neur

o-m

otor

del

ay, e

tc.)

C

areg

iver

s w

ith

posi

tive

expe

rienc

es

shar

e ab

out

bene

fits

of

RB

SK

w

ith

com

mun

ity

mem

bers

/

neig

hbor

s

Car

egiv

ers

supp

ort

othe

r pa

rent

s an

d gu

ide

them

on

how

RB

SK

wor

ks a

nd

spre

ad t

he i

mpo

rtan

ce o

f ea

rly in

terv

entio

n

thin

gs, w

hile

the

care

give

rs

are

out

for

eval

uatio

n/

man

agem

ent

of

the

child

W

hen

poss

ible

, fa

mily

mem

bers

pr

ovid

e m

onet

ary

supp

ort

to

the

care

give

rs

for

eval

uatio

n/tr

eat

men

t of

th

e ch

ild

Fam

ily

mem

bers

to

pr

ovid

e em

otio

nal

supp

ort

to

alle

viat

e ca

regi

vers

’ st

ress

Com

mun

ities

fo

rm

mot

hers

gr

oups

’ w

ith

child

ren

with

2D

s so

th

at

the

netw

ork

can

prov

ide

emot

iona

l su

ppor

t

eval

uatio

n an

d m

anag

emen

t co

sts

for

thei

r ch

ild a

t th

e hi

gher

re

ferr

al

cent

ers

AN

Ms

refe

r ch

ildre

n w

ith

2Ds

for

furt

her

eval

uatio

n

Fac

ility

-Lev

el

Rec

eive

th

e ca

regi

vers

w

ith

child

ren

scre

ened

to

have

2D

s w

ith

care

an

d em

path

y

Hea

lth

prov

ider

s to

as

sist

ca

regi

vers

at

th

e he

alth

fac

ility

by

help

ing

them

in

na

viga

ting

thro

ugh

the

heal

th s

yste

m b

y fil

ling

out

form

s,

guid

ing

them

to

war

ds

spec

ialis

t, di

agno

sis

faci

lity,

etc

. P

rovi

de

qual

ity

care

du

ring

the

trea

tmen

t/ m

anag

emen

t by

ex

plai

ning

th

e co

nditi

on o

f th

e ch

ild

to th

e ca

regi

vers

DE

IC/D

H

staf

f to

co

unse

l ca

regi

vers

on

se

rious

su

rgic

al

proc

edur

es

( fo

r co

nditi

ons

such

as

C

HD

s,

Clu

b fo

ot,

Neu

ral

Tub

e D

efec

t)

Pro

vide

rs

to

coun

sel

pare

nts

of

child

ren

who

w

ere

adm

itted

in

SN

CU

s ab

out

the

need

for

re

gula

r ch

eck-

up

/ fo

llow

-up

M

id M

edia

D

ispl

ay

RB

SK

po

ster

s w

ith

info

rmat

ion

on 2

Ds,

co

ntin

uum

of

ca

re

of

RB

SK

, an

d m

essa

ges

on

cure

vs

ca

re

at

Pan

chay

at

offic

e,

AW

Cs,

S

choo

l B

uild

ing,

etc

. C

reat

e R

BS

K-

spec

ific

disp

lay

area

/cor

ner

to

be

crea

ted

in

each

P

HC

/CH

C/D

H/D

EIC

w

here

in

form

atio

n

trai

ned

on

RB

SK

#

SN

CU

gr

adua

tes

follo

wed

-up

by

a he

alth

pr

ovid

er

at

leas

t on

ce a

m

onth

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 46

B

arrie

rs

Des

ired

Beh

avio

urs

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

Car

egiv

ers

feel

th

e ne

ed

to

have

‘g

uara

ntee

’ th

at

thei

r ch

ild’s

fu

ture

w

ill

be

heal

thy

afte

r th

e su

rger

y/ tr

eatm

ent

In

trib

al

pock

ets

of

Nor

th

Eas

t, pa

rent

s al

so

do

not

trus

t th

e m

edic

al s

yste

m d

ue t

o tr

ust

in

thei

r lo

cal

info

rmal

pro

vide

rs

Car

egiv

ers

perc

eive

m

edic

ine

to b

e cu

rativ

e an

d ca

nnot

dis

tingu

ish

betw

een

‘car

e’

and

‘cur

e’

Car

egiv

ers

do

not

unde

rsta

nd

the

conc

ept

of

man

agem

ent

of c

erta

in

cond

ition

s su

ch

as

deve

lopm

enta

l de

lays

(r

ehab

ilita

tive

care

) In

th

e ab

senc

e of

un

ders

tand

ing

of

reha

bilit

ativ

e ca

re,

care

give

rs t

end

to g

ive

Cou

nsel

ca

regi

vers

fo

r an

y fe

ar

rela

ted

to s

urge

ry

Ens

ure

that

th

e ca

regi

vers

do

no

t fa

ce a

ny d

iffic

ulty

in

getti

ng m

edic

ines

for

th

eir

child

ren

unde

rgoi

ng

trea

tmen

t/man

agem

ent

DE

IC

staf

f/pr

ovid

ers

to

expl

ain

phys

ical

ex

erci

ses,

th

erap

y fo

r pa

rent

s to

pr

actic

e at

hom

e w

ith

thei

r ch

ildre

n

DE

IC

staf

f co

nduc

t fo

llow

-up

calls

to

pa

rent

s fo

r re

peat

vi

sits

fo

r ‘re

habi

litat

ive

care

/

ther

apy’

ses

sion

s

incl

udin

g go

vern

men

t he

alth

in

sura

nce

sche

mes

, R

BS

K

succ

ess

stor

ies,

co

ntac

t in

form

atio

n fo

r hi

gher

ce

nter

s fo

r ev

alua

tion

and

man

agem

ent

of

2Ds,

co

ntac

t in

form

atio

n of

D

istr

ict/B

lock

le

vel

RB

SK

sta

ff, e

tc. c

an

be d

ispl

ayed

M

ass

Med

ia:

Sho

rt

TV

ad

s on

R

BS

K w

ith p

ositi

ve

role

m

odel

s e.

g.

athl

etes

fr

om

para

O

lym

pics

, etc

. P

ublis

hing

R

BS

K

succ

ess

stor

ies

in

the

loca

l ne

wsp

aper

s C

omm

unity

M

obili

zatio

n C

reat

e m

othe

rs

supp

ort

grou

ps

in

each

G

P

(led

by

com

mun

ity

volu

ntee

rs

and

mot

hers

of

child

ren

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 47

B

arrie

rs

Des

ired

Beh

avio

urs

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

up o

n m

edic

al c

are

in

the

abse

nce

of

any

‘cur

e’

Car

egiv

ers

in

cert

ain

case

s,

may

re

quire

m

ultip

le

refe

rral

s to

di

ffer

ent

heal

th

faci

litie

s fo

r ev

alua

tion/

tr

eatm

ent

of t

heir

child

ca

usin

g tr

ansp

orta

tion,

w

age

loss

, an

d ot

her

conc

erns

M

any

care

give

rs h

ave

a fa

talis

tic

attit

ude

tow

ards

the

2Ds

In

the

abse

nce

of

prop

er

info

rmat

ion,

m

any

care

give

rs h

ave

cert

ain

fear

s as

soci

ated

w

ith

med

ical

pr

oced

ures

lik

e su

rger

y, e

tc.

Car

egiv

ers

expe

rienc

e fa

tigue

an

d st

ress

as

th

e ch

ild

may

on

ly

have

lim

ited

impr

ovem

ents

ev

en

afte

r sp

endi

ng

mon

ey

on

trav

el,

and

with

2D

s

ICT

/Mob

ile:

Hel

plin

e to

an

swer

ev

alua

tion

and

trea

tmen

t re

late

d qu

erie

s of

th

e ca

regi

vers

of

th

e ch

ildre

n co

nfirm

ed

to h

ave

2Ds

Sen

ding

up

date

s/re

min

ders

fo

r th

e ne

xt s

teps

of

the

trea

tmen

t/eva

luat

ion

of

the

child

th

roug

h te

xt

mes

sage

s/S

MS

Nat

iona

l Com

mun

icat

ion

Fra

mew

ork

on R

BS

K

Del

oitte

P

age

| 48

B

arrie

rs

Des

ired

Beh

avio

urs

for

Prim

ary

Car

egiv

ers

Des

ired

Beh

avio

urs

for

Sec

onda

ry A

udie

nce

C

omm

unic

atio

n C

hann

els

Sam

ple

M&

E

indi

cato

rs

Fam

ily

Com

mun

ity

Hea

lth S

yste

m

expe

rienc

ing

wag

e lo

ss

Pot

entia

l Fun

ding

Indi

cativ

e so

urce

s of

fun

ding

fro

m P

rogr

amm

e Im

plem

enta

tion

Pla

n (P

IP)

incl

udes

for

SB

CC

act

iviti

es i

nclu

de:

RB

SK

IE

C b

udge

t (F

MR

cod

e B

.10.

7)

Formative Study on RBSK Deloitte

Page | 49

Phase 2: Advocacy* 20 for creating an Enabling Environment

Since RBSK is of national importance, the implementation of this communication framework will be led by the MoHFW as the convening Ministry and at the State level by the respective Departments of Health and Family Welfare. The Communication Framework envisages inter-ministerial and intra-departmental convergence with the existing programmes of the MoHFW and other ministries. Currently, there are other ministries that address issues of CWSNs. Prominent among them are Ministry of Human Resource Development (MHRD), Ministry of Women and Child Development (MWCD) and Ministry of Social Justice and Empowerment (MSJE). The efforts would need to be expanded to include celebrities, NGOs, civil society organizations, media, IT and Telecom companies and the private sector.

Advocacy with these various stakeholders will play a key role in ensuring that there is a supportive policy and programme environment in which the communication framework can be effectively implemented. Some of the key interventions in this approach would be:

1. Orientation workshops on RBSK : These workshops would be needed to sensitize health and other department officials about the importance of screening and minimizing disabilities for a healthy future of India. Further, they will help in increasing the scope of convergence with Ministries and national flagship.

2. National-level Consultations with all state Chief M inisters, Ministers and Secretaries : Sensitization workshops/meetings with senior representatives from stake holding ministries/departments at national level would need to be held to get their buy-in and support.

3. State-level Consultations with RBSK State Officials , State Representatives from Other Departments, Elected Presentatives of ZP : Orientation workshops/meetings with senior representatives from RBSK, Health, WCD, Education, Disability to get their buy-in and support to strengthen implementation of RBSK

4. District/Block level meetings between health and ot her department officials : One-to-one meetings between representatives of ICDS, Education, CS/CMO, DC/DM and ZP members at a defined frequency(monthly/quarterly) will help in ascertain progress of RBSK in the district convergence related issues

Implementation Framework is appended in Annex 1: Suggested Implementation Framework

20 *Indicates Prioritized Communication Activity


Page | 50

Need for Capacity Development

This chapter summarizes the various capacity development measures required at departmental (State/District/Block) as well as individual levels to ensure effective implementation of the RBSK communication plan. As described in the situation analysis earlier, in the absence of an effective communication plan, the knowledge among beneficiaries and other programme delivery functionaries at State/ District/ Block/ Community levels about RBSK is quite poor. This contributes to low utilization of RBSK services, especially the evaluation and management of screend cases. Many of the health functionaries also do not possess the capacity to implement overaching guidance including setting-up MoUs with private sector, religious trust hospitals, non-profits, etc.

Since the programme is in its infancy, it is the right time to introduce capacity development measures for the supply side functionaries of RBSK.

Building Internal Capacity of Health System

In order to increase effective utilisation of RBSK and to provide assistance to the caregivers of the children screened to have 2Ds, several capacity development measures are required within the health system at State/District/Block level. Some of the key measures required are mentioned below:

1. Training of Health officials: Training/Sensitizing health officials at DH/PHC/CHC about RBSK will help them to understand the details of the programme, which will help them to attend caregivers visiting health facilities in a better way.

2. Mapping of health services at State/District level : This will enable health officials to refer RBSK patients in an efficient manner. Additionally, it will help caregivers to navigate through health system easily.

3. MoUs and partnerships with NGOs, Trusts and Private sector: Since treatment of many 2Ds covered under RBSK is expensive, and limited capacity is available with government health system to handle such patients (especially in the absence of DEICs). Building capacity at State/District level to develop such partnerships is crucial for the success of the programme.

4. Development of IPC tools for FLWs: Since FLWs are a trusted source for health related information in the community, IPC tools like pictorial booklets, etc. are to be developed and distributed among them, to empower them in counselling caregivers of children having 2Ds.

Suggested Capacity Development Measures

In the context of the training related gaps identified in the Formative Research Report, several capacity development measures are required for different levels of stakeholders. The funding for this required

Capacity Development


Page | 51

capacity development can predominantly come from the RBSK training budget, which is under-utilised in most states. These capacity development needs are summarised in the table below.

Table 2: Capacity Development Needs by Type of Stak eholder

Stakeholder Capacity Development N eeds Budgets State Health Officials

� Training to understand RBSK’s objectives clearly and their roles in programme implementation

� Conduct a training needs assessment to understand gaps that may exist across district, block and community level to roll-out trainings for them

� Capacity to develop State Training Plan with a list of people to be trained/sensitized and develop tailor-made training plan for both Officials in Health Department and other related Departments, MHTs, and FLWs

� Develop the ability to advocate and influence policy makers, decision-makers with relevant information to motivate them to take action on critical issues related to availability of RBSK infrastructure (DEICs) to improve utilization

� Ability to develop MoUs for appropriate partnerships with hospitals and funding organisations to provide treatment and management of the 2Ds

� Ability to connect with non-profit organization and civil society organizations who can assist with funding tertiary care for BPL families

� Ability to map key service providers offering tertiary care and management services across their state

� Advocate for convergent platforms with other relevant Ministries/ Departments

� Understand the importance of IEC for the programme and what IEC/ BCC encompasses

� Training to make effective convergence mechanisms with other departments

RBSK training budget (FMR code A.9.12)

District Health officials


� Importance of IEC for the programme and what IEC/ BCC encompasses

� Ensuring effective implementation of IEC/ BCC activities

� Ability to sensitize frontline workers are appropriately sensitised/ oriented towards the programme

� Ability to train MHTs and FLWs on the programme, and clarify any doubts

� Ensuring effective convergence mechanisms with other departments (for example, by setting up a district level committee or leveraging DC/DM meetings)

� Ability to map key service providers offering tertiary care and management services across their state



Page | 52

Stakeholder Capacity Development N eeds Budgets � Ability to connect with non-profit organization and civil

society organizations who can assist with funding tertiary care for BPL families

Block Health officials


� Importance of IEC for the programme and what IEC/ BCC encompasses

� Ensure that frontline workers and teachers are appropriately sensitised/ oriented towards the programme

� Training to institutionalize recognition rewards for MHTs/ FLWs motivated and performing well in the programme

� Ensuring adherence to convergence mechanisms with other departments


IEC officials � At the National-level, training to develop IPC tools for ASHAs or leverage the modules developed by UNICEF (TARANG SBCC Training Module)

� At the State-level, training to understand IEC/BCC approaches available

� At the State-level, training to customise locally contextualized IPC tools for ASHAs

� Capacity to develop culturally appropriate IEC/ BCC materials taking into consideration state and local context;

� Capacity to monitor that district and block levels disseminate IEC materials and ensure that they are adequately used

RBSK IEC budget (FMR code B.10.7)

Other Departments

� Sensitisation on the programme, its objectives and why it is important/ beneficial

� Understanding the importance of the role played by teachers/ AWWs

� Understanding the importance of adherence to convergence mechanisms set up by Health officials

� Supporting the Health Department by encouraging mobilisation of children for screening

Not Available

Mobile Health Teams

� Refresher training on conditions and their complexities (every year)

� Interpersonal communication and soft skills training on how to communicate with caregivers (every year)

� Multi-skilling to provide empathy, guidance and counselling to parents of children with 2Ds

� Increasing self-motivation and involvement in the programme to encourage follow-ups with parents

� Develop ability to advocate for greater focus on the programme at block/ district level, among health and other department officials


Frontline Workers /

� Sensitisation on the programme, its objectives and why it is important/ beneficial

RBSK training budget (FMR


Page | 53

Stakeholder Capacity Development N eeds Budgets Teachers � Interpersonal communication and soft skills training to

explain the programme to the community, encourage utilisation, counsel caregivers and mobilise effectively

� Increase self-motivation/ involvement in the programme and highlight the importance of their role to serve as a means of incentivising performance

code A.9.12)

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

P

age

| 54

Im

plem

enta

tion

com

pris

es

of

the

conc

rete

m

easu

res

that

tr

ansl

ate

a F

ram

ewor

k in

to

actio

ns

that

ca

n pr

oduc

e re

sults

. G

iven

th

at

this

C

omm

unic

atio

n F

ram

ewor

k fe

eds

into

RB

SK

, on

e of

the

key

prog

ram

mes

with

in N

atio

nal H

ealth

Mis

sion

, im

plem

enta

tion

is t

he k

ey li

nk b

etw

een

Fra

mew

ork

and

the

actio

n pl

ans

that

are

exe

cute

d by

pro

gram

me

staf

f to

achi

eve

the

desi

red

beha

viou

r ch

ange

. Im

plem

enta

tion

nece

ssita

tes

unde

rsta

ndin

g of

the

Hea

lth D

epar

tmen

ts a

t N

atio

nal,

Sta

te,

Dis

tric

t, B

lock

and

Vill

age

leve

ls,

and

exam

inat

ion

of

inpu

ts r

equi

red

to o

pera

tiona

lise

the

Com

mun

icat

ion

Fra

mew

ork.

T

he d

etai

ls o

n th

e im

plem

enta

tion

step

s at

eac

h le

vel a

re p

rese

nted

bel

ow:

Nat

iona

l Lev

el: A

dvoc

acy

Act

iviti

es

Sta

keho

lder

s A

dvoc

acy

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• D

ecis

ion

Mak

ers/

P

olic

y m

aker

s of

RB

SK

at

MoH

FW

• O

rient

atio

n w

orks

hops

on

RB

SK

hi

ghlig

htin

g th

e fo

llow

ing:

• D

evel

op s

tand

ard

fram

ewor

k fo

r co

nduc

ting

• U

NIC

EF

•

Don

ors

• P

rivat

e se

ctor

Ann

ex 1

: Sug

gest

ed Im

plem

enta

tion

Fra

mew

ork

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

P

age

| 55

S

take

hold

ers

Adv

ocac

y A

ctiv

ities

In

puts

req

uire

d S

uppo

rt P

artn

ers

•

Rep

rese

ntat

ives

of C

entr

al

IEC

/BC

C B

urea

u •

Rep

rese

ntat

ives

of

conv

erge

nce

min

istr

ies

• E

lect

ed R

epre

sent

ativ

es-

Par

liam

enta

rians

, M

inis

ters

(U

nion

an

d S

tate

of t

he

core

and

con

verg

ent

Min

istr

ies)

•

Nat

iona

l rep

rese

ntat

ives

of

UN

ICE

F, o

ther

don

or

agen

cies

, etc

.

o

Impo

rtan

ce o

f scr

eeni

ng a

nd

min

imiz

ing

disa

bilit

ies

for

a he

alth

y fu

ture

of I

ndia

o

In

form

atio

n on

oth

er r

elat

ed

prog

ram

mes

of

natio

nal

impo

rtan

ce u

nder

diff

eren

t m

inis

trie

s e.

g. IE

-SS

A, D

DR

C, e

tc.

o

Incr

easi

ng th

e sc

ope

of

conv

erge

nce

with

Min

istr

ies

and

natio

nal f

lags

hip-

e.g

. adv

ocac

y w

ith M

oSJE

for

co-lo

catin

g D

DR

Cs

with

DE

ICs,

whe

reve

r re

quire

d o

D

evel

opm

ent o

f sta

ndar

ds a

nd

guid

elin

es; d

irect

ion

and

circ

ular

s/le

tters

to s

tate

for

impr

ovin

g im

plem

enta

tion

of th

e R

BS

K

• N

atio

nal C

onsu

ltatio

ns w

ith a

ll C

hief

Min

iste

rs, M

inis

ters

and

S

ecre

tarie

s ha

ndlin

g th

e re

leva

nt

Dep

artm

ents

for

enha

nced

co

llabo

ratio

n/ac

tiviti

es o

n ef

fect

ive

utili

zatio

n of

RB

SK

wor

ksho

ps

• D

evel

op e

vide

nce

base

d ad

voca

cy p

acka

ge, c

over

ing

o

Fac

t she

ets

on p

rogr

ess

of R

BS

K o

n va

rious

de

fined

par

amet

ers

o

Pre

sent

atio

ns

with

pro

gram

me

rela

ted

info

rmat

ion

o

shor

t film

s of

goo

d pr

actic

es a

roun

d th

e co

untr

y on

RB

SK

E

.g.,

Mod

el D

EIC

vid

eo

Sta

te L

evel

: Adv

ocac

y A

ctiv

ities

Sta

keho

lder

s A

dvoc

acy

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• D

ecis

ion

Mak

ers

of R

BS

K a

t S

tate

leve

l •

Rep

rese

ntat

ives

of S

tate

• O

rient

atio

n w

orks

hops

on

RB

SK

hi

ghlig

htin

g th

e fo

llow

ing-

o

The

impo

rtan

ce o

f scr

eeni

ng a

nd

• D

evel

op s

tand

ard

fram

ewor

k fo

r co

nduc

ting

wor

ksho

ps

• U

NIC

EF

•

Don

ors

• P

rivat

e se

ctor

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

P

age

| 56

S

take

hold

ers

Adv

ocac

y A

ctiv

ities

In

puts

req

uire

d S

uppo

rt P

artn

ers

IE

C/B

CC

Bur

eau

•

Sta

te r

epre

sent

ativ

es o

f co

nver

genc

e m

inis

tries

(MoH

FW

, IC

DS

-W

CD

, DoE

-MH

RD

, MoS

JE)

• E

lect

ed r

epre

sent

ativ

es -

MLC

,MLA

, Zila

Par

isha

d

• D

istr

ict M

agis

trat

es/

Dis

tric

t Col

lect

ors

•

Sta

te r

epre

sent

ativ

es o

f U

NIC

EF

, oth

er d

onor

age

ncie

s et

c.

min

imiz

ing

disa

bilit

ies

for

a he

alth

y fu

ture

of I

ndia

o

In

form

atio

n on

oth

er r

elat

ed

prog

ram

mes

of

natio

nal

impo

rtan

ce u

nder

diff

eren

t m

inis

trie

s e.

g. IE

-SS

A, D

DR

C, e

tc.

o

Info

rmat

ion

on c

urre

nt

conv

erge

nce

and

scop

e of

co

nver

genc

e w

ith k

ey

depa

rtm

ents

and

nat

iona

l fla

gshi

p pr

ogra

mm

es. E

.g. a

dvoc

acy

with

M

oSJE

for

co-lo

catin

g D

DR

Cs

with

DE

ICs,

whe

reve

r re

quire

d •

Con

fere

nce

with

DM

s/D

Cs

of a

ll di

stric

ts fo

r pr

iorit

izin

g ut

iliza

tion

of

RB

SK

to m

inim

ize

disa

bilit

ies

in th

e di

stric

ts a

nd h

ence

the

stat

e, c

ould

al

so b

e a

plat

form

to s

hare

initi

ativ

es

at d

istr

ict l

evel

; les

sons

lear

nt w

ill

info

rm a

nd im

prov

e im

plem

enta

tion

of

RB

SK

•

Fie

ld v

isits

to b

est p

ract

ice

area

s,

whe

re th

e ut

iliza

tion

of R

BS

K is

im

prov

ed a

t a r

apid

rat

e in

the

rece

nt

past

, adv

ocac

y of

thes

e be

st p

ract

ices

fo

r ot

her

dist

ricts

of t

he S

tate

• D

evel

op e

vide

nce

base

d ad

voca

cy p

acka

ge, c

over

ing

o

Fac

t she

ets

on p

rogr

ess

of R

BS

K o

n va

rious

de

fined

par

amet

ers

o

Pre

sent

atio

ns

with

pr

ogra

mm

e re

late

d in

form

atio

n o

S

hort

film

s of

goo

d pr

actic

es a

cros

s th

e st

ate

on R

BS

K

E.g

., M

odel

DE

IC v

ideo

•

Iden

tify

loca

tions

and

fa

cilit

ate

field

vis

its

Dis

tric

t Lev

el: A

dvoc

acy

Act

iviti

es

Sta

keho

lder

s A

dvoc

acy

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• R

BS

K d

istri

ct c

oord

inat

or

• D

HO

and

CS

/CM

O

• R

BS

K o

rient

atio

n w

orks

hops

for

m

embe

rs o

f ed

ucat

ion,

nut

ritio

n,

soci

al w

elfa

re a

nd o

ther

rel

ated

• E

vide

nce

base

d ad

voca

cy p

acka

ge in

lo

cal l

angu

age

• U

NIC

EF

•

Don

ors

• P

rivat

e se

ctor

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

P

age

| 57

•

ICD

S o

ffice

r

• D

EO

•

Dis

tric

t Mag

istr

ates

/ D

istr

ict C

olle

ctor

s •

ZP

mem

bers

•

PR

I bod

ies

depa

rtm

ents

•

One

-to-

one

mee

tings

bet

wee

n re

pres

enta

tives

of I

CD

S,

Edu

catio

n, C

S/C

MO

, DC

/DM

and

Z

P m

embe

rs a

t a d

efin

ed

freq

uenc

y(m

onth

ly/q

uart

erly

) to

di

scus

s o

P

rogr

ess

of R

BS

K in

the

dist

rict

o

Con

verg

ence

rel

ated

is

sues

•

Fie

ld v

isits

to b

ette

r pe

rfor

min

g bl

ocks

(w

ith r

espe

ct to

RB

SK

)

• F

act s

heet

s on

RB

SK

Nat

iona

l and

Sta

te L

evel

: Com

mun

icat

ion

Act

iviti

es

Com

mun

icat

ion

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• R

ole

mod

el o

utre

ach

cam

paig

n o

E

ngag

e a

role

mod

el (

Par

alym

pics

at

hlet

e) to

pro

mot

e ke

y be

havi

ours

. T

hese

can

be

popu

lar

figur

es a

t na

tiona

l, st

ate/

regi

onal

leve

l o

D

evel

op s

hort

film

s w

ith r

ole

mod

el

to n

orm

aliz

e di

sabi

lity

for

mas

s m

edia

o

In

volv

e ro

le m

odel

s to

giv

e aw

ay

awar

ds to

bes

t per

form

ing

MH

Ts

and

othe

r R

BS

K o

ffici

als

• Id

entif

y ro

le m

odel

s to

cha

mpi

on th

e ca

use

/sel

ect b

rand

am

bass

ador

s •

Dev

elop

app

eals

with

rol

e m

odel

s/

bran

d am

bass

ador

for

scr

eeni

ng a

nd e

arly

in

terv

entio

n un

der

RB

SK

•

Org

aniz

e ev

ents

like

“R

BS

K d

ay”,

cel

ebrit

ies

to

dist

ribut

e aw

ards

on

this

day

• U

NIC

EF

•

Don

ors

• M

inis

try

of In

form

atio

n an

d B

road

cast

ing

(MIB

) •

Min

istr

y of

Info

rmat

ion

Tec

hnol

ogy

and

Tel

ecom

mun

icat

ions

•

Priv

ate

sect

or

• M

ass

med

ia c

ampa

ign

o

TV

, Prin

t, O

nlin

e m

edia

(H

indi

an

d re

gion

al/lo

cal l

angu

ages

) o

R

BS

K s

peci

fic A

V c

onte

nt fo

r H

ealth

fa

cilit

ies

• C

onte

nt c

reat

ion

for m

essa

ging

on

the

sele

ct b

ehav

iour

s fo

r di

ffere

nt

med

ium

s in

clud

ing

vide

o ap

peal

s,

prin

t adv

ertis

emen

ts, p

ress

rel

ease

s, S

MS

/text

•

Hos

ting

talk

sho

ws

with

rol

e m

odel

s su

ch a

s

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

P

age

| 58

C

omm

unic

atio

n A

ctiv

ities

In

puts

req

uire

d S

uppo

rt P

artn

ers

E

ffort

s sh

ould

be

mad

e to

syn

ergi

ze th

e br

oadc

ast a

t nat

iona

l and

sta

te le

vel.

Par

alym

pic

win

ners

/ par

ticip

ants

•

Det

aile

d m

edia

pla

n fo

r th

e di

ssem

inat

ion

of

mes

sage

s fo

r ev

ery

med

ium

- th

is s

houl

d in

clud

e o

S

peci

fic ti

mel

ines

o

S

elec

tion

of T

V c

hann

els

and

prin

t bas

ed o

n cr

edib

le r

atin

gs

o

Tim

e of

exp

osur

e to

targ

et c

erta

in

audi

ence

s- f

or e

xam

ple

plac

emen

t of

ads/

shor

t film

s at

prim

e tim

e- b

etw

een

popu

lar

soap

ope

ras,

or

befo

re a

nd a

fter

ne

ws

on p

opul

ar n

ews

chan

nels

o

E

mbe

dded

mes

sage

s th

roug

h po

pula

r se

rials

on

TV

o

E

mbe

dded

mes

sage

s in

feat

ure

film

s or

do

cum

enta

ries

deve

lope

d on

the

issu

e (s

uch

as T

aare

Zam

een

Par

on

issu

e of

le

arni

ng d

isab

ility

)

Mob

ile c

ampa

ign

• P

artn

ersh

ip c

an b

e fo

rged

with

a s

ervi

ce

prov

ider

for i

nitia

ting

o

SM

S c

ampa

ign

o

IVR

cam

paig

n

o

Mob

ile m

essa

ges

thro

ugh

bulk

o

S

MS

/mus

ic/ji

ngle

/ cal

ler

tune

s o

O

ther

inno

vativ

e m

obile

mes

sagi

ng

• D

evel

op c

reat

ive

cont

ent/R

BS

K r

elat

ed

mes

sage

s/re

min

ders

to b

e di

ssem

inat

ed

thro

ugh

mob

ile p

hone

s vi

a S

MS

or

IVR

•

Alli

ance

with

mob

ile te

leph

ony

serv

ice

prov

ider

s

• U

NIC

EF

•

Min

istr

y of

Info

rmat

ion

and

Bro

adca

stin

g (M

IB)

• M

inis

try

of In

form

atio

n T

echn

olog

y an

d T

elec

omm

unic

atio

ns

• P

rivat

e S

ecto

r

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

Pag

e | 5

9

Dis

tric

t Lev

el: C

omm

unic

atio

n A

ctiv

ities

Com

mun

icat

ion

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• R

BS

K h

oard

ings

at s

trat

egic

site

s •

Pos

ters

on

key

deve

lopm

ent m

ilest

ones

in a

ll pu

blic

hea

lth fa

cilit

ies

/ del

iver

y po

ints

/ SN

CU

s •

Pub

lic S

ervi

ce A

nnou

ncem

ents

(P

SA

s) fo

r po

pula

rizin

g sc

reen

ing

even

t •

Wal

l pai

ntin

gs /

Pos

ters

on

gove

rnm

ent h

ealth

in

sura

nce

prog

ram

mes

at a

ll pu

blic

hea

lth fa

cilit

ies

• P

ublis

h su

cces

s st

orie

s of

chi

ldre

n w

ho o

btai

ned

free

trea

tmen

t in

the

loca

l new

spap

ers

/ mag

azin

es

• IP

C jo

b ai

ds fo

r F

LWs

• D

evel

op R

BS

K s

peci

fic c

reat

ive

cont

ent f

or

outd

oor

med

ia a

nd IE

C m

ater

ials

•

Iden

tific

atio

n/m

appi

ng o

f site

s- H

ealth

ce

ntre

s/ h

ospi

tals

sch

ools

, etc

. •

Sel

ect n

ewsp

aper

s/m

agaz

ines

to p

ublis

h R

BS

K s

ucce

ss s

torie

s

• R

BS

K D

istr

ict c

oord

inat

or

• D

istr

ict I

EC

Bur

eau

• U

NIC

EF

Con

sulta

nts

• P

rivat

e ag

enci

es

Blo

ck L

evel

: Com

mun

icat

ion

Act

iviti

es

Com

mun

icat

ion

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• R

BS

K h

oard

ings

at s

trat

egic

site

s •

Pos

ters

on

key

deve

lopm

ent m

ilest

ones

in a

ll pu

blic

hea

lth fa

cilit

ies

/ del

iver

y po

ints

/ SN

CU

s •

Pos

ters

on

the

cont

inuu

m o

f car

e of

RB

SK

from

• Id

entif

icat

ion/

map

ping

of s

ites-

Pan

chay

at

Offi

ce, H

ealth

Cen

tres

/ Hos

pita

ls, S

choo

ls,

etc.

•

Arr

ange

logi

stic

s fo

r w

all p

aint

ings

,

• R

BS

K B

lock

leve

l co

ordi

nato

r •

Priv

ate

agen

cies

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

Pag

e | 6

0

Com

mun

icat

ion

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

scre

enin

g, to

ref

erra

l to

eval

uatio

n d

ispl

ayed

in th

e w

aitin

g ar

ea a

t all

heal

th fa

cilit

ies

(incl

. SN

CU

s),

scho

ols,

and

AW

Cs

• P

ublic

Ser

vice

Ann

ounc

emen

ts (

PS

As)

for

popu

lariz

ing

scre

en d

ay

• W

all p

aint

ings

/ P

oste

rs o

n go

vern

men

t hea

lth

insu

ranc

e pr

ogra

mm

es a

t all

publ

ic h

ealth

faci

litie

s •

RB

SK

rel

ated

info

rmat

ion

(like

scr

eeni

ng

sche

dule

s, e

tc.)

. on

loca

l cab

le T

V c

hann

els

hoar

ding

s, p

oste

rs, e

tc.

Gra

m P

anch

ayat

Lev

el: C

omm

unic

atio

n A

ctiv

ities

Com

mun

icat

ion

Act

iviti

es

Inpu

ts r

equi

red

Sup

port

Par

tner

s

• R

BS

K S

cree

ning

sch

edul

es a

nd e

valu

atio

n ca

mp

sche

dule

pos

ters

at A

WC

s an

d S

choo

ls

• W

all p

aint

ings

at p

rom

inen

t loc

atio

ns li

ke

panc

haya

t offi

ce, s

choo

l pre

mis

es, e

tc.

• A

rran

ge lo

gist

ics

for

wal

l pai

ntin

gs, p

oste

rs,

etc.

at s

choo

ls, A

WC

s, P

anch

ayat

Offi

ce

• R

BS

K B

lock

leve

l co

ordi

nato

r •

Tea

cher

s / M

HR

D

• G

P m

embe

rs

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

Pag

e | 6

1

Sug

gest

ed ti

mel

ines

to im

plem

ent s

ampl

e A

dvoc

acy

and

Com

mun

icat

ion

rela

ted

activ

ities

at N

atio

nal/S

tate

/Dis

tric

t/Blo

ck/G

P le

vel:

Ye

ar

1

2

3

4

5

• O

rient

atio

n w

orks

hops

on

RB

SK

to h

ighl

ight

impo

rtan

ce o

f sc

reen

ing

and

a fo

cus

on m

inim

izin

g di

sabi

litie

s am

ong

child

ren

in In

dia

• S

hare

info

rmat

ion

on o

ther

rel

ated

pro

gram

mes

of

natio

nal

impo

rtan

ce e

.g. I

E-S

SA

, DD

RC

, etc

.

• In

crea

se th

e sc

ope

of c

onve

rgen

ce w

ith o

ther

Min

istr

ies

and

rela

ted

prog

ram

mes

of

natio

nal i

mpo

rtan

ce

• D

evel

op s

tand

ards

and

gui

delin

es; d

irect

ion

and

circ

ular

s/le

tters

to

Sta

tes

for i

mpr

ovin

g im

plem

enta

tion

of th

e R

BS

K

• N

atio

nal C

onsu

ltatio

ns w

ith a

ll C

hief

Min

iste

rs, M

inis

ters

and

S

ecre

tarie

s ha

ndlin

g th

e re

leva

nt D

epar

tmen

ts fo

r en

hanc

ed

colla

bora

tion/

act

iviti

es o

n ef

fect

ive

utili

zatio

n of

RB

SK

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

Pag

e | 6

2

• C

onfe

renc

e w

ith D

Ms/

DC

s of

all

dist

ricts

for

prio

ritiz

ing

utili

zatio

n of

RB

SK

to m

inim

ize

disa

bilit

ies

in th

e di

stric

ts a

nd h

ence

the

stat

e, c

ould

als

o be

a p

latfo

rm to

sha

re in

itiat

ives

at d

istr

ict l

evel

; le

sson

s le

arnt

will

info

rm a

nd im

prov

e im

plem

enta

tion

of R

BS

K

• F

ield

Vis

its to

bes

t pra

ctic

e ar

eas,

whe

re th

e ut

iliza

tion

of R

BS

K

is im

prov

ed a

t a r

apid

rat

e in

the

rece

nt p

ast,

advo

cacy

of t

hese

be

st p

ract

ices

for

othe

r di

stric

ts o

f the

Sta

te

• C

eleb

rity

outr

each

cam

paig

n- E

ngag

e a

cele

brity

(P

aral

ympi

cs

athl

ete/

Bol

lyw

ood)

to p

rom

ote

key

beha

viou

rs

• M

ass

med

ia c

ampa

ign-

TV

, Rad

io, P

rint,

Onl

ine

med

ia (

Hin

di

and

regi

onal

/loca

l lan

guag

es)

and

RB

SK

spe

cific

AV

con

tent

for

Hea

lth fa

cilit

ies

• M

obile

Cam

paig

n- P

artn

ersh

ip to

be

forg

ed w

ith a

ser

vice

pr

ovid

er to

initi

ate

SM

S c

ampa

ign,

Mob

ile m

essa

ges

thro

ugh

bulk

SM

S/m

usic

/jing

le/ c

alle

r tu

nes

and

Oth

er in

nova

tive

mob

ile

mes

sagi

ng te

chni

ques

• P

laci

ng o

f R

BS

K h

oard

ings

at s

trat

egic

site

s

• P

laci

ng o

f po

ster

s on

key

dev

elop

men

t mile

ston

es in

all

publ

ic

heal

th fa

cilit

ies

/ del

iver

y po

ints

/ SN

CU

s

• U

se o

f P

ublic

Ser

vice

Ann

ounc

emen

ts (

PS

As)

to p

opul

ariz

e sc

reen

ing

even

t

• W

all p

aint

ings

/ P

oste

rs o

n go

vern

men

t hea

lth in

sura

nce

prog

ram

mes

at a

ll pu

blic

hea

lth fa

cilit

ies

• P

ublis

h su

cces

s st

orie

s of

chi

ldre

n w

ho o

btai

ned

free

trea

tmen

t in

the

loca

l new

spap

ers

/ mag

azin

es

For

mat

ive

Stu

dy o

n R

BS

K

D

eloi

tte

Pag

e | 6

3

• P

rovi

de IP

C jo

b ai

ds f

or F

LWs

• P

lace

pos

ters

on

RB

SK

Scr

eeni

ng s

ched

ules

and

eva

luat

ion

cam

p sc

hedu

le a

t AW

Cs

and

Sch

ools

• W

all p

aint

ings

at p

rom

inen

t loc

atio

ns li

ke P

anch

ayat

Offi

ce,

scho

ol p

rem

ises

, etc

.

Sho

rt T

erm

Act

iviti

es (

1-3

Yea

rs)

Long

Ter

m A

ctiv

ities

(3-

5 Y

ears

)

Documents

Final RBSK National Communication Framework for UNICEF ...nhm.gov.in/images/pdf/programmes/RBSK/RBSK_IEC/RBSK_National... · CWSN Child With Special Needs DC District Commissioner