Behaviour Change Matters

OPED: INNOVATION AND PARTNERSHIPS KEY TO BOLSTER RISK COMMUNICATION AND COMMUNITY ENGAGEMENT

As COVID-19 cases rise again and a new but familiar fear rages, it is clear that Risk Communication and Community Engagement (RCCE) is the cornerstone of pandemic response. Stepping up communication strategies, innovation at local levels and partnerships for RCCE will be crucial to ensure that in 2022 vaccines reach the most marginalized and COVID Appropriate Behaviours (CAB) are consistently reinforced.

Over the last two years we have achieved much with more than 250 million reached and engaged; it is important to ensure we do not lose the gains made. Year 2021 showed some innovative best practices for vaccination coverage that can be scaled up. For example, in Maharashtra, an initiative in collaboration with Kolhapur Municipal Corporation addressed the issue of low vaccine uptake in urban slums. The challenge of internet access, digital divide and vaccine hesitancy fuelled by misinformation was addressed by digital mapping of households and community mobilization. Vaccination camps were held within the slums to make the service easily accessible to slum dwellers.

In Mizoram, a campaign focused on an ethnic group with communication material in local languages and social mobilisation helped dispel myths around vaccination. UNICEF has supported COVID-19 vaccination in five districts of the state. Communication materials promoting CAB, dispelling myths, and increasing demand for vaccines in local languages were developed and disseminated. Pastors and tribal leaders were involved in a unified response to the pandemic.

Folk media including music and street theatre in regional languages are powerful tools for spreading messages to the masses. In Tamil Nadu, a foot-tapping music video helped allay fears while in Mumbai, street theatre was used to effectively engage people in CAB messaging and allaying fears around vaccination.

Over the last two years, risk communication and community engagement strategies have drawn learning lessons from the polio campaign. The intensive mobilization strategy used for polio was effectively applied to ensure high coverage of COVID-19 vaccination. These include door-to-door mobilization in vulnerable areas and use of community influencers such as faith leaders to encourage people to vaccinate. In Uttar Pradesh, the cluster approach vaccination in select areas, including use of award winning puppetry for behaviour change has been effective.

Gender and equity focus is crucial to ensure vaccines reach the most marginalized. In Malkanagiri district in Odisha, volunteers supported by UNICEF visited a village cut off from the mainland as it is inside a reservoir on boats. They went house to house ensuring that the community has accurate information regarding the vaccine. More than 200 people were mobilized, with a majority being vaccinated. In Kalahandi district, where roads are poor and the terrain is hilly, social mobilisers are reaching villages inside forest areas. Reaching the proverbial last mile has ensured communities living in remote areas have access to the vaccine.

Partnerships are vital for behaviour change,
as is scale.

In July 2021, UNICEF forged a partnership with TRIFED (Tribal Co-operative Marketing Development Federation of India) under the Ministry of Tribal Affairs, for a communication campaign targeting 5 million people across remote tribal communities with key messages on COVID-19 vaccination. There are 705 Scheduled Tribes (STs) in India spread over 30 States and union territories. Poor geographical access as well as limited access to mass media are key challenges in reaching tribal communities. The campaign launched to promote COVID-19 vaccines among tribal communities leveraged the network of Self Help Groups and common touch points such as Common Service Centres, fertilizers outlet centres, Haats and Bazaars to promote vaccine uptake and COVID Appropriate Behaviours. Involving traditional leaders and faith-based healers to promote adoption of COVID-19 vaccines has proved to be an effective approach.

PRIs or Panchayati Raj Institutions have been engaged across states. Self Help Groups have ensured messaging not only reaches but also engages rural women. In Sirohi district of Rajasthan, social mobilisers say getting rural women to vaccinate is more difficult as they are often away working in the fields and on NREGA sites. Door to door visits and collective efforts of local NGOs, frontline workers and panchayat members have helped overcome resistance. In some cases, women who were initially resistant are now fully vaccinated and motivate other women in the community to vaccinate. Engaging with the community in their own language/ dialect has helped build trust. Visually-led communication materials developed specially for specific communities complemented by community mobilisers has ensured they relate to the messaging.

Clearly, messaging needs to be contextualized and relevant to local needs. In Mizoram, communication materials were prepared for specific vulnerable groups such as children. The state recorded some of the highest numbers of infections among children and young people. Elsewhere, in Giridih tribal district of Jharkhand, locally recruited social mobilisers and use of communication material in Santhali language helped reverse the mass refusal of the vaccine due to misconceptions surrounding its adverse effects.

All of this would not be possible without the strategic leadership of the Government of India and its state bodies, partnerships through various bodies such as the SBCC Alliance, private sector, National RCCE working group and the generous contributions of USAID, Gates Foundation, GAVI and ADB.

Moving forward in 2022, as vaccination opens for the teenagers, youth will have a critical role to play in dispelling myths and addressing vaccine hesitancy among their peers. Youth volunteer campaigns such as RokoToko and Yuvodaya in Chhattisgarh and Mai Corona Volunteer in Madhya Pradesh in partnership with Ministry of Youth Affairs and Sports have ensured youth engagement for pandemic response at scale. Harnessing the energy of youth will be crucial for sustainable change in communities.

The journey continues!
Sid Shrestha
Chief - Social and Behaviour Change, UNICEF India

STORIES FROM THE FIELD:
MUSIC BRINGS COMMUNITIES TOGETHER AGAINST COVID IN RAJASTHAN

Folk music has been the soul of Rajasthani culture for centuries. Each region here has its own form of traditional entertainment, storytelling and engagement with the surrounding communities. In Jaisalmer, the largest district of Rajasthan, traditional music has helped play a bridge between COVID awareness campaigns and the local population. A mid-media campaign with the local Manganiyar folk artists has led to better understanding of COVID Appropriate Behaviour (CAB) and vaccination process.

UNICEF, in consultation with the government and partners, identified the lowest vaccine coverage areas in the district. Two blocks Sum and Jaisalmer were selected after analysing the vaccination records and awareness programmes were conducted in 32 Gram Panchayats here in October. The campaign was extended to six more panchayats in the last week of December. Over 5,000 people participated in these programmes. In the two selected blocks of the district, vaccination coverage for first dose rose from 50% in August 2021 to a remarkable 90% in December 2021.

Jaisalmer district lies in the Thar Desert which straddles the border with Pakistan. It is the largest district of the state and the third largest in India. Despite being far -flung and least populated in the state, it is one of the most popular tourist destinations in Rajasthan. As of January 2022, Jaisalmer district has recorded a total of over 13,000 COVID-19 cases. The Manganiyars are a clan of hereditary folk musicians popular in the Thar region. A group of nearly 50 musicians were trained by UNICEF and partners in a week long workshop. “We gave them the script and messaging on CAB, CAB+, importance of both doses of the COVID vaccine, vaccination of pregnant women and myths vs. facts. They wrote the songs in the local dialect,” says Zameer Anwar, UNICEF consultant. In all, there were eight groups of six performers, trained and ready to spread awareness in the community. Folk artist Dayam Khan says a day ahead of each programme the group would visit the villages to make announcements in order to invite people for the programme. “Men and women came to these programmes, we told them about the COVID vaccine through songs and encouraged them to vaccinate. Many of these people, including pregnant and lactating mothers, took the vaccine. All the hard work of going house to house in remote areas has paid off,” he says.

Follow-up by the PRIs and health workers helped ensure participation of the left-out and drop-out communities. Manjaree Pant, UNICEF SBC Specialist, Rajasthan, says that one of the key challenges was the low vaccination rate amongst women, especially pregnant, breastfeeding and newly-wed. Despite new directives, the communities were apprehensive and fearful. It was critical to break myths and instill confidence and trust, and the folk form was very effective in doing this. Interactive delivery methods were used during the programme which concluded with collective oath taking to practice COVID Appropriate Behaviour and vaccination.

Interactive delivery methods were used during the programme which concluded with collective oath taking to practice COVID Appropriate Behaviour and vaccination ©UNICEF/India/2021/ HanumanChaudhary

Another challenge was ensuring that the songs were inclusive. “Folk forms tend to glorify social norms which may not be pro-women and inadvertently send out messages which may not be rights-centric. While orienting the folk musicians, we spent a lot of time discussing the rights perspective. We went through the songs they wrote. It was important to weave out not just gender-based biases but even community-based biases,” says Manjaree.

This intervention was supported by generous contribution from USAID. The campaign was flagged off by the District Collector and special effort was made to reach out to the communities who reside in remote areas. COVID awareness programmes were conducted at NREGA work sites. Vaccination camps were also organized at convenient locations to make it accessible for remote communities.

Local influencers such as the Gram Pradhan, Ward Panch, teachers, faith leaders, frontline workers and women Self Help Groups actively participated in the campaign. Similar mid-media campaigns using folk media were also organized in Barmer, Sirohi and Dungarpur districts. By the end of December 2021, the folk campaign went to four districts, 16 Blocks and 160 gram panchayats with a total of 166 shows, reaching over 888,850 people.

FROM MYTHS TO MILESTONES -- VACCINATING A VILLAGE IN JHARKHAND

How health workers and influencers convince a village to achieve 100% COVID vaccination

Siyankel is a small village in Murhu block of Khunti district in the state of Jharkhand. The village has a population of about 500, 98% of which are from the local tribal community. The closely knit village has 93 households with 251 men and 236 women. The community has lived a quiet and conservative life for decades. However, their usual challenges changed course as the COVID-19 pandemic spread to this area.

It started with the migrant workers returning home from different cities once the COVID-19 lockdown was announced in India in March 2020. Around 9,000 migrants came back to the 140 villages in Murhu block and the authorities started the process of quarantining them. There was fear and panic amongst the locals and Siyankel residents also started living under immense stress. There were rumours and confusion and lack of proper information. When the COVID-19 vaccination process began in early 2021, UNICEF partner organisation Karra Society for Rural Action (KSRA) started social mobilisation interventions in the village to tackle this grim situation.

Resistance and doubts

The health workers who were assigned the task to mobilise people for vaccination faced severe resistance and opposition from the community. Sadique Jahan, the programme manager of Karra society recalls, "I remember our first day when we went to convince people for vaccination in the village. They believed that this was not a mandatory process for everyone and they had messages and texts on their mobile phones that created panic and doubt in their minds." Convincing the gathering of 30 to 40 people was an arduous task for health workers. “It was like a public debate,” Sadique says. “The health officer finally took responsibility in case of any adverse affect or post-vaccination emergency.”

Turning point

As doubts prevailed in the area, convincing the Gram Pradhan (village head) for vaccination proved to be the turning point for health workers here. 65-year-old Mansidh Kadir sat down with the health workers and understood the vaccination procedure in detail. After this he was ready to get the first dose. Once the village head was vaccinated, some of the people started to feel confident and agreed to do the same.

Another major breakthrough was achieved as KSRA’s social mobiliser Sonali Devi along with Anganwadi Worker Madhuri Kumari started visiting the homes and conducting small group and one-to-one meetings. Through these meetings more and more women of the community were provided with correct information that helped convince the families. Initially, people did not talk much and looked at them with suspicion. There were lots of queries from the community such as “Will we die after taking vaccination? Is it safe? Why do I need the vaccine?” says Sonali Devi who along with Madhuri patiently answered these queries with all the details and government guidelines in the tribal language.

KSRA had started their initial phase of relief work in the area in May 2021. After continuous dialogue and persuasion, it was during the last week of October 2021 that few community influencers agreed to take the COVID vaccine and initially 20 people from the village also agreed to get the dose. Once the community witnessed their own leaders getting vaccinated, their fears and inhibition reduced and they started coming forward for vaccination.

A vaccinated village

The hard work, persistence and patience of social mobilisers and the Anganwadi worker proved to be instrumental for a successful vaccination rate. Today, Siyankel village is 100% vaccinated for the first dose and 80% for the second dose. Overall, in Murhu block 80% population has received their first dose of COVID-19 vaccine while 40% have received their second dose. The health workers continue to spread awareness amongst the locals through CAB (COVID Appropriate Behaviour) related participatory activities and counselling sessions.

MEET OUR TEAM: SUGATA ROY, SBC SPECIALIST, ODISHA

Rural marketing to polio eradication campaigns,
more than two decades of experience in humanitarian work and having completed a PhD recently, Sugata Roy has a bag full of experiences. He has worked with UNICEF field offices in Uttar Pradesh, Jharkhand and Tamil Nadu in the C4D and CAP sections, before returning to Odisha as a Social and Behaviour Change Specialist in 2021. He grew up in Cuttack and studied Rural Management at the Xavier Institute of Social Service, Ranchi. Sugata started his career with the global ad agency Ogilvy and Mather (O&M) that gave him an insight into the rural consumer. He has worked on the polio eradication campaign in Uttar Pradesh through some of the most challenging years of the polio programme.

Sugata wears his advocacy and community engagement hats with equal ease. “Advocacy, influencing policy, and building an enabling environment, and engaging communities are two wheels of the same cart. Working with communities is where I started and what I am drawn to most,” he says. After over 20 years he has returned to Odisha, the state where he grew up. “It’s always good to be back and contribute towards development of home state,” he says. Sugata believes that working in other states has brought him rich experience. “I learnt a lot, for example in Tamil Nadu where I was for over a decade, the state’s investment in education has great learning lessons for other states.”

A firm believer in continuous learning and upgrading skills, Sugata has never stopped the flow of knowledge in his life. “Social and behavior change communication is a very dynamic area, one has to be constantly updated and ahead,” he says. Sugata has just completed his PhD on community attitudes towards health and hygiene. In recent years he has also undergone important learning from some of the top most institutes of the country on digital marketing, behavioral insights on social norms, as well as building leadership. A simple family man, Sugata enjoys his time with his wife who works as a teacher, college going son and 12-year-old daughter. “They are always filled with humor, laughter and stories to tell,” he says.

RESOURCES AND LINKS

Social Media for Behaviour Change Toolkit developed by IFRC and USAID is designed to be helpful to anyone who wants to use social media to bring positive behaviour change regarding disaster risk reduction among people in their community or other groups they serve.
New materials added to the IEC eWarehouse include posters developed by MoHFW for COVID-19 vaccination for 15-18 year olds in Hindi and English; Training module on SBCC in context of disaster risk reduction produced by National Institute of Disaster Management partnership with UNICEF.
Communication materials developed by MoHFW such as toolkit for young people to become engaged in pandemic response and audio visuals on 15 Covid Appropriate Behaviours are also available in Hindi. and English.
Poshan Gyan by Niti Aayog is a comprehensive resource for communication materials on nutrition.
Health, Nutrition and ECD reference handbook is a collection of guidelines and tools from Central and State governments to support continuity of essential services and interventions during the pandemic, compiled by Poshan Weekly.
‘Families want a son at any cost’: the women forced to abort female foetuses in India; The Guardian, December 2021
In NFHS report card, the good, the sober, the future: Oped by Sriram Haridass, UNFPA Representative India and Country Director Bhutan, says 'To empower women and ensure gender justice, it is imperative to address harmful practices, such as child marriage and Gender-biased Sex Selection'. UNFPA, December 2021