Post on 27-Oct-2020
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
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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
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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.
Communication Standpoint
• 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.
Communication Standpoint
• 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
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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.
Communication Standpoint
• 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.
Communication Standpoint
• 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
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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.
Communication Standpoint
• 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.
Communication Standpoint
• 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.
Communication Standpoint
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• 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.
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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
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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.
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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
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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
o va
riabl
es o
f co
ntin
uum
of
care
and
sys
tem
ic le
vel,
a tw
o-by
-tw
o m
atrix
has
bee
n us
ed to
ana
lyze
key
bar
riers
fac
ed b
y ca
regi
vers
in
deta
il, p
rovi
ded
belo
w:
Tab
le 1
: Bar
riers
rel
ated
to a
cces
sing
RB
SK
ana
lyse
d us
ing
Soc
io-E
colo
gica
l Fra
mew
ork
LEV
ELS
B
AR
RIE
RS
TO
SC
RE
EN
ING
B
AR
RIE
RS
TO
EV
ALU
AT
ING
/ IN
TE
RV
EN
ING
EA
RLY
B
AR
RIE
RS
T
O M
AN
AG
EM
EN
T O
F
CH
ILD
RE
N W
ITH
2D
s O
RG
AN
IZA
TIO
NA
L (S
tate
/ Dis
trict
)
�
Lim
ited
avai
labi
lity
of v
ehic
les
for
MH
Ts
�
Sho
rtag
e of
sta
ff at
MH
Ts
�
Unr
ealis
tic ta
rget
s fo
r sc
reen
ing
�
New
bor
n sc
reen
ing
not s
tart
ed
�
Vac
ant
posi
tions
fo
r A
YU
SH
in
MH
Ts
�
Lim
ited
trai
ning
of R
BS
K s
taff
�
Lim
ited
DE
ICs
/ si
ngle
fac
ility
whe
re
all
scre
ened
ch
ildre
n ca
n be
ev
alua
ted
for
conf
irmat
ion
of
cond
ition
�
No
clea
r m
appi
ng
of
tert
iary
/dia
gnos
tic s
ervi
ces/
trea
tmen
t op
tions
in th
e di
stric
t/sta
te
�
DH
/CH
C
med
ical
fr
ater
nity
la
cks
deta
iled
info
rmat
ion
on R
BS
K
�
Out
-of-
pock
et
paym
ent
for
diag
nost
ics
�
Ref
erra
ls t
o m
ultip
le c
ente
rs t
o ge
t di
agno
sis
done
�
Lim
ited
arra
ngem
ent
for
tran
spor
tatio
n of
ca
regi
vers
(a
nd
mon
ey s
pent
on
tran
spor
tatio
n)
�
Poo
r in
stitu
tiona
l ar
rang
emen
t fo
r ac
com
mod
atio
n,
food
, an
d ot
her
rela
ted
aspe
cts
for
care
give
rs
�
No
clea
r m
appi
ng
of
tert
iary
/dia
gnos
tic
serv
ices
/trea
tmen
t op
tions
in
the
dist
rict/s
tate
�
Lim
ited
info
rmat
ion
give
n to
pa
rent
s on
th
e pr
oces
s of
m
anag
emen
t of c
hild
ren
with
2D
s �
Lack
of
D
EIC
s /
sing
le
cent
er
whe
re c
hild
can
be
man
aged
�
Lack
of
re
quis
ite
skill
ed
man
pow
er (
or r
ehab
ilita
tive
care
ex
pert
s) t
o m
anag
e ch
ildre
n w
ith
2Ds
�
Lim
ited
arra
ngem
ent
for
tran
spor
tatio
n of
car
egiv
ers
(and
m
oney
spe
nt o
n tr
ansp
orta
tion)
�
Poo
r in
stitu
tiona
l arr
ange
men
t fo
r ac
com
mod
atio
n, f
ood,
and
oth
er
rela
ted
aspe
cts
for
care
give
rs
�
Abs
ence
of
a de
fined
pro
toco
l of
de
alin
g w
ith f
amili
es o
f 2D
s an
d po
or i
nfor
mat
ion
and
coun
selin
g fo
r pa
rent
s
�
Cam
p-ba
sed
appr
oach
fo
r pr
ovis
ion
of
care
co
uld
lead
to
ce
rtai
n pa
rent
s m
issi
ng
out
on
the
serv
ices
(e
.g.,
if th
ey
are
unab
le to
com
e to
the
cam
p)
�
Non
-ava
ilabi
lity
of
spec
ialis
ts
to
offe
r se
rvic
es
for
child
ren
who
of
ten
requ
ire s
peci
aliz
ed c
are
�
Non
-ava
ilabi
lity
of
trea
tmen
t fo
r ce
rtai
n co
nditi
ons
O
RG
AN
IZA
TIO
NA
L (B
lock
A
dmin
istr
ativ
e)
�
Lim
ited
avai
labi
lity
of v
ehic
les
�
No
proc
ess
avai
labl
e to
ve
rify
child
ren
mis
sed
out
in
�
No
inst
itutio
nal
pers
uasi
on
from
he
alth
sys
tem
to fo
llow
-up
�
Lim
ited
avai
labi
lity
of
diag
nosi
s
�
Non
-ava
ilabi
lity
of
spec
ialis
ts
to
offe
r se
rvic
es
�
No
supp
ort
(acc
ompa
nim
ent
for
Nat
iona
l Com
mun
icat
ion
Fra
mew
ork
on R
BS
K
D
eloi
tte
P
age
| 27
Ang
anw
adi
Cen
tres
(c
hild
ren
enro
lled
but
non-
atte
ndin
g or
no
n-en
rolle
d)
�
Diff
icul
ty
in
recr
uitin
g LM
O
in
MH
Ts
rela
ted
infr
astr
uctu
re
at
the
Blo
ck
leve
l
pare
nts)
fro
m b
lock
lev
el o
ffici
als
to
the
dist
rict
/ S
tate
ca
pita
l ho
spita
ls
�
OR
GA
NIZ
AT
ION
AL
(P
HC
s/M
HT
s)
�
Non
-ava
ilabi
lity
of
com
plet
e sc
reen
ing
kit/e
quip
men
t no
t av
aila
ble
(Sne
llen’
s C
hart
w
as
mis
sing
in c
erta
in p
lace
s)
�
Ava
ilabi
lity
of f
ull
and
com
plet
e tr
aine
d te
ams
is a
con
cern
�
MH
Ts
do n
ot h
ave
any
man
date
ab
out
out-
of-s
choo
l ch
ildre
n /
AW
C c
hild
ren
�
Diff
icul
ty i
n co
nduc
ting
scre
enin
g at
AW
Cs
�
Lim
ited
follo
w-u
ps f
rom
MH
Ts
afte
r sc
reen
ing
�
PH
C
MO
s,
CH
C
MO
s no
t gi
ving
sp
ecia
lized
at
tent
ion
and
care
to
ch
ildre
n w
ith
2Ds
whe
n pa
rent
s co
me
to th
e ho
spita
ls
�
PH
C m
edic
al fr
ater
nity
lack
s de
taile
d in
form
atio
n on
RB
SK
�
Non
-ava
ilabi
lity
of
spec
ialis
ts
to
offe
r se
rvic
es
�
Non
-ava
ilabi
lity
of
trea
tmen
t fo
r ce
rtai
n co
nditi
ons
�
Poo
r co
mm
unic
atio
n w
ith
care
give
rs
on
the
conc
ept
of
‘cur
e vi
s-à-
vis
care
’
�
Lim
ited
role
fo
r M
HT
s ex
ists
be
yond
sc
reen
ing
whi
le
they
co
ntin
ue t
o be
the
fac
e of
RB
SK
fo
r co
mm
unity
mem
bers
�
Poo
r sk
ills
for
MH
Ts
to c
ouns
el
and
pers
uade
par
ents
C
OM
MU
NIT
Y
(Scr
eeni
ng
Site
s in
clud
ing
AW
C
&
Sch
ool)
�
Lack
of
ince
ntiv
es l
eads
to
low
pa
rtic
ipat
ion
by A
SH
As
�
RB
SK
do
es
not
syst
emat
ical
ly
incl
ude
AS
HA
s fo
r co
mm
unity
m
obili
zatio
n
�
Cor
rect
in
form
atio
n re
gard
ing
RB
SK
not
ava
ilabl
e w
ith A
WW
s
�
Tea
cher
s do
no
t ha
ve
info
rmat
ion
abou
t RB
SK
�
Tim
ely
info
rmat
ion
on
the
scre
enin
g ev
ent
not
prov
ided
to
teac
hers
/ A
WW
s �
Tea
cher
s un
able
to
mob
ilize
out
-of
-sch
ool c
hild
ren
�
Not
al
l ch
ildre
n co
me
to
AW
C
(rea
sons
in
clud
e m
igra
tion,
pr
efer
ence
fo
r pr
ivat
e pr
e-sc
hool
s)
�
Lim
ited
follo
w-u
ps
by
AW
Ws
/ te
ache
rs a
fter
scr
eeni
ng
�
No
ince
ntiv
es/s
kills
to
A
SH
As
to
follo
w-u
p
�
Lim
ited
info
rmat
ion
on
avai
labl
e tr
eatm
ent/e
valu
atio
n ce
nter
s
�
No
defin
ed jo
b ro
les
for
FLW
s at
thi
s st
age
unde
r R
BS
K
�
Lim
ited
info
rmat
ion
on a
vaila
ble
trea
tmen
t/man
agem
ent c
ente
rs
�
Lim
ited
info
rmat
ion
on
heal
th
sche
mes
or
T
rust
s or
fin
anci
al
sour
ces
of h
elp
�
No
defin
ed
role
at
th
is
stag
e un
der
RB
SK
for
FLW
s �
Lack
s sk
ill t
o pr
ovid
e em
otio
nal
supp
ort /
cou
nsel
ing
CO
MM
UN
ITY
(G
EN
ER
AL)
�
Lack
of
info
rmat
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te a
nd ti
me
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m
edic
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be
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e no
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eatm
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iven
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tain
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mun
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trus
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ited
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port
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as
he
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cle,
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anci
al a
ssis
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r lo
okin
g af
ter
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aini
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n pa
rent
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urag
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ch a
s he
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r th
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ning
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ildre
n w
hen
pare
nts
have
to
Nat
iona
l Com
mun
icat
ion
Fra
mew
ork
on R
BS
K
D
eloi
tte
P
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| 28
heal
th s
yste
m
�
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tain
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es
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alth
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tem
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rmat
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ay a
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ngan
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port
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old
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le c
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ay f
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icis
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lic h
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tem
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d fr
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ogra
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es
/ sc
hem
es
�
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ited
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urag
emen
t �
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rs o
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ldre
n w
ith 2
Ds
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ort
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le c
areg
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ay
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day
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al
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r m
edic
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robl
emat
ic
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in
form
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n on
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rious
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edic
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enef
its
IND
IVID
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R
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ith
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re/m
ultip
le d
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�
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egiv
ers
do n
ot w
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ting
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enin
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en
lack
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rrec
t /
com
plet
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atio
n ab
out s
cree
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anci
al
burd
en
due
to
out-
of-
pock
et e
xpen
ses
in g
ovt.
hosp
itals
(d
iagn
ostic
s)
incl
. pa
ymen
t fo
r m
ultip
le c
onfir
mat
ory
diag
nosi
s �
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nspo
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/ con
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nce
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cilit
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ly w
age
loss
�
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wai
ting
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at t
he h
ospi
tal
for
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give
rs
of
child
ren
with
sp
ecia
l ne
eds
(the
se c
hild
ren
can
be d
iffic
ult
to
man
age
depe
ndin
g on
th
e co
nditi
on)
�
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sles
with
in t
he f
acili
ty –
ref
erre
d fr
om
one
unit
to
anot
her
(in
th
e ab
senc
e of
DE
ICs)
�
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erra
ls to
mul
tiple
hos
pita
ls
�
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one
poin
t co
ntac
t/hel
pdes
k at
the
med
ical
Cen
tre
�
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of
aw
aren
ess
on
RB
SK
pr
oces
s an
d be
nefit
s
�
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anci
al
burd
en
for
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ain
defe
cts
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uire
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gery
�
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nspo
rtat
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cost
to th
e fa
cilit
y
�
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ly w
age
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�
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ting
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at th
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l �
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etiti
ve
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ts
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ited/
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resu
lts
�
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urrin
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pens
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ited
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ntio
n fr
om
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ical
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aff f
or o
ngoi
ng c
are
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IVID
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L C
AR
EG
IVE
R
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YC
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LOG
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ited
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t in
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lic h
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/ pr
ovid
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nsta
nt
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s
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regi
vers
�
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iety
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ng t
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e D
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ict/S
tate
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apita
l fo
r m
edic
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care
/eva
luat
ion
�
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r as
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ated
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ith
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ical
pr
oced
ures
�
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egiv
er s
tres
s as
the
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ld m
ay
show
lim
ited
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ovem
ents
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d th
ere
is n
eed
for
regu
lar
care
for
th
e ch
ild
�
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alis
tic
attit
udes
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ong
care
give
rs
�
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lings
of
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cert
aint
y an
d
Nat
iona
l Com
mun
icat
ion
Fra
mew
ork
on R
BS
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D
eloi
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P
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| 29
requ
ire
guar
ante
e of
he
alth
y fu
ture
of c
hild
’s h
ealth
�
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r as
soci
ated
with
goi
ng t
o th
e he
adqu
arte
rs/c
ities
for
trea
tmen
t �
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r as
soci
ated
w
ith
failu
re
of
surg
ery
�
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ited
succ
ess
afte
r ha
ving
trie
d m
ultip
le
doct
ors,
di
ffer
ent
trea
tmen
t met
hods
�
Lim
ited
trus
t in
th
e m
edic
al
syst
em a
nd g
ivin
g-up
on
med
ical
ca
re in
the
abse
nce
of a
ny ‘c
ure’
�
Per
cept
ion
of
med
icin
e as
cu
rativ
e no
t as
reh
abili
tativ
e an
d ca
nnot
di
stin
guis
h be
twee
n th
e co
ncep
t of
‘c
are
vers
us
cure
’ ap
proa
ch
�
Lack
of
emot
iona
l su
ppor
t fr
om
any
sour
ce t
o en
dure
the
lon
g-dr
awn
proc
ess
(for
del
ays)
National Communication Framework on RBSK Deloitte
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
National Communication Framework on RBSK Deloitte
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.
National Communication Framework on RBSK Deloitte
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
National Communication Framework on RBSK Deloitte
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.
National Communication Framework on RBSK Deloitte
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
National Communication Framework on RBSK Deloitte
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
National Communication Framework on RBSK Deloitte
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
National Communication Framework on RBSK Deloitte
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
National Communication Framework on RBSK Deloitte
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.
Nat
iona
l Com
mun
icat
ion
Fra
mew
ork
on R
BS
K
Del
oitte
P
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| 39
D
etai
led
Soc
ial a
nd B
ehav
iour
Cha
nge
Com
mun
icat
ion
Pla
n fo
r Scr
eeni
ng u
nder
RB
SK
Bar
riers
D
esire
d B
ehav
iour
fo
r P
rimar
y C
areg
iver
s
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
Diff
icul
ty in
car
ryin
g ol
der
child
ren
(4-
18ye
ars)
w
ith
phys
ical
dis
abili
ties
incl
udin
g co
nditi
ons
such
as
neur
al tu
be d
efec
t T
ime
lost
by
ca
regi
vers
w
hile
w
aitin
g fo
r th
eir
turn
fo
r sc
reen
ing
of th
eir
child
Man
y ca
regi
vers
do
n’t
have
cor
rect
/
com
plet
e in
form
atio
n ab
out
scre
enin
g
Man
y ca
regi
vers
do
not
hav
e fa
ith in
th
e pu
blic
he
alth
sy
stem
/ p
rovi
ders
be
caus
e of
th
eir
past
exp
erie
nces
M
any
pare
nts
are
fed-
up
that
sc
reen
ing
is
not
help
ing
Scr
eeni
ng
at
AW
C/S
choo
l P
aren
ts/
care
give
rs
kn
ow
maj
or
deve
lopm
ent
mile
ston
es
for
infa
nts
(0-1
yea
r of
ag
e)
Car
egiv
ers
know
of
th
eir
right
to
av
ail
scre
enin
g se
rvic
es a
nd t
ake
thei
r ch
ildre
n fo
r sc
reen
ing
serv
ices
C
areg
iver
s ar
e aw
are
and
unde
rsta
nd
the
conc
ept
of
scre
enin
g,
and
early
in
terv
entio
n fo
r ch
ildre
n
Car
egiv
ers
clar
ify
any
doub
ts
rega
rdin
g R
BS
K
or s
cree
ning
C
areg
iver
s ar
e
Fam
ily
mem
bers
en
cour
age
pare
nts
of
child
ren
to
go
for
scre
enin
g of
th
eir
child
F
amily
m
embe
rs
help
in
car
ryin
g ch
ild
to t
he s
cree
ning
si
te,
if pa
rent
s ar
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
Formative Study on RBSK Deloitte
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
Formative Study on RBSK Deloitte
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
� Training to understand RBSK’s objectives clearly and their roles in programme implementation
� 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
RBSK training budget (FMR code A.9.12)
Formative Study on RBSK Deloitte
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
� Training to understand RBSK’s objectives clearly and their roles in programme implementation
� 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
RBSK training budget (FMR code A.9.12)
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
RBSK training budget (FMR code A.9.12)
Frontline Workers /
� Sensitisation on the programme, its objectives and why it is important/ beneficial
RBSK training budget (FMR
Formative Study on RBSK Deloitte
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
)