Jan Andolan for behaviour change can be successful if front-line workers are energised with adequate counselling skills, knowledge, tools and also right motivation
By Raghwesh Ranjan
The ‘Poshan Abhiyaan’ was launched by the government with great fanfare on March 8, 2018, in Jhunjhunu, a small city in Rajasthan, where the Prime Minister made a call for waging a battle to end the evil of malnutrition in India. Poshan Abhiyaan focuses on reducing stunting, undernutrition and anaemia in women and adolescents. In two years, we have seen it being implemented in every state with much zeal. But the changes seen on the ground are minimal.
Educating families on the need for nutrition and motivating them on adopting these into their behaviour is crucial. In 2019, the campaign is focusing to address Poshan Vyavahar (Nutrition Behaviour) and communicating the five key components critical for a healthy life: ‘Poshan ke Paanch Sutra’. These start from the journey of first 1,000 days of a child, diarrhoea management, locally-available nutritious food, sanitation and hygiene, and anaemia. Every house needs to be reached to bring about behavioural changes. For this, the campaign’s first post, i.e. Anganwadi centres (AWC), and its soldiers, i.e. Anganwadi workers (AWW), accredited social health activist (ASHA) workers and auxiliary nurse midwives (ANM), play the most critical roles.
There are front-line workers (FLW) providing basic education, nutrition and ensuring health in rural India; they are taking forward the Jan Andolan agenda of Poshan Abhiyaan at community level and influencing people to change behaviour. But are our FLW themselves sufficiently empowered and aware to deliver what is expected of them?
Two independent studies supported by CIFF (Children’s Investment Fund Foundation) were conducted in Rajasthan during the past two years, to identify the enablers, motivators and barriers influencing maternal nutrition and feeding behaviours amongst infant and young child feeding (IYCF) practices. Each highlights a common thread—gender inequalities, social norms around food and beliefs and customs passed on through generations all dominate household decisions when it comes to nutrition. It was also found that the husband’s interaction with FLW is negligible, while mothers-in-law perceive them as someone who challenge her advice to the mother. Also, the AWW, ASHA workers and ANM are neither skilled in counselling nor they are taking it on a priority basis. Areas like timely initiation of complementary feeding do not even get prioritised in AWW counselling as they are understood as low priority in the worker’s own understanding.
Based on the results of various nutrition-related projects, it has been observed that AWW are aware of key IYCF practices, but their perception and knowledge about the rationale applicable to recommended nutrition practices is poor.
It is not a question of capability or knowledge; it is more about what enables FLW to be change agents. Are they equipped enough with the right tools to approach the communities? Poshan Abhiyaan identifies key messages that need to be reinforced for improving status of nutrition. But what will enable mothers to adopt the best practices recommended in these messages and not fall back on the social proof from the community to seek resolution?
An ongoing pilot by IPE Global in four blocks of Udaipur in Rajasthan is using Participatory Learning and Action (PLA) approach to strengthen community mobilisation for Jan Andolan. Facilitated by ASHA, it is bringing communities together and helping them identify and understand issues, find feasible solutions, and devise strategies. It is empowering women in the process, which is arguably the most important determinant of health and nutrition outcome of any intervention. Once an ownership is built amongst the community, there are better chances of sustainable adaptation of changes in behaviour. It presents an example where the cadre of ASHA, with proper training and supervision, is able to facilitate a large-scale change in the community.
Jan Andolan for behavioural change can be successful if all FLW are energised with adequate counselling skills, knowledge, tools and right motivation.
The author is director, Social & Economic Empowerment, IPE Global