Welcome to Vol.9 of 'Behaviour Change Matters’. In this edition, we share how Mizoram state in the north-east is leading on COVID-19 vaccine coverage and how school children in Maharashtra are learning about handwashing creatively. 'Meet our Team' features Sonali from the Maharashtra state office who thrives on seeking new challenges.
Sid Shrestha
Chief - C4D, UNICEF India
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UNDERSTANDING HOW THE REMOTE INDIAN STATE OF MIZORAM LEADS ON COVID-19 VACCINE COVERAGE
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(Top) Village task force managing the vaccination site at Ramthar Veng, Aizawl district, November 2021
(Above): In Lawngtlai district, a vaccination team walks in harsh monsoon weather delivering COVID-19 vaccines to remote villages, October 2021
Mizoram state in north-east India recorded a 77% coverage of the second dose of the COVID-19 vaccine; 92% have received the first dose. This is much higher than the national vaccine coverage which is 45% for the second dose and 83% for the first dose (data as of 26 November 2021). Mizoram is flanked by Bangladesh on the west and Myanmar on the east and south. Steep hills are separated by rivers creating deep gorges. Despite challenges posed by difficult geographic terrain, the state has achieved great success in high vaccine uptake, promoting COVID-19 appropriate behaviour (CAB) and containing the spread of COVID-19.
Mizoram recorded over 127,000 COVID-19 cases between March 2020 and November 2021. This is the highest among northeastern states. Surveillance data show that COVID-19 has had a maximum impact in the densely populated districts of Aizawl east and west. The state has one of the highest daily positivity rates. In the week of 16-22 November, Serchhip district had the highest positivity rate in the country at 26.26% followed by Lunglei at 19.24% compared to the national average of 0.93%. A high positivity rate indicates that the number of actual cases may be much higher than the number of confirmed cases.
The state government initiative of the ‘all mask campaign’ in October 2021 urged people to wear masks even at home as part of a ten-day special drive. The campaign promoting CAB raised awareness on the indoor transmission of COVID-19. It also focused on handwashing and practicing social distancing to prevent transmission. Thereafter, there has been a drop in the number of new infections.
At the same time, the vaccination drive has been stepped up. UNICEF has supported COVID-19 vaccination in five districts of the state. Communication materials promoting CAB, dispelling myths, and increasing demand for vaccines in local languages were developed and disseminated. Faith leaders and tribal leaders have been involved in a unified response to the pandemic. Pastors, sportspersons, celebrities, and local influencers urged people to vaccinate through social media.
Mizoram boasts of a strong community engagement group called the Local-level Task Force or Village-Level Task Force for COVID-19 management. This comprises members of the village council, the Young Mizo Association, Church Youth, women’s group, and community volunteers. The committee works closely with the health authorities for the COVID-19 vaccination rollout. They help in informing the community about the vaccination sessions through public announcements and WhatsApp groups. They also help provide the venue and logistics support for vaccination sessions. Local community involvement has been the key to a successful pandemic response in the state.
The health department’s services include mobile vaccination teams for door-to-door vaccination for disabled and home-bound people. Vaccination drives aimed at pregnant women have been organized. Special vaccination sessions for ‘people without identity cards’ are conducted every week in Aizawl's east and west districts. These include over 14,000 refugees from Myanmar in the state. The department has organized vaccination sessions in prisons, orphanages, old-age homes, de-addiction centers, and women's homes. In hard-to-reach areas, the Border Road Task Force (BRTF) has helped in transporting the vaccines.
There has been a focus on reinforcing CAB. Communication materials were prepared for specific vulnerable groups such as children. The state recorded some of the highest numbers of infections among children and young people. As of October 2021, 37% of all cases were under age 20. “People tend to not wear masks and follow CAB when with friends and family. This has become the main route of transmission. Emphasising on CAB at all times is important,” says Malsawmtluanga, pastor from Aizawl west.
Health officials say Mizos are a close-knit society, where the village or community is like an extended family. “This made it even more crucial to educate the community on CAB to prevent transmission between households. When there were active cases in the community, people helped each other with food and medicines. It was important to emphasize safe behaviour, especially to ensure children and elderly are protected,” says Dr. Lily Chhakchhua, of the health department. Village council members distributed masks and helped people get essential supplies. The biggest challenge was managing misinformation and fake news on television channels and social media platforms, they say.
Dr. Awmtei, District Immunisation Officer, Serchhip district says one of the biggest challenges in COVID-19 response was taking the decision regarding whom to put in home isolation as government facilities are often overburdened and some people refuse to stay in these facilities. “It was a challenge to deal with doctors and others who had a different opinion from the standard protocol,” he adds. Village council members say there were socio-economic challenges as well as many families were not able to work because of the pandemic. Funds from the municipal council were not enough to cater to the needs of all. As shops within localities ran out of stock, communities had to seek help from other localities. The shortage of resources sometimes created disagreements and misunderstandings between the local task forces of different areas.
As church services begin to open, the involvement of church leaders has been crucial. While a high literacy rate and the presence of one major religion, Christianity, has contributed to increased vaccine coverage in the state, pastor Malsawmtluanga notes, “Christianity also has many denominations within it and some have refused vaccination. These communities are the hardest to convince.”
Despite the multiple challenges, the state has demonstrated that strong leadership, involvement of civil society and community engagement are key to a successful pandemic response.
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BRINGING HOME THE MESSAGE: SCHOOL CHILDREN EDUCATE ADULTS ABOUT HANDWASHING IN MAHARASHTRA
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School children in Mumbai promote handwashing by sending postcards. Photo courtesy: CACR Mumbai
Thousands of school children in urban and rural Maharashtra have sent postcards to friends and relatives. These postcards are not birthday wishes or festival greetings but a simple yet important request: "please remember to wash your hands with soap". For many of them, this was a novel experience celebrating the Global Handwashing Day on 15 October.
Bushra Khatun, a standard 8 student of a municipal school in Dharavi, Mumbai, says, “I had never written a letter to anybody. When I got the postcard in class, I read it and got good information on handwashing with soap. I sent it to my friend in Juanpur, Uttar Pradesh. She received a letter for the first time. She called me and said that she was very excited that the postman came to her house, called out her name and gave her the postcard. I felt good sharing useful information with her. I told her to make sure her family members also follow handwashing with soap.”
Raaesa Patel, of Citizens Association for Child Rights (CACR), UNICEF’s partner organization in Mumbai says they visited a number of government schools on 15 October to raise awareness to mark Global Handwashing Day. Along with handwashing demonstrations, postcards in Hindi, Marathi and Urdu with handwashing messages were distributed to schoolchildren to send to friends and relatives. Shifa Mubeen Shaikh, a standard 8 student of a municipal school in Govandi says, “I had heard about Mother’s Day, Father’s Day and so on but for the first time I heard about Global Handwashing Day. Visitors to our school explained to us about handwashing, then we all got postcards. We were so excited to send postcards for free. I sent it to my relatives in Bihar. They called to say that it was very nice of me to send such a postcard and that they showed it to their neighbors as well.”
Over 65,000 postcards were sent, and it is assumed each was read by at least five people. This activity engaged 30,000 school children from standard 4-10 in districts such as Mumbai, Pune, Palghar, Nandurbar, Gadchiroli, Washim, Osmanabad, Aurangabad, Raigad and Parbhani. UNICEF’s partner civil society organizations CYDA, SACRED and CACR, along with Zila Parishad teachers of rural schools, helped ensure a wide reach.
According to Anand Ghodke, UNICEF Maharashtra, “The objective was to use the medium of the postcard – a long forgotten means of communication in today’s world – to promote handwashing with soap. This would help children engage with the theme of handwashing as well as learn about the postal system. We assumed that receiving a postcard from a child would be a pleasant surprise for friends and elders.”
Arvind Yadavrao Shelke, a teacher at a Zila Parishad school in rural Palghar district says, “Our school is in the tribal belt. Due to the COVID-19 pandemic our schools were not fully reopened, but we involved students in Global Handwashing Day activities. Students wrote postcards to their relatives and explained the importance of handwashing. For many of them, this was the first time they wrote a postcard. I hope students will not forget this novel experience and the message as well.”
Nitin Wadhwani of CACR Mumbai adds that when this idea emerged they went to a few post offices in Mumbai to procure postcards but found only a couple of them available. “We procured 10,000 postcards and got handwashing messages printed on them to ensure accuracy. These were given to children in government schools. They read out these handwashing messages in class and sang songs about handwashing. They were asked to write the name of the person they wanted to send it to and post it through a letterbox.”
This year’s theme for Global Handwashing Day was 'Our Future is at Hand – Let’s Move Forward Together'. According to a survey of rural schools, although 95% of schools had a dedicated handwashing space, only 40% had water and soap available. Another research shows that 67% of households report they need more information on handwashing, in particular, the critical times and steps of handwashing with soap.
In Maharashtra, more than 17.4 million people were reached with messages on handwashing through the week-long Global Handwashing Day activities organized by UNICEF and its partner organizations.
(Below) In some districts, postcards printed with handwashing messages were used to ensure accuracy.
Rural school children in Nandurbar district participate in Global Handwashing Day postcard writing activity. Photo courtesy: CYDA Pune.
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ADDRESSING SEVERE MALNUTRITION AMONG CHILDREN
THROUGH TELE-COUNSELLING
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India’s most populated state of Uttar Pradesh, with over two hundred million inhabitants, faces a serious health challenge for children. Over 18% of children below five years of age suffer from severe acute malnutrition as per the Comprehensive National Nutrition Survey 2016-18, Ministry of Health and Family Welfare, Government of India. UNICEF with support from Public Health Foundation of India (PHFI) has set up a phone-based counselling system in three high-priority districts namely Sonbhadra, Shrawasti and Balrampur.
To help the locals address this challenge, a team of eight counselors has been hired and trained by PHFI. Details of these children suffering from severe acute malnutrition were shared with the team after which their families received five counselling sessions, each one on a fortnightly basis. These sessions covered issues such as an overview of malnutrition, ways to provide a high-energy and protein diet, the importance of micronutrients, diarrhoea management, and feeding children during and after an illness. These sessions are interactive and the duration is about 16 minutes on an average. After each call, two sets of text messages and videos are sent to the family to reinforce the nutrition guidance. Over 500 children suffering from severe acute malnutrition have benefited from this intervention.
Comparing it with the previous year, Bhai Shelly, Communication for Development Specialist, UNICEF office for Uttar Pradesh says, “In 2020, we had used the tele-counseling model to reach women of Self Help Groups (SHGs) with advice and counselling on COVID-19 prevention during the lockdown. We also realised that services for pregnant women were disrupted and they could receive guidance through tele-counseling. This year, we decided to replicate the model with a focus on accelerating rehabilitation of severely malnutritioned children. We realised that it was crucial to ensure families have complete information and gaps in service delivery are addressed. For example, pregnant women and children receive take-home ration from the Anganwadi (pre-school centre), medicines from the Auxiliary Nurse and Midwife (ANM), as well as services, such as weighing of children which may have been disrupted. Often, families are not aware of the services available to them. Through this intervention we are able to create demand for available services and alert service providers so that gaps can be bridged."
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MEET OUR TEAM: "I AM WARY OF COMFORT ZONES", SONALI MUKHERJEE, COMMUNICATION FOR DEVELOPMENT SPECIALIST, UNICEF MAHARASHTRA
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From a young girl in Kolkata who aspired to be a journalist to a senior humanitarian professional at UNICEF, in a career spanning over 20 years, Sonali Mukherjee has straddled different worlds. She has been a part of the media and corporate industries, as well as non-profit and government agencies. As a UNICEF staff member and consultant, she has worked in the states of Jharkhand, Karnataka and Maharashtra.
Sonali recounts how growing up in Kolkata she always dreamt of being a journalist and writing human-interest stories. Her career started with writing for a Bangla fortnightly magazine of the leading media group Anand Bazar Patrika. “At that time, noted filmmaker Aparna Sen was at the helm of the editorial. I wrote on entertainment,” Sonali reminisces. Probably, it was her love for heartwarming stories that drew Sonali towards the development sector where she felt closer to changing people's lives. It started with a job at CARE in Asansol, West Bengal, on an HIV/AIDS program. This involved leaving home, reaching out to women in sex work, talking about sex and sexuality with women (and men), and, occasionally, even dealing with the coal mafia. Since then, she has worked on the prevention of child trafficking in states across the country, designed media strategies for HIV prevention in West Bengal, and also managed a tele-counseling service for homosexual men in Delhi. In Maharashtra, Sonali has designed campaigns for youth on HIV and worked closely with communities of sex workers, transgender folks, and bar dancers in Mumbai and Thane as part of the HIV programming.
Behind every successful individual, there are often open-minded and supportive parents. “My father always encouraged me,” says Sonali proudly. The confidence that her father gave her helped Sonali survive losses, battle depression and overcome a severe health crisis in life. She learned energy healing and trained to be a life coach. These experiences helped her find her bearings again, as did her pet Buddy, six-year-old Labrador whom she calls the baby of the family. Sonali talks about her loss and depression openly and believes we need to acknowledge our deepest sadness to be able heal ourselves. “There is stigma around it and people don’t want to talk about these issues”, she says. But ask Sonali what has been the key to a rich and varied work life, and she says “I am wary of comfort zones. I keep myself open to learning and nurturing relationships.”
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NFHS-5 Findings: The Union Health Ministry has released the 2019-21 National Family Health Survey (NFHS-5) Phase II Findings. Press Release, Press Information Bureau, Govt of India, November 2021
A Compendium of Factsheets published by the Ministry of Health and Family Welfare and an India Fact Sheet are also available.
The South Asia SBCC Conversation 7-9 December 2021 is a virtual event that will bring together social and behavior change leaders, practitioners, planners and researchers to advance dialogue, inspire collaboration and spark innovation across intersecting focus areas. The event is co-hosted by Breakthrough, BBC Media Action, Centre for Communication and Change -- India, John Hopkins Centre for Communication Programs and UNICEF. More information here.
Healthy Parents, Healthy Child Initiative New materials added to the IEC eWarehouse include Guideline for implementation of evidence-based strategies during the pre-conception and prenatal period for promoting the health of the couple, mother and newborn, UNICEF Maharashtra, 2018
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