IPPI in India
2000- 2001

RESEARCH BASED
COMMUNICATION
MODEL
for
UNREACHED
CHILDREN

By
Dr K SURESH
Project Officer, UNICEF
India Country Office
Reaching the Unreached
Communication Model


Process Evaluation
involves

Assessing
– Knowledge
– Attitudes/ Beliefs

Designing &
implementation of
appropriate
intervention

Outcome Evaluation

Recording behavior
Change
MONITORS
S/NID’s & H-HOUSE
GOVERNMENT--DIST/STATE
WHO/NPSP / UNICEF
ON THE SPOT GUIDANCE
END DAY CONSULTATIONS
Methods of Data Collection for the Indicators
Process Evaluation


Independent observers - NGO, Medical Colleges, IAP
members, Students …

Filled-in questionnaire within 10 days of S/NIDs were
included for the analysis


Five part questionnaire was developed
5000-9000 booths/areas observed On booth day and
third day for HtH activities
Process Evaluation Indicators


For Immediate intervention



Subsequent round




Quality of vaccine in Phase-III
Communities with 2+ Unimmunised children
Cold chain gap
Awareness regarding date/place
Micro-planning
Next year strategy


Training of service provider
Reasons for not-immunizing children despite
HtH for planning IEC/SM
Inclen India (USAID Support)

AIMS, NEW-DELHI
Nodal UNIT
PLANS, ORGANIZES ,
ANALYZES DATA
FEEDBACK TO ICC
24 MEDICAL
COLLEGES
ALL OVER COUNTRY
COLLECT
QUALITATIVE DATA
FGD'S, DI's
INTERVIEWING DIST
MANAGERS
Methods of Data Collection for the Indicators
End Evaluation


Multi pronged approach – carried in all 35 states/UTs
– 1041 clusters (975 normal and 66 high-risk)– In 218 clusters qualitative research carried out

Quantitative - 41640 children
– Structured surveys- Individual one to one interviews to
assess Knowledge, its extent, behavioral indicators

Qualitative - 202 FGDs & 467 DIs
– FGDs with beneficiaries, family influencers
– DIs with service providers, community influencers
– Village observation, Transects

Analysis
– A holistic approach
– Weaving the data from all sources
Indicators for the Communication ModelKnowledge





About the disease
Action Required
About the program
About NID
• Use of Mass media
• Use of Interpersonal
• Training and Orientation Workshops
Awareness - 80% (1995)  99.4%(1997), 99.5%(2001)
I
Prevention



‘Medicines required only when ill’
Concept of Prevention Vs. Cure - Health Vs. Absence
of Disease
Underlying Issue:
•
Distrust of Medicines per se and excessive medication
•
Particularly if free by Govt. & thrust without explanation
•
Identity of Service Provider
Many rounds & Given at home
New challenge
II
Empathy


‘Not for me’- Amongst Affluent
 because ‘it happens only to the poor’
 Hygiene factors at booth, ‘Look Good’, ‘Feel Good’- New problem
 Family doctor advice
Underlying Issue:
•
Lack of exposure, Used to better services, demanding
•
IAP/IMA/Pvt. Practitioners to immunize at their clinics
•
Private hospitals to open booths
•
Medical / Affluent college students to volunteer
•
Celebrity endorsements
Refusal declined on
Doctors advice - 6.1% (1995)  Nil (00)
III
Trust


Government Service


Expertise of Service
providers ??


Free service
– ‘No free lunches’
– Issue of dumping medicines

Readiness to believe
negative stories
Participation of
Volunteers 30%(1995) 
60%(01)
Training Outsourced
last year

??

Sensitization of Journalists
and other forums
Less negative reporting,
% of untrained staff - 26%(99) 5%(01),
91% SP satisfied with the training
III
Trust


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Religious lines
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Child too young

Appeals from religious leaders/
influencers-Verbal Print
Vedios of Mollavi’s appeal played
in UP & WB
Use of celebrities like Shahrukh
Khan
IPC and Use of SMCs
Difference in reach across religions not significant now
Coverage in (0-6m)- 75.7%(1996) 91%(2000)
In 2000 - <1m - 60%, <3m - 86% were reached
Empowerment



Fatalistic Attitude
– “Whatever is to happen will happen”
How does it matter if we miss?
– a few children
– a few doses
• Repositioning of program as People’s program
through Mass media and SM
“Every Child, Every Time” theme tune of
Audio/ Video spots
‘Not aware of need for additional doses’ - 10.4 (1996) 
4.5 (2000) (among those refused - 6.7(1996)  1.4% (2000)
COMMUNITIES WITH UNIMMUNIZED CHILDREN
DESPITE HOUSE TO HOUSE IMMUNIZATION

20
18
17.7
16
14
12
10.4
10
9
8
6
3.5
4
1.9
2
0.8
0
Oct.99
Nov.99
Dec.99
Jan.00
Dec.00
Among the communities with unimmunized children, % with
2+/100HH such children - 70% (Oct. 99)  18% (Jan. 01)
Jan.01
Issues to Tackle in 2001


Concept of Health as different from absence of
diseases as it becoming rare

Look good, Feel good and match demands
(affluent families)

Building knowledge workers amongst service
providers

Free Service- ??

Readiness to believe negative stories– Anti-fertility
– HIV/AIDS
Challenges...


Playing safe’ mentality- double edged sword

Traditionally restricted access to the young
child (0-3m)




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– Social restriction
– Exclusive breast feeding
Needs to be tackled as genuine concern
Cultural and religious diversity compound the problem
Fatalistic Attitude - Hardships and uncertainties of
life per se
Mental state - Historical suppression within the
community
Increase in zero dose children - 0.7(2000)
2.4%(2001)

Thanks for caring