Going the Extra Mile for Marginalized Children
Reducing infant and maternal mortality rates with Behaviour Change Interventions in Odisha
Around 5,000 babies in 117 tribal blocks of Odisha state died in 2017-18 alone. Over 270 mothers die each year in tribal areas – many more than in other areas of India. The state has the highest neonatal deaths in India and the highest burden is from the tribal districts (HMIS, Government of Odisha).
March 2019 – It was a warm, sunny day in Odisha – much more pleasant than chilly Delhi. We had driven over five hours to reach Raikana Village in Rayagada District, home of the Kandha tribe.
Rayagadha and Kohraput districts are home to one of the most marginalised populations in India. It can be difficult to provide services to these communities as they are located far from urban centres. A sub-health post was recently established there, but basic health services are yet to be delivered. Mobile networks are weak and often unavailable. When there is a health emergency which requires an ambulance, the Kandha sometimes find themselves in a battle between life and death, waiting several painstaking hours for the ambulance to arrive. There are often only two water sources in surrounding villages, raising serious water scarcity and quality issues. Although the Government has implemented several development programmes in Odisha and made commendable progress, the practices in tribal communities impedes the progress. Access to services is not the greatest challenges for the Kandha people; the tribe in these communities can be resistant to behaviour change due to strongly embedded cultural practices.
Focusing on social and behaviour change communication, UNICEF has conceptualized an innovative convergent intervention called “Sampurna Barta.” Launched in November 2018, Sampurna Barta means “complete comprehensive dialogue” and was initiated to support the state strategy for the reduction of infant mortality and maternal mortality rate in Odisha. Sampurna Barta includes a menu of high-impact communication messages and actions which support child survival and development. These cover topics such as early marriage, teenage pregnancy, newborn care, infant and young child feeding practices and water and sanitation. These messages are communicated through intensive community dialogue and persistent interpersonal communication with families during home visits.
By injecting these messages consistently into communities, the Sampurna Barta initiative also increases demand for health, nutrition, protection and water services provided by the Government. These messages come from formal channels like panchayat elected village leaders and health workers, and also from informal channels like religious and community leaders. Embedding the initiative into the community is essential to ensure its sustainability – that it keeps going even after UNICEF’s initiation and government support.
M. Bhanu, a health worker among the Kandha, told us that he can already see the benefit of the Sampurna Barta initiative:
“There has definitely been an uptake of services for health-seeking behaviours, routine immunization and more referrals to health centres.”
Sampurna Barta is now run across 15 high priority districts with a combined reach of 1.5 million tribal population. UNICEF and the Odisha Government supports the initiative with the implementation by two NGOs – SOVA and My Heart.
Sumati, a school peon in the area, said, “Since this programme started, there has been a 50% increase in latrine construction in the village. Soon the days of using the forest as our toilet will be history.”
The initiative is also creating champions for child protection. A smiling Mona Divya Rampuri told us, “I am committed to supporting our anganwadi didi (community worker) to end child marriage in my community.”
The Sampurna Barta social and behaviour change communication initiative will be gradually expanded to other districts of the state, such as the remote upper Bonda tribe of Malkangiri, who are nearing global extinction. There are only around 6,500 Bonda left, with only frontline workers as the primary point of contact between them and the outside world for basic services.
Reaching the most marginalized and vulnerable is one of UNICEF’s core mandates. Extending the resources and support to remote and often forgotten populations is what UNICEF does– we go the extra mile for children and families who may be otherwise forgotten. What better way to make a difference than through lasting social and behavioural change?