Social and Behaviour Change Strategy to fight Undernutrition in Rajasthan :

The Government of Rajasthan (GoR) is committed to accelerated reduction in undernutrition in the state. This determination is guided by the National Nutrition Strategy and the National Nutrition Mission (NNM) which identifies nutrition as ‘central to the achievement of other National and Global Sustainable Development Goals’ and ‘the most important entry point for human development, poverty reduction and economic development’.

The Govt, of Rajasthan is running a wide spectrum of programmes including the Integrated Child Development Services (ICDS), National Health Mission (NHM) – including Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A), Pradhan Mantri Matru Vandan Yojana (PMMVY), Rajasthan Janani-Shishu Suraksha Yojana, Prasooti Sahayata Yojana, Mukhya Mantri Rajshree Yojana, SABLA programme for adolescent girls, the Rajasthan Kishori Swaasth Evam Swachhata Yojana, Swachh Bharat including sanitation and The National Drinking Water Programme, Mid-day Meals Programme, Targeted Public Distribution System, and National Rural Livelihood Mission (NRLM) among others, contributing to improved nutrition outcomes, addressing both the immediate and the underlying determinants of undernutrition through nutrition specific and nutrition sensitive interventions.

The Government has already developed a state level nutrition strategy ’Nourishing Rajasthan – Vision 2022’ which prioritises constitution of an apex coordination mechanism to lead a multi-sectoral response for overcoming undernutrition in the state.

The Behaviour Change strategy builds upon a life-cycle approach, synergising health, nutrition, care and maternity protection messaging across the first 1000 days, adolescence and a multi-departmental convergence to tackle the burden of undernutrition in the state.

Objective of the Document :

 This document will guide integrated and data-driven SBC ( Social and Behavioural Change ) interventions across the state. It will promote consolidation of SBC interventions undertaken by various development partners in Rajasthan and simultaneously encourage innovation. It also proposes a roadmap for multisectoral response to Behaviour Change through convergence of ongoing programmes within the state steered by other departments such as Health, Rural Development, Panchayati Raj, Education and Food and Civil Supplies. The strategy document is meant to be used by policy makers across the GoR and its collaborators, including nutrition, Behaviour Change and Information, Education and Communication (IEC) experts, NHM, NRLM, state communication agencies, development partners, Non-governmental Organisations (NGOs), and media agencies.

1. Vision 2022 :

The NNM has set out a few national targets for accelerated nutritional results, particularly among children from 0 to 6 years, pregnant women and lactating mothers. Through its state nutrition strategy ’Nourishing Rajasthan–Vision 2022’, GoR has adopted the targets set out by the NNM as its own, and reinforced its commitment to becoming a leader in the fight against undernutrition.

2. Social and behaviour change framework :

This SBC framework highlights the need to understand and address several levels of influence so that specific interventions can be tailored to leverage them for fighting undernutrition. It aims to create a pro-nutrition environment to improve maternal dietary practices and infant and young child feeding for accelerated achievement of nutrition results. This comprehensive framework utilises a variety of programme components and channels and each one has a different role: reaching different audiences, expanding beyond service delivery platforms, and reinforcing/reminding about priority actions. It requires all programme components to work in close coordination to be able to create a change in Social Behaviour. It helps to identify the primary audience to be engaged through different programme components addressing the key determinants of priority behaviours (IPC with mothers, mobilisation of influential family and community members, strategic engagement with decision makers and mass communications for all audiences).   Key components of the Framework include:

Multi-stakeholder convergence  : For coordinated action among various supply side stakeholders to address underlying determinants of nutrition, calling for both nutrition specific and nutrition sensitive interventions.

Strategic engagement and outreach  : Through interpersonal dialogue, group forums/workshops, and print and media channels, aimed at engaging key influential groups, raising awareness of the recommended practices and their benefits, ensuring quality and adequate coverage of proven interventions, and understanding the resources required at community, district and state levels.

Improving system performance : To ensure an enabling environment to facilitate SBC (e.g. skilled and motivated frontline workers, adequate supplies of IFA, continuous supportive supervision and monitoring for corrective action).

Interpersonal communication : To mobilise existing programme platforms such as NHM, ICDS and Self Help Groups (SHGs) to coach and demonstrate age-specific recommended practices, solve common difficulties that mothers face, and deliver consistent and age appropriate messages in a timely and convincing way; implemented through home visits, AWC/PHC visits, Mother and Child Health and Nutrition Days (MCHNDs), and outreach sessions.

Mass communication : To model the behaviours for mothers and show the actions influential family and community members can take; include the use of TV, traditional channels such as local theater, mobile phones for accessing radio, video clips, text messages etc. for harmonising key messages across all participant groups from decision makers to family members.

 Strategic use of data : Generated through reporting mechanisms to make course corrections during the implementation and management of this BCC strategy.

3. Life-cycle approach :

This SBC strategy is underpinned by a life-cycle approach that aims to focus on the current as well as the future generations of yet-to-be-born girls for overcoming the problem of undernutrition. Strategies that go beyond just pregnant and lactating women and improve nutritional behaviours at each step of the life-cycle – infants, adolescents and married but not yet pregnant women – are to be employed.

The strategy aims to reach out to the audience at various stages in the life-cycle to disrupt the intergenerational cycle of undernutrition, which is often perpetuated with a high incidence of babies born with low birth weight, more susceptible to infections, more likely to experience growth failure, reflected in high levels of adolescent and maternal undernutrition and anaemia. It will be critical to improve nutritional behaviours across the life-cycle, to avert irreversible cumulative growth and development deficits that compromise maternal and child health and survival; and undermine the achievement of optimal learning outcomes in elementary education, impairing adult productivity and undermining gender equality.

4. Monitoring change – tracking indicators :

The NNM has laid out a framework for regular monitoring of nutrition outcomes, including a web enabled Nutrition Information System to monitor the Nutrition Strategy, linking MIS of ICDS, NHM/PCTS and data from Swachh Bharat. It has also proposed integration of child nutrition status monitoring within the Health MIS and the NHM Parent Child Tracking System. The DWCD, on its part, has already initiated work on a similar monitoring mechanism at the state level. To ascertain the impact of the behaviour change and programmatic interventions undertaken by the state for improving nutritional outcomes, the DWCD will monitor the key outcome level indicators periodically. The State and District Level Implementation Plans will also include a number of process indicators such as percentage of FLWs trained on counselling techniques, percentage of Anganwadi Centres (AWCs) supplied with updated IEC materials, number of awareness camps held, etc. that will need to be tracked on a monthly basis.