Social and Behavior Change Communication Activities

Review and Analysis of Existing BCC Materials (Flipchart)

Purpose:

The overall purposeof this activity wasto collect and review the already existingBCC materialsrelevant to SUAAHARA program, identify its strengths, gaps,

Areas of improvement and based on findings recommend one comprehensive BCC package for SUAAHRA.

As a part of review, a total of 99IEC/BCC materials developed by various governmental and non-governmental organizations were collected and reviewedthoroughly taking in-light of message comprehensiveness, accuracy, consistency, culturally appropriateness, image and gender and social inclusionprospective. The materials primarily included Flip Chart, Poster, Booklet, Leaflets, and Pamphlets etc. A detail inventory of all the materials reviewed hasbeen developed highlighting purpose, strengths and gaps of each material along with programmatic recommendations.

Materials review process was guided by the following points:

-Are the materials relevant to SUAAHARA program?

-How can we makebest use of already existing materials that are relevant to SUAAHARAand save time through revision/adaptation

-Who are the primary and secondary audience of BCC materials and how are the materialsbe used?

-Are the messages consistent with ENA+ training package of SUAAHARA program?

Taking the above mentioned point, materials developed by the Government Counterpart (Child Health Division) and SUAAHARA implementing partners i.e. Helen Keller International (HKI), Save the Children (SAVE), Nutrition Promotion Consultancy Services(NPCS) and Nepal Water for Health (NEWAH) on nutrition were further reviewed in-depth, analyzed and recommendation made for adaptation, revision and future improvement.

Materials review process also took into consideration the intended audience of SUAAAHRA program i.e. Female Community Health Volunteers (FCHVs) who will be the primary resources promoting nutritional and hygiene behaviors at household and community level and linking community with health service. The other key audience includedmothers of under2 years of age and their families of SUAAHARA program districts.

The following BCC materialswere reviewed and analyzed:

  1. Essential Nutrition Behaviors for Healthy Mother and Child- produced by HKI
  2. CHD/UNICEF - Newborn baby and Childhood Nutrition - produced by CHD/MOHP/UNICEF
  3. Food Behavior based Flipchart for FCHV- produced by NPCS
  4. Nutrition Related Information - produced by NPCS/UMN/CHD Nutrition Section
  5. Lets attention for child nutrition, save from malnutrition - produced by MoAC, Food Technique and Quality Control Dept/ CHD Nutrition Section/World Vision
  6. Child Protection Donation Program: Newborn baby and Child Nutrition - produced by MoHP/UNICEF/ Ministry of Local Development
  7. Mother Child Micro nutrition and Anemia - produced by MoHP/CHD, Nutrition Section/World Vision Third Issue 2063
  8. How to do poultry farming in the local level? - produced by HKI / USAID / Nepal Govt.
  9. Vitamin 'A' - Village Level Training

Comparative Chart Highlighting KeyMessage/Content of BCC materials targeted for Female Community Health Volunteers (developed by 4 partners) and its consistency with SUAAHARA ENA+ training package

Message content as per ENA+ training package / Essential Nutrition Behaviors for healthy mother and child–HKI / IYCF-CHD / NPCS Flipchart / NEWAH
Picture ID / / / / NEWAH does not have BCC materials (Flipchart) particularly targeted of FCHVs
Why nutrition matters?
-Global and national nutrition situation
-Under nutrition
-Growth Flattering 1000 days
-Essential nutrition action /
  • Every 5 out of 10 children under 5 years in Nepal suffer from anemia.
  • Most children suffer from anemia within 2 years of age since birth
  • Iron, Vit A and Iodine deficiency among woman and children
  • Causes of malnutrition
/
  • Every 5 out of 10 children under 5 years in Nepal suffer from anemia.
  • Most children suffer from anemia within 2 years of age since birth
  • Growth faltering "1000 days"
  • Effects of malnutrition
/
  • Management of malnutrition
  • Types of malnutrition
  • Protein Energy Malnutrition conditions
  • Iron/Vit A deficiency problems
  • Food containing Iron/Vit A

Breastfeeding practices/ Lactation management
-why breast feeding matters
-timey initiation of breast feeding
-exclusive breastfeeding and continuation of BF
-LM Anatomy and Physiology, composition of breast milk
-Good attachment and positioning, breast feeding beliefs and myths /
  • Breastfeeding with 1 hour of birth
  • Importance of breastfeeding for child and mother
  • Exclusive breastfeeding
  • Brestfeeding behaviours
  • Breastfeeding frequencies
  • Good attachment and positioning
  • Mother should pay attention during breastfeeding
/
  • Breastfeeding within 1 hour of birth
  • Importance of Colostrum
  • Exclusive breastfeeding
  • Good attachment and positioning
  • Breastfeeding frequencies and duration

Complementary feeding practices
-Contribution that breast milk makes to complementary feeding
- Characteristics of complementary feeding for each age group (6-9, 9-12.12-24) (food, amount, texture, variety, hygiene)
- Importance of ASF /
  • Complementary feeding after 6 months with continuation of breastfeeding
  • Reasons of complementary feeding
  • Locally available nutritious and energy dense food
  • Food frequency
  • Iodine
  • complementary feeding for each age group (6-9, 9-12, 12-24 months) (variety, frequency)
  • Responsive feeding
  • Preparation of super (sarbottam) flour
  • How to make food energy dense and Preparation of nutritious rice gruel (JAULO)
/
  • Complementary feeding after 6 months with continuation of breastfeeding
  • Reasons of complementary feeding
  • Introduction to locally available nutritious food
  • How to make food energy dense
  • Preparation of super (sarbottam) flour
  • Preparation of nutritious rice gruel(JAULO)
  • Food Frequency
  • complementary feeding for each age group (6-9, 9-12, 12-24 months) (variety, frequency)
/
  • How to prepare rice flour liquid
  • How to prepare nutritious rice gruel (sarbottam)
  • Importance of complementary food
  • Pay attention to prevent nutritious minerals
  • Less nutritious foods
  • Balance diet: body protection food, body growth and development food, energy providing food
  • Importance of food and nutrition

Care and feeding sick child
-Feeding during and after illness
-Responsive feeding
-Hand washing with soap during critical time
-Health care seeking ORT and Zinc during diarrhea, IMCI /
  • Food for sick child (0-6, 6-24 months old) during and after sick
/
  • No messages

Essential Hygiene Actions
-Assumption and principle of hygiene promotion
-Hand washing with soap at critical times
-Latrine use
-How hygiene and sanitation contribute to nutrition /
  • Hand washing: before cooking/ fooding/breastfeeding, after washing baby's feces, after using toiletary
/
  • Personal hygiene: Toilet use, hand washing, nail cutting
/
  • Personal hygiene

Women's Nutrition
-Malnutrition in life cycle
-Nutrition for pregnant & breast feeding mother
-Healthy timing and spacing
-Avoid smoking /
  • Food during pregnancy period
  • Food during post natal
  • during adoloscent
  • anti natal care
/
  • No messages
/
  • Food during pregnancy period
  • Food during breastfeeding

Others:
Early Childhood Development
  • Stimulation
  • Growth monitoring
/
  • Growth monitoring

Katchen Gardening
  • Kitchen garden (production of home-based food)
  • Village-home sample Agricultural Garden
/
  • No messages
/
  • Importance of Kitchen Gardening

Detail Analysis of Flip Chart developed for FCHVs by HKI, CHD and NPCS

Helen Keller International / IYCF-CHD / NPCS Flipchart / NEWAH
/ / / NEWAH does not have BCC materials particularly targeted of FCHVs
Strengths:
  • Covers majority of the ENA + messages
  • Pre/Pilot tested among FCHVs under Aama project
  • Already endorsed by the Government of Nepal
  • Illustration/pictures used are clear and consistent through out
  • GESI consideration in some instances
/ Strengths :
  • Messages are based on National IYCF strategy
  • Involvement of several stakeholders in the design process
  • Pre tested among the FCHVs
  • Guides the user to lead discussion and make it participatory
  • Messages are comprehensive
  • GeSI consideration
  • Pictures are very clear and consistent
  • Also talks about personal hygiene
  • Handy and easy to carry
  • Good color combination
/ Strengths:
  • Messages are clear and concise
  • Good quality of material. Pictures are real and attractive
  • Also talks about nutrition for pregnant and lactating mothers besides complementary feeding
  • Also has separate messages on vitamin A, Iodine, Iron, kitchen gardening and also a bit on hygiene

Gaps:
  • Some important ENA + messages/content are missing
-Healthy Timing and Spacing Pregnancy (FP)
-Danger of smoking to health
-How Germs can pass into our body and importance of hand washing
-Proper handling of food
-Community Led Total Sanitation
  • Content covered does not include comprehensive messages
  • Slides are not presented in sequential order (as per the ENA+ package)
  • Messages in some slides are overloaded and there are some grammatical mistakes
  • Some illustrations are not appropriate
/ Gaps:
  • Mostly focused on IYCF messages and does not cover messages on
-HTSP/ family planning
-Smoking
-Women’s nutrition
-Construction and use of latrine
-Proper handling of food
-Pictures and messages are overloaded in some slides / Gaps:
  • Messages are only focused on food (balance diet, types of food, energy giving food, food helping in physical and mental development etc.)
  • Key ENA+ messages are missing(Breastfeeding, lactation management, care and feeding of sick child, FP, smoking, EHA etc.)

Area of Improvement:
  • Review and revision of messages ensuring consistency t with SUAAHARA ENA+ Package
-Comprehensiveness
-Sequential order etc
  • Geographical consideration ( Mountain/Hills & Tarai districts)
  • GESI consideration ( message, image)
  • Simplification of messages as far as possible
  • Linking messages into behavior change action

Key Questions /Recommendation
  • What should be the format ???
-flip chart ??? as FCHVs already havemany
* How can we make it innovative???,handy, user friendly, pictorial, attractive for both the userand client.
-Flip handbook with key messages??
-Spiral book/ cue card ???
-Laminated discussion posters ??
-What else ???
  • Durable
  • Localization
  • Since HKI developed messages/flip chart has already been endorsed by GON, it should be made as base for revision.
  • Some missing messages/ images can be adopted/adapted from CHD developed flip book.
-There is also a need to develop materials that clients can use as the household level as reference particularly for key messages
-Flyers, leaflets, brochure, posters, ???? / This Flip Chart does not fit in for SUAAHARA ENA+ package but we can take out some relevant messages and images for SUAAHARA BCC materials

The ENA+ EHA Messages

  1. Optimal breastfeeding during the first six months ^ dlxgf;Dd lzz'nfO{ :tgkfg dfq u/fcf}+

  1. Optimal complementary feeding at 6 months with continued breastfeeding up to two years

aRrfnfO{ @ jif{;Dd yk vfgf ;lxt cfdfsf] b"w v'jfpg' kb{5 .
  1. Optimal nutrition care of sick and severely malnourished children, and targeting moderately undernourished children for prevention education

la/fdL / clt s'kf]lift aRrfsf] kf]if0f :ofxf/ u/f}+ / /f]syfd lzIffsf] nflu s'kf]lift aRrfx?nfO{ nlIft u/f}+ .
  1. Prevention of Vitamin A deficiency for women and children dlxnf / aRrfnfO{ le6fldg P sdLx'gaf6 /f]syfd u/f}+

  1. Promotion of adequate intake of iron and folic acid, and prevention and control of anemia for women and children

kof{Kt dfqfdf cfO{/g / kmf]lns Pl;8 lng k|f]T;fxg u/f}+ / dlxnf tyf aRrfnfO{ /QmcNktfsf] /f]syfd tyf lgoGq0f u/f}+ .
  1. Adequate intake of iodine by all members of the family kl/jf/sf ;Dk"0f{ ;b:ox?n] kof{Kt dfqfdf cfof]l8g lng] u/f}+ .

  1. Optimal nutrition for women (especially during pregnancy and lactation period) dlxnfsf] nflu kf]if0f :ofxf/ -ljz]iful/ uef{j:yf / :tgkfg u/fpg] cj:yfdf_

  1. Promotion of child spacing and family planning hGdfGt/ / kl/jf/ lgof]hgsf] k|aw{g .

  1. Dangers of smoking to the health of mother and baby cfdf / aRrfsf] :jf:Yosf] nflu w'd|kfg vt/fk"0f{

  1. Treatment and safe storage of drinking water vfg]kfgL z'l4s/0f tyf ;'/lIft e08f/0f .

  1. Hand washing with soap or ash at critical times (after defecation or handling feces and before preparing food, feeding children, and eating) hf]lvdk"0f{ ;dox?df ;fa"g jf v/fgL kfgLn] xft w'g] u/f}+ -lbzf ul/;s]kl5 cyjf lbzf kvfNbf /

vfgf tof/L ug'{ cl3, aRrfnfO{ Vjfpg' cl3 / vfg' cl3_
  1. Safe disposal of feces lbzfsf] ;'/lIft lj;h{g .

  1. Proper storage and handling of food to prevent contamination ;+qmd0faf6 arfpg vfgfsf] plrt e08f/0f tyf Joj:yfkg

  1. Community construction and use of affordable latrines ;fd'bflos rkL{sf] lgdf{0f tyf k|of]u

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