Behavioral Insights in the Indian Context
Pari, a doll to solve diarrhoeal woes in Bihar
Diarrhoea is a preventable disease that is still a leading cause of death in children under the age of five in India. Oral Rehydration Salts (ORS) containing zinc are accessible and widely advocated, yet mothers are not using them.
Because there is no way to see the depletion of the child's body caused by diarrhoea, caregivers, even mothers, do not recognise what diarrhoea does to the child's body. When their child has diarrhoea, 35% of moms believe that limiting fluids is the best solution.
This is because they operate from 'leaky bucket' mental model, in which they compare a youngster suffering from diarrhoea to a leaking bucket, and if you don't put additional water into a leaky bucket, it will leak out. This misunderstanding can be fatal
An inflated doll with two openings, one at the top and one at the bottom, is used for a demonstration. Frontline health professionals pour water into the top intake to inflate the doll, which represents a healthy baby.
The water is then released by opening the bottom outlet, resulting in the doll returning to its deflated state. This demonstration plays with the the leaky bucket mental model and exposes its flaws.
Pari has been used in Bihar for over two years at VHSND locations and 600 Primary Health Centers throughout eight districts (PHCs). In 2018, the Bihar government committed finances to expand Pari to all 38 districts in the state.
The results showed that appropriate knowledge of diarrhoea management was three times higher and the use of ORS and zinc was almost two times higher than women not exposed.
Source: Bill and Melinda Gates Foundation, BBC Media Action
Bulawa: Bringing girls to school through local traditions in Madhya Pradesh
Girl Child education has increasingly gained the attention of policymakers and they are taking active measures to address the gender gap in school enrolment. However, traditional thinking and cultural practices still remain huge barriers. Administrative efforts can only go so far. Parents and communities need to be invested in sending their girls and boys to school and provide the required social support to pursue education.
Tribal communities are steeped in local tradition which binds them and gives them their identity. Leveraging the local cultural practice of Bulauwa and bridging it with the educational ecosystem helped make a meaningful connection with local women. Bulauwa literally means ‘to call’. It is a cultural programme where women of the community come together to celebrate by singing and dancing. Organizing Bulauwa in schools helped mothers feel comfortable and the idea of using folk songs to deliver the message of the importance of education, especially for the girl child resonated with them.
The programme played an important role in changing the environment in the district. Till now 800 schools have executed the Bulauwa programme. Close to 45,000 women have participated in the programme and discussed their child;s education, and about 2100 girls have been re-enrolled in schools
Source: Piramal Foundation
Uptake of Iron Folic Acid (IFA) supplements
Anaemia is a widespread public health issue in India, affecting 53% of women aged 15 to 49 years. Anaemia is thought to be responsible for 20% of maternal deaths, and in pregnant women the condition can lead to low birth weight and cognitive issues in children. A simple way to tackle iron deficiency anaemia is for pregnant women to take an Iron and Folic Acid (IFA) supplement every single day. However, factors such as forgetfulness and lack of awareness about the ill-effects of anaemia on their and their child’s health contribute to women not adopting IFA pills.
In an attempt to test common barriers to uptake and adherence of IFA pills, an anaemia behaviour change programme was launched. Two interventions were identified based on the tests. These were a goal tracker and a counselling card job aid for frontline workers.
Following these initial tests, a larger field study was conducted. Women were provided with a goal tracker in the form of a calendar to hang up in their homes to track their daily IFA pill usage addressing the problem of forgetfulness.
The calendar acted as an interactive goal tracking device that triggered the women towards formation of a habit. The field results showed that the calendar increased adherence by 14%.
Source: Busara and Centre for Social and Behavioural Change, Ashoka University