BCC (Behavior Change Communication) Division, NRHM Haryana

'Behavior' is a very important health determinant. Promoting 'Healthy Behavior' to achieve the goal of health is key objective of health services. 'Health activities' to prevent disease and promote healthy life can be achieved through `Health Education' which is targeted at dissemination of correct information, motivation of people to adopt healthy life styles and guide people to avail of medical and health services for effective utilization of health services. Health behavior change refers to the motivational, volitional, and actionable processes of abandoning health-compromising behaviors in favor of adopting and maintaining health-enhancing behaviors.

Behavior change among individuals and communities is achieved through a combination of communication approaches and strategies/interventions on adoption of healthy behaviors. Behavior change interventions and communications therefore refer to an interactive process using behavior change interventions and communication approaches to develop, promote and sustain positive behaviors in individuals and communities. The approaches used are aimed at influencing behaviors of individuals and communities through targeted psychological positioning of information accompanied by activities such as skills building, marketing and advocacy to encourage social and cultural changes and to promote the adoption and reinforcement of desired behaviors. BCC service delivery focuses on the use of a variety of targeted messages and campaigns and the Media, including Drama, Poetry, Storytelling and Songs in addition to traditional print and audio mass media (Newspapers, Billboards, Radio and TV).

Behavior change communication (BCC) is any communication (e.g., interpersonal, group talks, mass media, support groups, visuals and print materials, videos, etc.) that helps foster a change in behavior in individuals, families, or communities. BCC is a process of working with individuals, families and communities through different communication channels to promote positive health behaviors and support an environment that enables the community to maintain positive health behaviors taken on. The BCC Division at Haryana is mandated to support the district administration in ensuring that communication activities in the district equip families and communities with appropriate knowledge, skills and attitude to improve health and lifestyle decisions. In order to meet this goal, various strategies including mass media, local and folk media, outdoor media, social mobilization, social marketing, community dialogue, interpersonal communication are employed.

Historically, this area of health development programming has suffered from a lack of a theoretically-sound, systematic, and evidence-based approach to communication planning, implementation and monitoring of communication activities. Communication, promotion of services/social marketing, demand generation, and interpersonal communication skills of front line workers remains a weak link which impacts the effectiveness of the national flagship programme NRHM.In this regard a novel BCC strategy was initiated in Haryana in 2008-09 to impart health education and to communicate the available information and knowledge to public in rural/remote areas in simple and easy to understand language. This is a major shift from conventional to rural centric and community participative approach targeting people right up to the grass root level. BCCDivision looks after building the capacity of paramedical staffs at districts, block and village levels to design, execute and evaluate strategic communication programs on behavior change. The division focuses on behavior change in seven thematic areas — family planning and reproductive health;adolescent, maternal and child health, referral transport and non-communicable diseases. The division's key strategies include the use of behavior change communication to increase uptake of positive health behaviors.The BCC Division is working in the following key areas:

A unique way of inter-personal communication at village level was started through SaksharMahilaSamooh (SMS), a village based CBO. SMS is an effort to harness potential of educated women in villages of Haryana. All the educated women who have completed their matriculation & above are members of "SaksharMahilaSamooh". In areas like Mewat, women who have completed the 8th class can also be made members of SaksharMahilaSamooh. A "subgroup on health" consisting of ten most active women in the group has been constituted. These women are being trained by the health department in BCC using simple health modules specially written for this group in Hindi. There are more than 6167 registered SMS groups in Haryana. For easy message delivery and for implementation of regular activities, an annual calendar has been prepared based on health determinants and programs. Fortnightly activities (Pakhwara approach) have been planned in such a way that all age groups are given target specific and need based information for desired impact and change in behavior. Educational material has been designed by the health department in the form of Flip charts which helps these women take the correct message to the rural public. A guide book in FAQ format has also been printed to enable them to plan their activities and also to make any need based changes in the scheduled activities. These groups are trained for disseminating messages to the community by carrying out activities like Group Meetings, Rallies, Competitions (Quizzes), Wall writings, Banners/Pamphlets and Cable publicity.

2. NEWS LETTERS Two kinds of Newsletters are published from BCC Division, NRHM Haryana i.e. SwasthSansar and Haryana Health. SwasthSansar is a bi-monthly Hindi newsletter for frontline workers and PRI members focused on a current health issue of concern, e.g., anemia, child health, maternal health, family planning, care during pregnancy, etc. Haryana health is six monthly newsletter in English for doctors on success stories and current significant articles by specialists to have an update in the area.

Effective IEC (Information education and communication) and BCC (Behavior change communication) is crucial to achieve desired outcome in any programme. The key strategy for generating awareness to improve health behaviors and promotion of health seeking behavior will remain interpersonal communication by medical/paramedical staff and community volunteers with the people. Initially, all IEC activities were carried out under the different programmes in the Department e.g. CH, MH, RBSK, PNDT, FP and ARSH. Currently, all IEC units of different programmes have been merged to form a fully-fledged BCC unit that spearheads planning, implementation and monitoring of all IEC/BCC interventions in the department and the health sector. Thus the BCC unit has the overall mandate of providing coordination and technical leadershipin designing, printing and implementing interventions for achieving healthy behavior adoption in the community. Under this component we are preparing, designing and printing yearly Calendars and Diaries, Posters, Banners, Hoardings, Brochures, Flipcharts and IPC Booklets for frontline workers like ASHA, ANM, PRI members and ASHA Trainers. Four IPC booklets have been pulished till now, these are Sanchar Margdarshika, PrabhavshaliVartalab, EvamSamvad, SurakshitMatratavandSwasthSuvidhaonkobehtar banana meinJansamudaekiBhagedari.

Public relations of NRHM Haryana is being dealt by BCC Division only in which the division organizes events, media and other conferences, workshops and Sammelans. Apart from these the division also works on press releases. In media activities, the division is focusing on carrying out mass media activities like Phone-in-programs, TV/Newspaper advertisements, Radio Jingles and Video Spots.

BCC division has developed documentaries for health awareness programs. These documentaries are used by frontline workers as a resource material. Some of the documentaries developed by BCC are KilkarianGoonjtiRahein(on Child and Maternal Health),BetikiVidayi(on PCPNDT Act),AakhriMauka(on High Blood Pressure),SwachtaMatra(on Personal Hygiene), Chinta Mat kerMaa(on Institutional Deliveries)andPadav(on Adolescent Health).

An initiative taken up by Mission Director to directly communicate fortnightly with ASHAs and ANMs through letters for dissemination of messages on particular health issues. This work is also carried out through BCC and till now letters have been written to ASHA, ANMs on Anemia, ANC, Post-Partum Care, HBPNC, etc.

An initiative has been taken up by BCC Division to include the IEC/BCC and SBCC part in the content of capacity building trainings of frontline workers done by other departments of NRHM Haryana. BCC also impart training on SBCC to DACs, BEEs and ASHA trainers for making them capable of implement SBCC for achieving the positive results in health determinants. BCC also works on monitoring and evaluation of capacity building initiatives to improve the practices based on learnings.

RAPID is an monitoring tool developed and employed by Haryana Health department for reviewing and having a clear picture of ground reality. BCC division also employs the same tool for monitoring the works of SMS groups. It is also aimed at knowing whether IEC materials have reached the targeted place and regular following is being done or not. It is also aimed at appreciation of best practices among frontline workers to give them recognition and motivation.