World Vision United States and India
This 8-page case study examines the rationale, strategy, and impact of World Vision's child survival project, Pragati, carried out in 3 districts of Uttar Pradesh, in north-central India. Pragati (which is Hindi for "acceleration" or "momentum") strove to improve health outcomes and change behaviours related to women's and children's health, and to ensure that pregnant women and new mothers had ready access to information about and methods of birth spacing and family planning. Pragati was supported by United States Agency for International Development (USAID) resources.
As detailed here, the innovation in this project was a timed and targeted approach to behaviour change communication (BCC) for all project components. That is, BCC on health, nutrition, and family planning was timed to a woman's stage of pregnancy, the age of her infant, and/or the fertility intentions of the couple. It sought to engage all decision-makers in the family, including but not solely limited to the individual who might accept a contraceptive method. World Vision developed, tested, and launched a package of training, tracking tools, job aids, and supervision protocols in this effort to ensure consistent content and quality of BCC across time and place.
This evaluation stresses that pivotal to Pragati's effort to share information with the right people at the right time in their lives was the project's ability to tap into India's existing community volunteer structure. Pragati trained more than 2,800 community volunteers and auxiliary nurse-midwives to carry out a series of 7 home visits for each family: 3 during a woman's pregnancy, one after childbirth, and 3 during infancy. The counselling involved delivering messages related to family planning/birth spacing, nutrition, and immunisation
Initial and refresher training sought to ensure that volunteers were able to demonstrate contraceptive use and talk acceptors through the process as often as necessary, until they felt comfortable in their knowledge and ability to use a method properly. They were also instructed on how to discuss side effects - actual and rumoured - in a clear, matter-of-fact way. During the home visits, volunteers carried a handbook containing a list of common myths and misinformation about family planning and other health behaviours, and corresponding correct information to counter these misperceptions. The volunteers learned to use 3 colour-coded registers to identify and track cohorts of women in the same months of pregnancy and, subsequently, birth cohorts of infants and their mothers for up to 3 years. All registers were printed with job aids and counselling plans at the bottom of each page for easy reference. (Regular supervision of volunteers indicated that nearly all of them used the registers, and that between 83% and 98% of them provided adequate, timely counseling via scheduled visits). Volunteers learned to include husbands and mothers-in-law during their house-to-house counselling sessions, project supervisors organised men's meetings, and street theatre troupes integrated family planning as a topic within performances held in the 3 districts.
The Pragati project undertook a baseline survey in 2003 and a final evaluation in 2007 to measure the effect of its work. Each study used a 2-stage, 30-cluster sampling method and a sample size of 300 mothers in each of the 3 districts. Over 4 years, the contraceptive prevalence rate more than doubled in the project zone. In addition, women's knowledge of at least one source of family planning increased from 27% to 99% of mothers of children less than 2 years of age in Ballia, from 21% to 91% of such women in Lalitpur, and from 31% to 75% in Moradabad.
World Vision concludes that, while Pragati holds promise for use elsewhere, "the timed and targeted approach, and the quality assurance that is embedded in its supervision component, is technically demanding. World Vision intensively trained and followed up with the volunteers and staff, many of whom had already gained a great deal of experience in the child survival program that preceded Pragati."
Posting by Mia Foreman to the CORE Child Survival (CS) Community Listserv on September 19 2008.