This 8-page paper explores participatory community ecotourism planning as carried out in May 1996 amongst local groups of stakeholders in Yuksam, one site of the Sikkim Biodiversity and Ecotourism Project (SBEP). SBEP is a collaborative initiative designed to conserve the biological diversity of Sikkim, a small Himalayan state in Northeastern India. This paper was one of those presented at the International Seminar on Ecotourism for Forest Conservation and Community Development, in Chiang Mai, Thailand, from January 28-31 1997.
Journal of Health Communication: International Perspectives, Volume 15, Supplement 1
According to the articles in this Journal of Health Communication supplement, the polio eradication experience provides a rich source of health communication knowledge. And yet, it is one that remains relatively unexamined. The papers in this supplement take a small step towards drawing out some of the lessons and looking at what these experiences have to say to the wider field of health communication. They focus on a series of tensions and the manner in which the polio programme has dealt with them.
The MSC process involves the collection of significant change (SC) stories emanating from the field, and systematic collection by panels of designated stakeholders or staff at various levels. Once changes have been captured, various people sit down together, read the stories aloud, and have in-depth discussions about the value of these reported changes. MSC occurs throughout the programme cycle and provides information to monitor and manage a programme. According to UNICEF, MSC "can also help uncover important, valued outcomes not specified initially. It delivers these benefits by creating space for stakeholders to reflect, and by facilitating dynamic dialogue."
This initiative draws on the internet to share and disseminate information that has been generated by those practising MSC. Anyone can sign in and send relevant material to the interactive portal. Existing topic areas include: exclusive breast feeding, girls' education, hand washing with soap, HIV and AIDS, and "others". There is also a discussion forum where people are welcome to send in their views. A resources section features manuals/articles, reports/books, and links.
Children, Education, Health, HIV.
The MSC technique is being used by UNICEF, India, as a participatory qualitative method of monitoring and evaluating its social and behaviour change communication programme in 8 districts in 7 states. The programme has so far been focused on 4 key behavioural changes - exclusive breastfeeding for the first 6 months of a baby's life, hand washing after defaecation and before handling food, girls completing primary education, and HIV prevention among young people. Currently these are defined as the "domains" for the MSC technique, and the stories therefore relate to these areas. The domains will be expanded to include certain key other child survival and development practices which the Communication for Development programme is planning to work on. According to UNICEF, as the MSC process captures both intended and unintended outcomes, it has added to the understanding of community processes. "The process of collecting and selecting the stories has been extremely empowering for the community members, and has built the capacities of all those involved with the process..." This website has been set up to share these reflections and lessons.
This portal is supported by UNICEF, India, with content management by Sambodhi Research & Communications Pvt. Ltd.
Email from Supriya Mukherji to The Communication Initiative on April 28 2010; and UNICEF MSC website, May 3 2010. Image credit: UNICEF India
Launched in December 2007 by the British Broadcasting Corporation (BBC) World Service Trust (WST), "Condom, Condom!" was a campaign to promote condom use among young men in India. The safe sex campaign seeks to change attitudes and behaviour through television, radio, and online public service advertisements (PSAs). Carried out in 4 phases, the campaign is designed to normalise the use of condoms, portraying those who talk about and use this safe sex strategy as responsible and smart (not promiscuous). This campaign uses a light-hearted approach to communicate a serious message and a practical approach to safe sex. Its central mascot is a coloured animated parrot, an animal that organisers believe represents talking and intelligence. The parrot has been designed to come across as smart, pesky, opinionated, and humorous.
An endline survey was conducted during January-February 2009 focusing on men living in the high-HIV-prevalent states of Andhra Pradesh, Karnataka, Maharashtra, and Tamil Nadu. The impact of the campaign was measured by comparing the findings of the endline with a baseline study, which was conducted in 2007 using the same methodology.
Approximately 99% of people interviewed recalled the parrot from the advertisements.
- The proportion of men exposed who were not embarrassed to carry a condom increased by 21% from baseline to endline. The increase among unexposed men was less than half that, at 7%.
- Men who agreed with the statement "I can buy a condom from any shop without any fear or embarrassment" increased by 21% from baseline to endline among those exposed. In contrast, this increase was only 7% for those not exposed to the campaign.
- Fear of being judged by shopkeepers when buying condoms stayed the same for those exposed from baseline to endline. However, among those unexposed, this fear increased by 7%.
- Fear of being judged by friends when buying condoms decreased by 9% for those exposed to the campaign compared to only 2% among unexposed men.
- There was a 7% increase in the men who thought that the use of condoms reflects smart and responsible behaviour. This number was only 3% for men unexposed to the campaign.
Among men exposed to the campaign, there was an increase by 18% of men who discussed condoms in the last 30 days from baseline to endline. Discussing condoms actually declined by 7% from baseline to endline among those who had not been exposed to the campaign.
Men exposed to the campaign who said they intend to discuss condoms with friends increased by 6% from baseline to endline. There was no change in intention to discuss condoms in unexposed men.
BBC WST website, April 1 2010.
This Express.co.uk online news article is about a shirt created by an Indian clothing designer who used condoms in the collar and condoms stitched to the fabric to raise awareness of AIDS.
SAFE - Social Action Foundation for Equity listserve, December 9 2009.
Nivedita is a 26-episode television serial drama advocating human rights, gender equality, and a reduction in HIV/AIDS stigma and discrimination in the context of the HIV/AIDS epidemic in India.
Nivedita was first broadcast on January 3 2010, and is televised on Doordarshan Kendra Hyderabad on Sunday evenings in the prime time slot at 7:35 p.m. in Telugu, the official language of Andhra Pradesh. Click here to watch episodes of Nivedita with English subtitles online (added only after the Telugu version of that episode has aired on TV). As part of the story, Nivedita, the young heroine, learns that her older, Sub-Inspector husband, Shyam, has been unfaithful to her while she was away giving birth to their second daughter. Nivedita is soon reunited with her childhood friend, Sushila. Faithful Sushila is now showing signs of ill health after her husband died a few months earlier, following a long battle with mysterious illnesses. Nivedita advocates the diagnosis and treatment of her friend and learns the hard truth about her own risk of HIV. Nivedita forms a self-help group (SHG) in which Sushila and her condition become accepted and understood. Nivedita is then able to negotiate first a female condom, then an HIV test, for Shyam.
The first 5 episodes set up the story, but from week 6 through 26 (ending July 18 2010), each episode concludes with an epilogue wherein a known celebrity directs viewers to various places they can find help. Depending on the viewers' situations and the topic of their questions, viewers responding to the series will be directed to:
- Local Asha Mitralus (SHG women trained in HIV topics by Andhra Pradesh State AIDS Control Society);
- The 104 helpline for answers to their questions about HIV and for referrals to Integrated Counseling and Testing Centers (ICTCs);
- District-level women's helplines;
- Anganawadi centres (for further referral to numerous women's welfare schemes and to the Legal Services Authority);
- Local SHG coordinators for increasing women’s social, economic and political capital and legal advocacy; and/or
- Local village health workers (Accredited Social Health Activist (ASHA) workers).
The interactive Nivedita website links the television show with organisers' broader vision of redressing women's vulnerability to HIV/AIDS: community-based action and formal government action. Namely, noting that SHGs play important roles in women's empowerment, both at the local level and through statewide networking, organisers welcome inquiries by post or mail from women needing help finding their particular community activist/organiser. In addition, those who register for access to the Nivedita referral network can access contact information for those within the formal government system (e.g., the Legal Services Authority and the Department of Women and Child Development) who can help them access counselling and shelter schemes. "With such safety nets in place a vulnerable woman is better placed to negotiate sex with her husband for the security of her family. She'll be a survivor, and so will her children, even if her husband and in-laws insist on making dangerous choices."
Organisers encourage people to download posters developed to support the series: "You can play a significant part in improving the lives of families around by simply hanging a poster in your office, meeting room or wherever people you serve congregate."
Women, Gender, HIV/AIDS.
According to organisers, because of systemic gender inequalities, women are less able to protect themselves and their children from HIV/AIDS. Lack of education, livelihood skills, access to information, mobility, defense against domestic violence, and access to legal and health services leaves women highly vulnerable to HIV/AIDS. Women are also biologically more susceptible to HIV/AIDS. However, organisers claim, data show that married women's single greatest HIV/AIDS risk factor is a husband with multiple partners. They note that, in India, women now make up 39% of people living with HIV/AIDS, a rising trend.
Email from James and Ava Kramer to The Communication Initiative on March 9 2010 and April 30 2010; and Nivedita website, March 9 2010.
The International Youth Foundation (IYF) implemented Planning for Life (PfL) from March 2007 to November 2009 in an effort to increase knowledge and skills around integrating youth reproductive health
To facilitate integration, IYF provided its partners in the 3 implementing countries with technical and administrative guidance, as well as programme materials and curricula including: a Framework for Integration of FP and RH into Youth Development Programs; RH Integration Self-Assessment Tool; the FP, HIV/AIDS & STIs and Gender Matrix; Project Design and Proposal Writing Guide; and Reproductive Health Supplemental Curriculum. This guidance is meant to enable teachers, health workers, vocational training staff and peer educators (PEs) to integrate topics such as abstinence, consequences of early pregnancy, and various contraceptive methods into lessons already being taught about HIV prevention. The emphasis during various trainings offered as part of PfL was on the importance of interacting with youth in a friendly, non-judgmental manner. Health professionals, vocational training staff and teachers were encouraged to engage youth in interactive discussions about RH issues, rather than providing information in a didactic manner.
In India, IYF worked with Youthreach and 4 sub-partners - Dr. Reddy's Foundation, Byrraju Foundation, Sahara, and PRERANA - to implement Project Samriddhi, the local PFL project. An additional partner, Thoughtshop Foundation, was also identified to develop training material for the project. Project Samriddhi reached youth with FP/RH knowledge and skills by integrating an RH curriculum and teaching aids into existing livelihoods projects implemented by the 4 partner organisations. Staff from the partner organisations took part in a training of trainers (ToT) session held in March 2009. The trainers reportedly spent considerable time befriending and establishing rapport with the participants before facilitating sessions on sensitive FP/RH issues. They said that when they used examples and experiences and had an open and interactive dialogue they were best able to reach youth. They also felt that their body language and maintaining a healthy and friendly environment helped the youth be more interactive. The teaching aids included various card games, puzzles on reproductive parts, and a flip book to facilitate storytelling. The final evaluation found that integrating RH lessons into vocational training programs towards the end of the training was most successful, as trainers had established a rapport with the students by that time.
In the Philippines, IYF partnered with the Consuelo Foundation and its sub-partners to include an RH curriculum for Muslim youth in the Foundation's employability and education training. Namely, the Foundation for Adolescent Development (FAD) adapted Consuelo Foundation's Adolescent Reproductive Health Curriculum for Young Muslims and then, in March 2009, trained 14 staff members from 9 youth-serving Consuelo Foundation partner organisations to implement the curriculum (which centred around an Islamic perspective and included Quaranic verses). The Friendly Care Foundation (FCF) provided a 2-week training on youth-friendly services in February 2009 to service providers in YRH/FP at 2 health facilities in Mindanao. The training included intensive discussions on how to be more sensitive towards youth, and especially Muslim youth. It also focused on teaching providers how to use verbal and non-verbal communication, and was intended to be culturally appropriate and respectful of the religious view of the area.
In Tanzania, IYF worked in partnership with 2 organisations, Tanzanian Red Cross Society (TRCS) and Iringa Development of Youth, Disabled, and Children (IDYDC), to integrate FP and RH messages into existing youth HIV/AIDS prevention programmes:
- IYF works with TRCS on Empowering Africa's Young People Initiative (EAYPI), a programme aiming to scale up peer education programmes, stimulate broad community discourse on healthy norms and risky behaviours, reinforce the role of parents and other influential adults, and reduce sexual coercion and exploitation of young people in project sites. The intention of the PfL project was to integrate youth FP and RH messages into the existing peer education project, while training youth friendly service providers in the community for referrals and consultation. As part of the PfL programme, TRCS and the Tanzania Ministry of Health (TMOH) provided health care professionals and teachers with a 2-week training on provision of youth-friendly FP/RH services and education. Youth peer educators (PEs) also participated in this training to provide information and suggestions to the service providers. The sessions focused on increasing knowledge about life skills, pregnancy prevention, contraceptive methods, and sexually transmitted infections (STIs), as well as providing them with strategies to better relate to and interact with young people. Strategies introduced to engage youth included question-and-answer techniques and incorporating songs and storytelling into the lessons. In addition to providing education and services (e.g., counselling youth on dual protection against HIV and unplanned pregnancy) in health facilities, during the PFL programme health workers visited schools to increase awareness of existing FP/RH and other services and to demonstrate their own youth-friendliness by providing basic health services (e.g. taking blood pressure and height and weight measurements, cleaning and bandaging minor cuts, etc.) on school grounds. Teachers trained by TRCS provided youth education on abstinence, the consequences of early sexual activity, FP methods, and STI and HIV prevention and detection. PEs provide outreach on FP/RH and HIV to both in- and out-of-school youth ages 8-30 (different PEs stated different age ranges of the beneficiaries). The teachers and PEs refer youth to trained youth-friendly service providers.
- With IDYDC, IYF worked through sports clubs in Iringa Regions to provide HIV prevention messages and life-skills education. Football and netball (volleyball) coaches had previously been trained to provide HIV prevention education to youth ages 13-17 years old who participate in the sports club. As with EAYPI, PFL worked with IDYDC to integrate HIV/AIDS prevention messages with FP/RH messages and reinforce life-skills education for youth. Before or after practice games, the trained coaches provide youth with education on RH and HIV/AIDS.
HIV/AIDS, Reproductive Health, Youth.
Because the pathway to becoming HIV-infected and pregnant is the same - unprotected sex - IYF contends that HIV prevention programmes and services offer an opportunity to provide youth with the knowledge and skills needed to address a range of RH issues, including pregnancy prevention.
IYF, USAID, World Learning - with Dr. Reddy's Foundation, Byrraju Foundation, Sahara, PRERANA, Consuelo Foundation, FAD, FCF, TRCS, and IDYDC.
This grassroots comics campaign on children's participation in local governance was organised in December 2009 by World Comics India in collaboration with Adithi-Plan.
World Comics India has created a methodology - the "grassroots comics campaign" - that it has applied to several social change efforts (click here for other examples). As World Comics India's founder, Sharad Sharma, explains in his Grassroots Comics Campaign Manual, grassroots comics are comics which are not prepared by professional artists, but by socially aware people themselves, based on their own views. The idea is that people can tell their own stories using the comics format, i.e. storytelling with a combination of images and texts. Through a series of workshops, ordinary people learn that "making grassroots comics is relatively easy and does not require heavy duty technical expertise of any kind. All one needs is a story, paper, pen and access to photocopying."
Recognising the power of being able to share their views with other people, comic drawers like the children participating in Ab Shasan Humro Hoi prepare black-and-white comics for distribution at a local level. After photocopying, the grassroots comics are pasted up in places where people gather leisurely, and in schools, at bus stops, in shops and offices, on notice boards, and even on electricity poles. "Only when the comics are distributed in the society, they make an impact. People become informed of new ways of thinking, and at best, the messages in the comics create local debate." There is also an experience of rallying - as is best communicated by viewing the series of photos available here - whereby children march with their comics on the streets and spark debate. As Sharma explains, "The close connection is the most important point here. The readers and the people who have made the comics are not very different from each other. Common people of the society, who feel strongly about some issues, prepare the campaign material themselves, instead of getting them done by an artist from the capital or abroad [the material produced will often lack a local touch, local language, and local culture]. One of the most important things...is the fact that when a wallposter comic is on view, not only a message is conveyed, but also debate takes place."
In short, "Grassroots comics help local people to bring forward their own issues and experiences by framing them in a visual story. Once the technique of making comics is understood by people, then they can prepare comics on almost any issue in a very short time."
After viewing and discussing with children the comics they produced as part of Ab Shasan Humro Hoi, the Village Head sanctioned 2 hand pumps when children reported a water scarcity problem in school and village. Sharma shares another example of impact: Rinku studies in Class 8 and was quite angry at the garbage lying next to her classroom. She drew a comic and sent it to her ward member and soon the school compound was cleaned. Here is a summary of the text of her 8-page comic "My Beautiful School" (see above for an image of the comic): "People are annoyed by the stench that surrounds an otherwise beautiful school. The children go about complaining to people but not many show concern. A teacher understands the gravity of the situation and complains to the ward member. The ward member gets the school cleaned immediately. Further dumping in the area is also stopped. The children noticing the clean unused space now decide to plant trees there. The school that once smelt foul now looks very beautiful and it even has a pretty garden in its backyard."
World Comics India and Adithi-Plan.
The Measurement, Learning & Evaluation (MLE) Project is an endeavour to identify which interventions of the Urban Reproductive Health Initiative (URHI) are most effective and have the biggest impact. Through capacity building and communication, the MLE project is working to promote evidence-based decisionmaking in the design of integrated family planning and reproductive health (FP/RH) interventions that serve the urban economically poor in India, Kenya, Nigeria, and Senegal.
MLE's communication strategy is built on collaboration with the country consortia (CCs) that are implementing URHI programmes in Uttar Pradesh, India, Kenya, Nigeria, and Senegal. According to organisers, this collaboration is essential in ensuring that the country programme activities are rigorously monitored and evaluated, that high-quality data are collected, and that the results of the impact analysis are used by the country consortia (CCs) to inform programme activities as well as disseminated nationally, regionally, and globally in an effort to promote and scale-up promising FP/RH practices.
The MLE project has developed a standard set of instruments and indicators for use at the individual, household, and facility levels, which will be reviewed by each CC and adapted to the local context. This core set of indicators is designed to allow for cross-country comparative analysis, while the adaptation provides opportunities to examine specific issues of interest for each country.
Through a quasi-experimental study design, MLE will evaluate the URHI interventions, which are developed around the following objectives:
- To develop cost-effective interventions for integrating quality FP with maternal and child health services;
- To improve the quality of FP services for the urban economically poor with emphasis on high-volume clinical settings;
- To test innovative private-sector approaches to increase access to and use of FP by the urban economically poor;
- To develop interventions for creating demand for and sustaining use of contraceptives; and
- To increase funding and financial mechanisms and a supportive policy environment for ensuring success to FP supplies and services for the urban economically poor.
From January through December 2009, MLE in partnership with the CC in India: created an in-country advisory board; conducted a baseline key stakeholder interviews; initiated a capacity assessment with the in-country research partner; trained data collection research assistants; pretested the baseline survey instruments; and began data collection. The baseline data collection activities are, as of January 2010, underway in India.
In an effort to build in-country capacity to undertake rigorous measurement and evaluation of population, FP, and integrated reproductive health programmes, MLE offered a six-hour M&E "101" Short Course for Beginners as part of the International Conference on Urban Health in October 2009. The course consisted of two sessions and covered: an introduction to M&E; uses of data; conceptual frameworks and logic models; development of indicators; data sources; and evaluation research, including descriptions of study designs and how to select the best design for a specific study.
From MLE's perspective, to revitalise global interest and funding for a new era in the promotion of FP/RH services, robust evidence-based strategies must demonstrate research-driven best practices, and this research must be disseminated widely. Successful local, national, regional, and global dissemination and use of the programme results depend on many factors, including the collaborative relationships among the MLE project and the CCs and the engagement of key stakeholders to improve policymaking and funding allocations at all levels. The MLE website is one way in which organisers are building those relationships and sharing information.
A variety of resources are offered on the website, such as links to presentations given by MLE partners and colleagues at various venues that highlight findings from the MLE project, its evaluation of the URHI, and other project-related insights and lessons learned, including a series of 6 stories written to personalise the RH barriers and challenges that women and men face living in urban slums. One may also find upcoming regional and global events that MLE partners and others from the broader urban RH community have submitted to the website. Similarly, as part of its larger aim of raising awareness of the importance for M&E (beyond URHI) and building M&E capacity, one page on the site offers recommended tools and resources to assist in incorporating M&E into public health programmes.
Reproductive Health, Population, Maternal and Child Health.
According to the United Nations, urban populations in Asia and Africa are expected to double between 2000 and 2030.(1) One in three urban residents lives in slums,(2) often beyond the reach of health services that address maternal and infant morbidity and mortality, including FP. CC interventions are developed around the understanding that the unique nature of urban poverty requires inclusive interventions and strategies that transform the challenges of urban slums into opportunities. The MLE project will determine if the country consortia has indeed managed to expand the reach and quality of integrated FP programmes and maternal and child health services in their respective urban project cities in order to reduce maternal and infant mortality and improve the lives of economically poor urban residents.
It has been argued that too few impact evaluations have been carried out; and, when they have, they frequently do not use rigorous methods, resulting in information that is misleading or of little use.(3) A dearth of rigorous impact evaluation studies leave decisionmakers with good intentions and ideas but little real evidence of how to spend scarce resources. The MLE project is based on the conviction that better coordination of impact evaluations across countries and institutions around common thematic areas can improve the ability to generalise findings.
(1) United Nations, World Urbanization Prospects: The 2007 Revision (New York: United Nations Population Division, 2008).
(2) United Nations, The State of World Population 1996 (New York: United Nations Population Division).
(3) William D. Savedoff, Ruth Levine, and Nancy Birdsall. (2006). When Will We Ever Learn? Improving Lives through Impact Evaluation. Report of the Evaluation Gap Working Group. Washington, DC: Center for Global Development.
University of North Carolina's Carolina Population Center, in collaboration with Africa Population and Health Research Center, International Center for Research on Women, and Population Reference Bureau.
MLE website, January 14 2010, and email from Libby Bixby Skolnik to The Communication Initiative on November 12 2014.
This 100-page report explores - through a concrete example - how the planning methodology called Whole-System-in-the-Room (WSR) works in practice.
C-Change website, January 6 2010.