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Bihar's statistics speak for themselves: the northern Indian state's population stands at 104 million – larger than any European country and one third the population of the United States. There are 27 million women of child-bearing age, 18.5 million children under the age of six and 200,000 community health workers looking after them.
Bihar also has 80% of its population living in rural areas and 40% living below the poverty line. The state's newborn and maternal mortality rates are much higher than the all-India level and it has among the lowest uptake of health services in the country. While the Government of Bihar has recently made major strides in improving the state's health infrastructure, awareness of critical family health issues remain low.
The Ananya programme, funded by the Bill & Melinda Gates Foundation, aims to reduce child mortality, improve maternal health and reduce infectious diseases in Bihar.
As a project partner, BBC Media Action has adopted a pioneering approach to improve the demand and uptake of life-saving family health behaviours amongst the population of 104 million.
Reaching this enormous audience through traditional forms of media is difficult. Only 27% of young mothers have access to any traditional media (TV, radio, newspapers or cinema). But add mobile phones to the mix and access goes up dramatically to 90%.
BBC Media Action has therefore adopted what has been called 'a 360-degree approach' – a combination of face-to-face communication, Information Communication Technology (ICT), mass media and community work – which is being implemented on an unprecedented scale.
These sustainable, scalable, innovative, and multiple channels of communication work together to create a whole that is greater than the sum of its parts.
The multiplatform approach consists of three complementary strands:
BBC Media Action has developed two innovative mobile phone services for CHWs: a training course called Mobile Academy, and an on-demand service called Mobile Kunji which is supported by a deck of cards illustrated with life-saving messages.
Humorous and engaging TV adverts about specific family health behaviours such as birth spacing are accompanied by a long-running radio series about critical maternal and child health issues.
10,000 street theatre performances and 6000 women's listener clubs will further engage and inform families about critical family health issues.
All these elements focus on the critical 33-month timeline from when a woman becomes pregnant until her child is two years old. The objective is to shift social norms and empower those who lack the information and power to make informed choices about their health.
To implement this project called Shaping Demand and Practices, BBC Media Action leads a consortium that includes Pathfinder International, the GSMA Development Fund and Madison World. This consortium works in close partnership with the government of Bihar at all stages.
For more on this project:
Empowering community health workers through Mobile Academy and Kunji
Improving family health in Bihar through mass media
Mobilising communities to improve family health in Bihar
From the BBC Media Action blog:
Multiple channels of communication will work together to create a whole that is greater than the sum of its individual parts
A Bihar village one winter morning
One of India's most populous states, Bihar has also some of the highest rates of maternal and infant mortality in the country. For over four decades Bihar has seen widespread poverty and little development. But things are changing…
On the way to school
These girls – getting an education and going somewhere – define the changing face of Bihar. Since the 2010 state assembly election, improvements in infrastructure and governance have helped foster new aspirations. The Bill & Melinda Gates Foundation's Ananya programme aims to reduce maternal and infant mortality by 40%.
A typical Dalit village home
As an Ananya partner, BBC Media Action is committed to improving the demand and uptake of life-saving family health behaviours in a population of 102 million people, including 25.9 million women of child-bearing age.
New hopes
A newly married woman watches our outreach work taking place a few feet away from her courtyard. In rural Bihar, young women lead a very restricted life and society is largely male-dominated. But there is a hunger for knowledge which can be used to bring about social and behavioural change.
Family values
The paper slips read mother, father, wife, sister, brother, children, teacher, neighbour and so on. As part of their research, the BBC Media Action team asked a man in a Bihari village to arrange the slips in order of importance. Parents and children took precedence way above his wife.
Harvest time
Thanks to their ample harvest, this family can send male children to a private school that teaches English. Education – rather than health - has become a high priority for those who can afford it. But men take little interest in issues like childbirth, immunisation and nutrition.
Health messages
A government campaign against the fever Kalaa-Azar on the local health centre walls. Offering compensation to patients for loss in wages, it recognised the need to connect health with livelihood. Such an insight makes for a much more convincing campaign.
A weekly rural market
Famers, traders and local village people buy and sell food and household items but also gather information and exchange opinions. For BBC Media Action, therefore, the weekly rural market or 'haat' is a touch point for the campaign.
A remote village shop
The booth sells a range of products, from pens to shampoos. Demand for such products is created by mass media and rural marketing. BBC Media Action aims to use a similar combination to inspire demand for health services.
A dealer of pre-paid mobile SIM cards advertises the latest offer
Such affordable deals mean mobile phone penetration has been phenomenal. 84% of community health workers in Bihar use mobiles in their work, which is exploited by services such as Mobile Kunji and Mobile Academy.
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